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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.09 -1 -25 BOX 17 . 61 ml 1 grim - -11.Fk �� I A so .- NON 01901 PUTNAM COUNTY HEALT DEPARTMENT DIVISION OF ENVIRONMENTAL EALTH SERVICES :.::.:.:__ _. �_:..:::.; :::.- I?.[ t).PO A� FA1R.,SEWA►GE TREAT -MENT SYSTE.M: FEI?AtR - � .. ;,-- :.:,...::;..k..G.- ., YES N Internal Use Only PERMIT # ❑ Z Repair Permit issued in last 5 years ❑ . Not in Watershed ❑ . ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. Delegated ❑ ❑ Repair within 2oo ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION Li TOWN (5 gTyM # OWNER'S NAME a Lt PHONE 223�- , MAILING ADDRESS f) &4 APPLICANT '41". Name &R DATE PROPOSED INSTALLER ADDRESS hip (i.e. , o4ner, tenant, contractor) FACILITY TYPE PCHD COMPLAINT # /PLAINT p PHONE # 7J �� �i71T t1 ,,P1 REGISTRATION /LICENSE # / 04-9 Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature and extent of the repair. .cr,44.tl r"r- t-mws '9 't LI.G . .L h ieh'i`eJo t-4, 3 5- L.F_ e-e-e-k 0-® cv -,4 I, as owner,agree to the conditions stated on t is form SIGNATURE TITLE DATE (owner) - I; the- septic-installer; agree-to comply-with the-conditions-of this permit for -the septic system repair- t SIGNATURE L-44 , pr" TITLE DATE (installer) Proposal approved with the following conditions: 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the Completed SSTS repair will function. 5. No completed work is to be backfilled until authorization to do so has been obtained from the Department. INTERNAL USE ONLY Proposal Approved Proposal Denied ❑ Inspector's Signature & Title Date Explfation Date ,Repair proposal is in compliance with applicable codes Yes 2 / No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev: 2/07 YNDALL _ SEEP y°ST_EMs ®mac. �J S /3 �- 5/, EXCAVATING CONTRACTORS 20 Ivy Mill Rd., Brewster, NY 1.0509 (845) 279 -8809 12 G r 61r„3rr +✓ r(O - r ' -" ~ EXCAVATING CONTRACTORS 20 Ivy Mill Rd., Brewster, NY 1.0509 (845) 279 -8809 12 G PUTN,-A-'vl COUNTY DEPARTNIENNT OF HEALTH DI -1510-N OF ENIVIRONNIENTA.L HEALTH SERVICES DESIONDATA SHEET - SUBSURFACE SEWAGE TREATIVEENINT SYSTEM Owner: -1 UAZ?= AE: Address: -6— 125, P, 71t:1. Located at (street): TM " Section: Block Lot Municipality: Watershed:. 7- 35?XAte—a SOIL PERCOLATION TEST DATA Witnessed by: Ize Date oCPre-soakina: Date of Percolation Test:- E4-;- S—//z Hole Nio. Run No. II Time Start - Stop I Elapse Time (min.) Depth to water from ground a surface (inches.) N-ater level drop in inches Percolation Rate mini inch inch I Z 9 3y -;-4 Yf I .3 _2 7 ?/-f 2-;-3 Y 3 zlf -A 1— y - y IZYV 6,7 1 2 3 4 2 4 1 2 4 Notes: ..,._.......,. w.....,_+ .. ..................w.,w«....u... nd,.. v.... uoia. r,.:.+. tiwrtw�' G: e. u�n.: u: uu: riw. u, uawin: vi., w. u. cuvuv. Y: xc:: Wr:, iec,. v..:»... a........, w. w. iu..,.,.. �-::. t..:: n: o.. �.. n. e.... u.,.,,.... �...,.,,.N........,... e.,..:.,. r. �...,..,,,..:..,.. .�a..w..u....,..a.Wr•:�i;...c,r ,. � .. ;,.a.a �.,,... ,.+.,:= ...:.-- .:_:.one.- n ... ••7 G_,_ ._ __ __... .........- ......... ... .. . ...... ......... ,.. .. « ......o. :�.,...- ....o..K..._... _.....v ._ . � G o .. .. TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED I,,N' TEST HOLES ` I� HOLE = HCL- M. HOLE 0.S 1.0' aw 2. J' 2.. 3.0' 3.5 4.0 5.z J. J' 7.0' u. z.........� ...._, .., 8.1 O� c n� Q 10.G' Lndicate level at which a-r, oundw-aier is encountered At 6— e L-,dicate level at w- ich mottling is ooserv-ed wc0 Indicate levp-1 to wEcn water level, rises a<<er being e:lcountelr�ed P— ' / P e ��? /; e De °^ hole observatior�s ���ad� ov: � G Dat Design Professional Address: gnat - rp: T YNDALL EXCAVATING CONTRACTORS 20 IV d -W9 j y Hill R Brewster. NY 10509 (845).279 jr,6s4-,1.t, � C SePr i C- OoO 7FIV oaf 3 g 3 s`` � 6� ,m i rlS Ill CL-S Sheet of PUTNAM COUNTY DEPARTMENT OF HEALTH"',' DIVISION OF-EN.V-IRON-.-MEN-T-AL-II-E-ATLH'SE-RV--ICES=...... FIELD ACTIVITY REPORT AT)DRE-TS• OV15- 2,!�47 Street Town State Zip PERSON IN CHARGE OR TNTF.RVTFWIFn. Dntp- 51 / Name and Title TYPE OF FACELITY: FINDINGS: I Signature and Title RFPORT RF.CFTVF-T) RV: I acknowledge receipt of this report: SIGNATURE: 02/96 Title: qa ;HERLITA AMLER, MD, MS, FAAP Co;nmissioner of Health aORET- A M.OLINARA, RN, MSN AssacfVe Commrs ibrrer of Health ,k DEPARTMENT OF HEALTH 1 Geneva Road, Srewmr, New York 10509 IUIIEST FOR FIELD 'T`ESTING Director All information below must be fully completed prior to any scheduling. DATE: ENGINEER OR FIRM:/ i PROLE #: PERSON TO CONTACT : -Pr 7 Q NEW CONSTRUCTION O I&PAM PROGRAM. CI ADDITION PRO REASON: DEEPS: A-'�PERCS :k " PIS TEST: 0 1- RO.A.D /STREET: -S TOWN: TAX MAP #: 3 6, °I -- SDBDYMION' LOT #: Q- .. A1 1,4 P1 ::z e— YES NO ❑ U Proposed SSTS witMu The dralmage .basin of West Branch or $oyds Carl Croton Falls Reservoirs. _....:❑ _ . o ._ ::._;; g ®p ose�E STS wNhin 500 feet of a xeservoix, reservoir stem or control l O is Proposed SSTS Witlua 200 feet of a wu se-or a;-DRC eitaud.. v O D Proposed SSTS deskmilow greatw tip 1000 galionslday or SPDES Per 0 D Proposed 'SSTS for a Commercial Project. J. BOND[ MORRIS, PE f F.flV7rD7T►lJel7lal f{P.lttt/1 FIA t required. ......... -. -- it is the responsibility of the design profressiond to pxovlde the above information pr or to soil testing. The Department will determine the NYCDEP project status {Joint or Delegated) based o the response. if you answered yes to any of the questions, NYCDEP muss Witness the soil tests. _This Dep ent will coordinate a mutually suitable time for field testing with the Design Professional and NYCDEP. ff a project. has been determinW to be Delegated based on the above responsq and then subsequent iQfoRuatdou indicates NYCDEP is required to wiriness the soil tests, it will be the s le responsibility of the design professional to schedule re-witnessing of the soft testing with NYCDEP. MOJCOUNTY USE ONLY DATE: TDM Z49 t e9 C3 COMMMTS- iBQ Em+i wwnatat Health (845) 278 -6130 tax (845) 278 -7921 Water Supply Section (845) 225-5196 Fax (845) 225 -5418 Nursing Services (843) 218-5558 Rx (845) 278-6026 WIC (845) 278 -6678 N=53ng Hone Care Rx (845) 278 -6085 Fsrly lnterveaiioa/Pres&ool (845) 278 -6014 Fax(845)278-6648 £'d 6869 -6LZ (9t8) !I 118PUA i el,7 n i 11 e,7 Cnini a K PUTNAM COUNTY HEALTH DEPARTMENT ° - DIVISION OF DMRONMENTAL HEALTH SERVICES THIS IS NOT A REPAIR PERMIT PnopoSAL FOR r=xPLORATION OF $EPTiC SYSMIW FA[LURg All information below must be fully completed prior to any scheduling SITE LOCATIO14 lPil TOWN TIM 0 OWNER'S NAME �fjrA ,(� . I i`n id %_ PHONE # MAIUN ©ADDRESS PROPOSED CONTRACTOWNSTALLER� , H01{VE # ADDRESS ll � REQiSTRION /LICENSE �4 �!° ZS"' a Roane for ea forstlo Q Mitre to surface back -up in house D 1i d limits al system for repair O other (exp below) FOR COUNTY USE ONLY Inspecccrs Sigrmlure &We Date App invnent Date: : ,;�- t:;. Tune: —If ©C� kly:eXC8t ep4iC Z -d 6969-6ZZ (9t R) IIePuA*l e£Z:0 6 I• � £Z Am m �11�cn 0 ld Id I Oki I ARREN 001. 96, rn 2!-Ln O s I$R ......... ............. IN . . . . . . . . . . . . . . . . . . . . . . . . . -------- . . . . . . . . . ............ 'II A% NF Ab 0 ld Id I Oki I ARREN LIFIC) or all 001. 96, rn 2!-Ln O s I$R ......... . 'a- . . . . . . . . . . . . . . . . . . . . . . . . . -------- . . . . . . . . . ............ LIFIC) or all RD t. 96, rn 2!-Ln RD t. SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINM RN; NISN m Associate Commissioner of Health July 12, 2005 Irene Mack 486 East Branch Road Patterson, NY 12563 Dear Ms. Mack: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re Addition — Mack 485 East Branch Road (T) Patterson, T.M. #36.9 -1 -25 ROBERT 1 BONDI County Executive I have received and reviewed the plans for the proposed addition at the above mentioned residence. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons: 1. The proposed addition is for an accessory apartment. Therefore, the SSTS design flow increases by 200 gal/day. 2. The legal bedroom count for the dwelling is three. The design flow for your proposed addition. is 800 gal/day,. therefore,. requiring a 4-bedroom system. 3. The addition of a potential bedroom requires this Department's approval of a revised septic system plan from a professional engineer or registered architect. Please revise the proposed floor plan to reflect no more than 600 gal/day SSTS flow, or have a professional engineer or registered architect design a sub - surface sewage treatment system meeting present code requirements for four bedrooms. If you have any questions, please contact me at your convenience. RM:cw Sinc ely, � N01.6 Robert Morris Senior Public Health Engineer Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool(845)278 -6014 Fax (845) 278 -6648 E15T IilANL7! , PLOT PLAN SCAM I •-W I 1 / 1 i I F _ 1 I 3 1 j ! AN,Plnry. I 1 i•sY Has (z .I i ! FAY r -i 1 I _ 1 � 0 1 taus 1 SPECIFICATIONS DIVISION I: GENERAL CONDITIONS GDERU IEnIARE3[xrs It(.hxlr,.aaNe r.lW pr tlrY w eitlgtrirt Ouryrb W Ter b rare. rwe 1rMiv d r Yrpl r Ir rbYWt alrilmrtl,ry rFr e. umiblrt.lk[a w M fr tllrtYYr.,r %b rrrrlr wYa rlr inter lrri y b x.lYrrt>v r b W reelmerry J IY aYrxlr. In f Wi M i,arlae WI iWfm a ror1 re mn. Imintim MrWa m W h Y uYN OirW rr,.q, rr Y Ixe J s1NMNt aL Wrn xbwrrN Yvir b a h Iv a6YII rir Mvre test's Ixa. 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W r ra41 fie lbb wN rWrs h ASIM AYS. (rrxtrra MI lew fb reN rvlary hwwi turtle rW, h M vblllN le real. M) IYiir(arelrmr+p Ir rilrthllrrW ww4 ]ixr, Ir Irbµ r } rr1lr rYR r A:rl W ii W\wl wtlb eaawe. W [arefe rilaq h YI %rrelr ;uiu J4rie geNhl W Irti mrFi w,R r (r! rh tl\rnL pR (hie re Ma5Y4re Il4kn; r ur alxe ii ]Shpts [arch 1, rrrrrxtll r11, Yn -1 a (YYM. /xNllrl Nice irrn la NY+Y rA d Tar Wiw,{ hwdralra,(aRPrIW I<rpNN IR - Wm JleJSe iIYN r Rwr IR LM tmtl wfxn des ra redreWarl n4 rNr IirWrt Ila:IrdW IYhY War relsylrara,r/xt ABBREVIATIONS r.R Ylra � nwaailY l �r. nx u:Irru:1 1.r1r4 la 14wa m ba. m rw rr ll NUMBER MM RETAIL 1 ROOM NAME KITCHEN Impl Wsn YOI riirlrxrYN as. rurw' wno W 4wwr� ai�..i AR ,v_14 4r m Wr Irr M yam ItFi MIR Mrd mr rr rm lewrirr 4d u:I:alrr lu w I4arl ® N ary.bl M els W!a u. �dn wrYi rar4 of Jrr rda, l w.. W�irY lux yl K r. ad tt KtY Y.n'r a n re�b1 rw rW rrrYr M fl (v �` W rrY,llr rbrl m (t �rtlrra/ h lrvrrNer am.rre NRI _ vl � IftA rr, • lmf tld �r n � INl �r p Iri ra Ym 'y'a'wed YM • in ratl �wYr4UrYw a6 M Re slvrw _ W Yrw Tar wwr nYS Im � ree14 Ir< rYr raaiw m .� rrir r~rerr.r m A Ir4aepwW ry` IaSR �yar uS ( an rm� irl r _ IA m ,wsiwrtiMr IR/f ti envier rMr1 bpr rwba Merlrl a *� atlr v sR raKi � Im m awrN 99Y p�wYel d SmI e�arNi 14 ul DRAWING CONVENTIONS 10 BUILDING J SECTION / 2 AIK-7—TT DOOR ELEVATION A02 .n.N1 NUMBER MM RETAIL 1 ROOM NAME KITCHEN REFERENCE 02 / h NUMBER 12 vhaN/ Specification, & Symbols T a1W /. slaa'Tala: INTERIOR MATERIAL/ A02� ELEVATION ny O FINISH TYPE NO L.Lr 'U� IL" 0 i L } :'gyp 3 ..4( Z � tiW O u��,�+l1 i W L d- CL >rr SR n' tn9�\d"�. 'Michael Louis Gallin Architemmc 55 H.6 Rood kogi , N/ 10533 ilrr dwip m r\,mnd.road m nom b,�rd.C.da.q.dd.rm�.+� 'Pruuim 6m AR h d bW God lode; mC. NOTE PROJECT HAS BEEN DESIRED TO D(CEED THE NEOSDREIROS OF THE NEW YOKK STATE DOW CONSERVATION WNSTRUCIM CODE NORTH (D LIST OF DRAWINGS A -01 Drawing List, Plot Plan, Rerj ' D. D—I Specification, & Symbols slaa'Tala: O ✓E�, _ A -02 Specifications Continued Demolition Plans ' Drawing Lis Plot Plan, A -10 A -11 Construction Plans Gen. Notes, ym s A -15 Exterior Elevations S -I- "; 0" Skirl N,: Nn: D—; MG Checked: ANG A A l ii 1st Floor -o' Plan sritE ,µ - =Y DEMOLITION PLAN LEGEND 1 I , I 1 I I C I 1 I 4 I I I I 1 L 0 I I t N Z I I f I w o I I I I Lo - - -- ---------------------- �I ow " �Lsement Floor Plan v SCALE v • -o HIS, Sh. fib: Demolition Plans D—: AG 0-6.4. MG I A 7 A C s V� OEM an 0 am m � N Z w o go Ln I Co ow cu— Walter and Irene Mack B—h 485 E- Rood PaBenm, rJ:n Yak 3563 Michael Louis 55 Ha b- Rood Gallin Architect,— IrvGgbn, W 10533 Theo dmnfp ve wwme d �momd a paMrbd by aPl�%I+, ihu degeand dart® nmv rn b i +Pad�.'nd v �d wbr.wti� pmm��cn Gam l.Yrld laii.G3�I J.1u. nlC. s4' � HIS, Sh. fib: Demolition Plans D—: AG 0-6.4. MG I A 7 A 3 Roof Plan Diagram suac w.rs. 2 1st Floor Plan SOLE 1/1'_1' -0' xv xr� F 9 :NCW gonlTun 5 i . 1 Wrl]IRUI.IIU11 Y(NY lLY[lYll Nw RfY� n�,bp 1/1' 41 rm N. J al re � Ir nc .sm m..r .ar Qs sw. aYa. 14 wm M� fannl 2 sra ¢ a�.o uy ema uy. sx -r. Y scar a a Ymlr Iipl rm.. -x s srw . o- repro am 0 o.pe oal Basement Floor Plan SCos 1/. P SHERLITA AMLER, MD, MS, FAAP Commissioner of Health L0RETTA..M0LINARI,_RN,_MSN - - . Associate Commissioner of Health ROBERT I BONDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Y1 reote_ /tea --k DATE 1 i/ 2 1 �! C. Ref ' eve Re: Addition- 4 — /,9( O — e-7-S_ No Increases in Number of Bedrooms 441? t tae g T Dear I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated 11 la //,q5, The addition is approved with the following conditions: 1. The total number of bedrooms must remain at 3 without prior approval by this department. 2. The area of the existing sewage disposal system, and its expansion area, must be maintained. plumbing _fixtures -iiiust'bd updated ' with wafdr saving 'devide's;iu:, new low flush toilets, restrictors for shower heads and faucets, etc. Any other permits or v 'ances required are the responsibility of the applicant and the jurisdiction of the Town of P ' If you have.any questions, please contact me at your convenience. GR: lm cc:BI (T) IP Very truly yours, Gene D. Reed Senior Enginering Aide 4CA NI $ vZ S � ov�l1 1�foa�GVca -?i Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner.oflYealth DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ADDITION APPLICATION ROBERT J. BONDI County Executive RESIDENTIAL ONLY STREET` "` TOWN%�7 E .� /9, TAX MAP# . S'6. 1N 7/02.2/- .z1. 9 NAME_ PHONE $* MAILING ADDRESS A/, N - i / 3 73 DESCRIPTION OF ADDITION CQNST2uc.-r c t4 cl F IaE " )( :c 3 t4D DiT iat4 NUMBER OF EXISTING BEDROOMS PROPOSED # OF BEDROOMS (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM-BUILDING INSPECTOR) "Any addition which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, - °Brews ter, -NY..-1-0509; Phone:.:(.845) 2a78�- 6130:.... 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) 3. Two sets of proposed floor plan (drawn to scale — with name, street and tax map #) *Non - professional sketches are acceptable 4. Copy of survey showing well and septic locations to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 . ,N SHERLITA AMLER, MD, NIS, FAAP Commissioner of Health Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ADDITION APPLICATION RESIDENTIAL ONLY STREET TOWN S°a TAX MAP#,jL. 7— —25- NAME � w �Z PHONE $ss 703: (d tS uN:r1PCHD# MAILING ADDRESSi DESCRIPTION OF ADDITION T c A T 7-4CAO P L,,a N S . /32 NUMBER OF EXISTING BEDROOMS 3 PROPOSED # OF BEDROOMS (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) "Any addition which is considered a bedroom requires formal approval,of plans (Construction permit) prepared by a Professional Engineer.or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, Brewster, NY 10509, Phone: (845) 278 - 6130._ 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) 3. Two sets of proposed floor plan (drawn to scale — with name, street and tax map #) *Non - professional sketches are acceptable 4. Copy of survey showing well and septic locations to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC(845)278-6678 Fax(845)278-6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LLQRF'TTPz MOLINARIy 1211'; MSN - Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 1050.9 PUTNAM COUNTY DEPT. OF HEALTH 1 GENEVA ROAD BREWSTER, N.Y. 10509 To Whom It May Concern: ROBERT J. BONDI County Executive RE: �r�Zfkle /t /— . Residence TAX MAP# TOWN_,., %T�.Ps- m s✓ According to records maintained by the Town, the above noted dwelling: IS IS NOT - - - IN COIViPLIANCE-WITH1-t6Wri code and-the total number of bedrooms is J This information has been obtained from: CERTIFICATE OF OCCUPANCY ASSESSOR'S RECORD OTHER BUILDING INSPf&OR Environmental Health (845) 278 -6130. Fax(845)278-7921 Nursing Services (845) 278 -6558 WIC(845)278-6678 Fax(845)278-6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP C'ommisssion'er of lealiti;` .. . LORETTA MOLINARI, RN, MSN Associate Commissioner of Health September 12, 2005 Irene Mack 485 East Branch Road Patterson, NY 12563 Dear Ms. Mack: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Addition — Mack 485 East Branch Road (T) Patterson, T.M. 36.9 -1 -25 ROBERT J. BONDI County'Efecutive I have received and reviewed the plans for the proposed addition at the above mentioned residence. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons: 1. The proposed addition is for an accessory apartment. Therefore, the SSTS design flow increases by 200 gal /day. 2. The legal bedroom count for the dwelling is three. The design flow for your proposed addition is 800 "gal /day,.therefore, xeQUiring a 4 bedroom system. 3. The addition of a potential bedroom requires this Department's approval of a revised septic system plan from a professional engineer or registered architect. Please revise the proposed floor plan to reflect no more than 600 gal /day SSTS flow, or have a professional engineer or registered architect design a sub - surface sewage treatment system meeting present code requirements for four bedrooms. If you have any questions, please contact me at your convenience. INURM Sincerely, Gene Reed Senior Environmental Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool(845)278 -6014 Fax(845)278 -6648 Nov 02 05 11:17a a B" .t• BRUCE R. FOLEY Public Health Director DATE: Dufresne -Henri DEPARTMENT OF I Geneva Road —Brewster, New York 845 - 855 -1780 HEALTH 10504 P•2 LORETTA MOLINARI RN., M.S.N. .Qssoelate Public Health Director Director of Patient Services REQUEST FOR ' L TUT . ATTENTION: a JOSEPH PARAVATI ,t *XGENE REF-D Ali 'information below must be Ally completeil`.prior to-any scheduling. DATE: ENGINEER OR FIRM: �o F , PHONE #: t 1 f REASON, � f DEEPS: PERCS: PU-N P TEST: ❑ ROAD /STREET: :1852- FEAST S&AA -CA TOWN: ... _— TAX MAP#: SUB DIVISION: _ H � pc i LOT #: M&* NYCDEP CRITERJA FOR JOINT REVIEW AND WITNESSING OF SOj:IsTESTING NO ❑ 18'. Q n it Proposed SSTS within the drainage basin of WestBraach orBoyda Corner Reservoirs. Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. Proposed SSTS within 200 feet of kwatercoarse or a DEC wetland. Proposed SSTS design flow greater Phan 1000 galloas/day or SPAES Permit req aired. k. Proposed SSTS for a Commercial Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project states (Joint or Delegated) based on the response. If you answered yes to any of the questions, NYCDEP must witness the soil tests. This Department will coordinate a mutua[lysuitable time for field testing with the Design Professional and NYCDEP °?�� If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil tests, it will be the sole responsibility of the design professional to schedule re- "witnessing of the soil testing with NYCDEP. COMMENTS: FOR COUNTY USE ONLY `" .1 N ce ! e,f Wciie +-o 31-7,g 3;00 3 ��� ��vt�i>J 4'c�i1e r (FIELDTEST) l.It]MC • Qi IT l.lr]h1 tell 161TV n=0n0TMCA1T rlC 0 0 -V JE rM 12563 MOIL aviland ollow !I Pond 104- 65 � IF I a ,01 C.) zu 'OUR"El JAI IQ 19 vp Ip Lake rhurn rner tembeck Corner s Lake v c nays- harles '2 IN N Mount Ebo �'k`BM+o eF r st Corporate rn rs HS DES Come!r Pond Brewster ItIon:. Pond p MS A > State on `O Police Old t a st z Church j > 312 ve OR 6 rs M ow OR ............ ........... 5 MOSS OR w 0 Cam C T Wcc,& T OL 5 1 0 4 m 9 -A SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health July 12, 2005 Irene Mack 486 East Branch Road Patterson, NY 12563 Dear Ms. Mack: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Addition — Mack 485 East Branch Road (T) Patterson, T.M. #36.9 -1 -25 ROBERT J. BONDI County Execuiive I have received and reviewed the plans for the proposed addition at the above mentioned residence. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons: 1. The proposed addition is for an accessory apartment. Therefore, the SSTS design flow increases by 200 gal /day. 2. The legal bedroom count for the dwelling is three. The design flow for your proposed addition is...800 gal /.day, therefore, requiring a 4 bedroom system. 3. The addition of a potential bedroom requires this Department's approval of a revised septic system plan from a professional engineer or registered architect. Please revise the proposed floor plan to reflect no more than 600 gal /day SSTS flow, or have a professional engineer or registered architect design a sub - surface sewage treatment system meeting present code requirements for four bedrooms. If you have any questions, please contact me at your convenience. RM:cw Sinc ely, Mae, Robert Morris Senior Public Health Engineer Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558. WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health June 8, 2005 Irene Mack 485 East Branch Road Patterson, NY 12563 Dear Ms. Mack: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive Re: Addition — Mack 5 East Branch Road Patterson, T.M. #36.9 -1 -25 I have received and reviewed the plans for the proposed addition at the above mentioned residence. Based on the information submitted, the above mentioned addition cannot be approved for the following reason: • The Town of Patterson has documented that the above noted dwelling is not in compliance with Town Code. This Department will not review applications for additions when the Building Department notes a non - compliance with Town Codes. This Department will commence with the review when the non - compliance issue is resolved with the Town of Patterson. If you have any questions, please contact me at your convenience. Si er ly, obert Morris Senior Public Health Engineer RM: cw cc: (T) Patterson Building Department Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 Sent By: Michael Gallin Architect; 914 693 4004; Jun -15 -05 9:56; Page 2/2 ,:.. .,�..... —. -.,- . 3 SAUCE a._FOLe�. RS Aeting PUhila lioalth DEPARTMENT OF HEALTH Division , Of Ens ironmentzl Health Services Cereya' Road, Brewster, New York 10509 (914) 278 -6130 ?= =.- Cuunry Dapt. of Health 4 Geneva Road B. ewst ., KY I05C9 Re: Residenc- Tax Map J,31, Tarn . Genus men: ?_cceiding.o re-.-crdls maintained by the Tow t, the abeye acted &-felling iS NOT in compiian_e �. nth T���, :..cAd� `!d the tctal number of bedreorn: cn record - - This infe►rnation has been obtained from: CERTIFICATE Or OCCUPAIICY: A2,3ESSORS RECORD: Building ins;,c SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 PUTNAM COUNTY DEPT. OF HEALTH 1 GENEVA ROAD BREWSTER, NY 10509 To Whom It May Concern: Residence ROBERT J. BONDI County Executive TAX MAP# �• �� `% - j - -5 n 7"7`r= �? �'ta ,-1 T`� • 1, " i According to records maintained by the Town, the above noted dwelling, is IN COMPLIANCE WITH TOWN CODE. IS NOT % IN COMPLIANCE WITH TOWN CODE LEGAL BEDROOM COUNT IS This information has been obtained from: CERTIFICATE OF OCCUPANCY: OTHER: Building Inspector Date CERTIFICATE OF OCCUPANCY Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Im Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 Sent By: Michael Gallin Architect; 914 693 4004; Jul -6 -05 17:44; Page 1/2 Architect Fax Transmittal No. Robert Morris 845- 278 -7921 Putnam Ccunty Department of Health �3T r Mai Tammy Feinman 485 East Branch Road ca» ...... na,r;m a Page 5. ,nary cow 6 July.2005 2 Re Letter of Compliance. The Form that follows states that Irene Mack's residence at 485 East Branch Road in Patterson is in compliance with -he Town Code. Is has been signed by the Patterson building inspector. The original was mailed to you from this office on June 23, 2005. Please reconsider Irene Mack's application and. please can't hesitate to call us at 914- 693 -4004 with any questions or concerns regarding this matter. Thank�you. 55 --win Ito- Rood I•vingtal• NV 10533 W 914 03 4002 h. 9'4 593 3993 nol i ,o•C.hl:ra Coln TI 11 . - "91']M. 1 lra 4 7. 74 Tr . AC 1^1 P nl IL Mk MrM^M "T \ IT i 9 M 4 Sent By: Michael Gallin Architect.; 914 693 4004; Jul-6-05 17:45; Page 2/2 DEPARTMENT OF 14EALTH Division, Of. E.nvircirrnerittJ Health Services C-t-nere Rcad, Brewster, N#w York 10509 (914). 27"LIO h P=.I-,. Co*ur.iy Dept. of HnM 4 Genavi RQuA B;-ewsm-7, NY 105C9 SAUCE. R - FOLIE', Arting PUhile )40<h LN Map Town__ Accwding to rezerds MaLnm-.edlby the T.oNyn, the abeyc noted dv.,dling 3 ;NOT irIC0mPAame%v:,thToN,,-.. code and the teal number of son reccrd is This been obtained from: -CERTIFICATE Of 0CCLFrANCY- A323ZESSORS RECORD: YTHER Suilding lns;.c or ►ICeelp - PI ITWOM mi INTY nFPARTMENT OF P. 2 Michael Louis Gallin Architect r Transmittal TO Address Robert Morris 4 Geneva Road Putnam County Department of Health Brewster, NY 10509 Copies To From Project Tammy Feinman 485 East Branch Road, Patterson Dot 23 June 2005 Cammen6 Enclosed please find a form signed by the Patterson Building Inspector stating that the Mack Residence at 485 East Branch Road is in compliance with the town code. Please proceed with the approval process for the work at the Mack property, and feel free to contact me with any questions regarding this matter. Thank you. 55 Hamilton Road Irvington, NY 10533 tel 914 693 4004 fax 914 693 3993 L� gallinarchitect.com r.: SHERLITA AMLER, MD, MS, FAAP Commissioner of Health Associate Commissioner of Health Irene Mack 86 -15 Broadway Elmhurst, NY 1 1373 Dear Ms. Mack: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 November 21, 2006 ROBERT J. BONDI County Executive Director of Environmental Health Re: Addition, A- 140 -05 No Increases in Number of Bedrooms Mack, 485 East Branch Rd. (T)Patterson, TM #36.9 -1 -25 I have received and reviewed the plans for the proposed addition at the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated November 21, 2006. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at three without prior approval by this department. 2. The area of the existing sewage disposal system, and its expansion area, must be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low -- -- Rush toilets-, restrictors for shower heads and- faucets, -ete: -- - - Any other permits or variances required are the responsibility of the, applicant and the jurisdiction of the Town of Patterson. If you have any questions, please contact me at (845)278 -6130 ext. 2261. GDR:Im Cc: BI (T)Patterson Michael Gallin Sincerely, Gene D. Reed Senior Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI R-N MSN Associate Commissioner of Health Irene Mack 86 -15 Broadway Elmhurst, NY 11373 Dear Ms. Mack: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 November 21, 2006 ROBERT J. BONDI County Executive ROBERT MORRIS-,--PE-- Director of Environmental Health Re: Addition, A- 140 -05 No Increases in Number of Bedrooms Mack, 485 East Branch Rd. (T)Patterson, TM #36.9 -1 -25 I have received and reviewed the plans for the proposed addition at the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated November 21, 2006. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at three without prior approval by this department. 2.. The area of the existing sewage disposal system, and its expansion area, must be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower..heads,aud faucets, etc. _ . Any other permits or variances required are the responsibility of the, applicant and the jurisdiction of the Town of Patterson. If you have any questions, please contact me at (845)278 -6130 ext. 2261. GDR:lm Cc: BI (T)Patterson Michael Gallin Sincerely, xxz_ -4). Z�2� Gene D. Reed Senior Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early InterventioniPreschool (845) 278 -6014 Fax (845) 278 -6648 I CERTIFICATE OF OCCUPANCY AND COMPLIANCE Elafim N_ o 1988 19 95 ` DATE ISSUED March 16, THIS IS TO CERTIFY THAT Irene Mack /Ilse Pletsch ON THE PROPERTY OF ; same a LOCATED ON ;East Branch Road HAS BEEN SUBSTANTIALLY CONSTRUCTED TO THE REQUIREMENTS OF THE BUILDING CODE, ZONING ORDINANCE-AND LOCAL LAWS OF THE TOWN OF PATTERSON, NEW YOhK AND MAY BE OCCUPIED AND USED AS Alterations.& addition to Existing Single Family Dwelling i Building Permit Dated .... Permit No. LM .... �R4.4. Application No ....................... SECTION ....... 82 ............. BLOCK ..........1......:.... LOT..... ... ?....(New TM - 36.9 -1 -19) FEE $ 15. oo 36.9 1 -25 _ BUILDING INSPECTOR MAY -17 -2006 10:38 FROM:PUTNAM COUNTY DEPART 845 - 278-7921 1* . SIMP -LITA AMLER, MID, MS, FAAP Commissioner of Health LORETTA MOLINARI. RN, MSAI Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 70:98557024 P:3/4 ROBERT J. BONDI ` STREET TOE 9aA9�6cK-, MAPk34'2---4) NAME w41 � a � ,gC y (tae\, PHONE'- 1 -2-1l-`2G--79 YCHBOALLL. MAILING ADDREss LA DESCRIPTION OF ADDITION ��, ^� a�w^ a 4c� c�: �ivc, � o �x �s� :t� o. C -'- ._ o15�c;r�s� NUMBER OF EXISTING BEDROOMS 3 PROPOSER # OF BEDROOMS-3 (FRONT CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) "Any addition which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary code. Please submit this form and the following to Pumam Cotinty Health Dept., 1 Geneva Rd, Brewster, NY 10509, Phone: (845) 278- 6130. 1. Cet°tifleid check or money order fbr $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including bmement) 3. Two sets of proposed floor plan (drawn to scale — with name, street and tax map #) `Non- professional sketches are acceptable 4. Copy of survey showing well and septic locations to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. CE TAE COMMENTS Environmental Health (845)27&6130 Fox(845)278-7921 Nursint{ Serviees (845) 278 -6558 WIC(845)278-6678 Fax(945)279.6085 Early Interventian/Freachool (845) 278 -4014 Fax (845) 278.6648 MAY -17 -2006 10:39 FROM:PUTNAM COUNTY DEPART 845 -278 -7921 4 u SHEttLITA, AMLE-R,�VIp,1diS, FMP Commisslvriei fly ealh` LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 'own Legal Bedroom Count TO:98557024 P:4/4 ROBERT J. BONDI Re: Locx \,2, (Owner's Name) Tax Map #: Address: &-'a4 -�). 9�c <:DA Town: Year Built: Accord' g t records maintained by the Town, the above noted dwelling, is in compliance with Town Code. is not in compliance with Town Code. . ... The Legs! Bedroom Count is: This information has been obtained from..: Certificate of Occupancy: Other: 7 l y Building speetor Date Enviroameutal licatth (845) 279 -6130 Fax(945)279-7.921 Nursing services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nurata8 home Care Fax (845) 278 -6085 Early Intervendon/Preschml (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Walter & Irene Mack 485 East Branch Road - Patterson, New York 12563 Dear Mr. & Mrs. Mack: DEPARTMENT OF. HEALTH 1 Geneva Road, Brewster, New York 10509 Re: ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health June 7, 2006 Addition — Mack, - 164 -06 485 East Branch Road (T) Patterson, TM# 36.9 -1 -25 I have received and reviewed the plans for the proposed addition at the above mentioned residence. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons: 1. The legal bedroom count for the dwelling is three. The potential bedroom count of your proposed addition is five. The proposed room in the basement titled "relocated den" has increased dramatically in size from the original den, and therefore by this Department's determination has the potential of being two rooms, one of which is considered a potential bedroom. 2. The kitchen adds extra flows to the septic system and thereby cannot be approved by this Department unless the septic system is designed and constructed to handle such flows. Because this Department considers a kitchen to add an extra 200 gallons a day flow, (the same as.a bedroom) it--is-considered.-the same as- a-bedroom. 3. The addition of a potential bedroom requires this Department's approval of a revised septic system plan from a professional engineer. Please revise the proposed floor plan to reflect no more than three potential bedrooms, or have a professional engineer or registered architect design a sub - surface sewage treatment system meeting present code requirements. A copy of this Department's guidelines has been provided for your use. If you have any questions, please contact me at your convenience. GDR:cj cc: M. Gallin, RA Sincerely, 44'rwe, �), rz5*( Gene D. Reed Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET -'SU'BSURFACE SEWAGE TREATMENT SYSTEM Owner Address —d ST '6jZA IVG H %2o ,4/7 k Located at (Street) Tax Map Block Lot (indicate nearest cross street) Municipality -T p,y Watershed .SOIL PERCOLATION TEST DATA Date of Pre - soaking 3/7/06 Date of Percolation Test 3 Z 810 Form DD -97 2- 6 Olt 30 3 2 3:a4 3 0 �3 - a-5Xy A 3 3: SS-- o S 30 a23 - 5 oZ ' /3.3 4 5 -31 .0 2 3:17-3: #7 3O 3 to 3 3,q7 0 4 5 1 2 3 4 F-7 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 2- 6 Indicate level at which groundwater is encountered fV o n9 r.-- Indicate level at which mottling is observed ®wG Indicate level to which water level rises after being encountered Deep hole observations made by: Date 3 ' 8 og Design Professional Name: Address: Signature: Design Professional's Seal TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST DOLES . -:�,.�.a - "-`DEPTH . r.. .�_ .. ,_ - - = " �.. __ HOLEri�10" .a�.-- _. -�,��� .. _HOLE NO �..;..;�.. -_:�,� ,.HOI✓E G.L. 1.0' TIC 8� 1.5' h 1. Goj< 1.0'i, SGL A 6i 5-a a lOGC6K '�,.0 2.5' 3.0' Y, 3.5' o �, loa, 4.0' S e Go .n a. s to Se Cm 6/. o 4.5' 5.0' 5.5 5 0 e w��o 661 6.5' G , o ' 7.0' 7.5' 8.0' . 8.5' 9.0' 10.0' ` Indicate level at which groundwater is encountered fV o n9 r.-- Indicate level at which mottling is observed ®wG Indicate level to which water level rises after being encountered Deep hole observations made by: Date 3 ' 8 og Design Professional Name: Address: Signature: Design Professional's Seal PUTNAM COUNTY DEPARTMENT OF HEALTH N DIVISION -OF. ENVIRONMENTAL_ HEALTH SERV-10ES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A: GENERAL INFORMATION Name of Project M 4,/-k, V) County Site ILocation ��95 % �3 AJGt/ ns��j 36. °1 - 1 ! Building'construction begun ),e5 Extent 5! 0 .. Is property within NYC Watershed ? :.............:.. Yes No SECTIONS. TOPOGRAPHY, (Please check all appropriate boxes) 1. Hilly' Rolling Q Steep slope Gentle .slope Flat 2. Evidence of wetlands a Low area subject to flooding Bodies of water Drainage ditches Rock outcrops 3. Property lines or comers evident ...............:....... .. .... ' es ,No 4. Do water courses exist on or adjoin the.property: � ............................ =Yes d No 5. Will these affect the design of the sewage system facilities? ............ Yes N 0 6. Do watershed regulations apply in this development ? ..............:........ Yes a No 7 Will extensive radio be necess Yes No grading ...............: ............................... 8 -. Will extensrvefilr be necessary for SSTS ? ............... ..................... Yes No' .9. Do filled areas exist within the SSTS area? ........ :.............................. 0 Yes No If yes, what..is the condition of the fill? SECTION C. SOIL OBSERVATIONS 10. Appearance of soiLED"Sand Gravel �oam Clay Hardpan Mixture 11. Observed from: a Borings a Bank cut Backhoe excavations 12. Soil borings /excavations observed by ! i° `74- on 3 8 06 13. Depth to groundwater A) o u,� on 14. Depth to mottling AInAi g- on 15. Are test holes representative of primary & reserve areas ...................... :............... 16. 'Soil percolation tests made by '..0 �{,¢/__ /A/ P25 ,, on 17. Soil percolation tests witnessed by + ° on SECTION D (on back) r Form ST -1 2. µ.. SECTION D. DRAINAGE 18. Will proposed grading- materiahy alter the natural drainage in this or adjacent azeas? a YesNo 19. Will groundwater -or surface drainage require special considerations .................... 0 Yes No 20. Will gullies, ditches, etc,, be filled•and watercourses :be relocated ? ................... . ...... 0 Yes No SECTION E. REMARKS. 21. If a common water supply is proposed, :has an inspection been made of the existing or proposed source and facilities? ...... Yes No Inspection -data 22, Do adjacent wells and/or sewage systems exist ?.............. :...... ............................... Yes ,.� .No 23. Additional comments 24. 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