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HomeMy WebLinkAbout1471DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www. s ca n y o u rd o cs . c o m 631- 589 -8100 34. -3 -1.42 BOX 14 ]�6 ' I i 01471 O� X PUTNAM COUNTY DEPARTMENT OF HEALTH . -...L :_�: : -Dl slON OE:_ENV.IRONMENTAL. HEALTH.S- ER�ICES =.. -._ :: . CERTIFICATE OF CONSTRUCTION COMPLIAN GE TREATMENT SYSTEM 0 PCHD CONSTRUCTION PERMIT # - -0, Located at i-�-D �-Ni S Q �'� -rAM► MAPI Fi i uzown or Village �� U-7ZS a t,) ( T) �0 3 Block 3 Lot Owner /Applicant Name I� �3�3(.,�5 4V �-{��� Tax Map ����i-7YL-` � Cr�P�S�'C�c710i►� Formerly Subdivision Name Subd. Lot # /� 13 Mailing Address POW( I S Lf,, /x%61 Z) .'%� t4-k-;e- A'( Zip le .-V7 Date Construction Permit Issued by PCHD Separate Sewerage System built by .ToJ (� ta1�K -LPL- Address � e . Consisting of 1250 Gallon Septic Tank and I2-0 Lam. Z - 7IL-f- iCH �.0 0 o -1 o S 120 f> Ft Ui_ 2i(7— FT D��� Other Requirements: Water Supply: Public Supply From, Address or: Private Supply Drilled by Address pl/ -7 oN W Has -erosion control been completed? S Number of Bedrooms 14 Has garbage grinder been installed? /v 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 a standards, rules and regulati ns Date: D 1 3t) 02— Certified by n Address 12 ( C U Y --M %� ik. R� Department of Health. P.E. R.A. License # S3 Z% 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 bject to modification or change when, in the judgment of the Public Health Director, such revocation, o ficati r change is necessary. By; Title: Date: Z �� a� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 F 440 U5 I r Ili =- '; - i , I -. J i 1Pe1/1510N5 121 C U S H MAN ROAD 845- 878-7894 °ATTERSON, NEW YORK 12553 LOT 2 B ANNE LAURENT RS 191EV1510N.- HOLMES ROAD PATTERSON(T) ' WALLACE , v . SSDS DE ,��►iv SIGN cNECKEO lof v COJ�-MVCTlod 01 D CONFIDENTIAL SETTLEMENT AGREEMENT AND RELEASE THIS SETTLEMENT AGREEMENT, made as of Fdtl`91113 - 2005, by and between Beech Tree Construction Corp., with its principal place of business located at P.O. Box 154, Mohegan Lake, New York 10547, its respective shareholders, principals, employees, agents, representatives, successors, assigns, heirs, executors, administrators, parents, subsidiaries, affiliates, related entities and corporations, past, present and future officers and directors (collectively, "BEECH TREE "), LISA MAILLER, an individual residing at '79 Stonyhill Road, Wappingers'Halls, New York, 12590, in her own right and on behalf of her representatives, agents, heirs, executors, administrators, successors and assign and anyone claiming through or under her (collectively, "MAILLER "), Carla L. Marin, Esq., as Escrowee, an individual 'with' her principal offices located at 17 Brewster Avenue, Carmel, New York 10512, in her own right and on behalf of her representatives, agents, heirs; executors, administrators, successors and assign and anyone claiming through or under her individually and/or as Escrowee (collectively, "MARIN ") Karen D. �Liotta, an mdivi ual residing in" t County of Duchess, State of New York, in her own right and on behalf of her representatives, agents, heirs, executors, administrators, successors and assign and anyone claiming through or under her (collectively, "LIOTTA "), and KeyBank, National Association, with.offices located at 738 Route 9, Fishkill, New York .12524, its respective shareholders, principals, employees, agents, representatives, successors, assigns, heirs, executors, administrators, parents, subsidiaries, affiliates, related entities and corporations, past, present and future officers and directors (collectively, "KEYBANK "), is a compromise settlement and release as to the rights, duties and obligations each party has regarding the claims made in the action entitled Beech Tree I Construction Corp. v. Anne Laurent, et al.. Index No. 1036 -2004, pending in the Supreme Court for the State of New York, County of Putnam (the "Action "), WHEREAS, BEECH TREE has asserted certain claims against MAILLER, MARIN, LIOTTA and KEYBANK, and MAILLER has asserted certain claims against BEECH TREE, MARIN, LIOTTA and KEYBANK; WHEREAS, MAILLER, MARIN, LIOTTA and KEYBANK have denied and continued to deny BEECH TREE's allegations and have denied and continue to deny that. they are liable to BEECH TREE in any way, and BEECH TREE, MARIN, LIOTTA and KEYBANK have denied and continued to deny MAIi.LLER'S allegations and have denied and continue to deny that they are liable to MAILLER in any way; WHEREAS, BEECH TREE, MAILLER, MARIN, LIOTTA and KEYBANK desire to fully compromise and settle the Action, and all disputes, controversies or. actions arising out of, under or with respect thereto; _r_- t1is "Se ttiem -ent-Agreeme'r - was-- negotiated,.._drafe. .d.-md, executed_ by_ the parties with the assistance, counsel and advice of their respective attorneys at law; and NOW, THEREFORE, and in consideration of the mutual promises, representations, warranties, and covenants contained herein, and for other good and valuable consideration, the sufficiency of which is acknowledged, and intending to be legally bound hereby, BEECH TREE, MAILLER, MARIN, LIOTTA and KEYBANK hereby represent, warrant and agree as follows: 1. BEECH TREE, MAILLER, MARIN, LIOTTA and KEYBANK hereby stipulate and agree that the Action and/or any other legal or equitable proceedings whatsoever which have or could have been brought with respect to any and all rights, duties, or obligations the parties had, have and/or may have with respect to each other concerning the claims asserted in the 2/14 Action 'are hereby resolved in accordance with the 'terms set forth 'herein: BEECH TREE, MAILLER, MARIN, LIOTTA and KEYBANK have further agreed, pursuant CPLR 2001 and 3025, to` amend' the `caption of this Action to remove "Carla L.- Mann" as ' a defendant and substitute as "Carla L. Marin, as`Escrowee." 2:' BEECH'TREE shall, and by this Settlement Agreement does hereby; agree to the dismissal of the Action without leave to``amend and with'prejudice, subject to' the Court's continuing exercise 'of jurisdiction over the enforcement of this Settlement Agreement. The Stipulation of Discontinuance shall state that all the claims, counter - claims. and cross - claims between the parties'to this Settlement Agreement are dismissed, with prejudice, with each party to bear its own costs and with the Court retaining jurisdiction over this matter .to enforce the terms of the Settlement Agreement. Accordingly, BEECH TREE, MAILLER, MARIN, LIOTTA and KEYBANK hereby stipulate and agree to execute and file a Stipulation of Dismissal, with prejudice. The Stipulation shall be filed within ten (10) days after the �satis -ffi ion" of XE'Y'HANK'' '- payment- obligations to- - BEECH TREE- -and- Mikl;LLER -- -under = - - paragraph 3 of this Agreement. 3. In consideration of the foregoing, on or before June 15, 2005, KEYBANK shall pay the total sum of $25,000.00 (TWENTY FIVE THOUSAND DOLLARS) to fully and finally settle any and all claims, demands and/or actions, including the Action and all, claims, cross- claims and/or counter - claims asserted therein by any party, payable as follows: . i. the total sum of $21,500.00 (TWENTY ONE THOUSAND FIVE HUNDRED DOLLARS) shall be paid to BEECH TREE by check made payable to "Stephen E. Butterfass, Esq., as Attorney for Beech Tree Construction Corp." 3/14 ii. the total sum of $3,500.00 (THREE THOUSAND FIVE HUNDRED DOLLARS) shall be paid to MAILLER by check made payable to "Marco Caviglia, Esq., as Attorney for Lisa Mailler." iii. On or before May 25, 2005, each of the above -named payees shall be required to submit completed W -9 forms to counsel for KEYBANK. 4. In consideration of the foregoing, MARIN shall disburse the sum of $5,000.00 (FIVE THOUSAND DOLLARS) to BEECH TREE, pursuant to Court Order, by check made payable to "Beech Tree Construction Corp. ", which sum she is currently holding in escrow in connection with the underlyipg transaction between BEECH TREE, Martin Laurent and Bullet Hole Properties, Ltd. pursuant to a certain Escrow Agreement, dated October 25, 2002. S. It is further understood and agreed that BEECH TREE and MAILLER are each exclusively responsible for any and all federal, state or local tax liabilities that may result from the payment of the sums set forth in paragraphs 3 and/or 4 herein. Should the Internal Revenue - Service or -airy �t t� or Vocal taxing auC'riority determine that any portion of-the payment referred", - -- to in paragraphs 3 and/or 4 herein constitutes taxable income' to BEECH TREE and/or MAILLER, they each hereby expressly agree to hold harmless all persons or entities released herein from any and all injuries, damages, penalties, costs, expenses or liability incurred as a result of any and all claims, demands, or causes of action which may hereafter be asserted against any such released persons or entities for failure to make any withholding of taxes. 6. In consideration for the payments set forth in paragraphs 3 and 4 herein, and for other good and valuable consideration, receipt of which is hereby acknowledged, BEECH TREE hereby releases and forever discharges MARIN, LIOTTA and KEYBANK from any and all claims, actions, causes of action, suits, debts, dues, sums of money, accounts, reckonings, bonds, 4/14 d. ... '.5. -.mss -. • .«w -"... av bills, specialities, contracts, controversies, agreements, promises, variances, trespasses, damages, rights, judgments, executions. and demands of every kind and nature whatsoever, in laws or . equity, which BEECH TREE may have had or claims to have had, now has or claims to have, .or . hereafter may have or claim to have which arise out of or are in any manner whatsoever, directly or indirectly, connected in any way whatsoever to the Action through the date of this Settlement . Agreement including, but not limited to, any and all claims, causes of actions, or suits for .. attorney's fees and demands, whether known or unknown, related thereto. This Release specifically does not apply to any claims related to the enforcement of the terms. of this Settlement Agreement. 7. In consideration for the payments set forth in paragraphs 3 and 4 herein, and for other good and valuable consideration, receipt of which is hereby acknowledged, MAILLER hereby releases and forever discharges MARIN, LIOTTA and KEYBANK from any and all claims, actions, causes of action, suits, debts, dues, sums of money, accounts, reckonings, bonds, $i-Hs; -spocia►iti-es,--contracts; controversies, agreernen:s;- pra-ni-ses; variances, trespasses,. damages . - = -- = rights, judgments, executions and demands of every kind and nature whatsoever, .in. laws or equity, which 'MAILLER may have had or claims to have had, now has or claims to have, or hereafter may have or claim to have which arise out of or are in any manner whatsoever, directly . or indirectly, Connected in any way whatsoever to the Action through the date of this Settlement . Agreement including, but not limited to, any and all claims, causes of actions, or suits for attorney's fees and demands, whether known or unknown, related thereto. This Release specifically does not apply to any claims related to the enforcement of the terms of this Settlement Agreement. 5/14 8. In consideration for the dis'niissal of the Action, and for other good and valuable consideration, receipt of which is hereby acknowledged, MARIN, LIOTTA and KEYBANK hereby release and forever discharge BEECH TREE AND MAILLER from any and all claims, actions, causes of action, suits, debts, dues, sums of money, accounts, reckonings, bonds, bills,. specialities, contracts, controversies, agreements, promises, variances, trespasses, damages, rights, judgments, executions and demands of every kind and nature whatsoever, in laws or equity, which MARIN, LIOTTA and KEYBANK may have had or claim to have had, now has or claim to have, or hereafter may have or claim to have which arise out of or are in any manner whatsoever, directly or indirectly, connected in any way whatsoever to the Action through the date of this Settlement Agreement including, but not limited to, any and all claims, causes of actions, or suits for attorney's fees and demands, whether known or unknown, related thereto. This Release specifically does not apply to any claims related to the enforcement of the terms of . this Settlement Agreement. -� – - -9�- �- �ursuapt to- this- SettlPrnent Agreement,. BEECH :.TREE_A—NI).."LLEk.hereby_. .._._ agree that MAILLER shall sell and transfer and BEECH TREE shall purchase the subject property which is known as Lot 2B on a certain map entitled "Final Subdivision Plot Prepared for Anne Laurent ", dated August 1, 1997 and filed in the Putnam County Clerk's Office on August 24, 1999, Filed Map No. 2798, which property is also described as Section 34, Block 3, Lot 1.22, Town of Patterson and County of Putnam (collectively, the "Property ") for the total sum of $130 (ONE HUNDRED THIRTY THOUSAND DOLLARS). Said purchase and sale shall take place within 30 (thirty) days of the determination that the Property has insurable title as any licensed and reputable title company may determine. 6/14 10. In consideration for the payments set forth in p ragraphs 3 and 4 herein, the agreement set forth in paragraph 8 for the purchase and sale of the Property, and for other good and valuable consideration, receipt of which is hereby acknowledged, MAILLER and BEECH TREE hereby mutually release and forever discharge each other from any and all claims, actions, causes of action, suits, debts, dues, sums of money, accounts, reckonings, bonds, bills, specialities, contracts, controversies,, agreements, promises, variances, trespasses, damages, rights, judgments, executions and demands of every kind and nature whatsoever, in laws or equity, which either party may have had or claims to have had, now .has or claims to have, or hereafter may have or claim to have which arise out of or are in any manner whatsoever, directly or indirectly, connected in any way whatsoever to the other through the date of this Settlement Agreement including, but not limited to, any and all claims, causes of actions, or suits for attorney's fees and demands, whether known or unknown, related thereto. This Release specifically does not apply to any claims related to the enforcement of the terms of this Settlement Agreement. 11. In consideration for the payments set forth in paragraphs 3 and 4 herein, the agreement set forth in paragraph 8 for the purchase and sale of the Property and for other good and valuable consideration, receipt of which is hereby acknowledged, MAILLER, MARIN, . LIOTTA and KEYBANK each hereby agree to execute any pleadings, stipulations and/or other related documents to remove the lis pendens from the Property and otherwise lift any cloud on title to the Property. 12. BEECH TREE, MAILLER and MARIN hereby warrant and expressly agree that they shall keep the terms of this Settlement Agreement strictly confidential and shall not disclose the existence and/or terms of this Settlement Agreement to any third party, with the exception of 7/14 their respective attorneys, accountants, insurance companies, bar associations (for reporting purposes only) and malpractice insurance companies (for reporting purposes only), to a Court ( if concerning this Settlement Agreement and the rights or entitlements thereunder as further specified in paragraphs 16 and 27 of this Settlement Agreement) title company and/or any other necessary party involved in the purchase and . sale of the Property. . BEECH TREE and MAILLER further warrant and expressly agrees that they shall not disparage MARIN, LIOTTA and /or KEYBANK in any manner whatsoever (e.g., written, verbal and/or electronically) and further agree that BEECH TREE and /or MAILLER shall not make any statement to any third party that could cause harm to the business or professional reputations of MARIN, LIOTTA and/or KEYBANK, their respective officers, directors, agents, employees, representatives and/or affiliates. 13. Every party hereto has had the opportunity to seek and receive independent legal advice from its respective attorneys with regard to the advisability. of executing this Settlement Agreement. EA-ffpariy &altbear its-own-costs and attorneys' -fees in- onnection..with.the.Action. and the negotiation, drafting and execution of this Settlement Agreement. 14. BEECH TREE and MAILLER hereby each expressly warrant and represent that there has been no assignment or other transfer by of any interest in any claim settled, resolved or waived hereunder which BEECH TREE and/or MAILLER may have against MARIN, LIOTTA and /or KEYBANK. Further, BEECH TREE and MAILLER hereby expressly agree to indemnify and hold MARIN, LIOTTA and /or KEYBANK harmless from any liabilities, claims, demands, damages, costs, expenses and/or attorneys' fees incurred by any and/or all of them, as a result of any person or entity asserting any such assignment or transfer, or any rights or claims under any such assignment or transfer. 8/14 15. BEECH TREE and MAILLER are not relying upon any representation, warranty or statement not expressly contained herein in connection with entering into and executing this Settlement Agreement. 16. This Settlement Agreement is not intended to be nor shall it be alleged to constitute evidence or be an admission by any party of any liability, omission or wrongdoing of any kind whatever, nor shall this Settlement Agreement be offered or received in evidence or otherwise filed or lodged in any proceeding against any party hereto, except as may be necessary to prove the terms of this Settlement Agreement or to enforce same. 17.. This Settlement Agreement contains all of the agreements, conditions, promises and covenants among the parties with respect to the subject matter hereof and cancels and supercedes any and all prior oral and/or written agreements and negotiations by and between the parties hereto. This Settlement Agreement shall not be modified, amended or changed and may not be changed orally, except by a writing signed by all parties to this Settlement Agreement. 18: Eac i'paity- -to-this Setttem -ent-Agreement -hereby expressly agrees .that.they.shalh._ _ each bear their own fees and costs incurred with respect to the Action and in connection with the negotiation and execution of this Settlement Agreement. including, but not limited to, all attorneys' fees and costs. 19. This Settlement Agreement shall not be held invalid by reason of any typographical or administrative error. 20. Any notices sent under this Settlement Agreement shall be made by Federal Express, U.P.S. or by certified mail, return receipt requested service, to each of the parties as follows: For BEECH TREE CONSTRUCTION CORP.: 9/14 Stephen E. Butterfass, Esq. 1065 Main Street, Suite F Fishkill, New York 12524 (845) 896 -4520 For LISA MAILLER: Marco Caviglia,'Esq. 2610 South Avenue Wappingers Falls, New York 12590 (845) 297 -0044 For CARLA L. MARK ESQ.: Carla L. Marin, Esq. 17 Brewster Avenue Carmel, New York 10512 (845) 225 -3778 For KEYBANK and KAREN D. LIOTTA: Andrew P. Karamouzis, Esq. Moran & d'Arcambal 265 Sunrise Highway, Suite 61 Rockville Centre, New York 11570 (516) 678 -6660 21. This Settlement Agreement may be executed in any number of counterparts, each of which shall be deemed an original, but all of which taken together shall constitute one and the same instrument. 22. This Settlement Agreement shall be construed and governed in accordance with the laws of the State of New York without giving effect to any applicable rules governing conflicts of law. 23. If any provision or any portion of any provision of this Settlement Agreement shall be held unlawful or unenforceable, the balance of this Settlement Agreement shall 10/14 nonetheless in all respects remain binding and effective and shall be construed to be in full force and effect to the extent lawfully permissible. 24. ' The provisions of this Settlement Agreement have been negotiated jointly by the parties and there shall be no presumption of construction for or against any party. The parties to this Settlement Agreement each agree that the language of all parts of this Settlement Agreement shall in all cases by construed as a whole, according to the fair meaning, and not strictly for or against any party. 25. All parties to this Agreement acknowledge that they have carefully read this Settlement Agreement and - understand all of its terms including the full and final release of claims set forth above in Paragraphs 6, 7, 8 and 10 herein. Each of the parties hereto further acknowledge that they have voluntarily and without duress, entered into this Settlement Agreement; that they have not relied upon any representation or statement, written or oral, not set forth in this Settlement Agreement; that the only consideration for signing this Settlement -" Agreeinerifris" set forth- iiergiil; "t'hat -lhd td-r sideYat mr mceived-*r-° executing -this° Settlement--, -- -- -- Agreement is good and sufficient consideration, greater than that to which any party may otherwise be entitled; that each party is currently represented by counsel; and that this Settlement Agreement advises, encourages, and gives every party the opportunity to consult with an attorney before signing this Settlement Agreement. 26. The foregoing warranties, covenants and representations shall survive the delivery of this Settlement Agreement. 27. The Supreme Court for the State of New York, County of Putnam, shall retain jurisdiction over the enforcement of the terms of this Settlement Agreement and for the resolution of any dispute pertaining to this Settlement Agreement. 11/14 28. The stipulation of settlement dated May 18, 2004 and executed by attorneys for Karen Liotta, Key Bank, Beech Tree Construction Corp. and Lisa Mailler is of no further force nor effect. IN WITNESS WHEREOF, the parties hereto have executed this Settlement Agreement on the date below written. Dated: July_, 2005 Dated: July _, 2005 Dated: M17/t3- 2005 Dated: July o , 2005 Dated: July V, 2005 BEECH TREE CONSTRUCTION CORP. By: Name: DOU LAS WALLACE, President -and- LISA MAILLER By: m Name: USA MAILLER -and- CARLA L. M RIN By. Name: Carla L. Marin, Esq. -and - KA . LIOTTA Name: KAREN LIOTTA. -and- 12/14 ACKNOWLEDGEMENT TAKEN IN ACKNOWLEDGEMENT TAKEN IN NEW YORK STATE , Q NEW YORK STATE j( State of New York, County of `"`" ss: State of New York, County of u't c ss: On theolo day of � , in the year 2005 bef�e met e un dsign� , persoQn � y appeared personally know to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his /her /their capacity(ies), and that by his/her /their signatures(s) on the instrument, the individual(s) or the person upon behalf of which the individual(s) acted, executed the instrument. On thelO day of � ' in the year 2005 before me, the and rsigne , personally appeared KAREN LIOTTA personally know to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her /their capacity(ies), and that by his/her /their signatures(s) on the instrument, the individual(s) or the person upon behalf of which the individual(s) acted, executed the instrument. �._,ACKNOWLEDGEMENT.TAK>EN.IN._ ._.,, - _...___r. _ ACKNOWLEDGEMENT TAKEN IN NEW YORK STATE NEW YORK 'STATE State of New York, County of ss: On theme day of , in the year 2005 before me the undersigned, personally appeared DOUGLAS WALLACE personally know to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose. name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her /their capacity(ies), and that by his/her /their signatures(s) on the instrument, the individual(s) or the person upon behalf of which the individual(s) acted, executed the instrument. Au MW Jt t 'old .. —+�.� I i aietS 'all4nd tieJofd �ut>� M 1A obi aiinG N3Hd3.LS BUMWASS 'oN one N r �i3/14 aualt w In W Cbx►y C.onvnisston Explm Februwy aw State of New York, County of TOm'�inS ss: On theotay of ft,,J, in the year 2005 before me,'the uned, personally appeared LISA MAILLER personally know to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her /their capacity(ies), and that by his/her /their signatures(s) on the instrument, the individual(s) or the person upon behalf of which the individuals/acted, xecuted the instrument. Q-0 PENELOPE S CARPENTER N*" Rbttc • Stot® d New Volk No. OICA6127197 Aualltled In Tonvkk» My Commlabon Expo • w ACKNOWLEDGEMENT TAKEN IN NEW YORK STATE State of New York, County of PUTNAM ss: On the 11 day ofSep ew.� ° ✓ , in the year 2005 before me, the undersigned, personally appeared CARLA MARIN personally know to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged tome that he/she/they executed the same in his/her /their capacity(ies), and that by his/her /their signatures(s) on the instrument, the individual(s) or the person upon behalf of which the individual(s) acted, executed the instrument. ■ MOUNT 1► 14/14 OFFICIAL SEAL. MARIN,PHILIP DOUGLAS Notary Public - Newyork Putn County My Commission Expires April 2S, 200p Reg. No. 02MA6125973 PUTNANI COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 2 /� Z %m;�, 0-k FINAL SITE INSPECTION Date: 2 a Inspecte y:, tzE� Street Location _n2F-S ' j7 Owner A/gGG�� G Town P��'�����/ Permit # TM # 3.�f — 3 -- �� ya Subdivision Lot # 4 $ 1. Sewage System Area a. STS area located as per app roved.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 ...... ............................... f-� II. Sewaae Systern � a. Septic tank size - 1,000 ....,? :1, 250 .. < .`.....other ................ b. Septic tank installed level ............................................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... ............................... f. Trenches Len h required 7 Z c Length installed _Z-Lo 2. Distance to watercourse measured +IC-10 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 314 -1 %2" diameter clean .................... z. .9. -:D.epth of gravel in -trench 121mir�imum :........::::... 10. Pipe ends capped .................................. :.................... g. PumR or Dosed Systems 1. bize ol pump chamber ................ ............................... 2. Overflow tank ............................................................. 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ............................................................ 6.- Cycle witnessed by H.D.estimated flow /cycle........... III. HouseBuildi_g a House I rated per approved plans .................. ........... b. Number of bedrooms ............................ f. . ............... IV. Well a. Well located as per approved plans . ............................... COMMENTS c. easing ib" above grace .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall WorkmanshiD 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 h. Surface water protection adequate .........................:i. . i Frminn rnntrA nrnv;APA PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM g C'PG h ! it ee Chit S oa %dig Owner or Purchaser of Building l�C e- t` ! d^ oti5 Building Constructed by 9 --3 L% Q Tax Map / Block Lot TownNillage T7 1 0(myn An Am. 4,k. -, Am j 1 Location - Street RO'OL� Subdivision Name 4 cdvt r~ l V Aen r5 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 ..system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month '�,_ Day Year Signature: 19a44do 0;m zdzev Title: 6^ S General Cfintrac# (Owner) - Signature Corporation Name (if corporation) a f Address: t 1. ke State e_ id )/ if Zip Corporation Name (if corporation) Address: State Zip Form GS -97 p (;FR]3FICATF OF CONSTRUCTION lY)MPL• Am c, 3efore a Certificate of Occupancy for a dwelling is issued by the local Building Inspector, n Certificate of Construction Compliance for the SSTS must fast be issued by the _ Department. The Department must be notified before the system is backfilled in order that an inspection of the completed system can be made. Open work inspections may be omitted 911be at the ' discretion of the Director or his designated representative. In order for the Department to issue a Certificate of Construction Compliance, the following must be submitted: (Note: All submitted Department application forms shall conta'm X81 signatures (no photo copies)). I . Certificate of Construction Compliance. (See Appendix Ins a. The Construction Compliance Permit is to contain the assigned fiI 911" a ress issued by the respective municipality. The "E 911" address is to vided at the "Located at is section on the permit form. The following telephone numbers are offered for the agency assigning the "E 911" addresses within the municipality: Carmel: Building Department Philipstown: Building Department 628 -1500 265 -3929 Kent: Building Department Putnam Valley. Town Planning 225 -3900 326 -3740 Patterson: Town Planning Southeast: Building Department 878 -6319 279 -5698 A Construction Compliance permit will W be issued without the current "E 911" address. C v J 2. Three (3) copies of a two (2) year guarantee, signed by the ' aller, and/or gener contractor, or the owner. (See Appendix K) 3. If the water su P ....1 PYis fr a drilled we a. Satisfactory results o a water analysis, for the parameters is able I bcl6w, conducted and reported by a NYSDOH approved laboratory under the "Environmental Laboratory Approval Program (FLAP)." d"il,L���v��i:. -� . �t L4.R¢'s.,�x' -- :•����•di :Y!'. i'�l• iii�vf .Y•�sri' CONTAMINANT MCL (1)(4)(5) Coliform bacteria Any positive result is unsatisfactory Lead 0.015 mg/1(15 ug/1) Nitrates 10 mg/l as N Nitrites 1 mg/! as N - Iron 0.3 mg4 Manganese 0.3 mg/l Iron plus manganese 0.5 mg/l Sodium No designated limit (2) pH No designated limit Hardness No designated limit [Alkalinity No designated limit NOTES: (1) Maximum contaminant level. (2) Water containing more than 20 mg4 of sodium should not be used for drinldngby people on severely restricted sodium diets. Water containing more than 270 mgll of sodium should not be used by people on moderately restricted sodium diets. (3) NTU means Nepbelometric Turbidity Units. (4) mg/l means milligram per liter. (5) ug/l means microgram per liter. 4. -b. A Well Completion Report signed.by the well driller, includin the results of least a 6 -hour pump test (See Appendix K). A minimurri well yield of S gpm is required. For yields less than S gpm see Appendix F for procedures on performing a 24 -hour well pumping test The results of the 24 hour pump test are to be submitted to the Department for review and a determination will be made regarding utilization of the well for supplying potable water to the dwelling. If the new well is found acceptable, then the procedures for determining the minimum potable water storage requirements, located in Appendix G, are to be utilized. If the water supply is from a public water supply, 'factory results of a coliform bacteriological analysis of a water sample taken m the service connection, performed by a laboratory approved by the NYS He th D eat "Environmental Laboratory Approval Program." S. Thee (3) sets of "as built' plans, signed and sealed by a Design Professional, licensed and registered to practice inNew York State. These plans shall be to scale (minimum 1 inch to 30 feet horizontal) and shall include: a. Surveyed house location with respect to property lin . The plan shall make reference, by note, to the source of survey. b. Metes & bounds description of prop Ines. c. Actual locations of installed SSTS and wale improvements. _d.' The distances-necessary- to lc:,at:, th.`.-septic taniv di . ution-bextsi jim:tion boxes, ends of the SSTS and well from two fixe oints, preferably the comers of the building. • e. The plan must include a legend, which reads as folio . "This Is to certib that the sewage treatment system was constructed indicated on this plan and that the system was inspected by me beJor was covered over. The system ivas constructed in accordance with all ndard rules and regulations of the Putnam County Department He and the New York State Department. of Health." E The "as- builf' plans must also include a e box, giving the information required on the original design drawin . Minimum size of "as- built' plans should be 11 inches by 17 inch a minimum scale of 1 inch to 30 feet. g. Space for Putnam County Health Department approval p (minimum 3" x S ") _preferably at the lower right-hand portion of an. Fee - See Appendix I. 'on Compliance Permit is issued by the Department, a copy of the Catificate of Construction Compliance Permit, Well Completion Report and approved "as- built" plans should be brought to the local Building Inspector for processing the Certificate of Occupancy. The local muaucipality should be contacted for their particular requirements for a Certificate of Occupancy. Z COGS - - BRUCE R. FOLEY LORETTA MOLINARI- R.N., M.S.N. , .. . Public Health Director-- Associate Public Health Director F 04 Director of Patient Services DEPARTMENT OF. HEALTH 1 Geneva Road �.: Brewster,- .New York 10509 Environmental Health (914)279-6130 Fax (914) 27i-7921 Nursing Services (914)278-6558 1YIC (914)279-6678 . Fax (914) 278.6085 Early Intervention (914)278-6014 Preschool (914) 278 -6082 Fax(914)278-6648 } E911 ADDRESS VERIFICATION FORM OWNERS NAME: o e �0 i c>,m S j-y ez c_ ti'o. ✓r - - - TAX MAP NVMBER: 3 -- E911 ADDRESS: % W4d TOWN: GL 0 So ki AUTHORIZED TOWN OFFICIAL: (Signature) DATE: The Putnam County Department of Health will not issue -.a Certifcate`_of - Construction Compliance unless'-the- above form is completed,_i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application, for a Certificate of Constraction Compliance. (E91IVEMIA) YML ENVIRONMENTAL SERVICES 321 Kear Street (914) 245-2800 Albert H. Padovani, Director LAB #: 93.200289 CLIENT #: 8641 NON 5TAT PROC PAGE 1 WALLACE, DOUGLAS DATE/TIME TAKEN: 01/31/02 12:10P P.O. BOX 154 DATE/TIME REC'D: 01/31/02 12:25P MOHEGAN LAKE, NY 10547 REPORT DATE: 02/08/02 PHONE: (914)-734-1187 SAMPLING SITE: LOT 4B,SUBDIVISION OF ANNE LAUREAT SAMPLE TYPE..: POTABLE : KIT TAP PRESERVATIVESL NONE COL'D BY: DOUGLAS WALLACE TEMPERATURE..: < 4C NOTES...: COLlFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~ —mm ~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 01131/02 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 01131102 LEAD (INS) <1 ppb 0-15 ppb 9101 01/31/02 NITRATE NITROG 0.55 MG/L 0 - 10 9139 01/31/02 NITRITE NITROG <0.01 MG/L N/A 9146 01/31/02 IRON (Fe) <0.060 MG/L 0-0.3 mg/l 2037 01/31/02 MANGANESE (Mn) <0.010 MG/L 0-0.3 mg/l 2037 01/31/02 SODIUM (Na) 3.78 MG/L N/A 01/31/02 pH 6.5 UNITS 6.5-8.5 9043 01/31/02 HARDNESS,TOTAL 58.0 MG/L N/A 01/31/02 ALKALINITY (AS 32.0 MG/L N/A 11JET-101J,iI COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDIil;i:�THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. ablic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. No limits for Sodium are proscribed. Suggested guidelines state ` that for Oeople on a sodium restTic� /diet,the water should . �/�. ��� contain no more than 2O mg/L of Sbd^=".� For ^.,"se on a moderately restricted diet, a maximum of 27q mg/L of Sodium ` is suggested. '� ^ YML ENVIRONMENTAL SERVICE'S 321 Kear Street N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 93.200289 CLIENT ON 8641 NON STAT PROC PAGE 2 WALLACE, DOUGLAS DATE/TIME TAKEN: 01/31/02 120OP P.O. BOX 154 DATE/TIME REC'D: 01/31/02 12:25P MOHEGAN LAKE, NY 10547 REPORT DATE: 02/08/02 PHONE: (914)-734-1187 SAMPLING SITE: LOT 4B,SUBDIVISION OF ANNE LAUREAT SAMPLE TYPE..0 POTABLE : KIT TAP PRESERVATIVES: NONE COL'D BY: DOUGLAS WALLACE TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF -mm ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, ]N 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 - -'MOD ERATELY''HARD 'WAJE3R: 70-140 MG/L. . MG/L =-MILLA1. LlTER HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) SUBMITTED Alber . Pado~'ni, M.T.(ASCp) Direc��r ' ELAP# 10323 r,... HEALTH PUTNAM COUNTY DEPARTMENT OF H DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM D PERMIT 1V r -r� -�Z Located at 4nLM� � 114" , TAMM #*-t- Town or Village P,trffe7tSUN KT Subdivision name AN AI G_ 7 LAIL) P -W T Subd. Lot # qD Tax Map 3 `f Block '3 Lot _ Date Subdivision Approved Renewal Revision I, If% Owner /Applicant Name - �-) LA-)LA Date of Previous Approval Mailing Address PO 6O X ) 5 q r%i 6 r1 e j 4k WC_ NJ zip IU5`f i Amount of Fee Enclosed Building Type W001) r id Lot Area 35 No. of Bedrooms Design Flow GPD &&-o Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of MIS gallon septic tank and % z o L. I2 2 C—T 1WYZf'✓8�CA'f' Z • Sl, T r'--1 LA__ 1c90 ©yi 1 Other Requirements: n To be constructed bye f�N Address C��Z N Water Supply: Public Supply From or: Private Supply Drilfed b'- Address Address & V16W f 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 thereto Signed:. Address. P.E. R.A. Date License # APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe t. pprove r discharge of domestic sanitary sewage only. By: &A./ Title: f� Date: 6 Z White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 Sent By: LLL; 1234567 ; Jan -4 -02 12:06; Page 1/1 aun lu uu JAI 3.uf Km rUAAm Ul W HEALTH FAX NO. 19142787921 P. I a 0 PUTNM COUNTY DEPARTIVIM OF W,ALTF[ DIVISION OF ENVIRONMENTAL HEALTH SERVICES A►TITFMUON 0 ADAM XGENE For Fill Ali lafotmedon must be &Uy completed prior to any Trenches inspeak ms being t usde• x • PCPID C coon Permit # Located: OWMIApp ' t Name: 0 U �- TM� 4 Block Lot Formerly: Subdivision Name: A-lVIVG 4 O6W 7 • Subdivision Los # Is system fill completes? t, bats: _ " I Z-8110 1 Is system complete? Date: Is tyetem constructed as per pleas. Is well drUled? q Datc —11 I t 0�_ h wen located as per Pkw? Are erosion control measures in plAm? �x I cat* that the syutem(sl as listed, at the above premises has been constructed end I have inspected And verified tbak compkeaom in accordamce with the issued PCM Coutrucdon Permit and approved plate and -the- StwWards, Ruses and RcSolations of the Putnam Coumy Dcpartwmt of /"..9 ....•.. a.. ....- >"Ieaith. .. . ..... .. .... a.. . ........ .. .. -.. ,�.�... r y . 5.•_ .... - . < .. . - ... _ .. .. —.... ..... . �. -... � ..- .. -.�. Date: Q + y a Certified by: PE RA Design Professional Coasmmu: Form FIR-" — • n ---- rat a -- -- Try . nAc �-7n �fn n4 klr%MC. CI ITklnM fMll IAITV n=l3n 7TMGnIT rim P 1 G BRUCE R. FOLEY� Public Health Director - LORETTA 41VIOLINARI 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 (845) 278 - 6014 ' Fax (845) 278 - 6648 January 14, 2002 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 John Karell, PE 121 Cushman Road Patterson, New York 12563 Re: Wallace,. Holmes Road (T) Patterson, Lot # 4B TM# 34 -3 -1.42 Dear Mr. Karell: An inspection of the fill pad at the above referenced project has been completed. The clay barrier needs to be installed upon completion of the final trench inspection. Trench plans must be submitted to this Department for final approval. Please not that field measurements by this Department in no way suggests the exact size, depth If you have any further questions, please contact me at (845)- 278 -6130 ext. 2261. GDR: cj Very truly yours, Gene D. Reed Environmental Health Engineering Aide .Y a a .,-SENDING CONFENTION, DATE : JAN -14 -2002 MON 15:15 NAME PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE 96287085 PAGES : 1/1 START TIME : JAN -14 15:14 ELAPSED TIME : 0012111 MODE : ECM RESULTS OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED.. BRUCE R. FOtEY L40NMA bIOLNURI B.N., KS 'N. P.eaa H-d* DOeaaer Aaxde ftNk Red& bftd r DvW. of tearer Sn.iw DEPARTMENT OF HEALTH 1 aemva Road linwater, New Yedt 10509 anhaasodt sera MAtTe -e17a rR Ms)r� -7arr n.m.a aa.ar. Mshrn_en wto WT72."" FftW318-6W isrb 10—th a MA21s -4014' ha ("27a -66th January 14, 2002 ^"�••r w�has-�rl �(»� -mu .` ........, ...- ,..... .. ....1,..,..., JobnJCarell;Pli__ ._ .._ __._. . - ..... -._ . -._. -- -- - --- -- --- •-- - --_ I e_�.. 121 Cushman Road Patterson, New York 17563 Re: Wallace, Holmes Road (T) Patterson, Lot # 413 TM# 34-3 -1.42 Dear Mr. Karin]: An inspection of tho fill pad at the above referenced project bas been completed. Tho clay barrier needs to be instaRad upon completion of the final trench inspection. 'bench plans must be ! submitted to this Department for final approval. Please not that field measurements by this Department in no way suggests the exact size, depth and location of the fill pad. If you have any furtha questions, ploase contact me at (945 )-278.6130 on 2261. Very truly yours, Gone D. Reed Environmental Health Engineering Aide t9DR:q PUTNAM COUNTY DEPARTMENT OF HEALTH r-, -- -_%, V SIGN-OF-EW- MONMENTAL HEALTH SERVICES- 7. .. DI I DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner 6) W MA-_A - C Address PO 66)( 15Y MAe_,qA v ke_ wner .1 LA Located at (Street) --A-K, A- Tol "i M i I 14AJ Tax Map Block Lot (indicate nearest cross street) Municipality 4��s:nj Watershed At W- e_- / /V, 1, 4 (4,6 SOIL PERCOLATION TEST DATA (_4c V10.41 Date of Pre-soaking -j_jL_—D2_ of Percolation Test . .................. ... .... ... . .. . ... ... . ..... .0 . I ...... .-Pro proLL` es;. if I Time Level Percolahan: a X1 Time Surface m Ground .. Start un. O."i tar a OD i`.'..,*..,.,.,.i :H6kN6;*:.-., ... ... .... ..... AV,rD co 3c) C' 10 30 9�? 2-9 57 2 30 &0 4 (0 2 3 z Lt Z-9 VV z 4 5 EW 'E 3 4 0 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each ch, s 2 min for 31-60 min/inch) All data to be percolation test hole. (i.e. :5 1 min for 1-30 minlin submitted for review. 2. Depth measurements to be made from top of hole. V­ r%r% 01 BRUCE R. FOLEY Public Health Director LORETTA MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewstet, 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 (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 May 3, 2001 John Karell, Jr., P.E. 121 Cushman Road Patterson NY 12563 Re: Proposed SSTS: Wallace Holmes Road; Lot #413 (T) Patterson, TM# 34 -3 -1.42 Dear Mr. Karell: 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. PC -97 notes incorrect drainage basin. 2. Design Data Sheet: -- A:-• - -Notes incorrect drainage basin: B. Does not provide percolation and pre -soak dates. C. Does not provide percolation rates. D. Does not soil profile. E. Does not note the required deep test hole information. ,,/%,-3. Minimum distances from the toe of slope to the property line is 10 feet. ✓4. Volume of R.O.B., unclassified and impervious fill is to be noted on the plan. 1/5. Elevations of proposed contours are to be provided. V- v6. Proposed contour line 686 does not appear to be correct. , , r 7. 2.5 feet is to be provided for the entire SSTS. The fill on the south side of the SSTS is insufficient. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this, regards. If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. Letter to: John kiiye"fl', Jr:; 2601 -21 Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:tn 4/truS' ' Py ly M/oms,* Senior Public Health Engineer 7' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVIISION OF- ENVIRONMENTAL- .HEALTH SERVICES­. DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYST -EM - Owner,�,� �,R. �-,,,� Address .vo-yv Aa4 p Located at (Street)OTAIMU7 �... �� Tax Map TO Block' 3 Lot I indicat nearest cross street) Municipality ��o4f Drainage Basin . 1141 V0147 SOIL PERCOLATION TEST DATA 9. SPf Date of Pre- soakine `7 /,,P-/,9 n i4u, Date of Percolation Test `1IW9 7 n IQ it same depth until approximately equal percolation rates are obtained at each (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be to be made from top of hole. Form DD -97 De th to Water Water from Ground Level Percolation Time Ela se.Time Surface (Inches) Dro In Rate Hole No. Run No. Start - Stop (Min.) Start Stop Incles Min/Inch 1 /:!p 2: Z/ TO ` 20 G h .2 U?.I- ..'L: Ste' ;ro : l 9 20 l T v 4 - zb 2 ?N' 23r 2: S� 3'0 �'" l9 I 30 4 2 2: 4 IQ it same depth until approximately equal percolation rates are obtained at each (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be to be made from top of hole. Form DD -97 2 Indicate level at which groundwater is encountered 102,*4 (6 ex 6A 1) Indicate level at which mottling is observedr Indicate level to which water level rises fter being encou tered 9_C � � ALil Deep hole observations made by: K fooli,ter& pc612 Date —7§J/7 .,��srN �iyar /ii e t &w••r IV4 G D �►° Design Meg Address:., 11 West Main Street ' Signature al CO r PUTNAM COUNTY DEPARTMENT OF HEALTH - L�IVXS1ON OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address 4 r l Located at (Street) Tax Map Block 3 Lot M ndicate nearest cross street) Municipality 2�� y Drainage Basin M 1 WjTjf2,A SOIL PERCOLATION TEST DATA Z-T 46 0 Date of Pre - soaking Date of Percolation Test Hole No. Run No._ Time Start - Stop Ela se Time Min.) Dep th to Water rom .Ground ... Surface (Inches) Start Stop Water - Level ... Dro In Inches Percolation - Rate Min/Inch 2 3 4 5 2 4 1 2 3 4 5 IN VTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtatnea at eacn percolation test hale. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 ndicate level at which groundwater is encountered /Yo Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: , f1c sir �0 1. Date _"Ap- Design Professional Name: J &A 777 G & � _ Address: Signature Design Professional's Seal of NEW`Yo J.0VS I. C& 9� r U01A 0- -- l� 2� "\ TEST- PIT DATA - ... - -- DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. Z HOLE NO. HOLE NO. G.L. 1.0' 1.5' 2.0' 2.5 3.0' Mail-- .H db 3j ., 3.5' 4.0' 5.0'. - i 5.5' Cno _. --- - 6.0' ,G 6.5' 7.0' <—� 7.5 crn 8.0' 8.5' _ .... ._ _ . _... . 9.0' _ 9.5' 10.01. ndicate level at which groundwater is encountered /Yo Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: , f1c sir �0 1. Date _"Ap- Design Professional Name: J &A 777 G & � _ Address: Signature Design Professional's Seal of NEW`Yo J.0VS I. C& 9� r U01A 0- -- PUTNAM COUNTY DEPARTMENT OF HEALTH DY'V'ISION OF ENVIRONMENTAL BEALTD SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM r / �vner 9(�U Address �,� �r `� 3cated at (Street) Ali 5 1 �-(1 AD Tax 1 Ol t7 Map Block 5 Lot indicate nearest cros s street) ' iunicipality Drainage Basin SOIL PERCOLATION TEST DATA )ate of Pre - soaking Date of Percolation Test De tb to Water Water rom Graund Level Percolation Time Ela se Time Surface (inc>zes) Drop In Rate R01eNo. Run No. Start -Stop 8l3% D.) -Start Stop Inches b n4:Ch l � 2 .3 I I- I I I 4 5 1 1 ) IP1.,, mm earn; 3) 1 1 1' F I ..I* •I I '- I I' 3 I I I I I •1 4 I I . 5 I I i I NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 ininrnch, s 2 min for 31 -60 minrnch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 PTH TEST PIT DATA . DESCRIMON OF SOM ENCOUNTERED 11Ti TEST HOLES F:OLE140. _ HOLEI0• ' HOLENO. ° 2 O' C 51 .51 7.5' 9.0' 9.5' . 10.0' Indicate level at which groundwateris 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:f Address: Z S A Signature: �. 6 • PUTNAM COUNTY DEPARTME NT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS •...._,._...., - ._.... .... _.. REVIEW- SiIEET -FOR- CONST.- iRu TIONPERb1IT -"- ... : _ • • = -•. __... - NAME OF OWNER: �,�J STREET LOCATION: I vli REVIEWED BY: AS, SRDATE: TAX 1�.L4Pa: (CONFIRMED) 1(1( N DOCUMENTS Y �' (REQUIRED DETAILS ON PLANS CONT'Dl PERMIT APPLICATION HOUSE SEWER -' /a" FT. 4 "0'; TYPE PIPE CAST IRON WELL PERMIT OR PWS LETTER NO BENDS; MAX BENDS 45° W /CLEANOUT C -97 RENEWALS LETTER OF AUTHORIZATION U SITE NOTE (NO CHANGE) N DATA SHEET (DDS) FILL SYSTEMS ORATE RESOLUTION 10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE T EAF FILL SPECS/ FILL NOTES 1 -5 -THREE SETS E PLANS -TWO SETS U FILL PROFILE &.DIMENSIONS (� VARIANCE REQUEST FILL Di EXPANSION AREA FILL GREATER TH9 �'2 FEET SEQUEST LEGAL SUBDIVISION U CLAY BARRIER C SUBDIVISION APPROVAL CHECKED . ILL CERTIFICATION NOTE U(--) DEPTH GAUGES (__)L—)PERC RATE 2i VOL. ON PLAN FOR RO.B., UNCLASSIFIED & IMPERVIOUS ()UFILL REQUIRED EPTW U SEPARATION DISTANCE FROM TOE OF SLOPE U CURTAIN D RE ED TRENCH LF TRENCH PROVIDED LOFT MAX. LOCATED IN NYC WATERSHED PARALLEL TO CONTOURS PLANS SUBMITTED TO DEP i DELEGATED TO PCHD 100% EXPANSION PROVIDED (� DEP APPROVAL, IF REQ'D DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL ( GEOIEXTILE COVER i DEEP TEST HOLES OBSERVED SEPAR4TION DISTANCES ON PLAN - FROM SSTS (_) PERCS TO BE WITNESSED 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL �EX- APPROVAL SSDS ADJ, LOTS 20' TO FOUNDATION WALLS WETLAND5 (TOWN/DEC PERMIT REQ'D ?) 100' TO WELL, 200' IN DLOD,150' TO PITS DATA DDS PLANS &PERMIT SAME 100' TO STREAM, WATERCOURSE, LAKE (inc. espan) ( 'PRE 19G69 9 NEIGHBOR NOTIFICATION ( ETTER BUZBA 50' TO CATCH BASIN, 35' STORNIDRAIN, PIPED WATER I; 10' TO WATER LINE (pits - 20') . �. ^: .._ � . -._ ;0' L�"r�R�I�ITI�'ENT DRAINAGE COURSE "_._.._.... _ _..._....._ .. ..._....,, s... ZSOIL TESTING DETAILS YEARS OLD 200'/500' RESERVOIR, ETC. 150' GALLEY SYSTEMS REQUIRED DETAILS ON PLANS ( a( )10' INlIN TO LEDGE OUTCROP SEWAGE SYSTEM PLAN - (NORTH ARROW) `7` `J SEPTIC TANK C,ZSSDS HYDRAULIC PROFILE IU10' FROl1 FOUNDATION; 50' TO WELL GRAVITY FLOW WELL CONSTRUCTION NOTES 1 -15 DIMENSIONS TO PROPERTY LINES DESIGN DATA: PERC & DEEP RESULTS (_)LOCATION OF SERVICE CONNECTION 2' CONTOURS EXISTING &PROPOSED _ (, -415' TO PROPERTY LINE DRIVEWAY & SLOPES, CUT SLOPE C. FOOTING /GUTTER/CURTAIi I DRAINS USDA SOIL TYPE BOUNDARIES (—)SLOPE IN SSTS AREA (520 %) ;,/"PROPOSED TITLE BLOCK; OWNERS NAME ADDRESS UURGRADED TO 15 %, IF REQUIRED TM#, PE/RA; NAME, ADDRESS, PHONE# DOSE/PUiVtP SYSTEMS DATE OF DRAWING/REVISION PUMP NOTES DATUM REFERENCE ( DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED LOCATION OF WATERCOURSES, PONDS (--) DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) LAKES,WETLANDS WITHIN 200'' OF P.L. PIT-AND D -BOX SHOWN & DETAILED FINISH FLOOR AND 1 AY STORAGE ABOVE ALARM BASEMENT ELEVATIONS CURTAIN DRAIN WELLS & SSDS'S W/IN 200' OF SSTS STANDPIPES, 5' BOTH SIDES, DETAIL PROPERTY METES & BOUNDS 15' MIN to CDS = >5 %, 20'-4%, 25' -3 %, 35' -1 %,100 % -<1% (_JEROSION CONTROL FOR HOUSE, WELL & 20' MIN to CD DISCHARGE /100' with 182 cons day discharge SSTS, EROSION CONTROL NOTE U( 10' NILN to NON - PERFORATED PIPE COMMENTS: (REVSI4EET)09 /01/00 4.0 CONSTRUCTION PERMITS , _101CUP / Prior to any construction of a SSTS, plans for such system must first be approved by the Department. There are generally two types of construction permits reviewed by the Deparlmentb ,thosp.requining.2-.feet of fill- or less, and those requiring greater than 2 feet of . fill. The submission requirements for each type are specified below. A. Construction Permit Submission Requirements For Lots p C R LOP equiring No fill or Fill Two -Feet Deep or Less �. Construction Permit Application. (Appendix K) Letter of Authorization for Design Professional. (Appendix K) Q�V Application for Approval of Plans For A Wastewater Treatment System. (Appendix K) ' Short Environmental Assessment Form (EAF).(Appendix K) Design Data Sheet. (Appendix K) NOTE: All submitted Department .application forms shall contain ori5dnal signatures (no photo copies). Three (3) sets of plans bearing the seal and signature of a Design Professional, licensed and registered to practice m New York S tate. Th ese plans shall be to .tscaie.(minimum. 4 -- inch -to -30 feet horizontal -and 1 inch t®10- ;feet-vert cal)- and- -_ U include, as a minimum, the following: Two (2) sets of house plans with title block as specified in 7. k. above, one of which must accompany copy of approved Construction Permit to the Building Inspector of the local municipality. Upon approval of the Construction Permit, the house plans will be signed and stamped: "Approved For Bedroom Count Only If water service is from a public supply or community supply, a letter from the water supplier will be required stating that they will be able to supply the property with water at adequate pressure. Well Permit Application, if required. (Appendix K) Applications for Construction Permits for lots created prior to 1969 will not be reviewed until. such time as the Department. is provided with proof that Fee See Appendix I. 14.16.4 (9195) —Text 12 PROJECT I.D. NUMBER 617.20 SEAR yAppendlz C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART 1— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR j _ � 2. PC9QJE� T M��K 3. PROJECT PROJECT LOCATION: Municipality ,�`%/ County 4. PRECISE LOCATION (Street address and road Intersections, 'prominent landmarks/, etc, or provide map) 5. IS RO SEO ACTION: . LWAaw ❑ Expansion ❑ Modificatlon/alteration B. DESCRIBE PROJECT BRIEFLY: T. AMOUNT OF LAIP A ECTEO r a. Initially acres Ultimately acres 8. WILL ROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ❑ es No If No, descrlbe briefly 9. H IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑ Industrial ❑ Commercial ❑ Agriculture 0 Park/For0t/Open.spacs.. 0 Other . 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL) ?KNo ❑ Yes It yes, Ilst agency(s) and permlt1approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? )&es ❑ No If Y03, 113t agency name and permltfapproval F T 1�u.rd�r1. 12. AS A RESULI OfiPROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑ Yes No 1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE W�l �j Z,,; Applicantlsponsor name: Date: Signature: If the action is in the Coastal Area, and you are a state agency, complete the , Coastal Assessment Form before proceeding with this assessment OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) 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 b Other Involved agency. C1 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: A , C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: Vd Ca. A community's existing plans or goals as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explain briefly, CS._ Groyt4h. subsequent development, or related activities likely to be Induced by the proposed action? Explain briefly. -. = C6. Lorig'term, short term, cumulative, or other effects not Identified in C1-05? Explain briefly. _ i CI -,, C7. Other impacts (including chap es in use of either quantity or type of energy)? Explain briefly. D. WILL THE PROJECT VE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT -OF A CEA? ....❑Yes- . _. - L`JNo� - : _�._ ._. -.. � _ _� �,...,�,. . _. _ _.__. � -_ ., .�.. -- -- -.._ -. « -� _ _....� ____ °__. .._. .. _ _... E. IS THERE, OR ISr- TH��&f? LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes L� 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 (Q magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed. If question D of Part II was checked yes, the determination and significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. ❑ Check this box if you have Identified one or more potentially large or significant adverse impacts'which MAY hoc - Then proceed directly to the FULL EAF and/or prepare a positive declaration. `in 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: ;cncy —Title o Responsible esponsible Oticer er in Lead Agency C Signature of Preparer (It different from rewns-ible officer) Date 2 PUTIVAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner ��U �j ��,�L� Address X01 -% Located at (Street) -i / Tax Map Block Lot indicate ne est os street) Municipality Drainage Basin . lz"v_44 SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test Hole No. Run No. Time Start —Stop Ela se Time ilr,,n) De th to Water rom Ground Surface (inches) Start Stop Water Level Dro In Incles Percolation Rate Min/Inch 1 2 3 4 5 _S . 2 3 c— Ata"f1ji �d 4 44a 04 AATJJZ!� 5 1 2 . 3 , 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s t min for 1 -30 minlinch, 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 t. TEST PTT DATA DESCRIPTION OF SOILS ENCOUNTERED Iii I TEST BOLES I:OLE NO. �% 1 HOLE NOY• - HOLE N0. 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: Address: ,C • o, al V v C Signature: •e• Design Professional's Seal b q _z `\ U ..9;- . C . 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: `poi 6 j::s W KS .& 2. Name of project 4. Design Professional: 6. Drainage Basin:.����,;� 7. Tyne of Project. 1 _D4- Private/Residential Apartments Office Building 5. Address: Food Service Commercial Institutional Mobile Home Park Realty Subdivision Other (specify) (L4k I S-� 3 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted Y_ 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... /V Ll 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 officiaIs, ordinances? - Z?.._. ,. 13. If so, have plans been submitted to such authorities? ........ ............................... 14. Has preliminary approval been granted by such authorities? Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water '� groundwater . 16. If surface water discharge, what is the stream class designation? ..................... 17. Waters index number (surface) ..............:............................ ............................... 18. Is project located near a public water supply system? ....... ............................... �. 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ JJ d 21. Name of sewage system Distance to sewage system 22. Date test holes observed 23. Name of Health Inspector 24. Project design flow (gallons per day) ................................. ............................... 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... �1 26. Has SPDES Application been submitted to local DEC office? ......................... Form PC -97 8/99 2 27. Is any portion of this project located within a designated Town or State wetland? 28. Wetlands ID Number ........................................................... ............................... 29. Is Wetlands Permit required?. .............................................. ............................... 06 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 A � other potentially known source of contamination? ............................... Yes/No By DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... 35. Are any sewage treatment areas in excess of 15 %slope? . ............................... 36. Tax Map ID Number .......................... ............................... Map � Block -3 Lot f . 37. Approved plans are -to be returned to ..... Applicant . -- Design Professional NOTE:. All applications 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 affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 the Penal Law. , SIGNATURES & OFFICIAL TITLES. Mailing Address: .... ............................... COUNTY DEPARTMENT OF HEALTH PUT14AM DIVISION OF ENVIRO NMENTAL HEALTH SERVICES RE: Property of Located at TN j Qd Subdivision of I71 5 kJA-U+CG7- Tax Map# Block 3 Lot Subdivision Lot # Filed Map # Z-� Date Filed 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 perniit(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 is conformity with the provision' ticle 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam Cow9bad e• yours, ,w Countersigne � Signed• _ P.E.; R.A., # er or ) Mailing Address , Mailing Address: fA C� State Zip State - _Zip / 643 7 .4L Telephone: ? _ Telephone: / -- 311- .�d 2 Form LA -97 \ t PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE XIM SYSTEM PERMIT # j0-6A0-'0/ Located at S Town or Villa e name �� Subd. Lot # Tax Ma 3 Block � Lot b� Subdivision I1R1'�J� T � P Date Subdivision Approved Q 12 l q I Owner /Applicant Name W 6 ��W i}7- Mailing Address PO � p K 15 � ► " „� l 0 dJ VJ L*a_� Renewal Revision Date of Previous Approval Amount of Fee Enclosed 03Z) Building Type Lot Area3 t S 'No. of Bedrooms T Zip Design Flow GPDF--6v Fill Section Only 4- Depth 2•.5r:t- Volume /000'iP__S PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of t2-TO Other Requirements: To be constructed by 7T P �j E gallon septic tank and Address J�MXAZ Al Water Suppy Public Supply From Address - br:-_ Private Supply- Drilled - by--- __..__.....� Ii 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 Signed: Addres or yy re airs th eto. P.E. X` R.A. Date s License #7 % APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. Approved for discharge of domestic sanitary sew a only. By: Title: Date: White copy - HD Vile; Y o copy - Building Inspector; Pink copy - O er; Oran copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL .COM$LETION REPORT Well Location Street Address: j!Mdj7tj Q Town/Village: Tax Grid # Map. Block Lots) j Well Owner: Name: Address: 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 —A Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock _ Other ' - Casing Details ." Total length aft. Length below grade ft. Diameter Tin. Weight per foot �Ib /ft. Materials: Steel _ Plastic _ Other Joints: _Welded X Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: 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 Compressed Air Hours t� Yield gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet f Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 3 If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information S Pump Type ' Capacity Depth _I Model 3,9-o Voltage its HP __YL_ Tank Type ,c Volume . li%hs PtIr. kM a1 Date Well Compl ted ®s / o/ Putnam County Certification No. 007 Date of Report // "60 l Well Driller (signature) I ft&vr..j Ar,0111* 1vUTA: hx9ct location of well with distances to at least two permanentfiandrAarks to be provided on a separateoftt/plan. Well Driller's Name p Address: / p Signature: Q Date: d White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 ' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _APPLICATION TO CONSTRUCT A WATER WELL -- _ "please print or type — .... PC HD Permit # Well Location: Street Address: yy��,,"" Tod illage Tax Grid # a �Z4� /Kd� / FWi _OA /iLp 3 q Block / Lot(s) (, qa, Well Owner: Name: Address: Dbo UJv,LAe - NY, I Klt Use of Well: C 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 __5 gpm # People Served Est. of Daily Usage 200 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling _� New Supply (new dwelling) Deepen Existing Well Detailed Reason USA for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes V No Name of subdivision Lot No. Water Well Contractor: Address: 6 -1k j�0 � Is Public Water Supply available to site? .................................. ............................... Yes No x Name of Public Water Supply: Town/Village —� Distance to property from nearest water main: Proposed well location & sources of contamination t be provided on eparate sheet/plan. I �� 0 Applicant ^Signature:_ Date: ' 0-) 3 ! 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. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a wa er well driller'certified by Putnam County. r Date of Issue � �'' '� � Permit Issui �Yfficial: Date of Expiration — —(' Title: 1 . Permit is Non -Trans errable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 d< -. ;� 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 (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 May 3, 2001 John Karell, Jr., P.E. 121 Cushman Road Patterson NY 12563 Re: Proposed SSTS: Wallace " Holmes Road; Lot #4B (T) Patterson, TM# 34 -3 -1.42 Dear Mr. Karell: 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. PC -97 notes incorrect drainage basin. 2. Design Data Sheet: A. Notes incorrect drainage basin. - - - B: - DouS� not °provide percolation and pre -soak dates. - C. Does not provide percolation rates. D. Does not soil profile. E. Does not note the required deep test hole information. 3. Minimum distances from the toe of slope to the property line is 10 feet. 4. Volume of R.O.B., unclassified and impervious fill is to be noted on the plan. - ___... - - - - - 5. Elevations of proposed contours are to be provided. - - - - - - - 6. Proposed contour line 686 does not appear to be correct. 7. 2.5 feet is to be provided for the entire SSTS. The fill on the south side of the SSTS is insufficient. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regards. If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. Letter to: John Karell, Jr., RE - May 3, 2001 -2- Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. P4be truly , s, 'Morn*s,. RAW Senior Public Health Engineer t ' 1�- _ BRUCE • R.- FOLEY`r -:� Public Health Director LORETTA M6bI ARI 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 (845) 278 - 6014 Preschool (845)228-6108 Fax (845) 278 - 6648 May 3, 2001 John Karell, Jr., P.E. 121 Cushman Road Patterson NY '12563 RE: Wallace Holmes Road, Lot #413 (T) Patterson, TM# 34 -3 -1.42 Reservoir Basin Dear Mr. Karell: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on April 13, 2001 is complete. The Department will notify you by May 20, 2001 of its determination. ®- r The - Prject" has° 1;en derdgated' to' *tlhe'- Pufiiam (ouy ' I�eath ' Depatmn- for o ^ - review pursuant to the guidelines set forth in the Watershed Agreement. Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame you may_notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project,:the office with which you filed the application originally; and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a prof ect, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Letter to: John Karell, Jr.., P.E. - May 3, 2001 -2- 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. Ve ly your Robert Morris, PE RM:tn Senior Public Health Engineer C v d W� Putnam County Department of Health � W Division of Environmental Health Servioee Appro ed ae noted for oonYormanoe with app c le Ru es and Regulations Of the a Health Departm t. A e 4­1 zj131d I Date N . W� MGK 46.03' '• �•�%'�� 516'35'09 "� � � C 18.54' Q S (f4_, -73 HEAl7HANDfHENEW'YORK`§TA7F (pi 50.00' 9 5 � b -AS— BUILT' 9 5 to i MEASUREMENTS• . /• � 98 lob No A $ REMARI r� o 1►g i Iy so 51 / R- 150.00 z do 8v Yb0Y, . 411 B� t V) - 6 (oL 10\ 38 to' - IT 6 e 8g r- o . W� MGK 46.03' '• �•�%'�� 516'35'09 "� � � C 18.54' Q S (f4_, -73 N .. (pi 91 9 5 � 10 9 5 to i ,l0 �i 98 lob r� 108 1►g : 14 51 53 5 59 59 . by` L• J7D /f �/' ���►'1 SAL— t-[ 54- 1' 61 1 (f4_, -73 (pi ; �p � ,l0