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00872
PUTNAM COUNTY DEPARTMENT OF HEALTH
- -'�" DIVISION OF- ENVIRONMENTAL HEALTH SERVICES
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR S E TREATMENT SYSTEM
PCHD CONSTRUCTION PERMIT # Zit -�I U
Located at l LkYD ^'Q 9jl VC Town omega . POr GZSo A l
Owner /Applicant Name Ki CZh N 14,40 OiQ- Tax Map _ Block _� Lot S6
Formerly
Subdivision Name Q LA l L P I DG c-
Subd. Lot #
Mailing Address f � D A LAA 12 LA 145- A4'raX,;b7, l- X ZiP i7 52r3
Date Construction Permit Issued by PCHD IZ�ZG /B
�+ G.�6! C•rncf"
Separate Sewerage System built by Address gyp, /_ L,,4
Consisting of 106 U Gallon Septic Tank and
,Other Requirements: Vz A r-1 //
a)L1A"- tzim& 146mc-
Water Suouly: Public Supply From nwli -X Al a c - Address
or: Private Supply Drilled by Address
.--.---Building-Type- WDQK�- fj8 Has erosion control been completed? � -
Number of Bedrooms 1� Has garbage grinder been installed?
I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as-
built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved
plans and the s dards, rules and regulations a Pu County Department of Health.
Date: Certified by P.E. R.A.
Address ,
# o 4131 1
Any person occupying premises served byythe above system(s) shall promptly take such action as may be necessary
to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage
treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval
of the private water supply shall become null and void when a public water supply becomes available. Such
approvals subject to modification or change when, in the judgment of the Public Health Director, such
revocati difica or change is necessary. p�
By: Title:"" Date:
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CC -97
0
1
y
® yy
y71(yl1jy11/11:�lIiIYV 1
l�RUCE R OLEY LORETTA MOLINARI. RN., M.S.N.
Publfc Health Directof - _._ ._ _.. .______ . ��w �04 _. _ ._ __..__�._____.- Associate "Puiilic Health Director `
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
z Brewster, New York 10509
Environmental Health (914)278-6130 Fax (914) 278-7921
Nursing Services (914)278-6558 WIC (914)278-6678 . Fax (914) 278-6085
Early Intervention (914) 278 - 6014 Preschool (914) 278.6082 ' Fax (914) 278 - 6648
OWNERS NAME:
TAX MAP .N NUMBER:
E911 ADDRESS:
TOWN:
AUTHORIZED TOWN OFFICIAL:
(Signature)
DATE: "L
d4 �
The Putnam County Department of Health will not issue a Certificate of
Construction Compliance unless the above form is completed, i.e., a legal E911
address is assigned by an authorized town official. This form is to be submitted
with the application for a Certificate. of Construction Compliance.
(E911 VERFRIvi)
PiTTA1AIVI COUNTY DEPARTMENT OF HEALTH
-- -- - DIVISION -OF--E ONMEN A�..: HEALTH- SERVICES --
CERTIFICATE OF CONSTRUCTION COMPII.KANCE FOR SEWAGE TREATMENT SYSTEM
PCHD CONSTRUCTION PERMIT #
Located at �/��/`li�U U�/ ��-' Town Hagei.f o�
Owner /Applicant NameBK —_TZI ! f' Tax Map 5 Block Lot S6
Formerly 16a w- 1 41414l'' Subdivision Name Q U A 1 L g k'D G L?
Subd. Lot #
Mailing Address R'0. 6 0?� 467 `57'L 11/-x . Zip /
Date Construction Permit Issued by PCHD
Segaarate Sewerage System built by` Lma >;4- 255�-_- ill!?: Address.; AO, plw�,
Consisting of l®Q0 Gallon Septic Tank and T �
Other Requirements: i./
C - -Water Su ® ®lv: Public Supply From Address
or: Private Supply Drilled by Address
[.. q
���.� ���. Has-erosion contrp�F- been-completed. �
Number of Bedrooms 3 . Has garbage grinder been installed? A/0 "
I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as-
built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved
plans and the standards, rules and regulations of the Putnam County Department of Health.
Date: '� v Certified by �'- P.E. R.A.
lilc�i n rlu ♦pa�ivn+u�
Address`/ �.�ri / //fit° All %r/ZZ7 —�'r�/ ^M&r/ A W License # 04 .511 e
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary
to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage
treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval
of the private water supply shall become null and void when a public water supply becomes available. Such
approvals are subject to modification or change when, in the judgment of the Public Health Director, such
revocZ107 dificati n or change is necessary.
By; Title: 0a*j1 Jz7;Pi J7- Date: '-_SA a
T
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy. - Design Professional
Form CC -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner or Purchaser of Iguilding Tax Map Block Lot
lom 63 - LLC - PAITQ?62 Q p
Building Constructed by Town/WHftge
1-+Ay (LAO D bj4tyC - CQ UAi L �t`OGC--
Location - Street Subdivision Name
WooT) Vi2AfnC - M0901AV, I )
Building Type Subdivision Lot #
I represent that I am wholly and completely responsible for the location, workmanship, material,
construction and drainage of the sewage treatment system serving the above - described property, and
that is has been constructed as shown on the approved plan or approved amendment thereto, and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and
hereby guarantee to the owner, his successors, heirs or assigns, to .place in good operating condition
any part of said system constructed by me which fails to operate for a period of two years
immediately following the date of approval of the "Certificate of Construction Compliance" for the
sewage treatment system, or any repairs made by me to such system, except where the failure to
operate properly is caused by the willful or negligent act of the occupant of the building utilizing the
system. :
The undersigned further agrees to accept as conclusive the determination of the Public Health
Director of the Putnam County Department of Health as to whether or not the failure of the system
to operate was caused by the willful or negligent act of the occupant of the building utilizing the
system.
Dated: Month 6 Day 2—V Year
General Contractor (Owner) - Signature
Corporation Name (if corporation)
Address: 190 & 4D f 94 e--
Signature: /L'o /L►o
Title: "Al fti Ena�2
Corporation Name (if corporation)
Address:
State /N_`f Zip IbLn2 State Zip
Form GS -97
YML EYXIRPNar. MENIAL ffRVICES
e tree
Yorktown Heights,-N-.-Y.--- 1-0598-
(914) 245-2800
Albert H. Padovan,i, Director
LAB #: 32.103403 CLIENT #: 54663 NON STAT PROC PAGE 1
----------- ~ ---- ~ ---------- N N N N N N N N N N N N N N N N N N N N N N N N N N ------------- ~ -----------
PRESTIGE HOMES LLC DATE/TIME TAKEN: 05/82/01 12N00
P.O. BOX 407 DATE/TIME RECD: 05/22/01 03:00
BREWSTER9 NY 10509 REPORT DATE: 05/24/01
PHONE:
SAMPLING SITE: LOT #11 HAVILAND DR ( QUAIL RIDGE SAMPLE TYPE..: POTABLE
PATTERSON NY PRESERVATIVES: NONE
COLD BY,: MIKE STANLEY TEMPERATURE—:
NOTES,.: COLIFORKMETH: MF
-------------
DATE FLAG PROCEDURE RESULT NORMAL --RANGE METHOD
05/22/01 MF T. COLIFORM ABSENT /100 ML ABSENT 1008
COMMENTS:
ENACT THESE RESULTS INDICATE THAT THE WATEC(WAS) AS NOT) OF A
SATISFACTORY SANITARY QUALITY ACCORDINZ-TOr-THE NEW YORK STATE
AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS
TESTED, AT THE TIME OF COLLECTION.
SUBMITTED BY: I -4z' I / I/
Albert 9-. Pad ni, M.T.(ASCP)
Director . I,
ELAP# 10323
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PERMIT FOR'SEWAGE TREATMENT-SYSTEM
p u7r e
PERMIT#
Located at /�I� /1. ivy /�j2� V G- Town or Village p A* g y�ot
�
Subdivision name 40t %r} /L kIly� Subd. Lot # _L1_
,--
Date Subdivision Approved
Owner /Applicant Name V ��v' 14 [IAN 1'� �
Tax Map Block __L_ Lot 5"7-/,
Renewal Revision
Date of Previous Approval
Mailing Address e, 12A-PA D LA UC P/yrToi�S /y Zip fos-6
Amount of Fee Enclosed
Building Type K/Lo J rain e Lot Area B, 5 No. of Bedrooms _ _� Design Flow GPD 00
Fill Section Only Depth Volume
PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Separate Sewerage System to consist of /Z�0 .t gallon septic tank and
647-1'e- A 6 -522P- Pri -^0 r[ C-LPS
.Other Requirements:
To be constructed by ' L -- 0-'& j A-AX Address lr G�.,Ale Aw /3�1 -1
Water Supply: jC Public Supply From (!VIAI L �v�� � lTV �,7-e a.�f-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 guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said
builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years
immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original
system or any repairs thereto.
SignedZ17 P.E. R.A. Date -r)
Address /.- A, S'Zc j License # G? 43 % /Y
APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the
sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or
modified w co sidere ecessary by the Public Health Director. Any revision or alteration of the approved plan requires
a new pern�i prove discharge of domestic sanitary sewage only.
By: Title: CJ / ` Date:
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CP -97
LAURENT ENGINEERING
ASSOCIATES, P.C.
j\ MILLBROOKE OFFICE CENTRE
Route 22 6 Milltown. Road Yo(k I (9184)2 8.6108 (FAX) 278-265a
- New
HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS
December 10, 1998
Robert Morris, P.E.
Putnam County Health Department
4 Geneva Road
Brewster, NY 10509.
RE: Individual SSDS -Kevin Hannah
Quail Ridge & Patterson Lot #11
Haviland Drive
Town of Patterson
Dear Mr. Morris:
Enclosed are the following:
1. One (1) print of SS -11 "Prol)osed SSDS," dated 12/10/98.
2. Three (3) prints of SF -11 "Preliminary Plan For Fill Placement Only," dated 12/10/98.
3. "Application For Approval of Plans For a Wastewater Disposal System."
4. "Construction Permit of Sewage Disposal System," dated 12/10/98.
5. "Design Data Sheet."
6. "Letter of Authorization," dated 12/10/98.
7. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only."
8. . Money order in the amount of $300.00, review fee.
If you have any questions, please call.
Very truly yours,
LAURENT ENGINEERING ASSOCIATES, P.C.
HWN: JM: hi
98048
N
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
- - - - -" APPLICATION FOR APPROVAL-OF PLANS FOR -
A WASTEWATER TREATMENT SYSTEM
1. Name and address of applicant: IA,F_--4I N HANNA
PhTr-Epbw Hq i-
2. Name of project: 1-07 III, INDIA I pVAl. '
4. Design Professional: V'1
6. Drainage Basin: GAT BILAiJ"
7. Type of Project:
A Private/Residential
Apartments
Office Building
3. Location T/V: PA TOLD
5. Address: 24 W- L-fOWO PAP
Food Service
Institutional
Realty Subdivision
Commercial
Mobile Home Park
Other (specify)
8. Is this project subject to State Environmental Quality Review (SEQR)?
Type Status (check one) ....................... ............................... Type I Exempt _
Type II Unlisted X
9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... No
10. Has DEIS been completed and found acceptable by Lead Agency? ...............
11. Name of Lead Agency
_._12. Is this:prcject -in an area under the control of local planning, zoning, or other
officials, ordinances? ......................................................... ...............................
NN
N#.
13. If so, have plans been submitted to such authorities? f�a
14. Has preliminary approval been granted by such authorities? ±�p Date granted: tAN
15. Type of Sewage Treatment System Discharge ................. surface water X groundwater
16. If surface water discharge, what is the stream class designation? .................... NA
17. Waters index number (surface) h
18. Is project located near a public water supply system?
19. If yes, name of water supply a'JM-- P-1VUe Distance to water supply
20. Is project site near a public sewage collection or treatment system? ................ wo
21. Name of sewage system NA Distance to sewage system N/,
22. Date test holes observed 11 I ( � `� 23. Name of Health Inspector AF M ..' TlEikWHt4
24. Project design flow (gallons per day) ....... ...........................:... ...................... (you
25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... Na
26. Has SPDES Application been submitted to local DEC office? ......................... NA
Form PC -97
OA
27. Is any portion of this project located within a designated Town or State wetland? N�
28. Wetlands ID Number... .................... ......... ...........:.::.- .:...:...::::-
29. Is Wetlands Permit required? ............................. .....:....... ... ............................. o
Has application been made.to Town or Local DEC.office?
30. Does project require a DEC Stream Disturbance Permit? .................................
No
31. Is or was project site used for agricultural activity involving application of
pesticides to orchards or other crops, solid or hazardous waste disposal,
landfilling, sludge application or industrial activity? ............................ Yes/No NO
32. Js 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 �0
DESCRIBE:
33. Is there a local master plan on file with the Town or Tillage? ......................... iE5
34. Are community water and/or sewer facilities planned to be developed within
15 years in or adjacent to project site? ................................ ...............................
35. Are any sewage treatment areas in excess of 15% slope? . ............................... !At
36: Tax Map ID Number .......................... ............................... Map 2h. Block Lot '5Ca
37. Approved plans are to be returned to ..... Applicant Design Professional
NOTE: All applications for review and approval of a new SSTS to be located within-the NYC Watershed shall
be =sent to the Department, and-need not be sent in duplicate to the DEP, although the project may require DEP
approval of the SSTS prior to final approval by the Department. Projects within the watershed may also
require DEP review and approval of other aspects of a project, such as stormwater,plans or the creation of
impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from
DEP and submit those forms to DEP for review and approval.
If the application is signed by a person other than the applicant shown in Item l .,the application must
be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision
may be grounds for the rejection of any submission.
I hereby affirm, under penalty of perjury, that information provided on this form is trite
to the best of my knowledge and belief. False statements made herein are punishable as
a Class A misdemeanor pursuant to Section 210.45. of the Penal Law.
SIGNATURES & OFFICIAL TITLES:
HAAS X. A, 44 A4614-
Mailing Address: ................................... 1.0 M)l j TDVI))4 hop
K yT>Z: f4Y W01
PUTNAI�I COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEAL'T'H SERVICES
- LETTER OF AUTHORIZATION
RE: Property of 9-E4tN 1+ANNA
Located at F+A\dLAt4D_ OP4
T/V TA7TEP-60N Tax Map 9 Block Lot 6V
Subdivision of OWNIt. P9k1;
Subdivision Lot # Filed Map 9 `��� Date Filed1 i
Gentlemen:
This letter is to authorize 1_ AA Ri Vi 4 NVAM6 , X. F•F•
a duly licensed Professional Engineer A 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 treatment 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.
Countersigned:
P.E., R.A., # _
56124
Mailing Address
State k6w Zip
t010
Very truly yours,
Signed:
(Owner of Property)
Mailing Address: � PAHJNi4D L&J e
State NEW 4
Telephone: Z1 Telephone: C 11q)
Zip K -G
Form LA -97
617.20
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
-For-UN-LISTED ACTIONS Only - -
'art 1 - PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
1. APPLICANT /SPONSOR: 2. PROJECT NAME:
3. PROJECT LOCATION: P0 4N
Municipality `Ti�i"i County
4 PRECISE LOCATION: (Street address and road intersections, prominent landmarks, etc., or provide map)
5. PROPOSED ACTION IS:
PLNew OExpansion ❑Modification /alteration
6. DESCRIBE PROJECT BRIEFLY:
1 ND I,1OAL, t�
7. AMOUNT OF LAND AFFECTED: I
Initially 0,iq acres Ultimately acres
8. WALL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
Xyes ONo If No, describe briefly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
Residential Cindustrial..... OCom.mercial OAgricultural OPark /Forest /Open space OOther
Describe: fJIH(ALF P'H14
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (FEDERAL, STATE OR LOCAL)?
OYes &0 If yes, list agency(s) name and permit /approvals
1 1. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
OYes I$1& If yes, list agency(s) name and permit /approval
.2. AS A R SULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION?
OYes WJo
Sic( :.iur;;
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF f.tY KNOWLEDGE
_HAR -Pe VJ- NI-W'5. JCL— PE
I
If the action is in a Coastal Area, and you are a state agency, comple'.e a
Coast; AssesSwte:it Form before proceeding with this assessme;., �`:
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS
- - REVIEW SHEET FOR CONSTRUCTION PERMIT ,
STREET LOCATION AA(1)i-A)Jb �R.I ✓E- N
, / w
REVIEWED BY RNI, GR, AS, MB, BH � D
DATE 1 / TAX MAP #
Y DOCUMENTS Y N
N _�.
i
SUBDIVISION
LEGAL SUBDIVISION
SUBDIVISION APPROVAL CHECKED
PERC RATE — / 5_
FILL REQUIRED _ 2 DEPTH - '170 c y,
TAIN DRAIN REQUIRED
LSTANDPIPES
GENERAL
LOCATED IN NYC WATERSHED
PLANS SUBMITTED TO DEP
DELEGATED TO PCHD
PEP APPROVAL, IF REQ'D
DEEP TEST HOLES OBSERVED
(- APPROVAL SSDS ADJ. LOTS ?
ETLANDS (TOWN/DEC PERMIT REQ'D ?)
ATA ON DDS PLANS & PERMIT SAME
ZE 1969 NEIGHBOR NOTIFICATION
:TTER BIlZBA
)0 YR. FLOOD ELEVATION
THER REQ'D PERMITS)
REOUHZED DETAILS ON PLANS
;WAGE SYSTEM PLAN - (NORTH ARROW)
;DS HYDRAULIC PROFILE
RAVITY FLOW
HOUSE SEWER -1/4" FT. 4 "0; TYPE PIPE
NO BENDS; MAX.BENDS 45° W /CLEANOUT
FILL SYSTEMS
CLAY BARRIER
10- FT. HORIZONTAL; LOPE 3:1 TO GRADE
FILL SPECS a , S' B3 .9ai/FILL NOTES
GAUGES
FILL IN EXPANSION AREA
TRENCH /
LF TRENCH PROVIDED J 60 FT MAX.
PARALLEL TO CONTOURS
100% EXPANSION PROVIDED
ON PLAN - FROM SSTS
10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL
20 T QUNDfk -T ON WAtb -S _15'WELL TO PL
100' -TO WELL, 200' IN DLOD, 150'PITS
t60' TO STREAM WATERCOURSE LAKE (inc. expan)
50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER
10' TO WATER LINE (pits -20')
59 INTERMITTENT DRAINAGE COURSE
2007500' RESERVOIR, ETC. _150' GALLEY SYSTEMS
CONSTRUCTION NOTES 'MIN to CDS= >5 0/o,10'- 4 %,25'- 3 0/o,30'- 2 0/o,35' -1 %,100' - <1%
DESIGN DATA: PERC & DEEP RESULTS 'MIN to CD discharge /100'with 182 cons day discharge
!'CONTOURS EXISTING & PROPOSED SEPTIC TANK
DRIVEWAY & SLOPES, CUT 10' FROM FOUNDATION; 50' TO WELL
FOOTING /GUTTER/CURTAIN DRAINS WELL
TOIL TYPE BOUNDARIES IMENSIONS TO PROPERTY LINE
TITLE BLOCK; OWNERS NAME,ADDRESS LOCATION OF SERVICE CONNECTION
TM #,PE/RA; NAME,ADDRESS,PHONE#
DATE OF DRAWING/REVISION
DATUM REFERENCE
.QQCATION OF WATERCOURSES, PONDS
LAKES AND WETLANDS WITHIN 200 FEET
PROPOSED FINISH FLOOR AND BASEMENT EL.
j
LAURENT ENGINEERING
P:C. _.
MILLBROOKE OFFICE CENTRE
Route 22 & Milltown Road
Brewster. New York 10509
(914)278. 6108 - (FAX) 278 -2658
HARRY W. NICHOLS JR., P.E.
CONSULTING SITE ENGINEERS
March 4, 1999 `
Robert Morris, P.E.
Putnam County Health Department
4 Geneva Road
Brewster, NY 10509
RE: Proposed SSTS
Hanna
Haviland Drive
Town of Patterson
Dear Mr. Morris:
In response to your review letters dated February 19,1999, we offer the following:
J1. Percolation test locations are now shown on the plans.
J2. Silt fence is now provided around the entire fill pad.
We trust the above adequately addresses your concerns and request the issuance of the
Construction Permit at your earliest convenience.
Very truly yours,
LAURENT ENGINEERING ASSOCIATES, P.C.
Harry W. Nichols, Jr., P.E.
HWN:JM:hs
98048
0
01/03/1999 10:45 9142713851 TLS CONSTRUCTION PAGE 01
m88 .�Vj'
1 Lou 9Q11 R "UCdo PE
C+uiob -op Ngdi oad
Te! FAt 914 -37I 3851520
APril 5,2001
Mr. Robert Monis
% Putnam County Dept ofHealth
Division of Environmental Health Services
Fax Message z?X -792!
Ref : Notice of Open Septic Inspection
Permit # P•29 -98 Haviland Drive, Quail Ridge Subdivision Lot #11
Owner Kevin Hanna
Gentlemen
I have inspected the above installation and the fields are substantially the same
as the original design drawing. There are 401 If of fields installed. The
required footage is 3751f. The tank is further than 10 Meet from the building.
The septic contractor is Jim Gaglasdo
Please arrange to inspect the septic installation as soon as possible.
j Will be OU, of tpyyfi tfierofore please contact Mr. Mike Stanley at
914-490-4629.
Thank you for your co-operation.
Yak Yours
Th -11-- M. Quartuccio
,
PUTNAAA c®uN�r 1 EALTH 19
y -h r
.10 { �
�. '- '� = 4 GenevarRoad , (914) 278,6730
8O
r Breyvster, MY'�10509 r � � � �- �19�
i
0
e
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
{
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner Vt� ? Ni�l{� Address 6 PAN4AHD LAW
Located at (Street) J- PNILkNU tipge f DkNf,wO LA Hr= Tax -Map '�.�%= Block
(indicate nearest cross street)
Municipality P1_NT'15R'z__PH Drainage Basin
1 Lot 6(a
tl,�,�LNHL,A
SOIL PERCOLATION TEST DATA
Date of Pre - soaking Date of Percolation Test
Hole No.
Run No.
Time
Start - Stop
Ela se Time
Min.)
NDe th to Water
rom Ground
Surface (Inches)
Start Stop
Water
Level
Dropp In
Inches
Percolation
Rate
Min/Inch
1
po°
2
®' - joj
I1
VL 2S
3
40''� - !0�`
��
2A_ U
�� I
4
to s�_ 11's
��
2s"
5
3
d - W-"
4
5
1
2
3
4
5
NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each
percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be
submitted for review.
2. Depth measurements to be made from top of hole.
Form DD -97
4
Indicate level at which groundwater is encountered jyc?i�E
Indicate level at which mottling is observed (AOMIF
Indicate level to which water level rises after being encountered
Deep hole observations made by: AG'i
Design Professional Name: 081a V%j, N'(,1 1-5, J,�- • fE-
Address: U M1LA T6v'-\ P-0*
B �Tlaq 10 5 o l
Signature:
Design Professional's Seal
e ?� CC
w
i
No. 56124
OAROFES &14�,�
TEST PIT DATA
DESCRIPTION OF SOILS
ENCOUNTERED IN TEST HOLES
DEPTH
HOLE NO.
I
HOLE NO. `� HOLE NO.
G.L.
0.5'
»iii
T01
0 li!
1.0'
1.5'
N1�D� sp-
2.0'
�`�-�t�"
5mv? 1,ohm
V 4 v
504wM, u*A\
2.5'
*i G,p*'46L
1 +t"p,�,vEI..
3.0'
3.5'
4.0'
4.5'
5.0'
5.5'
6.0'
6.5'*
7.0.1-
7.51
8.0'
8.5'
9.5'
10.0'
Indicate level at which groundwater is encountered jyc?i�E
Indicate level at which mottling is observed (AOMIF
Indicate level to which water level rises after being encountered
Deep hole observations made by: AG'i
Design Professional Name: 081a V%j, N'(,1 1-5, J,�- • fE-
Address: U M1LA T6v'-\ P-0*
B �Tlaq 10 5 o l
Signature:
Design Professional's Seal
e ?� CC
w
i
No. 56124
OAROFES &14�,�
BRUCE R: FOLEY- _. . _... .
Public Health Director
(k
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
LORETTA MOLINARI RN.; M.S.N:
Associate Public Health Director
Director of Patient Services
Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921
Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085
Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648
WIC (914) 278 - 6678 Fax (914) 278 - 6085
February 19, 1999
Jeff Moore
Laurent Associates
Millbrook Office Centre
Route 22 & Milltown Road
Brewster NY 10509
Re: Proposed SSTS: Hanna
Haviland Drive, Lot #11
(T) Patterson, TM# 22 -1 -36
Dear Mr. Moore:
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.
If percolation tests were not witnessed by a representative of the New York City Department
Environmental Protection on this lot, percolation tests must be witnessed by a representative of this
Department.
1) Percolation test locations have not been shown on the trench plan.
2) Silt fence is to be shown around the entire fill pad, i.e., the silt fence is to be
continual and along the north property line.
Upon receipt of a submission, revised to reflect the above comments, this application will be
considered further.
RM:tn
Very truly yours
Robert Morris, P.E.
Senior Public Health Engineer
14 . —,t
BRUCE R. FOLEY
Public Health Director
LORETTA MOLINARI RN., M.S.N.
Associate Public Health Director -
Director of Patient Services
The Putnam County Department of Health (Department) has determined that the above referenced
application, including fee, and received by this Department on February 16, 1999 is complete. The
Department will notify you by March 10, 1999 of its determination.
® The Project has been delegated to the Putnam County Health Department for
review pursuant to the guidelines set forth in the Watershed Agreement.
❑ Joint review with the NYCDEP will commence pursuant to the guidelines set forth
in the Watershed Agreement.
If the Department fails to. notify you within the above referenced time frame, you may notify the
Department of its failure by certified mail, return receipt requested. The notice should be sent to my
attention at the above address. This notice must include your name, the location of the project, the
office with which you filed the application originally, and a statement that a decision is sought in
accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed
Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the
notice, your application will be deemed complete, subject to standard terms and conditions as set
forth in the regulations.
Please be advised that projects within the NYC Watershed may also require Dept. of Environmental
Protection review and approval of other aspects of a project, such as stormwater plans or the creation
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921
Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085
Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648
WIC (914) 278 - 6678 Fax 914) 278 - 6085
February 19, 1999
Jeff Moore
Laurent Associates
Millbrook Office Centre
Route 22 & Milltown Road
Brewster NY 10509
RE: Hanna
Haviland Drive
(T) Patterson, TM# 22 -1 -56
Reservoir Basin East Branch
Dear Mr. Moore:
The Putnam County Department of Health (Department) has determined that the above referenced
application, including fee, and received by this Department on February 16, 1999 is complete. The
Department will notify you by March 10, 1999 of its determination.
® The Project has been delegated to the Putnam County Health Department for
review pursuant to the guidelines set forth in the Watershed Agreement.
❑ Joint review with the NYCDEP will commence pursuant to the guidelines set forth
in the Watershed Agreement.
If the Department fails to. notify you within the above referenced time frame, you may notify the
Department of its failure by certified mail, return receipt requested. The notice should be sent to my
attention at the above address. This notice must include your name, the location of the project, the
office with which you filed the application originally, and a statement that a decision is sought in
accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed
Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the
notice, your application will be deemed complete, subject to standard terms and conditions as set
forth in the regulations.
Please be advised that projects within the NYC Watershed may also require Dept. of Environmental
Protection review and approval of other aspects of a project, such as stormwater plans or the creation
o4
.—b
- -Letter to: Jeff Moore-= -February 1'9; 1999 - - -
.of impervious surfaces, and the project applicant should contact the Department of Environmental
Protection regarding such activities to see if Dept. of Environmental Protection review and approval
is required.
If you have any questions regarding this matter, please call me at (914) 278 -6130 ext. 166.
Ve uyll'y y /ou
'�(�
Robert Morris, PE
RM:tn Senior Public Health Engineer
T- , KITCHEN
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a1:t� /ice OIO 12�.4W I
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COUNTY DEPARTMENT OF MAP
PUTNAM
T- , KITCHEN
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a1:t� /ice OIO 12�.4W I
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COUNTY DEPARTMENT OF MAP
PUTNAM
t10USE PLANS APPROVED FOR
BFDROOM COUNT ONLY;
BFaRcom 5
WO
i mature & Title
30 0
I 14 1
I
BA I H
U.. I %z• SL. Ipe O
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9:i� /t• OIO 12'-4%4' 't LI :11 °/4- Q
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eUTNAM COUNTY DEPARTMENT OF HEAL�iii
HOUSE PLANS APPROVED FOR
BEDt OOM COUNT ONLY;
Signature & TitlL---44 e
- BRUCE -R- FOL"-EY
: Public Health Director
AM A.,
o
LORETTA " MOLINARI " RN., M.S.N.
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York .10509
Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921
Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085
Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648
WIC (914) 278 - 6678 Fax (914) 278 - 6085
. January 12, 1999
Harry Nichols
Laurent Associates
Millbrook Office Centre
Route 22 & Milltown Road
Brewster NY 10509
RE: Application to Construct a
Subsurface Sewage Treatment System
at Kevin Hanna, Lot 11
Quail Ridge
(T)Patterson, 22.4-56
Dear Mr. Nichols:
The Putnam County Department of Health (Department) has determined that the above referenced
application, received by the Department on December 28, 1999 is incomplete. Please be advised that
the following information is required before the Department may commence its review.
®"
Letter of. consent" from. Quail Ridge Homeowners Association allowing hook -tip to -public
water supply. Furthermore, the water supplier will be able to supply the property With water
at adequate preserve.
The review of your application will commence once the Department receives the requested
information and determines that the application is complete. The Department will notify you within
10 days of its receipt of the requested information as to the completeness of your application. Please
be advised that failure to submit information to the Department or to follow procedures is sufficient
grounds to deny approval, pursuant to the New York City Department of Environmental Protection
Watershed Regulations and Putnam County Department of Health regulations.
Should you have any questions or care to discuss this matter, please contact me at (914) 278 -6130
ext. 166.
Ve ly yours
Robert Morris, P. E.
RM/tn Senior Public Health Engineer
TNAM COUNTY DEPARTMENT OF HEALTH
IO
ION OF ENVIRONMENTAL HEALTH SERVICES
I k CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM
Located at _ j4R411 -hi-0 V P ,4a
Subdivision name 0-04 L-- 9-4 P'' C-- Subd. Lot # l i
Date Subdivision Approved 100 W
Owner /Applicant Name kzV I H !4m1 l\
Town or Village
PATT9 *0 1-4
Tax Map 14- 9 Block i Lot �(
Renewal Revision
Date of Previous Approval
Mailing Address ► Dlk -HNHO Ljf "ec PATVF–R-6I1 4. W-i�\
Amount of Fee Enclosed,
Building Type s 101`RLC– Lot Area 0 No. of Bedrooms Design Flow GPD
Zip �►IJ� f�''�"j
Fill Section Only Depth '2— Volume
PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Separate Sewerage System to consist of
io () a
T4- H( -14
Other Requirements:
gallon septic tank and
To be constructed by I-- @° V. Address
Water Supply: _ k Public Supply From OlkAK- �IAE W01jKM kW Address
or: Private Supply Drilled by Address
M
tl1 �F Mi
AM 0-- -0 rN. , H '
I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the
separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion
thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the
Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said
builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years
immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original
system or any repairs thereto.
Signed:
Address
R.A. Date 1-'L� k D) �%
License # 6W"
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 whe onsidered ne a sary by the Public Health Director. Any revision or alteration of the approved plan requires
a new perm' . roved f charge of domestic sanitary sewage only.
By: Title: Date: 3h
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CP -97
PU.TNAM COUNTY DEPARTMENT OF HEALTH-
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
ATTENTION ADAM XGENE
REQUEST FOR FINAL INSPECTION For: , Fill
All information must be fully -completed prior to any Trenches
inspections being made.
PCHD Construction Permit # P Z —�16
Located: 4-14.\1 l LkVD 19p-we-
Owner/Applicant Name: eEY t W L4" N * TM Z5 Block 1— Lot 5Z'
Formerly: Subdivision Name:
Subdivision Lot # /
Is system fill completed? Ycs Date-
Is system complete? YES Date: d
Is system constructed as per plans? -YES
Is well drilled? Date: ,d[ fll-
Is well located as per plans? ,tom /�- .. - - --
Are erosion control measures in place? YIC55 --
I certify that the system(s), as listed, at the above premises has been constructed and I have inspected
and verified their completion in accordance with the issued PCHD Construction Permit and
approved plans and the Standards, Rules and Regulatio of the Putnam County Department of
Health.
Date: /'y Certified b RA
Design Professional
Address: '�� LD�/�/ie5� �� ��eTb.� -i/vel Lic.
Comments: �E
Form FIR-99
BRUCE -R. FOLEY
Public Health Director
DEPARTMENT OF
I Geneva Road
�.` Brewster New Vork
HEALTH
10509
REQUEST FOR FIELD TESTINQ CD�IFlz�il Tlo�
f o
ATTENTION: ❑ ADAM STIEBELING GENE REED
All information below must be ul c completed prior to any scheduling. DATE: 4�
ENGINEER O G PHONE #: /
REASON::.... .......
DEEPS: ❑ CS: PUIT TEST: ❑
ROAD /STREET: , - 4ANJ I L-40 D P (V CC
TOWN: 2/h' - 491% TAX MAP #:
LORETTA MOLINARI • RN., M.S.N.
Associate Public Health Director
Director of Patient Services
SUBDIVISION: LOT#:
OWNER: , El/ //V ,W4i(1w* - 2 --7,5 ..
NYCDEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING
YES NO .7
_ - . _...... _. o....:..... _..4.... _ . Proposed- SSTS_within the drainage basin of West Branch or Boyds Corner Reservoirs.
❑ ❑ Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake.
❑ ❑ Proposed SSTS within 200 feet of a watercourse or a DEC wetland.
❑ ❑ ' Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required.
❑ ❑ Proposed SSTS for a Commerical Project.
It is the responsibility of the design professional to provide the above information prior to soil testing.
This Department will determine the NYCDEP project status (Joint or Delegated) based on the
response. If you answered yes to any of the questions, NYCDEP must witness the soil testing. This
Department will coordinate a mutually suitable time for field testing with the PCDOH_ , the Design
Professional and NYCDEP.
If a project has been determined to be Delegated based on the above response and then subsequent
information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility
of the design professional to schedule re- witnessing of the soil testing with NYCDEP.
FOR COUNTY USE ONLY -.A.
DATE: TOME:
CONTN ENTS:
XLDTEST)
' BRUCE R. FOLEY
Public Health Director
LORETTA MOLINARI R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648
April 17, 2001
Thomas M. Quartuccio, P.E.
1 Lounsbury Road
Croton -on Hudson NY 10520
Re: . Hanna
Haviland Drive, Lot #11
(T) Patterson, TM# 25 -1 -56
Dear Mr. Quartuccio:
The above regarded application is an cannot be processed
This means the project cannot be forwarded to a Putnam County Department of Health reviewer for
comments or approval until the following has been received:
1. A certified check or money order in the amount of $200 for a Certificate of
Compliance.
If you have .any question regarding this matter, please call me at (845) 278 -1630 ext. 2152.
Very truly yours,
Theresa Nemeth
Senior Typist
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
ATTENTION El ADAA1 GENE
REQUEST FOR FINAL INSPECTION For: Fill
All information must be fully completed prior to any renche
inspections being made.
PCHD� Construction Permit 411 ? 29 IS
Located: J4 A V 1 U V 12r] v e- ]?A (�L =�Sa�J
Owner /Applicant Name: E✓ I u LI A 0u h TM Block _� Lot �6
Formerly: Subdivision Name: Qt)AI &IQg G--
Subdivisiorl Lot
Is system fill completed? Date: 6
Is system complete? yC—S Date: a
Is system constructed as per•.pla�s ?C�
Is well drilled? Date:
Is well located as per plans? Ad& �T
Are erosion control measures in place ?_
I certify that the system(s), as listed, at the above premises has been constructed and I have inspected
and verified their completion in accordance with the issued PCHD Construction Permit and
approved plans and the Standards, Rules and Regulations of the Putnam County Department of
Health.
Date: Certified a
Design Professional
Address: !� �fJ 6U P Owl _ /_ Lic. # 0 IS
Comments:
• 4a 1: "
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
LETTER OF AUTHORIZATION
RE: Property of K5TIly 144 'VIVA _
Located at ,/X/ v;
TX , ���rli� Tax Map # Block �_ Lot 'G
Subdivision of OA1(__ 42-1 Wxc
Subdivision Lot # 11Z Filed Map # Date Filed
Gentlemen:
This letter is to authorize
Ille
W
a duly licensed Professional Engineer _�C or Registered Architect to apply for the required
wastewater treatment and/o ) 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.
State Zip���
Telephonelc -z71 Sd
Very truly yours,
Signed: LL_"
.
(Owner of Property)
Mailing Address: 6D,&_1410P
State A-' y
zip /0 sa3
Telephone: .. -S � 5 - P � - � I I1 '
Form LA -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner KLEV I P Address 0 D&W AID. >LArwz ?4-rrCkZ00
D
Located at (Street) RANILAUD 9J V6' - Tax Map 25' Block I Lot 56
(indicate nearest cross street)
Municipality —PATT MSC, P Watershed . el kai 1-0 Lj
SOIL PERCOLATION TEST DATA
Date of Pre-soaking C-_5 I Date of Percolation Test-4=Z— 01
. . ....
t te
... .
-Depth
e
..........
From wo n
T i[he J. A W
xo. S
D
MiN
NOTES: 1. Tests to be repeated at same depth until atmroximatelv eaual vercolation rates are obtained at each
percolation test hole. (i.e. :5 1 min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be
submitted for review.
2. Depth measurements to be made from top of hole.
Form DD-97
a
z-,iz-z
2
13
2
7
3
12'In-
•
13
3
�
4
1; 2
10 13
3
61
5
41;27
2
3-3
3
2
)3
4
1
3
NOTES: 1. Tests to be repeated at same depth until atmroximatelv eaual vercolation rates are obtained at each
percolation test hole. (i.e. :5 1 min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be
submitted for review.
2. Depth measurements to be made from top of hole.
Form DD-97
5
17
2
7
3
12'In-
�09A_
1
3
�
.4
5
NOTES: 1. Tests to be repeated at same depth until atmroximatelv eaual vercolation rates are obtained at each
percolation test hole. (i.e. :5 1 min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be
submitted for review.
2. Depth measurements to be made from top of hole.
Form DD-97
Indicate level at which groundwater is encountered N ,
Indicate level at which mottling is observed
Indicate level to which water level rises after being encountered A.-A--
Deep hole observations made by: _ ��� Date
Design Professional Name: -;9 --
Address: j Louk- oy& ; y
Design Professional's Seal
S�� PR;;fESS /py9`
M. eUg9 G�iGG'
4
\�
k
Q, 048918
'�\HF STA7E ���
TEST PIT DATA
2
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH
HOLE NO. HOLE NO. HOLE NO.
G.L.
0.5'
,
1.0'
t
2.0'
2.5'
3.0'
_ . 3.5 ":
4.0'
r�
5.5
-t
6.0'
I NJ
Ch
6.5'
7.5'
8.0'
8.5'
9.0'
10.0'
Indicate level at which groundwater is encountered N ,
Indicate level at which mottling is observed
Indicate level to which water level rises after being encountered A.-A--
Deep hole observations made by: _ ��� Date
Design Professional Name: -;9 --
Address: j Louk- oy& ; y
Design Professional's Seal
S�� PR;;fESS /py9`
M. eUg9 G�iGG'
4
\�
k
Q, 048918
'�\HF STA7E ���
BRUCE R. FOLEY
Public Health Director
April 6, 2001
LORETTA MOLINARI R.N.; M.S.N.
Associate Public Health Director
Director of Patient .Services
DEPARTMENT OF HEALTH
1. Geneva Road
Brewster, New York 10509
Environmental Health (845) 278 - 6130 Fax (845) 218 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278.6648
Thomas M. Quartuccio, PE
1 Lounsbury Road
Croton -on- Hudson, New York 10520
Re: Field Inspection - Hanna
Lot # 11, "Quail Ridge"
Haviland Drive, TM# 22 -1 -36
(T) Patterson
Dear Mr. Quartuccio:
The separate sewage treatment system for the above referenced property can be backfilled. The
following comments must be corrected in the field:
• All three (3) trees within the fill pad must be removed.
• Silt fence must be installed in the ground.
If you have any further questions, please contact me at (845) 278 -6130 ext. 2261.
Very truly yours,
Gene D. Reed
GDR:cj Environmental Health Engineering Aide
'tr,
t1-
BRUCE R. FOLEY
Public Health Director
Date:
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
LORETTA MOLINARI RN., M.S.N.
Associate Public Health Director
Director of Patient Services
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention. (845) 278 - 6014 Preschool (845) 278 -6082 . Fax (845) 278 - 6648
From: Gene D. Reed
Putnam County Department of Health
Fax #: a7/.— 3 6,9- /
No. Pages °Z
(Including cover sheet)
For your information Please respond ..
For our review Attached as requested
Y q
As discussed Please call
Notes/Messages
In the event of transmission /reception difficulties, please contact this office at
(845) 278 -6130 ext. 2261.
BRUCE R. FOLEY
Public Health Director
April 6, 2001
LORETTA MOLINARI R.N., M.S.N..
Associate Public Health Director
Director of Patient .Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (845) 278 - 6130 Faz (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 . Fax (845) 278 - 6648
Thomas M. Quartuccio, PE
1 Lounsbury Road
Croton -on- Hudson, New York 10520
Re:
Dear Mr. Quartuccio:
Field Inspection - Hanna
Lot # 11, "Quail Ridge"
Haviland Drive, TM# 22 -1 -36
(T) Patterson
The separate sewage treatment system for the above referenced property can be backfilled. The
following comments must be corrected in the field:
• All three (3) trees within the fill pad must be removed.
• Silt fence must be installed in the ground.
If you have any further questions, please contact me at (845) 278 -6130 ext. 2261.
GDR:cj
Very truly yours,
� n� e
Gene D. Reed
Environmental Health Engineering Aide
PUTNAM'COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES K
FINAL SITE INSPECTION V IVO,
0/
Inspocte Y: 41 ?Z,51i5l)
Street Location dAW1,4)yj2 -p7rjVj_::: Owner 7
Town 7',4 -r7 -g r,! V Permit#
TM tr a
, _a —) — 3/_ Subdivision Lot # /I
1. Sewage Systein Area
a. STS, area located as per approved plans ...........................
b. Fill sectioWdate of placement
3:1 barrier Lgth. - Width Avg.Dpth
c. Natural soil not stripped ..................................................
d. Stone, brush, etc., greater than 15,-from STS area
e. 100' from water course /wetlands ..* ................. .................
II. Seivagre Syste m
a. Septic tanksize 000 ....... 1,250 ......... 6th6 ................
- t�' Pevei ......................... z2i I ......
b.'Septictan ins ...............
c. 10' minimum from foundation ..........................................
d.. Distribution Box
1. All outlet ' s at same elevation-water tested .................
2. Protected below frost .................. . ...............................
...............
3. Miniinurn 2 ft.Original soil between box & trenches
e. Junction Box, - properly set .....................................
f..Arenches
T.-L-e-h-g-th required _,3 -2 5— Length installed 3 75-r
2.- Distance to watercourse measured+ I Oe> Ft .......... .
3. Installed according to plan ........................................
4. Slope of trench acceptable 1/16 - 1/32"Moot .............
5.` ' 10 ft. from property line - 20 ft.- foundations..........
6. Depthof trench <30 inches from surface.... ..............
7. Room allowed for expansion, ' 100% .................... 61�1_
8. Size of gravel 3/4 -1 %Z" diameter clean .....................
9., Depth of gravel in trench 12" minimum..........:::...... "
10. Pipe ends capped ................................... ; .....................
g. Pump or Dosed Systems
1. Size ot pump chamber .............. 4 ..................................
2. Overflow tank ....... .....................................................
3. - Alarm, visual/ndioi ...................................................
4. Pump easily accessible, manhole to grade ..................
5. First box baffled........ .................. .............. ..........
6. Cycle witnessed by 14. D.estimated flow/cycle ...........
III. House/Building
a. House located per approv6d*plans ... *.
b. Number of bedrooms ............
IV. Well
a. Well located as per approved plans ................................
b. Distance from. STS area measured.-t- I/ c ft...........
c. Casing 18" above grade .................................................
d. Surface drainage around well acceptable ........................
V. Overall Workmanship
a.. Boxes properly grouted ..................................................
b. All pipes partially backfilled ..........................................
c. All pipes flush with inside of box ...................................
d. Backfill material contains stones <4" diameter ..............
e. 'Curtain drain & standpipes installed according to plan..
f Curtain drain outfall protected & dir.to exist watercourse
g. Footing drains discharge away from STS area............
h. Surface water protection adequate ........................
i. Erosion control provided ................................................ .
YJ
0"Iff'R"x-
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IMAM
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IMM
Imm
Imm
Imm
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YJ
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner Ki 1l I N 4,&,U 0 � .' Address 0 DA0 AI'n.D�./4►�t P4"iic coa
Located at (Street) �AV �LAU D D 9J V& - - Tax Map 2S . Block I Lot 5-6
(indicate nearest cross street)
Municipality PAJT MSc7 u Watershed L/1S7- 4AA/ C-1 f,
SOIL PERCOLATION TEST DATA
Date of Pre - soaking =0 I Date of Percolation Test A--.z -- 01
..
;:. e:........
::I4: Ida:.:• ::
:Ruin:: :::
l YvP
>::Sta .::- : :Sto..., >':
..:.:..:..:.
e: Ti��e:
m
`:':: n: ::'.:':
•.: )..:
- e th to titer ..:
m round <``:.'.;
Fro G .:..: ,.. <.
u' ace �h....
rf m s
e
:Start_ :: :::Sty
::..:. ::..
e
Leve1
,..:. ........:...:..Iaho�i::
r
A . o I
n es
....�.......
Percy
Ra e
1
2,Z2 -�;7
2
13
3
3
10,,
10 13
3
�
a
10 13
3
5
_..
3
2
3
2
13
4
s
1 ) 7
3
'7
2..
It',�� Z'
22
I 2
7
3
l2, 2.
01-
1 f 1
3
4
12 S °�- 14
2
,5
NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each
percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be
submitted for review.
2. Depth measurements to be made from top of hole.
Form DD -97
DEPTH
G.L.
0.5'
1.0'
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 BOLES
HOLE NO.
HOLE NO.
HOLE NO.
2
Indicate level at which groundwater is encountered
Indicate level at which mottling is observed tip`
Indicate level to which water level rises after being encountered Aevl, - -4 .
Deep hole observations made by: Date
Design Yroressional Name: ?"GitI/�s �I/j��,� ,
Address: ,s .
Signature:-
Design Professional's Seal
QROFESSj��,
4.
o �
z'
G '9'
NZI
STATE
a
ca
Indicate level at which groundwater is encountered
Indicate level at which mottling is observed tip`
Indicate level to which water level rises after being encountered Aevl, - -4 .
Deep hole observations made by: Date
Design Yroressional Name: ?"GitI/�s �I/j��,� ,
Address: ,s .
Signature:-
Design Professional's Seal
QROFESSj��,
4.
o �
z'
G '9'
NZI
STATE
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
RE: , Property of
LETTER OF AUTHORIZATION
WA)
Located 'at amp ,l', % lac' .
—"' p- Zy '?6
Tax Map #�� � -_ - Block �_ —_ Lot ±;T
Subdivision of /%L_ '_)1Q; -z=
Subdivision Lot # Filed Map # _l�C� Date Filed2�
Gentlemen:
This letter is to authorize
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. -
ountersi gned:
P.E., R.A., # Cis 43 1 t t
Mailing Addresl G- �Jj ✓%�j'�
State /L ✓c I ' Zip
Telephone:
Very truly yours,
Signed:
(Owner of Property)
Mailing Address: . .d 7
State _, / I Zip /of 6
Telephone: ql / - Y� F(Q j V e'
Form LA -97
f
rr
t
BRUCE R. FOLEY
Public Health Director
April 6, 2001
LORETTA MOLINARI R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648
Thomas M. Quartuccio, PE
1 Lounsbury Road
Croton -on- Hudson, New York 10520
Re: Field Inspection - Hanna
Lot # 11, "Quail Ridge"
Haviland Drive, TM# 22 -1 -36
(T) Patterson
Dear Mr. Quartuccio:
f
The separate sewage treatment system for the above referenced property can be backfilled. The
following comments must be corrected in the field:
• All three (3) trees within the fill pad must be removed.
• Silt fence must be installed in the ground.
If you have any further questions, please contact me at (845) 278 -6130 ext. 2261.
Very truly yours,
Gene D. Reed
GDR:cj Environmental Health Engineering Aide
14.164 (1157)—Text 12
PROJECT I.D. NUMBER 617.21 - -- - -- -- _ _ - - -- - SEQR
-- Appendix C.
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM....
For UNL)STED ACTIONS Only. -
PART I— PROJECT INFORMATION (To be completed by Appiicant or Protect sponsor) -
1. APPLICANT ISPONSOR 2. PItOJECT NAME.
cil
3. PROJECT LOCATION:
Municipality //?WA
4• PRECISE LOCATION (Street a
rAk, 14
!
Jy %yJ�J County
i n "d road intersections, prominent landmarks. etc., or provide map)
S. IS PROPOSED ACTION:
New _- Q Expa:is o_ E] Mcdirccationtalteration - '� - - - -- -- - - - - -- -- - _ - - - . - -_- - -
6. DESCR:3E PROJECT BRIEFLY:
?. AMOU;1; OF LAND AFFECTEo: _ _ - -- -- - - - -- -- - -- - - - - -- -._. .
acres Ultiaateiy acres
R- 1111r� iPROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? "
I Yes No It No, describe briefly
9. YIrResidpeRSLAND USE IN VICINITY OF PROJECT?
ntia! G Industrial ❑ Connerciat ❑ Agriculture ❑ Park1F0re3UOpen space ❑ Other
Describe:
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL.
STATE OR LOCAIi?
Cl Yes _ No It yes, list agency(;) and permit/approrals
1t. DD° S ANY ASPECT OF THE ACTION HAVE A CURAEHTLY VAUD PERMIT OR APPROVAL ?,
Yes ON-0, It yes, list agency name and permit! pproval
j V1 S �6.,z yG
12. AS A RESULT OF PROPOSED ACTION Vi1LL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?
❑ Yes RNo
1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Apprican..Usponscr narne: Date:
1
;nature: • ,
If the action is in the Coastal Area, and you are it state agency, complete•the
Coastal Assessment Form before proceeding with this assessment
'ART Il— ENVIRONMENTAL ASSESSMENT (To be completed by Rgency)
A DOES ACTION EXCEED ANY TYPE i THRESHOLD. IN 6 NYCRR, PART 617.127 if yes, coordinate the review process and use the FULL E?AF.
❑ Yes 10 No
B. WALL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACnONS IN 6 NYCRR, PART 617.64• it 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, surtaee or'groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal,
potential for erns! n, drainage or flooding problems? Explain briefly
C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources-. at community or neighborhood character? Explain briefly
C3. Vegetation or fauna, fish, shellfish or wildlife species, significant. habitats, or threatened or endangered species? Explain briefly.
C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of u
or other naturai resources? Explain briefly -1
C5. Growth, subsequent development, or related activities finely to be induced b_y the proposed action? Explain briefly.
—_ C6_ Long .term, shortAern, cumutative, -or othifiifiects not identified in Ct•C5? Explain briefly.
C7. Other IT acts Q cludirig changes in use of either quantity or type of energy)? Explain briefly.
0. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS.?
❑ Yes ❑. No It Yes, explain briefly
ART III — DETERMINATION OF SIGNIFICANCE (ro be completed b A enc
INSTRUCTIONS: For each adverse effect identified above, determine whether it Is substantial, large, Important cr otherwise significant..
Each effect should be assessed in connection with Its. (a) setting (;.e. urban. or.rural); (b) probability_ of occurring; (c) duration; (d)
irreversibility; (e) geographic scope; and (I) magnitude. if necessary, add attachments.or-We rence supporting materials. Ensure that
explanations contairi 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'slgnlficant adverse impacts which MAY
occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration..
❑ Check this box if you have determined, based on the information and analysis above and any supporting
documentation, that the proposed action WILL NOT result In any significant adverse environmental Impacts'
AND provide on attachments as necessary, the reasons supporting this determination:
Name Of Lead Agency
Print or Type Name of Responsible Officer in Lead Agency Title of Responsible 0 icer
Signature at Responsible Officer in Lead Agency SiSnature of reparer (It 4iffettntfforn responsible o titer)
a
BRUCE R. FOLEY
Public Health Director
LORETTA MOLINARI R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648
May 15, 2001
Thomas Quartuccio
1 Lounsbury Road
Croton -On- Hudson NY 10520
Re: Proposed SSTS: Hanna
Haviland Drive, Lot # 11
(T) Patterson, TM #.25 -1 -56
Dear Mr. Quartuccio:
Review of plans and other supporting documents submitted at this time relative to the above-
regarded project has been completed. Comments are offered as follows:
1. It does not appear that an approval to install the trenches has been issued by this
Department. This is a violation of the Putnam County Sanitary Code. If you believe
a trench plan has been issued, please submit.documentation.
2. = Remove any reference to Laurent Engineering from-the plan. -^
3. The standard Putnam County as-built legend has not been provided.
4. Remove the soil certification from the as-built plan.
5: Source of the as -built survey is to be noted on the plan.
6. SSTS Guarantee has not been fully completed... (Enclosed)._ - - -
7. -Bactenological'water analysis results has notbeen submitt ed:
8. The locations of the. boxes and the ends of -all trenches are to be - provided -on the- - ---
plan,.
9. If contours are being shown, only existing contours are to be shown.
10. Please be advised that is may be illegal to use another engineers plans without the
explicit approval of said engineer.
Upon receipt of a submission, revised to reflect the above comments, this application will be
considered further.
RM:tn
enc. .
Ve ly your
Robert Morris, P.E.
Senior Public Health Engineer
�p
i�
BRUCE R. FOLEY
Public Health Director
LORETTA MOLINARI R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648
May 15, 2001
Thomas Quartuccio
1 Lounsbury Road
Croton -On- Hudson NY 10520
Re: Proposed SSTS: Hanna
Haviland Drive, Lot # 11
(T) Patterson, TM #.25 -1 -56
Dear Mr. Quartuccio:
Review of plans and other supporting documents submitted at this time relative to the above-
regarded project has been completed. Comments are offered as follows:
1. It does not appear that an approval to install the trenches has been issued by this
Department. This is a violation of the Putnam County Sanitary Code. If you believe
a trench plan has been issued, please submit.documentation.
2. = Remove any reference to Laurent Engineering from-the plan. -^
3. The standard Putnam County as-built legend has not been provided.
4. Remove the soil certification from the as-built plan.
5: Source of the as -built survey is to be noted on the plan.
6. SSTS Guarantee has not been fully completed... (Enclosed)._ - - -
7. -Bactenological'water analysis results has notbeen submitt ed:
8. The locations of the. boxes and the ends of -all trenches are to be - provided -on the- - ---
plan,.
9. If contours are being shown, only existing contours are to be shown.
10. Please be advised that is may be illegal to use another engineers plans without the
explicit approval of said engineer.
Upon receipt of a submission, revised to reflect the above comments, this application will be
considered further.
RM:tn
enc. .
Ve ly your
Robert Morris, P.E.
Senior Public Health Engineer
�p
i�
01/13/1999 09:41 9142713851 TLS CONSTRUCTION PAGE 01
m
- -. -___ _ ]PLTTNAIVI CO�TNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEAL'T'H SERVICES
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT-SYSTEM-
rAPPA,
Owner r Purchaser of Building Tax Map Block Lot
r
s moo. '���� .PATTW150 0 _ . -
Building Confftcted by Town/1re
�V l LJND D l y C- • Q UAi t ))6 G
Location - Street Subdivision Name
lrtico�, .1='tz�c Mo r>>� t_�►2 _ _ _ 11 _
Building Type Subdivision Lot #
I represent that I am wholly and completely responsible for the location, workmanship, material,
construction and drainage of the sewage treatment system serving the above- described property, and
that is has been constructed as shown on the approved plan or approved amendment thereto, -and in- :.:_.:
accordance with the standards, rules and regulations of the Putnam County Department of Health, and
hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition-
any part of said system constructed by me which fails to operate for a period of two years
immediately following the date of approval of the "Certificate of Construction Compliance" for the
sewage treatment system, or any repairs made by me to such system, except Where the failure to
operate properly is caused by the willful or negligent act of the occupant of the building utilizing the .. _
system.
- The undersigned further agrees to accept as conclusive the determination of thy: Public Health
Director of the Putnam County Department of Health as to whether or not the failure of the system
to operate was caused by the willful or negligent act of the occupant of the building utilizing the
system.
_. _ .._. Dated
Month Day . Year. _ _Signature: C.
JLL
�_ ... ._.... Title:
General Cofdraictor (Owner) - Signature
Corporation Name (if corporation)
Address:
State Zip
Corporation Name (if corporation)
Address:
State Zip
Foam GS -97
5 ILo' w
I — 1!I 11 \ \y
Q ACS ?T-
241 g 1
I� ABPT 5t3�
:iii. 41
4l JG z3
34 t,/ z3
34 OA
;Ji -f•JU p+y y
ns Pw. -i ! � • -- �
/ 1 t
/ 3s` JSi -I
I r IUC5o6dLTL ./
I I _
BSIDENGE
g1
k
a9y !r v m
N Iry t oo`
{i Ewar- FinTTc0.�.s4Fi�� `
H A_1
INITIAL L) E tGNEP-S 7
WIRENT ENGINEERING
ASSOCIATES,P. C.
M1LIBROOKE OFFICE CEMIRe
R—le 22 & Ni // /own Road
Lire s,' . New York 10309
10M '
1914I27B-610S - (1AYJ27B -Z65B
—_ CONSUL UIVO SITE ENGINEERS
AS BUILT DIMENSIONS
Tank or J.B.
"Y"
"X"
LF of Fields/JB
Took
�\ Q C..1
\ a
0
JB ql
28' -3"
48' -3"
35
2
34' -0
52' -8"
41
3
39' -11"
57' -0"
I — 1!I 11 \ \y
Q ACS ?T-
241 g 1
I� ABPT 5t3�
:iii. 41
4l JG z3
34 t,/ z3
34 OA
;Ji -f•JU p+y y
ns Pw. -i ! � • -- �
/ 1 t
/ 3s` JSi -I
I r IUC5o6dLTL ./
I I _
BSIDENGE
g1
k
a9y !r v m
N Iry t oo`
{i Ewar- FinTTc0.�.s4Fi�� `
H A_1
INITIAL L) E tGNEP-S 7
WIRENT ENGINEERING
ASSOCIATES,P. C.
M1LIBROOKE OFFICE CEMIRe
R—le 22 & Ni // /own Road
Lire s,' . New York 10309
10M '
1914I27B-610S - (1AYJ27B -Z65B
—_ CONSUL UIVO SITE ENGINEERS
AS BUILT DIMENSIONS
Tank or J.B.
"Y"
"X"
LF of Fields/JB
Took
33'6"
1714"
0
JB ql
28' -3"
48' -3"
35
2
34' -0
52' -8"
41
3
39' -11"
57' -0"
49
4
45' -10"
61' -2"
62
5
51' -9"
66' -0"
62
6
57' -9"
71'-0"
64
7
63' -9"
76' -2"
64
8
69'-8"
81' 3"
24
SIGNED: 4ti� �
/ N •'-
TOTAL 401 LF
10 -
Original Design Required 375 LF of Septic Fields 11 -15 thin soil rate
Compacted Soil 4/7101
rates
PT -1 7 minfinch
I
PT -2 13 minrn
/
T
PT -3 8 min/in
r
"This Design Professional has inspected the ROB fill material on 4.7 -Zoo I
82' • i'1'
h1 w and does hereby certify that such material has been placed and stabilized
4 `
is
in accordance with the requirements of the NYSDepartment of Health,
I
the Putnam County Department of Health and the approved ftl/ plan. The
'
material itself has been tested and at this time is considered suitable for
in
/
l u
use a subsurface sewage treatment system The soil percolation rate in
I
5�
the settled fill based on percolation tests aft stabilization is 11-15
In inrn ch. " ��CYGt�Y
tiro/
SIGNED: 4ti� �
/ N •'-
Design Professional
l
/
-
! 3a.�le}I i
•
(pry f
34 "r4 c.
y
5l1
a
("w 119rN6
1 i
MAID 7vt
r T
S cALE 1=30
D Pt 1 V a�° vx`c sstaygt
O
{
F
THOMAS M. QUARTUCCIO PE
1 Lo bury Baal
Cro — fludwq N.Y. 10520
Td & Fu 914-271 -3851
KaA. Hams
8 D-4 t� Pat"rsm N.Y. 12567
AS BUII.T SEPTIC PLAN P—it MP -29 -98
H-U-d Drh0. P.M— N.Y
Ts:NLpA Blade I Lai 56
DATE 4/6101 DWG NO. AB-1
PUTNAM COUNTY DEPARTMENT OF HEALTH
p, - DINIISION OF ENVIRONMENTAL HEALTH SERVICES
INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM
SECTION A. GENERAL INFORMA'T'ION
Name of Project' (T)(V)� County V-
Site Location 4" J V 440 (a.2 ell L�- t�
Building construction begun Extent `—
Is property within NYC Watershed ? ................. es ❑ No
SECTION B. TOPOGRAPHY (Please check all appropriate boxes)
1. ❑ Hilly F--] Rolling ❑ Steep slope J:::2'0'Gentle slope J:aflat (:f� 5S'i
2. Evidence of wetlands Low area subject to flooding
F-1 Drainage ditches PRock outcrops
3. Property lines or comers evident ....................... ...............................
4. Do water courses exist on or adjoin the property? ...............:...:
5. Will these affect the design of the sewage system facilities?............
6. Do watershed regulations apply in this development ? .......................
7 Will extensive grading be necessary? ................. ................,..............
8. Will extensive fill be necessary for SSTS? ..... ...............................
9. Do filled areas exist A ithin_the. SSTS. area? ...:... :::.:.:.:..........:..........:
If yes, what is the condition of the fill?
❑ Bodies of water
Yes ❑ No
❑ Yes
L� 110
❑ Yes
F--� No
YYes
F-� No
❑Yeso
❑ Yes
�to
❑.-Yes "No
- = - -..
SECTION C. SOIL OBSERVATIONS
10. Appearance of soil: E—y�and Gravel am Clay ❑ Hardpan fixture .
L� " ❑
11. Observed from: Borings .❑ Bapk cut
40'
Backhoe excavations
12. Soil borings /excavations observed by on ti, I
13. Depth to groundwater onw�
14. Depth to mottling on r
15. Are test holes representative of primary & reserve areas .... ............................... es No
16. Soil ercolation tests made b i+^� +A -tryL on i Z q8
P Y
17. Soil percolation tests N itnessed by on t .
SECTION D (on back)
Form ST -1
n ,
SECTION D. DRAINAGE -
18. Will proposed grading materially alter the natural drainage in this or adjacent areas? ❑ Yes L ��o
19. Will groundwater or surface drainage require special consideration? ..................... 0 Yes
20. Will gullies, ditches; etc., be filled and watercourses be relocated ? ...............::.:...... Yes, i'o
SECTION E. RENURKS
21. If a common water supply is proposed, has an inspection been made of the
existing or proposed source and facilities? .............................. ............................... F Yes No
Inspection data
22. Do adjacent wells a or sewage systems exist ?.. . es F No ''
.... ............. .....................
23. Additional con nts vv �iw
24. Site observerlinspector and title
25. Date(s) of observation(s)inspection(s)
113'.9
TEST PIT PROFILES
Hole k Lot 9 (
-Hole A 2 Lot
Hole € Lot r
Depth to water
Depth to water ora-k
Depth to water
Depth to mottling 6 k '
Depth to mottling
`I
Depth to mottling
Depth -to rock/imp... -
Depth to rock/imp. -,
f ti -
_. .
Depth*to rocklimp.
G.L. 6 Z
G.L.
G.L.
0.5 0�_ Gk ( S
0.5 �a�
0.5 ;.
1.0
1.0
1.0
2.0o l ' fL 2.0 2.0
3.0 S 3.0 . : 3.0
4.0 ..; ... 4.0 4.0. -
5.0
4Z 42
5.0 5.0
6.0 6.0 '6.0
7.0 7.0 U 7.0 3
8.0 8.0 8.0
9.0 9.0 9.0
10.0 10.0 10.0
PU I'NAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
I DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner - ,- AN to W Address C vO i L-
Located at (Street) lwq`r. 111tAID Tax Map 26' Block Lot
indicate nearest cross street)
Municipality --� Drainaae Basin
SOIL PERCOLATION TEST DATA
't
,' z, c
V- f, Ay'-
Date of Pre - soaking I I I Date of Percolation Test f (,
Hole No.
Run No.
Time
Start - Stop
Elapse Time
millin.)
Depth to Water
rom Ground
Surface (Inches)
Start Stop
Water
Level
Drop In
Inches
Percolation
Rate
'MinAnch
1
V'57�o���
22
.67
2
10-20
1-7
Z Z 2,S-
3
4
' s� ►r
��
ZZ
5
1
t�:og
I��•• 32-
ZZ
2 .
0 :33
--
Z��..
4
5
1
2
3
4
5
NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are ootainea at each
percolation test hole. (i.e. _< 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be
submitted for review. ;
2. Depth measurements to be made from top of hole.
Form DD -97
11 -17 -1998 1VSBAM FROM TO 92787921- P.03
(4 ®9.)
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Date:
To:
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road
Brewster, New York 10509
Tel. (914) 278-6130 Fax (914) 278 - 7921
FAX COVER SHEET
From:
Adam B. Stiebeling
Asst. Public Health Engineer
Fax #:
BRUCE R. FOLEY
Public Health Director
No. Pages 1 r
(Including cover sheet)
(-f #ice (rte.
For your information Please respond
Y AsF r your review Attached as requested
discussed Please call
Notes/Messages
�4vL c l `t I 7-q qe
In the event of transmission /reception difficulties, please contact this office at
(914) 278 -6130 ext. 157.
a
RECORD OF PHONE CONVERSATION
Time: 4z ; �3 °l
Date: j> 1,21 8
Person calling: ,% e _2=,c4- vYe Phone #:
Reason
() Inspection:
R ee and/ eres- �P C -�
Scheduled Field Meeting
Time:
Date:
Y N
Tentative /to be confirmed () ( )
Town: p<.k' ,
Road /Street: -C1 V - -GLla Y/ -
Tax Map
Comments:
.11 -17 -1998 11 :58RM FROM
'onger Hilt
1011
Cranberry Mtn.
M o
Browns Mtn.
ru��t ac.
3 �QRNNrKI RD.
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92787. \921 P .02
iRR4 ,4"
Brimstone Mtn.
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11 -17 -1998 11:57RM FROM
TO 92787921 P.01
LAURENT ENGINEERING
ASSOCIATdt, P.C.
MUBROOKE OFFICE CENTRE
R"o 22 8 Milltown Road
erewatof. Now York 10$49
.
(91a)278�tt�. (FAtp 27 ®-2688
HARRY W NICHOLS JR., P.E.
CONSULTING SITE ENGINEERS
FAX dRMSi'AAeSSION SHEET
Date:
Job No:
Number of
pages
including
this one:
To:
ADkrtb -ate►
Firms
PGµD
FAX Igo.:
From:
Jew— M90Q-f,
Project:
�vAti. P-+4Ns C' pk ot► L-OT 11
Message:
Please call (914) 278 -6108 if there
is a problem with
this transmission.
N
t '1f
�Qn1Y[COp[fRD�A1�lImlft�
di�wsiwhl6�M�. hwlif�w�lt1 - j
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PUTNAM COUNTY DEPARTMENT.OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date_• -
Re.: Property of �L.0
Located at,2�5
(T) f Sa,,J Section Block Lot II
Subdivision of
Subdv. Lot # J( Fi - M", # ai7• -q61 Date 3-y0• -5?:Z
Gentlemen:
This letter is .t.o ,authorize
a duly licensed professional engineer or registered architect
(Indicate
to apply for a Construction Permit.for.a separate sewage system, to
serve:the above noted property in accordance with the standards, rules
or.regulations-as promulaga.ted by the Commissioner of the Putnam ,County
Department of Health, and to•sign all necessary pap.ers on my behalf in
connection with this matter and to supervise the construction of said
.,system or systems in conformity with the provisions of Article 145 or
147, Education Law, the Public Health Law, and the Putnam Co.unty'Sani
tary. Code.
Countersign
P.E. , jj::* ,
Very truly yours,
Signed �f�h
Owner of frpperty
Address
Address Town
—7 Telephone
Telephone
co ac
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health, Services
AFF.IDAVIf� CORPORATE OWNER APPLICATION �
FOR PERMIT APPLICATION SUBMITTED TO
PUTNAM COUNTY HEALTH DEPARTMENT
TO:. Commissioner.of Health
In the matter of application for:
u 1 c
BONNIE L, NEMES
W'17ARY PUBUC, State Of New York
No. OtNE`, 076971,
a
Gfied in Dutch
ess Coun
r`c: c sron Fxphas 2128, �
f
IJCe-
represent that
to act for
I acn'an officer or employee of.the corporation. and am
authorizea .
N a f'Corporation)
having offices
at ;Z"
0 aa
ox3I
L�6d 2
Whose officers
President:
are:
�Q1�Yc`f�iCQ
• .� 1a�c
Ft ���I
,1 Q,Lo Fa
(Name 'and Address
Vice— President:
(Name and Address)
Secra *ary:
(jlame and Address)
_
Treasurers
(vame'and.Address)
and ndt I am and
cor:)oratio.n with
will be
respect
individually responsible for
to the approval requested and
any and all acts
all subsequent
of the
. acts relating
thereto.
.
Sworn to before
of
me.this
day Signed:
19� Tit 1 e :�d�2
2ti6�
N t P bl'
u 1 c
BONNIE L, NEMES
W'17ARY PUBUC, State Of New York
No. OtNE`, 076971,
a
Gfied in Dutch
ess Coun
r`c: c sron Fxphas 2128, �
f
PUTNAM COUNTY DEPARTMENT-OF HEALTH
'DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date
Re.: Property of Z/ft-
Located at.2f-9 ax 3i
(T) ?4M"2__&,0j -Section Block Lot—
Subdivision of
Subdv. I
Lot r4-Jad. Xap 7 -, Date te
VV m
. ..........
Gentlemen:
This letter is to 'authorize PE,
a duly.-licensed professional engineer or -registered architect
-(IndIci;1e)
to apply for a Construction Permitfor a separate sewage system, to-
serve. the above•noted property in accordance with'the standards, rules
,.or regulations as promulagated by the Commissioner of the Putnam County,
Department of Health,•and to-sign,all necessary papers on my behalf in
connection with this matter"an'd to supervise the construction of.said
,,system or systems in conformity with the provisions of Article 145 or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Countersi
P. E. fk=*
Very truly, yours
.Signed
Owner.of froperty
Address
Address Town
M6 .E
F Al.
XW 4 3 V
Telephone
Telephone
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services .
AFFIDAVIT — CORPORATE OWNER' APPLICATION
FOR PERMIT APPLICATION SUBMITTED TO
PUTNAM COUNTY HEALTH DEPARTMENT
TO:. Commissioner'-of Health
In the matter of application for:
S'i7cTio.J T��2ri iT �D� S�1�fr�.�i2�a.9c �yS•� ��d:��� 1�1. Lni Od
represent that I am an. officer or employee of.the corporation -and am authoriied'.
to act for.
(Name f Corporation) '.
having offices at ! "lGi� �4 V•�03
Pd"kl� �161� 260z
Whose officers are: j. .
President: �e,VY��a `� ����� 6t ���1 �� ;Al UQ
Fl�.
(Name `and . Address )
'Vice— President:
(.name and Address)
Secretary:
(;came and Address)
Treasurer:.
(Name ` and.Address) -
and that Tam and will be individually responsible for any and. all acts of the
cororation with respect to the approval requested and all subsequent acts relating
thereto.
Sworn to before me this �. day Signed:
of 19 -? Title: '
No tar-:: Public
BONNIE L. NEMES
ryi ;MARY PUBLIC. State of New York
No. 09NE5076971t
' 41!0ffed in Dutchess Cam
rxafres
- APril28,� •
Corporate Seal
PUTNAM COUNTY DEPARTMENT_OF.HEALTH
'DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date 7-22
Re.: Property of
Located at2¢q �` QF cr.. x
(T) Section /6-3,, ..Block Lot
Subdivision of��D(�=
a 1 ren rr .
Subdv. Lot # /( F4 -e-d- Map # Fi7. -qO Date
Gentlemen:
This letter is
to authorize
a duly - licensed professional engineer > or °registered architect
(Indicate
to apply .for a Construction Permit for ,a separate sewage system, to,
serve. the above noted property in accordance with'the standards, rules
or regulations as promulaga.ted by the Commissioner of the Putnam County
Department of Health,.and to-.sign all necessary papers on my behalf in
connection with this matter*`and to,supervise the construction of said
,system or systems in conformity with the provisions of Article 145 ?or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code..
OF NEW y�qy Very truly yours_,
�. Signed
Countersign d Owner .of roperty
P.E :.
Address /
pROF l 1��902
/I. P. 0. &x �� N
Address Town
X16 s /V /V 8 - i4 431 6 3 7
Telephone
s 9'z
Telephone
BONNIE L. NEMES
NC TARY PUgUC, State of New York
No. OiNESO769Yt;
tlaliffed in Outdhess Counts;;
t =i sron Ezplres AR6128, q
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services
AFFIDAVIT — CORPORATE OWNER APPLICATION
FOR .PERMIT APPLICATION SUBMITTED TO
PUTNAM COUNTY HEALTH DEPARTMENT
TO:. Commissioner'..of Health
In'the matter of application for:
FDOL
represent that
I am an officer or .employee of the corporation - and am
authorized,
to .act for
(Name f Corporation)
{
I
having offices
at V•'c.J04
P� 12402
Whose officers
ae:
��
�.
President:
I�,�trc�A�C� ��rac �}6� vl��l
t�1! el�olk
(name "and Address
,_ 4V0
"Vice- President:
(Name and Address)
Secretary:
(Name and Addzess)
Treasurer:
(Name` and. Address)
and fiat 'I am and
will be' individually' responsible for any and all acts
of the
cor oration with
respect to the approval requested And all subsequent
acts relating
therato.
Sworn to' before
me . this day Signed:
of
Title.:.,
Notar'- :.Public
BONNIE L. NEMES
NC TARY PUgUC, State of New York
No. OiNESO769Yt;
tlaliffed in Outdhess Counts;;
t =i sron Ezplres AR6128, q
` PUINAM CIXJNJTY - DEPAFr24ENT OF HEALTH L-07: 4�-- /
DIVISION OF RNBUZENTAL HEALTH SERVICES
DESIGN DATA SHEET- SUBSUFACE SEWAGE . DISPOSAL SYSTEM. FILE
Owner �v Address
Locates at (Street) r��ir��l _ �� l— Sec.. Block Lot
(indicate nearest' cross street)
Municipality Watershed .
SOIL PERCOLATION TEST DATA RBOUIRED TO BE SUBMITrM WITH APPLICATIONS
Date of'Pre- Soaking Date'of Percolation Test
HOLE
NUMBER CLOCK PERCOLATION PERCOLATION
Run Elapse Depth to.Water Fran Water Level
No., Time. Ground Surface In Inches Soil Rate
Start -Stop Min. Start Stop Drop In Min /In Drop
Inches Inches Inches
3
4
5
1 _
6
3
4
5
NOTES: 1. Tests to be repeated at same depth until. approximately equal soil rates
are obtained.at'each percolation test hole. All data to'be.submitted
for review..
2. Depth measurements to be made fran top of hole.
rev.,9 /85.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH, HOLE NO. HOLE NO. HOLE NO.
G.L.
2'
3'
4'. .
L / -l. iZt1✓ % / f
8'
10'
-
12'
13'
14'
- INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
INDICATE LEVEL, TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: DATE:
DESIGN
Soil. Rate Used 11� �"` Min /1" Drop: S.D. Usable Area Provided" X40
No. of Bedrooms �- Septic Tank - Capacity I11 S-v gals. Type
Absorption.Area Provided By _ L.F. x 24" width .trench
Other pE NEW
5
Name Signature
Address - L G' /. 51'2,rNC� / f�/LS S i SEAL
6f24, ;0 l l c� S 9u, �i �o, 051,
THIS SPACE ,FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved sq.ft /gal.: Checked by Date
It r PUTNAM COUN'T'Y DE PARTMEt?r OF HEALTH L-07-
DIVISION OF ENVIR0NMD7ML HEALTH SERVICES
DESIGN DATA .SHEET- SUBSUFAC..E SEWAGE DISPOSAL SYSTEM FILE NO. �- 7_�Z) ..
Owner (� T� Address; r
Located at (Street) 'vi„�,,�- �C, j - Sec. Block Lot
(indicate nearest cross street)
municipality �a�- ,�,L,tiJ Watershed
SOIL . PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH � APPLICAT'IONS ..
Date of Pre- Soaking Date of Percolation Test
HOLE
NUMBER C I= TIME PERCOLATION PERCbLATION
Run Elapse, Depth to Water Fran Water Level
No. Time Ground, Surface In Inches' Soil Rate
Start -Stop Min. Start Stop Drop In Min /In'Drop
Inches 'Inches Inches-
1.
_. 3
-4
5 7i Ul sn.✓
T
1 L-S
4
5
1
2
3
4 >..
NOTES: 1: Tests to be repeated at same depth until approximately equal soil.rates
are obtained at each percolation test hole. All data to* be submitted
for review.
2. Depth measurements. to be made from top of hole'.'
rev. 9/85
TEST. PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO.. HOLE NO. HOLE NO.
2'
31.
PDA
8'
10'
11'
12'
• 13' : .
.149
INDICATE LEVEL, AT .WHICH GROUNDWATER IS ENCOUNTERED
INDICATE LEVEL TO: WHICH WATER LEVEL. RISES AFTER BEING ENCOUNTERED.
DEEP HOLE OBSERVATIONS.MADE BY: DATE:
- DESIGN
Soil Rate Used / i .5 Min /1" Drop,: S.D. Usable Area Provided
No. of Bedrooms - Septic Tank Capacity IZS� gals. Type
Absorption.Area Provided By L.-F. x 24" width trench
pF NEW
Other
.
Name'o.�rtz�2i�c.E_ /"_►� Signature
Address .2 is i 1�l�l:�t>!/ S i SEAL _ 6
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil-Rate Approved sq.ft /gal. Checked by Date
SuaDiujsit►,L) — QizwZ Z!/2x
PUrNAM COUNTY DEPARTMENT OF HEALTH f- 07- ;
DIVISION OF HEALTH SERVICES
DESIGN DATA SHEET- SUSSUFACE- SEWAGE DISPOSAL - SYSTEM- - FILE NO. •- 9y
(bans C a, Address
Located at (Street) y Sec. Block Lot
(indicate nearest cross street)
Municipality , s,J Watershed
Date of Pre- Soaking Date of Peroolation Test
HOLE
NUKBER CLOCK TIME PIIROOLATION PERCOLATION
Run Elapse.. Depth to Water Fran Water Level
No. Time Ground Surface In Inches Soil Rate
Start -Stop Min. Start .Stop Drop In Min /In Drop
Inches Inches Inches
1
2
3
4
5 5�,� ���iui sc�.J �� ✓�%�
3
4
5
1
2
NOTES: 1. Tests-to be repeated at same depth until approximately equal soil-rates
are obtained at each percolation test hole. All data to'be submitted
for review.
2. Depth measurements to be made from top of hole.
rev. 9/85
x
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. HOLE NO. HOLE NO.
G.L.
1'
2'
3'
4'
d
s' /slo Lj ! �'�15'
9'
10'
11'
12'
13'
14'
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED --
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: DATE:
DESIGN
Soil Rate Used /6g1 -- Min /1" Drop: . S.D. Usable Area Provided adz?
No. of Bedrooms Septic Tank Capacity /ZSZ gals. Type
Absorption Area Provided By L.F. x 24" width trench
Other i'7L.� ti�F NEW
Name �& .c Signature o �m
Address i J i��r�✓� l/1 -s_i 6 SEAL
1�
THIS SPACE FOR USE BY HEALTH DEPARMENT ONLY:
Soil Rate Approved sq.ft /gal. Checked by Date
a� a
BRUCE- R... FGLEY --
Public Health Director
R. Petruccelli Engineer
392 Columbus Avenue
Valhalla NY 10595
Dear Mr. Petruccelli:
LORETTA--- M0L1NART'R:N:,- M:S.N.
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921
Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085
Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648
WIC (914) 278 - 6678 Fax (914) 278 - 6085
January 27, 1999
Re: Proposed SSTS: DeLucia
Haviland Drive
(T) Patterson
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.
If percolation tests were not witnessed by a representative of the New York City Department
Environmental Protection on this lot, percolation tests must be witnessed by a representative of this
Department.
1) Current codes requires that soil testing is to be witnessed by a representative
of this Department. Therefore, please schedule deep tests and percolation
tests with Gene Reed, Engineer Aide (ext.261) to arrange a mutually suitable
time.
2) All slopes in the SSDS area greater than 20% are unacceptable. All slopes
between 15 -20% must be reduced to 15% by the addition of R.O.B. fill.
3) Minimum distance from a trench to exposed rock/ledge is 10 feet.
4) Standard notes 1 -13 have not been noted on the plan.
5) United States Department of Agriculture soil type boundaries are to be
shown.
6) Datum reference is to be noted on the plan.
7) Erosion control measures for the house, well and SSTs are to be shown and
detailed on the plan.
..-1 4
- Letter to: -R. Petruccelli Engineer- = January -27,"1999 -2 =-
8) Location map, minimum scale 1 "= 2000', is to be provided.
9) Dimensions from the well to the property lines are to be shown.
10) Water service connection from the well to the house is to be shown.
11) Current Tax Map Number is to be provided on Construction Permit, Well
Permit applications and the Title Block.
12) Current PC -97 is to be submitted (enclosed).
Upon receipt of a submission, revised to reflect the above comments, this. application will be
considered further.
RM:tn
enc.
Very truly yours,
! ' b ,,/ &Yk,
Robert Morris, P.E.
Senior Public Health Engineer
In
!/ice Aii
sopleaft sm
VOW,
�Fewoftblo for
•
In
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVI1ROtM71AL HEALTH SERVICES
DESIGN- DATA.•SHEET- SUBSUFACE SEv9AGE DISPOSAL - SYSTEM -- FILE -N0: - -
Owner (�N i �o,�.0 rv�vS77Zt e_S C. i� Address S- razes,- ! LtJ
Located at (Street) Z_ Sec. /a Block 3 Lot ��-
(indicate nearest cross street)
Municipality �i1- i2Se„� Watershed Ny['_
SOIL PERCOLATION TEST.DATA RBOU.iRF.D TO BE SUBMITTED WITH APPLICATIONS
Date of Pre- Soaking Date of Percolation Test
HOLE
NUMBER CLOCK TIME PERCOLATION PERCOLATION
Run Elapse Depth to Water Fran Water Level.
No. Time Ground Surface In Inches Soil Rate
Start -Stop Min. Start Stop Drop In Min /In Drop
Inches Inches Inches
1
2
3
4
5
2
3 �ii�✓ /yg/
4
5
1
2
3
4 '
5
NOTES: 1`. Tests'to be repeated at same depth until approximately equal soil rates
are obtained at each percolation test hole. All data to be submitted
for review.
2. Depth measurements to be made fran top of hole. .
rev. 9/85
TEST PIT.DATA.REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
_ DEPTH - HOLE - -NO. -- -- - HOLE NO. -. - _ .. HOLE
G.L.
1'
2'
31
4°
5'
6'
7'
8'
9'
10'
11'
12'
13'
14'
�r v3aiu /siv�J /ZoyA
INDICATE LEVEL AT WHICH GROUNDWATER IS ENODUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENMUN'IERED
DEEP HOLE OBSERVATIONS MADE BY: DATE:
DESIGN_
Soil Rate Used �[ —r 5 Min /1" Drop: S.D. Usable Area Provided 5DOCI
No. of Bedrooms 4 Septic. Tank Capacity gals. Type (1,,.,c_
Absorption Area Provided By L.F. x 24" width trench
fir, NEY1/ yQQ
Other' \P x
Name n �/i,��1rurr�� Signature
s
Address SEAL4` '
Pte' �-iJel °� ifr✓2 -� i . S l
05�
t�tLJ� -7ani l7� i .S . 5 y ` `��
. SF4PRnsrec�nC�p\
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved sq.ft /gal. Checked by Date
punpm aXJNrY DEPART OF HEALTH
DIVISION OF HEALTH SERV'IC'ES
' DETAGliCD RE�tDSUTI/,!r �'s► �41.0 FAMIL�I � -
DESIGN DATA S=- SUBSUFACE SEWAGE DISPOSAL SYSM FILE NO. -
9lo MAIu•STRGET CSvLTG C�
Owner Lc-c GQ MAC.! 4- FioRCH Address= sREWS2EM .
- i- 1AYIL./�lJD DQlVC AhID
Located at .(Street) �.Slz-i MSTow36 I+%LL ROAD Sec. - 18 Block 3 Lot Z
(indicate nearest cross -street)
Municipality -i A -r7TF- ZSo>,ft Watershed C r o Ta )z
SOIL: PEROOIATION TEST DATA MUIM TO BE SUBMITTED WITH APPLICATIONS
Date of =Pre- Soaking i ( P-:571 8 Date of Percolation Test
LOT ` � � PERCOLATION PERaOLATION
NCiMSFR L-UJL TIME
Tizs - ►'•
21
2.q-
Run Elapse
Depth to Water Fran
Water Level
3
im
HO, Time
Ground Surface
In Inches Soil
Rate
start-Stop Min.
Start Stop
Drop In.
MinlIn Drop
Inches Inches
Inches
Z7
3
3..-
l 2
Tizs - ►'•
21
2.q-
Z7
3
7,0
3
Zz
z4.
Z-7
4
;
5
Z• 2
: S3 - Z : 3' 3
q-5
Z 9-
Z 7
3
Z1.41 - 3' 2 4-
5
2
--
• 3
4
NoTFS: 1. Tests to be repeated'at same depth until approocimately equal soil rates
are ' obtained at each percolation test hole. All data to' be suhmi.tttd
for review.
2. Depth measurements to be made from top of hole.
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date
Re: Property of—I)&)���
Located at & (1 (L S-
(T)� Section Block Lot
Subdivision of �V�J D C/
Subdv. Lot .# Filed Map # TDate
Gentl emett :
This letter is to au +horize AE*AJ*,4 (74A,4elilrZJC ,4X,
a duly licensed professional engineer (19'!e�•d+.R'su$i19 ' a
{ Lndicate
to apply for a Consiruction perm;,;, for a separate se�rage system, to
serve the above noted property in accordance with the standards, rules
or regtUations as prOMUlagated by the Commissioner of the Puta.am County
Department of Health, and to sign all necessary papers on my behalf in
connection w9,th this matter and to supervise the construction of said
system or systems in• conformity with the provisions of Article 145 or
147, Education Law, the Public Health Law, and the'Putnara County Sani-
tary Code.
Very truly yours,
Signed
CO=tersi.gned: Owner £Property
P'E'' Address
��,,��-
Addr�Fia y (�
Telephone
Town
Telephone
TEST ■ • Y• ' E• t ■RM TO BE SUBMITTED WITH ... d, •
DESCRIpTION OF • ■ S ENODONTERED IN TEST EOLES
DEPTH HOLE - NO. - -- HOLE W. H NO.
G.L.
2' �/i`NAY V Qi.vGL T
3'
4'
• i
6' t
71
8'
9t
10'
�T •
12'
13'
144
INDICATE LEVEL AT WHICH GROUNU?MM IS" ENCOUNTERED"
INDICATE LEVEL M WHICH WATER LEVEL RISES AFTER BEING.EN000NTERED N
DEEP HOLE OBSERVATIONS. MADE BY: M. sut�'Zi ,isr-1 CLARK DATE: JX 1 (./ 8S
DESIGN
Soil Rate Used 1 i -1 S' Min/1" Drop: S.D. Usable Area Provided.
No. of Bedrooms • 3 Septic Tank Capacity i O o o gals. Type
Absorption Area Provided By S75- L.P.-.x. 24" width trench
Other z 1=Ga— - i � k-
N E W
Name i�A►.! �o c.p1 -1 U� LA R�r��-, P;r -- . Signature
Address "7 3. 'FA I R 7 R I y E SEAL EI Z "i
C
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY::
Soil Rate Approved sq.ft/gal. Checked by Date
//
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N32'32'3 L4 i
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LOT A
SOIL.
NO OR
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BY 7
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