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HomeMy WebLinkAbout1462DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -2 -51 BOX 13 i' , In IL J ;'f . kw! Ll Be ' ' 01462 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ' p �We1163Perm�t # +� .'— .+ -,Tn e•5 "sj/ r'ry' a� 4tr �WELL COMPLETION REPORT A06 Well Location See s: Town/Village: 'Map Tax Map # ,'¢ Block a2 Lot(s)S% GPS Measure from land surface -s Well Log If more detailed' Information descriptions or sieve analyses are available, please attach. Well Owner: Name: ' Address: nun N Land Surface Use of Well: 1- Primary 2- Secondary _Residential _Public Supply Air cond /heat pump _Irrigation Business Farm Test/monitoring —Other(specify) Industrial Institutional Standby Drilling Equipment Rotary _Cable percussion> Compressed air percussion_Other(specify) Well Type _Screened _Open end casing.-k Open hole in bedrock _Other Casing-Details Total Length nft. Length below gradeVt. Diameter 7 in. Weight per foot 1b /ft Materials: Steel Plastic Other Joints: Welded . Threaded Other Seal: Cement grout Bentonite Other Drive shoe: Yes _ No Liner: _Yes No Screen Details Diameter (in) Slot Size I Length ft De t to Screen ft Develo ped? First Yes _No If yield was tested Feet at different depths during drilling list: Air (Hours 6 Mel Hours aam ice y Well Diameter (� Water Bearing (in) Formation Desci ns Per Minute Pump /Storage Tank Infc Pump T pe Capac Depth Did Model Voltage 2-V HP- Tank Tvoe 101 W/kfd Vol-5 on NOTE: Exact Locatio o ell with distances to at least two permanent landmarks to be provided on a separate sjet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 on Second Well Yield Test _Bailed _Pum Depth Date Measure from land surface -s Well Log If more detailed' Information descriptions or sieve analyses are available, please attach. Depth From SL ft. Land Surface co If yield was tested Feet at different depths during drilling list: Air (Hours 6 Mel Hours aam ice y Well Diameter (� Water Bearing (in) Formation Desci ns Per Minute Pump /Storage Tank Infc Pump T pe Capac Depth Did Model Voltage 2-V HP- Tank Tvoe 101 W/kfd Vol-5 on NOTE: Exact Locatio o ell with distances to at least two permanent landmarks to be provided on a separate sjet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 on PUTNAM ,COUNT' DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE. SEWAGE TREATMENT SYSTF,M Owner or Purchaser of Building Tax Map Block Lot� Building Constructed by Town/Village as Location - Street Subdivision Name Building Type Subdivision Lot 4 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 operateproperly 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 j'� Day oZ Year 25;711 Signature: r Title: _ �2 gene 1 Co tractor( er) - Signature Corporation Name (if corpora ' n) c Corporation Name (if corporation) Address: J ` Address. State` - � Zip � State Al- ZiP �vTD -� Form GS -97 PUTNAM ,COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map Block Lot S Building Constructed by TownfVillage a s -/r#f0100/zf. T � i�� 62¢11A97-Wel-J Location - Street I Subdivision Name As",O& 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 Day Z Year 2O // Signature: r Title: p2lp�, Contractor (CJ.-Ohier) - Signature Corporation Name (if corporatibn) Address: State' -� `��1�5 r `' Zip j J��ell -A<L, Corporation Name (if corporation) Address: &fee -y < -7 State Aj- Y` ZiplU =9 Form GS -97 PUTNAM,COUNTX DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE. SEWAGE TREATMENT SYSTEM 'NOvf� Ol�il'�f — Z�'JC- 3 y °Z. c.5_1 -� — Owner or Purchaser of Building Tax Map Block �t 1�vC Building Constructed by Town/Village ova t�oDo��. T /L G /ri W__)9 Location - Street �Y. Subdivision Name 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 Nt Day Year COI/ Signature: r Title: tractor (O.-Wner) - Signature Corporation Name (if corporaitibn) Address: 614J `�'L�"y "' ng Zip oS Corporation Name (if corporation) Address: %�AeQJ s/ �2 State Aj` �4 Zlp /oT� -`� Form GS -97 BRUCE R. FOLLY Public Health Dirwar Associate Public klealrh Director Direeror q% Palfc111 5ervicca DEPARTMENT OF HEALTH I Geneva Road' )Brewster, New York I0509 Eaviranmcatyt Healih (914) 278 - 61311 Fax (914) 278.7921 Nursing 5crvicci (914) 278 - 6933 NYiC (914) 278 - 6678 Fax (914) 278 -6085 Early lntcrvctdtlou (914).273.6014 Freschool (914) 27&6032 rqx (914) 278 -6648 OWNERS NAME:. TAX MAP NUMBER: E911 ADD RE SS: e� � 'S � �o� p(�� "C'RP►1L T0NVN: At7THO=E, D TOWN OFFICIAL - (Siguature) DATE: r'/ The Putnam County Department of Health. will not issue a Certificate: of Construction Compliance unless the above farm is completed, i.e., a legal E911 address is assibned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. 3 00.01 all SalvIoossv 099H OTZB LLZ rT6 'Ia.L 09 :0T MU TT /ZT /t0 • • �"�„ ,� � , i"�'". ,.k�» „�c -Y�, "t '' �:h� u..K5'.�.,,�K�"a �e�se•��a�21� tfrrake n�rr� �,t'��.:�. yd�'.. , ,...:, ...� -� , � . ;'„.; .: �o.,� �;'aY�..,�x_ } TO: Putnam County Health Department DATE: 5/2/11 1 Geneva Road RE: North County Homes Brewster NY, 10509 22 Theodore Trail — Patterson (T) Attn: Michael, Budzinski, PE, Director of Engineering Section: 34 Blk: 2 Lot: 51 Subd. Lot: 6 WE ARE SENDING YOU (X ) ATTACHED ( ) UNDER SEPARATE COVER THE FOLLOWING ITEMS VIA # COPIES DESCRIPTION 4 As -Built Plan e 1 Certificate of Construction Compliance 3 Guarantee 1 Well Completion Report 1 Laboratory Analysis 1 E911 Address Verification Form 1 Fee THESE ARE TRANSMITTED AS CHECKED BELOW: ( X) FOR YOUR APPROVAL ( ) AS REQUESTED ( .. ,� t-t7R Y0U"R USE .- .. ".. -.' _(" -�) -• FAR iii= viEV� "AIVD -COi iiviEiVT On behalf of our Client, please find the above enclosed in support of our request for issuance of the Certificate of Construction Compliance. Please contact us with any questions or comments, you may have. COPY TO: SIGNED: Ray Hamill 293 ROUTE 100 — SUITE 203 SOMERS, NY 10589 (914) 277 -5805 — (914) 277 -8210 FAX — bibbo @optonline.net IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE AT (914) 277 -5805 Apr 20 2011 11 :22 HP LRSERJET FR}{ YML ENVIRANM'tNTAL SERVICES 321 Kear Street Yorktown Heights,_N Y 10598 ('914)' . 245- 2800., -... - Albert H. Padovani, Director p.3 LAB 4: 1.101528 CLIENT #: 6471 NON STAT PROC PAGE: 1 of 1 NORTH COUNTY HOMES DATE /TIME TAKEN: 04/16/11 11:C 156 TOMAHAWK ST DATE /TIME REC'D: 04/16/11 12:C YORKTOWN HGTS, NY 10598 REPORT DATE: 04/19/11 PHONE: (914) -447 -8780 SAMPLING SITE: 6 THEODORE TRAIL, PATTERSON SAMPLE TYPE..: POTABLE : WELL TANK PRESERVATIVES: NONE COLD BY: JOE FESTO TEMPERATURE..:. 4C NOTES_..: COLIFORM METH: N/A DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 04/18/11 IRON (Fe) 0.104 MG /L 0 -0.3 mg /1 04/18/11 TURBIDITY (TUR 1.6 NTU 0 -5 NTU COMMENTS: Fe /Mn If both icon and manganese are present, their total value combined shall not exceed 0.5 mg /L. SM 18 -20 311 SM 18 (213013 THE ABOVE TEST PROCEDURES MEET ALL REQUIREMENTS OF NELAC, AND RELAT ONLY T E SAMPLES RECEIVED BY THE LAB SUBMITTED BY: Albert . Pa ovani, M.T.(ASCP) Director ELAP# 10323 04/20/11 WED 08:52 [T% /R% NO 63231 Z003 Apr 20 2011 11:22 HP LRSERJET Fnx YML ENVIRONMENTAL SERVICES 321 Kear Street Heights, N.;.Y . 1.05.9.8_.x. _. (914) 245 -2800 Albert H. Padovani, Director LAB #: 1.101400 CLIENT � #: 6471y�yr�N NORTH COUNTY HOMES 156 TOMAHAWK ST YORKTOWN HGTS, NY 10598 p.2 NON STAT PROC PAGE: 2 of 2 DATE /TIME TAKEN: 04/07/11 12:00 DATE /TIME REC'D: 04/07/11 12:45 REPORT DATE: 04/14/11 PHONE: (914)- 447 -8780 SAMPLING SITE: 6 THEODORE TRAIL, PATTERSON, NY SAMPLE TYPE..: POTABLE : WELL TANK PRESERVATIVES: NONE COLD BY: JOE FESTO TEMPERATURE..: < 4C -0TTIF0RM-- METH-:­14F NOTES_..__ . ._..._... .. _... .._ --------------------------------------- DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PH pH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF pH IS ONE OFD 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. pH IS A FIELD MEASUREMENT AND IS REPORTED FOR REFERENCE ONLY, 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) THE ABOVE TEST PROCEDURES MEET ALL REQUIREMENTS OF NELAC, AND RELA ONLY T THESE SAMPLES RECEIVED BY THE LAB SUBMITTED BY: pe Albert -A. Padovani, M,T.(ASCP) Director ELAP## 10323 04/20/11 WED 08:52 [TX /RX NO 63231 0 002 Apr 20 2011 11:22 HP. LRSERJET FAX p.1 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 1-1.1 - 24 -2300 Albert H 1 H. Padovani, Director LAB -##« -1. 101400- -N CLIENT #; 6471 NORTH COUNTY HOMES Yy -�- ~- ~ ~~�~ -- - - -- - - ---- NON- STATryPRO- - -.. PAGE: 1 of 156 TOMAHAWK ST DATE /TIME TAKEN; - 04/07/11-12.0 YORKTOWN HGTS, NY 10598 DATE /TIME REC'D: REPORT DATE: 04/14/11 12:4 PHONE: (914)- 447 - 87804/11 SAMPLING SITE: 6 THEODORE TRAIL, PATTERSON, NY COL D BY: JOE.FEWELL TANK SAMPLE TYPE.,: POTABLE PRESERVATIVES: NONE NOTES-- TEMPERATURE. C©LIFORM < 4C DATE FLAG PROCEDURE-- ��_ -�� -� -- _ ---------------- - -_ METH��MF�-- RESULT NORMAL - RANGE ~~- METHOD PUTNAM CNTY PROFILE 04/08/11 04/08/11 MF T. COLIFO RM LEAD (IMS) ABSENT /100 ML ABSENT 04/08/11 04/08/11 NITRATE NITROG 1�3 1'14 MG/ L G / 0 -15 ppb 04/11/11 NITRITE NITROG IRON (Fe) <0.01 MG /L 0 - 10 1.0 MG /L 04/11/11 04/11/11 MANGANESE (Mn) <0.010 MG /L 0-0.3 mg /l 04/07/11 SODIUM (Na) pH 11.1 MG /L 0 -0.3 mg /1 N/A 04/14/11 04/13/11 HARDNESS,TOTAL 7.1 218 UNITS MG /L 6.5 -8.5 04/08/11 ALKALINITY (AS TURBIDITY (TUR 106 MG /L N/A N/A 6.9 NTU 0 -5 NTU COMMENTS: PICT{ UP SM 18 -20 9222: SM 18 -19 3113; SM18- 204500NO SMIS- 204500NO; SM 18 -20 31111 SM 18 -20 31111 SM 18 -20 3111E SM18 -20 4500HI SM 18 -20 2340C SM 18 -20 2320B SM 18 (21308) COMMENTS: MFTC aew Co�iforrn 'that - -tRe water (was not) of a satisfactory sanitary York State and EPA federal drinkin watezt�tandardlfor to this parameter. This only, comment applies to the Total Coliform teat Fe /Mn If both iron and manganese are combined shall not exceed 0.5 mpresent, their total value 9' /L . Na No limits for Sodium are proscribed. Su that for people on a sodium restricted Suggested guidelines state contain no more than 20 mg /L of Sodium. moderately restricted diet, a maximum of 270 those on should is suggested. 9/L of Sodium 04/20/11 WED 08;52 [TX /RX NO 63231 [001 PI I NA"e1 COUNTY III Y •A I'd TM I ti I OF HEALTH I I I � DRVIMON OF ENWRONMENTAL HEALTH 14'< I I S � CoilgSTRU CTION PERMf FOR SEWAGE TREATMENT SY a -} V 1 PERMIT # P- Located at as 7 yft5QPR s ?RA /G Town or Village Subdivision nameSM61(,4Am*r ,9A.-, Subd. Lot # & Tax Map 3q Block SL Lot J-/ Date Subdivision Approved 14&co a 2 aCo.' Renewal X Revision Owner /Applicant Name A%R?iY Date of Previous Approval /91 - Mailing Address 15'6 JOAAAWWIC ST YoAKro &,,oj vY Zip /o.ryj- Amount of Fee Enclosed�SC�� %Ca Building Type RES i0, Lot Area S-; iy No. of Bedrooms 4— Design Flow GPD roy Fill Section Only Depth Volume IF PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Seweirage stem to consist of .10 gallon septic tank and (016 7 4 j4A502?r4e-j1 ® XIVST/� -L W /®" 00 — 07 Other Requirements: ia5b 6,4/ -, AC-0+p IA To be constructed by cf"Icw Address _� s T /Vf� Water Sun®ly: Public Supply From Address or: X Private Supply Drilled by ��� � _S0�S Address 1'gTi'�2co.y„ �v�' I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Director/Commissioner will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date License # O�,�f®Z .So AfAs ti lr 105717 APPROVED FOR CONSTRUCTION: This ;4proval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w en considered ne essary by the Director /Commissioner. Any revision or alteration of the approved plan requires a new pe it. Approved f discharge of domestic sanitary se age only. �y By: �/ Title, Date:.`% White copy - HD Fi ; Y 110 copy - Building Inspector; Pink cop;7�7r er ; Age copy - Design Professional rm CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTHQa DlrV. TcION. , F .ENVIRONMEN'TA L- HEALTH SE. S. CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # P° /3 —0.S Located at a a T/i .FO 002£ —rX41 L- Town or Village A77XeZ-.S yN Owner /Applicant Name NOA7#- ey.t w7i- tionrs . z-K Tax Map ��_ Block Z Lot si Formerly Subdivision Name - S/$7b'!,/l•Fr•,�47,r.�J Subd. Lot # Mailing Address /,i6 7"0 M,1N 4wi,- s/; )iA&7bcJ V X�f Zip /29's— Date Construction Permit Issued by PCHD Separate Sewerage System built by CE&I co C"s -eavoo y Address YS 6ARg1 rY &—vo ,6- fe- w.srElc Consisting of % Gallon Septic Tank and 1 arO &41 66 74F. AASDAI T.'d'o � Other Requirements: Water Suunly: Public Supply From Address or:- Private Supply Drilled by HYf%77' 4401QS Address P4rimdN . &- BIAlldailb �: y Yv - •`�'i Ofiiit '� a i..w ...v51G...+OT`i . a 01 been c l.�' -1 - _ - . -- Number of Bedrooms Has garbage grinder been installed? A) O 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: of O Certified by P.E. -"' R.A. 04 ab Au vc /.4 rFS/ LLB (Design Professional Address RI3 Rg,,m led -SwITE A03 License # ad i-7 Z I- Sp0q-ts Wr i0ST7 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 revoca 'on, modificatio or change is necessary. By: Title: Date: White copy - HD Fi ; Yel py - Building Inspector; Pink copy - Owner; Lang copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES wct I rnMPI 1=TIAM RFPnRT ° NOTE: Exact Location o yell witn alstances to at least two permanent idnunidins tu N!uvluuu ull a — Fula— ar /cov NiaY. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well fldriller Form WC -97 Rev. 3/06 Stree ddress: TownNillage: TWellLocation Tax Map # fter,5 0 Map °3� BlockaZ Lot(s)n Well Owner: Name: Address: Use of Well: _Residential _Public Supply Air cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring _Other(specify) 2- Secondary Industrial Institutional Standby Drilling Equipment _Rotary _Cable percussion, Compressed air percussion _Other(specify) Well Type _Screened _Open end casing. Open hole in bedrock _Other Total Length nft. Materials: Steel Plastic Other Joints: Welded Threaded Other Casing-Details Length below grade-49t. Seal: Cement grout Bentonite _Other' Diameter -in. Drive shoe: Yes _ No Liner: _Yes No Weight per foot 121b/ft Diameter (in) Slot Size Length (ft) Dept to Screen ft Developed? First _Yes _No Screen Details Second I Hours We#I Yield Test _Bailed _Pumped A Compressed Air Hours lYield gpm Depth Date Measure from land surface-static (specs ft) During yield test (ft ) Rehm Depth 07ompleted well in ft. 36 -rcel vr� Well Log Depth From Surface -:: Well Diameter If more detailed: Water Bearing in Formation Description ft. ft. Land Surface information °, - descriptions or sieve analyses are available, please attach. If yield was tested Feet Gallons Per Minute Pump /Storage Tank Information Pump T pe Capacity at different depths during drilling Depth 0(, Model /&EAON list: Voltage_ HP 6 �ovl Tank Type Volu e 3 Dace�wet'�Cor� eked t" 1N,�II�DrtllerkPC�Ce�freate�#- ��ry.. n F ,� Kx�N .;S�fate� r 5 W 1 -y,,,W ri- n �F� �' '�E� .T ". K3`4� x'4 � W ✓ Y xx 55L' : ' 't N] 'x''�7 t } Cox a i' 5 'i '�R �x"Y. A'2 4W .Nn 5' k •4 Y':- °f: yE' i i'-* iF ,`# :.�� , Pump�,(rtsta�.er � ate n¢ k: r : Wei', rill'Na e3 w >nrr Y ti@ v a d' S# x of goak$ ansM1a whs n . does...., r,.. Yy I *� i` Sx'x"k '�i x 'Cv_x. rY' xT. _,ter 5 Pumpt�Installer� ame8Add _ .j ..r ile yx P Y SX.gw' Yl�k'� '.:Yd '� '.'ir- il:Yyd_ M P xm to na ure 9� �:a., NOTE: Exact Location o yell witn alstances to at least two permanent idnunidins tu N!uvluuu ull a — Fula— ar /cov NiaY. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well fldriller Form WC -97 Rev. 3/06 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health October 15, 2007 Mr. Joseph Buschynski Bibbo Associates Mill Pond Offices 293 Route 100, Suite 203 Somers, NY 10589 Dear Mr. Buschynski: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Field Inspection — North County Homes 22 Theodore Trail (T) Patterson, T.M. # 34 -2 -50 Lot 6 The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. 1. Pipes not flush inside distribution box, please trim. 2. Force main not installed at today's inspection. 3 ready - for.,bPrlrn,.�.L•T?_.c oti-nt and,riiTpr, tpst,� If you have any further questions, please contact me at (845) 278 -6130. Sincerely, Aosepphit Environmental Engineering Aide / JD:ens 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 10/10/07 WED 04:23 TEL 914 277 8210 BIBBO ASSOCIATES LLP PCHD PUTNAM COUNTY DEPARTMENT Old HEALTH ADMSION OF ENVIRONMENTAL HEALTH SERVICES ,ATTENTION © JOSEPH R GENE REQUEST FOR FINAL INSPECTION All information must be fully completed prior to any inspections being made. For: Fill Trenches PCHD Construction Permit # r . P-1,3 C) Located: 2N rAo0o �t (-r) (V) u`"v Owner /ApplicazltName: ���� �""'+�I. °� • �''v`'• TM 3 y Bloch � Lot / Formerly: Subdivision Name: Subdivision Lot # is system fill. completed? � . is system complete ?6�e•3 Is system constructed as per plans? �5 Is well drilled? (165 is well located as per plans? . -5 — Are.erosion control measures in place? 46— Date: Date: Date: I certify that the system(s), as listed, at the above premises 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: K' – Certified by: PE RA Design Professional B880 ASS� � Address: 293 a Suite Lic. # �. s y92_ Irs, W 1050 Comments: 014) 2 -R-5WS Form FIR -99 [J 002 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF.ENVIR®NMENTAL HEALTH SERVICES .., .APIP-LICAT.10 -N -TO CONSTRUCT: A WAT ER LL.:.. please print or type PCHD Permit # Well Location: Street Address: Town/Village Tax Grid # ,207 74Cma'0®'e- 7�, 13 &ew,,.2:>*i Mapc-7 1- Block 2 Lot(s) 3,-/ Well Owner: Name: Address: ,4 %,.�dtdij` weS / S��O -%` 4 � Use of Well: &-I 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 J50- gpm # People Served Est. of Daily Usage 3 0o gal. Reason f ®r 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 _ t/ Is well located in a realty subdivision? ...................................... ............................... Yes .r/ No Name of subdivision J"I '9G Ae -m Lot No. Water Well Contractor: 77 V, 4�9 • 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. 'j ' .�.0 .Aprl.keant. Signa±ure: _ -- JgEjk- iI PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED) FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director y revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller c4rti fied by Putnam County. Date of Issue / Permit Issum ial: Date of Expiration i !'� Title: Permit is lion- Transfe ra le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 BIBBO ASSOCIATES LLP 293 ROUTE 100 - SUITE 203 SOMERS, NY 10589 (914).27.1-5805 <...:.(914.).27.7..8210 FAX !7 bibbo(Woptonline.net WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via • Shop drawings ❑ Prints ❑ Plans • Copy of letter ❑ Change order ❑ DATE / �. JOB NO: ATTENTION /(� C RE: zo�� ❑ Resubmit /7 G' eje • For your use O Approved as noted the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION c5's.�'s �s;•,�.!� /gam .� I HESI= .l�RE- 1'�tANSMITTED as checked below: � :. • For approval ❑ Approved as submitted ❑ Resubmit copies for approval • For your use O Approved as noted ❑Submit copies for distribution ❑ As requested O Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ O FOR BIDS DUE 19 ❑ PRINTS -RETURNED AFTER LOAN TO US REMARKS �_r� Gfct �G GJ�' �i �iAtir�t° Gs— d'/ 451:- 7' A9 1 020OS'� &-- 1744-e--- COPY TO L %�- rf 1- cL;'eror e ::Fore- fto 4.? �1 SIGNED: If enclosures are not as noted, k/ndly not/fy s at once. Z 'd dO 1N3WiNUd3a AINnoo WdNind : 3WHN i t' r • T)ecemlier 12; 2005 '�.i, representative may inspect and monit giision3 met: ;' :' F.i 4, Sincerely, - f �, A. ,. ' +tip �: ,j�.,:.1 .L'.v�rl..:a•l: �'• ,i:�rf'1'j.¢. ��'.. i .A C.10r,d ZO'd Danny Shedlo, P.E. Civil Engineer 11 Engineering Review Group xe: Roger Sokol, P -B -, NYSDOH 12 L- 8LZ -Sb8 :131 9T :ST NOW 5002- 2T -030 .eview) v 'York City Department of Environmental d that the above - referenced application is has no objection to the approval of the Us determination is based on the review of a titled "Sewage Disposal System" td 10/13/05 and last revised 11/17/05. Gssa of my staff at (914) 773 -4416 at the installation. 9 6:51 500Z ZL 380 Cb00- OLL- pl6:xe� pepartmont:4' ' �nvtronrnegtalf R bert Moms, P. Putnam Co. Health Dept. _',;;:.`: ";.:r, "'irk,;; :�,;;•- 4 4 Geneva Road ] ]Brewster, NY 105 G /Gramatan Lot 6 SSTS 22 Theodore Trail �`'����.����y��` P Patterson, Putnam Co -, NY Middle Branch Reservoir ,.;:�,•�a'?x :t::�'��'�f'����Y . DEP Log # 2005 -1B- (Joint .�:� : .1140 7 ex (71 ),595�5a�' Dear Mr. Moms: This letter is to inform you that the N Protection (Department) has determir ` f c complete. Jn addition, the Departmer i'�w #�� {,J:-- ` ' above- referenced regulated activity. subxnitted documents including the p1 - s:• � for North County Homes, d; v;' - prepared f 14 '1'' °'r�:4' .'. ;:..'.::;� �' T The applicant must contact Sissy " staff of eons -� 1��"iha - f �, A. ,. ' +tip �: ,j�.,:.1 .L'.v�rl..:a•l: �'• ,i:�rf'1'j.¢. ��'.. i .A C.10r,d ZO'd Danny Shedlo, P.E. Civil Engineer 11 Engineering Review Group xe: Roger Sokol, P -B -, NYSDOH 12 L- 8LZ -Sb8 :131 9T :ST NOW 5002- 2T -030 .eview) v 'York City Department of Environmental d that the above - referenced application is has no objection to the approval of the Us determination is based on the review of a titled "Sewage Disposal System" td 10/13/05 and last revised 11/17/05. Gssa of my staff at (914) 773 -4416 at the installation. 9 6:51 500Z ZL 380 Cb00- OLL- pl6:xe� U. �O IN3WidUJ30 ),iNf-10---.'j H1dNiF1d:3WUN Nomeinber-17.2005 . 446 s Sissy Da La Ossa Assistant Civil Engineer Engineering Review Group xe: Roger Sokol, P.E., NYSID014 Joseph J. Baschynaki, P.E. Bibbo L2& - 82.2 - sf-O: -A -i t7-- . J] S002-9T—f',011 Review) ental Protection (NYCDEP) has ion is complete- the design of the abov-,: referenced crossing between the roof!fboting drain and is matter, you may conlact (ne. at (914) 773- VO'Z[ 900�. L1. ACIN CVE0-0LL-V16:x8j Robert Morris s, P-E` Pr Putnam Co. Health Dept 4 Geneva Road Brewster, NY 10509 , Middle Br anch Reservoir "". 446 s Sissy Da La Ossa Assistant Civil Engineer Engineering Review Group xe: Roger Sokol, P.E., NYSID014 Joseph J. Baschynaki, P.E. Bibbo L2& - 82.2 - sf-O: -A -i t7-- . J] S002-9T—f',011 Review) ental Protection (NYCDEP) has ion is complete- the design of the abov-,: referenced crossing between the roof!fboting drain and is matter, you may conlact (ne. at (914) 773- VO'Z[ 900�. L1. ACIN CVE0-0LL-V16:x8j Re: SMG/Gramatan Lot 6 22 Tbeodore Trail Patterson Putnam Co., NY , Middle Br anch Reservoir "". 1 -1 4. -'7 DEP Log 2005 -MB -1140 (Jo - 651 W yl N) Dear Mr- Morris: The New, York City. Department of E r .,U .n .61M. detetmined that the above referenced Please note the following comment I application: pit �4k 1. Show adequate separation at I 4— the 2" forcemain. F"t4) 7.41:3 W If you have any questions regarding I 4416.-' Willwoh0c L . g' Sincerely, 446 s Sissy Da La Ossa Assistant Civil Engineer Engineering Review Group xe: Roger Sokol, P.E., NYSID014 Joseph J. Baschynaki, P.E. Bibbo L2& - 82.2 - sf-O: -A -i t7-- . J] S002-9T—f',011 Review) ental Protection (NYCDEP) has ion is complete- the design of the abov-,: referenced crossing between the roof!fboting drain and is matter, you may conlact (ne. at (914) 773- VO'Z[ 900�. L1. ACIN CVE0-0LL-V16:x8j SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Bibbo Associates Mill Pond Offices 293 Route 100, Suite 203 Somers, NY 10589 To Whom It May Concern: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive December 1, 2005 Re: Proposed SSTS: SMG /Gramatan 22 Theodore Trail, Lot # 6 (T) Patterson, TM # 34 -2 -51 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. Show adequate separation at the crossing between the roof /footing drain and the 2" forcemain. 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 Fn�nrnnrnantal_..Prr�tertinn Q�7_. thtc,_lnt,..nercolat?nn test_ m»st be. wtmesSed.by a ",representative of this. . Department. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:kly Very truly yo , '! Robert Morris, P.E. Senior Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF E � NV_1R.nNMENT A L HEAD:- TH -SL'R VICES _ . RE: Property of LETTER OF AUTHORIZATION C- Located at TN 2g %l Tax Map # c3 ¢- Block X_ Lot ASS/ Subdivision of c.S/�J P, Subdivision Lot # Filed Map #,29 77 Date Filed cS<�, , �a/ 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 s_ upply.systems in conformi with the provisions ( 1 T 1 o ✓1 0 E. /Ili .l •. ...+ •. . 11 T _ 1 1 • T. t �._�.._ ._ .,_ .._... _,...._:.. _.....: ,:_�... __.__..:P.�..._ i ions :�f Artic e.:.t 45._. n.Uc�r 147 ;,� t:.,, L,.ucutio�r-L•aw; he ruorrc rIeaitn aw, and the Putnam County Sanitary Code. Countersigned:��'' P.E., R.A., # Mailing Address,��� Sees GG�° State Zip _S: f Very truly Signed: of Mailing Address:,44rXLj /S6 /OlsrgLlcrwll � %r/�7`!�w`r State /lip g�y Zip_Q�98 Telephone: Gjj¢ - 77- Telephone: 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: that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: Having offices at: Whose Officers Are. President - Name: Address: 1:2 C, Vice President - Name: Address: _ �u Secretary -Name: Address: Treasurer - Name: Address: W 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: Sworn to before me this /.3'L%ay of month) d 7 d of (year) Notary Public KAIMEEN R PACELLA Corporate Seal Plotary Public, State of New York No. 01 PA6092646 Qualified in Westchester County Commission Expires May 27, 20 Form CA -97 BIBBO ASSOCIATES, LLP 293 Route 100 - Suite''20' - --- ------- Somers, NY 10589 DOSING CALCULATION .Project:, North County. Homes Designer: JB Checked: JB Date: 10/14/2005 PER PCHD CODE: 0.5 GAL/ L.F.ABSORPTION TRENCH PUMP CALCULATION DOSE REQUIRED 0.5 gal./l.f. x 667 I.f. = 333 gal. 2" POLY FORCE MAIN where Q=V x A V(FPS)= 3 A(FT 2)= 0.0218 Q(CFS)= 0.0654 Q(GPM)= 29.30 USE Q= 30 GPM LENGTH OF FORCE MAIN (ft.)= 200 ADDITIONAL EQUIVALENT LENGTH DUE TO FITTING LOSSES (ft.)= 40 L(ft•)= 240.0 - FRICTION LOSSES HF= 1.81 ft./1 00 ft. HF (ft-)= 1.81 ft./l 00 x 240 = 4.3 H(ft.)= 649-626 = 23 TDH (ft.)= 23 + 4.3 = 27.3 USE GOULDS MODEL WE05H RATED 44 GPM @ 27 FT. SEE ATTACHED SHEET FOR PUMP CURVE APPLICATIONS Specifically designed for the following uses: • Homes • Farms • Trailer courts • Motels • Schools • Hospitals • Industry • Effluent systems SPECIFICATIONS Goulds Submersible �i • Overload protection must smooth operation. Silicon can be operated continuously be provided in starter unit. bronze impeller available as without damage. • Shaft: threaded, 400 series an option. m Bearings: Upper and stainless steel. w Casing: Cast iron volute lower heavy duty ball bearing • Bearings: ball bearings type for maximum efficiency. construction. upper and lower. 2" NPT discharge adaptable m Power Cable: Severe duty • Power cord: 20 foot for slide rail systems. rated, oil and water resistant. standard length (optional lengths available). ® Mechanical Seal: SILICON Epoxy seal on motor end Single phase: CARBIDE VS. SILICON provides secondary moisture •'/3 and'/ HP —16/3 SJTO CARBIDE sealing faces. barrier in case of outer l acket with 115 V or 230 V three Stainless steel metal parts, damage and to prevent oil prong plug. BUNA -N elastomers. wicking. • 3/4 -1'/ HP —14/3 STO with w Shaft: Corrosion - resistant m 0 -ring: Assures positive Pump bare leads. stainless steel. Threaded sealing against contaminants • Solids handling capabilities: Three phase: design. Locknut on three and oil leakage. 3 mum. maximum. i '/2 •-1'/ HP —14/4 STO phase models to guard • Discharge size: 2" NPT. with bare leads. On CSA against component damage AGENCY LISTINGS • Capacities: up to 128 GPM.. listed models — 20 foot on accidental reverse rotation. " Canadian Standards Association • Total heads: up to 123 feet length SJTW and STW ® Motor: Fully submerged in TDH. are standard. high -grade turbine oil for Mechanical seal: silicon.. - - - lubrication.and.eff. icient beat .,.... �L .underwriters Laboratories _...- .....__._ --- t;arbide- rotary_ seat /silicon - ,transfer.--- - carbide - stationary seat, 300 m Impeller: Cast iron, semi- m Designed for Continuous series stainless steel metal open, non -clog with pump - Operation: Pump ratings are parts, BUNA -N elastomers. out vanes for mechanical seal within the motor manufacturer's • Temperature: protection. Balanced for recommended working limits, 104 °F (40 °C) continuous 140°F(60 0C) intermittent. • F t 300 METERS FEET aS enerS. DEN U0 90 stainless steel. Capable of running dry. 25 80 without damage to components. 70 20 Motor Single phase: •'/3 HP, 115 V, 200 V, 230 V, 60 Hz, 1750 RPM; 1/2 HP, 115 V, 60 Hz, 3500 RPM; '/ HP —1'/2 HP, 230 V, 60 Hz, 3500 RPM. • Built -in overload with automatic reset. • Class B insulation. Three phase: •'/2 HP — 1'/2 HP 200/230/ 460 V, 60 Hz, 3500 RPM. • Class B insulation. ©1995 Goulds Pumps a 60 W U a 15 50 Z 0 40 J a O 10 30 20 5 10 0 0L 0 L 0 SERIES: 3885 SIZE:' /' SOLIDS RPM: VARIOUS -5 GPM Fr 10 20 30 40 50 60 70 80 90 100 110 120 130GPM 0 20 30 m3 /h CAPACITY Effective May, 1995 83885 95- 20.6(1 DEC PERMIT NUMBER 3- 3724 - 00161/00001 FACILITY /PROGRAM NUMBER(s) III d cc j:t�t: NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Ak EFFECTIVE DATE March 5, 2004 _.. .,.._ ... _., . �... a..... -..._, -.:' ' .y.:... ;EkIRA710N DATE....._. PERMIT”' . ,. —1.11- P Under the Environmental Conservation Law (ECL) November 30, 2007 TYPE OF PERMIT (Check All Applicable Boxes) ❑ New ® Renewal ❑ Modification ❑ permit to Construct ❑ Permit to.Operate F-1 Article 15, Title 5: Protection of Waters F-1. Article 15, Title 15: Water Supply .CONTACT PERSON FOR PERMITTED WORK Pollution Control F-1 Article 15, Title 15: Water Transport 'NAME AND ADDRESS OF PROJECT /FACILITY Land Reclamation [K]Article Article 15, Title 15: Long Island F-1 Wells ElArticle 15, Title 27: Wild, Scenic & Recreational Rivers E:1 6NYCRR 608: DESCRIPTION OF AUTHORREO ACTNM Water Quality Certification F-1 Article 17, Titles 7, 8: SPDES F-1 Article 19: Air .CONTACT PERSON FOR PERMITTED WORK Pollution Control FArticle 23, Title 27: Mined 'NAME AND ADDRESS OF PROJECT /FACILITY Land Reclamation [K]Article 24: Freshwater F-1 Wetlands ElArticle 25: Tidal Wetlands E:1 Article 27, Title 7; 6NYCRR 360: DESCRIPTION OF AUTHORREO ACTNM Solid Waste Management F-1 Article 27, Title 9; 6NYCRR 373: Hazardous Waste Management 914 248 -5346 F-1 Article 34: Coastal Erosion Management .CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER F-1 Article 36: Floodplain Management 'NAME AND ADDRESS OF PROJECT /FACILITY Ginsberg :Development Subdivision; Bullet.Hole Rtad,:Fields`'Lar�Ez`,`afid Fair Street, Fields Corners. LOCATION OF PROJECT /FACILITY Articles 1, 3 17 19 27, 37; 6NYCRR 380: Radi atiti on �onfrol F-1 Other PERMIT ISSUED TO North County Homes, Inc. TELEPHONE NUMBER 914 248 -5346 ADDRESS OF PERMITTEE 156 Tomahawk Street, Yorktown Heights, NY 10598 .CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER Joseph Festo, President � � �� � - 'NAME AND ADDRESS OF PROJECT /FACILITY Ginsberg :Development Subdivision; Bullet.Hole Rtad,:Fields`'Lar�Ez`,`afid Fair Street, Fields Corners. LOCATION OF PROJECT /FACILITY Within the adjacent area of Fresh water :..etland_LC= 18.'._._.:.�.,_ „, COUNTY Putnam TOWN Patterson WATERCOURSEANETLAND NO. LC Class NYTM COORDINATES -18 II E: N: 4 , DESCRIPTION OF AUTHORREO ACTNM .Construct a water quality basin and associated structures, create. a vegetated water quality buffer and install a well for Lot 6, in conjunction with the development of a 16 -lot subdivision in accordance with plans and reports specified in Special Condition #1 of this permit. By, acceptance of this.permit, the.permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, the General Conditions specified and any Special Conditions included as part of this .permit; ..::... DEPUTY PERMIT ADMINISTRATOR ADDRESS Alexander F. Ciesluk, Jr. 21 South Putt Corners Rd., New Pal tz NY 12561. AFC AUTHORIZ D S NATURE _ ��}} Date =n cF �� 0A . 3 /S lO y Page 1 of 5 Ivor[nUoHomes161 pmt(A(;19)eh NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State of'New York, its representatives, employees, and agents ( "DEC °) for all claim -5, .suits,.actiogsrand damages,_to_the.: . eXteni' attri5iitali(e o tfie perrmtfee's`acts or -omissions in 'connection witFi the permittee'.s undertaking of activities in connection with, or operation and. maintenance of, the facility or facilities authorized by the permit whether in compliance or not in compliance with the terms and conditions of the permit. This indemnification does not extend to any claims, suits, actions, or damages to the extent attributable to DEC's own negligent or intentional acts or omissions, or to any claims, suits, or actions naming the DEC and arising under article 78 of the New York Civil: Practice Laws and Rules or any citizen suit or civil rights provision under federal or state laws. Item B: Permittee's Contractors.to Comply with Permit The permittee is responsible for informing its independent contractors, employees, agents and assigns of their responsibility to comply with this permit, including all special conditions while acting as the permittee's agent with respect to the 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 carry out 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 SAPA 401(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 upon request by a Department representative is a violation of this permit. 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.o.r..rescind.any_. order..cr termiraati�n.pr� viol slyawueE+ by- th�•Dep rtment orany of the - tarns, c;onditions•,o� requi- remeiits-corftainedin -... such order or determination. 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 (HWMF), 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 - 00161/00001 PAGE 2 OF 5 NUMBER ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (TITLE 5), 24,25,34,36 AND 6NYCRR PART 608 A. If future operations by the State of New York require an alteration in the position of the structure or work herein authorized, or if, in the opinion of the Department of Environmental Conservation it shall cause •unfeasohebli3'dbsi�uctioii foth`e free;iavigati6h of said waters or flood flows or endanger the health, safety orwelfare of the people of the State, or cause loss or destruction of the natural resources of the State, the owner may be ordered by the Department to remove or alter the structural work, obstructions, or hazards caused thereby without expense to the State, and if, upon the expiration - or revocation of this permit, the structure, fill, excavation, or other modification of the watercourse hereby authorized shall not be completed, the owners, shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. 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 may be required. 4. All necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended solids, sediments, fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other envirorim entaliy deleterious materials associated'with'the project. 5. Any material dredged in the conduct of the work herein permitted shall be removed evenly, without leaving large refuse piles, ridges across the bed of a waterway or floodplain or deep holes that may have a tendency to cause damage to navigable channels or to the banks of a waterway. 6. There shall be no unreasonable interference with navigation by the work herein authorized. 7. If upon the expiration or revocation of this permit, the project hereby authorized has not been completed, the applicant shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill 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. Such approved plans were prepared by on 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. ♦ 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 project authorized herein. Continued on next page... DEC PERMIT NUMBER 3-3724-00161/00001 PROGRAWFACILITY NUMBER Last updated 3103 (eh) PAGE 3 OF'5 Alk . 95- 20- 6F(7187) -25CR3 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSFRVATinN For Article 24 (Freshwater Wetlands) 1. The work authorized herein shall be accomplished in accordance with the following plans and reports: a. Plans entitled,. "Ginsberg Development Corp.," prepared. by Bibbo Associates, LLP Consulting Engineers and Planners: e "Construction Plan" (Drawing 1) dated i/29/98, last revised 6/4/01; ® "Construction Plan" (Drawing 2) dated 6/15/98, last revised 6/4/01; ® "Construction Plan" (Drawing 3) dated 3/19/98, last revised 6/4/01; ® "Road & Drainage Details" (Drawing 4) dated 3/19/98, last revised 6/4/01; ® "Details" (Drawing 5) dated 4/19/01, last revised 6/4/01 ® "Erosion Control Plan (Drawing 6) dated 6/15/98, last revised 6/4/01; ® "Erosion Control Plan (Drawing 7) dated 3/19/98, last revised 6/4/01; and ® "Erosion Control Standards (Drawing 8), dated 3/5/82, last revised 4/19/01: b. "Water Quality Basin Planting Plan," prepared by Jay Fain & Associates, dated November 18, . 1998, last revised July 16, 2001: c.. "Stormwater Pollution Prevention Plan" prepared by Jay Fain & Associates, dated March 4, 1999, last revised April 25, 2000. 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 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 a ro riate 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 maintained until a suitable vegetative cover is established. 4. If seeding is impracticable due to the time of year, a temporary mulch shall be applied and final seeding. shall be performed at the.earliest opportunity when weather conditions favor germination and growth but not more than six months after project completion. 5. Planting of the proposed water quality basin as shown on.the approved plans must occur prior to the completion of the proposed road. DEC PERMIT NUMBER 3-3724-00161/00001 FACILITY ID NUMBER PROGRAM NUMBER r Page 4 of 5 95- 20- 6F(7187) -25CR3 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPEC;; L CONDITIONS For Article 24 (Freshwater Wetlands) A& 6. The following wording must be incorporated within the Drainage Easement for this development: "No building or other permanent structure other than those shown on the final construction plans shall be erected or maintained within the vegetated water quality buffer easements; nor shall there be any other disturbance of the natural conditions thereof except as may, in the future, be approved for conservation purposes by the Town of Patterson and the New York State Department of Environmental Conservation." 7. Within two weeks after the completion of the plantings in accordance with the "Water Quality Basin Planting Plan" referenced in Special Condition #1 above, the permittee shall submit two copies of the following, documents to the undersigned Permit Administrator: A. A written certification by the design engineer or supervising consultant stating that the work has been completed in accordance with approved plans and reports. B. A series of photographs of the mitigation site during and at the completion of work. The photographs shall be accompanied by a key map and written description of the photographs. 8. The permittee is responsible for lost plantings if the survival rate of initial wetland and buffer plantings is less than 80% within 3 years after planting. 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. Distribution: D. Gaugler J. Fain & Associates J. Buschynski; P.E., Bibbo Associates NYC DEP (EOH) DEC PERMIT NUMBER 3-3724-00161/00001 FACILITY ID NUMBER I PROGRAM NUMBER Page 5 of 5 14 -16.4 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 SEQR Appendix C _ - ,..__ �.;..... -- StJae�Erlvtronrn ®n4aJ =Guei Ity etrIew�- :.•., .._ . ...�.�, ;.. _ K....,,. _ SHORT. ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR _ 2. PROJECT NAME. 3. PROJECT LOCATION: �% � Municipality �Gj �ij^fYJ' County / Gt / ']�Gr &y 4. PRECISE ZLOCATION N((Street address and road Intersections, prominent landmarks, etc., or provide map) ✓ 1 /l!O'OIOI/ =� 5. IS PROPOSED ACTION: New ❑ Expansion ❑ Modification /alteratlon 6. DESCRIBE PROJECT BRIEFLY: �GVC�o�J Lof �' `%Z! '�'�%P �G'�fiG«rG G� GJfi� oL .5 j7\ ' 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately y ' �T acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? OResldential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ ParklForesUOpen space ❑Other Describe:. 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE j {OR LOCAL)? dW Yes ❑ No If yes, list agency(s) and permit/approvals /�� jy�s•cs'oy ��a%, r0�sj41 �� – (��� . �s.ri %� 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Jig Yes ❑ No If yes, list agency name and permitlapproval �C//V /�� X717 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes WNo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicantlsponsor name: iy�I�i WGt'or' �s 14,07'VJ �yJC � Date: Signature: Or •, V 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 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No 8. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIOEO FOR UNLISTED ACTLONq IN 6 NYCp�,_PAAT 617.6? If No, a negative declarat!or. , :aY%b„- „upr3rsetldd-by a.iother lnvoived 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 C5. Growth, subsequent development, or related activities likely to be Induced,by the proposed action? Explain briefly. i 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._ IS THERE,. OR IS THERE-LIKELY TO SE; CONTROVEnSY RcLATCO TO POTCNTiAC ADVERSE ENVIRONMENTAL IMPACTS? W ❑ Yes ❑ No If Yes, explain briefly O ”- PART III — DETERMINATION OF SIGNIFICANCE (To be completed by- Agency) Im INSTRUCTIONS: For each adverse effect identified above, determine whether It Is substantial, large, Important or othe wise s g p t�t+t±cant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring,, du stow; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materF$js..E re: t 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 andlor prepare appositive 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 at as necessary, the reasons supporting this.determination: Name of Lead Agency .PAint of We Name of.Responsible Officer in Lead Agency Title of Responsible Officer u icer in Lead Agency ' Signature of Preparer I If different from responsible officer) Date Pq PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET- SU13S1fPTA:C_E SEWAGE tktATMtNf 8i(8'fkM Owner A1cprtZj ��o /a," Adaresq 12�� Al� cur, "q 3*7a-wo. Located at'(Street)maa� Map 4 Block Lot (indicate nearest cross street) Municipality _Al� Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre-soaking Zl- Date of Percolation Test Z,,,?= -/-;" - 9� Hole No. Run No. Time Start - Stop Ela6y Time i n.) Depth to Water From Ground Surface (Inches) Start . Stop Water Level Drop Indies In es Percolation Rate MinAnch 1 7 3 2,_rf -1,� f 3 2. 2 4 5 2 'z 3 4 5 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until appf6kirnately'equal percolation sates are obtained at each -160 min inch) All datald be percolation test hole. (i.e. s min for 1-30 mlinI r'i 1�' m submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST MOLES DEPTH HOLE NO. G.L. HOLE NO. . .0 HOLE NO. 0.5 1.01 1.5 2.0' 2.51 3.01 3.5' 4 ll , 9—.,Ve 4.5 1 5.5' 6.0' 6.5' 7.0' 8.0' 8.5' 9.5 'j 10.01 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: Date Design Professional Name: \7- Address: FHB f'AMOCIATES --Cum! - - - em-plannerZ MAMM^"—&P61. rrq.A WWWV W&ROMP wvv. Pinola Signature: _7L Design Professional's Seal 0 V) 4�i I FEs S 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .8 WACE SEWAGE'TREATMENT SYSTEM D E S M N 71i AT A' " 9f JTA E T fj Owner Address; / SSG; riria✓�a Ka!, /54 2W W, Located at (Strect)7,4_eo,06,r-�aj�- A-a/-inaat,�, ax Map Block Lot .F-I- (indicate nearest cross street) Municipality Drainage Basin 14_1,111� f SOIL PERCOLATION TEST DATA Date of Pre-soaking /Q Date of Percolation Test Hole No. Run No. Time Start - Stop Ela6y Time in.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Incics Percolation Rate Min/Inch 3 4, 5 �2 3 7,7 x,17- O,'rZ 3 la,22 //2 7 4 5 2 3. 4 5 NOTES: I. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. !; I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 . TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. D HOLE NO. G.L. 0.5' %W 1.0' O 1.5 1 2.0' Y 2.5' 3.0' y�� �rd�✓.� 7� 3.51 4.01 4.5' 1 5.0 ���.�eo�rd1.1111 r C7CH 5.5' S�NIi� ►� tS /'/ / 32O,, & - 6.0' y e 9f,o ve /, SW� 6.5' 8.0' i�ry c. 8.5' ..ry . .._....._. _,__9.0.__..._...:..x_-- .__.... 9.5' `0' pi?,c ` Wdicat` evel at which groundwater is encountered — ` -'��te `el at which mottling is observed — 'Ifidica � level to which water level rises after being encountered -- Deep hole observations made by: ,��6.,,5y-i��� /,;,9 Date � y� Design Professional Name:Vo�T Address:,.l� .z a,z /�o.��orcf Signature: u , Design Professional's Seal 1 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: yOr�%iO�Jd1 /1%, y la'.!; 7'e, 2. Name of project: 3. Location TN: /Q 4. Design Professional: ,s`g��Zl_,4,oy 5. Address: z 6. Drainage Basin: /y�� /G fla_ 7. Tvne of Proiect: ✓ Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted 9. Is a,Draft Environmental Impact Statement (DEIS) required? ......................... /V. . 10. Has DEIS been completed and found acceptable by Lead Agency? ............... IyIllf - 11. Name of Lead Agency 1-2: - Is -this project in an area under the control of local_ planning, zonings or_ other officials, ordinances? ....................................................... ............................... !.f' . 13. If so, have plans been submitted to such authorities? ........................................ 14. Has preliminary approval been granted by such authorities? Date granted; , O / 15. Type of Sewage Treatment System Discharge ................. ✓ surface water t✓ groundwater 16. If surface water discharge, what is the stream class designation? .................... /y, 14 - 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? ................ XI& 21. Name of sewage system Distance to sewage system 22. Date test holes observed ,(% ®U, ��'�8 23. Name of Health Inspector qo!p, 24. Project design flow (gallons per day) ...............:................. ............................... BOO 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... ye 26. Has SPDES Application been submitted to local DEC office? ......................... 1014- - Fnrm P(7_07 27. Is any portion of this project located within a designated Town or State wetland? r -21;: - vVetlaiid� - IDM�1u:rrbo :............................................ ..............................: ..- :...:.. t✓'.: 29. Is Wetlands Permit required? ................... 0 � ..9 %Z . ° < . ...................... .. O / Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ............................... 31. .Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste. disposal, landfilling, sludge application or industrial activity? ............................ Yes/No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous' waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ........ :................ 19 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? . ............................... p 36. Tax Map ID Number .......................... ............................... Map Block_gZ Lot 37. Approved plans are to be returned to ..... Applicant z/ Design Professional - NGTE: -:iii applications fur-review and,approvai of a neW -SSTS to be located'Witlun 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 applicationm, st be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with thicvrov4g on may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury; that information provided on this form is.4ue7 . e,r to the best of my knowledge and belief. False statements made herein are punishabt*as`? a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. N" .. SIGN4URES & OFFICIAL TITLES: Mail°i' Aidr LG /0 0 BIBBO ASSOCIATES LLP 293 ROUTE 100 - SUITE 203 SOMERS, NY 10589 (914) 277 -5805 (9l 4) 277 -8210 FAX . bibbo( mptonline.net TO WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ [LIEUVIEn @IF ll n&H1 �JI 044Z%d JOB NO: ATTENTION,00 RE: L O' ln' cf/%�'i G/zisra f •, the following items: ❑ Samples ❑ Specifications COPIES I DATE NO. DESCRIPTION �ior� �g7%o � ��' Qr/i armors THESE ARE- TR ?. ^fSIMOITTED as-checked below: ❑ For approval ❑ For your use ❑ As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS /qz'c l7 .n gs ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints 19 0 PRINTS RETURNED AFTER LOAN T,0 US COPY TO SIGNED: Jr ff enclosures are not as noted, kindly notify sat once. 13I13130 ASSOCIATES LLP 293 ROUTE 100 - SUITE•203 SOMERS, NY 10589 (914) 277 -5805 (914) 277 -821,0 FAX _. bibbo@optonline.net TO WE ARE SENDING YOU ❑ Attached O Under separate cover via _ ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ KKUTIKQ @[� V ° ° Kc@ 0VVQ1 DATE JOB NO: ATTENTION H L� Q •G/ RE: /Uo`- Coo,•,%` hi a.s O Samples the following items: ❑ Specifications THESE ARE TRAINGNIiT TED as checked beiow: O For approval ❑ Approved as submitted ❑ For your use O Approved as noted > ❑ As requested O Returned for corrections O For review and comment ❑ ❑ FORBIDS DUE REMARKS • Resubmit copies for approval • Submit copies for distribution • Return -corrected prints 19 0 PRINTS -RETURNED AFTER LOAN T,0 US COPY TO SIGNED: If enclosures are not as noted, kindly notify1us at once. SHERLITA AMLER, M% MS, FAAP LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Joe Buschynski Bibbo Associates Mill Pond Offices 293 Route 100, Suite 203 Somers, NY 10589 Dear Mr. Buschynski: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 RE: North County Homes -22 Theodore Trail, Lot # 6 (T) Patterson, TM # 34 -2 -51 Reservoir Basin ROBERT J. BONDI October 28, 2005 The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on October 14, 2005 is complete. The Department will notify you by November 20, 2005 of its determination. E) The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. 0 Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. you tatrf tLo_T epar rei4 fails--to notn' y hi - i_ a oof t ine; yGu r°ay10tiiy a h G .........,.. 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 approved, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2166. V �i ly your i Robert Morris, PE Senior Public Health Engineer RM.kly Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 13113130 ASSOCIATES LLP 293 ROUTE 100 - SUITE 203 SOMERS, NY 10589 (914).27.1-5805 1n.) 277 -8210 FAX ,.._ ,.. bibbo()optonline.net TO �9�01174,7 WE ARE SENDING YOU O Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter O Change order ❑ DATE JOB NO: ATTENTION �. RE: 1 � L ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION THESE ARE TRANSMITTED as checked below: O For approval ❑ Approved as submitted O Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested O Returned for corrections ❑ Return corrected prints O For review and comment ❑ ❑ FORBIDS DUE 19 0 PRINTS RETURNED AFTER LOAN T,0 US REMARKS COPY TO SIGNED: If enclosures are not as noted, k/ndly not/ us at once. NVC Environmental It - Protdbtion . Caswell F. Holloway Commissioner Paul V. Rush, P.E. Deputy Commissioner Bureau of Water Supply prush @dep.nyc.gov 465 Columbus Avenue Valhalla, NY 10595 -1336 T: (845) 340 -7800 F: (845) 334 -7175 April 27, 2011 Michael Budzinski, P.E. Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 Re: North Country Homes Lot # 4 — SSTS Renewal 22 Theodore Trail, (T) Patterson TM # 34 -2 -51.6 Middle Branch Reservoir Drainage Basin DEP Log # 2005-MB- 1 140-DJS. 1 Dear Mr. Budzinski: New York City Environmental Protection (DEP) has determined that the above - referenced renewal application, received by the DEP on April 18, 2011, is complete. The DEP has no objection to the approval of the above - referenced regulated activity. This determination is based on the review of submitted documents including the plan titled "SSTS for North Country Homes Lot # 4, 22 Theodore Trail, Town of Patterson, Putnam County, New York ", prepared by Bibbo Associates, dated October 13, 2005, last revision January 17, 2011. Please have the applicant contact David Alderisio at (914) 742 -2010 at least two days prior to start of construction of the SSTS so that the DEP may inspect and monitor the installation. c: Roger Sokol, NYSDOH Danny Shedlo, P.E. Civil Engineer III Wastewater Design Review SSM]RtLUA AMLER, MD, MS, FAAP Commissioner of Health ]ROBERT D!91R t PE VV'' ` DireCior of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Office (845) 808 -1390 Fax (845) 278 -7921 or (845) 808 -1937 April 20; 2011 Bibbo Associates Joe Buschynski, PE Mill Pond Offices 293 Route 100, Suite 203 Somers, NY 10589 Re: Field Inspection- 22 Theodore Trail (T) Patterson, TM 34. -2 -51 Dear Mr. Buschynski: A re- inspection at the above referenced lot has been completed. There are no further comments to be addressed at this time in reference to this Department's open work inspection. PAUL ELDREDGE County Executive If you have-any further questions lease contact me at 845 808 -1390 ext.- 43261. - GDR:cw Sincerely, Gene D. Reed Sr. Environmental Health Engineering Aide PUTNAM COUNTY DEPARTMEnTH DIVISION OF ENVIltON1 VIENTAL HC, FINAL SITE INSPEC-_ - AIL Street.Location...�. Town /J t ►c236f1 Permit - TM # q — 2— 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 ...... ............................... IL Sewage System a. Septic tank size - 1,000 ...:..... 1 ,250...'/.other ................ b. 'S eptic' tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Bog 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. .. Muumum 2 ft. Original soil between box & trenches e. Junction Bog - properly set .......... ............................... 6. renc es / / 1. Length required 661 Length installed 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1116 - 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 capped ................. f.... ,,.... �.a .� g. Perm or Dosed -stems 1. Size of pump chamber........... 92 .0... ....... 3 ....Q, ....1 2. Overflow tank ................... s .3 .. .....�....:....I ............. 3. Alarm, visual/ audio ........:........... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle.... III. House/Buildin2 a. house locatedper approved plans .............. b. Number of bedrooms .. ............................... C,� .4,.�. .... . IV. Well Well located as per approved plans....... :......... . 4...... b. Distance from STS area measuredp - . ft ........... c. Casing. 18" above grade ................ ............. ................... d. Surface drainage around well acceptable ....................... V. Overall Workmanshb3 . 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 watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate.... .... .... ........................ i. Erosion control provided ................. ............................... Rev. 12/02 /r1 u o 7 Date: :d by ., . O►;N OVA 1 E- T"FaMmol . r� ® L � MM WE ,/m I � A/ /0-M ell O►;N I Z, Fit IVA 19 WAIM I � A V KA K -' PUTNAM COUNTY DEPARTMENT OF HEALTH -R -.f.-D1-V,-IS1,0N7.OF-ENVIR -ONrvl.ENT;A-L�-H-E.,',ATL-11-�S-E -VICES FIELD ACTIVITY REPORT I kF - F-11 �07,057-0595 � Street Town State Zip PERSON IN CHARGE qzz eq. PUMP TEST%. E] DOSE TEST REQUIRED GALLONS * 3.3 if 91, 3 ?It/,, 74 19 —9 fop Signature and Title R FP QR TR FrF-TVF-T) IRV: I acknowledge receipt of this report: SIGNATURE: 02/96 Title: 0 �`` o� o 0 REQUIRED GALLONS * 3.3 if 91, 3 ?It/,, 74 19 —9 fop Signature and Title R FP QR TR FrF-TVF-T) IRV: I acknowledge receipt of this report: SIGNATURE: 02/96 Title: BIBBO ASSOCIATES, LLP 293 Route loo -Suite 203 Somers, NY 10589 ----'(914) 277-;8210 FAX" bibbo@optonline.net FAX COVER SHEET PLEASE DELIVER TO: NAME COMPANY FAX NUMBER L7>QZ>, FROM: I\A C, A' SUBJECT: 4o .( LOT Tj-5-7s-7- 2� COMMENTS: M PL614416-::- ^44-5 V-11 R4 A vl� ( (-tf 19 L OC JD 4 -le jes77 & 4. T-14A t".j r, yo at,Tr- AS REQUESTED FOR YOUR APPROVAL FOR REVIEW AND COMMENT NUMBER OF PAGES BEING TRANSMITTED (INCLUDING THIS PAGE) Hard copy being sent? - No . Regular Mail Overnight If you do not receive all pages in legible condition, please call (914) 277-5805. TOO 1E (IHOd <-+-+- dil salvioossv OHM OTZ8 LLZ PT6 lal 9V:LO NOW TT/8T/PO SJfEltLrrA AMLER, MD, MS, FAAP Commissioner of Health LOit1rTTA`1VIOLINARI RN', ISN Associate Commissioner of Health P DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 RUO UFST FOR FIELD ThSTIN ROBERT J. B.ONAI County Execulive All information below (must be fully completed prior to any scheduling. DATE: `"1 I 1 e- ENGMERING FRM; p ` -r PRONE #, A 141 -Z'4 PERSON TO CONTACT; 71. 4 , t6 i KNEW CONSTRUCTION ❑ REPAIR P.ROC-RAM ❑ ADDITION PROGRAM REASON: DEEPS: ❑ PERCS: ❑ PUMP TEST: R ROAD /STREET: ZZ'�a►E�%d � 1� TOWN: 17A -rr9V i TAX MAP suDDIVISION: f%la� &�1M AN LOT #: OWNER: oM NYCDEP CRITERIA FOR-JOINT REVIEW AND WITNESSING OF SOIL TESTING YES NO p Proposed SSTS within the drainage basin of Nest Branch or Boyds Corner & CI -otag Falls erveirs. ❑ servoir, reservoir Proposed SSTS within 500 feet of a re stem or control lake. t4 o Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ Proposed SSTS design flow greater than 1000 gallons /day or SrDES Permit rewired. ❑► Proposed SSTS for a Commercial Project. It is the responsibility of the design professional to provide the above information prior to soil testing. The Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered, to any of the questions, NYCDEP must witness the soil tests. This Department will coordinate a mutually suitable time for field testing with the Design Professional and NYDCEP- If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP Ls required to witness the soil tests, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. F R cotiNTY USE ONLY DATE: -;? TIIV : r' mq -FOR n=TBMG -Y.tv Environmental health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Sectiou (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (843) 278 -6026 WIC (845) 278.6678 Nursing Home Care Fax (845) 278-6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278.6648 700 fA QHOd fFF all SMIVI00SSY OSSIS OTZ9 LLZ VT6 rJE[J 8N : LO NON TT /9T /FO •: NEW YU EI,EC''RICAL IlNSPEC�'ION SERVICE$ 54 North Central Avenue, Elmsford, NY 10523.914-347 439 ...... ........__ ,. _ - - ROUGMG - - First Notice Second Notice Secuad Fl,— Third Fl, Firstk'i,.� -� _ outside, Garage ba ��1Viulti Tl,� -- semen �✓ � � Remarks Dat - c00 Q� QHOd FE-F all SaIVIOOSSV OflgIg 0TZ9 LLZ VT6 'Id,L W LO NOR TT /9T /VO SHERLITA AMLER, MD, MS, FAAP I Commissioner of Health ROBERT molzmi PE Director of Environmental Health . Bibbo Associates Joe Buschynski, PE Mill Pond Offices 293 Route 100, suite 203 Somers, NY 10589 Dear Mr. Buschynski: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Office (845) 808 -1390 April 14, 2011 Fax (845) 278 -7921 or (845) 808 -1937 Re: SSTS Renewal for North Country Homes Lot #6 — SMG /Gramatan Subdivision @ 22 Theodore Trail (T) Patterson, TM 34 -2 -51 Middle Branch Reservoir Basin PAUL ELDREDGE County Executive The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on April 12, 2011 is complete. The Department will notify you by May 3, 2011 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. 0 Joint review with the NYCDEP will commence pursuant to.the guidelines set forth in the Watershed Agreement. If the._Departrneat fails-to notify you within the above referenced time frame, you. may notify the Deparixnznt of its faiiure'by e�ri fled mail, eetum receipt requested: The notice should be senfto` my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed approved, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 808 -1390 ext. 43148. Michael J. l Director of MJB:cw SHERLITA AMLER, MD, MS, FAAP Commissioner of Health E,®RE`i'TA MOiUNA:RLIA N; Associate Commissioner bf Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT 1 BONDI County Executive .. , -' - y ROBERT MOMS, Director of Environmental Health TO: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW fi DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM JOINT REVIEW PROJECT: TOWN:. '?fi �g;esaAj SUB'D APP DATE NOTICE OF COMPLETE APPLICATION: DATE: // ❑ Within the drainage basins of West Branch, Boyds Corner Reservoirs or Croton Falls. ❑ Within 500 feet of a reservoir, reservoir stem or control lake. X1j Within 200 feet of a watercourse or a DEC wetland and appearing on a subdivision map approved after December 31, 1992. ❑ Design flow greater than 1000 gallons /day. ❑ Commercial SSTS. jtreview 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 r' 1 PIJTNAM C ®UNTX DEPARTMENT OF HEAL'T'H IV-1 EII�VTR�NMENTALI-HEA" � ""10 ES LETTER OF AUTHORIZATI ON RE: Property of �%D/L -1 ��, yv Ty �o•�� s ,vC, Located at as - rgfol)O2q 7,14,( T/V AtrIXsoti Tax Map # 3Y Block D- Lot Subdivision of S wi G d.. Subdivision Lot # h Filed Map # a STS Date Filed SF/T O l Gentlemen: This letter is to authorize 1616.00 �J.SOL r� LZ,4� a duly licensed Professional Engineer >C 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—conform It-,, tivitr. , tl:e pwisions o� AL aicie i5 and/or 147 ot'the Education'Law, the 'Public Health­­_ �V Law, and the Putnam County Sanitary Code. Countersigned: P.E., R.A., Mailing Address 1316av %ssocs NW, 1-41- Very truly yours, .ti Signed: 4/ �er of Property) / Mailing Address: /Vo t744 co,.•�„ry- ,�,, fs �„� �� % Cr�A/1r4c✓ K ST, %'o/l�TGw,� State J'V C,f Zip _ to fly State /W Zip /0 S- yF Telephone: �� /y� d — Si�f Telephone: 6' /Y) a'/,? -- S3 S�(o Form LA -97 BIBBO ASSOCIATES, LLP TO: f q/� c..0 , //yG, DATE: Lf L ®�� ,OnC Stiff/ Tom• 34 - 2 SI WE ARE SENDING YOU ( ) ATTACHED ( ) UNDER SEPARATE COVER THE FOLLOWING ITEMS VIA # COPIES DESCRIPTION �- GO/7S' //' • 2 i" �f" / C , /' R& A7 6 Z-2G Gil` ri 7ivh `. e 1��i' Ire- e- THESE ARE TRANSMITTED AS CHECKED BELOW: (X) FOR YOUR APPROVAL ( ) AS REQUESTED ( ) FOR YOUR USE ( ) FOR REVIEW AND COMMENT COPY TO: SIGNED: 293 ROUTE 100 — SUITE;203 SOMERS, NY 10589 (914) 277 -5805 — (914) 277 -8210 FAX — bibbo @optonline.net IF ENCLOSURES ARE NOT AS NOTED, KINDL Y NOTIFY US AT ONCE AT (914) 277 -5805 D I\Q 0 ti •'tip �O 0 a 0 / U cc IL ul i as •I oho h �0 V Q��Jj J _j* Yl 'i 100r � �j l OZ �o f O / ^ O 5._...00 4.4j- .. J� o► V,op -qo JG \Ol\ r,p\\ 0 fp 3 SOU COQ � gyp`• Yl goo i )7qz ' 6* 9Fl < boo 6�S j o I / Iz /.1 l I¢ ,° / 0 o m o W t . i I •o u O � O 0 O I I O' O a' wl f 1 I I I I I A 1 5 �O We // 0 Ao �r % 200, E 16, 93' '4= X 00 00! �- 30.65' - .�..., L -4g 0 77- INSET MAP 1 " 200' DATE: I DESCRIPTION �� pF Nf1y Y 0 P ,►. BU r W .. - - .. . - _ - - - OI-- HOUSE FROM SURVE SHEET FIELD FIELD PUTNAM COUNTY DEPARTMENT OF HE, DIVISION OF ENVIRONMENTAL HEALTH APPROVED AS NOTED FOR CONFORMA APPLICABLE RULES AND REGULATION: P TNAM COUNTY ALTH DEPARTMD r SIGNATURE q D THIS IS TO CERTIFY THAT THE CONSTRUCTED AS INDICATED WAS INSPECTED BY BIBBO AS COVERED OVER. THE SYSTEM WITH ALL STANDARDS RULES COUNTY DEPARTMENT OF HE) DEPARTMENT OF HEALTH. BY /CKI DATE: I DE AS -BUILT SEWAGE DISPOSAL 9 NORTH COUNTY HOME 22 THEODORE TRAIL TOWN OF PATTERSON , PUTNAM G # ITEM "XI /1 "B" Itcle 1 ST -IN 28.5' 22.5' 2 ST -OUT 20' 31.5' 3 PC 17' 37' 4 DB 129' 135' 5 TE 122' 126' 6 TE 122' 124.5' 7 TE 121' 122' 8 TE 120.5' 120.5' 9 TE 120.5' 119' 10 TE 121' 118' 11 TE 122' 117.5' 12 TE 120' 114' 13 TE 115' 108' 14 TE 111.5' 103' 15 TE 44.5' 40' 16 TE 48' 46' 17 TE 53.5' 54' 18 TE 56' 59' 19 TE 56' 62' 2U ..:._,.. °T ..._.. -, 55:5' 64.'5'- 21 TE 58.5' 69.5' 22 61' 74' 23 64' 1 78.5' 24 67' 1 83' DATE: I DESCRIPTION �� pF Nf1y Y 0 P ,►. BU r W .. - - .. . - _ - - - OI-- HOUSE FROM SURVE SHEET FIELD FIELD PUTNAM COUNTY DEPARTMENT OF HE, DIVISION OF ENVIRONMENTAL HEALTH APPROVED AS NOTED FOR CONFORMA APPLICABLE RULES AND REGULATION: P TNAM COUNTY ALTH DEPARTMD r SIGNATURE q D THIS IS TO CERTIFY THAT THE CONSTRUCTED AS INDICATED WAS INSPECTED BY BIBBO AS COVERED OVER. THE SYSTEM WITH ALL STANDARDS RULES COUNTY DEPARTMENT OF HE) DEPARTMENT OF HEALTH. BY /CKI DATE: I DE AS -BUILT SEWAGE DISPOSAL 9 NORTH COUNTY HOME 22 THEODORE TRAIL TOWN OF PATTERSON , PUTNAM G