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HomeMy WebLinkAbout1078DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.54 -1 -28 BOX 11 ME 11 'i No r m " 1 L I IN`r4 � r '- g IN - 0 ''''' ' r I : +- 9 -�' z L PUTNAM COUNTY DEPARTMENT OF HEALTH -� -DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION:COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # JR -7! =/O Located at 767NC%A) &r27 Rac�W Town or Village Acr /te%,�unn Owner /Applicant Namegaa er]`,,'l` 7o"4, , Tax Map Z.S .if Block �_ Lot 9,6 Formerly Subdivision Name .Pro o7r�%grre•�.SiH4a�6gafr Subd. Lot # 7S"¢9 Mailing Address /A y ,(7&x 8,73 4 /re�,sfer &Y Zip Oli-e 9 Date Construction Permit Issued by PCHD ! 447 11J Separate Sewerage S, stem built by ' L vN.'s /%n1 ;f y Address Consisting of /J00 Gallon Septic Tank and - SegAOCq y Pre 7 oa r z;;utC_Xi Other Requirements: F /ya7� g Qu7` /e7`,��5i� �►4�d er Water Suppy Public Supply From Address or: Private Supply Drilled by/(f, /¢&q'&_,-,fov1 Address ;gm �tl�ey! Al Building Type, Has erosion control been completed? - yes Number of Bedrooms ur Has garbage grinder been installed? A1,9 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: 9 /c Ll I- Certified by ��� P.E. &/ R.A. Al (Design Professional) Address License # -- 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 sewerbecomes 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 revocation, modification or change is necessary. By: , �• Title: Date: Whit c py - 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 VNellPec WELL COMPLETION REPORT Well Location Street Address: Town/Village: Tax Map # GPS 7o A/tW4U -v A ��2r11oA S4 Map Block, Lot(s) Well Owner: Name: Address: to 41 /�O,der k�33 ��ews �t�- N Use of Well 1- Primary Residential _Public Supply Air cond /heat pump _Irrigation Business Farm Test /monitoring —other(specify) 2- Secondary Industrial Institutional Standby Drilling Equipment otary _Cable percussion _Compressed air percussion_Other(specify) Well Type _Screened VOpen end casing _ Open hole in bedrock _Other Total Length eft. Materials: Steel Plastic Other Joints: Welded ✓ Threaded Other Casing Details Length below graddv ft. Seal: Cement grout Bentonite Other Diameter (0 in. Weight per foot ) &lb /ft Drive shoe: Yes _ No 1/ Liner: _Yes _No 1i Diameter (in) Slot Size Length (ft) Dept to Screen (ft) Develo ed? First _Yes No Screen Details Hour s Second Well Yield Test _Bailed _Pumped _ Compressed Air Hours_ Yield 1S— gpm Depth Date Measure rom land surface - static specs k) 36 During yield test (ft) Depth o compete we m . 1 3 o S. Well Log Depth From Surface Well Diameter If more detailed ft. ft. Water Bearing,_' in Formation Description Land surface information . . _. descriptions or sieve analyses are available, please attach. If yield was tested Feet Gallons Per Minute Pump /Storage Tank Information Pump Type ps, — ,%#Capacity i A- If Depth 275 9 11$S , Model Voltage O r ?2v HP 0• Tank Type .3 • to Volume at different depths drilling list: Date VVe Comp ted h ���„ / Well Driller � F `;: k� 'Pump Installer PC Cei tiflcate�# +0 ;Date 'k d� d 4 "'' .XkV yS k _rye R ='� PC ,Cettifcate #...x °* NY State #rJ of R po x w' x a� , z w �, z � P Well riller Name4 Address � �x )y % E L �a} _ ;,�.r vx� >�i.',:�76 s,. x3?-ax�'"t; Well Driller (' ture) k � x K 4J1 w %.R• �, 4 x :, �. ��ke..� . >i a x•^ �•"�:'� um Instal er Name °8rAddress� y k "`_ " p x s x n, r [ yb.y J' `-E k: Y �.s 4 Y J. :" I; •'4R j j'. i E "`'�j� w A .': i '1... _� _ .. .vy .X '.`` l .J.•, x.xxx«`..� P staller(slgnature)�, .iRXt.H"u'`.� dYYu.xp+ �.*..[ ?"k�� =r: +�krc.`;. ''^`, h C l'.x":�i +F t y i."' x' 'C NOTE: Exaj Location of well with dista ce I to at least two permanen&L+dmarks to be provided on a separate sheet/pl�b White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM %t ®�er�rr %rah 1,7;;. oZ.Y:.f"`r' l a28 Owner or Purchaser of Building Tax Map Block Lot Z?e4erf s e�nAi`r T Building Constructed by 74 NOA,7 ev,4_ >SW Location - Street if 113M__I'v�`i Town/Village Subdivision Name /&to-'o_ 7,,r,09- 7X9 9-I -2 el,5 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 a building utilizing the system. t 1-n Dated: Month Day 0 Year Signature: _Zj Title:. General Contr ctor (Owner) - Signature Corporation Name (if corporation) Address: State Zip Sta11Cl2 Corporation Name (if corporation) Address: State Zip Form GS -97 ,I a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM J;;- aZ3'✓'9� a28 Owner or Purchaser of Building Tax Map Block Lot Aellxdyt rr ra—& . T Building Constructed by 74 Ne& � Err 1?W Location'- Street it / Gtmvvz,�1-11 Town/Village Subdivision Name 7(orf 9 - 7r Y-1 lwrc e /$ 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 Zel building utilizing the system. Dat ed: Month Day 0 Yearii Signature: ° 1 t7�jF Title:.,L�IL,���/ General Contr for (Owner) - Signature Corporation Name (if corporation) Address: Corporation Name (if corporation) Address: State Zip State .Zip Form GS -97 - 7580 7579 3 7578 _ N 0 ail Q� ,wRra f'ARG�L "d' AZ A - 1.825 AC. AMA - 1.958 AC t 1, pw sir 1 i 1. FIN 51;T lmmw -gii � 4 pb: 6 , 5rONr W5. MT..WALL O,H, - x 287,62' � �Jx• 6�g 1 s \ �p dfi STONF- MA5. MT. WALL \0 \. PAR( r? tZtir. WALL \ 1. .�G 00 GAL P/ CONC a �a� SEPTIC CIrANK \ N P� a FLOANNO S \ F \ 1 3 OUTLET \ \ OSIN O� D BOX \ \ CHAMBER\ S \ PUTNAM COIINTY DE:PPRTMFNT OF E DIVISlO i OF en!'+liRt�PJ; "v [:PJT"!_ H[ALc � APRRD +,Tn A5 PsOTGf1 i�Or f,PPLIf P'L. Ni.iifS.irPJCii +_C`tll.A'ii. \ \ S \ PU "iht�fri COI;fJ'ft` E;F.i +.L'fIl C +cP ;i7i� flTLE gybf SSTS DESI N .' ATA \ \ S3 \ \ y 1) 6 BEDROOM RESIDENCE: DESIGN FLOW--7! 2) SEPTIC TANK CAP, REQUIRED- 1500 GAL fl� \ \DRILLED / 3) SOIL PERCOLATION RATE: 11 -16 MINI IN \ g 1'r2AN5FO�M�� - \ >s MF-;TT-;R PDX S, a C) Wi AMA - 1.958 AC t 1, pw sir 1 i 1. FIN 51;T lmmw -gii � 4 pb: 6 , 5rONr W5. MT..WALL O,H, - x 287,62' � �Jx• 6�g 1 s \ �p dfi STONF- MA5. MT. WALL \0 \. PAR( r? tZtir. WALL \ 1. .�G 00 GAL P/ CONC a �a� SEPTIC CIrANK \ N P� a FLOANNO S \ F \ 1 3 OUTLET \ \ OSIN O� D BOX \ \ CHAMBER\ S \ PUTNAM COIINTY DE:PPRTMFNT OF E DIVISlO i OF en!'+liRt�PJ; "v [:PJT"!_ H[ALc � APRRD +,Tn A5 PsOTGf1 i�Or f,PPLIf P'L. Ni.iifS.irPJCii +_C`tll.A'ii. \ \ S \ PU "iht�fri COI;fJ'ft` E;F.i +.L'fIl C +cP ;i7i� flTLE gybf SSTS DESI N .' ATA \ \ S3 \ \ y 1) 6 BEDROOM RESIDENCE: DESIGN FLOW--7! 2) SEPTIC TANK CAP, REQUIRED- 1500 GAL fl� \ \DRILLED / 3) SOIL PERCOLATION RATE: 11 -16 MINI IN \ s \ \ `/ / PURIAM COUNTY DEPARTMENT OF HEALTH l�lill�I J "; i;:. i 3 VI; 4�Pd',f3I Fl ?t'11_ H.E, L.TI-1 SERVICES. Af1fT0'vED t;.., 1,' . r' _CiULA'h('. v„ (jI= TP,E 1•EAL :I'll DEF'A,fl 1i �:t�'i . 2ATA rte �( -(!TL) 4w STS DESI N .) 6 - BEDROOM RESIDENCE :• DESIGN FL0 W- 75Cgpd- SEPTIC TANK CAP. REQUIRED: 1500 GAL ) SOIL PERCOLATION RATE: 11 -15 MIN / IN ) ABSORPTION TRENCH REQUIRED: 469 LF ABSORPTION TRENCH PROVIDED: 588 LF I DOSE TEST NOV. 15, 2013 DRAW =13" , DOSE =285 gal SEC NO: 25.54 BLOCK NO:1 i/VVAiJLV1\ 1TALMK NTS OFFSET DIMENSIONS # ITEM "A" "B" "C" 1 ST -CTR - 14.5' 32.2' 2 DC - 22.2' 35.5' 3 D -BOX 108.2' 85.5' - 4 TE 102' 81' - 5 TE 99' 81' - 6 TE 96' 82' - 7 TE 93' 84' - 8 TE 91' 85' - 9 TE 69' 24' - 10 TE 64' 25' - 11 TE 59' 26' - 12 TE.' 54'. 29' - 13 TE 48' 33' - 14 TE 108' 88' - 15 TE 104' 88' . - 16 TE 100' 87' - 17 TE 97' 89' - 18 TE 93' 88' - 1.9. TE 157.. _ 145'--- .. :... . 20 TE 158' 149' - 21 TE 157' 150' - 22 TE 157' 153' - 23 TE 147' 145' - 24 WELL 279' 240' - HOUSE LOCATION AND PROPERTY BOUNDARIES FROM SURVEY PREPARED BY: TERRY BERGENDORFF COLLINS STARR RIDGE ROAD ,BREWSTER, NY LOT NO: 28 ATE: I DESCRIPTION 1BY /CKI DATE: I DESCRIPTION BYICKI OF NFw y a. BU$�y ;10 AS -BUILT SEWAGE DISPOSAL SYSTEM DATE: .17-25-14 SCALE: 1 1"=30' YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 - - Albert H.-Padovani, Director ** TEST REPORT ** LAB #: 1.401156 CLIENT #: 2500 NON STAT PROC PAGE: 1 of 2 ANDERSON WELL DRILLING 152 BARGER ST ATTN: NORMAN PUTNAM VALLEY, NY 10579 DATE /TIME TAKEN: 04/03/14 12:15 DATE /TIME RECD: 04/03/14 01:20 REPORT DATE: 08/22/14 PHONE: (845)- 528 -1491 SAMPLING SITE: 70 NEWBURGH DR, PATTERSON, NY SAMPLE TYPE..: POTABLE BATHTUB PRESERVATIVES: HNO3 COLD BY: NORMAN TEMP RECEIVED: <20 >4.00 NOTES...: COLIFORM METH: MF START DATE /TIME END DATE /TIME FLAG PROCEDURE RESULT NORMAL - RANGE METHOD. PUTNAM CNTY PROFILE 04/03/14 0430 04/04/14 0400 MF T. COLIFOR ABSENT /100 ML ABSENT SM 18 -20 9222B 04/08/14 LEAD (IMS) <1.0 ppb 0 -15 ppb SM 18 -19 3113B 04/04/14 0300 04/04/14 0410 NITRATE NITRO 5.85 MG /L 0 - 10 HACH 10206 04/04/14 0320 04/04/14 0425 NITRITE NITRO <0.01 MG /L 1.0 MG /L SM18- 20450ONO2 04/07/14 IRON (Fe) <0.06 MG /L 0 -0.3 mg /l SM 18 -20 3111B 04/09/14 MANGANESE (Mn <0.01 MG /L 0 -0.3 mg /l SM 18 -20 3111B 04/11/14 SODIUM (Na) 79.80 MG /L N/A SM 18 -20 3111B 04/07/14 0404 04/07/14 0406 * pH 6.9 UNITS 6.5 -8.5 SM18 -20 4500HB 04/08/14 HARDNESS,TOTA 200 MG /L N/A SM 18 -20 2340C 04/04/14 ALKALINITY (A 112 MG /L N/A SM 18 -20 2320B 04/03/14 0150 04/03/14 0153 TURBIDITY (TU <1 NTU 0 -5 NTU SM 18 (2130B) COMMENTS: MFTC ota liform = This result indicates that the water (was not) of a satisfactory sanitary quality according to ew York State and EPA federal drinking water standard for this parameter. This comment applies to the Total Coliform test only. Pb /Cu LEAD limits for public schools are set at 15 ppb. EPA Lead & Copper Rule for Public Systems requires that no more than 10$ of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg /L, else water treatment must be undertaken to reduce the waters corrosive potential. Fe /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. IMS = IMMEDIATE METAL SAMPLE.(INTERPRETATION: WATER SAMPLED AFTER SITTING UNDISTURBED A MINIMUM OF 6 HOURS OR OVERNIGHT) NMS = NORMAL METAL SAMPLE. (INTERPRETATION: WATER SAMPLED AFTER RUNNING FOR 10 -15 MINUTES MINIMUM) YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovani, Director ** TEST REPORT ** LAB #: 1.401156 CLIENT #: 2500 NON STAT PROC PAGE: 2 of 2 ANDERSON WELL DRILLING 152 BARGER ST ATTN: NORMAN PUTNAM VALLEY, NY 10579 DATE /TIME TAKEN: 04/03/14 12:15 DATE /TIME RECD: 04/03/14 01:20 REPORT DATE: 08/22/14 PHONE: (845)- 528 -1491 SAMPLING SITE: 70 NEWBURGH DR, PATTERSON, NY SAMPLE TYPE..: POTABLE BATHTUB PRESERVATIVES: HNO3 COLD BY: NORMAN TEMP RECEIVED: <20 >4.00 NOTES...: COLIFORM METH: MF ------------------------------------------------------------------------ �----------------- - - - - -- START DATE /TIME END DATE /TIME FLAG PROCEDURE RESULT NORMAL - RANGE METHOD Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg /L of Sodium.. For those on a moderately restricted diet, a maximum of 270 mg /L of Sodium is suggested. *, pH Hd ALK pH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. pH IS A FIELD MEASUREMENT AND IS TESTED OUTSIDE THE HOLDING TIME. pH REPORTED FOR REFERENCE ONLY. TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG /L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG /L, DEPENDS ON THE SOURCE AND.TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0 -70 MG /L VERY HARD WATER: ABOVE 300 MG /L MODERATELY HARD WATER: 70 -140 MG /L MG /L = MILLIGRAM PER LITER HARD WATER: 140 -300 MG /L (1 grain /gallon = 17.2 MG /L) (ALKALINITY REPORTED AT pH 4.5) IMS IMS = IMMEDIATE METAL SAMPLE. (INTERPRETATION: WATER SAMPLED AFTER SITTING UNDISTURBED A MINUMUM OF 6rROURS OR OVERNIGHT) AND ABOAT TES TOOTH S �ME REQUIREMENTS SUBMITTED BY: P,*dovXni, 'M.'T'. (ASCP) Dire`t-tor ELAP# 10323 ! 08-22-'14 14:21 FROM- [­-fj BR7CE -R. 'FOLEY - -.. `_ -_. _... Public Health Director T -400 P0002/0002 F -766 :. ..... -- -LARETTA, MOLIAIARL IL.N, KS _ Associate Public IIcalth birector ,Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road' Brewster, New - York 14509 Euvironmealal 119ift (914)278-6130 rux (914) 218-7921 Nursing Services (914)279-6558 IYIC (914)278-6678 Fax (914) 218-6095 E30y Intervention (914}27.3-6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 E911 AA �:SS VERIFICATION FORM OWNERS NAME: _c_ Ac:l` 7M2 zai ll . r. TAX IVIAP NUNIAER: S'. E911 ADDRESS: 7D a'VI(W o TOWN: A1IJ- kl!ORIZ.ED TOWN OFFICIAL: (Signature) _...__.. DATE: : _ ' jrz• - _The Putnam County Department of Health, will not issue a Certificate of C�rstrrrcfro-n C- vmpliance- unless the above form is completed, -i:e aa- legal-r91 i addre.5s is assigned by ai a' authorized town official: This forty ls*to be submitted ivifll the application for a Certificate of Construction Compliance. (E911 VIIU -W 11-11-'13 15:06 FROM- ATTENTION T-315 P0001/0001 F -316 a* PUTNAM COUNTY DEPARTMENT OF HEALTH DAgSION OF-ENVIRONMENTAL MALTA SERVICES K JOSEPH REQUEST FOR FINAL INSPECTION Z GENE For: Fal All Wormation must be fully completed prior to any Trenches inspections being made. PCHD Construction Permit #. / _.af —/C? -_ Located: ! eP &e--, (T) (V) %��3 fjc 4 Owner /Applicant Name: TM Ar-J-'f' Block Formerly: Subdivision Name:,E �7 i •rG�s � Subdivision Lot # 7 9l? - Is system fill. completed? A-2,4 • _ Date; Is system. complete? �19 Date: ! /3 Is system constructed as per plans? s Is well drilled? .yf X ]late: _ Is well located as per plans? S Are. erosion control measures in place? � s 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 PCHI) . Construction Permit and approved plans and the .Standards, Rules and Regulations of the Putnam County Department of Health. _... _ Date: %111,1bj Certified by; PE k - - -- RA..`.. esign Profess onal Address-,,1V Aq®� 7& AV j c.s�r. i7`c. �o �s��-,FL•1%,� Lie. # C� ,�*`" .•Z ¢ Comments: /w/ s'� /� 7`s r �- r 1, ,V,0eC:r7 Form. FIR -99 ALLEN BEALS, M.D., J.D... a MARYELLEN ODELL Commissioner, of Health * . x' County Executive. MORRIS, " ORRIS, P.E., MPH Director ofEnvironmental Health DEPARTMENT. OF HEALTH. A Geneva Road,. Brewster, New York 10509 December 11, 2014 Phone #-(845) 808 -1390 Fax # (845) 278 =7921 Bibbo Associates Joe Buschynski, .P.E. Mill Pond Offices 293 Route 100,: Suite 203 Somers, NY 10589 Re: Field Inspection — Stanton 70 Newburgh Road (T) Patterson, TM 25.54 -1 -28 Dear Mr. Buschynski: A re- inspection at the above referenced lot has been completed. There are.no open comments to be addressed at this time in reference to this Department's open work inspection. If you have any further questions, please contact me at (845) 808 -1390 ext. 43261. . Sincerely, Gene D. Reed Principal Environmental Health Engineering Aide GDR:cw ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E., MPH Director of Environmental Health October 21, 2014 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 Bibbo Associates Joseph Buschynski 293 Route 100, Suite 203 Somers, NY 10589 Re: Field Inspection — Stanton 70 Newburgh Road (T) Patterson, TM 25.54 -1 -28 Dear Mr. Buschynski: MARYELLEN ODELL County Executive Per your submission for final compliance, the following item has not been corrected per this \ department's comment letter dater November 18, 2013. ..... .•- .• .I'he_ well :casrng.needs to•be- l$" above grade: �• � - If you have any further questions, please contact me at (845) 808 -1390, ext. 43261. Sincerely, Gene D. Reed Principal Engineering Aide GDR:cml ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E., MPH Director of Environmental Health November 18, 2013 DEPARTMENT OF HEALTH 1 Geneva Road,. Brewster, New York 10509 Phone # (845) 808 -1390. Fax # (845) 278 -7921 Bibbo Associates Joseph Buschynski 293 Route 100, Suite 203 Somers, NY 10589 Re: Field Inspection — Stanton 70 Newburgh Road (T) Patterson, TM 25.54 -1 -28 Dear Mr. Buschynski: MARYELLEN ODELL County_ Executive. - - The above referenced separate sewage treatment system can be backfilled. The following comments must be Corrected in the field: 1.. Erosion control measures have not been installed at time of inspection. 2. The well casing needs to be 18" above grade. If you have any further questions, please contact me at (845) 808 -1390, ext. 43261. GDR:clm Sincerely, -;c>,. 'C5-� Gene D. Reed Principal Engineering Aide r• � r � i� �, r.; ^� + per+ • -~ � � C TO: %0 N7c DATE: % / 77/ `t' RE:. 9rr7`v� S�FTS' 'ME ARE SENDING YOU ( ) ATTAGiED ( ) UNDER SEPARATE COVER THE FOLLOWING ITEMS VIA # COPIES DESCRIPTION LAd ft'c �7`ah Gr%i �Gr ciq i•7` 3 Gc�arA 7Rcc farms . THESE ARE TRANSMITTED AS CHECKED BELOW: (� FOR YOUR APPROVAL ( ) AS REQUESTED IREMARKS: COPY TO., PUT;AM COUNTY SLN 1 AU DE °AR 1�11ENT OF !- EALTH SIGNED: 293 ROUTE 100 - SUITE 203 SOMERS, NY 10589 (914) 277 -5805 - (914) 277 -8210 FAX - bibbo @optonline.net IFENaOSURESARENOTASNOTED, IaN ®LYNO77FY USA TONLEAT(914)Z77= S r u 11rAiv1 L V u N T Y DEYAKIMEN T OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH -SERVICES FINAL SITE INSPECTION Date: Inspected by: Street Location 6iffimkm % A4eiA) QLQ1 Owner. Town_ Y1 Permit # oY /o - TM # s �� / — 2-� Subdivision Lot # 1: Sewage System Area a. STS area located as per approved plans ..........:................ b.. Fill section- date of placement 3:1 banier Lgth. Width,_. Avg.Dpth c. Natural sod not stripped. ................................................. d. Stone, brush, etc., greater than 15' from STS area.......... ee 1 00' from water course/wetlaads....................................... aSa tmk =' e. -1,000 .......... 11250 ......... other.. b. ' S eptie'tanlc installed level ................................................. c. 10' ithni from foundation .... .. ................. .. .... ...... d. Distr � u `on Box 1. ou' dets at s= elevation -water .tested ................. 2. Protected below frost ................. ............................... 3. . Midnimn 2 R.000al soil between box &trenches e. J Ba properly set ......................... 6. 1.. required Length installed 2. Distance to watercourse measured f /vo Ft.......... 3. Installed according to p1an ......... ............................... 4. Slope of trench acceptable 1116 -1J32" /foot ............. 5. 101 from .property line - 20 ft., foundations.......... 6. Depth of trench <30 inches from surface .................. 7. t Boom allowed for expansion, 10.0% ......... :............... 8. Size of gravel 3/4 -1'A" diameter clean ...............•.:..: 9. Depth of gravel in-trench 12" miniaa .....:,........... .10.. Pipe a ed .................... ............................... g —r- 1. ite ................................................. 2. Ova$ow tazilc.. ............... .............. .................. . 3. �4larm, visuallaudio ............. ............................... 4. eaw accessible, manhole to grade ........:........ Pump . y- . 5. First box baffled ........................... .......... ...... ................. 6. Cycle witnessed by E.D.estimated flow /cycle........... IIZ. Huu di ' a. Elouse oiled_ = approved plans.. b Number of bed - rooms ..... .......... xfr.. ._ .. IV. Well U�� s.�41 r5 o ' e rjs� �•�r r> Wel�ocated as per approved pleas.......: �,�,��:.� b. Distance from STS area measured ft ..... .: c. Casing. 18" above grade ...................... . ...... z........ .. d. Surface drainage around well , acceptable......... ............. V., QXe_rr We hip a. Boxes properly grouted ................ ............................... b. All 1 p 3' bacUlled .......................................... C. All pipes $ush with -inside of box . ............................... d. Bacicfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfill protected & dir.to exist watercourse- g. Footing drains discharge away from STS area .............. h. Surface water protection adequate ..... _........... %........ i. Erosion control provided ........ ............................... Rev. 12/02 CONDnMWTS dre.0 0M PN1ChYAM COUN1'Y DEPARTMENT OF HEALTH ➢➢IIWSIION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SY PERMIT Located at %O "C L"rq`i /Pg �— 7Xf-9- 7cr,f7 Subdivision name Subd. Lot #,f-8 F ", -w /g-9 G 3-,20-31 Date Subdivision Approved,6 C,0,1 6 -90-JA Owner /Applicant Name %pOdee,71" S. is Town or Village ?q&e±-,A7A Tax Map25 -'$* Block / Lot eZ0 Renewal X Revision Date of Previous Approval e ,2¢ -/0 Mailing Address /01 01 AOX C933 Amount of Fee Enclosed 4cS00 el Building Type R �s i � Lot Area /• 7sd No. of Bedrooms .f Design Flow GPD /e Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of /Sp© gallon septic tank and rran aA Other Requirements: flood, g Oy,s'ii+g her To be constructed by %,13. P, Address Water Su 1 : Public Supply From or:' PrivAi6 Suppl�'Drilledby Address gait i�/fAei�3'on ::� :: `� :.::.:..Address P�✓��:,'� / /�� �,i .... I represent that 1 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 Director /Commissioner will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: P.E. x R.A. Date A / z_ License # �-Ynora- -s1 lV,Y /0nr9 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 Director /Commissioner. Any revision or alteration of the approved plan requires a new pe it. Approved for discharge of domestic sanitary sewage only. By ��c,�.� -� Title: ",01C ",01C Date: Wh e opy - 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 LETTER OF AUTHORIZATION RE: Property of /�v�e. -f �7Ar� �ofi S• Located at 7® /V *.4 zi' ye-_ / TN ��`�o� -�P� Tax Map # o2S . rf Block / Lot ,?8 Subdivision of — 7,S'49- 7x-. / /49G 'jr - s2o -3/ Subdivision Lot # W' Filed Map # 66 3 Date Filed 0 ;28 -5--9 Gentlemen: This letter is to authorize :1 ' GL a duly licensed Professional Engineer _p,' 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 provi -lions of Article 145 and/or 147 of the Education Law, the Public Health :. . Law, and the Putnam County Sanitary Code. Very truly yours, Countersigned: �...s� ' Signed: k&Allk P.E•, R•A•, # �s— i!`rgZ ¢ (Owner of Property) Mailing Address BIBS QW t0:5 E-8 LLP y ��� ✓i r..1..;7 .` �,�4`�r ?� Zip State Telephone: Mailing Address: Pa ax OL�U X71- akas,Ze, - State /(i✓ Zip Telephone: !/,f - 77g - v _J IO Form LA -97 BIBBO ASSOCIATES, LLP T0: 7 n, (. VW1 G�ci�7�? �c� f. DATE: RE: 0( s' er�r� WE ARE SENDING YOU ( ) ATTACHED ( ) UNDER SEPARATE COVER THE FOLLOWING ITEMS VIA # COPIES DESCRIPTION l ss�s s.• � � THESE ARE TRANSMITTED AS CHECKED BELOW: ( ) FOR YOUR APPROVAL ( !/ AS REQUESTED FOR YOUR USE r ( ) FOR REVIEW AND COMMENT REMARKS: SIGNED• COPY TO: 293 ROUTE 100 — SUITE 203 SOMERS, NY 10589 (914) 277 -5805 — (914) 277 -8210 FAX — bibbo @optonline.net IF ENCLOSURESARE NOTAS NOTED, IQNDL Y NOTIFY US AT ONCEAT (914) 277 -5805 V .�t •i- / / nrS 1 F' Ix om Lill a \� \ t s �— . •R• � U U Q o 0( N Io 0 / LL � c j' NO Cc, lu U m ' r' % �, , 1 •• ms's• \+ I •�.\\ \ +\ `\ ` \�\ \\ '� � ,' \L' �`�n', 1 9{ ' / (/%'% J� 111111 m tj:'w" �� :`�.�. � � +\ \ \� \ �� , '4i ' \ • \d n gym,'' ` °: o\: •''m, . \5' ' \ \y� \ \►` ci\ \ :[+ \`mac►\ `o .�\ �h \`� +\ kv 66141 lu \ � ml \ \ \ � � \ � ,,� \ '� \ \ °�°• 1 � `` t\ n � � t ` \ '. �^ OCR oz. NO PIT NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES I�ONSTRU CTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT #. 0 -0+-/O Located at R Town or Village 7j-g - s/ Subdivision name Subd. Lot # o-,5 Tax Map,Z!; 1* Block / Lot Z8 Date Subdivision Approvedf'/ 6- Renewal Revision Owner /Applicant Name Ro,6p�-%` Date of Previous Approval Mailing Address RO,13ax dl3 Zip /�O i a✓ Amount of Fee Enclosed Building Type RcxeiW, . Lot Area/. .,yid No. of Bedrooms ;,r Design Flow GPD 7S'0 Fill Section Only Depth Volume PCHD NO'T'IFICATION IS RE UIRED WHEN FILL IS COMPLETED Se&rate Sewerage System to consist of /.5'00 gallon septic tank and Xi -enc! Other Requirements: To be constructed by Water Supply: Public Supply From .-or: ... Private - Supply - Dr-i"Iled by/(,b A- Address Address Addres �t�//Q /e!/y, I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatments stem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Director /Commissioner will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed P.E. Address '3 i _ d _- a- i p 94 Z_ ._Z_ X R.A. _ Date # Soo w,--, / `y la, 8 i 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 Director /Commissioner. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only,. By: Ak Title: /47,0kic— Date: Wh (t copy - HD File; Yellow copy - uilding Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 e yt i • �71 / F• m � 'n RL In CL 1 3c \ %.IS •\ / / /. .r • x : � �/J 'nom m \ lu IN v. •'gym t \ t \ \ \ \•• . \ '\ y -149 nd IR Cd • , '•.\'\ , �` $ � t \t ��. \ tit �\ \ \��`1\ �\ a • 1,,n • � - �'�7 Y�� / \ ,• C4 ig 8 \ \ t m m 169 v ri vv. ,m IT 661 lu IL / 41 NO C PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES C STR�^Urr CTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at 7�? A&,wCIGr/"eA 1%Giwl Town or Village �I CS°0I1 7s49- 7,8-/ Subdivision name Subd. Lot #+ 6 Tax Map�S;r+ Block Lot 3 -;0 -31 Date Subdivision Approved Fik * 6G 3 ,6 j g- Lf-A Renewal Revision Owner /Applicant Name gzdeont S nApw cT. Date of Previous Approval Mailing Address Al Vim 8Iy3� c�i'Gh7S'�G'a IVY Zip/f%s'�9 Amount of Fee Enclosed `�as Building Type Recs.,W Lot Area/ No. of BedroomsDesign Flow GPD g�d0 / Ao7?4re Fill Section Only Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and 115 ,r /0'4711 ,�r Other Requirements: To be constructed by T, (9110, Address Water Supply: Public Supply From Address. -- :..... oor: "•- __..____ Private`Supply Drilled by ... °..T,lj';;� ..::_ :'.: ;...._ '::......_._...___......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 treatmentsystem 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 Director /Commissioner 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 (2y 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 7-1* -/O License # f - JaPw&r l -V y' as"8'9 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 n cessary by the Director /Commissioner. Any revision or alteration of the approved plan requires a new pe it. Approved f discharge of domestic sanitary sewag only. C, f � Date: L-M—/o By: Title: White copy - HD F Ye ow opy - Building Inspector; Pink copy - Owner O ' e; range copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or Woe Well Location Street Address: Town/Village: Tax Map # 701VW W1�41 ' / �4 f Sovl MapZ.<ffBlock l Lot(s) Well Owner: Name: Address: .062 v_%Pr BtI3 Phone #: 9�4. Oa- HTK �rc�ast�,r- �'ll�,y /O,,S��q 7�¢ X84,9` Use of Well: _Residential _Public Supply Air /cond /heat pump_ Irrigation 1- Primary Business Farm Test/monitoring _Other(specify) 2- Secondary Industrial Institutional. Standby Amount of Use Yield Sought _J gpm #People Served_ Est. of Daily usage gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drilling X New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes — No Is well located in a realty subdivision ? ............... .......................... ............................... Yes _ No i 11 Name of subdivision : ?G 3 104 & 6KJ(4a ZB.rA l Lot No. Water Well Contractor: 794 Address: Is Public Water Supply available on site? ....................................... ............................... Yes No J Name of Public Water Supply: . TownNillage Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: - _ O Applicant Signature: _. . PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Departmel take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any revision or alter Ion of the approved/ Ian requires a new permit. Well to be constructed by a water well driller certified by Putnam Coity. —7 I Date of Issue -- '_10 Permit Issu Date *of Expiration 2► Title: Permit is Non - Transferab e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; orange copy - Well driller Form WP -97 Rev. 3/06 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION.OF. ENVIRONMENTAL HEALTH SERVICES LETTER OF-AUTHORIZATION RE: Property of `a6C4' %57an;'a',h JK, Located at 7Q &C-02 1,r 4A /F®001 TN A 7'1erso., Tax Map # I J". Block �_ Lot �2 8 Subdivision of 7X449- I 'f9 a 3 -.20- s / Subdivision Lot / 'S" Filed Map # w6,7 Date Filed f -,ZB Gentlemen: This letter is to authorize G a duly licensed Professional Engineer k_ or Re6istered 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 .-inconformity with-the-pro Article 145 and/or-147 of the EducatiorrLaw;--the- Publie Health- - Law, and the Putnam County Sanitary Code. Countersigned: P.E., R.A., # a -,s'"�!� 4 Mailing Address BIBBO ASSOCIATES LLP 293 Route 100 S(�uile 203 - - - - Somers, NY 10589 State (914) 2 805 Telephone: Very truly yours, (Owner of Property) Mailing Address: /001 . ,�G,C 6f33 re44r'*r /Ivy State Zip Telephone: 9/,f - 774 - J-,7 ,f d Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FORAPPROVAI, OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: iU z ©Sro9. 2. Name of project: �l�'%`Giti h S;f�".�' 3. Location TN: �er�'yfi 4. Design Professional: Z_07/ y�0 s czg 5. Address: �2q,�/Po�fe /OO, fir, fc,2o,3 6. Drainage Basin: Fa 7''Owe? C� iQ,�,,eo- N 7. Type, of Proiect: 4. Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office. Building Realty Subdivision Other (specify) 8.. Is this :project subject to State Environmental Quality Review (SEQR)? Type Status (check one) . ............................... TYPe'I 1✓xe'mpt ....................... Type II ' Unlisted. 9. Is a Draft Environmental Impact Statement (DEIS) required? ............ ............... / a 10. Has DEIS been completed.and found acceptable by Lead Agency? ..........: :... 11. Name of Lead Agency 12. Is this pro ect in; an area under the control .of local lannin , zonin P J _....�..- :.._... _ ._..... or other w .... . ................_ P...... g ... _.__ g, Q. officials, ordinances? ............................................ . ........... :....... : ............ .............. 13.. If so, have plans been submitted to such authorities? ........... .......................... .. e s 14. Has preliminary approval been granted by such au=thorities? Date granted:. 15. Type of Sewage Treatment System Discharge................. surface water k groundwater 16. If surface water discharge, what is the stream-class designation? .................... N_,lf - 17. Waters index number (surface) .......:: ........................ . ................................ ............ itl. 18. Is project located near a public water supply system? ....... .......................... 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system?,; ............... 21. Name of sewage system Distance to sewage system 22. Date test holes observed 9- ,2r-er9 23. Name of Health Inspector/`' 24. Project design flow (gallons per day) ..........:.:..... .................. ............................... �O�O 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... /(J� 26. Has SPDES Application been submitted to- local DEC office? .......: .................. /VA , . 2 27. Is any.portion of this project located within a designated Town or State wetland? No -.28. Wetlands- ID- Number.. ........................................................ ............. :::::............. 29. Is Wetlands Permit required? ........ :............... __ Has application been made to Town or Local DEC office? ................................ 30. Does project require .a DEC Stream Disturbance Permit? .. . .. .............................. . Na 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 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 /Va DESCRIBE: 33.'. Is there a local master plan on file with the Town or Village ?_ 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ............ :........... ....... . ............................... 35. Are any sewage treatment areas in excess of 15 %o slope? . ............................... A la 36. Tax Map ID Number .. ......:.................. ............................... Map,2r-r4Block_L_ Lot X9 37. Approved plans are to be returned to..,.. Applicant �s _ Design Professional- ... NOM -All applications and approval of a'ne�v STS td "be Iocatecl within the Ni'C `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 stormwate yplans 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 Lithe 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. Thereby affirm, under penalty of perjury; that information provided on this form is true to the best of my knowledge and belief. False statements made herein arepunishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: Mailin '�d ^dXess: �� y` :.......................... 993 Routs 100 r Suite 203 �_ f ,. isomers, 10589 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET.- SUBSURFACE. -SEWAGE E TREATMENT SYSTEM Owner: /�OG�i'f'�gH ®H Address': 10o�X.�33, ;V J4 Located at (street): 7® it�Crv6yi'4/i Act -` TM 1# Section: _Block _Lot Municipality: Watershed: SOIL PERCOLATION TEST DATA Witnessed by: ;if, Date of Pre - soaking: "��'`O`I ._... .. 'Date dPercolation Test: `�—Zjr- o9 Hole No. Run No.'. Time Start :— Stop Elapse Time (min.) Depth to water from t ground surface (inches) Start - stop, - Water. Level drop in inches Percolation Mate min /inch !� p As 2 9.98 ,o: �z' 4 �?v .. 3 3 4--7 3 4 IS 5 -�? 1 ?.U8- 3 3 47& 2 -/ow— z 2 3 6' J 7a . 3 D.' -/W,10 a2 2 2 j 7 6" 3 4 v N -I /•o/ 22 27 6 3 7-7 5 4" 2 fflrja 7-x'3 9 Z01A 4 - 3 }1 1. 3 0 6 .O A4j di "1 Notes: �- toybe rep ted at same depth until approximately equal percolation rates are �aobiamed'at.,each percolation test hole. (i.e., < I min for 1-30 min /inch, < 2 min for 31 -60 min /inch). dat o be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97• pg 1 of 2 DEPTH G. L. 0.5' to r,,eW, 1.0' rrgc e -7-'iS�e 9ya ve- . TEST_PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE # / 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' . 5.0' 5.5' 6.0' r< rowrl 6.5' fve'�1¢Si %T 7.0' 7.5'4 7 .. 8.0' 8.5' 9.5, . HOLE # Z ,*mol %race K14) 1ryee ,f'or* e v^i / 7 HOLE # J. .6,;e- %o ,►c. , j4W, /1-0 e, 7�iae grave l o f LL Rvs�"f�awn o/ i/e- (/ro4%m 7�i:n a SA,►o✓ �127e:e iise� 7`O X0 HOLE # �� Nieai� Si:pma 7m- c e s - /rte one ru ✓e�: O /� "ve 6rocJ,� -A r!e's4noll e,ri /7, v m rW, /OG HOLE # S e yvm op e- '1e r 1 ve� y; ofve ditrryyj ,e7tire ,n 12; tm ce Tike- r� ✓e e 7 10.0' 1 9��i ✓e� Indicate level at which groundwater is encountered -- Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: „a4 ;� zr4-, Date X o2S =09 Design Professional Name: Address: • !w 13 V S 1 i, J' a W Design Professional = Seal - 19 s n� 055 AR�FH9SIOli *v 617.10 . Appendix C State Environmental ;Quality.Review.._._ SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I - PROJECT INFORMATION (To be completed by Applicant dr Proiect Sponsor) 1. APPLICANT/SPONSOR 2. PROJECT NAME . 3. PROJECT LOCATION: 7OW4 Municipality d /— G� / /�sph County 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) 7O /tJC�a6yr��j �o+�c% 5. PROPOSED ACTION IS: New Expansion Modiflcation/alteration 6. DESCRIBE PROJECT BRIEFLY: loevelelo '&c. lei' +V1q-rr�1A17Ce_ 7. AMOUNT OF LAND AFFECTED: Initially /.9" acres Ultimately /.9� acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential Industrial Commercial Agriculture Park/Forest/Open Space Other Describe: �- :.: /gf4rc fo fA 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? „ IRYes No If Yes, list agency(s) name and pennit/approvals: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? 0 Yes ® No If Yes, list agency(s) name and permittapprovals: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? Yes . ❑ No 1_44, I CERTIFY TAT T E INF RMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applican.gsponsor n e: 0 h %p 4 Date: Signature: h If the action is in -the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II - IMPACT ASSESSMENT To be corn leted by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I T_ HRESHO_LD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. n Yes n No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another involved agency. (-j Yes M No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C 1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: 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 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 use of land or other natural resources? Explain briefly. C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. Long tern, short term, cumulative, or other effects not identified in C1 -05? Explain briefly: C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? Yes No If Yes, explain briefly: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? Yes [:] No If Yes, explain briefly: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part II was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the 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 NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting this determin Name of Lead Agency Date Print or Type Name of Responsible Officer in Lead Agency Tide of esponsi le Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) pUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY..��5 BEDROOMS ALL SUBSEQUENT REVjSLON;'ALTERATIONIS TO THESE HOUSE P {dS plgUST BE SUB M, ED TO THE PCDOH FOR APPROVAL S AYURE & T f DATE e, 9F >�, eee �� ONE FM LLU FRONT ELEVATION i sToipA(3E OA/4 5 LL t Irri® ILLLJI NOTE pmm ON mm9y oTWm t Gana ses+U MLLN ®ro eEOEao�MMA µocr�. • i I min mm 'so n ■■■ - I ISO! : ■■:: iii goo iii iii IIIIIIII 1 :::j a all :o: RIGHT ELEVATION EB ■■ ■1 Fil men rrtv�ci.� nHmc ROBERT STANTON 70 NEW BURGH 70NEWBURGHROAO PATTERSON NY 12563 PUTNAM COUNTY BUILDER PAR DEVELOPMENT GROUP LLC ADDRESS: tODHARTFORDAVE Mt VERNON NY 10553 TWO STORY PROJ.ID#: 290239 SERIAL#: — ELEVATIONS SHEET# Sa DWN.BY: BAH CHECKED BY: DATE: 9-15-09 o _N � ¢ DWN BY ; # DATE N0TE7O81A1DBt EMATMNSWWN MAY Ne lBEATRUEREMSEMATMN a'�Na6EPURCK%W.PLEMM SEE &MDMER ra sELEanm amen � aiE �. j S4n.*re(udA~q�stemsofPA,tic 1004SPRINGBROOK AVENUE, MOOSIC,PA18507 tel. (570) 774 -1000 . Fax. (570) 774 -1010 - - - BAH 3 621 -10 f•1 Ni' IrJ IN' O vr lic TV s f T ' X im 14, 4 �= 11 �� 1. f _____ — _._____ JUN i r'd 9 Q; o._...._ .. o 1 0 Ruom - o RR` OM o a o uvc �, F eosi eeu I PORCH ON SR BY OTHERS I -------------- p . z i yjN -: �L'•:I r m R ra N • i•. f•1 y 1i• ra 114. " 17.2 1 '4..211nr 10 lir - i . uw �yw m c ,. I F//?S7" i'l-00A PI-AN F4.000 PL%4N. r -i sn s r rc v�X ' S— mu ama — 11) WX LFCGI iic $ ir NABS BEDROOM #3 AAEA•15330FT i 8 u i D SM1p' � E CMM FANAxiH S W LLJ ArTuHm #1 eegY Lm 24 x sa to Mu OPEN TO BELOW S o BATH #2 is CO � ®• x. �: a' IV ENDS gHg4MR pa FW91 LE7lpfi 6fFrIR — ��dl xi — — – – — — _ - 6ftIR _. — - lir t ?x6 ur LN ABWE . E�RJ1 xWRA6E�FLLl'CF$MG - .(r Z - (� 12 VSB SD VSBm r-2 Ily -- ONSITEVU& Ym OPEN TO BELOW Q BEDROOM #1 AREA '254 90 FT BEDROOM#2 AREA• 165 SOFT WINN . – Box FORM ON 57E – CEEAIG FAKUW W.VIGMQOSEf o W I r Zy _ N CrN"ARM I� H 1121mlon6N6 3016 7016 7016 3N6 } 1r i jrr L L TAP L L r. 1 1 jY4r 6'A sr s Z O 4 �mW 1 0 if F4.000 PL%4N. 17, -Is-, till APW 1,00 10 0 ZNZ'.,' P (0 I c4 0 09 ev . Is, 46 Is 00. Ak RNIV io o; A 1)v fie iu 661 ,oz. IL \'(70 N n n ~\ \ \� Sw ! f\ / N ^IQ ! ! \� \ \ \ Ne ul rb,) / / / n� �� \ \ n \ All / / / \\\ n \ c4 14 ... . .. .... .. ALLEN DEALS, M.D., J.D. Con 6doner of Health ROBERT MORRIS, P.E. Director of EnvirolEMO U Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Telephone: (845) 808 -1390; Fax: (845) 278 -7921 May 21, 2013 .Bibbo Associates Joseph Buschynski, P.E. 293 Route 100, Suite 203 Somers; NY 10589 MARYF.LL&N ODkU County Execadve Re: Complete Application Determination for - Stanton 70 Newburgh Road . (T) Patterson, TM 25.54 -1 -28 East Branch Reservoir' Basin Dear Mr. Buschynski: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and revisions received by this Department on May 3, 2013 is complete. The Department will notify you by June 11, 2013 of its determination. 0 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.notiee should"be sddtto' " 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 approved, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a 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) 808 -1390 ext. 43157. Respectfully, seph S. Paravati, Jr., P.E. !Assistant Public Health Engineer MJB:cw ALLEN BEALS, M.D:, J.D. Commissioner of Health ROBERT MORRIS, P.E. Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brew, ter, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 MARYiEL,LEN ODEL L County Executive TO: NYCDEP DEPARTMENT OF ENGINEERING AND DESIGN REVIEW ATTN: FROM: C_ ` DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM DELEGA TED New Application ❑ Renewal ❑ PROJECT: - LOCATION: �� ='�✓� /�( 13 / t-� & lyq 6 TOWN: DATE SUB'D APPROVAL ,z fik 0 C"&'? TM # 026- S � —( - ,)3 NOTICE OF COMPLETE APPLICATION DATE: aI 3 DELEGATED TO: �Gr�K,�ch %- � c DATE: RE: tifo� fS' WE ARE SENDING YOU ( ) ATTACHED ( ) UNDER SEPARATE COVER THE FOLLOWING ITEMS VIA # COPIES DESCRIPTION Cohs'�r, /perk .- c , THESE ARE TRANSMITTED AS CHECKED BELOW: FOR YOUR APPROVAL ( ) AS REQUESTED ( ) FOR YOUR USE ( ) FOR REVIEW AND COMMENT REMARKS: p�ase r��aee 7`44- Q�p��•'c� ah a.�a�� /ah s�rb.�,- 7J`�o1�% e- e,,y c1as&W, 7-4 el) /a 0 r- "c . Al v /'�'ce H ycV /frcw e,D J`7e:9 73'eGtcA . COPY TO: SIGNED: 293 ROUTE 100 - SUITE 203 SOMERS, NY 10589 (914) 277 -5805 - (914) 277 -8210 FAX - bibbo @optonline.net IF ENCLOSURES ARE NOT A5 NOTED, KINDLY NOTIFY U5 AT ONCEAT (914) 277 -5805 BIBBO ASSOCIATES, LLP TO: CO�ts�l� f e DATE: RE: WE ARE SENDING YOU ( ) ATTACHED ( ) UNDER SEPARATE COVER THE FOLLOWING ITEMS VIA # COPIES DESCRIPTION THESE ARE TRANSMITTED AS CHECKED BELOW: (x) FOR YOUR APPROVAL ( ) AS REQUESTED ( ). FOR YOUR USE ( . )...FOR REVIEW AND COMMENT REMARKS: 7-4 e- (:q �O/ei /-ee �W► la 0,0 t hGS C/CG�i - 7d L .lz , Tie l%w�r ev w ;_rw &s 7 ee;Pt *, h 7`4 � Gl�as'� :� y �ia�cr COPY T0: 293 ROUTE 100 - SUITE 203 SOMERS, NY 10589 (914) 277 -5805 - (914) 277 -8210 FAX - bibbo @optonline.net IF ENCLOSURES ARE NOTA5 NOTED, KINDL Y NOTIFY U5 AT ONCEAT (914) 277 -5805 ALLEN BEALS, M.D., J.D. Commissioner of)3eah6 ROBERT MORRIS, P.E. Directu dEavironmi mal Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York i 0509 Telephone: (845) 808 - 1390; Fax: (845) 278 -7921 August 28, 2012 Bibbo Associates Joseph Buschynski, P.E. 293 Route 100, Suite 203 Somers, NY 10589 MARYELLEN ODLLL County Executive Re:. Co plete Application Determination for Stanton 70ewburgh Road (T).-Patterson, TM 25.54 -1 -28 .East branch Reservoir Basin .Dear Mr. Buschynski: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and revisions, receised by this Department on August 16, 2012 is complete. The Department willmotify you by Septembef,,18, 2012 of its determination. D The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth J6 the Watershed Agreement. ❑ Joint review with the NYCDEP will. commence pursuant to the guidelines set forth in the Watershed Agreement. If the bepartment 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 approved, subject to standard terms and conditions as set. forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a 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) 808 -1390 ext. 43157. Respectfully, a beph S. Paravati Jr., P.E. Assistant Public Health Engineer JSP:cw 01 ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E. Director of Environmental Health DEPARTMENT:' OF HEALTH 1 Geneva Road, Brewster; New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 MARYELLEN ODELL County Executive TO: NYCDEP DEPARTMENT OF ENGINEERING AND DESIGN REVIEW ATTN: Q� ✓, ��� *•0" DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM DELEGATED New Application ❑ Renewal E PROJECT: LOCATION: � l zo�3r TOWN: &N<-1,SL9WN DATE SUB'D APPROVAL g �� TM# 025-�-v-� -o2B NOTICE OF COMPLETE APPLICATION DATE: L1, DELEGATED BIBBO ASSOCIATES LLP TO: /7`/i e DATE: RE: pin �dJ7 t�iS%�' 7,y .2j ,.r IL'C WE ARE SENDING YOU ( ) ATTACHED ( ) UNDER SEPARATE COVER THE FOLLOWING ITEMS VIA # COPIES DESCRIPTION hf7~r, erg -�r�' Aw z711 c- - r�' at2 Ar G e c- �•- AS'S'TS' cS'. • �� THESE ARE TRANSMITTED AS CHECKED BELOW: ( ) FOR YOUR APPROVAL ( ) AS REQUESTED FOR YOUR USE ( ): FOR REVIEW AND COMMENT REMARKS: /%,S'e /wre- 7`�'7` 1"'A e w e // /ins dee,n a6-1 COPY TO: i 293 ROUTE 100 - SUITE 203 SOMERS, NY 10589 (914) 277 -5805 - (914) 277 -8210 FAX - bibbo @optonline.net IF ENCLOSURES ARE NOTAS NOTED, A NDL Y N07YFY USAT ONCEAT (914) 277 -5805 30A - y SOCi�TES� L.L.P. Joseph J. Buschynski, P.E. Timothy S. Allen, P.E. jf, 1` gineers Planners Sabri Barisser. P.E. i ft w John P. McNamara, P.E. Robert A. B. Howe, B.S., Phys. August 23, 2010 Putnam County Dept. of Health 1 Geneva Rd Brewster, NY 10509 -2339 ATTN: Mr. Michael Budzinski P.E., Director of Engineering RE: Sta into n —SSTS Town of Patterson T.M. 25.54 -1 -28 Dear Mr. Budzinski: Enclosed in the above matter are 4 prints of a revised SSTS Site Plan dated 8 -19 -2010. In accordance with your letter of August 18, 2010, we have revised the plan as follows: 1) On the septic tank detail, the note applicable to maximum cover has been revised to 12 inches maximum. 2) The "for future use" label was inadvertently allowed to remain from the initial plan and is now removed. 3) The requirements for a stabilized construction entrance are now shown. 4) Minimum slope requirements for the effluent line between the dosing chamber and D -box are now noted. Please call if you have any questions. JJB /mme Enclosures Very truly yours, 04// Joseph J. Buschynski, P.E. Planning m Site Design o Environmental Mill Pond Offices • 293 Route 100, Suite 203 • Somers, NY 10589 Phone: 914 - 277 -5805 • Fax: 914 - 277 -8210 • E -Mail: bibbo@optonline.net Sherlita Amler, MD, MS, FAAP Commissioner of Health Robert Morris, PE • - �- Director of Environmental Health Robert 4. Bondi County Executive This Department has received and reviewed the submitted application and plans for the above - mentioned project and the following comments are offered for your consideration. •✓� The septic tank detail is to be revised to specify that tank cover in excess of 12 inches will require an• access,to• grade- manhole: _ 2. The label on the site plan, "For future use" is to be clarified. �3. A stabilized construction entrance is to be shown on the plan. The pipe from the dosing tank to the distribution box is to be specified with a minimum slope of 1 %. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. Respectfully, Michael J. Director of MJB:kly 11 Department ®i Health 1 Geneva Road, Brewster, NY 10509 Office (845) 808 -1390 Fax (845) 808 -1937 August 18, 2010 Joseph Buschynski, PE Bibbo Associates Mill Pond Offices 293 Route 100, Suite 203 Somers, NY 10589 Re: Stanton SSTS 70 Newburgh Road (T) Patterson, TM # 25.54 -1 -28 Dear Mr. Buschynski: This Department has received and reviewed the submitted application and plans for the above - mentioned project and the following comments are offered for your consideration. •✓� The septic tank detail is to be revised to specify that tank cover in excess of 12 inches will require an• access,to• grade- manhole: _ 2. The label on the site plan, "For future use" is to be clarified. �3. A stabilized construction entrance is to be shown on the plan. The pipe from the dosing tank to the distribution box is to be specified with a minimum slope of 1 %. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. Respectfully, Michael J. Director of MJB:kly 11 Sherlita Amler, MD, MS, FAAP Commissioner of Health Robert Morris, PE Director of Environmental Health Department ®f Health 1 Geneva Road, Brewster, NY 10509 August 9, 2010 Office (845) 808 -1390 Fax (845) 808 -1937 Joseph Buschynski, PE Bibbo Associates Mill Pond Offices 293 Route 100, Suite 203 Somers, NY 10589 Re: Stanton SSTS 70 Newburgh Road (T) Patterson, TM # 25.54 -1 -28 East Branch Reservoir Basin Dear Mr. Buschynski: Robert J. Bondi County Executive The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on August 6, 2010 is complete. The Department will notify you by August 29, 2010 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 approved, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a 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) 808 -1390 ext. 43148. Michael J. Director of MJB:kly Y, - ._.__�.. BRUCE,. K, 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 (914)278-6130 Fax (914) 278-7921 Nursing Services (914)278-6558 WIC (914)278-6678 Fax (914) 278-6085 Earty Intervention (914)278-6014 Preschool (914) 278 -6082 Fax(914)278-6648 .�� A WC TO: DEPARTMENT ENGINEERING AND DESIGN REVIEW PROJECT: 0 DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM SIAODO DELEGATED _........__ ... TOWN: -' C SE K ' PV DATE'SUB'D'APPROVAL:- LWA, 'e— NOTICE OF COMPLETE APPLICATION DATE:. ► r� S S0CIATES, LLA Pngineers - Planners Putnam County Dept. of Health 1 Geneva Rd Brewster, NY 10509 -2339 Joseph). Buschynski• P.E Timothy S. Allen. RE Sabri Barisser, P.E John P. McNamara, P.E. Robert A. B. Howe, B.S., Phys. August 5, 2010 ATTN: Mr. Michael Budzinski P.E., Director of Engineering Dear Mr. Budzinski: RE: Robert Stanton, Jr. — SSTS 70 Newburgh Road, Town of Patterson Enclosed in the above matter are 4 prints of a revised SSTS Site Plan and 2 sets of revised house plans. In accordance with your letter of July 20, 2010, we have. made the following revisions: 1) The SCS soil maps indicate that the parcel. is located: entirely within an area of CsD: - - -- --Chat ietd= Charlton. The soil type is identified above the title box "on the'piari. 2) On the enclosed house plans we have labeled the basement, first, and second floor plans. We have noted the attic space above the second floor on the elevation plan as "unfinished and unheated, for storage only". Stairs are provided to the attic to facilitate the transfer of stored items into and out of the attic. 3) Same as #2 above. 4) Same as #2 above. You recently advised that the basement layout qualifies as two potential bedrooms under the policy of your Department. The SSTS plan now defines the house as a 5 bedroom. Reference to a future bedroom has been removed from the plan. The system provides for a 1500 gallon septic tank and dosing chamber for the 5 bedroom house design flow. Planning o Site Design . Environmental Mill Pond Offices 293 Route 100, Suite 203 • Somers. NY 10589 Phone: 914- 277 -5805 Fax: 914 - 277 -8210 • E -Mail: bibbo ®optonline.net Please call if you have any questions. Very truly yours, Joseph J. Buschynski, P.E. JJB /mme Enclosures cc: B. Stanton, Jr. Sherlita Amler, MD, MS, FAAP Commissioner of Health Robert`Morris, PE --Director of-Environmental Health July 20, 2010 Joe Buschynski, PE Bibbo Associates Mill Pond Offices 293 Route 100, Suite 203 Somers, NY 10589 Dear Mr. Buschynski: Department of Health 1 Geneva Road, Brewster, NY 10509 Robert J. Bondi County Executive Re: Application to Construct a Subsurface Sewage Treatment System for Staton at 70 Newburgh Road (T) Patterson, T.M. # 25.54 -1 -28 The Putnam County Department of Health (Department) has determined that the above, referenced project, received by the Department on July 16, 2010 is incomplete. Please be advised that the following information is required before the Department may commence its review. 1. The USDA Soil Conservation Service soil type boundaries are to be shown on the site and identified on the plan. 2. The submitted house floor plans are to be labeled (i.e., first floor, second floor, etc.) 3. A basement floor plan is to be provided for the floor plans. 4.. The floor plans show a stairway from the second story. Is there a third story or floor for the house ? - Any floor area meeting the Building Code Requirements on the third story floor will be considered potential bedroom(s). The review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information as to the completeness of your application. Please be advised that failure to submit information to the Department or to follow procedures is sufficient grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed Regulations and Putnam County Department of Health, regulations. Should you have any questions or care to discuss this matter, please contact me at (845) 808 -1390 ext. 43148. MJB:kly Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845)22S-5186 Fax (845), 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing / Home Care Agency (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 BIBBO ASSOCIATES, LLP T0: P, 47-0 6i7�% e .DATE: W CAN l) zi KillE, RE: t v, ,q \ ;r' ?O /i e44#-r 1e l. 7 Gr,S'dh WE ARE SENDING YOU (x ) ATTACHED ( ) UNDER SEPARATE COVER THE FOLLOWING ITENIS VIA # COPIES DESCRIPTION 02 GiS e ar•s THESE ARE TRANSMITTED AS CHECKED BELOW: O FOR YOUR APPROVAL ( ) AS REQUESTED ( ) FOR YOUR USE ( ) FOR REVIEW AND COMMENT REMARKS: COPY TO: i 293 ROUTE 100 - SUITE 203 SOMERS, NY 10589 (914) 277 -5805 - (914) 277 -8210 FAX - bibbo @optonline.net IF ENCLOSURES ARE NOT AS NOTED, IQNDL Y NOTIFY US AT ONCE AT (914) 277 -5805 2 'ltP n ry: ' i 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM . 1 Owner: Address: Located at (street): li L.. TM # Section: _ Block _ Lot Municipality:.. Watershed: SOIL PERCOLATION TEST DATA Witnessed,by: ni/t). Date of Pre-so,- :ing _2. �(�� Date of Percolation Test: Notes: 1. Te:-ts to be repeated at same depth until approximately equal percolation rates are ob tined at each percolation test hole. (i.e., < 1 min for 1-330 min /inch, < 2 min for 31 =60 min /inch).' AI. data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97, pg. I of 2 PP I 3�r 30 '• 3% Depth i Time Elapse water 1 ground 1 Percolation - / 1 1 Rate 11 (min.) in inches min/inch Start - Stop r ' r IFMy �� OF F 1 Notes: 1. Te:-ts to be repeated at same depth until approximately equal percolation rates are ob tined at each percolation test hole. (i.e., < 1 min for 1-330 min /inch, < 2 min for 31 =60 min /inch).' AI. data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97, pg. I of 2 PP I 3�r 30 '• 3% 08/18/09 TUE 14:35 TEL 914 277 8210 BIBBO ASSOCIATES LLP -+44 PCHD PLEASE DELIVER TO: NAME BIBBO ASSOCIATES, LLP 293 Route 100 — Suite 203 Somers, NY 10589 - (914) 277 -5805 (914) 27M210 FAX bibbo @optonline.net FAX COYER SHEET COMPANY [a 001 FAX NUMBER FROM:�5� SUBJECT.. 767 WeOkf�e .s�".s!1,L DATE; COMMENTS: /T�9vi.,�c,�'•� �.7����- 1._,i� x}7442 /V AS REQUESTED FOR'YOUR APPROVAL FOR REVIEW AND COMMENT tBER OF PAGES BEING TRANSMITTED (INCLUDING THIS PAGE) 1py being sent? _ No Regular Mail Overnight in 1Pnih1p Mnriitinn ni,=zcc e-mU IW dl 177_C:Qnr_ 05/12/08 MON 09:06 TEL 914 277 8210 BIBBO ASSOCIATES LLP -+4-+ PCHD Z002 SHERLITA AMLER, MD. MS, FAAP -6ommissionerofHealth , LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 REQUEST FOR E][ELD TESTING ROBERT J- .80NDI County Executive All information below must be frilly completed prior to any scheduling. DATE: �" /� —ao? LN01NEERING IF1RM, V 660, Arx� : , 0 PHONE #: PERSON TO CONTACT:�u,%�+clic4s•,.r�f, ' NEW CONS'T'RUCTION ❑ REPAIR PROGRAM 17'ADDITION �::OGItAM REASON: DE:EPS:,9 Pt RCS: ❑ PUMP TRST: ❑ ROAD /STREET: TOWN: �`"� / /Cr '��'► - - TAX MAP #• SUBDIVISION: • 4.2a rr�r �1�.�t�r�9��1i" LOT OWNER: NYCDt P CRITERIA FOR JOINT REVIEW AND WIMSSING OF SOIL TESTING YES.. NO o ;�{t• ...- Proposed-SSTS-within the drainage•b'osin- of We' st,Braneli or.'Boyds..Corner.& .. - ..... -.. _ Croton Falls Reservoirs. O .W Proposed SSTS within 500 feet of a reservoir, reservoir stern or control lake. ❑ V Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ W Proposed SSTS design flow greater than 1000 gallows /day or SPDES Permit required. ❑ �" Proposed SSTS for a Commercial Project, It is the responsibility of the design professional to,provide the above information r' <or to soil testing. The Department WW determine the NYCDEP• project status (Joint or Delegated) based on the response. If you answered, ves to any of the questions, NYCDEP must witness the soil tests. This Department will coordinate a mutually suitable time for field testing with the Design Professional and NYDCEP. If a- project has been determined to be Delegated based on the above response. add then subsequent information indicates NYCDEP is required to witness the soil tests, it will be the sole responsibility of the design professional to schedule re-witnessing of the soil testing with NYCDEP. FOR COUNTY USE ONLY DATE: TIME:. COMMF.NTS• Environmental Health (845) 278 -6130 Pax (845) 278.7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (84$) 278 -6026 WIC (845) 278 -6678 . Nursing-Home Care Fax (845) 278-6085 Early Intervendow7resehool (845) 278 -WI4 Fax(845)278-6648 BIBBO ASSOCIATES LLP 293 ROUTE 100 - SUITE 203 SOMERS, NY 10589 (914) 277 -5805 - /2'77- 82..10. To / l/ � /7��i e2e�fif• INUVI Q OO CF U ° ° MNOVULM DATE JOB NO ATTENTION �- RE: 70 �cJ tir AV /OWn o a P�,So�i WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items:. ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION rie L o c.4 7/1," a THESE ARE TRANSMITTED as checked below: – ❑�For approval 2" For your use ❑ As.requested ❑ For review and comment D FOR BIDS DUE REMARKS COPY TO • Approved as submitted ❑ Resubmit copies for approval • Approved as noted ❑ Submit copies for distribution • Returned for corrections ❑ Return corrected prints VCan22rw-1i ,J E 4, y /S-, Aces 19 ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: If enclosures are not as noted, kindly notify is at once. 2 SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? a Yes 0 No 19. Will groundwater or surface drainage require special consideration? ..................... a Yes F� No 20. Will gullies, ditches, etc., be filled and watercourses be'relocated ? ......................... 0 Yes a 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? ................................ ............................... 0 Yes [7 No Inspection data 22. Do adjacent wells and/or sewage systems exist ? ............................ a Yes No 23. Additional comments 24. Site observer /inspector and title 25. Date(s) of observation(s)inspection(s) TEST P Hole # # Hole # �/ Lot. # Hole # Lot # Depth to water `� Depth to water .... --- Depth to water Depth to mottling • Depth to mottling Depth to mgttlingu _.. Depth to rock/imp. Depth to rock/imp. Depth to rock/imp -"� G.L. G.L. G.L. 0.5 0.5 0.5 1.0 1.0 1.0 2.0 N 2.0 2.0 V !t 3.0 3.0 r Z 3.0 4.0 '1 4.0 4.0 5.0 5.0 s 5.0 6.0 6.0 6.0 C 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 i iex isr weu V Y ��1 •y �� Nk r3R Y' R0. a V TALL. RD. HAZEL SITE LOCATION PLAN SCALE :: 17= 2000 DATUM: PROPERTY SHOWN ON TOWN OF PATr'6R50N TAX MAP: 2S.54-1-29+30 GU � ���`�� ©� � AC'S ��° ���� . 05/12/08 MON 09:06 TEL 914 277 8210 BIBBO ASSOCIATES LLP 444 PCED PLEASE DELIVER TO: NAME /1" el vp/l zih,5A. FROM: BIBBO ASSOCIATES, LLP 293 Route 100 — Suite 203 Somers, NY 10589 (914) 277 -58Q5 (914) 277-8210 FAX bibbo @optonline.net FAX COVER SHEEN' COMPANY SUBJECT: 7a /UG? �*rj Rol, DATE: " ±/ -09 COMMENTS: 14-1WW7 h 7 [a 001 FAX Nt]MRFR AS REQUESTED FOR YOUR APPROVAL FOR REVIEW AND COMMENT NUMBER OF PAGES BEING TRANSMMED (INCLUDING THIS PAGE) o7, lard copy being sent? No Regular Mail Overnight f you do not receive all pages in legible condition, please call (914) 277 -5805. Mtn. WBI, 9 Va. NEW F-F/.m iTl 0i ro, � PLAN SITE." LOC:. �. . -A SCALE-, V'= 2000, ex ST- PROPERTY SHOWN ON TOWN OF PATTERSON ol wsu TAX MAP: 25.54 -1.- 28 SO TUM: 05/12/08 MON 09:06 TEL 914 277 8210 BIBBO ASSOCIATES LLP 4-+4 PCHD BIBBO ASSOCIATES, LLP 293 Route 100 —Suite X0589 (914) 277 -5805 (914) 277 -8210 FAX bibbo @optonline.net FAX COVER SHEEN` PLEASE DELIVER TO: PANT( IAJi *e PROM: SURIECT: DATE: ,r~-IoZ-09 COMMENTS:i� / f �r �"%�j�cyr �„f i�v fe. Z001 NUMBER AS REQUESTED FOR YOUR APPROVAL FOR REVIEW AND COMMENT NUMBER OF PAGES BEING TRANSMITTED (INCLUDING THIS PAGE) 2 iard copy being sent? No Regular Mail Ovemight ;f you do not receive all pages in legible condition, please call (914) 277 -5805. .4 ----- - i A5 9-IOVvN ON I MAr Or- rROMRTY OF WAIN 5MAMA FILEP MAP NO. 669. PRTU2 6-26-92. 7562 I PARCEL 'T" FARM "E" PARCEL "t?" -� N CM 7-5(30 .62' 7579 Rem. 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