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PUTNAM COUNTY DEPARTMENT OF HEALTH Engineer to Provide Permit M
Dlvlelylo nmentel Health Services. Carmel, N.Y. 10512 1 u 1 �r on CERTQ [LATE OF COMPLIANCE
NSTfitUCTION PERMIT FOR SEWAGE DISP /� . SYSTEM
Permit /
CaRGtf- �oRD
12a
TT y'N
Town w— �
Subdivision N e Sabd. Lot N Tax Map Block Lot
Owner /Applicant Name
a /G - -y- - Renewal_❑ Revision ❑
Q Date of Previous Approval
Mailing Address /X/ •r � Town Zip
p
Building Type L Lot Area 2 �a FW Section Only Depth volume
Number of Bedrooms 1 Design Flow G P D �t PCHD Notl&atlon Is Requlred When Fill Is Completed
Separate Sewerage System to Consist of Gallon Septic Tank end 2_�.� l0� T��
To be constructed by 'TO g0 7)6i-M I /j0;b Address
Water SapPlpc Pliblic Supply From Address
or: Private Supply Drilled by Q 15 fU �� Address
Other Reodrements
1 represent that 1 am wholly and completely .responsible for the design and location of the proposed system($); 1) that the separate mwaga disposaa system
above described will be Constructed as shown on the approved amendment there to and In accordance with the standards, rules an regu wns o 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, heirs or assigns by the builder, that said builder will
place in good operating condition any part of mid sewage disposal system during the period of two (2) years Immediately following the date of the issue
once of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 211 that the drilled well described above
will be located as shown on the approved plan and that said well veil 7ja d in ccordance with the via rd rules and regu a ens of the Putnam
County Department of Health. P.E. R.A. -
Date Sign I
Address '3 r T/ FI Licen se NoT
APPROVED FOR CONSTRUCTION; This approval expires two years from the date Issued unless construction of the building has been undertaken and Is
revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction
requires a now �permit. .�Alpproveed�for disposal of domestic sanitary $ewagagl; a private we pply only
ley. Date ��i! ! L / �� gyiA Title
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QFP- 17 -PMMP TIIF 14:619 TFL:945- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2
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QFP- 17 -PMMP TIIF 14:619 TFL:945- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2
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�� ADDITION
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GAL. - - - - - -- O
SEPT IC TANK p
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100Y. f;X PA NSION AMeA
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°> 550KO 106 @ ZOO G.PD = (oG}7 &.P. D.
$OIL RATE USED-. 6-10 MIN. I ,' DROP
APPLICATION KATE : 0.410
A550RrTION TRENCH
95auIREO: 333 L.F.
PIeOvIDEO : 33�o L.F.
TF-ST PIT D55GR PTION5
HOLE `a` I : O "O�'O(o TOP501L
Ofo "'7 " &" SANDY SILT
F- 10LE'p 2'- 00 --0'&" TOP°>O►L
O "fo ° -7 "O' SANDY 4✓1LT
ND'fE:
60UNDAKY DATA TAKEN I-XOM MAP F'KE-
PAKC -P POK 6,IK7I006 E. KOe7eNOOKF' 4
E�KIC KIKMI-DC OAT60 MAY , IQ 38, PREPA
fJ'( HANK A. 15NYOCK • TOP06KAPH IC DATA
SUPPLIED 5Y K006KT H . DC —K6CM PoRF ,
L.':�'•
Putnam county
Division of n -_nt 1 health Service.
� d as n ot
orl for co7-c�anrs With
Ipplicable R`ul�s e
Of the
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PROJECT'
Pi�DP05�1� SSDS
5T, ^.sl COACH 1<10A 12
rA-TYOr IZG�,
CLIENT .
K�NNE57N 5GOF0�-L.D
t✓TAGEGOACH ROAD
PATT K'-')0N ; NEW YOKK
RANDOLPH W. LAURENT
ASSOCIATES, P.C.
j \ 73 FAIRFIELD DRIVE
PATTERSON. NEW YORK 12563
914.278.6108
\ CONSULTING SITE ENGINEERS
DRAWIN'Q TITLE
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ADDITION
�,-�-ra, 1002.0
JUNCTION 15OX (TYP.
P-XlsrI
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102DROOM
Kf;51DENGE
-ICOO GAL.
SEPT IC TANK
`1-11 50LID P.V.G.
OAWIX 2bl(
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------ -------- 1_— ------ - - - - -- - --1 LlPb9�
�` -'�_ - - _ _ `- ------- - - - - -- 100/ EXPgNSION ~ - - -- - --- - - - - °L
---------------------- AREAS
PROJECT
Pl
rATTO Ks.
CLIENT .
KEN
PAT TE1Z
, Fvmi�i": � �
t' t PUTNAM COUNTY::DEPARTI�wN OFHEALTS
tel Hedt6'Ser doer Carmel N.Y 10512 .
� P CERTD?
NSTRUC110N P FOR SEWAGE D_ _ STSTEM. _
near to ProvMe Permh M�
"4
► f�JAG>ti . DRS own a*-
Sabdlvidon N e Saw. Lot #
00. _Saw. Tax Map Block Lo6�
i -
Owner/AppWant Nwe 1`L�/1/l�lE�%!� J��ELD Reaewal_a Revleloa ❑
Date of Previous Approval
Mailing Address n s 1� Iq 4 l7o x.-3-7. ' Town ZIP
Ba11d1nQ Type /�, Lot Are. FID Section Only' Depth Volume
Number of Bedrooms` e /��/� Design Flow G P D G . PC�HpD NoUBCatlon is BegalroTdpWh�eynFib Is completed
separate Sewerage System m. oondst eat C.B. Septic Tank as i/ r n L� v0/j
To be comtraeted by ?D Y7EZAAIIJ &�b Address
Water Supply. Paibac supply From Address
or Private supply Drilled bx �iX 1571 �1i C A
Other Requirements
A represent that 1 am wholly. and completely responsible for the design and.iocation 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 stvndards; rules ago regutat ions. of a PutnWrFn
County Department of Health, and that on completion thereof a "Certificate of Conrtruction Compiiance" satisfactory :to the Commissioner of Healthwill
be submitted to the Department, and a written guarantee will be furnished the owner, his suceesso►s heirs or afsiyn3'by the builder, thst tisid builder. will
:,plan in good operating condition any part of said sewage disposal system during the period of two (2) yearf ifnmediately following the date of tbe'ifsu-
ance of the approval of the Certificate of Construction Compliance of. the original system or any rspeirsthsreto; 2) that the drilled well described above
will be loused as shown on the approved plan and that so id well earl a led in ccordance with the `Its rd rubs and rpu aZiTons : of . the Putnam
County Department of Health.. .
'Date Il I 0 U J �{// Signed P.E. R.A. _
Address ✓lj BFI YA License No
"APPROVED FOR CONSTRUCTION TMs approwl expues two Mrs.. from the date issued unless construction. of thg building has been undertaken and is
revocable for cause. or may be amended or rrmodrfied when considered necessary by the Commissioner 'of Health. Any change or alteration of construction
.
requires aaa new permit. A Drov /ed.for disposal of',domestic sanitary sewaq$, a'. rivals wa Ply' oMy.
1/87 Date v mac/ / [ / �v BY�T Title ����
3
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PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date
Re: Property of f:ENA1eTfi
Located at ,S7-
(T) P�}7rN �6� Section 7 Block �3 Lot Q
Subdivision of
Subdv. Lot # Filed 'Map # :Date
Gentlemen:
This letter is to authorize P/3/V W� _ 146IfZ-�UT
a duly licensed professional engineer k 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.
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Very truly yours,
Uj
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Countersigne �i � -e-
R.A. , # 9l4 2 -fV J-A-6te
�3 �i���'�i�� 172 ✓�
,Address
_ / - l)me-7�o.y Al' 5
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Telephone
Town,
Telephone.
tea.
P V .b . 1
LAURENT ENGINEERING
ASSOCIATES, P.C.
73 FAIRFIELD DRIVE
PATTERSON, NEW YORK 12563
RANDOLPH W. LAURENT. P.E. \
914.278.6108
HARRY W. NICHOLS JR., PE. CONSULTING SITE ENGINEERS
November 1, 1988
Putnam County Department of Health
110 Old Route 6 Center
Carmel, NY 10512
Att: John Kareil, Jr., P.E.
RE: Kenneth Scofield
Stage Coach Road
Patterson, NY
Dear John:
Enclosed are the following:
i. Four (4) prints of Drawing SS -1 "Proposed
SSDS ", dated 11 -1 -88;
2. "Construction. Permit for Sewage Disposal System ",
dated 11 -1 -88;
3. "Design Data Sheet ";
4. "Letter of Authorization ", dated 10 -1 -88;
5. Two (2) copies of Residence Floor Plan(s),
for "Bedroom Count Orly ";
6. A money order in the amount of $100.00 for
filing fee.
We would appreciate your review, approval and issuance of the
Construction Permit at your earliest convenience.
Sincerely,
LAURENT ENGINEERING ASSOCIATES, P.C.
Randolph W. Laurent, P.E.
/map
cc:
Mr. K. Scofield w/ l copy each
enclosures:
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APPENDIX B
PL'Ii�M COUNTY DMRMENr OF HEALTH - DIVISIal OF MTJ__RCM4aML HEALTH SERVICES
INDI47DUAL MTER SUPPLY & SUBSURFACE: Sr qA( DISPCSAL SISTIIMS
REVIEW SHEET - CONSTRUCTION Pr2MIT
DATE RiJT_= vr'D :
66 N &i&_T14 Ica r-t 6L-0 - CO PI BY:
(Name of Come_*-) (Street Location)
C:2RM YES I NO ► DCCL4�s
Permit Application
Corporate Resolution
Plans - Three sats s/s
Engineers Authorization
Design Data Sheet MCS) SUBDIVIS— I
Deep Hole Lcg Parc
Consisten t Per- Res i t (3) Fill
Pert Hole Depth
House Plans - Two sets
�%. - .:1. Well Fermi t; P ;v3
Variance Request ,
L' t`en't provide-a
60 ft. max.
Parelle to
100, exm.
10 i .
fill otes
new s ec.
denth uses
100 yr. flood elegy
200 ft. reservoir,
It
150 ft. tricrallYga
Vq
lecal Subdivisicn
-,Sund.i vision Accroval CE= tc
Ex- acaroval SSDS Pd- Lots Chec:c_
?W & D )
-Data Cn DDS Plans & P_r:iiit M =
REQUIRED DEIA TLS ON PL?-INS
S=.aage Syst_n Plan - (ncrtn arrow)
Sewage System Hv1=_ aul is Prot _1= -Gray �y Flow
....r & Dimensions - Voi�� -re
D o g ,Tranch /Ga11e?y; Puira pit de:..sils
SEptic '1`�Ic lk - Size, Detail
W1211'Detail, Service Line if cver
Ccnstrructicn Notes (grinder rte)
- ,Design Data: perc and deep resa is
—%�o -Foot Contours Existing & Proposed
Driveway & Slopes C=at
Footing/Gatter,Curtain Drains (discharge OK)
-'P-erc & Deep Holes Located
Representative or primary and Expansion
Expansion Area; shown; gravity fiaw,suff. size
- °°°T,ff �ed Pit & D Box Shcwn & Detailed
House -'No. of Bedroans
Wells & SSDS's w /in 200 ft. of Proposed System.
Derty Metes & Bounds
-Eou4e Setback Necessary (Tight lot)
- H e Seger - 1 /4 " /fL. 4 "0; Tyre pine
No Bends; Max. Bends 45° w /clernout
SEPARATION DISTALNCES SPECIFIED CN PLAN
Fields
10' to P.L., DriveHay, Large Trees,Top of fi.
20' to Foundation Walls
100'.to Well; 200' in D.L.O.D, 150' pits
['-160, to Stream, Wate rcourse, Lake ( inc. erpa:
'i5"' to Drains Curtain, Leader, Fcoting
351to catch basin,storndrain,aicei -ovate- rcou_r_
10„ to Seater Line (pits-20-'Y'
0 iinte ittent drainage course `{
10' -fran-Foundat'ion; 50' to well
15' WP11 fin Pr. 9
4-,�1
,• •:�` . . • 110 12 -
In IVA *3 •• C 101 Y• •1 III• •1'.F•.
DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE M.
Owner Kcmye T Address ���'� ,igD� ,y 57, S77k>,,5(O19GtI 1Z44.
Located at ( StreetGR I U- 4). Sec. -7 Block 3 Lot
(indicate nearest cross street)
Municipaiity ��7TEjZ ti' Watershed C 6 %Ql,�
SOIL PERCOLATION TEST DAT A RBQUlRED TO BE SUBMII= WITH APPLICATIONS
aa� ( //
Date of Pre- Soaking le g,F Date of Percolation Test /a o'L l pr
HOLE
NUMBER CL am TIME PERCOLATION
PERCOLATION
Run Elapse Depth to Water From
Water Level
No. Time Ground Surface
In Inches Soil Rate
Start -Stop Min. Start Stop
Drop In Min/In Drop
Inches Inches
Inches
1 IA; if- /S a j 0-7 �5 8
G
2 �� �l l GL� �� �� �7 I
3/ -' 0- J-,3 8 2-9
9-7
S
4
5 r
1 /aA. /q -- 9 : a-("1 -7
2 1�11;a7- l�?-:/,-7 /e
;�--7
3 la: 153 P-7 q'
4
5
1
2
3
4
5
N=S: 1. Tests to be repeated at same depth until approximately equal soil rates
are obtained at each percolation test hole. All data to'be submitted
for review.
2. Depth measurements to be made from top of hole.
rev. 9/85
DEPTH
1'
2'
3'
4'
5'
6'
7'
8'
9'
10'
11'
12'
13'
14'
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
HOLE NO. I HOLE NO, 11), HOLE NO.
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: D DATE:
DESIGN
Soil Rate Used Min /1" Drop: Q. -),,9 S.D. Usable Area Provided
No. of Bedrooms Septic Tank Capacity %liOC► gals. Type LONG•
Absorption Area Provided By :Z,,? L.F. x 24" width trench
Other
Name LEFT �/V G //11�7ZiN G rSGC, Signature P/
Address % F/i 12Pi LLL> Dl-1 vet ,SEAL
'FeTT
aF-
,U
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved sq.ft /gal. Checked by Date
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