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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.78 -1 -687 69 & 70 BOX 13 01356 17-- 91 o Ir I IN IN '. � NJ L T 01356 nb PUTNAM COUNTY DEPARTMENT OF HEALTH ._ _._..._. _..__ .D�-YISION- OF.ENVI-P -N-1 ENT- -A-��- -HE- -i TP- SE-R-1:7-1C CERTIFICATE OF CONSTRUCTION COMPLIANCE PCHD CONSTRUCTION PERMIT # P - U q - D FOR SEWAGE TREATMENT Located at 11 �} � b 1 VF &//zI G(t kkbTown or Village r ,�-li•FXSGA Owner /Applicant Name % )3 U 1(.04:96 Tax Map Z T 7 S1 Block I Lot '] Formerly Subdivision Name Subd. Lot # Mailing Address 4 (uuo (2A V Y�^ac -!!. f Zip l yJ11.4" Date Construction Permit Issued by PCHD -1 40 S%{ 6l o W 5) eA mi K C/ Separate Sewerage System built by 7 0! fbll () P-5 Address C0,11g [ At 1 0 S-1 L Consisting of l 2�C� Gallon Septic Tank and LC— 2-PI jii C(4 Other Requirements: Water Supply: Public Supply From or: X Private Supply Drilled by ftA _ Address, Address gl'P.W 54c-v- Al � lass y Buiidirig Type (iJ�G i✓j�i Has erosion-control been completed? T� Number of Bedrooms q Has garbage grinder been installed? /N 0 I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulatiorVs of Ihe Put am County D partment of Health. Date: [ �9' b� Certified by P.E. _ R.A. esi Profes io al) Address �.7i V S �V a W ice" 2 License # Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary 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 Jeubject to modification or change when, in the judgment of the Public Health Director, such revocatio at' or change is necessary. 4 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: 2 Hazel Drive Town/Village: Patterson Tax Grid # Map Block Lot(s) Well Owner: Name: Address: J.D.G. Builders,. Inc., 40 Shallow Stredad, Carmel, NY 10512 Use of Well: 1- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business. Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X 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 40 ft. Length below grade 39 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: X Steel Plastic Other Joints: _ Welded X Threaded Other Seal: X Cement grout _ Bentonite Other Drive shoe: XX Yes _ No Liner: Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Weil Yield Test _ Bailed X Pumped X.Compressed Air Hours _6_ Yield 6 gpm Depth Data Measure from land surface- static (specify ft) 60' During yield test(ft) 260' Depth of completed well in feet 310' Well Log If more detailed information descriptions or sieve .?nalyses. are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land surface 25 Drilling .in over urden clay and boulders Hit rock at 25' 25 40 Drilling in rock set casing, routed 40 310 1 Drilliniz in rock gr nite 0 If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 5 gum Depth 280' Model 5GS07412 Voltage 230 HP 3/4 Tank Type WX250 Volume 4_ allons Date Well Completed 7/25/05 Putnam County Certification No. 004 Date of Report 8/12/05 Well Driller (signature) lChristo-pher Beal NOTE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate sneetipran. Well Driller's'Name F Beal & Sons, Address: 4 Putnam Ave., Brewster,NY 10509 Signature: Date: 8/12/05 Christopher Beal White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 4 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well-Loeation =: - - -_- Street Address: - _ ._ . __ .... 2 Hazel Drive ToweVitlage: _ _ ' -- Patterson Tax Grid Map Block Lot(s) Well Owner: Name: Address: J.D.G. Builders, Inc., 40 Shallow StreamRd, Carmel, NY 10512 Use of Well: 1- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X 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 40 ft. Length below grade 39 ft. Diameter 6 in. Weight per foot __LcZlb /ft. Materials: X Steel Plastic Other Joints: Welded X- Threaded Other Seal: X Cement grout _ Bentonite Other Drive shoe: X Yes _ No Liner: Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes—No Hours Second Well Yield Test _ Bailed X Pumped XX Compressed Air Hours _6_ Yield 6 gpm Depth Data Measure from land surface - static (specify ft) 60' During yield test(ft) 260' Depth of completed well in feet 310' 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 25 Drilling in over urden clay and boulders Hit rock at 25' 25 40 Drilling in rock set casin routed 40 310 Drilling in rock granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 5 Qpm Depth 280' Model 5GS07412 Voltage 230 HP 3/4 Tank Type WX250 Volume 4_ 4 allons Date Well Completed 7/25/05 Putnam County Certification No. 004 Date of Report 8/12/05 Well Driller (signature) Christopher Beal Nu,i t;: Exact location of well with distances to at least two permanent lanamarxs to De proviaea on a separate sneevpian. Well Driller's Name F. Beal & So I Address: 4 Putnam Ave.. Brewster,NY 10509 Signature: Date: 8/12/05 Christopher Beal White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 ^ BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 LORETTA MOLWARl R.N., M.S.N. Associate Public Health Director Dimctor of Patient Services Environmental Health (845)278-6130 Fax (845) 278 - 7921 Nursing Services (843) 278 - 6558 WIC (845) 278.6678 Fax (845) 279.6085 Early Intervention/Preschool (843) 278.6014 Fax (84S) 278 - 6648 E911 ADDRESS VERIFICA'f)[QN MRM OWNERS NAME- I L i, E3U (�' TAX MAP NUMBER: 2- - - I 1� O — ( — ( 1� 1 0 t I 0 E911 ADDRESS: TOWN: A U (T) AUTHORIZED TOWN OFFICIAL. _ (Signature) DATE: /// .3el e S The Putnam County Department of Health will not issue a Certificate of construction Compliance unless the above form is completed., i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 verfrm) j, Page 1 of 1 �% EMt�rIN11Nf11 �ontoll, Mo. � 41 Kenosis ANenua B/ •ff WATER. SOIL AND AIR ANALYSIS Danb!wy, 0rWOCf1CUt OOM 1 Tekphorw 203- 7M-Mo P F Beal and Sons Inc Mailing Information: Collector's Information: JMS ID: 008019 Name: P F Beal and Sons Inc Name: Chris Beal Address: 4 Putnam Avenue Address of sits: JDG Builders 2 Hazel Drive City: Brewster City: Patterson State: NY Zip: 10509 State: NY Zip: Phone: (845) 279 -2460 Fax: (845) 279 -6613 Phone: Sample's Information: Site: Hose Spigot Date Collected: 11/4/2005 Date Received: 11/512005 Preservative: HNO' Time Collected: 3:00:00 PM Time Received: 10:00:00 AM Temperature: <4 Lab No.: J0511673 Matrix: Water Date Analyzed Test Name Result MCL Method 11/07/05 Alkalinity 18 mg /L N/A SMWW 23201$ 11/07/05 Lead (first draw) <1 ug/L 15 ug/L SMWW 3113 6 11/05/05 Color ND 15 Units SMWW 2120 B 11/05/05 Turbidity 0.2 ntu 5 ntu SMWW 2130 B 11/07/05 Hardness 34 mg /L N/A SMWW 2340 C 11/05105 Odor ND WA SMWW 2340 C 11107/05 Manganese <0.05 mg/L 0.3 mg/L SMWW 31116 (NY) 11/07/05 Sodium 0.4 mg/L N/A SMWW 3111 B (NY) 11/07/05 Iron <0.05 ppm 0.3 ppm SMWW 31118 11/07/05 Chloride 19.7 mg/L 250 mg /L SMWW 4500 Cl C 11/05/05 pH 6.75 S.U. 6,5 8.5 S.U. SMWW 4500 H B -NY 11/07/05 Nitrate 0.17 mg /L 10 mg /L SMWW 4500 NO3E 11/07/05 Nitrite <0.1 mg /L 1 mg/L SMWW 4500 NO3E 11/07/05 Sulfate 1.07 mg /L 250 mg /L SMWW 4500 SO4F 11/05/05 Chlorine Free Residual <01 mg/L N/A SMWW 4500CIG 11/05/05 12:00 PM Total Coliform Absent Absent SMWW 92228 Comments: At the time of the analysis the sample was Acceptable for Total Colifonn CFU m Coliforrn Forming Units MCL = Maximum Contaminant Level mg/L = milligrams per Liter N/A = Not Applicable ND a None Detected ntu a Nepheiopmetric Turbidity Unit ppm a parts per million S.U. = Standard Unit ug/L s micrograms per liter Units = Units Signature: Reviewed By: XAA Michael Lapmen Sharon Houlahan, Director President State M PH -0218 ELAP M 11715 CONNECTICUT. P 6W YORK AND WLAC CiRTVIED Tai Fme see -JW -sour 1 C Morste Fax 205 -71116-240111 1 Lab Fax 203-M-2107 I www.011MI Uarxnsraalaae PUTNAM COUNTY DEPARTMENT OF HEALTH _ DIVISION.. OF. ENVIRONMENTAL HEALTH SERVICES ; GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYST -7.0 Z�; J Owner or Purchaser of Building Tax Map Block Lot LA 1 demos si,�� Building Constructed by 1k �k Location - Street 1ty).C11,1 Building Type `��e rS o1n TownNillage L41�6- - Subdivision Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month Day LL Year ©S General GAiractor Owner) - Signature r . I, 6r. �LA'AAP_rA TA3f Corporation Name (if corporation) Signature: - Title: Corporation Name (if corporation) Address: L/U S 4011d4L) - fI46LAddress: State Zip UJ Z State Zip T.1� Z Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: 8/We t'>_ Inspected by: 6 Street Location - `T,Z1V- , ..... _.. . _ _ ..Ovmer Town Permit # TM # Z 6. 78 f — w/ 90 &"71 770 Subdivision Lot # --- 1. Sewage System Area YE NO COMMENTS 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. 1 00' from water course / wetlands...... .. .. ............................ IL Sewage System a. Septic tank size - 1,000 ........1,250.. .....other... ............. b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 7. 2. Protected below frost .................. ............................... Mi 3... nimum 2 ft. Original soil between box & trenches e. Junction Box properly set ......................................... 6. renc ems — 1. Length required 1Y i6O Length installed 5� 8e) 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ........................ 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. F 5. 10 ft. from property line - 20 ft.- foundations..:....... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 %.......... ............... 8. Size of gravel 3/4 - 11/2" diameter clean ...................: 9. Depth of gravel in trench 12" minimum ....... :........... 10. Pipe ends ca ed :.................... g ... ............................... ....� pum..- p Dose Systems - _.._ �' 1. Size of pump chamber ................ ............................... 2. Overflow tank ............................. ............................... 3.. Alarm, visual/.audio ........:........... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... M. House/Building a. house located er approved plans .................. . b. Number of bedpooms .............................. �..:. �<........ IV. Well Well located as per approved plans . ......:........................ b. Distance from STS area measured ft ........... c. Casing. 18" above grade ................ ............. ................... d. Surface drainage around well . acceptable ....................... V. Overall Workmanship . a.. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto exist waterco se o g' Footing drains discharge away from STS area.......... vo, /.� h. Surface water protection adequate ........ :........................... i. Erosion control provided ................. ............................... Rev. 12/02 T 'd d0 1N3Widdd30 AiNnoo WdNind :3WdN T26L- 8L2-Sb8 : X31 z2 : T T nHl sow- Z S -qnu PUTN" COY OVAR774M OF =ALM DMIONOWEVVELOIGMT AL EFALTR URVIM . AT'TENT'ION CjOW AGM For: rill All infortnation must be fully oosaplsted pr;w to ®y Treudbas X inspeztions.being made. PCHD Construe on Permit # Located: ,- tf 2w ygE _�_�___ f ri, C'� �° �v C / Owner /Appliaaat Name: 7- - fj 6""&K f TM'Z BIo* _, j Lot 4 f, 76 Formerly: --�' 9dWWWon Namie: A el - Lei &AWIVWon Lot # Is system fill Completed? Is system complete? 'e S Date: Is system consmawd as per per! Is well drilled? is well located as per pleas? Are erosion control measures in PkW Date: �E/d /V J I certify that the sysw*s), as llw4 at do slxm pmnisw W been cowwmW MA We inspected and verified their complefm is no dow sM die issued PCID Cow Prxmit and approved plans and the Stmt, Rules aad Jqpdoicius of the. how O y Dgmtaaomt of Health: Date: ,�, . — comw isy d�.�IE r X RA Prof r% ruz. � x Lie. # �7 Address: L& 6 04&4e_ ,.tom■ ■,�.., Comments: Forru FIR-99 SHERLITA AMLEk'106, 1VIS, FAAP -- - Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health August 15, 2005 John Karell 121 Cushman Road Patterson, NY 12563 Dear Mr. Karell: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 County Executive Re: Field Inspection — JDG Builders Hazel Drive, (T) Patterson T.M. 25.78-1-68,69,70 The above referenced separate sewage treatment system can be backfilled. The following comment must be corrected in the field: • The curtain drain outlet is installed in a low lying area subject to pooling. If you have any iikher quest ion s,'please contact .me at'(845) 27$ =6136, 6kf.- 2261.-'- " GDR: cw Sincerely, :4tre.-r-- Gene D. Reed Sr. Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 I J W ■QZ W It .. ■ QZ 7�' ■� w Z ■ LL. z'J ■ ° cr p ■ CL ° H H ■ W F ■ ¢LLp•Z► LLJ ■ (n W • LLJ a F- r ■ ■ ■ ■ ■ LLJ ■ OW Er > p 'Q ZOw■ w<Z■S LL Z olYp �Q a p w ■ au-O ■= LL ¢ °a�� eX-COD U 97 B cn w... ■ go ■ ■ : ■ : ■ ■ w ' N ' w O w ■ �i z p ■Q Z ❑ w ■ waz.S LL Z J ■ °Q O' n. O w °Wr'W �°CO;� Q0 I ¢,<I- = . Y O. U�0■ N LL MIC wr .� Jo. U.S. Postal Service CERTIFIED MAIL RECEIPT'', (Domestic Mail Only; No Insurance Coverage'Pmvideco PS Form 3800, February 2000...' See Reverse for k:structions U.S. Postal Service CERTIFIED MAIL RECEIPT = (Domestic Mail Only; No In Coverage Provided) . . See Reverse eor_tGtnxt�o^s PS Form 3800, February 2000 jjli 4i ':islf r?--- -y%i -R1 U.S. Postal- Service CERTIFIED MAIL RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) :, ; r` _ ,See Revers xx fib^' PS Forth 3800, Fd-WY 2000 ' - ' �E+ ��711i 1 ,' iL'}_ S {�''�'�'L4- t(•`'¢�f�.- �.�:�ia': .- • ./'iii t i t' ,.. t � 1 ' t y•. }.�- !t-�,,1.,- •fw}YS •+ Q Jit,tt,"n��c,�ii•)= ;i•`tv... ,,� Xst..:�t'' ` 11. •- ..• `ai 'KF�y,b+�1'".y. g �2 +d, r �' b'ff 'alelS:'(t!� O O •-��- !_. -. .rC r-'i lsi *Ulf, �y tt {{ , y ............... ...... , /(/ a'L• -- jo :'ON- jdV _laaAS •--• �-- • �� tit! �7� • /, y •� ° M • ............... --•--.... - aweNs,lua!d OU E • G' .�.� -- rr p.4 �• c�" ( tip `r +`fit" a� _ patrew .(C paiatdwo-1 aq aI) (App -lo lu. as d) O O +r ! e V ls saa g a6eod 18101 O° �- � • I w t r }: W • (paunballluawasSOpu3) r_3 :( _ OaA iJan 80 paputsaa ° O sssi.�- • 4(�k t+" Z ru ni uawasSOpu3) r • . r� "�t��rsdYi. 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M Postage $ ni ru -0 -D Cmffied Fee to ru Return Receipt Fee ni ru (Endorsement Required) C3 C3 Restricted Delivery Fee 0 C3 (Endorsement Required) C3 C3 Total Postage & Fees C3 C3 t Clepq) c* - _n _z Re, iplonq N me (P'ease r-s. C3 0 ..5-%t,.....1,,,,. ,Z ... w ................. ;I Smpt Apt. No.; Box o C3 C3 % M M .............. .1 .......... ................. woo C3 C.3 Cry •a A.4 r%- r%- erSo 1 I . . . . . . . . . . . . . . . . . . ■ .S. postal Service U - O ru ru ru rLj 0 -0 -0 ru ru ., �rs, A • Re ru F1 r' C3 0 Re-trIcIt'd F C3 (Edo,senwd Total C3 postage & Fees S N C3 ', rn 341 L Wee 4 P Ij ............ ... C3 S,rMt Apt ... C3.................................. 5P, V . . . . . . -"A A x Service. th U.S. Postal ty CERTIFIED MAIL RECEIPT (Domestic Mail oni�; No insurance Coverage PfOvidecO Ir Ir M rn ru ru r S Postage rr ru ru Cer-,.fied Fee pat•nark x.14 r. nj ru Her e5 g Re!Jm Receipt F • • ru ru Rest,,cted Del-very Fee C3 C3 Enclorse^,e"t Ftequ!re-,, C3 C3 t=j C3 C3 C3 C3 C3 r- r- Total postage& Fees I Z . —1 ... . D._ P�rmf C I (to C: PR ts ............. )1-e��(( �r� L7.......... .... ...... C dy. S !Ve Y los N PUTNAM COUNTY OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address. &Z-&I 171 V Located at (Street) 7_j1jej1_# :904D Tax Map 9-6.70 Block 1 Lot6404-74-> (indicate nearest cross street) Municipality &rtFg5g2AZ Watershed j3 ,vim SOIL PERCOLATION TEST DATA Date of Pre-soaking -3/2- Date of Percolation Test 3 Z2,5, C, f., .... . ...... . ..... ... .... .. .......... :XX ........ ......... ...... Depth ... Water ....... ... .......... ..... .. ...... ........... .. . .............. .... . . ...... ..... .. . A";�-N ..... ... . ..... .. . ............... . . . ............... 10. ... .... . .. ..... .......... . .................. .. . 'T F r.om: Jr xil .. Stop ... ui . ...... ti t W N.6 . ..... tin S too, .......... . ....... ....... - ... ....... ....... .... ... ....... Mart t S ... .. .. 10 6" X: . . ............ .... . ..... ...... Mann ..... ........ .......... ......... ... 2 /f' 4cl-z" ell '7 3 3 3 Y-y - �A -5 -3 4 0 ZY ;2-7 Agr -5 5 2 3 3 4 5 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. :5 1 min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 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' �1 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES Hui�E iv0: _ �_ -. _ .. __ HOLE NQ. HOLE Ild Indicate level at which groundwater is encountered �i d Indicate level at which mottling is observed Indicate level to which water level rises after being encountered 7 " Date �U Deep hole observations made by: J044= P .F � Design Professional Name: Address: Signature: Design Professional's Seal N 'PUTNAM COUNTY DEPARTMENT OF HEALTH IVISION_ OF ENVIRONMEN- AL. -HE.ALT- SER CES _ INITIAL INDIVIDUAL /COMMERCIA•L SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project �� � /f+ V) 4PAM - County &4A-L Site Location mej 02 7Uit ((l�p� i►9J 2S. 70 6 g� G!2 78 Building construction begun AIV Extent Is ro e p p rty within NYC Watershed ? ................. Yes No SECTIONS. TOPOGRAPHY (Please check all appropriate boxes) 1- ❑ hilly '❑ Rolling ❑ Steep slope Gentle.slope ❑ Flat 2. ❑ Evidence of wetlands a Low area subject to flooding ❑ Bodies of water ❑ Drainage ditches ❑ Rock outcrops 3. Property lines or corners evident ............................. ✓-es 4. Do water courses exist on or adjoin the property. .......... � Yes . ................. 5. Will these affect the design of the sewage system facilities ?............ a Yes 6. Do watershed regulations apply in this development ?....................... Yes 7 Will extensive grading be necessary? .................... ............. Yes 8: _...W'll ertenve fihbe neeess STS? ..................................... aryfor S .. ...� ,uYes 9. Do filled areas exist within the SSTS area ? ............................ ❑ Yes EJ N, 9, 1211"No dNo a No 2N0 No If yes, what is the condition of the fill? ; SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: ✓ Sand a Gravel Loam � ' =� �--� Clay ❑ Hazd an Mixture p ❑ 11. Observed from: ❑ Borings ❑ Bank cut . �Backhoe excavations 12. Soil borings /excavations observed b ' Y t4 ,on 3 3o e;,51 13. Depth to groundwater on 14. Depth to mottling on 15. Are test holes representative of primary &reserve areas ...... ................:.............. 16. Soil percolation tests made by.',, '' on 17. Soil percolation tests witnessed by (a , j- ; C, �Lr- �� on SECTION D (on back) NO M Form ST -1 SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? Yes EKNo 19. Will groundwater or surface drainage require special consideration? ..................... Yes Nom' 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ................... .. ...... 0 Yes �rNo 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? ....... i%11....51,ef" :? ................. ffYes F No 23. Additional comments 24. Site observer /inspector and title 10�, T 25. Dates) of observation(s)inspection(s) TEST PIT PROFILES Hole # Lot # Hole # Lot # Hole # Lot # Depth to water _ Depth to water D th t Depth to mottling _ Depth_t.0 M, . ing Depth to rock/imp. --.Depth to rock/imp. G.L. G.L. X11 1.0 2.0 3.0r 4.0 5.0 6.0 7.0 8.0 9.0 10.0 ep o water D-epth to:.mottling- ::.... _.. _.___...- Depth to rock/imp. G.L. a 0.5 0.5 1.0 1.0 2.0 2.0 3.0 3.0' 4.0 4.0 5.0 . 5.0 6.0 6.0 7.0 7.0 8.0 8.0 9.0 9.0 10.0 10.0 TYIW ARTIVMENT.G HEALTH A 17 MW Af rRC�rTIl�E�Te I ��TLH 'SER'��ICES ; = _ D�ACTIVITY REP4HT - - � -�` b z - ton vo 0, ink OVA t — C v ao- mv At y. z s 3 3 £ ' _ '+k'ai R lot 4 ' I �y � i y -volts-, — too c r .✓ ^ ATTY = r My T 04 i r y eT z PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS ........ _ _ __.._ _ . _.... REVIEW SHEET FOR CONS'TWC'i'):ON PERMIT NAME OF OWNER: STREET LOCATION: REVIEWED BY: RM, OR, AS, SRDATE: Y DOCUMENTS PERMIT APPLICATION )WELL PERMIT OR PWS LETTER PC -97 LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) CORPORATE RESOLUTION �) SHORT EAF (_)PLANS -THREE SETS (�f(�HOUSE PLANS - TWO SETS ARIANCE REQUEST SUBDIVISION LEGAL SUBDIVISION ( ) )SUBDIVISION APPROVAL CHECKED [tC RATE ,L REQUIRED DEPTH RTAIN DRAIN REQUIRED GENERAL CATED IN NYC WATERSHED DNS SUBMITTED TO DEP LEGATED TO PCHD P APPROVAL, IF REQ'D EP TEST HOLES 0 ISERVED Z WITNESSED -'- AL SSDS ADJ, LOTS ' REQ'D ?) SAME -(� --- 1^,C I� -FLOOD ELEVATION W/I 200' — . L�SOIL TESTING LOTS >10 YEARS OLD REQUIRED DETAILS ON PLANS C—)CSEWAGE SYSTEM PLAN - (NORTH ARROW) (_)C —)MS HYDRAULIC PROFILE C—)C--)GRAVITY FLOW (_)(_)CONSTRUCTION NOTES 1 -15 (_)( )DESIGN DATA: PERC & DEEP RESULTS (_)(_)2' CONTOURS EXISTING & PROPOSED (_)(—)DRIVEWAY & SLOPES, CUT (_)(_)FOOTING /GUTTER/CURTAIN DRAINS (J(__)USDA SOIL TYPE BOUNDARIES (—)(_)TITLE BLOCK; OWNERS. NAME ADDRESS TM#, PE/RA; NAME, ADDRESS, PHONE# (_)(--)DATE OF DRAWING/REVISION (--)(—)DATUM REFERENCE (__JULOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. (_)(_)PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS UUWELLS & SSDS'S W/IN 200' OF SSTS (_)(_)PROPERTY METES & BOUNDS (_)(__)EROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE COMMENTS: (REVSHEET)09 /01 /00 TAX MAP #: (CONFIRMED) Y N (REQUIRED DETAILS ON PLANS CONT'D) (_)(_)HOUSE SEWER - %" FT. 4 "0'; TYPE PIPE CAST IRON (_)(__)NO BENDS; MAX BENDS 450 W /CLEANOUT RENEWALS (-_)(__)SITE NOTE (NO CHANGE) FILL SYSTEMS (x(__)10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE (--)(_)FILL SPECS / FILL NOTES 1 -5 ((___)FILL PROFILE & DIMENSIONS UUFILL IN EXPANSION AREA FILL GREATER MN 2 FEET U(_) CLAY BARRIER (—)(__)FILL CERTIFICATION NOTE UUDEPTH GAUGES (_,(__)VOL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS (_))SEPARATION DISTANCE FROM TOE OF SLOPE TRENCH (--)(—_)LF TRENCH PROVIDED 60FT MAX. (__)(__)PARALLEL TO CONTOURS U(__)100% EXPANSION PROVIDED (_) (_)DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL U(__)GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS U(__)10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL (x(__)20' TO FOUNDATION WALLS (_)0100' TO WELL, 200' IN DLOD,150' TO PITS 0(,100' TO STREAM, WATERCOURSE, LAKE (inc. eapan) (_)0501 TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER TO WATER LINE (pits - (_)(--)50' INTERMITTENT DRAINAGE COURSE C__)C__)200'/500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS (_)C__)101 MIN TO LEDGE OUTCROP SEPTIC TANK (x(_)10' FROM FOUNDATION; 50' TO WELL WELL ( )(__)DBSNSIONS TO PROPERTY LINES (__)(__)LOCATION OF SERVICE CONNECTION (__)C__)MIN 15' TO PROPERTY LINE SLOPE (__)( SLOPE IN SSTS AREA (S20 %) ((_)REGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS )(_)PUMP NOTES C_)(_)DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED ()(__)DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) UUPTT AND D -BOX SHOWN & DETAILED (�(�1 DAY STORAGE ABOVE ALARM CURTAIN DRAIN UUSTANDPIPES, 5' BOTH SIDES, DETAIL ( _)(_)15' MIN to CDS = >5 %, 20' -4 %, 25' -3 %, 35' -1 %,100 % -<1% (_)(_)20' MIN to CD DISCHARGE /100' with 182 cons day discharge (_)x)10' MIN to NON - PERFORATED PIPE BRUCE R. FOLEY Public Health Director T0: Dear: LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 .Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Date: Re: Proposed SSTS: (T) Review of- plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: The construction of this sewage disposal . system may be..gibject to lo'caLwelaads.regulatio s ;..YOU -_ ._.__.;._..._...-- should contact local wetlands 'officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection on this lot; percolation tests must be witnessed by a representative of this Department: A in PIP APB ����� 0 v(Z- 3f.>s.i'l Upon receipt of a submission,: revised to reflect the above comments, this application will be considred further. f�cLvor'�i. Very truly yours, Robert Morris, P.E. Senior Public Health Engineer RM:tn sstsproposed PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: STREET LOCATION: REVIEWED BY: RM, GR, AS, SRDATE: TAX MAP #: (CONFIlZMED) Y N DOCUMENTS LPL _)PERMIT APPLICATION " "_)WELL PERMIT OR PWS LETTER (-__)(__)PC -97 UULETTER OF AUTHORIZATION (_(_)DESIGN DATA SHEET (DDS) UUCORPORATE RESOLUTION C__)L,SHORT EAF /,L_)PLANS -THREE SETS (__)(HOUSE PLANS - TWO SETS UUVARIANCE REQUEST SUBDIVISION (__)C__)LEGAL SUBDIVISION C_J(__)SUBDIVISION APPROVAL CHECKED (__)(__)PERC RATE UUFILL REQUIRED DEPTH UUCURTAIN DRAIN REQUIRED GENERAL Af i )LOCATED IN NYC WATERSHED IiS SUBMITTED TO DEP EGATED TO PCHD APPROVAL, IF REQ'D P TEST HOLES OBSERVED CS TO BE WITNESSED APPROVAL SSDS ADJ, LOTS &W5 ET A�fiD� OWN/DEC REQ'D ?) TA ON DDS PLANS & PE SAME 96 CATITTER BI/ZB 0'1 iF. 'FI�GOi; ELRV kTION'VJ L 200' ( �)( )SOIL TESTING LOTS >10 YEARS OLD SYSTEM PLAN- (NORTH ARROW) IRAULIC P"FILE )NSTRUCTION NOTES 1-15 SIGN DATA: PERC & DEEP RESULTS CONTOURS EXISTING & PROPOSED 'l.. DRIVEWAY & SLOPES, CUT FOOTING /GUTTER/CURTAIN DRAINS USDA SOIL TYPE BOUNDARIES ((__)TITLE BLOCK; OWNERS. NAME ADDRESS TM#, PE AME, ADDRESS, PHONE# C DA OF DRA IN G/REVISION TUM NCE L N OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. L )PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS WELLS & SSDS'S W/IN 200' OF SSTS 2 PRERTY METES & BOUNDS N C ONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE COMMENTS: . (REVSHEET)09 /01/00 Y (REQUIRED DETAILS ON PLANS CONT'D) HOUSE SEWER - %" FT. 4 "0'; TYPE PIPE CAST IRON (7/7 BENDS; MAX BENDS 450 W /CLEANOUT RENEWALS (,SITE NOTE (NO CHANGE) FILL SYSTEMS 0' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE FILL SPECS / FILL NOTES 1 -5 FILL PROFILE & DIMENSIONS FILL IN EXPANSION AREA FILL GREATER THAN 2 FEET CLAY BARRIER aF FILL CERTIFICATION NOTE DEPTH GAUGES VOL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS L,SEPARATION DISTANCE FROM TOE OF SLOPE E C (dam( )LF TRENCH PROVIDED 60FT MAX. (I,X__) PARALLEL TO CONTOURS 0100% EXPANSION PROVIDED / DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL (__�L_)GEOTEXTILE COVER / SEPARATION DISTANCES ON PLAN - FROM SSTS (� 0' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL 0' TO FOUNDATION WALLS (� 100' TO WELL, 200' IN DLOD,150' TO PITS L_) 100' TO STREAM, WATERCOURSE, LAKE (inc. eapan) (50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (pits - 20) E50' INTERMITTENT DRAINAGE COURSE (__ )200' /500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS C_) _)LO' MIN TO LEDGE OUTCROP SEPTIC TANK C—i( 10' FROM FOUNDATION; 50' TO WELL WELL IlVIENSIONS TO PROPERTY LINES (LOCATION OF SERVICE CONNECTION (_)(MIN 15' TO PROPERTY LINE ( SLOP SLOPE IN SSTS AREA 520 %) (___)(_)REGRADED TO 15 %, IF REQUIRED PUMP NOTES (_) DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED (___) )DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) C PIT AND D -BOX SHOWN &DETAILED (� 1 DAY STORAGE ABOVE ALARM JS PIPE BOTH SIDES, TA1L 5' 100 % -<1% L_) 20 to CD DISCHARGE /100' with 182 cons day discharge 10' MIN to NON - PERFORATED PIPE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS _ ._ .._ ..... R EVIEW. SH?!•FT FOR CONSTRTrC rION.PERMIT— NAME OF OWNER: STREET LOCATION: REVIEWED BY: RM, OR, AS, SRDATE: Y N DOCUMENTS (_)L_)PERMIT APPLICATION " "WELL PERMIT OR PWS LETTER UUP C -97 )(_)LETTER OF AUTHORIZATION (_)L )DESIGN DATA SHEET (DDS) ( _)L )CORPORATE RESOLUTION (_)L_)SHORT BAY .L_)(_)PLANS -THREE SETS ((_)HOUSE PLANS - TWO SETS (_)(_)VARIANCE REQUEST SUBDIVISION L _)(_)LEGAL SUBDIVISION (_)L_)SUBDIVISION APPROVAL CHECKED LL_)PERC RATE L_)(__)FILL REQUIRED DEPTH UC__)CURTAIN DRAIN REQUIRED / GENERAL /LOCATED IN NYC WATERSHED PLANS TO DEP DE 6 ATED TO PC (__);7P APPROVAL, IF RE Q' LCS TO BE WITNESSED APPROVAL MS ADJ, LOTS TLANDS (TOWNIDEC PERMIT REQ'D ?) CA ON DDS PLANS & PERMIT SAME 1969 NEIGHBOR NOTIFICATION 'TER BI/ZBA - YR... ELOOD_ELEVATION W/1200'. L TESTING LOTS >10 YEARS OLD EWAGE SYSTEM PLAN - (NORTH ARROW) SDS HYDRAULIC PROFILE 'RAVITY FLOW 'ONSTRUCTION NOTES 1 -15 IESIGN DATA: PERC & DEEP RESULTS 'CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT l OOTING /GUTTER/CURTAIN DRAINS (� USDA SOIL TYPE BOUNDARIES TITLE BLOCK; OWNERS NAME ADDRESS M4, PE/RA; NAME, ADDRESS, PHONE# DATE OF DRAWING/REVISION 6 DATUM REFERENCE 16 LOCATION OF WATERCOURSES, PONDS LLAKES,WETLANDS WITHIN 200' OF P.L. ((�—PROPOSED FINISH FLOOR AND kFROSASEMENT E LEVATIONS LLS & S5DS'S W/IN200' OF SSTS ROPERTY METES & BOUNDS ION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE COMMENTS: (REVSHEET)09 /01 /00 TAX MAP #: (CONFIRMED) ED DETAILS ON PLANS CONT'D HOUSE SE ER - V FT. 4 "0'; TYPE PIPE CAST IRON LAN END ; MAX BENDS 45° W /CLEANOUT RENEWALS I(C,�)( NOTE (NO CHANGE) FILL SYSTEMS JC�F 0' HORIZONTAL; PAST TRENCH SL OPES 3:1 TO GRADE ILL SPECS/ FILL NOTES 1 -5 ILL PROFILE & DIMENSIONS ILL IN EXPANSION AREA FILL GREATER THAN2 FEELAY BARRIER ILL CERTIFICATION NOTE EPTH GAUGES OL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS EPARATION DISTANCE FROM TOE OF SLOPE TRENF TRENCH PROVIDED 60FT MAX. .PARALLEL TO CONTOURS 0100% EXPANSION PROVIDED ETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS L_) 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL (20' TO FOUNDATION WALLS 0100' TO WELL, 200' IN DLOD, 150' TO PITS 100'TO STREAM, WATERCOURSE, LAKE (inc. eepan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (pits - 20') _ •.._ <.: 501-Ir" i ERi JKJOHN KARELL, JR., P.E. 121 CUSHMAN ROAD - - A"i'"I'ER�N, July 5, 2004 Robert Morris Putnam County Department of Health Geneva Road Brewster, New York, 10509 Re: JDG Builders Hazel and Zurich Patterson (T) TM # 25.78 -1- 68.69.70 Dear Mr. Morris: 845 - 878 -7894 Reference is made. to your letter dated May '11, 2004 relative to the captioned property. Please be advised as follows relative to your comments: 1--The house-ha5 been relocated;--the curtain drain-and trenches revised. 2. Depth of mottling is shown on the design data location on the plan. 3. Trenches have been checked and are drawn to the proper scale. 4: Driveway is labeled and grading shown: 5. Datum source is referenced. 6. The trench detail has been modified. 7. The stone wall has been shown on the plan. 8. The Town has indicated that there are no regulated wetlands on this property which would affect the location of the septic area. 9. The Town has indicated that the address will be Hazel Drive and has required that the driveway come off Hazel. 2 - If you have -any questions please call me at 878 -7894. V rY tru y y urs, John Karell, Jr., P.E. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEAL'T'H SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT PERMIT# 0 1/6 Located at �- D P V �'V �' C Town or Village PC{ _ g� � " ,/� 6 -11P_ - I bI Subdivision name 'i V Tk 'L - Subd. Lot # Tax Map 2-5 Block 13 1(Qe1e- Date Subdivision Approved �� y� 31 Renewal Revision Lot 70 Owner /Applicant Name -z- i7 C Mailing Address q 0 a ((O U i LU�� Date of Previous Approval ea Ctnme-L- Zip Amount of Fee Enclosed o 0 Building Type Vf s -Lot Area 1 •7,)-° No. of Bedrooms -) Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS RE12UIRED WHEN FILL. IS COMPLETED Separate Sewerage System to consist of C Other Requirements: 12-9 gallon septic tank and To be constructed by Water S� Public Supply From Ift i _.... - Address `C -) C"W- , :) or: _ Private Supply Drilled by ���11`L� I to tr- Address ` ' P I 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 s stern 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 t 3 ) I License # 5 3 7i1 I APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w sidered ecessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe prov dischar of domestic sanitary sews nly. By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pro essio Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATEKW U please print or type - - i �PCHD Permit # Well Location: Street Address: Town/Village -�l Tax Grid # f- "--& -� y P+ ;�m6B W MapLS' .7 Block I Lot(s) bf 6 % Well Owner: Name: Address: 'To C-1 PJ LD 1Z S Ito 5&ku-oW S;' 1 Ron, C: 66 k i i O's- I 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 _J� Est. of Daily Usage dal. 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 Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision '—" No. �-- ll,n,L,,ot Water Well Contractor: Address: - y6ko J7t�-�1�- 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 contaminat n t be pfVvided on separqtte sheet/plan. Date:. 3.3 Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health 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. y revision or alteration of the approved plan requires a new permit. Well to be constructed by a water we driller certified by Putnam County. Date of Issue t? Permit Issui fficial: Date of Expiration Title: Permit is Non-Transferifible White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 %d r 1�TE3TCHF.STER 15100ULAR $OIN IL S 27.811 x 44'e 2464 Sq. Ft . 24'x 16' fly room* 3A84 S . Ft. Second Floor io 28 8 Sq. Ft. ow era + +'.�r� • i o UL T ec��• s � nmteooea a asa ies 1 first Floor °'°°'` ws �• 1 ttl ILy 7777777-777 1 '7. T- s --r Ar T".S,tT; N 1 OF HEALTH H HOUSE PLt'AN Ai?I' OV :• I'U'2 I?E.DIMOM COUNT ONLY, ALL SLIs` < - ". ;NS TO THESE HOES. PLANS.i P" DOH rOR APPROVA - ek5-tM �7�� uNI�NI.SfI �-/7- Y {'ww 0 Rcap�ns Alit! Rd %n2da►e, New York 12544 (800) 832.3&5 ®. (914) 832 -9400 w• v,vrr�ptch�iern:cw.Lar.�Y�rr, , SIGNATURE & TITLE f. 1rr4 --4 V'J' JOHN i«RLL; 121 CUSHMAN ROAD wr a'earse PATTERSON, NEW YORK 12563 4 BR µpVS9E PLAN NPagW.• �M �G5? SNaW� ;• l 5 L/Y1P1CiROOE7 9XMNQa001w is ar®• FAWLY ROOM 9�Z�X13'L° ttl ILy 7777777-777 1 '7. T- s --r Ar T".S,tT; N 1 OF HEALTH H HOUSE PLt'AN Ai?I' OV :• I'U'2 I?E.DIMOM COUNT ONLY, ALL SLIs` < - ". ;NS TO THESE HOES. PLANS.i P" DOH rOR APPROVA - ek5-tM �7�� uNI�NI.SfI �-/7- Y {'ww 0 Rcap�ns Alit! Rd %n2da►e, New York 12544 (800) 832.3&5 ®. (914) 832 -9400 w• v,vrr�ptch�iern:cw.Lar.�Y�rr, , SIGNATURE & TITLE k 1rr4 --4 V'J' JOHN i«RLL; 121 CUSHMAN ROAD wr a'earse PATTERSON, NEW YORK 12563 4 BR µpVS9E PLAN NPagW.• �M �G5? SNaW� ;• l 5 k PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW-SHEET FOR CONSTRUCTION PERMIT.._.. _.._ _.: ... � .... _r _.. • - - -- -- ..____.. __ _ . _ NAME OF OWNER: STREET LOCATION: REVIEWED BY: RM, OR, AS, .SRDATE: TAX MAP #: (CONFIRMED) Y N DOCUMENTS Y '/4(REQUIRED DETAILS ON PLANS CONT'D) UU PERMIT APPLICATION HOUSE SEWER -" FT. 4 "0'; TYPE PIPE CAST IRON )(WELL PERMIT OR PWS LETTER �NO BENDS; MAX BENDS 450 W /CLEANOUT (_)(_)PC -97 RENEWALS (_)(_)LETTER OF AUTHORIZATION (IF ))SITE NOTE (NO CHANGE) (__)(DESIGN DATA SHEET (DDS) FILL SYSTEMS (_)(_)CORPORATE RESOLUTION ' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE ((_)SHORT EAF LL SPECS/ FILL NOTES 1 -5 UUPLANS -THREE SETS LL PROFILE & DIMENSIONS (_)(_)HOUSE PLANS - TWO SETS LL IN EXPANSION AREA (�(�VARIANCE REQUEST FILL GREATER THAN FEET SUBDIVISION LAY BARRIER U(__)LEGAL SUBDIVISION LL CERTIFICATION NOTE �)(_)SUBDMSION APPROVAL CHECKED EPTH GAUGES (�UPERC RATE OL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS (_)(_)FILL REQUIRED DEPTH �)�)SEPARATION DISTANCE FROM TOE OF SLOPE (_) CURTAIN DRAIN REQUIRED TRENCH GENERAL �) TRENCH PROVIDED 60FT MAX. LOCATED IN NYC WATERSHED PARALLEL TO CONTOURS PLANS SUBMITTED TO DEP CJVD100% EXPANSION PROVIDED DELEGATED TO PCHD DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL DEP APPROVAL, IF REQ'D (_)GEOTEXTILE COVER DEEP TEST HOLES OBSERVED SEPARATION DISTANCES ON PLAN - FROM SSTS PERCS TO BE WITNESSED 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL EX- APPROVAL SSDS ADJ, LOTS MIL20'TO FOUNDATION WALLS WETLANDS (TOWN /DEC PERMIT REQ'D ?) 100' TO WELL, 200' IN DLOD, 150' TO PITS DATA ON DDS PLANS & PERMIT SAME 100' TO STREAM, WATERCOURSE, LAKE (inc. espan) PRE 1969 NEIGHBOR NOTIFICATION 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER LETTER BUZBA 10' TO WATERLINE (pits - 20') (_)l00 YR. FLOCD iLiZ'ATI011' `dV/I200' - - - _ __.. _. . ( )( /)SOIL TESTING LOTS >10 YEARS OLD W E S M PLAN - (NORTH ARROW) ULIC PROFILE Lam/ RAVITY FLOW CONSTRUCTION NOTES 1 -15 (-DESIGN DATA: PERC & DEEP RESULTS ' CONTOURS EXISTING & PROPOSED RIVEWAY & SLOPES, CUT (_,FOOTING /GUTTER/CURTAIN DRAINS (USDA SOIL TYPE BOUNDARIES TITLE BLOCK; OWNERS NAME ADDRESS (TM #, PE/RA; NAME, ADDRESS, PHONE# DATE OF DRAWING/REVISION DATUM REFERENCE (� OCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. PROPOSED FINISH FLOOR AND BASE TEL VATIONS (� EL S& 'S W/IN 200' OF SSTS )PRO RTY METES &BOUNDS )(_)EROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE COMMENTS: (REVSHEET)09 /01/00 50' INTERMITTENT DRAINAGE COURSE 200' /500' RESERVOM ETC. _ 150' GALLEY SYSTEMS 10' MIN TO LEDGE OUTCROP 7C__)l0'FROM SEPTIC TANK FOUNDATION; 50' TO WELL WELL IMENSIONS TO PROPERTY LINES LOCATION OF SERVICE CONNECTION (_) MIN 15' TO PROPERTY LINE SLOPE SLOPE IN SSTS AREA 520 %) REGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS (__)PUMP NOTES DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) P T AND D -BOX SHOWN &DETAILED (_)(� DAY STORAGE ABOVE ALARM CURTAIN DRAIN STANDPIPES, 5' BOTH SIDES, DETAIL 15' MIN to CDS = >5 %, 20' -4 %, 25' -3 %, 35' -1 %, 100 % - <1% 20' MIN to CD DISCHARGE /100' with 182 cons day discharge ( 1 110' MIN to NON - PERFORATED PIPE 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 May 11, 2004 John Karell, Jr., PE 121 Cushman Road Patterson, NY 12563 Re: Proposed SSTS: JDG Builders Hazel & Zurich (T) Patterson, TM #25.78 -1- 68,69,70 Dear Mr. Karell: ROBERT J. B ONDI County Executive Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: 1. Mottling has been recorded at 4 feet. The curtain drain, as shown, does not fully protect the SSTS.- The house foundation cannot be used for groundwater protection. - - -" esigri data o2-. *'IS n plan does not note depth-of mottling. 3. Trenches do not scale to the noted lengths. 4. Driveway is to be clearly shown and labeled, furthermore, any proposed grading is to be shown. 5. Datum source is to be referenced on the plan. 6. Trench detail is to note "clean, dust free" crushed stone. 7. All stone walls on the property are to be shown on the plan. 8. There is standing water and wetland vegetaion in the area near Hazel Drive. The wetland is to be delinated or a letter from the Town of Patterson must be submitted stating that the area is not considered a wetland. 9. The legal address for the proposed residence is to be noted on the plan. It does not appear that the address will be Zurich Road. 10. A letter from the Town of Patterson is to be submitted stating that the property can be accessed by Batavia Road. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolafion tests were iiot-witinessed. by a'represeintative-of"the i4ew York City lleparinierit Environmental Protection on this lot, percolation tests must be witnessed by a representative o, f this Department. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:lm Ve ly Robert Morris, P.E. Senior Public Health Engineer JKJOHN KARELL, JR., P.E. 121 CUSHMAN ROAD s45- 878 -7894 - PATTTTERSON, NEVI! YORK, .12563 May 4, 2004 Robert Morris Putnam County Health Department Geneva Road Brewster, New York, 10509 Re: JDG Builders Zurich Road Patterson (T) TM # 25.78 -1- 68569,70 Dear Mr. Morris: Forwarded herewith please find four sets of plans for the captioned project revised in accordance with your letter dated April 27, 2004 as follows: 1. Neighbor notification has been completed. Copies of the mail receipts have been forwarded to your office previously. 2. The combination of the lots has been addressed by the Town Assessor. 3. The survey information has been modified and explained by the surveyor, Roland Link, L.S. 4. The profile is accurate and complete as we discussed. 5. The curtain drain standpipe detail is shown. 6. The erosion control barrier, silt fence protects the downgradient properties from siltation. 7. The dimension line has been added. Very truly yours, John Karell, Jr., P.E. PUTNAM COUNTY DEPARTMENT OF HEALTH ' DIVISION t Of' VIRONMENTAL HEALTH SERVYCES -_- . DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner 0 C� �0 i�-s Address (/y f�l�l��ir���7 Located at (Street) }9Z— Wig) C I r'PTax Map s Block Lot _d j ��% (igdic t nearest cross street _ Municipality fj Watershed SOIL PERCOLATION TEST DATA Date of Pre-soaking _ % Date of Percolation Test Pro 'th to Water, -s�� 'Water ,.:�� e 1 ' percola`' m Ground ve , s fiion':: Time EIa a Time : Surface(Incbes) Drop Intl Y'� <. h Hole rIo.;tuu ;::Start ;Stop Inc es > h�Ln/Inch : 3 ZZ,� 2 � Z Z 4 i i 1 yo P� 1 z 2 VA Z31 30 10 3 3 0 L P 1 2io'I 16 i 4 NOTES: 1. Tests to be repeated at same deptn unto approximaieq equal 17c1w1auv11 .a.%1,2 a%, WWVAUAW, "- ���•• percolation test hole. (i.e. s 1 min for 1 -30 mintinch, s 2 min for 31 -60 munch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. 3 4 5 NOTES: 1. Tests to be repeated at same deptn unto approximaieq equal 17c1w1auv11 .a.%1,2 a%, WWVAUAW, "- ���•• percolation test hole. (i.e. s 1 min for 1 -30 mintinch, s 2 min for 31 -60 munch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. DEPTH G.L. 0.5' 1.0' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.5' 8.0' 9.0' 9.5' 10.0' TEST PIT DATA . DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. % L HOLE N0.� HOLE N0. , Indicate level at which groundwater is encountered - �- - - Indicate level at which mottling is tp �- - - - - — N 0 14.164 (9195) —Text 12 PROJECT I.D. NUMBER 617.20 _. CE41D Appendix C State Environmental Ouality Review SNORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART 1— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANTISPONSORr -- 2. PROJECT NAM 3. PROJECT LOCATION: — -, I r Municipality Ioy�, 7} f - --P_,,r6 (j—,xi 1, l County i 4 PRECISE LOCATION (Street address and road Inlersecllons, prominent landmarks, etc, or provide map) 5. IS PROPOSED ACTION: QQ" ❑ Expansion ❑ Modiflcallonfalteratlon 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LANQ��JJ AFF�D: Initially acres Ultimately 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? K3 ❑ No It No, descries brlelly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? WRes!denllal ❑ Industrial - r� �.ICommnretaL.. �AZri�i!!uro �P:rk.'Fcrast'Opersyaa .. �.JOtt:a: � .... . 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? Q,Yas ❑ No 11 yes, Ost agency(3) and pem+itlapprovats 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR ❑ Yes K0 11 Y03, 03t agency name and•pemtitiappmul 12. AS A RESULT OF .ROPOSED ACTON WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑ Yes AtNo I CERTNFO MATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Appllcant/spizi C u� �"�Y�(' /'q Signature: f/ If the action Is in the Co astal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Acencv) A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL 0 Yes' ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, It legible) C1. Existing air quality, surface or groundwater quality or quantity,-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: C4. A community's existing plans or goals as officially adopted, or a Change in use Of intensity of use of land or other natural resources? Explain 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 C1-05? Explain briefly. C7. Other Impacts (Including changes in use of either quantity or type of energy)? Explain briefly. D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA? E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No It 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 (Q magnitude. if necessary, add attachments or reference supporting materials.. Ensure'that explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed. If question D of Part If 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 andfor prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result In any significant adverse environmental impacts AND provide on'attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of esponsi a Officcf in Lead Agency ignature -01 Responsible Officcr in Lead Agency Date n Title o espons a Office-f ivwture of repuer (t diftery responsi e o ricer) i t i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM' 1. Name and address of applicant: I D C, 8 V l L4 ciZ S Ll o S /tom W SrrLE P2-D-/ 2. Name of project: 3. Location T/V:- 4. Design Professional: - O#A,) ki W ELLJ, - 5. Address: 121-0 6. Drainage Basin: 01 ,47J 7. Tvne� 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)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... /V0 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency --- 12. Is this project in an area under the control of local planning, zoning, or other N O officials, ordinances?., ................. .....:.............. ................................ :. 13. If so, have plans been submitted to such authorities? ........ ............................... 14. Has preliminary approval been granted by such authorities? Date granted: — 15. Type of Sewage Treatment System Discharge ................. surface water' groundwater 16. If surface water discharge, what is the stream class designation? .................... 17.. Waters index number (surface) ........................................... ............................... 18. Is project located near a public water supply system? ....... ............................... 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ �'Jo 21. Name of sewage system Distance to sewage system 22. Date test holes observed 0 U _ 23. Name of Health Inspector 24. Project design flow (gallons per day) ................................. ............................... 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... N 0 26. Has SPDES Application been submitted to local DEC office? ......................... Form PC -97 8/99 2 27. Is any portion of this project located within a designated Town or State wetland? NO 28. Wetlands ID Number ..::. ..:..:::..- ..:...............:. 29. Is Wetlands Permit required? .............................................. ............................... Has application been made to Town or Local DEC office? 30. Does project require a DEC Stream Disturbance Permit? ........................ 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any 1 /} other potentially known source of contamination. Yes/No V DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... 34. Are community water and/or sewer facilities planned to be developed within A)O 15 years in or adjacent to project site? ................................ ............................... 35. Are any sewage treatment areas in excess of 15% slope? ............................. 36. Tax Map ID Number .......................... ............................... Map 5' 7 Block Lotk 67i -7d 37. Approved plans are to be returned to...... Applicant . _ %�- -_ Design Professional .. ................ _. _. I. NOT E:.AII applications for review and approval of anew 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 I .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 olthe Penal La�v. SIGNATURES & OFFICIAL TITLES. Mailing Address: ................................... / Z �1 241rWAI Ny ) Z-s-b3 RE: PUTNAM COUNTY DEPARTMENT OF HEALTH _ DIVISION OF ENVIRONMENTAL HEALTH SERVICES LE'MR, OF ON Property of 6-7 . �D '� C— , TN m - Subdivision of � U J I (,-A r ' • 131k - -W Subdi vjslon Lot # 7 O(Filed Map # Date Filed ff 3 Gentlemen: - This letter is to authorize a duly licensed Professional Engineer �� or Registered Architect to apply for the uir wa�+ater treatment and/or water supply peas) to serve the above -noted prop in accordancd with the standards, rules or regulations as promulgated by the Public Health Director e County Health Department, and to sign all necessary papers on my behalf in connection with thl matter and to supervise the construction of said wastewater trehnent and/or Water supply stems is conformity with the provisions of Article 145 and/or 147 of the Education Law, the public Health Law, and the Putnam County Sanitary Code. P.E., RA., # -S-3 Mailing Address .. _......_ _ very truly yours, R� Signed: l , of V") V State Zip , L L2 �3 Telephone: , f 7.e -7,,f- f V_ Mailing Address: 0 State A/ 0 S •Telephone: it 7/ c( Form LA -97 Sent By: LLL; , IT k FOLEY - . 51k Recta DErsaar tr 234567 ; Mar -16 -04 12:21PM; - O ' LCHMM tr ewmAtt w w %t o1�. Dkidw 4r Pa" S"a JJEPARMEN OF . d3 C�!'fs..111 .. - . 1. Oman Ii,osd • BMW*; Nwv. Yok,10509 Page 1/1 , -y YES NO ° o . _ ProposedSS'fS, tbinthedrainAgebasmo t�ifestBrm&or$oadeGmer.Iue. vairs:.. �. _..... _ ®.... -. _ - Imposed SSTS wftbk v00feet otarat mir, ruerv* stem or control lake. n >L. Proposed SM Witbm 200 feet of u watereme or it JZC.*aand. P �osed SS'1 S day 666 roA 'p . , $rester tliaa 1000 permit regtvred: .. ® Proposed MrS %r a Com,aerital'pro eat:.•..... respurtT oithe desiJu profeuional to �.' proriide the abm iutormation prior to soil te�. -This Department Al deteradae the NYCDEP project static (Joi�l or :De%ga�ed) b as the �...,.. :.- reapouse.. If you mmWed= to any of the gneatio s, NYC DE# iiist.Vjtueas the `w1, shag; bepartmeot W.m coorapate R ) Rh Ay. suitable time for field tuft rvitis tic P,C'DOHt tau Design . Profess end and NYCDEP. If a project bas beau determined to be Delegated b'med oa the sbm response and then subsequent information indicates lWCDEP u required to rdtaass'tlm sod t oftbt d eah,1 betbe sole responsm�ity esi�uprofessionaltotchednkre -711 em,'gotthcsbiltestuat i lrc ar. �eCOV.N'�c u}z T 'd d0 1N3Wl8dd30 AiNnoo WdNind : 3WUN WCE & . FOLRY T26L- BL2-S08 :131 Sb : T T 3ni 2002- S2-nON - .�(.- �P.E33'� - �IOL3p$rr�`a:A;aL;.'ar(;$ ci;- - - ... • Ametme P#W 1foM bkw tdr Mdiee W 4f tmkKt &IMM DETARTi1VWr OF HE*Q' TH 1 Ganes Road • Brewster, Now. Yak ; i0SA9 EMIR= A•TT>FE MON: cs ADAM S?IEBELEIG �GIO� DEAD Ail ldormadon below must be My comp�letred prior ie MW schedn]mg. EKGII MORFD E vX40N: ROa>ars =: TOWN: 7A SUMMS'ION: DEEPS: )L PER(E;A ffAs u., 1)'R* I VIP PHONE* PUMP TEST: 13 Fl TAR i1dAEN• 25 . � -- j .,� (o � ` ���p •' . x el Im 144 : rr r : t ; stn . ►r► :r ►i 7�► t r .yrr� us NO o ., >� Proposed SSiS wlitbin the draims�ge basin of �Yest $ranch or Bolds Cbrster Reaervott's. o Proposed SSTS within 300 fete of a.Tessrirc►ir, res or eontiol lake. y -- _ _. _...:._ p Froposed SSiS within 200 feet of aintercoarn or ttDECrre&a. o �^' Proposed SSTS design flog westert=t 1000 Sallow/by or SFDES permit xegai t&—. o M Proposed SSxS for a Cotomerical Praject. Ii lit& reapmiAwl of the design profesdonal to above inioriantion prior to sod testes ,— - - • - - Tbis Aepsrtnent will deknibe the NYCDEP project statii T(doiat or Aele�aEed)'TyAsad on the ,respoase.. If YOU wsWMd JM to am of the questians, NYCDZp MW witness the soil ie*q&,� This•= : = • -' Departmeat Wi eoordlgate a mutulll suitable time for field testing with the PCf10K the Deep ` Prafesdons) and NYCDEP. If a project bas been determined to ht Utgated baled ou the above response and t%ca subsequent information indicates NYCDEI' b regnusd to witness the soft tuft it wild be the sole responsibmv of the design professional to schedule reaMbiessiog of the soil testing frith NYCDBp. 4/4 abed !Nd9O :?l CO-9z -AON rowmvsconny •` L99�EZ1 =3.0 •`ill ./(g }ues 68 ro f ran 401low. YATES ENIA m PE YOU R A N RC OD ANCHE,S K 000 D ICT UPI. EP TON '- L PL gr E 0 Ir. ZUJCN HAZE DR & g 40, INW p 0 me 66 R Lake Charles r..' vMV scow ... .. .00 0=0 bo de JDJR, RD CEO T cao 00 DEN ON, D O o RED RE =TD EVOLUTIONARY,IA iv cao 00 16 25.70-1-66— 24 25 33 130.45 7 3 . 23 26 2.00 — 90.00 31.20 3,2 P 1 120 1 1 1 1 21 1 I 1 1 0 27 Z' MAINE 1 I 1 122 1 — 31 r. 40• 10AA 1 70.211 160.0 R 1 1 1 93,07L I 30 DRIVE- J. 870911&WSJ 14191 2?:56 —65.00- N, - I 751 # - - — — — — Awor 48 tvlvl 74 . mw v 'Amf • /aj 52\ glew smw AWT OAF1 Slag 46 70 e /eB 0-Mr ` s-1fm 3G 45 /ff" NOV 's-laf 37— './ja gle. 44 an' 71 We v 38� 67 I&W SAW 7 '0 Awl lze.29 72 0.00 &NJ �i$ — PARK 54 S/JW 6 /16 WAtr WAV /41 V \ siAm 49" S/W? 11 AM/ — WAV 1 cav R/Sff 1;5 .0, Axw &vli I- M LORETTA MOLINARI Public Health Director April 27, 2004 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 John Karell, Jr., PE 121 Cushman Road Patterson, New York 12563 Dear Mr. Karell: ROBERT J. BONDI County Executive Re: Application to Construct a Subsurface Sewage Treatment System — JDG Builders Zurich Road, (T) Patterson, TM# 25.78 -1 -68, 69, 70 The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on April 2, 2004 is incomplete. Please be advised that the following information is required before the Department may commence its review. •. Neighbor rloti.fica.ti.on has not been completed. • In addition: a. Lots must be legally combined. b. An actual survey must be used as the basis of the plan. Assumptions are not acceptable. C. SSDS profile is not accurate or complete. d. Existing SSTS is to be removed from plan. Only boundaries are to be shown. e. Curtain drain standpipe detail is to be shown. f. Erosion control barrier for the house has not been shown. g. The dimension from the curtain drain standpipes to the curtain drain is to be provided on the plan. The review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information as to the completeness of your application. Please be advised that failure to submit information to the Department or to follow procedures is sufficient grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed and Putnam County Department of Health regulations. , d S'ilUUId you -nave any questions or care to discuss this matter of, please coiitact me at (845)-278-" 6130 extension 2166. 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