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HomeMy WebLinkAbout1418DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -2 -2 BOX 13 I ru l*;' W� I, IN �I ' rA 066 PI `.jl 01418 ;. .. .....+._... +-.i e'rvrr. 7„R ... ^°v- .rv.Lr. .. .:'r -. --v iw ra-+:° � a'..•i_ x.•_�•_ -- �...Y_ _ . -._ � .� _M . ". rV EM [ W.MM d= DZFA 1 OF —� $atdoM. 1. Dl;lf l�su Sedeeer fb twald [emit/ I l Ili CBM CATSOF CODIJAN($ C0 PT T 1OS SBWA= Pea�lt if fJ Rev. IV[00 maw TM Lot Aces ' � t F01 Sectionv 4 Depili roiooe Numb aa d % Design Flow GP D C—� PCHD Natldcotle� b Yegg6ed Whoa FlD G a�pbad 5% Mina arvemp S7W a on" d G Septic Took oed_��� To M -by AdlLeee wow std Pare Sop* Fti. e Atkbeae on�Pehra Sew OrMed by Ad&v . iri I1'represent3hat 1 am wholly and completely res0onfible for ` the design and location of the proposed system(s)l, 1) that the'separata sew di sal stem asow described will be constructed as-shown on the approved amendment there to and in accordance with the standards, rules a regu ns o ham County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Heelthwill be submitted ao tile Oepa►trirant, and a writ_ ten ."grantee will be furnished the owner, his successors heirs or assigns by the builder, that said! builder will gNece in good operating condition my part, of said . sewage disposal system during the, period of two (2) years. hnmiediately ;following thedate.of the issu- ance o1,. the approval of the Certificate of Construction Compliance of the original system or any repairs taeret =ndf ) that the drilled well'dofr:Nbed above well be located as shavin on the approved Olen arid that said well led in a rdana with 'tM Ma tin Putwam County Oapartment Of Health. dab t i !� �. Signed RA. t �y Address License No APPROVED FOR CONSTRUCTION: This approvat expires two years from the data issued unless construction of the building ins been undertaken and is nwocabie for cause or may be ananded or modified when considered no.M rg E . by the Commissioner of Health. Any change or alteration of construction Maui as a new 0 it. for disposal of domestic san r s , private water supply only. ✓��J /� dab B Title 5 ` �! . ° ` )p TJ I)C)�_T 'A, t_�f ���f 11,11 _r-se- APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEH 1' Name and Address of Applicant: ' ` 2' Name of Project: . 4' Project Engineer: Lic'ens�e Number: Phone: O' Tvoe of 12 4 Lo oatio n z 5' Add V Private/Residen'tial' Food 'Service . ' �.�ConY�eroial * Apartments Institutional � � Hbbile Home Park Office Building � Realty Gu `djv1sion 0ther.(opeoify) ' . 7' Is this project subject' toState Environmantal -Ouality'ReviaV �SEQ�1� ' ' ^ Type Stat0s (Check One) ' Type I.� .Exempt ~ Type II. 'Unlisted O' I§' a Dr�ft Environmental Impact Statement (DEIS) required? ..,..,.,,...., QP 8' H&oDEIS been completed and found acceptab] ^by Lead Agency? ........ 10 N�� �e of�ead � ' ' `—' � Agency 11 ' I- this a p 'eot in an ar'ea under the control of -local planning, zoning, or other officials, ordinances? . . . �``'`'''''f^`^^^�^�'^`''^'''`^^^^^^^^^^^`^ ' 12' If so, have p1ans been- A�i ttad to suoh.autho[i tie`? .�'-'.....'..'.'.,� � 13 ' -.* . R8 preliminary l b � s pre 1m n�ry �pprovu een 'granted by sucb eufhori ties? Data!�G|anted:__^______ /4 �� of ° ga D�spooal�System' Discharge.. ' \ � � ' '� u�xu Disposal:, ...�� � Surface Water ' Pound ���era 5' If surface water discharge, what is the stream' class de's'ignation? .,'..~., | � | ' 6' Waters index number [surf�cal ' ' . ' .,,�...'.��.......,,.,..~.,.�.. 7' is project located near a'publio water supply system? . ., ., ' . , , . ^ ^ ^ '^^^ 3' If yes, narne of water supply Dintance.t~�*ate' supply I. Is project site near a public sewage�colleotioO or,disposal syatem?'^''. ` L Name of sewage system Distance to sewage syotem___��__ ' Oate observed: 23. Name of Health spe'tor: ' ' Project design flow (gallons per day1..,.....,'.,. . ' ' � , ', . ^. . . ^ ' . . . .. . , , . ^ . . 2. 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?..__ pJp 26. Has SPDES Application been submitted to local DEC Office? ............... K) /A 27. Is any portion of this project located within a designated Town or State wetland ?. ................... .... ............................... ........ N)O 23. Wetland ID Number ......................... ............................... tJ /d 29. -Is Wetland Perm it• required ? "•............ .................. Rln Has application been made to Town or Local DEC Office? !J /.a 30. Does project require a T EC Stream Disturbance Permit? ..........�......:. fJ 0 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 or NO v 32. Is project located within 1.000-feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential kno�wn•source of contamination? ...............YES or NO rl DESCRIBE: 33. Is there a local master plan or file.-with the Town or Village? 34., Are community water, sewer facilities -planned to be developed within 15 years? ViJKNo100 -35. Are any. sewage disposal_, areas in excess of_- _15- ._slope ? - ...... .. .. _....... Q0 36. Tax Hap ID Number ................ .. 37. Approved Plans are to"'be: returned to: ................. y-' - Engineer 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. Failure. to comply with ;this provision may be grounds for the ,rejection of any submission. I hereby affirm, under- penalty of perjpry,• that information provided on. this form is true to the best of my knou7ed5e and be 1 ief. Fa lse state ,rents made herein are punishable as a Class A Hisde,,eanor pursuant to Section 210.45 of the Pena 1 Law. n SIGNATURES & OFFICIAL TITLES ''aAILING ADDRESS: - a RANDOLPH W. LAURENT, P.E. HARRY W. NICHOLS JR., P.E. October 14, 1994 1�3 LAURENT ENGINEERING ASSOCIATES, P.C. MILLUROOKE OFFICE CENTRE k Route 22 & Milltown Road Brewster, New York 10509 (914)278 -6108 - (FA)O 278 -2658 } CONSULTING SITE ENGINEERS -- Mr. William Hedges Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Fair Street Patterson, N.Y. Dear Bill: Enclosed are the following: 1. Four (4) prints of Drawing SS -1 "Proposed SSDS", dated 10- 14 -94. 2. "Application For Approval of Plans For a Wastewater Disposal System ". 3. "Construction Permit for Sewage Disposal System ", dated 10- 14 -94. 4. "Application to Construct a Water Well ", dated 10- 14 -94. 5. "Design. Data .Sheet , 6. "Letter of Authorization ", dated 10- 14 -94. 7. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only ". 8. Check in the amount of $300.00, review fee. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Sincerely, T ENGINEERING SOCIATES, P.C. Randolph W. Laurent, P.E. RWL:bd 94080 enc. cc: Mr. J. Tanzi w /enc. DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 APPLICATTOi� -TO C0NSTnJCT:. n WA:=.P"'_'•-2 1- LL PCHD PERMITr�('�1 WELL LOCATION St eet Address o Village City d Tax-Grid Number '2 WELL OWNER ame u, Mailing Addr ss P-a / OPrivate h �/ O Public USE OF WELL primary secondary If RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP 0 ABANDONED 0 BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify 0 INDUSTRIAL O INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT�gpm /# 13 REPLACE EXISTING SUPPLY 4NEW SUPP Y NEW DWELLING PEOPLE SERVED, /EST. O TEST /OBSERVATION O DEEPEN EXISTING WELL OF DAILY USAGE gal 13-ADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE ®DRI LED 13DRIVEN E]DUG GRAVEL. O OTHER IS WELL SITE SUBJECT TO FLOODING? YES ✓ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. i WATER WELL CONTRACTOR: Name �{" fi7• Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ✓ NO NAME OF PUBLIC WATER SUPPLY: AZA- TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET date) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of 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 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 attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or 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. Date of Issue: C� ----� 19 Date of Expiration 19 7e, Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller PUTIqAH 000Wy DEPApTmv`7T OF HEALTH. DIVISION .OF HEALTH •SERVICES DESIGN DATA 5-SUBSUFA Owner S' Address�%_I sec. Lot Ii�cated at (Street) � � � S- n� f ' - � -_ , ...(indicate nearest cross streetY Municipality P Watershed SOIL FvWYEAIIGN-•TEST DATA RDWIRED TO BE .SU&Mr= WITH APPLICATIONS Date of Pre- Soaking Date of Percolation Test 'HOLE =' NUMBER . CLOCK TIKE PERCOLATION PERCOLATION Run Elapse Depth to Water ];Fran Water Level No. Time Ground Surface, In inches Soil Rates Start Stop Min: Start shop Drop M � Drop ` Inches - Inches Inches �� =as 6v za 17 a r 2 =9"S'O - t TEST PIT DATA RDQumm TO BE,SURjr= WITH APPLICATION DESCRIPTION OF SOIIS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. I HOLE N0. HOLE NO. G. L. - 2' 3' _ • 4' 5' 6' . 71 8' 9r 10' 11' 12' 13` S} ' --• o a vvt, 14' INDICATE ISVEL AT WHICH GROUNIXr=E,ft IS ENQOUNmm or) e n' INDICATE LEVEL TO. WHICH WATER LEM RISES AFM BEING ENODUNTERED N� C DEEP HOLE OBSERVATIONS MADE i'BY; laa_P egt-� ' Ce' • c e �3 DATE: /0 -1-2 DESIGN Soil Rafe Used 6 -7 Min/1" Drop:- S.D. Usable Area Provided . No. of Bedroans Septic Tank Capacity 1 ©D gals. Type •one.. Absorption Area-Provided By o O L.F. x 24" width trench Other Iii �� %� i� S • r \�� i� �'y1 /� a� ._ Address I Lid % ki/ /s.r �', i� SM MUS`SPACE FOR USE: BY HEALTil DEPARUMU. ONLY.- • - Date' A' i t 14' INDICATE ISVEL AT WHICH GROUNIXr=E,ft IS ENQOUNmm or) e n' INDICATE LEVEL TO. WHICH WATER LEM RISES AFM BEING ENODUNTERED N� C DEEP HOLE OBSERVATIONS MADE i'BY; laa_P egt-� ' Ce' • c e �3 DATE: /0 -1-2 DESIGN Soil Rafe Used 6 -7 Min/1" Drop:- S.D. Usable Area Provided . No. of Bedroans Septic Tank Capacity 1 ©D gals. Type •one.. Absorption Area-Provided By o O L.F. x 24" width trench Other Iii �� %� i� S • r \�� i� �'y1 /� a� ._ Address I Lid % ki/ /s.r �', i� SM MUS`SPACE FOR USE: BY HEALTil DEPARUMU. ONLY.- • - Date' PUTNAPI COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Located at��'�•. (T) Section f: Block �' Lot Subdivision, of Subdv. Lot ; Filed A1ap ;� Date Gentlemen: P This letter is to authorize, a duly licensed professional engineer I or registered architect_ (Indicate) 9 'Co apply for a Construction Permit for a separate -sewage system, .to serve the above noted property in accordance with the standards -, rules. or regulations.a's promulagated by the Commissioner of the Putnam County Department of Health', and to sign. all •necessary papers on my :behalf. in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article.l 5 or 147 Education'Law the -Public Health La��r, and the Putnam County Sani- Lary Code. r'15 ., rl Y �• Counte signed: P.E. , R.A. Very truly yours.', Signed ✓ Ow r of Property Address Address '(� / �✓!ILr�'�V)!`� y�':'':'� Toti,-n Telephone fir' Telephone 16'X 40' Unfinished SP-... -id Floor • 640 Sq- ,. Second Flocr " j � 0' First Floor 0 0 STANDARD NEWFOUNDLAND HATURES • Luxurious First Flocr Master Suite Fireplace Options Available • Comparunentalized First Floor Bath with Consult an Authorized Westchester guilder Two Separate Vanities for a Complete List of Options • Formal Entry Foyer fist's renderings and Floor Plan D:me;,sions are • Formal Dining Room A,'Fsreci5utions rr st t-- Wri -,en in t ., Contrac-,- No oral congi ions. • Formal Li��ng Room • Spacious Eat -in Kitchen ESTCHESTER ODULAR OMES, (NC. 1 Reagan's Mill Road • VVIngdale, NY 12594 �=1'L (914) 832 -9400 • (800) 832 -3888 �I : -_. VifE64- 'A`,-�f3ilVlGK-r 41.I-. 02 13 The useable volume of Well -X -Trot tanks is sometimes referred to as "Acceptance Volume" or "Drawdown." It represents the amount of water that can be accepted and stored by Well -X -Trots under varying operating pressure ranges (pump on /pump off settings). In the Well -X -Trot Effective _System Protection (ESP) sizing practice it is the amount of water that the pump can deliver in either one minute (ESP 1) or two minutes (ESP II). The useable volumes shown for each Well -X -Trot model listed are calculated by the application of Boyles Law Form DC -587 PRODUCT INFORMATION WELL•X•TROLO _..... . _ __....r - DRAW.D- OWN..- CHART_ -- -_- - - of Perfect Gases (P1V1 = P2V2) at the pressure ranges shown. The sizing formula used is the following expression of Boyles Law - Useable Volume Gauge Cut In Pressure ,+ 14.7 __Tank Gauge Cut Out Pressure + 14.7 Volume The comparative plain steel tank volume represents the total volume of an unpressurized galvanized well tank required to supply the same amount of useable water. MARK OF THE ORIGINATOR USEABLE VOLUME TOTAL TANK VOLUME (gals.) (gals.) MODEL NO. PRESSURE RANGES EQUIVALENT GALVANIZED TANK VOLUME PRESSURE RANGES (PSI)' (PSI) WELL- X -TROL 20140 30150 40160 TOTAL VOLUME 20140 30150 40160 WX•101 WX .7 1.6 .6 1.4 .5 1.2 2.0 4.4 •. 4.5 10 3 ' 6.0 14 0 .;:.,6-.g -102 WX 103 3.2 2.7 2.3 8.6 20:5 27.0. 31 9 WX•104S 3.8 3.2 2.7 10.3 24 5..: 31,01 37 5 WX•104 3.8 3.2 2.7 10.3 ' 24.5 ' 31.0 i37 5 - WX•104 -LTD 3.8 3.2 2.'7 10.3 24.5 31.0 37.5 WX•200 5.2 4.3 3.8 14.0 .315 43.0, 52 7 WX 200 UG 5.2 4.3 3.8 14.0 ' -33:5 43.0 '52 7 WX -201 5.2 4.3 3.8 14.0 .33.5 43.0 52.7 WX- 201 -LTD 5.2 4.3 3.8 14.0 33.5 43.0 52.7 WX- 201 -IN 5.2 4.3 3.8 14.0 33.5 43.0 52.7 WX -202 7.4 6.2 5.4 20.0 47.7 62.0 7510, - WX-20261-1 D ...,..- .7.4 G.2 5.4 2.0.0. 47.7- _.,._ ._ _..... .62,0 - -. , _. 75.0 WX- 202 -IN 7.4 6.2 5.4 20.0 47.7 62.0 75.01- WX. 202 -UG 7.4 6.2 5.4 20.0 `47:7.. 62.0. 75 0 WX -203 - 9.9 8.6 32.0 76.1 99.0 WX- 203•LTD - 919 8.6 32.0 76.1 99.0 119.4 WX -250 16.3 13.6 11.9 44.0 105.2 136.0. 185 2 WX.250•UG 16.3 13.6 11.9 44.0 105:2 136.0 1851 . WX -251 22.9 19.2 16.7 62.0 147.8 192.0 231:9 WX -251 UG 22.9 19.2 - 26; 7_ . 16.7 7 -23`2 r 62.0 . .86.0.__ z=;=205:3,__.._- � _ _ 147.8 " - 192.0 - .._ _ ?� ;`267.0, 231 9 <;322 2 WX -350 44.0 36.9 32.1 119.0 284.0 361.0 WX•401 6.5 5.4 4.7 17.5 42.0 54.0 65.2 WX -402 9.3 7.8 6.8 25.0 60.0 78.0 94.4 WX -403 11.3 10.5 9.2 34.0 73.0 105.0 127.7 W X -404 24.4 20.5 17.8 66.0 157.5 205.0 247.2 WX -405 32.6 27.3 23.6 88.0 210.0 273.0 330.5 WX -421 61.0 51.0 45.0 165.0 393.8 510.0 625.0 819.4 WX•422 81.0 68.0 59.0 220.0 522.9 680.0 WX -423 102.0 85.0 74.0 275.0 658.0 850.0 1027.7 WX•424 120.0 101.0 88.0 325.0 774.7 1010.0 1222.2 W X•425 141.0 118.0 103.0. 380.0 910.3 1180.0 1430.5 WX -426 163.0 136.0 119,0 440.0 1052.3 1360.0 1652.7 WX -427 204.0 171.0 140.0 550.0 1320.0 1710.0 2069.4 WX•451 5816 49.0 42.7 15010 377.7 490.0 593.0 WX -452 78,1 6514 57,0 ^11 :0 504.2 654.0 791.6 WX•403 97.7 81.8 7113 20-1,0 63017 818.0 990.2 WX-454 117,3 98.3 85.0 317.0 775.3 983.0 118818 WX•465 130,9 114,7 100,0 170.0 883.8 1147.0 1388.8 WX•456 190.1 130.8 114,01 122.0 100717 130810 1583.3 WX.457 105.4 163.7 142.6 528.0 1261.15 1837.0 1980.5 MARK OF THE ORIGINATOR i Model 6GS GOU LDS PUM PS. Ih METERS FEET 300 1000 � ...�....._ � � � .� � 1 , -, � 1 T.."., .- .__._...w...._ .. r -1 -- � � � � -� ,� � �- f - f� 60 Hz 3500 r ( �L r 275 900 - _. RECOMMENDED RANGE .(_ -� -�, - �_ 1.2-7.5 GPM - -. _-1 i I..- .i..� - ~�- -- -' 250 -1 T 800 l - _ _ _ _ R. 225 _ _ i I - GPM I . — i - — -- - f.:. loo °a 200 _. _ w 5 S _01- - - - - ._ _ _L_ - -. _ -1-� = 600 -- `..... .,. t U 175 - - - - - - F - - - - S 7• - - 150 500 _ _•_ _. " . _ .l _ _. _ _ - �.:._. _._ Q 125 � �- — -- -�.. - - -- - - -� - -- I- 400 ..- „i.,,..� jn 100 - �- 300 _ 200 �-1 _.L..; -,_.. 1 1 i :r� , • :�,t� _ r---' 100 ..._ _._.— ... _�..... ._ �i i�– _.— _ � ♦,,fit„ L . __- 0 1 2 3 4 5 6 7 8 9 GPM 2:0 =m3 /hr. ..:_.. ..:_... CAPACITY , ENSIONSAND WEIGHTS, ,ipp 4 Yb i RCt4 ^t{f trt,It I•;Y 1r a :dv Length (Inches) n `. Weight (ibs) i, DISCHARGE.IY+ NPT f Model ,,' t ,t HP t?hase; f Stages =' r ; t •. { ; °' r•V + t # a W. E ® +� Motor L.O.A.® W E PAotor Total f )5412R 22;11 210 , t /2RO : 'j 1 ii,'.:: 11 t:' +12.6 x',`r 22.1 �..tlg t t , :: is 5+ qw, 9 5 18 -26 r f 15412;22;]1 21 15.1 f 95 ry -! t :'24.6 ' I` tiR 9 +` 18 27 Ei t !4.' fi: a d !r r d x d . 20 31 18.2 28.9 1 i x 10412,22ftl3} .:''11 8 b,331 13 ' ;t; 23 ^ 36 %} WE 4r`t� .. r•f r �” 15412 j!+ „ it s n >,1 /tty , , 1 i �,rt 34: *� ;:• 28:1 '. <� .''41.7'.x 17 `45 13.6 2g —► E -3:84 " .Effective 1/ 151 43.2' 1 48 Fdmeter t -, 34,` ' ? 28 :1; 4 11 8 • I r t;:39.9 , ' 17' 23 :j. : '40 ' , ?� with cable " 's•q`w"aift:el r 'e: nAfd t. or`p, um:. �p ' , wit�"ht:o. u...rt � mEof tYor R„; -', j j 4+:r�. X{Alw_ , j? �:,:! tr . $ t 'r' 1••;, , a I f+ s ? gUaf3 x atep d sage WHP pumpwater.,end for_low head applications This model replaces the/a e A� length'tof assembly =complete pump'd water, end and motor � ^3 75 ,9ua MDTUR� r A, rlds�x'j.1 ll t r 1� �' �" Il li i 1 b di ! yfr tx , �5 t i• , 1 - , , .��. }V$�� if 1 N. [ GOULDS PUMPS, INC. Model 5GS SELECTION CHART Hormliiwer Ranae' /z -1'h. Recommended Ranae'i.2 = Z.5 0W6O Hz. 3,560 RPM Pump HP PSI Depth to Water In Feet /Ratings in GPM (Gallons per Minute) Model 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300 340 380 420 460 500 540 580 620 660 1700 1740 1780182018601 0 7.5 7.2 6.8 6.3 5.8 5.2 4.7 3.8 2.9 20 7.4 7.1 6.7 6.2 5.7 5.1 4.4 3.7 2.6 5GS05R +% 30 73 6.9 6.6 6.0 5.6 5.0 4.3 3.4 2.3 40 7.36.96.5 6.0 5.54.94.2 3.42.2 50 6.9 6.5 5.9 5.4 4.9 4.1 3.2 2.0 60 6.2 5.6 5.2 14.61 3.8 2.7 1.2 Shut-of i PSI 1120 112 1031 94 86 77 68 60 51 42 34 25 16 0 7.4 7.2 6.9 6.6 6.3.5.9 5.4 5.0 4.5 3.4 20 7.4 7.2 6.9 6.5 6.1 5.7 5.3 4.9 4.4 3.8 3.2 1.3 yZ 30 7.7 7.4 7.1 6.8 6.4 6.0 5.6 5.2 4.8 4.3 3.7 3.1 2.2 5GS05 40 7.4 7.1 6.76.46.0 .5.6 5.2 4.74.2 3.6 3.0 2.2 50 7.6 7.3 7.0 6.7 6.316.0 5.5 5.1 4.6 4.1 3.5 2.9 2.0 60 7.0 6.7 6.5 6.2 5.815.4 5.0 4.6 4.0 3.4 2.6 1.2 Shut-off PSI 166 156 147 139 130 121 113 104 95 87 78 69 61 52 43. 26 = -, %0 7.5 7.3 7.1 6.9 6.7 6.4 6.1 5.6 5.0 4.2 3.3 2.0 .< X20 7.5 7.3 7.1 6.8 6.6 6.4 6.1 5.8 5.5 4.8 4.1 3.1 1.8 5GS07,,�/ 30 7.67.47.2 7.0 6.8 6.5 6.3 6.0 5.75.45.1 4.4 3.5 2.2 40 7.6 7.4 7.2 7.0 6.8 6.5 6.3 6.0 5.7 5.4 5.1 4.7 3.9 2.9 1.6 t50 7.6 7.4 7.2 6.9 6.7 6.5 6.2 6.0 5.7 5.3 5.0 4.7 4.3 13.41 2,2 60 7.517.3 7.1 6.9 6.8 6.5 6.3 6.1 5.8 5.5 5.2 4.9 4.5 4.1 3.7 2.61 1.2 'Shut= off'PSI 12251216 208 199 190.182 173 166 156 147 139 130 121 113 104 87 1 69 52 35 17 0 7.6 7.5 7.3 7.1 6.9 6.6 6.1 5.7 5.2 4.6 3.9 3.1 2.1 20 7.4 7.3 7.1 6.9 6.7 6.5 6.0 5.6 .5.1 4.5 3.8 3.0 2.0 5GS10 1. 30 7.4 7.2 7.1 6.9 6.6 6.4 6.2 5.8 5.3 4.7 4.1 3.3 2.4 40 7.4 7.2 7.0 6.8 6.6 6.4 6.2 6.0 5.5 5.0 4.4 3.7 2.9 1.8 50 7.5 7.4 7.2 7.0 6.8 6.6 6.4 6.2 6.0 5.7 5.2 4.6 4.0 3.2 2.2 60 7.5 7.4 7.2 7.0 6.9 6.7 6.5 6.4 6.2 6.0 5.7 5.5 5.0 4.4 3.6 2.7 1.2 Shut-of PSI 253 245 234 227,219,210,201 193.184,175 167 158 141 123 106 89 71 1 54 37 19 0 1 7.5 7.21 7.0 6.8 6.5 6.3 16.0 5.6' 5.3 4.9 14.5 4.0 3.3 2.4 1.6 20 7.5 7.5 7.3 7.2 7.01 6.7 6.4 6.2 6.0 15.6 5.3 4.8 4.4 13.9 3.2 2.4 1.2 5GS15 1'% 30 7.5 7.4 7.3 7.2 7.1 6.8 6.6 6.3 6.0 5.7 5.4 5.0 4.6 4.0 3.5 2.8 1.8 40 7.5 7.4 7.3 7.2 7.1 6.9 6.7 6.4 6.1 5.8 5.5 5.2 4.74.33.73.2 2.2 50 7.5 7.4 7.3 7.2 7:1 6.9 6.8 6.5 6.3 6.0 5.6 5.3 4.9 4.6 4.0 3.4 2.5 1.5 60_ _ . ...... _ ..... .. -7.5 1 7.4 "7.2 Ti "7:0 16.9 1 6.b 6.4 6.1 15.7 1 5.4 5.1 4.1 4.2 "3.ti 2.9 2.0 Shut-off PSI 316 307 299 290 281 273 276 247 229 212 195 177 11601143 126 108191 1 74 1 56 1 39 22 113 i WELL- X- TROL"' SIZING CHART PRE- PRESSURIZED TANKS FOR WELL APPLICATIONS V A OPERATING PRESSURE - PSIG DISCHARGE RATE GPM 20140 30/50 40160 `CSC; 1 L`SP ii �x•! ESP 1 ESP 11 ESP I E SF EI 2.5 WX -104 WX -201 WX -104 WX -202 WX -104 WX -202 6 WX -201 WX -205 WX•202 WX -205 WX -202 WX -250 7 WX -202 WX -250 WX -203 WX -251 WX -203 WX -251 10 WX -205 WX -251 WX -205 WX -302 WX -250 WX -302 12 WX -205 WX -302 WX -250 WX -302 WX -251 WX -350 15 WX•250 WX -302 WX -251 WX -350 WX -251 WX -350 20 WX -251 WX -350 WX -302 (2)WX -251 WX -302 (2)WX -302 26 WX -302 (2)WX -302 WX -302 (2)WX -302 WX -350 (3)WX -251 30 WX -302 (2)WX -302 WX 350 (1)WX -302 (1) WX -350 WX -350 (2)WX -350 35 WX -350 () WX -350 (2)WX -350 (2)WX -251 (3)WX -302 1NX•103 11 1WX -350 8.0 0.37 3J 2.1 40 WX•350 (2)WX -350 (2)WX - ?_51 (3)WX -30?_ (2)WX -302 302 (1)WX 2 WX -•350 , �1 {: WELL- X -TROL IM I SPECIFICATIONS WARWICK, R.1, 02993 01MENSiQNS TOTAL MAX, DRAWDOWN VOLUME (GALS) SYSTEM SHIP WE TANK PIILCI.IAIIGC MODEL VOLUME kGALS;) ACCEPT, Ft,C +OR 2q'A0 - _ - {0f50 - 40 /fi0 CONNECTION (LDS.) (PSIG) - p,AMFTER( HEIGHT, 'i• .h, INB. INS,) 2.0 0.45 17 .6 ,5 '/; NPTM 5. _ 20 WX•1G1 8 121/1 is 4.4 0.55 1.G 1.4 112 '/; NPTM 9 20 0402 11 15 9 4!: • ' ` 1NX•103 11 244. 8.0 0.37 3J 2.1 2.2 'h NPTM _ 15 3 rt '� WWII > > 10.3 1.00 3.8 3.2 - ~3.2�^ 2.0 1'NP1F 20 30 19'/• ... 10.3 1.00 3.8 - 2.0 1' NPTF 25 YYX•104S 15'b }11i yrx•2p0 15111 22 14.0 0.81 5.2 4.3 3.8 1' NPTF 25 30 T^ WX•201 15111 231/8 14.0 0.01 5.1 4.3 3.7 1' NPTF 27 WX-n2 151/1 3141 20.0 0.57 7,3 G.2 5.4 1' NPTF 35 Q30 01203 32.0 0,35 - 9.9 8.6 1' NPTF 43 151/1 463A 34.0 1,00 12.4 10.5 91 11/6' NPTF 61 38 wx.p6 22 291h 44.0 0.77 16.3 13.6 11.9 ; 1'/ NPTF _69 38 YVK•260 22 35'/8 • '! W�F261 22 46'!. 62 0 0 55 22 9 19.2 16.7 1'/. NPTF 92 38 1N1GlOQ t' - 120'; i-7: n66 0 0 54 31 8 a �4 26 7 ,F. ; NPTF 23 2, f c - 123 ° 98 z -119/1 a�0.39 - 44 •�3 9 32.1 i NPTF I66 38 25 811/1 AND SYSTEM coNUinclrr.;. IrIcI unlllG IED4PLItAll1111. ANII PIITS:;IIHI OMWO WN CAN 6E AFFECTED RY VARIOUS AMnIFNT , Rev. 3/86 CERIPT! PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Must Provide s, 7 P.C.H.D. Permit N —= OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Luca at_,!�',— < �n .Sf_ ­hLTZ i_ l Formerly Owner plicaaf Plane -., Ivleiling dress 293 �S"Tr?t€T" zip b e 4 illege Tax Man ZO' Block 4= Lot Subdivision Blame Subdv. Lot # Date Permit Issued Separate Sewerage System built by e ,4• 0 ?La6V,2 l mSrVVcr /nv CO. W4- Address - ?0. &x d4/ 64RAIZA, L4L >o.5"iZ,- Consisting of %Don Gallon Septic Tank and �� %� � P,,s! - 44'� Water Supply: Public Supply From Address A ._ T- +..�rAddresa or: %r Private Supply Drilled byLU��t�i G=am_ t fl Building Type --��1, , i�.� Has Erosion Control Been Completed? Plumber of Bedrooms Has Garbage Grinder )Been Installed? Other Requirements I certify that the system(s) as listed serving the above premises were construqted essentiaily as shown on a plans of the completed work ( copies of which are attached), and in accordance with the standards, rules and reg Lions, in accordance with t filed an and the permit issued by the Putnam County Department Of Health. Date ` a �' Certified by P.E. R.A. I v 9 Address A1"114 Q " License No. Any person occupying premises served by the above system($) shall promptly take such action as may be nocossory to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a pub!(: sanitary Dewar becomes available and the approval of the private water supply shall become null and v - arherr -a•-p wyatw supply becomes available. Such approvals are sub)oct to modification or change when, in the Judgment of the Comm onor of M�114rir mbagWfca4lon or change Is noeosssry. W '4 WELL COMPLETION REPORT DEPARTMENT OF HEALTH Division -", Env rannar.tal PUTNAM COUNTY DEPARTMENT OF HEALTH STREET AOURES-S: r -e I4 2 WNW I / ELL LOCATION 4 Nd'zJ NAME: WELL OWNER AE OF WELL (.V primary 2 - secondary I,MOUNT OF US REASON FOR DRILLING DEPTH DATA DRILLING EQUIPMENT Office Use Only / —.'?/ r TAX GRID NUMBER: PRIVATE -.1 -e h I on •Z1 d fr" iD7 1 u PUBLIC RESID NTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED ❑ BUSINESS ❑ FARM O TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ YIELD SOUGHT gpm. /N0. PEOPLE SERVED 1:Y—/ EST. OF DAILY USAGE j� gal. [REPLACE EXISTING SUPPLY ®TEST /OBSERVATION ADDITIONAL SUPPLY ZNEW SUPPLY (NEW DWELLING) ❑ DEEPP�E(N�� EXISTING WELL WELL DEPTH �yf� ft. STATIC WA7'1=t3 LEVEL ft. DATE MEASURED ❑ ROTARY COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT CABLE PERCUSSION ❑ OTHER (specify): I WELL TYPE 1 ❑ SCREENED O OPEN END CASING OPEN HOLE IN BEDROCK O OTHER I CASING DETAILS TOTAL LENGTH LENGTH BELOW GRADE DIAMETER WEIGHT PER FOOT SCREEN DETAILS - DIAMETER (in) FIRST SECOND GRAVEL PACK NO GRAVEL I SIZE: WELL YIELD TEST T00: ❑PUMPED o COMPRESSED AIR ILED ❑ OTHER WELL DEPTH DURATION • It. hr. min. If detailed pumping I tests were done is in- 'ormation attached? 10 YES ONO DRAWOOWN YIELD It. I gpm. WATER 14 CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? ❑ YES 41NO ANALYSIS ATTACHED? ❑ YES NO PUMP 1 OR ATION TYPE CAPACITY MAKER d DEPTH MODEL 66670 VOLTAGIRJL HP 3 'SLOT SIZE .> ft. MATERIALS: STEEL ❑ PLASTIC ❑ OTHER _ ft. JOINTS: PrWELDEO ❑ THREADED ❑ OTHER 7a in. SEAL: EMENT GROUT ❑ BENTONITE ❑ OTHER lb./ft. DRIVE SHOE YES ❑ NO I LINER:OYES ONO LENGTH (It) DEPTH TO SCREEN (It) DEVELOPED? 0 YES 0 NO HOURS DIAMETER TOP I BOTTOM OF PACK in. DEPTH ft. I DEPTH _ WELL LOG If more detailed formation descriptions or Sieve analyses are available, please attach. DEPTH FROM Watcr Well SURFACE Bear- Dia- FORMATION DESCRIPTION tt. ft. I ^4 peter A STORAGE TANK: TYPE/ �,(/� ��) J. CAPACITY J Z. GAIr. WELL DRILLER NAME ADDREss ANDREWS WELILDRILLINA"' Clapp Hill Road LaGrangevl e, N.Y. 12540 914 - 223 -3375 0 ft. p0E Z� ARM, M@ Y CERTIFICATE OF LABORATORY ANALYSIS LAB ID NUMBER: 96 -0002 CLIENT: Laurent Engineering Associates Millbrook Office Center Route 22 Brewster NY 10509 SAMPLING LOCATION: COLLECTED BY: DATE COLLECTED: DATE RECEIVED: DATE OF REPORT: 293 Fair St, Carmel NY J. Tanzi 01/02/96 01/02/96 01/03/96 TIME COLLECTED: 10:30 AM ANALYTE RESULT* UNITS MAX CNTMT LEVEL ** METHOD ANALYZED Total Coliform Absent Must be "Absent" SM18(9223) 01/02/96 E. Coli Absent Must be "Absent" SM18(9223) 01/02/96 This sample, as submitted to the laboratory, and as compared to the New York State limits for drinking water quality for the tests performed, was: ✓ ACCEPTABLE. NOT ACCEPTABLE. `!t NYS ELAP #11218 Laboratory Director CT Lab Approval #PH -0171 *Underlined results are unacceptable according to health department and /or US EPA codes. ** Maximum Contaminant Level (maximum permissible concentration allowed by health department and /or US EPA codes). 618 Clock Tower Commons, Brewster, NY 10509 / 914- 278 -7600 / Fax 914- 278 -7754 I Q n Z j � � 3 -7—/o oo r M-e- j rir�uii�_4vs PUMP si.�tvi1;1. Clapp Hill Road LaGrangeville, N.Y. 12540 I I 1 �,► , � .. �� 0(15 '`' �, �0 M . ........._.._...__..__�:____�_ 0 1/, ao D'. o• S P" 4130 1 P P .9 7, o , 3 P M ; 50 0L 416' 3,6 GPt /0600 o `GP o I _ 316-6p G P /� : 00 ) . Oc) U �;p CP P 0 o 31.-OP- 13 , S GFM G � �: o 0 26 I 131 s GPH 00 Loy. �- �,y ' oo 315GeM z !0U ��- i a o 4 Zo4.1 .s PA Z: GO Z11 0:411 367 PM �a o ZC� 1 4, 0 0 JAI i ZUy.i P !.x'00 U a 1 . 3 -7: oO ev j......i.. . '. j I �(� Z.► ,3 —77 U ANDREWS PUMP SI..IIVllf'l . Clapp Hill Road LaGrangeville, N.Y. 12540 75 rim tea, o 3 �s 6P . _ �t � q;ro CPO -7o ' 113 Ui oLJ CL i j .. ' �. _. "Pv.,r f Q c., • s s e 0 icsic TH DEPT. 014 8 4` PUTNAM COUNTY :HEAL. 1 '` 4•(ienevg Road (814) 278 -613 c �a�U,� / _ 1 � �. Breuvster, NY T0509 Received ofE - _ The Sum Ofu For ; _ 0 CT -J�T oil s i o n ... ....... . and Cc art J- a 1, hi- t --he a It, o v e d� E it "a 17L 0., L an' reqcaz C- l l-,..t0t ." E r , - n 1,: ,Iace .3 the operating any T,?a.r'Z' of saj'a T-,�-:, which f:a-4.!-G -Q, t. tl-le aat�: o-,!7 e for a Me -�:.ail.urc to orp--at '.CC = r'e- C<:O of the the syst,--.. =�j, t Z. -h-a -andersic.nedt fu7 usive t�ll�� ,-hc of the ce <D d- n of t"_1 �., Department C": Tlo � the fa to c , c by the t -,e r r-, l_r c-n,- er o r,,u n g ..,s - - S 2 et ion W,cck Lot -J�T oil s i o n ... ....... . and Cc art J- a 1, hi- t --he a It, o v e d� E it "a 17L 0., L an' reqcaz C- l l-,..t0t ." E r , - n 1,: ,Iace .3 the operating any T,?a.r'Z' of saj'a T-,�-:, which f:a-4.!-G -Q, t. tl-le aat�: o-,!7 e for a Me -�:.ail.urc to orp--at '.CC = r'e- C<:O of the the syst,--.. =�j, t Z. -h-a -andersic.nedt fu7 usive t�ll�� ,-hc of the ce <D d- n of t"_1 �., Department C": Tlo � the fa to c , c by the t cz n le x —L . ...... L t ) r1k: l -2 6x I-a ti C6, 62co A c*,D . p • ) r1k: l -2 6x I-a ti C6, 62co A AS- BU /L 7' DINEN5 1ON CH.,4RT (1NAT.) N' A B / 20.01 57.0 2 2B.0 61.0 3 34.0 64.0 4 395 67.0 5 47.0 /05.0 6 52.0 106.5 7 57.0 1105 B 680 44.0 9 73.0 51.0 /0 78.0 56.5 0 X X x x � x X K - X- EX /S7. WELL G LINE �o M N /6 °//000'7 4 9B'• • • .165 000 F e THIe Is 70 CERTIFY THAT THE SEWAGE 0151`20sAL SYSTEM WA5 CONSTRUCTED As INDIGATED ON THI'� ?LAN AND THAT THE SYSTEM WAS INSPECTED 8'( ME PEFORE IT WAS COVEI:ED OVER THE SYSTEM WAS CONSTRUCTED IN AaORDANGE KITH ALL STANDA2D RULES AND REGULATIONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH THE NEW YORK.. 5.TATE DEPAfZTMENT OF HEALTN . r PUTNAM COUNTY'DEPARTMENT OF HEALTH V « DIVISION OF ENVIRONMENTAL_ HEALTH SERVICESu` CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # 4 o of Located at /3f A ST Town or Village 1047 - O* (%) 4.70 --r Owner /Applicant Name 6/6 TaMap Block Lot D. Formerly Mailing Address Subdivision Name Subd. Lot # %9,7*W5VA✓ A) Date Construction Permit Issued by PCHD f —19 ) LL- Separate Sewerage System built by Address Zip 12-S-6-3 Consisting of EX 7.5'0 Gallon Septic Tank and S � vri/� (�� �� ®�J% 7�4&-IVC . Other Requirements: Water Supply: Public Supply From Address Private Supply Drilled by &,<. f U97 -- Address Building Type - 001) FmMC Has erosion control been completed? �- Number of Bedrooms Has garbage grinder been installed? NO I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: l/ Certified by /lr� P. E. R.A. Address r2� CV3 (Desigp Professional) S3 1,) r�M rr R-� �o Q A.�-ne)s4 . NUJ l Z T 6 � 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 are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. WAJK� MA Ad copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM'COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT MENT SYSTEM ,7-,f lv4 / Owner or Purchaser of Building -Building Constructed by *,E-- r-MR-5T Location - Street W VOID FP_4M4. - Buildinelyop-, Tax M4p Block Lot -Tow . n /Village Subdix 1 ision A A i M"i" Subdivision Lot I represent that I am-wholly an&c, etely,x, spohsible.�,ibr the ()ca ion. workmanship; In material.` pinpl construction and drainaize of the sewage treatment system serving 44e above-.described property any that is has beeri construqted,x,qi.sh' <'onthe.a roved. plan or approved own, ahidridment thereto, and.4111 accordance with4he" js't .�",,-,;�t.,ule-s�and;�pplation&of�theNtnam . '. 11 ­ A ' ' "� P ., ent,'of;Healffi, and a artm, ounty, part of said . immediately , (alloy , 7­1 sewage treatin6hi" �A_ �pr .'Ope te ppetly.is' -to accept. ,as The. uh.dersighed"furthernrees. conclusive the determination mination of the: Public, Health �7' - Director "4the Putnam Countv Department offldalth� as'to wh6ihiu or not -the failiare'd th6'system to operate was caused by. the wi I or 'p C 'glikent'da of-the occ4parit of:thc building utilizing -the .1 .. 1 / Dated: Mdrith Day Year 1--7 ((/W Ajzf L_ General Contractor (Owrk4 - Signature .nmoration Name (if corporation) Address: State zit) Signature: Title- 0 Corporation j4arne (if c I or, orAtfbfi)° ­ 11­'' �p I Address'. j 5 State Llr_ 7-orm GS47 F Rock a+r I,nxtnw.*nnsa! YML ENVIRONMENTAL SERVICES 321. Kear Street . Yorktown Heights', N'. Y:' 10598 (914) 245 -2800 Albert H. Padovani, Director LAB #• 9.100113 CLI�'T #: 62347 -- « - - -_- NON - STAT- PROC ---- PAGE :wlwof «lww «-. «w w,rww www «ww.r ww «ww— «« « « «wwwwww wwww -. -w •15 TAN7,I, PATRICIA 405 FAIR STREET CARMEL , NY 10 512 DATE/TIME TAKEN: 02/08111 10. DATE /TIME RECD: 02/08/11 10:49 REPORT DATE: 02/09/11 PHONE: (845)- 225 -3404 SAMPLE TYPE..: POTABLE SAMPLING SITE: 405 FAIR ST, CARNAL, Nib PRESERVATIVES: NONE- KITCiiEN TAP TEMPERATURE•• - <: =4C > 40'I33Yr:::;PA'I'iTCI: TANZT�- ---.�. - -w s, _.� NT .w «... ~--- --. «,. �. ...wwwwwlwww -- .-- «.,--- . - - ---- ---- « » «...--- � —�--- - « - « -y DATE «FLAG «PROCEDURE RESULT NORMAL - RANGE METHOD 0-2/09/11 : MF T. COLIFORM ABSENT /100 ML ABSENT SM 18 -20 *922213 COMMENTS. MFTC Sew Coliform = This result indicates that the water according to (was not) of a satisfactory sanitary quality York State and EPA federal. drinking water standard for this parameter. This comment applies to the.Total Coliform test only. THE ABOVE TEST PROCEDURES MEET ALL REQUIREIylENTH OF NELAC, AND RELATE Y TO SE SAMPLES RECEIVED BY THE LAB SUBMITTED BY: Albert H. ad vane.., M. . (ASCP) EL p# 10323 Director 2012 -07 -02 03:53 » 8452787921 P 111 :. PIT �EP.a,1�CTIIEIVT (3F Il�alr i 1fI DIVISION OF ENVIRONMENTAL HEALTH 5ERVTCES ATTENTION JOSEPH 0 GENE REQUEST FOR 1':TNAL INSPECTION For: rill All information must be fully completed prior to anv "Trenches � inspections being made_ PCHD Construction Perrnit # 4 0z1 P - % l _ Located: _,. S". l P 5 77 (T) (V) PX PR!:�oAl Owner /Applicant Name: _TAN -R (' TM Y Block 2-- Lot -Z-- Formerly: _ ,Subdivision Name:._... Subdivision Lot # Is system fill completed? ALA Date: Is system complete'? . 5Zr_ _ S� Date: 7 Is system constructed as per plans? Is well drilled? Date: --� Is well located as per plans? Are erosion control measures in place? I certify that the system(s), as listed, at the above premises has. beef constru inspected and verified their completion in accnrdance with the issued PCHI t and approved plans and the Standards, Rules and Regulations of the Pie nt of Health. /- Date: _ 7 �?-�/ �''+ Certified by: / Design Frotessi N 41 - Address: j. 91�.l.'� $t�D� -� /' .S /1� i.ic. #2 Comments: TheeS 7 Fomi FIR -999 Sheet 1 of 1 R' Putnam County Department of Health ...... r �.... _ ... _ -�. • . . _ ._. - - -D1 �) .�... - - _ - .r......,. -. : s ^rE -cf Environmenta'..Health Seiwices- .. .�.. .. _ .__ .....�.. __.�. Field Activity Report Name: _Tani Telephone: _845- 225 -3404 Address: _405 Fair St. Patterson NY Street . Town State Zip Person in Charge or Interviewed: Date: Name and Title Findings: I went to site for a final inspection. There was an arch way opening instead of a clear opening of 4ft 5 inches. This is due to electrical wires in the area. The septic expansion was different then designed. The box was off to the side and 80ft of pipe and stone field. The trees are plus and minus 10 ft. from fields / 5/10 k— c✓cl2 �1 J ALL Ins S G�i� S �iLi�.(� LIIC+S CK Cc..�/ASCV �O L� SON �W �'{5r L✓4ji J's Inspector: Telephone. Sign e and Title - - -- - .. , ...._Report- P.ece�ved-b;y ....-- � - - - -� . _...__ _. _. ___ ,__ _.._.... _ ._._._ ... ... _. e- _. - _ _.. _- -- --• - - -� --- -._... - -- ..._ _..___._ . _, _.. I acknowledge receipt of this report: Signature: Title: Field Activity Report: cw Date: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: 7 -3 —/Z Street Location yD Inspected by: To Permit # oy�/g It TM # y _ 2 Z- Subdivision Lot 1. Sewage 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 ..................................... I............ d. Stone, brush, etc., greater than 15' from STS area.......... e. 1 00' from water course / wetlands ...... ............................... II. Sewage Svstem 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 ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set .......... ............................... 6, rent es 1. Length required Length installed 6 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 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............,: ...::..... ......- ...:...:................ �ys��mS -. _..__._....�..-- _...._. _.__...__.._ 1. Size of pump chamber ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual/ audio ........ :.......................................... 4. Pump easily accessible, manhole to grade ................. 5. First box ba$ led .......................... ............................... 6' Cycle witnessed by H.D.estimated flow /cycle........... III. House/Building a, house located per approved plans ... ............................... b. Number of bedrooms ....................... ............................... W. 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 ........................ I ....... .................. b. All pipes partially backfilled .......................................... c. All pipes flush with inside of box ................. :................ d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ........ :........................... i. Erosion control provided ................. ............................... Rev. 12/02 PUTNAM COUNTY DEPARTMENT OF HEALTHY:' P DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT-SYSTE PERMIT # Located at �— ,Sri%/ Town or Village Subdivision name Subd. Lot #. '" Tax Map Block -2 Lot 2— Date Subdivision Approved Renewal Revision jj / Owner /Applicant Name 540Sz� l� p�T�/G1 C� Tr/iV�f Date of Previous Approval s>// z-14 q Mailing Address `1�7 14 c5 4� g A,� Zip /,I Amount of Fee Enclosed 5"00 G Building Type ot Area No. of Bedrooms Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of (• % TO gallon septic tank and Other Requirements: To be constructed by L O�DE� /T 41L-17V Address Water Supply: Public Supply From Address -Private -Supply Drilled by �-�,�j �' � � � ca _ . - 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 Director /Commissioner will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address P.E. R.A. Date 1 /1ra/l` Li /✓ P License # APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Director /Commissioner. Any revision or alteration of the approved plan requires a new permit. Approved fo discharge of domestic sanitary sewage only. By- ,,Or-r',Title: Date: ite opy - HD File; Yellow copy - Buil 'ng Inspector; Pink copy - Owner; Orange copy - Design Pro ssional Form CP -97 REBECCA wIT'T WBERG, RN, BSN Public Health Director Director of Envuomnental Health DEPARTMENT. OF HEALTH 1 Geneva Road, Brewster, New York 10509 April, 19 2012 Phone # (845) 808 -1390 Patricia Tanzi Fax # (845) 278 -7921 405 Fair Street Carmel, NY 10512 Dear Ms. Tanzi: MARYELLEN ODELL County Executive Re: Accessory Apartment Renewal — Tanzi Increase in Number of bedrooms with new SSTS 405 Fair Street (T) Patterson, T.M. 34 -2 -2 I have received and reviewed the plans-for the proposed addition to the above mentioned residence. The proposal for the apartment has been approved as per plans bearing the approval stamp from this Department dated April 19, 2012. The addition is approved with the following conditions. 1. The total number of bedrooms must remain at three in the main house and one in the accessory apartment without prior approval by this Department. 2. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc ... 3. Approved SSTS must be constructed according to the approved plans certified by John Karell Jr. P.E. An deviation from the lan re uires a revision be submitted t_ Y -_ 'P.. .:..... . � submitted �_. o this Department. _...... _ _ 4. SSTS must be inspected by this Department before any backfilling. 5. A satisfactory bacteria test for the existing well is to be submitted prior to the issuance of compliance. 6. The house must be inspected for bedroom count before compliance is issued. 7. Once SSTS has been inspected and backfilled, a construction compliance package must be submitted for review and approval before operation of the new SSTS. 8. The approval is for the proposed changes only. This approval does not validate any construction shown as existing that has not obtained proper approvals. 9. This approval is valid for two (2) years and expires on April 19, 2014. Any permits or variances required under the jurisdiction of the Town of Patterson are the responsibility of the applicant. If you have any questions, please contact me at (845) 808 -1390 ext. 43157. Respectfully, oseph S. Paravati Jr., P.E. Assistant Public Health Engineer JSP:cw cc: BI (T) Patterson John Karell, Jr., P.E. go CIO 4 9 - 4_4u IJ I _"� r.,xb N(P . wl. j( idc In tt O-W O'd tri ti o O xq r� Jt Environmental Protection Carter A Strickland, Jr. Commissioner Paul V. Rush, P.E. Deputy Commissioner Bureau of Water Supply prushadep.nyc.gov 465 Columbus Avenue Valhalla, New York 10595 T: (845) 340 -7800 F: (845) 334 -7175 April 16, 2012 Mr. Joe Paravati, P.E. Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 Re: Tanzi Residence —SSTS 405 -409 Fair Street, (T) Patterson TM # 34 -2 -2 Middle Branch Reservoir Drainage Basin DEP Log # 2012 -MB- 0023 -DJS.I Dear Mr. Paravati: New York City Environmental Protection (DEP) has determined that the above - referenced application, received by the DEP on January 11, 2012, is complete. The DEP has no objection to the approval of the above- referenced regulated activity. This determination is based on the review of submitted documents including the plan titled "Subsurface Sewage Treatment Plan, Tanzi Residence, 405 -409 Fair Street, (T) Patterson, Putnam County, New York', prepared by John Karell, P.E., dated November 15, 2011, last revised February 7, 2012. If you have any questions regarding this matter, please contact the undersigned at (914) 742 -2055. c: Pamela Young, NYSDOH Sincerely, Danny Shedlo, P.E. . Civil Engineer M Wastewater Design Review REBECCA WrM44BERG, RN, BSN Public Health Director Director ofEmriromnental Health February 27, 2012 John Karell, Jr., P.E. 121 Cushman Road Patterson, NY 12563 Dear Mr. Karell: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 80 8-1390 Fax # (845) 278 -7921 MARYELLErT ODE_ LL CorattyE Re: Proposed SSTS (Addition) — Tanzi 405 Fair Street (T)Patterson, TM #34. -2 -2 This office in conjunction with the NYCDEP has received and reviewed the most recent set.of plans for the above - mentioned project. We would like to offer the following comments for your review and consideration. 1. The den/office is a potential bedroom. 2; :more that Mfiltrators or galleys cannot be used to show existing capacity for purpose. of deeming a SSTS as a complaint system. The engineer must provide adequate conventional lateral length and reserve area to provide treatment capacity for the additional bedroom. This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at ext. 43157 if any questions arise. spectfully, Joseph S. Paravati, Jr., P.E. Assistant Public Health Engineer JSP:hn cc: BI (T) Patterson d Environmental Protection Carter H. Strickland, Jr. Commissioner Paul V. Rush, P.E. Deputy Commissioner Bureau of Water Supply prush@dep.nyc.gov 465 Columbus Avenue Valhalla, New York 10595 T:(845)340 -7800 F: (845) 334 -7175 February 22, 2012 Mr. Joe Paravati, P.E. ' Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 Re: Tanzi Residence —SSTS 405 -409 Fair Street, (T) Patterson j TM # 34 -2 -2 Middle Branch Reservoir Drainage Basin DEP Log # 2012 -MB- 0023 -DJS.1 Dear Mr. Paravati: New York City Environmental Protection (DEP) has determined that the above - referenced application received by the DEP on February 16, 2012, is incomplete. The following information is required before the DEP may commence its review: e Note that infiltrators or galleys cannot be used to show existing capacity (I for purposes of deeming an SSTS as a compliant system. The engineer must provide adequate conventional lateral length and reserve area to provide treatment capacity for the additional bedroom. I i If you have any questions regarding this matter, please contact the undersigned at (914) 742 -2010. Sincerely, David Alderisio Associate Project Manager Wastewater Design Review c: Pamela Young, NYSDOH Jim Hyde, NYSDOH Ben Pierson, NYSDOH REBECCA WI'I°1'ENBERG, RN, BSN Public Health Director ROBERT MORRIS, PE - Director vt`G� �iroriineniai hlealth ' John Karell Jr., P.E. 121 Cushman Road Patterson, NY 12563 Dear Mr. Karell: . MARYELLEN ODELL Cowlty Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 January 23, 2012 Fax # (845) 278 -7921 Re: Proposed SSTS (Addition) - Tanzi 405 Fair Street (T) Patterson, TM 34 -2 -2 This office in conjunction with the NYCDEP has received and reviewed the most recent set of plans for the above - mentioned project. We would like to offer the following comments for your review and consideration. 1. Please remove note #6 from the construction notes since no well is being drilled. 2. Please provide two (2) sets of revised floor plans for the basement-apartment. 3. A note is to be placed on the plans that all plumbing for the basement apartment is to be directed to the separate SSTS for the apartment. 4. Show the location of the NYSDEC Wetlands (LC -15) which is within 200 feet of the proposed SSTS. 5. The pond is to_be labeled. I Y SDEC validation block is io be provided -anti signed by NYSDEC representative. 7. Provide a typical detail for the existing infiltrators. This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at (845) 808 -1390 ext. 43157 if any questions arise. S' cerely, oseph S. Paravati, Jr., PE Assistant Public Health Engineer JSP: cw cc: David Aldersio, NYCDEP Environmental Protection Mr. Joe Paravati, P.E. Putnam County Health Department 1 Geneva Road Brewster, New York 10509 Re: Tanzi Residence - SSTS 405409 Fair Street (T) Patterson, Putnam County Carter H. Strickland, Jr. TM# 34 -2 -2 Commissioner Middle Branch Reservoir Drainage Basin DEP Log #2012 -MB- 0023 -DJI.1 Paul V. Rush, P.E. Deputy Commissioner Dear Mr. Paravati: prush @dep.nyc.gov New York City Environmental Protection (DEP) has determined that the above - 465 Columbus Avenue referenced application received by the DEP on January 18, 2012, is incomplete. The Valhalla, New York 10595 following information is required before the DEP may commence its review: Tel. (845) 340 -7800 Fax (845) 334 -7175 • Show the location of the NYSDEC Wetlands — LC -15 which is within 200 feet of the proposed SSTS. In addition, label the pond that is shown on the site plan. • Provide a complete NYSDEC wetlands stamp on the site plan. • Provide a typical detail for the existing infiltrators on the site plan. If you have any questions regarding this matter, please contact the undersigned at ! (914) 742 -2010. Sincerely, David Alderisio Associate Project Manager Wastewater Design Review C* Pamela Young, NYSDOH Jim Hyde, NYSDOH Ben Pierson, NYSDOH +r i EPA Orr� �r c. 1, 1 � *Mot* d d REBECCA WMENBERG, RN, BSN Public Health Director Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 January 4, 2012 Fax # (845) 278 -7921 John Karell Jr., P.E. 121 Cushman Road Patterson, NY 12563 Re: Proposed Addition — 405 Fair Street (T) Patterson, TM 34 -2 -2 Middle Branch Reservoir Basin Dear Mr. Karell: MARYELLEN ODELL County Executive The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on December 12, 2011 is complete. The Department will notify you by January 24, 2012 of its determination. ❑ The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ❑x Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department-of its failure b certified mail return 9 retu receipt re uested The notice-should -- -_ -. `. _._..: _.Y__ _. _- ....... _........._ .._ .._.._P .._ _-- ._._.�.. _ -- -._ --- _ be sent to._._., t..... -.... _..._._....._....� my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed approved, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 808 -1390 ext. 43148. spectfully, seph S. Paravati, Jr., P.E. Assistant Public Health Engineer MJB:cw _ ... BRUCE. K _FOLEY. Public Health Director _._L,ORF77A. -M-OLIMARI, ?LM, •M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York •10509 Environmental Health (914)278-6130 Fax (914) 278-7921 Nursing Services (914)278-6558 WIC (914)279-6679 Fax (914) 278-6085 Early Intervention (914)278-6014 Preschool (914) 278 -6082 Fax(914)279-6649 TO: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW �G ✓�i� 7�i�,3;o PROJECT: DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM JOINT REVIEW ICAPI 2 �� - �A�f-, 6 TOWN: SUB'D APP DATE: AO NOTICE OF COMPLETE APPLICATION: DATE: a 0 Within the drainage basin of West Branch or Boyds Comer Reservoirs. o Within 500 fee e oir reservoir stem or control lake. Within 00 feet of a watercourse r a DEC wetland and appearing on a subdivision map approved after December 31, 1.992. Cl Design flow greater than 1000 gallons /day. 0 Cam, hl 5 S73 Jae PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of ��` �" Located at TN Y Sa Tax Map # Block Z Lot �- Subdivision of Subdivision Lot # Filed Map # Date Filed Gentlemen: -'T �'h re / l This letter is to authorize a duly licensed Professional Engineer to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to superyisethe construction of said wastewater tretment and/or water supply systems in conformity t erpfovtsunns of Article 145 and/or 147 of the Education Law, the Public Health Law, and 'l ati p �i q �J h itary Code. _ y`� fl 0 P.E., R.A., Mailing Address Very truly yours, 9 Signed: (owner of Property) State �3 Telephone: Mailing Address: 21 � r—,41 12 - State /V Telephone: NS-7-2_5_ 3 `'f D Form LA -97 14.16.4 (Z17) --Text 12 PROJECT I.D. NUMBER eir.st SEOR r Appendix C _ _ &tate €nvlmnmontal At±a lily. Review ..: _...... SHORT. ENVIRONMENTAL ASSESSMENT FORM For UNUSTEQ ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant-or Project aponsor) f. APPLICANT JSPONSOR 2. PROJECT NAME. 3. PROJECT LOCATION: M4niclpallty PA ' 0, l_ T t?aunty 4 % Ld 4. PRECISE LOCATION (Street address and read intsrssctlons, Prominent landmarks, etc., or provide map) 2g 3 r/ A, iz- s- L2�i1 PA71R-�e-15�o hJ ( .7-) 1 S. IS PROPOSED ACTION: ❑ New ❑ Expansion odificatiordalterstion ti. DESCRIBE PROJECT BRIEFLY; 1-7a h 5.r... 1'6p— '6Ai- ��,�1dC-iv7- , -�T- Al 7. AMOUNT OF LAND AFFECTED: Initially �' acres Ultimately Q / acres S. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Ryes ❑ No 11 No, describe briefly 0. WHAT IS PRESENT LAND USE IN VICINITY OF PR04ECT7 Ssldentlai ❑ Industrial ❑ Commercial 0 Agriculture 0 Pa*moraetlopen space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? )KYes ❑ No It yes, list ageneyp) and pmmitlapprovals ,OAT 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? 9Yes ❑No It yes, list agency name and parmitrapproval 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 / Applicantisponsor " name: Data. Signature: If the action Is In the Coastal Area, and you are a state agency, complete' the Coastal Assessment Form before proceeding with this assessment PART 11-- ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.127 If yea, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 647.6? It No, a negative declaration may be superseded by another invohvd atfeney. Yes No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE POLLOwING: (Answers may be handwritten, if legible) C1. Existing air Quality, surface or groundwater qudlty or quantity, nolse levels, existing traffic patterns, solid waste produclW' or disposal, Potential for erosion, drainage or flooding problems? Explain brfafly: 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: 04. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly C5. Growth; subsequent development, or related activities likely to be indueed.4y the proposed action? Explain briefly. Ce. Long term, short term, cumulative, or other effects not Identified In C1 -057 Explain briefly. 07. Other Impacts (Including changes In use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? _ . Cl Yea ❑ No. If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above. determine whether It is substantial, large. Important or otherwise significant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural); (b).pmbabllity of occurring; (c) duration; (d) Irreversibility; (a) geographic scope; and M 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. ❑ 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: Point or Type Name of Responsibl* Officer in Lea Agency Signature of Responsible Offeer in Lead Agency . Name of Lead Agency to Tit lo of Responsible Officer ignature a am east rom response e o ice, . EAS Farm 14 -16-4 (Page 2 of 2) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ BEcTC"r.'?," '_.':;3 5 FT-9 L?BSTJRFACEE, SEWAGE T.R.v .3'Y;ENT cvSmEM.::. . Owner Address 12- .57712,E& ! Located at (Street) 293 / l i2 S '}2 EE Tax Map 3 Block Z Lot _Z— (indicate nearest cross street) Municipality Pf4 �SDo Watershed Al /`i 1 ,DW L4:_ 6 wcI4 / SOIL PERCOLATION TEST DATA Date of Pre - soaking l �' e Date of Percolation Test No Hole Run No,. Time Start _Stop Elapse Time (Min) Depth to Water From Ground. Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch Pr 1 lD 10 2 3 p Z Z 1 n 3 y-b 4 5 PZ 1 do a.ry 30 L� pia. L6`l 4. 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. <_ 1 min for 1 -30 min/inch, 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 Pg. 1 of 2 ....DEPTH. G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA 7 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO_, D 1 HOLE NO. -D ..? :. HOLE NO. T'a -T-6 P yo I I `yb'P S0 � t. L_1, w D/S 62 Wig it -30 f N� 5-AWPY e w i_0 I-M St l.( L O& P-"2 5S u? Indicate level at which groundwater is encountered N Indicate level at which mottling is observed �- Indicate level to which water level rises aftef being encountered 6 Deep hole observations made by: � � j� Date // / / L//j 7- 21h Design Professional Name: g0 Signature: Design Professional =s Seal ()F NE - AP` KAF(/ y� C A PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES PEYCA ilON -F0R­APfK66VW0F PLANS FOUR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: G A� / 2. Name of Project: 'i W l E 't. Alm' ®d `3. Location: TN: 4. Design Professional: JG h 13 5. Address: 12-1 6A 9 6. Drainage Basin: /l/}'C /yl i d �-e 3Ng h e-A �9 ,�-sa ti� j! / 2 7. Type of Project: >_ Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) _ 8. 9 Is this project subject to State Environmental Quality Review (SEQR) ? .............. Yes/No l� Type Status (check one) ........ ........................... ............................... Type I Exempt Type II Unlisted v Is a Draft Environmental Impact Statement (DEIS) required ? .................... Yes/No 114 10. Has DEIS been completed and found acceptable by Lead Agency ? ............. Yes/No N d 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? .......................................................... ............................... Yes/No N D 13. If so, have plans been submitted to such authorities? ........ : ................. :...:.. Yes/No 14. Has preliminary approval been granted by such authorities? Date granted: 15. Type of sewage treatment system discharge ........................ surface water X 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? . ............................... Yes/No N D 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? .......... Yes/No /V 0 21. Name of sewage system Distance to sewage system 22. Date test holes observed I I 1 /� �/ 14123. Name of Health Inspector 24. Project design flow (gallons per day) ............................. ............................... �Z 25. Is State Pollutant Discharge Elimination system (SPDES) Permit required? ... Yes/No Al d 26: Has SPDES Application been submitted to local DEC office? Yes/No �^ Rev. 11/02 Form PC -97 Pg. l of 2 27. Is any portion of this project located within a designated Town or State wetland ?... Yes/No . ...__.._T_ � �._. 'd�zt arias iD'nutn er _... _ ... _...::. 29. Is Wetlands Permit required? ...................................... ............................... Yes/No (� Has application been made to Town or Local DEC Yes/No 30. Does project require a DEC Stream Disturbance Permit? .... .........................Yes/No 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? .......................................... .........................Yes/No 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 DESCRIBE: 33. Is there a local master plan on file with the Town or Village? .........................Yes/No 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? .................................. .........................Yes/No 35. Are any sewage treatment areas in excess of 15% slope? .............................. Yes/No Nd 36. Tax Map ID Number .............. ............................... Map Block Z Lot Z 37. Approved plans are to be returned to ................ Applicant �) Design Professional *:OTE: All applicatiofls for review. and -approval ofa new S STS to be located within the' NYC `Jdaters'hed sliall 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. 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 of the Penal Law. ,, SIGNATURES & OFFIC1AL TITLES Mailing Address: ........................... Form PC -97 0 R1 .. i z m 1 C r Noe �j D t - g ? o o 1 1 C r Noe �j D t I R x � o m I R x F, .-.. . , . ,. _.. _ ._Cry.. .. . - - - -_.. _. � ;• .. _ �,: - _ 4 o o �ais- Q 47� m 14� C I-CE I d c . Z. � f Cat . 02- ? F4 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREAT-MENT SYSTEM Owner: o yl -L I Address: P; e Located at (street): TNI 4 Section: Block Lot Municipality: Watershed: SOIL PERCOLATION TEST DATA Witnessed by: Date of Pre-soaking: Date of Percolation -test: Notes: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole, (i.e., _< I min For 1-30 min/inch, < 2 min for 31 -60 miniinch). All d ara to be submitted for review. 2. Depth measurements to be made from top of hole. Fnrm r)r)-,17 r .,P .1 MA -_-Run. NN.o .... ..... Ti Time . . ---Start,=-.--- Stop Elapse __ (min•) Depth to water from m ground surface (inches) Start - Stop Water ­.Ievel-drap- to inches Percolation min/inch 2 ji., 1"L 7 1.­.--­.­_..___­__ - 3. 1.4 - t ­ � 3 4 5 2 3 4 arm. L 5 2 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., _< I min For 1-30 min/inch, < 2 min for 31 -60 miniinch). All d ara to be submitted for review. 2. Depth measurements to be made from top of hole. Fnrm r)r)-,17 r .,P .1 MA - i rt I f �Hv'; . _ \ \ I an �'l �` ' r � / 4 y ,eE r fi �s`"a�t"k •� � �' '" ��' � '.e f t � mum S ly j Qt�St'� '� 7. 4 I N- -iJ+r•C',.F' /�) '� \,'iy , Ti F.Iir x VU NO % X 3 "4 jr -.4 1 y. r r} i}Fq /�. 4 oz MIft r dI hD o o k 4b too \ �a) LV,-i 1 \ \\ o rn ul VA t (env 10\ IIN SHERLITA AMLEI , MD, MS, FAAP Commissioner of Health ROBERT MORRIS, PE PAUL ELDRIDGE County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 -- Office (845) 808 -1390 t� Fax (845) 278 -7921 or (845) 808 -1937 ADDITION APPLICATION RESIDENTIAL ONLY f U L) STREET S C.� TOWN TAX MAP #,3 q NAME Z� PHONEv�o�S' .3 `lD / PCHD# U (� MAILING ADDRESS /1-S DESCRIPTION OF Qko ADDITION NUMBER OF E STING BEDROOMS S PROPOSED # OF BEDROOMS (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) "Any addition which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, Brewster, NY 10509, Phone: (845) 278 -6130. 1. Certified check or money order for $100.00. 2. Sketches of existing - 9prplan (drawn to scale, all living area _includinu basement, to be - shown and dimensioned and use of each room specified). (See Section 3.c of Bulletin HA -1) 3. Two sets of proposed floor plans (drawn to scale — with name, street and tax map #) * Non - professional sketches are acceptable and preferred. (See Section 3.d of Bulletin HA -1) 4. Copy of survey showing all well and septic locations on the subject property to the best of your knowledge. Include date of installation known. Contact this office with any questions. 5. Copy of Certificate of Occupancy from the Town or Certification from the Building Department with legal bedroom count of dwelling. f" OFFICE USE COMMENTS S. Sherlita Amler, MD, MS, FAAP Commissioner of Health Robert Morris, PE Director ofEnvironmental Health Patricia Tanzi 405 Fair Street Carmel, NY 10512 Dear Ms. Tanzi: Department of Health 1. Geneva Road, Brewster, NY 10509 Office (845) 808 -1390 Fax (845) 278 -7921 or (845) 808 -1937 August 23, 2011 Re: Addition - Tanzi 405 Fair Street (T) Patterson, TM 34 -2 -2 Paul Eldridge County Executive At thexequest of the Town of Patterson, this Department is writing this letter to clarify a previous denial letter by the Department dated May 10, 2011. The addition application submitted on April 13, 2011 was denied due to the illegal accessory apartment in the basement. The apartment contained two potential bedrooms plus a second kitchen. The total potential bedroom count for the entire structure (main house and apartment) is six (three bedrooms in the main house, two in the apartment and a second kitchen). The legal count for the structure is three. Based on the above, you have the following options: 1. Remove the accessory apartment and return the space to what it was before it was fini shed .into an.gnar.-fro.ent.. _. _. _................ _....� ... ... .. 2. Have a licensed professional engineer design a new current code septic system (tank and fields) for six bedrooms. 3. Have a licensed professional engineer verify that the current septic system (tank and fields) is large enough to support six potential bedrooms. The existing system has to meet current code. Please contact us if you have any further questions. Sincerely, —lea, ""C'k seph S. Paravati, Jr., PE Assistant Public Health Engineer JSP:cw cc: Nicholas Lamberti,. Building Inspector, (T) Patterson SHERLITA AMLER,IVID, MS, FAAP Commissioner ofHealth ROBERT MORRIS, PE :-hector of E, re Wronmodial Health_ . Patricia Tanzi 405 Fair Street Carmel, NY 10512 Dear Ms. Tanzi: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Office (845) 808 -1390 Fax (845) 278 -7921 or (845) 808 -1937 May 10, 2011 Re: Addition - Tanzi 405 Fair Street (T) Patterson, TM 34 -2 -2 I have received and reviewed the plans for the proposed addition at the above mentioned residence. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons: PAUL ELDRIDGE County Executive 1. The bedroom, office /computer room and the second kitchen in the basement are considered potential bedrooms. 2. The legal bedroom count for the dwelling is 3. The potential bedroom count of your proposed addition is 6. 3. The addition of a potential bedroom requires this Department's approval of a revised septic system plan from a professional engineer. -Please revise- the`p-roposed- "floor -plan to "reflect "no more than 3 potential bedroomsor have a professional engineer or registered architect design a sub - surface sewage treatment system meeting present code requirements. If you have any questions, please contact me at your convenience. Respectfully, (joseph S. Paravati, Jr., PE Assistant Public Health Engineer JSP:cw SHERLITA AMLER, MD, MS, FAAP Commissioner of Health ROBERT MORRIS, PE yr "ector of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Office (845) 808 -1390 Fax (845) 278 -7921 or (845) 808 -1937 Town Legal Bedroom Count & Proposed Addition Status Re: / (Owner's Name) Tax Map # Address: Town: Year Built: According to records maintained by the Town, the above noted dwelling, is in compliance with Town Code. Is not in compliance with Town Code. The Legal Bedroom Count is: Tl�.:s u�forn.atiVn' has' Peen c�.aEned- l�,:n:- •_ _._..• , ...._. _ Certificate of Occupancy: Other: . 1?6� The plans for the proposed addition are considered: New Construction Addition to existing house only Teardown and/or re -build allowed under Town Regulations &�60Z ow Buil ' spectoi Date 6. PAUL ELDRIDGE County Executive PLANNING DEPARTMENT P.O. Box 470 7. Patterson, NY 12563 Michelle Russo Sarah Wagar Secretary Richard Williams Town Planner TOWN OF. PATTERSON Telephone (845) 878 -6500 PLANNING .& ZONING OFFICIO FAX (845) 878 -2019 ZONING BOARD OF APPEALS Lars Olenius, Chairman Howard Buzzutto, Vice Chairman _. pviacy Bodor _ Marianne Burdick Gerald Herbst PLANNING BOARD Shawn Rogan, Chairman Charles Cook, Vice Chairman Michael Montesano Thomas E. McNulty Ron Taylor NOTICE IS HEREBY GIVEN BY THE TOWN OF PATTERSON BOARD OF APPEALS of a public hearing to be held on _t �" 8.10-011 .,..;; at the Patterson Town 4 :. Hall; ;:1142 Route 311, Patterson, Putnam County, New York to cgnsider the following __..app #teattons: . ,in 1) Kathleen Pettey Case #01 -11— Interpretation. —Held over from the January 19, 2011, February 16, 2011 and March 16, 2011 meetings. Applicant is appealing the determination of the Director of Codes that her existing dwelling is limited to two families. This property is located at 35 South Street (R -1 Zoning District). „Applicant is °requesting a- Special Use= Pernut ari = area variances- .pursuant to` §° 54 _ _ ofethe Pattera9 -47 wn- _Code; Accessory Apartments, in order to legalize lier �p existing accessary apartment § 1ry54 105 A(3 j of the 'Code requires- the�,floorarea of , the apartment.to beano less-thiin'400 °square,feet and. no._more thaii 600 square feet; - - -. Apollo fhas'Z;400- square feet; Vafi nce re4uestJW- is"foi 1,800 § 154 -105 A(4) of the Code states that the floor area of the apartment shall not exceed 35% of the entire livable floor area of the single- family principal dwelling and the accessory apartment combined; Accessory apartment is 44% of the entire livable floor area; Variance requested is for 9 %. This property is located at 405 Fair Street (R4 Zoning District).. 3) Lynn Billings Case #06 -11— Area Variances Applicant is requesting area variances pursuant to § 154 -7 of the Patterson Town Code; Schedule of Regulations, in order to construct an 18'x 22' garage on the existing 18' x 22' foundation of the original garage. The Code requires a minimum side yard setback of 15'; Applicant will have 5'; Variance requested is for 10'. The Code also requires a 25'rear yard setback; Applicant will have 17.5'; Variance requested is for 75'. This property is located at 35 North Street (R -1 Zoning District). By Order of the ZBA Lars Olenius, Chairman t N.- 3- T 61jAl a L Ol 12 lea fin"' Is t of .1 � I �j it/ 5 'Room J 4e..hop t , -t, (L-D wi v FA I ET= L -j q Is to 7;W /tl,4 L—I'vi"tij Pdc)O'A ILI I�� I 'Room IZ)+c k-ebi IT sLijiovs Toof- m I li v 4j 77 7. QJI) �. ro 77 7. QJI) MINI - ESTATE 22 ACRES PRIME ROLLING LAND For: The Farmer, The Professional, - -- The Ndfi*e 1.o�r, TFf��lii =Lew Sisoatt ►` _ '! The House. Huge picturesque Living Room with unique stone fireplace,. Country Kitchen with the most modern advanced design. 5 Bedrooms, 2 Living Rooms, second huge Kitchen for in -law or professional, additional huge fireplace, heated garage. The Land 22 rolling acres, partly pasture, partly wooded plus small brook in middle of woods:.. The,PaoI Huge in- ground heated & fanced Pool, Machinery and animal shed. PRICE: $ 1 10, 000. TAXES: $ 1990. Listed subject to errors, omissions, change in price, prior sale and withdrawal without notice NOTAS LAWSON ROUTE 100 ROUTE 202 SOMERS, N.Y. YORKTOWN HGTS., N.Y. 914 -277 -3548 914 -245 -5168 ROUTE 52 KENT /CARMEL , N.Y. 914-225-5689 Property Address Brewster Vicinity, Patterson, N.Y. All appointments and negotiations to be handled thru Notas & Lawson Carmel Office EXCLUSIVE AGENCY No. 5226 r.0 wmsom nw. Date...: .... 12% h�1964 ........................... No 19 TOWN OF PATTER-SON PUTNAM COUNTY, N.. Y. Application -for Installation of Sewage, Disposal facilities Fee of *7.50 must accompany Application The undersigned hereby makes application for approval of and a certificate of occupancy ." for the installation of Septic Tank X Cesspool ❑' Chemical Toilet [:) Privy. ❑ on the property deKribed. below. Locationof Property •- •-- •..-......•- - - - - -• .... 14?LMM4 . ......................... . .. ................. I .................................... VlAagq Street or Avenue 22 Subdivision ------------------------------------------ ............................ Acres . ............................ ............. ................. Block No. Lot No. size of Lot -. Character of building Dwelling J1 Garage ❑ Store ❑ or other ❑ No. of ` Occupants .... ....... Bedrooms_-`,_.-. �3 ----------- Baths.._ x ................. Extra Showers ........ 1 ............ Garbage Disposal Sink ............................................... Automatic Laundry Washer....__. _._.__...._____..._____________ Source of Water. Supply Public 0 Drilled Well..C] Dug Well ❑ Spring ❑ Ground ❑ ...... 1�4 '4).chhu t Name of Owner. Address ..tw_ ..... ........ rp ..................... ...... Diagram showing location of proposed installation on•,prop:erty. (Show, distance frdin adjoining property line and distance from neaiest water' ' watercourse or source of water supply, within 200 feet. -Also show location of dwelling"or building to be served). Percolation Test Time in Min Inches 93 r ti V Tank Cap: Linear ft. of in ouls. • Trench Correeti9vai--if atiy to U mdde by DwpectoC4.'r4 G e peraI Contractor:.:._:. .... .... z .. Subcontractor ................. ........................... (sign) Addiess "AddresA ................................................. ........ ....... ....... ------------------------- ------­------- eetifi ot of 'Occupancy I certify that I have inspected the fdbilities called for in the foregoing application a4,4 find that the same are installed its sho;wn in the diagiiiin -there om with the changes noted, and find that the same comply witji the sewage reqlati6fis of the Town Board of health h of the Town of Patterson and do hereby grant this CER'T1776ATE 6F .'OCCUPANCY. Premises were inspected on the following dates First ........... Last ............. Other ........... Date Issued ................... ............................ ...............::. .........•... Sanitary Inspector