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HomeMy WebLinkAbout0744DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 24. -1 -21 BOX 8 00744 � 16 it irr 4116 Ndo 00744 I:r�epreleiit that l.arn wholly -and C6mPIateWr4S0Q abomrs, d"incrbo. dwill be .c onluW;Ied &$,ShOW",on th to6nty Diiarim ant of Halth.•Snj, that on`con Oa "MR . led to the DePik6sint.- and a written OK41 jn.qppdd operating condition any part of aria " 6C.11116 apP►Civill 01118 te"06tdll 61!'Cohl will be. 4 . loistoll As 0 -0,00i ih6,s6Prv;oi plin. and. that a. Id welf.mAll b County 04" 0.0"ith. , Deft sign 2A APPROVED FOR CONSTRUCTIOW. This apprO1181,034P.Ir"AWO Ye ca revocable for usi or . may be amended or modified when ionsidiii "lQuires a ew pornit/Approv ad f Of disPosl of domed kahl By_ 10/88 Date . for t he design . and location of th ' a ProposeW,syStimis); 1) :that the saparaWnwaige,di I 0�rod arnindrnSnt there to'arid In accordance with the standards. rules an o requ.istions or W-1190. ,if%wj;of a,- It or %ortificate 6f'C6njjructIon`Co lanca�-'sj Isfacti yio the Comfir0silonomir of Hesilthwill kio'Iiiip be iurnlsh" the owner., his,'sucoaasors. heirs mossigns by tho'b4i . kkor. that-isid bulkier will an during the PW& of,two Q) I Immediately following t data of It Inu- t t 0 at,: .2) st t he drilled iviall described I I "am t ng, :=nc. jtih-yt'� .1 rft rules and regulations .-of, the Putnam p.E.9L iA. License No date Issued unless� Construction of the building nghas been undertaken and I$ by the Commissioner of Health. Any change or alteration of construction 1pd/or iI a to' ater wPpl on Title '14 PUTNAM COUNff DSPARTMENT OF EMALTH , I ATROPCOMPUANCE' , 96" oocnorr POW FOR UWAM DION" URIM F 7 qgod A Hldedag a Q AD W V16801 Subd- Lai 1 :.. 2_4 IT -PLAZA :AEALT'l of Dab Pro* M� Aiwa ................... . Toem ZIP Date Subdivision AbDioved.' now ft Thle -7 Dw& liitw Do 14p Flow G P. Nodfleation Is Regahved Whole I!Mkwmp� ', Ssiana Sewisiv, im Sop* TO'* saA 60 $]Rim 110 edd, 16. ;6:, -- " T ". ! . , 11. � -�,- TS, Do dd�. � . . .. ­ - I I., . W"ve, S 8adic Sttppb Ptah Alice OO --Pdv I aft Sop* MEW by ;0 A 16 : C �h i r 1 9 Primp, i�mp 7A 'Ai/ 'Wk VvX AiAPh I:r�epreleiit that l.arn wholly -and C6mPIateWr4S0Q abomrs, d"incrbo. dwill be .c onluW;Ied &$,ShOW",on th to6nty Diiarim ant of Halth.•Snj, that on`con Oa "MR . led to the DePik6sint.- and a written OK41 jn.qppdd operating condition any part of aria " 6C.11116 apP►Civill 01118 te"06tdll 61!'Cohl will be. 4 . loistoll As 0 -0,00i ih6,s6Prv;oi plin. and. that a. Id welf.mAll b County 04" 0.0"ith. , Deft sign 2A APPROVED FOR CONSTRUCTIOW. This apprO1181,034P.Ir"AWO Ye ca revocable for usi or . may be amended or modified when ionsidiii "lQuires a ew pornit/Approv ad f Of disPosl of domed kahl By_ 10/88 Date . for t he design . and location of th ' a ProposeW,syStimis); 1) :that the saparaWnwaige,di I 0�rod arnindrnSnt there to'arid In accordance with the standards. rules an o requ.istions or W-1190. ,if%wj;of a,- It or %ortificate 6f'C6njjructIon`Co lanca�-'sj Isfacti yio the Comfir0silonomir of Hesilthwill kio'Iiiip be iurnlsh" the owner., his,'sucoaasors. heirs mossigns by tho'b4i . kkor. that-isid bulkier will an during the PW& of,two Q) I Immediately following t data of It Inu- t t 0 at,: .2) st t he drilled iviall described I I "am t ng, :=nc. jtih-yt'� .1 rft rules and regulations .-of, the Putnam p.E.9L iA. License No date Issued unless� Construction of the building nghas been undertaken and I$ by the Commissioner of Health. Any change or alteration of construction 1pd/or iI a to' ater wPpl on Title '14 ~PUT14W COUIM DMPAMINU ,OF REACTS \ \� DiN 1 HedIS Seevloea..CLtsai. N Y 1P61?' > a howme Pwtalt 1 ldi ` k a" C8t1IIRCATB OF QON MMM' a\ STSTE1[. iD0lISllQCIIOrI PlRSf1� 1�Ot SEWA� DfSi0a1L `•. 1 c� Tu �A Mip Hloek Lot . Eaotiwel_ C� lleylaleo' p OwtiMe /A t Noon Delie Pe ( Aaiistaa t9 X2,0 "l7TL Town : 4 Da P Subdivision '1pnroved Fee- Enclosed SeCdob.6 D,�? vao.e Nwbw 1 Hoifwna '' . DaISn Fbw G . P D �.�� PC® Noildtti6 t+ltegaleed When F ®)e eepkted . S a oa1111" etL _(.aPw so ptic Teat. f �' OCi ». .� a T� be ompliviead;bj 17 Atwha+oa w.aer Attheaa as ;/' RL(ff S DsiBsd bf 'T�:., lddee� i .; s ✓u aril r 1 represent that 1 am wholly and compNtely responsibN for the deign and location of -ine proposed syflem(s): 1) ,that ,the sep rat: sew disposal' em Coo above Department Of o1N�K�esnd that o ompNtion fhNeof aaCatfhcat tof Const►uctfo�Complianc satisfactor !o,t rpu ant o m 4 .. y to tM Commissioner of Health will be submitted to the Department and`;'a written..yilarakee will br- Yurnishap the owner, his s4eoa4w he1►i oi.aslijins by the buildN; thaY,fald b-- -- wlll Place in 'good Opwatine- 'condition iny:,0art Of,ztaid eavyao. disposal system' Burin - the parfod of two (2):yeN8 immediately following the date. of the isau- ance' of the'approYal,of the Certificate' of Construction, ComplMnce of the original,Sy tem or any irs t ato•3) that tM Wlllesl well described @bow 0 wNl M IocatW as ihown on t1e opprowd "'pl n and;that aid will will a instaiNO .in =a n 'with t a S, les and rpuSTOn . of tM .: Putnam County O.Wrtma ofJ��M "Kh Data. ��"L [� Sieved P.E. R.A. - Addrex License. APPROVED FOR CONSTRUCTION This approval expiref`two ear from the date ,sued unNSS coo ruction of the buiWinq .has been undertaken and is revoeaplet3w. useor- may.be,amended,or hodifiedwhencon nary tna C"Misslohe► f Health. Any change or alteration of construction reouires a W it. Approved for . dispopl of domestic t y x a4e /a private water wppy ony.. Rev. v. �. 10/8.8. oat. By Tit b // (3 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 Street Address Town/Village/City Tax Grid Number Sta e Coach Road T /Patterson 8 -1 -3 WELL OWNER Name Mailing Address ®Private Joseph F. Panzarino Box 352 Patterson NY 12563 0Public USE OF WELL 1 - primary 2- secondary O RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP O ABANDONED D BUSINESS O FARM p TEST /OBSERVATION O OTHER (specify 0 INDUSTRIAL b INSTITUTIONAL O STAND -BY D AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED /EST. OF DAILY USAGE gal REASON FOR DRILLING 13 REPLACE EXISTING SUPPLY ❑ TEST/ OBSERVATION M ADDITIONAL SUPPLY NEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING __ _Potable water supply for new residence 3/89 Yellow copy: WELL TYPE Ox DRILLED O DRIVEN []DUG 15 [3 GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES . x NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Stage Coach Properties Lot No. 5 WATER WELL CONTRACTOR: Name to be determined Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES x NO NAME .OF PUBLIC WATER SUPPLY: n/a TOWN /VIL /CITY DISTANCE TO PROPERTYv FROM NEAREST WATER MAIN: n / a LOCATION SKETCH & SOURCES OF CONTAMINATION PRO D COON SEPARATE SHEET 11/7/96 (date) PERMIT TO CONSTRUCT A WATER WELL re 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. 1 3. Submit a Well Completion Report on a form provided by the Putnam County Health Departmi During all well drilling operations, the applicant shall take appropriate action to assure t�'t any and all water or waste products from.such well drilling operations be contained on this,r property and in such a manner as not to degrade or 'otherwise aii- - ce or groundF Date of Issue: � Date of Expiration 19 C� Permit Issuing Official '! Permit is Non - Transferrable White copy: HD File Pink copy: Owner ?' 3/89 Yellow copy: Bldg. Insp. Orange copy: We]', 15 1 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 Street A ress ll.fJ own illage City Tax Gr d Number q- — WELL OWNER a Mailing Address 94 61m 1A W-A rivate D Public E OF WELL V- V- primary - secondary SIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP 0 BUSINESS O FARM 0 TEST /OBSERVATION 0 INDUSTRIAL O INSTITUTIONAL O STAND -BY 0 ABANDONED 0 OTHER (specify O AMOUNT OF USE YIELD SOUGHT � E*gpm /# S RE LACE EXISTING SUPPLY U EW SUP Y NEW ELLING PEOPLE SERVED_ /EST. OF DAILY USAGE. &66 .gal ❑ TEST/ OBSERVATION. Ll ADDITIONAL SUPPLY O DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING Now WELL TYPE DRILLED DRIVEN DUG GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES �0 ( IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name 17 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES LINO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH &',jROURCES OF CONTAMINATION PROVIDED S P RATE SHEET ate) (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 g operations be contained on this property and in such a manner as not to degrade or of erw se cont minate surface or groundwater. Date of Issue: 194- Date of Expiration In 1 19 1'q Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller Re.: Property o Located at (T)* - , . Block t; Lots_ Subdivision. of Z t!) 6z= Subdv. Lot # ___.Filed Map # Date Or. MICHAEL DALY, P.E. Gentlemen: CONSULTING ENGINES^ P. 0. BOX 243 This letter is to authorize SWO606916:9. low? a duly licensed prof ess.*onal engineer or t (Indicate to apply for a Constriiction Perm it for a separate sewage system, to serve the above noted property in accordance with the standards, rules or reguhAtions ae promulagated by the Commissioner of the Putnam County Department of Health, And to sign all necessary papers on my behalf in connection with ills matter and to supervise the construction of said system or systems. in conformity Vith the provisions of.Article 145 or 147, Education Law; thp.'Public Health Law, and the Putnam County Sani- tary Code. Countersi Very truly yours, Address 5.IMCHAEL DALY, P.T- CpNSULTING ENGINEER Alt &HRIOgOCC, N. T. 14587 Telephone ned OwnhjV of Pro rty // Address c �4l -�vs lt, �ls L._/7 9 Town Telephone if 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 Street Address oilNT�' WILL ROAD o Village City Pi4T7t N Tax Grid Number — l-- 2-4`/ WELL OWNER Name Mailing Address 67Z PLAZA &AL-Ty A%Private O Public 6 1 SE OF WELL - primary 2- secondary *0 RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY 0 AIR /COND /HEAT PUMP 0 ABANDONED 0 FARM 0 TEST /OBSERVATION 0 OTHER (specify, U INSTITUTIONAL 0 STAND -BY O AMOUNT OF USE YIELD SOUGHT 5 gpm /# 0 REPLACE EXISTING SUPPLY 13 NEW SUPPLY NEW DWELLING PEOPLE SERVED U /EST. OF DAILY USAGE Q. gal 0 TEST /OBSERVATION 13-ADDITIONAL SUPPLY © DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING 005 E WELL TYPE DRILLED O DRIVEN E]DUG GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES '-A NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: (PIf)NTl f L.L. Pr,'rATt= S Lot No. ?y WATER WELL CONTRACTOR: Name T bo 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: CH 6 SOURCES OF CONTAMINATION PROVIDED , ®ON SEPARATE SHEET ,. sienature 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 any and all water or waste products from such well property and in such a manner as not to degrade or Date of shall take appropriate action to assure that drilling operations be contained on this otherwise to urface or groundwater. Issue • - 1-1"i 19 Date of Expiration Permit is Non - Transferrable 3/89 19�,� Permit Issuing Official White copy: HD File Pink copy: Owner Yellow copy: Bldg. Insp. Orange copy: Well Driller TING ' 9149625837 P.02 a PUTNAM COURTY DEPARTMENT Dk• .i:UIt;ALTH DIyiSZON OF ENVIRONMENTAL HEAL',11,1 SERVICES _q, D , at a Re; Propertr, .. - - -- Located at. Lot j Subdivision of Subdv. Lot # 3 Filed Map # Date Gentlemen: CONSUi<'�E;'d�: ��NGfNE�R This letter is to au.•t1wr:i-ve a duly licensed prof essiona i engineer ✓ Ur• (Indicate) to apply for a .Constructs or-, Portwl.t for a ycpax,c :O -e� sewage system, i,Q serve the above noted property J.n accordcanco ;art tli. the standards, i••lllo -i or regulations as prowulago Lod by thc: Conti of, thr, Putnam Coiint-y. Department of Health, and tc., sign all. necetiz,,t:t %y papers on cu)� behe If i.ti connection with this lint -ter and to stipervise ••..Ate construction of 8a i.rl system or systems in conformity w:i tb of Articic2 :1.'.l rya: 147, Educative. Law, the Publ tc Hna.lth, Law, F o �#1 Che Putnam County 8w ­L;.-- •- < tary Code. Very truly ;l;., . •rs , Signed' !f Count e r s i gne �:. 0 Y :.t - f ro{�terty �� '�, � �l.x° e:� s� --- ..__.......__. � J� Address CON_ ULTING k ENGINEE� Ta��. S P, 0. BOX Z43 SHEN q l~� 'OLD{ Teleplione - re;. (' phone - - - - -_ mi =yak= IV comb a. W sommOuted by ow of .: PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT. TO: Commissioner of Health In the matter of application for: represent that ,I am an officer or employee of the corporation and am authorized to act for (Name of Corporation) having offices at c/o 106, �� 1 tens'/ Whose officers are: V. v (Name',Anff Ad ress) P.,,. JJ Vic-e =Pr e-s-i-d"e n t : (Name and Address) Secretary: ' "'(Name and Address) Treasurer: (Name and Address) Taiwan a 't + =;:. and-,will be individually responsible for any and all acts of the City of TMRritlon Kith respect to the approval requested and all subsequent acts relating A- terican4 . 4te in ) es: - Sworn to efore me 'this'? 28th day Signed: of APr 19 93 Title: 7]7 by u T - � — ���,.�r.✓C C.-vvf ' ' Nota y -rub 'c C. -_rhen Do Duarl pecial NotarYANS : Corporate Seal 8/84 O Ik Aul Jot a.nd Ouwy= 474 Aoelw Nine, R-2).2 kakwa.4, Aeat *&4 10536 1) - -d --tivl � AS a Le-u n 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 #P80--9G IS WELL SITE SUBJECT TO FLOODING? YES --g0 IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: C utii Lot No. WATER WELL CONTRACTOR: Name �,'�j , 1� 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 _bySOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET �eljv/x2".o '54,zo 1-�, __,I) �In &-L- gardf-_e (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 -y (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 Department attached to this permit. 3. Submit a Well Completion Report on a form requirements of the Putnam County Health provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: 19" Date of Expiration 9 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller Street ddress To Village City Tax Grid Number WELL LOCATION �lll. AP a1 Z 4 -1 -zi Ai Name I Mailing Address C&Pflvate WELL OWNER e5r -� ?b ,i�a�c o� — O Public USE OF WELL 34dSIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED ®- primary 0 BUSINESS O FARM (:]TEST/OBSERVATION O OTHER (specify 2- secondary 0 INDUSTRIAL O INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVEDD /EST . OF DAILY USAGE 6pC0 gal E3 REPLACE EXISTING SUPPLY O TEST/ OBSERVATION GLADDITIONAL SUPPLY REASON FOR DRILLING SEW UPPLY (NEW DWELLING O DEEPEN EXISTING WELL DETAILED G REASON FOR DRILLING WELL TYPE RILLED DRIVEN ODUG OGRAVEL 0OTHER IS WELL SITE SUBJECT TO FLOODING? YES --g0 IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: C utii Lot No. WATER WELL CONTRACTOR: Name �,'�j , 1� 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 _bySOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET �eljv/x2".o '54,zo 1-�, __,I) �In &-L- gardf-_e (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 -y (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 Department attached to this permit. 3. Submit a Well Completion Report on a form requirements of the Putnam County Health provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: 19" Date of Expiration 9 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 HEALTH ,t I DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of 52- 5 Art iTY Located at CoVfflz -f V- 0Jar17 (T) Flk�l eA&5 v NI Section V Block I Lot Z I Subdivision of �l�h' V�Aw e15'W-r915 Subdv. Lot # ✓ Filed Map # Date MICHAEL DALY, P1. Gentlemen: CONSULTING ENGINEER P. 0. BOX 243 This letter is to authorize SHENOROCK, N•Y• 10587 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 YOT1 , �G. Signed ' i y' 0 e of Troperty , , �- i t w�E Countersigne P.E. R.A. # 4M6 b Address I MICHAEL DALY..P_1'_ S,..... I)t Address CON -0.111 Tlwr ENOWNEE Town R P. 0. BOX 243 SRENOROCL N. X_ 10587 9i 2. - c) Telephone Telephone whit!b t Dike spy +Fta� A pa..../br Dt1ai b _Ave 04? ; CU27 `p21 f raprossnt that 1 am wholly aM tonlpm" rofpon!, for the "Ina . ,tocitia -above do wiaO, will ta eoinorudiw as shown on the* PING, iimndmant tlNra, to Cwntr Ooattllwnt or IMplllti am that en, eanpNtbn;tM►io/ si .��Co►tNnta; : o M MNIRtM te?tM' ONNt!!IMK. and i w►Nton) wraetoo will M fuW41 d'th ' M a1oN MMatM 'otibrMUn. my pvt_ Of. low, solve ,eN000i sy dI "a of tM aNr�wl Of cartitkme of conftrudlo� CowlpWlca=..or•tM « will M looatad N.Miarw ew'tM`at>MwM.N0!f ano that. nW win wail be 6$u" O _ In county oqwt111aat Of Msaltfl. ac: AfM11pVQp fro ll'CONfTPUtT10 41 TMt apM,owl ex twe nireaNN for w M amanMO or ""Willi Millari.con Y. b! in W►aa •' nave mat. ' foi ilywl,_M dofnolt sni y r }Q,ss Y11 r 1 rr :'P17.�OVIZ�'Lo1N :�A+�k AVp/V6 gt,,42N{ Isad' Sys tam(fi ill that the Y /aU dl .. YI ftNll . noa.wlth tM standitds, rbli$ a rope ciro iam w mulfadiir eo t6e comml«IOnp of mealthrwu. C' M S. hobsor'aigns by the OulwK. tm stid,bulwar win : f I`of twe (!) Yews hit fonowkl/ the at* of t" kssl- t ~ft" l;sny repairs i ! tft&t, like WON wall mote �h tM tta IM.' n0 felu oiwi M ' the putMm J.E. V 8.-f6 8 - as eonstlYttbri ;Af tM. h1llldhq has bow Yndwiskon and Is IonM '0/ MMltfl Any ehai� O( alit n� of ,ee,Mtrudi" apt Asupbb ��y `l�,{� ' TitM . J, OLD '�M 15 L °T DDtA!llD�fr Ol,�i1i.'ls - �I • Db1iMs• dbnlwliwhl BMW 8aniea�: �1dal.'I/ Y.1�6U - /i Niwl/r[�w«It / • 0! 00MUAIwri 1 1 lOI� M UWAM DEFOUL : I!®[ r�1 / P So ;. .. Doti aI has 'A AUG 198► - �i�a� jai... �1N� '((��- � 1'�i� P-- ►� Z Ye... K�•1'Cd�AF� -: � �: i o 53(v bate :'Subdivision } Fee Enclosed 0 Amnnnt ,' 'Sum s �� TI w Al;. Z• 3t97, ,g(� � ab 35 w�..a3�5 c�Y,. , P moo G D lh�ar �t �aie�a - . Daaipl Flow - ! ®Pi�atll� b Seq�i� Wrw Se.,M.D,- is swim t dji 0' � � � JW '' AAitra whit!b t Dike spy +Fta� A pa..../br Dt1ai b _Ave 04? ; CU27 `p21 f raprossnt that 1 am wholly aM tonlpm" rofpon!, for the "Ina . ,tocitia -above do wiaO, will ta eoinorudiw as shown on the* PING, iimndmant tlNra, to Cwntr Ooattllwnt or IMplllti am that en, eanpNtbn;tM►io/ si .��Co►tNnta; : o M MNIRtM te?tM' ONNt!!IMK. and i w►Nton) wraetoo will M fuW41 d'th ' M a1oN MMatM 'otibrMUn. my pvt_ Of. low, solve ,eN000i sy dI "a of tM aNr�wl Of cartitkme of conftrudlo� CowlpWlca=..or•tM « will M looatad N.Miarw ew'tM`at>MwM.N0!f ano that. nW win wail be 6$u" O _ In county oqwt111aat Of Msaltfl. ac: AfM11pVQp fro ll'CONfTPUtT10 41 TMt apM,owl ex twe nireaNN for w M amanMO or ""Willi Millari.con Y. b! in W►aa •' nave mat. ' foi ilywl,_M dofnolt sni y r }Q,ss Y11 r 1 rr :'P17.�OVIZ�'Lo1N :�A+�k AVp/V6 gt,,42N{ Isad' Sys tam(fi ill that the Y /aU dl .. YI ftNll . noa.wlth tM standitds, rbli$ a rope ciro iam w mulfadiir eo t6e comml«IOnp of mealthrwu. C' M S. hobsor'aigns by the OulwK. tm stid,bulwar win : f I`of twe (!) Yews hit fonowkl/ the at* of t" kssl- t ~ft" l;sny repairs i ! tft&t, like WON wall mote �h tM tta IM.' n0 felu oiwi M ' the putMm J.E. V 8.-f6 8 - as eonstlYttbri ;Af tM. h1llldhq has bow Yndwiskon and Is IonM '0/ MMltfl Any ehai� O( alit n� of ,ee,Mtrudi" apt Asupbb ��y `l�,{� ' TitM . 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 # 'P(90-AG WELL LOCATION ',-Street Add ss -Name To rS Village City Tax G id Number Z WELL OWNER ailing #5dress rivate 0 Public USE OF WELL Q- primary 2- secondary SIDENTIAL 0 BUSINESS 0 INDUSTRIAL D PUBL C SUPPLY Q AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION b INSTITUTIONAL O STAND -BY 0 ABANDONED 0 OTHER (specify 0 AMOUNT OF USE YIELD SOUGHT 6- gpm /# 0 REPLACE EXISTING SUPPLY 0-6W 4UPPLY (NEW DWELLING PEOPLE SERVED /EST. OF DAILY USAGE(p al 13 TEST/ OBSERVATION LI.ADDITIONAL SUPPLY ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN ®DUG O GRAVEL. OTHER IS WELL SITE SUBJECT TO FLOODING? YES L,,-'NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: U Lot No. v WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES __ZN0 NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER'MAIN: LOCATION SKETCH URCES OF CONTAMINATION PROVIDED N SEPARATE SHEET (date) signatur 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 dri n operations be contained on this property and in such a man r as not to degrade or of er i contam to surface or groundwater. Date of Issue: � 19 Date of Expiration 19 Pe it 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 HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Located at L--OV Q 11-1_ ..gym out ► 5._ Y - ► (T) ir1Z�Di.� �i Z+ Block Lot 21 Subdivision of Subdv. Lot # _�3 Filed Map # Date T. MICHAEL DALY, P.E. Gentlemen: CONSULTING ENGINEER This letter is to authorize P•0• BOX 243 a duly licensed professional engineer or registered architect (Indica e 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'tconformity with the provisions of Artic1e "145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, Signed Countersigne Owneddif PropertSj P.E., R . A . , # � 1 ham. ' .� (J✓ I�� ��-- Adddress T. MICHAEL DALY. P.E. � ``✓ / )j Address CONSULTING ENGINEER Town P. 0. BOX 243 16 a SHENOROCK, N. Y. 10587 Telephone Telephone Cl /e/ 2 F 0,9�-7 . I 0 POW en It said-bulklar will i 4ki 00 the Imm• discrim above tile, Pitnim s; construction of t4 bUildingtos-been uindertalcOn and is io n P a .. r , of Heart . h Any change or aliwation of construction mor supply only. Title 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 #.k ,WELL LOCATION Street Ad � ress Qjm Village City Tax Grid Number ._ t� ' .. J e ) LL 1t ©N' % C'RTC ��0 [5 —�.-6- WELL.OWNER Name Mailing Address . /A - G.Ptivate a '7 I� Z A �1A1 O Public 'USE OF WELL 1 - primary 2 - secondary (�}'T�ESIDENTIAL ❑PUBLIC SUPPLY O BUSINESS. O FARM 0 INDUSTRIAL C3INSTITUTIONAL QAIR /COND /HEAT PUMP ABANDONED O TEST /OBSERVATION O OTHER (specify O STAND -BY O AMOUNT . OF USE YIELD SOUGHT .5"_ gpm /# PEOPLE SERVED b /EST. OF DAILY USAGE (y0 gal REASON FOR DRILLING [KEW SUPPLY 'O PROVIDE ADDITIONAL SUPPLY ❑ TEST OBSERVATION OREPLACE ISTING SUPPLY ODEEPEN EXISTING WELL DETAILED REASON' FOR DRILLING rf� 5c.: WELL TYPE 06RILLED DRIVEN DUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES 1-� NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: ��_y j U � �i l C. L�"+�IA`I 5 Lot No. —j WATER WELL CONTRACTOR: Name >1�,� 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 KET H & SOURCES OF CONTAMINATION PROVIDED ON REAR.OF THIS APPLICATION N SE 'Z � G (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. Date of Issue: / 19 Date of Expiration: 19 hermit Issuing Official White copy: H. D. File Permit is Non - Transferrable Yellow o0 Buildin Tn for 2/87 PY• Pink Copy: g � Owner Well Driller A PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date ��lil /a 9 Re: Property of �� I LQ � j< i , -L-T—" Located at (TY Iz- ni'� Section. Block 4(- Lot Subdivision of 11` Subdv. Lot # ,�j Filed Map # /lvZ Date, -,) -2�G T. MICHAEL DALY, P.E. Gentlemen: CONSULTING ENGINEER P. 0. BOX 243 This letter is to authorize SHENO"IOCK, N. Y. 10587 a duly licensed professional engineer %( or registered architect (Indicaate 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, �'Signed Countersign P.E. , R.A. , # - 7� Address Town er of r perzy T. MICHAI:i DAL: , E, Address CONSULTING ENGINEER P. 0. n N . Telephone Pa. - d �- — �6 Telephone �Teaee%� PUTNAM COUN'T'Y DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY &.SUBSURFACE SSPM DISPOSAL SYSTEMS AA-'X (Name of Owner) COMMENTS REVIEW SHEET - CONSTRUCTION PERMIT (Street YES I NO DA BY: Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log TE REVIEWED: Consistent Perc Results (3) 30" Perc Hole Other 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 Sipe li.c_Tank. - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existin =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 Shown & Detailed House - No. of Bedroans Wells & 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 (inc. expan) 15' to Drains- Curtain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fran 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 6 "DEEP TRENGy_ GRADE AND BURY BOTTOM 1 -- __Ll11D TAMP IN PL.AGE. � TAM I PLACE. 2' - SFGTION THRU� -FILL PAP � E NTS SILT FENCE T�)ETAIL _ N.T.S. N t , -2mF / LINE 11 � P .. i/8.. W 1 1250 _ N 14e, 0 1 SEPT LLJ w a bI' Q d > D -BOX• INL SET ON GONG. FT'G 3' -6" MIN 3.5' O.B FI L �A/V ALAPr DEPTH - ALL OUTLET5 SET i LEVEL IN, d COUNTRY HILL ROAD / ;^ i - PROPER (T -PIC �: r 2ND FL. - E - PROPER (T -PIC �: r 2ND FL. PDTNAM CODNTY DEPARTMENT OF HEALTH Division, of F�vhoomental Hedth Servloee Csemei N Y.1051? , . CERTIFICATE to Pw vide P4011 *0 �'... oa OF COMPLIANCE IICTION PERMII FOR SEWAGE DISPOSAL SYSTEM Permit . M' Ro . ,�(o, a V I o6Ad at Ulage . Snbdlvlslon Natn 1 abd -Lot N � Tu �Lot Ron• Owner /Applk ant Nome / Date of Prevbne• Approv MaWng Addreer .. DII' > � 7_" / Town � r .11 . � . � 7�p' : . � 0509 °c_ �S) 1•T� cam) ' . e 27 x'2191 BaudlnS Type Lot Area Q Only, Depth - volume ow G P ,D PM Notiffe"on Is Repaired When FM le completed . Number of Bedtroome Design S Separate Sewersge System to coorlst of )) �G611on Septle Tanls an Tfi ;be canstructed by ' Addteee i Wait" SaPpl) He Supply Fiom Addreae —� f oi. Private Supply DrWed by' , . Other Regalrementer' o B S I QT �RI(J�1�J' `f�ltolt°ImP i�i'7 er Lo1N.. �fK .hula VrS ALr�P/% I represent "that;t'.am wholly antl' completely responsible f.r tfie design and location of 'the 1 proposed systom(s) 1) that the separate sewage disposal system above described will be constructed as shown on ttie;approved, amendment the►e'.:to and 'in'accordante with tAe stindartls rules in regu a ions o e u rn I 'County Department'ot'. HeHth;`and 6l i on completion thereof a..- Certificate of Construct on. satisfacto►y to :the Comrnissioner of ,Health will i 'be submitted to the'Depa►tment and _a wnttee guarantee :will De turn�shetl the owner, his•successors„het►s or assgns Dy, the DuiWer, that said builder will place: in good operating_ condition any part :of ,said +sewage disposal systgTFduriny .the period of two "(2) years im lately followirp'thedate of tM issu- ance,'of the approval •of, the Certificate of Constiucbon.•Compliance of the oriy�nil system or .any repairs thereto 1 hat the drilled well deser ibed•abova will Ae located as shown,on the a_ppioved plan and that saitl well will be Installed ',in accordance with the andardf; I and repu a ons. , of the ;Putnam { County Department oft.1.4"It ..r. ,Date.. , Sipneda - _✓ Aotl►sss SuL�MDD�k �U�' �A License No 8 APPROVED FOR CONSTRUCTION Thls approval expirestwo years from!he.'`date,issuetl unless construction:bfahe building has been undertaken and is re'ouble'for, cause o.r rr4y be anientled o''r mod ifiid'when,consitleretl necessary'by the Commissioner of. Health. Any change of alteration of construction ►eouiros a new: pe mit.,, Approvi for disposal of, domestic san�taiy'se3v�ge• a r, wste'w6ter supply only.' Rev. , . Date' BY -1/87 0 Mauing Aaareee Town"'1.(ti zip BUnding Type m_-Lot Area G Fill Sectlon 0 n1Y DepthcL• Nnmber.of Bedrootne,` Design Flow :G /P /D t7 PCHD NotlBcatlon is Requlred;Wben Fill is completed Separate Sewerage System to consist of -2-62 Gauon Septlo Tank and l°(° 7 7� ►t �Gt� To be' oonsttacted by ,• i' _ Address ! Water Snppl3; PARe'SaPPIY:From Address '. or: • • ✓Private Supply Dellled by To 3 r 17 _Address' .�Yi sl:rsu 6'� ^.f /:reyT �'D. w ".'. i'o 'Q �.:wO V.I ti�. T�r../�"�T1. n. /i�� \r �.]t��. /i[1 �•1 wi7W 1 represent that I am wholly and completely responsible for the design and location of the proposed systenl(s);; 1) that the sepal ate. sewage . disposal system above - ;described will be constructed asshown on the approved amendment there to and in accordance with the standards, rules and regulations of e Putnam . County Department of .- Health, and that on completion.if4reof,a 'Certificate of Construction'Compliance" satisfactory to, the Commissioner of Healthwill be 'submitted to the Department,., and a written, guarantee. will be furnished the, owner, his successors, heirs or,asstgns by the builder, that said builder will place 'in good operating'condition•,dny ,part. of .said sewage disposal''system during the period'of two (2) year s;lmmedlately following thedate of the issu- ance of the approval: of the `Certificate of "Construction Compliance of the original system, or any repairs thereto; hat he drilled well described above will be. located as'shown on the approved plan and that said well will be installed in accordan with t standa , r regu a ions f the Putnam County Department of- Health. Date Signed P:E. !E • R,A: Address ° t tense No � APPROVED FOR C+NSTRUCTICIN This approval expires one year from e d issued ass construciI n of the building has been undertaken and Is revocable for :cau or mb b amended or Todi}ied when considered nec y.. the 'CO issi0 of of . Any - change orA al ation of construction requires a new ermit: ved for disposal of domestic sandary,' and /or', r s o Date v BY Title /_ Division Of Environmental H%aj�h Services TWO COUNTY CENTER — CARMEL, N.Y.. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:C�,�,�, � T; LOT NO.: 3 WATER WELL CONTRACTOR: Name j t'3 7 Address: IS,PUBLIC WATER SUPPLY AVAILABLE TO SITE: _ YES ✓ NO NAME OF PUBLIC -WATER SUPPLY: TOWTN /V /C DISTANCE TO PROPERTY FROM NEAREST WATER.MAIN . LOCATION SKETCH & SOURCES OF CONTAMINATION, — (date) (s,ignature) 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 epartmen , Date of Issue: 1 ' i P �ffit Iss ing Offi •ial Permit is Non - Transferrable STREEi AGGRESS. 10MVILLA /C1iT IAX GRW NUM6EA. YELL LOCATION Go�►a .� «�,�� P�,;,,� -�,y —��,� ` _ _ NA&iE. • ADDRESS: 2`08IVATC WELL OWNER � % ZZ x O PUBLIC USE OF WELL &rRESIDENTIAL ❑ PUBLIC SUPPLY O AIR /CONO. /HEAT PUMP ❑ ABANDONED 1 -.. primary ❑ BUSINESS ❑ _FARM O TEST /OBSERVATION ❑ OTHER (specify) 2 ; secondary O JNOUSTRIAL O INSTITUTIONAL ❑ STAND -BY O .MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED 8 / EST. OF DAILY USAGE •Co00 gal. REASON FOR LiKNEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION DRILLING O REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DRILLED DRIVEN DUG GRAVEL F_� OTHER WELL TYPE IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:C�,�,�, � T; LOT NO.: 3 WATER WELL CONTRACTOR: Name j t'3 7 Address: IS,PUBLIC WATER SUPPLY AVAILABLE TO SITE: _ YES ✓ NO NAME OF PUBLIC -WATER SUPPLY: TOWTN /V /C DISTANCE TO PROPERTY FROM NEAREST WATER.MAIN . LOCATION SKETCH & SOURCES OF CONTAMINATION, — (date) (s,ignature) 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 epartmen , Date of Issue: 1 ' i P �ffit Iss ing Offi •ial Permit is Non - Transferrable PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Da to �v Re: Property of Buckingham Development Corp. Located at Rt. 164, Patterson Section Map 15 Block 4 Lot _43 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 Jaw, and the Putnam County Sani- tary Very truly yo , Signed 0 Countersign ` ll�aell, P.E ., R.A ., #CJ f7 ;3o A 2-1� Address Oc 0,20 Telephone Owner of/Property Rt. 22, P.O. Box 377, Brewwter; N.Y. 10509 Address (914) 279 -9400 Telephone Putnam County Department of Health Division of Environmental Sanitation AFFIDAVIT - CORPORATE C14NI:R APPLICATION FOR PERMIT APPLICATION ..SUBMITTED TO PUTN-01 COUNTY HEALTH DEPARTMENT TO: Commissioner of Health - In the matter'of application for construction xe_rm.Lt IRr_ separate sewage system- -— Weissman, V. Pres. represent — ---- — --- — — — — — — — - :_ that r am" an officer or employee of the cor'poration*and am authorlz*ed' to act for F — — o7n)— 7 (name 07.corporatll having offices at Rt. 22, P.O..Box 377' - -- — - -- — — — — — — — — — — Brewster, R.Y. 10509 Whose -offic'er's are -President Robert Fr�eg2.s:L 74-are lin-9 KdUr7e_sT)_ 7 Jerry Weissman Vice- President -- — — — — — — (game and 7A_dd_re_GST Secretary. . . . . . . . . . — — — — — (rani� Wn_d Xd_dr7e_s7)_ — Treasurer 7ranre and 1d3z:e_s7)_ •.and that I am and will be individually responsible any or a l acts of the corporation with respect ,to the approv s.ed a 1.1' sub- Bequint acts relating thereto. Sworn to before me this day S* e of 191 Title., Notary -Publiq%j Notari Plab4c, State of Netw TeA 7, 4� 'Corporate Seal u 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:5 j -�► l.•OP -P Addre s s'j" T- Located at (Street \� -Block 4 Lot E-3 n ica e neares cross street) Municipality. Watershed, SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS o e Number CLOCK TIME -K PERCOLATIONi;Z;Le, PERCOLATION Run apse -Depth to Water Water Level-... No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min./in drop Inches Inches Inches f 2-, 0 �C7 - -- -1 7 - - -- \ 1 ZL1, 1 3 y t7 rB((4 5 CD 0 2 0_ � �.._,. �. �O ZO ZI , ..._... ... ._� Z 30- 4 5 1 2 3 5 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 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" I 24" 1 301 36•• ' 42 "�n1^ 48" 54" I. 60" 66.. 7211 78'► . INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED ' INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED 42 —�� TESTS MADE BY Date `t 8 L DESIGN Soil Rate Used °L l - 30MirVl ".Drop: S.D. Usable Area Provid No. of Bedrooms 4- Septic Tank Capacity 1 Z hrz) Gals. P) ZqMoa,,,c Absorption Area Primed By�_L.F.x24 ;/� d r 0 Name To - rn ���� �.�,�.� ?�� , igna ure Address Z SEAL ��o .0 10 S'A-7 gore THIS SPACE FOR USE BY HEALTH DEPARVEM ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date CODE t.ssc f�..V.Elwa CODE F�SIC UFCKAWCAL COW H.Ir..L cifclp�4-cuoc .A1 If.% AL "AwrARD PL Ll,,SING LCIZE Evil C.' ,VICvT FAST EJLC-%G C,.,E (CT) If— V111f. FIRE I-SE"CIS CM AND N, , :A , SATE L'.%ftgy CONS (.l,LE. U,S WE A-3 1 .1 ,..A 1`11EIR.CTIrN 1�24!1; #*,?,%T 0 FA I% :�5ZPW.QCO WX!6114 ACT A% SE Aun- *xI ut"I. rA.:Ly A:-?[H:­,L TO 60-b(-CA J: +bl I C;"-: N C','-E Ef PICA "t-UP fi.I? P,!MCT S �C.. 1,�Tl l—ILY LSTLI.NaS WAL L K EC!W. lEt, 1.0 THE , JrAL GJV'IS AS XP�,-:.VAt: wM-NTS FXL= LT ED ZC"G &X3 U—Cf-Ei C-L C­:�OL k,GuE:.T1.1S ­E W_,�P�,EO70 1.11 Be -NY.WJ'Ri' ',CA USE GROW R2 AND R3 AMD.TWO FAMILY I•' LMOS 1.1-TI FANJLI� I VELI Jl33 DESIGN [-'ASIS ACTWL �_I.T NON SILEEPIK'A.EAS- LIVE M- r-0 PSF 01-AD LOAD-. ic PSF OR C 1,,.L 10G T NO I lv�ARD Sm, m 25 PST (S) 20 PSF A- S E_ RD VP IFT W,IJF • 2011.25)-25PSF.PVERKA.Gs-25(2)-50 PSI, TOP �HZ)RO LWE LOAD - 40 PSF, I CP cllcJRo V-.o LOAD _7 7 PSF, BOTIEW CHORD DEAD LC�-10 PSF C_ LIVE LOAD•30 PSF, TOP C.�O MAD L WAD- 7 PS(;9 TTCM CHORD DEAD LbAL, 10 PSF -A [TFEFtS LIVE L LOAD-. PSF.DEAD LOAD•�O SF OR - ACTUAL �, GMT MODELS A 7 77 MASS. C, A : V1 LD IN* dOW r W-5. U,,L. ORU bI&TIC-PLUM1111,111 CODE UArS CLECTFrAL Coot bOCA 570 ItECHAN,CkCODE RHODE ISLAND SEAL IN tWOODE 1904 �CA00.102 FAMILY OWCLLING CODE 1995 PL rAff CoUjq f DELFART_ �, -LLW OF MaT3 IT�-TER`o =;f LEVEL H�,UE.,PLA�E.D � f -.I NOUSE PLAITS APPROVED FOR x .. .. ...... ... 1�. F, E A F ✓ 1.101- F MR0014 COUNT 01-ILY; 14. 1 ". I D NA' I -ARE- y- E,� W!, _OS 0F � CoW':, 6!041. b- -PT OUVI..- t!SE,UF­,,'1S& * c, > n Y• ,.WjUT IN � , 11.1171.. ULxl op Fm A 1`0.w MODUA S E LEVVL 40W_ P_ c _ KO E (T�_ CEE~_ SPACE OR FLAA. �ENLNT F C—�T oA s AS .A. N;B-Colo� J.- .PACI�R' K/!L �,S 0S. !14 A 15 TO A Ok— 'h,L (",.Amw L :Fa ?,-:;A.' I.V IN, ik—NGS L �t C.ft- 0.,.E •1 C. V_ARK 1K F...' R I.E. :e 11-� I LT OR pt:. C ,EZ -X I. ,*I,- 11ONDM&E SNGLELEV(71-NONE -< RACED ON A R u W ]HE W ­�f ICA� ED I OR LIKi'S:011- A' AtL .cs, Av^_ ...7c:s si. SENENT I`WrAlr3N — A ��Tka ENTRY WWI MOMC '-MM C•_R­-G u, " i..•. TIE F" ".a ARE '.25 -6 a: T Signature Title '11. a TWD �­EL N-� ?ACED 69 A HALF NOOJ J <C.W.'HAE# CR&dL FVA­TK)•1 ATH A lsPLn -AER SERVINIiM UT•ER Lk:VLL AND E,ASi3"FNt S KATAIIE EITHER A 4*-G' OR 4'- LE�TXM DIFTERIENCL L '--I. L IO.FF. sm. jv b"&- . . . ; IT. AN OPTEIIY 111 Ati"_,ts. E­h Ir ­AE FOR s-:D It Id iT­_. w07l NAT BE' —5. AND eMODE ISLAND. TE FIN:SHEWIST &JUNA Z, - 4 Ld x .. .. ...... ... 14. 1 ". I D NA' I -ARE- y- E,� W!, _OS 0F � CoW':, 6!041. b- -PT OUVI..- t!SE,UF­,,'1S& * c, > n Y• ,.WjUT IN � , 11.1171.. ULxl op Fm o AS .A. N;B-Colo� J.- .PACI�R' K/!L �,S 0S. !14 A 15 TO A Ok— 'h,L (",.Amw i7, :Fa ?,-:;A.' I.V IN, ik—NGS L �t C.ft- 0.,.E •1 C. V_ARK 1K F...' R I.E. :e 11-� I LT OR pt:. C ,EZ -X I. ,*I,- W ]HE ­�f ICA� ED I OR LIKi'S:011- A' AtL .cs, Av^_ ...7c:s si. TIE F" ".a ARE '.25 -6 a: --A! L K FF. --.CRP. L '--I. L IO.FF. sm. jv b"&- Ati"_,ts. E­h Ir ­AE FOR —5. AND eMODE ISLAND. 4 Ld I +A TI - ECTI*I* TIP; SLCr ["j. TAP OE ALS C. V_ARK I +A TI - ECTI*I* TIP; SLCr ["j. TAP OE ALS 13�g - z'O 2co I I - - Q►.1 -i0 - - - I� O• MIGE.(.7 O O �4' •SP�iCI- - . -. in UT 1'. �1 Z'i; 7pFFiT I 1 Iii Ce.A.I uCINT'� I 1 I 1- {.: IITCI-IEN L_ elo0 j ; �_e. 1 ' -N 0 z Co zrli rO ��� 1Y2 -. �: •i 1 I I -� I 10 Pa'Er..�ti1 I = '� f.: I 2i � - I �. i CL co - I I r. i I *o aoT•TO...� I '—"LE waLi V .--. 1'/<F - - °";Y�" I To •�2+nL� �TC.e,) �l,[�_ j LIV IN� {iQ1�M ! YCRY, STATE ^IVISMN OF 1 HOU 1G A,VO CO- '4.•1UNJ1Y RENEWAL THIS P IS mAPPHO AL IS AJPI- CA.ILc OfilY TO TKOS; 1: STA'!_' Al ..E Ci -..! r4A' -l.F Ai:TJ.� S MIN f IF FO •tl ' + /C•i. "-•' c.:: l I. INtNT Z�' /i - = -5' /ti D, . n.. A. EL ELrv)lr_ p[auEl_ �0 12 2 Ip 1 0D 7 A:-:? IN C�.IJII�IJPP LI �Tj _ -. 25 _ r-s^ THIS APPROVAL 3N41t MOT RCLIEYF THE 1 �•�- " - -�"" - " "-'�' •���• ^�� � -� I - - _ :fl l4Ji ,��3�Orti191llTT ,fOR�0EV4T•., .- ,V01 �. ;;+ ... _ -... -- v - -_ . "... -L �_. u.O.OIM[IFiB'IfOR•DOCS FORE.,- _ .r M- n- _ - 4 rEr- `n.N -IiOJ "RE310N31RIL(iY FOR ;_-- 1•� a =O CEIUNCi HEICIHT - - • EXCEL HOMESINC _ Y c As LE P.O. BOIL BS DRAWN BY: . MY }Iintown, PA 17059 REVISIONS+ PLAN NO' x 717 436 -8971 , I fo 0 o c 0 01 I - (-P .. I io C. Is - I I n __ IF F E-9 CD , 110, d. 1 I J0 m CD ----- ----- ► �l� �Ko�o 4 I io C. Is - I I n __ IF F E-9 CD , 110, d. 1 I J0 m CD ► �l� �Ko�o 4 17 ld/z Sg Z 0. 01 --pw N * -Z (01 rk O BRUCE R.` FOLEY LORETTA MOLINARI R.N., M.S.N. ,4 --late Public Health Director ?_okc Health..Dtrecror - C �� - W Director oj.Patient Services = DEPARTMENT OF HEALTH I Geneva . Road - Brewster, New York 10509 REQUEST FQR FIELD TESTING ATTEN 10X: 0 ADAM STIEBELI;itiG XQENF,.REED' .-UI information below must be jolly completed prior to any scheduling. DATE: ENGINEER OR FIRM: 14,1­1�' �G r, � / �� PHONE #: X75' tad 3 REASON: ROrLD /STREET:- TOWN: SUBDIVIS.ION:'. DEEPS: PERCS: j PU11IP TEST: o EcYS'G�+� �U •� r ` TAX LOT #: c It is the responsibility of the design professional to provide the above information prior to soil testing. .This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered= to any of the questions, NYCDEP must witness the soil testing. This Department wvill coordinate a' mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP, If a project has been determined o' 'be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP, FOR COUNTY USE ONLY DATE: Z2= V AV f 30 TIME: % :,2 /� � � I- -C% : 00 COM I F,:NTS: _ TELDTEST) tN DEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING YES 1N0 0 Proposed SSTS-within the drainage basin of West Branch or B.oyds Corner Reservoirs. - -0 Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. 0 Proposed SSTS -w-li 'hlin 200 feet of a watercourse 'br a DEC wetland. o Propas.ed SSTS design flow greater than 1000 gallons /day -or SPDES Permit required. 0 )k Proposed SSTS for a Commerical Project. It is the responsibility of the design professional to provide the above information prior to soil testing. .This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered= to any of the questions, NYCDEP must witness the soil testing. This Department wvill coordinate a' mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP, If a project has been determined o' 'be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP, FOR COUNTY USE ONLY DATE: Z2= V AV f 30 TIME: % :,2 /� � � I- -C% : 00 COM I F,:NTS: _ TELDTEST) -*- Z-" AIL. qo 12563 T. d Pond 164- sines Corners oteinbeck Corners a cc 22 and )w Lake I Charles -77-7," Mount Ebo Corporate GeRfer 54 16.76AC. 59 124.01 AC. CAL. 9 AL \ 43 CpaME� cEN 53 J' g6 40 10.52AC• '� s 1 55 ' 4t• 4.65 AC. .' I1.00AC. s �, r 49 32.47 AC. CAL. 1gy'65 4)E62 « l 52.33 I 1 d 104 = 57 9.63AC, 10.96 AC. y5.4 9.05 AC. y ;4.04 1054•p2 * 48 10.471 AC. 1 CAL.J I x' 34.87 AC. CAL. SCj AL 500/ ` 54 16.76AC. 59 124.01 AC. CAL. 9 AL \ 43 CpaME� cEN 53 J' I ' AC. L�L. 49 32.47 AC. CAL. 9� l 52.33 I 1 10.96 AC. y5.4 9Q 9 yy6 47 ° r I x' 34.87 AC. CAL. `•�� 5 _ s'1 ' �Y Ill.el Ifis 60 _ \ 50 52 / 14,87 AC. �9 r 13 a a•`I ;c 015 •.� ass 9 ROUTE Rt z� 13 it 1 ,17y9 a LO '� •,r 1.51 ac , ��` 422 5\ 45 23.40 AC. M1�9 • y .12 e74u eti 3 a •moo ��, 4150° 10 T • ° : /21 J ` I •• J 47 m 44 A9• 2.OAC• `� 1.9 AC. 232 AC a , 63.42 AC. CAL. I I • 47165 •r� '2 c a�. , e °tip° LB6 AC. c 42.65 AC. CAL. 20 I 22 A� i y �AL . , CAL. _ ,-128 sj 3233 AC. AL. 12.32 AC. 8 fir,,9 . /•'`. 29.70 p,,CAL.\ f J 242.76 b10� 6 '3O • _. ..n.._.. . `.._. 9 _\ .. _. �'m s� _ � � . _... _... pC• G� - 105 '� • 6 \A 400 n� 31 .Loo 4C g.oln 9 �° s � •a Ifiq�19 , 6 94 PC• e� � 1v 5 �1�• EC1R1 le 11.66 Al 32 \ '�'. EL 195.52 s 33 4' � � • u�� 4 .\ STATE 1]]1.52 t EI 2s b ' s,. s% � Irs• 12.00 _ t35 ° 9 \ 2252.54 � � � .eb torw9w .•wu �' � 109.e6. /� NEW � � � � Y 211,4263 � •i �- I I� z9 65a• - 4se 3.34 AC. 194.05 89 / 38.69 AC. I r 103 / • \ 81JO MANS \1 \� s< ' \ \ \\ PNNQ ` ; XI. s Y 10� 3.19 AC. / 2.54 AC. n 24. 1 ` � ,102 A 2.44 AC. ,n.9 N 59 ro �a 97 96 95 85 126 127 1.0 1.36 AC, AC. AC. 1.42 0 B4 � a r 37 WI a ygi li . y34.533 AC. AAC A •2.1' AIN ' 0 I �� Ia4•• n40 no � 906 AO; I 8 ;165e I 83 e2 �4 AC. 3 AC. 1 rC ' 39 • �v I „ el .• p �•� •s I 1 79''0 9.t9 P/0 p 0 35-3-29 BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road " Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Date: %.2 Ze l® To: t S / D o` Lot �s Fag #: -77-3 d No. Pages (Including cover sheet) From: Gene D. Reed Putnam County Department of Health For your information For your review As discussed Please respond Attached as requested Please call Notes/Messages Z-v 7— 7— A &,e E 15 T . J; 0e--9 In the event of transmission /reception difficulties, please contact this office at (845) 278 -6130 ext. 2261. SENDING CONFIRMATION DATE DEC -8 -2004 WED 10:33 NAME PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 919147730343 PAGES : 4/4 . START TIME : DEC -08 10:31 ELAPSED TIME : 01'35" > MODE : ECM' RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED ! 4 ISRt%CB R FOLb'Y LORb7TA MOI.MAR1 R.N., W.N. Ar0110 H dth llbruw A—A* P4111 mwhh DbRaw Dbrccar of Paderr arr.iw i { DEPARTMENT OF HEAum I Geneva Road 9rewstcr, New York 10509 r.wravr.w ndro (MS)2n.6uo Faa(1e5)271 -7911 Nurel ltMm (M5)271.6551 P'IC (115)271 -d671 to(MS)r71-6W Early tnh ^eaoeq(N5)2n.6ot4 Fwcled MS)27140n ru(145)279.6606 I M FAX COVER SH F VV I' Date: is To: +__.6 e y r.. w: -7-7 -3-03 V-3 Z' .4n. Pages T '(Including cover sheet) From: GAaa DLJj1p11 I Putnam County Department of Ilealth Fnr your information. °! Please rc+pond For your review _ Attached as requested As discussed __ Plense call Nota fflessagn �CnZG -S IEEE F�� Q Aj for_ S 7- . In flit mat of transmission /reception difficulties. pleise contact this office at (845) 278 -6130 ext. 2261. 'PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project F/4772 En04 County ?(ETA/. -i/ Site Location e--o j Lj1 &y 7� `Building construction begun NO Extent Is property within NYC Watershed ? ................. �s No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. El 'Hilly .0 Rolling F7 Steep slope 0 Gentle slope 0 Flat 2. F1 Evidence of wetlands F Low area subject to flooding Bodies of water Drainage ditches F-� Rock outcrops 3. Property lines or corners evident .................. .............:................. ..... a lies a No 4.' Do water courses exist on or adjoin the property? ............................ 0 Yes F--] No 5. Will these affect the design of the sewage system facilities ?.....:...... F7 Yes 0 No . 6. Do watershed regulations apply in this development? ....................... Yes No 7 Will extensive grading be necessary? ................. ............................... 0 Yes 0 No 8. Will extensive fill be necessary for SSTS? .................... a Yes No 9. Do filled areas exist within the SSTS area? .... :.................................. Yes a No F-� If yes, what is the condition of the fill? — SECTION C. SOIL OBSERVATIONS a 10. Appearance of soil: 0 Sand F� Gravel F� Loam a Clay F-� Hardpan F, -1 Mixture 11. Observed from: F7 Borings F7 Bank cut F--J Backhoe excavations 12. Soil borings/excavations observed by on 13. Depth to groundwater on 14. Depth to mottling on 15. Are test holes representative of primary & reserve areas ...... ............................... 0 Yes F--J No 16'. Soil percolation tests made by on 17. Soil percolation tests witnessed by on SECTION D (on back) IJ Form ST -1 2 SECT-ION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas?� Yes � No 9. Will groundwater or surface drainage require special consideration? ...................... No --]Yes F� F 20. Will gullies, ditches, etc., be filled and watercourses be relocated? ................... ..... .. F7Yes F--] No SECTION E. REMARKS*. .2 1. If a common water supply.is proposed, has an inspection been made of the existing or proposed source and facilities? ................................................................. F--J Ye's F--]No Inspection data 22. Do adjacent wells and/or sewage systems exist? ..................................................... Yes 'F--]:N(?- 23. Additional comments 24. - Site observer/inspector and title 25. Date(s)-ofpbservation(s)inspection(s)- 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. µ 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 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM 4 Owner /�5 % 2 /L,G, Address Located at (Street) Tax Map Block Lot (indicate nearest cross street) Municipality Ar7*, zs on/ Watershed ��¢5 i (��i¢ j� GI-� SOIL PERCOLATION TEST DATA Date of Pre - soaking �2 0 /o S Date of Percolation Test GZa / Ze S- 1 2 3 4: 5 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 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.01' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. I HOLE NO. JT 7 fY r S -- �c ✓I HOLE NO. 3 .2 V ivied, 1i,- lsr� lit ft ko Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered /S, ,f� " j Deep hole observations made by: ( Date Design Professional Name: Address: Signature: Design Professional's Seal PUTNAM COUNTY, DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address Located at (Street) Tax Map Block Lot (indicate nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA z Date of Pre - soaking Date of Percolation Test 1 - 2 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s l min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to t submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 3 4 1 4 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 l min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to t submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 DEPTH G.L. 0.5' 1.0' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 80' .8.5' 9.0' - 9.5'. . 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. 5' HOLE NO. -5- B -7 Av wt To 00 m o / -_ v ,1 • AI K e Z...' V4 Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Date �-► o� Design Professional Name: Address: HOLE NO. Signature: Design Professional's Seal 2 s� Signature: Design Professional's Seal 2 MAY -31- 2005 01 . -49 PI.1 HARRY W NICHOLS 914 279 4567 P.01 BRUCE R. FOLEY LORBTTA MOLMAR! R.N., M,S.N. Pf�tic Htolrh Dirccroi -- �� Atsoeiale Public Health Director _ Dlrteior oj.Pat(�nl Servieri ' DEPARTMENT OF 1EAL EK . I Geneva.Road _ Brewstcr, New York 10509 �rtivtn ✓3 l� S-b.++� "' ATTENTION Q AD01 STIEBELU:CG iYl:, REED � — "j� "CU � v`sc� " ✓��` AJI information belovr must be jd,,y completed prior to aw, scheduling. DATE: ' `— cemct�� ENGIiNEPR.OR FIMI: _ l laY t �u h ! PHONE AI: _... REASON:.. - -- DEEPS, PERCS: FLmp TEST:.© ROrI..0 /STRtEf _ cU k f1`04-1 I - TOWN: G' �11,� i. rAX "1- SUBDIVTSfON; S LOT #: OWNER:- ti ' jL','RfT . A FOR JQINT RE}r(,EW AND WITtNES51 T ST_N f Y-ES NO'. ..prop�sed SSTS-within-the drainage-basin oi' West-Branch or-B,oyds'Corner Reservoirs. ❑ Proposed SSTS within $00 feet of a reservoir, reservoir stem or control Iake. �d. d Proposed SSTS yvi't?rih 200 feet of a tivptercourse "or a DEC wetland. a Proposed SSTS design flow greater than 1000 gallons/day-or SPDES Permit required. p p4. Proposed SSTS for a Commerlcal Project. It is it is resp'dnsihillty ortiie design p-roGsion4l to provide the above information prior to soil testing. Phis 'Department- will determine the IYYC'DEP .project status (Joint or Delegated) based on the response. !f you answered kei to any of the questions, NYCDIP must witness the soil testing: This Department svill coordinate ti mutually suitable time for- field testing with the -PCDOH, the Design Professional and NYCDEP, _• If a project has been. determined fo'be Delegated based on the above response and then subsequent information indicates .NYCDEP kregWred, to witness the sail testing, it will be the sole resp.Q.nsibili,ty of :he design professional to schedule re- witnessing of the soil testing with NYCD -tP, FOR 00Uir'rY USE ONLY DAT E: �— D O TELDTEST) J - O -BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 FAX COVER SHEET Date: ' Za To: 10 X/ I DIZ4�0.9 ®mda- a Fag #: 7 7 3 From: Gene -D. Reed Putnam County Department of Health J For your information For your review As discussed Notes/Messages No. Pages z (Including cover sheet) Please respond and p _ Attached as requested Please call cd5 t—j'%A C:,) 0 Z Zo �e ®® -e- ev S e9 m 11-z In the event of transmission /reception difficulties, please contact this office at (845)r278-6130 ext. 2261. A V A SENDING CONFIRMB DATE : JUL -21 -2005 THU 12:44 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 919147730343 PAGES : 2/2 START TIME : JUL -21 12:43 ELAPSED TIME : 00'45" MODE : ECM RESULTS OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... i B%UCE 0. FOLEY LORETTA MOLD ARI &N, M.B.N. PoDdc tlad1h OMdar ApsAw Pottle RoM DGedar i • Dkww cV Pahl SE"l= DEPARTMENT OF HEALTH I 1 Geneva Road BtewsM, New YQ* 10509 . Z",4 rjw Baca (us)rn =suo F.04ns7e••wii ryWFg tnrlm (F1n 27t .673e wtC MS)27t -M7a Fw(04s)271.60s r ue lau—em (els)27r.be14 FwYd ({17)27aeett P.(MS)rn-6m PAXC9Y�H�i I Date. To:. p /51it/ �E/t 9!24 da a Fa> N:. �..' 3 -03 ','3 No. Pas" 2 I, (Todedrlt cover sheet) From: one D .ed Putnam County ]Department of ReaM For your Information "Pk. reepood For your review __ Attached am requested _ As discussed Plefre can Notes/M sa;os ( mvt I vy % a-Z� In the event of transmission/reeeptbn difficulties, please contact this office at (945) 27841.30 ext 2261. MAY -31 -2005 01:49 PM HARRY W NICHOLS= 914 279 4567 P.01 BRUCE R FOLEY * LORETTA MOLINARI R.N., M.S.N. tfolic Heoirl:... ©incror - 'f'� Apoclale Publle Health Director ti.. . Director of, Client servicri DEPARTiviENT OF HEALTH I Geneva . Road _ Brewster, New York 10509 �� ry,ytp ✓s 54 .K - REQUESI FQR FIELD TESUNG, ATTEINTION v ADAM STIEBEI.WG ENE REED � — "3j 0 :1l information belovr must be CuNCt.�� �111X completed prior to ais;r scheduling. DATE: ErNGINEFR,OR FIPW: IVY G►u h: �! . PHONE #: aL 7' °:tC6 3 �,.. REASON; . DEEPS: PERCS: PC,JM? TEST: 13 TOWN: G' �!. TAX "#, �- SUBDIVISfpLI; C,uti , J� �� 5 _ -- LOT #: j p �'RIT�RIt� FOR 10� ItE)aEW An WITNES i(JESTIN r YES NO C Proposed SM -within -the drainage basin of West Branch or B.oyds Corner Reservoirs.. a '1 Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake, ). 0 Proposed SSTS within 200 feet of a w6tercourse `or a DEC wetland. Proposed SSTS design flow greater than 1000 gallons/day-or SPIMS Permit required. Proposed 5STS for a Commerical Project. IE is .the respd'nsiliility ortlie. design p- rofessional to provide the above information prior to soil testing. This *'Department will determine thi MO?EP .project status (Joint or Delegated) based on the response. If you answeredX_G to any of the questions, fYYCDEP must witness the soil testing. This Department will coordinate a' mutually suittible time for field testing with the P001j, the Design Frvfe5sional and NYCDEP, If tect has -been. determined o''be Delegated based on the above response and then subsequent a pro information indicates .NYCDEP is.required,to witness the soil testing, it will be the sole responsibility of­he'desigrn professional to schedule re- witnessing of fhe soil testing with IYYCDEIP. _ FOR C' 67Y USE 6NL`x , DATE: ME: .MLDTEST� 12563 22 6 a nes 91D 7W 164- Corners. YT �ffmwulk lAnd ow N 168 P, I I I ids Isaa xi cpG \" 70 \ •) 15.05 AC. CAL i ,� '�' '\ C\ !, 55 l ` ; II.00AC. e � fpm •`-� Mize. 54 58 16.76AC. \ AL 4� 5! 97662 w° �rJ 202 kG '' _ .\ �•. I 2 104 i .. % JL 8 Npoo •' `' C I 9.05 AC. 4a►aa B2 ' \116.10 / .� \ . `fit ylaAa 1o9+• \ 48 r 5 9 ( \ \ X cI ' y1 • : t / 410 124.01 AC. CAL. ` A a \Y �` . A 10.471A sl CAL. � � � • SCN S�DOL DISTRICT 1 CENTPp� � �f \ 43 CpRMEI 53 . \ � AC..l:'AL. 49 32.47 AC. CAL. .per , I 1 52.33 10.96 AS 2 qp l �6q 47 �, l 34.87 AC. CAL 286.3 6 a 60 � II 50 16 e�,T2J •� 52`x• // /i i e�199 A1914\ u� 14.87 AC. I di S �, 9�ss ROUTE 13. 13. 90y3! 46 I lt6,15 o aai `so 57 •qt�i' � 3'�r r 1.57 ac i .a 4° �A �q X64 ,fir N 1 uay° a Lv- +i'a `19 , 10 s r I6 ° b• ° ' •o'�a �L5 422 161 a` 45g� 24 , /17 ae e e . 2 .. '1 13.9 tlAC. 1pt4 n / AG 8L t w 3.12 2 40 AC. `c^ °•+' � o g 1y,,0 Is o � 1 19179 44 41 . - � II X• , � 9m , 2.OAC 232 At 4 ,a 19 ! v a 63.42 AC. CAL. cl 473 2 / l "1" � / . � °tip °' '� � 1.86 AG � 42.65 AC. CAL. i 1.09 . 0 26 20 I 2x2 At CAL. 6\ a i , 6t y 28 s j AC. AL 12.32 A2. 8 B2l�9 0, 2a216 29.70 --CAL.\ �10P GFL,. 1 fi\4 1p5 L 700 °8 a1 y� ?��� �e `��> 94PC \el�. 5 A9 AC. a �Z11.B0 \ a 11.66 ELECrF�� 199.92 si.a' s 34aa o �yo °� m � 4 a•p ` STATE 5 ' sf. B19� 12.00 O i - CoMM°M LAM° NEB _ _ � _ _ �Q�� I I 6l4a9 <!B 3.34 AC. _ I I I 19a.os � 6 / 38..A9 A.C. I � I It 103 \ 36 \ _ J \ � \ \ \ \\ 'Y 01 POND Y 234 Ac. 24. 102 m 2.44 AC. aa.a I 00 85 u 97 96 95 yy ° sa S 926 127 1.0 1.36 4a 1I 216.05 2 AC, AC. At, A1.42 G 84 37 y34.533 AC. \' ,, gn 9s GAC 1.23 Zj1.9i `. I O6 AD I . j > '� e j I �° aeo•• > 91 93 , ° 0 AC. .3 !16.68 .? a 82 a ' AC. Y� 39� ,s�^' 'e i �e4w 81 eaaa `A 79e'O 66 PIO IO 35 3 29 - ae `e BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Date: 6 /3 /06 ,..6 _ G_ From: Gene D. Reed Putnam County Department of Health For your information For your review As discussed Notes/Messages S Fax #: -773-03!V-3 No. Pages 7 (Including cover sheet) Please respond Attached as requested Please call a-/ ep !i 30. Z:�Ixn k5 In the event of transmission /reception difficulties, please contact this office at (845)'278 -6130 ext. 2261. SENDING CONFIRMATION DATE JUN -3 -2005 FRI 11:27 NAME PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 919147730343 PAGES : 4/4 START TIME : JUN -03 11:25 ELAPSED TIME : 01'36" MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... BRUCE R FOL6Y � T.OR1'77A MOLINARI RN., M.S.N. Pn6hc. Hmfrh Dtrec7w A—.I.. P.M. Hrahh D&.— Di—,., 4f P ikw &"*- DEPARTMENT OF HEALTH I Oenevn R —d 9raw'ter, New Ynrl: 10509 & -t—rltl nen119 (845)279 -r,uo ru(UP274-7921 N;,WM 9—kn (945)279.6556 all: llgy)9;0.. 6679 F'.(R45)278.6MS .. - La ln—d9 (845)279.6014 irexEnnl 195)5) :7A.1OA2 Fu(M5j211.6649 kAS_GQVER MUM ,... .. .. To: –Dnyt A7yt9�ok !luch)dlne cover sheet) from: Grua.) —Reed—_ -- Putnam County Department of Health For your information Please respond .._.._. For your review .hunched as requested .__.. -_ As discussed Please call Notes/Messages T 9� �Q -�V 6/2 @ �r 3 O Li the event of transmission/reception dilircultiex. please contact this office M (945) 279-6130 e)R, 2261. Sheet of PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLH SERVICES FIELD ACTIVITY REPORT rRIJ z31 I acknowledge receipt of this report: SIGNATURE: 02/96 Title: _Rcv y AUG -11 -2005 10:30 AM HARRY W NICHOLS ,BRUCE IL FOLEY Public Hicith,.Dlr «tor 914 279 4567 d -(::),7 �01 0 LORETTA MOLINAM RN., M.S.N. Associate -Publlo Health Dlrecror bireeter of. p'.4110 servlees DEPARTMENT OF HEALTH I Geneva' Road Brewster, New York 10109 HEQ1IFS.1 FOR FrELD TF=2JG ATTENTION: a ADAM STIEBELING *ENE REED All inlorrhation below must be 104 completed prior to any schedaling. DA'V'E: E�,'GINEER OR ZRZtiI; r PHONE #: DEEPS: o PERt:S: PUMP TEST: ❑ p /J p u ROAD /STREET: TOWN-* TAX "M: SUBDIVISION: LOT #: OWNER -CIL -�� t�IJ a , MycipEP CR1TERi I FOR JQINT Hl''4 EW AM W 19MING OE SPIL 'FSTING YES NO ❑ ;1, Proposed SSTS-within the drainage basin of West Branch or Boyds Corner Reservoirs. 0 01L PrQposed 6STS within 500 feet of it reservoir, reservoir stem or control lake. ❑ Proposed'SSTS within 200 feet of a watercourse or a DEC wetland.' o A Proposed S'STS design flow greater than 1000 gallons /day -or "DES Permit required. o Q_( Proposed SSTs for A Commerical Project.. - It is the responsibility or the design proGsional to provide the abort Information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. if you answeredya to any of the questions, NYCDEP must witness the soil testing. This Department will coordinate a mutually suitable time for field testing lath the PCDOH, the Design Professional and MYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, It will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. tg� roP. couwry usz Om.Y DATE; �j iO� TIME. CONIME\TS: _ (FIELD EST) BRUCE R: FOLEY Public Health Director Date: DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 W '5 7 t� �_! f✓ovivT2x,�fi GG �s77 Gm7— T From: Gene D. Reed Putnam County Department of Health For Y our information For your review As discussed Fax #: -7.7 3 —0 3 V-3 No. Pages '2 (Including cover sheet) Please respond Attached as requested Please call Notes/Messages eS-1– b e tg, - Co�T?,Y �iGG iz� G� f 3 ®® ` %A k!5 l In the event of transmission /reception difficulties, please contact this office at (845y278-6130 ext. 2261. SENDING CONFIRMATION DATE AUG -29 -2005 MON 13:09 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 919147730343 PAGES 2/2 START TIME = AUG -29 13:08 ELAPSED TIME 00'42" MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... BRUCE K 170LEY L0153tTA MOUNAN R.N., M.S.N. Z liM Hea11h nk.,. w A/1Ma6• Pablfc Heahh Dhrctw Dbeclw of Palaaf 5"c" DEPARTMENT OF HEALTH 1 Geneva Road _ _ _ 9rcwnter, New Ymk W09 emlramm�wHePiral115lrn -6UO fa 0+5)179 -1ri1 - .� NnW.Q 9m5m (11511': -6S3A MKI &6)211.66711 Fa (NS)179 -6dY FArtY fixenePllau 1143)271 •b0N rneAtal (91/J 179fdtd ra (N61771 -66,P • M�sX OVTA VHF.tT Date: _ - -- . To:L,E 6A [7A1F 0I i _ _- Fax M�. 7 •"0.7iSL3 . _ T& ' uN7'e --.Y k/ LL No. Pages ... Z — fleeludiaR cover sheet) Prom: trem JL_Rsid -- Putnam county Departeaenl of Health zFor your infarmation ✓lease respond ... Far your review _ Attached as requested As discussed - Please can Ccw- a —r Y_GlirG4_ 4o-2t-3. - -- — QAJ In the event of transmission /reception difficaltles. please contact this office at (945)'278 -6130 ad. 2261. SENDING CONFIRMATION DATE AUG -18 -2005 THU 11:18 NAME PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 919147730343 PAGES : 2/2 START TIME AUG -18 11:17 ELAPSED TIME 00'42" MODE ECM RESULTS OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... • BRUCE R F01.8Y LORMA MOL1NARt R N., M.S.N. PuM¢ H.afM A'nr AnadM PMlk 7idd Dk"M r Din— V Pw&w Svlw s DEPARTMENT OF HEALTH 1 Owns Road B7evslcr, NOW Y_air 10309 Ewl...nbl Walk %43)271 -61)0 FtrptS)271.7921 nanlnl atnl- (115)271.65SR WW (1[3) 271 -6171 Ft.(145)271.6015 14ity hkrvtutlw (R1)1279-6011 h•ttaae (M512714012 Pn11451271.6611 In the event of trnnsmirston /reception dirtice ties, please co•taet this Office at (613) 278 -6130 mt: 1261. ' 71 � C �vr7'ty ki ee �aY `(1.wAadlag emer'lheet) ' From: Putnam county County Department of Hnith Rol your informolion L"Y"se.re"mod __— For your reviml _ Att•e►ed as requested — As discussed — .. Pkase tall Notes/Messages 5 _. 0 In the event of trnnsmirston /reception dirtice ties, please co•taet this Office at (613) 278 -6130 mt: 1261. ' y l ° IN eoll ry 1.1 I 4 ' r • r 'J .7. r