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HomeMy WebLinkAbout1217DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.63 -1 -46 BOX 12 I rm 'Irs IONL �L .. L� . T y, , �� .:. �� el Or r = ., - ON L� . T y, , �� .:. �� el 01217 AM COUNTY DEPARTMENT OF HEALTH IVISION -OF E- NVIRONMENTAL-HEALT l-= SERVICES= FICATE OF CONSTRUCTION COMPLIANCE PCHD CONSTRUCTION PERMIT # FOR SEWAGE TREATMENT SYSTEM Located at 40 LAW OAT VP-NI5 Town or Village ATTF -4 D N Owner /Applicant Name Faw'*oO 6401A Tax Map 25.0 Block Lot Formerly Subdivision Name P UTKAA -Lr Subd. Lot # A+5,, A40 Mailing Address 40 LAf-G7 f o t -l- D !ZI ug� PA'Tr&-F'6 0 A r NY Zip 12�i 6 Date Construction Permit Issued by PCHD Separate Sewerage System built by Or C:AVA1'lo ^' Address 24 mccv�w y povoL f t.4Wj l Zti Z Consisting of 0 Gallon Septic Tank and Wo L-F Other Requirements: Water Sunoly: Public Supply From Address or: Private Supply Drilled by Address p�T��� P � � x-o0 -Buidiri i g yp e "' " .� � �� "'� � 'Has erosion control- lfee`ri "c6mpl'efed7 Number of Bedrooms f�) Has garbage grinder been installed? 00 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 regulatiops of the Putnam County Date: 01) ®11 rj Certified by of Health. (De i n Professional) / Address l�sO �`L g A1, Y 1 Il License # P.E. X R.A. 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 ar ubject to modification or change when, in the judgment of the Public Health Director, such revocatio ,, m 04fica tio change is necessary. By: Title: �� Date: 3 �� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 v - r WE L Le.COMrLETj.UDlr%zrUA1 ��..� � .DEPARTMENT OF HEALTH ,r Q�o- Of P Env{ rnnment:al Healt`Iq Services PUTNAM COUNTY DEPARTMENT „OF'.HEALTH, . Office; Use Only WELL�LOCATION STREET AOORESS ; . W. ,t TAX GR!O NUMBER: : ��� R -. �®$�rSf_o VOrk ' WELL OWNER ADDRESS BIVATE ' .' ku I7g0 Der :DId10 ` Ors. f +d York O PUBLIC USE OF WELL 1= primary 2 - secondary RESIDENTIAL O PUBLIC SUPPLY_ 0 .AIR /COND, /HEAT PUMP. 0 ABANDONED. O BUSINESS O.fARM_ _ O TEST /OBSERVATION O OTHER .(specify) O INDUSTRIAL O INSTITUTIONAL' O STAND-BY.' 0, `o MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED -2 / EST. OF DAILY USAGE gal. REASON FOR DRILLING []REPLACE EXISTING SUPPLY NEST /OBSERVATION ADDITIONAL SUPPLY N..SUPPLY' (NEW DWELLING) DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 2� ft. STAT16WATER LEVEL 20 ft: DATE MEASURED 0/� DRILLING EQUIPMENT O ROTARY:,. COMPRESSED AIR'. PERCUSSION .. ' O DUG O WELL POINT 0 CABLE PERCUSSION. O OTHER (specify): WELL TYPE y TI SCREENED O OPEN END CASING OPEN HOLE IN BEDROCK O OTHER.* CASING ,.DETAILS---- TOTAL LENGTH . MATERIALS:. ,_STEEL” : 0 PLASTIC' O OTHER LENGTH..BELOW. GAADE ` ft. JOINTS: .....:0 WELDED :.(THREADED 0 OTHER DIAMETER' - in. SEAL CEMENT.GROUT-. 0 BENTONITE.:OOTHER WEIGHT PER FOOT Ib. /ft. DRIVE SHOE:UYES 0 NO .. LINER: OYES. 0 NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (It) DEPTH TO SCREEN VQ DEVELOPED? FIRST OYES ONO HOURS SECOND :; GRAVEL PACK. ❑YES D No cRAVEL:: . .. . . . . .. ... . SIZE DIAMETER OF PACK In: TOP DEPTH fL BOTTOM OEM tt. WELL YIELD TEST If detailed pumping METHOD: O PUMPED i tests were done is in- w ^MPnESSED A!R i formation attached? O SAILED O OTHER o:0 YES ., .0 NO if more detailed formation descriptions or, sieve analyses. WELL .LOG are available; please attach. DEPTH FROM " SURFACE Water Well gear- 013- ing meter. In .: FOR!,tATIOM DESCR!?f!OH ON t. 1t. WELL•DEPTH IL DURATION'" hr. min. DRAWOOWN ft. YIELD 9Cm Surface o grime o d5 I y Soft we® Ie e 220 2 30 .220 3 HOPE g 0 285 G o 260 20 723 285. , H®M grey white grit teo WATER .. X(CLEAR : QUALITY O CLOUDY -,.,HARDNESS O COLORER. ? yMyES ONO ATTACHD STORAGE TANALYSIS CAPACITY, GA I0 PUMP II�FORPdATIOtI TYPE ubmrsible CAPACITY I. FAKER DEPTH MODEL 12, VOLTAGEM.HP WEu DRILLER NMI,_ MILL -DRILLING' INC o oa ADDRESS :' pllenl.� _ slGia, Br te6 NY r$ Mo M1110 President. 3/69 Jan 07 05 01:,09p TOWN OF PRTTERGO 845-878-2019 P•1 JAM-07-2005 12:10 PM HARRY id NICHOLS' 914 279 4567 P.02 BRUCE L FOLEY PiA11C mow vk*10; 4 upwa.... OF BEAM— I Optys-Road.— 1sftwstG4 New Yo;x '10509 Nwgb&IkM4w (flQUI-SUS .-VIC JNQ-171-M F11Vt4)174-6*17 Tmshosipi4pyijan F4x(pw)t7r-6641 7211 ADDRPSSY&RIETCAnON FORM TAX'w nmuc- M2. 4Co Ae L. AV-CPDK P P.- N AMP? =1) Tow-AMCLAU 77 -7 75 7 Thf, Put== County Depament of Health will not L�ue ConstructiouCo=p9anceunliss the above P0rM-L--C:0mp1cttd,'1.e., a legal y,911 j4 a3ithosind tows o MtIBI-' ThislOmis to be submitted'- vii � ih;'application for it CertMcatc of Contraction Cataphum January 7, 2005 Putnam County Health Department One Geneva Road Brewster, NY 10509 Aft: Robert Morris, P.E. Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 Tel: (833) 2794003 Fax: (845) 2794567 Email: hnengineer@aol.com Re: Individual SSTS Compliance - Edward Gracia 40 Lakeport Drive Patterson, NY 12563 Permit # P -13 -91 Dear Mr. Morris: Enclosed are the following: 1. Five (5) prints of Drawing S -1, "As Built SSTS," dated 01/04/05. 2. "Certificate of Construction Compliance for Sewage Treatment System, ". dated 01/07/05. 3. Three (3) copies of "Guarantee of Subsurface Sewage Treatment System," dated 6/15/93. 4. Laboratory Report, dated 06/09/93. 5. "d1/ell Completion Repo lt" dated-06 /415;93. 6. Application Fee in the amount of $300.00 payable to Putnam County Health Department. 7. "E -911 Address Verification Form," dated 01/07/05. If there are any questions concerning the enclosed, please call. Very truly yours, H ry W. Ni hols Jr., P.E. HWN:jmm 04- 014.00 ,� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SU13SURFACE SEWAGE TREATMENT SYSTEM . Owner or Purchaser of Building Tax Map Block Lot Building Constructed by y TownNillage Location - Street Subdivision Name p—E`) t Df5t-t c,v� Building Type A464 Subdivision Lot # I represent that I am wholly" and completely responsible for the location, workmanship, material, . ' .. construction and"drainage of the sewageireatment 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`.gt�arantee to the owner; his successors, heirs or assigns, to place in.good op.e.rattng.condition any parr =-of said `9ystetn constructed by me which fails vto 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 .0 b Day � Year Signature: _ Title: �2 General Contractor (Owner) :Signature cv�a,r 6N. Address:;...G�c. corpoiation)' :> `Corpo ` to ame (if'� corporate ri) r pD::.:. ::p�1 ~ o►d y' };Address�:�q hd UST... - State Zi �G State ,Q L1� lNs Zip 1' �� � Form GS -97 Northeast n29, 6AIlIl Street 06037-9990' RAW REPORT 'TO: Mill Drilling Inc. Putnam Avenue Brewster, NY 10509 C'T.Destitflcmtionn: PHA -0606 EPA Certification: CT -024 USDA Certilficai>tion"i' '0976 LABORATORY REPORT -- WATER SNIPPILY TIESTIIZG -- Sr't&IPLE SITE.t- Edward Garcia Adrian Road Patterson, NY. 10509 SOURCE: New Drilled Well DATE SAMPLE COLLECTED: TIME COLLECTED: COLLECTED BY: DATE RECEIVED @ LAB: DATE(S) TESTED: TESTED BY: PURCHASE ORDER NO.: REPORT DATE: 6/2/93 5:00 p.m. Mill Drilling Inc. 6/3/93 6/4/93 M.L. N/A 6/09/93 SAMPLING POINT Not Given TREATMENT: None TEST PERFORMED RESULT: RECOMMENDED LIMIT BACTERIAL: Mg/L = Milligrams per liter. Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml ICHEMISTRY: Chlorine Residual 0.00 m /L - - - -- ._....:..RESzUL 51A5ED,ON - -SAIi PL)ES- S'U-BPATTT 7-ID /DOLI.IjuC'TLD: - • 6/3/93 - ..3... ...._.....� ._._.. _.... .._..._ _ _ SAMPLE, LIE, AS TESTED ABOVE: E POTABLE or ONOT POTABLE ,PER STATE OF CONNECTICUT DEPT. OF HEATH SERVICES STANDARDS FOR POTABLE WATER) co AAO�n,� Director CT: (203) 828 -9787 o>r -800 -825 -0105 / OUTSIDE CT: 1 -800 -554 -1230 I/ DIVISION OF,ENVIRONIVIENTAL HEALTH SERVICES COUNTY OF PUTNAM -STATE OF NEW YORK IN TIM MAT ) R OFT COMPLAINT AGAINST �G1 RESPONDENT(s), P t Jul �2 Arising ut of the Alleged Violai ions of the Public g g Health Law of the State of New York, the Sanitary . Code of the State of New York, the Sanitary Code of the County of Putnam, and Administrative Rules Regulations and Standards Promulgated Pursuant Thereto STIPULATION OF DISCONTINUANCE CASE NO. Facility No. &,e4 IT IS HEREBY STIPULATED AND AGREED by and between the respective parties hereto that the within matter is hereby terminated upon the following terms and conditions. 1. The Respondent(s) admit the truth of the allegations set forth in-the Statement of Charges.... 2. ThatXespondent(s) represent: it is in compliance-with the Code(s). it will be in compliance with the Code(s) by 90 El That Respondent(s) understand an appropriate civil penalty may be • posed b , e Eby Order which amount will be determined at the discretion o ti u lic eat � r.. That in mitigation Respondent(s) Asserts: 6)4" LA DATE: a Brewster, New York 10509 • i s0- STIPULDISCONTAFFDV .per y Iw =P-60- slim �. e►�r � .. � ! I w c -o++ n C -s.wwt y (J+/oavt r..+tnt O '+r M wmawno�.s iA nos. Chssw+ +'� GaOROCIC�¢i¢t.04 4p0 poCm -lNi E) 4RdQ QR� ep o4o °c7Md6ts�_0_maa o¢,Qo'4o..oc Evi "os✓�nc "riRA¢p�,aQOwCtl4,:gdboo .ec_ X9.0 .'.°,SegQ66kwQO' o¢ C®WWtZaN�CQl�a �L7�so°' ;tui46t�t�4ixy Q® QFO Coa0�e1 ®O D�G3gGi000 .T1 B.^• ' ^ A•! • ta...b . ^ qn t ,.v! M' � r I .nn "4 Du b •M tit ?oar , �Yi•� ! 1 � •n � M t N9 d. -..ry r • ®� '4 h'N` m w ii�W U' :Y t♦ n "AMP, r.ry�..y. 1 .gal a m r 4w~«�►s. a ".a � ti•!. r a t r to ut h ., ^ PAUL P. PIAZZA Building Inspector TOWN OF PATTERSON CODE _ENFORCEMEI\NT_.,,4>�FJ�E.. .....�_--- .._:........_.._ _.......,._... _... _ _._ _.. PUTNAM COUNTY P.O. Box 470 Patterson, New York 12563 December 9, 2003 Mr. & Mrs. Edward Gracia 40 Lakeport Road Patterson, New York 12563 RE: TM — 25.63 -1 -46 , Building Permit # 1905 Dear Mr. & Mrs. Gracia, Telephone (845) 878 - 6319 Fax (845) 878 - 2019 Thank you for meeting with me on December 1, 2003. As I explained to you, the reason for my request was to see for myself the status of the open building permit, number 1905. This permit was issued in 1993 and to this date, remains open. The permit was issued for a single family, three - bedroom home with an attached two -car garage. During my inspection, the following items were observed and need to be corrected. This inspection is not to be considered a final inspection and there may be other items that need to be addressed. ._.. _. _.._ __ . ..... 1. The fourth bedroom in tliebasenient is to lie iemoved. 2. The furnace room door hinges need to be adjusted .so that the door is self - closing. 3. The furnace room ceiling needs to be fire rated with a one -hour rating. 4. Handrails need to be installed on all stairs, both interior and exterior. 5. Smoke alarms are to be installed in all three bedrooms and in the common hallway on the second floor. 6. Smoke alarms are to be installed in the first floor and basement ceilings. 7. The door from the mudroom to the garage needs to be self- closing, self - latching. 8. The handrail on the rear deck is leaning and needs to be re- secured. 9. The Putnam County Health Department permit has not been signed off. Due to the fact that you are living in the residence, it is imperative that this be accomplished as soon as possible. Please be advised that at this time you are in violation of not only the Town of Patterson Town Code, the State of New York Building Code but also the Putnam County Health Department rules and regulations. Until such time that the Health Department_issues..are resolved, your,- building - permit is - :- being-placed on hold. Please contact this office when the matter is resolved. If I do not hear from you within 60 days, I will be forced to issue a Court Appearance Ticket. If I can be of fiuther assistance, please contact my office at 845- 878 -6319. Thank you. PPP /cs Sincerely, Paul P. Piazza, Building Inspector cc:. Robert Morris, Putnam County Health Department �. _ -.._ .. LORET"T -A. - MOVINF.RI.•:'.V:; �4.S:N, - - - . - . Acting Public Health Director Director of Patient Services _..... _ .. _ _ _ ...� .._ .. - �•-" �OBERT� J: ' BONDI County Executive 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 (84)) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 OFFICE USE ONLY /if0 Re: Dear Letter of Continuance Case# This letter is to inform you that Eric S. Zaidins, Esq., an Administrative Law Judge, has order that the informal Hearing of Id— J 1/ Case # will be �1 t continued on , at A.- M..,at the, Putnam, County . Department of Health, 1 Geneva Road, Brewster, NY 10509. Should you have any question relative to this matter, do not hesitate to contact me at this office. Sincerely, Rick Carano Supervisor, Public Health Protection RPC:tn (CONT'D LTR OFFICE USE – RC) LORETTA MOLINARI Public Health Director 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 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 CERTIFIED RETURN EIlD RECEIPT REQUESTED Mr & Mrs. Edward Garcia 40 Lakeport Road Patterson, NY 12563 Re: Case No. 117 -04 -19 Facility No. P -13 -91 40 Lakeport Road Dear Mr. & Mrs. Garcia: ROBERT J. BONDI County Executive September 1, 2004 The Hearing scheduled for September 1, 2004 has been rescheduled for October 6, 2004 at 9:30 A.M. in the Hearing Room, at the Putnam County Department of Health, 1 Geneva Road, Brewster, New York 10509. Sincerely, Rick Carano Supervisor, Public Health Protection RC:tn cc: R. Morris G. Reed DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OF PUTNAM -STATE OF NEW YORK _. _._._....._ _.___.__ ..-- - ,. _.�.____ . .� ._._. __._.,.._ - _- ..- ......- - - - - .. -. -_. IN THE MATTER OF THE COMPLAINT AGAINST i Mr. & Mrs. Edward Gracia . RESPOND- ENT(s), : Arising out of the Alleged Violations of the Public NOTICE OF HEARING Health Law of the State of New York, the Sanitary Code CASE NO. 117 -04 -19 of the State of New York, the Sanitary Code of the County Facility No. P -13 -91 of Putnam, and Administrative Rules Regulations and Standards Promulgated Pursuant Thereto TO: Mr. & Mrs. Edward Gracia PREMISES: 40 Lakeport Road 40 Lakeport Road (T) Patterson Patterson, NY 12563 TM# 25.63 -1 -45 & 46 Permit #P -13 -91 PLEASE TAKE NOTICE THAT CHARGES have been preferred against you to the effect that you have violated the health laws as more fully set forth on the reverse side of this notice: YOU ARE. HEREBY SUMMONED TO APPEAR at a hearing to be held under the provisions of the Putnam County Sanitary Code and Public Health Law of the State of New York before Eric S. Zaidins, Esq., an Administrative Law Judge of the Department of Health of the County of Putnam on the 1 s` day of September 2004 at 9:30 A.M., in the Hearing Room, located at Route 312, 1 Geneva Road,' Terravest Corporate Park, Brewster, New York, at which time the charges will be informally discussed, and such adjourned dates as may be designated. AT ALL TIMES YOU WILL HAVE THE RIGHT to be represented by counsel and the right to deny the charges, in whole or in part, following which the matter *wff be 'rescheduled io a'date certain 'and a Formal Hearing will be conducted thereon, and a record of all the proceedings will be made, witnesses will be sworn and examined and cross examined, and documentary evidence maybe offered and received, and you may produce witnesses and evidence in your behalf; AT THE HEARING; IN THE EVENT YOU WISH TO ADMIT TO THE CHARGES, the Hearing may be terminated by written stipulation of discontinuance provided the violations have been corrected; UPON YOUR FAILURE TO APPEAR, a warrant compelling your appearance may be issued or an Inquest Hearing conducted and a determination made; CIVIL PENALTIES up to $1,000 for a single violation, per day, may be assessed against you,'and such further orders may be made herein. as the circumstances may warrant; THE BOARD OF HEALTH may issue a warrant to any Peace Officer of the County, pursuant to Section 309 of the Public Health Law, to bring to its aid the power of the County whenever it shall be necessary to do so, with the same force and effect as if such warrant had been issued out of a court of record. PUTNAM COUWY BOARD OF HEALTH DATED: August 13, 2004 BY: Brewster, NY 10509 Public Health Director STATEMENT OF CHANCE 1f 1S HEREB e ALLEGED THAT -THE P EI`'O°NS-HEREIN -BEFOR NAN/iC�.i� D RESJF�DI�YD EKTS are charged with violations of the Health Laws of the State of New York and the County of Putnam as follows: PUBLIC HEALTH LACY OF THE STATE OF NEW YORK Violations of any and all provisions of the Public Health Law of the State of New York and the State and County Codes and Administrative Rules and Regulations promulgated pursuant thereto — which shall be found to be found to constitute a NUISANCE, particularly, and not limited to the provisions of Article 13 of the Public Health Law. SANITARY CODE OF THE STATE OF NEW YORK PUTNAM COUNTY SANITARY CODE Article III, Section 2e - August 11, 2004 site visit shows evidence of Sanitary Sewage Treatment System being utilize without a Certificate of Construction Compliance. ADJOURNMENTS: Public Health Law violations are serious. They affect or may affect the. health, safety and welfare of the community. They cannot be permitted to go on indefinitely. Casual adjournments or hearings will be granted. Applications for adjournments must be made in person or by counsel to the Hearing Administrative Law Judge at the time set for hearings, except for legal excuses. Persons operating an establishment, business or facility without a permit, for which a permit is required - will not be granted an adjournment. Health matters are involved and the Public Safety is a paramount consideration. I,M: t11 cc: L. Molinari 0 R. Carano R. Morris File ❑ i HEARINGS JANUARY 5, 2005 1/3/20U5 :. ,:..' .... r - t <;.":': .� v x..., •: :- ,. •: ,. .: .,; . ,. : .. .'>:._• ..... .., .. r ... ,, CASE# ._s...+;a'. .. ar•: r ,.�:. .. ., .3 ,. F CIL,I7 �I':. PCHD� :TIiVIE ,1 sA < � X '.§•zE ..Nj3 z'* _�?. r: •., F. GRN R �S.CHDL.: .f.^. S, L' �s< �,`&...s•. �' fs`: �9.... A: r.. ��,. k....., vdz�.,>. ur,..=,: �,-..:r �s.,*,..... v�. c. zs. .zas�soV":,ss;Xx_...�;r:... +.._ F §#P.'s..,....r,.;., � . w u«...�n�>.�. -._�.. •„�..s• . uu:..a,�.- ,a�,.�.>a.....,,..� . ., ?:.nS.a_Y,,w ....a 3..L:us .0 _,CONJ' :.:.w«�:,m.�ta.z .R:me..,n ,t ,.� x.n:.'ean= .r JOANIE'S OLD SPRUCE HELL INN 162 -04 -02 39 -AA78- B.S. 09:30 A.M. 12/24/04 WATER CONDOMINUM W.S. 169 -04-01 A.B. 09:30 A.M. 12/13/04 , COUNTRY HILL ESTATES W.S. 170 -04-01 A.B. 09:30 A.M. 12/10/04 t NEMAREST CLUB W.S. 171 -04 -01 A.B. 09:30 A.M. 12/17/04 ARCHER ROAD W.S. 172 -04 -01 A.B. 09:30 A.M. 12/10/04 ALPINE ACRES W.S. 173 -04-01 A.B. 09:30 A.M. 11/9/04 t GRACIA (40_�LA_I£EP_ORT ROA)� M ` 0930.A.M 8 MILLER AVENUE APARTMENTS 163 -04-01 A.B. 10:00 A.M. 12/10/04 , 12 CROTON FALLS ROAD APART. 164 -04-01 A.B. 10:00 A.M. 12/10/04 ENERGY BUILDING CORPORATION 165 -04 -01 A.B. 10:00 A.M. 12/10/04 i R & J's EAST END DELI 144- 04 -34A 39 -AT37 MAB 10:00 A.M. GARRISON LANDING W.S. 059 -03 -01 A.B. 10:00 A.M. RAINBOW W.S. 176 -04-01 A.B. 10:30 A.M.. 12 /10/04 SIGORJONSON /SAMANTHA LANE 147 -04-19 B.H. 10:30 A.M. r , r r ' 'x Page 1 r LORETTA Acting 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 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 O FIFRC E USE ONLY lie. �PP S. 9 po,TiF�njl V. � t;7_5_0 C) �I�KWOAr Re: Letter of Continuance ..Case # W -0 f ./7 Dear ROBERT J. BONDI County Executive This letter is to inform you that Eric S. Zaidins, Esq., an Administrative Law Judge, has. / order that the informal Hearin Si MOCase'# of �l ~� will be _.coi1tirilzed'_ .on. .. ) - !� -at ..9 ,13 A. Ni: -at the Putnam County-... Department of Health, 1 Geneva Road, Brewster, NY 10509. Should you have any question relative to this matter, do not hesitate to contact me at this office. Sincerel Rick Carano Supervisor, Public Health Protection (CONT'D LTR OFFICE USE — RC) f _.-._ _...� LORETTA MOLINARI R.N., Acting Public Health Director Director of Patient Services a 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 Early Intervention/Preschool (845) 27,8 - 6014 Fax (845) 278 - 6648 OFFICE USE ONLY Re: Letter of Continuance Case # W -a ROBERT J. BONDI County Executive Dear This letter is to inform you that Eric S. Zaidins, Esq., an Administrative Law Judge, has, order that the informal Hearin of S'i . QM Case # l -0~ will be -. ccL�tinue�i. orC..L 1. �at A: M: at "�h Fuui�u3r Cuirr�ty k Department of Health, 1 Geneva Road, Brewster, NY 10509. , Should you have any question relative to this matter, do not hesitate to contact me at this office. (CONT'D LTR OFFICE USE - RC) Sincerel , Rick Carano Supervisor, Public Health Protection �.526 170 670 P— RECEIPT FOR ".. RECEIPT FOR CERTIFIED MAIL NO IN�URAN,CJE,CG N16 INSURANCE COVERAGE PROVIDED NOT FOR INTER NOT FOR INTERNATIONAL MAIL (See Reverse) (0 ent to Sed to Street and NO. IcL .P'6'.',"State pn ZIP Code o O'SCF) Postage -'ti S IT5 �W Postage deriiiied.Fee .Certified Fee Special Delivery Fe e', special-Deliver y Fee Postage Restricted Delivery Fee Ftesiricted Delivery Fee Return Receipt showing to whom and Date Delivered J r.Q 0 Certified Fee Atu�rn Receipt showing to'wfiom,arid Date Delivered, 1.0o Return n R &ceipt showing to whom, Restricted. Delivery and Address of "Delivery TOTAL Pos!a and Fees Postmark or D Return Receipt s owlpg, Postmark ,,-, te' to whom and Date I -Deliyi Ln Ln 0 'n Arn rs "P 526 170 671 RECEIPT FC IR CERTIFIED MAIL t, 40 INSURANCE COVERAGE PROVIDED NOT FOR INTERNATIONAL MAIL (See,Reverse) in 0 CS Cn 00 LL CA Ck. -D MAIL S 179 P 526170 667 RECEIPT FOR CERTIFIED MAIL,,. NO INSURANCE COVERAGE PROVIDED NOT FOR INTERNATIONAL MAIL (See Reverse) 0 q in C0 CD CS a co 0 E 0 U. U) a. Sent to 0 L9 cxu 9 V) u) Street an N6. Ita( K Stateand 'ZIP Code 04 rsn C) KA Postage P.O., State a d ZI Cod .Certified Fee 0 special-Deliver y Fee Postage Restricted Delivery Fee Return Receipt showing to whom and Date Delivered J r.Q 0 Certified Fee Date, and Addrbit o— M lftr&\ . e 1 1. Special Delivery Fee Restricted. Delivery Special Delivery Fee Postmark or D Return Receipt s owlpg, Restricted Delivery Fee to whom and Date I -Deliyi Ln Return Receipt showin , g r 0 0 Date, and Addres Return Receipt showing to whom, a TOTAL Postage Date, and Address of Delivery 00 Postmark or TOTAL Postage 00 co 0 E 0 ILL LL U) IL CL "P 526 170 671 RECEIPT FC IR CERTIFIED MAIL t, 40 INSURANCE COVERAGE PROVIDED NOT FOR INTERNATIONAL MAIL (See,Reverse) in 0 CS Cn 00 LL CA Ck. -D MAIL S 179 P 526170 667 RECEIPT FOR CERTIFIED MAIL,,. NO INSURANCE COVERAGE PROVIDED NOT FOR INTERNATIONAL MAIL (See Reverse) 0 q in C0 CD CS a co 0 E 0 U. U) a. Sent to Sent to Pbut I 4abersaria Street and No. 9 L 14 S Lo'Vel rinir i b fr; le— K Stateand 'ZIP Code 04 rsn C) KA Postage .Certified Fee 0 special-Deliver y Fee Restricted Delivery Fee Return Receipt showing to whom and Date Delivered J r.Q 0 Return Receipt %hoinVo w-Abm. Date, and Addrbit o— M lftr&\ . e 1 1. Certified Fee �' TOTAL Postage and Feq Special Delivery Fee Postmark or D Restricted Delivery Fee P-521 279 617 RECEIPT FOR CERTIFIED MAIL NO INSURANCE COVERAGE PROVIDED NOT FOR INTERNATIONAL MAIL (See Reverse) (0 Sent to Pbut I 4abersaria 9 In _7A Street §nd N o. (c ;16 . Rikkes 1 cl�-41 0 P.O., StW ate and Zip, Cod 6( �K, Postage S Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt showing to whom and Date Delivered r 0 0 COY) Return Receipt showing to whom, Date, and Address of Delivery CD TOTAL Postage S 0 Postmark or D e _A Y 0 LL U) IL * 70- 66 9 W Sent to :street an i 3, Postage 6 7, Ceriiiiei specia -7. Rbitri to wr Oaf( 1 0 0 CL. : 66 526 �76 8 M'. .RECEIPT AIL NO INSURANC 'Ed VbAGCVROMED, NOT FOR INTERNATIONAL� MAIL ji Sent I C4 Street and b P F code bi 'State nd lPt S, Postage Certified Fee Delivery ee� Special b '. Restricted 6efivery F pp- ;j in Return Receipt sh&Ali;6 i,(jwhdmand Datd-D61jvered, CO OR turn eClil. in to om. ch Date; apildi dr ve 06 'Fees c TOTOTAL` V.,dVd A o Pos't'm'ar at tl Ate' U. 23 i i . {� Y Division 110 OLD ROUTE SIX CENTER, CA APPLICATION TO C .7 T. •OF'..RE RMEL, N:Y h Sv • 225 =0310 E' ITER WELL PCHD PERMIT,# WELL LOCATION trees Address T Village Cis ;Tax', Grid Numb r WELL OWNER Name Mailing? A/d ss $' Wrivate �. O Public' E OF WELL RESIDENT C PUBLIC SUPPLY Q AIR /COND /HEAT PUMP`;, O;ABANDONED primary 0 BUSINESS 0 FARM 0 TEST` /OBSERVATION ,0 OTHER (specify 2 - secondary 0 INDUSTRIAL CIINSTITUTIONAL 0 STAND-BY AMOUNT OF USE - YIELD SOUGHT 5 7° gpm /Il PEOPLE SERVED �r' /EST. OF DAILY�USAGE- gal 13 REPLACE EXISTING SUPPLY 0 TEST/OBSERVATIOON M ADDITI,ONAL SUPPLY REASON 'FOR DRILLING NEW UPPLY EW DWELLING) 0 DEEPEN EXISTING WELL DETAILED Y7-, � J REASON FOR,. DRILLING WELL TYPE MDRILLED ® DRIVEN ®D UGC - ^Q GRAVEL.:'--; OTHER +'Q IS WELL SITE SUBJECT TO FLOODING? YES 3_ L NO� IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: "g Lot WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NAME OF PUBLIC WATER SUPPLY: /t) TOWN /VIL /CITY _.- .DISTfiPTC--iO-- FRCyi'EItY- FROM NEAREST WATER' "MAI'N:' ` '-/��� .;.- __...,_......_.._..,...�.. , - LOCATION SKETCH & SOURCES OF CONTAMINATION PROV �ON SEPARATE SHEET (date) signature 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 thirti� (30) days of the co0 mmpletion of water well construction, the applicant shall: 1. Pump the well'until the water is clear. 2. Disinfect the'well in accordance withrthe requirements of the Putnam County Health Department attached to this permit. 0 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 loth wi e contami ate surface or groundwater. Date of Issue: _19 Z/ ��✓ Date of Expiration V 19 q 3 Fe it Issuing Official Permit is Non_ Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller J DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225-0310 October 9, 1991 Randolph Laurent 73 Fairfield Road Patterson, MY 12563 JOHN KARELL Jr., P.E., M.S. Public Health Director Re: Proposed SSDS: Gracia Adrian Road (T) Patterson TH 025.63 -1 -45,46 Dear qtr. Laurent: Revien of plans and other supporting documents submitted at this time relative to the above- captioned project has been completed. Comments are offered as follons: 1. Lot area, design plan, subdivision name and subdivision lot numbers have not been noted on construction permit. 2. Deep test hole data notes ledge at 6 feet in test hole 1. This nould require 1 foot of R.O.B. fill. Revise plan accordingly and note volume and fill specifications. A / 3. 'Lab_?- •propcood -and existing veils on- pla;ae t L�! 4. Pump pit dimensions, elevations for alaro, on, off, etc., dose volume has not been noted on plan. O �i 5. Actual SSDS hydraulic profile has not been shorn on plan. 6. Equal distribution system is to be utilized nhen a pump system is proposed. Lateral to be dosed are to be of equal length. Distribution boas detail is to be shorn on plan. 7. Neighbor notification is required as per outlined in the Putnam County Program Revien and Policies. Upon Receipt of a submission, revised to reflect the above comments, this application hill be considered further. der ;;-; ours , 9MW Robert Norris Assistant Public Health Engineer RH /jp ` . T Pur, ; .CO(.JNTX.br'l'� Or, fiEALTd': . DIVISION OF FNVIl2CPI2�rAL' "'F�ALTfi _= S�TZVTCFS 1 ' DESIGN DATA SHEET- SUBSUFACE vSEKPGi DZSA'KAL. cvcTlu tii�E 'i�TJ. - Owner 6109 42 1,4 _ Ac dress Located at (Street)'. D%z //T7o %7417 ° ` . ,. +See_- �� Block Lot �(o ( indicate nearest cross strut) .. �s ` { municipality .. �7� 3 ' Watershed GQB 771 SOIL' PE20QLATION TEST nATP, RDC)CllII.M TO BE ..SUBMI -= WITH APPLICATICNS Date of Pre- Soaking 1 Date of Percolation Test HOLE NUMBER CLOCK TIME PrRa1=CN ' PERaOIA'I`ION Run Elapse Depth to Water From Water Level- NO. Time Ground Surface In Inches " Soil Rate Start -Stop Min. Start Stop Drop In . Min/In Drop G ° T # Z Inches Indies Inches 'f 1l 2 o - /o.d4- ZZ" s' 4 1 101,05-119.-Z-6 : ZI Zd" 4 3" 3� 2-311 �. 7 �7 7 o. 210 2-6 -'10 Y9 L� �o�_.. _ _._Z3''. 3' To 3 /o; 4.8 - 'lo 27- Zolt Z3 3•. 7.3 4 5 1 ' 2 3 4 S NOTES: 1. Tests. to be repeated' at same depth until apprcxiaately equal soil rates are'obtained at each. percolation test hole. All data to' be suimdtt0d for review. 2. Depth measurements to be made fron top of hole. rev. 9/85. i, INDICATE 1= AT. WHICH GROUNDWATER IS EN INDICATE L=mmmai WATER LEVEL RIM AFTER G EMOUNMERED • DEEP BOLE OBSERVATIONS MADE BY: i 7-c 9c _DATE: _4LO/z/ DESIGN Soil Rate Used 6,1 0 min/I" Drop.- , 0.90 S.D. Usable Area provided No. of Bedrooms Septic Tar-j-, Car-le-city s- C! Absorption Area Provided By 6 a & L.F. x 240 width trench I Other 0A),L,: LAUReAtT F_A1GiA1oEiA1G Name 43_$0C1ATES.1 P•c.- Signa Address. 73 rAiRFIEzo QgovE SEAL V. TTERSoAl A1,6V__Y_0R1-z 1z THIS SPACE MR USE BY HEALTH DEPARM4ENr ONLY: 3oi1 Rate Approved ...; sq-ft/gal. Checked by Date c ti 71", yl 3 3 PUTNAM COUNTY DEPAFtTMENTYi OF HEALTH APPLICATION FOR APPROVALS OF PLANS =FOR A``WASTEWATER'DISPOSAL SYSTEM fl , 1. Name and. Address of Applicant. F Vl 6, 2. Name of Project: fROPO S &`� SS DS 3. _. Location T/V /C: ��!'T�`?2SOP3 .' 4. Project. Engineer: Kiq DOL1014 l,1)•)- %10E7AJT 5. Address: 75 F/1 //?F/EZZTPDIE' License Number: Phone 6. Tvoe of Pro ect: ; l� 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)? Tvpe,Status (Check One) Type I.. Exempt Type II. Unlisted _— 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. /yy 9. Has DEIS been completed and found acceptable by Lead Agency? ........... /J /A 4 _ 10. Name of Lead Agency A2 II � 11. Is this project _ .__lc�cai . n.lAnni.ng., .zoning, �or other officials aordinances ?r. the. contr_, o l._nf•..••........••......•..•: A9 0 12. If so, have plans been submitted to such authorities? 4 ties? .................. 13. Has preliminary approval been granted by such authorities? ��fi- Date Granted: 14. Type of Sewage Disposal_ System Discharge...... Surface Water-2( _Ground Waters 15. If surface water discharge, what is the stream class designation ?........ 16. Waters index number (surface) ........• ... ............................... 41� 17. Is project located near a public water supply system? ..... .............. A) 18. If yes, name of water supply :)o Distance to water supply 19. Is project site near a public sewage collection or disposal system ?..... NO 10. Name of sewage system x)14 Distance to sewage system A. Date observed: 23. Name of'Health Inspector: . (794,1012 4. Project design flow (gallons per day) ...... ............................... �� 25 Is:,State Pollutant Discharge-Elimination System (SPDES)�- P.ermi,t required ?.. A7D 26 Has SPDES•Applicat`ionbeen` submitted to local DEC Offi e? .............. '2 Is any portion of this project located, within a desi :gnated Town or State ° land ? ............... ¢. ................... wet . . ..... l�28. _Wetland ID Number ...................... ......°o e .....: >............ . 29..J s Wetland Permit• required? ............o . ..................o............ Has application been made to Town or Local DEC Office? .................. /om p� 0 No 30." Does project require a DEC Stream Disturbance Permit? ....o .............. ;:,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 32. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site,* salt stockpile, landfill, sludge disposal site or l) 0 . 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? 35. Are any sewage disposal areas in excess of 15% slope? ........................ A C� 36. Tax Map ID Number ........... >.. .................. .......... ...... .....a f.� 37. Approved Plans are to bes returned to: .................. Applicant iC Engineer Yf 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 prodided on this form is true to the best of my &nov7edge and belief. False statements made herein are punishable as a Class A aisdemeanor pursuant to Section 290.45 of the Penal Law. 0 SIGNATURES & OFFICIAL TITLES MAILING ADDRESS: t � . PUTNAM COUNTY' DIVISION OF ENVII Re'' of ITT ♦TT1lT1TT ATE >•iT }y y.i �'�, .� ERVICES F a Located at (T) r T rz�g ection o2!5`.;,&'?j ..,"Block ;`` /' Lot Subdivision of Subdv. Lot # Filed Gentlemen: p # Date This letter is to authorize k,,4 7- d��f/ a duly licensed professional engineer X 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 zcnformity ,with the -provisions. of A t-_:-cle. 111-5 or. 147, Education Law, the Public Health,Law, and the Putnam County Sani- tary Code. ; OF NEW N C r �P� «uAM 06 4 J Ti uJ Countersig o 1 �g� 0 45 ,/ R.A. , ��(DP-E. '.' ; P Address Telephone /t ^l Very truly yours, i gned`�... FA2�6 ::Z - a, Owner of Property Address _ Town Telephone LAURENT ENGINEERING ASSOCIATES, PC. 73 FAIRFIELD DRIVE ?ATTERSON, NEW YORK 125133 (914) 278.6108 -(FAX) 278.2658 HARROY W. CHO S JR.,, PE. CONSULTING SITE ENGINEERS October 18, 1991 Putnam County Health Department 110 Old Route Six Center Carmel, NY 10512 Atta Robert Morris RE: Proposed S5DS Adrian Road Patterson, N.Y. Dear Bobo In response to your review letter of October 9, 1991, we offer the following: le Lot area and design flow have been added to the construction permit. Subdivision name and subdivision lot numbers do not apply. Please destroy the old construction permit and replace, it with the enclosed one. 20 One foot of R.O.B. fill had been indicated on the plan and volume and fill specifications are now shown. 3. Existing and proposed wells and SSDS °s have been 4e Equal distribution and laterals of equal length have been provid.edo Distribution box detail has been shown on the plan. Enclo "sed are four (4) prints of the following: SS -1' "Proposed SSDS' °, revised 10 -13 -910 And one (1) copy of the following: "Construction Permit for Sewage Disposal System", dated 9 -25 -910 Kindly review the enclosed items and contact us with your comments and /or approvals. Very truly yours, LAURENT ENGINEERIN ASSOCIATES, P.C. Randolph W. L urent, P.E. `"�'`�'''•�-- •° �..''�a RWL :bd Nv i'f.l.l,_, 91030 encs o cc: E. Gracia JOHN N. CALBO Building Inspector i / V TOWN OF PATTERSON PUTNAM COUNTY BBB —ssis PATTERSON. NEW YORK 12563 Laurent Engineering Associates, P.C. 73 Fairfield Drive Patterson, New York 12563 RE: Edward Gracia Slater Road Patterson, New York October 21, 1991 Dear Mr. Laurent, As per our conversation relating to the above mentioned property, according to Patterson Town Code, Mr. Gracia's property is considered to be a buildable lot with the stipulation that it receive Department of Health approval. -•- If I.may be of further assistance, please do not Hesitate to contact my ofgice: Sincerely, J N. albo lding Inspector JNC /cs .......... .... . . L. AUR .EN,T- .ENG1- N- EER- I- NG.._.... ASSOCIATES, PC. 73 FAIRFIELD DRIVE PATTERSON. NEW YORK 12563 914.278.6108 . ?� \ CONSULTING SITE ENGINEERS Date: 10 -21 -91 To: Putnam County Health Dept. Job No.: 91030 Project: 110 Old Route Six Center Proposed SSDS Carmel, NY 10512 Adrian Road Attention: �-- p�TO Patterson, NY Gentlemen: We enclose ( copies of: O B/W Prints O Reproducibles O Reports O Tracings O Specifications O Memorandum 0 Copy of Letter ❑ Description: Revision/Dote No. Letter from Patterson Building Inspector 10 -21 -91 Per your request. Sent Via: KI Our Messenger O Your Messenger Copy to: • Blueprinter • Nand Delivery O First Class Moil O Special Delivery 0 Very truly yours. LAUR ENGINEERING ASSOCIATES, P.C. Per: Randolph W. aurent, P.E. LAURENT ENGINEERING ASSOCIATES, PC. 73 , FAIBEIE1_D DRIVE - ' PATTERSON, NEW YORK 12563 RANDOLPH W. LAURENT, PE. (914)278-6108-(FAX) 278.2658 HARRYW.NICHOLS,JR.,•PE. CONSULTING SITE ENGINEERS I LIST OF PROPERTY OWNERS ADJACENT TO EDWARD; GRACIA ADRIAN ROAD PATTERSOH, NEW YORK 59 -1 -4 Alex & Wanda Chewuk 45 Lakeport Drive Patterson, New York 2563 59 -2 -7' S. Imbimbo 59 -2 -8 40 Park Avenue, 11E New York, New York 10016 59 -6 -2 Hazel Martinez 59-6 -3 10 Slater Road 59 -6 -4 Patterson, New York 12563 - 59 -6 -15 James V. & Bonnie S. Daleo 57 Allen Road Brewster, New York 10509 59 -7-2 Fernanda Lorenzo RD3 Highland Drive Peekskill, New York 10566 59 -7 -3 G. Paul Habersang 626 Riverside Drive New York, New York 10031 59 -2 -4.4 Paul O. Habersang 626 Riverside Drive, Apt. L15 New York, New York 10031 V 429 56 58 /, 58 - --- -------- 0, ------- I % -- -- ----- - - - --- 46 fill ---- — ----- - - -------- - -- --------- --- -------- 7 ------- 45 ------------ 60 - ------------ ---- -- jo I 3, ------------ --------- - - - -------- VII - ------------- ---------- 44 - --- -i 429 :1 44 --- o . I FOR TUX PURPOSES ONLY REVISIONS sFm-L osmx-r mFoZ—To N—o`--r—' LEGEND kz . . . . . . . . . . PRELIMINARY TOWN OF PATTERSON coumry. N.Y. A T X 3 S !C' ---NT C� CF cr -N: SZS7-E�!S D7S 20 N1 & SU---CU--IFA - A D on c a-T-e-ENIS EYS 10 I PC - t j I' eS Pre-1969 N--j�bor norifica-LIO-11 Li tre.-)ch orovided 60 f: rc-) n. A6 X 10 Lam. I sill rot=s s 100 vr. _lord elev. 200 ft. resen,702.ri, etc. L_j 150 D C CL 2 -7 plans Three sats _mac; thcrizat c� I (D SU.-=7�:7. S TCN CJ s•; i — Coll c pes "t-s (1) Fi a=rc F01-2 ce Oth ca jo,asd pip-is Two se -s wall 1=- =r NTariaLpce Re=.L:e A-T Subdivis --oa Azorovai checkai 1 SsD.s Adi. Lotts Checked x-aporc,va w,atland (T-�,m/DEC P= R & D) Data On DDS PlaIs • Same � - u —I � �, D E 7� =I- -S 0 -N P! : --N' S Sawac:a S-11 -11 a1l, arrcw) -Lil- & D —47,-.=ns- 7 D or i Bck; Tr=---C�-!1Ga11 =rY; =-'g P' D Serv4ce 17 comer -Ine N 1= 0-* ;.Gr & & & Daeo =S nd e.,czar z: c:1 =vity zlvw,S-az�. C".Ze tz Ha.:'.se - INZo. Of- B--3-r,-cr-Ls Is & ss-LsIS -,;/in 200 0;: p- :JCS c,; & (Ti-q-11t.- lot) pe P-1 7 Fo-.-,se Sawer Ty, :-B - No 3ar-3s; Max. Ber-s .15" w/cleanou-, N" DT S:, ON P—T-.N F-i=—' ds j 10, -t-o P.L. Drivel a\7, jarq-a 'Imes, T:;: O-L --- 20, to Fouma-a-tion wahs 100, to Well; 2001 in D.L.O.D, 130' 100, to st-'rea-m, Waterco,--= Lake Unc. ex a, 15, F--\o---- n, pc 10 to Wat -r Line 50, SeStic 101, fr= tO Wall i.:,), well t. pr- 9 PUTNAM COUNTY (DEPARTMENT OF HEALTH (DIVISION OF ENVIRONMENTAL HEALTH SERVICES / FINAL SnT INSPECTION a' Date: �6 0 Inspected by: Owner_ _ . .. - GI 4 .- Town �,�1rT� �Sonl Permit # TM # 2- -, 6 ; Subdivision Lot # 1. Sewage System Area a. STS area located as per approved plans ..........:.......... b.. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped ............ ............................... d. Stone, brush, etc., greater than 15 from STS area.... e. 1 00' from water course / wetlands ............................:. II. Sewage System a. Septic tank size - 1,000 ...:....1,250 .. ....other......... b. ' Septic tank installed level .......... ............................... c. 10' minimum from foundation .... ............... ................. d. (Distribution Box 1. All outlets at same elevation -water tested........... 2. Protected below frost ........... ............................... .3... Nfmimurn 2 ft. Original soil between box & trenc] e. Junction Box properly set .... ............................... 6. Trenches 1. Length required 3 6 Length installed 3j 2. Distance to watercourse measured ..�- (o c-> Ft.......... 3. Installed according to plan ... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot........ 5. 10 ft. from property line - 20 ft.- foundations..... 6. Depth of trench <30 inches from surface ............. 7. Room allowed for expansion, 100 % .................... 8. Size of gravel 3/4 - 1'/2" diameter clean ............... 9. Depth of gravel in trench 12" minimum .......:....... �Fi e ends capped ................. ............................... 6 - Pum -o: IDose�� steans _ ... . . ize of pump chamber ......... ............................... 2. Ovedlow tank .......:............. ............................... 3. Alarm, visual/audio ........:.... ...........:................... 4. Pump easily accessible, manhole to grade........... 5. First box baffled .................. ............................... 6. Cycle witnessed by H.D.estimated flow /cycle..... IM 16louse/Buildlifig a. house located er approved plans ........... ... ......... b. Number of bedrooms ....................... ��...: -..... IV. Well Well located as per approved plans . ......:........................ b. Distance from STS area measured -'/ o° 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 pl f. Curtain drain outfall protected & dir.to exist waterc g. Footing drains discharge away from STS area......... h. Surface water protection adequate ........:.................. i. Erosion control provided ......... ............................... Rev. E/002 vi f► co Sheet. of�_ �t PUTNAM.:COUNTY DEPARTMENT OF HEALTH: DIVI$JON.OF,ENVJRONMFNTAX iIEATt NvcFRVICES .... ; �,.. , a... . FIELD ACTIVITY REPORT N AMF :i =� -7`- TPI- An )RF.CC: /� 7 Street Town- State y Zip �� ``�.y• PERSON IN CHARGE _ (1R TNT_FRVTF?WFn : l'7 4✓.f C Name and Title TYPE OF FACILITY: FINDINGS:Og�1� ..��1/St'��G7'J�iIJ' �.v+`r'i ��&A=T?—X ,1 e2'D ,r2 �22 _ - A5— R73ZV h;—)F L Y A 5" .Signature and Title RFPORT RFrF-TVFT) RV: I acknowledge receipt of thi's report: SIGNATURE: - 0.2/96 Rev. fi G35 T'ANKI STONE #,4,:L'. O v O j �A �11�R1 D� �4N 1 L . NOT. FUNCT'IONI� R.0 � - _ A -469 1 A. I I g� L I sss 1 A -467 I A- I I 654.4 I I f l 0._ 1 It TREI .H CTrf)\ \ -T� ��5, :1 -460 1 - {59 I�,. A �. A- i A -4 11' e. per_ \ I I '\ < .. 1 I 1 1°iCij,•, (yy-',, 1 I 155 I ss S oo0�•I I KL$pp�D 1 j, ; 1 UT L /TY I 1 ..� .650 . `..1 - 4t - G411p �.C' I 1 I- - -- / :! . ! ' -\ -. I __•- .._. !_ �� i': _ ,z�( :.d ®PAL VG -- - 1 - - .}_y..,. - \r -- -i- - -- — �T 1 rR i r W u =G71ni4•)rl I 1 . 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