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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.18 -1 -15 BOX 27 03446 OL f I� Ll'� ■ , '�, � .T ' •; • 4m 1 �. 1 ' ■I r I ` -, ,, '; ' i .I 03446 i � t FPM CGli BRUCE R: FOLEY Public ..Hgt�leh� Diy�,ctEr, • „r;; ;,,, „_.,_;o _ -„_ . • • LORETTA MOLMARI R.N., M.S.N. a ;4ssociirte Public Health Director Director of Patient Services DEPARTMENT OF HEALTH ' 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 December 6, 2000 Gerald Riso 14 Briar Ct. Putnam Valley, NY 10579 Re: Addition - Riso - Briar Ct. ! No Increases in Number of Bedrooms (T) Putnam Valley Tax # 73.18 -1 -15 Dear Mr. Riso:, I have received and reviewed the plans for the proposed addition to the above- mentioned i residence. The proposal for the addition has been approved as per plans bearing the approval stamp form this Department dated December 62000 The addition is approved with the. following conditions: i 1. The total number of bedrooms must remain at Four 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 and faucets, etc. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley. If you have any questions, please contact me at your convenience. Very truly yours, Michael Luke ML:kg Public Health Technician cc: BI I DEPARTMENT OF IMALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 ' — TeL (914) 278 - 6130 F= (914) 278 - 7921 BRUCE R. FOLEY Public Health Director PROPOSED ADDITIO \T APPLICATION (RESIDENTIAL Oti�I,Y) STREET 3Zk�hxL C'� N NAME PHONES 6s/ /PCHD 0o MAIL UNI G ADDRESS, I'-( DESCRIPTION OF ADDITION�ox�.e. NIi'VgBER. OFE)aSTINGBEDR00�-IS "—/..PROPOSED- OFBEDROON.jS (FRON-I-CERTr OF OCCUPANCY-OR CERTIFICATION' FROM BUILDNG NSPECTOR) . *Any addition which is considered a bedroom Tequires formal approval of plans (Construction -Pe'rmit ):prepared -by'.a Professional Engineer car Registered Architect:in accordanceN th = -` appf ca'�Ie sections of the Putnam County Sanitary Code..". Please submit this form and the following to Putnam County Health Dept., 4 Geneva Rd., Brewster, NY 10309, Phone 273 -6130. 1 Certified check or money order for' $100.00 2: Sketches of existing Iloor_plan.(drwn to scale, all living area including basement) *.Non- professional sketches. are acceptable Two sets of proposed floor plan (drawn to scale, with name, street, and tax map # Non-professional sketches are acceptable - ----4.: Copy of surrey showing well and septic location, 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 Cert. of Occupancy from Town or Certification from Building Dept. with legal. ,-bedroom count of dwelling. OFFICE USE' Comments Gerald R. � P Briar Court Putnam Valley, New York 10579 ir..� � =.� .. i.: iC. '�. •,if.- ...•.�.in. -.� -« _, . -:w - � -. _ :.i+ -�i� -. -. a, .. :•w -1 .. s._. .. _. ,iirt�y. ;'n �. i. - .i.a........ .. ..- �...�., �- .. .�a:'..•. i December 2, 2000 Department of Health 4 Geneva Road Brewster, New York 10509 Dear Sir Madam: Please find in, the attached the application for the renovation of my basement of my home. Also attached, are the following documents. • Certified Check for $100.00 • Sketches of `Before" and "After" construction Copy of well and septic survey • Copy of Certificate for Occupancy : Putnam'County DOH Certificate of Construction for Sewage Treatment System — CO does not specify the # of legal bedrooms. The construction will consist of framing the basement, dry wall, and adding lighting, ventilation, and electrical outlets. The only other change will be the installation of an egress window if required. construction wiH create two rooms, (1) mechanical room, and (2) a wide open general living area, i Sincerely, Gerald Riso (845) 526 - 6511 li IT OF HEAL-7K pU I-JOUSE Ar-PIi0'tI'LD VOR 'GO HT CNI-(, C- 1-1 F, 10,0 Sigri.-Iturro & Vftlo 26 JuD ❑ Access Doors Mechanic (j 13 AFT M E T .-4 R rF___ Water Heater V 261--- > 7 —Furnace Well Tank • Oil Tank Central Air i Stairs • 9 a 26 IE1 El Access Doors 0. Mechanical Room E: Overhead Lighting ti E Electrical Outlets Support Columns C), Egress Window 'A F 13 7 BEFORE tt AFTER 'arh "a� � i -r-'u vii _- i- io.•.: -_� v ..6...., " `• . • i'.. r ...... � I BRUCE R FOLEY, R.S. - �� Acting Public ,Health Director DEPARTMENT OF HEALTH Division, Of Environmental Health, Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 Putnam County Dept. of Health 4 Geneva Road OTHER �_ �-• �- nSc*--._, �... ,,,,,_..- .._.r.w_.- ._.�... -.:-- yam._._ - ., - -,, _... ,_,. ...�!^x^ - - _...�....' -- - - CERTIFICATE OF COMPLIANCEHOCCUPANCY CERTIFICATE NO.: 98- 181 PERMIT NO.: 98- 271 TM#: 73.18 -1 -15 (Lot #8) DATE: November 19, 1998 LOCATION: 1'4 BRIAR COURT ISSUED TO: 37 CROTON DAM ROAD CORP. This certificate covers the construction of: New One - family Residence /No Deck 1 Family Year Round Multiple bedrooms The applicant having heretofore filed an application for a building permit pursuant to the Town Code, Sanitary Code, the Uniform Building &. Fire Code and the Laws in effect in the Town of Putnam Valley, Putnam County, NY, having paid the required fee. therefor and the undersigned having by personal inspection ascertained that the applicant has subsequently proceeded with the erection or improvement of the proposed structure in compliance with the requirements of the laws as aforementioned; that.. the said. work and materials. met -every ,requirement of. the..-�.awp and that the premises have now been fully completed and are ready for occupancy pursuant to the provisions of law. Now, therefore, this certificate of compliance /occupancy is hereby issued under the seal of the;Town of Putnam Valley. TOWN OF PUTNAM VALLEY, N. Y. By: CODE ENFORCEMENT OFFICER PUTNAN.�COUNTY DEPARTMENT , HEALTH -i..., Blt lS!E3N Oi i K, ERON',,iEN i •ql fii Ai Iii Si i'zYi d �, CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCH D CONSTRUCTION PERMIT # Located at /Y. .��r.4,r , ^'c ; �4- own r Village Owner /Applicant Name _'�l r" !4 )J QA o, r U; Ca>e, Tax Map 1 i t� Block Lot Formerly. Subdivision Name Subd. Lot # 0 Mailing Address `; l r ;J ij� �K j"Z G t- r �� r,1 r L� Zip Date Construction Permit Issued by PC ' HD Selgarate Seweirage System built by 5'2 0; 4 rf ?v 0,4-t i �,?'P ice, Address Consisting of � Gallon Septic Tank and 460 t: 1 '6i ��r :. 4( roc' 5 Other Requirements: / Water SU]p1gl y: Public Supply From Address ore Private Supply Drilled by of Bedrooms Address /_5_0 =Has erosion control beeri completed? grinder been installed? I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. ;`Zc, Date: 11 Certified b y �' ..�__ ^.` --- P.E. 1 ,.._(Design Professignal) Address r,�, , c : �,:.�t:�7i :w, r �;� ►,�:..� ,, f.�: ; 3 �,.r' /,� ,�., t'. t` , License # G� r Any person occupying premises served by the above system() shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of.the separate'sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is.necessary. y By: X61, r�r � ! Trtle. '` 1 -'� ` f `� V A Date: " fi r White copy - HD File; Yellow. copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 i GeraM R. Riso 14 Briar Court Putnam Valley, New York 10579 Wb�.�V�J �`a w�r,.r ..• .� u�-�ps y.. ad :(�j »i+4/`^Wa..si�rft�c'i�rtirM .r ten. �•. -rnv .�. �. 1. -.'`r �•i ..wx.r .•u. �..Y..� n•.'Pa�M r- w.0A.•lia.awrJlw..t ..T�vw -: rt +•.�w�.••�� ,December 7, 2000 Department of Health 4 Geneva Road Brewster, New York 10509 Dear Sir. Please find in 'the attached schematics for the first and second story of my home that I forgot to include With my previous communication Sincerely, Gerald Riso (845) 526 - 6511 V.S. CONSTRUCT IONC0RP.1LOT P-8 17•4• IS -I.- N 10 LAUNDRY ni 7777 'CEO im rAHILY ROOM zx6 148 TEst L 2).6 EXTERIOR VALLS e IG* O.C. 2. 2X4 MARRIAGE VALLS"@ 3. 811 CLG HT. 4. RDor SYSICK TO BE. 16'.'07C.--- S. BARRIER VII!lV0VS-- SINGLE HMIIS. 40� )31-10 V m*I^ d A C. SIAIC LAB MIT vi AND Pr$klASCL LOCASIC-f 9*-6 112* 7681 v 76 ia,D C& s U. 324 a C 11.70' LOOK KITCHEII 1!!e! .2-rk 112' . . 2.4 SR STUDS Z_ 3-0- PAN F Al LCLL .3ms Z_ Z_ in I I I id 10 AIIDVC • 14LAt PIK ft N.Ic.c 30• 34, 1"911411 W, .1A I n. 91-91 Z.EXC.fE r MNUFAMURED NODULAR STR RAAF_ 101A 683, LivrRia. PA 444-3395 rm (211) 4! C W-W DINING P0014 LIV11hr. RGCPA iV Is,-t' SN- /ON-?/NY I is j rll I P i. 27646 HAMILTON 2 1ST' STORY CHECCED Vf- AIS D165 PIER FD -10 -ftv'W P"8090i 2D/19 4OZ5 T— !_4'LL Ll t APR 30 '98 13:49 FR EXCEL HOMES 717 444 7577 TO 1914962624) PNa YNl�� }DI�, y l y C i l °'Paa ii +0 0 C•MzDA H gig ° A C mh g� -• rr /ES -0' mm apt, PP r ^' O S � N � 1 N CID b I f r I r I �N p C I pN I V° V V I Pw 4- �A. N oa a R a i IV N a z I d gffi Y N A 3 a pr z Z I r K m N g o A a• -3• 8' r5� 1 4a .`1 N - O _ r —� Q l ---j C `� o = O y �� -pO a'-9• � •'-T pl sfi = o - o R W N m P T I `4 12•_11•. Ia• -11' 20'•6' I � �•.p• li'-9' UNIT 'C'. 27' -6' P.01,i02 i 1 i I I i I i I I I I I I j I I - 16• -T I 9 9••fi it - 1 I I I � I I I = I 1 — — m 1 r o I I — I �I I ■ N O O I I O - f�l' 1wt1. c,le I 1 I `Q ► I v I 1 ? •�1 I I Q e' -b lit• . I N � � g�br�• I' 7 p o o 7�t � P.01,i02 i 1 i I I i I i I I I I I I j I I d 'r' j�]7 1��T'�NAT1 M COUNTY DEPARTMENT �®I}��I'q' HEAILTII� I/ .•Q•N. �W..r,.r ` �Awl�J. 1I�++Y'+l'•u ®�- .C�TLL.�V'����1Y .�Itz l\ CAT E OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM own r Village f2vrf%1 -L, VA Owner /Applicant Name 'S1 bWfW Qom h P, C Tax Map -73, 106 Block I Lot Formerly. Subdivision Name L r /) c *c. 3 Subd. Lot # 0 �MailingAddress V*" 12P , O55(r✓f/J(7 /V J Zip /c,5r6-Z rx Date Construction Permit Issued by PCHD 10-- �1 - -17 Selgaratte Sewerage System built by 3*7 0-11d7en/ pAz, rOP. 60,oW, Address Consisting of /*"� Gallon Septic Tank and 400 W 2 `w 1 pf r2 "ete5 Other requirements: Water Sum b: —0 14 14085. r,t (� Public Supply From, c or: y- Private Supply Drilled by 1° � ��ir'�S `�✓s Address o 'V<< Address 45'lew7r Z, �� r —�— Number of Bedrooms Czes b55KIas garbage grinder been installed? Na I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: Q 6 l ��`5 Certified by 2<1', P. E. K --- DeAan Professimn Address i Ns rrr &-A; &,jera ( �, s�� � ► S 44<-o,, Pic, License # e�- I 4v--5r fv -i-c- z t 1:�rzexj5Tt -7z /t/ El f Any person occupying premises served by the above system(4) shall prozptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revoc ion, modification or change is necessary. firP By: Title: ° Date: White copy - HD File; YdIJA copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: - - - Inspected - Street Locatior ' "' I' c`�. 0- ar Owner tMcc� Town Permit .5— TM # 73 - 18– 1 ^ US- Subdivision Lot # 1. Sewage System Area a. STS. area located as per approved plans ........................... b. Fill section -- date of placement II barrier Lgth. Width Avg.Dpth c. Natural soil not stripped. d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course /wetlands................. II. Sewage System a. Septic tank size - 1,000 ... 1,25 other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation ....... :.................................. d. Distribtuion Box I All out ets at same elevation -water tested ................. 2 i Protected below frost .................. .....:......................... 3! Minimum 2 ft.Original soil between box & trenches Junction Box - ropzrly set ... .............. ............................... engtlprequired �(�c�Length installed 2.; Distance to; watercourse measured Ft.......... 3.' Installed according to plan ......... ............................... 4., Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. "from'property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface ..:............... 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 1 %z" diameter clean .................... 9.. Depth of gravel in trench 12" minimum ................... 1:0. l Pipe ends capped ...... .. ......... .......................e....... g. Pump or Dosed Systems T. Size ot pump chamber ................ ............................... 2. ' Overflow tank ..................... 3. !Alarm, visual/audio .................... ............................... 4. Pump easily, accessible, manhole to grade ................. 5. ;First box baffled .......................... ............................... 6. 'Cycle witnessed by H.D.estimated flow /cycle........... III. House/Building arouse located per approved plans ...................... .... . b. Number of bedrooms ................ ... ...:............... ............ IV. Well a Nell located as per approved plans . ......................:........ b. Distance from STS area measured ft., .......... c. Casing 18" above grade .................. .................... ............ d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backflled ........... ............................... c. All pipes flush with inside of box ... ..........................:..:. d. Backfill material contains stones <4" diameter .............. e. Curtain drain & 'standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 1/97 Form 14 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT NUT E: Exact location or well wttn aismnces to at Least two permanent nu►wili -5 Lu uv vlvvlu. ".. a aW" �.... �r.u. =• Well Drillees Name P.F a 560s, e. Address: 4 Putnam Ave Brewster, 10509 Signature: Date: 10/30/98 White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 : Y` Kramers Pond Rd Woodland Estate Towii%Village °" T _ j Putnam Valle ax Grid'# 5 W1517, GvT ;t x8 Map73,1$ Block 1 Lot(s)JO Well Owner: Name: Address: V. S. Cor oration, 37 Croton Dam Road, Ossining, NY 10562 Use of Well: =Primalry 2- secondary x Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling ]Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing x Open hole in bedrock _ Other Casing Details Total length 32 - ft -. Length below grade 31 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: - - -X -- Steel- _ Plastic _ Other Joints: _ Welded X Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: X Yes _ No Liner:_ Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes No Hours Second W.ell Yield Test _ Bailed X Pumped X Compressed Air Hours 6 Yield gpm Depth Data Measure from land surface - static (specify ft) 30 During yield test(ft) 560' Depth of completed well in feet 665' Well Log If more detailed information descriptions or sie.�e Bnalysds ..:,.wb:.: are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description fft. ft. Land Surface 14 Drillin in ove burden clay and boulders 14 1 Hit roc< at 14, �w- 4 . 32. =.: ln,_:.D ii -11 -in zin. roc . set.. casino. , rqut 32 665 D ' If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 5 _Wm Depth 580! Model5GS10412 Voltage 230 HP Tank Type WX302 Volume 86 gal. Date We I Completed 8/4/98 Putnam County Certification No. 002 Date of Report 10/30/98 Well D ' le ig Per a NUT E: Exact location or well wttn aismnces to at Least two permanent nu►wili -5 Lu uv vlvvlu. ".. a aW" �.... �r.u. =• Well Drillees Name P.F a 560s, e. Address: 4 Putnam Ave Brewster, 10509 Signature: Date: 10/30/98 White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 1. 1. • , `, X12 =1998 1,0:10, �I. NORTHEAST ]LABORATORY OF DANDURY y'.f 1. •, ... .. �' ,. .....r ! •.�.- ...�. w��., •1 RTt.. 4� .. w 4•f.'+Fr.w..�mn1..+.' '� / .. 39-3 >M ML•Pt wlnr ROAD - DAXU=r, CT 06811 0=17"- 7905 - FAZ "I 7"A3662 P.01 CT Cear' "p1i -0404 ...,•' ": - • - , MY Cent: 11471 Y4%AnJX TORY REPOR'i' -- . WATER SUPPLY '1' +WJrZ l I B>ICPOR'><' TOE P.F.13EAL & SONS DATE SAMPLE COLLECTED: 10120199 do 11/6(98 4 PwNAM'AVENUE TIME COLLECTED: P.M. BREWSTER, N.Y. 10509 COLLECTED BY: M. BEAT. DATE RECEIVED Q LAB: 10/20/98 & I1/6198 TESTED BY: LAB #11471 & 11301 REPORT DATE: 11 /11/9$ i $ LE SITE: VS CONST., LOT 1t8, PUTNAM VALLEY, N.Y. SAMPLTNG� TANK via= WELL-NEW 'SgFid1T Pi 1C: KONX TEST PERFORMED �T: MAXIMUM CONTAMINANT LEVEL BACTERIAL: Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml f =ICALS: pH 7.72 no designated limit 11 16 - Turbidity 3.2 NTUs 5 NTUs C)E�MI�TRY• Nitrite N <0.01 mg/L as N: l mg(L, as N 11301- Nitrate N <0.01 mg/L as N 10 mg/L as N Alkalinity 96.0 mg/L no designated limits Hardness 76.0 mg/L no designated limits 11/6 - Iron 0.118 mg/L 0.30 041L Manganese 0.037 ttig(L 0.30 mg/L •..._ .. - ...._.:�._:_._,�.�...... .__..,r,...,..._.,._ , ..:.. ,�;,. � � . � - `•. :.:(trtute_ + �binvd•Liz�c•fas•Irc*�•pti,g'._ .....,..���.,:..� ......., Manganese = 0.50 mg/L) Sodium 25.5+ m81L 20 WA* * Lead 0.005 mg/L 0 "015 • •' M) = milliliter M&/L = tnilligtttmt par Liter ND = was detected NTU =Units i "Notificaden (,eves ••'Action Level RESULTS )BASED ON SAMPLES SUBMITTED:I0/20M & 11!6!98 SAMPLE, AS TESTED ABOVE: �X OTA.BLE or OT POTABLE (Plot Nrw YORK STATE DEPT. OF twALTH SERVICES $1'ANOMW FOR POTABLE WATER) Laboratory Director •NORTHEAST LABORATORY,129 MULL STREET, B1RWN, CT 06037• (860)82 &9781- FAX (860 )529 -1050 TOLL FAEF wtTiiWN CT: 800- 826.0105.OUTSIDE CT: 800 -654 -1230 TOTAL P.01 I i PUTNAM COUNTY DEPARTMENT OF }WEALTH IDMSION OF }ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM EM 3 7C ro f c �v p,� jvt �o�p Ld 73 10 1 d 5 Owner or Purchaser of Building Tax Map Block Lot 376roT0 N VA. N/1 &ZoAp LoRP, ?uTNAMI v�l� -E� Building Constructed by TownNillage 13aia�q Caviar (F*6i'mm.lp „��aa LILNE) Location - Street FZ�S�'D P_wr1A L Building Type LINCA.R = Subdivision Name 2 Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is 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 treatment system, or any repairs made by me to such system, except 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 P `b)ic Health Director of th Putnam County Department of Health as to whether or not a failure b0he system to operate wall, cau y the willful or negligent act of the occupQ of t ;f e building utilizing the D oft; Day Year if Signature: Title: PP ES A2 E.N T ) - Signature Corporation Name (if corporation) Corporation Name (if corporation) Address: 3 7 C 9 o -Fn n.i -t-?A r-t &oA' p Address: State 0_5 i lV 1 N 6, N Y Zip 10S 6 2- State Zip Form GS -97 IN�SITE ENGINEERING, SURVEYING& LANDSCAPEARCHITECrURE, P.C. LETTER OF TRANSMITTAL Route Brewster, New York 10509 (914) 278-6392 T Del-averg: ne Avenue ' � (914) 297-1742 Wappingers Falls, New York 12590 TO: Date: 11 It.- 118 /0 Job No. 1i 1147 3, CS Attn: ❑ Resubmit copies for approval Re: --------------- - LJ C -17 k-TL rZj�PCV /2r-T- 1740 70 ?,00.00 e� ................... ................. ................................................. . .. .... ..... . ........ ...................... ............. ......................... ................................................................................................................................................. ................................... 171 For review and comment ❑ WE ARE SENDING YOU 'ached ❑ Under separate cover via ❑ Shop Drawings ❑ Prints ❑ Plans ❑ Copy of Letter ❑ Change Order ❑ the following Items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION /0 ltt5- (3U10 7eiAW(N!§ it' ❑ Resubmit copies for approval ,,F15or.approval ❑ For your use ❑ Approved as noted --------------- - LJ C -17 k-TL rZj�PCV /2r-T- 1740 70 ?,00.00 e� ................... ................. ................................................. . .. .... ..... . ........ ...................... ............. ......................... ................................................................................................................................................. ................................... THESE ARE TRANSMITTED as checked below: Approved as submitted ❑ Resubmit copies for approval ,,F15or.approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections n:Retum corrected prints 171 For review and comment ❑ f V DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 TeL (914) 278 - 6130 'Fax (914) 278 - 7921 FAX COVER SHEET Date: Z To: 1W CJ kts�Qw _Q M-5� oy. Fax #: ®_— yj Public Health Director No. Pages (Including cover sheet) From: Adafn D. Stiebeling Asst. Public Health Engineer __:. - .._�..... .. _ . For your ir°;f r`mat`ion ... : _ __ . _ Please respond _ ... .. _ F your review Lgo� As discussed Notes/iMessages I �P 56E I I �"11�'d Attached as requested Please call M CV--f;-Pk, In the event of transmission /reception difficulties, please contact this office at ; i� a0 (914) 278 -6130 ext. 157. &,Mr'g ef -o 0 P 'k, 1C. ce MMUMMON-PUMPOWSWAINDMOSALSMM 4.0 Tax M BP— Fast ......... Date Of Addim Town -Datg. tibdivisioh �ARRxU ed ri L'a Fee Enc-.1 Ose T* rot Am Pa" Fm NO&W of Bedrotmsis- Malign Flow G P D L PcE" i. S411111111b SI-6MV SYdm 6 0" It 2-ELP—Galls, geplgc- Tiusk End Aex--, [- F- 6C 2-' 1,6t. 1p k) TakC�ie5 To be esissbud@4 b Addis Y Wave, sowtv Pao sqq* prM --Addren On I rag►asent that l a m -wh6ily and com6I*'t:e'iV'. fespoinsible"for the design and'lo'cation of the proposal SyStOrn(i). 1) that the Mbbv@ dk&ib6d will be comdruLied'as shown on the approved amendment there to and in accordance with the standards, rules 7FW 7ro-9 -&n&M', County Depakinint' Of H'm'ltl and -that opp�mpiiatlon thereof ' 'Certificate ' th,*,1,7,,..1i,I n, and I a of Construction Compliance" w ten. guarantee will be 4 rnfthe� the owner. his succe 16— be suornittivii to :64 0064rimem. &,hd a written, u will ppce any nors.- hairs Or assigwis by stvq condition, a ""a disposal So. . om - 1 1, syito r m during the . I ,po fly, tiWissu- Par ripq Of two (2) yms,jmm@ajjt4 of, 011" of the 1��ifkate of construction Comonance of the original ':above Oproval. i�iterh T or�ajy, ra"I!s,1kherato; 2) that the.dr I da, will be located is dwwm an thei "ad plan and that mid well Will b* Installed, in ac Co do the sfindaiiK'Irplek, and i county Depikivisni'ot'Walth., Date 4- Signed .i. A 9 See Address ilkileMG -1-Ift er-14 P"06]g License No': IMPROVED FOR CONSTRUCTION: This app ►I i0val ex0ir ed unles Sir . u 0 f. t A as two year. from the date isi o 970iing Or bit nstruction revocible for cause or may tpe amended Or modified whericonsldsrid necessary ne► of Hqft: Any change "Paul y p M & now Per It Ap' Ov 0! disposal of domestic sanitary' Re' 10/88 Title LS , . !t W YlV/LL�ii 4Ni IWSYIT ®IC 1QlIG(919�1LLIp1 • , / adC/ "']..i 07 Q 2 L. //VGRrQ 7�L SrliL 124 0 8 iron �R&D "73, /0. i F1e� i .tNc�Yt'. Q►/Ei.b�inc a . . Dnb � of . TOWM1 zip /7643 Ua�e SubdlyiSlOn Annroved /�D q- �-g�f Fee Enclosed am�,,,,t ;fit Fdty G P ID PCHD 14092mftm 00 Mtn 'PM lb c'mP%W � , b G=zba 9140 at> s ltyll SoC�Q'2 sy Tw codS -to.lka by AM=. U N /C��lOc llt Clew 2� ester � Aft .- 1 roprorant. 4hat•t om'ruh011y and eompbtely vos�nsiblo 4or 4h0 dotign and location Of the proposed syatem(s); 1), that the hipara40 disposal 8 slam tibdt/0 dg!$CriQled., CJ.ilF too co PIE:PYCted IIS .S aoarrl Orl;fh0 app(OVa anierodni6nt thire to and in- acmwdanco with the standards, rules a. , rcgu ions 0 o nam t:ounty Oobevtwac nt 04 C ltth, -and tPU]t on 46ompbtion ,thO►oof'a,'.Cortiricato of; Const►uetaon Complianeo•'. sotis4ae4ovy 40 the CoTTlsWOnp 04 N0814hezill be saeaT1440d to ¢o,o Oopac4w1OT4,-and o t�viQt061 proWVOnt©0 rv�Il .Do 4urnlsAOd Oho OiynOV, hi8:�ecCOSeara; hoiv8'or assbpne by the ®ui0mcra,.tAat sold builder c-aUl 019460 iA 0-9 ®�aotMC eoaoa8i410n .'oa►y padt of said t?aiboo dispoml systam durfra the pOrigd o4 two (8t ytnvs ionni6diatoly folQ=lnD thOdote of the imu- a0ce, of, t6e6 apOw-al Of tho'.'Covtifkato 04 I ons4ruc4ioa,' Compl6onco of 4ha original system ov any r(it Ms t6moto; 2) that the drilled wall described above W16 bo loc;6 6 tab w On t� boo plan grid tho4 &W evoll iailll bo installed im aceordoaeo with the standards, rube and regu - ens of the Putnam t otenty O sar4ncec,4 of Poq IQa4O SZtiJnod k,,. P.E. A. — �"'��`� N t�� Ad61vi mt 1AN/7Z e<uY611 r d P cd x e . ep Lit nso No F. . -.. !t78$:d"? 4PPAOVEO FOR COH7 TRUCTIOW: This approval ettpiroa taro vs fr m data u iess ris4ruction of the building .has boon undertaken and is ravlftoblo for rA s0 01, be omondcd or nwdified arhon•'COn Grp n spr by.Ahe. lssionai. of mcalth. Any Change Or a1tg7 don 04 not Ion y rmuiros a nbi, perm A F. ov0d fov dispomi 04 dom0st can ege;'a r- a tar. supply only. Rev. per' 10/88 onto J ®y Title DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 '- AFFLTCATTON TO CONSTRUCT A WATER WELL' PCHD PERMIT # I Z- 9 5 WELL LOCATION Street Address Town/Village/City Tax Grid Number WELL OWNER Name Mailing Address private D Public W OF WELL � primary 2 - secondary XRESIDENTIAL O-BUSINESS O INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /H T PUMP O FARM O TEST /OBSERVATION CIINSTITUTIONAL O STAND -BY D ABANDONED 0 OTHER (specify, O AMOUNT OF USE YIELD SOUGHT gpm /# O'REPLACE EXISTING SUPPLY 33NEW SUPPLY NEW DWELLING PEOPLE SERVED_ /EST. OF DAILY USAGE 30C..�tal ❑ TEST /OBSERVATION Q ADDITIONAL SUPPLY CI EEPEN EX STING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING iWELL TYPE MDRILLED DRIVEN DDUG C]GRAVEL 0OTHER IS WELL SITE SUBJECT TO FLOODING? YES >:� NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES Y/ NO NAME OF PUBLIC WATER SUPPLY: &1A TOWN /VIL /CITY DISTtANCE .To;. °PPOPERTY' FROM NEAREST WATER "riAIT3: �2/Z//✓iyU ` LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED N SEPARATE SHEET ........... - °- 2i zn (date) (s natu e) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions oflSubpart 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 unt'il 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 co a or groundwater. Date of Issue: t:f7 19 �.• Date of `Expiration ` 19_'x_7`_ Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller WELL LOCATION DEPARTMENT OF HEALTH Tax Grid Number WELL OWNER �i�N� Mailing Address L,�C eil at 11" Division of Environmental Health Services E OF WELL - primary 2 - secondary SIDENTIAL U BUSINESS ® INDUSTRIAL ® PUBLIC SUPPL Q AIR /COND /HEAT PUMP ® ABANDONED ® FARM ❑ TEST /OBSERVATION ❑ OTHER (specify O INSTITUTIONAL ❑ STAND, -BY AMOUNT OF USE 4 Geneva Road, Brewster, New.York 10509 REASON FOR DRILLING DETAILED REASON FOR DRILLING (914) 278 -6130 - AP- PI; TCM} ION� TO!�;GONST. RileT� -A: uWATERLU+l8a�,.:_-:�:::.- .�,�.,_.,;.1 WELL TYPE DRILLED r PCHD PERMIT WELL LOCATION Street Address Town/Village/City Tax Grid Number WELL OWNER �i�N� Mailing Address L,�C eil at 11" �RP_j, NS ivate D Public E OF WELL - primary 2 - secondary SIDENTIAL U BUSINESS ® INDUSTRIAL ® PUBLIC SUPPL Q AIR /COND /HEAT PUMP ® ABANDONED ® FARM ❑ TEST /OBSERVATION ❑ OTHER (specify O INSTITUTIONAL ❑ STAND, -BY AMOUNT OF USE + YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE 7300 gal EI REPLACE EXISTING SUPPLY ® TEST/ OBSERVATION I2. ADDITIONAL SUPPLY NEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED ®DRIVEN ®DUG ®GRAVED ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: - /!�/G1�P Lot No. WATER WELL CONTRACTOR: Name 4-1,440 ((0eV Address: -G(h!K /tYc/C�/,A% IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES Zj_NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY Al, DISTANCE- T4.PROPERTY FROM.NEAREST,WATER MAIN:. - W1VKWCI� ✓r LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED !_ j� SEPARATE SHEET (date) 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 thirt3- (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 ' dr ng operations be contained on this property and in such a "manner as not to degrade or o r ise con minate surface or groundwater. Date of Issue:— 19* 4 r - Date of Expiration 19 Permit Issuing Official Permit is Non - Transfer able White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. .Orange copy: Well Driller i s i o..adw�ttae rani AA" PQl11AY CODIf1'! DgAtl' OF �A1.'1W Y It61? , . Dlvl�ita d "`iMC /s PievNa ltNt 1 �t�ka�ailal � Senrkaa. lrtiural: N. • ' w CF�i�[CATB 0 its Dmeo�nL'siaY� Pets.lt - Wit: =.,r^ M�7,..o�no,— „..- - ;, � r� �� .rt v � {/tv� -_:`; .r.' .mss + -• c "t.C.:v - Lai Zyt— LN.L:.1L_BiOI�' Qwwewd ❑ O �EY].Ci1�tfi Co. l IN C. ,-- Data of PreNwa Approval 3fi=n L''i' Tdfw, UjtLL Em NLa z� Ir11o�k3' wPA glo�lP (rLM) Fee Enclosed ® Amnnn � �dE -'•O� t Dli . Tm-- 1 F fi1P►l, w Mee l►4JLn AiG • F® soMm o* misuse 4134111 Mas e 4 Deatp FU.w G P D rib P�C®N�ullye� soma” Sys to a m" d j2-a OWIM saplte Tank = . ebb LP A WNse sib Ptbtaels * hems Adilre.s rsPdifita; s.b a n, o l�j�_1L1�1 _..ikes. LIN1CNf�1tJN _Odm 95e41PINIS ;,ta _J '; Qnr 1 np►eant that 1 �m wholly ind,eompMtst above dew ibei will a oomtruet•d as show county 04ioivint • of MMlth. and,tMt be submitted to tie D•partriiaet and • a lute M joe" ;ophiitM�g ealdlflon,.auiY.a am of the eoprova, ,of. the Certificate I wo be locate" is Howe en; ter akwevad pi County Daoaftinext of Maattli. ' Date J 23 � � Aadressl� APPROVED POR;CONSTRUCTIONtThMJ Depth vahme tomdred Whom FM Is aaaoleted respoesibie.for the design and location of the proposed system(s); 1) that the a crate awe • dis oats stem on tAi approvtl amabm•n•t there to and in accordance with the standards, rums an regu a one .1 • . T 11 eonsolatioii;tMiaof a - -Cartifkab of Construction Complmnir, satisfactory to the Commiss lonw of Nelthwill rittfin,juarantae wit, be "furnished the owner' his succes orsi heirs or assigns by the builder. that aid buVAW will t of said ,f6wage AMgesaf system during the period of two (2) yews Unme"iately f §IOWloD th•"ate of ter issu- Construetion Compliance of, th•,orgtnal, system or any repairs tMntos 2) that the drilled well deslu(be" a6ow wain" that said waltw111 be Install" In accordan' with "the standards. rules and r•guaiTo s of the Putnam Signed • RE. RA. L,C•Me NO Ols1ry a► t N two i ► dat u'n?j construction of the building .has been undertaken and is revocable for cause or ` y be an>M,dia or niodHia" whan_Con ry by 'ter Commissioner of Malth. Any change or alteration of construction i rpuNa a nNw� 'R. vpiova" .foe Pisposai of doeiagk ar • hat• wetw supply only. RE\T. Oele [ / I�r !r Title 1088 I I . . • I C ®G DEPARTMENT OF HEALTH WELL OWNER Name L8 Mailing Address ,Wrivate • W, 2N UeM1151 • Le{$iLZ J ® Public Division of Environmental Health Services RESIDENTIAL ® BUSINESS ® INDUSTRIAL ® PUBLIC SUPPLY O AIR /COND /HEAT PUMP ® ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify U INSTITUTIONAL O STAND -BY AMOUNT OF USE 4 Geneva Road, Brewster, New.York 10509 REASON FOR DRILLING DETAILED REASON FOR DRILLING * (914) 278 -6130 "m:,.. — - - ;,: =.;- ;:- y'':"s`•:.js;...= :-:'.: :.:;: ,. = a..:::•a%er-,�i-: a_'a's*m� ;:,,:. „s "-•. APPLICATION 4TO CONSTRUCT A WATER WELL � + - - :.'- ,:.:.::.a� :.�a;..'a =3 .._�' :'.::�;�. .:a. i WELL TYPE PDRILLED PCHD PERMIT # �� WELL LOCATION A Street Address Tam/village/City Tax Grid Number L� *NCA l fi f I WELL OWNER Name L8 Mailing Address ,Wrivate • W, 2N UeM1151 • Le{$iLZ J ® Public USE OF WELL �- primary 2 - secondary RESIDENTIAL ® BUSINESS ® INDUSTRIAL ® PUBLIC SUPPLY O AIR /COND /HEAT PUMP ® ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify U INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT_ gpm /# PEOPLE SERVED /EST. OF DAILY USAGE al ® REPLACE EXISTING SUPPLY O TEST /OBSERVATION 13 ADDITIONAL SUPPLY jd NEW SUPPLY NEW DWELLING)- ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE PDRILLED ®DRIVEN []DUG ®GRAVEL. ® OTHER IS WELL SITE SUBJECT-TO FLOODING? YES_NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: LBxIx Lot No., WATER WELL CONTRACTOR: Name Ut4YL fA M Address:— UW�N0 IS PUBLIC MATER SUPPLY AVAILABLE TO SITE: YES _ NO NAHE.OF PUBLIC WATER SUPPLY: WA TOWN /VIL /CITY DIST.ekE TO PROPERTY FRdM NEAREgf -WAfiE9 MAIN LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET (date) ( gna ure 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 othe, s conta inate surface or groundwater. Date of Issue: 19 q3 &v Date of Expiration (p 13 19_ Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller LINCA>' M Lat 8 PUTNAM COUNTY .DEPARTMENT OF HEALTH .APPLICAlI'ON'FORr APPftOVAL, NS 'POR-A WASTEWATER DISPOSAL SY�TEM`� V. Name and Address . of Applicant: L INCA?- DEVELDPME 4t co • INC - LIME J INC" 2; Name of Project: 55D5 FOR. UNCAP CEYEt PME,?�tt 3. Location T /V /c: RitNkM VALLEY CD • , Kc 4! Project Engineer: INNte EtJCaINEE t� AND DE•S1Cat���5'. Address Imo.. e'•(n WK PIA, KY, 10512 License Number 61q?)1 Phone: Ctor225"ldLoo. 6. T ..Pro ect: ; Food Service Commercial` 'Apartments I Institutional Mobile Home Park Office Building Realty Subdivision Other ,(specify] 7.; Is this project subject to State Environmental Quality Review'"(SEQR) ?. Type Status (Check One) Type I.. Exempt Type II. Unlisted 8. is a Draft'Environmental Impact Statement (DEIS) required? ..::...'...... Pb 9.; Has DEIS.been.completed and found acceptable by Lead Agency? ....... _r .... NIA 10. Name of Lead Agency l�a Leg s :fiJ�� .pray b—an xaraa.;x r— the cant ro?� s�f a ccal. 14nn g'r`- 2-2 -6 i rig f-•" .. •..':: or 'other officials,. ordinances ?. .......... :. ............................. �I.DU• PF,Pa'Ilt 12. If so, have plans been submitted to such authorities? .......:....,....... bb 13. Has prelimihary approval been sranted by such authorities ?- WA Date Granted: N�ih 14. iType of Sewage Disposal System Discharge.: :..: Surface Water X Ground Waters 1'5. IV surface .water discharge, what is the stream class designation ?........ _K/A__ !6. '!Waters index number '(surface) ........ .. ... ... ... A I7.. !Is- .project located near_ a .publ..ic. _water _supply ..system? .................. 1`i0 :8. 'if yes, name of water.supply. .. N/A 'Distance to water supply N A I 'Is project site near .a public sewage ',coll,ection or, dlspo al 'system?.... . IJO .0. Name of sewage system' Nlh+` ;Distance to sewage system 1A 'i. Date observed: UNW10wh1__ 23. Name of Health Inspector: UNK- t�lhll�_ :4. Project design flow (gallons per day)...... ............................ ft GPD 2. 25. Ism State.. Pollutant Discharge Elimination System (SPDES) Permit required ?.._ NO 26. Has SPDES Application been submitted to local DEC Office? .n........oa a D o N 27. Is any portion of this project located within a designated Town or State �t-"5 CTowA_,) wetland? ..................o......,..... 28. Wetland ID Number 29. Is Wetland Permit required? . <. ..... NDT TOA Has application been made to Town or Local DEC, Office? >..eo..00.. >...... NA 30. Does project. require :a DEC Stream Disturbance Permit? 1� 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 D DESCRIBE: 33. Is there a local.master plan or file with the Town or Village? ........... --Y 34. Are community water, sewer facilities planned to be developed within 15 years? �1D _ S:�Are any sewags_d.isposal areas, in excess . of -45.X slope ?.. _ ..,. 36. Tax Map ID Number o .......... 37. Approved Plans are to be returned to: .............. e. -- .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. % hereby_ affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the Pena l Law. SIGNATURES & OFFICIAL TITLES MAILING ADDRESS: %SLi i T�.1<EN F�1� � T►-1E �11..� D M�.P ��. 2t4 33 E3, � 1.�t� �' S ��`�� , 3 4 2 \ 4. 2 - -- - 5 L Tests to repeated'at same depth until approximately equal soil rates are obtained .at each percolation test hole. All data to' be sw--- ed 'for review. 24, Depth measurements to be made fran top of hole. rev. 9/85 7- T C -TH -3 "s,Fi Ld EL J. Name jo-j,5,1yE 4 1>E Iat-f, C-Signature Address M41 V-ouv'rs to SEA 61 THIS SPACE MR USE BY IMALTH DEPAMCM ONLY: Soil Rate Approved sq.ft/gal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH _;DIVISION OF ENVIRONMENTAL HEALTH SERVICES p+pro-....nry :; .4ias.w�..- »�+.. •- :ro''e^�.ti.4+., ... ,..:: T�-..=, q:::. i. . 1- ef-+- �=• ie. .,—.. r� :i:�:-i^'�'•".111�`.�.e:''�; �, p,,, .. Date , 3 93 Re: Property , of UNCAR MWELORMI✓t t W. INC. I Located at BIRCN HILL RD. f)f` AR (T) PLI'CMM Sec t ion_33.IL_Bl o ck Lot I5 Subdivision of LINCA? SUPS Y15bW Subdv. Lot # y Filed Map # 2452A Date -q!15189 Gentlemen: This letter is to authorize I451irl ENGIN%$ING AND rV515N PC-. a duly licensed professional engineer or registered architect (Indicate to apply fora 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 :- connect® x-:. �Gh.-: tha: s•-_ ma.tt.er,_,and_.,to._.su�ervise .t}ae..,constcton id +.7�...•r�..w,..� .. ......... ...y. -..._ � .... �.-..0 �,. s.'a. -ar• ..f- os.�.M- .- .- »....... .-•. .. .ter .. .... � ..... 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. Very truly yours Signed Countersigned.; P.E. , .$alt. _ .. ..._...�EFFREi �� � � C01JT1:,l•N�D � RE.. ..... _. -- -- - _. ... -_.. t l Iti1 QI1�ICa AND DE%O PC Address t t • C� CAF -UP1, , NN. 10 12 Telephone - ......Ad. �IttLE r��� N.d • nc�� Town. ess 2a►_44ti -4�� Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services - .'•:.: :;:,:;:s,;�_.; «,,., .�,},, -. �. n�". �I �iFF$ D" �► ViT'-"" �E) RP�flbl' AT��WIdT�R" �& R$ ��Al�.:.:::., �:;-;.,,:.;.�::-- �;: ::- ::,,c:.; having offices at W"M PERX140 11CAS Whose officers are: ° Presi dent: Donald Nuckel 281 Liberty Street L; t1 e PerrU o NT' 0 76 4-3 (Name and Address) f Nice- President: (Name and Address) (.lame and Address) M` Treasurer: (Name and Address) and fiat I am and will be individually responsible for any and all corporation with respect to the approval requested and all subsequ thereto. / Sworn to before me this day mf t ric 19-2-3 41oca:: �Fuhlic. . ARLENE FAUSTINI NOTARY PUBLIC OF NEW JERSEY M? Gerruiussson Expired June A.1996, 8:' L Sianed: Title: _ r _, (corpora to . Seal ` APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW S_ HEET_ for CONSTRUC IO PERMIT NAME OF O ERA /L�,.' - ST i2EE f LO� TT N (/ �:,:. BY DATE (O � TAX MAP # DOCUMENTS. Y� 1 LPERMTT APPLICATION I-PC -1 WELL PERM: IT; PWS'LETTER i'ENGINEERS AUTHORIZATION DESIGN DATA SHEET(DDS) -DEEP HOLE LOG CONSISTENT PERC RESULTS (3) ,PERC HOLE DEPTH ,CORPORATE RESOLUTION CLANS THREE SETS MOUSE PLANS - TWO SETS VARIANCE REQUEST GENERAL 1JEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED PERC RATE FILL REQUIRED DISCHARGE (OK) [UPERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY AND EXPANSION XP. AREA; SHOWN; GRAVITY FLOW, SUFF. SIZE PUMPED PIT & D BOX SHOWN & DETAILED - NO. OF BEDROOMS WELLS & SSDS'S WAN 200 FT. OF PROPOSED SYSTEM METES & BOUND ILLJ HOUSE SETBACK NECESSARY (TIGHT LOT) VFILL SE SEWER - 1 /4 "/FI. 4" 0; TYPE PIPE ENDS; MAX. BENDS 45 W /CLEANOUT FILL SYSTEMS BARRIER HORIZONTAL: SLOPE 3:1 TO GRADE SPECS H GAUGES PROFILE & DIMENSIONS i CURTAIN DRAIN REQ mSTANDPIPES TRENCH EX- PROVAL SSDS ADJ., LOTS MLF TRENCH PROVIDED LAND (TOWN/DEC PERMIT R & D) 0 FT MAX �DATA ON DDS PLANS & PERMIT SAME PARALLEL TO CONTOURS ,PRE -1969 -NEIGHBOR NOTIFIFICATTON 911100% EXPANSION PROVIDED LETTERBUZBA I SEPARATION DISTANCES SPECIFIED ON PLAN °100-YR. FLOODELEVATI0�1 = -- -DSV WIRED DETAILS ON PLANS 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL -SEWAGE SYSTEM PLAN - (NORTH ARROW) 20' TO FOUNDATION WALLS -SSDS HYDRAULIC PROFILE m GRAVITY FLOW 100 TO WELL, 200' IN D.L.O.D., 150' PITS D/ J BOX M TRENCH/GALLEY m P- PIT DETAILS 100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) SEPTIC TANK - SIZE, DETAIL 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER WELL DETAIL, SERVICE LINE IF OVER 10' TO WATERLINE (PITS -20') CONSTRUCTION NOTES (GRINDER RATE) 50' INTERMITTENT DRAINAGE COURSE DESIGN DATA: PERC AND DEEP RESULTS 200 FT. RESERVOIR, ETC.QD 150 FT. GALLEY SYSTEMS TWO -FOOT CONTOURS EXISTING & PROPOSED SEPTIC TANKS. DRIVEWAY k SLOPES CUT m10' FROM FOUNDATION; 50' TO WELL FOOTING/GUTTER/CURTAIN DRAINS WELL E015' WELLTO P.L: COMMENTS: Ilk r +! �. - �� �•^ M r ;rte �;: PlAr Vi r• _ ��' I' �_ ._ ��.._ = iinl °''�' '�y.i , 4j�t - +'s.�. �'y, c:�i�'Y'- ;a.,�t� ��``� = -J�� � ;�'� =L "` � eL��•x� �i;ii� r =u r-- ;h�� ,- ,:�+�` , L'M� THE �s �j -r SDALE 11 48" First Floor 010 0:0 KITCHEN 1 BREAKFAST I 12' -0"x 11_ e-IF X IS W T)TTARTMEM' CIF 11E.A10 ? a il`. N F PPRIMT—T-11,; FOR P 'OP _ 13' -0° DININ 9_ x 'G X 4� (.1 e 27'8" X•48' • 2656 Sq. Ft FAMILY �0910 20- 0 X 13 -0 : I' �\ 11 te 48' VING Roofs 19'- 9. X 13'- 0" 27'8' 27'8' t STANQARD. SCARSDALE 11 FEATURES • 4-Spacious Bedrooms • Framingham Pediment on Front Door • 2%z Baths • Fireplace Options Available • Open Two -Story Entry Foyer • "Boxed-out" and "Angle Bay" Options i I • Formal Dining Room Available • Formal Living Room • Consult an Authorized Westchester Builder i • Spacious Country Kitchen with Breakfast for a Complete List of Options Room and Pantry • Artisrs renderings and Floor Plan Dimensions are • "Cottage-Style" 3056 Lower Level Windom approximate. All specificadons ffwt be Witten In ft Contract No oral condiftu. with Architraves on Front 56N ESTCHESTER MODULAR HOMES, INC. P.O. Box 900 • Dover Plains, W 12522 (914) 832-9400 - (800) 832-3888 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date ?A -T7 Re: Property of LANCAg Located at (-"Odic (T) ForwmA VAj-L-cY Se c. tion 7:3. LE> Block I Lot A 15 Subdivision of L_WC_A.?_ I. 5t4j3P1Vj�lOVA Subdv. Lot # Filed Map .# 2A33 ,&, Date q .S IM Gentlemen: This letter is to authorize- Insite Engineering & Surveying, P.C- a duly licensed professional engineer x ( Indicate) to apply for a Conistruction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promu'laga.ted by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in -his 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. Countersigned:,., Jeffrey J. Contelm P. E. Yx.*Y, # 61931 In'site,Engineering & Surveying, P.C. Td-dress Route 22, Brewster, NY 10509 278-4990 Telephone Very t Signed 031 Address L-i ME F69PM W 1-7 0 4- 3 Town I Telephone INSITE-0 SUENGINEERING & RVEYING, P.C. v ouTp 22� �• `.;: - _ 914 ,278-499P grewsfer, New'ir:ork 10509 " ' " "�e'e 91'4 ;278-6392 - 7 DeLavergne Avenue (914) 297 -1742 Wappingers Falls, New York 12590 TO: p6t( LETTER OF TG°3QNSW` TAT Q9T t�4 � �..- JOB NO. , _ . • .. _. � -•q l ArrEN,not4 Ro b mo/e R 15 RE: SS ti5 R ❑ !Copy of Letter ❑ Change order ❑ WE ARE SENDING YOU Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ !Copy of Letter ❑ Change order ❑ ❑ Samples ❑ Specifications THESE ARE TRANSMITTED as checked below: For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS: COPY TO SIGNED: 11 enclosures are not as noted, kindly notify us at once ... InsHe En.gineedng A, Design, P.C. 1849, Rt. 6 Carmel, NY 10512 Phonez (9.14) 225-6200 . 9.�f4j.,225,-0430_.- _F4x:L EIRMIIMM0111079*112 L LIEVVIE12 OF IrMARSEOVURL I JOB No. DATE tohl ■01;1-9 > WE ARE SENDING YOU )6OAttached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑- Samples ❑ Specifications C] Copy OfL letter ❑ Change order ❑ COPIES DATE No. DESCRIPTION For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted i z3 A13 copies for distribution CO . ��A_%CtION FE FM I t A-PPLA MIt 10 0 ❑ Returned for corrections /3/T3 prints Or- P0th6TjZAjVW ❑ I Ar-FicAva or- cor-PoFA m ovojeg�64+9 _19--0 PRINTS RETURNED AFTER LOAN TO US Wr-�LL it APPLACA-h& * am.00 r-EF, (AA&T 0?cf-1 REMARKS COPY TO S I G NED It enclosures are not as noted, kindly notify us at once. T—*� TT D as checked below- tHESE'A'C" RANS I t For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution > ❑ As requested ❑ Returned for corrections ❑ Return —corrected prints ❑ For review and comment ❑ ❑ FOR BIDS DUE _19--0 PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO S I G NED It enclosures are not as noted, kindly notify us at once. i T .t+sf.�. ... writ ..a .-. ... .. +it.e++.._, _.. ..rn, :.� i .`+ . �.�_. z -.. ':�� . �•.'.++E��e�s •ni �.:v.0 .. :m,•c . -- _ . i. a..)f`«��:�r..E+c':. �i;.r.. - -::v ...s; -�+ , LOT 8 AREA ?.436 ACRES f i 13 12 t1 10 ! o 5 4 3 2 R.66; 1 A. `\• 9 8 7 6 ?lAR COUR T p o S 79,40 ,00 Vd merly Lincar Lane) g �' 191.69. i LOT 9 THE DIRECTION ALA 77 ON OF N -LAW, i I, Y 3 `f ' F k"W _ ms`s , t3" x� C Y C K ++ J ,47` Y � v 4 . h �f `�"• - Sf � � �t ?'•F"' .R "� l :. '�� Y�£ 0 .Y R � iy .��� u�- Y 9 - p q ' ., :{fly k •-4 '`hxY `'e `d: .h i ! + W ,)) Alf . 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