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BOX 12
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01189
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\ PUTNAM COUNTY DEPARTMENT OF HEALTH
_...__ DIVISIGNt OF ElIT�RONMENTAL -HEALTH - SERVICES..... - --
C ICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM V N
PCHD O TRUCTION PERMIT # Q
Located at S u L-L 11%A*1 Town or Village 9'
Owner /Applicant Name MI64+Acr--L 1 AIZ LOKj Tax Map Block 1 Lot 4o)zo
Formerly Subdivision Name
Subd. Lot #
Mailing Address 57 Og4NG 1-E Po,4 D . 1�/�- � X250 f�l %`� Zip
Date Construction Permit Issued by PCHD 10- 1:7 t�
Separate Sewerage S, sy tem built by �(�AeL MQLO 4 Address �►./�
Consisting of ,0o6 Gallon Septic Tank and X50
Other Requirements:
Water Supply: Public Supply From Address
or: X Private Supply Drilled by i SIAM eL►, Address C j&Mt7_-j 'j l.`j 1O RR2
co 1 N G.
"'Bui'ldrng Type j�� fi2�j��AL Has erosion control been -completed?
Number of Bedrooms 2 Has garbage grinder been installed? t4D
I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as-
built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved
plans and the standards, rules and regulations of the Putnam County Department of Health.
Date: 1 - 6 - 6 Certified by
Address
P.E. %, R.A.
License # 9b 17
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary
to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage
treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval
of the private water supply shall become null and void when a public water supply becomes available.. Such
approvals are subject to modification or change when, in ;the judgment of the Public Health Director, such
revoca ' modificat'o or change is necessary.
By: MW Aw Title:
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CC -97
1
P TI NAM COUNTY DEPARTMENT OF HEALTH
DRVRS ION OF IENWRONMIENTAL_IHIIEAILT HI SERVICES
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM'
Owner or Purchaser of Building Tax Map Block Lot
Building Constructed by Town/Village
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 good operating condition
any part- of said system constructed by me which fails to. operate for a period of two years
immediately following the date of approval of the "Certificate of Construction Compliance" for the
sewage treatment system, or any repairs made by me to such system, except where the failure to
operate properly is caused by the willful or negligent act of the occupant of the building utilizing the
system.
The undersigned further agrees to accept as conclusive the determination of the Public Health.
Director of the Putnam County Department of Health as to whether or not the failure of the system
to operate was caused by the willful or negligent act of the occupant of the building utilizing the
system.
Dated:. Month_ Day g Year _J! _ Signature:
Al Zee"�
% Title:. 0(% 147r
General Contractor (Owner) - Signature
Corporation Name (if corporation) Corporation Name (if corporation)
Address: V jgR NcA 12o, fl . p,4TiE Address: SQ IIV
State Zip I.�2_56, State Zip
Form GS -97
M �o
tuly r,rvt
4` '� Wt•:l,,l, (:Ur1rLt;r tc tc
DEPARTMENT OF HEALTH
- Health Services �
Division Of Environmental ~Heal
Yo� PUTNAM COUNTY DEPARTMENT OF, HEALTH
Office Use Only
WELL LOCATION
STREET ADDRESS: TOWNIVIMAGLICHY TAX GRID NUMBER.'
��0 6— Q�sO/I 0 — I — �
WELL OWNER
NAME: ADDRESS:
rn gr Pd
(PIV PRIVATE
0 PUBLIC
USE OF WELL
1 - primary
2 - secondary
X RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /CONO. /HEAT PUMP O ABANO NED
O BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify)
❑ INDUSTRIAL O INSTITUTIONAL O STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT _;L— gpm. /NO. PEOPLE SERVED S / EST. OF DAILY USAGE Zoo gal.
REASON FOR
DRILLING
[]REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY
NEW SUPPLY (NEW DWELLING) ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH (9 0 S ft.
STATIC WATER LEVEL :ft_
DATE MEASURED
DRILLING
EQUIPMENT
O ROTARY C9 COMPRESSED AIR PERCUSSION ❑ DUG
O WELL POINT ❑ CABLE PERCUSSION .' ❑ OTHER (specify):
WELL TYPE
O SCREENED O OPEN END CASING OPEN HOLE IN BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL LENGTH _ fL
MATERIALS: )4 STEEL ❑ PLASTIC ❑ OTHER
LENGTH BELOW GRADE - ft.
JOINTS: ❑ WELDED [XTHREADED ❑ OTHER
DIAMETER (D in.
SEAL: 19 CEMENT GROUT O BENTONITE OOTHER
WEIGHT PER FOOT /9 Ib. /ft.
I DRIVE SHOE 5'YES ONO
I LINER: CJ YES 5YNO
SCREEN
DETAILS .
... ...
DIAMETER (in)
'SLOT SIZE
LENGTH (ft)
DEPTH TO SCREEN (11)
DEVELOPED?
FIRST
O YES ONO
.HOURS,,.
.SECOND...:
....._..._.....
.. _ ,...
... .... _.
�. .._ ....... ...
GRAVEL PACK
O YES
O NO
GRAVEL
SIZE:
DIAMETER
OF PACK in.
TOP
DEPTH tL
BOTTOM
DEPTH ft.
WELL YIELD TEST ; If detailed pumping
METHOD: O PUMPED tests were done is in-
�A COMPRESSED AIR , formation attached?
1`�
O BAILED O OTHER ; 0 YES O NO
YY �LL LOG ' If more detailed formation descriptions or sieve analyses
are available. please attach.
DEPTH FROM
SURFACE
w�ccr
Bea r•
ing
e11
Dia-
Meier
FORMATION DESCRIPTION
coat
It
WELL DEPTH
It.
DURATION
hr. min.
DRAWDOWN
It.
YIELD
gpm.
Llril
Q
er S
0
its
WATER O CLEAR TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? O YES O NO
STORAGE TANK: TYPE
CAPACITY GAS.
PUMP INFORMATION
TYPE
MAKER
MODEL
CAPACITY
DEPTH
VOLTAGE HP
WELL OAtIIER NAME 7 j4gI�S!&/ j,( 4j (�o 1�7r. OATEf �/ 9
ADDRESS p S7 P,T' 52— SIGNATURE
C RRME L V i 0 51a &YA
J/89
I
-- - '50 So: Buckhout St,`IrVrVd6, -fl.Y: 1"0533 6 (914) "591 =9010 o Fax (914) 591' =9011
December 4, 1997
Katonah Pharmacy
294 Katonah Avenue
Katonah, NY 10536
Re: Drinking Water Sample
Lab Log In #7560
Mike Barlow
East Branch Road
Patterson, N.Y.
Dear Sir:
Following is the result of an analysis performed on a sample of
drinking water received on November'25, 1997:
Analyte Method
Total
Coliform 9222 -B*
* = STANDARD METHODS
NYS Drinking
Result Water Standard
Negative Negative
For additional information, contaact . your-local Water.: Supplier or
County Department of Health. (Westchester 914 593 -5192)
Very truly yours,
C solidated Technology, Inc.
dwJ
ohn P. MCCuire
JPM:kv
9-[Z~
`
YML IRONMENTAL SERVICES
` ` 321 Kear Street
yorkt!lyn Aeiqh VA. R.Y� MAN
(914) 245-2800
Albert H. Padovaki, Directbr
!
LAB #: 93.015235 CLIENT #: 8326 NON STAT PROC PAGE
BARLOW, MICHAEL DATE/TIME TAKEN: 12/11/97 02:30
350 ADAM STREET ` DATE/TIME REC'D: 12/11/97 03^40
BEDFORD HILLS, NY 10507 REPORT DATE: 12/18/97
PHONE: (914)-278-7756
SAMPLING SITE: PUT MLAKE� PATTERSON SAMPLE TYPE..: POTABLE
: CORNER {]F SULLIVAN & ROANOKE PRESERVATIVES: NONE
COL'D BY: AME ' TEMPERATURE..:
NOTES... : 'ITCHEN AP ` ' COLIFORM METH: MF
DATE FLAG PROCEDURE RESULT NORMAL - RANGE, METHOD
. PUTNAM CNTY PROFILE
' 12/11/97 MF T. COLIFORM. PRESNT /100 ML ABSENT _1008,
12/11/97 ' LEAD (IMS) -� 2.9 Opb 0-15 ppb 12345
12/11/97 NITRATE NITR8G 0,30 MG/L 0 - 10 � '
12/11/97 NITRITE NITROG <0.01'MG/L N/A
12'11/97 ` IRON (Fe) ' 0,683 MG/L 0-0"3 mg/l
. 12/11/97 MANGANESE (Mn) 0.078 MG/L 0-0.3 mg/l '
12/11/97 'SODIUM (Na) 33 MG/L N/A
. 12/11/97 pH 7 UNITS 6.5-8.5
12/11/97 HARDNESS,T[lTAL 328.MG/[ ` N/A
12/11/97 ALKALINITY (AS 14 �MG/L N/A ' .
12/11/97 � TURBIDITY (TUR � 4.p NTU
12/11797— MW 'FECAL 0OLI`F --ABSENT-00 YL '- - ABSENT'
12/1 r
� 1/97 E. OLI (CONFI ABSENT 100/ML ABSENT
!
' !
COMMENTS: . �
BACT THESE RESULTS INDICATE THAT THE WATER (WAS) OF A
SATISFACTORY SANITARY QUALITY ACCORDING TO THE -lNEW TYORK STATE
AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS
TESTED, AT VE TIME OF COLLECTION. '
'
Pb/Cu LEAD limits for public schools are set at 15 p`b.
EPA Lead & Copper Rule for Public Systems requires that no more
than 10% of their, distribution points have a LEAD value of more
than 15 ppb and aCOPPER value of 1;i mg/L, else water
treatment must be undertaken to reduce the waters corrosive
potential.
. |
Fe/Mn If Qoth iron ind manganese are present, their total value '
combined shall not exceed 0.5 mg/L.
|
Na No limits for Sodium are proscribed.'Suggested guidelines state
that for people on a sodium restricted diet,the water should
contain no more than 20 mg/L of Sodium. For those on a
/
o
,.
' YML ^ ` VIRONMENTAL SERVICES
' 321 Kear Street
- wn-Heigh±s,_N.y. 10598-'--'-7---7---------�
(914) 245-2800
| Albert H. Padovani, Director Y
| . |
LAB #: 93.015105 CLIENT #: 8326 NON STAT PROC PAGE 2
BARLOW, MICHAEL . DATE/TIME TAKEN: 12/11/97 02:30
350 ADAM STREET ` DATE/TIME REC'D: 12'/11/97 03:4`
BEDFORD HILLS, NY 10507 REPORT DATE: 12/18/97
' . PHONE: (914)-278-7756
SAMPLING SITE: PUTNAM LAKE, PATTERSON SAMPLE TYPE".: POTABLE
: CORNER OF SULLIVAN & ROANOKE PRESERVATIVES: NONE
COLT BY: SAME � � TEMPERATURE..:
NOTES...: KITCHEN TAP COLIFORM METH: MF
~~~~~~~~~~~~~ ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~�~~~~~
| DATE. FLAG PROCEDURE RESULT NORMAL - RANGE METHOD
moderately restricted diet, a maximum of 270 mg/L of Sodium
is suggested.
`
'
SUBMITTED BY:
Director
ELAP# 10323
. .
'
/ YML ENVIRONMENTAL SERVICES
Q 1"321 Aar Street
Yorktown Heights,/N.Y. 105q8
~----�-r ` --�-- 1qr4) 245=;800 - --
Albert H. Padovani, Director
` !
LAB #: 93.015390 CLIENT #: 8326 NON STAT PROC ' PAGE. 1
~~~~~~~~~~~~~~- ~~~~~~~~~~~~~~~~~~~ =~~~~~~~~~~~~~~~
BARLOW ADAM MICHAEL DATE/TIME TAKEN: 01/03/98 11:00
| �
350 STREET . DATE/TIME REC!D: 01/03/98 11:15
BEDFORD' HILLS, NY 10507 ` REPORT ATE: 01/05/98
PHONE: (914)-27877756 '
�
SAMPLING SITE: PUTNAM LAKE PATTERSON ' ` SAMPLE TYPE..: POTABLE
: CORNER OF SULLIVAN& ROANOKE PRESERVATIVES: NONE
COL'D BY: E , . � J . . _ `TjMPERATURE,,; ( 4C
NOTES..": KITCHEN TAP | �COLIFORM METH: MF
~~~~~~~~~~~~~~~~~~�~~~~~~~~~~~~~~~~~~~~ ~~=~~~~~~~~~~~~~~~~~~~~~�~~~~~~~~~~~~~~
'ATE FLAG PROCEDURE. RESULT NORMAL — RANGE METHOD
01/03/98' : MF T. COLIFORM ABSENT /100 ML � ABSENT 1008
` �
) .
COMMENTS:
BACT:vTHESE RESULTS-INDICATE THAT THE WATE (WA S)
WAS NOT) OF A
iSATISFACTORY 'SANITARY QUALITY ACCORD!, NE�~��THE NEW YORK STATE '
, AND EPA FEbERAL.DRINKING WATER—STANDARDS, FOR THE PARAMETERS
TESTED, AT THE TIME OF COLLECTION. �
�
�
`
SUBMITTED BY:
'
Director
/
'
ELAP#-10323
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vC005,16,06n tfi&,gapto od- u'loWi6notruction of-tho buit4ift
n boon,. ghfiortaftog!. wind -W
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ad Ic C?tv ppIV only.
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4 i 4 DeneV� ,;M(914) P78"61H3pDEPT.a
f' - B 10509: ,, t - £ { `►�� 6
Received
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DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New-York 10509
(914) 278 -6130s! �p
APPLICATION TO CONSTRUCT A WATER WELh�
PCHD PERMIT 0 �!v
IIeL LOCATION
Streeff jj Address Town i age City Tax , Grid Number
�•vG'1WCV�i vlr.t/ cv
WELL OWNER NTER
Name
Mailin Address
3 LouYf a Mur,a
�q�oha l�S�t�
oPrivate
0 Public
USE OF WELL
1 - primary
2 - secondary
RESIDENTIAL
00 BUSINESS
0 INDUSTRIAL
0 PUBLIC SUPPLY
0 FARM
C31NSTITUTIONAL
Q AIR /COND /HEAT PUMP
0 TEST /OBSERVATION
0 STAND -BY
0 ABANDONED
0 OTHER (specify
AMOUNT OF USE
YIELD SOUGHT ' gpm /# PEOPLE SERVED '3 /EST. OF DAILY USAGE 4 d el
® REPLACE EXISTING SUPPLY 0 TEST /OBSERVATION 13. ADDITIONAL SUPPLY
® NEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
w wg e es
TELL TYPE
n DRILLED
DRIVEN
[]DUG
®GRAVEL.
0
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
HATER WELL CONTRACTOR: Name T Se.., b 0 Address:
IS PUBLIC STATER SUPPLY AVAILABLE TO SITE: YES NO
NME OF PUBLIC MATER SUPPLY: /U //4- TOWN /VIL /CITY
DISTANCE.TO PROPERTY FROM.NEAREST WATER MAIN:
LOCATION SKETCH�&SOURCES OF CONTAMINATION PROVIDED
tL� SEPARATE SHEET
(date)
0
gnature)
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the provisions
of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within
thirty (30) days of the completion of water well construction, the applicant shall:
1. Pump.the well until the water is clear.
2. Disinfect the well in accordance with the requirements of the Putnam County Health
Department attached to this permit.
3. Submit a Well Completion Report on a form provided by the Putnam County Health Department.
During all well drilling operations, the applicant 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 cont am rface or groundwater.
Date of Issue: 19�
Date of Expiration 19 !'F Permit Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
50 Z Nd 3- 5661
I IN n
G A i --m
'LAURENT ENGINEERING
ASSOC_ IATES, P.C.
MILLBROOKE OFFICE CENTRE
Route 22 & Milltown Road
Brewster, New York 10509
RANDOLPH W. LAURENT, P.E.
(914)27.8-6108 - (FAX) 278-2658
HARRY W. NICHOLS JR., P.E.
'CONSULTING SITE ENGINEERS
LIST OF
ADJACENT PROPERTY OWNERS,
Edward Hage.nah
Sullivan Drive
Patterson,, N.Y.
25.62-1-47
Douglas, Charles B. & Mary Ellen
25.70-1-43
62 "Sycamore Rd.
Patterson, NY 12563
25.62-1-48
Olivier; William & Theresa
68 Sycamore Rd.
Patterson,�NY 12563
25.621-60
Kaplah,-MArk & Barbara
36 Sullivan Dr.
Box 528
Pattersoh,,NY 12563
Terzian, John
RR 1 Box 184
28 Sullivan Dr.
Patterson,'NY 12563
25.62-1-53
Fisher, Robert J.
176-BroadwC'
New York, NY 10038
25.70-1-42
Perri Builders, Inc.
1 Division St.
Tarrytown,;NY 10591
25.70-1-44
Kopec, Richard & Antionette
33 Sullivan Dr.
Patterson, NY 12563
50 Z Nd 3- 5661
I IN n
G A i --m
1
LAURENT ENGINEERING
ASSOCIATES,- P.C.'.._
MILLBROOKE OFFICE CENTRE
Route 22 & Milltown Road
Brewster, New York 10509
RANDOLPH W. LAURENT, P.E. ; (914)278- 6108 - (FAX) 278 -2658
HARRY W. NICHOLS JR., P.E. a, CONSULTING SITE ENGINEERS
LIST OF ADJACENT PROPERTY OWNERS
Edward Hagemah
Sullivan Drive
Patterson., N.Y..
25.62 -1 -47
25.70 -1 -43
25.62 -1 -48
25.62 -1 -60
25.62 -1 -52
.. 25.62 -1 -53
25.70 -1 -42
25.70 -1 -4.4
Douglas, Charles B. & Mary Ellen
62 Sycamore Rd.
Patterson, NY 12563
Olivier, William & Theresa
68 Sycamore Rd.='
.Patterson, NY 12563
Kaplan, Mark & Barbara
36 Sullivan Dr.
Box 528 •
Patterson, NY 12563
Terzian,.John
RR 1 Box 184
28.Sullivan Dr.
Patterson, NY 12563
Fisher, Robert J.
176 Broadway
New York,.-NY 10038
Perri Builders, Inc.
1 Division St..
Tarrytown, NY 10591
Kopec, Richard & Antionette
33 Sullivan Dr.
Patterson, NY 12563
FORMAT Date 1 -19 -95
_:.
NEIGHBOR NOTIFICATION - !
CONSTRUCTION PERMIT
,
Richard & Antionette Kopec
33 Sullivan Dr.
Patterson, NY 12563
-RE: Department of Health Review of {';•
—Proposed Sewage Disposal System
foni property:
flame: Edward Hagenah
Address: Sullivan 'Drive
Town: -Patterson, V.Y.
Tax Map: 25.62 -1 -49 .& 50
Dear Mr. & Mrs. Kopec:
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
her,,
on the Health Department's review of :this application, you may'
call Mr. Hedges or Mr. Morris of the Health Department at 273 - 6130.
. _ ..
-Very truly..yours ,
By
Title Age
RECEIVED BY;
Address:
Tax Map: - --
JK;cj
F ORMAT
NEIGHBOR NOTIFICATION
CONSTRUCTION PERMIT
Perri Builders., Inc.
1 Division St.
Tarrytown,:NY 10591
Date
RE: Department of Health .Review of
Proposed Sewage Disposal System
for property:
Name: Edward Hagenah
Address: Sullivan Drive
Town: -Patterson, N.Y.
Tax Map: 25.62 -1 -49 & 50
Dear Perri Builders, : Inc.
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 D'epartment's review of this application, you may
call Mr. Hedges or Mr. Morris of the Health Department at 278 - 6130.
Very truly yours, _
By 1_
Title Agee
RECEIVED BY:
Address:
Tax Map:
JK;cj
E
FORMAT - Date 1 -19 -95 _
NEIGHBOR NOTIFICATION
CONSTRUCTION PERMIT
Robert J. Fisher
176 .Broadway
New'Yor.k, NY 10035 RE: Department of Health Review of
Proposed Sewage Disposal System
for, property:
flame: Edward Hagenah
Address: Sullivan Drive
T own: - Patterson, N.Y.
Tax Map: 25.62 -1 -49 & 50
Dear Mr. Fisher:
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 whi=ch may bear
on the Health Departbent s review of this application, you may
call Mr. Hedges or Mr. Morris of the Health Department at 278- 6130.
RECEIVED BY:
Address:
Tax Map:
JK;cj
FORMAT
_ ... _ ..._
NEIGHBOR NOTIFICATION
CONSTRUCTION PERMIT
John Terzian
RR 1 Box 184
28 Sullivan Dr.
Patterson, NY 12563
Date - -
1 -19 -95
RE: Department of Health Review .of
Propo.sed Sewage Disposal System
for property:
Name: Edward Hagenah
Address: Sullivan Drive
Town: -Patterson, N.Y.
Tax Map: 25.62 -1 -49 & 50
Dear Mr. Terzian:
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 273 -6130.
Very truly yours,
By
Title Age4
RECEIVED BY:
Address:
Tax Map:
JK;cj
Date.._
FORMAT - _ Date_.. 1- 19 -95..
NEIGHBOR NOTIFICATION
CONSTRUCTION PERMIT
Mark & Barbara Kaplan
36 Sullivan Dr. RE: Department of Health Review of
Box. 528 Proposed Sewage Disposal System
Patterson, NY 12563
for property:
Name: Edward Hagenah
Address: Sullivan Drive
Town: -Patterson, N.Y.
Tax Map: 25.62 -1-49 & 50
Mr. & Mrs. Kaplan:
Dear
Please be advised that an application for a Construction Permit
relative to th.e 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..s-ite 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.
V.e.r• y.- - .tr- -u_ l.y.. yours,.'
By'' '
Title Ag t
RECEIVED BY:
Address:
Tax Map:
JK;cj
A
FO RMAT
NEIGHBOR•NOTIFICATION
CONSTRUCTION PERMIT
William & Theresa Olivier
68 Sycamore Rd.
Patterson, NY 12563
Dear - Mr. -& Mrs. Olivier:
Date - " 1 -19 -95
RE: Department of Health Review of
Proposed Sewage Disposal System
for property:
.Name: Edward Hagenah
Address: Sullivan Drive
Town: - Patterson, N.Y.
Tax Map: 25.62 -1 -49 & 50
{
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 prdperty.has.been made to the Putnam
County Department of Health. Attached please find a copy of the
latest sate plan.
If you have any questions, concerns or information which 'nay 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,
By
Title Age t
RECEIVED BY:
Address:
Tax Map:
JK;cj .
._.FORMAT _.
NEIGHBOR NOTIFICATION
CONSTRUCTION PERMIT
Charles B. & Mary tllen Douglas
62 Sycamore Rd.
Patterson, NY 12563
RE: Department of Health Review of
Proposed-Sewage Disposal System
for property:
Name: Edward Hagenah
Address: Sullivan Drive
7.
Town:, . Patterson., N.Y.
TaX Map..: 25.62 -1 -49 & 50
Dear Mr. Mrs. Douglas:
Please be advised that an appli,cationi 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 ti
County Department of Health. Attached please find a copy of the
5:
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 273 -600.
..Very truly yours, -
B
Y
Title A t
RECEIVED BT:
Address:
Tax Map:
JK;cj'
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mplete items 1 and /or 2 for additional services. '
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PS Form 3811, December 1991 *U.S. GPO: 1993 -352 -714 DOMESTIC RETURN RECEIPT
LAURENT ENGINEERING
ASSOCIATES, P.C.
MILLBROOKE OFFICE CENTRE
Ro}Ra 22 8 Milllavn Road '
Brewster. New York IDS09
_ .. (914)27e- 8106 - (FAx):27a.2RSa .....
CONSULTING SITE ENGINEERS
Date: $- %-
Job No.:
v a � ud, �✓ � of �i��i q� / /�'
Project:
_ 'F/ AW �c,�ofeleSS f
Attention:
Gentlemen: We enclose ( ) copies of:.
B/W Prints O Reproducibles O Reports O Tracings
O Specifications O Memorandum O Copy of Letter O
Description: Revision /Date No.
Sent Via:
O Our Messenger O Blueprinler O First Class Mail
O Your Messenger O Hard!Delivery O
Copy to:
O Special Delivery
I
Very truly yours,
LAURENT ENGINEERING ASSOCIATES, P.C.
Per: ✓�.MSOQ7 __ __
LAURENT ENGINEERING'
j ASSOCIATES, P.C.
MILLBROOKE OFFICE CENTRE.-
Route 22 & Milltown Road
Brewster, New York 10509
RANDOLPH W. LAURENT, P.E. (914)278 -6108 - (FAX) 278 -2658
HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS
February 14, 1995
Mr. Edwin Polese, P.E.
East of Hudson Staff Engineer
NYCDEP
Bureau of Water Supply & Wastewater Collection
465 Columbus Avenue i
Valhalla, N,.Y.. 10595 -1336
RE: Proposed SSDS
Sullivan Drive
Patterson, N.Y.
T.M. 25.62 -1 -49 & 50
Dear Mr. Polese:
Enclosed are the following:
1.: "Application to Construct a Sewage Treatment System on N.Y.C.
Watershed ", dated 2- 10 -95.
2.. "Construction. Permit ", dated 1 -12 -95 (PCHD).-
3. Four (4) prints of Drawing SS -1 "Proposed SSDS ", dated
1- 11 -9.5.
4. One (1) copy of "Design Data Sheet ".
5. Three (3) copies of Floor Pladilfor the proposed 2- bedroom
residence.
6. One' (1) copy of "Short Environmental Assessment Form ", dated
2- 10 -95.
Kindly process the enclosed and provide us with the required.
approval. Any questions you might have or should additional
information be required, please contact us.
Very truly yours,
LAURENT ENGINEERING ASSOCIATES, P.C.
Harr W. N' ols,.Jr., P.E.
HWN:bd
94119
enc.'
cc: Mr. E. Hagenah w /enc.
Mr. W. Hedges
eel d
� v
�_ ao
0000�o
f
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
January 12, 1995.
Mr. William'Hedges
Putnam County Health Department
4 Geneva Road
Brewster, NY 10509
RE: Individual SSDS - Haganah
Sullivan Drive
Patterson, N.Y.
Dear Bills'
Enclosed are the following:
1. Four (4), prints of Drawing SS -50 "Proposed SSDS - Lots 47 &
5011, dated 1- 11 -95.
2. "Application For Approval of Plans For a Wastewater Disposal
System ".
3. "Construction Permit for Sewage Disposal System ", dated
1- 12 -95.
4. "Application to Construct a Water Well ", dated 1- 12 -95.
_... ..... _ -..5 :._
-"Design Data - Sheet n .:.: _......_. _.._..� _... -- -
6. "Letter of Authorization ", dated 1- 12 -95.
7. Two (2) copies of Residence Floor Plan(s), for "Bedroom
Count Only ".
8. Check in the amount of $300.00; review fee.
We would appreciate your review, approval and issuance of the
Construction Permit at your earliest convenience.
Very truly yours,
LAURENT ENGINEERING ASSOCIATES, P.C.
Harry W. Nichols, Jr., P.E.
HWN:bd
94119
enc.
cc: Mr. E. Haganah w /enc.
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONTMENTAL HEALTH SERVICES
Re: Property of_
a�
Date
i f
Located at ,Sv /�iVtiH �ri ✓P ;
(T) PVkr -90,, Section 9S.70 Block f Lots y% t $0
Subdivision of
Subdv. Lod ; r iled 'lap Date
Gentlemen:
This letter is to .authorize Newry
a duly licensed professional engineer -X or registered architect
0. (Indicate)
to- apply for a Construction Permit for a separate -sewage system, to
serve the above noted property in accordance igith the standards -, rules.
or. regulations..as pr.omulagated by the commissioner of the Putnam County
Department- of Health', and to' sign, all necessary papers on 'my :behalf.-in.
connection Taith this matter and to supervise the construction of said
system or systems in conformity with the provisions of Article 145 or
147, Education Lair, the-Publ;ic Health Lair, and the Putnam County Sani-
tary Code ;z1
Very truly yours, ,
U) ' .I
Countersig' d N .5612
P.E., R.A.,
Millbrooke Office Centre
Address
Brewster, NY 10509
914- 278 -6108
Telephone ;
Signed
Ot,ner of Pro erty
Address
/as3 6-
T o z,m.
9/y - ; YP - '?K6-"
Telephone
At-ler,NA-TO
SOON R,001� PLAN
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° ]E' TJ Ir N A. t_:( C O TJ N'r -se-
APPLICATION FOR APPROVAL
OF PLANS FOR A WASTEWATER DISPOSAL SYSTEH
1 . Name and Address of Applicant:
3y
Ir,I" . /Vy - I- OS31�'
2. Name of Project: 8_010015e)
6S.yS 3.._, Location CVD/V&— ,� Pa��ersoh
4. Project Engineer: vey �/ /
✓��s 3� 5. Address: Millbrooke Office Centc
Brewster,. 14Y 10509
License Number: S6 i
Phone: 0914) 278 -6103
6. Toe of,Pro ect:
_ ✓ Private /Residential
Food .Service ....Cor�,nercial ,
Apartments
Institutional :X6bi le Nome Park
Office -Bui Ming
Realty Subdivision :. Other (specify)
7. Is this 'project subject: to'-State
Environmental•Quality.Review (SEQR) ?-
Tyoe Status (Check One) Type I..
Exempt
Type II.
Unlisted.
8.'Is a Draft Environmental Impact' Statement (DEIS) required?
9. Has DEIS been completed and.found` acceptable by Lead Agency? ... ....
10. Hame of Lead Agency
11. Is this project in an.area under the control of local planning, zoning,
or other officials, ordinances? ........................................... No
12.. if so, have plans been. .5ubmitted to such : author A ties? ......................
13. Has preliminary approval been granted by such authorities? Date Granted:
I,. Type of Sewage Disposal'System Discharge....;.. Surface Water Ground Waters
15. .If surface water discharge, what is the stream class designation ?.........
I I
:6. Waters index number (surface)..... .............. ' .......................
•� -
�. Is project located near 'a public water supply system? ....... `........... N d
°. If yes, name of water supply Distance to water supply
9. Is project site near a public sewage collection or disposal system ?..... ' ho
�• Name of sewage system /1��,� Distance* to sewage, system
Date observed: / _S - 23. ` Name of Health Inspector: 1✓,'
Project design flow (gallons per day) ....... /GU
2.
25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.._ h/o
26. Has SPDES Application been submitted to local DEC Office ?. ............... A
27. Is•any portion of this project located within a designated Town.or State
wetland ?............ ...: —No
23. Wetland ID Number %y
29. -Is Wetland Pernit• required ?'................................................
Has applica'tion been. made '.to Town or Local .DEC Office ?. .............:.,`... �i`-`�-
30. Does project. require d'-DEC Stream Disturbance -Perm, it? ................... M
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 Igo
32. Is project located - within 1;000 feet of existence of... abandoned landfill,
ha- zardous waste site, salt stockpile, landfill, sludge disposal site or
any other potential known source of contamination? :.............YES or hO NO
DESCRIBE:
33. ,Is there.•a local. master plan or file with the Town. or Village?
34. Are com.- muni.ty water, sewer .facilities planned to be developed within 15 years? 0,,,, lrH0F1v ;-7
35. Are any' sewage. disposal areas in excess -of 15% slope? ......................... NO
35...Tax:Hap ID dumber ......................... ...............................
37. Approved Plans are to"be: returned to: sApp�licant Engineer
? the application is signed by a person other than the applicant shown -in Item,1, the.
°pplication 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 cry knoxled,e and belief. Fa Ise stata-,�ents made
herein are punishable as a Class A Hisdamie-anor pursuant to Section 2.10.45 of
the Penal Law.
>IG,NATURES OFFICIAL TITLES:.
Millbro e Office Centre
J 4 LIhG ADDRESS: Brewster; NY 10509 10509
, 0 l iti
SOMIS
New York City
Department. of
��PEnvironmental Protection_._._ .._
SUBSURFACE SEWAGE TREATMENT SYSTEM DETERMINATION
Pursuant to the authority granted under:
Section; I 100 of the Public Health Law;
Section 18 -03 of 15 RCNY; and
Section 128.1 of 10 NYCRR;
and in' accordance with the standards of
10 NYCRR Appendix 75 -A Wastewatertreatment Standards - Individual Household
Systems;
NYSDEC Design Standards for Wastewater Treatment Works; and
NYCDEP Procedures and Practices for the Approval of Septic Systems and Wastew
Treatment Plants.
the New York City Department of Environmental Protection makes the following determinations
with respect to the sewage disposal system(s) plan described below:
Name of Project:
aka:
Location:
Owner:
.Address:
Drainage Basin:
Ed Hagenah Proposed SSDS
Sullivan Road, Putnam Lake, Town of Patterson, County of Putnam
Edwin J. Hagenah
39 Cortlandt Manor Road'
Katonah, New York
East Branch Reservoir
Type of Sewage Treatment System and General Description:
Shallow absorption trench on -site sewage treatment system. The system consists of a 1000 gallon
septic tank and 251 lineal feet of leaching trenches to be installed in accordance with the Proposed
SSTS drawing number SS -1 dated January 11, 19951Last revised May 1, 1995. A reserve sewage
treatment area has been designated on the drawing iri .accordance with New York State Health
Code. A seven foot deep curtain drain is located eighteen feet up -slope of the system. This
system is for a two bedroom house.
Dates of Site Inspections and Soils Test: Percolation and Deep Hole Tests April 20, 1995
V
New York City
Department of
Environmental
Protection
Bureau of Water
Supply & Wastewater
Collection
r�
Mr. Harry Nichols, P.E.
Laurent Engineering Associates, P.C.
Millbrooke Office Centre
Route 22 and Milltown Road
Brewster, New York 10509
Dear Mr. Nichols:
June 30, 1995
RE: Ed HagenahProposed SSDS,
Town of Patterson, County of Putnam
East Branch Reservoir; Project Log 2883
Sources Division Enclosed please find the New York City Department of Environmental Protection's
(914) 742-2002 PEP) SUBSURFACE SEWAGE TREATMENT SMEMDETERMINATION for the above
referenced property located on Sullivan Road in Patterson, New York.
Please contact Margaret Lloyd at 742 -2033 at least 2 days prior to the start of
465 Columbus Ave. construction of the subsurface sewage treatment system so that we may inspect and monitor the
Valhalla, Nevi York 10595-
1336 installation. A copy of this determination must be available. at the project site during
construction.
MARILYN GELBER
Commissioner
ROBERT P: LEMIEUX':'
First Dspttty cmrnmissior r
Acting Director .
Printed on recycled paper
One set of plans bearing our conditioned stamp of approval is enclosed.
Very truly yours,
s'W. Roberts, P.E.
Program Engineer
Encl:plans
XC: Director of Environmental Health w /encl.
Putnam County Department of Health
4 Geneva Road
Brewster, New York 10509
DETERMINATION
- ( - Approved ( ) -- Disapproved -
( ) Conditionally Disapproved ( XXX) Accepted design
.1.. Generally the installation of a curtain drain requires demonstration of its ability to
adequately intercept groundwater. However in this case staff has determined that the
cu. am drain is a safety feature and not a direct functional requirement of the system. A
swale must be included to divert surface runoff away from the system.
CADATANISCHAOENAH.DET Z
I
Cou dAfions of Acceptance:
ace:
Prior to the commencement of any construction requiring a building permit, the applicant
must provide at least 48 hours actual notice to the NYCDEP engineer or his
representative making this determination.
2. The facility shall be constructed and completed in accordance with the. engineering report,
plans submitted, specifications provided, which form the basis of this acceptance, and in
accordance with the conditions of this determination.
3. The project construction must be commenced within two (2) years of the date of the
determination.
4. The applicant will provide "as built" plans to NYCDEP, certified by the engineer, where
required or requested.
When installed the system must be operated and maintained in accordance with NYCDEP
Regulations and all other applicable regulations and/or standards.
6.. In the event that the material submitted is inaccurate or misleading, or the owners of the
project do not have the legal right to develop or use the property where and as showri on
the material submitted to this office, this acceptance is withdrawn.
7. This determination constitutes acceptance only of the physical design of the septic system
for proposed installation and operation on a watershed of the New York city plater
Supply. An acceptance of the septic system design does not effect any existing property
rights, title, or interest, including without limitation, any public or private restrictions upon
the use of the land. Therefore this determination shall not be considered to be a grant or
waiver of any property right.
8. _ The sewage disposal, system shall be constructed in conformity. with the data and plans .as
approved or commented upon. Any significant change in the system must be approved in
advance of construction by the Department of Health and this Department.
9. The system shall receive only the domestic sewage from the structures shown on the
plans. The nature and quantity of flow from the structures shall not be changed without
prior acceptance of this Department and the Department of Health. -
10. All parts of this system are to be operated and maintained properly. In no case is sewage
or sludge to be exposed or any other unsanitary or unsafe condition to be created because
of the use of this system. Guidance on standards is found in the Waste Treatment
Handbook issued by the New York State Department of Health under New York State
Code of Rules and Regulations (10 NYCRR 75).
CMATANISCWAGENARDET
• 11. Whenever sludge and scum shall so accumulate in any septic tank so as to occupy together
at any point more than one- fourth of the distance between the bottom and the flow line,
the tank shall be cleaned.
i 2: = Whenever sludge and-scum are removed from any septic or settling tank or any part'of the
system it shall be done in such a manner as to cause no nuisance, and the material shall be
disposed of in accordance with applicable regulations.
13. This acceptance shall not be construed to invalidate any rule or regulation enforceable by
local authority having jurisdiction.
14. All duly enacted rules and regulations for the protection of the water supply shall be
complied with (Administrative Rules and Regulations for the Protection from.
contamination to the Public Water Supply of the City of New York adopted under the
authority of Section 70, 71 and 73 of the New York State Public Health Law).
15. This system shall be abandoned and a connection made. to a public sewer if and when a
public sewer is built that is available to this project:
16. Whenever' it is determined by this agency that additional replacement or improved sewage
treatment facilities are necessary such facilities shall be professionally designed at the
expense of the owner or owners of this project. Plans are to be submitted to this agency
and the Health department for review and approval, and facilities shall be constructed and
maintained at the expense of the owner or owners of this. project. .
17. All material removed from the area of the failing subsurface treatment system shall be
hauled and disposed of in accordance with all local, state, and federal laws or regulations,
including those of this Department, pertinent thereto,
Determination ma
Date: June 30, 1995 s W. Roberts, P. E.
Program Engineer
Environmental Programs
New York.City Department of
Environmental Protection
CADATANISCHAGENAH.DET 4
for Acceptance:
Engineer
Iental Programs
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' SITE_ LOCATION_ -PLAN_
SG A.L. E : I °=1000
PROPERTY SHOWN ON TOWN OF
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SSDS DESIGN DATA
DESIGN FLOW — RESIDENTIAL
2 6EDROOMS ® 200 G.PD. = 6400 G.p,G
SOIL RATE USED: / /- /5' MIN. //" DROP
APPLICATION RATE: .BO
ABSORPTION TRENCH
REQUIRED: 250
PROVIDES 25/
TEST PIT DESCRIPTIONS
HOLE i/ / 0 6 TOPSO /L
8!7-0••9/LTY SANDY LOAM
HOLE S2 : O- 6'TOPSO /L
6t 7-'051L TY SANoy, z a4M
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I.
ENINL
Mr. Harry Nichols, P.E.
Laurent Engineering Associates, P.C.
Millbrooke Office Centre
New York city Route 22 and Milltown Road
Department of
Environmental Brewster, New York 10509
Protection
RE:
Bureau of Water
Supply & Wastewater
Collection
Sources Division
(914) 742 -2002
465 Columbus Ave.
Valhalla, New'York 10595-
1336
MARILYN GELBER
Commissioner
ROBERT P. LEMIEUX
First Deputy Commissioner
Acting Director
Printed m recycled paper
June 30, 1995
i
Ed,HagenahProposed SSDS,
Town of Patterson, County of Putnam
East Branch Reservoir; Project Log 2883
Dear Mr. Nichols:
Enclosed please find the New York City Department of Environmental Protection's
(DEP) SUBSURFACE SEWAGE TREATMENT SYSTEM DETERMINA TION for the above '
referenced property located on Sullivan Road in Patterson, New York.
Please contact Margaret Lloyd at 742 -2033 at least 2 days prior to the start of
construction of the subsurface sewage treatment system so that we may inspect and monitor the
installation. A copy of this determination must be available at the project site during
construction.
One set of plans bearing our conditioned stamp of approval is enclosed.
Very truly yours,
AQ
W. Roberts, P.E.
.m Engineer
Encl:plans
I
XC: Director of Environmental Health w /encl.
Putnam County Department of Health
4 Geneva Road
Brewster, New York 10509
f