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HomeMy WebLinkAbout1434DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -2 -20 BOX 13 IA"6 i, .. . 1 '1 � oil' ' 1. ' kT I 6 � �. ■ �T 1' .I 01434 Rev. 3/86 YU1 141AM UUUN7'T VErAlt1'1Y ENT 11F HEALTH Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Must Provide, t P.C.H.D. Permit # CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Malling Address ZD6 .8a6- VSO 0i2&P .s! W Zip_ /7,</ -7 own r Vhlage Tax Map � ock _ _2 Lot Subdivision Name d /e •�dY Subdv. Lot #_1Q) S Date Permit Issued Separate Sewerage System built by P Address Consisting of %012 Gallon Septic Tank and _7100 Water Supply: // Public Supply From Address or. Privates Supply Drilled by ez 4 F . r— M < Address S Building Type t? s�����>� / Has Erosion Control Been Completed? Number of Bedrooms _ Has Garbage Grinder Been Installed? Other Requirements I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulations, in accordance with the filed plan, and the permit issued by the Putnam County Department Of Health. d Date �y� �� Certified by e ! v P.E. R.A. Address 974, r 6 2 License No. Any person occupying premises served by the above systems) 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 sewerage system shall become null and void as soon as a publi: unitary sewer becomes available d the approval of the private water supply shall become null and void w bfK'w+td{_ M+PDIY becomes available. Such approvals are subject t.ano modification or Change when, In the judgment of the Commissions Mealt a Ora , modification or r change Is neeeswry. Date �_ /� �/ �� By— Title �� A 01_ _ G� a' WL'LL GVr1rLL11VLV mr,rVA1 DEPARTMENT OF HEALTH nevi - L-rv-i, u—'-'n nil TleaIth PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only -- WELL LOCATION STREET AOURESS: TOWNIVIELACILICIfy TAX GRIO NUMBER: Lot #10, Hi hview Drive Windsor Oaks, Carmel, NY _Z WELL OWNER NAME: ADDRESS: BOX 451 Pyramid Custom Home Corp. Crompond, NY 10517 ❑ PBIVATE O PUBLIC USE -OF WELL 1 - primary 2 - secondary Q RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM O TEST/ OBSERVATION ❑ OTHER (specify) O INDUSTRIAL O INSTITUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD SOUGHT 5 gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING []REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY @NEW SUPPLY (NEW DWELLING) ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 205 ft. STATIC WATER LEVEL eft. I DATE MEASURED 4/10/95 DRILLING EQUIPMENT CR ROTARY Q COMPRESSED AIR PERCUSSION ❑ DUG O WELL POINT ❑ CABLE PERCUSSION O OTHER (specify): WELL TYPE O SCREENED O OPEN END CASING Q OPEN HOLE IN BEDROCK ❑ OTHER CASING TOTAL LENGTH 52 _ fL MATERIALS: Q STEEL O PLASTIC O OTHER LENGTH BELOW GRADE 51 f(, JOINTS. O WELDED Q THREADED ❑ OTHER DETAILS DIAMETER h in. SEAL: W CEMENT GROUT ❑ BENTONITE ❑OTHER WEIGHT PER FOOT 19 lb./ft. DRIVE SHOE Q YES 0 NO I LINER: ❑ YES Q NO SCREEN DETAILS GRAVEL PACK DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST O YES ONO HOURS SECOND O YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH ft. WELL YIELD TEST t If detailed pumping METHOD: O PUMPED ; tests were done is in- COMPRESSED AIR ,formation attached? O BAILED ❑ OTHER ; O YES O NO 1r�l�LL LOG If more detailed formation descriptions or sieve analyses are available. please attach. DEPTH FROM SURFACE water pear- Ing Well Dia- octet FORMATION DESCRIPTION CDGE tt n WELL DEPTH ft, DURATION hr. min. DRAWOOWN It. YIELD gt:m. surface 30 Dr..11dncf in overburden clay & boulders 30 Hil r ck at 30' 205 6 120 30 30 52 Dr:lllng in rock, set casing, grouted 52 205.Dr::114nq in rock granite WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS ❑ COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES ONO STORAGE TANK: TYPE Well Xtrol WX #250 CAPACITY l• PUMP WFORMATIOH TYPE submersible CAPACITY 7gpm MAKER Goulds DEPT}( 140' MODEL 7EH05412 VOLTAGE 230HP_s wELL DRILLER NAME P.F. Bea 1 & Sons, Inc. DATE 22 9 5 AODRESs 4 Putnam Avenue SIGNATURE Brewster, NY 10509 siuy I'vfcofm T. Beal, Jr TYPE: LAB ID NUMBER: LABORATORY REPORT PW 95 -2933 CLIENT: P F Beal & Sons 4 Putnam Ave Brewster NY 10509 SAMPLING LOCATION: Pyramid Const., Lot 10, Highview Dr, Carmel NY COLLECTED BY: P. Beal DATE COLLECTED: 06/13/95 TIME COLLECTED: 9:15 AM DATE RECEIVED: 06/13/95 - DATE OF REPORT: 06/16/95. ANALYTE RESULT UNITS METHOD ANALYZED Total Coliform Absent - Colilert 06/13/95 E. Coli. Absent Colilert 06 /13/95 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: ACCEPTABLE. NOT ACCEPTABLE. Laboratory Director NYSDOH ELAP #11218 CT Lab Approval #PH -0171 618 Clock Tower Commons, Rte 22, Brewster, NY 10509 / 914- 278 -7600 / Fax 914- 297 -0536 PUTIQPI4 COJN'L'X DEPAX<M� T OF HEALTH DMSIOIN OF E1YViR0LQ -ID4 A.L RFALTH SERVICES Oar Znstruc vex of Building 3 Building by r !? nor L�tYon -'- Street 2 3y Section Block Lot j / /*��C C �2 /ec' Subdivision true Subdivision Lot Building ice . C- UPR`lTi- e.E OF SUBSURFACE SO,e_ CE DISPOSAL SYSTEM I represent that I an wholly and completely responsible for the location, wor}rnrrnship, material, construction and drainage o€ the sewage disposal system, serving the above described property, and. that it has -been constructed as sham on tiie approved -plaft or approved amend Tent. thereto ..and :.in accordance with the staneards, rules and regulations of the .Putnam, County Department of Health, and hereby guarantee to the cremer, his successors, hears or assigns, to place in good operating condition any part of said systen constructed by me which fails to operate for a period of two years i.umediately following the date of approval of the "Certificate of Construction. Compliance" for the sewwage disposal system or any caused by the willful or negligent act of the occulpant.of_ the building utilizing the system. N The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Envixor_ -,ental. Health Services of r the Putnal-n County Department of Health as to whether or not- the failure of the system to operates caused by the willful or negligent act of the occupant of the building utilizing n the system. Dated this 3U day of 19 qk Signa Title Co. .tractor (D6,er> - Si Inat� Corporation blame (if Corp.) 0 111)&J27 Address I rev. 9/&5 mk Corporation Name (if Corp.) AZZ.ress (O ' . _ .1 ,• ' : 4 1' - L' i�Y F iEs }1 t ,e�y { �y . 1. , "i - - I r Q ' t { ) , t t r 4I - `%+te�h`i•� o- t �G t' \ t is P. { , r - f it d�'^'T` Y 1r ;fit: 11 W v 7 a ;, l4 f�yyx k iy .a - 1 c i..�� 'cL T . ter= S y, { rte}... y y 1. n a ,�} k r4 an 2� des fits �r s i � ar. a ry c 4 i +�y, a�S r-' -, . t r &7 I 11 I t �* t ..,.. _ v+ n Y, r j "I ;r IQ� r rh��+��YL '- - � r< tkh z /� { aasilk F r 1!d a 1 .In .- r -iy ais"^EM�yy �ii� J r .' £y r d Aid ,e 1 t 7 f a ,..� •b"F" .�i'�sM'�,�j�". yr t s e, imt 1. r v fyPta aN N '� i _�� ti } k v �' k - 1 r f f b� t l r�, +.�zp�� z e i /Q r S et \ 1 s _ ,.Y Ok t `Y^S°;, ttF tic-x art.'�ixiriar r 4,_r w, , " ` . s _ rte/ `«� `tsr - s w"r _"F S - _, Q..: wr r'r r} --� r il- i ."aStwy2s �'. 1. r /� r t t x M: a : ((��,, a ill j r < r '''v��.+R. -,yr `i #; cr't� ' W - s �` .5 4 cZ < h.. C`- s``i:i 9ss ...r' 4 a 4 a i..1 t '. H 4's a��I i I d y�Yy'��y r 1 MM 1t�a �. r t•; . _,rte 5 r, �7 `r. t yr,d �wY `'•1 !a� % 1 -, wl�O WOOOEK F 'may 4 rteI'— x c" �: �EC _.4.� 3'7PP,r.. _ 4r°^c §P"'��•`w� ih?rS L ... d ' ',;"sue , .: v ti ' _ rt F, s ` ' i 3 B y N u '7j -I',- •,zt"3M1Y� ^L { �. Eo�Yd , (� „J s r t[+, �iJ� ; t �" ?r t -' -t °"F G , p i V "I'll- ri (�ilf �' fit' A 11 �' 1 k, i s.4'G ,,x �l' s t r'+ �r,z _ Vf 3 oNt s >e,� s v �F y� � x`�'` u r��� w r -�/yC .WANG t t F ry•"�,� �•�^ s Y tea" o - s .V, ) , �!• 3' F .. t • -� y �� 0�� - f 'F; , ` Z"G Cl it ! v x ,��` ,Z s 3� � � `��� s y/G . oboo' ,It - � t •t rNr 't I - - .,,tea 1. �f fi r r yq , , 1 ...v F - • ✓ \. .. n "> 7 { l tr ,y 1 Yr 4 q• f- G. �J t?'q w k�, k yr s � 7 a � - De artment o H ®al3�t� 11 rutinam County. p R tal Health S-A, ,71 NZ , r vi j T , �' X30 �', �h :v a it ,, . I , .!, sion o nv ro, • pprOVBL� as :noted for con, . _,.,e?,_ the n ; Plicable; °I ules and Regulation I � ,?" �, � - `, . _ .. .: . .;_ ' V^Iirn$'y HAalth . _ Ani 'tmeat • L,�`,:. � h� � 'a , S r r s y r r � � "'Sr x. s:.' 3 ; �, �Y 4 Ytr �., r..... K'- .,. .. - i. � .. .. � � � .. .. -. �' .. ..� ... i ,., __ .. ..- - Sabitrltki� liira �,✓ h�%sdr l "%� �s Subd- Lest ll) Tu map ` :3 BMek _LN o..IKi�pprca Na■P yrAlr�;�d �r.� ?fin �Qre,P_ /o— Ra°°"v_° R°.W°° ° Date of Ptevbo App mvd MraS Adiraa %�, 0, B S!Sr�ir�e l: ���> Towa (.X. ZIP Date Subdivision ADDr-yed Fee Enclosed u Ammin Aj D.r+rs Tn. 5,��- � hot Arms I Fm settle. o* u Depth off '- volaoe 416!�z Nobadaf Beienmr `S DWV Flow G P D %D PC® NoMmi lag 4IIeQdm4 W6es Pm 4 oa tpMOrd saparNa sacra imp syalam a aaaalat at To w:' by Sept)c Tank Wa4a SIlp*. pile Stiff Ftim Addran an Vol" a.t..f. Seip* Dowd by se Otrar �ataa�b 1 repe»nt1hat 1 am wholly and completely iesponsibl� forths.desgn and location of the proposed system(s); 4) .that the apa►ata saw di sal stem above described will be constructed as shown on the appro've'd amendment there to and in accordance with the standards, rules a ►pu ns o na County Departnlant of Health, and that on completion.themof a: "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be svemitted to the Departpent, and a written guarantee will be 'futnished.tha owner, his successors, heirs or assigns by the bulkier, that said bulkier will one in pod oparatkg f:Ondition; any part Of, uq sawaga disposal system during the period of two ( yews bnnadletely following the dab Of the IM- once of the apparel of tlw Cortifkate � of;.Const►uction Compliance tin riginal system or any r, s thereto; 2) that the drilled well dassyibad above will be located as Mlown on the aPprosesl plan anA.thifulowall will be In act n n w h the nda rules and regUUMons of the Putnam County .04pertnnnt Of t "itit. Date r . _ r/� _9� Si/ne0 P.E. It^. tllhrorfQ:'' s6r71/ F� AAdreM erae No APPROVED FOR CONSTRUCTION: This app►aral e"irimtwo years fro n" dt :issued unless construction of the building ilas been undertaken and is rerOCable for cause or may be amended or modified whim considered necessary_ by' the COmMISSiOMr of Health. Any charge or alteration of Construction requires new permit. ow_ d ter. disposal of domestic sanitary aver nd or ivab warp supp Title 10/88 . DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New.York 10509 (914) 278 -6130 APPLICATION 'TO CCiNSTRUCT A wA'�ER WELL PCHD PERMIT 0i�� WELL LOCATION Street Address > T Village City Tax Grid Number A, « _.'20 WELL OWNER Nam t-a 71 Cri e ail* 9 Addrss ,Private as u+ On lY O Public USE OF WELL primary secondary RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUP AY Q AIR /COND /HEAT PUMP O ABANDONED O FARM [)TEST/OBSERVATION O OTHER (specify, b INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED& —S /EST. OF DAILY USAGE 4 b_,gal O REPLACE EXISTING SUPPLY O TEST /OBSERVATION GL ADDITIONAL SUPPLY aNEW SUPPLY NEW DWELLING D DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN ODUG O GRAVED O OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: h 66k s Lot No. /n WATER WELL CONTRACTOR: Name %a!� 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 PON SEPARATE SHEET 9S - I 't, I JIV (date) (si g nature) (date) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: r �[G%`���G 19 Date of Expiration 19,07 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller 2' O S 3✓ A, �. ' C APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM i . Name and Address o- Appl tcant: 2. Name o-" Project: / 1l do Locatioro/Y /C; 4. Project_ Engineer: r S.,Address: License Number: 5 124 Phone: ;;-7� —G d� 5. TyEa of Project: -- r.� Privaie /Resice�ntial Food.Ser.vice .•COwc�ierciAl , Apartments - jnstitutional - ;iobi le, Home Park 0.Irrice Builaing __;.Realty Subdivision Other (specify) 7. Is this. project subject to State Env ironmental•C•uaIity Review.(SEQR)? Tvee Status (Check One) Type -I... Exempt s. Is a Dram Environ:;:ental imipact Stater�ent (DEIS) required? .. ...... d s. Mas DEIS•been completed and found' acceptable by Lead Agency ?.. ......... t0. Name of Lead Agency` l �i. Ts this project in an area under she control of-local planning, - zoning,. ,�/� or other oificials,-crdinances? ........... /vo �2. 1-1 so, have plans been to such :authodties ? .................. .• _ 1/ 11- �.1 .. 1 • • • L - 'as preliminary approval been 'gran�ed by such -authorities ? / Date Granted: 11V Type of Sewage Disposal. Sysle -m Discharge...... Surface Water t,�Grdund Watei 15• 'f surface water discha -roe, chat is the stream class designation ?........ "U :6. 'haters index number (surracb) ............. _.......................... �. Is project located near a'public Mater supply system? ................. 3 'f Yes, narle o; water supply Distance to water supply project site near a public sewage collection or disposal system ?..... g. Name of sewage system /// Distance" to sewage system S • Date observed: 23. Name of Health Inspector: • Pro' ect design "low (gallons per day) ..................... ... i .......... . 60 0 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.._ /v o 26. Has SPDES: Appl ication been sut itted to •Local DEC - Office? 27. Is any portion of this project located within a designated Town or State wetland ? ........ ......................... ............................... a 28. Wetland ID , lumber .......................... ............................... 29. -Is Wetland Pe „it.• required?' .............. ..:............................ —A has application been made to Tewn or Local DEC Office? 30. Does project require a DEC Stream•Disturbance Panit? ............... 33. ?s or was project site used Tor agricultural activity involving application. O pesticides to orchards or other crops, solid or hazardous waste' disposal; fi 11 ing, sludge application or •industrial acti`rity? .. - .. YES or No /Vc 32: is project located--within 1.-,000--Feet of existence of abandoned` landfill, hazardous waste site, salt stockpile, landfill,.sludge disposal site or 1J any ether potential kno n•s'curce of ccntaninaticn? ....YES or No' - _ - _...... _, _ J 33'. 1s •tbere a local n2ster plan or file - with: the Town or Village? . 34.- Are cor,:;:0nity: water, sewer facilities planne -d i o be developed within i5 years? 35_ Are a6y sewage disposal areas-in excess of 15-- slope? ......................... 35. Tax Nip ID t;u,_,ber ............ ..... ......:. ' 3 � : —��J 37 -Approved Plans are' to'•be returned to: ..... . .......... ApP� icant y' Engin the application is signed by a person Other than ttie. applicant shown in Ite:�.1, the: 'cplicat"on rust be•acca�,paniad by •a'Letter of Autherizayicn: Failure to cc:mply with th• provision ray be -grounds for the rejection of any sub{nisslon. .i hereby a-`firm, uno'er penalty o;` F -_rjury -- that info JJ at ion pr•cyided on this form., is true to the best of my knculedce and belief. False stat6-7rents made herein are punishable as a Class A Hisde:7eanor pursuant to Section 210.45 o;" t� e Pena 1 Law, IC;;Ai I;RES OFFICIAL TITLES J LING ADDRESS: _.PUT'NAM COUN'T'Y DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET- )SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner /��� ✓� ;R�� �' vsrer_2n, AV4rC �Mdress Rd• Ar enl Cio.,,d �3:� l►/Y �/,7 , r Locatea at (Street) 'e „,/ & ye A17"j,.5o i Sec. 3 L/ Block 2- Lot (idaicate nearest cross street) Municipality ��p,�,�,,,, Watershed SOIL.PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre - Soaking Date of Percolation Test / -may - 9 - L�I /0 2 /�'o - is = ?> HOLE y. ;?3- �S �r NUMBER CLOCK TIME PERCOLATION PERCOLATION ” 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 Inches Inches Inches 5 2 /�'o - is = ?> �)^ y. ;?3- �S �r .�6.-7 L 5 1 42:d14 :3� �y..' �S �r .? /.S L 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 mk TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G. . L. 21 31 Y-e— y ✓eo y 41 51 61 7' 8' 91 10, 121 131 14' INDICATE LEVEL. AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH VATER LEVEL RISES AFTER BEING ENCOUNTERED V /_4z DEEP HOLE OBSERVATIONS MADE'BY: DATE: DESIGN Soil Rate Used 21-3c) Min/1" Drop: 'S.'D. Usable Area Provided No. of Bedrooms Septic Tank Capacity /00c, g-61s.' Type Absorption Area Provided By ��Oc) L.F. x 24" Width trench Other '21 /,// - - - Name Signature . . . .... N I CP Address -% SEAL P1 r ,111ow- Aerlekec)v�Cfr All lr,?.F '1111-6--bPACE -FOR USE BY HEALTH DEPARTMENT ONLY: sF N9. _51 1?1. 00- Soil Rate Approved sq.ft/gal. Checked by Date 0' I First Floor Ul DINING ROOK t ' "cNEN 1.I1 .G' X IS' -O' KI+ 16' ; Ems: �� r1 a _I fl. _ r _ c.) L14 .a r r 2T 8 N �} r \•- LIVING R O O ld .� FtaSTEFr BEOROOF! ,_,�,� _ �• � + 1 1,\ STANDARD D ��D �EVV FOUNDLAND FEATURES Luxurious First Floor Master Suite - Fireplace Options Available • Compartmentalized First Floor Bath with Consult an authorized V'Jestchester Builder • . Two Separate Vanities for a Complete List of Options • Formal Entry Foyer • A.Ilstls ren�er;ncs and FloDr Plan Dirrnsions are «,;iSCa Jo: rs n+USt'tP_ vvr; en irl hr ap�rcr�,.ate. i,;l ._ • Formal Dining Room Contrac-L No oral co, K5iz;ons. • Formal Living Room • Spacious Eat -in Kitchen ESTCHESTER ODULAR OME�S[ �C. Reagan's Mill Road �Yjngdale, NY 12594 i. (914) 832 -9400 • (800) 832 -3888 ca r-C H i ., I •ri to I 3 _ PUTNAM COUNTY DEPARTRENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES J Re: Property of. YGti id Located at D 1i Section ��/ Block 2 Lot �O (T) Subdivision of �,✓ 1 �Q Filed 114an 1 Date L, Subdv. Lo T _ Gentlemen: // I This letter is to authorize arm T, a duly licensed professional engineer X or registered architect (Indicate) to apply for a Construction Permit for a separate ses. *age system, .to serve the above no property in accordance sai.tiz the standards, rules• or. regulatiori s..as, promulagated by . the Commi.ss.ioner of the Putnam County Department of Fiealth', aid to sign. a11. necessary gapers on my :behalf. in connection jYith this matter and to supervise the construction of said system or systems in conformity -with- -thy =N o ^ z5t. o .I�s,-- _o.f_::arti cle_1- 5�_.Qr. 147, Education Law, the - Public Health Lau,, j and the Putnam County Sani- tary Code. Countersign P.E., R.A., Millbrooke Office Centre Address Brewster, NY 10509 914 - 278 -6108 Telephone Very truly yours, ti Signed / %mer of Property , ddress �1 Telephone - Fiitnam "aunty Department of Health Divisior; .'.f Environmental. Sanitation AFFIDAVIT - CORPORATE a4NER APPLICATION . FOR PERMIT. A.PPL,ICAT. -IOXt SI;E.1 TAD TO' PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health - In the matter of application for 4 . -- represent. that .x am an officer or employee_ of the corporation and am. authorized' to act for. P r ' (name of corpo tion'- having offices at -� �P � ab Pofvo - - - - - - _ ._. _ Whose officers -are President - �G'S•E� /f /%%� -. -, /� ^ , - - _ tame ana- TddreSS) _• ` -' -' - Vice President - • (Name and _Address) - _ c Secretary (Nam and Tddress)- (Name and dress), r and that z= am -and w�.11 be individually responsible fort any' or all a�tp� of. the- corporation with respect to the approval requested and all •sub- sequent acts relating -thereto. S orrk to before me this •�y day r . // .. y .Signed o f c`�t''j b�{_ 19�t3 Title ' .Notary Pull ic' J BONWE N=ARY PUBLIC, e — — QUAURD, !:2 [ T; ffi GGE��i�ISS !Qf <t.7.5'•'ilics�,.:c. ��,�? . Corporate Seal I LAURENT ENGINEERING Ap§PCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road Brewster, New York 10509 RANDOLPH W. LAURENT. P.E. (914)278-6108 - (FA)) 278 -2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS January 19, 1995 Mr. William Hedges Putnam County Health Dept. 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Lot #10 Fair Street Subdivision Windsor Oaks Highview Drive Town of Patterson, N.Y. Dear Bill: Enclosed are the following: 1. Four (4) prints of Drawing SS -10 "Proposed SSDS", dated 12 -3 -94. 2. "Application For Approval of Plans For a Wastewater Disposal System ". 3. "Construction Permit for Sewage Disposal System ", dated 1- 18 -95. > -- 4., -to- Construct a- Water Wall'- ' y dfl�Ed i•. 1V� �.�.�._.._.. . -. 6. "Design Data Sheet ". 6. "Letter of Authorization ", dated 1- 18 -95. 7. "Corporate Affidavit ", dated 6 -3 -93. 8. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only ". 9. Check in the amount of $300.00 for Review Fee. Kindly review the enclosed items and contact us with your comments and /or approval at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. 1.tr Ha ry W. N'chols, Jr., P.E. HWN:bd 94103 cc: Mr. J. M _rra- w /enc.