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HomeMy WebLinkAbout0821DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 24. -2 -55.2 BOX 9 lirm Ir 4. ' kc ,, 00821 PUTNAM COUNTY DEPARTMENT OF HEALTH _ _ _ DIVISION OF _ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT O�- Located at Town or Village Owner /Applicant Name i M a N I P � �� Tax Map Block - 2- Lot 66.2- Formerly Mailing Address Subdivision Name Subd. Lot # 641 Miw TooP SAD �4W6i EA. Date Construction Permit Issued by PCHD d-71 111 OZ r/�R•I� 2. N� Zip a Oy Separate Sewerage System built by PVJ" P OL'1 Address 6(o DAP kA H • DA1 b4 Cr 06'311 Consisting of 19-60 Gallon Septic Tank and '5 04 Other Requirements: F � !�Q el 61'6 FA Water Sunnly: Public Supply From Address or: Private Supply Drilled by � 5 SONS Address MML6 P4, .. Building. -Type ._ F-r'-aI a Mc.-- Has erosion control been completed? %y Number of Bedrooms Has garbage grinder been installed? No s 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 Deohrtment of Health. Date: Q l I Q� Certified by P.E. X R.A. (Desi rofessional) Address 29450 U-- 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 approvals a subject to modification or change when, in the judgment of the Public Health Director, such revocati dific o r change is cessary. / By: Title: / " Date: L %J 4 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 0 'PUTNAM COUNTY H ALTH DEPT `26 3 4 I 1 Geneva Road ;(845) 27O&6130 1 � Brewster NY 1 509 `�8x f 3 "31aG r � }3, ,Received of r The Sum Of (} /- c.yrf� % �� Dollars ,. [..Cash ❑CheckO Credit Card By , 0 Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 mA Telephone (845) 279 -4003 Fax (845) 279-4567. August 12, 2003 Robert Morris, P.E. Putnam County Health Department One Geneva Road Brewster, NY 10509 RE: Individual SSTS Compliance - DiPasquale Parker Subdivision - Lot # 2 11 White Hawk Trail Patterson, NY . Dear Robert: Enclosed are the following: 1. Five (5) prints of Drawing S -2, "As -Built SSTS ", dated 03/06/03. 2. "Certificate of Construction Compliance for Sewage Treatment System ", dated 08/12/03. 3. Three (3) copies of "Guarantee of Subsurface Sewage Treatment System ", . dated 12/18/02. 4. Laboraf6ry Report, dated 02/28/03. 5. "Well Completion Report"; dated 03- 05 -03. 6. Application Fee in the amount of $200.00 payable to Putnam County Health Department. 7. "E -911 Address Verification Form ", dated 12- 18 -02. If there are any questions concerning the enclosed, please call. Very truly yours, I '-' Harry . Nich s Jr., P.E. HWN:gav 02- 055.00 43 Gs :1 Pfd I CC 100 CO -� DATE; The Putnam County Department of Health will °not issue a Cekiflcate of _ Coasfructiou Compliance unless the above form is'completed; i,e., a legai E911 add res4 is assigned by. an authorized :town :offkiai..This form is to be wb�Wtted with" the application for a Certificate of Construction Cornplince. _.__ (E91 I VERFW- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Stre t Address: # j ( W ITS 14W L/g41/ Town/Village: ��.. E'1ZS' ®n1 Tax Grid # Map Block �. Lot(s)564, Well Owner: Name: Address: SNV\'j► AS uA.L 641 PAAmwiJ _,, - $TZLl,,1sT— Z__ Use'of Well: - rima 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length 1,ft. Length below grade tj. I ft. Diameter L in. Weight per foot alb /ft. Materials: K Steel _ Plastic _ Other Joints: _ Welded A Threaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: Yes No Liner _ Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped Compressed Air Hours Yield 5' gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet 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 `/ a 131 N4ttb Z p 3 N CT's 0� (p 2 Jq1V If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type 4j uJ2 Capacity Depth 4 Mo&14 isj -51/ 101 Voltage —O HP I I � Tank Typp jr Volume 9 Date Well Completed / �'L dr. Putnam County Certification No. 4GLS� Date of Report 3 S o 3 Wel ODrill (signature) Ivu iz: t;xact location of well wan aistances to at least two permanent lanamartcs to ne proviaea on a separate sneevpian. Well Driller's Na a Di7,bS ct`S N..S Address: T ON Signature: 71 Date: 5� D' White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HI -- s DIVISION OF ENVIRONMENTAL HEALTH GUARANTEE OF SUBSURFACE SEWAGE TREATMEN Owner or Purchaser of Building Ta04ap U VV t4 Building Constructed by V► NtrL 0AW K I Location - Street Building Type CALTH )ERVICES SYSTEM ock Lot T'r e j O nJ TownNillage Subdivision Name r Y a Subdivision Lot # I represent that I am wholly and completely responsible for the location, construction and drainage of the sewage treatment system serving the above - that is has been constructed as shown on the approved plan or approved am accordance with the standards, rules and regulations of the Putnam County De hereby guarantee to the owner, his successors, heirs or assigns, to placo in'g( any part of said system constructed by me which fails to operate for immediately following the date of approval of the "Certificate of Constructi, sewage treatment system, or any repairs made by me to such system, exci operate properly is caused by the willful or negligent act of the occupant of ti system. - -The undersigned further agrees to accept as conclusive the determinati Director of the Putnam County Department of Health as to= whether or not to operate was caused by the willful or negligent act of the occupant of 1 system. Dated: Month Day Year _ Signature: Title: _ General Contractor (Owner) - Signature Corporation Name (if corporation) CorporatiodNo Address: 641 MIL4 7 Ovid �V Address: to State Zip S� State Drkmanship, material, -.scribed property, and idment thereto, and in artment of Health, and id operating condition period of two years i Compliance" for the t where the failure to building utilizing the of the Public Health :'failure of the system building utilizing'the A Al r' (if corporation) �r.JLJ dhip ,M 4. Form GS -97 YML ENVIRONMENTAL SERVICES 321 Kear Street ' - -- ' --- Yorktown Heights, N.Y. '10598' - --- ' - (914) 245-2800 - Albert H. Padovani, Director LAB Q 3&.301361 CLIENT #:. 114 TPRLISH & SONS BOX-271, 45 MAPLE AVE. ATTENTION: DWAYNE TORLISH ARMONK, NY 10504 SAMPLING SITE: WHITE HAWK LANE : TANK COL'D BY: D. TORLISH NOTES...: ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE NOW STAT PROC PAGE 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE/TIME TAKEN: 02/21/03 12:30 DATE/TIME REC'D: 02/22/03 09:00 REV ORTDATE: 02/20/03 PHONE: (914)-273-3448 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE - -TEMPERATURE..: < 40 ' COLIFORM METH: I'-IF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 02/22/03 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 02/22/03 LEAD (INS) <1 ppb 0-15 ppb 9101 02/22/03 NITRATE NITROG <0.2 MG/L 0 - 10 9139 02/22/03 NITRITE NITROG <0.01 MG/L N/A 9146 - --02/22?03 'IRON. lFe) ' - '.0.617-MG/L -'-0=0.3 mg/l. ' 2037' 02/22/03 MANGANESE (Mn) <0.010 MG/L 0-0.3 mg/l 2037 02/22/03 SODIUM (Na) 3.19 MG/L N/A 02/22403 pH 5.8 UNITS 6.5-8.5 9043 02/22/03 HARDNESS,TOTAL 68.0 MG/L N/A 02/22/03 ALKALINITY (AS 46.0 MG/L N/A - 02/22/03 TURBIDITY (TUR � ' 4�.8 '. NTU 0-5 NTU � � COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER -STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF-COLLECTION. | Pb/Cu LEAD limits for p/ EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. �blic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn-If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no, more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y; 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 32.301369 CLIENT 0 114 NON STAT PROC PAGE 2 T8RLISH & SONS DATE/TIME.TAKEN: 02/21/03 12:30 BOX 271, 45 MAPLE AVE. DATE/TIME REC'D: 02/22/03 09:00 ATTENTION: DWAYNE TORLISH REPORT DATE: 02/28/03 ARMONK, NY 10504 PHONE: (914)-273-3448 SAMPLING SITE: WHITE HAWK LANE SAMPLE TYPE..: POTABLE : TANK PRESERVATIVES: NONE COL'D BY: D. TORLISH '' - - ' .EMPERATURE..: < 4C NOTES...: COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ pH Hd DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD is suggestec. pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0770 MG/L ' VERY HARD WATER: ABOVE 300 MG/L MODERATELY'HARD WATER: 70-140 MG/L MG/L = MILLIGRAM PER LITER HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) SUBMITTED BY Di ELAP# 10323 OP U7 o ev ae t, 62 0 67 Ifi C. is ME r)F 7- OtST 4"0 PVC BOX ; 3 18 Zo 6 21 7 Z3 3 LP cof ecic TVP3 'VX PA 1000/ 0 N ARVA 4AL. SEPT tc -Thk bvcK c u EXIg TING G 4 gQ R p "L5 1 Oli N CE 16 ts 4.13 u O U PO Mf'Cl4AMSrg SoLtD p4C lbq 35 Cl- C17 C:) M DIMENSION CHART (in feet,) Number A 55 17 2 67 Ig . 3 178• 4 115 I83 5 16.8 177 6 162 1'12 7 I SS I G7 8 149 162 9 142 157 0 145 145 152 1.50 12 'I S's 1.56 1 3 165 1.62 Iq 172 168 Is 179 17,4 16 185 180 1 7 I72 191 is 166 187 19 160 182 20 154 178 2 1 149 174 22 144 I70 23 138 166 24 136 152 W on N O 0 e h m/ N . ^i OP re M r a .W -" MM .N� 01 ry N o v m V A N 03 w O 0PM P b b • P P' h n ' 0 G�� b by h tu f1 0 I Name: Sample Date: Receipt Date: Report Date: Sample Site: AQUA ENVIRONMENTAL LAB 56 Church Hill Road • Newtown. CT 06472• (203) 270 -9973 Professional Water Systems 963 Ethan Allen Highway Ridgefield, CT 06877 2/25/2003 2/26/2003 1:55:00 PM 2/27/2003 DiPasquali - 11 Whitehawk Trail, Patterson, NY Sample ID# 38119 Sample. Type: Drinking Water Sample Source: Sampler's pws Name: Parameter Sample Result Units Limits Metals Copper ND :. mg /L 1.3 Iron 0.06 mg /L 0.3 Manganese ND m /L 0.05 Minerals Chloride ND mg /L 250 Hardness 34 mg /L No limit set Sodium 3.7 mg /L 28 Sulfate 14.2 m /L 250 Nutrient Nitrate as N ND mg /L '10 Nitrite as N ND m /L Physical Color 4 CU 15 Odor 0 0 -5 Scale _.PH 6.8--- SU ...... 6.4 Turbidity 3.3 NTU 5 Report signed ba„K.ar 't,ct, wt CT Lic PH -0787 NY Lic 11706 Page 1 of 1 ND = Not detected "= above specified-limit Ala, PUTNAM.COUNTY DEPARTMENT OF HEALTH -5 vcty 4t.,C70 -, DIVISION OF ENVIRONMENTAL HEALTH SERVICES 4- 1 Y-�Uz FINAL SITE INSPECTION Date. a Ile t( Street Location! Ihspe ted by: r4- 14AIR 7-MA It- Owner Z)!A4,5ePe1w44:1 Town,_? 13, - &;�2 Permit # - F 2 TM# Subdivision Lot # :i 1. Sewage System Area YES NO !COMMENTS a. STS area located. as per approved. plans ............................ ri ! `AAArk., ..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 I-0-Mr-orn water cGur-se/Uetlan d,& 2- a. S.eftic . tank size - 1,000 ........ i -150 . ...... other..* ............... . AcZZ9, 4-0 b. $eptic tank installed level ................................................ —7- c. 10, minimum n fromfoundation ......................................... -­4 ies ;Aezo.Ar d. b-tuto Q:MF .2 Pr6tected belowfrost .................................................. .3 1 ....'Mimmurn 2 ft.Original soil.between box &.trenches 0 Junction roperly set ...................................................... 'end- l.: re Len installeci--, ob UE6etd'-Wateroo rifeeastired,` t D117s 'to an.., -7-7 7-1 - 37 fia&o�r( n,g ...................... ............... 4. ;S,l,qpe of trench acceptable.1/16 - 1/32"/foot ............. 5. 10--`ft vft,6 qrn property line -'20 ft.- foundations .......... ., 6.. DOOoflfench <30 inches from surface ..................... T. Room allowed for expansion,. 100% ................. ........ Tip LTe1-MQ96W--,=.- "At,' Depth: of in trench 12" ........ ep. :6 gravel minimum ................... 9. FIT W. M IV. 1.1 ends; capped ........ RA I . . .................... 2. Overflow tank ............................................................ 3. Alarm, visual/audio .................................................... 4. Pump easily accessible, manhole to grade .................. 5. First box baffled .......................................................... 6. Cycle witnessed by H.D.estimated flow/cycle ............ d: Surface drainage round .............. V. Overall Workmanship a. Boxes properly grouted .................. ..........4................:... b. All pipes partially bac k-filled ........... ............................... c. All pipes flush with inside of box .................................. d. Backfill material contains stones <4".diameter........... e. 'Curtain drain & standpipes installed according to f Curtain drain outfall protected & dir.to exist waterd g. Fogr4 -dischargr-aw-ay. Rev. 1/97 oy 3 4 el x o, �7. 3,Q X 71 IV$ A 47— r--- ag 01 BRUCE R FOLEY Public Health Director DEPARTMENT : :OF .. HEALTH 1 Geneva Road, Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 December 30, 2002 Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Re: Field Inspection - D'Pasquale White Hawk Trail, (T) Patterson Lot # 2, TM# 24 -2 -55.2 Dear Mr. Nichols: The following comments must be corrected in the field. 1. Field measurements by this Department indicate a water course exists within 100 feet of the exiting SSTS. 2. The stone used in the SSTS trenches is mixed with stone dust and crushed fines and is not suitable for its intended purpose. Please note that only dust free crushed stone or washed gravel may be used in SSTS trenches. _ 3. Silt fence below the well construction area is not properly installed in the ground allowing tailings and silt to wash down hill of the site. Please note that all erosion control measures must be properly installed prior to any construction. 4. The well casing must be raised up to a minimum of 18 inches above grade. 5. A bedroom count must be performed by this Department. 6. A pump test must be performed and witnessed by this Department once the electrical inspection has been completed and notification of such has been submitted to this Department. 7. Upon inspection it was noted that the SSTS construction site was extremely wet with water running along system, out of trenches and below system area, It is requested by this Department that deep. test holes be witnessed by this Department to determine if ground water exists. Please call me at the number below to set up an appointment prior to any testing. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Sincerely, Gene D. Reed GDR: cj Environmental Health Engineering Aide e BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 LORETTA MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845)278-6130 Fax(845)278-7921 Nursing Services. (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 December 30, 2002 Simone D'Pasquale 647 Milltown Road Brewster, New York 10509 Re: Field Inspection - Simone D'Pasquale 11 White Hawk Trail, (T) Patterson Lot # 2, TM# 24 -2 -55.2 Dear Mr. D'Pasquale: The following items are in violation of Article III, Section 2C of the Putnam County Sanitary Code: 1. Erosion control measures have not been properly installed below the well construction area. This violation may lead to an enforcement hearing and subsequent fines. The violation is to be immediately corrected to minimize the number of days you are out of compliance. Please note that fines may be issued for every day the violation is not corrected. Sincerely, Gene D. Reed Environmental Health Engineering Aide GDR: cj BRUCE R FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient .Services. DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 Environmental Health (845)278-6130 Fax(845)278-7921 Nursing Services (945)V8-6559 WIC (845)278-6678 Fax(845)278-6085 Early Intervention/Preschool (,845)178-6014 Fax(845)278-6648 December 30, 2002 Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Re: Field Inspection - Simone D'Pasquale 11 White Hawk Trail, (T) Patterson Lot # 2, TM# 24 -2 -55.2 Dear Mr. Nichols: The following items are in violation of Article III, Section 2C of the Putnam County Sanitary Code: 1. Erosion control measures have not been properly installed below the well construction area. This violation may lead to an enforcement hearing and subsequent fines. The violation is to be immediately corrected to minimize the number of days you are out of compliance. Please note that fines may be issued for every day the violation is not corrected. Sincerely, Gene D. Reed Environmental Health Engineering Aide GDR: cj t SENDING CONFIRMATION_ __ _. DATE : DEC -30 -2002 MON 16:49 NAME : PUTNAM COUNTY.DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE 92794567 PAGES 1�1 START TIME DEC -30 16:48 ELAPSED TIME a 00'47" MODE G3 RESULTS OK . FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... BRUM R POMY 1.O"ITA b9XM RI tt.N. M.SA P.W. &." Cdvefer AUWM Patrk HMO 90%Ww OD�m� �Pd7rnx Sinhv . DEPARTMENT OF HEALTH IOonevaRoad, Browder, Now York 10509 imlranrml ILdeh (M�171 -6130 Pa (lllli ».791t N—bs &,dm 01 278.6531 WIC(94S)272-6679 R.W4"I -6015 December30,2002i�(us1171 -sat4 Peer(,a5)17e -66u Harry Nichols, PE, Patterson Pack, Suite 106 2050 Route 22 Brewster, New York 10509 Rc:. Field Inspection - D'Pasquals White hawk Trail, ('f) Patterson Lot 0 2,1W 24- 2.55.2 Dear Mr, Nichols: The fonowing comments must be corrected in the field.. 1. Field measu rcmeass by this Department indicate a water course exists within 100 feet ofthe exiting SETS. r 2. The stone used in the SSYS trenches is mixed with stone dust and crushed fines and is not t suitable for he intended purpose. Please note that only duet $ee cnwhod stone or washed gravel may be used in SSTS trenches. 3. Stilt fence below the well construction area is not properly installed in the ground allowing WSW and silt to wash down hill of the site. Please note that all erosion control measures must be properly installed prior w any construction. 4. The well casing must bo raised up to a minimum of 18 inches abovo grade. 5. A bedroom count must bo performed by tts Department. 6. A pump teat must be performed and witnessed by this Department once the eloctrical inspection hasbeen completed and noti icationofsuchbasbeensubmittcdtothisDepartmont. 7. Upon inspection it was noted that the SSTS construction site was extremely wat with water running along system, out of trenches and below system area. It is requested by this Department that deep test holes bo witnessed by this Department to determine if ground water exists. Please call me atthe numbec below to set up an appointment priorto any testing. If you have any further questions, please contact me at (945) 278 -6130 Co. 2261. Sincerely, Gana D. Reed GDR:cj Rav romamnal Health Engineering Aide DEC -20 -2002 10:19 AM HARRY W NICHOLS 914 279 4567 P.01 • DEC-18-2M 17:38 FF MspUTNAM COUNTY DEPART 845 - 271.7921 T0s92794567 Pn1i1 .e DICC-10 -0000 01120 PM HARRY M "%CWM -0 -- 914 374 A967 pool VVIK m CQVM VZPARTri'aM oe WALTR ng" MR ga. FW 7 Aaca: rriI.i�.... Treaabes PCHD cmwwon Polo 0 423 —D 21-- P�Si A2&) Lccatsd; 11 wr�.Yt NA �� t'�wu& ����, �.. �, �._. .Y._.�('r) M........- _w.��.�_... , OwnerlAppliomNam: ,5111, .jjf_;L. TM 241 Bic& ,.Lm. Lot AU Ponsaarlpr �bdlvldon Nstn« Subdividm Lot 0 � fui eompleted4 , It me= oomow. DOW: „ 12- %its0h sm 1s VxW eo,a+ uded as per pieo0 Is wed 6510 Is va Imod"pslrpiAal An c ado control musim in F" i that die rpmu*j sA W 0 the sbme pegies< bas bw ooestc ood and X ts" hupected and vedled thalr eomplertm In aoaordagoo with tbt issued PCM Coutmdou Permit and approved plus and the 3uWw6, bin mW Admilkidwn of the Putnam Cmq 08putmw of D proms st �o sz_ at UNZ # Address: R��� �, ,i�..1�x�1�4;c. � 1..�.. Cootmeap: • FOL ADAM I(CM 0 ' . ,. (NAM „ . Yom& =q2 -2= WM 16142 T1L1845.276 ^79el Nfapemmm CMXN 0.0% me* CF P. 1 )WAO CDT 1M-7P TPA - A4c%- ?7A -7gP1 NAME: PI_ITNAM COUNTY DEPARTMENT OF P. 1 DEC -18 -2002 04:28 PM HARRY W NICHOLS 914 279 4567 P.01 • 2�iQ -'�q21 # 07.055-x2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIM-ION OF ENVIRONMENTAL HIALTH SERVICES ST FQR MAL IN$PEG. ON For: Fill Date: t jr t_o?- Trenches ftlp PCHD Construction Permit # Located: l i W%tTi f- N A%4U TQA 16 (T). (V) w, 9,%jMM+S,pL) Owner /Applicant Name: 5 t "* o-� " f AS j A try TM 2y Block 2 Lot 5. s . z Formerly: Subdivision Name: , Subdivision Lot # Is 'system All completed? Date: it system complete? , , „•Yx6 Date: 't z • il- o z Is system constructed as per plans? Yes Is well drilled? yes )~late: M- 1 . 07- TS well located. as per plans? Yes 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 PdHD Construction Permit and approved plans and the Standards, Rules and Re lations of the Putnam County Department of Health, A Date: Itc. _ 1 fr 107- _ Certified DWgn professional Plr RA Address, 20 sfl Ro,)EL Z §061026 119, A =09L,ic, # 1!74 Comments: AA/P 7Z 4",::: -- FOR: 0 ADAM Gd GENES C (WE) Form FUL -99 SENDING CONFIRMATION DATE : DEC-18-2002 WED 17:38 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845-278-7921 PHONE PAGES START TIME ELAPSED TIME MODE RESULTS 92794567 DEC-18 17:37 00'44" G3 OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED.. OCC-10-2002 04120 P" HARRY W WSCHOLD 9l4 279 4567 P.01 7trmm comm DzpAw=NT or amTR Ontmo 0yVanom"MALM"Is SEW= MORMON For. Fm Date; -JWW.AlftL TMAN PCHD C.V.W. Pk 0 LwAtW: 11 WKM AhlAit TRAw m m OWWIAROMNIur. Sillgb)l jjfAdQ,'"lL TM 214 Bi oak I Lot _tL2 Blibdivisim L&O 2- ls'rjq= fm wsoplaw? Dow h rflm eampW Iva r?mte: k2- it- 021 Is oval dstlad7 Its Data VI-IS-01. Is wall Wood me per pla=t vas — Are mmion caauW mum= In phW I to that the qgm*l a ACK 41the Aban pfftim has boom commoucled mad I have bqmcd and vedled dick complatloo in woorbace with the iced Mw commurda PenrAt and approved place aid the Stodarde, RWft god doax of the Putmam Cot Dmutnww of Hftltbh �.- - L. - Date: it 19M -CadWz--Pp OW6_4 Pli&.:<RA—. 71) Addrom, ILQI-% # conslamr, FOR 0 ADAM II MM CJ Form FBt-9P WOO =-ja-em wmir.:42 MiB45—'M- ^79P' t4VEsnA, wCMpM0q-XU1qD0CF P. 1 A BRUCE R FOLEY� LORETTA MOLINARI RN., M.S.N. Public Health Director 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/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 January 13, 2003 Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Re: Field Inspection - D'Pasquale White Hawk Trail, (T) Patterson Lot # 2, TM# 24 -2 -55.2 Dear Mr. Nichols: The following comments must be corrected in the field. 1. Field measurements by this Department indicate a watercourse exists within 100 feet of the exiting SSTS. 2.. Silt fence below the well construction area is not properly installed in the ground allowing tailings and silt to wash down hill of the site. Please note that all erosion control measures must be properly installed prior to any construction: 3. A pump test must be performed and witnessed by this Department once the electrical inspection has been completed and notification of such has been submitted to this Department. 4. Upon inspection it was noted that the SSTS construction site was extremely wet with water running along system, out of trenches and below system area. 5. Per our field meeting on January 6, 2003, it was agreed that a curtain drain needed to be installed and the existing stream needed to be piped. Revised plans need to be submitted to this Department for review reflecting all changes considered. If you have any further questions, please contact me at (845) 278- 6130'ext. 2261. Sincerely, Gene D. Reed GDR: cj Environmental Health Engineering Aide SENDING CONFIRMATION DATE JAN -15 -2003 WED 16:44 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 77921 PHONE : 92794567 PAGES : 1�1 START TIME : JAN -15 16:42 ELAPSED TIME : 00'44" MODE : G3 RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... BRUCE R POI.BY t.ORE7TA MOI.DIARt B.N., K&M RMe Hmaa OWtw Moerm P00, Phaaa DPaeta 12bego,- f Panew So%*- DEPARTMENT OF HEALTH I (k— Road, Brewster, New York 10509 xnxrlx ®mgpl liana Ms)2tti•612a Pn (NS)17a•792t rea.ty 6.nim (ISS)2rs•sss1 Wrc (us)2n•ss» sn(BM272-600 January 13, 2003 J1" NW"-dOe4Yw�b.W ("27a -sou mn(as>)2n -66u I Harry Mchols, PE ! Patterson Park, Suite 106 2050 Route 22 Brewster, Now York 10509 Re: Field Inspection - D'Pasquale White Hawk Trail, M Patterson Lot # 2, TM# 24 -2 -55.2 Deer Mr. Wichols: The following comments must be corrected in the field. 1. Field measuraneots by this Department indicate a water course exists within 100 fed of the exiting SETS. 2. Silt fence below the well construction area is not properly installed in the ground allowing tailings and sift to wash down hill of the site, Flossie note that ell erosion control measures must be properly installed prior to any construction. 3. A pump test must be performed and witnessed by this Department once the electrical i inspection has been completed and notification ofsuchhasbeen submitted to thisDepartment. 4. Upon inspection it was noted that the SSTS construction she was ad emely wet with water running along system, out of trenches and below system area 5. Per our field meeting on January 6, 2003, it was agreed that a curtain drain needed to be installed and the existing stream needed to be piped. Revised plans need to be submitted to this DeparttneM for review reflecting all changes considered. If you have any further questions, please contact me at (945) 279 -6130 mtt. 2261. i Sincerely, Gene D. Recd GDR:cj Environmental Health Engineering Aide PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLH SERVICES FIELD ACTIVITY REPORT NAB' 72 1,0 5 a uig G,C Street Town State Zip PERSON IN CHARGE _ OR INTERVIFWE LJ/, st/ /C//ce /_�� llatP: 5 L1.2'e�,9:3 . PUMP TEST DOSE TEST REQLUED GALLONS 9- 9,y o /.2 8. 7 aal, L. START '. 'Z /" C EL. STOP 2eJ 8 " • Title is '•: : i acknowledge receipt of •• SIGNATURE: 02/96 Titl m A' /.2 8. 7 aal, L. START '. 'Z /" C EL. STOP 2eJ 8 " • Title is '•: : i acknowledge receipt of •• SIGNATURE: 02/96 Titl LORETTA MOLINARI R.N., M.S.N. Acting 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/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 May 14,.2003 Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Dear Mr. Nichols: ROBERT J. BONDI County Executive Re: D'Pasquale White Hawk Trail, (T) Patterson Lot # 2, TM# 24 -2 -55.2 The above referenced separate sewage treatment system can be backfilled. There are no further comments to be addressed. If you have any further questions, please contact me at 845- 278 -6130, ext. 2261. Sincerely, Gene D. Reed Environmental Health Engineering Aide GDR: cj iieldins b SENDING CONFIRMATION DATE MAY -14 -2003 WED 15:26 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845- 278 -7921 PHONE 92794567 PAGES : 1/1 START TIM MAY -14 15:25 ELAPSED TIME 00'38" MODE : G3 RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... 0. LORMTA MOLINARI RX, U.S.N. BOBBRT J. BONDI Ald-g Pnblk Hpa4 M—w c—V P.Mft Ditina aj PatirAt Serrka , DEPARTMENT OF HEALTH 1 Ctmeve Rued. Brewster, N— York 10509 eovlr4nutp1hl HniW (8451278.6134 Pn(845)278 -7921 Ntmltry Sw, w (845) 278 -6558 WIC (a45) 278.66%8 F.(545)279-6M W1y h4erne11ce/Pte4easet (845)278.6014 Pn("216.55 8 May 14,.2003 Harry Nkho* P8 Patterson Park, Sulk 106 2050 Route 22 Brewster, New York 10509 Re: D'Pasquale White Hawk Trait, M Patterson Lot 0 2, JW 242 -55,2 Dear I&'Twbola: The above ta&mnccd seperak sewage treannem System can be backfiUed There are ao 8trther comments to be addressed. If you bave arty further queatiooe, please comet me at 845- 278 -6130, ext. 2261. Sincerely, peso A. Reed Environmem d Health Engineering Aide pDR:cj ticldins I 'A —A" IIL i QV.fOxj . "Pzm) 'KCS AL Y )E S i ONE DAYS STORAGE (E- 6"t,�4' } EL 836 49 SIF i Q PK f P ON�EL e`))tnsid�.the house"' ' hl GAG �•,u'WALLS fimo I-� DB -I �! D15TR15UTI ON SOX 7 uo-r 70 a'At E / � rte- -- •'y,���/ TIC PUMP OFF(ELA -WoL) BOTrOM(EL448:�11` ) iL, � APPKOX• �X15YING � o n ell / \ / b/I/ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FO REATMENT SYSTEM PERMIT # -P- a ,3- 0)— Located at i W�-aT }�kl��i— fi��- Town or VillageGo Subdivision name �¢ Subd. 'Lot # Y Tax Map �4 Block 2 Lot ' !� Date Subdivision Approved $ 100 Owner /Applicant Name Renewal Revision Date of Previous Approval Mailing Address Gill (P IL IT-04 "I D �6"T6?— Amount of Fee Enclosed 000 Zip Ipso Building Type Lot Area No. of Bedrooms Design Flow GPD__e 00 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of ATOP P-tol ro prc-4 .. Other Requirements: P&Mf --2Y` . 17- 1�a gallon septic tank and —!9J '4 1--r— To be constructed by U Address Water Supply: Public Supply From Address or: _Private Supply Drilled by -rp n 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: A,0AA1A1L P.E. �k R.A. Date ! -if /&& Address d 2 `� �6 ��I2. A) � w50I License # �I if ZK 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)ieQ considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. Approv r discharge of domestic sanitary sewa only 1 By: Title: Date: l"I d �— White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 BRUCE R. FOLEY Public Health Director- TO: PROJECT: 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 DEPARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM TOWN: C S C.� PV DATE SUB'D APPROVAL: NOTICE OF COMPLETE APPLICATION DATE: tJ .. .. ......... ............ BEDROOM 2 13' 0— x I - Hot -SECONUFLO.OR DINING 040OA4 13. 0.. 12••0- Go • LIVING nOOA4 FIRST -F.L.O.0 n T MASTER BEDROOM 17*-0 OPEN <: Pr AM COUNTY DEPARTME OF HEALTH 3]` PIlAfS APPROVED FOR BEDROOM. COUNT ONLY, lip BETIF06 4828 = 1344Sif ALL SU; QUEN'l TO THESE HOUSE Dy 'a T1, cll T 11 7! .1 A_4-�4; pGp9i; FOR APPROVAL qTl LE DATF, DA KITCHEN OM -MORNING 1400M N'I BATH 1 N x O►E N ABOVE r FAMILY ROOM 13' 0" W 0- FOYER BEDROOM 4 4828 = 1.1 44.ql 1: 12%0- OR.ESSIN BEDROOM 3 WALk- 13'-0" 10'-0' CLOSET- BEDROOM 2 13' 0— x I - Hot -SECONUFLO.OR DINING 040OA4 13. 0.. 12••0- Go • LIVING nOOA4 FIRST -F.L.O.0 n T MASTER BEDROOM 17*-0 OPEN <: Pr AM COUNTY DEPARTME OF HEALTH 3]` PIlAfS APPROVED FOR BEDROOM. COUNT ONLY, lip BETIF06 4828 = 1344Sif ALL SU; QUEN'l TO THESE HOUSE Dy 'a T1, cll T 11 7! .1 A_4-�4; pGp9i; FOR APPROVAL qTl LE DATF, DA KITCHEN OM -MORNING 1400M N'I 1 N O►E N ABOVE r FAMILY ROOM 13' 0" W 0- FOYER 4828 = 1.1 44.ql 1: PUTNANI COUNTY DEPARTME \'T OF HEALTH .. DMSION OF ENN IRONNIEN -fAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT' NAME OF OWNER: STREET LOCATION: REVIEWED BY: RM, OR, AS, SRDATE: TAX i L*= -. (CONI MNfED) Y i p06UNIENTS Y \ IREOUiRED DETAILS O� PLANS CO \`f'D) �. PERMIT APPLICATION (JUHOUSE SE�S'ER -' /" FT. 4 "0'; TYPE PIPE CAST IRON. WELL PERMIT OR PWS LETTER C-JUNO BENDS; bIAX BENDS 450 1j` /CLEANOUT• (___)PC -97 RENEWALS L_ )LETTER OF AUTHORIZATION (___)(_)SITE NOTE (N-0 CH_4NGE) DESIGN DATA SHEET (DDS) FILL SYSTEiNIS CORPORATE RESOLUTION Us`}10' HORIZO \ ?AL; PAST TRENCH SLOPES 3:1 TO GRADE I SHORT EAF U(JFILL SPECS! FILL NOTES 1 -5 PLANS -THREE SETS UUFILL PROFILE & DIMENSIONS HOUSE PLANS - TWO SETS (�UFILL Lti EP.�.i \SION AREA VARL�NCE REQUEST FILL GREATER MAN 2 FEET SUMMSION UU CLAY BARRIER LEGAL SUBDIVISION UUFILL CERTIFICATION NOTE . ' SUBDMSION APP VAL CHECUD U(_JDEPTH GAUGES PERC RATE 61.0 - 12 W-4 U(_JVOL ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS L_)FILLREQUIRED DEPTH UUSEPARATIONDISTANCEFRO `ITOEOFSL•OPE - (•-)(JCURTAL I DRAIN REQUIRED FRENCH GENERAL UULF TRENCH PROVIDED LOFT MAX. UULOCATED IN NYC WATERSHED UUPAR.4LLEL TO CO \?OURS . UUPLANS SUByIITTED TO DEP - UU1-1 l -EXPANSION i PROVIDED (__)DELEGATED TO PCHD ' U(__)DETAIL/DUST FREE CRUSHED STONE OR WASHED. GRAVEL. (�UDEP APPROVAL, IFREQ'D. GEOTEXTILE COVER ' LJ. _)DEEP TEST HOLES OBSERVED UU PAR4T10- DISTAtiCES '. U(�PERCS'TO BE WITNESSED (__)(�10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL . . CJ�EX- APPROVAL SSDS AD7, LOTS UU20' TO FOU \�T ION WALLS _ - (_J LjWETLANDS 'FTOW)`i/DEC:PERbIIT.iiEQ.'D ?) . UU100 `TO'WELL,200'Ri.DLOD,150'TOPITS UUDATA ON DDS:P'LANS. &: PERMIT SAh7'E , . U(�100' TO STREkM, WATERCOURSE, LAXE (Iric. espiB) U( )PRE 1969 NEIGHBOR-NOTMCATION (x(__)50' TO CATCH BASIN, 35' STORMDRAI\', PIPED WATER ( -J(�LETTERBUZBA - "' � VU10'TOWATERLINE(pits -20') . UULOOYR FLOOD ELEVATIONWR200'_- . - - - ...... _ . 50; Wti RMITf ENT DRAINAGE-COURSE . - (.(�SOILTESTING LOTS>10YEARS OLD U(U /500' RESERVOIR, ETC. 150' GALLEY SYSTEiMS. RBOUi1tED DETAILS ON PLANS -}200' UU10'.MINTO LEDGE OUTCROP _ (�( JSEWAGESYSTEMPLAN- (NORTHARROW), SEPTICTANK (_JC_-)SSDS HYDRAULIC PROFILE (�(�10' FRO`I FOUir'DATION; 50' TO WELL ' UUGRAVITY FLOW WELL - - S___) . _ -1 CONSIRVC.10.z1.PiQxE S 1= 15__�.�_— ._...___ _. DISIE'NSIONST0-PR0PERTYZLYES . -_ -- UU UU DESIGN DATA: PERC & DEEP RESULTS (_)(JLOCATIOii OF SERVICE CONNECTION - (__ C_)2' CONTOURS EXISTING & PROPOSED (__.)L_)MPi 15' TO PROPERTY LINE ( _JUDRIVEWAY & SLOPES;. CUT ' SLOPE UCJFOOTING /GUTTER/CURTAIN DRAINS Df (520 %) 4 UUSIAPE SSTS AREA (_wUSDA SOILTYPE BOUNDARIES L- �UREGRADED T015 %, IF (_J(�TITLE BLOCK; OWNERS NAME ADDRESS pOSE/PUb1P SYSTENIS XTP- SYSTEMS ThL:, PE/RA; NAME, ADDRESS, PHONE# UUPUMP NOTES O tJUDATE OF DRAWING/REYLSION U( 756/6 OF PIPE VOLUbIE/DOSE VOLUME NOTED ()(JDATE REFERENCE RE _JDOSE UUDETAIL FOR FORCE MAIN, (PIPE TYPX, ETC.) (_)(JLOCUM OF WATERCOURSES, PONDS (-J( AND D -BOX SHOWN & DETAILED LAKE5,WETLANDS WITHIN 200' OFP.L. -JPIf UPI DAY STORAGE ABOVE ALARiti1 - (LJ( PROPOSED FINISH FLQORAND CURTAT\DRATN .. . BASEMENT ELEVATIONS .._ UUSTAhDPIPES, 5' BOTH SIDES, DETAIL - - (�(�)WELLS & SSDS'S W/IN 200' OF SSTS (_)(_ J15' bIRi to CDS = >S %, 20'-4 %i- 25' -3 %, 3�'•1 %� 1b0 %-<1% ( __)( PROPERTY METES &BOUNDS U(___)20' bIhN to CD DISCHARGE/100' irlth 182 cons day discharge U(JEROSION,CONTROL FOR HOUSE, WELL & UU10' MhN to NON-PERFORATED PIPE SSTS, EROSION CONTROL NOTE . COMl1ENTS: (REVSHEET)09101 100 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL �P please print or type PCHD Permit # / - v� 3 — 0 -L. Well Location: Street Address L Town/Village a Tax Grid # 6 t Map" Block Lot(s) % Well Owner: Name: S �w5 D+ P Say Address: V-1 C(O t gowo "} Use of Well: 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 5 f gpm # People Served A 2_ Est. of Daily Usage _E op gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling 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 Is well located in a realty subdivision? ...................................... ............................... Yes -- No Name of subdivision Lot No. 12- Water Well Contractor: I$ DI Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: `— Town/Village `- Distance to property from nearest water main: `-� Proposed well location & sources of contamination to be provided on separa sh plan. ��'Q� Date: _Applicant Signature: U 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 iller certified by Putnam County. Date of Issue L Permit Issui Date of Expiration Title: Permit is Non- Transfe rabl White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 TUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION�O &. ENVIRONMENTAL "HEALTH'SER'�IESd r. 'APPLICATION' FOR APPROVAL; OF PLANS FOR / f„ ::. ; A, WASTEWATER TREATMENT. SYSTEM .. If �l+:M t hl'..... -f,U%r-. 1. Name and addaress,of,applicant . ;." :� � .._ ��� r.. � ,, //�� (� ) r/ Jt�'. \. l {' Ali:• , v' !.�'C: 2. Name of project 3, Location TN 1 4: Deign Professional: ���� P� e� 5. Address: 1 ( .`,. , ) S, , " 1 F. 111 , 1 /� •1 . .. F� Q 4 O 6. Drainage Basin: ' �a+G r _rs r 7. T e of Pro Private/Residential Food Service Commercial-,,," V , Institutional _. Apartments ..,.. }.....__�._._..__........ obileme Parke. Office Buildin g Realty Subdivision ,. ,Other:'(specify) _.... 8. Is this project subject-to State Erivironmenfal Quality`Review (SEQR)? Type Status.,(.check.one) ........... Type >.I• 'Exempt ' �...... ....., ..... �...a 1 }:QType�II' 9. Is a Draft Environmental Impact Statement (DEIS)- required? .. No 10: -Has'DEIS been completed and found acceptable by Lead Agency?.... 11: -Name oMAd Agency A ,t ,t this�ro�ect in In area under the control of local planning, 4oning „or other{ tt< rat ocials;.ordmances ?'' ` �'p ” ' y` ' ` { "i lii "1.•k..a` 13 :If so-,. ave= plans' been sub'mitteid t' 'r ' 'k o` such authorities . ................ .. ' _ ; ':, , t t t '• 'LL{ !'.J1.11 i • v', '! r4 7Has prehmm ry,approval b ,p,&ran ted:by such authorities? D te'gTanfed:`''' ' ,.,:. . ; .. :.: � ' is �. >�;•• i� }i ")..r.. � .(;It) 15. Type of Sewage Treatment System Discharge ................. surface w11 ater � groundwater � ., • i. 'i:. ;;: L:1RtiIC �c rlFl,v1�•At:i�ti 16.iY If,sur#'aee,water discharge ,what is the'strearniclass designation? ... ..,:.....,. " .. .:1• i :''i;i_ , ,'1.: z'r•.t}i';' ;; —.,���.. °i,.l Si Y J i'.Ji/.i�.�.�l:i\ .�, 17: ` Waters'index number (surface) ............ ........................... �. ply {tit: \�r•�e'11�:`li' 18. Is project located near'a public water supply systems ` k1 jt`i" :4 i`.(1 1j?1:`11'14ti; 4 -}. �. .. ,*,tf`° i � •`,, rla it ).. '.:.,,, ,.� ..':.� , t'.. ,11��A��';l.t. \^ ,T1 —•t+ 19. If yes, name of water supply 1� : � i ', D.istance, o; "4tert li, plyi�tN !:.li 6��t,.�ri7iJ'.Yj.l�'i t.7i1� �iiJ�.].:1 .,,� }.,. •:�,:,_,. .. ., 20. Is project site lnear, ,a,public'sewage 21. Name of sewage system `Distance to:'sewage sysfeni`e'�'� 22. Date test.holes~observed 23. Name of Health Inspector 1f1>6 �JA"Lii1�(�I 24. Project design flow (gallons per day) .......................... ,.... .... ................. 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... l�0 26. Has SPDES Application been submitted to local DEC office? ......................... i Form PC -97 27. Is any portion of this. project located within a designated Town or State-weiland? 28. We ID Number ............................................................. ............................... t%A 29. Is Wetlands Permit required? ............................................ Has application been made to Town or. Local DEC office? .......... . ...... ................ i t" 30. Does project require a DEC Stream Disturbance Permit? .. ............................... �Q 31. Is or was project site used for agriculltural activity - involving application of esticides to orchards or other crops, solid or hazardous was_ te _ disposal,.- l and.filling, sludg e a pp lication or industrial activity? .... Yes/No � p 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: tJ 0 DESCF BE: _.. 33. Is there a local master plan on file.with the Town or Village ?. ..........................; 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ....... ................................................. .......:.. r10 35. Areany sewage treatment areas in excess of 15% slope? . ............................... 3.6. Tax Map ID'Number .......................... ............................... Map Block. 2 Lot%s'2 37.,...Approved plans are to be returned to ..... Applicant Design Professional NOTE;:All-applicationsfor review and approval of a new SSTS'fo 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 approvalmof the_SSTS prior to final approval by the,.pepartment. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or thecgeation of impervious surfaces, and the project applicant should obtain the appropriate forms for such act��i tie s�friom 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 /.,the application. must be accompanied by a Letter of Authorization Form LA-97). Failure to comply with Wis rovision 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 o m knoWed a and belief. False statements made herein are punishable a .T .Y b' .f p s a Class A misdemeanor pursuant to,Sect' n 210.45 of the Penal l w� SIGNATURES & OFFICIAL TITLES: 1W - (40 Mailing Address !-�s� �r T'' t �W 4rV ' Harry W. Nichols Jr.,. P.E. Patterson Park, Suite 106 2050 Route 22 ' - Brewster, NY-10509 - Telephone (845) 2794003 Fax (845).2794567 June 24, 2002 Putnam County Health Department One Geneva Road Brewster, New York 10509 Att: Robert Morris, P.E. Re: Individual SSTS Lot # 2, Parker Subdivision White Hawk Trail Town of Patterson Dear Mr. Morris: Enclosed are the following: 1. Five (S) prints of SS -2, `Proposed SSTS," dated 6 /24/02_ 2. "Short EAF," dated 6/24/02. 3. "Application for Approval of Plans for a Wastewater Disposal System." 4. "Construction Permit for Sewage Disposal System," dated 6/24/02. 5. "Application to Construct a Water Well," dated 6/24/02. 6. "Design Data Sheet." - 7: "Letter of Authorization & Corporate Resolution," dated 1/30/02. 8. Two (2) copies of Residence Floor Plan(s), for `Bedroom Count Only." 9. Review Fee in the amount of $300.00. 10. Pump Calculation We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, Harry W. Nic olif s Jr., P.E. HWN: JM: jmm 02- 035.00 SHORT ENVIRONMENTAL ASSESSMENT FORM: For UNLISTED ACTIONS Only_ PART. I—PROJECT INFORMATION (TO be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR 51r6 ADH DI 2. PROJECT NAME 7 3. PROJECT LOCATION: 14-1" (9/95)—Text 12 4. PRECISE LOCATIOJ (Street address and road Intersections, prominent, landmarks,. etc., or provide. map) OJECT I.D. NUMBER 617.20 S E0 R:,� Appendix C State Environmental Quality-Revlew SHORT ENVIRONMENTAL ASSESSMENT FORM: For UNLISTED ACTIONS Only_ PART. I—PROJECT INFORMATION (TO be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR 51r6 ADH DI 2. PROJECT NAME 7 3. PROJECT LOCATION: Municipality County 4. PRECISE LOCATIOJ (Street address and road Intersections, prominent, landmarks,. etc., or provide. map) 011A_ 5. IS PROPOSED ACTION: K NOW C1 Expansion ❑ Mod If Ication/al teration 6. DESCRIBE PROJECT BRIEFLY: •7. AMOUNT OF LAND AFFECTED: i Initially acres Ultimately acres 8.1 WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR-OTHER EXISTING LAND USE RESTRICTIONS? --ayes -[:],No If No, describe briefly 9.: WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential 0 Industrial ❑.Cornmercial ❑ Agriculture ❑ Park/Forest/Open space 0 other Describe: it! 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY. STATE OR LOCAL)? ❑ Yes JgMo If yes, list agency(s) and permit/approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes RNo If yes, list agency name and permitlapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? C3 Yes 1�kio I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE F1 Applicantisponsor name: Date: Signature; A A- 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 PUTNAM COUNTY DEPARTMENT OF HEALTH.... DIVISION OF.ENVIRQNIYIENTAL HEALTH SERVICES DESIGN DATA SHEET'- SUBSURFACE SEWAGE TREATMENT SYSTEM Owner 51MPHt; D I P 4L`5 Address 64i AL1 i Qij � epaj5T5410Si Locatedat (Street) 3PAA -Ol Tax Ma P Block 2 Lot .. (indicate nearest cross street) r- Municipality P�"t' von Watershed CAl�7 6 —AANV4 i' - SOIL PERCOLATION TEST DATA Date of Pre - soaking Z� I Date of Percolation Test Hole No. R,uu N. ::Time Stax't $top1!iin.) a &6 Time De tb to Water _p m F- o r pn G d. r _ o Surface %(Inches) Start . ..:Stop Water e vel Dropp In finches :Percolaq on Rate iVlio/Ioc6: ; 21.1- Ilt .it.. 4. S � 2�� U 24, 10 .2. 3 4 i +�� ���� Ila'�(N 2 - -.,.. 4 NOTES: 1. -Tests to be- repeated. at same depth until approximately equal percolation rates are obtained at each percolation test hol'e.: (i.e. s 1 min for 1 -30 min/inch s 2 min for 31 -60 min/inch) All data to be' submitted forureview 2. Depth measurements to be made from top of hole. Form DD -97 Indicate level. at which -groundwater is encountered N brig Indicate level at which mottling is observed kk Indicate lev,el..t.o which . water level rises after being encountered: --PA Deep hole *observations made by-. D&OPJ dot q5 Muboawxj Design F Address: Signature: i3f. NEW Ic Al LU No. 561 TEST PIT DATA 2.- 46 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES �DE,PTH HOLE NO. HOLE NO. G HOLE NO. G.L. 0.5 T'4 1.01 2.0' L/r( 2.5' 3.01 3.5 4.0 4.5' . 5.0 5.5 LOP 6.0 6.5 7.0' .. 7.5 8.0 8.5 . . ... ..... 9.0 9.5 10-.01 ... Indicate level. at which -groundwater is encountered N brig Indicate level at which mottling is observed kk Indicate lev,el..t.o which . water level rises after being encountered: --PA Deep hole *observations made by-. D&OPJ dot q5 Muboawxj Design F Address: Signature: i3f. NEW Ic Al LU No. 561 tt I r 14'1 �1�i `t..'�K,�; Sx)Ejll,I I.T PUTNAM COUNTY DEPARTMENT OF HEAL DIVISION OF ENVIRONMENTAL. HEALTH,SERVICES''< < { LETTER OF AUTHORIZATION RE: Property of r�{� S Located at � 1 I W l-f' 17� � A��— 1 • ,. ,., „� .:,:,, JI�I . TX P Tax Map # _ Block Lot { 1 Subdivision of Subdivision Lot # Filed Map # 2� I Date Filed.._ Gentlemen: This letter is to authorize :.....a-dudy.licensed.ProfessionaI Engineer _or Registered Architect . for the re q uired " 'wastewater treatment and/or water supply permit(s) to serve the above- noted-property m 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'.tlus '; matter and to supervise the construction of said wastewater tretment and/or water supply $ ysterii$':in - - conformity -with- the - provisions: of Article 445 - and/or: 147 of -the -Education L--aw; = the- Public'-Health .Law, and the Putnam County Sanitary Code. P� of NEW ro Very truly yo s, _.__...... a, C.ountersigne �' Signed: P.E., R.A., # = \ W ! (Owner of Property) 2 0. r, Mailing Address✓ Mailing Address: �. /Yi i t•CtU�nJ� (�( State (�� Zi IDS Q� State Zi !'x.:0.;4 •, :i:',,,. p p Telephone: ' Telephone: s1..�7 Form LA -97 Harry..W. Nichols Jr., P.E. -Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509-- - 279-4003, Fax 279-4567 CONSULTING SITE ENGINEERS A. U,44 P : - - ■ JOB No. PuAf? 410",h1l - --------- F0.1pp- -- - --- -- . .. .... Frmly&v r 6�A TE —VAL mS D .... ... F x TO 14 1-D 14 KO-1-FT ..... ... .. _VA4 r .... .. .... .. . Harry W. Nichols Jr., P.E. -:'Patterscin Park, Suite 106 2050 Route 22: :1 Brewster, NY I0509 j" 279 -4003,- Fax 279-4567 CONSULTING SITE ENGINEERS I JOB No. Q SHEET No. 2 COMPUTED BY N W 0 DATE CHECKED BY I 4A X 48(c p VA01 O+AM BE R SIZING -; dj FREE! MR-: 54��E P. 6NE RA& ff-. is P vx� P 77 Z ------- ---- ............... vj I ......... . ... 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Ses!Ea FALLS NEW YM 13148 01985 Goulds Pumps, Inc. Effective July, 1985 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Stre t Address- -- jI 1 ' , W iT E jL4l LAN �- Town/ 'i lage: _ / E�ZS' VAI Tax Grid # Map -, Block �,, Lot(s)56, L Well Owner: Name: Address: 641 M1114mwi,) --gip �s-rErz_ Use of Well: - rime 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length 1, ft. Length below grade __t L l ft. Diameter in. Weight per foot _lb/ft. Materials: Steel _ Plastic _ Other Joints: _ Welded A Threaded _ Other Seal: Cement grout _ Bentonite _ Other Drive shoe: Yes No Liner: ' Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes No Hours Second Well Yield Test Bailed _ Pumped Compressed Air Hours 40 Yield S gpm Depth Data Measure from land surface- static (specify ft) During /yield �test(ft l�7 © Depth of completed well in feet as Well Log If more detailed information descriptions or sieve. analyses_:.'.._........ are available, please 1 o ra Depth From Surface Water Bearing Well I Diameter(in) Formation Description `ft: .__ ft. Land Surface �'% oZ 33/4 94MYA-IJ Z d 3 1rJ t'i` If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth Model.4 G 54112 Voltage e O HP 1 !!al Tank Typ Itr Volume Date Well Completed Putnam County Certification No. Date of Report We rille (signature) iNm'E: txact location of well witti distances to at least two permanent landmarks to be provided on a separate sheettplan. Well Driller's N e D 1 S r dC� NS Address: ON Signature: ' Date: White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97