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01502
V
'OUNTY 6EiiIhMkNT OFEMUIEt'
PUTNAM C
i.
ARev. 3186 slon of Environmental Hesith'services., Carmel, N.Y . 16512.- .'Engineer to Provide, Permit
'R sl
on CERTIFICATE OF -�G
A
ONSTRP0rNPERMlT FOR S DISPO AL SYSTEM Permit N
owl
A
lAcated at M u LLE f F4 ni
Subdivision Nam Subd. Lot TaX Map_'I -5 BI Mt
Renewal-0 —Revision —0
6wilier/ApplIcantName'
Date of Previous Approval
Malft Address Ole) AE-'F-I -A NJ _E,,e-AL. �EV5L, To. ZIP
Tc_
Building Ty, Lot Area
FM on o* D-pth)WI volume
PCED Notification Is Required When Fill Is completed
Number of Bedrooms Design Flow G/P/D is
Separate S 'pverais System to consist Gal n Septic Tank an d
To be constructed by -rn k�lst zSt� M I Address
W ater S P13'.
UP Ptibllc $npply From Address
or
p sil L
Other Requirements is tzs
I represent rn,wnolllyand.�omol.tely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal ,system
above dim'!h:, 11 be'constructed as'sho�vn on, t . he . approved amendment there. to and in accordancewith the standards, rules and re
hoC9ula!:i5,nsoV Ine. r4xnam
County Depart,mpqt, of , H"ffh; that on completion therero a "Certificate of Construction Compliance" satisfactory to or" r rr� .nor of Healthwill.'
be iubmittedjo the:De 'partment, an d r 'a written guiiante a will be furn*ished the owner, his successors, heirs or assigns by the builder, that said.bulider,will
place in good operating . c0dition ariy., part of - said. sewage disposal syit . em during the period of two (2) years immediately following the date of the' issu-
ance of the approval of the Certificat• of Construction Compliance of the original system of any thereto; 2) that the drilled well described above
will be located as sh6Wn.on the approved plan and that said well will be inst '. i . with a standards, rulq and rag—uraT—ionsol" the Putnam
County Department of
Date
.7 Rtfl S ignewd P. E. R.
A.
0. . Address
\A PPRO FOR 9ONS.'RUCTION- This approval expiresone
y"ocabie�foor b
taus or may PI or modiiied when c6nside
uires. a new it.- A r disp6sal of domestic' son
By
,X
F
License No J
le- date- issued unless con ruction o f t ie building has been undertaken and 1
;y, by. mm� ,r f Health. Any charnor alteration of construction /ly
e'. an r i t supply only.
TRANSMITTAL # 7
T(.): Putnam County Health Dept. Date: July 17, 1986
County Office Buildinq Job #:
Two County.Center
Carmel, NY 10512
Attn: Mike Budzinski
Subject:. Burdick Glen Lot #5 - Fill Permit
The following items are herewith transmitted:
Attached Separate Cove_ Q Delivered
ITEM COPIES DESCRIPTION.
1 1 Construction Permit
2 1 Letter of Authorization
3 1 -Design Data Sheet
4
For: Q
Approval _
Q
Review and Comment
Q
Record
Q
use
As Requested
Other
Remarks: Resubmitted for 4 bedroom design
C File Signed: t d
J. Robert Folchetti & Associates m
F. O. Box 374
%R hone # (914) 279 -3155
Ecewster, NY 10509 -0297 279 -3346
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01
.-PUTNAK'COUNTY DEPARTMENT OF H13 ALTH
DIVISIW; W -ENVIRONMEN'kAL HEALTH SERVICES
Date March •25 1986
Re.: Property o f,7 Horizon Construction
Located at Bullet Hole Road
(T)Patterson
Section. '73- Block 3 Lot 29
Subdivision of Burdick glen
Subdv. Lot. # 5 Filed Map.# Date
.ntlemen:
Thi.s.le.ttor is to" authorize J: Robert Folchetti & Associates
:a duly': licensed professional engine.er. X or registered'architect
t.(.) apply, for` a- 6 ,i s t r uc' on Termit for.a separi.-ite sewage,_system, to
so'r ve the. -a'dv
e,-#Oted.property in accordance w-ith the standards, rules
o: °. regulations
egulation -a- omulag
-pr s 'ated by the Commissioner of the Putnam County
.
Dopartment,-of Heaiih. and to sign all necessary papers on my behalf in
C(",zxiiectio,n',with -this matter and, to-supervise the- construction of said
s,,,,4tem or sy6tem#,., -3.n conformity with the provisions of.Article 145 or
.V 7, Educdiion.Law., -th-e.7,Public Health Law, and the Putnam County Sani-
Aor I Code
..y
Very truly yours,
Si
Ccuntersigned
�1011
P:E01 R*A.,, e051011
P. b. Box ,374
Telephone
rto�r of Property C/.
F Ian Realty & Development Corp.
Rnni- Avenup.
Address
Brewster, NY 10509
Town
(914) 278-2111
Telopho-ne
V21
PUTNWA rOUNTY
DEPT, OF HEALTH
-'FUTNAM COUNTY DEPARTMENT OF HEALTI
DIVISION OF ENVTRONMENTAL HEALTH SE'NICES
COUNW OFFICE`BUILDING, CARMEL, N. Y. 10512
)ESIGN :DATA SHEET SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
lwnexr, i-lc „r��.1 C'.r�ry 4 °ncr:_1 Addresse AAw -t=Ayj4 , •gip
i;ocated at (Street Sec. 3lock_ ,V Lot s
'Z Vie. nearestross s ree
n
!�un3.cipalityT4 -� .1.'r�i
Watershed
SOIL PERCOLATION TEST-DATA REQUIRED TO BE SU3MITTED WITH APPLICATIONS
Ble
:Number CLOCK TIME PERCOLATI V PERCOLATION
apse p o a er
water ve
Not Time. From Ground Surf:Lce in Inches Soil Rate
Start -Stop Min.. Start Stop Drop in Min. /in drop
Inches Inch s Inches
Notes: l) Tests to be repeated at same depth u itil approxi. t �equa1
rates are obtained at each percolation test ho i_e ..All date3
for review.
2) Depth"measurements to be made from t)p of hole.
PU �'g'��3��ti t,;;,;�7,pN . �,
(DEPT, OF HE ALTil]
2
°I Z 2 -�_q 2ig
j U
1
2\
21
-- f 3
�+
era a ..:,��
��.
L
3
5
2
`Y'S7 �o v b
Vic:'
�::1
`G,'';
3
6,
Notes: l) Tests to be repeated at same depth u itil approxi. t �equa1
rates are obtained at each percolation test ho i_e ..All date3
for review.
2) Depth"measurements to be made from t)p of hole.
PU �'g'��3��ti t,;;,;�7,pN . �,
(DEPT, OF HE ALTil]
i
::. .
,
CNDZQA!t'EI ;�k T; °��A
C �.yRT►
Y4MMIO�, t�RI
I
�- ITCH Gk�4 ND WATER `IS'
WHTCH WATEF3 'LT�L RISES
, I
:EIVCOUNTM ED
AFTER EINa ENCOUNmFR'D
yTp
Da ..
tl
So�:�:'.#�ate: Usedl
o •
Abs
u Ni�nfT'!Drops
0 •. �k Capacity
By ti�ox2%+
s. D. .Us ble 'Area Provided
Qals .
widt
_ �.___,_.
(��'aw r '
04 W S 1 0 1
ONLY : �`� ,'• ''�
ChocV 3d
aNiV� ��I
��RGtlff7Pl � �/�T "rs�m.. _•__ _
THIS.; $PACE FOR
So11:.,.Rall :A 1?rovod
ra
USk. ]3X .:I£'ALTT DEPARTMENT'
;• Sq. Ft/Ml.
" '•,� may:.
C2. C1,100
PUT NAM r, 0
9EPT., OF HE.' ad � r
e(G t U.':t n7f {•t
r"',
.j � I/ � f^t '�•' .,.,, �•?'�. +. i:,
.
r,•e
satrM' -merx earmn1k,'rors.ia'r
1":i�rtmi"'n
r:Y.
e
Putnam County Department of Health
Division of Environmental Sanitation
AFFIDAVIT CORPORATE OWNER APPLICATION
FOR PERMIT APPLICATION SUBMITTED TO
PUTNAM COUNTY HEALTH DEPARTMENT
TO: Commissioner of Health - In the matter of application for
_ Burdick GlerL _ 1�LQtp— . L,— 'L and. E _ — _ _ _ _ _ _
I, _ Ed Heelan ---------------------
, repre &ant
that I am an officer .or employee of the corporation and am authorized
to act for Horizon Constructio- n
_ _ _ _ _ y ----- _ _ _ _ r _ _
(name o corporation)
having offices at
Whose officers are
President _ _ _�(,� — _� � � °"`"!_' /`!• "
ZName a d Address) _
-Vice- President;_ __
me and Addr ss�
/ (Na e )
Secretary — — — — r` --DIJ_ D_2ZA _ �_ ��!��*'�� —Lam•
(Name and Address) _
Treasurer _ { ---
_ (Name and Address) _
and that I am and will be individually responsible for any or a ac
of the corporation with respect to the approval requested, ind
sequent acts relating thereto.
Sworn to before me this day Signed
of 19 Title
NojWry Public
RICHARD I. GQl_DSAND
Notary Public, State of New Yo
No. 61573920
Qualified in Putnam Cry. No.
Term Expires , 7 9
jzfo_ 31
Corporate Seal
ENVIRONMENTAL ENGINEERS
P.O. BOX 29, P#tE NEW YORK 10509
DEP.j. 0� tAEALTH
9Ep�
Mr. John Karell, Jr., P.E.
Director of Environmental
Health Services
2 County Center.
Carmel, NY 10512
Dear Mr. Karell:
May 5, 1986
Re: Burdick Glen Lots 1, 5, 7, 3
(914) 279 -3346
This letter is in response to your comments of April 24., 1985.
Lots 11 5, 7 -- Fill Permits only
1. A signed authorization was filed for each lot. A
corporate resolution has been requested from Horizon
Construction.
2. Two sets of house plans were filed for lot 7 on April 22.
House designs for the other lots have not been determined
except the bedroom count has been established at 3. These
applications are for fill permits only, and a second design
application will be required. It is requested that these
lots be approved on the condition that house plans are
submitted with the design application.
3. The number of bedrooms is shown on each permit application.
At your suggestion it has been added to the plans.
4. A key has been added.
5. Fill section _slopes are shown on the details.
Lot 8
1. Top and toe lines have been added.
2. The septic tank size has been increased from the allowable
of 1,000 gallons to 1,250 gallons.
C
Mr. John Karell
-2-
May 5, 1986
3. a. .See lot -1� :5,. � - #1.. - - _.._._ .-,- _.,. __ - .._ _ _...,_r . _ .
b. A key has been added.
c: The slope of the fill section was already shown on the
detail.
We trust that these changes are sufficient to permit approval of
the applications.
Thank you for your cooperation.
Very truly yours
f
Aj. Robert Folchetti, P.E.
JRF:ks
cc: File
Attachment: 3 copies each -- Plans for Lots #1, #3, #5, #8
DAVID D. BRUEN
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
April 24, 1986
J. Robert Folchetti, P.E. & Associates
P.O. Box 297
Brewster, New York 10509
Re: Proposed SSDS's
Burdick Glen
(T) Patterson
Dear Mr. Folchetti:
JOHN SIMMONS. M.D.
Deputy Commissioner
Review of plans and other supporting materials received
relative to the above - captioned projects have been completed
.with comments offered. as .follows:
J Lots #7 5,1
1. A co.rP
. orate resolution must be filed authorizing the
applicant to act,on behalf of the corporation..
2. Two sets of house plans are not provided
3. The number of bedrooms proposed does not appear on the
plans
✓ 4. A key to the deep hole /percolation hole designations
is not provided.
5. Fill section must slope from top to toe 1:2.
Horizontal distance between top and toe for a 4 foot
fill section is 8 feet, five foot, 10 feet, etc.
Lot #8 \
1. The extent of the fill top to toe is not shown on the
plan drawing.
2. A 1250 gallon septic tank should be provided
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
2;
J. Robert Folchetti, P.E. & Associates April 24, 1986
o . 3. See comments 1,4 and 5 above
.Upon receipt of submissions revised to reflect the above
comments, these projects will be considered further for
approval.
ve t r r
JIhn Kare 11 91 r. P.E.
D rector,
JK:pt Environmental Health Services
c c J K
File
SUPPLY & SUBSURFACE Ste+
REVIEW SHEET - QoNSTRUCTIaLV PERMIT
(Name of Own )
cams
DATE REVIEWED:'Z a
BY: �J �
DOCUMENTS
Permit Application lo '7 3
Corporate Resolution
Plans -.Three sets 5� f
Engineers Authorization
Design Data Sheet (DDS)
Deep Hole Log
.Consistent Perc Results (3)
30" Perc Hole �J�
Other
House Plans - Two sets 3 a ✓
If PWS — Letter
"Variance Request
REQUIRED DETAILS ON PLANS
Sewage System Plan
Sewage System Hydraulic Profile - Gravity Flow
Fill Profile & Dimensions - Volume
D or J Box;Trench /Gallery; Pump pit details
Septic Tank - Size, Detail
Well Detail, Service Line if over
Construction Notes
Design.Data
Two -Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footing/Gutter Curtain Drains
Perc & Deep Holes Located
Representative of Sewage & Expansion Area
Expansion Area;shown;gravity flow,suff. size
_ If Punhed. Pit &, D Box Shown & Detailed
iled
House - No. of Bedrooms
Wells & SSDS's w /in 200 ft. of Property Located
Property Metes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4" /ft. 4 "0; Type pipe
No Bends; Max. Bends 45" w /cleanout
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L., Driveway, Large Trees
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. expan)
15' to Drains- Cartain,Storn,Leader,Footing
25' to Catch Basin
10' to Water Line (pits -201)
Septic Tanks
10' from Foundation
50' to Well
15' Well.to PL
GENERAL
Legal Subdivision
Subdivision Approval Checked
Etc- approval SSDS Adj. Lots Checked
Wetland (Town/DEC Permit R & D)
Data On DDS Plans & Permit Same
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;
TRANSMITTAL #- 1
To: Putnam County Health` Dept .,APr: _.;_::, .. 86 ..
County Office Building Job
Two County Center
Carmel, NY 10512
Attn: Mike Budzinski
Subject: Horizon Construction Fill Permit t- (ra 44
The following items are herewith transmitted:
Ex_-/ Attached
Z Separate Cover /_ / Delivered
Item
Copies
Description
1
1
Construction Permit _
2
1
Letter of Authorization
3
1
Sheet
4
4
—Design-Data
Drawings - Septic Sygt m
1
SSDS P1 n
For: L X j Approval
L/ Use
/ Review and Comment
Record
Remarks:_ Two copies of House Plans to follow.
As requested
Other
CC: Mr. Ed Hee lan
File Signed:
j
J.'Robert Folchetti & Associates Telephone # (914) 279 -3346
P. O. Box 374 279 -3155
Brewster, NY 10509 -0297
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date March 25, . 1986
Re: Property of Horizon Construction.
Located at Bullet Hole Road
(T) Patterson Section 73 Block 3 Lot 29
Subdivision of Burdick Glen
Subdv. Lot # 5 filed Map # Date
Gentlemen:
This letter is to authorize J. Robert Folchetti & Associates
a duly licensed professional engineer X or registered architect
(IndicateT_
to apply for a Construction Permlt for a separate sewage system, to
serve the above: -rioted property in accordance with the standards, rules
-
or�rpgulation . s 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, the Public Health Law, and the Putnam County Sani-
...tary Code.
Very truly yoursi
s'
y
0 P
truly yo Property
Sign 4d of Property C/
CountersigipLed- Realty &
He lan Realty & Development Corp.
P.E., R.A., 051011 Root- Avenue
Address
P. O. Box 374 Brewster, NY .10509
Address. Town
Brewster, NY 10509 (914) 278-2111
Telephone
(914) 279-3346
.Telephone
PUTNAM COUNTY DEPARTMENT OF HEALTH
` DIVISION OF ENVT.RONMENTAL HEALTH SERVICES
COUNTY .OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner Address
Located at (Street Sec. Block Lot ...sue
6dicate nearer cross street
Municipality.. Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
apse Depth to Water a er Level
No. Time From Ground Surface.in Inches Soil'Rate
Start -Stop Min. Start Stop . Drop in Min. /in drop
Inches Inches Inches
1 �Ra SLAV
5 G - 3 10iO lboo 3,31
5
Notes: 1) Tests to be repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole. A11 data to be submitted
for review.
2) Depth measurements to be made from top of hole.
2
3g
/d vd
I
1
IPA
03
6,2)
4
1- 47-0
k
3
6, 3
5
/0! ;L ° J C'39
19
119
k
6,0
6/3
S�
3
Jo;/ 7 -035" '
i
1 �Ra SLAV
5 G - 3 10iO lboo 3,31
5
Notes: 1) Tests to be repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole. A11 data to be submitted
for review.
2) Depth measurements to be made from top of hole.
REQVIAED -TO d-BE, .STJBMITTED ,WITH APPMOATION
ON .4 SOTL3 YENCOUNTF�D -TN ,TEST HOLES
INDICATE LEVEL AT WHICH GROUND WATER IS.ENCOUNTERED
INDICATE LEVEL T0.WHICR.WATER LEVEL RISES AFTER BEING ENCOUNTERtD
TESTS MADE BY Date
- -- D—
Soil Rate Used C-- 0 Min/1 "Drop: S.D. Usable Area.ProvidedSSC2 -1L
No. of Bedrooms 3 Septic Tank Capacity 1000 Gals.
Absorption Area Pro` vlded By 333 L.F.x24" �`�b�"� d'�
`l�'sRul3 r� 1 1 5 >,
Address SEAL
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: �S Soil Rate Approved Sq. Ft /Cal. Checked by
i
1
Dom..
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF
SOILS ENCOUNTERED IN TEST HOLES
DEPTH .
HOLE NO.. � r
HOLE NO. HOLE NO.
G.L.
-
6"
., w V\) LJA� _.
12"
TAyJ Y14t
18 11
,I�-�
24"
Mot s— ✓�
3011
i nc�c A aZy"
r-►4 Y � a�
36„
y
42"
48"
54 it
d 1-0dr- 61rCA H
60"
SwAD
66"
72"
78"
8411
INDICATE LEVEL AT WHICH GROUND WATER IS.ENCOUNTERED
INDICATE LEVEL T0.WHICR.WATER LEVEL RISES AFTER BEING ENCOUNTERtD
TESTS MADE BY Date
- -- D—
Soil Rate Used C-- 0 Min/1 "Drop: S.D. Usable Area.ProvidedSSC2 -1L
No. of Bedrooms 3 Septic Tank Capacity 1000 Gals.
Absorption Area Pro` vlded By 333 L.F.x24" �`�b�"� d'�
`l�'sRul3 r� 1 1 5 >,
Address SEAL
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: �S Soil Rate Approved Sq. Ft /Cal. Checked by
i
1
4-4hich ilia attached)'.an'd in' acco
Putnam County Department• f HealEh'.
oate 20'`' id er 1,4
Any person occuDYlhg premises serve)
Condition -s resultI." rom`such usage
a'valliblq and ths; approval of the, pri!
suti)ect _tto* -m*' difiutlori o►; change %
i
rA
f7
DEPARTMENT OF HEALTH
----Division Of -Eniirbrimdrital- Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
i1WELL LOCATION
STREET AOURESS. TOWNIVILLMICH! TAX GRID NUMBER:.—
A" LIZ-,
. . . . . . . 73-3-29
WELL OWNER
NAME. ADDRESS:
A ;V6 11
9PRIVATE
0 PUBLIC
USE OF WELL
1 - primary
2 - secondary
e(RESIDENTIAL ❑ PUBLIC SUPPLY ❑ -AIR /COND. /HEAT PUMP 0 ABANDONED
❑ BUSINESS 0 FARM - ❑ TEST/OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY ❑
AMOUNT OF USE
YIELD SOUGHT A7 gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE j52L gal-
REASON FOR
DRILLING
NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY.--` : ❑ TEST /OBSERVATION
O.REPLACE EXISTING SUPPLY. ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL'OEPTH K _ft-
STATIC WATER LEVEL v ft.
FDATE MEASURED
DRILLING
EQUIPMENT
❑ ROTARY 9'COMPRESSED AIR PERCUSSION 0 DUG
❑ WELL POINT- El CABLE PERCUSSION 11 OTHER (specify):
WELL TYPE
0 SCREENED .0 OPEN END CASING. OPEN HOLE IN BEDROCK ❑ OTHER
CASING
TOTAL LENGTH ft-
MATERIALS: FSTEEL ❑ PLASTIC 0 OTHER
LENGTH.BELOW GRADE tL
JOINT R
.0 WELDED THREADED 0 OTHER
DETAILS
DIAMETER in.
-S:
SEAL: ❑ CEMENT GROUT ItSENTONITE 0 OTHER
WEIGHT
PER FOOT Z 1b./ft.
DRIVE SHOF' 9YES ❑ NO I LINER:OYES NO
SCREEN
DIAMETER (in)
'SLOT SIZE
LENGTH (ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST .
OYES ONO
HOURS
SECOND
GRAVEL PACK
C1 YES
0 NO
GRAVEL
SIZE:
DIAMETER .
OF PACK in. I
TOP
DEPTH tL
BOTTOM
OEM — It.
WELL YIELD TEST If detailed, pumping
METHOD: 0 PUMPED 1 tests were done is in-
IfCOMPRESSED AIR formation attached?
0 BAILED C1 OTHER OYES ONO
It more detailed formatiori.,descriptions or sieve analyses
'WELL COG are available please attach.
FROM
DEPTH FROM
SURFACE
Water
pear-
ing
Well
Dia-
meter
FORMATION DESCRIPTION
COOS,
tt.
ft
WELL OEM
ft,
DURATION
hr. min.
DRAWOOWN
ft.
YIELD
gpm.
surface
V
_T70
L
46
WATER &(CLEAR TEMP-.
QUALITY 0 CLOUDY HARDNESS
0 COLORED ANALYZED? 0 YES ONO
ANALYSIS ATTACHED? 0 YES 0 NO
STORAGE TANK TYP E—Cid-im-C-)
CAPACITY 0-6 (,*,,jjbA D k&,,,;4GAL.
"*A17 & SONS, INC. DATE
ADDRESS Well Drilling S1011MRE
Rte. 311 R.R. 2 Box 171A
PATTERSON, NEW YORK 12563
PUMP WFORMATION
TYPE & CAPACITY -7 — c'
MAKER DEPTH
HP
MODEL le VOLTAG&j3V_ Hp
rA
f7
• 1 LAB # 93.007554
Yorktown Medical Laboratory, Inc.
321 Kear Street Date Taken: 8/i8/88 Time: IOpm
Yorktown Heights, N. Y. 10598 Date Rc' p d: .._ . . _ . . .Time.:
- -
lA88
Director: Albert H. Padovani M. T. (ASM
Collected By: u van
Referred By:
T- SULLIVAN, KATHY
BULLET HOLE RD.
PATTERSON,NY. 1256q
L
-1 Sample Location: Kitcrlen
J
LABORATORY REPORT ON THE QUALITY OF WATER
INORGANIC NON- METALS (mg /L)
Acidity
Alkalinity
Chloride
Detergents, ?,;BAS
Hardness, Total
Nitrogen, Ammonia
Nitrogen, Nitrate
Phosphate, Total
_ Sulfate
_ Sulfide
Sulfite .
METALS (mg /L)
Phone N t7t .-
Phone N Sample Type:
Repeat Test? _ (check one)
MICROBIOLOGICAL (CFU /100mL)
GENERAL BACTERIA
Standard Plate Count '44o
(CFU /1.OmL)
MEMBRANE FILTRATION TECHNIQUE
�( Total Coliform C
Fecal Coliform
Fecal Streptococcus
MOST PROBABLE NUMBER TECHNIQUE
Copper
_ Iron _ Total Coliform Index
_ Lead
_ Manganese
_ Sodium KEY FOR TERMINOLOGY
Zinc CFU = Colony Forming Units
MISCELLANEOUS
pH. (units)
Color (units)
Odor (TON)
Turbidity (NTU)
N/A = Not Applicable
LT = Less Than (<)
GT = Greater Than ( >)
TNTC= Too Numerous To Count
CON = Confluent ( =TNTC)
NR = Non- reactive
Potable
Non - potable
STP INF
STP EFF
Other:
Sample Status:
(check each)
Outgoing
.— HNO3
_ HC1
H2SO4
NaOH
ZnOAc
Na2S203,
Other:
LE
b °C
GT
h0C
pH
LE 2
_ pH
GE 9
pH
GE 12
_
_ Other:
REMARKS /COMMENTS'•(For Lab Use)IELAP #10323
THESE RESULTS INDICATE THAT THE WATER SAMPLE WAS (WASN'T) (N /A) OF A
SATISFACTORY SANITARY QUALITY ACCORDING TO TH YORK STATE DRINKING WATER
STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTIO .
THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DIDN'T) (N/ MEET THE
SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STA E D NKING WATER
CODES ,/P` R TH,F, PARAMETERS TESTED, AT THE TIME OF COLLECTION.
/x/ 1
klb-er
Yadovani, M.T. (ASCP), Director
2/86(RvsdT /87)RWE
PUTNAM COUNTY DEPARIMENr OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Cathy & Peter Sullivan
Owner or Purchaser of Building
Owner
Building Constructed by
Bullet Hole Road
Location — Street
Patterson
Municipality
Frame
Building Type
73 3 29
Section Block Lot
Burdick Glen
Subdivision Name
5
Subdivision Lot #
GUARANM OF SUBSURFACE SEWAGE DISPOSAL SYSTEM
I represent that I am wholly and completely responsible for the location,
workmanship, material, construction and drainage of the sewage disposal system
t- .._serving the above described property, and that it has been constructed as shown on
the approved plan or approved amendment thereto, and in accordance with the
standards, rules and regulations of the Putnam County Department of Health, and
hereby guarantee to the owner, his successors, heirs or assigns, to place in good
operating condition any part of said system constructed by me which fails to
operate for a period of two years in-mediately following the date of approval of the
"Certificate of Construction - Compliance ".for the sewage disposal system, or any
_..____._ _._.... repairs -ode- by--me- to- sueh-system;- except--where --the--failure -to, operate -properly' -is--- -' ---..__w
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 Environinrntal Health Services of the Putnam County
Department of Health as to whether or not the failure of the system to operate was
caused by the willful or negligent act of the occupant of the building utilizing
the system.
Dated this 20 day of Oct. 1988
4
General Contractor (Owner) - Signature
Corporation Name (if Corp.)
Bullet Hole Rd., Patterson, NY 12563
Address
rev. 9/85
mk
Signature ALOE h Al
Title
Corporation Name (if Corp.)
Bullet Hole Road, Patterson, NY 12563
Address
I,-
O*q
_-., -1-
IV.
V.
VI.
FINAL SITE INSPECTION
.;CATION� .4CdtOAjM
Date
Insppct by
bA Ai'QO-kij-6jVN
Tm # OR sumivisim LcT # -7 .5 - 3
NO CCMMENTS
DISPOSAL ARFA
a. SDS area located as per app roved plans
b. Fill section - Date of placement 3CO C %A
2:1 barrier. LGM WIDTH �AGGXPTH
c. Natural soil not stripped
V/
d. Stone, brush, etc., greater than 151 from SDS area.
e. 100 ft. fran water course/wetlands.
SEW-AL -E DISPOSAL SYSTEM
a. Septic tank size ti1 00 � 1,250
b. Seotic tank installed level
c. 101 minimum from foundation
d. No 90' bends, cleanout within 10 ft. of 45' bend
V/
e. DISTRIBUTION BOX
1. All outlets at same elevation - water tested
2. Protected below frost
3. Minimum 2 ft. original soil between box and trenches
f. JUNCTION ]BOX --properly set
g. MRENCEES
1. Length reauired - 333 Lena -h installed
2. Distance to watercourse measured. ft.
7"
3. Installed according to plan
4. Distance center to center
v
5. Sloce of trench acceptable 1/16 - 1/32 "/foot.
6. 10 feet fran prccerty line - 20 feet - foundations
7. Depth of trench < 30 inches frcin surface
8. Roan a-Ilcwed for expansion, 50%
9. Size of gravel 3/4 - 1 '§ diameter
10. Depth of gravel in trench 12" minimum
11. Pipe ends capped
h. PUT OR DOSE SYSTEM-9
I. -Size-of--purp
2. Overflcw tank
3. Alarm, visua;Afi;dio
4. Pump ta�s accessible manhole to grade,
5. First,-bbx baffled
6. P7d!e witnessed by Health Departnent
--' estimated flow per cycle
HOUSE
a. Hcuse located per approved plans.
X
b. N=ber of bedroans
L/
WELL
a. Well located as per approved plans
b. Distance fran SDS arL-;; measured ft.
c. Casing 18" above grade.
d. Surface drainace around well acceptable. IV
I
OVZRALL WOREMASHIP
a. Bcxes properly grouted
b. All pipes partially bar-kfilled
c. All pipes flush with inside of box
d. Bar-t-,fill material contains stones < 4" in diameter
e. Curtain drain installed according to plan
f. Curtain drain outfall protected & dir.to e-xist.watercoursE
g. Foctinq drains discharge away fran SDS area
h. Surface water 2rotecticn adequate
i. F-r--csion controi provided on slopes greater than 15%.
4-
PUTNAM COUNTY HEALTH DEPARTMENT
~ DIVISION OF ENVIRONMENTAL HEALTH SERVICES
John M. Simmons, M.D.
Deputy Commissioner of Health - FIELD ACTIVITY.REPORT - Sheet of
��� INSPDCTION
NAME Orig. Routine
Orig. Canplain
ADDRESS `(� QA LAyt-& dd pa ; elq 7.� -a9 _ Orig. Request
No. Street Towir TH No. Campliance
vw, � Complaint Camp
MAILING ADDRESS Final
P.O. Box Post Office Zip Code Group Illness
Construction
TELEPHONE
Reinspection
PERSON IN CHARGE Field, Sampling Only
OR INTERVIEWED Field Conference
Name and Title /
Other .
DATE TYPE FACILITY
TIME - ARRIVED TIME LEFT lain
FINDINGS:
INSPECTOR: �G�/LC� [.fA�� TELEPHONE:
Sianature and Title
PERSON IN CHARGE OR INTERVIEWED:
I acknowledge this Field Activity Report. SIGNATURE:
6/86 TITLE:
� c-�:, m- N°r*"$+,+.T. _n �,� r r� .,• �,, s+� � � -. ,'.�' � h*--"F'" {�"i ' r may+ �, � rr�Y*�-,�r.-- f�-rt i .. , ' ; -�a& a '�t ,3""�j,�-� za'�•�+�sr -. ;. t 1,,� '" ,� "�7-•a .+�'"•`,' "! .
a ? �
Rv t5 ` I'n PUTNAIK COVxTY DEPARTMExT OF HEALTH rf r it
(' l f ion of Environmental;Healin Servloee Carmel N Y 10511 Engineer to Provide Permit M
on CERTIFI
TE MPLIAN 6
CA OF CO CE `
Permit N s r fi
' CONSTRUCTION PERMPl R EWAGE DISPOSAL SYSTEM ka
I:
_ - t
cT Pa terson
ye B l l e t Holy •Road Town or Pillage -
Sabdivteton Nerve Burdick, - Glen... �:-Sttba:�iot q 5 Ta:
owns : /AppucentName" Cathy& Peter .Sullivan
Renewal^ � RevieWn
Date oUPrevlons Approval ❑ � ,
MaillngAddreea 10 Rn�lp Rta� Town LaIR® Casta�l, —NY' �P 1DS12
r.
42899
Bailding Type Frame Lot Area FID Section Ouly Depth volume
Three 6'00 ,...
Number of iledrooms Design Flow G/R /D:- PCHD No_ ,tfficatlon °le R«tnired When Fill ie completed
Separate Sewerage,System to conelst of Ge�on Septic Taolt o
a
T•
To be constrbcted by 9 Address'
watei S
_PO b Pnbuc'Sopply Flom Afbirei}s
or: X Private Supply DrWed by Add►eiu+.
ome,Regairemente *Re hires :about_ 300 :Cu Yds common -fill to be . 1 cad "'n. r" us:_e aviation
1 represent that`1 am wholly and completely iesponsiblefor thedesignAnd location of the proposed systems) ) that theseparato sewaye.dosposal= system
. ..
above descr�b -d will be, constructed as shown on the approved amendment thereto and rn� accordance w�th,the standaids rules °an raga a rout o e'� 4. nam
County Department ;of. Na41th antl that,on completwn theeof a Cert�ficste of Construction;Comphanca SaGSfactory to .the Comm�sslonerCOt HealtAwill
be subm�ttedcto the Department and a wutten'yguara� tee will De turnKhed t'he owner hrs successors heirs or assigns by the DWlder that said bwMer will
place'�`vn good,operat�ng cona�t�on xany,:.part of �spitl sewage disposal system during the periodTOf two -(2j years immediately follow mgtthedete oftthe_iuu-
ance;of the approval Of the CErbf�cate'Of COnstruCUOn Complmnte of the original system or any repairs thereto 2) that tha* driliad.well'defc►ibed above
will ?tie located -as shawn:on the approved plan anQthat seed Willi wUl beanstalled ,m cordance w th the stands s rules sno- raga a ons of "she Putnam
County Department of Health ' c
Date ,. i ignetl a P E R A
Address # 9 Fair Street met NY. 105E L,cen :e`Nd;
�s approval expues.essmyesr from the date issued unless Construction of the budding has been undertaken" and is
APPROVED FOR CONSTRUCTION Th'
re4ocaDle for: Cause or,may be amendeC or motldred whemcoiisrdered necessary iby the Commfisioner of .Health .Any Change O[ :alfe►atfon. of,conftruction
requires a - new, permit •° Appro -iii or disposal of "domestic ssndsry�sewsye' antl /or i star supply only-
Dated ez. l /.� 9y Tide
�j
6.. DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATION -T0 CONSTRUCT A- WATER .WELL " " ``
PCHD PERMIT #
WELL LOCATION
Street Address
Bullet Hole Road
Town /Village /City Tax Grid Number
T. Patterson 73 -3 -2
WELL OWNER
Name Address gtPrivate
Kathy & Peter Sullivan 10 Roslyn Rd. Lake Carmel NY 10512 O Public
USE OF WELL
1 - primary
2- secondary
W' RESIDENTIAL
O BUSINESS
O INDUSTRIAL
O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED
O FARM O TEST /OBSERVATION O OTHER (specify
O INSTITUTIONAL O STAND -BY O
AMOUNT OF USE
YIELD SOUGHT Five gpm /# PEOPLE SERVED Six /EST. OF DAILY USAGE gal
REASON FOR
DRILLING
MNEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION
OREPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL
DETAILED
REASON FOR
DRILLING
Redidential
use
WELL TYPE
®DRILLED
ODRIVEN
EIDUG
GRAVEL 0 OTHER
IS WELL SITE SUBJECT TO FLOODING? YES X NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: y,,
Burdick Glen Lot No. 5
WATER WELL CONTRACTOR: -Name - ? - 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: --Over _One Mile
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED (See Dwg. 1, Job #S.0.2385 By John
❑ ON REAR OF THIS APPLICATION ®ON SEPA SH re P.E T
1 December 1 6
(date) ignature
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. k
Date of Issue: ��'--1 S� 1.9
Date of Expiration :c:�a' < 19 '
Permit is Non - Transferrable
I
8/86
ermit Issuing f ' al
APPENDIX B
PUTNAM COUN'T'Y DEPARUSWr OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
required
60 ft. max.
Parellel.to
SHEET - CONSTRUCT ON PERMIT
_ DATE .
,. EWED
BY: �......_
(Street Location)
YES NO DOCUMENTS
Permit Application
Corporate Resolution
Plans - Three sets
Engineers Authorization
Design Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results
Perc Hole Depth
s/s
SUBDIVISION
Perc -- 1
(3) Fill &0 C -.
cd
House P] s - 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; Pump pit details
Septic Tank - Size, Detail
Well Detail, Service.Line if over
Construction Notes
Design Data: perc and deep results
Two -Foot Contours isti_ n_ g . & 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,Pumped Pit & D Box Shown & Detailed
House - No. of Bedroams
Wells & SSDS's w /in 200 ft. of Proposed System
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 fi'
20' to Foundation.Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, lake Unc. expa
15' to Drains-Curtain, Leader, Footing
351to catch basin,stormdrain,piped watercour.
101.to Water Line (pits -201)
50' intermittent drainage course
Septa Tanks
10' fray Foundation; 50' to well
15' Well to PL
9
d'
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH.S'ERVICES
COUNTY OFFICE_ BUILDING, %CARMEL;' N. -Y. ' "10512
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE N0.
Owner I<ff& v't Per 5'u I 1 4 Address (c� H re Rada
Located,at (Street Sec:- T Lot Z9
indicate near s cross s R re PkrB1ockd lc Gleam 5116A.1 Cd-&*
Municipality �a g Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE- SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
RUP Elapse Depth to Wa er, Water EFve
No. Time From Ground Surface in Inches Soil Rate
_Start -Stop - Min. Start Stop Drop in Min: /in'drop.
Inches Inches Inches.
. i c^ r
2 @_ct J 4A i Vt i c Ma �eyl (a ( Tevn PeV7_-1 a tiosj 665 .. _
.. - .
(_ 1. — l U _ N - .c _
5 -(o
Y,P_2�Qo
5.
2.
3
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.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO._ HOLE NO._
1811 �. _ ...... ..
84" ..
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER -LEVEL RISES . AFTER BEING E N_ COUNTERED ," o P
(1981 _ perms Vic( i14�_ �3G _
:DESIGN
Soil Rate Used 8-(o Min,/1. "Drop: S.D.- Usable Area Provided No. of Bedrooms Septic Tank Capacity. 6b d Gals. Type Met 4c,14"
Absorption Area Provide 3 L.F.x24" b" rfinch-.-
P BYE' �
Jt1`iY. �v11YN0'7 \lYQ J N PRE.Nr" ��ti. FI il
JOHN H. PRENTISS, P.E.
Address RD9 FAIR ST 914- 878 -6170
0
THIS SPACE FOR USE BY HEALTH DEPARTMT ONLY:
0
PrGrp
, . Vs 7)
OF rHE SiPS�
Soil Rate Approved Sq. Ft /Gal. Checked by Date
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
Jason K. Mitchell
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Mission Arts Design Group Inc.
2 Raymond Drive
Carmel, NY 10512
Re:
Dear Mr. Mitchell:
Addition — Approval — A- 161 -07
No Increase in Number of Bedrooms
315 Bullet Hole Road
(T) Patterson, T.M. # 34. -3 -44
L-
ROBERT J. BONDI
County Executive
ROBERT MORRIS, PE
Director of Environmental Health
August 7, 2007
I have received and reviewed the plans for the proposed addition to the above mentioned .
residence. The proposal for the addition has been approved as per plans bearing the approval
stamp from the Department dated August 7, 2007. The addition is approved with the following
conditions:
1. The total number-of bedrooms must remain at three without prior approval by this
department.
2. The area of the existing sewage disposal system, and its expansion area, must be
maintained.
3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush
toilets, restrictors for shover .heads and faucets; -etc. - - -
4. This Department recommends you contact your local Building Department to ensure
setbacks and other current codes can be met.
5. The approval is for the proposed changes only. This approval does not validate any
construction shown as existing that has not obtained proper approvals.
Any permits or variances required are the responsibility of the applicant and the jurisdiction of
the Town of Patterson .
If you have any questions, please contact me at (845) 278 -6130, ext. 2261
Sincerely,
4�c' � Va
Gene D. Reed
Senior Environmental Engineering Aide
GDR: ens
cc: BI (T) Patterson
James Baumann
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648
SHERLITA AMLER, MD, MS, FAAP
_ Commissioner o .Health... _ ..........
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
ROBERT J. BONDI
-, -- County,. Executive,
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ROBERT MORRIS, PE
Director o
ADDITION APPLICATION RESIDENTIAL ONLY
STREET !/ .1K Ille 9�7 TOWN ; TAX MAP# �
NAME 40M15P.t/ PHONE PCHD# --0 t7
MAILING
ADDRESS
DESCRIPTION OF
ADDITION OWO-
NUMBER OF EXISTING BEDROOMS 3 PROPOSED # OE BEDROOMS_
(FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM- BUILDING INSPECTOR)
* *Any addition which is considered a bedroom requires formal approval of plans (Construction permit)
prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the
Putnam County Sanitary Code.
Please- submit -this form and the following to Putnam County Health Dept., 1 Geneva Rd
BrewsterNY' 1 U509, Phone': (845)278 -6130.
Certified check or money order for $100.00.
Sketches of existing floor plan (drawn to scale, all living area including basement)
Two sets of proposed floor plan (drawn to scale — with name, street and tax map #)
*Non- professional sketches are acceptable
/4. Copy of survey showing well and septic locations to the best of your knowledge.
Include date of installation if known. Label all wells and septic systems within 200 feet
of the property line. Contact this office with any questions.
t/5. Copy of Certificate of Occupancy from Town or Certification from Building
Dept. with legal bedroom count of dwelling.
OFFICE USE
COMMENTS
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention /Preschool (845) 278 -6014 Fax(845)278-6648
AUG -07 -2007 09:29
mv�
MISSIONARTS DESIGN GROUP 8452282594 P.01
i1 r t S De Mis-sto-
S :i"g—n, Orou"
inc.
" ArAilecture on a Fitier Scale"
To:
Gene Reed
From:
Jason K. Mitchell
Fax:
278 -7921
Pages:
3
Phone: 278 -6130 ext. 226I Date: 8.7.07
Re: Batunatin Residence CC: File
TM # 34-3 -44
❑ Urgent ❑ For Review ❑ Please Conitmtuit ❑ Please Reply ❑ Please Recycle
Attached please one copy of the Existing Basement and one copy of the Proposed Basement fix
James and Jennifer Batunann's Residence located at 31 5 i3Jet Hole Road, Town of Patterson,
as per your request.
Thankq.
QRYn,oM l�+.�CN,�,�i tly 1051 ■Phi 845.29-8. 2333. ■ F= 845.ESS.S594 ■ Mwo AqF lC' c7i,,oL��m ■
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PUTNAM COUN'lY DEPARTMENT OF HEALTH
PLANS APPROVED FOR BEDROOM COUNT ONLY
BEDROOMS
7,/A,*- 34.— 3
ALL SUBSEQUENT REVISION/ALTERATIONS TO THESE HOUSE
PLANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL
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SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Town Legal Bedroom Count
ROBERT J. BONDI
County Executive
Re: 4 (Owner's Name).
Tax Map #:
Address:f����'
Town: �v
Year Built:
According to records maintained by the Town, the above noted dwelling,
is y in compliance with Town Code.
is not. in compliance with Town Code.
:.
The Legal .Bedroom Count is
This information has been obtained from:
Certificate of Occupancy:
Other:
Building specto� Date
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Nursing Services.(845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648
MiSsionArts Design Group, Inc-
2 Raymond Drive.
Carmel New York 10512
Phone: 845 - 228 -23j3 --
Fax: 845- 228 -2594
e -mail: MissionArtsDG@aol.com
TO: Putnam County Dept. of Health
1 Geneva Road
Brewster, NY 10509
LETTER OF TRANSMITTAL
Date: June 22, 2007
- : -
Alf Baumann Residence
315 Bullet Hole Road
Town of Patterson
T.M. No. — 34 -3-44
Project #: 3185
We are sending you attached under separate cover, the'following items via
❑ U.S. Mail ❑ Overnight ❑ Pick Up ❑ Hand Delivery
❑ Originals ❑ Reports ❑ Plans ❑ Colored Prints
❑ Prints ❑ Photographic Exhibit ❑ Specifications ❑ Other:
Copies
Date Dwg. No.
Description
1
Health Dept. Town Compliance /
Bedroom Count Form
1
Health Dept. Addition Application
2
6 -21 -07
Existing First Floor Plan
2
6 -21 -07
Existing Second Floor Plan
2
6 -21 -07
Proposed First Floor Plan
2
6 -21 -07
Proposed Second Floor Plan
2
6 -21 -07 S -1
Plot Plan ( Existing and Proposed )
1
4 -21 -86
Copy of Original Survey- Created
-
_
_. ___.__..:.... __.� ........ . ... ... .... �._._...._
-
.- .._by.BWgess &.Behr Updated. by_
"
Taconic Surveying
1
10 -20 -88
Copy of Original As -Built - Created
by Prentiss, P.E.
These are transmitted:
• For approval
• Approved as noted
❑ For review /comment
Remarks:
❑ Approved as submitted ❑ For your use
❑ As requested ❑ Returned for corrections
❑ Resubmit copies for approval ❑ Submit _ copies for distribution
SIGNED:
Jason K. Mitchell
Copies to: James Baumann
Joseph M. Sinisi, President, MissionArts Design Group Inc.
File
1.
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SCALE:
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(06.21.01)
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all located by: Surveyors survey -- _ - 29 -- - — _
We III drlilars report
Enolnso�s mssurernents.L.t-
Tank, boxes, pits, galleries St. laterals located :by:Contractor-
E nq weer:
He o lth dapt:
Field inspection by: Health dept ® dot e:_
Enga neon dote :
This is co cer;ify.that the sewa
disposal system was constructed
NOTES: indicated on `this plan and that
system was in•,,pected by me befor
was hovered outer. The system wa
constructed in accordance with a
standard rules and regulations o
the P.C.H.D. S the N.
b MENSIONS
A uB- Ct= �JZI- fo f
A - C 7r��i�
A - E _ �.1 rr^- P_�� B - E S$ _' �?�� �s Foot. IRKE 31
A H s -�QT pI%B - H
SANITARY SYSTEM DESIGN "AS'BUILTn
OWNER: ^-
LOCATION
Totit n:2/iZTy� C ounty:C_ %�
SVBDIVISIO�N,�g2Zc -I
Map: �7� iJ-��- — — —
Block'. — LOT N'2-
8 u il de r.-
Survey or:
i
Dot JJ-��-- -
lroN 1 'e: /O -Z� -� Scale: ��' Sofx,2
JOHN H , P R E N T I S S P E. DW
CONSULTING ENGINEER
RID , F -'4 <« r) to R M E L NY 10512-(9 1 878 -6170.
21_oyRC� R..o.P�• . 1 � , '
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t
s*%noo 0unty DePaY cmen'6 tat bealLli
Division of Environmental Health Servicee
t
9pproved as noted for.confornance with
applicable Rules and EsElilations of tlfv
lutnr Coun y Healtii.Departnent..
, :Sy QTI0.tllT T; t p
t
6tkUrwd
all located by: Surveyors survey -- _ - 29 -- - — _
We III drlilars report
Enolnso�s mssurernents.L.t-
Tank, boxes, pits, galleries St. laterals located :by:Contractor-
E nq weer:
He o lth dapt:
Field inspection by: Health dept ® dot e:_
Enga neon dote :
This is co cer;ify.that the sewa
disposal system was constructed
NOTES: indicated on `this plan and that
system was in•,,pected by me befor
was hovered outer. The system wa
constructed in accordance with a
standard rules and regulations o
the P.C.H.D. S the N.
b MENSIONS
A uB- Ct= �JZI- fo f
A - C 7r��i�
A - E _ �.1 rr^- P_�� B - E S$ _' �?�� �s Foot. IRKE 31
A H s -�QT pI%B - H
SANITARY SYSTEM DESIGN "AS'BUILTn
OWNER: ^-
LOCATION
Totit n:2/iZTy� C ounty:C_ %�
SVBDIVISIO�N,�g2Zc -I
Map: �7� iJ-��- — — —
Block'. — LOT N'2-
8 u il de r.-
Survey or:
i
Dot JJ-��-- -
lroN 1 'e: /O -Z� -� Scale: ��' Sofx,2
JOHN H , P R E N T I S S P E. DW
CONSULTING ENGINEER
RID , F -'4 <« r) to R M E L NY 10512-(9 1 878 -6170.