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Home My WebLink About0368DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -81 BOX 5 00177 L, l_ IN I rlL :1 OL h��`; 00177 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # -- 5-7- Located at; / 4 � /Q ((�r Village Owner /Applicant NameLLA.SS ;; _ ii`S,Q Tax Map 13 Block Z, Lot Formerly ' llw4 Subdivision Name i� h5cyri(/1� Subd. Lot # 6.1 Mailing Address / W �s T 4ycun ,61 Be, Date Construction Permit Issued by PCHD Zip Imo- M Separate Sewerage ystem built by �'1(_ L� a Address �� VVjP�T 1-6_Lnw L& Consisting of Gallon Septic Tank and Z. i (D' � J %EJ6 sV,} Other Requirements:_ Water Supply: Public Supply From Address ®r: Private Supply Drilled b 7 �� 4 — pP Y y NIa�L. ��LI 1. L 1�1��Gi �nY - Address u�2.F,vJ�s r"� , . Building Type Q�61& Has erosion control been completed? Number of Bedrooms Has garbage grinder been installed? TV0 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 Per7and ved plans and the s dards, rules and regulations of the Putnam County' Department of Health. Date: Z Certified by // �D � . i " A / P.E. R.A. Address 1 ,o. A ,.►- License # Any person occupying premises served by the above system(s) shkf 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,, dificatio r change is necessary. r // By: / Title: / Date: V 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 GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Building Constructed by Tax Map Block Lot Tow illage - 4 V, Gvt pe O' �AA Sc 7 i3D t u ►Slot J T Location - Street Subdivision Name Building Type 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 occupa of the ilding utilizing the system. 7'Wnth 1 �Day Y5' Year 9 Coni factoA,(gwner) - Corporation Name (if corporation) Address: State Zip Signature: Title: 6� hr Corporation Name (it corporation) Address: State Zip Form GS -97 • PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Ridge View Road Town/Village: Patterson, NY Tax Grid # Map Block Lot(s) 36 Well Owner: Name: Address: Classic Homes & Development, Brewster, NY -Alan Finn Use of Well: 1- primary 2- secondary xxx Residential Public Supply Air cond/heat pump Irrigation Business,' Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion XXX Compressed air percussion Other (specify) Well Type Screened Open end casing xxx Open hole in bedrock _ Other Casing Details Total length 45 ft. Length below grade 44 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials:xxx Steel _ Plastic _ Other Joints: _ Welded xxx Threaded _ Other Seal: xxx Cement grout _ Bentonite Other Drive shoe: xx 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 xx Compressed Air Hours 6 T Yield6 e 5 gpm Depth Data Measure from land surface- static (specify ft) Overflow During yield test(ft) 200 Depth of completed well in feet 365 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 10 Soft limestone 10 365 Medium to hard white limestone If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 220. 2 Pump Types ubmersi Oapacity 5 Depth 200 Model 5GS05 Voltage 230 HP •1' /,Z r Tank Type aiaoragmVolume 62 inn 3 365 .6,5 Date Well Completed 1.1/1.0/98 Putnam County Certification No. 2 Date of Report 1.1/12/98 1Z471 Well 1 "1 NOTE: Exact location of well with distances to at least two permanent landmarks to be Vovid6d on a ftfi V Sheet/plan. Well Driller' me M L RILLING, INC. Address75 Putnam ,.Avenue, Brewster, NY Signature: f%. Date: 1.11y2198 White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 .� NORTHEAST LABORATORY OF DANBURY CT Cert: PH -0404 39 -3 MILL PLAIN ROAD - DANBURY, CT 06811 NY Cert: 11471 LAW (203) 748 -7903 - FAX (203) 748 -0652 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: MILL DRILLING, INC. DATE SAMPLE COLLECTED: 11/10/98 75 PUTNAM AVENUE TIME COLLECTED: 1:30 P.M. BRESTER, N.Y. 10509 COLLECTED BY: ROB MILL DATE RECEIVED @ LAB: 11/10/98 TESTED BY: LAB #11471 & 11301 REPORT DATE: 11 /17/98 SAMPLE SITE: AL FINN - CLASSIC HOMES, LOT #36, RIDGEVIEW RD,. PATTERSON, N.Y. SAMPLING POINT: TOP OF WELL SOURCE: WELL -NEW TREATMENT: NONE TEST PERFORMED RESULT: MAXIMUM CONTAMINANT LEVEL BACTERIAL: Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml PHYSICALS: pH 8.06 no designated, limit Turbidity 18.0 NTUs 5 NTUs CHEMISTRY: Nitrite N 0.07 mg/L as N l mg/L as N 11301 - 'Nitrate N 0.03 mg/L as N 10 mg/L as N Alkalinity 84.0 mg/L no designated limits Hardness 86.0 mg/L no designated limits Iron 0.666 mg/L 0.30 mg/L Manganese 0.048 mg /L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium 7.6 mg/L 20 mg/L ** Lead <0.005 mg/L 0.015 * ** m1= milliliter mg/L = milligrams per Liter ND = none detected NTU =Units * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED: 11/10/98 SAMPLE, AS TESTED ABOVE: ❑ or CkOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Laboratory Director •NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060379 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105. OUTSIDE CT: 800 - 654 -1230 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Street Location `tT.>,-,- Vj C tA1 '[jjztvE Torn TMr_ Date: Qg Inspected by: e ONvner 19',0A 12.A Permit# F— 6-7-13 Subdivision Loth L Sewage System Area a. STS area located as per approved plans ........................... b.' Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dptli c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. -100' from water course / wetlands ...... ............................... II. Sew- 0'e Svstem - a. peptic tank—size - 1,000 ...... ;:.1, 250 .! ...... other ................ b. Septic tank installed level....`,,...... .......................... c. 10' minimum from foundation .......... ............................... d. Distribtuion Box 1A� oufl utlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches Junction Box - properly set ..................... ............................... ength required 7 Length installed s 2. Distance to watercourse measured+ZGo Ft.......... 3. Installed according to plan ......... ............................... '4. Slope of trench acceptable 1116 -1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface.................. 7. Room allowed for expansion, 100% .......................... 8. Size of gravel 3/4 - 1 %" diameter clean .................... 9.. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ........ ............................... ................ g. PUMD or Dosed S :stems 1. Size ot pump chamber ................ ............................... 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/Building a. ouse locatEd per approved plans ... ............................... b. Number of bedrooms ... .................. .q... ........ IV. Well xu up-modfr a: Well located as per approved plans . ............................... b. Distance from STS area measured t lo o ft..:........ c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercoursf g. Footing drains discharge away from STS area........... h. Surface water protection adequate .............................. ig i. Erosion control provided ................................................ YES NO COMMENTS X LOW X �C X d-- DMSION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION C,OMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # /0— 57 Located at --T-� C � To or Village Rn-EMSOA) � & Al I , Owner/Applicant ant Nam -- Tax Map Block Lot i r Formerly_ /� Subdivision Name Subd. Lot # —3% Mailing Address Date Construction Permit Issued by PCHD ..5- Zip Separate Sewerage system built byj�_ dry �f /il,� Address foAD h2& Consisting of L J Gallon Septic Tank and 57 -- Z-, g Z7 Z Z2go, % e,y Other Requirements: Water SuVI14: Public Supply From Address or: Private Supply Drilled by Address 715 5� � J Building Type 2-455 i jor.611�. 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 st#ndar(J9, rules and regulations of the Putnam County BWaoi pnt of Health. Date: L �1Certified by Address �f% 130 � 1Y �/�6 Any person occupying premises served by the P:E. l License # 4-5-5- s) sW 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 ai ubject to modification or change when, in the judgment of the Public Health Director, such revocation, mo 'ficatim hange is necessary. A 111f� 2B °'u/�-� Title: ' � G�CL Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 v PUTNAM COUNTY DEPARTMENT OF HEALTH' DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Ridge View. Road Town/Village: Patterson, NY Tax Grid # Map Block Lots) 36 Well Owner: Name: Address: Classic Homes & Development, Brewster, NY -Alan Finn Use of Well; 1- primary 2- secondary XXx Residential Public Supply Air cond/heat pump I.rrigation Business Farm Test/monitoring Other(specify)- Industrial Institutional Standby Drilling Equipment' . Rotary Cable percussion XXX Compressed air percussion Other (specify) Well Type Screened; Open end casing xxx Open hole in bedrock . Other Casing Details ' Total length 45 ft. Length below grade 44 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials:xxx Steel Plastic Other Joints: _ Welded xxx Threaded Other Seal: xxx Cement grout _ Bentonite Other Drive shoe: xx Yes _ No Liner _ _ Yes _ No 9 :} Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test Bailed Pumped xx Compressed Air Hours 6 Yield6.5 gpm Depth Data Measure from land surface -static (specify ft) Overflow During yield test(ft) 200 Depth of completed well in feet 365 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 10 Soft limestone 10 365 Medium to hard white limestone If yield was tested at different depths during drilling, list: Feet. Gallons Per Minute Pump /Storage Tank Information 220 2 Pump Types bmers i KNpacity 5 Depth 200 Model 5GS05 Voltage 230 HP 1/2 Tank Type Dia-phragmVolume _ 2 ion 3 365 6. 5, Date Well Completed 11/10/98 Putnam County Certification No. 2 Date of Report" . .. 1,1 /1:2/,98 Well i,%v i r.: cxact <ocanion of wen with atstances to at Least two permanent landmarks to ne provtaeu on a separate sneevplan... . Well Driller' 1441- BILLING, INC, Address75 Putnam Avenue Brewster NY Signature: f, Date: 1111219 / F 8 White copy: HID File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 s 1 i NSA 4VIV NORTHEAST LABORATORY OF DANBURY CT Cert: PH -0404 39 -3 MILL PLAIN ROAD DANBURY, CT 06811 NY Cert: 11471 LAW 1 (203) 748 -7903 - FAX (203) 748 -0652 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: MILL DRILLING,` INC. DATE SAMPLE COLLECTED; 11/10/98 & 12/16/98 75 PUTNAM AVENUE TIME COLLECTED: 1:30 P.M. BRESTER, N.Y. 10509 COLLECTED BY: ROB MILL DATE RECEIVED @ LAB: 12 /15/98 TESTED BY: LAB# 11471 & 11301 REPORT DATE: 12 /16/98 SAMPLE SITE: AL FINN - CLASSIC HOMES, LOT #36, RIDGEVIEW RD,. PATTERSON, N.Y. SAMPLING POINT: TOP OF WELL SOURCE: WELL -NEW TREATMENT: NONE TEST PERFORMED RESULT: MAXIMUM CONTAMINANT LEVEL BACTERIAL: Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml PHYSICALS: pH 8.06 no designated limit 12/16/98 Turbidity 0.46 NTUs 5 NTUs CHEMISTRY: Nitrite N 0.07 mg/L as N 1 mg/L as N 113 01;- Nitrate N " 0.03 mg/L as N 10 mg/L as N Alkalinity 84.0 mg/L no designated limits Hardness 86.0 mg/L no designated limits 12/16/98 Iron <0.03 mg/L 0.30 mg/L Manganese 0.048 mg/L 0.30,mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium 7.6 mg/L 20 mg/L** Lead <0.005 mg/L 0.0151*** m1= milliliter mg/L = milligrams per Liter ND = none detected NTU =Units * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED: 11/10/98 SAMPLE, AS TESTED ABOVE: MOTABLE or AMNOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Laboratory Director -NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060379 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 'GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM i n Owner or Purchaser of Building r 0 Ah Building Constructed by Locate n - Street l3 1 21 Tax Map Block Lot A,�64 (-< 6-VN Town/Village Subdivision Name PCs: 11CL11d Building Type 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 dct 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 occupagt -Gkhe building utilizing the system. . •� 2�.�, Dated: Month 10 / 6� Year General Contractor (Owner) - Sigria e Corporation Name (if corporation) Address: State 4 Zip _ /o Signature: Title: Corporation Name (if corporation) Address: Iva State Zip 10 S701 Form GS -97 -nn A6gr "Vp 915;ubdlir-4�" soft - 9 . . . . . . . . . . . . :77 TUMMI-A odw rem -Y dial lm"aoi ion ti P, atsio !,be W- mid. iiw Wr V a WS ipm N lOCafad as tt» sioill" plan *4 tMt Yid,wN1 'M.. . AVw- rem ..APP*b 0 1-, 0 nsrafdd F, r, Rem'i. -4- MIS., aid' aYgamlp 1) that tM Sswat !006 isvitem tMt the ON TIT 777 _JWS tlMn, uf%WUken and., Is Commialonar o1 k Any cMi* or skiffition' fvlq coly.: I TItW. 44, OMNI&/ 7-Z�' y -nn A6gr "Vp 915;ubdlir-4�" soft - 9 . . . . . . . . . . . . :77 TUMMI-A odw rem -Y dial lm"aoi ion ti P, atsio !,be W- mid. iiw Wr V a WS ipm N lOCafad as tt» sioill" plan *4 tMt Yid,wN1 'M.. . AVw- rem ..APP*b 0 1-, 0 nsrafdd F, r, Rem'i. -4- MIS., aid' aYgamlp 1) that tM Sswat !006 isvitem tMt the ON TIT 777 _JWS tlMn, uf%WUken and., Is Commialonar o1 k Any cMi* or skiffition' fvlq coly.: I TItW. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .Date ",2 Re: Property of zqG 6J.5 0 Located at <D��' j/��.✓ ��i�E Tom/. (T) /�.¢77�.�So -✓ Seri -ems l 3 Block Lot g Subdivision of Q Subdv. Lot # Filed Map # Date Gentlemen: This letter is to authorize S%�'✓ °s�� '9�% a duly licensed professional engineer for r (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: ��'I Owner Property P.E. , R.A. , # ;711 lr_93S, 7 Address RO, 13&-,-e- 2-V3 Address Town ��.. Telephone I/ c/ - g;, ?K- y-� sy Telephone SCALE IN 1110 OF AN INCH i 3 4 51 6 t c ' f i ° P/0 • «28 29e aot� i >r �4 P/0 3-1- " a II y P%0 3• I • er ,y\ ~ - - - - - - 150.56 157.]4 103 170.43 200 P u.n ti 3.71x' P/0 3-1-22 Y4 3-31 2T w 38 ' 3t 90 m i 17� 25 � 2G, .2 48 .tAL xpCi )�°°ua ° , y 3.65 AC.° 36 Np 99 1019.25 7i1 GCAL 2.27 1.68 w ^Lox 14'AGe Jo. 23 LC C.CAL Ar CAL \6 \0x 166 x59.94 tss t IS 220 160.20 \6)'j6 /, ` q 42 '� ' . • _72.3 r `G I s.r' 9 r - n Is A 4 ' 0 267 AC. 2.9 1.84 AC. p n 5 rro, � L; • 2.16 CAL. ,tz.ot ° 44 x43 42 77 3G6o9 t tut, 4 1 AC. 2s aC. L'N L i AC.CAL. pz.2 „ 's �,2 45 y t x 46 . a 37 N 1.13 ACS► z.2 AC. b a ss g 46 e 1.761.65 41 840 c39 r 38 m Ln6 AC. g e 9.06 AC, :34' ,,,o r� . ?„ o 47 .. • .50 3.1 A ` G : • e g 1 • o o tv ypMR9 47 �8: p iclu t�oCotnL Itnt ' 95 1 1.80 5.121AC.CAL. ` „_ 6,�4 .3o a,�I� \4' 3.1 b itiL a AC, AG AG a N 3.99 AC. CAL $ 44 1)1,N w 1,12A V44 3.4 AC. 1L. ACS +v •' M 807.12 CAL CAL Gale F u1 u , b a7 sl- 48 X. es e9 32 A , yO6y, 4 50 120 •3Sp G2 I S AGCAL n - 1:60 AC. s P v }� S +�„ AC. CAL, 1; 558AC. 1.68 �• ro cy� 4 �fiz a ~� SI % 1.9 AC.CAL • 36 61614 49 AC. 90 91 •4 3� \� , )9 cAENt 1 a. eW$ 35 � N3.3 AC. CAL. �•• � s I,o3 1.12 � 1.64 AC. i" X30, � 4.09 AC. Yd = z.l SAC. m +. 53 pz, 6 0 + 7 a s9. /s 13.83 AC. CAL. 'z 34 " vPot No , gzll AC.CaL4W, N3.59 AC CAL AC 16 R)tj 6jd t� Ji 465.00 a n • 33 £\ %, 16\ 51 .. ° 5.01 4G 66 B5 a °. '614 I J ra OS AC ' sy o` 2'/ m x2.22 AC.CAI. 4, n $ p C. ma b�ICA ,, 52 _;ua 3�''S\ .� AC. CA 618.95 „ 126 U4 AC. 1.25A h x \ CAL,,, '� - ' ' Y' • ? ' ' 9 " AC. 84 y 5 / ry' 29'3, p 5)x� _ .. AC 3. B 16. CAS^ 4 3.50 AC. a 2. 16 at.caL. +>4` 52 91 x272 to3 a ; • �\ / / 45 39 , J,� J•J� . 'i )pp.GO s plt.cA ' P\ .g 'g .2.3 , 7 6 L 1 29 �G� S .2 •a ,,a9° �; 4.62AC• 12010 4.19 597 1; 4.67 AC. CAL.AC`^^ss;;,, ac. Lot 123 AdAt ! \71 1.87 AC. 9 Z!u+�� ,11.1e 30 44; ery 661.76 a At 1p. T 2 y ' • >' 12 'N Qe 11 !�v �0 ti°°9° $4 i ii aAC:cpttiaw ` �.� ,6' t • 1.26 ' " p 12 n 13 - ' -3r� i j t° 92 coat ° 78 AC. 6 Is.2 3.36 A 2.06 AC. "egt . ?�5.0�9'AC, v° 06� � 1. J 79 1.6e zo2AC• ;5.41 AC. 5 r5 30°. o ,, j9: 54 P 26.75 AC.' Il r 2` sz9 z6 y • >� laze /� m 55 7 6.21 AC. CAL. A • `96 0. 1.71 Ac. 8 3:° �C AC. I 6 88 AC. v is, 409? 61456 ` i , Aq 2.45 AC. CAS. 290.65 ¢ 2j1,p0 �... I _ 366.56•' i tern 5.24 AC'' • o^ •1.4` A 9 d 15.4 10.3 B0T.94 •- 2 a 57 Q '� 23 I f L93AC 2.oeaC ° 5.59 AC. 1� ?' \1 °` ' 622.89 1- a� ,/. W \,04.69 AC. t�s �`o 27.52 ACl uz.sp Zb:�4,r" e 25 a 1.49 A6. 9 3 J • f �\ 4.95 AC, j50' 59 X ':1 01.1% / �g001 .96 AC 15 2 \ " g ,9 24 ' CA 611. c './ ,h I a 600.00 �• / �a 13 5.35 AC. CAL. a \ 57 5 a / 171.04 e / / \ v ¢ sip.i•612 o O 58 6.49 AC. 2.0 AC. O ` I N t �i wl3 1, 163 .; 163.20 V / / y 61,1 O JAW 41x6) I 167.0 ^ 7.47 AC. Mu.n _ 59 19x.1 e •T• 40NF - 5 • � 1s l 21 � I � 21.97 AC. AC CAL. � 93.45 is IC3.86 . ° S Z 150 150 m 6� 1 20.e9AC. 20 ' , ' 1. C I ti e / J \ 4.73 AC. )4x..7 I /..� •-- �.../' .� N4` ' 665.00 402.35 -•� . 90662 � I \ 19.86 AC. 18 I r \ 19 2.06'AC. I I •` . � txn 217,02 ' / ? • I.00 r I I 1 1 ID 18.92 16.64 AC. 'ts9faAC. - 1.00 actl I ` 63 �e3m6 4 ` �,�' �'o, ACAL. N"o 16 19 6 I 115.71 A aMal 05. 11 , ` d 1/73 101 G •t G- { a tue \ 83.92 AC. CAL. 4x4 zz F I l / \ 63 /�° 1.77 ACS t eer 0 ✓'`,1 11,10 AC. CAL. ) 14 1.831 AC. 1 1 1 .85 AC. 64 t3l 3 ACC 1'Rc 1 �a � 10, 58 AC. CAL 1.59 AC. 11 1116.fit) Q 1068 e .✓ 12 1 st 1 2.35 3.1 �0 9.78 AC. MI-11' 12S $ I 11 18.88 ac. \ J 66 2 AC. 35 6610 11 \ 3°9.42 r"•+ N e QC•, \ !•� 6.82 AC. CAL. 11 1. 31.73 / �. i / I ' • teiC% zid 66C. 2.1 AG 8 ° / . y, I• 41.2 AC. r 377.30 � ,L' t/ \ 14.57 AC. CAL. 5 'c �. P tai. 8 t, y a� ^1 r. ii At. '& 2. I A.C. r,2, ff� 1.15 AC. ;' I - � Ado@ BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH Division of. Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 December 16, 1998 Shawn Daly P.O. Box 418 Shenorock NY 10587 Re: Proposed SSTS: Classic Homes Ridge View Drive, Lot #36 (T) Patterson Dear Mr. Daly: 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: 1) Water analysis indicates turbidity and iron exceeds States standards. It is advised that the system is flushed and the water re- sampled. 3) Property metes and bounds are to be provided. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ve ly yours, Robert Morris, P.E. Public Health Engineer RM:tn 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, INew York 10587 Dear N.-Ir. Daly: BRUCE R FOLEY Acting Public Health Director November. 3, 1997 Re: Proposed SSDS: O'Hara Lot 36 (T) Patterson 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." "You are referred to Article 128.1 of the official compilation of Codes, Rules and regulations of the State of New York, Title 10, relative to'the need for approval of individual sewage disposal systems by the City of New York. You should contact city Officials in this regard." 1) Engineer's Authorization has not be signe�by e Trench cover is to be noted as geotextlte -/3) Erosion control measures are to be shown and detailed for the house well and SSDS. ,/Furthermore, a note is to be added stating all erosion control measures are to be installed prior to the start of any construction. ✓) Plan has not been signed and sealed by the design engineer. ✓5). The location of the SSDS and the proposed well on Lot 37 is to be staked by a Licensed Surveyor prior to the installation of the SSDS. This is to be noted on the plan. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Very truly yours, �h,vll /&W Robert Morris, P. E. Public Health Engineer >;Livmh watershed i% -v VI J;C Slttbdhlra� Nine O Let OwedA�ierrt NOM � � 1 ;l ' 1y�e '.Lot ,fie, kC= pip Sedlou peg Vaame Nober d Heioems DealSb Flow G P D 0 �J FCHD NoMidled b l:agdhed When FM Is esmpleled «*' S"Waf Senerep $yme m to bas" d :(m, o - T� be oer4taebd • F�'a � . Witter SplJt. Ftdllk SepI±tie� „ - .. Addssaa des' � ifFeh�'s �:De®ed by �• � t �� — Addlew: , Ober Retemaltb f rtp►eant that 1 am wholl and.eomDNtHy responsible for the dasgn and location of `the P►ot►ot�d systems) 1�, that the separate saw di tai s Item i above desrcritMA will be'eonstruetad at shown on the jipproved amendment then to and in, accordance wiWthe standards, rules a rpu of o nine county. DepiftTMt of Nrllt, and thaf_ on compNtion thereof a 'Catificat or Coestruction Comolianu Ytisfactwy to Ma''Commiuione► of MwKhwill a apbrnitted ao .thh. Depar raw irid r wiitten,•,ouaranti will be, furnished ,tM owner hif.succe, - heNS or as q.iy the butWa►. that said builder will olaee in .gooe Operitinp Condition any!oart of ,raid »vra4e dispowl sy8!!u durirp A 0 perioA: of tvvo (2) yeais,l" ateiy'followinq the date of the Isatl- f t11i epprovil of the.iCertifkate "of Coni iiiction.:como4iice o /.tha agmaP,'fysteioor an r Mains ther o the Aihied well'desciibed above win be located as shat- on the aOproved; pMn and.tMt. said well wi11,M.lnstal in 'atco p: wit M sta Y N nd rqY a�iiOnf 'Of the Putnam county Oegit of; Ith. F � . Date ,.A !�; y� n Sid P.E. Address T� license No APPROVED FOR CONSTRUCTION This appioval expires two years :from the date isfued unNSS construdIon of he building .has been' undertaken and is revocable foi,au", w may Oe:aenende0 of mOdifiod 'whenconsideied;necessary,by tha' :Commissioner of MNlth. Any change or alteration of construction re0uhes a new per it: Approved for dit�po-s I*of domestic sanitary se —w r only." , REV. OaN� ^'� By .• / Titli?�i 10/88" �'' -s. M1}n�3.�� ^..- ^-�.ik •� —.' -f ,�.. ,. i.\ .fi:-.. : -•_. . }S�{ >.: ti„ly ^•4L» - '�'+,'�.��sm F. - _ ''"�f T' � .. w IDTNM[OEPA�lH DbYCDY DO' dDtn[twraa�W Ha�Ih Salr�ba. Ca�1. N.Y 1�SU,�a� C �GTB OF 00�l�ANCS FOIR SNWAGE.01 IOSAL SYSTM - -v VI J;C Slttbdhlra� Nine O Let OwedA�ierrt NOM � � 1 ;l ' 1y�e '.Lot ,fie, kC= pip Sedlou peg Vaame Nober d Heioems DealSb Flow G P D 0 �J FCHD NoMidled b l:agdhed When FM Is esmpleled «*' S"Waf Senerep $yme m to bas" d :(m, o - T� be oer4taebd • F�'a � . Witter SplJt. Ftdllk SepI±tie� „ - .. Addssaa des' � ifFeh�'s �:De®ed by �• � t �� — Addlew: , Ober Retemaltb f rtp►eant that 1 am wholl and.eomDNtHy responsible for the dasgn and location of `the P►ot►ot�d systems) 1�, that the separate saw di tai s Item i above desrcritMA will be'eonstruetad at shown on the jipproved amendment then to and in, accordance wiWthe standards, rules a rpu of o nine county. DepiftTMt of Nrllt, and thaf_ on compNtion thereof a 'Catificat or Coestruction Comolianu Ytisfactwy to Ma''Commiuione► of MwKhwill a apbrnitted ao .thh. Depar raw irid r wiitten,•,ouaranti will be, furnished ,tM owner hif.succe, - heNS or as q.iy the butWa►. that said builder will olaee in .gooe Operitinp Condition any!oart of ,raid »vra4e dispowl sy8!!u durirp A 0 perioA: of tvvo (2) yeais,l" ateiy'followinq the date of the Isatl- f t11i epprovil of the.iCertifkate "of Coni iiiction.:como4iice o /.tha agmaP,'fysteioor an r Mains ther o the Aihied well'desciibed above win be located as shat- on the aOproved; pMn and.tMt. said well wi11,M.lnstal in 'atco p: wit M sta Y N nd rqY a�iiOnf 'Of the Putnam county Oegit of; Ith. F � . Date ,.A !�; y� n Sid P.E. Address T� license No APPROVED FOR CONSTRUCTION This appioval expires two years :from the date isfued unNSS construdIon of he building .has been' undertaken and is revocable foi,au", w may Oe:aenende0 of mOdifiod 'whenconsideied;necessary,by tha' :Commissioner of MNlth. Any change or alteration of construction re0uhes a new per it: Approved for dit�po-s I*of domestic sanitary se —w r only." , REV. OaN� ^'� By .• / Titli?�i 10/88" �'' -s. 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 , — VQ To Village City Tax Grid Number i_qz_;- . - 1- -A,-i 7 a oz--,�- ' i';�7 - WELL OWNER Name - Mailing Address private D Public U E OF WELL 1 primary - secondary QJ�IDENTIAL O BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION 0 OTHER (specify C3 INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT !�F___gpm /4i PEOPLE SERVED_ /EST. OF DAILY USAGE L&13 Sal O REPLACE EXISTING SUPPLY O TEST /OBSERVATION Q ADDITIONAL SUPPLY &NEW SUPIPLY (NEW W LLING 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE [3.DeILLED DRIVEN DDUG 0GRAVEL 0OTHER IS WELL SITE SUBJECT TO FLOODING? YES �N0 WELL IS LOCATED,IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name ""�v Pte. (_ Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES C._iO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED EDARATE SHEET (date) s 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 anner as not to degrader otherwise contamin a surface or groundwater. Date of Issue: 19_�'� Date of Expiration 19j� ' Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller LOT 36 MI-I -1 COUt11'Y INTARU• EM of HEAL111 'SECT I,ON 27 DIVISION OF I.11V.I11QI•1CNM 11111L'111 SUIVIM DGSIGu U11rA SIIEEr- SUQSUEACC SEWAGE DISPOSAI, SYS TH FMC 110. Owner PETER 0' HARA Address. P.O. BOX 282, PATTERSON, NY Located at (Street) _ B.OUTE 311 /CROSS ROAD See. _10 Block 2 Lot 11 (indicate nearest cross street) I-Ulicipality PATTERSON Watershed - CROTON SOIL PEIMLAnCN MT DATA PBOUIM TO BE SU 3UIIFD Wl1II APPL ICKCIONS Date of'Pre- Soaking 9/14/88' Date of Percolation Test 9/14/88 MOLE 11:28- 11:46 18 Ilt MER CLOCK TIME PEROOLTMON FF1100LATIM Run Elapse Depth to Water Fran Water Level No. Tine Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Hin /In Drop 24 Inches Inches Inches 1) 1 11:, 29 -11:59 30 24 '26 2 15 2 11:59 -12:29 30 24 26 2 15 3 12:29 -12:59 30 24 26 2 15 A 5 2) ], 11:28- 11:46 18 24 27 3 6 2 11:47 - 12:05' 18 24 27 3 6 3 12:05 -12:23 18 24 27 3 6 4 1 r1, LES 1 16 2. t.�v. 9/05 Tests to be repoabA at same depUs until approximztely egttil coil rtes are obtaino3 at eadi percolatim tr_.rt Dole. All data to' Ir_ subRittecl for review. Depth nr_a.surumnts to be mx3e Fran lop of bole. 1 , E 8 E � n Q!� / lib, 3 /'f'c VAA. C 3 A 1 r1, LES 1 16 2. t.�v. 9/05 Tests to be repoabA at same depUs until approximztely egttil coil rtes are obtaino3 at eadi percolatim tr_.rt Dole. All data to' Ir_ subRittecl for review. Depth nr_a.surumnts to be mx3e Fran lop of bole. 1 , E 8 O'NARA SUBDIVISIOt '1'E �'1' 1'1'1'_UlYl!A Itt)JU.l ll11) 'lU 13C sunt- J -ma) 111'111 11l'l'Ll(W1'1.Ut l SECTION 2 L)ESCIUl1r.10N OF SU1l.S 114COU1J1'1's ul) Im 'l.mr flour 1ka'll l How. t40. 3 6 A I IOLC 140. 36-8 110111; I )J . 36" 42" /4811 54" 60" 66" 72" 78" 04" TOPS IL BROWN GRAVELLY 'LOAM w /SILT f 11 1DICA1m LEVEL AT WuIQt GEZOUNUA I m IS Er1000w=FD None 111UICAIE LEVEL m wuat WATER IMM RISES AFM DEM FNJL7UNMMEO N/A DEEP DOGE 00SMMTICUS WE 8Y: J. F. E 8 E R L E DATE: 916188 DESIGN 75D0 Soil Rata Used 16 HUVJL" Drop: S.O. Usable Area Provided ._.+..�� P. M I C!y 1- t lo. of Dedrocm ; 4 Septic Tank Capacity 1:288 - . gals. M Absorption Area .Provided Dy 571 L.F. x 24" width trends Outer Alt. 'Design or Dosing Required li A. tlauk3 BALDWIN & CORNELIUS, P.C. Signatu%ef � -. :a: ft 10dress R0 5 . Route 22 _ SCAG °° ' ,1980 • Brewster. New York 10509 �OfESSi0N�� 11115 SPACE LUII USE DY 11 AM11 DEPAtil1•IMIr ONLY: 0. Soil Rate Approved sq.fk;/gal. Checked by Ual.•e 6" TOPSOIL 12" 113" BROWN, 24" STONY 30" LOAM 36" 42" /4811 54" 60" 66" 72" 78" 04" TOPS IL BROWN GRAVELLY 'LOAM w /SILT f 11 1DICA1m LEVEL AT WuIQt GEZOUNUA I m IS Er1000w=FD None 111UICAIE LEVEL m wuat WATER IMM RISES AFM DEM FNJL7UNMMEO N/A DEEP DOGE 00SMMTICUS WE 8Y: J. F. E 8 E R L E DATE: 916188 DESIGN 75D0 Soil Rata Used 16 HUVJL" Drop: S.O. Usable Area Provided ._.+..�� P. M I C!y 1- t lo. of Dedrocm ; 4 Septic Tank Capacity 1:288 - . gals. M Absorption Area .Provided Dy 571 L.F. x 24" width trends Outer Alt. 'Design or Dosing Required li A. tlauk3 BALDWIN & CORNELIUS, P.C. Signatu%ef � -. :a: ft 10dress R0 5 . Route 22 _ SCAG °° ' ,1980 • Brewster. New York 10509 �OfESSi0N�� 11115 SPACE LUII USE DY 11 AM11 DEPAtil1•IMIr ONLY: 0. Soil Rate Approved sq.fk;/gal. Checked by Ual.•e ��r> st�.. ° i7.: ai ,�• rxx^ °n�`^ �,i._ _ <zrnr> 2' :" i,t, =,^- n. r^^a• a t 9' .. fi.: m. ry•�- f t� K `-•. .M. �• _ �T ., �' Q 1pTNAM 00DlR'11' DEPARTAUM OF HEALTH a y T . /a.l �G ` DNIi� d BnYrssN�l Sa�loeo. Gitel. llY 14612 .� Fwvidi lw�lt 1 ^ J/' as CEaTHaCATB OF Rev. 10/88 S�nM $ewer S7�.ta;owit d�GoBara,S�pAc Y'oek � - = Z � �' 1 i Gtr•,[ -i'l Te, be enpftwoeod by Address WSW S"Ors ✓Fite S Iy Addren n a..e. saippitr DdRed by adirew County be, VAM Dim in ance of WHO be k APPROVED FOR COI revouble for cause, or requires a new ;permil that ,the separate uw di sal t stern rdt; rules a rpu n} o na Ktory to the Commis"ner of Health will signs by, thra builder, that Yid. builder will inma0ia t•hy following thedete of the taw- o; ) that the drilled we 11 g wit" 06- s and rqu slalomof 1M Putnam e% . P.E. _ R.A. of the building .has been undertaken and is Ith. Any change or alteration of Construction only. .Title . DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 _ APPLICATION TO CONSTRUCT A WATER WELL �f PCHD PERMIT #/ WELL LOCATION _ Streetli&ddress '— VjnA Qtawh 4E 7Village/City Tax Grid Num er �J ' WELL OWNER Nam; d Mailing , ID-2P_>oX Z,6 Addre ivate O Public U, E OF WELL 1 L primary - secondary G 4dfiDEN,TIAL D BUSINESS D 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 t.— gpm /f/ 13 RgPL ACE EXISTING SUPPLY LI'1fEW SUPPLY DWELLING ) PEOPLE SERVED & /EST. OF DAILY USAGE &oo Sal O TEST /OBSERVATION GI ADDITIONAL SUPPLY D DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DMILLED DRIVEN []DUG [3GRAVEL 0OTHER IS WELL SITE SUBJECT TO FLOODING? YES C-90 IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:. d:: Lot No. WATER WELL CONTRACTOR: Name �";'�3 a'� Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES '--"CIO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED 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 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 contami ate surface or groundwater. Date of Issue • �� 19 Date of Expiration 19 5 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date 1 I �!f I g-,t> Property of Located at (T)G�- t•Tj�. Sege Block p . Lo,t Subdivision of Subdv. Lot # _Filed Map., # i ?jZPC> E Date „,t:. T. MICHAEL DA�.Y, P.E. X. Gentlemen: .`'`�• ..,. CONSULTING ENGINEER P. 0. BOX 243 This letter is to authorize SHENnR(1('K. N y 1(1587 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 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_pnd to supervise the construction of said system or systems in conformity with the provisions of Article 145 or s . 147, Education Law, the Public Health•Law; and.ttie Putnam. County Sani- tary Code. Very truly yours, n e d <�r Countersignes�* Owner of Property P.E., R. A. # `Z Address T. MICHAEL DALY, P.E. Address Town P. 0. BOX 243 SHENOROCK, N. Y. 10587 Telephone — Telephone r1---L PUTNAM COUNTY DEPARTMENT OF HEAY.TH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: C)% NA A. 2. Name of Project: 4. Project Engineer: 6. 7. License Number:_ Igoe of Project: Private /Resident Apartments Office Building Is this project subject Type Status (Check One) • r� t., LocatAondVV /C *ddres; VDC Y, 7 F-1 C�il.l lU: -o5-o- ial Food Service Commercial , Institutional Mobile Home. Park Realty Subdivision O.t'Ker (specify) _ to State Environmental Quality Review (SEAR)? Type I.. Exempt Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ................ KIA 9. Has DEIS been completed and found acceptable by Lead Agency? •.........�r, JAN 10. Name of Lead Agency 1 11. 112. Is this project in an area under the control of local planning, zoning; or other officjal's, ordinances? ........... .............. If so, have plans been submitted to such authorities ?. ...:.:. o 13. Has preliminary approval been granted by such. authorities? Date Granted: 14. Type of Sewage Disposal System Discharge.'�YYF> 6yOF, Surface Water Ground Waters 15. If surface water discharge, what is the stream class designation ?........ _ 16. Waters index number (surface) .. 7. Is project located near a public water supply system? .................. 8. If yes, name of water supply — Distance to water supply x , 9. Is project site near a public sewage collection or dlspo.pal system ?..... 0. Name of sewage system Distance to sewage system _ 1. Date observed: 23. Name of Health Inspector: 4. Project design flow (gallons per day) .......... ...............••••• 2. 25. Is State Pollutant Discharge ElirRinati,on 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 ,` U wetland ? ......................... ... �1 28. Wetland ID Number ...........::.. .:.� :.,,... ' 29. Is Wetland Permit required? ......................... ....... . Has application been made to Town or Local DEC.Office? b 30.' Does project require a DEC Stream Disturbance Permit? ................. 31. Is or was project site used for agricultural activity involvingg'application of pesticides to orchards or other crops, solid or hazardous waste disposal, +, landfilling, sludge application or industrial activity? ......... YES -or NO 1J 32. Is project located within 1,000 feet of existence of abandoned landfill l, hazardous waste site, salt stockpile, landfill, sludge disposal site °or any other potential known source of contamination? ..............YES'or NO Nell DESCRIBE: 33. Is there a local master plan or file with the Town or Village? ........... 34. Are community water, sewer facilities planned to be deve:lopeo within 15.years? b 35. Are any sewage' disposal areas in excess of 15% slope? .:...................... 36. Tax Map ID Number ...................................... 37. Approved Plans are to be returned to: ................ Applicant '_Enginee`ir 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 informat ton provided on this form is true to the best of my know ledge and be 1 ief. Fa Ise statements made herein are punishable as a Class A Misdemeanor pursuant_. o Section 214.45 of the Pena 1 Law. SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: 1 24' T. MICHAEL DALY, P.E. BOX 243 SHENOROCK, N.Y. 4 BEDROOM COLONIAL 5 I NGLE FAMILY RESIDENCE 24' BDRM #1 G L. GL. i ME ME SECOND FLOOR Vail = V-011 I /a" = V-O° MASTER BDRM Q P2 24' ZF-N IDtn? t" ' � �tiZbt9faZZ� DREWAY 0. RIDGE IV -V W DRI .. .O' • .4 fi 3.::.r r! ,_,t..y,- ...;F -, k., . ;1 -xv,y � .t -` F �^ li . 1 :. p.. `� k `.1 { f t Ye ` -.� � 4. �?, �.!, 'U,.. 1 � _ .4 �. ". •{�� A ' x , ! A ,u y _ 4 w, �"`.' 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