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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