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Home My WebLink About1330DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 25.77 -1 -17 BOX 12 ., 1! RZ f :: Wk J T ■ I ti ' 16 1 rI'I I I r6 I� I ' • 01330 } r . - DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLTCATTON TO - CONSTRUCT. A:.- WATER WELL _,..__...___...:._.. ._.._... . _.. . _ PCHD PERMIT # WELL LOCATION Street Address Tom /Village City Tax Grid Numbgr SZ z WELL OWNER Name Address Private !% %L.Eltif .JiJ� ,eJ+/ -r 2_,j L ,Civ 47 j-: 4 i Public VE OF WELL - primary 2 - secondary RESIDENTIAL RBUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY, ❑ AIR /COND /HEAT PUMP D ABANDONED D FARM 0 TEST /OBSERVATION D OTHER (specify, O INSTITUTIONAL ❑ STAND -BY, O AMOUNT OF USE YIELD SOUGHT ,3 gpm /# PEOPLE SERVED? ,5' /EST. OF DAILY USAGE(yJJ gal REASON FOR DRILLING )ANEW SUPPLY []PROVIDE ADDITIONAL SUPPLY DTEST /OBSERVATION ❑REPLACE EXISTING SUPPLY 0DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE [ffDRILLED DRIVEN ODUG ❑ GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES /'i NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name 1_57),2 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES 41 NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY - DISTANCE-- T0.- .PROPERTY- -F ROM- -NEARE -ST. .. WATER ... MAIN: _ .. _l _...._ _ _.... ___ _.._. _......... _._ LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION SEPARA E ST � P (date) C/ (si V ature) PERMIT TO CONSTRUCT A7 WATER WELL • ., This permit to construct one water well' as s . ,et 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 (3O).:days,of the completion of water well construction, the applicant shall: L 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. Date of Issue:— 19 55:�7 - �- Date of Expiration 19� ermit Issuing fficia Permit is Non - Transferrable PUTNAM COUNTY DEPARTMENT OF HEALTH ; \ Rev, 3/86 n'0 1)lvlslon of Envl;onmenta! Health S®;vlee®. Carmol, N.Y 10512- Engineer � Provide q on CERTYFI A 0 COMP SYSTEM -.. • Peenilt ,H CONSTRUCPIOPi,PE FOR $ GE DISPOSAL SY 7, ��W - 000 _viR�e_ f9�% Z Sabd.'Lot q Tax ' Map Bled{ �- rot Subdivision Blame Owner /Applicant Name A� ,dam ,iJf2Cd --� Renewal ❑. "R ®y1 ®lon ❑ Date of Previous Approval Mailing Address 7—'S 4A)rr.A4A7' %%%1, To" i'i®�7.�%� -i�� /��/ yip Bulldin j. Type /� i. Lot Area o `� 'JU � Fill Section Only Dopth volume Number of Bedrooms ` Design FIOw.G /P /D � P� Notification Is Re aired When Fill Is completed l �7 Separate Sewerage System .to. consist of / Gapoa Soptic Tank ®ad ✓J L� ✓� �� %/ To be constructed by �o /� '/� Address Water Supply: Pob1lc;Sapply'Feom ry r� Address oe: , Private Sapply.Drllled by Address Other;Regaleem ®ate, ..� ' . • I represent that I am wholly and;.completely' res'ponsiDle forfhe design antl location ot..the Droposed system(s); 1) that the separate sewage disposal system above described will be constructedas shown.on the approved amendent, there to and in accordance with the standards, rules an regu a ons o e . u nam County Department• of Health_ arid antl that on completion thereof a- . Certif icate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and wa.wr�tten guarantee - will be ' furnished the owner,•his successors, heirs or assigns'by, the builder, that sai&builder will place in g9od.'operatin9 condition any `pert of sa ;sewage disposal system during the period of. two (2) years immediately following tnedate of the, issu- i - ance of the approval of the Certificate, bf Construction .Compliance of the original system or any repai s thereto; 2) that the drilled well described above will.be locates as shoavn'on the approved.Dlan and tnat said well will be.inst 1 `;n 'accortlance with the s nda s, r s and regu actions of `the Putnam County Department of Health. - oats,'' 2+%�,�. Signed �(� — P.E. � /R� A, Address- /t' /�. 7 /� 42 - License No r -. . APPROVED FOR ,CONSTRUCTION This approval- expires;@ year from the' date issued unless construction of the building. has been undertaken and is revocable for cause or may be amended or modified When considered necessary by the Commissioner of Health. Any change or alteration of construction requires a new per it. Approved for disposal of domestic sanitary sevdsi�e,- anC7or_ pr' e w r supply only. i Da �` _ BY .le -- xisr- welt C, /y J ' .AGE. DISR05AJ . ON TH15 z'3 % ®MSPECTED BY C� O 5.04 /7-30 //E. 4 v Oi S'_I EX /S r /NG RASED RANCN LtV ,k �. _ � La v � ti i.. i za •,r.. �.,..a�.... a 1'. _u y �� ,.r,.� �a4ty �.� .1 `� T rK t, >S � Li✓ _ 3 �5, ..L_ y� Y t��'Y .5 C� �� s�^9�'�` 1.t 2 knyi /y J ' .AGE. DISR05AJ . ON TH15 z'3 % ®MSPECTED BY C� O 5.04 /7-30 //E. 4 v Oi S'_I AT cv- r e,4semelvr WESSTER PLAC E COURSE 11 0 /1 0 5 IC D c If 7' T IV S WEBS TER PACE %B /TUM/ 1 , /-z'gas OQ 'ji PP, CDE -3 F 50"L APP AB TE HOUC-- MOZIC-9 D. s F.; R 6j F,, T p PF -R OP 0 st-o 3 gglj Rz's a EIV ce c3l ez ?0. 0 ip,9 a SOO WOO 6A Se AT cv- r e,4semelvr WESSTER PLAC E COURSE 11 0 /1 0 5 IC D c If 7' T IV S WEBS TER PACE %B /TUM/ 1 , /-z'gas OQ 'ji PP, CDE -3 F 50"L APP AB TE HOUC-- MOZIC-9 D. s F.; R 6j F,, T p PF -R OP 0 st-o 3 gglj Rz's a EIV ce ez ?0. 0 ip,9 a SOO WOO 6A Se AT cv- r e,4semelvr WESSTER PLAC E COURSE 11 0 /1 0 5 IC D c If 7' T IV S WEBS TER PACE %B /TUM/ 1 , /-z'gas OQ 'ji PP, CDE -3 F 50"L APP AB TE HOUC-- MOZIC-9 D. s F.; R 6j F,, T p PF ?. N o�gN is 60 L. Z NI a �Z 17 7 l4 Z 71�19-lc::L '1 -A�-B rn N 7 l(1 m m m HI I T 4 0 W Q �a��oaew�ron� cr ^ �' LL (t� 00�o °z W oo fZ oo � LL �W �tj s o� o� �po pp Hd35C P'.q s w r J d .� i � set '' w & 1 CERTIFICATE OF LABORATORY ANALYSIS LAB ID NUMBER: CLIENT: SAMPLING LOCATION: COLLECTED BY: DATE COLLECTED: DATE RECEIVED: DATE OF REPORT: 96 -4209 J V Construction Inc. Hose: Webster Place Jerry 07/08/96 -07/08/96 07/10/96 TIME COLLECTED: 9:35 AM ANALYTE RESULT* UNITS MAX CNTMT LEVEL ** METHOD ANALYZED Total Coliform Absent Must be "Absent" SM18(9223) 07/08/96 E. Coli Absent Must be "Absent" SM18(9223) 07/08/96 This sample, as submitted to the laboratory, and as compared to the New York State limits for drinking water quality for the tests performed, was: - V ACCEPTABLE. _ NOT ACCEPTABLE. NYS ELAP #11218 Maryann Fasano, Assistant Laboratory Director CT Lab Approval #PH -0171 * Underlined results are unacceptable according to health department and /or US EPA codes. ** Maximum Contaminant Level (maximum permissible concentration allowed by health department and /or US EPA codes). 618 Clock Tower Commons, Brewster, NY 10509 -9241 / 914- 278 -7600 / Fax 914 - 278 -7754 / E -mail: NoAmLabs ®aol.com a WELL Cviir LL611V1Y iNx-r v>Zi Office Use Only C1. * DEPARTMENT OF HEALTH Di.vi• Sion "Of "Fnvirortmenta -1,-Hea1•th•- Services.. .IV. Y�4 PUTNAM COUNTY DEPARTMENT OF HEALTH _ �--- "'� SIREEr ADDRESS: wNlVl TAX GRID UA18ER: WELL LOCATION .} ;' �— Ive— ! . ,- f C �ar Yl WELL OWNER NAME: ADDRESS: , vs cons_" ltctoyl PgIVATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIRICONDJHEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT S — gpm. /N0. PEOPLE SERVED / E-ST. OF DAILY USAGE gal. REASON FOR DRILLING PLACE EXISTIN(, SUPPLY QTEST /OBSERVATION [ADDITIONAL SUPPLY UNEW.SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH ft. I STATIC WATER LEVEL _� it. DATE MEASURED DRILLING EQUIPMENT ❑ ROTARY YCOMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION O OTHER (specify): WELL TYPE ..// ® ❑ SCREENED O OPEN END CASING OPEN HOLE IN.BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH __�_ _ ft. MATERIALS: STEEL ❑PLASTIC ❑ OTHER LENGTH BELOW GRADE ft. JOINTS: C] WELDED THREADED ❑ OTHER DIAMETER __ 7 _ in. SEAL. ❑ CEMENT GROUT ❑ BENTONITE 46TH R WEIGHT PER FOOT I_.Z__ lb.31t. DRIVE SHOE: YES ❑ NO I LINER: n YES AD SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (11) DEPTH TO SCREEN (ft) DEVELOPED7 FIRST _ O YES O NO SECOND r HOURS GRAVEL PACK O YES O NO GRAVEL SIZE: DIAMETER OF PACK (n. TOP DEPTH it. BOTTOM OEM It.. . WELL YIELD TEST If detailed pumping' 9 P P M CH00: O PUMPED tests were done IS in OMPRESSED AIR , ! ormation attached? BAILED O OTHER ) ❑ YES ❑ NO WELL LOG it more detailed formation descriptions or sieve analyses are available, please attach. oEPrN FROM SURFACE. yv, +rr gear- my well Dia- meter In fDRMAT+DN DESCRIPTION coal It it WELL DEPTH I I. OURATIO14 hr. min. DRAVIOOWN It. YIELD 9Cm llure Suruce d q 'f T1711P 7r-1: WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? DYES ONO ANALYSIS ATTACHED? OYES ONO STORAGE TANK: TYPE,,22). 4A, JA CAPACITY GA) . CQ w PUMP FORMATION j� TYPE 14 CAPACITYP�� MAKER 9 DEPTH ll �•�'' MODEL VOLTAGES r HP A WELL DRILLER NAME DATE �RT M. HYATT & SONS, INC. Well Drilling SIGNATURE Rte. 611 R, R. 2 Box 171A pATTF2:�Ot,1_. NEW YORK 12563 3 /Uy _ COUNTY DE--OP-FM/IFN-L `OF HF.�M-H D.I. amen or Purchaser ot,/Buildi-ng S-ettion. Block Building Constructed - by ID LID Lc>catron Street. Subdivision tyre 16.ird c i.pa-1 i ty Subdivision Lot- Buildi-ng CJJ�TI ",\rTZE 0 S- U L--,: F. DISMI----;�rT SYST—EM J. reoresent that 1 an wholly and co.moletely responsible for the 1cc—'ation, I hip, z-ate—rial, construction ajid drainage of the sewage disposal -sposal. sys-*-c--.-,, serving the above 011esc-rLbed propext , a-r.-d. that it has -be�-ri constx-Lcted as -shcr.,-n on y the aoDro•ed -olaft or approved thereto,-. a-nd-.'in accordance with stp-n(:!ards, rules and regulations o-f Uie:Putna'71 County C--par-trpant of Eea3-'c-h,, C. --jite e a, -o a in Cj(D;-� gaaaxa -- 'L. 0 U . ne-r,. his successors, heirs or assigns,. .'L. place operating condition* any part of said system, constructed by me which fails oDarat - e for a -pericd of two years ir-reliately fol.3-owing the date of approval - of -k*.. !i e "Cer'i"ica-te o' Construp'-ion. C07-,Ioliapc�" for th(�� 5ewag OT: rep?d-rs -mece by to such SYS'Le-n, eXCED-t where the failure to operate cause-': by t",,e will- or negligent ac-*L-- of: the ccciipa-nt- o)'- the bui-ldi.ng the S11's, I. The unders,;-gned .further agrees to a'ccept as conclusive the 'die D;_rc-ctor c-"' the Division of arivizoa:-,c-nt-aJ- S-ervlce-s of the Putna.:-,) Depar&,ent- of' EealLh as to w-Clethex or not. the failure of the syste-11 to oC>aI7C,.Le caused by 'Uic -,;i3-lj:"Li1 or nealicen'C- act of the occupant, of the building utili.:- the Sys tc-:-,i. Dated this d'a Y Of /Y 1.9 Ge�nex-,2.1 Co!�Lrac-Lo)- Sioratura (j 'F Corti Ad(Ub-e.ss Sic;n�atur(�,� Title J cor-coraLl�on (lit T ox e- s S 1 IN ID CERTINCATB 0 C NSTRIICTIOMCOMPLIANCE I?OS S�wAb�- ut,rus�.,isx�rmx we - , J own or Vnlag 1 Located at (rv-c, l 4 Tag .c.- -7,A Block , Lot _r_( A_ Ca �� or®®rl Sdbdivi ®Ion Plam® ubdv. Lot q / Ownee %appucastt lvame Y' 6x a orcoa, A�� Ztp �. ] HDa4®1P ®milt easa� 9Co ,YleYllng Addreesi.: a.. „ �� g.. �' � � � paste erog System c L�i� �`l %, Addiwe a^anale ei Se ;sew tent bout D 0.0 irallbn Septic Tank and 3 3 ��. ®Voter. Supplyt PnbNe Supply From _ Address ort Plyate sapply. D re� rilled, by Add iv 1 a svca&� Bn114 Type Hae'Eioaion Controls Completet$Y t Nnlnbee of Beduoo�e H"e Gaibage Grinder Been In"ed? �ln � iegtt�menae - - I certify that the,systam(s) as listed serving the shove premises vitro oonat tad esaentially.as.shovn the. plans of'the completed wiorlc (copies of which are,atLacAedY, "and in accordanceraith the standards rules and re tions, in a cordance trip a f plan, and the permit issued by the Putnam' - County Depaitmeitof'Health. Pate /' Q " ""' Certified by P.E .R.A. Address Clean N se O: Any person, occupying ,premises served by_ tho above systems) shalh prompfly_`take wcA action 08 miy.be neceefa►y to e®eurm the correct on of -apy ,unsonitary conditions resulting from such usage Approval .of the ;soparate aawerage system shall become null and void me soon as a pubs,: sanitary sewer becomm Y evelleple,anb the- _approval of to ®sprivate water;supvly ahl'I bacoma null and'.voiA uvhen a,•public orator supply ®oeomss available. Such approvals are subl modif 4foe or eAange when;' in the ludgrn W'of the:Commisslonai of hange1 is eessory. C -. Titb � CLM .. . i PUTNAM COUNTYPEPARTUrn ®p HOUSE PLANS APPROVED FOR I BEDROOM LOPED: _WALL -... .. _! Signature &-.Tit t� 9F�__ o,'t: ,— 5-.3yZ. - - - � �� -3�-4 t,..� 44�_a• �IT9,= 4'DORMER `$ SERIES --- 2SX441232 ELn ti —_y c .TVA . -PHONE w3lo W24 - 824_ 42- 42' � L _ - ! - O T .... fit. , . p 00 p FAMILY RM -. -FM4ECLING ON KITCHEN N w e BAT14 '� BE�DRM 3 b _ O A N m , _ N O to 0. a _. n, ' 3 ORM. CLM .. . i PUTNAM COUNTYPEPARTUrn ®p HOUSE PLANS APPROVED FOR I BEDROOM LOPED: _WALL -... .. _! Signature &-.Tit t� 9F�__ o,'t: ,— 5-.3yZ. - - - HOME3' CORpORM10N ,AVIS P11. � �� -3�-4 t,..� 44�_a• �IT9,= 4'DORMER `$ SERIES --- 2SX441232 ELn ti FLOOR PLAN c jQ � T .... fit. , . 00 HOME3' CORpORM10N ,AVIS P11. AVlS MODULAR SYSTEM. CUS-'OM -SQ.FT ., `$ SERIES --- 2SX441232 ELn CAPE+ SHED DORM. FLOOR PLAN c jQ � -NOTr'-- CAPE-'5Ec-nct.tF-1t4isAv,rt---,- -8v ac F Nrtsr;� Avt�:*Hwtr, cbfipdfiAiiciwAms-,pk FSATWI) Injo IK I -T*.r ..: N -PHOE: CUST.0V*SF_RIES'.*._*. SQ.FT DWIt SHED DORMER MBEDRM. o 4-611• " cu F3 0 El lavoi -NOTr'-- CAPE-'5Ec-nct.tF-1t4isAv,rt---,- -8v ac F Nrtsr;� Avt�:*Hwtr, cbfipdfiAiiciwAms-,pk AVIS- MODULAR SYSTEM CUST.0V*SF_RIES'.*._*. SQ.FT DWIt SHED DORMER IF-LOOPPLAN April 17, 1987 Putnam County Department of Health 110 Old Route 6 Center Carmel, N.Y. 10512 Att: John Karell, Jr., P.E. Re: Proposed SSDS -Lot No. 2 Webster Place Patterson NY 12563 Dear Mr. Karell: Enclosed are the following: 1. 2. 3. 4. 5. Three (3) prints of Drawing S -3 Lot 2" dated 3- 23 -87; r F11/ R(� >:RMC E r) '87 APP 20 P3:19 "Proposed SSDS "Construction Permit for Sewage Disposal System" dated 3- 20 -87.; "Application to Construct a Water Well" dated 3- 20 -87; "Design Data Sheet" Three (3) prints of "Property Survey ", dated 3 -3 -87; 6. "Letter of Authorization ", dated 3- 20 -87; 7. Two (2) copies of Residence Floor Plan (s), for "Bedroom Count Only ". We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Sincerely, LAURENT ENGINEERING ASSOCIATES, P.C. Har yW.7chols, Jr., P.E. /map CC: Mr. Andrew Jurgens w/ one copy each LAURENT ENGINEERING ASSOCIATES, P.C. - - 73`FAIRFIELD-DRIVE —q. PATTERSON, NEW YORK 12563 ' 914.278.6108 RANDOLPH W. LAURENT, P. E. HARRY W. NICHOLS JR.. PE. ' CONSULTING SITE ENGINEERS April 17, 1987 Putnam County Department of Health 110 Old Route 6 Center Carmel, N.Y. 10512 Att: John Karell, Jr., P.E. Re: Proposed SSDS -Lot No. 2 Webster Place Patterson NY 12563 Dear Mr. Karell: Enclosed are the following: 1. 2. 3. 4. 5. Three (3) prints of Drawing S -3 Lot 2" dated 3- 23 -87; r F11/ R(� >:RMC E r) '87 APP 20 P3:19 "Proposed SSDS "Construction Permit for Sewage Disposal System" dated 3- 20 -87.; "Application to Construct a Water Well" dated 3- 20 -87; "Design Data Sheet" Three (3) prints of "Property Survey ", dated 3 -3 -87; 6. "Letter of Authorization ", dated 3- 20 -87; 7. Two (2) copies of Residence Floor Plan (s), for "Bedroom Count Only ". We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Sincerely, LAURENT ENGINEERING ASSOCIATES, P.C. Har yW.7chols, Jr., P.E. /map CC: Mr. Andrew Jurgens w/ one copy each APPENDIX B O'I'i M COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIROMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT ( of Owner) (Street Location) DOCINENTS DATE IEWED : b 0 BY: W. Mj� - 6-'b is)a Permit Application D' 1,h"G Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results` Perc Hole Depth s/s h /4�7 ,6 +6'01 SUBDIVISION Perc (3) Fill cd House Puns - Two sets Well ! permit; PWS letter Variance Request GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pmp'.pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data: perc and deep results Two -Foot Contours Existing & Proposed. Driveway & Slopes Cut Footing /Gutter,Curtain Drains*(discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If Pmped Pit & D Box Shown & Detailed House - No. of Bedroans Wells &-SSDS's w /in 200 ft. of Proposed Systems Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees,Top of fil: 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake Unc. expan' 15' to Drains - Curtain, Leader, Footing 351to catch basin,stormdrain,piped watercours+ 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' from.Foundation; 50' to well 15' Well to PL - nIPM COUNTY DEPARnMa OF HFAIJ,. DIVISION OF ENVIRCRMCAL HEALTH SERVICES DESIGN DATA SHEET- SUS5UFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner SuR 4�/ /rs• Address Located at (Street) Sec. Lef Block I' Lot !j lSo /,Q -�s'zc (indicate nearest cross street) � C�� municipality % ilig r ENV1 r!o -1FNs'T.A!_ NE ^:! TH SOIL PERCOLATION TEST DATA RDQ(IERED' -TO 1BE' SUBMI,= WITH APPLICATIONS Date of Pre - Soaking / Z.. - /IS - Q g� '$7 D y� 4 ation Test / 2 - /T" 96 HOLE NLksm CT-= TIME PERCOLATION PERCOLATION Elapse No. Time Start -Stop Min. Depth to Water Fran Ground Surface Start Stop Inches Inches Water Level In Inches Drop In Inches Soil Rate Min/In Drop A 2 3 /. ys� z: IZ : z 2y 0;7 3 4 4 5 4 5 l 2 3 4 .5 NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2. Depth measurements to.be made from top of hole.. 9 /RS DEPTH G.L. o -G 2° 3° o 4° 5° 6° 7° TEST PIT( I'A REQUIRED To BE SUBMITTED W1 APPLICATION HOLES HOLE NO. / HOLE NO. ? i 9° /Cfy.1�oG/ 10° 110 ...._ 12° 13° 14° //a R a c% INDICATE- LEVEL AT WHICH GROUNDWATER IS ENMUNTERED INDICATE LEVEL TO WHICH WATER LEVEL. RISES AFTER BEING ENC=rERED Al DEEP HOLE OBSERVATIONS MADE BY-. DATE: DESIGN Soil Rate Used Min /16' Drop: S.D. Usable Area Provided No. of Bedroans Septic Tank Capacity gals. Type Absotption Area Provided By L.F. x 24°' width trench Other Name 4461A ,WT ,GNc,. / 1vFERi1✓c, ,9-0o T� J .Signature . y Address V,6- SEAL = I lL TfIIS SPACE FOR USE BY HEALTH DEPARD ONLY: ,o �, 90FESS 10�v Soil Rate Approved sgoft /gal, Checked by Date VCS PUTNAM COUNTY DEPAR'IlMM OF HEALTH r DIVISION OF HEALTH SERVICES W A LL DESIGN DATA .SHEST- SUBSUFACE_ SEWAGE..DISPOSM,.. SYSTEM FILE NQ: Owner ANN Cw 1UR 6f,-OS Address Located at (Street) WC- 6S?I12 f G 9, WA?:E-L 1) Sec. Block Lot (indicate nearest cross street) Municipality ftc-gsoo ; Watershed •■ Date of Pre- Soaking TON TEST DATA RDQUI TO BE APPLICATIONS Date of Percolation Test 7, SOLE a411 3" 3.0 NU-SER CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level- 3 X5,3 No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches cc 1 7th_ /foi` U M" �. " !, 3 r, a 2 90s --- 9 `' Cow a41, - }I" 3" a 0 3 9`a- Ic' 770 4. 5 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to'be submitted for review. 2. Depth measurements to be made from top of hole. rev. 9/85 a411 3" 3.0 2 35 3 � 5� l0 6 6,�,�� "A o a3 3 X5,3 4 10 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to'be submitted for review. 2. Depth measurements to be made from top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH' _ --HO E NO. HOLE -N0. -- -BOLE NO. G.L. 1' 2' 3' 4' 5' 6° 7° 8' 9' 10° 11' 12' 13' 14' INDICATE LEVEL, AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used Min /1" Drop: S.D. Usable Area Provided No. of Bedroans Septic Tank Capacity gals. Type Absorption Area Provided By L.F. x 24" width trench Other Name Signature Address SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date SEWAGE DII/is lyre �� Lot Area ' �� 1 [F;IMlBeetles �Onl b Dept valaoe Nuuiir a[ Beiee�e t DWV Flow G P D a PCSD �atl oa k Required Whs FM k aongiMlod st�.aa. s wmv syaem to abet d 1� Q d .rklim Sep* Ts di Wasr Sa>*l. Yiie Sep* Fray Aditrime MIN V wt... SEPA Did o11Me•e•d 1 represent'-that 1 am wholly and Completely raspons" fort" ddtgn and k►eation of the Proposed. sy51em(s)1 l) that the Mraot* saw di al s slam above Ancribad will broonstructed as shown on,theapproved amendment hiri. to and in accordance with the standards, rules an rpu nfa7io s o► i County Department of M N I.% and that o ,iovnpletioin thereof a "Certificate, of Construction Compliance" satisfactory to the Commissioner of Mwlthwill be submitted to the a".artmernt, and a written guarantee will be furnished the owner, his succsmor% heirs or assigns by the buckler, that said builder will place in good ,oMallaog condition any pat of said sewage' disposal .system during the period of two (2) years Immediately following thedate Of the INNU- ens of the appovel -of tee.Certifkate.of Cons fuction Compile. of the original. systam of any repair tM►etol2I that the drilled well desolbW above will be limated as shown on the approved plan and that said well will Oa inst l in accordance with the st r s and rigu�Ta MS of the Putnam County papartirant, of Hoa)th. Date Gi 5 nod 11 Address ' I v WZQ t. M M No APPROVED FOR CONSTRUCTION: This approval erplet two yaws from the date -issued unless construction of the building has been undertaken and is j'pcable for cause or may tw an- aflded or modifled when considered nocessary by the. ommissioner of. Hut th. Any change or alteration of construction re luires. eve permit Approved for disposal of domestic son ttary s p, ppyronly. Rev. ;k 088 Oats —'rte J a . Title v sa 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 #�! WELL LOCAT %ON t ee Ad �o . t� ss W o Village City Ta Gri Nu ber y. - - WELL OWNER ame T Mailg Address JaPrivate O Public USE OF WELL 1 - primary - secondary `RESIDENTIAL ® BUSINESS ® INDUSTRIAL r O PUBLIC SUPPLY ®AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION t3 INSTITUTIONAL O STAND -BY ®ABAND014ED O OTHER (specify fo AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED ,?�"6 /EST. OF DAILY USAGE &p0 O Bal O REPLACE EXISTING SUPPLY O TEST /OBSERVATION 13 ADDITIONAL SUPPLY JJNEW SUPPLY NEW DWELLING D DEEPEN EXISTING WELL Alea J i REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED ® DRIVEN ®DUG ® GRAVEL O OTHER IS WELL SITE SUBJECT TO FLOODING? YES iC NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: N/A Lot No WATER WELL CONTRACTOR: Name JOP Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO.PROPERTY FROM NEAREST WATER MAIN:. LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED MON SEPARATE SHEET (date) Tgnatu e 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 nQt to degrade or otherwise contaminate surface or groundwater. Date of Issue: 2- S 19 47 gr �° Date of Expiration 19 % $ Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller RANDOLPH W. LAURENT, P.E. HARRY W. NICHOLS JR., P.E. April 19, 1996 Mr. William Hedges Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: SSDS & Well Renewal Webster Place Patterson, N.Y. Dear Bill: LAURENT ENGINEERING ASSOCIATES, P.C. `'MIL- LBROORE OFFICE'CENTRE Route 22 & Milltown Road Brewster, New York 10509 (914)278 - 6108'- (FAX) 278 -2658 CONSULTING SITE ENGINEERS With regard to the aforementioned project, enclosed are the following: a) Drawing SS -2 "Proposed SSDS ", dated 4- 12 -96. (4 prints) b) "Application For Approval of Plans For a Wastewater Disposal System ", dated 4- 19 -96. C) "Construction Permit ", dated 4- 19 -96. d) "Application to Construct a Water Well ", dated 4- 19 -96. e) "Letter of Authorization ", dated 4- 19 -96. 0 Copies of Construction Permit and Well Permit dated 4- 13 -95. Please review the enclosures and issue a renewal at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. u� ' n - Harry W. Nichols, Jr., P.E. HWN:TR:bd 95010 RmgAM coutm DEPAMMaN ' 011,. x.t}:AL'Ili DIVISION OF ENVIRONM grAL HEALTH SERVICES ...... -DESIGN_ DATA. SHEET- SUBSUFACE SEKWE DISPOSAL SYSTEM � FILE NO. Address ZfvS J - /ey�/�� Located at (Street) Ia /�o� ✓%rz, Sec. 4 7 Block Lot 47 (indicate nearest cross street) Municipality S r7��. -s Watershed SOIL PERCOLATION TEST DATA REOUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking Date of Percolation Test HOLE NUMBER CLOCK TIME PERCOLATION PERCDLATION Run -Elapse. Depth to Water From Water Level No. Time Ground.Surface In Inches Soil Rate Start -Stop Mina Start. Stop Drop In Min /In Drop Inches Inches Inches NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2. Depth measurements to be made from top of hole. rev. 9/85 . . ... , - - --------- DESCRIPTION OF SOBS rMO(JN`I7-'P!-F'- IN MST 110117S DEPTH HOLE NO. HOLE NO. HOLE NO. G. L. 20 31 4' 51 6' 02 .71 go 10, 12' 131 141 INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE . LEVEL .TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY:-S/7." DATE: -�-1411r- DESIGN Soil Rate Used 7.. "Min/111 Drop.- S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity gals. Type Absorption.Area Prbvided By 'L.F. x 2411 width trench Other lle:: A7a,0-, Name m! fini, Address ruc. 2"". 4-,� Y.A. Croton kl4s, N.Y. IQY151 Signature THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soill Rate Approved sq.ft/gal. SEAL Checked by Date 0 APPLICATION FOR APPROVAL OF. PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant:. . Tr.' V, <ru��ic�� Az 2. Name of Project: '7 �c�� S:�DS _ 3.._._location'aV /C: Project Engineer: y /lL'_ r) % ? '5. Address: Millbrooke Office Centr 4. Arr � ,r:l,3 -w. Brewster,, NY 10`509 License .number: Phone: '(914) 278 -6103' 6. TyDe of Project: ' 'u Private /Residential Food.Ser.vice Cornercial , T_ Apartments Institutional Hobile Nome Park Office Building... Realty. Subdivision' Other (specify) 7. Is this project subject -to State Environmental Quality Review (SEQR)? Tyoe Status (Check One) Type T.., .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. dame of Lead Agency •hs this- project --inen--a-re -a under•'the control -of - local-planning;- z-on irrg, or other officia1s, ordinances? ......................................... A/v f2. If So, have plans been . sub -mitted to.such,aut,horAties? 13,. Has .prel in. inary approval -been `granted by such authorities? � Date Granted: --! ►•:. Type of Sewage Disposal: Systeri Discharge...... • Surface Water /k' Ground Waters 15. If surface water discharge, what is the stream class designation ?........ i �i Waters index number (surface) .......... ................................... �. Is project located near a pubis water supply system ? .................... /n °• If yes, name of water supply �A /L/,� Distance to water supply -- 4. Is project site near a public sewage collection or disposal system ?..... A/o 0. Name of sewage system Distance'to sewage system S• Date observed: 23. Name of Health Inspector: Project design flow (gallons per day) ..................... - 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?:.�11� 26. Has SPDES Application' been submitted to local DEC Office? ................. 27. Is any portion of this project located within a designated Town or State wetland ?... ....... 1Zr2 28. Wetland ID Number. ....................... ............................... /,/4 29. -is Wetland Permit required? .. ........ ............................... . Has application been made to Town or Local DEC Office ?. .................. V S 30. Does:project require a DEC Stream Disturbance Permit? r( /o 31. Is or was project site used for agricultural activity involyin.g application OT pesticide$ 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;O0O - 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? .......,.... lib 3.4 Are cormunity Hater, sewer facilities planned to be developed within 15 years? 1ko 35. Are any" sewage. disposal areas in excess of 15- slope? ..................:.. 36. Tax:Hap ID Number ....................... ............................... 2S•7� 'i� 37 Approved Plans are' to'•ba returned to: . .................. Applicant )V Engineer r._ 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 ary submission. .i hereby affirm, under penalty of perjury;• that information provided on this form. is true to the best of my knowledge and be fief. Fa Ise state,,7e'nts made herein are punishable as a Class A Hisderreanor pursuant to Section 210.45 of the Pena 1 Law. ;1GNATURES & OFFICIAL TITLES: t MillbrO0 Office Centre AILING ADDRESS: Brewster, NY 10509 PUTNAM COUNTY DEPARTMENT OF HEALTH, DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date kf °/ % ,("I' Re: Property of �% �c7r�fi�rycTf�h ZGrc _ Locdted at�.hs y�ti /�cr� .Z$. 77 l7 (T) j o��e� soy, Section ?S,7g Block .1 Lot JJ' Subdivision of Subdv. Lot # Filed Map # Gentlemen: Date This letter is to authorize r. ry-Ky a duly licensed -professional engineer k or registered architect ( Indi c a ee to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the-standards, rules or regulations as, promulagated by the Commissioner of the Putnam County Department of Health,. and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, tb& Public Health Law, and the Putnam County Sani- tary Code. J'��•N�,��! Very truly yours, �r. s Signed `G N 5612 fir% Owner of Propert , Countersigned: OFFSSIVA � /� _ P E , R . A . , #_ 56 /Z y •� , l/. �r�c, c Jruc TiDh c - Address. Address Town RA Telephone Telephone 1AA °:ai ° 165V RM&Oar to Frvddq Pewit. \ . •m CE27UWATE OF COIRUANCE N MUM 1102 SEWAGE Ddi;W , "EM a. P -87 Feeagad r _ Cct a wm at VMV � Manila, -F a Tea A� � Blodt Lot y / T�t V� S �� 1 -F`+ 1 �ewel_:� Bevbka p '�-d r Q o L► h a T7 / f� Deb of Frevioaa Approved -7 - Z-3 - Q 7 �.o. cr M-11118 Addnw ��(J� BOX :4--fQ flnf-o Cirlidivicinn Annrnved Fee Enclosed[] Amr„i„f- TAN ell (' ��., x« L W Area Of s 9 FAD seams O* LJ . D-P& Vabaee tvMdW at I Deelp Flow G F D 6e a6 1 FcHEI- tvtSikaaess Is E•aeitrea when Fm a cosiqiWod sepor oe saga sy.as t. ea..let sic °DU Gedigm Taiok .od_3 3� <LY-: A sE f1 u, 1 P"' CA To be ownhociad by '7" Q Address. Wataa fib: PA& Sltpply Fns Address Upply DdW by _— Addre @l Otiw I represent'-that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage dis Paul t stem above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a regulations o nom County .OdpOrtment Of Health, and that on Completion thereof a " Certificato of Construction Compliance" satisfactory to the Commissioner of H•althwill be aHbrAItted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the bulkier, that aid builder will plec• In good operating condition any part of aid sawage disposal system during the period of two (2) years Immediately following Mediate of tho issu- ance of to approval of to Certificate of Construction Compliance of the original system or any repak hereto; 2) that the drilled well described aboiro wile be located as shown On the approved plan and that old well will be instal in accordance with the st r bs and regu aeons Of the Putnam County Department of Haelth. Date - - Signed P.E. RA. Addres i`'tilbrn� �4'c CAP Gam' "LL) —License No APPROVED FOR CONSTRUCTION -This approval expires two years from the data issued unless construction of tho building his been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change, or alteration of Construction requires permit. Approved for disnosat- of-domestic sanitary sewage, and /or prI to wator_wpply only. Rev._ 1��88 Dato e-r /� ' / S By r"�'' ! - 1`Title -._.J DEPARTMENT,OF HEALTH Division of Environmental Health Services ,4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO-CONSTRUCT A WATER WELL p PCHD PERMIT # (-" 41' WELL LOCATION Stree dyes o Village City Tax Grid N r R �y �-S`,� _ - Pit ki _ i S-O WELL OWNER e //<�o,�' C o ai ing� Address Private / G D a: c Public ,USE OF WELL 0J - primary 2- secondary Q-R IDENTIAL O BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY ❑ AIR /COND /HEAT P 0 ABANDONED O FARM O TEST /OBSERVATION ❑ OTHER (specify O INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT 57 gpm /# 13 REPLACE EXISTING SUPPLY NEW SUPPLY _ NEW_ DWELLING PEOPLE SERVED_ _ /EST. OF DAILY USAGE &00 gal O TEST /OBSERVATION ' 13 ADDITIONAL SUPPLY O DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE %DRILLED ODRIVEN QDUG 13 GRAVEL 0OTHER IS WELL SITE SUBJECT TO FLOODING ?. YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: p Lot No. WATER WELL CONTRACTOR: Name T O D 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 MON SEPARATE SHEET (date) (q' 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 thirt3• (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 ? :y i� /�9 % 5i t •• _.._._..._ Date of Expiration,;' /� fj 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller • 1 . lNAM 'OOUNV- DEPARTMENT OF HFAII, DIVISION OF EWIRORMUAL HEALTH SERVICES T -.. _ DESIGN DATA •SHEET-SEMS UFACG- SEW/AGJE�gDISPOSAL SYSTEM FILE NO. �� cvyCa�S�N` �V• IGwST66a• i�,UIsGX�f�{% Pal�w -�oti� Owner �� /li /� iii/ TuR " _ / Address 0 r Located at (Street) W,,E5 Ss-r lz PL. Sec. Block I,otl((fig�g�1:�5 , (indicate nearest .cros ) s street Municipality - �� % %�I� S �� Watershed CRS 7'6A1 r SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITM WITH APPLICATIONS - Date of Pre - Soaking Date of Percolation Test / 2 - /S- 8(� HOLE 4 NtMBER C LCK TIME PEROQI mw PERCOLATION - Run Elapse Depth to Water'.From Water Level No. Time Ground Surface In Inches Soil Rate Z Start -Stop Min. Start Stop Drop In Min/In Drop Inches Inches Inches 3 Z- 9 5 5 - NU -VES: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to'be submitted fot review. 2. Depth measurements.to.be made from top of hole. rev. 9/85 2 _ 3 4 5 - NU -VES: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to'be submitted fot review. 2. Depth measurements.to.be made from top of hole. rev. 9/85 DE�:PTH � v 2'. 3' 4` 5' 7' m 10! n TEST PIT REIDUD= TO -BE SUBMITTED W1 .PPLYcATION " DESQULMON OF SOILS IN TEST HOLES HOLE NO. / HOLE NO. Z HOLE 00. AloTT�&IA1> 4i =S„ J�oG 13° INDrCATE LEVEL AT-WHICH GROUNDER IS ENCOUNTERED INDICATE'LEVEL TQ WHICH WATER LEVEL RISES AFTER. BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY :. DATE: .DESIGN _ Soil Rate Used !g- ID Min /1" Drop: - S.D. Usable Area Provided No. ."of Bedrooms Septic Tank Capacity gaffs, Type = Absbtption Area Provided By L. F. x 24'° width trench Other. Nate GAlJ1L wit/` - �r/C,. / /�/`�pli / ✓c /�l�vc _ 1 .0 � i?c, •Signature • Address - % 3 /� /,�� /�G/Z D%Z V,� SEAL s T ' W ii/�,/, -I ZSG 3 1 �' '1711S SPACE FOR USE BY \OFESSIO�P Soil Rate Approved sq.ft /gal. Checked by Date r if PUTNA111 COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIROT-01ENTAL HEALTH SERVICES Y Date Re: -Property of Located at VS. 7r 17 63 (T) Section -±Lzrt--Block Lot P-4 P191ersom Subdivision of Subdy. Lo Filed �faD Date Gentlemen: This letter is to authorize- 17-I-?,,l 1X- A,',: ..a duly license¢ professional engineer - X or reg-istered archite6t (Indicate) to- apply for a Construction Permit for a separate •seiqage system, to serve the above noted property in accordance i -iit-h the standards., rules, or* r e gula*t Lon s. a s promul a ga t ed by the Commissioner of the Putnam County 1:1 necessary papers on 'my' :behalf.. j* T5" 0* f Health', 'and to S3.94 department connection i-iith this matter and to supervise the construction of said system or systems in conformity i4ith the provision. of Article 147, Education Lair, the.'Publ"ic Health Lai - *,; and the Putnam County Sani- tary Code. 9E Ntl . NIC) tr C-j Cc C-) Countersigned. . . OFESSI P.E. , R.A. , -:M • e Millbrooke Office Centre Address Brewster, NY 10509 914-278-6108 Telephone Very truly yours, Signed AA h A Ow er-ofPro erly Address Town Telephone SUPERVISOR - -- Michael- Griffin z .. (914) 878 -6564 TOWN COUNSEL Curtiss, Leibell, & Shilling (914) 225 -5598 Fax 225 -5946 ROUTES 164 & 311 PATTERSON, NEW YORK 12563 TOWN BOARD w.__._...... ...._..,.._ Joseph Dirks=_. -- .._.... Ernest Kassay Raymond O'Neill John Owen Feb. 27, 1995 TOWN CLERK Rose Beers (914) 878— 6500 Fax (914) 878-6343 Mr. Jerry VanCougnett. P.O. Box 449 Patterson, NY 12563 Dear Mr. VanCoughnett: The proposed house, driveway, and septic on Lot 2 of your subdivision located between Watkins Place and Webster Place in the Putnam Lake area is not within Town regulated wetlands. This observation is based.on the plans dated 10/28/94 for the proposed SSDS. Si cerely, Ted ozlowski Environmental • PROP" _ O- F2 %II r — -4. is c r 1 t C s �4 cno Z4, Mr. K , � eax : TYP. I s FP Y V. P - SITE :_LOC�4TION. " *P-I - SCALE PROP.L RTY SHOWN ON TOWN OF t , Pw 2577 P/R 2578 =SS'DS :DESIGN .DATA nP�IGN FLOW. LR� ID � ;y 3 BEDROOMS' -4 ZOD:G P D X600 G P:D.`r S01L'RATEUSED 8:.10 Mm.- ' /" DROP: / YAPPLICATION RATE 9 G P D /Sir. I' SORPMQN :_?gg� �� f REQUtRED..T334.� , tPROVIDE� 33`4 y F " ;��ST PIt D•�SCRIP �IO�y` HDiE �x f a O �T0 0 6" rOPSO /L / r T27_yO SANDYL0.4IN. ±; H04AP: r O 6 7O 7 0 .SANDYS /LTrL ,; r O 6'".,3 >O .SA/VDY;,S /LTYLOA „ r `.9'O 719 s.ONDYio:4M , Hv4E�`ZA: OHO' 0;6 "•TOP.S'O /[.�m ': i n > s , -� :� �•+. S• If LE Ei.\'�F <. � - . , o a I r =: _ I .y �, : � 1 ,'.:� r PROPERTY LINE ,•1, .• ., ,. ... -... � :- 1> }� ^.:.�.. -. .. .. -,� .: '. -.: - AAA ' -•4r �: ;'x "; '�,' : 1 4��n.v. E>� iiP 1: HAZ L: ✓ ✓E:: r r = /_ x x y, m . ..«s x�?•ey� vt. � ..._�. ... • r :x5- ..�., -:::�: _ •.,. m.�i- `�,:rnsrann *nototm ntune r ^x: u1 5: ca J�... .?..i�. .. _ pit PR PR *: PE 1 -, ISED GRADE n 13ED SPOT GRADE ` 19ED ROOF di F'OfOTII EA7ION T'E9T •LOCA' .. t f Y P LOCATION 1SED WELi.' <, isc ,sstis� - y.. - a. - - ... .� 4.,^.. «, b 4�i.,y.. x+50 1• ::.'.'} :R Sv, —C .F; 4 A,.Pf'.PDX/ 'A >G.' `LOCAT70.V OF.'IJNOE.P6R L/N17 -, C'ABL-E 3 ' t I. r Y Y bl & , t V N 1 : =� L l•' —y`r =: dNE BYS'T E / Id C�� •L: pit PR PR *: PE 1 -, ISED GRADE n 13ED SPOT GRADE ` 19ED ROOF di F'OfOTII EA7ION T'E9T •LOCA' .. t f Y P LOCATION 1SED WELi.' <, isc ,sstis� - I% lQ11�IA11[ OODNTY D�A!!�i!' OF HEALTH �+�`• \ °' Dl.lata� 1 HWIA Saedep. � FLY 1861? _� to hwl� l�ai�lE/ E a ClZt1II�ICATS OF•OONOUANCR M Ow�ae� � . �v V , 1�a s .; � c � ' � ��" 1} • Q....�..t r� r yte.W,e ❑ Dili Am ra41 Date Subdivision' A�nrtived Fee Enclosed. .`'Ainri„r,t , Nt her, at pedna�a Dea1� In G F D Whoa . SecNe� Depth . S.r nti SY, Ti "..O iwbo ed h7 Addim e AAdiami V. WaMr Stf Fttiia ; ' , z S Ftra: Otr.r ie.gtta>ta avow dgCribeO will a oonstrucgO is drown on,tAa apfa•owd amindmentxthen to and in atcordenp w{th'tM ttan)` tMt the p noel ,aew di pl uem feprpMt .that 1 am wholly anrf eompNtely naponsiph fp;tM w+qn and kx�tion O/tM prOpopd fyftem(f)i 3 ' derds;.iulea a. ►aqu of o CouiKy; 0epartment:,of MlMlth, and that on colripNtio�,tiiareo/ i{ �CertNidfi of Construction,COlnpliLn swil`ifectory to the Commimianer of Meelthwill ;tie iueniltted to tM >Depirtnwnt anil a written quarantie will be.`furnisMd tM owner hif fucapo►ti' MMr'oi apgni by the tiutlttar, tfiaC pb Oufldw will SYSTM N!ee `ih, "011,40 eriatin/ ;eorbtlbn any.rparl 'o1'pW pwafle ditpoYlTsyRim ourino' the ppioil of two'(2) yivFbnn e0wX f62Z. ,Z"i ati of the im. Once Of M; appoval,,of,tM CatNketd of :Cohfiructia ;Conlpllinn of'kIH o►ginal tystNn o► any•npek M►etoi 2) thet the diOled well davtbed a6ow NNII; tN loe�ked ai Aioern oll tM'ioprovid. plan ihtl,that eakl well will tie Inatel in accordanoi .vr tM: R Na' end reou onsti f tqe '. Putnam .County DaOartmMt oqf "Sikh. A . Addr l.ieeroe No 'APPRQVED'ROR CONSTRUCTIorc TMs appoval expMK, two yeirs Iron the dato Jsiuid 4, "Tco, r4,alimiv of therbuildino 1►ef; been ,uO-it kein and is revocable fo[iciuih or fnay M iman0ed ourodified w,ftn con fide►ed,nii"ry by- tM ConlTiffioi,Wif Mwlth. Any change oi. ilte►ation of construction re0uhea permit pgow0 for di 1- et-donteitk pnitaiy pwa4e, and /a -p► to water wpply ony. Rev. o.te T BY r f ' Title ' 10/88' - n, DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 APPLICATIONITO CONSTRUCT A-WATER WELL p PCHD PERMIT # P-� LOCATIO Stree dyes N age /City Ta x GrWELL �� id � �i i � � t6 WELL OWNER e Otis ,Cc, ai ing,/� A o U Address, Private a' Public SE OF WELL primary 2 - secondary 7WIDENTIAL ® BUSINESS ® INDUSTRIAL OPUBLIC SUPPLY QAIR /COND /HEAT P60 OABANDONED O FARM O TEST /OBSERVATION G OTHER (specify 0 INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT �- gpm/ # O REPLACE EXISTING SUPPLY 4NEW SUPPLY NEW DWELLING PEOPLE j SERVED,/EST. OF DAILY USAGE 6a00 gal O TEST/ OBSERVATION. 13 ADDITIONAL SUPPLY 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE IRDRILLED ®DRIVEN ODUG []GRAVEL OOTHER IS WELL SITE SUBJECT TO FLOODING? YES &"" NO IF WELL IS LOCATED. IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: NO Lot No. WATER WELL CONTRACTOR: Name 7-6 5 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: DISTANCE TO. PROPERTY FROM NEAREST. WATER MAIN: �fl� LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED MON SEPARATE SHEET (date) TOWN /VIL /CITY PERMIT TO CONSTRUCT A WATER WELL re 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 thirt -y (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 irate surface or groundwater. Date of Issue: 0 /j9 Date of Expiration /"j 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller 7. Letter dated 2 -27 -95 from Mr. Ted Kozlowski, E.C.I. We would appreciate your review, approval and .issuance of the renewal Construction Permit at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. Jr. P.E. HWN:bd 95010 encs. cc: Mr. J. VanCoughnett w /enc. LAURENT ENGINEERING �........_.....:_..__.._.. _ _ ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE—— Route 22 8 Milltown Road Brewster, New fork 10509 RANDOLPH W. LAURENT, P.E. (914)278 -6108 - (FAX) 278 -2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS March 2,_1995 Mr. William Hedges. Putnam County Health Dept. 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Renewal Name Change .& Lot #2 Webster Place Patterson, N.Y. Dear Bill: Enclosed are the following: 1. Four (4) prints of Drawing SS -2 "Proposed SSDS.- Lot #2 ",' revised 3 -2 -95. 2'. "Application For Approval of P1ans.For a Wastewater Disposal System ". 3. "Construction Permit For Sewage Disposal System ",•:dated.; 3 -2 -95. 4. "Application to Construct a Water Well ", dated 3 -2 -95. '- - - 5. - "Letter of Authorization ", dated.3- 2-95.. 6. "Design Data Sheet ". 7. Letter dated 2 -27 -95 from Mr. Ted Kozlowski, E.C.I. We would appreciate your review, approval and .issuance of the renewal Construction Permit at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. Jr. P.E. HWN:bd 95010 encs. cc: Mr. J. VanCoughnett w /enc. O 3E.A, x.. 'aC APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEH i._ --Ranee--and Address • of. App11.c,.nt,: _ _ r�� ae �4�iHG . y .T t/ --Ranee--and �•� rvGfi�h.�.. ?�..... 2. Name of Project: / ro V 4. Project Engineer: 7Tar� c , I r . S. - Address: c�� ua + SO L/ .. License t;ur,,ber: X4.12— ' Phone: ��-� c� 6. Tvoe of Pro.iect I.-` Private/Residential' Food.Service Cor:aercial , Apartments Institutional Mobile }-;ore Park ,,Gfr:ice Building ,3 Realty Subdivision Other (specify) T. Is this project subject to State Environmental Quality Review.(SEQR) ?. Type • Status •(Check One) -Type I.. Exempt Type U. Unlisted. t,-- 8. I a [jraIt Envircn.-mentaI Irpact Statement (DE;S)• required? .. ...... t _ g. .F- S_DEIt been completed and 'found acceptable by Lead Agency.? ....... .. _� 10.. NaAe of .Lead Agency 11. Is- „this.project in an area under Che control oF•local planning, zoning, or other officials, ordinances? ............. ......... _ .... ... .... No +2.� 1-F �so, have plans been.suCmi.tted to such, author .sties ?....._V ............. ~ �J 13. Pas preliminary approval been 'granted by such authorities? � Date Granted: �. `�• Type of Sewage Disposal: System* Di :scharge...... Surface Water Z--� Ground Water; 15.' If surface water discharge, what is the strewn class designation ?........ 5. Waters index number ( surface) .............................................. �. Is project located near a public water supply system? 3. If yes, na,,,e or water supply t: ✓G Distance to water supply Is project site near a public sewage collection or disposal system ?..... /(/0— ' {te'''e of sewage system /�� Distance, to sewage system Date observed: �+�” –� S-`��_ 23. Name of Health Inspector: � � f'i'� -�► "�S' Project design flow (gallons per day) ..................................... Gro 6 25. Is State Pollutant Discharge Elimination System (SPDES) Pe nnit required ?.. 26 Has SPDES Application been submitted to'local DEC - Office ?. . 27. Is any portion or this project located within a designated Town or -State wetIand? ...... ............................... ........................... 23. Wetland ID Number ..... .................... ............................... 29. 'Is Wetland Pernit• required?.............................................. Has application been made to Town or Local' DEC' Office? ............... ' U 30. Does project require a DEC Stream Disturbance Pe mit ?�..:. /L/ -6) 31. Is or was project site used for agricultural activity involving application solid or hazardous waste disposal oT pesticides to orchards or other crops, p; 1, " I- endfilling, sludge application or industrial activity? ...... YES 'or ;NO '� d 32. Is project located within 1;000•�eet o-" existence of. abandoned.landfiil, hazardous waste site, salt stodkpile, landfill, sludge d,ispos'al site or any 'other potential known•source or contamination? ...............YES or NO /UiJ DESCRIBE: 33. Is there a,a�`Ocal master plan or file-with the. Town or Village? ...:......... 3�. Are coimuni,'y w.ater;.sewer faci I i t ies. planned to be developed within 15 years? 35, 'Are any sewage disposal areas in excess of 15% slope? .. ••.•. U __. . ... Tax .Nap _, �� . .........._.. _,.... _. .. Q, 9�2i 37. Approved Plans are tobe: returned to : ................ ' Applicant �/ Engineer I' the application is signed by a person other than tfie. applicant- shown in Item,1, the. ppl.ication f-aust be-accc;mpanied by -a Letter of Authorization: Failure to camply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penally of F?rjury;• that information Proyided on this , ,� is true to the best of cy knoulc-dce and belief. ~False staterents ,ado herein are punishable as a Class A 'XisdG�eanor Pursuant to Section 210.45 of the Pena 1 Law. r ;.IGNATURES & OFFICIAL TITLES: I, Q -4 LING ADDRESS: 1 i 1 i r PU'iiVAM COUNTY DEPARTMENT OF . FIB 1LTH DIVISION OF ENVIRONMENTAL"HEALTH SERVICES Date Re: Property of A/I(jeV tW ,5J&z,,f S�-'� Located at n � = /SZ z (T) M7_7225K4 7 AI Section zky� Pxp %� Lot Q h�J /3 - /SZIa ENVIR0NMFNT•A!. HEA! TN Subdivision of SERVIC;;- ` Subdv. Lot ,# Filed VPA. 2p3-19 Date Gentlemen: n This letter is to authorize W. NIC1106,3 a duly licensed professional engineer or registered architect (Indicate to apply for a Construction Permit for a separate. sewage system, to ry 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 iu'` connection with this matter and to supervise the construction of said system or-systems in conformity with the pro "visions "of Article 145 or'' 147, Education Law, the-Public Health Law, and the Putnam County Sani- tary Coi Coun er: P.E. , R. Address Telephone Very truly yo Sigr�-ed Owner o Address Town' P141 a7, , Telephone .r� ►oo.ao• 8 -►52. I Cd B 1524. B - I uQ -7 B -1488 � B• 1525 oQEO= zo 7F � . 5 -1524 I B -144.1 Y 8.1523 a- lsoo r — � 8-M52► N 2.00.00.' B•1502 I lam-to, LOT Nf s 8*R7=BrI50t B -FJV= F.5-1526 -IP(dU-4111 ':ofQ MAP'Ea' OF- RUTNAIi I BILE -D MLP-a IL-PK T:1L.rD BLtR -31 TOLiNJ (3 F- N PUTt Jzsm Co., N-y 'FC a E I Is =:�01 P Qe H 3. 148-7 O R�{,�oau -ins cra c encl�tnol UDICICT O 1EeEr)U L*14- M4Z)el ?FO ALTEZdU -(CU CC- A Dm* ou ev2vE.K WA6, GeEPA EM) IU AGL.A>ZDAIJCE VIfT11 'i0'T3lIS MAp Iii A�1toLS�nc U;ocsECl�or,1 -TUE. E.XP5rlLA. c.oOE or PeACMCE PU LAWD 'eg 1 147 720'3 cr-rL-- KIF-U YOerL `rATE EDcXAnOU ¢oor� e( 7wE U 1 -roe►c sr2tre Ahi,aca any! op LAIC! UQDUa--EnDUUD 1-70ucrtXE-i5., IC ALN,, Pe-c # ,eAOOAIL L&-H> SUS s.'WD CEenPCATIC 7 Uar 64owU. ALL c - enGicar�, wE1zecU *IAL•L ¢t�f`l or.1LIl - rD'NE. Pee-,oU cOe ti44W 711E Az-- vA.LIr-> POO TW-'7 MAP A1`►o copies SuevEy t5 PIZF -?APID A,UD a.! WK;> BELMLF "rD-WE. TUEZECr OQL-1 11= hA.Iib MAP Ce COPIES, TRLE coMPAU`i AQD LEJ- 1DIL16 tQx5 1TL.MOQ L1STE� ESE-AZ -r"F- IkAP EA- b SEAL CC -114e "EIDEOkI. C -IMPI( Ti0UYi AZEE IKY "T2AWSqEEABL-F_ -itz (e 1c1lJoG£ SIC�1 1A3►JQE ApF Py ADCnrrTOUA,L ul�rrTL-moQ,4 op- Si�fE1..tr cAaQElxi. ►W -EECAJ 151 C. MA,I �J I-Trraeuv - r 1�/S LPL trio gb5U7 Q IJ UU aocx� BP�E ISTE2 , 1-1 EY 1 J02JL J Uo. PA C-C--.y -1,2. 3, y,5 Va.00 f � O QPROR WfL\ r ! /S. . �� mot,. •�. • • 527, 9 SPi•0_ /4% H ' � PROP. 3BOKM., RES /DENCE ,• ` ` • � Ll. EL = 523.0 � I 532.0 QO I /5L6 OOp I rz I 6/ a 0 \�W � ♦ �� i' X70' , 7v1 x rW b 0 r / /0000 4' . EA S E M E N T . AP- whMATE [OCAT /ON a, ' � - LWOERGROUND •CABLE � ' � P 6(lUH /NO!/S S!/RFiICE COU�PSE � 6 "6;AW L BASE CO!/.rSEl WEBS MR PLI�c % AfOP05ED • EXTENS /ON OF_kWEBSTER PL 4CE /, /B/.TYJM /NO US PANEHE/VT% Cg" OF A'0.K!�J.__— . eutnam County Department of HeaTt19 x, 9i OT1L12 tal H6alth S8T•�SCG+ it i on of En 6 for rjuro1o:i as roteSd3 d' fieF ?�j6ns of1the. ,utnam County Health Departmont,•. pig!]at13Le i4 Titl9