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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 4.14 -1 -11 BOX 3 III �I I19 1 A.i 0 1 1 I Ll we �L �1 :I 'r ly �. I I 16 L I� In I _. ,. , INE 00002 PUTNAM COUNTY DEPARTMENT OF HEALTH k16 DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Q , Located at /-:'-V/''T ba' -r LPG Town or Village Owner /Applicant Namei2L Alt—)Dd Zk 5� Tax Map _ Block % Lot Formerly Mailing Address % 17 95 Date Construction Permit Issued by PCHD Subdivision Name Ceti -�TAT"S Subd. Lot # /0 Separate Sewerage System built by 6&)A,6 Address Zip Consisting of Gallon Septic Tank and 0- a,,:5)2 c; . y)k- e- / eo `robwtd P6 P- Other Requirements: �/'�7ir�vf� `�✓ f3 ° �� f--l% L Water Supply: Public Supply From Address or: Private Supply Drilled b y�.� %A6 Address 1 _� PP Y Y �� �� � Building Type j C --1 Has erosion control been completed? Number of Bedrooms Has garbage grinder been installed? _� ®,1s7 I certify that the system(s), as listed, built plans (copies of which are atta( plans and the standards, rules and r Date: Certified serving the above premises were constructed essentially as shown on the as- ied), -1n accordance with the issued PCHD Construction Permit and approved of #1e Putparp Count) Department of Health. wtkA P.E. �/ R.A. Address -d!" �ii�'�• -- License # Any person occupying =premises served by the above system(s) 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 a ubject to modification or change when, in the judgment of the Public Health Director, such revocatio , o ficati r change is necessary. By: / ` Title: U'�- Date: White copy - HD File;.Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES " `�lcJ C'oeP►" FINAL SITE INSPECTION Date: (41,F10 Inspecte y: E ra Street Location 15u g -- D;Zii,e Owner ST1 E3iG,-_ Town pA ,,r -�C_ tz el Permit # - P-- - , e� TM 9_ 4, (�� - ( � 1 / Subdivision Lot # le) ,oy,4K ga 17e196aE 1. Sewage System Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 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. Sey0ge System a. 6eptic tank size - 1,000 ........1,250 ........other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......................................... d. Distribution Box 1. All outlets at same elevation -water tested............, 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box -properly set ........... ............................... f. reT nches 71—eng-Th required Length installed.? , 2. Distance to watercourse measured -1- r e:,c> 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 %2" diameter clean .................... 9. Depth of gravel in trench 12" minimum..,.:::: 10. Pipe ,,a ped ........................... ::.:.:..:......:::........... g. PUMD err Dose stems ize pump c am er.......... ...................... . 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.... K-91 III. House/Buildin a. House located per approved plans ... .............:................. b. Number of bedrooms ...................... ) ...g,Q ................... IV. Well a Well located as per approved plans . ............................... b. Distance from STS area measured ' 13 7 ft ........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled .......... . ........:...................... 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 watercours g. Footing drains discharge away from STS area...........: � h. Surface water protection adequate ............................ ::. L Erosion control Drovided ................. ............................... _7 r�t <<l I EN INU UVIVEVILIN I'S 11�e e 5 7 i:- t. l .nom —7- z.'- �., S z e _7 r�t <<l 1 s h. ' V _ r , r. j z s f F r <. , , 3 ♦' , Y _ • y Y F veq�kN�c 11/07/2000 12:51 9147349121 ANTHONY S PISARRI PE PAGE 01 11!u3r00 FRI 11M FAA PUTNAM COUNTY DEPARTNMNT Or SEALTH D>T MON OF ENVIRONIKENT'AL HEALTH SERVICrLS ATTENTION 0 ADAM WGM RB"Sl E09 MAL INSPE For: Fill All infounatim must be fully completed prior to any Trenches inspccdow being made. PCHtD Construction Permit A F" 3 8 8.+ Located: OwDer/Appiieaw Name: Q , F�!e . TM _ !� Block _1_ Lot o Formerly. ACMD aTA81L$ Subdivision Name. -.*Keg QLi OG ;`rc'.�t S Subdivision Lot 6 (o Is system fill completed? Y6 Date:. It 1,,, 2 92 Is system comylete? N o Dace: Is "em constructed as per plans? N /,& Is well drilled? 00 Dace: Is well located as per plans" _ -- _ N/A Are erosion cotaroi measures in place? DES I certify tkat the System(s), as listed, at the above premises bas been couamcted and I have inspected and verified their completion in accordance with the issued PCHD Coaattuction Permit and approved plans and the Sta»dards, Aides and R eplatiow of the Putnam County Department of i%altb. Date: , /! ob �: Certified b ' w Professional Address: •5,tp nJ.rR A) y Lie. g Couanems:.,,,, Form FYA 99 2� . 3 BRi CE R. FOLEY Public HealM D1rec:er DEPARTMENT OF HEALTH 1 Geneva Road Hrcwster, New York 10509 LORETTA MOUNARI" R.N., M.S.N. Aisociare Public Neaith Directcr Director of patiant Servicaa Earironmeatal Health (914)278-6130 Pax (914) 278-7921 ti arslnq 3ervless (9141273-6559 WIC (914)27S.66'9 Fax (914) 278-6085 Early Interveatiaa (914)2"8-6014 preschool (914) 2186082 Fox(914)278-6648 OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS. TOWN: sTit2 /?%o clk Lx? A/v.tir f' lz �, I--z, A'UTHORT-ZED TOWN OFFICIAL: - (Signature) DATi:: /z /z 00 The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted -with the application for a Certificate of Construction Compliance. (E91 I - vERFRX4; s MEA - 3.686. ACP�5- limit i of fill . r 190 51 g2 jcsr? to rlorES: !o w �j- t1 • 5 �,� `jp�i raft - o' J / t 51� junc box (typ 2) 4opNalT P1 \1 gc4 / 3,) 8 2 } LF , 14' l / dust box siphon chamber �Y� •� ,>J� ° tank rY '/ ' c (V Q pn �C.I it � � r i WELL.- it IV\7 1 •' '/ l� I?- 225.00, b- 12' ilk � tintt p 1-7 00' ° `�' Delta= 2•�° 5�' S2" � ' v� PLAN VIEW Scale 1 " =30' s t The Mign engineer has i:.spected the ROB fill materw on 72 Af (dat r- f 3 . and does her -by certify that s mb'miterral has been placed and statahzed. I I m accordance with the regoiremrnts of the N.Y.s. Dqn or w" the Pnit>f4n County Departmem of Health and the aWowd fit plea The ••..: " •�•!••��•+ rnatamal.itset has been tested and artlistineis«onirdcedat $ tabbefort uxtna. �ubsnfaCe` sewagedrspoiilsystem =�pei,ratt }TE LOGATiDtJ PL nrt6e setikd fill band on Qereoiition casts altei senb�lrzat is "•,�_m�neb, g .G r •�9GA UE:, it - ''l .. f` _ "TFti's" is to certify that th:,e s ;vua e'' treatment 'system .was con:struc -ted as cri.d'ica :ed an "t`his Plan and: that the system wais inspected by .ri-me before it' was covered over. The . system was constructed io accordance with all standard rules and regulations of the Putnam County Health Q ` Departrne'nt a ?) d, the New Yoe -k. Stpte' 'Departmerit of Health." :, rro Note: .'House location Eby. Terry Bergendorff Collins, L.S. , 0 TIES Tank siphon 58.5 20 A 8 A' :. " .. ' -D. Box 7..7.5 51: J. Box -1. 91:5 ?3 ;. q & ;.: - 92 r.7 . i3Z � 2 96 79 !a : �3 g7 l8 r35_ 4f.5 3 100 >5 8,5` ��.. 79 /n`2 19 :.138.1' .. ¢... 1:05 9,1 2' ` - 85 /0,7 Ob f42. 5 110 97 14(c., 6 115, 103, !4-" .. 97 1./7 . Z2 . 'i 6o l �3 7 120 109 as !03 iz.Z 2.3: 1164 (f :.. S 125:5 115 !(o:- l09 . ! z$ . Z4 158. 1:2 5" N ot`es 1. > ..4 BR Residence ' ' 2:) 12,50 gallon septic tank: 3 ).: Soria raite used '0.5 -gal /' ;f /day:. 9 4.)' 824 I.f. 2.4. trench, 6 o —c M g 5. -) . Sip "lion used — 20" draw — 416. gaflons ::o a' ": N CV '• \':.: .:': :::\ '... :: \': :..... J •.\ ::::::•.': :.. .... '. .: `':: :.�'. \:'.:':: •lI \ :•:•: ••:•' : A: 11• • .�i��' •:•:•%: :tit :Y r BATH r� 1 `2 V ' BEDROOM 4 •� %` • �. 9'•8" x 12'4" • .� ORESSING• BEDROOM,. WALK* 13' •' x 10'- } — ! N -0 CLOSET j r MASTER BEOROOM BEDROOM 2 j - OPEN N 17'0 x 16'•8" 13• o••,. ts••s•• i tPART jis T OF HEALTH 1 • H&S P S APPROVED FOR BE-DR .OM COUNT ONLY, �... -- ALL SUBSE01 . N AS T SECOND F L 0.0 R PLANS -T BE S -jL-; WfLD TO T11E PCDOH FOR" = 1344S F • 3 TLE DATE { KITCHEN ji)l DINING ROOM � MORNING ROOM 13' 0" •. * 12..0 _:jL • ^f OPEN ' ABOVE LIVING ROOM Uo FAL41LY ROOM 1 �'•O" x 1 t'•0" 17' 0" ■ f 7' O" ' FOYER �• FIRST. FLOOR r 4828 2 'G 3r S IIAI 5f� i� ►Z el.1 . 1( �c( zooms T 7-- --5( 0. 20, 7 FT � Hoier ot4 ZF-Ne,,TH, 3�, T �✓ p/?T C7 u/l�THr PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Sunset Road Town/Village: Patterson Tax Grid # Map Block Lot(s) Well Owner: Name: Address: Westchester Modular Homes., 1995 Route 22, Brewster, NY 10509 Use of Well: 1- primary 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 132 ft. Length below grade 131 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 Well Yield Test Bailed X Pumped X Compressed Air Hours 6 Yield 5' gpm Depth Data Measure from land surface- static (specify ft) 30' During yield test(ft) 480' Depth of completed well in feet 545' Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diamctcr(in) Formation Description ft. ft. Land Surface 60 Drilling in ove burden clay and boulders 60 Hit rocc at 60' 60 132 Drillinjin roc t, set casing, routed 132 545 Drilli in roc ranite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 5cfpm Depth 500, Model 5GS10412 Voltage 230 HP 1 Tank Type 02 Pime 6 al. Date Well Completed 10/18/00 Putnam County Certification No. 002 Date of Report 12/18/00 zfr. NOTE: Exact location of well with n&S at least two permanent landmarks to be provided on a'separate sheet/plan. Well Driller's P__/%e s Inc. Address: 4 Rtn n Ave., Apr, NY imp Signature, Date: 12/18/00 "Malcolm White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 NE NORTHEAST LABORATORY OF DANBURY 39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404 LABS . _ (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 SAMPLE SITE: WESTCHESTER MODULAR, SUNSET RD., PATTERSON, N.Y SAMPLE POINT: TANK HOSE BIB SOURCE: WELL TREATMENT: NONE LABORATORY REPORT REPORT TO: MAXIMUM CONTAMINANT TEST PERFORMED P.F. BEAL & SONS DATE SAMPLE COLLECTED: 12/5/2000 & 12/11/2000 4 PUTNAM AVENUE TIME COLLECTED: 4:00 P.M. & 12:30 P.M. BREWSTER, N.Y. 10509 COLLECTED BY: G. JABLONKA & MTB 0 DATE RECEIVED @ LAB: 12/6/2000 & 12/11/2000 0 per 100 ml TESTED BY: LAB #11471 LAB LD.# BEAL139 & DE -27 • Color (Apparent) REPORT DATE: 12/13/2000 SAMPLE SITE: WESTCHESTER MODULAR, SUNSET RD., PATTERSON, N.Y SAMPLE POINT: TANK HOSE BIB SOURCE: WELL TREATMENT: NONE ml= milliliter mg/L--milligrams per Liter ND =none detected MCL= Maximum Contaminant Level "Notification Level ** *Action Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: UOTABLE or ONOTPOTABLE RESULTS BASED ON SAMPLES SUBMITTED: 12 /6/2000 & 12/11/2000 0 r s d 0 4 Fhb Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 MAXIMUM CONTAMINANT TEST PERFORMED RESULTS METHOD # LEVEL (MCL) OR STANDARD BACTERIAL: 12 /11/2000 • Total Coliform (Bacteria) 0 per 100 ml SM 9222B 0 per 100 ml PHYSICALS: 12 /6/2000 • Color (Apparent) 13 - EPA 110.2 15 • Odor ND - - 3 Units • pH 7.81 - EPA 150.1 No designated limits • Turbidity 4.2 NTUs EPA 180.1 5 NTUs CHEMISTRY:12 /6/2000 • Nitrite Nitrogen <0.005 mg/L as N EPA 354.1 1.0 mg/L • Nitrate Nitrogen 2.29 mg/L as N SM 4500D 10 mg/L • Alkalinity 228.0 mg/L SM 2320B No defined limits • Hardness 278.0 mg/L EPA 130.2 No defined limits • Iron 1.40 mg/L EPA 236.1 0.30 mg/L • Manganese <0.01 mg/L EPA 243.1 0.50 mg/L Combined limit for Iron plus Manganese = 0.50mg/L • Sodium 4.6 mg/L EPA 273.1 20.0 mg/L ** • Lead <0.001 mg/L EPA 239.2 0.015 mg/L * ** ml= milliliter mg/L--milligrams per Liter ND =none detected MCL= Maximum Contaminant Level "Notification Level ** *Action Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: UOTABLE or ONOTPOTABLE RESULTS BASED ON SAMPLES SUBMITTED: 12 /6/2000 & 12/11/2000 0 r s d 0 4 Fhb Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 NE NORTHEAST LABORATORY of DANBURY 39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404 LABS (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 LABORATORY REPORT REPORT TO: P.F. BEAL & SONS DATE SAMPLE COLLECTED: 1/17/2001 4 PUTNAM AVENUE TIME COLLECTED: 10:30 A.M. BREWSTER, N.Y. 10509 COLLECTED BY: P. FAHEY DATE RECEIVED @ LAB: 1/17/2001 TESTED BY: LAB# 11471 LAB LD.# PFB -008 REPORT DATE: 1/18/2001 -- SAMPLE SITE: WESTCHESTER MODULAR HOMES, LOT #10, SUNSET DR., PATTERSON, N.Y.' SAMPLE POINT: HOSE BIB SOURCE: WELL TREATMENT: NONE M[AX1MUM CONTAMINANT TEST PERFORMED RESULTS METHOD # LEVEL (MCL) OR STANDARD CHEMISTRY: • Iron <0.03 mg/L EPA 236.1 0.30 mg/L ml= milliliter mg/L=milligrams per Liter ND--none detected MCL= Maximum Contaminant Level * *Notification Level * "Action Level COMMENTS: -All holding times (were) met. RESULTS BASED ON SAMPLES SUBMITTED: 1 /17/2001 Laboratory Director EI�I�D -NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060379 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 I 4 f� PUTNAM COUNTY DEPARTMENT OF HEALTH ENGINEER TO PROVIDE PERMIT # ON CERTLFICAjf,9F COMPLIAN E� Division of Environmental Health Services, Carmel, N. Y. 10512 PERMIT CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM k. ^ e down or Village i Located at " Tax Map Block Lot / 0 Subdivision S Subd. Lot N Renewal._ Revision Owner /Address L Date Of Previous Approval ocr ; Building Type �G XA: Lot Area O� Fill Section Only E3 N T Number of Bedrooms 13 Design Flow G /P /D fit/ P.C. H. D. Notification Required LA) of Separate Sewerage System to consist of Logo Gal. Septic Tank and (0 00 LEI) F • T / Kf A1C h To be constructed by r '. Address Water Supply: Public Supply From Private Supply to be drilled by Address _ %� p �1 Other Requirements I , *W • 0. iV - �f E 1 DEB- ij "I /'f 1 N Z)/�,�-�l 1 represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations of e Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Health will be submitted to the Department, and a written guarantee will be furnished the owner,,his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system during the period of two (2) years Immediately following thedate of the issu- ance of the approval of the Certificate of, Construction Compliance of the original system or any repairs th eto; 2 that the drilled well described above 1 will be located as shown on the approved plan and that said well will be InstaUa4 in accordance with t Stan r r s and regu ads of the Putnam .\ County Department of 00alth. Date Signed P.E._Z R.A. V © cC 10-168 �. Address License No. APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued u construction of the building has been undertaken and Is revocable for cause or may be amended or modified when co id a necessary by the Co issio r of Health. Any change or alteration of Construction ;,�equires a new permit. Ap oved gfd' 1 of domesti rani sewage, an or priv to uiyr ....� �_ %� v _ .r \ate �/ ey Title 6/85 PUTNAM COUNTY DEPARTMENT OF HEALTH H Permit q 7 Division of Environmental Health Services, Carmel, N. Y. 10512 CO RUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM7� Town or Village Located at Fi��{ -s�`� Tax Map Block Iot / .A . i ,;-r` '"ra Subdivision L- �t'�tt C �th7(�E t;C �'� Subd Lot q - -�, Renewal _ Q Revision Building Type I I�Et�lTif�li -t- Lot Area �.4ce47 - Number of Bedrooms Design Flow G /P /D Separate Sewerage System to consist of C) , �Gal. t�Septic Tank To be constructed by Date Of Previous Approval Fill Section Only P.C. H. D. Notification Required No and -fin.✓ LE F WI (IGFA190; Address Water Supply: Public Supply From Private. Supply to be drilled by tcF -{�lfA w+ , Address i Other Requirements l F V l7 �1 L�. /A I represent that 1 am wholly and completely responsible for the design and location of the proposed 'system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regu a ions o e u nam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, h r assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system during the period of two ) y rs immediately following the date of the issu- ance of the approval of the Certificate of. Construction Compliance of the or coal system any ►e irs t ereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installedacfrdance h th s3iq ids- rules and reg-Ma ons of the Putnam County Department of Health. , Date Signed Address -l°QA kffn APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued revocable for cause or may be amended or modified when consider ssary by the Co������ requires a n w permi�Apr di sposal of dome ni swage, a tl /or pr Date By Rev. 9 -81 P.E. R.A. License No. uction of the building has been undertaken and is of ealth. Any change or A ^Lon of construction Title AUv -18 -Q0 SAT 8:53 AM PUHAY CTY ENV HEALTH 1*A% N0. 19142797921 PUTNAM COUNT' DEPARTMENT OF 19EALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE Old' SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building 1. ttullding Constructed by Tax Map Bloch Lot 0 N �'ov+�t�iilage' Ile_ Location - Street Subdivision Name Building Type Subdivision Ldt. # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the abovo- described property, rind that is has been conatrueftd as shown on the approved plan 'or approved amendment thereto, Wd in accordance with the standards, riles and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in goad operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the daze of approval of the "Certifieate.'of Construction Compliance" for the sewage treatment system, or any repairs made by me; to such systeaa, except when the failure to operate properly is caused by the willful or neglipmt act of the occupant ofthe building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the wi11ful or negligent act of the occupant of the building utilizing the system. Rated: Month Day LO O Xoar &-�,'Oco Signature: �_.. Title: General Co ar ( ) - Signature Corporation Name (if corporation) Address: /�YG LeLA 2- State _.. -A 'y Zip /'©/ 5c 5' Corporation Dame (if corporation) Address: R 7 R 2 4rclts -1�1 State N '( Zip Za D I Form G5 -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERM GE TREATMENT SYSTEM PERMIT # rye Located at 4b gr_ER_ 'el oc Subdivision names Subd. Lot # Date Subdivision Approved Sg- Owner/Applicant Name l/if�`�� /uL+4i2s� Town or Village PAZZU4,64!2AJ Tax Map 4A .Block / Lot // Renewal Revision Date of Previous Approval Mailing Address 1995 &rYr,1-- 9 Z Ege&)6re4 A Zip /D5o Amount of Fee Enclosed AG Building Type &gja6AI 6' Lot Area 5-6'75 No. of Bedrooms 4— Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of /2"!�(> gallon septic tank and cile:16 i na► ±-an _T Other Requirements: Z v.- t6rr!'3 To be constructed by (jAlEf: Address Water Supply: Public Supply From Address or: � Private Supply Drilled by P� 46-A& el,-,90S Address , � ,� �Vr I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment s,, em described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or anyrepairs thereto. R.A. Date License # 05757L ' /E7e&5 &- APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w c nsidered ecessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe i . pprove discharge of domestic sanitary sews a only. By: r Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: gys neH 1 ' cv"We. x'VrL- I, Gus �N GEL S represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: _W�{r�2onuLr�2nE� Having offices at: 1995 jE�v M 2 9, , 154Ws� , AJ,K Z0 Eb g Whose Officers Are: President -Name: G'klxe,,.=s A/, A1,11rt�,gg— Address: 3D A>.9 Z z, A /9b 6c% lz� Vice President - Name: Address: Secretary -Name: Address: Treasurer - Name: Address: and that I am and will be individually responsible for any and all is f e corporation with respect to the approval requested and all subsequent acts relating theret . Signed: Title: Sworn to before,me this _I day of 7�(month) a o p ► (year) `1 _arrL A Notary. Public Carol J. Pomeroy # 01 P06045706 Corporate Seal Notary Public, State of New York . Qualified in Putnam County Zoo2 Mfgorn!"on . Expires July 31, CL PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of AnAAT'-s Located at �}V �-7 7-64 -5 0N Tax Map # A-.14- Block / Lot /I Subdivision of (1'a�. Subdivision Lot # /0 Gentlemen: Filed Map # /& Ar,4 Date Filed &/49 8 This letter is to authorize Ar -76.) ,t p1:5,4,ep— d6 . a duly licensed Professional Engineer r✓ or Registered Architect to apply for the required wastewater treatment and/er water supply permit(s) to serve the.above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Educatio aw, the Public Health Law, and the Putnam County Sanitary Code. 41 C R.A., Mailing Address b Data : a"Zr4vor, State 147o igt_ Zip `06-6 Telephone: Aj*) 686 Very truly of : f 1,:r- /27 . #:2-2, f e cv6 State. A Zip. Telephone: Form LA -97 TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. 2 HOLE NO. G.L. 0.5' ,vim, 4"') 1:0' 2.0' 2.5' 3.0' 3.5' r 4.0' = 4.5' 1 -a 5.0' 7, 426 /7.5' 9.5' 10.0' Indicate level at which groundwater-is- encountered - - -- - — - - - -- -- -- - - - - -- - Indicate leyel_at_wluch mottling is observed _., -_ ... Indicate level to which water level rises after being encogWerd. - - - - Deep hole observations made by: Date /Z h6 2m o Design Professional Name: Address: ANTHONY S. PISAARI, P.E., P.C. CONSULTING ENGINEER 3 RMALIND DRIVE CQ7 ,.NEW YORK 10567 - Signature: /xV1,011 Design Professional's Seal �oct. OF NEW- Y Ck y�FdA�q 057512 R�FESSIONP� C ki PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR ATMENT SYSTEM PERMIT # P ' %8- 04- Located at Q V p'"V-- 9--4 D (4 DP-1'4 f Town or Village f aI—rC:F-6 o N Subdivision name bty►Ea- ��E �5T " Subd. Lot # 1 Tax Map 4- 1 4 Block Lot Date Subdivision Approved Renewal Revision X P 1 ErF- -o s,T�Bi J Owner /Applicant Name L-l; Date of Previous Approval �Q titi Mailing Address -7405 C f rn "N6 Amount of Fee Enclosed 4 1700 oa GiI.SN1)�L� fqY Zip 06. Building Type Lot Area 41' n4. No. of Bedrooms 4 Design Flow GPD P500 Fill Section Only X_ Depth t I Volume WO PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage -System to consist of I q-60 gallon septic tank and Other Requirements: P65044 51 P 1+0 P C JKP1 A p F11O1 •.�To be constructed by ,Water Supply: N -r- O ' V Address Public Supply From or: A- Private Supply Drilled by T-•6 ,P- Address Address 500 LF 05 I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the soarate sewage tre atment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. � I Signed: !L„ , P.E. fC R.A. Date Address )I,li H 8� - ►�Y laid License # r7 611A APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w onsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe v7v� ge of domestic sanitary sewage only. By: Title: Date: dqlhh, White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 Mr. Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 Val n RE: Individual SSTS Quaker Ridge Drive, Lot #10 Town of Patterson Dear Robert: In response to your review letter dated 8- 26 -99, we offer the following: 1. Pump Pit and Dosage has been added to the Fill Plan. 2. Metes & Bounds are now provided on both maps at a slope oft" =100'. 3. Curtain Drain Detail is now provided on the Fill Plan. 4. Fill Pad dimensions are now provided. 5. A Note stating there are no flood plain areas on or within 200' of the site is now provided. We would appreciate your review, approval and issuance of the Permit at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. Ni ols Jr., P.E. HWN:JM:his 91060 FMA LAURENT ENGINEERING ASSOCIATES, P.C. 20 Milltown Road Brewster, New York 10509 HARRY W. MCHOLS JR , P.E. (914 )278 -6108 - (FAX) 278 -2658 CONSULTING SITE ENGINEERS September 7, 1999 - Mr. Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 Val n RE: Individual SSTS Quaker Ridge Drive, Lot #10 Town of Patterson Dear Robert: In response to your review letter dated 8- 26 -99, we offer the following: 1. Pump Pit and Dosage has been added to the Fill Plan. 2. Metes & Bounds are now provided on both maps at a slope oft" =100'. 3. Curtain Drain Detail is now provided on the Fill Plan. 4. Fill Pad dimensions are now provided. 5. A Note stating there are no flood plain areas on or within 200' of the site is now provided. We would appreciate your review, approval and issuance of the Permit at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. Ni ols Jr., P.E. HWN:JM:his 91060 FMA BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road .Brewster, New York 10509 LORETTA MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Harry Nichols Laurent Associates Millbrook Office Centre Route 22 & Milltown Road - Brewster NY 10509 Re: Proposed SSTS: Stabile Quaker Ridge Drive, Lot #10 (T)Patterson, TM# 4.14 -1 -11 Dear Mr. Nichols: August 26, 1999 Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regards. If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. 1) Pump pit detail and dose is to be provided if the pump pit is to be installed utilizing the fill permit. Otherwise remove pump pit from plan view. 2) Metes and bounds are to be provided for the entire property at any scale. 3) Curtain drain detail is to be provided fill plan. 4) Fill pad dimensions are to be provided on the plan. 5) Show limits of 100 year flood plain elevation within 200 feet or the property or add a note none exist. A Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ve t ly your Robert Morris, P.E. RM:tn Senior Public Health Engineer Sheet of PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLII SERVICES FIELD ACTIVITY REPORT S -fA6 /`1- E.. Ar A TitF - Tel: A TITIR F C C: �)l%G�. 4LW_ Street 'Town State, Zip PERSON IN CHARGE d nR TNTFR VTFW'P.T); Tate. Name and Title TYPE OF FACILITY: FINDINGS: REPORT R ECEIVRTI RY' I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Rov PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Pi �iR-0 �7'tt�� t�� Address 146 (Olt Lh < C4EHOkE HI 11106 Located at (Street) (U4� P-�Q (A5-- PP\tr-- Tax Map, 14 Block (indicate nearest cross street) Municipality PAJ-1 EF-60H Drainage Basin ' I Lot 1) SOIL PERCOLATION TEST DATA Date of Pre - soaking 9 j j o) 19 ,� Date of Percolation Test Hole No. Run No. Time Start - Stop Ela se (pMi Time n.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Minanch t 4 oe? 4�1 '� 0 24 24 7/6 76 X41 I 2 4 �' e�°s V 24 24'4 1/+ 46/1 3 uti e��,s /j0 Z4 24''l4 14 4611 4 - 5 2 4"1 fio 114 1/4 4- / 1 3 5'' "�� '110 2 244 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtamea at eacn percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. i 1bP5oiL u_6� HOLE NO. HOLE NO. Indicate level at which groundwater is encountered ti ' Indicate level at which mottling is observed 21_ Indicate level to which water level rises after being encountered Deep hole observations made by: L• E H D , Date Design Professional Name: FFAp ) W, MILM -4, d2—PC, Address: 2-0 MtL -0-d w14 (LOA-P bIL&V,5 TCP— NY j &, Ipq Signature: Design Professional's Seal i� W Uj No. 56124 ty�� a V A OFESSIO K PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner / A 1 C- Address Located at (Street)ll. / Tax Map Block Lot rl (indicate nearest crosg street) Municipality Ayos^- Watershed SOIL PER( Date of Pre - soaking 11 _� SlId- TION TEST DATA c/ Date of Percolation Test .......... Hole. No Ruu Time Efa se Time : �ikLn) D epth to'Water From r n G ou d Surface (Igcl�es) Water ev L ` el )¢rop In Percola oit. t< Rate No. Mart Stogy ,,:...: . Start Staff Iuc7ies MI nc)h ? ;; 2 it 3 413 9-3� 2 � :� - -15'A -70 2.1- )3 / 30 3 30 — .3 30 4 5 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. T rte: 1_10p o-n �% 3-� Form DD -97 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. %/i1 /jX HOLE NO. HOLE NO. Indicate level at which groundwater is encountered Indicate level at which mottling is observed N%ig Indicate level to which water level rises after being encountered Al A Deep hole observations made by: S. ROsvu(tt 4 6 � j � �,, IJAt' k- Date A1.1.3 1Y Design Professional Name: Address: Signature: Design Professional's Seal r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT STREET LOCATION (,l�eGf_ /L�� / %� NAME OF OWNER REVIEWED BY Rai, GR, AS, MB, BH�3 D A T E 4114 �1 TAX NIAP # Y N DOCUMENTS Y N b •�� /�� /vim —/(--,) PERNET APPLICATION EROSION CONTROL:HObSE,WELL, SSDS PC -I PERC & DEEP HOLES LOCATED WELL PERMIT _ PWS LETTER REPRESENTATIVE OF PRIMARY &,E1 . LETTER OF AUTHORIZATION ,,s LOCATION MAP,Q DESIGN DATA SHEET (DDS) EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE / \ ,,CORPORATE RESOLUTION IF PUMPED, PIT & D BOX SHOWN & DETAILED SHORT EAF HOUSE -NO.OF BEDROOMS PLANS - SETS WELLS & SSDS'S W/IN 200' OF PROPOSED SYS. OUSE' -L ' �TW ETS PROPERTY METES &BOUNDS ARIANCE REQUEST HOUSE SETBACK NECESSARY (TIGHT LOT) FEE HOUSE SEWER -1/4" FT. 4 "0; TYPE PIPE SUBDIVISION>S� "7 NO BENDS; MAX.BENDS 45° W /CLEANOUT LEGAL SUBDMSION %� FILL SYSTEMS 7-SUBDIVISION-APPROVAL CHECKED CLAY BARRIER PERC RATE10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE FILL REQUIRED_ DEPTH FILL SPECS FILL NOTES CURTAN DRAIN REQUIRED FILL CERTIFICATION NOTE ANDPIPES DEPTH GAUGES GENERAL ILL PROFILE & DIM)✓T7SIONSR i LOCATED IN NYC WATERSHED VOLUME PLANS SUBMITTED TO DEP FILL IN EXPANSION AREA DELEGATED TO PCHD TREDjCH �CJ DEPAPPROVAL, IF REQ'D LF TRENCH PROVIDED 60 FT MAX. DEEP TEST HOLES OBSERVED 1,,nPARALLEL TO CONTOURS PPRCS TO BE WITNESSED = 100% EXPANSION PROVIDED E2- APPROVAL SSDS ADJ. LOTS SEPARATION DISTANCES SPECIFIED WETLANDS (TOWN/DEC PERMIT REQ'D ?) ON PLAN - FROM SSTS DATA ON DDS PLANS & PERMIT SAME 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL RE 1969 NEIGHBOR NOTIFICATION 20' TO FOUNDATION WALLS _15'WELL TO PL E-ITER BUZBA 100' TO WELL, 200' IN DLOD, 150' PITS 00:KR- FLOOD'- EEEVA`IT0N 100' TO STREAM WATERCOURSE LAKE (inc. expan) QTFER REQ'D PERMITS) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER MQUIRED DETAILS ON PLANS 10' TO WATER LINE (pits -20') SEWAGE SYSTEM PLAN - (NORTH ARROW) 50' INTERMITTENT DRAINAGE. COURSE i SS IDS HYDRAULIC PROFILE 200'/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS GRAVITY FLOW 00` COiiSTRUCTION NOTES 15'MIN to CDS= >50/.,*'- 4 %,25'- 3 %,30'- 2 0/.,35' -1 %,100' - <1% DESGN DATA: PERC & DEEP RESULTS 20'MIN to CD discharge /100'with 182 cons day discharge IT ONTOURS EXISTING & PROPOSED SEPTIC C TANK DRidEWAY & SLOPES, CUT 10' FROM FOUNDATION; 50' TO WELL FO(lnNG /GUTTER/CURTAIN DRAINS WELL SOL TYPE BOUNDARIES DIMENSIONS TO PROPERTY LINE TI-LE BLOCK; OWNERS NAME,ADDRESS LOCATION OF SERVICE CONNECTION TVL,,PE/RA; NAME,ADDRESS,PHONE4 v J r DA E OF DRAWING/REVISION V� u 2 �u �- DA!UM REFERENCE J LOCATION OF WATERCOURSES, PONDS ___ _.. -• -• — —� LAIES AND WETLANDS WITHIN 200 FEET it ®PI2(POSED FINISH FLOOR AND BASEMENT EL. jJ CONINIEWS: 1 ..�,. PUTNAM COUNTY DEPARTMENT OF HEALTH �b DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM 7 � 64/7i/ 1414_ Owner I - R® 5 N 61-0 Z Address f_'Ao1 �gh Located at (Street) ��9 ��� r�/' Tax Map 'Block %� Lot r (indicate nearest cross street) Municipality Drainage Basin,�1s~i SOIL PERCOLATION TEST DATA Date of Pre - soaking $ — /a- 9j Date of Percolation Test g Hole No. Run No. Time Start - Stop Ela se Time Min.) De�pth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 2 9,00 - 9.6� '� Oro `` d,s' k 3 02. 3 B 3 g;O ? -9./5— 'r)Si i 3/1 s V s ��a -9;33 aa'' �2�'' 3 r' 3 2 3o 3 30 4 5 1 2 3 4 ;5;, NOTES,.-',' ' 1..Tests,.to be repeated at same depth until approximately equal percolation rates are obtained at each ` percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be ? submitted for review. Depth,measurements to be made from top of hole. 21�60^0- lv ��T C31 _ j�� Form DD -97 6� S of r/3- QI-30 �C)T# /0 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' LF 2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO.� HOLE NO. Indicate level at which groundwater is encountered Alolt� Indicate level at which mottling is observed A Indicate level to which water level rises after being encountered% Diholgobservations made by: Date LDatlkn P�Lpfessional Name: 1, gt2P- ;7-- .A r� ssa cif /TUW&/ X040 AIL�. LLJ Signature: dr) 4Ai L , Design Professional's Seal p��pf NEW y04 yh NICNQ�� ¢ * c ul tu �No. 56124 pAOFESS����� LAURENT ENGINEERING ASSOCIATES, P.C. 20 Milltown Road Brewster, NY 10508 Telephone (91 4) 278 -6108 Fax (914) 278-2658 To: PC--14n Attention:5 MUK, �4" Laurent Engineering Date: 81 i6 Job No.: TOGO— I O Project: 95-4—A 6 1 L-G (T) PA LM . Im rd Gentlemen: We enclose (�) copies of: O B/W Prints O Reproducibles ❑ Reports O Specifications O Memorandum O Copy of Letter Description: Sent Via: O Our Messenger ❑ Blueprinler O Your Messenger O Hand Delivery Copy la O Tracings O Revision /Date No.' O First Class Moil O Special Delivery C Very truly yours. LAURENT ENGINEERING ASSOCIATES,P.C. Per: �- ✓ /`– IF T- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT S' S to NS E�" DR I ve- ! ~ / 0 �Q Located at v Subdivision name f �;,,�;.s Subd. Lot # to Date Subdivision Approved cq /6 e:!5k Owner /Applicant Name t�, "Ovr- "14✓ Wes Mailing Address (q q G . LZ Amount of Fee Enclosed Town or Village P'A7MW--,ff*) Tax Map 4,t_+_ Block _L_ Lot 11 Renewal Revision Date of Previous Approval Zipa c Building Type Rz- siar-ik-- Lot Area fiNo. of Bedrooms A— Design Flow GPD, Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of j zip gallon septic tank and c s r . Vj Other Requirements: a4,,,j&agc � To be constructed by 4fX,, vie ;/' Address Water Supply: Public Supply From Address or: Private Supply Drilled by ( ]` ZQ Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or pNrepairs thereto. �-- -� Address ,057672- R.A. Date / M Z- py License # OS-715-41, APPROVED FOR CONS'T'RUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new perm�i£- proved f scharge of domestic sanitary sewage only. By: Title: M—A-/— - Date: t� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design 4fessional Form CP -97 BRUCE R. FOLEY Public Health Director k LORETTA MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, . New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 August 20, 1999 Harry Nichols Laurent Associates NEllbrook Office Centre Route 22 & Milltown Road Brewster NY 10509 Re: Proposed SSTS: Stabile, Quaker Ridge Drive Quaker Ridge Estates, Lot# 10 (T) Patterson, TM# 4.14 -1 -11 Dear Mr. Nichols: Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. 1. Show limits of 100 -year flood plain elevation or add a note to the plans stating none exist within 200 feet of property line. 2. Provide erosion control measure for the house. 3. Dimensions of the fill pad are to be provided on the fill plan. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, S Z4Rogan SR:tn Public Health Technician HARRY W. NICHOLS JR., P.E. March 30, 1999 \ j \ LAURENT ENGINEERING MILL ROO EIO F CE CENTRE Route 22 8 Milltown Road Brewster, New York 10509 (914)278.6106 - (FAX) 278 -2658 CONSULTING SITE ENGINEERS Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS (Renewal, increase in bedrooms) Pietro Stabile Quaker Ridge Drive - Lot #10 Town of Patterson Dear Robert: Enclosed are the following: 1. Five (5) prints of SS -10, "Proposed SSDS," dated 3- 30 -99. 2. "Short EAF," dated 3- 30 -99. 3. "Application For Approval of Plans For a Wastewater Disposal System." 4. "Construction Permit for Sewage Disposal System," dated 3- 30 -99. 5. "Application to Construct a Water Well," dated 3- 30 -99. 6. "Design Data Sheet." 7. "Letter of Authorization," dated 3- 30 -99. 8. Two (2) copies of Residence Floor Plan(s), for `Bedroom Count Only." 9. Review Fee in the amount of $300.00 We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. r' GvL,v Harry W. Nichols Jr., P.E. HWN:JM:his 91060 To: LAURENT ENGINEERING W ASSOCIATES, P.C. MIL.LBRCCK2 04:7710E CENTRE RoAd / \ \ Biw, sw,, NO- Yom WWII (914)27&41CA . (FAX) 275.2'--58 CONSULTING SrfE ENGINEERS Date: 4 26 Job No.: Project:, CT PMQL�aK Attention: �- Gentlemen: We enclose (L) copies of: • BAY Prints O Reproducibles O Reports O Tracings • Specifications O Memorandum O Copy of letter O Description: Revision /Date No. Sent Via: • Our Messenger O Blueprinter O First Class Mail O Special Delivery • Your Messenger O Hand Delivery O Copy to: Very truly yours. LAURENT ENGINEERING ASSOCIOicS, P,C. Per: -- -- -- - -- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES PERMIT # CONSTRUCTION PERMIT FOR SE ENT SYSTEM .P- �58 ^ 04- Located at Q U �k —��-- R-1 D b�--1� Town or Village Subdivision name 6'Jhy- 4-- Subd. Lot # 1 D Tax Map 4.14 Block Lot I Date Subdivision Approved Owner /Applicant Name P ) EErR-o Mailing Address 7406 �p f rn t-AN15' Amount of Fee Enclosed 4 19? &40 Renewal x Revision X Date of Previous Approval GjL&-N1M-L61 hli . Zip Il�jfi�J Building Type Rh iL16Nc-E, Lot Area f�'W No. of Bedrooms 4 Design Flow GPD Ob Fill Section Only X_ Depth t' Volume Q6 Li PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of I �60 gallon septic tank and 500 1,F A65 Other Requirements: DaS�N�a 51 P H a N 1f LL 1 To be constructed by Address Water Sunnly: Public Supply From Address or: Private Supply Drilled by T ` 0 'V' Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date � / IM 11 License # JI 0 14 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only. Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 um PUTNAIJI COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION Property of _ PIETp -6 z57pc$ aJ,� Located at �J � �" �(A T/V PA TMA-" H Tax Map # 4,14 Block Subdivision of aVP(V-6F— �LkPkl�- I Lot 11 Subdivision Lot 9 10 Filed Map r Date Filed Gentlemen: This letter is to authorize {� �`l W `� a duly licensed Professional Engineer or Registered Architect to apply for the required wastewater treatment and/or water supply permits) to serve the above -noted property in accordance with the standards, rules or revelations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam Count; Sanitary Code. NEW y ®� NIcl -j T Very truly yours, Countersigned: r W Signed:1� P.E., R.A., # 07 (Owner of Property) kN 0. 5612 Mailing Address � Mailing Address: 146 64 j"- LftN� BP_5tN'?- EP- (4 ILt�N PA-LC= State NEll iO4LZip 0701 State NEB Y,Oi-- Zip Telephone: (q H� �7� '%b Telephone: Fonn LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: Pt TIRO �5i AI311. GH m Lf�ME 2. Name of project: 1 HD N 1 D%A L- 3 Location T/V • P 6, rrEv-6D N 4. Design Professional: 'A-V-f--1 6. Drainage Basin: r-NbT 7. Tyne of PrgLect: k Private/Residential Apartments Office Building y� N►c t�►f -�; ��- QGS. Address: 2s? mi►-i WtA F2 'D Food Service Institutional Realty Subdivision Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) .....................:. ............................... Type I Exempt Type II Unlisted X 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... No 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency 12. Is this• project in an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... 13. If so, have plans been submitted to such authorities? ........ ............................... 14. Has preliminary approval been granted by such authorities? No Date granted: 144 NA YES NO NA 15. Type of Sewage Treatment System Discharge ................. surface water x groundwater 16. If surface water discharge, what is the stream class designation? .................... NA 17. Waters index number (surface) ............................................ ............................... N& 18. Is project located near a public water supply system? Nil 19. If yes, name of water supply NN Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ 1A 21. Name of sewage system I NA Distance to sewage system W A 22. Date test holes observed 23. Name of Health Inspector 24. Project design flow (gallons per day) ................................. ............................... $� 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... Np 26. Has SPDES Application been submitted to local DEC office? IA Fnrm Pr-07 2 27. Is any portion of this project located within a designated Town or State wetland.? No 28. Wetlands ID Number ........................................................... ............................... N R 29. Is Wetlands Permit required? ......................................:....... ... ............................. 1-0 Has application been made to Town or Local DEC office? ...:........................... N A 30. Does project require a DEC Stream Disturbance Permit? 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfillin stud e application or industrial active Yes/No ° 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No. N Q DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... DES 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... NQ 35. Are any sewage treatment areas in excess of 15% slope? . ............................... Fit) 36. Tax Map ID Number .......................... ............................... Map 4,14 Block 1 Lot it 37. Approved plans are to be returned to ..... Applicant "� Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater,plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I 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 Penal Law. SIGNATURES & OFFICIAL TITLES: RA W Mailing Address 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only art 1 - PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR: i- �1cT4 Sri A4311L 45 12. PROJECT NAME: 1N1(V 1bVAL— '5 '6 3. PROJECT LOCATION: Municipality PA7TF1260N County PVT`NAM �. PRECISE LOCATION: (Street address and road intersections, prominent landmarks, etc., or provide map) aV Af -6IZ, i 4P64f5 D P V�-�- 3. PROPOSED ACTION IS: &New OExpansion 0Modification /alteration i. DESCRIBE PROJECT BRIEFLY: 1 Np i j i1),J N L- , iN 6I4-+ bP— if) Ci�4z '. AMOUNT OF LAND AFFECTED: Initially '%? -606 acres Ultimately 'k696 acres 1. W /ILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Ayes ONo If No, describe briefly WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑Industrial• . _ OCommercial OAgricultural OPark /Forest /Open space OOther Describe: Io I NgL,6 PA HiL.Y i 0. DOES ACTIOIN INVOLVE A PERiN11T APPROVAL, OR FUNDING, NOW OR ULTIMATELY FR011.1 ANY OTHER GOVERNrNIENTAL AGENCY (FEDERAL, STATE OR LOCAL;? OYes 12kNo If yes, list agency(s) name and permit /approvals 1. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? OYes IkNo If yes, list agency(s) name and permit /approval ?. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? OYes *qo I CERTIFY THAT THE li i,F^0'RM T ION PROVIDED ABOVE IS TRUE TO THE BEST 0= t.1Y KNOWLEDGE t'1'AE - r W NI 4fJia5 iy ` ()E, L:'._ Al l! If the action is in a Coastal Area, and you are a state agency, com, ;e-.e a For;rt Irafora proceeding v:ith this assess^ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL Q vlease print or tvDe PCHD Permit # i Well Location• • Street Address: Tow_nNillage Tax Grid # QU n-o-- PO(Ae DOE F T F—WA Map 4-14 Block I Lot(s) 1S Well Owner: Name: Address: 6 L�5N© rr> , NY 09595 Use of Well: X Residential Public Supply Air/Cond./Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served � � Est. of Daily Usage al. Reason for _ Replace Existing Supply Test/Observation Additional Supply D!2 ng New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Drilled Driven Gravel Other Well Type Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ......... Yes 7G No ............................ ............................... . Name of subdivision ppuo F— -'5V N'rr=-1) Lot No. _ Water Well Contractor: U : Address: ................................ ............................... Yes No Is Public Water Supply available to site? .. k Name of Public Water Supply: -- TownNillage - Distance to property from nearest water main: -- Proposed well location & sources of contamination to be provided on separate s he et/plan. Date: a 9 Applicant Signature: V PERMIT TO CONSTRUCT A WATER WELL Tlis permit to construct one water well as set forth above, is granted under provisions of Article 10 of the P,rinain County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided th't within thirty .(30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the reluirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or W41 driller shall take appropriate action to assure that any and all water and waste products from such wall drilling operations be contained on this property and in such a manner as not to degrade or otherwise cantarninate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be awonded or modified when considered necessary by the Public Health Director. Any revision or alteration ofthe approved plan requires a new permit. Well to be constructed by a water rw driller certified by Putnam G -Unty. I]t-te of Issue 1q,'/eU1'q P ermit Issuing Official: IAte of Expiratio Title: — P Knit is Non- Transfe ble mite copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP-97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT � �, , TREATMENT SYSTEM PERMIT # )0 3 0 - Fj f 7_ ! 3- r ' Town or Village ea>�i+�S Tax Map At. 1�1 Block I Lot 1 a_ Located at 0 „ r k Subdivision name gj � � Subd. Lot # 10 Date Subdivision Approved Owner /Applicant Name --8 r, irn Mailing Address 174 6 �- (,t 4 1e Renewal wl'** Revision Date of Previous Approval 10 3 zip— Amount of Fee Enclosed O b od Building Type te ell< � `Lot Area 3, a9& No. of Bedrooms 4 Design Flow GPD 19610 Fill Section Only Depth 1 )-w c.y,.Volume Separate Sewerage SXstem to consist of —L I. gallon septic tank and 000 Z r. Other Requirements: S To be constructed by 1'J Address Water Suuoly- Public Supply From Address --j- - __1/ Private Supply Drilled by Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the Seurat ewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the that said Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, builder will place in good operating condition any part of said sewage treatment system during the period of two (2) y ears immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date -7 -9-5� License # mil° f 2- APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the s ,ewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires new pe Approve r discharge of domestic sanitary sewage only. By: Title: Date: White copy - 110 File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional CP -97 Form BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 April 22, 1999 Harry Nichols Laurent Associates Millbrook Office Centre Route 22 & Milltown Road Brewster NY 10509 RE: Application to Construct a Subsurface Sewage Treatment System at Stabile, Quaker Ridge Road, Lot #10 (T)Patterson, TM# 4.14 -1 -11 Dear Mr. Nichols: The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on April 22, 1999 is incomplete. Please be advised that the following information is required before the Department may commence its review. • Please submit two sets of house plans for the above - referenced project. The review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information as to the completeness of your application. Please be advised that failure to submit information to the Department or to follow procedures is sufficient grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed Regulations and Putnam County Department of Health regulations. Should you have any questions or care to discuss this matter, please contact me at (914) 278 -6130 ext. 166. Verl, r ly your Robert Morris, P. E. RM /tn Senior Public Health Engineer rc1xA>�twNTY vaBrABmxromBEeLTg 7,~-- , -- -- - - - -- toPravldeler�ll 9 DhMwdReeiesimm ei! Saev0oas, CaaaneL ILY.1a'i12 as CIIHiD?ICATS OF COMPI M2 CON51M M MUM MR SEWAGE DISPOSAL SYSTEM Ltia/iladat Str6irYw Nacre Lat / TM Map— '1—=°1 —Black L't �LL� Revwm p Olf..dApp&@st Rivals �.�29 -� Do" of Prevbaa Apr, ,W 'mil � dG� �4� . �..-A J r TO" I�LEI YJ�I.6 '#�1.'� Maiij Addaaw TJp Date Subdivision ARRroved �y, / Fee Enclosed 'Amn„nt �e 1yp, ` 1 h I Q L Lot Aaan 4 6 K6_ A e- •fi Flk S-6. 0* r 1 Depib.�valome in G Nobar d Beiw�a �Z Dealan Flow G P D (DbD PCBD Nodkittloe IS Ra mh d Wbse Fso Ir o"Mob ed Sapaaeta Sova m* S7eiaea a oaaaid Of + 6� GlBan Serdc Tank X�� T* be., by Addn" Water Suppir p Sappy Fitess Milton an ✓ Pd d. Sevpb' DAW by Ad&.n IV Otbar R-Pbeomb 1 represent that 1 am wholly and completely responsiplefor the design and location of the proposed system(s). 1) that the separate saw disposal s stem !trove described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a ragu ns o nam County Department of FIMRh, and that on compNEion thereof a "Certificate of Construrtlon Compliance" satisfactory to the Commissioner of Heelthwill be Submitted to the department, and a written 1warantee will be turnish" the owner, his successois, heirs or assigns by the builder, that sahl builder will place in good operating condition sniy part of aid a wa," disposal, system during the period of two (2) years Immediately following thedate of the inu- anp oR the approval of the Certificate of Construction ''Complianu of, lhr originel system or.any repairs thereto; i) that the drilled well described above will M loeaed as shown on the eppioved glen and that ssld well wi • in ` ccordanp with. he sta is rules vnd r iaii ns of the Putnam County Oepartmerlt of HYlih. Cate Sign P.E. R.A.- Add►.ss qp 1!:�61 i� 1 1 —ice l� license No 422 6 t APPROVED FOR COIVSTRUCTIOM This approval axpins two y"05 hofn•tha ,date . iswad un s construction of the building .Ms been undertaken and is m revocable for cause or may be a ended or modified.wheii considsiedn 'gory by _ the Commissioner of Health. Any Change or alteration of construction "quires a new perm Approve0 /foorr' disposal of domestic sanitary' sewage and /or MW Supply only. 10/88 —�.— �— = / i / � � _lore /may_ s m m-� - v 77 D u 0 �• � r ➢ -.i ((� �Ar i'r r "I �1 h Ye ' i iSt F'�m� - Fr�Q I�:Fto- a A m N N V =O � � C � D � � Z � ➢ 'Ill 4 ir;iy!�Yr h�li�:4 � � rll���i / r i 1, ;,;fit!. it 0 Z N N 0 ➢ �¢ ® o �i ILI m 4 / i / � � _lore /may_ s m —� D u 0 �• Q Y ➢ -.i ((� �Ar i'r r "I �1 h Ye ' i iSt F'�m� - Fr�Q I�:Fto- a A m N N V =O � � C � D � � Z � ➢ 'Ill rn ir;iy!�Yr h�li�:4 � � rll���i r r i 1, ;,;fit!. it 0 Z N N 0 ➢ �¢ ® o �i m LAURENT ENGINEERING ASSOCIATES, PC. 73 FAIRFIELD DRIVE PATTERSON, NEW YORK 12563 RANDOLPH W. LAURENT. PE. (914).278.6108 -(FAX) 278-2658 HARRY W. NICHOLS, JR., PE. CONSULTING SITE ENGINEERS September 23, 199• Mr. William Hedges Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Renewal Quaker Ridge Drive Patterson, N.Y. Dear psi I I g Enclosed are the following: 1. "Application For Approval of Plans For a Wastewater disposal System". 2. "Construction Permit for Sewage Disposal System", dated 9-23-93. 3. "Application to Construct a Water Well",..dated 9-23-9 . 3. 4. Three (3) prints of Drawing SF-10 "Preliminary Design For .Fill Placement Only", dated 9-8-93. 5. One (1) print of Drawing SS-10 "Proposed SSDS". dated 9-893. 6. "Letter of Authorization", dated 6-22-92. 7. "Design Data Sheet". We would appreciate your review, approval and issuance of the renewal Construction Permit at your earliest convenience. Sincerely,, LAURENT ENGINEERING ASSOCIATES, P.C. Randolph W. Laurent, P.E. RWL.-bd 91060 enc. CC., Mr. Stabile w/enc. L��U'�'N.A.� COiJN'r"SZ" �Ep,A,Rx"MEIV•'T' Off' HEAx.'T� .;;..APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: D �J�ihI L t�rti= 2. Name of Project: 1��'l%(�D�J�t� ��C>5 ti i��� 3.._, Location /C: to 4. Project Engineer: N� �� :-uN� 5. Address: or ziy$ License Number: r'�:��d� Phone: 6. Type of Project: Private /Residential Food-Service - ...Commercial Apartments Institutional Mobile Home Park Office Building 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? iJ y 9. Has .DEIS been completed and 'found acceptable by Lead Agency? ....... n) 10. Name of Lead Agency tI.- Is this project in an area under the control of -local planning, zoning, or other officials, ordinances? K)d 12. If so, have plans been submitted to such, author .sties.....__. .............. r�/A_ 13. Has preliminary approval :been' granted by such authorities? N�f� Date Granted: 14. Type of Sewage Disposal. System Discharge...... Surface water Ground Waters 15. If surface water discharge, what is the stream class designation ?........ /A :6. Waters index number (surface) ................. r7. Is project located near a public water supply system? .................. ►J 0 S. If yes, name of water supply QJA Distance to�water supply , 9. Is project site near a public sewage collection or disposal system ?..... IJD 0. Name of sewage system Q/A Distance to sewage, system I- Date observed: 23. Name of Health Inspector: 1.. Project design flow (gallons per day) ..................... D/) _ r 2. 25. Is State Pollutant Discharge Elimination- System (SPDES) Permit required ?.. �p , 26. Has SPDES-Application been submitted to local DEC Office? ............... t,1 >A - ;r. 27. Is any portion of this project located Within a designated Town or State wetland?..* ............................................................... �)�) 28. wetland ID Number ...................... .. ...................•........... IJ /d 29.-Is wetland Permit= required? .............. ............................... Has application been made to Town or Local DEC Office? .................. A, 30. Does project require a DEC Stream Disturbance - Permit? ................... 31. Is or was project site used. for agricultural activity involving application of pesticide$ to orchards or other crops, solid or hazardous waste disposal;``'` landfilling, sludge application or industrial activity? ........ YES or NO K)o 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 Q DESCRIBE: 33. Is there a local raster plan or file with the Town or Village? ........... 34. Are con-nunity water, sewer facilities planned to be developed within 15 years? 0N1c'N3A00 35. Are any sewage disposal areas in excess of' 15-0 slope? ........................... 90 36. Tax Hap ID Number ......................... .........-.l 37. Approved Plans are'to"be. returned to: ................ . App-licant 1/ Engineer If the application is signed by a person other than the applicant shown in Item.1, the. application must be-accompanied by-a Letter of Authorization. Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this fora is true to the best of my know7edge and belief. False statements made herein are punishable as a Class A Hisde-neanor pursuant to Section 210.45 of the Pena, Law. SIGNATURES & OFFICIAL TITL TAILING ADDRESS: t!-:20 tom) K) DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New -York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # r, - $ ?, -9)4 WELL LOCATION Street Address o Village City Tax Grid Number WELL OWNER Naime I I Mailing Address oPrivate O Public USE OF WELL (D- primary 2- secondary ® RE IDENTIAL 0 BUSINESS 13 INDUSTRIAL ❑ PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION b INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT !J gpm /# IO REPLACE EXISTING SUPPLY NEW SUPPLY NEW DWELLING PEOPLE SERVED 0 /EST. OF DAILY USAGE - 2fb al O TEST /OBSERVATION 12. ADDITIONAL SUPPLY O DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING L WELL TYPE DRILLED DRIVEN ODUG OGRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES ✓ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:U Lot Nb. Ip WATER WELL CONTRACTOR: Name 'm G' Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: Wk TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED f3ON SEPARATE SHEET IIIV' ?V7 2 (date) ( dignature) 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 thirt;• (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 Department attached to this permit. 3. Submit a Well Completion Report on a form requirements of the Putnam County Health 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 manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: �'� 19 -�J- ,Date of Expiration 19 Permit Issuing Officia Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller PUI :M COUNTY DEPARTMENT OF HE 'rH DIVISION OF ENVIRONMENTAL HEALTH SERVICES D a t e v► iwi, .0 2'1- Re: Property of r/ Located at C?�__k,j ('P (T �-Section Block Lot Subdivision of_C����c Subdv. Lot # /0 Gentlemen: Filed Map # This letter is to authorizL��v-,CAwG A ''v Date a duly licensed professional engineer --or registered architect (Indica e) to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules. or regulations as promulagated by the. Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Cou 7_3 lie S� r Address ! '2 (9/O 2 7cP - 6/oCP elephone Very truly yours, Signed Owner of Property 7wor G4. Address Town Telephone AMMER : Street Town ry States Zip . PERSON IN CHARGE OR Name `and °Title " 4 F TYPE OF FACILITY . "--TIN 44 Aeff e��, r4 ' r r JF �. _ e INSPECTOR!' , Signature and Title RFPORT RFCV..TVF.T) RY:- - I Icknowledge receipt of this report SIGNATURE; 02/96 Title. Rev. - _ DES%GN DATA SHEET- SUBSUFACE SEKAGE DISPOSAL SYSTEM FILE NO. Ownertl 0 `�� ✓ PzUress '7�0 l- 1�� !raLffOr3A1 -- Located at (street) aUA. - fz1l76r� u� Sec_ L} . 14 Block' f Lot 1 l (indi n est cross street) M.unicirelity fA Watershed D SOIL PE ODUOICN TEST DATA REQUIRED TO HE SU.&Ml TED W= APPLICA'LTICNS Date of Pre - Soaking Date of Percolation Test _ I� HOLE Mw—BER C= TIME PERCQLATIGN PEROC)=ON Run Elapse Depth to Water Fran Water Level— No. T� Ground Surface In Inches Soil Rate Start Stop Min. Start Stop Drop In Min /?h Drop Inches Inches Inches 2 :;�5 , o .4. .5 .. 3 4 0 1 2 3 4 5 -1/9 NOI: 1.' Tests to be repeated• at saim depth until approximately equal: soil rates. are' obtained at each percolation test hole.. All data to' be svkznitted for review. 2. Depth measurements to be made from top of hole. rev. 9 /g5 TEST DATA REQUIRED TO BE SUBMITTED WLTH APPLICATION DESCR1:PTI0N OF SOILS IN TEST HOLES DEPTH HOLE NO. 1 HOLE N0. HOLE NO. G.L. 1' 21 3' 41 51 61 7r 8' 91 101 11r 12' 13' 141' INDICATE LEVEL AT WHICH GROUNgRATER IS ENCOUN =D INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENOOUNTERED DEEP HOLE OBSERVATIONS MADE BY: � DATE : . DESIGN Soil Rate Used �%jl, Min/1" Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity J,B" gals.- Type Absorption Area Provided By j pp L.F. x 24" width trench Other `� I a2 0 ► L!. I a L _ Ir7' 1JIA r -7k -,I ) Nam- � A N ill», 111. LAU F_: =O Signature T Address SEAL THIS SPACE.-FOR USE BY-HEALTH DEPA.RnMU ONLY: Soil Rate Approved sq.ft /gal. Checked by rl) 5 f zr. ,tj� m z� Date i *. ' 1 rsipraiiottMl 1 am wholly slid- comPMte+ly rafpontiblefp�tha desgn_arW location of ,tna p►opo'sad sYtym(s) 1) "that tM`ttparat.»w ` ^di fil. SY 'item • abovb dasuiMd, wilt;bp'cbnstruaiii'as sit v o on theapprovb•aniendlnent there'tii and'in_ accordance with.the-Standards, iules a r"u Ions o naf"- County Deportment uoI iiisftl, and tMt.on eom'piytion;thpswf a "Cartdiati, of Construction Compliance fatisfaetory to tlia Cominissiorpr.,of H4*,Rhwflt be aubmitt d''to. ift 0apartlii nt an0 a zwNtten !,tiwnnf a will ba YuinisllW _tne ovrnar his wcaagas,'MNs oasesipras'bY the builder, that }saf0 Oui " will i>f+>n in poel opNileM a eontlifion any =art of =tiW t/Mla/a''dispof�l syitam au.flp,.tn. paifoA >of two (z) j4dr(i nmedlatlly fotgwfi» tMAata'bf`tfN NIU- aha of tM `aOproval 01 tM Cartltkate- o/ Construction'.Com a oigfnal ystNn or any r Ms t_rit that tM dNINd M well desalbsb, pbovp tlrlN M loeatid as fherirn:on tM "proved plan and tl+at YW well w be I, stalNd n acco nq Rh tM:- uNS, anA ►pq ns of `•the Putnam ,,. j... ...d i+ County rtmant of,,FlNn� Data Address '%® r r w� -i y[1.cen se No APPROVED FOR CONSTRUCTION Thisvpp►ovalAxpires two years from tM.dab iislfad unNSS constiuetiOn ;o/ 'the building 1►as bean uedeitaken and is evocable for cause or, may, be• amerxeee, or, nioditistd wMn eonsidarsid nacaSss► by the °,Commj*Wonei of; •,Health ,Any chinas or sneration of corart►uction squires a niw parmit. A rovad /or AispOSal of donl'istie sanitary saw ;and /d► "privaH .water supply only -Rev. 10/88 Wte BY Title 17 �� 2 �/ !9'E -per �'� � �i ;. /� `'� `' � �P`�V /� � y�Q, ,O ,B � ' ,. � , �; � �`;� : � � � gyp.,, � - � � ,, i ,�,^' � - ` � ,. � �� �, � �; . = � � �y , '(P' `` 4 � .. � \ i� ;`. .. t ���� F �.�.,,,I 'Dr. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FYhE N0. Owner L, C— AZbE1,C SOA36ZJr- Address Located at (Street Sec. Block Lot n ica e . nearest cross s ree Municipality % Watershed dyc SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED.WITH APPLICATIONS Hole- Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Water T e No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. "Start Stop Drop in Min. /in.drop Inches Inches. Inches- 1 1z "00 IZ:!4Q !49 AD 212-'4- f:2Zr 31123- -16. 4 to I Z 12' a) It., _a 2ft'1 35-- (: t% Z 67 I vg 3 . 5 Notes: 1) Tuts to be repeated at same depth until apppproximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. ( HOLE NO. HOLE NO. G.L. 'p IL_ 6" 12" 18" ... 2411 LOAM 301 3 6 if 42" 48" 54 it 6o" 6b„ { s 72" r 78 .. 84" ... INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED f INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE. BY . - j'/(/ . `; ; ° '; .,Date DE_ IGN Soil Rate Used3 Min/l "Drop: S.D. Usable �- No. of Bedrooms Sept 'c Tank Capacity jC } �� 0� r' �a B Absorption_ Area Proves By _C L. F. x24 lob R u- 5 tZ ET"1�1. e_,j27. . Name bignature Address SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date. DEPARTMENT OF HEALTH - Division Of Environmental Health Services Ceneva Road, Brewster, New York 10509 (914) 278 -6130 Randolph Laurent, P.E. 73 Fairfield Drive Patterson, New York 12563 Dear Mr, Laurent: Nice try, but you lose. WH :cj cc: MB Encl. July 13, 1993 JOHN KARELL Jr., P.E., M.S. Public Health Director Re: Renewal; Construction Permit P- 38 -84, Stabile Quaker Ridge Drive Patterson, New York TM# 4.14 -111 Very truly! yours, William Hedges $r. Public Health Sanitarian LAURENT ENGINEERING ASSOCIATES, PC. 73 FAIRFIELD DRIVE PATTERSON, NEW YORK 12563 RANDOLPH W. LAURENT, PE. (914) 278.6168 - (FAX) 278 -2658 HARRY W NICHOLS, JR.; PE. CONSULTING SITE ENGINEERS July 8, 1993 Mr. William Hedges Putnam County ,Health Department 4 Geneva -Road Brewster, NY 10509 RE:, Pie , tro Stabile T.M. 4.14-1-11 Quaker Ridge Drive Patterson, N.Y. Dear Bill: Ref erence is made to our recent renewal request for the above referenced lot submitted by our letter dated June 22, 1993. Since this is, our second revewal re ei quest th first request submitted on July 15, 1991, we don't feel that it is necessary to submit a new plan since we are the engineers of record and which was granted a renewal prior to the PCHD adopting a new policy on March, 22,,:.:1993.. We would appreciate your consideration in thi's matter. Sincerely, ENT ENGINEE NG ASSOCIATES, P.C. andolph Laurent, P.E. RWL:bd 91060 iflf [661 nd 03AII LAURENT ENGINEERING ASSOCIATES, PC.- 73 FAIRFIELD DRIVE PATTERSON: NEW YORK 12563 RANDOLPH W. LAURENT, PE. (914) 278.6108 - (FAX) 278-2658. HARRY W. NICHOLS, JR., PE. CONSULTING SITE ENGINEERS June 22, 1993 Mr. William Hedges, Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS and Well Renewal Permit No. P-38-84 Pietro Stabile Quaker Ridge Drive Patterson, N.Y. Dear Bill: Enclosed are the following: 1. "Construction Permit for Sewage Disposal System", dated 6-22-93. 2. ."Letter of Authorization", dated 6-22-93. 3. '!Application to Construct Water Well", dated 6-22-93. The Construction Permit.was previously renewed July 24, 1991., We would appreciate your review, approval and issuance of the renewal Construction Permit at your earliest convenience. Sincerely, LAURENT ENGINEERI fj"SSOCIATESF P.C. Randolph W. urent, P.E. RWL:bd enc. cc: Mr. P. Stabile 'A DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 ' (914) 2-781*-6130 APPL-I*iZ.'A'T-ION .T(J,,COINSTRUCT .A.. WATER WELL PCHD PERMIT f. W . ELL Lo CATI ON Street Atre a Ton / —lilsoetetry Tax Grid umber v V._./ —/ . VV-1 sm WtLL_0WEA Name 'Mailing Ad ' dress 77, IVX. A a P_ ri IV a t E3 Public SE,. OF WELL primary. , -.secondary, RESIDENTIAL OPUBLIC 'SUPPLY "Oft/HEAt PUMP �0-iiim -/OBSERVATION O INDUSTRIAL 0 INSTITUTIONAL b, STAND-BY C7 ABANDONED 0 OTHER (specify 113. AMOUNT OF„ USE. YIELD SOUGHT '44: gpm/# PEOPLE SERVED,-._ ,/EST. OF DAILY USAGE 96'V Sal :O REPLACE .'EXISTING SUPPLY El TEST/OBSERVAT -ION -13 ADDITIONAL SUPPLY NEW s UPPLj (NEW DWELLiNd) 1j:DEEPEN 'E, ISTING.:WELL REASON .FOR bk-l" NG LLt DETAILED REASON FOR DRILLING WELL TYPE DRILLED E)6RIVEN i"I'DtG E] O'GRAVEL :0 �' OTHER ..IS,.- WELL _ SITE. SUBJECT TO FLOODING? -..YES 'NO. IF WELL IS LOCA-M I ''A s DIVISION, NAME �`OF `SUBDIVISION:_.- No. 'CIO Lot' VA7ER WELL CONTRACTOR: Is PUBLIC WATER SUPPLY AVAILABLE TO'SITE: YES No NAKE. 'OF, PUBtiC. _WATER SUPPLY T6WN/VIL/CITY DISTANCE TO.PROPEkTY FROM*NEAREST WATER RAIN: LocArioN SKETCH ES OF C 0 NT AMINATION P []ON., SEPARATE` SHEET ICX4.0 :Odate) g 'na tt i 'r'-e PERMIT TO 'CONSTRUCT A WATER . . WELL This permitto construct one water well .as set forth above-is granted under the-'provisions .,of Subp4it 5-2 of Part 5 of the*New'York Siake Sanitar! Y Code. and provided that within thin;- (30) days of the completion .-Of,wa-ter''we'll construction.' the applicant shall: 1. .Pump the well until -'the water' is clear. 2. Disinf ect.-, the well in acdordance with the requirements of the' Putnam County* -Health Pepartment.a.ttached to this permit. 3. . Submit a Well Comple t . ion . Report 1. on a'iorm provided by the Putnam County Health Department. .,bu v kig all well drilling operations_, the applicant shall take ap'p'ropriate 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 de,grade'or: otherwise contaminate surface or groundwater. Date. of Issue: 19 Date of Expiration 19 .,Permit Issuing Official 'Permit is Non-Transferrable 3/8 y White 'copy: 'HD File Pink copy:, Owner Yellow copy,. ' . Bldg' Insp. Orange copy:-Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date 1 3 Re: Property of I +�hp • Located at ,_` . (T) Section Block Lot Subdivision of C`jlQ �dC •p G���TQ c Subdv. Lot # /0 Filed Map # Date Gentlemen: This letter is to authori a duly licensed professional engineer or registered architect_ (Indica e) to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rule$ or regulations as promulagated by the Commissioner of the Putnam County Department. of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction ot'sa. "dr- system or systems in conformity with the provisions of Article 45 147 Education Law, the Public Health Law, and the Putnam County-.—,,. s s � Y• -��r5 �.: tary Code. M Very truly yours, Signed �l,.�Q a4;/, Owner of Property 7wof : GzV 'o Address Town VS/" 3 8ol. -0i4. Telephone LAURENT ENGINEERING ASSOCIATES, PC. 73 FAIRFIELD DRIVE PATTERSON, NEW YORK 12563 RANDOLPH W. LAURENT, PE. ( 914) 278.6108 - (FAX) 278 -2658 HARRY W.NICHOLS, JR., PE: CONSULTING SITE ENGINEERS July 15, 1991 Putnam County Health Department 110 Old Route Six Center Carmel, NY 10512 Att: Mr. Robert Morris Re: Renewal and Name Change Permit No. P -38 -84 ' Lot #10 Quaker Ridge Estates Patterson, New York Dear Bob Enclosed are three (3) copies of the following items: 1. "Construction Permit for Sewage Disposal System ", dated 7- 15 -91. 2. "Application to Construct a Water Well ", dated 7- 15 -91. 3. Authorization Form dated 7- 15 -91. Fill placement permit was issued by Putnam County Health. Department on October 8, 1987 for fill placement of the SSDS and to drill the well under the name of Bruce R. Glickman Inc. We are requesting a change of the owners name and a renewal. If you have any question, please feel free to call. Sincerely, LAURENT ENGINEERING ASSOCIATES, P.C. 6�Randolph Laurent, P.E. RWL : bd ` 91060 enes. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property of Date I ■ \ ` I Located (Aa y Section Block • _/ i Subdivision of Subdv. Lot # /0 Filed Map # Date Gentlemen: This letter is to authorizeYj:jA-L1fJ/44eA L:f.2, 4i2 z LZU a duly licensed professional engineer or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- +��i` tart' Code. rrF, OF. NEW y`�, ILlfq S� Very truly yours, W' Er fA ZQ. _ " If � izoe'— O Coun`iersi P.E., R.A., Addi�ess -i .r � Telephone Signed Owner of Property -7 �zc 9' Z-11-1701 Vc. Address r--'.21eh Lcrle 4 A) y // -j-?S- Town Telephone DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL PeRn PERMIT #E_43 -3 P .. WELL LOCATION Street Addr s Town /V+ G44f- Tax a ctD h! ✓ S Grid Number WELL OWNER Name M Min Addres �j° e s. 6,v K a. le rivate D Public USE-OF WELL 0--primary 2 - 'secondary tESIDENTIAL ❑ PUBLIC SUPPLY Q AIR /COND /HEAT PUMP 0 BUSINESS 0 FARM p TEST /OBSERVATION 0 INDUSTRIAL O INSTITUTIONAL O.STAND -BY O ABANDONED O OTHER (specify Q AMOUNT OF USE YIELD SOUGHT _- r�gpm /# PEOPLE SERVED /EST. OF DAILY USAGE 0gal REASON FOR DRILLING 13 REPLACE EXISTING SUPPLY 0 TEST /OBSERVATION Q ADDITIONAL SUPPLY MEW SUPPLY NEW DWELLING 0 DEEPEN EXISTING WELL DETAILED REASON FOR. 'DRILLING WELL TYPE ODRILLED DRIVEN C]DUG GRAVEL a OTHER . IS WELL SITE SUBJECT TO FLOODING? YES XNO 1N" WELL 1S LUI: ; 1SJ) LN A KISAL -1.1 bU4MVItilUNt NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name 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 GL4si�_gnatu�lre) ON SEPARATE SHEET ' 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 Department attached to this permit. 3. Submit a Well Completion Report on a form requirements of the Putnam County Health 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 th ise :7-64. contaminate surface or groundwater. Date of Issue: 19� D Date of Expiration Z 19 q Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller n DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT :4 ��g WELL LOCATION Street Address_ . Town Village City . Tax Grid Number WELL OWNER Name . c.— Mailing G A Address Oftivate- G �� O Public .USE OF WELL 1 --primary 2= secondary elESIDENTIAL O BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY ❑AIR /COND /HEAT PUMP El ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify O INSTITUTIONAL O STAND -BY p AMOUNT OF USE YIELD SOUGHT S gpm /# PEOPLE -SERVED-'. 4p /EST. OF DAILY USAGE'+90 gal REASON FOR. . DRILLING MikkisUPPLY. O REPLACE EXIST NG SUPPLY O PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION O DEEPEN EXISTING WELL DETAILED.. REASON FOR .DRILLING . ,WELL TYPE [DVfILLED ODRIVEN QDUG El GRAVEL OOTHER IS WELL SITE SUBJECT TO FLOODING? YES v NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 2,p Lot No. A O ,WATER WELL CONTRACTOR: Name i3,� Address: =IS PUBLIC WATER SUPPLY AVAILABLE.TO SITE: YES v NO :NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE ,.TO PROPERTY FROM NEAREST WATER MAIN: fry,• . . LOCATION SKETCH & SOURCES OF.CONTAMINATION PROVIDED O ON REAR.OF THIS APPLICATION ®'6N SE E HE (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 3: Submit a Well Completion Health Department. Date of Issue: 19 Date of Expiration: 19 Permit is Non - Transferrable 2/87 attached to this permit. Report on a form provided by the Putnam County 7 Permit Issuing Ufficial White copy: H. D. File Yellow copy: Building Inspector Pink Copy: Owner Orange copy: Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date / Re: Property of AfJG cd�r or. W-M,a '*)0 IAJ Located at li11 FIA Jf I IDA t ;:;Of Pie 7-'V tip � d 5e 2y� Block (T) 9wif•K Co d .v Lot -V . n ^' U'CZi31L. Subdivision of Subdv. Lot # /0 Filed Map # / g/S C�Date gt S Gentlemen: This letter is to authorize � a duly licensed professional engineer el or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the-Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, S i gn e d� Counters i // Owner of Pr perty P.E., R.A., # Address l Town Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PER.KIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health In the matter of application for: G XTCn� S r D.✓ D /= 7-� wl E q j ZP represent that I am an officer or employee of the corporation and am authorized to act for 61,- c /c L, r C�!vr1 /A� //V Q - (Name of Corporation) having offices at Whose officers are: President: 6U-6,4t..; S , (rL # c ✓, .-1 /1,-j ,312 i T L /-3e'2D /4�� /U% /oso(- Name and Address �t SPresident: a-am n Vice P C (Name and Address) Secretary: (Name and Address) Treasurer: Sv SAa� S _ CL 1 C -1<-"4 S>9 (Name and Address) and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Sworn to before me thisD day 19 f8 . 8/84 Signed: Title: L 44-12?' -w LOREM M. KIRBY Nute4;+ Public, State of' New York No. 03- 4825277 C�;; t:q:cate tiled in Bronx County Comrn,salon Expires July 31, 1888 rnnratP Seal i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of /G• �✓ Located at ' (T) ` /.7 dc rrld" Section Block Lot A� Subdivision of Subdv. Lot # Filed Map # Date L MICHAEL DALE', P.E. Gentlemen: CONSULTING ENGINEER P. 0. BOX 243 This letter is to authorize SHENOROCK,N.Y. 10587 a duly licensed professional engineer C or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tarode. . ti G� ov .� IL MICHAEL DALY, P.E. y�'4 `' �,'� CONSULTING ENGINEER t i gn'e&: P. 0. BOX 243 C., `� 610049% N.Y. 10587 r 4-6& Address e Telephone Very truly yours, Signed ;'. 4&' Own Property Addr,e 0MIOELLA & SONS INC. BOX 695 .AMAWAU( NY 1=1 Town '. v�77.�3 Telephone Aatnam Countv Department of Health Division of Environmental Sanitation AFFIDAVIT - CORPORr1TE CIWNER APPLICATION FOR PER_`1IT APPLICATION SUBMITTED TO PUTKAM COUNTY }HEALTH DEPARTMENT TO: Commissioner of Health - In the. matter of application for 0 0 —` — I, J�--C.- `— _ _ — — — — — — — -- — . represent that.I am an /officer or employee of the corporation and am authorized to act for . ,66b "4i __ —__ ___ (name of corporation) -- having offices at!�:"�- �o_/��t_l_.(C 15.7• 1�idl — — — -= — .- Whose officers are President �or.•sS _•� �.t�r•� �t, 7Name and Address) — — — Vice - President - _ _ _ _ _ _ _ _ _ _ (Name and Address) — — — Secretary A=ZID Z. � - — —�— — — — — — (Name and Address) Treasurer_ _____ _ ___ _ ______ 4 ___ __ (Name and Address) and that I am and will be individually responsible for any or all acts of the corporation with respect to the approval requested and all sub- sequent acts relating thereto. Shorn to before me this day Signed _ _ s 4a" Notary'% r• YouNc i�me�► 1br at l aw Stetof York e �s {� Na 02y04V45k2 in t m County 4M, ... y Corporate Seal PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date r Re: Property of L t./4 CZ-�oAL Located at � &ArFR �06K (T)''. 7 Section Block Lot Subdivision of QG�jL:�`^��a %� Subdv. Lot Filed Map # Date Gentlemen: This letter is to authorize a duly licensed professional engineer__X, or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction.of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public. Health Law, and the Putnam County Sani- tary Code. Very truly yours, Signed 4 Countersigned: Owner of Property R.A. x � Address Telephone Address Town Telephone