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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -76 BOX 5 00172 l arm I ,o -'� 6. 16 i ;�.,. �. i j 0 8, r . r F-2 �. W . 00172 s d DEPARi1YIE1v i OF PJEAI.T.Ii DMsion of Env1rnnmentrd Health Services 6 Genava Road BTeWstsr, New York 10509 " Tel. .-(9114) '278.6130 Fax (914) 278-7921 .. .O y .. 6, Zmal"1111i BRUCE R FOLLY Puba., Hecirh Directcr STREETZT i��� ✓� ► i�ro,�c TOWi�t" 1G S�� TXMA2., NAME r► , Pxoti -E i 7/ PcRD ,� 36p 0 - 0 1 Afi.l?v , ADDRESS 23 . ?)`bE,6V+L-uJ 'Nave- � rso�n ,V y' (2523 DESCRIPTION OF ADDITION � +shed 4S�Mn ' NL 13ER OF Ek�S ??�'VG BEI3ROO:YLS PROPOSED 4 CF BEDROONIS 3, (FROM r- El. T. 0: 0CC P. ANCY OR CERTIFICATION FROM BUILOLNC r\SPF-CTOR) *Any addition which is corsider.d a bedroom requires formal approval of plan (Coamcdon Permit) prepe::Pd by a rcf_ssional Engineer. or Regist;°red Arcn tect in accordance with aaplicab:e sections of th.t Pusan Cozity Sanita.*y Code. Please submit this fc1z: a, : ;d the fo'lowing to P,&am County riealth- Dept., 4 Geneva Rd., Brewster. NY 10509, Phone 278 -F130. 1. Certifiei'check or money order for 5100.00 Sketches of existing floorp;art (drawn to sca?e, all living area Including basement) Non- professiom2l sketc'n_s arc accept,ble 3.7wo sets of proposed floor plan (drawl to scare, with name, stree'., a and •a;: r_�ap T) . * Non- p :afcssionai skete :hes are acceptable 4. Copy of survey showing well and septic location, to the best of your knowled,e. IncWe date of ins?allatiol.if kno-wn: Label all well s and septic systems wi�'ai -n 200 feet of the property fire. Contact this office wit any questions. 5. Copy of Cent. of Occupancy frcm Town or Certification from: Building Dept. with legal bedroom court of dwelllno1Z. OFFICE U Com me z F:b 93' - ` DEPARTMENT OF HEALTH Division . Of Emkonrnental Health Services 4 Ceneva' Road, Brewster, New York 10509 (914) 278 -6130 - Putr._rr. Country Dept. ofHeait-; 4 Geneva Road 3:cwster, NY 105C9 Re: ,E,t",e 77' Residence Tax Map / a - Tom , z'i`ew--; oA BRUCE R._FOLEI. A c_ Acting Puhile malth 01."! -t. -3, C:entiamen: According to records majntairec by the n Twthe above noted dti.ellin� is :S IM0;' in conlplianc.- v,ith -1ov,,, code and the total number of bedrooms on record is --� This infor nation has been obtai.2ed from: CERTIFICATE, Or OC;CT T?A24'CY: A. SESSORS RECORD: tilding inscec"tdr LORETTA MOLINARI Public Health, Director 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 Robert J. McCarthy 129 Maple Ave. . Patterson, NY 12563 Dear Mr. McCarthy: ROBERT J. BONDI County Executive November 19, 2004 Re: Addition — Emmitt, Ridgeview Dr. No Increases in Number of Bedrooms (T) Patterson, TM #13 -2 -76 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 November 19, 2004. The addition is approved with the following conditions. 1. The total number of bedrooms must remain at three three 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 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. ML: lm cc: BI (T) Patterson Sincerely, !�IZ Michael Luke Public Health Sanitarian r ��i�i� ✓iC�J � r � t/ �� 3 y6 tp !~-- , 6 --q I'ar pii pr D q 05 t,0 (��vvvvt. r- PUTNAM COUNTY DEPART=MENT OF HEAD HOUSE PLr>rl APPROVED FOR 7 A J iii �I�r)t.�(.! 11.1f'j± y, PEfs t g �Y Signature & Title Date e r PUTNAM COUNTY DEPARTMENT OF HEALTH Holul E P.-APIS, ArFFRAWED-FOR s. PfEs 0'4 J!4 g �171 tore & Title Date 34 /7 My NP rhop 4- rf EI VIU -TNAMI -GOUT IT( DEPARTMENT OF 14EALTH HOUSE PLANS APPROVED FOR JIX Sicwature ,Title Date C � -� -sue► -+ N , Y f zS� 3 ��'�' 7 b -:Z^, At 23 R W -7 i1► ar�� �� p TA- ` m 4 11 13 - Z -'?4 6.1f Del I Z3 Zs i3-Z-76 j J (`ate �Q�Ige� f— V —1 -I ( )ld i 0 it b,l-q i m y 1 i , X, . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Q23 In Located at V: 6 To or Village 4S Owner /Applicant Name d NW;-�A Tax Map _ Block Lot 7(a Formerly '� Subdivision Name Z9 r )Wig Mailing Address Subd. Lot # Zip Date Construction Permit Issued by PCHD �tL Separate Sewerage System built by Ale, :W 1 ,�57 , Address '50)t "gSWx'j&' NY Consisting of j Gallon Septic Tank and ' Z -1,11, /--;' 'Qz z y OY ZZEA611 Other Requirements:_? ! 'R' 0, A. rl Z,/- Water Su ®toly: Public Supply From Address r to ®r:. yrJ Private Supply Drilled by Address Building Type : IXA,771tt Has erosion control been completed? Number of Bedrooms Has garbage grinder been installed? I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the stan ards, rules and regulations of the Putnam County Department of Health. Date: l Certified by , P.E. R.A. � (De ' n Profe sional) Address rt 9' �3 a,�c 4'l License # Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject, to modification or change when, in the judgment of the Public Health Director, such revocation, modification or ch ge is necessary. By: Title: -5 '. Date: 20 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 13 WELL COMPLETION REPORT Well Location j Street Address: Town/Village: Wr�s p'/ Tax Grid # Map « Block % Lot(s) Well Owner: Name: / Address: Use of Well: 1- primary 2- secondary Residential Business Industrial Public Supply Air cond/heat pump Irrigation Farm Test/monitoring Other(specify) Institutional Standby Drilling Equipment Rotary Cable percussion A Compressed air percussion Other (specify) Well Type Screened Open end casin X Open hole in bedrock Other Casing Details Total length ft. Length below grade ft. Diameter in. Weight per foot �v``i lb /ft. Materials: Steel Plastic Other Joints: Welded Threaded Other Seal: _ Cement grout _ Bentonite Other Drive shoe: Yes No Liner: Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test Bailed Pumped Compressed Air Hours Yield 6 gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface .. If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth Model Voltage HP Tank Type Volume Date Well C mpleted�j Putnam County Certification No. Date of Report G� Well Driller (signature) NOTIV: Exadt location of well with distances to at least two permanent Yandfharks to be provided on a separate ffi et/plan. Well Driller's Name Ay, /)ml Address: r60 -71C.,; 31 Signature: Date: White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 NORTHEAST LABORATORY OF DANBURY 39 -3 MILL PLAIN Roan - DANBURY, CT 06811 (203) 748 -7903 - FAX (203) 748 -0652 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: HYATT PUMP SERVICE RR2, BOX 141C HOLMES, N.Y. 1253.1 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: Total Coliform (Bacteria) PHYSICALS: Color Odor pH Turbidity CHEMISTRY: Nitrite N Nitrate N Alkalinity Hardness Iron Manganese Sodium Lead CT Cert: PH -0404 NY Cert: 11471 DATE SAMPLE COLLECTED: 8/11/99 TIME COLLECTED: 8:30 A.M. COLLECTED BY: C. HYATT DATE RECEIVED @ LAB: 8/12/99 TESTED BY: LAB# 11471 REPORT DATE: 8/17/99 NUIZIA CONST., LOT #13, RIDGEVIEW, PATTERSON, N.Y. FAUCET WELL -NEW NONE RESULT: 0 ND 7.24 0.32 <0.005 1.97 155.0 186.0 <0.03 0.033 6.2 0.002 ml = milliliter mg/L = milligrams per Liter * *Notification Level ** *Action Level MAXIMUM CONTAMINANT LEVEL per 100 ml 0 per 100 ml 15 3 Units no designated limit NTUs 5 NTUs mg/L as N 1 mg/L as N mg/L as N 10 mg/L as;N mg/L no designated limits mg/L no designated limits. mg/L 0.30 mg/L mg/L 0.30 mg/L . [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] mg/L 20 mg/L *.* mg/L 0.015 * ** ND = none detected NTU =Units RESULTS BASED ON SAMPLES SUBMITTED:8 /12/99 SAMPLE, AS TESTED ABOVE: MPOTABLE or DOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Laboratory Director -NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 -FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 NE NORTHEAST LABORATORY of DANBURY CT Cert: PH -0404 LABS 39 -3 MILL PLAIN ROAD - DANBURY, CT 06811 NY Cert: 11471 (203) 748 -7903 - FAX (203) 748 -0652 STATE OF NEW YORK INTERPRETATION OF LABORATORY RESULTS In New York, the Department of Public Health (DPH) uses a combination of standards and advisory levels to help consumers interpret their water test results. Their excess does not necessarily mean that the water is harmful, but it might indicate that the source of the problem be found and corrected. For specific questions concerning your analysis, or any treatment your are considering, contact the Laboratory or your local Health Department. Coliform (Bacteriological Test): This test is made to detect organisms of the so- called coliform group, found mostly in the intestinal tract of man and other animals. The presence of coliforms indicates the possibility that disease - producing organisms may also be present in the water. Limit: 0 /100 ml. Color: Color may result from iron, manganese, humus, plankton, weeds, or industrial wastes. No designated DPH MCL limits Odor: Odor is a subjective evaluation of acceptability of the water. Not to exceed a value of 2 on a scale of 1 to 5. pH Value: pH defines the hydrogen -ion concentration in water and represents the aggressiveness of the water toward pipes, etc (a low pH being more corrosive). Recommended Limit: 6.4 to 8.6 range. Turbidity: This test measures the light scattering property of solids in water as compared to a standard clay suspension. Limit: 5 Units. Nitrogen Constituents: These may indicate sewage or other nitrogenous organic contamination. Nitrate Nitrogen in excess of 10 mg/L is potentially dangerous, particularly for infant feeding. Limits: Nitrate: 10 mg/L as'N; Nitrite: 1 mg/L as N; Alkalinity: Alkalinity is a measure of alkaline substances such as hydroxides, carbonates and bicarbonates with capacity for neutralizing acid. No designated DPH MCL limits Hardness: Hardness is primarily a measure of calcium and magnesium in water and is related to the soap - consuming power of water. No designated DPH MCL limits Iron: Excess iron results in color and turbidity. Iion stains laundry and fixtures orange -brown and promotes iron bacteria which can impact a taste and odor. Iron can be removed with a water softener,, iron filtration or ion exchange. DPH MCL: 0.30 mg /L Manganese: Manganese causes black stains on laundry or fixtures. Manganese is removed with a water softener, iron filtration or ion exchange. DPH MCL: 0.30 mg/L Iron plus Manganese: DPH MCL: 0.50 mg /L Lead: Lead is a metal formerly used in soldering joints in plumbing systems. It is now prohibited, but many houses still have lead in their plumbing systems. Lead can build up gradually in the body and can have effects on the brain and nervous system. Action Level: 0.015 mg/L. Sodium Persons with high blood pressure, hypertension, congestive heart disease or persons on a low salt diet should consult their physician before consuming a source with a high sodium level. DPH GUIDE:20 mg /L for people on a severely restricted sodium diet. 270 mg/L for people on a moderately restricted sodium diet. Note: mg/L = Milligrams per liter N= NitrogeN ml= Milliliters DPH= Department of Health NTU= Nephelometic Turbidity Units *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM r►� i4c Owner or Purchaser of Building ORz(v� C�►sT�ucT ��/� Building Constructed by V3 `)Z J ✓) L Location - S reet Buildi g Type Tax Map Block Lot Town/Village ZJ Subdivision Name 23 Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is 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 sewage treatment 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 Public Health Director. of the Putnam County Department of Health as to whether or not the failure of the system to operate was 'caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Mo th' Day Year Signature: Title: General Cottractor (Owner) - Signature C "q99ucT1w (fw. Corporation Name (if corporation) Address: ?0. Z 3 Z , r� SIt Kee". i1 State f V Zip 12 Z " Corporation Name (if corporation) Address: State Zip Form GS -97 r NORTHEAST LABORATORY of DANBURY 39 -3 MILL PLAIN Roan - DANBURY, CT 06811 (203) 748 -7903 - FAX (203) 748 -0652 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: HYATT PUMP SERVICE RR2, BOX 141C HOLMES, N.Y. 12531 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: CT Cert: PH -0404 NY Cert: 11471 DATE SAMPLE COLLECTED: 8111/99 TIME COLLECTED: 8:30 A.M. COLLECTED BY: C. HYATT DATE RECEIVED @ LAB: 8/12/99 TESTED BY: LAB #11471 REPORT DATE: 8/17/99 NUIZIA CONST., LOT #13, RIDGEVIEW, PATTERSON, N.Y. FAUCET WELL -NEW NONE TEST PERFORMED RESULT: BACTERIAL: no designated limits ` Total Coliform (Bacteria) 0 PHYSICALS: 0.30 mg/L . Color 0 Odor ND pH 7.24 Turbidity 0.32 CHEMISTRY: detected NTU =Units Nitrite N <0.005 Nitrate N 1.97 Alkalinity 155.0 Hardness 186.0 Iron <0.03 Manganese 0.033 Sodium 6.2 Lead 0.002 ml = milliliter mg/L = milligrams per Liter * *Notification Level ** *Action Level MAMMUM CONTAMINANT LEVEL per 100 ml 0 per 100 ml 15 3 Units no designated limit NTUs 5 NTUs mg/L as N 1 mg/L as N mg/L asN 10 mg/L asN mg/L no designated limits mg/L no designated limits ` mg/L 0.30 mg/L mg/L 0.30 mg/L . [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] mg/L 20 mg/L ** mg/L 0.015 * ** ND = none detected NTU =Units RESULTS BASED ON SAMPLES SUBMITTED: 8/12/99 SAMPLE, AS TESTED ABOVE: �X OTABLE or OT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 ° !U!lIAM COUNT F OWAllfi0W OF RUM 1lOrsLe■awW SW O Sureties. co" N.Y. lfsl? a■ PesQl Nab u 2 t i �— COfflltUCION P11111W ��tAL Xm r q Ar eve■ a Tut: Map mink �••_Iw _ >Q�r S�� ■M ■ p Deb T4; Tow. �+AtK. 7aJ/�1 zip ?ee Enclosed ❑ Amniint •++`s ale i i7AL: Lot Ana 1, Z 3 ZZ AG a pB see" 0* Depth vawm lim" r of . .Daipl Plow G P D S� PM Naldnda■ r Whw 101 r es"bod Swags Sew'wrp sylowe M a■am of m6b nose SVO TEA T'�1 1, —r� TS V auniuseled ti -T -t i3� Aal>reoo Wager Ss,■trs PIS SI** Flees Adder an Sw* NEW by I ►eprea s t that 1 am wholly and completely responsible for the design and location of the proposed system(s). 1) that these orate saws a die ll s slam above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regu a oM d 111a r11 C.wley oepW ellnt of 1/MR0, and that on complation,thersof a •Certificate of Construction Compliance'* satisfactory to the Commisskmes, of Hm*hwial M s bseletad to tow 0%Wtalelq% well a written guaralatea will be furnished the Owner, his suconrors. helm or assigns by the builder. that old builder wIB pact is pin .dparaMll co"KI h. any pert of old OWNIS deposal system during the period 'Of two (2) years hnmadlatay following thedate Of the Walk. ma Of tin approval of the Certificate of Construction Compliance of the original system a any repelrs thwelol2) that the drMW wall daWOM above well be geoated Mown a file approved pan and that said well will be Instal in with 67 It!pAlrdS. rules and regu oM of the Putnam Cote ty IrlalK Of IL ` OMe signed Adrr iLsW ;—o Lo, No APPROVED FOR CONSTRUCTION: Thb approval expires s from the dftgo unless struclion of the building has eon undertaken and Is revocable for may a enleaded Or medMed who► non ry b t o ...... W of Health. Any change or alteration of construction fes"ines p OMe u�Ll �/pewd for dlepoesl of ®ddkyrlestk. eswaga, to water tu00b eny' Title Rev,,. PUT NAM CORY DEPAITMENr OF HBALTH DMd= of Bnvb ttms■W Huth Saws. Carted. N.Y.1012 r le P,evWe poe" r dal CP�11Y+[CATB OF'70�HiANCB� N Pl�1' F00 SXWAGE DISPOSAL SM= POOR r at vfAtge l � ear■ at Sltbivwr■ Nnr ' Let r �� Ter: map !l 3S stet o..sdsppras■e N... 20 a-Pp- R.ew.a p Revile■ p Date 0jWvbn App m'd Maw Additive f?X js Town A �y� ZIp 1 0 rata Riihdivisinn' Annroved Z4 elm Fee Enclosed tJ e,,,nll "f• S i©e Rev. salSirs Type Let Ann, \ ►.�3(L FM sects■ 0* Deptb' k Yzz� ow G P D5. (C,1','' PC® Nod atlols r Seed When FM supasde sen.,.8a symm ge c,,m of J Sf 51) &a.. Septic Twa . A hi I=r (2 -%A 271 N To he ondn c/ed by wager Sup*. F OF Supply Fran Addiees ✓ an >!�� supply DtfBed by G t repressnt':that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sawage di sal a stem above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a regu ns o nom County Department Of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Heelthwill be submitted to the Department, and a written guarantee will be, furnished tin owner, his successors, heirs or assigns by the builder, that said bulkier will pace in good Operating condition any part of aid sewage disposal system during the period of two (2) mmediatey following thedate of the lau- ance of the approval Of the Certificate of Construction Compliance of the original system or any repairs o; 2 that the drilled well described above will be located as shown on the approve plan and that said well will be Installed in acco rice w h led s and rqu a�T�i%ns of the Putnam county Depart of Heelttl. Date t® 9� 7 spned r 92M P.E. /ZR.A. / K !i License No:t -( J APPROVED FOR CONSTRUCTION: Thil approval expires two years from the date Issued unless codstruction of the building has been undertaken and it revocable for cause or may be amended of modified when considered necessary by the Commissioner of Health. Any change or alteration of construction re0uiress as now permit. Approved for disposal of domestic segrWy ssseeewpprivate water supply only. -� n� PUTNAM COUNTY DEPARTMENT OF HEALTH I DIVISION OF ENVIR ONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: 7,/a o p Inspecte y: 4! Street Location 'rrp jfi.E Vj F w 'pp,, Owner `#A 7z A Town Permit ,# 7>_ ,570 -.23 TM # 1 _ 2 - 76/ Subdivision Lot # i " iz;�h� We �, E�.t, W L. Sewage System Area . YES NO COMMENTS a. STS area located as per approved plans ........................... b. Fill section - date of placement Fill &A, 3:1 barrier Lgth. Width Avg.Dpth C �o�„ ..<< C. Natural soil not' stripped ................... ..........................:.... ` gyp, d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/ wetlands .............. ................... :.... o II. Sewage System 721P- a. Septic t c size' 1,00 .........1, 250 ......... other ................ b. Septic tank instal ed level ................ ............................... c. 10' minimum from foundation .......... ............................... >C d. Distribution Box 1. A out ets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box properly set ........... ............................... f. Trenches 71-en-g-th required Sao Length installed 6_#0 p 1C 2. Distance to. watercourse measured Ft.......... 3. Ins d c ding to 4. S1 e f t h Viceptab 1/ - 32" /foot ............. . 5. 10 from property line - 20 - foundations.......... 6. Depth _of trench <30 iKV2di*ftetA c s m u ce L' 8. .X. 7. Ro ow r e o °/ ................. ' Siz a - c .... ................ 9. De f avel in trench 12" minimum ................... �C 10. Pipe ends capped ........................ ..................... ........... g. Pum2 or Dosed Systems Size ot pump c am er ................ ............................... 2. Overflow tank .............:.............:. ............................... 3. Alarm, visual/ audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated -flow /cycle:':...::.... . III. House/Buildin a. House located per approved plans ......................... b Number of bedrooms.. IV. Well un�C'in:.lce -Q 1gsMr��: 7CV40.1 a..+mvdc l Well located as per approved plans ...................::.�e b. Distance from STS urea measured 1 d 8 ft........... c. Casing 18" above• grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ............... ............................... K b. All pipes partially backfilled .......................................... c. All pipes flush with inside-of bo" x ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain .outfall protected & dir.to exist waterco g. Footing drains discharge away from STS area............ h. Surface water protection adequate. ............ ................ i. Erosion control provided ......... ............................... { . A • .. - �._ Rev. 6/97 ,,,,,, _. 1\ w1 >� `. •. t FILTE son �wfiQ�pffi-CC#LtL�'C9 ®�' r I 4 DG'bt, .WIDE AND �r 's'DEEF TRENCii~'i; L9Z !3 ' .; `5`aM \FY4 .. F, , ~` AN SUiY.' WTTC NO WELL sit r x — ��� • � >C , Al TC y,, A tOpyg E?cPq�tQ I .0i X Sao;= -_' - ew . OTI1�tG DISGH. \� 4'7O 1 250 GA ;'MASONi?Y TANK r k a �\ 51 --T' FE�IGE, T lvd FRO � s AS tIN y 001 t WS r r .'Fi ;now'. own Rol 6�, k 882 t $9 L' a ►� DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 June 17, 1998 Sean Daly Box 243 Shenorock NY 10587 Re: Proposed SSTS: Macaluso Ridge View Drive, Lot #13 (T) Patterson, TM# 13 -2 -76 Dear Mr. Daly: BRUCE R. FOLEY Public Health Director Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. 1) The minimum of 2 feet of fill is required over the entire SSTS area. Upon receipt of a submission, revised to reflect that above comments, this application will be considered further. Ve t my yours, Robert Morris, P.E. RM:tn Public Health Engineer DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 Sean Daly Box 243 Shenorock NY 10587 Re: Proposed SSDS: Macaluso Ridge View Drive, Lot #13 (T) Patterson, TM# 13 -2 -76 Dear Mr' Daly: May 8, 1998 BRUCE R. FOLEY Public Health Director Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: "The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." 1) Current codes requires fill be placed in the expansion area. 2) Trench detail is incorrect. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Very truly yours, - hw/ mo/�, Robert Morris, P. E. Public Health Engineer RM:tn Ayi PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH-SERVICES Date Re: Property of Located at (T) %i 7XeSolij / 3 Block ? Lot Subdivision of �' HA%PI.- , Subdv. Lot #- . Z3 Filed Map. # Date Gentlemen: This letter is to authorize J e/n..N SpsE ?la a duly licensed professional engineer 11-� ore-�� (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours,,: Signed Countersigned: �Q Owner roperty P.E. , R.A. , # 63 Address Address Town �V - 776 S- 77.3 Telephone ?/ y, �r?n- Telephone Ar #, t a }` "t,.y„ 1� rC.�} �k.�41� Y'4,7 i; Spy V,_J .r FIn h �r �� { 1 roy wbm a�IfMi i,; L Pt Y u M, i Y "xi L� `fi 1..:�i � r a 2 F �lbx ' � � �llib A�iiraa +aay c7 r L�1Sai�aat � Dttai b t » i^ x -� z � ;. �v..3•. r- ''c-F4 {, 7� �:�I ... y' 'hr� ��. „C� s. < SrY �'�'��S ?s5� iE�:.i Y. t;,, e.rL . s.>< . 1 egrMNMt iMt 1 awtwMlly.aM ean�MtMY ►�pOnWM top tMO antl butiOn of tM OropoaW fyft«n(pi lj that tM� •ta �I YL' Om MOVO �Ie I0aO wiN;M aO1lit►uNiO af'f�own p1 tM atip�oMd anwtbniaet tMra to anO fn acooraat+a with tM WMMAf.yruNf a s. .;.p�wrty Oapetoa!!!�2�M �w!Kt!. air ilnt en'can�Mtbn_th«aof a?'t;«t(Ikata�d Coftkruetioe COmWy�a" ntUlaet«Y'to tM COmmhNOiiar dtt'wNliwla w ww�aaa t• i. ofr.rtwi�t: aM . wraa� tai.►ai�..'wia tbe wn.1�.e tM owe« a+f .Kafi.r� Mrf a y tM waur et'rN wai« wla . ` t11ac0 M ;f!M M!MM�e iattNw awr tart W ?YN fwvaN !NpW * au►In� tM arI" d two (!1 f /olbwMy tAaMt� d 1M NMt' ' anaa, 01 'tM MMe!M d tM, hrtMlpb d Et iii6i dlori; Coa!WWtoa oI tM;or Sany : M wia Maar aiwo : s t « W qM M Isepa>t as rlerw M tM a/pawN MM aM that ta1O waa vial w Mfta Ewalt t �iM mows �1 z tM w1Mtw i >z 4r OalO f3� �� w ti E a n 3 s 1,414 • '� - - nr :, ArM110V[O 1011 COffiT1111CT1AN: TMf aNlOittl OKoMa two yN►s Irotw tM�`tMb IfNNO unNp oantrttctlstt. of M Ou1NN/ haf OMn umtartattan aM If . :, nwsMM fM aYU.'!r trtar w aniwaN1 or tttett111aA warn conf1On�O y IfMOtt�ar ed 1wa I�iwNnr�}aMw AoarwM tr �tarup a4 � Any ehtq a alt «atwe etatntct o1 a qA4 r f y 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 # V WELL LOCATION Street ddre s To Village City Tax Grid Number WELL OWNER Name Mailing _ Address Crivate O Public USE OF WELL 1 - primary d) 2- secondary -- Ly"li�SIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY ❑ 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 /# 13 REPLACE'EXISTING SUPPLY EKEW SUPPLY NEW DWELL(ING) PEOPLE SERVED` /EST. OF DAILY USAGE !� Sal O TEST /OBSERVATION D. ADDITIONAL SUPPLY O DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING .% WELL TYPE 015k-ILLED 13DRIVEN CIDUG GRAVEL D OTHER IS WELL SITE SUBJECT TO FLOODING? YES 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 t— so NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED N SEPARATE SHEET © (date) (signatur This permit to construct of Subpart 5 -2 of Part 5 thirty (30) days of!the PERMIT TO CONSTRUCT A WATER WELL one water well as set forth above is granted under the provisions of the New York State Sanitary Code, and provided that within 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 contamina surface or groundwater. Date of Issue: 19�_�`�l 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 ' ,p. VI'MCkHT A. RTTARZ,: P. E. % CONSULTING ENGINEERS 1065.: SPILLWAY ROAD •C.�[)TF�:x.- N. Y. 10588 =_.' `.'err Fax (914) ,245 -6335 G� Viif. Licenaed Professional EnEr. . FACSIMILE C0�': "' SHEE`T ' Date. Sender: 'r � �e-,l To.- G - __ • E. • Fax Number: �0 L, oe� Attenti / eeTbei.n sent (including this sheet)t Comments:;- r; — _ °------------------ _----- .__. -._ -- - --- i � t a. VINCENT A. ETTARI, P. E. CONSULTING ENGINEERS. -, 1065 - SPII,I,WAX ROAD SHRUB OAK, N. Y. 10588 (914) 245 -6320; Fax (914) 245 -6335 Vincent A. Ettari, P.E. Licensed Professional Engr. August 18, 1993 Putnam County Department of health Division of Environmental Quality Geneva Road Brewster,, New York 10509 Attention: William Hedges Re: PROPERTY OF GAIL SIGURJONSSON LOCKWOOD LANE, MAROPAC, NIV YORK TOWN OF CARNEL, TAX MAP NUMBER: 2 -2 -1 bear Mr.'Hedges: On February 9, 1993 this firm received a letter from you concerning the above referenced property. Prior to the composition of that letter, we meet several times with you to discuss that property and our current proposal to fill some of the wetland on the site. Apparently the site had been the subject of several submissions to your Department, both of which resulted in a rejection of the permit application. It was thought by this o ffice that if some of the wetland was filled, septic - wetland offset distances could be increased, thereby creating greater conformity with the codes of the New York State Department of Health. The Now York State Department of Environmental Conservation (DEC), on June -16, 1993, sent us a notice of "Incomplete Application," a copy of which is attached to this letter. In that memo they request that the amount of area proposed to.be filled be reduced, along with the area proposed for the well. They also requested that we pursue the possibility of obtaining Health Department variances for the site In its current condition, that is, with out any filling to increase'the septic - wetland separation distances. Consequently, we would like to explore this possibility. Consequently, we ask that this matter be placed on the next'availabl.e agenda of the Board of Healh; to discuss the possibility of obtaining variances without increasing the wetland - septic distances by filling the lot. P Sincerely Yours, t Vinc'ene —A, ttari, P,E. v� m Mr. Vincent Ettari 1065 Spillway Road Shrub Oak, NY 10588 r-- DEPARTMENT OF HEALTH Division Of Environmental Health Services Geneva Road, Brewster, New York 1oSO4 (914) 278 ^6130 February 9, 1993 JOHN KARELL Jr., P,E., M.S. Public Health Director I have received and reviewed the plans and other supporting documents concerning the development of a single family residence on the above mentioned parcel. The lot is located particularly within the boundary of a New York Classified Wetland (OL -42), and entirely within the 100' buffer surrounding this wetland. The parcel is. not part of a NYS. Health Department approved subdivision and appears to have been created by deed only i'n approximately 1970. Therefore approval by this Department would require that all present code requirements of the Putnam County'Health Department be adhered to. Approximately ;four years ago, an application to construct a residence on this parcel was prepared by John Prentiss, P. E. and reviewed by this Department. Although the application is no longer on file with this Department, approval was not granted for the following reasons. 1. Wetland permits from both the Town of Carmel and NY5 Dept. of Environmental Conservation were required. 2. The sewage disposal system was not 100' from the wetland boundary. 3. Soils within the proposed sewage disposal appeared to be common fill with ground water at 4 feet from witnessed deep test holes, This area appears to have been filled. Original soils at 5 fret t indicates typical.wetland characteristics. -2� Therefore if you wish to pursue with the development of this parcel, the following must be submitted. 1. A complete application for the construction of a sewage disposal system and individual water supply must be submitted for review. 2. New deep ,test hole and percolation test must be conducted and witnessed by this Department. If you have any questions please contact nee at your convenience. Very truly yours, . William Hedges Sr. Public Health Sanitarian WHi)P r lyaw York State Department of Environmental Conservation Division of Regulatory Affairs 21 South Putt Corners Rd., New Paltz, NY 12561 -1696 Telephone; W4) 255.3121 Thomas C. Jorling Commissioner June 16, 1993 GAIL SIGURJONSSON WEBBLR 14ILL RD MAHOPAC NY 1054I RE: DEC NO. 3- 3720 - 00182/00001 -0 FRESHWATER WETLAND OL -42 PERMIT APPLICATION SIGURJONSSON PROPERTY - LOCKWOOD LANE TOWN OF CARMEL, PUTNAM COUNTY ,NOTICE OF YNC;OMPLETE APPLICATION . Dear Ms. Sigurjonsson: We. have reviewed the materials submitted to date for the above referenced application. Based on our review, t.hc application is incomplete for lack of the following information: I . Provide'an engineers report and plans which addresses the suitability of the septic system site, as well as the comments and royuirements of the Putnam County Department of Health. Include deep test hole and percolation data to justify the feasibility of the site, The report should also discuss the impact of the proposed septic system on the wetland. 2. Address the possibility of reducing the amount of wetland arga to be filled and other disturbances proposed within the boundary of Freshwater Wetland OL -42. For example, repositioning or reducing the size of the septic system, house location; eliminating the proposed filling of ditches within the wetland and fill for the proposed well. 3. Provide details on the suitability of the proposed well location. Address the feasibility of eliminating the proposed placement of fill in the vicinity of the well. 4. The post office has indicated that the above address is undeliverable. Please verify the correct address so that we may update our records. Provide three (3) copies of the requested information. In summary, the project, as currently proposed, does D_QJ appear to meet the Standards of Permit Issuance set forth in 6NYCRR § 663.5. The feasibility of the project and minimization of the Gail Si &urjonsson Page 2 June 16,. 1993 associated impacts on the wetland need to be thoroughly investigated, including the possibility of obtaining variances from sail ?aCk requirements from other agencies having approval power over the project. If you have any further questions, please contact me. Thank you. Sincerely, Mary Beth Kolozsvary V Environmental Analyst Region 3 cc:. S. Smith (w/ application materials) W. Hedges, Putnam County DOH a VINCENT A. ETTARI, P. E.. CONSULTING ENGINEERS 1065 SPILLWAY ROAD SHRUB OAK, N. Y. 10588 (914) 245 -6320; Fax (914) 245 -6335 Vincent A. Ettari, P.E. Licensed Professional Engr. August 18, 1993 Putnam County Department of Health Division of Environmental Quality Geneva Road Brewster, New York 10509 Attention: William Hedges Re: PROPERTY OF GAIL SIGURJONSSON LOCKWOOD LANE, MAHOPAC, NEW YORK TOWN OF CARMEL, TAX MAP NUMBER: 2 -2 -1 Dear Mr. Hedges: On February 9, 1993 this firm received a letter from you concerning the above referenced property. Prior to the composition of that letter, we meet several times with you to discuss that property and our current proposal to fill some of the wetland on the site. Apparently the site had been the subject of several submissions to your Department, both of which resulted in a rejection of the permit application. It was thought by this office that if some of the wetland was filled, septic- wetland offset distances could be increased, thereby creating greater conformity with the codes of the New York State Department of Health. The New York State Department of Environmental Conservation (DEC), on June 16, 1993, sent pus a notice of "Incomplete Application," a copy of which is attached to this letter. In that memo they request that the amount of area proposed to be filled be' reduced, along with the area proposed for the well. They also requested that we pursue the possibility of obtaining Health Department variances for the site in its current condition, that is, with out any filling to increase the septic - wetland separation distances. Consequently, we would like to explore this possibility. Consequently, we ask that this matter be placed on the next available agenda of the Board of Healh to discuss the possibility of obtaining variances without increasing the wetland- septic distances by filling the lot. � sr •rj i t 1 cer == rs, Ali J) . p..y 1711 �� n ent tai �' ' P. E. 064 8 rz;: 6 r New York: .State Department of Environmental Conservation, Division of.Regulatory Affairs 21 South Putt - Corners Rd., New Paltz, NY 12561 -1696 �. Telephone: (914). 255 -3121 Thomas C. Jorling Commissioner... June.16, 199.3'. GAIL SIGURJONSSON WEBBER HILL RD. MAHOPAC NY 10541 RE: . • DEC NO. 5- 3720 - 00182/00001 -0 FRESHWATER WETLAND :OL -42 PERMIT APPLICATION SIGURJON. SSON PROPERTY, -. LOCKWOOD LANE_ TOWN OF CARMEL,. PUTNAM COUNTY NOTICE OF INCOMPLETE APPLICATION . Dear Ms. Sigurjonsson: We have reviewed the materials submitted to date for the.above referenced application. Based.on our . review, the application is incomplete for lack of the following information: 1. Provide an engineers report. and .plans which addresses the *suitability. of.the' septic system _ site, as well: -as ' the comments and requirements of the 'Putnam County Department of Health. Include deep, test, hole and percolation data to justify. the.. ' feasibility of the site. The. report should also discuss the impact of the proposed septic system on the wetland. 2. Address the-possibility of reducing the amount of wetland area to be filled and other disturbances 'proposed' within the boundary of Freshwater Wetland OL -42. For example, repositioning or reducing the, size. of the septic. system, .house location, eliminating the proposed filling of ditches within the wetland and fill for the proposed well. 3. Provide details on the suitability of the proposed well location. Address the feasibility of eliminating the proposed placement.of fill in the vicinity`of..the well. 4. The post.office has indicated that the above address is undeliverable. Please verify the correct address so that we may update our records. Provide three (3) copies of the requested information: In summary, the project, as currently proposed, does not appear to meet the..Standards. of Permit Issuance set forth in 6NYCRR § 663.5. The feasibility of the project and minimization of the Col' /3 - DESIGN U►1TA SHEE'r=SUBSUFACE SEWAGE DISPOSAL SYS'1 M FILE M. Owner . PETER O'HARA Address P.O. BOX 282, PATTERSON, NY Located at (Street) Sec. _ 10 _ Block 2 Lot 1 1 (indicate nearest cross street) mmicipality PATTERSON Watershed CROTON SOIL, MRCOL1tMU TEST DATA 1UXM 2ID TO BE SUDMi71Tb mil APPLICATIONS mate oC Pre - Soaking 9/07/88 Date of Percolation Test 9/08/88 YT br,4 HOLY flu-mm C wtK TIME PEncoL.ATIm MCOLATIM Run Elapse Depth to Water Plan Water Level tlo.. Time Ground Surface In Incites Soil Rate Start -Stop Min. Start Stop Drop In Rin /In•Drop Incites inches Inches 1) 11:58-2:28 30 24 25 1 30 2 2:28 -2:58 I 30 24' 25 1 30 3 2:58 -3:'28 30 24 25 1 30 4 5 2) 1 1:48 -2:15 27 24 27- 3 9 2 2:17 -2:49 32 24 27 3• 10.66 3 2:50 -11:22 32 24 27 3 10.66 4 llv� 1. 2. rev. 9/05 Tiests Ito be repeated' at same dephh unti l approximately cygtxA coil rates axe of taincd at each percolation t s, hole.. All data Lo* w subrdttbd for review. DepUt'measuranehts Lo be made fran trop of hole. p YT br,4 llv� 1. 2. rev. 9/05 Tiests Ito be repeated' at same dephh unti l approximately cygtxA coil rates axe of taincd at each percolation t s, hole.. All data Lo* w subrdttbd for review. DepUt'measuranehts Lo be made fran trop of hole. p I)i::l'll l G. L. 611 1211 11311 24" 30" 36" 42" 48" 54" 60" 66" 72" 78" O'HARA SUBDM410N TES•1' PIT U11'rA JU)JUJ.IiW '1'0 UI; SU11.11'r1l) M111 AITLI A'LIU11 SEC T I M 2 DESCRIEYMN OF sulM UXX)UN1'1!W) 0 T2Sr IMES I IOLE 140. 13 A TOPS' IL BROWN LOAM W /SILT SM.*STONES 1' -2' ROCK '0 5' IIOLE W. 138 IME W. TOPSOIL BROWN LOAM 64" ROCK 0 6.5 FT. 21101CM LEM AT %WCR GRa* 17W1M IS 11 None u -micam LEVEL 2C? WE3IC1t WMM LF'M RMES AFM BEMG N/A VEW HOW OBSERVATIONS MM BY: J. F. E B E R L E DATE: 9/6/88 DESIGN Soil irate Used jo Mit i" Drop.. S.O. Usable Area Provided 8004 S . F tb. of Dedroans 4 Septic Tank Opacity ` Wa gals. IOW M 667 L.F. x 24" width trends Absorption Area Provided By Mer Alt. Design or dosing required; 2 ft. we 11anu BALDWIN & CORNELIUS, P.C. AddVess _ RD 5 Route 22 fliewster. New York 10509 SPACE MR USE BY t1CJWM DCPMIMII! MY: i,:' Soil. hate Awroved sq. f t/gal. Checked by Date ae ;y rl� CD 0 Soil. hate Awroved sq. f t/gal. Checked by Date ae ;y rl� DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL i--, PCHD PERMIT WELL LOCATION Street Address I 4� Town Village City Tax Grid Number 3 WELL OWNER Name AQ M ling Address ,1 Z A rivate O Public. USE OF WELL l primary 2- secondary "SIDENTIAL 0 BUSINESS O INDUSTRIAL O PUBLIC SUPPLY ❑AIR /COND /HEAT PUMP O FARM p TEST /OBSERVATION D INSTITUTIONAL O STAND -BY ❑ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT _5-gpm /# PEOPLE SERVED 8 /EST'. OF DAILY USAGE &CO pal REASON FOR DRILLING El WLACE EXISTING SUPPLY e'NEW S PL DWELLING ❑ TEST /OBSERVATION CI ADDITIONAL SUPPLY ' 0 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE �H1-LLED ODRIVEN QDUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES °� NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. 1 WATER WELL CONTRACTOR: Name ��"��.1� Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES 4--'NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: /I LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED t N !SEPARATE SHEET (date) (signature PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within 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 not to degrade or otherwise contaminate surface or groundwater. Date of Issue: _19� Date of Expiration 19 �% Z-�_ Permit Issuing 0 cial Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller EATING AREA DINING ROOM SECOND FLOOR 1/811 = it-oil KITCHEN STUDY FOYEI FIRST F LIVING L G BATH DRE-561N6 D MUD L. BATH Room R Room 0 Y GL. GL. GL. G G 24� FAMILY -ROOM PUTNAl-1 COUNTY LjEPAgVTI IT O TZWC1 �.:. MA5TER ,, ,- R HOUSE PT, I'4S �._ _. ,; '�' BDRM #2 BDRM #5 BORN BEDROOM TH EATING AREA DINING ROOM SECOND FLOOR 1/811 = it-oil KITCHEN STUDY FOYEI FIRST F LIVING G BATH DRE-561N6 L. BATH Room 0 GL. GL. GL. HALL 25 �.:. MA5TER BDRM #2 BDRM #5 BORN EATING AREA DINING ROOM SECOND FLOOR 1/811 = it-oil KITCHEN STUDY FOYEI FIRST F LIVING PUTNAM COUNTY DEPARTMENT OF HEALTH ' DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of 0-tl1jZ p, Located at M ' (T)�- T"CXj►._( S Block ; ',.•. "L4t___'� , �''° '. R a. �' ,' Subdivision of •F --V�.Y �, Subdv. Lot ## Filed Map # T. MICHAEL DALY, P.E. Gentlemen- CONSULTING ENGINEER P. 0. BOX 243 •' This letter is . to authorize SHENORM'K� N X 10589 � a duly licensed professional engineer ✓ or (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 p romulagated 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 s4ipervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very.truly yours, ned J Countersigneal._, l Owner of Property /"�// — ?. a . - T-', C, - � il� P.E., R.A., h! `M4�6 Address T. MICHAEL DALY, P.E. ��- -C c- S 0 u`J �� • ��. 12_ �� 3 Address I.P. O. BOX 243 Town ' SHENOROCK, N. Y. 10587 % S 2_cj Telephone Telephone PUT NAM COUNTY D E PARTM ENT O F HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: HAQIk 2. Name of Project: 'IJJ - 3. LocationJKV /C: 4. Project Engineer:, —T— �L�(dP��,� _ 5. Address: WOK Z4-317> C: IQ License Number: �� �'w Phone: 6. Tye 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? ............. t��A 9. Has DEIS been completed and .found acceptable by Lead Agency? ........... 10. Name of Lead Agency. 11. Is this project in an area under the control of local planning, zoning; or other officials,,.ordinances? ................ .t..�.................. "5 �_p 971r_ 4 '2. If so, have plans been submitted to such authorities? .......... 0 3. Has preliminary approval been granted by such authorities ?, Date Granted: ^ 4. Type of Sewage Disposal System Discharge.� Surface Water Ground Waters 5. If surface water discharge, what is the stream class designation ?........ 6. Waters index number'(surface) .......................................... " 7. Is project located near a public water supply. system? ..i ............... 3. If yes, name of water supply Distance to water supply i. Is project site near a public sewage collection or disposal system ?..... ). Name of sewage system Distance to sewage system I. Date observed: 23. Name of Health Inspector: 1. Project design flow (gallons per day) .......... F,5. 9t 0 .................... 2. 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. 26. Has SPDES Application been submitted to local DEC Office? ............... 27. Is any portion of this project located within a designated Town or State ,l U wetland? ... ............................... N 28. Wetland ID Number ........................ ............................... -- 29. Is Wetland Permit required? ............. ........ ... .......... ........... Has application ;been made to Town or Local DEC Office? .................. f` 30. Does project require a DEC Stream Disturbance Permit? ...................,f;:F b 31. Is or was project site used for agricultural activity involving applicat oh;. of pesticides to orchards or other crops, solid car hazardous waste dispas.al, g sludge application or industrial activity? ........ YES or:•NO landfillin slu 32. Is project located within 1,000 feet of existence of abandoned landfir11, hazardous waste !site, salt stockpile, landfill;'.sludge disposal site or O any other potential known source of contamination? ............... YES•or NO DESCRIBE: 33. Is there a local master plan or file with the, #own or, Village? 34. Are community water, sewer facilities planned to be developed within 15 years? b 35. Are any - sewage disposal areas in ! '1 excess of 15X slope? .. .... r :........... 36. Tax Map ID Number .............. ................:.......f. ~.. :...:t.(p 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 may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant_ o Section 210.45 of the Penal Law.' 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