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PUTNAM COUNTY DEPARTMENT OF HEALTH
�JR'e'v.*3186 Dlvieion of Environmental Health Services, Carmel, N Y.10512
Engisieer Must Provide P _ 93_ ' .8 .7
P.C:H D Permit q
ZCATE -OF CONSTRUCTION__ COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM .,,
" Town or V e
Located st
Bullet H 01 e Road Tax Map 7 3 Block ` Lot 1
Owder /applicant Name H o-w a r d K i n Formerly Subdivision NamZu R--k ' eldSubdv. Lot .# 13
Mailing Address 9Q Dove .Court zip 10520 Date Permit issued,. 9/'30/87
Croton, New York
Separate Sewerage System built by Steve Gardner Address Ybrktown, NY
Consisting Of Ga cauonSepticTadiana 571 L.F. Perf, PVC:.Fields (Split System)
Water .Supply: - Public Supply From Address
or: _X Prlvate•Supply DrWed by wrag Bros, Address Danbury-4T
Building Type Residential Has Erosion Control Been Completed? N/ A
Number of Bedrooms 4 Has, Garbage Grinder Been Installed? No
Other Requirements 1.5 ft fill. (AVG) placed on lbt
2 certify that the system(s) as listed,serving the above premises w are, constru t seesntiall as ho, t e completed work ( copies
of which are attached); and inaccordance with the standards, rules and regul in a4o an e' i plan, and the Permit issued by the
Putnam County Departmen 6Of Health'.
2 _ X
Date _._, � Certified by _ -. .� P.E. R.A.
Address BaICWin License No. 38329
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 sgparate.sevvera9s iystem -shall become null and void ar soon.aa a pubtl: sanitary sewer becomes
available and the approval 01 the private water supply shall become. null and 'void when a public water : supply becomes available. Such approvals are
subject to modification or change when, in the judgment of 14 Com �ssnnerr.Of�M /with;. ch�rrovbcetlon, modification or change. Is necessary..
Date d BY Title -A
Yorktown Medical Laboratory, Inc.
321 -Kear Screet -
Yorktown Heights, N. Y. 10598
(914) 245-2800
Director: Albert H. Padovani ,tit. T. (ASCP)
r �
Karen King
9Q Dove Court
:.Croton- on- Hudson,.NY 10520
L_ J
32.'031609 1
LAB '# " - - -- --
_ 9 9 T i _. :3
. _...� -D s•t e. "aTa : � — 0 .2 OPM ....
-Date Rc'd: 1 -29-90 – Time:
Date Reported: FFR_ 0 1 18 _
Collected By: K. King
Referred By:
Sample Location: Kitchen tap: _
RD 2, Bullet Hole Rdg Patterson9 NY"
Phone # 271 -4541
Phone # I Sample Type:
Repeat Test?. (check each)
LABORATORY REPORT ON THE.QUALITY OF WATER
INORGANIC "NON—METAL S mg /L MICROFsIOLOGICAL. CFU /100mL
_ Acidity
_ Alkalinity
_.Chloride
Detergents, MBAS
Hardness, Total
Nitrogen, 'Ammonia.
_
Nitrogen.' Nitrate
Phosphate, Total
_ Sulfate
_ Sulfide
Sul.fite
METALS (mg /L)
Copper
_ r Iron, _ ..
Lead
Manganese
_ Mercury
Sodium
Zinc
MISCELLANEOUS
pH (units)
_ Color (units)
_ Odor (TON)
Turbidity (NTU)
GENERAL BAC.TE.RIA
_ Standard Plate Count
MEMBRANE FILTRATION TECHNIQUE
V Total Coliform
Fecal Coliform
—.Fecal S.trept,ococcus
MOST PROBAB.LE.NUMBER TECHNIQUE
Total Coliform Index
Fecal Coliform Index
KEY FOR
TERMINOLOGY
CFU =
Colony Forming Units.
CON =
Confluent (q.v. TNTC)
LT =
C = Less Than
GT =
> = Greater Than
N/A
Not Applicable
S/A _
See Attached
TNTC=
Too Numerous To Count
REMARKS
/COMMENTS .(For Lab Use)
.(Potable
Non- potable
— STP INF
_ STP EFF
Other
role Sta +us
(check each)
Outgoing
HNO3
_ HCl
H2SO4
_.NaOH
_ ZnOAc
Na2S203
Other:
Incoming
L_E
b °C
,;"GT
.4 °C
pH
LE 2
_ pH
GE 9
pH
GE 12
Other:
ELAP No. 10323
THESE RESULTS INDICATE THAT THE WATER SAMPLE Wass (Wasn't) (N /A) OF A
SATISFACTORY SANITARY QUALITY ACCORDING TO THE ORK STATE PUBLIC DP.INKIt�G
WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE COL ECTION.
THESE RESULTS INDICATE THAT THE WATER SAMPLE (Did) (Didn't) (N /A , MEET THE
SATISFACTOR`' CHE- 1,1ICAL QUr+LITY STANDARCS OF THE NEW YORK PUBLIC RI ING WATE"
CODES, FOR THE PARAMEJE4k� TESTED, AT THE TIME OF SAMPLE COLLECTION.
/x/ �/��� 2 /86(Rvsd7 /87)RWE
.. � .a^ ^ . -. .. � _.. ,�_. _' � '. tom. ._ .. .. �• .' .
Westchester County Department'of'Health
.tx'.,.
MI, CClNP1mcm REpw
;:'This report is to be completed by well driller am submitted to Health Department, together with
laboratory report of analysis Of water sample indicating water is of satisfactory bacterial
quality, before certificate of construction compliance is issued•
Well construction to be in accordance with Bulletin SD-62
eRUUM k REGULATICUS RELATING TO INDIVIDUAL WATER SUPPLIES"
LOCATIMs MUNICIPALM Patterson
SECTION BIACIt
IAN
{"'V .T. OWNERS Howard King 9 Q Dove Court., Croton, N: Y.
''MU DBILN;M
WWI
_...
�: L•njt�
Wragg Bros. Well Drilling Corp. 44 Miry Brook Rd., Danbury, CT
Name Stire-OT Imes City and Town
30 Feet I or 6
t __Pum yed
t t -
Hourst8tatict 30 Feet Makes None
-enen oaken 6 Slot
DL' -rtert 6 2nohes Kields 5 a.P.M. t_or Pumwd 325
Feet s Iwnnth Nom: n31se
Steel t t ' None t
'Unds t Diamete! In.s
TOTAL VWTH OF W= 325 P=T
WIM Loa
1< Amrww r&7. - viva aeaarlp oxan or ZW=T'ions penetrated, such ast peat, silt, sand, awed
, Ground Burface t cly, hardpan, shale, sandstone, granite, eta* Include size of gravel dianete2
and sand (line, medium, coarse), color of material, structure (Loose, packed,
t oemented, soft, hard). For examples 0 ft. to 27 ft, line, packed yellow sandf
t 21 ft. to M ft, ara,Y xraaite,
0 Ft.to 18 a Gravel
r 325 Ft.t Granite, an Quartz
18 Ft.to
�.
w>
, -- n.to
Ftr.to Ft. t
�� Ft.to Ft.t
Ft-to
Ft.to F't.
t
'' well Was Completed 12 / 7 / 8 8 Date of Report 12/7/88
OS
! "J Well Driller ' Wragg Bros
r .
SELL PIT AND PUMP EQUIPMENT DETAILS
Check ; Pft wit1 la= inc&a' Gravity Draft► to
.r
Pit with "ch Gravity Drain to Basement
X . Pitless AdapteR- ® Casing Min. 12 inches above grade
..._, 0thert Describe
Pumps Make Red Jacket Type Submersible 'Capacity 1 /2HP G ®P ®M® 5
Pei 7
gtora a Tanks WX 203 80 gallon
g Type Capacit$ Cal. (let .Gal. Kin ®) ..
DIAGRAM SHOWING LOCATION OF WEI% ON RmSF.S
Indicate location of houses well and
sewage disposal system with distances.
Also indicate direction of slopes, and
direction with distances to all wells
and sewage disposal systems within 250 feet.
'ice. �.• � � ..
tY a'r
l r
era`
tJ!
I certify that the individual mater supply itdicated above was installed as per the
rules and regulatiorw of Bulletin 3D.62 of the Westchester Coup y Department of Health.
OF
Sworn- to. before me .this r'� day l`
1.9$9
Notar�PU ®> �. Fr,�ld County
NOTARY PUBLIC
MY cOMMISSION EXPiRLS MARCH 31. ISM
TE L�NSPEC-712N
7�
Late
h- =-f P CIR ECE
1 . Size C-f
I!C* ICN
IL C),F, LOT
a
cr
AREk
Fli= L-,:
%--a= a-9 Per a=roved Dia-lis
sz-- of piacanp-rit
6. C-,,,cie by Ems. =j Ele- ant
r
2:1 b-
ECUS E
C.
b7at7=,-1 Scil act
N-c-'re-- cz-
WELI lc:cz-z a--=-rcve:a clans
d-
.- cr== f =cm SDS
stcne, brush et-c: —tar 15
--------
e.,
i0o ft- f::--, water
DO
(J (
�
si z a 1,000 1,257
I
eve L
d-
Cro (130' c-,==- Ur wifrli- 10 f cf 45'
e.
DESTI-3 =)-U7_p--rN 31--X
ALL sa-me e e
2. Prct=-=—=-- f r--St
- cric -::i� soil he-t-a-een bcx
2
f-
j-U T:
2- ------------
Lnc
3. Ln s Z-0 rd-Lan
Di
C. 10 -f—, 7r 20
7. < 30 -inches
8. -fcr 50%
V.
t-sm-ch 12"
h- =-f P CIR ECE
1 . Size C-f
2. tank
ra-
- era P.LM, 0 E- - ez
Fli= L-,:
6. C-,,,cie by Ems. =j Ele- ant
VC e
ECUS E
N-c-'re-- cz-
WELI lc:cz-z a--=-rcve:a clans
h. E.4st-�rlcz f=--. SZE Maa-sllre," ft I
c- C:-:---'nc 18" crate-
--------
ar-= - arcranE wiaLll
arcutez
b- 2I.Ces r _Lv c GL i - -
c. Vices fl'lshl With inside cf I:cx
ccn�-;--is s- nes < 4"
e C21.—,
air, aczcrdj-nc to
cat faill vrcta-'=,-3 & di7-.to e-,;c
c:---2=arce away f--crn SD.S a-7,
crcvic�z cn sicces
z 12ni
c Z:
',71��-
�iIYA
Building Constructed by
Location - Street
Municipality`` 1
Building Type
i
ug
,Subdivision Name
Subdv. Lot #
GtARANTEE OF SEPARATE SEWAGE 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 thereto,
and in accordance with the standards, rules and regulations of the Putnam
County Department of Health, and hereby guarantee'to the owner, his success-
ors, heirs or assigns, to place in good operating condition any part of
__ m urhi rh f'a;.ls to operate for a period of two
years immediately following the date of initial use of 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 occu-
pant of the building utilizing the system. _
The undersigned further:agrees to accept as 'conclusive the determin-
ation of the Director of,the.Division of Environmental Health Services
of the Putnam County Department of Health as ib whether or not the fail-
ure of the system to operate was caused by the willful or negligent act.
of the occupant.of the building utilizing the system., / JA
Dated Ithis day o 19-2y Signature
Title.., C1%N'c-
Corporation Name if corp.
3S3 �o2Ki O�0 0
Address p 09
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPLETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department of Health
_Se- ction._... _
Block
/ T A-+
ug
,Subdivision Name
Subdv. Lot #
GtARANTEE OF SEPARATE SEWAGE 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 thereto,
and in accordance with the standards, rules and regulations of the Putnam
County Department of Health, and hereby guarantee'to the owner, his success-
ors, heirs or assigns, to place in good operating condition any part of
__ m urhi rh f'a;.ls to operate for a period of two
years immediately following the date of initial use of 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 occu-
pant of the building utilizing the system. _
The undersigned further:agrees to accept as 'conclusive the determin-
ation of the Director of,the.Division of Environmental Health Services
of the Putnam County Department of Health as ib whether or not the fail-
ure of the system to operate was caused by the willful or negligent act.
of the occupant.of the building utilizing the system., / JA
Dated Ithis day o 19-2y Signature
Title.., C1%N'c-
Corporation Name if corp.
3S3 �o2Ki O�0 0
Address p 09
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPLETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department of Health
1. represent that 11 am wholly anp` 'completely responsible for the devgr
above.descrrbed. will be'constructed'as shown on the approved amendn
County .Department of Health sand that . di completion thereof a (
be i6bAiti6d to the Department' and a,:wrdten guarantee will be
place 'in good.uperating 'condition any ,part of Said sewage, dispos
once, of the approval of the CmEificate''oI Construction. Complian
will be locatetlas shawnon Me approved plan and that said welt will bi
County. be-Pa , rfin enY of Health
Date Signed
AddressL7ilf, .E:�C�.Rn 6+-
APPROVEO..FOR:CONSTRUCT.ION This approval expires two Years
revocable' for cause" r ma be. amended` or moditied� when considare"
requires a ne p mif proved for disposal of domestic 1 sand
Rev. �� e
1/87, Date By
a`nd location of the proposed 'System(i) .1) that the 'separate, sewi e' disposal ..system
int there: to and in acCOrdake with `the standartls Iulesan- r"u a �onS O e u nom
srt�f�cate ;of Construction Compliance} satisfactory to flie Commissioner of . Healthwill
urnishetl'•the owner,• his tucces 'traits or assigns by, the buJtler,�thaY said <builtlec v4ill
Isystem -dunnq the. per,iodo (2) y rsimmediately,followirig`the.date.oftheissu-
s':of th �g�nal,'syste or ny. epa' eroto;2) that;the tlrilled.well descr!bad above
Install „i actor n , „ h am
e f?.
RA-
22 i t 1050 License No
from e, qa issued unless constr ction of _the building has' been undertaken and is
ry b a Co m' f " • r .,Health. Any change or alt4[at ion of construction
age i / r' t t 'sl DIY only. '
Title
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
-" - APPLICATION TO`'CONSTRUCT- A -WATER WELL
Prue PRRMTT $
WELL LOCATION
Street Address Town Villa e City Tn
Bullet Hole Road Pattgerson
G ict Number
1
WELL OWNER
Name
Howard Xing,
Mailing Address
9Q Dove Court Croton NY
ZIPrivate
D Public
USE OF WELL
1 - primary XX
2 - secondary
$KRESIDENTIAL
O BUSINESS
0 INDUSTRIAL
O PUBLIC SUPPLY O AIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION
U INSTITUTIONAL O STAND -BY
0 ABANDONED
❑ OTHER (specify
AMOUNT OF USE
YIELD SOUGHT >5 gpm /# PEOPLE SERVED 4 /EST. OF DAILY USAGE 250 gal
REASON FOR
DRILLING
• NEW SUPPLY ❑PROVIDE ADDITIONAL SUPPLY
❑REPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL
OTEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
Applicant requires water supply for proposed 3
bedroom home
'to e constructed.
WELL TYPE
XIDRILLED
[]DRIVEN
®DUG
®GRAVEL
11
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES X NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Burdick Woods Subdivision Lot No. 13
WATER WELL CONTRACTOR: Name Undetermined 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
O ON REAR OF THIS APPLICATION 0 SETC.�C
9/2/87
(date) (signature
PERMIT
TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the
provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code; and
provided that within 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 permi
3. Submit a Well Comp etion Report on a form prov ded kPPu ount y Health Departmen . Date of Issue: 3 s 19 7
Date of Expiration: 19 it Issuing f icia
Permit is Non - Transferrable White copy: H.D. File
Yellow copy: Building Inspector
2/87 Pink Copy: Owner
Orange copy: Well Driller
t •' no t• •' .41 D Y• •1 DIT INV. M• MSS
DESIGN DATA SHEEILSUBSUFACE SEWAGE DISPOSAL SYSTER FILE Dp.
Owner. HOWARD KING Address _ -90 Dove Court, Croton, NY
Located at (Street) Bullet Hole Road Sec. .73 glock 6 Lot 1
(indicate nearest cross street)
Municipality Patterson Watershed Croton
• ■ ' DI• •• •' Y.� t • Y• • �• t• yt • • � t Yet Y: t✓• •'
Date of Pre- Soaking
Date of Percolation Test
LOT 13
25
26.75.
1.75
SOLE
3
3:25 -3:55
30
NUMM C =
TIME
PEk2COLATION
PEROOLATION
Run
Elapse.
Depth to Water FYom
Water Level
No.
Time
Ground Surface.
- In Inches Soil Rate
Start-Stop
Min.
Start . Stop
Drop Li MW):n Drop
Inches Inches
Inches
A l 1:07 -1:38
31
24 26
2 15.5
2 2:57 -3:28 31 24 22.5 1.5 20.6
3 3 :30 -4:02 32 24 22.5 1.5 21.33
4 4:04 -4:34 30 24 22.5 1.5 20.0
5
B 1 1:08 -1:41- 33 25 27.5 2.5
2
2:49 -3:24
35
25
26.75.
1.75
20.0
3
3:25 -3:55
30
25
26.'5
1.50
20.0
4 4:00 -4:30 30 25 25.75 1.75 b 17.14
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 submittbd
for review.
2. Depth neasurements to be made from top of hole.
rev. 9/85
TEST PIT DATA REQUIRED TO BE SUL3MITTED WITH APPLICATION
DESCRIPTION OF SOILS BP,COLNTERED IN TEST HOLES
• ;.._: DEPTH ° - HOhE NO 1 3'9--"-" HOLE 1\TO . 13 B' _ ...:: HOLE NO.-
G.L.
6"
12"
18"
24"
30"
36"
4211
Topsoil
Sandy Clay
Silty Sandy
48" Clay
5411 h
60"
66"
72
78'►
8411 I,
Topsoil
Sandy Loam
Boulder
13C,
Topsoil
Sandy, Clayey
Loam
Rock
Rock
INDICATE LEE"M AT WHICH GROUND WATER IS ENCOUNTERED N/A
INDICATE LEVEL TO WBICH WATER LEVEL RISES AFTER BEING ENCOUNTERED.. N /A..
TESTS I1ADE- BY J o hn E b e r I e'- _ . - Date Ra r c h 19&5
DESIGN
Soil Rate Used 20 NLin/1 "Drop: S.D. ,Usable Area Provided
PEE NEW y
No. of Bedrooms 3 Septic Tank Capacity Gals. Ty
Absorption Area Pr�^ij ,4ggg By . L. F. x24 -37 wid 1 re .° quired 0.
Address RD 6
''c U✓ Y
THIS SPACE FOft-- ,PSE "]N�'
Soil Rate Approved
DEPARTPMiNT ONLY:
Sq. Ft /Cal.
Checked by Date
TEST .PIT DATA REQUIRED TO BE SUI'TfITTED WITH APPLICATIOid
DESCRIPTION OF' SOILS ENCOUF EPED IP TEST HODS
T�EPTH .. HOI 1V0.;- 13D ,� HOLE H0LEv,N
G. L.
611
12"
18"
24"
3011
36"
42"
am
5411
60"
66"
7211
78
84"
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED N/A
INDICATE LEVEL TO WHICH-WATER LEVEL RISES AFTER BEING ENCOUNTERED N/A
_ �.- . .. TESTS "'i�ADE'B1,.,....._. _.._�Joh.�_., be'rl "�'. . -. .... _.._ .� -- ....._.. -- •- -- •---- ••Daae " `Ma "r'rh-_19-�.g-_...._.._.__.. ...
DESIGN
.Soil Rate Used 20 Min/l "Drop: S.D. Usable Area Provided 5000
No. of Bedrooms Septic Tank Capacity 1000 Gals. Type Masonr
Absorption Area Provided *.L29 L.F.x24" 5b" width trench.
Other1.5 Fill Required`.
I`ame BALDWIN & CORNELIUS, P.C. Signature
Address RD 6, ROUTE 22 SEAL
BREWSTER, NEW YORK 10509
THIS
SPACE FOR USE
BY .HEALTH DEPARTM0NT
ONLY:
Soil
Rate Approved
Sq. Ft /Gal.
Checked by
Date
APPENDIX
PUTNAM COUNrY / DI' 'Ji ICI OF HEALTH DIVISICN OF ENVIRONMENTAL :1 • is SERVICES
• .._ _ _ -
--
REVIEW. SHEET ..._.CONSTRUCTION PEEL
Name of Own )
DATE ' 1?.
BY: lj
(Street Location)
YFS NO DOCRMUS
Permit Application
Corporate Resolution
Plans - Three sets
Engineers Authorization
Design Data Sheet (DDS)
Deep Hole Log
Consistent Perc Results
Perc Hole Depth
• I�
INS
�
MM
NOMINEE
OM_�_
M�
LF trench provi
requir
./
-
NEWS
mom
IMAM
mm�
MINERIESE
/
IF
mom.-
-
SHE
. -. ._ -
��
01 MINES
W11�
���
1Mr
1��
1��
1'�
1��
��
House Plans - Two sets
Well permit; PWS
Variance Request
s/s
SUBDIVISION
Perc
(3) Fill l {�
cd
letter
GENERAL -
Legal Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Weiland (Tcwn/DEC Permit R & D)
to 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 (grinder 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 Pumped Pit & D Box Shown & Detailed
House - No. of Bedroams
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
to P.L., Dr• y Large Trees,Top of fill
20' to Founda on Wal s
100' to Well. 200' i D.L.O.D, 150' pits
100' to Str , Wa course, Lake (inc. expan)
15' to Drains in, Leader, Footing
351to catch basin,stormdrain,piped watercourse
10' to Water Line (pits -201)
50' intermittent drainage course
Septic Tanks
10' from Foundation; 50' to well
15' Well to PL
9
PETER C. ALEXANDERSON
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
Mr. Donald Crotty
Baldwin & Cornelius, P.C.
RD6, Route 22
Brewster, New York 10509
Dear Mr. Crotty:
September 21, 1987
�K
JOHN SIMMONS, M.D.
Deputy Commissioner
JOHN KARELL, Jr., P.E.
Director
Re: Burdick Woods Subdivision - Lot #13
Review of plans and other supporting documents submitted at
this time relative to the above - captioned project has been com-
pleted. Comments are offered as follows:
1. The house is-considered to contain four bedrooms: The
sewage system must be designed accordingly; i.e.: an
additional 142 lineal trench and a 1,250 gallon septic
tank is required along with a split or dosed system.
.2. The well has been reloca -ted-- and -is now considered to be
" "below 'and 'in diredt- line of "drainage and within" 10- Meet "
of the sewage system on the adjacent lot to the right (on
the plan).
3. A north arrow is hot provided.
Upon receipt of a submission, reviewed to reflect the above
comments, this application will be considered further.
i oh y t my n Karell, Jr. P.E., Director
Environmental Health Services
JK /jt
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ADDITION APPLICATION RESIDENTIAL ONLY (c.
STREET � i/..�f/TOWN TAX MAP # oZ�
NAME l � �, PHONE S 7 � �PCHD# ),q4 -, 0 3 Z l0l
MAILING
ADDRESS
DESCRIPTION /
NUMBER OF i 1' // �1 1: 1 1 1' //
Y. )H u A I N 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,
Brewster, NY, 10509, Phone: (845) 278 -6130.
1. Certified check or money order forl100.00.
-2:
Sketches- of existing- floor plan (drawn to-scale, all living -area ineluding-bagemei t, to be
shown and dimensioned and use of each room specified). (See Section 3.c of Bulletin
HA -1)
3. Two sets of proposed floor plans (drawn to scale — with name, street and tax map #)
* Non - professional sketches are acceptable and preferred. (See Section 3.d of Bulletin
HA -1)
4. Copy of survey showing all well and septic locations on the subject property to the best
of your knowledge. Include date of installation known. Contact this office with any
questions.
S. Copy of Certificate of Occupancy from the Town or Certification from the Building
Department with legal bedroom count of dwelling.
OFFICE USE
COMMENTS
5.
Town Legal Bedroom Count & Proposed Addition Status
Re: wner's Name)
i
Tax Map #��
Address:
T T
Town: r
Year Built: /�W
According to records maintained by the Town, the above noted dwelling,
is ,/ in compliance with Town Code.
Is not in compliance with Town Code.
The Legal Bedroom Count is:' Z
This information has been obtained from:
Certificate of Occupancy:
Other: s
The plans for the proposed addition are considered:
New Construction
1� Addition to existing house only
Teardown and/or re -build allowed under Town Regulations
8u'i ing specto� Date
6. \. .
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
I. ROBERT MORRIS, PE
Director of Environmental Health .
Howard & Karen King
360 Bullet Hole Road
Patterson, NY 12563
Dear Mr. & Mrs. King:
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Office (845) 808 -1390
Fax (845) 278 -7921 or (845) 808 -1937
April 11, 2011
Re: Addition- Approval - King
No Increase in Number of Bedrooms
360. Bullet Hole Road
(T) Patterson, T.M. 34.4-21
PAUL ELDRMGE
County Executive
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 April 11, 2011. The addition is approved with the following conditions:
1.
2.
3.
4.
The total number of bedrooms must remain at four without prior approval by this Department.
The area of the existing sewage disposal system, and its expansion area, must be maintained.
All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets,
restrictors for shower heads and faucets, etc.
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 other 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 your convenience.
Respectfully,
Joseph S. Paravati, Jr., PE
Assistant Public Health Engineer
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cc: BI, (T) Patterson
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PUTNAM COUNTY DEPARTNffi�7T`OF`$EALTH :�,
Rev. 3/86 Division of Environmeatal Health Services, Carmel, N.Y.1051Z
S Engineer Mast Provide -
P.C.H.D. Permit N 3 -' ' ' 7
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM ' z'i v P ..r S C ii
Town or Village
Located at ; �JJ C �' Tax Map Block E' Lot 17
H o °-1 _'1 r 1.1 K i n 9%
Owner /applicant Name Formerly subdivision Name`=t4.Y' +'i? ^fit lniCiSabdv. Lot p
Maiitng Address ' Q L'-(-) Y 2 'L' U r r Zip 11,1520 Date Permit Issued
Crofon, Wl'-w YGr!.<
Separate Sewerage System built by Steve Gar - " Address ! riTktCydE ; , NY
i Fields �" r+
Consisting of ' +.+ a �. Gallon Septic Tank and 5 -71 '... i � P -" '- f . it - `R V
Water Supply: Public Supply From Address
or: Private Supply DrWed by'N1ra- n fir.Z'> Address Df:3 }bu -,'fir .T
Building Type `n5.1 ti!Pn w' Elea Erosion Control Been Completed?
Number of Bedrooms Has Garbage Grinder BeenAnstalledY i iC1
Other Requirements 1.5 f t_ _ t. (,�•t'V'is. ) Ci3.ac7t(� or, tot. i
I certify that the system(s) as listed serving the above premises were constructq&' essentially, a.'ohow vt eh %ana+Cr —it a completed work (,copies �.
of which are attached), and in accordance with the standards, rules and requiat4cnay, in acaor nge,w thy -the jed plan, and the permit issued by the
j
Putnam County Department Of Health.
Date !' y`� P�, Certified by 'd.x 'r cc ` ' { P.E. R.A. i
Address License No. r:
J'
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a pubc': sanitary sewer becomes
available and the approval of the private -water supply shall become null and void when a public water supply becomes available. Such approvals are
subject to modification or change when, in the Judgment of the Commiis�iner of Health. ;fish revocation. modification or mange Is necessary. a
Date 5 i f • '7 BY ^ s TRIO
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