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Home My WebLink About1748DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -4 -87 BOX 16 If .. IN r ;. Ir , ` 1. 1 1L k, L 16, r Revd 318 uarAKiivir,Pal urn�.v.rn Health Services; Carmel, N.Y 10512. Ebgineer Meet Provide P.0 H D Permit M- JAI"44 _�G\�1 _�L 11/ Taz Map�J . Block Lot — Owner/ llaxnt Name " A . G Gd�� Vj app K TFormerty Subdivision Name ' Sabay. Lot #_ Mailing Address ZIP Date Permit Issued 2r D Separate" Sewerage System built by .� �4N la� a!� Address n OSb Consisting Gallon Septic Tank andT��•f�) (-{� Water Supply: Pubuc Supply From Address ore Private Supply Drilled by f i/I I/L1 N� . ( N t • AddressA11'E:1 Has Erosion Contiol Been Completed?— BaU d i g Type , � Number 'of Bedroo a Garbage Grinder Been Instilled? � fl Other Requirements 10%'D__� 1 4•UM_rb% N M�l1 I certify.that the systems) "as listed serving the above pr4imises were constructed essent dlly'as shown the plans of the completed'viork ( copies of which.&is attached)', "and in dccordance.with the standards, rules ' and r ations,'in accordance with " a f 6d. lan, and the permit issued by the Putnam County Depaarrrtmea t'Of Health. "� ''' Oats — certified, by Address P.E. y R.A. t94 Licehse Any 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 condition; resulting, from such:.usage. ,Approval_ of the separate, sewsrege,systein shall become null and void as noon as a pubV: sanitary swwr 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 Commissloner of 11'eaft such revocation, modification or change Is necessary, Oats BY _J Title in PUM M COUNTY DEPARiKENT OF HEALTH DIVISION OF ENVIRQSR TA BEAM SERVICES If I Coe 0 C." Owner or Purchaser of Building Section Block Lot Location - Street 12 Municipality Building y Pf_�U) Kls Ilb Subdivision Hama T V Subdivision Lot GUARPKI.'EE OF SUBSURFACE SEPMGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system . serving the above described property, and that it has-been constructed as shown on the approved plan:. or approved. amendment, thereto,:: and ..,in _ accordance .with. the standards, ,rules- and regulations 'of the: Putnam`. County Departnent '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 i=ediately following the date of approval of the "Certificate of Constriction Compliance" for the sewage disposal syste-n, or any - �._ . _.__�pai�s=-i��c�..Ly- m�: -tz,� �u.°.i:..�YSt�.,- •r- �c�pn`� =. v�ier�.th�a•- f�lirP- _to_:.o�era+.�: nriape�],Y_.�,s _4_..., ..._ 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 Environinental 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 /Vou day of a gg 19 Signature Title �Qf General.Con "actor (Owner) - Signature Corporation Name (if rp.) daio< rev. 9/85 mk 9A-&4A� Corporation mama (if Corp.) /04 Address Lot 5 4' WCLLL UVr1rLL11UA 1cr!rUAI DEPARTMENT OF HEALTH Diyasiog_ Q{ Fny- irpamentR? - wealth Services YOB �._ _ PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only -. WELL LOCATION STREET ADDRESS: 1OWNIVIELAMERRY TAX GRID NUMBER: Ice Pond View Estates, Lot 5, (Steinbeck Estates, Patterson, �-Y 41 WELL OWNER NAME: /ti c- ADDRESS: Patrick Crawley, Woodside, New York BIVATE I o PUBLIC USEjQE1ELL 1 QEt 2 - secondary RESIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND. /HEAT PUMP O ABANDONED 0 BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY O MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED 2 – 4 I EST. OF DAILY USAGE gal. REASON FOR DRILLING []REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY XMNEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 685 ft. STATIC WATER LEVEL . ft. DATE MEASURED 1.1/19/93 DRILLING EQUIPMENT ❑ ROTARY XXIKCOMPRESSED AIR PERCUSSION ❑ DUG O WELL POINT O CABLE PERCUSSION O OTHER. (specify): WELL TYPE O SCREENED O OPEN END CASING =OPEN HOLE IN BEDROCK O OTHER CASING TOTAL LENGTH — tL MATERIALS: )1 STEEL O PLASTIC O OTHER LENGTH BELOW GRADE 40 ft. JOINTS: O WELDED )V1 THREADED O OTHER DETAILS DIAMETER 6 in. SEAL)=CEMENT GROUT O BENTONITE OOTHER WEIGHT PER FOOT 19 lb. /ft. DRIVE SHOE O YES O NO LINER: O YES ONO SCREEN DETAILS .... _ .... DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST ❑ YES ❑ NO HOURS SECOND _ .. - - ._. ... GRAVEL PACK r0 YES ❑ NO GRAVEL SIZE. DIAMETER OF PACK in_ TOP DEPTH tL BOTTOM DEPTH ft. WELL YIELD TEST if detailed pumping METHOD: O PUMPED tests were done is in- }IR COMPRESSED AIR ,formation attached? O BAILED ❑ OTHER ; ❑ YES ❑ NO WELL. LOG If more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE water Bear- ing well Dia- meter FORMATION DESCRIPTION CODE ft. tt. WELL DEPTH ft. DURATION hr. min. DRAWOOWN ft. YIELD gpm. Land 4 Brown soil 4 685 Hard grey & white granite 685 6 – 400 6. WATER H3 CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? DYES ONO ANALYSIS ATTACHED? JK YES ONO STORAGE TANK: TYPE Diaphragm CAPACITY 86 GAT.. 23 PUMP INFORMATION submersible 7 TYPE CAPACITY MAKER GOULDS DEPTH - MODEL 7EH10412 VOLTAGE 230 HP 1 WELLDAILLERNAME MILL DRILLING, I 'n �:) ADDRESS Putnam .Ave. SIGt1ATU i Brewster, NY gob -t ill , j/69 J Q .. _ „�;. � .. - -> _ �..,. - � . _ .,.. _..... >..-�. - T- �.- ..y-- ��►�.,..r..�._ -.. -.- .emu.__.. .�__.- ��,. .. - NORTH AMEMC AN ANALYSIS DATA SHEET TYPE: PW LOCATION: Pat Crowley REPORT TO: Mill Drilling ADDRESS: Putnam Ave. CITY, STATE, ZIP: Brewster, NY 10509 DATE COLLECTED: 12 -02 -93 TIME COLLECTED: 11:00 COLLECTED BY: Bob Mill REPORT DATE: 12 -07 -93 LAB # : 93 -6408 SAMPLE SOURCE: - DATE ANALYSIS RESULT UNITS METHOD ANALYZED Total Coliform MF Absent /100mL SM 17 (9215D)12 -06 -93 THIS SAMPLE AS RECEIVED AT THIS LABORATORY MET THE REQUIREMENTS OF NEW YORK STATE DRINKINGWATER STANDARDS. Laboratory Director NEW YORK STATE ELAP CERTIFICATION NUMBER: 11218 618 CLOCK TOWER COMMONS, RTE 22, BREWSTER, NY 10509 / 914- 278 -7600 / FAX 914- 278 -7754 WS$W Sa*pb; Poll& Sop* F1ti• Addreaa ors_ �Pd�pba Supply O�.d by Odw I,repreeent that I am wholly and completely responsible for the design and location of the propose system($); 1) that the separate, sew _di VI sal s stem above described will be constructed as shown on the approved amendment there to and in accordance with the standarils. rulis a regu ens o m County Department of Health. and that on completion thereof a "Certificate of Construction Compliance" Satisfactory to the Commissioner of Healthwill be submitted to the DepeKment. and a written guarantee, will be furnished the owner. his successors. heirs or anions by the buildii. that mid bulkier will place ,in good .opwatkq condition any part of mid sewage: disposal system during the period of two (2) yens Immediately following thedate of the isso- once of the approval of the Certificate o1 Construction .CompliaAd iginal system or any repairs t eto; 2) that the drilled well described a6ow WIN tee located as shown on the sOpwoved plain and.lhat said well wilt accordance with he stn s, r s and r"Mil nsof the Putnam County Daprtneetit of Health. Data 7 J to . Z 5 Address711 License No APPROVED FOR CONSTRUCTION: This approval sxpMestwo years from the dale -issued unless construction f the building has been undertaken and is revocable for cause or may be amande0 or rnodified when considereaancessery by the Commissioner of Health. Any change or alteration of construction nouirea new permit. Approved for disposal of domestic Sanitary sewage rw p oly only. REV. 10/88 BY � Title �� DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 PCHD PERMIT WELL LOCATION Str et Address . T wn Village City Tax Grid Number t3 3 6"7 WELL OWNER N e l Mai ng Address a !' l.- G s ! Pr vats ublic USE OF WELL CD: primary 2 - secondary SIDENTIAL 0 BLIC SUPPLY 0 AIR /COND /HEAT PUMP 0 BUSINESS O FARM 0 TEST /OBSERVATION ® INDUSTRIAL O INSTITUTIONAL 0 STAND -BY O ABANDONED 0 OTHER (specify AMOUNT OF USE YIELD SOUGHT�I.— _gpm /# PEOPLE SERVE q-- OF DAILY USAGE aG gal 0 REPLACE EXISTING SUPPLY O TEST/ OBSERVATION GI: ADDITIONAL SUPPLY gjNEW SUPPLY NEW DWELLING) ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE I ODRILLED O DRIVEN ®DUG [3 GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES ENO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: t ,, ffikj � � /7-e-_ Lot No. S WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ENO NAME OF PUBLIC WATER SUPPLY: i[J 4= TOWN /VIL /CITY TT QT�ATI•A TO .DAQPERTV FZ±Aw! PTE4.ST T'.rATF+P.' MAIAL� _ L LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED T SEPARATE SHEET L (date) (s nature) r 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 Department attached to this permit. 3. Submit a Well Completion Report on a form provided by During all well drilling operations, the applicant any and all water or waste products from such well property and in such a manner as not to degrade or Date of Issue: 19 Date of Expiration 19 �._S of the Putnam County Health the Putnam County Health Department. shall take appropriate action to assure that drilling operations be contained on this otherwise contaminate surface or groundwa -r Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller P UT NAM COUNTY DEPARTMENT O F' HEALTH T'r5•iEJii - "!-'.'L'.Y. "'i• i'pp�-R(i /1.. ni / }��__��_"tr�iih�i� .el .)p �';:C L T -rpn ran (i, _.Ft� �,�rv., X.r:�..•._» -��:u, �.. ....__..,. »�_... -... i� 'Y"i -a. —lJ -P'l:i "�YCJ- -i �rC'",v 'i7'!r't3i �{��AT ERl - `1 �7'PCiJ`~ "A L' T.'`S"11 =Y'1 -"•." 1. Name and Address of Applicant: — __IJ'4 Tic C_ c �- i ter•• � � 1 -� /`F-y � -3 2.2 2. Name of Project: oc'L SS,� 3.._• Locatio�. J' /C' 4. Project Engineer: ar la/ /llc c 5. Address: 7) License Number: SG.IZ.'Y Phone: ;)-7� –G. Md 6. Type,off Project: - Private /Residential Food Service .._.Commercial , Apartments Institutional Mobile Home'Park Office Building;. Realty Subdivision Other (specify) 7. Is this project subject:to State Environmental Quality Review (SEQR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted./ 8. Is a Draft Environmental Impact Statement (DEIS) required? 9. Has DEIS been completed and found acceptable by Lead Agency? ........... 10. Name of Lead Agency - .ti.. Is this project in an area. under the control of -local planning, zoning, or utner°of ic;'ia:ls � ardinances? ...- ...................... 12. If so, have plans been.. submitted to such author .sties ?.. ................... /yd 13. Has preliminary approval been granted by such authorities ate Granted: — 14. Type of Sewage Disposal; System Discharge...... I Surface Water round Waters 15. If surface water discharge, what is the stream class designation ?........ :6. Waters index number (surface) ........... ............................... ,} / :7. Is project located near a public water supply system? .................... :8. If yes, name of water supply Distance to water supply —® 9. Is project site near a public sewage collection or disposal system ?..... i .0: Name of sewage system ! Distance to sewage system '1. Date observed: _c7- Z- Qf? 23. Name of Health Inspector: Aty. 1L1, 9b �24il S CLj 4. Project design flow (gallons per day) ..................................... 806 ,2. 25. Is State Pollutant Discharqe.Elimination System ( SPDES) Permit required? 26. Has SPDES Application been submitted to local DEC Office? ............... 27. Is any portion of this project located within a designated Town or State / wetland? ................................. ............................... /d 28. 28. Wetland ID Number ........................................................ 29. -Is Wetland Permit, required? ....... ..... ............................... 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 or NO IZ14CII 32. Is project located within 1.000-feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or NO DESCRIBE: 33. Is there a local master plan or file with the Town or Village? 34. Are community water, sewer facilities planned to be developed within 15 years? _ ..� 35. Are any sewage disposal areas -in - excess of 15� slope ?..... - _ 36. Tax Map ID Number ......... ............................... .. .......... 37. Approved Plans are to 'be returned to: ................ . Applicant Engineer If the application is signed by a person other than the applicant shown in Item.1, the. application must be - accompanied by y-a Letter of Authorization. Failure to comply with this Provision may be grounds for the rejection of any submission. I hereby affirm,. under penalty of perjury.,- that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Cla s A Misdemeanor pursuant to Section 210.45 of the Penal Law. 1 SIGNATURES & OFFICIAL TITLES: `-1 TAILING ADDRESS: DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL �Q° % PCHD PERMIT 0i4 s-19 WELL LOCATION treat .Address To Village City 4. a 6s Tax r d mbar "f g- 3.6- WELL OWNER Name l /-Q J776, ai A ress . O . Ze A 0- 7 g�Private S D Public E OF WELL primary 2 - secondary RESIDENTIAL ® BUSINESS ® INDUSTRIAL ® PUBLIC SUPPLY O AIR /COND /HEAT PUMP ® ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify U INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED3�5 /EST. OF DAILY USAGE 90 D gal O REPLACE EXISTING SUPPLY O TEST /OBSERVATION 13. ADDITIONAL SUPPLY ANEW UPPLY NEW WELLING ) ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING ett) gfE S .. , WELL TYPE DRILLED O DRIVEN ®DUG OGRAVEL [:]OTHER IS WELL SITE SUBJECT TO FLOODING? YES /"(, NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISI Lot No. WATER WELL CONTRACTOR: Name rb p Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES x. NO NAME OF PUBLIC WATER SUPPLY: IAA" TOWN /VIL /CITY `"D'TSTANG 'TO.PkOFERT '-1'ROM_NEAMS-T-VA`rER -iyAIN .....- .,,_..._t...�- ...�._ a_� ._ ^ »._.__.- ....__..___......__. LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED I QON SEPARATE SHEET /a 'A.;z 0J (date) s gnature) LT 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 thirt3c (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling: perations, the applicant shall take appropriate action to assure that any and all water or wa e products from such well dril ing o era ons be con ined on this property and in su h ner as not to de ade or of is co su ace or groundwater. Date of Issue: 19 i Date of Expiration ?/ 19 ermit ssuing Officia Permit is Non- Transferr ble White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp.. Orange copy: Well Driller LAURENT ENGINEERING ASSOCIATES, PC. 73 FAIRFIELD DRIVE PATTERSON, NEW YORK 12563 ,.>,..,.,. ..... �x,.r>• f ?�,�N�f�L'i�ti "V�T.LAUfitEl�l�P� ."° .. ...._ !, 51g1 .2 ?- 8*51l?84•(FAX•?�278�26b-� .�.,.� �. -„_..:.. �. ,.�..�- ..V�,...y._�.....4_...�� _......_._<.. HARRY W.NICHOLS, JR., PE. CONSULTING SITE ENGINEERS December 9, 1991 John Karell, Jr., P.E. Putnam County Department of Health 113 Old Route Six Center Carmel, NY 10512 Re: Ice Pond View Estates -- Lots 3 & 5 Farm to Market Roar Patterson, New York Dear John: In response to your comment letter dated December 2, 1991 we note the following: Lot ;$3 1. The gravel portion of the curtain drain has been extended 30 feet to the east. it is 113 l.f. in length and has been labeled on the plan. The invert of the curtain drain at the catch basin has been added. 2. 100 gallons are to be dosed. This has been indicated on the Punp Chamber Detail. Lot #5 i Yi ...i.n'.v. tart- of .. t: h. e..- cuxta. in „dra.i.n_at_._the-- ca..tch._- basin , has..be.en-. ..._.._._ ......�...._. added 2. The length of the gravel portion of the curtain drain has been noted. 3. The system has been revised to indicate all trenches are 56 feet long. Enclosed are four (4) prints of the following: SS -3 "Proposed SJDS ", revised 12-- 5 - -91. SS -5 "Proposed SJDS ", revised 12 -5 -91. Kindly continue with your review and issuance of the Construction Permits. Very truly yours, LAURENT ENGTNEERTNG ASSOCIATES, P.C. Ila ry W. ' chols, Jr., P.E. HWN : bd 8635 ancs . cc: Mr. R. Hartz w /enc. DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225-0310 December 2, 1991 Mr. R. Laurent 73 Fairfield Drive Patterson, NY 12563 Re: Construction Permits Ice Pond Realty Subdivision Lot 3 Lot 5 (T) Patterson Dear Mr. Laurent: Review of the captioned projects have been completed by the writer with comments offered. as follows: Lot 3 1. What is the extent of the gravel portion of the curtain drain. The curtain drain should be extended to the east 30 feet. 2. State number of gallons pump dose. Lot 5 1. Indicate invert of curtain drain pipe at catch basin. 2. Show length of gravel portion of curtain drain. 3. Show all trenches 56 feet long. Very rul yours ' I�IJ J Ii IJ6,hn arel 1, Jr., P. E. Public Health Director JK/j P DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 December 2, 1991 Mr. R. Laurent 73 Fairfield Drive Patterson, NY 12563 Re: Construction Permits Ice Pond Realty Subdivision Lot 3 Lot 5 (T) Patterson Dear Mr. Laurent: JOHN KARELL Jr., P.E., M.S. Public Health Director Review of the captioned projects have been completed by the writer with comments offered as follows: Lot 3 - 1. What is the extent of the gravel portion of the curtain drain. The curtain drain should be extended to the east 34 feet. 2. State number of gallons pump dose. Lot 5 1. Indicate invert of curtain drain pipe at catch basin. 2. Show length of gravel portion of curtain drain. 3. Show all trenches 56 feet long. Very rul yours I /j6,hn arell, Jr., P. E. Public Health Director JK/jP i DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 December 2, 1991 Mr. R. Laurent 73 Fairfield Drive Patterson, NY 12563 Re: Construction Permits Ice Pond Realty Subdivision Lot 3 Lot 5 (T) Patterson Dear Mr. Laurent: JOHN KARELL Jr., P.E., M.S. Public Health Director Review of the captioned projects have been completed by the writer with comments offered as follows: Lot 3 -..� 1. What is the extent of the gravel portion of the curtain drain. The curtain drain should be extended to the east 30 feet. 2. State number of gallons pump dose. Lot 5 1. Indicate invert of curtain drain pipe at catch basin. 2. Show length of gravel portion of curtain drain. 3. Show all trenches 56 feet long. JK /jP Very rul yours A I,68,hn are 11, Jr., P. E. Public Health Director 0 11 l�r s ,�.. cFo�,�- cJ �H,P,.,r 7�� _ (r c6 �� 6j rA Lc:_ _ r:i - Q . rte-__*.^_ C= �,f - -- �r rte..•'^ = � "ur =� a GI c^ I I FT G-, AL--thCr_��L =C:i - tc= cC cz CN & L��• 1 if -- i =� G7 /.x.' T� Yom` - •^ -CM: :/ C -� �• - -J _ -rti f -`�� ' ` y LCL & _t 4 - =LAN Cl - 20' t-n : C= �C�-Z1C, ; al I c _ loo, 1 200' in D r..C.D, loo, tc �c:., c_.,r -_►- . ^ i _= ' 'tip: --�__ 1 ,\��_ -- 0RRTHAM8R( IN HOUSING OUSING -43 S-4 9 TWO STORY 4828 t 040.00.. 'GEOR010. 3 Cr SECOND FLOOR 7 I j VIIJ t. 48' 7. M. 01-1 BATH MIC MASTER BATH W/G.ARDEN TUB 4828 = 1344SF 48' if . .........i. OINING .00. -0-.l .G .00. o% 8' 71 11�71 "18000- .0's. FIRST FLOOR ALL FLOOR PLANS AND ROOM SIZES ARE APPROXIMATE NORTH AMERICANHOUSHNIG COIZIV PlAm, Prices And Specifications Subica To Cha,nge Without, Notice Copyright 1985 ....".00. 13•0". 17•0. 4828— 1344SF P.o. box 145 • point of rocks, maryland 21777 (301) 948-8500 • (301) 694-9100 • (301) 442-1410 (Sec Rcvcrsc Sidc) w cc) c Cd tto 28' TWO STORY 4828 t 040.00.. 'GEOR010. 3 Cr SECOND FLOOR 7 I j VIIJ t. 48' 7. M. 01-1 BATH MIC MASTER BATH W/G.ARDEN TUB 4828 = 1344SF 48' if . .........i. OINING .00. -0-.l .G .00. o% 8' 71 11�71 "18000- .0's. FIRST FLOOR ALL FLOOR PLANS AND ROOM SIZES ARE APPROXIMATE NORTH AMERICANHOUSHNIG COIZIV PlAm, Prices And Specifications Subica To Cha,nge Without, Notice Copyright 1985 ....".00. 13•0". 17•0. 4828— 1344SF P.o. box 145 • point of rocks, maryland 21777 (301) 948-8500 • (301) 694-9100 • (301) 442-1410 (Sec Rcvcrsc Sidc) LAURENT ENGINEERING ASSOCIATES, PC. 73 FAIRFIELD DRIVE PATTERSON, NEW YORK 125.63 ~RANDOLPH W. LAURENT, PE Y V iS'i4)`[78�60t3 =lFAkl HARRY W.NICHOLS, JR., PE. CONSULTING SITE ENGINEERS November 1, 1991 Putnam County Department.of Health 116 Old Route Six Center Carmel, NY 10512 Att: Robert Morris Re: Proposed SSDS, Lot #5 Ice Pond View Estates Farm to Market Road Patterson, NY. Dear Bob: Enclosed are the following: 1. Four (4) prints of Drawing SS -1, "Proposed SSDS- Lot #511, dated 10- 22 -91. 2. "Application For Approval of Plans For a Wastewater Disposal System ". . J. ' °Construction Permit for Sewage Disposal System ", dated 10- 22 -9.1. 4. "Application to Construct a Water Well ", dated 10- 22 -91. _!'D`.s.l•gn -Dataa 5. "Letter of Authorization ", dated 10- 22 -91. ?.. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only ". 3. "Affidavit - Corporate Owner Application ", dated 4- 23 -39. 9. A money order in the amount of $30.0.00 for review fee. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours,. LAURENT ENGINEERING ASSOCIATES, P.C. t .• L Harry W. Ni ols, Jr., P.E. HWN:bd 9695 -5 encs. cc: D. Cioccolanti w11 copy each PUTNAM COUNTY D E PARTMEN T O F H EAL TH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: i 0 leu)� A� MP-ik /G So -^I O, 2. Name of Project: 3.._, Loca ion T/V /C: 4. Project Engineer: it i�%'✓`G/-S 5. Address: License Number: Phone7� 6. Type of Project: -. ,• _ �: _ Private /Residential Food-Service .Commercial , Apartments Institutional Mobile Home Park Office Building,, Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted ^< 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. GAG 9. Has DEIS been completed and found acceptable by Lead Agency? ........... 10. Name of Lead Agency -- 1fi: °Is�tnis project 'in an--area- under'-i he-concroi- of�- iocal�- pl•ar�ning; -zoning,_._ - - or other officials, ordinances? ......... ............................... moo. 12. If so, have plans been submitted to such authorities? .................. l 13. Has preliminary approval been granted by such authorities? Date Granted: 14. Type of Sewage Disposal:System Discharge...... Surface Water x Ground Waters 15. If surface water discharge, what is the stream class designation ?........ A)A 16. Waters index number (surface) .... ....... ............................... A4 17. Is project located near a public water supply system? .................. 18. If yes, name of water supply ,47;4 Distance to water supply 19. Is project site near a public sewage collection or disposal system? ..... �o 20. Name of sewage system "' Distance to sewage system 21. Date observed: �3 -eff 23. Name of Health Inspector: 24. Project design flow (gallons per day) ...... ............................... �/ d 2. ? 9 ..3s Stat.e�Po:1 1d i Di.rsh= r9a. E-1.:;minatd;on :.S-yst?m-- ;: :(SPDES; _Perm1t,areq��:red ?.; 26. Has SPDES Application been submitted to local DEC Office? /) A 27. Is any portion of this project located within a designated Town or State wetland? .................................. ............................... k) C 28. Wetland ID Number .............................. ....................... A)1' 29. 2s Wetland Permit required? .............. ............................... Has application-been made to Town or Local DEC Office? ......... :........ P/ 30. Does project require a DEC Stream Disturbance Permit? ................... /0 0 31. Is or was project site used for agricultural activity involving application of pesticide$ to orchards or other crops, solid or hazardous waste disposal"` - landfilling,"sludge application or industrial activity? ..a..... YES or NO . PO 32. Is project located within 1;000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or NO /y DESCRIBE: 33. Is there a local master plan or file with the Town or Village? ........... `DES 34. Are community water, sewer facilities planned to be developed within 15 years? %_ _._. 3.5 —. Are . ant_.sewage._dJsposal,areas_AP excess .of _15 %- 0.6pd? 36. Tax Map ID Number ......................... ............................... - 37. Approved Plans are to be returned to: ................ Applicant _ Engineer If ;the -applica`tion is signed by a person other than the applicant shown in Item.1, the. application must be-accompanied by 7a Letter_ of Authorization; Failure to comply with this pr6v1sion.may be grounds for the rejection of any submission. F1i 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 th Pena 1 Law. SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: .�1, O'IZ111M COUNIT DEPARIIE•M OF < I : °DIVISION :OF: "BEAL2Ii SE tr ICES. .; DESIGN ' ABTA -SME'I�•- 9JBMF'ACE'tff AGE mYJO OGmer .r A - i.....CF� - - lk+'t>14�i - ,g��s- dc3ress = _z J,eaz ....: r ....... Located- at•-(Street)-�pAfZtA.: Sec.. .:..Block_...Z .. Lot 7-0-- (indicate nearest cross street) Municipality w N o P A77 M'23o N Watershed Oao7 o fJ . SOIL . PEROO =CN TEST DATA RBXIRED TO HE SUBMI= WITH APPLICATIONS f. _Date of Pre- Soaking 25131.05 Date of Percolation Test SOLE NL�IDER ' (1= TIM., PF•EtOQI,A2ZON -__.. -•- -- --- :-- _..._. -. PEROO=ON Run �FAapse Depth to Water From Water Level • I Ho:...__....._......:.. _ Time Ground Surface in -Inches .. .Soil Rate. Start-Stop Min. Start Stop Drop In Min/?n Drop .......Inches .. _ :..... Inches • . .._ Inches . : r._ . •.. 1... I %35: Z,oS -. .. X30 ..... .....�c� •.........._..�.i, 24 ,._: 3 2;3°i ' 3 %07 ;3'o - �a� 2 Z;o$ -2 ;38 .. � 36 • 1 2 3 ' z NXES: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained .at, each percolation test hole. All data to'be suL=ttP_i for review. ' 2. Depth measurements to be made fran top of hole. rev. 9/85 7�ST P I. RDOU= '.t6'13E SUBMT4TED .:1ti LM APPLICATION DESCitIPTION OF. SOILS FNOOUNTERED IN '.LAST -'-HOLES 2 .. G.L. , .. .._.._. _� .. ... .... ,x• -. �!�:;:..w�:.': - a, > :.:..._ -.. - ... 1s �.TO ego ( L,-M 7 PSO i t.. - 3e:r .......:...... _ _ ... . Y.� , `L :. .'�'J ' ,J t •• 1.Xl:j ,: -7.. ••+. 4 .. t:'7 /!'% ?% `; j'; .'iix .'}y ! ty3 s1� h -t i:�..- 7e wl( 12' ' 14' INDICATE LEVEL YAT WHICH GROUNDWAM IS +ENOOUNTERED O U . _.. y 7 Aga. INDICATE LEVEL M VMCH M= LE.M RISES AFTER BEMG M= MUD DEEP' HOLE OBSERVATIONS MADE BY: I.A L ",K o, L} bATEs DESIGN Soil. Rate Used MirVIl' Drop: 0, (p o S.D. Usable-Area Provided . No. of Bedrooms Septic Tank Capacity - (Z5U gals. Absorption Area Provided By (o -7 L.F. x•24" width trench Other `7 ' T) 6" j V (2 ZT M t) D i2,A-( aAr- Type Name t-Aoiip-N7 9mCaanJc-rK,NCt Assoc Pc- Signature Address 73 . D 21 V 5- SEAL - t-IN), Uj I TO W`y I ��i'r�(p3 yJ'FO No. 56124 THIS SPACE FOR USE BY HEALTH DEPAMENT ONLY: Soil Rate Approved sq.ft,/gal. Checked by Date Vo 0. - 40 Al 55 pS 0Q 1� v 00 oaptr� 000 OWL A: ........... O WELV Alt LOT AP-e-A 80,021 5a rt. /-0!57 AcllzE� tit 0/0 � Putnam County Department of Health / Division of Environmental Sanitation r AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT. APPLICATION SUBM?TTED• TO _ - PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health - In the matter of application for ' I, ..._DAV1C — 6- ibC6-oL.P, -C - - -- '- --- - -- • represent. _ that.I am an off* er or employee of the corporation and am.-authorized: to act for_ _ D _ M t� 21e-- Ts�A _Ts_ `� j? i - — (name of corporat - *on) having offices at _�T� . CQ r SI MP!gbPj 1Zo/kp_ ` ..:170 — - - - -- -- — — -- _ — Ga (ZiArrU �_/U•`�^ _10.SiZ�.— _ _ _ — Whose officers *are President _ Qs� Gloc-eo --- -- --• - -- -- -� (dame an Kddress) Vice - President ' Q (Namq and Address) ' Secretary —0� C(. 0 Gc_, C, - (Name and Address) Treasurer w :• - (Name and Ad s) and that I- am-and will be individually, responsible fon any or all aptp� of. the- corporation with respect to the approval eques,ted and. all .sub - .seque =rit acts. relating thereto. : t Sworn to .before me this �day S*gne 't1 Jl � of 19 Title �(��.� Notary. Public'.. EDWARD J. CRESCFMT1X Notary Public, tvcw Yo ! tlua11f1y in Futnam CciM:y . Term pours Nmwnber 3o, T8 Corporate Seal i lod o� � F ° Z