HomeMy WebLinkAbout0850DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
25. -1 -11
BOX 9
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
Harry Nichols, P.E.
Patterson Park
Suite 106
2050 Route' 22
Brewster, NY 10509
Re: Proposed SSTS: Alan
482 Haviland Road, Lot #2
(T) Patterson, TM# 25.4 -11
Dear Mr. Nichols:
ROBERT J. BONDI
County Executive
May 12,200
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:
1. There is no record of soil testing witnessed by a Representative of this Department
in the revised SSTS area.
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.
Ve ly yours,
Robert Morris, P.E.
Senior Public Health Engineer
►k m
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
Harry Nichols, P.E.
Patterson Park
Suite 106
2050 Route 22
Brewster, NY 10509
Re: Proposed SSTS: Alan
482 Haviland Road, Lot #2
(T) Patterson, TM# 25 -1 -11
Dear Mr. Nichols:
ROBERT J. BONDI
County Executive
June 16, 2003
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: .
_ 1_. ... All watercourses, wetlands and waterbodies within 200 feet of the property are to be
shown. The actual location of the stream on the property is to be shown on the
1 " =30' scale plan.
2. All proposed and existing wells and S STS's within 200 feet of the proposed well and
SSTS are to be shown on the plan. Furthermore, if any are existing or proposed
across Haviland Road they are to be shown.
3. The house, well and SSTS are to be staked by a licensed surveyor prior to
construction. This is to be noted on the plan.
4. Roofing /footing drain discharge pipe is to be a minimum of 10 feet from the SSTS.
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.
V ly y s,
Robert Morris, P.E.
Senior Public Health Engineer
1 1 &R��1
Harry W. Nichols Jr., P.E.
Putnam- County Health Department
1° Geneva Road .
Brewster; NY 10509
Att: Mr. Robert Morris, P.E.
Senior Public Health Engineer. crag"
Re: Proposed SSTS - Ross Alan .
482 Haviland Drive
Patterson, NY
T. M. # 25.4-11
Dear Mr. Morris:
We have revised the location of the proposed residence and SSTS, placing the SSTS
within the area of the previously performed deep hole and percolation tests.
Accordingly, enclosed are five (5) prints .of Drawing SS -2 "Proposed SSTS ",
revised 04/23/03.
Very. truly yours,
Harry W. Nichols Jr., P.E.
HWN:gav
02- 111.00
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
Harry Nichols, P.E.
Patterson Park
Suite 106
2050 Route 22
Brewster, NY 10509
Re: Proposed SSTS: Alan
432 Haviland Drive, Lot #2
(T) Patterson, TM# 25.4-11
Dear Mr. Nichols:
ROBERT J. BONDI
'County Executive
March 26, 2003
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:_
1. Additional soil testing is to be witnessed at the lower end of the revised expansion
area due to site conditions.
2. Proposed well locations for all wells within 200 feet of the property are to be shown.
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.
Very truly yours,
Robert Morris, P.E.
Senior Public Health Engineer
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
Harry Nichols, P:E.
Patterson Park
Suite 106
2050 Route 22
Brewster, NY 10509
Re: Proposed SSTS: Alan
'432 Haviland Drive, Lot #2
(T) Patterson, TM# 25.4-11
Dear Mr. Nichols:
ROBERT J. BONDI
County Executive
March 17, 2003
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:
1. This Department has documentation of May 2, 2002 on file that notes that the
wetlands were flagged and a survey also shows the location of the wetland on Lot #2.
The area shown on the plan submitted does not conform to the information on file.
Furthermore, the wetland was flagged during a drought period..
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.
Very truly yours,
Robert Morris, P.E.
Senior Public Health Engineer
RM:tn
To: PC /J 0
Harry W. Nichols Jr., P.E.
Patterson Park, Suite 106
VAT - - -2050 -Route 22 -- -
Brewster, NY 10509
Telephone (845) 2793003
Fax (845) 2794567
Date:
Job No.:
l T river. yri. Sl d �-t
Attention: /& '� moYvtS� Ji p _
Gentlemen: We enclose (9 copies of
)(—B/W Prints Reproducibles
. Specifications Memorandum
Description:
—Z,.
Sent Via:
Our Messenger Blueprinter
Your Messenger Yliand Delivery
Copy to
0,_4- — l I 1 uo Z
Project P�v,ovs���_
1 14J
11,��✓fGi'1 ��,lL
`— J J
Reports Tracings
Copy of left
g3
Revision/Date No.
--L& U
First Class Mail Special Delivery
V70." ly yours,
H Nich Jr., R.E.
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 31, 2003
Harry Nichols, P.E.
Patterson Park
Suite 106
2050 Route 22
Brewster, NY 10509
RE: Application to Construct a
Subsurface Sewage Treatment System
at Alan
Haviland Drive, Lot #2
(T) Patterson, TM# 25 -1 -11
Dear Mr. Nichols:
The Putnam County Department of Health (Department) has determined that the above referenced
- application,- received by the Department on January 22, 2003 is incomplete. Please be advised that_
the following information is required before the Department may commence its review.
• Engineer authorization has not been signed by owner.
• Tax map page shows that there may be wetlands and or a stream on the property.
These items are to be located or a letter from the Town of Patterson submitted stated
there are no wetlands, waterbodies or streams within 200 feet of the property.
The review of your application will commence once the Department receives the requested
information and determines that the application is complete. The Department will notify you within
10 days of its receipt of the requested information as to the completeness of your application. Please
be advised that failure to submit information to the Department or to follow procedures is sufficient
grounds to deny approval, pursuant to the New York City Department of Environmental Protection
Watershed Regulations and Putnam County Department of Health regulations.
Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130
ext. 2166.
I ►TJii�i1
Ve y yo &W
s,,
Robert Morris, P. E.
Senior Public Health Engineer
Enclosed are the following:
Harry W. Nichols Jr., P.E.
Patterson Park, Suite 106
-
- 2050 Route 22 ..
- -:
-
Br ew ster, NY 10509.
Telephone (845) 2794003
Fax (845) 279 -4567
January 15, 2003
Roberti MOM* s" P.E.
Department of Health
One Geneva Road
Brewster, New York 10509,
Re: Proposed SSTS -
D'Apice Subdivision, Lot # 2
Haviland Drive
Patterson, NY
T.M. # 25:16 -1711
Renewal of P =30 -83 .
Dear Robert:
Enclosed are the following:
NOV -17 -2002 01:06 PM HARRY W NICHOLS
3RUCE R FOLEY ...
P:blt: Health_ Director — --
914 279 4567
P.01
o..- o.l1
LORETTA MOLINARI R.N., M.S.N.
Aisaviate Pubt(e Xralth Director
Director of . Potlent services .
DEPARTMENT OF HEALTH . ......
_ 1 Geneva Road -
Brewster, Now York 10504
_.. RFC'[ RA FOR F1 ri rY'ES j
-MENTlON: a ADAM STIEBELING n REED -30-03
.0 information below must beLJlX completed prior to any scheduling. DATE:
ENGIYEER OR irIl2M bLr , A 'O
REASON:
PERCS.,X PUMP TEST: D
ROADISTREET: !''aY1.1 �_..,
T O IV N; _ TAX ivIAP #: J
SUBDIVISION:' LOT#:
e • : • ►n : ►1e 1 ►t ► • e
• ,
YES NO
Proposed SSTS-within the drainage basin of West Branch or B.oyds Corner Reservoirs,
a 0�- Proposed $STS within $00 feet of a reservoir, reservist stem or control lake.
c ,s Proposed SSTS within 200 feet of a watercourse or a DEC wetland.
Proposed SSTS design flow greater than 1000 golonslday-or SPDES Permit required.
-gL' Proposed SSTS7or 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. It yowaaswerecrym to any of the questions, NYCDEP must witness the soil testing, This
Department will 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 „!s 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,
12- % j FaR co*ry usi O,,1t.Y
DATE: (0 42 / db o
COMSIFST
d I r%rr OTC -- .•• - .•
NOV -17 -2002 SUN 13:20 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION TO CONSTRUCT A WATER WELL
please print or type - — "- - PCHD Permit # ~ ��
Well Location:
Street Address: Town/Village Tax Grid #
�f hNJ L" PJ4'4r-- p N1 %�-69H Map ,
Block Lot(s)
Well Owner:
Name:
Address:
Ro 5,5 A LAM
I 4 $ P
AMOOo -i N� 105H
Use of Well:_
Residential Public Supply Air /Cond/Heat Pump Irrigation
1- primary
Business Farm Test/Monitoring
Other (specify)
2- secondary
Industrial Institutional Standby
Amount of Use
Yield Sought 5+ . gpm # People Served _4 -(a Est. of Daily Usage $ offal.
Reason for
Replace Existing Supply Test/Observation
Additional Supply
Drilling
New Supply (new dwelling) Deepen Existing Well
Detailed Reason
for Drilling
Well Type
'-A Drilled Driven Gravel
Other
Is well site subject to flooding? ................................................. ...............................
Yes No X
Is well located in a realty subdivision? ...................................... ...............................
Yeses_ No
Name of subdivision �� PAP I 1
Lot No. !�
Water Well Contractor: J BD Address: -
Is Public Water Supply available to site? .................................. ...............................
Yes No X
Name of Public Water Supply: - Town/Village
-
Distance to property from nearest water main: -'
Proposed well location & sources of contamination to be provided on separ a sheet/pIan.
Date: 0 i 15 0 Applicant Signature:
MA
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 el driller geTtified by Putnam
County.
dd
Date of Issue d Permitis "Att fficl Z
'
Date of Expiration 0 Title:
Permit is Non-Transfeerfibib
White copy - HD file; Yellow copy - Building Inspector;"-Pink copy - Owner; Orange copy - Well driller
Form WP -97
a
PUTNAM COUNTY DEPARTMENT OF HEALTH.,...
DIVISION OF EN RONMENTAL HEALTHSIERVICES,
LETTER OF AUTHORIZATION
RE: Property of ALAS .. . .........
Located at D P--t'-4
TN Block Tax Lot
Subdivision of
Subdivision . ubdivision Lot # Filed Map # (P Date Filed.—
Gentlemen:
This letter is to authorize s �\bk 01115
a duly licensed Professional Engineer or Registered Architect to.Apply for the. required
wastewater treatment and/or water supply permit(s) to serve the above-noted property in icc'6r&ace
.N...
with the standards, rules or regulations as promulgated by the Public Health Directo'r" 0_ fih�e-47L." l"iiia�ffi:;'-"
County Health Department, and to sign all necessary papers on my behalf in connecti'
on.,with-this
matter and to supervise the construction of said wastewater tretmen * t and/or water supply systems * ''in
confornuity with the f Article 145 and/or 147 of the Education Law, the Public Health
provisions -o
Law, and the Putnam Q04hty�Wiitary Code.
-Countersigned:
P.E., R.A., # -
Mailing Address
?) 4 W 6� �
State zip
Telephone: do Ik5) �MJ hid *01PY CP!9
Very truly yours,
Sighed:
(Owner of Property)
Mailing Address: 4-C WOP P-ow'
State Z
Telephone: 0
Form LA-97
PUTNAM-.COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner %�,o s.S��� Address' 446
Located at Street Tax. Ma �- ,.....Block L
/ ot
(Street) p
indicate nearest cross street) -
Municipality -�,,���, Watershed
SOIL PERCOLATION TEST DATA
Date of Pre - soaking cc _ v�....o v Date of Percolation Test Jzc..10102- --
. ..:.;....:::.
,.:. ..::,::;:..:.:::< �:.:,•::.::.;:::,;.:>:>:.;;':::: :::;:.;:. >: >:: >::;:':::;.:: >:<: '::::: >'. <;:.•:::;�: ..:. .. ..o''�?�!aier;.;:.:;' >. ... ;:..
Pr r and »<:;; <::>
e'Tim . a
:.::..: • .,..:::..«:<:: >:: : >;::;: >:<: >:';.:::.:. >;;;;::.: < >::> � .........:.5.... ..... n.... es.1.......�..o
.i::• :•`::: : :i: i:•: ::. • ...: .: .. .. ..:: :. /...:i ". ':: ii }.
.. :.. 'v: : .: ..
Hole R ;:<:<: :'. Start' >: to <:: .::
I?;..;:: :<::: )<n:es. ;Mm/Inc6; >:.:
# l 1 09 9 8 -0:ag� 24— z� 3 3,
2 10:0110;24 IS- zq - 27 3
3 10; 2S - I 2-4- 2�
4
5
3D 24 2 S 14 1 t. y 24
2 10.31 -11.01 40 2y- ZS 1V4 Z9
3 II:�Z- I1:.3$ ?v0 ' . -- 2-9- 2S'h 29
4
5
2
3
1.1
NOTES: 1. Tests 16' be repeated at sameidepth_uritil appcozimately equal percolation rates are obtained at each
percolation test hole.:7' :e. s I rain for;l =3;0 m*inlinch, 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 TEST. PIT„ DATA.
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. A HOLE NO. B HOL..E NO.
G.L. `saY Sci l SUP 5ok
1.0' -
2.0' h a WAk
3.0'
3.5' c.. a w o Oz., 5ftod
4.0 Sion QA 11 a ' �Qc,Jzt
4.5'
5.0'
6.0'
7.5' 6 . G" 6'
8.0'
8.5'
9.0' .
9.5'
10.0'
Indicate level at which- groundwater is"encountered Ga
Indicate level at which mottling is observed
Indicate level to which water level. rises after being. encountered 6'- 6a
Deep hole observations:made by: Date 1.1-10-o2_
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION, OF: ENVIRONMENTAL- HEALTHI.SERVICES:".�'-``: =-
.APPLICATION. FOR APPROVAL OF PLANS FOR .
A WASTEWATER TREATMENT SYSTEM; '
1. Name and address of applicant:
4G6, 6W-OF 9 P-OA9
mop V, o
2. Name of project: i-t5 15,4.7T'_5 3. Location TN :. X 4 ._ /--;5 c?! .
4. Design Professional: MR�- W, P/tcµdL J, JIZ 5: Address: 20, 0
6. Drainage Basin:
7. Type of Project:
X Private/Residential Food Service Commercial
- Apartments Institutional Mobile Home Park
Office Building - Realty Subdivision Other (specify)
8: Is this project -subject to State Environmental Quality Review SE R ?' -
:'Exempt T YPe Status check one ................. ............................... Type I `
Type II- Unlisted k
9. Is.a Draft Environmental Impact Statement (DEIS) required?
10.. Has DEIS been completed and found acceptable b Lead Agency? ......
C=) r
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 beensubmitted to such authorities? D
.. -
14: Has preliminary approval been granted by such authorities? 00 Date, granted:.
I5:
Type of Sewage Treatment System Discharge ... YP ea
g .... Y $ ••••••••••••. .... surface water 1C groundwater
16. If surface water discharge, what is the stream class designation? ......... N.�.
17. Waters index number (surface) ..................................................... .:..........:.....:... fl:
18. Is project located near a public water supply system?...........
.........................
.. N�
19. -I f yes, name of water supply Distance to water: supply: `:N A
10. Is project site near a public sewage collection or treatment system? ::....:'::::..:. 1�0
21. Name of sewage system P4 N Distance to sewage system' A
22. _ Date test holes observed. 23. Name of Health Inspector --
24. Project design flow (gallons per day) ................................. ...............................
25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... l40
...
`16. 26. Has SPDES Application been submitted to local DEC. office? NA
Form PC -97
2
27. Is any portion of this project located within a designated Town or State wetland? N�
28. Wetlands ID Number ........................ .................. . ...... . .............. .............
.......::::::
29. Is Wetlands Permit required? ............................................... ............................... f p
Has application been made to Town or Local DEC office? ...............................
30. Does project require a DEC Stream Disturbance Permit? .. ............................... N 0
3.1. 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 jUp
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? .................I.........::; Yes/No !Up
DESCRIBE:
33. Is there a local master plan on file with the Town or Village. ..:........
34. Are community water and/or sewer facilities planned to be developed within
15 years in or adjacent to project site? ........................................... I .................. .. t0
3.5. Are any sewage treatment areas iii :excess of 15% slope? . ............................... 1"p
36. Tax Map IDNumber .......................... .........................I..... Map �Lfz- Block Lot 11
37. Approved plans are to be returned to ..... Applicant jC - Des -ign 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 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, tinderpenaliy of perjury, that inforthation 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 PenahLaw....
SI G!VA T URES & OFFICIAL TITLES:
Mailing Address: ...................................
14 -164 (9195) —Text 12
PROJECT I.D. NUMBER 617.20 SEAR
- - _ ._Appendix..0 - -
f State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
a
0
1. APPLICANT /SPONSOR pDy,�5 H
2. PROJECT NAME
2 lJ
3. PROJECT LOCATION: n _ ,�
i T�1`-6oN
Municipality 1'� County
4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map)
5. IS PROPOSED ACTION:
New ❑ Expansion ❑ Mod If[cationtalteration
6. DESCRIBE PROJECT BRIEFLY:
�Np►�iUJ Ri., ajejTh
7. AMOUNT OF LAND AFFECTED:
0�1 94 p$�
Initially acres Ultimately acres
B. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR-OTHER EXISTING LAND USE RESTRICTIONS?
01-YOS ❑ No If No, describe briefly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
® Residential ❑ Industrial ❑ Commerclat ❑ 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 9[No If yes, list agency(s) and permit /approvals
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
❑ Yes ENo If yes, list agency name and permit/approval
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?
❑ Yes SNo.
PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
I CERTIFY THAT TH,E.
tINFORMATION
Applicant/sponsor VV (�I'1rOl.l� 41>
name: Date:
Signature:,
iA
If the action is in the Coastal Area;i --.Ab & owire,,a;itate.', agency, complete the .
Coastal Assessment Form befoee.ipfoceeting with this assessment
v.rcn
1
--
SECOND `F.L'O'.O'R P
1
DINING ROOM
13' 0** w 12*•0"
SXGWATURE &TITLE
KITCHEN
.1 0
-MORNING AOOU.
R A
FIRST FLOOR
0
RRUV
1344SF
5ATE
of,
MAW r
-N . "---I - -
. I. 1.1�1\ AJ
FAMILY ROOM
7' 0"
v u ;Lpnj61T9
13EDRCOMS
�1UE1�T IL'ISION f A I,1 .: r'.�
,r .
II
-- ~'Y30H FOR AP
SECOND FL0.0R- 1344SF
t
Scm 3
J4iIj ..� (` L
•• KITCHEN -
!'
DINING BOOM p I MORNING HOOAA
I'acknowled e'recei P t of this report: SIGNATUR'; _
.,�.:
02%96. Title
'PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INITIAL INDIVIDUAL /COMMERCUL SITE INSPECTION FORM
SECTION A. GENERAL INFORMATION
Name of Project /iL. N 9TV) &rlr 5726 oi✓ County
Site Location-- yAiC1b gA) D -p Z, T,!4 -144 9— l
Building construction begun A10 Extent
Is property within NYC Watershed ? ................. Yes F-� No
SECTION B. TOPOGRAPHY (Please check all appropriate boxes)
1.. illy a Rolling a Steep slope [7 Gentle slope Ef Flat
2. Evidence of wetlands Low area subject to flooding F7 Bodies of water
Drainage ditches a Rock outcrops
3. Property lines or corners evident ................
Ines No
4. Do watercourses exist on or adjoin the property? .1�s7o r-�Ve1 a Yes F7 No
5. Will these affect the design of the sewage system facilities ?............ 70 Yes F-� No
6. Do watershed regulations apply in this development ? ....................... F7 Yes [7 No
7 Will extensive grading be necessary? ................. ............................... Yes �No
8. Will extensive fill be necessary for SSTS? 0 Yes No',
9. Do filled areas exist within the SSTS area? ........ ............................... a Yes ���No
If yes, what is the condition of the fill?
SECTION C. SOIL OBSE VA
TIONS
10. Appearance of soil: Sand Gravel Loam pBackhoe Clay � Hardpan F7 Mixture
11. Observed from: � Borings a Bank cut excavations
12. Soil borings /excavations observed by K- ` a-f DD � f-I, �, on
13. Depth to groundwater ` — " 6 " on
14. Depth to mottling n/o^/e—:� AlgjjE P on
15. Are test holes representative of primary & reserve areas ...... ...............................
16. Soil percolation tests made by W, Ah r,Yoa-s on
17. Soil percolation tests witnessed by C, �� on
SECTION D (on back)
C
Form ST -1
I
2
SECTION D. DRAINAGE
18. Will proposed grading materially alter the natural drainage in this or adjacent areas? F7 Yes o
19. Will groundwater or surface drainage require special consideration? ...................... F_7 Yes No
20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... F-1 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 Yes No
Inspection data
22. Do adjacent wells and/or sewage systems exist ?........ ............. ............................... ffyes No
23. Additional comments
24. Site observer /inspector and title 2���
25. Dates) of observation(s)inspection(s) L_T/ o /D 2
TEST PIT PROFILES
Hole # Lot # Hole # 'Lot #
Hole # Lot #
Depth to water Depth to water
Depth to water
Depth to mottling Depth to mottlin
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
PUTNAM COUNTY DEPARTMENT OF HEALTH C
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner , Address "VjAAAj7�> 'p Z,
Located at (Street) 7zi �T�y Tax Map 925-, Block. I Lot
(indicate nearest cross street)
MunicipalityY -Tr,� Watershed
SOIL PERCOLATION TEST DATA
Date of Pre - soaking i`� / /D_ Date of Percolation Test
Form DD -97
2
M07— iG12
4
5
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. 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
DEPTH
G.L.
0.5'
1.0'
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. A HOLE NO. HOLE N0.
2�
Indicate level at which groundwater is encountered ,L `
Indicate level at which mottling is observed lvc x, w
Indicate level to which water level rises after being encountered
Deep hole observations made by: 4= ,, Date lallcle.%
r
Design Professional Name: —
Address:
Signature:
Design Professional's Seal
7
411
DEPART
01 U' NT"E' 6
TUTNAM`�'�C
Division pr ronmA a
X
'Located at li7l V
Building 7T
-Nurhber'of. Bedrooms ,,-
'Izoi�l` j "I
i e. p, a`ia, t, -a" - S e W` 8 r
So constructed by T
ro.m. —
Priiate.:SuWy -to be,'drill&,by.
-Other. Requirbininii-*�
represent'i'h'A"t i4M,Who`Ily and *'coM6lit6ly re'spon'sible foi the,'di
atii6veaescriiied will i4 constructed ii -sti6wA on- tii6igiprov" a me
County` .Department 'of, ;Health,','and hat on c-br�61citioril.ihe!eof
OuArahie It'.
14- . I ` e�:*_
"a ) `d' sewage i
1�.c n good � opiraiiihj',con Rion - Any part o "said -
i, ance of'th�q`;approvail 0 1 e ificaie ,6f,'ccinit�ructidn" OMP
will ,, , be'16 - cat'e'd as-, n..o 'i pl.an a . rid 'ihat said well w
County
Do port
S4
FOR CONSTRUCTION s approval expkes'one
'a �! 1 11 1 - . -
re4ocable for cauworma en �oi_ odifled wqeilcomm
mrequires a new :permit .' V or- disposal J of dourest r
Rev. 9-,1
M-`0F HEALTH
Carmel N: Y 6512'
TOWM or Viliew. 7,
iii6ck
%7 d.
Previous ApprS�V
"4
Fill 'Section ,Only ❑ u %
NotifiCitiqn.,Requ red
-7
-g
41"
_iii,locatlon -o '�thw ppposo sy it`ei -i Ahat, he' :
sepirito'4"o0e,dlsj' AS t
em
gent there io`irdln
Accoidan'co with i"he'A"claftisi'rules and:rogulations of the . Putnam
ertificate of Construction ilancill'rsatisfactory to•the.-Commissioner of, Healthwill
fuinishetl the owner, his successors, heiriebr,aisijiliVy AhS builder, tiisfsaid, bulldor Will
(2).'yomirs lrnrnediately�, qpoWIn*g'6e,iate,of iho Issu-
:doU the lciii9inal'system -,or any tfiitreto. 2)'that the drilled weli'descrilbod'abcive
installed acc dance it standards,4 rvie's-sn'd reg-MITo—fos, of the Putnam
T
P. E. R-A.
License No-
1A
rom.the 'clati,Isstied structionl ,bf, the 6'iilldinii has tiaein "iindertak6n'and is
necessary e rnmiiiioh '-Health occonstruction
'.title
r bilia'k', 'Su p jconli
I - PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date /0-
1 a- ri� Re: Property of 0 � � �, � - � A(��.. t,,.,�•_,
Located at Phi -m_ras Do �i . I � 06V ? L.A1JI PQVIF
(T) f)6k Sm Section Block J Lot /Z)
Subdivision of -DA- I C
Subdv. Lot #f, 12— Filed Map ## %9c� e Date
Gentlemen:
This letter is to authorize
a duly licensed professional engineer 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 system.s-.in._conformity_. wi.th__the ._p.r_ovisions of - Ar.ticle,...145 or-,
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Very truly your ,
/ Signed `
Countersigned: v��L� /f 0 er of Property
P.E. , ,E 5_3T7
Address
Address Town
Mud N I 9 `F? Z_
i J I Telephone
Telephone RECEIVED,
kl 0 2 3 1983
PUTNAM COUNTY
DEPT, QF HEALTH
A r
r:1 . " O
' PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING; CARMEL, N.--Y:- -- 10512- --
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL, SYSTEM FILE NO. /
Owner DAP! CE / Address Z��ryL� -��
Located at (Street A %i11416_ Sec. /OP Block % Lot �®
..indicate nearer cross street)
t-dT
Municipality. P044_sm.7, V/ Watershed /y y
SOIL PERCOLATION TEST'DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
140 1 �7
Number CLOCK TIME
PERCOLATION
PERCOLATION
Run apse
Depth
to Water
Water ve
No. Time
From Ground Surface
in Inches
Soil Rate
Start -Stop Min.
Start
Stop
Drop in
Min. /in drop
Inches.
Inches
Inches
IT
1 i % I. Z! l Z
210
25
T ..
5 !,!nU 3 1983
PUTNAM COUNTY
DEPT, OF HEALTH
Notes: 1) Tests to be repeated at same depth until approximately 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 hole.
140 1 �7
5 l�S3
Tz k 13
/3
T ..
5 !,!nU 3 1983
PUTNAM COUNTY
DEPT, OF HEALTH
Notes: 1) Tests to be repeated at same depth until approximately 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 hole.
3
A7
4
IT
T ..
5 !,!nU 3 1983
PUTNAM COUNTY
DEPT, OF HEALTH
Notes: 1) Tests to be repeated at same depth until approximately 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 hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION i
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH -HOLE - -NO. HOLE NO. - -HOLE -N0.
G.L.
6"
12"
18"
2411 �►�� �o�t�
3 0 if
36"
`t2" ., .
5411
i
60"
66"
7211 y`
7$n
8411
INDICATE LEVEL AT WITCH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TQ W CH WATE LEV RISES AFTER BEING ENCOUNTERED'040�
TESTS MADE-BY L.i --1` a7i2 Date .
DESIGN
Soil Rate .Used I? Min/1 "Drop: S. D. Usable Area Provided
No.'of Bedrooms' Septic Tank Capacity t0" Gals. Type.
Absorption Area Provided By33ff L:F.x2411 ' —jb"— / w c
Address SEAL r'
m
THIS SPACE VOR' USE BY HEALTH DEPARTP4ENT ONLY:
Soil Rate Approved Sq. Ft /Gal. Chocked by
M3N
to
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
FINAL SITE INSPECTION
StreetLocation- 94W,6AAJD - - - - - - -
Town
TM # 2!5n — //
Date: 3 0
Inspected by:
-:Owner 1,,4 hz-,C - - - -
Permit # �� d
Subdivision Lot # �L.
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 ...... ...............................
H. Sewage System
a. Septic tank size - 1,000 ...... . , 250 ........other ................
b. ' Septic tank installed level ................ ...............................
c. 10' minimum from foundation .......... ...............................
d. Distribution Box
1. All outlets at same elevation -water tested .................
2. Protected below frost .................. .........:.....................
3... Minimum 2 ft. Original soil between box & trenches
e. Junction Box - properly set .......... ...............................
6. Trenches,
1. Length required Length installed 7
2. Distance to watercourse measured .�-/ pmt..........
3. Installed according to plan ......... ...............................
4. Slope of trench acceptable 1/16 - 1/32" 50ot .............
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 -11/2" diameter clean .................... `
9. Depth of gravel in trench 12" minimum .......:...........
10. Pipe ends capped ...............................................
- g. Pump-or-Dose ystems -" ---- -
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/Buildin'
a. House located per approved plans .............................
b. Number of bedrooms ......................
1V. Well ......................... ....
Well located as per approved plans . ......:........................
b. Distance from STS area measured / J/ z _ ft...........
c. Casing. 18" above grade ............................. :.................
d. Surface drainage around well acceptable .......................
V. Overall Workmanship . �I
a. Boxes properly grouted. ............................
..... .... .
b. All pipes partially backfilled .............................. .......
.....
c. All pipes flush with inside of box ... ...............................
d. Backfill material contains stones <4" diameter............ Lzo
e. Curtain drain & standpipes installed according to plan..
f. Curtain drain outfall protected & dir.to exist watercour
g. Footing drains discharge away from. STS area.., .... * ..Ok
h. Surface water protection adequate:' .. ....:..........................
i. Erosion control provided ................. ................::.............
Rev. 12/02
COMMENTS
tic -...4
•��•rxlse.�
.. - - -- . -
SITE INSPECTION FOR FILL—PAR
Date:
Inspected by:
Fill pad located per the approved plan
Fill Pad Length Required Length_
Fill Pad Width Required Width
Fill Pad Depth Required Depth
Run -of -Bank Fill Quality
Slope from Top to Toed
8 �
Impervious Layer Installed
Erosion Control Installed
Sieve Test Results (if applicable)
Additional Comments:
1-
U„ r v
NOV -03 -2003 10:56 AM HARRY W NICHOLS 914 279 4567
P.01
PUTNAM COUNTY DEPARTMENT OF HEALTH
DI SXON.OF ENVMONMENTAL HEALTH SERVICES
REQt ST FOR raAL INSBECTION For: Fill
,.,.._ .,
_. , . ..
Date:
Trenches �•
Nn�..
PCHD Construction Permit # r 30�4rx
Located: 14A916AjQ , hit t, (T) M y.s AK122AI
Owner /Applicant Name: &kr , I AL) TM 25. . Blbck I Lot
Formerly; rSubdivision Name: V A P I Z:
- .'.
Subdivision Lot g Z
Is- systeo fill Completed?- Date: m J, n3
is system complete? S_ Date, ynJ. 03
is system consti�cted as per plans?
Is well drilled? l— Date: Oal- QA
.Is well located as per'plans?
Are erosion control measures in place?
I certify that the system(s), as listed, at the above premises has been constructed and X have inspected.'
and -verified their Completion in accordance with the issued PdHD Construction •Permit and
approved plans and the Standards, Rules and Regulations of the Putnam County Departmeat•of'
Health.
• - - - -- ' .
3. 3� Certified by:. M PE RA ,
' Desi rofessional -.' • • '
Address: �22 hgtjs&7kL P ,j l0,�o Lic. 56.124
Commeats:.
FOR: 0 ADAM jo GENE
Form FM -99 :,F.:. �ti''.: •, ' .
NOV -3 -2003 MON 11:13 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date 10- )-1 -Al
Re: Property of Qjj� �Aj P �� �1 C
Located at M T'2'j -SDPJ HA-lfiLANJh., 'b 8--'%JE-
(T) &Ikk -SW Section Block Lot J Q
��
Subdivision of ICL-
Subdv. Lot # Filed Map # Date
Gentlemen:
This letter is to authorize J b HA) )t M65 ; J-I?-
a duly licensed professional engineer 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 frith the' provisions of Article 145 or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Very truly yo s,
Signed
Countersigned: Owner of Property
—7
P. E. # 3 2-7 /
Address
6t6 4�1
Address
' 1�, /637)--
Telephone
Town
Telephone
CID
��IOV 2 3 '1983
PUTNAM COUNTY
e0 °I O
AM COUNTY DEPARTMENT OF HEALTH
1�F OF ENVIRONMENTAL HEALTH SERVI E O
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM
PCHD CONSTRUCTION PERMIT #
Located a^l- f4A1Q AP D ET -11JE Town or Village �EP -5eH
Owner /Applicant Name
kz,�o ALAH
Tax Map Block
Formerly ..__. Subdivision Name
Subd. Lot #
Lot
DI I te
Mailing Address 4&,o ba "P RJ AD A' D�L I PJ� Zip 105-H
Date Construction Permit Issued by PCHD
Separate Sewerage System built by JPAE; 6 A�I�lWO Address 31 WA6 �M t4 ?A rm
NIT I
Consisting of g�`GJ� Gallon Septic Tank and Ab� TTLEVUH
Other Requirements:
Water Sunnly:
Public Supply From
Address
or: � Private Supply Drilled byw �� Address ���%/
- Buildin T YP e - Has erosion control been completed? �E
� ........ .
Number of Bedrooms Has garbage grinder been installed? C
I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as-
built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved
plans and the standards, rules and regulations of the Putnam County ep ent of Health.
Date: K 102A 01, Certified by P.E. R.A.
(D ign Pr fessional) `
Address ZQ,S -D �(� 2�',r?.- N) '�� License #b�
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 ubject to modification or change when, in the judgment of the Public Health Director, such
revocatio , ificat' or change is necessary. /
��
G o
By: Title: Date:
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CC -97
Nov 0 03,.01:39p TOWN OF PATTERSO 845 -8 78 -2019 p•2
NOV- 17- 2.003,11 :54 AM HARRY W NICHQLS 914 279.4367 P.632
- * # 4Ot WA MOUNA -RK, bU.N. '
6ASJCE R FOLEY
ream H.� Ota+urw• ,... .... •• •. - •A+naO,[. hlNa• Qhtaa... _.. .
04rerw �j
Mw &,wm
vt8N�'
_• -_. ,• ..._.... , , ..•.. - -- Ma,11 OF' MALTS .,.......__ .. .... ._.....,
Snswitaq -Now Yglk • 10544 _ .... _ . ...... .
RAW vaij flaw 930271.644 raa14):110mt
x1iftsw*0 Orp»r• SH...wrap14 1111 un .raQrgrn•wis ... ..,.
prry fiaC.�n pigtt!t[•fot< rratkbi rNquiAan r..m9)rir - "41
E91X..An])BES`.VV$I.ZCATIC N�FORM
OFYTIERS NAbtE: i''`Q �� A L -A} A r _
TAX' yumm.
�s11wDDR�ssa.. •, •. �'�- f�V4i,. � 1V� •
Tort. PA p . ' - w....•
AU•THOR=P 7Qwr .SlMCLtU . .._ .
b�iTE r / /7/ `
_.. The Putnam County Dtputnest of Healtb wiU cot issue a 'Cei tificatt 'oi
Coustructiou Compliance- t dic s ft above form is completed; Le—p ale 1 E911
• addrt= is. �sstgood bY. Am AithoAnd town ofiidaL M form•is to be submitted
.with the application for at Cent pege.of Constmcdoa Compliance: - - --
• • ......• • .ter_• .. a ..w « • 1 r .. .. . ••
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF. ENVIRONMENTAL HEALTH SERVICES
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM
AH
Owner or Purchaser of Building Tax Map Block Lot
ALA A,( trJU,
Building Constructed by
Location - Street
i Fe) 196H
Building Type.'
TownNillage
D' A� ►G�-
Subdivision Name
z
Subdivision Lot #
I represent that I am wholly" and completely responsible for the location, workmanship, material,
construction and "draina''ge of the sewage Ire atment.system serving tl0above- descri bed prop' erty, 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 'parr-of said ls3 stern confs1ructed by ' me which fails` to operate for. a period of two years
immediately following the date of approval of the "Certificate of Construction Compliance" for the
sewage treatment system, or any repairs made by me to such system,..except where.the failure to
operate properly is caused by the willful or negligent act of the occupant of the building utilizing the
system.
The undersigned further agrees to accept as conclusive the determination of the Public Health
Director of the Putnam County Department of Health as to whether or not the failure of the system
to operate was caused by the willful or negligent act of the occupant of the building utilizing the
system.
Dated: Month Day Year Signature:
X9., Title:
General Contractor '(Owner) - §ignature
Corporation Name (if corporation)
Address: i'�p & 1&4 P-4 1�rM oh /L .
State 1y,&v York - Zip /oSSD
Corporation Nam (if corporation) /
Address: 37 �� �.e 4► -...,
��.
State-( Zip
Form GS -97
L AQUA ENVIRONMENTAL LAB
56 Church Hill Road • Newtown, CT 06470 • (203) 270 -9973
Report of Analysis
Name:
Ross Alan
Units
466 Bedford Rd
Biological
Armonk, NY 10504
Sample Start Date:
5/19/2004 8:45 AM
Sample End Date:
5/20/2004 8:45 AM
Receipt Date:
5/19/2004 9:15 AM
Report Date:
5/26/2004
Sample Site:
482 Haviland Drive - Patterson, NY
Sample ID#: 48425
Sample Type: Drinking Water
Sampler: RA
Parameter
Sample Result
Units
Limits
Biological
Coliform Bacteria
absent
none
0
e Coli Bacteria
absent
none
0
Metals
Copper
0.03
mg/L
1.3
Iron
0.04
mg/L
0.3
Lead
0.0164
mg/L
0.030
Manganese
ND
mg/L
0.05
Minerals
Alkalinity
190
mg/L
No Limit Set
Chloride -
53:0
m ._ _: _-
-- 250,.
Hardness
277
mg/L
No Limit Set
Sodium
16.6
mg/L
28
Sulfate
22.3
mg/L
250
Nutrient
Nitrate as N
ND
mg/L
l0
Nitrite as N
ND
mg/L
1
Physical
Color
5
cu.
15
Odor
0
0 -5 Scale
2
PH
7.2
SU
6.4-10
Turbidity
1.1
NTU
5
Report Approved by:�(�(�� µ f, l J--� CT Lic PH -0787 NY Lic 11706
Page 1 of I
ND = Not Detected
* = Above Specified Limit
PUTNAM COUNTY DEPARTMENT OF HEALTH', '{
_D_IVISIO. -OF ENVIRONMENTAL HEALTH SERVICES.,; :., .• ".'..
LETTER OF AUTHORIZATION
Q � 4A� 4 _
RE: Property of
Located at HANILA )An OP-1vE
T/V PQT`T' -�pl -1 Tax Map # �-� E Block 1 Lot 11
Subdivision of ®� AP, Li�_
Subdivision.Lot # �-
Gentlemen:
Filed Map # k9 rr'( Date Filed. _
This letter is to authorize I -/ -i� �J l O1 C_114461 J(L- P15 - "'-
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'Puhiam
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,Ahe Public Health
Law, and the Putnam anitary Code.
NE
Q
Countersign
P.E., R.A., # �'
J' No•
Mailing Address
W oaiw�
Very truly yours, Signed:
(Owner of Property)
� P-5 VW Are R--
V
State 1
11
Zip
Telephone: %�5) Z) 9 - 4 00 �
Mailing Address: P -oy';,
AD
A.
State Zip
Telepfiorie: (91H)
Form' LA -97
f-3
Harry W. Nichols Jr., P.E.
Patterson Park, Suite 106
2050 Route 22
-- — - - Brewster, NY 10509
Telephone (845) 279-4003
Fait (845) 2794567
Date: Z6 -0
To: � G � Job No.:
- Project
4e2— -2�-
Attention: 96 �r Ury jPI' 4C Pq �-rmLa!2 ,
Gentlemen: We enclose (S-. copies of
j131W Prints Reproducibles Reports .Tracings
Specifications Memorandum Copy of letter
Description: Revision/Date No.
Aq*-- AJi1{I ��rt'� 1i ,_,,. "7- 7'x—/14
o
�s 14 LA a-J 40
ti r-ti,l::.- I,.d z_VtcL L z-A.,
Sent Via:
1/ Our Messenger Blueprinter First Class Mail Special Delivery
Your Messenger Hand Delivery
Copy to
Very ly yours
Ha Yr.t tic is Jr., P1.
VV
NOV -5 -2003 10:35 FROM:PUTNAM COUNTY DEPART 845 -278 -7921 T0:92794567
A O
n
N
r -4
Ekl6r. Srq WA
_ ,_ ;�.
IL
�a=a • W EXPA
•
ac -z
Mr
PPOPM D 591
-41.rf
bip
t "
hra A"�i YJe(typ� • � ; M1N.
t; 10
_^
128 !Gp�, fE /ila 4'm S0L"ti PVG
t'11Nklr *: -r sod as
a� SF. 9L. 415.dog d
• g�, 60.1.00+
Par >P. w %14
o�
• 'en
s= 9
.4
Y
o
w
Z
st ;•�T'ia "w � 8
P: 1/2
Y1
1 �
i
1 '
r•
v
f •
A
C
t
SENDING CONFIRMATION
DATE NOV -5 -2003 WED 10:15
NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH
TEL 845 - 278 -7921
PHONE
: 92794567
PAGES
: 1/1
START TIME
: NOV -05 10:14
ELAPSED TIME
: 00'40"
MODE
: G3
RESULTS
: OK
FIRST PAGE OF RECENT DOCUMENT TRANSMITTED...
O
a
• � v
LORMA MOUNARI R.N., M.S.N. ROBERT J. BONDI
P011, Hava6 Dnvrror Corny fxaabe
DEPARTMENT OF HEALTH
1 Geam Reed, Brewster, New York 10509
6aV1==Wld Bmlt6 (845)273.6130 Pos(945)27E -7911
NW*4 8ervlm (I45)273.635E WIC (845)278.6676 Fee(845)776.6083
sady Inte vaetleanh-1.1 @45)272-6014 ft (845)278.6M
November 4, 7003
Harry Nichols, FE
Patterson Park, Suite 106
2050 Route 22
Brewster, New York 10509
Re: Field Inspection – D'Apice
Haviland Drive, M Patterson
Lot # 2, TMII 25.-1.11
Dear Mr. Nichols:
The following comments must be addremed
1. A portion of the system appears to be Within the 100 -foot wetland buffer.
2. 100° /a expansion area must be staked out in the field.
3. A bedroom count must be performed by this Department upon 8t0her
completion of construction.
4. All laterals must have two feet of solid pipe from the junction box to the
pipe. Perforated
5. Remove large rocks from bacldill material.
6. Footing drain discharge was not found upon inspection.
If you have any further questions, please contact me at 845- 278-6130, ext. 2261.
Sincerely, .
� V,
Gene D. Reed
Sr. Eavironmcatal Hmhh Engineering Aide
GDR:cj
June 4, 2004
Robert Morris, P.E. - - --
Putnam County Health Department
1 Geneva Road
Brewster, NY 10509
Harry W. Nichols Jr., P.E.
Patterson Park - Suite 106
2050 Route 22
Brewster, NY 10509
Tel: (845) 2794003
Fax: (845) 2794567
Email: hnengineer@aol.com
Re: Individual SSTS Compliance - Ross Alan
D'Apile - Lot # 2
482 Haviland Drive
Patterson, NY 12563
Dear Mr. Morris:
Enclosed are the following:
1. Five (5) prints of Drawing S -2, "As Built SSTS ", dated 11/05/03.
2. "Certificate of Construction Compliance for Sewage Treatment System ", dated
06/02/04.
3. Three (3) copies of "Guarantee of Subsurface Sewage Treatment System ", dated
06/02/04.
4. Laboratory Report, dated 05/26/04.
5. "Well Completion Report", dated 10/28/03.
6. Application Fee in the amount of $300.00 payable to Putnam County Health
Department.
7. "E -911 Address Verification Form ", dated 11/17/03.
If there are any questions concerning the enclosed, please call.
Very truly yours,
Harry .Nichol Jr., P.E.
HWN:gav
02- 111.00
Harry W. Nichols Jr., P.E.
Patterson Park, Suite 106
Y AV 2050 Route 22
Brewit6r; NY 10509
Telephone (845) 2794003
Fax (845) 279 -4567
Date:
To:. Job No.:
Project ^A< 1114� — f l
avt C"• vile,
_g
t
Attention: )LC) ✓
L4S�
T'" 4
Gentlemen: We enclose (�) copies of
�L
B/W Prints Reproducibles Reports .Tracings
Specifications Memorandum Copy of letter
Description: Revision/Date No.
I'
Sent Via:
kour Messenger Blueprinter First Class Mail Special Delivery
Your Messenger Hand Delivery
Copy to
Very , tryly yours
Ha rry Yr.-U Lich Jr., P:E.
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PERMIT #
CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM
P°
� -al -a3
Located at H A 1 J-A �4D D iL- 1 `4 5 own or Village VP TTEP- OF4
Subdivision name P Subd. Lot # Tax Map Block Lot. 0
Date Subdivision Approved ®� ' � Renewal X Revision
Owner /Applicant Name PLO 65 k L, AH Date of Previous Approval
Mailing Address 4- Co G B�-0 Ft P'V P-Q ko A P'6 0 t4 y-- a � J Zip
I D TD&A
Amount of Fee Enclosed 4 po bo oc,
Building Type F-E6 ID15H 4,P- Lot Area 41, 00) No. of Bedrooms 4" Design Flow GPD 000
Fill Section Only Depth Volume
PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Separate Sewerage System to consist of
-%6 H 61 t-
gallon septic tank and G-6- Lf- 45
Other Requirements:
To be constructed by `rP Address
Water Supply: Public Supply From _
or: Private Supply Drilled by Y9 1D
Address
Address
I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the
sparate sewage treatments sy tem described above will be constructed as shown on the approved amendment thereto and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion
thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the
Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said
builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years
immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original
system or any repairs thereto.
Signed:
Address q-D 5
P.E. A R.A.
Date '011151 ®,�
b46TIEPL 14� k 0 5'A License # 5 (" 1 M
APPROVED FOR CONSTRUCTION: This approval expires two years from they at'4 issued unless construction of the
sewage treatment system has been completed and inspected by the PCHD and ��ewo able for cause or may be amended or
modified when c si red necess by the Public Health Director. An g q ion or,altec t on of the approved plan requires
anew permit. Apr ed for d' arge of domestic sanitary sews �b 6.
By: Title: Date:
White copy - HD File; Yellow copy - Building Inspector; Pink copy -r Owner; Orange copy.- Design Professional
Form CP -97
O
A - .
♦ _ 1 .7
�. m FAMILY RM. rA PR•
-� _--- • 1 _ .... - 1 q4 x 136 RM.
BEO 'RM. DINING RM. ; ow. s
Y
h 126 x 116 x I 1 CD NOR,CD
84TH N - u
d' I KIT
6
W I LINEn i
100"I I
i
1._ o4Nta`! 1
Up RANGE
g EN,
• � � 11 � , ,jig
BED IN. - -� -�- - _� - -- 1! LIVING RM. ; GARAGE
126x FIB ii �; li 20 ° Ix 136: 214x218
• I
Ala I I I
II it �I i,
1 CON I.i Ii ii ii �
(V i II
__I .iI X11 II �! �1 W112 I
i I
-
WALK IN
jwALK•IN CL. CL. FOYER I.L.___J l.. _ J L._..._. A t.:
PO CH J S"
i
� �'"; ' ,� ;� �� iii �g .. �.•:. � : p ' �,._, . _� . s� - �
• (� .,� ' S L .N MASTER BATH
.RM. -'
16° x_ 12°
- -,•�_
f Iry �
r "
J `
1 1
Io
,
IV '
1
10 A
W
u
I -A,�
r I
I
LORETTA MOLINARI R.N.,- M.S.N.
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
November 4, 2003.
Harry Nichols, PE
Patterson Park, Suite 106
2050 Route 22
Brewster, New York 10509
Re: Field Inspection — D'Apice
Haviland Drive, (T) Patterson
Lot # 2, TM# 25. -1 -11
Dear Mr. Nichols:
The following comments must be addressed.
ROBERT J. BONDI.
County Executive
1. A portion of the system appears to be within the 100 -foot wetland buffer.
2. 100% expansion area must be staked out in the field.
3. A bedroom count must be performed by this Department upon further
completion of construction.
4. All laterals must have two feet of solid pipe from the junction box to the
perforated pipe.
5. Remove large rocks from backfill material.
6. Footing drain discharge was not found upon inspection.
If you have any further questions; please contact me at 845- 278 -6130, ext. 2261.
Sincerely,
W. RON W/03 VRAM.- �
Gene D. Reed
Sr. Environmental Health Engineering Aide
GDR: cj
F.
I'
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 6, 2004
Harry Nichols P.E.
Patterson Park, Ste 106
2050 Route 22
Brewster, NY 10509
Re: Proposed SSTS: Alan
Haviland Drive
(T) Patterson TM# 25.4-11
Dear Mr. Nichols:
ROBERT J. BONDI
County Executive
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:
-- 1...The - --as- built -.- glans- submitted differ from - -- the - -previously submitted..-as- built_. plans.
. . _.. .
Therefore, the boxes are to be exposed and a Department Representative will check the
trench locations.
2. The SSTS has not been installed according to the approved plans.
Upon receipt of a submission, revised to reflect the above comments, this application will be
considered further.
Very truly yours,
'1� 6-1 MAO
Robert Morris, P.E.
Senior Public Health Engineer
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
OFFICIAL NOTICE OF PERMIT SUSPENSION
CERTIFIED RETURN RECEIPT REQUESTED
Harry Nichols, P.E.
Patterson Park
Suite 106 .
2050 Route 22
Brewster, NY 10509
Re: Suspension of Permit: P -30 -83
Ross Alan
482 Haviland Drive
(T) Patterson, TM #25 -1 -11
Dear Mr. Nichols:
ROBERT J. BONDI
County Executive
June 14,-2004
Please be advised that the Permit P -30 -83 for the above regarded project has been
suspended by this Department for the reasons noted below:
The SSTS has not been constructed in accordance with the approved plan.
The as -built plan submitted locates the existing SSTS within the 100 foot wetland
buffer.
The suspension of the permit will remain in effect until these 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.
1 0'
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.
P obert ly yo
Morris, P.E.
RM: Im Senior Public Health Engineer
cc: BI (T) Carmel
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
OFFICIAL REQUEST FOR STOP -WORK ORDER
.q
ROBERT J. BONDI
County Executive
June 14, 2004
Paul Piazza, BI
Town of Patterson
Town Hall
P.O. Box 470
Patterson, NY 12563
Re: Stop -Work Order Request: Permit P -30 -83
Ross Alan
482 Haviland Drive
(T) Patterson, TM# 25 -1 -11
Dear Mr. Piazza:
TheP-ermit .P -30-83 for the above regarded project been suspended by this Department for
the reasons noted below:
The SSTS has not been constructed in accordance with the approved plans.
The as -built plan submitted locates the existing SSTS within the 100 foot
wetland buffer.
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-
613 0 ext. 2166.
V ly y s,
Robert Morris, P.E.
Senior Public Health Engineer
RM: hn
cc: Harry Nichols, P.E.
O
O
O
tf)
Lu
co
c
S 682327'. E
LIMITS OF FLAGGED WETL..s
AS LOCATED 812102
N 68 23'27" W
PARTRIDGE
0
584.15'
573.71'
LANE
AREA RESERVED FOR ol
ROAD WIDENING
PURPOSES
AREA
87.121 S.F.
2.00 AC.
UP
UGHT
XV 0
S
0
ti
A
O
REV. 07-23-C
Oc,-2;
X t
-
PROJE CT
T:
p F
482
Ew LL— -F�AE p
0 CUENT
W
30` Sz5 °08
Sit ;-Fl-td vj 3 -V W 451.10
HAVfLAND ROAD
- 21
rm
0
1:
co
rl 1-Y 81-
48
:PROII
4AI':Z
zz
21
46 L.F� ACS Teatiew CT-WX
t
201-
13
LU
19 P
14
4
Ln
12 &AL-
��e W, TANK
O
REV. 07-23-C
Oc,-2;
X t
-
PROJE CT
T:
p F
482
Ew LL— -F�AE p
0 CUENT
W
30` Sz5 °08
Sit ;-Fl-td vj 3 -V W 451.10
HAVfLAND ROAD
C:
0
DIMENSION CHART (in feet)
Number
A
1 35
17
2
25
57
3
59
55
A
64
61
5
69
66
6
-75
12
8o
71
8
85
89
y
91
89
10
116
90
11
112
85
12
108
l9
13
104
74
14
99
68
15
96
62
16
91
57
17
55
88
19
61
92
1y
66
95
20
-72
99
21
l8
103
22
83
107
23
99
112.
IAI'
S
V