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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)
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are obtae,-4 at each percolat-ion test hole. r�,Z? Cata to be
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2- Cecth ma,-u: teats to be r;ade f:ca top cf hole.
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are obtae,-4 at each percolat-ion test hole. r�,Z? Cata to be
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;.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.
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