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BOX 17
.Jr� E T
f ,J r'
lot ::-
lViffAif C017l1f'Y DQATi1� OF �Aldl�
1� Baelsi 8wr1eM. drtrl. N.Y.1sS1Y
s�al�ec s+o� ssiw� a�osAl.
tasst M FwaW Feeghttt
puma . ��_y- i
litMr6! Zif, • 5
❑ D..NIa� ❑
Date of FrevMsta Apprevd
rg■,g�A�,aaa� PyT,.�,cy T•gr.KtsT kDSa�
Date_ Subdivision Annroved Fee Enclosed & Amnh,nt
lutist Ter (� `a1� P1 j,I —IM Am I , E2 CT Fly s«tl m 0 D-P& Vab.
Nmwbw of swkesmo L Daskis Mw G F D 4 a,0 FC® Nsd5catlad is RewMr@4 Wbm M Is ees*
Sepwa . swap SYM• is cubit d 10 o a sq* T it 5O
To be essinkaaltd b TPA D Addleaa
wales Sufft" — watt. Ftsim Adhbaa
en ZA PIdwaftS lmet D1Ead by aa.�
Otbr. Le�u�aab
1 r p► even tAhat 1 am wholly and completely responsible for the design and location of the proposed system(s)1 1) that the r ate sew di ssl stem -
-- . , daatb•d will be constructed as shown on the approved amendment there to and in accordance with the standards. rules a ragu f
County Department of Health. and that on completion thereof • "Certificot• of Construction Compliant' satisfactory to the Commissioner of H•althwin
he subrMlt•d to ten Depa trawd. and a written guarantee will be furnished the owner. his suconaers, heirs or assigns by the builder, tiAt said builder will
psac• in good .operating condition, any part of said swage disposal system during ten period of two (t) yews Immediately following the "to of the Now
eeiea of the approval of the Certificate M Construction compliance oft origfnat system or eery spin thereto; Z) that the drilled well Opo►IbM above
will be located as shourn on the approved plan and that sold well will be In In accordance with the stands s6 r and regTai axis of the Putnam
County Oepertme t/oof "with. % /
signed RE. V R.A.
.m.M V—AiEr:tf--L-D r License No5[or
APPROVED FOR CONSTRUCTION: This approval •nplres W goers Ill the date issued unless construction of the building has been undertaken and Is
revocable fa c use or may be amended or modified when con rig by t C mlsslona of Health Any change or alteration of construction
to""" a n OM It. for disposal of domestle van t ater supply only.
Rev.. Ilk
f,j��
10/88 °� )
By Title Ilk
0
Building Constructed by
Location - Street
ITT -'F- (ZSo
Municipality
�--
Building Type
Subdivision Nance
Subdivision Lot #
GUAFA= OF SUBSURFACE SEWAGE DISPOSAL SYSnM
I represent that I am wholly and completely responsible for the location,
workmanship, material, construction and drainage of the sewage disposal system
serving the above described property, and that it has-been constructed as shown on
the approved plan or approved amendment thereto, and in accordance with the
standards, rules and regulations of the Putnam County Department of Health, and
,hereby guarantee to the owner, his 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_ me. to. such system, 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 Director of the Division of Envi.ronft ntal 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 day of �J �— 19
General ntract.or(Owner) - Signature
w A � eo_u .
Corporation Name (if Corp.)
rev. 9/85
mk
Signature
Title• ... ♦ .
Corporation Name (if Corp.)
M.
AS- 13UIL.-T' DIMENSION GNART.
N _
A
E5
�-
Z
75. 0
COI.0
3
13�oCo
1 07.4
4
14 ro . 0
l 1 Co . 0
5
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ro
1 5:5 Co
12 7. 5
7
1 57 . G0
1 3q-. 5
8
I cc . 5
140. a..
5
165.0
140.0
10
188.0
144.0
I 1
100.0
1 48.0
12
154. 0
1 5t.0
l 3
(9 Gv . 0
1 5 -D . 0
GXiSTIN(e
- . 2 680R.Gbr.+s
- R�2IDENC�
fw6 .. 1000 6+Y.
52ATt�TANK �L�
e.m.lq P.V.C.,
i
i
>E DISPOSAL.
6,T6D ON THIS
sPEGTED 6Y
GU LAT I ONS
IT OF HEALTH
°_NT OF HEALTH .
i
1pproved R13 noted
OS 6,n
,pplioable Holes and 11,8113;
m
?utna County Health D,par
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- ..... Pun >.km I3CT +TY L-PARTM NT OF HEAVII
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PUTNAM
COUNTY
DEPARTMENT OF
HEALTH
APPLICATION
FOR APPROVAL OF
PLANS FOR A WASTEWATER DISPOSAL
SYSTEM
1. Name and Address of. Appl i cant:
2. . Name of Project: /0rd oS�d SS/r !`�z is 3.._ Location TN /C::-'"esd�
• .. Go- r y ", � . /�'G U U r , �
4. Project Engineer: G-u��� w"� ��g , /ss;�::v°�G ; 5. Address: 73,
:x
License Number: SZ....: Phone•�v'
6. Type of P o ect ' .. �
r/ Private /Residential Food..Secvice ... .Commercial- {
Apartments Institutional Mobile Home Park
Office Building Realty Subdi.v,isfon Other: (specify)
7. Is this project subject to State Environmental. :Quali.ty Review (SEQR)?
Type Status (Check One) Type I.. Exempt
Type II. Unli-sted
8. Is a Draft Environmental Impact Statement (DEIS) required? ............. o
9. Has DEIS been completed and found acceptable by Lead Agency? .........
10. Name of Lead Agency / A
11. Is this - project in an area under the control.-of locale planning, zoning,
or other officials, ordinances? ......... ............................... 6
12. If so, have -plans been submitted "'to such authorities? .................. ��
13. Has preliminary approval been granted by such authorities? Date Granted: A-
14. Type of,Sewage Disposal.System Discharge....... , Surface ,Water._ Ground Waters
15. If surface water discharge, what is the stream class designation ?.......
16. Waters index number. (surface) ........ .... .'.:.............. "
17. Is project located ". near a "public water supply system? ................... /U'G
18. If yes, name of water supply X(114 Distance to water supply
19. Is project site near a public sewage collectioh.or disposal system ?..... %�lC
20. Name of sewage system Al 1A- Distance to sewage system
21. Date observed:' 23. Name of Health Inspector:
24. Project design flow (gallons per day) ...... ............................... Do
i1
2
State__ Po 1_1mtant_.Dischar9e: E1 imination...System _ (SPDES) ,Permit required?.. iu G.
26. Has SPDES Application been submitted to local DEC Office? .......e..... �-
27• Is any portion of this project located within a designated Town or State �Q
wetland? ................... ..............< ................•..............
28. Wetland ID Number .....................................
!�
:c
2.9. -Is.. Wetland. Permit' required?' ..:••.•.• .•,.•....•.•000e•e :..•,
Has, application been made ,to.Jown. or Local _ DEC..Office? .b. • . • . • .. • ............
30. Does project require _a,DEC•.,Stream Disturbance Permit ?,••••••..•...•.•o.
/U
31. Is or was project site used.for agricultural activitynvolwing application
of pesticides to orchards or other crops, solid or haArdous'waste disposaY;� ,-,
landfilling, sludge.application`'or industrial activity ?:'........ YES or NO
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? a. . ::... YES .'or NO
DESCRIBE:
33. Is there a local master plan or file with the Town or Village? .... :..':... ten'
:34. Are community water, sewer facilities planned to be developed within 15 years. 1 "d
35.-;Are any „sewa9e disposal `areas Jin excess 'of 15X:alope? /�-
36. Tax Map ID Number ............ 3 ............ .
37. Approved Plans are to be° returned to: ... Applicant Engineer .
...... :..._..
Yf 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.-- 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.knoaledge and belief. False statements made_
herein are punishable as:a,C7ass A Misdemeanor,pursuant,to Section 210.45:6f
the Penal Law.
SIGNATURES & OFFICIAL TITLE- ar F �`L
E O �/ ,V it e/yl
MAILING ADDWBSS(• t �
,PUTT` AM COUNTY
DE:!'Ta OF HEALTH..:...
LAURENT ENGINEERING
ASSOCIATES, PC.
73 FAIRFIELD DRIVE
PATTERSON, NEWYORK- 12563
RANDOLPH W. LAURENT, PE. (914) 278.6108 - (FAX) 278.2658
HARRY W. NICHOLS, JR., PE. CONSULTING SITE ENGINEERS
October 13, 1992
Putnam County Department of Health
Route 312 Geneva Road
Brewster, NY 10509
Att: Mr. William Hedges
Re: Proposed SSDS Expansion
Fairfield Drive
Patterson, N.Y.
Dear Bill:
Enclosed are the following:
1. Four (4) prints of Drawing S -1 "As -Built Plan (SSDS
Expansion) ", dated 10- 13 -92.
2. "Certificate of Construction Compliance for Sewage Disposal
System ", dated 10- 13 -92.
3. Three (3) copies of "Guarantee of Subsurface Sewage Disposal
System ", dated 10- 13 -92. /ao
4. Money Order in the amount of $00.00 payable to Putnam County
Health Department. �.
If there are any questions concerning the enclosed, please call.
Sincerely,
LAURENT ENGINEERING ASSOCIATES, P.C.
Harry W. ichols, Jr., P.E.
HWN:bd
.91032
enc.
cc: R. Stabe w /enc.
LAURENT ENGINEERING
ASSOCIATES, PC.
73 FAIRFIELD DRIVE
PATTERSON; NEINYORK 12563
RANDOLPH W. LAURENT, PE.
HARRY W.NICHOLS, JR., PE.
Ii
Putnam County Department of Health
110 Old Route Six Center
Carmel, NY 10512
(914) 278.6108 - (FAX) 278.2658
` CONSULTING SITE ENGINEERS
Att: Robert Morris
Re: Proposed SSDS Expansion
Fairfield Drive
Patterson, NY
Dear Bob:
Enclosed are the following:
1. Four (4) prints of Drawing SS -1 "Proposed SSDS",
dated 5- 10 -91.
2. "Construction Permit for Sewage Disposal System ",
dated 5- 10 -91.
3. "Design Data Sheet ".
4. "Letter of Authorization ", dated 5- 10 -91. ~
5. Two (2) copies of Residence Floor Plan(s), for
. "Bedroom County Only ",
5. "Application for Approval of Plans for a Wastewater
Disposal System ".
7< One hundred fifty dollar review fee.
We would appreciate your review, approval and issuance of the
Construction Permit at your earliest convenience.
Sincerely,
LAURENT ENGINEERING ASSOCIATES, P.C.
Harry W. N hols, Jr.,. P.E.
HWN:bd
encs.
May 10, 1991
cc: Roger Stabe
_....,=.48. ....._..__..... _,.._ _ ._..�,
777111 = BATH 11
A - • '
�.`• W
BEDROO�.I <
7`
l K_, oRtsslNc
BEDROOM 7. wALK
-0•• x 101.0" i`-1 IN
CLOSET
-3 ,
MASTER SEOFkOom
BEDROOM Z — = OPEN ,.
11. 0- 15.43..
i
STUDY
I
SECOND FLOOR _ 4828 = •-1344SF
48' 3 -
.. KITCHEN `i c/
OfN,Na ROOM p f OOM ~�
.aoaNlHa a
13. 0" r 12••0" L--1
U �� n
s •
1 —T-
0 EN
ABOVE
LIVING nOOM w FAMILY n0Ol.1
1 �' O" 1 •'•O" 13. O•' • 17* O-• .
raven <
FIRCT FI nnn
APIP = 11n ^cc
I
BATH
A a
BEDROOM a 12,-0- ,
- \ ORtSSING
y'•8" a 7 ?'" � �
BEDROOM,. WALK'
13' -0" x 10'-o- ;) IN
CLOSET
MASTER 8EOROO#A
1� 17'-0 16'-6-
BEDROOM 2 t _ _ OPEN -_
13' 0— w 15'.8"
1 '
+ ;STUDY
SECOND FLOOR 4828 = .:1344SF
KITCHEN
• � R/hlM 4 `
01"INQ MOOM p 1/ MORNING AGOIA Mv+
y�
13' 0— as 12.,0..
-1
•. _ OPEN
A®OVE t
LIVING nOOM uo a FAMILY MOOM
FI�2C�° r:s nnn
aov(Em p
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date,`(
ICI CAE 0 T
Re : .r Wr —o-€
Located at�����Li7i \V
(T) ection �J<o, -r" Block Lot I�
Subdivision of
Subdv. Lot # Filed Map #
Gentlemen:
Date
This letter is to authorize 4,Ar-jZj W O C.H -BLS 32
a duly licensed professional engineer or 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 with this matter and to supervise the construction of said
system or systems in conformity with the provisions of Article 145 or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
�r NEW
�<o �Q� 4A N I CN9'f' `' _Q s Very truly yours,
cc
Signed
No. s 2a Owner o Property
Countersigne 6� <c,
D-E-, R.A., #
Address
Pr\-7Tel�soi�1 i u t 12�Co3
Telephone
Address
Town
c\\-�,- 00`6- c-\\�.�
Telephone
P=M COUNTY DEPARTMENT OF HEALTH
DIVISION OF HEALTH SERVICES
.,. _ DESIGN DP�2A „SiET-•SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO.
�i� l comer �� R Si,4 E Address 5 FO- N A 2E s`
Located at ( Street) Sec-3C,-5 Block I Lot 1
(indicate nearest cross street)
Municipality CIA<l TE� (ZSo Watershed G2o-�o N
SOIL PERCOLATION TEST DATA RDQUIRED TO BE SUBMITTED WITH APPLICATIONS
Date of Pre - Soaking E - 3 I Date of Percolation Test
HOLE
KbMER CLOCK TIME PERCOLATION PERCOLATION
Run Elapse Depth to Water From Water Level
No. Time Ground Surface In Inches Soil Rate
Start -Stop Min. Start Stop Drop In Min /In Drop
Inches Inches Inches
(110'24_io'.54 '.30 24'' 2-7 �J`' 16
-I 2 10:'�5-
3
4
0
2 I'.I5• I'.�
3
4
r
24 -2& /i 7 - /-, ”
30 2�`' 27" . _5
:36
' 3v
3 Ell/ Fp�
N4 y
4
Dept ACTH
12
�a i
NOTES: 1. Tests to be repeated at same depth until approximately equal so, rates
are obtained at each percolation test hole. All data to'be submitted
for review.
2. Depth measurements to be made fran top of hole.
rev. 9/85
DEPTH
G.L.
1'
2'
3'
4'
5'
6'
7' .
8'
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
HOLE NO. HOLE NO. 2 HOLE NO.
6.
9'
10'
11'
12'
13'
INDICATE LEVEL AT WHICH GROUNDWATER IS ENOOUNTEPM
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENOOUNTERED —
DEEP HOLE OBSERVATIONS MADE BY: Cam. �-} 1�-} C�C�L DATE:
coil Rate U % Drop __. _....__ S. D.- i; a�le fi�:r. =x Provided
No....of Bedroans 2 Septic Tank Capacity 1 D OD gals• Type CDti1G
•Absorption'Area Provided By 2 So L.F. x 24" width trench
Other Of NEW y
Name I-AJREN T "C- ASSoG PC . Signature mikk1r.104 //
w
!- 1 i
Address "13 F-cxj r�i P ff 1ci T)ri YQi SEAL •� ' v2
yiP No.56124
EYSC7 _i 01517. Op�OFESSIONP�v
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved sq.ft /gal. Checked by Date