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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25. -1 -10 BOX 9 ® UTNAM COUNTY DEPARTMENT OF HE DIVIS'ON OF ENVIRONMENTAL HEALTH S CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # SW -11 -03 Located at 480 Haviland Drive Owner /Applicant Name David Rathbun Formerly Prestige Homes Town or ViHage Patterson Tax Map 25 Block 1 Lot to Subdivision Name N/A Subd. Lot # N/A Mailing Address 4861 South Lake Drive, Boynton Beach, FT. 1336 Zip Date Construction Permit Issued by PCHD 8 -28 -06 Separate Sewerage System built by Land Works, Inc. Address 44 Meeting House Road Pawling, NY 12564 Consistin of 11000 Gallon Septic Tank and g P Fo u r (4) drop boxes with 375LR of aPT wide trenches Other Requirements: Water Supply: 0 N/A Public Supply From Address or: x Private Supply Drilled by Existing Address J-------•---=•, Building -Type .Single- Family residence Has erersion.. control been completed? No Number of Bedrooms 3 Has garbage grinder been installed? N/A 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 oft Putnam CoFkty Department of Health. r, n Date: 9 _29_n6 Certified by y ° am ✓-�� 4-, P.E. x R.A. Address 11 W. Main St., P (Design NY 12564 License # 61468 -1 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocatigh, modificatigfi or change is necessary. I By: Title: ^' Date:. , W-06 White copy - HD it ; Y o copy - Building Inspector; Pink copy - Ow, er; k1ge copy - Design Professional Form CC -97 10/03/2006 13:50 8458786343 PATTERSON TOWN HALL 10/03/2006 13:48 FAX 6466553772 ZARECKI ASSOC SEP -;3;? -2006 11:41 FROM: PUTNAM COi N Y DEPART S45- 278 -7921 TO".99553T'r4 SHERl,M AMI.ER, MI). MS. PA" CammLovioner of Health L.ORE7TA MOLIMARI, RK. MSN Rsroclafe Comm sslonar of Reohh DEPARTMENT OF HEALTH 1 Geneva Road, 6rewsor, New York 1 0509 E911 ADDR vRRMC N RM OWMIVS NAM-. TM -al-A HAt'hbuo TAX MAP NU ER: 25-iLut� - 011 ADDRESS-. 4AO Havj,]„Snel Trig TOWN; Patterson, NY AVTRORT M TOWN OMC1AL! DAVE: PAGE 01/01 IM 001 ROBORT .t. BOT401 cavoll .V Fsoc?rthK ponERT MORRM P9 Direc4rirofF4 roam&dalHealth The Putnam County I)epaz tmeat of 8o4th will not Ussue a CerMate of Constmcdon Compliance unlss the above Torso b eomplet4 i.e? 11 lepi E911 address is ssi ftn0d bT as anatcorized tvm official. Tbb form 4s to be snbaaitted "th the applit;ation for a Certiftate of Conamedon Compliance. 2911 addresaverificadon Zdviropineetel RMth ($49) 2704180 Au (US) Mm I Water Sop* Sadao (e49)=S -S18d Fax (AqS) �S�S418 Nursing 9ervk9v (845) 2786558 Fnx (45) 278 -026 WfC (045) 210-6578 Nursing Home Carr Pais (045) 272 -4 0S5 rarly IetemrMonMmgth"I (R4S) 278.6014 Fox (845) 278.464a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address:" - - " Haviland Drive T6wifNill' &: Putnam Tax Grid # Map Block Lot(s) 10 Well Owner: Name: Address: Prestige Homes II P.O. Box 407 Brewster, NY 10509 Use of Well: 1- primary X=[ 2- secondary X 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 X Open hole in bedrock _ Other Casing Details Total length __3Lft. Length below grade 28 ft. Diameter 6 in. Weight per foot 17lb /ft. Materials: -y Steel _ Plastic _ Other Joints: _ Welded Threaded _ Other Seal: _ Cement grout z Bentonite Other Drive shoe: It Yes No I 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 X Compressed Air Hours 6' Yield 50 gpm Depth Data Measure from land surface - static (specify ft) 35 During yield test(ft) 50 Depth of completed well in feet 485 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 230 Grey Granite 280 300 1 1 Soft Granite with mica . 300 465 Grey Granite with feldspar 465 485 50gpm Soft Spots - Granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth Model Voltage BY OTHLF:S Hp Tank Type Volume ,4 465 '2 gpm 435 50 gpm Date Well Completed 3/12/04 Putnam County Certification No. 2 Date of Report 3/16/04 17 IeT(si 1...1 . Lxa%,L iv1,auV11 UL wcu wtui utstances to at Least two permanent tanarnartcs to oe proviaea on a separate sneevplan. Well Drille ' Signature: Address: 75 Putnam Ave. Brewster NY Date: 17-33— O White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 10/03/2006 11:27 8452795075 luiux'2000 12:59 W 12037982107 MIL PAGE 03 JAIS ENVIRONDfENTAL SERVIC 4 MILL DRILLING lZ1 001 W:., ... Page 1 of 1 - �/Il S EN Zemwab/ is�rheA, ees. K"wma"mm IMAM. SOU AND At* AVALYars DanburA OonneodcaAoe" I T�IepAor►e - 791t�p Mailing Inform"on: Nome: Mill Drilling Co Addrm*-. 75 Putnam Avanue City_ Brewster State: NY Phone: (845) 279 -5041 Sample's Informd9on:— Mill Drllling Co Collectors Infw'mstion: JMB 10, 015176 Nome: Robbie MITI Address of sib: 480 Havpand Read David Rathbun! LOt 010 City: Patterson ZIP: 10500 State: NY ZIP; Far: (845) 279.6070 Phone: $11a: Boftom of Tank Data Collected: 9/27/2006 Date Reeelwd: 6/27/'1008 Pneervadve: HNO' Time Collected: 1:13:00 PM Time Received: 2:30-00 PM temperature: 4 Lab No.: JOBM154 IYMtdx: Water Dote Analyzed Test Name T Result IMCL Method Og128/06 Manganese 0.03 ppm 0.3 PPM SM 5111 B 09/28106 Sodium 14,1 ppm N/A SM 3111 B 09/27106 pH 6.75 S.U. 6.6.8.6 6.U. SM 4500 H B 09427!06 Color ND 15 Unite SMWW 2120 B 09/27108 Turbidity 0.15 ntu 6 ntu SMWW 2130 8 00/28/08 Hardness 150 mg /L NIA SMWW 2340 C 0927/08 Odor ND NIA SMWW 2340 C Oo/28/0e Iron e0.06 ppm 0.3 ppm SMWW 31118 MAW Chloride 32.4 ma'L 250 mg/L SMWW 4110 B 09/28101➢ Nitrate .3.32 mg1L 10 mg/l_ SMWW 4110 S MIMI Nitrite <0,05 mg1L 1 not SMWW 4110 B 09126/06 Sulfate 25.9 mg/L 250 mg/L SMWW 4110 B. 09127106 Chlorine Free Residual � <0.f mill, NIA SMVvW 4600CIO 06/2708 2:46 PM 6, Coll Absent Absent SMWW 9228 8 09 .7/08 2:48 PM Total Cofifv-m Absent Absent SMWW QU3 8 92melenf0: At the time of tho analysis the sample was Acceptable for Total Cvliform At the time of the analysis the sample was Aceeptsbie fOr E. Coll CPU • Cdiborm Forming Units MCL - Mnidmum Contsminent Leal MOIL 2 millisreme per titer WA + Not Applicable NO 1- None Debct.d ntu w Nephelopn*Wc TurbidAy Unit ppm • pwim per million e.u, a Saww1srd Unit Units MF Units 819mature: ti s oo , Reviewed sly: Michael UPOW Swan Houlahan, Director Prooldent Slats #: PH4216 SLAP fl: 1171 tl CONNIp71Q1IT. NW VQXX AND MLAC UMN IM, Tb aoears -&W@ I Lab Fss M-099 -01ae I *V1 *,)nWr&WV%'0Aene 10/03/2006 11:27 8452795075 MIL PAGE 02 PL"AM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ----WELL COMPLETION REPORT Well Location Well Owner. Use of Well: 1- primary X= 2-secondary DrlWng Equipmejit Well Type Street Address: Town/Village: Tax Grid -#— Haviland Drive Putnam Map Block Lot(s) 10 Name: Address: Prestige Homea•TI P.U. Box 407 Brewater, NY 10509 X Residential Public Supply Air coed /heat pump Irrigation Business Farm TeWmonitoring Other(specify) Industrial Institutional Standby Rotary Cable percussion X Compressed air percussion Other (specify) Screened Open end casing i'i; Open hole in bedrock _ Other Casing Details Screen Details Total length +3,LR. Longth below grade 28 ft. Diameter 6 in. Weight per'foot 1 7Ib /ft. Diameter (in) Materials: Steel _ Plastic _ Other Joints: _ Welded _K,- Threaded _ Other Seal: _ Cement grout Bentonite Other Drive shoe: X Yes No Liners Yes No Slot Size Length(ft) Depth to Screen (4) Developed? First Yes—No Hours Second Well Yield Test _ Bailed _ Pumped X Compressed Air Hours _6__ Yield - 50 gpm Depth Data easute m s e spoci 35 During yield test(ft) 50 Depth of completed well in feet 485 Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(la) Formation Description f. !t. Lsnd Surface 280 Grey Granite 2 320 Soft Granite with mica :.300 ..... -465 .... - - Gre - Granite with -fel'ds at' 465 485 SOgpm Soft 5potd - Granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth Model Voltage BY OTEyES HP Tank Type Volume 465 2 gpm 485 50 gpm Completed 3/12/04 tram only Cat ficadon No. 2 1 ate of Report 1.3/16/04 17;v� nu7rLr: kma lomon OI wou WWI ulatauccs to = IoaS< MU FMM4 UO {IL 16MU MIA-J w uv r,.......,.. v.... o rw ....��_r._.. Well Drill D Inc . Address: 75 Putnam Ave r w ,, �NY Signature: Date: ©– O White copy: HD File; Yellow copy - Building Inspector, Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL_ HEALTH SERVI-CES - -- GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM David Rathbun Owner or Purchaser of Building Prestige Homes Building Constructed by 480 Haviland Drive Location - Street Single Family residence Building Type 25 1 10 Tax Map Block Lot Patterson Town/Viffagr- N/A Subdivision Name N/A 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. tted, Mo Day Year lP General Contractor (Owner) - Signature Land Works, Inc. Corporation Name (if corporation) Signature: Title: r-e S Corporation Name (if corporation) Address: 44 Meeting House Road Address: State Pawling, NY Zip 12564 State Zip Form GS -97 ZARECKI & ASSOCIATES, L.L.C. Engineers - Surveyors - Architects -- — 11 West Main Street PAWLING, NEW YORK 12564 (845) 855 -3771 FAX (845) 855 -3772 TO: Putnam County Health Dept. 1 Geneva Road Brewster, NY 10509 WE ARE SENDING YOU: ❑ Shop drawings ❑ Copy of letter 104TTI 10s] m I I DATE: 10 -3 -06 JOB NO.: 2002,086 ATTENTION: Karen Yates RE: David Rathbun Haviland Drive (T) Patterson Putnam County, NY ® Attached ❑ Under separate cover via ❑ Prints ❑ Plans ❑ Samples ❑ Change order ❑ the following items ❑ Specifications COPIES DATE NO. DESCRIPTION 1 11 -30 -04 Well Completion Report 1 9 -27 -06 JMS Environmental Services THESE ARE TRANSMITTED as checked below: ® For approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑For review and comment ❑ ❑ FOR BIDS DUE ❑ Prints returned after loan to us REMARKS: COPY TO: i i SIGNED: ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints If enclosures are not as noted, kindly notify us at once. Client Copy TO: ZARECKI & ASSOCIATES, L.L.C. Engineers • Surveyors - Architects 11 West Main Street PAWLING, NEW YORK 12564 (845) 855 -3771 FAX (845) 855 -3772 Putnam County Health Department 1 Geneva Road Brewster. NY 10509 A WE ARE SENDING YOU: ® Attached ❑ Shop drawings ® Prints ❑ Copy of letter ❑ Change order L WIN EA NA "T1 A. I rva I DATE: 10 -3 -06 1 JOB NO.: 2002.086 ATTENTION: Mr. Michael Budzinski RE: DAVID RATHBUN As -Built for Subsurface Sewage Treatment System Modification/Renewal * (T) Patterson Putnam County, NY ❑ Under separate cover via ❑ Plans ❑ Samples ® attached documents the following items ❑ Specifications COPIES DATE NO. DESCRIPTION 1 9 -26 -06 ❑ Submit Check #399411758 in the amount $300.00 payable to PCHD 1 9 -29 -06 []Return Form CC -97 Certificate of Construction Compliance for Sewage Treatment System 1 11 -30 -04 Well Completion Report 1 9 -27 -06 Environmental Services, Inc. Water, Soil & Air Analysis 1 9 -27 -06 Form GS -97 Guarantee of Subsurface Sewage Treatment System 1 10 -2 -06 E911 Address Verification Form 4 9 -28 -06 1 OF 1 j As -built for Subsurface Sewage Treatment System Modication/Renewal 7771=7 77 THESE ARE TRANSMITTED as checked below: ® For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections []Return corrected prints ❑ For review and comment ❑ []FORBIDS DUE ❑ Prints returned after loan to us REMARKS: Mike: The above is being submitte for your approval. If you have any questions or comments, please do not hesitate to call our office. Thanks, Eva SIGNED: ��- COPY TO: D. Rathbun If enclosures are not as noted, kindly notify us at once. Client Copy A : n Page 1 of 1 J��YSIEnvironmental Services, Inc �� 41 Kenosia Avenue WATEA, SOIL AND AIR ANALS Danbury. Connecticut 06810 1 Telephone 203 -798 -2229 Mailing Information: Name: Mill Drilling Co Address: 75 Putnam Avenue City: Brewster State: NY Phone: (845) 279 -5041 Mill Drilling Co Collector's Information: Name: Robbie Mill Address of site:. 480 Haviland Road David Rathbun/ Lot #1C City: Patterson Zip: 10509 State: NY Zip: Fax: (845) 279 -5075 Phone: JMS ID: 019175. Sample's Information: Site: Bottom of Tank Date Collected: 9/27/2006 Date Received: 9/27/2006 Preservative: HNO1 Time Collected: 1:15:00 PM Time Received: 2:30:00 PM Temperature: <4 Lab No.: J0609154 Matrix: Water Date Analyzed Test Name 09/28/06 Manganese 09/28/06 Sodium 09/27/06 pH 09/27/06 Color 09/27/06 Turbidity 09/28/06 Hardness 09/27/06 Odor 09/28/06 Iron 09/28/06. Chloride 09/28/06 Nitrate 09/28/06 Nitrite ' 09728106... - - Sulfate .." .... ".. .... 09/27/06 Chlorine Free Residual 09/27/06 2:45 PM E. Coli 09/27/06 2:45 PM Total Coliform Result MCL Method . 0.05 ppm 0.3 ppm SM 3111 B 14.1 ppm N/A SM 3111 B 6.15 S.U. 6.5 -8.5 S.U. SM 4500 H B ND 15 Units SMWW 2120 B 0.15 ntu 5 ntu SMWW 2130 B 150 mg /L N/A SMWW 2340 C ND N/A SMWW 2340 C <0.05 ppm 0.3 ppm SMWW 31116 32.4 mg /L 250. mg /L SMWW 4110 B 3.32 mg /L 10 mg /L SMWW 4110 B <0.05 mg /L 1 mg /L^ SMWW 4110 B _ 25.9 mg /L 250 mg /L SMWW 4110 B'..... <0.1 mg/l- N/A SMWW 4500CIG Absent Absent SMWW 9223 B Absent Absent SMWW 9223 B Comments: At the time of the analysis the sample was Acceptable for Total Coliform At the time of the analysis the sample was Acceptable for E. Coll CFU = Coliform Forming Units MCL = Maximum Contaminant Level mg /L = milligrams per Liter N/A = Not Applicable ND =None Detected ntu = Nephelopmetric Turbidity Unit ppm = parts per million S.U. = Standard Unit Units = Units Signature: �!�+���tG� . G�"�_ Reviewed By: �"-14ti Michael Lapman. Sharon Houlahan, Director President State #: PH -0218 ELAP #: 11715 CONNECTICUT. NEW YORK AND NELAC CERTIFIED Top Free 866- JMS -5097 I Corporate Fax 203- 798 -2408 1 Lab Fax 203 - 798 -2107 1 www.jmsenvironmental.00m S.HERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health September 27, 2006 Zarecki & Associates 11 West Main Street Pawling, NY 12564 Dear Mr. Zarecki: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive . ROBERT MORRIS, PE Director of Environmental Health Re: Field Inspection — Prestige Homes Haviland Dr, (T) Patterson TM # 25 -1 -10, Lot # 1 The above referenced separate sewage treatment system can be backfilled. There are no other concerns on this property at this time. If you have any further questions, please contact me at (845) 278 -6130 ext. 2155. Sincerely, oseph Digit Environmental Engineering Aide JD:ldy Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool(845)278 -6014 Fax(845)278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH �� CI� L DIVISION OF ENVIRONMENTAL HEALTH SERVICES L FINAL SITE INSPECTION kA r_9- Date: V40109- Inspected by: Street Location 411—v, Lo Owner leml 3VIL) Town /a?rY2S0 Permit # 5w- TM # J 2- - 2 5-- /- /d Subdivision Lot # / 1. Sewage System 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. Septic tank size - 1,000 ... ... . 1 ,ZSO.........other ............. b. ' Septic tank installed level ............... ............................... c. 10' minimum from foundation ......... ............................... d. Distribution Boat 1. All outlets at same elevation -water tested ........:....... 2. Protected below frost ............... ............................... Mi 3... nimum 2 ft. Original soil between box & trenches e. Junction Boa: - properly set ......... ............................... 6. reT n hes 1. Length required 3�J� Length installed �� 2. Distance to watercourse measured Ft..::a.4o 3. Installed according to plan ........ ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot............ 5. 10 ft. from property he - 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-Dose& Systems - 1. Size of pump chamber ............... ............................... 2. Overflow tank ........................ ............................... I 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. House/Building a. house located per approved plans ............... . b. Number of bedrooms.....: ......... ............................... 'IV. Well Well located as per approved plans .......:........ �.... b. Distance from STS area measured ft.......... c. Casing. 18" above grade ............... ..............:................ d. Surface drainage around well acceptable ...................... V. Overall Workmanship . a. Boxes properly grouted ................. ............................... b. All pipes partially backfdled ................................. I ....... , 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 watercoui g. Footing drains discharge away from STS area .............. h. Surface water protection adequate ........ :........................ i. Erosion control provided .............. ............................... Rev. 12/02 612-7 /M PWA K PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # sw -11 -n -1 Located at Haviland Drive Town or Village Patterson Subdivision name N/A Subd. Lot # N/A Tax Map 9_ Block _ I Lot 10 Date Subdivision Approved .TU1;E 92, 1983 Renewal Revision xx Owner /Applicant Name David Rathbun Date of Previous Approval A ri ] 91 9001 Mailing Address 4861 South Lake Drive, Boynton Beach, FL Zip 33436 Amount of Fee Enclosed $ 2 s o_ n o Building Type Residential Lot AreaMac No. of Bedrooms 3 Design Flow GPD 600 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1 -l000 gallon septic tank and Frn,r prn;? RnxPs And 375 LF of 2FT wide trench for hnrh i ri -avy and reseree c3tatamc_ Other Requirements: To be constructed by Address Water Supply: - -- Public Supply From - - -- Address or: x Private Supply Drilled by Existing 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: P.E. XX R.A. Date 6 -99 -06 Address NY 32564 License # 61468 -1 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 considered ne essary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. pproved f discharge of domestic sanitary s age only. By: Title: Date: White copy - HD F ; Yello py - Building Inspector; Pink copy - O er; Gage copy - Design Professional Form CP -97 ZARECKI August 25, 2006 ASSOCIATES, L.L.C. Mr. Michael J. Budzinski, PE Putnam County Department of Health 1 Geneva Road Engineers Architects Brewster, NY 10509 Surveyors RE: David Rathbun Proposed SSTS Modification/Renewal Joseph Zarecki, PE (T) Patterson Jeffrey Hecker, LS Putnam County, NY Curt Johnson, RA Dear Mr. Budzinski: This is in response to our phone conversation on August 25, 2006 regarding the 11 west Main St. above - referenced project. Pawling, NY 12564 (845) 855 -3771 1. The drop box detail has been revised as requested. (845) 855 -3772 Fax 2, The certification note has been revised to match the percolation Website: zareckLcom data submitted. email: zarecklassoc @earthlink.net 31 Bailey Ave. If you should you have any questions or concerns, please do not hesitate to Ridgefield, CT 06877 contact me. (203) 438 -7094 (203) 438 -7157 Fax Smc Jonathan Walsh, ETT Project Engineer cc: D. Rathbun... _ _ _ . ........... .. _ 2002.086 TO: ZARECKI & ASSOCIATES, L.L.C. Engineers • Surveyors • Arch_ itects 11 West Main Street PAWLING, NEW YORK 12564 (845) 855 -3771 FAX (845) 855 -3772 Putnam County Health Department 1 Geneva Road Brewster, New York 10509 WE ARE SENDING YOU: ® Attached ❑ Shop drawings ❑ Prints ❑ Copy of letter ❑ Change order 07M Off V1a1&Wh7K DATE: 08 -25 -06 1 JOB NO.: 2002.086 _ATTENTION: Mike Budzinski, PE RE: Rathbun Haviland Drive Patterson, NY ❑ Under separate cover via ❑ Plans ❑ Samples ® Hand Delivered the following items ❑ Specifications COPIES DATE NO. DESCRIPTION 4 08 -25 -06 Revised Site Plan for SSTS Modification Renewal 1 08 -25 -06 Cover Letter THESE ARE- TRANSMITTED as checked below: For approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ ❑ FOR BIDS DUE ❑ Prints returned after loan to us REMARKS: COPY TO: SIGNED: ❑ Resubmit ❑ Submit ❑ Return copies for approval copies for distribution corrected prints If enclosures are not as noted, kindly notify us at once. Client Copy ZARECKI Asso . iATES, L.L.C. Engineers o Architects Surveyors Joseph Zoreckl, PE Jeffrey Hecker, LS Curt Johnson, RA 11 West Main St. Pawling, NY 12564 (845) 855 -3771 (845) 855 -3772 Fax Website: zarecki.com email: zoreckiassoc @eaOhlink.net 31 Bailey Ave. Ridgefield, CT 06877 (203) 438 -7094 (203) 438 -7157 Fax August 22, 2006 Mr. Michael J. Budzinski, PE Putnam County Department of Health 1 Geneva Road Brewster, NY 10509 RE: David Rathbun Proposed SSTS Modification/Renewal (T) Patterson Putnam County, NY Dear Mr. Budzinski: This is in response to your letter dated June 28th, 2006 regarding the above - referenced project. The items listed below address each of your comments as stated in your letter. 1. 2. 3. 4. 5. 6. 7. The topography of the site was field measured after alterations to the fill were completed. Those field measurements are now shown on the plans included in this package. The requested note in regard to topographic contours has been added and is located within the map notes. The locations of all four (4)- percolation tests have been located per field measurement made. The required certification note has been added. The percolation tests have been re- conducted within the altered fill and the results of those tests are included here within. Four percolation tests were conducted and have been located on the plans. We contacted your office and Gene Reed witnessed the percolation tests performed on August 16th, 2006. - We have also included within this package a certification of the altered fill to update all records that the newly altered fill still conforms to all design and code requirements. If you should you have any questions or concerns, please do not hesitate to contact me. Sinc , Jo athan Walsh, ETT Project Engineer JW /ep cc: D. Rathbun WE ARE SENDING YOU. Attached Under separate cover via, the following items - QShop drawuigs [i Prints ®Plans Q Samples [] Specifications [] Copy of letter [] Change order , Q.:, PUTNAM COUNTY DEPARTMENT OF HEATLH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET.- SUBSURFACE SEWAGE TREATMENT SYSTEM_ Owner: David Rathbun Address: ; . Haviland Road Located at (Street): Partridge Road Tax Map 383 Block 2 Lot 25 -1 -10 (indicate nearest cross street) Municipality: Patterson Watershed: N/A SOIL PERCOLATION TEST DATA Date of Pre - soaking 8 -15 -06 Date of Percolation Test 8 -16 -06 h F �,k;+ , vi,+il �" �. ,� . ` u�^p.».t§w. n'MC ••e•�. � � 4 om Crra nd R^c.�a W t vel \Dv� '4 ' n 8 r x i 1:45 -2:07 22 18 -21 3 7.3 1 1 2:09 -2:31 22 18 -21 3 7.3 2 2:35 -2:57 22 18 -21 3 7.3 3 4 5 1:46 -2:18 32 18 -21 3 10.6 2 1 2:29 -2:59 30 18 -21 3 -- 10.0 3:03 -3:33 30 18-203/4 .23/4 10.9 3 4 5 1:58 -2:40 42 18 -20 %z 2 %z 16.8 3 1 2:43 -3:13 30 18 -20 2 15.0 2 3:16 -3:46 30 18 -20 2 15.0 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e.< 1 min for 1 -30 min/inch, < 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 PUTNAM COUNTY DEPARTMENT OF HEATLH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - - . -.- .- - - DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner: • David Rathbun Address: Haviland Road Located at (Street): Partridge Road Tax Map 383 Block 2 Lot 25 -1 -10 (indicate nearest cross street) Municipality: Patterson Watershed: N/A SOIL PERCOLATION TEST DATA Date of Pre - soaking 8 -15 -06 Date of Percolation Test 8 -16 -06 T N�-,u �� x � .� No St- PQiamtor 4 1 1:53-2:26 33 18 -21 3 11.Oy 2 2:28 -2:58 30 18 -21 3 10.0 3 3:04 -3:34 30 18-20% 2.75 10.9 4 5 1 2 3 4 5 1 2 3 4 5 T DEPTH G.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' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. HOLE NO. See note below* Indicate level at which groundwater is encountered: See note below* Indicate level at which mottling is observed: See note below* Indicate level to which water level rises after being encountered: See note below* Deep hole observations made by: *Test hole information from approved plan SW -11 -03 Design Professional Name: Joseph Zarecki, PE Address: Zarecki & Associates, LLC, Signature Design Professional's Seal ATTENTION PUTNAM- COUNTY DEPARTMENT OF HEALTH DIVISION'OF ENVIRONMENTAL HEALTH SERVICES ❑ JOSEPH ❑x GENE REQUEST FOR FINAL INSPECTION All information must be fully completed prior to any inspections being made. PCHD Construction Permit # SW -11 -03 For: Fill X Trenches Located: Haviland Dr. & Partridge Rd. (T)(V) Patterson Owner /Applicant Name:. David Rathbun TM 25 Block 1 Lot 10 Formerly: Prestige Homes Subdivision Name: Dapice Subdivision Subdivision Lot# 1 Is system fill completed? Yes Date: 8 -12 -06 Is system complete? Yes, Fill Placement Only Date: 8 -12 -06 Is system constructed as per plans? Yes (except topsoil) Is well drilled? Yes Is well located as per plans? Yes Are erosion control measures in place? Yes Date: 5 -12 -06 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 Date: 8 -22 -06 Certified by: PE X RA s n ofessional Address: 11 West Main Street, Pawling, NY 12564 Lic.# 61468 -1 Comments: Except the in of topsoil_ Form FIR -99 ZARECKI & ASSOCIATES, L.L.C. Engineers - Surveyors - Architects 11 West Main Street - - PAWLING, NEW YORK 12564 (845) 855 -3771 FAX (845) 855 -3772 TO: Putnam County Department of Health 1 Geneva Road Brewster, NY 12509 WE ARE SENDING., YOU: ® Attached ❑ Shop drawings ® Prints ❑ Copy of letter ❑ Change order DATE: 8 -22 -06 JOB NO.: 2002.086 ATTENTION: Michael J. Budzinski, PE RE: David Rathbun Proposed SSTS Modification/Renewal (T) Patterson Putnam County, NY ❑ Under separate cover via the following items ❑ Plans ❑ Samples ❑ Specifications R Other documentation attached COPIES DATE NO. DESCRIPTION 1 8 -22 -06 1 pg Letter to Michael Budzinkski in response to June 28"', 2006 letter 1 8 -16 -06 2 pgs PCDH Design Data Sheet - SSTS (FormDD -97) 1 8 -16 -06 1 pg Test Pit Data - description of soils encountered in test holes 1 8 -22 -06 1 pg PCDH - Division of Environmental Health Services - Request for Final INspection 1 8 -21 -06 1 of 1 Site Plan for Subsurface Sewage Treatment System Modification/Renewal THESE ARE TRANSMITTED as checked below: 0 For approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ ❑ FOR BIDS DUE ❑ Prints returned after loan to us REMARKS: COPY TO: David Rathbun SIGNED: ❑ Resubmit ❑ Submit ❑ Return copies for approval copies for distribution corrected prints If enclosures are not as noted, kindly notify us at once. Client Copy 30 221 PUTNAM, COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner jkddres*s k. Located at (Street) Tax Map Block Lot Indic to nearest cross street) Municipality g so e Watershed. Z,,-,, 5-� SOIL PERCOLATION TEST DATA Date of Pre-soaking 8115-1,06 Date of Percolation Test 8, 6zor. NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, .g 2 min for 31-60 min/inch) All data to bi submitted for review. 2. Depth kneasurements to be made from top of hole. Form DD-97 I . .... ....... ep W. e r a er:.::.: From V ... . ... .X., r H un* it t .......... nX S ta S t .. ..... 2 3 73 3 1;-35—X't57 ;2- Z /6— ZI :3 7,3 4 5 1 416 -;L; to 3 It 2 Za 30 18- )-Z 3� 3 3,'03 3:33 30 78- 12-0 4 5 3 1 1"68-2,1zlo ZZ, 2 3,'*►3 30 ao 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, .g 2 min for 31-60 min/inch) All data to bi submitted for review. 2. Depth kneasurements to be made from top of hole. Form DD-97 I TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH - - - - - HOLE..NO. _.. _ HOLE N0.. _ HOLE N0. G.L. 0.52 i;3- 2; �� 33 /a -- a/ 1.0' 1.5' ztz8 _ SS 3O 2.0' 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' 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Date Design Professional Name: Address: Signature: Design Professional's Seal 279- 6 81„3 PUTNAM COUNTY DEPARTMENT OF .HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address ' Z2�4► /,,_4 j n k Located at.(Street) Tax Map Block Lot (indicate nearest cross street) Municipality Watershed h,:"' SOIL PERCOLATION TEST DATAo'�G�- Pi Date of Pre - soaking 01-71,06 Date of Percolation Test alto, o6 >!�urface >(ltiches); Star <Sfo: >> a�vaaJV• •. avaw w vv •vY......... ... ... -...� _ -r - -- -___'- -rr r , 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. fQI Form DD -97 131 e 3%z :t:;-,'l 2 q; 5"8 -- f /0;08 l 0 3X9.- : 16 X 3 3 /0 ;13 8 �2 ^ 'y 3' F411 4 5 1 ,l(� (71- 2 /0; 00 - /0; o s 6-- F 3 4 5 3 1 - �- ?,s �� - 3 3> 3 4 5 ,►,l1Tr, o. , 'r__. .. 4- L_ A ,� A - +h „n +;1 annrnx ;matAlV P.niml percolation rates are obtained at each a�vaaJV• •. avaw w vv •vY......... ... ... -...� _ -r - -- -___'- -rr r , 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. fQI Form DD -97 DEPTH G.L. 0.5' 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' 10.0' TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST DOLES HOLE_NO.____ __ _ ... _ - . _. HOLE NO. /0-101Y /49j /l 13 ::D�_ HOLE N_ 0. �RWVNMMMA I 11,t11- 5- a, , ;Z3 ;5 j, L /#- iZ, / —2 Z/ 2> #,t 7 Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Date Design Professional Name: Address: Signature: Design Professional's Seal .r z �r SHERLITA AMLER, MD, MS, FAAP Commissioner'of Health LORETTA MOLINARI, RN, MSN Associate' Commissioner of Health ROBERT J. BONDI, County Executive ' ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH l Geneva Road, Brewster, New York 10509 June 28, 2006 . Joe Zarecki, PE Zarecki & Associates 11 West Main Street - Pawling, New York 12564. Re: Proposed SSTS — Trench Plan for Rathburn, Lot # 1, DaPice. Subdivision (T) Patterson, TM# 25 -1 -10 . Dear Mr. Zarecki: This ' Department has received and reviewed the submitted application and plans for the above referenced: project and the following comments are offered for your consideration. ✓l. Portions of the upper SSTS reserve area exceed the maximum allowable slope of '15 percent which is unacceptable. v12. A note is to be placed on the plan stating the date and source of the topographic contours. . The location of the percolation test hole conducted in the ROB fill is to be shown on the plan. V14. The ROB fill_ certification_ note from Section 4.B. 13.c of PCHD Bulletin ST -19 is to be provided on the plan. t/5. The submitted permit and plans are not approvable since the percolation test result in the ROB fill is greater than the original percolation rate of the existing soil. V16. A minimum of one percolation test in the fill pad for each of the primary and reserve SSTS areas is to be conducted. V/'7.- Please contact this Department to witness percolation tests in the ROB fill pad. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. MJB :cj Respectfully, Michael J. Director of Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -51.86 Fax (845) 225 -541.8 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 Ifel o ZARIEcCKI[ & ASSOCIATES, L.L.C. IEIIngtimeeirs ° Suir veyo>rs ^ Au°chRects 11 West Main Street . - PAWLING, NEW YORK 12564 (845) 855 -3771 FAX (845) 855 -3992 Putnam County Department of Health 1 Geneva Road Brewster, NY 10509 WE ARE SENDING YOU: ® Attached ❑ Shop drawings ® Prints ❑ Copy of letter ❑ Change order T vl,N 10011001 DATE: 6 -23 -06 1 JOB NO.: 2002.086 ATTENTION: Mr. Gene Reid RE: RATHBUN SSTS (T) Patterson Putnam County, NY ❑ Under separate cover via ❑ Plans ❑ Samples the following items ❑ Specifications COPIES DATE NO. DESCRIPTION 4 6 -21 -06 Site Plan for Subsurface Sewage Treatment System Modification/Renewal 1 6 -21 -06 Check #838 in the amount of $250.00 1 6 -22 -06 PCDH Division of Environmental Health Services Construction Permit for STS 1 PCDH - Design Data Sheet SSTS - Soil Percolation Test Data THESE ARE TRANSMITTED as checked below: N For approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ ❑ FOR BIDS DUE ❑ Prints returned after loan to us REMARKS: COPY TO: ❑ Resubmit ❑ Submit ❑ Return copies for approval copies for distribution corrected prints If enclosures are not as noted, kindly notify us at once. Client Copy PUTNAM COUNTY DEPARTMENT OF HEATLH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _DESIGN DATA SHEET — SUBSURFACE SEWAGE TREATMENT SYSTEM Owner: David Rathbun Address: Haviland Road Located at (Street): Partridge Road Tax Map 25 Block (indicate nearest cross street) Municipality: Patterson Watershed: SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test 1 Lot 10 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e.< 1 min for 1 -30 min/inch, < 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 ` Depthto Water �:� a From Ground Water Leyel ;Percolation Time Ela se Time Surface Inches Dro In No Ru_ri.No 'Start Sto Vlin Start `.Stop Inches min/ch Hole r' 12:37pm- 1 1 1:07 m 30 6" - 73/4" 1 3/4" 19 1:07pm- 2 1:37 m 30 6" - 7V213 1 %2" 22 1:38pm- 3 2:08 m 30 6" - 7V2" 1 %2" 22 4 5 1 2 3 ' 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e.< 1 min for 1 -30 min/inch, < 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 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Joe Zarecki Zarecki & Associates 11 West Main Street Pawling, NY 12564 Dear Mr. Zarecki: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health May 23, 2006 Re: Fill Pad Inspection - Rathbun Haviland Drive (T) Patterson, TM# 25.4-10 An inspection of the fill pad at the above referenced project has been completed. Trench plans must be submitted to this Department for final approval of construction prior to the installation of the separate sewage treatment system. Please note that field measurements by this Department in noway suggest the exact size,.depth' -- and location of the fill pad. If you have any further questions, please contact me at 845- 278 -6130, ext. 2261. GDR:kly Sincerely, 4=� ep, A Gene D. Reed Sr. Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool(845)278 -6014 Fax(845)278 -6648 I, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION ❑ JOSEPH ❑x GENE REQUEST FOR FINAL INSPECTION For: Fill X All information must be fully completed prior to any Trenches inspections being made. PCHD Construction Permit # SW -11 -03 Located: Haviland Dr. & Partridge Rd. (T)(V) Patterson Owner /Applicant Name: David Rathbun TM 25 Block I Lot 10 Formerly: Prestige Homes Subdivision Name: Dapice Subdivision Subdivision Lot# 1 Is system fill completed? Yes Date: 5 -10 -06 Is system complete? Yes, Fill Placement only Date: 5 -10 -06 Is system constructed as per plans? Yes - (except topsoil) Is well drilled? Yes Date: 5 -10 -06 Is well located as per plans? Yes Are erosion control measures in place? Yes 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: 5 -19 -06 Certified by: !�� ��.. PE X RA �� Address: 11 West Main NY 12564 \ Lic.# 61468 -1 Comments: Clay barrier has been covered over with topsoil. Four random points were chosen and uncovered excellent quality clay to proper installation specifications. Five (5) holes dug in fill pad revealing more that adequate depth. Access ramp to be removed and regraded upon completion of construction Form FIR -99 In n' N 0 r D m ))` C) rij 2 y 00000000000 OOpO�o � � °OOOOOOO� (4 sos v eo9 I -�606 I LPRoPosED I 1 I i 610 FILL PAD I I —612 I -674- GABION RETAINING WALL I 40.7' 2 STORY DWELLING GAR SLAB: 626.1 48.8' r v A ' D HA VILA ND U) co CO�1 UOD O O DR/ V, e ''P IJTNAM;(:U 7�tTY DEPARTMENT ��OF HEAI�T'13' DIVISION OEE S NN Ma T- 4LR EAI�TH'SERVICES _� - I'Ti�TA�L SM." . INStL�71ID1�T • Date Inspected by Street Location �al; e - - - -�- - - - ttP erml t� ubdiVision 'S:ewage ,System b xea , .110 ' _" °: NTS area located�as�per a�ppravedplans b . Fill$ section';`,`1ate�of,,p"lacement '; 3 �1barnerLgth Width - tb ' , ,. c Natural soil not stepped dtone,kbrush; etcg%eater than 1 n` S Star fro �' ea �,8 y ` �> from;water,�ourse%vvtlands I.' Sewak-eWSgsiem tt ax, a 4SepfictankAsize l D00 1 X60 other 'b S.epticrrytanki'nstallecl�level � � �...,�� c ,.1;0 4minimum from foundation:..,. F,�,xs: d Distribution boa l All' flet$ at sameKelea#ion water :. 2 Protectedbslowfrost `lriunum'2 ft aQriginalsoil betweenbox & trenches ka e Junction:oz ro erl. set ............. P :.P .,y' 6 :re>3i es 1 Length egwe uistalled Length ` �'' istance'to watercourse measured Ft r 3. ll ", alled according to plan '`Slopeoftrenchacceptable 1/16 x'%32" /fort 5: i0 it ' from roe line 20.ft foundations .,:..... P P rt3' .... b De th of tf6n& <3O inches from- surface ..:............:.. :7 Room allowed for expansion, 8 Size of gravel 3!4 1%' diameter clean .............:...: ' 9 Depth of:gravel. n trench 12" mmimum ..............:.... lt) Pipe endsca ed ... 9. •Pu� mp orposed; 5s "terns 1 Size ofpump,chamber :........ .... 2 ,Oveitlow'tank 3R rtAlarm;sua]/auiho �, : M, t 4 'Pump easily accessible; manhole to gra .,. ..... 5 <First'boxs `iMed: P: 6 >C cle witnessed by R.-D.4tiestimat e d;flowfcycle...:....... III„House f :uiliM. aiouselocate +perYapproved plena .:.. ...........:........:.......... b Number of bedrooriis ................... IV, Well � � ..... Well located as per opiovedplans ..............: ................ b ;distance groin ST,Sarea measured . ft,.........: c basin '1`s" above grade. .....:............. g d surface drainage around well' ; acceptalie .....................:. V: Overall Worlanshiu a..:.Boxes properly, grouted ... .: .......... :...... ..:....................... .. b All pipes \partially backfilled ................ . C. ill pipes lushwith;uiside::of`b �x ....:........... U BackUmaterial 'contain= stones,�O ",diameter ......:....... e Curtain draLn standgip:es installed :according to plan.. f curtain dram, outfall protected': &,dir to exist watercourse g. `Foote drains: discharge - W—from STS;area .........:..:.. h. Surface water. protection adequate ........ :.......................... i. Etokonzontrol roviided ........................... .. .Rev.` 2/02 1 fy Run,of Bank F "Quality t- S1ope.from Top to Toe 3/ S�ECT'IO1� FAU F PAID impernous Layer7nstalled �/ 4 :«r,pect�d by r' Sieve Test Results (if apphcablej N� - dditionalComments. Fs3ipad located per.the.a roved lan ; Run,of Bank F "Quality S1ope.from Top to Toe 3/ impernous Layer7nstalled �/ rosian Control Installed Sieve Test Results (if apphcablej N� - dditionalComments. ; 05/19/2001 10:30 PAX 84585-33772 ZARECKI ASSOC PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION ❑ JOSEPH D GENE QUEST FOR FINAL INSP CE TION All information must be fully completed prior to any inspections being made PCWD Construction Permit # SW -11 -03 Located: Haviland Dr. & Partridge Rd. Owner /Applicant Name: David Rathbun l+onnerly: Prestige Homes Is system fill completed' Yes IS systei'il complete? Yes, Fill Plae For: Fill X Trenches _ (T)M Patterson TM 25 Block 1 Lot 10 Subdivision Name: Dapice Subdivision Subdivision Lot# 1 Date: 5 -10 -06 .hment only Date: 5 -10 -06 Is system constructed as per plans? Yes - (except topsoil) is well drilled'' _ Yes Is well located as per plans? YeS Are erosion. contrail measures in place? Yes Date: 5 -10 -06 [a 002 I certify that the system(s), as listed, at the above premises bas 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. tbC.Putaam .County Department of Health. \ ,. Date: 5 -19-06 Address: .11 West Main Certified by: NY 12564 PE X Lic.# 61468 -1 RA Comments: Glay barrier has been covered over with top;(?1 /. Four random points were chosen and uncovered excellent quality clay to proper installetion specifications. Five (5) holes dug in fill pad revealing more that adequate depth. Access ramp to be removed and regraded upon com lotion of construction — Fonn FIR-99 G"P) I'=;• Pig TM • qa�- a7A -7QP1 K1061P • PI ITKIOM (,ni IKITV IIf= PAPTMP►JT f1P P P r 1 A Affl I.UUIN 1 Y IIEYA.tKUV1LIVT U1U' H H;AL'1'11 DIVISION OF ENVIRONMENTAL HEALTH SERVICES a FINAL SITE INSPECTION Street. Location. 11AViG�4�l Town TM #_ 2.6-, 1. Sewage Svstem Area Date: Inspected by: Owner P-jZ0Sr:/G& Permit # S w — // — o Subdivision Lot # a. STS area located as per approved plans.......... .. ................ b. Fill section - date of placement 3:1 barrier Lgth.T Width . Avg.Dpth c. Natural soil not stripped ................. d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... H. Sewage System a. Septic tank size - 1,000 .......... 1, 250..... : .... other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ...................0........... 3. .. Minimum 2 ft.Original soil between box & trenches _. e. Junction Box - properly set ..... .....................0......... '6. Trenc ei� 1. Length required Length installed 2. Distance to watercourse measured 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' /i' diameter clean ............. . ...... : 9. Depth of gravel in trench 12" minimum .......:........... 10. Pipe ends capped ........................ .....................:......... g. Pump or Dosed Systems 1. Size of pump chamber ................. ............................... 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........... M. House/Buildhig a. house located per approved plans ... ....................:.......... b. Number of bedrooms ....................... ............................ .... IV. Well Well located as per approved plans . ......:........................ b. Distance from STS area measured ft.......:... c. Casing. 18" above grade ................ .............:................. d. Surface drainage around well acceptable ........................ V. Overall Workmanship . a. Boxes properly grouted ................... ............................... b. All pipes partially backfllled ........... ............................... c. All pipes flush with inside of box .................. 0............... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ........ :........................... i. Erosion control provided ................. ............................... Rev. 12/02 SITE INSPECTION FOR FILL PAD Date: 7 2 Of Inspected by: 2r" Fill pad located per the approved plan Fill Pad Length // Required Length Fill Pad Width r'—) Required Width ®� Fill Pad Depth o2 Required Depth 2 S Run -of -B ank Fill Quality ().1 Slope from Top. to Toe .. 7-e -beImpervious Layer Installed �j 0 `1 �O �� �o� le& --- Erosion Control Installedcitm ye S 141111k9 Sieve Test Results (if applicable) Additional Comments: 42 e ✓e— �ea V. Reserved for Field Sketch if Applicable pal , //,2- ® U � �t �l 6 r r JUL -23 -2004 08:05A FROM:NADERMAN LAND P &E 914 962 5963 TO:18452787921 .� ?yS - a 70, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INSPECTION REQUEST INTI T-'TIT AT For: Fill -Date: Trenches PCHD Construction Permit # Located: ws1114, 0vV 0/z*'11� ,os zT/�aG ' !.±A T) M Owner /Applicant Name: TM as Block Lot /O Formerly: Subdivision Name: A : PP61ee Subdivision Lot # Is system fill completed? �'° $ y � Date: 7Z /0'y Is system complete? Date: Is system constructed as per plans? Is well drilled? Date: Is well located as per plans? V-0::( Are erosion control measures in place? I certify that the system(s), as listed, at the above premises has been i and verified their completion in accordance with the issued approved plans and the Standards, Rules and Regulations of . e Health. �$ Date: d Certified c 2 . DY: have inspected Permit and D artment of Address: W9 0W�— ,dolt 7 a� f 9 Comments: FOR: ❑ ADAM XGENE JUL -23 -2004 FRI 08:03 f TEL:845- 278 -7921 P: 1/1 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 a LORETTA MOLINARI Public Health Director July 29, 2004 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. Barry Naderman Naderman Land Planning & Eng. 3799 Nelson Ave. Box 7 Jefferson Valley, NY 10535 Dear Mr. Naderman: ROBERT J. BONDI County Executive Re: Prestige Homes II, Inc. Haviland Drive, Lot #1 (T) Patterson, TM# 25.4-10 An inspection of the fill pad at the above referenced project has been completed. Comments are offered as follows: 1. It appears the fill for the house above the SSTS fill pad is in excess from that which was approved by this Department. At this time it is questionable whether a proper slope can be- maintained without interfering with the proposed septic system: Therefore revised plans must be submitted to this Department showing the actual house location and elevation along with any revisions to the topography necessary to ensure the safety and proper functioning of the septic system. Please note that field measurements by this Department in no way suggest that exact size, depth and location of the fill pad. If you have any further questions, please contact me at 845- 278 -6130, ext. 2261. GDR:km Sincerely, Gene D. Reed Environmental Health Engineering Aide LORETTA MOLINARI Public Health Director 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 July 30, 2004 Barry Naderman Naderman Land Planning & Eng. 3799 Nelson Ave. Box 7 Jefferson Valley, NY 10535 Dear Mr. Naderman: ROBERT J. BONDI County Executive Re: Field Inspection - Prestige Homes II, Inc. Haviland Drive, Lot #1 . (T) Patterson, TM # 25. -1 -10 Permit # SW 11 -03 The following items are in violation of Article III, Section 2C of the Putnam County Sanitary Code. 1. Site construction is not in accordance with plans approved by this Department. 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, "'g -0 - 1&/ Gene D. Reed SR. Environmental Health Engineering Aide GDR:km LORETTA MOLINARI Public Health Director 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)279-6648 OFFICIAL SUSPENSION OF PERMIT CERTIFIED RETURN RECEIPT REQUESTED July 30, 2004 ROBERT J. BONDI County Executive Barry Naderman Naderman Land Planning & Engineering 3799 Nelson Ave. Box 7 Jefferson Valley, NY 10535 Re: Suspension of Permit: Prestige Homes II, Inc Haviland Drive, Lot #1 (T) Patterson, TM# 25.-1 -10, Permit # SW -11 -03 Dear Mr. Naderman: Please be advised that the permit SW -11 -03 for the above regarded project has been suspended by this Department for the reasons noted below: J.— Site construction is not in, accordance with plans approved. by this D.epartment.... _ ... . The suspension of the permit will remain in effect until theses issues have been satisfactorily addressed. Furthermore, pursuant to Article III, Section 3, Paragraph d, of the Putnam County Sanitary Code, whenever inspection indicates construction to be otherwise than in accordance with the permit, all work shall cease upon written notice served upon any person connected with or working in said system. Please be advised that appropriate steps must be taken immediately to resolve these issues. Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130, ext. 2166. Very truly yours, d2 ��' 9, AZ f--a le Gene D. Reed Sr. Env' ental Health Engineering Aide Robert Morris, PE Sr. Public Health Engineer GDR:km Cc: Paul Piazza BI, (T) Patterson LORETTA MOLINARI Public Health Director 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 (8 45) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 OFFICIAL REQUEST FOR STOP -WORK ORDER Paul Piazza, BI Town Hall P.O. Box 470 Patterson, NY 12563 Dear Mr. Piazza: ROBERT J. BONDI County Executive July 30, 2004 Re: Stop -Work Order Request: Prestige Homes 11, Inc. Haviland Drive, Lot #1 (T) Patterson, TM # 25. -1 -10 Permit # SW -11 -03 The Permit SW -11 -03 for the above regarded project been suspended by this Department for the reasons noted below: I._ _..... J., Site construction is not in accordance with plans approved by this Department. - 1. It is respectfully requested that a Stop -Work Order be issued until these items have been satisfactorily resolved. Thank you, in advance, for your cooperation in this matter. Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130 ext. 2261. Very truly yours, 0 Gene D. Reed Sr. E nme Health Engine ring Aide Robert Morris, PE Sr. Public Health Engineer GDR:km ?25 1" PUTNAM ,COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address Located at (Street) to,A Il�+� X 0YOG _.. Tax Map _ (indicate nearest cross street) - f Municipality ��C Y's O1i Watershed SOIL PERCOLATION TEST DATA Block Lot Date of Pre - soaking �� � f ?y p 6_ Date of Percolation Test - f 21 f 10010 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 �V_d PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # SW -11 -03 . Located at HAVILAND DRIVE Town oILAMbap PATTERSON Subdivision name N/A Subd. Lot # N/A Tax Map 25 Block 1 Lot 10 Date Subdivision Approved JULY 22, 1983 Renewal X Revision X Owner /Applicant Name DAVID RATHBUN Date of Previous Approval APRIL 21, 2003 Mailing Address 4861 SOUTH LAKE DRIVE, BOYNTON BEACH FLORIDA Zip 33436 Amount of Fee Enclosed $400.00 Building Type RESIDENTIAL Lot Area 2.0 ac No. of Bedrooms 3 Design Flow GPD 600 Fill Section Only X Depth 2.5' Volume 650cy PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1 - 1000 3751f OF ABSORPTION TRENCH gallon septic tank and FOUR DROP BOXES AND Other Requirements: 2.5' OF ROB FILL OVER PRIMARY AND EXPANSION AREAS To be constructed by TO BE DETERMINED Water Supply: Public Supply From Address Address or: x Private-Supply-Drilled by- _- EXISTING Address- ___I ...,.. - -- .__..... _. ... -'] I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatments stem 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: Address 11. WE P.E. X R.A. Date �woc, ST T, PAWLING,NEW YORK 12564 License # 61468 APPROVED FOR CONSTRfJCTION: 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 sidere ecessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe prov r discharge of domestic sanitary se wa a only: By: 1 Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner. of Health DEPARTMENT -OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive OFFICIAL REINSTATEMENT OF PCDOH PERMIT June 20, 2005 Town of Patterson Town Hall P.O. Box 470 Patterson, NY 12563 Paul Piazza Re: Reinstatement of Permit: SW -11 -03 Rathbun, Haviland Drive (T) Patterson, TM # 25 -1 -10 Dear Mr. Piazza: 0 Please be advised that the Permit SW -11 -03 for the above regarded project has been reinstated by-this Department. _ It is respectfully requested that any stop -work order issued by the Town of Patterson in . relationship to this Department's permit suspension be removed. Thank you for your assistance in this matter. Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130 ext. 2261. RM :kly Ver ly yours Robert Morris, P.E. Senior Public Health Engineer Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 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 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I — PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR 1. PROJECT NAME David Rathbun Haviland Drive 3. PROJECT LOCATION: Municipality: Patterson County: Putnam 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) Intersection of Haviland Drive and Partridge Lane 5. PROPOSED ACTION IS: ❑ New ❑ Expansion ® Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: Construction of a single - family dwelling with associated grading and sewage treatment system. 7. AMOUNT OF LAND AFFECTED: Initially 10 acres Ultimately 2.0 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ® Yes ❑ No If no, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ® Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open Space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ® Yes ❑ No If yes, list agency(s) name and permit/approvals: Putnam County Health Department SW -11 -03 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? 0 Yes ❑ No If Yes, list agency(s) name and permit/approvals: Putnam County Health Department SW -11 -03 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION: ® Yes ❑ No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Jose h Zarecki Date: N'Sf % � a.04z'9 Signature: "L.—I -- If action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the full EAF. ❑ Yes X No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.4 ?. If No, a negative declaration may be superseded by another involved agency. ❑ Yes X No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers maybe handwritten, if legible) Cl. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: No C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: No C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats or threatened or endangered species? Explain briefly: No 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: No C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: No C6. Long term, short term, cumulative, or other effects not identified in C 1 -05" Explain briefly: No C7 Other impacts (including changes in use of either quantity or type of energy? Explain briefly: No D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? ❑ Yes X No If Yes, explain briefly E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes X 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 (f) 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. If question d of part ii was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. ❑ 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. Name of Lead Agency Date Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Pre parer If different from responsible officer W 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: DAVID RATHBUN 4861 SOUTH LAKE DRIVE BOYNTON BEACH, FL 33436 2. Name of Project: HAVILAND DRIVE 4. Design Professional: JOSEPH ZARECKT, PE 6. Drainage Basin: N/A 7. Type of Project: 3. Location: TN: . PATTERSON 5. Address: 11 W MAIN ST. , PAWLING, NY 12564 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) ? ............:. Yes/No des Type Status (check one) ...................................... ............................... Type I Exempt _ Type II x Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required ? .................... Yes/No NO 10. Has DEIS been completed and found acceptable by Lead Agency ? ............. Yes/No NO 11. Name of Lead Agency N/A 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? .... Yes/No.. YES 13. If so, have plans been submitted to such authorities? .. ............................... Yes/No 14. Has preliminary approval been granted by such authorities? Date granted: N/A 15. Type of sewage treatment system discharge ........................ surface water x groundwater 16. If surface water discharge, what is the stream class designation? .......................... N/A 17. Waters index number (surface) ............................................. ............................... N/A 18. Is project located near a public water supply system? . ............................... Yes/No NO 19. If yes, name of water supply Distance to water supply N/A 20. Is project site near a public sewage collection or treatment system? .......... Yes/No NO 21. Name of sewage system Distance to sewage system N/A 22. Date test holes observed SPP nnte* 23. Name of Health Inspector See note* 24. Project design flow (gallons per day) ............................. ............................... 600 25. Is State Pollutant Discharge Elimination system ( SPDES) Permit required? ... Yes/No NO 26. Has SPDES Application been submitted to local DEC office? ......................... Yes/No N/A Rev. 11/02 Form PC -97 *Test Hole infromation from approved plan SW -11 -03 Pg. Iof2 27. Is any portion of this project located within a designated Town or State wetland ?... Yes/No NO 28. Wetlands ID number .................................................................. ............................... N/A 29. Is Wetlands Permit required? ...................................... ............................... Yes/No NO Has application been made to Town or Local DEC ........................... Yes/No NO 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 NO 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 NO DESCRIBE: 33. Is there a local master plan on file with the Town or Village? .........................Yes/No YPS 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? .................................. .........................Yes/No NO 35. Are any sewage treatment areas in excess of 15% slope? .............................. Yes/No NO 36. Tax Map ID Number .............. ............................... Map 25 Block 1 Lot _- 37: Approved plans are to be returned to ................ Applicant X 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 stormwater 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 1, 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. 1 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 Mailing Address: ........................... Form PC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH ------ - --- --- DIVISION -OF ENVIRONMENTAL HEA-L--TH SERVICES RE: Property of Located at LETTER OF AUTHORIZATION DAVID RATHBUN HAVILAND DRIVE TN PATTERSON Subdivision of Tax Map # 25 Block 1 Lot to Subdivision Lot # 1 Filed Map # 1936 Date Filed JULY 22, 1083 Gentlemen: This letter is to authorize JOSEPH ZARECKI PE 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 tretment 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. Countersigne P.E., R.A., # Mailing Addi 11 W. MAIN ST., PAWLING, State NY Zip 12564 Telephone: 845- 855 -3771 Very trul yours, Signed• (Owner of Property) MailingAddress:_48f)-L SOUTH TAKE DRIVE State FL Telephone: BOYNTON BEACH Zip 33436 Form LA -97 PUTNAM COUNTY-DEPARTMENT OF HEALTI DIVISION OF ENVIRONMENTAL HEALTH SERVI a' , CONSTRUCTION PERMIT FOR SEWAGE TREATMENT. SYSTEM PERMIT # SW -11 -03 Located at HAVILAND DRIVE Tgwn or Village L Patterson Subdivision name N/A Subd. Lot # N A Tax Map 25 Block 1 Lot 10 Date Subdivision Approved _ JULY 22, 1983 Renewal x Revision x Owner /Applicant Name DAVID RATHBUN Date of Previous Approval APRIL 21, 2003 Mailing Address 4861 SOUTH LAKE DRIVE, BOYNTON BEACH FL Zip 33436 Amount of Fee Enclosed _ $400.00 Building Type RFSTDFNTTAI, Lot Areal, oaereNo. of Bedrooms 3 Design Flow GPD 600_ Fill Section Only x Depth 2.5' Volume 650cy RE PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLE D Separate Sewerage System to consist of 1 -1000 gallon-septic tank and 4 drop boxes and 375 if of absorption trench Other Requirements: 2.5' of ROB fill over primary and expansion areas To be constructed by . to be determined Address Water Sunoly: Public Supply From Address In x Private Supply Drilled by existing Address J� I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage ==entsystem 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: Address 11 Wes K P.E. x R.A. Date S a Oa License # 6146A APPROVED FOR C &STRUCTION: 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 considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only. By: Title: Date: 'White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 ZARECKI & ASSOCIATES, L.L.C. Engineers • Surveyors • Architects 11 West Main Street PAWLING, NEW YORK 12564 (845) 855 -3771 FAX (845) 855 -3772 TO: Robert Morris, P.E. Senior Public Health Engineer Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 WE ARE SENDING YOU: ® Attached ❑ Shop drawings ❑ Prints ❑ Copy of letter ❑ Change order MWEE Ofd VIUMMOK DATE: 6/2/05 1 JOB NO.: 2002.086 ATTENTION: Robert Morris RE: Haviland Drive ❑ Under separate cover via ® Plans ❑ Samples the following items ❑ Specifications COPIES DATE NO. DESCRIPTION 3 5/27/05 ® For review and comment Site Plan for Subsurface Sewage Treatment System Modification/Renewal 3 5/27/05 Fill Placement Plan for Subsurface Sewage Treatment System 1 5/27/05 Construction Permit Application 1 Letter of Authorization for Design Professional 1 Application for Approval of Plans for a Wastewater System 1 Short EAF 1 Check for $400.00 application fee THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted ❑ Resubmit ❑ For your use ❑ Approved as noted ❑ Submit ❑ As requested ❑ Returned for corrections ❑ Return ® For review and comment ❑ ❑ FOR BIDS DUE ❑ Prints returned after loan to us REMARKS: COPY TO: copies for approval copies for distribution corrected prints If enclosures are not as noted, kindly notify us at once. Client Copy ru ° I 1 ri Lf) ' IT Postage rn 0 .Ce C3 Return R (Endorsement Be wired) C3 Restricted Delivery Fee 111 (Endorsement m � Total Postage 8 Fees ru O en To C3 �'V C( erl N Sbee ;llpL ivo.; 1 or po Box No. l City, S te, Zt 0 Complete items 1, 2, and 3 Also complete A• Rem 4 If Restricted •Delivery is desired. ` CQgglu. X ■Print your name and address on the reverse 13 Addressee so that we can return the : to you °: ` B ° , • , Painted Name) 0 Attach this card to the back of the mailpiece, . 47UF r or, on the front.If.space permits ,`. D: Is ery address different from ftem 1 ' , Qs If YES. war delivery address below: ❑ No 1. Article Addressed to: J?Gci6 e r7MC�1171L '3'7cti Iti�lS6,nrJ�okrT AL. 3. Se Type 'A hied Mall. ❑'Exprr3ss Mall red' , ❑ Return Receipt for Merchandise t�� 3 O insured Mail::. ; O C.O.D. , COt ri. ^ . 4. Restricted Delivery? P tta Fee) C3 Yes Fi_Articie Number (Ttanster rrnrn servfce;�abeq _ „ 70 0 2 r 131;5 , 0 0 0 3, 9 8 Q.5 16,6 2, PS'Formr 3811, Augdst 2661'; }Domestic Retum Receipt' 102596-024+1640 e Engineers • Architects Surveyors Joseph Zarecki, PE Jeffrey Hecker, LS Curt Johnson, RA David Johnson, CPESC- CPSW®. 11 West Main St, Pawling, NY 12564 (845) 855 -3771 (845) 855 -3772 Fax Website: zarecki,com email: zareckiassoc @earthlink.net 31 Bailey Ave, Ridgefield, CT 06877 (203) 438 -7094 (203) 438 -7157 Fax June 1, 2005 - Robert Morris, PE Senior Public Health Engineer Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 Re: PCHD Permit #SW -11 -03 David Rathbun Property Haviland Drive Town of Patterson Tax Map ID: 25 -1 -10 Dear Mr. Morris: On behalf of the applicant, David Rathbun, we hereby'submit the following: • Three (3) sets of Plan entitled "Site Plan for Subsurface Sewage Treatment System Modification/ Renewal" prepared for David Rathbun, dated 5 -27 -05 • Plan entitled "Fill Placement Plan for Subsurface Sewage Treatment System" prepared for David - Rathbun, dated 5 -27 -05 - • Construction Permit Application dated 5 -27 -05 • Letter of Authorization for Design Professional • Application for Approval of Plans for a Wastewater System • Short EAF • $400 fee paid by check #37139618 -7 from Zarecki & Associates, LLC The existing site consists of 2.0 -acre lot located at the intersection of Haviland Drive and Partridge Lane in the Town of Patterson. The lot was created as part of a lot subdivision on the Final Subdivision Plat by Robert W. Dapice dated 7/22/83, Filed Map 1936. The site received Putnam County Health Department (PCHD) approval for a 3- bedroom house with associated grading and a septic system designed for a flow of 600 gallons per day on 4 /21 /03_under- the name of Prestige Homes II, Inc. During.construction. of- the approved septic system on the site, the previous owner was informed by the PCHD on 7/29/04 that the "fill for the house above the SSTS fill pad is in excess from that which was approved" and that there was concern whether a proper slope could be maintained without interfering with the proposed septic system. The PCHD required that revised plans showing the actual house location along with any revisions to the topography necessary to ensure the safety and proper functioning of the septic system be submitted for review. Since that time, Mr. Rathbun has purchased the property "as is" and has contracted` with Zarecki & Associates to modify the approved plan to address the PCHD comments. Deep test and percolation test results from the approved plans have been utilized in the modified plans. As part of the modifications from the approved plan, the building foundation is being raised and a retaining wall has been proposed at a location approximately 20' to the rear of the dwelling. With the exception of the retaining wall, the septic system design, components and grading is similar to what was previously approved. However, it should be noted that the fill pad was partially installed during the previous construction. The final fill pad elevations from the previously approved plan have been noted on the Fill Placement Plan. Our office will verify that the required depth and quality of fill is in place prior to construction of the proposed septic system. t We trust the enclosed is sufficient to proceed with review. If you have any questions or anything further is needed please do not hesitate to call. Sincerely, JZ/ ds Enclosures 2004.081 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 (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Date: 5 To: :J0� Z– Fag #: a s 5— `3 7 ? Z From: Gene D. Reed Putnam County Department of Health /For your information r your review As discussed Notes/Messages No. Pages 2. (Including cover sheet) Please respond Attached as requested Please call In the event of transmission /reception difficulties, please contact this office at (845) 278 -6130 ext. 2261. 10/01/2004 12:59 914 -232 -6827 "'OD, & ASSOC. PAGE 01/02 J. ROBERT EOL.CHETT,i-8t -- - - -- - - 'ASSOCLA.YUS, L.L.C. CIVIL 1,ENVIRONMENT L ENGINEERS 247 ROU'T'E 100 PINEW000 BUS, CTR. SOMERS, NY 10589 (914) 23Z -2500 (914) 232 -6827 (FAX) 40 RAILROAD AVENUE MONTGOMERY, NY 12549 (914) 457 -5318 (914) 457 -0302 (FAX) FAX TRANSMITTAL SHEET TO: Mr- Robert Morris, P.E. Putnam Coutxty Department of Hea th FROM, Paul J. Pelusi0 FAX #: (845) 278 -792 ; DATE: October 1, 2004 I NO. OF PAGES (including cover sheet): PLEASE DELIVER TI3MS DOCUWNT IMMEDIATELY TO ADDRESSEE. PLEASE TELEPHONE US AT (914) 232 -2500 IF ANY DOCt)MENT IS, ILLEGIBLE OR IF ALL PAGES ARE NOT RECEIVED. OCT -1 -2004 FRI 12:53 TEL:045- 278 -7'921 1.10•IE:PUTNAM COUNTY DEPARTMENT OF P. 1 :f 10/01/2004 12:59 914- 232 -6827 1=n1- CHETTI & ASSOC. PAGE 02/02 J. ROBERT FOLCHETTI & ASSOCIATES, L.L.C. CIVIL/ ENVIRONMENTAL ENGINEERS -- — -- September 30, 2004 Mr- l3arry Naden -nan REt -HAVILAND DRIVE LOT #10 Dear Mr. Naderman: Please be advised that Amy office is currently working with Nir. Richard Hama of Prestige Homes U, Lac. to determine the cause and provide recommendations to remediate the observed settlement of the foundation system for the newly constructed single farailyresidence. As you are aware, the 'town of Patterson. Building Inspector's Office bas issued a stop work order pending completion of the foundation system investigation. Soil borings were completed on -site by Soiltesting, Inc, ou. September 23, 2004. We are presently waiting for the results of the analyses of soil samples collected on the 23rd to deterin' ine the physical, properties of the soils. The completed soil testing results should be available n.6 latex than Octbber 4, 2004 ' and we anticipate completing our investigation within one week ofreceipt of the completed analytical results. The actual remediation work can be expected to tale one to two weeps of or Owner's authorization to proceed. If you have any questions or cornments'please contact the at your earliest convenience. :. Very truly yours, PJP /jac R. Morris, P.E. (PCDOH) K, Hanna (Prestige Ll) File cc: 13 247 ROUTE 100 Pinewood Business Center SOMERS, NY. 10589 914 -232 -2500 Fax 914- 232 -6827 OCT -1 -2004 FRI 12:53 www-jrta. com TFL:845 -278-- ?921 haul J. Pelusio 0 40 RAILROAD AVENUE MONTGOMERY, NY 12549 845 -457 -5318 Fax 845 -457 -9392 NAMr= :PUTNAM COUNTY DEPARTMENT OF P. 2 I I I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES RUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM 'F EnTownorVillage PERMIT # Located at,&A1114 4AId D4/l/� Subdivision.name o,&e/ -V'e✓. bA0/c,o-Subd. Lot # _L Tax Map 9S Block J Lot / 0 Date Subdivision Approved 9,e,;2,7/9'-3 Renewal ->K Revision Owner /Applicant .1we, Date of Previous Approval Mailing Address �00 &OX 90 7 Zip / So Amount of Fee Enclosed -0�3 0 47, o 0 Building Type Lot Area 9- 0 No. of Bedrooms Design Flow GPD L"o 0 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage S s� tem to consist of / o o O gallon septic tank and 37s:' - ��' �'L✓ia�soi®r✓ ?..mac,. s Other Requirements: 0''41-' /�� ��� y �,����s /aY✓ �P 3 To be constructed by ;!2 Address Water Suuuly: Public Supply From Address or:. Private Supply Drilled by --a 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. D. & o: Address 3 799 ^'��✓' ° °X . , >', d��'�Say✓ t//icense # 7� 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 considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new p it. Approved r discharge of domestic sanitary sewage only. By: L�^ � Title: Date: `2 � 1 White copy - HD ile; Y to copy - Building Inspector; Pink copy - Owne , &a ge opy - Design Professional Form CP -97 r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL _ .. please print or type _ _.._- -- -- - PCHD Permit # Sw _ 1 1-0-2) Well Location: Street Address: Town/Village Tax Grid # / ,401' AI'v 0---4 4be- ,o.�ji or✓ Map gS Block / Lot(s) O Well Owner: Name: Address: / so✓ / -v "00 4 o S/o7" B.�b✓�y�/i� N Use of Well: �_ Residential Public Supply Air /Cond/Heat Pump Irrigation /O-1�09 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought .S gpm # People Served Est. of Daily Usage,/Poo gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling >4 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 .o4o01495' Lot No. / Water Well Contractor: 7v 4?Z- Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: / O D 1.2—' Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: /&/2 Zo a-- Applicant Signature: _ 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 well driller certified by Putnam County. 1' A Date of Issue 4-2,1 —L9 Date of Expiration —S/-05— Permit is Non - Transferrable Permi Title: White copy - HD file; Yellow copy - Building Inspector; Form WP -97 . NEW YORK STATE DEPARTMENT OF HEALTH Specific waiver Bureau of Community Sanitation and Food Protection from Requirements of Part 75 and Appendix 75- A,10NYCRR — -- - - -- -- for Individual Household Sewage Treatment Systems Name of Applicant No. Street . City/Town State Zip Address �•v• t' aS� Aft) 41Sg11P Site Location 1AA.VtL.APO lULi� f,7 �j t,��- 1. Reason why site does not meet IONYCRR Appendix 75 -A (check appropriate box(es)): Separation distance cannot be achieved. Excessive slope. High groundwater. inadequate depth to bedrock or impermeable layer. J Soil unsuitable. Other(explain) ....................................................................................................................................... ............................... 2. Proposed design or conditions of waiver: ................................................................................................................................................................................................................. ............................... ........a........!.. ............' AE- ....O.P..... .. N ...... ......... T.OEA4.`. 1 ............................................... 3. The proposed design may have the following limitations (check appropriate box(es)): J Increased risk of well or spring contamination. Increased risk of surface water contamination. J Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. Other(explain) ...............................................................:. .........I..................... ....................................................... I............ Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. in accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked by the issuing official for a change in conditions for which this waiver was granted. r. ORIGINAL - Local Health Agency .... ............................... COPY - Applicant/Design Professional nnu 41)')c 17/01% (GEN -152) 'SW-4-03 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. C 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, it legible) C1. Existing air quality. surface or groundwater quality. or 'quantity, noise levels. existing traffic p5ttems. solid waste proouction 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: tu0 C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: ItW Cs. A community's existing plans or goals as officially adopted, or a change in use or :ntensity of use of land or other natural resources? Explain briefly. ' V C5. Growth, subsequent cevelopment, or related activities likely to be Induced by tra proposed action? Explain briefly. .Co. Long term, short term. cumulative, or other effects not identified in C1 -057 Explain briefly. C7. Other Impacts (inclucing changes in use of either quantity or type of energy)? Explain briefly. u0 D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? L� 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 (f) 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 imparts AND provide on attachments as necessary, the teasons supporting this determination: a F'pw A 12--o wlimcl A.. 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/Presthool (845) 278 - 6014 Fax (845) 278 - 6648 NAME: ADDRESS SITE LOCATION: DATE: PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAVIER ?tf,ST1 Gam. 410 M �-5 ,�C . ► G . ?-0- boy- tfA�- �t' Qkt�15?"fc� W `( t 12 6�A'UILAV � �� t �� . i��'►'CC��o1� %1 STAFF PRESENT: Rob M., Mike B -,'j Shawn R., -Bill H. SPECIFIC WAVIER REQUEST: 'BE. vl- g41 �Co i>2-rPt4f%j L,,I}jL_ O Ff.EX DOES THE PROPOSED VARIANCE REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? REQUEST APPROVAL OR DENIED P ED FOR f G• DIRECTOR OF (SPECWAIVER) (` DATE: DENIED YES NO WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? + -- + - - -+ YES NO DISCUSSION REQUEST APPROVAL OR DENIED P ED FOR f G• DIRECTOR OF (SPECWAIVER) (` DATE: DENIED 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 Barry Naderman, P.E. 3799 Nelson Avenue Box 7 Jefferson Valley, NY 10535 Re: Proposed SSTS: Prestige Homes II, Inc. Haviland Hollow Road, Lot #1 (T) Patterson, TM# 25 -1 -1- Dear Mr. Naderman: ROBERT J. BONDI County Executive March 3, 2003 Review of plans dated December 19, 2002 last revision dated February 15, 2003 and other materials relative to a construction permit for the above captioned property has been completed by this Department. Based upon such review, and pursuant to the provision of Article III of the Putnam County Sanitary Code, you are hereby advised that the proposed method providing water supply and sewage disposal are considered inadequate as set forth below. Therefore, approval of these plans cannot be granted. 1. Minimum distance from the toe of slope of the fill to the property line is 10 feet, 0 separation distance is shown. 2. Minimum distance from the fill pad to the well is 100 feet, 90 feet of a separation distance is shown. It is your legal right to request a waiver of the denial based on item(s) noted above. The denial request must be submitted in writing after the receipt of this letter. The request must specifically state the waiver being sought. If you have any questions, please call lie at (845) 278 -6130 ext. 2166. RM:tn V myy obert Morris, P.E. Senior Public Health Engineer nd o' i ��`�- �i(oZ• 5163 - - t - -- - -- - 1C)OC; bo 60 EXPANSION ARE 0 u q`�D o1A e 46' LF ABS TILC14rli C-ryp N 60 �o e+ M d• � I r 0 GAL. J.66x TYP_. SEPTtCTApI 4'40 5ALSS�No SbR 35 PROPOSED 4 BR. ------ -- RESIDENCE _ _ - - --'- ----------- 13F. 100.6o, - - - - - -- FF. 609.00' - -` - - -- -- ' ----- - - - - -- rWATER SERVICE - - ---�- -- - -- -- -- -- PROP ELL - 6 h N - N ° m G 516 °L1IO�W' 35.30 X525 °0840 "Ir / I 64. uj b O 0 in b M: Z� 1 "- 6L0� w b ,P Q 0 e 630) N SENDING CONFIRMATION DATE MAR -16 -2003 SUN 11:08 NAME PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 919149625963 PAGES : 1/1 START TIME : MAR -16 11:07 ELAPSED TIME : 00'25" MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... .,yam Mi 19 ----- - - - - -- , I Oiq 55 t�uds9 ' �- � ef2t�r �%,;ZDA _ NOISN Vd %A ^r -- F7 Mr. Robert Morris, P.E. = PCHD ':February 18,• 2003 Page 2 . 5', As we discussed, due to the :limited area, the toe, of the fill . for the disposal area cannot maintain 10'.from the property line. Regarding . the, well, the grading of the fill for the disposal area extends up to the rear of the proposed residence:: This is to allow the proposed grade at there yard• .to.,be at.basementlevel and simplyblend into the`fill for th6disposal area; Therefore, we believe it is appropriate for the `well setback .to be considered from the trenches .sin'ce`the fill .gradually continues to rise'. towards the residence .6. We have obtainedahe.as -built records.of all septcs and wells within'200' of'the`properfy..'A 100' scale'plan - of.these' adjoining septics arid wells•' has-been -adde d to the tr endh plan Dwg S- 1. 7. Based upon the FEMA mapping; there are-ho 100 -year floodplcnnswithin ; 200' .of the property sand .a note stating such has` been added to the plan:. 8. The.. drywell has beeri modified to:infiltration trenches and relocated to,.. -beyond 50" from.the.proposed well 9. The: proposed infiltration,trenches are proposed beyond 20' from the residence. 10. As we discussed; 'percolation test #2 •is located within the expansion area lust'above the first,junetion' box, :11: Erosion - control has been added to the well._ '1n addition, a silt fence detail'. - -' has been provided... t 12: The grading of the fill has been revised to more. specifically ill ustrate that the fill extends 10' beyond the trericlies :and slopirig'3: i to grade: 13. The trench detail has been revised to specify a geotextile cover only. 14:. The service connection from the well to the residence has been added. 15: A north.arrow.has been added to the plan. We are.hopeful we have addressed the comments to•your. satisfaction. We acknowledge that the issue of the toe of the fill "slope starting within 10' of the - property line may require consideration of a`waive'r. As such, .we -are, providing herewith the required Speci�, -Vgar fpm ca ; I/ 14 s 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 (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 Barry Naderriian, P.E. 3799 Nelson Avenue Box 7 Jefferson Valley, NY 10535 Re: Prestige Homes II, Inc. Haviland Hollow Road, Lot #1 (T) Patterson, TM# 25 -1 -10 Reservoir Basin Dear Mr. Naderman: January 23, 2003 The Putnam County Department of Health (Department) has determined that the above referenced application, .including fee, and received by this Department on January 6, 2003 is. complete. The Departinenf will notify'you by February 12, 2003 of its determination. ® The Project has. been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. 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 Department of Environmental Protection review and approval of other aspects of a proj ect, such as stormwater plans Letter to: Barry Naderman, P.E. - January 24, 2003 -2- or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2166. Ve ly yours, Robert Morris, PE Senior Public Health Engineer NEWT YORK STATE DEPARTMENT OF HEALTH Specific Waiver Bureau of Community Sanitation and Food Protection from Requirements of Part 75 and Appendix 75- A,10NYCRR for Individual Household Sewage Treatment Systems Lut Name First M.L Name of Applicant �i= �.�1'�G4c .6�oS Ml�iE iPSt� Olrif% _ { No. Street City/Town Slats Z9 { Address /ls�, ^TV: 4,/. .G AV low SB±/��E% ;�$i2�w.sY�2 N' , . /e SO 9 No. Street City /rown S Zip Site'Location ,�o�,y�,,�� -j• cow -n�ij- . of!/ /L�6iv0 GAy i .O.s✓N�'��- .od;�r.�OYg ✓� .I 1. Reason why site does not meet 10NYCRR Appendix 75 -A (check appropriate box(es)): Separation distance cannot be achieved. Excessive. slope. J High groundwater. [-J Inadequate depth to bedrock or impermeable layer. J Soil unsuitable. JOther (explain) .......................................................................................................................................................................... ............................... .............................................................................................................................. ............................... ..............................................................................................................................:......... .......:....................... ....................... . . .. . . . . . . . . . . _ . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. Proposed design or conditions of waiver: . ........................................................................................................................................ ............................... 3. The proposed design may have the following limitations (check appropriate box(es)): Increased risk of well or spring contamination. Increased risk of surface water contamination.. i___I Expected design life of the system will be diminished. 0 Operation of sewage system is subject to mechanical problems. Other(explain) .................................................................................................................................................:............ ..........__.....__....__..__._ . ..............................:...... ............................... Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked by the issuing official fora change in conditions for which this waiver was granted. ........................................................... ............................... RE ?RES'cNTATIVE OF COMMISSIONER OF HEALTH DATE................................................. ............................... ORIGINAL - Local Health Agency COPY - Applicant/Design Professional rock= 4c .1% I 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 January 23, 2003 Barry Naderman, P.E. 3799 Nelson Avenue Box 7 Jefferson Valley, NY 10535 Re: Proposed SSTS: Prestige Homes II, Inc. Haviland Hollow Road, Lot #1 (T) Patterson, TM# 25 -1 -10 Dear Mr. Naderman: Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: I/�3. V 4. 5. ri 8. 9. 10. 11. 12. House plans submitted are considered to. have, five,(5)_p9tential bedrooms. _..... _ ........ _: _.... All watercourses and water bodies with 200 feet of the property are to be shown or a note added stating none exist. The number of bedrooms is to be labeled on the house in the plan view. Scale ofthe location map is to be noted on the plan s within 200 feet of the property line are to be shown or a note added stating none exist. All 100 year flood plain. Boundaries within 200 feet of th erty are to be shown or a note added stating non exist. Minimum distance from.a dry well to a well is 50 fee Minimum distance from a dry well to the foundation is 20 feet. The minimum of one percolation test is to be provided in the expansion area. Erosion control measures for the well is to be shown. Furthermore, erosion conttoI detail is to be provided. Fill is to be shown extending 10 feet horizontally past the edge of any trench and then sloping 3:1 to grade. M Letter to: Barry Nadermaii, P.E. - January 24, 2003 -2- 13. Trench cover is to be noted as geotextile material onl . 14. Location of the service connection from well to the house is to be shown 15. North arrow is to be provided on plan. . The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:tn Ve y yours, /4VV0 gi. Robert Morris, P.E. Senior Public Health Engineer 14 16.4 (11/95) - - Text 12 PROJECT ID NUMBER 617.20 SEAR Appendix C State Environmental Quality Review _SHORT ENVIRONMENTAL ASSESSMENT_ FORM -- -- For UNLISTED ACTIONS Only PART 1 — PROJECT INFORMATION (To be completed by ADDlicant or Proiect Sponsor) 1. APPLICANT /SPONSOR Barry Naderman, P.E. 2. PROJECT NAME Residence for Prestige Homes II, Inc. for Prestige Homes II, Inc 3. PROJECT LOCATION Municipality Town of Patterson county Putnam 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) At the Northwest corner of Haviland Drive and Partridge Lane 5. IS PROPOSED ACTION: ®New ❑Expansion ❑ Modification/alteration 6. DESCRIBE PROJECT BRIEFLY Construction of a single family residence with associated driveway and septic on an existing residential lot. 7. AMOUNT OF LAND AFFECTED: Initially 0.6 acres Ultimately 0.6 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ®Yes ❑ No If No, describe briefly 9. WHAT IS THE PRESENT LAND USE IN VICINITY OF THE PROJECT? ® Residential ❑ Industrial ❑ Commercial ❑ Agricultural ® Park/ForesUOpen space ❑ Other Describe: Single family Residential 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ® Yes ❑ No if yes, list agency(s) and permittapprovals Town of Patterson Building Permit. NYCDEP SDS Approval 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENLY VALID PERMIT OR APPROVAL ® Yes ❑ No ff yes, list agency(s) and permit/approvals PCHD and Town of Patterson Realty Subdivision Approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION ❑ Yes ® No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsorname: Barry G. Naderman, P.E. for Prestige Homes II, Inc. Date: 12/24/02 I 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 A DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAR Yes JXrNo 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 IX I 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 pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Blain briefly: No C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly. No C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly. No C4. A communitys existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly: No C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. No C6. Long term, short term, cumulative, or other effects not identified in C1-05? Explain briefly: No C7. Other impacts (including changes in use of either quantity or type of energy? Explain briefly: No D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT.OF A CRITICAL ENVIRONMENTAL AREA (CEA)? Yes X -No , If Yes, explain briefly: E. IS THERE,.OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? Yes 1XI No If Yes, fain 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 (f) 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. If question d of part ii was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. heck this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to 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 ac ILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting Name of Lead Agency Date Print or Type Name of Responsible Officer in Lead Agency LS :1 Ill Signature of Responsible Officer in Lead Agency 0 33Q (0 Title of Responsible Officer Signature of Preparer (If different from responsible officer) 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: 2. Name of project: 3. Location TN: 4. Design Professional:, G. � Address: 37,Py 7 6. Drainage Basin: ,�sr . ,Bi24^46,11 7. Type of Project: 2< Private/Residential Food Service Apartments Institutional Office Building Realty Subdivision .?,�.tc-E'•�so.✓ y�y, ivy i v.S'3S Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? == Type Status (check one) ................. : ................................ ..... Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... yo 1 -0. 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? ... .......... ... _.. .._ ..._.....,✓ 13. If so, have plans been submitted to such authorities? :....... ............................... �,/�' 14. Has preliminary approval been granted by such authorities? Date granted:.' 15. Type of Sewage Treatment System Discharge::..-...:::: : :::. - - surface'water-- :. _- 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? ,lii®!L i4/dJ�c 19. If yes, name of water supply 05soz . Distance to water supply /Ja 20. Is project site near a public sewage collection or treatment system? ................ ,/D 21. Name of sewage system Distance to sewage system 22. Date test holes observed 23. Name of Health Inspector 24. Project'design flow (gallons per.day) ................................. ............................... X00 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... ova 26. Has SPDES Application been submitted to local DEC office? ......................... �✓,� Form PC -91 1 8/99 i - 2 27. Is any portion of this project located within a designated Town or State wetland?'S 28. Wetlands ID Number .......................... ............. .............•:. ....o .. ...........�..z ... ...! p400,_W.W . 29. Is Wetlands Permit required? ,41 O Has application been made to Town or Local DEC office? /Vzlot 30. Does project require a DEC Stream Disturbance Permit? ............................... /✓07 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 eO 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 -v 6� DESCRIBE: 33. Is there a local master plan on file with the Town or Village? y. 34. Are community water and/or sewer facilities planned to be developed within - 15 years in or adjacent to project site? ..............................:. ............................... 35. Are any sewage treatment areas in excess of 15% slope? i✓ D 36. Tax Map ID Number .......................... ............................... Map ;--s Block / Lot 37. Approved plans are to be returned to ..... Applicant Design Professional NOTE:.A l 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 stormwater 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 & OFFICL41 TITLES.-,;f Mailing Address:.. ... ............................... 37 %9 .,,�- Zsrrr-' eoz e 130X -7 i AUta7;26 -2002 10:1.1P FROM: NADERMAN LAND P &E 914 9625963 TO:19452792199 P:3/3 PUTNA.M COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: A Subsurface Sewage Disposal System represent that I am an officer or employee of the corporation and am authorized to act for: Name. of Corporation: Pregtige Homes II, Inc.. Having offices at: /k-,7 s6 2� SvTtf �✓��GvS�& Whose Officers Are: President - Name: 1 r! ` S% Ai✓ LV Address: Vice President - Name: Address: Secretary - Name : %" 1 ! LLB S'j`,4-NLC- Address: Treasurer —Name: 5 rA^-,.L�E.'7 Address: and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating. thereto. Signed: Title: Sr 7r_'✓"'� Sworn to before me this day of _(month) (year) Notary Public KERRI NIELSEN Notary Public, State of New York No.5036978 Qualified in Dutch � Corporate Seal Commission Expires Form CA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM I /' "t`Z 'e, "g a /rze • J aa7v -Po /J 0'X yo 7 -Address 7" Located at (Street),ce.,we�ol.4,ky . -c-,? I Tax Map ;zs . Block r Lot 6? (indicate nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA Date of Pre - soaking -7//7/0 9,/.P/ o Date of Percolation Test 71181'-O,;'-9` 101171op- NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. _< I 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 . ... .... i.7 7 /.n' //_3 2 0 0 3 :os /-35 3o a3 4 5 3 Y 3 0-' d- 2 3 67� %y /3-3 3 9'Y 30 /3.3 4 5 3 2 //41 7 , 5- 3 5 3 . Z: 3 13- ay a7 3 13 .4 :Sy �Y a y y6 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. _< I 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 DEPTH G.L. 0.5' 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' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. lie ti✓ o o Q,�/,J' f /�✓� S /G�/s��''Lo.6rt HOLE NO. -13 wooO,5�O ,.a So /G ,omi- � s HOLE NO. c w.o O rJ,�Q /d-o@ 61, � Indicate level at which groundwater is encountered /t/o.✓� Indicate level at which mottling is observed A,- o.✓F` Indicate level to which water level rises. after being encountered ;►io �r Deep hole observations made by: Date /8 oa- Design Professional Name: Address: r%�.�.�.2►✓ ` ,o,✓.,i..��- r.,.G.,,oc. 3 ��� ,✓.�so.✓ ��' -,gam 7. Signature: a Design Professional's Seal 2 PUTNAIII COUNTY DEPARTMENT OF HEALTH _ DMSION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: Tim 141 STREET LOCATION: REVIEWED BY: RM, OR, AS, SRDATE: T.4X t�LAY=: (CONFI MED) Y pOCUtiIENTS Y (REQUIRED DETAILS O� PLANS CO \�T'Dl PERMIT APPLICATION ' (� HOUSE SEWER -'b" FT. -t "0'; TYPE PIPE CAST IRON. (� .1) 'Ed OR PWS LETTER �NO BENDS; MAX BENDS •!S° W /CLEANOUT• PC -97 RENEWALS IZ LETTER OF AUTHORATION 2;(SSITE NOTE (NO CHANGE) DESIGN DATA SHEET (DDS) FILL SYSTEMS CORPORATE RESOLUTION 10' HORIZONTAL; PAST TRENCH SLOPES 3 :1 TO GRADE LffL_JSHORT EAF FILL SPECS! FILL NOTES 1 -5 PLANS -THREE SETS (� FILL PROFILE & DIMENSIONS ( 2' HOUSE PLANS - TWO SETS ; yam e FILL Lei F- XPA�\SION AREA VARLA.NCE REQUEST FILL GREATER TH.dY1 FEET x°` SIMDMSIOIN (.,C) CLAY BARRIER (__ LEGAL SUBDMSION C FILL CERTIFICATION NOTE , ' (�SUBDMSION APPROVAL CHECKED (DEPTH t;AUGES L PERC RATE - (�VOL 0;1 PLAN FORRO.B., UNCLASSIFIED & IMPERVIOUS ( DISTANO =LJwN ' ( )GMTAL I DRAIN REQUIRED � TRENCH GENERAL LF TRENCH PROVIDED LOFT NIAX. LOCATED IN NYC WATERSHED r _ ' 'TOURS -- ,� PLANSSUBMITTEDTODEP - AXPpeT iSIOrPROiDE D' R . DELEGATED TO PCHD DETAIL/DUST FREE CRUSHED STONE OR WASHED. GRAVEL. f DEP APPROVAL, IF REQ'D. GEOTEXTILE COYER DEEP TEST IiOI:ES'013SERVED iEPAR4TI0N DISTANCES ON PLAN : FROMM SS1'S WITNESSED TOP OF FILL . . w ( 10' TQ P.L, DRIVEWAY, LARGE TREES,• EX- APPROV L SSDS AD7, LOTS. 0' TO FOU\DTION WALLS S:(TOW)l/DE'C.PERNllT;REQ'D ?) L�(_)100'TOWELL, 200' IN.DLOD,150' TO PITS " � • � jjATA-0,N DDS PLANS.& P' E' RNM SAME (��100'TO STREA�, WATERCOURSE, LAKE (iac ezpaa) .. • (,_)( PRE 1969 NEIGHBORNOTIFICATION a0' TO CATCH BASD (,35'SIORMDRADlPIPEDWATER �L___)LETTERBI/ZBA :. 10, TO WATERLINE (pits -20') " VU100 YR FLOOD ELEVATION WR 200' S0' I \TLRb1IITEN'1 DRAINAGE COURSE . (�d SOILTESTL`(G LOTS>10 YEARS OLD 300' /500' RESERVOIR ETC. 150' GALLEY SYSTVNS. E O (--)10'•bIMTO LEDGE OUTCROP _ - ((, �SEWAGESYSTEMPLAN- (NORT1iARROW), SEPTICTAKK GRAVITY FFLLOWCPROFILE (�U10' FROM FOUNDATIOV;v ' TO WELL -- ACONST $U4'TI9Y.pLOTES_1- 15__'� - - - - -- - -- - ( ( �DISIENSIO :iST0-PROPERTYT.INES'- -. "'- DESIGN DATA: PERC & DEEP RESULTS L�LOCATION OF SERVICE CO`IiiECTIO\ ' COANTOURS EXISTING & PROPOSED (�f JML`I 15' TO PROPERTY LINE ' DRIVEWAY & SLOPES. CUT FOOTINGIGUTTERICURTADI DRAINS SL (S 0 %) USDA SOIL TYPE- BOUNDARIES SLOPE Di SSTS AREA ?SREGRADEDT015%,1FREQUIRED TITLE BLOCK; OWNERS NAME ADDRESS DOSE/PLMIP SYSTEMS Th1", PE/RA; NAME, ADDRESS, PHONE# PUbIP NOTES L2(�-JDATE OF DRAWING/REVISION DOSE 75' /6 OF PIPE VOLUIFMMOSE VOLUME NOTED C-K JDATU ERM (7C jDETAIL FOR FORCE b1AIN, (PIPE TWA, ETC.) L TION OF WATERCO RSES, PONDS pR AND D -BOX SHOWN & DETAILED ' I s WZTLANDS�'F 200' OFR.L. I_��1 DAY STORAGE ABOVE ALARM HFLQORAND CURTA 'BRAIN _ BASEMENT ELEVATIONS STANDPIPES, 5' BOTH SIDES, DETAIL WELLS & SSDS'S WAN 200' OF SSTS " MS' bIT1`1 to CDS=>5 %, 20' -4 %j 25 =3 %, 35'- 1 %o,1b0 %-<1% �EPROPERTY METES &BOUNDS 20' b1IY to CD DISCHARGE/100' ivith 182 cons day discharge EROSWN,CONTROL FOR HOUSE, WELL & LJ10' NIP1 to NON- PERFORATED PIPE SSTS, EROSION CONTROL NOTE . COMMENTS: (((EVSHECT)09101 /00 — AUG -26 -2002 10:10P FROM:NADERMAN LAND P &E 914 962 5963 TO:19452782199 P:2/3 PUTNAM COUNTY DEPARTMENT OF HEALTH ]DIVISION OF ENWRONAIENTAL HEALTH SERVICES r UTTER OF,AUTHORIZATION RE: Property of Prestigd- Homes n, Inc. Located at liaviland Road -@ Partridge .Lane TA' Patterson Tax Map 4 1 = Block 1 Lot 10.1 Subdivision of Robert W. ' bapice' Subdivision Lot it 1 Filed Map 9 /93.6 Date Filled /a /Y e-3 Gentlemen: This letter is to authorize Barry G. Naderman, P.E. a duly licensed Professional Enoineer X or Registered Architect to apply for the required wastewater treatment and /or Nvater supply permit(s) to serve the above -noted property in accordance with the standards, odes or regulations as promulgated by the Public Health Director of the Putnam Count), Health Department, and to sign all necessary papers on my behalf in connection -with this matter and to stipen,ise the constriction of said wastewater tretment and/or water supply systems in conformity with the - provisions of Article 145 and/or 147 of the Education Law, the Public Health La%,,-, and the Putnam County Sanitary Code. Very truly Fours, Countersi Slcincd:� (Owncr or Prop:rtp) Mailing Address Naderman Land Plan' g & Engirieering,P.C. 3199 Nelson Ave.- Box 7 �Je ersor, Valley State NY Zip 10535 Telephone: 914 - 245 -5403 Mailing Address: PO Box 407 Brewster State New York Zip 1 0 q 9 Telephone: 914- 490 -4629 _ Form LA -97 n . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET SUBSURFACE SEWAGE TREATMENT SYSTE Tel ...... Owner :5 ixA Address '?2 Located at (Street) 13Q/9 5•7-0A1,—,-- Tax Map 2 -5, Block Lot (inAicate nearest cross street) Municipality R-g7-7�� e, _ Z7!5o A/ Watershed "_-5r 73�ZdA� &I-1 SOIL PERCOLATION TEST DATA Date of Pre-soaking - /gi "6e 2 Date. of Percolation Test 7 :Z NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I 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 N t. ...... I .. -S .. :..::..:.::..:pia . . ....... ...... ...... . .... ..... ....... ... Ti ag .. �: ;r >:.:<.:;. MWI . ......... .. . . .... . .... ..... .. . . . . . . . . . . . . . . . . . ........ .. 2 .30 go A;Iy 13,3 30 4 5. 2 3 4 5 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I 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 Sheet_( of_� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLH SERVICES _ FIELD ACTIVITY REPORT Ar)T)RF ,q4. Mbll iVD P drz7��i1/ AZ-& Street Town State Zip . PERSON IN CHARGE Name and Title TYPE OF FACILITY:. FINDINGS: d2. Signature and Title REPORT RRCFTVFT) RY: I acknowledge receipt of this report: SIGNATURE: 02/96 Rev. Title: PUTNAM COUNTY DEPARTMENT OF.-HEALTH )DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET.- SUBSURFACE, SEWAGE. TREATMENT SYSTEM Owner Address Located at (Street) 4, Tax Map 2 67, Block Lot to (indicate nearest cross street) Municipality TTY T?g-ig2a Watershed 3 1 h wt "Al SOIL PERCOLATION TEST DATA - Date. of Pre-soaking ZZ 1 -7 /0 -.Z- Date*of Percolation Test 7 l ?2 10 P Z? // NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained each percolation test hole. (i.e. .g I min f6r 1-30 min/inch, :5 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 0� Yy -3 .4 5 _3 2 3 3 4 3,26— 3,7` 30 0 WA, -7 2' 3 ,3f 13 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained each percolation test hole. (i.e. .g I min f6r 1-30 min/inch, :5 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 0� DEPTH G.L. 0.5' 2.5' 3.0' 3:5' 4.0' 4.5' 5:0' 5.51...... 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0'., TEST PIT DATA,. DESCRIPTION OF SOILS ENCOUNTERED IN.TEST HOLES HOLE NO. / HOLE NO.- ;L HOLE NO. 3 B 9.5' 10.0' Indicate .level at which groundwater is. encountered Indicate level at which. mottling is observed A/ 14- Indicate level to which water level rises after being encountered Deep hole observations made by; Date 7 �� Design Professional. Name: Address:. Signature: Design Professional's'Seal Y Fa I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCUL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project /V) �',4Tf�RS d,V County PuT/V,if Site Location &i&64 AA1,1D 20, r - S, —1 —/0 Building construction begun Al, 0 Extent �- Is property within NYC Watershed ? ................. dYes 0 No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. Rilly 0 Rolling Steep slope Gentle slope F--J Flat 2. 0 Evidence of wetlands 0 Low area subject to flooding a Bodies of water Drainage ditches F—� Rock outcrops 3. Property lines or corners evident ....................... .................:............. 4. Do water courses exist on or adjoin the property? ............................ 5. Will these affect the design of the sewage system facilities ?............ 6. Do watershed regulations apply in this development ? ....................... 7 Will extensive grading be necessary? ................. ............................ .... 8. Will extensive fill be necessary for SSTS ? ........... .... 9. Do filled areas exist within the SSTS area? ...... ............................... If yes, what is the condition of the fill? ,es Yes a Yes. Yes Yes .0 Yes 0 Yes 0 No e o No 910 W N O SECTION C. SOIL OBSE VATIONS 10. Appearance of soil: Sand F--J Gravel Loam F--� Clay a Hardpan F7 Mixture 11. Observed from: Borings F--J Bank cut. 0 Backhoe excavations 12. Soil borings /excavations observed by D G; P D, on 7 / 8 ©--Z 13. Depth to groundwater A/ on 14. Depth to mottling 15. Are test holes representative of primary & reserve areas ...... ............................... on 16. Soil percolation tests made by 8147M.Y AJA,p t'77,4 Z on 17. Soil percolation tests witnessed by TC F E D �, G. �. on SECTION D (on back) Form ST -1' A [., y SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? 0 Yes N 19. Will groundwater or surface drainage require special consideration? ..................... Yes 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... Yes No SECTION E. REMARKS 21. If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities ? ................. ............... ............................... F__] Ye•s (No Inspection data 22. Do adjacent wells and/or sewage systems exist? ..................... ............................... ElYes F--].,No 23. Additional comments 24. Site observer /inspector and title 9::� 766 `P� G 7, 25. Date(s) of observation(s)inspection(s) % //A /0 2 TEST PIT PROFILES Hole # Lot # Hole # • Lot # Hole # Lot # Depth to water Depth to water Depth to water Depth to mottling Depth to mottling Depth to mottling.. Depth to rock/imp. Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L. 0.5 .0.5 0.5 1.0 1.0 1.0 2.0 2.0 2.0 3.0 3.0 3.0 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 JUN -5 -2002 08:39A FROM:NADERMAN LAND P &E 914 962 5963 �e e BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH I Geneva Road c Brewster, New. York-10509 110301CLOWWWO-Mi i - -f t 1 T0:18452787921 P:2/4 LORETTA MOLiNAItI.1LN., M.S.N. Associate Public Health Director Director of Patient SeMces ATTENTION: a AA01 STIEBELR1G GENE REED All information below must be J& completed prior to any scheduling. DATE: / °� ENGINEER ORFIRM: 4ffA'e_ , itr oE.asyi0y✓,4E PROVEN: 9 /f� �YS•.Syo,j REASON: DEEPS:)K PERCS .�K PUNIP TEST: 0 ROMSTREET: AoAO TOWN: TAX MAP #• aZ .S, SUBDIVISION: _r&- 4,04VI -f o,.� /=o,ei iso,[� i�'-✓ 'w• '0 */t5'LOT#: / 69r3) OWNER: YES NO a Prop.ose.d.SSTSwithin the drainage&sin of West-Branch or Boyds Comer-Reservoirs. Pro osed SSTS within 500 feet of a reservoir reservoir stem or control lake. Proposed SSTS within 200 feet of a watercourse or a DEC wetland. Proposed SSTS design flow greater than 1000 gallons/day or SPDES Permit re ed. Proposed SSTS for a Commerical Project.. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered yes_ to any of the questions, NYCDEP'must witness the soil testing. This - Department gill coordinate a mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the.above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. - FOR COMNTY USE ONLY • (FIELDTESn TI IN- 4 - ?AA? TI IF 19: SA TPI : A4q- ?7A -7gP1 NAME: PI ITNAM rni INTY n1=PQPTMPNT nr P P JUN -5 -2002 08:39A FROM:NADERMAN LAND P &E 914 962 5963 TO:18452787921 P:1/4 `b a A' 0 NADERMAN LANED PLANNING AND ENGINEERING, P.C. BARRY G. NADERMAN, P..E. FAX MEMO To: GENE REED -'PCHD FAx: (845) 278-7921 FROM: BARRY G. NADERMAN, P.E. DATE: 6/5/02 NO. OF PAGES: 140 (INCLUDING COVER) RE: FIELD TESTING - HAVILAND DRIVE - PATTERSON COMMENTS: Gene, Attached find a testing request for the lot on Haviland Drive we spoke about earlier. - Since we last spoke, I did have a field meeting with Sissy. DelaOssa - -NYCDEP. Based upon that field walk, the system m..be within 200 feet of a watercourse depending upon the results of the testing and survey. Therefore, I think it would be prudent to conduct the testing w/ DEP just in case. The property is located at the intersection of Haviland and Pca~tridge Lame just south of Brimstone. There was a previous permit issued in "83 for a residence on this site (P- 21 -83). Thank you for your assistance. 6 0 3799 nelson ave. tel: 914.245.5403 box 7 fax: 914.962.R63 Jefferson valley, ny 10535 e: bgn@nadermdn.com .TI IN -4 -?ARP TI IF 1 9: riR TPI : R4S- ?7A -7gP1 h10MP: PI ITNOM f' i NTV nPP0PTMPWT nr P 1 I JUN -5 -2002 08:40A FROM:NADERMAN LAND P &E 914 962 5963 D UT CHESS COUNTY PUTNA I / -Ift TO:18452787921 P :3/4 t� �. ►b1IJuC�}!'- rv'vuraar[y,� a r S i!1/fl*fe: /Wgnagememi:, ' a� W 2 i >' N 3 \ a 0 12563 z 8i t D 21 viland I WA7 65 t N •{ I o to N rb s G9p ~� ,' oa Qe G.1 S t m w Cp l ri, ft Y M C, qo ,may /I.. I. C. 0 R t FOR ADJOINING AREA SEE MAP NO.13 123 JUN -4 -2002 TUE 19:50 TEL:845 -278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 3 JUN -5 -2002 09:40A FROM:NADERMAN LAND P &E 914 962 5963 70:18452787921 P:4 /14 _ •.!''7.^G?`_�iG;. TS',' +y:.�''r:��,r <A 1 i( i';� ��,*,�h!�+: r: - .... .aaf�i +%� �',. yY'A•r _ .. v T,Fpr\,.. 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Fes ��..a• +. -r. , �}x. .,,u � 'r,.` � is ,i• � -- .f � ' �r: %:, roe ,:.I � ,•�`, �`.. �''� Q(�?I`�� .. - . ^:q ID 4 � _ r -.� _.gin, - �a�',;,�" .�_;'�' . • • f� _ 15• *t•'., Ff•.:r::. •GJ/ -^ter AV r3 7-7 TY DEPARTMENT OF P. 4 JUN -4 -2002 TUE 19:51 TEL:e45- 278 -7921' NAME:PUTNAM COUN 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 (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Date: 4C To: -DG 1-a 055� Fax #: 7 73 -tv V S 15;- From: Gene D. Reed Putnam County Department of Health ✓ For your information For your review As discussed Notes/Messages No. Pages (Including cover sheet) I ✓ Please respond Attached as requested Please call In the event of transmission /reception difficulties, please contact this office at (845) 278 -6130 ext. 2261. 30 0 SENDING CONFIRMATION DATE JUN -23 -2002 SUN 22:33 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 919147730355 PAGES : 4/4 START TIME : JUN -23 22:30 ELAPSED TIME : 02'19" MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED.. a a BRUCE 0. FOLEY LORMA MOLMARF 0.N, MB.N. Paafk HOM D6+da A-4m Pa67k Hedd Deedw D6ew d Petlwt &,W- DEPARTAfENT OF HEALTH 1 a eeva Road Bmwner, New Yod: 10509 r..e..a>.alt5a10 (6{5)171•cU0 Fa(115)271.7921 Nmdly Sw*. (14S)278.6358 WIC (i15)27t -6671 Fa(115)171.6015 [ay laft —tin (145)271 -5011 V. hod (115) 2746011 Fa(N5)"I.66/1 VAN ('OVER 4EnET Date: L 1L gx To. S��v 'l�n � OS;a.O Fau<fh. 77� -03' S ate• _ .. . No. Pages 41 (Iududing cover sheet) From: flap0.p- IM Putnam County Department of Heaith 1 —% For your information e respond For your review Ansehed as requested As dbeusaad Pie an call -- In the Event of transmudon/reOp ion dlff6CUltim, please contact this office at (845) 178 -6130 ewL 2261. _ �RUCE' 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 (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Date: To: tA. 19-25iO From: Gene D. Reed. Putnam County Department of Health For your Information For your review As discussed Notes/Messages Fax #: 773 _ 03 'b No. Pages s2 (Including cover sheet) `1 Z lease respond Attached as requested Please call ri 'O® In the event of transmission /reception difficulties, please contact this office at (845) 278 -6130 ext. 2261. SENDING CONFIRMATION DATE : SEP -9 -2002 MON 10 21 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 919147730355 PAGES : 2/2 START TIME : SEP -09 10:19 ELAPSED TIME : 01'06" MODE : ECM RESULTS : .OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED.. From: Geneb. Reed BRUCE R FOLBY a x LORMA bML04AR1 R.N., M.N. AWIe Ardd D&w Mwiat AWw Na91h Uftk• For your review D6— qj A.4 Sn.tei As discussed DEPARTMENT OF HEALTH Notes/Messages 1121 I zvailq 1 Cxnevs Road i>/e97//L lIn water, New Yak 10509 f9W 11!9 17AQ b,y& nsol B.V0 WW271.6U0 ra(W278-lay N"dry tntlen (113)271.6551 1P7t: M5)]7t•6671 11a(81S)271 -6015 t.Ar Inknnlem (115)271.6011 hvtluol (945)2716012 Fu(135)271.6611 FAX COVHR RHF:E9' Date: 9 / 2/0-1 TO:S�s,yDA L..Q3•`� No. Pages .2 (IndadioR cover sheet) From: Geneb. Reed Putnam County Department of Health v For your information ✓ Pleam respond For your review Muched as requested As discussed Please can Notes/Messages 1121 I zvailq I i>/e97//L e�err f9W 11!9 17AQ 10:00 i In the event of transmission/reception dillicuRles, please contact this office at (845) 278 -6130 e= 2261. \\ ` PUTNAM COUNTY DEPARTMENT OF HEALTH Permit 1, ! l - +� ,Division of Environmental Health Services, Carmel, N. Y. 10512 S . O. • 2071 CO 'TRUCTION'PERMIT FOR SEWAGE DISPOSAL SYSTEM T. Patterson Town or Villige Located' at lHayi -1 and Road Tax Map 18 Block 1 rvc 10.1 Subdivision Robert W Dapi ce Ste• Lot b ' Renewal _❑ Revision _0 , owner /Address Robert W. Dapi ce, 200 Westmoreland Ave. , A teatPbiaUsous Approval . Building Yype Frame Lot Area 2.00OA. NY 10�,Q ?Section only ❑ Number of Bedrooms three Design Flow G /P /D 600 P.C. N. D. Notification Required Separate Sewerage System to consist of 1000 Gal. Septic Tank . and 3781 'X .2411 W. x 2411 D. ' To be constructed by Address Water Supply: Public Supply From X Private Supply to be drilled by Address Other Requirements -NOne I represent that '1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to 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 Commissioner of Healthwill 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 disposal system during the period of two (2) years immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above ,will be located as shown on the approved plan and that said well will be installed ' accordance with th a ards, rules and regu aTons of the Putnam County Department of Health. Date September 9,-.1983 Signed P.E.._ R.A. Address =RD 9 Fair St armel NY Oftl 2 License No. 29206 APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and, Is, , revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction requires a. new permit. Approved for disposal of domestic 5#pitarWsewage, ano /or private writer supply only. Rev. 9 -e1 __. U Department of Health, and to sign all necessary papers on my behalf.in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 .-or 147,' Education Law, -the -Public H:�alth Law, and the Putnam County Sani- tary Code. 6hEL ig� , R.A. /. , RD 9 Fair St. Address Carmel, NY 1051.2 878-6170 Telephone Very truly yours, C Signed �. e�.J°" k2 Imo ,2 . _ •— .. . Owner of Property 200 Westmoreland.Ave. Address White Plains, NY,,. 10602 Town ON rV 'elephone9 SEQ coUc� � � O�P� SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Merm DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 To: Margaret O'Connor, PE, NYCDEP From: Michael Budzinski, PE, Director of Engineering CC: File, RM Date: July 17, 2006 Re: 2nd Quarter (Apr. 1- Jun. 30, 2006) Report ROBERT J. BONDI , County Executive Attached please find the second quarter report for the year 2006 for the Individual SSTS, Realty Subdivision, and Commercial SSTS programs as required by item #12 in the Delegation Agreement. The data is also enclosed on the computer disk. Kindly advise this office if there are any questions. Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (843) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool(845)278 -6014 Fax(845)278 -6648 Separate - 5ewerage ; system To be''constructed by b Water Supply Other,...Regw en s. y l represent that 1: am wtholl ; above dascribed will be' ' cor County. Department of l be.submrli ed''to•the'bip+ place in good, operating _a - ...tee. ..� '. we•.........:.r - ��`.r� i- will be' located as snown on the approved, plan and that -said well well be Installed County,.'Oepa'rtment of Health ` Date zS�gned, f , AdCress ' RD 9 Fair arme'1 ;ry 1 .41 PPROVE& FOR CONSTRUCTION This approval expires one` yearr from the dat', revocable for cat or may be amended or modifledwhen cons�dereG necessary by, required;a new permit i4pprovetl for di3poSal of tlomesticc I sewe 1 � Z 83 z K�5 ':Date By K PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Sept. 9, 1983 Re: Property of Robert W. Dapi ce Located at Havi 1 and Road (T) 18 9 9XAYM Block 1 Lot 10.1 Subdivision of Robert W.:Dapice Subdvo Lot # 1 Filed Map # r Date Gentlemen: This letter is to authorize John H. Prentiss., a duly licensed professional engineer X or registered architect- (Indicate) to apply for a Construction Permit for a. separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public I4alth Law, and the Putnam County Sani- tary Code l� RD 9 Fair St. Address Carmel, NY 10512 878:;'6170 Telephone Very truly yours, Signed ' Owner of Property 200 Westmoreland Ave. Address White Plains, N`.., 10602 Town XN r'V t c t elephone03 Q , SE _ o)N�� t0i . Notes: 1) Tests to be repeated at Same depth until approximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of bole. FUTNAM'COUNTY DEPARTMENT..�OF HEALTH DIVISION OF- ENVIRONMENTAL F3EALTH'SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM .,,` -FILE NO.. owner D_ Ut Address_ v:iea�4 Sri�� �rf „�y . .Located at (Street QQ� ll Dr ���ica ,�tt Block L of 4 O.J. _):,:):,: la � e neares cr ss 's ryes L� Municipality � s. Watershed r r, SOIL PERCOLATION•TEST DATA REQUIRED TO BE SUBMITTED. WITH APPLICATIONS• i Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Wdter Water Level j No. Time From Ground Surface in Inches Soil Rate Start -Stop Start Stop Drop..in; drop` .Min. inches Inches Inches r l 4 2 CP A 9 311)61 u-11, �41r Y ` 4 514 11*8 u 151: Ito • .�+• ILY�. 113E /� �” �• � 11- ! � a knff Notes: 1) Tests to be repeated at Same depth until approximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of bole. TEST PIT DATA REQUIRED. TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE TESTS MADE BY E /4-#4m °113] fie. (J. ".M Date'%. Mau _jya3 t< DE IUN Soil Rate Used �- Min,/l "Drop: S.D. Usable `Area Provided_ ®p 1 No :t, of .Bedrooms p Septic Tank Capacity ®nth ";;Gals.;. Type o Absorption Area -Provided Byjbog L.F.x24" width. trench. Other Nora► pE -ssI00 ame } P, % a . F.Q- g, FAIR ST. Address :, s HE 9114-8713-6-17 0 — THIS SPACE. FOR USE.BY HEALTH DEPARTMENT Soil Rate Approved Sq. Ft /Gal. s o� Date uj cc Q. 0* S YSB 15, crc sr- 71?J TR2 so, Dal - - i 1/ YOW OIL SOME DEC) HA V/IL AND 2977"45'20" W L-S 24-03-10 84.66" 55.12' E)R1 I N16*21 10. iA r d 00 U) ff a n N Q) (o 9 ` COUNTY CLERK'S OFFICE ON OCT06ER 14, 1983 AS FlLED A4AP11936. O 0 ' TESTS RESUI AS BUILT SUMMARY (2) DEVICE• A(I) B(l) DB1 71'-2" 59'— 7" DB2 75' -9" 65' -5" DB3 80' -4" 71' -9" DB4 85' -3" 77' -6" END OF TRI 61' -3" 97' -7" END OF TR2 W-110 101'-7* END OF TR3 71' -9" 103' -9" END OF TR4 77' -3" 106' -9" END OF TR5 112' -2" 74' -5" END OF TR6 116' -6" 80' -4" END OF TR7 121'-7- 86'— 7" i O 0 ' TESTS RESUI AS BUILT SUMMARY (2) DEVICE• A(I) B(l) DB1 71'-2" 59'— 7" DB2 75' -9" 65' -5" DB3 80' -4" 71' -9" DB4 85' -3" 77' -6" END OF TRI 61' -3" 97' -7" END OF TR2 W-110 101'-7* END OF TR3 71' -9" 103' -9" END OF TR4 77' -3" 106' -9" END OF TR5 112' -2" 74' -5" END OF TR6 116' -6" 80' -4" END OF TR7 121'-7- 86'— 7" TRENCH DESIGN LENGTH AS BUILT LENGTH (2) 1 60 FEET 60 FEET 2 60 FEET 60 FEET 3 57 FEET 57 FEET 4 55 FEET 55 FEET 5 46 FEET 46 FEET 6 48 FEET 48 FEET 7 50 FEET 50 FEET NOTES: 1. POINTS TAKEN AT REAR FOUNDATION WALL CORNERS 2. AS BUILT SUMMARY BASED UPON nELD MEASUREMENT CONDUCTED ON SEPTEMBER 19th, 2006 BY ZARECKI & ASSOCIATES, LLC. 3. AS BUILT PLANS BASED UPON DESIGN PLANS APPROVED JUNE 20, 2006 (FILL) AND AUGUST 28, 2006 (LATERALS) .. xl r. "Ti I