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HomeMy WebLinkAbout1563DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -4 -84 BOX 14 01563 -1 i m' r� ,� . milru If 1. IN we 01563 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTIZIJC3'iON PERMIT FOR SEWAGE TREATMIENTSYSTEIVI`- - MLA&C PERMI T # J -! �L Located at Town or Village - A-CTGZSoN Subdivision name lzo5, Oo D Subd. Lot # Date Subdivision Approved owjj Owner /Applicant Name R Z.I*5 ,, l i C, Tax Map Block +- Lot Renewal Revision Date of Previous Approval Mailing Address 1 '2. SAM & PIKE— Cr t q( u L� Zip Amount of Fee Enclosed $ 300'.,�q Building Type k05 Lot Area 2.S-(P No. of Bedrooms 3 Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 9W, Lit Dr—, —rf(KU Ckf —S gallon septic tank and 4-32- UE of Other Requirements: To be constructed by (' t s C &CCU �� P.. (JJC. Address �� � ( L �S'Z �i 10-5017 Water Supply: Public Supply From Address or: Private Supply.Drilled b� ,A-I _ S60US Address % °�'� _ _ _ _ -_.. �S2�Z NK LOSS � 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 P.E. 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 wh9weprisidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new perm,'t . prove discharge of domestic sanitary sewage only. By: Title: (i Date: j b White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 4 Geneva Road (914) 278 - 6130 Brewster, NY 10509 �atev ' 1 Received of �" �` fi For T1-IAN K ,YOU► } Dy Cash, � C],�:Check}`. � M O� � ;❑ Credit Card: � By - "' .4 ^ x x .ZI PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES to � APPLICATION TO CONSTRUCT A WATER WELL please print or type ° _ ' ..: P�HD Permit Well Location: Street Address: Town/Village Tax Grid # 14." i t�"n'rw,i - rW(bQL i.-hr'v 1 PAITLYC-scn i Map Block 4 Lot(s) 8 c Well Owner: Name: SA-00L-c- Address: Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought -5' gpm # People Served S Est. of Daily Usage !LO gal. Reason for. Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason i p..t3iDC'� �'1I�'t. i.sO'T- 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 P-Le s amJk -Y�4 Lot No. Co Water Well Contractor: P,J=, 13oAo, Address: 4 Pu'mAm &UM Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: MIN Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate heet/plan. Date: l i Applicant Signature: - PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions 'of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION:. This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. revision or alteration of the approved plan requires a new-permit. Well to be constructed by a water ell 'ller ce 'fied by Putnam County. Date of Issue 0 Permit Issuing Official: Date of Expiration d Title: Permit is Non- Transfe •able White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 P. W. SCOTT Engineering & Architecture, P.C. 3871 Route 6 BREWSTER, NY 10509 E-Mail: pws @bestweb.net (914) 278-2110 FAX (914) 278-2166 TO Putnam County Dept. of Health 4 Geneva Road Brewster, New York 10509 tbArr ape w0. I RE. I WE ARE SENDING YOU P Attached ❑ Under separate cover via the following items: ❑ Shop drawings ,5b Prints ❑ Plans ❑ Samples 03 Specifications ❑ Copy cf letter ❑ Change order 71 COPIES DATE NO. DESCRIPTION Application for Approval Construction Permit for Sewage Treatment System L orm CP_ 'f PA-IQ ILetter of Authorization (form LA-97or CA-97) & Design Data Sheet (form DO-97) Short Form EAF 2 House Plans'(2sets) Application to Construct a Well form WP -97) Check ;118 for. the-amount of $'-boo,oO 3. TH§E ARE TRANSMITTED as checked Eelo w ' n g s w ❑ For approval ❑ Approved as subm:lLed ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections For review and comment ❑ REMARKS TO C3 Resubmit -copies for approval ❑ Submit - copies for distribution ❑ Return - corrected prints ❑ FOR BIDS DUE a PRINTS RETURNED AFTER LOAN TO US V 1 %-)A 1 I 1 -lj / 1 V 1 t 1 1 L L 1 i ai %. i 1 T 11.11 11 IL. -J 1 11 DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: Saddle Ridge Homes, Inc. 12 Saddle Ridge court Holmes. NY 12531 2. Nameofproject: Rosewood Subdivision 3. LocationTfV: Patterson P.W. Scott, Engineering 4. Design Professional, & A r c h i t e c t u r e , P . c . ' 5 . .Address: 3 8 7 1 Route 6 6. Drainage Basin: East Branch Reservior Brewster, NY 10509 7. Type of Project: X 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 x 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... No 10. His DEIS been completed and found acceptable by Lead Agency? ............... N/A 11. Name of Lead Agency Town of Patterson Planning Board 12. Is this project in an area under the.control of local planning, zoning, or other officials, ordinances? ........................................................:. ............................... Y e s - 13. If so- have,plans -been submitted to -such" authorities? :..... :. ..... ...... ... Yes = Su b d i v`i s 3. o n 14. Has preliminary approval been granted by such authorities ?Y e s Date. granted: 8 /-9 7 15. Type of Sewage Treatment System Discharge ................. surface water X groundwater 16. If surface water discharge, what is the stream class designation? .................... N/A 17. Waters index number (surface) ........................................... ............................... N/A 18. Is project located near a public water supply system? ....... ............................... No 19. If yes, name of water supply N/A Distance to water supply N / A 20. Is project site near a public sewage collection or treatment system? ................ No 21.,' Name of sewage system Ike d i v i d u a l tot Distance to sewage system 22. Date test holes observed 12/8/95 23. Name of Health Inspector M i k e ,B u d z i n s k i 24. Project design flow (gallons per day) cPn. 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? ......................... NIA Form PC -97 is any portion or finis project located within a designated Town or State wetland? N o 28. Wetlands ID Number ............:........................ ......................... ...... ................ N'/ A ` 29. Is Wetlands Permit required? ................................ ............................... N o Y, ..,.�Has:application been- made-to Town or Local DEC'`ice? ::.::..::. N �. A 30. Does project require a DEC Stream Disturbance Permit? .. ............................... No 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 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 No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... Y e s 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................. ............................... Yes 35. Are any sewage treatment areas in excess of 15% slope? .......................... No 36.'' Tax Map ID Number .......................... ............................... Map 3.4 Block_ Lot 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 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- antacl prz5val of other aspects of a project, suchas st6iiiN er 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 SectiO Penal Law. ' , 1 SIGNATURES & OFFICIAL TITLES: Q Peder W. Scott, P.E. R.A. - Agent for Applica Mailing Address: .....:....... 61 :6.x..1 -4 8 ". �`� �(� � � � Route 6 SO,'�tcyr' �.�,'.,'1� t''�, ,rpcaster, NY 10509 !! ; �.. l JJ';! :i .atl P!U "iNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: Saddle Ridge Homes, Inc. 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Type II 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 10. `; I� DEIS -$een completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency Town of Patterson Planning Board Exempt _ Unlisted X M N/A 12. Is this project in an area under the.control of local planning, zoning, or other officials, ordinances ... Yes ....................................................... ............................... 13: `If so; have plans been�subm tted to such authorities? ...� ......� ................... Yes - S ub.d i v i s i o n 14. Has preliminary approval been granted by such authorities ?Y e s Date granted: 8/97 15. Type of Sewage Treatment System Discharge ................. surface water x groundwater 16. If surface water discharge, what is the stream class designation? .................... N/A 17. Waters index number (surface) ........................................... ............................... N / A 18. Is project located near a public water supply system? ....... ............................... N o 19. If yes, name of water supply N/A Distance to water supply N / A 20. Is project site near a public sewage collection -or treatment system? ................ No 21. Name of sewage system,` I hi d- iv -i d u 11 y =Lot; . Distance to sewage system 22. Date test holes observed 12 / 8/ 9 5 23. Name of Health Inspector M i k e ,B u d z i n s k i 24. Project design flow (gallons per day) ................................. ............................... 800 c P n 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? ......................... N/A Form PC -97 12 Saddle Ridge Court Holmes, NY 12531 2. Nameofproject: Rosewood Subdivision 3. LocationT/V: Patterson 4. Design -Professional• & Architecture, P . C r.'5. g Address: 3 8 7 1 Route 6 6. Drainage Basin: East Branch Reservior Brewster, NY 10509 7. Type of Project: X 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 Type II 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 10. `; I� DEIS -$een completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency Town of Patterson Planning Board Exempt _ Unlisted X M N/A 12. Is this project in an area under the.control of local planning, zoning, or other officials, ordinances ... Yes ....................................................... ............................... 13: `If so; have plans been�subm tted to such authorities? ...� ......� ................... Yes - S ub.d i v i s i o n 14. Has preliminary approval been granted by such authorities ?Y e s Date granted: 8/97 15. Type of Sewage Treatment System Discharge ................. surface water x groundwater 16. If surface water discharge, what is the stream class designation? .................... N/A 17. Waters index number (surface) ........................................... ............................... N / A 18. Is project located near a public water supply system? ....... ............................... N o 19. If yes, name of water supply N/A Distance to water supply N / A 20. Is project site near a public sewage collection -or treatment system? ................ No 21. Name of sewage system,` I hi d- iv -i d u 11 y =Lot; . Distance to sewage system 22. Date test holes observed 12 / 8/ 9 5 23. Name of Health Inspector M i k e ,B u d z i n s k i 24. Project design flow (gallons per day) ................................. ............................... 800 c P n 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? ......................... N/A Form PC -97 27. Is any portion of this project located within a designated Town or State wetland? No 28. Wetlands ID Number ............................................. �.............. ............................... N / A 29 Is Wetlands Permit required? .......................................:...... ............................... No :.. _ - - - _ _.. Has applicationbeeri'rtrad-e'to Town or L ocal`DEC office`?" 30. Does project require a DEC Stream Disturbance Permit? .. ............................... N o 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: No M 33. Is there a local master plan on file with the Town or Village? ......................... Yes 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... Yes 35. Are any sewage treatment areas in excess of 15% slope? . ............................... No 36. Tax Map ID Number .......................... ............................... Map `'� Block Lot 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 duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershe�ay—alz._ " 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 Tor 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 affzrm, 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: Peder W. Scott, P.E., R.A. — Agent for Applica: Mailing Address: ................................... 3 8 7 1 Route 6 Brewster, NY 10509 14-16-4 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 SEQR Appendix C State Environmental duality Review SHORT EiVYIRONMENTAL "/SSESSMENT�FORMr For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT (SPONSOR 2. PROJECT NAME Peder Scott Rpbov;000 5ut6DiJtIto -rJ 3. PROJECT LOCATION: Municipality Patterson County Putnam 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) 1& Tommy Thurber Road S. IS PROPOSED ACTION: ® New ❑ Expansion ❑ Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: Septic System with 1250 gallon septic tank and rows of ai' x 2' trenches = .4?32- lineal feet. Installation of a well. 7. AMOUNT OF LAND AFFECTED: Initially • 2 acres Ultimately a 2 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? E) Yes ❑ No It No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? nn ` T..J Residential ❑ industrial ❑ Commercial ❑ Agriculture I ParldForestiOpen space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? Yes ❑ No It yes, list agency(s) and permlUapprovals Putnam County Health Department 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? 0 Yes n No it yes, list agency name and perrnlUapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑Yes ON, X N/A I. CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ApplicanUs Signature: ponsor Date: 1 If the action is in the Coastal Area, and you are a state agency, complete' the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by F,gency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes n No WILL ACTION AECEIVE COORDINATED. REVIEW AS PROVIDED FOR UNLISTED ACTIONS-IN•6 NYCRR, PART 617.6? - It No, a negative declaration may Oe superseded by another Involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED wrilf THE FOLLOWING: (Answers may be handwritten, If legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential far erosion, drainage or flooding problems? Explain briefly: . W C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: No ` C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: No 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 brie No CS. Growth, subsequent development, or related activities likely to to induced by the proposed action? Explain briefly. No C6. Long term, short term, cumulative, or other effects not identified in CI-CS? Explain briefly. No C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. No D. IS THERE, OR ISr �THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? C3 Yes L_] No If Yes, explain briefly PART ill— 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 (.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 and/or prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result In any significant adverse environmental Impacts AND provide on•attachments as necessary, the reasons supporting this determination: Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Name of Lead Agency Date A Title at Responsible Officer Signature of Preparer (It difierent from responsible officer) �� - . .L.i �._-��GSI �. CrYr . ►.cr'. G- ��"'vt _ _ ��. = - at (S"-aez)TAM1�Ad � Hhl_L_f D%TaNt T -. 3�j ��cc_ `� :c SG nea:esz =oss S aet) L P- OT- O}-4. ^'=C`I T�'S�' LA7—r'k ?2ZT,-= "CD :.c. 'CVS Dai-- Cf ?=e-- Sca:c:.-.c Cate c4f Par.. l arcn 'Fast :^• Lapse Le�c:� rYa�.°r''- rra • � -- H.'�._...._ � � L(Q�!��t "_ _�...:. j � alt" . _ ._.. '�� '` I'1 / �: I t CL5 : 1 Test; to be repeat' at same depth until apzcatLy equal. oi , mts are obtae,-4 at each percolat-ion test hole. r�,Z? Cata to be for review. 2- Cecth ma,-u: teats to be r;ade f:ca top cf hole. Q�85 _ i _ Level T:. GrC=d nc� les So=? eta �.7C es 7- :C. -1P5 _ • � -- H.'�._...._ � � L(Q�!��t "_ _�...:. j � alt" . _ ._.. '�� '` I'1 / �: I t CL5 : 1 Test; to be repeat' at same depth until apzcatLy equal. oi , mts are obtae,-4 at each percolat-ion test hole. r�,Z? Cata to be for review. 2- Cecth ma,-u: teats to be r;ade f:ca top cf hole. Q�85 _ i r ''4 GB ;. IV \qtr V1RM t( o IkTo- �lut~ NO LEo'NE C' ............ . At I.S )ZZ ...C:. ' OP,SPX)_!_TIClL�S ."V__ o DESIC� 2 i /l " DiOD: S.C. USaolc A�Ca ��vVjC 3oll Fate Used i�: \o. Of scans Septic Tara: Ca-,zc_ty 1IA 0 ga ls. :i�SOit1CC1 AiCa'��OViG�CV i`,! L. F. 2 " 'rliC.t . L G G ^. ,q&To- S N, IS SPACE FOR USE BY HEUTH DEPAMEVT ONLY: _ 30 il Fate Approvca :,;:it /5a? . ' C:e�x ov .... Late :D177-_r 7�I Cr �_IV C�Z L -yL = S=771=5 �-C . D.T` C)F. 0�, -��., .FR��+ -�...c -� at (S`�t) i�M!- �,�d -�� H/�t_l P-OAD/TDNHiT �� - 3`� �?cc= c--za ne=esz =Css s =aet) p AT— T—EER ,5o M °rate- -s;:ed co= p=zCCL=-CN 'LSD' L'V—a RE TU = ' " ". Sur1 r''_^�'7 .-rr' a: °I,s.C.??'=CVS Data cr ?re -Sca.c i1 Data of Pe= .vatic^ Test �CL�. • . 7E Cr�ti-CV :.1 arse Cemr-1 'Bate.- From Wat.°_*- Le`le+' Ti:-,P- Grct:rd Surface :_._ 7 -nc:es So Rata Drco �-1c.'es --• hes Inches - . ' Q -.. ► 6'iy" do �ti ^... .J HAl._... �L(�._e'� (ti 1: 5 'E=: I 1 2- ;.ev. 9/85 Tests to be repeated at same depth until arprcrdmately equa]_ soil- rates are obta. inea .at each c�- =Iation test hole. ' ALA rata to' be sz:� -ni tte'' for review. Dep �`: and -- . �; eats to be lade frcn tip of hole _ 2 ��lE Stir A pu 4 , , rc 0 V Kvt5�- LiUY� e, �o NO LCt 0' .2' .3' Aj IS _.... -.M - D.''.l.ii1 .LLL�V1_.L T` / iTl •.rr L..a .. (I a�s.uit ru�VurJ RIS ....0 r. %L \ � .�. _ .. ....... .. .. .. ... )ZZ? HOLE OP-! -=CLqS MADE 3Y: c DESI&N Soil Rate Used 2 .Min /1" Droo: S. D. Usable ?rea Provided _;12?0 J Io. of B ro LS Scptic Tank : a- kZc: -t* -, I �� 0 ga-, Absorption i rea Rrovided By 2^ L.F. .. 24" width �c ^c ^. Dthar FILL P-G4` 0 Q w SLATG.�NEFWI�f�t /tRcN pc S. �a-re :c;::aturc Address Sak"rj , 140( MIS SPACE FOR USE BY HEATH DEPAa�TIT ONLY: soil Fate approvc3 'f t /gam l . C:ccked by Date P. W. SCOTT Engineering & Architecture, P.C. 3871 Route 6 . BRENSTER, NY 10509 E -Mail: pws @bestweb.net "" (914) 278 =2110= =FAX (914) 278 =2166 O Putnam County Dept. of Health 4 Geneva Road Brewster, New York 10509 VE ARE SENDING YOU P; Attached G Under separate cover via ❑ Shop drawings Prints ❑ Plans ❑ Copy cf letter ❑ Change order Lj )ACC ATTENTIO i RE. � Lc-,T— +1 f the following items: Samples E Specifications COPIES I GATE I NO. DESCRIPTION Application for Approval ` (Construction Permit for Sewage Treatment Sys temLrorY C.PI 2� (Design Data Sheet (form n0 -97) dimN EVIARKS ❑ For approval r Approved as subm::ted = Resubmit For Y our use _; Approved as need _ Submit _ r' As requested — Returned fcr =recticns Return 52 For review and comment C _copies for approval — copies for distributie^ corrected prints ❑ FORBIDS CUE = PRINTS RETURNED AF- ER LOAN TO US C 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 -6 Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 December 11, 205 ly Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Peder W. Scott, PE 3871 Route 6 Brewster, New York 10509 Dear Mr. Scott: Re: Proposed SSTS: Saddle Ridge Homes 16 Tommy Thurber Lane TM# 34.4-84, Town of Patterson 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 sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department of Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. 1. Permit application is for a four bedroom residence. Please submit a new construction permit application for a three bedroom residence. 2. Design data sheet is to contain original stamp and signature. Photo copies are not permitted. Also, design data sheet submitted note an incorrect length of trenches and a note stating dosing is required for a four bedroom residence on this lot. Subdivision approval limits this lot to a maximum three bedroom residence. 3. Two feet of fill is required per subdivision approval on this lot. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Sincerely, Shawn Rogan Public Health Technician SR:cj BRUCE R. FOLEY °PubliC.:•Health Director December 11, 2000 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 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Peder Scott, PE 3871 Route 6 Brewster, New York 10509 Re: Dear Mr. Scott: Saddle Ridge Homes, Inc.; 16 Tommy Thurber Lane TM# 34.4-84, Town of Patterson Reservoir Basin - East Branch The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on November 28, 2000 is complete. The Department will notify you by December 31, 2000 of its determination. ® The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines get 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 would be sent to my attention at the, above, address...,_.._...r. This-notice must-include-y(A f name, th'e lbcatibi 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 New York City 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 DEP review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2159. Sincerely, amt eou Shawn Rogan Public Health Technician SR:cj PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONNTIENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS __ _... REVIEW SHEET FOR CONSTRUCTION - PERMIT . NANIE OF OWNER: Q._ STREET LOCATION: __ l 1/�i / �(✓Y L ��' REVIEWED BY: RNL GR, AS, &ATE: �� t� TAX MAP#: (CONFIRMED) H—__ -4/ O y Y N DOCUMENTS (z Lj., PERVIIT' "': CaTI 'N a Y Y -N (REQUIRED DETAILS ON PLANS CONT'D) �UHOUSE SEWER -' /�" FT. 4 "0'; TYPE PIPE CAST IRON (,-)LUWELL PERMIT OR PWS LETTER 3 �• S� LINO BENDS; MAX BENDS 45° W /CLEANOUT (,U(__)PC -97 RENEWALS ((_)LETTER OF AUTHORIZATION n S E NOTE (NO CHANGE) UL JDESIGN= DaT- CSHE=ET (DDS) /01� �5'/ FILL SYSTEMS LJL�CORPORATE RESOLUTION 5 `� (/ )(_J10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE V)( _,SHORT EAF Q! )(___)FILL SPECS/ FILL NOTES 1 -5 C i, )(_ )PLAINS -THREE SETS C% )( FILL PROFILE & DIMENSIONS (/J(_JHOUSE PLANS - TWO SETS ( )LJFILL IN EXPANSION AREA CUUVARIANCE REQUEST FILL GUAM THAY,2 EEET SUBDIVISION (_)(_) CLA ARRIE U�(__)LEGAL SUBDIVISION L� CE CATION NOTE ( L_)SUBDIVISION APPROVAL CHECKED _)(FILL (_DUDE GES . UUPERC RATE / —des (Z)UFILL REQUIRED DEPTH (- -)L- -) , . ON P FOR RO.B., UNCLASSIFIED & IMPERVIOUS _ REQUIRED (J(�CURTAIN DRAIN REQUIRED (_) (SEPARATION D STANCE FROM TOE OF SLOPE TRENCH GENTRAL GULF TRENCH PROVIDED LA, g 60FT MAX. (LOCATED Ii NYC WATERSHED CONTOURS (PLANS SUBMITTED TO DEP DELEGATED TO PCHD U��Up00A ° /EXPANSOION PROVIDED, (V( JDEP APPROVAL, IF REQ'D , ^ Sum/ (IjUDETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL (- %(�GEOTEXTII,E COVER U(_)DEEP TEST HOLES OBSERVED UUPERCS TO BE WITNESSED SEPARATION DISTANCES ON PLAN - FROM SSTS L/ L_)10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL (Z)(JEX- APPROVAL SSDS ADJ, LOTS - V)C_)20' TO FOUNDATION WALLS (_)( WETLANDS (TOWN/DEC PERMIT REQ'D ?) (--)( ' A-0' ADS'&gTF5AMEr U100' TO WELL, 200' IN DLOD,150' TO PITS 0(,_)100' TO STREAM, WATERCOURSE, LAKE (inc. espan) (_J(ZGjPRE 1969 NEIGHBOR NOTIFICATION (�(_—)50' TO CATCH BASIN, 35' STORNIDRAIN, PIPED WATER (_J(jQ)LETTER BI/ZBA (U(_)10' TO WATERLINE (pits -20') ( _J(�100 YRt ,FLOOD ELEVATION W/I 200' (e!!�)U50' INTERMITTENT DRAINAGE COURSE (_J(�pJSOIL.TESTPiG LOTS>10 YEARS OLD — 90'/500' RESERVOIR, ETC. 150' GALLEY SYSTEMS REQUIRED DETAILS ON PLANS _ k/)C_J10' MIN TO LEDGE OUTCROP ((jL JSEWAGE SYSTEM PLAN - (NORTH ARROW) (%L JSSDS HYDRAULIC PROFILE SEPTIC TANK FROM FOUNDATION; 50' TO WELL (�L JGRAVTTY FLOW L)(JCONSTRUCHON NOTES 1 -15 U10' WELL C/)( M ENSIONS TO PROPERTY LINES DESIGN DATA: PERC &DEEP RESULTS / (�(�LOCATION.OF SERVICE CONNECTION U2' CONTOURS EXISTING & PROPOSED. (� )ML 15' TO PROPERTY LINE UUDRIVEWAY & SLOPES, CUT SLOPE (__)FOOTING /GUTTER/CURTAIN DRAINS (� USLOPE IN SSTS AREA !jj�% (S20 %) ( (USDA SOIL TYPE BOUNDARIES (�L_-)TITLE BLOCK; OWNERS NAME ADDRESS UWREGRADED TO 15 %, IF REQUIRED TM#, PE/RA; NAME, ADDRESS, PHONE# DOAfPUMP SYSTEMS ( OF DRAWING/REVLSION UUPUrIP TES _JL__)DATE �J)(__)LOCATION ( _JDATUM REFERENCE (UUDOSE 75° o F E VOLUME/DOSE VOLUME NOTED U )UJDETAIL FO OR MAIN, (PIPE TYPE, ETC.) OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. U_)PIT AND 0 HOWN & DETAILED UUl DAY ORAGE BOVE ALARM (--)PROPOSED FINISH FLOOR AND / BASEMENT ELEVATIONS CURT DRAIN UUSTANDPIPEXCE/100'with ES, DETAIL (/)LJWELLS & SSDS'S WAIN 200' OF SSTS (PROPERTY METES BOUNDS (_)U15' MIN to C2o,-Z,4%,25'-3%,35'-I%,100%-<I% )20' MIN to C 182 cons day discharge f C_J( 0' MIN to N ATED PIPE COMMENTS: y / LEVSHEET) -*t- - ,1.7A C~�'L7I"_' DE?�Iv 7T OF Dr7lSlCL] OF .=.. FMALTH SaTT ---=-S _ ............. _ .... APPENDIX I DESIG;J DAMI SF1g7 -Gi DISPCISAL SYS�.""'`, ?r"% 1C. Cwner E"� aTe dF• Aj4UQE�4 Fs�� Address 23o PAp-4L k E i,►`i �- 10 [GA rr;,czt at (Street) 1AHOAt4Y HA L-L R4AD)1PHHYV4 SLUSec. 34 (indicate nearest woss street) i.11lhiclx 1; tlr Watershed SOIL PERCC)LA'L -tV TEST DATA RFS(TL M TO HE SUEM1?'I'y?J . =1 APPLI=CNS Date of Pre- Scaking Date of Pe=colatien Test HOLE, NL'� CI.00; PERca=cN PERCOLAT'ICN Run Elapse Depth to . Water rYccIl Water Level No. Time Ground Surface. in inches ' Soil Rate S taz.'t -S too Min. s tazt Inches Stop Inches Droo In Inches Yii n/T : Di o-o 2 , NOTES: 1. Tests to be repeaters at same depth until appraod:mately equal soil rats are • obtained at each percolation test hole. ' 'All data to' be submitted for review. 2. Depth measurements , to be made from top of hole. rev. 9/85 ..L. DFS(_'T=ION or 5U iii vLyl'Z ii1 1 Ic; '1' :5'1' L "l Ltd HOLE M. Co � miz. vo. GB HOLE NO _ w r WE SIL � � oU E S 1A L M. 1, K M ... i i �t I t LIQAE c ral -0o t (Y 0 v r� LiV nU �, 0 N0 LEA Ito ,j tile*_ .2' MOICATE LEVEL AT WHICH GRCWa TE- Z IS ENCOUNT= - °EN7DICATE 1,2'S7LT; - TO-•WHIC i- - =UL\TTE< D DEEP HOLE OBSERVATIONS MADE BY: P�'h� DATE: 1.0 R 5 � DESIGN Soil Rate Used �" Min /1" Drop: S.D. Usable Area Provided io . of Bedroc= Scptic Tank Capacity I � 5 O gal-s. Type J Absorption Area Provided By �? L.F. x 24" width trencla Other I' FILL 4410 of ro LEla rnl� r`� D05► Nk or-brb Fen- H, J1(M , Name o EHu%MEEPJKAt AP-N- PL w signature MIC-110 - y r y Address �`l 1 (o SEAL • C-. W m • s� No A6 PHIS SPACE FOR USE BY HEALTH DEPARIl= ONLY: Soil Rate Approved sq.ft /gal.' Checked by Date 1 � PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES RE: Property of LETTER OF AUTHORIZATION Located at Va To m m! j -r" V-6eK- VA-"CL T/V Pj�-ifU12-6o rJ Tax Map # 12)lq Block 4 Lot 8`4 Subdivision of P-4,1 3 0--LJ oc, 0 :5 8 n i U) %10 tJ Subdivision Lot # R-4 Filed Map # ;Z8 t Date Filed Gentlemen: This letter is to authorize t ) Pi c- - a duly licensed Professional Engineer _> or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health.. Law, and the Putnam County -Sanitary Code:- Countersigne P.E., R.A., # a sq -3 ' eg Mailing Address s119 1 I " <p State N is w �j &a_ic- Zip (e Sb j Telephone: g y 6- - a 7'�K- :�- 110 Very truly yours, Signed: (Owner of ro erry) Mailing Address: S-toALr-_ ?-ioGaz-Z 1l d',4 State V` n Zip i ti Telephone: 1A Form LA -97 Street `° Town . State PERSON IN CHAR 1E y '- Name and °Title TYPE OF FACILITY �j Z: ? 77 ` FINDINGS. ''A O a } FT Signature and Ti le RFP()RT- FCF.TVF RYA' I acknowledge receipt of this report. SIGNATURE; t ,02/'96 Title:: u Rev. -�: BRUCE R. ' -FOLBY Public Health Director LORETTA MOLINAMI 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 - 6614 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 May 29, 2001 Peder Scott PW Scott Engineering 3871 Route 6 Brewster, NY 10509 Re: Field Inspection: Saddle Ridge Homes, Inc. Tommy Thurber Lane, Patterson Lot #6, TM #34 -4 -84 Dear Mr. Scott: The SSTS can be baclfilled. The following comments must be corrected in the field: No comments. If you have any further questions, please contact meat (845) 278 -6130 ext. 2261. Very truly yours, Gene D. Reed Environmental Health Engineering Aide GDR/jp PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: : s o% Street -L cat :I�speete y: G , 7Z'5 - o ion ` ToM24 � � T,��rrr'RX sz ~L nJE Owner , r7 N��ES , �/V Town _ �i�7z-iZ.S 6e✓ Permit # TM E_ 3 - -Y - S 0 Subdivision Lot # G 1. Sewage Svstetn 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. S Wage System r---, 1 a. Septic tank size 1,000 ..... .,25 JG .........other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ................. ............... d. Distri ution 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. renl ches en required _ X129 Length installed rf 3 z 2. Distance to watercourse measured + i oo 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 .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 1%" diameter clean .................... 9. Depth of gravel in trench 12" minimum..,..,.-.., ... �....10. Pipe ends capped ..................................... .................... 8 Pump or Size oDosed ump chamber 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.estimated flow /cycle........... M. House/Buildin a. House located per approved plans ..: ...:........................... b. Number of bedrooms ...................... .�-�.'. ... 2.1................ . IV. Well aif a. Well located as per approved plans. �............................ t b. Distance from STS area measured / a 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 of box ... ..:............................ 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 ... ............................... i. Erosion control provided ................. ............................... COMMENTS See 4 "// IG� ICi IC9 ICS IG� ids Imo! v NU. UdIJ Idb::e I U m i 9/'9M CO VN - --'D id-riliRl ll MEM ll Y!'1C "'l EAL- 11-H *• DIMIC N OF EN ONMENTA, HEALTH SERVICES ATUNTION O ADAM GENE — REM MT F ®R FTNAI, INSPECTION For: Fill All information must be fu lly completed prior to any Trenches ,inspections being made. PCH D Coast ctiou Peru it # . I Q1 Located: ! Ak-1 _+ � (T) Owner, PP t Flame: ; 7 E TIC Formerly: S+CrPrP.1' t�/i Subdivision Name: Subdivision Lot # _ Is systean fill co mpleted ?. q9 Bate: Is system complete? Date: Is system constructed as per plans? _ Is well drilled? Is well located as per plans? Are erosion control meal Tres in place? Dane:. I cei* 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, Mules and Regulations of the Putnam County Department of Health. - Date:. CeMcd by: PE PL - - - — Design Piofessional Address: s /-14togic. # � 9� Comments: Form FIR 99 Flu. GG I�YJG PU' SIAM COUNTY DEPARTMENT OF HEALTH . . "DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION 13 ADAM Off M99 7F 55 0XIMR, 1z •� All information must be fully completed prior to any .inspections being made. XGENE For: Fill PCHD Coast ction Pen ait # i Located: —CpA kmj —T wgg, _ (T) Owner /Applicant Name: 5yR t: CAMP kp S _TM. Formerly: L&J—D Subdivision Name: {� Subdivision Lot # Is system fill completed? `6� Date: Is system complete? Is system constructed as per plans? Is well drilled? Mo 94 Is well located as per pla is? _ IVLI Are erosion control measures in place? Date: Date: Trenches I cetify 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:: 19101 Certified by: PE X RA Design Professional .— Comments: . Form FIR -99 NU. 227 D01 P.W. SCOTT email pws@beshv&.net ENGINEERING & JwRCHITECTURE, P.C. O 3871 ROUTE 8 (1945) 278 -2110 BREWSTER, NY '0509 _.:._ ,,......__...._._._._.::...... _. - TO, FAX: M: FAX: NO OF PAGES INCL. TRAN-3,PAITTAL: a FROM. W �' 1 TO: FAX: DATE: Please c 111 845-278-2110 if this trammission is illegible or unclear .- :�I -1- 11,- i:44Md PUTNAM COUNTY DEPARTMENT OF HEALTH P02 - ..DIVISION - OF_:E: IRONMENTAL- HEALTH -,SERVYCES... - -, GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 341# -y -85/ Owner or Purchaser of Building SIAbLc R i AYE k Building Constructed by Location • Street Tax M Block Lot _Ajc_ TownNiIlage Subdivision Name Li �. Building Typc Subdivision Lot # ,- 9.0 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'epproved 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 fora period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing. the system... The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the_ Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month Day Year Q rk _QV-. r General Contractor ( Corporation Name (if corporation) Address:.— 5 �`��� ��L�� State, Zip L Signature: KU Oq Title: U- ., 2 1 Corporation Name (if corporation) Address:. PPJJ State � A).kzip Form GS -97 BRUCE R FOLEY °.' LORETTA MOLINARI R-N., M.S.N. Public Wealth. Director ti OQ� ociate Public Health Director .... ... .. ,. D . .�...i. ... Vices.:..•_;.,.. irec ;or o •- Patient. $e __ _... DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New .York 10509 Environmental Health (914) 278 - 6130 Fax (9.14) 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 E911 ADDRESS VERIFICATION FORM OWNERS NAME: Hampshire Land Company Lot 6 TAX MAP NUMBER: 34 -4 -84 E911 ADDRESS: TOWN: AUTHORIZED TOWN OFFICIAL: (Signature) DATE: 16 Tommy Thurber Lane Patterson The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERFRIvI) N� NORTHEAST LABORATORY OF DANBURY 1N ACC09oA 39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404 �o` n': : :.... :.:; -203) 748- 7803' = F�X (263)x48 -0652 NY Gertz - _41471':.: -..,. „__ -;� :¢._ •:. , . LABS < _ LABORATORY REPORT REPORT TO: P.F. BEAL & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 A SAMPLE SITE: SAMPLE POINT: SOURCE: TREATMENT: DATE SAMPLE COLLECTED: TIME COLLECTED: COLLECTED BY- DATE RECEIVED @ LAB: TESTED BY: LAB LD. # REPORT DATE: 5/16/2001 & 5/24/2001 9:00 A.M. & 1:00 P.M. A. BEAL 5/16/2001 & 5/24/2001 LAB #11471 MAY -92 & PFB -63 5/29/2001 SADDLE RIDGE HOMES, LOT #6, TOMMY THURBER, PATTERSON, N.Y. TANK HOSE BIB WELL NONE ml= milliliter mg/1--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 UOTPOTABLE RESULTS BASED ON SAMPLES SUBA=ED:5 /19/2001 & 5/24/2001 fi 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 NL4XL%" CONTAMINANT TEST PERFORMED RESULTS METHOD # LEVEL (MCL) OR STANDARD BACTERIAL: 5/16/2001 • Total Coliform (Bacteria) 0 per 100 ml SM 9222B 0 per 100 ml PHYSICALS: 5/24/2001 • Color (Apparent) 0 - EPA 110.2 15 • Odor ND - = 3 Units • pH 6.64 - EPA 150.1 No designated limits • Turbidity 0.31 NTUs EPA 180.1 5 NTUs CHEMISTRY: 5/24/2001 •- Nitrite Nitrogen <0.005 mg/L as N EPA 354.1- - 1.0 mg/L - • Nitrate Nitrogen' - 0.33 mg/L as N SM 4500D' - 10 mg/L • Alkalinity 84.0 mg/L SM 2320B No defined limits • Hardness 92.0 mg/L EPA 130.2 No defined limits • Iron <0.03 mg/L EPA 236.1 0.30 mg/L • Manganese 0.010 mg/L EPA 243.1 0.50 mg/L Combined limit for Iron plus Manganese = 0.50 mg/L • Sodium 3.1 mg/L EPA 273.1 20.0 mg/L ** • Lead <0.001 mg/L EPA 239.2 0.015 mg/L * ** ml= milliliter mg/1--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 UOTPOTABLE RESULTS BASED ON SAMPLES SUBA=ED:5 /19/2001 & 5/24/2001 fi 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 Engineering & Architecture, P.C. LLB U J cl ti �L� ifLt��tiLt�,�LL'U 3871 Route 6 BREWSTER, NY 10509 E -Mail: pws @bestweb.net OArE I Joe No. 1 r-ENnoN. - (914) 278 -2110 FAX. (9j 4) .: 278,2I66 ..... - �.. _ ::...< _. N... TO Putnalm County Dept. of Health RE: Septic As —Built 4 Geneva Road Brewster, New York 10509 J6 WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ &GL the following items: Samples ❑ Specifications COPIES DATE NO. DESCRIPTION 1 ❑ Approved as submitted 1 Certificate of Construction Compliance 1 ❑ Approved as noted 1 Well Completro.n Report 3 S T- "O 1 I Guarantee of Subsurface Sewage Treatment System 3 f_" 1 As —Built Septic Plan C FOR BIDS DUE Fee: $200 (MAIL THESE ARE TRANSMITTED. as checked..below ❑ For approval ❑ Approved as submitted Resubmit copies for approval If For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ` Return corrected prints ❑ For review and comment f_" C FOR BIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS 'OPY TO SIGN PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well- Leca?ion -. = Stmt Address: °- - :`ownllage: NOTE: Exact location of well with ciplances to at jqast VVo permanent lanamarks to be provtwa on a separate sneevpian. Well Driller's Name P. %l'1i - • - D. 1 Perry L. White copy: HD File; Yell6w copy- Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 Tommy Thurber Lane, Lot #6 Patterson FaxGridC Block Lot(s) Well Owner: Name: Address: Saddle Ridge Homes, Inc., 12 Saddle Ride Court, 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 __ 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 8 gpm Depth Data Measure from land surface- static (specify ft) 30' During yield test(ft) 180, Depth of completed well in feet 235' Well Log If more detailed information descriptions or sieve analyses are avaifa -6 e`,­ - please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 9 Drilling in over urden clay and boulders 9 Hit rock at 9' 9 32 Drillin i c ,. -- grouted - 32 235 Drilling in rock granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 5o= Depth 200, Model 5GS05412 Voltage 230 HP Tank TypeWX250 Volume 44 Date Well Completed 3/9/01 Putnam County Certification No. 002 Date of Report 5/1/01 Well er (s eal NOTE: Exact location of well with ciplances to at jqast VVo permanent lanamarks to be provtwa on a separate sneevpian. Well Driller's Name P. %l'1i - • - D. 1 Perry L. White copy: HD File; Yell6w copy- Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 Q �' PUTNAM C�O��TJNTY �DEPARTMENT OF HEALTH CERTIFICATE OE CONSTRUCTION COMIPLUAIetCE F nG E TREATMENT SYSTEM PCHD CONSTR CONSTRUCTION IPERMIIT # � j, Located at IRUMM LA,&J& Town or Village Owner /Applicant Name 5ffi t6 llD6t KX*6 Tax Map �.��" Block Lot Formerly kMAMM I-AryD egPuP Subdivision Name O56 )V_ Subd. Lot # 6P Mailing Address [ 2 549aL fWy t 49oz- -r kxmo�-5 �i 4 Zip 2�3/ Date Construction Permit Issued by PCHD D 01 Selgarate Sewerage System built by (z.( 4 -Address (2 Consisting of 12-0 Gallon Septic Tank and �} -32 L;' aE ?_ V' Gvf r Other Requirements: Wztg SUW1y: Public Supply From Address or: Private Supply Drilled by PgUq L � Address zVL k-f (0561 _._. B urlding_Type._K _� �. -__.� __ :: _: Has erosioncontral -been-completed ?.- -_ -- —�i5s.__._—..:::_:__ Number of Bedrooms 3 Has garbage grinder been installed? W 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 f Putnam County Department of Health. Date: Z O Certified by P.E. � R.A,%� (Design Professio 1 Address 9 ( License # d q� 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 subject to modification or change when, in the judgment of the Public Health Director, such revocati , dif /ica n or change is necessary. By: % ✓ Title 4 Date: d White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 INV. Ee 20 a o o / 40,14 INV. 749.37 �_ ✓ 1092 INV. 750.27. I RlP —RAP \ 55/ .63 RIP —RAP POND N� _ 47� IOAP) ���\ SOS 3208 I 15'PCC o / P h 5' POD ry I POND INV. 753.21 E TOP 750. 12 744.73 INV. 747. 12 52 i_r 145.48' „E { j W" , Iv Mcr, 2,5561 ACPT5 F9,3OIIW 170,96 u 15 I6 I Sll °29'3011w '— 113,55 c P- 200,00' C- 93,10' Delta -26 °4075" i i t i p CH. Q N09 ;32_08_ r 52.49' E lw i1 vl p O �N p n N �' o 4 OMHM2 WIM5 I U -Milry I'Ol,� W/ GUY WIM P-200,00' C- 35,12' delta -l0 °03'45" Off, (ti 35, it t; : >i r I +i i P i 9 i 1 } � P t `l . a r i �; ' A s i ' f `� D � } . , r I +i i P i 9 i 1 } � P t `l . a r i �;