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HomeMy WebLinkAbout0249DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 5. -1 -12 BOX 3 .. . t!IJ6 TV I 111 LORETTA MOLINARI R.N., M.S.N. Public Health Director ROBERT J. BONDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 . Environmental Health (845)278-6130 Fax(845)278-7921 Nursing Services (845)278-6558 WIC (845)278-6678 Fax(845)278-6085 Early Intervention/Preschool (845)278-6014 Fax (845) 278 - 6648 Hedwig, Douglas & Mimi 575 Birch Hill Rd. Patterson, NY 12563 August 15, 2003 Re: Addition — 575 Birch Hill Rd. No Increases in Number of Bedrooms (T)Patterson, TM #5 -1 -12 I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated August 14, 2003. The addition is approved with the following conditions. 1. The total number of bedrooms must remain at four without prior approval by this department. 2. The area of the, existing sewage disposal system, and its expansion area, must be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Patterson. If you have any questions, please contact me at your convenience. Very truly yours; -- ----._ �_. Michael Luke ML:hn Public Health Technician cc:BI T T T PUTNAM COUNTY HEALTH DEPT. 02 5`6 2 4 1 Geneva Road (845)'278130 Brewster, NY 10509 Date I /l//63 Received of The Sum Of 0,1 { Akv cAllt A 4 � Dollars $ i ev • 0 y For /,t.,� - 44 -o? Jaa -0 3 ,S-esl�s r / 4 a o THANK YOU! ❑ Cash ❑ Check ETM.O. ❑ Credit Card By 5 BRUCE R. FOLEY LORETTA MOLINARI R.N., M.S.N. Public Health Director Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention (845) 278 -6014 Preschool (845) 278 -6082 Fax (845) 278 -6648 ADDITION APPLICATION (RESIDENTIAL ONLY) STREET 575 Birch Hill TOWN Patterson TX MAP# 5 -1 -12 NAME Hedwig, Douglas & Mimi PHONE PCHD# '?-Q3 MAILING ADDRESS 575 Birch Hill Road Patterson New York 12563 DESCRIPTION OF ADDITION Addition of recreation room, office, bath and laundry to an existing 4- bedroom dwelling, NUMBER OF EXISTING BEDROOMS 4_ PROPOSED # OF BEDROOMS 4 (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) * Any addition which is considered a bedroom requires formal approval of plans (Construction Permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 4 Geneva Road, Brewster, NY 10509, Phone 278 -6130. 1. Certified check or money order for $100.00 2. Sketches of existing floor plan (drawn to scale, all living area including basement) *Non- professional sketches are acceptable. 3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #) *Non - professional sketches are acceptable. 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact. this office with any questions. 5. Copy of Cert. of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE Comments Feb98 BFhouseguidelines BRUCE R. FOLEY LORETTA MOLINARI R.N., M.S.N. Public Health Director Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention (845) 278 -6014 Preschool (845) 278 -6082 Fax (845) 278 -6648 ADDITION APPLICATION (RESIDENTIAL ONLY) Putnam County Department of Health 4 Geneva Road Brewster, NY 10509 Re: 575 BIRCH HILL ROAD Residence Tax Map 5 -1 -12 Town PATTERSON Gentlemen: According to records maintained by the Town, the above noted dwelling is IS NOT in compliance with Town code and the total number of bedrooms on record is G This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER:' �1' I Building Inspector BFhouseguidelines ` ZARECKI ASSOCIATES, i. L,.C. Engineers e Architects Surveyors Joseph Zarecki, PE Jeffrey Hecker, LS Curt Johnson, RA David Johnson, CPESC- CPSW®. 11 West Main St. Pawling, NY 12564 (845) 855 -3771 (845) 855 -3772 Fax Website: zarecki.com email: zoreckiassoc @earthlink.net 31 Bailey Ave, Ridgefield, CT 06877 (203) 438 -7094 (203) 438 -7157 Fax August 11, 2003 Mr. Bill Hedges Putnam County Department of Health 1 Geneva Road Brewster, NY 10509 RE: Hedwig Residence 575 Birch Hill Road Town of Patterson TM #5 -1 -12 Dear Bill: Enclosed please find drawings depicting an addition at 'the referenced property. The proposed one -story addition includes enlarging the existing breezeway (connecting to the existing garage) and construction of a Music /Recreation Room w /office. The existing dwelling consists of four bedrooms, two baths, kitchen and a living /dining area. There are no proposed changes to the existing dwelling; therefore the bedroom count will remain at four. The project requires the Health Department 'sign -off' prior to submission to the Town of Patterson Building Department. Please review for bedroom count per the Health Department's general memorandum of 7/27/00. If you have any questions and /or require additional information, please contact our office. Rev. i�INK t CEj P" 3/ 86 . PUTNA COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Servlees, Carmel, N.Y. 10512 Engineer Mast Provide P 9 - P G -A -n_ vpr...tt e__ LUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM i ©r`tf1 si H a1 Reoad Located at r -c " ; ; Owner /applicant Name Anthony ' Mastraeddo Formerly 1 M.iling ariareea' =i Leonard Drive Zip (1681.2' Nww Fairfield, CT Patterson f" Town or V e 7 _V .Ta: M�- .��rLot ;.Subdivision Name I Subdv. Lot M mate Permit Issued, (x t. 149 1986 Separate sewerage System built by Leonard Lobriac0 Addre A °JoCls Dr., 'New Fairfield, CT Consisting of 450 Gallon Septle Tank and �� �••� Water Supply: Public Supply From Address or: x Private Supply Drilled by meal Address Brewster, New York Building Type Singly Family Has Erosion Control Been Completed? NA Number of Bedrooms 4 - Has Garbage Grinder Been Installed? No Other Requirements I certify that the'system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and regulationa,'in accordance with the filed Ilan, and-the permit issued by the Putnam County Department Of Health. -1,' Oats / ''o� Certified by P.E. R.A. Address RE, 67 Route 22, Brewster, NN 1059 'A� License No.. 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 sewerage system shall become null and void as soon as a pub(':' sanitary sewer becomes available ants the approval of. the private water supply shall become null and void when a public water supply becomes available. Such si>provals are subject ttos,)�modification or change when, Inn the judgment of the Commissioner of Mealth,4such revocation. modif�lut {on or change Is necessary. Date d / ��y/ BY may.. Vii. °. ALL WTUI6ANOM! KN O W V" roe Ine+yr A14 oorcrf TIiN<a 9nr W MID UP 911 GMU MAN TIC R OMM UAL OF THE 1~011 .90 110NAT111M APP9W 1949011. Z S74° 12'20'E 1166.08' s�9. u N A a ti NTS'09'�eW 247.11 NT4.20'26'W 14 N72.33'4T'W 0 22119' C N74.31 *' W u (271.00' Lor i S74 "12'20' E 291.11' LOT 2 10.922 AC. V ' N746 31'4 2'W 124.52' N69.501 061W n1f OR40Y 193.7 5 N74.13'0j'W 93.42 466459120'x! — I HERESY CERTIFY TO — 80.35, DANBURY SAVINGS 8 LOAN THIS SURVEY IS ACCURATE AND CORRECT BY: GERALD L. LYNN WAPPINS[NS FALLS, N.Y. N.Y. RES. SURVEYOR me. O49tf l N 584.44' Ami- 00 74.121204E GAR Loo o+� 0 MELL OKH 24S' X10' N74.12'2(' W TAL 293.33' 149 A ORN E MAI y ��k � to � 1 c f' o'Z SCALE,1' =50' "AS- BUILT" PLAN FOR/TO uu Z _w 8 ANTHONY 5 CLELLIA `.: MASTRACCHIO SEPT IC H + r.� FIELD -4 •ti;,� oat# , tr TOWN OF PATTERSON PUTNAM COUNTY co lA4D'M: NEW YORK � ... Q 439.2 0' To � �f S ��k � to � 1 c f' o'Z SCALE,1' =50' "AS- BUILT" PLAN FOR/TO PSfi O► NEr, r g4o� L �1�0p} ANTHONY 5 CLELLIA MASTRACCHIO + •ti;,� oat# , tr TOWN OF PATTERSON PUTNAM COUNTY lA4D'M: NEW YORK JULY 21, 1987 or)o 2032. 3G4k, 6 pf t�DSF D75 P `p� 4, 6 ROST-D)S �ROU6kOt�k� t'R!M r_ l�5 BATI -i kj t 13V% XRDCABIG)Co. /0 9 E3EDRO6M'.�.: ..,_ .. >t4�._Co� .0 {t' -10 . .f!) �.; 3 I�: -�O•` x l'.I' -SOy -. - i 4-8 D46 4x4 POSTS -Das CLO. CONC. SLAG OTH O J -S x i 0 -q x BY &RS UVINCa ROOM 6� uPE:,LYFAbT I! • TIMBER Tr2U55 S , 0�cc) U �JV KITCi-dEW } 1.A -i82 .3 M•i32.3 (>• ¢S ?�:JST_D15 2 i!'-{O "X t°S' =�'1 3 o ;::t. ,.- �'•. J DINIi�q AREA PORGN D 0. IsY 10• AC_,.o„ C)45 . 304 .'.PAS C, ON C.: 5>`AB pY OTHERS EXISTING FIRST FLOOR SCHEMATIC PLAN Hedwig Residence SO 1/.,,_1,A„ PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLV; BEDROOMS a'// or nature & Tulle Date .i?�2 -a ?i ILy oOM �7 I �G�7�ZO0 M Or EXISTING SECOND FLOOR SCHEMATIC PLAN Hedwig Residence SC: S. " =1'-O° .Rev. 31 6 K CERMC OF PUTNAM COUNTY DEPARTMENT OF HEALTH nviionmental Health Serviced Carmel, N.Y. 10512 Division, of E , - Engineer ee Provide,p . 9'3 $ 6 :C - , P.H D: Perrmit. # =— Located at �N o r tl Birk Hill R o a Ownee /appucant Name Anthony Ma O Mailing Address 3 Leonard Drive New Fairfield, CT 06812 Patterson Town or V age Tax Map 7 Bloc Lot' 7 "IAe —. Subdivision Name Cr S ` Sabdv: Lot N 2 Date Permit issued Oct ..14, 1986 Separate Sewerage System built by Leonard Lobriaco Address Joels Dr., New Fairfield, CT Consisting of 1.250 Gallon Septic Tank and 571 LF Water Supply: Public Supply From Address ors X Private Supply Drilled by Beal Address Brewster, New York Building Type SIngle Family Has Erosion, Control Been Completed? NA Number of Bedrooms 4 Has Garbage Grinder Been Installed? No Other Requirements I certify that the system(s) as listed serving the'above premises were constructed essentially as shown on the plans of the completed work ( copies of,which are attached), and in accordance with the standards, rules and regulations, in accordant with the filed plan, and the permit issued by the Putnam County Department Of Health. �` Data � � Certified, by P.E. Z R.A. Address RD 6, Route 22, Brewster, NY 10509 license No. 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_Sep.0 ate mwerags system shall Decome null and void as soon as a Dub ?: sanitary sewer becomes awliable and the approval of the private water supply shall become null and void when a' public water supply becomes available: Such approvals are subject to modification or change when, in the judgment of the Commissioner of Health *such revocett= n�modcation or change Is necessary. By PUTNAM COUN'T'Y DEPARMAERP OF HEALTH DIVISION OF.ENVIRO1IZ=AL HEALTH SERVICES Owner or Forchaser of Building Section Block Lot Building Constructed by Location - Street Municipality Buildinjo Type Pr4 +11C. Subdivision Name Subdivision Lot # GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me.which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the swage disposal system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environmental Health Services of the Putnam County Department of Health as to whether or not the failure of the system tro ate s caused by the willful or negligent act of the occupant f the ui di ng the system. Dated this day of 19 f 7 Signature Title General Cx6tractor (Owner) - Signature Corporation Name (if Corp.) Corporation Name (if Corp.) Address Address f rev. 9/85 mk BREWSTER LABORATORIES Box 224 - BREWSTER, N.Y. (914) 225 -2072 — WATER ANALYSIS REPORT -- SAMPLE NO. 6634' SOURCE: Anthony Mastracchio hose bibb -well Birch Hill Patterson, NY COLLECTED: July i7, 1987 BY: P.F.Beal & Sons, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method p per 100 ml. This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. July 22, 1987 (� J�n� Roy Bickwit P.E. Director II. IV. w vi. APPENDIX C FMAL SITE INSPECTION Date Ins , Aby TION I �- (�! OWNER S�CN Lii T SLLGP_GE DISPOSAL AREA a. SDS area located as per apnroved plans b. section - Date of placeTLent 2:1 barrier_ LGTH W-= AVG_DPTH - °Fill c. Natural soil not strinoei d. Stone, brush, etc_, greater than 15' from SIDS arey_ I e. 100 ft. from water course /wetlands. SEYIUu� DISPOSAL SYST -- a. Septic tank size - 1,000 ,250 ( i b. Sentic tank installed level I c. 10' minim mn fran foundation I I d. No 90° bends, cle=ncut within 10 ft- of 450 bznd ( I Lq r e. DISTRIBUTION BOX 1. All outlets at same elevation - water tested 2. Protected bell rrost 3. MLnim= 2 ft. original soil between box and t`znches I I f. JUNCTION BOX --prccverly set g. 1 i 1. Izngt "h re�:ire 1 Lzncth install ' () - 2. Distance to wat_r� se ft. 1--I 3. Installed accc-rding to plan I A. Distance canto_- to center 5. Slope of trench acceptable 1/16 - 1/32 " /foot. 6. 10 feet from nrcze_rty line - 20 fit - four_daticn_= 7. Depth of t_encl7 < 30 inches from surface 8. Roan allc e: for exmansion, 50% Ir 9. Size of gravell 3/4 - lg" diameter 10. Depth of Gravel in trench 12" minimum ( I I 11. Pine ends caprea I I h. PLMP OR LOSE SYSTEMS 1_ Size of pL= ch -amber : f 2. Overflow tank I 3. Alarm, visual /audio ( I 4. Pwo easily acc= essible manhole to grade 5. First box baffled ( I 6. Cvcle witnessed by He.:.1th Derax .ent estimated flow per cycle ECUSE a. Eouse located per approved plans. b. Number of bedreans WELL a. Well located as per amoroyed plans b. Distance from SDS area measured c. Casin 18" above Grade_ d. Surface drain -ace around well acceptable_ GVERA IL WORKMASH.IP a. Boxes properly qrcuted ( Q ✓Q f o, b. A11 pipes tia11v backfilled ( I - c.. All pipes_ flush with inside of box C" d. Backfill material contains stones < 4" in diairater ( I e. Curtain drain installed according to plan f. Curtain drain outtall protected & dir_to exist.wate_rcours g. Footing drains discharge awe from SDS area ( I h. Surface water rotection adeauate I i_ Errosi.on control provided on slopes greater than 1 >I.3� .�w�lc� h L.F. C� �� <i�� '� ! �� ho�1 � � � - o� i i Co, q PUTNAM. COUNTY DEPARTMENT OF BEALTH :• Red. 3/86 Division of Envlroumental Health Services Carnet N.Y. 10511 r,' Engineer to Provide Permit # �oon;CERTIFICATE OF COMPLIANCE, CONSTRUCTION:PERMIT!FO EWAGE DISPOSAL SYSTEM` ° P ®rmlt # ' Patterson Lee>itr�a 8t North Birch Hill Road Town er vluage Wh'i.te Tail .Acres 2 Sabdivlston Name. Sabd. Lot # Tax Map . ` % Block l ' r t 'Anthony L, Mastracchio _ Renewal Owner /Applleant Name Date of Previoae Approval Making Address 3, Leonard Drive Tlwn New . Fa i r•f i e l d , C Tip 0 6 812 'Buildbtg Type Single FalnllV„_Lot Area .1.0.922 Ac 1?ipSectionOnl X ' 1.000 c x De th 3.5 vehnae i�Namber of Be_ diems 4 Design `Flow G /P /D 8 0 0 PCHD Noti6catlon is Begaired When F1111e completed 1250 ,N, Sepdcate. Sewerage System to rnaeleIt of - Gallon..SeptIe T=,k and � k � t To be conetracted by 'TO be Determined Address Water Suppl Pd61k supply From Address X To be determ> ned� or: Private Supply Drnled by dress " Otber Requirements ? 1 represent thatl am wholly and` completely •respon3ible for'th'e devgn an`d location of the. proposed 'systern(s); 1), that the separate -sewage disposal system . .. 4 above "describeq'will ba constructed. as shown'on the approved;a`mendmerif there"to.antl in:8ccordbnce with the standares, rules an ..regu a ions o e u nam County' Dapart,ment of.(Mealth, .anG that on. completion thereof a Certificate' of`ConstrucGon Compliance ""satisfactory to trie Comniissioner'of.Health 'ill be submitted to .the Department, Aa .a written- guarantee will be' furnished the owner,'fus s4Ccessors, heirs or assigns by.the builder, that said builder'will place in good' operating con ddion _aAy. %part, of `said- :sewage .disposal system'during the period `of two (2) years immediately following thedate of tfie issu= ance;;of the rapprovai, of 'the Ceitificate of. Construction Compliance .of the , igmal system or any - repairs thereto- , 2) tha :the drilled •well described -above will be located as shown on the approved plan`and thatsa�d well will bo'i' tall n .accoidance with the 'st'n lards ules rogu a�f`on ;. of a Putnam County OOparfinent of Health :ro. 3�0 5, /��� Date ig ed �JV�� P.E'R.A. r !' Address License NO v/ APPROVED FOR CONSTRUCTLON Th!s approvalexpues o ear from the.d -e_' ed,un ess. construction -of the building has -been undertaken and is -;revocable for cause or. may'be amenCed or cooified when co d red ne ssar,'y: Com - signer Ty Health. Any change . or alteration.of construction iequires'alf new perms . Approve&' for disposal of do itary swag /or,' diva wbte -.',Date- / �f-��� BY rr7L/(( Title. , .. IH IILI1LIn bivision Of Environmental HvAlth Services TWO COUNTY CENTER - CARMEL, N.Y. -.10512 (91 4) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL IS WELL SITE SUBJECT TO .FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: WAte I.ail Acres LOT NO.: WATER WELL CONTRACTOR: Name To be Determined Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO 4rll1E OF PUBLIC WATER SUPPLY: Not Applicable TOw'DI /v /c )ISTANCE TO PROPERTY FROM NEAREST. WATER MAIN > 2,000 , OCATION SKETCH & SOURCES OF CONTAMINATION See S S Plan Enclosed 10/9/86 (date) (s-igna tiVrej PERMIT TO CONSTRUCT A WATER WELL r This permit to construct one water well 'as set forth alive wis granted under the provisions of Subpart 5 -2 of Part 5 of ti- t Dw York State Sanitary Code, and provided that within Qh'1•rjt1 0) days of the completion of water well constructior�,! he a� Wtant shall. 4 '-44 ti�r� °. "Y 1. Pump the well until the water is clear. '1��1•/ 2. Disinfect the well in accordance.with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report onfi form provided by the Putnam County Health Departme Date of Issue: :19 Permit Issu ng Off ci.al . Permit is Non - Transferrable TALE1 IAZ (AU NUQI6ER. TELL LOCATION . North Birch- Hill -Road Patterson 7_1 -7 WELL OVINER NAME. • Anthony Mastracchio, 3 ADORESS: Leonard Drive, New Fairfield CT [� 'VAT[ p PUBLIC USE OF WELL CD RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED 1 - primary ❑ BUSINESS ❑ _FARM ❑TEST /OBSERVATION ❑ OTHER (specify) 2 - secondary C1 INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ 114OUNT.OF USE YIELD SOUGHT 5+ gpm. /N0. PEOPLE SERVED Not Av. / EST. OF DAILY USAGE 800 gal. REASON FOR Q NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION DRILLING ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL WELL TYPE Q DRILLED DRIVEN E:] DUG GRAVEL -OTHER IS WELL SITE SUBJECT TO .FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: WAte I.ail Acres LOT NO.: WATER WELL CONTRACTOR: Name To be Determined Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO 4rll1E OF PUBLIC WATER SUPPLY: Not Applicable TOw'DI /v /c )ISTANCE TO PROPERTY FROM NEAREST. WATER MAIN > 2,000 , OCATION SKETCH & SOURCES OF CONTAMINATION See S S Plan Enclosed 10/9/86 (date) (s-igna tiVrej PERMIT TO CONSTRUCT A WATER WELL r This permit to construct one water well 'as set forth alive wis granted under the provisions of Subpart 5 -2 of Part 5 of ti- t Dw York State Sanitary Code, and provided that within Qh'1•rjt1 0) days of the completion of water well constructior�,! he a� Wtant shall. 4 '-44 ti�r� °. "Y 1. Pump the well until the water is clear. '1��1•/ 2. Disinfect the well in accordance.with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report onfi form provided by the Putnam County Health Departme Date of Issue: :19 Permit Issu ng Off ci.al . Permit is Non - Transferrable . UMAM LUUMI VkXAKiMr: X Ur' tii'RUM — U1V151UN Ur' MVIRUNMFUXAL HEAU M 5hRV1U;b INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PE WT'.. (� DATE REVIEWED: � L nr L AC✓YS 141 le,4 BY: 51-f ( Name of .Owner) ( Street Location ) MMENTS YES NO Z be.1-ve ; ► was 5. t�Fp��icd ✓rvin 1'f �a5 a Six --Io' S.17J.VI Sic ;t i ,r r r i i i l DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet.(DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank— Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area;shown;gravity flow,suff. size If Pumped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 "/f t. 4 "0; Type pipe No Bends; Max. Bends 45° w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains- Curtain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' from Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Etc- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same C 0 me x 7 i? v -- t 1 <IJ J. h 0 rt; S 2 a-o ,I- PUTNAM COUNTY'DEPAmum OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS 6qo ( c4 o (Name of Owner) REVIEW SHEET - CONSTRUCTION PERMIT (Street Location) DOCUMENTS DATE REVIEWED: BY: PA [-:--> Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area;shown;gravity flow,suff. size If Pumped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains- Curtain,Storm,Leader,Footing . 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fran Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same DEPTH G. L. 611— 12" 1811 21111 X011 36" 11211 11811 51111 6o" 66" TEST PIT DATA REQUIRED TO BE 'SUB)MITTE.D 1•11:T11 APPLICATION DESCRIP'I'1011 OP SOILS E1100UI ?!EKED II.1 TEST 110 '1.'1 11012 1406. D1A 110LE 110. D1B'' DOLE 140. Sandy -Clayey Lo' ?m Sand.y Qlaypy _I nam 3.5' to Rock 7211 ,• 71311 IIDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED IPIDICATE LEVEL TO WIIICII WATER LEVEL RISES AFTER BEING ENCOUNTERED `l'ES`1'S 141 DE BY Baldwin & Cornel i ug _ P-r_ Date 6126186 Soil hate Used 20 MtVl "Drop: S.D. Usable Area Provided 5,000 SF 11o. of Bedrooms 4 Septic Tanlc Capacity 1250 Gals. 11" jpe Concrete, Absorption Area Provided By '571' L.F'.xW! • -XX b"— width tretl0l, i Tiaiue Baldwin & Cornelius, ?_C Address RD 6, Route 22 .Brewster, New York 103= THIS SPACE FOR USE BY HEALTH DEPARTMENT ON �51, Soil Bate Approved Sq. Ft/Gal. ChF`�;- •�'�'�i"" yy :.,.: 1WEIVE OCT I F 1996 ' PUT N A M <:'11..1 s'1! T Y t. OF hLAL i 1'1 3.5' to Rock 1'U'1'IM-1 VUUII'I'Y UBUMITI -181IT Ulr 1 I'11 U1V1J1U11 VIP EllV1.11U111-1L11'191L 1 1;1'11 13LIIV1l;L3 UUUII'1'Y U117101 DUI Lull lu (;I11il.iLL ;• 11. Y. 10512 ULUlUII DATA III M -'1'- IJEI'/11111'1'L BL1-JAUL UlUIIUS/IL UYN1LI.131311861r1LL IIU. UNl►ol; White Tail .Acres Addivau North Birch Hill Road (AKA Stagecoach) LUCULed uL' (U6'eut N. Birch Hill Rd. f3eo. I3IOCIC — LOL jliiill%ute lii:aiioC ni�ollg �I:t�eeGj' IIu1t1c1Jh111Ly Patterson NaLe1g1►ed U01L I' AIVULfI'1'lUll '1'L3'1' DATA I!L'QU111LU 11'U BE SUUI-111"1' 111'1'11 Al'!'Llh'11'I'lUIIU I l (W it 111111111m. ULUCK '1'11-11 I'LllUULII'1'1UI1 I'LIICUlATIUll Milli Vli D55 ITajiCli Ca 14505 F LU FID V 61 11U. '1'lme . 11'-0111 Urou►►d, 13111'1'x09 III li rlleu full Poky I1Lul•L -Mvp ldlll. 8LaI-t UL'o ) Ural, lu 1d1►i. /li► tlruJ, Inches 71101168 111CIIOO 11 J B j 3:14 3:44 30 '•21 22.5 1.5 20 • .� 1 3:44 4:14.r . 30 21 22, 5 , 1.5 20 v iY. w 34:14 4:44 30 21 22.5 1.5. 20 rx 1iFY�' .me C 19:59 10:29 30 21 23.0 2.0 00:29 '10:59 30 21 23.0 2.0 t;,R � (t J4, *!'Y HEALTH X0:59 11:29 30 21 23.9 2.0 De NY' 15 _ 11 zta_lvw,,. A IluLeu I l ) '1'n;,Lq to be repeated ab a i raLoo a►'o uhLulued 1AL eaUll pera9l, L . •1 ul' rev OH. 2 1�:I,L1► menuummento to b made ��it ',):t•)�4f�},,�;�'•�ecli1.! 01) O!' 11010. 77-1 I\ 16 I JIUS, P.C. �1D SURVEYORS IK i LOCATION Poi SIT A C 92' BC 122 2 A D 1'SO bD . 146' AE- 176' PEE 100` AF 145' BF 41' AG (55' _ 6G 124 A I i149, 6 I 119' A2 144' F32 114' A3 ;139 013 110' A4 134' 134 I o5' A5 ;1.31 0�5 loo, AG �r26' s3C- g6' A-7 i Zz' 87 92' Ag J1.1 7' 87' IL .2-7- Ik 3.i' IM ��� HI i4.' H 15` Hk `(o' Ht_ 17' °AS E