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35. -5 -16.2
BOX 16
17-2 r 1611M r
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Km 1
01803
ALLEN BEALS, M.D., J.D.
Commissioner of Health
RODERT -1 o=, S;-P:E. 3vgPH .�
Director of Environmental Health
October 6, 2014
Patricia Galgano
541 East Branch Road
Patterson, NY 12563
Dear Ms. Galgano:
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Phone # (845) 808 -1390 Fax # (845) 278 -7921
Re: Addition — Approval — Galgano
No Increase in Number of Bedrooms
541 East Branch Road
(T) Patterson, T.M. 35.5 -16.2
MARYELLEN ODELL
County Executive
This Department has received and revieved 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 October 6, 2014. The addition is approved with the
following conditions:
1. The existing SSTS has been upgraded to four bedrooms by replacing the existing 1,000
gallon septic tank with a 1,250 septic tank. The existing 500 LF of fields. are now large
enough for four bedrooms based on new design flow of 150 gallons per day per bedroom.
2.--- The total number of bedrooms must remain at four without prior approval by this
3. The area of the existing sewage disposal system and its expansion area must be
maintained.
4. All plumbing fixtures must be updated with water saving devices, i.e., new low flush
toilets, restrictors for shower heads and faucets, etc ...
5. The approval is for the modifications only and does not validate any construction shown
as existing that has not obtained proper approvals from other agencies having
jurisdiction.
6. This approval is valid for two (2) years and expires on October 6, 2016.
Any permits or variances required under the jurisdiction of the Town of Patterson are the
responsibility of the applicant.
If you have any questions, please contact me at (845) 808 -1390 ext. 43157.
Respectfully,
Jo eph S. a�ravati,
ssistant Public Health Engineer
JSP:cml
cc: BI (T) Patterson
SHERLITA AMLER1- MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner. of Health
't!ERBONDI
XTJ.
ounty Executive
D.
ROBERT MORRIS, PE
Director of Environmental Health
..DEPARTMENT OF HEALTH
I Geneva Road..Brewster, New York 10509
ADDITION APPLICATION RESIDENTIAL ONLY
STREET TOWN 4n:
TAX MAP#
5
NAME PHONE -7- PCHD#,,'A':§
MAILEVG
ADDRESS
DESCRIPTION OF
- ADDITION 3 -/,1
NUMBER OF E)aSTING'13EDROOMS &PROPOSED #.OF BEDROOMS
(FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR)
"Any addition which-is considered a bedroom requires formal approvafof plans (Construction permit) prepared by
a Professional Engine;Dr or Registered Architect in accordance with applicable sections of the Putnam County
Sanitary Code.
Please submit - leis fdrm 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 $100.100,
(drawn.'to scale,. all. living- area including base ment,to be.
shown and dimensioned and use of each room -specified). (See Section 3.c of Bulletin
HA-1)
Two sets of proposed floorplan.s (drawn to scale = with name, street And tax- map
Non'-professional -sketches are acceptable and preferred. (See Section i * 3.d of Bulletin
HA 1)
Copy of survey, showing -all well and septic locations on, the subject property ' to tie best
-
of your knowledge.. Include date of installation known. Contact this office with any
-questions..
.5. Copy of Certificate of Occupancy an' from the Town or Certification from the Building
.
Department with legal bedroom count of 'dwelling. .5
OMC8 USE
COMMENTS
5.
Environmental Health (845) 278 =6130 Fax (845) 2.78-7921
Water Supply Section (843)-225-51-86 Fax (845)225 -5418
Nu ' rsing Seryices (845) 278-6558 Fax (845) 278.6026
Nursing Home Care Fax (W) 278-6085 WIC (845) 27&,6678
Early Intervention f Preschool (845) 228-2847 Fax (845)'22.-5-1-580
' D' ,
M ,
SHERLITA AMLER, MA MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Co mmissiongr of Health
DEPARTMENT OF .HEALTH
1 Geneva. Road. Brewster, New York] 0509
ROBERT J. BONDI
County Executive
.ROBERT MORRIS, PE. -
Director of Environmental Health .
Town Legal Bedroom Count & Proposed A.dditiod Status.
Re: (Owner's Name)
Tax Map' #
Address:
Town: ,--�r'e
Year Built:
According to records maintained by the. Town, the above -noted dwelling;
is - in. compliance with Town. Code.
Is not in compliance. with Town.Code,
"The Legal Bedroom Count is:' '
This_inform"ation has been obtained' from:
Certificate of Occupancy: 1/
Other:
The.plans for the proposed• addition are considered:.. r
New Construction
Addition to existing hourse :only
Teardown and/or re =build allowed under Town Regulations
- ..........:.10rt-t-jjdjng4g $ _ _ _or Pate.
6.
Environmental Health (845) 278 -6130. Fax (845) 278 -7p21
Water Supply Section (845) 2.25-5 f86 Fax. (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278 -6026
Nursing Home Care Fax (845) 278 -6085, -WIC. (845) 278 -6678.
Early Intervention % Preschool (845) 22$ -2847 Fax (845) 225=1580
s
A
� `i 1 F .c3Yan can 1? D
. �A�12�S acv ivy
0
TENTIAL
BEDROOM
Room
.s
o
t :OUN Y DEPARTMENT OF llf,,Ai.i � ]
.&P[11 ?OVED FOR EEDROOM COUNT ONIA,
ell
B Q
P,EVISIONIALTERATIt'N5 TO THESE EIW SE
tm:Y ' BE SUENITTED TO THE PCDOH FOR APPROV.ikL
foll
ffPt
DATY, 4- VIuwa�Y � -�
C LOSE i
do /o of
M -a )" Lever
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86 PiJTN COUNTY' DEPARTMENT OF HEALTH °
Division of Environmental Health Services, Carmel, N.Y. 1.0312
+ : rEngtneer Must Provide :?
'P.C.H.D. Permit N —
w
CERTIFICATE OF CONSTRUCTION COMPi.IANCE FOR SEWAGE DISPOSAL SYSTEM
ToSto�or Village
Located at •�< - r ' 9�/vJr' f ` R.. Tai Map—,35 Block Lot "
Owner /applicant Name E�°294.:�A: 6 ,' - Formerly Subdivision Name '!17 Sabdv. Lot M
Mailing Address n 1 ` / '< c C- ZIP Date Permit Issued
Separate Sewerage System built by '�• ^ ` t'T !f �r Address -J f 'x'
Consisting- of '^ < Gallon Septic Tank and
Water Supplyt Public Supply From /2/"—'- Address
ort �' Pdvate Supply Drilled by . fit r tr r rvc . 4 Addresa _ R, 7-A/
117'.' �'/\ r �L`
Building Type > `'�' r l Has Erosion Control Been Completed? " ti,�
+i
Number of Bedrooms Has Garbage Grinder Been Installed?
Other Requirements
f
I certify that the system(s) as listed serving the above premises were constructs essentially as shown on the pans of the completed work ( copies
of which are attached) , and in accordance with the standards, rules and regal °ti na, in acco dance ith the f' ed pla , the permit issued by the
Putnam Ccupf<y Department OF Health. f
I a
Oats L~ f y Cortiftod by T `' P,E, R.A.
Address 1 1111 k i[:ck ! :'.-',. ";'(^ " � '] i(' • t ��{tY 1�� J i `�f:"'�{ License No. .Y�1?`!
Any person occupying premises served by the above systems) shall promptly take such actiot(as may be necessary to;,secure the correction of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage system shall becogio null and void as soon as a pubs': 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 Commissioner of HeN)th, such revocation, modification or change is necessary.
By Title
f
l
f
i
i
-__- IC
L31 J-�rie-r (5 kerl
------------------
fataam County Deprinsent ofEwa
Df*hd 4 of i# viroaseetell lSlervices
SETS R10"dr — Final site Mapoctlon
Date: 9 :L ��,i `o do
_-
-i- 'Ft-�s a� c_i�.� Owtm�t:
f �
Town: Iie,r��, Repair !unit #:
1. Type of 3ysbut: Conventional Aitera me ® Comments:
2. Am
Yes Y No
I N/A
I Comments
L Sepic tank sin® —1,000 1,250. . othm ..... 11
4--
e ..
b. Septic tank Installed loyel......................
/J.
I
C. 10' ti+om Undation ..................
d.
L All omlots at same elevation ( ) .. .
ii. Ptotebied below Bost ....................
W. MW=m 2 ft. Original soil between Doss &
e. sat ....................... ....
L ate for on
il. LAnob ie*z d Length
M cheelced
iv. instilled awor&% to plan .....................
V. 10 ft. flom property line —20 ft - foundations ...
A Sian of gravel % - l diameter clean .........
::... _ ._ .. vil. 4f gravel in trench 12" Rtiaimm ..........
- -
IL
3.
a as ved plans
b. a.
L conrsa/wadsmds
4. 0"110 .
L Boxes pwpuM grouted and installed correctly ...........
b. All pies Melt with inside of boss ..........................
c. BadM material contains stones <V diameter .........
d., Curtaim drain &standpipes installed according to plan
o: Curter drain MIMI protected & dir to exist watercourse
f. hooting drains discharge away from SSTS area .........
' g. ErosioC control provided ............................ .
Additional Co=ef ts:
IiFSI Rev- 011312
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR
YE NO Internal Use Only PERmrr #
❑ Repair Permit issued in last 5 years ❑ Ot In Watershed
❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. Nd Delegated
❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review
SITE LOCATION Sqi EAst i3eRAg4 I:I' TOWN PgTmRsoty TM # Z .
OWNER'S NAME PATRtc iA CALLAN O PHONE # SqS °41.14 -3`I0• =P
MAILING ADDRESS f o . bgr, Q'I —k3reLu i e-,r N i 1015o
APPLICANT . PATRICIA rkLC -AN y OW NSK
Name & Relationship (i.e., owner, tenant, contractor)
DATE s��l'�s I FACILITY TYPE //0 "e PCHD COMPLAINT #
PROPOSED INSTALLER �a� PHONE #
;
ADDRESS 37 1� e �rm L gam/ REGISTRATION /LICENSE # A�-A /. -13
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.
I, as owner,agree tot a conditions stated on this form
SIGNATURE TITLE OVACr. .DATE 31181
(owner)
- -t, the - septic installer; agree to. comply with the conditions of this permit for the septic-system repair
SIGNATURE LIv4 TITLE -, ;hA #V DATE
(installer)
PrOlDosal aDDr4VLh the foowing conditions:
1. Procurem nt 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.
iN t ERNAL USE ONLY
Proposal Approved Proposal Denied ❑
eo
�-/
Inspector's Signature & Title Datd / Expi ation ate
Repair proposal is in compliance with applicable codes Yes No O
COPIES: PCHD; Owner; Installer
PC -RP 99ML Rev. 2/07
Rev /86 PUTNAM COUNTY :DEPARTMENTOEHEALTH s Y
Division ii Eovlronmental Health Services, Gi mel, N;Y 10512-
EngLseer Maat Provide Q
P.CH D PermitN r!
CATE OFXONSTRUCTION COMPLIANCE FOR SEWAGE.DISPOSAL SYSTEM r.AA r
Village
Locatm at,-:
t ax Map 7B4O6i -_b� _Lot 9.
OwnerlappUranl Name - Formerly Subdivision Name Sabdv. Lot N �--
ou
r
MaUhtg Address__ z =—� 1 „'��s Pp , . Date Permit I.sisiped —
D.
Separate;Sewernge Syetem.:bullCby1� �( Address C7T�
Consisting of food Gallon Septic. Tank and�j/GHES
:2^9 Lr.
Water Supply= PubUc Supply From Address
or: Private Supply Denied byQ%�� ��fO �oi�G- AddressTQFi:iS'T? A7
Has Erosion .Control Been Completed?-. P S
Bwmwg Type - --�- --
Number of Bedrooms a Has Garbage Grinder "'InstaUed ?'-
Other Requlmzuento
I certify thet,.the,ayatem(s)•as .listed serving the above prem Use e,.were conatruc essentially as shown on the ans of the completed.aork ( copies
of which are attached)," in eccoidance` with -the standards rules and raqul 1 ne in.accC"d ce ith the f d p1 d the permit 'issued by the
Putnam =Cou Department O! Health
p.E.� a.A.
Dab 1 •.! .S_( by
Ce►tif
Addresi' License No. <
Any person occuDyinit premises w44d by. ;0 above' fysterntq shall, promptly. take sues actfo �s may be necessary to secure the correction of any unsanitary
conditions_ resulting from such usage - Approval of the feparate sswerage system it ail become null and void as soon is a pubs% sanitary awar 'becomes
available and this approval of the,;priwte water supply shali;eecome null and-vold whin a ,public water 'supply becomes available.' Such approvals are
sutijoct.•to modification or change'when,, ii+ the, judgment -.Of thil 'ComMlssiohar ai , su'eli'rw tIon. modNication or change is necessary.
Dates a B .. Title
Title
CQ
WELL UUMFLE*11UN KrxuNl
DEPARTMENT OF FEALTH.
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
`STREET
WELL LOCATION
ADDRESS: wNrVtL I TAX GRID NUMBER:
EAST -BRANCH ROAD P A TTE R S 0 N', i -N
WELL OWNER
_,%.
NA�- ftf .�qq S:
rod Rock, 15 Rhodes, Ne�,q F-toMellej NY 1 10 � C"), 0 1 ,[E]
FBIVATE
❑ PUBLIC
USE OF WELL
1 - primary
2 - secondary
=8ESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP 0 ABANDONED
C3 BUSINESS ❑ FARM 0 TEST /OBSERVATION 0 OTHER (specify)
C3 INDUSTRIAL 0 INSTITUTIONAL 0 STAND-BY ❑
AMOUNT OF USE
YIELD SOUGHT a gpm./ NO. PEOPLE SERVED EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
❑REPLACE EXISTING SUPPLY ❑TEST/OBSERVATION ❑ADDITIONAL SUPPLY
)fiyEW SUPPLY (NEW DWELLING) DDEEPEN EXISTING WELL
DEPTH DATA---:
..i. 1. .
WELL 6EPV,
-viG Aft.
ST' IC W4TEFfttkC
AT
DATE MEASU ED
BATE
DRILLING
EQUIPMENT
❑ ROTARY X 0 DUG
, ,COMPRESSED AIR PERCUSSION
0 WELL POINT 0 CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED 0 OPEN END CASING ;U:QPEN HOLE IN BEDROCK 0 OTHER
CASING
TOTAL LENGTH I Lam__
MATERIALS: XMTEEL ❑ PLASTIC 0 OTHER
LENGTH BELOW GRADE ft.
JOINTS: 0 WELDED XQ/1(THREADED 0 OTHER
DETAILS
DIAMETER —in.
SEAL.-)U CEMENT GROUT OBENTONITE OOTHER
'WEIGHT PER FOOT lb./ft.
I DRIVE HOF—AYES ONO I LINER: DYES ONO
DIAMETER (in)
SLOT SIZE
LENGTH (it)
DEPTH TO SCREEN (it)
DEVELOPED?
SCREEN
FIRST
0 YES. -O NO
...DETAILS
SECOND
HOURS
GRAVEL PACK
❑ YES
0 NO
GRAVEL
SIZE:
DIAMETER
OF PACK in..
70P
DEPTH ft.
BOTTOM
DEPTH h.
WELL YIELD TEST. ► If detailed pumping
METHOD: 0 PUMPED 1 tests were done is in-
/[COMPRESSED AIR lormation attached?
0 BAILED ❑ OTHER ❑ YES C3 NO
It more detailed formatkon descriptions or Sieve analyses
IWELI LOG are available, please attach.
DEPTH FROM
SURFACE.
Bear-
ing
D'a
meter
In
FORMATION DESCRIPTION
coof
WELL DEPTH
It.
DURATION
..hr. min..
ORAWOOWN
..It..
YIELD
. .....
,an,
S.rfa.
96
Hardpa boulders
n
96
9, 3
'e& '6d 16d-gt-
BrcMn W ,elll
1301�
Ta-r `ogrey bldc� grTate
CID+
WATER = CLEAR TEMP.
QUALITY ❑ CLOUDY HARDNESS
0 COLORED ANALYZED? &YES ONO
ANALYSIS ATTACHE M. YES ONO
STORAGE TANK: TYPE By O,f"IL;Rs
CAPACITY GAL.
PUMP INFORMATION
TYPE
MAKER
MODEL
CAPACITY
DEPTH
VOLTAGE — HP
WELL DRILLER NAME
Mill DrillIng, Inc,
ADDRESS 3 jGt -4
-Avenue
putricui
B rew ster, NY R t res fdeh,_
3/89
TARLTON ENVIRONMENTAL LABORATORY, INC.
A. Division ..of..lYoriheaxUaboratories; 4inc..,. ., - -.. CT Gent: -
DANBURY: 39-3 MILL PLAIN ROAD - DANBURY, CT 06811 and PH -0606
L"s BERLIN: 129 MILL STREET - BERLIN, CT 06037 NY Cert: 11471
LABORATORY REPORT -- WATER SUPPLY TESTING
REPORT TO:
MILL DRILLING, INC.
PUTNAM AVENUE
BREWSTER, N.Y. 10509
DATE SAMPLE COLLECTED: 3/14/96
TIME COLLECTED:
10:10 A.M.
COLLECTED BY:
RUSS
DATE RECEIVED @ LAB:
3/14/96
DATE(S) TESTED:
3/14/96
TESTED BY:'
LAB#PH0404
REPORT DATE:
3115196
SAMPLE SITE: BJR CONST. CROP., (BRAD ROCK, EAST BRANCH RD., PATTERSON, N.Y.
SAMPLING POINT: NOT STATED
SOURCE: WELL- DRILLED -NEW
TREATMENT: NONE
-TEST PEIiFORiiTED - RESULT: RECOMMENDED LIIVITr
BACTERIAL:
Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml
CHEMISTRY:
Chlorine Residual * mg/L - - - --
m1= milliliter
mg/L = milligrams per Liter
ND = none detected
RESULTS BASED ON SAMPLES SUBMITTED:3 /14/96
SAMPLE, AS TESTED ABOVE: IMPOTABLE or OINOTPOTABLE
(PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER)
*BACTERIA SAMPLE COLLECTED IN A SODIUM THIOSULFATE BOTTLE.
/*7
CT: DANBURYAREA (203) 748 -7903 - FAX (203) 748 -0652 - CT: NEGVBRITAIN/HARTFORDAREA (203) 828 -9787 - FAX (203) 829 -1050
TOLL FREE WITHIN CT: 800 - 826 -0105 - OUTSIDE CT: 800-654-1710
LAURENT ENGINEERING
ASSOCIATES, P.C.
;. -:._..... ... c ._. " :aMMILLBROOKE OFFICE CENTRE
Route 22 & Milltown Road
Brewster, New York 10509
RANDOLPH W. LAURENT, P.E. (914)278 278 -2658
HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS
May 15, 1996
Putnam County Department of Health
4 Geneva Road
Brewster, NY 10509
ATT: Mr. William Hedges
RE: Individual SSDS
East Branch Road
Patterson, N.Y.
Dear Bill:
Enclosed are the following:
1. Four (4) prints of Drawing S -1, "As -Built Plan", dated 5- 15 -96.
2. "Certificate of Construction Compliance for Sewage Disposal System ", dated 5- 14 -96.
3. Three (3) copies of "Guarantee of Subsurface Sewage Disposal System ", dated 5- 13 -96.
4. Well Completion and Well Log Report,_date4.12- 12 -95._
5. ":Laboratory Report - Water Supply Testing ", dated 3- 15 -96.
6. Money order in the amount of $200.00, payable to Putnam County Health Department.
If there are any questions concerning the enclosed, please call.
Very truly yours,
LAURENT ENGINEERING ASSOCIATES, P.C.
P6
Harry W. Nich r,Jr., P .E.
HWN:DJ:bd
94077
enc.
cc: Mr. P. Savarese
3- T T. 7-P,
e
p2 1 r
er aE nA =Jua
F-A,S 7- 8WA �jo t4
Yi•'„^. tiQn - Street
-0
7i� aL
c Zia T-ty
,<-IIVV 77/al-
B1, Ty�
D>` APJMEtrX OF HF T S
V -a-
Section 11crt
S.)bdiv4,sion Nc.7c
uhavisicc Lot
I Ze.ores8nt that 1 am wholly and- xesprnsible -I"Ox th"a lo�tiCmr
raiage of the disposal system
0 rl an n
r tV, Z%: -1 t-_ha4- it haS-beer- ConStXUCted as S4CWM'M
�-hc above
ttls appr.�;Ivcd plart or approved artenamerit ti-cretc.), arid ,.n accordance with the
rules and regul.ations of the. F,-•ki-navi County rep&rbrezt 0f Realtb, and
-1y guarantee to t-he cwn<---x,- - M.- -1 hei-
rs or assigns, to place in -g6cA
operat.irig condition part of mid systpzn constru--t6d by m wbich fails to
for a Of two yaa , fc-,C-Inwing tine dates O� aWroval of the
cert if J. Cate of L:onstructiorj C-c!mpl5ancel fcz. th sewage dLsposal Sysbem, or 4�!u
s T) to system, except. ,e fallue to acetate properly -LZ vtr
the systim•
Ube e-etemwzlatioa-
Of 4-t,.C-
Z-er its ces of the Put.-I= CoLuity
t PL�S., ( t t!.e n O OOP-Xat e
Iv tl-pa wl".1ifful cir act building utilizing
t-be nwstem.
this aa
L
cr-,nt -actor CDr-rye-r)
c
ddress
/'I ( 40 p c ('L u< ( cl cc/
)-,sv. 9/85
Trk-
/-j - / , I/ j -? �.
Q/X G C) 6 iOD
ems
..*- .F.'.,+, so---,. .,...•.a.+� +.,�.,.......�..�,. .._.�... .�r -. v' t`z c-x, - w.x,,'.= "°'�;x •,'�s-r:�,., ._- a-,. -y -;!s T.shi?rffm- '.'•"S "Sw"...`� 7__`_�'''' ^y-'`- r"v^T-"'-�rt-•'6 vv-Txe,.,��...
• _ $ f o! Iffia'�vBwa: sl�aa: Y81Y. &Q69B eo v x- CATf$
a-,, r moa_ 0 Revum 0 '
aA 'n l , " 9 I 1 f 11 Dab d Proyhmo APSOVIA
/. It q-Gje4 lKidA !A PQL-F 0 p Town �
,nrnt7aA 1�7J ! . FPP F.nrl ncPri'� e,,,.,,,..r
1 represent that I,am wholly;and.completely r(
above deacribad will be constructed at shown,c
County Dmpartmrwlt of Health. and that on.
be submitted to tha .Departll'ldnt and. a : Wri
piece In good o�riating corii9ition anV.,part
DIIC®1 of the approval, of thai'.C®!timato .of: 't
will Do, loested as shown on the oopfoved plan
county Oopertmti nt of Obmltii.
Date'.lS``_
_ - A.)
onsiblo for the detigr
he approved amends
mpletton tliaiaoP is is<
gtlaiantoo will 00
oid dispos
atri ction _Complies
that slid yell ariil.b,
APPROVED FOR CONSTRUCTION: T1011 approval as
revocable for Clause or may, b0 amdnildd'.or maidifled'A
Rev.
requires e . permit. Approvcd''foi dispotal of d
10/88 oat®
two years
16 location of the proposed systam(s)1 l) that the separate wwage. disposal system
,t'there to and in. accordance with tho standards, rules a regu Ions o • nam
iif,cafo. of- 6oristruction Compliance" satisfactory to the Commissioner of Moslthdrill
rnisfioo tno ownw, his succo ears, hairs or'asslgns by the buiklcr. that said budder will
systdM during the -par I" of two.(2) Vows imnla,ztiatoly, folloahng the date,of the iwu-
of th, erisim, skit l or any repairs tho7 o; 2) that he drilled walI doscribed above
istal in' ocoordawoD •with standar ru saw r®gu ens of the Putnam
P.E./ !! ��R.A4.
License No 4102:4
om the .date issued unless construction of t t( building .has boon undertaken and is
CeEedUy by the, Commissiotlor of Health. Any change or alto7stion of construction
swage, an r–pN at r supply only.
Title���y �—
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
APPLICATION' T0- CONSTRUCT A- WATER--WELL" -- ' .. - .1 t 7
PCHD PERMIT #
WELL LOCATION
Street Address
W
own V llage City
Tax Grid Number
-s—• 6a z
WELL OWNER
Name
Mailing
Address
' t /��%` .�
JaPrivate
. e. 0 Public
USE OF WELL
(I' primary
2- secondary
RESIDENTIAL
0 BUSINESS
0 INDUSTRIAL
O PUBLIC SUPPLY O AIR /COND /HEAT PUMP 0 ABANDONED
O FARM O TEST /OBSERVATION 0 OTHER (specify
U INSTITUTIONAL O STAND -BY 0
AMOUNT OF USE
YIELD SOUGHT
gpm /#
PEOPLE SERVED /EST.
OF DAILY USAGE ..... ,gal
REASON FOR
DRILLING
E] REPLACE EXISTING SUPPLY
5kNEW SUPPLY NEW DWELLING
0 TEST/ OBSERVATION y
0 DEEPEN EXISTING WELL
12-ADDITIONAL SUPPLY
DETAILED
REASON FOR
DRILLING
S
WELL TYPE
�- DRILLED
DRIVEN
E]DUG
O GRAVEL
0
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDI Iwrl N, NAME OF SUBDIVISION:
n �� —s� lf t�s) Lot No.
WATER WELL CONTRACTOR: Name =2122 Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE.TO.PROPERTY_FROM NEAREST WATER MAIN:. - -
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
'M ON SEPARATE SHEET
(date) signature)
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• Z C2 19
Date of Expiration 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
a
First Floor
X
MASTER BEDROOM
14'.1. X 13'- O'
— 40'
DINING ROOK KITCHEN
W —O'X W -O, CIE' =LAX 13' —O' \Y`(
VP
27'8
r�
- 4 ~
LIV.IHG ROOM
J
141- 0,X 13' -O'
STANDARD NEW FOUNDLAND FEATURES
• Luxurious First Floor Master Suite • Fireplace Options Available
• Compartmentalized First Floor Bath with • Consult an Authorized Westchester Builder
Tv✓o Separate Vanities for a Complete List of Options
• Formal Entry Foyer . Arist's renderincs and Floor Plan Dir.-tensions are
• Formal Dining Room approxir-.a;e. AII- sr-eciftations must t�,_ Writ-,en in ;he
• Formal Living Room PUTNAM COUNTY DEPARTFIE4+l:izcl9FN4MAL izjons.
• Spacious Eat -in KitchgRUSE PLANS APPROVED FOR
BEDROOM COUNT ONLY;
Sigreture & Title (Date
in
LAURENT ENGINEERING
ASSOCIATES, P.C.
.... .. ,..: ,,,._- ........_ _ ,..�'�: -•:, .__— v... - � - .. „MILLBROOK�OFFICE CENTRE•, ,,,_ �„« _� .___ ..... :« - .. - � _... ,...
Route 22 & Milltown Road
Brewster, New York 10509
RANDOLPH W. LAURENT, P.E. (914)278-6108 - (FA)O 278-2658
HARRY W. NICHOLS JR., P.E. in CONSULTING SITE ENGINEERS
August 15, 1995
Mr. William Hedges
Putnam County Health Department
4 Geneva Road
Brewster, NY 10509
RE: Individual SSDS
East Branch Road
Patterson, N.Y.
Dear Bill:
Enclosed are the following:
1. Three (3) prints of Drawing SS -2 "Proposed SSDS - Lot 2 ", dated 6- 30 -95.
2. "Application For Approval of Plans For a Wastewater Disposal System ".
3. "Construction Permit for Sewage Disposal System ", dated 8- 15 -95.
4. "Application to Construct a Water Well ", dated 8- 15 -95.
' 5. "Design Datd Sheet
6. "Letter of Authorization ", dated 8- 14 -95.
7. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only ".
8. Money order in the amount of $300.00, review fee.
We would appreciate your review, approval and issuance of the Construction Permit at your
earliest convenience.
Very truly yours,
LAURENT ENGINEERING ASSOCIATES, P.C.
Har W. Nich Is, Jr., P.E.
ry
HWN:bd
94077
cc: Mr. A. Bijou w /enc.
FOEOTERIC
iULi- 14- 24 RM N
TO 19142782bt)U r1. 0�
)?UT;VAM COMITY DE.PARTnmr of HEALTH
DIVISIO14 OF SNAVXRO-NMIENTAL HEALTH SERVICES
Property
i
Located at
(T -Bloak-5- Lot
Subdivision of 04
,-1ubdv. Lot
Filed Map # Date
Gentl men
This 16tter is to alzthorize— LT.
..a duly- 13.qOnSO4 prof essidnal engineer X or registered architeet
(1-nd4ea is e)
to al to
slsxve supply for a Constrtzetion Pernit for a Separate -seuraqesylstem,
the above noted
property in accordance i-iith the standards•, rules,
or ri�ula't ions., as prozaulagated by the Cos-n-vissioner of the Putnam County
Do ar�tmexx of Realth', and to'. sign ill.rxficessaz•Y -da-pe.-&-q In
conaectioA with this matter and to supervise the construot-ion 1Df said
systen, or systems :Ln.r,'onf rmi'y with the provisiolls of Artie-le 145.__P
147, education Lmir tb-e_,Pub1;io HealNth Later, and the Putnam Couxit} Gani-
tary Code.
Couixterui&-ne
mc 1�2
Millbrooke Office Centre
I
Address
Brewster, NY 10509
Very truly yoxxrsf
Signed
Address
��� il� /3 7j
Totm
. 719- 6V--f2f I
Telephone
0
TI1TC1 D MD
e
��CJTJTAt -:C GOXJN TX
3DEPA '_'R_13CM)E11-7'r
(D )F 11 )a:'AI )`.. `_'
- - APPLrGA72ON� FOR=- =APPROVAL- OF PLANS- FOR A- WASTEWATER -. 01_SP_OSAL- .SYSTEF4
i . Name and Address of Applicant: �aV �-j e
2. Name of Project: 7"ry�J s•�r/ 3.•_Jocatiorf4j�/V /C: T lf�eys6�,
4. Project Engineer: �r-� ��s T� 5. Address: Nillbrooke Office Centr
Brewster, NY 10509
License Number: X56 /%lam Phone:-(914)'278-6-108
6. Tyoe of Project:
_ Private /Residential Food .Service ....Commercial ,
Apartments Institutional Mobile Home Park
Office Building Realty Subdivision Other (specify)
7. Is this project subject-* to State Env ironmental•Quality Review (SEQR)?
Tyoe Status (Check One) Type I.. Exempt
Type II. Unl- fisted, _ c
8. IS a Draft Environmental Impact Statement (DEIS) required? ........... A/o
9. Has DEIS been completed and found acceptable by Lead Agency? ........... &AI
10. Name of Lead Agency
11_. Is this ..- prpj:a - -in.,an.:a.rea_.under: the_control, of- .local p lane -i- ng-__-_zoni-ng, __ _
or other officials,.ordinances?
12. If so, have plans been.sub,7itted to such:: author .sties ?.....................
13,. Has preliminary approval -beers granted by -such authorities? Date Granted:
Type of Sewage Disposal_ System Discharge...... Surface Water _Ground Waters ;
15. If surface water discharge, what is the stream class designation? ........
t
:6i Waters index number (surface) ...............................
1. Is project located near a public water supply system ?. ..................
8. If yes, nave of water supply A4Z-4 Distance to water supply
9. Is project site near a public sewage collection or disposal system ?.....
-0. Name of sewage system T Al - Distance, to sewage system
1. Date observed: 0�3 23. Name of Health Inspector:( 9- aZ-?4L - dr
�
,
-,. Project design flow (gallons per day) ..................... ............... co
2.
25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. /yo
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 ? .................... ....... .... ............................... X�
23. Wetland ID plumber .................. ............................. /Y
29. -Is Wetland Permit-required ?'.............................................. ' Po
Has application been made to Town or Local DEC Office ?. ...............'... i1 /o - / //W
30. Does: project require a DEC Stream Disturbance Permit? .......
31.
Is or was project site used for agricultural activity involving application
OT pesticides to orchards °or other crops., solid or hazardous waste disposal,
landfilling, sludge application or industrial activity? ........ YES or'h0
1116
32. Is project located-within 1;000,feet of existence of abandoned landfill,
hazardous waste site, salt stockpile, landfill, sludge disposal site or
any otherppotential known•source of contamination? .....'..........YES or No
DESCRIBE:
33. Is there a local master plan or file.with the Town or .Village?
34. .Are cormunity water, sewer facilities planned to be developed ^within 15 years?
35. Are any- sewage disposal areas..in_excess of 15` slop? ............... ho
36. Tax:Hap ID N umber ......................... ............................... -?:S Z
37. Approved Plans are' to''be: returned.to: .....f........... . App1 fcant Engineer
If the application is signed by a person other than the applicant shown -'In Item.1, the.
pplication must be- accompanied by -a Letter of Authorization: Failure to comply with this
:provision may be grounds for the rejection OT aqy submission.
I hereby affirm, under penalty of perjury;- that information provided on this
form is true to the best of my 1<now7edse and be 1 ief. False statements made ,
herein are punishable as a Class A Hisde-ae -anor pursuant to Section .210.45 of
the Pena 1 Law.
IIGNATURES & OFFICIAL TITLES:
'AILING ADDRESS:
Millbrooke Office Centre
Brewster, NY 10509
_. _ J`I'NAM COUN'T'Y DEPARTMENT OF HEAL_ _.
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN,DATA SHEET- SUBSUFACE ..SEWAGE.DISPQSAL.SYSTEM FILE NO. _
Owner Address _za/KZ_s'`�
Located at (Street) ���,� �ricr��,/„ /Yd Sec. .3$ Block S Lot
(indicate nearest cross street)
Municipality Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
3 71 IT p qt
Date of Pre-Soaking Date of Percolation Test �J_
HOLE
NUMBER CLOCK TIME PERCOLATION PERCOLATION
Run Elapse Depth to Water From Water. Level
No. Time Ground Surface In Inches Soil Rate
- - -fit xt -Stop Min. Start Stop Drop In. Min /In Drop
1-0,4 -) Inches. Inches Inches
2 17
4
5
1
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.
rev. 9/85
mk
.3 .0. j�?
4
5
1
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.
rev. 9/85
mk
G.L.
if e
2'
3'
4'
5'
6'
7'
8'
a
10'
11'
12'
TEST PIT DATP IQUIRF.D TO BE 'SUBMITTED WITH AF CATION -
DESCRIPT,_.O OF SOILS ENCOUNTERED IN TEST hvL'ES
HOLE NO. / HOLE NO. HOLE NO.
Soil Rate Used 3o Min /1" Drop: 'S.'D. Usable Area Provided
No. of Bedrooms �3 Septic Tank Capacity ®Od gals. Type _.
Absorption Area Provided By L.F. x 24" width trench -
OF hEwY
Other C� N t E 4.
.. l c . 7k - <,A R 7r—
Name ��Z��r. �i1�l�iiSaGj� JAS �G. Signature' A"" M1,
.. z
Address / _L�j �CF G E FJC g -SEAL \ Gc No.56124
06o!�
THIS SPACE FOR USE BY HEALTH.DEPAR'IMENT ONLY:
Soil Rate Approved sq.tt %gala Checked by Date
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Oil
_ �RL�F ��,ctt�rd�E.�' j ~ � � y �t't� >� � � �•. ',z�;�.�.,��t t� � �`.
• ' A,a ., 1i T ylY c � ; � � 51v � L7 �I,.t�`� � S'�� .��V `'-
' `k r '4;G -rte .� t '.�r f���'' '"i•xr��.�,. 1, ;,z-yi � �i
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"W0 PLANS APPROVED FOR BEDROOM. COUNT OtNIA,
-4- RYDRVONIS 4-131 -lq UJP
%MO
ALL SUBSIDiur: \T Ia- VTSIONIALTERATIONS TO THESE I3v i8
4iBlCS %ViT 15E SLI.SJiTTED TO THE PCDOU FOR APPROV tt
t,; ..
i
� �� � °'.
;�a .4.:_
;��:r �_
NIF Y
N/F VAUTAMS
i
F
i
LOT NUMBERS ARE AS SHOWN ON MAP
ENTITLED " FINAL SUBDIVISION PLAT OF
ANTHONY BIJOU" AND FILED IN THE PUTNAM
COUNTY CLERKS OFFICE.
THIS' PLOT PLAN IS BASED UPON
AN ACTUAL FIELD SURVEY PERFORMED BY YE
CrAND .IS ACCURATE AND CORRECT BY:
GERALD L. LYNN �j
PATRICK & PATRICIA SAVARESE
& 1'
PAWLING SAVINGS 9ANK
It's Successors and /cjr. Assigns
"AS-BUILT" PLOT PLAN FOR /TO
PATRICK & PATRICIA
LAND SURVEYOR, P.C.
& I
SAVARESE
"
ALL CERTIFICATIONS HEREON ARE VALID
FOR THIS YAP AND COPIES THERE OF
COMMONWEALTH 't
LAND TITLE INSURANCE COMPANY
TOWN OF PATTERSON
ONLY IF SAID YAP OR COPIES BEAR THE
H"RES.9ED SEAL OF THE SURVEYOR
& _
PUTNAM COUNTY
GERALD L. LYNN
WHOSE SIGNATURE APPEARS HEREON.
WAPPINGERS FALLS, N.Y.
NEW YORK LAND SERVICES, INC.
NEW YORK
N.Y.,;REG. SURVEYOR
TITLE NO. 95NYPU6171
MAY 3, 1996
No. 049292
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95 -02 LLL