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HomeMy WebLinkAbout0792DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 24. -1 -101 BOX 9 i L ti F irr Ai ' ' �Ll ' T 14 I ' `1 L Lo UL 00792 \� PUTNAM COUNTY DEPARTMENT OF HEALTH �- DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR S MENT SYSTEM PCHD CONSTRUCTION PERMIT # —- ��_O Located at 11 5m p p �e Town or Village j�>D H Owner /Applicant Name`J1_�NEH t 0ll M I 0 Tax Map /2-4* Block I Lot 101 Formerly F0�05 PrlmN Subdivision Name Bl G► E l_1 i Subd. Lot # 17, Mailing Address I I (-Wil. -o h P—O ) Date Construction Permit Issued by PCHD Separate Sewerage Svstem built by "BEM 119-1 Zip I O S AI, Address �� C(j?�I.LtOd (4-4. 3i'wST�o.r� IoSj Consisting of i P5 p Gallon Septic Tank and CM— lF Ai5 P—E 1+1 Other Requirements: Water Supply: Public Supply From, Address or: Y, Private Supply Drilled by �' � ` Qi i.-� f00 H i HL . Address' P40PAt, ME Building Type._ Has erosion control been completed? YE5 Number of Bedrooms Has garbage grinder been installed? N 0 I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: Certified by k,- P.E. is R.A. (Design 1'r fessiona0 J Address �1� '��4,b0gL COMMot45 Of I,q� �jRE�I�iE�-i �l License # 1 o Sod Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become'null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocatio , m dificatio or change is necessary. By: Title: LQ lu- Date: d J White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 !1/1rMIo% s =' l ( VGNLWTi/ 171�1VIY"YSii1711/V7Wl1lYi111A' - I�GaJ�IW1 i11i1VGdWIN�i5�7�1 V11[ vVt47VYyyf�f ylll p[ V17I Vti1: VN^ VtiKf Yf4YVMi/ Irf y3yVTWtNFlIfV /i/tif[i/�,(1/17IFL.vliill.' W7HVlilVivtiTi/37Pltily ki w PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT.' Well Location Street Address: Big Elm Road Town/Village: Brewster Tax Grid # Map Block Lot(s) 22 Well Owner: Name: Address: Steven Dottavio, 5 Progress Street, Brewster,­NY 10509 Use of Well: 1- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 31 ft. Length below grade 30 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: X Steel Plastic Other Joints: _ Welded X Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: X Yes _ No Liner: Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes—No Hours Second Well Yield Test _ Bailed X Pumped X Compressed Air Hours 6 Yield 5 gpm Depth Data Measure from land surface- static (specify ft) 30' During yield test(ft) 265' Depth of completed well in feet 305' Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 12 Drillin in overliurden 12 Hit rock at 12' 12 31 Drill ina in rock - set casing. aroutsd 31 305 Drilling in r c If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump TypetF,4tw ii j Capacity 3P ,- 7. tO Depth a�i�' Model S�� Voltage, HP Tank Type &� Vol79'L- Date Well Comp eted 8/14/99 Putnam County Certification No. 002 Date of Report 8/17/99 W gng u' T. NOTE: Exact location of well with distances to at least two permanent landmarKS to be provided on a separate sneevpian. 4 Putnam Avenue Well Driller's N e P. F Boo& So , Inc. Address: Brewster, NY 10509 Signature: Date: 8/17/99 Malcolm Ir. bealY_Jr_.` White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 e�\\ COUPITY DEPARTMENT OF HEAII.YD Dhtdm d misvkMaiasw Ded& Smrveass. CogniaL N.Y. 16912 Effakew to Pravbie Pat r, PPM PDO S WA®8 DEPOSAL STS= rMNOWPIS WAIN 17—okMWAM0 .I., 4 J f f to R ;.. '?1 SJ' �EM la 0-. Daft ii ♦ ► `A e Lr. To be onbucted by %� Other Retmirmiinsto 1 represent that I am wholly and completely responsible for the design and. location of the proposed, system($); 1) that the separate sewage di $91 system above described will be constructed as shown on the approved amendmont there to and in accordance vilth the standards, rule$ a regu ens o e nam County Department of Health, and that on complotion thereof a " Catificato of Construction Compliance" satisfactory to the Commissioner of Mealthwill be submitted to the Oopertment, and a written guarantee will be furnished the owner, his succasswrs, heirs or assigns by the builder, that said builder will place in good orating condition any port of raid sewage disposal system: during the period of two (2) yews immedlately following thedato of the issu- ance of the approval of tho Certificate of Construction Compliance of th original system or, ny rapairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will he Instal in accord Enco w tlw eta rd ub nd r�uTa onfi�s of the Putnam county Departtlmenntt !off Health. �[ Cate 2' / ! ! Signed � P.E. !` R.A. - ..- -- - - - - f! .itA APPROVED FOR CO STRUGTIOI revocable for use o may be Omer requires porovad REV.' 10/88 Date . n. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map Block Lot pprri -ER-60 IJ Building Constructed by TownNillage I I bp_�pLE?? 1) �-e�i r-- b (A 5LN) Location - Street Subdivision Name Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system.. . The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month '92 Day 1 '� Year X000 Signature: Title: HEM` General Contractor (Owner) - Signature Corporation Name (if corporation) Corporation Name (if corporation) Address: 11 c,ft?4 -00 (4NP a Address: � C44W O RN0 �k:*A7M State NOW TpPA�- Zip 1050 State N50 � J pML Zip 10 M Form GS -97 NB NORTHEAST LABORATORY OF DANBURY 39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404 LABS (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: MR. STEVEN DOTTAVIO DATE SAMPLE COLLECTED: 2/28/2000 5 PROGRESS STREET TIME COLLECTED: 7:15 P.M. BREWSTER, N.Y. 10509 COLLECTED BY: STEVE D. DATE RECEIVED @ LAB: 2/29/2000 TESTED BY: LAB# 11471 REPORT DATE: 3/2/3000 SAMPLE SITE: 19 BRADLEY DR., BREWSTER, N.Y. SAMPLING POINT: WELL TANK SOURCE: WELL TREATMENT: NONE TEST PERFORMED RESULT: MAXIMUM CONTAMINANT LEVEL BACTERIAL: Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml PHYSICALS: Color 0 15 Odor ND 3 Units pH 6.75 no designated limit Turbidity 0.75 NTUs 5 NTUs CHEMISTRY: Nitrite N <0.005 mg/L as N 1 mg/L as N Nitrate N 0.29 mg/L as N 10 mg/L as N Alkalinity 93.0 mg/L no designated limits Hardness 100.0 mg/L no desigiiated'limits Iron 0.046 mg/L 0.30 mg/L Manganese 0.059 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium 4.0 mg/L 20 mg/L ** Lead 0.008 mg/L 0.015 * ** m1= milliliter mg/L = milligrams per Liter ND = none detected NTU =Units * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED:2 /29/2000 SAMPLE, AS TESTED ABOVE: OPOTABLE or DOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826- 0105.OUTSIDE CT: 800 - 654 -1230 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: `� O t Inspecte y: g:547 jae4 Street Location �1 �/ Q� �/ Owner b144�Ywa Town Permit # 7 TM # -- / I 2 Subdivision Lot 1. Sewage Svstem Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. Sewage System t. a. Septic tank size - 1,000 ...... ::1, 250 .. ...... other .:.............. b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... ............................... f. renTT- I . Length required-697 Length installed 2. Distance to watercourse measured j--200 Ft.......... 3. Installed ac orsk'°tig to ..:...........................: 4. Slope�e acceptabl 1 6 1/32" /foot .......:..... 5. 10 ft. m roperty line - 20 - foundations.......... 6. Depth of trench <30 inches fr s rfa e ................. 7. Roo Soa,'Aeltrench p loon, o ...... .... ......... 8. Size 1' m ter 1 9. Dep 12" minimum ................... 10. Pipe ends capped.-..: ................. _.. _ . ... .............. . ................ g. Pump or Dosed Systems Size ot pump c am er ................ ............................... . 2: Overflow tank ............................. ............................... 3. Alarm, visual/ audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First lox baffled .......................... .......:....................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Buildin a. House located per approved plans........... 5... b. Number of bedrooms ....................... ............................... IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured 4 /y o ft........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 6/97 ..r.n wry ��waw .rr�wrmn 09 -08 -1999 02.10PM FROM TO 05 PUT`A:�>I COUNTY 1E I N OF HEALTH V , DIVISION OF ENTMOIN"MENTAL HEALTH SER`ICES • �•* t • 92787921 P.01 For: Fill Trenches PCHD Construction Permit tr_ ` " Located d���y� ( OAnAeSaILI Owner /Applicant Name TM lot?ti.o; Fortnerly Allif Subdivision Name �fJ;S�d/✓ Is system fill completed ?_ Is system complete? Is system constructed as per plans? u ,_ Is well drilled? Is well located as per plans Are erosion control measures in p jZ6 Date Date I certify that, the. system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordan ued PCHD Construction Permit and approved plans and the Standards, Rules an C Putnam County Department of Health. - a� �� t� 0 s' I W Date: f — Certified by- PE RA„ Address �0 1141 Comments: Form FIR -99 TOTAL P.01 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New.York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # P2?-N WELL LOCATION Street Address Lr p Town/Village/City Tax Grid Number _�_ WELL OWNER Name mailing e \ Address SPrivate O Public USE OF WELL 0) - primary 2- secondary fS RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP 0 BUSINESS O FARM O TEST /OBSERVATION 0 INDUSTRIAL U INSTITUTIONAL O STAND -BY D ABANDONED O OTHER (specify p AMOUNT OF USE YIELD SOUGHT_ gpm /# PEOPLE SERVED -5 /EST. OF DAILY USAGEAao Stal REASON FOR DRILLING O REPLACE EXISTING SUPPLY 11 NEW SUPPLY NEW DWELLING O TEST /OBSERVATION 13. ADDITIONAL SUPPLY 13 DEEPEN EXISTING WELL DETAILEDi REASON FOR DRILLING WELL TYPE ®.DRILLED DRIVEN DUG OGRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 01L Lot No. WATER WELL CONTRACTOR: Name IfA9 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _2�,__NO NAME OF PUBLIC WATER SUPPLY: "(p� b TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED (DON SEPARATE SHEET 2 - -7-1-7 (date) signature PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the Department attached to this permit. 3. Submit a Well Completion Report on a form requirements of the Putnam County Health provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilli perations be contained on this property and in such a manner as not to degrade or other' s contami a surface or groundwater. Date of Issue: 19 Date of Expiration 19 Permit Issuing Official Permit is Non - Transferr ble White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL. HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET for CONSTRUCTION PERMIT STREET LOCATION -:620 .Ll Dr NAME OF OWNER ') 0 TT A q t c BY B. HEDGES R.MORRIS OTHER DATE 2- /24 q�' TAX MAP # Y DOCUMENTS. PERMIT APPLICATION PC -1 WELL PERMIT EEI PWS LETTER AUTHORIZATION L- J DESIGN DATA SHEET(DDS) CORPORATE RESOLUTION PLANS THREE SETS HOUSE PLANS - TWO SETS 62- = VARIANCE REQUEST SUBDIVISION 1 LEGAL SUBDMSION 2 C SUBDIVISION APPROVAL CHECKED = PERC RATE -2� (- ;i = FILL REQUIRED N 0 DEPTH = CURTAIN DRAIN REQUIRED =STANDPIPES "D Y ® EXP. AREA; SHOWN; GRAVITY FLOW, SUFF. SIZE PUMPED PIT & D BOX SHOWN & DETAILED HOU - OOMS 00 FT. OF PROPOSED SYSTEM = P NDS 6 i4.- = HOUSE SETBACK NECESSARY (TIGHT LOT) = HOUSE SEWER - 1 /4 "/FT. 4 "0; TYPE PIPE = NO BENDS; MAX. BENDS 450 W /CLEANOUT FILL SYSTEMS t LAYBARRIER 0 FT HORIZONTAL: SLOPE 3:1 TO GRADE LL SPECS = FILL NOTES LL CERTIFICATION NOTE EPTH GAUGES LL PROFILE & DIMENSIONS VOLUME ERAL FILL IN EXPANSION AREA = ADJ. LOTS = WETLAND ( TOWN/DEC PERMIT REQ ?) TRENCH / = DATA ON DDS PLANS & PERMIT SAME l 7_J F TRENCH PROVIDED =60 FT MAX = PRE- 1969 - NEIGHBOR NOTIFIFICATION IsARALLEL TO CONTOURS LETTER BI/ZBA 100% EXPANSION PROVIDED._ _ = 100 YR. FLOOD ELEVATION SEPARATION DISTANCES SPECIFIED ON PLAN REQUIRED DETAILS ON PLANS FIELDS SEWAGE SYSTEM PLAN - (NORTH ARROW) 0' TO P.L., DRIVEWAY, LARGE TREES TOP OF FILL SSDS HYDRAULIC PROFILE =I GRAVITY FLOW 20' TO FOUNDATION WALLS LJJ 15' WELL TO P.I CONSTRUCTION NOTES (GRINDER NOTE) 00 TO WELL, 200' IN D.L.O.D., 150' PITS ESIGN DATA: PERC AND DEEP RESULTS 100 TO STREAM WATERCOURSE LAKE (INC.EXPAN) TWO -FOOT CONTOURS EXISTING & PROPOSED 5 'TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER ® D OPES CUT V TO WATER LINE (PITS -20') = CURTAIN DRAINS 1200 & INTERMITTENT DRAINAGE COURSE m ROSION CONTRO • OUSE,WELL, SSDS FT. RESERVOIR, ETC.= 150 FT. GALLEY SYSTEMS ER dN�ONTROL NOTE 5' MIN TO C.D. S= >5 %,20'- 4 %,25'- 3 %,30'- 2 %,35' -1 %,100' <1% ® PERC & DEEP HOLES LOCATED 0' MIN TO C.D. DISHARGE /100' WITH 182 CONS DAY DIS. REPRESENTATIVE OF PRIMARY AND EXPANSION SEPTIC TANK ® LOCATION MAP =10' FROM FOUNDATION; 50' TO WELL COMMENTS: _ P.L TNAM ' COUb7rY DEPARTMENT OF HEALTH' DIVISION OF ENVIM4141 Jai, HEALTH SERVICES DESIGN DATA•SHEET- SUBSUFACE SEWAGE DISPOSAL SXSTa4 FILE NO. Cremer 10 &T IAcV 10. . ' Address liq Located at (Street) 10 rZ-AV,r_-`(.. ag \VE Sec. . Block I : Lot nearest cross street) Municipality .......: ..... Watershed* G►2v�0 N SOIL PERCOLATION TEST DATA -REQUIRED TO BE"SUB�11 ED WITH APPLICATIONS Date of - Pre - Soaking. -- " -�j1_ Date of 'Percolation Test" _ HOLE_... . NUMBER CLOCK TDIE 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 '3 4 2 12' l' - 5 3 IN1DTES: 1. Pests to be repeated at sar�a depth .until: approximately..equal: soil -rates are obtained at each percolation test hole. A11 data to be.suhcnittea for review. 2. Daoth reasurements to to iniade from, top of hole•. TFST PIT DATA MU= TO BE SU- a,iI'LTM WITH APP.L,ICATION DESCRIPTION OF SOUS ENC OCWrMM IN TEST HOLES DEPTH HOLE M. • :..::HOLE ir0. ' : :�:. :. :: ,'�� -' � - := :-=- •..- _:_: :_ „:HOLE M. G. L. - . .. ... _ _..... .. ... . . 2 , `.r a 6 _.. .. 7, -_ 8t 90 !R ©GK 0 ►2 90 9O(%K:. �.� 91 ...:� W Al E 131. o 141 INDICATE LEVEL AT WHICH GROUN gATER IS..DIC. ' '1 IRDICATE LEVEL TO j11HICH h?ATER IZVEL RISES AFTER BEING :ENCOUNTERED?- N �� DE—Ell HOLE OBSERVATIONS W DE BY: �2 i41 - -- :.DATE: DESIGN Soil Rate Used .2 3O Min/1" Drop: S.D. Usable Area Provided No. of B-e3rocns Septic 'Tar%: Capacity gals. Type r .Absorption Area Provided By aa-7_ L.F. Y 24" �ridth' trench Other c +y+• v r t�arte r�V ASS QC, . t 9, 6, . Signature 3 � z R. P-0 dress ��U D��fG� G t�4T12 SEkT try. No: BF_ 124 : > 10 ' r• `fiiIS SPACE FOR USE BY HEALTH. DEPARIMENff ONLY: .; hate Approva-1 " s�. ft /qal . Checked by ..Date )E:_> iC7 .x, �1 C�. M (C; CD XY N C'se JD )E r-> !� �R �' � � �7 x O �' ��E � � . 'J- �s APPLICATION FOR .APPROVAL:.OF PLANS FO, R.A.KASTEWATER DISPOSAL SYSTEH Haase and Address'.of: Appl icant:. . 0 OTTANI 10. -• - .. .. ... ..�q "1;t5� X2.1 L� '.i�h! �j,tS�t7 , .. .... '.. •.. ., C�12,�W �'T�rZ. t�l'� - - i Oct �t .. .. .. 2. Vane of. Project: r0 3. _• Location T/V /C: Address: Mlllbrooke. Office Cent. 5: 4., Project. Engineer: J�,�.., tJl�4 -�D �F�Z E . . •...Br6,wSter., td Y.. 10 09 License Nu'ber:_ 5�2 Phone: 1914).278 6.. TYDe 07- Pro.iect - ' Private /Residential Food.Service . _ Cort- neetial ". Apartments Institutional ..,.,.: .: ; -:Nob.i•le Home': :Park Office Building. Realty .Subdivision ; Other- :.(specify.) . Is -this project subject* to State Environmental -Quality Review (SEQR)? Tvoe Status (Check One) Type Z.. Exempt Type II. Unlisted. X �.'.Is a Draft Environmental Impact .Statement (DEIS) required? ?. • Has DEIS been completed and round acceptable by.-Lead Agency? •.............. N1 /A - •1 -.... H.arne of Lead Agency... j, Is this project in an area under•�Che control of•local planning, zoning, or other officials, ordinances? ......... ............................... NB..._..- . - - -.. f so, have plans been.scab- ,pitted to such:author.ities ?.... N�A_ - -• - -- -.as preliminary approval bee�i 'granted by .such by Date Granted:_ , Type of Sewage Disposal; Systeri' Discharge...... . Surface Water'. _ZGround F.'::L::rs { If surface water discharge, what is the stream class designation ?..... ;aLers index number (surface) ............... ........................ .. - Nl.._- -'s project located near_ a publ is water Suppl}' System? .................. +gip .. .... . r: ; r, _ of '�',_ L_ r s u n p l ;y' ------- N�g- -- - O i s Lance o xa t e r s u p p l. P�iL I1C Sn' 2cG Col IBC? 10n 0; diSp1SaI S }'Oi.'1 ?.... _Nd c S��G „S e..' Distance to se age s }'sty i ..... O �, 25. Is State Pollutant Discharge El ini nation" System (SPOES) :Permit required?... 26. Has SPDES Application been sub�i fitted .'to',Iolcal DLC..•O,ffice? 27, IS any portion of this project. located with'in,•4,..desig6a-te'd'.Tor?n or State wetland? ........ .......... ............................................. 28. Wetland ID Number, .................... ...................... /A 29. Is Wetland Permit ..re -qu i. red?:* .......................................... ....... E Has application been.:nade to Town or 16cal DEC bif Tice. 30.. Does.proje . ct require-a DEC. Strum*Disturbance Pe M', I i t ..................... 31. Is br;�.was_project site used for-a'gr•dultural -activity -involvAn.g:-6ppli6ation of_--,Pe's�tiMde$ to orchards-or other crops' -solid or ha7z:rdous waste disposal I t6s, sludge application or. industrial activity? YES"o-r. NO 12 e cJ- located-w"I thin 1;000 feet oT existence -of abando.ned landfill So pile an* T 1 6 haz d s I udge --di sposal site r ,�aste. site salt stock any --othe rUpo t e n t i.a. I known . s ou rc e of' co n*tarfl nation? or NO DESCRIBE: 33. is there a local master plan or file .-with the Town or Mi. I I a'ge? ........ Are c om-si u n i t. y water, sever facilities planned to be developed within 15 years? .5. Are any' sewage, disposal areas in excess of 15% slope? ................... pD 1,'u m. b .2 r ......................................................... returned to: .................. . E n S pp�r eci Plans are' to 'be: r 40 i c an t the application is signed by a person other than the applicant shown in I'Len, .1, the L with i,, 1;) cation must be•accon, anied by -a Letter' o17 Authorization: Failure to comply wi' t. P ovision may be grounds for the rejection:of any submission. I hereby ef'fim , under penalty or perjury.• that information provided on this or-,• ' is true to the b-est of r,-,y knowledge and b-37fef. Fa7se statc-7,-_nts* -.made herein are punishable as a Class /,'% Hisde7•eenor pursuant to Section 210-45 of t 1'1e?enE i 1_aw, A 4 A 1_; Cc 11 DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 Harry Nichols Laurent Engineering Millbrook Office Ctr. Route 22 & Millbrook Road Brewster, NY 10509 Dear Mr. Nichols: ILI BRUCE R. FOLEY, R.S. Acting Public Health Director March 3, 1997 Re: Proposed SSDS: D' Ottavio Bradley Drive (T) Patterson Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: "The construction of this sewage disposal system may be subject to local wetlands 'regulations. You should contact local wetlands officials in this regard." "You? are referred to. Article 128.1 of the official compilation of Codes, Rules and Regulations of the State of New York, Title 10, relative to the need for approval of individual sewage disposal systems by the City of New York. You should contact city Officials in this regard." 1. Footing/Gutter drain discharge has not been shown on the plan. 2. All wells within 200 feet of the proposed SSDS and all SSDS within 200 feet of the proposed well must be shown on the plan or a note stating none exists. 3. Erosion control for Aell. SSDS and house is to be shown on the plan. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Very truly yours, I J Robert Morris, P. E. Public Health Engineer R1VUjp RANDOLPH W. LAURENT, March 6, 1997 Robert Morris, P.E. Putnam County Health Department. 4 Geneva Road Brewster, NY 10509 RE: Proposed SSDS -Lot #22 Big Elm Subdivision Patterson, N.Y. LAURENT ENGINEERING Dear Robert: In response to your letter dated March 3, 1997 we have enclosed the following: ' ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 8 Milltown Road Brewster, New York 10509 P.E. (FAX) (914)278 -6108 - (FA) 278 -2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS Three (3) prints of Drawing SS -22, "Proposed. SSDS ", revised 3 -6 -97. If you have any questions, or should you require additional information, please contact us. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. Nic ols, Jr., P.E. HWN:RL:bd 88044 -22 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date 2'. -7 -�7 Re: Property of Located at f2gA0L_e f M \N r (T) t�A- fTG—rLSON Section 2-, Block Lot g 7 Subdivision of Subdv. Lot # 22 Filed Map ,5'1 ZQ'%2 Date Gentlemen: This letter, is to authorize_ a duly licensed, professional engineer -or registered architect Undicate 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 co- ra-Lection with this matter and to supervise the construction of said system or systems in conformity vrith the provisions of'Article 145 or 147, Education Law, the Public Health Law, and the Putnam County San .i- tart' Code. Counter _? 0�j __ - Ili?. H_ 900Kg Address �1.�c:l.CT�iIOIlCt Very tr_J.0.3Z,Yours , Signed Owner of Property -rS E�Verj 2'aTTA\4 to _ Address Town IL Tel_eT)hone BE �r ;0i i C� is j 57,0 Wood Dock I q "nature g, �',?.� Date 8'x 12' Living Room 13'x 23'4" I Foyer DiningRoom 12'4" x 12' 1 ;1 jf ' !!i i� I N too, °i, E 1C A 51 D f•I ' -' AREA l l�l I / JUNCT1pN aprc CTYP> ) !0 8 22 ' 99 0 Soup • II Pvc Sw:° 3g 7 21 is Z i2 6 20 ' 1 i3 5 19 1 14 ¢ i8 3 17 �5 46 ABS TeeNCN CT.rp 2 1� 1250 GAL, GPTIG TANK +� `f� �LI� P.V.C. SDZ -35 v N N 0 O. 0 L TINc— dEOP"o OM R ESf DANCE 0 t 1 t I. I I A ,K ry a . m { m DIMENSION CHART (in ft.) No. A B rIO0' 2 3.3 3 35 ' 5:3 4 44! 57' 5 50 Cot' ro 5ro' Coro' 7 ro 3 8 r09' 7 -7 9 ro5` 112 10 55' 109' I I 5-3 107 12 4 "8' 100' 14 38 ' 9 7 I5 35' 9ro' ICo 79' 31 ' 18 8ro' 51 20 9 3 57/ 21 5-7 22 102/ � I 0 Z / J l0i u.; i2F ---- i3{ 141 �5F-- 1250 COAL- SBPTIG 7ANk r D r