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HomeMy WebLinkAbout0871DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.-1 -55 BOX 10 00871 J , 00871 �: �.��.. .� n =Z= f r Z :F '_r �' = SUPK-Y & =fir^ �� rc 1nC _• mar /r I I I ,-v E c ^C--r �*-�*= Fes_ � ���.ca • � v� �:,;_„�:•,� �= •`�cr_� =mac:. =arc Cti _- Ev and dae= ISM CC Czt Cf cz Cf igol • o Wall; 200' p- -- 100, to str 1J' iC L7L= ^ tiir. = =n. L;,___, . 10 t3 Line purkmm aXUXY DEPARUMU OF BEALTE1. DIVISION OF 'nVn�a�� HEALTH SERVICES T>ETAC-`I4C-T> RG-61Dr�"t"IAL ( 4.1 AJC.LC- FA%n%L:v DESIGN D= S=-SMSMCE SEWAGE DISPOSAL SYSTEM Fm, No. 9 (. MAI ki --T?,C-E 7 (6Q JrC- D) Owner Ler>c-P-mA,&j 4- Hox�-H Address - "AVILAW'D r->1ZFVC-- AND Located at (Street) s21 W.. CA3C- ;t4%L-L P-OAT> ,,T Sec. -48 Block 3 Lot (indicpLte nearest cross street) Municipality TAT ISCP 1%.3 Watershed 'C—'P-wrc3).� SOIL PERCO=CN TEST DATA REQUIRED M BE SUBMITTED WITH APPLICATIONS Date of Pre-Soaking z:s-/ 8 Date of Percolation Test Z sT PERCOLATION EROOLATION Run Elapse. Depth to Water From Water Level NO. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start stop Drop In' Min/In Drop Inches' Inches Inches 91 -7 3 3.6r 2 3:.45 L- 3's )o Z.4 P — 3 10 Z4 z 4 5 a -2 a x. 2 -3 7 - :3 *. za t7 3 a.--7 3 4 2 3 4 5 I=:-. 1. 'Tests, to..., be.- repeated' at same depth until approximately equal soil rates are cbtained at each percolation test hole. -All data •to' be suhmitttd for review. 2. Depth neasurerents to be node fran top of hole. DEPTH G.L. E ST pIT'DATA REQUI= TO BE SUBMItMD WIM APPLICATION -HOLE NO. 2' S/4Np v cnQAV��I v 3' 4' Roc K • i 6' V 8' 9' 10' o f)IC-0 "5�>v0� GoSZAVEsl,.l.y Lo FTM - Races /Z., 12' 13' 14' _ INDICATE ima; AT Tnaicii GROUSER IS ENCOUNTERED �o�C INDICATE LEVEL TO WUICH EATER LEVEL RISES AFTER BEING ENCOUNTERED lyo Nf-Z DEEP HOLE OBSERVATIONS MADE By: M. Bvo'Z1 cySk1 CLARK DATE: lit 4) af- • DESIGN ..Soil Rate _Used Min/1" Drop: S.D. Usable Area Provided 5 aoo No. of Bedroans • 3 Septic Tank Capacity 1 0 0 0 gals • Type Absorption Area Provided By 3 0o L.F. x.24 ' .width trench Other r er THIS _+ - -SPAM FOR USE BY H&UM'DEPARM= ONLY: �• • Soil Rate Approved sq.ft/gal. Checked by Date •�ll�T�iVISiO✓ — �C VjY7C_ l�)DCa,� c�D%' —��� PUINAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMERM HEALTH SERVICES DESIGN - DATA- - SHEET- SUBSUFACE - SEWAGE DISPOSAL SYSTEM. . _.__FI ... _. Owner.iA11CoiW _L.4.eD:asirzl r-S L-Tub L:-Tub Address S7��,,,� Located at (Street) bC_'U'N_'Jb LA. Sec. 9 Block .3 Lot 3— (indicate nearest cross street) Municipaiity 1�en_s�,.� (�) Watershed lu YC SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking Date of Percolation Test HOLE RMBER CLOCK TIME PE RCOLA7.'ION PERCOLATION Run Elapse No. x Time Start -Stop Min. Depth to Water Fran Ground Surface Start Stop Inches inches Water Level In Inches Drop In Inches Soil Rate . Min /In Drop, 1 2 3i�l� 4 5 w 1 VA 3 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeaters at same depth until approximately equal soil rates are obtained.at each percolation test hole. All data to'be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA RDQUIRED TO BE SUBMITIM WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE. I90._ HOLE NO. _ HOLE NO. G.L. 1' 2' 3' 4' D 7 W/� IV I, �3U.�i,�s;� r �. s' 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUN'T'ERED DEEP HOLE OBSERVATIONS MADE BY: DATE: '. DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided S� S/: No. of Bedrooms - Septic.Tank Capacity /?moo als. Type C_�., �`�;c,GF PlEily2> Absorption Area Provided By 4oi L.F. x 24" width � Other i=>cl Name /t d�A -c.� (� cv= lam= Signat:' Address S7- SEAL THIS SPACE FOR USE BY HEALTH DEPARMeM ONLY: Soil Rate Approved sq.ft /gal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date 3 Z10 —9 b Re: Property of UMICOM Located at 3!�'- �S• (T) Subdivision of Section U Block 3 Lot 62�, Subdv. Lot # Z 2-- Filed Map # Date Gentl emltx : This letter is to authorize &1UAL,4 a duly licensed professional. engineer X —4. (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 oat' behalf in connection with this matter and to supervise the construction of said System or in, .cvnformity with the pro-Oisio' ns cf Article 11+5 or 147, Education Lass, the Public Health Law, and the' Putnam County Sani- tary Code. very truly yours, Signed Countersigned: Comer £Property P.E. , R.A. j # o5i�39 Cd2 � Address Address 19f V- 7, 5'}7, Telephone • Town q4~ -I -:�-8 - -0-7')-� Telephone PUTNAM COUNTY DEPARTA'IBNT OF HEALTH R` Rev. 186 . Division of Environmental Health Serviced, Carmel, N.Y 10512 = Engineer Must Provide P 2 9 I h P.C.H.D. Permit 7�' FOR: SEWAGE at r •'�. �°. Formerly TIVIM-0, Town or Villago Tax MaP _Block Got Subdivision Name n r S/ubdv. Lot N� Date Permit Issued Separate Sewerage System 'built by 11Jlr��, ;�1 fiul l&iS 1DrD -+ Address (`t- P MQi..dbirah Consisting of I27O Gallon Septic Tank and 46 LF ABS Tl"• s cY q ne Water SapP1Yc Public Supply From �a Ae_ t htrikn Addres tl�S• - DRS e✓ (for: Private Supply Drilled by Address + i i 10 Building Type R2S1 tl'ci' Hes Erosion Control Been Completed ?S Number of Bedrooms Has Garbage Grinder Been Installed? Other Requirements I certify that the system(s) as listed serving the above premises were constructed essentially as rho on he plans of the completed work ( copies of which are attached), and in accordance with.the standards, rules and re, ce lations, in accordan w th f' ed plan, and the permit issued by the Putnam County Department Of Health. • Date '] Certifietl by P.E. R.A. Address r. 601jeAm' a License No. Any person occupying promises served by the above system(s) shall promptly take such action as may be nocosaary to sacuro the correction of any unsanitary conditions resulting from such usage. Approval of the separate s2werago.systom shall become null and void no loon as o pub?i: sanitary wwor becomes available and the approval of the private water supply shall become nul n void when a public water supply bocomoa availabl0. Such approvals are subject to m7zol or change when, in the judgment of the Co I �pf111o1erAo�4 Health hf(l1r�e /,v'oc/of4ion, modl4leation or chango ll6sf�JRoLcosm►Y. 41 Date � ByvMv Tltlo 1L- -c. LAURENT ENGINEERING ASSOCIATES,. P.C. MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road Brewster, New York 10509 / (914)278- 6108 (FA)O 278 -2658 HARRY W. NICHOLS JR.; P.E. CONSULTING SITE ENGINEERS September 9, 1997 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Compliance Quail Ridge - Lot #12 Danand Lane Town of Patterson, N.Y. Dear Robert: Enclosed are the following: 1. Four (4) prints of Drawing S -12 "As -Built Plan", dated 9 -8 -97. 2. "Certificate of Construction Compliance for Sewage Disposal System ", dated 9 -8 -97. 3. "Guarantee of Subsurface Sewage Disposal System ", dated 9 -8 -97. 4. Bank check in the amount of $200.00 payabl to-Putnam County Health .Department .. ... . ... .. .. .. . __. If there are any questions concerning the enclosed, please call. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. Nichols, Jr., P.E. HWN:bd 96004 -12 cc: ' Mr. H. Lipstein w /enc. 0 ?-1 S_ 19'Q_7 DXVxSXO ,C • NVXXi '''" � ki r'A-9 $ tv:t" S ' coy" ( . t� Or vt. C (lit $711 ing Con5Uuct:.ed by RU -ildar 5 �+:� Sys on _ Sicr)c Lod, S .vision I Stab=.vTs3 -M Lbti .. Crtl�.R�~e.F.' Cc SU'•taSC+�nt.."�.. S� 'I�,E �7.�iPf�„�x SYST�'� I represent tbat- 1 4M Wholly and completely gor. Oie lomt�ion, e,'Or:4t• y9p7�pe z±•.t�x�.aJ.,. c;OnsCruc%Uon and drainase aj! the sewage disposal, syste. -: a:'x,ving the above deSc.. ibe4 prcra-r'y, and -that it ham' bin odnstructed &S ahcwn'on O- Q aui>roved -oXarf qr approved amen iment thereto :..and ' in accordance with the : L,.n6; "'-dS, * � u es and r- jglat ions of the -Ruitnah County D*&rt 'fit of Vealth, ana c% -Ilex' his h. itr, Ot a.SSignSe .t O Q3.ACe in 900d operating condit io.h &ny part Of said syst e.m c0nst:rn'c:t ed by mm- which fails to opera6a* ko: a }x:i:iod of t:;o }'eex .t,^T ° 1 4 ,y tpUowo ncg the date of apptova! of the "Cej:t_i i'jc. -_ .0 O`' COI2: kT.I:G .G>7 t.cmp iF_!ncesr ior the 3f!e;;gP_ diiposal system; j or any 1 q' a•.rs ,made by r;n ho Su"u3 ckxorept w: arr- the �all=e to egerate properly is paused' by the illstti:l- or nj? +jha cc",pEint.of the WU&nCj utillzing Vi t Lnd'&.L':i1.C,+'1ned fl). t;he +3Crnf' S Co accept as c:ncluskve the detlec.+i1Lriat-ion Li the Virscbor v;: Lhe Division of gwdt;h Services of .tbe Po.tn2 l �'001)L'y. Del.u"rt".0 ent o C�i'�L 1: }l as to F- "ttl?�r;.f' <,f. TIC: .hsI ii: i_w f the systan to 0ti caused J>.► thve '111 -1fu2 or ri'co�.xg,+...�:L acs o:' ,the QCC+i_ ni o t5 a? tii�� �z i li �-n5 the lit �}a1g c:' CF r-1 r:ioi:•.C- 4.tlr: � !..' .1 — .�a�.�iY «�... �' ��1.1/.�'3 ..Tl� LJ(� �l..r� �IL _� �.eC. t j^ C:0=X•at (xI Nx a (ig Corp.) I i `i �,i•t ( xeSri fiY0vii N eki Ly� � TOTAL F.02: J1- LP4,i ->trvi cti;:li :.trk:T+ 7 ,u rVI V-I -i COUNly 1J!S. !iK.i✓11i DrV'XSXON .Cy kiVXFti�s ii£A.L'+'�FiE,S a,-ner C X R1rchasOC Of ZUAding $ L]:Cj g Con's Ct.ed by - Xomtk -n -- S`xc -et + % �' ri 0 5 �sV iLe-lity, R • Aaildirg �yc� S�!ct�on Blcx.3c Lot 57-4yvisloa Nam 17 S,_ bUv] sion Lot GUsRAtrTeF. C� SiT%SCr�c:,f� SZ'= DzSP0SA.Zr, SYS '1 r represent that S tm 14holiv and completely responsible for Whe lomt on, cozkirx�hsoxp, r,�.texci.a)., Gonstruc -.ion and drainage c$ the sevage disposal. system sezvi ng �hQ above deSCZLbed prod -yLy, z�. that it as shown' az 'Che av,*xoved.plari sir approyecl amen-Amen` ,`_hereto;, 2rtd'.in actordance with the at.,un&a:: APP END I X C FINAL S I cc I PtSPEGT I ON DAT E: Inspected by: � : ��°°�•� STREET LCC.9T I CN r -)Q AJ U +� rl.�� Pi=r?t 1 ! T # p- T?'1 # OR SURD 1 V I S I ON LOT # ! 1. SEXAGE DISPOSAL AREA a. SDS area located as per aacroved clans b. Fill section - date of placement 2:1 barrier LGT1-I W I DT c. Natural soil not stripped d. Stone brush,etc.,greater than 15' frar e. 100 ft. f rcm water bourse /wet 1 ands 11 SEWAGE DISPOSAL SYSTEM a'a.Seotic tank size - 1,000 b.'Seotic tank installed level c. 10' minim.m from foundation c. DISTRIBUTION BOX 1. All outlets at sane elevat4on - wat 2. Protected below frost 3. Minin- m 2 ft. original sci l between e. XNCTICN BOX - groper1v set . TPE*FES 1. Length r-acuired ? Cistance to watercourse maasurer ►rstalieV according to clan SOS - pc t -d x =^d trencr c- irstallec ft. =. S1cce of 6.:-ench acceptable 1/16-- 1/22 .. 10 feet :-cm orooerty_ line - 20 feet - -:u 6. Ce:-th cf trench <-30 inches frcm surf =.s- 7. 8. Pocm ailcwed for Size of travel 3/4 exeansicn. 100% .Z�L - 11" diameter ciea^ 9. Decth of gravel in trench- T. rice ends capped c PI hP OR DOSE SYSTEMS 1. Size of oar c chamber 2. Overflcw tank 3. Alarm, visual /audio 4. Puno easily accessible manhole to grade 5. First box baffled 6. Cycte witnessed by Health Department estimated flow per cycle 11. HOUSE a. House located per approved plans b. Numer of bedroans 1. WELL a. Well located as per approved plans b. Distance frcm SOS area measured c. Casing 18" above grade d. Surface drainage around well acceptable OVERALL WORKKkNSH I P a. Boxes procerly grouted b. All pipes partially backfilied 0 Al l pipes flush with inside of box d. Backfill material contains stones < 4" c e. Curtain drain installed according to olan f. Curtain drain outfall protected & dir tc. a. Footing drains discharge away fran SOS ar h. Surface water or©tection adecuate f ti F r^ 7t I _7T T7 T' Odw Ro*&=momb I 00resent-that I SwW . Itchy and i"pisiill abwipSiiewibodwihi tie'ionitructei ai ihom � Couniy . Delmatmint of Hamith. ani'thai tilice in joed.opersting c�niiltio'n.any p once of 04 S*igsl of tlio'cirilfk kite : " C will be located SO; d tow qn,jfts SjjjiwAdp! County Dwart Wte 7 P-2 Aimo;k" APPROVED FOR,CONSTRUCTIOtC.This revocable for cause orniny tie'as trend A or requires a Mw permit. Apow6vid for di Rev. 1.0/88 sea m will lmm- PAE P.A. ife No has tleen undertaken and is or alteration of construction / LAURENT ENGINEERING ASSOCIATES, P.C. \ MILLBROOKE OFFICE CENTRE RojAa 22 6 Milltown Road Brewster, New York 10509 (914)2768108 ..(FAX) 2762858 CONSULTING SITE ENGINEERS Date: To: �z2�r✓� F� �f/y /o�� Attention: Gentlemen: We enclose O B/W Prints O Specifications Descril5fion: copies of: O Reproducibles O Memorandum Job No.: Project: L r I 111 1 = O Reports O Copy of Letter /� / L /�' �Gic rGi d iV'7� ©N/ ✓ s y i f mss' 'mac s Sent Via: O Tracings C Revision /Date No. /'- __ • Our Messenger. O Blueprinler O First Class Mail O Special Delivery • Your Messenger O Hand Delivery O G Copy lo: " Very trul Y Yours, LAURENT EH INEERING ASSOCIATESIP,C. Per: P% RANDOLPH W. LAURENT, P.E. HARRY W. NICHOLS JR., P.E. December 28, 1995' f Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Proposed SSDS Quail Ridge - Lot #12 Danand Drive Town of Patterson, N.Y. Dear Mike: Enclosed are the following: LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road Brewster, New York 10509 (914)278 -6108 - (FA)) 278 -2658 CONSULTING SITE ENGINEERS 1. Three (3) prints of Drawing SF -12 "Preliminary Plan For Fill Placement Only ", dated 12- 28 -95. 2. One (1) print of Drawing SS -12 "Proposed SSDS ", dated 12- 28 -95. 3. "Application For Approval of Plans For a Wastewater Disposal System ". 4. "Letter of Authorization ", dated 12- 28 -95. 5. "Design Data Sheet ". 6. "Construction Permit ", dated 12- 28 -95. 7. Two (2) copies of Residential Floor Plans for "Bedroom Count Only ". 8. Money order in the amount of $300.00 for review fee. Kindly review the enclosures and issue a Construction Permit at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. Nichol , Jr., P.E. HWN:TR:bd cc: Ms. N. Horch w /enc. Re: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date /nf qq Property of A),411)0 i()6 �F�Fl2yI114/(� LocAtted at 17A11AND : re) 05 (T) ft�,%�/Q_V/ Section Block Lot Subdivision of 00XIL Subdv. Lot # / Filed Map # 00 Date 2) Gentlemen: This letter is to authorizejmg,Q l�: /t%1C1�OLS Csl� P EF, a duly licensed professional engineer or registered architect (Indicate) to apply for a Construction Permit for a separate sewage-system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of, the Putnam County Department of Health,. and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Lary Code. Countersigne P. , - I e Public Health Law, and the Putnam County Sani- n�/ LL 7W,OJkE a��i e C NT/2F Address .e��ysr-jo Telephone Very truly yours, Signed Owner of Pro erty AdcUless Neay Yllge �- Town Telephone _PUTNAM .COUiv'I'Y DEPARnfr OF HEALTH DIVISION OF ENVIROL HEALTH SERVICES DESIGN DATA-SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. /Uoy tleRe ff s Owner AFL /A�JE ),E0,eK'2pAtli Address 11 SHEET -A97$1 /t��tJl1 IG�i� Located at (Street) Na M) Sec. a s . . Block % Lot (indicate nearest cross street) Municipality P4T7- r-gSG/J _ _ Watershed O,Q,V/y SOIL PERCOLATION TEST DATA -REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre - Soaking 2G� - ��� Date of Percolation Test -'L�7 HOLE NUMBER CLOCK TJME PERCOLATION PERCOLATION " Run Elapse Depth to Water From Water. Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. -Start Stop Drop In Min /In Drop Inches Inches Inches 1 O (� ' t 2 3 4 5 1 ' 3 4 5 NOTES: 1. Tes��: be` 'repeated at same depth until. approximately ..equal_ soil - rates are obtained at each percolation test hole. All data to be submitted for review. 2. Depth measurements to be made from top of hole. TEST'PIT DATA REQUT.RED TO'BE SUBMITTED WITH APPLICATION DESCRIPTION OF.SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO / HOLE W. - ._o?- _. _ HOLE N0.' G.L. l- 1' ' 2' ZAJ 3' �Jf 6' 7' . 8' 9' 10' - 12' 14' INDICATE LEVEL, AT idHIC'H GROUNDWATER IS ENCOUNTERED -- INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERS —' DEEP HOLE OBSERVATIONS MADE BY:- S . 1k).qK- L ��7i DATE: // DESIGN Soil Rate Used tp -7 Min /1" Drop: S.D. Usable Area Provided No, of Bed-rooms Septic Tank Capacity IUD gals: Type CdNc Absorption Area Provided By L.F. x.24" Width trench Other 3'' .�:= �� r f 'i-1• rvi� Qt Name %h°/2y Gti iJiCadLS �%' . P Signature f . r Cr Address ,1L��G�� "i�� ��G /CC� SEAL ' k w J� No. 124 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSA L.SYSTEH '1 . Name and Address of Applicant: iQYYJfiA) 2. Name of Project: aAGPGS�D �5 3.._,_Location T/V /C: d'/1a) C, GA 4. Project Engineer: 11) gay 1,J, 1i),C1 eLS �R .�' 5. Address: Millbrooke Office Centr Brewster, NY 10509 License Number: 15& Phone: (914) 278 -6108 6. Type of Project: Private /Residential Food.Service Cormercial , Apartments Institutional Hobile Home Park Office Building Realty Subdivision Other (specify) 7. Is this project subject*to state Environmental-Quality Review (SEQR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted. 8. Is a Draft Environmental In. pact (DEIS) required? .......... :.. /ilG� 9._Has DEIS been completed and found acceptable by Lead Agency ?• ........... 10. Name of Lead Agency OU' /It 1i. Is this project •- n.._zn_- area - under�� the control - of=l -ocal planning;- zoning -; - or other officials, ordinances? ......................................... A) C ,2.' *If so, have plans been .submitted to such. author .sties ?.. :.................. _ Q.- Has preliminary approval beep 'granted by such authorities? Date Granted: r ►•:. Type of Sewage Disposal:System Discharge....... Surface dater X Ground Waters (5. If surface water discharge, what is the stream class designation ?........ A) E :6` Waters index number (surface) ......................... ............ .. . n) //q �. Is project located near a public water supply system? .................. °. If yes, name of water supply'4x'Ag I:'iDG c2Ar5p_ Distance to water supply "RKs c6 3: Is project site near a public sewage collection or disposal system ?..... AJ61 Name of sewage system Nff} Distance'to sewage system Date observed: - %� -% -�{�, 23. Name of Health Inspector: M, ef)12 -Z tl�k I Project design flow (gallons per day) ...................... .............. 0 r�� 2. ,Is State Pollutant Discharge El in, ination:System ( SPDES) Permit required ?.._ �c7C 26. Has SPDES Application been submitted to local DEC Office? ............... A) 27. Is any portion of this project located within a designated Town or State wetland ? .................... ............. ............................... G 23. Wetland ID Number ........................ ............................... 29. 'Is Wetland Perm it• required ?'.............................................. ' GV Has applit .ation been made to Town or Local DEC Office ?. .................. N/t� 30. Does project require a DEC Stream Disturbance Permit? ................... 31. Is or was project site used for agricultural activity involving application OT pesticide$ to orchards °or other crops, solid or hazardous waste disposal, landfilling,'sludge application or industrial activity? ........ YES or NO A) C 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 or NO t) (2 DESCRIBE: 33. Is there a local master plan or file with the Town or Village? ...... . 0 34. Are co�:munity water, sewer facilities planned to be developed within 15 years? �� G' 35. Are any - sewage. disposal areas in excess of 15- slope? ........................ /)C 36. Tax'Hap ID Number ......................... ............................... 51� 37. Approved Plans are'to''be: returned to: ................. ' App"licant Engineer If the.application!is signed by a person other than the applicant shown in Item.1, the. application must . be - accompanied 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 f6 m, is true to the best of my knoule,dse and be lief. False sta'te,ents made herein are punishable as a Class A Hisderneanor p rsuant to Section 210..45 of the Pena I L a �r. ,9 j >IGNATURES & OFFICIAL. TITLES: AILING ADDRESS: Millbro�e Office Centre Brewster, NY 10509 i)T I .. 1: ;-, � . . , , , '. , -: , .1 1 - , I , ,- �, - ,�'� ' , � � , , t. , 1. I �-,:�,� , , . , . 11 ' w " t, .. �-, ,' " ,.IL 7 , , � -A . 11 I , � 11 - I , ,:, " -." t., �l , , � 1 �,,�,,�r I , - , " .�* , � � , , , I . , � � , --� -�, l � � , , - �,�,- , - . , . '. � �, I I - ; 1. e"- s , , I " �,, �� , ,- �:4�t,.",: %� ,i, I . ,"�". ��:- ".1 � , �, �, � 11 `t� ,v ... I- !�11. 1 1 I . I - � 11 ,,�,, q, , . I : ",%,"; �,' r, ,,,,a,�,,� �.,L',�I � - � . , ,, � , -.: ". ,4 1 - ,j ,�-,;,, A. � " P ',-,'� � '"�-� , -� - , �, ",r , , ' k ! 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