HomeMy WebLinkAbout0647DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
23.06 -1 -32.1
1 001 1 see T
AJ66
00647
~Ila
so" it
cam
APPRdV,10 Irbit CONISTRUC
""tow f-.G" Ne
Rev,i.
milan 1 of NUNN will
tast aid bVimisrol"
IN* the date'st the jow-
wd vto ~aw 86"0
Tm�s :4114 "Putomm*
of the build* hes"DOW'UnCIVUken iftd 15
ft; Any ChIMP Or ONOrStIO . n Of, CDiIdFUCtlOn
mly.
Title
N
... ... .,. .. �- .•. . ... .... ... � .. � SY C - � e .., to �'
DEPARTMENT OF HEALTH
Division of Environmental Health Services
110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310
APPLICATION TO CONSTRUCT A WATER WELL
PCHD PERMIT # `/
WELL LOCATION
Street E�ddt�ess o illage City Tax Grid Number
vc,-11 du 1� 0 w s 2014P — l —,72-
WELL OWNER
Name
U
Mailing Address
Z Rog 30 /,2-SY,
Private
O ublic
6 SE OF WELL
- primary
2 - secondary
RESIDENTIAL
9-BUSINESS
® INDUSTRIAL
O PUBLIC SUPPLY O AIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION
[]INSTITUTIONAL O STAND -BY
O ABANDONED
O OTHER (specify
O
AMOUNT OF USE
YIELD SOUGHT _gpm /# PEOPLE SERVED /EST. OF DAILY USAGE &VOgal
O REPLACE EXISTING SUPPLY O TEST/ OBSERVATION 13 ADDITIONAL SUPPLY
&NEW SUPPLY NEW DWELLING1 ® DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
WELL TYPE
PtDRILLED
®DRIVEN ®DUG GRAVEL.
0 OTHER'
IS WELL SITE SUBJECT TO FLOODING? YES 1/ NO
F WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:V
Lot No.
WATER WELL CONTRACTOR: Name �`/ Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO
NAME OF PUBLIC WATER SUPPLY:
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: R/4
TOWN /VIL /CITY
LOCATION SKETCH & SOURCES OF CONTAMINATION
%ON SEPARATE SHEET
22
(date) (signature)
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well 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
thirt;c (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 mannerag not to degrade or otherwise contaminate surface or groundwater.
Date of Issue: 19��
Date of Expiration 19 e-' 140, Permit Issuing Of f 1�—a
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
l
PUTNAM COUNTY DEPARTMENT O F HEALTH
APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM
1. Name and Address of Applicant: y 'co G Py/; g '
19AT7- rR.So/.i Al 1z5-63
2. Name of Project: 3' IV t S t :3.._. Location TN /C: = ;p4T7Ev°.sv.�
GAvq/� /.iT -
4. Project Engineer: 43,5o c.. P !P. 5. Address: • -73 .'F.4iRici ,64o OR.
16.
I r.
1 .
j4SA So
License Number: N✓ ++s'� �Z 9 Phone: 2,78 - 610,
Type of Project: ,; : !;•:; :F: { lt_t K.;
4_ Private /Residential Food -S. ecvice - ..:.Commercial
Apartments :- Institutional Mobile Home Park {
Office Building,,,. } j Realty Subdivision'. Other (specify)
Is this project subject to State Environmental Quality Review (SEAR)?
Type Status (Check One) Type I.. Exempt
Type II.. Unlisted _X,_
Is a Draft Environmental Impact Statement (DEIS) required? ............. //0
Has DEIS been completed and found acceptable by Lead Agency? ...........
Name of Lead Agency
Is this project in an area under the control of -local planning, zoning, yf s
or other officials, ordinances? ......... ...............................
... .��5
If so, have plans been submitted to such authorities? ..................
Has preliminary approvaf bbeen'granted'by such authorities? A Date Granted:
Type of .Sewage Disposal. System Discharge...... Surface Water _Ground Waters
If surface water discharge, what is the stream class designation ?........ AT
Waters index number.( surface) ........... .................:.............
Is project located.near a public water supply system? .....:............ Al-0
If yes, name of.water supply /1/�i4 Distance to water supply /✓
• 7
Is project site near a.-public sewage collection.or disposal system ?..... -A1<2
Name of sewage system !thq Distance to sewage system = -
Date observed: S Z/ 23. Name of Health Inspector: /'7674
Project design flow (gallons per day) .......................... ........
?.5. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. /10
76. Has SPDES Application been submitted to local DEC Office? .:............. IVIA
27. Is any portion of this project located within a designated Town or State
wetland? ................................... ............................... /Vo
28. Wetland ID Number............ ....._... ......... ...........e...................
29. -Is..Wetland Permit- required? ......... ...................- ....::::.: .
Has application been made to Town or Local.DEC Office? .................. IVIA
0. Does project_reggjre•a...DEC Stream Disturbance Permit? ................... /Vo
31. Is or was project site used for agricultural activity involving application
of pesticides to orchards or other crops, solid or hazardous waste disposal,
landfilling, sludge application or industrial activity? ......... YES or-NO'
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 A✓ o
DESCRIBE:
3. Is there a local master plan or file with the Town or Village? ...........
4. Are community water, sewer facilities planned to be developed within 15 years? N�
5. Are any sewage disposal areas in excess of 15% slope? do
6. Tax Hap.ID Number .......................... ............................... 1
7. Approved Plans are to be returned to: ................ Applicant X_ Engineer
f the application is signed by a person other than the applicant shown in Item 1, the
pplication must be -.accompanied by a- Letter_. of Authorization: Failure to comply with this
rovision 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 Misdemeanor pursuant to Section 210.45 of
the Penal Law.
:GNATURES R OFFICIAL TITLE S: t 1Q7r -A7 -)
AILING ADDRESS:
LIAR 19 1992
PUTNAM COUNTY
DEPT.- OF HEALTH
y _.
..
2.
?.5. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. /10
76. Has SPDES Application been submitted to local DEC Office? .:............. IVIA
27. Is any portion of this project located within a designated Town or State
wetland? ................................... ............................... /Vo
28. Wetland ID Number............ ....._... ......... ...........e...................
29. -Is..Wetland Permit- required? ......... ...................- ....::::.: .
Has application been made to Town or Local.DEC Office? .................. IVIA
0. Does project_reggjre•a...DEC Stream Disturbance Permit? ................... /Vo
31. Is or was project site used for agricultural activity involving application
of pesticides to orchards or other crops, solid or hazardous waste disposal,
landfilling, sludge application or industrial activity? ......... YES or-NO'
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 A✓ o
DESCRIBE:
3. Is there a local master plan or file with the Town or Village? ...........
4. Are community water, sewer facilities planned to be developed within 15 years? N�
5. Are any sewage disposal areas in excess of 15% slope? do
6. Tax Hap.ID Number .......................... ............................... 1
7. Approved Plans are to be returned to: ................ Applicant X_ Engineer
f the application is signed by a person other than the applicant shown in Item 1, the
pplication must be -.accompanied by a- Letter_. of Authorization: Failure to comply with this
rovision 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 Misdemeanor pursuant to Section 210.45 of
the Penal Law.
:GNATURES R OFFICIAL TITLE S: t 1Q7r -A7 -)
AILING ADDRESS:
LIAR 19 1992
PUTNAM COUNTY
DEPT.- OF HEALTH
U--M OaJN I Y Dr- PAR'RMZr OF HFALT'�
DIWL,,j OF ENVDUZE ML HEALTf3 SERV c-,-,
DESIGN DATA SHEET- SUBSUFACE SrWPGE DISPO.AL SYSTQm FILE NJ.
owner C GSA/ Ov&,Z Address PArTEP.s -,%/ � /ZSlp3
RTC p= 3 l l
Located at (Street) ov El2 G o -lz R .O. Sec. 23.6 Block ( Lot 3 Z
(indicate nearest cross street)
Municipality P19 TT,Er-?s �•y Watershed C re,:' -j%DA/
SOIL PERCOIMCN TEST DATA RBNRED M BE SUBMITTED W= APPIJ=CNS
Date of Pre- Soaking S/-2 a Date of Percolation Test O z8 9-
HOLE
NUMBER CDCR TIME PEROQIATION PEROD=CN
Run Elapse Depth to Water Fran Water Level
No. Time Ground Surface In Inches Soil Rate
Start-Stop Min. Start Stop +Trop In Min/In Drop
C40T We i Inches Inches Inches
1 9'.33' l0•' 03 .'3v
Z4'
�'3 /t"
% a
�o
>T-1 2 /D'o4 - /D. 3sf :30
?�"
ZQ /S �f
i '/� '
.40
3/0 351.1:05 :3Q: 2¢" 2q-ii
244 of Y24 . �O
5 -
l y 3s- io.�os :3o
i9•
zoYL"
l %z
Zo
:2 2 10 *06 /0'36 : 3a'
iS ls"
i '/� '
ZG. ¢
3 /0:37 - //:07- 3,o 2-4 2-6 1 30
4 H"400- // :38 :30 24-',
1
2
NOTFS: 1. Tests to. be repeated* at same depth until approximately equal soil rates
are'cbtained at'each percolation test hole. All data to' be subrittbd
for jteview.
2. Depth measurements to be made Fran top.of.hole.
rev., 9/85. :.... ........ !
TEST PIT Hl .. QU= TO BE SUBPSIT= WTTH k .ICATION
DESCRIPT.IvN OF SOILS ENCOCTDII`II2� IN TEST HOLES
DEPTH HOLE No. -1 - I BoLE No. 7P - z- HOLE NO. ?P- 3
G.L.
2'
3'
4'
5'
6'
7'
•81
9'
-roPS01z-
e
,it-TY SANVy
L OA M
MA
G
E
Iva /Qocr /t
vIATER AT .5 - o'
No Rocic
wATEP. AT
TvPSo / L
5/c7y . -4A,t1oY
Lo
5 /4TY
La
iVo R c-,.
y ✓A -rER /-IT 3'- o"
10'
12'
MAR 19 Iss?
13'
PUTNAM COUNTY
14' DEPT, OF HFaLTH
INDICA2£ LEVEL AT WHIGS Gmmmm IS ENOOONTEE m 3'- o " ?- 5'-
o "
INDICATE LEVEL TO WHICH MTER LEVEL RISES AFAR BEING F.NDOtNTERED .5A Jar F
DEEP HOLE OBSERVATIONS MADE BY: G. All 7cNc o M. KEf: DATE:
DESIGN
Soil Rats Used 4,6- 40 Min/1" Drop: S.D. Usable Area Provided
.Absorption Area Provided By L.F. x 24" width trench
Other
LAURF-AIT EA/G /AIREIA/G
Name Assoc lAT ES . P• c. Signatur
Address 73 CA I R PI E[ O Q R i v E
SEAL
PA TTER-4 oA/ A/EKrYoP. r
N 0:.0 45��1
1
THIS SPACE MR USE BY HEALTH DEPAF MMC ONLY:
Soil Rate Approved sq . ft;/ga1- ''Checked
by
Date
DIVI9TT�M C(JDTI1' DEPARTi� OF HEAL
_ _4 OF ENVDF a � FILTH S
DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner COG /`C/ Ov%rE� Address /7R 2 BoK 304 PATTFF..50" /.,/y 1ZS63
RTr. W 31l
Located at (Street) OvFR oo r_ Rv. Sec. Z3.6 Block I Lot 3Z
(.indicate nearest cross street)
municipality PA TTER.S C. •y Watershed C)fo To A,/
• • • DI• •• •' Y7► t • Y• • 7• P 9t • f Y:If • •
Date of Pre - Soaking S /$L8`7
Date of Percolation Test
811 VOI
Z-f
Z7"
HOLE
6.7
31'
4.7
NLEBER C1=
TIME
PERCOLATION
PERODI ATION
Run
Elapse Depth to
Water Fran
Water Level
7.o
No.
Time Ground
Surface.
In Inches
Soil Rate
Start-Stop
Min. Start
Stop
Drop In
Min /In Drop
Oka T/.VG t e T
All 0 . ;�_ Inches
Indies
Inches
Z�7 311
6.7
Z-f
Z7"
3"
6.7
Z�7 311
6.7
5
2 vxCCEiV ED
3 AR 1g
4 p U NAM COUNry
5
EALTH
NOTES: 1. Tests'to be- repeated at same depth until approximately equal soil rates
are'obtained'at - each percolation test hole. All data to' be submittbd
for review.'
2. Depth measurements to be made from top of hole.
rev. 9/85
12. 2 lo: Z l- 10:41
'-: Z ca'
-z4.*
Z7 '
31'
4.7
3 /0:4z• II:o!
: z
z4-"
7-7"
3"
7.o
5
2 vxCCEiV ED
3 AR 1g
4 p U NAM COUNry
5
EALTH
NOTES: 1. Tests'to be- repeated at same depth until approximately equal soil rates
are'obtained'at - each percolation test hole. All data to' be submittbd
for review.'
2. Depth measurements to be made from top of hole.
rev. 9/85
TEST PIT 'E)XT= TD BE SUBMITTEa WITH ; :LICATION i
DES -)N OF SOILS ENCOUNTERED EKED IN TE Sa- tiOLFS
DEPTH HOLE NO. HOLE NO.
HOLE NO.
G-L.
2'
3'
4'
5'
6'
7`
9'
10'
11'
12'
13'
14' i
IMICATE LEVEL AT WENCH GROUNDWATER IS ENOOUNTEPM _
INDICATE LEVEL TO WHICH HATER LEVEL RISES AFTER BEING F.NOMMTERED ^
DEEP HOLE OBSERVATIONS MADE BY: DATE:
DESIGN
Soil Rate Used 7 Min/]." Drop: S.D. Usable Area Provided
No. of Bed-reams Septic Tank Capacity gals. Type
Absorption Area Provided By L.F. x 24" width trench
Other • -
LAUREA/T EA1GJN9E1N.G Nam ASSOCIATES. P. C. Signa e
Address 7.3 FA J R F /Et 0 p R i v E SEAL
CO
' z
PA TTERSOA1 _ A1,6K.*' ydRr I Z5 &3. * O No, 0451, �/t
THIS SPACE FOR USE BY HEALTH DEPARZIFTr ONLY:
Soil Rate Approved sq.ft/gal. Checked by Date
0
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date 15, / &' -q 1-
Re: Property of Z)()l(:�E
Located at (We P1 -010 K/ Z-002 1 D
(T) &7-T- P7eScrA-) Section A5, & Block r' Lot
Subdivision o 7rJ::fr
Subdv. Lot # % Filed Map #SSO Date
Gentlemen:
This letter is to authorize jQAA) DQLEll Gtr. L i2FzJ
a duly licensed professional einginee- '"k'`-/.or registered architect
(.Indi�� cate
! F
to apply for a Construction'Permit for a separate sewage system, to
serve the above noted property in accordance with the standards, rules
or regulations as promulagated by the Commissioner of the Putnam County
Department of Health, and to sign all necessary papers on my behalf in
connection with this matter and to supervise the construction of said
system or systems in conformity with the provisions of Article 145 or
147, Education Law, the Public'Health Law, and the Putnam County Sani-
tary Code. r F, Of NEW
I�Q'� �IILLIA 0,10
�\\e Very truly yours,
Signed
Countersigne `:4A Al oa5�a1 Owner of Property
0. P.E , R.A., # Address
�)?) r—/4 zR Fl C-"Z D 7�1 VE-
Address
fa j-, T o� �y ias�-
Telephone
Town
�,�7R � ��-
Telephone
LAURENT ENGINEERING
ASSOCIATES, PC.
73 FAIRFIELD DRIVE
PATTERSON, NEW YORK 12563
RANDOLPH W. LAURENT, PE.
(914)278-6108-(FAX) 278.2658
HARRY W.NICHOLS, JR., PE. CONSULTING SITE ENGINEERS
March 18, 1992
Putnam County Health Department
110 Old Route Six Center
Carmel, NY 10512
Att: William Hedges
RE: Colin Duke - SSDS
Overlook Road
Patterson, N.Y.
Dear Bill:
Enclosed are the following :`.'
1. One (1) print of Drawing SS -1 "Proposed SSDS", dated
3- 18 -92.
2. Four (4) prints of Drawing.,SS -;1F "Preliminary Design
For Fill Placement Only",, dated 3- 18 -92.
3. Application For Approval of Plans For a Wastewater
Disposal System ".
4. "Construction Permit for Sewage Disposal System ",
dated 3- 18 -92.
5.
"Design
Data Sheet ".
6.
"Letter
of Authorization ",
dated 3- 18 -92.
7.
Two (2)
copies of Residence
Floor Plan(s), for
"Bedroom
Count Only ".
3.
A money
order in the amount
of $300.00 for review fee.
Kindly review the enclosed and contact us with your comments
and /or approvals at your earliest convenience.
Sincerely,
LAURENT ENGINEERING ASSOCIATES, P.C.
RWL:bd
92019
encs.
cc: Mr. C. Duke w11 ea.
I 0�� I
FAM LAURENT ENGINEERING
LAURENT, PE.
HARRY W. NICHOLS, JR., PE.
Putnam County Health Department
110 Old Route Six Center
Carmel, NY 10512
ATT: William Hedges
RE: Proposed SSDS
Overlook Road
Patterson, N.Y.
ASSOCIATES, PC.
73 FAIRFIELD DRIVE
PATTERSON, NEW YORK 12563
(914) 278.6108 - (FAX) 278.2658
CONSULTING SITE ENGINEERS
April 1, 1992
Dear Bill:
Revisions per
your markup are as follows:
1. Minimum required separation distances have been provided on
'f both plans.
2. Curtain drain has been added to. Drawing SS -1F with
separation distances. I
-- - _ --'" -- ��-• °�°
SS =1-F and include the volumes for the expansion area.
4. A note limiting the residence to three bedrooms has been
added to the plan.
5. Using New York State regulations for pump systems, 75% of
thevolume of the system-
ystem�-would require 327 gallons dosed.
However, your department allows a maximum of 100 gallons
dosed. The calculations for the tank elevations for the
dosed volume and one day's storage have been added to
Drawing SS -1.
6. The depth gauges are labeled. -°
7. The system and proposed well were re'l`ocated to provide a
100' separation distance from wells 'to toe+'�-of "s�.ope of the
primary system. � • �'
8. The absorption trench, baffle box and j'
3. The fill volumes calculations have been provided on Drawing
9. The depth gauge will be placed on existing grade. No bench
mark shall be required for fill levels.
unc:tion box details
are crossed off Drawing SS -1F
as requested: -
9. The depth gauge will be placed on existing grade. No bench
mark shall be required for fill levels.
April 1, 1992
Page 2
89014
Enclosed are the following:-
One (1) print of SS -1 "Proposed SSDS ", revised 4- 1 -92'.
Three (3) prints of SS -1F "Preliminary Design For Fill
Placement Only ", revised 4 -1 -92.
We trust this answers all of your comments. Kindly notify us of
your approval at your earliest convenience. If you have any
questions, please feel free to call.
Very truly yours,
LAURENT ENGINEERING ASSOCIATES, P.C.
Randolph W. Laurent, P.E.
RWL:bd
89014
encs.
cc: Mr. C. Duke
rw,
N6
'Nl�L
w
'G
/
� r
r
115.00
r! 502 °92'S`1'�
/ vry SffOf
I ! j
1 1 1 �" °1• I r j
i i, 'Jl 1 � l r �/ /• J t
� r /
1
K I
GX.
W ELL
I i I 1
1 I I t
I I I
qt "4 rear P.v.c.
INSTALLEt'
VE� f1 GALL`f
RNSH W /C�RAOe
/ GAffCD(IYP)
r,.
f
1
HOLE
a
I
,li
III
11
I I I
r
ill
I
• II
I
� I I
i
PROP
I
,
i I I
I�
I
! II •'1
I
II
! I
I �•i 1, 1
k 1
i l
1 1
1
I I ! 1
\
I ` 1
1
!
�1
N12• 1
270
1
K I
GX.
W ELL
I i I 1
1 I I t
I I I
qt "4 rear P.v.c.
INSTALLEt'
VE� f1 GALL`f
RNSH W /C�RAOe
/ GAffCD(IYP)
r,.
f
1
HOLE
a
I