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HomeMy WebLinkAbout0843DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25. -1 -9.4 BOX 9 1 . i ;. . Irl �� �� ii•tip BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N.; M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 February 16, 2001 Barbara & Steven Tangredi 8 Partridge Lane Patterson, NY 12563 Re: Addition: Tangredi No Increases in Number of Bedrooms Partridge Lane (T) Patterson TM #25 -1 -9.4 Dear Mr. & Mrs. Tangredi: I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the. latest revision date of February 17, 2001. The addition is approved with the following condition. Based on the information submitted, the above mentioned addition is approved with the following conditions. 1. The total number of bedrooms must remain at four without prior approval by this Department. 2. The area of the existing sewage disposal system, and its expansion area, must be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e.; new low flush toilets, restrictors for shower heads and faucets, etc. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Patterson. If you have any questions, please contact me at your convenience. Very truly yours, ...- William Hedges Senior Public Health Sanitarian WH/jp cc: BI (T) Patterson I .J DEPARTMENT OF HEALTH Division • 0f Environmental Health, Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 12 . BRUCE R— FOLEY. R.S AttinB PUMC Moalth Direst. -jt Putr:arn County Dept. of Heald; 4 Geneva Read 3:ewster, NY 105C9 Residence Town Gentlemen: Accoiding to records maintained by the T0w n, the above noted dwelling IS -. - TS NOT . _,_ _ __ - -- - -. in co;nplian.,m �� -ith ToNti cods and the total number of bedrooms on record is This information has been obtained from: CERTIFICATE Or OCCUPANCY: A3 ESSORS RECORD: OT HER uildin-a Inspector �;4, DEPART NE i ' OF HEALTH Division of Environmental Health Services 4 Geneva Road BreWsur, Naw York 10509 Tel. (914) 278 - 6130 Fax (914) 278 - 7921 PROPOSED At7�I� �I PPLY ATICl?r (BEE D NTI_A,I�QI\ -Yl BRUCE R. FOLEY Public Health Direc!cr STREET �iTO"-MXMAP# T MAaM '� " £ PHO-.N PCIiT3 # "O NLAILLNe ADDRESS a4z e r DESCRIPTION PTION OF ADDITIO;d NUMBER OF EXISTING BE ROO:1LS� PROPOSED # OF BEDRO (FROM CEFT. OF OCCiJPANCY OR CERTIFICATION FROM BLILDLNG INSPECTOA) *Any addition wench is considered a bedroom 'requires format approval of plaits (Construction Permit) prepared b�� a fr,:fssio:lal Engineer or Registered Architect in accordance with applicable sections of th° Puraam County Sanitary Code. Please submit this fern zad the f0owing to ?ub= Couaty Health D,-pt., 4 Geneva Rd., Brewster, NY 10509, Phone 278 -6130. 1. Certified check or mo-acy order for $100.00 2. Sketches of existing floor plan (drawn to scale, all living area Including basement) " Non- professiowJ sketches are acceptable 3. Two sets of proposed floor plan (drawn to scale, with name, stree.., and tai: map,",) * Non- professsorW sketches are acceptable 4. Copy of swrvey showing well and septic location, to the best of your knowledge. Include date of installation if kno.in. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Cert. of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwe?lingg. OFF[ :E UMW Commen's Feb 98 or Provide Mast 'P.-16 17d D. Permit &dv Lot # 'PdvMe Supply DOW Y— b Addries A Jr X 4klo -rn NSA Erosion Conlzol.Bein Comn � e.Gdoder Garbag Been 660160 Other Res aijidimments I certify that the system(s) as listed serving the above preaLsei! wer!t-tons cted a sentiall as shown the 1" of the completed work.( copies of which are attached) and in accordance with the standards, n ac r c f :and the permit issued by'the a, County Department bpi th fttn&M , z U Date -,CsrtifIed*by' P.E.— A.— :Llcense No Any person occupying promises served by &84bbve System(S) shall promptly. ta ke su action as may be necessary 10 iM4Vre the correction .of any unsanitary conditions resulting from such Usage.-lAoproval of 'the separate sewerage system Shall become null and void as soon is a Publ,-. unitary ewer becomes available and the approval of the - pr,14iWwiter '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.CommiWoner of Meal U �O�n.mio!djflcatlon or change Is necessary. :By Title i (• " j PIITNAM COUNTY DEPARTMENT OF HEALTH 4 1 e eV x„ ., t ' < Division of Environmental Health'Services, Carmei, N Y 10512M ,. a t f � � '� ;a', . a 5 Mst A& P[O v Permi -. t _ _ _CERTIFICA_ TE " ®F,CUNSTItLTCTION> COMPLIANCETUR SEWAGE DISPOSAL. SYSTEM`' VA% T/QSG%I.•''' A, } Town or vnlage Witt` Tai Map Bloch 'Lot ' Owner /appllcasit Name i r . r ' y� Sa Su d ° m" Lot q M,vung= aaa.ee�=— �Ll -�A p` �� DatePermftlseaed �J - / /-", paste Se erage`System bailt;by , ' Address r Consleting of �25� Gallon Septic Tank and ✓D L� /T l�/yC..C�' ...`_ t � Water Sapply= Fai ll& Sa as From' r + PP Y A ors Private Sapply Drilled by i s a L,N s s Address Banding Type /P�s! i�T /}L Has Erosion Control Been CompleteaY "Number of Bedrooms ''t Has Garbage` Grinder Been InstslledY� b3,v Othei Requirements I certify at;the sy_e'fem(s) ae listed serving the abov Me ,-,F9nqtjruC ted esaentiall ae'ahown `the 1 a of`the completed work I copies of which era attached) and in accordance with the etandarda rules andr ationa ac r v ce wi e f plan, end the permit issued by the putnem Co y Dep�a%rtmefit OP Health AIA Oats (,/J) a! Csrttfled by' Y At } P E, f •R:A. Addreu j 'An person occupying premises served by,ahe above systems) shall promptly ,taketw action °af may tun sitar to u ! ►a the correction t Of any UIIYr11ta ►Y I. Y ! ,conditions reiutt ng from: such 'usage ;Approvsl,.of the separate saweiagesystpm, shall become null ind votd at aoo "�i a pubs; 'Ynitary awar.,bewmas available antl,the app ►or +l of the private'vvater supply shall'becoms; null `antl void when a w wpply bdeomaivallabN. Such approvals are tublect ,Eo modif{ tion, or change when in the :judgment, of the Commissioner of modifkatlon or• el+anga If,;'naeifgry. te 0 PUI'NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMaUAL HEALTH SERVICES uen Owner or Purchaser of ilding Building C6nstructed by -1'aoAn U�ne_ Locatio - Street Municipality Co�ono& Mau G r Building Type s / -- ?,- 5r Section Block Lot Subdivision Name .1� Subdivision Lot # GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, worlu nship, material, construction and drainage of the sewage disposal system serving the above described property, and that it 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 imuedi.ately following the date of approval of the "Certificate of Construction Compliance" for the sewage disposal 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 Director of the Division of Environmental Health Services 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 bui ding utilizing the system. Dated this / day of 0,-_ 19 ieA(Contractor Owner) - Signature Signature /Z,7- Corporation Name (if Corp.) co /M-0 to�-1 Address rev. 9/85 mk Corporation Name (if Corp.) /' s «� 7A Add ess /2 SP�� i C�G�a WELL COMPLETION REPORT Office Use Only DEPARTMENT OF HEALTH ` Division Of Environmental'Hiilth"Services - " OF HEALTH J PUTNAM COUNTY DEPARTMENT STREET AOURESS: IOWN ! I TAX GRID NUMBER: WELL LOCATION Partridge Lane, Patterson, New York NAME: ADDRESS:. Q P91VATE WELL OWNER Steve Tangredi, 14 Center Road Carmel, NY 10512 ❑ PUBLIC USE OF WELL 6H RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED 1- primary ❑ BUSINESS O FARM O TEST /OBSERVATION O OTHER, (specify) 2 - secondary O INDUSTRIAL O INSTITUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE'SERVED / EST. OF DAILY USAGE gal. REASON FOR .[]REPLACE. EXISTING SUPPLY C]TEST /OBSERVATION ❑ADDITIONAL SUPPLY DRILLING [2]NEW SUPPLY . (NEW DWELLING) [] DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 625 it. STATIC WATER LEVEL 16 ft. DATE MEASURED 7/12/96 DRILLING Q ROTARY ® COMPRESSED AIR PERCUSSION ❑ DUG EQUIPMENT ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE 1 ❑ SCREENED O OPEN END CASING ® OPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH 31_ ft MATERIALS: ® STEEL O PLASTIC 0 OTHER CASING LENGTH BELOW GRADE 30 ft. JOINTS: ❑ WELDED W THREADED ❑ OTHER DETAILS DIAMETER 6 in. SEAL: ® CEMENT GROUT O BENTONITE 0OTHER WEIGHT PER FOOT .1L Ib. /ft. DRIVE SHOE ® YES 0 NO LINER: CJ YES kI NO DIAMETER (in) 'SLOT SIZE LENGTH (It) DEPTH TU SCREEN (It) DEVELOPED? SCREEN DETAILS FIRST O YES ONO -- ....�_ .... ._ .. ._._ _ . _. SECOND..._ _..__..r.__....._.._ .... IfOUliS GRAVEL PACK ❑ YES GRAVEL DIAMETER TOP BOTTOM ❑ NO SIZE. OF PACK in. DEPTH tL DEPTH ft. WELL YIELD TEST It detailed pumping �r, I LOG It more detailed formation descriptions or sieve analyses are available, please attach. METHOD: O PUMPED 1 tests were done is in- DEPTH FROM water Well EI COMPRESSED AIR ,' ormation attached? SURFACE Bear- DIa- FORMATION DESCRIPTION coot? O BAILED ❑ OTHER ❑ YES O NO it. tt. Inc meter WELL DEPTH DURATION DRAWOOWN YI&O Surface 1 Dr:.11iig in overburden clay and boulders It. hr, min. ft. gym. 1 Hi rib 4k at 1' 625' 6 hr 540' 10 ='1 31 Dr lli in rock set casi.E2, grouted 31 625 Dr lli in rock granite Hydrof 7acked well WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? ❑ YES O NO STORAGE TANK: TYPE Well Xtrol WX #250 PUMP INFORMATION CAPACITY, F GAIL 44 TYPE submersible CAPACITY 5 M WELL DRIVER NAME P . F. Beal & Son C. OAT, 0/9/96 MAKER Goulds DEPTH 560' ADDRESS 4 Putnam Avenue srcrr MODEL 5GS10412 VOLTAGE_23_QHP I Brewster, NY 10509 al olm T. Beal, Jr. NORTH AMERICAN _-LABORATORIESI-INCR CERTIFICATE OF LABORATORY ANALYSIS LAB ID NUMBER: 96 -6669 CLIENT: P F Beal & Sons 4 Putnam Ave Brewster NY 10509 SAMPLING LOCATION: COLLECTED BY: DATE COLLECTED: DATE RECEIVED: DATE OF REPORT: Steve Tangredi, Taryn Ln, Put Lake MTB 09/27/96' TIME COLLECTED: 11:30 AM 09/27/96 09/30/96 This_ sample,., as ..submitted..to.the_laboratory, and as compared to the New York. State limits-for r-drinking water quality for the tests performed, was: ✓ ACCEPTABLE. NOT ACCEPTABLE. NYS ELAP #11218 Maryann Fasano, Assistant Laboratory Director CT Lab Approval #PH -0171 * Underlined results are unacceptable according to health department and /or US EPA codes. ** Maximum Contaminant Level (maximum permissible concentration allowed by health department and /or US EPA codes). 618 Clock Tower Commons, Brewster, NY 10509 -9241 / 914 -278 -7600 / Fax 914 - 278 -7754 ANALYTE RESULT* UNITS- ' MAX CNTMT LEVEL "* METHOD ANALYZED Total Coliform Absent Must be "Absent" SM18(9223) 09/27/96' E. Coli Absent Must be "Absent' SM18(9223) 09/27/96 This_ sample,., as ..submitted..to.the_laboratory, and as compared to the New York. State limits-for r-drinking water quality for the tests performed, was: ✓ ACCEPTABLE. NOT ACCEPTABLE. NYS ELAP #11218 Maryann Fasano, Assistant Laboratory Director CT Lab Approval #PH -0171 * Underlined results are unacceptable according to health department and /or US EPA codes. ** Maximum Contaminant Level (maximum permissible concentration allowed by health department and /or US EPA codes). 618 Clock Tower Commons, Brewster, NY 10509 -9241 / 914 -278 -7600 / Fax 914 - 278 -7754 UNMDW to 7777777��77 .,;--' OF 00 ieetlllt Z Oil L 17 AQ, i�V6WM Dale AA_ Timm- 77 rOV, '07 V D 'i�6 Enclosed tbat6 Subd on ed ti, t t 7 P, - • 'PC® kol�Cdloe kBi64iiiiW, Whs PiMsommiMsted Aimee's Teak T fj s . p **,- Fred& Weber S114* - S o -"006fei o saws Vidi oat's stem CRnstry C *!J#•ctory 40 tht'CommiuldirwrW Z'Ithwill Of"'Hialth; Die- ' ' - � ' i W will the, -helri of-asigna"by'tho Toad 6�w 4"iiii Irrifnedial: I el, ibliamiNq the date. of,thwism- two(2), yl Oise, .. , •,"W4,66nieltion sny..ps�t of 'd; )t t the drilled, well 4 Once of the a 64� 'C- W—li - - - f C n r *"'torniihi Ir -60­ if" P� orlill w T. t t"afn 'Oiir owed in & r '' le- Ofhe IN a dowOn* P•P@rtwoiet of. 0 W. P.C. RA. el, and I _dN: T ion Ai'�RC)Vlfb FdO.k ;OPlSTl4(XTI Mif app! a Gxp 'Flr,40. , .4 , vuilding, 'Any chanve,or arierat ion -:o'f' constrijct ion revocable for .cam Ar,r"ywi wi in requires 'a vr!iiirmli. Ic Safi witai� 9a" `*Y. disli6sal iii':idl Rev. 10/88-004 er 0 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 APPLICATION TO" CONSTRUCT Pi WATER WELL PCHD PERMIT # WELL LOCATION Street Address o Village City Tax Grid Number • — -- WELL OWNER 10amb Mailing Addr ss I HOWISS Wrivate O Public USE OF WELL (D- primary 2- secondary 19 RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP 0 ABANDONED 0 FARM 0 TEST /OBSERVATION 0 OTHER (specify O INSTITUTIONAL 0 STAND -BY p AMOUNT OF USE YIELD SOUGHT gpm /# FIREPLACE EXISTING SUPPLY .NEW SUPPLY NEW DWELLING PEOPLE SERVED ,� /EST. 0 TEST /OBSERVATION O DEEPEN EXISTING WELL OF DAILY USAGE_j62a_ga1 13 ADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE MDR ILLED DRIVEN DDUG GRAVEL O OTHER IS WELL SITE SUBJECT TO FLOODING ?. YES // NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:4 Lot WATER WELL CONTRACTOR: Name J(.- Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: % TOWN /VIL /CITY DISTANCE TO_ PROPERTY". FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET (date) s 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 su h a manner as not to de rade or otherwise contaminate surface or groundwater. Date of Issue: C �� 19 Date of Expiration 19� Permit Issuing Officia Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller Ritnam County Department of Health Division of Environmental Sanitation AFFIDAVIT - CORPORATE a4NER APPLICATION FOR PERMIT. A- PPLICAT�ION SUBMITTED} TO _ - PUTNAM COUNTY HEALTH DEPARTMENT TO: Co 'ssio er of eat h - In the matter of application for I, A1 �? .; _ _ _ •- -= - represent. 7/ that .1 am an offi er or employee of the corporation and am -.author! ed' to Act for, ! Ca /C7; (name of corporatio ) having offices- at _ _ � � � 9 r� /YC, /%I?f� _ � /� S�31 Whose officers -are President 0/ U C G �� l a' e an d Address Vice - President - '(Name and Address) — — —_— Secreitary (Name and Address)' `- -' — -- — — .._. _. ,.•_• _... Treasilrer' - ---- - - ---- •(Name and. A,ddress_) _ '.... ^r- ..`.'___.._. . and t:,at I- am-and will be individually responsible fon any'or. all aptp of. the- corporation With respect to the approval re 9t es.te rid •all .sub seique t acts relating -thereto. ` Sworn to before me this day Signed 1� . of l9q4 Title f( —� o ary Publi BODEJ. DAYM MO'E4B4PU81'1R BEATS 6F: iF,R �?8.S RM. 149953x OU.AUFM 1.4 D ii Ck"M �1 3 71 if O,K►_s AUG, g .i Corpor4te Seal PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIROXMENTAL HEALTH SERVICES Date Re: '".Property of . I,� \��LU.. %%!��r Located at (T) �4,"�TY�D�.� Section Block i Lot Subdivision of i /mil: r%GT' �': �.'�! L !, / /��!%'n: 3,. , . fit.•) Subdv. Lot .# Filed \Lfap -y ��'r' �J Date Gentlemen: This letter is to authorize 1-4QY,.w 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 re:gula'tions as promulagated by the Commissioner of the Putnam County Department of Health, "and to' sign, all necessary papers on 'my behalf. 1n. connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Hgalth Lai.•, and the Putnam County Sani- tary Code. Counter ', ly a vj. MIC /Q cs jC/) ` ✓nom P ., E., R.A., m No. 55124 Very truly your r_ Signed 01,n,�o Property rt- r2 Address HP Address - Town - Telephone -- / 2j Telephone h JIVAM CaUlY DEPARTHENT OF DESIGN DATA SHEET- SUBSUFACE Sr's+TAGE DISPOSAL SYSTEM - FILE No. owner r %mac I,,- GDS Address (��j �D�l� � d'Lt� • F{DI�I./1�-5 til `( (2�: � r Located at ,(Street) fZI✓� f1��i. :Sec- �Z�, Block �_ Lot�•� (' di t-rre nearest cross street) Municipality Plq-T Te7Z�N Watershed G'2o VA/ SOM PERCOLATION TEST DATA REQt IPM TO BE SUBMI= WITH APPLICATICNS Date of Pre- Soaking. 2 / /�j'1 �� Date of Percolation Test BOLE NU Bm CLOCK TII2 PERCOLATION PERCOLATION Run Elapse Depth to Water Frcm ...Water Level No. TiiT Ground Surface In Inches Soil Rate St r` -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches' 1: 17, 2: 59 - 2: I 3 Z'. I Z Z: Z-1- I Z 3 Ir—D Z 2- I D 2 3 4 - 5 . 1 2 3 4 5 NOTES: 1. Tests to be repeated at same dept - until apprcximately equal soil rates are obtained at each 'percolatioft .test hole. All data to' be suhmitt�d for review. 2. Depth reasuremnts to be made1 -from top of hole. rev. 9/85 DEPM HOLE NO. - HOLE NO_ '�/ - HOLE NO. G.L. i�' - (pPSOrL jOPSoJ �— 3` siLTY 5J}4 -D 51vTy Sf:�ND 4` yj G 14vel, Gi2A 5' 6' -7 8' 9` 10' y 12' -14' _ INDICATE LEVEL_ AT WHICH CROP IS BNCOUNZ�RID _ J K} INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENMUNTERED N M DEEP HOLE OBSERVATIONS MADE - -BY: DATE: 5 /2 DESIGN Soil Rate Used Min/1" Drop: S.D. Usable Area Provided,; - No. of Bedrooms Septic Tank Capacity / 254 gals. Type Go/IlG Absorption Area Provided By L.F. x 24" width trench Other Narm . ,!' r"� 2 �, Signature"' ;o j !' U t' Address IDD SEALS 1 G�_T 7- h_� . �lOal w, THIS SPACE FOR USE BY HEALTH DEPAFMdEM. ONLY: ,f. Soil Rate Approved _ Z'rd by �.. Date US :.:....:........ :. Q wand 48. :'BATH j 01- BEDROOM DRESSING F ). .. ..WALK' DRESSING I IN BEDROOM 3. IN CLOSET 13*-0** 1 CLOSET r I' >4A.ST I- R'13 ED ROOM BEDROOM 2 OPEN a, 01, x 15,-8- S T U OY- -S E-C 0. N�. D F L 0.. 4828 =-.'1-3 44S. F.. * 48 1 PUTINAM COUi W "Y D'--'-PARTM 0F..nALTA sins .HoLys-:E PT AN T .!BEDRCj4--1 C016f•T zz—. KITCHEN B /70� QIN,IN*G fio0m p MORNING AD , Signature &Title Dad @/ N IN OrEN ABOVE LIVING MOOLA u FAMILY MOOM 13,-0-x Iv-o- 13- 1 7- 6-- foyEm RST FLOOR 482.8 1 1 4A -q r- )D E P .A. rF2'T M E rT 'r O Ir ' )EX >E A .Z' 1-X APPLLCATION FOR APPROVAL OF. PLANS FOR A WASTE - _ WATER DISPOSAL SYSTEM - i . Name and Address of Applicant:>1 2. Name of Project: 6.7- UPD2rr� X925 3.:_. Location /C: 4.. Project Engineer: R'IA4�1�� W. GND�,� ;�f�_. 5. Address: fir- License Number: Phone: 1 1 _ Col -08 6. Tyoe of Project: . �.. - Private /Residential• Food.Service z •- ...Conynerc-ial Apartments Institutional Hobile Home Park Office Building Realty-Subdivision Other (specify) .7. Is this project subject' t'o State' Environmental.•Quality .Review. (SEQR)? Type Status (Check One). Type I.. Exempt ✓. Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? �U 9. ,Has DEIS been completed and found acceptable. by Lead.'Agency ?, ..... 10. Name of Lead .Agency ►J /.� 11., Is this project in an area under the control of -local planning, zoning, Y -oe-other officials, ordinances?: __- .- ._................... -... tiId 12. If so, have plans been,sub7itted to such. author .sties ?........................ /A 13. Has preliminary approval been granted by such authorities? N/A Date Granted: 14. Type of Sewage Disposal: System. Discharge...... Surface Water v Ground waters 15. If surface water discharge, what is the stream class designation ?........ 6. Waters index number (surface) . ....... ............................... N) I& 1, Is project located near a public water supply system? N 0 3. If yes, name of water supply Distance to=water supply 9. Is project site near a public sewage collection or disposal system ?..... 1,10 '3. Name of sewage system /A Distance to sewage system 1. Date observed: 23. Name of Health Inspector: !A ,. Project design flow (gal•lo day) ..................................... X00 2. 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.._ �p 2'6. Has SPDES Application been submitted to local DEC Office? ............... K) /A 27. Is any portion of this .project located within*.a designated Town or-State - wetland? .................................. ............................... f\) e) 23. Wetland ID Number ......................... ............................... u/d 29. -Is Wetland Permit - required?... ............ ............................... ti n .'Has application. been made to Town or-Local DEC Office? .................. q Al 30. Does project.* require a-- DEC Stream Disturbance Permit? 31.. Is or was project'site used for agricultural activity involving application of pesticideq to orchards or other crops, solid or hazar8ous waste disposal', landfflling,`slud�b application or industrial activity? :....... YES or NO tiv 32.. Is project located within 1- 000-feet'of existence of abandoned 'landfill; hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? . .:............YES oi- NO kl�l i DESCRIBE: 33. Is, there a local master plan or file.-with th'e Town. or'Village ?, ........... 34. Are con- Punity water, sewer facilities planned to be developed within 15 years? UN VN)A00 35. Are any. sewage. disposal areas in-excess of ,15�4 slope? ........ 36. Tax Hap ID dumber ... .............................. .... 37. Approved Plans are'to''be: returned to: ................ Applicant i_ Engineer If the application is signed by a person other than the applicant shown in Item.1, the. application must be-accompanied by-a Letter of Authorization: Failure to comply with this Drovision may be grounds for the rejection of any suNnission. I hereby affirm, under penalty of perjury,- that information provided on this form is true to the best of ry know7ed5e and be 1 ief. Fa Ise state.-;,ents made herein are punishable as a Class A Hisde7reanor pbrsuan to Section 210.45 of the Pena 1 Law. SIGNATURES & OFFICIAL TITLES: 0 ':AILING ADDRESS: '8 ky 3�'V. RANDOLPH W. LAURENT, P.E HARRY W. NICHOLS JR., P.E. July 20, 1994 Mr. William Hedges Putnam County Health Department 4 Geneva Road .. Brewster, NY 10509 LAURENT ENGINEERING ASSOCIATES; P.C. - - - MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road Brewster, New York 10509 (914)278 -6108 - (FA)O 278 -2658 CONSULTING SITE ENGINEERS RE: Individual SSDS Car -Dee Building Corp. Subdivision - Lot #4 Partridge Lane Patterson, N.Y. Dear Bill: Enclosed are the following: 1. Four (4) prints of Drawing SS -4 "Proposed SSDS - Lot #4 ", dated 7- 20 -94. 2. "Application For Approval of Plans For a Wastewater Disposal System ". 3. "Construction Permit for Sewage Disposal System ", dated 7- 20 -94. 4. "Application to Construct a'Water Well ", dated 7- 20 -94. 5. "Design Data Sheet ". 6. "Letter of Authorization ", dated 7- 20 -94. 7. "Corporate Affidavit ", dated 7- 18 -94. 8. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only ". 9. Check 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. ichols, Jr., P.E. HWN:bd 94051 -4 cc: Mr. G. Macaluso w /enc:' lot