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HomeMy WebLinkAbout1562DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -4 -83 BOX 14 01562 PUTNAM COUNTY DEPARTMENT OF HEALTH .;:_- Dl. .- ISIONT- ,OE_:ENVIRONMENTAL HEALTH- SLRVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR TMENT SYSTEM PCHD CONSTRUCTION PERMIT # P - 7 — GG f _S e Located at v M M Y( ry ag-13 _ R 1 �J F Town or Village F}° J , �l Owner /Applicant Name Hfir C ua6m NOME; Tax Map ` , Block 4 Lot --Z.3— Formerly H/9 r C. unloim 140L SCEs Subdivision Name 2 65 e W C26 p Subd. Lot # - !S7- Mailing Address R F E) 4�-- 2 M E KEEL S-ipEE F K r4T61J 11 11 t-j `r Zip tG Date Construction Permit Issued by PCHD Separate Sewerage System built by HAr C,,)Sn M HoMe Address la i�IEKEEL sTR ET KRTO�/tl �) 10536 Consisting of 16G6 Gallon Septic Tank and ,5-00 � _�' d �' 2 ' yJ l D E A 5&RQTin tJ TRENCH Other Requirements: 3' R o R F' l L. L (l 0 66 e y� Water SupDIV: Public Supply From Address 4 ev7AfgM Avf, 13KE J-5TcK) tjy ✓ Private Supply Drilled b sa9 or: pP Y Y � F 13EY+ L � So Inc- � n Address Building Type S/)iG - -CC F-f r\J'jLY Has- erosion cointi6fbeeri c °ompleted? YES - Number of Bedrooms 3 Has garbage grinder been installed? N D 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 acco Construction Permit and approved plans and the standards, rules and r ul tions of the oun e - nt of Health. Date: [Drc, 27,2 0 Certified by P.E. ✓ R.A. (Design Professional) Address ?u7Ngm E n3F.-1mFRak^+ ; P LL OLD e&)-rC (, License # o 6 74(1/ �RE N Y 10s6 9 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are ubject to modification or change when, in the judgment of the Public Health Director, such revocati n, m dificat' or change is necessary. /(� By: Title: ( 0 Date: dl White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy.- Design Professional Form CC -97 f7a � 9 t ` Pin 7,:hi5smmw� The Sum Oft 4 M V, - For r 7 y ❑, s >°�.� C] Check ,:'��. � M O ❑ Gred� and -� � By �- FROM : PUTNAM ENGINEERING PLLC PHONE NO. : 914'225 2955 Mar. 08 2000 11:47AM P1 PUTNAM COUNTY DEPARTMENT OF HEALTH IbILUN OF LI N VIRONNIENTAL HEALT1j. *9ERZ''IC S__ , _ . GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Buildin Hhr Cu s:n•jJQ .z:s Building Constructed by Location - Street Building Type 3 J4., — -J—) — S 2 — Tax Map Block Lot — ea-1 ± I �k s Town/Village Subdivision Name Subdivision Lot # I represent that I am wholly and compictcly ropollsible ffn- Ihr, hic,nlion, workmnnship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. DatedS Month la Day Year 00 General Contractor (Owner) - Signature NSF cusTrr NDr��s Corporation Name (if corporation) Address: c7 State �]/► I? /7/, #'N Zip S3 Signature: Title: - -- —/'� — H# F_ C - 14 - Corporation Name (if coorrp— oration) Address: c� l�] - c State prgf pj ip I��`6 Form GS -97 OCT -29 -00 07:15 AM TOWN OF PATTERSON MUCE 1L FOLEY 9148792019 P.04 AmouleAs part Ndakh Dbwo. Dtstwor 4f Plat An wir ]DEPARTMW OF HEALTH I (h teva Road Bmwita, New York 10509 Lor3�or�ato�l iCwt�h 1i:d) 8!9.6134 R� (914) lit •l91Y "Ivtl IdI l OMM (ltd) SH • 4041 W19(114)Z79-0-16 10014)218-604S l�1�fy istle�VatlOOi (914) 2"t •101` Frlleit /t (914) Zi1�QQtZ Fta ('91Aj �llt • i64! f -)b• `- •► •; OWNERS NAME.. TAX 13APNG:'tiIBER.- Ep11 ADDRESS: TOWN: r AUTHORMED TOWN OFFICIAL: (Signature) DATE: d d d The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a letiax E911 address is assigned by an authorized town official, This foram is to be submitted with the application for a Certificate of Construction Compliance. 1z ! ! YFirc 'Ru; PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well L-bcaticirf- ' :;.Street Address: - Tommy Thurber Lane, Lot #5 Town/U- iliage: - -- Patterson Tax Grid• #_, = _ - a Map Block Lot(s) 5 Well Owner: Name: Address: Saddle Ridge Homes, Inc., 12 Saddle Ridge Ct, Holmes, NY 12531 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 35 gpm Depth Data Measure from land surface - static (specify ft) 30' During yield test(ft) 180' Depth of completed well in feet 245' 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 5' Drillinc in overburden clay and boulders 5' Hit ro6 at 5' 5' 32' Drillinc in rock set casing, routed 32, 245' Drillinc in rock r If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 7gnm Depth 200' Model 7GS05412 Voltage 230 HP 1-2_ Tank Type WX250 Volume _g Date Well Completed 10/16/00 Putnam County Certification No. 002 Date of Report 12/19/00 W d r re) n lm a- 1 NOTE: Exact location of well with distances to ►e t two permanent ianamarxs to oe pr(widud uu a bUpa,a« b„UVuY,C„- Well Driller's N P4Fal & on Inc. Address: 4 Ptzlzam AvEmae, master, NY 10509 Signature: Date: 12/19/00 �co , Jr. White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 NORTHEAST LABORATORY OF DANBURY ..39 IVlILL pj'M Y ROAD"_. DANBURY, CT ' 668 Y 1' ' ;� CT Cert -PFI= 04114 (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 MAXIMUM CONTAMINANT TEST PERFORMED RESULTS METHOD # LEVEL (MCL) OR STANDARD BACTERIAL: • Total Coliform (Bacteria) LABORATORY REPORT per 100 ml REPORT TO: 0 per 100 ml PHYSICALS: P.F. BEAL & SONS DATE SAMPLE COLLECTED: 11/16/2000 4 PUTNAM AVENUE TIME COLLECTED: 9:00 AM. BREWSTER, N.Y. 10509 COLLECTED BY: C. PFISTER • Odor DATE RECEIVED @ LAB: 11/16/2000 - TESTED BY: LAB #11471 6.13 LAB 1D.# BEAL130 No designated limits REPORT DATE: 11/22/2000 SAMPLE SITE: SADDLE RIDGE HOMES, LOT #5, TOMMY THURBER LANE, PATTERSON, N.Y. SAMPLE POINT: TANK. HOSE BIB SOURCE: WELL -NEW TREATMENT: NONE mg/L as N MAXIMUM CONTAMINANT TEST PERFORMED RESULTS METHOD # LEVEL (MCL) OR STANDARD BACTERIAL: • Total Coliform (Bacteria) 0 per 100 ml SM 9222B 0 per 100 ml PHYSICALS: • Color (Apparent) 0 - EPA 110.2 15 • Odor ND - - 3 Units • pH 6.13 - EPA 150.1 No designated limits • Turbidity 0.88 NTUs EPA 180.1 5 NTUs CHEMISTRY: • Nitrite Nitrogen <0.005 mg/L as N EPA 354.1 1.0 mg/L, • Nitrate Nitrogen 0.41 mg/L as N SM 4500D 10 mg/L • Alkalinity 28.0 mg/L SM 2320B No defined limits • Hardness 48.0 mg/L EPA 130.2 No defined limits • Iron 0.040 mg/L EPA 236.1 0.30 mg/L • Manganese <0.01 mg/L EPA 243.1 0.50 mg/L Combined limit for Iron plus Manganese = 0.50mg/L • Sodium 4.0 mg/L EPA 273.1 20.0 mg/L ** • Lead <0.001 mg/L EPA 239.2 0.015 mg/L * ** ml= milliliter mg/L= milligrams per Liter ND =none detected MCL= Maximum Contaminant Level * *Notification Level ** *Action Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: MOTABLE or ONOT POTABLE RESULTS BASED ON SAMPLES SUBMTTTED:11 /16/2000 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 UTNAM NGINEERING, Pric. Engtneers, and Architects SEPTIC SUBMISSION FORM TO: 15� Q C I. E25 D DATE: PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: % <' s -r6 t1g 6> LJ,5S P-65f- WOOD LoT #.S- �- ENCLOSED, PLEASE FIND: COPIES OF THE SSDS PLAN ❑ COPIES OF THE HOUSE PLANS ❑ CONSTRUCTION PERMIT APPLICATION (Revised) l�Y WELL HEALTH DEPARTMENT FEE ($I ) C � Tz,) 1 q�tP�t ❑ SHORT EAF ❑ DESIGN DATA FORM ❑ LETTER OF AUTHORIZATION ❑ APPLICATION FOR WASTEWATER TREATMENT (PC -97) ❑ LETTER OF EXPLANATION REMARKS: I JCLbl)E'5 : C ,-jj Qtrc.,4-e a('_ C6a -dcucl i o Co rn ip I ; a tl ec � � SG�a�,� area- +rte e n-� Sys -F-�M ; l,� e l( Cori (� I e•}-i v r� � � Q ac--� ; Labvrr�in Zepcc +, 3 Ce)aies (32 e-:L)at'czAec, tl q COPIES TO: SIGNED: d�'M �A, �1h, 4 OLD ROUTE 6, BREWSTER, NEW YORK 10509 • (845) 279 -6789 • FAX (845) 279 -6769 • EMAIL: puteng @bestweb.net PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES. FINAL SITE INSPECTION _..,. a_.�.....z..._w... ..... Inspected y: ef, r?e ,5y Street Location �o,4m / %uv t3E9Z ZEN Owner AA F e4,s n ®ri lgoty :5 Town _ ?A I-rw7zs ow Permit # 7 - Oo TM 9 3 S — �/ — �� , --� " Subdivision Lot # S 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 ...... ............................... II. Sewage System LIa. eptic to c size - 1,000 .... 250. %other ................ b. Septic tank installed level ...........:. ............................... c. 10' minimum from foundation...._ ...... .................. :............ d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box -properly set ........... ............................... f. Trenches T.—EeRgith required 50e Length installed O� - 2. -Distance to watercourse measured -t rd d 3. Installed according to plan ........ ............................... 4. Slope of trench acceptable 1/16.- 1/32" /foot ............. 5. 10 ft. from property line - 20 f.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100% ......................... 8. Size of gravel 3/4 -1'h" diameter clean .................... - 9.- -Deptlrofgravel-intrench -12" minimum ................... 10. Pipe ends capped ................................... :.................... g. Pump or Dosed Systems ize ot pump chamber ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual/audio........ .......... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ........................................ ::........: ....... , 6. Cycle witnessed by H:D.estimated flow /cycle........... III. HousAuildin a. House I ocated per approved plans.. ........... b. Number of bedrooms ..................... ....... ..... t�.. � ....I...... . IV. Well a:. Well located as per approved plans . ............................... b. Distance from. STS area measured -i�- / o a 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 ... ............................... d. Backfill material contains stones <4" diameter .............. e. •Curt ain drain & standpipes installed according to plan.. f. Curtain drain outfall protected. & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... f -r 0 I� 161 ME IMMI Ids ICS icy icy ME f -r BRUCE R. FOLEY Public--'Hd'a1th- Dfre&6r-';:7- LORETTA MOLINARI R.N., M.S:N. Director of Patient Services DEPARTMEN - T,.-'.-OF HEALTH t - Geneva exA Road Brewster, NOY-York 10509 . 7- Environmental Health (914).*.--6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Wit (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 . Trel400l (914) 278-6082 Fax (914) 278 - 6648 FAX COVER SHEET Date: ;2- ZZ9 Z 49 e::2 To: Zdl-11, Z-\IAle,- If Fax#' 76 P — 7-eo No. Pages (Including cover sheet) From: Gene D. Reed Putnam County Department of Heal(k ✓ For your information Please respond For your review Attached as requested As discussed Please call Notes/Messages O-W 4- e k-, In the event of transmission/reception difficulties, please contact this office at (914) 278-6130 ext. 2261. 1 12/13/2000 15:51 FAX 845 2796769 PUTNAM ENGINE iK1NV .6 Y QJ 111 YL1 M C® ]DEPARTMENT O HEALTH DMSION OF ENMONKMAL HEALTH SERVICES c uul /uul M JEST FOR FINAL INSPECTION For: Fill Trenches PCHD Construction Permit # — —_ -. Located TGIa'7ot'Y �! �1e�. GPI -�.l (1? {�Ij /�� �-TlrY1��%a•J Owner /Applicant Name /-�Ct/ST� &S TM Block Lot S6.S Fo �IM'S Subdivision Name A�4t;Wztj_Q Subdivision Lot # Is system fill completed? Date Is system complete ? Date Is system constructed as per plans? Is well drilled? Date / / /;�/" Is well located as per pans? Are erosion control measures in place? I certify that the system(s), as listed, at the abovepremises 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 Comty Department of Health. 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 (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 Date: la-/q/ea To: c GYwe- ' - TV0zi3GrL 1-0,V0 GmT as 2d��u/aaD Fax #: aZF - - 671'7 No. Pages z - -(Including cover sheet)-- - - - - -- - From: Gene D. Reed Putnam County Department of Health For your information Please respond For your review As discussed Attached as requested Please call Notes/Messages dz —z- 1 7- 7'�V'5 P'4p zv -n"L n .Vs =fii�s /►N �iCT T�tJ 1 'PP t-7 , OR' 3 F:!� D06-2 r /LG Mo In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 2261. FROM PUTNAM ENGINEERING PLLC PHONE NO. : 914 225 2955 Nov. 29 2000 05:19PM P1 PUTNAM COUNTY DEPARTMENT OF HEALTH IDWISION OF ENVIRONMENTAL HEALTH SERVICES ... -. xu. ra. ru i- ..,.r ._ r,... .. ... +y. ... t. z. - - -y.- >• .. .. � r ... _. _.... ��. .... � _ ....r.,_ - ,_.. .. .- ..r_. w + ,.n nn REQt3E51 FOR EINAL INSPECTION For: Fill x Trenches PCHD Construction Permit # — %-- O b Located 70Mm%i� ZAtIA3zz 447,z^6''_ M Owner/Applicant Name 1-1,4F CUSS /-�ez' TM 35 Block 4- Formerly - t 7 Subdivision Lot # v~ Is system fall completed? yF S Date_eht Zoo Is system complete? o Date Is system constructed as per plans? IVIA Is well drilled? Ale Date Is well located as per plans? t­1 Are erosion control measures in place? I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. .. _ . .__Date:..... a.... 077: Certified by: ��__ PE) R4 . Design nal jOU?h/tm &-),j /GC G Address - dG!> oeev)2r 6 Lic. # Q 7 Comments: FOR: ® ADAM O ENE Form FIR -99 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE-TRE_TMtNT SYSTEW- " PERMIT # P .. -1 - O® Located at TOiMM�( '"fN191_b&� CA" J� Town or V*ge IOWTFOao -J Subdivision name "-1A roo) Subd. Lot # _� Tax Map 3!5 Block 4— Lot ; Date Subdivision Approved 1 1 I 1 , VO Renewal Revision Owner /Applicant Name Mr— 697T&A &Vjg5? Date of Previous Approval /0-0 Mailing Address R.c%04"` Me" "Z- STat -'LT , 6ji j Zip I 053k Amount of Fee Enclosed Building Type Sir( AM. Lot Area241 U-No. of Bedrooms 3 Design Flow GPD_160_ Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1000 gallon septic tank and '-00 CT Other Requirements: S" P 015 i'l w C la (o �, To be constructed by -m g,- pe Tt:; � j,�jL­yo_ Address Water Supply: Public Supply From Address V -Private Supply Drilled. by ,'Tb 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 s, sy tem 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: P.E. R.A. Date OC i Address Pu`t�(1 �•1bd��'"�cc�C : p�.0 L , CW i2wrE License # Q6"7 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. Approv or discharge of domestic sanitary sewage only. By: ` Title: V p� Date: d White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 Public Health Director TO: )U A, U Dear: ._ - .. - ---• - ��ORE` PFA-_, 1�bLINARP�' R. N:,_.1VI.S:N'::::.:.::�:..,:::. ... Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509, Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Date: Re: Proposed SSTS: HA F/,e ✓r-,, (T y „l.Gi G�cyvL J 41, 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: The construction of this sewagg Qs osal system may be subject t cal wetlands regulati You shoul �Iocal nds o fficia this regard. If percolation tests were n tnessed by a represe e of the New York ty Departmen Environmental Protection on this lot, olation tests must be wi ed by a represen e of this Department. S ltd y4 P44 C Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. b, �v�.�� LQ �v /-D Y�C_ Sly e Very truly yours, Shawn Rogan SR:tn Public Health Technician sstsproposed PUTNAM COUNTY DEPARTNIENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS LL-'' .. :. REVIEW SHEETTOR.CONSTRUCTION PERMIT !! ' NAME OF OWNER: HA F C.E -0-k" 1 STREET LOCATION: �/ / �I&Ly-�!" A- � REVIEWED BY: RM, GR, AS T/ ATE: t TAX MAP=: (CONFaNIED) � /,-s , Y N DOCUMENTS Y N (REQUIRED DETAILS ON PLANS CONT'D) �oD� S✓ (4L)PERMTT APPLICATION LHOUSE SEWER -' /�" FT. 4 "0'; TYPE PIPE CAST IRON U L/)(WELL PERMIT OR PWS LETTER �(__)NO BENDS; MAX BENDS 451 W /CLEANOUT (�(_)PC -97 RENEWALS L�LETTER OF AUTHORIZATION -(=3(7jSfiE NOTE (NO CHANGE) (/)(_)DESIGN DATA SHEET (DDS) FILL SYSTEMS (-Z)(--)CORPORATE RESOLUTION (�)L )10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE ) )SHORT EAF ((___)FILL SPECS / FILL NOTES 1 -5 (� )L _)PLANS -THREE SETS (�L)HOUSE PLANS -TWO SETS (�UFILL PROFILE & DIMENSIONS L,L /VARIANCE REQUEST (lUU� -L IN EXPANSION AREA SUBDIVISION FILL GREATER TH4A'2 FEET (_)LEGAL SUBDIVISION (_/)U CLAY BARRIER (_�_)L )FILL CERTIFICATION NOTE ( /` )(_)SUBDIVISION APPROVAL CHECKED /)(DEPTH GAUGES �UPERC RATE d 130 �UVOL. ON PLAN FOR RO.B., UNCLASSIFIED &IMPERVIOUS UFILL REQUIRED 3 � DEPTH L)(_,6CURTAIN DRAIN REQUIRED L!)USEPAP ATION DISTANCE FROM TOE OF SLOPE . .TRENCH GENERAL (((ELF TRENCH PROVIDED 6oZ7 / 60FT MAX. ( f�(_)LOCATED IN NYC WATERSHED �UP�•. -LLEL TO CONTOURS (_J _)PLANS SUBMITTED TO DEP 0)(_)100% EXPANSION PROVIDED ((_)DELEGATED TO PCHD (((�DETA]L/DUST FREE CRUSHED STONE OR WASHED GRAVEL (_)( f)DEP APPROVAL, IF REQ'D (2!�)(�GEOTEXTILE COVER L!,L _)DEEP TEST HOLES OBSERVED SEPARATION DISTANCES ON PLAN - FROM SSTS U( _)PERCS TO BE WITNESSED (�(J10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL (U(__)EX- APPROVAL SSDS ADJ, LOTS (ZJC_j20' TO FOUNDATION WALLS (___)(WETLANDS (TOWN/DEC PERMIT REQ'D ?) (/__)( —)100' TO WELL, 200' IN DLOD, 150' TO PITS (Z)(_)DATA ON DDS PLANS & PERMIT SAME (/)(_J100' TO STREAM, WATERCOURSE, LAKE (inc. eapan) (_)(L)PRE 1969 NEIGHBOR NOTIFICATION (/)L)g0' TO CATCH BASIN, 35' STORNIDRAPi t, PIPED WATER L,�)LETTER BUZBA (�( x)10' TO WATER LINE .. :. _...... (40100 YR- -FLOOD •EL'EVATION-WI1200' " "' �(�50' INTEI2NIITTEIV"I DRAINAGE COURSE (_) )SOIL TESTING 1,07`9>10 YEARS OLD X300' /500' RESERVOIR, ETC. 150' GALLEY SYSTEMS REQUIRED DETAILS ON PLANS (�(�10 Iti1T(i LEHGl flfiJTeItOP ` L• i �� (yJL )SEWAGE SYSTEM PLAN - (NORTH ARROW) SEPTIC TANK (�(_JSSDS HYDRAULIC PROFILE U(J10' FROM FOUNDATION; 50' TO WELL LJ GRAVITY FLOW WELL �) 6NSTRI C_ZL_)DIJIENSIONS TO PROPERTY LINES O(_)DESIGN DATA: PERC &DEEP RESULTS ((_)LOCATION OF SERVICE CONNECTION ( �)L)2' CONTOURS EXISTING & PROPOSED (i )U� 15' TO PROPERTY LINE ((_)DRIVEWAY &.SLOPES, CUT SLOPE L/,L_)FOOTING /GUTTER/CURTAIN DRAINS (L)L�USDA SOIL TYPE BOUNDARIES U(USLOPE IN SSTS AREA �� (S20 %) (L)LJTITLE BLOCK, OWNERS NAME ADDRESS (—) ) GRADED TO 15 %, ff REQUIRED TM#, PE/RA; NAME, ADDRESS, PHONE# UUPUN, NOTES DOSE/P EIS (/)(_)DATE OF DRAWING/REVISION (_)(_)DOSE "% IPE VOLUME/DOSE VOLUME NOTED (Z_)L )DATUM REFERENCE U)ULOCATION OF WATERCOURSES, PONDS. UUDET R FORCE MAIN, (PIPE TYPE, ETC.) LAKES,WETLANDS WITHIN 200' OF P.L. L--) A� D- X SHOWN &DETAILED U_)PROPOSED FINISH FLOOR AND UU1 DAY STORA E ABOVE ALARM BASEMENT ELEVATIONS CURTAIN DRAPi 1 �)(_)WELLS & SSDS'S WAIN 200' OF SSTS UUSTANDP 5' BOTH SAS, DETAIL L/�L�PROPERTY METES &BOUNDS UU15' N1IN 107 CD ° , 20' -4 %, 25' -3 %, 35' -1 %,100 % -cl% (�( _)20' NIIN to RGE /100' with 182 cons day discharge LPL )10' N o NON -PER TED PIPE COMMENTS: (REVSHEET) BRUCE R. FOLEY ^° Public-° Heath ^'-`Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New. York 10509 LORETTA MOLTNAR '` ils`sociate Pubfic Health Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 February 18, 2000 Paul M. Lynch, PE Putnam Engineering 102 Gleneida Avenue Carmel, New York 10512 Dear Mr. Lynch: Re: Proposed SSTS: HAF Custom Homes Tommy Thurber Lane, TM# 34.4-56.5 (T) Patterson, Rosewood R.S. Lot #5 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. Provide all construction notes (1 -15) as per Bulletin ST -19, revised December 1999 and attached. - Please note separation distances on the plans. - - - - a. 10 from property 11ne to toe of the slope o�fill pad. b. 10' from ledge outcrop to toe of the slope of fill pad. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Very truly yours, Shawn Rogan Public Health echnician SR:cj $O 00� ) { MIN LOT AREA (SF) 150' Rf0'D: STREET FRONTAGE (FT) 200 li X61 " MIN LOT WIDTH: 50 ti r T { REO D. FRONT YARD (F) i REO'D SIDE YARD (FT) ' 40 50 .REO'D_ REAR YARD_ (FT); + _ MAX. BUILDING HEIGHT (f f 35 i M % 5. DEVELOPMENT COVERAGE MAXIMUM NO.: STORIES 1000 6 MIN. LIVABLE 1ST FLOOR AREA (SF) nx � O x 0 x n q v �x 4 Nlf FREEMAN 1 14A1 \ 1 a 119L 4A I 1 a ryry H ^x 0 CV�. Road )ride7iing' `. Ana= � =. 0. s0s.; Ag7n x I $ I \\. to 0i h Pr Cspa .F,M79 x I SA 'O F 11 q x ro D ea Wn t91 A 11 I I Lot \ , Area= 9B, 5 S . scud Z2 c \ ^ x x O y1 P. r Tea = _82.0140 SA 9 90 a y\ \�`9 a m 0720 "A' 12 g9 \max �ts47 DSOb 2.06. C BO. 41 '4 W 50.7 ' /i i / �' j 5y 0 x n i�49' }f $ x 02'41 1,54.K' �� � � NO _ �"��•_ �— o0 ^x a Sp n �x Lot No. 8_______1 °• Lot No: 7 -- Area= 95.483 Sq. Ft. Ana= 84.120 Sq. Ft' 2.192 Acres_ 3» Acnes 0 C \ ProPose 7A \ )RK )m /ED IRT- WISE m BE !N 7 i- 0 CIA TES N/ F .,'H YH A. SS w K m oad, iden a 0.052 - s Road -)V in 7 Ts Area�­ 2f7 SF-�6 0 005 Acivslk, • -DOSING REQUIRED FOR 4 ,Tl FILL DEPTHS 'INCLUDE I' EAI NOTE. FILL.. DEPTHS FOR CG � INSTALLATION OF.:qUI A -'4. BEDROOM HOUSI POSSIBLE BASED -ON Road. )Fidenira . ­�, i Area- 927 SFa� SPECIAL N&E. 0,021 Arrest . .. SEWAGE SYSTEM ",W 'ENTIRE 'DEPTH 'AND WITH SIMILAR ONSI� ll� W 1 17 IL WE A zl_�A s c—, ims, � n MEN I TER I'm ;SSDS SCHEDULE DEEP HOLE FIN 9 SLQF!E PERC.RATE GROUND WATER IMPER.LAYER L.F. TILE FIELDS FILL - URTA IN '.REMARKS -AREA'. DESCRIPTION FLOOR SSLk4: (MIN /IN) (DEPTH TO), (DEPTH TO) : JBDR. 48DR. DEPTH VOLUME DEPTH UNG TH eA C. 804.00' 8V 6-7 NIA NIA 300 400 N/A N/A N/A NIA 4 * .2.529, SAND /GRAVEL , .t 814,60' f . J7. 11-15- NIA NIA 375 500 NIA N/A NIA NIA 2 2.464 SAND /GRAVEL �'REFER TO 820.00' 3? .16-20 3­0" 5'-0" 429 5710 888 C) NIA NIA SPECIAL NOTE 3 2.748 SANDY LOAM 798.00" 2 .30 NIA 51-6 - .500 667- 1.51 444 C l NIA NIA 4 2.252 SILTY - SANDY' LOAM: SILTY - SANDY' ,.8, 85.-00 ZFE1 I 1& 96 Eff 6 2.558 SILTY - SANDY -LOAM 786.00' 16--�20 4'-0" 6'-0" 429 NOT PERMITTED 2' 592HC NIA NIA 753-00- 21-30 NIA NIA 500. 667* NIA NIA NIA NIA 7 1.931 SANDY LOAM . 8 2.1-92 SILTY sANDYJOAM. 742.00' 127. 21-30 NIA 500 NOT PERMITTED 3- 888 CY 7'-0" 100' 9. 2.266 SILTY -SANDY LOAM sli 1,6-20 NIA 429 571* 2' 592 0 7'-IY' 100, PUMP SYST. [DUE TO GRADE -.S&M�SAWY LOAM :21 -�-Jo 51-0" 5'-6" 500 NOT PERMITTED .1.5' 444 C NIA NIA -REFER TO SPECIAL NOTE.'. 10, 2.969 _ 7 i- 0 CIA TES N/ F .,'H YH A. SS w K m oad, iden a 0.052 - s Road -)V in 7 Ts Area�­ 2f7 SF-�6 0 005 Acivslk, • -DOSING REQUIRED FOR 4 ,Tl FILL DEPTHS 'INCLUDE I' EAI NOTE. FILL.. DEPTHS FOR CG � INSTALLATION OF.:qUI A -'4. BEDROOM HOUSI POSSIBLE BASED -ON Road. )Fidenira . ­�, i Area- 927 SFa� SPECIAL N&E. 0,021 Arrest . .. SEWAGE SYSTEM ",W 'ENTIRE 'DEPTH 'AND WITH SIMILAR ONSI� ll� W 1 17 IL WE A zl_�A s c—, ims, � n MEN I TER I'm PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM.- Owner �' L) 5-Cagy,.- Address EFOl�' 2 Kr-9: L KAT'D#J'-%4 Located at (Street) LA-NS Tax Map Block _ i' Lot5(a , S (indicate nearest''cross street) Municipality 12 Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test Hole No. Run No. Time Start - Stop Ela se Time (pMin.) De th to Water rom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 1 2 3 4 5 _2_ 3 4 2bo 5 1 r 2 3 4 5 - NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates arefi0taftieaat qaih83J 00 percolation test hole. (i.e. s 1 min for 1 -30 min/inch, _< 2 min for 31 -60 min/inch) All data to be submitted for review. San8S F311';f3Hn 2. Depth measurements to be made from top of hole. A1NfiO3 d'� 0311(3338 Form DD -97 Indicate level at which groundwater is encountered Indicate level at which mottling is observed N Indicate level to which water level rises after being encountered '� ' 0 Deep hole observations made by: Date Design Professional Name: &M Address: Signature Design Professional's Seal ���a; �!fi►v �,� �. r,"tp ��.. �y rrt liA A DESCRIPTION OF SOILS ENCOUNTERED IN TEST DOLES DEPTH HOLE NO. HOLE NO. HOLE NO. :G.L.: 0.5' 1.01 r" -�I -1 1.5 LIONr1 boA 2.0' 2.5' 3.5' 4.0' -@ 4.5' C// 5.0' 5.5' , 6.0' 6.5' G L,-- 7.0' 7.5' 8.0' � � ' / �•�c PL A;;7 8.5' 9.0' ` 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed N Indicate level to which water level rises after being encountered '� ' 0 Deep hole observations made by: Date Design Professional Name: &M Address: Signature Design Professional's Seal ���a; �!fi►v �,� �. r,"tp ��.. �y T0: �i ' /19. Dear Date: (T) ,����� , -444-V- Y - y- Reservoir Basin The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on F2 b is complete. The. Department will notify you by�.,� j' of its determination. P" The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. 0 Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the 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 naive; the location of the project,_ the . - ~office with- which you Flbd the applicafion"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 Dept. of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (914) 278 -6130 ext. 2159. Very truly yours, Shawn.Rogan SR:tn Public Health Technician ws2 BRUCE R. FOLEY Public Webhh 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 (914) 278 -6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 wIC (914) 278 - 6678 Fax (914) 278 - 6.085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -082 Fax (914) 278 - 6648 TO: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATti1ENT SYSTEM PROGRAM DELEGATED PROJECT: PV .. DATE StiB'D APPROVAL -- ^. NOTICE OF COMPLETE APPLICATION DATE: Z ., i L %A al Ii. t..., V 1. A i LL` .L tii� 11ViL' lr a AJV . la r- 1&-u . L Ja DIVISION OF ENVIRONMENTAL HEALTH. SERVICES { APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: �� 2. Name of project: 4AF- 4S SM LzT 3. Location TN: � - ---� 4. Design Professional: I U71f..*. i W9Y,-)1(4e. ^de. 5. Address: (° 2 6. Drainage Basin: ��" �'--- ''�y °5 k-z— 7. Type of Project: Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ..................:.... ............................... Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... b 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency ►J /� 12. Is this project in an area under the control of local planning, zoning, or other o cials,_.ordinanc.es? _ r - .......... ..............................r ..:...... ............................... 13. If 'so, have plans been submitted to such authorities? ........ ............................... rJ & 14. Has preliminary approval been granted by such authorities? _ Date granted: r--J /71�, 15. Type of Sewage Treatment System Discharge ................. surface water Xgroundwater 16. If surface water discharge, what is the stream class designation? .................... 17. Waters index number (surface) ........................................... ............................... N 18. Is project located near a public water supply system? ..... ............................... 19. If yes, name of water supply Distance to water sup L� 20. Is project site near a public sewage collection or treatment system? ................ r- � 21. Name of sewage system Distance to sewage system� nnt Lie 22. Date test holes observed 23. Name of Health Inspector �(LO -f CAT ,24. Project design flow (gallons per day) ................................. ............................... o 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... 9-1 O 26. Has SPDES Application been submitted to local DEC office? ......................... r,� j-� 27. Is any portion of this project located within a designated Town or State wetland? I`1 d 28. Wetlands ID Number ......................................................... ............................... 29. Is Wetlands Permit required? .............................. .....:...... ............................... Has application been made to Town or Local DEC office? ....... ►J .d 30. Does project require a DEC Stream Disturbance Permit? r1J0 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No DESCRIBE: 0 N .z� 33. Is there a local master plan on file with the Town or Village? ......................... t�110 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ......... ............................... r-J 0 35. Are any sewage treatment areas in excess of 15% slope? . ............................... ►mod 36. Tax Map ID Number ............... . ........ :................................ Map 34 Block L4 Lot P- (o ,E 37. Approved, plans are to be returned to ..... Applicant X 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 duplicat6io' theDEP; althoagh-th 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 Law. SIGNATURES & OFFICIAL TITLES: 1 U Mailing Address: ................................... NQ5t--,-1Z1 r -J l� ,d."--I 5�� 1--� V t 0 5 t Z AIN HITV,314 AN )0 IONind AG,OU 14.16.4 (2187)—Text 12 PROJECT I.D. NUMBER 617.21 SEAR Ap pendix C State Environmental Quality Review . NT. FORM _... SHORT ENVIRONMENTAL ASSESSME .. r,� r „.�......._. -..- ...., - - For UNLISTED ACTIONS 'Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. AP LICANT /SPONSOR ( f= + 6 1 fVG�iK -1 ^� L7 2. PROJECT NAME f `v V WIC 3. PROJECT LOCATION: �.i1 f�A -T-r--j �. Municipality County 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) �� S�v� ��T(�rJ i`�!s t° ©tit ��►�.� 5. IS R POSED ACTION: New ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: L CT- 7. AMOUNT OF LAND AFFECTED: Initially 2' O t acres Ultimately 2 r ( acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? iya res ❑ No If No, describe briefly 9.T IS PRESENT LAND USE IN VICINITY OF PROJECT? KResidential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/ForestlOpen space ❑ Other Des ribe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCALXN ? ❑ Yes o I f yes, list agency(s) and perrnlVapprovals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes XNo If yes, list agency name and permiUapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REbUIRE MODIFICATION? ❑ Yes No r-J 1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE &160JK'6 (46 � �r ` '�"�� Date: � � Applicant /sponsor name:E '-4r%A Signature: If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PANT If— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAR ❑ Yes ❑ No • B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another Involved agency. ❑ Yes ❑ No - .:,.C_: COIJ LQ. ACTION ..RESULTJPIANY.ADYfRSE.EFFECTS ASSOCIATED WITH'THE FOLLOWING: (Answers may be handwritten;A- legible) -,•••• . C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or.cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities likely to be iriduced.by the proposed action? Explain briefly.. C6. Long term, short term, cumulative, or other effects not identified In C1 -05 ?. Explain briefly. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether it Is substantial, large, important or otherwise significant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF andlor prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Print or Type Name of Responsible Of icer in Lead Agency Signature of Responsible Officer in Lead Agency Name of Lead Agency Date 9 Title of Responsible Officer 1 • h L {� Signature of Preparer (If different from responsible off icerCi San At IS 141-1 3H AN LLj1N 33A 13338 1n4* 33381 nd . PUTNAM COUNTY DEPARTMENT OF HEALTH _ DIVMSION_OF...ENVIRONMENTAL HEALT!K-_$1KRV CES_.__, LETTER OF AUTHORIZATION RE: Property of Located at T-D M t 4-y cj �z L"k TN Tax Map # Block L— Lot Subdivision of Subdivision Lot # Filed Map Date Filed l l 266b Gentlemen: This letter is to authorize ��`�"�► �1rZ. �L� a duly licensed Professional Engineer A or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Dep - ertt -:and to sign all necessary papers on my behalf in connection.with this._ t6 O4 gnt } ` ` __._ _ .. matter and to ���/ ,s�e,�the� copstruction of said wastewater treatment and/or water supply systems in conformityyi*,,*l provisions bf Article 145 and/or 147 of the Education Law, the Public Health Law, and the S Countersigned: P.E., R.A., # Very truly yours, Signed: (Owner of Propem•) Mailing Address Ay5 Mailing Address: 10 Mekeel Street State 1IJ Zip�/ �' Telephone:�—`'� —�c7 Katonah State N.Y. Telephone: 914-245-5817 Zip10536 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIDAVIT - CORPoPuTE 6VVNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for:�V� I Gerard Farinella represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: H.A.F. Custom Homes Inc. Having offices at: 10 Mekeel Street, Katonah, N.Y. 10536 Whose Officers Are: President - Name: Gerard Farinella Address: 10 Mekeel Street, Katonah, N.Y. 10536 Vice President - Name: Address: Secretary -Name: Helen Farinella Address: 10 Mekeel Street, Katonah, N.Y. 105,36. Treasurer - Name: Helen Farinella Address: 10 Mekeel Street, Katonah, N.Y." 10536 and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Signed: Title: Akkh. Sworn to before me this day of UC4jN%x% onth) 1614 (year) A. 1Ot� Vnuv� .. otery, li a of Pd ®w 1fo#,. 4800380' ' 'Qualffie in Putnam County Term Expires M •• Corporate Seal Form CA -97 UTNAM APr a m j NGINFERING.PC.c.c. _ Englneers and Planners SEPTIC SUBMISSION FORM TO: Z2g f-;7_ DATE_ PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: d- Ar C kS 70 P-7 J ENCLOSED, PLEASE FIND: COPIES OF THE SSDS PLAN CE! rt-pe-F-t41 ENT 0^44-Y) 2 GO-F I F-1, 01:7 THE -51S>5 ¢',,A,4 (Ter_ N r_&i 2 COPIES OF THE HOUSE PLANS CONSTRUCTION PERMIT APPLICATION WELL PERMIT APPLICATION HEALTH DEPARTMENT FEE ,� SHORT EAF DESIGN DATA FORM LETTER OF AUTHORIZATION 4_1 APPLICATION FOR WASTEWATER TREATMENT (PC -97) ❑ LETTER OF EXPLAINATION REMkRKS: CO ?IES TO: SIGNED: 101 GLENEIDA AVENUE, CARMEL, NEW YORK 10512 • PHONE (914)225 -3060• FAX4914)225 -2955 -PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES N a DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM . -_. - - ` Owner ­ Address AVZ M EVUL S T - VATMJ'v'�44 1 Located at (Street) :ILT2� C44'15" Tax Map 3 Block 4- Lot 56 • S - (indicate nearest cross street) Municipality rAn-1-t"uU Drainage Basin � � � � 6 r &S SOIL PERCOLATION TEST DATA Date of Pre- soaking V 1 1 0 ; av Date of Percolation Test Q �1 Hole No. Run No. Time Start - Stop Ela se Time �1VIin.) De th to Water om Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 1 11, 51. a"Z4 30 1 1 21 2 12 '. Zz IZ:5 �� ! �I y 12-- _.... 3 Iz:SZ 1: ZZ 3j 4 5 2 3 .. 4 1 2 3.. 4 NILJUEN: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at eacn percolation test hole. (i.e. < 1 min for ;l -30 min/inch, <_ 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 tL'.7A. AAA seta; c -,► DESCRIPTION OF-SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. - :_. _ - - 0.5' 1.0' 1.51 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' Indicate level at which groundwater is encountered NA Indicate level at which mottling is observed' Indicate level to which water level rises after being encountered Deep hole observations made by: 1'(A Gv ul� Dates l �? Design Professional Name: Address: 4-ovn te4n,- 43rewS W I Signature: Design Professional's Seal r OF NEW A. ICU CFO 0 6 7 d a% '��UFESSI��'� [A Al". XA^ I fA^jM,AI"_ I"-- IA^TA^1"1 L"-. I".. IMAIM ATM A I "_ TAM I".. I"-- I IK YMP PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEAL'T'H SERVICES CONSTRUCTION PERMIT TREATMENT SYSTEM Located at bM �w ug422,E2 LA r Town or Village f,---T7 ZS Subdivision name Subd. Lot # Tax Map Block �" Lot Date Subdivision Approved 'FM � Z 8 1 / L I /10W Renewal Revision Owner /Applicant Name _ ' M'C'P Flt) Mf,-S Date of Previous Approval Mailing Address Amount of Fee Enclosed Building Type S1 Vr, F&m Lot Area 21 b No. of Bedrooms i Design Flow GPD Zip Fill Section Only � Depth 3 Volume OCO PCIiD NOTIFICATIOli1 I31tE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of b gallon septic tank and Other Requirements: To be constructed by `T'y B� T->45,T- Address Water Suo ®lv: Public Supply From Address or: _ Private Supply Drilled by in �� ���' 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 treatments sY tem 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 repa�Wb. Signed: V P.E. tk R.A. Date 0 Address License # ©lo, LAK, 02, fstKC--lDA GA- e-tSL- /J-( 1 oSUZ 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 considered necessary by the Public Health Director. Any revision o alteration of the approved plan requires a new pe pprove r discharge of domestic sanitary sewag l B �' Title: �S U / ✓`�L � Date: '315A) Y• 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 .,p3ease print.or�type Well Location: Street Address: TownNiilllage Tax Grid # O M M LAN- f /d�� Map 51 Block Lot(s)!� Well Owner: Name: Address: FZF ID I#-2 �f SZ' C- dsTsr" C o 0 5 Use of Well: V 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 Ml nl Gj gpm # People Served M Est. of Daily Usage " gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision }yt5 Lot No._ Water Well Contractor: :Z,2 r3:r� -Ptz� Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: TownNillage Distance to property from nearest water main: 2 t- l t� Proposed well location & sources of contamn id epara eet/p lan. Date: b Applicant Signatu 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 11 driller certified by Putnam County. Date of Issue /0-0 i Permit Issuing Official: Date of Expiration Title: Permit is Non- Transfe ra le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 BRUCE R FOLEY Public • Health Dii•edrw �• DEPARTMENT OF HEALTH 1 Geneva Road Brewster,, New York 10509 LORETTA MOLINARI R.N., M.S.N. -Assoc'i`ate -HeWlth Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 February 18, 2000 Nursing services (914) 278 - 6558 WIC (914) 278 - 6678 . Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 Paul M. Lynch, PE .Putnam Engineering 102 Gleneida Avenue Carmel, New York 10512 Re: HAF Custom Homes, Tommy Thurber Lane, (T) Patterson TM# 34.4-56.5 Reservoir Basin - Middlebranch Dear Mr. Lynch: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on February 14, 2000 is complete. The Department will notify you by March 5, 2000 of its determination. S. 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 Department 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 project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (914) 278 -6130 ext. 2159. Very truly yours, Shawn Rogan Public Health T chnician SR:cj K44tpW H E.A W-r4 L1 PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOIj COUNT ONLY, ALL Sti 'QI)rNX j,,p,,Vj3I0NfALTL-:I?AnONS To THESE HOUSE PLAN _'. BE TO '111E PC FOR APPROVAL — - -- - .-4.4.d I - QI Oi s ! _ TZ ru • � I tb � � l — — N� —.� .°►tom � r 9[ ion Ole s N ` y • W �W? , ,N x n O IL s ! _ TZ ru • � I tb � � l — — N� —.� .°►tom � r 9[ ion Ole s N ` y • W �W? , ,N x n O - - - -- i ll ' IL L J CISi 17 _ � I �i U, i �� aw '37Y.21 k SCPT:(G • � � � ..,• _ ".. � :� ,. ..� .' t, ��-�,+ . �j. t f } .� a • r 1` 1'4�s` b' � 4Y5 }r,< `? �,..?'o �rt� ,.�Ctr .a`. �a.��"� t - , _ • a,W'rF Y.'4hh m� x 4.: e X+ -d { & �+t�,: s; n 6'Sa �,7 3:rit 3 �• L'ir'(. i is r t_ I SURVEY NOTE: HOUSE LOCATION AND SETBACKS BASED:ON SURVEY BY 'TER'RY BERGENDORFF'CWlJvS DATED DECEMBER 7.ZGW , r r AS -BUILT MEASUREMENTS ( IN FEEir ) REVISIONS' .. NO. DATE DESCRIPTION . PUTNAM' :ENGINEERING, hLLC. ENGINE _RS PLANNERS 4 OLD ROUTE:, 6; 8 "RE,WSTER,: NE'W YORK 10509 rt (8 45j 279 6759 FAX (845) 279 6769 .._. �.., .•� �.,..• t.- �..:�` - Cam'` . .- a'!x•�.:.: . sir; _ " (.,. r�.�4g� -_yam ✓ _ .,. :,. va.' '��:J ct � xi::a, .,G a;m � �... .. r�:. , =x. 1�. s. YY- _. �" �.y 1+ i" .riT F - y�y'Uy. ir. �, 1fi... �iY., �. �YC:.` Yx S,..., RIa- L_.1 �k :.'w�i6.rsi'�:Ix4�::- ...K�S'ie+ _{�1.. r�,�]t ..v k. p. . ,... •, Nt, .n. 4'�t.�. �.... -4�# r. :R- ..�..j ".}��ar-�. J.��J i ';ui: _. x i Y •,a - _ } �.. e.� Y. eii. n. eT. iIQ.> a= �i����. �.. �i�, Y. d. �ta7 .��bX's.3_s:�'F�,x�.AJ.GU'Le��' di*'. #z'u. .a ! j ...^ ,�I� � '!,`. a i 4 'ti `�.4� ' � •��{ �`"�ji ..Ytz.. �• °,��P�?atasXx�Ki�. K -�.,3>�: �€: �l l�°•''., �."- x::`: tiw�'. �' l+z,..�,�._�..a;.�v'•z:'��,._,. _ ...l..,Y�.>w.�":'�'�..���`�.n�� ..� 1 2 3 4 5 6 7 8 1'9 10 11 12 13 14 15 16 17 18 19 20 21 A N/A 60 61- 61 63 66 69 73.1 78 84 90 97 142 .135 130 125 120 115 111 110 10( B 30 47 48 50 51 57 60 67.;.72 79 86 91 '134 129 124 118 112 108 104 101 9 C 20 REVISIONS' .. NO. DATE DESCRIPTION . PUTNAM' :ENGINEERING, hLLC. ENGINE _RS PLANNERS 4 OLD ROUTE:, 6; 8 "RE,WSTER,: NE'W YORK 10509 rt (8 45j 279 6759 FAX (845) 279 6769 .._. �.., .•� �.,..• t.- �..:�` - Cam'` . .- a'!x•�.:.: . sir; _ " (.,. r�.�4g� -_yam ✓ _ .,. :,. va.' '��:J ct � xi::a, .,G a;m � �... .. r�:. , =x. 1�. s. YY- _. �" �.y 1+ i" .riT F - y�y'Uy. ir. �, 1fi... �iY., �. �YC:.` Yx S,..., RIa- L_.1 �k :.'w�i6.rsi'�:Ix4�::- ...K�S'ie+ _{�1.. r�,�]t ..v k. p. . ,... •, Nt, .n. 4'�t.�. �.... -4�# r. :R- ..�..j ".}��ar-�. J.��J i ';ui: _. x i Y •,a - _ } �.. e.� Y. eii. n. eT. iIQ.> a= �i����. �.. �i�, Y. d. �ta7 .��bX's.3_s:�'F�,x�.AJ.GU'Le��' di*'. #z'u. .a ! j ...^ ,�I� � '!,`. a i 4 'ti `�.4� ' � •��{ �`"�ji ..Ytz.. �• °,��P�?atasXx�Ki�. K -�.,3>�: �€: �l l�°•''., �."- x::`: tiw�'. �' l+z,..�,�._�..a;.�v'•z:'��,._,. _ ...l..,Y�.>w.�":'�'�..���`�.n�� ..� 13 14 15 16 17 18 19 20 21 22 2 3 142 .135 130 125 120 115 111 110 106 104 103 134. 129 124 118 112 108 104-101 97 94= 91 i 1 t 4 i ' f Putnam County Department of Health Division of Environmental Health Servioes Ap d ae noted for conformance with fe lc R a and Regulation of the am C Health Departm ' tl 6 0 gr3ature Q e t } i SSD PREPARED FOR: DESCRIPTION HAF HOMES ROSEWOOD SUBDIVISION, LOT 5 :. TOMMY THURBER LANE, PATTERSON r ` \\ A R TA C MAP 35 BLOCK s 4 IOT 56 5 T01NN }OF PATTERSON Yr 4Y� kL �� 52:31' .J +�k'"��'`c� .vy .,ik I �. �i.Et:.�ft �a�l, ao�yy�5,�,��� 7 i't�.., is r?+ s �. �. {., tt rf .�„f ?M� {,� tsr: .s � =sR•.,�a. } Y ° },.5��c; '`�. ,h t d.. 1�,. -,.`fit -�F V,1�; Y*. �,�,_�''.i�i e:!�Sd�ai�..3'iJ'�TQ`r ��c'�..Y t.. '1�a, T., 3'.a�.'��'i� 5�.`''�i. �+ . �, �J;;y"�_: � �..atik`7Zu'�� %a�a� "�a:4.�r�us':f$h� ": eye.. � %r.�.��.�:�`,i,'=�a';t�»,�..�.' +.;e:.43se�: €.t«'tvx:�c'�:�<�.�• ?c'Y _ `v,.,;�+;s(�.n..�.°.£'�-5i`b AS_ 5t ILT: ' 11..�- 1fiis'is to certif, �corrstrur,ted as it inspected by Put The,syslem was rule's and reyulat ' lieclth and the P 2. `. 7hes,SSDS cansie cc•ncrete septic ;french odditioi DATE; O+ NEWy Oy DECEMBER pSC PROaECi3?MPNAGER °y GAT PRAWNrOY i I � CHCCKEt) BY os�aae GAT