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Home My WebLink About0847DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25. -1 -9.8 BOX 9 ' r .. ' 'i �� . �. I A6 0 . _ •. ti I VLq IV PtTNAM COUNTY DEPARTMENT OF HEALTH DIVISION- OF-ENVIRONMENTAL HEALTH SERVICES CATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM STRUCTION PERMIT # P -11 _1H Located at PAPV NC l.AHrE Owner /Applicant Name r`t Formerly NJ NI_116P_ Town or Village ppil�Ei -60-H Tax Map _� Block i Lot 9'6 Subdivision Name lA4_ r961�- Subd. Lot # m Mailing Address f6 kLT �S� 1�1 �yH �-t'�t�t -� �� Zip Date Construction Permit Issued by PCHD Separate Sewerage System built by Consisting of ) -'-V.® Gallon Septic Tank and Other Requirements: Water Supply: Public Supply From, or: 9 Private Supply Drilled by --- Building Type P-6-6 i DeAA C-e .. Number of Bedrooms 1H(.• Address I'l BODO l &l AE W•PFiWWL- 5to i,r P&5 TP-r✓H(AA Address H1 -T()H 14�AlT Address F$& a Jg MA PhM%40 I Has-erosion--control been completed? yef - - 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 regulations of the Putnam County Department of Health. Date: Certified by 4�',94 A P.E. R.A. _,4J Address aV �" )1 TowM P-A: OP—E j J Nrofe� nal)jO'�OQ �icense # 5�61Z" 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 bject to modification or change when, in the judgment of the Public Health Director, such revocation, o f cation ange is necessary. By: Title: (� /�� Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 V S i y ' y � y / S 1111 %11/ 111 1111W[1/1N:11N31111C111i2H1lIV 1/11141/N11Ii'll�/Nt1l NIA/ y1�/ 111VViV1iI� (`IIV11ey111/V:IJVIHNI�( 1111 / 11711 1171 N:�(1/11/Nlyyll/Y/ANNIy/V /11G /N ®.NNIN111 i/V1�1111Hi7111N 1 M dd HARRY W. NICHOLS JR.. P.E. November 6, 1998 7 0001 LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE. CENTRE. __- Route 22 & Milltown Road rn \ Brewster, New York 10509 (914)276.6108 - (FAX) 278 -2658 CONSULTING SITE ENGINEERS Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Compliance Ken Winkler Car -Dee Subdivision Lot #8 Partridge Lane Town of Patterson Dear Mr. Morris: Enclosed are the following: 1. Five (5) prints of Drawing S -8, "As -Built Plan ", dated 11 -2 -98. 2. "Certificate of Construction.'Compliance for Sewage Disposal System ", dated 11 -2 -98. 3. "Guarantee of Subsurface Sewage Disposal System ", dated 7- 29 -98. 4. Well Completion Report. 5. Laboratory Report, dated 10- 28 -98. 6.* Application Fee in the amount of $200.00 payable to Putnam County Health Department. � rn If there are any questions concerning the enclosed, please call. � -a Very truly yours, - -; LAURENT ENGINEERING ASSOCIATES, P.C. cr Harry W. hols, Jr., P.E. 94051 -8 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location ' - Street Address:- // A ct - kne Town../µµV,,illage: /3 !1F Tax Grid # Map 25 Block l Lots) 9°6 Well Owner: Name: n ,�_� Address: !(l /� er Use of Well: 1- primary 2- secondary Residential Business Industrial Public Supply Air cond/heat pump Irrigation Farm Test/monitoring Other(specify) Institutional Standby Drilling Equipment Rotary Cable percussion _x Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length eft. Length below grade eft. Diameter Tin. Weight per foot _j Llb /ft. Materials: Steel Plastic Other Joints: _ Welded X 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 -ice Compressed Air Hours Yield A gpm Depth Data Measure from land surface- static specify ft) During yield test(ft) Depth of complleette..d well in feet Well Log If more detailed information descriptions or sieve analyses ace'available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface ` If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information / Pump Type Capacity Depth Model Voltage HP Tank Type Volume Date Well Completed 51=1 Putnam County yCje'rtiif % ication No. V / . Date of Re ort/t p�itJ , 6 z Well Driller (signature) F Nu IX: Lxpct location of well wttn distances to at teast.two.permanentPanam�ortcs to oe provtaea on a separate pneevptan. A , Well Driller's Name t' tc� Address: , .- w "7 IV ,y, Signature: Date: j White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building � ^j e- z,64 , �-VA `N Building Constructed by 9 6-se Location - Street ASrlJ��Ti.�L. Building Type . 2r-5. ► 1.8 Tax Map Block Lot TownNillage eAA � Inc- Subdivision Name 0 Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years < immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to -operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system_. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month 1 Day Year General Contractor (Owner) - Signature Corporation Name (if corporation) Address: 9 A�oer et&-,-c . L*"Ale- State All Zip Signature: `*V�- L Title: Corporation Name (if corporafion) Address: LaVle State �C7uau��Zip 1 syO Form GS -97 • :ti 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: MR. KEN WIlJKLER 9 PARTRIDGE LANE - PATTERSON, N.Y. 12563 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: TEST PERFORMED AS ABOVE KITCHEN SINK 'WELL-NEW NONE BACTERIAL: 10/27 -Total Coliform (Bacteria) PHYSICALS: pH Turbidity CHEMISTRY: Nitrite N 11301 -Nitrate N Alkalinity Hardness Iron Manganese Sodium Lead RESULT: 0 5.95 0.80 <0.01 1.4 90.0 120.0 0.031 0.011 12.9 0.006 ml = milliliter mg/L = milligrams per Liter * *Notification Level ** *Action Level DATE SAMPLE COLLECTED: 10 /20/98 & 10/27/98 TIME COLLECTED: 11:00 A.M. & 3:30 P.M. COLLECTED BY: K. WINKLER DATE RECEIVED @ LAB: 10 /20/98 & 10/27/98 TESTED BY: LAB #11471 & 11301 REPORT DATE: 10 /28/98 MAXIMUM CONTAMINANT LEVEL per 100 ml 0 per 100 ml no designated limit NTUs 5 NTUs 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 In [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] mg/L 20 mg/L ** mg/I. 0.015 * ** ND = none detected NTU =Units RESULTS BASED ON SAMPLES SUBMITTED: 10/20/98 & 10/27/98 SAMPLE, AS TESTED ABOVE: MOTABLE or MINOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) r/ Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060379 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826- 0105.OUTSIDE CT: 800 - 654 -1230 Re y �1 �� Jon e PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION �' Date: 7 .3o yg �i . Inspected by: s et Owner wy,Mk.Lg R Town Permit #_ 1°— 17 — 74 TM * a 1 — �,3 Subdivision Lot # jtio c �r,p., 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. 100' from water course/ wetlands ... ............................... II. Sewage System a. eptic tank size - 1;000 ........1,250 ........other............ b. Septic tank installed level ............ ............................... c. 10' minimum from foundation ..... : ............................... d. Distribtuion Box 1. All outlets at same elevation -water tested............. 2. Protected below frost .............. ............................... 3. 1%,finimum 2 ft.Original soil between box & trench Junction Box - properly set .................... ............................... 1.— Length required 5 S U Length installed 5,6- 2. Distance to watercourse measured tt"a 0 Ft....... 3. In ;of cco to to plan .... ............................... 1 Xftom r h ptable 1/16 - 32" /foot......... prope EnIs '20 ft.- f undati ons....... Iptre�ric fro urface ............... 7. RoEved or expanse 00 % ...................... �avel 3/4 - ' diameter clean ................. 9. Depth grave in�cenc�i l2" minimum ................ g. Fump 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. ouA sated per approved plans .............................. b. Number of bedrooms ................... ............................... IV. Well a. Well located as per approved plans ............................ b. Distance.from STS area measured / o 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 pla f. Curtain drain outfall protected & dir.to exist waterco g. Footing drains discharge away from STS area........... h. Surface water protection adequate .............................. i. Erosion control provided ............. ............................... Rev. 1/97 -3 r %'88 I relpresent-3hat I srn.,'whollj and, c6onowitely ►isil above described will be construCied*as shown 6n' County - Department of Halt . h.. and t . h I at :oh cc be UOMMW to the Department. and a wfitii POM 0 good-oplWatlillig conditon'sny'.parl: o ortio,of the app oi -1 of Coor'llficate- of Cc w1oll be located as showe'on too* approved Plan an county DOPIit M,M oil' H is Ith., for the design and location of the proposed system(s)i. 1) roved amendment there to and In accordance with. the stand of Construction Compliance" astil APPROVED FOA eONSTRUCT.§OtA-*Th'is,ip,pr.6v,i.1 expire$ two years ;f revocable for Cause or may "amended or modified When considered no Muir" a now permit.. Approved for disposal I of domestic san"ry- Date By 11114 r to the Commissioner'bil HUNhwill by the bulkier. that said bulloileir will Itately'119111owing thisdato Of the Issu- I t drilled will 6SWIlloid above II d-lualloris the. Putnam L4 A UIV-1—I'License No struition of the building Jos been undertaken and is Of H"Ith. Any change or alteration of Construction Upply only . Title' �00^ pia � JIMMY v ;—M M I Rk RMA MI 0.4 1 —90@2110919-01 Bad FM Secdom, Oub Depth -YolbkMW 'DedSm Flow. 4G'P D 14 z"r SGPWSN Si*o"o b Addmm y wow: PoW Silp�ly him Adikvi�. in DOW . . . . . . . . . __iwwnu S111111-010Y by --AdMm Odw the proposed systemi(s); that the separate n=di'WUIj5;F above ducribed. will 0� Coris!rujt0,jj shpWn'on thst'jipprove4 arroandat-ent there to arid in accordance with the stanitsrds, rules an o regumilops or. , m Couilty - Depsirt"mt, Of t*Rh %aid,thist on i" qactory l ., o the qominls"nar..41 Healihwill kat4 � of.Construction Cornplianw'.�'mti n, 10116d iihs, his sui h"eirr a ns th'b I ari-t! I mrt,soid . .0ulider Will rr�snt..arki a� writto ,pArantae, will_ be *Wn by , e pild P" in - 11100111- operating - Y., rt'-pi.-spid, "wage ilkp6sal s4itini;'during the pwW lat*ly following the djt4 of jjij: Im- . , ' 1, , 0_ 4;?" udlon,C6 o4hill iyscini ior any repair$ t 0; t Pt the drilled'well so" of the' 40prova"I of, j 901lif o. of N ii9cribed'ab be as,sho�n an , approved pian.grid "that said Wait mr, accor"n 'a fttftafn in wit It a., rep, .,of, Cou n1ty'Diapartment of Hiasjtlj.� Oats P.E. R.A. APPROVED. FOR CONStRUCY-164: This ii revocable for cause or . m . a . y be in�'Iii ' f isp "Ouk" Pwmlt.. PiPPr"JorA _ Rev. &--- - - J'/ lofwl.-z 10/88 lu iceMe No i expires t"'iemrs -from.thi: 4:tate' Wo U.Mwconstruction oi the buiNing his. been undeir-U'kan and Is I wtion considered r�,Gceiiiry by the Commissioner ommissioner of,,Hufth. Any change or alteration of construction r n 40'rn"Ic,it: i a ry prIvatj_WAtgL-supp#y only. Title ---------- DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO_CONSTRUCT A WATER WELL PCHD PERMIT d WELL LOCATION Streggt Address own Village City Tax Grid Number WELL OWNER Name M; K. Akm % /e✓' Mailing 25 )Eouic Address OPrivate 3.9 Al. .5 er an C7- 06784 OPublic USE OF WELL primary 2- secondary ® RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify O INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED — 5 /EST. OF DAILY USAGE D d al REASON FOR DRILLING O REPLACE EXISTING SUPPLY 53NEW SUPPLY NEW DWELLING ) O TEST /OBSERVATION 0 DEEPEN EXISTING WELL O: ADDITIONAL SUPPLY DETAILED REASON FOR DRILLING WELL TYPE ®DRILLED DRIVEN []DUG GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: C R pEE &D4- c-oAen Lot No. 8 WATER WELL CONTRACTOR: Name 212 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES >�, NO NAME OF PUBLIC WATER SUPPLY: ZA TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: n LOCATION SKETCH _§ SOURCES OF CONTAMINATION PROVALXA/ti ON SEPARATE SHEET XS -'/(' (date). nature 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 Department attached to this permit. 3. Submit a Well Completion Report on a form requirements of the Putnam County Health provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: �- 19_ Date of Expiration 19. — Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller RANDOLPH W. LAURENT, P.E. HARRY W. NICHOLS JR., P.E. August 5, 1996 Mr. William Hedges Putnam County Health Department 4 Geneva Road Brewster, NY 10509 LAURENT ENGINEERING ASSOCIATES, P.C. MILL"BROOKE OFFICE CENTRE Route 22 & Milltown Road Brewster, New York 10509 (914)278 -6108 - (FA)O 278 -2658 CONSULTING SITE ENGINEERS RE: Individual SSDS - Renewal and Name Change Lot #8 Car-Dee Subdivision Patridge Lane Town of Patterson, New York Dear Bill: Enclosed are the following: 1. Four .(4) prints of Drawing SS -8 "Proposed SSDS ", revised 8 -5 -96. 2. "Application For Approval of Plans For. a Wastewater Disposal System ". 3. "Construction Permit For Sewage Disposal System ", dated 8 -5 -96. 4. "Application to Construct a Water Well ", dated 8 -5 -96. 5. "Letter of Authorization ", dated 8 -5 -96. 6. Two (2) copies of floor plan, for bedroom count only. 7. Design Data Sheet. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, LAURENT ENGINEERING A OCIATES, P.C. Harry W. Nic Is, Jr., WRE. HWN:TR:bd 94051 -8 cc: Mr. K. Winkler w /enc. - r-> c r �c 1�r Ea. i c". <D T-T 1v x x� APPLICATION FOR APPROYAL,.OF:,PLAIIS .FOrR.,A..WASTEWATER DISP.OSAL•SYSTEH ' `i : N2me and Address bf: Applic'a'nt M.r. /r%Ai, rieTl ' Wink ter -• e ?: 6 S a .... ........ O 4 2. - ...tlzne of Project: pro pcsc'c� 5 J..S'• • ' 3 •_ Location QyY 4. Millbrooke Office Gen t . -.- .Project Engineer: Add ress: 47T owe - _......._..__.._ -Brewster ";' NY 10509 . License Hu 'ber.: 56 /2=4 Phone (914).:278 -6108 :, _ <: fi. Type of Pro.lect, :✓ Priv'ate/ResidentJal Food.se'rvice,r r Com•nercial , Apartments Institutional Nobi,le 1'8me,Par.k Office'. BU,.,:, ing Realty .S'ubdivision ot her: ,(s'pec'ify) V. Is this project subject to' State Envi ronnental •Quality Review (SEAR)? Tvoe Status (Check One) Type I.. Exempt _........ . Type 'II. Unl- 'isted.. 3. s a Draft Environmental Inpact.Statement (DEIS) required? ...... ..... .... 9 Has DEIS -been' completed and found acceptable by Lead Agency ?, ...... N A .M. flame of Lead Agency N /A. 11. is this'project�in an area under-'the control of -local planning., zoning, .or other officials, ordinances? .......................... NO, 2. : f so,. have pl--ns. b6-En..sub:-,1itted to such :author.1ties ?...'.�...' ...... X/IA 3. Has prel iminary approval ..beep*' anted ;by such `authorities? A' .'Date Granted: Type of Seeage Disposal; system Discharge.-:.;. . ••Surface water• •'✓ Grounrd'•waters S. If surface water discharge, what is the stream, class designation ? ......•.. s� Waters index 'number.(surf ace) A ' �. TS project located near a ypubl is water' supply system? .................. • /`%O. f .yes; 'mar „e of water supply N /A' _.Dista'nc'e to water supp, ly Is project site near a public sewage _coa lect,ion:or...disposa'l. syst�n ?.... . /V�- �. fume of sewage systeinii/ __Distance' to sewage system P Date observed: �J-�Z =$� 23. tame of health Inspector: Mr. N1- &<jz1v�s�Gi . •project design flow (gallons per day) ...................... $00 _ i 2. Is State' �Pol lutant Discharge 'E1 in "ination System (SPOES) Permit required ?.. A) 0 26. Has SPDES .-Appli- cation -been, sua~fl,tted to local' DEC Office? .......... 27. Is any_. portion of -this pro3ect located ,. within` -a'designated'Town or 6tate . /�0 wetland? .. 23. Wetland TD Number .. ........ 29. Is WetlGnd Permit reQuired? 1l% "0 . . Has appli,c�`tion "been made to Tow- n or Local DEC Office? ...... 30. .Does .pro3ect7 require a DEC StreGn Disturbance Permit? ...... , .. , ........ IVa 31 ..Is or was "project (site -used '-f oir agricultural` activity "•involving application OT" pesticide$ to orchards -or other crops, or hazardous waste disposal, " ,..: landfilling, sludge application or industrial activity? YES:.. 'or'. h0.'" 32. 1s project 1ocat'e'd •.w:i:th:in ...1 -,000 -feet -or". existence -of". abandoned." Iandf.111, .',._. hazardous ua`ste site;'�s'alt..stockp "ile, Landfill ,%sludge- disposal�'site-or 11 .... " any other potential known source of contamination? ...............YES or..N0 DESCRIB.E: 33. 1s t her e a local master plan or file.with the Town or Vi. 1la'ge? ..... ... 34. Are, '- co,-,:itm "n "ity water, seater facilities planned to be developed within 15 years?.—A90 35. Are.`,a "n y- sewage, disposal areas in excess of 15- slope? ...... ..... ........ � 35. Tax V.ap ID Nurmber ........................... 6. 37. Approved Plans are' to''be.returned..to: Applicant Engineer the `a "pplication',is signed:.by.a person other than the "applicant shown.'in Item•1, "the." =pplication must be�accommpai'ied by `a Letter of Authorization Failure to" comply with this - Drovision. may be grounds for :the .rejection;of .any suonission: - X-,-hereby-affirn, under penelty of-per wry -- that information provided.on this fom, ' "is true to the best :of my knox.ledge. and. belie False;sta`te,Pnts nao'e herein are punishable as a Class A Hisd&Teanor pu uan Section 210.45 of the Penal Law. 1G-NATURES` & OFFICIAL .TITLES: A A) MiIIb' ke..0ffice Centre .... ULING ADDRESS: Brewster, NY 10509,: . 1 _PCPIVAM C0Ut7C DEPARTMENT OF HEALTH - - -- - DIVISION OF .EIQVIFiOt.,KE L_HEALTH SERVICES DESIGN DATA :SHEE"P- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner /Vli. K �n n�i !/l�i �r %` Aciciress 25 �od �c 391V O(, gc ,Sh�r-r»an CT.. 7 Located at (Street) �ar�riv%g� ,�a�e, Sec. 25 Block / I,ot 9.8 ( indicate nearest -cross street) ) LL Municipality.. 70V�_-rsort ^.. Watershed SOIL. PERCOLATION TEST DATA REQUIRED TO BE SU&MITTID WITH APPLICATIONS Date .of .Pre- Soakinj /��88 � Date of Percolation Test HOLE NUMBER CLOCK TI2•T �f Run ...:..... .-Elapse, No. Thre 'Start -Stop Min. �l 12:29 - 1,7:42 PERCOLATION PERCOLATION Depth to Water 'Fran water. Level .Ground Surface. In Inches - Soil .Rate -Start -.Stop Drop In Min /In Drop Inches 'Inches. .Inches l /2:30• -�!: D� . ._... 27 .2 2'12:43 -- ;vo u 24.. ..: 2.7. . 24........ 24 25-%2 r. i %z 20 5 20 l /2:30• -�!: D� . ._... 3GD. .2 3_/ 32 - 2:02 34 24.. ..: 2.7. . 24........ 24 25-%2 i� }OTc 1. Tests to be repeated at_ sama depth until. appraximately ..equal _soil rates are obtained at each parcolation test hole. All data to ba .submitted for review. " 2. Dapth.iTUasurezei.its to be made from top of hole. r. i %z 20 1 Y2 20 i� }OTc 1. Tests to be repeated at_ sama depth until. appraximately ..equal _soil rates are obtained at each parcolation test hole. All data to ba .submitted for review. " 2. Dapth.iTUasurezei.its to be made from top of hole. rr!;e Signature Q - 3dress / � sF-DL /F'fG. ;?Z M• O Wr1 G+�� J'�� No.5612A t4� srgwsier-� N.Y /0309 ��QFESS +o,`,..:; THIS SPACE FOR USE BY HEALTH DEPAR24ENT D\U Y: Soil Rate Approval sq. ft /gal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Mr. ��o y� j7 �o �i h k %e r Located at T) /�a erS•oYl Section tJ Block 1 Lot 7.6 Subdivision of CQrr �CCj�da, Gpi•i�„ Subdv. Lot �`,� �J' Filed Map Date Gentlemen: This letter is to authorize �R 6A) , /J/ C /•{VLS 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 z,-ith the standards, rules or regulations as promulagated by the Commissioner of. the Putnam County Department of Health,. and to sign all necessary papers on cny behalf in connection with this matter avid to supervise the construction of said system or systems in conformity N,-ith the provisions of Article 145 03,- 147, Education L - Public Health Law, and the Putnam County Sani- OF NEW YlI tary Code. /-`via NICH Q V9 d Z�ery truly yours, X sat ;� � cu N ; ?a Signed Owner of Property Co tersi ed� ' R� ?FESS% w LP •,E;', h.A. Address ,QZ,i / 1 �P- �-rY.,G� y ��iT'i GCiLi% �� ,:• /1 �_' �c i� . Y /� f �.. / Ci Cj i i .� ' A dress Toro Telenhone Telephone 48 • r , f'l t OVE { LIVING 131.0" x 1 C'•0" 13' 0" x 17' 0" -EF f0YEn �- i + 4 { {�� RSY FLOOR 4828 _ BATH U -I J { t BEDROOM 4 �� K DRESSING 9'.8 x 12' -0•' ttt BEDROOM 3. _ WALK' IN }3' -0 " x 10' -0' 1 ��" CLOSET 1•,tp.STER BEDROOM BEOROOM 2 OPEN ry 17'-0 x 1 6' B'• - 'tic^ STUDY.:' SECOND FL0.0R 4828 = i344SF J1 p .{ KITCHEN ��• c DINING ROOM ► 1-{ORNING A00M f 13' 0,• x 12'•0" • r , f'l t OVE { LIVING 131.0" x 1 C'•0" 13' 0" x 17' 0" -EF f0YEn �- i + 4 { {�� RSY FLOOR 4828 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New.York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL 1��s PCHD PERMIT #_ WELL LOCATION Street Address Town Village City Tax Grid Number WELL OWNER N Mailing Address -210 0 Pr ivate Public USE OF WELL I - D primary 2- secondary ta RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY D ABANDONED ❑ OTHER (specify O AMOUNT OF USE YIELD SOUGHT r gpm /# PEOPLE SERVED /EST. OF DAILY USAGE ZZ) gal ❑ REPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION M ADDITIONAL SUPPLY NEW SUPPLY NEW DWELLING O DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING ) WELL TYPE ®DRILLED DRIVEN []DUG 0GRAVEL 0OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: , Lot No . WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES 1,/ NO NAME OF PUBLIC WATER SUPPLY:[ TOWN /VIL /CITY i DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: i! LOCATION SKETCH .& SOURCES OF CONTAMINATION PROVIDE QON SEPARATE SHEET A, (date) �s PERMIT TO CONSTRUCT A WATER WELL is permit to construct one water well as set forth above is granted under the provisions Subpart 5-2-of Part 5 of the New York State Sanitary Code, and provided that within irt7 (30) days of the completion of water well construction, the applicant shall: sl. Pump the well until the water is clear. Z. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. Submit a Well Completion Report on a form provided by the Putnam County Health Department. g all well drilling operations, the applicant shall take appropriate action to assure that id all water or waste products from such well drilling operations be contained on this ',ty and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Issue: 19 Expiration 19� Permit Issuing Offic -s Non - Transferrable White copy: HD File Pink copy: Owner Yellow copy: Bldg. Insp. Orange copy: Well Driller Putnam County Department of llealth Division of Environmental Sanitation AFFIDAVIT - CORPORATE WNER APPLICATION _ _. FOR PERMIT. APPLICATION SUBMITTED- TO PUTNAM COUNTY iiEAi,TH DEPARTMENT T0: Co issioner of eal h - In the matter of application for x, _.�y�`�%� /�1��'.:--- - - - --- represent.. that .I am an offi er or employee of the corporation and am: authorized' to act for. Gi ' ( ;;2, /v (name of corporation) havin g offices at _. �,^ _ _ _ — Whose officers -are President _ CJ�� J� ✓'!�!�►c'G 761,5 O ?�� ' (Name ani ddress) Vice - President - '•.�'r_ --'- '(Name and _Address) - '- '____^.,.....s:,._, ..... Secretary _ " — ^ ^ (Nam dd e and Ares_ s) treasurer' _ _ _ _ ' -' — '- (Name .and Address)^ and tiat I: am-and will be individually responsible for) any'or all aPtp of the- corporation with respect to the approval reoeste rid -all .sub -` sequeit acts relating -thereto. sw rn to before me this - day Signed of fu 19 Title ��V Publi 1§M I DAM 21C) m P=c. swt op :ax Fop$ REG. 1499r3%- QiJcsm I.N arm'R.Ess fPC:'�i:`WI &SIND?iR SAvis.', ";�� Corporate Seal p U 1r 1\T Al t4 C O TCJ W x _Z" 17 E P ,A. T M E N T O F' APPLICATION FOR APPROVAL _.OF- PLANS: FOR A - WASTEWATER- DISPOSAL SYSTEM - 1 . Name and Address of App 1 i cant:; 2. Name of Project: if�'U(�D�J�t� �iGJDS 3 .,_._Location /C:5�"("f��:o.`� 4. Project Engineer: KT Y Ul. KII GNOLLS 7R_. 5. Address: License Number: Phone: 2'l�?_GIofd 6. Type of P.ro ect: ✓ Private/Residential Food .Servic,e ....Comriercial - Apartments Institutional Mobile Home Park.. Office Building ; : s Realty Subdivision Other (specify) 7. Is this project subject' to State Environmental Qual ity RevJew' (SEQR)? Tyoe Status (Check One) ' Type I. Exempt ✓ Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ...........'., tJU 9. His DEIS been completed.and found acceptable by Lead-Agency? ......:.... �)/� M. Name of Lead Agency rJ l.5 i 1.. Is this project in an area under the control of -local- planning,, zoning., "-or' o the r'off icial ,. ordinances? ......... ............................... til l i2. - If so, have- plans been .submitted to such. authorAties? ....................... O/A 13. Has preliminary approval been granted by such authorities? WA Date Granted: I". Type of Sewage Disposal. System Discharge...... • Surface Water v Ground Waters 15. If surface water discharge, what is the stream class designation ?........ O /A 6. Waters index number (surface) ........... ............................... K1 /A• :7. Is project located near a public water supply system? N) 3. If yes, name of water supply /'a Distance to=water supply , 9. Is project site near a public sewage collection or disposal system ?..... Qlo O. Name of sewage system Q/A (Distance to sewage system 1. Date observed: 5— 15P 23. Name of. ,Neal th. ,I_nspector: k4rz, Project design flow (gallons per day) ......'.7......: .............. ADD 2. 2 . Is State Pollutant Discharge EIiminat ion _System (SPDES) Permit required ?.._ 26. Has SPDES Application been submitted to local DEC Office? t�11A 27. Is any portion of this project located within a designated Town or State wetland? .................................. ............................... �)i) 23. Wetland ID Number ......................... ...................•........... IJ /4 29. -Is Wetland Permit.,required? .............. ............................... Has application- been made to Town or Local DEC Office? .................. !J /� 30. Does project require a DEC Stream Disturbance Permit? ............• ....... ►� 0 31. Is or was 'project site used for agricultural activity involving 'application of pesticides to orchards or other crops, solid or hazardous wastd disposal landfi11ing, sludge application or industrial activity? YES or NO t,)v 32. Js 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 YES or NO K) el DESCRIBE: 33. Is; there a local master plan or fi le.with th'e' Town or Vi 11 age? ............ .. 34. Are conmpunity water, sewer facilities planned to be developed within 15 years? U►JKN�10!� 35.. Are any sewage_d- isposal areas in- excess of 15%' slope? ........... . .:- ::::........ go 36. Tax Hap ID Number ........................................................ 37. Approved Plans are - to''ba. returned to: ................ • App-licant Y" Engineer If the application is signed by a person other than the applicant shown in Item .1, the.. spplication must be-accarnpanied by y-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 my knowledge and be 1 ief. Fa Ise statL-rents made herein are punishable as a Class A Hisde:;,eanor ur ant to Section 210.45 of the Pena 1 Law. 11 p If >IGNATURES & OFFICIAL TITLES: 'AILING ADDRESS: tt I / rM H1'1d3H 'Rte- Nil:(1. MVNIN 03 A1.30 9 8 Ila UrIM COUNTY . DEPARM41OF HEIV DIV.A.SION OF HEALTH SERvs:CES DESIGN QNTA SHEET- SUBSUFACE SEWAGE DISPO.AL SYST l FILE NO.- Owner• A. �e� D�_O_r—O Address Located at (Street) MZ�r =l'r,�45_ Sec- Block Lot (indi nearest'cross street) Municipality 09-rre eL ,Aj Watershed. 61007aN • ■ • 01•x• •' Y�► ■' V• • D• ■° i■ • : t Y7� • • • Date of Pre - Soaking ��l�j'I89 Date of Percolation Test F✓� /�f'��g HOLE N[MBM CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Frcm- Water.Level -No, Time Ground Surface In Inches ° Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 1 2 12 43 - 1 40 (7 2-7 3 to 3 j: p 4 - - - 5 - 1 12_:56 - 1:60 -2 C 3 5 1 2 3 4 5 NOTES r 1: Tests to be repeated at same depth until: ��•appraximately equal soil rates are obtained at each percolation {.test , hole. All data to• be surmittlad for review. 2. Depth rreasurenents to be made frcin top of hole. rev. 9/85 DEPTH HOLE NO. HOLE NO'. ' '. r HOLE NO. G.L. V F11$01 - _ ire.... 31 �pfi[D SILY S►'�ND. 4' 5' 71 9' 10' 111 .. 12` 13' 141 INDICATE LEVEL AT WHICH GROUNUM= IS ENKaJNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED -7'11) " DEEP HOLE OBSERVATIONS MADE BY: pC f fD N - DATE: DESIGN Soil Rate Used Min/1" Drop: S.D. Usable Area Provided No. of Bedroans Septic Tank Capacity j rLS� gals. Type COKG_- Absorption Area Provided By �J�D L.F. x 24f1 width trench i Other q Ice Signature! "W. Rrcy �- Address F�'L/ C/� 5� f/ �i •SEAL •t a f" 124 01 Im FPO mv TULS SPACE FOR USE BY NA12HWAaka Wt&&ZEX: soil. Rate . S �I�S> H1� V3H � Approved Checked by Date �Id PUTNAM COUNTY DEPARTUENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date ,o Re: -Property of ti Located at �kn (T) Section —Block —Lot Subdivision of Subdv. Lot Filed Map. Date Gentlemen: This letter is to authorize OQrr, 0.- 6 duly licensed professio'nal 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 •egulations as promulagat.ed by the Commissioner of the Putnam County Department of f Health, and to sign. a 1-1 ndcessary papers on'my behalf. .in- connection with this matter and to- supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147,' Education Lair, the -Public Health Law, '.and the Putnam County Sani- tary Code. Countersigne P-E . , R.A.-I X" 0 N X Address ice 77 (6 a b` Telephone Very truly yo u r s< —_ Signed Own�of' Property Addr'ess Town Telephone 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 8 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 #8 Partridge Lane Patterson, N.Y. Dear Bill: Enclosed are the following: 1. Four (4) prints of Drawing SS -8 "Proposed SSDS - Lot #811, dated 7- 20 -94. 2. "Application For Approval of Plans For a Wastewater Disposal System ". 3. 4. 5. 6. 7. B. 4, "Construction Permit for Sewage Disposal System ", dated 7- 20 -94. "Application to Construct a Water Well ", dated 7- 20 -94. "Design Data Sheet ". "Letter of Authorization",,-dated 7- 20 -94. "Corporate Affidavit ", dated 7- 18 -94. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only ". 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. Ha ry W. N chols, Jr., P.E. HWN:bd 94051 -8 cc: Mr. G. Macaluso w /enc. 0 i 9 •;. BA TH. 2 e I BEDROOM 3 } BEDROOM 2 1 A& 3 _ — AC\D 14/3 -� r- --I rAC\ XESSI TO ii" / FIRST - -_ _ - -_ di FLOOR !!! DOWN { A 1' W. L C. I� IUD BATH J ' BEDR - &OM 1 FI I h Q1 s FRONT p n BY DATE CREST :HOMESSCHULTDHOMES CORP. NpIAL E80.3-0.9 NAME: BLC DATE: 3/18/98 SCALE: 114'= 1' -0 ", C"—HALF TO THE BEST OF MY KNOWLEDGE. BELIEF AND PROFESSIONAL JUDGEMENT. THIS SPECIFIC MODEL HAS BEEN PREPARED FROM A PREVIOUSLY APPROVED SYSTEMS MANUAL DEPARTMENT OF STATE APPROVAL NO. M0705 -96 -016 AND MEETS ENERGY PORTION PART S OF THE N.Y.S. ENERGY CODE EXPIRATION DATE 1/13/99 BUILDER: THE BUILDER BUILDING SITE: PATTERSON. N.Y. ((30 PSF SNOW (TRL55E5 24� O.C.) ` '.L APPROVAL: LIM14'f`D TO MU— 61998 SECOND FLO(WORr Bu"T PORTION TITLE: COMPOSITE. ELECTRICAL PLAN (SECOND) 4430 -2003 CUSTOM TWO STORY DWG NO: E80309S (2A -1 OF 4) REV. THE BUILDER, LA GRANGEVILLE, N.Y. (WINKLER) p ELEC. PANEL DROP W /CABLE TO REACH FRONT CORNER CERTIFICATION LABELS--, GFl FAMILY ROOM �� i DINING ROOM / KITCHEN II // GFl d FI 0 II 114/3 N � /� GFl / II l / II �� it 3w - -__ -- J 3W — 4/3 \ \ / — — — 3 DOWN 14/3 3W fiD TO BAS 3W EMENT 1 \ \/3 3C GFI / 3W STUDY / REVISED KR. LIGHTS 14/3 FOYER \ TO SECOND 14/31 i FLOOR AC Wj❑} UP \_ 14/3 1 / LIVING ROOM TO THE BEST OF MY KNOWLEDGE. BELIEF AND PROFESSIONAL JUDGEMENT. THIS SPECIFIC MODEL HAS BEEN PREPARED FROM A PREVIOUSLY APPROVED SYSTEMS MANUAL DEPARTMENT OF STATE APPROVAL NO. M0705 -96-016 MID MEETS ENERGY PORTION PART 5 OF THE N.Y.S. ENERGY CODE Da4RATION DATE 1/13/99 BUILDER: THE BUILDER BUILDING SrrE: PATfERSON. N.Y. 35 PSF s9r) .C.> z "A" —HALF OF NpK; .RD L� � ?A aw MAt•6f 1996 3W w.P. cFl FACTORY BUILT PORTION EXTERIOR GFI RECEPTACLES TO BE LOCATED 24" MAXIMC/M FROM FRONT & REAR DOOR CREST HOMESSCHULT HOMES NAME: J. SEES DATE: 5 -5 -98 1 SCALE: 1/4 " =1' -0" (UNLESS DQ?hS % N pTbVR7 1HOUSE) SERLAL E8 03 0 9 TITLE: ELECTRICAL PLAN N0: 4630 -2003 CUSTOM TWO STORY DWG NO: E80309 2 OF Tur rai DI nra IA rRANrFVII I F. N.Y- (WINKLER) +f �' "— ti� ,. i:s' . -. t `j?. it r- ,f DIMENSION CHART (in f t. T „I 41 R g�a . Ii - 3 14