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HomeMy WebLinkAbout1559DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34.-4 -79 BOX 14 .,'. t x y �., 01559 PUTNAM COUNTY DEPARTMENT OF HEALTH -- D�ISION OF ENVIRQNMENTAL:HEALTH SERVICES UiR CERTIFICATE OF CONSTRUCTION COMPLIANCE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # ?-Q- 00 Located at g -rO/,kM `11 TK61(� L�Town or Village f A 7T� S 0 I �; Owner /Applicant Name :MC 0, ( �,� AA_Ok e� Tax Map G4 Block Lot Formerly Subdivision Name f?z � oop Subd. Lot # J- Mailing Address I V �i �2�2 Zip 'I Date Construction Permit Issued by PCHD Separate Sewerage System built by PAT VNPAtL- Address Consisting of 1250 Gallon Septic Tank and 4o(, LF , 2A-' (! t) I D C- TX QCAIES Other Requirements: Water Suuuly: Public Supply From. Address or: Private Supply Drilled by 00YD %�� �.� _Address �� Q-+ 5L' `I2ti j `- Biuldirig f ype . 1Z- Has erosion control been completed? `t ' Number of Bedrooms Has garbage grinder been installed? 7 I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations a Putnam County Department of Health. Date: Certified by P.E. R.A.. 6 7 �F Desi n Professional) Address � } 1 License # 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 sewage treatment system shall become null and void as soon as a public 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 ' ect to mo ifcation I or change wlien, in the judgment of the Public Health Director, such revocation, Of0difibatio n or ge is necessary. By; 1 Title: _ Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 MiMlM1M:M4M[M.?� �S. C t r_ o , v ^k PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Town/Village: Tax Grid # i4m rho.-ber er3 Map Block Lot(s) Well Owner: Name: Address: M)gl2 G9r t 22 I-vj 04 &V'4j ZQ Ally Use of Well: Residential Public Supply Air cond /heat pump Irrigation 1- primary Business Farm Test/monitoring Other(specify) 2- secondary Industrial Institutional Standby Drilling Equipment x Rotary Cable percussion 2L Compressed air percussion Other (specify) Well Type Screened Open end casing _X Open hole in bedrock Other Total length 3 ft. Materials: Steel _ Plastic Other Casing Details Length below grade __,a_q_ft. Joints: _ Welded _ )(Threaded _ Other Diameter 4, in. Seal: Cement grout Bentonite Other Weight per foot �Ib /ft. Drive shoe: Yes No Liner _ Yes XNo Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? Screen Details First Yes—No Second Hours Well Yield 'Pest Bailed _ Pumped Compressed Air Hours Yield /0 gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet Well Log Depth From Surface Water Well Formation If more detailed ft. ft. Bearing Diameter(in) Description information Land Surface ' descriptions or _ ...- . sieve analyses . _.._ are available, -4 Dlease attach. If yield was tested at different depths during drilling, list: 7/-3//6(9 PTE: Exact 14 Well Driller's Name Signature: Feet I Gallons Per Minute PumpfStorage Tank Information e03 well with distances to at oleo/yl M y< Pump Type,Si� 4' Wapacity _dk gAM 5 . Depth 31 Model Voltage a3D HP � Tank Type �C-Volume 77 � landmarks to be proviclM on a'separate sneevpian. Address: !may Date: e S/ 2 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Flug 16 01 03:14p Pat Tmndall 845- 279 -5989 p•3 i0'c �tl101 i o£zl"V;"08 ,,t,3 emS,Ino - SOEO-gmoo8 XIH.t.11fa MU T70Q. j 901-6L8(OA) XV.4 - 4346-VU(099) -LE090 1.0 'NIY=G `.LOLLS TgR 6Zt '4901.V40M LSir'�II�TOIK• ' I lwv;lfs Mum= ff"W" Ko ads • u g �79V.L+<►d.l.Ol�•�► � 1_^_! � OSY .'3idillVr • I 11p1o�oLangt7R�apOOx+.,��,(Q,E l��la�J'W�1��1( Pu*m3P'mma111 InrY lad stli�!��%+ a7!1!!I!uil-ll I i + ++74km S10'0 Z'6(Z vam -yum 900'0 ..Ilt° o'oZ VELZ data 'Ilft L'E S - vMaS'a rs►Zvat vgm to,o> V Tmoro r9¢zvaa EWO W-q impp7 OR rOEI Vd3 'Vm 0'89 I PMJV ON QUEZ WS of !r!1 l %ft of 00051+ WS H F J i [ 9Z'Q MWK • I 'M W3 msovm too i ]EJ.SQAf Sfax S l'09t vd3 SrUNi t'b t. �;p)qutL • Ulum p0:edarsap olq i'05 t Vd3 - 66'9 8d • ? urin t - - C1N APO • t 51 rot t Vd3 - 01 ; (1� ) lop* • 7IV3V9AHd ' fN�s Emm PU001 Ad Ifmo.v (• s). Twft - f any anyawls xo vla z z 1 WON TiJM TOM i XRV191W10H 350338 �'Id1H�+S l '.['N'3C'rI.LSlIS�iS `33�11i1.iln�IAL 89 i00L9L8 :uv<[ ,Lvodm MAN Q1 g'i►'1 1 Ltrl t #RV7 :A8 Q3.LS3L IM W.7VM .XLWn0,0 XLnd. "3 10(luStm :oi GaAmai13 ;va �13N07�d1+1t '.L -'115 G311-rxnoll) 60Sbi: 'R,'N'amwas i varo oast :au 7 qpm i. avtq 'rml AAl U t00US I/S :tTm3'1'(0o aldY1tbS Ova AIIN07riy11 'Sel V '9K 7.140 dS . I tbWIM :9* la 'L=990 'AMUWIM - WON ratlrr'U Firm axnuxvcl A-CF x$OJii'ZIOSvq ZSVSKINON! • wit T0'd 60GS6LZSPGT Ol Aafwtda d0 Stn 1Sd3HIKN W02lzl Wdta :10 11OW -SL -99 .4 A Irm . 0AC- 0,70-70a4 NAME: PI ITNAM rnuNTY DEPARTMENT OF P. 3 BRUCE R. FOLEY �' LORETTA MOLMARI R.N., M.S.N. Public Health Director Associate Public Health Director - --= ireclor o -° atienf er4ices -- -- � �- DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 - Environmental Health (914)278-6130 Fax (9,14) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 E_911 ADDRESS VERIFICATION FORM OWNERS NAME: Hampshire Land Company Lot 1 TAX MAP NUMBER: 34 -4 -79 E911 ADDRESS: 68 Tommy Thurber Lane Patterson TOWN: AUTHORIZED TOWN OFFICIAL: (Signature) Gbz�/� DATE: �% // 2S- The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E91 I VERFRM) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 6t66 Owner or Purchaser of Building Tax Map Block Lot mle,144ecl Building Co structe by Location - Street �- PC5 Building Type & 71�7� e rso ki Town/Village Subdivision Name i Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is 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 immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the . .. system. The undersigned further agrees to accept as. conclusive the determination of the Public Health Director 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: nth Day L/ . Year o / Gee, ,Oral Contra or (O r) - Signature A44 44ID11 e t/ Ca r,lcoti If1l Corporation Name (if cdrporation r C oration Na a (if c oration) Address: Z Z t' // Address: 20 Aq State W Z Zip IDS-d Y State a YYz i p do Form GS -97 P. W. SCOT Engineering & Architecture, P.C. 3871 Route 6 BREWSTER, NY 10509 E -Mail: pws @bestweb.net (914)..278 2110 FA,(9�4) 278 -2166 TO Putnam County Dept. of Health 4 Geneva Road Brewster, New York 10509 WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via ❑ Shop drawings Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ LLB LI �� ° �� i�` °� � DATE /.�. ^ l�.l� I JOB NO. ArTENTiorat RE: Septic As— !`Built the following items: Samples ❑ Specifications COPIES OATE NO. DESCRIPTION I I Certificate of Construction Compliance I I I Well Completion Report 3 1 Guarantee of Subsurface Sewage Treatment System 3 ( 1 As -Built Septic Plan Fee: $200 THESE ARE TRANSMITTED as checked below: ❑ For approval C For your use ❑ As requested ❑ For review and comment ❑ FOR BIDS DUE REMARKS COPY TO ❑ Approved as submitted Approved as noted ❑ Returned for corrections Resubmit copies for approval ❑ Submit copies for distribution Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: _ Nr NORTHEAST LABORATORY OF DANBURY 0 �N ACC09oq� 39 MILL PLAIN ROAD DANBURY, CT 06811 CT Cert: PH -0404 203)- 748 = 7'303-- 'FAX`(203)'748 -0652 LAB$ www.NORTHEAST LABORATORIES. com LABORATORY REPORT REPORT TO: MR. & MRS. MALONEY DATE SAMPLE COLLECTED: 8/15/2001 & 8/26/2001 22 IVY HILL ROAD TIME COLLECTED: 10:00 A.M. & 12:00 P.M. BREWSTER, N.Y. 10509 COLLECTED BY: T. MALONEY DATE RECEIVED @ LAB: 8/15/2001 & 8/26/2001 Fax:PUTNAM COUNTY HEALTH DEPT. TESTED BY: LAB #11471 LAB LD. # NY -92 & NY -96 REPORT DATE: 8128/2001 SAMPLE SITE: 68 TOMMY THUBER. BREWSTER, N.Y. SAMPLE POINT: BEFORE HOLDING TANK & OUTSIDE SPIGOT SOURCE: WELL TREATMENT: NONE MAXIMUM CONTAMINANT TEST PERFORMED RESULTS METHOD # LEVEL (MCL) OR STANDARD BACTERIAL: • Total Coliform (Bacteria) ABSENT per 100 ml SM 9223 ABSENT PHYSICALS: • Color (Apparent) 10 - EPA 110.2 15 • Odor ND - - 3 Units • pH 6.99 - EPA 150.1 No designated limits • Turbidity . 4.1 NTUs EPA 180.1 5 NTUs CHEMISTRY: • Nitrite Nitrogen <0.001 mg/L as N EPA 354.1 1.0 mg/L •. Nitrate Nitrogen - . - - - 0.26 mg/L as N SM 4500D _ _..10 mg/L • ,.Alkalinity _._.. 44.0 mg/L SM 2320B Nodefined`limits • Hardness 58.0 mg/L EPA 130.2 No defined limits • Iron (8/27/2001) 0.042 mg/L EPA 236.1 0.30 mg/L • Manganese <0.01 mg/L EPA 243.1 0.50 mg/L Combined limit for Iron plus Manganese = 0.50 mg/L • Sodium 3.7 mg/L EPA 273.1 20.0 mg/L ** • Lead - .0.006 mg/L EPA 239.2 0.015 mg/L***. ml= milliliter mg/L--milligrams per Liter ND =none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count * *Notification Level ** *Action Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: X❑ OTABLE or OT POTABLE`7� RESULTS BASED ON SAMPLES SUBMITTED: 8/15/2001 & 8/27/2001 • C-:� Laboratory Director •NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 m r NB j NORTHEAST LABORATORY ®F DAN13URY `�0O �N ACCO'D 39 1NIIhT:;FAI1lI)t- >l3ANBURYy. �`c :: Q81, ._ CT Cert: PH -0404 0 203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 LABS www.NORTBEAST LABORATORIES. com < LABORATORY REPORT REPORT TO: MR. & MRS. MALONEY DATE SAMPLE COLLECTED: 8/15/2001 22 IVY HILL ROAD TIME COLLECTED: 10:00 A.M. BREWSTER, N.Y. 10509 COLLECTED BY: T. MALONEY mg/L DATE RECEIVED @ LAB: 8/15/2001 Fax:PUTNAM COUNTY HEALTH DEPT. TESTED BY: LAB #11471 EPA 273.1 LAB LD. # NY -92 0.015 mg/L * ** REPORT DATE: 8/16/2001 SAMPLE SITE: 68 TOMMY THUBER, BREWSTER, N.Y. SAMPLE: POJNT: 13L.FORE HOLDING TANK SOURCE: WELL TREATMENT: NONE MAXIMUM CONTAMINANT TEST PERFORMED RESULTS METHOD # LEVEL (MCL) OR STANDARD BACTERIAL: ® Total Coliform (Bacteria) ABSENT per 100 ml I SM 9223 ABSENT PHYSICALS: o Color (Apparent) 10 - EPA 110.2 15 a. Odor ND - - 3 Units * pH 6.99 - EPA 150.1 No designated limits o Turbidity 4.1 NTUs EPA 180.1 5 NTUs CHEMISTRY: • Nitrite Nitrogen • Nitrate Nitrogen ® Allcalinity ® Hardness • Iron ' . m Manganese * Sodium o Lead <0001 mg/L as N .0:26 . - mg/L as N _: 44.0 mg/L 58.0 mg/L 0.443 mg/L <0.01 mg/L. 3.7 mg/L 0.006 mg/L EPA 354.1 1.0 mg/L SM 4500D .. 10 mg/L _ SM 2320B No defined limits EPA 130.2 No defined limits EPA 236.1 0.30 mg/L EPA 243.1 0.50 mg/L Combined limit for Iron plus Manganese = 0.50 mg/L EPA 273.1 20.0 mg/L ** EPA 239.2 0.015 mg/L * ** ml= milliliter mg/L--milligrams per Liter -ND =none detected MCI—Maximum Contaminant Level TNTC =Too Numerous To Count * *Notification Level * **Action Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: ®X OTABLE or DOT POTABLE f RESULTS BASED ON SAMPLES SUBMITTED: 8/15/2001 • d j Laboratory Director -NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037- (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 o OUTSIDE CT: 800 - 654 -1230 PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: S o _ ;....Inspecte. _ _y:.- C,- TZEn -. = StreefiLocation�;�;y Tuxarz "L,u; Owner-' M�fLoy6Y Town P,ATT 7eson/ Permit # Tom- / -en TM # -3 Sz - 4 - 01 Subdivision Lot # 1. II Sewage Svstein Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped... ......................... ...................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... . Sewage System a. Septic tank size - 1,000 .... ..other ................ b. Septic tank installed level .............. ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. TUI out ets at same elevation -water tested ................. 2. Protected below frost ...........:...... ............................... 3. Minimum 2 ft.Original soil between box & trenches e. 'Junction Box - properly set ........... ............................... f. re-n -c'Fies — p p y T.-Ue-n-g-th required 1fo© Length installed f406 2. Distance to watercourse measured fi t Ov Ft......:... 3. Installed according to plan ................. :....................... 4. Slope of trench acceptable 1/16 -1/32" /foot ............. 5. 10 ft.. from property line - 20 ft: foundations.......... 6. Depth of trench <30 inches from surface ........ :......... 7. Room allowed for expansion, 100 % .........:............... 8. Size of gravel 3/4 - 1' /z" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped....::...::..7.-:. ,--_._; ..........:.................... g. Pump or Dosed Systems 1. Size ot pump c am er ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. HouseBuildi4g a. house located per approved plans ................ b. Number of bedrooms ........................1f....... ..................... . IV. Well a. -Well located as per approved plans . ............................... b. Distance from STS area measured /2_ _ ft........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. 'Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area .............. h. Surface water protection adequate ...... ...........:.... ...... .......* i. Erosion control provided ........... :.................................... `-- n— . ripe v� v I= ON � 44 Ri ... -._ -.mac. -. • -. .. -. . iwa....a'�.�.-PUI- 14Aa'Y'.CO.UN l{ tl.DEPA151T`YLL11AVTOF= UAL TIB-' a.. ... ..�r�. -mow... �+ua _: -.. r. :.. ..... .: .... .... IDMSION OF ENVEt®NMENTAL HEALTH SERVICES ATTENTION ® ADAM GENE All information must be I ally completed prior to any inspections being made. For: Fill Trenches _ K PCHD Construction Pen nit # — 1 ° ° -0 Located: zs%r T4% &� CcAvpz, (T ) ( RtY� t-SOA dw Owner /Applicant ame: lbw TM IL, Block q , Lot Formerly: A Su division Name: w000 Subdivision Lot # l Is system fill completed ?l� Is system complete ?�5 Is system constructed as per plans? YLPh Is well drilled? o Is well located as per plans? Are erosion control meal ,ores in place? Date: Date: Date: �((® I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their coral ,letion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regina of the Putnam County Department of Health. / Date: �[ �Z"�� Certified by: PE M Design Professional Comments: Forth FIR -99 _ BRUCE R. FOLEY Public Health Director July 5, 2001 LORETTA .. MQL1NARL R.N..M.S.N... Associate Public Health Director Director of Patient .Servire.e DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 27.8 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Peder Scott, PE PW Scott Engineering 3871 Route 6 Brewster, New York 10509 Re: Field Inspection - Maloney Tommy Thurber Lane, (T) Patterson TM# 34 -4 -9 Dear Mr. Scott: The following comments must be corrected in the field: 1. Silt fence is not installed. All silt fence must be properly installed prior to any construction. - If you have airy futther' questions, please'contacfine at'(845) 278 -6130 ext. 2261:` GDR:cj Very truly yours, Gene D. Reed Environmental Health Engineering Aide M .... BRUCE _ R..._FOLEY -_.. - . ... _ .. - Public— Health - Director - July 5, 2001 - - -._. LO_ RETTA__ MOLINARI R.N., M.S.N., . �. w Associate 2Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 . Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 ' Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Peder Scott, PE PW Scott Engineering 3871.Route 6 Brewster, New York 10509 Re: Field Inspection - Maloney Tommy Thurber Lane, (T) Patterson TM# 34 -4 -9 Dear Mr. Scott: The following items are in violation of Article III, Section 2C of the Putnam County Sanitary Code: 1. Silt fence is not installed. All silt fence must be properly installed prior to any construction. A formal notice of hearing may be issued if the violation is not corrected within 5 days. It is truly hoped that the above violations are corrected without having to take legal action. Very truly yours, Gene D. Reed Environmental Health Engineering Aide GDR:cj c. .i _,.y._.. —..�� .... 1 PUTNAM COUNTY DEPARTMENT OF HEALTH a, DIVISI ltT OF ENVIRONMENTAL HEALTH SERVICES_ CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM ter. PERMIT # Located at TDrrjnn V TMOIL,tg r. Town or Village P/I777,i'- o3 Subdivision name ,e os &-w oy o Subd. Lot # _� Tax Map Block Lot _ Date Subdivision Approved I /// I / o o Renewal Revision Owner /Applicant Name 62*1i s y►'tA [,p a1 LE!l Date of Previous Approval Mailing Address oL 1 d /fi LL, /21), IA Zip nS`� Amount of Fee Enclosed P 30O, C20 Building Type Ae53i DL- vc,& - Lot Area ,2.$Z kNo..of Bedrooms 4 Design Flow GPD 8- 60 Fill Section Only Depth Volume PCIl1D NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of (2-SO gallon septic tank and ` Q6 06 2+k w�W lKalo�s A am-ft z God Other Requirements: To be constructed by `T l Pte--- Address = V IZcIPA -c, (3 (-au)5Ti31�, Water Sur�nly: Public Supply From. � Address � or: Private Supply Drilled by Address f` I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thqreba,. R.A. Date License # 105 c1 APPROVED FOR CONSTRUCTION: This approval expires two years from fhe date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered. necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new p it. pproved r discharge of domestic sanitary sew ge only. By: G'"� � Title: Date: White copy - HD F' e; Y 610 copy - Building Inspector; Pink copy - O er; Or copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL :.PIRA�e print.or. types - 1 - ti... _.. _ .. , ,a >: _,... � _ .. �. - - . �PCHD Permit Well Location: Street Address: Town/Village Tax Grid # log jomnt 7710"192%4AIE" R4-T2"72 Svn/ Map 3,11 Block Lot(s) Well Owner: Name: Address: Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 779-pin # People Served .`5' Est. of Daily Usage 6 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ............. Yes No Is well located in a realty subdivision? ...................................... ............................... Yes_ No Name of subdivision oSL.Joor� Lot No. Water Well Contractor: pad Address: Is Public Water Supply available to site? .......... ............................... Yes No X_ Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination t provided on separate sheet/plan. Date: Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and 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 or their designated representative 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. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and 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. APPROVED_ FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. I A Date of Issue A Z ( —cc Permit Date of Expiration . 2 j --0-2 Title: _ Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 BRUCE R. - -: FOLEY - Public Health Director LORETr MOUNT RI t N. M:S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 Environmental .Health (914)278;,6130 Fax (914) 278-7921 Nursing Services (914)278-6558 WIC (914)278-6678 Fax (914) 278-6085 Early Intervention (914)278-6014 Preschool (914) 278 -6082 Fax(914)278-6648 TO: DEPARTMENT OF ENGINEERING AND. DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM PROJECT: TOWN:, C" StK PV <<:' K DATE SUB'D APPROVAL: NOTICE OF COMPLETE APPLICATION DATE: r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL -A-WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: Thomas Maloney 22 Ivy Hill Road Brewster, NY 10509 2. Nameofproject: Rosewood Subdivision 3. Location TN: Patterson 4. Design Professional ° & . Architecture, P . C r 5 g Address: 3 8 7 1 Route 6 6. Drainage Basin: East Branch Reservior Brewster, NY 7. Type of Project: x . Private/Residential Apartments Office Building Food Service Commercial Institutional Mobile Home Park Realty Subdivision Other (specify) 10509 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................:.. Type I Exempt Type II Unlisted x 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... No 10. Has DEIS been completed and found acceptable by Lead Agency? ............... N/A 11. Name of Lead Agency Town of Patterson Planning Board 12. Is this project in an area under the .control of local planning, zoning, or other officials, ordinances? .............. :..:........ ................ ............ :................. ....... .............. 'Ye s 13. If so, have plans been submitted to such authorities? ........ ............................... Yes - S ub.d i v i s i o n 14. Has preliminary approval been granted by such authorities ?Y e s Date granted: 8/-97 15. Type of Sewage Treatment System Discharge ................. surface water x groundwater 16. If surface water discharge, what is the stream class designation? .................... N/A 17. Waters index number (surface) N/A 18. Is project located near a public water supply system? ....... ............................... No 19. If yes, name of water supply N/A Distance to water supply N/A 20. Is project site near a public sewage collection or treatment system? ................ No 21. Name of sewage system Individual Lot Distance to sewage system 22. Date test holes observed 1 2/ 8/ 9 5 23. Name of Health Inspector M i k e lB u d z i n s k i 24. Project design flow (gallons per day) ................................. ............................... 800 cPn 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? ......................... N/A Form PC -97 27. Is any portion of this project located within a designated Town or State wetland? 28. Wetlands ID Number .............................................. ............ ............................... i............. ............................... _ L No N/A �•�.,� 29. Is Wetland- a?ermit.re _ . : ................ ........::..:.........��.� quired? ................... _ ... _.... Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ............................... 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No 32. Is project located within 1,000 feet -of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No DESCRIBE: N/A No No No 33. Is there a local master plan on file with the Town or Village? ......................... Yes 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... _ Yes 35. Are any sewage treatment areas in excess of 15% slope? . ............................... No 36. Tax Map ID Number .................................................... 3 4 Block .4 Lot 7 9 31. Approved plans are to be returned to ..... Applicant x Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department; and need not be sent in- duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICL4L TITLES: Nailing Address: ................................... p licar. Peder W. Scott; P.E. R.A. - 6hen. or^A p 3871 Route 6 pr4 1- �d Brewster, NY 10509 1NHO 1�1v,aa 14-16-4 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 SEQR pen State Environmental Quality Review. SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I-- PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT (SPONSOR 2. PROJECT NAME Peder Scott Maloney Septic 3. PROJECT LOCATION: Municipality Patterson County Putnam 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) 68 Tommy Thurber Road 5. IS PROPOSED ACTION: u New 0 Expansion 0 Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: Septic System with 1250 gallon septic tank and .7 rows of 58' x 2' trenches = 406 lineal feet. Installation of a well. 7. AMOUNT OF LAND AFFECTED- Initially ' 2 acres Ultimately ' 2 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes 0 No II No, describe briefly 9. WyyH--��AT IS PRESENT LAND USE IN VICINITY OF PROJECT? 'CJ Residential __.._� Industrial _ O Commercial 0 Agriculture,.. - .. -O. Park /Foresil0pan_ space.._..^_.- D_Qthar_.__._......_. Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? Yes 0 No If yes, list agency(s) and permlUapprovals Putnam County Health Department 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes LI No 11 yes, list agency name and permlUapprovai 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? 11 Yes 0No i N/A I. CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicantisponsor U S C Date: 3 ' 30 _C5)� Signature:'— If the action is In the Coastal Area, and you are a state agency, complete* the Coastal Assessment Form before proceeding with this assessment OVER PART II— ENVIRONMENTAL ASSESSMENT (fo be completed by agency) A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR, PART 617.127 If yes, coordinate the review process and use the FULL EAF. ❑ Yes L No B. Wl!.L ACTON RECELVE COORDINATED. REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NY.CRR, PART-617:6? lt- No,.a.negattve- declaration. c may be superseded by another Involved agency.H.. " ❑ Yes `No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) Cl. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: No C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: No ` C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly. No Cd. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly No C5. Growth, subsequent development, or related activities likely to be induced by the proposed action ?,Explain briefly. No C6. Long term, short term, cumulative, or other effects not identified in C1-05? Explain briefly. NO C7. Other Impacts (including changes In use of either quantity or type of energy)? Explain briefly. No THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? C1 Yes O No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether it Is substantial, large, important or otherwise significant. Each effect should be assessed in connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting (� documentation, that the proposed action WILL NOT. result in any significant adverse environmental Impacts AND provide on' attachments as necessary, the reasons supporting this determination: ILA 0-6 .1 P 1jul L-ft. int or Type Name o esponsible Otticer in Lead Agency Title ot Responsible OttiZer Signature o espo sib O fficer in Lead Agency Signature of Preparer (if di erent o - &— I 01 )n� G ]AI-43h Date 2 LOT- DIVISICLT or rte' LT'S - R 711 _ . _.. APPENDIX I DESIGN LAT `S� - Su- :SU -FA=- SZgr Gi OISP . AL S1S.Y _. come- F-,5 kTE OF AHULP-1-4 Address `.3o PA94- A. VE L;cate:: at (Street) I�t-tMpd -+� HI4L1..F ��NM�TN .0 .. 3`i Block `� Lct (indicate nearest =oss st eet) .µ..u•� c;rali.tr P�tTT'ER�or -► Wate=shei -o=. PEnG7LU -1T 7,`i ?'_ ST DATA tREQ �� M BE =MS'I'T'. � - .1=1- APPS M--ICNS zata of P`•e-Seak:.ng (I Date of Per =lat =cn Test 411 -116 HOLE NGME R Cl=% TIME P C�iAZ'ICN PazC0= —C,1 Run Elapse Ho. Tim Star''.: -Stoo M-.in. Deptz to . `water Fr= Gn:cund Sum +ace Start Si Cp n(:: "nes Mr.r .es Dater Level In Inches ' Drop I'1 L1CIes Sail- Rate - �q i X06 .. _ (a� �0 l4'1't -" J�'��►�" 4114, 23/ A _-- _.3._...� -- 1:13.. :_1?� VG I ILI S 1. Tests to be repeated at same depth until apprc x mately equal soil rates - are • obt-ai.ned .at each percolation test hole. • 'ALI, data to* be sulzai.tte3 for review. :.2' . Depth :rn_asurem ats to be made fran tap of hole.: rev. 9/85 TEST PIT DATA REOULRED TO BE SUM= ME= ;0PLIC-2kTICIN DESa=10N OF SOILS aKMR\7r= IN TEST EOLr:.S IA- (� DE lyd HOLE NO - HOLE NO. ' HOLE N10. 0 - e)L-Al, 21 31 41 51 61 7` 9 M­10� . LONM t4o 0 10 12' . .......... 13 INDICATE I= AT WHICH GROONU�V= Is a\C0UL\=-,M INDICATE I,,-vm TO wAUC,,j ?=r% LEVEL RISES A= BEING M\=UNT= DEEP HOLE OBSERVATIONS MADE BY: P C.N O DAM: DESIGN -Soil Rate Used Min/I" Drop: S.D. Usable Area Provided ;5000 A No. of Bedroa-ns Septic Tank Capacity gals.. Type Absorption Area Provided By L.F. x 24" width trench Other c C.3 c4w�� .2 Nam- Q FHu1t4EEP)4AtAP.LK-PL jnat Si P1" 0�7�41 Cl- Address � J (10 LU THIS SPACE- T-70R USE BY EF-UTH DEPAMaT2 ONLY: Soil Pate Approved '.sq.*ft/gal. Checked by Date P. W. SCOTT Engineering & Architecture, P.C. 3871 Route 6 BREWSTER, NY 10509 E -Mail: pws @bestweb.net (014)476-2'110 (,, "' FAX (914)- 278 =2166 " -' _.. TO WE ARE SENDING YOU Attached ❑ Under separate cover via _ ❑ Shop drawings Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ dCCITTE n @GP 4 ° a @W0 11 C1TQd DATE 4t O O JOB NO. ........ ATTENTION .. .......... _. RE: %�.:. 1 1 04 C7 I1""^ - `ee�Aj c fnllnurina i *cmc• ❑ Samples COPIES DATE NO. DESCRIPTION --- "" THESE-ARE-'TRANSMITTED as checked ' beloW: - - /For approval ❑ Approved as submitted • For your use ❑ Approved as noted • As requested ❑ Returned for corrections ❑ For review and comment ❑ ❑ FORBIDS DUE REMARKS COPY TO ❑ Specifications • Resubmit copies for approval • Submit copies for distribution ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: H enclosures are not as noted, kindly notify at once. P. W. SCOTT Engineering & Architecture, P.C. 3871 Route 6 BREWSTER, NY 10509 E -Mail: pws @bestweb.net (914) 278 -2110 FAX (914) 278 -2166 TO Putnam County Dept. of Health 4 Geneva Road Brewster, New York 10509 WE ARE SENDING YOU Attached ❑ Under separate cover via ❑ Shop drawings ED Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ DATE JOB NO. ATTENTIO RE: f4 L_Oyuoly i. r,. Application for Approval ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION i. Application for Approval Construction Permit for Sewage Treatment System (form CP j Letter of Authorization (form LA -97or CA -97) Design Data Sheet (form DO -97) Short Form EAF House Plans (2sets) Application to Construct a Well (form WP -97) Check # for the amount of THE ARE TRANSMITTED as checkep Eelow, n g s �L72rGlc -A-7?"rj i:e4c4-N. ❑ For approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections For review and comment ❑ ❑ FORBIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints P.W. SCOTT ENGINEERING & ARCHITECTURE, P.C. 3871 ROUTE 6 BREWSTER, NY 10509 LETTER OF AUTHORIZATION Re: Property of Thomas Maloney Located at TommyuThur.ber Lane T/V PattersonTaX Map # 34 Subdivision of Rosewood Subdivision Subdivision Lot # i Gentlemen: Block 4 Filed Map # 2 8 1 4 (914) 278 -2110 FAX (914) 27.8- 216.6 .. Lot 79 Date Filed 1/ > 1/2000 This letter is to authorize Peder W. Scott, P.E., R.A., a duly licensed Professional Engineer X or Registered Architect X to apply for the required wastewater treatment and /or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and /or water supply systems in conformity with the provisions of the Public Health Law and all applicable Sanitary Codes. Very truly yours, Signed: �U L (Owner.of pro erty) Countersigned: Peder W. Scott, P.E., R.A. P.E., R.A. #: 059346 Mailing Address: 3871 Route 6 Brewster, NY 10509 (914)268 -211`0 Mailing Address: 22 Ivy Hill Road Brewster, NY 10509 Telephone: C giyj d �q_ 944 + A R C H I T E C T U R E - E N G I N E E R I N G - S I T E E P L A N N I N G BRUCE R. FOLEY :`Public - Fealth- Director LORETTA MOLINARI R-N., M.S.N. -- Associate. Public : -Feclth.tflirector Director of Patient Services DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 Environmental Health (914)278-6130 Fax (914) 278 - 7921 Nursing Services (914)278-6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 E911 ADDRESS VERIFICATION FORM OWNERS NAME: Hampshire Land Company Lot 1 TAX MAP NUMBER: 34 -4 -79 E911 ADDRESS: 68 Tommy Thurber Lane Patterson TOWN: AUTHORIZED TOWN OFFICIAL: (Signature) 2 ao 0 DATE: The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a lecral E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERFRK Yt ALL SUBSEQUENT RENISIONJALTEMATIONS TO THESE HOUSE PA,ANS MUST BE §UBMITTLD TO THE PCDOR FOR APPROVAL !iIGNATURE • TL' DATA j � CPCC)T\Tn -PT (-)C-)R COPYRIGHT 19M OMMAS : CUTLER ARCHITECTS. ALL RIGHTS RESERVED. THESE PLANSPDRAWINGS ARE THE SOLE AND EIMUSIvE PROPERTY OF DOUGLAS CUTLER ARCHITECTS AND USE WITHOUT EXPRESS WRITTEN PEWtSSION IS STRICTLY PROHIBITED COPYING THE PLANSCRAWINGS OR CONSTRUCTING THE ARCHITECTURAL WORK DEPICTED WITHOUT AUTHORIZATION VIOLATES FEDERAL LAW, TITLE 17 U.S. CODE. OFFENDERS MAY BE LIABLE FOR AN nk#CnC)N PROMBITING CONSTRUCTION AND A MONETARY AWARD OF PROFITS, WAAGES AND ATTORNEYS FEES' d. a j. COPYRIGHT 19M OMMAS : CUTLER ARCHITECTS. ALL RIGHTS RESERVED. THESE PLANSPDRAWINGS ARE THE SOLE AND EIMUSIvE PROPERTY OF DOUGLAS CUTLER ARCHITECTS AND USE WITHOUT EXPRESS WRITTEN PEWtSSION IS STRICTLY PROHIBITED COPYING THE PLANSCRAWINGS OR CONSTRUCTING THE ARCHITECTURAL WORK DEPICTED WITHOUT AUTHORIZATION VIOLATES FEDERAL LAW, TITLE 17 U.S. CODE. OFFENDERS MAY BE LIABLE FOR AN nk#CnC)N PROMBITING CONSTRUCTION AND A MONETARY AWARD OF PROFITS, WAAGES AND ATTORNEYS FEES' co 'o � j c3 OD 4, Y A� L E G E N D WATER SERVICE GATE VALVE WETLANDS BOUNDARY LINE PROPERTY LINE 4m EXISTING CONTOUR LOT, 00111"t 2 M j So 9 -3 t W M AaMINERMOMM"M M � t i INVERT OUT TO TRENCH NOTE- WATER SERVICE PIPE SHALL BE BEDDED AND BACKFILLED WITH ' TRENCH # SERVED TRENCH INVERT SAND TO A MINIMUM OF J" ON ALL SIDES. NO JOINT IS PERMITTED BETWEEN CORPORATION STOP 6 CURB STOP. INVERT CHART FIRST FLOOR: 804.0' BASEMENT: 795.0' INV. OUT OF BLDG. 801,25' INV, IN SEPTIC TANK: :800,75' INV. OUT SEPTIC TANK: ' 800.50' OVERFLOW D -BOX # INVERT IN INVERT OUT TO TRENCH HIGH LEVEL OVERFLOW TO NEXT D -BOX GRADE AT' OVERFLOW D -BOXES TRENCH # SERVED TRENCH INVERT GRADE OVER FIELDS 1 800.25 799.75 800.00 801.75 P1 799.50 801.00 2 799.75 799.25 799.60 801.25 P2 799.00 800.50 3 1 799.25 798.75 799.10 800.75 P3 798.50 800.00 4 798.75 798.25 798.60 800.25 P4 798.00 799.50 5' 798,25 797,75 798.00 799.75 P5 797.50 799.00 6." 797.25 796.75 797.00 798.75 P6 796.50 79800 7 - - - - P7 796.00 797.50 t t .PR. OPERTY IDENTIFICATION 805 OWNER; MR. & MRS, THOMAS MALONEY ADDRESS: 22 IVY HILL ROAD BREWSTER, NY 10509 800 E911 # 68 TOMMY THURBER LANE T, M. # 34 -4 -79 795 PROPERTY 68 TOMMY THURBER LANE ADDRESS: PATTERSON, NEW YORK i I i Op 09_� f -. '1N3hldVd30 3H1 A8 ,- AVN 60 03Sf1V0 2103 x )338.210 NO 03M3N38 !IV(] 3H1 N08J S21V3,I AiNnoo NVNind 3H1 -Cl ` d 3Hi 30 A11I18ISNOd � t 213H10 -11V (INV AINO 'Z IAONddV SI NVId SIH1 L pllddV AONVdf1000 3o W g 921 3H1 .JO dOi33dSNl ).LNf100 NVNlild 3H1 y p 30NVIIdN00 NOiion i 5 SIHl JO ADNVdnooO -A, A�€ HON: 9 .JO Nf1NININ V '0 fg Hi ONI1113H0V8 83J.JV t _ & � j 'NVId SIHL NO - % t t .PR. OPERTY IDENTIFICATION 805 OWNER; MR. & MRS, THOMAS MALONEY ADDRESS: 22 IVY HILL ROAD BREWSTER, NY 10509 800 E911 # 68 TOMMY THURBER LANE T, M. # 34 -4 -79 795 PROPERTY 68 TOMMY THURBER LANE ADDRESS: PATTERSON, NEW YORK i I i Op 09_� f -. '1N3hldVd30 3H1 A8 ,- AVN 60 03Sf1V0 2103 x )338.210 NO 03M3N38 !IV(] 3H1 N08J S21V3,I AiNnoo NVNind 3H1 -Cl ` d 3Hi 30 A11I18ISNOd � t 213H10 -11V (INV AINO 'Z IAONddV SI NVId SIH1 L pllddV AONVdf1000 3o W g 921 3H1 .JO dOi33dSNl ).LNf100 NVNlild 3H1 y p 30NVIIdN00 NOiion i 5 SIHl JO ADNVdnooO -A, A�€ HON: 9 .JO Nf1NININ V '0 fg Hi ONI1113H0V8 83J.JV t _ & � j 'NVId SIHL NO 'H1lV3H j NOIS30 IVN0Ili0i NOI1VllV1SNl N 1 11N83d 3Hi . ,INV 'SNVId 3S 3H1 01 dOl2 n-AMOIIV 38 - IVW �2 i - -� "��.arioN E'�SEMENr 264.84' � CH. pO'.CN — c FLAG5TONE� WALK — At?�A — 2.5291 AC. t 1! 1 1! /' A A 1! -I' Y7 I N22 °3~ ISZ? \ 6 bn \ .S o° N S 63 z� S cp, � D ROSEWOOD LOT #1 AS-BUILT A B c WELL 581611 33 901 1 31 1 -011 661 -611 2 36 1-811 71 1-911 3 1 42 -811 11 761 -6 4 481-8 11 01-611 8 5 541-611 85' -0'` 6 68 1-011 961-611 7 751-311 103' -0" 941-311 011 9 391-611 87- 84 ° -0" 801-9!! 771-61 731-6 11 12 731-31' 671-311 13 70' -0" 61' -9" 07" 15 20' 8 bb'-V" 16 241-011 591-011 17 25 1-011 51 1-911 18 21 1-011 201-811 D