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HomeMy WebLinkAbout1458DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -2 -47 BOX 13 01458 Well Owner: Use of Well: 1- primary •filling Equipment ell Type Casing Details Screen Details Well Yield Test Well Log If more detailed information descriptions or sieve analyses Eire avaiiable; )lease attach. If yield Wass at different depths during drilling, list: lZ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION �POn T Street Address: 0 Town/Village: Tax Grid # d Map3 �1 Lot(s)v- s: Name: AddresBlock Residential Public Su 1 Business pp y Air cond/heat pump Irrigation Farm Test/monitoring Others eci Industrial Institutional (p �') Standby Rotary Cable percussion ol Compressed air percussion Other Screened Open end casing (specify) Total length g � Open hole s eci in bedrock _ Other Materials: ials: -X Steel _ Plastic _OLength below grade a6 ft, her Joints: Diameter _Welded -X— Threaded _Other Weight per foot —in. Seal: Cement grout _ Bentonite - lb /ft. Drive shoe: —Other . Yes _ No Liner:_ Yes No Diameter (in) Slot Size Length(ft) Depth to Screen (ft) First Second _ Bailed _ Pumped Compressed Air vfeasure from land surface - static (specify ft) Hours Yield During yield ft test � () Depth of compl � eted well i fee, 80#,aA,t. 4ti e &acr De th From Surface Water D. D• Well Formation Bearing Diameter(in) Land Surface Description r ✓eloped? Yes_No gpm Feet Gallons Per Minute Pump /Storage Tank Information Pump Type, Capacity "p1 Depth / Model &S',DS Voltage A96 HP ' 6- Tank Typeej��.ro /Volume County Certification No. Date of Reort Well Driller (signature) A /_ /� Aw_rI/_ w ./ - - --- �- ••._• wiw utstarlces to at least two permane landm ks to be provided own a eparate et/plan, Well Driller's Name I Signature: Address: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy py Owner; Orange copy Well driller DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM ti � PERMIT # 3 i" 03 D 3 g 3 Located at rMe 2 /blle. Ac- Town or Village alyk -, 'vs� Subdivision namoJ?ya o-6i-jo of ej Subd. Lot # 02 Tax Map Block oZ Lot f 7 Date Subdivision Approved , 4,wly Owner /Applicant Name,1;01,6!�% //, Renewal _ Revision Date of Previous Approval Mailing Address o2 121,14f ji /94c� �/or7�i�s�c•- �% % �ds73 Zip 3e2 Amount of Fee Enclosed `�,_i40 Building Type Lot Area 1.5'? No. of Bedrooms + Design Flow GPD 844 Fill Section Only Depth Volume FPCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage -System iem to consist of /,?-,f'O gallon septic tank and Other Requirements: To be constructed by /t// Ac5r Ca d� ..Water Sums -Y: ..Public Supply. From Address 4 jJ`��,'QO-r Address or Private Supply Drilled by 'Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatments stem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the 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: P.E. ✓� R.A. Date A,4r4raee. •1 . Li1,,.. sir s.-_r• _LG� _ /�/l%t��,Y �.�, C`s7oi► �w� /s, N�`J License # - APPROVED FOR CONSTRUCTIION: This approval expires two years from the date issued unless construction of the sewage treatme system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified wh n co sideredAecessary by the Public Health Director. Any revision or alteration of the approved plan requires a new perm . prove r discharge of domestic sanitary se7T)t By: �%� Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional F m CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL - . please punt of type - _ _.. - -... - Y'Clfl� - Permit -# � =C7 Well Location: Street Address: Town/Village Tax Grid # a ersorr Map 9,f Block of Lot(s) 47 Well Owner: Name:J';-41.��4te //, • Address: /�oiy e �4i' /�Cr�s n / �dZ „�GI'f0�► ✓ - �GiGeJ ✓ 0I'J�G�jG�.S%�Ci' i%y�0 , 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 vhf gpm # People Served _ 17_ Est. of Daily Usage 30d gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling ✓ New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes .✓ No Name of subdivision (J/ e9 ,t- cSFa cs, Lot No. o� Water Well Contractor: ,Z'a'0 Address: Is Public Water Supply available to site? .................................. ............................... Yes No �✓ Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: 1,Z -// :.03 _ . Applicant Signature: -Z� 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 modifle hen considered necessary by the Public Health D,*rector.,,A y revision or alteration of the approved 2Lir4e w to be constructed by a water ell 'ller certified by Putnam County. 77�07 Date of Issue Permit Issui fficial: Date of Expirafion WWO Title: Permit is Non- Transfe able White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 I A 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 March 22, 2004 Bibbo Associates 589 Route 22 Croton Falls, NY 10519 ROBERT J. BONDI County Executive Re: Proposed SSTS: Fratelli Home Bldgs. 40 Bullet Hole Road, Lot 2 (T)Patterson, TM #34 -2 -47 Dear Sir or Madam: 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. The proposed well location is to be staked by a licensed surveyor, this is to be noted on the plan. 2. A two foot clay barrier, minimum depth 1 foot below footing drain; is to be shown between the SSTS and the house foundation. - 3. Mini7aram'-d siance-from the purimp pit force-main o the,property-1 rie i§ 10,'feet. -- The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local, wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. Upon receipt.of a submission, revised to reflect the above comments, this application will be considered further. Ve ly yours, //Ono Robert Morris, P.E. Senior Public Health Engineer I: STO A { ROBERT J. BONDI County Executive 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 March 22, 2004 Bibbo Associates 589 Route 22 Croton Falls, NY 10519 RE: Fratelli Home Bldgs. 40 Bullet Hole Road, Lot 2 (T) Patterson, TM #34 -2 -47 Reservoir Basin Dear Sir or Madam: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on December 23, 2004 is complete. The Department will notify you by April 15, 2004 of its determination. ® The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed - -. - Agreement.:. Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require 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. Letter to: Bibbo Associates — March 22, 2004 -2- 1. you have any questions regarding this matter, please calf me at (845) 278 -6130 ext. 2166. Yep1lyly yon obert Morris, PE RM:hn Senior Public Health Engineer r. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS _ - ...... _..�._.... -: -. -- REVIEW SHEET FOR. CONST.RTJCTION PERMIT - _. NAME OF OWNER: STREET LOCATION: REVIEWED BY: RM, GR, AS, SRDATE: Y� DOCUMENTS (_)PERMIT APPLICATION �)�)WELL PERMIT OR PWS LETTER (� C -97 (�) ETTER OF AUTHORIZATION (�( DESIGN DATA SHEET (DDS) CORPORATE RESOLUTION W ( )SHORT EAF PLANS -THREE SETS ( x )HOUSE PLANS - TWO SETS �);ILEGAL VARIANCE REQUEST SUBDIVISION SUBDIVISION SUBDIVISION APPROVAL CHECKED PERC RATE )FILL REQUIRED DEPTH (_) CURTAIN DRAIN REQUIRED GENERAL (L� LOCATED IN NYC WATERSHED PLANS SUBMITTED TO DEP ( DELEGATED TO PCHD (�DEP APPROVAL, IF REQ'D (D EP TEST HOLES OBSERVED FRCS TO BE WITNESSED (_) �'X- APPROVAL SSDS ADJ, LOTS C__) WETLANDS (TOWN/DEC PERMIT REQ'D ?) DATA ON DDS PLANS & PERMIT SAME WPRE 1969 NEIGHBORNOTIFICATION LETTER BUZBA ESOIL YA,TJON W/I200', TESTING LOTS >10 YEARS OLD 'AGE SYSTEM PLAN - (NORTH ARROW) HYDRAULIC PROFILE VITY FLOW C_ffl CONSTRUCTION NOTES 1 -15 �56DESIGN DATA: PERC & DEEP RESULTS 2'CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT (� FOOTING /GUTTER/CURTAIN DRAINS C �USDA SOIL TYPE BOUNDARIES _TITLE BLOCK; OWNERS NAME ADDRESS PE/RA; NAME, ADDRESS, PHONE# DATE OF DRAWING/REVISION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS / LAKES,WETLANDS WITHIN 200' OF P.L. ((_)PROPOSED FINISH FLOOR AND / BASEMENT ELEVATIONS (! � WELLS & 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 45° W /CLEANOUT RENEWALS (__)SITE NOTE (NO CHANGE) FILL SYSTEMS 1 ' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE L� FILL SPECS/ FILL NOTES 1 -5 (� FILL PROFILE & DIMENSIONS (_) FILL IN EXPANSION AREA U L GREATER THAN 2 FEET LAY BARRIER FILL CERTIFICATION NOTE (_) DEPTH GAUGES (_) ,OL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS L� SEPARATION DISTANCE FROM TOE OF SLOPE E C )LF TRENCH PROVIDED 60FT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED (/)DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL (_ _)GEOTEXTME COVER SEPA ATION DISTANCES ON PLAN - FROM SSTS ( 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL )20' TO FOUNDATION WALLS L100- TO WELL, 200' IN DLOD,150' TO PITS 100' TO STREAM, WATERCOURSE, LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER w10' TO WATERLINE (pits - 20') 50' lNTERMRTTR..N^T D A'LVAsE COURSE �200'/500' RESERVOM ETC. _ 150' GALLEY SYSTEMS 10' MIN TO LEDGE OUTCROP � � SEPTIC TANK t___Jl___)10' FRO ;0F;SkRVICE D ION; 50' TO WELL WELL D MENSION OPERTY LINES L CONNECTION (MIN 15' TO PROPERTY LINE SLOPE SLOPE IN SSTS AREA 520 %) _)(__)REGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS L_) PUMP NOTES DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) bxc))l PIT AND D -BOX SHOWN & DETAILED DAY STORAGE ABOVE ALARM CURTAIN DRAIN (_) hSTANDPIPES, 5' BOTH SIDES, DETAIL () 15' MIN to CDS = >5 %, 20' -4 %, 25' -3 %, 35' -1 %,100 % - <1% P20' MIN to CD DISCHARGE /100' with 182 cons day discharge (_,10' MIN to NON - PERFORATED PIPE 1316130 ASSOCIATES LLP 589 Route 22 – Box 403 CROTON FALLS, NEW YORK 10519 (914) 277 -5805 .. FAX.19�14) Z77-8210..— ,.. r.. TO / 6i j1As• LOti•,�y Gt / %�I P11 Or WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via ❑ Shop drawings O Prints O Plans ❑ Copy of letter ❑ Change order ❑ �DATE ? - 't Q DATE ATTENTION RE., zo ssoos: �S� %v-vy 7 ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION S Z_"C ri�so 4 G THESE ARE TRANSMITTED as checked below: • For approval ❑ Approved as submitted • For your use ❑ Approved as noted • As requested ❑ Returned for corrections ❑ For review and commenter ov. r Pi ❑ FOR BIDS DUE 19 • Resubmit copies for approval • Submit copies for distribution • Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS 71- 47 • C . 4 J" / $7,,sG_ �1, 9WOP_'e 5414'G/7 COPY TO SIGNED: L �_4. If enclosures are not as noted, kindly notlf us at once. 16 04 11:40a y . PLANNING DEPARTMENT P.O. Box 470 `J`lY42 Route 311 Patterson, NY 12563 Melissa Brichta Secretary Richard Williams Town Planner TOWN OF PRTTERSO 845 - 878 -2019 Telephone (9l4) 878 -6500 TOWN OF PATTERSON FAX (914) 878 -2019 PLANNING & ZONING OFFICE March 16, 2004 Mr. Joseph J. Buschynski. P.E. Bibbo Associates, L.L.R. 589 Route 22 P.O. Box 403 Croton Falls, NY 10519 RE: GDC Subdivision Bullet Hole Road/Fields Comers Road Dear Mr, Buschynski: P.2 ZONING BOARD OF APPEALS Howard Buzzutto, Chairman Mary Bodor Mananne Burdick Ginny Nacerino Lars Olenius PLANNING BOARD Herb Schech, Chairman Michael Monresano David Pierro Shawn Rogan Maria Di Salvo This is to confirm our conversation. The Planning Board's concurrently with its approval of the above - mentioned subdivision also granted a wetlands/watercourse permit for the intrusions into the wetland buffer as shown on the approved subdivision plats attached hereto. The pernutted intrusions into the wetland and/or buffer included construction of wells for Lots 91 and #2. Please feel fr ee to contact my office if you have any further questions. Sincerely yours, Richard Williams Sr. TOWN PLANNER 03/16/04 TUE 12;28 [TX /RX NO 80921 Q 002 H-gr 16 04 11:40a v' TOWN OF PRTTERSO 845 - 878 -2019 P.3 03/16/04 TUE 12:28 (TX /RX NO 80921 16 003 GDC SUBDIVISION LIST OF MATERIALS February 1, 2001 Prepared by Donald J Donnelly Land Surveyor. P.C. • Sheet 1 of 7 Final Subdivision Plat Dated October 19, 2000; Last revised January 16, 2001 • Sheet 2 of 7 Final Subdivision Plat Dated October 19, 2000; Last revised January 16, 2001 • Sheet 3 of 7 Final Subdivision Plat Dated October 19, 2000; Last revised January 16, 2001 • Sheet 4 of 7 Final Subdivision Plat Dated October 19, 2000; Last revised January 16, 2001 • Sheet 5 of 7 Final Subdivision Plat Dated October 19, 2000; Last revised January 16, 2001 P.3 03/16/04 TUE 12:28 (TX /RX NO 80921 16 003 ya -4u of i u su / -Zac KJ F 3DEC PERMIT NUMBER -3724-00161/00003 FACILITY /PROGRAM NUMBER(s) NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Aim s PERMIT Under the Environmental Conservation Law (ECL) EFFECTIVE DATE March 11, 2004 November 30, 2005 F-1 Article 27, Title 9; 6NYCRR 373: Hazardous Waste Management Article 34: Coastal Erosion Management F-1 Article 36: Floodplain Management EArticles 1, 3, 17 19, 27, 37; 6NYCRR 380: Radiation itontrol F-1 Other PERMIT ISSUED TO TELEPHONE NUMBER TYPE OF PERMIT (Check All Applicable Boxes) 914 939 -6621 - 32 Barton Place, Port Chester, NY 10573... ® New ❑ Renewal ❑ Modification ❑ Permit to Construct ❑ Mark: J. Fusco, President Article 15, Title 5: Protection Waters a Article 17, Titles 7, 8: 7. ` Ginsbe rg - - evelopmentSubdivision, Bullet Hole Road,. Fields. Land and:Fair.Street, Fields Corners ±, of Lot No. 47, Sublot No. 2 SPDES TOWN Article 15 , Title 15: Water Supply F Article 19: Patterson LC -18 Class II Air Pollution Control Install a water well with service line within the 100 foot adjacent area of wetland LCA 8 for a residential house to be Article 15, Title 15: Where 1 , Title Transport Article 23, Title 27: Mined Land Reclamation Article 15, Title 15: Long Island Wells ® Article 24: Freshwater Wetlands F-1 Article 15, Title 27: Wild, Scenic Article & Recreational Rivers Tidal Wetlands ands F-1 6NYCRR 608: Water Quality Certification Article 27, Title 7; 6NYCRR 360: Solid Waste Management EFFECTIVE DATE March 11, 2004 November 30, 2005 F-1 Article 27, Title 9; 6NYCRR 373: Hazardous Waste Management Article 34: Coastal Erosion Management F-1 Article 36: Floodplain Management EArticles 1, 3, 17 19, 27, 37; 6NYCRR 380: Radiation itontrol F-1 Other PERMIT ISSUED TO TELEPHONE NUMBER JM Fratelli Home Builders, Inc. 914 939 -6621 ADDRESS OF PERMITTEE 32 Barton Place, Port Chester, NY 10573... CONTACT PERSON FOR Plt t ITTED WORK--'-"'- ............. ............................. - _..........:_ .._.. .................._............ _...:......._. NUMBER . . Mark: J. Fusco, President J­TELEPHONE NAME AND ADDRESS OF P .ROJECT/FACILITY 7. ` Ginsbe rg - - evelopmentSubdivision, Bullet Hole Road,. Fields. Land and:Fair.Street, Fields Corners ±, LOCATION OF PROJECT/FACILITY Lot No. 47, Sublot No. 2 COUNTY TOWN WATERCOURSEIWETLAND N0. NYTM COORDINATES Putnam Patterson LC -18 Class II DESCRIPTION OF AMORIZEO ACTIVITY Install a water well with service line within the 100 foot adjacent area of wetland LCA 8 for a residential house to be constructed on Lot 2 in accordance with the plan referenced in Special Condition 1 of this permit. By acc`'eptarice of`fhis permit; 'tlie permittee agrees that the permit is contingent: upon strict, compliance with the i ECL., all applicable re, gulations, the General Conditions specified and any Special Conditions included as part of this per. _...... _. DEPUTY.PERMITADMINISTRATOR ADDRESS _. _....._ ..... _ Alexande'r F: Ciesluk, Jr. 21 South Putt Corners Rd., New Paltz NY 12561 ew AFC . AUTH E SIGNATURE Date //0 y Page 1 of 4 JMFratelliHomeBldrs161 pmt(AC19)eh NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION NOTIFICATION . OF OTHER PERMITTEE OBLIGATIONS Fe,e A: Permittee Accepts Legal Responsibility and Agrees to Indemnification e permittee.expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the of New York, its representatives, employees, and agents ('.'DEC ")_fc -r al�..elaims, wits, actions; and damages, to the t _attributable to tl'Ie`perrriittee's acts or omissions in connection with the permittee's undertaking of activities in ection with, or operation and maintenance of, the facility or facilities authorized by the permit whether in compliance t in compliance with the terms and conditions of the permit. This indemnification does not extend to any claims, suits, s, or damages to the extent attributable to DEC's own negl igent or intentional acts or omissions, or to any claims, or actions naming the DEC and arising under article 78 of the New York Civil Practice Laws and Rules or any citizen r civil rights provision under federal or state laws. B: Permittee's Contractors to Comply with Permit permittee is responsible for informing its independent contractors, employees, agents and assigns of their nsibility to comply with this permit, including all special conditions while acting as the permittee's agent with respect permitted activities, and such persons shall be subject to the same sanctions for violations of the Environmental Conservation Law as those prescribed for the permittee. Item C: Permittee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights -of -way that may be required to carryout the activities that are authorized by this permit. Item D: No Right to Trespass or Interfere with Riparian Rights This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. GENERAL CONDITIONS General Condition 1: Facility Inspection by the Department The permitted site or facility including relevant records, is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation (the Department) to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71 -0301 and SAPA401(3). The permittee shall provide a person to accompany the Department's representative during an inspection to the permit area when requested by.the Department. A copy of this permit, including all referenced maps, drawings and special conditions, must be available for inspection by the Department at all times at the project site or facility. Failure to produce a copy of the permit Department representative is a violation of this permit. upon request by a General Condition 2: Relationship of this Permit to Other Department Orders and Determinations Unless expressly provided for by the Department, issuance of this permit does not modify, supersede or.rPS,cind any - y such rorderr or determination. iously.issu? .n, the Depart,,ent or any of the terms, conditions or requirements contained in General Condition 3: Applications for Permit Renewals or Modifications The permittee must submit a separate written application to the Department for renewal, modification or transfer of this permit. Such application must include any forms or supplemental information the Department requires. Any renewal, modification or transfer granted by the Department must be in writing. The permittee must submit a renewal application.. at least: a) 180 days before expiration of permits for State Pollutant Discharge Elimination System (SPDES), Hazardous Waste Management Facilities (HWM,F), major Air Pollution Control (APC) and Solid Waste Management Facilities (SWMF); and . b) 30 days before expiration of all other permit types. Submission of applications for permit renewal or modification are to be submitted to: NYSDEC Regional Permit Administrator, Region 3 21 South Putt Corners Road, New Paltz, NY, 12561, (845) 256 =3054 . General Condition 4: Permit Modifications, Suspensions and Revocations by the Department The Department reserves the right to modify, suspend or revoke this permit in accordance with 6 NYCRR Part 621. The grounds for modification, suspension or revocation include: a) materially false or inaccurate statements in the permit application or supporting papers; b) failure by the permittee to comply with any terms or conditions of the permit; c) exceeding the scope of the project as described in the permit application; d) newly discovered material information or a material change in environmental .conditions, relevant technology or applicable law or regulations since the issuance of the existing permit; e) noncompliance with previously issued permit conditions, orders of the commissioner, any provisions of the Environmental Conservation Law or regulations of the Department related to the permitted activity. DEC PERMIT . 3- 3724 - 00161!00003 NUMBER PAGE 2 OF 4 u ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (TITLE 5), 24,25,34,36 AND 6NYCRR PART 6 . 1. If future operations by the State of New York require an alteration 608 in the position of the structure S 4. All necessary precautions shall be taken to preclude contamination cause unreasonable obstruction to the fre@navioationofsejd; ester - °: _ ., of the State, or cause loss or destruction of the natural resources of P the the Department to remove 5 5. Any material dredged in the conduct of the work herein permitted and if, upon the expiration or revocation of this permit, the structure, rill, excavation, or other a evenly, without leaving large refuse piles, ridges modification of the watercourse hereby authorized shall not be h may to the State, and to b Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill a 6. There shall be no unreasonable interference with navigation by the and restore to its former w claim shall be made against the State of New York on account of any such removal or alteration. a 7. If upon the expiration or revocation of this permit, the project hereby 2. The State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvement of navigation, or for other purposes, and no claim or right to compensation shall accrue from any such damage. 3. Granting of this permit does not relieve the applicant of the responsibility of obtaining any other permission, consent or approval from the U.S. Army Corps of Engineers, U.S. Coast Guard, New York State Office of General Services or local government which maybe required. expense to the State, and to such extent andnn such ltime and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure orfill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. 8. If granted under 6NYCRR Part 608, the NYS Department of Environmental Conservation hereby certifies that the subject project will not contravene effluent limitations or other limitations or standards under Sections 301, 302, 303, 306 and 307 of the Clean Water Act of 1977 (PL 95 -217) provided that all of the conditions listed herein are met. 9. All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or his agent as part of the permit application. Suchf�pproved plans were prepared by SPECIAL CONDITIONS ® The enclosed permit sign must be conspicuously posted in a publicly accessible location at the project site.. It must be visible and protected from the elements at all times. The permittee shall require that any contractor, project engineer, or other person responsible for the overall supervision of this project reads, understands and complies with this permit, including all special conditions to prevent environmental degradation. 0 For Article 15, Protection of Waters and Article 24, Freshwater Wetlands permits, the permittee or an authorized . representative shall notify the Department by mailing. the attached form at least 48 hours prior to the commencement of any portion of the proj2ct authorized herein. Continued on next page... DEC PERMIT NUMBER 3-3724-00161/00003 PROGRAWFACILITY NUMBER c:\Formslapage.frm Last updated 3/03 (eh) PAGE 3 OF 4 0 95- 20- 6F(7/87) -25CR3 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Ak SPECIAL. CONDITIONS. For Article 24 Freshwater Wetlands F2004. and house service line shall be constructed in accordance with the plan drawing titled Disposal System,. Property Of JM Fratelli Home Builders, Inc., located at 40 Bullet Hole repared by Bibbo Associates, L.L.P., dated December 2, 2003 and last revised March 5, 2. EROSION CONTROL: Prior to commencement of the activities authorized herein, the permittee shall install securely anchored silt fencing and /or continuous staked hay bales along the limits -of- disturbance or as shown on the plans or drawings referenced in this permit. These erosion control devices shall be maintained until all disturbed land is fully vegetated to prevent any silt or sediment from entering the freshwater wetland or its adjacent area. Silt fencing, hay bales and any accumulated silt or sediment shall be completely removed for disposal at an appropriate upland site. 3. All areas of soil disturbance resulting from this project shall be seeded with an appropriate perennial grass seed and mulched with hay or straw within one week of final grading. Mulch shall be maintain until a suitable vegetative cover is established. ed STATE ENVIRONMENTAL QUALITY REVIEW Under the State Environmental Quality Review Act (SEAR), this project has been determined to be a Type II Action and therefore is not subject to further procedures under this law. Distr : D. Gaugler J. Buschynski, Bibbo Assocs. DEC PERMIT NUMBER 3-3724-00161/00003 FACILITY ID NUMBER PROGRAM NUMBER Page 4 of 4 LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early InterventioNPreschool (845) 278 - 6014 Fax (845) 278 - 6648 January 7, 2004 Bibbo Associates 589 Route 22 P.O. Box 403 Croton Falls, NY 10519 RE: Application to Construct a Subsurface Sewage Treatment System JM Fratelli Home Builders 40 Bullet Hole Road, Lot 42 (T) Patterson, TM# 34 -2 -47 Dear, Sir: The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on December 23, 2003 is incomplete. Please be advised that the following information is required before the Department may commence its review._ M _ • It appears that the proposed well location is within a New York State Environmental Conservation (NYSEC) wetland buffer zone. Please submit a NYSDEC permit allowing the construction of the well. • If a wetland permit from the Town of Patterson is required, please submit or submit a letter from the town stating a wetland permit is not required. The review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information as to the completeness of your application. Please be advised that failure to submit information to the Department or to follow procedures is sufficient grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed Regulations and Putnam County Department of Health regulations. Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130 ext. 2166. V ly y. s, Robert Morris, P. E. RM:tn Senior Public Health Engineer 611360 ASSOCIATES LLP 589 Route 22 — Box 403 CROTON FALLS, NEW YORK 10519 (914) 277 -5805 FAX (914) 277 -8210 T0. O /1 WE ARE SENDING YOU ❑ Shop drawings ❑ Copy of letter DATE JOB NO. ATTENTION V RE: Lo x'02 c� /yG� Gra�a err "�s�,S' Tip L3 IL -� -7 ❑ Attached ❑ Under separate cover via the following items: ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Change order ❑ COPIES DATE NO. DESCRIPTION SS S S• �� ��„ s THESE ARE TRANSMITTED as checked below: 2'F or approval...._, . ❑ For your use ❑ As requested ❑ For review and comment ❑ FORBIDS DUE ❑ - Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints . 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO SIGNED: If enclosures are not as noted, kindly notify L# at once. V/ 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEAILT SERVICES LETTER OF AUTHORIZATION RE: Property of SJ_ ,f02:2 Located at �/10 % W. T/V ✓"� J%�Be�So�Gi Tax Map Block Lot 7 Subdivision of Subdivision Lot Filed Map # 77 Date File& , Gentlemen: This letter is to authorize] a duly licensed Professional Engineer &---' or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with -the. provisions of Article.145. and/or .1.47-af th�.E.ducation.Law, the ­Publie Health: - 9 Law, and the Putnam County Sanitary Code. Countersigned: P.E., R.A., # P.5 Sy',Z IL Mailing Address State,.' Zip Telephone: 21 f- - o-9 77 - s8of°' Very truly yours, Signed: (Owne of Property) Mailing Address:? Z 412 6"Z.� /.�-2 State /l /Y Zip -7 Telephone: 662 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: ,p�j ,,w C �p�/ �� j rC�,C" 5��`7 # z/ f represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: `fj1/J �=�('� JCL i 4A!,er 13cwl,Vt�S' -2 C. Having offices at: .4Z 47 �} f Whose Officers Are: President - Name: Al Al e . , � sc o Address: -302 6A,e oAl j��LA Cc o c'f%ES T�x /01/ Vice President - Name: Address: Secretary -Name: f Al of Address: ,l IA y Treasurer - Name: Address: tl and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating theretp. Sworn to before me this 15 day of Nod (month) QcX 3 (year) Notary Public ' U DONNA GIAQUINTO Notary Public, State of New York No. 01GIO051 132 Qualified In Westchester County Commission Expires November 20, �✓� Form CA -97 Signed Title: Corporate Seal 14 -16-4 (2187) =Text 12 PROJECT I.D. NUMBER 617.21 Appendix C State -Envlrcnmerital Quality Raactty SHORT. ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) SEOR 1. APPLICANT /SPONSOR 2. PROJECT NAME 3. PROJECT LOCATION: Municipality County �d'7 4. PR''EEjCIISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) ,c 5. IS PROPOSED ACTION: kNew ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: / fLi 7. AMOUNT OF LAND AFFECTED: 0 °% � � Initially gX . acres Ultimately 0?1 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ❑ „Yes No to No, describe briefly 8. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ar Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? Yes ❑ .9 No It yes, list agency(s) and permitlapprovals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? „ Yes ❑ No If yes, list agency name and permitlapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes ZNo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: �/ 6 �%'�i /'� // / /OJl'ii X�GIi1"%, /IC" Date: C Signature: If the action is In the Coastal Area, and you are a state agency, complete' the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? It yes, coordinate the review process and use the FULL EAF. ❑ Yes ONO B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PAflT 617.6? If No,.a negailvg 0eclara4(on , may be suparsed�e,d/ by another Irlvulvod agency.' El tom Yes , No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing tratllc patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly:: /(/4�1 0�lr exlif' c i Xi'126 G%`jr' 4it1,AGC,7L C7. 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: CA. A community's existing plans or goals as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities likely to be Induced,by the proposed action? Explain briefly. C6.. Long term, short term, cumulative, or other effects not Identified in C1•C5? Explain briefly. C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. "D.. —I &THERE, "Ort_l IS THERE "LIKELY Tb BE, CONTR.OVER$Y.I?EL TED TO POTENTIAL-. AlVERSE -E- NVillONfi'Ei$TTAtiMPACTS? -- ❑ Yes ^ONO 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. ❑ 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 thls.determination, Name of Lead Agency 1_1 330 CO Print or Type Name of Responsi le Officer in Lead Agency Title of Responsible Officer i Signature of Responsible Officer in Lead Agency ;signature o Preparei (if different from responsible officer) Date 2 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: J/`'J�G7`e /�' • p1�, �//�li� /A"ersi�c IVY 2. Name of project: Lo t '*�, 3. Location TN: f%`e� -sati 4. Design Professional / �d�o,�'s.,.GL110 6. Drainage Basin: 5. Address:,*5w`f4' 7. Type of Project: Private/Residential Food Service Apartments Institutional Office Building Realty Subdivision Commercial Mobile Home Park w ( "p • ) nA. Zcii 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) .. .............................:. Type I Exempt Type II V' Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... ltl,+ 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 ... ..........._..._._....._.._ 13. If so, have plans been submitted to such authorities? ......... ..... 14. Has preliminary approval been granted by such authorities9r,/,-,s Date granted: /,c5h4- . o?IW/ 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? ....... ............................... Ala 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ �Jv 21. Name of sewage system Distance to sewage system 22. Date test holes observed/%y, /f 91,01 23. Name of Health Inspector A I//-h� 24. Project design flow (gallons per day) ................................. ............................... 2RC 25. Is State Pollutant Discharge Elimination System (SPDES).Permit required ?... 26. Has SPDES Application been submitted to local DEC office? ......................... A� Form PC -97 7. Type of Project: Private/Residential Food Service Apartments Institutional Office Building Realty Subdivision Commercial Mobile Home Park w ( "p • ) nA. Zcii 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) .. .............................:. Type I Exempt Type II V' Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... ltl,+ 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 ... ..........._..._._....._.._ 13. If so, have plans been submitted to such authorities? ......... ..... 14. Has preliminary approval been granted by such authorities9r,/,-,s Date granted: /,c5h4- . o?IW/ 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? ....... ............................... Ala 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ �Jv 21. Name of sewage system Distance to sewage system 22. Date test holes observed/%y, /f 91,01 23. Name of Health Inspector A I//-h� 24. Project design flow (gallons per day) ................................. ............................... 2RC 25. Is State Pollutant Discharge Elimination System (SPDES).Permit required ?... 26. Has SPDES Application been submitted to local DEC office? ......................... A� Form PC -97 2 27. Is any portion of this project located within a designated Town or State wetland? yc-s 28. Wetlands ID Number—., . ............................... _,.......:.........,.... .. .................................. 29. Is Wetlands Permit required. ......................... S �.y ........ ................. ....................e Has application been made to Town or Local DEC office ?l-'Yfa%g� G 4 apll � I 30. Does project require a DEC Stream Disturbance Permit? .. ............................... o 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 Ala 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? ........................... Le -.9 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... V� 35. Are any sewage treatment areas in excess of 15% slope? . ............................... _Ao 36. Tax Map ID Number .......................... .........:..................... MapJ1 Block o2 Lot 7 37. Approved plans are to be returned to ..... Applicant r/ Design Professional y NOTE: All, applications:for review and approval of a new,SSTS to_ be located within:th�NXC_WersPdha11 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 4 impervious surfaces, and Ithe project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval... If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision . may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, . that information provided on this form is 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 & OFFICIAL TITLES: LZ �ti `, ar ��•> co Mailing Address: .................................... pe c? 02� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ,....,_ -.,. _._. —._. _... ))E $.I N,.DATA•SHEET -- SUBS- UlltFACE SEW-- i -GE`TRE=ATMENT- SYSTEM . ' M.. Owner ZixAddress.? r8c�x.yv�,�% for �c/iesi� ivy /o��� Located at (Street),(�� /fP Tax Map \7 f Block 2- Lot 4 7 (indicate nearest cross street) Municipality ®-soj Drainage .Basin Date of Pre- soaking SOIL PERCOLATION TEST DATA - 7 - Date of Percolation Test Hole No. Run No. Time Start -Stop Ela se Time Min.) Depth to Water rom Ground Surface (Inches) _ Start Stop Water Level Dro In Incles Percolation Rate Min/Inch S' 3 % 1�30Z 2 a`7- 2 f- v2 3 O ' - / / /G 4 5 5 i 2 3 4 N OTES. 1. Tests to be repeated at same depth until approxirha%]3�tiit$ircolatioit rates are obtained at each percolation test hole. (i.e.. s 1 min for 1 -30 min/inch, s`2 inin•f6f3-1 -60 min/inch). All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered +" Deep hole observations made by:/ ,,y,ff� j� 1r+H� �'cCo /s�H Date if - /� -P8 Design Professional Name: o f�; , �e `, j, . Address: BO ASSOMTE Consulting Enginem-Piannaru . 22 4. Hardaerabble Rd Crt � n FaUS,. N.Y. 10519 Signature: ` t Design Professional's Sea.I// BU s {- q�'` r 0 �r 'J` 1`. 0559 4' \ \A40FESS1��% 2 w TEST.PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 0.5' 1.0' 1 ✓�rdl Jfoc.�� ���CoW� 7 ltiN. 1.5' 2.0' 2.5' 3.0' el d, Gh� 7�0 3.5' 4.0' ARae 4.5' 6.0' "FAI & , 6.5' J 7.0' 7.5' 8.0' 8.5' 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered +" Deep hole observations made by:/ ,,y,ff� j� 1r+H� �'cCo /s�H Date if - /� -P8 Design Professional Name: o f�; , �e `, j, . Address: BO ASSOMTE Consulting Enginem-Piannaru . 22 4. Hardaerabble Rd Crt � n FaUS,. N.Y. 10519 Signature: ` t Design Professional's Sea.I// BU s {- q�'` r 0 �r 'J` 1`. 0559 4' \ \A40FESS1��% PUTNAM COUNTY DEPARTMENT OF HEALTI DIVISION OF ENVIRONMENTAL HEALTH SERVI CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMEN PCHD CONSTRUCTION PERMIT # Y -03 Located at t du -Ilex TinGf- K!. Town or Village A'17- T62SC'U Owner /Applicant NameT/+JCon= #o,,f 1Jtjcost5 Tax Map _35� Block Z Lot yZ Formerly Subdivision Name G1W�1'77 -y1'77 4SsoC, Subd. Lot # a 1_J_ Mailing Address 3R 84z r 000 pCc PO 2 rG /,/�S �� ,�� Zip SOS' 73 Date Construction Permit Issued by PCHD G/1! Z jG Y Separate Sewerage System built by Cr/ G / G!-/ Cows T. xrsc Address rp ldcyo, , .Mevsr�.c. Consisting of Z sy Gallon Septic Tank and SO y L 4 AtQsa Pri o-y Other Requirements: 12-5-0 -64C, a f.ONL A^1-9 G /r�•4i t dEe Water Supply: Public Supply From Address o n / /0/8 Rf si/ , or: Private Supply Drilled by d MEAT /li �> �'wri SO-VT Address e, rfr ,CS0'C/ Nk /ZS63 - Building Type a �,S �F'rc1 Has erosion control been com feted . - - .- ; ... p, �. -. Number of Bedrooms or Has garbage grinder been installed? /U 0 I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: /- /`f - ©J— Certified by P.E. ;K__ R.A. (Design Professional) Address 813 o A45 s0C_;4 a P. A144 PON Fr-.'c FS License # DSS9 Z cl of 3 20 C,M X00 — sa, ZOs, so r,"s ry � /o,c-ey Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals ar, bject to odification or change when, in the judgment of the Public Health Director, such revocation, o ication hange is necessary. By: Title: Date: & d % 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 fit�o OIL WELL COMPLETION REPORT NOTM Exajt location of well with distances to at least two permanent landmVks to be provided on a separate VteVplan. Well Driller's Name Address: rr A�r Pi & P, jr, So &."g1l &trnm (3 Signature: 7XL6Ea�- jAe Date: 71,29-14 4& U White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC-97 Street Address:'­­ 0 4 Aj&± gok Ld � Pktaoh Map3� BlockZk Lot(s) Well Owner: Name: ,,- -1 xMI =1 -C"111 Address: du�& Use of Well: 1-primary 2-secondary Residential Business Industrial Public Supply Air cond/heat pump Irrigation Farm Test/monitoring Other(specify) Institutional Standby Drilling Equipment Rotary _ Cable percussion ;2L Compressed air percussion _ Other (specify) Well Type Screened Open end casing --y Open hole in bedrock Other Casing Details Total length Q�Lft. Length below grade a6 ft. Diameter 7 in. Weight per foot _j7lb/ft. Materials: _X Steel Plastic — Other Joints: — Welded _X Threaded Other Seal: )(Cement grout Bentonite Other Drive shoe: Yes No ILiner: 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 _Pumped Compressed Air Hours Yield !�,6gprn Depth Data Measure from land surface-static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses are avail-able, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface In I ✓ If yield was tested at different depths during drilling, list: Date Well Completed 7/d_//O�L 1 Feet Gallons Per Minute Pump/Storage Tank Information Pump Type 9 Capacity jgff rh Depth /& M o d e I &G66119 Voltage 6196 HP Tank Type ��.(-d lVolume _6j) Putnam County Certification No. Date of Report Well Driller (signature) 007 7 1 MA � - t*zt NOTM Exajt location of well with distances to at least two permanent landmVks to be provided on a separate VteVplan. Well Driller's Name Address: rr A�r Pi & P, jr, So &."g1l &trnm (3 Signature: 7XL6Ea�- jAe Date: 71,29-14 4& U White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC-97 Dec 12 03 08:02a TOWN OF PRTTERSO 845 - 878 -2019 p.2 12111/03 THU 12:28 TEL 914 277 6210 BIBBO ASSOCIATES LLP m 003 tA C�� y * t?v_ c.r.?'t'A._ MOLINARI„ R.N.. M.S.N. BRUCE R. FOLEY 4 Asrociate Public Healdf Director' Public fleuhL Dlrecrur y� l4/ -`{ Director of Paricnr Services DEPARTMENT OF HEALTH 1 Geneva Road* 33rewsler, New York 10509 ruviroouwntal Ilcolue (914)279-6130 %K(914) 279-7921 Nursing Service (914)278.6558 WIC (914)27B -6678 Fax (914) 278 -4065 Early 1werwcnliuu (914}278-6014 Preschool (914)278 -6082 I °dc (914) 278 -6646 OWNERS NAINI E: 7 -A?: iv1A.a' NUMBER: E911 ADDIU SS: TOWN: �D 14e- L07 7 /yve - 'r '0'9'f/% AUTl101tl"LLU 'fOtiYN 01r1tXCIAL: (Signature) DATE: 1.7112 /a rr - The Putnam County Department of Health, will not issue a CertiYlcaic Iii Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized towel official. This form is to be submitted with tl'Ie :Ihl)licatiOn for a Certificate of Construction Compliance. ((;91 l VEltOW) 12/12/03 FRI 08:53 [TX /RX NO 76311 2002 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL, HEALTH.- SE VICr S GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM i'YI K Tics Z_ / /� 45 gly L Owner or Purchaser of Building Building Constructed by y� UL LC l /70 LLC xD Location - Street 2o�Aq 'j5- 11111 Building Type Tax Map Block Lot TownNillage .eIX,g7i9N C 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 system. _ ..... .. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. . Dated: Month Day � Year O q ler4al Contractor (O ner) - Signature Corporation Name (if corporation) Address: 5A� >r1N �L.4 State Zy y Zip Signatur Title: c���� C4sT '7L&G� Corporation Name (if corporation) Address: �` jLt��f' U4jf A-2:K` State Zip Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVYCEc GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Building Constructed by � vLL�I I74L� �Q Location - Street Building Type _525c 9// `/7 Tax Map Block Lot Town/Village Subdivision Name Subdivision Lot # Z 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 buildin utilizing the system. g b 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 /V Year D y " �4'eral Contractor (O ner) - Signature Corporation Name (if corporation) Address: rIN 110L,4 C,,':;- State zip �v_= Signatur C CDlLS%. )u-G� Corporation Name (if corporation) Address: �G T�'jw�(• �QL`�if /Fig State r �' � zip L s� l Form GS -97 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H Padovarii`; Director LAB #: 93.402660 CLIENT #: 58032 NON STAT PROC PAGE: FUSCO, JOHN JR DATE /TIME TAKEN: 11/18/04 10:30 3 TARA WAY DATE /TIME RECD: 11/18/04 11:00 TUCKAHOE, NY 10707 REPORT DATE: 12/13/04 PHONE: (914) -337 -0708 SAMPLING SITE: 40 BULLET HOLE RD, PATTERSON SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COL' D BY: JOHN FUS_CO JR.- - - - -- TEM-PTRATURE - < -4C- NOTES ... : COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 11/18/04 LEAD (IMS) 1.0 ppb 0 -15 ppb 9101 11/18/04 NITRATE NITROG 0.22 MG /L 0'- 10 9139 11/18/04 NITRITE NITROG <0.01 MG /L N/A 9146 11/18/04 IRON (Fe) <0.060 MG /L 0 -0.3 mg /l 2037 11/18/04 MANGANESE (Mn) 0.075 MG /L 0 -0.3 mg /l 2037 11/18/04 SODIUM (Na) 8.13 MG /L N/A _ 11/18/04 pH 7-.3 UNITS .6.5 -8.5 9043 11/18/04 HARDNESS,TOTAL 198 MG /L N/A 11/18/04 ALKALINITY (AS 114 MG /L N/A 11/18/04 TURBIDITY (TUR < 1., NTU __ . -.. _ -..... .. _0,-5.. NTU .- COMMENTS: -Pb/Cu LEAD--limits--for-public schools are set at 15 ppb;-*- - EPA Lead & Copper Rule for'Public Systems requires that no more than 10% of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg /L, else water. treatment must be undertaken to reduce the waters corrosive potential. Fe /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg /L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg /L of Sodium is suggested. YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H.- Padovani-; D i ec a - LAB #: 93.402660�M CLIENT Y #: 58032 NON STAT PROC PAGE: 2 FUSCO, JOHN JR DATE /TIME TAKEN: 11/18/04 10:30 3 TARA WAY DATE /TIME RECD: 11/18/04 11:00 TUCKAHOE, NY 10707 REPORT DATE: 12/13/04 PHONE: (914)- 337 -0708 SAMPLING SITE: 40 BULLET HOLE RD, PATTERSON SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COLD BY: JOHN FUS CO JR.. ^ — - - y __ _ -- _— TE- MPERAT -URE ..: < -4C IVOTES�NNNNN- -- -- -u COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PH PH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF PH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW PH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF PH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG /L: THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG /L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0 -70 MG /L VERY HARD WATER: ABOVE 300 MG /L MODERATELY HARD WATER: 70 -140 MG /L -MG /L = MILLIGRAM PER LITER HARD WATER: 140 -300 MG /L (1 grain /gallon = 17.2 MG /L) SUBMITTED BY: Director ELAP# 10323 ' YML ENVIRONMENTAL SERVICES 321 Kear Street ' Yorktown Heights, N.Y. 10598 Albert H. Padovani, Director LAB #: 93.402746 'CLIENT #: 5803F NON STAT PROC PAGE; i FUSCO, JOHN JR DATE/TIME TAKEN, 12/02/04 10:30 3 TARA WAY DATE/TIME REC'D: 12/02/04 10:45 TUCKAHOE, NY 10707 REPORT DATEs 12/03/04 PHONE: (914)-337-0708 SAMPLING SITE: 40 BULLET HOLE RD, PATTERSON SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COL'D BY: JOHN FUSCO JR TE�iF�RATURE..: < 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 12/02/04 NF T. COLIFORM ABSENT /100 ML ABSENT 1008 COMMENTS: BACT THESE RESULTS INDICATE THAT THE WAT WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD Ih�=�� ~THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS� TESTED, AT THE TIME OF COLLECTION. SUBMITTED BY: Albert H. Padovani, M.T.(ASCP) Director ' B-AP# 10323 .CU UNAM t-UUIN 1 Y L .LrA- K1'1V1LiN 1- UV' UEAL•1.1i DIVISION OF ENVIRONMENTAL HEALTH SERVICES �� � z /0,1 _ ®le / FINAL SITE INSPECTION q Date: 7 z / Inspected by4 _ Street Location y7-,61 aGE �z Owner i 1 jf1oW'!5' jg,/ D5 - Town Permit# p� 3:K _ ©3 TM # 3 �}� — 2 — �e ? Subdivision Lot # 1. Sewage System Area, a. STS area located as per approved plans ..........:............. b.. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped .............................................. d. Stone, brush, etc., greater than 15' from STS area....... e. 100' from water course / wetlands... ..................... H. 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....:.. ....'. 2. Protected below. frost .............. ............................... 3... Minimum 2 ft. Original soil between box & trenche e. Junction Box - properly set ....... ............................... 6. Irenches 1. Length required S o d Length installed Sc2i 2. Distance to watercourse measured -f- i o o 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 ....... :.......... 1 endscapppped .................... ............................... e. um .. r Dose c - Systems . ize of pump chamber ........................... I... ... .... 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/Buildirig a. House located per approved plans ............. . b. Number of bedrooms ................................ .... �� IV., Well Well located as per approved plans . ......:........................ b. Distance from STS area measured 4- 2.00' - 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 watercoi g. Footing drains discharge away from STS area............ h. Surface water protection adequate ........:..................... i. Erosion control provided ............ ............................... Rev. gr/002vi 07/19/04 MON 11:21 TEL 914 277 8210 BIBBO ASSOCIATES LLP - o- +4.PCHD PUTN .AM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION 0 JOSEPH ® GENE LTEST FOR FINAL INSPECTION For: Fill All information must be fully completed prior to any Trenches inspections being made. PCIHD Construction Permit i P3 LI – 0 Pcl. e fSd Located: SiA/ -1 01 QwnerlApplieant Name: mc+ir%rs 1'1Vl _3 ` _Block -Z- Lot y 7 Formerly: Subdivision Name: Subdi"visiol � Lot # Z- Ts system fill. completed? N %/� Date: Is system cozmplete? Date: Is System Constructed as r pleas? . . Is well - drilled ?. NO Date: 7Z y�0t Is well located as per plams`7 Are. erosion_ control measures .in place? . I certify that the system(s), as listed, at the above premises)as been eonstnicted and Y have inspected and verified their completion in 'accordance with. the issued,. PCHD Construction Permit .and approved plans and the Standards, Rules and Regulations of -the Putnam County Department of Health. Date: 7 -% 9 -� Certified by: ' PE `'� RA Design Professional Address: SCJ .#'A ffss'aGS faeZc' Z Lic. # Comments: f- b+c Form FIR -99 [a 001 <,- kinhic- 13I'ITMOM" rn11NTY nFPAPTMFNT OF P. 1 • 6 , LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 16509 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 July 22, 2004 Joe Buschynski Bibbo Associates 589 Route 22 Croton Falls, NY 10519 Dear Mr. Buschynski: ROBERT J. BONDI County Executive Re: Field Inspection - J.M. Fratelli Home Builders, Inc. Bullet Hole. Rd., (T) Patterson Lot #2, TM# 34. -2 -47 The,above referenced separate sewage treatment system can be backfilled..The _ Following comments must be corrected in the field: 1. A pump test needs to be witnessed by this Department once the electrical inspection has been completed and notification of such has been received by this Department. If you have any further questions, please contact me at (845) 278 -6130, ext. 2261. Sincerely, 4�-� 0, 61�7- Gene D. Reed SR. Environmental Health Engineering Aide GDR:km SENDING CONFIRMATION . DATE JUL -23 -2004 FRI 14:21 NAME PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 92778210 PAGES : 0/1 START TIME JUL -23 14 :20 ELAPSED TIME • 00,001, MODE : ECM RESULTS NO ANSWER FIRST PAGE OF RECENT DOCUMENT FAILED TO SEND FULLY... a ],ORHTFA. MOIINARI ROBERT J. BONDY ➢vbll, H,shb Dlr Ja rO1 °ry eSe t DEPARTMENT OF -HEALTH I ecii -a Road. Brewster, Maw York 1D509 Li.bai�esW Bi•10 (848)179 - 6116 FU (245)279-7921 NaMaB Berrlm.,(845)278,,6558 WIC (845)278.6678 P.(845) 278.6885 EN(y n*rmendRaWml,(845)278.6o14 Fu(945)278 -6648 ' July 22, 2004 Joe Buschyasld Bibbo Asmoiates 589 Route 22 Croton Falls, NY 10519 i; ?.;;' Ry;' Field Inspection –LK Fratolli Builders, Inc. Bullcl Hole Rd, (T} Patterson Lot H2, TMO 34. -2 -47 . Deaf Mr. Buschyaski: The above tefeicnced sepsrate sewago trestment system can be backfilled. 'lhn Following comments must be corrected in the field: 1, A pump test needs to be witnessed by this Department -cc the electrical inspection bas bectl ennipletcd and notification of such bas been received by this ..Department.. . If you have any tLriher questions, please contact me at (845) 278 -6130, art. 2261, Sincerely, Qene D. Reed 9R..Environmeh* Keith FAWnecriag Aide GDR:km 11/12/04 FRI 16:21 TEL 914 277 8210 BIBBO ASSOCIATES LLP . o BIBBO ASSOCIATES.'LLP CONSULTING ENGINNERS_p"NNERs Project . Feature I I��►11.1 i 1. I II I f (T D' ✓J' s I I(II � , i r ' I ,.I I f I I 0002 Sheet___,L�{ Designed D*e Checked Date 0 _1 . ,. - -_ Ir - � t. .. l < J71' I _ I f ... .I 0 _1 . ,. 11/12/04 FRI 18:21 TEL 914 277 8210 BIBBO ASSOCIATES LLP - BIBI30 ASSOCIATES, L.L.P. -- . -- .Consutting Engineers - Planners - ......�.�..._.__ FAX TRANSMITTAL 0001 John P. McNamara, P.E. Joseph f, Buschynski, P.E. Timothy S.Allen; P.E.: Leonard J. Bibbo P.E. Robert A. B. Howe, B.S. DATE: To: Ased # -7 k- -79 y FROM' 1�.�'Q'y �/f�'"' /� # (914) 277 -8210 RE: 6C4 -re G4z- MESSAGE: Art- Q/� Tes ry l� _... _ ..... NUMBER OF PAGES BEING TRANSMITTED (INCLUDING COVER): 2— If you do not receive all pages in legible condition, please call (914) 277 -5805, Planning - Site Design - - Environmental S89 Route 22 - P.O. Box 403 - Croton Falls, NY 10519 - -(914) 277 -S80S - (91 4) 277 -8210 Fax 11/01/04 MON 15:09 TEL 914 27Y 9210 b BRUCE R. FOLEY Public RealtA Director bll3Bij .a:7S:u: :IATES LLP DEPAR7 MNT : ()~` HEALTH l • Gen, -,va -toad "Brewster, New ''flrk 10509 PCHD a001 LORETTA MOLINAK R.N., M.S.N. Associate Public !Health Director Director of Patient Services EMST FOR FIELD TESTING ATTENTION; o JOSEPH PARAVATI. : ( GENE REED All information below must be fully completed prior! any scheduling. DATE: ENGINEER OR FIRM: PHONE #: REASON: DEEPS .-` - - -V PERCS: Q PUNT TEST. X ROAD /STREET: I&l� TOWN= _ /�e�1 -- -- - -- - TAX MAP #: 3 G SUBDIVISION: �9 /�i i'1 a1 1%• ! . = , :1� � _ _..... LOT #: R-S � OWNER: i14 ��ff7- � �/�D�'Z£ - -', wilL - a _ yz l NYC )EP CRITERIA FOR JOINT RE` U= W_AND WITNESSIS6 Ob' SOIL TES'T'ING YES .. -:NO.- - ❑ 0 Proposed SST'S within the drainage basin ofWest Branch or $oyds Corner Reservoirs. ❑ W Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake, ❑ W Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ M Proposed SSTS design flow greater than 1d100 gallons /day or SPDES Permit required. ❑ Proposed SSTS for a Commercial Projerc'• It is the responsibility of the design pr'Ofessionet, stn fIxe ahoye infotmation prior to soil testing. This Department will determine the NYi_"DEk prajr z +..st:>Itjtb (Joint or Delegated) based on the response. If you answered 14vs to any c `. the NYCD,EP aaust witness the soil tests. This Department vdll coordiuuate si mutually cwitahlo i 1nF• R?, 1' e.id 1..sting-with the Design Professional and NYCDEP.. :. , If a project has been determined to be Delegawd Ua�:t. r ::a -'kc above response and the. subsequent information indicates NYCIPLP is requilr :d to witness. ':.:..:� <ii. tests, it will be the sole responsibility of the design professional to schodule re-�v fnei�z:!g ef fb ti ?; ".'.esting with NY'CDEP. Fog COUNTY.11 DATE:''- . AA r ' 71 (FIELDTEST) _?F4iaa MFIF I 1q. 1 �7. TF1 '-; -rte^': +' "= '� • -• ` ' K-41! r-OUNT'Y DEPARTMENT OF P. 1 oU) o'* �C6 it 11 cb /A 3 !1 to IEn C x p I i NI N N I �I 4oz Y c / Town Of Water Quality Bu O hj b� ry i 4J.28' 53 0 S5251'52 "WQ,. 5 e= 100.00' 15.11' jj'44 ,yo CS \ Q� 77.0' W d I 5yote o I` L� rn y l N38 55'05 "W 4. `* Z S52- 11.23 "W 64.45, Deck 4 BEDROOM RESIDENCE — — Gravel::;T"� DMH Q) % EXPAN AREA 0' AV \y � N I w I N � G �J Boundary Boundary so ° �� N N (N o O oU) o'* �C6 it 11 cb /A 3 !1 to IEn C x p I i NI N N I �I 4oz Y c / Town Of Water Quality Bu O hj b� ry i 4J.28' 53 0 S5251'52 "WQ,. 5 e= 100.00' 15.11' jj'44 ,yo CS \ Q� 77.0' W d I 5yote o I` L� rn y l N38 55'05 "W 4. `* Z S52- 11.23 "W 64.45, Deck 4 BEDROOM RESIDENCE — — Gravel::;T"� DMH Q) % EXPAN AREA 0' AV \y � N I w I N � G �J _17 7­ ­­: . - - UN-br- I u1mr-MIUM ITEM A B C T-1 15! 24.6 T-2 21.9 16' PO3 26.5' 13.5' DB-4 59.6 51.5' J-5 W 46.6 J-6 W 419 J-7 46' W 41.5'..11.5' TE%-9 1 873 41' TE-10 9T 58.6 TE-1 1 55.5' 86.5' TE-112 34! 86.6 Putnam County Department of Health Division of Environmental Health ServioeE Approved as noted for conformance with -1---app1, ca -.18 RU194--a d Regulations of the P11 0 he al h Departure t. j Signature & Title 7bate' Lot / k 1A