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Home My WebLink About1564DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -4 -85 BOX 14 - 3r - 01564 PUTNAM COUNTY DEPARTMENT OF HEALTH .DIVISION OF ENVIRONMENTAL HEALTH. SERVICES — — CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # IPJ - 4 DL - a Located at i !S7ZTA M MAN V H14" RDI-I !D Owner /Applicant Name E131 JAX D SCHI EF--ELREIM Formerly Town or Village TDWN Or A+T1FF0N ,U'4� 3y - _s Tax MapID -34 Block 4 Lot S -L Subdivision Name ROSEWOOD 9V8I)l ii1Sl0H Subd. Lot # MAf' HO'- 2614 FLED 1- i171rU, LOIND- i Mailing Address If? TA MH NY WILL 9ft t?ARHkL% /ti.Y Il96-1 2 Date Construction Permit Issued by PCHD Zip I OEI 2 Separate Sewerage System built by -.mss Zug y, a 0�. tL�TAddress &, e i � p LA4Z L&_rp iC „qty ALL: Consisting of Gallon Septic Tank and DISPD 4L TAENCH, Other Requirements: Water Sup"I : N/A Public Supply From. W LISTMAOT /ON BOXES hND SDD LF Or— Address or: Private Supply Drilled by \S T, i , � , Address � � t� � i-W 0`{ (.�1 '� �1 tl I a��r7 Building Type R1=5i D�NI Has erosion control been completed? Ya Number of Bedrooms 3 Has garbage grinder been installed? NO I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: 4 -15-03 Certified by .,TORN J DRAG -&4 P.E. R.A. (Desi n Professio aw Address-_ FERRY eREEK ROAD VASHJNG7DN al1fLC N.Y.. 10992- License # PEAZGDI J LS -1917D Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are sect to modificatio r change when, in the judgment of the Public Health irec or, such revocation, m(�,J,J catio n or change i e By: Title: Dater White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 TOWN OF PRTTERSO 845 -878 -2019 P•2 - t nug , 07 03 09: 14a .. `T -' -' ... CMG BRUCE R FOLBY. LORETTA MOU ARI R.N. MS.N. -�. P:iMi ffealtl! Dlreo:cr '�, • Y +k* .tJrocau PvbUd Health Dlreatcr t�becror of i`+At;67tt Sarvters DEPARTMENT OF HEALTH 1 (`reneva Road Brewster, New York I0509 $s.iroomeata! Sevq� (9l� }278 •5130 Fmc (414) 2�8 - 7921 NixrA A S+r•!ta (914) 278 -6553 WIC (913) 273 •5678 1 sY (914) 278 • 6Qa5 Early Lntcrraa[lOS 0014)218 -bats ?rt0C%06l (914)378 -G082 Fea(923)278 -5648 OWNERS NAIME: TAY !7[AAi'.PJUNIMER., E911 ADDRESS. TON ti : AUTHORMD TO�vty OMCTAL: (Signature) DATE: _ _8/ �;7 The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, ie., a legal E911 address is assigned by an authorized towns official. This form is to be submitted writh the application for a Certificate of Construction Compliance. (791 Z VERrMM,, TEL:e45 -278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Welf1[;ocatian --'-" Strteet AddreNi: -` ' " Tamarmy hall Rd. Town7Village: Patterson. Tax Grid # Map 34 Block . 4 Lot(s) .56. Well Owner: Name: Address: 25 %and xo Dr. F.dxiard Schiefel.bein Cr r,,,1a d Manor. NP 10567 Use of Well: 1- primary 2- secondary Residential Public Sp pply Air cond /heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion X Compressed air percussion Other (specify) Well Type, Screened Open end casing x Open hole in bedrock Other Casing Details. Total length 25 -ft.. Length below grade 24 ft. Diameter in. Weight per foot. 17 lb /ft. Plastic:. Other. Ma #erials N. Steel _ _ Joints: , _ Welded% IF-Threaded- � .. Other. Seal: Cement grout., 8,ntonite Other Drive shoe: x Yes No ILine r:. Yes, No.... Screen Details Diameter (in) Slot Size . Length(ft) Depth to Screen (ft) . Developed? First _ Yes No- Hours" Second = Well Yield Test Bailed Pumped Compressed Air Hours _ Yield. 20' gp n Depth Data epsure from lan4 su ac&static specify ft) t)1. During yield test(ft) Depth of completed "well to feet "' 1451 Well Log If more detailed information descriptions or sieve analyses are available, please attach.. De thlrom Surface Water Bearing Well Diameter(in) Formation Description. ft. ft. Land Surface ? Sarad 2 245 6 Cratite If yield was tested at different depths.. during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information . ; Pump Type Capacity Depth Model . Voltage HP Tank Type Volume ". Date Well Complet.6d 4/17/01 Putnam County ication No. 014 Date of Report 5/2/0 Well Driller signature) 14u,iz: txact location of well wim aismnces to at least two permanent ianamarxs to oe prgviaea on a separate sneeuptan. . Well Drille?s Name J. ' ° Fxker, or, T"to ° Address: 1613 R°Aite 9W' PO Box 5 mt1tola, 14y 1:2547 Signature:, Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 08/19/2003 15:10 9142453170 YORKTOWN MEDICAL LAB PAGE 01 YML ENVIRONMENTAL SERVICEE': 321 Kear Street (914) P45-28430 Albert H. Padovani, Direc.:to• LAB 93.302171 CLIENT #z 56823 NON STAT PROC' PAGE 15CHIE` --'E-LBEN, EDWARD i:12 TAMMANY HALL ROAD CARMEL, NY 10512 DATE/TIME TAKIL'IsIt. Q`i:00A DATE/T I HE REC;' D:; /('3'_" i' 9 : 3()t) REPORT DATE t) 6 / 1. 9 / 0 PHONE.- (646)12-&'I'-*)v'*.) SA&IPLING SITE: 152 TAMMANY HALL ROAD SAMI�-"LE TYF-1-1. -ES1 CARMELp NY PR --1- (VAT 1V7_5_ NONF-_ COL 'D BY E. SCHIE T FELBEN IFMF.-F:'�ZATURE..d 4C NOTES ... : KIT TAP DATE FLAG PROCEDURE SZ E S UL T NORMAL !-'tiANO•.,- 'METHOD PUTINIAM C14TY P'OF ILE 00 "Ill/03 IIP T. COL IE70RII A65ENT /100 ML AaSqNT 1008 08/11/03 LEAD (IMS5 E1.7 ppb ppb 910.11. i 1 /0 3 NITRATE NITROG 1.39 HS/1- 06/11 /Q3 NITRITE NITROG . 0 1 MG /L N 1A q i46 08/11 /03 IRON (Fe) 060 MG/L Cl•--:).::3 mg/1 !2 0"1" 7 06 /11 /03 MANGANESE (Mn) <(1.0i MG /I- G-0.12 (fig 2037 08 /11 /03 SODIUM (Na) 31.9 MG /L N /O 0I=3 n I /Q::3 pH 6.3 UNITO 6-5-113.5 9043 08/11/03 HARDNESS, TOTAL <2 MG/L N/A: 08/11j03 ALKALINITY (AS 204 MG/L N/A 08/11/03 TURBIDITY (TUR <1 N'ru n- -3 N-TU CONNENTS: L-sACT THESE RESULTS INDICATE THAT THIF WATER ( WAS NOT: di.. A SATISFACTORY SANITARY QUALITY AccormiNeDCHE:- NEW YORIK STATE. AND LPA FEDERAL DIRI NIA ING WATER STANDARDS, POR THE IPARPMG-TERS TESTED, A-I' -,rHE --r1ME OF COLLECTION. F*b IC u LEAD limits for public 5chools are set at 15 ppb. EPA Lead '& Copper Rule for Public Systems rcaquires that no moi-F-ul than 10% of their distribution points have a LEAD valuej of more than 15 r)pb and a COPPER value of 1.3 mg/L. else water treatment must be undertaken to reduce the waters corrosive potential. I 1:7e/Mn If both iron and manganese are present, th ?ir tizital va)lue combined shall not exceed 0.5 my /L. i Na No limits for Sodium are proscrii-ned. Suggested r 'd 4 u A. , el that for pe,:)ple on a sodium restricted diet,thi�_x water �4houit:l contain no -more than 20 mg/L of Sodium. I-..or those on � moderately restricted diet, a ma:•.imum of 2'70 tnrj/L oi-S-.j'j1U(y1 is suggested. 08/19/2003 15:10 9142459170 YORKTOWN MEDICAL LA13 PAGE 02 YML ENVIRONMENTAL SERVICES � 3E '1 Kear Street z ._._.. 1't ktown..Heigt•i.ts,_, N,.Y. .Li: }`:,9 -- -:: 4 Albert H. Padovani, Director L.A13 49 43.:342171 CLIENT #a 56223 INION ur y�rr Y,r STAT FRGC PAG c yrrry Mrryry--- --y /Y - - ---- -- rrK - ----- -_ - rr. ... — SCH I EFELBEN . EDWARD 1.52 TAMMANY HAI._I_ ROAD CARMEL, NY 10512 SAMPL I NO 3 T TE u 15e TAMMANY HALL ROAD : CARMEL, NY COL'L' BY E. SC41E:F'ELBEN NOTES.... KIT TAP rr...y.r.YyrrYti KNrY r../lV.V K.•yrrr My r..,rrw. n/K Nr^rw yr_,_ pH H r_1 DATE FLAG PROCEDURfE. DATE /TIME 00/10/03 09 :000 i7ATEr /T I MN lwE_C ' U; 0E3 / ], i i U,? 09. 30A FiEF'OF,%T' DATEE : ' ()a/19/()3 PHONI:' : (646 )1972-291 () SAMPI E I *YFE:..: F'OT ABLE:.' FRE-S - RVAT I VI. °S : NONE TFEMPE: RATURE ..: ,, 4C C;JL..I -ORM METH.: M RESULT NURHAL -I+ RANGE METHOD I pFI SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF pf•I11S MIC: (:.)F THE IMPORTANT AND FrUiZ iUENTLY USED TESTS IN WA'T'ER CHE-.11 T TTt1' . WATER' WITH A LOW P)--! MIGHT BE CORROSIVE 7'0 METAL. PIPES 4ND FIXTURES. THE NORMAL_ RANGE OF pl•I IS 6.5 TO 0.5. � TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUI9 C hl;,"Ef0NAT2'.:, II�fI['fGii.... fIIF,: HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MC ;, /L_ . DE PE ND S I ON THE SOURCE ANI) TrZ1:!ATMF:NT TO WHICH THE WESTER HF-1?;S 1' EEN L.)E-JE Ti °U _ SOFT WATERa 0-70 rIG /1_ VERY HARD WAT>r'F {: ASOV� 30( ) MG /L MODERATELY HARD WATER: 70 -140 MG /L 110/L = M 1 L..L I GRAD? FER L. I TEI HARD WAI -df —.. ' 146 --300 . 1,10 /L. (a.. fir. i n lga.L .L Fyn :f.7 r' I•IC� !L_ i SUBMITTED BY: 1 _ - ry •• Albert H. F`adovani., M.T. (ASCP) Director PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 1 GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map Block Lot Building Constructed by ow illage I 5-W /"1/I� D ,Rd��wvoo Loca on - Street Subdivision Name Z- 5 dsry 1 *5404-1-L,.-i -74 Z_ % Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the -- = - - - -- 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 U Day ZS� Year 0601 c General ontractor (Owner) - Signature Corporation Name (if corporation) Address: 61M zje . 9, State ` Zip Z Sz Signature: Title: Corporation Name (if corporation) Address: State Zip Form GS -97 ,.,..:..:.. BRUCE Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 r- LORET -N MOCINARI 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) 228 - 6108 Fax (845) 278 - 6648 June 22, 2001 John Dragon, P.E. 5 Perry Creek Road Washingtonville NY 10992 RE: Application for Construction Compliance Subsurface Sewage Treatment System at Schiefebein Tammany Hall Road, Lot #7 (T) Patterson, TM# 34 -4 -56 Dear Mr. Dragon: The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on June 8, 2001 is incomplete. Please be advised that the following information is required before the Department may commence its review. • Application for a Certificate of Construction Compliance cannot be processed. Only plans-have-been received. Please review Putnam County Bulletin ST -19 for•current - submission guidelines. • Remove all notes and details not relevant to the as -built plan. • The location of the ends of all trenches are to be provided. • Standard as -built legend is to be provided. • Source of as -built survey is to be noted on plan. • Remove proposed well, location from plan. • In essence, the as -built plan cannot be a revised construction plan. The review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information as to the completeness of your application. Please be advised that failure to submit information to the Department or to follow procedures is sufficient grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed Regulations and Putnam County Department of Health regulations. Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130 ext. 2166. RM:tn VFely yo R Mom s,.P. E. Senior Public Health Engineer BRUCE R. FOLEY Public health Director - w LORETTA MOLINARi Associate Public health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental IIealth (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) 228 - 6108 Fax (845) 278 - 6648 June 22, 2001 John Dragon, P.E. 5 Perry Creek Road Washingtonville NY 10992 t Y •- Dear Mr. Dragon: RE: Application for Construction Compliance Subsurface Sewage Treatment System at Schiefebein Tammany Hall Road, Lot #7 (T) Patterson, TM# 34 -4 -56 The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on June 8, 2001 is incomplete. Please be advised that the following information is required before the Department may commence its review. ® Application fora Certificate of Construction Compliance cannot be processed.. Only plans have been received. Please review Putnam County Bulletin ST-19 for current submission guidelines. Remove all notes and details not relevant to the as -built plan. ® The location of the ends of all trenches are to be provided. ® Standard as -built legend is to be provided. 0 Source of as -built survey is to be noted on plan. Remove proposed well location from plan. ® In essence, the as -built plan cannot be a revised construction. plan. The review of .your application will conunence once the Department receives the requested information and determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information as to the completeness of your application. Please be advised that failure to submit information to the Department or to follow procedures is sufficient grounds to deny approval, pursuant to the New York City Department of Environmental Protection _Watershed Regulations and Putnam County Department of Health regulations. Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130 ext. 2166. RM:tn Ve R ert Morrls, P. E. Senior Public Health Engineer JOHN J. DRAGAN P.E., L.S. -r- T- Perry Creek Road. Wash! ngtonvi Ile, New York 10992 (W496-6956 TO A- rA"W'L' �' Me /-,y A'WI-- . d4lie., LE77ERD (031F 7RANSMY'YAL DATE 73 DATE J08 NO. A'MWnOk-- — RE: r A00 WE ARE SENDING YOU KAttached ❑ under separate cover via [:] Shop Drawings X-Prints ❑ Plans ❑ Copy of letter ❑ Change order 1:1 ❑ Samples the following Items: ❑ Specifications COPIES DATE NO. DESCRIPTION r A THESE-ARE TRANSMITTED as checked'beI0[w:- For approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS ❑ Resubmit_ copies for approval ❑ Submit__ copies for distribution ❑ Return -- corrected prints COPY TO SIGNED: it enclosures are not as now, kincity noft us at of �1 t CONSTRUCTION PERMIT FOR S, t 1�, #..�'1�'a'i SYSTEM • ..� �' Located at T fo0 &1 Al V W.i C_e_ 12c�rt To Village rr -son/ << Subdivision name ,fit, r�d�/, ,r0,�,.Subd. Lot # _� Tax Map _ ?;t Block _I Lot j-4_ Date Subdivision Approved /i Novo Renewal Revision Owner /Applicant Name d&7,-4,--1 Date of Previous Approval Mailing Address ZS" d&4/ Geyo zip AL!E4 z ' Amount of Fee Enclosed Building Type Lot Area No. of Bedrooms 3 Design Flow GPD jW Fill Section Only Depth Volume PCH D NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED ew4M?D Se6arate Sewerage _System to consist of jZ4V / �� /w on septic tank and Other Requirements: To be constructed by Address Water Supply: Public Supply From Address . or:*'--' rivafe Suppl Drilled by 11iyJl>w� _ ... _.....Address- I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs,Aereto. 4- S 3'j/ 70 Signed: P.E. YZgOl R.A. Date .0- Z*'`Qa Address psi y.r >t> cam/ v.;ca- Lic nse # ,01 V. /Q 3T 2— APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w nsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe ",pproved f ischarge of domestic sanitary sewage only. By: Title: (J Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 14.164 (A7) —Text 12 PROJECT I.D. NUMBER 617.21 SEAR Appendix C _ &ta a En 1 .. _ � :.., .....,:._. .... ... — t v ronmental Quality Review y SHORT ENVIRONMENTAL ASSESSMENT FORM.. For UNLISTED ACTIONS Only. PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR . 12. PROJECT NAME 3. PROJECT LOCATION: Municipality )! yj;% County a. PRECISE LOCATION (Stre_t address and road intersections, prominent landmarks, etc., or provide map) a/v T/fys y s 5. IS PROPOSED ACTION: 0 Expa ^slon 0 Mcdification/alteration 6. DESCRIBE PROJECT BRIEFLY: Lo 7. AMOUNT 02 LAND AFFECTED: InitiaCy + acres Ultimately 3 acres o/Slz.,P�tot�y e. WILL PROF SED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 044, D No If No, describe briefly 9. VlHA7 I ESEhT LAND USE IN VICINITY OF PROJECT? asidentia! space- ..._ ._....1...... G Industrial Commercial ❑ Agri,u►ture O.Qark/ForesUOpen � - � � Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL. STATE OR LOCAQ? Yes 0 No If Yes, list agency(s) and permlUappr0vaI3 11. D0= ANY ASPECT OF THE ACTION HAVE A. CURRENTLY VAUD PERMIT OR APPROVAL? es D No If yes, list agency name and permIUapproval 12. AS A RESULT OF ROPOSED ACTION WILL EXISTING PEAMfT /APPROVAL REQUIRE MODIFICATION? 0 Yes No I CERTIFY THAT THE INFORMATION PROVIDED• ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponser name: D .�G/�1�T =�Z- /3�'7�C/ Date: Signature: ev" If the action is In the Coastal Area, and you are a state agency, complete•the Coastal Assessment Form before proceeding .with this assessment nvtsa PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION, R"" eCEIV£ -COOK —DIN TED :MiEW.'AS•PROVIDED FORbNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration �., .. miy be Supersededd by another Involved agency.. . ❑ Yes ❑ No ' C. COULD ACTION. RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) Cl. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain brlefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant_ habitats, or threatened or endangered species? Explain briefly: S 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 C5. Growth, subsequent development, or related activities likely to be induced'by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified In C1•C5? Explain briefly.. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No It Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whetherit Is substantial, large, Important or otherwise significant. Each effect should be assessed In connection with Its.(a) setting (i.e. urban or.ruraq;_(b) probability.of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (i) 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'slgnificant 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 Title of Responsible Officer Signature of reparer (Ii differentTforn responsi ble officer) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL _.:., - please print or type . - PCHD Permit #""r- / �. ^ �a.._00. . Well Location: Street Address: o illage Tay rid # c� �✓ Maf 3 Block y Lot(s) _-V6 Well Owner: Name: ebsl --v Address: Z s- %ter �,•� ,1�s�� car � !rL- Core - irJ1�r� Use of Well: esidential 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 pm # People Served 7,- Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply &7y we ing Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes 41�o Name of subdivision /142 5 6'111'19,0,0 SY�.oiviS�� Lot No. 171_ Water Well Contractor: y Vgmp> %r / Address: Is Public Water Supply available to site? ................ ............................... ................. Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well well location & sources of contamination to be provided on separate sheet/plan. Date: f, 7,3 Applicant Signature: �J J0 e,-&, v PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water el driller certified by Putnam County. Date of Issue 7i► Permit Issui ial: �✓ Date of Expiration ,; Q Title: Permit is Non -Trans a ra le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of &�94r I C �- // Located at T/V IVI7t-SG #A./ Tax Map # v Block Y Lot S-jg Subdivision of �p svc� �� Sc�rS�i�� .si�i �✓ o� Subdivision Lot # �' Filed Map # 2,6 /e% Date Filed J�11.y i/, Z, Gentlemen: This letter is to authorize �pyl t,J ,T' /�,�i�r �� s t .S' 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 Courity Sanitary Code. Countersigned: P. E., R. A., # �c�/utog LS y9/70 Very truly yours, Signed: I n (Owner of Property) Mailing Address 67A -2 9Y Lewty-14,Y. Mailing Address: '?iS 511/ 6i'6, 4. /t/9C_GCam— &e72-s%Ar' /°9/jvU State Zip /df'� �' State AZ Zip /C Telephone: 71 Z -�,95- ,Vk40 Ate-/ Telephone: 7.0 X517 yje. -6 'vs-' Wig Form LA -97 PUTNAM 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: 4o w',"e v 2. Name of project: ,��ip��o. Location TN: )*zs-vu%,/ 4. Design Professional: 5. Address: C-& � &sue 6. Drainage Basin: ;y Y c k/. A74- S1 -le-2) 7. Type of P o'ect: Private/Residential Food Service Apartments Institutional Office Building Realty Subdivision Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted ✓` 9. Is a- Draft Environmental Impact Statement (DEIS) required? ......., 10. Has DEIS been completed and found acceptable by Lead Agency? ...yam. 11. Name of Lead Agency '12. Is this project in an area under the control of local planning, zoning, or other ye s _.:-.._....._..-..._.. officsa1s,. ordinances2_..,...........Y� ................. ....... ........ ,...................................... - �✓�,�c .:/,1�101- 13. If so, have plans been submitted to such authorities? ........ ............................... yam_ 14. Has preliminary approval been granted by such authorities? Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water --A,, oundwater 16. If surface water discharge, what is the stream class designation? .................... 17. Waters index number (surface) ........................................... ............................... 18. Is project located near a public water supply system? ........ ..............................j 19. If yes, name of water supply ��,� Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ V10 21. Name of sewage system Distance to sewage system � --�✓�- C' 22. Date test holes observed 23. Name of I~'iealth Inspector 24. Project design flow (gallons per day) ................................. ............................... (roy 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? ......................... ,vim Form PC -97 8/99 P 27. Is any portion of this project located within a designated Town or State wetland? J9Wcb 28.. Wett_ands,ID_Nmber.. ;. ..... ...........................:................... .T..:,:.. :.:...............::.. 29. Is Wetlands Permit required? .............................................. ............................... 00 Has application been made to Town or Local DEC off ce? ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ............................... AIR 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'— AA0 .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 �o DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... 1 W5 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent.to. project site? ................................ ............................... ,110 . 35. Are any sewage treatment areas in excess of 15 % slope? . ............................... .moo 36. Tax Map ID Number ........................ ..........:......... 0........ Map 3 g/ Block_ Lot j-4 37. Approved plans are to be returned to ..... Applicant _ /� Design Professional applications for review and approval of a new-SSTS to be located within the NYC Watershed shall' be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the'project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 2;0.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: Mailing Address: ................................... �SJ� 122 P, �o� � PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner e-7 ag9,z,,Address Located at (Street) � 4?0,q-n Txmap K Block Lot,;M (indicate nearest cross street) Municipality 0,,,r 10'W';0 �g Watershed A-/ V e- SOIL PERCOLATION TEST DATA Date of Pre-soaking Date of Percolation Test ..... ..... .............. ....... .. A t r W a er - . ............ iep r 0 m L el Percale on. 61.i 1�io Run loo T�np�e Mart St*d**j* Ela se Time Surface S ........ tap ..... b. n 2 3 4 5 2 3 4 5 I 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. -.q I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH - OLE NO:. HOLE NO... _. -.. HOLENO '-..... G.L. 0.5' 1.0' 1.5' � - .. ... 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Date Design Professional Name: yV",t,/ Address: �opSS10 �9 ,y J. pq,� � Signature: Design Professional's Seal z w z 0. 42601 �� Of NEW �� -BRUCE R:''FOLE'i' :;,,., .. ..._..... -" Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 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 September 8, 2000 John Dragan, P.E. L.S. 5 Perry Career Road Washingtonville NY 10,992 RE: Application to Construct a Subsurface Sewage Treatment System at Schiefelbein Tammany Hall Road, Lot #7 (T) Patterson, TM# P/O 34 -4 -56 Dear Mr. Dragon: The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on September 1, 2000 is incomplete. Please be advised that the following information is required before the Department may commence its review. , .:...............,. �.....__Tw.o.(2) sets.of.house- plans.have.not been submitted, .. ....... �.:.........._ .._. - -- . - - -- The review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information as to the completeness of your application. Please be advised that failure to submit information to the Department or to follow procedures is sufficient grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed Regulations and Putnam County Department of Health regulations. Should you have any questions or care to discuss this matter, please. contact me at (845) 278 76130 ext. 2166. Very ly yours, Robert Morris, P. E. RM:tn Senior Public Health Engineer f _.. BRUCE R.-.. FOL-EY.. _ Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services. DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York. 10509 Environmental Health (845) 278 - 6130 " Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 John Dragan, P.E. L. S. 5 Perry Creek Road Washingtonville NY 10992 Re: Proposed SSTS: Schiefelbein Tammany Hall Road, Lot #17. (T) Patterson, TM# P/O 34 -4 -56 . _. _ Dear Mr. Dragan: September 8, 2000 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-lacal- wetlands` -offieials-il ehis-fegud. -" -- 1) Design Data, i.e., deep test and percolation test results are to be noted on the plan. 2) Construction notes 1 -15 have not been provided on the plan. 3) Title block is to note "SSTS Design", property street address, municipality and tax map number. 4) Location of all watercourse; ponds, lakes, wetlands within 200 feet of the property lines are to be shown and note added stating none exist except as shown. 5) Location of the service connection-from the well to the house is to be shown.. 6) USDA soil type boundaries are to be shown. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:tn Ve ly yours, Robert Morris, P.E. Senior Public Health Engineer _ I x! BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road t 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 _ John Dragan, P.E. L. S. 5 Perry Creek Road Washingtonville NY 10992 Re: Proposed SSTS: Schiefelbein Tammany Hall Road, Lot 07 (T) Patterson, TM# P/0 34 -4 -56 Dear Mr. Dragan: September 8, 2000 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 • - � • °- � •shoul'd °contact local wetland`s officials in this regard. 1) Design Data, i.e., deep test and percolation test results are to be noted on the plan. 2) Construction notes 1 -15 have not been provided on the plan. 3) Title block is to note "SSTS Design ", property street address, municipality and tax map number. 4) Location of all watercourse, ponds, lakes, wetlands within 200 feet of the property lines are to be shown and note added stating none exist except as shown. 5) Location of the service connection from the well to the house is to be shown. 6) USDA soil type boundaries are to be shown. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:tn Ve ly yours, - Robert Morris, P.E. Senior Public Health Engineer W BRUCE - FOLEY ., .. _ ..- . _ �...- .. . . Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road t Brewster, New York 10509 LORETTA MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services . Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 John Dragan, P.E. L.S. 5 Perry Career Road Washingtonville NY 10992 Dear Mr. Dragon: . ,r September 8, 2000' RE: Application to Construct a Subsurface Sewage Treatment System at Schiefelbein Tammany Hall Road, Lot #7 (T) Patterson, TM# P/0 34 -4 -56 The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on September 1, 2000 is incomplete. Please be advised that the following information is required before the Department may commence its review. ®- Two (2) sets °of house "plaiis'have not been submitted. ' The review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information as to the completeness of your application. Please be advised that failure to submit information to the Department or to follow procedures is sufficient grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed Regulations and Putnam County Department of Health regulations. Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130 ext. 2166. Very truly yours, . Robert Morris, P. E. RM:tn Senior Public Health Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH .�.,�,.:..�. _ -: DMSION OF ENVIRONMENTAL HE.i►L•Tff'. ..` -' _ ..- INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATNIENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: �7,T) LOCATION: IV '3EVIEWED BY: n, AS, SRDATE-. TAX IvLAP =: (COWMNED) S4- `i` J Y DOCUMENTS PERMIT APPLICATION WELL PERMIT OR PWS LETTER W,(,:!:J LETTER OF AUTHORIZATION ( GN DATA SHEET (DDS) CfDLJCORPORATE RESOLUTION vUSHORT EAF UUPLANS -THREE SETS (_)UHOUSE PLANS - TWO SETS LJL-)VARIANCE REQUEST / SUBDIIS IO ." U SEGAL SUBDIVISION LS0�UBDIVISION N APPROVAL CJWCKED UUPERCRATE 2( L—)L—)FILL REQUIRED DEPTH Lji CURTAIN DRAIN REQUIRED GENERAL LOCATED IN NYC WATERSHED (=c6PLANS SUBINIITTED TO DEP LSD LEGATED TO PCHD U(t/ DEP APPROVAL, IF REQ'D P TEST HOLES OBSERVED (-,::)PERCS TO BE WITNESSED ( ROVAL SSDS ADJ, LOTS WET " S (TOWN/DEC PERMIT REQ'D ?) A ON DDS PLANS & PERMIT SAME_ Pik 1969 NEIGHBOR NOTIFICATION LETTER BUZBA (� 100 YR. FLOOD ELEVATION W/I 200' SOIL TESTING LOTS >10 YEARS OLD AGE SYSTEM PLAN - (NORTH ARROW) ; HYDRADULLII- CPROFILE STRUCTION NOTES 1 -15 - N DATA: PERCj"EEP RESULTS C E TG & PROPOSED FRIVEWAY & SLOPES, CUT OOTING /GUTTER/CURTAIN DRAINS USDA SOIL TYPE BOUNDARIES J LE BLOCK; OWNERS NAME ADDRESS TM°, PE/RA; NAME, ADDRESS, PHONES :ATE OF DRAWING/REVISION DATUM REFERENCE OCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. U2PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS ELLS & SSDS'S W/IN 200' OF SSTs ( f(_)PROPERTY METES & BOUNDS COMMENTS: Y/ (REQUIRED DETAILS ON PLANS CONT'D) - . L__)HOUSE SEWER - %" FT. 4 "0'; TYPE PIPE CAST IRON (� IN BENDS; NLAX BENDS 450 W /CLEANOUT RENEWALS SITE NOTE (N'0 CHANGE) FILL SYSTEMS U 10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE Z L SPECS/ FILL NOTES 1 =5 L PROFILE & DIMENSIONS L IN EXPA�tiSION AREA FILL GREATER nT4 V 2 FEEAY BARRIER L CERTIFICATION NOTE PTH GAUGES L. ON PLAN FOR RO.B., UNCLASSIFIED & IMPERVIOUS PARATION DISTANCE FROM TOE OF SLOPE IREN LF TRENCH PROVIDED 60FT MAX. (PARALLEL TO CONTOURS 100% EXPAh.SION PROVIDED DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL GEOTEXTME COVER SEPARATION DISTANCES ON PLAN -FROM SSTS 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FII.L 20' TO FOUNDATION WALLS WELL, 200' IN DLOD,150'T O PITS - - 100' T•O•STREANl WATERCOURSE; LAKE (mc: espan)- .. • 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER T 10' TO WATER LINE (pits -20') 50' INTERMITTENT DRAINAGE COURSE L� 200'/500' RESERVOIR, ETC. 150' GALLEY SYSTEMS �LJWFROM 10' NIIN TO LEDGE OUTCROP SEPTIC TANK FOUNDATION; 50' TO WELL WELL DIMENSIONS TO PROPERTY LINES LOCATION OF SERVICE CONNECTION L�N 15' T.O PROPERTY LINE SLOPE SLOPE IN SSTS AREA (520 1/6) REGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS PUMP NOTES DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) PIT AND D -BOX SHOWN & DETAILED (__)L,,1 DAY STORAGE ABOVE ALARM CURTAIN DRAIN X20' ANDPIPES, 5' BOTH SIDES, DETAIL ' NIIN to CDS= >5 %,20'4 %,25 -3 %,35'-1 %,100 % -cl% MIN to CD DISCHARGE /100' with 182 cons day discharge ' MIN to NON- PERFORATED PIPE Aug 07 03 09:13a TOWN OF PRTTERSO Buitd.ing Depcut.tmevl t TO: FROM: 845 - 878 -2019 TOWN OF PATTERSON PUTNAM COUNTY PATTERSON. NEW YORK 12563 P.1 Telephone 878 -6319 Numbe!c o6 pag .ns ..4nc�ud e PUTNAM COUNTY DEPARTMENT OF HEALTH eem& le ter DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Inspecte y: lZEEa Street Location Owner 6cr/ /e,=g S ,-iAi Town _ p.¢ri'EttSo�i/ Permit # •pV 4�4 -co TM E Subdivision Lot # 7 1. Sewage Svstein Area iYE a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ...........................:... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. Sewage System a. Septic tank size - 1,000 .......... 1,250 ......... other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......................................... _ d. istribution Box . All outlet,; at same elevation -water tested ................. 2. Protected below frost ................. ............................... 3. Minimum 2 ft.Original soil between box & trenches___ e. Junction Box -properly set ... ............................... y . f. ren7` c eFi s . Length required 6 O Length installed H2O 2. Distance to watercourse measured -f-10 o Ft.......... 3. Installed according to plan ......... ............................... VA 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•. Sin-of grayel-3/4-7 . 1 .V27.diameter.clean .................... ......,�...: . 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ................................... :.................... g. PumD or Dosed Systems Size ot pump chamber ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual/ audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ..............::........::..... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. HouseBuildin` a. House located per approved laps..:................................ .. ........ ......... =- ..... b. Number of bedrooms... ... IV. Well - a. ell located as per approved plans . ............................... .. b. Distance from STS area measured F r 0 ft........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ......... ............................... c. All pipes flush with inside of box .......................... - d. Backfill material contains stones <4" diameter .............. e. 'Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from - TES.- are h. Surface water protection adequatif 4 /t�� COMMENTS 6 BRUCE R. FOLEY Public Health Director June 5, 2001 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 John Dragan 5 Perry Creek Road Washingtonville, New York 10992 Re: Field Inspection - Schiefelbein Tammany Hall Road, (T) Patterson Lot # 7, TM# 34 -4 -56 Dear Mr. Dragan: The following comments must be corrected in the field: 1. The silt fence must be properly installed in the ground. " If'you have- any further questions;-please contact me at (845) 278- 6.1 -30 ext.- 2261. - -- - Very truly yours, Gene D. Reed GDR:cj Environmental Health Engineering Aide � G BRUCE R. FOLEY Public Health Director • P1.. - LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH. 1 Geneva Road Brewster, New York 10509 Environmental Health (845)279-6130. Fax(845)278-7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 May 23, 2001 John Dragan 5 Perry Creek Road ` Washingtonville, New York 10992 - - Re: Field Inspection - Schiefelbein Tammany Hall Road, (T) Patterson - Lot # 7, TM# 34 -4 -56 -" " -" - Dear Mr. Dragan: The following comments must be corrected in the field: 1. Trim back pipes in some junction boxes and maintain seals around pipes in others. Junction boxes 7, 8, and 9 are backwards. -- - -- - -• - -- --A bedroom-,count must be performed by'this Department (house. waslocke-d):. 3. The well appears to have been moved from the approved location. This is in violation of v Article III, Section 2D of the Putnam County Sanitary Code (see attached). 4. Silt fence needs to be installed below the separate sewage treatment system area: -...-If.y_ouhave.any further.questions, please. contact meat Very truly yours, Gene D. Reed GDR:cj Environmental Health Engineering Aide o Public Health Director .LORETTA -�MOL-INARI- RN.;:M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF BEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 .nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Date: Z O MWI-10TWOUT No: -Pages._.. _. . _ .... - (Including cover sheet) From: Gene D. Reed Putnam County Department of Health ._,___-. P lease - respond-- For your review Attached as requested As discussed Please call Notes/Alessages In the event of transmission /reception difficulties, please contact this office at - - (845) 278 -6130 ext. 2261. 05/21/01 MON 11:07 FAX MAY -14 -01 TUE 3.49 PM PUNAM CTY ENV HEALTH 0 FAX N0. 19147787921 PUTN'AM COUNTY DEPARTMF ,I TT OF HFAALT111 DIVISION OF E KMONMENTAL i MALTH SERVICES ATTENTION 0 ADAM �G ►ENE PJEQI C FOR FINAL INSEECUM For Fill All information must be folly completed prior to any Trenches - inspecdous being made. PCHD Construction permit # —P U' YZ -t::)o Located: PAT,r&-^5e i DM OwnWApplieant Nemo: F&u9ao SC.vi eAw. r!y - % = Block �._ Lot 11 Formerly: Subdivisic a Name: Subdivision Lot # Is system fill completed? Date: Is system complete? w Date: S' Is system constructed as per plans? 16a Is well drilled? yes Date: Is well located as per plans? 6tadM As /i/adrar u,/s �►«�� Are erosion control measures is place? Ye's I cer&y That the system(s), as listed, at the above premises : h. been co.a ,tad end I bave inspected Sand verified their eompletioa in accordance with the issued PCW Construction Permit and approved pleas and the Standards. Rules and ReguWc w of the Putnam Couaty Dept of Health. 001 P. 2 Date: s� /�f 0l Certified by: �— �w PE ..�.___ _.�._.._., ............. ._.__._•_...�...__. _ _ _ ._. g? e�si, �a�I' rofersional.......-....___. �_ ........___......�........ - -_ -- .........__ -ZRA Address: w� ssr�•vGr�NV�e. NY �o Lic. # yZL o Cow: Form FIIZ 99 - :. _. -= ALAN, ..P E.; L.S, . _ Consulting Engineer and Land Surveyor SV OmPerry Creek Road Washingtonville, New York 10992 (gg5)(0*) 496 -6956 June 1, 2001 Putnam County Health Department 1 Geneva Road Brewster, New York 10509 Atten: Gene Reed Re: Sanitary Facilities, Lands of Schiefelbein Lot No. 7, "Rosewood Subdivision" P/O Tax Map 34 -4 -56, Tammany Road, Town of Patterson, Permit No. PV -42 -00 Dear Sir: On May 12, 2001, I inspected the disposal system installed on the subject premises prior to backfill. A re- inspection was made on May 30, 2001. The system consists of a 1250 gallon concrete Lo -Boy septic tank, 10 distribution boxes and 500 LF of disposal trench. The system was installed in substantial conformance with - approved drawings and with County Health Department.requirements. I hereby certify the system is adequate to service a 3 B.R. dwelling. Please note the house location was changed from the subdivision drawings due to excessive ledge rock at the planned location. The proposed well was also moved as a result of the house move. The actual well location is more than 200 ft. downgrade of any existing or planned disposal system and is more than 100 Ft. upgrade of any existing or planned disposal system. /SIAZE OF o ,0 9- r a I so �o `nol, 491 �O NEER PNO Respectfully submitted, J J. Dragan, P.E., L. S. BRUCE- R. FOLEY _ Public Health Director DEPARTMENT OF HEALTH .1 Geneva Road Brewster, New York 10509 M LORETTA MOLINARI R.N., M.SN. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 July 17, 2001 John Dragon, P. E. 5 Perry Creek Road Washingtonville, NY 10992 Re: Proposed Compliance Schufebeen Tammany Hall Road Lot 7 (T) Patterson TM #34 -4 -56 Dear Mr. Dragon: 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: r` 1. Certificate of Construction Compliance is to be submitted. 2. E911 form is to be submitted. i 3. Well log is to be submitted. 4.,.- — Water analyses results- are-to >be- submitted: 5. Two additional copies of the SSTS Guarantee is to be submitted. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, Robert Morris, P. E. Senior Public Health Engineer RM/jp PUTNAM COUN'T'Y DEPARTMENT OF HIAL"I H ED ffiION OF ENVIROKIENTAL HEALTH SERVUCES x WIEII.L COMPILETIION REPORT , eBD;A dam Street Address; To�rn/Vi�lage: Y� T'ai"Grid � T amanm Hail Rd. Patwt:o�eara Map 34 block 4 Lot(s) .56 ._ + Wen 0ymer, Name: Address: 25 Rancho Dr. Edward Schisit1baiin Cozrzlofld Karadr, t4y 10567 V00 of weDD: x Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) �- sic ®r►� Industrial Institutional Standby Delftg Equipment • Rotary Cable percussion x Compressed ait percussion Other (specify) Wen Tyra � Screened Total length Open end casing �5 ft. � x Open hole in bedrock Other Materials: x Steel ` Plastic Other camas Deftiila Length below grade Oft, joints: _ Welded n Threaded Other Diameter 6 in. Seal: x Cernent root _ Dentonite Other 1�e.ight per foot 17 lb/ft. _ Drive shoe: x Yes No Liner Yes � No �&QQaM ilDeftlb ]Fist O6 yfeld Irmt _ Bailed :fig e�urs m i 60' If more detailed YL information Land Surfgw de criptions or z sieve sulyses please attach it yeeta was tesm at different depths during drilling, list: Feet Diameter (in) ISlot Size A Compressed Air Surface Water Well ft. Desiring Vismeter0n) 2 245 x 6 3epth to Screen (ft) Developed? Ycs_NO Hours Hours _ Yield 20 gpm Gran i e e 245' gOrilatio® Gallons Per Minute Pump /Storage Tank Informatio Pump Type Capacity Depth Model' Voltage HP Tank Type _- _ Volume 014 112/01 07 . ExZ ac of well wi distances to at mast two peaTnanent landm to be prga+rd® on a separate sheet/pian. J. T. Eckerson, Inc. 2415 Routa 4th, PO' Ban 5 Well Ilea's N&me Address: Sig Date: gl2 /0� ° ,rat. r Waiter copy: HD File; Yellow copy Wing Inspector-, pink copy - Owner; Orange copy - Well drillor Form WC -4? �N oSZi :d�J� 1N34Vdu1�13i] d30 -11118 3Ni� ,1 "i'du l o �EIU"uc l l ri 4F I T 11 2 1 7r I Es Z 453 V VISION ION M��— f 80•7' DF DISTURFSIaNCE�` LIN fix' ` —_� PAR 5UB0� —� (, :q 7.8. _ � flt1, ss_ l \ ks - XISTIN6 WELL f T w f � m v- o� N I ZSD C yL�N K b LD `vz� l /A il.p✓ F c)-C co CA VA fr .k - _r___ -MP. ELL ao�naa Pv �71SPbSAL�SYSfEM `'AS QUILT" taOUS� W�LLE . A�kAMY RALL AD ; cam PIED CDQRCCT `. 730 -'` I I. EDWARD M4 CLLEH J: SCMIEFELC3LIhl 1 2. �RTHf =fZM MDME FUNDiNG� ITS SUCCESSORS N ND DR ASS IG NS. C�JV, ARCH 1, 20011' TOWN oF' PATT PUA MnY 3gZ0D r, 1