The URL can be used to link to this page

Home My WebLink About1098DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.54 -2 -33 BOX 11 17--N-0 ' ' ■■ I I *�l him 0111 1 16 i ,� '1 a IN it i r _ oil �1 ffl- Moo] i' TNAM COUNTY DEPARTMENT OF HEALTH y *ft�:--nIVISION- OF-- ENVIRONMENTAL HEALTH. SERVICES- CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # �' �� " O (/ Located at 3 QU O CA Town or Village Owner /Applicant Name I�I�h�L � � � ;'t° ':,, -Tax Map 2f7 - 6A Block 2. Lot 1)09 Formerly Subdivision Name pUTHAM 1�4_e Subd. Lot# 106+ " '70 02 Mailing Address `71 a(C�C`6f'0— 11 fRBEF P6F-T Q409mg_j ) Zip i° 5'1 lj� Date Construction Permit Issued by PCHD Separate Sewerage System built by JA*4 �N-"A-00 Address Consisting of 1O00 Gallon Septic Tank and Other Requirements: Water Supply: Public Supply From, Address or: _ Private Supply Drilled by 014 Address Building 'Fype'- - Has erosion control been completed? Number of Bedrooms 2- Has garbage grinder been installed? yo 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 regulatio s of the Putnam County Department of Health. Date: h-ak S Certified by P.E. R.A. � � �� Professional) J 7' c 4y 4-o License # 'S !'L-4 Address (D gn 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 ar u 'ect to modification or change when, in the judgment of the Public Health Director, such revocation catio r change is necessary. By: Title: (� Date: 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 WELL COMPLETION REPORT Well Location Street Address. Town/Village: JI Tax Grid # Map %,'Block Z Lot(s) Well Owner: Name. Address: ® �✓ Use of Well: 1- primary 2- secondary Residential Public Supply Air con eat pump Irri tion Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion ",Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length ft. Length below grade ft. Diameter in. Weight' 'f* lb /ft. ` Materials: Steel _Plastic _Other Joints: _ Welded _.X Threaded _ Other Seal: Y Cement grout _ Bentonite Other Drive shoe: Yes No '' Liner: 'Yes. No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test Bailed Pumped Compressed Air Hours Yield gpm Depth Data Measure from land surface - static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses .... are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface �. �. If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information ' Pump Type ,5 v Capacity 5�� ,,� Depth 2$0 Model T C 50 s4�Z Voltage Z36 HP 314,0A Tank TypeQA -302- Volume 9 e ! -S Date Well C mplete Putnam County Certification No. Date of Re ort Well Dri r ignature) NOTE: Exact location of well Well Driller's Signature: ft distances to at least two ,er}anent landmarks to be prove o�nla White copy: HD File; Yellow copy -Building Inspector; Pink copy - e speevpian. C -;k Viiv - tll"E� f F orm WC -97 Apr 11 05 09:48a TOWN OF PRTTERSO 845- 878 -2019 p.l ,APR -11 -2005 10:01 AM HARRY W NrCHOLS 914 278 4567 P.02 .. • � IAICTII MOLIKARI• fill. M.N. ' .. - -.._.. _ ;.. _. _ _..._...- _ .....- fl A1106-1L.. gOL-E'i(�...._- _- -'-• --- - -- . _ - - - - - - - - - _.....w .._ . _...__............. _.. . �vORs Math D4wtw• N • • - d fttalati %Wblk.KroYh .Abedar. OImaw •Q/ AAW Strvfea OF ' IMAL m . _. _ .. ____... • Brewster, Now Yolk ' 10509 - .: _ �r _.__ , . _.,,...• _ ..... ... , • ..i�;itn.�.w iw�t>L Ot��l•1do r�coiU rn•ws� ' . • • Ptt1r'7iltNip�o�'6! <)iff•f011 lro�lwl pl�}17ti0<Z f1x(1{�f1S•ibll . Y,911 ADUESS'• UTFICA110N FORM OWNERS NAMES MIGNMei.�. A+n 4 4 E9I I ADDR�;S3;.. .3 Q u e C G4 W- T O'W Tf: . AUTBOR=p TQWN.0FFICLAI -. (Signatnro) Tha' Putnam County Departmeat of Health wfll not Issue a Ce`riit'icate �of • _ Constructioh Compliance•unleas the above fDrm•!s•eompleted; Le,, a legal Vol l , ' - address fs, a�lgaed by an fttilhorirecl town aiftclal. Tlfif totn� is to be suDtnitted - _ _..... • ._ ... -with the appUcation for 4 CeA ficate of Cowtmctiotl Complfsnce. FROM :Vincent McGough FAX NO. :8455312042 Jun. 21 2005 01:48PM P2 MPY - 81 -8605 1.;32 Fi?O, -.H20 SERVTCES LLC 84r- 87c.-44?0 ?L1t531 k^ P,1 Pape i of i rintaarrhi8r/w'hee, rarf. - _ _ __ a.4'srt n1L A" AIR ANAL Sri N'k�nOW AY�liuf roim3a9�, Corvae�rleut o3EM0 f �Ti l�llan! 4W= lva =��' __.. _ -.- _ • - - _ 820 Seivices Melling Irfbrmatien: collectors tnfonnsuo"! JMS 10. 000930 Name; H2O Services Nam: Shaun Boyd Address: 13 CakMvll Read Address of site: 3 Garfield Road CRY. Patterson Cif: Pgtiemn Static NY ap: 12538 Waft; NY Phone: (845) 279.4420 Fax: f�harle: 8an►p18'e Information: alts: Tank bate Colhsatcd: 51812005 onto Rpolvml: S1S120Ca Pmor ative: HNO3 Time Colleded: 11:00:00 AM T1mq Recolved; 12:31U,00 01A Temperahrre: K+1. Lab No-: J0604M Matrix: water Cate Analynd Test Name Rnu t Md.. Method 05/09/06 Color NO 15 Units SMWW 2120 B 06/Q8/06 Turtdd►ry 0,2 ntu 5 Mu SMYJYr`2,130 9 05/10/06 Hardness 2044 r, pIL N/A SMWW 2340 C 05/09/05 Odor ND N/A SMWW 2340 C 05MOM5 Iron <R1 mg/L 0.3 nV& SKIWW 31118 05/10/05 Manganese . <0. i mg/L 0.05 mg& SMWW 31116 051!0/5 Sodium 7.1 mg1L 28 MWL SMWW 31118 06/10105 Chloride 98.0 ma/i. 250 mg/L SMA W 4500 CI C 05/09/06 pH 810 S.'.:. &R.5 $IV, SMWW 4800 H B -NY 05/10105 Nkrate 0.1 MOIL 10 rtg/L SMWiN 4500 NO3E 03/10103 Nitrite c0A mGVL 1 mp/L BMWW 4000 NO3E 05/10/05 Wate t 7,S mg& 250 .mart SMVWI 4500 804F 05/1.79/05 Chlorine Free Residual c0.1 ma/L NIA SMVX./ 4500MG 1.13/09/05 . 2-00 RA Tote! C011brm _ Absoo, Absent SMVVW -92226 ,06mmanb: At tho time of the dneWs &.v eampic we* Acoeptabib for ToUl CoUform Slgnauire: tiAkhatl Lapman 9l!aron Nauiahan, olmetor pr"dent 'States; PH-We FLAP d; 1.1718 3) -0-0% L/ G"Nrctimn. MW 10S K MCI 1.4 uft a¢MT" tol Rwr cwp&vu k* 2ft -m.law 0 lab Far ma- me -afft I em PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SU13SURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map Block Lot Building Constructed by TownNillage o6je jzp pip pM� Location -. Street Subdivision Name Bbil•ding Type.' Subdivision Lot # I represent that I am wholly" and completely responsible for the location, workmanship, material, constructiorr anddrainage of the sewagelreatment .system serving ttie'above- desenbed 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 'prt—of said 18'ystem confs1ructed by ' me which fails'to operate fora penod 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: ..,; w Dated: n h Day ear ?a� Signature: INI), lwdE /// Title w,- _ _ _ -- 1.. General o 6ractW(0wner) "�ib&Gre J . Corporation Name (if corporation) Address: State Zip I K" A Corporation Name (if corporation) Address- ft %M qD P�YlAtA,, State 0 Form GS -97 . I - su: . v :. .. 1 ., r,. June 20, 2005 Robert Morris P.E. Putnam ,County Health Department One Geneva Road Brewster, New York 10509 Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 Tel: (845) 279-4003 - Fax: (845) 2794567 Email: hnengineer@aol.com Re: Individual SSTS Compliance — Mike Antaki 3 Quogue Road Town of Patterson, NY T.M. # 25.54 -2 -33 Dear Mr. Morris: Enclosed are the following: 1. Five (5) prints of Drawing S -1, "As Built SSTS," dated 6/16/05. 2. "Certificate of Construction Compliance for Sewage Treatment System," dated 6/20/05. 3. Three (3) copies of "Guarantee of Subsurface Sewage Treatment System," dated 6/20/05. 4. Laboratory Report, dated 5/9/05. 5.` "Weil- Completion, Report,,, dated 6/24/05. _ 6. Application Fee in the amount of $300.00 payable to Putnam County Health Department. 7. "E -911 Address Verification Form," dated 4/11/05. If there are any questions concerning the enclosed, please call. Very truly yours, Harry W. Ni ols Jr., P.E. HWN:JM:j m 04- 056.00 �— - ---- _ Page 1 of 1 JMSfnvironmanfal Sarvicos, inc. �� WATER. SOIL AND AIR ANALYSIS L ° ' 41 Kenosi3 Avenue 1 Dan". Connecticut 06810 1 Telephone 203 -798 -2229 __ .._.. _.... H2O Services Mailing Information: Collector's Information: Name: H2O Services Name: Shaun Boyd Address: 13 Caldwell Road Address of site:. 3 Garfield Road City: Patterson City: Patterson State: NY Zip:. .12563 State: NY Zip: Phone: (845) 279 -4420 Fax:. Phone: Sample's Information:' Site: Tank Date.Collected: 5/9/2005 Preservative: HNO- ', Time Collected: 11:00:00 AM empera ure. Matrix:. .. Water '•• Date Analyzed Test Name 05/09/05 Color 05/09/05 Turbidity 05/10/05 Hardness 05/09/05 'Odor 05/10/05 Iron 05/10/05 Manganese 05/10/05 Sodium 05/10/05 Chloride , 05/09/05 pH 05/10/05 Nitrate. 05/1.0/05 -• Nitrite-•• - - - 05/10/05 Sulfate 05/09/05 Chlorine Free Residual 05/09/05 2:00 PM Total Coliform JMS ID: 000930 Date Received: 5/9/2005 Time Received: 12:30:00 PM Lab No.: J0504622 Comments: At the time of the analysis the sample was Acceptable. for Total Col iform Signature: %�� , Reviewed By: X11 Michael Lapman Sharon Houlahan, Director President State #: PH -0218 ELAP #: 11715 05 3) q -dl- CONNECTICUT. NEW YORK AND NELAC CERTIFIED Toll Free 866- JMS -5097 I Corporate Fax 203- 799 -2408 1 Lab Fax 203- 798 -2107, 1 www.jmsenvironment3l.can Result MCL Method ND 15 Units SMWW 2120 B 0.2 ntu 5 ntu SMWW 2130 B 204.0 mg /L N/A SMWW 2340 C ND N/A SMWW 2340 C <0.1 mg/l_ 0.3 mg /L SMWW 3111 B <0.1 mg /L 0.05 mg /L SMWW 3111 B 7.1 mg /L 28 mg /L SMWW 3111 B 68.0 mg /L 250 mg/ L. SMWW 4500 CI C 8.0 S.U. 6.5 -8.5 S.U. SMWW 4500.H B -NY 0.1 mg /L 10 mg /L SMWW 4500 NO3E <0:1 mg /L 1rng /L SMWW 4500 NO3E 17.5 mg /L 250 mg /L SMWW 4500 SO4F <0.1 mg /L N/A SMWW 4500CIG Absent Absent SMWW 0222B Comments: At the time of the analysis the sample was Acceptable. for Total Col iform Signature: %�� , Reviewed By: X11 Michael Lapman Sharon Houlahan, Director President State #: PH -0218 ELAP #: 11715 05 3) q -dl- CONNECTICUT. NEW YORK AND NELAC CERTIFIED Toll Free 866- JMS -5097 I Corporate Fax 203- 799 -2408 1 Lab Fax 203- 798 -2107, 1 www.jmsenvironment3l.can PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES / FINAL SITE INSPECTION Date: Z115 Inspected by: all ]na-�4 - -Street Location �;4 z fib c7 Yzt V _ _...Owner A; T,.A�f Town Prszs- rE29o�/ Permit # or ! 0 0 3 TM # a- S. 5- 1/ -- - 3 3 Subdivision Lot # 7y s - 70 C :z- 1. Sewaze Svstem Area a. STS area located as per approved plans .......... .. ................ b.. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................. d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course /W tlands ...... ............................... IL Sewage System a. Septic tank size 1,000 .. ....1,250.........other....... 0�p b. * S eptic'tank inst a el ................ ............................... c. 10' minimum from foundation ...................................... <,Dlstribution Boxes t- -1 outlets at s "ame elevation =water r tested 2. Protected below frost .................. ............................... 3. N inimum 2 ft Ongmal sort between box & true e. _Junction > =B.ox properly set .F r �_ 4 _ "'` �,W 6.v ,renc es,Y - _ -_`s` - " . 1. Length required z Length installed 2;z;z, 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property he - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 11/2" diameter clean .................... 9. Depth of gravel in trench 12" minimum ....... :........... 1 .............................................. dR ?_ 10 Pipe ends ca e g,; umti.or nose vstems��_ �f —r - hize of pump`cnamber Overflow tank ........... ............................... 3. Alarm, visual/audio ........:.......... 4. Pump easily accessible, manhole to grade ................. 5. First box ball e d .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... M House/Buildidg a. House locatedper approved plans.......... b. Number of bedrooms ....................... '02..-....23 ... IV. Well Well located as per approved plans . ......:........................ b. Distance from STS area measured -/ /D 5-, 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 wJffidnside =of box .... ............................... e. Curtain drain & standpipes installed according-to 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 ................. ............................... Rev. 12/02 NO I COMMENTS r �� APR -12- 20'05''•02:08 PM HARRY W.NICHOLS 914 279 4567 P.01 PUTNAM COUNTY DEPARTMENT OF 11FALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES REQUES1 pOR FIbIAL JbISEM dN For: Fill Date: 04-11-OS: OS. Trenches _- _...... I Z .^.,. ' � _ ✓ „_ PCHD Construction.Penmit # _ P- 10 03 Located: a Giddit 90Alb (T) _. PikTrzg&&a Owner /Applicant Name:. tt.M ALL syti.&cj TM %§.S+ 'Block 2 Lot Al-- Formerly: Subdivision Name: -- Pj1uA.e LAiv-r ... Subdivision Lot '# 1654.70¢z Is's ' ieff ill' completed ?': Date -: I5 system;complete7 , Date: 94 It a5 Is system constructed as per plans? Y,�t�6 Is well' drihed? _vas Date: __. o 4 x,1.0.J .Is well.:located.asper pleas? vas Are erosion control measures in place? — I certify. that the syster* •as listed, at the above premises has been constructed and T have inspected' and .verified their completion in accordance with the issued PCIM Construction permit and approved plans and' the Standards, Rules and Regulations .of the Putnam County Department of Health. .. .. . _ %A 'SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health April 19, 2005 r. DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Harry Nichols P.E. Patterson Office Park 2050 Route 22 Brewster, NY 10509 Re: Field Inspection — Antaki Garfield Drive, (T) Patterson T.M. #25.54 -2 -33 ROBERT J. BONDI County Executive Dear Mr. Nichols: The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. 1. Pipe at septic tank inlet needs to be trimmed back. 2. Remove rocks from backfill material prior to backfilling. 3. A pump test needs to be witnessed by this Department once the electrical inspection has been completed and notification of such has been submitted to this Department. If you have any further questions, please contact me at (845) 278 -6130, ext. 2261. GDR: cw Sincerely, Gene D. Reed Sr. Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 SENDING CONFIRMATION DATE : APR -20 -2005 WED 09:14 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845- 278 -7921, PHONE : 92794567 PAGES : 1/1 START TIME : APR -20 09:12 ELAPSED TIME : 0014111 MODE : G3 RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... SHERLITA AMI.6R, MD, MS, 1rAAP Camnuttimer of Neatth LORETTA MOLINARI, RN, MSN Attoctart CommltNoner oflfea th April 19, 2005 Hat7y Nichols P.E. Patterson Officc Park 2050 Route 22 k DEPARTMENT OF HEALTH I Geneva Raad, An :u ^,nc. >: =w YPrk :6509 Rc Field Inspection - Antakl (Inii field Drive, (T) Patterson ROBERT J. BOND[ camp• &-.d.. Dear Mr. Nichols: The above referenced separate sewage tr alown- .1 . i zm be backtillcd. The following comments must be corrected in the field. I. Pipe at septic tank inlet needs to bP. trimmed Nick. 2. Remove rocks from backflll material prio- to backfillinp. 3. A pump test needs to be witmtaaed by ibis L)eL)arttncnl once the electrical inspection has been completed and not :r,rnY;• : ,C >nrh bas been submitted to this Department lfyou haveuny luttherqucstions, please cpntari • :• :u 1$•t ?) !/8 -6136, cxt. 2161. rare P, Rrr,i F.n�i•rnm :••171 N.•nIO1 Fnni,crrinry A d,t GDIL'cw Enamummem 7r,011, (8 /s12 :8.5 •.ec rM(8 +5)278-7921 Nurdn88eMma (815)278.6558 W(Ci8•- i?2!8.4678 F..(815)278 -H18< 6n71r latemm�aNPnuhonl �` �'•? -'S , :nlr Fna (835)2'18 -61i.e MAY -02 -2005 OS : 2 7 AM HARRY W N I CHOLS 914 279 4567 P.02 BRUCE It. FOLBY Public X.eolrh_.Dlrecior --• ATT ENT f0,N: LORETTA MOLINAR1 M4,.. M.S.N. Aisoclate Publto Health Director Direelor of ,1 aN$nt Servleei DEPART YMNT OF HEALTH 1 Genova- Road Brewster, New 'York 10509 REQUEST. FOR FIELD IMING 0 ADAM STIEBELING GENE'itEi;D A11 information below'must be f�U completed prior to any scheduling. DATE; 04. jig . 09 EYG111TE rR OR FITtl1i: 1 AQ!i W WAU MR. PC. PHONE 0: _ Z79• 4 a � REASON: - DEEPS: 0 ' , PERCS: ❑ PUMP VEST: 1( ROAD /STREET: TOWN: TAX MAPf#: C ¢•a -.. 5 SUBDIVISION: LOTS: OWNER:t.�M�►fCt :FS'IT MON(_- QE,94U, TES.11NG YES NO ❑ a Proposed SSTS•within the drainage basin of West Branch or B.oyds Corner Reservoirs. o .. _ _ .❑ P.roposed.$S'TS w1th1n.S00Seet.o.f a.reservoir, reservoir stem or control lake.- - - - ❑ ❑. Proposed'SSTS within 200 feet of a watercourse or a DEC wetland. 0 wProposed SST$ desigq flow greater than 1,000 gallons /dayor MES Permit required. ❑ a_ . , Proposed SSTS for a Commerical Project. It is tfic responsibility o,f 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 answeredyea to any of the questions, NYCDEP must witness the soil testing. This Department will coordinate 'mutually suitable time for field testing with the PCDOhf, the Design Professional and NYCDEP. If a project 114s 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 IY'YCDEP. FORCOU&-ry USE bm,., '7 �% DATE: TI1IE: (FIE DT'EST) MAY- 02 -2 005 08:27 AM HARRY W NICHOL.S 914 279 4567 BY THIS CERTIFICATE OF 0QMftIAN0E 1'HE NEW YORK - BOARD OF F "R,E UNDERWRITERS BUREAU OF ELUCTRICITY 40 FUI-TON STREET - NEW . YORK, NY '10=1111 CWtTIFIES TMA"Y' Upon the application of •WILLIAM PitARELLA PO BQX 158 NY 1 l:itZ�WSTEFi, OSOB, • Located at GARFIELD RQAID PATTERSON, NY 12553 Application Number: 2b28129 upon premises owned by MIK0 ANTAKI GARPIELD ROAD PATTERSON, NY "2 583 CartlfIcate•Nurnber; 2028129 Section; Block, Lot! Building Permit; BDG: W104 P.03 Vescrlbed as a occupancy, whemin the premises electrical sylstem aor1810118 of electrical devices and wiring,.dese toed below, leated in /on file oremite5 lit, Basement, AtleChed Gatuga, t�ifdde, " A visual inspection of the premises eiectilcal System, limited to electrical devices and wiring to the extent detailed he yin -.•was - -- conducted... r1_ accordance ' -with th9, ` requarements of ..'Ahe ..tipplicab(e..- code..amftr , .standard . promulgetod by the State 0i Naw, York, Department of State Code Entorceiment end Administration, or other authority having Jurisdiction, and found to be in.comptlance therewit>,•.on the 2sony of A*, 2005. Le mm' UOLU zz RiiKrelianeoae CL1tTiF1CATE NV aSR FROM THP AQARD 1437 SEPTIC. PUMP AND ALARM Alarm a »d 9mcrgengVqu1pm8W A�1f1URriCC6 l{Pd ACCCaISDriaY . Dish waxhcr 0 KW RAage 1 p " iW Clothes Dryor 1 0 4.5 XW Mieco -wavetb 1 0 20 Amps . Fumaoo 1 0 Oil BEII TlarisformdP 1 0 •.w Air Coodltloacr 1 U '12000 BTU ' Meta" - • y 1+i3P •• 9!!11 .. Panda confinaod eh tract Pfev 2 .. • ' Thls ceriiftoete may not he Filtered in any way and is vall6W oniv by the presence of a rQlsed Seal at the locution indicated. A11 -0 600 /700•d 190 -1 loll Olt I►0 I= 4010 -9eJd w892 ll lO.OQ -ids - PG1GiS MnW nq - CIS TPI GaS- a7G!_7Qa9 tC • DI ITAlf1M e-m IAITV nr!rne1nTMrAtT nr n PUTNAM COUNTY DEPARTMENT OF HEALTH _.. _ .. DIVISION OF- ENVIRONMENTAL IiEATLII SERVICES - - FIELD ACTIVITY REPORT Street PERSON IN CHARGE Town PUMP TEST 7- y I / Z State DOSE TEST REQUIRED GALLONS Zip � /7 /.., -;� Z9 arW?"WilF",F %J-W, Signature and Title RFP0RT RF.r,F.TvRn RY: I acknowledge receipt of this report: SIGNATURE: 02/96 Title: U • SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health May 11, 2005 Harry Nichols PE Patterson Office Park 2050 Route 22 Brewster, NY 10509 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Field Inspection — Antaki Garfield Drive, (T) Pattersoyl T.M. #25.54 -2 -23 ROBERT J. BONDI County Executive T Dear Mr. Nichols: A re- inspection at the above referenced lot has been completed. There are no further comments to be addressed. If you have any further questions, please.contact me at (845) 278 -6130, ext. 2261. GDR: cw Sincerely, Gene D. Reed Sr. Environmental Health Engineering Aide Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool(845)27.8 -6014 Fax(845)278 -6648 0 UTNAM COUNTY DEPARTMENT OF HEAL SION OF ENVIRONMENTAL HEALTH SER CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM &7. MIT # a J60,3 Located at -7ar-$ Subdivision name Subd. Lot # 704 Z Date Subdivision Approved I L31 % l Owner /Applicant Name L( Lq r1l Mailing Address 79 tl C �,S �� s't��z /'o►- Town or Village &alltilr4qs Tax Map 2-5t 9q Block : Lot 33 Renewal I Revision _i," Date of Previous Approval -7- 26 -01 cv Amount of Fee Enclosed X266 Building Type ! eh lc Lot Area 0,-4 S" No. of Bedrooms Zip I O!E Design Flow GPD 406 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of Other Requirements: P v w•J2 1000 gallon septic tank and 2,2-2- To be constructed by 1 ',j D Address Water Supply: Public Supply From Address Private-Supply Drilled by _ T-13 -,D 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. Signed: Address Yelt Date - 0 �--0 S License # 5-4, 1 2_1 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only. Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION_ TO CO_ N_STRUC_ T A WATER WELL �i please print or type PCHD Permit # J 10 — 0 3 Well Location: Street Address- Town/V' Tax Grid # Ma ZS,S'9 p Block Z Lot s �) 33 Well Owner: Name: / "i ttrL, i1 MTh �ii(� Address: -% 9 ti I C-eJe r 5�v-e ej- Pa,-kL�vv. Use of Well: - (/Residential Public Supply Air /Cond/Heat Pump Imgation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served 3 Est. of Daily Usage ¢a O gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling V"New Supply (new dwelling) Deepen Existing Well Detailed Reason G w P Sic 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 Name of subdivision ,,,,.,, J S" Lot No,'7oM - 704x2- Water Well Contractor: TA- b Address: Is Public Water Supply available to site? .................................. ............................... Yes No ✓ Name of Public Water Supply: Town/Village ---" Distance to property from nearest water main: — Proposed well location & sources of contamination to be provided on separate sheet/ an Date: I -p�'_ per' Applicant Signature:.. ,V PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue Date of Expiration Permit is Non - Transferrable Permit Issuing Official: Title: White copy - HD file; Yellow copy.- Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 } PUTNAM COUNTY DEPARTMENT OF HEALTI IVISION OF ENVIRONMENTAL HEALTH SERVI ONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM P RMIT # _0 t) Located at PP-NE Subdivision name FPM L'V,6 Subd. Lot # ') 42- Date Subdivision Approved N l t� 1 Owner /Applicant Name Mailing Address Hi6t� O- Akr,&P0 % wco j5rp4� Amount of Fee Enclosed ' dU(Z) Town or Village PAi'IF�-� ®0 Tax Map�6 -4 Block 1. Lot tjA E- I Renewal Revision Date of Previous Approval Pon Gff 5, 1� W Zip Building Type R4b IOEHLZ Lot Area 0 '4� No. of Bedrooms 2 Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED 4ocp Separate Sewerage System to consist of J 000 gallon septic tank and U2- Lf ItK I � Other Requirements: To be constructed by j IV Address Water Supply: Public Supply From Address or: Private Supply,_Drilled by p :. __ 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 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 �® i -`� -I 1 R.A. Date 0 l 2's 104 License# 56124 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 wh c nsidered ecessary by the Public Health Director. Any revision or alteration of the a proved plan require anew pe proved discharg f domestic sanitary sewa T3��'1 ��- / —�� By: Title: Date: b White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL _.._please print or type _...... _. .. , _ PCHD Permit# " P �� -�3 ;SlJ- 3/•-�. Well Location: Street Address: Town/Village Tax Grid # 6W16W DRN I% FA T I i~l 6 P N Map'11j, 6 q Block 2 Lot(s) � 9 Well Owner: Name: Address: i 0m 5 Ufi.ta qAH 6 ft ff IELP d --)`l6 PAM( -600 JAY iZ40? 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 gpm # People Served _4-6 Est. of Daily Usage 0 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling 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 .k Is well located in a realty subdivision? ...................................... ............................... Yes k No Name of subdivision NrHRl� LNg Lot No. Water Well Contractor: T60 Address: Is Public Water Supply available to site? .................................. ............................... Yes No X Name of Public Water Supply: °" Town/Village �- Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate heet/plan. d�I a�i �� Date: Applicant Signature: A I L A G V r PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED.FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a w ter well driller certified by Putnam County.' Date of Issue d 2.4 Permit Is s ' g Offi 'al: Date of Expiration Title: Permit is Non -Trans rrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - C,imer; Orange copy - Well driller Form WP -97 January 5, 2005 Putnam County Health Department One Geneva Road Brewster, New York 10509 Aft: Robert Morris, P.E. Re: Individual SSTS Revision Garfield Drive Patterson, N.Y. T.M. # 25.54 -2 -33 Dear Mr. Morris: Harry W. Nichols Jr.; P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 . Tel: (845) 279 -4003 Fax: (845) 279 -4567 Email: hnengineer @aol.com The above referenced project will now require a pump in the SSTS system to properly serve the needs of the proposed residence. Accordingly, we are enclosing the following: 1. Five (5) prints of Drawing SS -1 "Proposed SSTS," revised 1/3/05., 2 "Constriction Permit," dated 1/5/05. 3. "Well Permit," dated 1/5/05. 4. "Pump Selection and Dosing Volume Calculations," dated 1/5/05. 5. Revision Fee in the amount of $200.00. Kindly process the enclosed at your earliest convenience. Very truly yours, ti Ha ry W. N' ols Jr., P.E. HWN:jmm .S �d c- NVr so 14J 3 H .A N xspf3y #43 Harry ..W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 (845) 279-4003, fax 279-4567 - CONSULTING SITE ENGINEERS JOB No. SHEET No. OF COMPUTED BY DATE CHECKED BY DATE > _p 6 A S:17AM G kj EAD pi jA4P C,14-4,4,18ER 130-r-110 M_ ELI y" 13 9-r,4nc- hbEA P/pa /_&:4c-'-n+ (2" pi/c 0 b j-rrT.(/vc'-_S IJ I L/ NT- Plp_i=L T' Cl+'F_C*_ �V6L L/ r__ Q. 1'712- ;rAl..E VAL*Vr-- Gel, it -4, 10 v Cz _&T E -.14 60 CYPA4 Ij - ----------- - ---------- ------ - ------- ....... ............... ..... .................. ......... . .... ...... . ................ . ........ . . . ......... ............. ......... ...... .. . ...... . ...... .. . ...... . ..... . . .......... ... ... 236 -- -- -------- . ......... .................... . ---------- Harry -W: Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 8r'ewste*r, NY 10609 ($1$ 279 -4003, Fax-279-4567 - DOONSULTING SITE ENGINEERS JOB No. SHEET No. 2— 1 ".OF COMPUTED BY JA' DATE CHECKED BYhk& DATE —01 - -Drj 13 bl (-7 5- ys-T8m 1104� w5wc,.r i161- "B ! op - 7--2 2- L x 7, 05k- -4 0 0 L ...... ------ -17- AN - -------------- . ..... .... .......... d- ..... ..... . ........ . . . . ........ - - ---- - .......... .. ......... .. . .......... ... . ........... . . ...... • r 14.16.4 (2417) —Text 12 _ PROJECT I.D. NUMBER 617.21- SEbR' Append Ix- C ......... __......._.._ _ . State Environmental Ouallty Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (fo be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR F2. PROJECT NAME 3. PROJECT LOCATION: Municipality County 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) 5. IS PROPOSED ACTION: ❑ New ❑ Expansion ❑ Modificationlalteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ❑ Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ❑ Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/ForesttQpen.space.. O Other S' Describe:...... _ ., 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ❑ Yes ❑ No If yes, list agency(s) and permlUapprovals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes ; ❑ No If yes, list agency name and permll/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? •0 Yes ❑ No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE , Applicant/sponsor name: Date: Signature: If the action Is In the Coastal Area, and you area state agency, complete' the, Coastal Assessment Form before proceeding with this assessment OVER 0 r PART II— ENVIRONMENTAL ASSESSMENT (To be completed by agency) _ A. DOES ACTION NEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes o - B. --WILL ACTION RECEIVE COORDINATED REVIEW AS-PROVIOED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be supersedeedd by another involved agency. ❑ Yes (1No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, It legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, 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: Iw 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 00 C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. 7W 0 C6. Long term, short term, cumulative, or other effects not Identified In C1•C57 Explain briefly. l�v C7. Other ,Impacts (including changes In use of either quantity or type of energy)? Explain briefly. 0 D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ymo 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. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a' positive declaration. PC 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:. a),ij° GAn Ozres4 i 1)1(L,Pt ct24- or Ty Name of nsib Officer in L a Agency Tit e o espo si e Off* cer Signature of Res erin Lead Agency Signature of Preparer (If i erent rom -responsible officer) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ,pCONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # P - / O- U Located at b a r t* d dl I)CLU 2, Town or Village •�o sYt Subdivision name �l/' . �, �c Subd. Lot # 2n&Lz_ Tax Map ZS Block 2.. Lot Date Subdivision Approved D ] Renewal Revision Owner /Applicant Name 0'4 � S Z ` � i i g n Date of Previous Approval Mailing Address �yar -Uj b r Am f F E 1 d Zip / 3 ount o ee nc ose Building Type Lot Area 0,' S— No. of Bedrooms 2 Design Flow GPD 4W Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of Oa0 gallon septic tank and Other Requirements: To be constructed by Address Water Supply: Public Supply From Address _ or: l/'_ Private Supply Drilled by • T pi) ' " Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the ssQarate sewage tre atments em 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 10 2-0 -0 3 License # q61124 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless, construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new p it. Approved f ischarge of domestic sanitary sew ge only. r �` By: C � � Title: -Date: : White copy - HD Fil; Yellow c py - Building Inspector; Pink copy - r ran opy - Design Professional Form CP -97 'PUTNAM COUNW HEALTH DEPT O'2 4 578 !' 1 Geneve Road. (845) 278 - 6130 .. i• . ' ; Bre�ster; NlY;10509 s ", 4 Received of: µTe Surn Qfr Dollars $3D0 .;For � ,.. 12 THANK .,YOU!~ CY . ' Q Cash: T ❑ ^Check '} O ❑Credit Card ` gy N1 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/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAVIER NAME: ADDRESS: SITE LOCATION DATE: l A444 Dpwi PAMMft L2- t03 STAFF PRESENT: Rob M., Mike B., Gene R., Shawn R., Bill H., Joe P. SPECIFIC WAVIER REQUEST: tL✓� t DOES THE PROPOSED VARIANCE REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? YES NO WILL DISAPPROVAL RESULT IN A SIGNI ICANT HARDSHIP? YES NO DISCUSSION REQUEST APPROVAL OR DENIED FOR it 'A DIRECTOR OF (SPECWAIVER) APPROVED DENIED DATE: / 2 —/ 1416.4 (9/95) —Text 12 PROJECT I.D. NUMBER 617.20 SEAR Appendix C_ State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT; FORM For UNLISTED ACTIONS Only ' PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR J OA'G 4w V n H PROJECT NAME ppOn• 4q � x 3. PROJECT LOCATION: �1 Q� PLI Nhm Municipality 1 G� County 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) 5. IS PROPOSED ACTION: New ❑ Expansion ❑ Modiflcatlon/alteratIon 6. DESCRIBE PROJECT BRIEFLY: ' iNavlq�R� '�Jh�1 ' 7. AMOUNT OF LAND AFFECTED: TfPS p' �- Initially acres Ultimately acres a. WJ4 PROPOSED ACTION COMPLY WITH EXISTING ZONING OR-OTHER EXISTING LAND USE RESTRICTIONS? Jitt�f „es ❑ No If No, describe briefly 9. WVAT IS PRESENT LAND USE IN VICINITY OF- PROJECT? Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other - Describe:.. _ .. .. .... 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ❑ Yes No If yes, list agency(s) and permlUapprovals 11. DOES ANY 4SPECT OF THE ACTION. HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ KNo Yes If yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑ Yes No . I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE �1 r ' Y ` O� ( " " � Date:) Y O Applicant/sponsor name: Signature: If the action is in- the' 'Coastal Area, and you are a. state agency, complete the . Coastal Assessment Form before proceeding with. this assessment OVER SW -3i-&3 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate'the review process and use the FULL EAF. ❑Yes 5allo 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. ❑ Yes No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater. quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, arc�iaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: 1�4 C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: Ida C4. A community's existirg plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly. /Y C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not Identified in C,1-05? Explain briefly. NO. . C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. h!r" D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA? ❑ Yes No E. IS THERE, ORBS THERE•LAKELY T&BE, CONTROVERSY RELATEb TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes IZNo 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 matir'ials Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part 11 was checked yes, the determination and 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 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 ft"4k, Print or ype Nam of Respon a Officer . ead Agency Ti I Responsible Officer feu Si 'ature of Responsi a cer Lead Agency 7gnature of Preparer(if different from responsible o (icer) Il 4 �U-)-3�-�3 NEW YORK STATE DEPARTMENT OF HEALTH Specific Waiver Bureau of Community Sanitation and Food Protection from Requirements of Part 75 and Appendix 75- A,10NYCRR __ .._ ......__...... _- _. _......_._.... 1 or. Individual Household -Sewage Treatment Systems Last Name First Md. Name of Applicant �j UU,,( No. Street . Cityrrown State Tip • Address Q ,�...: pkrt"�o N� say No. street n cityrrown State Tip Site Location 4 Aaftm I, QiW f— RA UV4, w 1,,,k z,A- -Z 1. Reason why site does' not meet 10NYCRR Appendix 75 -A (check appropriate box(es)): 'UtSeparation distance cannot be achieved. Excessive slope. High groundwater. Inadequate. depth to bedrock or impermeable layer. Soil unsuitable. E] Other (explain) ...................................................................................... ............................... ......................................................... ......................... . . . . .. . . .............................. . . . . .- - - - - -- - - - -- - ------ - - - - -- - -- - ...................................................................................................................................................................... ............................... . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . .. . . .. . . . . . . . . . : .. . . . . . . . . . . . . . . . . ......................................................... : ............................ :. . . .. . . . . . . . . . . . . . . . . . .. . . . . .. . . . . . . . . . .. . . . .. . . . . . . . . . . . . . . . . . . . . . .2. Proposed design or conditions of waiver: -'j W A....... >$+r��%,��`........... ......................................................... ............................... ------------ - - - - -- - - -- - _ ............................................................................................................................................................ ............................... . .. . . ... . ... . . . . . . . . . . . . .. . . . . . . . . . . .. . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . .. . . . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .. .. . 3. The proposed design may have the following limitations (check appropriate box(es)): Increased risk of well or spring contamination. Increased risk of surface water contamination. Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. Other(explain) ............................................................... :............................. ............... ....................................... :. Additional information attached Construction pursuant to *this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations, Part .75.6 (b), a waiver is hereby granted. This waiver may be revoked by the issuing official for a change in conditions for which this waiver was granted. cu ....................... .t .... ...................... ..... : ....... ... mr.rIlrar Y 1 N 11YC Ur VVM IJalWrtc �' ncrw�n ORIGINAL -Local Health Agency COPY • Applicant/Design Professional It Di1 ?E. ...... 2. 4,10 ........................................... ............................... ►v\U +ooc 171013% (GEN -152) t' T `u i Harry W. Nichols Jr., P.E. r Patterson Paris, Suite 106 j ; 1 2050 Route 22 . ..,.f�il .{E... E H S Brewster, NY 10509 Telephone (845) 2794003 04 JUN 2 4 AM (j 16 Fax (845) 2794567 To= t Attention: I Date: 6� HIa�1 Job No.: o� -ate .Project.. - T() Gentlemen: We enclose (.copies of 7"'13/W Prints Reproducibles Reports .Tracings Specifications Memorandum Copy of letter 1 Description: Revision/Date No. Sent V'a: ur Messenger Blueprinter Your Messenger Hand Delivery Copy to first Class Mail Special Delivery Very trul you ©. It To: PL / D Attention: ILL- Grrt Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 —• -•• -Brewster, NY 10509 Telephone (845) 2794003 Fax (845) 2794567 Date: �"az- `x'0.3 Job No.: 0 3 —oa/ Project "r-S., 4 . l fl t'Qc, Gentlemen: We enclose copies of B/W Prints Reproducibles Reports Tracings Specifications Memorandum Copy of letter Description: Revision/Date No. Sent Via: Our Messenger Blueprinter Your Messenger &/Hand Delivery Copy to ENc First Class Mail Special Delivery VeTW� y yours, Ha Ni ch Jr., P:E. f 25.54- 2 -10 -11 25.54 -2 -17 25.54 -2 -23 25.54 -2 -24 25.54 -2 -32 25.54 -2 -35 LIST OF PROPERTY OWNERS WITHIN 500 FEET SULLIVAN - 03- 001.00 05/16/03 MARSELLA, JOHN & JOANNE 47 NEWBURGH ROAD PATTERSON, NY 12563 EVANS, THOMAS & DENISE 13 CALVERTON DRIVE NEW FAIRFIELD, CT. 06812 CHAMBER, CHRISTOPHER, KEVIN & KATHLEEN 2 OAKFIELD DRIVE PATTERSON, NY 12563 NEGGIE, MI"CHAEL NEGGIE, GRACE 8 OAKFIELD DRIVE PATTERSON, NY 12563 COUNTY OF PUTNAM COMMISSIONER OF PUTNAM 40 GLENEIDA AVENUE CARMEL, NY 10512 CULLEN, ERIC & CAROLYN 4 QUOGUE ROAD PATTERSON, NY 12563 Harry W. Nichols Jr., P.E. • Patterson Park, Suite 106 2050 Route 22 .... .. Brewster, NY 10509... Telephone (845) 279 -4003 Fax (845) 279 -4567 Date: May 16, 2003 RE: Department of Health Review of Proposed Sewage Treatment System for Property Name: Joan Sullivan Address: Garfield Drive Town: Patterson, NY Tax Map #: 25.54 -2 -33 Dear Eric & Carolyn Cullen: Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at 278 -6130. Received By: Address: Tax Map #: Very truly yours, By: Harry W. Nichols Jr., P.E. Title: Agent 3..Als�o;' coin p e.e kZgnqt�rq so.compet X -Sl - . " 1, ."'Z�"L "r, j-., � �,; t itemAlf.Restrict6d'Delivery. is .desired.'. .g ht, A red Print name;arid.'a` ,yo* -the reverse. 4r address on d Ad ress; d"dd rnpAhe- ee qu�t. aM@:!a!j address re�yprsa: so:thdtwe�,can r4i6pi�jh6,-card to-you.. -back B.'Redelved by� , 1c. Aqyou�%;1,4 Attach-:ffils,6&d,Ao:the of the matt lace . r o� 6. A I'M oit:on.Afie -thdft nt'If.'qOik 4�e!pafrn!t drent jtem,.1?:::';13" Ij delivery address'differentfrom dam 1? 'y Article-Addressed to: if YES, enter delivery PWI* -address below No- ktic 0.. Christopher Chamber John & Joanne Marsella Kevin & Kathleen 47 Newburgh Road 2 Oakfield Difive Patterson, NY 12563 Patterson, NY 12563 3. �Seyce Typ a _rtifiddVall, Mall, Q -ExpressWall'. ❑Retuni:Recelpt fbr*Merchahc,.. 7 Rdtum-Recdipt &. M ❑ In'sOred Mail O.D. 4. Restricted 'DeIlvery? (Extra Fee) E3 elive Article Number 7002 - - ----- 2410 0000 4207 4315 1 7002 0510 0002 17 47 7434 ft V t (transfer pM 4e c e 00 , 3 Form 381:1,*,:A46u'st''2001 Domestic Return. Re 16695-02 celot �3811 � jITS: rib. -6 bo,mestc Retum.�ede F6.0 i ;!and:3. s6<completei.,'. item -4:if; , R 1 6 - strI6td&DdIivery--is desired. Print your. name and address.on the reverse so that We can return the card to you. Attach -this -cdrd'to th6back- of the mAllplece, or on the front if-O'Paice Oermiti. Article Addressed *to: Michael & Grace Neggie 8 Oakfield Drive Patterson, NY 12563 Article Number (T—Ifer from qerv16R 'atx'__ 3 Form .,August 201 t -S tore 1`1'2 '�an d gen 113 A t estncted= Deltve ` +i5 desired a ❑ dre'ssee ■ nntyournamp.apd,4 pss - Received ' n' d reverse B. Received by. (Piinted A!m.) C. D to of 661IN4 - . . . . . . . . . Thai 6f;,thO, 41, h if 4s Punted rent from s' lfi :D4: Is delivery add 17 'add era4,from ,iteii Arti cleAddiessed t cad WYES, enter delivery address below: belm '2�1 Arti 7002 0510 0002 1522 1893 7002 2030 0003 2586 1890 (Transfer hr Hit i 4� 7R..7,pt to25s5 62 Mmtl iwo August -200 � 31 I r onip eta . ften ; s 1y -2, and-6 Also complete p;ete.:. X'-Si nature Item 4if Restdcted, Delivery AsAesired 1,.Pdnt Yqu l :so,thai 'W h card t, you f f f ELEY-fiCA A L S.-E -Pa -U Postage $ 018E UNIT I D . O'n 1, Certified Fee 2,30 Return Reclept� Pee $ Postmark (Endorsement Required) 1.75 Herb Restricted D 'Ver Fee a' I (Endorsement Required) 1 Cle rk: KSPHRO i . Total Pdai h 7.1j 0 o 05/16/03 - I Christopher Chamber sent To rU C3 'NEiji-AWi Kevin & Kathleen orPOBox 2 Clakfield Drive C3 C3 ct'y` state, Patterson, NY 12563 "- 1 77T .Ftil6 A L AkIIIIIll Postage $ CI-83 I Certified Fee Return Receipt Fee (Endorsement Required) Restricted Delivery Fee (Endorsement Required) ".30 U S III, UN-11 '111: 0012, Postmark Here Clerk.' KSPHRO Total Po, , I � 4 = 0 1 (Ulb/1' U'VC13 Sent To Michael & Grace Neggie 8 Oakfield Drive I or PO so), ' pit; scare Patterson, NY 4-2563, U.S. Postal ServiceIrm fCERTIFIED MAILT,, RECEIPT 3 n (Domestic Mail Only, No Insurance Coverage Provided) r Z� =ff-man :11 JA;,4A L U S E U Postage go $ 0.83 UNIT ID: 0012 3 Certified 3 ^ Posirna* 3 Return Reclept Fee Here :1 (Endorsement Required) 1.75 :1 Restricted Delivery Fee Clerk: KSPHRO -q (EndamemetAquired) U Total Postana A P"51 4.88 05/16/03 sent ro Thomas & Denise Evans traet AF 13 Calverton Drive or PO Sm New Fairfield, CT 06812 city? Buie n ir IN. CO z1:""ff412FnA@' nolwigi ,For delivery information visit our webs.ite 6.tWww.usps.com& -D ro I p,,,Q gE, E , I, I A L U S E ru Postage $ 0.83 UNIT ID: 0012 M C3 Certified Fee 2.10 C3 Return Reclept Fee Postmark (Endorsement Required)' I f5 Here C3 Restricted Delivery Fee Clerk' KSPHRO M (Endorsement Required) 0 ru Postp— A P— 4.8-0 0516" 3 Total tA ru C3 Sent TO Eric & Carolyn Cullen 0 4 Quogue Road or PO Box Patterson, NY 12563 city state; _ Affill U.S. Postal Service'rIll i . r CERTIFIED MAIL. RECEIPT M M '(Domesfic Mail Only; NO Insurance Coverage Provided) A R Y F A Ao o"' I A L ru E 7 M - Postage $ 0'53 UNIT ID: 002 C3 Certified Fee 0 230 C3 Postmark Reft�.,R Fee Ham .. t - P' 1. 0 (End R.Ieq U d) 1.75 0 Restricted Delivery Fee Clerk: KSPHRO r:l (Endorsement Required) -r ru Total Po- 65/16/03 ru o Sent County of Putnam o C3 r Commissioner of Putnam ------- or P6 So 40 Gleneida Avenue Carmel, NY 10512 77Q, y k-23' AAL US -E Postage ostage $ 0,83 UNIT ITJ! 0012 lam- I-q Certified Fee 2.30 Postmark rU C3 Return Receipt Fee (Endorsement Required) Here 1.75 C3 C3 Restricted Delivery Fee CILPrk.- OPO HR (Endorsement Required) C3 Total Pw---- d' 1 7 4_58 0511116,10 1 Ln c3 - Sent T- John & Joanne Marsella ru -Strawt,;� 47 Newburgh Road ------- C3 6 or ---PO Box --------- Patterson, NY 12563 City, State ....... n ir IN. CO z1:""ff412FnA@' nolwigi ,For delivery information visit our webs.ite 6.tWww.usps.com& -D ro I p,,,Q gE, E , I, I A L U S E ru Postage $ 0.83 UNIT ID: 0012 M C3 Certified Fee 2.10 C3 Return Reclept Fee Postmark (Endorsement Required)' I f5 Here C3 Restricted Delivery Fee Clerk' KSPHRO M (Endorsement Required) 0 ru Postp— A P— 4.8-0 0516" 3 Total tA ru C3 Sent TO Eric & Carolyn Cullen 0 4 Quogue Road or PO Box Patterson, NY 12563 city state; _ Affill U.S. Postal Service'rIll i . r CERTIFIED MAIL. RECEIPT M M '(Domesfic Mail Only; NO Insurance Coverage Provided) A R Y F A Ao o"' I A L ru E 7 M - Postage $ 0'53 UNIT ID: 002 C3 Certified Fee 0 230 C3 Postmark Reft�.,R Fee Ham .. t - P' 1. 0 (End R.Ieq U d) 1.75 0 Restricted Delivery Fee Clerk: KSPHRO r:l (Endorsement Required) -r ru Total Po- 65/16/03 ru o Sent County of Putnam o C3 r Commissioner of Putnam ------- or P6 So 40 Gleneida Avenue Carmel, NY 10512 I��I 'THW Ntui .....II ..... , .. 2I ........ �I .. 4I 5� 6I . Sen�x a ln� ur ww min ; L- S. I �'� '1- 800 - 345 -7334 \ \ \ 1 -•1 — \, - \- --� - —� — - \ .% P/0 25.47.1 -4 I \ \P/0\25.47 \I 7 \ 8� \ tw \ \ 1 24\ \ \ \ \ • ^1J \ 71.f9 8 \ d7Y � \ \ 8• 1 -ii X91 10.11 ar.• a 51 \ \ \ wJ \ 26 \ \ \ \ txi / Aw / 25 / / ,rr• / !!Rr / /grow/ rao /21 MKS \ \ \ Rv7 ♦;2�C .,.,n\ _ \ \ �`\ . " � \ �,,� . !': rr.+i " ^ °•w,.� y,,,,,e � � � un 1 / 1 I I 1 1 a.7 \'�` / / �,{, \ \ \ \ % \" wt ♦ ,d`, r TWO' 33 A "oil "oil I• Ila aN i I + /!Re laws p `Aw \ Q _ \ 1r l /cc� I. cnr ` 1 321 I — J- atr 1 !rp I I J^ �r 7J a�� N w I 1 31 4' !rn ' 1 I 1 I i ' o loss / • v. .o2t"f'•• Jr, i+ a At /riT!/ I I I 10.00 �,,:..:, n �'ii j• / , {i / / �� / / , / / / / /' / / _ _ ' � \ � `,w \ ROAD.... _ ..__. - / . / .:./ . -. j ... ! 147 . / /13 4770 70.09 / / / / /`� / / ..• ,_ _ _ �. _ �. 133.51 _ roan I I laucas;?1r> ✓o / / / /.F' / / 01.90 53 -- 1 I I 1 36 �' �qo / / l / y / !:u/ 14 1 I 1 371. I rJvo / / 1 I I t5 I 4 I I 1 I y lffi W gyxr.W" / / J+ oy / / / l I 1 1 11 It / 1 rxs: I / r I I uali / a�i/ // /8 / /rJe13! 1 I 1 I I •• 170 !f4 _ / F �/ !T /J/ / • / / +f 21.13 50.01 — \/ I 11N1 N 01 PLACE `S6S7 W5 !�� ea7 ro.r Pro 116009 -- - - - -1- li.1// /'7 // l ! ! \� `\ .. ` w\ j, ROAD ---- . - - -aW /47q/ / a l 16 1 l uar'S \ �\ a.9a axr � / !� / / / 1 ! lgnr — — _- '•:.• � `. a7r \ ` 0000 "J/ _ _ — \ I I I — ::9- _ MY, l +xt l l l 1 Aw — — au , I 1 i —�f " ass/ arr 103.90 u1.01 �gf 1 1 ^o 'I I 8 I I rft7 gr7° _ N sm rn7 I. 'w I 1 nti p� I ( W I I 1 /!4Y / ' 0 '111.10 11 RfJ° 1 I _ 4� IM I 1 / 1 ' I au y� a 48 Q• I I � LORETTA MOLINARI R.N., M.S.N. Acting Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Harry Nichols, P.E. Patterson Park Suite 106 2050 Route 22 Brewster, NY 10509 Re: Proposed SSTS: Sullivan Garfield Drive, Lot #7054 -7062 (T) Patterson, TM# 25.54 -2 -33 Dear Mr. Nichols: ROBERT J. BONDI County Executive June 10, 2003 Review of plans and other supporting documents submitted at this time relative to the above- regarded project has -been completed. Comments are offered as follows: - 1. Grading for the house and septic tank has not been shown. 2. Minimum distance from the well to the property line is 15 feet. 3. The SSTS is in direct line of drainage of the existing well shown on Quogue Road. 4. Grading of ir the. expansion area must be shown. 5. Neighbor Notification is required. 6. USDA Soil type and boundaries have not been shown. 7. Larger surface rock locations are to be shown. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ve y yours, ;.kj Robert Morris, P.E. Senior Public Health Engineer LORETTA MOLINARI R.N., M.S.N. Acting Public Health Director Director of Patient Services DEPARTMENT OF* HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845).278 - 6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Harry Nichols, P.E,. Patterson Park Suite 106 2050. Route 22 Brewster, NY 10509 Dear Mr. Nichols: ROBERT J. BONDI County Executive May 27, 2003 RE: Application to Construct a Subsurface Sewage Treatment System at Sullivan Garfield Drive, Lot #7054 -7062 (T) Patterson, TM# 25.54 -2 -33 The Putnam County Department of Health (Department) has determined that the above referenced application received by-the. Department on May' 8 2003 -is incomplete. -Please be advised that'tlie following information is required before the Department may commence its review. • Neighbor Notification has not been submitted. The review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information as to the completeness of your application. Please be advised that failure to submit information to the Department or to follow procedures is sufficient grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed Regulations and Putnam County Department of Health regulations. Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130 ext. 2166. V Robert Morris, P. E. RM:tn Senior Public Health Engineer PUTYADI COUNTY DEPARTtNIE \T OF HEALTH _ DMSION OF ENVIRONMENTAL HEALTH INDfV_ MUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT' NAME OF OWNER: STREET LOCATION: REVIEWED BY: RM, GR, AS, SRDATE: T.AX NtAP =: (CONFIRIMED) Y •N DOCUtiIENTS 1' (REOUiRED DETAILS 0\ PLANS CO \'T'D) _ L-- PERMIT APJ'LICATION ' ; ` ( OUSE SERER •' /�" FT. 4"0'; Tl PE PIPE CAST IRON. ()Cj1VELL PERMIT OR PWS LETTER ( 0 BENDS; MAX BENDS 45° WICLE AN OUT• P C -97 RENEWALS (� LETTER OF AUTHORIZATION L x '_'TSIIE NOTE (\0 CK .khGE) DESIGN DATA SHEET (DDS) I'ILL SYSTENTS Lj CORPORATE RESOLUTION 10' HORIZ0TEL; PAST TRE`iCH SLOPES 3:1 TO GRADE SHORT EAF I.L SPECS: FILL NOTES 1 -5 PLANS -THREE SETS .ILL PROFILE & DI`IENSION'S UUH OUSE PLANS -TWO SETS FILL LN F_XPAINSION AREA UUVARLA.NCE REQUEST FILL GREATER TWA \' 2 FEES SUBDIVISION (_)(,2 :LAY BARRIER (�L AL SUBDIVISION U L CERTIFICATION NOTE . UBDIVISION APPROVAL CHECKED EPT$ GAUGES PERC RATE L ON PLAN FOR R.O.B., UNCLASSIFIED & IAIPERVIO US (�FILLREQUDZED DEPTH U, SEPARATIONDISTANCEFROIITOE 'OFSLOPE CURTAIN I DRAIN REQUIRED TRENCH GENERAL (� LF TRENCH PROVIDED LOFT D•IAX. LOCATED IN NYC.WATERSiHED (PARALLEL TO CONTOURS A . PLANSSUBNITITED TO DEP - ( )�1011/6 EXP?. SIONPROVIDED_._._...__.... DELEGATED TO PCHD C ) D TAIUDUST FREE CF�USHED STO \`E OR WASHED. GRAVEL . ( DEP APPROVAL, IFlEQ'D, � OTEXTILE COVER DEEP TEST HOLES'OBSERVED . ' PERCS'TO BE WTTNE3SED • • - _ • �EPAR�:TION �DIS?AN•C�S 0 \PLAN = FROiy1 SSTS - :: • . , FRCS ROYAL SSDS AM, LOTS. L� }t' —J10' I DRIVEWAY, LARGE TREES,'TOP OF FILL . . �20' TO FOUNT I)X 'ION WALLS 3XI~TLANDS TOWN/DE'C EERb1IT;REQ'D ?) ( f� 100' TO'Vi'ELL,200' M.DLOD,150' TO P,1T5 ` ' DATA-ON DDS:PLANS.&.'PERT'&l SA 14 100' I 0 STREA:�1, WATERCOURSE, LAKE ('i4c. esp�Q� %PRE 199 NEIGHBORNOTIFICATIOY 50' TO CATCHBASI�I,3S' STORIMDAt JN, PIPED WATER LETTERBIMBA W INE its- 0' (� 16 TO WATERLINE (p 2 ) YR.. FLOOD ELEVATION NVA 200' _ S ° Z79RINUTTEN . DRAI`i MU-COURSE, . (SOILTESTI`iIG LOTS>10 YEARS OLD 200'!500' RESERV�OD2, ETC. _ 130' GALLEY SYSTEMS. IED DETAILS ON PLANS __10'.bILNTO LEDGE OUTSEWAGE SYSTEMPLAN- (NORTH ARROW), SEPTICTANK SSDS HYDRAULIC PROFILE G (� 10' FROh1 FOU\T)ATIOY; 50' TO WELL RAVIIY FLOW WELL. CONSTF3UC'I'Igy.I!COTES_1 -I5_ _._— L:)DISIE'NSIO:PSTO•PROPERTYLriES - - -- -- -- - DESIGN DATA: PERC & DEEP RESULTS LOCATION OF SERVICE CONNECTION )2' C0�'` TOURS EXISTING & PROPOSED ti1LN 15' TO PROPERTY LANE • ' DRIVEWAY & SLOPES;• CUT FOOTIPiG /GUTTERICURTAhN DRAINS SLOPE - USDA SOIL TYPE BOUNDARIES 'UUSLOPE IN SSTS AREA _(S20%) • " _ .4 :• TITLE BLOCK; OWNERS NAME ADDRESS UUREGRADED TO 1S %, IF REQUIRED TNIN, PE/RA; NAME, ADDRESS, PHONE# DOSE/PUMP SYSTEMS (_,� DATE OF DRAWING/REYLSION PUMP NOTES , DATUM REFERENCE HE DOSE 75% OF PIPE VOLUMEMOSE VOLUME NOTED (� OCATIOi (OF WATERCOURSES, PONDS U DETAIL FOR FORCE MIN, (1?IPE TYPA, ETC.) 'LAKES,WETLANDS WITHIN 200' OF P.L. U PIT AND D•BOX SHOWN &DETAILED f_ _) PROPOSED FINISH FLQOR AND 1 DAY STORAGE ABOVE ALARZ &BA EMENT E LEVATIONS CURTA=AA1N LS & SSDS'S WAN 200' OF SSTS STANDPIPES, 5' BOTH SIDES, bETr�IL I5' i111N to CDS = >S %, 20'4 %i 23' -3 %, 33' -1 %100 % -Q% PERTY METES &BOUND$ IN to CD DISCHARGE/100' with 182 cons day discharge SION CONTROL FOR HOUSE, WELL & T20'bl 10' K IN to NON-PERFORATED PIPE SSTS, EROSION CONTROL NOTE . COMMENTS: (Il1rVSHELT)09 /01!00 _PUTNAM COUNTY.-DEPARTMENT OF -HEALTH = " DIVISION: -OF ENVIRONMENTAL- HEALTH,.SERVICES`'•'I ' _ :..::..._. •APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT :SYSTEM w_ ^ ' = „::. _ `. ' .`. 1. Name and address of a licant: J QAH 2. Name of project: �� 1 ��1 3. Location TN: r 4. Design Professional: Wr �1��'1�� 5.. Address: 6•. Drainage Basin:r 7. Type of Project;.' 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)7' Type Status (check- YP ( ) :..:................... .::............................ Type I Exempt Type II -Unlisted,: 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... ►J 10. Has DEIS been completed and found acceptable by Lead Agency? Y? ......... .. .11.' Name of Lead Agency ''- ._ .l2:. ,Is.this project in an area.under the control of local planning zoning, or other ..... officials, ordinances? .................................................... ..... ............................ 13. If so,. have plans been submitted to such authorities? ........ ............................... ��• . 14. Has preliminary. approval been. granted by such authorities? Ob Date granted: _15. Type of Sewage Treatment- System Discharge. .::............. surface water X - groundwater 16. If surface water discharge;•what is the stream class designation? ................... 1�R 17. Waters index number (surface) ............................................. ............................... ....N :..:.: 1.8. Is project located near a, public water supply. system? ................... :.................... , 19.• ... .. If yes, name of water supply N R Distance to w•apr: supply!-:i� -20: Is .project site near a public sewage collection or treatment system” ystem? ::.............. - p 2-1. Name of sewage-system !�`' Distance: to. Jewage system 22. Date test-holes observed p 0 23. Name of Health Inspector (aELfi 24. Fro..ject design 'flow (gallons per day) .................................. .............:..........::... -- 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit .required?..... 26. Has SPDES Application been submitted to local DEC office? ......................... orm PC -97 ..2. �-__ ... 2 ?. Is any portion: of this proj.eQt located within a designated Town or State wetland? . © - 28. Wetlands .ID . Number ... . .......... . ....................................... . ................................... � g 29. Js Wetlands Permit required? .......... ....................:... ............................... Has application been made to Town or Local DEC office? ............................... 30. Does prcject�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, landfilliri:g, sludge application or industrial activity? 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 I`10 DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... �C 34.. Are community water and/or sewer facilities.planned to be developed.Within 15 years in or adjacent to project No site? ................:............... ............................... o 33. Are any setivage treatment areas in excess of 15% slope? .. .............:................. N� 3.6- Tax Iv1ap ID Number ............................ Map Block '� Lot 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 1 .,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. Ihereby affirm, tin der penally ofperjury, 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 Sectio 21t SIGNATURES-& OFFICIAL TITLES: Mailing Address: ........ ;.*;..; . �AP-RY i 2oSo P-� .... . . . ..... PUTNA4d:CQjTNWDEPARTM I ENT OF HEALTH DIVISION ;OF ENVIRONMENTAL HEALTH SERVICES ...- DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner: Address'. 60-riat pp-m5- 04J6 Tax Map— .-.,,..Block Ldt-417- Located at (street) 64'+ie-w . ..... (indicate nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA Date of Percolation lation Te st Date of Pre-soaking 01 ..2 Q %6 3. 4 -2- lit 3 II/L., Urv* 4 tom 1011 lei- 11''x- U11t., '631 I 5 4 .-777 7 2 - 3" .5 NOTES: 1. Teasb be reptatedat same depth until appr9ximately equal percolation rates are obtained at each percolation test, hole. (i:e;:5 I min for 1-30 min/inch, s 2 min for 31-60 min/inch) AlLdata to bi7' submitted for review. 2.' Depth measurements to be made from -top.of hole. Form DD-97 TEST. PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES. DEPTH HOLE NO. HOLE NO. HOLE NO. GL 0.5' 2. G 1.0' 1.5'i'2D. 2.0` 2.5' 3.0' 3.5' 4.0' 4.5' oust fip�� Ouv�' ��oW�l 5.0' . 5.5' VA %tkk, OG - 6.0' 6.5. 7.0' 7.5' 8.0' 8.5' 10.0' REUDiStt R p�,l�l.. . ...�An1Qj t..QflM Wt %Q\Jvo Indicate level at which' groundwatefis encountered Indicate level at which. mottling is observed Indicate level to which water level -rises after being.encountered Deep hole observations made by: 0EM PLE0 Date . ®i 1246 Design Professional Name: 1ir'P- - r-1 % NwMWQ3 VI - TE Address: U50 e. '�.� , Design Professional's Seal "Vr a , U1 2i1'E` No. 124 v OAR�FESS�� 2. G REUDiStt R p�,l�l.. . ...�An1Qj t..QflM Wt %Q\Jvo Indicate level at which' groundwatefis encountered Indicate level at which. mottling is observed Indicate level to which water level -rises after being.encountered Deep hole observations made by: 0EM PLE0 Date . ®i 1246 Design Professional Name: 1ir'P- - r-1 % NwMWQ3 VI - TE Address: U50 e. '�.� , Design Professional's Seal "Vr a , U1 2i1'E` No. 124 v OAR�FESS�� Or In PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH •SERVICES.:;' • Y LETTER OF AUTHORIZATION JOAH 60L ��M Property of ___....._._ ..._ ,..:'.' • Located at T/V Pa 0 Tax Map # 25,64 Block Lot 3 Subdivision of Subdivision'Lot # 105M 10(0,1- Gentlemen: Filed Map # Date Filed.. This letter is to authorize N VJ , W iL'A O L-5 J U— — - a duly licensed Professional Engineer or Registered Architect to-ply 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,te 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. 1.47. of the' Education. 37 a11e P..u_blie.Health::.._.._. _ 'Law, and the Putnam C2ypt y Sanitary Code: Countersigned: P.E., R.A., # _ Mailing Address w s P_ State �� Zi P Telephone: a, Very truly yours, Signed: / (owner`o Property) Mailing Address: State �`1`� Zip Telephone: Form-LA-97 P.U.TNAM -COUNTY DEPARTMENT OF HEALTH D- M-SION OF ENVIRONMENTAL HEALTH LETTER OF AUTHORIZATION RE: Property of A!ArAm 7 77- Located at T/V ?A H Tax Map#_ 1—Gw 6+ Block Lot Subdivision of 8ubdivision*Lot # Filed Map # k4 Date Filed. -_. Gentlemen: This letter is to authorize 4A fi Registered Architect a duly licensed Professional Engineer ',N or to -99RIY for the required wastewater treatment and/or water supply permit(s) to serve the above-noted -property "*m'ac-cordA'ce,,,*,**,;'.-.-'.- - with the standards, rules or regulations. as promulgated by the Public Heialffi Director of thelaig County Health Department. and to sip all necessary- papers on my behalf in connection,-with--this'.. matter and to supervise the construction of said wastewater tretment and/or water supply systefris in conformity with the.prolvisions. of Article 145 and/or. 147 of the Education. Law, •the Public H -ealtff':, Law, and-the Putnam C Code. -Countersigned: P.E., R.A., # _ Mailing Address bww.�Tm- State Zip . 1 0 Telephone: ® 0 Very truly yours, -PMRCF Mailing Address: Inv ;T6 F00, . ....... r IL State z i p Telephone: .. P Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 - Brewster, NY 10509 .. —Tel: (845)279- 4003--__.._._._. _ .._ .. _.. -• Fax: (845) 2794567 'Email: hnengineer@aol.com July 28, 2004 Putnam County Health Department 1 Geneva Road Brewster, New York 10509 ATT: Mr. Robert Morris, P.E. Senior Public Health Engineer RE: Individual SSTS Revision / Name Change: Michael Antaki (formerly Sullivan) Garfield Drive Town of Patterson T.M. # 25.54 -2 -33 Dear Mr. Morris: Enclosed are the following: 1. Five (5) prints of Drawing SS -1, "Proposed SSTS ", dated 07/28/04. 2 "Construction Permit for Sewage Disposal System ", dated 07/28/.04. _. 3 -., 'Application-to Construct'a Water Well" dated,07 /28/04-. 4. Two (2) copies of proposed floor Plans were submitted previously. 5. Review Fee in the amount of $200.00. 6. Authorization Letter. If there are any questions concerning the enclosed, please call. Very truly yours, all Harry W. Nichol r., P.E. HWN:gav 04- 056.00 Cj1 �� + � � .rte �.. - I_' � .r � � _..�- �� . PUTNAM COUNTY DEPARTMENT OF HEALTH -� DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM i Owner 5U`L. / Vfr^/1% Address Located at (Street) Q(,D6 �� ., Tax Map g�lock 2,_ Lot 3. (indicate nearest cross street) Municipality A Watershed A5T ic'AAICf/ SOIL PERCOLATION TEST DATA Date of Pre - soaking _ / Z;9- 3,Z e3 Date of Percolation Test ;z /0,3 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 _3o 3 4 5 ao 4 5 1 2 3. 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 DEPTH G.L. 0.5' 1.0' 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' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO.. 13 HOLE NO._ 2 Q r Indicate level at which groundwater is encountered nlezV Indicate level at which mottling is observed /,/y I;-- Indicate level to which water level rises after being encountered Deep hole observations made by: � �'�j )r 7 F. , C F f-/, 7, Dater 2 0-3 T T- Design Professional Name: Address: Signature: Design Professional's Seal PUTNAM COUNTY DEPARTMENT OF HEALTH • DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIA•L SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project 6yi-L>VI.OAI � ) /� T� iIL county y ii l�/"J Site Location-- . 7Z mil, L �7�%Z i /� ' 2s-, 5 a2 3 3 Building construction begun A10 Extent Is property within NYC Watershed ? ................. ffyes No SECTION B. TOPOGRAPHY (Pleas check all appropriate boxes) 1. Q `Hilly .F Rolling Stee slope dGentle slope F7 Flat 2. Evidence of wetlands Low area su ' ject to flooding a Bodies of water F7 Drainage ditches F7 Rock outcrops , vr¢ Ce. 5v/der-5 3. Property lines or comers evident ...................... ............................... Q Yes No 4. 'Do water courses exist on or adjoin the-property? .,�?r�a�..s�w... a Yes 5. Will these affect the design of the sewage system facilities ?............ 0 Yes 6. Do watershed regulations apply in this development ? ....................... Ye l 4 — Te.xv✓,e- ve0 / 'Lv9 e 7 Will extensive grading be necessary?...�ldy! on�.,:c..a.�� Yes I8: Will extensive fill be necessary for SS f. S? ............................... -- 9. Do filled areas exist within the SSTS area ?.A. y'.. 9R:mya. -1... O � %4 i�9 c ��ioclJaeY 5 Yes - dyes �No �No No l fo 0 No If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: Sand F--J Gravel Loam F7 Clay � Hardpan Mixture 11. Observed from: a Borings F-7� Bank cut F–,–' 31ackhoe excavations 12. Soil borings/excavations observed by e!�, M--'rT) on I 13. Depth to groundwater on 14. Depth to mottling AJ p A)h,� on 15. Are test holes representative of primary & reserve areas ...... ............ .................... Q Yes F-� No 16. Soil percolation tests . made by, G✓, on �- 17. Soil percolation tests witnessed by e� `� ?, G, l�� 1`�� on SECTION D (on back) Form ST -1 s 2 SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? Yes No 19. Will groundwater or surface drainage require special consideration? ...................... Yes o 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... a Yes ' SECTION E. REMARKS 21. If a common water supply is proposed; has an inspection been made of the existing or proposed source and facilities? ................................ .....................:......... F� Yes - - No Inspection data 22. Do adjacent wells and/or sewage systems exist? ..................... ...... ...................:..:... ffyes a .No 23. Additional comments xr 5 .;►h a `Ze,` eo,�e_ ®✓u 24.. Site observer /inspector and title a, TLcr , � ', G�,j 25. Date(s)�of observation(s)inspection(s) / /Z4 Io 3 TEST PIT PROFILES Hole # Lot # Hole # -Lot # Hole # Lot # Depth to water Depth.to water Depth to water Depth to mottling Depth to mottling _ . Depth to-mottling -- - . Depth to rock/imp. Depth to rockiimp. Depth to rock/imp. G.L. G.L. G.L. O.s . 0.5 0.5 1.0 1.0 1.0 2.0 2.0 2'.0 10 3.0 3.0 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 I I I G I I i I I I 1 1 I 11 1 ,•ivl ::.7 I nr: 1 •F�0 �� rrn \r..� \ 21 1 I 1 1 ii,°s nrJ. I nrs ♦ r.:d � � I. �. I,na I tilt II rre:l � risJ 1 tit• I w.00 a stl I \ ` T,� 7�e � � \ \ \ 1 :xae1 I I rl mall -, i - 1 .�II•�iwj rv,l.Zx.l �sr _. 1. • 119 r... a t -20\ - � _ �.. ._�_...�. _ .\ 8' ;1is rra P \ ,WJ 1 I l e t 1 I 1 1 8, I I 1 , I rriJ \ +�ti �� ♦\ \\ 2 \mJr \/ sJSJ m.li \ \ m+e ff ` -I — w,rJlio 1 I I, I I I' G s9+ \ \ \ \ � � ter\ �- s:�a4bv- •..��... - 127 1 1 261 g , \\ — roro , I I 1 n , 1 8 703, 1 s 1 1 \ \ .xrr \ '� nvr b I ► I w Avr \ . \�� to'y I �s� 7 - l 1 .roJS 1 ,rJt \ I inv I , %r1 rou �nII•ry ivJS ,vJi 1 I \ 5 +°° , tw �"J �xr ?0001 9e. c000 19,e.j1 .RCS 11 I .tYJ w.00 l( 32 ,,,zelr v _ _ °° °° 1 1 I wrr N o ,mf 1'aa rocs 29 .rte 8 1 ,a:r 1ir I ,ro1714 1 roil 1.vir i 1 I 1 mo -- tvJ zo.00 mu 1 291 ,ro 1 , 30 1 I g 1 ,' 1 `IP I , v t .mf I 1 1 %•r I I i , i I I , I I 60.00 _ 1 ,0000 IWO ROAD W uro „25, s, 1 � I 1 I , I III w I a1v I law t•I _ 1•_0.00 , I 2547 uo on I 1 , I I 36 •nv 35 ,zaw s•rxJ I I ,. I I 1 - l 1 1 I I I I 1 371 I V 11 ► V sri _- W— Nicr+ - -- -Na 39 1 38 , 1 PUTNAM COUNTY. NEW YORK a,E °► AEnut AIIDTObIAnn_:•' °':• ,, I J 1 g —' !nv 8 1, II II II 11 1 I my II II l�1rr11 r�u I r4n 1 rof; •1.16 I f1NJ !�'� lAft rats na• a �. e, � ,ou.00 - r.rJ 8 My 1 !rn i rmn I !'r , I , vo - ,60.0 r _ 40 ,°° 00 1 ' N.is, owl' Nrs i 1 laool NJS _ - ,°°°o IFNf 11trJ I !RY I ... _. / I ._ .. .. �� FftD .l7Jf Nri •... (.- :. ; RA[I lfAr !M/ I I I rna 1 _ 1 � 1 43 , 8 — �� 8 � •44 ... ..� '_ Aral !xt I l 1 I Iva °o -.. _ i 1 II 1 _ — — nro I 421 i , I II , —SS 1 1 , ► II 1 II --- Y rxf 8 8 ' 1 1 , I 1 I I 1 lf.S• T,. is _ 8__ rolcr I I` II I 1 I I 160 0 fArl 1 1100.0 ROAD s, 1 � I 1 I , I III w I a1v I law t•I _ G..,I. l,7: sxu r, °7v nr. 46 lxe� 47 8. 1� 1. I 1 �\ � ,c•r. ,\P /0 'LS`62.1.36 s» ,o+. °T x sww 1 eo.0 :GEND lic 2547 --I- P R E L i M l N A R Y SCALE TOWN* . OF PATTERSON . _ I LINE D : � KVaA'I%N LT IIAC °o • ,CAlE0,01MMI,IR Iwo 25.53 25.55- -- 25.6 1 ,woo .7<� � 1 ► I ► I , ,___ - 11 PUTNAM COUNTY. NEW YORK a,E °► AEnut AIIDTObIAnn_:•' °':• 50 1 1 1 S 1lfsl NW 1 -- 4M., 1' 1 I I I I I sry I ..L -- —' p woo , laool NJS _ ,°°°o IFNf 11trJ I !RY I , luol R]I7�I 4w, NJ•1 Nu ( l��s G..,I. l,7: sxu r, °7v nr. 46 lxe� 47 8. 1� 1. I 1 �\ � ,c•r. ,\P /0 'LS`62.1.36 s» ,o+. °T x sww 1 eo.0 :GEND 2546 2547 --I- P R E L i M l N A R Y SCALE TOWN* . OF PATTERSON . _ I LINE D : � KVaA'I%N LT IIAC °o • ,CAlE0,01MMI,IR Iwo 25.53 25.55- ULOA4= MU 134 M nswt;alrmmc 25.6 1 25.62 25.63 6 PUTNAM COUNTY. NEW YORK a,E °► AEnut AIIDTObIAnn_:•' °':• T 'i' 0 W Harry W. Nichols ]r., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Telephone (845) 279 -4003 Fax -(84&) -279 -4567 _ ..... _ .October 22, 2003 Putnam County Health Department 1 Geneva Road Brewster, NY 10509 ATT: Mr. Robert Morris, P.E. Senior Public Health Engineer RE: Proposed SSTS (Sullivan) Garfield Drive Patterson, NY T.M. # 25.54 -2 -33 Dear Mr. Morris: In response to your June 10, 2003 review letter, we note the following: 1. 2. 3. 4. .. 5 7. Grading around house.and septic tank added to plan. Well has been located 10' from property line with note "to be staked by surveyor ". New survey data obtained (see enclosed) and key hole added to plan. System reduced in size to serve two (2) bedrooms. Expansion is located in flat area. Neighborhood notification previously done and copies of list and receipts forwarded to your attention. USDA Soil-types added to plan. " Area of rock outcrops located on plan. The SSTS has been reduced to a two (2) bedroom system and we are enclosing the following: • Five (5) prints SS -1 "Proposed SSTS ", rev. 10/10/03. • "Construction Permit for Sewage Treatment System ", dated 10/20/03. Kindly continue with your review of this application and issuance of the permit. Very truly yours, Harry W. Nic Jr., P.E. HWN:gav 03- 001.00 LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 November 7, 2003 Harry Nichols, P. E. Patterson Park Suite 106 2050 Route 22 Brewster, NY 10509 Re: Proposed Construction Permit Sullivan — Garfield Drive (T) Patterson TM #25.54 -2 -33 Dear Mr. Nichols: ROBERT J. BONDI County Executive Review of plans dated April 9, 2003 last revision dated October 30, 2003 and other materials relative to a construction permit for the above captioned property has been completed by this Department. Based upon such review, and pursuant to the provision of Article III of the Putnam County 1. . T Sanitary Code, you are hereby advised that the proposed method providing water supply and sewage disposal are considered inadequate as set forth below. Therefore, approval of these plans cannot be granted. A two bedroom SSTS design is proposed (400 gal/day flow). Current codes requires a minimum design flow of 600 /gal/day. It is your legal right to request a waiver of the denial based on item(s) noted above. The denial request must be submitted in writing after the recepit of this letter. The request must specifically state the waiver being sought. If you have any questions, please call me at ext. 2166. VepAtruly yours, /14;uo /W" Robert Morris, P. E. Senior Public Health Engineer RM /jp • Narry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Telephone (845) 279 -4003 Fax (845) 27.9 -4567- .... - _.._.........._. October 30, 2003 Putnam. County Health Department 1 Geneva Road Brewster, New York 10509 ATT: Mr. Robert Morris, P.E. Senior Public Health Engineer RE: Individual SSTS (Sullivan) Garfield Drive Town of Patterson T.M. # 25.54 -2 -33 Dear Mr. Morris: In reference to your review letter dated September 28, 2003, we note the following: _ .. L. House description now reflects a two (2). bedroom residence. We trust the above adequately addresses your concerns, and request your continued review and approval of the application. Very truly yours, Harry W. Nich is Jr., P.E. HWN:gav 03- 001.00 9s: /, 'ciao co May 2, 2003 Putnam County Health Department One Geneva Road Brewster, New York 10509 Att: Mr. Robert Morris, P.E. Senior Public Health Engineer Re: Individual SSTS (Sullivan) Garfield Drive Town of Patterson T.M. # 25.54 -2 -33 Dear Mr. Morris:. Enclosed are the following: 1. Five.(5) prints of Drawing SS -1, "Proposed SSTS'% dated 04/09/03..:... 2 . Short EAF,- dated 04/09/03: _ _ ..:.__.:....... _ . 3. "Application for Approval of Plans for a Wastewater Disposal System ", dated 04/09/03. 4. "Construction Permit for Sewage Disposal System ", dated 04/09/03. 5. "Application to Construct a Water Well ", dated 04/09/03. . 6. "Design Data sheet ". 7. Two (2) copies of residence floor Plan(s), for. bedroom count only. 8. Review Fee in the amount of $300.00. If there are any questions concerning the enclosed, please call: Very truly yours, Harry W. Nichols Jr., P.E. HWN:gav 03 -001.00 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Town/Village: Tax Grid # Map %,;'Block Lot(s) Well Owner: Name: Address: Use of Well: I- primary 2- secondary �X/ Residential Public Supply Air con eat pump Irrig tion Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion __x Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length ft. Length below gradeft. Diameter in. Weight per foot lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded Threaded _Other Seal: Cement grout Bentonite _ Other Drive shoe: Yes No Liner: Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test Bailed _ Pumped Y Compressed Air Hours Yield gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve. analyses .... _ . _ are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface A;i&/Ir L. Ar If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type 3.t, Capacity S� Depth 2-SO Model SC SO 711Z Voltage :Z36 HP 31.4 I%.P, Tank Type(Ox- 662 Volume 96 8 s / s ' Date Well Complete 3 0 Putnam County Certification No. Date of Re ort Well Dri r signature) ivvi E: txact Location of wen Well Driller's N Signature: White copy: HD q nistances /st two -nermanent ian amarxs to oe provic}e1a-on a separate sr►e�e�vptan: Address: Date: Yellow copy - Building Inspector; Pink copy O er; Orange copy - Well -driller Form WC -97 DIIV ENSI0.N .CHA T. (in feet) Number A . 8 C 2 26 1 3.. 3 G` 79 64 y� 3 63 10 G 2 G '1 8 36 4t 9 '2G, 39 10 . 27 43 I 1 .. Zg 48 2 99 101 13 99 105 19- 99 104 N G ` Q C m 0 A