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Rev. .3/86 PUTNAM COUNTY•DEPARTMENT OF- HEALTH
Division of Environmental HeaNb Services, Carmel, N.Y. 10512 .. '
yLamtftedlat En& r Mast Provide P C:H D PermiERTIFICATE OF CONSTRUCTION' COMPLIANCE FOR SEWAGE, DISPOSAL'$YSTEMTown or VillaB Lv r. s u Ta: �` `^, S' 7' �r MaP- B1«�c =C_�-
Formed Subdivision Name �a►'`11 Sabdv: Lot q_
/ Owner/applicant Name Y
yJ Ada r c:*, zip o( ? , Date Penmit issued
Melling
C 9 3
^rte
Separate_ Sewerage System built by �r , ` Address �+^
Consisting of �Q Gallon Septic Tank and r/
Water, Supply: Public Supply From . Address
or: (e= Private' Supply Drilled by L 13,J d–fo , Address
BU" Type' �*�� G�ew �i 4 1 Hue Erosion Control Been Completed 9 _+ --5
Number of Bedrooms Has Garbage Grinder Seen Installed? ✓i'm
Other Requirements
I certify that „the syatem(s) as listed'servin4 the above premises were. %constructed essentially as shown on the plans.of the completed work ( copies
of which are attached), and,- in accordance with the standards, -rules and reg tions, in accordance with a fled plan, and the .permit issued by the
Putnam County Department ;Of Health.' - -
Date - 9 �f . if!* b p.E.. -A R..A.
Address
t .c License No.
Z . 1 2/
Any person occupying `premises served by the above systems) shall promptly."take such.actton as may be necessary to secure the correction of any.. unsanitary
available and the approval u tfiu ge ,Approval: of the separate sewerage, system ihsll become null and void as soon�ss a,pub(I: sanitary, awe►' becomes
conditions resulting from,`wch.;ua
private, caster supply shell become null
and, when a public, water supply 'becomes available. such approvals are
subject 'to modification of change when;' in the Judgment of the Cam mmissioner.-af .Hselth, efi' revocation, modification or m
change is eesgry,
Tit
JUN 23 '93 14113 FROM
��.az788268
CORNWALL HORSE
YML ENV I RUNPIMm 1 !'7t... ,..,.. .
321 Koar Stpo*t
Yor•ktoWn Htlsahtz, N.Y. 100 w
(914) 245A2800
Albort H. Padovant, Dir*ct r
sB Os 93.007787 CLIENT fit 1522 STi
sHMNry NIyrMrw. 4I lVMNIiMMMNMtiNA1�vMNM�'�.N�VN�NM M�'�INNMM e�piMl1(}+�M Mw.l ply All
RNWALL HOMESUILDERS, DA'
30 6. MAIN ST. DOW
REWSTER, NY 10509 REI
PHI
AMRL I NG S I TE R LOT 13 SOMERSETT DR.
I PATTERSON NY
;OL r D SY 4 STEVE t, 0PARCO
40TES...a
arti, YINNNNfn ►I�MN.VNMaMNW'� +N.IMNNMNAI MIVMMMNAr 1VMIMNw.
DATE FLAG PROCEDURE
PRGE 02
PRo rl PAQ9 i
Al •....1/rIr «}+M N.iMN4,rNN�/NA/N,y N.++rN ANA
E /TIME TAKEN: OV221413 14410
EE/TIME ARC109 06/22/93 14:28
OAT DATE$ 06/23/93
NE : (924)-279-6016
SAMPLE TYPE..a
PRESERVATIVES$
TEMPERATURE..;
COL.YFORM METHS
NMNa MNMkrMNNNMN+MM
NORMA4. — RANGE
06/23/7$ MI~ T. COLIFO RM ASSENT /100 ML ASSENT
COMMENTS $
SALT THESE RESULTS INVICATS THAT THE WATER (WAS NOT) OF A
SATISFACTORY SANITARY QUALITY ACCORDING C1 HE NEW YORK STATE
AND EPA*EDERAL DRINKING WATER STANDARDS, R THE PARAMETERS
TESTED$ AT'THE TIME OF COLLECTION,
SUBMITTED ---------
H. Padovani,.
MoT.(ASCP)
i.1 r- 4} .- t ^-§*
O i t- Q 6-4L
�t,v4ovvo
POTABLE
NONE
< 40
MF
'NMIV/vNHMryM
.f:
SLAP# 10
PUMAM COUN'i'X DEPARTMENT OF HEALM
DIVISION OF ENVIROL NI!AL $FALTH SERVICES
Owner or Purchaser of Building Section Block Lot
C5 .3
Building Constructed by
�� M ����T 'C�t2► L' �
Location - Street
Municipality
Building Type
Subdivision Name
Subdivision Lot
GUARAWEE OF SUBSURFACE SEWAGE DISPOSAL SYSTai
I represent that I am wholly and completely responsible for the location,
workmanship, material, construction and drainage of the sewage disposal system
serving the .above described property, and that it has -been constructed as shoran 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 .cons tructed , by me which fails.j: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 determination of
the Director of the Division of Environhy ntal Health Services of the Putnam: County,
Department of Health as to whether or not the failure of the system to oper�L,�e was
caused by the willful or negligent act of the occupant of the building utilizing
the system.
Corn Vi [.i �tl�I�fs.�61
Corporation Name (if Corp.)'
/55 Ajii 6b Rjyk,41 AI /2�L_01
Address
rev. 9/85
mk
Signature
Title � ,1
Corporation Name (if Corp.)
N� �S0
Address
V 9142786268 CORNWALL HOME P02
/1f��w t�nT T ���rnt w�n�r.ti• n�r�r. �r....
. YO
DEPARTMENT OF HEALTH
Div i.sion Of P„virunmental- Health Services
PUTNAM COUNTY DEPARTMENT nP HEALTH
Office Use Only___
WELL LOCATION
STREET AOURESS: TUWRIIIL IC1117 TAX GAI0 NUMBER:
Cornwall Hill Patterson, NY Lot x`13
WELL OWNER
NAME: ABORESS:
Oornwall Horne 131drs, 155 E. Main St. , Brewster,NY 10509
(�] PBIVATE
❑PUBLIC
USA OF WELL
1 - primary
2 - secondary
® RESIDENTIAL Cl PUBt IC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
❑ BUSINESS Q FARM ❑ PEST /OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL. ❑ INSTITUTIONAL ❑ STANO -SY Cl
MUNT OF USE
YIELD SOUGHT — _ gonl3NO. PEOPLE SERVED .-/ EST_ OF DAILY USAGE gal.
REASON FOR
DRILLING
❑REPLACR EXISTING SIMPLY TEST /OBSERVATION � EJADDITZONAL SUPPLY
®NEW SUPPLY (NEV tfWELLING) 8DEEPF,N EXISTING WELL
DEPTH DATA
' Uvt=LL DEPTH 0 '_ ft.
STATIC WATER LEVEL _Z) ft.
DATE MEASURED 5/5/93
DRILLING
EQUIPMENT
® ROTARY IN COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify)'
WELL TYPE
❑ SCREENED ❑ OPEN END CASING -M OPEN HOLE IN BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL. LENGTH -_. 62 fL
MATERIALS: CS STEEL ❑ PLASTIC 0 OTHER
JOINTS: ❑ WELDED 0 THREADED ❑ OTHER
SEAL: f0 CEMENT GROUT ❑ BENTONITE CIOTHER
_ _
LENGTH BELOW GRADE _ .. _. ft,
DIAMETER in.
WEIGHT
FIRST
PER FOOT .. -.... _. 1b./ft.
I DRIVE SHOE OYES D NO
I LINER: OYES M NO
SCREEN
DETAILS
DIAMETER (in)
-SLOT SIZE LENGTH (It)
DEPTH TO SCREEN (ft)
DIEVELDPEM
0 YES ONO
HOURS
5ECOND
GRAVEL PACK
' Has
Ll
GRAVEL. DIAMETER
SIZE: Of PACK In.
TOP
DEPTH ti.
sunchi
DEPTH _ K.
WELL YIELD TEST !( detailed Pumping
p p
Mt:TMOD: O PUMPED i tests were done is in-
W COMPRESSED AIR ; formation attached?
D BAILED C3 OTHER ; 0 YE5 ❑ NO
WELL L0� 1f more detailed formation descriptions or $love analyses
are available, please attach_
�SU fAFCEM
Weer
scar.
'"9
oar
I °qtr
FORMATton oe CRIPrtott
coos
tt.
it.
'NELL OEPTN
It.
DURATION
hr, min,
ORAWODNN
ft_
YIELD
Qpm_
$�rlice
140
Di
it I
ing in o ve vbuvdvn v1 ay at1d b1
&L-.,;i.
t
20r
b
T85
31f
140
62
D
it
1ng in rock, set •- casing, grouted,
62
205
D :
7ili
ing in roc grans e.
WATER 0 CLEAR r TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? O YES O NU
ANALYSIS ATTACHED? O YES ❑ NO
STORAGE (T.ANk .._TYP`E '
CAPACITY CAS. _
WELL DRILLER NAIA , rPoFeal. &w Sons, l c. °A 19193
AooAE55 Pu'ti tam Ave,t;: WMMU
BrewBtAZ-, .`.NI' 0 "509 �_
PUMP INFORMATION
n'PE CAPACITY
4AK DEPTH
aDDEI VOLTAGE —HP —
-C
ca Z :-T-7-5121
Af-
area
c cm - Tat - cf
PIE
2:1
C-
r=
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I,Oco
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C. ilk R-`_ j= f-
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at
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CN
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ECCZE-..
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C-.
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C.S=
z c r C= I —. CE r
caz-
cv-cl ------
r7 C�-C-Lr=
e-
LV. E-Z'.—
Plans -
EcuEe 2.c=-
C=
r
JS 13
C -== --* n. C. ." =c= - ------------
WaLLI
t�-1 ins-:6e cf
Nll
s--::ne:s < in.
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TANS
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DRQN
777777777,-
SOWMVSY@N=ioemdwet ---- Septic Task MWL- *00 IL"f� A-(jjre � It—% - .gtn c,4.–.F-
To Wesuskuded by Ad&m
WIAW SW*2—PdWl.g Supply Flions— Addrese
an Supply DdW by --Address
itaiy responsible for the do$
holly. and � c9mpl", , 11 - iliwand location of the Proposed syitenl(S); 1) that the separate
above -41igacrib" will be constructed as jhow6 on thespproi�" amendment there to and in accordance with the'stindards. rules-s-n7r—"uWRxlVFns -OdYW'4 Q-ffn
County Department ' of kesith. and that on completion '* theroof�s!-C"ficstil of Construction ComplianW satisfactory to the Commissioner of He .
be sublimated to the Depiftmod. mind a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder.'thit said builder will
place in :pod .operitAii comnilition . ani-part of said sawagaidisposal -system during the period of two (2) yews Immediately following thodate of the issu-
was of the approoral, "of :tire Certificate' of. Construction Compliance of the, original or any repairs ifterato; 2) that the d►liled -well described above
will be located as sh=m on the aril that said well will be Instal in accordance ith the standarft r is nd roe-UN NMR—of the Putnam
County Dope mant of ""Ith
P.E R.A.
Date Fc,
-73 4, 4, 'Q
Address License No
APPROVED FOR CONSTRUCTION: This apprOval'OXI)Ir 05 . two years
ravocagto for cause or may be a m it -or modified when considered
""ouires a raw par It. . Approved . for . dis . Posal of domoslicuniter
Rev. I ,-- - 71--, S.
a
from the data issued unless construction of Ge building has been undertaken and Is
ticassilry by the commissioner of Health. Any change or alteration of construction
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New .York 10509
(914) 278 -6130
APPLICATION TO CONSTRUCT A WATER WELL
n PCHD PERMIT #
WELL LOCATION
Street Addr ss own
{ vei
it sage City Tax Grid Number Number
2 `GVIp 2-3;1 '�I
WELL OWNER
Name Mailing ddre
v nk"V 40r00►+e_0 I'a
+v �ckiv� Private
i _ G' C _ 0Public
(5SE OF WELL
1- primary
2- secondary
RESIDENTIAL O PUBLIC SUPPLY
BUSINESS O FARM
0 INDUSTRIAL b INSTITUTIONAL
O AIR /COND /HEAT PUMP O ABANDONED
O TEST /OBSERVATION O OTHER (specify,
O STAND -BY O
AMOUNT OF USE
YIELD SOUGHT '- gpm /# PEOPLE SERVED 6_ /EST. OF DAILY USAGE O Q al
O REPLACE EXISTING SUPPLY O TEST/ OBSERVATION 13 ADDITIONAL SUPPLY
OLNEW SUPPLY NEW DWELLINGY ® DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
WELL TYPE
ORRILLED
DRIVEN
®DUG
®GRAVEL
0 OTHER
IS WELL SITE SUBJECT TO FLOODING? YES L,,"' NO
WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: L ak"
Lot No.
WATER WELL CONTRACTOR: Name -7-13)) 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: A/A
LOCATION SKETgL& SOURCES OF CONTAMINATION PROVIDE
/ M 7WN SEPARATE SHEET
( a e) signature)
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the provisions
of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within
thirt -y (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 Of a
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
V 203 869 5105 S.H.LoPARCO
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
t
P02
Date
Re: Property of ��, S�cv��
Located at ve 9G e%�t7 C
(T) / a' a`-� Section Block LO t_
Subdivision. of
Subdv. Lot Filed Map # a1 7 /4 Date
Gentlemen:
This letter is to authorize fia 116LJT�
r
a duly licensed professional engineer or registered - architect
(Ind
ivat7
to.apply for a Construction Permit for a soparate sewasvr Gysteml to'
sere' the above noted property in accordance with the.°s,ti�dards;..rules
or regulations as.promulagated by the Commissioner' :of;the.: Putnam- County. ..
Department of Health., and to sign all necessary pa per s;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, th,o.Public Health Law, and
tary Code. of NEt�,
NIC/y!'0
AU
C o un t e r s i g -611 N0 56124NP��,
OFESSIO
P.E., R.A•,
Address
Telephone
ql� .- 2r7f� -l�lD 8
the Putnam.County.Sani-
Very.
truly our ,
Signed
O-s.,zer. of• Property j 4 0
Address
aGe b
Town...
r
Telephone
LAURENT ENGINEERING
ASSOCIATES, PC.
� 73 FAIRFIELD DRIVE
PATTERSON, NEW YORK 12563
RANDOLPH W. LAURENT, PE. (914) 278.6108 - (FAX) 278 -2658
HARRY W.NICHOLS, JR., PE. CONSULTING SITE ENGINEERS
February 4, 1993
Mr. William Hedges
Putnam County Health Department
Route 312, Geneva Road
Brewster, NY 10509
Re: Individual SSDS Renewal
Lot #13, Cornwall Ridge
Somerset Drive
Patterson, N.Y.
P -53 -87
Dear Bill:
Enclosed are the following:
1. Four (4) prints of Drawing SS -13 "Proposed SSDS.- Lot 13 ",
dated 5- 14 -87.
2. "Application For Approval of Plans For A Wastewater Disposal
System ".
3. ".Construction Permit for Sewage Disposal System ", dated
2 -4 -93. (Renewal)
4. . "Application to Construct a.Water Well"-dated 2 -4 -93.
5. "Letter of authorization ", dated 2 -4 -93.
We would appreciate your review, approval and issuance of the
renewal Construction Permit at your earliest convenience.
Sincerely,
LAURENT ENGINEERING ASSOCIATES, P.C.
Harry W. Nichols, Jr., P.E.
HWN:bd
93011
enc.
cc: Mr. S. LoParco w /enc.
P UTNAM C OUNTY D E PARTMENT O F HEALTH
APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM
1. Name and Address of Applicant:
2. Name of Project: LI-OZ a5-Id SS,�S 3.._- Location /C: a o
4. Project Engineer: �r,�7 r �T �4r1��: �C, 5. Address: 7� T� �.� ��� r
License Number: Phone: 7 -LI,
6. Type of Pro ect:
Private/Residential Food.Ser-vice Commercial
Apartments Institutional Mobile Home'Park
Office Building "Realty Subdivision Other (specify)
7. Is this project subject to State Environmental Quality Review (SEQR)?
Type Status (Check One) Type I.. Exempt
Type II. Unlisted
8. Is a Draft Environmental Impact Statement (DEIS) required? ......,<!!.G..
9. Has DEIS been completed and found acceptable by Lead Agency? /Y% -i
10. Name of Lead Agency
11. Is this project in an area under the control of -local planning, zoning,
or other officials, ordinances? ......... ............................... �
.
12. If so, have plans been..submitted to such_. author. hies ? ......................
- - - -�
13. Has preliminary approval been granted by such authorities? Date Granted: —ZU-2-
14. Type of Sewage Disposal. System' Discharge ......^ Surface Water t/ Ground Waters
15. If surface water discharge, what is the stream class designation ?........ ✓v
16. Waters index number (surface) ........... ...............................
17. Is project located near a public water supply system? ..................
98. If yes, name of water supply /it- Distance to water supply
19. Is project site near a public sewage collection or disposal system ?..... G
b. Name of sewage system ✓V/ Distance to sewage system
1. Date observed: te' 23. Name of Health Inspector: AL 13VJ-2-1 kCk
:4. Project design flow (gallons per day) ... q �� ..............................
25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... Ad'
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 ? .................. ......... .. ............................... //U 0,
28. Wetland ID Number ........................................................ ILI
29. Is Wetland Permit required? ...............................................
Has application been made to Town or Local DEC Office? ............ ......
30. Does project require a DEC Stream Disturbance Permit? ................... r
31. Is or was project site used for agricultural activity involving application
of pesticides to orchards or other crops, solid or hazardous waste disposal;``'`
landfilling, sludge application or industrial activity? ........ YES or NO
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 /"
DESCRIBE:
33. Isthere a local master plan or file with the Town or Village? ...........
34.--- -Are, commdti ty_ water, sewer facilities planned to be developed within 15 years? /vd
35.:,- Are. an y sewage disposal areas in excess of 15% slope? ........................ ,Ad
36. Tax-- MapLIb Number ....... ...................... .. ..... 2-3,—/- `fi 3
.. ....... ...... ... ...
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 y-a Letter. of Authorization: Failure to comply with this
provision may be grounds for the rejection of any submission.
I hereby affirm, under penalty of perjury,, that information provided on this
form is true to the best of my knowledge and belief. False statements made
herein are punishable as a Class A Hisdemeanor pursuant to Section 210.45 of
the Pena 1 Law.
SIGNATURES & OFFICIAL TITLES:
TAILING ADDRESS:
r.T— •°r.r'F� - -- r�- ;r..c-- .r.?+�.-+ .-r -� arm3. ._- - ^'":fe. ^.3- �.'�_TM�::'z{"_ '�^.°- .�'. SK. ^.,�. -.. -p -v '�.c_ .""Y ..�; i
s 1 PUTNAM COUNTY, DEPARTMENT OF.HEALTH.
rmlt N ~
Division of Envlronmentel'Health Servkes Carmel N Y: 3051 ?:., :eer
to Provide Pe
TE OF COMPLIANT
R t M
Perini . g
ICONS TRU PERMIT FOR.SEWAGE DISPOSAL SYSTEM
Q .
Low a< C. w
(LG'• Town
Sabdl�islon Name Lot N T3 Tai Map . Block Lot
Po
60VJ �✓�l...t
Renewal O Revision p
Ownei /Appllcanf Name -
Date of Provl
ods Approval
'.
Mailing Address ?Z"� �� �T c �1 I iii 1 \ice - Town 1(�
�.
ZA5�s bSNxr(�a� Lot Arim .; I z z �'•� • Fill Secdon Oil De th VoBallding T Nambor. of Bediooms DeelgnFlow G P D �� 'PCHD Notification is Required When Fill
c
Sopusfe,Sowerago System to couslpt of i7rJ0 Gallon Soptic Tsok "end 4_
To\be constrpeted by � C :> (11 [7!_(! Address
u
Water Sappli Public, S 1 From ' `x Address
upPY
or: ' - Prlvatef,Sapply Drl�ed by �� � — Address
Other Reoairemente
I iepresent,ttiat�,l am wholly and eomplet.1""'sponsiole for the desjgn antl location of, lhs proposetl systems) 1) tnaf the separated sewagw disposal system
a,9 bove tleuribe l will be, constructed as shown on the approved amendment there to and in- accortlance wish i614tanclardi. iules an regulations o e u nam
County Department of 'Health, antldhat on completion thereof -.Certificate, of(Construction Compliance ".satisfactory to the Commissioner of Health will
be submitted- to '!he Department; and a -written guarantee'w�11 .De furnished the owner, his successors, heir3 -or. assigns by fhe builtler, that: said builder Will
f
place 7n gootl "bperatin9: condition 'any .,pait of said. sewage' disposal - system :C,': g'the period -of two (2) years 1 etliately following thedats of the isw-
once ;of the, approval oi.; the Certificate of. Construction Compliance o/ the or' inat system or any repairs thereto ) tha he drilled well-described above
will be located as shown on the approved plan antl that ss�d well will b'e Install i accortlanee with th "ndartls, lea, regu ions of 'the Putnam
County ADeepartmenl1toof Heaallltt`h�?, - 1 ✓ /,,
Date Cllr I.C7� �"1 v Si9netl c q PE ^•A•
•�'.�� —lam 1T 'T 1�, License No.� r�
Adtlress CPI 'C df
APPROVED FOR. CONSTRUCT ION. This approval. expll @S two ysars 1 om the te'iss ed unless construction of the building has been .undertaken and is
revocable fo! use r ay be amended or modified when considered ecessar y the _ missioner o H - Ith. Any change or alteration f construction
requires ne pe i pproveA for disposal of ao ' Aic-aahitsr ow , •antl /or` r to a DP
..
I'sz87 Date V/., -• _ ...BY
JV
w
LAURENT ENGINEERING
ASSOCIATES, PC.
73 FAIRFIELD DRIVE
PATTERSON, NEW YORK 12563
914.278.6108
RANDOLPH W. LAURENT, P.E.
HARRY W. NICHOLS JR., PE. Fq CONSULTING SITE ENGINEERS
May 18, 1987
Putnam County Department of Health
110 Old Route 6 Center
Carmel, N.Y. 10512 , ;rn
Att: John Karell, Jr., P.E.
a
Re: Cornwall Ridge Estates
Lot No. 13 °o <
Route 164 & Cornwall Hill Road `a
Patterson, NY
5
7
Dear Mr. Karell.
Enclosed are the following:
1. Three (3) prints of Drawing SS -13 "Proposed SSDS -
Lot 13" dated 5- 14 -87;
2. "Construction Permit for Sewage Disposal System"
dated 5- 18 -87;
3. "Application to Construct a Water Well" dated
5- 18 -87;
4. "Design Data Sheet"
5. "Affidavit - Corporated Owner Application ",
dated 4- 16 -86;
6. "Letter of Authorization ", dated 5- 18 -87;
7. Two (2) copies of Residence Floor Plan (s) , for
"Bedroom Count Only ".
8. Check in the amount of $100.00 payable to the Putnam
County Health Department.
We would appreciate your review, approval and issuance of the
Construction Permit at your earliest convenience.
Sincerely,
LAURENT ENGINEERING ASSOCIATES, P.C.
Harry W. Wichols, Jr., P.E.
/map
enclosures
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
t �i
_I
o Village City Tax Grid Number
f� 16_G --Z. I
WELL OWNER
Name
Co 1.,1_ 14 fLL
Mailing Address rivate
-16.S WC. ' Z3 4 -r v-�N , 14 13 Public
USE OF WELL
primary
2 - secondary
M- 6SIDENTIAL
O BUSINESS
O INDUSTRIAL
O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED
O FARM O TEST /OBSERVATION O OTHER (specify
13 INSTITUTIONAL O STAND -BY O
AMOUNT OF USE
YIELD SOUGHT
gpm /#
PEOPLE SERVED:5 -S /EST. OF DAILY USAGE $UC7 gal
REASON FOR
DRILLING
EffNEW SUPPLY
OREPLACE EXISTING SUPPLY
O PROVIDE ADDITIONAL SUPPLY O TEST OBSERVATION
0DEEPEN EXISTING WELL
DETAILED
REASON FOR
DRILLING
ULVJ q6 k
- G
WELL TYPE
DRILLED
DRIVEN
DDUG a GRAVEL ® OTHER
IS WELL SITE SUBJECT TO FLOODING? YES ✓ NO
IF WELL IS LOCATED IN A REALTY. SUBDIVISION, NAME OF SUBDIVISION: !
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.
0_1
Kenneth Emerson
represent that I am an officer or employee of the corpo - tion -dAd am authorized
to act for Cornwall Hill Estate's, Inc.
(Name of Corporation)
r7i
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 .2 Katonah, N.Y.
(Name and Address)
Secretary: Janet G. Mastropietro, 223 Katonah Ave., Katonah, N.Y.. 10536
(Name and Address)
Treasurer: Lvnne 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.requdsted and all subsequent acts relating�
thereto.
Sworn to before me this da y Signed:
of rI lud _r\ 19i Title: Vice President
J201
Notary Public
LIONEL ViEINSTEIN
Notary Public, State of New Yiorff
No. 60•4199160
QuaNfled In WastchWter COW ir
cbmMISS10tr Expires mbrct
8/84
Corporate Seal
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date_ ONV { f> , (q'(�-'�%
Re: Property of
Cg R).1 WALL.
N ILL
E- s:,ArrF-,O,
1 N C
Located at
'ZOP_MYVALL- }SILL
ka2 i C I(o4
(T) Section 1-5 Block % Lot Z. i
-. Subdivision of CORNWALL. I�IDGG
Subdv. Lot # Filed Map # Z11`7,1 Date !J v Z' O
Gentlemen:
This letter is to authorize Randolph W. Laurent
a duly licensed professional 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-
tary Code. " C IM W
Co
P.E.., R.A. ,
0 )�
A, ILLIA Z
Very truly yours,
Signed. -
Ow-her :of Property
2Z3 Kationah Avenue
• Adddr e s s "'
Ov
7� T-AigMsL'D - piZ1YE K2Ltona'Yi�g N.Y. 10536
Address T.gwn
914 -23 -2 -7171
Telephone
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONME -NTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. >a:10512
DESIGN DATA SHF:W- SEPARATE•SEWAGE DISPOSAL SYSTEM FILE N0:
Uwix,rCoRlilUflt.b ���u- �S�cQ I1,IC. _ AddreeeZZ3 ICss�a�1 -� �vG. -n.l�.t�- ,cL��� �Ic75�o .
WAS. KI �� SLR, '
Located et (Street Sec. �� Hlock�_Lot?`�
An.1-* nearest cross street)
Municipality ia.�'T.(�,SZ,�1 Watershed
:301L PERCOLATION TEST DATA REQUIRED TO BE SUBMITTEII WITH APPLICATIONS
ITu7 u
NW111-1. CLOCK TIMI.
PERCOLATION
PERCOLATION
T{wi
Elapse
Npth to Water
Water ve
Nu.
Time
From Ground
Surface
in Inches
Soil Rate
Start -Stop
kin.
Start
Stop -
Drop in
Min.. /in drop
Inches
Inches
Inches
67
Z, 2 V 4'S- : 56
a:10
a�
�5
)1
TEST PIT DATA REQUIRED TO BE -SUBMITTED WITH APPLICA`!'ION
DESCRIPTION OT' SOILS I-NCOUNTERED IN TEST HOLES'-
DEPTH HOLE NO. BOLE NO. HOLE NO.
G.L. •
611
.12 01
18"
24"
30" .
36"
42"
48
5401
O So�^
1 NI)1 OATH U Vrl, AT WHICH GROUND. WATT:R IS ENCOUNTJ RI D
1 NI r I CA'1'h' LEVI - :L TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
`1 X3'1'3 KUNg . 13Y R , W . L . Date
Still Hates Used ra -% MIYV1 "Drop: S.D. Usable Area Provided SO O®
No. of Uedroorns 4 Septic Tank Capacity 1 Zip Gals . S-" ;,
AbaorNLion Am& PrOVdda By (, L.F.x24" �� _ c 0` � "T. nc .
UA, fl
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Address V SI:A'�,,'; S: :'; si = ►
"tom 77 ER �N 1. c:. ((��•` C-7
THIS SPACE FOR USE BY HEAL'PH DEPARTMENT ONLY:
Sq, Ft/Gal.
Checked by
Date
RECRVED
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