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HomeMy WebLinkAbout0738DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 24. -1 -15 BOX 8 1'6m r '6 - uL 00738 A. C& PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # 10 - 70 -tS 7 f Located at 4a 0 Town or Village Owner /Applicant Name � G/' �� '^�' Tax Map zP- Block Lot Formerly -T Subdivision Name Mailing Address Date Construction Permit Issued by PCHD / 57f F Subd. Lot # %C Zip Separate Sewerage System built by C�� Gam.' Address�X 17 Consisting of Gallon Septic Tank and Other Requirements: Water Supply: Public Supply From, Address, or: Private Supply Drilled by 41 AyJe�se,• Address -Building Type r�� i�G't° Has erosion control been completed?� Number of Bedrooms Has garbage grinder been installed? AICI I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regula�o.£the Putnam County Department of Health. Date: Certified Address :2- P 7 Z P.E. -*'- R.A. License # -:—' 0 J_9 Any persottOCCUpying premises sery yhe abov em(s) shall promptly take such action as maybe necessary to secure the correction of any unsanitary °cond ..wng resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocatiorl, o ificatio change is necessary. By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: wn/Villa rr��%. Tax Grid # Map � Block Lot(s�/ Well Owner: Na Address: Use of Well: 1- primary 2- secondary _Residential Public Supply Air cond /heat pump - Irrigation Business Farm Test/monitoring Other specify) Industrial Institutional Standby Drilling Equipment � Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length eft. Length below grade � ;-� Diameter in. Weight per foot /� lb/ft. Materials: �- Steel _Plastic _Other Joints: _Welded Threaded _Other Seal: � Cement grout _ Bentonite Other Drive shoe: Yes _ No Liner: Yes ZC'No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _Bailed _Pumped Compressed Air Hours? Yield 10 gpm Depth Data Measure from land surface - static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface -- - - Well Location Street Address: wn/Villa rr��%. Tax Grid # Map � Block Lot(s�/ Well Owner: Na Address: Use of Well: 1- primary 2- secondary _Residential Public Supply Air cond /heat pump - Irrigation Business Farm Test/monitoring Other specify) Industrial Institutional Standby Drilling Equipment � Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length eft. Length below grade � ;-� Diameter in. Weight per foot /� lb/ft. Materials: �- Steel _Plastic _Other Joints: _Welded Threaded _Other Seal: � Cement grout _ Bentonite Other Drive shoe: Yes _ No Liner: Yes ZC'No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _Bailed _Pumped Compressed Air Hours? Yield 10 gpm Depth Data Measure from land surface - static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface -- - - If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity � Depth ��''a Model /�'�— % Voltage Zia H1P ��--- Tank TypeGJ� �(o Volu e � yo Date Well Completed Putnam County Certification No. rt Date o70 Well Driller (signature) N E: act location of well with distances to at least two permane lan ks to be provided on a separate sheet/plan. Well Driller's Name�� 4A,_� Address: of Signature: �A� �� Date: 6-11/9 White copy: HID File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 Wy V A 34 DO - NIX., -4761, o` 0 F.3 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map Block Lot Building Constructed by celv, ,7�- ,-ii lead Location - 91reet Building Type Town/Village Subdivision Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department 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 treatment 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 Public Health Director 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. �17 -f Dated: Month _ Day Year Signature: 44-"6 4" General Contractor (Owner) - Signature e , j CSW�. Corporation Name (if corporation) Address: /-5, X State '),V Zip Title: Corporation Name (if corporation) pW"V, oy' Address: W✓) State /Z�� Zip Form GS -97 PUTNAl`I COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Street Location Town 7- 'Q-#er5 on Tr Date: Inspected by: (1, ee Owner A :VRA G l e-D . Permit # P— 70 Subdivision Lot 9 9 A 1. Sewage System Area ; a. STS area located as per approved plans ........................:.. b. Fill section - date of placement 3:1 barrier Lgth. `Vidth Avg.Dpth c. Natuial soil not stripped .................................................. d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/ wetlands ...... ............................... II. Sewage System a. Septic tank size cv)e ......1,250 ......... other ................ b. Septic tank instI ........ ........ ............................... c. 10' minimum from foundation .......... ............................... d. Distri tuion Box outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches Junction BoY - properly set ....................... ............................... Length required �} 3 a Length installed 30 2. Distance to watercourse measured 74-2 ©oFt.......... 3. Ins4 acfoing t .............................. 4. Slo o r accept la -1/32" /foot ............. 5. 10 from propertrpiir4 ' ft: foundations.......... 6. Depth of tren <3 surface.................. 7. 10) q (e or 0 % ................... .. 8. k4el 3/ 1 %" diameter clean .................... 9. D of gravel in trench 12" minimum ................... 10. Pipe ends capped ........................ ............................... g. Pump or Dosed Systems Size ot pump chamber ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual / audio .................... .....:......................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Building a. House lo-cated per approved plans ... ............................... b. Number of bedrooms ............................... ...ee..ow.... IV. Well a. Well located as per approved plans ............................... b. Distance from STS area measured ft ........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship - a. Boxes properly grouted ................... ............................... b. All pipes partially backfiIled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... - EMEME // / / YML EN�I �AL SERVICES -��z ��ear���ree�� Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 32.903149 CLIENT #r,10691 NON STAT PROC PAGE 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ CATUCCI, WILLIAM COUNTRY HILL RD. PATTERSON, NY SAMPLING SITE: COUNTRY HILL RD. : PATTERSON, NY COL'D BY: WILLIAM CATUCCI NOTES...: KIT TAP owi—m- DATE FLAG PROCEDURE DATE/TIME TAKEN: 06/16/99 01:00P DATE/TIME REC'D: 06/16/99 02:20P REPORT DATE: 06/24/99 PHONE: (914)-621-5961 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 06/16/99 MF T. COLIFORM ABSENT YML EN�I �AL SERVICES -��z ��ear���ree�� Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 32.903149 CLIENT #r,10691 NON STAT PROC PAGE 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ CATUCCI, WILLIAM COUNTRY HILL RD. PATTERSON, NY SAMPLING SITE: COUNTRY HILL RD. : PATTERSON, NY COL'D BY: WILLIAM CATUCCI NOTES...: KIT TAP owi—m- DATE FLAG PROCEDURE DATE/TIME TAKEN: 06/16/99 01:00P DATE/TIME REC'D: 06/16/99 02:20P REPORT DATE: 06/24/99 PHONE: (914)-621-5961 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 06/16/99 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 06/16/99 LEAD (IMS) <1 ppb 0-15 ppb 9101 06/16/99 NITRATE NITROG 0.42 MG/L 0 - 10 9139 06/16/99 NITRITE NITROG <0.01 MG/L N/A 9146 06/16/99 IRON (Fe) 0.060 MG/L 0-0.3 mg/l 2037 06/16/99 MANGANESE (Mn) 0.017 MG/L 0-0.3 mg/l 2037 06/16/99 SODIUM (Na) 5.68 MG/L N/A 06/16/99 pH 7.4 UNITS 6.5-8.5 9043 06/16/99 HARDNESS,TOTAL 88.0 MG/L N/A 06/16/99 ALKALINITY (AS 122 MG/L N/A 06/16/99 TURBIDITY (TUR <1 NTU 0-5 NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WA ER (WAS (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDIy�r7O THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. ablic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelinesstate that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/Lof Sodium is suggested. � YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 014> 245-2800 Albert H. Padovani, Director LAB #: 32.903149 CLIENT #: 10691 NON STAT PROC PAGE 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ CATUCCI, WILLIAM COUNTRY HILL RD. PATTERSON, NY SAMPLING SITE: COUNTRY HILL RD. : PATTERSON, NY COL'D BY: WILLIAM CATUCCI NOTES...: KIT TAP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE DATE/TIME TAKEN: 06/16/99 01:00P DATE/TIME REC'D: 06/16/99 02:20P REPORT DATE: 06/24/99 PHONE: (914)-621-5961 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L MODERATELY HARD WATER: 70-140 MG/L MG/L = MILLIGRAM PER LITER HARD WATER':-140-300 MG/L (1 grain/gallon =17�2 MG/L) SUBMITTED BY: Albert H. , � Director ELAP# 10323 aDP> UUCMN !IU@ 1101t SZWA A�■teet Dana L 11. I M AdiiO�,'L' K° `.701��S ZIP Date Subdivision` ADD roved Fee-Enclosed -amci„nt alleft T*P� &20&t [4z:= _ rot Amin Pm Secbe olio Depilb Votaoe Naiabar 1 Bedteam ,. - DeafQu Pow G P D PC® NotlMtioa1. Ybgtitled Wbeuli Is aofapN .. 20 Stip�eala Srw+eop S„a. a aim d �-: —G.Bw SmIldc T..t T be rtT ?�j, 1�. Address WOtae Sttppbs Saippl� Ftaa ' ' : Addteas Sw* Deed b' �.. " OtYae,Rdtp�elea�ta - . I,np►tprit = that 1 am. wholly and'completaly respon sible for tM datpn and location ,of the proposed system(s); 1) that the aapa►ate'saw ` di m in sta a0ow'di+scrit►ad will be constructed as "shown' tl approved mnenoriient Cheri to and.in accordance with the standartls„►ulas a regu ions o . ins ISGIRIPm County Wpaftmarit :ot ►IMKh. and that on corn'vmion theraot a'•Catifiate of. Construction Compliarow satisfactory to the Commisik►ne of NOalthwill be suOmlttod'to: iM`Oeartmont and,a.wrlttan guarantN will.bo:!urniiMd the "nor, his successors, he a s by the builder will oNte'in ped opMdtMip eoiidition any part of `sald swage disposes systtin during the period of two (2) I retie tely following the ate Of the iwu- anei_ of tM app►oval'of ; tM'C .... trill. Constiucti" taim0le o1 the :oiiyiMl cyst o► an rapai►s o; 2 t the drilled well described above wile Oe IoeatgA as shosril on tM approved plan and that laid well wi11.M Installed ,n wK M ' s, r t and �agu ai�r%ns of the Putnam County rt bf Iseal Sign.. - P.E. Addre !' �� a �icfanse No APPROVED R�Op CONSTRUCTION This approval expires two orn the date issu unless a struction of the building has been undertaken and is revocable foY.tau ormey bu :afneW d 'or modiiiid %vhan.consi easary by>tM C issioner of NeaKh. Any change or it eration of construction requires a ;Mw mat. owd foi disposal of domestic fa ry age, a o►` a .water supply only. Dot t1Y Title ^s. r £' bb1 oy Z£ I •4 [ff� y 9f'014 i 'eu e1n aro /i I pS'914 6� � bl iV921 tl r� i.q Otl� eA } Z0 s9'I 01 !z1 921 z il. +p la 16 S6 96 46 06 I:a 66 ¢ 11 r/ r/ /' \. / I L 9tx ,1 11 Li al I 1 'Otl 692 10 'Vol r; \ SNP"W, ,9a ° 1.. 9£ / '6tl 69.9£ 69 6 •ti9 10'161 I e 19 a r C. IKI 31 1s ✓ � • ` s''� p / g — �qx ,i;>: p y B NZy6� s \ e st lilt 7r 00'114 " 8 ✓ HAS , � m un Of• s � 91011 Z£'ZI � 'ltlYOtl OL'6Z `r O � '1110 '011 ££'Z£ rr 1• OZ 92 3 90 aol '1 r '1 \�o / (S/p/f/ rf r 61 P OY 2f't 4, LZ 99Ta ° . tit Z1 0 A 6'I w a � 1 "' � � �. '` a ti 1'�. /'' • ! S{� y,�'� bb Pi N .p!/ $ BI ooslg ' °' t: a \1Va�9i Ib rf li ufel !r - a�>.. ZZ bZ S� y Sb X9'191 Zb L y f b9! 31noa 9�`.� ' a i rl�. t� U2'9t• 9b $• m SI o C4'f06 I 61'69! 6B6 �,r' a•. F +1 blt-0 4i6 su „41w 6`l; I OS i'9sx ° 1110 '3v !8'b£ g. �� ra Lb �, od 1110 '0tl WU '0V 96'0 1 1 6b 'lV/7 '011 ££2S I �' r P$ '" ONOS ltlb1N30 13W1ld £b �� '1110 '0tl 10'bZl s�latsl0 '0 Nag wol j 6s 90 �u 7' 619111 frest 011 90'6 206 Y L6 � 0' \\ 9S 1110 '011 01'11 0tl 6b'OZ ig6r x ' \ `ycc9` ttti bS 0'S I r 'ltl '0tl S'61r '�tl 59'6 r 1 11 � s \ i 99 v' 8 '\ � � � °q� 9.1.9 L•1-bl r• — •�!L/ '�- - - - - -- \' -�—01 I b1 0 /d— —0 /d 000696 N 9_1 61 0/d - -- 1 N9NINtld0 CIA NI31tl9S s e u. t § ©3}�•iU181 3 T1,11 r Atp*I_.INI_II 00 ES rook �Mendel Pond ai Corners erS 84 to S A -C Q " ~ Mount Ebo land om, . wntain 67 Y Gt IVA,— Putna Lake rn 67 Y Gt IVA,— Putna Lake rn PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES j CONSTRUCTIO PERMIT FOR SEWAGE TREATMENT SYSTEM ✓ PERMIT # 0 Located at Lo .(h A- A ,11 �Ya,r d own or Village "aa A <10;J Subdivision name G 1k;11 Subd. Lot # Tax Map 4 Block f Lot Date Subdivision Approved Renewal Revision ✓ Aee ,w® w rrrir' Owner /Applicant Name e f nlm ,,h L G G Date of Previous Approval .19 P7 Mailing Address /. - y Amount of Fee Enclosed 9 o v i^/ N 14,1//% /y C/ zip/'#3-f/ Building Type %3el"04i d ef Lot Area % s No. of Bedrooms Design Flow GPD j o v Fill Section Only. Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of /� v� gallo /n septic tank and of d F Other Requirements: To be constructed by Water Supply: Public Supply From ori" ✓` Private Supply Drilled by Address Address Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: o� �L�v� P.E. r'-,g Date OIJ 7,J �`Jv— Address 7 y D 9 APPROVED FOR CONSTRUCTION: This approval expires two ye 'Wl' unless construction of the sewage treatment system has been completed and inspected by the PCHD ause or may be amended or modified when c idered necessary by the Public Health Director. Any rev the approved plan requires anew permit. 1p ved for arge of domestic sanitary se nly. 1 By: Title: G Date: / White copy- HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES RE: Property of Located at LETTER OF AUTHORIZATION ,l ho Gu 1fd1&10 T/V� Tax Map # Subdivision of L.* w 2.4- Block. I Lot /d' ex Subdivision Lot # g Filed Map # 21'b I Gentlemen: Date Filed This letter is to authorize d �' v - % ✓A s'! a duly licensed Professional Engine or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education taw, the Public Health Law, and the Putnam County Sanitary Code. _<; Very truerof Countersigned: Signed: G C� P.E., R�, # > erty) Mailing Address ,;Mailing Address: ��� /%J/�i_lll/✓i 140(- W;,) P. lo5 I / 7V 4K State State Zip Vii`' Telephone: l y Telephone: 7d Form LA -97 14.16.4 62/97) —Text 12 FPROjjECT I.D. NUMBER 817.21 SEOR Appendix C State Environmental Ouality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (ro be completed by Applicant or Project sponsor) 1. APPLICANT (SPONSOR 2. PROJECT NAME 3. PROJECT LOCATION: A, Municipality �l7 yr /f County � 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) � CG�� ' // o� /4A> /,/-,9 ( / ") , 04 5. IS PROPOSED ACTION: ;4New ❑ Expansion ❑ Modificationlalteratlon 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: �� Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? XF esidential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other r ibe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE QR LOCAL)? Yes 13 No If yes, Ilat agency(a) and permlUapprovals/ /�G./f0� 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Q Yes JgNo If yes, list agency name and permlUapproval 12. A A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? Q Yes NO I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE V Ap4icanUsponsor � v Date: �7 ,name: Sipature: If the action is in the Coastal Area, and you are a state agency, complete' the Coastal Assessment Form before proceeding with this assessment OVER 1 PART 11— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No 4i. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another Involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities likely to be Induced.by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not Identified in C1-05? Explain briefly. C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether It Is substantial, large, important or otherwise significant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse Impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box" if you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Name of ea Agency Date 2 Title of Responsible Off icer Signature of Preparer (if different from responsible officer) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR . A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: alb e 4 lk ,0'a •''o C"'a 2. Name of project: 3. Location TN: 4. Design Professional: 5. Address:'7�r��r�sf �i'• 6. Type of Project: 15. If surface water discharge, what is the stream class designation? 16. Waters index number (surface) 17. Is project located near a public water supply system? ....... ..:............................ —Ala 18. If yes, name of water supply Distance to water supply 19. Is project site near a public sewage collection or treatment system? ................ l✓d 20. Name of sewage system 21. Date test holes observed Distance to sewage system 22. Name of Health Inspector Form PC -97 k--Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subidvision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEQR)? Ale, Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ...................... .... — 9. Has DEIS been completed and found acceptable by Lead Agency? ............... 10. __Name of Lead. Agency 11. If this project is an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... �S 12. If so, have plans been submitted to such authorities? .......... .............................�f 13. Has preliminary approval been granted by such authorities ?, % Date granted: 14. Type of Sewage Treatment System Discharge .................. surface water vlgroundwater 15. If surface water discharge, what is the stream class designation? 16. Waters index number (surface) 17. Is project located near a public water supply system? ....... ..:............................ —Ala 18. If yes, name of water supply Distance to water supply 19. Is project site near a public sewage collection or treatment system? ................ l✓d 20. Name of sewage system 21. Date test holes observed Distance to sewage system 22. Name of Health Inspector Form PC -97 2 23. Project design flow (gallons per day) ................................. ............................... G o 24. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... Ala 25. Has SPDES Application been submitted to local DEC office? ......................... 26. Is any portion of this project located within a designated Town or State wetland? My 27. Wetlands ID Number ........................................................... ............................... 28. Is Wetlands Permit required? .............................................. ............................... Has application been made to Town of Local DEC office? 29. Does project require a DEC, Stream Disturbance Permit? .. ............................... Ala 30. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfillin sludge application or industrial active Yes/No �v 31. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination. Yes/No A1142 DESCRIBE: 32. Is there a local master plan on file with the Town or Village? ......................... A& 33. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................. ............................... _ /✓� 34. Are any sewage treatment areas in excess of 15% slope? . ............................... A41- 35. Tax Map ID Number .......................... ............................... Map 4 Block ! Lot 8' 36. Approved plans are to be returned to ..... Applicant t.-I Design Professional If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). 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 misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES. Mailing Address: ................................... PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ APPLICATION TO CONSTRUCT A WATER WELL. OAn (-/ / please print or type PCHD Permit # ' Well Location: Street Address: Town/Village Tax Grid # i// /;J Jj°'v-S017 Map P.4- Block L Lot(s) IS- "n Well Owner: Name: Address: All Use of Well: /Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought -5' gpm # People Served A Est. of Daily Usage el" eU gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling V4 New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type ✓' Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No w Is well located in a realty subdivision? ..................................... ............................... Yes No r' Name of subdivision 50 (_n i- � Lot No. 9� Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: "' Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: / Applicant Signature: of PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and 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 or their designated representative 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. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and 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. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue Date of Expiration Permit is Non - Transferrable Permit Issuing Official: Title: White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REV W HE T for CONSTRUCTION 'PQE�RMI STREET LOCATION NAME OF OWNER J �-- BY B. HEDGES R.MORRIS THER DATE 1 /��.FAX MAP # DOCUMENTS. Y ZI PERMIT APPLICATION -1 LL PERMIT ITIPWS LETTER ENGINEERS AUTHORIZATION m DESIGN DATA SHEET(DDS) M CORPORATE RESOLUTION M PLANS THREE SETS m HOUSE PLANS - TWO SETS M VARIANCE REQUEST SUBDIVISION F GAL SUBDIVISION BDIVISION APPROV ECKED RC RATE LL REQUIRED DEPTH CURTAIN DRAIN REQUIRED EDSTANDPIPES GENERAL m EX- APPROVAL SSDS ADJ. LOTS m WETLAND ( TOWN/DEC PERMIT REQ? ) CD DATA ON DDS PLANS & PERMIT SAME m PRE- 1969 - NEIGHBOR NOTIFIFICATION m LETTERBl/ZBA m 100 YR. FLOOD ELEVATION EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE 'IF PUMPED PIT & D BOX SHOWN & DETAILED HOUSE - NO. OF BEDROOMS WELLS & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER - 1 /4 "/FT. 4 "0; TYPE PIPE NO BENDS; MAX. BENDS 45° W /CLEANOUT FILL SYSTEMS C�AYBARRIER 0 FT HORIZONTAL: SLOPE 3:1 TO GRADE FILL SPECS m FILL NOTES FILL CERTIFICATION NOTE DEPTH GAUGES FILL PROFILE & DIMENSIONS VOLUME FILL IN EXPANSION AREA TRENCH LF TRENCH PROVIDED m 60 FT MAX PARALLEL TO CONTOURS 100% EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED ON PLAN ,-- REQUIRED DETAILS ON PLANS FIELDS WAGE SYSTEM PLAN - (NORTH ARROW) ® 10' TO P.L., DRIVEWAY, LARGE TREES TOP OF FILL L DS HYDRAULIC PROFILE m GRAVITY FLOW W20' TO FOUNDATION WALLS 15' WELL TO P.1 �C� CONSTRUCTION NOTES (GRINDER NOTEL 100 TO WELL, 200' IN D.L.O.D., 150' PITS ESIGN DATA: PERC AND DEEP RESULTS A00 TO STREAM WATERCOURSE LAKE (INC.EXPAN) TWO -FOOT CONTOURS EXISTING & PROPOSED 0' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER DRIVEWAY & SLOPES CUT 10' TO WATER LINE (PITS -20') FOOTING /GUTTER/CURTAIN DR�II�S 50' INTERMITTENT DRAINAGE COURSE ROSION CONTROL; HOUSE , SSDS - 200 FT. RESERVOIR, ETC.m 150 FT. GALLEY SYSTEMS EROSION CONTROL NOTE l5' MIN TO C.D. S= >5 %,20'- 4 %,251- 3 %,301- 2%,35' -1 %,100' <I% ERC & DEEP HOLES LOCATED 20' MIN TO C.D. DISH ARGE /100' WITH 182 CONS DAY DIS. REPRESENTATIVE OF PRIMARY AND EXPANSION SEPTIC TANK LOCATION MAP m 10' FROM FOUNDATION; 50' TO WELL COMMENTS: _......:.... PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Pate Re: Property of Located 104 IU( / { ) on Block Lot 1 _ Subdivision o.f l Subdv. Lot # Filbd Map Date L MICHAEL DALY, P.E. Gentlemen: CONSULTING ENGINEV, P. 0. BOX 243 This letter is to authorize / a duly licensed professional engineer Y or t (Indicate to apply for a Construction Permit for a-separate sewage system, to nerve the above.note.d property in accordance with the standards, rules or regu;Ations as promulagaited by the Commissioner of the Putnam County Department of .Health, And to sign all necessary papers on my behalf.in connection with *hie wattor 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. Very truly yours, Signed d Own r of Properly Countersi 1 i�Address Address MICHAEL DALY, P -L Town CONSULTING ENGINEER 's NQ AHWROCK, N. V. 10+87 Telephone Telephone DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # ` WELL LOCATION / //�/ /S�]treet A dress To Village City Tlaw/x Grid Number iVV VV WELL OWNER N M ilin Address RESIDENTIAL O PUBL C SUPPLY 0 AIR /COND /HEAT PUMP 0 BUSINESS O FARM O TEST /OBSERVATION 0 INDUSTRIAL 0 INSTITUTIONAL 0 STAND -BY ivate 4/,13 Public 0 ABANDONED 0 OTHER (specify, O E OF WELL 1 - primary - secondary AMOUNT OF USE YIELD SOUGHT_ gpm /# O,�, REPLACE EXISTING SUPPLY 0 / EW UPP Y W DWELLING PEOPLE SERVED & /EST. OF DAILY USAGE, gal 0 TEST /OBSERVATION 12. ADDITIONAL SUPPLY 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE RILLED DRIVEN ODUG GRAVED OTHER IS WELL SITE SUBJECT TO FLOODING? YES ✓ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: u' Lot No. WATER WELL CONTRACTOR: Name �"(o j:'V-> Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER--MAIN: " LO ATION SKETCH SOURCES OF CONTAMINATION PROVIDED N PARATE SHEET (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 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 dril 'ng operations be contained on this property and in s�WZ manner as not to degrade or other a conta ate surface or groundwater. Date of Issue: Date of Expiration �- ' 19 -1 P rmit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 , Fax (914) 278-7921 Mr. Tom Daly, P. E. Box 243 Shenorock, NY 10587 C BRUCE R. FOLEY Acting Public, Health Director May 19, 1991 Re; Proposed SSDS: 52 Plaza Realty Lot #9 Country. Hifl Road (T) Patterson Dear Mr. Daly: Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: "The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." "You are referred to Article 128.1 of the official compilation of Codes, Rules and Regulations of the State of New York, Title 10, relative to the need for approval of individual sewage disposal systems by the City of New York. You should contact city Officials in this regard." 1. Erosion control measures for the well has not been shown on the plan. 2. Current code requires that the deep test holes and percolation tests are witnessed by a representative of this Department. 3. Trench cover is to be noted as geotextile material or equivalent. Upon receipt of a submission, raised to reflect the above, this application will be considered further. Very truly yours, lkba�gm____ Robert Morris, P. E. Public Health Engineer RvUjp DERAWMENT OF HEALTH Division of Eniironnnental Health Se?-vices 4 0ene4s Road Brewster, New York 10509 Tel. (914) 278 - 6130 Fiat (914) 278 - 79111 Mr. Tom Daly, P. E. Box 243 Shenorock, NY 10587 BRUCE R. FOLLY Acting Public flealth Director '%,.-lay 19, 1997 Re. Proposed SSDS: 52 Plats Really Lot #9 Country 1-1d] Road (,.F) panerson Dear Mr. Daly: T Rv"6cw "A plans and (-Aiwf v 111"s (imo 1%, I-Ilive ((° Ont: (waptiolwd j 1 hr's I, :I -wnpcW' ornvll-n!5'A,'I- , Ocrcd m q, ',* -" '*-� -7 jl-';� -m- jg,�. C � t I f " , - 11 . Yoo.Ajouldcontad h)Qa.1 we-Orl(Is fffrl('Wl� this --yo,ti al-c "Iu-6.c3't- 1"S.1 ofth �ITIA Vh-4: iYs tt of Y�'rl" 10, �-`HoiVc il., --Jnls��' 1,02. �"ppftyva!' of fl-161"'idual S�zw- �jv)!�ill id'(y 41 OW's rn c -V �' Vie' !I "n �L k I A% . , 1. id Et ";a-w , 1.01 tilt 111,110,1 ei.A' sbos"'Jl i)jk 111f, 3} E1 Ir, i>k mpre-swiativc of this N-paritpetit, I'rcrtch cwcr its to be natal as gcotextilc material or equivalent. J -'iL'! o", i vil Wrther. Jp VM WAY y0tus, Robert Mori* P. E. Public Health Enginecr y. J A/6- ge S3T� Clr�2 ort ".sr�s✓+r sl, } OF NE{y yo . Y�..`a`L r` 51F i � �� 11.� .. \ '.. 1 �`.} I: •. y � 1 t a,. ` ✓ � �} �. ' � .. .: pp az '" �,KV'iii"Y'C � .. �. ��Y�.. f+ }+. .f � _Anti i � � •L�j� �. ! - -ij :7' (�' a�'�$,y?%4p' car•.tia, f _ , V��j,'- s. t1.. u � 7y+t *IQM1�'+'� �. ^y3�� ° a \ _ ,4 f Q i y Y :i - .. '�•� / � "44.x'}, -t ��� yi%.� + ��I'�i � ^� � �.. `� ` ��` i.�- ^�.e+e � lr.� �� .X � �i;.e,�.�.� -mow �5t'�. :�.,� - -e1y. �, r , a� - ;•^i�1ri; -'.a -- - - � _ X t ,,_t r, rya. r trif �j s•. !•�` %.� .. � .. � 5 „� �'y,, fii y •'� '�:A� '�A/R ,� ,�& a,ro�t.a -g„�.. a,.r.. > +. �a !1 {yY {^ t 11ll.Cl ) i. h• •.y _ t .. Y _ 'f 1 • DEPARTMENT OF HEALTH Division of Environmental Health. Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278 - 6130 Fax. (914) 278 - 7921 August 25, 1998 Frank Sullivan 2972 Ferncrest Drive Yorktown Heights NY 10598 Re: Proposed SSTS: Horacio Country Hill Road, Lot #9 (T) Patterson, TM# 24 -1 -15 Dear Mr. Sullivan: BRUCE. R. FOLEY Public Health Director Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: The construction of this sewage disposal system maybe subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department of - Environmental or the - Putnam- County Department of -Health on-this lot, percolation test- must be- - witnessed by a representative of this Department. 1) Deep test�must be witnessed by a representative of this Department if deep test5were not witnessed after subdivision approval. 2) Current codes requires that the maximum possible expansion area is shown. 3) Expansion trenches are to be shown. Upon receipt of a submission, revised to reflect that above comments, this application will be considered further. RM:tn Ve ly yours, Robert Morris, P.E. Public Health Engineer Signature andTitle�w _ PP,POPT'RF,rPTVFT.) RV: I acknowledge receipt of this report: :SU 02196 MATURE: Title: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner f)o2RAG/o Address _Gouiy�y yjj Located at (Street) -j-, 16 q Tax Map 05 Block I Lot (indicate nearest cross street) Municipality PA r7og 6 ©A/ Watershed East SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test 1 2 3 4 G 2 3 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 NOT�G1© Ldf TEST PIT PROFILES Hole # Lot # Hole # Lot # Hole # Lot # Depth to water Depth to water Depth to water Depth to mottling Depth to mottling Depth to mottling Depth to_ rock/imp. Depth to rock/imp. Depth to rock/imp. . G.L. G.L. G.L. 0.5 0.5 0.5 .1.0 1.0 1.0 2.0 2.0 2.0 3.0 3.0 3.0 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6.0 6.0 i 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 i Hole # Lot # Hole # Lot # Hole # Lot # Depth to.wat�r ...... Depth to 'water, i Depth-to water Depth to mottling Depth to mottling Depth to mottling Depth to rock/imp. Depth to rock/imp. Depth to rock/imp. G.L. G.L. t G.L. 0.5 0.5 0.5 1.0 1.0 1.0 2.0 2.0 2.0 3.0 3.0 3.0 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 : 10.0 10.0 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # P- -70.9A WELL LOCATION Street Address o Village City Tax Grid Number WELL OWNER Name Mailing Address 57- A-4 Z A eca-Ai-Ty e%Private 0 Public USE OF WELL 1D primary 2- secondary 'i RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED D BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify, 0 INDUSTRIAL U INSTITUTIONAL O STAND-BY- O AMOUNT OF USE YIELD SOUGHT E gpm /# 0 REPLACE EXISTING SUPPLY RNEW SUPPLY NEW DWELLING PEOPLE SERVED C� /EST. OF DAILY USAGE 6j2 ,gal O TEST/OBSERVATION.' 13-ADDITIONAL SUPPLY D DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING Al W 14D U5 WELL TYPE ®DRILLED ODRIVEN DDUG OGRAVEL OOTHER IS WELL SITE SUBJECT TO FLOODING? YES _�< _NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 6t7uNTIZy HILL tEST ]Ea Lot No. WATER WELL CONTRACTOR: Name 7, S, ®, Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION KET n & SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET dat 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 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 s ch a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: iii 19 Date of Expiration 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 o:.er/AmMost Nr ,5Z PLAZA k FA L-t y eatae..a_� Date at Prevlea. s - Town Ant... 'S i DENT l =L cot A0,6 1 • S h A I G. M seam 0* D va NI>•ba d Heie�e Dedgu Flow G P D !Rn��%� / PCHD Noddle doe b Requhed When FM Is ansplebed Sepnete Set►orp Spa. a as.M ee a 'J'Z. S # C' 9dw Sapde T.ek .red ✓ L_f L Z6/ �� TA eN G H - T'be aMetnc/ed T; R. u Adilmse wow S"4*. plot Sop* Few Addrew an pel..fe Sllppb De1Bed by f i L7.. Addrm OIMr R4eeaeAte 1 represent that 1 am wholly and completely responsible for the design, and location of tho proposed system(t); 1) that the separate s.w di al stem above described will be constructed as thown.opalneapprovod amendment there to and in accordance with the standsrds, rulesa regq ns O am County. 'Oeps"inent of Hasltli, an0 tMt on coenpNtion thereof a "Certificate of Construction Compliance•' satisfactory to the Commissioner of Healthwill be submitted to the ispaKnipnt, and a written' quara'nt" will be furnished the ownd, his sucaaers, heirs or assigns by the bu80er. that, sled builder will DIM, :in, good oposratM p conidition 46y part'. of Yid slawage disposal system during the period of 21.y#s Immediately following the data of the lam - on" of the approval of the Cirtifiiate of Construction 'Coinptisnce Of'thri orginai'system or ny rope ;2) that the drilled well described show will be located as i on the approved plan and that said well will be Installed in , a 9 h tM . ► rules and rpu aiiToei . of the Putnam county o a` nrerlt f.►wren: �_ Date. Si)ned P.E.JL R.A. - Adass Ra >X , 4 r c. 1_IC.nse No ¢R 469 APPRO I FOii � CONSTRUCTION: This approval expires two years from the date issued unless construction of the building .has been undertaken and Is revocable for 'Cause or may aImanded or modified when considered necessary, " ommisslonsr of HMnh. Any change or alteration of construction requires a ew permit. Approved for d1*101of domestic sanitary sesy -e,- aedjp& -ffiv a water supply only. �/88 Date / -- 9 Title tee. y _� DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT #-"P40-70b WELL LOCATION Street dress 'Trwtt LL, o Village City Tax Grid Number - l i e WELL OWNER N 4EL Mai 1in Address � 0 -fox 1 C'rivate �� 0 Public SE OF WELL 1 - primary - secondary -- //L GRESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O FARM 0 INSTITUTIONAL O AIR /COND /HEAT PUMP O TEST /OBSERVATION O STAND -BY 0 ABANDONED O OTHER (specify, O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED g /EST. OF DAILY USAGE _6 Sal ❑ REPLACE EXISTING SUPPLY O TEST/ OBSERVATION M ADDITIONAL SUPPLY W-NEW SUPPLY DWELLING 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING prwc7cr WELL TYPE E315R"iLLED 13DR1VEN ODUG O GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES �i1d0 WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name -y—, . j�) -Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES L—,"NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF SEPARATE (date) CONTAMINATION PROVIDED SHEET 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;, (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 Issu 19� Date of Expirat' 19 S Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller PUTNAM COUNTY DEPARTMENT OF IIEAL,rH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re : Property of 52- pLP`ZA Located at C oU Y)J-Tz-f i -i1t�i , V-04'.7 (T) ? WrIl5orJ Section Block Lot 15 Subdivision of �y✓�'� ��wiS��iS Subdv. Lot # Filed Map # Date Gentlemen. This 'Letter is to authorize a duly licensed professional engineer �70r registered architect (Indicate 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 1l7, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. tersi ned: Crun g p.E. , R.A. , -2 & -V/ Tlephone f Very truly yours, Signed Owner oper .y Address `\ Gr1- I Ajdress Town Telephone Re; TING 9149625937 P.02 PUTNAM COURTY DEPARTMEIVT OF ..11L, DJ:V:rS10N OP'. BNVlR0NM1NTAL.f1EA1Lf1'jJ SERVICES Date Property of Located at 1U..4'r:VA�0 (T) S o c L j. k Lot Subdivision of- Q,160.- Subdv. Lot # filed map ate t M0.4.4i.', kLY, P.E. Gentlemen: CONS Ili" il "NKGINEER This letter is to auttwri�e a duly licensed prof essior.aj orgineer or (Indicate to apply for a Construction Pern):I.t for a sewage sys•errit i.o serve the above noted property in accordailec. :4it)i the standcards,. or regulations as prowulaga Lod by the Conimis,:,;;ojior of the Putram (,o-onty Department of Health, and f.c.) sign all necess.e�x%y papers on my beha I f, im connection with this matter aired to supervise t.h,", construction of sai-0 system or systems in corfformi 1*.y* with the of Article J.117, 147, Education Law, the Pub*'.*i..c 11calth Law, a*o(1A Ghe Putnam Cowlty bia-ri,-- tary Code. Very truly .:./-.-.:ursj of rty Signed o.: Countersignel:',.. P.E. R.A. Address CONSULTING INGINEEF! P.O. BOX 243 0QK, Nryr-tm' Telephone S �u j 1-11 �'. . ca q_S T In icri T. . c p h o n e commiti Dep rtnwst . of mmmltk, -ale tMt ain C, a- ion.thereof,a :Ivor 68 1* to tow DeportsmMtl. and o'. Written VAWaMM win M fui psa M "pjd v*42 e coiMNMn sty part of pM..fewaN sINYOYI ` as" of the a»rwiai of_ the CwtNkat• of Construction Commi.hq,. pion oe loeaq/ M *AM on tttapprowd 0" end that low. We"' •illbi. h Cwhyt.Degrtmam.of "WOOL AMIlOVto From CONSTmOCTIONsThU pfiroell eiPir4 `yerri t I ncose for CWN Or ,'m y be artnilMif or ngdM1ed WNW eO _ !HYMN • now oermN.' AdNdilad for dismisses of dsssout y 1 Rev. oDate i X0/86 i •n ieat• of Construction C~14ica" satisfactory t0 the COmmiaM W of t4MNh*IN kMd 04 owner; Ms;nston�on, MYS or ioljns_hy the builder. that old t1uNMr Will aNrn durMN the arbel`of t��w tln.el.taiy: roltewMi � lMgte of tM INY the o►IjAwi syrt•m or any 12) that.tM drilled Wll deunMd aian, ailed Mi. 99r9M VAh'tYhn and /ajia ns t lM ►YtMSn o c�� l.ICOM -0 41 8 4 6 n'th• eats` IstwA tints" construction of the building has titian undertaken and. is {{pry by t CommiWOner of MMNh. Any NNnge or aswation of construction, Vol a " drlsat•.watM ntoVly only. TNle® r DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT #P-10-6(0 WELL LOCATION Street Address un Ilii, Town/Village/City Tax Grid Number 9_0 c W New 15 ow 15 -y -� WELL OWNER Name Mailin Address f7 A (cam; I1J M. ?-9 D 2 14�t�i.r�� /)"Private Public SE OF WELL primary 2 - secondary RESIDENTIAL BUSINESS 11 INDUSTRIAL D PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP D FARM D TEST /OBSERVATION U INSTITUTIONAL D STAND -BY D ABANDONED ❑ OTHER (specify AMOUNT OF USE "YIELD SOUGHT �J gpm /46 PEOPLE SERVED 8 /EST. OF DAILY USAGE (040 gal REASON FOR DRILLING EW SUPPLY D PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION OREPLACE EXISTING SUPPLY ® DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING Nvv. WELL TYPE RILLED 13DRIVEN ®DUG ® GRAVEL ® OTHER IS WELL SITE SUBJE& TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Gouniltiq 141Lti ws'fpfe, 5 Lot No. q WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION ON S SHE (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 thirty (30) days of the completion of water well construction, the applicant s.hall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the County Health Department attached to this 3. Submit a Well Completion Report on a form Health Department. Date of Issue: 2 19 '1l Date of Expiration: 19_ requirements of the Putnam permit. pro Pe y the Putnam County ermit Issuing Officia Permit is Non - Transferrable White campy. Yellow co 2/87 PY• Pink Copy: H. D. File Building InspecWr PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property of Located at (T) Section Subdivision of Date z 1) ( Q v Block Lot JI5 Subdv. Lot # q Filed Map # Date T. MICHAEL DALY, P.E. Gentlemen: CONSULTING ENGINEER P. 0. BOX 243 This letter is to authorize. a duly licensed professional engineer or registered architect (Indicate 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. Very truly yours, igned Countersig e P.E. , R.A. , # 9`�� Naaress Gicrna Town . i er o ropert Address Y. MICHAEL DALY, F.E. CONSULTING ENGINEER P. 0. BOX 243 SHENOROCK, N. Y. 10537 Telephone 0 S -7 D v Telephone •@4llUl[ COD[f!'t DQA<'!!�[fl' OF �AL� m' Fa®FOD Dbw.. at�..aaw BaaYr 5..1e..: Ct�sal. lr.� 1®6l? a� Pasant'® .r UWAM VOW TWO 4w oa:.d�rrro.•� x�tl. CS , de kM pat� d sio Fe'e Enclosed' ntint try a altt.. sofrf>wp 8P� is D` PCB: m 04 whom ' �.o' S�e aada d fi7�i is Da d , 11a M Swad. alai i ,e�- ►/ ..�.. s;pb Dew rs ` % %'s %7 1 ►ap►asanC.tlNt 1 am who11Y anq eompNtly rnponsibb foi'tM dotiyn and location of `tho p►oposad :YSt ®m(s)a 1)'that tAO at® ssw di fal atom atwvfa Oase►lba0 wlil be eonftrucNd ae Nown on tIN;sOor td an»nAma�t thi to a"' Il aceoidanp with tM 1taMirtlf; rules a rpu nt o Inanarn emmfy OaP�ftmmt of 'Maolttf,- and,that on eomPNtiai'tfiaaof a" 'Cartif"t Of, Constfuctiob°Coinplionea"- milsfietory'•to, the' ComnaisMdnli.of,,Haalthww M fi1b111Kte0 -to ttN.,Dpe►MiMrt and a,- written oua►antw will M fumisl► d the owner „his- fpcaafswst ov Msoi'assims by the buihtay. that 'said buildar,arltl, .. Y,. .. ' ttt�q . to hood owatNi/\ eoedlttoh a""y ,Part.'of laid aawaja dfsPOfal fyatalll durifi�`;the period of; two (t) :yaa/a immadtatsly foUOwiny tt 4daite of,Aha asau, aea:;O/. tM',aPProlral_.of 'tM .CMtNkata, \of Comtiuctioh'tompliifiu of ;tM aiMin�l systant;o►, any r loiptoi.Z).that tp• drilNd wail ddsa"0 a6a ® WIN is IOtJtsO as sllalrw oh tM aPpovad Olen and that laid wall will tN Instal in : accordan with ou a of'' ih Putnam Y u cOullty ftlllallt of: Health L \ . ifxlrlEa P)o APPROVE6 FC+p'�CONSTAUCTION. Th oval expires two YfaM7 from -t-ho data 'issuW' uelass'cori ructbn'of'.tho budding -bas been undo►takan and is Iwoa:abN fOr .GYtO oi, nlay Oe`anandW;or modifI” wiwwconsida►i0nacastaiy, by the+ COfnrnissiOfler ; P.Hatilth:. An f:hafapa. or altWatbn of constfucttan faOuMas s Par A q��ecd /IM itpoMl of domeslkaawaae prkatb wat®r supply. only. REV .. Dina /''` a BY Titlo ti DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT WELL LOCATION Street Address To V• age City Tax Grid Number WELL OWNER Name Mailing Address rivate Ll D Public USE OF WELL 1 - primary 2- secondary eRESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY OAIR /COND /HEAT PUMP []ABANDONED O FARM O TEST /OBSERVATION 0 OTHER (specify O INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /4� PEOPLE SERVED /EST. OF DAILY USAGE &cy gal REASON FOR DRILLING ° EW SUPPLY []PROVIDE ADDITIONAL SUPPLY C3 TEST/ OBSERVATION OREPLACE EXISTING SUPPLY []DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE ®DRILLED DRIVEN DDUG ❑ GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES 1/' NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: ',,),�n�4 gill �sf�5 Lot No., C7 WATER WELL CONTRACTOR: Name, /�.J�, Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER-MAIN-­- LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED OON REAR OF THIS APPLICATION L ON S� i 44�, (d te) (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 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. Date of Issue: 19 Date of Expiration: .19 -7 Permit issuing �ffic —ice Permit is Non - Transferrable � copy: H.D. File Yell Buid In c to r 2/87 oW copy. lin g spe Pink Copy: Owner Orange copy: Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Located at J, Section / 5' Block Lot Subdivision of Subdv. Lot #__L Filed Map # �1� 7i Date ,6�2-2Z z6-6 Gentlemen: T. MICHAEL DALY, P.E. CONSULTING ENGINEER This letter is to authorize P. 0. BOX 243 -011ENEWOEK; N. y. toss? a duly licensed professional engineer v or registered architect (Indicate 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. Very truly yours, S.gned Countersigned : CVner of fro rty P.E. , R.A. , # Address Address Town CONSULTING ENGINEER P. 0. BOX 243 SHENOReem, N. Y. 105117 Telephone Telephone �,`�,.'.! • r; � ., ` fit f.• • ., 1A i v. I ' of v� �:'. r ' ,•�7 /./ � ,lr. ' r a Aw :A/ T�y l l �LL- j tc�l Oils COMPUANCE- ONInMff-FOR -70 CON�i S*V�AqE AN ITYOO pp "County pepartTent;. of- H"Ith,,,and that on corn;Aeti6n,t;eriof i',!icer6ficati.,of pons�!i�ct Ion, f:omOliancs-! satisfactiory16-the Comm'issioner oU Health will ` PUin M COUN'T'Y DEPAR'IlMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS ' OUL(( , T)'k� (Name of Owner) COK1ENTS 3G �6 -►6 I"' REVIEW SHEET - CONSTRUCTION PERMIT BY: (Street Location) YES I NO DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other a House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions.- Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion- Area;shown;gravity flow,suff. size If Pumped Pit & D Box Shawn & Detailed House - No. of Bedrooms lls & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake Unc. expan) 15' to Drains- Curtain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' from Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same 1 represent that 1, am wM abo46 descrilbe6'wHhii.c —C -.MilijiakineRt;-of be subirn -; 64 '-ittid 'to, 6 place ;k, good ante qf, ther approval 'o' will be 116cated4i sK66A� ounty1Pepq!!TPntl :q -i APPROVED � % -C"' �Oiable for Lis or requires{ a now er Miss 0 n the approved plan and that said Will )aj!l, be it iealth `- Sign '7t ,1 ,"Ad a Sox Z4 'RUCTION This a6'pro4al;'expWei one year-,r y be 1 ed or.modilied w66n,�onsidered,ne , � " " ., r, of -domestl i sanitary' L. BY OYHEALTW, - 'Eh or k R e S 'A lbn- ❑ -DiWof Pr6Aa' #Approval -' 7- [Fid' d- oily, �-i T.CHD-N4Affliill1on Is Regtilred whiin FU 1i; co6i Ohitid .' BS t that., ;he separate sewage disposal syste!1j.• :L . ln", �6ada'nca" ijfi the standards, rules and regulations of. the, Putna'm •t'0,,t.he:Cornrri'!ss ?��erof` eilth'Will -�,aqory ' I . tl 1. 1 . , ner,.'his,Wccessors,';heirs.'or',assigiis by the b6ildsir..ttiat said buildir will er WO atlilatamly , 1 s�liowi I n . g !he, date .. of,the I'm, hi"" !, system -olri,a.A9jrepairs -t r I 6'at, the drilled well described above once n FV- and 71req t h the u latloiris 7f the '.,FiutmS'm • 01 P.E. R.A. License t46 4&—' of us n �is',14e"n'uhdaiirued. un ess!�C6�.i6�UA taken and is of edristructisin �,--166M e an alteration, private P1 tie Division Of Environmental Huh Services TWO COUNTY CENTER — CARMEL, N.Y..105iT —tS— ) 225-3641 _ APPLICATION TO CONSTRUCT A WATER WELL IS WELL SITE SUBJECT TO FLOODING? _ YES _/ NO IF WELL IS LOCATED IN A Kt:ALTX SUtSlllVlJlUiv, l klb UY 5UbUlVIb1QN:C00"jjZ� LOT NO Q WATER WELL CONTRACTOR: Name F3 i7 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ✓ NO NAME OF PUBLIC•WATER SUPPLY: TOWNI V/C. DISTANCE TO PROPERTY FROM NEAREST WATER. -MAIN ' LOCATION SKETCH & SOURCES OF CONTAMINATION . - T2-� %r_- (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 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 for pro ided by the Putnam ounty Health epartment. Date of Issue: C 1 Pe it Issu ng fficial Permit is Non - Transferrable 0 STREEI A 7 - WWN /VILLAGE/CITT IAX ViO NUMBER. II ELL LOCATION c,,a►�.< «� �v,,;, ' l�,>- c- ri5�►a -� _ _ NAME. • ADDRESS: VPSIVAT[ WELL OWNER � � iZ�—' zZ �e „� � _ �,�z ,� ❑ 2U80LIC USE OF WELL ('RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP ❑ ABANDONED 1 - primary ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) 2 - secondary ❑ jNDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED 8 / EST. OF DAILY USAGE (000 gal. REASON FOR 93,/NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ORILLING ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL WELL TYPE I a DRILLED DRIVEN F-1 DUG F_� GRAVEL F_� OTHER IS WELL SITE SUBJECT TO FLOODING? _ YES _/ NO IF WELL IS LOCATED IN A Kt:ALTX SUtSlllVlJlUiv, l klb UY 5UbUlVIb1QN:C00"jjZ� LOT NO Q WATER WELL CONTRACTOR: Name F3 i7 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ✓ NO NAME OF PUBLIC•WATER SUPPLY: TOWNI V/C. DISTANCE TO PROPERTY FROM NEAREST WATER. -MAIN ' LOCATION SKETCH & SOURCES OF CONTAMINATION . - T2-� %r_- (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 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 for pro ided by the Putnam ounty Health epartment. Date of Issue: C 1 Pe it Issu ng fficial Permit is Non - Transferrable 0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner %,j Q<j Aj.4 iJarA L"c2p Address "Ec Z.2 -:aoy.. x_171 '�'AZFI Tc f Located at (Street 7 ems. _ Block 4 Lot.9 Nndicatelnearest cross s ree Municipalit Watershed R,ukg:Z SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole- Number CLOCK TIME .0-c� PERCOLATION PERCOLATION . Elapse Depth.—to Water., a er Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min: /in.drop Inches Inches Inches 2 m 2.of �. �� 9.�I4�� l 4- 7. 1 O — _ ? 2 2... 3 :.n 70. -L, � 4 2 4 30 ?� 'z�' 12 �2 20. 5 . .1 2 ... 3 5 Notes: 1) Tests to be repeated at same depth until a roximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 6" ` 12" - 18" 24" , 3011 36,E . 60" i 66" 781 8411- . INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED. INDICATE LEVEL -TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY T 7ZGS ) Date i1LG �{ DESIGN Soil Rate Used -? aMJ -rVl Drop: S.D. Usable Area Provided 5 �l No. of Bedrooms Q- Septic Tank Capacity 1 Z50 Gals. of N Absorption Area. Prided By 57(0. L. F. x24 r E M-A\ Add_ re s s ox ZA a z • Signature THIS SPACE FOR USE BY .HEALTH DEPARTMENT ONLY: SEAL KP'� \4, Soil Rate Approved Sq. Ft /Gal. Checked by Date Putnam County Uepartment of Health Division of Environmental Sanitation /AFFIDAVIT - CORPORATE CUNER APFLICATION . FOR PERMIT APPLICATION'.SUBMITTED TO PUTNOI C04INTY HEALTH DEPARTMENT TO: Commissioner of Health -'In the matter'of application for „- -„ goUtruction ,permit for separate sewage system — I, Jerry Weissman, V. Pres. _ — — — _ represent .. — - -- —• - - -- —�.. that I am an officer or employee of the corporation' and'.am authorized to act for,�,c�E�.�►,.c� (name o?. corporat on) , ... having offices at Rt. 22, P.O:.:Box 377 - --- Brewster, N.Y..10509 Whcse officers are President Robert Fregosi 7Name and Address) _ Jerry Weissman Vice- President - -- - - — — — — ame an — — �- -- (gd Address Secretary. _ (Name and Addiess)— Treasurer f . - : -- _7 __ -- - -.- TName and Address) sand that I am and will be individually responsible any or.all acts, of the corporation with'respect_to the apgrov a ted'end sub - -to acts relating thereto. Sworn to bef re me this (Y day S' ed of A4 19" Title — Notary Fu dc • . kin R. V1W S. BARR Notary PubNie, State of New Ya[i Resirim ^• in Foekl-nd CutAta_6,, Comaii�,•r,u Exure 'Corporate Seal Ick 1\ kin R. V1W S. BARR Notary PubNie, State of New Ya[i Resirim ^• in Foekl-nd CutAta_6,, Comaii�,•r,u Exure 'Corporate Seal Ick PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Buckingham Development Corp. Located at Rt. 164, Patterson Section Man 15 Block 4 Lot J Gentlemen: This letter is to authorize / =Z a duly licensed professional engineer or registered architect (Indicate) 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. . Very t L Signed Counters i g n � P .E ., R.A ., # 4�) �7 (914) 279 -9400 A 2 Telephone Rt. 22, P.O. Box 377, Brewwter, N•Y• 10509 Address Address 0S-Z2 7 Telephone 50- 14Y.WJ.111, 4 G-PA.. MA; ND^, A TIC4 fX-A USE CROUP R2 85 NT AND TIC FA IY C-----L?15S A.11 FIMTY DESIGN i'Acis i".s ,­ . - �C i Z, -ps.� NL J- ,R ACTV' - -V--.1T DEAD L"D 1; PSC CR h,'-AL -LIGIT sm 75 Ps, (a) • 2c :sr 2411 25;-z psr,z-,sR—.Gs :0:21-: Ps;F O� C,? CItCLVAD . 40 PSF, 1f CN *'D AD PsF, 6o"T.— —opD DFID n51 R4 --I- L—. LGIC - 5C 1.9. !L- CnD D Ut AC PV iYE ir.AD--C PSr. T,z-, t CAD, 4C PS.F OR At7TUIL -9—T -Aw F --E LEr- S-K . P- A -ED CM Em, P L i1 EL -.aLEj,,7L A ZE A 'I" ti -T - 711. Ek.RY �Ik ".'AI �ICErl(;- A I'Ll KALF Ch—.. t J'.r�,LT— W—E. A V --a AMU :111,5 .-1 11C !ATifr A OR A• - 0• A -1 �. DOT EKE wCE coo • r—, "WAE RAND' N,oa AN OP UN- NS_- a) 12 IM P,.T:;1-. A,:11v n 1:1 . 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C— P.-Sr.;CODE 1: FAS-: Mt CODE VACS QS&F' RAI STATE PLVMh9hO CODE VACS CLECTF—L CDOE : C111f fl-r:APD LC7EWj) 60CA 678 VfCV.A%,CALCOOE RHODE ISLAND BiJILDING DOOM 1964 .:-�T -Sr bjET—C ( ax ic" CABO' 0 2 FAMILY DWELLING CODE t983 , N, t C— vi -1E wr 1.�c "r, i,> AND NUJ.Z`, t ":,E ji�y) "-WiK V TE (.—k.-Y t,.s A ., 11OiI " S,O.o , ,A .5..' ACT t5 i :p`!';2 3 -!� Z -11 A1172 1�-6�0 Mt,J] f-V:Lv I 11,11C-HID t,.,r I m �-X .0. . - _.: k C!•7,E OF 0V.,.S -5-7H F�,CA ,,O,jP A? F:R W -CT IcA J -Y E 4"Ct.tr,S 3ALL K 1L4 TO 14E LV- AL *0Y *1 S AS P! W -B A r �710 TO 2C AN.) U—SPU ri t. (.:It.FOL fi,rULAT—S A-t 70 —.M 50- 14Y.WJ.111, 4 G-PA.. MA; ND^, A TIC4 fX-A USE CROUP R2 85 NT AND TIC FA IY C-----L?15S A.11 FIMTY DESIGN i'Acis i".s ,­ . - �C i Z, -ps.� NL J- ,R ACTV' - -V--.1T DEAD L"D 1; PSC CR h,'-AL -LIGIT sm 75 Ps, (a) • 2c :sr 2411 25;-z psr,z-,sR—.Gs :0:21-: Ps;F O� C,? CItCLVAD . 40 PSF, 1f CN *'D AD PsF, 6o"T.— —opD DFID n51 R4 --I- L—. LGIC - 5C 1.9. !L- CnD D Ut AC PV iYE ir.AD--C PSr. T,z-, t CAD, 4C PS.F OR At7TUIL -9—T -Aw F --E LEr- S-K . P- A -ED CM Em, P L i1 EL -.aLEj,,7L A ZE A 'I" ti -T - 711. Ek.RY �Ik ".'AI �ICErl(;- A I'Ll KALF Ch—.. t J'.r�,LT— W—E. A V --a AMU :111,5 .-1 11C !ATifr A OR A• - 0• A -1 �. DOT EKE wCE coo • r—, "WAE RAND' N,oa AN OP UN- NS_- a) 12 IM P,.T:;1-. A,:11v n 1:1 . BE 7E i 9 X-DEP OR NDt!c� -`,UR -rw-6 LEVEL P. - i.666K Eff4ER OR REL."s !rNT -F TION (0,K A I K1.8 ARE THE. y LW :NE NE t.-- Xl %,A OF VAL'L ✓0 M 15; 11 D. K. C--- hL:1 AS,A •'i,8 -CON- A: 41 AN2 lk;—Gs L..., C751: �c AND L,11 41.s T,4E t-.S f +.1: :'f � tt.,-.fTE [Et O- 1- VLCN OR AIJ ,*LD ON ST-E 'OR OF IPZ 01 I 7t SCR 1 EIR A! L I. —Es .1 ."-. CS SW L .':,r -'S 1��j C1 "A',i, ARE 23t�00 E iL K P F. z ccep. I A�11 L 5-LL HE FAL,-T U:, 0 Fe. E. iL ST V, =:.iiy F, r L... • 6 AND RHODE UU40, PUTHAT-1 COUNTY DEPARTMENT OF IaALTR HOU.': PLANS APPROVED FOR —J, B 0014 COUNT ONLY; IS ig-ature -T Iate n & Oil- Ld E 7 ,A i O 44 cl 7 p IO I I<,:ICC O 1 [� Le. UW �rf vw&- Nr_L IO'O - I•i `''V I 0, O W7 CSIJ A I L___J a 1,LF11, of C. � . I 52a , I IT !` 'o it I i Oe i v4! - i TO i Olo I'-(. ' -1 O Fiat: I I L4) - Ppom 2 113,�Z po Ep"'i V In In _ 1 I I .91 i 1 I : 0 POYER.. 91 I LI�/IN RQp� 1 YCR{: STATE ^:;IS!r1 of �i _n l i I j�� 1 HJt1 1 !G AVD CC.•1..1JtJ11 r t2cC1E \'i4L THIS P .A AP7k0' Al IS A / ?L.f.titL,i O':! Y TO 1 i FAC fJ .., 4' I Al 5T %' It ("/4: wou r�'i., L `vim :..: cL£CTt�IL Pa1JE� -� + � '. �. - - I Z�• Z w/ wlft To, Ll �ul%f�ESi - JPPUED 3 = O CElu --c HEICTHT 2A tij- o1'�E. HEADE S OF" nl.L_ InITIp��OO�,S l• 5� c,Plp� SEJJ �.n %z>ow' 1 1 . . a) Zr (.0 E1rTE�lO� wa�> FO r, ©I 4DR1. 2= 1'12 5' /tom O O i • •' - - MI L_C.AI ZI 5 Imo_ !- _ µo7• TXI9 •rr +ovllL sXalL nor RELIEY[TNI [OR: D[YW `.— _.`.._ 11 �:._ :�. -•_. _ .. .. ..._ __ - '_ - - -.-_ _ .. SM.U>t EllTD- gORppEeTXt • - -" -- ro - - . _ ._r. ,.N isJtl 0.ES IOXSIRILfTL' 'rol i. EXCEL HOMES'""Zze� tJ - =T9� —- P.O. Box 69 DRAWN BY: A ' / <M Miffllnfown, PA 17059 REVISIONS: PLAN 140, 717 436 -8971 Lp PJM In f, P) fn-,P- 0 o m r o -n �r�F 1 c O I � d a o LP -4 CO 0 lo� 41 M r- , a) W 0 > Z'7 � <.p C UNIT ti 13.0' I �rfol LP 0 0 lXN ZOE IJ ...... .... ur pin 0 m cx CD �1� -�Ko to: ol ca E7 Lu 0. 91A 1 RECORD OF PHONE CONVERSATION Time: 8 . Date: .zx Z9 Person calling:.. rra w IC 5u /l f ra !? Phone #: Reason () Inspection: 0 eeps nd/otl gerc Scheduled Fialrl MaPt;nQ t Time Date Y N Tentative /to be confirmed Town: —74 Road /Street: Ceu y? ; j LW Tax Map #: 2 eV Comments: Dee,0os A00 off -�rd � Ic s 3 r� I nor' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner H o k RC l 0 Address AZZ-Ie l I�� Located at (Street) Tax Map Block Lot (indicate nearest cross street) &43. Lo Municipality �% ��QS Q �� Drainage Basin . C e pTpA/ SOIL PERCOLATION TEST DATA Date of Pre - soaking 90 - 05 ^ % Date of Percolation Test O 7-- l Hole No. Run No. Time Start - Stop Ela se Time i Iin.) Depth to Water rom Ground Surface (Inches) Start Stop Water Level Dro In Incles Percolation Rate Min/Inch 3 2 30'' 3 4 5 1 %Mi,,1.3 2 ®1 to: 31 19 l9 3q_ I 3 p; t I :d� 1 ) 9 31q 31 4 ti 5 1 2 3 ►. 4 E0 1 Y L 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to'be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 0/flqC /D 1�Ya z 1 U TEST PIT PROFILES Hole # Lot # Hole # a2 Lot # / Hole # Lot # Depth to water _ Depth to water -+ Depth to water or Depth to mottling Depth to mottling Depth to mottling / Depth to. rock/imp. Depth to rock/imp. Depth to rock/imp. . G.L. G.L. G.L. 0.5 0 l 0'.'5 0.5 1.0 1.0 r� 1.0. 2.01' 2.0 _ 2.0 Q Ln 3.0 3.0 3.0 4 4.0 r 4.0 4.0 �1 5.0 S` 1 5.0 5.0 6.0 P, e 6.0 1 ' 6.0 7.0 0 G 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.( Hole # Lot # Hole # Lot # Hol Depth to water Depth to water. Depth to water -. Depth to mottling Depth to mottling Depth to mottling Depth to rock/imp. Depth to rock/imp. Depth to rock/imp. a` G.L. G.L. G.L. 0.5 0.5 0.5 1-.0 1.0 1.0 2.0 2.0 2.0 3.0 3.0 3.0 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 SAM CpG a P Ci * * BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH Division of Environmental. Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 September 23, 1998 Frank Sullivan, P.E. 2972 Ferncrest Drive Yorktown Heights NY 10598 Re: Horacio Country Hill road, Lot #9 (T) Patterson Dear Mr. Sullivan: Soil testing has been scheduled on October 6, 1998 at 10 a.m. on the above regarded lot as noted below. Pre - soaking. Percolation tests. Deep test holes. A site map, showing the percolation and/or deep test hole locations, must be submitted to this office prior to the testing date. Please be advised that it is your responsibility, as the design engineer, to notify this Department if the project falls within the parameters of a New York City Department of Environmental Protection joint review as noted below: SSTS design greater than 1000 GPD. Within 500 feet of a reservoir, reservoir stem or control lake. Within 200 feet of a watercourse or Department of Environmental Control wetland. Drainage basin of West Branch or Boyd's Corner. Mel Kek, Senior. Engineering Aide will witness the test(s). If you have any question regarding this matter, please call me at (914) 278 -6130 ext. 166. V ly yours, obert Morris, P.E. RAW Public Health Engineer TRW-REDA ........ .1 ......... ........... I . _I SCALE IN 1110 OFAN INCH I I� N VAM PFO-14-1-6 - K 4- 14 1 Zia N ' aq 1 56 ¢ 0 4 14. AC. 1Ck* -j 4.65 RC ^14.5 55 )0.4; j u6 6: 57 DI 9.05 AC. CD U 534.04 48 10.47 AC. CAL. 43 so PAL soqoo. CptiMEl 52.33 AC. RIAL. 34.87 Ac. %all - 42 15.54 ;C. CAL. 4'1 4 44 2.t 7 44 A, ? A, 29 70,�;,CAL N 1)lA1.9 72 00 10.02 AC. C it ID 54 JL 17.10 AC, C Loz CC. set I 516.10 710 59 124.01 AC. CAL. S 4s 49 53 10.96 AC. 52.47 AC. CAL. 55.L Op 50 4.ej 16Q1.81 163 52 A I 46 C. 45 24 22 3.12 AC 12 a 19 ;C. 63.42 CAL. 1.86 AC 2.32 AC.o- z 6 . 20 32.33 AC. CAL. 12.32 AC. ROUTE "17 C. 12 a 19 ;C. 63.42 CAL. 1.86 AC O \ I 42.65 A 15. 1 194,05 YOW 69 36 '38.69 A.C. 10; ang 101 3.19 AC. 2.84 AC. loz i OD 2.i4 AC. 37 ab ts ., 2 r 90 L 6 2 V g 2B0 I 24? 345�3AC AC. AC I 1. a i 5 RECORD OF PHONE CONVERSATION Time: -1 ( 13� Date: AjT Person calling: - ,Phone #: Reason ( ) Inspection: lw ee nd/ eres: ' Scheduled Field Meeting Time: Date: Y N Tentative /to be confirmed () ( ) Town:D� Road /Street: Tax Map Comments: r�c;o U�^ �2 t2V d2;6 2 424-/n f� . 'f// 55 ast 3 I i. - , , 1 7\7 12563 5 3 "Jias --xa pn g' i CA 22 0 aviland ollo► 164 65 ai es Corners R-21 RD Nom, R 6 Putna Lake murn 66 teinbeck Corners Lake s fharL- 22 eFor s! Ique Area Mount Ebo qr r&' Corporate 62 HS *ES Brewster PUId FPM 2 SSSS s S eman S State Police ■ Old Southeast Church 311 s hers rem tA em Hu co ,Y con .yr.A.0 r. Loa Al Nk so h c �5 4 u�ti r' ,yg,x n_ �y i4 �� � � � ,�. 59 9 '1' �,♦ �0 3, i �' r�� ',�,° a � w�i f 1' v y r BB .e y •� �" 7� 7 .H'q � b, � iv, $.l. �N .M.•4 �' :n.'v"$ 'd- , IOC C41 ���'�, �.. IF low Pk�''Rti@ . :.� .•�} 9,.� b 4� e'