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HomeMy WebLinkAbout0591DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -1 -55 BOX 7 00591 IN IN no I J L ��L1�. . . �. �. �. L : J� Le , I . 00591 PUTNAM;COIINTY :DEPARTMENT OF HEALTH": } . Div" o[ llavlre6a"tal;Health Servk Caemel, N.Y 10512 Mart Provide H D. Permlt Y CERMCATE.OF CONSTRUCTION :COMPLUNCE FOR`SEWAGE- DISPOSAL SYSTEM or VM 0 Located at. L)z 3 IQ Tan'MaP ,sled; Lot_ Owner/applicant Name 154 Forme ely Snbdlvirloti 1S r 1 Address' �ss`S /.11 Sj�—ziP Fee Enclosed Amount --7-7'" Date Permit ..Issued° Separate Sewerage System. built by ' Address /. Conolt-"' of � Gallon Septic v.& a d . 5 Water Supply: Public Supply From Address on private Supply Drilled. by Address A - a / i f Mildln6 Type ir'C r , Q/ Lot . Size .% & HAS Erosion Control Rapp CmmPl pted . . Number of Bedrooms t Has Garbage. Grinder Been Installed! Other Requirements I certify that the system(s) ae.listed serving the above premises were constructed essentially as a on the plans of the completed work ( copies of which are attached),. and in accordance with :the standards, rules and ri ' I tions. in :accordance a filed plan, and the permit issued by the . Putnam County Department Of Hehlth'. Date ^ ^ Certified by P.E. R.A. Address _tAdIbM66 llfanss NO. a Any person 'occupying premises served. by the. above systam(s) Shall,prpfrptii take such action as maybe naaasitry to secure the correction, of iny' unsanitary conditions resultliq horn such usage. Approval of tM separate sawe►ip system shall become null and void as soon as a pub(,: sanitaiy srwar becomes available and the- approval of the private water supply shall become null and void when a Public water 'supply bKOmos available. Such approvals are subject yt.modif Dion 01 Change when, 'In the I, gfnent of It ommissioner of eat ton, n;MdlfWlofi'or change If "necMieiY. 3/89 ate ,z By. _ TRle S arty cr^�s�;aksr • , �'�� � ��■ TYPE: LAB ID NUMBER: LABORATORY REPORT PW 95 -0689 CLIENT: Steve LaParco 25 Indian Harbor Drive, #10 Greenwich CT 06830 SAMPLING LOCATION: Kitchen tap: Lot #5, Devon Rd, Patterson NY DATE COLLECTED: 02/14/95 TIME: 3:30 PM COLLECTED BY:' S. LaParco DATE OF REPORT: 02 /17/95 ANALYSIS RESULT UNITS METHOD ANALYZED Total Coliform Absent Colilert 02/14/95 E. Coli Absent This sample, as collected and submitted to the laboratory, did meet the requirements of the New York State Sanitary Code Part 5 -1 for bacteriological (sanitary) quality. 618 Clock Tower Commons, Rte 22, Brewster, NY 10509 / 914- 278.7600 / Fax 914.297.0536 "4 office COMPLETION REPORT Office Use Only * * DEPARTMENT OF HEALTH Division Of Environmental Health Services Y �4 PUTNAM COUNTY DEPARTMENT OF HEALTH 3 STREET ADDRESS: TURMILAQualy TAX GRID NUMBER: WELL LOCATION Lot #5, Cornwall Hill, Patterson, New York 2 3-- _'5 S� NAME; I ADDRESS: 155 East Main Street p P8IVATE WELL OWNER Cornwall Home Builders Brewster, NY 10509 O PUBLIC USE OF WELL ® RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED 1 - primary O BUSINESS ❑ FARM O TEST /OBSERVATION O OTHER (specify) 2 - secondary ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR I [REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION []ADDITIONAL SUPPLY DRILLING I MNEW SUPPLY (NEW DWELLING) ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 285 ft. I STATIC WATER LEVEL 25 ft. I DATE MEASURED 8/8/94 DRILLING ® ROTARY ® COMPRESSED AIR PERCUSSION ❑ DUG EQUIPMENT O WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING ® OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH 62 ft_ MATERIALS: ® STEEL O PLASTIC O OTHER LENGTH BELOW GRADE 61 ft. JOINTS: O WELDED ® THREADED O OTHER DIAMETER 6 in. SEAL: ® CEMENT GROUT O BENTONITE ❑OTHER WEIGHT PER FOOT 19 1b./ft. I DRIVE SHOE ® YES O NO I LINER: O YES Ea NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (It) DEPTH TO SCREEN (It) DEVELOPED? FIRST O YES ONO HOURS SECOND STORAGE TANK: TYPE CAPACITY GATE. WELL GRILLER NAME P.F. Bea 1 & Sons,: I c... ADDRESS 4 Putnam Avenue SIGNATURE 1 Brewster, NY 10509 GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE. DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH ft. WELL YIELD TEST It detailed pumping P P 9 METHOD: O PUMPED tests were done is in- COMPRESSED AIR , formation attached? O BAILED ❑ OTHER ; ❑ YES ❑ NO 1P1FLL LOG If more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE tt. tt. wager "ear- 'e9 wean Die- meter FORMATION DESCRIPTION CODE WELL DEPTH It. DURATION hr. min. DRAWOOWN ft. YIELD gpm. s nice 47 Dr ll ' ng in overburden clay & boul ers 47 Hil, r ck at 47' 285 6 220' 10+ 47 621Dr:_Lling 1 in rock, set casing, grouted 62 2R5 T)r- 1 1 i nrr i n rnek crrani to WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS ❑ COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO PUMP INFORMATION TYPE submersible CAPACITY 5qpm MAKER Goulds DEPTH 240, MODEL 5GS05412 VOLTAGE230 HP_i - MalcolmrT. Beal, Jr. STORAGE TANK: TYPE CAPACITY GATE. WELL GRILLER NAME P.F. Bea 1 & Sons,: I c... ADDRESS 4 Putnam Avenue SIGNATURE 1 Brewster, NY 10509 oAt 22 95 - MalcolmrT. Beal, Jr. Puram COUNI'X DEPARn -TENT OF HEALIII DIVISION OF ENVIRONRMML MALTH SERVICES Owner or Purchaser of Building Section Block Lot Building Constructed by °M ��T Location — Street Municipality Building 'IA:>e Subdivision Name . S.. Subdivision Lot ff GUARANTEE OF SUBSURFACE SENTAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has -been constructed as sham on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Deparbrent of Health, and ,hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction. Compliance" for the sewage disposal system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant.of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Envi.ronh ntal Health Services of the Putnam County Department of' Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. 3_ o• this ._ of i Cocovidl M Corporation Name (if Corp.) Al ire, Address rev. 9/85 mk Signature a. b0l,,11(4�4 Title 4i V Corporation Name (if Corp.) N� ds0 Address RANDOLPH W. LAURENT, P.E. HARRY W. NICHOLS JR., P.E. February 23, 1995 err, j E10 Mr. William Hedges Putnam County Health Department 4 Geneva Road Brewster, BY 10509 RE: Individual SSDS - Lot #5 Cornwall Ridge Devon Road Patterson, N.Y. Dear Bill: Enclosed are the following: LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road Brewster, New York 10509 (914)278 -6108 - (FAX) 278 -2658 CONSULTING SITE ENGINEERS 1. Four (4) prints of Drawing S -4 "As -Built Plan ", dated 2- 23 -95. 2. "Certificate of Construction Compliance for Sewage Disposal System ", dated 2- 22 -95. 3. Three (3) copies of "Guarantee of Subsurface Sewage Disposal System ", dated 6- 10 -93. 4. Well Completion and Well Log Report, dated 2- 17 -95. 5. Water Analysis Report, dated 2- 17 -95. 6. Check in the amount of $200.00, payable to Putnam County Health Department. If there are any questions concerning the enclosed, please call. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. Nichols, Jr., P.E. HWN:bd 93011 -5 encs. cc: Mr. S. LoParco '�� � (r7 G��.! gmt ' Acma � . 'CG�T % •�I.'i'_ . gam' �J; �eptA datame::: , Flow-G.1 ® PCHID NadMid6in :b z WbastOM is $mpa.a6o _....: Sy®o@Rt to, esladd Torm&`�d+. . -16 be OWN&MOba,by Addmm Weser Sallpo : 10101ft Sisk ettr i� Septet DiMW by —Addrow 1 rep►el:eret.tljat 1 wen wA011y arid- tompk+t0ly'►ofpon;i0lo for =ant and location. of rho proposed systems) ;` t) that -the parete sew di Wl stems above eteseribod will be eonsirticte>d ai shown on the approved amendment. thoro to • and in accordance with the standards,• rules a ►agu na o nam County gope►tmilnt of MYeitl`y� and,that on completion thoroof o •Ceirtifigotp of Construction Comp lla `ytat isfaetory to the Commissioner of Mealthwill t►a ;wbtnitti0 to the Department and a, written; guarantee`' aeilt be "4urnishod tho: ownw 'his- �iccovears, heirs or asslpnn by the builder, that said; builder will Ohee in guess .opoiatifip' eon6Nion_Aj part, oP'.�k7 .s®areya. ®ispoiol sp om' during the par bd of,tenro (Y) yews Immediately following thedate of the itau- anee of ttie appr"at of thro,Cartifkoto';o9 ConiCrudion,,Gompltsnce of ho original systaM or any repairs hefelo; 2) that the drilled we Is adore WIN be Iocated'as Nieirlrw "on the! approviid, win and that said well will bban in iieeoklancd with the ita ro ru sand regu one of the Putnam County oepartn" of HwRU; Dater !� f� l� S1gn¢u RE. _At:�RA. - +1�_ Address License No !� APPROVED P06h COPdSTRUCTIOfd iTni app: _val eiipir®t taro years Irons the date Ai un6s constiuction, of •tho building has been undertaken and is revocable IeN cause or enaY tie eT�Afb or modified when considel.o6 neeessgrq..by. the„ Cominissiono► of Health. Any C11Gne0 Or Oeteratbn of construction requires a now permit: Approved for disposal of, ilemoitIc tanita►Y. ttrar o ' and ate' water s_upplY only. Rev. �..A 10/88 onto �—O- Tltoo _... 1 n WELL LOCATION WELL OWNER � E OF WELL primary 2 - secondary AMOUNT OF USE DRILLING ETAILED REASON FOR DRILLING u DEPARTMENT OF HEALTH Division of Environmental Health Services ,4:6eneva Road, Brewster, New York 10509 (914) 278 -6130 AP.v7ICATION TO CONSTRUCT A WATER WELL t Name Mail PCHD PERMIT #jL Village City Tax Grid Number &:L- .5 fT. - ., 1-55 ss r rivate 1 --T .t ,i­7 rEi<- Ki _ O Public O RESIDEilI&L O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED O BUSINES""' O FARM O TEST /OBSERVATION O OTHER (specify 0 INDUSTRIAL CIINSTITUTIONAL O STAND -BY O YIELD SOUGHT rE� gpm /# PEOPLE SERVED ±j -4. /EST. OF DAILY USAGE Agiv gal L] REPLACE. tXIS TING SUPPLY [3 TEST/ OBSERVATION 11 ADDITIONAL SUPPLY WELL TYPE DRILLED []DRIVEN C]DUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REAL SUBDIVISION, NAME OF SUBDIVISION: i Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE`,TO SITE: YES v-"NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED OON SEPARATE SHEET (dale) '� gnature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one waterwell as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this'.permit. 3. Submit a Well Completion ,Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products - from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: 19� Date of Expiratio 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller PUINAM OOUNTX DEPARM�frNT OF HEALTH DIVISION OF ENVIRCUMENTAL HEALTH SERVICES DESIGN DATA S'H=- SUBSUFACE S5QGE DISPOSAL SYSTEM FILE NO_ Owner _f-1110 Address lr' � Located at (Street) 'bv�vpM tCAt Sec. Block ( Lot (.indicate near t cross street) M=icireiity Watershed D�3 SOIL PF RMLAMCN TEST DATA REQUIRED TO BE SU&MI= WlE APPLICATICNS Date of Pre - Soaking ,°1- (2— q 3 Date of Percolation Test, BOLE NLI� CLO K TIME PERCO=CN PERCOLATION Run Elapse Depth to water Fran Water Level. No. Time Ground Surface In Inches Soil Rate Start Stop Min_ Start Stop Drop In Min /In Drop Inches Inches Inches 1 v3T - T oS 136 2.3/� l 3` 4. 10, -OS -1b,3 36 1t 36 j'q Ili 2 9 1 to - q'. � c 36) �2* 4 :2- /� , I �� 17 3 q' ,46 -- 10!10' 3D G f 71 �. S•�f,1 3a 1 ��� 1 � 4 1 iy 11 — /U; -to 5 1 2 C .4 5 NOTES: 1. Tests to be repeated•. at same depth until approximately equal -soil rates are' obtained .at each percolation test hole. AU data to' be' sukmittod for review. - 2. Depth measurements to be made from top of hole. rev. 9/85. TEST PIT DATA REQUIRED TO BE. SUBMITTED WIM APPLICATION DESCRIPTION OF SOILS ENCOUMTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO_ 7r HOLE NO. G.L. 1' 2' /d 4' 5' 6' ?t 8' 9' 10' 11' 12' 13' 14' INDIME LEVEL AT waicff GROUN RATER IS ENCOUNTERED l�t N imickTE LEVEL TO wHSCx kaTER LEsm RISES AFtTER BEING ENCOUNTERED DEEP BOLE OBSERVATIONS MADE BY: DATE:. (q � .. .. DESIC� . • - Soil Rate Used Min/' Drop: S.D. Usable Area Provided No. of Bedrocros _� Septic Tank Capacity a gals. Type Absorption Area Provided By �'?bp L.F. x 24" width trench Other Name k A). gy p L55 Signature.. Address i SEAL No 56124 Ala— THIS SPACE FOR USE BY 'HEALTH DEPAMMU ONLY: Soil Rate Approved sq.ft /gal. Checked by Date _ 0 P�U'�"N,A.Nf. CO�CJNf'r'X" )DE.P,A,RTMENT •OF x3E.A.L.7C23 APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL. SYSTEM 1. Name and Address of Applicant: L- 4rzs1�Go 2. Name of Project: 1��'UPD�I%t� ��ps 3.._. LocationdJV /C: 4. Project Engineer: ` W. �IIGND�.� �fz. 5. Address: ����j�T✓I�1X� �I�$ License Number: 12A Phone: 2'1!? _ 61*0' 3 6. Type of Pro ect: I Private /Residential Food-Service ....Commerciale Apartments Institutional Mobile Home Park office Building. Realty Subdivision Other (specify) 7. Is this project subject to State Environmental - Quality Review (SEQR)? Type Status (Check One) Type I.-. Exempt ✓ Type II. Unlisted. v 8. Is.a Draft Environmental Impact Statement (DEIS) requ.ired? t�lU 9. Has DEIS been `completed and found acceptable by Lead Agency? ... rJ /A 10 Name of Lead Agency ►.1 /� 11. Is this project in an area under the control of-local planning, zoning, or other officials, ordinances? ........ ...........•................... K1d 12. If so, have plans been..subm ttted to such : author .sties ? *.................... r� /Q 13. Has preliminary approval been granted by such authorities? N��_ Date Granted: 14. Type of Sewage Disposal; System Discharge......' 'Surface Water v Ground Waters 15. If surface water discharge, what is the stream class.designation ?......... O /A :6. Waters index number. (surface) ........... .......................:....... :7. Is project located near_ a public water supply system? .................. ►�rJ S. If yes, name of water supply 4.1 /A. Distance tdwater supply , 9. Is project site near a public sewage collection or disposal system ?..... IJo ro �. Name of sewage system Q/A Distance to sewage system tE 1. Date observed: 4o, 23. Name of Health Inspector:" rz—f. UG?' iNsl�l d. Project - design flow (gallons per day) ..................... .. .......... Si�4 2 . 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. Q0 26. Has SPDES Application been submitted to local DEC Office? 27. Is any portion of this project located within a designated Town or State wetland? ..... ............................... ........................... 01) 23. Wetland ID Number ......................... ...................•........... 29. -Is Wetland Permit required? .............. ............................... n Has application been made to Town or Local DEC Office? 0/4. 30. Does project require a DEC Stream Disturbance Permit? 31. is or was project site used for agricultural activity involving application of pesticide$ to orchards or other crops, solid or hazardous waste disposal;`=" landfilling, sludge application or industrial activity? ........ YES or NO. r.lv 32. Is project located-within 1;000•feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known-source of contamination? .....• ......... YES or NO DESCRIBE: 33.,..Is there a local master plan or file with the Town or Village? 34. Are cormmunity water, sewer facilities planned to be.developed within 15 years? UNIrQA Q 35. Are any sewage disposal areas in excess of' 15a slope? 36. Tax Map ID Number ............. ......................... ....... .......... 37. Approved Plans are to*•bei returned to: ................ . Applicant Y_ Engineer If the application is signed by a person other than the applicant shown in Item.1, the. application must be-accompanied by-a Letter of Authorization. Failure'to comply with this ,Provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury,- that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Hisdeen,eanor pursuant to Section 21.0.45 of the Pena 1 Law. 3IGNATURES & OFFICIAL TITLES: r� oN1____ --,1�1 11� • w APPENDIX 3 FUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS n REVIEW SHEET for CONSTRUCTION PERMIT IA.ME CF Y N TION PWS LE iER AUTHORIZATION DATA SHEET(DDS LOG PERC RESULTS (3) DEPTH RESOLUTION 4l=:t:iTP E SETS tn HOUSE PLANS - TWO SETS M VARIANCE REQUEST GENERAL LEGAL SUBDIVISION, SUB D N APPROVAL C.'-IECKED RC RAqE-- G STREET LCCAT?C` DATE Q ckKrAjrDRAIN REQUIRED W STANDPIPES VAL SSDS ADJ. LOTS �L_U. (TOWN/DEC PERbIIT R & DATA QN DDS PLANS & PERNHT SAME RE- 1969 -NEIGHBOR NOTIFIFICA C� LETTER BI/ZBA m 100 YR FLOOD ELEVATION TAX MAP Y -6:E=-FERC &--DEEP HOLES LOCATED -Q�j�pR TATTVE OF PRIMARY AND EXPANSION . AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE iPED PIT & D BOX SHOWN & DET i Q QFWEDROOMS S & S 'S W/IlN 200 F PROPOSE) SYSTEM PRO _PE R S & BOUNDS LSE SETBACKNECESSARY (TIGHT LOT) R - 1 /4 "/FT. 4"0; TYPE PIPE S; MAX. BENDS 45 W /CLFAINOLT FILL SYSTEMS CLA m 10 FT HORIZO . FILL SPE =DEPTH AUGES FILL P I CD VOLL-ME AL: SLOPE 3:1 TO GRAD & DIMENSIONS TRENCH THE ' PROVIDED. MAXr CONTOURS °`o EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED ON PLAN Azuyiiu:L LL' 1l11LJ V1\ r L111\ J W 10' O P.L., DRIVEWAY, LARGE TREES, TOP OF FILL PISEWAOE-STSTEM PLAN - (NORTH ARROW) Ct 2 0 FOUINTDATION WALLS ULIC PROFILE FLOW F11000 0 TO WELL, 200' IN D.L.O.D., 150' PITS t Rnx �NCH/GALLEY L= P- PIT DETAILS 7 _ TO STREAM WATERCOURSE LAKE (INC.EXPAN), - SIZE, DETAI GAIL, SERVICE LINE IF OVER MON NOTES (GRINDER RATE) DATA: PERC AND DEEP RESULTS- 0 X-CONTOURS EXISTING & PROPOSED AY & SLOPES CUT i /GUTTER/CURTAIN DRAINS W 50' TO CATCH BASIN, 35' STOR-N DRAIN, PIPED WATER m 10' TO WATERLINE (PITS -20) m 50' LNTERMITTENT DRAINAGE COURSE N200 RESERVOIR, ETCH 150 FT. GALLEY SYSTEMS SEPTIC TANKS M FOUNDATION; 50' TO WELL WELLS m 15' WELL TO P.L. Nt Q ,_ �iSD °2000� d Iii. �I I� `p i1 �I 20 I oN Z r/z/ rol la m 1 Y 1, F 1 . i {j f f I �lv• O �7. D j