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Home My WebLink About1805DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -5 -19 BOX 16 d - � ' ,� . ��6 . k.1 .� i. r 'r ' 01805 -OF NM MN, .,i #UTNAWCOWYPEPART Rev, HEALTH Division of Environmental Health Services, Carmel, N Y.16k2' 1 E�mgln eer Must Provide ',P;C OF- CONSTRUCTION, COMPMANCEYOR SEWAGE 'DISPOSAL'SYSTEK- NORTH � �s �p � ��y � $fin r,,d� � Lbp� ,��i �y tl `�; c `�fY tx� L' .+5. i5 G 4 �I �% '%�YF" t 1 `R R. A� LABORATORIES5 ONCM i FSa ANALYSIS DATA SHEET TYPE: PW LOCATION: East Branch Rd, Patterson NY REPORT TO: Michael Barlow ADDRESS: East Branch Rd CITY, STATE, ZIP: Patterson NY 12563 DATE COLLECTED: 01 -06 -95 TIME COLLECTED: 08:10 AM COLLECTED BY: C. Barlow REPORT DATE: 01 -07 -95 LAB # : 95 -0058 SAMPLE.SOURCE: - Kitchen tap DATE ANALYSIS RESULT UNITS METHOD ANALYZED Total Coliform Absent COLILERT 01 -06 -95 THIS SAMPLE AS RECEIVED AT THIS LABORATORY DID MEET THE REQUIREMENTS OF NEW YORK STATE DRINKING WATER STANDARDS. Laboratory Director NEW YORK STATE ELAP CERTIFICATION NUMBER: 11218 618 Clock Tower Commons, Rte 22, Brewster, NY 10509 / 914. 278.7600 / Fax 914- 297 -0536 t a WtJLt; UUr1rLC11Ua ccr,rUr<1 * * DEPARTMENT OF HEALTH 2�, �� Division Of Environmental Health Services I� 'j0 -. _.:....:: __. -,: • "PUTNAhI' COUNTY DEPARTMENT OF "HEALTH Office Use Only WELL LOCATION STREET ADURESS: WN(I TAX GRIO NUMBER: E4 f [ VS o yj 3-5-- S °-- WELL OWNE R NAME: ADDRESS. ' l Ith QE a1,-10 a 1,_ a San 1'0 91 PRIVATE PUBLIC USE OF WELL 1 - primary 2 - secondary 9RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP U ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) 1. O INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY O MOUNT OF USE YIELD SOUGHT —s�� gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGES 0 gal. :REASON FOR DRILLING ❑REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY MINEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH '�S`s ft. STATIC WATER LEVEL as ft. DATE MEASURED �0"/` - DRILLING EQUIPMENT ❑ ROTARY a COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED O OPEN END CASING ® OPEN HOLE IN BEDROCK ❑ OTHER CASING .. TOTAL LENGTH L57/ _ ft MATERIALS: III STEEL ❑ PLASTIC ❑ OTHER LENGTH BELOW GRADE 6_0 ft. JOINTS: ❑ WELDED 9THREADED ❑ OTHER DETAILS DIAMETER in. SEAL: ('CEMENT GROUT ❑ BENTONITE ❑OTHER WEIGHT PER FOOT _ Ib. /ft. I DRIVE SHOE: 6ZYES ONO LINER: DYES $NO SCREEN DETAILS DIAMETER (in) SLOT SIZE LENGTH (It) DEPTH TO SCREEN (It) DEVELOPED? FIRST _ ❑ YES ❑ NO HOURS SECOND �fiR'nV'EL ,!v ONO .GRA -VEL. - SIZE: DIAMETEd OF PACK In. TOP _ ..,..._........._. . DEPTH h. • BOTTOM ., ........ . DEPTH R. WELL YIELD TEST pumping I It detailed METHOD: O PUMPED it tests were done is in- M COMPRESSED AIR , ! ormation attached? TP1 ❑ BAILED ❑ OTHER ; ❑ YES, 0 NO 1�I�LL LOG If more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE. wait( Bear- irtg Well Dia- in FOFU�ATION DESCRIPTION poE ft tL WELL DEPTH DURATION. ft. hr. min. ORAWOOWN It. YIELD gpm. Land s ' 3 ass 6 so WATER CKCLEAR TEMP. QUALITY 0 CLOUDY HARDNESS t ❑ COLORED ANALYZED? ❑ YES W NO ANALYSIS ATTACHED? JKYES `B NO STORAGE TANK: TYPE Wel(ex Two CAPACITY GAlr. PUMP INFORMATION S I t CAPACITY TYPE Y MAKER ° m u I cL DEPTH 2 �t MODEL. (�� -- - -�~ VOLTAG&00 HP r �- WELL DRILLER NAME DATE ADDRESS R bs– %�f S2 51G?tATURE C&A QS-/ •, r,�y �: .. � 5 :1fti ,r � 1fs; i Ws ;....� •� '`. 2..� !> ar � a G..] } 'i1!� � � - `. t .Y'.i�R' . r. I _P_UMAM COUN-1^I DEPAR`IMMr OF HEALTH DI.VISION OF ENVIRONMEKAL HEALTH SERVICES L 01-04!� k lizzo u1i Owner or Purchaser of Building Building Constructed by r Location - Street Subdivision Name TA TEXS0// REicipality Subdivision Lot # Building Type GUARANTEE OF SUBSURFACE SEWAGE'DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, maLerial, construction and drainage'of the''sewage disposal system serving the above described property, and that it has been constructed as show=' 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 disposal system, or any. repairs made ,�by ii e to such • sv= temi, • except where • the failure- to operate properl. is ' caused by the willful or negligent act of the occupant of the building utilizipg the system. The undersigned further agrees to accept as conclusive the detemination of. the Director ' of the Division of Environmental Health Services of the Putnam County Department of Health as to whether of 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. n Dated this 13 day of (� 19�_ S}.gnature � - �— �r Title General Contractor (Owner) - Signature Corporation Name (if Corp.) 6, 9A IiC�. Address rev. 9/85 Corporation Name (if Cori?.) dress WELL COMYLE:TIUN tc -ruxr DEPARTMENT OF HEALTH ° �, .'..`" °�'i' vision- �- �- 'Eriv�roninentai•- Hea1=t -h 8e =v�ce� =.-� - PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only - - - -- - - -. WELL LOCATION STREET ADDRESS: 'NNE I TAX LAID NUMBER: f l IS 0 WELL OWNER NAME: AOOAESS: u.�QE a ►-�� r, aunsan PBIVATE O PUBLIC USE OF WELL 1 - primary 2- secondary %RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED ❑ BUSINESS ❑ FARM O TEST /OBSERVATION O OTHER (specify) O INDUSTRIAL O INSTITUTIONAL O STAND -BY O MOUNT OF USE YIELD SOUGHT — gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGES gal. REASON FOR ORILLING FIREPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY MINEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 1�5s_ ft. STATIC WATER LEVEL --s-1a ft. DATE MEASURED DRILLING EQUIPMENT ❑ ROTARY OL COMPRESSED AIR PERCUSSION ❑ DUG O WELL POINT O CABLE PERCUSSION O OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING ® OPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH __jV_ ft MATERIALS: 00 STEEL O PLASTIC O OTHER LENGTH BELOW GRADE S� ft. JOINTS. O WELDED [5THREADED O OTHER DIAMETER in. SEAL: 9i'CEMENT GROUT ❑ BENTONITE OOTHER WEIGHT PER FOOT _ Ib. /ft. DRIVE SHOE RYES ONO I LINER: b YES VNO SCREEN DETAILS. DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (it) DEVELOPED? FIRST OYES ONO HOURS GRAVEL PACK O YES O NO GRAVEL SIZE. DIAMETER OF PACK in. TOP DEPTH tL BOTTO61 DEPTH ft. WELL YIELD TEST It If detailed pumping METHOD: O PUMPED i tests were done is in- COMPRESSED AIR , formation attached? ❑ BAILED ❑ OTHER ; ❑ YES ❑ NO formation descriptions or sieve analyses are availlable, WELL LOG 'a' re ableep lease attach. DEPTH FROM SURFACE water Bear- ing Well Dia- (meter FORMATION DESCRIPTION cool ft. It. WELL DEPTH ft. DURATION hr. min. DRAWOOWN It. YIELD 9Fm. Surface C i a ikAdnav A5,5 ss So WATER ❑ CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS ❑ COLORED ANALYZED? OYES, ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY GAIL. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAME � L DATE ADDRESS R b— 7 jr 6' -; . SIGNATURE 6 coAGa l � t ` n aSd 1�4 a_ ED CR F= i 1 �� Tam - c= F!aC --=,L v t c- 2- - L- I I I -: -------------------I I I lo :74Z ECX �• iv_ =n` � % _' CT.C� � ��_ � �C_vc— G_.t G.� i.. - =__._ C= I I I ✓ r C. 1 Z. c_ c- L . F_ _=, : hc_,z = i C. a -i 1-.; L,=c f" c.; with CL < A' -T- a,4-- te (-w IA g Nre r el- fL�l e r ..►ems 41tbd Lost / -Tax bLp » r Bill& Qsr;A�ieat Ntie Date of Prevletaa. Appei►vrtl Memo Aaioou Torn" lll�Y �, f�- fT�'t�ci� . u division A Fee Enclosed Amniint s Type �7t_ 4-r� .. roc e„e;' _/ /La; N A-C— Fm seem, o* -Vahma, FEZ r� N= bac.1 Heir s �� DWO Fbw. G1 D �� PCHD Notl0ntlea 4 Reaohrret W6ep ta.oatipist�d may. Seweet�e S�rtelar a ce�ilatel /0 0 0 6W.Am Saptk Teak ma Z� -S i O t X ' "�✓ x 18 4V LA- 'I YL�4 -t�s Ti be o aftaclea by Address Wflttr SIV** I" s�ppV FtaM Atidteaa �n X— &W* DtMed by Aah.aa Otber q` N e9 rim 1 represent that l am, wholly air completely responsible for the design and location of ,the Proposed, tystern(s); 1) that the rate taw di W slam above described will be constructed as mown on the approved amendment there+ to and in accordance with the standards. rules a rpu ns o nam County. Department. of /tealth� and that on completbri the►aaf a • -C"f ieato' of Construction Compliance satisfactory, to the GommissioM► of, Nwlthwltl a subniltted; to .the Dapartn+ant, and 'a written auarantN willW`furnisli�d the owner hu_>;uecewor heirt of assigns by' the butlde►.'that fa10 builder will pleca. M good :epiit enion ina yfi edtely followin/ tMAate of the hsu- , ni 2 a 'anea of Ili* approval of the Certificate of Conatruction., Compliance of the original system or any repairs thereto; 2) that the drilled weir describe0 a6a county' Department of IlMlth. ` tWN be bated III shown on the appror•d Plena : that sag wNl will'be Installed in rdance with t andardt, rules and ra/u —Gins — of the Putnam 11 bate . ��%'� Zi "' 1. 3 Signed 1 9 a P.E. R.A. Add►an.._ License No Z APPROVED FOR CONSTRUCTION. Thif approval expires two yairs from the dale. issued unless construction of the building has bean,undartaken and Is revocable for CaYta Or may be a111MMlad or modified when con dMed nieefYry py t1ie.COminissionar of /ewnh Any charge Or alteration of ewntt►uctbn "Quires a new permit. APp(p, for disposal of do n ry and / learn 'wafer supply only. � j Rev. ". Title 10/88 - - - -- DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT AT)vR PCHD PERMIT # WELL LOCATION Street Addr s To Village City Tax Grid Number WELL OWNER Name fq r4_r _Le__2 Mai ing Address )aPrivate �, & >� u-•d / 0 Z O Public USE OF WELL 1 - primary 2- secondary 113 RESIDENTIAL D BUSINESS D INDUSTRIAL ❑ PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION ❑ OTHER (specify b INSTITUTIONAL O STAND -BY D AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVEDl_(�a_/EST. OF DAILY USAGE�� Sal 0 REPLACE EXISTING SUPPLY O TEST/ OBSERVATION M ADDITIONAL SUPPLY 1XNEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN ®DUG ® GRAVEL. ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES _ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: c2�E�6ry Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY -DISTANCE--TO PROPERLY FROM NEAREST--WATER- MAIN:- LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED&ev 1)�C- T, T�'3' 570IZ5_71 6Y 7�.."N. OON SEPARATE SHEET (date) (signatu e) 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 thirt7 (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or of w se contaminate surface or groundwater. Date of Issue:_ ,c Date of Expirations 19 Permit Issuing Offic Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller 12/92 n+eOAKDALE 24' X 48' • 1152 Sq. Ft. 48' PUTNAM COUNTY DEPARTMENT Or HEAL'I 24' ..HOUSE. PLANS, APP' Fiii - BEDROOM COUNT O'vL•Y; L-BEDROOMS s Signature & Title cr Date Ae l 2, MicE�el,�,�l�v A4 y. STANDARD OAKDALE FEATURES • 3 Spacious Bedrooms • Fireplace Options Available • Double Entry Bath • Consult an Authorized Westchester Builder • Master Suite Features Walk -in Closet for a Complete List of Options • Eat -in Kitchen • Artist's renderings and Floor Plan Dimensions are approximate. All specifications must be Written in the Contract. No oral conditions. ESTCHESTER MODULAR HOMES, INC. i RL'. 30 Reagans Mill Road • Wingdale, NY 12594 (914) 832 -9400 • 1800) 832 -3888 PUTNAM-COUNTY DEPARTMENT OF HEALTH DIVTSION -,OF - ENVIRONMEPLT..L---.UEALT Date C) Re: Property of Located at r-- (2-4---7 C- kf (T) 357-1-- Block Subdivision of Subdv. Lot # Filed Map #L2=S�S' -/� Date Gentlemen: This letter is to authorize R-'e' Ti S-1 a duly licensed professional engineer 0 r registered architect (Indicate— to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection wi-th this matter and to system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Address -7 0 Telephone Very truly yours, Signed Owner of Property Address Town 9)t' - 01-7 9 - W � Zk- Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH / 113, Q DIVISION "OF ENVIRONMENTAL HEALTH SERVICES 30512 -COUNTY OFFICE BU3LDING; CAMEi; N. -Y-.-z-;- :. "...:�.., DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO -. OwnerH /�� Addre s s p Located at (Street) 35, S� Block . _5 . Lot:. (Indicate neares cross street Municipality. Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS 'Hole _ Number CLOCK TIME PERCOLATION PERCOLATION.. Elapse - Depth to a er Wat er - ve No. Time From Ground Surface in Inches Soil Rate.:;,; Start -Stop Min. -Start Stop Drop in Min. /in drop' Inches Inches Inches 1.. 1 11:00 -11:30 30 2-4 12- 18 �S 2 11,3o -1Z-;oo 30 2_1 Z,Z_Y2_ 1 3 1,2:cp -12%30 30 2-* 5 Z 1 11 :0 s 30 2-4 �— 3 1.V31 -1;Z-:03 3y. 2-4 7 -30.. 4 2 99.:40 - �'!o 30 3 12:10 9z:o o -1Y8 . 1= 3 v 4 Notes: 1) T&Rts to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2). Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO,BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS - ENCOUNTERED IN-TEST HOLES. - DEPTH HOLE NO. HOLE NO. ;2� ROLE N - b . G.L. 611 1.211 1811 2411 3011 36'1 42" 48!' 5411 60" 66 72 781► 8411 INDICATE LEVEL AT WHICH-GROUND WATER IS ENCOUNTERED ,INDICATE, ]BEVEL WHICH WATER LEVEL RISES, AFTER BEING ENCOUNTERED No C-(44-J615 TESTS MADE BY <j DESIGN Soil Rate Used21-30 Min/1"Drop: S.D. Usable Area Provided 36CO' No. of Bedrooms Septic Tank Capacity 100o Gals. Type 2 ye,,� Absorption Area Provided,By_�o L.F.x24" �c 36"' ..-width trench. Other, MN ti. PRvings, P.E. R09 FAIR ST 914-6 Address CARMEL. NEW YORK M878-12 170 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft/Cal. Chec 61 r4 E I jj JIBS k -I SO A Ll S" Vf- J SEAL �UT�T�x2 C��T1�TT.•iT r?�r A��'i�:�.?'•a'T Q1=' r?"��,�T�r� _ r ow i b Len Cost Brvtnc.4 APPLICAT?ON FOR APPROVAL OF PLANS FOR A WASTEWA.T ER DISPOSAL SYST M T Pat�ersoh .' '2n8""Address` cf AppTfcant: Nli ctigej... �Y�rtes Drwe 2. Name of Project: "P S.R. Dwetl 3. Location (D/V /C: F<t+e-rsov, 4. Prcjec_ Engineer: JON N. , P.E. RD9 FAIR 5T 914-878 -6170 CARMEL. NEW YORK Ma 2 License Number: 292.06 Phone: 6. Type of Project: ;7�priVat,e /Resi dent ial Apartments Office Building 5. Address: Food Service Commercial Institutional Mobile Home Park Realty Subdivision Other (specify) 1. Is th:s projdct subject to State Environmental Quality Review (SEAR)? Tyne Status (Check One.) Type I.. Exempt Type II. Unlisted ✓ 8. Is a Craft Environmental Impact Statement (DEIS) required? We 9. Has C =IS beerj` completed and found acceptable by Lead Agency? ......... 3. Name cf LEad Agency t. is Chis project in an area under the control of local planning, zoning, or other officials, ordinances? .......... %45.0 C„ •a '• AD .. .. .. ,.,a. , '-.•. ' ; �^'. . a �.�, CCTB►�� R'@L1;�1• ?. If , have plans been submitted to such authorities? ................... .. S. Has preliminary approval been granted by such authorities? Date Granted,: Type cf Se�nage Disposal System Discharge...... Surface Water ✓Ground Waters If s�-lrf_ce water discharge, what is the stream class designation ?........ . Wate-:, index number (surface) ........... ............................... . Is Frciect located near a public water supply system? .................. N ft . If yes, na;ie of water supply Distance to water supply Is r-c_ -ct site near a Dub! c sewage col Or 'c' .Z;)os- . er,. ..... . hTo Na :_ c se °;agp syste��: Distance �c sewage s%,::' %'_'em Naae of He:.T'�r: ?`nsbecto -: M.Bpdi�i�Sk„P.�.,Sr.P►N•E• Prci design flow (gallons per day) ...... ............................... 6 00 2. "is State .Pollutant Disc,hzi-ge "Eliminaticn System (SPDES) Permit re;uired ?. fie, k V. Hzs SPDES Appliciion been submitted:.to local DEC_: Off ,ircg? .... o r Is any portion of this project located within a designated Town or State wetland? .................................. ............................... Westland ID Number ........................... ...... ................ . Is Wetland Permit required? ................. . ........... ..:... .....;... Has application been made to Town or Local DEC Office? .................. . Does project require a DEC Stream Disturbance Permit? No 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 tj F . 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 W o DESCRIBE: } Is there a local master plan or file with the Town' or Village? Are community water, sewer facilities planned to be developed within 15 years? Flo Are any se -Wage d.is`posal areas in excess of 15% slope? ...... ................ No Tax Map:.TD " Number .� 1t � ; �i;SKbd;- Lo-�: #2- pled, N4wo.4�:I' Approved Plans are to be returned to: Applicant e/ Engineer the application is signed by a person other than the applicant shown in Item 1, the )lication must be accompanied by a Letter of Authorization. Failure to comply with this ivision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this forn is true--Ib 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. per 6wo►ersl in MOCAr fii 1NG A DRcS� : ,. ... x5.-ir > .. , .4 (SPA e ypar) AGN E661 SOMS Hi- V3 f -ANA AiNnQo wvfgind JOHN H. PRENTISS. P.E. CONSULTING ENGINEER R.D. 9 - FAIR STREET CARMEL, N. Y. 10512 -9869 ( 914) SA.NK16 8.6170 878 TO: f4, y, 1-4- pf+, rf fn✓irahftentall DATE 27- J4nLcary f994 CeAieN4�iog1 e}(,5 CoivM�tcS %�IVenae y Sn76e ;So RE: tNw- PuAetIt" of Michael acC-�+'eryl 6driew, Lf[ft 171�ML �4. I c. PKth.l�,� T P�{��•� P.C. Box 661 Va(ti «ilc(INY fay9f, ATT.- crol: iff -S'19� WE ARE SENDING YOU THIS DATE THE FOLLOWING: 0 BLUEPRINTS (' B, & W. 0 BOOKLETS 0 TEST REPORTS 0 SPECS 0 CATALOGUE CUTS 0 Shop Droll ngs E] SAMPLES 0 LETTERS 0 SENT FOR THE FOLLOWING REASON: 0 YOUR INFORMATION 0 APPROVED AS NOTED For Approval 0 YOUR USE 0 DISAPPROVED 0 0 APPROVED 0 RESUBMIT 0 NUMBER COPIES DRAWING NUMBER PREPARED BY DESCRIPTION f (Jobs.o. s��) -'iZ,�S oF�; « Soh, -�I s sE+e D� :,• REMARKS: Fsrwmtrje•� as per P. C,O. N. ,- ,egaid,er.►�n't . CG: c PW N F; le r BY Sent via: TITLE J xc:Neuberger /Hook,w /o encl. Landau, w/o encl. Picha., Barguet,.Polese,w /encl. New York City May 13 1994 Department of y i Environmental Protection Mr. John Prentiss, P.E. Rd. 9 Fair Street Carmel, New York 10512 Bureau of Water Supply & Wastewater Collection RE: Proposed Subsurface Sewage Treatment System Barlow Residence - East Branch Rd. (T) Patterson, East Branch Reservoir Subbasin 5 Jay Street Dear Mr. Prentiss: Katonah, New York 10536 (914)23 . 2-5171 Enclosed please find the New York City Department of Environmental Protection's SUBSURFACE SEWAGE TREATMENT SYSTEM DETERMINATION for the above referenced property MARILYN GELBER located on East Branch Road in Patterson, NY. Commissioner Please contact this.office at 232 -5171 at least two. days prior to the start of construction of the subsurface sewage treatment.system so that we may inspect and monitor the installation. A copy of this Determination must be available at the.project site during the construction period. RICHARD D. GAINER, P.E.- Deputy Commissioner One set of plans bearing our conditioned stamp of acceptance is enclosed. 0 EP:ep Encl:plans XC: Mr. John Karell w /encl Putnam County Health Dept. 4 Geneva Road Brewster, NY 10509 '2P • A Printed M recycled Paper Very truly yours, Edwin Polese, P.E. East of Hudson Staff Engineer New York City Department. of Environmental'' Protection'' SUB SURFAC E S SWAGE TREATMENT SYSTEM D ETERM =NAT = ON Pursuant to the authority granted under: Section 1100 of the Public Health Law; Section 18 -03 of 15 RCNY; and Section 128.1 of 10 NYCRR; and in accordance with the standards of: 10 NYCRR Appendix 75 -A Wastewater Treatment Standards - Individual Household Systems; NYSDEC Design Standards for Wastewater Treatment Works; and NYCDEP Procedures and Practices for the Approval of Septic Systems and Wastewater Treatment Plants. the New.York City Department of Environmental Protection makes the following determinations with respect to the sewage disposal system(s) plan described below: Name of Project: Barlow Residence aka:, Map 35.5, Block No. 3, Lot 19 Location: East Branch Road (Co. Rt. 65) Street Patterson Patterson, Putnam Villa e Hamlet .Town and Count Owner: Michael & Cheryl Barlow Address: 28 Old Village Road, Katonah, NY 10536 Drainage Basin: East Branch Reservoir Type of Sewage Subsurface sewage treatment system for new Treatment System and General 3 bedroom residence. Description: Dates of Site Inspections: Dates of Soils Test NOT WITNESSED BY NYCDEP Page 1 of 4 DETERMINATION ( ) Approved ( ) Disapproved ( ) Conditionally Disapproved O Accepted design Conditions of Approval: A. When placing fill on the subsurface sewage treatment system area cut the tree stumps at ground level over the area and 10 feet beyond. Do not dig up the tree stumps. The area shall then be plowed perpendicular to the ground slope to a depth of 3 inches. Place the fill on the perimeter of the site and push it into place in such a manner as to minimize compaction of the native soil,. SEE FOLLOWING PAGES FOR ADDITIONAL CONDITIONS Page 2 of 4 s 1. Prior to the commencement of any construction requiring a building permit, the applicant must provide_.,at least 48 - hours actual notice to the -- NYCDEP engineer or his representative making this determination.. 2. The facility shall be constructed and completed in accordance with the engineering report, plans submitted, specifications provided, which form the basis of this approval, and in accordance with the conditions of this determination. 3. The project construction must be commenced within two (2) years of the date of the determination. ` 4. The applicant will provide "as built" plans to NYCDEP, certified by the engineer, where required or requested. 5. When installed the system must be operated and maintained in accordance with NYCDEP Regulations and all other applicable regulations and /or standards. 6. In the event that the material submitted is inaccurate or misleading, or the owners of the project do not have the legal right to develop or use the property where and as shown on the material submitted to this office, this approval is withdrawn. 7. This determination constitutes approval only of the physical design of the septic system for proposed installation and operation on a watershed of the New York city Water Supply. An approval of the septic system design does not effect any existing property rights, title, or interest, including without, .l- imi_tation'; any public or private restrictions upon the use of the land. Therefore this determination shall not be considered to be a grant or waiver of any property right. 8. The sewage disposal system shall be constructed in conformity with the data and plans as approved or commented upon. Any significant change in the system must be approved in advance of construction by the Department of Health and this Department. 9. The system shall receive only the domestic sewage from the structures shown on the plans. The nature and quantity of flow from the structures shall not be changed without prior approval of this Department and the Department of Health. 10. All parts of this system are to be operated and maintained properly. In no case is sewage or sludge to be exposed or any other unsanitary or unsafe condition to be created because of the use of this system. Guidance on standards is found in the Waste Treatment Handbook issued by the New York State Department of Health under New York State Code of Rules and Regulations (10 NYCRR 75). Page 3 of 4 d �a 11. Whenever sludge and scum shall so accumulate in any septic tank so as to occupy together at any point more than one - fourth of the distance between the bottom and the flow line, the tank shall be cleaned. 12. Whenever sludge and scum is removed from any septic or settling tank or any part of the system it shall be done in such a manner.as to cause no nuisance, and the material shall be disposed of in accordance with applicable regulations. . 13. This approval shall not be construed to invalidate any rule or regulation enforceable by local authority having jurisdiction._ 14. All duly enacted rules and regulations for the protection of It:he water supply shall be complied with (Administrative Rules and Regulations for the Protection from contamination to the Public Water Supply of the City of New York adopted under the authority of Section 70, 71 and 73 of the New York State Public Health Law). 15. This system shall be abandoned and a.connection made to a public sewer if and when a public sewer is built that is available to this project; 16. Whenever it is determined by this agency that additional replacement or improved sewage treatment facilities are necessary such facilities shall be professionally designed at the expense of the owner or owners of this .project...Plans -are to-be -submitted to this agenncy 'and the Health department for review and approval, and facilities shall be constructed and maintained at the expense of the owner or owners of this project. 17. All material removed from the area of the failing subsurface treatment system shall be hauled & disposed of in accordance with all local, state, & federal laws or• regulations, including those of this Department, pertinent thereto. Date: /i't� 13 Determination made by: Edwin Polese, P. E. East of Hudson Staff Engineer New York City Department of Environmental Protection This determination letter must be maintained by the applicant and be readily available. n n r r. New York City 3/4 6/9+ Department of March 15, 1994 Environmental Protection John H. Prentiss P.E. Rd. 9 Fair Street Carmel, New York 10512 Bureau of /err Water Supply RE: Proposed Subsurface Sewage Treatment System Michael & Cheryl Barlow Residence (T) Patterson, East Branch Reservoir Subbasin i lay Street Dear Mr. Prentiss: <atonah, New York 10536 914)232 -5171 This office has received your submission for the proposed new subsurface sewage treatment system for the Michael and Cheryl Barlow residence on East Branch Road in the Town of Patterson (Tax Map. 35.5, Blk. 5, Lot 19). The :ommissioner drawing is dated January 1, 1993. We notice that this Department did not witness the deep hole or soil percolation tests. It is our policy to be present at such tests. Please arrange'to conduct these tests again and provide us with a minimum of 48 hours advance notice so that we may be present. We also require an area location plan be indicated on the submission. An application form and a construction report form' are enclosed for your use when-the revised drawings (three copies) are resubmitted. Encl. EP:ep 'rinted on recycled paper We thank you for your cooperation in this matter. Very truly yours, Edwin Polese, P.E. East of Hudson Staff Engineer • a l f ! New York x: l a D011110 Environmental Protection �{ 1 11 1 1; East. of Hudson District, Jay Street, Katonah, New York 10536 APPLICATION TO CONSTRUCT A SEWAGE DISPOSAL SYSTEM ON NEW YORK CITY WATERSHED Your building site is located within the Watershed of the New York City Water Supply. Under New York State Public Health Law, the design and construction of all sewage disposal systems constructed in this watershed must be approved by this Bureau. The inspection, review and approval performed by th.is office is independent of that performed by any other agency. Please complete the following information and return this sheet to the above address. You or your authorized representative will be contacted to schedule a time to perform a site evaluation. Owner's Name: Current.Address: Daytime Phone: - Contact Person: (Owner /Contractor) Phone: PROPERTY LOCATION Town: Street Address of Site: Subdivision Name & Lot #: Tax Map Number: Number of Bedrooms: Property Owner's Signature: Date: Village or Hamlet: Acreage of Lot: t, a r SANITARY CONSTRUCTION REPORT TO BE COMPLETED BY APPLICANT AFTER R _:_ .....�r..w. DEPARTMVE&T -SITE VISIT — lle System No. Ce - omn, of Date MEW Environmental Protection Soils Report x East of Hudson District, Jay Street, Tax Maps: Katonah, New York 10536 Building Permit» SPDES Pcrmit� Owner's Name Ivtunicipality County Property Location: Subdivision: Lot: Date Subdivision Fled: File Number: No. Bedrooms: Acreage of Lot: Is SEQRA Review Required: Date SEQRA Review Completed: PROPOSED SEWAGE DISPOSAL SYSTEM Type System: Flow Ground Slope: Depth to Groundwater or Impervisous Layer Stabilized percolation rates: wl Hole Depth ins. Rate 1 in./ min. #2 Hole Depth ins. Rate 1 in./ mina DESIGN DETAILS Depth of trench inches Name of Design Professional: Width of trench inches -- Address. __:. _. _ - linear feet of inch perforated pipe Name of Builder: Address: inches of slope per foot inches of crushed stone or washed gravel below the inches of crushed stone or washed gravel above the OWNER/REP SIGNATURE THIS AREA FOR NYCDEP USE ONLY Conditions of Approval: 1. Watershed Inspector to be notified prior to start of construction. DATE The NYCDEP grants approval for the above described CERTIFICATION sewage disposal design in accordance with the Design Approved: above Condition of Approval & with NYSDOH Date Name Title Rec::irements. Any deviations require approval in w; ing from NYCDEP. Project Construction Constructon Approved: must begin within two (2) years of Approval date. Date Name Title June, 1993