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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -2 -48 BOX 13 I'll IN M '4 T � ti J 1Tti I 'T. ' '. ` i I� �m IN �� I r , 01459 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPI,F,TION RF.PnRT 1W, e 11 Location - Street Address: _ : - - 34 Bullet Hole Road i own/V illage: ]Patterson ax chid. T `_ . . . - - . _ Map 34 Block 2 Lot(s) 46 Well Owner: Name: Address: NBA Development 950 Route 6 Iahopac, NY 10541 Use of Well: 1- primar3r= 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion t Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock _ Other Casing Details Total length m ft. Length below grade 59 ft. Diameter 6 in. Weight per foot 17 lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded X Threaded _ Other Seal: _ Cement grout X Bentonite Other Drive shoe: 1; Yes _ No Liner _ _ Yes _ No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield Test _ Bailed _Pumped k Compressed Air Hours 6 Yield 80+ gpm Depth Data Measure from land surface - static (specify ft) 30 During yield test(ft) 330 Depth of completed well in feet 350 Well Log If more detailed information descriptions or sieve analyses __. ,... -._ ......... _ are available, please attach. Depth From Surface Water Bearing Well Diameteron) Formation Description ft. ft. Land Surface 10 6" Broken Ledge 10 30 611 Hard Granite 30 50 611 Soft Brown Spots t.Pj U . IC_�....._.. r _yard Granite , ' Y T 250 35Q� '? a ,- !` 6" •• trey Hard Granite o---t If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 200 0 Pump Type 5VIf Capacity ai *L, Depth S Model Jr�C(iiP Voltage 1 -30 HP MOO Tank Type / Volume 7601" 1" 350 30+ Date well Completed 3/12/05 Putnam County Certification No. 02 Date of Report I r ature 3/24/05 TJ J C 1.V 1 L'. L ACM L LVVaL1V11 Vl wcll W lul ulbuul :ea tV at MUSt two permanent ianamarKs to ne provlaea on a separate stieevplan.-�,— Well Driller's..Na 11, lli Inc. Address: 75 Putnam Ave., Brewster, N-Y Signature: / Date: 257.3 –01131*- White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINA_RI, RN, MSN - Associate Commissioner of Health January 17, 2008 Mr. Richard Zapp Putnam Engineering 4 Old Route 6 Brewster, NY 10509 Dear Mr. Zapp: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: NBA Development 34 Bullet Hole Road (T) Patterson, TM # 34 -2 -48 ROBERT J. BONDI County Executive ROBER.T._MORRIS, PE -.._ _ Director of Environmental Health This Department is in receipt of your letter dated January 8, 2008, regarding the vent pipe on the septic tank installation at the above referenced property. This Department's regulations and/or State regulations do not require septic tanks which are installed in series to . be vented above grade and for those tanks which are installed in series, a vent pipe only has to be provided between the two tanks above the tank liquid level. -Therefore,-, the-vent pipe- installed - above -grade can--be- cut - and -. eapped .. _Shoald- you:,l.-av-. -a y _..._._..__ questions concerning this matter, please feel free to contact this office. MJB:kly Respectfully, Michael J. Bud, Director of En� Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 UTNAM NEINEERINE, PLLC. January 8, 2008 Mr. Michael Budzinski, P.E. Director of Engineering Putnam County Health Department 1 Geneva Road Brewster, NY 10509 RE: NBA Development 34 Bullet Hole Road Town of Patterson TM #34 -2 -48 PCHD Permit #P -3 -03 Dear Mr. Budzinski, During the installation of the 500 -gallon septic tank in series with an exiting 1000 -gallon septic tank, for the above referenced residence, a vent was installed above grade between the two tanks. The new owner of the property Ms. Rosemond Kissi has complained of foul odor emanating from this vent. Based on our review of Putnam County Health Department (PCH.D) design standards, the tanks need not be vented above - grade. just a.4" vent Pipe between the two tanks is required. We would like'to instinct 'me buiider to eut off and cap the vent to alleviate the problem, however, attorneys for the current owner and builder are involved and have requested a written approval from the PCHD authorizing the removal of this vent. I would appreciate if you could send us a letter that we could forward to the attorneys. Sincerely, PUTNAM ENGINEERING, PLLC chard J. ZpKJ /f RJZ /ea •�/ (L083) 4 Oro RouTE 6, BREwsTER, NEw YORK 10509 • (845) 279 -6789 • FAx (845) 279 -6769 • EmAx: info@putnameng.com Mar 07 07 12:29p TOWN OF PRTTERSO 845- 878 -2019 p.1 $R[10E R. FOLEY pe kk MwO Dtn ~ DEPARTMENT OF MLALTH I Geneva Rmd Brews Wr, New Y41rk 10509 /Me&* PWAC lfSAM DW*da► of P&** SerriM CO3W,, W HMO p14)rn.6130 1=014)2n-Ml tu��t see�so.. 0140 VI.05r wu PM 3n • "70 Fa 0141 2» • 00 F.4fi IMtr� 4, p14)7it -4014 rradvd (114 2T04W Fs (914 37! - finl . OWftRS NAME: TAX i►ZA.1P NITMBER: 3 E911 ADDRESS: CA TOWN: �rcn� � <�� AuTIJoRUMD TOWN OtrXxtclAL. G�-A DATE: .[' Rty prl.Wrtwent of Healtu. wiljj not-issue. a Certificate of _ P _ Construction Com liaaae tioless the above farm is completed, i.e., a legal E911 address is assiped by M tmthotized two official. This forma is to be submitted with the application for a Certificate of Construction ComAsuee. (S911 VUR" PUTNAM COUNTY DEPARTMENT OF HEALT DIVISION OF ENVIRONMENTAL HEALTH SER CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at 34 13 " 4"'W_ 'r2'P Town or Villa ge�c�� --1 Owner /Applicant Name N 311 Formerly Tax Map 3 Block. Z Lot Subdivision Name S "4 Ci RAwi,MI -3 Subd. Lot # 3 Mailing Address I S"V 1Zcnrrti'' (�, tL�14 ,CAA c- 0 �l Zip %O S O Date Construction Permit Issued by PCHD l 13 iv to Separate Sewerage System built by N17A Address c16; 1 - 1 acrd Consisting of 1-- !s vc> Gallon Septic Tank and Other Requirements: Water Supply: Public Supply From Address or: Y Private Supply Drilled by M iLA- I P c- Address '70 ?y>x 3 4n '6 rte. Building -Type ► : -��`t� i Number of Bedrooms 4 Has erosion control been completed? Has garbage grinder been installed? Q-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 o Co epartment of Health. Date: o • Certified by P.E. �< R.A. (Design o ess ) Address 4 G� License # GPI q4 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 White copy - HD Fi change is necessary. `- Title: Date: co y - Building Inspector; Pink copybvner , range copy - Design Professional Form CC -97 PUTNAM COUNTY (DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Loeation " Street Address:'' —._' 34 Bullet Hole Road TOwn/Villa e: Patterson Tax Grid # Map 34 Block 2 Lot(s) 4i? Well Owner: Name: Address: NBA Development 950 Route 6 I•iahopac, NY 10541 Use of Well: 1- primarygm 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion t Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length �j_ft. Length below grade 59 ft. Diameter 6 in. Weight per foot 17lb /ft. Materials: -.I- Steel _ Plastic _ Other Joints: _ Welded X Threaded . Other Seal: _ Cement grout X Bentonite Other Drive shoe: R Yes No Liner _ Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test Bailed _ Pumped k Compressed Air Hours Yield 8o+ gpm Depth Data Measure from land surface- static (specify ft) 30 During yield test(ft) 330 Depth of completed well in feet 350 Well Log If more detailed information descriptions or sieve ana _vses,..:_........._..39 are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 10 6" Broken Ledge 10 30 611 Liar Granite .�.,_..._._�Q_..___�_._.....- .._... .....F,_ -._. _SOft roTIn1.. ,hors. 50 120 6" " Hard Granite „ r 250 350 E0+ 6" Grey :lard Granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 200 0 Pump Type Capacity a, L' Depth a S Model J-CGG' r Voltage '�-3(71% HP Tank Types / Volume —% v�" G � 350 30+ Date Well Completed 3/12/05 Putnam County Certification No. 02 Date of Report 3/24/05 I r ature NOTE: Exact location of well with distances to at least two permanent landmarks to be prdvided on a separate sheet/plan Well Driller's.,N X, lli Inc. Address: 75 Putnam Ave., Brewster, NY Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Page 1 of 1 %� Fn vfronmenfal Services, Inc. 41 Kenosia Avenue V VIATFA, SOIL AND A!A ANALYSIS AA.DanburY Connecticut 06810 I Telephone 203 -798 -2229 NBA Development - Mailing Information: Collector's Information: JMS ID: 052978 Name: NBA Development Name: Joan L. Address: 950 Rte. 6 Address of site: 34 Bullet Hole Road City: Mahopac State: NY Phone: (845) 628 -3060 Sample's Information. Site: Kitchen Tap Preservative: HNO3 Temperature: <4 Matrix: Water Zip: 10541 Fax: (845) 628 -5018 City: Patterson State: NY Phone: Date Collected: 3/5/2007 Time Collected: 11:30:00 AM Zip: Date Received: 3/5/2007 Time Received: 2:15:00 PM Lab No.: J0702052 Date Analyzed Test Name Result MCL Method 03/07/07 Manganese <0.05 ppm 0.3 ppm SM 3111 B 03/07/07_ Sodium 20.8 ppm N/A SM 3111 B 03/05/07 pH 6.8 S.U. 6.5 -8.5 S.U. SM 4500 H B 03/05/07 Color ND 15 Units SMWW 2120 B 03/05/07 Turbidity 0.14 ntu 5 ntu SMWW 2130 B 03/06/07 Hardness 190 mg /L N/A SMWW 2340 C 03/05/07 Odor 1 mg /L N/A SMWW 2340 C 03/07/07 Iron <0.05 ppm 0.3 ppm SMWW 3111 B 03/06/07 Chloride 68 mg /L 250 mg /L SMWW 4110 B 03/06/07 Nitrate 1.62 mg /L 10 mg/L SMWW 4110 B 03/06/07 Nitrite <0.05 mg /L 1 mg /L SMWW 4.110 B 03;0 - 6/07- ....__. :.... _ .Sulfate •- - - - .- .. .. �.._.i7`.�'nigiL - �-- -- - -- 23G..rng /L._....SMWW 41106 03/05/07 Chlorine Free Residual <0.1 mg /L N/A SMWW 4500CIG 03/05/07 2:30 PM E. Coli Absent Absent SMWW 9223 B 03/05/07 2:30 PM Total Coliform Absent Absent SMWW 9223 B Comments: At the time of the analysis the sample was Acceptable for Total Coliform At the time of the analysis the sample was Acceptable for E. Coll CFU = Coliform Forming Units MCL = Maximum Contaminant Level mg/L = milligrams per Liter N/A = Not Applicable ND = None Detected ntu = Nephelopmetric Turbidity Unit ppm = parts per million S.U. = Standard Unit Units = Units Signature: N4464 _ Reviewed By: Michael Lapman Sharon Houlahan, Director President State #: PH -0218 ELAP #:'11715 CONNF-CTIGUT. NEIN YORK Aa ID NELAjC' CERTIFIED Toll Free 886- JMS -5087 1 Corporate Fax 203 -798 -2408 1 Lab Fax 203 - 798 -2107 I www.jmsenvironrrental.com PUTNAM COUNTY DEPARTMENT OF HEALTH _. _.. h..., �. , -:D�� :� O=,N-- O:F-- ENVI.�RONMEN'1'A�:_� �A ?- - - - ��Vlc,- ES. GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser o Building Tax Map Block Lot Lxa 2 Building Constructea by TownNillage Location - Street cT Subdivision Name �& 1�11\c? '&h, � 1�v�►e. � -3 Building Type Subdivision Lot # I represent that I am wholly and completely 'responsible for the 'location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the. building utilizing the 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 03 Day 0-7 Year o O� zi Lx__� __7 :�� — — --- . _ General Contractor (0 er - Signature Corporation Nam (if corporation) Address: J le A State 0 \,ek,, Zip 0 S q Signature:. Title:. T�Lh Corporation Name (iffcorporation) Address: State Zip Form GS -97 UTNAM IVGINEEa , PLLE_ Eng/neers ancts SEPTIC SUBMISSION FORM TO: �LK_ / ?vt�3, s rc,; DATE: PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: ENCLOSED, PLEASE FIND: COPIES OF THE SSDS "AS- BUILT" PLAN CONSTRUCTION COMPLIANCE CERTIFICATE WELL LOG lam' HEALTH DEPARTMENT FEE ($300.00) X-W-- ANALYSIS GUARANTEE FORMS - 3 ORIGINALS �E 911 ADDRESS FORM ❑ LETTER OF EXPLANATION REMARKS: I COPIES TO: SIGNED: (SepSubFo= -2M) 4 OLD RouTE 6, BREWSTER, NEw YoRK 10509 - (845) 279 -6789 - FA x (845) 279 -6769 - EMAIL: puthamengineering @rcn.com SHERLITA AMLER, MD, MS, FAAP Commissioner, of Health LORETTA MOiLINARI, RN, MSN Associate Commissioner of Health Paul Lynch Putnam Engineering 4 Old Route 6 Brewster, NY 10509 Dear Mr. Lynch: ROBERT J. BONDI County Executive - - ROBE RT'MORRIS PEW¢' Director of Environmental Health DEPARTMENT- OF HEALTH I Geneva Road, Brewster, New York 10509 November 29, 2006 Re: Field Inspection — NBA Development Bullet Hole Road, (T) Patterson TM # 34. -248 The above referenced, separate sewage treatment system can be backfilled. There are no open comments to be addressed at this time in reference to the open work filed inspection. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Very truly yours, �k Gene D. Reed Environmental Health Engineering Aide GDR:kly Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early InterventioniPreschool (845) 278 -6014 Fax (845) 278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: o Street Location o - Inspected by: < �� OVSPr._ _ 'Town :fie Permit # lup p h TM # 3ry., _ 2- _ [yc g Subdivision Lot # 3 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 ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water tours tlands ........................... ... II. SewaLre Svstem , a. Septic tank siz - 1,000 1,250.........other -�.. °v b. � Septic'tank irist evel ............................ ":.% " 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. Trenches 1. Length required 5- 7 / Length installed 7 / 2. Distance to watercourse measured 4- 10,9 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 d .......... ... _.__9 Pu.mD.or-Dose . vstemg.: -. :z.__�,�:.._ 1. Size of pump chamber ................ ............................... 2. Overflow tank ............................. ............................... 3. AlarrnvisualAlaudio ........:........... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. C�yycle witnessed by H.D.estimated flow /cycle........... M. House/Buildine a. House located per approved plans.... b. Number of bedrooms... ...... ...................... ; .............. IV. Well o►a vs o Well located as per approve plans.. ...:? Distance from STS ar easured - c. Casing 18" above grade ................. ............. ........ ......... d. Surface drainage around well . acceptable ....................... V. Overall Workmanship . a.. Boxes properly grouted. .................. ............................... b. All pip y backfilled ... ............................... c. All pip th 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 watercourse g. Footing drains discharge away from STS area............ 0 h. Surface water protection adequate.... ....:., ........................ �.: i. Erosion control provided ................. ............................... Rev. 12/02 i • 1 MITI i% LM MOM— �'. WAS r =1VAIK�lll . 0 W PERAWr -►�� �� 7 0 = INE /OWNS mm— - ONI 1 11/15/04 MON 17:12 TEL 914 277 8210 BIBBO ASSOCIATES LLP 001 a d PUTNAM COUNTY DEPARTMENT OF BEALTH DMSION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION ❑ JOSEPH GENE REQUEST FOR FINAL INSPECTION For: Fill /V All information must be fully completed prior to any Trenches inspections being made. D PCHD Construction Permit # 1 -' 3 - 03 Located: 3q 6h /k. /- %/o%. RA (T) (V) e 7TEe,5&d Owner /Applicant Name: 1W4 1)&W 4,ve -vf TM •3 Y Block Z Lot 4P� Formerly: Nwk► "A. hb•,,s Subdivision Name: o 41&A4 4 4v Subdivision Lot # _ Is system fill completed? Date: Is system complete? (V' Date: /! /, 5 � 0-- Is system constructed as per plans? -� Is well drilled? /UO Date: J1 /.rld `f Is well located as per plans? Are erosion control measures in place ?� _ I certify that the system(s), as listed, at the above prenuses has been constructed and I 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 - Date: 40014 /14- 90al- Certified by: - PE � RA Design Professi nal Address: Q'6Eo.iSnr_is / /!'. Z?- Lie. PO 4301E Y031 Grp, /W--1 C,/ /f ,Uy _- Comments: Form FIR -99 A ' D 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 Joseph Buschynski Bibbo Associates Mill Pond Offices 293 Route 100, Suite 203 Somers, NY 10589 Dear Mr. Buschynski: November 22, 2004 ROBERT J. BONDI County Executive Re: Field Inspection — NBA Development Formerly SMG Gramatan Bullet Hole Rd. (T) Patterson, TM # 134. -2 -48 The above referenced separate sewage , treatment system can be backfilled. - The following comments must be corrected in the field: 1. Cleanouts must be installed per the approved plan. 2. Pipe sleeve under the drive needs to be exposed for inspection. 3. A bedroom count must be performed by this Department upon further completion of construction. 4. The well must be inspected by this Department upon completion. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Sincerely, Gene D. Reed i SR. Environmental Health Engineering Aide GDR:km 11/27/2006 ROT 14:70 FAX 434 PCHD PUTNAM COUNTY DEPARTNWgT OF HEALTH DMSION OF ENVIROT'NMN'Y': HE Tit SERVICES ATTENTION Q JOSEPH GENE RF(�t1FST FOR PiNAL INSPECTION For: Fill All information must be fully completed prior to any Trenches inspections being made. 16002/002 PCHD Construction - Permit # ? s —o3 r� Located; 3A &, , r^- 4"u (T) (� B 'T 1 ILrt'o N3 Owner /Applicant Name: tibP.- TM �_ Block Z- Lot 4e� . Formerly: i.1IA- Subdivision Name: �.�. Subdivision Lot Is system fill completed? _ Date: Is system complete ?' `� � Date: _ I� -z 1142 .a - - Is system constructed as per pleas? Is well drilled' Date: Is well located as per plans? +� Are erosion control measures in,place? I certify that the system(s), as li sted, at the above premises has been constructed and I have anspecttd and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Staaduds, Rules and Regulations of Co Department of Date: �g-11g(a Certified by: v — - Desigp Pr Address: 4v-%L -b ; fr to Lic. # 042`1 1(.V-- b 'Sa Comments: i,��SP �-t`►��.►G?���'"� n- �1�.J Sc��c� Form Flk -99 rn .oilc_�7q_7ga9 NAMF:PUTNAM COUNTY DEPARTMENT OF P. 2 PUTNAM COUNTY DEPARTMENT OF HEALTH (g. - -'DIVISION OF ENVIRONMENTAL HEALTH SERVIC: CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # P" 3 -0 3 Located at '3L} 'i3iJL-LE," Town or Village Subdivision name 5 en wt Am ", ubd. Lot # 2 Tax Map '34. Block `Z Lot 46 Date Subdivision Approved � 1 Z 0 1 Renewal Revision Owner /Applicant Name N 13 A i &-C, Date of Previous Approval Mailing Address PL�Cvr�- to tom' ,Y Zip y S� Amount of Fee Enclosed 26 Building Type FMiYW�At— Lot Area a, G No. of Bedrooms 14 Design Flow GPD &OZ,7 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System t�nsist of 1 o tro gallon septic tank and -1 1--� Other Requirements: J C�Z �;hc —r'v (aJ,tJc�7r� �'�''`'� ' `' 7W To be constructed by N 0 n Q r �� Address f D Water Sunnly: Public Supply From Address ,..__or• ._-. � Ari�r�P c „p�.ly.L�*�llPd by l�t!(� ,..�._ �,�- !�.�,►.? �_. _ _,...�- _ dilrocs_. _. ?. _ . , . ^. I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance” satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs theret_� Signed:`_ Address 4+ u o P.E. R.A. kj-% License # Date I I Z� v (r7 (fq(1--1- APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modifie4 when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new p rmit. Approve for discharge of domestic sanitary se wa a only. 9 � By: ' Title: Date: A White copy - HD FVe; e o copy - Building Inspector; Pink copy - Ow er; fran copy - Design Professional Form CP -97 pUTNAM ENGINEERING, PLLC 4 Old Route- 6 - - _ Brewster, New York 10509 Phone: 845- 279 -6789 Fax: 845- 279 -6769 e -mail: putnameng -com TO: Date: - RE: AJ 9A l P/E Job: 4o7 L We are sending you Zattached under separate cover, the following items via U. S. Mail, Overnight, Hand Delivery, Pick Up: Originals Reports Plans Prints Photographic Exhibit Specifications Colored Prints Other: These are transmitted: REMARKS: For approval _. Approved as submitted For your use — Approved as noted As requested _ Returned for corrections For review /comment — Resubmit copies for approval Submit _ copies for distribution &zj-s 1,V1 17- f- 0 Copies to: SIGNE _�� a, TOWN SIGNATURE SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI;'RN;-MSN" Associate Commissioner of Health Paul Lynch, PE Putnam Engineering DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 November 7, 2006 ROBERT J. BONDI County Executive ,ROBERT MORRIS, PE ' Director of Environmental Health 4 Old Route 6 Brewster, New York 10509 Re: Proposed SSTS Revision for NBA Development Lot # 3, SMG Gramaton R.S. (T) Patterson, TM# 34 -2 -48 Dear Mr. Lynch: This Department has received and reviewed the submitted application and plans for the above referenced project and the following comments are offered for your consideration. ✓ 1. A four (4) bedroom SSTS design requires a minimum septic tank volume of 1250 gallons. The submitted plans and permit specify a 1000 gallon septic tank which is unacceptable. Z2. The locations of the percolation and deep.test holes are.to be shown on the plan. -- - — - " - 3. 'Aseptic tank detail is'to' be added to E6 plan. _ _. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. MJB:cj Respectfully, buk i Michael J. Director of Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Located at T/V c ,on�c ;c� Tax Map # �1 y . Block 'I Lot Subdivision of Subdivision Lot # fled Map # Z-67-7 Date Filed Gentlemen: This letter is to authorize Pula -rr�su � 1,1—; �' S ��U% --c a duly licensed Professional Engineer - ->,e_4xRegistered 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 tretment and/or water supply systems in conformity with the provisions of Article 145 147 of the Education Law, the Public Health -J Law, - aiid the' Putnam Cou ode: - Very truly yours, = a}: 8 Countersigned: Signed: P.E., R.A., # �% �'' 1O ner of Pr rty) Mailing Address q . &tom t?4 -t,4 r-6 Mailing Address: State Zip , M o -( Telephone: State . `� Zip 1u Telephone: V 7V — To&ci Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIlikVif CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: T C_C% represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: Having offices at: 9 <0 k Whose Officers Are: President - Name:— L"'Y.W, CNN,--x - \_SAq'r' Address: Vice President - Name: Address: Secretary -Name: -Address:, Treasurer Name: Address: 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 thereto. Signed.-, Title: �w Ito L7 efo me this 4, �b day of Notary lic _ (year) i G. CAREY State of New York Qualified In"' Commission Expire M�l Form CA-97 Corporate Seal November 3, 2006 Michael Budzinski, P.E. Putnam County Health Department 1 Geneva Road Brewster, NY 10509 RE: NBA Development SMG Subdivision, Lot #3 Town of Patterson TM #34-2748 Dear Mr. Budzinski, In response to your letter of October 24, 2006, 1 include the following for your disposition: 1. Construction Permit Revision fee in the amount of $250.00 2. Construction Permit Application 3. -Letter of Authorization / Affidavit= Corporate Owner 4. Application for Approval of Plans for a Wastewater Treatment System Sincerely, PUTNAM ENGINEERING, PLLC Paul M. Lynch, P.E. PML/EA Enclosures (L06351) 4 OLD ROUTE 6, BREwsTER, NEW YORK 10509 o (845) 279-6789 o FAx (845) 279-6769 o EMAIL: info@putnameng.com PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR ._: _..._...�... _.- ..�.....�. _ A WASTEWATEY2 TREATMENT SYSTEM 1. Name and address of applicant: - N 131\ Pr .v ;, L 1- ttkAn y_11l__1( VI y - - 1 v -L 41. 2. Name of project: 4-r- 3 - SkA 3. Location TN: 4. Design Professional: _��ru„ F—,i i J, ( c 5. Address: y o i p 6. Drainage Basin: w IPrx.a_;:r m)4& -c4t � u . �, �, 7. Type of Project. Private/Residential Food Service Commercial Apartments Institutional T Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review:,(SEQR)? Type Status (check one ) .......... :............................................ Type I Exempt R . 9. Is a Draft Environmental Type II-7 Unlisted vironmental Impact Statement (DEIS) required? p 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. officials ordinances9 - ' • •••••••••••••••••••.•.......... e+ a... nq• Ceee.. �... a. a. a+..« c.. �ar9� .l.wrca...rra'19a:Pi.�::!"^•- 13. If so, have plans been subriiitted -to such authorities? 14. Has preliminary approval been granted by such authorities? )L5 Date granted: 15. Type of Sewage Treatment Sy stem 'Discharge ................. surface water Zgroundwater 16. If surface water discharge; what is the stream class designation? .................... 17. Waters index number ( surface) ......... *............... ...... ........ ........ .... ............. ... .�. 18. Is project located near a public water supply system? ...... ....................:.......... 19. If yes, name .of water. supply Distance to water supply 20. -Is project site near a public- sewage collection or treatment system? ................ SU P 21. Name of sewage -system Distance. to sewage system 22. Date test holes observed 1111 23.. Name of Health InspectornAm,,, Tt r,,at2 c� 24. Project design flow (gallons per day) ............... 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 1;57 26. Has SPDES Application been submitted to local DEC office? NA Form PC =97 2 -27. Is any portion of this project located within a designated Town or State wetland? 0 218.. Wetlands ID Number... - - - ..................:.. . . . :.: 29. Is Wetlands Permit required? ............ ... d . Has application been made to Town.or Local DEC office? ......................... 30. Does project require a DEC Stream Disturbance Permit? ................ . )} 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/No i O 32. Is project located within 1,000 feet :of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No I'y 'DESCRIBE: C, 33. Is there a local master plan on file with the 'Town or Village? . ..� 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ............. ....................::......... . 35. Are any sewage treatment areas in excess of 15% slope? . ........- .:......... ti?7 36. Tax Map ID Number .......................... ............................... Map 3q _ Block Z. Lot 37. Approved plans are to be returned to ..... Applicant Design*Professional - NC .—A– IIapplications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within -the watershed may also require DEP review and approval,of other.aspects of a project, such as stormwater plans or the creation . of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item 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 afrm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief.. False statementss made herein are punishable as a Class A misdemeanor pursuant to Sect' w. SIGNATURES & OFFICIAL TITLES. Mailing Address: .. ..4 ............. ::..:�`......... SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LOkEl "iA- MGiLINAki -, RN ; -MSN Associate Commissioner of Health Mr. Paul Lynch, PE Putnam Engineering 4 Old Route 6 Brewster, New York 10509 Dear Mr. Lynch: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 October 24, 2006 ROBERT I BONDI County Executive - itORERT- MORRIS, PE - 7 - Director of Environmental Health Re: Proposed SSTS Revision for NBA Development SMG Subdivision, Lot # 3 Bullet Hole Road (T) Patterson, TM# 34 -2 -48 This Department has received the submitted engineering plan'for the above referenced project although your submittal is deemed incomplete. Please submit the following items to complete your application: Construction Permit revision fee in the amount of $250.00. Construction Permit application form. vs. Letter of Authorization. t. Application for Approval of Plans for a Wastewater Treatment System. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. MJB:cj Respectfully, Michael J. Director of Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early InterventioniPreschool (845) 278 -6014 Fax (845) 278 -6648 m PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # r-3-03 Located at �' /�%` /'�'' e Subdivision name' /V6-��ic.;f,s , Subd. Lot # Tax Map. Block Lot Date Subdivision Approved A"ri!Z 02e:;r/ Renewal Revision Owner /Applicant Name Mailing Address Amount of Fee Enclosed 1' 3_t7 o Date of Previous Approval Zip 4� �,Vc-,Op Building Type / rvV/ . Lot Area No. of Bedrooms �7 Design Flow GPD G4570 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of rpp Ca gallon septic tank and v? �.f. Other Requirements: To be constructed by Address Water Supply: Public Supply From .., or., ..... _ _. Address _ riva c-S'upplly ir:"cd uj - 2 55 _ I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the se arate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said buildet 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: ,ki" P.E. R.A. Date Z=19--03 LLp s—f ��y7`� z z License # o � _X* ¢03 ; e y_, rP;-, / -a / /s/ /-11 / 01.4117 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage trea nt system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modifie hen consider- necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new p it Approv or discharge of domestic sanitary sewage only. By: 4 Title: ,/� Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Arofessio Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL '} ple'as�piinl•ortype " ' - Well Location: Street Address: Tax Grid # ®Town/Village ` /� �/ /�1• G gn5ali Map ,3f, Block Z Lot(s) ,fg Well Owner: Name: Address: Use of Well: 4,/ 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 rt gpm # People Served __ Est. of Daily Usage 3 GSA gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling 41 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 F1 No Name of subdivision ,S'/� -j�' -- �'j'a� 7°r�� S� ��. Lot No. Water Well Contractor: % ; 01- a, Address: Is Public Water Supply available to site? .................................. ............................... Yes No a✓ 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: _ % _ G- G?, Applicant Signature: 7 ©,; �c,) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. revision or alteration of the approved plan requires a new permit. Well to be constructed by a water ell ller ce ified by Putnam County. Date of Issue l 3 Permit Iss Official: Date of Expiratio _ -1 1L) Title: Permit is Non- Transf rrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 BRUCE R FOLEY �r � � LORETTA MOLINAR1. RN.,'1vLS.N:' Public- Health to —r .. _ d Assodate.- P_ublic._Heatth. Director. _ -�, Director of Patient Sery ices DEPARTMENT OF MALTH . 1 - Geneva Road Brewster, New. York � 10509 Environmeatal Health (914) 278 = 6130 Fax(914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278' - 6678 Fax (91.4). 278 -:6085 Early Intervention (914) 278.- 6014 Preschool (914) 278 -6082. Fax (914) 278 - 6648 TO: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM JOINT REVIEW PROJECT: (¢E" TOWN: �JA BLS REVISION DATE: rhi, lo3'.. (]TREV2, 'd AO iN3WidUd30 AiNnoo WUNind:3WUN T26,L-6L2-SI7t3"- W-L trobw 10.3 .1_WWQ_VP - UVVq Marc-h 12, Robert Morris, P.E Putnam Co, Health Dept. ::4f:,:: 4 Geneva Road .K 'v Brewster, NY 10509 e - R North County Homes, s, lot 3/Gramatan Subd./SMG 34 Bullet Hole Road Patterson, Putnam Nfiddle Branch Reservoir DEP Log # 13828 (Joint Review) Dear Mr. Morris: This letter is to inforin you that the New York City Department of Environmental Protection (Department) has determined that the above-refe renced application is complete. In addition, the Department 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 "SDS property of North County Homes", dated 1116103, and last revised 313103. The applicant must contact Sissy De La Ona. of my staff at (914) 773 .4416 at -that a.Department leassf .2'da�ys pner to the. start f conStryl A, ft art c On o—he SSTS so representative may inspect and monitor the installation, a Sincerely, Danny Shedlo, P,E. W Project Manager Engineering Design &Review xc: James Covey, P-E, NYSDOH U ZO'd 20:TT io, ZI JPW 2V20-�IZ-VWX2J 9NId33NI9N3 d3a DAN 131660 ASSOCIATES LLP 589 Route 22 — Box 403 CROTON FALLS, NEW YORK 10519' (914) 277 -5805 FAX '(914) •277= 8210::. _....... TO WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via • Shop drawings • Copy of letter ❑ Prints ❑ Change order ❑ Plans ❑ 0.19VVIM @1P DATE 3 -3-03 J08 NO. AT7EN.T10LVti.. _ RE: For TS'o�� sf J is %f t�i fc / gr! approval the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION For J is %f t�i fc / gr! approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution CzYAs requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US THESE ARE TRANSMITTED as checked below: - For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution CzYAs requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS 7a mss' e az ' s-M? - p3,S'" 1/C ,se A-9 / ' � r 71 e- o 71f c71i %1`i&- COPY TO SIGNED: If enclosures are not as noted, kindly notify us once. T 'd 30 1N3WIdbd30 AiNnoo WUNind :3WUN ��b� ata -5w • ��l _ i--1 Fax Operation and Englneexinb Oi`'ision Cover e e,. .. - -. • .. a -. - Y ..._ —1..a...�..___�,. .......r.... __.. BRUCE R. FOLEY _.. Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health .(845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278.6014 Fax (845) 278 - 6648 Bibbo Associates 589 Route 22 Croton Falls, NY 10519 RE: North County Homes 34 Bullet Hole Road, Lot 43 (T)Patterson, TM# 34 -2 -48 Reservoir Basin Dear Sir: February 24, 2003 The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on January 22, 2003 is complete. The Department will notify you by March 12, 2003 of its determination. x,- -`- ❑ 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 aproj ect, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of V; --etterlo: Bibbo- Associates -J ebruary-244, 1 =ZG03 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) 278.-.6130 ext. 2166. Very y you s l. Robert Morris, PE RM:tn Senior Public Health Engineer 616130 ASSOCIATES LLP ' 5803-Route 22 - Box 403 CROTON FALLS, NEW YORK 10519 (914) 277 -5805 FAX (914) 277 -8210 To �, CoLi��y ��/��i Z2*27`r WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via _ ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ DATE -^� JOB NO. •ATTEN 'OFJ -... RE: ze��,3 �+- ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION �+- ZA �2� �s THESE ARE TRANSMITTED as checked below: .._ . .._ .. ..... - -- or approval � •- ❑ For your use > ❑ As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS ❑ Approved as submitted ❑ Resubmit ❑ Approved as noted ❑ Submit _ ❑ Returned for corrections ❑ Return _ —copies for approval —copies for distribution corrected prints 19 ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO SIGNED: N enclosures are not as noted, kindly notify Vs at once. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL, HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Located at�c� T/V ZZ&rs'd� Tax Map # Block o2 Lot Subdivision of Subdivision Lot # ,� Filed Map # e 7 7 Date Filed Gentlemen: This letter is to authorize ;Iv,&P /- SSoG"';5; Z G a duly licensed Professional Engineer 4--1 or Registered Architect to apply for the required wastewater treatment and/or water supply pefmit(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 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Very truly yours, Countersigned: Signed: ✓ P.E., R.A., # �7-3— 12 g- ner o Property) Mailing Address J;��%/,f�z,7e .2 Z State /1%y Zip Mailing Address:rfLi Co�h75 17GAW S State A43, f Zip %_5�e9 Telephone: %/ - 7 7- ,S ,60,5"_ Telephone: 7 /_f" - oZ 1W - LSj 4 C 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: represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: Having offices at: 't S Whose Officers Are: President - Name: Mky& _9. Address: \ S (�, Vice President - Name: Address: Secretary -Name: -Vk �S , iV 9 /e.5:�9, Address:.._ Treasurer - Name: Address: 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 thereto. S rn to 6t, before me this � day of (mont 2(ju (year) Nota R08ER1 L. CECERE Notary Public. State of New York No. 60- 0606425 County / Qualified in Wes Term Expires ., Fomi CA -97 Signed: Title: -,e5 Corporate Seal 1416.A (2/87) —Text 12 PROJECT I.D. NUMBER 617.21 Appendix C _ _ ........ _ .. _.. -3: ate- Fnrlroamental- OtraJty- Rbvfew SHORT. ENVIRONMENTAL ASSESSMENT For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) FORM SEAR 1. APPLICANT /SPONS R 2. PROJECT NAME. / �0 3. PROJECT LOCATION: Municipality Gj %flciy��j7 County 4. PRECISE LOCAT_t I..O (Sttrr4et address and road Intersections, prominent landmarks, etc., or provide map) 5. IS PROPOSED ACTION: . 'a New ❑ Expansion ❑ Modificationlalteration 6. DESCRIBE PROJECT BRIEFLY: �. /J 7. AMOUNT OF LA D AF 'ECTED: Initially acres Ultimately acres B. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ❑.No No, ,Yes If describe briefly 8. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? 0 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)? ly Yes ❑ No If yes, list agency(s) and permitiapprovals 7' 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? & y Yes ❑ No If yes, list agency name and permlUapproval 12. AS A RESULT LF PROPOSEDACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE AplicanUsponsor me: ���' CU�� y °� e' s Date: Siplature: 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 ?'ART 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 ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by, another involved agency... - - - -_,:._ . -•...• ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explain briefly. C5. Growth, subsequent development, or related activities likely to be Induced,by the proposed action? Explain briefly. CIO •"t C6. Long term, short term, cumulative, or other effects not Identified In C1-05? Explain briefly. N r C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. r .. D. IS THERE; OR- IS- THERE-LIKELY TO BE; CONTROVERSY RELATED TO POTENTIAI�ADVEIa$E ENVIRONMENTAL IMI?AOIS? _.__ ._____ ....._.., ❑Yes ❑ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether it Is substantial, large, important or otherwise significant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed. ❑ 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: Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Name of Lead Agency Date 2 Title of Responsible Officer Signature of Preparer (if different from responsible officer) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES J ' /I ,_.:.::....._. _ _ .... _........... _ .., . AP- PLICATION F OR-A-PPROV-Ai; OF PLANS, FORS.._. _ _ _... _ _ _ _ A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: /1c,w lS � 2. Name of project: , �Sti'�' -�,�,� �f 1, 3. Location_TN: 4. Design Professional: , /� aiS'ac s',C3 5. Address:�7`� 6. Drainage Basin: 7. Type of Project: Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEAR)? Type Status (check one) ....:.................. ............................... Type I Exempt Type II / Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 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? ........ ............................... e S 14. Has preliminary approval been granted by such authorities Date granted:/45�,G 15. Type of Sewage Treatment System Discharge ................. surface water --"' groundwater 16. .If surface water discharge, what is the stream class designation? .................... 17. Waters index number (surface) ..............:............................ ............................... 18. Is project located near a public water supply system? ....... ............................... 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? .................. . ............... Na 21. Name of sewage system 22. Date test holes observed 23. 24 25. Distance to sewage system Name of Health InspectorAza,� J- / c��tiy Project design flow (gallons per day) .......................:......... ............................... 6-1� Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? ......................... /t"14 Form PC -97 27. Is any portion of this project located within a designated Town or State wetland? O 28..... Wetlands.ID_Number. ,... .. .. ........... - ..._ :�• 29. Is Wetlands Permit required? ................ ......... lb)O Has application been made to Town or Local DEC office? ........... 30. Does project require a DEC Stream Disturbance Permit? .. ............................... 4 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 O 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 lua DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... Y 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... 35-.- Are any sewage treatment areas in excess of 15% slope? . ............................... /1110 36. Tax Map ID Number .......................... ....................... .I....... Mav,7*- Block Lot 8 37. Approved plans are to be returned to ..... Applicant Design Professional —NQTE;,E ll.:applicatisins_fnr reviPw.and_appreYal_bfa.nevi, SST.Sto be,!ocated- Zvi +lur. the I�TVr:�xzafe� shed sha.?1- - - 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 activ6es 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 tree - 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. Mailing Address: ................................... fe 2 ;Z AV �J l� E i o j4 ` 3 ry PO co W LO CN LAJ w mil ' j ;oa Qo / 11 WI !I N I. � .y � �I XI : N t LO 0 M N WI d 0_ co IS ici- LLI `I . is �. !/ i ,,, .> ,/ , � �' • •J p Lo PLI, j . M CZ 0 0 �o 53$: H AS -BUILT (EXISTING) OFFSET DIMENSIONS # ITEM "A" 113 ,; „^„ JB 67' 78' 30'..(1�_. JB 2 ST -0 - 22.5' 49.5' 3 JB 61.5' 84' - 4 JB 61.5' 86 �5' - 5 JB 62' 89' - 6 JB 63.5' 91' - 7 JB .64' 93' - 8. JB 66' 96' - 9 TE 38' 70' - 10 TE 21' 52' - 11 TE 20' 52' - 12 2 TE 23' 53' - 13 TE 29' 56' - 14 TE 33' 57' - 15 TE 86' 111' - 16 TE 92' - 17 TE 98' 18 TE 103' 129' - 19 TE 110' - 20 TE 95' 124' - 21 CO 39' 7.5' - 47.5'... 57,: - 65 -BUILT NOTE: THE EX15TINS 424 LF 5ST5 FIELDS MERE "FIELD MEASURED BY BIBBO ASSOCIATES, LLP 584 ROUTE 22, C,ROTON FALLS NY AS -BUILT (NEW) OFFSET DIMENSIONS , # ITEM "A" p 23 JB 67' 78' 24 JB 70' 80' 25 JB 74' 82' 26 TE 99' 27 TE 96' 109' 28 TE 94' 108' 29 TE 49' 52' 30 TE 5UR1�Y NOTE: TOPOGRAPHY AND, BOON SUBDIVISION PLAT OF PF ASSOCIATES AND SMG L PREPARED BY: DONNELL 1424 COMMERCE STREET, DATED: AUG. 26, 2004 AS -BUILT NOTM: I. THIS. 15 TO CERTIFY TH, AS INDICATED ON THIS Pl ENGINEERING, PLLC BEFOI CONSTRUCTED IN ACCORI OF THE DUTCHE55 COUNTI DEPARTMENT OF HEALTH. 2. THE 55T5 CONSISTS 01 1000 GALLON PRECAST