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Home My WebLink About0370DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -83 BOX 5 00179 BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1. Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 *14ft7ROW8 Alfred & Debra Casella 32 Ridgeview Dr Patterson NY ',12563 Re: Addition- Casella - Ridgeview Dr. No Increases in Number of Bedrooms (T) Patterson Tax # 13 -2 -83 Dear Mr. & Mrs. Casella: 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 form this Department dated April 6, 2001 The addition is approved with the following conditions: 1. The total number of bedrooms must remain at Four without prior approval by this department. 2. The area of the existing sewage disposal system, and its expansion area, must be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Patterson. If you. have any questions, please contact me at your convenience. Very truly yours; William Hedges WH :kg Senior Public Health Sanitarian cc: BI T. MICHAEL DALY, P.E. BOX 243 SHENOBOCK, N.Y. 4 BEDROOM COLONIAL. SINGLE FAMILY RESIDENCE M ' I. :21" SECOND FLOOR I /V" = V-0" PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE., TRH TMENT SYSTEM PCHD CONSTRUCTION PERMIT # '/� L Located at e q D. gt VE . Town Village -7��Sv NJF� Owner /Applicant Name CA.594-1-A Tax Map f 3 Block Z Lot 83 Formerly Subdivision Name 42 W4 .Z„3DiOs,en) S&Vla,J�y Subd. Lot # '315 Mailing Address 4'1 ,bG,,g' j/ /, g, A / 4/0i � Date Construction Permit Issued by PCHD Zip / Z 531 Separate Sewerage System built by�� cG Y Loi✓l i /AIL. Address L,¢iv� (- ACcAEj �zs Consisting of 12 Gallon Septic Tank and Water analysis result for sodium (Na) is 3• Mg/L. Ater cpntatning roue c114 _ r ° Other Requirements: drip' na by zo !� se`.� r �' a s,. W.te+ on7al�l:�s � R,4k . rnore than 270 mgil of c :`: 1: ; 1 is r ....Ty N rte�n- rr,. -'�' Water Supply- Pub1 ,R £ olzaini diets. PU YNAr :lkMk�TY DEPT. C1F'ITf:i`ik.� � 13 • ��T>E R W or: �rivate; Supply Drilled by �� 1 C G K � Sd /l1, / ,, Address �t Building Type ��Si,,�j�. Has erosion control been completed? YES 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 th standards, rules and regulations of the Putnam Co D partment of Health. Date: Certified b P.E. 1 R.A. J0 y (Desi rof l Address �i✓UPQ License # y Cp 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 revocati . , modification or change is necessary. n By: Title: Date:�� —/ White copy - HD File; Yellow - Building Inspector; Pink copy - ner; Or g copy - Design Professional Form CC -97 CA 1 �( / �' r Ak ,;ilk 11009 rA 17*-2* r7 -3 1/2- fbr Pv, Z, R Aw 5& CERTIFICATION ?01eb PATIO DOOR ?Jai* PATIO W.0 MM W4444 WM 4. Ll I L9 JJ 142 L�Kr O/W "M 4 FAMILY ROOM 7 —1d, NOOK 836 a- - 3/a I DINING ROOM KITCHEN --,-1 . 11271127-1 ;n ILI 1� ILI, 81-7 1/2* P.O. A 942 939 PANEL CROP 12' tlRCR:� 450 ARCHWAY W3627 W4444 OC3084 —;3-9.—. OMEN IF iA-lRCT-l;m- 7,) Pk .\4 _, LIVING r4 ROOM � ^� �� =� r__ , :gin FOYER •:30-STEEL i I FRONT11 26 Tif ., :� U - 4)i!l 'I 171 -a J (D 4 _VC2TTSIOEUGH 7,2 o l l �, r p A 10 'c , ._b" ir, — m Tw ow w w V.7"= omu NW poortmom Amooffla. IIQ PWM W= PWI 8M MaAF10 iTpl A PRLVIOtMY APPFOU SYS704 ov%WmIff w MIC � t W100 1. NO Km CNVW mNno. ow 3 w 'm —A DIDIV wm �,rm"jm Maom Wv. t 6K FIRST FLOOR I)H t-WILING IIEIUIIT) ,*1,03Y SUILT 7ORTION -b ! m-- 0 lk.-) b.;I& — - - - - - - — - - 4, BATH I BATH 2 BEDROOM t II MR7 1 9-1 i II i ZT rL (4) LAYERS 3/8• (3) 24/0 PLYVVOOO 23W BEDROOM 3 PLY OEEP I pq 1 an 4 pn 28 p CLE HOUSE F A" ROUGH OPENNG CUSTOMER TO AWASE SZE L BEDROOM 2 m THE -vowmm=�m Mir FRONT i LP A, SECOND FLOOR (96" CEILING HEIGHT) CREST HOMES oROVa�Aiv *o E80901 MILT -1=011 Msl3-u-:3 a An OUNTY HEALTH -2w_ kPTNAW-C -DEPT .,I --'--;"4'G .... ... �'iRieid�(914).278h 9 Ji? Date 'P saw� Dollars a F IiUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE, RE, TMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located. at 2 1 D r� ]�� 1) G To Village Owner /Applicant Name_ -CA 15I-4—A Tax Map Block 7, Lot 83 Formerly --.O 'A4, eA Subdivision Name 4 `/ W4 Mailing Address 9. Subd. Lot # .30 Date Construction Permit Issued by PCHD J/0 / 1 � Separate Sewerage System built by ��i tL Y 6,vr, i Ak,. Address Zip / 7, 53/ L Consisting of ` Gallon Septic Tank and ZIAI, Water, analysis result for sodium (Na) is Opt irl) -Water cpntalning anc� c si�a,a �u ,�1 �. „ ,., --�- Other Requirements: .-drinr, ng. —b et+.1e .i scver''r 13 a {,'� ' �'� NAte� Qili�l'll'`�r more.than 270 ingiL of siodzto'n tr, u; nut. �A ost-u uy yr " -T— Water Supt : Publk. upp lF,;�oin, � diets. Z'i11'i'vi�rilA�dd e�sTY DEPT. 4 F IEfiI '4 1&, 13 ' C,�,u'i_ 9 W ®r: Private Supply Drilled by 1 t - G 6k �' &Al i Address er t,:� i LS 7 Building Type `�iagyni�. Has erosion control been completed? Y�5 Number of Bedrooms Has garbage grinder been installed? /yo 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 th standards, rules and regulations of the Putnam Co D partment of Health. Date: 0 Certified b Y P.E. "' R.A. (Desi Address � rofess'o ) - >�•v�' / License # % 3 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 an 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 revocatio. , modification or change is necessary. By: Title: Date: White copy - HD File; Yellow - Building Inspector; Pink copy - er; Or ge copy - Design Professional Form CC -97 t BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845)278-6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 ADDITION APPLICATION (RESIDENTIAL ONLY) STREET 3c� ✓ j ew �e1.L{� & TOWN TX MAP# NAmE —A M'- Wcf2A Cz% 1l PHONE tq� - $79 - q qj5 PCHD #A9 I- U MAILING ADDRESS 31 4 OCZ4 b!z . LI- � oo ; DESCRIPTION OF ADDITION Olev�o e, .1- Gc.bp V e— NUMBER OF EXISTING BEDROOMS PROPOSED # OF BEDROOMS (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) *Any addition which is considered a bedroom requires formal approval of plans (Construction Permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 4 Geneva Road, Brewster, NY 1009, Phone 278 -6130. 1. Certified check or money order for $100.00. . 2. Sketches of existing floor plan (drawn to scale, all living area including basement) *Non- professional sketches are acceptable. 'e'3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #) *Non- professional sketches are acceptable. A. Copy of survey showing well and septic location, to the best of your knowledge. Include.date of installation if known. Label all wells and septic systems. within 200 feet of the property line. Contact this office with any questions. v-'.45. Copy of Cert. Of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE Comments Feb98 BFhouseguidelines I I CERTIFICATE OF OCCUPANCY AND COMPLIANCE C`�.��x� .�� r # #.�x��x�, .ear .�x.� ; :3 . ,}��: N2 2568 19 99 DATE ISSUED --MYA -28, THIS IS TO CERTIFY THAT ON THE PROPERTY OF Same LOCATED ON Ridge View Road HAS BEEN SUBSTANTIALLY CONSTRUCTED TO THE REQUIREMENTS OF THE BUILDING CODE, ZONING ORDINANCE AND LOCAL LAWS OF THE TOWN OF PATTERSON, NEW YORK AND MAY BE OCCUPIED AND USED AS- SinQte Famity Dwetting wl Wood Deck Building Permit Dated ..10-5-98. Permit No. 2662..... Application No. J0.91 ............. SECTION ........ ......... BLOCK ........ K ............. LOT.. 83 (S.D. Lot # 38) ........ FEE 25.010 BUILDING INSPECTOR Icy T. MICHAEL, DALY, P.E. BOX 243 SHENOROCK, N.Y. ` 4 BEDROOM COLONIAL 5 I NGLE FAMILY RESIDENCE %qHAL7L BATH Room G L. BDRM #2 BDRM #5 SECOND FLOOR 1/8" = 11-o" St MA5TER BDRM 24'. i i, i � !R FUTNAM COUNTY DEPARTMENT OF HEALTH Dieu d Erwdmonewd BOOM Seevloe -. Ct NWL N.Y. 10512 Enshesse to Pbvlda Felt r � FOR SEWAGE DOPOSAL SYSTEM an CERMCATE OF COIDUANCE Face r P �—p g ' Pr�.�i� S rvV L LaeaMd ad rs t ew or ie Sbw l7' �d�P� Sabd L-t r 3.6 T. Map /Bloek �" ea• �^'' O..rr /Affffic.t Naga. P, 0 r /-/Ae! W fwd —f Revf. u ❑ Date d PWA. Approve) Mal ks Aftsess p Town /9%✓- ZIP—/ 2�J natP Subdivision Annroved e? 1..7— Fee Enclosed ❑ An,.,,."f- >� Type �G5! D�/UTT% Lot Ate. IiiPCHDNodSmdmiRoqWmdWbmFMI@mmioWd Sectlon oay / ve AiP Nober d Hoiioa�e De ftm Flow G F D i� /of Separate Sewenta Sy"a a to oast" d GaO-a Sq* Twit end C 1A / • Z A/'-'11 To be aanohraebd by T`, = Address Water Sapp• Supp4y Fnn Addeero an .. Slllpp Deified by %i , �j Addmn iris • -"` - • 3/�5i -� 1 r*pra*nt that 1 am wholly and comple tely responsible for the design and location of the proposed system(s); 1) that the separate s*sr di sal s stem .bow* described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a rpu erns o n County Department of Harsh, and that on completion thereof a '•Certificate of Construction Compliance" satisfactory to the Commissioner of HesKhwill b• submnt*d to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said bulkier will place in good ops►atkg condition any part of saki sewage disposal system during the period of two (2) years immediately following the date of the issu- ance of the approval of, the Certificate of Construction Compliance of the original system gr any rape thant :2) that the drilled well described above win be located 's shown n the approved plan and that aid well will be Inst in accordance ith the a rd rules and rpu TIons of the tam County Depa nMnt o Hulth. Data Signotl P.E._ R.A. _ 6c9X .)- � S U G 1 Adtlna - License No APPROVED FOR CONSTRUCTION: This approval exDka ter Y s f m the date i cage unl s conftr on of the building .has been undertaken and if revocable for cause or nay be amended or modified when con d ary by t ommissioner of Health. Any change or alteration of construction ►squires • no perm A waved for disposal of tlomest a cage, and ivate water supply only. Rev . 10/88 Data ev Tithe PUTKAM COUNTT DEFAnWWT OF HEALTH _ / DhW= d 1bavkommnW Buft Sgevieeg. C11I" N.Y.10512 TE OF CO11Qi1ANCB off i CO PNEW FOR SEWAGE DEAL SMIM Locate tit Town car Yee Rev. 10/8 SllbirMw Nara cube. Let r Tax Map Block let t Renewal_ ❑ Revl ikef ❑ Owaar /A� Naha Dated ow Apprvol MatBll8 Adigw Z Towne �` N Subdivision Approved Fee Enclosed 9� Amaunt Btd k fR Type -Lot Area 1 iC.L�.� FM Sew o Dept. �Volasme ! G Nwobar d Beiaa�a Dea1Qn Flow G P D - PC�HD- N- of�mlytlon he Regahe4 When Fm Is completed Sopaeate Sowlemps Sydem b ooaalat of Ga@w Sq* Tack and l L) t R-R. �' To be oaao4we/a -by -1 �� Addteeo Water Sa*pb't P&1c SW* Filar Ad&vm an `" -aw"o Sqq* Delhi! Odw 1 ►sprasntAhat 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the aparate saw d' sal s stem above described will be constructed as shown on the approved amendment there to and in accordance with the standard; rules a rpu ns o a County Department of Health. and that on completion thereof a "Certificate of Construction Compllance" satisfactory to the Commissioner of Hsrlthwill be submitted to the Department, and a written "&rants* will be furnished the owner, his succesaas. heirs or assigns by the bulkier. that saki bulkier will place in good opwatkg condition any part of aid swage disposal system during the period of two (2) year m*dlately following thodoto of the issu- ante of the app ravaf of the Certificate of Construction Compliance of the original sy o► an repairs t *t :2 that the drilled wolf described -bow win M loeatsd as shown on the opprov*tl plan and that aid well will M Instal a wit M ►d s and rpu aZiTons of the Putnam County Daly of Health. Date 1r� Signed RE..A. Addr*ss ::a2k :Z—A-5 License No APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless constfuction of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction squires a new pqrnit. Approved for disposal of domestic sanitar /age and pr ate water supply only. Date J %c= � s2��` �� Title �7 "� PO Box 733 Marlboro, NY 12547 Phone 914 - 236 -7823 Fax 914 - 236 -7823 ENVIRONMENTAL LABWORKS, INC. ELAP #10824 February 26, 1999 The Builder, Inc. 1 Rita lane Lagrangeville, NY 12540 Dear Builder, The following are results of the analyses performed on a water sample labeled Casella, Lot 32 Ridgeview Dr., Patterson, NY received 2/18/99. PARAMETER RESULTS MAXIMUM CONTAMINANT LEVEL Lead 0.003 mg /L 0.015 mg /L Iron 0.10 mg /L 0.3 mg /L Sodium 3.2 mg /L - - -- Manganese 0.008 mg /L 0.3 mg /L Alkalinity 97 mg /L - - -- Total Hardness 110 mg /L - - -- Nitrate, as N ND <0.05 mg /L 10.0 mg /L Nitrite as N ND <0.02 mg /L 1.0 mg /L pH 7.42' mg /L 6.4 -8.5 units Turbidity 0.7 NTU ND = None Detected The data contained in this report were obtained using EPA or other approved methodologies. The outside laboratory used ELAP #11216 are NYS ELAP certified for these analyses. If you have, any questions or require any additional services, please do not hesitate to call us 914 - 236 -7823. Thank you, Anthony J. Falco Laboratory Director �I BACTERIA L.ML AT 35-C : TOTAL COLIFORMS / t00ML' + OTHER TESTS REMARKS L ABSENT t " ;METHODOFIXAWNATIO s'.,. MPIV O MF'0 Colilert lA THESE RESULTS INDICATE THAT THE:WrATER WAS OF A SATISFACTORY SANITARY QUALITY tIN RESPECT-T0;THE'ABONE.TEST, WHEN THE SAMPLE WAS COLLECTED: ' REPORTED BY 41 ICE' ; DATE `2 19 -99 r is EN1ldHONN1ENs `AL Ll PO Box 733 Marlboro New t r r FE. I Faz..(914) 236 =391. } ZLAP ID# 10824`. BOTTLE NUMBER l l �L VTERIOL.OGICAL4EXt4 ®AII®P9'TI® . s s. COIL•ECTED.BV D DATE D TIM COLLECTED D DATE D IME RECEIVE 99�ts.Ptt g g'9 ` EXACTCOLLECTtON,P.OINS S SAMPLECOLLECTED'FROM ' P PUBLICrS UP. P.L`Y I] PRIVA' NA N NS OP WATER SORCE T „" , ,•' ` `REPORT • �. \- i i .fir lll� �;�Y �4 t `'t t � t a BACTERIA L.ML AT 35-C : TOTAL COLIFORMS / t00ML' + OTHER TESTS REMARKS L ABSENT t " ;METHODOFIXAWNATIO s'.,. MPIV O MF'0 Colilert lA THESE RESULTS INDICATE THAT THE:WrATER WAS OF A SATISFACTORY SANITARY QUALITY tIN RESPECT-T0;THE'ABONE.TEST, WHEN THE SAMPLE WAS COLLECTED: ' REPORTED BY 41 ICE' ; DATE `2 19 -99 r is 'TT 2 4 5 6 SCAIE IN 1/10 OF AN INCH _ -- 13456197,31 1e3 170.4] zoo P/0 3 -', P%0 3 -1.67 P/0 3 -1 -22 . 29 tt 24.E � 3-0 27 '�'N 1 t L 1'�4 / �` „ 38 '� I' 4r �` 90 NI a _ 25 ;26, g23 48 g A� A /� b : 3.65 AC.�1 as � • � "� • '1 1019.25 AL N • t / a. e4099 qte. r, HILL GCAL 2.27 1.88 Z t C ; P / t°° g 41 0 40 143 AGe a 160 ay 77? C.CAL C � tcs / 42 �. . . r 220 tw. 1 0 4 �;-3 0, 35pi, 1 ' C �,� `` iss T33 7T4 i \ ��S i+ • 2.16 2.67 C. 1.4 s6OAC. p• �jc 96 A.��4, 44 -43 420 3e6.o3 ° ,ya" • AC.CAL 23y2t' AC. 1.25 _ r 1.761.65 41 40 539 ar 138 = 46 ;1.46 AC. 20° it g 9 9 e6 AC. 3J4;INAC$t►� r • 2 S 2.2 A 2 i-40 ACp 47 46 I so °It7 AG . 9 • Y 1 �\ aw 69 47 4► °.1 l 19 AL ; � 95 .1 1.80 ~ 5.12 11A C.. CAL. 3,99 AC. CAL " - 44 ° a « °'•'1i � 3 ° �4�� 3 1 I AG AG AC. « ^' $ �3�. 4s 3.4 AG w ept.ti CAL C Cab r ' 37 $ e�cte 48 AG 89 • 32 szo "t2o 1z 19 AGCAL• • .. - as 1.60 A 0 , 3w.°t � � " 36 b \ 3.64 AC. CAL. g �58AC I.se •6 °314r'r 4 ' !A F' - ' ' 1.9 AGCAL • 6 "g•�° 49 I1G, 90 91 • ^}„ 51 :`y �, �° 35 N3.3 AC. CAL. �, lOi 1.12 1y64 AC. 3��' ��'4.09 AC. z R, 13.63 AC. CAL. 9 21s at.. w�34 \ $ °zt.ee 53 .• p °r �C. ' a ^ 1 6 AC 295 2i1 aauti .� ,•3.59 AC °CA �. . 65•°0 1J9AC. 16 MTh $� 00 8 n ` 4 5.01 AC. 86 % •• r . • ai aos. • 33 x' `gql, � � 05 A 14 6' Y0� 52 2T � -222 AC.CAL a�•p 6jey9 �� 26 U4AC. 1.25A \ CALn is L = 1` • * zr 32 . 4 G CA ea s 8 3.8 AC. CAS'' 6 3.50 AC. s 216 ac caL , ,45 52 ' 82» 103 A 127 AG y �tp e ac. zato / 454 t9 TM J� i1t ° 53 R 300 °0 �6iGCA P\ • $ 1.72 9C°1F,F » g t 91 �r 1J a �LC�. AC. t 401,: 123 AG o J �s9s. 1.57 At S4� a 30 a 4.67 �C' AL ` � ¢. ,• `�,�`2 b I !Alt' a �; tid' i ti gACCA�y.�.�� " ro Me' y Alt' z 13 3.36 A� 6.0 '11C. /6� 53 " 92 „ 79 AC. 5.41 AC. is 23006wAC. a =� r,�� q§ L- 54 �� • 26 75 AC. � J 79 lse a28 & 2�5 ' 6.21 AC. CAL. S 96 AC. 1.71 4G Sz3.zc g e 3a2e a 55 so "tflsb ��,b 6 e 2.45 AC.. AL. 250.0 1 z� a A 10 J \1.54 At 366. 3• N ' ••�• , C 15.3 a 5.59 AL- 5.24e0064 57 a 23 1 'IA4 I z0e o�58 t ,/ 26 4.69 AC. �� • �`O, 27.52 AC/ Iszw 4.95 AC 59 X 25q 1.�4s4rnG g a of f CA 86 A 6�yta, _ \•.� .f 29 4 Nal / • 'm � 38.31 e 5.35 AC. CAL. a ' J: v n 171,01 I/ 4 518.2 °612 a$ � 58 « 6 49 -.2.0 AC. p � � �• � 1 163.20 I b p• G. 163.0 A10.63 f 7.47 AC. 184.1 R r. 5 , �,. �eNN _ 21 v 21 1 103.86 AC. CAL. sse3z 193.45 '4t,� 2.7.AC. 1 a22.2 w 304.66 7i0 20.89 AC* .. �'' - 20 v !. 0 _ 4.73 AC. 1 2461 / / /••.� 1 '' 426.79 , �t1Aat 11! IM /�..- �... /'••�`` 62 - 665.00 402.33 A I NJw SCAQ. 1 19.86 AC. G 18 e 1 / \ 19 2.06 'AC. I 1 r 217.02: 10 `�, 16.64 AC. 017. • 9• 1.59 AG __ • C za C� y. . �J { J4. is t �C r� Y 13.07 9 \ AL AL �P6.66 W \1A 55 ,1 18.90 AC. A I . Vs 56 81.48 AC. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date:. Inspected by: Street Location _ RjD6Z5VI1 W l -210 Ovrner _ P, 42VIA PA Town -PAv'T at/ Permit # 'P— 58 - 9� TM r / — Subdivision, Lot # 3 g " D `HA 1. Seivage System Area . a. STS area located as per approved plans ..................... b. Fill section - date of placement 3:1 barrier Lgth. :� a ` Width /aD Avg.Dpth c. Natural soil not stripped ............. ............................... d. Stone, brush, etc., greater than 15' from STS area.... e. 100' from watercourse/ wetlands .............................. II. Sewage Svstem a. eptie t size -1,000 .... b. Septic tank installed level ......... ............................... c. 10' minimum from foundation ... ............................... d. Distribtuion Box outlets at same elevation -water tested.......... 2. Protected below frost ........... ............................... 3. Minimum 2 ft.Original soil between box & tren Junction Box - properly set ................ ............................... I . Length required _Y _ Length installed 4 2. Distance to watercourse measuredfia 00 Ft... 3. Installed .according to ............................... 4. S rich acce a /16 -1/32" /foot....., 5. 10 fr operty in - 20 ft.- foundations... 6. Depth of trench <30 inche o a e........... 7. Room Nae ......., 8. Size ame er clean ............ 9. Depth. trench 12" minimum............ 10. Pipe ends capped ................ ............................... g. Pum p or Dosed Systems I o 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. oust located per approved plans ....................:.... b Number of bedrooms ....................... %3 IV. Well a. Well located as per approved plans ........................ b. Distance from STS area measured 0 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 f. Curtain drain outfall protected & dir.to exist watt g. Footing drains discharge away from STS area..... h. Surface water protection adequate ........................ W 9 U ''E 'ro PROP HOUSE . F'r 512 - z _ 4 Cl 1/4 " /FT. / 1250 GAL. MASONRY TANK MIN'.' .11A.0.5. / -I' A.0.5. FILL VH !(1 y{iTN N ,lOo �w # �10096 -' 13 L If CLAY 5,4ARI =R Ln b9 uE - I6 O' 1' NT5 4RU m. L =51 .22' 504 50: y W Y 4 WhLL UUl"lYLr.11U1V r.�rU�l DEPARTMENT OF HEALTH Division Of.'Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH' Office Use Only WELL LOCATION SiREEi ADDRESS: 76WN19TEXCEICITY TAX GRID NUMBER: Ridgeview Rd., Patterson j WELL OWNER NAME: Steven Schweitzer ADDRESS: The Builder, Inc., 1 Rita Lane, Lagrangeville, NY 12540 ❑ P8IVATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary' ® RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP ❑ ABANDONED ❑ BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY '❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING ID NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION O REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 124 ft. STATIC WATER LEVEL 10 ft. DATE MEASURED 12/15/98 DRILLING EQUIPMENT ❑ ROTARY 11� COMPRESSED AIR PERCUSSION 0 DUG ❑ WELL'POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED ❑ OPEN END CASING. 0 OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH 21 tL MATERIALS: :EI STEEL ❑ PLASTIC ❑ OTHER CASING DETAILS LENGTH.BELOW GRADE 20 ft- JOINTS: p WELDED fl THREADED O OTHER DIAMETER 6 in. SEAL: ® CEMENT GROUT ❑ BENTONITE ❑ OTHER , WEIGHT,PER FOOT 17 Ibdit. I DRIVE SHOE: ❑ YES ® NO LINER: O YES ONO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (iQ DEPTH TO SCREEN (ft) DEVELOPED? FIRST O YES ONO HOURS SECOND GRAVEL PACK. ❑ YES O NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH -ft. BOTTOM DEPTN It. WELL YIELD TEST If detailed pumping METHOD: O PUMPED i tests were done is in- ® COMPRESSED AIR ,formation attached? O BAILED O OTHER 'D YES O NO �IELL LOG It more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear- ing Well Dia- meter FORMATION DESCRIPTION CODE, ft: (t WELL DEPTH It. DURATION hr. min, ORAWOOWN ft: YIELD gpm. Surface 10 Clay 10 124 x 6 Granite 124 6 8 WATEP O CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? O YES ONO ANALYSIS ATTACHED? O YES ❑ NO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELLORIUERNAME J. T. Eckerson, Inc. DATE 12/21/11 ADDRESS 1613 Route 9W SlG AMRE . . Milton, NY 12547^ Vice President PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM L:4s F_ a/, ,% Owner or Purchaser of Building Building Constructed by Z17264_ Ur Is-_,,j __�P_ I W E_ Location - Street 1? r-s-S i D5tjrl NL_ Building Type - 03 Tax Map Block Lot (!ow illage NAkj\ S e_C4-7C,-J .� Subdivision Name 3� 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 with1he 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 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 C) '�)— Day General Contractor (Owner) - Signature 2-e j (I ZaN�' 2A.)C. Corporation Name (if corporation) %Z_C4 C d 4A Zip are: ` uP Corporation Name (if corporation) DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 f June 18, 1998 Sean Daly Box 243 Shenorock NY 10587 Re: Proposed SSTS: Macaluso Ridge View Drive, Lot #3 8 (T) Patterson, TM# 13 -2 -83 Dear Mr. Daly: BRUCE R. FOLEY Public Health Director 1 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) Fill is to be shown extending 10 ,feet past the edge of the trench and then sloping 3:1 to grade. Upon receipt of a submission, revised to reflect that above comments, this application will be considered further. 111110y VP;: ly yours, : &Xle,_7 . Robert Morris, P.E. 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'INY 10587 Re: Proposed SSDS: Macaluso Ridge View Drive, Lot #38 (T) Patterson, TM# 13 -2 -83 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) Trench detail is incorrect. Revise separation distances accordingly. 2) Current codes requires that fill is placed is the expansion area. 3) Proposed contours are to be shown. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Very-truly yours, Robert Morris, P. E. Public Health Engineer Rv1: to 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, New York 10587 Dear Mr. Daly: �-X/.� BRUCE R FOLEY Acting Public Health Director November 3, 1997 Re: Proposed SSDS: O'Hara Lot 38 (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 revelations. You should contact local wetlands officials in this regard." 69, htG 1) Engineer's authorization has not bee seed by the property owne V2) Trench cover is to be noted as geoteYtile. ✓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. -/4) Plan has-not been'signed and sealed by the design engineer. ✓�) Remove or cross out fill settlement note. This is not applicable for fill sections 2 feet or less. 6) Add fill specifications, i.e., the 0% allowed to pass a 100 and 200 sieve. "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." Upon receipt of a submission, revised to reflect the above, this application will be considered further. Very truly yours, hr,a/ R*W Robert Morris, P. E. Public Health Engineer R'\,1/mh watershed PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date /o2 Re: Property of �, �.9GyLUSy Located at � 83 (T) fF�TT75,e5E5v,/ � `3 Block Z Lot Subdivision of ffis�i9 Subdv. Lot # .36 Filed Map # Date Gentlemen: This letter is to authorize cS"" -To 4yr/,/ a duly licensed professional engineer y 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 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. Countersigned: ; P.E. , R.A. , _4e, o, 0 &x ;Z V3. Address Ao 11 AN 17 5773 Telephone Very truly your Signed 'Own e of r'opperty Address A� Town Telephone QS... .... �. .. ... .. s- .rt{�'u�'w.� .,k�".h3�..S- _ ,�" ""�"•".'�"' ;. ��•� --sx:. fir R' ![RMAII[ 0 01 Wff DEPARIMM OF HEALTH Dh1eM et Hedlh Set IWkia. cmi" N.Y IN" Bdt�aelr a hiGidi heat `1 °�� a CSNII+IGTS OF COMPiJAM . . . 2OLli01!1 Ffl FOR, UWAOE 01M. KMALSYSTBM .. hewlt r Laliaai V1 ow■ "es. r ®� SeM� Neese , LatC J Tex Map Block -5 ewe OlrndA feat Nw ,1 � Roucwal_ Qevlelae ❑ Date ac Prevloas`Approval ,t O ii M� Ads�ae T Towt± N z ubdivi`sion •A' -- d .. Fee Enc3osed. 11 i"Ami h'Pe11 1'1 /%l Am FiS Section 0e4 Depth �_vokatae t Kober at Baief>tos lisiv Flow G P D PCHD'Notldadon is lZequt nd Wkea Fm s a' Sepne�le srwewp._ r•h. o..de! d,Go9w S�ptlt T�eli - To be oeeiletaead bPi. 17 Atkbxa s,.' As1�en Water Selppb: Pwim& S pta� otb.r 1 repraarit'tliit 1 am_ wholly and comDNtaly nsponfi0le fa 4M deign and IOC{titln of_'tha proposed'.iystem(s); 1►' hat .the separab fear disposal stem above delCripeO will tia Conitructe0 ai shown On the approved amariAment tnera to and in accordance with the standards, rutbfa r" sons o Putnam County. WphrteMht of ""� Nand tha! on comp) "tha.of a ^Caafitatp of Construction' "Compliance ot1sfattory, he Cominiffbmr of Multhwill be yArn. ted, to the Opntiriint and., a` written: gu'arantet will be furnisMd't a ovrnar his suctaaor" •heirs or assigns ha bumer. that f.a, bulkier will olaCa irl pod opertll lg 00#ion anY.:I ort of selo sewage disposal system ,durin9'the•per1 0 of .two (2) year I III ly IlOw169 the date of the isau- !eq of the litpp/artl ;of the CertiflateOf ConAruction" Compliance of „th. original systern a:' y'rap. t theret t t drilled well'aeaaibid above will Oa grutid as sherirn o tM,a00!owd pion and tMt said wall will'bi Installed, in eccordan the ndpr le ,.a puTaiiphi t - the Putnam Cove Dpaft of Ith. ,.:. Date �. Signed• RA. Addnsi _-1�- License No APPROVED FOR CONSTRUCTION Thii'approlial axpires.two years from the date .issued unleis construction of the building .has been undertaken and is revocable for ci fa or may bo ananded or modified when ionsidered neeeisiiy; by Y” 0. OM one i of i4Mltn. Any thenga or alteration of construction re0uiref a haw perm Approved foi,•difpousof domestic unitary sew gwna i-iw er.`sulgy only. Rev. a :. 11c'/ _._ 10/88 —T —'-- Br Title 0 I DEPARTMENT OF HEALTH Division of Environmental Health Services ' y 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION, Street Address o Village City.. Tax Grid Number WELL OWNER N e Mailing Address rivate D Public 7 E OF WELL C .- OF 2 - secondary SIDENTIAL D BUSINESS D INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT UMP O FARM ❑ TEST /OBSERVATION tIINSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT 15— gpm /# 13 REPLACE, EXISTING SUPPLY f HdW UPPL DWELLING PEOPLE SERVED /EST. OF DAILY USAGE_4g2D gal ❑ TEST /OBSERVATION Q ADDITIONAL SUPPLY O DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE EIISR'ILLED DRIVEN E]DUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES L--'90 IF WELL IS LOCATED'IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. z:,6 WATER WELL CONTRACTOR: Name r � ;; > Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH 6 SOURCES OF CONTAMINATION PROVIDED i 9RARATE SHEET r' �... (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 contaminate surface or groundwater. Date of Issue: 19 . Date of Expiration 19 `�` Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller LOT 38 SECTION 2 I ul1 -1 OOU 1117 DL• tIARI •11'M OF 111:111,111 DIVISIM OV EWIl2CRI- IME11L 11111U111 SU IC1S D13SIGN UiATA SI IIXr- SMSUMC SBIAGE DISPOSAL SYS11a l FILE 113. Omier PE.TES O' HARA Address.-P.O. BOX 282, PAT TERSON, NY Located at (Street) ROUTE 311 /CROSS ROAD Sec. 10 Block 2 Lot �- (indicate nearest cross street) Mwiicipaiity PATTERSON Watershed CROTON SOIL ' PERCOLMCN ZEST D11TA iZDCxTIFtCD TO BE SUBMITTED WIZIi APPLICATIONS Date of pre - Soaking 9/16/88 Date of Percolation Test '9/16/88. DOLE NU-mm C7 &M TIME F tOOLATZON PEROOLATION Run Elapse Depth to Water Mcom Plater Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In tiin /In Drop Inches Inches Inches 1) ], 1:28 -1:46 18 24 27 3 6 2 1:46 -2:16 30 24 27 4 10 3 2:16 -2:46 30 24 27 3 10 4 5 Z ] 1:15 -1:21 6 24 27 3 2 2 1 :21 -1:33 12 24 27 3 4 3 1:33 -1:45 12 24 27 3 4 4 5 • t 1. to be repeated' at csn►. depth until approxi.m-.,tely equal Soil rates are obtained .at each percol.ation test )sole. All (1-tt.a to' be subnittOd for review. 2. Depth nr- asuronents to be mull.. fran top of bole. rev. 9/05 i i t V-V . m < r A , . 2 1 i ) `o 5 • t 1. to be repeated' at csn►. depth until approxi.m-.,tely equal Soil rates are obtained .at each percol.ation test )sole. All (1-tt.a to' be subnittOd for review. 2. Depth nr- asuronents to be mull.. fran top of bole. rev. 9/05 i i t I)I�:l'll l 6" 12" 1 A" 24" 30" 36" • �i 2" 4811 54" 60" 66" 72" 78" O'NARA SUBDIVISION '1 EST 1'1'1' DATA W- JUl11111 I0 UL•' GU131•1l.TrIZ 141111 AITL1C;11'1'J.0I I SECTION 2 UESaU1'1'l0N OF GULLS ElX=HfML:U IN '1.18.1' HOLES IOW: 1.10. 3 8 A BROWN LOAMY I IOLC 140. 3 8 B TOPSOIL BROWN GRAVELLY ROCK ® 6 ft. 110111•' I1J. 04" I! 1UICAIE LEVEL AT wual GPMEWJ M IS FIJO _uHT'Em Hone It IUICAIE Lmm TO wIIICII wNTE t LEVEL RISES Arm DEING II�(fil'Ium N/A UCCP MOLE ODSMMTl= MME Bit— J.F. E 9E RL E DUE- i 9/6/88 Soil. Irate Used 10 Hwl" Drop: 8.D. Usable Area Provided 53 or. ^' llo. of Iledroa, 4 Septic. Tank Capacity .Absorption Area Provided By 4____ 4 4 -- L.F. x 24" width trends r r. .uUlurrrrr.I J� �i1c.�r�.4 �i�'� Outer lbHu BALDWIN b CORNELIUS, P.C. Signature° Mdress RD 5 .. Route 22 SCl►L = m ' 1980 NEW Y DPI •� =s�0 3 8'3 • • Brewster. New York 10509 �� °ROFES$ ' 1111S SPACE: Wit USE BY IlEftlAll DCPAI1;11`MUr CHLYt • Soil Irate Approved sq. f t/gal. Checked by Mite 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 To Village City Tax Grid Number ' WELL OWNER ame Mailing Address Wrivate O Public USE OF WELL primary - secondary EKESIDENTIAL O BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O FARM O INSTITUTIONAL O AIR /COND /HEAT PUMP O TEST /OBSERVATION O STAND -BY O ABANDONED O OTHER (specify, O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE(�Zgal 13 REPLACE EXISTING SUPPLY O TEST /OBSERVATION Q ADDITIONAL SUPPLY E EW §UPPLY 4VEW DWELLING ) 0 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING -y WELL TYPE [2dILLED DRIVEN []DUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES t--'NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name �� Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: 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 Department attached to this permit. 3. Submit a Well Completion Report on a form requirements of the Putnam County Health provided by the Putnam County Health Department. During all'well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a m nner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: •r�- Date of Expiration 19�� Permit Issuing Officia 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 Re: Property of 01 IN Located at ' ��oo�,�-' III 1� kk t✓ T.M' (T) r..t crcc Div:" Block �:. Lo t, Subdivision of r, Subdv. Lot # rc, Filed Map # ?j(. C> Date /L w T. MICHAEL DALY, P.E. Gentlemen: CONSULTING ENGINEER P. 0. BOX 243 This letter is to authorize SHENQRQCK N X 1A587 a duly licensed professional engineer V-,*' or r- +Qr�r^ x�t (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. t. t Very truly yours, ned Countersign � � Owner of Property.. —P. () , -T� C, '/ r-)- �- P.E., R. A., h Address T. MICHAEL DALY, P.E. ��{-� �._ 0 Addre s s P, 0. BOX 243 Town SHENOROCK, N. Y. 10587 7 2_rl Telephone 9fCT�z a�4- Telephone rte. -+ P UTNAM C OU NTY D E PARTMENT O F HEALTH APPLICATION FOR APPROVAL OF PLANS &9& FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: 2. f�, 2. 4. 6. 7. Name of Project: 3. Location <V /C: i Project Engineer: ��, _ b... Address: �0x License Number: 48 4'4o tl� Phone: Type of Project:, _ Private /Re'sidential Food Service Commercial , Apartments Institutional Mobile Home' Park -------- Office Building Realty SubdiVision"__ Other (specify) 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? 9. Has DEIS been. completed and found acceptable by Lead Agency ?:..' ....,..... , 1 10. 1 11. Name of Lead Agency , Is this project in an area under the control of' local planning, zoning; or other officials, ordinances? "F�►- .Q PT- or If so, have plans been submitted to such authorities? 13. Has preliminary approval been granted by such authorities? Date Granted: 14. Type of Sewage Disposal System Discharge.,�,:�r : >, v F' Surface Water Ground Waters 115. 16. If surface water discharge, what is the stream class designation ?........ _ Waters index number (surface) ........... -A 17. Is project located near a public water supply system? . 18. 19. !0.. !1 If yes,. name of water supply Distance to water supply Is project site near a public sewage collection or disposal system ?..... Name of sewage system Distance to sewage system Date observed: 23. Name of Health IAspector: A. Project design flow (gallons per day) .......... e,5.1RO .• ..............•••• ' 2. 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. t 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? .................................. ............................... 28. Wetland ID Number ........................ ............................... 29. Is Wetland Permit required? ...... ..... .. . . ..... ...........:.......... ... Has application been made to Town or Local DEC Office? ........:.......... 30. Does project require a DEC Stream Disturbance Permit? ..:.....:........... b 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops,`soT1d for hazardous waste dispo §al, landfilling, sludge application or industrial activity? YES o� NO, 32. Is project located within 1,000 feet of - existence bf abandoged.iandfill, hazardous waste site, salt stockpile, landfill, sl'udge disp,0a- -- site' or any other potential known source'of contamination? ......:,......YES or NO N� DESCRIBE: ` 4 33. Is there a local master plan or file with the town or Village? 34. Are community water, sewer facilities planned to be developed within 15 years? 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 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 pr'ovi'ded 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. & OFFICIAL TITLES: SIGNATURES MAILING ADDRESS: 3 X -2.4-2