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HomeMy WebLinkAbout0811DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 24. -2 -38 BOX 9 I HIS � ., �, ,, No . kc INN �. r � 04 �, %I T R 41, i IN I I IN `*T �. ; . . , N0,o. T�. . ` UL 00811 PUTNAM COUNTY DEPARTMENT OF HEALTH C DIVISION OF ENVIRONMENTAL HEALTH_SERVICES . . CERTIFICATE OF CONSTRUCTIO{N� COMPLIANCE F REATMENT SYSTEM PCHD CONSTRUCTION PERMIT # f 1 ' et C - �/- J Located at bbl' Town or Village Owner /Applicant Name Formerly Tax Map Block Subdivision Name Subd. Lot # Lot S ) Mailing Address . P 4 B0y, 41-0 P k � H Ha-rJ 'OK- Zip Date Construction Permit Issued by PCHD Separate Sewerage System built by NF ti , CO li i �1� 9 Address P0 Consisting of 1 �� Other Requirements: Water Supply: Gallon Septic Tank and 1504 �-� N170"b Public Supply From or: Y Private Supply Drilled by tA l Lmi ilmekrT .. I.. Building- Type Address Address0�'��`�,�� Has erosion control been completed? V. 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 regulatio s of the Putnam Aunty D en of Health. Date. ` �' ' � Certified by P.E. R.A. Desig ofessional) Address jyi VQ1 4- TvAel. - CA MM" t ►y-�J r) � License # 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 approva a subject to modification or change when, in the judgment of the Public Health Director, such revocat o , dificatio change is necessary. By: ✓�' Title: /✓6�� Date: 0,1 / If White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 'AAIAAIAAIM1"I MAIAAIM INI IM[ 4AIArI AA IMIAf17MI AA [AJ.11M[M[I.191ArIA1.1IATfMiMf. _[M[ArtAA[MIM[. _[ AAI AAI AA [A11IAA[AAIAAIAMM/AAIAIVATIM[AB ._ _ _•..• 1 _ MENEM k .y PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: SI -} G R , Town/Village: Pofe r-e Tax Grid # Map Block Lot(s) Well Owner: Name: ' , / Address: Use of Well: 1- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock _ Other Casing Details Total length ,5"D ft. Length below grade ft. Diameter 7 in. Weight per foot ��lb/ft. Materials: Steel _ Plastic _ Other Joints: _ Welded Threaded _ Other Seal: _ Cement grout Bentonite Other Drive shoe: Yes No Liner _ Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _Pumped JL Compressed Air Hours CS Yield 3Q gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses are available, please attach. De p th From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 456 t C ve v�d lys I 4� Q 6 A10 If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information a/d Pump Type / Capacity , Depth Model �`��. Voltage HP r Tank Type ; Le Volume aa, , ds 30 Date Well Completed a �v Putnam County Certification No. 60-7 Date of Report c17166 Well Driller (signature) ., iNtiihr rxact location of well �witn custances to at least two petmaneilt laltamarxs to ue provtaea on a��separatosneevptan. Well Drillees Name ,�►oYr ty Address: A00 R/e, 3& eersch r �l Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Harry W. Nichols Jr., P.E. 311 Clock Tower Commons Route 22 -- - - - Brewster, NY 10509 - - - - - -- Telephone (914) 279 -4003 Fax(914)279 -4567 June 6, 2000 Robert Morris, P.E. Putnam County Health Department 1 Geneva Road Brewster, NY 10509 RE: Individual SSTS Compliance D.E.W. Construction 885 East Branch Road Town of Patterson Dear Robert: Enclosed are the following: 1. Five (5) prints of Drawing S -1, "As -Built Plan," dated 5- 25 -00. 2. "Certificate of Construction Compliance for Sewage Disposal System," dated 5 -16- 00. 3. Three copies of "Guarantee of Subsurface Sewage Disposal System," dated 5- 16 -00. 4. Well Completion Report dated 2 -7 -00. 5. Laboratory Report, dated 6 -6 -00. 6. E -911 Address Verification Form dated 5= 25 =00. - 7. Application Fee in the amount of $200.00. If there are any questions concerning the enclosed, please call. Veryltruly yours, Harry W. Nichols Jr., P.E. HWN:JM:his 00- 122.00 NE NORTHEAST LABORATORY of DANBURY 39 MILL PLAIN ROAD - DANBURY, CT 06811_ CT Cert: PH -0404 LABS (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: D.E.W. CONSTRUCTION P.O. BOX 420 PATTERSON, N.Y. 12562 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: Total Coliform (Bacteria) PHYSICALS: Color Odor pH Turbidity CHEMISTRY: Nitrite N Nitrate N Alkalinity Hardness 6/5/2000 - Iron Manganese Sodium Lead DATE SAMPLE COLLECTED: 5/30/2000 & 6/5/2000 TUVIE COLLECTED: 8:00 A.M. & 2:30 P.M. COLLECTED BY: D. FINNEY DATE RECEIVED @ LAB: 5/30/2000 & 6/5/2000 TESTED BY: LAB# 11471 REPORT DATE: 6/6/2000 TOCIDLOWSKI, LOT 0, EAST BRANCH RD., PATTERSON, N.Y. KITCHEN WELL NOT STATED RESULT: � MAXIMUM CONTAMINANT LEVEL 0 per 100 ml . . 0 per 100 ml 12 15 ND 3 Units 7.59 no designated limit 2.3 NTUs 5 NTUs <0.005 0.24 98.0 96.0 0.102 0.104 20.6 0.001 ml = milliliter mg/L = milligrams per Liter * *Notification Level • ** *Action Level mg/L as N 1 mg/L as N mg/L as N 10 mg/L as N mg/L no designated limits mg/L no designated limits mg/L 0.30 mg/L mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] mg/L 20 mg/L ** mg/L 0.015*** ND = none detected NTU =Units RESULTS BASED, ON SAMPLES SUBMITTED:5 /30/2000 & 6/5/2000 SAMPLE, AS TESTED ABOVE: X or MINOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) *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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building P ,FIB E i 8 DH Building Constructed by -5 Fws pky Location - Street P-Ei� �o5- He, Building Type ?-4 s S Tax Map Block Lot PNrraFRj'�->QH TownNillage Subdivision Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage, treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Date - Month Day Year y ©' 6-76eneral �trac Owner) - Signature f a __& - Corporation Name (if corporation) Address: �/,2.� l0, 61, State z4--'.'. �,' Zip 1,9� Signature: Title: G�� Corporation Name (if corporation) Address: i Q '� �Kphco State i Zip 1'��' Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM D. E •� � flN5 c'Rv GTt o� � , 2 �� Owner or Purchaser of Building - Tax Map Block Lot P,F -W . LON6-(?-04 4 10H Building Constructed by.. Location - Street P_Ei6►D5H6,f', Building Type ppr TownNillage Subdivision Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails* to operate for a period of two years immediately following, the date..of approval of the. ".Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Date Month JUG Day 6 Year y© General tra Owner) - Signature Corporation Name (if corporation) Address: �/,CD) ,11� 62, State /rte. )�, Zip 10.� Signature: Title: p.E�,\r4, r-0ws�9_0g1W � Corporation Name (if corporation) Address: State IyY zip 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 P ,F,�J , 4 1 off Building Constructed by Location - Street Building Type PPrTr5R•60 H TownNillage •1 Subdivision Name Subdivision. Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage.of the sewage treatment. system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. . _ _ I . _ 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. Date Month JvN� Day 6 Year Signature: Title: General P4i tra Owner) - Signature V�� aanaly� &M= Corporation Name (if corporation) Address: /10, 62, State /1<. )-� Zip 12 P -E�.V4 , U w3-f;-0 (:�\w ) , Corporation Name (if corporation) Address: State p� fox �a QepSE� -5as Hsi zip f 256 Form GS -97 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 (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 ' 1 1' O► 1 03 OWNERS NAME: T bG l b Lo W �il�► p,� -w - c4 HS ?r_\)c noR) TAX MAP NUMBER: E911 ADDRESS: S�5 ��Sr BRNGN �Lp j�D TOWN: AUTHORIZED TOWN OFFICIAL: (Signature) DATE: Gil% �Z 2 �o 0 O The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERFRM) PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Street Location s i ��/G J «(, Town -TM # ; '.1. Sewage System Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d., Stone, brush, etc., greater than 15' from STS area.......... e: 1 00' from water course / wetlands ...... ............................... II. Sewa e S stem a... Septic tank size - 1,000 ........ 1,25 .........other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... ............................... f. Trenches Length required _ Length installed 0,y 2. Distance to watercourse measured god Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface ................ ... 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 1' /2" diameter clean .................... . 9. Depth of gravel in trench 12" minimum ....:.............. 10. Pipe ends capped ........................ ............................... g. Pum2 or Dosed Systems Size ot pump chamber ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual/ audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Build nn a. House ocated per approved plans........ ..:....... b. Number of bedrooms.* ........................... Y.... ...... IV. Well a7—Well located as per approved plans . ............................... b. Distance from STS area measured J D ft........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain ' drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided .......................... ::..................... Rev. 6/97 Date: / o0 Inspecte y: a, ea Owner 5AW-D1,61 Permit # P— / 3 — S Subdivision Lot # -- -11 , 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 (914)271-6130 Fax (914) 278-7921 - Nursing Services (914)278-6558 WIC (914)278-6678. Fax (914) 278-6085 Early Intervention. (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648. Date: To: M7217Y 5, i r AWA , , From: Gene D. Reed Putnam County Department of Health _ For your information For your review As discussed Fax #: 9 7 9 — 7 No. Pages (Including cover sheet) Please respond Attached as requested Please call Notes/Messages S �. e%© 'R A k FFL L )'v/O c ©m M In the event of transmission/reception difficulties, please contact this office at (914) 278 -6130 ext. 2261. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES REQUEST FOR FINAL J—NISPECTIO For: Fill Trenches PCHD Construction Permit #- /0' /3-83 Located FqJ g tet,_ L Ra.-J (T) Owner /Applicant Name ToC' 14ws1'e1 TM Block �Lot . Formerly Subdivision Name Is system fill completed? _ Date Is system complete? Date Is system constructed as per plans?��zs Is well drilled? Yr- Date 9-0 -60 Is well located as per plans? -6.5 Are erosion control measures in place ?_ G__ I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. Date:_- — 46 _Certified by: YPE G/fA_ Desi rofessianal Address 3 It Lie. Comments:_ Dorm FIR -99 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT WAGE TREATMENT SYSTEM PERMIT # Located at �a��.F� Town or Village��T't;Ea(�' -rte Subdivision name Subd. Lot # Tax Map Block '2 Lot Date Subdivision Approved Renewal Revision Owner /Applicant Namee__L.,� n Date of Previous Approval5��� Mailing Address i Amount of Fee Enclosed'P Building Type Lot Area No. of Bedrooms Design Flow GPD Zip Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED to consist of gallon septic tank and Other Requirements: /2 ' P-015 ` % v1 ratite. To be constructed by Address Water Supply: Public Supply From Address _ or., Private Supply Drilled by "T p - �' .. Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment sY t s, em described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate- of Construction Compliance ". satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will ished the owner, his successors, heirs or assigns by the builder, that said builder will place in good oper c ition any of said sewage treatment system during the period of two (2) years immediately folio a ate issuance of the proval of the Certificate of Construction Compliance of the original sy y repairs ther e Signed: Address P.E. X R.A. Date License #0&-7 44C42 W 2 C-AWFOa ANA1,-- c. ►a. QNJ (aSI'Z- APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified whe considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new per pprove discharge of domestic sanitary sewage only. By: t,✓ Title: Date: 9/2/v White copy -. HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 "PUTNAM ENGINEERING, PLLC 102 Gleneida Avenue Carmel, NY 10512 914 -225 -3060 Fax: 914 -225 -2955 LETTER OF TRANSMITTAL _Date: clon t:2 2 , `� 9 RE: `2AN C) ( t-1 3.- ; We are sending you attached under separate cover, the following items: Shop drawings X Prints Specifications Copy of letter Plans Other: No. of Copies Descrintion hesp arc fimnsliiiiited: For approval _ Approved as submitted -.- _ For your use, Approved as noted As requested — Returned for corrections For review /comment — Resubmit copies for approval _ Submit _ copies for distribution MARKS: 'o5-l" ►ies to: will If enclosures are not as noted, kindly notify this office. ' Gjv !jV\^ 17 '-\' k�� i 1� I . .tL rF r,. r GAL hesp arc fimnsliiiiited: For approval _ Approved as submitted -.- _ For your use, Approved as noted As requested — Returned for corrections For review /comment — Resubmit copies for approval _ Submit _ copies for distribution MARKS: 'o5-l" ►ies to: will If enclosures are not as noted, kindly notify this office. ' Gjv !jV\^ 17 '-\' k�� i 1� I . .tL rF r,. r .PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES v DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM - Owner Address ti ew l'u P� '`sue _ Located at (Street) t�As'T" — °0�� �.� Tax Map 2+ Block 2- Lot 3S (indicate nearest cross street) Municipality Drainage Basin le�1257 -5,- " P--� G. SOIL PERCOLATION TEST DATA Date of Pre - soaking -7 / 'i � Date of Percolation Test' -7 1 Hole No. Run No. Time Start - Stop Ela �se Time Min.) Depth to Water From Ground Surface (Inches) Start . Stop Water Level Drop In Inches Percolation Rate Minanch .1. 1 Vol ..9-37 � -37 0 2D 223/4 31� I 2 10 :043 3o 20'.:- 222FL 3 10:ol 10: 3 3 ,o 2-o 2,2 ` 2, � �j2 12 4 5 2- 1 91,01 1111-1 3 6.7 _ - 2 -- 9'S4 2�. ��r�, 21'l2 3 g,'�5 .. . 3 9:-C;97 /6.2z 2-:7 18 21 %z 9 4 5 1 Z 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' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. is HOLE NO. TS D �oNn,-4 IDK r3Ve&W rj T"rL. -1 �rS�• CO�2SL S�'•rr� F3(Z.ativ� WA��2 vi gzr- 4 �z HOLE NO. 2 Indicate level at which groundwater is encountered /2 Indicate level at which mottling is observed 4 � Indicate level to which water level rises after being encountered + 2 Deep hole observations made by: R H o '• G 256C> f Ka-j 44 Date 9 2 9F5 Design Professional Name: �y rrsd►v�� rr i rJL� �P Address: I b 2 •+--_ Signs Design Professional's Seal 0F. NE�v ya\ C t p— �[c+ 067446' FEZONP�� - Dr. Paul L. Sandin Mr. Robert Moms Putnam County Departme Geneva Road Brewster, NY 10509 Dear Mr. Morris: 147 Brainards Road Phillipsburg,: NJ 08865 Home (908) 859 -2995 January 11, 1999 I have been working with Mr. Ken Hurley of Putman Engineering for the past year, seeking to receive Board of Health approval for the Septic System on our property in Patterson. Ann Bassett with Colwell Banker has had a buyer on the string for the past five months, and the sale cannot be consumated until Septic Approval is granted. Mr Hurley informs me that the proposal from his office was sent to you on 10/29/98, which is 11 weeks ago. Can you give me any indication as to when we might expect the examination to be concluded? Thank you very much, Paul L. Sandin CC: Mr. Ken Hurley Ms Ann Bassett fir. Pau( L. Sandin 147 Brainards Road Phillipsburg, NJ 08865 Home (908) 859 -2995 February 20, 1999 Mr. Ken Hurley Putnam Engineering 102 Gleneida Ave. Carmel, NY 10512 Dear Ken: Thanks for your persistence. We are glad that we finally got the septic approval. I have enclosed a copy of the letter from the Health Department, stating that the materials from you had been misplaced. I guess all of your calls were of little avail when they could not even locate the paperwork. Enclosed is a check for the balance of $825.00. Will you make sure that Ann Bassett has at least what she will need for verification, and send the rest to me. Thanks again for your help! kJ BRUCE R. FOLEY Public Health Director Dr. Paul L. Sandin 147 Brainards Road Phillipsburg NJ 08865 Dear Dr. Sandin: 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 (914) 278 - 6130 Fax (914) 278.7921 Nursing Services (914) 279.6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 February 2, 1999 Re: Construction Permit This Department is in receipt of your letter dated January 11, 1999, in'which you request the status of your Constriction Permit renewal. The paperwork submitted by Putnam Engineering had been misplaced. Putnam Engineering has submitted copies of the papeiwork on February 1, 1999. Your permit has taken top priority and will be reviewed on February 2, 1999. Any comments will be forwarded to Putnam Engineering. I apologize for any inconvenience this may have caused RM:tn Very t ly yours, Robert Morris, P.E. Senior Public Health Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # Well Location: Street Address: Town/Village Tax Grid # &'1" Map '24- Block I Lot(s) 3g Well Owner: Name: Address: t L 1 ''l &R4i N49_D5, LW 6 Use of Well: Residential Public Supply Air /Cond/Heat Pump rrig`a ion 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5 r4l gpm # People Served LeNb^ Est. of Daily Usage49 al. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type _ Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yeses No ' Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Lot No. Water Well Contractor Tib 706, 5­C Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of cont afir o e pr e o separate sheet/pl 3 i Date: l Applicant Signature: ` PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED_ FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue 2 Permit Iss ' Official: Date of Expiration ?�' Title: �� Permit is Non- Transfe ra le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 FROM PUTNAM ENGINEERING PLLC PHONE NO. 914 225 2955 Jan. 12 1999 02:27PM P5 is F LA pubsox IBM 11 111 owdomomm, Willow ka�:....:;•.. �;- � •. is aO�rM M� aalld��/ !Irl� AYw•. • DoA^JSt3 R A*& Oat 0 �M r6l TIC i fat Mr,Va Malmo a* Lj 00 was" d �,..�.. Owlp Dan, O ! 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M tM t>iMatr a>r ualalla.oawv W-49% aalrw wa arlta► Ms4 ar,!r. i r 1 i ' I , r � II 1 r 1 1 1 i • ' � i C7 BRUCE R. FOLEY jp Public Health Director - DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 September 11, 199.8 Ken Hurly Putnam Engineering 102 Gleneida Avenue Carmel NY - 10512 Re: Proposed SSTS: Renewal Sandin East Branch Road (T) Patterson Dear Mr. Hurly: Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: There is no record in this Department that the above regarded lot has received a construction permit approval in 1983 or of subsequent renewals. Please submit any supporting documentation that may be available. Upon receipt of a submission, revised to reflect that above comments, this application will be considered further. V ly yours obert Morris, P.E. RM:tn Public Health Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH SUBDIVISION ' LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED. PERC RATE FILL REQUIRED DEPTH (� CURTAIN DRAIN REQUIRED i ✓" STANDPIPES GENERAL ! LOCATED IN NYC WATER rSDZ PLANS SUBMITTED TO DE DELEGATED TO PCHD DEP APPROVAL, IF REQ'D / DEEP TEST HOLES OBSERVED PERCS TO BE WITNESSED EX- APPROVAL SSDS ADJ. LOTS DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS �tEOUIRED DETAILS ON PLANS i REVIEW SH T FOR CONSTRUCTION PERMIT -- - �L �Y,GC"YL) STREET LOCATION.CG w iL���` -i, fly NAME OF OWNER REVIEWED BY GR AS, NIB, BH T qI l ' TAX MAP # (RM, , 77 � Y N, OCUMENTS Y N_ L� ,r PERMIT APPLICATION � g gGRAVITY F E SION CO TRgL':HOUSE,WELL, SSDS +� PC -1 r PER & DEEP-HOLES LOCATED WELL PERMIT _ PWS LETTER REPRESENTATIVE OF PRIMARY & EXPANSION V LETTER OF AUTHORIZATION i LOCATION MAP DESIGN DATA SHEET (DDS) EXP.. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE CORPORATE RESOLUTION IF PUMPED, PIT & D BOX SHOWN & DETAILED SHORT EAF HOUSE - NO.OF BEDROOMS PLANS - THREE SETS / WELLS & SSDS'S W/1N 200' OF PROPOSED SYS. HOUSE PLANS - TWO SETS PROPERTY METES & BOUNDS VARIANCE REQUEST HOUSE SETBACK NECESSARY (TIGHT LOT) FEE , • j HOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE SUBDIVISION ' LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED. PERC RATE FILL REQUIRED DEPTH (� CURTAIN DRAIN REQUIRED i ✓" STANDPIPES GENERAL ! LOCATED IN NYC WATER rSDZ PLANS SUBMITTED TO DE DELEGATED TO PCHD DEP APPROVAL, IF REQ'D / DEEP TEST HOLES OBSERVED PERCS TO BE WITNESSED EX- APPROVAL SSDS ADJ. LOTS WETLANDS (TOWN/DEC PERMIT REQ'D ?) DATA ON DDS PLANS &PERMIT SAME _. PRE 1969 NEIGHBOR NOTIFICATION LETT ER BI/ZBA 100 YR. FLOOD ELEVATION OTHER REQ'D PERMITS) 1 NO BENDS; MAX.BENDS 45" W /CLEANOUT FILL SYSTEMS CLAY BARRIER 10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE FILL SPECS FILL NOTES FILL CERTIFICATION NOTE (DEPTH GAUGES FILL PROFILE & DIMENSIONS FILL M EXPANSION AREA T ER NCH LF TRENCH PROVIDED 60 FT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED ON PLAN - FROM SSTS 10' TO P.L., DRIVEWAY, LAR GE TREES, TOP OF FILL 20' TO FOUNDATION WALLS- 15'WELL TO PL 100' TO WEISI�200 DL01) 0 ITS 100' TO STREAM WA'T'ERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (pits -20') 50' INTERMITTENT DRAINAGE COURSE 200'/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS / CONSTRUCTION NOTES 15'MIN to CDS= >5 0/o,10'- 4 %,25'- 3 %,301- 2 %,35' -1 %,100' - <1% DESIGN DATA: PERC & DEEP RESULTS / 20'MIN to CD discharge /100'with 182 cons day discharge 2' CONTOURS EXISTING & PROPOSED / SEPTIC TANK DRIVEWAY & SLOPES, CUT m 10' FROM FOUNDATION; 50' TO WELL FOOTING /GUTTER/CURTAIN DRAINS j WELL SOIL TYPE BOUNDARIES /I I DIMENSIONS TO PROPERTY LINE TITLE BLOCK; OWNERS NAME,ADDRESS LOCATION OF SERVICE CONNECTION /;TM#,PE/RA; NAME,ADDRESS,PHONE# DATE OF DRAWING/REVISION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS /LAKES AND WETLANDS WITHIN 200 FEET PROPOSED FINISH FLOOR AND BASEMENT EL. COMMENTS: �tEOUIRED DETAILS ON PLANS i i 77 � � g gGRAVITY F i ER BI/ZBA 100 YR. FLOOD ELEVATION OTHER REQ'D PERMITS) 1 NO BENDS; MAX.BENDS 45" W /CLEANOUT FILL SYSTEMS CLAY BARRIER 10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE FILL SPECS FILL NOTES FILL CERTIFICATION NOTE (DEPTH GAUGES FILL PROFILE & DIMENSIONS FILL M EXPANSION AREA T ER NCH LF TRENCH PROVIDED 60 FT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED ON PLAN - FROM SSTS 10' TO P.L., DRIVEWAY, LAR GE TREES, TOP OF FILL 20' TO FOUNDATION WALLS- 15'WELL TO PL 100' TO WEISI�200 DL01) 0 ITS 100' TO STREAM WA'T'ERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (pits -20') 50' INTERMITTENT DRAINAGE COURSE 200'/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS / CONSTRUCTION NOTES 15'MIN to CDS= >5 0/o,10'- 4 %,25'- 3 %,301- 2 %,35' -1 %,100' - <1% DESIGN DATA: PERC & DEEP RESULTS / 20'MIN to CD discharge /100'with 182 cons day discharge 2' CONTOURS EXISTING & PROPOSED / SEPTIC TANK DRIVEWAY & SLOPES, CUT m 10' FROM FOUNDATION; 50' TO WELL FOOTING /GUTTER/CURTAIN DRAINS j WELL SOIL TYPE BOUNDARIES /I I DIMENSIONS TO PROPERTY LINE TITLE BLOCK; OWNERS NAME,ADDRESS LOCATION OF SERVICE CONNECTION /;TM#,PE/RA; NAME,ADDRESS,PHONE# DATE OF DRAWING/REVISION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS /LAKES AND WETLANDS WITHIN 200 FEET PROPOSED FINISH FLOOR AND BASEMENT EL. COMMENTS: DEPARTNMNT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 September 22, 1998 Putnam Engineering 102 Gleneida Avenue Carmel NY 10512 Re: Proposed SSTS: Sandin East Branch Road (T) Southeast, TM# 24 -2 -38 Dear Sir: BRUCE R. FOLEY Public Health Director Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department of Environmental or the .Putnam County Department of Health on this lot, percolation test must be witnessed by a representative of this Department. 1) There is no record of an construction approval being granted by this Department. Please submit documentation of the previous approval. 2) Design data sheet notes ground water at 4.5 feet. Please be advised that due to the dry weather conditions, deep test hole results that note ground water will not be accepted until further notice. Deep test holes will have to be excavated when it is determined that ground water has returned to normal levels. Monitoring standpipes can be installed in lieu of reopening the test hole at a later date. 3) The 100 year flood elevation is to be shown or noted on the plan. 4) Hydraulic profile is to provide invert elevations of the house sewer, septic tank and distribution box. 5) Proposed SSTS appears to be in- direct line of drainage to the existing well to the north. 6) Footing/gutter drain is shown discharging within 100 feet of Haviland Hollow Brook. A letter from the Town of Patterson is required stating that the footing/gutter drain can be discharged within 100 feet of the brook. Letter to Putnam Engineering - September 22, 1998 -2- 7) Erosion control measures for the house, well and SSTS have not been shown. 8) Location of the service connection from the well to the house is to be shown. Upon receipt of a submission, revised to reflect that above comments, this application will be considered further. Ve ly your Robert Morris, P.E. RM:tn Public Health Engineer FROM PUTNAM ENGINEERING PLLC October 29, 1999 PHONE N.O. 914 225 2955 Jan. 12 1999 02:25PM P2 ErVnvws and -- Mr. Robert Mortis, P.E. Putnam County health Depaetment Geneva Road Brewster, NY 10509 RE: Sandin East Branch Road Southeast TM #24 -2 -38 Dear Mr. Morris: This office is in receipt of your latest memorandum for the above project and we offer the following comments: 1) Enclosed are the previous approvals dated 8/27/90 and 7/12/87. 2) Mottling was observed at 4'0'° by your office, which is an indicator of the high water level. Two feet of R.O.B. fill has been proposed to compensate for the high water level. 3) The entire site is located in flood zone A6. 4) Invert elevation has been noted on the SSDS plans for the house, septic tank and distribution box. 5) Well keys have been shown on the SSDS plan with separations labeled. 6) Enclosed is a letter from John N. Calbo, codes enforcement officer for Town of Patterson, concerning roof and footing drain discharges. 7) Erosion control has been added to the SSDS plan. 8) The water service connection has been added to the SSDS plan. 9) Percolation tests were witnessed by Field Technician, Vinny, from your office on 7/8/98. 102 6LENEIDA AVER UE. CARM @L. New YORK 10512 9 PNowE (910)225 -3060- FAX (914)225 -2955 \, �O uv. 9f 8o PUTNAM ENPINEERING PLLC PHONE NO. : 914 225 2955 Jan. 12 1999 02:26PM P4 �_ . .WO DIt1111�M�� �6�� iPM IM a M WAN 2014" 0 T. N.:. oa..rA�.�r..Ne.. P�u�.. �•nlQ�1 IMAM $•7_,192_'�'°��4Xc- D-p& � vvbm . . gSdFmrw C I! Dim ---. r/uw ewer :fib �— I s nw.riN nt 1; am ah.NY .i,. O.i11i�t1�i� NIr. b ttM MAN• +�^• IK.Ii.w .� qM .>�� tyQ.11Kp 4 It tigt too ti nw. M«IMO .w M..wlb<aatM N 111.we.a tM s.w�+L,u.�riMait ItNf. a a� a.m.rYi�e� wru tr. fnn.u.1. hdN r C..nb► Oro MIM.1 N NtMth M/ tMt «► c+mrMMn IMMgt. "Ce111fit.t. N OdM. C.IerNM.r' r11A.al.Iy a t11.. GaewlrlalM► M 1«NUIr11N b MaMtt.4 a u..o�rrtw«A. ais . wsa. t» + wa1 0. ai.,rlw dw me w�a bW + � lwilw HMO �� M t" B: VMS . e e.d t� memwn .rr pm .r an •a..r b �. rw /.rYb arrwn» qiM tr. �►wa w.0 SIMON $0010. .w 0 1" 40 ..�1 of tre p"k+a N gom&uttl.ii ___ 0 atp► tM .a Ir1 /tlplp� WIN N Mart./ M $11.1.11 M am apem .. NM •M twtrw w.r air M IMta�w t WV OMM� M MaaR0. / t. MA to A01MItoveD Cp«/Tltt�talONiY.M aMrMW sN M t11. MN Itarw rMwa .onluwdMw N tre wiwrn leas M� miof IS .M e �.r..r1a IM aall.. M q.Y N .MMW ..11NrNM aM. IM t:.el M. . Am a, i •� swerms" N IS --We IOMr.a . Aw"Wo tv rwprQ1 N drMlwk aaliR. . /.1 ! •1 1 m i- T� / A Rw p 1�r// FROM PUTNAM ENGINEERING PLLC PHONE NO. 914 225 2955 Jan. 12 1999 02:26PM P3 At this time we would ask for your continued review of the above project. Very truly yours, PUTNAM ENGDMEMG, PLLC By: "4 Ken Hurley KN:rk (File 98050) PUTNAM ENSINEERINEi PLLr- §3 n and Pbnn" 102 6 1 ENEIDA AVENUE. CARPEL, NEW YORK 10512 • PRONE (914)225-3060- PAX (914)225 -2 5 FROM : PUTNAM ENGINEERING PLLC DATE: TO: FAX NO.: PHONE NO. : 914 225 2955 (.J Eng►r�s OW Pis /2."'7 -6 �--- Jan. 12 1999 02:25PM P1 RE: 5A ,Z C> I tJ <,'S ,: I�EA st" 80A NG #4 _ _ �rr�A tcj PAGES: . inetuding this corer sheet.'' PR6V IOVS APP2AVA� To ;its c vsS 7)4r-- lz4o From the desk of-- KEN HURLEY 102 6LENEIDA AVENUE. CARMEL, NEW YORK 10512 •PHONE (91,4)225- 3060-FAX (914)225 -2955 Dr. Paul L. Sandin 147 Brainards Road Phillipsburg, NJ 08865 Horne (908) 859 -2995 January 11, 1999 Mr. Robert Morris Putnam County Department of Health Geneva Road Brewster, NY 10509 Dear Mr. Morris: I have been working with Mr. Ken Hurley of Putman Engineering for the past year, seeking to receive Board of Health approval for the Septic System on our property in Patterson. Ann Bassett with Colwell Banker has had a buyer on the string for the past five months, and the sale cannot be consumated until Septic Approval is granted. Mr Hurley informs me that the proposal from his. office was sent to you on 10/29/98, which is 11 weeks ago. Can you give me any indication as to when we might expect the examination to be concluded? Thank you very much, l Paul L. Sandin CC: Mr. Ken Hurley Ms Ann Bassett PUTNAM, ENGINEERING, PLLC 1,02 Gleneida Avenue Carmel NY 40512 914- 225 -3060 Fax: 914- 225 -2955 Ne are sending you attached Shop drawings Specifications Plans No. of Conies LETTER OF TRANSMITTAL Date: c-L, �. RE: `SAN Q(cl under separate cover, the following items: X Prints Copy of letter Other: Description r .. N lec all 1'Mlw -_ arc duns ���«ru: — for approval — Approved as submitted For your use _ Approved as noted As requested _ Returned for corrections For review /comment — Resubmit copies for approval wb'" surer, — Submit ^ copies for distribution ARKS: 'nP 5 s to: SIGNED: r' • 1 if enclosures are not as noted, kindly notify this office. ,I44— MAKES -• Im� r .. N lec all 1'Mlw -_ arc duns ���«ru: — for approval — Approved as submitted For your use _ Approved as noted As requested _ Returned for corrections For review /comment — Resubmit copies for approval wb'" surer, — Submit ^ copies for distribution ARKS: 'nP 5 s to: SIGNED: r' • 1 if enclosures are not as noted, kindly notify this office. ,I44— October 29, 1998 Mr. Robert Morris, P.E. Putnam County Health Department Geneva Road Brewster, NY 10509 RE: Sandin East Branch Road Southeast TM #24 -2 -38 Dear Mr. Morris: This office is in receipt of your latest memorandum for the above project and we offer the following comments: 1) Enclosed are the previous approvals dated 8/27/90 and 7/12/87. 2) Mottling was observed at 4'0" by your office, which is an indicator of the high water level. Two feet of R.O.B. fill has been proposed to compensate for the high water level. 3) The entire site is located in flood zone A6. 4) Invert elevation has been noted on the SSDS plans for the house, septic tank and distribution box. 5) Well keys have been shown on the SSDS plan with separations labeled. 6) Enclosed is a letter from John N. Calbo, codes enforcement officer for Town of Patterson, concerning roof and footing drain discharges. 7) Erosion control has been added to the SSDS plan. 8) The water service connection has been added to the SSDS plan. 9) Percolation tests were witnessed by Field Technician, Vinny, from your office on 7/8/98. 102 GLENEIDA AVENUE, CARMEL, NEW YORK 10512 -PHONE (914)225 - 3060 -FAX (914) 225 -2955 - At this time we would ask for your continued review of the above project. Very truly yours, PUTNAM ENGINEERING, PLLC By: Ken Hurley KH:rk (File 980540) PUTNAM ENGINEER /NG. PLC Engineers and Planners 102 GLENEIDA AVENUE, CARMEL, NEW YORK 10512 • PHONE (914)225 -3060• FAX (914) 225 -2955 \6 1 'Rev. 1 1/88 MUM COUNrr DEPAUlUItr OF KLUM " ` . Dilfli atllovrrllsswld B•wW 3�vlssa. Ctr>.ai. N.Y. laSU belosor le Pfev Pan" Pfd A FOR WWAW DEFOML SYS= >tiifbl•o Nsne t -j/I�' -%fii. Litt i o..adAPp�eg.e 11.•■.l irul. SAr•1D► r•.) w CZWfB LATE OF COYPUMUZ Two a Volvo Taw MOP 15 hied 3 rr iswwewel RewbbR Dab of Flow Aff vd MaIrS AMWee -- �Z W � �QEfcT Tw' 6- T WI W STb t'j ap 115q(0 Date Subdivision Anoroved Fee Enclosed 0 Amniint •fi11lat 2YP• 4AS 124M • QF-� • L•t Asa, �� 120 SGt. F'['. Pto Sweden Ottb LJ Dap(r va m Near of 3 D••ip Flow G P D rM Nowks sp b =rv++4 wraR PU b osptpletd S.weft se-Mose s,.gons Po anew at to sw* Tack ••d 429 L,F of Z't -j1of AFibog --,0 cal 'I 2.x.1 CA To be onswi ew by To 8r-- L*TEP"- 1lbjE2 Air wow SePb° FA& S"* Ft.t. Ailhaoa an s•nb DM b �Ktnlr�lt =�� ui� O&W Spllilg MMft V4,0-15, Fi LL 1 raorasant that 1 am wholly and completely responsible for the design and location of the proposed sysfem(s)1 11 that the saparate few • dl aYI s��,M�� soolre described will be constructed as shown on the approved amendment there to and in accordance wan the standards, rule an rqu a one of • Y"Twiii� Courdy DeoWment of HmMl% and that on ca illation thereof a - Certificate of Construction ComWiance" satisfactory to the commissioner of Maaahwia be submitted to the Oap•rtwwl4 and a written guarantee will be furnished the owner. his s wAssrors. heMS or snips by the builder. that said twiddle will gem in pad ep«atllg cendRlan any port of sold swage disposal system during the period of two (!) vows Immediately following the date of the i•Rs• Mar Of the approval of the Certificate of Construction Compliance of the original system or any repairs thwetos 2) that the drilled welt deviled aiteve WO N loaded a dwa oo the •oorev A Wan and that said wen will be installed t a oroawoe waft the fta ules and rGIRSMR—of the Putnam cewty oft"" of oft"#L Daft O i1C� 9-9 dM -2 4A C-L- ►JY t.tcense No 3899 e) APPROVED FOR CONSTRUCTION: This approval 611016raf two revocable for cause er nay N am•mded or modified when consi PSW MM a M Perm R Appralod for dilpes•1 of domestic s Oab my the date isaled unlesa construction of the building has been undertaken and 11 afy by the ComMMjWW of NYRw. Any change or alteration of construction only. �� Tale :�• �., ' ' - : a�:'�'at �, to sy °V��+'rt�7'�sti�5 "\`�5 (; � +. �'���F �.{ P r ti a Y5 s•"Y i � -; °,. I =�i �vL • s i, � c d�•q -t 51?'r�.' �1 �� '�4 jpk. .'<`T� µ i r. � 5 p •� '• •. `� ?`fF�r..t� 7. IN a il�R go::� I j�'�� S ` � • , .. ���.• ..t' `�� tFt��"lt tta iSla���, �M �S.j`,y iiS.tl.X. "��, ry i •y r t; llfl7(AIlCOtlI1lY IAl1lQo w Rpm IZA .' + :.. •' , •' . , .. D11WsI1 f��1N a�MlatllliM. Crl�i A.Y. !MU ,_:M1r� wrtMr tit�it /' 'J'101rl POPM 41t S=W&CM wpow, t1=T= tegowad �oP•n1S'�3c1YtG Petters M �l . I , ftlilrYlr NN. n .I j ow AAlw�rl, moft Harter 2 QA Ward Stroar iww I bftf. resid rice 87 a set Am ��1�._._ h say.. 0* pN,+;_,�VAMs, Ndr f� I Dalp Hr. G ! a d�0 IN =RempownY wb.Mirnaw" t roles V.+.t1� s� r .t 10000 L Ztmt To 00 too be decermiried wtlo.r or sop* � Adhw .. .. . 0l1 FINI I sal See,* Do" by to bA Ia r .-.Ad6oW Goal memob .nW haMM1 tn11 a tad �Ir�rlly e0wrpstMy tONSMOI0 t0t IM d~ oM tliilalrtl N tM Mfw404 oyt{rf�lli I IAU the St0 ww • Oil OwM ewlwo MfirrO deou Mtl biN tfO Oowft psr 1s tlro••w M Me MMONw wwOwradwo theme N oft in esowd w was the IIMO1f /t. IWM Mow Cttwlty O�MffwlMt N she thill M soltr0W** fttwwwyt 1 "CrIM MOO M CrwtYOWM CrA ONADO • dWWMofy 10 1 Cowuw4MOM1 of OWIMleMl M PI O IN tad tlllOtrwl fll/ s le/Nlort VOM OIOO t•tr N tvroA MU IM ort 6 ills VASM0Ity son R otf011f by am to NW. am YM So~ Wei Pike vt ;M apryttr 6 " Mi" any test t1 tsto twlyo dis"M wdm rwwav as wow of Iw t!1 yowl iwwNMNh1 14"Wohw the eats N the Wow Mp at tlq otgltiNl of IM: ortiltNtr of GMtlrotiMt'CMItN+snp Of tArRgUw 11111sn1 R a01► IrgYO tlrrsMlll ttyol f lo Oti1M0 wN NNwN swr lead W am" is NNW* ale t awe"" rtslt Ow toot aid boll wal M iAlgl" M waMSi leYlt the O) 06 tytof one xy� COwwty DOOM WOM tlf ffwsit iI s /M Md.Ww r • ONO , , ./ - • f � LAW, APPROVC0 Ron CONVIN IONt Thit "Dra f onern two MRS "IM ttot0 wow tMlMtrtltor of arm aftwo IIW OMP YMMWIM A" is Ipouble /M strtrsO of may tiff now*" of fOMlfiMleuwt Consider" *000smy or Itll Coal isionsf of fpotllt slry sNnOf 01 sKt trtale rf srlrfttviflow mawk t s MW ttwlwo. As tot view" oaf 40"Ais W1kMy Mt~il�•l!A/ot ,Mwo1r NIM .tflNfy 0asy. 3 I i J I i I l I I I I JOHN N. CALBO Building Inspector TOWN OF PATTERSON PUTNAM COUNTY PATTERSON, NEW YORK 12563 October 26, 1998 Putnam Engineen.ing 102 G.2eneida Avenue Canmet, New yoAk 10512 RE: FOOTING /GUTTER DRAINS Deah Mn. HuAtey, In Aupon�se to youx tetten ob 10121198; to the but ob my knowledge, booting and gutter drains are pexm.itted within 100 Ueet ob a stAeam on bxook. I{ I may be ob 6uAthen assistance, pteaze do not he s.i.ta to to contact my o 6 6 ice . S.incenety, Jo VW. . Catbd, C es En6oncement 066icex JNC /cs _ Telephone . . 878 -6319 PUTNAM ENGINEERING, PLLC LETTER OF TRANSMITTAL 102 Gleneida Avenue Carmel, NY 10512 _ ... Date: 914 - 225 -3060 Fax: 914 -225 -2955 RE: 4:51A Pi tf pl-� �� S TO We are sending you attached under separate cover, the following items: Shop drawings Prints Specifications Copy of letter Plans Other: ri ! �!• 0�7 -v` ._ jWjA ■rte! 1. �� •�' These are transmitted: _. For approval _ Approved as submitted _ For your use _ Approved as noted _ As requested _ Returned for corrections — For review /comment _ Resubmit copies for approval _ Submit _ copies for distribution REMARKS: Copies to: SIGNED: If enclosures are not as noted, kindly notify this office. 1416 -4 (2(87) —Text 12 PROJECT I.D. NUMBER 81T.21 SEOR q, Appendix C State Environmental Quality Review SHORT .ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant.or Project sponsor 1. APPLICANT /SPONSOR Pik Tf,JA M 2. PROJECT NAME, PA La L S o fps rz.) i r-4 3. PROJECT LOCATION: _ I ��Z'T�i2 Fo TN Municipality r V County 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) 40a' sow o F= I•-• &-, ' 1 "r`► 0 l-A o I..•l-•oi..w c+4 o y! 7 4 i:'r-- `^r E-ST S t 01IF,- OP Cmsr A- �.N- � tz , 5. IS PROPOSED ACTION: %ew ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: �p 7. AMOUNT OF LAND AFFECTED: Initially 1 -9 S acres Ultimately � ��t g acres 8. WILL ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? �aq Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? AResidential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCA�No C3 Yes If yes, list agency(s) and pennlVapprovals it. DOES ANY APPPSccc,,,PEECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes UPJo If yes, list agency name and permlUapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMI'T1APPROVAL REQUIRE MODIFICATION? ❑ Yes No I- CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE p, Z-2 Z lf-j Applicant/sponsor name: �V- Date: 1 Sionature: If the action Is In the Coastal Area, and you are a state agency, complete'the Coastal Assessment Form before proceeding with this assessment OVER 1 FART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF ❑ Yes ❑ No .,. B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another Involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels,. existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly; C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities likely to be induced..by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified In C1•C5? Explain briefly. C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. :. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (ro be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it Is substantial, large, Important or otherwise significant. Each effect should be assessed in connection with Its (a) setting (i.e. urban or rural);. (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been Identified and adequately addressed. ❑ Check "this box if you have identified one or more potentially large or significant.adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or' prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental Impacts AND provide on attachments as necessary, the reasons supporting this determination: Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Name of Lead Agency Date 2 TitTe-of Responsible officer Signature of Preparer (if different from responsible officer) Received ot,_ f �- The Sure Of ® ® a IIIIiI Y7Yi1[Vtir11i YI1f1/1YVlYYTI i' r / y r, y %IY1171I111YYT11VIY 11'YV7YVI W FYY[1lY111Y1 V1IIVYIHYIW "1l11kVY1V V I V VA111'11YYIYV INi1f VtilYYi VYl V V>1/YI VNI W I VYlY1AH Vl VYIV1130 V 11/111 Vlili 1 �I i P'UTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of �� ��r j 0 w Located at �o,(�v �� j6k4 T/V � Tax Map # 2_4 Subdivision of Subdivision Lot # Gentlemen: Filed Map # Block 2 Lot �� Date Filed This letter is to authorize f VlWA-M EP �L II) LZ:'MN1(S a duly licensed Professional Engineer )�c,-_ or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public. Health Director of the Putnam County Health Departme d to sigrr;�ll necessary papers on my behalf in connection with this matter and to super f wit 'on Qf said wastewater treatment and/or water supply systems in conformity wi cl.e 145 and/or 147 of the Education Law, the Public Health Law, and the Put S ode. Very truly yours, I Countersigned- Signed( i (Owner Mailing Address 2 �� eJ U,/. State :J Zip I b'�;) 2- Telephone: Mailing Address: State Zip .� Telephone: &7- 9�b� Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES { APPLICATION FOR APPROVAL OF PLANS FOR - - A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: 144 L_ Sor► r311--3 Ft4 i LL- I PS .&A b! t o s 2. Name of project: �� O rJ — G,::5 ( S 3. Location TN: 4. Design Professional Address: I- 02 Gl ErJGt u* b 6. Drainage Basin: (fA R 7. Type of Proiect: _ Private/Residential Apartments Office Building Food Service - Institutional Realty Subdivision Commercial Mobile Home Park Other (specify) 8-'Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted X 9. Is a Draft, Environmental Impact Statement (DEIS) required? .......................... 111 45) 10. Has DEIS been completed and found acceptable by Lead Agency? ............... N 11'. Name of Lead Agency tJ / A.. 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ........................................... : ..................................... :.....:.:.... 1j- �..... 13. If so have plans been submitted to such authorities .................... 14. Has preliminary approval been granted by such authorities? Date granted: 15. Type of Sewage Treatment System Discharge .................. surface water >e groundwater 16. If surface water discharge, what is the stream class designation? .................... 17. Waters index number (surface) ............................................. .............................�� 18. Is project located near a public water supply system? ....... ............................... QICG= 11�Z•- 19. If yes, name of water supply Distance to water supply T`I6M 20. Is project site near a public sewage collection or treatment system? ................ 21. Name of sewage system Distance to sewage system ►TM`M 22. Date test holes observed '1 3° 11.9 23. Name of Health Inspector 24. Project design flow.(gallons per day) :b® O 25. Is State Pollutant. Discharge Elimination System ( SPDES) Permit required ?... 7140 26. Has SPDES Application been submitted to local DEC office? ......................... 1J d Form PC -97 2 27. Is any portion of this project located within a designated Town or State wetland? 28. Wetlands ID Number .............................................: Nj ............. ............................... b 29. Is Wetlands Permit re uired. . .f i!J Has application been made to Town or Local DEC office? ............................... w /2�-_ 30. Does project require a DEC Stream Disturbance Permit? .. ............................... 1_J D 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No DESCRIBE: �Id 4�__) t_� A!�71) 33. Is there a local master plan on file with the Town or Village? ......................... 1J e!�? 34. Are community water and/or sewer facilities planned to be developed within - r 15 years in or adjacent to project site? ................................ ............................... 35. Are any sewage treatment areas in excess of 15% slope? . ............................... 36. Tax Map ID Number .......................... .......:....................... Map 2-4" Block 2 Lot 3F5 37. Approved plans are to be returned to ..... Applicant Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent.to the Department, and need. not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES. U-Cy.1is. Gi SIG t--Iv�(ZL Mailing Address: ................................... 10 2- _ l_0 '� . >:'. i 160 z au sr: 4 8� 9 L b &AL. ..pdG btp?1G TA IC DrBoX $ q BL9LT¢iG M;FYZ9— aRiVG- %A1 { W w14Y c•8• DIMENSION. CHART (in feet) Number A 1. 22 A 5 2 68 90 3 32 S5 4 5 27 qro 6 27 41 7 27 37 8 28 3r9 g 3 f 32 . f0 35 31 t;1 97 f {2 (iZ 95 109 13 94' 106 14 93 1o3 r5 91 101 ! e 91 99 17 91 100 y PAF?CEL :4 PLAIT... NOTES THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WAS CONSTRUCTED AS INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS INSPECTED BY ME BEFORE IT WAS COVERED OVER. THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE WITH ALL STANDARD RULES AND REGULATIONS OF THE DEPARTMENT OF HEALTH AND THE NEW YORK STATE DEPARTMENT OF HEALTH. SURVEY INFORMATION FROM SURVEY PREPARED BY TGY.CY BER6EWbD2FG GOLLIHS i L.4. G, I R �s ray �� •. �. •y'.i f 3., � # '�'.�`R s � '?^t - ''4 '4 IT „ 1 �1 ,.� PUTNAM COUNTY �.I 1 Ft :. t� ' ., £Qit!fsfon of�Enwronmental ,_CONSTRUCTION PERMIT FOR „SEWAGEDISPOSAL SYE Located at �� t Branch 'Road -Subdivision X +Owner /Andress l� ggT1C�1T1�F�LSt Building Type 1 Fa1Tl Residence got Areal X87 1, ;:Number - -of Bedrooms 3 Design £lOw G /P /D 600 GPD.� 1000 c n d`Separafe Sewerage..System to co6siit ,of; `C a;To be constructed by ' T0 ,be determined x k Public, Water Supply Supply From l 3 �f~Pnvate Supply ,io be tlrilletl by' Address 1 :. 4 z ,t:,'•�Other.,ARequirements x 2 in`:1- 111`requir -ed r t; l represent that l am wholly and completely responsible for the des#9n, above,.described' ' 411 be' constructed as shown on the approved amendnil County.' Depart Mont M. Health ;,and that'on completion_the►eof a "C. 1. be subMitted,.to the,Qepartmint, and a- wr#tten ;guarantee will be.f } R ':place in good - operating condition any ,part of said "sewage clispgsa F'ance of .:the approval of, -the ',Cert�hcate,`of Construction. "Compliaic "will be located as shown on the approved plan antl that said well will De a `County- Department of Health * W 4 Sc _ y... + S w {t .•�Jd a. ,•;Date ci�Ci%`�� �- _ � Signed Add:eu -C.,g hIri;hAss�'ciates APPROVED FOR CONSTRUCTION -This approvalLexpires� one yea► i revocable fo r. cause or may be pmended.or °modified,when. cons k,'requires. a new ;permit. ApproJed for d'i'posal -of domesfi sanI ar DDate rJByI " }:Rev 9'81 PARTMENT OFrHEALTH Permit:a f1%1' 'th Services, Carmel, N . Y 10512 4 Town Of Patterson x 5 tir own or illage I a fi. Tax-W- 1596:'.:, p" 15 "s Block - `3 rot r �� irRenewal s .[� V Rev.{sion P1 �Y R` =1 fL83 ,6 trreViOuS Approval d .9 ft� _.:� Fill'- 5ectiOn`Only �� ^ "`a ]W�-L x - .�• `C N x l P G :H D Notification Required xx`�' X429` L,� F x��x 2'� w�ide;�, trench ° • ; apt�c�Tank :and:' Address ' termined a c i a M Y { t Fi d d + L r " a L fi cationlof,.the proposed systems) -,1) "at~the separate:s6wage,disposal system #re to and #�n accordance with the standards ru10'a RF regu lat ions o e u nam ife *of Construction Compliance 'satisfactory to'the,Commissioner`of HeaithWill ed the owner hii'successors, heirsor aesigns`.by,the:builder;,that_ said builder..will �M�d4, ing the period -of 3wok(2) years immediatelytfoltowing the'date'of.,the issu- Ae original system %or any`repairs$liereto 2) fliat:ahe drilled well describeC above''. etl �nj accordance with the standards rules an _ regu a-n ns of _ the Putnam Cam' 26008, .a icehse' +No C 37: F z f a .L the", date issued ,u_ onstruction of the'buildrng. has .been undertaken' and is fry by the 'Corn Issione :ofSHealth Any change'„or Iteration of ;construction ge nd %or p i a <wat :;ripply only c ' yit T.. \� y 11 t �; PUTNAM COU �` ,t st f Orvisro`n of = Envi�gnn jz CONSTRUCTION�PERMIT IFOR 'S,EWAOE�:.,OISPOSAI 'LOCated.,at c 4�'s'�' ' �A140- r r- ,r rJIA Y S Subdlvfsion Owner %Addiesar ��•�� £ r ff t i. o e r 6uiltlin9xTYPe� ` �A►1 —J '�t —^ E LOt «Area " � � 4 Number of Bedrooms 4 Design Flow Separate :soweiage System to coe'sist of � c11 7k1, "To be constructed by` TOE "L�iE z. r Water Supply 4 Public Supply From * ` T. t• tgF i �'SPrivate.5upply;to�De tlrilletl by � s 1i n dZ Fr t L_ �EQ( IeE i[ .Other Requirements a 1---- > once of,ahe aRr will be located a, County Departrr y '. l C APPROVED FO w` [equves a new " ►mit 14ppro for disposal of zdom Date (1 V4 a "k a fay l -Y DEPARTMENT OF HEALTH Permit r '' , �l'Healrh Servrces Carmel Y. 10512 y N a YSTEM `� j:To�til E)F' B.'r EizS'Ot�l 4;, -'Town or 'r ;silage;. + �z Tax M ; 14 M Renewal f Ravieion Q 1 DateOf Previ6ua Approval �S�' f �ti Fill Section'only ❑ �"• � t Notification Required - c�'T� ' a; « ;Gal Septic Tank_ f -,''', 'y '" ;� Address ' •., _ k -• r )n and location of the proposed systems) � 1) that the sepaiate sewage disposal 'System mans there to ands in accordance with the standards, rules a�regu a ions o e u dam `C'ertificate of Construction Compliance satisfactory to ttro.Commissioner of. }te Ahfwill j furnished the ovVner his successors, heirs ^or; assign's'oy the °buildei, thpYsold builder- -,will isei iystemaduring`.;the period of two (2) years fritmeGately following�thedste�of the:ISw rice of the original_systeiri or anyrapairs thereto; 2) that,the'olrilled well Qesaibsd afyo "ve", , �. f ba installed.,in accordance -with the standar s, rulea•and regu aTi oni s of the: Putnsm � K ► L'icense No..�l:fc00$ ar, om the date .i`ssued unl construction 4of the «builtlfng •fias been undertaken and =,is S d:neeessary by ,the Com' sslo r,of.Health. Any charge or. atteratbn of construction Y swage, and /or pr v e wa r supply only t Title 1 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 A Luku 75m rn4 Address V)bop Nii.� "Tie c t Cogrr TN,. 'PAT rWSoT Y )Z57, I Located at (Street ,s A,v� Sec. ,,4- I5 Block 3 Lot �1,ndicate nearest ree Municipality Watershed Cro -row SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole 1' 10 I'4o -t^..... ,,Z o " /• 7 Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Water ve No. Time From Ground ' Surfae in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 1 ;13. 1 12:0S.- IZ•35 o" 2 �� �" 106, 2. I Z` -S7 - It. o•7 3.0,, - - = d2.0 " V,d2 a2 is/, 3 1' 10 I'4o -t^..... ,,Z o " /• 7 /. % I $ i 1 iZ'io - iz44fl 3o1 - Ig 1 SA 2 Iz43_ 1 ;13. _3o4,,.:.. 1%# ?.,7 J.1 - ;I$�1 3 I' is- 145 3a.:.:. p lg X9.5" „ 1.5 5 �2: a o- .2'So o 1 e " 5-" 4,57 •, �ZOZ, II J 4 PU NAM COUNTY 5 DEBT, OF KEA Notes: 1) Te qts to be repeated at same depth until approximatelyy 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. 1� 4 �)�. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS.ENCOUNTE'RED IN TEST HOLES DEPTH HOLE NO. # I TIOLE.NO. HOLE NO. G.L. 611 1211 18" 24" a 3011 Lo A m 36.. W le- LA 42" 48" 5411 6011 (1�ATE12.. 66" 72'► 7811 84" INDICATE LEVEL AT WHICH GROUND WATER.IS ENCOUNTERED INDICATE LEVEL.TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY gZAC Date- DESIGN Soil Rate Used Ac) Min/1 "Drop: S.D. Usable Area Provided 5-6-tm No. of .Bedrooms Septic Tank Capacity I .0 AL k WIA SoNk' Absorption Area Provided By 4 _ L.F.x24" p L15 �(] e c .z Name _ate" s ti A s -_ r, et _ _r_ Signature Address" SEA �� THIS SPACE FOR USE BY HEALTH DEPARTMENT. ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Pate PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of /�'U L- SAND \N Located at EAa j RiZ%}NC,N (T) Section %✓ Block Lot Subdivision of A Subdv. Lot # NLA Filed Map # NA Date N A- Gentlemen: This letter is to authorize C4sK,N /Ts�c�c,i •� 1 �S �� a duly licensed professional engine der or registered architect (Inicate 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 • conf-ormity with the provisions of Article 14.5. or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersi .E. R. A. 37 I=A gz Address Telephone Very truly yours, Signed ►,; Owner of Property"' ��'W ` VVL�l i' �.YWV1 0 Ai-U Address Town Telephone PUMAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIROIMTTAL HEALTH SERVICES Date: �;�£ 13.1983 Re: Property of, A L LAH �SrA r` rH Located at CAST Nc N aAD Section -r6j Block 5 Lot Gentlemen: This letter is to authorize a duly licensed professional engineer, to apply for a Construction Permit for a separate sewerage system; to serve the above noted property in ac- cordance with the standards, rules or regulations as promulgated by the Connissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to super- vise 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 Sanitary Code. Countersigned: Cashin Associates, P.C. 37 Fair Street Carmel, New York 10512 (914)- 225 -8088 RIM, 0 Very.truly yours,. �Mz 1 a Mat Oaf Address 1 '41, 1 t N i • JUN 16 1,063 PW NAM COUNTY DEPT'. QF HEA'L -1y M aa�ir�eMi:,y � o � Ai>tih�tra �b wa)ar ie Mwla most aMi b Ot�'l�ftl+►11�1�7 emu... Oyu "�i�'�wb �� �• O.g : Ft (�1... � I - attraMOntYliat I Tii�'wholq MO:cpnpMtNy rHPoetibN tOr ti Msi�n ai ,"io' K 01 tM p►OpoMO syttNn(ps 1) that the apgat* wts= difamI =em at o elaeiiait wili.bo ConftrueWO of fhowe"tl ' , pimty �O�Oartnlfnt.: of iwNh, -:atir _that oncon bi ulb� to tM. ONMt. M., aM 'a, nNtai Mtco _ Ih po/ 'iP rotY4 on: env M!t •o/ oaoa of tM ammko l ,ol tM.'Gitowde M Co'n nst►u#Ien Collianp' Ytis>faeto!y: to tM ComniiMlO(Mr ofaMMlthwiU fN► his nuawroiti hil 414:liim*s,by tM Wtldii►. tlNt said 6444 ► win • hkoirio0. of two (2) Vows hnelaNately foltowwo tllaalata of the Nry. Lftirtan ar aiiy'ipaYt_tMratos 2) that the arm wMl doeirm" 060w I. represent that 1 am `wholly and "completely responsible forthe des v above described well be constructed as shown on the.approved amen County OspartmenY Hof Health, and that on completion thereof' be submitted to the -bepartmant and -a written.`guarantee' will t place in goo d• operating condition any.-part of,said sewage ii isp once, of thi; approval'of the-" Certif icate of Con truction; Complii Will be located as shown on the:approyectDlan and'that said;weltwill' County 1Oepa►tmTen'�t(•)of:c,H�ealth. ; Date. t c J L71:'. 1 Sign ;Address ; APPROVED FOR CONSTRUCTION This appiovY V- expirestwo yea revocable for cause•oi may be amended'.or modified when consitlai •requires -a new permit. Approved, fOr•disposal of domestirsanit rev. 1/87 Date I ion 'of _ the proposetl systern(s),: W that the separate''sewage, disposal system to and.in accordance with the standaros,.rules:an regu a �onS o ; e; u nam of.Construction'COmpliance' satisfaciory-to the Conimissionei of Health will I the owner his successors, heirs or assigns by the builder, that said builder will dunng,the period of two ..(2) years Immediately, following thedate,of.the issu- original -system or- any repairs thereto; 2) that the drilled .well.'doscribed above in accordance with the °st daids; rules and reguaions of `the Putnam P. E. R.A. date ih"d. uniass construiction of the building has been undertaken and is Dy the`,Commissioner of Health Any change or alteration'of construction and /or t' supply only. ` ti »r 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 1°5-83 WELL LOCATION Street Address .3r' r1 Town/Village/City Tax Grid Number o P 5 - 3 -1 WELL OWNER . Name &x_ Mailing Address OPrivate 202 'Z-5T. T S-or -A tkyOPublic USE OF WELL. 1 - primary 2 - secondary KRESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION p OTHER (specify []INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /41 PEOPLE SERVED�F /EST. OF DAILY USAGE600 Sal O REPLACE EXISTING SUPPLY O TEST /OBSERVATION GI ADDITIONAL SUPPLY 1XNEW SUPPLY NEW DWELLING) 0 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED []DRIVEN ODUG GRAVEL OOTHER IS WELL SITE SUBJECT TO FLOODING? YES V' NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No..'. (WATER WELL CONTRACTOR: Name ir eC> Address: ,IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: I`I�A TOWN /VI^L/C,ITY I DISTANCE--TO -PROPERTY FROM NEAREST- WATER- MAIN: LOCATION SKETCH b SOURCES OF CONTAMINATION PROVIDED go' ON SEPARATE SHEET (date) (§ g n 0 64 6) 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,r (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 suc a manner as not to degrade or of wise contaminate surface or groundwater. Date of Issue: 19 Date of Expiration 19_ Pe it ssuing Officilf Permit is Non - Transferra le White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller Re: PUTNAM -COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date A 10. 1 IBI Property of Located at Block -�S Lot (T) Section- Subdivisi.on of Subdv. Lot ,#I,:I/t-\ Filed Map # Date Gentlemen:, I 'Sz This letter. is to authoxize cll� —SvA IQ A C- kTES 6 duly licensed professional engineer 'x- or registered architect .(IndicateT to apply for a Construction'Permit fora separate sewage system, to serve the above no,ted.property in accordance with the standards, rules or regulations as promulagat . ed 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_provisibns of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersig P.E.!, R'.A. Address Telephone Very tr ours., 3igne Owner of Proorty Address Town Telephone j