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Home My WebLink About0782DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 24. -1 -91 BOX 9 1 ru 116 �; L%, I oil ■ , 00782 i PUTNAM-COUNTY DEPARTMENT OF HEALTH- DIVISION OF ENVIRONMENTAL HEALTH SERVICES PCHD TE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PERMIT # P - I A Located at 42ol'Z.-I'NO Town or Village EA:Ue12SOAI Owner /Applicant Name 12 OSS ALA` Tax Map Block I_ Lot 1 Formerly Subdivision Name 01& _(�O Subd. Lot # 8 Mailing Address 25 IM M /!�IV/ G W Date Construction Permit Issued by PCHD 2 -) - o &x 5�Z Separate Sewerage System built by fx2grACg Address p> STIF-12 �( Consisting of 1250 Gallon Septic Tank and 500 Other Requirements: Water Supply: Public Supply From Address *20^KIElz- IAA P or: Private Supply Drilled by Vgg22 Address �( G Building Type V2 yg& t erAj I A), Has erosion control been completed? �( S Number of Bedrooms Has garbage grinder been installed? 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 regulatig4s of the Putnam County *pagmAt of Health. Date: 2 - 12.q% Certified by "L, - U P.E. of R.A. (De on Professional) Address "i LL 12,OaKEMEIM fl; MIFIA is License # 5 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions 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 revocatio , m dification or change is ixecessary. By: `� /% Title: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 0 '07 c 0 j/ U.7 WrIlaij I .%Jvrlr IJZ.L LVLI r Vl%.L DEPARTMENT 0F'HEALTH . Division, Of Eriviro'nm6ntal, liealrfi�',,S#rvices PUTNAM COUNTY DEPARfMENT, OF HEALTH- Off i,ce Use Only 002 _7 1 , 7 7 WELL LbCATION' STREET AOURESS: �TOWNIVILPGLICIFY TAX GAID NUM9R. fie\. WELL OWNER NAME AODAESS: T�k), 1VATE 91BLIC., ,-US OF WELL primary 2 - seciondary., (R'fESIDENTIAL 0 BUSINESS, ❑ INDUSTRIAL 0 PUBLIC SUPPLY Q AIR /COND. /HEAT PUMP 0 -ABANDONED. 0 FARM 0. TEST /OBSERVATION',; 0:.OTHER,(Specify) 0 INSTITUTIONAL 0 STAND-BY 0 AMOUNT OF USE YIELD SOUGHT, prp./NO. PEOPLE SERVED EST. OF DAILY 9 USAGE gal. REASON FOR DRILLING 11PEPLACE EXISTING SUPPLY [1TESt/OBS*ERVATI0N_ VADDITIONA. . L SUPPLY "'MINEW, SUPPLY (NEW DWELLING)', DEEPEN EXISTING WELL. .DEPTH DATA WE LL DEPTH STATIC WATER LEVEL ft. DATE MEASURED 14, DRILLING EQUIPMENT . 0 ROTARY 0 WELL. POINT Ga"C,0M.PRE.SSED AIR PERCUSSION Q DUG 0 CABLE PERCUSSION 1j.OTHER'-.(sp6c1fy) WELL TYPE 0 SCREENED 0 OPEN END CASING 0 OPEN HOLE IN: BEDR b'OTHER, CASING TOTAL LENGTH MATERIALS -M"STEEL .0'-P§TIC 0 OTHER. LENGTH BELOW GRADE ft. JOINTS-. OVELDED 21HREADED 0 OTHER DETAILS DIAMETER in . SEAL: 0 EMENT G'R'OUT: 0 BENTONITE 0 QTHER- WEIGHT PER FOOT —.1b./ft. _117 DRIVE SHOE E.ZlES 0 NO UNER:0 YES ONO , SCREEN DIAMETER (in) ZLOT SIZE LENGTH (11) DEPTH TO SCREEN fft) - DEVELOPED? -DETAILS FIRST dts 000 SECONg GRAVEL PACK GRAVEL SIZE. DIAMETER qF"PACX In.. Too DEPTH JL: BOTTOM PTH DEPTH It. WELL YIELD TEST If detailed M�?I! - 0 PUMPED t tests were—w Ur COMPRESSED AIR formation 0 BAILED 0 OTHER 0 YES pumping e is in= attached? 0 NO WELL LOG if more detailed formation descriptions or-sieve.analyses are available, please attach. EPTH FROM SURFACE 'Water' Pear• ing Well Oia- meter FORMATION DESCRIPTION fL WELL L OEM IL DURATION hr. min. DRAWDOWN It. YIELD 9prn. Land Surfac e n A" . jo zag WATER W UER WATER CLEAR TEMP. AT QUA CL 0 CL TY 0 QUALITY .0 CLOUDY HARDNESS CO 0 COLORED ANALYZED? OYES ANALYSIS ANALYSIS ATTACHED? O. YES ONO ONO STORAGE TANK: TYPE CAPACITY GAL.. PUMP INFORMATION TYPE MODEL CAPACITY DEPTH VOLTAGE HP_ WELL DRILLER NAME LAS� 41% E f zo ADDRESS SlGiIXTURE 6& j/ U.7 NORTHEAST LABORATORY OF DANBURY CT Cert: PH -0404 39 -3 MILL.PLAIN ROAD - . DANBTjR, Y, CT 06,811 NY Cert: 11471 (203) 748 -7903 =FAX (203) 748 -0652 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: MR. .. STEVEN D'OTTAVIO 5 PROGRESS STREET BREWSTER; N.Y. 10509 t SAMPLE SITE: .SAMPLING POINT: SOURCE:, TREATMENT: TEST PERFORMED BACTERIAL: Total Coliform (Bacteria) PHYSICALS: CHEMISTRY: pH Turbidity Nitrite N Nitrate N Alkalinity Hardness Iron Manganese DATE SAMPLE COLLECTED: 2/16/98 TIME COLLECTED: 7:30 A.M. COLLECTED BY: STEVE DATEAECEIVED @ LAB: 2/16498 TESTED BY: LAB# 11471 REPORT DATE:448/98 8 CORTNEY LANE, PATTERSON, N.Y. TUB WELL -NEW NONE RESULT: MA30MIUM CONTAMINANT LEVEL 0 per 100 ml 0 per 100 ml 631 no designated limit 0.42 NTUs S :NTUs <0.01 mg/L as N 1 mg/L as N 2.32' mg/L as N 10 mg/L as N 67.0 mg/L no designated limits 140.0 mg/L no designated limits <0.03 mg/L 0.30 mg/L 0.030 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium 21.6 mg/L 20 mg/L ** Lead <0.005 mg/L 0.015*** m1= milliliter mg/L = milligrams per Liter ND = none detected ' NTU =Units * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED:2 /16/98 SAMPLE, AS TESTED ABOVE: MOTABLE 'or DOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) �n Laboratory Director •NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 l r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL'HEALTH: SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Q65 ALA.W Owner or Purchaser of Building . Tax Map Block Lot go-55 ANN Building Constructed by Location - Street Building Type TownNillage TS i a E I t-v\ Subdivision Name L o+ 9 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. Dated: Month 2 Day 11 Year lqq 2 Signature: IRZ4�� W_e Axh • Title:. P- 'esA CL �,,'t General Contractor (Owner) - Signature ]ZO 5 -5 N 6 Corporation Name (if corporation) Corporation Name (if corporate n) State ►,� Zip Address: /� D . /,So x 53 -?L 13itgw�&` State Zip _& Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH. SERVICES . GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM R0ss ALA 4 Owner.or Purchaser of Building Tax Map Block Lot Building Constructed by Town/Village C�,y N 51 LA F-- C_f�_r Location - Street Subdivis on Name Building Type 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. Dated: Month 2 Day -_- Year Signature: /LeD , Title: �,�..;�,i,P.✓'�- General Contractor (Owner) - Signature ):Zo Corporation Name (if corporation) Corporation Name (if co 'ration) Address: 25 P_ y-JgA ( LA4e_5 J2ZV .Af2VaW, Address: �d-13kx.532 13, State N `( Zip State Zip /050 Y Form GS -97 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 KOSS A L A-10 Building Constructed by - 60 es-rbA t { tit' Location - Street Building Type 'PD5"T'T��SGS� TownNillage Subdi ision 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. Dated: Month 2 Day 11 Year 1 O Signature: C,?4 1P,1Z Z d Title: General Contractor (Owner) - Signature _EZQSS ALA9 I S 6 ?�TO Corporation Name (if corporation) Corporation Name (if corpo ation) Address: 1 Address: Y d, 3a x � 5-3 2 /.9Eew e� State] Zip . State J� env Zip Form GS -97 LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road " Brewster, New York 10509 (914)278- 6108 -(FAX) 278 -2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS i February 19, 1998 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Compliance Big Elm Subdivision 7 Lot #8 Courtney Lane Town of Patterson Dear Mr. 'Morris: Enclosed are the following:. I.-, Four (4) prints of Drawing =S -8 "As -Built Plan ", dated 2- 12 -98: 2. "Certificate of Construction Compliance for Sewage Disposal System ", dated 2- 12 -98:• 3. "Guarantee of Subsurface Sewage Disposal System ", dated 2- 19 -98, 4. Well Completion Report, dated 8 -4 -97. 5. Laboratory Report,.dated 2- 18 -98: 6. Application Fee in the amount.of $200 :00 payable to Putnam County Health Department. If there are any questions concerning the enclosed, please call. Very truly yours, LA UP ENGINEERING ASSOCIATES, P.C. Harry W. Nic ols, Jr., P.E. " HWN:TR:bd . 88044 -8 77- t �_, t { r_,'� r ?_» n.: t .. t., t F � �'i r..n ii t� - R4�.,Sn.•. � y �y ,t nti �,`r 4. � e ° ; ', , ^, � � . .. Q�� lQ1TIA�[ OODNR D�AD'lD�I' OF �ALTH �` DbYiti dDJlti�sW HeoNS Seedeee. N MA a FtwWe Fwtalt/ ellA f■��_ 4 t' _ :t �' ��1��JOI�.. S . Owed Netr� 2D 5 5 .ALA N I t�1 G°"�I u ❑ t R°'Id'° 'S ❑ �. Do ofFroviau te Appov�l t `° h. harp Subdivision Annr� ed =`" • -q0 Fee Enclosed: am�;inr~ ._., D;OO iN'f14L 304 Wild T!M 'lot Atet -�. G FiO; p� ` Yoane:Y i r Ntirberd Biil�er Delp' Flow G F D Q Q PCHD NolldcoUoti 4 Degatred Wren FN b a�aMad SYaa= a o:wet`dt�QeBw Trek ADO L�ABSA�">Z�NGl . • , To M bl t t Wtlgr Sf= Ftiic $�pDl/'Ft� s A ' -County Departmerk 0f APPROVEO�ROR�CONS rrvoeaba for avea of.m DD,�� n0ukp spa //Jnit- 11.CV y' �:.[ � '.i 1��88- pate �•�„,._.:.._ artm�nt an0 a writtanrOuarsntii will 4 agns ey''tM ftuiklM,,that,g10`ttulkler will CWWltbn MY..part ofykl lwaN dhtaotN tyttfel durirq tM pplod Of ,two;l2)M1yf+ar Uhmedlat�ly folbwinj tMA�tti3Of tow issu- Rw eM GMtNkato' -of, Construct bn Compliiriu of t1n orginal;tYttNn o► any r�yits tlii►itot 2)lhs h#'4*IlM "l difleraw e6wn tl» ppowid pUn anifli t n W w`NI will tie Insta in attordana with t ita ras,` rum, one riqua—T fMn of . the, Putnam $ a +. SgniO ' P E R:A. — ,�/ ►�Ihrp� , t Cleanse No RUCTION TIHt approil axpN�f:two yal/f r /rOm the fiats isivad unlss ^,coe uctbn of, tM tiYiginq Aaf baM uliOMtak and it to imandad or modiflud whin aonsidntaO MCeffiry by t a r of'Na@HN Any change or - alteration Of Construction A edv lor�disposal Of domastk MnRatr N t a Y only �S 3 Y 3 s'. v T {tN 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 # WELL LOCATION Street Address Town/Village/City Tax Grid Number i f: - 1 -- WELL OWNER Name Mailing . Address G 2 gtPrivate O Public USE OF WELL %RESIDENTIAL ❑ PUBLIC SUPPLY 0 AIR /COND /HEAT PUMP 0 ABANDONED primary 2- ,:secondary 0 BUSINESS O FARM O TEST /OBSERVATION 0 INDUSTRIAL U INSTITUTIONAL O STAND -BY ❑ OTHER (specify 0 AMOUNT OF USE YIELD SOUGHT t% gpm /# PEOPLE SERVED3 -5 /EST. OF DAILY USAGEA Sal REASON.; FOR 13 REPLACE EXISTING SUPPLY ❑ TEST/ OBSERVATION Q ADDITIONAL SUPPLY DRILLING ® NEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL DETAILED S REASON FOR DRILLING WELL TYPE I ®DRILLED 13DRIVEN DDUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES JC NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: ?j1�j f: L�A Lot No. 2? WATER WELL CONTRACTOR: Name -(gyp Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES )4 NO NAME OF PUBLIC WATER SUPPLY: I11A TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ®ON SEPARATE 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 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: e-Z 13 19 _ZZ— 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 P"'x' m axjm'Y DEPARM7r ' OF BEALTf' DIVIi .J OF • BEALTH SERV. J . DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM-, FILE.NO. owner. v.S.S. ACAS(/... Address 25 6YR4M CA/(,E RD...A.Rr�i -VA �Y /� sa ¢ Lccated at (Street) .A10 Z z Sec. Block S Lot 7 2• (indicate nearest cross street) .: municipality ,�A T% f?, watershed . ego TO V SOIL PERCOIAMCN TEST DATA REQUIRED TO BE SUM= WITH APPLICAT'ICNS. . Date of .Pre - Soaking g o1 8 Date of Percolation .Test S HOLE NUFMER _. CLOCK TIME .. PTtRCx) TION PERCOLATION Run. . Elapse Depth to Water ..Fran Water _Level No. Time ... Ground Surface. In Inches Soil Rate /dj,2,1t8 ..Start. Stop .Mini. ... Start., Stop;.` Drop In rsin/In Drop Inches Inches Inches to ZG /z Z /z �2 3 to 1 2 3 5' r.�.�w.. =... y j • . NOTES: 1. : Tests "65 "be repeated at same depth until appr9ximately equal soil rates are obtained at each percolation i test hole 'All data to --be suimittod for review. 2. Depth measurements to be made fran top of hale. rev. 9/85 Name LAU �wT ;C� ✓G /� C' � I1 ✓C /�s s OC �c . Signatur c� ' Address %3 ,�/I �� ?/C y �,� SFAL 4 045 ,12 Q.? THIS SPACE FOR .USE -BY -HEALTH DEPAMMEW ONLY: Soil Rate Approved sq.ft/gal. Checked by Date r-> T-T Ir 111T _Z11 L__f TJ XT,:c -Sr r-> za_ APPLICATION. FOR APPROVAL .OF PLA14S FOR .,.A.V?AST -EWATER DISPOSAL, SYSTEH ... ... ...... Name and Address of: Appl ica.nt:. ..?,055'A!�AhA INC, 151 IZAiA LAK5 12OA, b KY 2. -.-Nam of Project: ?051✓0 .3 .__Locatlon, T/V/b-. PA:J::f 5 Millbrooke Office Cent 5. Address. 4. �P`rorj''ect Engineer: 4, is 40"1 NY. iG5Q9 License Nu'ber: Phcihe.: (914).278 =6103: IJ 6.. Type of-,:�,,r a Commercial Pr�'te/Re ..F0*0 ervAce'... Apartments J n s. tA t u t 1 o n a- e Home.: Park Offit6 Building_ ........ k&a I it .."S, :ubd'.1,v.ision, -.Other .,,(-soeci f y) 7. -is this -project -subject' to State En'viro'n''m'ental -Quality Review (SEQR).?,. TYDe Status (Check One) Type 1. Exempt Type II. Unlisted. )e S.' Is a Draft E n v i r'06n.-ii e n t a I Impact Statement- (DEIS) required? .............. . No 9. Has, tEIS been completed 'and found acceptable by Lead Agency? . ............ m I'A 10. Name' of Lead Agency ?1- Is this 'project in an area under•'t'he control of-local planning., zoning, o.r.other.,.Pfificials, ordinances? ............. ................ ; .......... ';2. If so,, have plans been',*suL-mifted to such .'authorJ . tie . S?....--. ............. SI/A 3. Has prel in. inaFY approval beep' -by *such -a uhori'ies? a L Date Gr .. nted: S/A Type of Sewage Disposal: System Discharge...... -Surface Water X Ground Waters 5. 117 surface water discharge, what is the stream class designation ?......., A Waters index-n' omber (surface*)' ............ . ......... Is Project located nea,F a public water supply system? .................. Yes. nar,-,e, of,.-w.C"Cer supply /A Distance to water supply _75 projecIL, site near a public sewage collection or . disposal syst;.-..m? ..... 0 Project design -Flow (gallons per day) ------ of.:' sewage . system ..Distance to sewage system __.O/� Date observed: 2;, N, a rp. e of Health I n s p e c t o r 0 U t2Z N-5ie-, Project design -Flow (gallons per day) ------ 2. 25. Is State Pollutant Discharge Elimination System (SPDES). 'Pe rmit required ?.. jJrj 26. Has SPOES Application been submitted`to` local DEC 4OffIce? N 27. Is any portion -of this.-Project located within;a designated Town or. State wetland? ........ .....: .............. ............................... N G 28. Wetland ID Number .. ....... ........................... + ..... N/A 29. 'IS Wetland Permit required ?.: Nd; Has 'appi.ic?_tion been made to Town 'or Local DEC Office ?* ....... .... N/A 1.. 30. Does project require a DEC Stream Disturbance Pe <<it? ................ NG 31. Is or was project site used `for--.-agr- icuatu:ral activity involving.'applicat 'on Of pesticide,5 to orchards• o(' other crops-, solid or hazardous -waste .disposal , land-filling, sludge application or industrial activity? YES 'o NO 32. Is project located-within 1;000-feet, of exis.tence'Of abandoned Ia0dfill hazardous uaste'site,; salt .stockpile,'.,'l*andf` ill ; sIud9e.d1sposaI site or any other.,potential "known-source of contamination? .............:.YES or NO DESCRIBE: 33. Is there a local master plan' or file:with the Town orVilIage? �L�JD 3;. Are co unity water, sewer facilities planned to be developed within 15 years? 110 35. Are any sewage.disposal areas in excess of 15% slope? ......................... S 35. Tax Flap ID Humiber ....... ....:............................ ........ ......... �( r 37. Approved Plans are'tobe: returned to: ............... ' Applicant __� Engineer I the a0lication'is signed by :a person ocher than tfie applicant shown in Ttem.1, the. pplication must be - accompanied by y-a Letter of Authorization: Failure to comply with this orovision may be grounds for the rejection °of.any submission:. I hereby affirn, under penalty of perjury;- that information provided on this form. is true to the best of m y knoxlc -d,e and bA11eF. False sta`t ,--nts *made herein are punishable as a .Class A Hisde�,eanor pursuant. to Section 210.45 of the' Pena 1 Lair. 1G;' :TURES- & OFFICIAL TITLES: ,lill�fooke Office Centre LIfdG ADDRESS: Brewster, NY 10509 ' / \ LAURENT ENGINEERING / ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE . / Route'22 8 Milltown Road_ - Brewster, New York 10509 . RANDOLPH W. LAURENT, P.E. (914)278 -6108. (FAX) 278 -2658 HARRY VV. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS . January 16, 1997 Mr. William Hedges Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Big Elm. Subdivision - Lot #8 Courtney Lane Town of Patterson, New York Dear Bill: Enclosed are the following: 1. Four (4) prints of S$-8, "Proposed'SSDS - Lot #8 ", dated 1- 16 -97. 12. "Application For Approval of Plans Fora Wastewater•Disposal System ". 3. "Construction Permit of Sewage Disposal System ", dated 1 -16 -97 4. "Application to Construct a Water Well", dated 1- 16 -97. 5. "Design Data Sheet ". 6. "Letter of Authorization ", dated 1-16-97. 7. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only'.'. 8. Money order in the amount of $300.00, review fee. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. Nichols, Jr., P.E. HWN:TR:bd 88044 -8 cc: Ross Alan, Inc. w /enc. PUTNAM COUNTY DEPARTMENT OF HEALTH ' DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date I - lCa -Gi-7 Re: Property of 9_OSS ALAtj _TNG Located at Cal) 12.-fW15`j l-ANr (T) Section Block l Lot l Subdivision of Subdv. Lot # Filed Map # 2 2 Date 3 2 670 Gentlemen: This letter is to authorize .l, AFFZ�f V1 , KIG��QLS 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 ublic Health Law, and the Putnam County Sani- pf NEW YD tary Code. NtC o Very truly yours,. xW No. i 2d � S i gn e d Countersigned: A IrtEss10NP� Owner of Property P'__* • , # ,5(e ► 24- 2 5 0`f RA tit LAIC. &2A2 Address ,� I 19 F ;:. AIi Town Telephone (1114) 218 - Telephone S j - - . � * ,I - . , - I ,;. `�� w f. •� - y3 `�_Ij,. U } —am Y 1. '.� ;I -, ?3 t ',4 'x } ,4_'. � C - - 6 t , �;;l . . + S. 7 - • ( ♦ � .. _ N � - �l ''i" rt f "{ . - , : . _ . 1. {- ,. ., 1 - .- . '� r .��. . �- 5.. _ k yL . ►1 _. �'' _ .i ,T t ci "t fJ A,t i K. . t' f r J .`. �Y - t Y 1 } r :r t: a. V Y , Y ..J. - �'n ..,. - y // c - i { . <, ' f t t P z a_ i r: .ti G� $ pq_��nv% 1. 'fir- 'M• . >. - .t x4 -r. c #• J v`_ E ., a gB, 1-1 .. S 4 • : a:.a.. Jt tii:� - - z r. �� r- ,, r ` y C e its y�� K a 'el IN - � - 0. - , . . . . . . . !! *1 ,,.;;.In , '�i __Y11__'l.. _41* I . . .!, __-, s IY r z.r s, ' r r t, s t, �b W� �; h , :.,. 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