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HomeMy WebLinkAbout0276DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -1 -6 BOX 4 �i �I • I�� J �♦ T . ' r 111: :ev. . .0/88 rumor COUNTY DEPARTM M.OF lGr1LTS Dlvblw of t wAsmeoM He" Seavle.m Camel. N.Y.1111512 tD Pwvlds Pafall / am CER]"ItATE OF CODII7AN(* NSTlIICTN)N PERl14t FOR SEWAGE DlISr0 L SYSTEM LeeN.a %rl. SulsdlylsM. N.me //�� / c.ea. Let r Tax Map Ft/a'1G if 1 f� .f f Renewal j�' Revlaka ' p Own /ApPYeeat Nam is t�5 vnew, o p ECG, ' '" / J Date d Prevbas App--d . 9 r M Addeoes l� f% Lam,. C :C 04,00 U ` Town �� , i /�- K' ✓� zlp � Date Subdivision A /nnroved Fee Enclosed 0 Amniint- Bedlillog Type )PE-2 It Area 4& eze- Fm seceion Odr Number d Bedrooms Deaip Flow G P D PCHD Notldcudou Is Repaired Wbeo FM Is eompk ted j SePureft Seerm se System to eaneklt d der d Go Oea Septic Took .ea V6,0 L� „df� % ;-, %,,4 e - f To be osustrudted byT' /� Address '�� Water Sapplr: PdW* Supply Fros Address out>lelrstte Supply DdEM by d Add..o.. 1 represent that 1 am wholly and completely responsible for the design and location of the proposed systenl(s); 1) that the separate sewage posa disl system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules regu vent 01 Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of HMithwill be submitted to the Department, and a written guarantee will b*'.furnished the owner, his successors, heirs or assigns by the builder, that said builder will DISCI' In jOOd operating condition my part of said "Wege disposal system during the per lod of two (2) years immediately following the date of the Inu- Once of the app -M of the Certificate of Construction Compliance of the original system or any repairs' Hereto; 2) that the drilled well described above wilt be located as ~A on the approved plan and that said well will bum Instal in accords a wit the std and r s and requ o�a�i ns of the Putnam Countyj apart nM Off Health. Date C! /rfJR J Signed P.E.- R.A. Addressn/ �� ~, License NO APPROVED FOR CONSTRUCTION: This approval expires two years from the datel, slued unless construction of the building has been undertaken and is revocable for cause or may be amorided.or modified when considered nace - the Commissioner of Health. Any change or alteration of construction requires a nne_w Ligon nit. Approvi d for disposal of domestic —sanini sewage /Or ate water suoDly only. Date Title � 4g 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 # WELL LOCATION Street Address 23 % o To Village City Tax Grid Number 2. -v--S WELL OWNER Name Mailing Address 0private Py�" O Public USE OF WELL primary 2- secondary RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP ❑ ABANDONED BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify 0 INDUSTRIAL O INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT , gpm/ # PEOPLE SERVED,6 --,!5 /EST. OF DAILY USAGE _8 G j Sal REASON FOR DRILLING C] REPLACE EXISTING SUPPLY ; NEW SUPPLY NEW DWELLING ❑ TEST /OBSERVATION 13. ADDITIONAL SUPPLY O DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING ' /-. • i �� ` - :� WELL TYPE DRILLED DRIVEN DUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES __NO NAME OF PUBLIC WATER SUPPLY:` r¢ TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDE ®ON SEPARATE SHEET 121 (dat.) )(signature PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise cont inate surface or groundwater. Date of Issue: 9 19 Date of Expiration 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller lE'�UTN,A.i�C COCJ�TTY 1�EPA.L'rM�r7T OF 1~XEAL�' APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1 . Name and Address of Appl scant: AM, KIC)A 2. Name of Project: O'T2a-­-E B PS 3.,_._Location /C: �Sa 4. Project Engineer: �-i f�{'�i'z_�1( -}Dls, rte. 5. Address: License Number: Phone: �L'1 6. Type of of Project: Private /Residential Food- Service ....Commercial Apartments Institutional Mobile Home Park Office Building , Realty Subdivision Other (specify) 7. Is this project subject:to State Environmental•Quality Review (SEQR)? Type Status (Check One) Type I.. Exempt ✓ Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? U 9. Has DEIS been completed and found acceptable by Lead Agency? J/A 10. Name of Lead Agency ti. Is this project in an area under the control of -local planning, zoning, or other officials, ordinances? .......... ............................... �l�l t2. If so, have plans been..submitted to such. author .sties ?...................... ►� /� 13. Has preliminary approval•been granted by such authorities? WA Date Granted: 14. Type of Sewage Disposal. System Discharge....... Surface Water ✓ Ground Waters 15. If surface water discharge, what is the stream class designation ?........ O /A :6. Waters index number (surface) ......... ;7. Is project located near a public water supply system? .................. 8. If yes, name of water supply Q/A Distance td�water supply. 9. Is project site near a public sewage collection or disposal system ?..... l,10 Q. Name of sewage system Q/A Distance to sewage system _ i. Date observed: 23. Name of Health Inspector: 4 '. Project design flow (gallons per day) ...... ............................... g� . 2. 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.._ aJo 26. Has SPDES Application been submitted to local DEC Office? ►.)>D; 27. Is any portion of this project located within_ a designated Town or State wetland? . ............................... r.1�J 23. Wetland ID plumber ........................................................ ►J /� 29. -is Wetland Permit.• required? ................................................ Has application been. made to Town or Local DEC Office? tJ A, 30.. Does project require a DEC Stream Disturbance Permit? ................... x.10 31. is or was project site used for agricultural activity involving application of pesticide$ to orchards or other crops, solid or hazardous waste _ i -isposal;` landfilling, sludge application or industrial activity? ........ YES or NO 00 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 K) (J DESCRIBE: , 33. Is there a local master plan or file -with the Town or Village? 34. Are community water, sewer facilities planned to be developed within 15 years? UN VQAOO 35. Are any sewage disposal areas in excess of"15% slope? ... :.................... —go 36. Tax Hap ID dumber .......... I�G - 37. Approved Plans are•to••ba returned to: ................ • App-licant _Y/_ 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 maybe grounds for the rejection of any submission. I hereby affirm, under pena7ty of perjury,-:-that information provided on this forr,7 is true to the best of my know7edge and be ief. Fa lse staterr,ents made herein are punishable as a Class A Hisderreanor pursuant to Section 210.45 of the Penal Law. f SIGNATURES & OFFICIAL TITLES: ',AILING ADDRESS: FORMAT Date August 10, 1993 - NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT RE: Department of Health Review of Kessler, Robin Proposed Sewage Disposal System 349 Mooney Hill Road for property: Patterson, NY 12563 Name: Ms. Amanda Cushman Hoffman Address: Mooney Hill Road Town: - Patterson, N.Y. Tax Map: 12.-4-5 Dear Ms. Kessler: Please be advised that -an application for a Construction Permit relative to the construction of a sewage system and /or well proposed:•for—the captioned .property has been made to the Putnam County Department of - :Attached. please find a .copy of the latest.. site plan. .. t. If'you. have any questions, concerns or information which may bear <` on the Health Department's review of this application, you may call: Mr. Hedges or Mr. Morris of the Health Department at 273 76130. RECEIVED BY: Address: Tax Map: JK;cj FORMAT NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT Carlson, Richard A. & Agnes W. 5 Manor Road Patterson, NY 12563 Dear Mr. & Mrs. Carlson: Date August 10, 1993 RE: Department of Health Review of Proposed Sewage. Disposal System P or property: Name: Ms. Amanda Cushman Hoffman Address: Mooney Hill Road Town: Patterson, N.Y. Tax Map- 12. -4 -5 Please be advised that an application for a Construction Permit relative to the construction of a. sewage system and /or well proposed, for. the captioned property has been made to the Putnam a County De.p'r.tment of 'Health. Attached ,please find. -a .copy .of. the latest. site plan: If*you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call': Mr. Hedges or Mr. Morris of the Health Department at 273 -6130. Very truly yours, By Ag V- Title RECEIVED BY: Address: Tax Map: JK;cj FORMAT NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT Harris, Andrew & Hettwer, Mary Mooney Hill Road Patterson, NY 12563 Dear Mr. Harris & Ms. Hettwer: Date August 10, 1993 RE: Department of Health Review of Proposed Sewage Disposal System for property: Name: Ms. Amanda Cushman Hoffman Address: Mooney Hill Road Town: Patterson, N.Y. Tax Map : 12.-4-5 Please be advised that an application for a Construction Permit relative to the construction of a sewage system and /or well proposed,, for. .the captioned property has' been made to the Putnam County Department. of: Health.. Attached please fihd..a .copy of the latest. site plan...:. If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call:Mr. Hedges or Mr. Morris 'of the Health Department at 273 -6130. Very truly yours, By Title Agent RECEIVED BY: Address: Tax Map: JK;cj FORMAT NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT Taub, Murray G. & Judy M. 6 Manor Road Patterson, NY 12563 Dear Mr. & Mrs. Taub: Date August 10, 1993 RE: Department of Health Review of Proposed Sewage Disposal System for property: Name: Ms. Amanda Cushman Hoffman Address: Mooney Hill Road Town: Patterson, N.Y. Tax Map : 12.-4-5 Please . be advised that an application for a Construction Permit relative to the construction of a sewage system and /or well proposed., for. the captioned property has been made to the Putnam County. Department, of'. Health... -Attached .please find a, .copy of the latest. site plan. if-you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call': Mr. Hedges or Mr. Morris of the Health Department at 273 76130. Very truly yours, By T i t le Agent RECEIVED BY: Address: Tax Map: JK;cj FORMAT NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT Ladau, Robt. & Anne H. Mooney Hill Road Patterson, NY 12563 Dear Mr. & Mrs. Ladau: Date August 10, 1993 RE: Department of Health Review of Proposed Sewage Disposal System for property: Name: Ms. Amanda Cushman Hoffman Address: Mooney Hill` Road Town: Patterson, N.Y. Tax Map: 12. -4 -5 Please. be advised that an application for a Construction Permit relative to the construction of a sewage system and /or well proposed,-. for•.the captioned property has been made to the Putnam County Dep ar f_ tment . o Health.. Attached please f ind a copy. of . thee latest. site plan. .. If,you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call': Mr. Hedges or Mr. Morris of the Health Department at 273 7-6130. Very truly yours, 'By Title Agent RECEIVED BY: Address: Tax Map: JK;cj FORMAT NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT Chamberlain, James & Lois Mooney Hill Road Patterson, NY 12563 Dear Mr. & Mrs. Chamberlain: Date August 10, 1993 RE: Department of Health Review of Proposed Sewage Disposal System for property: Name: Ms. Amanda Cushman Hoffman Address: Mooney Hill Road Town: Patterson, N.Y. Tax Map: .12.-4-5 Please. be advised that an application for a Construction Permit re-l-Ative to the construction of a sewage system and/o ' r we * 11 proposedj for. the captioned property has been made to the Putnam County Department of. H.eal.th....-.::-Attached please find.,'a copy . of I the.: lates.t site Plan. .If *you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call:Mr. Hedges or Mr. Morris of the Health Department at 27876130. Very truly yours, B Aaed Title Apen RECEIVED BY: Address: Tax Map: JK;cj 4A FORMAT NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT Hamilton, Susan P.O. Box 25369 Los Angeles, CA 90025 Dear Ms. Hamilton: Date August 10, 1993 RE: Department of Health Review of Proposed Sewage Disposal System for property: Name: Ms. Amanda Cushman Hoffman Address: Mooney Hill Road Town: Patterson, N.Y. Tax Map: 12. -4 -5 P leas e.be advised that an application for a Construction Permit relative to the construction of a sewage system and /or well proposed: for. . the captioned property has been .made to. the Putnam County Department of Health attached please find. a..cop.y of, the,.. latest. site plan. If *you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call: Mr. Hedges or Mr. Morris of the Health Department at .273 -6130. Very truly yours, By Title Agent ' RECEIVED BY: Address: Tax Map: JK;cj PUINAM COUNTY DEPARn TENT OF HFAL_ TH DIV - ION OF ERV1PLNRMML HEALTH S: ICES DESIGN DATA SHEET- SUBSUFACE SEMP E DISPOSAL SYSTEM FILE NO. owne_Y AM4b,\, CA t2le-- NM,W P.ddress �v. �rX 2%�G GtI 1MAA -b P �iJ Located at (street) Sec. 12 . Block Jot (indicate nearest cross street) M=icipality Watershed G�oTad� SOIZ PEF2COLA cN TFST DATA R.DQUT.RED TO BE SUB4I= Pr= APPLI=CLNS Date of Pre - Soaking :7- 16' -- 1,72 Date of Percolation Test -1—(6- HOLE NL': B ER C= T'I2 PEE CO=CN PERCOIATICN Run Elapse Depth to Water From hater Levu No. Tines Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In -. "'Min /In Drop Inches Inches inches 111:)�!�,12.eZ :0 N 32:1. ('4 2 1/I - A , I / /.: . . � 3 l/I,: ti 5 1 5. G NOTES: It Tests to be repeated at same depth until apprucirnatel.y equal: soil rates are* obtained at each percolation test hole. All data to* be suhmittbd for review. 2. Depth me zurements to be mane fran top of hole. rev. 9/85- TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCI TION OF SOILS ENCOUNMERED IN ;T SOLES DEPTH HOLE NO- j HOLE NO. HOLE No. G.L. - 2 I'T C) Gi 31 4 5' 61 7` 81 91 .101 12' 13' 14' 7ND!C-kTE LEVEL AT WaICF1 GROUNDMITER IS ENCOUNTERED INDICATE LEVEL TO W-KCH WATER LEVEL RISES AFTER BEING AUNT= .DEEP HOLE OBSERVATIONS MADE BY: DATE:. DESI&N Soil Rate Used Min/1" Drop: S.D. Usable Area Provided No. of Bedroans 2k Septic Tank Capacity gals.- Type .Absorption Area Provided By L.F. x 24" width trench 7 Other 9. P2 Name Signature Address '1 1? �Aj SEAL THIS SPACE FOR USE BY'SEALTH DEPARZENT ONLY: Soil Rate Approved sq.ft/gal- Checked by Ir &j CIO, L No. 56124 -00n--MiO� Date V-1 PUTT. I COUNTY DEPARTMENT OF HEM, H DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Aj. A DA &U -'HWA \ Located at (T)'� \�S���Section Block Lot Subdivision of Subdv. Lot # Filed Map # Date Gentlemen: This letter is to authorize -E-E (-g 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 Lana, and the Putnam County Sani- tary Code. Countersigned P.E. , _y-� - , h Address Very truly yours, Signed �- Osaner of Property ODX f-'�27<-' Address ' Town Telephone Telephone Lo C POOP FIRST FLOOR 1590 SO. FT. BEDROOM 134 X 142 fjEATH i:Eo7N CLOUT DRESS In CL. I Cl BEDROOM BEDROOM 13' x 142 138 x 100 _eCC•:D $0. FT L R M R / PUTNAM CpUNXY DEPT MOUSE PLANS !. PROVED F :Tl .. Y T .a N- l ROOMS 9Ignatur0 &TIt��.�w- " or 171-AY "IM __-�1 Date a _ i.' s v � � t 2 c �,• �I\ � /� IF / / � s /'l -�- .. •a l 4a`. �r� /ice �.. t,�. •� _ / 1 \ R� 1 `1 j; LAURENT ENGINEERING ASSOCIATES, P.C. 73 FAIRFIELD DRIVE PATTERSON, NEW YORK 12563 RANDOLPH W. LAURENT, PE. (914) 278.6108 - (FAX) 278.2658 HARRY W.NICHOLS, JR., PE. ffA CONSULTING SITE ENGINEERS August 9, 1993 Putnam County Health Department 4 Geneva Road Brewster, NY 10509 ATT: Mr. William Hedges RE: Proposed SSDS Mooney Hill Road T.M. 12. -4 -5 Town of Patterson, N.Y. Dear Bill: Enclosed are the following: 1. One (1) print of Drawing SS -1 "Proposed SSDS", dated 8 -6 -93. 2. Four (4) prints of Drawing SF -1 "Preliminary Design for Fill Placement Only ", dated 8 -6 -93. 3. "Application For Approval of Plans For a Wastewater Disposal .System ". 4. "Construction Permit for Sewage Disposal System ", dated 8 -6 -93. 5. "Application to Construct a Water Well ", dated 8 -6 -93. 6. "Design Data Sheet ". 7. "Letter of Authorization ", dated 8 -6 -93. 8. Two (2) copies of Residence Floor Pl.an(s), for "Bedroom Count Only ". 9. A check in the amount of $300.00 for Review Fee. 10. Letter from Patterson Building Inspector, dated 8 -5 -93. 11. Neighborhood Notification list and certified mailing receipts. August 9,.1993 Page 2 93042 -A Kindly review the enclosed items and contact us with your comments and /or approval at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. . C Harry W. Ni ols, Jr., P.E. HWN:bd 93042 -A ' enc. cc: Mr. R. Montgomery Jr. w /enc. s- 0 ��CTTNAM CO�CJNT'X- nEP.A.RTMENT OF' HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: AWOpa &yS- MAN. +V2P--rMh� 2. Name of Project: 132 -- �P�� 3.,_, Location /C: r 4. Project Engineer: _(� 4- u) j�6L4 Ift='. 5. Address: License Number: Phone: 2-7 - 6lof3 1 6. Type of Project: t: .. , V Private /Residential• Food - Service ....Commercial Apartments Institutional Mobile Home Park Office Building:, Realty 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. Xs a Draft Environmental Impact Statement (DEIS) required? fJ U 9. Has DEIS been completed and found acceptable by Lead Agency? .. 10. N,ame of Lead Agency ti. Is this project in an area under the control of -local planning, zoning, or other officials, ordinances? ........ .............................. 12. If so, have plans been..submitted to such, author .s ties? ..................... rJ /A 13. Has preliminary approval been granted by such authorities ? Date Granted: 14. Type of Sewage Disposal. System Discharge...... -'Surface Water ✓ Ground Waters 15. If surface water discharge, what is the stream class designation ?........ O/ /A :6. Waters index number (surface) ........... ............................... 7. Is project located near a public water supply system? .................. N�1 If yes, name of water supply Distance to6water supply si,Is project site near a public sewage collection or disposal system ?..... Q0 Nine of sewage system Q/A Distance to sewage system 'ate otserved: _ 2� _�!, 23. Name of Health Inspector: K/17— • .l-A.524EL, bject design flow (gallons per day) ..................................... Fe ,g�- r• :• s. r 2.. 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. e�p 26. Has SPDES Application been submitted to local DEC Office? ............... 27. Is any portion of this project located within a designated Town or State wetland ? .................... .............. ............................... n)0 28. Wetland ID Number ......................... ............................... 1J 14 '29. -Is Wetland Permit• required?. .............. ............................... Has application been made to Town or Local DEC Office? hJ /1� 30. Does' project require a DEC Stream Disturbance Permit? Q0 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 00 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 k)d DESCRIBE: =; 33. Is there a local master plan or file-with the Town or Village? 34. Are community water, sewer facilities planned to be developed within 15 years? dN KQ, WQ 35. Are any sewage disposal areas in excess of 15% slope? .....................,... 0o ff _ 3,6. Tax Map ID Number ......................... ............. ................... I2 37. Approved Plans are'to "be: returned to: ................ . Applicant 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 maybe 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 Pena 1 Law. SIGNATURES & OFFICIAL TITLES: ',AILING ADDRESS: v DESIGN DATA S'r =- --- URSUFACE SB4,hLE DISPOSAL SYSTEM FILE NO. Owner A ti/ Akr 1/i'LAO Address EP EyX '2*6 , I _'t=1MXK) EV—, o - (, Located at (Street) �D N ti` 4-fl LV ��� Sec. 1� " Block Lot (.indicate nearest cross street) Msunicipality ,b� —j`� me_ j Watershed SOIL PERCOLATICN TEST DATA RDQU= TO BE SU&4I= WITH APPIJCATICNS Date of Pre - Soaking '7 I Date of Percolation Test SOLE N[zmm CLOCK TIME PERCOLATION PE RC OLATIC N 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 111. -12'• a 2 p� 2� 2'i 'h . 2 2: P9 , I2 i 1 2- r/� �a' \ 4 2 2 '�7 a 2 W. - I h - 1' /. 4�2. 5 1 2 3 4 5 NOTES: 1.- Tests to be repeated•at same depth until approximately equal soil rates are* obtained at each percolation test hole... All data to* be suhmitt�d for review. 2. Depth irnasurenents to be made fran top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WrM APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTS HOLE NO. j HOLE NO. '? G 1 2 3 4 HOLE NO. � INDICATE LEVEL AT WHICH GROUNI ,Q= IS ENCOUNTERED INDICATE LEVEL TO WHICfi WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MR.DE BY:�, DATE:.; DESIGN Soil Rate Used .Min/1" Drop: S.D. Usable Area Provided No. of Bed.rocros 24 Septic Tank Capacity gals.' Type Absorption Area Provided By _lj L.F. x 24 width trench Other /-7 1 1 I , I _ 2 � 4�Z, 19 P2 1& 0 ,p Nam 1 Na �( ?_ _ �ti�_, (�� �� ,`j�f , Signature V Address :22 � .. -: C) �- • SEAL OFD No. 56124 THIS SPACE FOR USE BY 'B ALTH DEPAR MENr ONLY: Soil Rate Approved sq.ft /gal. Checked by Date I IOM PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date 2.) - <;: - 7/-j Re: Property ofM Q� �/� ��1�\ {- fQ'Fi•/(��� Located at N jLL -yLc�> Section Block 4 Lot Subdivision of Subdv. Lot # Filed Map # Date Gentlemen: This letter is to authorize`( ,�- a duly licensed professional engineer 1�z 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. Countersig: P.E. , P '�)- 1 i 1~� Djz I UE Address Telephone Very truly yours, Signed �Owner of V d _ �,�X Address alT Town (41A) 09 _ fail Te pho e JOHN N. CALBO Building Inspector TOWN OF PATTERSON PUTNAM COUNTY Telephone 878 -6319 PATTERSON, NEW YORK 12563 August 5, 1993 Mr. William Hedges Putnam County Health Department Rt. 312 Geneva Road Brewster, New York 10509 RE: TM - 12. -4 -5 (12.5 acres) Mooney Hill Road Patterson, New York Dear Mr. Hedges, This is.to inform you that the above noted.tax parcel constitutes a single building lot in the Town of Patterson. If you have any questions,_ please do not hesitate to contact this office. Very truly yours,, t Frank Blasi Temporary Building Inspector cs cc: Mr. H. Nichols Neighborhood Notification List T.M. 12. -4 -4 Patterson 12. -4 -1 Kessler, Robin 349 Mooney Hill Road Patterson, NY 12563 12. -4 -2 Carlson, Richard A. & Agnes W. 5 Manor Road Patterson, NY 12563 13. -1 -18 Harris, Andrew & Hettwer, Mary Mooney Hill Road Patterson, NY 12563 13. -1 -20 Taub, Murray G. & Judy M. 6 Manor Road Patterson, NY 12563 13. -1 -21 Ladau,,Robt. &.Anne. H. Mooney Hill Road Patterson, NY 12563 13. -1 -22.2 Chamberlain, James & Lois Mooney Hill Road Patterson, NY 12563 Kent 12. -3 -1 Hamilton, Susan P.O. Box 25369 Los Angeles, CA 90025 i \ f Itv I'1 Oy 41V To Neighborhood Notification List T.M. 12. -4 -4 Patterson 13. -1 -15.1 Rinaldi, Salvatore & Diana 13.- 1 -15 -.2 132 Fairway Drive 13. -1 -15.4 Carmel, NY 10512 13. -1 -17 13. -1 -18 Harris, Andrew & Hettwer, Mary Mooney Hill Road Patterson, NY 12563 Kent 12. -3 -1 Hamilton, Susan P.O. Box 25369 Los Angeles, CA 90025 1 FORMAT NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT Rinaldi, Salvatore & Diana 132 Fairway Drive Carmel, NY 10512 Dear Mr. & Mrs. Rinaldi: Date August 10, 1993 RE: Department of Health Review of Proposed Sewage Disposal System for property: Name: Ms. Amanda Cushman Hoffman Address :Mooney Hill Road Town: Patterson, N.Y. Tax Map :12. -4 -4 Please be advised that an application for a Construction Permit relative to the construction of a sewage system and /or well_ proposed,, for. .the captioned property has been made to the Putnam County Department of. Health. :.Attached please, find a.copy of the: latest site plan. If you have .any questions, concerns or information which may bear on the Health Department's review of this application, you may call': Mr. Hedges or Mr. Morris of the Health Department at 278 -6130. Very truly yours, By t Title Agent RECEIVED BY: Address: Tax Map: JK;cj FORMAT NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT Harris, Andrew & Hettwer, Mary Mooney Hill Road Patterson, NY 12563 Dear Mr. Harris & Ms. Hettwer: Date August 10, 1993 RE: Department of Health Review of Proposed Sewage Disposal System for property: Name: Ms. Amanda Cushman Hoffman Address:Mooney Hill -Road Town: Patterson, N.Y. Tax Map :12 . -4 -4 Please be advised that an application for a Construction Permit relative to the construction of a sewage system and /or well proposed:• for. the captioned property has been made to the Putnam County Department of Health...-.Attached please find.a. copy .of the,.. latest site -plan. If,you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call': Mr. Hedges or Mr. Morris of the Health Department at 273 -6130. Very truly yours, By Title AQ t RECEIVED BY: Address: Tax Map: JK;cj FORMAT NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT Hamilton, Susan P.O. Box 25369 Los Angeles, CA 90025 Dear Ms. Hamilton: Date August 10, 1993 RE: Department of Health Review of Proposed Sewage Disposal System for property: Name: Ms. Amanda Cushman Hoffman Address :Mooney Hill Road Town: Patterson, N.Y. Tax Map :12 . -4 -4 Please be .advised that an application for a Construction Permit relative to the construction of a sewage system and /or well proposed.: for. the captioned property has been made to the Putnam County Department . of Health..- , Attached .please .find a..copy of the. latest site .plan. If,you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call: Mr. Hedges or Mr. Morris of the Health Department at 273 - 6130. Very truly yours, By Title Age ' RECEIVED BY: Address: Tax Map: JK;cj 3 Q ­7 MTKAM MUM DEPARTMEM OF EIZALTH' J­- DMWIm offZevk=iMMW Redill SMA16& CaniiwL N.Y " 11612 I 112 SEWAGE DISPOSAL S1 Subwldsn Name Sam. W # MWMg in beeee to PWVWPN 01_.�. np Date Subdivision Approved Fee Enclosed U Amniint, Ae)- 51 te;P legZ19 EZA4 Z Lot Arm FM Swdm 0* V.M. "VC0 111111111112 TY" S�F ... . I LJ D-P* NwWbw of Bodnionts Design Flow G P D PCM NotMakdon Is Required Wbm FM Is completed _1 sopwaft &MUINP System to am" at GoUsss Sop& Tank and 44-7H7 To be ounbeeted by Wallso, SEP*. Psh.ft Sqp* Frooa Address an Je- JMv#Ao Sup* Darted by -FRIP ---Add. Otbasr.Requkemeoft— represent that I am wholly and completely responsible for the design and location of the proposed system(s); .1) that the separate gp=L_diVI system above described will be constructed as shown an the approved amendment there to and in accordance with the standards. rules on4Tr 07 Vu1nam County Department of ►@qftN and that on completion thereof a "Certificate of Construction Compliance" to the Commissioner of Healthwill 0 be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the bulk ier. 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 the "to of the Ism- once of the app ►- &I of the Certificate of Construction Compliance of he original system or any r S thereto; 2, that the drilled well described above A o Ins ad will be located as shown an the approved plan and that said well will b dance rith the ndarA uies and reguMTons of the Putnam County 04"Tta" of. Health. Dow, 9 silo,! P.E. _�A. Addre- IjUe-, IL4&- Aj conse No APPROVED FOR CONSTRUCTION- This approval 6xPIr@Z two Years from the date issued unless construction of the bl(ilding.has been undertaken and Is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change onto or alteration of construction requires a now permit. ad for disposal of Uki sanitary sewage, and/or private My!!ff supply only. Rev e 88 Date 10/ i ii RANDOLPH W. LAURENT, P.E. HARRY W. NICHOLS JR., P.E. August 28, 1995 Mr. William Hedges Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: SSDS Renewal - Permit #P -38 -93 Robert Montgomery Mooney Hill Road Patterson, N.Y. Dear Bill: Enclosed are the following: LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road Brewster, New York 10509 (914)278 -6108 - (FA)O 278 -2658 CONSULTING SITE ENGINEERS 1. Four (4) prints of Drawing SS -1 "Proposed SSDS ", dated 8 -6 -93. 2. Four (4) prints of Drawing SF -1 "Preliminary Design for Fill Placement Only ", d�d 8 -6 -95. 3. "Application For Approval of Plans For a Wastewater Disposal System ". 4. "Construction Permit for Sewage Disposal System ", dated 8- 28 -95. 5. "Application to Construct a Water Well", dated 8- 28 -95. 6. "Design Data Sheet ". 7. "Letter of Authorization ", dated 8- 28 -95. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Ha ' W. Nich Is, Jr., P.E. � HWN:bd 93042 -1 enc. cc: Mr. R. Montgomery w /enc. - r o I- APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1 . Name and Address of Applicant: ALA 'An, NM �,o j-�D tii�KI D . j jpx GU S !uS Ar i e2 I 72 2. Name of Project: (����� 3.._._LocationOV/C:_ �o 4. Project Engineer: W 5. Address: ��!J�,�.11z�1�t�.Iti► License Number:_ _• Phone:—,?, 6. Type of Pro.i.ect: ✓ Private /Residential Food.Service ....Commercial , Apartments Institutional Hobile Home Park Office Building Realty Subdivision Other (specify) 7. Is this project subject'to State Environmental - Quality Review (SEQR)? Type Status (Check One) Type I.. Exempt ✓ Type II. Unlisted. Y 8. Is a Draft Environmental Impact Statement (DEIS) requ.ire,d? 9. Has'DEIS been completed and found acceptable by Lead Agency? ......:.... NJ/ /A 10. Name of Lead Agency rJ /A 11. Is this project in an area under the control of-local planning, zoning, or other officials, ordinances? 0 12. If so, have plans been _submitted to such : author .sties ?'....`................ rJ /b 13. Has preliminary approval* been 'granted by such authorities? NSA Date Granted: 14. Type of Sewage Disposal, System Discharge....... Surface Water V Ground Waters IS. If surface water discharge, what is the stream class designation ?........ /A :6. Waters index number ( surface) ........... ............................... ►. , i7. Is project located near a public water supply system? .................. N ()• 8. If yes, name or water supply Q/A Distance td water supply 9. Is project site near a public sewage collection or disposal system ?..... 0. Name of sewage system Q/A Distance to sewage system 1 . Date observed:. 23. Name of Health Inspector: t� e. Y Project design flow (gallons per day) ..................................... OD 25. Is State Pollutant Discharge Elimination System (SPDES) 'Permit required ?.. �p 26. Has SPDES Application been submitted to local DEC Office? .......... A 27. Is any portion of this project located within a designated Town or State wetland? .................................. ............................... 28. Wetland ID Number .......................... ............................... ►4 29. -Is Wetland Perm, it• required?*.............................................. Has application been made to Town or Local DEC Office? IN) /..k 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—ii.sposal;}'`. landfilling, sludge application or industrial activity? YES or N0 )v 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? ............... or NO K)(J DESCRIBE: 33. .Is there a local master plan or 'file•with the Town or.Yillage? 34. Are community water, sewer facilities planned to be developed within 15 years? V :NK) 35. Are any sewage disposal areas in excess of' 15% slope? ........................ S10 36. Tax Hap ID Number ........................................................ 37. Approved Plans are'to­ba returned to: Applicant Engineer If the application is signed by a person other than the applicant shown in Item.I 'the. application must be-accompanied by y-a Letter of Authorization: Failure to comply with this provision may 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 know7edge and belief. False staterents made herein are punishab7e as a Class A Hisder,-eanor pursuant to Section 210.45 of the Pena 7 Lair. >IGNATURES & OFFICIAL TITLES: TAILING ADDRESS: PUR M.CCUN'TX DEPARM,97r OF aEALTH DIV' - .ION OF HEALTH S 7ICES DFSiGN DATA S'dFEEET- SUBSUFACE SEWAZE DISPOSAL SYSTE•i FILE NO. cwner ��eess D. D �G (c� bl� v Kited at (Street) Sec. Blodk 4 Lot (indicate nearest cross street) Municipality Watershed o COIL PE:'2MLb=C -N TEST DATA REQC IRM TO BE SUEMS= WITH A.PPLICATiCLNS Date of Pre-Soaking. 'j , (� Date of Percolation Test HOLE = - NUwB'-PR CL= =-r, P 2CO=CN 4 PERCOi.� MCN Run Elapse Depth to Water From Water Level- No- Tug Ground Surface In Inches. So-i-1 Rate Start -Stop Min. S tart Stop Drop In Min /In Drop .. 1 Inches Inches Inches 2 = 3 2 4 3 �.. 4 ; �j�AA - :7iI 5 .. 1 2 2 A 2 2 3 4 =�"I _ I !�� 2�i 2A 5 1 . 2 3 4 5 1.' Tests to be repeated at sane depth until apprcximately equal soil rates are' obtained at each percolation test hole. All data to' be suh nitUd for review. 2. Depth ma.siirements to be made fran top of hole_ rev. 9 /g5 TEST PIT DATA RDQU.Li2ED TO BE SUBMiT' M WITH APPLICATION DESCF TION OF SOILS ElCak=M IN iT BOLES DEPTH HOLE NO_ HOLE NO_ `?! HOLE NO. 6' 71 9' 10' 11' 12' 14' INDICATE LEVEL AT WMICH GROUNI ?WTR IS EIJOOUNI'ERED N/A IN- DICkTE LEVEL TO hHICH WATER LEVEL RISES AFTER BEING ENCOUNT —ERED N�A DEEP ROLE OBSERVATIONS MADE BY: },1( (� , W , W�5 pz:51� DATE:. _ 2 P - DESICMi Soil Rate Used �IO Yin/1" Drop: S.D. Usable Area Provided Gi la �• No. or Bedrooms Septic Tank Capacity �D 9�s • ��YPe0 1 C Absorption Area Provided By r p L.F. x 24" width trench Other Na1re `�i- �� �i I liH-D �� Signature 1�-:,� Address ��j�(I € L� Tai �1 SEAL w n THIS SPACE FOR USE BY 'HEALTH DEPAMIEW ONLY: Soil Rate Approved sq.£t /gal. Checked by Date PUTI .1 COUNTY DEPARTMENT OF HEi. .'H DIVISION OF ENVIRONMENTAL HEALTH.SERVICES Date Re: Property of .ALLW 2A I�lSL(1✓AQ H OfElAA\ J Located at (T) fLj Section Block Tom• Subdivision of Subdv. Lot # Filed Map # Lot Date Gentlemen: This letter is to authorize a duly licensed professional engineer V 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 Laser, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, 1 . Signed o�. 0i,•ner of Property Countersigned: s, No.5S124 w _ P. E. , ��. , Address i�1214 6�CVKA —01A Address TOIVA elephone �11:4 ) -j Tel phone 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 # sn9 --9. WELL LOCATION Street Address /) V llage City Tax G� '- 4rfidNumber 1 - 2 Z_ '7 - / 0. WELL OWNER Name � Mail * g Address JPrivate Public �E OF WELL 6'' primary 2- secondary J] RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL. ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify b INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /# PFOPLE SERVED,5-tZ, /EST. OF DAILY USAGE &Ck� gal REASON FOR DRILLING 0 REPLACE EXISTING SUPPLY WNEW SUPPLY NEW DWELLING ❑ TEST /OBSERVATION CIADDITIONAL SUPPLY 13 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED 13DRIVEN DDUG GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES �_NO NAME OF PUBLIC WATER SUPPLY: A4 TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED )ON SEPARATE SHEET (ate) (s�.$nature) r� 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 requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as of to degrade or otherwise contaminate surface or groundwater. Date of Issue: Date of Expiration 19� Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 _ Yellow copy: Bldg. Insp. Orange copy: Well Driller M l l FV'iT) M COUMY DEPAlliilEW OF HEALTH D1.ww aramba4maw BOOM Sae.loe.. Cnsd N.Y. twit > to Fla ld.:I `taki M CdMUftATE OF: COMKAANCB COIN PMW Fast SEWAM D18 MU:STUZM at W O^Arll� I f LL— i2Ur�fJ Imi Nabs " : -. Let r ZIP 42 `71 i.�fil�1� - Lot Area � $. � (:.� 4!0 Fm Seetiea Onb Wm., Vd M �D Numb PCHD Notldwllon M Regdmd Wbea Fig b implobd Sopseab ""MOM a Srtm to am" 414,P51) a Soptla Tact ••a d 0 Tta M:aadeou/od by e �/� Address WSW Suffb: F Sw* Fi Address ee Z_._Pehats Snub DeMed M ��••" I represent'ahat I am wholly and: ompletely responsible f6r the design and location of the proposed system($). 1) that the separate saw Ai "I stem w .bo described will be constructed as shown on the approved amendment there to and in accordance with ten standards, rules a regulations o ruin County Department of HmaA,. and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Coinmissbner.of Haelthwill. be submitted to the Department, and a written guarantee will be furnished ten owner, his sucamon. Heirs or assigns by the bulklar, that mid builder will Place in flood .operating condition any part of said wwage disposal system during the period of two (2) yens Immediately following thedat. of ,the lieu - ance of -tM,appmal of ten Certificate of Construction Compliance of lhf original system or any raWirs.t, 0: 2) tent ten drilte0 well described Woes WIN be located as shown on the approved plan and that said well will be insta in accordance wtth ten standa % ru f rpuu O of the Putnam County Deportment of Hatttyyh,,. Date 1 Signed P.E. b /R.A. _ L Address ' d License NO -� APPROVED FOR CONSTRUCTION: This app val expires two years from the date i ad unless lonstruction of the building .has been undertaken and if revocable for cause or may be amended or modified when considered necessary by ten Commissioner of Health. Any change or alteration of construction R2V . require& a "N permit.. ApWojMd for disposal of domestic �sanitary sewage. and private water supply only. Is- 10/88 Oab —� DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL p PCHD PERMIT # /�� WELL LOCATION Street Address op 1 r? To Village City Tax Grid Number 2. WELL OWNER Name 1 Mailing -0 NX 12- -l( Address OPrivate P _ _,Ofj 0 O Public USE OF WELL 0- primary 2- secondary ® RESIDENTIAL O BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify, O INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm/ # E3 REPLACE EXISTING SUPPLY Et NEW SUPPLY NEW DWELLING) PEOPLE SERVED_ to /EST. OF DAILY USAGE �i� Sal O TEST /OBSERVATION Q ADDITIONAL SUPPLY O DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN DDUG OGRAVEL 0OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. _ WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES Z NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED MON SEPARATE SHEET 4 i . 9- (date) I (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 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 su a mannerCa.5__not--to degrade or otherwise contaminate surface or groundwater. Date of Issue: 19� ��... �' Date of Expiration 19 � Permit Issuing 0 ficial Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller BEDROOM 134 X 142 EATH 1 s. rX 'Loscl DRESS. RIA. C-.CSET .ODF WASTER BEDROOM BEDROOM BEDROOM 134 x 142 138 x loo 134 x 194 Ercc•::) F,;,, CRpjTU*10UNT- Y DEPAR","KENT OP Atm oo, HOUSE P A P- "S A P P 0 F, 0,R FIRST FLOOR 1590 SO. FT. P JOHN N. CALBO Building Inspector TOWN OF PATTERSON PUTNAM COUNTY PATTERSON, NEW YORK 12563 August 5, 1993 Mr. William Hedges Putnam County Health Department Rt. 312 Geneva Road Brewster, New York 10509 1l i� C RE: TM - 12. -4 -4 (40.66 acres) Mooney Hill Road Patterson, New York Dear Mr. Hedges, This is to inform you that the above noted tax parcel constitutes a single.building lot in the Town of Patterson. If you have any questions, please do not hesitate to contact this office. Very truly yours, Frank Blasi Temporary Building Inspector cs cc: Mr. H. Nichols Telephone 878 -6319 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. ffA CONSULTING SITE ENGINEERS August 10, 1993 Putnam County Health Department 4 Geneva Road Brewster, NY 10509 ATT: Mr. William Hedges RE: Proposed SSDS Mooney Hill-Road T.M. 12. -4 -4 Town of Patterson, N.Y. Dear Bill: Enclosed are the following: 1. Four (4) prints of Drawing SS -2 "Proposed SSDS ", dated 8- 10 -93. 2. "Application For Approval of Plans For a Wastewater Disposal System ". 3. "Construction Permit for Sewage Disposal System ", dated 8- 10 � .93. 4. "Application to Construct a Water Well ", dated 8- 10 -93. 5. "Design Data Sheet ". 6. "Letter of Authorization ", dated 8- 10 -93. 7. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only ". 8. A check in the amount of $300.00 for Review Fee. 9. Letter from Patterson Building Inspector, dated 8 -5 -93. 10. Neighborhood Notification list and certified mailing receipts. :August 10, 1993 Page 2 93042 -C Kindly review the enclosed items and contact us with your comments and /or approval at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. chols, Jr., P.E. HWN:bd 93042 -C enc. cc: Mr. R. Montgomery Jr. w /enc. PYJ'TNAL� COU].V"TX �Ep,p,,RTMENT OF' HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: ALA �SQ.l -l-t 2. Name of Project: �Ot� ��� 3.._. Location /C:�o 4. Project Engineer:1`� W t�l�ND1�dz 5. Address: �T%l FILE Iii) l License Number: Phone: 21 _ 61,19 b 6. _Type_ of Project: ✓ Private Residential Food-Service ....Commercial Apartments Institutional Mobile Home Park Office Building. -Realty Subdivision Other (specify) 7. Is this project subject: to* State Environmental-Quality Review.(SEQR)? Type Status (Check One) Type I.. Exempt ✓ Type II. Unlisted. 8. Is a Draft Envirbnmental Impact Statement (DEIS) required? ............, I.IU 9. Has DEIS been completed and found acceptable by Lead Agency? nJ1A 10,. Name .of Lead Agency 11. Is this project in an area under the control of -local planning, zoning, or other officials, ordinances? ...... .............................. 12. If so, Have plans been.-submitted to such. author .sties...................... 13. Has preliminary approval been granted by such authorities ? M/,A,_ Date Granted: 14. Type of Sewage Disposal: System Discharge .....•. Surface Water v Ground Waters 15. If surface water discharge, what is the stream class designation ?........ 0/ /A :6. Waters index number (surface) ........... r.V,6, J. Is project located near a public water supply system? .................. n)r� 8. If yes, name of water supply WA Distance td water supply 9: Is project site near a public sewage collection or disposal system ?..... .0. Name of sewage system Distance to sewage system :1. Date observed: 23. Name of Health Inspector: •f. Project design flow (gallons per day) ...... ............................... `�iDD 's?, - 2 . 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. 00 26. Has SPDES Application been submitted to local DEC Office? ............... KVA 27. Is any portion of this project located within a designated Town or State wetland ? ............... .................. ............................... r)�) 28. Wetland ID Number ........................................................ u& 29. -Is Wetland Permit., requ i red? .......... ....... 6 )0 hJ Has application been made to Town or Local DEC Office? :.:....... ........ /'. 30. Does project require a DEC Stream Disturbance Permit? ................... f.�D 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 0 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 k1Q DESCRIBE: 33. Js there a local master plan or file•with, the Town or Village? ........... 34. Are, community water, sewer facilities planned to be developed within 15 years? Q W:fQ 00 35. -.Are any,sewage disposal areas in excess of* 15% slope? V0 36-.-. Tax-' Ha •- ID Number ..... ............................... . ... .......... 37 - App,rove`d. Plans are* to"be; returned to: ................ Apps icant _Y/ Engineer I-f the application is signed by a person other than the applicant shown in Item.1, the. sppli`cat_i;on =gust 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 form is true to the best of my know7edge and be l ief. Fa lse statements made herein are punishable as a Class A Xisdameanor pursuant to Section 210.45 of the Pena 1 Lair. SIGNATURES & OFFICIAL TITLES: ',AILING ADDRESS:�°r��dt� 1, •`i �t--�� h DESIGN DATA S•HJ=- SUBSUFACE SEWP� DIS:PPOSSAL� SYSTEM FILE NO. Owne s p . o r Located at (Street) QODNr- Sec. 112- Block - Lot (indicate n'PA e—s tI cross street) Municipality EV- - - watershed o 0 SOIL PERCOLA.TIC N TEST DATA RDQU= TO BE SLT&41= WITH APPLICATIONS Date of Pre-Soaking, Date of Percolation Test HOLE Nth CLOCK TIME PERC OT=CN P£RC D=C N Run Elapse Depth to Water Fran Water Level- No. Time Ground Surface In Inches Soil Rate Start-Stop Min. Start Stop Drop In Min/In Drop Inches Inches Inches 3 4 5 NOTES: 1.• Tests to be repeated at same depth until approximately equal •soil rates are* obtained at each percolation test hole. All data to'be suimitted for review. 2. Depth mea.svreTents to be made fran top of hole. rev. 9/85 a 1 � •.tai �? Z- 2- 3 " fl �4 .5 3 4 I j 66 2tj 2 2� �1 5 1 2 3 4 5 NOTES: 1.• Tests to be repeated at same depth until approximately equal •soil rates are* obtained at each percolation test hole. All data to'be suimitted for review. 2. Depth mea.svreTents to be made fran top of hole. rev. 9/85 a TEST PIT DATA REIQUIRM TO BE SUBMITTED WITH APPLICATION DESCPLUITION OF SOILS MMIIERED IN TEST HOLF-S DEPTH HOLE NO. HOLE NO. HOLE NO. 63 71 8' 91 10, 13' 14' INDICATE LEVEL AT waica GROUNDRATER IS ENCOUNTERED INDICATE LEVEL TO WHICH. WATER LEVEL RISES AF= BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: M r—, DATE:. DESIGN Soil Rate Used D Min/I" Drop: S.D. Usable Area Provided r No. of Bedrooms Septic Tank Capacity p gals.* Type Absorption Area Provided By z9 - L.F. x 24" width trench Other LA C2 Name Address T_ THIS SPACE FOR USE BY-HEALTH DF-PARDENr ONLY: Signature. SEAL No. 56124 Soil Rate Approved sq.ft/gal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of z:LU'L9WAQ HGr FM,, (J Located at (T);�(� Dpi Section ��, Block �- Lot Subdivision of Subdv. Lot # Gentlemen: Filed Map # Date This letter is to authorize y' k) . jJI -r,z . a duly licensed professional engineer V 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. �q 'gyp Very truly yours, Signed 'tom: Owner of Property Countersigned: s�^ No. 55124 P. E. , P-- . Address Addi-esg TOWA Telephone �4(4)�2��_ Tel phoneT / \ r All E;XtST:IIN6 — --- -� RADE 1. 'r.OH fill must be stabilized by alloving the koH fin to settle naturally for a period of at least 6 months and include, at least one freeze -thav cycle or Sill stabilation may be .achieved by mechanical compaction in approximately si:r inch lifts to the approximate density of the undisturbed underlying granular soil. The results of density tests must extend three (3') feet performed, in the undisturbed underlying soil and in the till pad-are to be submitted to tfT1i1 pad d three thieve the Putnaa County Health Department if mechanical compaction is to be utilized. onal soil with the final 2• site modification activities involving placement of Sill are to a conducted during soil with a,wi 1 to three relatively dry periods to minimize soil smearing and excessive soil compaction. o-" the with a one (1)eto three 3,. Run of bank Sill shall be suitable for sewage absorption, be free of Sines or other ch =s deep end ha lext inches wide. unsuitable material and shall have an in -place percolation rate at least equal to that p an ,- ..., in the natural soil after the required stabilization period. The engineer /architect ,O +agt.v in the till after stabilization. (\