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HomeMy WebLinkAbout0579DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -1 -43 BOX 7 00579 r,� Ir 0 .L ,. ... ' on L ' moll I ' 4 �l 00579 - •-- -�-: -� =--7- ..�,,.,,y. >..---- ..,,;<- >...�x mss °' -•-, i- .•a,.°u-�-M1+^•^2�.+£ns;.r^.�^ M'r 777:7- *r-4*-+c 7- 7. s�f R's•rY•8<A. Z+R+^- -'T- -n ...�^' c`�'q�'.'� ,- : - .. � .v - _ F Viz{ - f 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_ $�rlice 140 Di it I ing in o ve vbuvdvn v1 ay at1d b1 &L-.,;i. t 20r b T85 31f 140 62 D it 1ng in rock, set •- casing, grouted, 62 205 D : 7ili ing in roc grans e. WATER 0 CLEAR r TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? O YES O NU ANALYSIS ATTACHED? O YES ❑ NO STORAGE (T.ANk .._TYP`E ' CAPACITY CAS. _ WELL DRILLER NAIA , rPoFeal. &w Sons, l c. °A 19193 AooAE55 Pu'ti tam Ave,t;: WMMU BrewBtAZ-, .`.NI' 0 "509 �_ PUMP INFORMATION n'PE CAPACITY 4AK DEPTH aDDEI VOLTAGE —HP — -C ca Z :-T-7-5121 Af- area c cm - Tat - cf PIE 2:1 C- r= t: I,Oco tank C. ilk R-`_ j= f- e - Len= at r r: a,: CN Ile, C_ C=rt ECCZE-.. C7' C-. C-f t= =--C-- 22 u_' —=-u - C.S= z c r C= I —. CE r caz- cv-cl ------ r7 C�-C-Lr= e- LV. E-Z'.— Plans - EcuEe 2.c=- C= r JS 13 C -== --* n. C. ." =c= - ------------ WaLLI t�-1 ins-:6e cf Nll s--::ne:s < in. E=;:: -install & cn sl so, �Tr�) ro <T T�v cry (7Yio> Bg Se, soyb SQL /b c 4'65oLto P� -G I �?1lD d(fEL . 5 I TANS dt?9 vr,- S T6. PROJE h� G (Tt CLIEN �frz r_ DRQN 777777777,- SOWMVSY@N=ioemdwet ---- Septic Task MWL- *00 IL"f� A-(jjre � It—% - .gtn c,4.–.F- To Wesuskuded by Ad&m WIAW SW*2—PdWl.g Supply Flions— Addrese an Supply DdW by --Address itaiy responsible for the do$ 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 Na011: `i- AfT7 b G. _ _ fLI18 llT' . .1'[ ' r. -" .✓,Y '• / //f �� 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 N 'o.. V! , . ";ENTA2 HEM it '87 NAY 18 P/;, :39 A m. u c3N 126987 _ t Ip . - _ ►o _ P�A� TuB �IL,f�Etz IJA1uz- PROVFinI� r T�-+B ARLA SY GLV9• GA¢vE�l �v �N All 51 -f�ab rL ; I m OI Bot1�2 SGo2ri.1 v3 — — —, 8Gt72 N '_4y2, °i �3 � -- T- -- M f O I I I a C.iau m I T./ O T p I o IJ I -- i - -� -- ❑ ® \16W 12 a \�4 1 I ��v 1 1 ' I m ,J %!AdLr FL _ At`flt, FAA J r 2piu.JG'f;Y 1 ®I � J I j -- I I ' I ;X' I t�A5TE2E02l� c_+ I i Tv I I _9n V I� 0?- oll O Avis f-10MES COR URATIOf nris,rn. , rte' AVIS .MODULAI? R11z�� SERIES tax �` 1288 5�?_r -1 p1t> 2- s o2y - 180.0 ' \ \ \ \\ \ \\ \\ \\ \\ \\ \ \ \\\ \\ \\ �1 5�y \ O . h \ 9� (940 ?ccoot,e �jSDS LET i L N —05�z8) LOY ". M>:�n1oF� SITE LOGATIOr SCALE : i' = loop 55D5 DESIGN DE51GN FLOW - RE51DI A. 5501Z00M5 0 2.00 r- F' SOIL 9ATR USED". V -'i APPLICATION RATS : Loo A1550P6TION TRENCH iZEQUtiZED: 400 L.F PRovIDEt� : 400 I..F TEST PIT QE;SG' - o'e' ry - PROJECT .CDZkAWAL.L T-rDc f CdG�LWALI_ 1- ilt_.L