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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -4 -80 BOX 14 01560 or 61 ` ti, ;ii . � N4 , , , Ir Aml L 01560 BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services 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 September 13, 2002 Frank Antonucci 54 Tommy Thurber Ln. Brewster, NY 10509 Re: Addition - Antonucci, Tommy Thurber Ln. No Increases in Number of Bedrooms (T)Patterson, TM #34 -4 -80 Dear Mr. Antonucci: I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated September 13, 2002. The addition is approved with the, following conditions: 1. The total number of bedrooms must remain at four without prior approval by this department. 2. The area of the existing sewage disposal system, and its expansion area, must be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Patterson . If you have any questions, please contact me at your convenience. Very truly yours, r `x� Michael Luke Public Health Technician ML:lM cc:BI BRUCE 'R. FOLEY i Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 ADDITION APPLICATION (RESIDENTIAL ONLY STREET �J� TOM'kY -f MW TOWN Q41e-550A TX MAP# 54-'A-$0 > ppru ;::914 45107q'-4% NAME �ro,�� Acs t:cc � PHO4 %q57' S°110 PCHD# /t MAILING ADDRESS SL� -MWL,4Ay 11K Lir1n -� La i rr�sy<y 16 �j y DESCRIPTION OF ADDITION S i a` Roar V is i 3)0�"4c, 4- 6wth CW1A, uP54ao V N MS TlvMER OF EXISTING BEDROO �C PROPOSED # OF BEDROOMS (FROM CERT. OF OCCUPANCY OR CERTIFICATION MOM BUILDING. INSPECTOR) *Any addition which is considered a bedroom requires formal approval of plans (Construction Permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. _. ... _ ..._ Please submit this form and the following to Putnam County Health Dept., 4 Geneva Road, Brewster, NY 10509, Phone 278 -6130. 1. Certified check or money order for $100.00. . 2. Sketches of existing floor plan (drawn to scale, all living area including basement) *Non - professional sketches are acceptable. 3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map 4) *Non - professional sketches are acceptable. 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Cert. Of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE Comments Feb98 BFhouseguidelines DEPARTMENT OF HEALTH Division . Of Environmental Health Services 4 Geneva' Road, Brewster, New York 10509 (914) 278 -6130 - BRUCE R._FO�EY. R g Acting Puhlia mealth Dire!t. .j, Putnam County Dept. of Heap t~ 4 Geneva Read 5.Cwstc:, NY 10509 e Re: YI /'��z/ Residence Tax Map — �U To -wn kzenuemen: Acco ► din& to records maintaired by the Town, the above noted dwelling is in compliance N�1th Tom,: code and the total number of bedrooms on record i5 This infoLmation has been obtai. -d from: CERTIFICATE Or OCCUPANCY: ASSESSORS RECORD: RAWL /WrWl UCCj 'DA% " 9 - / 3 Dear Mk' Le 1 r ti cusp & i CPI e soda l�s � ® d- s ce.,v�,e-W TL-.e, zwj6vd li,4. C� S Os s i 1�a Vie, 9',n k* 5- i lt- a4 F + O L), ;r P. COca kVL-e; L4ovv e -, - I'✓1 PC( lnaQ e, n^.e a pp ro \1 a 1 S �,r a L4 Bedfc) ate, h ov5e, Ctvlj Wes., �b 0 6 da6\n Ca pp.M4aA do vvtd\je. UOId k('AtSN, pus se..coLA_cJ. AOC)s,(COA54l(UCh�peC*k\� -T� ct LA t yon very uA L)c1A �,r 0 L� d ( ya,,.r k42/ ( p d PUTNAM COUNTY DEPARTMENT OF HEALTH - :.,D ISION...OF ENVIRONMENI'AL.:HEA:LTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at 64 -rcH l' T H O W L L A He Owner /Applicant Name f �"* V k 6 "H"Ll Formerly Town or.Village _P<7-0-50H Tax Map 4 Block 4 Lot 6 0 Subdivision Name Subd. Lot # Mailing Address .7 GP4,56 - f k's '�AV ¢p AV '6� 014 `5A1-et'i j N f Zip 106io Date Construction Permit Issued by PCHD ` a Separate Sewerage System built by e- '�' � '� Luj Addressl q J (1tifl POT 'S's (N Consisting of Gallon Septic Tank and 5 00 A?)5 -F' H4"t� Other Requirements: P Water Sup IV: Public Supply From Address or: Private Supply Drilled by _ P BE AL 4- GOH . Addr 4 PuTla fir 0xi, Number of Bedrooms 4- ess Has erosion control been completed? Has garbage grinder been installed? Te H�3 I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which:are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam Coun D partment of Health. Date: CI �� Certified by ti CL P.E. X R.A. Addressd�J�'�,,�...W ijt".g Pres��on 10 ,6a License #`1~ Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval,of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvo e subject to modification or change when, in the judgment of the Public Health Director, such revocatio /, , odific nor change is necessary. ji By: kx Aw f Title: Date: 7. 7 d> Z_ White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 k. F ANTOIMc 5't Zonn�ny �HVe$Ee �aUE PATrEesoN3 , NY t 253. 9 -%x-02 -rAX MAP # 3L!- 4-80 GXIS�Ii�C� !F1QST F:LcolZ PL.,AtJ SCALE - 114" = 06, 4' -0" 6� -6" 7' -6" 7' -6" 6' -6" 44' -0" 54 - CO`MVV-tY UMI e- pr�creeso►J } tJ Y -TAx MAP 4F "3�A-Lk-$0 1---: XT SS Cn sy-c.oNo L.00,z SCALE s :i 13 -0" 32' -0" SHED DORMER L i 4 i i MR.�r1QS. � ,htJTbNVCGI Stet Tomrgy T4t%)2Bst lA►aE pArrGy -soN , Wy 1 2-5G.13 02 'CAx MAP A* T:1ZSr IFLooe Pt-NrJ SCALE a V4' = 1W PUTNAM COUNTY DEPARTMENT Of HEALTH HOUSE PLANS APP O;rED FOR BEDROOM COLINiT ONLY; BEDROOMS -Tmfwe & Gtk ' ®ate 4' -0" 6' -6" 7' -6" 7' -6" 6' -6" 4' -0" D!- L, rJo. mvl.4MiZs. F Amrowccx *lr --16A "AP At- 3%A-A-90 r-Loog- cli PUTNAM COUNTY DEPARTMENT Of HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY, BEDROOMS rJo. 5 GI -46, 4o E- T LU O Z U 11. 11 14 1h ►!e 11 18 19 4o t► I�J � O o 11 l0 1 (o 3 r2 1 l �! loll l l l 1111 loll l � lll! /11111 ' �joL1D WG SDR- OZ l9V _ � 4�1� c ►P' is PUTNAM COUNTY DEPARTMENT OF HEALTH : � .• DIVISION OF- ENVIRONMENTAL HEAL- TH-SERV1-CE S..w . -., CERTIFICATE OF CONSTRUCTION COMPLIAN E TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # 25 01 f- -3. -pZ Located at 54 -rvw� tNjkt�- L'#"Ht Owner /Applicant Name"} fil U �j- ljil -IV tLj Formerly Mailing Address i Qo "© R.P Ka Town or Village PAT"��R -SON Tax Map � 4' Block 4" Lot � 0 Subdivision Name P-9 Subd. Lot # 5o: VH '5 P 1LlA i W Date Construction Permit Issued by PCHD G) r)-� 101 Zip 1 0610 Separate Sewerage System built by � i I s d L Address l (-�`5 P�b Ro � 55PCEr'r\ N3 10 C\ 1% Consisting of t1-�o Other Requirements: Gallon Septic Tank and G ©o Lr- A65 Water Supply: Public Supply From Address or: Private Supply Drilled by �Elk1, + Add, 4" PUFO �' PN, B�5 Building Type _ . ?-El71 P -5M 6-1� Number of Bedrooms 4 ess Has erosion control been completed? Has garbage grinder been installed? YES Hb I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam Co un D partment of Health. Date: f3i 1 d� Certified by P.E. X R.A. (D sig Professional) n r� Address �05 �� W ��- P7 Io �o °� License # 61 v Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approv a subject to modification or change when, in the judgment of the Public Health Director, such revoca i , odific n or change is necessary. /1 By: / Title: / Date: 7, 7,1 ,10 2— White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Tommy Thurber Lane Lot 2 Town/Village: Patterson ITax-Giid# ,( Map % Block T Lot(s) 80 Well Owner: Name: Address: Franlc.Antonnucci, 570 Taxter Road, Elmsford, NY 10523 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 32 ft. Length below grade 31 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 12 gpm Depth Data Measure from land surface- static (specify ft) 80' During yield test(ft) 200' Depth of completed well in feet 265' 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 15 Drillini in ove burden clay and boulders 15 Hit rocc at 15' 15 32 —Drill-in in --roc set eosin grouted-– - 32 265 Drillinj in rocl granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 7g�m Depth 220' Model 7GS07412 Voltage 230 HP 3/4 Tank Type WX302 Vol me 1. Date Well Completed 8/28/01 Putnam County Certification No. 002 Date of Report 9/25/01 Well ri r (' a r al I UTE: rxact location of well wttn distances to a ast two permanent lanamarxs to De pr ovt a on a separate sneevptan. Well Driller's Name P. /-2zjo�, I nc. Address: 4 Putnam Ave., piaster, NY 10509 Signature: Date: 9/25/01 Perry L. gal White copy: HD File; ellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050,Route22 Brewstei, NY 10509 Az Telephone (845) 2794003 Fax (845) 2794567 January 22, 2002 Robert Morris, P.E. Putnam County Health Department One Geneva Road Brewster, New York 10509 Re: Individual SSTS Compliance - Antonucci Rosewood, Lot # 2 54 Tommy Thurber Lane Patterson, New York Dear Robert: Enclosed are the following: 1. Five (5) prints of Drawing SS -2, "As Built SSTS," dated 1/22/02. 2. "Certificate of Construction Compliance for Sewage Treatment System," dated 1/14/02. 3. Three (3) copies of "Guarantee of Subsurface Sewage Treatment System," dated 1/14/02. 4. Laboratory Reports, dated 10/5/01 and 1/8/02. 5. "Well Completion Report" , dated 9/25/01. 6. Application Fee in the amount of $200.00,Ayable to Putnam County Health Department. 7. "E -911 Address Verification Form," dated 1/3/02. If there are any questions concerning the enclosed, please call. Very truly yours, i Harry W. Nichols J#1 P.E. HWN:jmm 01- 029.00jan PUTNAM COUNTY DEPARTMENT OF HEALTH. ..:.. DI ISLON.,O.F LI VIRONMENT'AL HEALTH. SERVI -CES ..::_- ::%.. GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM FP-ttN�L 4 JVUF, ,�►- rrINUCZ-I Owner or Purchaser of Building Fq_P�H1L � J� UV_5 Awl t H \jc b1 Building Constructed by Location - Street R t,:� /s 2 � 0 e� f A (-, r-- N, 4 &) Tax Map Block Lot TownNil lage k6E:,--wocz Subdivision Name .. 2 Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed. as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any pan of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system,..except where the failure to operate-Properly is..caused.- by_.the willful or-negligent act of.the.occupant of the build-in-g- •utilizing thew - system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month .M Day Year ✓vim Gene a Contractor (Owner) - Signature Corporation Name (if corporation) Address: I C" P'OOD �00 516P lL En State t Signature: ✓"' Title: QWHO — Corporation Name (if corporation) Address: r� Zip j 05 o State Zip � � S 0 Form GS -97 NE NORTHEAST LABORATORY OF DANBURY +o,N ACc�Ao •39 -MILL Fjj A N RQAW ,- .DANBURiY, CT., Q_6011 CT,Cert:, -PH- 0404... w 203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 LABS www.NORTBEAST LABORATOR1ES.com a REPORT TO: P.F. BEAL & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLE POINT: SOURCE: TREATMENT: TEST PERFORMED 0 .; 1 Z • � �� DATE SAMPLE COLLECTED: 10/2/2001 TRV1E COLLECTED: 2:00 A.M. COLLECTED BY: PHIL, DATE RECEIVED @ LAB: 10/2/2001 TESTED BY: LAB# 11471 LAB LD. # PFB -103 REPORT DATE: 10/5/2001 ANTONNUCCI, TOMMY THURBER, LOT #2, PATTERSON, N.Y. WATER TANK WELL NONE N[AXEV" CONTAMINANT RESULTS METHOD # LEVEL (MCL) OR STANDARD BACTERL4,L: • Total Coliform (Bacteria) 0 per 100 ml SM 9222B 0 per 100 ml PHYSICALS: • - -Color (Apparent) 60 - EPA .110.2. .15. • Odor ND - - 3 Units • pH 6.56 - EPA 150.1 No designated limits • Turbidity 19.0 NTUs EPA 180.1 5 NTUs CHEMISTRY: o Nitrite Nitrogen - -- <0.005 mg/L as N EPA 354.1. _ _ . _. L0..mg/L • Nitrate Nitrogen 0.43 mg/L as N SM 450ONO3D 10 mg/L • Alkalinity 40.0 mg/L SM 2320B No defined limits • Hardness 44.0 mg/L EPA 130.2 No defined limits • Iron 3.65 mg/L EPA 236.1 0.30 mg/L, • Manganese 0.113 mg/L EPA 243.1 0.50 mg/L Combined limit for Iron plus Manganese = 0.50 mg/L • Sodium 3.8 mg/L EPA 273.1 20.0 mg/L ** • Lead 0.006 mg/L EPA 239.2 0.015 mg/L * ** ml= milliliter mg/L--milligrams per Liter ND =none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count "'Notification Level ** *Action Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: MOTABLE or D VOT POTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) RESULTS BASED ON SAMPLES SUBMITTED: 10/2/2001 Laboratory Director •NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037° (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 PUTNAM COUNTY DEPARTMENT OF HEALTH ;DIVISON -.OF, .ENVIRONMENTAL- HEALTH: SERVICES I GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM fR-I�NH L J� JVuE A(�► Owner or Purchaser of Building Building Constructed by C34 Tc)nMq Location - Street Nt 4 8o Tax Map Block Lot Town/Village kSEW 06D Subdivision Name .. IL Building Type Subdivision Lot # 1 represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed-as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system,..except where the failure to__ _, sperate.properl-y-is- caused- by' -the willful or n' egligent� act -ofthe- o- ccupantofthe-bu -ding utilizing thee` _._ , .... . system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the' failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month -Day �� Year Gene(aj Contractor (Owner) - Signature Corporation Name (if corporation) Address: Po,�b P-.Qn 6160r,En State Zip 1051 p r Signature: . 9:�� Title: Corporation Name (if corporation) Address: 1 t✓Q-oSh P°r�o �9 I S`SKOM State Ny Zip � oi;V Form GS-97 BRUGE;,R .FOLEY IARRiZ'A AIOCINARI R.N.; M'S N " a...._..vs..._.,.- r_.. Public'. Hrakb Dble1w Asroetale PaN-k Hfsddh Dbvefor , Dkeeror of 'Padw &rvka - D8PARTNENT -OF HEALTH ......: .1 Geneva . Road . _. 8rowster, -New Yo1,Jo$o9 -- 8orlroomsakl BealW (914) 278.6,139.4 T"10278 - MI Nurskg "ca (914) 211.63ks WIC (91'4) 878.6678 . Fax(P14)27I-608$ lrarlyTikrriol W(914) 271•• 6014 �,,Presebooi (91,Q 87wa Pax (914) Y71" 664E. - `E211,ADDR VERIFICATION FORNd OWNERS NAME: � 1'r�f -I0 CZ,I TAX MAP NUMBERS ' 44 _ BID E911 ADDRESS: TOWN: P(�ri -�7QN AUTHORIZED TOWN OMCIAL: -- (Signature) DATE: The - Putnam County, Department of Health will not issue .a . Ce>rtificate. of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form -is-to be submitted with the application for Certificate of Construction Compliance. (E91) VERFRM) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF,ENVIRONNIEh"TAL HEALTH SERVICES 6' FINAL SITE INSPECTION ` Date Inspected . y, Street Location _ a�i7�r Ti���z r� E� Ls� v Owner _ 4&7v Town Permit # P - a — - O TM # 3 - - 8 o Subdivision Lot # __,2 1. - ewaa e System Area YES O COMMENTS 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 strippe'... d�Stonz, brush,_etc., greater- -than 1 -5' -from STS.area....... e. 100' from water course / wetlands ...... ............................... II. SewaQe System S. a. Sep-tic tank size - 1,000 .... ..1,20 .......other ................ . 1_4 b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......................................... . d. Distribution Box 1. TUI outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box -properly set ........... ............................... f. Irenches T-E-en-g-th required 56,:51 Length installed 5 ®, 2. Distance to watercourse measured-- t o 0 Ft.......... 3. Installed according to plan ....... ............................... 4. Slope of trench acceptable 1/16 -1/32" /foot .............. - 5. 10 ft. from property line - 20 ft: foundations.... . 6. Depth of trench <30 inches from surface . �a���n 7. Room allowed for expansion, 10:0;=.4W.* 0° . ................. at —v � vi 6aK � vl JI -( ..'1 /L �liGLL 11V Vibul ' u ..._.�9..Depth_of gravel m trench 12 mi 10 `Pipe_.e ends capped .. .......... ............ ........ c .................. g. Pump or Dosed Systems 1. Size ot pump c am er ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ......................................... :................ 6. Cycle witnessed by H.D.esftmated flow /cycle........... III. F a. ._carF/.v r�.u_racua.a ................... - nrnc'W -�� a. Well located as per approved plans . ............................... b. Distance from STS area measured 4- / O D 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 e�urtain drain & standpipes installed according to plK f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area............ .... h. Surface water protection adequate ... :................................ eaPS SEP-25-2001 10:44 AM HARRY W NICHOLS 914 279 4567 P.02 For., is AN Wb=ft =9 MOW Pdw to OW Low - P441-4 as BW* Lat .Mike is sys im h wd w4w." FK awa in -owdam ift the ImW PCW ConmWon PKmh ad approv48 Phu of He" AA �j IL �L ® pmrama&ad i I Aftsm cam ug,# 1p �a 0 D` 0 i _:.. BRUCE R.' FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 September 28, 2001 Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Re: Field Inspection - Antinucci Tommy Thurber Lane, (T) Patterson Lot #2, TM# 34 -4 -80 Dear Mr. Nichols: In reference to the above noted project, the following comments must be corrected in the field: 1. Large rocks and boulders must be removed from the backfill material. Trenches haave not been ins ected due to the system being backfilled_ All trenches must be uncovered so this Department may complete its inspection of the system. 3. A bedroom count needs to be performed by this Department (house was locked). If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Very truly yours, Gene D. Reed GDR:cj Environmental Health Engineering Aide o' SEI - — _ , . ING CONE DATE OCT -1 -2001 MON 11:04 NAME PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 92794567 PAGES : 1/1 START TIME : OCT -01 11:03 ELAPSED TIME : 00' 40" MODE : G3 RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... a BRUCE R MLEY LORWTA �' MOLR)ARI RN., Ma.N. �00M 0' Amee/m• h'I Nro /r6 Olremr ODMUY of %aflvx $IiJC6r DEPARTMENT OF MEALTH :1 Geneva Road . Brewster, New York 10509 26r6ammbl B..e4 (ati)27a•6120 F4M6)271•]931 N.M.A&M- 00)"11•6rra Wae(615)270_66n Fj gW)I7I.d 6 " wes..se. (943) Sn• 6614 FU(145)278-66a P— b.1(1116)211 -)912 F..(1I5)228•6112 September28,2001 _ ...._._ ...... _ .. `r-_._.. .........� .._.- -Patteraon Park, Suite 106... , ...... _.�..._. _ .......__ ...., _ -,. .,,........ ...,, �.•• 2050 Route 22 Brewster, New York 10509 Re: Field Inapeetiion - Antinneci Tommy Thurber Lane, (T) Patterson Lot #2, TM# 344.80 Dear W. Nichols: In re &mnec to the above noted project, the - following comments must be conocmd in the field: 1. Large rocks and boulders must be removed from the backfill matorid 2. Trenches heave not been inspected due to the system being backlllled. All trenches must be ttneoorored 80 this Department may complete its inspection of the system. 3. A bedroom count nods to be performed by this Department (house was locked). If you have any Wher questions, please contact me at (845) 278 -6130 ext. 2261. Very truly yours. Gene D. Reed GDR:ej Environmental Health Engineering Aide BRUCE R. FOLEY._,.. Public Health Director October 15, 2001 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York .10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC .(845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 r 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 -. Harry Nichols, PE___.________. Patterson Park, Suite 106 2050 Route 22 - -- --Brewster, New-York--10509 - - -- - -- - - - - -- - --- ._._... - -- Re: Field Inspection - Antinucci Tommy Thurber Lane, (T). Patterson... _._.. - - -___. ....... Lot # 2, TM# 34 -4 -80 Dear Mr. Nichols: The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field: No further comments. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Very truly yours, Gene D. Reed GDR:cj Environmental Health Engineering Aide SENDING CONFIRMATION DATE : OCT-19-2001 FRI 16:08 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845-278-7921 PHONE : 92794567 PAGES : START TIME : OCT-19 16:07 ELAPSED TIME : 00'39" MODE : G3 RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED. BRUCE R. FOIZY LORETrA MOLJNARI RN., MR P.Nk )kd1h 0&r A. 1 . P.Nk HWlh DL. - &�e.rar 0( DEPARTM13NT OF HEALTH I Geneve Road Drawsta, Now York 0509 B.Uh ") 279- 6L)G Fft(45)271.1921 9—k.(145)2M-4S5$ WIC(US)T)6.6671 F.(94S)172-885 Early rpt.,.eem. (943)272-dD14 F.04027"44 r—hay (US)211.5912 MWS)222-6113 October 15, 2001 ffarry. Nichols PE 2050 Route 22 BroAsta, New York 10509 Re: Field hapecticin - Antinucei Tommy Thurber Lane, M Patterson Lot* 4 TM# 344-80 Dear W. Nichols: The show referenced separate sewage ftiantent system can be backfilled. The following comments must be corrected in the field: No figther comments. If you tave any firrihn qucsfions, please contact me at (845) 278-6130 W. 2261. very truly yours, 14. 01 Gene D. Read GDR;cj Environmental Health Engineering Aide NORTHEAST LABORATORY or DANBURY ID 114 ACCOgo 4 39- MILL. PLAIKROAD.. . DANRURY, CT .. 0681.1— CT Cert: PH-0404 203) 748-7903 - FAX (203) 748-0652 N Ceit: 11471 °. www.NORTHEAST LABORATORIIES.com REPORT TO: P.F. BEAL & SONS 4 PUTNAM AVENUE BREWTER, N.Y. 10509 SAMPLE SITE: SAMPLE POINT: SOURCE: TREATMENT: TEST PERFORMED CHEMISTRY: • Iron LABORATORY REPORT DATE SAMPLE COLLECTED: TIME COLLECTED: COLLECTED BY: DATE RECEIVED @ LAB: TESTED BY: LAB I.D. # REPORT DATE: ANTONUCCI, 54 TOMMY THURBER LA., BREWSTER, N.Y. KITCHEN SINK WELL NONE RESULTS METHOD # <0.03 mg/L EPA 236.1 1/15/2002 10:00 A.M. C.B. 1/15/2002 LAB# 11471 PFB-006 1/25/2002 MAXIMUM CONTAMINANT LEVEL (MCL) OR STANDARD 0.30 mg/L ml=milliliter mgfL=nulligrams per Liter ND=none detected MCL=Maximum Contaminant Level TNTC=Too Numerous To Count *Notification Level "Action Level CO-1 EAE9TS: -All holding times (were) met. (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) RESULTS BASED ON SAMPLES SUBMITTED: 1/15/2002 �. -02 Jx Aft Laboratory Director •NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828-9787 - FAX (860)829-1050 TOLL FREE WITHIN CT: 800-826-0105 e OUTSIDE CT: 800-654-1230 From: Master Water Conditioning 610- 323 -5526 To: P.F. BEAL & SONS c MASTED 14 F �i . - ate. WATER ANALYSIS Sample Number: 44668 Customer: ANTONUCCI, FRANK (845)228 -5910 General Information: No, of persons in family: No. of bathrooms in use: WATER SUPPLY: Deep Well PUMP: Capacity 300 When drawn, water is: Clear Stains: REMARKS: Date: 1/8/02 3 3 Pressure 40 Date: 1/9/02 Time: 12:52:42 AM Page 1 of 1 WE DO NOT TEST FOR BACTERIA PURITY A QUESTION? CONTACT YOUR LOCAL HEALTH DEPT Wcode: DSPS Dealer: P. F. BEAL & SONS (845)279 -2460 RECOMMENDATIONS: NS -30T - REGENERATE 1 X 6 DAYS FOR 7 GPM RAM /HH TEST RECOMMENDED TEST RECOMMENDED RESULTS LIMITATIONS RESULTS LIMITATIONS _._. Hardness: .. 3 0 -4.00 gpg Iron, _ 0,18 0.300 ppm pH: 6.85 '" 7.0 -8.5 Turbidity: 2.1 ntu Alkalinity: 1.99 14.620 gpg Sulphates: 0.71 14.620 gpg Chlorides: 4 14.620 gpg Iron Algaes: NONE None TDS: 59 500 ppm RECOMMENDATIONS: NS -30T - REGENERATE 1 X 6 DAYS FOR 7 GPM RAM /HH Anention: mph Gentlemen: We enclose ( ) copies Of O B/W Prints O Renroducibles O Specifications 0 M=Qmad= puwm hTt, sym 106 wo Raw u Bw*Var, NY tO"g Td*m (NS)179 4M fax (N3) 3794367 Date: -- - - Job No.: 0 _D2� Projeot ,IN HT. 0NO"'('( O Tracin¢s _0 Description: Revision/Date No. Sent Via: 0 Our Messenger 0 Your Messenger Copy to 0' Blug&ter 0, Han_ d DeUvery 0 First Class Mail 0 Special Delivery 0 ` Very trul yo . Nchniv Ir P R NORTHEAST LABORATORY OF DANBURY �wo,N ACC09oA� WILL, PLA- - aROAm- . :,DANBURY, .CT.... 06 &11?-,yCT-;.Cert: -PH_0404.....:..a...�o: c� 203) 748 -7903 - PAX (203) 748 -0652 NY Cert: 11471 www.NORTHEAST LABORATORIES.com Q = REPORT TO: P.F. BEAL & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLE POINT: SOURCE: TREATMENT: TEST PERFORMED PHYSICALS: o Color (Apparent) O Turbidity DATE SAMPLE COLLECTED: 2/6/2002 TIME COLLECTED: 1:00 P.M. COLLECTED BY: C.B. DATE RECEIVED @ LAB: 2/6/2002 TESTED BY: LAB# 11471 LAB I.D. # PFB -013 REPORT DATE: 2/8/2002 FRANK ANTONUCCI, 54 TOMMY THURBER LA., BREWSTER, N.Y. KITCHEN SINK WELL NONE RESULTS METHOD # 0 - EPA 110.2 0.20 NTUs EPA 180.1 MAXEWUM CONTAMINANT LEVEL (MCLI OR STANDARD 15 5 NTI?s "m1= miIlilitei` mg /L =milligrams per Liter - ND =none detected MCL= Maximum`Contarffiiiarit`Level TNTC =Too Numerous To Count - * *Notification Level * * *Action Level COMMENTS: -All holding times (were) met. (PFD STATE OF NE V YORK DEPT. OF I- 1 —EALTH SERNIICE'c S EAN`-?Au?)S FOR POTnR ?,E AA/ATER) RESULTS BASED ON SAMPLES SUBMITTED: 2/6/2002 WA41wo r,�&� a o Laboratory Director °NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037m (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 e OUTSIDE CT: 800 - 654 -1230 Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 ,...... _. . • oute . w J Brewster, NY 10509 Telephone (845) 2794003 Fax (845) 2794567 To: P �A D - Attention:, Gentlemen: We enclose (f) copies.of B/W Prints Reproducibles Specifications Memorandum Description: W NTE' 1r�" C_wo4 -I -N" N Sent Via: Date: Job No.:. Project A ATM 5,A T o mmi Y1�t� l.� P M- 9-5ot, Reports Tracings Copy of letter Revision/Date No. Our Messenger _ Blueprinter First Class Mail Special Delivery Your Messenger Hand Delivery Copy to Very ly yours, Ha . Nichols Jr., P.E. Dc)NSTATE OF NEW YORK ;--DEPARTME Flanigan Square, 547 River Street, Troy, New York 12180 -2216 Antonia C. Novello, M.D., M.P.H., Dr.P.H. Dennis P. Whalen Commissioner Executive Deputy Commissioner �S February 5, 2002 Dear Commissioner/ Public Health Director: I'm writing with regard to the upcoming Commissioner's Call of March 6, 2002 to be held at the Desmond Hotel and Conference Center in Albany. In our January briefing on terrorism planning, we provided a county health department planning template to the NYSACHO membership. Please continue to use that guidance in preparing the first draft of your plan and submit it to your Regional Director by February 22nd so that we may quickly review them prior to March 6th. This will enable us to assess preparedness planning efforts and to better judge the level of detail needed in our presentations at the Call. An electronic submission of your draft in MS Word would be preferred. At the Call, we will provide several detailed planning documents in the areas of surveillance, response, hospital preparedness, training and communication. Also, as you are aware, Regional meetings are being arranged in February and early March to bring together state and county health departments and hospitals and other health care providers. This effort and our more extensive planning documents will enable you to more fully develop your plans which we would like, to receive by April .12:. -- -- -- A specific.agenda and our planning documents will be sent to you prior to the Call. If you have any questions about the arrangements for the Call, please contact Sylvia Pirani at 518 473 -4223. Questions on planning issues should be directed to Dr. Birkhead at 518 402 -5382 or to me at 518 402 -7500. Very truly yours, Ronald Tramontano Director Center for Environmental Health cc: D. Whalen G. Birkhead S. Pirani J. Bennison Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Boyd Artesian Well Co. 1054 Route 52 Carmel, NY 10512 February 5, 2002 Re: Proposed Well: Daniel 17 Summit Road (T) Patterson Dear Mr. Boyd: The site plan that submitted for the above regarded project has been received by this Department on February 4, 2002. Review of plans and other supporting documents submitted at this time has been completed. Comments are offered as follows: 1. Neighbor notification documentation — Neighbor notification form signed by property owner or returned certified return receipt requested from the U. S. Postal Service. This is required for replacing an existing supply over 5 feet from the existing well. ff there are any questions please contact the writer at (845)278 -6130 ext. 2235. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, � T5 (�.T5.,- k�� Daniel Hadden Public Health Technician cc: RM p B CE R. FOLEI' Public Health Director DEPARTMENT OF 1 Geneva Road Brewster, New York l:17:�111�11 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Boyd Artesian Well Co. 1054 Route 52 Carmel, NY 10512 February 5, 2002 Re: Proposed Well: O'Rourke 47 Putnam Drive (T) Kent Dear Mr. Boyd: 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. Site plan (or tax map) of property showing locations of proposed well, _ . existing septic system and house'.. The well shall be -dimensioned from two fixed points. 2. The site plan is to also include location of all existing septic systems and wells within 200 ' feet of the proposed well as well as all possible sources of contamination within 200 feet (i.e.< salt storage, oil tanks, land fills....) If there are any questions please contact the writer at (845)278 -6130 ext. 2235. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, /q/" S�Wv�j Daniel Hadden Public Health Technician cc: RM STATE OF NEW YORK 'DEPARTMENT OF• HEALTH . :.....:. 5 Penn Plaza New York, New York 10001 -1 7�3 Dennis PI.-Whalen I :.: ••r =, ,.•.: :: Executive;DeputyCommissioner Metropolitan Area Regional Office Antonia C. Novello, M.D., M.P.H. Commissioner: - AD January 24, 2002 Bruce R. Foley Public Health Director Putnam County Department of Health 1 Geneva Road - Route No. 312 Brewster, New York 10509 Dear Mr. Foley: em 13 A;�h I am writing to offer the assistance of the Metropolitan Area Regional Office (MARO) in your on -going effort to address terrorism preparedness and response activities in your county. As you know, an interim planning guide on the development of local terrorism and response plans, developed by the State Department of Health, was distributed to counties at the January 3, 2002 New York State Association of County of Health Officials (NYSACHO) meeting. Counties were requested to develop local plans as fully as possible within a 4 -6 week timeframe. We currently anticipate that Commissioner-Novello will convene a Commissioner's cell. .early._ March 2002 to discuss the progress of state and local planning efforts. Accordingly, I am offering the assistance of key senior program staff to address any questions you may have about the development of your plans or in facilitating communications with hospitals or other key players. Please direct you questions to the following individuals listed below: Program Environmental Health Hospital' EMS Disease Control. Regional Contacts Phone Number Brian Devine 212 - 268 -7185 Mark Knudsen 845- 794 -2045 Paul Kaczmarek 212- 268 -6554 Robert Iovine • 212- 268 -6632 Richard Gallo .914-654-71'68 r, A copy of the Emergency Preparedness Standards utilized by the Joint Commission on the Accreditation of Health Care _Organizations QACHO) ;_ -is @nclosed. for-- your.review_ and may be. helpful in d6i fifying" the internal structural, organizational and operational requirements which must be adhered to by hospitals in the emergency preparedness. If you do not have a copy of the NYSDOH Emergency Preparedness Interim guide, please contact Mr. Devine's office. We are eager to continue this important collaboration with you and your colleagues over the next several months to help ensure local and state preparedness and coordination in this region. Thank you for your cooperation. Sincerely, Celeste M. Johnson Regional Director cc: Dennis P. Whalen Guthrie S. Birkhead, M.D. Wayne M. Osten Ronald J. Tramontano Elizabeth C. Tomson Revised Environment of Care Standards for the Comprehensive Accreditation Manual for Hospitals. (CAtti H Note: These standards contain revised, clarifiedlanguafe; ifot additional 'ie4direments' Although this language is ho`spital- specific, similar language is underdevelopment for other healthcare settings. -u Standard EC IA The organization has an emergency management plan. Intent of ECAA The emergency management plan comprehensively describes the organization's approach to responding to emergencies' within the { organization or in its community that would suddenly and significantly affect the need for the organization's services, or its ability to provide those services. The plan addresses four phases of emergency management: mitigation; preparedness,' response, and recovery. i The planning process provides for a. the conduct of a hazard vulnerability analysis' to identify potential emergencies that could affect the need for the organization's services, or its ability to provide those services. b. the establishment, in coordination with community emergency management planning (where available), of priorities among the potential emergencies identified in the hazard vulnerability analysis for which mitigation, preparation, response and recovery activities will need to be undertaken. c. identification of specif c procedures to mitigate; prepare for, respond to, and recover from the priority emergencies. d. definition of and, where appropriate, integration of the hospital's role in relation to community -wide emergency response agencies, including identification of the command structure in the community. e. definition of a common (that is, "all- hazards ") command structure within the organization for responding to and recovery from emergencies, that links with the command structure in the community. f.' Based on the experiences of health care organizations responding to the September 2001 terrorist attacks in New York City and Washington, DC, it is recommended that the following be included in the planning process. While not currently a require- ment, it is being proposed as an addition to the standard Cooperativeplanning among health care organizations that, together, provide services to a contiguous geographic area &r example, among hospitals serving a town or burrough) to facilitate the Umely sharing of information about essential elements of their command structures and control centers for emergency response. names, roles, and telephone numbers of individuals in their command structures. resources and assets thal could potentially be shared or pooled in an emergency response. names ofpatients and deceased individuals brought to their brgahiihtio' ditofacilitate identification and location "of of the emergency. g ' initiation of the procedures in the response and recovery phases of the plan, including a description of how, when, and by whom the phases are to be activated. h. notification of emergencies to external authorities, including possible community emergencies identified by the organization (for example, evidence of a possible bioterrorist attack). i. notification of personnel when emergency response measures are initiated. j. identification of care providers and other personnel during emergencies: k. identification and assignment of personnel to cover all necessary staff positions under emergency conditions. I. management of the following under emergency conditions: 1. Patient care - related activities (for example, scheduling, modifying, or discontinuing services; control of patient information; patient transportation). 2. Staff support activities (for example, housing, transportation, incident stress debriefing). 3. Family support activities., 4. Logistics relating to critical supplies (for example, pharmaceuticals, medical supplies, food, linen, water). S. Security (for example, access, crowd control, traffic control). 6. Communication with the news media. m evacuation of the entire facility (both horizontally and, when applicable, vertically) when the environment cannot support adequate patient care and treatment. n. establishment of an alternate care site(s) that has the capabilities to meet the clinical needs of patients when the environment cannot support adequate patient care, and procedures that address, where applicable, 1. Transportation of patients, staff, and equipment to the alternate care site. 2. The transfer of patient necessities (for example, medications, medical records) to and from the alternate care site. I-a 3. Patient tracking to and from the alternate care site. 4. Interfacility communication between the organization and the alternate care site. p; re- establishment of usual operations following an emergency. _.. _ . - c plan identifies, a. an alternative means of meeting essential building utility needs (for example, electricity, water, ventilation, fuel sources, medical E' gas/vacuum systems) when the organization is designated by its emergency management plan to provide continuous service during an emergency. 'mob. backup internal and external communication systems in the event of failure during emergencies. IQ `mac. facilities for radioactive, biological, and chemical isolation and decontamination. d. alternate roles and responsibilities of personnel during emergencies, including who they report to within the organization's command structure, and, when activated, within the command structure of the local community. The plan further provides for a an orientation and education program for all personnel, including licensed independent-practitioners, who participate in imple- menting the emergency management plan. Education addresses, as appropriate to the individual 1. specific roles and responsibilities during emergencies. .2. how to recognize specific types of emergencies (for example, the symptoms caused by agents that may be used in chemical or bioterroiist attacks). 3. the information and skills required to perform assigned duties during emergencies. 4. the backup communication system used during emergencies. 5. how supplies and equipment are obtained during emergencies. b. procedures for an annual evaluation of the organization's hazard vulnerability analysis and of the emergency management plan, including its objectives, scope, functionality, and effectiveness. Standard EC.2.9.1 Drills are conducted regularly to test emergency management. Intent of EC.2.9.1 The response phase of the emergency management plan is tested twice a year, either in response to an actual emergency or in planned drills. Drills are conducted at least four months apart and no more than eight months apart, Testing includes a. for organizations. that offer emergency services or. are designated.as disaster receiving stations, at least one drill - yearly that . . includes'an influx of volunteer'b'r'simulated patients: b. participation in at least one community-wide practice drill yearly (where applicable). relevant to the priority emergencies identified by the organization's hazard vulnerability analysis, that assesses communication, coordination, and the effectiveness of the organization's and community's command structures. Notes: .1. Tests of a and b may be separate, simultaneous, or combined. 2. Drills that involvepackages ofinforination that simulatepatients, theirfamilieso and visitors are acceptable. 3. Tabletop exercises, though useful in planning or training, are not acceptable substitutesfor. test a. 4. Staff in each freestanding building classifted as a business occupancy, as defined by the Life Safety Code, that do not offer emergency services nor are designated as disaster receiving stations need only participate in one emergency preparedness drill annually. Staff in areas of the building that the organi- zation occupies must participate in such drills. S. In test b, "community- wide "may range from a eontiguousgeographic area served by the same health care providers, to a large burrough, town, city, or region. ' emergency A natural or man -made event that significantly disrupts the environment of care (for example, damage to the organization's building(s) and grounds due to severe'winds, stoma; or earthquakes); that significantly disrupts care and treatment (for example, loss of utilities, such as power, water, or telephones, due to floods, civil disturbances, accidents, or emergencies within the organization or in its community); 'or that results in sudden; significantly changed or increased demands for the organization's services (for example, bioterrorist attack, building collapse, or plane crash in the organization's community). Some emergencies are called "disasters" or "potential injury creating.even:ts'.' (PICEs). =mitigation activities: Those activities an organization undertakes in attempting to lessen the severity and impact of a potential emergency. ' preparedness activities: Those activities an organization undertakes to build capacity and identify resources that may be used should an emergency occur. ' hazard vulnerability analysis: The identification of potential emergencies and the direct and indirect effects these emergencies may have on the health care organization's operations and the demand for its services. P Activation: ....,.... ._ ....T.he_need for mass distribution of antibiotics^ will. be determined by- the..:.0 Commissioner of Health or the Commissioner's designee and will activate this plan. Assumptions: 1. The local supply of antibiotics and /or medical supplies has been assessed and has been deemed insufficient to meet the needs. 2. The Governor (or designee) after consultation with the Commissioner of Health and the locality will request a "PP" (PP)Nender Managed Inventory (VMI) from the CDC. 3. The PPNMI will arrive within 12 hours after being requested. 4. New York State assume responsibility for the contents of the PPNMI until contents are delivered to the affected locality. 5. The affected locality will be responsible for the PPNMI contents delivered to it and will identify suitable locations for storage and distribution. 6. Undistributed or unused supplies will be returned to the federal authorities. New York State Responsibilities: General Responsibilities 1. New York State will be responsible for accepting the PP and for the initial breaking down of the contents of the PPNMI(s). _..._ . ;.: _.:...T 2...New.York. StateoA ill. determine. the .location for rece,iving,delivery of the.,._._:, _ ..... PPNMI from the CDC. 3. New York State will be responsible for security of the PPNMI until it is delivered to the affected locality and for any remaining contents that are not delivered. 4. New York State will retain responsibility for any undistributed contents until they are returned to CDC. 5. New York State will be responsible for replenishing local supplies of antibiotics and other medical supplies offered to the affected localities prior to arrival of PPNMI contents. 6. New York State will ensure the availability of anti -toxin kits to localities. 7. NYSDOH will assist local heath units by developing protocols governing volunteer activities. I* New York State, Emergency Management.O.ffice. (NYSEMO 1. NYSEMO will coordinate state assets necessary to receive and transport the PPNMI to the affected locality with support from the New the New York State Department of Transportation, Department of Corrections, Office of General Services, and the Division of Military and Naval Affairs. This will include the transport of PPNMI contents either to the local point of distribution or to a local storage area, depending on local needs, and unloading the distributable portion of the PPNMI at the local point of distribution or storage area. 2. NYSEMO will also be responsible coordinating the return of any unused supplies or medications from the affected locality. State Police / National Guard: 1. New York State Police and or the National Guard will provide security at the break -down site, during transport and unloading of the PPNMI contents, and during return of any unused medications. Department of Health ( NYSDOH) 1. NYSDOH will be responsible for notifying other affected partners 2. NYSDOH will assist the locality by providing staff, equipment, patient information, protocols for distribution, and adverse event monitoring. 3. NYSDOH will ensure the breakdown of the PPNMI into. individual dosing units and providing generic labeling for the medication. - 4.- NYSO0H- d ell ensure that,the- proper storage r-equirements•exist.for the - -- - contents of the PPNMI during storage at the central site and during transport. 5. NYSDOH in consultation with CDC and the affected locality shall make recommendations for the use of individual items within the PPNMI. 6. NYSDOH with guidance from the State Education Department's Board of Pharmacy will approve the local health units storage and distribution sites. 7. The regional offices of NYSDOH will assure that the localities choice of storage and distribution sites meets the requirements set forth above. Local Responsibilities: 1. The affected locality that receives the contents of a PP will be responsible for ensuring the proper storage of any items received. 2. The affected locality shall ensure the security of any items received both at the local storage site(s) and at the point(s)'of distribution in accordance with the State Education Department Board of Pharmacy standards. FA, 3. The affected locality shall ensure adequate staffing to ensure patient safety including•. .adequate staffing to screen. patients for.contraindications,- ;ensure -- . medical consultation on -site, ensure patient education, and.distribute medications in accordance with Department of Health and State Education Department requirements. 4. The affected locality will ensure the medical follow -up of adverse events and cooperate with NYS DOH in the data collection of adverse events. 5. The affected locality will develop a distribution plan of contents to local sites such as hospitals, diagnostic and treatment centers, and other healthcare providers. 6. The affected locality will retain responsibility for any undistributed contents until they are returned to the state. 7. All localities will assess the need for anti -toxin kits and communicate their needs to the NYSDOH. nonSTATE OF NEW YORK .. DEPARTMENT OF HEALTH. Flanigan Square, 547 River Street, Troy, New York 12180 -2216 Antonia C. Novello, M.D., M.P.H., Dr.P.H. Commissioner Director of Public Health Putnam County Health Dept. Dear Commissioner/ Public Health Director: Februa ry 5, 2002 Dennis P. Whalen Executive Deputy Commissioner I'm writing with regard to the upcoming Commissioner's Call of March 6, 2002_ to be held at the Desmond Hotel and Conference Center in Albany. In our January briefing on terrorism planning, we provided a county health department planning template to the NYSACHO membership. Please continue to use that guidance in preparing the first graft of your plan and submit it to your Regional Director by February 22nd so that we may quickly review them prior to March 6th. This will enable us to assess preparedness planning efforts and to better judge the level of detail needed in our, presentations at the Call. An electronic submission of your draft in MS Word would be preferred. At the Call, we will provide several detailed planning documents in the areas of surveillance, response, hospital preparedness, training and communication. Also, as you are aware, Regional meetings are being arranged in February and early March to bring together state and county health departments and hospitals and other health care providers. This effort and our more extensive planning documents will enable you to more fully_ develop your plans which we would like to receive by April 12. A specific,agenda and our planning documents will-ge 6'rifto you`prior t`,o the Call. ff you have any questions about the arrangements for the Call, please contact Sylvia Pirani at 518 473 -4223. Questions on planning issues should be directed to Dr. Birkhead at 518 402 -5382 or to me at 518 402 -7500. Very truly yours, l Ronald Tramontano Director Center for Environmental Health cc: D. Whalen G. Birkhead S. Pirani J. Bennison z ' BRUCE : -'R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Harry Nichols, P.E. Patterson Park Suite 106 2050 Route 22 Brewster, NY 10509 Re: Proposed Compliance: Antinucci 54 Tommy Thurber Lane, Lot #2 (T) Patterson, TM# 34 -4 -80 Dear Mr. Nichols: February 4, 2002 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. Water analysis results for the following has exceeded State standards: a) Color b) Turbidity 2. All water analysis results submitted must be from a New York State certified lab. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. VeOr ly yoi Ro orris, P. E. Senior Public Health Engineer M�1 m - BRUCE R. FOLEY - Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Harry Nichols, P.E. Patterson Park Suite 106 2050 Route 22 Brewster, NY 10509 Re: Proposed Compliance: Antinucci 54 Tommy Thurber Lane, Lot #2 (T) Patterson, TM# 34 -4 -80 Dear Mr. Nichols: January 29, 2002 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. Water analysis results for the following has exceeded State standards: ti-� Turbidity c) Iron d) Iron & Manganese It is advise that the well is flushed and resampled. . construction of this sewage disposal. s_ ystemmayhe .subj.ect_to_lacaLmetl d re s ulations. You should contact local wetlands-officials-in- Environmental Protection on,tt isdot; pe"r"colation tests must be witnessed v a re esentati -e of this c� (ruf�,.� Gv>`a�jao .�l�J-�J f��J rw�t.0 c� ilk � �- If��► �- 14S Upon receipt of a submission, revised to reflect the above comments, this application will bey considered further. v ftbert orr y s, kl 1.40 R is , P.E. Senior Public Health Engineer I i t I n :�- . i PUTNAM COUNTY ]DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT F (6R SEWAGE TREATMENT SYSTEM e PERMIT # -a -0 C /) 54- �, HHy y213c� LAma P ,4rrEr—�d� Located at Town or Village Subdivision name 12�0545-w®d® Subd. Lot # Tax Map '22f` Block `- Lot Date Subdivision Approved Renewal Revision _ Owner /Applicant Name PKAHt, 1'• 4 Jib- AN -INcX-C-1 Date of Previous Approval Mailing Address -7 G ��{ `� Petro P-04-P `yoor/f N Y Zip !0 57'10 Amount of Fee Enclosed Building Type P& `9 / P6'fiJ6'6- Lot Area Z 4C No. of Bedrooms 4- Design Flow GPD 0`0" Fill Section Only Depth Volume PCID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 12 ' gallon septic tank and 501 C--i' 14,V 5 i Other Requirements: To be constructed by 1-9 Address Water Supply: Public Supply From Address _ Lr: %�- Private Supply Drilled by 7-8 - Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage 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 57 401 License # 567 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 wheTp sidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. oved for 'charge of domestic sanitary sewage only. 1. By: Title: Date: of White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL _. Tnf_ -.- >, Pleasepririfortype, _ _ 4v -'PCHD Perinit` #' Well Location: Street Address: Town/Village Tax Grid # '5+ Tdn M)--' TIN C441-IL i AN& PATX- io%JMap Block 4- Lot(s) Well Owner: Name: Address: ff"tJY146- AhWwU I `i Cf-OCY5 ROW F44-D 50^ r7,A,6M My jo"o 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 i- gpm # People Served 4 Est. of Daily Usage _gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling X New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No x Is well located in a realty subdivision? ...................................... ............................... Yes X No Name of subdivision F�oSEt^'VyP Lot No. Z Water Well Contractor: T-8 D Address: Is Public Water Supply available to site? .................................. ............................... Yes No k Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on sep "te sh et/plan. Date. 6A;11 Applicant Signature: U PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director,.y revision or alteration of the approved plan requires a new permit. Well to be constructed by a water, el driller certified by Putnam County. i Date of Issue Permit Issui cial: Date of Expiration Title: Permit is Non-Transfe-Ara6fe White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 -i�— 14 r jr.w. Ao PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR' CONSTRUCTION PERi•'IIT -' :^ = -: r NAME OF OWNER: _= C/(/d6"2:::f :C/ STREET LOCATION: REVIEWED BY: RM, GR, AS, SRDATE: IN / DOCUMENTS PER_ APPLICATION )WELL PERMIT OR PWS LETTER (1j LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) Lo�CORPORATE RESOLUTION (_SHORT EAF PLANS -THREE SETS (_J(__)HOUSE PLANS - TWO SETS (__)(VARIANCE REQUEST SUBDMSTON (___)ULEGAL SUBDMSION (_J(_JSUBDIVISION AVPROV AL CHECKED (••)(_)PERC RATE It ( )( JFILLREQUIRED DEPTH (__)CURTAIN DRAIN REQUIRED GENERAL )LOCATED IN NYC WATERSHED (_�) PLANS SUBMITTED TO DEP DELEGATED TO PCHD ( DEP APPROVAL, IF REQ'D DEEP TEST HOLES OBSERVED ERCS TO BE WITNESSED EX- APPROVAL SSDS ADJ, LOTS WETLANDS (TOWN/DEC PERMIT REQ'D ?) (DATA ON i DDS PLANS & PERMIT SAME (PRE 1969 NEIGHBOR NOTIFICATION LETTER BI/ZBA �• -•- (_7100 YR.- FL OOD ELEVATION W/I200' - -' ( )( )SOIL TESTING LOTS >10 YEARS OLD _j(USEWAGE SYSTEM PLAN - (NORTH ARROW) _j SSDS HYDRAULIC PROFILE ( GRAVITY FLOW CONSTRUCTION NOTES 1 -15 - - DESIGN DATA: PERC & DEEP RESULTS T CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT FOOTING /GUTTER/CURTAL I DRAINS USDA SOIL TYPE BOUNDARIES C_JTITLE BLOCK; OWNERS NAME ADDRESS TM#, PE/RA; NAME, ADDRESS, PHONE# ()DATE OF DRAWING/REVISION (ZUDATUM REFERENCE (,)L__)LOCATION OF WATERCOURSES, PONDS LAKES,W ETLANDS WITHIN 200' OF P.L. (LY )PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS HlWELLS & SSDS'S WIIN 200' OF SSTS HH(�PROPERTY METES & BOUNDS EROSION,CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE COMMENTS: (REVSHEET)09 /01/00 TAX I,-LAP =: (CONMNiED) Y (REOUiRED DETAILS ON PLANS CO \"!''Dl U� OUSE SEWER - %I' FT. 4 "0'; TYPE PIPE CAST IRON ( (ONO BENDS; DLA.X BENDS 45° W /CLEANOUT RENEWALS (.__)USITE NOTE (NO CHANGE) FILL SYSTEMS 0' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE �) FILL SPECS! FILL NOTES 1 -5 FILL PROFILE & DIMENSIONS (___) FILL IN EXPANSION AREA FILL GREATER TN.4 N 2 FEET CLAY BARRIER FILL CERTIFICATION NOTE DEPTH GAUGES VOL. ON PLAN FOR RO.B., UNCLASSIFIED & IMPERVIOUS UI SEPARATION DISTANCE FROM TOE OF SLOPE TRENCH LF TRENCH PROVIDED LOFT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED UDETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL �} GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN -FROM SSTS X10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL TO FOUNDATION WALLS C- 100' TO WELL, 200' IN DLOD, 150' TO PITS 100' TO STREAM, WATERCOURSE, LAKE (inc. expan) C) 50' TO CATCH BASIN, 35' STORNIDRAIN, PIPED WATER (� 10' TO WATERLINE (pits,- 20') •_ 50' INTERMITTENT DRAINAGE COURSE (_)U200' /500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS (_L��(,O'FRONI )(J10' MIN TO LEDGE OUTCROP SEPTIC TANK FOUNDATION; 50' TO WELL WELL DIMENSIONS TO PROPERTY LINES - U LOCATION OF SERVICE CONNECTION MINI 15' TO PROPERTY LIME SLOP U"SLOPE IN SSTS AREA (920 0/6) (__)(__)% REGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS PUMP NOTES U DOSE 75% OF PIPE VOLUI4IE/DOSE VOLUME NOTED �) DETAILFOR FORCE MAIN, (PIPE TYPE, ETC.) U PIT AND D -BOX SHOWN & DETAILED (� 1 DAY STORAGE ABOVE ALARM CURTAIN DRAIN STANDPIPES, 5' BOTH SIDES, DETAIL (� I5' DIIN to CDS = >5 %, 20'4%,25'-3%,35'-l%, 100%-<l% (___) 20' b1IN to CD DISCHARGE /100' ivith 182 cons day discharge ( )( )10' b1INN to NON - PERFORATED PIPE PUTNAM COUNTY- DEPARTMENT OF HEALTH D M-S-I0 ..E VTRON EN -T-AL HEALTH-SE 'V LETTER OF AUTHORIZATION RE: Property of P. J A�4r 1 t*yCG! Located at '54 lr�MMIL" 7"4v9-RC f —Ahgt—,_ T/V PAME9 -4 ©0Q Tax Map # �' Block + Lot 124 Subdivision of��'`'OGD Subdivision Lot # Filed Map # 2-g Gentlemen: Date Filed 11 i i 100 This letter is to authorize h iz g)` w. N I GfieL S, /9-- a duly licensed Professional Engineer X or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public 1fealth Director of the Putnam County Health Department, and to sign all necessary papers'on my behalf in connection with this �- - - fnaaer- and - to- supervise-the -construction of said wastewater tretment and/or water gapply systems in conformity with the provisions of.Art cle 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam C,�,aary Code. Countersi P.E., R.A. Mailing A State Zip 10 Oct Telephone: (�4e,7) Z-7q - 4_O° Very truly yours, Signed: (? - o7 (Own tPropeny) F'rookk_ F. A%xic)aVGC,i Mailing Address: "7 Goss P oAA State �Jex-�'Yof-- Zip 10SC10 Telephone: C0 - 9 Iq -59 D--6 (CaO 91e -&4 s- aAt t? Harry W. Nichols Jr., RE Patterson Park, Suite 106 .. .. .. .. .... ... i . ... - - .. . _.... ..... . _ .. ..... , . 2050 Route-22 "• Brewster, NY 10509 Telephone (845) 279 -4003 Fax(845)279 -4567 June 5, 2001 Robert Morris, P.E. Putnam County Health Department One Geneva Road Brewster, New York 10509 Re: Individual SSTS Rosewood -Lot # 2 54 Tommy Thurber Lane Patterson T.M. # 34. 4 -80 Dear Robert : Enclosed are the foll owing: . 1 2 3 Five (5) prints of Drawing SS -2, "Proposed SSTS," dated 6/5/01. Short EAF. "Application for Approval of Plans for a Wastewater Disposal System," dated 6/5/01. "Construction Permit for Sewage Disposal _System," dated. 6/5/01. "Application to Construct a Water Well," dated 6/5/01. `design Data Sheet." "Letter of Authorization." Two (2) copies of residence floor Plan 5. 6. 7. 8. 9. If there are any questions concerning the enclosed, please call (s), for bedroom count only. Review Fee in the amount of $300.00. . Very truly yours, H � W. ols Jr., P.E. HWN: JM: jmm 01-029.00 PUTNAM - COUNTY DEPARTMENT OF HEALTH D. M-SIQ _.OF.X im NNURON-MENTAL HEALTH -SERVICE'S DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Ff-MIL + 0446 6, AH11 Address `16P% r"O 99, 5 5'4t'6 "'Y L0210 Located at (Szreqt).T0ffiM)ii' 7-H-rL6612- LAMS-1 T*VnAA//" Tax Map Block 4 Lot e,(-> (indicate nearest cross street) Municipality 4W Watershed SOIL PERCOLATION TEST DATA Date of Pre-soaking Date of Percolation Test Hole N .0.�- •2 t P -7 3 12,V 4 5 2 3 • 2,11M Z;�Vq 4 5 2 3 4- I . Tests to Do repeated at same depth untii approximately equal peredlation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, s 2 min for 31.60 mt'nhnch) All data to be Submitted for review. 2. Depth measurements to be made from top of hole, _—DEPTH G.L. 0.5' 1.0' 1.51 2.0' 2.5' 3.0' 3.5' Y. 4.5' 5.0' 5.5' 6.0' 6.5' `. 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA DESCRiP'TION OF'SOILS ENCOUNTERED IN-TEST HOLES f r i _.`:HOLE N0. .:_ :_ -: HOLE N0-, v -o :2 I�IR • n Indicate level at which groundwater is encountered NWA6 Indicate level at which mottling is observed. Rbm5 Indicate level to which water level rises after being encountered NA Deep hole observations made by; J5 fr MwK WV-; Date 1 Design Professional Name: 14AW 71 M►LRoul , Jp_ P� Address: 2a��tzo -T �� of NEW 1 10 V� �,�P�yy. NICHp� 4t - / 1 .. Signature: Design Professional's Seal W Uj yi' No. 56 24 FE 110 PUTNAM COUNTY DEPARTMENT OF HEALTH DRgS.1ON,,OF.ENYYIRONMENTAL HEALTH .SERVICES :: .. = 'PLYCATION IFOR APPROVAL OF PLANS FOR - A WASTEWATER. TREATMENT SYSTEM 1. Name and address of applicant:. '•iAN�'- �' ?" �JULIC L �°►� i i �i%/ 2. Name of project: 2 �i T� 3. 'Location TN: p,�r-r 0N =- 4. Design Professional: P�S. Address: 6. Drainage Basin: 7. Tyke of PrQiect; X Private/Residential. Food Service Commercial Apartments . _. Institutional Mobile Home Park - Office Building Realty Subdivision _� Other (specify) 8. Is this project subject to State�Envitonmental Quality -Review (SEAR)? Type Status (check one)..... ................... ..............:.......:.......: ::Type.I .... Exempt Type II Unlisted 9. Is a Draft Environmental Impact. Statement .(DEIS) required? ............. . ....... :.... �® 10. Has DEIS been "completed and found acceptable by Lead Agency? ............... •/� 11. Name of Lead Agency _-121 . Is.•thls project in' an' area under the control of local planning, zoning; or other;- ' . • - . officials, ordinancesT:::::::::::.:.: .::::.:::.................................. ........,.,.................... , 13.. • If so, have plans been submitted' to: such authorities? :...:.:: ..:: :....... : ::.............. :. Nd '14: Has preliminary�pproval been:g anted by such authorities? luo Date gamed: NA 15. Type of Sewage_ Treatment System Discharge........ ::.:..:: surface water X .groundwater . 16. If surface water discharge, what is. the* stream. class designation? ..o:-o.1 :... :..::. :..: N A 17. Waters index number ( surface) ::..:::................. ..........::.::..:.. ::............................. ry tJ 18. Is project located near a public water supply system? ............ :............. ............ No 19. If yes, name ofwater supply, NA Distance,:to water supply N 20. Is ro ect site near a public sewage.collection or treatments stem? ........::.::::: 21. Name of sewage system NA Distance to sewage system NA 22. Date test holes observed 1219 `�� 23. Name of Health Inspector M, 24. Project design flow'(gallons per day) : ................. .......................................... ::.:. 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? .:....................... NA 2 27. Is any portion of'this project located within a designated Town or State wetland? �d 28WenLD-.Number oe•e w�.�i.�e. �e•.00- o111.. oo. oe00 . eoo.ew. - i io.v . ... 29. Is Wetlands Permit required? .............................................. ............................... �a 30 31 Has application been grade to Town or Local DEC office? o .....................:........ bra Does project require a DEC Stream Disturbance Permit? .................................. Is or was project site used foi agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No (1d W 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? ................... ............ I Yes/No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... Y6 34. Are community water and/or sewer facilities planned to be developed within 15 ye,ars in or adjacent to project site? ................................ ............................... Na 35. Are any sewage treatment areas in excess of 15% slope? . ............................... No:. 36. Tax Map ID Number .......................... ............................... Map Block 4- Lot 60. 37. Approved plans are to be returned to ...:. Applicant Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC-Watershed shall be sent to the Department, and-need not be sent in duplicate to the DEP; although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities- from DEP and submit those forms to DEP for review and approval. ... If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm) under penalty of perjury, that information provided on this form -is true to the best,of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to.Section 210.45 of the Penal"'w. 41 77 SIGNATURES &JO �M4 arms. 4-an0o ON ifld Mailing Address:.......GRA- �O�0 :.......... N Ict-16c�5 , .%�2 ° l6 A4 A(EA Zo *o fE.7— ' ZZ 14164 (9J95) —Text 12 PROJECT 1.0. NUMBER 61%30 'SEOR - Appendix. C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM . For UNUSTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project 'sponsor ` 1. APPLICANT AMt4SOR FgAH Y• � jwfC E' APriHucC- IL 2. PROJECT NAME Lcsr - ttrl 95 J. PROJECT LOCATION: NAM , PAT E PUT I' Munk County Jpaity /. PRECISE LOCATION (Sheet address and road Intersections, prominent landmarlu, etc, or provide map) 5. IS PROPOSED ACTION: ,, , .. ` %New ❑ Expansion ❑ Modlticatlonlalteratlon 6: DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND ECTED: ,t '1-' � 2, 4G Initially acres Ultimately Bona 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR•OTHER MISTING LAND USERESTRICTIONN.- BY.. ❑ No If No. describe briefly v 9. WHAT 18 PREW LAND USE IN VICINITY OF PROJECT? . BRasldentlal II IndustiW . ❑ Commerclal ❑ Agriculture ❑ ParklForwtlOpen span ❑ ouw _. oescrlb�. G71►- tCal. -�•. _Fiinr�"f'_.. � . . ,,. ... ...�.. _ .. .,. - . _.. _ . ..... _A,__ ....._ _......_..,._...... .._.. 10. GOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTNER GOVERNMENTAL AGENCY (FEDERAL. STATE OR LOCAL)? 13Y" 09 No If yes, list agwwXs) and permltlapprovals -._. _. . 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yet ®No If Y04 not apeney name and PaTraUapP 12. AS A RESULT Of PRONGED, ACTION WILL EXISTING PERM(TUPPROVAL R=RE MODIFICATION? ❑ Yes 1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BENT OF MY KNOWLEDGE , "' 46 &(6t447— Appliml/sponsor now Date: Sipnalurs If the action Is In tho,.Coastal Area, and you are a state agency, complete the . Coastal Assessment Form before proceeding with'this assessment OVER PART [I_FNVIRnNUFNTAL ASSESSMENT [To be comoleted by Aoencvl A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 0 NYORR, PART 617.41* if yes, coordinate'the review process and use the FULL EAF. B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.0? It No, a negative declaration maybe upersoded, by anothef. Involved agency., - ❑ ye: ❑ 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 or disposal,- potential for erosion, drainage or. flooding problems? Explain briefly: C2. Aesthetic, agricultural, arcKieologlcal, historic, or'othir natural or cultural resources; or commurill . y or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly; C4. A community's existing plans or goals as officially adopted, at a change In use or Intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities likely to be Induced by the proposed action? Explain briefly, 06. Long term, short term, cumulative, orcther_effects not identified In C145? Explain briefly. C7. Other Impacts (including of energy)? Explain briefly. rn "gas In use of either quagtity or. type :z L. <C= D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEAT-i ❑ON6 Yes.. E. IS THERE, OR 13 THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? 0 Y03 ON* It Yoe, explain briefly PART 111 — 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) If necessary, add attachinents . or nce supporting materials. Ensure that irreversibility; (e) geographic scope; and M magnitude' rifenitr �t explanations contain sufficient detail to show that all relevant adverse Impacts have-been identified and adequia' tely addressed. If question D of Part 11 was chocked 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 Identifled" 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 d ete"im'Ined, Oas"edon 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: Name of LOB Agency Print or Type Name of Responsible Offlic.er.ln �Pa Agency Title of ItespmWe Officer Sisnature of Itespon SlilInature of Fm—parer (it dif IereM ImmL respons ible of ficet) Dato 2 - 56�04��4o E V-- 1 MA I � I I� �o � I z I v I 11 13 14 It) Ib 11 18 19 20 ZI �J 0 111 /l,l� /l/I °IZ/ ll/lllwll /1 �lll /lllll i i i f r i djoLlD INC, 5DR -'%G� i 1 i I �z Q� N_ N �11�GIP• Gov �v 9' o Ol