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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25. -1 -45 BOX 10 IN 4.0 I� or 06 11:. PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL- HEALTH- SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT #' Located at I I DANAND LANE Owner /Applicant Name RIC!ARD PALMIERI Formerly Mailing Address I I DANAND LANE, PATTERSON, NY Town or Village PATTERSON Tax Map I s Block 3 L,ot 2 Subdivision Name QUAIL RIDGE Subd. Lot # Zip 12563 Date Construction Permit Issued by PCHD 9118106. Separate Sewerage System built by 12- PAL-He E2 I ! "- Address Consisting of 750 Gallon Septic Tank and 100 L.F. (ADDITION) ADDITIONAL Other Requirements: Water Supply: X Public Supply From (,_P c-ikt (- 216 c C Address 91: Private Supply Drilled by - Building Type- -FRAME DWELL!NG Number of Bedrooms 4 Address -. - ---Has erosion control been completed? Yes Has _garbage grinder been installed? NO I certify that the system(s), as listed, serving the above premises wer I~ted. essentially as shown on the as- builtplans (copies of which are attached ), ' c ordance 'th e ' U o ction Permit and approved Tans and the standards, rules and re ulat of the P �artiw Sit`oFealth. Datc: 1(1 -/ a Certified ll P.E. X R.A. (Design Profession . ' 139109 Address 392 COLUMBUS AVE. VALHALLA. NY 10595 � '. ' L•ieiense�k"1 � � O w / ``� Any erson occu remises served b the above stems sl t�� take such action. as may be necessary P PY�g P Y system(s) () P .Y .. f• r- •. to secure the correction of any unsanitary conditions resulting from s`>h- usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health. Director, such revocatio , modification r change is necessary. By: Title: Date: `lam White copy - HD Fil , Yell y - Building Inspector; Pink co (Jr; Orange copy - Design Professional Form CC -4.7 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF- ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM r Owner or Purc`�h_"aser of Building Building Constructed by 1 \ Dom" p L � Location - Street Building T9pe Tax Map Block Lot TownNillage Subdivision Name - Subdivision Lot # I represent that, I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the millful or negligent act of the occupant of the building utilizing the s} 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 0 Year ZOO to Signature: . 1C k n � . G.�J �,�_�. Title: General Contractor (Owner) - Signature Corporation Name (if corporation) Address: State Zip Corporation Name (if corporation). Address: State Zip Form GS -97 'N -------------- DO U RLPH C. PETRUCCELLI PETRUCCELLI Principal ENGINEERING TO: Mr. Richard Palmieri 11 Danand Lane Patterson, NY 12563 TRANSMITTAL DATE: November 6, 2006 PROJECT. Septic System As-built Richard Palmieri We are sending to 6 . you today kv Pick- thefollowing: - Five (5) copies of revised plans 11 Danand Lane Patterson, NY • ;Iyo it have ve any q ties iong'dj4 are ifi -fi-e-id-of cinytTiing fnrttrer p7eose do -not hesitate to-call; FROM.w'.r'�2 RudVlph C PetruccMi, P.E., FIN9PE qj 392 COLUMBUS AVENUEe VALHALLA, NEW YORK 10595 • PHONE: 914 948-3629 o FAX: 914 948 -6903 e-mail: petruccellienggaol..com Member National Society of Professional Engineers SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN,_MSN Associate Commissioner of Health Rudolph Petruccelli 392 Columbus Avenue Valhalla, NY 10595 Dear Mr. Petruccelli: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 October 31, 2006 Re: Field Inspection — Palmieri 11 Danand Lane (T) Patterson, TM # 18. -3 -2 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health The above referenced separate sewage treatment system can be backfilled. There are no open comments to be addressed at this time in reference to the septic system inspection. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. GDR:kly Sincerely, Gene D. Reed SR. Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 A C0 F G J _ �• or x M _ _ Sheet�of zr - 7 W. *. _ * PUTNAII%I COUN'Y;DEPA3RTMETT OF HEALTI n r DIVISIoNN, "NN�IRONMENTAL I3EATLIi SERVICES � a ' 3 J� ?c ate" -'`-:r »� +fir' �.,a , "� '�" - '''i{r NOS FXELDACTI {VIT1'RPORT' t, I �111 1- T 3 I* !, 2 4Y Y i M " NQ11CfE TPt I �4 1 &k J 4. _ l s f > ,fir- -- '..+..�,..� c. 3 - w , -'��+ H„T;Ricec �.4'x%4x1� �4 �14TTE =L�sD AJ� t . ,� Street f ` Town x State ` Zzp ,�� ; F ti .t - - r Y- - '�` x A fi' L �pFRSON IN CHARGE r �. �, t r 4 , sue. o o a Y I'll � ' TNTFI .T WFT7 Tate l 13 -o a uK `Name and title �� Y TYPE OF FACILITY s oa 1�Cr g ..- s= -� 1 Y .� t si` z,° z^x. t _ s ",! ,"+s„ s ter` Y. <'.t.. + - f._ �_a�, ;.. .2 '.7� Jw - ,wry. :'°{ _ - ,. .} r r. ?�.�ar - - - - .::ri: a ._, -,.-� x- r. g ^'a Vie . ` ' �•s r�F- +` : ., "� _ '; %' ; ;. , k FINDINGS E a nkv �n i s y � - �g 11 , ✓) G La/ 111 � r � sl raL4� �S ii `$ .r d � I - ,w__,J . �Q v� k f + a t 3 any. € tig8 t R 2+. ri` 'x£j+ �i t 6F{ t "+, a < s .ice $ �— � ,�� --+ z a�� �$ 5- Y"ta.,r `" ti y -s- -_ �k" _' "Y'f - r �'sa ' ' r z '3' - % '.; . sir a e t.'„.��z,se:" 'T '' y,�, c - s 3 "R, 5. - is x �, �- -�.:, �" , rtR t x ..r1's A s„� �'��.�.'� x t ? 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M`"-T -E b. - z ra i h `?'S�" '£.. irk +' o- �. - .a .a �&_ ^fir- -r "zs sa, ' g -'r# �r �z - z`-a'" sir.,, ° .& a -, € - w� ..� .Krs _ t � "usat %" - et,. - -� 1,. n- ` 4� 1-1 rw r'n nr G i�� irr+('Ti�R / /%� Vii "� TFi • k x s y k 1-11 I "k �r rte- -ca.,. x .r-i Signature and Trtie �U I�*a�p$TRFC,FTUFT)�R�y:�f� x����, s - rs is *a -r..r - :t r r 11 I acknowledge receipt of phis report SIGN�Tt�RE ' 1. n tq� _. :Tine.. , _ �H .' — 11 FROM : PETRUCCELL. I ENGINEERING FAX NO. :914948690-7- Oct. 27 2006 03: 37PM P2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SER VTCES ATTENTION 13 JOSEPH REQUEST FOR FINAL N3PEGTLON All information must be fully completed prior to any inspettiontt being made. © GENE For: Trenches PCHD Construction Permit # Owner /'Applicant Natric: LC, ALK1M1 -TM 1!j5 Block 3 Lot 2 Formerly: �_. Subdivision Name: QU4 (L_ RID S ubdivisiori lxt # (Q Is system 'fill completed? R A _ Date', Is system complete? Date: 10 12310 Is system constructed as per plans? Is well drilled? tq / Date: is well located as per plans? Are El(lsion control measures in place? 1 certify that the systetii(s), ss listed, at tic mbove,.p�repuses has been constructed and have inspected and verified their completio, n. the issupd PCHD Construction Permit and .approved..plans.a-nd- the - Standards, Rules --and- Rcgi+laiier ;tif.the Putnam County TJel, nent of _ Health. Date. Date:._ l0 4.2 -710! - -. : ;.'Cc�tificd ley: 1UPOLP11 C• TWrR. @ U.a. PE k RA. Design Professional Addrts,,,: .34?-- L°oc�U M�.�s ',��1�, &U441. NY 105 5 r.rc.. QR . 391- Comments: Q.I`.IA M (7MA L� . �75I`7 6A>✓ S� �1� T�1 � ,� I DO .._._._,,.T.. L 2 PUTNAM COUNTY DEPARTMENT OF HEAL DIVISION OF ENVIRONMENTAL HEA CONSTRUCTION PERMIT FOR SEWAGE TREA PERMIT # &23�-06 - Located at I 1 DANAND LANE Subdivision name QUAIL RIDGE Date Subdivision Approved Town or Village PATTERSON Subd. Lot # 6 Tax Map 19 Block 3 Lot 2 Renewal Revision X Owner /Applicant Name RICHARD PALMIERI Date of Previous Approval 4/4/90 Mailing Address 11 DANAND LANE, PATTERSON, NY Zip 12563 Amount of Fee Enclosed Building Type FRAME DWELLING Lot Area 0.96 Ac No. of Bedrooms 4 Design Flow GPD 900 Fill Section Only Depth Volume PCHD NOTIFICATION IS RE U11 ED WHEN FILL IS COMPLETED ADDITION EXISTING Separate Sewerlagt Systelm to consist of 1000 GAL (TO REMAIN) gallon septic tank and SEPTIC TANK, AND 100 L.F. - 24" WIDE ABSORPTION TRENCH Other Requirements: RUN OF BANK GRAVEL FOR GRADING PURPOSE ONLY To be constructed by Address Water Sunuly: X Public Supply From QUAIL RIDGE ..__ -o -- Drilled-by---_.._......ry.__... Address ADDITIONAL 750 GAL I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate a sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately follow' the date of issuance of the approval of the Certificate of Construction Compliance of the original system or any re it thereto. Signed: P.E. X R.A. Date 9115/05 Address 392 COLUMBUS AVENUE, VALHALLA, NY 10595 License # 39109 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new rmit, Approved discharge of domestic sanitary se age only. By: � - Title: � � Date: / —/ -(0 White copy - HD - Building Inspector; Pink copy - copy - Design Professional Form CP -97 'r' v PETRUCCIELB.II �NGpntEEkING n September 13, 2006 Michael J. Budzinski, P.E. Director of Engineering Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 RE: Proposed Palmieri SSTS (T) Patterson TM #18 -3 -2 11 Danand Lane East Branch Resevoir Basin Dear Mr. Budzinski: This is in response to your letter of September 8, 2006. 1. 2. 3. M RUDOLPH C. PETRUCCELLI, P.E. Principal The absorption trench detail has been revised. The PVC pipe from the tank to the junction box has been specified as SDR -35. The junction box detail has been revised to show 2 feet of solid pipe out of the box to the perforated pipe. A six (6) inch bed of 3/4 inch crushed stone or washed gravel has been shown on the septic-tank -detail.,- _ Attached are five (5) copies of revised drawings for your use. Very truly yours, PET U CELL N NEE NG u ph . Pe uccelli, P.E., F.NSPE Principal cc. R. Palmieri 392 COLUMBUS AVENUE 0 VALHALLA, NEW YORK 10595 o PHONE 914 948 -3629 o FAX 914 948 -6903 Member National Society of Professional Engineers SHERLITA AMLER, MD, NIS,_FAA_ P Commissioner of Health LORETTA MOLINARI, RN, MSN. Associate Commissioner of Health Mr. Rudolph Petrucelli 397 Columbus Avenue Valhalla, New York 10595 Dear Mr. Petrucelli: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 September 8, 2006 ROBERT J. BONDI ` County Fxecutive ROBERT MORRIS, PE Director of Environmental Health Re: Proposed SSTS for PA eiri 11 Danand Lane (T) Patterson, TM# 18 -3 -2 This Department has received and reviewed the submitted application and plans for the above referenced project and the following comments are offered for your consideration. /I The absorption trench detail is to be revised to delete the references to straw and untreated building paper as the barrier over the gravel. The detail is to specify geotextile filter fabric over the gravel. - The -PVC Dine- from• the -sel tic. tank- to- .the-i.unction boxes- is -t(5 he specified as SDR -35 minimum. The junction box detail is to be revised to specify a minimum of 2 feet of solid pipe out of the box prior to the perforated pipe. In addition, the type and depth of bedding material for the junction box is to be specified. ,4"" The bedding material type and depth are to be specified on the septic tank detail. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. �IJB:cj . Respectfully Michael J. Director of Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 6 Jy David S Warne r T, 20b6 Michael Budzinski, P.E Putnam Co. Health Dept. 4 Geneva Road Brewster, NY 10509 Re: Palmieri Residence 11 Danand Lane Patterson, Putnam East Branch Reservoir DEP Log # 2006 -EB -0934 (Joint Review) Dear Mr. Budzinski: This letter is to inform you that the New York City Department of Environmental Protection (Department) has determined that the above - referenced application is complete. In addition, the Department has no objection to the approval of the above - referenced regulated activity. This determination is based on the review of submitted documents including the plan titled "Proposed Septic Addition" prepared for Mr. and Mrs. Palmieri, dated 08/15/05 and last revised on 07/18/06. X48 The applicant must contact Sissy De La Ossa of my staff at (914) 773 -4416 at — - least -2 -days- prior -to -the start-of constr.0 tion -o f. the.SSTS_so_that a- Deparfm_Qnt._.._ ------ ------ P e... representative may inspect and monitor the installation. 4 Sincerely, Danny Shedlo, P.E. Civil Engineer II Engineering Review Group xc: Roger Sokol, P.E., NYSDOH Town of Patterson Planning and Zoning Office Town of Patterson Building Department OWPETRUCCELLI ENGINEEkIIN L?e)�'o September 8, 2006 Michael J. Budzinski, P.E. Director of Engineering Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 RE: Palmieri SSTS (T) Patterson TM #18 -3 -2 11 Danand Lane East Branch Resevoir Basin Dear Mr. Budzinski: RUDOLPH C. PETRUCCELLI, P.E. Principal In response to your letter of August 11, 2006, please be advised that as of this date, we have not been notified of the status of the above permit. Therefore, we are seeking a decision in accordance with Section 18 -23 (d) (6) of the New York City Department of Environmental Protection Watershed Rules & Regulations. Thank you for your consideration in this matter. .Very._ truly-yours,._ PET CELL E INEERIN Rudolph C. Petruccelli, P.E., F.NSPE Principal cc. R. Palmieri 392 COLUMBUS AVENUE • VALHALLA, NEW. YORK 10595 • PHONE 914 948 -3629 • FAX 914 948 -6903 Member National Society of Professional Engineers September 7, 2006 Dear Mr. Budzinski, As per your request I am notifying you in reference to my application. Richard Palmieri-TM# 18-3 -2 11 Danand Lane Patterson, NY 12563 Application Filed with The Putnam County Dept. Of Health I am requesting a favorable decision in accordance with section 18 -23 (d) (6) New. York_ City._ Dept ....Of_..:Environmental__.._ Protection Watershed Mules and. regulations. I have received a wetlands /watercourse permit #0606 -01 from the Town of Patterson dated August 3' 2006. Thank You, Richard Palmieri 2 'd A0 1N3Wl8dd30 AiNn00 WdN1nd:3WHN :y September 72006 . , Fex (7'0) 595= 35'57:.. t. • , !: ieau4fVlTaterSi 'iQp'1�j. < *.•'.f; .�e,a; t =a �:�1�(Midlfi,'7!leppxY0f1.C: �'; x •a , . ' �'t =:r i r � :FrE;�9:y�') X42- 20Q.1 #• '' =_ ; ` ` =.! `Faxs7;4 74 a�:a'.;; ftMagp a'�,� .•3x.�.�. *: ;T:�t'..,1 g- l:.e,�r. ":mot; '-'-L.1 �; �ngineer� ,rigflfvlsl�inEOF{•'`�,<'.`', 1. jye• a�vY.i+adrSiNrF..S. •�;�k'.,7'� is . 97�i s�'-� .'F' (''6914).73- 0.3?�3� �!' ��.i•.4'z+Fii �' "rrl�i',c.L {,� �a.l'? .r.Ly�£r4` n ti:i:r t �.zr Aiwa. <.y�.,,,., �. ;� .a,;L�;.ic�S::,�' �•1 t »a�.; -?;' � �� a W nra'so.•iaEo- 1 7n *H Michael Budziriski, P.E Putnam CO., Health Dept. 4 Geneva toad Brewster, NY 10509 i26L- 8L2- Sb8:�31 Re: Palmieri Residence 11 Danand Lane Patterson, Putnam East Branch Xeservoir DEP Log # 2006 -EB -0934 (Joint Review) Dear Mr. Budzinski TT :t7T nHl 9002 -L -dM This letter is to inform you that the New York City' Department of Enviroznuental protection (Department) has determined that the aboverreferenced application is complete. In addition, the Department has no objrecdon to, the approval of the above - referenced regulated activity. This determination is based on the review of submitted documents ianclnding the plan titled "Proposed Septic Addition" prepared for Mr, and Mrs. palmieri., dated 08/15/05 and last revised on 07/18/06. The applicant must contact Sissy De La Ossa of my star: at (914) 773 -4416 at least 2 days prior to the start of construction of the SSTS so that a Department representative may - inspect and monitor the installation.. Sincerely, �J Danny Shedlo, P.E. . Civil Engineer 11 Engineering Review Group xe: Roger Sokol, P.E., NY'SDOH Town of patterson PlannimB and Zoning office Town of pattmon Buil&* Depwti ne-nt /7:91 9007 1 aaS M0- SLL- p16:x8J lrle l� August 29, 2005 1,:.VGII lV1 kk Depa 'en.iiiv. Michael Budzinski, RE Enveronmental Putnam Co. Health Dept. Pr ®tection 4 Geneva Road Brewster, NY 10509 Re: Palmieri Residence, SSTS 11 Danand Lane Emily Lloyd Patterson, New York commissioner East Branch Subbasin DEP Log # 2006 -EB- 0934 -SS.1 Te (718) 595 6565 Faz (718).595 3557:_' Dear Mr. Budzinski: Bureau of Water Supply asSGDlumbus Avenue The New York City Department of Environmental Protection (NYCDEP) has Vafalla New York ,osss,sss determined that the above referenced application is incomplete. The following information is necessary to complete the application: DwAd.S Warne:, Acting Deputy commisslone .: 1. The Deep Hole test must be witnessed by a DEP/PCDOH representative. :�ic 2. Show location of the well. Fax (914) 741 -0348 1,`. 3: The proposed expansion area must be out of the 100 -foot buffer to the _ �t���_.... . us _ _......__....-.__ - foot.. _o _. _... Joseph Mag'glo P E pc�� ?regulated wetland. Deputy Director 4. We recommend you to replace the existing 1000 -gal tank by a 1250 -gal Engineering`Dlwslon EOH tank, instead of adding a 750 -gal tank. Tel (914) 7,73=4470 Faz (914):773 0343 If you have any questions regarding this matter, you may contact me at (914) 7. -4416. 773 Sincerely, Ss�l� Sissy De La Ossa Assistant Civil Engineer Engineering Review Group s•'��yCCITY Dl- M� - Dip Xe. Roger Sokol, P.E., NYSDOH Q��MEnirALPRO Town of Patterson Building Department Cwww.nycpgov /dep' . ('7189' DEP HELP' SHERLITA AMLER, MD, MS, FAAP ✓- Commissioner of Health -" --- ` -- ' LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 August 11, 2006 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Rudolph Petrucelli, PE 392 Columbus Avenue Valhalla, New York 10595 Re: Palmeiri 4S (T) Patterson, TM# 18 -3 -2 East Branch Reservoir Basin Dear Mr. Petrucelli: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and revisions received by this Department on August 8, 2006 is complete. The Department will notify you by August 31, 2006 of its determination. ❑ The project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. 0 Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement: If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the - - -_. -New YorkAagt Department of Environmental Protection Watershed Rules-and Regulations....lfthe_Department. fails to notify you within 10 days of the receipt of the notice, your application will be deemed approved, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the New York City Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2148. Respectfully, Michael J. MJB:cj Director of Ws2 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 76014 Fax (845) 278 -6648 c it I !� /0 — — — _ k i i SHERLITA AMLER, MD, MS, FAAP . ._ Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF ' HEALTH 1 Geneva Road, Brewster, New York 10509 S S`i bP,: LA OSSA ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health TO: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM JOINT REVIEW PROJECT: 1 A t- MI612I TOWN: 1� /"i--(-r6OSDN SUB'D APP DATE NOTICE OF COMPLETE APPLICATION: DATE: 9 / /-- DO ❑ Within the drainage basins of West Branch, Boyds Corner Reservoirs or Croton Falls. ❑ Within 500 feet of a reservoir, reservoir stem or control lake. Within 200 feet of a watercourse or a DEC wetland and appearing on a subdivision map approved after December 31, 1992. ❑ Design flow greater than 1000 gallons /day. ❑ Commercial SSTS. j treview Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH. DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at I I DANAND LANE Subdivision name QUAIL RIDGE Subd. Lot # 6 Date Subdivision Approved Owner /Applicant Name RICHARD PALMIERI Mailing Address 1 I DANAND LANE, PATTERSON, NY Amount of Fee Enclosed Town or Village PATTERSON Tax Map 19 Block 3 Lot 2 Renewal Revision X Date of Previous Approval 4/4/90 Zip 12563 Building Type FRAME DWELLING Lot Area 0.86 Ac No. of Bedrooms 4 Design Flow GPD 800 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED ADDITION. EXISTING Separate Sewerage Systern to consist of 1000 GAL (TO REMAIN) gallon septic tank and SEPTIC TANK, AND 100 L.F. - 24" WIDE ABSORPTION TRENCH Other Requirements: RUN OF BANK GRAVEL FOR GRADING PURPOSE ONLY To be constructed by Water Sunnly: X Public Supply From �r. P"rtvate'Supply Drilled by Address QUAIL RIDGE Address ADDITIONAL 750 GAL I represent that l am wholly and completely responsible,for the design and location of the proposed system(s) and that the separate sewage, treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" sa ' e Public Health Director will be submitted to the Department, and a written guarantee will be furnish s I essors, heirs or assigns by the builder, that said builder will place in good operating condition any 1�l-se ent system during the period of two (2) years immediately follow' the date of issuance val -qthe C 1 c,# of Construction Compliance of the original 4A system or any re it thereto. r r s Cr w Signed: P.E. X A d91 Address 392 COLUMBUS AVENUE, VALHALLA, NY IO_ RpPcrLIi NP' R.A. Date 8/15/05 License # 39109 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has.been completed and inspected by the PCHD and is revocable for cause or may amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of.domestic sanitary sewage only. By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY. DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DES IGN"DATA- StlEET -- SLJBSURFACE SEWAGE TREATM ENT- SYSTEM..._.. - Owner P.t ef ktirj PR L- N , c 2 r Address (( PA N n-N u 1-6 1 Sarre z.s Located at (Street) I I qr, A, n 1, n Tax Map 16 Block 3 Lot Z (indicate nearest cross street) Municipality P,g• =i:ILSo r/ Watershed SOIL PERCOLATION TEST DATA Date of Pre - soaking .3` 30/ 0 G Date of Percolation Test S"�P / 0 6 Hole Run No. Time Start -Stop Elapse Time (Min.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min /Inch 1 Jo;�y to :1 Z o 2-5— 2 10',(1 Jo :ll 4 2- 3 0 . to zo 4 /o:�L "lo:al o z3 3 3.0 5 1 2 3 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. <_ 1 min for 1 -30 min/inch, 5 2 min for 31 -60 min/inch). All data to be submitted for review. 2. Depth measurements to be made from top of hole. DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' '6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. A - " HOLE NO. 1>05vIi. -) %PScl(l Fli.l_ t4 ,L/1 -i4, Vi (T-V t i MAIYOI AL V-c 1i).! SQMC r2, 0. SuMG 0 0.eg, (*11-k✓jtL HOLE NO. Indicate level at which groundwater is encountered t o t4c Indicate level at which mottling is observed - No N C Indicate level to which water level rises after being encountered N. 'k . Deep hole observations made by: P.E. Date _ R- EvSG� � 3i oG Design Professional Name: Pg,-nz. v cc E t- c., £„c.ru&/••qkddress: 3 ":F Z CGc"•-, 'T r A✓C-",(LC Tfi gn8P_AAAAWnal =s Seal 11<� N ,OF NEIV � �Q. O \Q�G. PETR C� n " �. s�0 39109 AROPES SIoNP�' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _. _. _. - - — APPL- -IEATION- FDR-APPROVAL OF PLANS FOR A _ \VASTEWATER TREATMENT SYSTEM 1. Narne and address of applicant: Richard Palmieri I 1 Danand Lane Patterson, NY 12563 2. Name of project: Septic Addition.For Palmieri 3. Location T /V: Patterson 4. Design Professional: Rudolph Petruccelli, P.E. 5. Address: 392 Columbus Ave 6. Drainage Basin: Putnam Lake Valhalla, NY 10595 7. Tvue ofProiect: X Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Enviromnental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II _ Unlisted X 9. Is a Draft . Environmental Impact Statement (DEIS) required? ......................... No 10. Has DEIS been completed and found acceptable by Lead Agency? ...................... N/A 11. Name of Lead Agency N/A 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ..:.::::::...:::..:. Yes 13. If so, have plans been submitted to such authorities? ........ ............................... Yes '4. l-Ias preliminary approval been granted by such authorities? Yes Date granted: 08 -013 06 15. Type of Sewage. Treatment System Discharge ................. surface water X groundwater 16. If surface water discharge, what is the stream class designation? .................... N/A 17. Waters index number ( surface) ........................................... ............................... N/A 18. 1s project located near a public water supply system? ....... ............................... No 19. If yes, name of water supply Distance to water supply �0. Is protect site near a public sewage collection or treatment system. ? ................ No 21. Naive of sewage system Distance to sewage system 22. Date test holes observed 05 -31 -06 23. Name of Health Inspector Budzinski 24. Project design flow (gallons per day) .............................................. 200 gallons per bedroom 25. is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? ......................... N/A Form PC -97 27. Is any poili on of this project located within a designated Town or State wetland? Yes 28. Wetlands ID Number.......................................................................... ................ 0606 -01 129. Is Wetlands Permit required? .............................................................................. Yes Has application been made to Town or Local DEC office? ................................. Yes 30. Does project require a DEC Stream Disturbance Permit? ................................. No 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 No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No No DESCRIBE: Is there a local master plan on file with the Town or Village?.,_ ...................... No 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ............................................................ No 35. Are any sewage treatment areas in excess of 15% slope? ................................ No 36. Tax Map ID Number ......................................................... Map 18 Block 3 Lot 2 3 Design Professional 37. Approved plans are to be returned to ..... X Applicant _ NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be s61t l3e0diffi6fit-and -heed'_h6f_b6-_se-fit -iff-diYp1fda& to the DEPT - although "the` project _ffidY-FeqUiJr6_ 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 PEP for review and approval. If the application is signed by a person other than the applicant shown in Item I., the application must be accompanied by a Letter of Authorization (Form LA-97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that inforniation provided on this form is true to the best of my knowledge and belief. False statements nuide herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of (11 L SIGNA M?ES&,0FFICUL TITLES lt.qy 90 MaiIJng,Midrc&'-t 14 -18-1 (2187) -Text 12 PROJECT I.D. NUMBER O1T.Z1 SEOR State Environmental Cuallty Review SHORT. ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART 1-- PROJECT INFORMATION (To be completed by Appllcant•or Project eponsof) 1. APPLICANT /SPONSOR PROJECT NAME. A, (2-A P Pt (rM c a- I P. P Ac. ti � t1:ii f S' S 7` S J. PROJECT LOCATION: ('LJ Municipality j�it�-7—� County r N /1 H 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) (I UhH +h L 5. IS PROPOSED ACTION: ❑ New §9 Expansion ❑ Modiflcationlalleration 6. DESCRIBE PROJECT BRIEFLY: M S- i w4C- A-f l a /`1 O n r % A-i- L_ v NI S f-P n e- 7%R'N1K /yv-r 4 ! v o .7. AMOUNT OF LAND AFFECTED: G b rO Initially - acres Ultimately O bores 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? c4Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? to Residential . - ❑ Industrial ❑ Commercial ❑ Agriculture ❑ PuWForseUOpen epaos ❑ Other .- Describe:. ... osE �Stht rc rr0 10. DOES ACTION INVOLVE A PERMIT APPROVAL., OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENr.v (FEDERAL wi STATE Ofi LU_ CAL)? ❑ Yes ® No It yes, list agency(s) and permtGapprovals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ®'Yea ❑ Nti If yes, list agency name and pennitlapproval Q w t� p 1 �., G (7G /� R'lLT7` rLIYr •- C-s✓/L t~i c rir or- O C c.. c- wO47,ec- r ��'fiAc,?+ (7 GPI% nTd-r� r - C �-r7 �� t:a-� d� Cam+'► I';YL u a.7 v. t� H /�-� Mr �- uG S-.Ci' f C. r- IL . !7,1 ti C 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMmAPPROVAL REQUIRE MODIFICATION? CR Yes ❑ No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE n (� Appllcantfsponsor name: 12-,t C-;4 D Ac,1 c. t1t C4, i Date: / U 5� _ Signature: If the action is In the Coastal Area, and you are a state agency, complete" the Coastal Assessment Form before proceeding with this assessment PART 11-- ENVIRONMENTAL ASSESSMENT.(To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.11? If yea, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No S. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED•, CTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration —may-be superseded by another Involved. agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE I.OLLOWiNG: (Answers may be handwritten, If legible) C1. Existing air quality, surface or groundwater quality or quantity, notes levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain brlofly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C9. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: 04. A community's existing plans or goals as ofticially adopted, or a change In use or Intensity of use of land or other natural resources? Explain briefly. CS. Growth; subsequent development, or related activities likely to b6 Induced.Qy the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effacts not Identified In C1-CS? Explain briefly. C7. Other Impacts (Including changes In use of either quantity or type of energy)? Explain briefly. D., IS THERE,-OR IS THERE LIKELY TO OE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? Yes No If Yes, explain briefly PART Ili — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) s n,, .^rLn INSTRUCTIONS: For each adverse effect identified above, determine whether It Is substantial, large. Important or oth"lse.g�ficant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural); (b) probability of occ=4 (c) ilkifion; (d) Irreversibility; (e) geographic scope; and (0 magnitude. If necessary, add attachments or reference supporting materlal>r-'>EWsu4.that explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adegeoelya cir"Q". ❑ Check this box if you have Identified one or more potentially large or significant adverse ,iRipact h MAY occur. Then proceed directly to the FULL EAF and/or prepare a' positive declaration.' ❑ Check this box if you have determined, based on the lnformat6 and analysis above and arty. supporting documentation, that the proposed action WILL NOT result in any significant adverse environment Impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of ea Agency Print or Type Name of esponsi le Officer in Lea Agency Title @ Responsible Officer Signature of esponsi a Officer in Lead Agency Signature of reparer III different from responsible officer) Date EAS Form 14-164 (Page 2 of 2) PLANNING DEPARTMENT P.O. Box 470 1142 Route 311 Patterson, NY 12563 . Melissa Brichta Secretary Richard Williams Town Planner Telephone (845) 878 -6500 TOWN OF PATTERSON FAX (845) 878 -2019 PLANNING & ZONING OFFICE WETLANDS/WAMCOURSE PERMIT TOWN OF PATTERSON Routes 164 & 311 Patterson, New York 12563 Date: August 3, 3006 Permit #0606 -01 Permit is hereby issued to Richard Palmieri ZONING BOARD OF APPEALS Howard Buzzutto, Chairman Mary Bodor Marianne Burdick Martin Posner_ ...- - Lars Olenius PLANNING BOARD Herb Schech, Chairman Michael Montesano David Pierro Shawn Rogan Maria Di Salvo Location of work: 11 Danand Lane Patterson, NY 12563 To conduct work as follows: To allow the 100% expansion area for the residential subsurface sewage treatment system to be placed in the 100 foot controlled buffer of a Town regulated Wetland/Watercourse in accor_ dance with the approved application form and plans prepared by Petrucce4i Engineering dated August 15, 2005 and last revised on July 18, 2006. GENERAL CONDITIONS . 1. No activity shall be permitted within controlled areas except as identified in the approved application and plans. 2. All work shall be performed in accordance with the New York Guidelines for Urban Erosion and Sediment Control. 3. The Permit Holder shall notify the Environmental Conservation Inspector (E. C.I.) in writing, at least five business days in advance of the Date on which project construction is to begin. WETLAND/WATERCOURSE PERMIT August 3, 2006 Richard Palmieri Pg. 1 4. The Permit shall, be prominently displayed at. the project site during the undertaking of the activities authorized by the permit. 5. The boundaries of the project shall be clearly staked or marked and maintained. In . addition, any wetlands contained within the boutdaries of the project shall also be staked or marked. 6. The Environmental Conservation Inspector (E.C.I.) or his designated representative shall have the right to inspect the project.. 7. The Permit shall expire on completion of the acts specified and unless otherwise indicated shall be valid for a period of one year. 8. As a condition ofthe issuance ofthis permit, the applicant has accepted expressly by the execution of the application, the full legal responsibility for all damages, direct or indirect, of whatever nature, and by whomever suffered arising out of the project described herein and has agreed to indemnify and save harmless the town from Suits, Actions, Damages, and costs of every Name and description resulting from the said project. SPECI[ L COMMONS 1. The Applicant shall provide the Town of Patterson Planning Department with three copies of the engineering plans last revised on July 18, 2006. 2. The E.C.I. shall place permanent markers along the wetland boundary. i '�/ i`i4i1" cc: Environmental Conservation Inspector Town Engineer Codes Enforcement Officer WETLAND/WATERCOURSE PERMIT August 3, 2006 Richard Palmieri Pg. 2 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health July 31, 2006 Rudolph Petrucelli, PE 392 Columbus Avenue Valhalla, NY 10595 Dear Mr. Petrucelli: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County aecutive - ROBERT MORRIS, PE Director of Environmental Health Re: Application to Construct a Subsurface Sewage Treatment System for Palmieri at 11 Danand Lane (T) Patterson, TM #.18 -3 -2 The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on July 24, 2006 is incomplete. Please be advised that the following information is required before the Department may commence its review. The USDA Soil Conservation Service soil type boundaries are to be delineated on the plan. Both deep test holes are to be shown on the plan and the deep hole descriptions are to be provided on the plan and the soil data sheet. The PCHD SSTS notes are to be provided on the plan. A location map is to be provided on the plan. •/ Application form PC -97 is to be completed and submitted. v/'o Erosion control measures are to be shown on the plan. 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 (845) 278 -6130, etc. 2148. MJB:mcb V�e�ry�truly Michael J. Director of Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 - Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 PE i} 4, iE +n It-- V n ,, ,, 3 ol • PI �r °I II t� c, `4 :f �i j .i ii r.; 1 PUTNAM COUNTY DEPARTMENT OF HEALTH - -.DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN.DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner R1 c "tio PprL. H I c 2I Address / ( PA, g n-r+ D L# 10-'�rca_s v N, N • `f Located at (Street) .11 0 P'.", t, n Tax Map 1 8 Block 3 Lot Z (indicate nearest cross street) Municipality Pa.,, ,-E 2s o rr Watershed SOIL PERCOLATION TEST DATA Date ofPre- soaking S %3a / o G Date of Percolation Test S��P / 0 6 Hole No. Run No Time Start.= Stop (Min) Ti me Depth -to Water _ From Ground Start Ce 'Inches) Water Level Drop ss Percolation Min /Inch 2 �o'.t2• 10;11 9 Zn. z 3 3 10'.22 ro :3L 10 2-0 3 '1q 3 �� 3.1 5 1 3 4 5 1 2' 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. <_ 1 min for 1 -30 min/inch, 5 2 min for 31 -60 min/inch). All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 Pg. 1 of 2 o, ,o 14 -184 (?!87) --Text 12 PROJECT I.D. NUMBER 617.21 SEOR V Appendix C Stafe gmiloonitiental QuNity getrlew SHORT. ENVIRONMENTAL ASSESSMENT FORM. Far UNLISTED ACTIONS Only PART I-- PROJECT INFORMATION (TO be completed by Applicant-or Project sponsoo 1. APPLICANT /SPONSOR 2. PROJECT NAME, A-Ir o AL-", C t?-I iAt- Hr tA,r SS 7'S 3. PROJECT LOCATION' 1 Pu ti Mynlcipallty j,—� County r rq h 4. PRECISE LOCATION (Street address and toad Intersections, prominent landmarks, etc., or provide map) �I OhHirwa �-�E 5. IS PROPOSED ACTION: El New W Expansion ❑ Modlfieation/aiteration S. DESCRIBE PROJECT BRIEFLY: Sb r7 e IY s. i�t-c- A-n o ri c) o 04'A c_ SGT d � f-R 7 0aY ( v O Le- o -A- / 7 7. AMOUNT OF LAND AFFECTED: G 8 6 �6 Initially - acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ®•Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? 51 Residential Q Industrial ❑ Commercial ❑ Agriculture 0 Park/Forest/Open spaos ❑ Other Describe: vroE 1=" t(, y 10. DOES ACTiON.INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL., STATE OR LOCAL)? ❑ Yes ®No It yes, list agency(s) and permwapprovals 11, DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? to Yes O No If yes, list agency name and permlt/approval O (Jr L- p 1 r. r, l7G10.4 A-rOlQ Ir — CC-f t-r7 Ae ch-sr_ d- Cp-ev j C,,) &ti Gy/X-c OF Lis I SIAM G 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REOUIRE MODIFICATION? Yes ❑ No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: IZL L14 k-yt --D PALL /1144,1.. Date: L \ Signature: \ If the action is in the Coastal Area, and you are a state agency, comptete'the Coastal Assessment Form bef ore _proceeding with this assessment r Y PART I[-- ENVIRONMENTAL ASSESSMENT (To be completed by Aaencv) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN b NYCRR, PART 617,12? It yes, coordinate the review process and use the FULL EAF. ❑ Yas ❑ No B.-WILL ACTION -RECEIVE COORDINATED REVIEW-AS PROVIDED FOR UNLISTED •, CTIONS IN 8 NYCRR, PART 817.6? If No, a negative declaration may be superseded by another Involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, It legible) C1. Existing air quality, surface or groundwater quality or quantity, nets* levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problerne? Explain brlofiy C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood. character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife epecios, significant habitats, or threatened or endangered species? Explain briefly: 04. A community's existing plans or goals as officially adopted, or a change In use or Intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities ll"ly to be Induced.4y the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not Identified In CI-05? Explain briefly. . C7. Other Impacts (Including changes in use of either quantity or type of energy)? Explain briefly. D. IS THERE,-OR i TNERE- Ut<ELY TO BE, ddNTRdVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explaln briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether It is substantial, large. Important or otherwise significant. Each effect should be assessed in connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration (d) Irreversibility; (e) geographic scope; and (n magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately addressed. ❑ Check this box if you have Identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare appositive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental Impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Asency Print or Type Name of esponsi a Of ticer in Lea Agency Title of esponsi icer ignature of esponsi a Officer in Lead Agency Signature of reparer erent from responsible off iced Date RAS Form 1416 -4 (Page 2 of 2) o o PUTNAM COUNTY DEPARTMENT OF HEALTH - - - -- -- .-,-DIVISION OF ENVIRONMENTAL HEALTH- SERVICES - RE: Property of LETTER OF AUTHORIZATION Located at 1 'DAM A-N b LA-HC P2-, -i r Subdivision of Subdivision Lot # Tax Map # / -9 Filed Map # Block 3 Date Filed Gentlemen: This letter is to authorize (2- v'3 o L P h G Lot 2 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 accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and /or 147 of the Education Law, the Public Health Law, and -the Putnam County Sanitary Code. - Countersigne . P.E., R.-A., # __ 3 5 /o y Mailing Address 3 9z 6w_ r A4.1e Very truly yours, Si ed: (Owner of Property) - 1 - Mailing Address: } \ IJar�` 9 10 2 V +C-17`4L" PV�kisoY\j State /-(, y Zip / o r_ I- Telephone: q/ `�/- i y g- 3C )--5 State (� \� Zip Z 0 Telephone: 0 `1 S — Z11 Form LA -97 43,FTER1,TTA AMLER, MD. MS, FAAF LORIKrI" rA MOLINARI, RN. MSN Assoclate C;ommixciorrer of Kealth DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ku 6Y ROBERT J- DONDI County Executive February 24, 2006 Mr. Rudolph Petrucelli, PE C1 i Petrucelli Engineering' 392 Columbus Avenue Valhalla, New York 10595 Re: Palmieri SSTS 11 Danand Lane ('1) Patterson, TM# 25 -1 -45 Dear Mr. Petrucelli: This Department has received and reviewed the revised plan for the above referenced project and the following comments are offered. I. Since modifications to the existing SSTS are being proposed thus requiring the issuance of a construction permit, the following items are required to complete your submission: a. - 02(5tfeelcs$: b. AnDiication foiffiTC 97 c. - Soil data sheet d. Short F,AF e. Letter of Authorization 2. Since the original soil testing is in excess of ten (10) years old, new percolation and deep test holes will be required in the proposed primary and reserve areas. Please contact this Department to schedule a mutually agreeable time for the testing by completing and submitting the request for soil testing form. 3. The design of the 100 percent reserve system trenches is to he shown on the plan.. 4. Since it appears the SSTS reserve system will be situated within 100 feet of the Tovim wetland, a Wetland Permit, issued by the Town, is to be submitted to this office. In addition, you will need to inlbrm. Mr. Richard Williams, at the Patterson Town Hall, in writing, as to how, where and what measures you intend to utilize for the soil. testing within the wetland- buffer. Environmental Health (845) 2711-6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225.5418 Nursing Services (845) 278 -5558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Houle Care Fax (845) 278 -6085 Early tnterventluibTrexcbool (845) 278-6014 Fax (845) 278 -6648 a�1 .-b PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF. ENVIRONMENTAL HEALTH, SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner c �cr,, �c-o Pte,- H I r 21 Address t J)A rr rrM o Lh ; 1 111 .C�Ls 0 H, Located at (Street) I I D A-ty A-- E> L A Tax Map 16 Block 3 Lot Z (indicate nearest cross street) Municipality_ P-a r- Z r0 r, Watershed SOIL PERCOLATION TEST DATA Date of Pre - soaking 30/ o G Date of Percolation Test f 0 6 No., Run No. Time Start - Stop ;. Elapse Time (Min) Depth to Water From Group Surface (Inches) Start . Stop Water Level Drop In Inches Percolation Rate Min /Inch 1 lo;r`f�1o:11 7 2 0 257 s �•� 2 X0;11 • lo:ll 9 3 l0'.11•�o:JL to Zo s3Vq .3 Y 3.1 4 /0;31 - 10;a1 i 2 0 y3 3 3. o 5 1 3 4 5 1 2 3 4 5 NOTES: 1. Tests to be reheated at same death until ahhroximately eaual percolation rates are obtained at each percolation test hole. (i.e. 5 1 min for 1 -30. minhnch, <_ 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 Pg. 1 of 11.18 -4 (21117) --Text 12 PROJECT I.D. NUMBER 617.21 SEOR ' Appendix C -_ State Environmental Quality Review SHORT. ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I-- PROJECT INFORMATION (To be completed by Applicant.or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME. A(- H r tA, r S S 7- S 9. PROJECT LOCATION: 9^- ('v M Mtunicipallty f -rre_ d County r N h 4: PRECISE LOCATION (Street address and road Intersections, prominent landmarks, ate., or provide map) M �lw h l- "F_ 5. IS PROPOSED ACTION: ❑ New §9 Expansion ❑ Modificatlonlalteraticn 6. DESCRIBE PROJECT BRIEFLY: A-L M f—P r7 c. fr / M 0 F fi+-t 1r " C) O 7. AMOUNT OF LAND AFFECTED: G b 6 Initially - acres Ultimately acres S. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? OYes ❑ No If No, describe brlefly 8. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ResidenUal ❑ Industrial Commercial ❑ Agriculture ❑ ParklForeeUOpen space ❑ Other rJ❑ Describe: c"> wE �r1t.lC. y /��! r, e,/!,i74-L- IZ-Gr� 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ❑ Yes ® No.. It yes, list agency(s) and permjt1approval3 tt. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? to Yes ONO It yes, fiat agency name and permlUapproval t7etoA t- r► -+4Yr - CC41-r7 Ar CA-T 6- &*rr'`t jC.-) 60Ai/k- ,c#t -ce u� SSrs C. 6- r S77 •, C 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? Yes ❑ No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE AppllcanUsponsor name: IZt c w A-yt b pa,_ tit i"L, I — Dale: � _ D Signature: P� O If the action Is in the Coastal Area, and you are a state agency, complete'the Coastal Assessment Form before proceeding with this assessment J d,,n - • '^.4 PUTNAM COUNTY DEPARTMENT OF HEALTH - ° . ,- DIVISION OF ENVIRONMENTAL HEALTH -SERVICES LETTER OF AUTHORIZATION RE: Property, of 2- G (t PA L H �2 Located at i D A H k ri o t, A- e-i C r P � � �t � 2 To r-r T/V Tax Map # Block 3 Lot 2 Subdivision of Subdivision Lot # Filed Map # Date Filed Gentlemen: This letter is to authorize (2- v %N o L' P H C_ P u C I- (-I P. F- 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 accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Counterstgne . Mailing Address 37)- �•- A �f �yC State `/ Zip l o r� r Telephone: Very truly yours, Signed. (Owner of Property) Mailing Address: �' 1✓" Y -k'�'soY\J State 'Y Zip I ZS (03 Telephone: b � S Form LA -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Mr. Rudolph Petrucelli, PE Petrucelli Engineering 392 Columbus Avenue Valhalla, New York 10595 Dear Mr. Petrucelli: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 February 24, 2006 Re: ROBERT J. BONDI County Executive. Palmieri SSTS 11 Danand Lane (T) Patterson, TM# 25 -1 -45 This Department has received and reviewed the revised plan for the above referenced project and the following comments are offered. 1 Since modifications to the existing SSTS are being proposed thus requiring the issuance of a construction permit, the following items are required to complete your submission: a. Application fee of $300.00 (2005 permit fee less $100.00 addition fee previously submitted) Application form PC -97 - _.. _.... _....._...___._ . _ .....__ _._..__...._.__..._ ...___. C. Soil data sheet ✓ d. Short EAF Xe. Letter of Authorization 2. Since the original soil testing is in excess of ten (10) years old, new percolation and deep test holes will be required in the proposed primary and reserve areas. Please contact this Department to schedule a mutually agreeable time for the testing by completing and submitting the request for soil testing form. 3. The design of the 100 percent reserve system trenches is to be shown on the plan. 4. Since it appears the SSTS reserve system will be situated within 100 feet of the Town wetland, a Wetland Permit, issued by the Town, is to be submitted to this office. In addition, you will need to inform Mr. Richard Williams, at the Patterson Town Hall, in writing, as to how, where and what measures you intend to utilize for the soil testing within the wetland buffer. Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (843) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 Upon completion -of the will- continue its -fev-16wi.- Kindly - advise 'u__s__ if there are any questions. Respectfully, Michael Director MJB:cj Cc: R. Williams, (T) Patterson 572.0 574.5 LEGEND v,►" I a WEDLAND, FLAG m I 1 I 574.0 T.W. 572.0 o I 16111 "BLACK h w. J / /BIRCH 12'L000ST 1 11 16"MAP LE )S FLA GGED B Y MAR Y JAEHArIG B'MAPLE } I I I } PER 28, 2005 14" TWIN I I I I \ © LOCUST I I I I 1 \ } I I I l \ \ \s74.s rw. LE I I I \ 57 w0 22"BRCH LACK I' 12"CHERRYII 116'MAPLEI I 1 BI 20'MAPLEI 110'MAPLE I 1 SEPTIC EXPANSION AREA �7Z' 57aoi 4• W. WL I \\ I \ \ \ \ \ \ \ \ \ \ \ 14-SLACK E$ 1 \ \\ \ \ \ \ \ \ \ \ ` 1 SII CH I z to V \ \ \\ \ \ \\ \1\ 1 I c TRENCH ONES _ \ \ \ Q \ 1 \ \ \ \ I I 1 \572.0 T . \\\ \} 1 1 1} 1 1 \\ I 9 Posy s I x y* 1 I F1.H603•� 5jp1 510.8 \ 111 1000 GA IIII I I 1 1` 1 1 }}\ 1 1 I zo'As SEPTIC TANK w �• \ I \ \� '�. I �� 1 I I I 11 I 1 11 \ 11 11 1} j \ \ 11 1� 116'MAPU $\ W j l �211ST u 1 I 4" PVC soR 35 \ `3 \I I I I I 1 120.E i UIsr I I I I ADDMONAL \\ \ 1\ \ 1 I, I I I 1 1 1 1 I I \\ I I I 750 ca I aal I I I \ es�1a"MAPLE SEPTIC TANK A 1 \\ I I I I i\ I I I vY I I Irl �I- J-17 .6 S>N 0,0 r.W LL 809.7 T.BW. i i ` / / // / / \ 1 22( '1 1 I Z T gpp,g 5 T.W. I I \ \ \ \ \1 11 I T 81 0.J 1 O 609.1 807.&WI I \ , e1o.0 60 • I F}�SEMENT N52100 �✓ 609.7 I \ �. PLAN SCALE: 1 " =M -0" i t ,i. i DATA 1. MUNICIPALITY: TO", OF PATTERSON T A V M AP DESIGNATION: 18 BLOCK 3, LOT 2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIA"L SITE INSPECTION FORM SECTION A. GENERAL INFORMATIO Name of Project (T ) Gam( County. c�"r Site Location zllti 10. Appearance of soil: ; Sand 0 Gravel Loam F__J Clay a Hardpan Q Mixture 11. Observed from: Borings Bank cut r"�l Backhoe excavations 12. Soil borings /excavations observed by &VA on"(% 13. Depth to groundwater A-52, i on 14. Depth to mottling on Building construction begun Extent Is property within NYC Watershed .................. Yes � No SECTION.B. TOPOGRAPHY (Please check all appropriate boxes) 1. 0 Hilly F Rolling [7 Steep slope Gentle slope a Flat 2. a Evidence of wetlands a Low area subjec to flooding � Bodies of water aDrainage ditches � Rock outcrops 3. Property lines or corners evident ....................... ............................... .. Yes � No . 4. Do water courses exist on or adjoin the property? .:.......................... � Yes � No 5. Will these affect the design of the sewage system facilities ?............ a Yes. � No 6. Do watershed regulations apply in this development ? ....................... ®Yes � No 7 Will extensive grading be necessary? ................................................ a Yes � No 8. Will extensive fill be necessary for SSTS? ....... � Yes � No 9. Do filled areas exist within the SSTS area? ........ ............................... � Yes � No . If yes, what is the condition of the fill? a SECTION C. SOIL OBSERVATIONS 15. Are test holes representative of primary & reserve areas ...... ............................... F"� Yes F__] No 16. Soil percolation tests made by 17. Soil percolation tests witnessed by SECTION D (on back) on on Form ST -1 a 15. Are test holes representative of primary & reserve areas ...... ............................... F"� Yes F__] No 16. Soil percolation tests made by 17. Soil percolation tests witnessed by SECTION D (on back) on on Form ST -1 a 4 SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? F--] Yes � No 19. Will groundwater or surface drainage require special consideration? ....................... *.F--] Yes 4 No 20. Will gullies, ditches, etc., be filled and watercourses be relocated? ......................... F-I Yes E]j] 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--J Yes F--J No Inspection data 22. Do adjacent wells and/or sewage systems exist? ..... i ................................................ Yes F--J No _J CP 23. Additional comments A 24. Site observer/inspector and title 25. Date(s) of observation(s)inspection(s) TEST PIT PROFILES Hole # # Hole Lot ff- Hole# Lot# -J-Lot Depth to water 7V Depth to water -'- Depth to water Depth to mottling �Z Depth to mottling Depth to mottling Depth io-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 5.01 5.0 J 5.0 6.01 6.0 6.0 7.0 7.0 4 . -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 DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address PPn1,4,v;� r Located at (Street) Tax Map Block Lot (indicate nearest cross street) Municipality Watershed 4�45 7 SOIL PERCOLATION TEST DATA Date of Pre - soaking -5- 3o O 6 Date of Percolation Test LZ 31 O I3epth :.t : >:From NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 3 i��� z -io; 3� /o 0 a-v - z 3 % 3% 3.0 5 1 2 3 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 PLANNING DEPARTMENT .P.O. Box 470 1142 Route 311 Patterson, NY 12563 Melissa Brichta Secretary Richard Williams Town Planner Telephone (845) 878 -6500 FAX (845) 878 -2019 March 31; 2006 Mr. Richard Palmieri 11 Danand Lane Patterson, NY 12563 TOWN OF PATTERSON PLANNING & ZONING OFFICE ZONING BOARD OF APPEALS Howard Buzzutto, Chairman Mary Bodor Marianne Burdick Martin Posner Lars Olenius. PLANNING BOARD Herb Schech, Chairman Michael Montesano David Pierro Shawn Rogan Maria Di Salvo Re: SSTS Soil Testing Tax Map No. 25. -1 -45 Proposed Septic Addition prepared by Petruccelli Engineering last revised 3/25/06 Dear Mr. Palmieri: I have received your request for soil testing to evaluate a proposed expansion of your existing septic system, and have discussed your proposal with Ted Kozlowski, Patterson ECI. The soil testing proposes the excavation of two test pits and two percolation test holes. From the,plans submitted it appears that the soil testing proposed will be conducted entirely outside of the ' 100' controlled area of the wetland, and so is not regulated or prohibited by the Town. I would recommend that the test pits are refilled _within 24- hours, as per the Town's Code, and the disturbed areas . appropriately stabilized with seed and mulch. You should be aware that the plans indicate that a portion of the septic system expansion area is proposed to be located in the 100' controlled area of the wetland regulated by the Town ofPatterson. This potential disturbance will require the issuance of a wetland/watercourse permit by the Town of Patterson Planning Board. Please feel free to contact my Office if you have any further questions. Sincerely yours, v Richard Williams "TOWN PLANNER PETRUCCELLI ENGINEERING Mr. Robert Morris, P.E. Senior Public Health Engineer Department of Health 1 Geneva Road Brewster, New York 10509 RE: Proposed addition - Palmieri 11 Danand Lane (T) Patterson, T.M. 25 -1 -45 Dear Mr. Morris: RUDOLPH C. PETRUCCELLI, P.E. Principal December 6, 2005 This is in response to your letter of September 14, 2005 to Mr. Richard Palmieri. On September 28, 2005, Mary Jaehnig, certified soil scientist, made a soil survey and wetland delineation of the above property and submitted a report to us on November 11, 2005. On November 2, 2005, Bunney Associates Surveyors field located the wetlands flags. The attached drawing was revised showing the latest wetland line and the one hundred foot buffer setback. In addition, we have revised the drawing to show an additional 100 linear feet of absorption trench, six (6) feet east of the existing trench. You will note that the addition of the 100 feet of fields falls outside the 100 foot wetland buffer, and within a slope area of 10 to 14 %, well within the 15% requirement. We are therefore, requesting a waiver of installing additional fill within the buffer area, to accomodate the expansion area, at this time. Access to the east end of the property is available along an easement on the south side of the property if expansion of the system, in the future is necessary. At that time, a wetlands permit will be pursued from the town of Patterson. At this time, since no encroachment will occur in the wetland buffer, if the waiver is granted, no permit is required. Thank you for your consideration in this matter. Very truly4ours, 7 udolph CE I EERIN . P TRUCCELLI, P.E., F.NYSPE Principal cc. R.Palmieri 392 COLUMBUS AVENUE ® VALHALLA, NEW YORK 10595 PHONE 914 948 -3629 ® FAX 914 948 -6903 Member National Society of Professional Engineers PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES STRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # P— (� ()(0 Located at I 1 1) k^ Av,-A Lek Town or Village Subdivision name 0 0 i ' I a 2 Subd. Lot # (D Tax Map 1 Block 3 Lot Z. Date Subdivision Approved Renewal Revision_ Owner /Applicant Name 1 C.h et r Ci 4°t1 M; 2tr i Date of Previous Approval 91q19 0 Mailing Address I I A- Wr-►, 0 L yt- j k— � ke.fSorJ , 1s1 Y Zip 12.5 63 Amount of Fee Enclosed Building Type T:--1 Pfmt- 'Dwdli� Lot AreaQ &6 p0o. of Bedrooms y Design Flow GPD__�LdO Fill Section Only Depth Volume CX►S+ Separate Sewerage System to consist of 100 0 U n To Qer464 gallon septic tank and q JJ ; �-d j 4 L (750 GwL . 5c.AG "rmwK) Pmd 10 0LF--T - L4'1 WI0e- p bS0w -PIJQ TYthGh Other Requirements: � y r� 0 1' 3 ytN � (r(y1Vt U W rrZ 6- (AA ins Pule (po,S �t, 01 1 IY To be constructed by Address Water Supply: �_ Public Supply From OQ P� r�q Address or: Private Supply Drilled by Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guar rnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good o k part of said sewage treatment system during the period of two (2) years immediately folio ' g the P �s�� approval of the Certificate of Construction Compliance of the original system or any r rs the w Signed: , , w P.E. V R.A. Date h 0S" Address i ��- L c. S— License # —?j)6 APPROVED FOR CONSTRUMM s approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only. Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health September 14, 2005 Richard Palmieri 11 Danand Lane Patterson, NY 12563 Dear Mr. Palmieri: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Proposed Addition - Palmieri 11 Danand Lane (T) Patterson, T.M. 25.4-45 ROBERT J. BONDI County Executive Review of plans and other supporting document submitted at this time relative to the above mentioned project has been completed. Comments are offered as follows: 1. The minimum of 2 feet of fill is required for the entire SSTS. v/2. All water courses, streams, water bodies and wetlands within 200 feet of the property lines are to be shown. ✓3...Current code. require_ments_state.that the maximum slope an SSTS_can be proposed_.___ on, is 15 %. .>k 4. A wetland permit or a letter from the Town of Patterson stating that a wetland permit is not required must be submitted. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:cw Sin re , Robert Morris P.E. Senior Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health September 8, 2005 Richard Palmieri 11 Danand Lane Patterson, NY 12563 Dear Mr. Palmieri: .DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Proposed Addition - Palmieri 11 Danand Lane (T) Patterson, T.M. 25: -1 -45 ROBERT J. BONDI County Executive Review of plans and other supporting document submitted at this time relative to the above mentioned project has been completed. Comments are offered as follows: /1. The plans submitted show five potential bedrooms. The original Health Department approval was for a three bedroom house. The bonus room and exercise room are considered potential bedrooms. !/2__.Plans.have..b.e.en returned. Two sets -.of plans. are.to.be_labeled as existing and two sets of plans are to be labeled as proposed. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM: cw Si y, Robert Morris P.E. Senior Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health ROBERT J. BONDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 R4�� `) �,. �1t? ADDITION APPLICATION RESIDENTIAL ONLY STREET 1 L TOWN DSO J_TAX MAP #_ -t G NAME a i C I J%C Prk lhlic-V! PHONE DNS -1 � - -I qo PCHD# MAILING ADDRESS (� n- \a DESCRIPTION OF ADDITION � R-0 0 vn 0 JC.✓ 2 5 a — I —45 N �U( 6e8roovn- NUMBER OF EXISTING BEDROOMS 3 PROPOSED # OF BEDROOMS (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) "Any addition which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, -NY- 1.0509, -P-- -hone: (845) 278 - 6130:.:....._- 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) 3. Two sets of proposed floor plan (drawn to scale — with name, street and tax map #) *Non - professional sketches are acceptable 4. Copy of survey showing well and septic locations to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS 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 y V ' ' - SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509' PUTNAM COUNTY DEPT. OF HEALTH 1 GENEVA ROAD BREWSTER, NY 10509 To Whom It May Concern: n Re: Residence ROBERT J. BONDI County Executive TAX MAP# TOWN YEAR BUILT According to records maintained by the Town, the above noted dwelling, IS IN COMPLIANCE WITH TOWN CODE. IS NOT IN COMPLIANCE WITH TOWN CODE LEGAL BEDROOM COUNT IS This information has been obtained from: CERTIFICATE OF OCCUPANCY: OTHER: Buttdmg pspeMm , �-s Date CERTIFICATE OF OCCUPANCY lm Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health May 10, 2005 Petrucelli Engineering Rudolph Petrucelli 392 Columbus Avenue Valhalla, NY 10595 Dear Mr. Petrucelli: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive Re: Proposed Addition - Palmieri 11 Danand Lane (T) Patterson, T.M. #25. -1 -45 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: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. - - -- !j -1. - One- hundred:percent expansion area is to be shown. -- Hatched - lines -are acceptable for expansion.- -- - -- trenches. 2. The minimum of 2 feet of fill is to be provided for the expansion area. Proposed contours are to be shown. Title block is to note tax map number. ,/ 4. The minimum of a 1250 gallon septic tank is required for a 4 bedroom house. Tanks can be proposed in series. ✓5. Putnam County Department of Health allows trenches to be proposed 6 feet on center. 6. Fill must extend 10 feet horizontally past the edge of any trench and then slope 3:1 to grade. Upon receipt of a submission, revised to reflect the above comments, this application will considered furthered.. RM:cw Ve 1 YOU , Robert Morris, PE Senior Public Health Engineer Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT 1. BONDI County Executive February 16, 2005 Richard Palmieri ` t 11 D zmond Lane Patterson, NTY 12563 Re: Addition — Palmieri, 11_ Demond Lane (T)Patterson, TM #25. -1 -45 Dear Mr. Palmieri: I have received and reviewed the plans for the proposed addition at the above mentioned residence. The plans indicate that the proposed addition will consist of the following: A fourth bedroom constructed over the garage. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons: 1. The septic system was constructed for a three bedroom residence. 2. The legal bedroom count for the dwelling is three. The potential bedroom count of your - proposed addition is our. 3. The addition of a potential bedroom requires this Department's approval of a revised septic system plan from a professional engineer. Please have a professional engineer or registered architect design a sub - surface sewage treatment system meeting present code requirements. If you have any questions, please contact me at your convenience. Very truly ufs, William Hedges WH:lm Senior Public Health Sanitarian 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 BRUCE R Fni,Lsy Public Hacich Direc :cr DLPARTNEN I OF SALT. Division of En irennsental Health Semces 6 Genava Road Brewster, New York 10509 Tel. -�9:4) 279 - 6130 Fax (914) :79 - 7921 Z PR- ODOSE-1) A Mt'i'tON APPLIC AT_ION {SIPFIv'TLAL STREET � TO IN TX MA.P # vZS n '� NANIM �� PHONNE � � PCxn r _ IVLAMDie ADDRESS DESC.RIPTiON OF ADDITION �t,�£8ER OF E)aSTTLN G BEDR00:1NL�c,I 'PROPOSED # OF - BEDR00yLS_�_ (FROM CERT. OF ✓CCUTIA►�Cf dR CERTiF(CaTIc��; rr "c2OM &L'1L�LNQ Iti5 °ECTOR) *.Any addition Nvhich is cow dered a bed.ioom tequires formal approval of plans (Construction Permit) prepared by a -r,:f_ssiwal Engineer or Registered Architect in accordance with applicab:e sections of t1l1e Puman Co -zity Sanitsry Code. Please subnit tihis fcrm and he fo :lowing to Putaam County Health L -.pt.; 4 Geneva Rd., Brcwst.r, \Y 10509, Phone 211 MI 30. 1.- Certified-,check or. money order for 51OO.C�� Sketches of existing floor p,an (drawn to scale, all living, area including basement) " Non-professional sketches air accepLble 3.'Two .sets of proposed floor plan (drawn to scale, with name, street, and tw. r:-,.-.p T) * Non- professionai sketches are acceptable 4. Copy of vincy s :owing well and septic location, to the best of vour knowled;e. Inc"ude date of installation if im_o ' .vn: Label all wets and septic systems within 300 feet of the property Up. e. Contact this office wi-h any questions. 5. Copy of Cerc. of Occupancy from Town or Certificadot:57 -= Building Dept. with legal. bedroom count of dwe1lir.c, OFFICE Coinme=s r:e 9g, fr .' DEPARTMENT OF HEALTH DKI ;ion . Of Environmental Health Services 4 Ceneva' Road, Brewster, New York 10509 (914) 278 -6130 Putnt".. County Dept. of Health 4 Geneva Road Bxwstcr, NY 10509 Re: Rcsid�nc� Tax Map, Tom Geralt.men: ! E R._FOLE'�, q-c_ Aeting PUNIC ?40alth Dl.ettor According ►o records maintained by the To% ry the above noted d\ elling is IS NOT :J �l in coropliance��,ith l o��,;. codes �d tree total number of bedreorn, on record This in&b=ation has been obtained froir.: CERTIFICATE OF OCCUPANCY: , SSES50RS RECORD: Building iris; ector PAUL P. PIAZZA Building Inspector TOWN OF PATTERSON CODE ENFORCEMENT OFFICE - - PUTNAM COUNTY — ..- - - -- P.O. Box 470 Patterson, New York 12563 TOWN OF PATTERSON Telephone (845) 878 - 6319 PUTNAM COUNTY Fax (845) 878 - 2019 PATTERSON, NEW YORK 12563 NOTICE OF VIOLATION TO: Richard Palmieri DATE: December 1, 2004 11 Danand Lane Patterson, New York 12563 LOCATION 11 Danand Lane TM - 25. -1 -45 1. YOU ARE HEREBY NOTIFIED THAT YOU HAVE BEEN FOUND TO BE IN VIOLATION OF THE TOWN CODE OF THE TOWN OF PATTERSON, NEW YORK. SECTION: §154 -126A Certificate of Occupancy required. Original Certificate of OccunancYis for a 3 bedrooms. Property has _ 4 bedrooms. (description of violation) VIOLATION OBSERVED BY THE BUILDING INSPECTOR December 1, 2004 2. THE FOLLOWING CORRECTIVE MEASURES SHOULD BE TAKEN NO LATER THAN 30 DAYS FROM THE DATE HEREOF. 3. FOR THE PURPOSE OF APPLYING THE PENALTIES DESCRIBED IN SECTION � 154 -131 OF THE. TOWN CODE, YOUR FIRST VIOLATION SHALL BE DEEMED TO HAVE OCCURRED AS OF December 1, 2004 4. THIS OFFICE IS READY TO EXPLAIN THE CAUSE OF VIOLATION IN DETAIL. PLEASE NOTIFY THIS OFFICE OF THE TYPE AND TIME OF CORRECTIVE ACTION. cc: TOWN BOARD PLANNING BOARD ZONING BOARD OF APPEALS TOWN ATTORNEY TOWN PLANNER �FZN tPA�PPI�AZZA, BUILDING INSPECTOR � e_ VOGLER BROTHERS i9PTIC TANK SERVIcK voct[r Cleaned - Repaired - Installed 39 North St., Katonah, N.Y. 10536 232 -5535 /� Date - 20C� n Located & dug up ser Pumped septic tank Snaked & cleaned line Erneraent-v Phew York Total e Note: All bills due when received ... Interest of oei month charoed on a / / cast due accounts VOGLER BROTHERS SEPTIC TANK sERVICK Cleaned - Repaired - Installed �' 39 North St., Katonah. N.Y. 10536 232 -5535 Da e L L.� 20 Mr. Located & dug up septic tank $ Pumped septic tank t Snaked & cleaned line Emergency Service New York State Tax l -� Total due S . .. I Note: All bills due when received... Interest of 1 112% pei month charged on all past due accounts ''r EVANS SEPTIC TANK SERVICE, INC. P.O. BOX #505 • MAHOPAC FALLS, N.Y. 10542 (845) 628-0166 DATE INVOICE NO. P.O. NO. TANK DEPTH FIELDS SEPTIC TANK PORT-A-POTTY PORT-A-PO-7Y NOT RESPONSIBLE FOR DRIVEWAYS SUBTOTAL TAX TOTAL m EVANS SEPTIC TANK SERVICE, INC P.O. BOX #505 • MAHOPAC FALLS,, N.Y. 10542 (914) 628-0166 DATE, INVOICE NO. P.O. NO. TANK DEPTH FIELDS SEPTIC TANK PORT-A-PO-7Y NOT RESPONSIBLE FOR DRIVEWAYS s u BTOTAL- TAX TOTAL SEPTIC TANK SEWER SLUDGE GALLONS HOURLY RATE OTHER SEWER SLUDGE GALLONS HOURLY RATE OTHER :r j . j' SUBTOTAL NOT RESPONSIBLE FOR DAMAGE TAX TO DRIVEWAYS. TOTAL Ll ��. ✓ ��; ' SEPTIC TANK SEWER SLUDGE GALLONS HOURLY RATE OTHER :r j . j' Ll j• f i t Cf �' , / 3 SUBTOTAL TAX NOT RESPONSIBLE FOR DAMAGE TO DRIVEWAYS. TOTAL PUMMCOUNTIAIMEMURAIM Uddt ngibu iumo mid Bm� li1 ler+iom CMC UML N.T. III =CZR=IDhgV W pew* �. C011121MC10!(DiY■! M /NwAM. 0loYL 31p A7 a 110 Two a VVkV- siaawm Nib ' .r t° . r r l $ Melia .... — .' oa�edAppilomt leer :;w; =:a:. _ N..e.�l.�.� � •�s."l�ow � .... Q p Deb of Previous �( j resiii� Yiidee r V 0 W rry 1�•C? Y�1 .�- :�a+� � nr o++rs Tip. WCOYD C= `�1►ii� bet Am © +1 IM s.t&S, o b D,,* aLvd..e NgstiMe eI y++r■ Design Flow G P ®_ lG_ P� NNNeaftar ir'Necililrrd \Yrea PI! V aM1gMMd ,womb aweedse bmm it ae."d .J — n." s "w gW FIVC u in s mr.ew b ' Adilnrr wfwe SV*, ?SC %&M. sm* Feels G•Vp'1-+ L tQ fl '0 *c ,►diiee,; en s pqglb Dd W by address 1 fepr - "that 1 am wholly and completely responsible for the design and location of the proposed system(s1i 11 that these eta .__Ow di sel . wn above described will be constructed as shown on the approved amendment there to and In accordance with the standards, rules a regu o County ONMrtment of min ft. and that on colhple1 thereof a °Cartifieate of Construction Compllanp^ satisfactory to the Commissioner of MNKhwill M VAWAW to ter Department, and a written guarantee will M fumbhedIIIN owner, his sucesssorg, heirs Or assigns by the WNW. that aid builder will prce N good operetMlg cowdRlOh any part o< pld swreee dlSPOOl syttern d)rring the period of ,two (!1 yeera knmedlately followlp thedatii of the laau- e1N of the eppreeal of the CSVMk b of Comtfuctien -CGMPlianoa of the original system or repairs theretol 2) that the drilled well 4 afted abase ON N WAtdd ea MINOR on the ppreved pin ale that NW Well will be Installed ;k1 accordance wd ter 080dar4 r)llss and rep -UM rli Of the Putnam Cmihly Do lot VAMIL Dote ( ..; Signed License No APPROVED FOR CONSTRUCTION: This approval expires two years from the date Issued unless construction of the building has been undertaken and is rwocable for tam or may be ensend , or modified when considered neceaY►y by the Commissioner of HNNIL 'Any Change or alteration of construction abuk" Mw permit. Approved for diwasel of domestic Unitary water sappy only. Rev. Title p 1088e7 EVANS SEPTIC TAN, K' SERVICE,, INC. P.O. BOX #505 • MAHOPAC FALLS, N.Y. 10642 (914) 628 -0166 TANK SEPTIC TANK SEWER SLUDGE GALLONS HOURLY RATE OTHER - LZ �.1 �r i SUBTOTAL Payment is due in fug within 30 days. TAX Accounts not paid by due date are subject to a no interest charge per month on the unpaid balance. TOTAL Collection fees will be at the customers expense. -- r. � C' i EVANS SEPTIC TANK SERVICE, INC. P.O. BOX #505 • MAHOPAC FALLS, N.Y. 10542 (914) 628 -0166 TANK DEPTH DATE INVOICE NO. P.O. NO. FIELDS SEPTIC TANK SEWER SLUDGE GALLONS HOURLY RATE OTHER LZ �.1 i SUBTOTAL Payment is due in full within 30 days. TAX Accounts not paid by due date are subject to a 2% Interest charge per month on the unpaid balance.. TOTAL Collection fees will be et the customers expense. � -.1 ; in CERTIFICATE OF OCCUPANCY AND COMPLIANCE zowiX�X� Qx No 1679 19 93 . DATE ISSUED January 22, THIS IS TO CERTIFY THAT Richard Palmieri ON THE PROPERTY OF Same LOCATED ON Denand Lane HAS BEEN SUBSTANTIALLY CONSTRUCTED TO THE REQUIREMENTS OF THE BUILDING CODE, ZONING ORDINANCE AND LOCAL LAWS OF THE TOWN OF PATTERSON, NEW YORK AND MAY BE OCCUPIED AND USED AS Single Family Dwelling with Wood Deck_ Building Permit Dated J. i8 -9 ?• Permit No... ?7. ... Application No. ...... Mh........... SECTION .......?:8 .............. BLOCK ........ A............. LqT�. ....6.........CIs. -er �5. -1 -45) FEE $ 15.00 BUILDING INSPECTOR y -a: w APPENDIX I_ PUMAM COUNTY DEPARTMENT OF HEALTH DIVISION.OF- ENVIRObZjENrAL HEALTH SERVICES Owner or Purchaser of Building Section Block Lot Building Constructed by Location - Street Municipality .Building Type g Tax Map Number e�ua.;L ti=t 0A ex_- Subdivision Name Subdivision Loot # GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, wor)mianship, material, construction and.drainage of the sewage disposal system serving the above described property, and that it 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.successorst heirs or, assigns, to place in good operating condition any part of said system constructed by me which'-fails 'to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage disposal 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 Director of the Division of Environmental Health Services 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 this -;5 ¢b . day of tW,. 19_91, Signature Title General Contractor (Own - Signature Corporation Name (if Corp.) Address rev. 9/85 Mk Corporation Name (if Corp.) Address . 16 el� AREA c_ DS area F,'Ir� c -�- -mac=- -�•� Cam__ �� °"'� �-/ °� CwLNJER z T E, mrCL"e!E p? ac_ = ,2t E:-=- -_C�_. ! 1 _ Dc= L: C= C a vial i- t_ =c c = - =- :- r• - -C- -LCD= c: c 1. S_2° C- r= cL Z. C:`v ems-- cl E. CCiC I w=- - = = = —= by EGG =I E5 = r .ct__ - - c- zar c. �e _ N=_.Ccr C =Q WaL h All C_ AL-'. yiL•.=c flu n With de c LC- e_ C= —;wiz c-_ ; - i n= all— C; ,,l C- _ ^_ ciscl'=Zce E °vay f=an Ems- area C=Ct ' -_C: =mo t= I I I _ -- i_ c= - c-, ETcc == 2_I ��ie_' C_ PG��T7 1 �c� ' r_ct `2.Z� C---- —2.Z e_ DO ft_ f_:..:._wat- CcL== i:Ya- tG_rC'<_ zz !,ace C___CLt_ wil -u l� C_ E _ — Z r_! -,GT=l1 1 :i�G_— F 1 i CL. -__ G. ►c: - E-= 'JG_.0 1 - t_ =c == ' c__c_ CN �• j'i� cam= �_ 'r.c - =- _�._= ti ==c �= � -- I I I �.P/ E:-=- -_C�_. ! 1 _ Dc= L: C= C a vial i- t_ =c c = - =- :- r• - -C- -LCD= c: c 1. S_2° C- r= cL Z. C:`v ems-- cl E. CCiC I w=- - = = = —= by EGG =I E5 = r .ct__ - - c- zar c. �e _ N=_.Ccr C =Q WaL h All C_ AL-'. yiL•.=c flu n With de c LC- e_ C= —;wiz c-_ ; - i n= all— C; ,,l C- _ ^_ ciscl'=Zce E °vay f=an Ems- area C=Ct ' -_C: =mo t= I I I _ -- i_ c= - c-, ETcc == John M. Sermons, M.D. lvlkw •• IK a _E' ;41ZI51 m DIVISION OF ENVIRONMENTAL HEALTH SERVICES Deputy Camni.ssioner of Health - FIELD ACTIVITY REPORT - Sheet of P INSPDLTION NAME �.�~"� r ► v� _ Orig. Routine �� � � .,�.� �:�+' �_, ;,..�..�,� wig. Complain ADDRESS _ g. Request No. Street � IM No. MAILING ADDRESS P.O. Box Post Office Zip Code WWDIIAN• : • i PERSON IN CHARGE _ OR INTERVIEWED Name and Title DATE ' TYPE FACILITY TIME AR VED TIME LEFT `- , FINDINGS: Compliance Complaint Carp Final Group Illness Construction Reinspection Field, Sampling only Field Conference Explain INSPECTOR: Signature and Title Ap PERSON IN CHARGE OR INI�RVIEWID: I acknowledge this Field Activity Report. SIGNATURE: 6/86 TITLE: TELEPHONE: t- 4. e1ll CAO 5 PROPOSED SEPTIC SYSTEM PROFILE SCALE. 1 " 20' -O" HORIZ. & VERT. ' LEGEND AL WEDLAND FLAG.. _ . WL #3 12- LOCUST e -W LE REMOVE GRAVEL © LOCUSN t ON PLAY AREA LOCUST WERE NECESSARY I 12WLE 1 I \ \ ` 12-CHERRY ` 118 "MAPL PROP, HAYakn AND SILT FENCING (TYP) \ \ \ \ \ \ ) EXISTING TRENCH LINES �1P., Lo.l. \ \ \ ,0.0 TO Shy 010 PLUG SEPTIC TANK HOLE AS NECESSARY EXIST. 1000 GAL SEPTIC TANK (TO REMAIN) Off' N N PROP. 4' PVC PIPE _ 0 1.0% MIN. PROP. ADDITIONAL 750 GAL--/ SEPTIC TANK POINT O 1 Z D �w T V � Z M 9� Q G °° B/C 84 N52'00'W S 6os 6 1 PIPE �01.OS MMIN aw. 7 8t00 T.WX So;. D.W. •/ I I NOTE. INFORMATION REGARDING THE EXISTING SYSTEM WAS OBTAINED FROMAS- BUILTPLANONFILE, PREPARED ONDECEMBER 8, IM qW. t I ` EASEMEW I T NEW TRENCH LINE ' 1 I' I I I I I I I I I I �I ! PLA SCALI NOTE: WEDLANDS FLAGGED BY AJ SEPTEMBER 28, 2005 1 '4 u•: �� _ �.._. ��1 iMtblYwli ltinit /, Iii or - r A Hr67 / V a 11,Yw Pew �'u.n�. v f� 1 rar�rr/ Al1iM s 1•nOrMSwC;ttNt 1 aT` WAONy.•alld conplKaty nmwngbN fa tM AfsiOn old location Of tM proflOMd II 1: I that the ' - ata di fe1: em . l' aOO�e dertxiMO. wiN;tla oolNtrucNO as'tlwwn oii „tM afMrewo aAonOnwnt tMre to antl in iccoiAinp with tM stOndgC ruNi arm rMu _ The 0 cowrty asp wtnteet_ of 44lieRIN. swWAM t of Construetion.Compltanp'• otidaQory to the Commissioner of 1�Itbwill`: wiNnlb/ to tfN peN�tnwnt: aM a wrlttiw Wararltaa wiu; t» turn , oemar. Mi; fucpfao►s, ben or asMns'.bY the .OutWo. that s10 b4imer will H OtiOa . M pOd ,Ma►atMN'. oowitiiM' !nr hart ef• fU/ 'NM!Mr dilpeYP,;y .. i!M tM fI frfo0 ( =1 YMis �IMNtNy'.foNOwfM .tM d�b;of tM bRt- i ° aea of ,� O"W” 1 N the :Catmieate of Conshudion ConiplNna o1 M NMI gStarn:, rsgairf;t i 2j tfiat the &MW vriljl Oetvitler ievo MN M IOCatN M f1101M11 M tllt ask 1 wNl wiil•M in tad np: t ' .tR an0 '►AUWWO et toe -Put In - �, u ir Dew . Z SNMd F E. _ RJ►. �N►OS �IL,Vr'� - ` License NQ 71 IO-1 N A/MOVEO FOR CONSTRUCTIOffi Thb a00*081 expire two "ers from the dst0'- lalued .unlett construction of tbi -tipild n'@ he$ been ti ' 4 am acid iS Mietati.M4or cum ar mey tla amoi/ r or nbalilid wtiai:eonSWi► O na�►y Oy. tM C"O!I ieeer" of Pismll Aclianji or �Raritidn of construction t wSuMM • Mw prnip. A /Oa ditp0Y1 Of donwflk N11RMr Mw�l.to .water .futtOM OMY �� e r g� 10/88 wie,�_�L/G r Tur ks �+.w«yw,w,.,,.., •.,. -Nn: :4 „F'"3"Tr +y'.s?' s.^ ..�a� ^,."'- -•^.- +r*,:, ., ,..,r�' '",-�. t^'s” � .'.:!$.. � .>.. n. �WTN/� c�UNt �ePrt = 012 0 4 d K X110 OId Rt 6 Ctr, < Phone 914 220310 Carmel, New York 1051 k �i Date / v pU 19 ,� -� � � • `" '` new 8@ FRecem6d rt gx� N T,he S -Of'- IV PEP r r/f '{ Y ri ti. Cash: Ow;Check , � � [VI � Gredat Card- .. „ gY PETRUCCELLI 392 COLUMI3US AVINO F VALI IM.LA, NF.W YOI(K Ill �'►5 � RUUOLhII C. 1'EIkU(:C[LLI, i'f TRANSMITTAL DATE: TO: BILL HEDGES PROJECT- PALMEIRI AS -BUILT PUTNAM COUNTY HEALTH DENAND LANE DEPARTMENT PATTERSON,N.Y. WE ARE SENDING YOU TODAY BY per_ THE FOLLOWING MATERIAL.FOR :TIIE ACTION INDICATED. (3)THREE COPIES OF.THE PLANS FOR THE.ABOVE MENTIONED CERTIFICATE 'OF CONSTRUCTION COMPLIANCE (3) THREE COPIES OF THE GUARANTEE OF SUBSURFACE SEWAGE DISPOASL SYSTEM . THANK YOU FOR YOUR COOPERATION IN THIS MATTER,IF YOU NEED ANYTIIING ELSE OR HAVE ANY QUESTIONS PLEASE CALL OUR OFFICE AT (914)948 -3629 ATTACKED COPY, IF CHECKED. BY. RUDOL['ll C. ['E'I'[IUC(, I:. n. n L'TRUCCELLI - •- 392 COLUMBUS AVEMM ENGI NEEDING •� - •• - VnLHnLLn, NEW MURK IU595 RUDOLPH C. PEI RUCCELLI, PE IVED APR `� J 1992- /J 'TRANSMITTAL .. ,PUTNAM COUNT`( DEPT, OF HP! ALTF1 Z� q2 ' Date: ' To: Q. '_1 LL P ro j ect ibc(. Pal (s�rl�i S�PT]C� _ We are sending-you today by PSI L . the following material for action indicated.- 0 C�J� ���� •aF � __ 1? -t-'"Y t S�T> : ��i. �5 � 7� - Dc"C�301C � ..1��� -� - .. lE LIM kw* IN �� � b+►>� �'f� � �'� �'�� C 6�(_� I A) q Ab -362ct Please sign and return -By: —I, Sl�lo� attached copy, if checked. Lo C P-•-T- I CD r---j c, 59' z" 971 412; 1001 -QU Ml-o PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ ___PROPOSAL FOR SEWAGE .DISPOSAL SYSTEM REPAIR NO Internal Use Only ❑ Repair Permit issued in last 5 years ❑ Not in Watershed ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. , Delegated ❑ ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland / ❑ Joint Review SITE LOCATION 0Dg11 011n01 �((� t' TM # Q �. OWNER'S NAME C yl 9 Q J M i L'/ + PHONE # MAILING ADDRESS V101 APPLICANT Name & Relationship (i.e.,kwner, tenant,, contractor) DATE FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER �aVa4)V_k 4 _ PHONE # ADDRESS er �jl�� J � REGISTRATION /LICENSE # 1.150 pG Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed trenches) NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location and proposed pump systems will require submittal of proposal from licensed professional engineer or registered architect. -,,) 1 �— - r -4-- / - r-_�- / -4- I, as owner, or report a nt of owner agree to the conditions stated on this form SIGNATU TITLF�J(�tits� DATE O Proposal approved with the following conditions: 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name b. Site Street Name, Town and Tax Map number c. Location of installed components tied to two fixed points d. System description (e.g., 1250 gal. Concrete septic tank, etc.) e. Installers' name and phone number 3. System repair to be performed in accordance with the above DroDOsal and conditions. Inspector's COPIES: PC -RP 99ML Rev. 8/05 }� Proposal Denied 41 w v g,!Title /j _�_ Date (PCHD); Yellow o n 1); Pink (Installer), Orange (Applicant) { Z` \ I AR, 1 TRENCH LINES POST AHED L 6 \ FL. 603• `a z .6 1000 �N 1000 GAL. 5 SEPTIC TANK 3 o \a ED != i 4 PVC SDR 35 I ADDITIONAL �\ \ ` \ 11 I 1 { ,I "t. kkt 750 GAL. I SEPTIC TANK \ ` II 4;11 i I e 0.3 rw. \ r, I �.w. I rl X1-1 _176 s o.3 a w. , 6,1 �? I L1 T- 60;8 w'Z 7 a : ! I I to % N 7 Fj1� 6 T.W. I , 609 609.1 607.5 8•W i 610.3 W 610.0 1 EI ASEs ' 0 0 °00N52 609. # qci c T 3 , t s , 1 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES Q PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR YES NO Internal Use Only �.. ❑ Repair Permit issued in last 5 years ❑ Not in Watershed ❑ I Repair within Boyd's Comers, W. Branch or Croton Falls Res. Delegated ❑ ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION 1%. n at,-,d d, (�� (�O% j�e -,� TM # ) %01 1 OWNER'S NAME K t C k 9 a 1 AI i er, PHONE # � ti MAILING ADDRESS J1 17n, ri a n APPLICANT tf o 5i° ln(,*,�iJt, '44"7" Name & Relationship (i.e.,bwner; tenant, co! ntractor) DATE FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER y�xAJ�2,(w a PHONE # �j � /S- �.-'15 7/ ADDRESS q L7 3�0' LA S: ,,, � y REGISTRATION /LICENSE # PG- Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed trenches) NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location and proposed pump systems will require submittal of proposal from licensed professional engineer or registered architect. � � i � !� 1, as owneZor epo rte a nt of owner agree to the conditions stated on this form SIGNATU TITLF,6 2-- ✓? DATE Proposal aooroved with the following conditions: 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name b. Site Street Name, Town and Tax Map number c. Location of installed components tied to two fixed points d. System description (e.g., 1250 gal. Concrete septic tank, etc.) e. Installers' name. and phone number 3. System repair to be performed in accordance with the above proposal and onditions. Pr posal Approved j� Proposal Denied Aj 4&/67 :Z Inspector's Sigrh'ite re T le Date COPIES: (PCHD); Yellow o n 1); Pink (Installer), Orange (Applicant) Of,-00 QQMI APR -13 -2006 16:18 INTERSTATE LUMBER 203 531 e050 P.05 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMff FOR SEWALGE TRFATMINT SYSTEM PERMIT # Located at _ !. _ a lii t4 ,k v Subdivision name Subd. Lot # Town or Village P4k: r r- A- s o ti Tax Map _j 8 Black Lot 2 Date Subdivision Approved Renewal Revision Owner/Applicant Naive _ L r_ rrnra- p - ��� h !_ Date of Previous Approval / Y� �'O Mailing Address 1 I` D A r4 ,+Hp L"e . P rt-a rL r. /l Jr • `[ Zip r 1sw3 Amount of Fee Enclosed' Building Type. Ej@:!t: C b WCvA,% , _ot .Area f?. U"o_ of Bedrooms L _ Design Flow GPD- (3 y o Fin Section Only _ Volume /� P �1t ON CO TED A- P Q f ..� �.M &yi r r) Separate Setveraae, ft faem to consist of I o o o gallon septic tank and A-D a ►i o #r' 0 Q F - 2.'i tr VSL t 0 £ k its-* I-,* ad l"0-L.J+ c-M Other Requirements:, To be constructed' by Address - � .Private Supply Drilled by Address I represent that fam" wholly and completely responsible for the design and location, bf the proposed systems) and that the ge V/,a Unomtmom described above will be constructed as shown on the approved amendment thereto and in accordance with die standards, rules and regulations of the Putrmm County*Deputsnent of Health, and that on completion thereof a "Certificate bf Construction Compliance" satisfactory to the Public Health Director will be submitted to the Depaetmem,,and a written guarantee will be famished the o'wnw. his successors, heirs or assigns by the builder, tbat said builder wilTplace n good operating condition any part of said sewage he kunt system during the period of two (2) years immediately follow the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any r it thereto. /� Signed: P.E. R.A. Date Address Coy -am * vj Awco g-we% " -Y lot" - License # APPROVED fOR- C0RMUCTION: This approval expires two yearn from the date issued unless coasmwdon of the sewW treatinent system-has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit:: Approved for discharge of domestic sanitary sewage only. By: Title: Date: White copy -`HD Pile; Yellow copy - Building Inspector, Pink copy - Owner; Orange copy - Design Professional Pam CP -97 Tnrni o