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Home My WebLink About0390DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -3 -27 BOX 5 I L I 7 ". L 1 I J. ti. 00199 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health May 25, 2005 Felix Maisonet 99 Somerset Drive Patterson, NY 12563 Dear Mr. Maisonet: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive Re: Addition — Approval - Maisonet No Increases in Number of Bedrooms 99 Somerset Drive (T) Patterson, T.M. #13. -3 -27 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 the Department dated May 24, 2005. 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/iqly yours Robert Morris, PE Senior Public Health Engineer RM:cw cc: Building Inspector, (T) Patterson Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 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 MAY -13 -2005 13:18 FROM= PUTNAM COUNTY DEPART 845 -278 -7921 SHERI.ITA ANTLER, MJ3, MS, FAAP Commissloeter of Renith LORET.F"A MOLINAW, RN, MSN Associate Commissioner of HeWth (DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 TO:95312263 P:3/4 ROBERT J. ,R0ND1 County Executive f1R'�'LTr�� y1af �STP�E7 ! � �®lif fi/ T N /5�d�ki fD/ /i PP13ta0PM % &I P DPESCPIUPTION OF ---r ADIDMON /-54 NUIaMER OF 1EYUSTRIXO BEDROOMS 7' PROPOSZ D # OF BEDROOM 'l _ (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) "pAny addidoo which is considered a bedroom requires foxnoal approves! of plans (Comtructiou permit) ptepared by a Professional Engineer or Rc&teaed Architect in accordance with applicable mxtiow of the Putnam County Sanitary Code. Please submit this form and the following to Putaam County Health Dept., 1 Geneva Rd. Brewster, NY 10509, Phone: (845) 278 -6130. 1. Certiiffied check or mmomey order for $ 1()0.00. 2. Sketches of cxistitlg floor plan (drawn to scale, W living area 6ficludiag besemnent) 3. Two sets of proposed floor plan (drawn to scale — with name, street and tax map #) "Non-professional sketches are acceptable 4. Copy of survey showing well and septic locations to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5, Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. Oak FICE USE COMMENTS Environmental 1Heulth (845) 278 -6130 Fax (845) 278 -7921 Kvrslmg Servlces (845) 296 -6558 MqC (845) 278 -6678 Fax(845)VII-6085 Early Intervention/Preschool (945)279 -6014 Fan (845) 278 -6648 '7-d E9aa- 1ES -Sbo -1 3NI1SI21H0 e8I :60 SO 91 Real T DEPARTMENT OF HEALTH Division . Of Environmental Health Services Geneva. Road, Brewster, New York 10509 (914) 278 -6110 Putr._rr. County Dept. of Heait'. 4 Geneva Road 3_cwster, NY 105C9 C ;enuemen: BRUCE R._FOIEI!. A c Aetlnp PUNIC Health 0ire:t. .3, Residence Tax Map Tom 2 -7- e2 Qf,L," According '�o records mair)tairpd by the To%smn, the above noted dot elling IS Dom_ .J NO in cornpiian — v,ith code and the total number of bedroom: on record is T'nls inforrnation has been obtained from.: CERTIFICATE Or OCCQPAlr'CY: A SESSORS kECCRA: U HER Buildinc, InsC ct r MAY.'24.2005 21:52 9149348851 MAISONEM@ LIB; TATE #6111 P.001 /)01 MAY -25 -2005 Felix Maisonet 99 Somerset Drive Patterson, NY 12563 May 20, 2005 To: Department of Health A.ttn; Robert Morris Please be advised that I am the owner of the above property and I am giving; Christine Garafo[a our realtor with Coldwell Banker the permission to pick up the approved plans and paper work regarding; the above residence and any future paperwork for our property. If you have any questions, you may contact me at 914 -844 -3301. Sincerely, F fix Maisonet SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Felix Maisonet 99 Somerset Drive Patterson, NY 12563 May 23, 2005 Dear Mr. Maisonet: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Addition — Maisonet 99 Somerset Drive (T) Patterson, T.M. #13. -3 -27 ROBERT J. BONDI County Executive I have received and reviewed the plans for the proposed addition at the above mentioned residence. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons: 1. Dimensions of all rooms have not been provided. 2. The legal bedroom count for the dwelling is four. The potential bedroom count of your proposed addition is five. 3. The addition of a potential bedroom requires this Department's approval of a revised septic system plan from a professional engineer or registered architect. Please revise the proposed floor plan to reflect no more than four potential bedrooms, or have a professional engineer or registered architect design a sub - surface sewage treatment system meeting present code requirements. If you have any questions, please contact me at your convenience. 114'UrR i Si ere , Robert Morris Senior Public Health Engineer Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 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 1H ACCOMD� CE V,'.. THE MOW, CODE Of KACTCE RA WrJ SIJRet". ADorao ST THE Hew YOVX STATE A5SOCIA.I 'OA Of PkOPESS IO 1404 LARD ELI[VETOES. CEATIRCAIIOHS SHALL E11H ONLY TO THOSE INDIVIDUALS AND INMTLTIOHS. SHOVM HE; EOH UHDEB THE TITU POUCY HU."K SHOWN A.ECIM SAD CERDRCATIOHS ALE HOT TPANSF£r'JLELE. LOTTO AREA = 1.005 AC. COpYR1GNT 0 1997 auHHEY ASSOCIAZC$ ALL RIGHTS. RESERVEO Uriautharj' e64T ddplit.ation is aviolatior. Iowa FF'EMI, ES SHOWN iiZAFON e-C!NG LOT 10 AS SHOWN ON "SHEET'i OF SUBDIVISION MAPOP SECTIONTVJO- CORNWALL RIDGE'S SAID MAP FILED 114 THE PUTNAM, C.DI:I,,ry C'_E:RK'5 OFFICE 0,1 MAY 23., I9bfn AS MAP NO. 2117A. W wl sli IP- J. J. N. C. ING. 0A D 110AUT14ORIZZO ALTERATION OR A0011101,4 TO A SURVEY MAP BEARING A LAUD 5URVEYOR'3SiAL IS A VIOLATION OF SECTION '(2091 ,UB- DIVISION 21 T' OF THE HEW YORK STATE EOUGA -TIOR LAW. THE LOCATION OF UHO£ROROUND IMOROVEMENYB OR ru,r Rn Arj4%Ag JSB. IF A7A-e F_*15T. ARE 110T CERTIFIED. _ ' _ SURVEY OV PROPERTY (� 51TUATE IN/�TTV42 c - TOWN ® i B ERSON PUTNAM COUNTY NEW YORK SCALE , 1' • 40' DATE* SEPT. 23,1992 CErT REVISED: JAN. 3, 1993 BROUSHT TO BATE 1 JAN.15, l993 + AUG. E3,1995 « •. tir-C. IB,%SS7 FILE N P31-3 f'_ A71 <•n:F<ofio.0 h•rwn ar• vc� for rh• inap end rey:•r ,! tfivael oney It eoid mop or «pirf Erar 1h• Impneud :1.:._, a•al' of f *. e. Wrier chef• .iE- af..• eDD.or• h•r•on. SURVEYED 8 PREIARED 6Y f BUNNEY ASSOCIATES LAND SURVEYORS LANE.= ... . BjRCW�S/TER� NEW YORK 10509 �': A H. Y. a. Ic. Ne, a9aa� _ I ..F u A - W wl sli IP- J. J. N. C. ING. 0A D 110AUT14ORIZZO ALTERATION OR A0011101,4 TO A SURVEY MAP BEARING A LAUD 5URVEYOR'3SiAL IS A VIOLATION OF SECTION '(2091 ,UB- DIVISION 21 T' OF THE HEW YORK STATE EOUGA -TIOR LAW. THE LOCATION OF UHO£ROROUND IMOROVEMENYB OR ru,r Rn Arj4%Ag JSB. IF A7A-e F_*15T. ARE 110T CERTIFIED. _ ' _ SURVEY OV PROPERTY (� 51TUATE IN/�TTV42 c - TOWN ® i B ERSON PUTNAM COUNTY NEW YORK SCALE , 1' • 40' DATE* SEPT. 23,1992 CErT REVISED: JAN. 3, 1993 BROUSHT TO BATE 1 JAN.15, l993 + AUG. E3,1995 « •. tir-C. IB,%SS7 FILE N P31-3 PIS I! I 1 I ' I i I , i - -- - - i i I f/r I _ _ 1 I , 4 1 I 1 I ! 1 i o .I. __ ! - 199 --i- of -- I r-�- -� ;:.•�__ ._�— L ZS 9 i i. I _ J� i �_ tl f' 1 i I^ ' I 1 I f, + ( T I - - it , 1:x I 7_� I- --� • r� I I , _i�'; , Ld �__ i_}. __�__� -L__�Y 11 � ! " '� _l_- ` � _1 ( 1 � __i"- > i .- `�. -i-. -- i �.. - ' - I _l_._. -.. • I � -I- ( - i ' - ' Y I I � I � It ,I I._ -1_ I i I I i i I - I '' 13 _ - -- - - - ' - �- - i___�___ _ a �.__ _ _ , I } I � ' I ! �- _I- --_j i -�_ _ -._ -j_ t� i i i I � i I I _•__ I I T _ : I L �I LA -{T -1 -1 1 ! 1 - -, PUTNAIVI COUNTY ;DEPARTMENT OFHEALTH E eer ;to provide Permit q Division of Envieonmenfal:Health,Servleee Carmel N Y 10512 >� on CERTIFICATE OF COMPLIANCE Permit q CONSTRU 0 PERMIT FOR SEWAGE DISPOSAL SYSTEM Loeated at LL 14I LL i L, 7 AdIENE&W ' Sabdlvlslon Nem LL S Lubd: ot q Taz MspBlock Lot1�L. (` - Renewal �' - Revision - ❑ Owner /Applicant Name Co �,ti i11 l JL ' ES'tI�ZS 1' i` l C Date of.Prevloue ,Approval ' Mailing Addeeas ZZ-21 iLta -, —�J Town zip�L Building Type Lot Area Fill Section Only 'Depth volume Number of Bedrooms Design Flow G P D 8 � � PCHD Notlticadon]e Regnlred�9hefi Is leted Sews e System to'conslet of po Gallon Se tic Tank and �7 Z L • /Vc Separate rag Y P r To be constructed by trO ,%r--- t- t l LIC -0 Address Water SupPly: Public Supply From ' Address or: ✓ Prlyate Supply'DrWed "by Cent�a t o I "CO . Address Other Requirements I represent that I am wholly and; completely respon ;iblefor.thedesignerd location of tha proposed systeih(sj;.;l► that the,separate.sewage,disposal. system above tlescritied will be constructed as shown on'flie aDProyed'amenOment ther'e`to and.in accordance with the standartls; rules an regu a ions o e ° ,u_ nsm County .Department_ of. Health, grid that on completion thereof a "Certificate; of Conitruction Compliance" satisfactory to the Commissloner-of Healthwilt be submitted to the Department,' and a Written guarantee will tie'turnishid- the . owner his successors, heirs or assigns by the builder; that said builder will place m good ,operating condition any' part o1 saitl sewage disposal system, durrnp the period of two (2) years immediately following , the date of the isw ance of the approval_ of the'Certificite of Constiuction ,Compliance. o the originafsystem or any rb 'rs thereto; 2) that the drilled well described above will be located.as shown on thwapproved -plan and that said well will be ins Iled.an accordance with the ntlar s, rul f and regu a rTions of tbe' Putnam County Department of Health.' �'� �.�: Oats Signed P E. Address , d � j ? icense No ZA APPROVED FOR ONST UCTION: This approval expires two Yea from the, da issued ,unless constr ction of the building has been undertaken and is revocable fot.ca or may b mended'or, modified when consider ,ne ry;Gb t Coin ssi n of Health.;, Any change or alteration o 'construction �," reouires a n w it. br tl for disposal of domestic sari wage,.a or r a t sd on � Rev: 1/87 Date By Title - II. ::, IV. V. VI. APPEND.LX u FINAL SITE INSPB=ION Date �G y Inspected y GMER _ TM # OR . SUBDIVISION IAT # CWENTS SETHAGE DISPOSAL AREA a. SDS area located as a roved plans i b. Fill section - Date of placement 2:1 barrier. LG � WIDTH �._ AVG.DPTH c. .Natural soil not stri d. Stone, brush, etc., eater than 15' fran SDS area. e. 100 ft. fran water course /wetlands. Ix SEWAGE DISPOSAL SYSTFM % a. Se tic tank size _, ,04(Y 1,250 b. Septic tank ins etl level c. 10' mininnnn fran foundation d. No 90° bends, cleanout within 10 ft: of 450 bend e. DISTRIBUTION BOX " 1. All outlets at same elevation - water tested 2. Protected below frost 3. Minimum 2 ft. original soil between box and trenches f. JUNCTION BOX - properly set g. TRENCHES 1. Length required - z/ /�U Len h installed 2. Distance to watercourse measured. ft. 3. Installed according to plan 4. Distance center to center 5. Slope of trench acceptable 1/16 - 1/32 p /foot. 6. 10 feet from property line - 20 feet - foundations 7. Depth of trench < 30 inches fran surface 8. Roam allowed for expansion 50% 9. Size of ravel 3/4 - 1111 diameter 10. Depth of ravel in trench 12" minimum 11. Pi' ends capped h. PUMP OR DOSE SYSTEMS 1. Size of ump chamber 2. Overflow tank 3. Alarm, visual /audio 4. Pmn easily accessible manhole to rade 5. First box baffled 6. Cycle witnessed b Health Department estimated flow cycle HOUSE a. House located approved plans.. b. Number of bedrooms WELL w a. Well located as approved plans b. Distance fran SDS area measured ft. ��e c. Casing 18" above d. Surface drainage around well acceptable. OVERALL WORICMA.SHIP a. Boxes ro grouted b. All pipes partially backfilled c. All pipes flush with inside of box d. Backf ill material contains stones < 4" in diameter e. Curtain drain installed according to plan f. Curtain drain outfall protected & dir.to exist. watercoursr= g. Footin drains discharge away from SDS area h. Surface water rotection adequate i. Errosion control provided on slopes greater than 15 %. r CWENTS SETHAGE DISPOSAL AREA a. SDS area located as a roved plans i b. Fill section - Date of placement 2:1 barrier. LG � WIDTH �._ AVG.DPTH c. .Natural soil not stri d. Stone, brush, etc., eater than 15' fran SDS area. e. 100 ft. fran water course /wetlands. Ix SEWAGE DISPOSAL SYSTFM % a. Se tic tank size _, ,04(Y 1,250 b. Septic tank ins etl level c. 10' mininnnn fran foundation d. No 90° bends, cleanout within 10 ft: of 450 bend e. DISTRIBUTION BOX " 1. All outlets at same elevation - water tested 2. Protected below frost 3. Minimum 2 ft. original soil between box and trenches f. JUNCTION BOX - properly set g. TRENCHES 1. Length required - z/ /�U Len h installed 2. Distance to watercourse measured. ft. 3. Installed according to plan 4. Distance center to center 5. Slope of trench acceptable 1/16 - 1/32 p /foot. 6. 10 feet from property line - 20 feet - foundations 7. Depth of trench < 30 inches fran surface 8. Roam allowed for expansion 50% 9. Size of ravel 3/4 - 1111 diameter 10. Depth of ravel in trench 12" minimum 11. Pi' ends capped h. PUMP OR DOSE SYSTEMS 1. Size of ump chamber 2. Overflow tank 3. Alarm, visual /audio 4. Pmn easily accessible manhole to rade 5. First box baffled 6. Cycle witnessed b Health Department estimated flow cycle HOUSE a. House located approved plans.. b. Number of bedrooms WELL w a. Well located as approved plans b. Distance fran SDS area measured ft. ��e c. Casing 18" above d. Surface drainage around well acceptable. OVERALL WORICMA.SHIP a. Boxes ro grouted b. All pipes partially backfilled c. All pipes flush with inside of box d. Backf ill material contains stones < 4" in diameter e. Curtain drain installed according to plan f. Curtain drain outfall protected & dir.to exist. watercoursr= g. Footin drains discharge away from SDS area h. Surface water rotection adequate i. Errosion control provided on slopes KITCHENO. DININO 13'-Z'X 9-4- BEDROOM *tZ 16- 7IX W-0, MASTER BEDROOM W-1 -X 13,-0- P T I- OF I, I AT Y LD"F a - * Proposed 2nd Fioor/u"�kwv��kc-o 6ayewt (By GtheF ) 0 LAURENT ENGINEERING ASSOCIATES, PC. 73 FAIRFIELD DRIVE PATTERSON, NEW YORK 12563 914-278-6108 RANDOLPH W. LAURENT, P.E. -' HARRY W. NICHOLS JR.. PE. CONSULTING SITE ENGINEERS April 30, 1987 Putnam County Department of Health 110 Old Route 6 Center. Carmel, NY 10512 Att: John Karell, Jr., P.E. Director, EHS Re: Cornwall Ridge, Lots 10, 23 & 24 Cornwall Hill Road (T) Patterson, New York Dear Mr. Karell, Enclosed are three (3) prints each of the following revised drawings for the proposed SSDS designs for the above mentioned lots: SS -10 "Proposed SSDS -Lot 10 ", revised 4- 28 -87; SS -23 "Proposed SSDS- Lot .23", revised 4- 29 -87; SS -24 "Proposed SSDS -Lot 2411, revised 4- 29 -87. Below is a summary of .the revisions and /or comments: LOT No. 10 1. Two (2) copies of second floor plan are also enclosed; 2. The proposed well has been moved; 3. Lot 35 Proposed SSDS area has been added to the plan indicating approximately 143 feet separation from the proposed well of Lot 10 and not in direct line of drainage. (Please note that we have not been authorized by the owner to design Lot 35 yet and it is not known at this time what type of dwelling or number of bedrooms is proposed since these plans are only prepared when a purchaser has selected a specific house to which the plan is specifically designed). 4. The distribution box has been relocated and the profile has been revised accordingly. LOT No.23 1. The absorption trenches have been reorientated to parallel the contours and the profile has been revised accordingly. page 2 John Karell, Jr., P.E. Lot No.24 1. Lot 26 proposed SSDS area has been added to the plan indicating approximately 173 feet separation from the proposed well of Lot 24 and not in direct line of drainage. 2. The baffle boxes have been replaced with junction boxes. 3. An additional junction box has been added mid -run between the septic tank and the first junction box for clean -out purposes. 4. The profile has been revised accordingly. 5. The junction box detail has been added. We trust everything is now in order for the issuance of the permits. Sincerely,. LAURENT ENGINEERING ASSOCIATES, P.C. a Richard S. Clark /map CC: J. Mastropietro w/ one copy each. APPENDIX B PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS (Name of Owner) COMMENTS LF trench provided U required __5: 60 ft. max. Parellel to new no] REVIEW SHEET - CONSTRUCTION PERMIT DATE BY: (Street Location) YES NO I DOC[INi WS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth REVIE J rv?tiwav 1,2-- s/s SUBDIVISION Perc 2 (3) Fill .^ cd House Pl s - Two.sets Well permit; PWS letter Variance Request GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flow -Pill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes (grinder notes) Design Data: perc and deep results Two-Foot Contours Existing & Proposed Driveway & Slopes Cut Footing/Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area;shown;gravity flow,suff. size If Pumped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Proposed Systems Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 1'0; Type pipe No Bends; Max. Bends 45° w /cleanout SEPARATION. DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees,Top of fill 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains - Curtain, Leader, Footing 351to catch basin,stormdrain,piped watercourse 10' to Water Line (pits -201) 50' intermittent drainage course Se tic Tanks 1�0' from Foundation; 50' to well 15' Well to PL 9 LAURENT ENGINEERING ASSOCIATES, P.C. 73 FAIRFIELD DRIVE PATTERSON, NEW YORK 12563 % DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. .10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL -� PCHD PERMIT # '°� WELL LOCATION Street Address LL tAiLL QTown Village City Tax Grid Numb r �: 53 I S—�o —Z• . WELL OWNER Name ' " &RESIDENTIAL O BUSINESS 0 INDUSTRIAL Mailing Address vate IQ A- � 0Public O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify, O INSTITUTIONAL O STAND -BY USE OF WELL 1 - primary 2 - secondary AMOUNT OF USE YIELD SOUGHT 57 gpm /# PEOPLE SERVED3 -ij' /EST. OF DAILY USAGE &L-X;gal REASON FOR DRILLING UINEW SUPPLY OPROVIDE ADDITIONAL SUPPLY OTEST /OBSERVATION ❑REPLACE 'EXISTING SUPPLY 13DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED aDRIVEN aDUG ®GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES' ✓ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name-!�:) F-g CC-_'rEg&_4jk1�� 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: }�•i� LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION ON SEPARATE EE (date) signatu 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 s.hall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the County Health Department attached to this 3. Submit a Well Completion Report on a-form Health Depar4ent� �( Date of Issue: �I 19�J Date of Expiration: 19 v Wtute copy Permit is Non - Transferrable Yell �e`q,ui repents of the Putnam )e mit:_ ir3hovi y Jf }yhe P n m' ou 2/87 suing utticia ow: py. Pink Copy: Orange copy: H. D. File Building Inspector Owner Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO. PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health In the matter of application for: Cornwall Hill Estates, Inc. I, Kenneth Emerson represent that I am an officer or employee of the corporation and am authorized to act for Cornwall Hill Estates, Inc. (Name of Corporation) having offices at 223 Katonah Avenue Katonah, N.Y. 10536 Whose officers are: President: Edward H. Emerson, 223 Katonah Ave., Katonah, N.Y. 10536.. (Name and Address) Vice - President: Kenneth Emerson & Martin Diano, 223 Katonah Ave . , Katonah, N. Y . (Name and Address) Secretary: Janet G. Mastropietro, 223 Katonah Ave., Katonah, N.Y. 10536 (Name and Address) Treasurer: Lynne Diano, 223 Katonah Ave., Katonah, N.Y. 10536_ (Name and Address) and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Ate Sworn to before me this % day Signed: y� of 19 v I •f . Notary Public LIONEL WEINSTEIN Notary Publlo, State of New Y&N No. 60.4 199160 Qualifies in We., ;':rh;:,:: i CCUntg Obnnmission- Expires M.nr- h 30, 19 8/84 Title: Vice President Corporate Seal PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date A zi 14, 128-7 Re: Property of Co sR1.1 YYALL V4 1 LL E-s'Z A r '$ i 1 N C Located at LO'R1.fWALL. N ILL 1Z.4AQ> N _Rny' j E )(o4 (T) ? '- -ERSo0 _Section 1S Block (o Lot Z- I Subdivision of CoR14WALi- IZIDC7C C Subdv. Lot # Filed Map Date 5 Z Gentlemen: This letter is to authorize Randolph W. Laurent a duly licensed profe .psional engineer X or registered architect_ (Indicate to apply for a Construction Permit for 'a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- to Co P. Address Z-79 'Telephone C6/y� T � "U Very truly ;Mour,s, � O� Signed. Ovf,�er of�` roperty 2 Kati.anah Avenue Address" Katonah, N.Y. 10536 Town 914 -232 -7171 Telephone PU`T'NAM COUNTY DEPARTMENT OF HEALTH V1' zagyIl"Will"i4lNL 111u1L111 �L11V1lrL.J aCOUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE N0:• Uwtwr Cozj jW&L.L 141r_L EsT-rz s 1Nc. Addres6 EZ3 V_ATOkjLN Ayr✓ K,t�To►J.bH, t`1Y tOS3Co . Located at 7( Street) , a I (oA See. 15 Block Co I,ot�_ ( cate nearest cross s rep Mwlicipality _�iTE�SaI.! Watershed C'l� 301L PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED' WITH APPLICATIONS ni)-f Nwnlit:r CLOCK TIME PERCOLATION PERCOLATION Hun Elapse Depth to a er water ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches .13 j �s 1 11'.0.5- 12.25 SO 1)� o�� 3 ►� �(n b% 2 p:io_ I,40 �� arr7 3 ►r h� V 42 _ a' 65 ►� 33 ._ -� -, Nuton: rates 1) Tests to uro obtained be repeated at at each percolation same depth text until hole. 1.jj�roximatel A�1 dai a to be equal soil submitted for rwvlo;s). " -pth measuremean to he nwic) from top of tu►1 e . .13 TEST PIT DATA NLtZUIRED TO BE SUBMITTED WITH APPLICATION DESCRTPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. 1 DOLE N0. HOLE.N0. G.L. 6" ��►� 18" 24" 30" 36" 4211 4811 1) 11 Wn E�11 1NDICATP: LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE 1.H;V1:L TO WHICH WATER UVEL RISE -3 AFTER EYEING ENCOUNT 'PESTS MADE 13Y R. w. L • Date I&V MIGN Soil Hate Used_ r 7 Mir1/1"Drop: S.D. Usable Area Provided Soo* -S.F. No. of Septic Tank Capacity IZ50 Gals -G-,hype Absorption Arm► rov cie� 'By Co" IZ. L.F. x2411 '- , '� - rwl' db'lwmnch Nciirk; Addre6 s THIS SPACE FOR USE BY H.CALTH DEPARTMENT ONLY: Soil Rate Approved Sq..K /Gal. Checked by RECE ' SEP �.0 ►° � DEpT AO COUNTy F HEALTH Date Yr , �m / l i o ; I� . 1 1 .- oo': w z i L= 40.54' dt1DT07o6T1+Pt41GdL =RAM SUB'DtVlSiow! PLAY WO Gor-QWaL.L Zkoe'E, :XtS"C Wl�l -1t1J t0o''.i.1P6,Y�D1�.1""( J�tr1.O Et. >c.X� sf W t- ti'4?clll ZLL7' Ui�LiQAUIEtrC 671aD 1 1 C ov- pr-09 6ED DE`/ol I f rD P409o5t✓D 'S} St7S LAC,4TIOf,1 L o-r 35 , , l �1 5� R� } .'3/86 PUTNAM COUNTY 'DEPARTMENT OF HEALTH IlMslon_ of Envirot mental Heath Services, Carmel, N Y 10512 Engla D MtProvid1 CE FOR SEWAGE DISPOSAL SYSTEM TIFICATE OF CONSTRUCTION. COMPLIAN own e Located at ' ' Tai Map—l/:, oc,Lo I OvrnerLapplicant Name; ; Formerly Subdivision Namet b�dv. Lot q_ MaWng Address 6Y ✓T��V� zip j Date Permit Issued Putnam County Department Of- Health. ' j Date i 1 �J ` Certified byTi/plrly Any person occupying_oremiai servad.by the above systems) shall oromptly ?ti conditions resulting. - from such -usage: Approval '.of the_separate aswerape'syl available and the approvbl of the private water supply shail become null and,`v sub)ect to. modification or change when,, in the -I' dg of the •Commissia Date by C -S P.E. qR:A. d Licence No.-�f� L su'Ch action of may be necefiary to secure the correction of any unsanitary n s6 ll become nuii and void as soon as a pubt ?: unitary avrer. becomes :vviien a publlt water wpply becomes available: Such approvals are of �Halth, such revocat Ion, modification of change Is necessary. .-►- Title_ _ a PUTNAM CODNTT DEPARTMENT OF HEALTH an CERTOWATE OF COMPUAMM CONS1lQ Now SYSrm ` resit 0 f- i 2 we t � Tat; Map � � Mock � t •• otrtaadAppiraN Natar ��Ll,�j�,�l �N 1:T lteoewal_❑ RevlaMe M. �c p�>J S!/fil Date of Previou Approval Molft Addirtl r —z/ I: MN V�_: Tower TJp Date Subdivision Approved Fee Enclosed 0 Amn„nt• adk%t Type JR f r 1100— -P A L_ L t ,tea Fm Section oaly LJ Deptb vabtam Flow GPD ONumbr at Hedtee�a D {� PCHD Nolmea8oa d Reaohed: Wben F®4 aempided . Sepewle Sure mo sydm a mew e[ 620 (E-2 Septle T a and �-1' T�'F✓tJ [�tt' To be oa..h.oi.d by. Adlhwe Wow Sup*. Pda Sop* Frame Addrese r' an p t..ee sgvb Dryad byY ice. ?1Al_' �' .[dd�eiG , A ELLIN M Aq �. 151 ,5J- i 5- 1t2- Ov" R"ok""N" 1 represent -that 1 am wholly and completely responsible for the design and location of the proposed system(:); 1) that the separate d disposal t item above described will be Constructed as shown on the approved amendment there to and in accordance with the sUndards, rules an regu a +ons o » u nam County Department of Health, and that on Completion thereof • "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be fubmitted to the Department, and a written guarantee will be furnished the owner, his successors, halls or assigns by the builder, that mid builder will DIM M good operating eondttion any part of mid mwage disposal type uring the period of two seers Immediately following thedate of the imu• ante of the approval of the Certificate of Construction Compliance the: iginal stem any re Ys t eto; that the drilled visit deecri0ed 86040 SsiN be located as shown on the approved plan and that mid welt will ire INd in acco n the radar s, les and rog— arM of the Putnam County Department: of Health. Oate igned P.E. RA.� hr Address License No APPROVED FOR CONSTRUCTION: This approval expi/es two years from the date issued unless construction of the building has bee r+ undertaken and is revocable for caum or may be amended or modified when considered necessary b mm of Hearth. Any change or alteration of Construction "quires ew Permit. Approved for disposal of domestic sanitary sew" an or `ray. 4ev. . LO/88 oa. /� � Title i- Geri // l �� PUINAM COUNTY DEPARTMERr OF HEALTH DIVISION OF EWIROWENML $FALTH SERVICES ✓�� ,ZY,r/��. Owner or Purchaser of Building Building, Constructed by Location - Street Municipality Buil g Type /3 3 :.7 Section Block Lot Subdivision Name Subdivision Lot # GUARANTEE OF SUBSURFACE SENAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage off°the,sewage disposal system serving the above described property, and that it has :been constructed as shown on the approved plan or approved amendment thereto, and in-`accordance with the standards, rules and regulations of the Putnam County Department of Health, and ,hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage disposal system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant.of the building utilizing the system. The undersigned further agrees to accept as conclusive the deteanination of the Director of the Division of Environft ntal Health Services of the Putnam County Department of Health as to whether or not the failure of the t operate was caused by the willful or negligent act of the occupant of � zl g utilizing the system. Dated this �_ day of 19 9, General. Contractor Owner) - Signature Co ration Name (if Corp.) rev. 9/85 mk 0 Signature Title 1A.:AI& /* Corporation Name (if C9 R!%) s BREWSTER LABORATORIES Box 224 - BREWSTER, N.Y. (914) 855 -1930 - WATER ANALYSIS REPORT - SAMPLE NO. 8657 TEST WELL SOURCE: Felix Ma-is:onOt ;Cornwall. Estates Lot #10 Patterson, N.Y. COLLECTED: 9 / 2 / 9 3 BY: P.F.: Beal & Sons BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 9/7/93 This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. 0 per 100 ml. DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # P-071 WELL LOCATION Street Address ,Q o Village City Tax Grid Number D - WELL OWNER Name Mailing Address OPr vate O Public USE OF WELL �- primary 2- secondary RESIDENTIAL O BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION 0 INSTITUTIONAL O STAND -BY 0 ABANDONED O OTHER (specify, O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE 66y0, gal REASON FOR DRILLING 0 REPLACE EXISTING SUPPLY 0 TEST /OBSERVATION 13 ADDITIONAL SUPPLY 19NEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE 13DRILLED ®DRIVEN DDUG GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES tl/ NO IF WELL IS.LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Gt-a0 WAw fi�i Dlx Lot No . 10 WATER WELL CONTRACTOR:. Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: EVA TOWN /VIL /CIT.Y DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: "LOCATION'SKETCH & SOURCES OF CONTAMINATION PROVIDE M ON 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 anner as not to degrade or other�alEe contaminate surface or groundwater. Date of Issue: Date of Expiration 19� �rmt Issuing Off. Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller y �e W Y0 WC:LL L;Ur1YLL11ULN A -EXUR1 DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only � ;7 --- ��,,✓' WELL LOCATION STREET AOORESS: 713WN/vitullillclly, TAX GRID NUMBER: Devon Rd. Patterson,NY Lot #10 WELL OWNER NAME. ADDRESS: Felix &Lynn Maisonet, 916A Wheeler Ave. ,Bronx,NY 10473 ❑ PBIVATE 0 PUBLIC USE OF WELL 1 - primary 2 - secondary -10 RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING [REPLACE EXISTING SUPPLY TEST /OBSERVATION ❑ADDITIONAL SUPPLY E]NEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 185 r ft. STATIC WATER LEVEL 30 ft. DATE MEASURED 5/L93 DRILLING EQUIPMENT )a ROTARY RkCOMPRESSED AIR PERCUSSION O DUG O WELL POINT O CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING IR OPEN HOLE IN BEDROCK 0 OTHER CASING DETAILS TOTAL LENGTH 62 tL MATERIALS: 0 STEEL O PLASTIC '0 OTHER LENGTH BELOW GRADE 61 ft. JOINTS: O WELDED 13 THREADED .0 OTHER DIAMETER —_Sz in. SEAL: ® CEMENT GROUT O BENTONITE 0 OTHER WEIGHT PER FOOT 19 Ib. /ft. DRIVE SHOE ® YES O NO L1NER:OYES BNO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST OYES ONO HOURS SECOND GRAVEL PACK ❑ YES O NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM' OEM It. WELL YIELD TEST If detailed pumping METHOD: ❑ PUMPED i tests were done is in- 'Cl COMPRESSED AIR , formation attached? O BAILED O OTHER ; ❑ YES O NO �� /ALL LOG if more detailed formation descriptions or sieve analyses WELL are available, please attach: DEPTH FROM SURFACE Water Hear- Ing Well OIa- meter FORMATION DESCRIPTION woe ft ft WELL DEPTH ft. DURATION . hr. min. DRAWDOWN ft. YIELD gpm. Surface 40 D il*ng in overburden clay & bout er ck at 401 185 6 120 30+ 40 62 D it 'ng in rock, set casing, grou ed. 62 185 D3'illing in rock granite. WATER O CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES ❑ NO STORAGE TANK: TYPE WellXtrol 302 CAPACITY 86 —GAL. PUMP INFORMATION .TYPE submersible CAPACITY 7 g MAKER ou DEPTH 140 1 MODEL 7EHO5412 VOLTAG ?30 HP -1 WELL DRILLER NAME P.F. Beal & Sons DATE X3/93 I/ , n i ADDRESS 4 Putnam Ave. SIG frdITURE'� Brewster, NY 10509 f UN- \l e ��,, �I PU11,MM 03= DEPARTMENT OF DIVISION OF ENVIRCR4ENTAL HEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Address 226 'W f ,ST �i5, Mz l�U • 1,ga ITS 21 Cv I�DI�jGf- 1S'r�E� , tJ Located at (Street) Sec. - Block 3 Lot (indicate nearest cross street) municipality Watershed • SOIL PERCOLATICN TEST DATA RBQUIRED TO BE SU34T= WITH APPLICATICNS Date of Pre- Soaking Date of Percolation Test HOLE REBE R CLa:K TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min.' Start Stop Drop In Min /In Drop Inches Inches Inches 2 3 1.9,f;, 21 I.l IL u 5 it 11:v5,12:2s �� 2Z 7 %Sn 2(0.�� ,� ol. 2 3 4 5 1 2 P 61 33 3 4 5 NOTES: 1. Tests to be' repeated•at same depth until approximately equal soil rates are' obtained at each percolation test hole. All data to* be submitt!i for review. 2. Depth measurements to be made frcm top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES o- r DEPTH HOLE NO. HOLE NO. HOLE NO. . G.L. 1' 2' 3' 4' 5' 6' 7' 8' 9' 10' 11' 12' 13' 140 INDICATE LEVEL AT wHIC H GROUNI7iMM IS ENCOUNTERED INDICATE LEVEL TO WHICE WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE:. - DESIGN Soil Rate Used Min/1" Drop:. S.D. Usable Area Provided �yQOO 5 f. No. of Bedroans 91? Septic Tank Capacity p gals- Type liD f� ri. Absorption Area Provided By 50 D L.F. x 24" width trench Other Name IZ `�' ►P I /DLS �2 . ~ Signature , Q Address �,92 IR�IP.i�I� Da1VfS SEAL W n r ,s No. 86124 Z r� J'� THIS SPACE FOR USE BY HEALTH DEPAffMT2 ONLY Soil Rate Approved sq ft%gal `Checked by Date -o PUT NAM C OUNTY D E PART MEN T O F H EAL TH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM I. Name and Address of Applicant: WX VAI��tJc`C Z Ifs 1N�5'�G+� :[e- A\If . _ S N I-(e 216, 2. Name of Project: memos- 7 . SSDS 3.. _.Location�l /C: = �fTT�or�1 4. Project Engineer: �,�Y 1A) MC-Ho -f, 5. Address: Jet, ir;t -� IVF License Number: �5 Phone: 2 - o ,�> 6. Type of Project: ► : - .. _ Private /Residential Food .Service ....Commercial Apartments Institutional Mobile Home Park Office Building. ....Realty Subdivision _.Other. (specify) 7. Is this project subject'to State Environmental Quality _R view (SEAR)? Type Status (Check One) Type I.. Exempt 1/ Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. Ia 9. Has -DEIS been completed and found acceptable by Lead-Agency? ........... 10. Name of Lead Agency 11. Is this project in an.a.rea.under the control of -local planning, zoning, or other officials, ordinances? ......... ............................... N 12. If so, have plans been - submitted to such..author.ities? 13. Has preliminary approval been granted by such authorities ?M(A Date Granted: 14. Type of Sewage:. Disposal_ System Discharge...... Surface Water Ground Waters 15. If surface water discharge, what is the stream class designation ?........ '6. Waters index number (surface) ........................................... tj14 ;7. Is project located near a public water supply system? .................. fJ 0 8. If. yes, name of .water supply /, Distance to water supply :9. Is project site near a public sewage collection or disposal system ?..... tJa :0. Name of sewage system Distance to sewage system A. Date observed: 23. Name of Health Inspector: Mrz. W.d3u0Zl0 -s i 4. Project design flow (gallons per day) ...... ............................... l ao iu 2. 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. Lid 26. Has SPDES Application been submitted to local DEC Office? ............... 27. Is any portion of this project located within a designated Town or State wetland? ......................... ...... .......................... ....... N 28. Wetland ID Number ........................ ............................... N� 29.-Is Wetland Permit- required?. .............. ............................... Q0 Has application been made to Town or Local IDEC Office? ................. _W A 30. -Does project require a DEC Stream Disturbance Permit? ................... f�Jy 31. Is or was project site used for agricultural activity involving application of pesticide$ to orchards or other crops, solid or hazardous waste disposal *,, ` landfilling, sludge application or industrial activity? ........ YES or NO l� D 32. Is project located-within 1;000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ...:.:.........YES or NO I o DESCRIBE: 33. Is there .a local master plan or file with the Town or Village? ...........S 34. Are community water, sewer. facilities planned to be developed within 15 years? kN14tJ,9W0 . 35. Are any sewage disposal areas in excess of 15% slope? ........................ 36. Tax Map ID Number ...................................................... 2 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 Drovision 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 Hisdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: TAILING ADDRESS: YTIU1J;Y l j:, �pMC'r"'et' T Ot)O 11 ,A t spfTl c -(i t .i t j t 3 i i 3. { 4 r c I3o N PVG I Jae 3 ' J ��T N tr A*_ t_'77U► I.T N GHA, r47 CAN rr) 1 3°I.ly 5`I -G .rutnam County Department Of Heald Aviaien of Wronmentay Health Sefivicer 3p ed as noted f�r conformance it tapplioable Rules and Regulations of the 'utnam -Aponnty H qalth Department.. c i PROJECT. PROPOSED SSDS -jee -r 'w T►UD GO�NW�I.I. j�InG� LO' CLIENT re, " � � ✓ D ice+ � i G✓Uti� 2iL LAURENT EN.GINEE ASSOCIATES, PC 73 FAIRFIELD DRIVE PATTERSON, NEW YORK 12 (914)278.6108 CONSULTING SITE ENW DRAWING TITLE SCALE 11I 3dt pFI� DATE O DRAWN BY VG•V'( CHECKED BY E {(JN W InR Nn /JI Il n i $s o 56124 p�A��e.c�ONP`• DRAWING No I ---I Q_ 11 Ito _4 3 103.'1 1 IS • �O G 12'1.8 1'��•� 7 °I i(o�•Fo 1�q,8 10 1 Giq. D i lv/�.lo ti� 1�t'1•� tG1.3 .60-0. 13 �3•D 411.0 kF SD. MA .rutnam County Department Of Heald Aviaien of Wronmentay Health Sefivicer 3p ed as noted f�r conformance it tapplioable Rules and Regulations of the 'utnam -Aponnty H qalth Department.. c i PROJECT. PROPOSED SSDS -jee -r 'w T►UD GO�NW�I.I. j�InG� LO' CLIENT re, " � � ✓ D ice+ � i G✓Uti� 2iL LAURENT EN.GINEE ASSOCIATES, PC 73 FAIRFIELD DRIVE PATTERSON, NEW YORK 12 (914)278.6108 CONSULTING SITE ENW DRAWING TITLE SCALE 11I 3dt pFI� DATE O DRAWN BY VG•V'( CHECKED BY E {(JN W InR Nn /JI Il n i $s o 56124 p�A��e.c�ONP`• DRAWING No I ---I Q_ 11 . FORAM COOM'Y DEPAlTIEW OF KCALTH . / c,� Se>rt�lo.y: Csemel. N H 1116U 1'B�� PwvWe F.atalt WOO IlANCB (AIISIITJC1111N FAIL � SaWA6� DI8�0�AL SYS'1'®1[ �!t / ., ,' ?/ r :. Stela w.. Pistilli, KW W ALL —I - ro<r 1 b T" Maw IJ :rem . 3 �� `. 7 . oaa.r Ar.�i�t Daft 4 Pty KNOW 99Mr i �l Tom; 123 Date Subdivision Approved Fee. Enclosed amniint stlrft lYr i2N?7l:I,tn Secdoei Nm bw.d Beiesm , F{ow G P D 06. PC® D1ofJOestlaa d Yequbred iP6es'M to ee-p56b4d tal Sap lie S. , iis. *= I� Comm at Se-ile TN& ..a 14 be. e4+�e�id':bFp Atldri+aa Wafae Sit:" Ptiie Sttippb; Fttatt Adieu Stl ptWedbr .��M .z� ,4�. ---r— --1 Or.�pr.Nntt Mt Imam wholly and design and location of the proposed system(s); 1) that this separate Nw di YI • stem above described vrlh be conitructed as shown on the approved amendment there to and in accordance with the standards. rules a rpu ns o "In am County 64pertment of', ►teeRh, , and that o "n con+plstbf�'tt�ereof a ^Catifkata ' of „Constiudiorr, Cofnplianca•• satisfactory to the Commissioner of Meaithwill a submitted 'to the peprrtor ent• and a written gwranta. will be furnished the owr!ar• his successors, helm or assigns uy the builder• that *Said bulkier will Place in `good opeiating, ooriditlon My part .of, siid`sawage, ii sal sy sini during _the.paiod of two years Immediately follpwing3Mdaq of the iseu- awq of the appmal;of. the Certifkate-.of `Construction Compliances f tne'orginal stanl :any r a t ` o; )that the drilled well describe0 660w WIN be located as shown on fh approved plan.and that said well will tie INd in &coo n the rxla S. Ns and rp ai oii ni of the • Putnam County Department of Health. Date v 1 : �J iin.d t P.E. ITT 4 Add►e UCGf a No APPROVED FOR CONSTRUCTION, This apprdiial expires two years from the date -issued unless construction of the building has been undertaken and is revocable for puse or may pa amended or modified when considaed'n.eesssry b mm n of 'Health. Any change or alteration of construction reouIres "w permit: Approved for• dispossl of domestic sanitary :swag' an or w Rly. Rev. LO/88 pat.LL �i!�� t Title y, 1i a ti PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES'..: Date 1-2-IG%._Gf7 Re: Property of �pU /SDA)�T Located at DfZII/F- (T) Section -Block /3. Lot a2 Subdivision of Subdv. Lot # /n Filed Map # 0?//-74 Date 5-a Gentlemen: This letter is to. authorize %zie�! !� • /CDlS . tT%Z; Pte. a duly licensed professional engineeror registered architect (Indicate to apply for a Construction Permit for a separate sewage -system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health,. and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Educati1 �� tary Code. �C2ti.a �t r is Health Law, and the Putnam County San!— Very truly yours, ONNo. U6124 f Signed A 1; FESSION Owner of Property Countersigned .,,,. D-E, R.A. , # 5�o %iL i NJii . % s F.VM0IW4Kzff: ,SQm pie Sal_ PR I ✓G Address Telephone -:-----1 APPE*DIX C FINAL Slit INSPECTICN C7 STR>rT LOCATION JO,r,P,.Ga-UrI vim- PERT I T # TM # OR SCE I V I S ICN LOT # 13 DATE: Inspected by: S: /e =74n,- CWNER - " 3 r a 1. SEWAGE DISPOSAL AREA a. SOS area located as per aDcroved olans b. F111 section - date of placarnnt 2:1 barrier LGTH WIDiri AVG.DPTH c. Natural soil not stripped d. Stone brush etc. reater than 15' fr= SCS area e. 100 ft. frcn water course wetlands 11 SEWAGE D I SPOSAL SYSTEM a. Seotic tank size - 1,000 1.250 b. Seotic tank installed level c. 10' minim.m frcm foundation d. DISTRIBUTICN BOX 1 . A l l outlets at same e i evat-on - wat— . yes :.ed 2. Protected below frost -. Minim..m 2 ft. original sci 1 be *_•Nee^ bcx = d trenches e. JLINCTICN BOX - crooerly set S , NO CC". ENTS . 4" I I F. 1 th recuired - I� 7� arc=:- instal led 16D 2. Cis:..n.ce to watercourse measured ft. I r.sta 1 1 ed accord i no to c i an -�. Slcce of �rench accept hie 1/16 - ? %32 'coot 5 10 feet =ran property 1=re - 20 fee: - z:i-ndaticns 6. Death cf trench < 30 incies from 7. Roan allcwed for exoansicn. 100% S. Size of gavel 3/4 - 1.L" diameter clear 9. Death of gravel in trench. 12" minima t/ 1771 10. Pice ends capoed c. PIMP OR DOSE SYSTEMS 1. Size of mm chamber 2. Overflcw tank 3. Alarm visual audio - 4. Pura eas i 1 y access i b 1 e mariho 1 e to grade 5. First box baffled 6. Cycte witnessed by Health Department estimated flow per cvcle I I . HOUSE a. House located per acoroved ol.ans b. Nurser of bedroam V. WELL a. Well located as per aporoved plans b. Distance fran SDS area measured ft c. Casing 18" above grade d. Surface drainage around well accectable OVBIALL WORWANSH I P a. Boxes procerlv grouted b. All of es oartially backfilled C. All oioes flush with inside of box d. Backfill material contains stones < d" =�ameter e. Curtain drain installed according to ol- ^. [/ 7 _ f. Curtain drain outfall protected & dir tr exist watercourse 9. Footinq drains discharge away from SOS a ^ea h. Surface water protection adecuate IAPPE*D I X C STREET LOCAT I ON PERM IT # FINAL Siic INSPECTION GATE: J /� I nspec+..ed by: S TM # OR S>BDIVISICN LOT # I: SEXAGE DISPOSAL AREA a. SDS area located as per approved plans b. Fill section - date of Placement 2:1 barrier LGTH WIDir. 1 c. Natural soil not stricoed a. Store brush etc, greater than 15' from SCS area e. 100 ft. from water course /wetlands 1 1.. SEWAiGE DISPOSAL SYSTEM a. Seotic tank size - 1.000 1.2 b. Seotic tank installed level c. 10' minima from foundation c. DISTRIBUTICN BOX 1. Ail outlets at sane eievat4on - water - 2. Protected below frost Minimm 2 ft. oricinal sci 1 betwee^ 1-c e. - LNCTICN BOX - crooer1v set 11 Le th recuired 2. Cost nce -o watercourse measured Installed acc:rdina to clan 4. Sicpe of Tench accept die 1/16 10 feet `rcn orooerty 1 ir.e - 20 feet - 6. Derth cf t .-each < 30 inc,,es fr.= scr`a-- i' . Rocm a 1 icwed for exeans icr . 100` 8. Size or Gravel 3/4 - 1 1.-" diameter c e - 9. D --th of trend: 12" in tren 12" minirnri T. Pice ends capped PUFF OR DOSE SYSTEMS 1. Size of ouTo chamber 2. overflow tank 3. Alarm, visual /audio 4. P= easily accessible marhole to Grad= 5. First box baffled 6. Cycle witnessed by Health Department estimated flow per cvcle 1 1 . HOUSE a. House located per approved plans b. Nuricer of bedrooms V . lM'ELL a. Well located as per approved plans b. Distance from SDS area measured c. Casing 18" above grade d. Surface drainage around well acceptable OVERALL WORKKk4SH I P a. Boxes properly grouted b. All oipes partially backfilied c. All oipes flush with inside of box d. BackfiII material contains stones < A" c=a e. Curtain drain installed acdording to oia^ f. Curtain drain outfalI protected & dir tc g. Footing drains discharge array from SOS a-y h. Surface water_protectien adequate is ist water YES NO 00"�ENTS I i � I b- RANDOLPH W. LAURENT, P.E. HARRY W. NICHOLS JR., P.E. March 20, 1997 Mr. William Hedges Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Proposed Expansion Somerset Drive Town of Patterson, New York Dear Bill: LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road Brewster, New York 10509 (914)278 - 6108 - (FA)O 278 -2658 CONSULTING SITE ENGINEERS k33 The applicant proposes a 2'/2 story addition; remodeling of the existing first floor and finishing of the existing second floor. The existing house contains two (2) bedrooms, one of which is proposed to be converted to an office. One bedroom and a playroom are proposed for the second floor of the existing residence. The addition will consist of a 2 -car garage on the first level, storage on the second level with access only from the garage and one bedroom on the third level. The existing system is designed for.3 bedrooms. An application is being made for an expansion to 4 bedrooms. In this regard enclosed are the following items: a) "Application For Approval of Plans For a Wastewater Disposal System ". b) "Construction Permit ", dated 3- 19 -97. c) "Letter of Authorization ", dated 3- 19 -97. d) Floor Plans for bedroom count. e) SE -10 "Proposed SSDS Expansion ", dated 3- 19 -97. f) Bank check in the amount of $100.00. Kindly review the enclosures and issue a permit at your earliest convenience. Very truly yours, LA NT ENGINEERING ASSOCIATES, P.C. Harry W. Ni rhols, ., P.E. HWN: TR: bd 92066 cc: F. Maisonet w /enc. P UT NAND C OUNTY D E PARTMEN T OF HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: VA1,�—o05::C Z?� ° MfE Te5x4 6,,94e r= A te . _ S U I—rr—= 21 ea 02 H tF, sr�r�- Tp ► •y' 2. Name of Project: MF'P6i,: 17 SSDS 3.,_, Location�l /C: ►2�0►.1 4. Project.,Engineer: UI QlrHo,5 ,Tg 5. Address: �I�1L113�1 oK�l�� `rGGG�Nt�� License Number: Phone: 6. Type .of Project: P0vate /Residential Food.Servic.e - :.'.Commercial Apartments Institutional Mobile Home Park Office Building ,> Realty Subdivision Other (specify) 7. Is this project subject*to State Environmental Quality4Review (SEQR)? Type Status (Check One) Type I.. Exempt t✓ Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? :•.....a...:... 9. Has DEIS bee n, completed and found acceptable by Lead Agency? ........... 10. Name of Lead Agency N1A 11. Is this project in an area under the control of -local planning, zoning, or other officials, ordinances? ....:.... ............................... tJ 12. If so, have plans been.submitted to such. authorities? ..................... _QIA_ 13. Has preliminary approval been granted by such authorities? QIA Date Granted: 14. Type of Sewage Disposal_ System• Discharge ......^ Surface Water ✓ Ground.Waters 15.. If surface water discharge, what is the stream class designation ?........ f t6. Waters index number (surface) ........................................... i7. Is project located near a'public water supply system? U :8. If yes, name of water supply QIA Distance to water supply .9. Is project site near a public sewage collection or disposal system ?..... K)a :'0. Name of sewage system Distance to sewage system A. Date observed: t1, 23. Name of Health Inspector: N4!=. ��1 .�'ru►�Z1 �?S�'. 4 Project design flow (gallons per day) ...... ............................... r2. 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. X16 26. Has SPDES Application been submitted to local DEC Office? ............... . 27. Is any portion of this project located within a designated Town or State wetland ?. .. ...:... ....... .. ............................... N 28. wetland ID Number ........................................................ T 29. -Is wetland Permit -required ?. .................... ...................... . Flo Has application been made.to Town or Local DEC Office? .................. 30. Does project require.a. DEC Stream Disturbance Permit? ................... Me 31. Is or was "project site used for agricultural activity involving application of pesticide$ to orchards or other crops, solid or hazardous waste disposal;` landfilling,*sludge application or industrial activity ?......... YES or No 32. Is project located-within 1000 -feet of existence of abandoned landfill, hazardous waste site,'salt stockpile, landfill, sludge.disposal site or any other potential known - source of, contamination? ...... "......... YES or NO i� 4 DESCRIBE: 3. Is there a local master plan or file with the Town or Village? ........... 4. Are community water, sewer facilities planned to be developed within 15 years? M01400WO 5. Are any sewage disposal areas in excess of 15% slope? ........................ 3. Tax Map ID Number ........... ............................... .......... . Approved Plans are to''be returned to: ................ Applicant Engineer the application is signed by a person other than the applicant shown in Item.1, the. plication must be-accompanied by y-a Letter of Authorization: Failure to comply with this ovision 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 Hisdemeanor pursuant to Section 210.43 of the Penal Law. NATURES & OFFICIAL TITLES: 'ING 4DRESS: I C 5EGONO FLOOR PLAN scf tee: i/4 • r' O` GLO5eT GL05ET —�� -- ----— o - - - -- r — r MASTER ii HALL / PLAYROOM 0 n I ho- J � V r, 4• 4' GLOS�Tn i ic1t11dP3 �5 )^j�ll Lii;OUFt.H=ri of ivision of Environmental Health f:Eii 3Y. ServI c'. !,;Prove -S noted for conformance pi-t",, lic4ble Rules and Regulations of t);f: Itnam County Heal h De axtment. J lV i a 6EOROOM 2 _ �1 [ [ S� � Z NINWW 1 CONSTR ✓GT H s,l 5 Q•O-CN I NG wNOOW� �P• •O 2-.12 •HD1L 42,; N q N N V 2t• •O" 5EGONO FLOOR PLAN scf tee: i/4 • r' O` GLO5eT GL05ET —�� -- ----— o - - - -- r — r MASTER ii HALL / PLAYROOM 0 n I ho- J � V r, 4• 4' GLOS�Tn i ic1t11dP3 �5 )^j�ll Lii;OUFt.H=ri of ivision of Environmental Health f:Eii 3Y. ServI c'. !,;Prove -S noted for conformance pi-t",, lic4ble Rules and Regulations of t);f: Itnam County Heal h De axtment. - 1 —26 Li0_ —�_— _ — — — — — — _•— — — — — �- CJC19TING . MWATON p1 I p ?-GONG 3L.AD NIWWM ON VAMP_ Ok KIem U J fOR0113 /ILL DISC. f1TGN SLAG eX15TING 9 D TONAR,D OVCKNHAO Og9R5. 1 /p•7ype G�NGICC TG O P } _ ii O ° 'X'SH6ETRLCK ALL STUDOeo RIALi$ STAIRS -4 I CLW " •� YCCILIN6. 0 TO 9 AL 6IL G JCLf- GLOSI.66 UG OICG • " G.O. r7 I fiRST 5TCp U Q D OW —p7TI� --12',P Fl "O COW— ML LEO LW "Y WLLMN (T(7) . . ° u N Q V n � 2 ".G "• 1G bGON I _ . 3 :Poumw CDNCRfiG FOUNDATION WALL -O .0" r _ ... .i!.. -ti1 v i.: ...- i L. Y7 1.% :;,J "r! -.l ;.i!i •.:.I7 1, 1i1 ... .•r i3.l �.� GARAGE FLOOR PLAN 6CALC: ,• ; i�ion of kgvi nma_�tal Health Servic�b . yt -O• ,�.,:;.ovcd as not�ld. fo:r co�.formance wi _ -able Huies and Riegulations of the Ut pan County Health epartment.. '!.Rnsa.t.xra X TitIR $ 2JW ° 5TORAGE a .ccixAr._n tcr] W /NOOW RELOLAre '/3 WALL L� IIG• b• 4l V cr � �-(�) I• /Y . Il�r MICRO -IAM�R 4' Po s1 � PLUSH GIROCR_ [��-,cezvewnry -1 FIRST FLOOR PLAN 64TH / 1 O I i •remove exlsT � GLOStT v cloa)z. \ I 1 1 O 1 w 1 I BEDIZQ7M +F 1 KITCHEN DINING ROOM FAMILY ROOM 1 Fd W.I. c. 1 LIVING ROOM v O FOYER P•K. ru'criam Coxm -ty Denartm n c of liealtI:� ;lvision of Lnvironm - -ntal T alth Servi .:: p,,)'_"07Ca as for Con ormapme %Vith .ale k?il.le • a.rd F. - Ula.tioils of the %a " "n m County