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HomeMy WebLinkAbout0844DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25. -1 -9.5 BOX 9 .' L IL I' ■ ` PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION -OFE ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE PCHD CONSTRUCTION PERMIT # F'10' q� Located at PAP.T'A-1PAF. i-ANF- Town Owner /Applicant Name C40-y"� PArWGA LJ'JKQJ1' i Tax Mi r Formerly TMENT SYSTEM -g Mt74N I Lot q, f7 KM-At- Q 0 e' 01' mis K%- Cb "' Subdivision Name CAP-,, DIE FE Mailing Address 641L LA9 /3Kn1xl` DXI 'qE Subd. Lot # r:�, BV_EVJ STt"R N`r Zip lor7al Date Construction Permit Issued by PCHD O j I b 1% Separate Sewerage System built by © F he IM,,- Address riq L RAC+AWL N%l a iaq Consisting of 9000 Gallon Septic Tank and 42 9)(o L-F A- 670?_F'h J H T ia-t; ^e H Other Requirements: Water Supply: Public Supply From Address or: Private Supply Drilled by Wes+ 8906, WEB Address XPIL 1AAW_ P-P• i xeuiwer p.ES p�.NGG Type Has erosion°control- °been completed ? Number of Bedrooms Has garbage grinder been installed? No 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 regulation; of the Putnam County Pepprtment of Health. Date: (0* fl) Certified by Address 20 1'' IU -I"OvM "• P.E. A R.A. i40"9 V License # 66 11-4 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocati0 , / c o change is necessary. B y. Title: Date: ViC White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Partridge Lane Town/Village: Patterson Tax Grid # Map Block Lot(s) Well Owner: Name: Address: Gary Ljunquist 542 Lakeshore Drive Brewster Use of Well: 1- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion _2L ..Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length __2L_ft. Length below grade 181 ft. Diameter 6 in. Weight per foot 17 lb/ft. Materials: X Steel _ Plastic _ Other Joints: _ Welded X Threaded –Other Seal: X Cement grout _ Bentonite Other Drive shoe: X Yes Ho= Liner: Yes x No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First NONE _ Yes—No Hours Second Well Yield Test Bailed Pumped X Compressed Air Hours 6 Yield 15 gpm Depth Data Measure from land surface- static (specify ft) 20 During yield test(ft) 405 Depth of completed well in feet 405 Well Log If more detailed. information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 9 6 soil 9 405 6 Granite,Quartz If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type q,,b Capacity 8 Depth 3 0 0 Model 3 NFL 72-8 Voltage 2 3 0 HP 3/4 Tank Type WR 14 0 Volume 12o Date Well Completed 4/7/9E Putnam County Certification No. 010 , Date of Report 4/22/98 Well Driller (signature) NOTE: Exact location of well with distances to at least o ipermanent landm1rks to be provided on a separate sheet/plan. ;D Well Driller's ame Wragg Bros. Address: 162 Baker Rd. Roxbury , Ct . Signature: Date: 1 White copy: HD File; Yellow copy - Building Inspector; Pink copy- Owner; Orange copy - Well driller Form WC -97 NORTHEAST LABORATORY OF DANBURY CT Cert: PH -0404 39 -3 MILL PLAIN ROAD - DANBURY, CT 06811 NY Cert: 11471 (203) 748 -7903 - FAX (203) 748 -0652 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: WRAGG BROTHERS 162 BAKER ROAD ROXBURY, CT 06783 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: DATE SAMPLE COLLECTED: 5/13/98 & 5/18/98 TRVIE COLLECTED: 8:00 & 10:00 A.M. COLLECTED BY: GREGG M. DATE RECEIVED @ LAB: 5/13/98 & 5/18/98 TESTED BY: LAB# 11471 REPORT DATE: 5/19/98 JUNGQUIST, PARTRIDGE LANE, #4, PATTERSON, N.Y. TANK WELL NONE TEST PERFORMED RESULT: MAXIMUM CONTAMINANT LEVEL, BACTERIAL: 5/18 -Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml PHYSICALS: pH 7.49 no designated limit Turbidity 0.46 NTUs 5 NTUs CHEMISTRY: Nitrite N <0.01 mg/L as N 1 mg/L as N Nitrate N 1.12 mg/L as N 10 mg/L as N Alkalinity 185.0 mg/L no designated limits Hardness 138.0 mg/L no designated limits Iron <0.03 mg/L 0.30 mg/L Manganese <0.01 mg/L - 0.30 mg/L - [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium 10.2 mg/L, 20 mg/L ** Load <0.005 r,3e, O.C. S * ** m1= milliliter mg/L = milligrams per Liter ND = none detected NTU =Units * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED:5 /13/98 & 5/18/98 SAMPLE, AS TESTED ABOVE: AMPOTABLE or AMNOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800- 826 -0105 •OUTSIDE CT: 800 - 654 -1230 ..y PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM �ir�R� fi PAT�IUa L.JvHUQU;�r 0 �� Owner or Purchaser of Building Tax Map Block Lot Building Constructed by Town/Village C P--' D &� SL%A, CO Q. S(/bON(50 M Location - Street Subdivision Name Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the looa4en, workmanship, material, construction and tage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the ".Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month OA`>J Day iI Year 1�lb lo- General Contrac (Own - Signature Corporation Name (if corporation) Address: 5W�, I.P`VZ6t'1OPi5 IDQav�i State WW`s 1 E�L- 1 -4 Zip 10 `;01— Signature: Title:. Corporation Name (if corporation) Address: PC) P0, C'� Z State Zip ZD 5-b 5 Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION - -- - -- - -_ Date: Inspected by: '2 Street Location Owner Mu ca l Town ev'��,� Permit # P — (G 96— TM # _ ;� f�-, 1 — �I , 5 Subdivision.Lot # 1. Sewaze Svstem 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. 100' from water course/ wetlands ...... ............................... II. Sewage System a. 6eptic tank size - 1,000 ....... 1, 250 ......... other ................ b. Septic tank insta ed- evel ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribtuion Box CIA All at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches Junction Box roperly set ....................... ............................... engtTi required -;5 3 G Length installed 3 B 2. Distance to watercourse measured 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%" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ...........:.:::::.::-. .........::........:::.:..:.... g. Pump or Dosed Systems ize ot pump c am er ................ ............................... 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. HouseBuildin a. House located per approved plans ... ............................... b. Number of bedrooms ....................... ............................... IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured ft........... c. Casing 18" above grade ........................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially 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 & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 1/97 omi - :P, PUTNAM COUNTY HEALTH PT !DE. r O 14 5 64F k 4 Geneva Road . (914) 278.8130 S Brewster NYy10509 k Date �'� 19� a F Recewedo The Su -Of `✓ ,Dollars $ �J° CA • Fo - s- TH ANK Y :.' ❑cash . ,- �� .Check � M 0: ❑: Credit :Gard _ DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 27 =7921 June 11, 1998 Harry Nichols Laurent Associates Millbrook Office Centre Route 22 &Milltown Road Brewster NY 10509 Re: Macal Development (Linquest) Partridge Lane, Lot #5 (T) Patterson; TM# 25. -1 -9.5 Dear Mr. Nichols: BRUCE R. FOLEY —Public Health -Director A field inspection was conducted by the writer on June 11, 1998. At the time of inspection the following was noted: 1) Trench was not adequately covered, i.e., the top of the trench must be 6 " -12" below grade. -- — 2) Fill-must extend- -1 0-feet--horizontally past the- edge of-all-trenches and-then - slope 3:1 to grade. 3) It was not apparent that a clay bermhad been installed. Please contact this office when the required revisions noted above are completed. Furthermore, the ends of the trenches are to be left exposed for the final inspection. Ve truly yours, h,,tiv y�la� Robert Morris, P.E. Public Health Engineer :4=1 f LAURENT ENGINEERING ASSOCIATES, P.C. MILL-BROOKE OFFICE CENTRE---- Route 22 & Milltown Road Brewster, New York 10509 RANDOLPH W. LAURENT, P.E. (914)278 - 6108 -(FA)O 278 -2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS May 8, 1995 Mr. William Hedges Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Proposed SSDS Car -Dee Bldg. Corp. Subdivision - Lot #5 Partridge Lane Town of Patterson, N.Y. Dear Bill: Enclosed are the following: 1. Two (2) prints of Drawing SS -5 "Proposed SSDS ", dated 4- 18 -95. 2. Four (4) prints of Drawing SF -5 "Preliminary Design for Fill Placement Only ", dated 4- 18 -95. 3. "Application For Approval of Plans For a Wastewater Disposal System ". 4. "Construction Permit for Sewage Disposal System ", dated 4- 18 -95. 5. "Application to Construct a Water Well ", dated 4- 18 -95. 6. "Design Data Sheet ". 7. "Letter of Authorization ", dated 7- 20 -94. 8. "Corporate Affidavit ", dated 7- 18 -94. 9. Cut sheet for Goulds submersible pump Model 3871. May 8, 1995 Page 2 94051 10. Two (2) copies of Residence Floor Plan(s), for 'Bedroom Count Only ". 11. "Freshwater Wetland Permit Modification ", dated 4- 18 -95. 12. Money Order in the amount of $300.00, for Review Fee. Kindly review the enclosed items and contact us with your comments and /or approval at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. �n Harry HWN:bd enc. cc: Mr. G. Macaluso w /enc. AM COUNTY DEPARTMENT OF HEALTH OTDIVISION OF ENVIRONMENTAL HEALTH SERVICES 11 CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # P - 10 - 16 Located at pAR� P -iQLxE LAWr-- Town or Village PAT rMb H Subdivision name L�� -D�t Subd. Lot # �3 Tax Map �-6' Block I Lot ° Date Subdivision Approved Owner /Applicant Name Mailing Address 115 Amount of Fee Enclosed PAIL) F W" V5 L- Renewal Revision M A CAL DeN FLQ gmFPr C4 Date of Previous Approval L7- . hoLME� P-6, NoLrnE� N✓ Building Type 12zS►0l:ML' 6`l-i) 196 Zip�1 Lot Area I.9$j No. of Bedrooms �% Design Flow GPD (POD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1600 Other Requirements: l I1Iqj 4LW P4VJ00 L/' gallon septic tank and 112126 L-' T96"C44Y To be constructed by Oil SPATF, Address Water Sunuly: Public Supply From Address or: k Private Supply Drilled by Address IGE 8A)tM 129 120 ,o3ow, C-r: I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date '5 17 18 License # 6(0/11 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 when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe rt pproved for discharge of domestic sanitary se only. gy; Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 b.11t`s Till. i loE Ai<a. � °� " I' Ale, An s«Ibe ody Dew valo.e Nsi p Flow G P D . (� Q P(XD b Requit Wbm F® is colsi W Swa v.0 $oww!e S2�,{b Comm 41 DG_ ' G�Bw Sapp Ttieh '' Te bw Md ily IFOW Stt�: = Pti ie S� Ftnta Adthaa el Muir 1- epresent "chat l am wholly and completely nsponsibio for the design and location of the proposed• system(s); 1) that the separate saw di wl slam above described will be constructed as shown oe -the app!p . amendment there to and in accordance with the'standards, rules a regu ns o County Depaitnt«it . of ""Ith, and that on completion thereof a "Certificate of Construction Compliance" sstishctoiy .to the Commissbnar`of Maalthwill be a0bmltted• to -the. Oepaitmant, rind, will a furnished the owner h4i"seors, heirs or assigns by the Wilder. that. said builder will pMC} in hood ooe►etinj,eorWltlori' tany pat of •YI0 fiwaoe dispofel system duili the period "of *9 (21 Yeas rnnwdiateiy following,thodab of the itau- ana of .the approval ,of tow 'certifkate,of Conitructiog compliance of orginet system orvly repairs t o. 2).that the drilled well 0esdo" a6- wIN a located at shoern . on the epprovad, pie anA thaf.taf0.wel1 will,a instal in aeeordan wit staiwa ru n rpu a�iir�of tAe Putnam County Depaitasan e. w Signed RE: '/ RA. — Daq Address �, iceMe No �i�� APPROVED f'Olt CONSTRUCTION' Thi1 w .. -- ` -- - --- - revocable for caua o� -me- M.amiiW�O'o nauires a w painit. ppiovi0 'for 4 Rev. 10/88 °ate sU j - HARRY W. NICHOLS JR., P.E. \ LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE _ Route 22 3 Milltown Road Brewster, New York 10509 (914)278.6108 - (FA)O 278 -2658 CONSULTING SITE ENGINEERS Date: �`'�A7 �S ►� q� U To: PC-h Job No.: 4 (A NHm\ Project: CApPE6 l OT- 6 Attention: P4KP -r Momt�; (T) Pip- H X G tlemen: We enclose ( ) copies of: B/W Prints O Reproducibles O Reports O Tracings O Specifications O Memorandum O Copy of Letter ❑ Description: Revision /Date•No.. S nt Via: Our Messenger (A04s%) O Blueprinter O First Class Mail O Your Messenger - Hand Delivery O Copy to: D Special Delivery Very truly yours. LAURENT ENGINEERING AISSOCIATES,P.C. Per: �•Ut/"y/ RECORD OF PHONE CONVERSATION Time: �j 3 Date: 9 'g, Person calling: Phone #: %�. 7 1g Reason Xinspection: S, S, S () Deeps and /or Peres: Scheduled Field Meeting Time: Date: Y 1\ Tentative /to be confirmed O ( ) Town: Road /Street: _ CI y' <<T�Z- ja Tax Map #: Comments: DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 APPLICATION TO-CONSTRUCT-- A--WATER WELL Q PCHD PERMIT # IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Ga o r, Lot N . WATER WELL CONTRACTOR: Name p - •Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES P-' NO NAME OF PUBLIC WATER SUPPLY: ty /A- TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ,[ ON SEPARATE SHEET (date) gnature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant any and all water or waste products from such well property and in such a manner as not to degrade or Date of Issue: -,3 19 �S Date of Expiration Permit is Non - Transferrable 3/89 shall take appropriate drilling operations be otherwise contamina4-e- Issuing Official action to assure that contained on this uxfzce or groundwater. White copy: HD File Pink copy: Owner Yellow copy: Bldg. Insp. Orange.copy: Well Driller Street Address To ' Village City Tax Grid Number WELL LOCATION Nome Mailing Address if I ,Private WELL OWNER G jM113Public OF WELL RESIDENTIAL 0 PUBLIC SUPPLY AIR /COND /HEAT PUMP O ABANDONED (�SE - primary 0 BUSINESS 0 FARM 0 TEST /OBSERVATION 0 OTHER (specify 2- secondary 0 INDUSTRIAL U INSTITUTIONAL 0 STAND -BY O AMOUNT OF USE YIELD SOUGHT %? gpm /# PEOPLE SERVED /EST. OF DAILY USAGE betO Sal 0 REPLACE EXISTING SUPPLY 0 TEST/ OBSERVATION ' 12 ADDITIONAL SUPPLY REASON FOR DRILLING gjNEW SUPPLY NEW DWELLING) 13 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE ©DRILLED DRIVEN ODUG [:] GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Ga o r, Lot N . WATER WELL CONTRACTOR: Name p - •Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES P-' NO NAME OF PUBLIC WATER SUPPLY: ty /A- TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ,[ ON SEPARATE SHEET (date) gnature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant any and all water or waste products from such well property and in such a manner as not to degrade or Date of Issue: -,3 19 �S Date of Expiration Permit is Non - Transferrable 3/89 shall take appropriate drilling operations be otherwise contamina4-e- Issuing Official action to assure that contained on this uxfzce or groundwater. White copy: HD File Pink copy: Owner Yellow copy: Bldg. Insp. Orange.copy: Well Driller : .. . ... r • 48 F7 BEDROOM t ;'J K DRESSING• y'•8" x 12'4" BEDROOM J. WALK 13'-0— x 10' -0' CLOSET r '' 1 ^► Li1�t i�r COrJI'ITY tLi'�! ",l'i': :'a2` 0Y'1FI '4LTH OUSl PT _•.L-� MASTER BEDROOM ' BEDROOM 2 OPEN N EDR0 ,0''' :, x 16 •8 1.3' 0' • 1 sTUO�•: 1'' ' Ft. 344S4828 10" F'. SEGO.I D :. . 48' KITCHEN DINING ROOM MORNING A DO, F.1 13' 0' x 12 Li \ `, • Lam-• 1�-- •._ --' ••J ._• .. —. -t _ OIEN , ABOVE I LIVING MOOL1 v FAMILY n00L4 foyEn I RST FLOOR 482 Dj -UIYJAM 00UNI'Y DEPAR71 1T OF HEI, . 1 DIVISION OF ENVIRORMqML HEALTH SEZVICES DESIGN DATA SHEET- SUBSUFACE.SEWAGE DISPOSAL SYSTIf FILE. N0. Owner Located at (Street) Sec. c Block I Lot j (indi, e nearest cross, street) Municipality Pfi-T`72- 6qZ AJ Watershed 69076N Date of Pre- Soaking S/Z 7 / k Date of Percolation Test S Z 7 Iff -HOLE NUI SER CLOCK TIME PrRCO=CN PERCOLA'T'ION :Run Elapse Depth to i4ater _Fran Water Level .No. T'' Ground Surface In Inches Soil Rate Start -Stop Min. Start stop Drop In Min /In Drop Inches Inches Inches 1 5: ob 5: 2 4 2 S :Z9 - 5:5Z 23 2 3 27 3 0 C3 4 5 1 2 3 4 - 5 NOTES: 1.. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to* be subnittlBa for review. 2: Depth me_asurments to be made from top of hole. rev. 9/85 LIr.Jl.2tlt'11VLV kil: JV.LLti7 L.LVI.,VVLVlr.rcr , l 11V - lrz).c MUL& -b DEPTH HOLE NO. _ HOLE NO. j HOLE NO. G.L. 21 1 'AM p 3' f�N� 4` 5' 71 8' 91 ; 10' 11' 12' 13' - 14' INDICATE LEVEL AT WHicE GRwNI7r7ATER is F.IKJC7NTEF2ED r�, INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENMUN ERM DEEP HOLE OBSERVATIONS MADE BY: �CffD Ac(��, �I �c,�z��s . DATE: 5 /Z DESIGN •Soil Rate Used F -1�9 Min/1" Drop: S.D. Usable Area Provided No. of Bedrooms 3 Septic Tank Capacity 1000 gals. Type C M6 Absorption Area Provided By 3 (� L.F. x 24" width trench Other ���,1 �� �� I ►2 gip:_..._ . Nom. A NI G}-iD G Signature vrs . . ,- Address L-� or-i c✓ SEAL 5 Ci�4 G ^� et THIS SPACE FOR USE BY HEALTH DEPARIMEN2 ONLY: Soil Pate Approved sq. f t,%ga l.* - Checked . by Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date ♦I UL� 7i� ��� Re: -Property of I✓«C�i��� %� \I�j.U''�; 1!�� "I �D��K' Located at 1I� (T) ection Block Lot Subdivision of Subdv. Lot Filed Ifap f; ��j Date Gentlemen: This letter is to authorize LI. /��c -(tic- l.; C a duly licensed professional engineer✓ or registered architect (Indicate) to-apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules. or regulations as .promulagated by the Commissioner of the Putnam County Department of Health, and to* sign. all..necessary papers on my behalf. in connection with this matter and to supervise the construction of said system br systems in conformity with the provisions of Article 145 or 147, Education L-aw, the -Public Health Law, and the Putnam County Sani- tary Code. Countersig P.E., R.A., O N Address Telephone Very truly youi1,,�' Z-7� Signed_­, / -��' Oi, of Property Address f 1���,�:� !�,� 4/ � ✓ ill ToWn Telephone .4- ­.", Putnam County Department of Health Division of Environmental Sanitation AFFIDAVIT CORPORATE 9INER APPLICATION FOR PERMIT. APPLICAT-ION SUBMTTTED• TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Co Assioner of ealth - In the matter of application for -7 represent. that .I am an officer or employee of the corpor&.tion and am-. authorised 7 to 2LC*t for. (name" of corporation) havink offices at ` - �?�_ /_f o9r��,/inp `�� 5��/ Whose officers -are President ze Waii-i-e -En-E KEr-es Vice-President - - - - - - CN a _Me­aTd_AUdTe --- -- - - ---- secreitary (Name - and Address)" _7 Treasurer' - - - - - - - (Name - - - e and Address) and that I- am-and wx.'ll be individually responsible fo n any* or all ap tp of the-corpor.ation with respect to the approval requesle -rid -all :sub_' sequelhit a6ts ela i r ting -thereto. Sworn= to 6e7 fore ine this g day signed of '-flt [A) 199• Title .0 ary Pabllicc/ REEG. 1491.153OG OUAURED IN RF CHESS tC_'�NL-N Corporate Seal . . LO-f 52 Goulds SubrnersiblE Effluent Pumps 3871 R-I foi automatic o*matic arid;­ ...."ilabie SPECIFICATIONS:.- ATURES�'­ 4�'.y�l.'.'p'p'e'F.aii'on.':Auto'�nat*6� .. .. ...... models include Me�cury Float :..: a Pump l o- n t Semi = Sw. tc assembled ­ : - ahi, and pr e s e t Solid handling capability d gp� pyr� P_Pbt v` ' ' : at . , 3/4" M aximu f ." pho6ical,seal pr6l 6 6 i 6 G apaci GPM C asi Base: Rugged ' Iq: .� . ..s . i't6tafHeads 0. jq -24 feet thermoplastic .design'p" " � -Sizb APP �.q( t an. 'por.(o§!o�,rest,�14nc, e c ..... .. ,s.re.0gt.q' M hahical --Sdal*�Car o n'R '001yest( -7, . 1, Motdr: Cover: f-41-68 Igg eat pepi,ipa!ly- 0-p-S." ed for Head /Ceramic- Stationary coverrwith integral handle and,float� na a$t. -ng Effluent s stems, h points t atia, 0C F (60 Homes, S 6- ' Cable: e"v"'e r' d' Maximum * Power bl' uty. rated'; Fdst6h�&� 300 ie§ S d water, resistant tainless eavy duty'.-su"' 0. Rin'g:. Prbvi es'posi ive sealing C able'-of r'ffining dry without' ap u No gaskeii.'fo rep ace', uring.,..�--,,., 0 be aterina.,.: t maint6h'�`n6`6t:-*0-­:: am.age to components. M t o or-i-v­­: Stain ldss"ste 0 1 fast6i�iers::� in I e:* 0.4HP, 115c Pha§:;: r 2 3 6 Li§t6a' mb'deis'dvaila'ble: 60 Volt, Hi:t 1 �50 RPM UP built in over..t'' lo'a wit h-a'u'to'matidreset. Xihoy.�is4registered General Electric Material•: Power Cord:'.1 0 foot stand eg Pow . ard length' :16/3 SJTO'with Nema 5-15P' -prong gro*bnding plug. Optional 20' length. 1. 6/3 SJTW with Nema. - 5-1 5P- 3'pi�ong grounding plug. V: F. A, PIP 9 st Z 44. Submersible - .Effluent Pump METERS FEET MODEL: 3871 SIZE: 3/4" SOLIDS RPM: 1550 HP: 0.4 i [(b]GOULDS PUMPS, INC. SBNECA FALLS WVJ'IM 13148 Effective October, 1988 01988 Goulds Pumps, Inc. SPECIMCATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE PRINTED IN U.S.A. 8 25 7 w g 20 U 5 z z 15 4 ®13 J og 10 H 2 5 1 j n n MODEL: 3871 SIZE: 3/4" SOLIDS RPM: 1550 HP: 0.4 i [(b]GOULDS PUMPS, INC. SBNECA FALLS WVJ'IM 13148 Effective October, 1988 01988 Goulds Pumps, Inc. SPECIMCATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE PRINTED IN U.S.A. t New York State Department of Environmental Conservation 21 South Putt Corners Road, New Paltz, NY 12561 -1696 (914) 256 -3000 - Division of Regulatory Affairs FAX (914) 255 -3042 April 28, 1995 ATTN GREGORY MACALUSO PRESIDENT MACAL DEVELOPMENT CORP 175 E HOLMES RD HOLMES NY 12531 Re: Freshwater Wetlands Permit Permit No.: 3- 3724 - 00100 /1 -0 Town of: Patterson, Putnam County Facility Name: Car -Dee Building Corporation Subdivision FW /SD Resource No.: BR -3 Dear Mr. Macaluso: PERMIT MODIFICATION 7 T Is e �P�t1s i e 2 Michael D. Zageta Commissioner In accordance with your consultant's written request of April 20, 1995, the above permit is hereby modified as follows: _...�o change..the. permittee to Macal .R .elopment..Corporation,. and ..........._:._ ....... _._ 2. To extend the expiration date to December 31, 1996.` I All other terms and conditions remain as written in the original permit. Please attach this modification to the front of this permit (copy enclosed). Sincerely, Michael D. Merriman Deputy Regional Permit Administrator Region 3 MDM /LGB /btmacalaso.Itr(mm l) Enclosure cc: Law Enforcement (2) R. Wood S. Smith FM N'ichols j.LaurentsEnginee.ri i )-6f (7:8F) -25c NEW Yi— STATE DEPARTMENT OF ENVIRONMENTAL CONSERVA. ,,N SPECIAL CONDITIONS For Article 24 ( Freshwater Wetlands STATE ENVIRONMENTAL QUALITY REVIEW ACT Under the State Environmental Quality Review Act (SEQR), the project associates with this permit is classified as an Unlisted Action with the Town•of Pattersor Planning Board designated as the lead agency. It has been determined that the project will not have a significant effect on the environment, 1 DISTRIBUTION P. Keller .Law Enforcement R. Wood ' J. Steeley Laurent Engineering DEC PERMIT NUMBER 3- 3724- 56 -1 -0 FACILITY ID NUMBER PROCRAM NUMBER Page 4 of 4 95.20 -61 (7:87)- -5c I .I NEW.Y. STATE DEPARTMENT Of ENVIRONMENTAL CONSERV, .4 SPECIAL CONDITIONS For Article 24 Freshwater Wetlands - - 1. To satisfy the requirement of General Condition .No. l, the permittee or .a representative shall contact, by telephone, the Division of Law Enforcement in New Paltz (914/255 -5453) 48 hours prior to the commencement of any por- tion of the project authorized herein. 2. The permittee shall require that any contractor, project engineer, or other person responsible for the overall supervision of this project reads, understands and complies with this permit, including all special conditions to prevent environmental degradation. 3. Prior to commencement pf any of the wetland buffer disturbance activities authorized herein a row of staked hay bales, silt fence-;• -or - other erosion control measures shall be installed at the perimeter of the areas to be disturbed. This barri er to sediments (including well drilling slurr� is; to be maintained until all disturbed land is heavily vegetated. 4. As depicted on the approved plan and in accordance with detail sheets dated June 15, 1988 submitted with the permit application, the stormwater drainage outfall structure shall terminate with a runoff dissipator trench immed- iately preceeded by a temporary sedimentation basin. As indicated,the latter shall be fully maintained until all exposed are fully stabilized. 5. All areas of soil. disturbance resulting from this project shall be seeded- with an appropriate- perennial grass seed and mulched with hay or.. straw within one week of final grading. Mulch shall be maintained until.a suitable vegetative cover is established. 6. No disturbance to the wetland proper is authorized. :..7......F.or..an.y, of.. the lots- in. the. subdivision containing portions, of Freshwater -. -- - Wetland BR -3 or the adjacent 100 foot control area, the deed for each such property shall contain a restrictiop as written below: For as long as any portion of.the property described in this deed is subject to regulation under Article 24 (the Freshwater Wetlands Act) of the Environmental Conservation Law of the State of New York (ECL), there shall be no construction, grading, filling, excavating, clearing or other regu- lated activity as defined by Article 24 of the Environmental Conservation Law on this property within the wetland area or 100 foot control areas as shown on the Final Subdivision Plat at any time without having first secured the necessary permission and permit required pursuant to the above noted Article 24. This restriction shall bind the Grantee's, their successors and assigns and shall be expressly set forth in all subsequent deed to this property ". If requested by the Department, the permittee shall submit a copy of the deed of the first sale .for an affected lot to the Regional Permit Administrator in the New Paltz office within 30 days of receipt of the request. DEC PERMIT NUMBER 3- 3724- 56 -1 -0 Continued on next page... FACILITY 10 NUMBER I PROGRAM NUMBER I Pak C' �3_ of 4 a 20.6a ( 1186) -25c Freshwater Wetlands )DITIONAL GENERAL CONDITIONS FOR AR..%:LES 15 (Title 5), 24; 25, 34, 36 and 6 NYCRR Part 6... ( ) That .if` €uture operations by the State of New York require an al• other environmentally deleterious materials associated with the toration in the position of the structure or work herein authorized, or prpject. if, in the opinion of the Department of Environmental Conservation 14. Any material dredged in the prosecution of the work herein permitted - it shall cause - unreasonable obstruction to the free navigation of said -- -- shall -be removed evenly, without leaving large refuse piles, ridges across waters or flood flows or endanger the health, safety or welfare of the bed of a waterway or floodplain or deep holes that may have a the people of the State, or cause loss or destruction of the natural tendency to cause damage to navigable channels or to the banks of resources of the State, the owner may be ordered by the Department to a waterway. remove or alter the structural work, obstructions, or hazards caused 15. There shall be no unreasonable interference with navigation by the work thereby without expense'to the State, and if, upon the expiration or herein authorized. revocation of this permit, the structure, fill, excavation, or other 16. modification of the watercourse hereby authorized shall not be com- plefed, the owners• shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. 17 That the State of New York shall in no case be liable for any damage t:; in;ury t: the structure or v; ork herein aUthoriZa'v:hi.h rnay be caused 18 by or result from future operations undertaken by the State for the conservation or improvement of navigation, or for other purposes, and no claim or right to compensation shall accrue from any such damage. Granting of this permit does not relieve the applicant of the responsi. bility of obtaining any other permission, consent or approval from 19 the U.S. Army Corps of Engineers, U.S. Coast Guard, New York State Office of General Services or local government which may be required. All necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended solids, sediments, fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any If upon the expiration or revocation of this permit, the project hereby authorized has not been completed, the applicant shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. If granted under Article 36, this permit does not signify in any way that the project will be free from flooding. If granted under 6 NYCRR Part 608, the NYS Department of Environ- mental Conservation hereby certifies that the subject project will not contravene effluent limitations or other limitations or standards under Sections 301, 302, 303, 306 and 307 of the Clean Water Act of 197.7 (PL 95.217) provided that all of the conditions.listed herein are met. All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or his agent as piit of the permit application. Such approved plans were prepared by on I.- R 95.7U•b tyraol — A.x DEC PERMIT NUMBER 3- 3724- 56 -1 -0 FACILITY/PROGRAM NUMBER(s) NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION AM tlllir/ W : PERMIT Under the Environmental Conservation Law EFFECTIVE DATE EXPIRATION D_ATE(s)- — ' December 31, 1990 t n PERMIT ISSUED TO Article 15, Title 3; 6NYCRR 327, Car -Dee Building Corporation Attn: Pat Carbone 6NYCRR 608: ADDRESS OF PERMITTEE Article 25: 9 Quincy Lane White Plains, NY 10605 328, 329: Aquatic Pesticides AGENT FOR PERMITTEE /CONTACT PERSON Water Quality Certification TELEPHONE NUMBER Tidal Wetlands Article 15, Title 5: a Article 17, Titles 7, 8: Proposed subdivision west side of Haviland Road south of Brimstone Article 27, Title 7; 6NYCRR 360: LOCATION OF PROJECT/FACILITY Protection of Water TOWN /OLF4�p§tp XW TPatterson SPOES UTM COORDINATES Solid Waste Management' Putnam Article 15, Title 15: Article 19: DESCRIPTION OF AUTHORIZED ACTIVITY Article 27, Title 9; 6NYCRR 373: Waste Management Place approximately 330 cubic yards of fill within the 100' buffer Water - Supply • in- -ord-er- to- •-construct--drillin --ri access road's --and drill -thre-e• ire-lls-•'- construct 'a Air Pollution Control' ::division plan dated March 31, 1988 prepared by Laurent Engineering Hazardous •'Marcli 23 1989 and as conditioned herein. ' Article 15, Title 15: Article 23, Title 27: Article 34: Management Water Transport Mined Land Reclamation Coalstal Erosion aArticle 15, Title 15: N F7 Article 24: Article 36: Management Long Island Wells Freshwater Wetlands L—J Floodplain Article 15, Title 27: N —New, R— Renewal, M.—Modification, a Articles 1, 3, 17, 19, 27, 37; 380: Radiation Control Wild, Scenic and Recreational C— Construct ('only), 0— Operate ( "only) 6NYCRR Rivers ' PERMIT ISSUED TO PERMIT ADMINISTRATOR , De Car -Dee Building Corporation Attn: Pat Carbone 1 1L ya y ADDRESS OF PERMITTEE New Paltz, NY 12561,Z W- .6..,., _ _ 9 Quincy Lane White Plains, NY 10605 AGENT FOR PERMITTEE /CONTACT PERSON TELEPHONE NUMBER Laurent Engineering Associates ( 278 -6108 NAME AND ADDRESS OF PROJECT /FACILITY (If different from Permittee) Proposed subdivision west side of Haviland Road south of Brimstone Road: - LOCATION OF PROJECT/FACILITY COUNTY TOWN /OLF4�p§tp XW TPatterson UTM COORDINATES Freshwater'Wetland BR-3' Putnam DESCRIPTION OF AUTHORIZED ACTIVITY Place approximately 330 cubic yards of fill within the 100' buffer of the above wetland • in- -ord-er- to- •-construct--drillin --ri access road's --and drill -thre-e• ire-lls-•'- construct 'a stormwater.drainage outlet structure in the buffer in accordance with a preliminary sub - ::division plan dated March 31, 1988 prepared by Laurent Engineering (last revised : •'Marcli 23 1989 and as conditioned herein. ' ' GENERAL CONDITIONS . By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compli- ance with the ECL, all applicable regulations and the conditions specified herein or attached hereto. 1 . The permittee shall file in the office of the appropriate regional permit administrator, or other office designated in the special coltditions, a notice of intention to commence work at least 48 hours in advance of the time of commencement and shall also notify him/her promptly in writing of the completion of, the work. 2. The permitted work shall be subject to inspection by an authorized representative of the Department of Environmental Conservation which may order the work suspended if the public interest so requires pursuant to ECL §71 -0301 and SAPA §401(3). 3. The permittee has accepted expressly, by the execution of the application, the full legal responsibility foc all damages, direct or indirect. of whatever nature, and by whomever suffered, arising out of the project described herein and has agreed to indemnify and. save harmless the State from suits, actions, damages and costs of every name and descrip- tion resulting from the said project 4. The Department reserves the right to modify, suspend or revoke this permit at any time after due notice, and, if requested, hold a hearing when: a) the scope of the project is exceeded or a violation of any condition of the permit or provisions of the ECL and pertinent regulations are found; or b) the permit was obtained by misrepresentation or failure to disclose relevent facts; or c) newly discovered information or significant physical changes are discovered since the permit was issued. S. The permittee is responsible for keeping the permit active by submitting a renewal application• including any forms, fees or supplemental information which maybe required by the Department.`no later than 30 days (180 days for SPDES or Solid or Hazarduous Waste Management permits) prior to the expiration date. 6. This permit shall not be construed as conveying to the applicant any right to trespass upon the lands or interfere with the riparian rights of. others in order to perform the permitted work or as authorizing the impairment of any rights, title or interest in rre�e41- or"p�*,sonal property held or vested in a person not a party to the permit. 7. The permittee is responsible for obtaining any other permits• approvals, lands, easements and rights-of-way which may be required for this project. 8. Issuance of this permit by the Department does not, unless expressly provided or, mod(fy, supersede or rescind an order on consent or determination by the Commissioner issued heretofore by the Department or any of the terms, conditions, or r quirements contained in such order or determination. 9. Any modification of this permit granted by the Department must be in riting and attached hereto. PERMIT ISSUANCE DATE PERMIT ADMINISTRATOR , De ADDRESS 1 South Putt Corners Road 1 1L ya y �ty Will}am St le New Paltz, NY 12561,Z W- .6..,., _ _ AUTHORIZEDS IGNATURE 4 Page 1 of �P . piJ'TNA� CO�CI�7'r�Z" i�EP,A.RTM�N'r' Off' HE.A.x..'Z'i� - - - -- -- - - APP-LI -CAS ION- FOR APPROVAL OF PLANS.-FOR, A. MAST- EWA7ER -- DISPOSAL -- SYSTEM 1. Name and.Address of Applicant: �/IkG1�li �t✓1)',�'l >ti�i =t�1`r G/JI2�'01"LS'TIG>t,� �I0 L,A 2. Name of Project: 3.,_• Location /C: S�( 4. Project Engineer: W. kJIIf4OJt�S 71 -. 5. Address: t�( *M00rl� License Number: �56;J1: Phone:_ 1 1 6I*o6 6. Type of Pro ect: :: ', ••, t: ... . ✓ Private /Res.idential '. , Food Service ....Commercial , Apartments Institutional Hdbile Home Park Office Building : .".Realty, Subdivision. Other. (specify) 7. Is this project subject`to State Environmental Qual.i.ty,Review (SEQR)? Type Status (Check One) Type I.. Exempt ✓ Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. wo 9. Has DEIS been completed and found acceptable by Lead Agency? ......:..... 10.. N.ame of Lead Agency 11. Is this project in an area under the control of -local planning, zoning, or other officials, drdinances? " .... ............................... ..., �l.rJ..... _....... 12. If so, have plans been - submitted to such : author .itie_.s ? ..................... _ rJ/A 13. Has preliminary approval been granted by such authorities? NIA 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) ...... ............................... r7. Is project located near a public water supply system? .................... N D 8. If yes, name of water supply WA Distance tdwater supply, 9. Is project site near a public sewage 'col l- ection or disposal system ?..... IJo ,0. Name of sewage system K) /A ,Distance to sewage system 1. Date observed: 5- 12 23. Name of Health Inspector: .,�7;7laP711\14�>J:�_A �. Project design flow (gallons per day) ..................................... 6_00 2. 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.._ ejp 26. 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? .................................. ............................... 28. Wetland ID Number .......................... 0 29. -Is wetland Permit required? .............. ............................... Has application_ been made to Town or Local DEC Office? .Q 30. Does project require a DEC Stream Disturbance Permit? �JD 31: Is or was project site used for agricultural activity involving application of pesticide$ to orchards or other crops, solid or hazardous waste disposal',. landfilli.ng,'sludge application or industrial activity? ........ YES' or NO . .e.)0 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? .............. or NO I�)Q DESCRIBE: 33. Is.there a local master plan or file with tHe'Town or Village?. ........... ` h 34. Are community water, sewer facilities planned to be developed within 15 years? M VN3a100 35. Are any .sewage__01spos_al: - areas i.n...excess of 1.5ro_ slo e?.._ ,.._....._..r._.,............., , ........,_.._ . 36. Tax Hap ID Number ...... ......... ....... . 37. Approved Plans are' to••be. returned to: ................ ' Applicant V/ 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. 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 r7y knowledge and belief. False staterfents made herein are punishable as a Class A Hisdeer,eanor pursuant to Section 210.45 of the Pena 1 Law. ., / A 31GNATURES & OFFICIAL TITLES: 'AILING ADDRESS:' IJ ,`�. 1050GI -n9tA w� � - •lylx3 �N Ova ` Ay �n r era _ In Uu x m, � N OW �o.o► •,moo o• oos � , �'►� ��s . oo/ YZ =, �b -v tiz•,LZ ;gy ' ,� „ •D 'IM •1821 iy�X•� � M 3 1 d- a N Leo' Lo7, I fl . - DIMENSION---CHART (in ft.) No. A B 16 4 q' goy 4 53' 5 4-31 4co 6 401 jo to ell Ito erp I 14 I local 'Putnam County Department of Health rtivision of Environmental Health Services AMOVed 60 toted for conformance with OPI �_b e Rules and Regulations of the Cou& ealth Department A G:A A