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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 24. -1 -103 BOX 9 jr y I . IN L XI , ,6 �I I I' I ;J I y � I f� Ii 00794 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIAN GE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # P ' % S . j (,_ �/ Located at �� pR�VG Town or Village PATH Owner /Applicant Name xm-Vt y p_E�67l Tax Map Y't' Block ( Lot I®13 Formerly _ Subdivision Name .$16 ewA Mailing Address %I Subd. Lot # y Ll, jio pt'u�yfZ' f`�`� Zip f OSD Date Construction Permit Issued by PCHD 10 J � i J Da Separate Sewerage System built by BORM- 0"'� N6 La Address f'p` kCq' - b �' nq P Consisting of P-151� Gallon Septic Tank and 6 M LF- P$Ab TP-5H H Other Requirements: i �' fILL Water Supply: Public Supply From Address or: X Private Supply Drilled by P'r_'FPAL+ ioH Address`q PU�r�Pc� - Building -Type - P-E6 �D5VALF,, - - Has erosion control been completed?5 Number of Bedrooms 4- Has garbage grinder been installed? IQ% 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 C unty epartment of Health. Date: I Certified by P.E. R.A. Address "/��� r 1 ICY � 2 �(n P rofessi , t o,s A License # 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 approva a subject to modification or change. when, .in the judgment of the Public Health Director, such revocatio , inodificati o change is necessary.. By: Title: Date: L 6 116- White copy - HD File; Yellow copy - Building Inspector;. Pink copy - Owner; Orange copy - Design Professional Form CC -97 ._-- j i �. i I R _,__ ..._.__a......_._,,:._..__._... PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Bradley Road Town/Village: Brewster Tax Grid # Map 2A Block I Lot(s) �Q Well Owner: Name: Address: Steve Presti, 561 Brewster Hill Road, 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 41 ft. Length below grade 40 ft. Diameter 6 in. Weight per foot __j3_lb /ft. Materials: X Steel —Plastic —Other Joints: _ Welded X Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: X Yes _ No I 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) 510' Depth of completed well in feet 550' 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 25 Drillini in o e burden clay and boulders 25 Hit rcitc at 25' 25 --- - -41- _ Drillin i in- roc - --set--casin - – routed 41 550 Drillin i in r ciranite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type SaB, Capacity S0 y w 1. Depth 3cQ Model 5-1,Pn- 31acatai Voltage 03 * HP 3M Tank Type 5161r Volume G I'/" Date Well Completed 11/23/99 Putnam County Certification No. 002 Date of Report 12/1/99 Well Driller (signature) Perry L. Beal NOTE: Exact location of well with distances to at Least Well Driller's Name P. I: Signature: Perry L. White copy: HD File;, lanamarKS Lv OC pruviucu vu a scpaiaw auccupiwi. Address:4 Patnarn Ave., Brewster, NY 10509 Date: 12/1/99 copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 BRUCE R. FOLEY Public Health Director F'* LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 May 24, 2001 Harry Nichols, P. E. Patterson Park - Suite 106 2050 Route 22 Brewster NY 10509 ......Re:. _ -7 : Proposed Co_mpliance: _ Presti..:. 28 Bradley Drive, Lot #24 . . - _- — - -- - - - - -- -- -- - -- - ------- - - - - -- (T)- Patterson, -TM# 24. -1 -103 Dear Mr. Nichols: Review of plan s and other supporting documents submitted at this time relative to the above- regarded project has been completed.. Comments are offered as follows: 1. The water analysis for lead exceeds State standards. ... _ 2. Downstairs room requires a 6 foot archway opening. - Upon. receipt of a submission, revised to reflect the above comments, -this application will be - - - - considered further. Very twivours, Robert Morris, P.E. Senior Public Health Engineer RM:tn a>_ i s Harry W. Nichols Jr., P.E. _ Patterson Park, Suite 106 2050 Route 22 _. Brewster, NY 10509 Telephone (84S) 2794003 Fax(845)279-4567 May 14, 2001 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSTS Compliance Big Elm, Uot #24 28 Bradley Drive Patterson, NY Dear Robert: Enclosed are the following: 1. Five (5) prints of Drawing SS -24, "As -Built SSTS," dated 5- 14 -01. 2. "Certificate of Construction Compliance for Sewage Disposal System, dated 5- 14 -01. 3. "Guarantee of Subsurface Sewage Disposal System," dated 5 -8 -01. 4. Well Completion Report, dated 12 -1 -99. 5. Laboratory Report, dated 5- 10 -01. 6. Application Fee in the amount of $200.00 payable to Putnam County Health Depart 7. ment. „8. E911 Compliance Form. If there are any questions concerning the enclosed, please call. Very truly yours, H Nich s Jr., P.E. HWN:his 00- 088.24 To: P CAS D Attention: Gentlemen: We enclose (0 copies of. 12 B/W Prints O Reoroducibles O Specifications _ O Memorandum Descriptiam Harry W. Nichols Jr., P.E. Pit e= Park. Sub 106 2050 Rom 22 &m tai NY 10509 Takpbm(w5) ?79.4003 Fax (845) 2794567 Date: Job No.: ProjectiL���yl O Revorts O Copy of letter �T O Tracings O Revision/Date No. Sent Via: _ O Our Messenger O _Blueprinter O First Class Mail O Special Delivery O Your Messenger 19 Hand Delivery O ` Copy to ' Very truly yours, Harry W. Nichols Jr., P.E. NE _ NORTHEAST LABORATORY OF DANBURY 39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404 L"s (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 LABORATORY REPORT REPORT TO: MR. STEVEN PRESTI DATE SAMPLE COLLECTED: 4/25/01 & 5/7/2001 28 BRADLEY DRIVE TIME COLLECTED: 9:00 P.M. & 11:00 A.M. BREWSTER, NY 10509 COLLECTED BY: S. DATAVIO DATE RECEIVED @ LAB: 4/26/01 & 5/7/2001 TESTED BY: LAB #11471 LAB LD.# NY -39 & NY-47 REPORT DATE: 5/10/01 SAMPLE SITE: SAME AS ABOVE SAMPLE POINT: TANK & KITCHEN FAUCET SOURCE: WELL TREATMENT: NONE MAXIMUM CONTAMINANT TEST PERFORMED RESULTS METHOD # LEVEL (MCQ OR STANDARD BACTERIAL: • Total Coliform (Bacteria) 0 per 100 ml SM 9222B 0 per 100 ml PHYSICALS: • Color (Apparent) 0 - EPA 110.2 15 • Odor ND - - 3 Units • pH 6.79 - EPA 150.1 No designated limits • Turbidity 0.71 NTUs EPA 180.1 5 NTUs CHEMISTRY: • Nitrite Nitrogen <0.005 mg/L as N EPA 354.1 1.0 mg/L • Nitrate Nitrogen 0.32 mg/L as N SM 4500D 10 mg/L • .. Alkalinity 36.0 _. ,mg/L ' SM 232013 No defined limits • Hardness 70.0 mg/L EPA 130.2 No defined limits • Iron 0.062 mg/L EPA 236.1 0.30 mg/L • Manganese <0.01 mg/L EPA 243.1 0.50 mg/L Combined limit for Iron plus Manganese = 0.50mg1L. • Sodium 3.6 mg/L EPA 273.1 20.0 mg/L ** • Lead — 5/7/2001 0.007 mg/L EPA.239.2 0.015 mg/L * ** ml= milliliter mgaFmilligrams per Liter ND =none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count " "Notification Level ** *Action Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: Fff-11POTABLE or DOT POTABLE RESULTS BASED ON SAMPLES SUBMTTTED: 5/04/01 & 5/7/2001 Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060379 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 NA LABS NORTHEAST LABORATORY of DANBURY 39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404 (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 191 :10 AN 0) W49 Z_ 6 Z4 i REPORT TO: STEVEN PRESTI • Total Colifonn (Bacteria) DATE SAMPLE COLLECTED: 4/25/01 28 BRADLEY DRIVE 0 per 100 ml TIME COLLECTED: 9:00 P.M. BREWSTER, NY 10509 COLLECTED BY- S.P. 0 - DATE RECEIVED @ LAB: 4/26/01 • Odor ND TESTED BY: LAB #11471 3 Units • pH LAB LD.# NY -39 EPA 150.1 No designated limits REPORT DATE: 5/4/01 SAMPLE SITE: SAME AS ABOVE 5 NTUs CHEMISTRY: SAMPLE POINT: TANK SOURCE: WELL mg/L as N EPA 354.1 TREATMENT: NONE 0.32 mg/L as N MAXIMUM CONTAMINANT TEST PERFORMED RESULTS METHOD # LEVEL (MCL) OR STANDARD BACTERIAL: • Total Colifonn (Bacteria) 0 per 100 ml SM 9222B 0 per 100 ml PHYSICALS: • Color (Apparent) 0 - EPA 110.2 15 • Odor ND - - 3 Units • pH 6.79 - EPA 150.1 No designated limits • Turbidity 0.71 NTUs EPA 180.1 5 NTUs CHEMISTRY: • - Nitrite Nitrogen <0.005 mg/L as N EPA 354.1 1.0 mg/L • Nitrate Nitrogen 0.32 mg/L as N SM 4500D 10 mg/L • Alkalinity.._., ty...__-------- - -.__. .0 mg/L _...SM 2320B - - - - -. - -- No.defined limits • Hardness 70.0 mg/L EPA 130.2 No defined limits • Iron 0.062 mg/L EPA 236.1 0.30 mg/L • Manganese <0.01 mg/L EPA 243.1 0.50 mg/L Combined limit for Iron plus Manganese = 0.50mg/L • Sodium 3.6 mg/L EPA 273.1 20.0 mg/L ** • Lead 0.054 * ** mg/L EPA 239.2 0.015mg/L * ** ml= milliliter mg/L- =milligrams per Liter ND =none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count " "Notification Level ** *Action Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: MIPOTABLE or ONOTPOTABLE RESULTS BASED ON SAMPLES SUBMITTED: 5/04/01 Wifu Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060370 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 05 -10 -2001 08 :32AM FROM NORTHEAST LAB OF DANBURY TO 18452783612 P.01 .28 • Total Cal PAYS19AtI Color.(A) • Odor + pH Turbidity NN RTHEAST LABORATORY OF DANBVRx 39 1 ULL PLAIN ROAD - DMBURY, CT 06811 CT Cert: PH4a04 - (203) 748 -7903 - PAX (203) 748-0652 NY. Cert: 11471 ND LABORATORY REPORT - PRESTI DATE SAMPLE COUICT'ED: 4/25/01 & 5/7/`2001 DRIVi TIME COLLECTED: 9:00 P.M. 8t: 11:00 A.M. VY 10509 COLLECTED BY: S. DATAVIO -,0.005 DATE RECEIVED avdj LAB: 4/26/01 & Y712001 1.0 mg/L TESTED BY: LAB #] 1471 SM 4500D LAB L10 NY-39 & NY-47 mg/L RIEPORT DATE: No defined limits OL SAWAS ABOVE EPA 1302 QS; TANK & KITCE EN FAUCrT WELL ms/L U NONE c0.01 mg/L EPA 243.1 1►' AXQ—W-M CONTAMhMT i$j RESilLTS NEROD 0 1EVIL1,Mgp OR 3TAlYI1!ARD • I%UXe NR • Nitrate Nit • Alkalinity Her& ess i Irvn • Msngehea� .j Saditstn •; Lead- 5n X01 -- illilitcu - "NatiQcation 1 C'OMNN= -AD holding tir Sr#MpLB, RESULTS 0 per 100 W SM 92221.3 0 PC 100 ml 0 - EPA. 110.2 15 ND - - 3 uniu 6.79 - EPA 150.1 No designated limits 0.71 NTUs EPA 180.1 5 NTUs -,0.005 mgt w N EPA 354.1 1.0 mg/L 0.32 mg/L as N SM 4500D 10 InFA 36.0 mg/L SM 2320B No defined limits 70.0 m91 EPA 1302 No defined limits 0.062 ms/L EPA 236.1 030 mg/L c0.01 mg/L EPA 243.1 0.50 m*I, Conf MuM Limit for Iron. plus Manganese 0.50nw/L 3.6 MOIL EPA 273.1 20.0 mg/L ** 0.007 MOIL EPA 239.2 0.015 mg/L• *• Pet l iter ND --none detected MC1;- -1*2dmum Contaminant Level TNTC =Too Nuz=mus To Count ration Lend (wrr) me .TED: X� OTAIRLE or DOT )POTA'8LE t ODi SAM ILE-9 SUBMCTTED: $104101 5/7/2001 Laboratory Director 1ORT HEA T LABORATORY, I29 MI].L STREET, BERLIN, CT 06037• (860)828-9787. FAX (860)829 -1050 TOLL FRM WITHIN CT: 800 - 826-0105 . OUTSIDE CT: 800454 -1230 TOTAL P.01 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM I �A 8 1 14 Owner or Purchaser of Building Tax Map Block Lot N� Q" boy "05-f7 Building Constructed by Location - Street P-,56 � -0 �-:_H ("5 P14j_T_EVD0tq Town/Village 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. Dat�th �`� Day $ Year 2 0 0 \ General Contractor (Owner) - Signature Alb I$ ['J�qe ., ryI Corporation Name (if corporation) Address: S Proy vw 1f_ State Zip Signature: 0. L4 Title: 8 U �- .iI� Corporation Name (if corporation) Address: & ,, 3 a Jaaila,( State o S) _ _j Form GS -97 BRUCE R. FOLEY Public Health Director LORETTA MOLINARI • R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278.7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278.6085 Early'"Icterveadoo-(914) 278.6014 Preschool (914) 278 -6082 Fax(9l4)17f-W8 E911 ADDRESS VERIFICATION FORM OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS: TOWN: Sib eu%i - Lor AUTHORIZED TOWN OFFICIAL,: (Signature) DATE: G ` The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town-official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERFRM) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION - Date: 3 D 0 Inspecte y: a, -b Street Location bYzgDL�;/ 71:10 vE Owner pTZ6�_T/ Town Permit # p- z i - go TM #_ -7_y_ Subdivision Lot # 2,o " zrla c4;V 1. Sewage Systeiin 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 a.Septiccttan— k size -1,000 ........1,250 .......other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1 A 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. Trenches . engt required 5-oo Length installed >—oo 2. Distance to watercourse measured- ©o Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 -1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 -1 %2" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped .................................... :.................... g. Pump or Dosed Systems Size ot pump c ham er ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ........................................ :.................. .. 6. Cycle witnessed by H.D.estimated flow /cycle........... III. ouse/Buildin a. House located per approved plans ... .:.::.......................... b. Number of bedrooms ..............�f.... :........................... . IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured ' oo 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 & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... .............................:. i. F.rosinn cnntrnl nrnvideri rJANI I� L%!L� IBS icy ICS Icy INS 1.11 A' ME ice/! Imo' v� ki H) res H " BRUCE - R. FOLEY Public Health Director - - LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 Date: it / / 5 /o z� i L W'TA 9 M. Re-! Gm 2, e4 8, la &'-74m From: Gene D. Reed Putnam County Department of Health /For your information For your review As discussed Fax #: 9- 7!} — 4f 5-C, -7 No. Pages ;:2- (Including cover sheet) Please respond Attached as requested Please call Notes/Messages O' K -13'0 C 1< r-I ZL :!"'5' z -5 , r � � iI :i 1 *-ZA 7 In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 2261. NUV -b r -zUwt9 n 4. 1 J r-11 MHKK T W N 1 O-MULb • 714 C!7 40b! a sal •'. P PUTNAM COUNTY DEPARTMENT OF EEALT$ WMION OF LPN V><ItONME1V'fAL HEALTH 9EIMMS ATTENTION 0 ADAM GENE MUST MAL 2I9EC 0 For:. Fill All Mrtwttloa must be hilly completed prior to any Trenches iaspe loan bein made. PCHD Construction Pe 't # Located: 01 Uwaa /Applicant Nave: Tbi Bloek La: iormetly: subdivision Name: P Subdivisioa Lot # Is system in completed? Date: is syrrtem complets? Date:— Is "am constructed, as per pleas? is wen deed? Date: I t — -7 -Qd Is well looted as per platy? _ Are erosion control measures in I ca* that the system(s), as listed, at the above premises has been copstuucted and I have inspected and verified theft completion In sccordrwce with the issued PCHD Construction Pamit sad approved plan: and the Such* Iitrlaa and Regulations of the Putnam Couaty Deputmeat of Health Date: A— 7 — Certified by: PE M profeasio Address ,krA- Liao. 0 6,121A Y . b 1 00-086,06 9 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES PERMIT # Located at CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM P 3 0IZ -1�1 / 3 v _ Town or Village PAT� EIL6 dH Subdivision name B � b Subd. Lot # Tax Map fN- Block I Lot Date Subdivision Approved i i Renewal Revision Owner /Applicant Name 6T"15� 5 Date of Previous Approval Mailing Address C/O N_zo5—JflL S-rmum pk-vjGTY— Zip Amount of Fee Enclosed T AIL) r P-L-NOOM Building Type �L J VD51 g Lot Area No. of Bedrooms 4 Design Flow GPD 8W Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of fiPz- N(/4 Other Requirements: /h I P_-0, 6 I V7© gallon septic tank and To be constructed by dQ� 6(J"(4, 'j "I xa_ ddress '' D . 94X r1 `a- Water Supply: I Public Supply From Address or: _ X Private Supply Drilled by 7-0 P Address 19000(-,F- A65 (o 01 I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the karate sewage treatment s, sy tem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate- of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: ,, r ' P.E. R.A. Date _ld 21 60 ` Address '7-6 *D g sL 0 R hf y lv -10'j License # *45'fZ-�( APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when sidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new Perm i . A roved f ischarge of domestic sanitary sewage only. By: Title: --- Date:3 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL ` _ / please print or type PCHD Permit # Well Location: Street Address: Town[Village Tax Grid # 6PLADL&PP4145 pNIIElp-goOH Map 9A Block Lot(s) Well Owner: Name: Address: X055 Use of Well: i Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served �*i Est. of Daily Usage o© gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling Y, New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No X ..................... ............................... Is well located in a realty subdivision? ................. Yes 5( No It Name of subdivision BI C\ ELm �J�pi�It�jiO'N Lot No. 9JA Water Well Contractor: -rW, Address: Is Public Water Supply available to site? .................................. ............................... Yes No X Name of Public Water Supply: Town/Village '- Distance to property from nearest water main: Proposed well location & sources of contaminatio to be provided on sep ate sheet/plan. ` Date: _ ._Applic ant Signatur e: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and 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 or their designated representative 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. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and 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. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water 1 driller certified by Putnam County. Date of Issue �� J Permit Issui icial: Date of Expiration 0 Title: IG Permit is Non - Transf rra le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Harry W. Nichols Jr., P.E. Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, New York 10509 October 25, 2000 Re: Individual SSDS -Lot # 24 Trench Permit Big Elm Subdivision Bradley Drive Patt erson, N.Y. 24. -1 -103 Dear Robert : Enclosed are the following: 1. Five (5) prints of Drawing SS -3, "Proposed SSTS," re Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Telephone (845) 279 -4003 Fax (845)279 -4567 vised 10- 24 -00. 2. "Construction Permit for Sewage Disposal System," dated 10- 24 -00. 3. "Design Data Sheet." Results of Perks in Fill. If there are an y questions concerning the enclosed, please call. Very truly yours, Harry W. Ni7Jr., P.E. HWN:jm 00- 088.24 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address ��'���' 5i5k Cam... Located at (Stree,t)_&f@Ld Tax Map '2 --`�� Block Lot 19'% (indicate nearest cross street) Municipality Pmmlazo-\ Watershed E�Pr MLH SOIL PERCOLATION TEST DATA Date of Pre - soaking q 1 H OO Date of Percolation Test' , .... ... .. ...... ....:...........:.......... ..:......:.....:.::......... .:... :.,...:..:.:..:::.. ..:.::...::.: �.: a th t > . o >G.... uo :::> z wr.:... ; ::. e1. <: < >: :.;: e N:..:;.;...;: °;:::: ,.:•<:,.:. >:::;:; >:, :, :EIa se.Time .......... .....:.:...; ... S.u.. • ce.:.. u : ,.::•::Sto . I..::.:.: : b n :::<: n.. :: Ra e. :..... . ;.::.:.::; :... 2 15-0 9!6 � OAL 4 _.. 5 2 3 VT ��i i� ?-� 2-�, 3 `71 1 4 5 a 4 �` KNO. '56124 'y�Jl r% NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 m clinch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97' SEP -08 -2000 02:18 PM HARRY W NICHOLS 914 279 456( r.bl PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION ❑ ADAM 4ENE All information must be fully completed prior to any Trenches inspections being made. I/ PCHD Construction Permit # Located: (T) (V)y„en'o� Owner /Applicant Name: TM .-2:1_ Block / Lot 103 Formerly: Subdivision Name: Subdivision Lot # Is system fill completed ?. ..o Date: `l'- 7-06 Is system complete? Date: Is systein constructed as per plans? Is well drilled? Date: Is well located as per plans? Are erosion control measures in place? I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion 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; -2-7-49P Certified by: PE L•! RA ofessional Desig . Address: a4S'o l e'.11 flreag 1L /V of Lic. # fit Comments: Form FIR -99 y a q I, I 9/11/0 v C�1 3 ' 14 VFK ,4 4Z -D f:- PTH 0 716IAlAG DL s t 6 Al 0 BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 -.6648 Date: 9 //3 Ion To: _f{.41?XV NVz&oL—, Fax #: 72 'el Sl -7 %Ze: 4a 7- 2 316� 0LM AJ-AIV —'Z 1 —90 No. Pages (Including cover sheet) From: Gene D. Reed Putnam County Department of Health - c/, For-your information For your review As discussed Please respond Attached as requested Please call Notes/Messages /.GL A7 A P22� A)�t % d LSE 6. it xwe- /E NT e0 F /L�GDS, W. F.5.5 In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 2261. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM b PERMIT # PJ Il Located at �� ��Vk Town or Village FmTE�60n Subdivision name $i(A 51AA Date Subdivision Approved Owner /Applicant Name Subd. Lot # Tax Map " Block I Lot 1 � - ilk 111- Renewal Revision Mailing Address I)-r:) V�-p'cn ~ P4 A0 Amount of Fee Enclosed 4 �)(NN Date of Previous Approval Building Type Lot Area 'kM No. of Bedrooms 4 Design Flow GPD Zip IOSoH Fill Section Only Depth 2� �' Volume 444 PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of Other Requirements: 1 "4 gallon septic tank and 5W Lf %k �-A*S To be constructed by 14 .a - Address Water Supply: Public Supply From Address _ or:, Private Supply Drilled by �'� �4�� - Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: 4 P.E. X R.A. Date Address LAJ t-li H441MEcR jfit% "0 1n� i PC 44 �ILLTIW0 XQ License # 15(1'-4 WV 5Na- N�) 10101 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w n c nsidered ecessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pnp-r rovdischarge of domestic sanitary se a only. B Title: Date:/ 4V Y� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278 - 6130 Fax (914) 278 - 7921 Harry Nichols Laurent Associates Millbrook Office Centre Route 22 & Milltown Road Brewster NY 10509 Re: Proposed SSDS: Ross Alan Bradley Drive, Lot #2f- (T) Patterson, TM# 24. -1 -102 Dear Mr. Nichols: May 20, 1998 BRUCE R. FOLEY Public Health Director Review of plans and other supporting documents submitted at this time relative. to the above - captioned project has been completed. Comments are offered as follows: "The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." 1) Revise plan as per guideline set forth in the Putnam County Department of Health Procedure and Polices Subsurface Sewage Treatment and Water Supply Facility Program Guidelines for fill sections greater than 2 feet. 2) Title block is to provide street address of property. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Very truly yours, c 6W AWO Robert Morris, P. E. Public Health Engineer R, :tn BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH Division of Environmental Health Services 4. Geneva Road Brewster, New York 10509 Tel. (914) 278 - 6130 Fax (914) 278 - 7921 May 20, 1998 Harry Nichols Laurent Associates Millbrook Office Centre Route 22 & Milltown Road Brewster NY 10509 RE: Ross Alan Bradley Drive, Lot #24 (T) Southeast Reservoir Basin East Branch Dear Mr. Nichols: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on May 12, 1998 is complete. The Department will notify you by June 8, 1998 of its determination. 12 The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. El Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Dept. of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Dept. of Environmental Protection regarding such activities to see if Dept. of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (914) 278 -6130 ext. 166. Ve ly yours, Robert Morris, PE RM:tn Public Health Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH DOCUMENTS Y N 1 PERMIT APPLICATION 37 EROSION CONTROL: HOUS E,WELL, SSDS 2 C -1 38 PERC & DEEP HOLES LOCATED 3 WELL PERMIT_ PWS LETTER 39 REPRESENTATIVE OF PRIMARY & EXPANSION 4 LETTER OF AUTHORIZATION 40 LOCATION MAP 5 DESIGN DATA SHEET (DDS) 41 EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE 6 TE RESOLUTION 42 IF PUMPED, PIT & D BOX SHOWN & DETAILED 7 e SHORT EAF 43 HOUSE - NO.OF BEDROOMS $ PLANS - THREE SETS 44 WELLS & SSDS'S W/TN 200' OF PROPOSED SYS. 9 HOUSE PLANS - TWO SETS 45 PROPERTY METES & BOUNDS 10 VARIANCE REQUEST 46 HOUSE SETBACK NECESSARY (TIGHT LOT) FEE 47 HOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE SUBDIVISION 48 NO BENDS; MAX.BENDS 45° W/CLEANOUT LEGAL SUBDIVISION FILL SYSTEMS SUBDIVISION APPROVAL Cl IECKED 49 CLAY BARRIER PERC RATE 50 10- FT. I IORIZONTAL;SLOPE 3:1 TO GRADE 11 FILL REQUIRED DEPTH 51 FILL SPECS - FILL NOTES 12 CURTAIN DRAIN REQUIRED 52 FILL CERTIFICATION NOTE 131 1 ISTANDPIPES 53 DEPTH GAUGES GENERAL 54 FILL PROFILE DIMENSIONS LOCATED IN NYC WATERSHED 55 VOLUME PLANS SUBMITTED TO DEP 56 FILL IN EXPANSION AREA DELEGATED TO PCHD TRENCH DEP APPROVAL, IF REQ'D 5 7 LF TRENCH PROVIDED 60 FT MAX. 14 DEEP TEST HOLES OBSERVED 58 PARALLEL TO CONTOURS 15 PERCS TO BE WITNESSED 59 100 %EXPANSION PROVIDED 16 EX- APPROVAL SSDS ADJ. LOTS SEPARATION DISTANCES SPECIFIED 17 WETLANDS (TOWN /DEC PERMIT REQ'D ?) ON PLAN - F1t0N1 SSTS 18 DATA ON DDS PLANS & PERM_IT SAME 60- ]0' TO P.L., DRIVEWAY; LARGE TREES, TOP OF FILL 19 PRE 1969 NEIGHBOR NOTIFICATION 61 20' TO FOUNDATION WALLS _15'WELL TO PL 20 [jjLETTER BI /ZBA 62 100' TO WELL, 200' IN DLOD, 150' PITS 21 100 YR. FLOOD ELEVATION 63 100' TO STREAM WATERCOURSE LAKE (inc. expan) 22 OTHER REQ'D PERMIT(S) 64 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER REQUIRED DETAILS ON PLANS 65 10' TO WATERLINE (pits -20') 23 SEWAGE SYSTEM PLAN - (NORTH ARR0ii06 50' INTERMITTENT DRAINAGE COURSE 24 SSDS HYDRAULIC PROFILE 67 2007500' RESERVOIR, ETC. _150' GALLEY SYSTEMS 25 GRAVITY FLOW 26 CONSTRUCTION NOTES 68 15'MIN to CDS= >5 %,10'- 4%,25'- 3%,30'- 2 %,35' -1 %,100' - <1 %' 27 DESIGN DATA: PERC & DEEP RESULTS 69 20'M[N to CD discharge /100'with 182 cons day discharge 28 T CONTOURS EXISTING & PROPOSED SEPTIC TANK 29 DRIVEWAY & SLOPES, CUT 70m 10' FROM FOUNDATION; 50' TO WELL 30 FOOTING /GUTTER/CURTAIN DRAINS W L 31 SOIL TYPE BOUNDARIES 71 ® DIMENSIONS TO PROPERTY LINE 32 TITLE BLOCK; OWNERS NAME,ADDRESS72 LOCATION OF SERVICE CONNECTION _ TM #,PE/RA; NAME,ADDRESS,PHONE# 33 DATE OF DRAWING /REVISION 34 DATUM REFERENCE 35 LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET 36 mPROPOSED FINISH FLOOR AND BASEMENT EL. COMMENTS- +4 k - DIVISION OF ENVIRONNIE\TAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW S SHEET FOR CONSTRUCTION PERMIT STREET LOCATION Q� I /���� N NA•1E OF OWNER 0 055-5 A 1} . REVIENVE B ' .iii, R, AS, MB, B11 E E � �'��' TAXLNIAP# L—I COMMENTS- +4 k - PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: P\01595 /A LA �4 & RAtl L,AV-E R-oAD AP-MoN�L NY 10604 2. Name of project. $tci ELM 5` DW15ioA- LoT' u} 3. Location TN: PAT1- ffK0r+ 4. Design Professional: +A -V-1 V4 W �L4 � i Pt- 5. Address: LAWiEW VHQINEEP4- A55p mss Pte. 6. Drainage Basin: LR01ro" 20 miu.Towa Ro 8 N? 1cuc� -1 7. Type of Project: X Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt X Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... No 10. Has DEIS been completed and found acceptable by Lead Agency? 11. Name of Lead Agency — 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... 'E4) 13. If so have plans been submitted to such authorities? N o 14. Has preliminary approval been granted by such authorities? ' Date granted: _ 15. Type of Sewage Treatment System Discharge ................. surface water X groundwater 16. If surface water discharge, what is the stream class designation? .................... 17. Waters index number (surface) 18. Is project located near a public water supply system? ....... ............................... N 0 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ... ........ :.... N, 21. Name of sewage system Distance to sewage system 22. Date test holes observed 7I2'I I$q 23. Name of Health Inspector HIK6 fiLV21N5k1 24. Project design flow (gallons per day) ................................. ............................... duo 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... M o 26. Has SPDES Application been submitted to local DEC office? Form PC -97 i 36. Tax Map ID Number Map 'Ly 2 27. Is any portion of this project located within a designated Town or State wetland? No 28. Wetlands ID Number ........ .................... ..................... ............................... 29. Is Wetlands Permit required? No Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? NO 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/No N ° 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination. Yes/No N DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... NHS 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? N ° 35. Are any sewage treatment areas in excess of 15% slope? . ............................... No 36. Tax Map ID Number Map 'Ly Block l Lot Ill. 37. Approved plans are to be returned to ..... Applicant is Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall -be-sent to the Department, -and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater4 ,plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). 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 misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: 90.10 NJ 9- AV1 Mai4q Address:. .........�6 .................... �i i1f?!:J kllv'kil f 1'ti 1 .J0 4AJ► EK- C"CAIN EWryG r-io 14 -16-4 (2187) —Text 12 PROJECT I.D. NUMBER 617'.21 SEAR Appendix C State Environmental Duality Review — - SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART 1— PROJECT INFORMATION (ro be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR AL-At-4 2. PROJECT NAME• 9l'1 ELM S u6DIVIS1oN -O( 14 ' 4fos�p 1S� 3. PROJECT LOCATION: p �q�. Municipality PA�''(LSON Purafw\ County 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) BA-AD� OP-�vE ' 5. IS PROPOSED ACTION: �J` New ❑ Expansion ❑ Modificationlalteratlon 6. DESCRIBE PROJECT BRIEFLY: I✓O A&211U A\0t4 or 51Ah\.£ PAIVJML► 7. AMOUNT OF LAND AFFECTED: - - -- -- - - - - -- -- --- -1 t - - -- - - - - -- Initial) Y — acres Ultimately I acres 8. WILL ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? IL� � �PROPOSED fC as ❑ No It No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? t& Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Fore31JOpen space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ICI Yes f? No If yes, list agency(s) and permlVapprovals ;1W*4 of P�?414 410CA Oreq_ P�a�w,�u.QEQm� 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes ZNo If yes, list agency name and permiVapproval 12. AS A RESULT PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? rOVvF�t ❑ Yes ES No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor ' 11 ' Q.E Qej A(4g�AT me: Date: i 4 Signature: If the action is In the Coastal Area, and you are a state agency, complete' the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another Involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explain briefly CID rl C5. Growth, subsequent development, or related activities likely to be Induced by the proposed action? Explain briefly. <_ C CO . C6. Long term, short term, cumulative, or other effects not Identified In C1•C5? Explain briefly. " C� Gl) C— E tV C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No _. _..If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether It Is substantial, large, Important or otherwise significant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (Q magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately addressed. ❑ Check this box If you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box If you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result In any significant adverse environmental Impacts AND provide on attachments as necessary, the reasons supporting this determination: Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Name of Lead Agency Date 2 Title of Responsible Officer Signature of Preparer (If different from responsible officer) P.UTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET- SUBSURFACE SEWAGE TREATMENT SYSTEM Owner - - �SZ ALAN Address ��RA� t,� R-0�D /�t;�o►�� Located at (Street) BW)Ue 04* / &' all\ F 0 , Tax Map I-LA Block I Lot I 0 (indicate nearest cross street) Municipality PNTTOLIZoN Drainage Basin C" P_ o 0 SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test Hole No. Run No. Time Start - Stop Ela se Time (pN1in.) Dep th to Water )From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 1 II15 11 5 10 V14" �� t 2 1 b I'�'b �o 1A, wl� 2'v �2) 3 I'U� 1'L�1 �o 'L'1� %b`(ti" VV 1,11 . 4 5 1 `Ill ,ail �6 `L�i ��1Mm %w l� 1 2 I l'�� . 11 0 ;o.. " UIW 'VH1 X 311 3 111'1 � ItiLA� �0 Z1� ICY THA 13f 1 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are ootainea at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. A HOLE N0: G.L. 0.5' 0 -(oN ioPS�►L 1.0' . 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' [AMA I,ORm HOLE NO. 11 Indicate level at which groundwater is encountered Nc4e Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: 1- E A ) Pc. i +D Date 'I Design Professional Name: W I N1o�4, Address: A55o�.AMVI�X; , e,C_ �3-o c��w—►�N Sz -oe�o BP�W� -�! `osoq Signature: Design Professional's Seal �P '�OF�i w c r!Y" -1 ry NO, r = � � 2 September 29, 1998 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Proposed SSTS Ross Alan Bradley Drive Lot #24 Dear Mr. Morris: In response to your review letters dated May 20, 1998, we offer the followil 1. Plan has been revised per guidelines for fill sections greater than two feet. 2. Street address of property is now provided. We trust the above adequately addresses your concerns and request the issuance of the Construction Permit at your earliest convenience. Very truly yours, ..LAURENT ENGINEERING ASSOCIATES, P.C. - Harry W. chols, Jr., P.E. HWN:JM:hs 88044 -24 .;y ��• LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 3 Milltown Road - - •- - - - • - Brewster. New York 10509 (914)278.6108 - (FAX) 278 -2654 HARRY W. NICHOLS JR.. P.E. CONSULTING SITE ENGINEERS September 29, 1998 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Proposed SSTS Ross Alan Bradley Drive Lot #24 Dear Mr. Morris: In response to your review letters dated May 20, 1998, we offer the followil 1. Plan has been revised per guidelines for fill sections greater than two feet. 2. Street address of property is now provided. We trust the above adequately addresses your concerns and request the issuance of the Construction Permit at your earliest convenience. Very truly yours, ..LAURENT ENGINEERING ASSOCIATES, P.C. - Harry W. chols, Jr., P.E. HWN:JM:hs 88044 -24 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of P-oSS �tM Located at $RAOLE� DRa,JE T/V PNT1_F-Q-5 °N Tax Map # 1A Subdivision of $l4 I; LM 450 601 �"Jt J5 orJH Subdivision Lot # 2-4 Gentlemen: Block Lot o Filed Map # 2'AG'LA Date Filed 4 -)'1- iti This letter is to authorize` a duly licensed Professional Engineer X or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. o� NEW 1, N41CHO� Very truly yours, R y 4r-4— Countersigned: � r� � 4 Signed: P.E.,1 9:k-,# /I,/ (Owner of Property) No. 56124 /,, Mailing Address State NtYS per-- Zip jor-�o0\ Telephone: (C 1 Mailing Address: 25 &PAM t-N� ?--0 AD AP4W\L State 14eo `')� Zip_ Telephone: (,IVA) 4"1 IoSoN Form LA -97 LAURENT ENGINEERING j a ASSOCIATES, P.C. j \ MILLBROOKE OFFICE CENTRE / Route 22 8 Milltown Road Brewster, New York 10509 PER \ (914)278.6108 - (FAX) 278 -2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS April 29, 1998 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Big Elm Subdivision - Lot 24 (T) Patterson Dear Mr. Morris: Enclosed are the following: 1. Five (5) prints of SS -24 "Proposed SSDS ", dated 4/28/98. 2. Five (5) prints of SF -24 "Preliminary Plan For Fill Placement Only ", dated 4/28/98. 3. "Short EAF ", dated 4/28/98. 4. "Application For Approval of Plans For a Wastewater Disposal System ". - -5. - "Construction Permit for Sewage Disposal System ", dated 4/28/98. 6. "Application to Construct a Water Well ", dated 4/28/98. 7. "Design Data Sheet ". 8. "Letter of Authorization ", dated 4/28/98. 9. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only ". 10. Review Fee in the amount of $300.00. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. �rry W. Ni ols, Jr., P.E. HWN:JM:bd 88044 -24 I BEOROOM 4 W-8 :• x 12' -0'• BEDROOM 3. 13• -0•• x 10' -0- BATH ►(��J W WALK' IN CLOSET t • err r• T F ` I • ^�tN. , t MASTER BEDROOM 17'-0 x 18'•8" BEDROOM 2 _ _ BEN • 13• o•• x 1s• 8• J tiVA�'iOV'NTY DEPARTMENT 0 R� 1 HOUSE PLANS AD Ro �� FOR OONI COUNT ONL " OONIS `. t I SECOND FLOOR 8 = .•1344SF ;ianature & Titie ?ate cl KITCHEN i .�.•t »�`% ' r DINING ROOM p I� MORNING ROOM M 13,0"m 12••0' L.•-� i �i..._ IN OPEN ABOVE LIVING A004 w FAMILY ROOM 17••0•• x Ia'•0'• r •1 13' 0'• a 17' 0" FOYER �- FIRST FLOOR 48 28 = 114ac F �i..._ IN OPEN ABOVE LIVING A004 w FAMILY ROOM 17••0•• x Ia'•0'• r •1 13' 0'• a 17' 0" FOYER �- FIRST FLOOR 48 28 = 114ac F i. IT ►0 i aox WI OAF Fl.F- _Ar F-X)5r. WF41L pri 92W - 'DEPrIC TANK DIMENSION CHART (in feet) Number 2 III' 119' 180' I �� X06 1 2w' I° Zo7' 2113' 1� 212' 2ZZ' 1� t loo' 15 1 ?d7' 16 197. 11 ®'