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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -4 -15 BOX 14 01520 0 11 3 L . ;. , 01520 UTNAM COUNTY DEPARTMENT OF HEAL - SION OF ENVIRONMENTAL HEALTH 'SER CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATN PCHD CONSTRUCTION PERMIT # = �a� —0-5, Located at Town or Village A-H_e�s?0 A) Owner /Applicant Name S�-� jZ�, -t. �T .!}�y2 -- Tax Map ` _Block _ Lot Formerly Mailing Address 2W<' Subdivision Name 5A K e---4- d Subd. Lot # 14 P477� 414; Cl I , A- / Zip I LS-9 3 Date Construction Permit Issued by PCHD `l SeQarate Sewerage System built by i" �-�'� Address M t LL C il-P Consisting of i I--N-0 Gallon Septic Tank and % Other Requirements: Water Su nnly: Public Supply From Address or _ Private Supply Drilled by L Address y'W'J ` BuiidiYgType °i�OCa/..�. %'%"�P'- ._ _- .,,Has erosion- control_been,completed? _, VrJ' Number of Bedrooms 1—f Has garbage grinder been installed? N'6 I certit that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built phns (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans aid the standards, rules and regulations f the Putn County Department of Health. Date: /0� Certified by P.E. R.A. JV A esi rofessional) 2 aj Z Addre5 � � License # > 1 % Any parson occupying premises served by the above system(s) shall promptly take such action as may be necessary to secire the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatm t system shall become null and void as soon as a public sanitary sewer becomes available and the approval of theprivate 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 revoc 'on, modificatio r change is necessary. By: G Title: AW Date: ' Whiwopy - HD F' e; Y copy - Building Inspector; Pink copy - Owne • Ora a copy - Design Professional Form CC -97 �' ly PUTNAM COUNTY DEPARTMENT OF HEALTH -- -- - -- DIVISION OF- ENVIRONMENTAL'HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Town/Village: Tax Map # GPS 41° 27.42N 58 Nosh Kola Lane Patterson Map Block Lot(s) .I 730 37.61W 20' 140' 210' Well Log Depth From Surface Well Diameter If more detailed ft. ft. Water Bearing in Formation Description inforlation Land Surface in o r descriptions or Hit rock at 5' sieve analyses 5 32 Dr' are available, 32 210 Drilling in ro k granite please attach. If yield was tested Feet Gallons Per Minute Pump /Storage Tank Information at different depths Pump Type sub. Capacity 10gpm during drilling Depth 160' Model 10GS10412 list: Voltage 230 HP 1 Tank TVDe WX302 Volume fib gallons NOTE: Exact Location of well with distances to at least two permanent landmarks to be provided on a'separate sheet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 Well Owner: Name: Address: Mark Shkreli, 429 Ice Pond Road, Patterson, NY 12563 Use of Well: 1- Primary 2- Secondary X Residential _Public Supply Air cond /heat pump _Irrigation Business Farm Test/monitoring —Other(specify) Industrial Institutional Standby Drilling Equipment XRotary _Cable percussion XCompressed air percussion . Other(specify) Well Type _Screened _Open end casing X Open hole in bedrock _Other Casing Details Total Length 32 ft. Length below..grade3lf ,. Diameter 6 in. Weight per foot 191b /ft Materials: X Steel Plastic Other Joints: _. Welded X . Threaded Other Seal: X Cement grout Bentonite Other Drive shoe: X Yes _ No Liner: _Yes X No Screen Details Diameter (in) Slot Size Length ft Dept to Screen ft Developed? First _Yes _No Hours Second Well Yield Test Bailed )Pumped _)L Compressed Air Hours 6 lYield 40 gpm Depth Date Measure from find surface-static (specify ft) During yield test () Depth ot7ompleted well in 20' 140' 210' Well Log Depth From Surface Well Diameter If more detailed ft. ft. Water Bearing in Formation Description inforlation Land Surface in o r descriptions or Hit rock at 5' sieve analyses 5 32 Dr' are available, 32 210 Drilling in ro k granite please attach. If yield was tested Feet Gallons Per Minute Pump /Storage Tank Information at different depths Pump Type sub. Capacity 10gpm during drilling Depth 160' Model 10GS10412 list: Voltage 230 HP 1 Tank TVDe WX302 Volume fib gallons NOTE: Exact Location of well with distances to at least two permanent landmarks to be provided on a'separate sheet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 P . i MIKS R ram Arbd:r Ab" oft~ RX7 WMK Amom P&M MmM AID DBPARIMBN!' Ola %MALTM - 1. G a Rod, BMWM.Nw Yak low tarry sLNer 1+1��n -� � pN)1�•if» t+riptt)3'Ii -row 1pb pMst�.6o1� t�otsftoo -wo i , /' f_J 1 ► OWNSRs NAME: VA s 1 CCt/KP 04�0 ) E911 ADDPJM: zVoa q A oc * L ,4 Nf TOWN: Q/t l V- cnz --q O { J evneoar�Towno�a�c tsir�) _ Thu MUM c4uw'pDepoebmt OfETakh va w hue a calf ew m k p�1�i00 C udw tM obm form Is cemoded, Le., a legal 9911 odds u b as iBved by a mWwW toga officirl, This form is to b` wbmitted wft4 the oppU=doa flora ofCoadtto'000 Comp�mce... 09111moo p'1vY! -K.l -t-fl ' 7a% vl'n� 12 GvS it IHT N R-0� PA-TI R- X -fo j ti 1 1 12 Sb*3 vlz:((� k e - YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y.'10598 - (914) 245 -2800. Albert H. Padovani, Director. LAB #: 9.900081 CLIENT #: 71 NON STAT PROC PAGE: 2 of 2 LUMAR PLUMBING DATE /TIME TAKEN: 01/23/09 08:30 502 NORTH MAIN ST. DATE /TIME RECD: 01/23/09.09:40 BREWSTER, NY 10509 REPORT DATE:. 01/30/0.9 PHONE: (845)- 279 -4324 SAMPLING SITE: 58 NOSH KOLA LANE, PATTERSON SAMPLE TYPE..: POTABLE KITCHEN TAP PRESERVATIVES: NONE COLD BY: TROY GASPARINI TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 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 RELATE ONLY TO THESE SAMPLES RECEIVED BY THE LAB SUBMITTED BY:. Albert H. Padovani, M.T.( )'.SCP) Director ELAP# 10323 a o YML ENVIRONMENTAL SERVICES 321 Kear.Street Yorktown Heights, N.Y. 10598 (914), .24.5 -280. 0 Albert H.. Padovani; Direto LAB #: 9.900081 CLIENT. #.: 71 NON STAT.PROC .PAGE: 1 of ..2 .LUMAR PLUMBING 502 NORTH MAIN ST. BREWSTER, NY 10509 DATE /TIME TAKEN: 01/23/09.08:30 DATE /TIME REC D; 01/23/09 09:40 REPORT DATE: 01./30/09 PHONE:.(845)- 279 -4324 SAMPLING SITE: 58.NOSH KOLA LANE, PATTERSON SAMPLE TYPE...: POTABLE KITCHEN TAP PRESERVATIVES: NONE COLD BY: TROY GASPARINI TEMPERATURE...: < 4C .NOTES..:: COLIFORM METH: MF DATE FLAG PROCEDURE PUTNAM CNTY PROFILE 01/29/09 'LEAD (IMS) 01/29/09 NITRATE NITROG 01/23/09 NITRITE NITROG 01/27/09 IRON (Fe) 01/29/09- MANGANESE (Mn) 01/30/09 SODIUM (Na) 01/23/09 pH 01/29/09 HARDNESS,TOTAL 01/29/09 ALKALINITY (AS 01/29/09 TURBIDITY (TUR RESULT <1 ppb <0.2 MG /L <0.01 MG /L <O..060 MG /L <0.010 MG /L 5.38 MG /L 6.8 UNITS 70.0 MG /L 50.O..MG /L <1 NTU .NORMAL -:RANGE 0 -15 ppb 0 - 10 1.0 MG /L 0 -0.3 mg /l 0 -0.3 mg /l N/A 6..5 -8..5 N/A N/A 0 -5 :NTU METHOD SM 18 -19 3113B SM18- 20450ONO3 SM18- :204500NO2 SM 18--20 3111B SM 18 -.20 3111B SM 18-20 3111B SM18 -20 450.OHB SM 18 -20 2340C SM 18 -.20 2320B SM 18 .(2,130B) COMMENTS: Pb /Cu LEAD limits for public schools are set at 15 ppb. EPA Lead -& Copper Rule -for.Public Systems requires that no more than 10% of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg /L; else water treatment must be undertaken to-reduce the waters corrosive potential.. Fe /Mn If both iron and manganese are present, their total value combined 6hal1 not exceed 0..5 mg/L., Na _No limits for Sodium are proscribed. Suggested guidelines state that for people.on a sodium restricted diet,the water should contain.no more than 2.0 mg /L of Sodium.. For those on a moderately.restricted diet, a. maximum of_270 mg /L of.Sodium is suggested. pH pH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF'pH IS,-ONE OF .THE IMPORTANT_ANDFREQUENTLY USED TESTS IN WATER.CHEMISTRY_. WATER WITH A LOW pH.MIGHT BE CORROSIVE TO METAL.PTP.ES AND FIXTURES. THE NORMAL RANGE. OF pH IS 6:.5 TO 8.5. Dec. 29 •2048 ° 13:45 HP L.ASERJE7 FRX _ F. YNlL ENViRONmEkTAL8RkV10ES 3a�.� Kear - Street. _ . xokkt -6Wh .Rei hto N' Y. 10598 } Albert. H; VAd6- Vani.;. -nirdator LAB #k : 9'. 8 0 x52 B . CLIBA]T NON , STAT PROC PAGE. 1 of 1. w.NN M.vW NNrr .r .r NNrN �.nN NN�� NMw MMNM NNwN'Nw.yy w•N ni wr NY.:.. r AIMMNNNwN NNNww.NNw��.v w.N Nr. r. . ...rw. .•ry w•r.. LUMAR P14UM91Ni; DATt /TIMt TAKEN: 11/18/0.8. 08 :46 502 .NORTH MAIN 'S'P. " ..'13ATR/T1ME RECD: 11/18/08 09:15 SR9%STFR, .NX 10509 REPORT DATE: 12/29/08 ViAtM: (845)-27.9-4324 SAMPLING SITE:' 58 NOSH KOLA LANE SAMPLE TYPE:.: POTABLE BATHROOM FAUCET PRESERVATIVES: NONE COLD BY:. SHRELI TEMPERATURE..: < 4C NOTES :. COLIFORK METH; MF tiw..+..rM iH.Vw ww NNti.. wrN NMw M•YM yNry w'4y MNN Mw: .. .�.:.ryti ywrryyr ...w'Irw.- ---- N.irNNN4NNNM.V NN wNN 11NM NNw.I IV ''DATE FLAG PROCEI5URE " RES�7�,m ::.. EdRMAL .- RANGE METxOII 11/18/08 MF T. COLI> OPR Ass N'r 1'0 0'.. ABSENT SM 18 -2'0 9222B COMMENTS:. 12129108: AMMt=EA Rt�ORT MFT'C THESE R8SULT'S IMIdATE. THAT��. WA (WA) (WAS NOT) OF A SATZSF'p,C$'ORY SANITARY QUAI.ITY AGCORDI ICE NEW YORK STATE AND SPA FEDERAL DRIAiNG WAnR*.STANDARDS ,� , .- -kO tHE PARAMETERS TES'9D, AT 'THE .TIM'S OF COLI;>3&Xb.*. THE ABOVE TE9T. P=SDUR9,§ T .ALL Rj3QUIRXME,NTS OF NELAC, AND RELATE ONLY TO ' SR.' SAMPLES . R *C'EZivtn -BY THE LAB STMAMITT" ED 8Y A�.bert • FI. �varii,, 'M: T. ASCP Director ,103.23 i,.4, , PUTNAM COUNTY DEPARTMENT OF H ■ DIVISION OF ENVIRONMANTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM MA-AI - 5.� K)Lc t,- i Owner or Purchaser of Building Building Constructed by Location — Street Building Type Tax Map Block Lot A) 7-J Town/village S4 Subdivision Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the, sewage treatment system serving the above - described property, and that it 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 tfogowin g the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repair 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 undersigaed further agrees to accept as conclusive the determination of the Commissioner of Health 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 _bay 10 Year Wo-1 Signature: /G (Sipirc System Installer) Title: Genet Contractor Owner) -- Signature PCHD License* ^r b c) Corporation Name (if corporation) Co 'on Name (if corporation) Address: 43 F_,,, t- <1(ts PQ Address: � zip State: .. _ y_;_. Zip /G 5 ! State: / �' . porn► as-9r SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health February 3, 2009 John KareIl Jr., P.E. 121 Cushman Road Patterson, NY 12563 Dear Mr. Karell: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Construction Compliance Application for Shkreli — Lot # 4 Knosh Kola Lane .l (T)Patterson, TM. # 34 -4 715 1 - The. Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on February 2,2009 is incomplete. Please be advised that the following information is required before the Department may commence its review. °fl. The E -911 form is to be submitted, The E -911 address .is to be provided on the construction compliance permit application. je-3. The SSTS guarantee form is to be completed by inserting the appropriate information in the month, day and year blanks. 4. A water sample analysis, in accordance with Table 1 in Section 6.3 of Bulletin ST -19 is to be submitted. A. Four (4) copies of the as -built plan are to be submitted. The review of your applicat. on will commence once the Department receives the requested information and determines that the application is complete. Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130 ext. 2148. MJB:kly Respectfully, Michael J. Director oineering Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845),278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 . PUTNAM COUNTY DEPARTMENT OF HEALTH IVISION OF ENVIRONMENTAL HEALTH SERVIC CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM 05 Located at PoAIJO 1ZQ Subdivision name S [4:: 9- %.—L.+ Subd. Lot # Lf Date Subdivision Approved [ I Town or VillageN ITS d /) Tax Map 3 T Block `( Lot lS� Renewal A Revision V Owner /Applicant Name %Ili 1li-V- 12&LLr Date of Previous Approval ZZIO -5 Mailing Address "l Zf Zc- PO-A,0 fit! Ay AWleri-D1'1 Zip l -iU 7o-3 Amount of Fee Enclosed Building Type �J UQ D );C-W 9 Lot Area No. of Bedrooms q Design Flow GPD oro`v Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of L 3-0 gallon septic tank and S L' Z Other. Requirements: To be constructed by K-p h� D& Address �(` .iu /✓ % Water Supply: Public Supply From Address or: _/ Private Supply-Drilled by ^ �E//`�'L Address �If'.�GU.i72 R 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 R.A. Date o4,P/" /0 License # P3 L7 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 whe c sidered ne essary by the Public Health Director. Any revision or alteration of the approved plan requires a new permiyfA pro ved f scharge of domestic sanitary sewage only. By: Title: Date: �� s White copy'- HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEAL'T'H DIVISION OF ENVIRONMENTAL HEALTH SERVICES :.. APPLICATION TO CONSTRUCT A. WATER WELL ..� >. please print or type PCHD Permit # Well Location: Street Address: pp To it ge Tax Grid # VJMap _'CQ A A"6 �l � 3 Block Lots) Well Owner: Name- Add ess: ( Z F3 Use of Well: Residential Public Supply Air/Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2-secondary Industrial Institutional Standby Amount of Use Yield Sought _� gpm # People Served __�_ Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply HDrnllanng New Supply (new dwelling) Deepen Existing Well Detailed Reasons for Drilling Well Type X, Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No 9, Is well located in a realty subdivision? ...................................... ............................... Yes— No Name of subdivision R"IL"'fl —( Lot No. Water Well Contractor: 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 provided on s parate sheet/plan. Date:_- - Applicant Signature: 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 water iller ce ified by Putnam County. Date of Issue 0 12,10 I Permit Issuing i Date of Expiration ') Title: Permit is Non- Transff a e White copy- HD file; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WP -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health October 3, 2007 John Karell Jr., P.E. 121 Cushman Road Patterson, NY 12563 Dear Mr. Karell: DEPARTMENT OF ' HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Field Inspection — Shkreli' Ice Pond Road (T) Southeast, Lot #4 T.M. # 34.-4 -P /O 15 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health 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 the S.S.T.S. open work inspection. you -have -any further questions, please contact me at (845) 278-6130,'-ext. 2261. GDR:ens Sincerely, c) , Gene D. Reed Sr. Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -541.8 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 SHERLUA AMLER, MD, W. FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive July 12, 2005 John Karell., Jr. 121 Cushman Road Patterson, NY 12563 Re: Shkreli SSTS Ice Pond Road (T) Patterson TM # 34 -4 -15 Dear Mr. Karell; I am in receipt of your letter dated July 6, 2005. In response to your letter, please be advised of the following: I have. called- and left messages at your office in an attempt to discuss this situation with you since my field inspection on June 22, 2005. This morning you stated you would call me on July 12, 2005, to set up a field inspection. Response to your comment #l: This Department differs from your opinion on who should be responsible to correct. the situation when the SSTS is not constructed according to the'app o' ved plan s. I have forwarded a letter dated June 22, 2005, which outlines this Department's position. A meeting has been scheduled for July 18, 2005, at this office to discuss this matter with you. Response to your comment #2; .You..wrote it is "preposterous" to suggest that fines may accumulate on a daily basis. Firstly, it is your opinion on what is preposterous. Secondly, please note that the regulations are the same as when you were Putnam County Director of Health. Thirdly, although it is seldom used, fines may be imposed for instances of non - compliance, not just when there is a potential public health hazard. Please,be advised the.construction of an SETS above ledge rock, as it appears in this situation, is a potential health hazard, This is because if the SSTS is allowed to remain as Water Supply sedlao (846) 225 -5166 Pax (845) 225 -5418 Environmental Health, (845) 279.6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 VW(345)278-6678 Fax(845)279-6095 Early Intervention/Presehool (845)278-6014 Fax(845)279 -6648 O . . - AD-constructed, , t`is possible that sewage effluent could enter fractures in ledge rock and therefore, the effluent will not be treated. This can allow pathogens to enter the groundwater that, may potentially contaminate wells within miles of the SSTS. You wrote that you do not wish to discuss a remedy with the owner only to have this Department require something else. It is simply this Department's position that the SSTS be reconstructed according to the approved plans. This is why the plans are reviewed and approved by this Department prior to construction. The SSTS was not constructed in accordance with the approved plans. Furthermore, there is a large outcropping of ledge rock that was not shown on your plan and it appears the contractor went outside the approved SSTS area and broke through the ledge rock to install the SSTS, If it is not possible to construct the SSTS according to the approved-plans, revised SSTS plans must be submitted meeting current codes requirements. As an experienced Professional Engineer licensed in the State of New York, you would have the expertise to submit revised plans meeting current guidelines, if it is required in this case. This Department's personnel will always be available for assistance .as a reference on the . current guidelines. However, this Department's personnel is not responsible for the design of a SSTS or a revision to an SSTS, this is the. Design Professional's responsibility. If there are any questions please feel free to call. Sincerely, Robert Morris, P.E. Senior Public Health Engineer RM:kly Cc: Dr. Amler; L. Molinari, M..Budzinski, G. Reed DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OF PUTNAM -STATE OF NEW YORK r' IN THE MATTER OF T IE CQMPLAINT AGAINST_ JOHN KARELf T _.E:" y_ .._.._.. � . :. RESPONDENT(s), : Arising out of the Alleged Violations of the Public Health Law of the State of New York, the Sanitary Code of the State of New York, the. Sanitary Code of the County of Putnam, and Administrative Rules Regulations and Standards Promulgated Pursuant Thereto TO: John Karell, P.E. 121 Cushman Road Patterson, NY 12563 Copy NOTICE OF HEARING CASE NO. 079 -05 -19 PREMISES: Ice Pond Road (T) Patterson, Lot# 4 T.M. # 34.4-15, Permit # P -09 -05 PLEASE TAKE NOTICE THAT CHARGES have been preferred against you to the effect that you have violated the health laws as more fully set forth on the reverse side of this notice: YOU ARE HEREBY SUMMONED TO APPEAR at a hearing to be held under the provisions of the Putnam County Sanitary Code and Public Health Law of the State of New York before Eric S. Zaidins, Esq., an Administrative Law Judge of the Department of Health of the County of Putnam on the 7`h day of September, 2005 at 9:30 A.M., in the Hearing Room, located at Route 312, 1 Geneva Road, Terravest Corporate Park, Brewster, New York, at which time the charges will be informally discussed, and such adjourned dates as may be designated. AT ALL TIMES YOU WILL HAVE THE RIGHT to be represented by counsel and the right to deny the charges, in whole or in part, following which the matter will be rescheduled to a date certain and a Formal Hearing.will be conducted thereon, and a record of all the proceedings will be made, witnesses will-be sworn and- examined and cross examined, and documen_ tart' evidence maybe, offered and received, , and you may produce witnesses and evidence in your behalf, AT THE HEARING, IN THE EVENT YOU WISH TO ADMIT TO THE CHARGES, the Hearing may be terminated by written stipulation of discontinuance provided the violations have been corrected; UPON YOUR FAILURE TO APPEAR, a warrant compelling your appearance may be issued or an Inquest Hearing conducted and a determination made; CIVIL PENALTIES up to $1,000 for a single violation, per day, may be assessed against you, and such further orders may be made herein as the circumstances may warrant; THE BOARD OF HEALTH may issue a warrant to any Peace Officer of the County, pursuant to Section 309 of the Public Health Law, to bring to its aid the power of the County whenever it shall be necessary to do so, with the same force and effect as if such warrant had been issued out of a court of record. PUTNAM COUNTY BOARD OF HEALTH DATED: July 11, 2005 BY: Brewster, NY 10509 Sherlita Amler, M.D. Commissioner of Health STATEMENT OF CHARGE IT IS HEREBY ALLEGED THAT THE PERSONS HEREIN BEFORE NAMED RESPONDENTS are charged with violations of the Health Laws of the State of New York and the County of Putnam as `follows: PUBLIC HEALTH LAW OF THE STATE OF NEW YORK Violations of any and all provisions of the Public Health Law of the State of New York and the State and County Codes and Administrative Rules and Regulations promulgated pursuant thereto — which shall be found to be found to constitute a NUISANCE, particularly, and not limited to the provisions of Article 13 of the Public Health Law. SANITARY CODE OF THE STATE OF NEW YORK PUTNAM COUNTY SANITARY CODE Article III, Section 2C Separate Sewage Treatment System not installed in accordance with the approved plans. June 15, 2005. ADJOURNMENTS: - Public Health -Law violations are serious. They affect or may affect the ....._..._ ..._.__..... _ _ . _ ....._.....:.. _ _._ ......... _ ..._.._ health, safety and welfare of the community. They cannot be permitted to go on indefinitely. Casual adjournments or hearings will be granted. Applications for adjournments must be made in person or by counsel to the Hearing Administrative Law Judge at the time set for hearings, except for legal excuses. Persons operating an establishment, business or facility without a permit, for which a permit is required — will not be granted an adjournment. Health matters are involved and the Public Safety is a paramount consideration. SA:kly j R. Carano Cq' R. Morris I - G. Reed C� file G ��. DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OF PUTNAM -STATE OF NEW YORK INTHE MATTER OF THE COMPLAINT AGAINST . -:.. -. + 1VtARK SIKRELI RESPONDENT(s), Arising out of the Alleged Violations of the Public NOTICE OF HEARING Health Law of the State of New York, the Sanitary Code CASE NO. 080 -05 -19 of the State of New York, the ;Sanitary Code of the County of Putnam, and Administrative Rules Regulations and Standards Promulgated Pursuant Thereto TO: Mark Shkreli 429 Ice Pond Road Patterson, NY 12563 PREMISES: Ice Pond Road. (T) Patterson, Lot#. 4 T.M. # 34.4-15, Permit # P -09 -05 PLEASE TAKE NOTICE THAT CHARGES have been preferred against you to the effect that you have violated the health laws as more fully set forth on the reverse side of this notice: YOU ARE HEREBY SUMMONED TO APPEAR at a hearing to be held under the provisions of the Putnam County Sanitary Code and Public Health Law of the State of New York before Eric S. Zaidins, Esq., an Administrative Law Judge of the Department of Health of the County of Putnam on the 7`" day of September, 2005 at 9:30 A.M., in the Hearing Room, located at Route 312, 1 Geneva Road, Terravest Corporate Park, Brewster, New York, at which time the charges will be informally discussed, and such adjourned dates as may be designated. AT ALL TIMES YOU WILL HAVE THE RIGHT to be represented by counsel and the right to deny the charges, 'in whole or in part, following which the matter will be rescheduled to a date certain and a Formal Hearing will be conducted thereon, and a record of all the proceedings will be made, witnesses will be sworn and examined _ and , cross _ examined ,.,andAocumentavy-evidence maybe offered - and.receiv8d; _and you may produce witnesses and evidence in your behalf; AT THE HEARING, IN THE EVENT YOU WISH TO ADMIT TO THE CHARGES, the Hearing may be terminated by written stipulation of discontinuance provided the violations have been corrected; UPON YOUR FAILURE TO APPEAR, a warrant compelling your appearance may be issued or an Inquest Hearing conducted and a determination made; CIVIL PENALTIES up to $1,000 for a single violation, per day, may be assessed against you, and such further orders may be made herein as the circumstances may warrant; THE BOARD OF HEALTH may issue a warrant to any Peace Officer of the County, pursuant to Section 309 of the Public Health Law, to bring to its aid the power of the County whenever it shall be necessary to do so, with the same force and effect as if such warrant had been issued out of a court of record. DATED: July 11, 2005 Brewster, NY 10509 PUTNAM COUNTY BOARD OF HEALTH BY. - Lid'- �✓ Sherlita Amler, M.D. Commissioner of Health •� STATEMENT OF CHARGE IT IS HEREBY ALLEGED THAT THE PERSONS HEREIN BEFORE NAMED RESPONDENTS are charged with violations of the Health Laws of the State of New York and the County of Putnam as fob lows,,;, -. _.. . _...... - - PUBLIC HEALTH LAW OF THE STATE OF NEW YORK Violations of any and all provisions of the Public Health Law of the State of New York and the State and County Codes and Administrative Rules and Regulations promulgated pursuant thereto — which shall be found to be found to constitute_ a NUISANCE, particularly, and not limited to the provisions of Article 13 of the Public Health Law. SANITARY CODE OF THE STATE OF NEW YORK PUTNAM COUNTY SANITARY CODE Article III, Section 2C Separate Sewage Treatment System not installed in accordance with the approved plans. June 15, 2005. ADJOURNMENTS: Public Health Law violations are serious. They affect or may affect the -.. - -..health ,.,safety - 'and.- welfare,•of •the- community.-- They-cannot -be permitted to go -on- indefinitely. Casual adjournments or hearings will be granted. Applications for adjournments must be made in person or by counsel to the Hearing. Administrative Law Judge at the time set for hearings, except for legal excuses. Persons operating an establishment, business or facility without a permit, for which a permit is required — will not be granted an adjournment. Health matters are involved and the Public Safety is a paramount consideration. - SA:kly R. Carano —/ R. Morris G. Reed p� file T 'd d0 1N3W18Ud30 AiNnoJ. WUNlfld :3WUN T26L7842 - Sb8:131 Tb :9T 03M S002- 9 --inf a a T �( 6A o K ai J POK .845 °g / 9"7894 121 C V N. ROAD,.__ _. - Brewster, New fork, 10509 Re: Shkreli Ice Pond Road, Patterson (T) TM # 34.4 -P /..0.15 Lot # 4 Dear Mr. Moms: Receipt is acknowledged. of letters from Gene Reed dated June :15, 2005 and June 21, 2405 relative to the captioned property. - On June 22; 2005 the writer discussed- this matter with ydu and requested that a meeting be., scheduled at the site. To date you have not advised me when you are available to: meet: The June 21 letter arrived subsequent to, tny, request for a -meeting. I am surprised and concerned relatve.,to the. tone of the letter given the nature of this matter. Specifically relative to this letter:, 1. The letter should be*. address to the owner. I am not responsible for this property or the installation of the septic system on this property. The owner is: 2. To suggest that fines will accumulate on a daily basis in this matter is preposterous and sores to cause the owner of the property undue anxiety. Daily accumulation of fines is reserved for, say a sewage overflow, where each day a public health hazard is created. This is not a situation where a public health . hazard even exists. TO 30bd OSf1JV8 T b0L59bZbT6T Z6:TZ 5002/6Z/90 2. Again, it is requested that we meet at.the site. to discuss how to handle this matter.,i I do not wish to suggest: a remedy to the owner, have the work done and then have you require something else. Very truly yours. John Karell, Jr., E. cc: Loretta Molinari Michael Budzinski, P.E. Z0 39Gd Osfrjvd r b0L9SPZP16T U:TZ 9002/6Z/90 d JO 1N3WIdW30 A1Nnoo - wuNihd : 3wuN SHERLITA AML,ER, M D, MS, FAAP L.ORETTA AR UNARt, RN, MSN /i wdate CiaMmW80/ier of Heakh i n0PARTUFNT' OF: HEALTH S26L78L2- Sb8 :-131. 20 :9Z 03M 5002- 9 --inf June 15, 2005 John Y.Arell Jr. F.E. 121 Cushman Road Patterson, NY 12563 ROWRT L BOND1 Dear Mr.Kamll: An inspection at the above referenced lot has been completed.. The following comment must be addressed. j......� .,...._..1..° The SSTS vas not. installed in aceo� ce witiiihe appove pla°ns. _ .__ ... . 2. The SSTS area has been cut prise• to ig0alling.the system:; 3. The SSTS is within 10 fcet d rock. If you have any further questions, please cwt me at (845) 278 - 6130, ext. 2261. Suety, -all �. Gen D.-Reed Sr. Environmental Healthy ineering Aide GDR:cw w.ry sr�► aa~. �s �� � ce4s) �s -s+oe RUA, 'I Meaft (W)2%4130 Fax (945) T7S MI NwvJa% SeeA (M9) 27WM WW(05)2784678. Faa ($4$) 27&4WS 60 39Vd OSfma T VKSSVZti161 ZC :TZ 9002/6Z/90 b "d d0 1N3W121dd30 AlNnoo WUNlfld. :3WUN 126L- 8L2-Sb8: X31 . Zb :9T 03M sow-9 -inr SHERLITA AMLER, MD, MS, FAAP RO ERT:I..8ONDI Commissioner of Health Woe _0 y. LORETrA MOLINARI, RN, MN Associate Commissioner of bfealth r DEPARTMENT., OF. 1 Genevll Rod, &**sW, New York 10509 June 21, 2005 John Kamll Jr. P.E. 121 Cushman Road Patterson, NY 12563 Re: Field Inspection Mark Shkreli Ice Pond Road, (T) Patterson Lot #4, T.M. #34.-4 -P /015 Dear Mr. Karell: The following items are in violation Article III, Section..2C of the Putnam County Sanitary Code: • Sanitary Sewage Treatment System not installed per the approved plans. This violation may lead. t4 an enfomelrnnt headng:and subsequent fines. The violation is to be immediately corrected to minimize the number of days you are out of compliance. Please note that fines may be issued for every day the violation is not corrected. . Sincerely, Gene D. Rced Sr, Environmental Health. Engineering Aide WOW 090 rear (M!) W -3186 ft ($0) U544111 Ea.irown d SUM (US) 27861]0 Fan (345) 278 -7921 Nardeg Swvbn (MS) 27W$1 , WK (145).278-6678 Fox (145) 2784W5 Early 1 (05) 278 -6014 Fax (R4S% i7ft -A"X b0 39Vd 0SM" T POL99OZO16T ZE :TZ 900Z/6Z/90 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health John Karell, Jr. 121 Cushman Road Patterson, NY 12563 Dear Mr. Karell; DEPARTMENT OF HEALTH Geneva Road, Brewster, New York 10509 June 22, 2005 ROBERT J. BONDI County Executive Re: Shlcreli SSTS Design Professional Responsibilities In response to your call this morning, I have made a site inspection at the Shkreli property. Comments 1 through 7, lists field observations made by me on June 22, 2005, and also references the standard notes that are on the approved plans. Subsequent comments refer to the current Putnam County Health Department guidelines, the Putnam County Sanitary Code and current acceptable practices. Comments are as follows: 1) ,The SSTS was not constructed in accordance with the approved plans. Major.. __.._ _.. modificatiotis'were made fo the ,SSTS'without,tevised-plans being "submitted' and approved by this Department. Furthermore, it appears that the SSTS, as constructed, does not meet current Health Department Guidelines. A) Construction note 5, on the approved plans states: "Construction of SSTS to be in accordance with these approved plans, any revision thereto, and the rules and regulations of the government agency. " B) Construction note 8, on the approved plan states: "County Health Department approval is based on the location of the SSTS, well, building, setbacks and driveway as shown on the approved plans. " 2) Sections of the SSTS are not in the approved location. In addition, due to the relatively flat natural grade in the proposed SSTS area, the SSTS was approved as an equal distribution system. The SSTS was not constructed as an equal distribution system. 3) There are substantial fines in the gravel used in the absorption trenches. Current . code guidelines require that clean crushed stone or washed gravel is to be used. Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 The_trench detail mtheA p,ypd; . us notes ru§hq shed. avel is_to be used. Revise detail to note clean crushed stone. 4) Large rock was in backfill material. Current codes require that all rock greater than 4 inches in diameter must be removed from the backfill material. 5) Trees are within 10 feet of the SSTS. Construction note 1, on the approved plans states: "All trees within 10 feet of the proposed subsurface sewage treatment system (SSTS) shall be removed." 6) Large surface ledge rock is in the SSTS area. Current codes require that all surface ledge rock be shown on the plan. The ledge rock was not shown on the approved plans. 7) There is an approximately 4 ft. cut in the SSTS area. The cut is by the surface ledge rock and it also appears the ledge rock has been broken to install the SSTS. Cuts in the SSTS area were not shown on the approved plans. Cuts in the SSTS area are rarely, if ever, approved by this Department. Furthermore, the excavation of ledge rock for the installation of an SSTS is not approvable by this Department. A) Construction note 9, on the approved plan states: "Cut or fill is not permitted in the SSTS area, except if so specified on the plan. In reference to our conversation today of what is the responsibility of the Design Engineer, please be advised of the following: - - As-a- Design- Professional submitting an applicatior_.for, a Putnam County. Health.___ Department Construction Permit for Sewage Disposal System (SSTS) it is certified at the bottom of the application by the Design Professional 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 .............. As a Design Professional submitting a request to the Putnam County Health Department for a Final Inspection, it is certified by the Design Professional on the request form that: "I certify that the system(s), as listed, at the above 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 Health. " °The coinrrient' on the Request for Final Inspection form you submitted stating: ;'S ystern in the same place, modified slightly," does not remove your responsibility to have the system constructed in accordance with the approved plans.) In addition, Putnam County Sanitary Code notes the following: Article 1, Section 6(a): "Such permit or written approval may contain general or specific conditions and every person who shall have obtained a permit of written approval as herein required shall conform to the conditions prescribed in such permit or written approval." . Article 1, Section 6(b): "Any permit or written approval shall terminate and become null and void upon service of written notice that the process of construction reveals otherwise than indicated in the approved plans and application........." Article 3, Section 2(c): "Such system shall be constructed in accordance with the standards, rules and regulations duly promulgated by the New York Department of Health and the Department with terms and conditions of the permit issued therefore or approved amendments thereto." Article 3, Section 2(d): "Whenever construction indicates the construction to be otherwise than in accordance with the Public Health Law or this Code or the condition of any permit or written approval issued pursuant thereto or the standards applicable to said construction, all work shall cease upon written notice served upon any person connected with or working in or about the said system or any part thereof........... " It is this Department's position, based on the above information, that the Design . ..Ptofessidnal•is Me pOrnsible for the construction-and -location of the SSTS. Furthermore, if it is found that construction is not in accordance with the approved plans, an informal hearing can be scheduled with the Design Professional. I have outlined below what is considered acceptable current practices in the Individual SSTS Program for future reference. If the Design Professional fmds that the construction of the SSTS is not in accordance with the approved plan, the Design Professional should have the contractor reinstall the SSTS in accordance with the approved plan. If the Design Professional chooses to submit revised plans to this Department for review and approval, revised plans will be accepted after construction. However, the revised plans must be approvable under current guidelines and additional soil testing may be required, as warranted. This practice is not endorsed by the Department. Waivers or waivers that have not been previously approved will not be considered. If it is found by the contractor or Design Professional, prior to construction, that the system cannot be constructed in accordance with the approved plans for some unforeseen reason, the Design Professional is to submit revised plans that meet current guidelines to -this- Department- for- - review and approval..- -If constructi•on:has =begun wand it is;- then,found -:4 ,• :: that the SSTS cannot be constructed according to the approved plans, all work shall cease until revised plans are approved by this Department. If requested by the Design Professional, Health Department personnel will meet in the field or office to discuss any proposed alterations prior to submission of the revised plans. This practice is encouraged by the Department. All revisions to the SSTS must be approved prior to the initial construction or the continuance of construction of the SSTS, depending on the situation. Current Codes require that all SSTSs are to be constructed in accordance with the latest approved plan without exception. Minor field changes will be considered on an individual basis; however, this Department strongly advises that notification of a field change is received prior to construction. In reference to our conversation today on final inspections; a request for a final inspection is to be made only after the Design Professional has inspected the SSTS and is confident that the construction is in accordance with the approved plans. Slight field changes will always be considered as a normal construction practice by this Department. Comments 1- 7, and in particular 1,2,6 and 7, in this letter clearly notes that more than slight modifications from the approved plans have been made during the construction of the Shkreli SSTS. I believe that you are mistaken when you stated today that it is the Health Department's responsibility to direct you on what changes should be made to an SSTS that has not been installed according to the approved plans. It is the Design Professionals responsibility to correct the situation and to either have the contractor reinstall the SSTS according to the approved plans or to submit revised plans for approval that meet current Health Department guidelines. If there are any questions; do-not-hesitate to contact me:.,. - Ve ly Ax, '�"' Robert Morris, P.E. Senior Public Health Engineer RM:kly PUTNAM COUNTY DEPARTMENT OF HEALTH '. bese - i01 1 /-0 DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: Inspected by:c,,Tze� d7 7Z -Owner;- Town Permit# TM#-3 1g, q— 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....... 11L Sewage System a. Septic tank size - 1,000 ......other................ b. 'Septic'tank installed level ............................................... c. 10' minimum from foundation .......................................... d. Distribution Box 1. All outlets at game elevatio<igter tested.. ......... 2. Protected below frost .................................................. 3. .. Nlinimurn 2 ft. Original soil between box & trenches e. Junction Box properly set ......................................... 6. 1'renches -1. Length required Length installed 2. Distance io watercourse measured a-00 Ft.......... 3. Installed according to plan ........................................ 4. Slope of trench acceptable 1/16 - 1/32"/foot ............. 5. 10 ft. from property line - 20 ft.- f4oundations ......... 6. Depth of trench <30 inches from surfice .................. 7. Room allowed for expansion, 100% ........................ 8. Size of gravel 3/4 - 11/2" diameter clean .................... 9. Depth of gravel in trench 12" minimum ....... i ........... -1.0':.--Pipe . ...... g. Pump or Dosed Svstems 1. Size of 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 ........... I II House/Building a. House locate er approved plans......... b. Number of bedrooms .......................... . ......... IV. Well Well located as per approved plans... b. Distance from STS area measured ;e ft ........... c. Casing. 18" above grade ................................................ d. Surface drainage around well acceptable ....................... V.. Overall Workmanship . a.. Boxes properly grouted .................................................. b. All pipes partially backfilled .......................................... c. All pipes flush with inside of box .................................. d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall prot e* * ected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate.... .... : .......................... i. Erosion control ded ................................................ Rev. E1002Vi Fill pN located per the approved plan Fill-Pad L. Required Le h Fill Pad Width Fill Pad Depth an Run -of -Bk Fill Quality Slope from Top to Toe Impervious Layer jzstalle erosion Co r tfol Installed Sieve 'Pest Results (if applicable) Additional Comments: Required Depth t') - V °X: � of Y CAW :. Sheet of - PUTNAM COUNTY IAP) RTMENT OF,$EALTI - DIVISION OT ENVIRONMENTAL H.EATLIi,Sl�,RYICES FIELD ACTIVITY REPORT NAME:` TPi• AMER, R' :��� �dN� j�_'� 7; �/�'�O/u Street ,Town ...... State ° Zip K "PERSON IN" CHARGE �. _ .r .. r —ORK rZ- Narile° and, TW6- " TYPE OF�l FACILITY FINDINGS :' r t, N -- 2 VI) _/ Lv vle IS e Signature and Title: RFP(1RT RF;C RTVF:T) RV: ' I acknowledge receipt"of this report. ' SIGNATI7RE; T 02%96 Ti le 'Rev. T 'd JO 1N3Widbd30 AiNnoo. WUNind:3WHN T26L-eL2-sve:-131 2S:L0 NOW S002-ET-Nnf PL7NAM COUNTY DEPARTMENT OF HEALTH.. DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION C3 JOSEPH GENE REQUEST FQR- FINAL 1KSP]8CnQN . For: Fin All information must be fully' completed prior to any Trenches inspections being made. PCHD Construction Permit # Located: I ce— Pogo- Xr)m '00ewwo Owner/Applicant Name'- TM 14 Block Lf Lot Formerly- Subdivision Name: Subdivision! Is Bymxn fill completed? Date: Is system complete? Date: Is system constructed as per plans? Is well drilled? Date., is welt located as per plans?. Are erosion control meaMesuil Place? I certify tha the systcjn(s), as listed, at the above premises has beep constructed and I have inspected and verified their completion . in accordance with the issued FCHD Construction Permit and approved plans and the Standards, Rules and Regulations of 69 Putnam County DcP artmen t Of Date': Cerdficd by: PE RA Address, 41 # Comments: =2"e ^,Ofre .,A -rb Form FIR-99 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA 1VIOLINAI; - Associate Commissioner of Health June 15, 2005 John Karell Jr. P.E. 121 Cushman Road Patterson, NY 12563 Dear Mr.Karell: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Field Inspection — Shkreli Ice Pond Road (T) Southeast Lot #4, T.M. #34. -4- P/O 15 ROBERT L BONDI County Executive An inspection at the above referenced lot has been completed. The following comment must be addressed. 1. The SSTS was not installed in accordance with-the plans.__ 2. The SSTS area has been cut prior to installing the system. 3. The SSTS is within 10 feet of ledge rock. If you have any further questions, please contact me at (845) 278 -6130, ext. 2261. GDR: cw Sincerely, Gene D. Reed Sr. Environmental Health Engineering Aide Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 OFFICIAL SUSPENSION OF PERMIT CERTIFIED RETURN RECEIPT REQUESTED Date: June 21, 2005 To: John Karell 121 Cushman Road Re: Patterson, NY 12563 Dear Mr. Karell: Suspension of Permit: Mark Shkreli Ice Pond Road, (T) Patterson Lot #4, T.M #34. -4 -P /015 ROBERT J. BONDI County Executive Please be advised that the permit P -09 -05 for the above regarded project has been suspended by this Department for the reasons noted below: 6 Sanitary Sewage Treatment System not installed per the approved plans The suspension of the permit will remain in effect until these issues have been satisfactorily addressed. Furthermore, pursuant to Article III, Section 3, Paragraph d, of the Putnam County Sanitary Code, whenever inspection indicates construction to be otherwise than in accordance with the permit, all work �- -- - shall cease- upon-writ-ten-notice -served upon any person- connected with-or working- Please be advised that appropriate steps must be taken immediately to resolve these issues. Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130 ext. 2166. Very truly yours, ,<</. n Gene D. Reed Environmental Health Engineering Aide Robert Morris, PE Sr. Public Health Engineer GDR:cw CC: Mark Shkreli Paul Piazza, Building Inspector, (T) Patterson Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health V� LORETTA MOLINARI, RN, MSN Associate Commissioner of Health June 21, 2,005 John Karell Jr. P.E. 121 Cushman Road Patterson, NY 12563 Dear Mr. Karell: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive Re: Field Inspection — Mark Shkreli Ice Pond Road, (T) Patterson Lot ##4, T.M. #34. -4 -P /015 The following items are in violation Article III, Section 2C of the Putnam County Sanitary Code: • Sanitary Sewage Treatment System not installed per the approved.plans. This violation may lead to an enforcement hearing and subsequent fines. The violation is to be immediately corrected to minimize the number of days you.are out of compliance. Please note that fines may be issued for every day the violation is not corrected. . Sincerely, Gene D. Reed Sr. Environmental Health Engineering Aide Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT-- t --r -o� 9 (n�� ��t1 Located at TC e— P d 0 d I 6 d Subdivision name >1+KJJZ,�LL- Subd. Lot # Date Subdivision Approved SI-Vo 3 Owner /Applicant Name Mailing Address I LM -)-Ce- Town or Village Tax Map 3q i9a+f -er& a V1 Block 4 Lot �r Renewal Revision le' Date of Previous Approval (ma) U �6 *4,-S6 A P I Zip 12-S-b Amount of Fee Enclosed 00 Building Type(�U��Z�p -, Lot Area (d )I-No. of Bedrooms Lf Design Flow GPD U Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and Other Requirements: To be constructed by 4a k&,t /+J Address P A S L .h N j Water Supply: Public Supply From Address _.. _ _._.... Addresslr�.cn�.'i'e!":. Private- Supply-Drilled 1��.y,:(- --° - I represent that I am wholly and completely responsible for the design and location of the proposed systems) 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 R.A. Dato����i�� License # S 3 Z7 I 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 w n co sidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe ; i proved discharge of domestic sanitary sewage onl . By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PITT NAM COUNTY DEPARTMENT OF HEAL'T'H DIVISION OF ENVIRONMENTAL HEALTH SERVICE APPLICATION TO CONSTRUCT A WATER WELL _r:_... T... . asepr..�..-..._:._ � ... please print or type - Perrriit'# _ Well Location: Street Address: Town/Village Tax Grid # Pv P 1) P4#Pl F4--0M0J �7) Map 31 Block q Lot(s) f Well Owner: Name: Address: 54(a -t-4-0 1 422q P Ap p d ii Al ; /M 5 Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1-primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought S gpm # People Served Est. of Daily Usage 7 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason -e-i43 for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No < Is well located in a realty subdivision? ...................................... ............................... Yes 3t No Name of subdivision Lot No. Water Well Contractor: Address: Rv'ew,S}--r N r 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 contaminfoto be provided on s parate sheet/plan. Date: _ fl o Applicant Signature: - 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 Direct y revision or alteration of the approved plan requires a new permit. Well to be constructed by a w er we 1 driller rtified by Putnam County. / Date of Issue q2-7 /0 Permit Issui facial: �l�i✓ Date of Expiration �, Title: Permit is Non- Transf drrablre White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 2 -'LORETTA: MOLINARI R.N., M.S.N. - Acting Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 July 14, 2003 John Karell, Jr., P.E. 121 Cushman Road Patterson, NY 12563 Re: Proposed SSTS: Shkreli Ice Pond Road, Lot #4 (T) Patterson, TM# 34 -4 -15 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. Split systems will not be approved by this Department. 2. System is to be staked by a license surveyor prior to construction. This is to be noted on the plan. 3. The footing /gutter drain is going under the driveway. A sleeve must be proposed to protect this pipe. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ve yours, Robert Morris, P.E. Senior Public Health Engineer RM:tn LORETTA MOLINARI R.N., M.S.N. Acting Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 John Karell, Jr., P.E. 121 Cushman Road Patterson, NY 12563 Re: Proposed SSTS: Shkreli Ice Pond Road, Lot #4 (T) Patterson, TM# 34 -4 -15 Dear Mr. Karell: ROBERT J. BONDI County Executive June 10, 2003 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: Percolation tests were not witnessed by a representative of the l�ew Yofk City Department Environmental Protection on this lot. Please contact Gene Reed of this Department to schedule tests with the New York City Department.of Environmental Protection. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ve y yours Robert Morris, P.E. Senior Public Health Engineer d d dU 1NdWIdVddU A1NI IUJ WON11 1d; dWUN 6d6L-tiLd-SVti Idl L5 4 F.YS. Please note the following comments regarding the system design above ' ; ' referenced: 9 °:,;; •...... 1 _ As you are aware, this subdivision was approved by the town of Patterson on May 1, 2003. The Department does not have any June 3, 2003 . g ' please notify us if the subdivision plan was approved by your office. 2. Soil tests report of lot # 4 is not included in the documents sent to the Department with the SSTS plan. Soil tests still need to be performed ' Robert Morris, P.E and witnessed by the Department; if your office has already Putnam Co. Health Dept. t..:,:... .': 4 Geneva Road ' ` Brewster, NY 10509 Re: Shkreli Subd. Lot # 4 Ice Pond Road Patterson, Putnam '•' • East Branch Reservoir DEP Log # 12493 (Joint Review) Dear Mr. Morris: Please note the following comments regarding the system design above ' ; ' referenced: 9 °:,;; •...... 1 _ As you are aware, this subdivision was approved by the town of Patterson on May 1, 2003. The Department does not have any _ " record of an approval issued by Putnam Co. Health Department, ' please notify us if the subdivision plan was approved by your office. 2. Soil tests report of lot # 4 is not included in the documents sent to the Department with the SSTS plan. Soil tests still need to be performed ' and witnessed by the Department; if your office has already certified data:, If you have any questions regarding this matter, you may contact me at (914) 7734416. p' Sincerely, �H4 i � r . •...i. " � � , i;yrf •��,.,`•� •_ Sissy De La Ossa. ' Assistant Civil Engineer '.;r. Engineering Design & Review ,x� F:.• xc: John M, Dunn, P.E., NYSDOH �, ��.• i ':.+I���WBC`._i�'�'71i�w5'f*,y� -•jai r:•, •. .,. , ....:r_i-- Y•;.'�'- .il.'::!.:..r ._i!4r.'h!i�•,4, ,;,. K !4!ti :i:!4i.�; ,., tr..._....._.—..:.._--. ..........c._...,..— ...._.__h:— .....E «.- .....- ZO'd ZZ :ST 20, 2 unr 2b20- €ZZ- VT6:xe3 9NId33NI9N3 d3Q JAN LORETTA MOUNARI R.N., M.S.N. Acting Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278-6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 John Karell, Jr., P.E. 121 Cushman Road Patterson, NY 12563 RE: Shkreli 'Ice Porid Road, Lot 94 (T) Patterson, TM# 34 -4 -15' 'Reservoir Basin Dear Mr. Karell: ROBERT J. BONDI County Executive May 21, 2003 The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on May 9, 2003 is complete. The Department will notify you by June 11, 2003 of its determination. T ❑ _ The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ® Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a 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.. z- ,May.21, .-2003. �= 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 1 ly yo , Robert Morris, PE RM:tn Senior Public Health Engineer PUTi`IAl1I COUNTY DEPARTNIE \T OF HEALTH _ DMSION OF ENVIRONMENTAL HEALTH INDIMUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATME \T SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERNITC" `NAME OF OWNER•. ~.STREET LOCATION: REVIEWED BY: RM, GR, AS, SRDATE: TAX 1`LaP =: (CONF4��iED) 1'\ DOCUMENTS Y (REOUTRED DETAILS ON PLANS CO\`I'D) PERi`11T APPLICATION ' '; '• � HOUSE SEWER -' /A" FT. 4 "0'; TYPE PIPE CAST IRON. �(_yWELL PERMIT' OR PWS LETTER ( NO BE \DS; DI•+.X BE \DS 45' NVICLEA\ OUT• �� RENEWALS (, (f)LETTER OF AUTHORIZATION Llo_)SITENOTE (N\0 CH_ANGE) ,. ((__)DESIGN DATA SHEET (DDS) FILL SYSTEMS (CORPORATE RESOLUTION s 10 HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE SHORT EAF FILL SPECS! FILL NOTES 1 -5 �PLANS•THREE SETS FILL PROFILE & DIMENSION'S HOUSE PLANS -TWO SETS VLF1,L7 Lei E.X'P.UNSI0N AREA C UVARLkNCE REQUEST FILL GREATER TNd \ 2 FEET SZJ BDMSYON CLAY BARRIER (:� )LEGAL SUBDIVISION FILL CERTIFICATION NOTE . SUBDIVISION APPROVAL CHECKED DEPT$ GAUGES PERC RATE VOL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS FiLLREQUIRED DEPTH ( �USEPARATIONDISTA \CEFRO`ITOE'OFSIOPE UU CURTAlN DRAIN REQUIRED RENCFi GENERAL U�L_JLF TRENCH PROVIDED LOFT NIAX. L4L_ LOCATED IN NYC.WATERSHED ' C�'(�pA.RALLEL TO CONTOURS ;. PLANSSUBivIIiTED TO DEP - 1Oa'Io EXPA_SION PROVIDED DELEGATED TO PCHD �---1) DETAIIIDUST FREE CRASHED STONE OR WASHED- GRAVEL. ( )DEP APPROVAL, IF ItEQ'D, (iUGEOTEXTILE COYER ' UDEEP TEST HOLES 'OBSERVED SEPAR4:TIO�I DISTANCtS ON PLA\ : FROM SSt. ... ' ( PERCS'TO BE WITNESSED X10' TQ P.L. DRIVEWAY, LARGE TREES,`IOP OF FILL . . E- APROVAL SSDS AD2, LOTS. FOUND.ktO N WALLS s -0TO (�SVZT LANDS TOWN /DEC.PERNIITR .L 100`TO'WELL,200' IN.DLOD, j50' TO PITS '- ( DATA OiI DDS:FLANS. &:PERi1IIT 5A1tiIE ( 100 -10 STREA-M, WATERCOURSE, LAKE ('Lqc. ezpia) (,�(�PRE 1969 NEIGHBOR-NOTIFICATION a0' TO CATCH BASIN 33' STOR.NIDAALN, PIPED WATER Pf LETTERBltZBA (� 10' TO IVATERLI`iE (pits -20') - !y IOO YR.ELOO]?.ELEYATION W/I200' y 50'L\ TERiMITiENT DRklNkGE•COURSE i 4 LiSOILTESTI`(G LOTS >10 YEARS OLD .1200' 1500' RESERVOIR C. , ETC 150' GALLEY SYSTEMS. BE01 UTR ED DETAILS ON PLANS (�U10'.bIINTO LEDGE OUTCROP _ SEWAGE SYSTEMPLAN- (NORTHARROW), SEPTICTANK (, SSDS HYDRAULIC PROFILE 10' FROM FOUNDATION; 50' TO WELL ' GRAVITY FLOW WELL. - -- (.01— _. - -U' DIti11:ti�IO:tSTOPROPERTY'LL` s - - -- -- -- _._.. (�.. - DESIGN DATA: PERC & DEEP RESULTS OCATION OF SERVICE CONN'ECTIO\ T CONTOURS EXISTING & PROPOSED Nlr- i 15'T 0 PROPERTY LINE DRIVEWAY & SLOPESj CUT ' SLOPE FOOTING /GUTTER/CURTAIi i DRAINS CID USDA SOIL TYPE BOUNDARIES � $LOPENt SST5AREA_ (520 °!0) • " 4 uf.rLE BLO CK; OWNERS NAME ADDRESS LPL jREGRADED T015 %, IF REQUIRED TbI{!, PE/RA; NAME, ADDRESS, C PHONER DOSE/PUIyiP SYSTEMS )B DATE OF DRAWING/REVISION (DATUM REFERENCE . LOCATION OF WATERCOURSES, PONDS . L'AKES,WETLANDS WITHIN200' OFP.L. ( ZL jPROPOSED FINISH FLQORAND BASEMENT ELEVATIONS (WELLS & SSDS'S W/IN 200' OF SSTS LEPROPERTY METES & BOUNDS EROSION1,CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE . CONI YIENTS: (R VSIiEET)09ro1/0o I( "PUMPNOTES DOSE 75% OF PIPE YOLUMEMOS•E VOLUME NOTED U DETAIL FOR FORCE bIAIN, (PIPE TYPA, ETC.) L, PIT AND D -BOX SHOWN & DETAILED CJ ` DAY STORAGE ABOVE ALARM CURIA Nisi DRATiN _ STANDPIPES, 5' B 0TH SIDES, DETAIL' U20' biIN to CD DISCHARGE /100' with 182 cons day discharge (!'JL.)10' bIL`I to NON- PERFORATED PIPE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH^ SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM PC) #V:;() Owner i .'Address '� Z� C�%'U A)7 i Located at (Street) Tax Map Block Lot .� (indicate nearest cross street) Municipality Watershed ' SOIL PERCOLATION TEST DATA �V � 60 TOM Date of Pre - soaking 2_' l� t t Date of Percolation Test 0 ) P3 so 3 4 NOTES: 1. Tests to be repeated at same depM nt;l�aprproximately equal percolation rates are obtatnea at each percolation. test hole. (i.e. s 1 min for 1 -30 minrnch, s 2 min for 31 -60 min/inch) All data to be submitted for review. _. Deoth measurements to be :Wade frog, too c hole. i t f i TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST BOLES Indicate level at which groundwater is encountered�� Indicate level at which mottlin is observed* -.- iJ � p� - -_ - g Indicate level to which water level rises after being encountered .-W Q Deep hole observations made by: , � , Lop Date 2 11 Q 6 Design Professional Name: o Address: _ 1A CUSffilvi MU Signature:. Design Professional's Seal �F NEW y REQ CC w 5321 �� u '°ROFE PART 11— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR. PART 617.47 It yes. coordinate the review process and use the FULL�EAF ❑ Yes ❑ No - _ _ - . - ._ . .. _ B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR. PART 617.6? _ 11 No, anegative declarat a may be superseded by another Involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) Cl. Existing air quality. surface or groundwater quality or quantity.•noise levels, existing traffic patterns, solid waste production Of disposal. potential for erosion. drainage or flooding problems? Explain brieftys C2. Aesthetic, agricultural. archaeological. historic, at other natural or cultural resources; or community at neighborhood character? Explain briefly: Q. Vegetation or fauna. lisp, shellfish or wildlife species. significant habitats, or threatened at endangered species? Explain brieny: G. A community's existing plans or goals a$ officially adopted. or a change In use of 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. C6. Long term. short termk cumulative. or other effects not identified in C1-05? Explain briefly. C7. Other Impacts (including changes to use of either quantity or type of energy)? Explain briefly. D. WiLL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA? ❑Yes ONO E IS THERE. OR IS THERE LIKELY TO BE. CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes. explain briefly PART lit— 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 11 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 occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box if you have determined. based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on *attachments as necessary, the reasons supporting this determination: Print or Type Name of esponsi a Officer In Lead Agency Signatyritat Responsible Officirr in Lead Agency Name o ea A`,ency Date 2 Title of espons f Orticer 1Cnaturf of reparer t diffirritnt train respon t o i.cal i i } t 14.184 tM5) Text 12 J PROJECT L0. NUMBER 617.20..._. State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For tiNUSTED ACTIONS Only PART I— PROJECT INFORMATION (ro be completed by Applicant or Project sponsor] 1. APPLICANT SPONSOR 2. OJ NAME S �v--v- —, a (� ��L- ( 4 6r- K0V,s 1OT-� 3. PROJECT LOCATION: _ Municipality ' er County 1 � 4. PRECISE LOCATION (Street address and road,,ippn"�teneettons, prominent tandmaft. etc, or provide reap) coo � �v . � �- 1rJu �- -" } �1. j � Uj S C) � va, p 6 � VW. ®pt vim' a. IS PA POSED ACTION: New ®Eupanstcn ❑ Modincattontaltentton 6. DES RIBE PROJECT BRIEFLY: Fl j a 7. AMOUNT OF LAND AFFECTED: Initially O • 0 acres Ultimately r 0 acres a. Wit{. PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ] xas ❑ No 11 No. descrIbe bdelly e.tT IS PRESENT LAND USE IN VICINITY OF PROJECT? Rsaldentlal ®Industrial ❑Commerclat ❑Agriculture- 0 PartdF0re3t1Open3p3ce (j Other . scAw ",......._ . 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? Yes VNo It yes. dst agency(3) and penniUapprarals I. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? Yes ❑ No It yes, Bst agency name and.permillapproral 12. AS A RESULT OF ROPOSEO ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑yes o CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE AppllcanU3pon4f narie: —' � t Date: ` Slpnaturc 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR ._ . y _ .. ,.._.....�_....._.. _:_. A'WASTEWAT IIR TRE"NMNT SYSTEM 1. Name and address of applicant: I�� L4 2L° Lz--e N 0 1110 PA-,ttc� =I S'o 1� PY tZ�Z'`� 2. Name of project: u-i q- f+0 5i4�- 3. Location TN: Z tj (T) 4. Design Professional: _ M 14,N' Yms"L- 5. Address: 17-1 CkAA KQVK AkV4 6. Drainage Basin: 7. Tvoe. f roject: Private/Residential Food Service Commercial Apartments Institutional Office Building Realty Subdivision 8. Is this project subject to State Environmental Quality Review Type Status (check one) ....................... ............................... 9. Is a Draft Environmental Impact Statement (DEIS) required? _ Mobile Home Park _ Other (specify) . (SEQR)? Type I Exempt Type II Unlisted -- 0 62 10. Has DEIS been completed and found acceptable by Lead Agency? ........ ........ 11. Name of Lead Agency 12. Is this project'in an area under the control of local planning, zoning, or other officials, ordinances? .... ........ .... ... . ............... I. - ....................... 13. If so, ave plans been submitted to such authorities? .................. 14. Has r lim ary approval been granted by such authorities ?t Date granted: cs' s -1 -o3 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? ....... ............................... /V 0 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ �/ 0 21. Name of sewage system Distance to sewage system 22. Date test holes observed 11'0 :1; . 23. Name of Health InspectoroC'i--c a 24. Project design flow (gallons per day) .... ............................... � -0 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 00, 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 ?(sl 28. Wetlands ID Number ::......... ............................... -- . ................. ............................... 29. Is Wetlands Permit required? .............................................. ..................:............ Has application been made to Town or Local DEC office? . ............................... . 30.. Does project require a DEC Stream Disturbance Permit? ................ 0 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, p 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 �J 0 DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... S 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 A Block IF Lot 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 $ec+n 2V Q.45 of the, Penal Law. SIGNATURES & OFFICIAL TITLES.. 2 Mailing Address: ................................... pUTNAM COUNTY DEFARTMENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH SERVICES RE: Property of Located at T/V v 3� Tax Map # Block + Lot 1 Subdivision of Subdivision Lot # t Filed Map # Date Filed LETTER OF.A.UTH. _ _ .. _....._. QRI�ATION �.� L- P" ' Q w-ei Gentlemen: This letter is to authorize `J� h n ins a duly licensed Professional Engineer 4,-"'o-r Registered Architect to apply for the required wastewater treatment and/or water supply perrait(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. 92 Countersigned: P.E., RA., # — Mailing Ad ess R G� s 0 State Zip 2 a� Telephone: ' r _-7 (� - VII�ry.tn Signed: (owner orProvem) Mailin Address :42� f'C• g state 1 ' - zi 2- -- P Telephone: Form LA -97 4.0 CONSTRUCTION PERMITS IOJCUW 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 Departm. ent; those.requiriag- 2-feet of fill or less, -an& those requiring greater -than 1eet_of-- fill. The submission requirements for each type are specified below. A. Construction- Permit Submission Requirements For hots K) t/! Letter of Authorization for Design Professional. (Appendix K) Application for Approval of Plans For A Wastewater Treatment System. (Appendix K) - /Co orate - ' rp Resolution (if corporate ownership). (Appendix K) Short Environmental Assessment Form (EAF).(Appendix K) Design Data Sheet. (Appendix K) NOTE: All submitted Department .application forms shall contain original signatures (no photo copies). Three (3) sets of plans bearing the seal and sigdiature of a Design Professional, licensed and registered to practice in I,tew York State. These plans shall be to kM'(miaiii iu —FIRE io-30 -feet horizontal and 1- inch to 10 feet verticaly an l — ~--- " - shaU include, as a minimum, the following: Two (2) sets of house plans with title block as s ecified in .7. k. above, one of which must accompany copy of approved Consction Permit to the Building Inspector of the local municipality. Upon approval of the Construction Permit, tke house plans will be signed and stamped: "Approved For Bedroom Count Only'. d,4— 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) ty 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 9 Fee - See Appendix I. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Welt Location .. Street-Address: - -- , . Y _. 429 Ice Pond Road To-wn/Vi lager Patterson T�� Map Block Lot(s) Well Owner: Name: Address: Viktor Shkreli, 429 Ice Pond Road, Patterson, NY 12563 Use of Well: 1- primary, 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary Cable percussion X , Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 31 ft. Length below grade 30 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: X Steel Plastic Other Joints: _ Welded X Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: X Yes - No Liner _ Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed X Pumped X Compressed Air Hours 6 Yield 30 gpm Depth Data Measure from land surface - static (specify ft) 30' During yield test(ft) 140' Depth of completed well in feet 205' 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 8 Drillin in over den clay Hit rock at 8' 8 31 Drillin in .r 31 " _ y 105 ...., Driifin _ in rock ........ _._ ........ _ ...�,._�_ ��._ arani te l -a If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank InformaEon' Pump Type sub Capacity - Depth 160' Model 10GS10412 Voltage 230 HP 1 Tank Type WX302 Volume 86 lions ' Date Well Completed 10/30/03 Putnam County Certification No. 006 Date of Report 5/24/04 Well i1t (signet , Adam L. Beal NOTE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. Well Driller's a e P. F.. Beal & Sons tt Inc. Address: 4 i� Ave., +pr. » im Signature: /00" Date: 5/24/04 Adam L. Beal White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 7D -•4 feey Y'{ C✓ d d -JU 11Y .JW1CJVC=U n11V11U.J WV1'4 -U 10 •=1~1N a 4 ' pubrrc Hcardh Director 0 b -- . LOItI�- , MOLIAfA1Eii ..R,t4,. duodwe P41fo HedPth Dir dir Drreetor of patked spb*ee DEPARTN%vff OF BEALTH 1 I Geneva Road S Brewster, Ncw, Yo* ,10509 -Q r' TF � A=N ION: o ADAM SIIEBELING XPENE REED , All information below must be Juk completed prior to any schedmEng. IIMON., ROAD SMET: TOWN; SUEAMSION: DEEPS- o A 0 0 PERCS:)K IPTEST: o I, M�01 a •�� . +�: i ; � : � : ?��a�� :,�� vrr� ..yr� � • • r :-err YM NO 0 °t Proposed S5TS within the drainage basin of West Branch or Boyds Corner Reservoirs. o P 934 SSTS rriNa 500 feet of reserypiyr teservoir, lake.. proposed 5STS within 100 feet of a watercourse or aDEC wetland. ca Proposed SSTS design flow greater than 1000 gaAonalday or SPDES Permit rewired.. p Proposed SSTS for a CommericalProject. It is the responsibility of the design professional to provide the above information prior to soil t' 40ing. _ This Department will determine the NYCDEP project status Joint or D . _... _ „ .. „ -._.. ( elegated) baste on the . . . . response.. If You ansvrered ya to any of the questiou;.NYCDEP must witness the soiltestia *:' Tlds• - Department will coordinate a mutually suitable time for field testing with the T•CD040 the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil taft, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDM FOR CK)w7l Y FJsEckw DATE: Ve 868d •`51:t,1 10- 8Z -noW •` Lgsvee1 •`ill :A9 jues _ iV0 29-Z-30 I73� r51.92 ACS -------- - - - - -- � - -� - � ,-�. +. _- t.. 63 fit, . 2 w roz r ' AC CAL. _ 27 3 1.92 ACS / ; it ` \�2857 AC. 62 771 • J� L CAL 0 �a4 zip % \ .�7 r � i �..�.:� / rt +acr. 6.26 AC. i S tam Is`� `aa 8 5 r AL _ ���'• . a `�\ 6� / » 3 • /� / 8 �/ 77,2 470.22 102.89 AC. CAL. X. �.. * j 5'B1AC. �° 76 27 / 09.9).41 AC. 900.45 AL J w 11 p Ile 1296.7 a' yy 42 AC.% ' • 47.7 5a.e5' �° •W �Y 9.55 AC. % I i ' 1 6.29 AC. e. ce y zes.ts las.o izJ 8 10 72 sat `� 7• 4 AC. • �6 ~ , T00 36.o � 6 AC. � 1 1.06 AC 920.00 °e 64.9; ac, ► : AL. / 26 1 75 67 AC. R . a t / CAL 70.06 AC. CAL. %tool % • \ V - 621.97 360.6'+ I S ,. 934 A� 394.02 ti I �y 26.60 AC. / \ / 497.07 _w O s � 71er Iw.et ti ti 25 ._ -- 59 12 0 71.91 AC. 96.53 9 40.73 AC. CAL. 4 • 74.41 AC. sr ►; z ,ti 48 3 I i % POND g�A N. -25 AC h �.•�"�..�.._. ¢� " Cp ti 47 39LJ9 N y L24 AG CAUn 99tia J c 8 ° �,.�7° �, Y.`39 " a •ro•456 s ,, 14 Q t Y ExEitPT \ 10.09 AC. CAl.. 38 g 44 \ 4. • >�' $ �` TOWN OF \ • 4.2 10 � 4.49 AC. 4` \ AVTER f oti°' 5.18 AC. 43 9 8 , \r �9 15 �•� 1 w 26 Ie .6,3 ` \ q�' , .. c 109 ►C . Ir 3.79 AC. J y I �, \ 0 • 4.45 AC. r�O� yy000 ` y 5t 19 r - c?I 43.46 AC. 9.39 AC. v 37.3 •a r 7.76 AC. 16 m CAL. I / J 'b� • "'" 'Y N 21.05 A C. 435 `297 AC I S 17 22.26 AC. CAL LeE 'i69 Aty't6` Ii (t 35 �1s 2.BTAC. dtw ° 7.2 qv s \,v 37, 275'7AQ 7.3 1AC SCH 3tast a AL 1yP iI 4.15 AC; ' • TNAt I 34 TOWN OF \•� AL ~ i r IO 20� N PATiERSON »4o,AS tnt• N 6 37.s7� ,,, I 24 15.51 AC. \ 32 s 569AC J,�� y I•Aecs 22.27 10.71 AC \• 49.02 AC. CAL p 12.78 AF: a - `yam r 8 1 Q� 5.38AC ;J 2I { s ►: / //' 22.26 33 \'\ y �. ►T 9P X3.02 �`7i \ ♦a 1 ♦�' Y 4913 0 - y; * .p o , / 22.25 2.28 13 q v ! • ,a 28 .a. > a° 4 22.24 t , E huh 25.211 30 ° �, 31 L B5 _ .� t 591 ,, 8.24 AC. -4 S 2 2.29 2.42AC. 29 • • zo c :n= PUTNAM COUNTY DEPARTMENT OF HEALTH -DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM -P Owner 5 9 g:Kel, I ..leg Addres..leg g, Located. at- (Street) j%3_c)j_j �T7 L t- Tax Map 32 Block V Lot (indicate nearest cross street) Municipality _PA7— Watershed -Olt 7 � oA.Ic-4Z SOIL PERCOLATION TEST DATA r; Date of Pre-soaking 1.;7- Z 1 -3 le I Date of Percolation Test, NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at percolation test hole. (i.e. s I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth rpeasurements to be made from top of hole. Form DD-97 ... .......... . . ...... ................. ...... .. ma, - ............. . ........................ . ........ ........ ... ..... ... ... ..... .................... ........ .... DVeth*..t'' Water ...... ........... ... ... ..... , ......... ....... ....... ... . ........ ....... " . . ..... . .......... ...... . ......... . .. ... . ........ .... ":'.R "N ....... .... .. ....... . . . . ...... . ....... . ...... ........ X.St ...... 'to . . . ...... ... me rom Ground :,.:,Surf9L& e ,) St eve ir�npictes 1-11,grcol ati Rate one Hole a. N' .... .... �T 6.li �,I**.-,J:��ii.--,. . ......... .... I . ........ ar, .................... :X .... 0 . . .:. ... -X. ... .... ........ 30 2 a,'l -7. 3c� - -------- 3 A;15 All ins 30 'a co 2 Xa- .20 5 2 1150 " 10 0 /Z 3 ;Z: A"5-6 3o. /z 0 4 5 3 2.. 340) 17,1 3 o I IQ- 20 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at percolation test hole. (i.e. s I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth rpeasurements to be made from top of hole. Form DD-97 TEST PIT DATA 2 Q1"%DTD1rTn1V nV SOILS VxTr4n1FMTrr "W" TXT :I.. �N TEST MOLES DEPTH HOLE NO. HOLE NO. F HOLE NO. G.L. 0.51 1.01 13 Er. 1.51 2.0' .0 .2.51 3.0' 3.51 Y 4.0 z 6V 5.01 5.5' .5 6.0 6.50 7.51 . 7 8.01 8. . 5 ------- 9.0 9.51 10.0 Indicate level at which groundwater is encountered AzoAlj!� Indicate- lev-e-l-at- which - mottling bs ved.__.__A1,qA) -Indicate level to which water level rises after being encountered Deep hole observations made by: -2 7) 'H - A Date Design Professional Name: Address: Signature:. Design Professional's -Seal V 04 i .: PUTNAM COUNTY DEPARTMENT OF HEALTH _. DW.ISI N.,®:F.:El [RONM ENTA--L- HEA.E'T- SE- RY -CES :._:_ -a INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM, SECTION A. GENERAL INFORMATION Flame of Project 50 KIZJ:-� i Al County = PvTNdi�J Site Location e y� ®�vr� �-tI, -3 Building construction begun Extent Is property within NYC Watershed ? ................. dyes 'E] No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. Hilly a Rolling 2. Evidence of wetlands, F7 Steep slope Gentle slope Flat dBodies of water (PoN D 1 Low area subject to flooding Drainage ditches a Rock outcrops 3. Property lines or corners evident ........................ 4. Do watercourses exist on or adjoin the property? ...................... 5. Will these affect the design of the sewage system facilities ?.........:: 6. Do watershed regulations apply in this development ? .................... 7 Will extensive grading be necessary? .............. ............................... Fl Yes No DYes' --j No yes : No Yes No YesNo 8. Will extensive fill be necessary for SSTS? ......... ............................... 0 Yes No 9. Do filled areas exist within the SSTS area? ........ ............................... F-� Yes ffN 0 If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: Efs and Gravel Loam Clay 0 Hardpan D Mixture 11. Observed from: a Borings Bank cut Backhoe excavations 12. Soil borings /excavations observed by TZr—E2 -p, G ��4 on 13. Depth to groundwater Alc2A/j5 on- 14. Depth to mottling worv� C— - on. 15. Are test holes representative of primary & reserve areas... .......• 16. Soil percolation tests made by B rM A "s�4 rZaNc r( t`' i;1 on 17. Soil percolation tests witnessed by a, TZe c�p c- Lhq on SECTION D (on back) No Form ST -1 SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? Q' YesNo 19. Will groundwater or surface drainage require. special consideration? ..................... a Yes . No 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... F_� Yes` No SECTION E. REN-LARKS 21. - If a common water supply is proposed, has an inspection been.made of the existing or proposed source and facilities? ................................ ..............................: (� Yes Inspection data 22. Do adjacent wells and/or sewage systems exist? ..................... ...... .......................... ❑ Yes ffNo 23. Additional comments A J F � MOU"p BF- 'S M0, 4/✓ 5, :a,Tt's p4FS la /V 24. Site observer /inspector and title Cffivg D, 25. Date(s) of observation(s)inspection(s) TEST PIT PROFILES Hole r Lot Hole# Lot r Hole # Lot 9 Depth to water Depth to water w __ Depth toawate -- Depth to mottling a Depth to mottling Depth to mottling Depth to rocVimp. Depth to rocVimp. Depth to ro' Wimp. G.L. , G.L. 0.5 G.L.. a . 0.5 1.0 1.0 1.0 2.0 2.0. 2.0 3.0 3.0 4.0 4.0 5.0 5.0 3.0 4.0 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 ' . 9.0 10.0 ' 10.0 10.0 PUTNAM COUNTY DEPARTMENT OF HEALTH -.DIVISION OF ENVIRONMENTAL HEALTH .SERVICES, DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner :5Hi<Rr-L1 Address Located-.atz(Street) -5ili-1-6 de z- Tax Map 3.q Block Lot (indicate nearest cross street) Municipality oae V Watershed gg:Sr' ER&WC-tt SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test Form DD-97 23-- Z5 2 3 4 5 03 73-- 2 ;L5-7 ;2�7 3 0,136--/2 30 .2- 7 oz_ !P 4 ----------- 3 4 3c) Iz 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 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 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH r HOLE NO. HOLE NO.' � HOLE NO. G.L. - - .� 2.0' 2.5 DeoN Uair4e.5 3.0' SaVtaQY 3.5' r: a 4.0' ki le 4.5' a e ^a 5.0' �- 5.5' ^ 6.0' 6.5' 75" 8.0:. g0 IV _.. Indicate level at which groundwater is encountered ii( ©rc� - - - -- - -- -- -- - - -- - - -- Indicate Ievel at which mottling is observed _ Indicate level to which water level rises after being encountered. - - - - - - - -- Deep hole observations made by: Date. 12,1A _ Design Professional Name: Address: $ Jz. Signature: Design Professional's si g nature ana ime RF [ART RFCFTVFT� RY i acknowledge receipt of this report SIGNATURE: .02,196 Title; Rev,. PUTNAM COUNTY DEPAR'TMEN'T OF HEALTIE1 DIVISION OF .�N'6��2 O�I� TAL �I�E AL'TH- SER'6�CEs` - INITIAL WDIVIDUAL /COMMERCIAL SITE INSPECTION FORM, SECTION A. GENERAL INFORMATION Name of Project _r;t/K7ZEL/ E175oA County P vTit z9 Site Location 1e_ Building construction begun _ �/p Extent -�'- Is property within NYC Watershed ? ................. dyes D No SECTION . TOPOGRAPHY (Please check all appropriate boxes) 1. Hilly Rolling Steep slope . J#Gentle slope Flat 4 2. a Evidence of wetlands. Low area subject to flooding Bodies of water aDrainage ditches Rock outcrops oV%&Ce_ 15""IderS.', 3. Property lines or corners evident ....................................................... 4. Do water courses exist on or adjoin the property? ........................... 5. Will these affect the design of the sewage system facilities ?........:. 6. Do watershed regulations apply in this development ? .................... 7 Will extensive grading be necessary? ............... ............................... - - --8. Will extensive fill -be necessary for SSTS? . ............................... 9. Do filled areas exist within the SSTS area? ..... ............................... If yes, what is the condition of the fill? Yes. �o O No -Yes . No Yes No Yes No Yes -No , Yes N ❑ o SECTION C. SOIL OBSE VATIONS 10. Appearance of soil:. Sand Gravel F-1 Loam lay f__� Hardpan E] Mixture 11. Observed from: a Borings F__� Bank cut Backhoe excavations 12. Soil borings /excavations observed by 7 o � D F, G, 'D. k, —on a ,� 13. Depth to groundwater 1,,1gAj on 14. Depth to mottling Alp NC on 15. Are test holes representative of primary & reserve areas ... Aol x.�� 4 .......•..••. Yes ❑ No 16. Soil percolation tests made by on - 41196" 17. Soil percolation tests witnessed by �, , 7Z-kg- P G D, �I �_ on SECTION D (on back) Form ST -1 SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? EJYes No 19. Will groundwater or surface drainage require. special consideration? ..................... 0 Yes �No 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... a Yes` SECTION E. RENT ARKS 21. If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities? ................................ ..............................: Yes No Inspection data 22. Do adjacent wells and/or sewage systems exist? ..................... ............................... Yes N.o 23. Additional�comments �x:s FJHa TetM lr �►,,� e�ssv�r %� sus -Ae,�, 24. Site observer /inspector and title D, Rri-e n A.49* � 25. Dates) of observation(s)inspection(s) z /sc TEST PIT PROFILES Hole Lot # Hole # Lot r Hole # Lot # Depth to water Depth to water ... ... _. ...�_ .. � ..........._.__..- __...... -._.o ..�. -.a. . .ter ..._.. __ .. - Dept`Ti to mottling _..f Depth t o mottling Depth to mottling Depth to rock/imp. Depth to rock/imp.. Depth to rockhrnp. G.L. G.L. G.L.. 0.5 0.5 0.5' .: 1.0 2.0 1.0 1.0 2.0. 2.0 3.0 3.0 3.0. 8.0 4.0 4.0 4.0 5.0 5.0 5.0 .S 7.0 .8.0. . 9.0 M M 7.0 7.0 , 8.0 8.0 10.0 • 10.0 10.0 • • • • • • . • • . • • . • • r . • . • • •.•• . . • ..� . ...� • • • • . . • • s • • • • • • • • • • • • • • • • • • • • • 1 F Al i t t Y t 1 f �t ��5i+� �c�� � 7AgpMtyYYiYY�Yr� . 5 , • 4 t, w