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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.47 -2 -13 BOX 11 i,yti u :6� i 01024 PUTNAM COUNTY ' DEPARTMENT OF HEALTH __ _.I)LVISLON...QEENLVIRQNMENTAL. HEALTH-SERVICES---- CERTIFICATE OF CONSTRUCTION COMPLIANCE FO ATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at * T A AH � 6 �- o1�D Town or Village Owner /Applicant Name 64-r-4 f- Formerly Tax Map %-'4'-) Block I- Lot 53 Subdivision Name Krw hti� UAlLa \ Subd. Lot # '"CO 'S-D A , Mailing Address a PP-1"14F- 4 6W6-r6�- N`J Date Construction Permit Issued by PCHD Separate Sewerage System built by ti1 Address (�I.rhQ�li PP wl-,�t4A Consisting of I © D Gallon Septic Tank and OJ ' L F 06, T116KX A-� Other Requirements: �-1 f14 , PU(V g;?, 5 �M Water Supply: Public Supply From Address Zip d4 01 'WO or: ., Private Supply Drilled by 1N A g k � ` 0�4- ATJA Address V� b - P V-0 4W 1 _._.. , ..Building-Type _ -?-�.�. Number of Bedrooms Has erosion.control been completed? - %(65 Has garbage grinder been installed? 9b 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 regulationsiof the Putnam County Department of Health. Date:. S" 14- y 3 Certified by Address P.E. iC R.A. License # 5 012 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 subject to modification or change when, in the judgment of the Public Health Director, such revocatio , m dificati r change is necessary. XU= By: Title: Date: f Z -3— White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 0 II vj }GIaAU � >30� CiYP.) �pJrr.sa _ t 1 O N fi5 °13�00'{V I 1 Gpi 'f NAMES X Z � O o,344� — — t 14� l�i(. (v72.0 ? ' Z 1 IZOI'• i6il�. ✓fr�I7G . — P.iCJTN•AM COUNTY DEP,A,RT�SENT OF HEALTH FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Appl icant: &S; 5-M eM. a ;j 1�r-7- IL 2. Name of Project: p}'Lve2e-47 3.._. Location &V /C: 4. Project Engineer: 1J•. Ole -OVA "T �.. 5. Address: T� License Number: ��o j 2 Phone: 6. Type of Project: is ^� Private /Residential Food.Service = ' ' .• Commercial , Apartments Institutional Mobile 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 Impact Statement (DEIS) required? I9. Has DEIS. been completed and found acceptable by Lead Agency? ........... 10:, Name of Lead Agency tl.� Is this project in an area under.- the- control - of -local - planning,- zoning., .,_....•,.. . or-.•other' - off- icials; °ordinances? .:.:. �2. If so, have plans been. submitted, to such authorities? �A 3., Has preliminary approval been granted by such authorities ?_.Wk� Date Granted: 4. Type of Sewage Disposal, System Discharge...... Surface Water ✓ Ground Waters 5. If surface water discharge, what is the stream class designation ?......... QIA S. Waters index number (surface) ..... ............................... .... , i. Is project located near a public water- - supply, system? .................... o i If yes, name of water supply ��/ Distance to water supply / �. Is project site near a public sewage collection or disposal system ?..... . Name of sewage system Distance to sewage system i . Date observed: 23. Name of Health Inspector: fit,? W.,ktjtLJk]�-zrA - . Project design flow (gallons per day) ...... ............................... Aw 2. 25: -Is- State-- Pollutant.••D- ischarge- •Elimi• nation - System- (SPDES)-- Permit-- required? . 26. Has SPDES Application been submitted to.local DEC Office? ............... QIA 27. Is any portion of this project located within a designated Town or State wetland ?.. ..... ................. . ............................... Q1D 28. Wetland ID Number .................... .. ............................... 29. -Is Wetland Permit- required ?• ........................... ......... ....... Has application been made to Town or Local DEC Office? .......... ......... 30. Does project require a DEC Stream Disturbance Permit? ................... ►.1b 31. Is or was project site used.for agricultural activity involving application of pesticide$ to orchards or other crops, solid or hazardous waste disposal;'''``' landfilling, sludge application or industrial activity? ........ YES or NO %Q 32. Is project located within 1000 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 DESCRIBE• . 33. Is there a local master, plan or file with.the Town or Village? .... ........ 34. Are community water, sewer facilities planned to be developed within 15 years? oU! 35. Are any sewage disposal areas -in excess of 15% slope? �. 36. Tax Map ID Number ......................................................... J.A7.4•n_2_, J $IJ. 37. Approved Plans are to be returned to: ................ Applicant 'V Engineer Cf 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 )rovision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form -is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Hisdemeanor pursuant to Section 210.45 of the Pena 1 Law. _ IGNATURES & OFFICIAL TITLES: AILING ADDRESS: PU'IN M C CUM DEPAi LNUM OF aEALTH DIVISION OF ENVIROtHilUAL HEALTH SERVICES DESIGN DATA Sd=- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. ownerM i-� Located at (Street) L- A M E-2 p Sec. 2 Block Lot h (indicate near t cross street ) municipa-Lity f3 Watershed e-tr=� SOIL PERCC)LATICN TEST DAM ' D t• :Iti TO BE SUBMI= WITH APPLICATICNS Lute of Pre- Soaking _ 2� ��_ Date of Percolation Test HOLE NUMBER CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start-Stop Min. Start Stop Drop In, Min /In Drop Inches Inches Inches -'/'X 1 yrl 22. 2 3 Z �o i54P or, a I 4 A0 5 _ 2 �8 3 5 1 2 a 31pp 'h0a " Z�� %Kra u.�J 22. 3 4 5 NOM: l.., Tests' - to be 'repeated' at . same depth until apprc imately equal soil rates are;:obtained at each percolation test hole., All data to* be subnittl2d for review. 2. Depth measurements to be made from top of hole. rev. 9/85 TEST PIT DATA RDQUIREV TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS E OOUNrERED IN TEST HOLES DEPTH HOLE NO. I HOLE NO. �. HOLE NO. r, 1' 2' 3' 4' 5' 6' 7' 8' 9' 10' 11' 12' 13' I lsll fly I-OA A SAN P�( �DPN1 I :g tq � I OAKA I t -OAP4 . r 14' :._�:�,.... INDjQTEjEUEh AT WHICH, GROUNDrr�ATER_ IS. ;ENQQUNI'FtED. :.:.. .. . �I Qit INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE By:— j� I I.U_d� DATE:. DESIGN Soil Rate Used Min/1" Drop: S.D. Usable Area Provided1� No. of Bedroans y Septic Tank Capacity gals . ' Type GMG . Absorption Area Provided By L.F. x 24" width trench Other Name .,-E \� W, Mr C� oi- : Signature.- Address SEAL THIS SPACE FOR USE BY -HEALTH DEPAP-MENT ONLY: Soil Rate Approved .,y qo�s =o� sq.ft /gal. - Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property ofMA ,- r4M�-�7L� �JTOOnMAKI Located at (T) Section Blocks Lot Subdivision of Subdv. Lot # Filed Map # Date Gentlemen: This letter is to authorize� t�ri yU , t`11G1'tOL� , �f re - / a duly licensed professional engineer G/ 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- -irk--conformi -ty with--the provisions-,of - Article 145 -or - 147, Education Law, the Public Health Law, and the Putnam County Sani- tary C Count P.E. Very truly yours, Signed O ,� of Pr6perty FOM AA FU a I ZU rl-� ft Eu W-M U Telephone Addre s Towh Telephone I 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 # fz3 WELL LOCATION Street Address Town Village City Tax Grid Number WELL OWNER MRS Name Mailing rG Add e s d T 0,rP, 900N oftiva e O Public USE OF WELL U - primary 2- secondary RESIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP 0 BUSINESS O FARM O TEST /OBSERVATION 0 INDUSTRIAL O INSTITUTIONAL O STAND -BY O ABANDONED p OTHER (specify D AMOUNT OF USE YIELD SOUGHT _gpm /# EI REPLACE EXISTING SUPPLY NEW SUPPLY NEW DWELLING PEOPLE SERVED OZ^ /EST. OF DAILY USAGE_jtpD gal ❑ TEST /OBSERVATION 12-ADDITIONAL SUPPLY D DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING O � .� WELL TYPE DRILLED DRIVEN ODUG OGRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES V NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name_ 1�V Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ✓ NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE'.TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED IXON SEPARATE SHEET (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 requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise Contaminate surface or groundwater. Date of Issue: �A'`�� 19 Date of Expiration 19 Permit Issuing 0 fici Permit is Non - Transferrable 3/89 White copy: HD File Pink copy: Owner Yellow copy: Bldg. Insp. Orange copy: Well Driller m •SENDER: - Complete items. '1 and 2 when eddttioneC services ere desire d, and � complete items t 3 and 4. Put your address in the' "RETURM:TQ Spa -Ce,on the reverse�side: - from being returned to you. The return rec i t fee wilt rovide Failure to do this will prevent this card ' ou the name the of arson delivered to and the date of d "liver, additional ees t e o owing services are: available. onsu t postmaster or ees an c ec ox es , or additional services) requested W 1: ❑ S(t'ow to whom delivered; date,•and addressee's address. 2 U Restricted Delivery .� (Extra charge) 3. Article Addressed to (Extra 'charge) 4. Article Number �Ype,ofLervice: aa Pe.t-r�� 'Y�C..�c� �J , - ❑'Registered �] Insured'.' ���(p3 �ertified ❑ COD. � Express MaiC' ❑Return Receippt . for• Merchandise Always obtain signature of addressee - - or agent grid .DATE DELIVERED.. 5: i ture A •tlressee : .. 8.`'Addressee's Address (ONLYff X requested arul fee paid) . - 6: ign re,— Agent: X - - 7. Date of Delivery. PS Form 3811, Apr. 1989 *us.G.RO. 1e89- 2s8•815 .: DOMESTIC RETURN RECEIPT •SENDER: - Complete items. '1 and 2 when eddttioneC services ere desire d, and � complete items t 3 and 4. Put your address in the' "RETURM:TQ Spa -Ce,on the reverse�side: - from being returned to you. The return rec i t fee wilt rovide Failure to do this will prevent this card ' ou the name the of arson delivered to and the date of d "liver, additional ees t e o owing services are: available. onsu t postmaster or ees an c ec ox es , or additional services) requested W 1: ❑ S(t'ow to whom delivered; date,•and addressee's address. 2 U Restricted Delivery .� (Extra charge) 3. Article Addressed to (Extra 'charge) 4. Article Number �Ype,ofLervice: aa Pe.t-r�� 'Y�C..�c� �J , - ❑'Registered �] Insured'.' ���(p3 �ertified ❑ COD. � Express MaiC' ❑Return Receippt . for• Merchandise Always obtain signature of addressee - - or agent grid .DATE DELIVERED.. 5: i ture A •tlressee : .. 8.`'Addressee's Address (ONLYff X requested arul fee paid) . - 6: ign re,— Agent: X - - 7. Date of Delivery. PS SENDER: Complete items I. grid 2 ;when additional services ere desired grid complete items • 3 and 4. Put your address in the "RETURN TO" Space on the reverse side. Failure to do this will prevent this card from being returned to you. The return recei t fee will rovide you the name of the arson delivered to and the date of delivery. For ad mona ees 3 e o owing services are avai a e. Consult postmaster or ees an check ox(esl for additional ervice(s) requested. 1.. ❑ Show to whom delivered, date, and addressee's address. : 2. 0. Restricted Delivery (F.ztrg charge) (Extra charge) [3. Article Addressed o: - 4. Article Number Ralph 4 An. nC t ��t � T pe of Service: . .... ..._..... . RegiStared u "inswad Certified,, COD a Return- Race ipt ' �� ❑ Express Mail � for Merchandise 4� , et ^!fit Always�`�Abtsigneture of addressee or agent and,DATE DELIVERED.` 5..' Signature - Address a B. Address dress (ONLY if req and ee "d)' 6. Signature - Agent X 001 ' :7. Date of Deliveryj`" PS Form 3811, Apr. 1989 *u.s G Po. t9as z3a Sts ST ETURN RECEIPT -. S S P 521�279 845 �; RECEIPT, FOR CERTIFIED NO.INSURANCE COVERAGE PROVIDED 1 'NOT FOR k a S-0 PO 1989 238 815 flOMESTIG RETURN RECEIPT SENbER,, Complete itei�e 1 en7 � vufiian 4dtlitionai service's are desired, - and- eomplete -tems Put �toUr address tnr'�he t t�T17RN TC?- ' >�paCe oar the reverse stile., Failure to do this Win prevent "this card fltoin being t�turned to your The r turn•�fee t_fee vyi(I txourdeE�+o�r the name of the person delivered to and tFie to =of deitver F:or a ttt#�na ees "4he .iailor+Wng services areav8tla6fe�onsuT€,postmaster or ees an s ec ox es �irzadditltrital set vta�lsy rer}tiested, �' D Show to whprtt dei�trbrech date, and addressee :a address 2 al Restricted 4eUvery '. �Exrru chage} a i�ztra charge'- 3 .`Art +cle Addressed 4: -Article Number. }►1};�j'jtrk,�>� � tt'F`n��r�.���-��t.Efi 1 � °s '� �1 5�'� Type of Sernee: �� 3 ..� � :• e Q Registered 0 insured a�Caiiified iQ C04" EKpre'ss';Maii �.� Retyen IieCetppt " �� - f r Merchandise Always oktairi signature of ?8ddiassee or agent and DATE PF- i.IVEFtEp. ,5 S' INTERNATIONAL MAIL F`. (See Reverse) is ent fo o= Street�`and No,. � an'ZIP Codes f. I r . i in r. I:. d I 6; . a v g afore y Addre�ssg�� � $ $. .,•Addressee's Address J 6 iC�' - f .� -" � •'. ' 'requested and fee paid) _ _ ; " . - X - - 7s �D to of etiveKy k a S-0 PO 1989 238 815 flOMESTIG RETURN RECEIPT SENbER,, Complete itei�e 1 en7 � vufiian 4dtlitionai service's are desired, - and- eomplete -tems Put �toUr address tnr'�he t t�T17RN TC?- ' >�paCe oar the reverse stile., Failure to do this Win prevent "this card fltoin being t�turned to your The r turn•�fee t_fee vyi(I txourdeE�+o�r the name of the person delivered to and tFie to =of deitver F:or a ttt#�na ees "4he .iailor+Wng services areav8tla6fe�onsuT€,postmaster or ees an s ec ox es �irzadditltrital set vta�lsy rer}tiested, �' D Show to whprtt dei�trbrech date, and addressee :a address 2 al Restricted 4eUvery '. �Exrru chage} a i�ztra charge'- 3 .`Art +cle Addressed 4: -Article Number. }►1};�j'jtrk,�>� � tt'F`n��r�.���-��t.Efi 1 � °s '� �1 5�'� Type of Sernee: �� 3 ..� � :• e Q Registered 0 insured a�Caiiified iQ C04" EKpre'ss';Maii �.� Retyen IieCetppt " �� - f r Merchandise Always oktairi signature of ?8ddiassee or agent and DATE PF- i.IVEFtEp. ,5 S' INTERNATIONAL MAIL F`. (See Reverse) is ent fo o= Street�`and No,. � an'ZIP Codes f. I r . i in r. I:. d I 6; . a v JOHN N. CALBO Building Inspector TOWN OF PATTERSON, _._..._� . ... -_.... PUTNAIvI...EOIINTY_... __._..� _...._.._...._...._ -- - -_... 8e6- _ Telephone.- 6319 PATTERSON. NEW YORK 12563 February 22, 1993 Mr. William Hedges Sr. Public Health Sanitarian Department of Health 4 Geneva Road Brewster, New York 10509 RE: TM - 25.47 -2 -7 & 13 Old TM - 50 -3 -3 50 -3 -9 Rea & Hyndman. Thames Road & Perry Road Patterson, New York Dear Mr. Hedges, This is to inform you that the above noted tax parcel meets the minimum requirements of the -Town of Patterson .zoning regulations for a single building lot. If I may be of further assistance, please'do, not hesitate to contact this office. Very ruly yours, ' r a Andrew W. Barone, P.E. Temporary Building Inspector AWB /cs LAURENT ENGINEERING ASSOCIATES, PC. 73 FAIRFIELD DRIVE _ _PATTERSON,. NEW YORK 125.63.. - „ RANDOLPH W. LAURENT. PE. (914) 278.6108 - (FAX) 278.2658 HARRY W.NICHOLS,JR.. PE. CONSULTING SITE ENGINEERS January 19, 1993 RE: Department of Health Review of Proposed Sewage Disposal System For property: Mrs. P. Hundman & Mr. J. Rea Thames Road Patterson, N.Y. T.M. 25.47 -2 -7 & 13 Dear Mr. & Mrs. William Grozenger: Please be advised that an application for a Construction Permit relative to the construction of a sewage system and /or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call Mr. Hedges or Mr. Morris of the Health Department at 278 - 6130. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W.Llichols, Jr., P.E. HWN:bd enc. q' . r _.s LAURENT ENGINEERING ASSOCIATES, PC. 73 FAIRFIELD DRIVE PATTE_RSON, NEW YORKJ2563.__ RANDOLPH W LAURENT, PE. (914) 278 6108 -(FAX) 278.2658 HARRY W.NICHOLS, JR., PE. CONSULTING SITE ENGINEERS January 19, 1993 RE: Department of Health Review of Proposed Sewage Disposal System For property: Mrs. P. Hundman & Mr. J. Rea Thames Road Patterson, N.Y. T.M. 25.47 -2 -7 & 13 Dear Mr. & Mrs. Ralph Funigiello: Please be advised that an application for a Construction-Permit relative to the construction of a sewage system and /or well proposed f or. the. captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call Mr. Hedges or Mr. Morris of the Health Department at 278- 6130. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. t� Harry W: Nichols, Jr., P.E. HWN:bd enc. M C , µ LAURENT ENGINEERING ASSOCIATES, PC. 73 FAIRFIELD DRIVE _....._... ,._ _....- _ _.....__ _ ___PATTERSON,. NEW YORK 1256 -3 _.__.....__.. RANDOLPH W.LAURENT, P.E. (914)278-6108-(FAX) 278.2658 HARRY W.NICHOLS, JR., PE. CONSULTING SITE ENGINEERS January 19, 1993 RE: Department of Health Review of Proposed Sewage Disposal System For property: Mrs. P. Hundman & Mr. J. Rea Thames Road Patterson, N.Y. T.M. 25.47 -2 -7 & 13 Dear Mr. & Mrs. John A. Casamassa: Please be advised that an application for a Construction Permit relative to the construction of a sewage system and /or well proposed for the captioned property has been made to the Putnam County- Department of.Health. Attached please find a copy of the latest site plan. If you have any questions, concerns or information which may bear on the Health Department's review of' this application, you may call Mr. Hedges or Mr. Morris of the .Health Department at 278- 6130. Very truly yours, . LAURENT ENGINEERING ASSOCIATES, P.C. Harry W Nichols, Jr., P.E. HWN:bd enc . M 0 , e a LAURENT ENGINEERING ASSOCIATES, PC. 73 FAIRFIELD DRIVE . .PATTERS0N,_NEWY0RK.12563 -____ _..__._.v__,. _._.... ..... RANDOLPH W. LAURENT, PE. (914) 278.6108 -(FAX) 278.2658 HARRY W.NICHOLS, JR., PE. CONSULTING SITE ENGINEERS January 19, 1993 RE: Department of Health Review of Proposed Sewage Disposal System For property: Mrs. P. Hundman & Mr..J. Rea Thames Road Patterson, N.Y. T.M. 25.47 -2 -7 & 13 Dear Mr. & Mrs. Michael Ostuni: Please be advised that an application for a Construction Permit relative to the construction of a sewage system and /or well proposed for• the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call Mr. Hedges or Mr. Morris of the Health Department at 278 - 6130. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. clVichols, Jr., P.E. 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I _ 4w 17 - \ \ \ \ o I rar9 I I 8 39 \Isar - - - '_ _ sau :; r 1 rasa itur/ I Sasr 1 -wi sari .mss rcvs 1 xr� I - �� 100.00 \ of \ \ IA93 100.00 mv I _ _ -' - 1070 I I JOtt I • .+ F s. 6000 4000 9 �tI lAtJ \lAII \ �AV�/ JO J I 1 76. 100.00 JOJJ I V' i 1 % i 11016 i 301! I I my I / SaY 1 Scvf 76.75 IAII \ \ \ 59.22 �dl I scs. S \\ 4(i IA,ie -- -_ \ \ \ 3 45 . (�- I $__ sass 8' i I I I 1..5 i i \ .9? 8 I I I I r1 -r/ 8 100.00 8 Jtx� \ \ \ 33.02\ B0.00 ra .,, �- „„.6000 AM \1976 \ 9I. S7 .911 i 'f'm /1956 V %9 44 I� �LG-;i+ y' 0 00 i 79.29 1 THAMES> as i 41 / .907 / o ao .%s - - - r ~ $ I t ROA D 71" / IlS6 45.9 J /A! 140.00 I 1 IIO.00 _ _ " 60.00 I 10.00 ) 1w 43 g I - - -- _J �Si`�7'� -1�(l� 21 I I G ___ F9Oy/ 4W � �b I e5.29 slip i ° I 1201 1 19 i i - - -- o I I IAS7 d2 - - I _ _ 1'•'/t (3101 I SiGf(f' ?/0fI SIN 1 5101 1 J 01 I J /O/ (3 /X I �y!?� 1 1 I $ Au - -• - -• i - -. _ _ a oD I I I / JC97 091/ •� 3•`AA! I L^'3�=b �:h� ,� JCIf _ _ a 4000 . -s;, k I I *091 - - ._^- 26 1 ? 1.410 O9� _ - 154 I 1 _ - - 100.00 160.00 -- ...,. -_: I 3//61 3//91 S/,v I1 /1/ 11/11 I I 80.00 00.00 - - - •- -- J�11 i I 1 1 - "' -1 0117 I I � ° _ 1-f," I s.» 22 1 t J /.e1 S�t9 31!010,1' - - - -- 1 I I I 3� /J 1 23 I I .. g 1 I ( I 1 1 ! 1 3/x 24 1 1 25 11406:1 I e.09 �I I I I I 1 8 _____ I10000 si/✓ 1 I � I I I I I I s; +o 1 80 00 4000 S: Q )8 !2 411.01 I I 1911 100.00 I ROAD 55 _ _ _ S R .lib 65 - - I 1o0, 160 p0 1 - _ PAC 80.00 60.00 1 1 1 8 - _ - - _ I 1 60.00 J/6/ I I 1 I I I I I I 3112 "a � I 8 156 8 _ _ _100.00- - - I I I I R 1911 64 81 Jibs 130 I 129 39 I I ( 281 1P71 I� 10.00 100.00 LAURENT . ENGINEERING ASSOCIATES, PC. 73 FAIRFIELD DRIVE _.. -. -_ - "PATTEASON-NEW YORK RANDOLPH W.LAURENT, PE. (914) 278.6168 -(FAX) 278.2658 HARRY W.NICHOLS, JR., PE. CONSULTING SITE ENGINEERS List of Adjacent Property Owners Rea / Hyndman T.M. 25.47 -2 -7 & 13 Thames Road Patterson, N.Y. 25.47 -2 -6 & 14 Ostuni, Michael & Carmela 3 Thames Road Patterson, NY 12563 25.47 -2 -12 Casamassa, John A. & Miriam D. 11 Thames Road Patterson, NY 12563 25.47 -2 -20 Funigiello, Ralph & Anna 4 Thames Road Patterson, NY 12563 25.39 -1 -37 & 42 Grozenger,William & Bonnie 13 Perry Road Patterson, NY 12563 I repressmUthat,l am mholly' and completely 69100 aboin Aefc►ibd will be constructed a$ shown on it County Dipartimnt , of Hiellh.: &'no that on tort be "" heed to the Oep.rtmmt ind• a :writteri plate in good ieritkiil eoodition ,any pert of a an of the 8"Mrial of ter certificate of Coni will be located' as ahuiM on the approved plan and County Dap�rtnttaiit of Nultlt.` ` Date Add ION: h_ APPROVED FOR CONSTRUCTIONeThi approv fei�OcibN for.cause or may be :& 'Or m6dtfi requires a ew permit. Approved for ,dispossl ReV. 10/88 Data mss, iblefor the design and location of the "propomd'• system(s). 1) that the aparit• sew 'di sal s stem kporoved amendment there to and in accordance with the standards, rules and requ ns O Mipn.theraof a " Catificito ';o1,Constructio.nCompliana" Milifactory to the Commissioner of Mealthwill INrint" will -Oe furnished the owner; his succassors. heirs or assigns by the builder. tMt said bulkier will fd.aawage, disposal 3y am durirp' the pMkiO Of two (2) yews Immediately fO1klwing tMdate 01 the 1311W disposal of the Iglnal'system or any .r�irs ttleretoi 2) that the drilled well Ascribed above It said well *IIIte Instal in accordance "with, the sta _ a s. uws end rpu la olio ns of the Putnam • SigneO p:E. � R:A. \ - license NO expires two years from t data iuued unwss on. ruction of lee building has .been undertaken and is Health. when considered necessary by. the Commissioner of. Health. Any change or alteration of construction domesife sanitary sews an /er privai tear Supply only. lae Titre LAURENT ENGINEERING ASSOCIATES, PC. 73 FAIRFIELD DRIVE _....._._...- ..... ---_ - -._ - - PATTERSON"NEW YORK 12563 _ _ ._ _ . _.--- --- ._....._.. RANDOLPH W. LAURENT, PE. (914)278.6168 -(FAX) 278-2658 HARRY W.NICHOLS, JR., PE. CONSULTING SITE ENGINEERS February 19, 1993 Putnam County Health Department Route 312, Geneva Road Brewster, NY 10509 Att: Mr. William Hedges Re': Individual SSDS Thames Road Patterson, N.Y. Dear Bill: Enclosed are four. (4) prints of Drawing SS -1 "Proposed SSDS'", revised 2- 22 -93. Regarding your marked up comments, we note the following: 1. Wells and septics within 2001, as required, have been added. 2. Dimensions for house and well locations added. 3. Cleanout provided. 4. Green cards from certified mailings enclosed. 5. Letter from building inspector enclosed. 6. The expansion area shown represents 100% of the primary area. Should this area be needed in the future, it will be filled and regraded, with a pump system provided. Kindly issue the necessary construction.permit for the SSDS. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Har y W. Ni ols, Jr., P.E. HWN:bd 92076 enc. cc: Ms. P. Hyndman w /enc. Mr. J. Rea w /enc. LAURENT ENGINEERING ASSOCIATES, PC. 73 FAIRFIELD DRIVE PATTERSON, NEW YORK 12563 RANDOLPH W. LAURENT, PE. (914) M.6108 -(FAX) 278 -2658 HARRY WNICHOLS, JR., PE. CONSULTING SITE ENGINEERS January 19, 1993 Mr. William Hedges Putnam County Health Department Route 312, Geneva Road Brewster, NY 10509 Re: Individual SSDS Thames Road Patterson, N.Y. Dear Bill: Enclosed are the following: 1. Four (4) prints of Drawing SS-1 "Proposed SSDS",.dated 1-14-93. 2. "Application For Approval of Plans For Wastewater Disposal System". 3. "Construction Permit for Sewage Disposal System", dated 1-14-93. 4. "Application to Construct a Water Well", dated 1-14=93. 5. "Design Data Sheet". ,6.-z-,-"Letter of Authorization", dated 1-14-93. 7 ...Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only". 8 'Money order in the amount of $300.00, review fee. __)..We,._:�rould appreciate your review, approval and issuance of the 1. 1 �Coris�truction Permit at your earliest convenience. =-: Sincerely, LAURENT ENGINEERING ASSOCIATES, PX. J Harry W. Nhols,.-Jr., P.E. HWN:bd 92076 cc: Mrs. W. Hyndman w/enc. Mr. J. Rea w/enc. PU1 M COUNTY DEPARTMENT OF HE 'H DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date q- 7 fS. Re: Property of MA;. rA Cpm�\Kl Located at (T) Section L Block �'� Lot Subdivision of Subdv. Lot # Filed Map # Date Gentlemen: This letter is to authorize 1- a duly licensed professional engineer L/ 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 _.. --- 'Syst em'or' °s'ysfems' in- conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary C Count P.E. W1i al �Cox Telep one Very truly yours, Signed 0�. of Pr6perty Opp Address�T r,-A-Tvo Toy .Telephone I LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE 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 September 7, 1995 Mr. William Hedges Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Renewal Mrs. Patrick Hyndman Thames Road Patterson, NY Permit #P -3 -93 Dear Bill: Enclosed are the following: 1. Four (4) prints of Drawing SS -1 "Proposed SSDS ", revised 2- 22 -93. 2. "Application For Approval of Plans For a Wastewater Disposal System ". 3. "Construction Permit for Sewage Disposal System ", dated 9 -7 -95. 4. "Application to Construct a Water Veil ", dated 9 -7 -95. 5. "Design Data Sheet ". 6. "Letter of Authorization ", dated 9 -7 -95. We would appreciate your review, approval and issuance of the Construction Permit Renewal at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. Nichols, r., P.E. HWN:bd 92076 cc: Mrs. Hyndman w /enc. PViNAM CODNTY DEPAETNM OF EMUTH J DI�Yaa o1 ,Redlh Saevloaal. claaieel: N.Y. lean . ro Paevlde Paean r ee CEMEWATE Or COMUMCB ,(•�� -soy, ❑ Otf.arlAp OMM Melilla " Date oI Previoae U1110112 Ad6sas Z33 /�/o��t i�/ <°_�T- Teem jig Subdivision :Approved Fee Enclosed Type 2Si UGC P Y ! � ,L Lot Area O.: dfS`1 �c IM Seedoa only Dpi Vohuw Neaibae of Beiaoneo Flew G P D� . - PCHD NotlBtatloa 6 Eequleed When:F10 b ampbtaed _.;„ Sepenie Se*eeat4 SyWeo i.- aoasioC of _Septic •Tank Te be:o .efed: ?' f Adthow ` �d W4dW S"* ?d1 Sap�tb i?ro® _ ------ orr Ito S.ppb� Da�e11 by • J . A Otree i�east4emeala - `O 1 r wesent:.that 1 am wholly and compbtely rospons�ble for thedesgn and location, of the proposed fystem(s); l) that the saparata ss02-4!9109.32 abOYe desaitied will be condiucted as_ hown on the approved amendment the►e -to and in accordanca with the standards, rules a reign i ,ss County. iopartment M NeeKA, anA that on complotwn'tMreof a "Catifii to of .Construa ion Compliance•' satisfactory to the Commissions► of tiNRhwtll be submitted to the Depertn", and, a wrlttan guaientae wili:psi Turn" the owner his successors, he" or *assigns by the bu kler, that said bulkier will 1 place in food" operatklg an'dition any part. -'of said sewage Afsposal system, tlu►irg, the, period Of two (2j Yarn immediately folkiwifp tMdats Of the leas- anee of the 8*6val of tha"Ce'rtiflkita of "Construction. Compliance of:.th0 original system or any repairs then i2) that the drilled well desallied 460" wql be locsted;as Awn on tM'aPprovid plan aetl,tMt saki well wtllba Instal in ai:cordan with t dam r rule ah reou runs of the Putnam County: Department`of HeeltA. P� Date 7:S S q E. _ R P A. Address'L,4 "'!??U C 1cense No =5!i�/'t6y APPROVED FOR CONSTRUCTION TMs approval expaet two yarn from the date issued unless construction of the building .has been undertake and is revocable for cause of may,De,amendad-or mo .!fied when considered necessary missioner of Health. Any change or alteration of construction requires a new psr it Approved for dispp=al,of tlomestic unitary saw and / wa water supply on1Y_,., /T %/° �V • Oate s eY! Title ` � 10/88 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 0 ''�� -93 WELL LOCATION Street Addres o Villa City Tax Grid Number i iWELL OWNER Name Mailing Address - G L CIPrivate O Public !USE OF WELL Q primary 2- secondary RESIDENTIAL 9BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify Q AMOUNT OF USE YIELD SOUGHT s gpm /# O REPLACE EXISTING SUPPLY gNEW SUPPLY NEW DWELLING PEOPLE SERVED 23 /EST. OF DAILY USAGE yon gal O TEST /OBSERVATION Q ADDITIONAL SUPPLY 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR ,I DRILLING WELL TYPE DRILLED DRIVEN ODUG 11 GRAVEL 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 MUD Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES -NO NAME OF PUBLIC WATER SUPPLY: /S/ TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ®ON SEPARATE SHEET / (date) 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 thirt7 (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to cddeegrade or otherwise contaminate surface or groundwater. Date of Issue: � 19 ! 5— ,�-�►� Date of Expiration Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller • 1. 2. 4. 6. 7. PUTNAM C OUNTY D E PARTMENT O F HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM Name and Address of Appl icant: ASLi , 1A) 5;, Name of Project: WO0a4-2e-5-7 ���r�- 3.._. Location&V /C: Project Engineer: 10- N1LdP V2 –f iz _ 5. Address: License Number: �56 ( 0* Phone: IGg Type of Project: i.... - Private /Residential* Food .Service . .Commercial , Apartments Institutional Mobile Home Park Office Building, . Realty Subdivision Other (specify) Is this project subject to State Environmental-Quality Review (SEAR)? .Type Status (Check One) Type I.. Exempt a� Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? .............. $10 9. Has DEIS been completed and found acceptable by Lead Agency? ........... 10. Name of Lead Agency 'I - 11 —Is ••th s•- pr© ject... i• n-- an-- area••under-- the, -cont rol• °-of Iocal•- planning; zoning _;...__._....__..._.._..., orother officials, ordinances? ........... .............................�_ 12. If so, have plans been submitted to such authorities? .................. 11 . Has preliminary approval been granted by such authorities ?_ Date Granted: 14. Type of Sewage Disposal_ System Discharge....... Surface Water Ground Waters 15,. If surface water discharge, what is the stream class designation ?........ MIA 16. Waters index number (surface) ........... .................:............. M 14 17. Is project located near a public water supply system? .................. N n 18.If yes, name of water supply T/ Distance to water supply 19. Is project site near a public sewage collection or disposal system ?..... U- 20: Name of sewage system N/A T• 1 ?1. Date observed: Distance to sewage system ,_ 23. Name of Health Inspector: Mfz• Mrs "� :4.' Project design flow (gallons per day) ...... ............................... U 25. Is" State- PoTTutant "Discharge'E1iroination System (SPDESY Pie rmit- i=equTred ?�: (J � 26. Has SPDES Application been submitted to local DEC Office? ............... QI1A 27. Is any portion of this project located within a designated Town or State wetland? .................................. ............................... 1R 28. Wetland ID Number ........................ ............................... �.1. 29.-Is Wetland Permit- requi, red?'• .............. ......0.......................: I�1� Has application been made to Town or Local DEC Office? .................. 30. Does project require a DEC Stream Disturbance Permit? ................... *1b 31. Is or was project site used for agricultural activity involving application of pesticides_ to orchards or other crops, solid or hazardous waste disposal;"'`` landfilling, sludge application or industrial activity? ........ YES or NO ®10 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 N DESCRIBE: 33. Is there a local master plan or file with the Town or'Village? ........... _ 1_ 34. Are community water, sewer facilities planned to be developed within 15 years? ux1T a5-: Are-any sewage - disposal areas-in excess of 15%- slope? .:.:.....::.:.:: ..:. . 36. Tax Map ID Number ......................... ............................... Sri-An ¢l 37. Approved Plans are to be returned to: ................ . Applicant Engineer rf 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 my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the Pena 1 Law. , A n SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: ,a�"Ta��6'J m PUTNAM COUNTY DEPARTMENT OF.-HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICE DESIGN DATA SHEET.- SUBSURFACE SEWAGE TREATMENT SYSTEM'. Owner Addressi�ES Located at (Street)1c,< YA, ,"7,2 Tax Map,?. }iBlock, . Lot7 4 T161 _3 (indicate nearest cross street) Municipality ,¢•7-TF25oAV Watershed�i�jGff SOIL PERCOLATION TEST DATA.. Date of Pre-soaking 5 �6 /D� �v Date of Percolation Test / 7 /per D epth to Water Water From Ground Level tz Percola on Hole No Run No. Time : Start> Stop ETa se Time Ln:) Surface (Inches) Start Stop .. Aropp In Incties Rate Mafia... 2 :����� 3q 0 2 - , 2. ! s 4 2 Z// -x,11/ 3.v 3 ;z# — marf /3 1-7d / 5 1 2 3 4 - 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN.TEST HOLES DEPTH HOLE NO. _ HOLE NOC ^ ' V `' HOLE NO. G.L. 1.0' 1.5, 2.0' 2.5' 3.0' 3.5' )4A Wt Olive- 4.0' 4.5• as 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 7 8.0' 9.0' 404'4 j 9 l #-6!' 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed 64 D " Indicate level to which water level rises after being encountered Deep hole observations made by: C; c ��D t�'� G,'D, i-� , Date 5" 7 Design Professional Name: Address: Signature: Design Professional's Seal r •o _ PUTNAM_COUNTY DEPARTMENT OF HEALTH N DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project ,�7�� V j e7 --O V) ?,f77rF2e1V County la(.) 7;1/�/�9 Site Location _E4,4i 0�5-S ?W- 1 /'�% 2 S, S% 7 — v2 — 7 4 (3 Building construction begun Extent Is property within NYC Watershed ? ................. Yes Q No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. 0 Hilly Rolling Steep slope F7� Gentle slope /Flat 2. Evidence of wetlands F --- ] Low'area subject to flooding F--] Bodies of water Drainage ditches Rock outcrops: 3. Property lines or corners e vident ............ ............................... 4. Do water courses exist on or adjoin the property? ................ 5. Will these affect the design of the sewage system facilities? 6. Do watershed regulations apply in this development ?.......... 7 ..Will extensi' ve- gr' ading' be-. ri ecessary? .....::::..::::.::.... - -. 8. Will extensive fill be necessary for SSTS ? ............................. 9. Do filled areas exist within the SSTS area ? ............................ If yes, what is the condition of the fill? 'Yes Yes Yes des .—F 77-1 - es Yes Yes a dNo F�No ffNo - ' No No [2"'No SECTION C. SOIL OBSE VATIONS 10. Appearance of soil: Sand F7 Gravel ZLoam Clay E] Hardpan 0 Mixture 11. Observed from: 0 Borings F--] .Bank cut Backhoe excavations 12. Soil borings /excavations observed by D -. e JJ N, on 7 0 13. Depth to groundwater �-= 46 on 14'. Depth to mottling �� �'� on 15. Are test holes representative of primary & reserve areas ...... /.&4Wt W.......... es n No 16. Soil percolation tests made by /f/j.-1,� /��_� on 17. Soil percolation tests witnessed by 4::;", zeZ g on SECTION D (on back) Form ST -1 2 v SECTION D: DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? 0 Ye No 19. Will groundwater or surface drainage require special consideration? ..................... Yes No 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... 0 Yes F:�! No SECTION E. REMARKS 21. If a common water supply is proposed; has an inspection been made of the existing or proposed source and facilities? ................................ ............................... Yes No Inspection data �. f Yes. No 22. Do adjacent wells and/or sewage systems exist ?........... 7 -fi ......... 23. Additional comments 24. Site observer /inspector and title allA I,' 2a-tz D 25. Date(s) of observation(s)inspection(s) 5,2 7 % -- TEST PIT PROFILES Hole # Lot # Hole # 'Lot # Hole # Lot # Depth to water Depth to water Depth to water Depth to mottling Depth to mottling Depth to mottling 'Depth* to rock/imp: Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L. m I 0.5 .0.5 0.5 1.0 1.0 1.0 2.0 2.0 2.0 3.0 3.0 3.0 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 'Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 Brewster, NY 10509 Telephone (845) 2794003 Fax (845) 2794567 May 23, 2002 Robert Morris, P.E. Putnam County. Health Department 1 Geneva Road Brewster, NY 10509 RE: Individual SSTS D'ottavio (Formerly Hyndman) Thames Road Patterson; N.Y. T.M. #25.47 -2 -7 & 13 New deep hole and percolation tests were:performed at the above noted site since -the date of the original testing exceeded ten years. Replace the previously sent permit and data sheets with the following: 1. Five (5) prints. of Drawing S -1, "Proposed SS.TS," revised 5- 22 -02. 2. "Construction Permit," dated 5.-2.. 2-0_ 2. ......_ _. .._- 3. "Design Data Sheet "^ (5 -7 -02 Testing date)... _.__ . _..__..__ ...__._ ........... _.........._.- - .. :.. -.. I........ . Kindly continue with your review of the application. Very truly yours, Harry W. Ni hols Jr., P.E. HWN: his 02- 016.00 I acknowledge receipt of this:report: SIGNAT. ' G2/96 Title, Rev . BRUCE R. FOLEY _ Public Health Director_ _ -• -- -- -' DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Harry Nichols, P.E. Patterson Park Suite 106 2050 Route 22 Brewster, NY 10509 Re: Proposed SSTS: D'Ottavio Thames Road (T) Patterson, TM# 25.47 -2 -7.13 Dear Mr. Nichols: April 22, 2002 Review of plans and other supporting documents submitted at this time relative to the above- regarded project has been completed. Comments are offered as follows: If percolation _tuts --weFe - not 'wi"tnessed -by a representative of the New York City Department rnvironmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ve y yours Robert Morris, P.E. Senior Public Health Engineer RM:tn BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 March 19, 2002 Harry Nichols, P.E. Patterson Park Suite 106 2050 Route 22 Brewster, NY 10509 Re: Proposed SSTS: D'Ottavio Thames Road, Lot# 5060 -5064 & 5074 -5078 (T) Patterson, TM# 25.47 -2 -7.13 Dear Mr. Nichols: Review of plans, and other supporting documents submitted at this time relative to the above- . ....__. . regarded project has.been completed. Comments are offered as.follows: , 1. Please submit documentation of the previous approval including a copy of approved plans. The previous approval cannot be located. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ve y yours, V&/ Adno Robert Morris, P.E. Senior Public Health Engineer RM:tn ZZHarry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Telephone (845) 2794003 Fax(845)2794567 March 5, 2002 Mr. Robert Morris, P.E. Putnam County Health Department One Geneva Road Brewster, New York 10509 Re: Individual SSDS D'ottavio (Formerly Hyndman) Thames Road Patterson, NY T.M. # 25.47-2-7)13 Dear Robert: Enclosed are the following: 1. Five (5) prints of drawing.S-1, "Proposed..SSDS," dated 3/5/02. 2.. "Short EAF," dated 3/5/02. 3. "Application for Approval of Plans for a Wastewater Disposal System." ..4. "Construction Permit for Sewage Disposal System," dated 3/5/02. Y 5. "Application to Construct.a Water. Well," .dated .3/5/02. 6. 'Design Data Sheet." 7. "Letter of Authorization,". -dated 3/5/02. 8. Two (2) copies of Residence Floor Plan(s), for `Bedroom Count Only." 9. Review Fee in the amount of $300.00. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, Harry W. Wichols Jr., P.E. HWN:JM:jmm 02-016.00 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FOR APPROVAL OF-PLANS-FOR- _- A : - WASTEWATER TREATMENT SYSTEM - 1. Name and address of applicant: 2. Name of project: I�Dw�L�ai. ? �'� 3. Location TN: 4. Design Professional: IA?%H `N OM Jt"; tE 5. Address: '20' o K q1_ 6. Drainage Basin: FAST bF-AH0 1A �4T — 1 ocQ`\ 7. Tyne of Project: _ k Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted X 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... lye 10. Has DEIS been completed and found acceptable by Lead Agency? ............... NA 11. -Name of Lead Agency N 12. Is this,-project in an area under the control of local planning, zoning, or. other officials, ordinances? .:...........:......................................... .....................T......... YG� ..... . 13. If so, have plans been submitted to such authorities? ........ ............................... tAo 14. Has preliminary approval been granted by such authorities? +No Date granted: ' 15. Type of Sewage Treatment System Discharge. ................ surface water '6 groundwater 16. If surface water discharge; what is the stream�class designation? ........ ::........ N� 17. Waters index number (surface) ........................................... ............................... NN 18. Is project located near a public water supply system? )�a 19. If yes, name of water supply N Distance to water supply : N 20. ''Is project site near a public sewage collection or treatment system? .........`.....:: o 21. Name of sewage system Distance to sewage system r� 22. Date test holes observed 23. Name of Health Inspector W WK. 14 ^V605 24. Project design flow (gallons per day) ................................. ............................... q' po 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... - -� - 26. Has SPDES Application been submitted to local DEC office? ......................... P+ Form PC -91 2 27. ' Is any portion of -this project located within a designated Town or State wetland? kD 28. Wetlands ID Number........................... -- ............. ...........:...........:.:.-..... ........................:.....: *A 29. Is Wetlands Permit required? Has application been made to Town or Local DEC office? ............................... !� R 30. Does project require a DEC Stream Disturbance Permit? .. ............................... &D 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal,. landfilling, sludge application or industrial activity? ............................ Yes/No 14t 32. Is project located.within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............ Yes/No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... 34. Are community water and/or sewer facilities planned to be developed within - 15 years in or adjacent to project site? ............... ............................... 1`1 35. Are any sewage treatment areas in excess of 15% slope? . ............................... ND 36. Tax Map ID Number .......................... ............................... MapU,11 Block �-- Lot-7) > 1 37. Approved plans are to be returned to ..... Applicant X Design Professional NOTE:.All applications for review.and approval -of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to- final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown.in Item 1.,the application must be accompanied -by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as ' a Class A misdemeanor pursuant to Section 210.45 of the Penal L,qw. „ SIGNATURES & OFFICIAL TITLES: Mailing Address qL PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET- SUBSURFACE SEWAGE .- - TREATMENT SYSTEM' Owner Address �j lf- AD�.E'i .A�N- Ply yotl Located at (Street) MG6 P--*D Tax Map 6,A1 Block 2- Lot (indicate nearest cross street) Municipality'TT�Il-- -�Oi-1 Watershed _ ��NL1 SOIL PERCOLATION TEST DATA Date of Pre - soaking 12I 0,11 Date of Percolation Test No. Run No Time Start Stop Ela se Time �1VI' D�epth to Water F-ro Ground Surface (Inches) ; Water Leve! Aro In .: p Percolation . Rate ;Hole m: ) ...... St art Stop Inches `S 1 2 � 5 � � � 'J � � T !�� '1 �4 ' �) Do 3 2�. ��6 30 14 4 14 5 2 3 ,��,, _ ��� �o 14 4, � � �� �-`� ._. �•. � 221 .. . ... 5 , 3 4..: 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made. from top of hole. Form DD -97 TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 1.0' 2.0' �iL ��(�sh Ljil.�'� LQfltn 2.5' 3.0' 3.5' 4.0' 4.5' �a0 i `D 5.0' (,o fi 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 10.0' ' w a � C Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: WIWA to Date Design Professional.�Iame:. 09 M tvrWV) V k - QE Address:, `A, Signature:. Design Professional's Seal NEW YpA N CCNOO ,f- r�t tp'� � �P'n No. 56124 �AOPESSlO/ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH. SERVICES LETTER OF AUTHORIZATION.... RE: Property of _ �1`a 9�v 1 6 Located at � "� � �% P__0'�D TN FA"MP-"�0�4 Tax Map # 4-1 Block 9-- Lot 1 > > b Subdivision of PUT -� P,t"A L,-Ps lj--6� Subdivision Lot # 6onl2s Filed Map # Date Filed _ Gentlemen: This letter -is to authorize Hrk��j �4 1( DG,4D Jig-' PE a duly licensed Professional Engineer X or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Direcfbr of the Putnam County Health Department, and to sign all necessary papers'on my behalf i'n'connection with 'this matter and to supervise the construction of said wastewater tretment and/or water supply systems iii - .: con.tormity -with, the pro snO le 145-and/or 147 of the-Education Law; the' Public l iz��irr Law, and the Putnam de. Countersigned.- P. E., R'. A., # S 4L r F 1 Very truly yours, Cl) — .56124 �, Signed: (Owner of Property). Mailing Address DSrJ 22-- State Zip IOaq Telephone: ��j . ��- `l�' -+ c� Mailing Address: �� �� d 0 JQ —\\11F, �w�-rEiZ State 1� i Telephone: (W), Zip Fomi L:1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # I - J Located at T I��� � S Tom. Subdivision name 0u Ke. �dr -evSd� Subd. Lot # q -swjax Map 2SA7. Block Z Lot 7,13 Date Subdivision Approved Owner /Applicant Name 51�vc. D 1n_'4y1 d Mailing Address Renewal Revision Date of Previous Approval 10 -- -1- %_- Zip 105,1 v Amount of Fee Enclosed 360, 00 Building Type ! t zs a Lot Area 0,1TI No. of Bedrooms Z Design Flow GPD !COQ Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of OOP gallon septic tank and 33& /A' r 41 r Other Requirements: 2 - 0 . P, I .I 4 To be constructed by ?R L) Address ., Water Sunaly: Public Supply From Address _ I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment 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 "Ceftif cate 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 5-2-2--oz License # 14124 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 ermi . ved for discharge of domestic sanitary wage only. By: Title: 1'✓ Date. Whit copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design rofessional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELLW_ please print or type PCHD Permit # J '� Well Location: Street Address: TownNillage Tax Grid # kTrCP - 50 0 Map �G Ml lock �- Lot(s) -110) Well Owner: Name: Address: PN-4a PAEWST5N Wy W; 0 Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 45V gpm # People Served S- �'1 Est. of Daily Usage +M gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes— No Name of subdivision Lot No.oL H� Water Well Contractor: p Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: `®- Town/Village --- Distance to property from nearest water main: Proposed well location & sources of contaminatio to be provided on sep to s eet/plan. Date: i A licant Si nature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed byer well driller certified by Putnam County. / Date of Issue � Permit Iss Date of Expiration Title: v® Permit is Non- Transf ble White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 NEW YORK STATE DEPARTMENT OF HEALTH Specific Waiver Bureau of Community Sanitation and Food Protection from Requirements of Part 75 and Appendix 75- A,10NYCRR __...__.�...._...___.._...... _.,._..._ _..__.....___ ._...._....._.... _ __ _._._._ ____. - for-Individual Household Sewage. Treatment Systems _- ..._.... _.. _ 1. Reason why site does not meet 10NYCRR Appendix 75 -A (check appropriate box(es)): Separation distance cannot be achieved. Excessive slope. High groundwater. Inadequate depth to bedrock or impermeable layer. Soil unsuitable. Other (explain) .............. !l ......... ..i�^?:... t- . *,4. �-tJt7 6X . . ................ ............../19 .......... .. ............................... 2. Proposed design or conditions of waiver: ................................................................................................................................................................................................................. ............................... t 4 Q !N4... ..ki u.�- �,,............. .........%. .........!�..L ................. .... .......... ............ ... ......... . ........ . ... .. ....... ............ .................................... ...................................... . ........ .......................... ............................................................................................................................................................... ............................... 3. The proposed design may have the following limitations (check appropriate box(es)): Increased risk of well or spring contamination. Increased risk of surface water contamination. Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. Other(explain) ................................ ..............................: . ........................................... ............................... Additional Information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations, Part"75.6 (b), a waiver is hereby granted. This waiver may be revoked by tpe4ssuing official for a change in conditions for which this waiver was granted. ORIGINAL -Local Health Agency J COPY - Applicant/Design Professional .............................................................................. ............................... DATE rV-AU +131)a 17101)% (GEN -152) BRUCE R. FOLEY .Public Health Director- NAME: ADDRESS: SITE LOCATION: DATE: STAFF PRESENT: SPECIFIC WAVIER REQUEST: DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 = 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAVIER A® ENVIRONMENTAL CONTAMINATION PROBLEM? YES NO WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? YES NO REQUEST APPROVAL Q$ DENIED PRO D DENIED REASON FOR DENIAL . 94 DIRECT OF P LIC HEALTH DATE: J Z� It DF-SLGLI4 DATA SHEET-SUBSMCE SERAZE DISPOSAL SYSTEM FILE NO. Located at (Stree sec. 2 Block Lot (indicate near t cross street)- municioality watex-shed. SOIL PE•COLATICN TEST akTA REQ=M TO BE SUB= WITH P-PPLICATICNS Date I of Pre-Soaking Date of Percolation.Test HOLE NLW-.BER C= TIME PERCO=CN PER00=0 Run Elapse Depth to Water From Water Level No. Tug Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min/In Droo Inches Inches Inches 2 3 Or 4 5 4 t 1/-" 3 P/9 4 5 2 3 4 5 Tests 'to be repeated' at same depth until approximately eqLja .: soil rates are* obtained at each percolation test hole. .. All data to' be suhmitUd for review. 2. Depth weasur.eTents to be made frcm top of hole. 9/85- TEST PIT DATA REQUIRED TO BE SUBMITTED W= APPLICATION DESCR7'"^"ION OF SOILS ENCOON IN TF_ HOLES DEPTH HOLE NO. I HOLE NO. �i. HOLE NO. G.L. 1' { y11 3' 4' 51 N P� 6' t ,u 7� 8' 9' 10' 1x' 12' 13' 14' INDICATE LEVEL AT Ili -RICH GRO(JNUAM 7S ENCOUNTERED INDICATE LEVEL ' TO WH2CH i4 T I= = � RISES AFTER BEING ENCOUNT MED DEEP HOLE OBSERVATIONS MADE BY: 1k) I LW A M DATE:. —z. DESIGN Soil. Rate Used 21 D Min/1" Drop: S.D. Usable Area Provided No. of Bedroans y Septic Tank Capacity I Dip gals. Type Absorption Area Provided By 36, L.F. x 24" width trench Other Name `� fit) . fJf �-to�s Signature O N Address ''1,h SEAL �T r� 9 THIS SPACE FOR USE BY 'HEALTH DEPARZMU ONLY: AR�FESSIDNP Soil Rate Approved sq.ft /gal. Checked by Date APR -26 -2002 08:43 AM HARRY W NICHOLS 914 279 4567 P.01 L. ►7i 4' BRUCE- L - FOLEY Pwb1ir H+alrti..:bfrtotor LOR13ri`A• MO NARI FLN,, M,S,N. Aumlate Publlr Xealth Director OlreCtar Q00tftns strvfcts DEPARTMENT OF HEALTH 1 Qeneva Road Brewster,. New York 10509 REQ11PZ1OR Fran imr iG ATTENTION: a ADAM STIEBELI G `GENE REED AJI information below must be (� completed prior to any scheduling. DATE: -d 2- ENGINEER OR FIMI: Airvil v PHONE N: ��,��*.P 7Z' REASON: -- DEEPS: o PERCS: ( PVWIP TEST: o ROAMTREET: / 1t a� TOWN: TAX MAP#: SUBDIVISION: `--- LOT #: OWNER- z) crewc- a.*,z V I NYCDEP CRIJERtA Fort JOINT , SSINQ OFSQIL TEhUINQ YES. NO .Proposed SM-withla the drainage basin of West Bra yh:or 8.gy�s Cor'oet••Reserv'oirs: - "� Q' " Proposed SSTS,w "ItGii Sbb feet of a reservoir, reservoir stem or control lake. o Jd Proposed SSTS within 200 feet of a watercourse or a DEC wetland. o 16 Proposed SSTS design flow greater than 1000 gallons/day-or SPDES Permit required. P.... �d Proposed SSTS for it Commerical Project. 1 t is thi responsibility of the design prot�eisional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered= to any of the questions, NYCDEP must witness the soil testing. This Department will coordinate a mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP, FOR C"PUirTY USE ONLY DATE: e2 TIME: __ Z'7 /: 3 p (MOTEST) APR -25 -2002 THU 19:56 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 68 �. �I ZO � {t & 1, �O \ o� YO p � R IN RD" 4e' NE%OP t i m 9 O NILES R mG ANCHES 2h ROM v comp o o% c v E RD KEN 9= pE�o 0 09 �. ?. Qo G RD T L AF Q r2 RS D i Ql o i > a a aD < aD g e o _ r d ILT N O ONpgpY LA O Q pL WT L all a ¢� E CT 'ft O aT D ` Z TON RD . ,;<:., i p RO m D t r' �0 ZURICH �aP N4�Aq(cPQO ir / ut410�! p 1 T N 0 LN .., O i y Pgi D Q � O Lak Sol N O -� Rf EY I P/0 2"9-1- 46 I tl 969000 PERRY \ 38 4A7B , \ \ I ROAD IW \ \ w \ 100.00 l 1 60.00 100. 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CORP.) AND AGAIN TODAY 1/14/03 AND WATER IN FLOWING IN AGAIN. WETLAND IN REAR OF HOUSE (BUILDING GOING ON NEXT TO HIM) Jc (z C_ C`7 111�'4 le, le a 7 19��dz�r� (5,51 Date January Page 1 of 1 a 5�03 14.164 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 SEAR _ - __..-- APpbndlz.C. ; . --- -._ State Environmental Ousilty Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be comptcted by Applicant or Project sponsor)' 1. APPLICANT ISPONSOR V 2. PROJECT NAME.' T5 0' 0.��Ii4d 3. PROJECT LOCATION: r ��W )90 Municipality aV�'%^t County 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) 5. IS PROPOSED ACTION: nn � New C3 Expansion a Modificationlalteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres. 8. WILL PROPOSED ACTION COMPLY- WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ([Yes CJ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? 0 ❑ ❑ ParklForest10pen ❑ Other sidential Industrial' Commercial Agriculture, • space . .Describe:... _ . _ .. .. .. .. .. .. .._ . .. ........ _ ..... _ .. _. 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAU? j es C No It yes. list agency(s) and permittapprovals L1 (it, y --vi, �. it, DOES ANY AS ECT OF THE ACT. :N HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? ❑Yes Nom, if yes, list acency name and perrmlUapprovai 12. AS A RESULT OF PROPOSED ACTION WILL 61STING PERMITIAPPROVAL REOUIRE MODIFICATION? ❑ Yes No 1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE °�211i� Ll Date: AFpllcanUsponsor name: = , Signature: M If the action Is In the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 11 _,1d_a L, PART 11— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A,.•�O�S.ACrTiON., ,C 0 ANY.TY..PE.1 THRESHOLD IN 6 NYGRR, PART 617.12 ?. - If. -yes coordinate -the review- process and use the FULL EAF. r Yes B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? It No, a negative declaration may be superseded by another involved agency. Yes o C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quallty.or quantity, noise levels, existing traffic patterns, solid waste production or tlisposat, potential for erosion, drainage or flooding. problems?'Explain briefly: - C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources: or community or neighborhood character? Explain briefly: Per ` C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: Ca. A community's existing plans or goals as officially adopted, or a change in use or ;ntensity of use of land or other natural resources? Explain briefly. C5. Growth, subsequent cevelopment, or related activities likely to be induced by ue proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not Identified in C1-05? Explain briefly. NO C7, Other impacts (Inclucing changes in use of either quantity or type of energy)? Explain briefly. `V-D D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? LJYes Klo If Yes, explain briefly PART 111 — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with Its (a) setting (I.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a positive declaration. Check this box if you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental imparts AND provide on attachments as necessary, the reasons supporting this determination: �� Ali, (�J i> C9 l(z Name of Lead Agency 13 Print or y Name o Respo i e Officer in lead Agencv Title oRespo O icer Vh".,j k, Sign t re of sponsible Officer in Lead Agency Signature of Preparer (If different from responsible orticer) �MoL___, Date C, sir PUTNAM COUNTY DEPARTMENT .OF HEALTH.... -....- _ -_ -.: DI- VISI.ON. OF. ENVIRONMENTAL HEALTH SERVICES - , DESIGN DATA SHEET- SUBSURFACE SEWAGE TREATMENT SYSTEM .... Owner �`' �� G 7'�A,: �n Address ► ve__ ��►��so Located at (Street) Q`,� �a�. Tax Map ox Block Z Lot 7,1 (indicate nearest cross street) Municipality �av�vice_� r r Watershed ,Eas� Jam. SOIL PERCOLATION TEST DATA Date of Pre - soaking 9 - 6a -0Z Date of Percolation Test 7--7 -6 2_� 5 2, 1 1.146 Z! 14 .2. 2-i ► J �. ;-41 3 242 3;1z 4 5 2 .I 3� 36 36 Depth to Water Frrom Ground Surface (Iacbes) . -I Start Stop; F - o-14e a�lJ�, a� -" - Z7 2-f iter` ::Elapse Time Start:. Stop ..::......: :.(Min.) (1,38 - 2,;09 3a �:Z! 3 9 3d 2-:40. - 3.10 130 5 2, 1 1.146 Z! 14 .2. 2-i ► J �. ;-41 3 242 3;1z 4 5 2 .I 3� 36 36 Depth to Water Frrom Ground Surface (Iacbes) . -I Start Stop; F - o-14e a�lJ�, a� -" - Z7 2-f iter` :.::.. :vel Percolation �pp Ia Rate ches jVlio/Iach.: 2.� 13/ l�)V1 n, i 3 ...... - 4 5 NOTES: 1. 'Tests to be repeated at same depth until aDDroximately eaual Dercolation rates are obtained at each percolation test hole. (i.e. s I min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. ` 2. Depth measurements to be made from top of hole. Fn. nn-o- Indicate level-at which - groundwater is encountered - -- Indicate level at which mottling is observed Indicate level to which water level rises after being encountered 61 -9'� Deep hole observations made by: w Date 5 o2— Design Professional Name: Address: z-csa �n � Signature Design Professfi TEST PIT DATA - 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. /f HOLE N0. HOLE N0. G.L. 0.5' S" Tip Sa1L. �„ Tai'soiL 1.0' _ 1.s' ._. .. - - -.... soy ��► ... 2.0' 2.5' 3.0' AA LD, tan, 3.5' 57ANDY. I-Oh-"l 5A14Dy �-o A4oTT4,iu6 5.0'.. -- _....... 5.5' 6.0' _... _._ . 6.5' 7.0' .. 7.5' -F c 8.0' CDM 9.0 9.5' �• .. �-� -< �-- Indicate level-at which - groundwater is encountered - -- Indicate level at which mottling is observed Indicate level to which water level rises after being encountered 61 -9'� Deep hole observations made by: w Date 5 o2— Design Professional Name: Address: z-csa �n � Signature Design Professfi Harry W. Nichols Jr., P.E. Vff Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Telephone (845) 2794003 Fax (845) 2794567 May 14, 2003 Robert Morris, P.E. Putnam County Health Department One Geneva Road Brewster, NY 10509 RE: Individual SSTS Compliance D'Ottavio 7 Thames Road Patterson, N.Y. T.M. # 25- 47 -2 -7.3 Dear Robert: Enclosed are the following: 1. Five (5) prints of Drawing S -1, "As -Built Plan ", dated 02/10/03. - - .•..2,- .._....= 'Cel- tificate of- Construction Compliance- for - -Sewage- Di-s•posaI. - System ", dated 05/14/03. 3. Three (3) copies of "Guarantee of Subsurface Sewage Disposal System ", dated 05/14/03. 4. Laboratory Report, dated 05/09/03. 5. Well Completion Report, dated 11/18/02. 6. Application Fee in the amount of $200.00 payable to Putnam County Health Department. 7. E -911 address verification form, dated 12/18/02. Kindly process the enclosed at your earliest convenience. Very truly yours, Harry Y Nichols Jr., P.E. - HWN: av 02- 016.00 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street ddress: q f TownNillage: �ti ae Tax Grid # Map 41Block 11 Lot(s)`j,i5 Well Owner: Na A ess. �® FoCp Mciuk VCG e Use of Well: 1- primary 2- sec6ndary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length e0 ft. Length below grade ' 1—ft. Diameter in. Weight per foot lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded Threaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: Yes No Liner: Yes K No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Di.� °L _ Yes—No Hours Second Well Yield Test _ Bailed _ Pumped _X Compressed Air Hours. I Yield � tpm Depth Data Measure from land surface- static (specify ft) 30 During yield test(ft) Depth of completed well in feet 1-6 r Well Log If more detailed information descriptions or sieveanalyses._ ...__ are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface n I 4 L' ..:. _ ._. _._._.....__...-._.--- _.___.._..._..._.._�......_.y .. _. ..._... _ _. ....... __. _.._ .._.........._.. -___ -- If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type .5 °� . Capacity Depth 415— Model 7a1+1a417 Voltage 2.30 HP I.0 Tank Type; = T j Volume Date Well C mpI ted Putnam County Certification No. Date of Re rt Well Drill ignatur NOTE( Ekact location of well with distances to at least two .permanent fandnlarks to be provided on a separate sheet/plan. L>�� Lome i AYt'/ , LL( _ L ice' k`PV !<_/ Well Drillers Name ( Address: P 0M Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Name: Sample Date: Sample Time: Receipt Date: Report Date: Sample Site: L AQUA ENVIRONMENTAL LAB 56 Church Hil oad • N wto CT 647Q • (203) 270 -9973 eaor COinaivsis Steven D'Ottavio Rapid Water Service 5 Progress St Brewster, NY 10509 5/6/2003 12:00:23 PM 5/6/2003 12:45:23 PM 5/9/2003 7 Thames Rd., Patterson, NY Sample ID# 39431 Sample Type: Drinking Water Sample Source: Sampler's RA Name: Parameter Sample Result Units Limits Biological Coliform Bacteria absent none 0 e Coli Bacteria absent none 0 Metals Copper ND mg /L 1.3 Iron 0.29 mg /L 0.3 Lead 0.0015 mg /L 0.015 Manganese 0.02 m /L 0.05 Minerals Alkalinity 125 mg /L No limit set Chloride 206.9 mg /L 250 Hardness 416 mg /L No limit set Sodium _ 31.8 * mg /L 28 --_._ Sulfate_._..._....._..._....... ,. _. _ =__._. __. ...._31:2.... -__ ..........._.._... m. t; .._..,- - -. _._._..�__250....... Nutrient Nitrate as N 5.8 mg /L 10 Nitrite as N ND m /L 1 Physical Color 5 CU 15 Odor 0 0 -5 Scale 2 PH 7.6 SU 6.4-10 Turbidity 1.4 NTU 5 �,.• ND = Not detected Report signed by CT Lic PH -0787 NY Lic 11706 " = above specified limit _. Comment: Based on the bacteriological examination, this water was safe for drinking purposes at the time the sample was collected. Page 1 of 1 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH ,SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM L Owner or Purchaser of Building Tax Map Block Lot 4!�jTFy j� p OTT g j b Building Constructed by Town/Village is Location - Street Subdivision Name - Building Type 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 gopd 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 riegligent act of the occupant of th4 building utilizing'the system. Dated: Month �� Day �� Year 3-0o Signature: Title: (ot General Contractor (Owner) - Signature Corporation Name- (if corporation ) Corporation Name (if corporation) 5 pp- T11' Address: Address: State - t`1 I Zip State Zip 1 �(01 Form GS -97 DEC-19-02 02:10 PM TOWN OF PATTERSON 9149782019 P.e4 BRUCE R. FaLly- U0=A-'biQLWA9'RN- M-5-N, Aug$* NW& Ildsh oftelo• it Dbow DEP47WSM OF HEALTH I Own Rosd owmisr, Now York 10509 14orft hrvkd P14)311- 6$51 WIC 014271471 YU01011-441S P,21 i AnDRESS VRRIEIC61TON FORM owftpts NAM.. TAX W NUM MU Aw E911 ADDRZSSi M 7 T)4AHI* RAP TOWN, A U-TEORMED TOWN OMCL41,,- (SIpatun) DATE The Putnam Comity Depefteat of Health wjU not issue . a CtWcate of Construction Compliance UUlew the above-form.b completed; i ;&- a legal 1E911 address Is assigned by an sithorized town offIclal. This form Is to be submitted with the application for i CirUcate of Cow truction COMPHinci. CE91 1 VERn" PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES f / FINAL SITE INSPECTION ` Date: iZ�l9 /o:Z Street Location _ __.._..._ _..... Owner e-- 1--I,n4 pp, e / c to ed-by: C , TZ�ET 7 f/A�✓l7 L Town P�.�� r ?�n�y Permit# rte- 3 -9� . 5G✓;/€3 O� TM # ,7 Subdivision Lot .# soe,7o -.5 o� �. 1. Sewage 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 stem j a: eptic si c ze '1,000,12 ... :1, 250 ......... other ................. . b. Septic tank instal edlevel ................ :.............................. c. 10' minimum from; foundation .......... ............................... d. istribtui n Bo out ets at same elevation -water tested ................. 2. Protected below frost .................. ............................... .3. Minimum 2 ft.Original soil.between box &..trenches Junction Bog - properly set ....................... :.............................. 1. ength required '3 3 Length installed 3 33 2. Distance to watercourse measured 4- i o o 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 - 11 /Z" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... _ .._,.x.,10 ends capped..., , _ ..........__.._.. -. ........... .......... .. uin Dosed ste s . °. 6 pump chamber ..................... . .......................... 2. Overflow tank ........................... ............................... 3. Alarm, visual/audio ............. ............................... .... r 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... M. ouseBuildm a. House located per approved plans.................................. b. Number of bedrooms ......... ............. ...A ..... K ....... .......... IV. WeU . a. Well located as per approved plans . ............................... b. Distance from STS area measured . � / e° �--). ft........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ............................. :.................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box .... :.............. ............... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing.drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 1/97 M. NO COMMENTS t r :,� . ...._....._. _ . ....... / f ` a3 t t u < c-71k*, I . DEC -17 -2002 09:35 AM HARRY W NICHOLS 914 279 4567 X COUNTY 'DEPARTMENT-OF.HEALTH.._..,..• ...."... ..,,,.:... . OF ENVIRONMENTAL WEALTH SERVICES P -01 SPE For: . Fill Date: 12 • ;,12Z Trenches ✓ PCM Construction Permit Located: kA 2DAN' (T) M „ y- imasoa Owner /Applicant Name: *rzJ= b' Q :1FAJio „ TM 25.,11 Block ,? Lot "t t Formerly: Subdivision Name: -- Subdivision Lot # ' Is'system fill completed? Date: Is system complete? ycs _ , Date'.►'� •mix. o� Is system constructed asper pleas ?- Yep Is well drilled? Ycs Date: ►z - (S - 02 .Is well located as perplans? yes _ -- Are erosion control measures in place? yes I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and. verified their completion in accordance with the issued PdRD Construction Permit and approved.plahs and the Standards, Rules and Regulations of the Putnam. County Department of Health. RA.........._ � .......... --- ._..._.. ........ Desi Professional. � Address: 2.05n gagC"t 2z Comments :. FQR:... 0 ADAM W/GiNE C) (N) Forria M -99 DEC -17 -2002 TUE 09:49 TEL:845- 278 -7921 �..NAME:PUTNAM CrnINTY n9PQPTMCAJT nc L 0 BRUCE R FOLEY LORETTA MOLINARI RN., M S N: Public Health Director O� Associate Public Health' Director Director of Patient Services : DEPARTMENT : OF ::...... - HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 M Early Intervention/Preschooi (845) 278 - 6014 Fax (845) 278 - 6648 December 23, 2002 I Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Re: Field Inspection - D'Ottario Thames Road, (T) Patterson TM# 25.47 -2 -7.13 Dear Mr. Nichols: The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. R....,A.pum4p,test needs to,be atnessed_by_this_Depal mellt.gnee the:.electrical..inspection,h :....... been completed and notification of such has been submitted to this Department. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Sincerely, Gene D. Reed GDR: cj Environmental Health Engineering Aide PETER C. ALEXANDERSON County Executive JOHN SIMMONS. M.D. Deputy Commissioner DEPARTMENT OF HEALTH JOHN KARELL, Jr., P.E. Director : Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225-0310 July 15, 1987 Patrick Hyndman 2383 Northwest 29th Road Boca Raton, Florida 33431 RE: Lot 5074 -78 Z� Thames Road (T) Patterson (T) Putnam Lake Dear Mr. Hyndman: I have received your letter of May 30, 1987 with the enclosed tax receipts. As you stated, I incorrectly noted that your lot was 80' x 100' instead of 100' x 100' as your records indicate. As I stated.in my letter of May.22, .1987, however, the._. 'minimum 'sgeVdtdtion ' distances remain 100' from your well' to all sewage disposal areas and 100' feet from your sewage disposal area to all wells including your proposed well. On a lot 100' x 100', even placing a well in once corner and sewage disposal system in the other, severely limits the amount of area available for a sewage disposal system. Also, all surrounding walls and sewage disposal areas must meet minimum separations from the proposed facilities on your lots. This of course, is assuming there are no physical restrains on your property such as a high ground water table, poor soils, or insufficient original soil to allow the construction of a well and sewage disposal_ system. Therefore, it is impossible to determine if the .lot is approvable without a complete application being submitted by a licensed professional engineer for our review. d WA As I have stated in my previous letter, variances for separations of less than 100' from any well to any sewage disposal system can only be granted by the Board of Health and similar requests in the past have generally been denied. Also, before you proceed, please check with the town Zoning Board concerning their requirement of a minimum of 6 lots (120 x 100 ). If you have any questions, please feel free to contact me at this office. Very trWly yours,, William Hedges Sr. Environmental Health Technician WH:pt cc:File WH JK PETER C. ALEXANDERSON County Executive JOHN SIMMONS. M.D. Deputy Commissioner DEPARTMENT OF HEALTH JOHN KARELL. Jr., P.E. Director Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 1 May 22, 1987 Patrick Hyndman 2383 Northwest 29th Road Boca Raton, Florida 33431 RE: Lots 5074 - 78 Thanas Road, (T) Putnam Lake Dear Mr. Hyndman: I received your letter of May 6, 1987, requesting a waiver to install a well and sewage disposal system on the above mentioned lot. I have checked our f iles and did not find a permit or an application for a permit on this property. The tax maps indicate this property is small (80' x 1001) and, therefore, probably would not be able to meet our minimum separation distances (i.e., 100 feet from well to sewage disposal area). This Department generally does not grant variances on any lot that does not meet our minimum requir- eznents. . However;.- if you..wi•sh, to proceed ,with a variance, a complete application for the construction of an individual water supply and individual sewage disposal system must be submitted by.a licensed professional engineer or architect, reviewed by this Department and approved or rejected. If it is rejected, you have the right to appeal to the Board of Health for a variance. A variance from the Town may also be required since the minimum lot size in Putnam Lake is 120' x 100'. If you have any questions, please feel free to contact me at this office. Very truly yours, William Hedges, Jr. Sr. Environmental Health Technician WH :Ink Winifred Hyn an Northwest 29th Road wBoca Raton, Florida 3'343 1 7. 4?7 C�a r.rl rTl is < < Xm 731. Z/ 711 el<O 10 t�? W. !.' .`9 PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225-0310' May 22, 1987 Patrick Hynclnan 2383 Northwest 29th Road Boca Raton, Florida 33431 Dear Mr. Hyndman: JOHN SIMMONS, M.D. Deputy Commissioner JOHN KARELL, Jr., P.E. Director RE:Lots 5074 - 78 lianas oa , T) Putnam Lake I received your letter of May 6, 1987, requesting a waiver to install a well and sewage disposal system on the above mentioned lot. I have checked our files and did not find"a permit or an application for a permit on this property. The tax maps indicate this property is small (80' x 100') and, therefore, probably would not be able to meet our minimum separation distances (i.e., 100 feet from well to sewage disposal area). This Department generally does not grant variances on any lot that does not meet our minimum pegui repents. --However, if you wish to proceed with a variance, - - -a - - complete application for * the -construction of an individual water supply aria individual sewage disposal system must be submitted by a licensed professional engineer or architect, reviewed by this Department and approved or rejected. If it is rejected, you have the right to appeal to the Board of Health for a variance. A variance from the Town may also be required since the minimum lot size in Putnam Lake is 120' x 100'. If you have any questions, please feel free to contact me at this.office. Very truly yours, William Hedges, Jr. Sr. Environmental Health Technician WH:rnk ll_ t i-ck, M�nJman .. 2383 NORTHWEST 29TH ROAD BOCA RATON, FLORIDA 33431 �. . Id 6_151 4l .. r G�� 3 S r x' 't' Rp CcEE'NN pp SCHOOL TAX 'TAX .RECEIVER SC OOLEDI•STRICTL' ,. _ FULL FOR TAXESCEIPT li -1 THE'BANK OF N Y TOWNS OF SOUTHEAST 50 MAIN STREE'i P.ATTERSON AND -CARMEL- FISCAL 07/01/86 f' BRENSTER' NY k•1 "0509 YEAR 06/30/8,7 372400` 50 3 9 -Co FR rT- .'log.DG OFP,TH 100 00 THAMES CLS, 311. ,y3730OI __,_ ._.__.._.._ _._ _ - -- --• LOTS 5074 5078 MAP +.T = t 001279 ' j .TOWN OF u' ,PATTERSON �x�,� BREWSER CENTRAL Y4D 713900 .34.Q4' O:TALQ = 0 E PAAYMENT! PAY NOUN 4 1 TAXES WILL BE C LLECTED.AT THE. BANK 50.MAI 3T .BREW ( NY'Fgg0n 9 'AM TO 3 PM 'MON fRI'.SEPT 1 - -SEP,T 3D OLIDAYS ,EXCLUDED. '.00T 1 OCT-31 T XES. MILL B COLLECTED BY TAX C- OLLECTOR..; ( 'PART PAY 'THRU S 507 15. WITH 2% sER VI CEI CHARGE ADD D. ' i PARTIAL. PAYT:. FEE e'q 0.68 n FOR FULL PAYMENTS FROM FUL11LOP %pYM11ENggT66.FTOOM11.00 31/861'��D 2Z ,IN7ER� /86 FOR PARTIAL PAYMENTS INCLUDING$E�VICE CHARGE° FIRST -HALF $ r 17 .36 - DUE NO LATER THAN. D9/ 15'/86 I SECOND HALF '$ ` 47 36 ouE BY ' 03/15/87 TO CO MM . OF FINANCE i �`.HYND;MAN °PATRI�CKi" ?` - •4�98fls492 .d F, 2383 NN 29TH: RD, -BOCp _RA;TON F.L?A 3343Z' eSTIMATEOSTAThAl013' AODRESSGORRECTIG 'i'-• ¢' ., ' L li ( J..� ANON TI . U L L C04NTV & TOWN TAX COUNTY, OF- POTOAK FULLPAYMENTRECEIPT SALLY- HAMEL TAX COLL TOWN OF, PATTERSON FOR TAXES, . P 0.' BOX .421 RATT;ERSON'�NY 12563-. ";�Flsc ^� O1 /OII'BT ,0f , R '.R7 R L07nn - YEAR f 97 =f IA7- �x 372400 50 -3 9 - 530"' - 'FR FT 100.0G '` DEPtH 100'. THAMES' CLS 3151 ROLL SECT 7 SCH 373001 MOTS 074 ,5078, M'AP _ a Maf NT COUN:TpYp OF:PUTNAM I90 190 28.841700 5.48' PA1T'ER,SON FjRE$O1 190':, . lSO, '13:99:8700 2:65 PkITNAM- LAKEE-:L IgpT < 290`",' - ISO - X11 783400 -- 0.45 PUTNAM LAKE SANIT 2.24• -.- 4 `TOTAL _19.35, PAID . JAN, 2 2 1987 `f n- 1 ' 0ATTERSON TAX -.- S _ DURINOPENALTY FREE PERIOD FROM JAN TO j TOTAL TAX DUE l 19.35 � - Ry IF PAID AFTER JAN •11F' AID APPROPRIAT EST NALCY ,:. AS F,OLLOWJ �-l1 SF � FEB P3 MAR. 2Y `APR '+Z' -' MAY 4Y JUNE SEA- JULY'.6X �j 1 "fVARIABIE INTEREST RATE lZ�x PER ANNUM = a •� f� OMAN,-PATRICK �wc.vm Npu an•aaaw 2383 NW 29TH 'MY . 80CAaRATON FLA 33432 r -,' „ i 3 Patrick HyHIlJ11 an 2383 NORTHWEST 29TH ROAD BOCA RATON, FLORIDA 33431 ,11!1' -4 11 :;I Y4 Ad QOrLLG� /G u et2 - Gi/Jrl !��ilt'zj cv�/J�s U/c�Iirf✓� ��2—��v/ �ar�'L /1G�G��1� Lv /li if��u`��6�64'� LlaC( 4/O'�ln� G�i2 --•C /Gtr- ccr�v,�t�1C�� �6L tr �y.,GG�saC<� �•t/L�G�P,iJ -iy�� _ FT AM A/ O 27, Gl,/'.GQII< �jn� -% C� � .eu :G� � j:+L°.f /�il✓IGFI.�i:/ e�Z%7'. xy.G.jf.J/ G4/G Ciiu ✓ G�GVL L�6t� 504 °97'00 "E t 7 N 40 4'00" E " m 4 a w o 100.00' In O � Z 2 n m >v 03 p cp 'm 100% EXPANSION AREA j'J• sox (Tv P) ? B tti Ao LF A&S TaENCIA YP) 33' 9 c 6 1000taAL. t$ 35' to SEPric rAMX $ - IA 4 tt A "m 6oL,b PJc 40' is tz " Pd MP ewl►h06t1 , { D I ` r y i i 504047'00,W i 100.00' 3 t t. i a too./. EXPANSION AREA { 100.00' O O O � O ' t r- am 0 W 0 � o d X �.9 u m t 7 N 40 4'00" E " m 4 a w o 100.00' In O � Z 2 n m >v 03 p cp 'm 100% EXPANSION AREA j'J• sox (Tv P) ? B tti Ao LF A&S TaENCIA YP) 33' 9 c 6 1000taAL. t$ 35' to SEPric rAMX $ - IA 4 tt A "m 6oL,b PJc 40' is tz " Pd MP ewl►h06t1 , { D I ` r y i i 504047'00,W i 100.00' 3 t t. i a too./. EXPANSION AREA { 100.00' O O O � O ' t 1 DIMENSION CHART (in feet) Number /fj 30 27 2 25 36 3 "94 96 4 96 95 5 98 94 6 00 93 7 102 92 8 129 122 9 132 127 10 133 130 11 135 135 12 134 136 13 55 59 14 57 56 IS 60 54 16 64 52 z�F4 rm,�f rz 0^ L? ' cry' =2= Lm o I o T C�IgT�tr A�j 8 _ MoJOp r I \ �- 40 jn{rF. �rn/GD as o I+ I11f►rGllora � l pox (tYP. T.a4 I PIZL TC .� 1 ! r' ,-r M . v o TAX 501 L �o 1tu9K \ APPI 8 I AB 13"90 f�v 000, 75y� q"m�ON -'�i \ p�22) F 1 E \1.97: F II s/A o i 11 TE � a xf 40 WOLF �0n 1 � {GY.K I+ALL � 1 i�l'�iJG�ED 2 B>;�jtOn1 �/ r F1Gt -e 1 � ��•i1DP�GC � l \q )�NGF � tG+M35t / ,� �.y1C�C•tv:p 1 1 — Ale it 1 WELL 6 � - �Ip� CU• 10 � �., � . � t 'f NAMES oA, p, I RO. �t i i L I �I'�[ hriGJ r Y tl �- �� 4 a 3 p r r �r •� r (7��tDEryL� V z i , - � PROJEC