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Home My WebLink About3218DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73. -1 -3 BOX 26 I ru IN we Is IN III I'y 1 � IL I MINI IN i r,� In I ' �,' , 03218 rUW MC0UMDErAgngwOFIZA1= toFwrli•Fiwallt/ DNliia�d��kw��IdBuMt +B•nb�a.CaM4N.Y.11u1 BBM • A18 or Cum Faeeit I � CownVC1111011 FOIE M UWAat$ MWOM SMMii ~ L ; y.,y��am� rE✓�- _..x..... .Q :�. Tsr1 ��.i^. .. :v - _ _ . Ko_ _ .... Tin..i r. �.•. �M �i. '�T .V,:-..ri.T� ^� +P'r0 �.as._ _.�.r. r+ Sahadie IIaigia w / y Tax Map_}� : 5 } ► r.. . . t)..sr /Appllo.t w.. PAT 114AQ 0 1640m t PArrucA fiA"7 -i t c-(r- >i..dw.I_D If..I.be ❑ Date •t Provides Aaoraval .105 .4<2 Daift ,n err-S 1pe3 A�J&L_ w Awe 3 .AC- � F® Seeds cob' Depth V•lame Nenlhss r poiesms Desiga Flaw G F D G7 t rte PCHD NoWh'tls b R*Qdmd W6s Fill Y completed Sops nM Swilign {o Sylig m w aoslet d t� Gale S•plle Tnk add ��U �• lJ 1 Dl =. LiDSe!+� b M,essheets' ti-z Qlg-- Wa1ar Saate6s Foie sop* Fesm Addnm asl %� � Seppb Ddled b -ry BS- Otte L�airomsta l/ Z" 1 raprelaht'fhst 1 am wholly and completely responsible for the design and location of the proposed system(s): 1) that the �Y raft• tern • db oY1 a stem abova described will be constructed as shown on the approved amendment there to and M accordance with the standards, rules and rpuMtions o • m CowAty 0"artment of ""*I% 'and thet an eonplet.lowthNeof a ..C•rtilicate of Construction Compliance" salisfeclory to the COMMIS Oner Of hbalthwill be submitted to ten Department, anw a written guaranue will be furnished the owner, his au amors. hen a assigns by the builder. that Yid builder will place M pod .aporetbq ceMRie". s y. z of fled sawo" dirpomi. system during the period of two (2) years Immediately following th•date of the law area of the approval of the Certificate of Construction Compliance of the orlgMa stem # any r h•r•tol 2) that the drilled well described above WIN be bated M lga on the approved plan and that Yid well will be M 1 fth t e rules and ngu ores of the Putnam Catrnty O•poremalM M IWRh. . Oat• `7i ��j �� Signed P. F_ RA.. —_ Adww ti;7'7 A I IZ. S� s!iiJ�1.Q1i Z.� t� ��{ { 01 I Z� License NO 4"144G APPROVED POfI CONSTRUCTION: Thle approval acpi►es s from the date issued unless construction of the building has been undertaken and is revocable for comes a may be amended or modified when nee aY►y by ten Commissioner of Health. Any change or alteration of COndructbn requires a2 per IL Approved for disposal of domestic oli ?wag•, and/- to water supply only. Rev.. • 3 ) 2 `1 3 des �1'r`_".�� Title 10/88 _r Rev. 3/86 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N.Y. 10512 { e ` Engineer Mast Provide P.C.H.D. Permit N -- CERTIFICATE Located at Owner /applicant Mailing Address Separate Sewerage System built tUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM -� Town or Village �� d T_ map 3 Block 1 Lot ��)L &/� t/`6 erly Subdivision Name Sabdv. Lot N Consls of� /cftl� Zip Date Permit Issued Septic Tank and �ilJ Water Supply: Public Supply From Address L ori:rl , — vat�e�fSupply Drilled by C'r Address "1h7 ,f"% REGISTERED HAIL RETURN RECEIPT REQUESTED / Date - -�-F -' �l !1 - - - -- Building Inspector ifll`� �IJIC'w��a� ...:.....: \1J�: -r.l (\ ,'UTh`Al•, lr /lplf '{ 1C'�,� (4(L- - ) �- - - - - -- - -- -- -- �47r•r /�V/ t /r y/ /L/ Iv Re: Construction Permit for single family residence _ / Applicant I%I✓1C__1��C - - - -- --- --- -- Street C_ 1 U%& GA leP. --------------------------- Tovn 1 l,w..� LL.EY --- Tllt / ----------------- --- - - - - -- Dear --------------- -- - - -- This Firm Q am) submitting an application to constructs sevage disposal system serving a single family residence on the above captioned property, to the Putnam County Department of Health. In order to process this application the Health Department requires that the following information be obtained from your office: 1. Prior to your issuance of a building permit 4,'�� A) Is Zoning Board approval. required for any variances? /u,. �_ /• tYw C� Yes No .��_; tt � r H) Is any portion of the parcel located within a reguldted vetland or control -area, and if so is a vetland permit required? Yes - - -- _ No _ ✓ __ y <.:u C) Is any other local permit or approval necessary? tw' Yes - No --- -; If the ansver to any of the questions above is yes, please contact the, Department in vriting or by phone, 278 -6130 within 15 days of the date of this''.`` eorreepondenw, I1 the ansver is no, you need net reapend to thin correspondence. Very trilky you s, ;. Health Department Inspector Engineer;' .Qi►� � •-' ~ • - -. � - -- �• -- • -» -' ' JK /3p . vetland bh 0 r `` !! //. war 3/x/43 z1f �� . PUTNAM COMTX DEPAR`_ 1W-C OF HFALIVta. DIVISION OF F.i` VIRONMU_C'A7, HEALTH .i:(. ; ;:5 icwner or Purchaser of ng ConSt- iUCted b, T,ocatior - Street �;unicrp3.l�ty `i; ice' Bdilding Type ._� I Sractlon i Tax p SuL�di.vis.�,,r�; IVarrre S" i C.)A t �Jaot run GUARP.= OF SUBSiJFZFP_M SiDWACM DIS 1 SYSTV- 1 represent that I am wholly and completely re:=-,)onsible for the location, workmanship, material, construction and. drainage of the sewage disposal system serving the above described property, and. that it. has constructed as shorn on t:.he approved plan or approved «rnendment thereto, and in accordance with: the t standards, rules and. regulations of Putnam Coun t y Deparlu ent of Health,. and { hereby guarantee to the o;aner, his successors, heirs or as signs, to place in good operating condition any part of said system constructed by isle which fails to operate for a pariod of two years immediate_- y follc�ring thy,- date of approval of the ' i "Certificate of Construction Compliance" for the disposal ETysL n, or any ��, _a:ilac� -u Y� -rwl Y is _ caused by the willful. or negligent act of th.e occupa -art- of tiie building uti14 Zing � the system. THe undersigned further agrees to accept as concl.iasive tine dete�m�natzon of #e Director of tie Di.visioil of EnvironnIent: -al Heath Services of the Putnam Co1.nity Pepartnent of Health as to whether or not the failure of the systEM to o� =rate was caust by the willful or negligent: act of the occupant of the �u -lding util -i_z ing the System. Dated this (Jay of _ _ 19 VI Signature Title 'i Contractor (Owner) -- Signature Name tit Corp v9cLres s ation Nan le ; i. f- Corp A ai--ess -- 9/85 16 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 LAB #: 32.406376 Ci'IFNT #: 4%- MACQUIGNON, PATRICK PO BOX 259 PUTNAM VALLEY, NY 10579 NON STAT PROC PAGE 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE/TIME TAKEN: 04/11/95 13:45 DATE/TIME REC'D: 04/12/95 16:15 REPORT DATE: 04/13/95 PHONE: (910-528-4941 SAMPLING SITE: 255 CHURCH RD BATH SAMPLE TYPE..: POTABLE : PUTNAM VALLEY, NY PRESERVATIVES: NONE C011D BY: PATRICK MACQU7GNON TEMPERATURE..: { 4C NOTES...: ' CO| IFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAO PROCEDURE RFSULT NORMAL — RANGE 04/13/95 MF T. COLIFORM ABSENT /100 ML ABSENT ' COMMENTS: PACT THESF RESULTS INDICATE THAT THE WATF ,(WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDI��-�� THE NEW YORK STATE AND EPA FEDERAL WINKING WATER STANDARDS, FOR THE PARAMFTERS TESTED, AT THE TIME OF CO}'LECTION. SUBMITTED BY:—_'_'_ _�p- Albert _---__------- H. Padovni, M.T.(ASCP) Director Xy V. ELAP# 10� O PUTNAM COUNTY DEPARTMENT OF HEALTH D.+IVISION OF ENVIRONMENTAL HEALTH SERVICES 7 .. .... - _. -y. ':.. V� -'.. .v K'. .= .t`i'e:. _.e - c - v r ...o .-• -__T,' x - sr - ; ..r• - .O , .r.;`+i. ter.- . - _ f Date .��UuA � zit K5-5 Re: Property of ��T Y/ac��nG/��(ZCGtts0�- Cie %d< Located at C 4UiZ -G W i PAT> (T) pyrt zi V61f— Section oo Block Lot Subdivision of {J. Subdv. Lot # Gentlemen: Filed Map # Date This letter is to authorize L, ( ::)uL L NG\A �Z a duly licensed professional engineer or- r-e r= ed3qsh4.te9% - (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. CounUr' si P MO HA Cdr P.E., R.A., # I v a f d rz- < -- Address C40--Le, LiF-- L. , JJ . `F, (y3 Z cj14 Telephone Very truly yours, Signed Owner of Property ~% i kvu,L- Si' Address Town Telephone DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -.6130 APPLICATION TO CONSTRUCT A WATER �WELL r PCHD PERMIT # WELL LOCATION Street Address Town V11 iy 01_ fax Grid Number WELL OWNER Name Mailing Address i�ia-t' LAA, uL- ST ®Private vTj_rA. --, VAA .cam O Public OF WELL 1 primary 2 - secondary RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP O ABANDONED ® BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify, ® INDUSTRIAL ]INSTITUTIONAL O STAND -BY fo AMOUNT OF USE YIELD SOUGHT 5j gpm /# PEOPLE SERVED /EST. OF DAILY USAGE Z-Vo gal REASON FOR DRILLING 03 PLACE EXISTING SUPPLY O TEST /OBSERVATION M ADDITIONAL SUPPLY EW SUPPLY NEW DWELLING ®.DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING -u &-ty- svr7 n_-'r. CAC Nt___v ze5;;Iyr� OV—_ WELL TYPE bdDRILLED ®DRIVEN DDUG ® GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES _ 0 IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Q_U Lot No. WATER WELL CONTRACTOR: Name "ib tiE ip n7nz_�_t sl Addresses: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _X NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY 1j1S`l Tl YitUPEK` Mt i LOCATION SKETJJON SOURCES OF CONTAMINATION PROVIDED j 1 It - SEPARATE SHEET / (date) (s 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 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 otherwise contaminate surface or groundwater. Date of Issue: Z2- 193 Pi��dbe4w Pdir1 Date of Expiration -7 '2,1 19 J'C_ Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller a Paul Lynch 103 Fair Street Carmel, NY 10512 Dear Paul: ,_. , •a.�r. r. a..- �:+isr:..-... '-,. -q �. .ecr.. -.. �r ...._.. .ds� ^. ..rte DEPARTMENT OF HEALTH Division Of Environmental Health Services Geneva Road, Brewster, New York 10509 (914) 278 -6130 February 3, 1993 JOHN KARELL Jr., P.E., M.S. Public Health Director Re: Proposed SSDS: Maquignon & Moreiock Church Road (T) PUtnam Valley TM #60 -1 -45.4 Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: 1. Deep test hole #2 notes a depth of 6 feet, therefore, the minimum of one foot of ROB fill is to be placed. 2. The plan view of the proposed SSDS indicates a 20% slope, therefore, a minimum of 2.5 feet of ROB fill would be required in a 50 foot run. The fill is to be shown extending _10 feet past the edge of the trench and then sloping 3:1 to 3. Neighbor notification is required: Upon Receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, Robert Morris Assistant Public Health Engineer RM/ j p Ax it DECK i� 30 X 10.. Ft Y n%o%jm 18 X 13 owm Amli; ril KIT-Jlm'� � 0 10 X 12 9 x 12 LNm 1e NO. 10829 FIRST. FLOOR FIRST FLOOR r. GARAGE 24 X 24 HoU,SE PUN S APPROVED FOR BEDROOM COU":T O;'1; LL; MSTR HALLWAY MST B -x EDW 12 X 1. e 3 17- 7--IV ate I r4 DECK _.� _ .. , 10 _--- -- �. FANS -Y ROOM 30X - 18X 13 N .'8WFST* � VG RM KIT 10 X 12 11-3 X 12 9x12 1s x NO. 10829 FIRST. FLOOR f FIRST FLOOR I GARAGE 24x24 ,HALLWAY MSTR. BATH B IDMA. , a x I* 12 X 184 M - i B 3 2 9-$ X 14 BEDROOM 13 X 10 i i REGISTERED MAIL `RETURN RECEIPT REQUESTED Building Inspector 1v` 4 F&VI u n i7 c c= -- - rbL,Vj Cx �uTlJh�n lV// L,-Sa- �(��C� -.� 4w i- SG«c.r /17��1 Re: Construct: residence Applicant Street Town Tht Dear Ale, 0 nr—l.G- ------------ - - - - -- Date Lon Permit for single family Coo —t- �•li --------------------------- This Firm (I am) submitting an application to construct a sewage disposal system serving a single family residence on the above captioned property, to the Putnam County Department of Health. In order to process this application the Health Department requires that the following information be obtained from 'yaur office: 1. Prior to your issuance of a building permit A) Is Zoning Board approval required for any variances? Yes No B) Is any portion of the parcel located within a regulated wetland or its control area, and if so is a wetland permit required? Yes No -- - - - - -- --- - - - - -- C) Is any other local permit or approval necessary? No If the answer to any of the questions above is yes, please contact the Health Department in writing or by phone, 278 -6130 within 15 days of the date of this correspondence. If the answer is no, you need not respond to this correspondence. Name Health Department Inspector JK /jp wetland bh Very tru you s, Engineer, Architect, Owner �NumBER 10829 Mr i MI I =,c Y 4 t` aM tip y,,�Y >v� ivt+ *' ? - 'LC _ -�i,`" 71i #c_ aye : •yet' -F The Fwydly Farmhouse ere's afour- bedroom classic for the family that loves tradition. From the clapboard siding and DECK the covered porch to the formal living 30 X10 FAMILY ROOM room with colonial windows, this home g' 16 X 13 is loaded with old - fashioned warmth. KFST But that doesn't mean you have to DINING RM KIT BR R X 12 vi -c 1p convenicrce. Look-at ,h 11 -3 X 12 strategic kitchen location between the formal dining room and the breakfast room. The family room with fireplace LIVING ROOM GARAGE and the handy first -floor powder room 16 X 12-9 11U 24 X 24 are just steps away. _= Upstairs, you'll find three bedrooms FOYER served by a hall bath, and a master suite with its own private bath. NO. 10829 For price information or to order FIRST FLOOR this plan, see page 190. 54'-0''' Plan No. 10829 Bedrooms: 4 Baths: 2i4 Living Area: First floor 1,116 sq. ft. Second floor 825 sq. ft. Total Living Area: 1,941 sq. ft. Basement 1,116 sq. ft. Garage 576 sq. ft. Foundation Options: Basement 100 �= IBEDRM.3 EDROOM 2 9-6 X 14 13 X 10 SECOND FLOOR W It COUNTRY HOME PLAN *4992 I 1 COUNTRY U ►� /._ � ICLIYCIWpImWllLL .W. ninm NnT�CI w I�u i. iliuNU t 1 m muni mn n o'^ � � �� r In i¢on, ■ - ... -.� ....i. • I ui m IIW i i.- ei':"no:3 1� WAZ��- l- V. _ — r r �� i/ ere's afoot- bedroom classic for the family that loves tradition. From the clapboard siding and the covered porch to the formal living room with colonial windows, this home is loaded with old - fashioned warmth. But that doesn't mean you have to givc up convenience. Look at the - strategic kitchen location between the formal dining room and the breakfast room. The family room with fireplace and the handy first -floor powder room are just steps away. Upstairs, you'll find three bedrooms served by a hall bath, and a master suite with its own private bath. For price information or to order this plan, see page 190. Plan No. 10829 Bedrooms: 4 Baths: 2% Living Area: First floor .1,116 sq. ft. Second floor 825 sq. ft. Total Living Area: 1,941 sq. ft. Basement 1,116 sq. ft. Garage 576 sq. ft. Foundation Options: Basement 100 •`. Slail�� ! �! M MRS :«lr ILL'- :•• �- J BEDRM. 3 EDROOM 2 8-6 X 14 13 X 10 I = SECOND FLOOR COUNTRY HOME PLAN*1992 COUNTRY APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS : 5HEE7f -fe *.. x[?�4 iiJr'TI�?�'tT PERMIT.- . _ I - ��AA / 9a • mys.O a in 1. -: wca •, .W T NAME OF OWNER Iy` �,��6'`) J STREET CATION BY � ` �° DATE -3 TAX MAP # �09 o V DOCUMENTS. YN/ _ m T1T[ /a i 1 Tl / T /_T APPLICATION PWS LETTER ERS AUTHORIZATION DATA SHEET(DDS) DEEP HOLE LOG CONSISTENT PERC RESULTS (3) ERC HOLE DEPTH CORPORATE RESOLUTION PLANS THREE SETS HOUSE PLANS -TWO SETS CI: REQUEST GENERAL GAL SUBDIVISION SUBDMSION APPROVAL CHECKED RC RATE FI REQUIRED CURTAIN DRAIN REQUIRED mSTANDPIPES EX- APPROVAL SSDS ADJ. LOTS n,WETL4,ND (TOWN/DEC PERMIT Ti Dj_ DO #�R_ DATWON _ °'DDS PLANS- &=PERMIT SAIOPRE_-196 9 _ E NEIGHBOR NOTIFFIFICATIN LETTER BI/ZBA It UIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SDS HYDRAULIC PROFILE CD GRAVITY FLOW / J BOX m TRENCH/GALLEY m P- PIT DETAILS EPTIC TANK - SIZE, DETAIL LL DETAIL, SERVICE LINE IF OVER ONSTRUCTION NOTES (GRINDER RATE) ESIGN DATA: PERC AND DEEP RESULTS TWO -FOOT CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES CUT FOOTING /GUTTER/CURTAIN DRAINS 70MMENTS: C! m +0 pct HOLES LOCATED ATIVE OF PRIMARY AND EXPANSION . AREA; SHOWN; GRAVITY FLOW, SUFF. SIZE ;JMPED PIT & D BOX SHOWN & DETAILE - NO. OF BEDROOMS & SSDS'S WAIN 200 FT. OF PROPOSED SYSTEM ROPERTY METES & BOUNDS OUSE SETBACK NECESSARY (TIGHT LOT) OUSE SEWER - 1 /4"/FT. 4"0; TYPE PIPE NO BENDS; MAX. BENDS 45 W /CLEANOUT FILL SYSTEMS LAYBARRIER rDEPTH uA FT HORIZONTAL: SLOPE 3:1 TO GRADE S GAUGES LL PROFILE & DIMENSIONS OLUME TRENCH �LF TRENCH PROVIDED 60 FT MAX PARALLEL TO CONTOURS m 100% EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED ON PLAN 1- 1-J--10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL Z_20' TO FOUNDATION WALLS 100 TO WELL, 200' IN D.L.O.D., 150' PITS 100 TO STREAM WATERCOURSE LAKE (INC- EXPAN) �-p- 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER t,a-+ 10' TO WATERLINE (PTTS -20') ' 50' INTERMITTENT DRAINAGE COURSE 200 FT. RESERVOIR, ETC.m 150 FT. GALLEY SYSTEMS SEPTIC TANKS 10' FROM FOUNDATION; 50' TO WELL WELLS 15' WELL TO P.L. Paul Lynch 103 Fair Street Carmel, NY 10512 Dear Paul: a ...... ... ., .= � _ � .�. ' :iul+ri 'ItnAtCL' :Ir:.' ✓:c.'hiS � �... _:�. � ..;, Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services Geneva Road, Brewster, New York 10509 `914) 278 -6130 February 8, 1993 Re: Proposed SSDS: Maquignon & Morelock Church Road (T) PUtnam Valley TM #60- 1 -45.a Review of plans and other supporting documents submitted at this time relative to the above- captioned project has been completed. Comments are offered as follows: 1. Deep test hole #2 notes a depth of 6 feet, therefore, the minimum of one foot of ROB fill is to be placed. 2. The plan view of the proposed SSDS indicates a 20% slope, therefore, a minimum of 2.5 feet of ROB fill would be required in a 50 foot run. The fill is to be shown extending 10 feet past the edge of the trench and then sloping 3:1 to Upon Receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, Robert Morris Assistant Public Health Engineer RM/7 P ', + -13 =_ - %'I/I /�G? V ! C�lU�✓ ¢ `mil l/iZGJ2.�l� ,r' • M ng.n61 d L. xva_ ",tn 158. z1 �0 .-' T .a 3 o 04 cc 4 co -7 :•1 c w CO tp Lo r' AC. T ('t( 871.4p �etf51 R yes 3• a 5 (t0 AC. �. ' ..7 r �' tt: 7 0 : + o '�9 IV-/ 1 2.8�+ , �! . r e � sic sow' -� �, 1.2 5 o t1 h r ^ ` . i � 9 � AC i.�z4.�_P� I. ?5�1 .4 1•r 4 3 �f3 o CAL..- m1�A'3 3(1 IT`QS.. nd a ls.J.1.(11O_ AC. C V -I a; N �7P 1 .�2 nr e , t.j. ' �+,� ,. 8 7 A� ' r7 �L / y 41461,..- ._- I ^2 Af '�I �" 1• / ^ , ,�, '? �: f' A6.TF AS `, �cYrti�� 0 4C. — 7z r . � `,l CAL. _ A (1 {�i �SZ, et „� 101 % ` ^ 1.82 !, •� o �\ A' z E S�� N \ �.� 5.3?. AC. ��,z2 -, 6 ..�•' fn 1 1 1- 3.87 AC. '3• —:1 � b� � 9- a a. �0T I.'+1 �A,t P� r �.PPf ” ' 791 P SI Q9 2f 24 rf \0e i9 \if 1 Yr 0 I 1 0 �l C - - -- - - -- -- - ._._._...- I\ 6 1. A f 5' t}� __ - 1 26 A rr� ..) , i� Teti � __. 5c' i• i = Lr o l r{\ 1 \ nl? 0� fa o ��.... : ,�. _ ..._ ...� ..... _ � ...L!. t� _... �r�_• ; ( 1� ` \:cif • �._f' ....: tEl'•.� � .'s :;�,,.,,lt�._� .f ._ _. _ +l 3Z rpp` I ,�.I^40 Ar r f% ` �'�•72a; ; Ida.: _ .,31 ct Fn AF 1 r3. UJ , 19 AC. r,Al_.. �. 23 c��- ��,�; 2�s._ AC AC ` A e �: Ar y:- v j� r: ol 73.18 n, \•o � -BS. I 17.3.45 y 1 i Sent to MA"I CY) Street and N —ro,, jZV( - C P'.C>ti State, and ZIP' Code Postage Ze, Certified Fee 00 Special Delivery Fee Restricted Delivery Fee 0 Return Receipt Showing U. to Whom & Date Delivered Sent to MA"I Street and N —ro,, jZV( - P'.C>ti State, and ZIP' Code Postage Ze, Certified Fee f evu I Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to Whom & Date Delivered Return Receipt Showing to Whom, Date, and Addressee's Address TOTAL Postage V$ ZY4 & Fees .. Postmark orbate 0 0) tp O O O LE Cn a. -.824 ;489: 536 Certified Mail Receipt No Insurance Coverage Provided Do not use for International Mail .mqmm —Es (See Reverse) Sent to Mow Street& No. LA • P.O., State & ZIP Code 074 127 787 i Postage 1---A - Certified Fee 074 127 764 Street and No. Acv Special Delivery Fee No Insurance Coverage Provided Restricted Delivery Fee M ED STATES Return Receipt Showing uMTEDSr.TES to Whom & Date Delivered Restricted Delivery Fee Return Receipt Showing to Whom, -V. Date. & Address of Delivery to Whom & Date Delivered TOTAL Postage $ T�( & Fees Date, and Addressee's Address Postmark or Date Postage $ ;7? & Fees Sent to -P 074 127 788 :•P 074-127 765 Street and No. 074 127 787 i Receipt for Certified Mail 1---A - Receipt for Certified Mail 074 127 764 Street and No. No Insurance Coverage Provided Receipt for Certified Mail 1: No Insurance Coverage Provided Receipt for Certified Mail M ED STATES Do not use for International Mail uMTEDSr.TES Do not use for International Mail Restricted Delivery Fee P.O., State and ZIP Code -V. (see Reverse) to Whom & Date Delivered Sent to Sent to Street and No. 074 127 787 i ,?_ b S e.;- C- L- A 1.1 k3 1---A - RO., State and ZIP Code 074 127 764 Street and No. Postage Receipt for Certified Mail 1: Certified Fee Receipt for Certified Mail No Insurance Coverage Provided t—w six. POSTAL Es Do not use for International. Mail wTEosTATEs Z4<> Restricted Delivery Fee P.O., State and ZIP Code Return Receipt Showing (see Reverse) to Whom & Date Delivered (See Reverse) Return Receipt Showing to Whom, Date, and Addressee's Address Postage $ ;7? & Fees Postmark or Oat6 U Certified Fee Special Delivery Fee /* Restricted Delivery Fee Return Receipt Showing a) to Whom & Date Delivered Return Receipt Showing to Whom. C Date, and Addressee's Address TOTAL Postage c; & Fees 0 Postmark or Date 0 00 0 00 (y) (W) E E 0 UL 0 UL cn IL (n fL Sent to Tc,-w, ?—& as Street and No. 074 127 787 i ,?_ b S e.;- C- L- A 1.1 k3 1---A - RO., State and ZIP Code 074 127 764 I WIJ')e , P �`( 1 U 4 Postage Receipt for Certified Mail 1: Certified Fee Receipt for Certified Mail No Insurance Coverage Provided t—w six. POSTAL Es Do not use for International. Mail wTEosTATEs Special Delivery Fee Restricted Delivery Fee (See Reverse) Return Receipt Showing (see Reverse) to Whom & Date Delivered (See Reverse) Return Receipt Showing to Whom, Date, and Addressee's Address TOTAL Postage & Fees Postmark or Oat6 U ? /* Sent to A it> z ej-1, I`A^k)L) I FIR Street odNo. GNMufrl' lid. to 4. Postage Certified Fee Special Delivery Fee 074 127 787 i P 074 127 766 P 074 127 764 Receipt for Certified Mail Receipt for Certified Mail 1: Receipt for Certified Mail No Insurance Coverage Provided t—w six. POSTAL Es Do not use for International. Mail wTEosTATEs No Insurance Coverage Provided Do not use -for International Mail No Insurance Coverage Provided Do not use for International Mail (See Reverse) (see Reverse) (See Reverse) Sent to A it> z ej-1, I`A^k)L) I FIR Street odNo. GNMufrl' lid. to 4. Postage Certified Fee rn O to 0 0 )0 - stmark or Date 00 V) 7- E E o j; 4. 0 ILL L to a. Sentio Street and No. ?-!±(, 6U"Ce-it, R.OS iqte.qnd,7IP Code, Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to Whom & Date Delivered LIZ> Return Receipt Showing to Whom, Date, and Addressee's Address TOTAL Postage & Fees $ Postmark or Date 17! . . . . . . . . . ... i. ii Ii T Ci) C O Q 00 M E 6 u- CL Sent to 'Lt-(SG Street and No. Vy. Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to Whom & Date Delivered Return Receipt Showing to Whom, Date, and Addressee's Address TOTAL Postage & Fees $ Postmark o r'Date % Special Delivery Fee Restricted Delivery Fee --------------- Return Receipt Showing to Whom & Date Delivered Return Receipt Showing to Whom Date, and Addressee-§'Adjress TOTAL Postage,' & Fees D rn O to 0 0 )0 - stmark or Date 00 V) 7- E E o j; 4. 0 ILL L to a. Sentio Street and No. ?-!±(, 6U"Ce-it, R.OS iqte.qnd,7IP Code, Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to Whom & Date Delivered LIZ> Return Receipt Showing to Whom, Date, and Addressee's Address TOTAL Postage & Fees $ Postmark or Date 17! . . . . . . . . . ... i. ii Ii T Ci) C O Q 00 M E 6 u- CL Sent to 'Lt-(SG Street and No. Vy. Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to Whom & Date Delivered Return Receipt Showing to Whom, Date, and Addressee's Address TOTAL Postage & Fees $ Postmark o r'Date % Sentio Street and No. ?-!±(, 6U"Ce-it, R.OS iqte.qnd,7IP Code, Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to Whom & Date Delivered LIZ> Return Receipt Showing to Whom, Date, and Addressee's Address TOTAL Postage & Fees $ Postmark or Date 17! . . . . . . . . . ... i. ii Ii T Ci) C O Q 00 M E 6 u- CL Sent to 'Lt-(SG Street and No. Vy. Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to Whom & Date Delivered Return Receipt Showing to Whom, Date, and Addressee's Address TOTAL Postage & Fees $ Postmark o r'Date % . . . . . . . . . ... i. ii Ii T Ci) C O Q 00 M E 6 u- CL Sent to 'Lt-(SG Street and No. Vy. Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to Whom & Date Delivered Return Receipt Showing to Whom, Date, and Addressee's Address TOTAL Postage & Fees $ Postmark o r'Date % - . „P ."074 .127. 784 p 074'127 785 � o Receipt for Receipt for P 074.127 786 Certified Mail Receipt for :.No Insurance coverage Provided Certified Mail MTEe =nrES Do not use for International Mail No Insurance Coverage Provided Certified Mail -, .. tam No Insurance Coverage Prodded: :lot: Use.'f09' .�.tgrriati .:r:•;'r1 t. t.. ,. :a'��.. ... -. .. .. - - ' !I 'ros's2'inI'Ci” t' `wre:i st.rzs='i.Jv'li trt usB tOP ;niell'IaCiGu51'IVi 31I' (See Reverse) eosTlL SEW CE /Cou Rn. —.1 Sent to (.W '(4i-F,-d 14 K02 e— Street and No. Zrt 1 ULu) cl"I/ILtGl 2v t 'P.O.,'State and1fPlCode L r. VJt2C Ln( v S i Postage Certified fee Certified Fee Special Delivery Fee Postage u Special Delivery Fee Return Receipt Showing Restricted Delivery Fee to Whom & Date Delivered Return Receipt Showing Return Receipt Showing to Whom, to Whom & Date Delivered_ Date, and Addressee's Address Return Receipt Sh6wi6 g lb Who t Date, and Addressee's Address & Fees TOTAL Postage r' PostmaMi bate & Fees 1 � Postmark 9r Dats_`- TOTAL Postage f Return Receipt Showing to Whom, & Fees ', U I � I rn C C 7 O O 00 E 0 •P 074 127 763 Sent to ' I Ul,,, t W Street and No. I Liu u> =-ttit < kiA�Y �t,L�� P.O., State and ZIP Code I,uAIUVACr 10r7- loS^4l Postage •t� Certified fee �e Special Delivery Fee Postage Restricted Delivery Fee $ Return Receipt Showing $ to Whom & Date Delivered Certified Fee Return Receipt Showing to Whom, (jib Date, and Addressee's Address TOTAL PostSgel' �•- ` t /r; Restricted Delivery Fee & Fees PostmaMi bate T N C O O O th 0 LL rn P 82.4 489 537 P 824 489 538 Receipt for Certified Mail Receipt Certified Mail I No Insurance Coverage Provided Certified Mail Receipt T• No Insurance Coverage Provided Do not use for International Mail No Insurance Coverage Provided awTEOSUTES (See Reverse) -® Do not use for International Mail a ys= Do not use for International Mail =T.Esgga j (See Reverse) sent to MfTEesT.TES (See Reverse) POeT.t SEa',Ic, Sent to Restricted Delivery Fee I Liu u> =-ttit < kiA�Y �t,L�� 'iUiv ntco Street and No. P.O., State and'ZIP'Code- '174- GNcAU�-i.l �- L-A.s 447,1c- N1.7' IPiO., 'Stale and ZIP,Code Postage Q"PIJtK. $ Postage $ i Certified Fee (jib Special Delivery Fee C Restricted Delivery Fee Return Receipt Showing to Whom & Date Delivered TOTAL Postage f Return Receipt Showing to Whom, & Fees ', U Date, and Addressee's Address Date, and Addressee'* Address TOTAL Postage & Fees —3 �^,.... il, \ TOTAL Postage ' ' Postmark or Pate ' s' k & Fees Postmark or bat% } Postmark or Date( ` Sent to Restricted Delivery Fee Sent to �ae and No P.O., State and'ZIP'Code- L-A.s 447,1c- N1.7' . I) Postage $ l oc-?q Certified Fee o Return Receipt Showing to Whom, C Special Delivery Fee Restricted Delivery Fee Return Receipt Showing TOTAL Postage f to Whom & Date Delivered & Fees ', U Return Receipt Showing to Whom, Date, and Addressee'* Address 00 TOTAL Postage ' ' TOTAL Postagtlr', I) s' & Fees Postmark or bat% } Postmark or Date( ` !/t>Jc t ,T 4 ,� wwcrt>✓ TSc�w�r� Street & No. P.O., Slate & ZIP Code Pvrwof�t VIsI,L.E� N:tl 1v5� l Postage Certified Fee Special Delivery Fee Restricted Delivery Fee Sent to i o Return Receipt Showing U v to Whom & Dale Delivered l oc-?q � o Return Receipt Showing to Whom, C Date, & Address of Delivery Restricted Delivery Fee Return Receipt Showing TOTAL Postage �'• to Whom & Date Delivered & Fees Return Receipt Showi g to Whom, . 1 Postmark or Date 00 1 TOTAL Postagtlr', I) ' &Fees Postmark or bat% } � r,l a Sent to ;:reel & No. P.O., State & ZIP Code VAjcjsy 4).Y. l oc-?q Postage 101 Certified Fee /I ' � VV Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to Whom & Date Delivered Return Receipt Showi g to Whom, Dale, & Address of Delivery \ TOTAL Postagtlr', I) ' &Fees Postmark or bat% } � r,l PUTNAM COUNTY DEPARMEIR OF HEALTH DIVISION OF ENVIRCNMENTAL HEALTH SERVICES DESIGN DATA SHE1Jr- SUBsumcE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Pb�r tti► <at�utCj�x�� `�� Address `7t 57'n2,o-;�T 1�►� Ul�t,(� ULD Located at (Street) Sec. 66f Block 1 Lot 4f, ¢ (indicate nearest cross street) Mani cipality J ?, n,� z,�- V)k'Z ,tom Watershed . r--�-zJ 5 SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking I Z ( ci Z Date of Percolation Test 1 Z 1z- i Z- HOLE NUMBER CLOCK TIME 4A PERCOLATION e� ... r. _�� .�._ _..: PERCOLATION Run No. Elapse Time Start-Stop Min. Depth to Water From Ground Surface Start Stop Inches Inches Water Level In Inches Drop In Inches Soil Rate Min /In Drop 1 11!oz - ti' 3z 30 Z4t�Z - 'Z& itz -Z 1 2 I1 " 52 -TOZ 30 Z4 t/z (3/4 1� 3 Zl} 4 12.33 - 1!03 30 i z4 �� - z� 7y t � 111 5 24 f`q J Z�.3��i 2 �P�EOFNELY 3 A Z 1112 -..3o 4A ZCQ ,� . e� ... r. _�� .�._ _..: ..:.._..�.5 ..�..._._. .._ .._._ 2 W34 - tZw4 `30 z 4�i� - Z %/4 Z 3 1Z`oy - (Z!34 30 Z4, /ti Qe4 Z i� 5 1 2 kit 36 -(Zvly 3U 24 f`q J Z�.3��i 2 �P�EOFNELY 3 A Z 1112 J aP 4.IZ!�Q - �.,G�. 30 t / Z4 2 - .Z6 i r �I►.' +. 'r 5 NOTES: 1. Tests 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 fran top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCX)UNITRED IN TEST HOLES DEPTH HOLE NO G.L. 1' 2' 3' 4' 5' 6' LG� �0U>a 7' 8' 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED � DEEP HOLE OBSERVATIONS MADE BY: 7wiV DATE: %s,` -? DESIGN- Soil Rate Used t& - 7-0 Min/1" Drop: S.D. Usable Area Provided S uu o c; No. of Bedrooms Septic Tank Capacity iUuo gals. TypeCfA,3Jr-, Absorption Area Provided By L.F. x 24" width trench �P,Mf NEIy Other 0- 1 ILL k w,,. /b 5 J�M�c► C 4 yN f Name Signature _ � i•. Address t o.3' f- ? ST SEAL �tis� os a Ae G2CLtN f.3 -`f . 101 fZ �pROFESSION��'� THIS SPACE MR USE BY HEALTH DEPART ONLY: Soil Rate Approved sq.ft /gal. checked by Date Ti LUA H saNr� PC -I . L?U'�^NAM CC.IUNTY DEPARTMENT OF HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYST,nEM( 1. Name and Address of Applicant: 'i Nx- M1 QL)iGia0LJ 2. Name of Project: 3. Location Tom- l�'�r�-ux -t VLSLL 4. Project Engineer: L -T Lf-CG 1?r- 5. Address: l03 "F ire S� _ License Number: in'7 446 Phone: ZZZf 0'15f 6. Type of Project: �G Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) T. Is this project subject to State Environmental Quality Review (SEAR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted 3. Is a Draft Environmental. Impact Statement (DEIS) required? 3. -Has DEIS been completed and found acceptable by Lead Agency? i� ). Name of Lead Agency Al 1. Is this project in an area under the control of local planning, zoning, '"" _._. ,.•_.._F or other officials, ordinances? ............. ?. If so, have plans been submitted to such authorities? (J•, 3. Has preliminary approval been granted by such authorities? Date Granted: �. Type of Sewage Disposal System Discharge...... Surface Water Ground Waters i. If surface water discharge, what is the stream class designation ?......... �. Waters index number (surface) ..... .... ............................... Is project located near a public water supply system? If yes, name of water supply N A Distance to water supply !. Is project site near a public sewage collection or disposal system ?..... Name of sewage system Distance to sewage system Date observed: 23. Name of Health Inspector: �20TSE(2T 001Z,e�S Project design flow (gallons per day) ......... ....... ............. ... C��a 2. 27. Is any portion of this project located within a designated Town or State wetland? .................................. ............................... 28. Wetland ID Number 29. Is Wetland Permit required? ............... Has application been made tc Town or Local DEC Office? e _ 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 . 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 ?i� 34. Are community water, sewer facilities planned to be developed within 15 years? 00 JJi -ArG any - 141a.g�>_.rj 1. \i�l. �,SIZl_aro'+_a'S_... {�.��x:. Fi 5.7 l7) �..iM S,opO�i •.VV. .U... 36. Tax Map ID Number .................... ............................... Q.� 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 a Letter of Authorization. Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under pena 1 ty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made here in are pun ishab Te as a C lass A N7sd eanojr p to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: 0 3 -FA %Z Sou MAILING ADDRESS: C'k'�- State Pollutant. Discharge Elimination ,- .._...__., ._... r_ 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? .................................. ............................... 28. Wetland ID Number 29. Is Wetland Permit required? ............... Has application been made tc Town or Local DEC Office? e _ 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 . 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 ?i� 34. Are community water, sewer facilities planned to be developed within 15 years? 00 JJi -ArG any - 141a.g�>_.rj 1. \i�l. �,SIZl_aro'+_a'S_... {�.��x:. Fi 5.7 l7) �..iM S,opO�i •.VV. .U... 36. Tax Map ID Number .................... ............................... Q.� 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 a Letter of Authorization. Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under pena 1 ty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made here in are pun ishab Te as a C lass A N7sd eanojr p to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: 0 3 -FA %Z Sou MAILING ADDRESS: C'k'�- 1M t. f} Y, 1. Fla 'F. i.; .f • i� e. 2, R F PI.A�1 eutnam l;ounty department of Health ��i301 :ivision of Enviroripntal Hq4t h rvider prove as notod for conformance with q;licable Rules and Regulations of th utnam County ealth DenaLtte !rn R T1 +lA yam' / i C i.i OID/ 0 felft zv- A 8 C D NOTES 1 444 3-7 z *j 4 3 Z 13 Y4 s-6 3 1 a R5 5 �/ 5 a W 63 6 1 t 6� 7 lei iq ►56mG e t 6 30 b -BDK j9 /oq. /Z, 10 //7 /3z 11 z5 61 12 39 . 6 /y 9 o G O Brio "This is to certify that the sewage disposal system was constructed as indicated 'on this plan and that the system was inspected by me before it was covered over. The system was constructed in accordance with all standard rules and regulations of the Putnam County Department of Health and the New York State Department of Health." el S- 163J&T (� rnaF. rir7.E: 5CN/r�� O�L�rI _ aAfJ, P�GFILe,C�MTAILS eIr is C, 5 W' as -Z of OLD CHURCH ROAD PM I 4.- -41 sicri PM CHURCH-ROAD LE a—CW ,16IF- RAs, Crfmr-, or-T,41ub 44�t-j, I-F- 'J�/-ircrK verr. 73 I CHURCH-ROAD LE a—CW ,16IF- RAs, Crfmr-, or-T,41ub 44�t-j, I-F- 'J�/-ircrK verr. 73