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HomeMy WebLinkAbout1803DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -5 -16.2 BOX 16 17-2 r 1611M r J T �. �rl,- t 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 m ��S�r: �,r� ; Lg.V � L E a tS a `.t 's !4 i� 't 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 �0... 7Im ' ■ O 14 i3 Q e: ny r re ,rAivK �O -sa . � t � . fit: F � * Eb .} 41 a r �,k �i x-rxw r ar+•?^F?tiet"e yk'`,c }y t :zYx }' U1 4 t fir, ^ w ` . ` � r ry 7� ~ k. � t � :- .X � J_ •:% i�''x'3i? 41 1 3 I �� ,. >z •. i 3 t Y(O AFI is Tit 5 u. j v S t 'i PS�( �-Ap� h� � Wl 7{') S .rt ✓y t a d q I y ate. ! fpy Yr.�a a ?z�t ` iYtw.t4���1�,?,y.�i+$da t 1nA' rF- 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 'q'•`C r > "� m ti :. . a r tT R�7"R"'!" q'3r'.rt �Qt 3 i : t5 v t S i � M d t1 �'J�tR ii kvyi "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 ri C,\SUR\ �yF :y al �l I 1 1} i .0 LEA" =100' _��pF NEtbY o ? hO.049Z9ry ✓e lAtiD 95 -02 LLL