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631- 589 -8100
33. -2 -27
BOX 13
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01405
Rev. 3/16
It
./ ..- _._C�RTIFICATR OF 1
Located st
Owner /applicant Name z
Mailing Address
P[TfNAM COUNTY DEPARTMENT OF HEALTH
/D1 vision of Enviiomnental Health Seivioes,'Carmel, N.Y. 10512
- -.. Engineer Must Provide
INSTRUCTION COMPLIANCE FOR SEWAGE..DISPOSAL SYSTEM
Tax MaP_Block�. Lot ,
Uormerly Subdivision Name :ASnbdv. Lot N
Date; Permit Issued
Separate Sewerage System -built by,!52A, V : )NL. Address
Consisting of 4 Gallon Septic Tank 'and 6:M 1/4- l% AM hz-4 ,
Water Supply: Public Supply From Address
or: ll Private Supply Drilled by A- Aj A 4.%j:d�J Address &•D5�7 ,, G t_ �i4 Ll 1
Building Type
Has Erosion Control Been.Completed? I —r
Number of Bedroo s Has Garbage Gripder Been Installed?
Other Requirements iBD ; J0.
I'csrtify that the systam(s) 9ij listed sere ng the above•premises were constructed-essentially as shown on t plans of the completed work ( copies
of which are attached),: and in accordance with the standards, rules and reg lions, in accordance with the iied lan, and the permit issued by the
Putnam County Department df Health
Date �r" -�� Certified by P.E. f R,A.
Address ��gopTlo.Gi�
Any person occupying premises served by;the above systems) shall promptly take such action of may be necessary to secure the correction of any unsanitary
conditions resulting, from such usage Approval of the separate swwerege system shah become null and void as soon as a pub %sanitary sewer becomes
evallal ie; and the approval of the private watei supPIY shilt'become'riull arid' void' when a public water supply becomes available. Such approvals are
subject to modification or change when, in 'the Judgment of the Commissioner of Me th, eh.revo on, iflcatlon or eMnge is necessary.
Date G Q /% e -�� Title ��__!
Received',of-
The Sinn Of
.no-w�.n;.m.n�•,�...mni. ±o-na. m•na.ni.,n,vm.no-na.wi• ±�.,i. ni.,na•m. ±o-no-no- n.nu,vni. m.nm,�.,i. no-+ i.. o-ni• m• m.m.:.ne +a•,�em "a.;nno-ni^ +tn•.;
PU'IV M COUN'T'Y DEPARTKEW OF HEALIH
DIVISION OF ENVIROMMM 1 PL ALTH SERVICES
Owner or Purchaser of Building
Buildiny Constructed by
tioStIeet
cipality
Building Type
.2-'
Section Block . I
Subdiv sion Nacre
Subdivision Lot 7
GUARAI= OF SUBSURFACE SEAM E DISPOSAL SYSTEM
I represent that I.am wholly and completely responsible for the location,
workmanship, material, construction and drainage of the sewage disposal system
serving the above described property, and that it has-been constructed as shown on
the approved plan, or. approved amendment the r.eto,; and ' in accordance. with : the..
standards, rules and regulations of the' Putnam County Dgpart�nt of Health,' and
hereby guarantee to the owner, his successors, heirs or assigns, to place in good
operating condition any part of said system constructed by me which fails to
operate for a period of two years irmnediately following the date of approval of the
"Certificate. of- Construction Compliance" for the sewage disposal 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 Director of the Division of Enviror* ntal health Services of the Putnam County
Department of Health as to whether or not- the failure of the systan to operate was
caused by the willful or negligent act of the occupant of the uilding tilizing
the system. Ar-
Dated this 6a day of �_ 19 4`2 Signatur
Title -
Corporation tame (if Corp.)
!l
Mdress
♦► r
rev. 9/85
mk
mot- r-ty
WELL COMPLETIUN KEYUK-t
DEPARTMENT OF HEALTH
Div_ isicn •.Of- F ^••;' ^nme!? *_aJ..HPa.lth - Services
��'W 4 PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
_-
�—
WELL LOCATION
STREET AOURESS: WNIYIL 1 1 17 TAX GRID NUMBER:
WELL OWNERN
NAME: _ ADDRESS:
'1'f% tM
BIVATE
PUBLIC
USE OF WELL
1 - primary
2 -secondary
ESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
O BUSINESS D FARM O TEST /OBSERVATION ❑ OTHER (specify)
O INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
— r
YIELD SOUGHT �S gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE( (0 gal.
REASON FOR
DRILLING
(]REPL E EXISTING SUPPLY ❑TEST /OBSERVATION []ADDITIONAL ,SUPPLY
�SOUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL
DEPTH DATA
'WELL DEPTH ft. I
STATIC WATER LEVEL —ft.
I DATE MEASURED
DRILLING
EQUIPMENT
O ROTARY O COMPRESSED AIR PERCUSSION 0 DUG
❑ WELL POINT Ca egfLE PERCUSSION O OTHER (specify):
WELL TYPE
❑ SCREENED UjeFt N END CASING O OPEN HOLE IN BEDROCK O OTHER
TOTAL LENGTH _2j _ ft
MATERIALS: Q�3' E O PLASTIC O OTHER
CASING
DETAILS
LENGTH BELOW GRADE Sit.
JOINTS: O WELDED P EADED ❑ OTHER
DIAMETER in.
SEAL: GPEEMENT G T O BENTONITE OOTHER
WEIGHT PER FOOT % lb. /rt.
DRIVE SHOE ES D NO
I LINER: CJ YES
DIAMETER (in)
'SLOT SIZE
LENGTH (ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
SCREEN
DETAILS
FIRST
O YES' O NO
SECOND---,
GRAVEL
SIZE:
IAMETER TOP
OF PACK in. DEPTH ft.
HOURS
BOTTOAt
DEPTH tt.
GRAVEL PACK
❑ YES
❑ N0.
WELL YIELD TEST It detailed pumping
P P 9
METHOD: ❑ PUMPED 1 tests were done is in-
O CO ESSED AIR , formation attached?
AILED ❑ OTHER ; O YES O NO
'It more detailed formation descriptions or sieve analyses
�%�LL LOG are availabfe,'please attach.
DEPTH FROM
SURFACE.
water
pear-
I ^9
Well
D'a-
meter
FORMATION DESCRIPTION
COOE
It.
ft.
WELL DEPTH
It.
DURATION
hr. min.
DRAVIOOWN
It.
YIELD
gpm.
Lane
Surface
d ��
WATER EAR TEMP. J
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? ES ❑ NO
ANALYSIS ATTACHED? ES ❑ NO
(
STORAGE TANK: TYPE W-J
CAPACITY Cf-d GAL. B
PUMP INFORMATION
TYPE J A 41 CAPACITY /d
MAKER6 —' 0 U1 b_ DEPTH 0W
Z MODEL dam;[ VOLTAG0_!_e HP
WELL DRILLER NAME / v/ f �.NC G DAT
ADDRESS U 9- 3 I RE
(Z
:3/89
YML ENVIRONMENTAL SERVICES pi
21 Fear Street
Yor ktow i He ishts, N.Y. 10598
r5 --
Albert H. Padovani, Director
.- ..e.,,,..,•e �-•.. _ ... _.. _ _... _ -. a -. r... -..... __ _., . - -. � � � .. r ...._.._ _._ _ � - ___ .� � __ _ _ _ _ ... _ � .. _ e• . _
LAB 4: 93.008221 08221 I_ L I ENT #: 26 NON :..TAT. PR n_:. PAGE 1
DENNIS MALANt=HL_K DATE/TIME TAKEN: 10/13/93 ' 10:00
PO BOX 313 DATE /TIRE RECD: 10/13/93 16:0.'-:.'
i_ROTON FALL =:, IVY 10519 REPORT DATE: 10/15/93
PHONE: (914)-277-31.92
SAMPLING SITE: FAIR ST KITCHEN TAP SAMPLE TYPE:.: POTABLE
: PATTED _ON, NY PRESERVATIVES: NONE
i= OL._' D BY: DENNIS MALANt_ Hi K TEMPERATURE..:
NOTE_:... a COLIFORM METH: MF
DATE. FLAB; PROCEDURE RESULT NORMAL — RANGE
10/15/93 MF T. C OL I FC tRM ABSENT /100 ML ABSENT
COMMENTS:
BA! :T THESE RESULTS INDICATE THAT THE
! ATE R ( i T (W A: NOT). OF A
SATISFACTORY SANITARY QUALITY A _ ORD I + HE -NEW
YORK :=STATE
SAND EPA FEDERAL DRINKING WATER := TANDARDSv FOR THE PARAMETER==
TESTED, AT THE TIME CiF COLLECTION.
SUBMITTED BY: - - - - -- ------------=----------
Albert H. Padovani, M.T.(ASC:P)
Director FLAP# 10323
PUTNAM COUNTY DWADYB8iI OF HEALTH
1 � ,� DtaYi� scat 8>n�eoenlal Heebde Saevloee. Cesassal. N Y 1F31? ' � is PaovWe�lenWt 0'
1 n. am C1211FWATB OF CO
COM1tIIt;WN MW M UWAM;DMOSAL SYS'I= `
l-
IX S W -� J.
Names ia��S *i' sE SG' Dom_ iat i `� Tax 3 ' i
C3
—
rt a
/� Daft of havlosio
A.. /� V W I), Town
)ate Subdivision Approved Fee Enclosed . Amr,f;nr -�
A m 0 2 -71 Fm Section 010 . Depth
Naas6ar SIR Ded gm Flow G P D PnCHD Nodbmdm 6 Sequhod Wbeti li m b =mpkted
Sepee�Ia Sewarep Spy 6 seat et S-ptic Teak
To be. eentbvieW bl
p .:. Address
W Stlppbi PtbSe SEPPIY._Feas Addseea :
an g Sepjy dhd by
1N
1 repreasnu.that t sm wholly and tompNtily responsible for the design and location of the proposed system(s). 1) that the a rate !nr di sal stem
above described will be construcHd as shown on. the approved amtlldrmmt there to and in accordance with:the standard;, rum, a rpu ens o n
County Depeitment of Maetth, and that opcompletion_thi . eof a.c•Cwtifioate of Construction ComPliapce" satisfactory. to the Commissioner Of Nealthwill
be submitted to the. DpMovent and a written :gilarantae will bo: furnished the owner; his.succsmofb, hairs or assigns by the baiNa►, tlHt said builder will
Olafy Yl'. gooe►'oparating eondltbn anY Hart ot: saki sawa4e difpoYl :ystanl Aurhp, a perioel of two (2j years ImaledNtely following too date w the Hta-
anee of the'approral of the certificate of Construction, Complienee of a or stem of any rapd►s t1wetoi 2) that the drilled wall described aria
wit be located as shown on the epProrod plan and tfiit'fakl. well will M'in in nob with tM ndeftls. rules antl rpuTaiio s of the Putnam
County Oftertmot 'oosyff ,"With.
Date ✓ -�J cc Signatl _-
Addr /�T LLD License Plo
APPROVED FOR CONSTR' !0N Th i.pproval sipires two years, from. the' date ,issued unless Construction of the building has been undertaken and is
reroeaflle for cause or fn.y,.w emended -or, modified when consitlargd necessary by the Commissioner of Health, Any change or alteration of construction
raquIref a parmn._ ar fof disposal of.domestk ianhary o ►ivate water supply only. �J f���
Rev. �J��_ l ... C pe7y`��
10/88 ease er -
y Title
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
APPLICA`I ION- '120- CONSTRUCT 'A ' WATER -WELL
PCHD PERMIT #
WELL LOCATION
greet Add rys
�'
Town VS�ag� City Tax �rid Number �
/tJ
WELL
P 12
Name
�f) /GAe%
Mai in Add Wrivate
G�E'TH A O Public
(vSE OF WELL
- primary
2- secondary
RESIDENTIAL
0 BUSINESS
O INDUSTRIAL
O PUBLIC SUPPLY O AIR /COND /HEAT PUMP ❑ ABANDONED
O FARM O TEST /OBSERVATION O OTHER (specify
O INSTITUTIONAL O STAND -BY O
AMOUNT OF USE
YIELD SOUGHT !j gpm /# PEOPLE SERVED 0,,9 /EST. OF DAILY USAGE 6 Bal
❑ REPLACE EXISTING SUPPLY O TEST /OBSERVATION Lb ADDITIONAL SUPPLY
$-NEW SUPPLY NEW DWELLING O DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
A)j5i7 0 ,524"S
22SAl C6
WELL TYPE
DRILLED
DRIVEN
0DUG
GRAVEL 0 OTHER
IS WELL SITE SUBJECT TO FLOODING? YES Ck NO
NAME OF SUBDIVISION: Y-/SL
Lot No.
WATER WELL CONTRACTOR: Name M2 Address:
IS PUBLIC WATER SUPPLY AVAILABLE
TO SITE:
YES NO
NAME OF PUBLIC WATER SUPPLY:
h)/A
TOWN /VIL /CITY
DISTANCE TO,PROPERTY FROM NEAREST WATER MAIN: �f
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
WON SEPARATE SHEET
(d
(date) T- (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
thirt } - (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.
Q` c-
Date of Issue • O 19
Date of Exp ion 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
PUTNAM COUNTY DEPARTMENT OP HEM ST FLOOl"?, rLAN
A. N S A R 0 V. ED F
!BED!R�uN COUNT i�,ONTL'�
I
U)
F. 01
_2, F. t
&
I
N
SCGUNU FLOOK FLAN
SGALL :
14' .
COuntY Npar-tnienl• of Health
Sanita-tion
AFFIDAVIT -- CORPORATE 9,7NER APPLICATION
LICAT-1014 SUBMITTED' TO
COUNTY I.I.EAr-TH DEPARTMENT
TO: COrn',116G5.0ner of Health' In the Mattex• Of application fbr
- — — — — — — — — — —
I
represent.
that .1 am an officer or erjpY
OYee of the corporation and am.; authorlied
to act fox,.
L4 L< � C_ � V'1
• (name O
f corporation)
havIng offices at
AAJ 1J_
41 0 6
CF_ 4e;,
7name ianT d
Mawle-1-13a Agdress'
gecrie�tary
(Sarre` and Xdlr8ss
1�2FC V
Tree e
carer':
(N M e Tau- -S�-r
e
a d
and that I AM-"d be individually responsible f0h any' ap to,
9f the-corPOra-iOn faith respect to the dHroval re
Seque t a6t r Sub-
elatl�g -thereto.
S�"Orn� to e this -_- -..day
Signed
i5l 71 tie
Vi EL
"r
o
�?o tar pL Iblic-
NATALIE m, COLLETTA
NOTARY PUBLIC• State of f4ew York
No, 499300S':
Qualified in Ulster C
,Cqmrnission expires
PUITMM •• a• 'LNto OF
DIVISION OF ENVIMORdENTAL, HEALTH SERVICES
DESIGN SKEET- SUBSMCE SEWAGE DiSPC1c_AL SYSTEM FILE 'NO.
_/.::: ?AdEess`
Located at (Street) /��/2 0(?72� �' Sec. Blor -k Lot oZ�
(indicate nea-est cross street)
ttmicipality t'ATTF49,0 � � Watershed C/-0 7J A)
SOIL pERMI.ATICN TEST DATA RDQU732FD TO BE STjM4I TED WITH APPLIC-ATICNS
Date of Pre - Soaking JT' - /JT q�? Date of Percolation Test
HOLE
N(-w-R;R CL=
TIME
PERCD=CN
PERCOLATION
Run
Elapse
Depth to
Water Fran
hater Level
No.
Tug
Ground
Surface
In Inches
Soil Rate
Start Stop
Min.
Start
Stop
Drop In
Min /In Drop
Inches
Inches
Inches
Cl 221-12',41
'4
3
4
5
11,2 , o?,G
3
4
5
1
2
3
4
5
�A -
5�
NC7I'FS: 1.• Tests to be repeated• at s m depth until apprcximatel.y equal: soil rates
are• obtained at each percolation test hole.- All data to' be subnitUd
for review.: -.
2. Depth mea_s=eTents to be made fran top of bole.
rev. 9/85
DEPTH
G.L.
2'
3'
4'
5'
6'
7'
8'
9'
10'
11'
12,..
1cJl rs1 Lki.Lei 1-,G1UAAt, . LV Or, JUtX1L'l1ru Wlla tirYLLI tillViV
DESCRIPTION OF SOILS ENCOUNTERED IN TEST SOLES
HOLE NO HOLE NO. HOLE NO.
14'... .
INDICATE LEVEL AT WHICH GROUNUOM= IS ENCOUNTERED
INDICkTE LEVEL TO WHICS ItiMTER LEVEL RISES AFTER BEING ENMUNT -T-M D
DEEP HOLE OBSERVATIONS MADE BY: DATE: DL)/#
DESICI
Soil Rate Used 7 &,:.&) Mi.n/l Drop: S.D. Usable Area Provided
No. of Bedroaals -) Septic Tank Capacity /a Ig0 gals. Type -C -4
Absorption Area Provided By -��- L.F. x 24" width trench
Other
Name- Signature—
Address 70 L�-19E/F_ 1 02 %%12 I�� SEAL)
No. 045781.
A40FESS%
THIS SPACE FOR USE BY-HEALTH DEPAF ONLY:
Soil Rate Approved sq.ft /gal. Checked by Date
PC -1
� L
PUT NAM C OUNTY" D E PART MEN T O F H EAL TH
= APPi ic:A=� 0r� M=GR APYRJVAi= �i-
:PLANS 'M A--=NASTEVAI- R'DISPOSAt: SYSTEM'
1. Name and Address of Applicant: ZI /JI4 2�yILDII�lG�
_399 10ar W
2. Name of
Project: �iE'OPOS
�
SSOS
4. Project
Engineer: /c
% LndZ IPf-j
O. I_Aa awT
License Number: ZIe. Phone-:;M b104
6. Type of Project:
3. Location T/V /C: ?,J TZ_r f M)
5. Address: -.�
Private /Residential Food-Service Commercial
Apartments Institutional Mobile Home Park
Office Building Realty Subdivision Other (specify)
7. Is this project subject•to State Environmental Quality Review (SEQR)?
Type Status (Check One) Type I.. Exempt
Type II. Unlisted X_
8. Is, a Draft Environmental Impact Statement (DEIS) required? ............. O
9. Has DEIS been completed and found acceptable by Lead Agency? ........... AJ
10:-'Name of Lead Agency N I
I. Is this project in an area under the control of-local planning, zoning,
o.° other off iciai's, ordinantes?. :. ::. : .:...:....:..... :....... :..... f3L1
►2. If so, have plans been.submitted to such.. authorities ? ....................
13. Has preliminary approval been granted by such authorities ?+ Date Granted: N
14. Type of Sewage Disposal System' Discharge ...... Surface Water _Ground Waters
15. If surface water discharge, what is the stream class designation ?........
:6. Waters index number (surface) ........... ...............................
:7. Is project located near a public water supply system? Q) O
8. If yes, name of water supply A) 1, 4 Distance to water supply
9. Is project site near a public sewage collection or disposal system ?..... A) 6
0. Name of sewage system A) /� Distance to sewage system A) Ilq
1. Date observed: /il1lKI 67WA) 23. Name of Health Inspector: dA)g 21 AJ/)"
4. Project design flow (gallons per day) ...... ............................... 0-0
25. Is _State Po.l,lutant Discharge Elimination System ( SPDES). Permit requi. red ?..._.�...dt
26. Has SPDES Application been submitted to local DEC Office? A)�l4
27. Is any portion of this project located within a designated Town or State A)e
wetland? .................................. ...............................
28. Wetland ID Number ...................... ............................... ��64
29. Is Wetland Permit. -required? ....................... A)0
Has application been made to Town or Local DEC Office?
A)l,4
30. Does project require a DEC Stream Disturbance Permit? ................... A) d
31. Is or was *project site used for agricultural activity involving. application
of pesticides to orchards or other crops, solid or hazardous waste disposal,
landfilling,'sludge application or industrial activity? ........ YES or NO /1% D
32. Is project located-within 1. 000 feet of existence of abandoned landfill,
hazardous waste site, salt stockpile, landfill, sludge disposal site or
any other potential known source of contamination? ..............YES or-NO A) U
DESCRIBE:
33. Is there a local master plan,or.file with the Town or Village? A90
34. Are community water, sewer facilities planned to be developed within 15 years? NO
35-. Are any sewage disposal areas in- excess of 15% slope? ........................ �?
36. Tax Map ID Number ................. ............................... . ......��
37. Approved Plans are to'be. returned to: ................ . App'l,icant _ Engineer
If the application is signed by a person other than the applicant shown in Item.l, the.
application must be-accompanied by y-a Letter of Authorization. Failure to comply with this
Provision. may be grounds for the rejection of any submission.
I hereby affirm, under penalty of perjury;- that information provided on this
form is true to the best of my knowledge and belief. False statements made
herein are punishable as a Class A Hisdemeanor pursuant'to Section 210.45 of
the Pena 1 Law. ,, , le ,
SIGNATURES & OFFICIAL TITLES:
AA) V DENT , 6 646,FN
i�L P
TAILING ADDRESS:
I
PUINAM COUNTY DEPARTMENT OF HEALTH
_OiY ISt6N OF' VIRONMENTAL HEALTH SERVICES
p Date.
Re: Property of
Located at "7�- /k
(T) � T% /=�CS01,l. Secticn , Block o` Lot
Subdivision of
Subdv. Lot m Ll(� Fj.l.ed Map #
Date
Gentlemen:
This letter is to authorize D L�
a duly licensed prui'csG9.Onal ellgirleor %\ or registered architect.
to apply for a Construction Pe-r[NiL roI a 'se a* to Sewage systemf to
serve the above noted property in accordance with the standards, rules
.or regulations. ,Iq promul�igated t)y the Ccsmrrla.ssioner of the Putnam Couxity
Department of Heal.tt�, and to. si.,Qjl al.l; iiecessary
connection with t1,i� matter and to $UPOrvise the construction of said
system or Rystema in coni'az,mity ►v•i tlt the proviSiona of Ar °tide 145 or
4 +r
147, Educatiorn Law, t}le Public Heal t-h Law, and t i he ' PLltnan, County SRni --
terry Code.
Col.intersig]
D , R.A.
Address
Telephone
Vary truly yours
Signed }C
Owner of Property
Add 'eag
a l Al 1114 1-
r 7&0 z^
Town
aq 4
Telephone
LAURENT ENGINEERING
ASSOCIATES, PC.
- PA - R8614 - - �__ - .... -.. -... .
73 FAIRFIELD DRIVE
TTE W "V0RK 12563
RANDOLPH W. LAURENT, PE. (914) 278.6108 - (FAX) 278.2658
HARRY W.NICHOLS,JR., PE. CONSULTING SITE ENGINEERS
June 3, 1993
Putnam County Health Department
4 Geneva Road
Brewster, NY 10509
Att: Mr. William Hedges
Re: Proposed SSDS
Lot 40 Fair Street Subdivision
Fair Street
Town of Patterson, N.Y.
Dear Bill:
Enclosed are the following:
1. One (1) print of Drawing SS -1 "Proposed SSDS ", dated 6 -3 -93.
2. Three (3) prints of Drawing SF -1 "Preliminary Design for
Fill Placement Only ", dated 6 -3 -93.
3. "Application For Approval of Plans For a. Wastewater. Disposal
System ".
4. "Construction Permit for Sewage Disposal System ", dated 6 -3-
_ _9.3.y.
5. "Application to Construct a Water Well ", dated 6 -3 -93.
6. "Design Data Sheet ".
7. "Letter of Authorization ", dated 6 -3 -93.
8. "Corporate Affidavit ", dated 6 -3 -93.
9. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count
Only ".
10. A check in the amount of $300.00 for Review Fee.
June 3, 1993
Page 2
Kindly review the enclosed items and contact us with your
comments and /or approval at your earliest convenience.
Very truly yours,
LAURENT ENGINEE NG ASSOCIATES, P.C.
R ndolph W. aurent, P.E.
RWL :bd
enc .
93039
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