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HomeMy WebLinkAbout1566DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -4 -87 BOX 14 I,y'L 100. Me 1 � .` `� ;1 ` V ,, . or r 1 d 17 - Nor L 01566 y.. :a.w:- ._n^.. -.... - .,.r.- .� -...L .s_:�. ^v��. Ti7'\..?-'. ^V ^....' r.-., .a•'�;,iM I.J.Y.:-.:.sr; G ,._... �,/"y...f.,a'.rffra .� .. .. 4 v -+A;.- .sa5.- ..f.++Y -.... _ ,. ..�f -� .. r\ �a PUTNAM COUNT' DEPARTMENT OF HEALTH- . ' `DIVISIf-?N OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEW NT SYSTEM PCHD CONSTRUCTJO ERMIT # J !-: � -C CC S�- r Located at `_o �i - Town or Village Owner /Applicant Name �iy��{..� � P ,0UlA3-0 Tax Map Block Lot Formerly �iS`G1U,' 1. ( Subdivision Name Subd. Lot # Mailing Address ftkU—M O i,� ic, �� 000e 6,ft" L2AO QQU5(7- Zip rc4wS INE Date Construction ermit Issued by PCHD ' Separate Sewerage System built by FALUM ho 1g2o ; 4: X69 s &(k zz- Consisting of Gallon Septic Tank and v�7 ( QjcGci j�. �LiyC 1. Other Requirements: Water Supply: Public Supply From . Address. or:__ Private Supply Drilled by Address I Into 2-'X4— 3u PW( t Building T yp e Has erosion control been completed? Number of Bedrooms 4" Has garbage grinder been installed ?( p 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 regulation o e Putnam County Department of Health. Date: Certified by (Des' n Profe,�s�p ) Address kL l`� License # 10� S 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 ubject to modification or change when, in the judgment of the Public Health Director, such revocatio mo ificatiA or change is necessary. By: Title: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Date: 1 �� Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES s ._. ,........__ _ ..... _ _ .. _..eC WELL COMPLETION REPORT K� x Well Location Street Address: a TownNillage: Tax Grid # 17 46 7,-1 a. A � r+ 1, RI P"'t. ,,,. l'-_ S1-:- -YF olm Well Owner: Name: " ,t, I LL ly / Address: (LT ZZ` POVit. PLAIds PJI Use of Well: 1- primary 2- secondary -.�— Residential Business Industrial Public Supply Air cond/heat pump Irrigation Farm Test/monitoring Other(specify) Institutional Standby Drilling Equipment Rotary Cable percussion — Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length =ft. Length below grade ��V- -ft. Diameter 7 in. Weight per foot 1-7 lb/ft. Materials: JY Steel _ Plastic _ Other Joints: _ Welded Threaded Other Seal: —Cement grout __XBentonite Other Drive shoe: Yes No Liner _ Yes _X No Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? Screen Details First _ Yes—No Second Hours Well Yield Test Bailed _ Pumped Compressed Air Hours Yield gpm Depth Data IMeasure from land surface- static (specify M During yield test(ft) IDepth of completed well in feet Well Log If more detailed information descriptions or - sieve analyses are available, nlease attach. If yield was tested at different depths during drilling, list: Depth From Surface Water Well ft. I ft. Bearing Diameter(in) Land Surface I 4L Feet I Gallons Per Minute Formation 9 Pump /Storage Tank Information 1% NOTE: E act location of well with distances to at least two permanent and arks to be provided on a separaWsheet/plan. Well Driller's Name //h Address: 16d , sljzn A :Y /�s6. Signature: Date: i " " D / White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 BRUCE R FOLEY _ . Q� � L 1 A M M.S.N. Associate Public Health Director Public Health, Qirector _ ... -..... _ DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 -6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervenrion (914) 278 - 6014 Preschool (914) 278-6082 Fax (914) 278 - 6648 E911 ADDRESS VERIFICATION FORNI owNERS NAME: TAX MAP NUMBER: E911 ADDRESS: TOWN: Hampshire Land Company Lot 9 34 -4 -87 176 Tammany Hall Road Patterson AUTHORIZED TOWN OFFICLA.L: (Signature) DATE: 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. (E91 I VER-7-RIvi U BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. µ 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 7, 2001 Peder Scott, P.E. PW Scott Engineering 3 871 Route 6 Brewster NY 10509 Nil Re: Proposed Compliance: Palumbo 176 Tommy Thurber, Lot #9 (T) Patterson, TM# 34 -4 -87 Dear Mr. Scott: Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: 1. E911 address is noted as 16 Tommy Thurber Lane. The Certificate of Construction Compliance notes the address as 176 Tommy Thurber Road. The Well Completion_ Report notes the address as Tammany Hall Road. The as -built plans note the address as 176 Tammany Hall Road. Correct the submitted documents according. 2. Well Completion Report does not provide tax map number or pump /storage tank information. Upon receipt of a submission, revised to reflect the above comments, this application will be considered hlrther. Ve ly yours, / Ww Robert Morris, P.E. Senior Public Health Engineer RM:tn BRUCE R. FOLEY Public Health Director' DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 L_ORETTA. 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) 228 - 6108 Fax (845) 278 - 6648 June 7, 2001 Peder Scott, P.E. PW Scott Engineering 3871 Route 6 Brewster NY 10509 Re: Proposed Compliance: Palumbo 176 Tommy Thurber, Lot #9 (T) Patterson, TM# 34 -4 -87 Dear Mr. Scott: Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: 1. E911 address is noted as 16 Tommy Thurber Lane. The Certificate of Construction Compliance notes the address as 176 Tommy Thurber Road. The Well Completion Report notes the address as Tammany Hall Road. The as -built plans note the. address as 176 Tammany Hall Road. Correct the submitted documents according. 2. Well Completion Report does not provide tax map number or pump /storage tank information. Upon receipt of a submission, revised to - reflect the above comments, this - application will be considered further. VPAZurs, Robert Morris, P.E. Senior Public Health Engineer RM:tn "� I � •°� �+� ((1)t psi '� �1�l i" ��,'�. 1�1 I:�1 ���� � � � �� � �t �I awli 801 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # P V - y l - DO Located at 171 17trKarv�!4 0AI-4- Town or Village 1z>AM-e- -'7z!g o9 Owner /Applicant Name A-0 pay Tax Map 5 1J— Block y Lot Formerly t b9> S Hn �2Z� L^a1 m rp wv,P A-#,J V Subdivision Name Q-6-s ew o-J•n Subd. Lot # 9 Mailing Address{ -L l i pc .rs—' Co . :D 0 J � �y �e�l rt�� �2� ArO . p26-Jyla p L�5 "2 Z Date Construction Permit Issued by PCHD 1 b / a- lo..Z) PLJ" fJ5) 011 Segas•ate Sewerage Systems built by j ?A-W yr jbo 0 Q m , CcsN ST. Address "-Jim 9 -;L b ip1F—� to U- t a�g Consisting of Gallon Septic Tank and bt-`/ A400 1 ' of� F1LL- Other Requirements: WateK SugZly: Public Supply From. Address or: Private Supply Drilled by w,-i L. -tax'► t-{,a ft-t r Address I o 1 ' 2� pA- -rrr--rzs N,y • �aso3 Building Type Has erosion control been completed? `J & Number of Bedrooms Has garbage grinder been installed? !j c1 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: o Certified by o a ,X�77 P.E.'X R.A. (Design Professional) Address '3T 7 ( 4UTl 6 N y�1 License # n 5 `i '3 V4, 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 subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 BRIXE R. FOLEY LORF-TTA MOLNAEU R-N., NLS.N. Pubix Health 0recxf Aijoci= Public Health Dirdr—rcr ARUN= "OF' HEALTH I Geneva. Road Brcw3ter. Now York 10509 'Eaviroamtatal Health (914)278-6130 Fax (914) 273-7921 Stm4n4 Urvicits C91C272-6559 WIC (914) 273 .5673 Fax (914) 278-608! Early Interveaftoo, (914) 273 - 6014 'Preschool (914) 278-6082 Fwc (914) 278- 6649 UMIM IM Z I OMMIN 01-3 121 to" 8 16100 141IMMI I OWNERS NAME- TAX -MAP NUMBER: E911 ADDRESS: TOWN: AUTHORIZED TOWN Of (Signature) DATE: 0— �g The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a le,,al E911 address is amig ped by an authorized town official. This form is to be submitted -,vith the application for a Certificate of Construction Compliance. 1 =91 I'V E RI-RM, 1\ P. W. SCOTT Engineering & Architecture, P.C. 3871 Route 6 BREWSTER, NY 10509 E•Mail: pws @bestweb.r,Oet x(914) 278 = 2120` -fl�f'(914)' 278 =2166 " TO Putnam County Dept. of Health 4 Geneva Road Brewster, New York 10509 WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order .❑ LLT� sCn O[ L ° , @200CT4Q� 1, ' OA rE J JOB NO. ' A'rTENTtN- NO. RE: Septic As -Built 1 1 2L 21 _rC 1 1 Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION 1 1 Certificate of Construction Compliance 1 1 Well Complet an Report 3 1 Guarantee of Subsurface Sewage Treatment System 3 1 As -Built Septic Plan s Fee: $200 THESE ARE TRANSMITTED as checked below: ❑ For approval ff For your use ❑ As requested ❑ For review and comment ❑ FOR BIDS DUE REMARKS COPY TO Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: PUTNAM COUNTY DEPARTMENT Off' HEALTH -: : ;..... DIVISION OF .ENViRONMENTAL_HEALTH,SERVICES, - - GUARANTEE OF SUBSURFACU SEWAGE TREATMENT SYSTEM &A�, %AtUAAV Owner or Purdbhser of Building Building Constructed by 97 Tax Map Block Lot { SQ1J TownNillage, t7& 71"4 _RVJZ851?-- _fQ5 IIQ Location - Street Subdivision Name Building Type Subdivision ::,ot # 1 represent that I am wholly and completely responsible for the locati( n, workmanship, material, construction and drainage of the sewage treatment system serving the abt ve- 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 Count) Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place i i good operating condition any part of said system constructed by me which fails to operate I'm a period of two years immediately following the date of approval of the "Certificate of Constri tction Compliance" for the sewage treatment system, or any repairs made by me to such system, +;xcept 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 n of 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 ZQ Year ( Signature: ` tCb %0 Xk 0�3 Oa l tle: OLZ ��OR— General Contractor (Owner) Signature Corporation Name (if corporation) Corporation I lame (if corporation) Address: 22, PLAt QS Address: State Zip State Zip Form GS -97 206 080 'ON T2b9e28968 F i100S Md LS:60 Za /Z2 /90 NE Combined limit for Iron plus Manganese = 0.50mg/L e Sodium 6.1 mg/L EPA 273.1 20.0 mg/L ** a Lead 0.001 mg./L EPA 239.2 0.015 mg/L * ** ml--milliliter mg/L--milligrams per Liter ND =none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count " "Notification Level ** *Action Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: MOTABLE or ONOTPOTABLE RESULTS BASED ON SAMPLES SUBMITTED: 5/7/2001 �p H 4I�9����xis1 Laboratory Director -NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 o OUTSIDE CT: 800 - 654 -1230 NORTHEAST LABORATORY OF DANBURY _ - • ­39 MILL PLAIN ROAD DANBURY� CT 06811 CT Cert: PH -0404 LAB.q, (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 LABORATORY REPORT REPORT TO: PALUMBO BLOCK COMPANY DATE SAMPLE COLLECTED: 5/7/2001 ROUTE 22 TIME COLLECTED: 9:45 A.M. DOVER PLAINS, N.Y. 12522 COLLECTED BY: ANTHONY PALUMBO DATE RECEIVED @ LAB: 5/7/2001 TESTED BY: LAB #11471 LAB LD.# NY46 REPORT DATE: 5/10/2001 SAMPLE SITE: LOT #9, TAMMY HALL RD., PATTERSON, N.Y. SAMPLE POINT: KITCHEN SINK SOURCE: WELL TREATMENT: NONE NVIAXIMUM CONTANDNANT TEST PERFORMED RESULTS METHOD # LEVEL (MCL) OR STANDARD BACTERIAL: O Total Coliform (Bacteria) 0 per 100 ml SM 9222B 0 per 100 ml PHYSICALS: • Color (Apparent) 0 - EPA 110.2 15 • Odor ND - - 3 Units • pH 7.13 - EPA 150.1 No designated limits • Turbidity 0.90 NTUs EPA 180.1 5 NTUs CHEMISTRY: • Nitrite Nitrogen <0.005 mg/L as N EPA 354.1 1.0 mg/L • Nitrate Nitrogen <0.20 mg/L as N SM 4500D 10 mg/L o Alkalinity - -••_ 58.0 mg/L SM 2320B No defined limits a Hardness 60.0 mg/L EPA 130.2 No defined limits • Iron <0.03 mg/L EPA 236.1 0.30 mg/L o Manganese 0.184 mg/L EPA 243.1 0.50 mg/L Combined limit for Iron plus Manganese = 0.50mg/L e Sodium 6.1 mg/L EPA 273.1 20.0 mg/L ** a Lead 0.001 mg./L EPA 239.2 0.015 mg/L * ** ml--milliliter mg/L--milligrams per Liter ND =none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count " "Notification Level ** *Action Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: MOTABLE or ONOTPOTABLE RESULTS BASED ON SAMPLES SUBMITTED: 5/7/2001 �p H 4I�9����xis1 Laboratory Director -NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 o OUTSIDE CT: 800 - 654 -1230 PUTNAM COUNTY DEPARTMENT OF HEALTH ., DMSION OF ENVIRONb1ENTAL HEALTH SERVICES / t FINAL SITE INSPECTION �w.:..t..,. �.- . _ - ..w...- .__�.�,.�:... ,... ,� ... ... - _.. _.. _ •Inspecte y: �, F,-T Street Location_ A,✓ "z Owner PvLvdMa Toti`n Permit 4 'r y • -el�3 - oo Tivi Subdivision Lot 4 e 1. Sewage Systein Area a. STS area located as per approved plans ....................... b. Fill section - date of placement 3:1 barrier Lath. Width Avg.Dp c. Natural soil not stripped ................. ............................... d. Stone, brush, etc., greater than 15' from STS area...... . e. 100' from water course / wetlands ...... ..:............................ II. Smlacge System a. Septic tank size - 1,000 ...... ,25 ....... other ......... a b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ................. ............... d. Pistribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Origmal soil between box & trenches e. Junction Box - properly set ........... ............................... f. Trenches TLeength required 5-7/ Length installed X5-7/ 2. Distance to watercourse measured -- i o v 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 %z" diameter clean .................... 9. -Depth-of-gravel intrench -121-minimam .... :.:.::.:�. - 10. Pipe ends capped .................. ............................... g. PUMD or Dosed Systems 1. Size of pump c amb 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.estirnated flow /cycle........... M. House/Building a. House located per approved plans..:.. . ............ b Number of bedrooms ......................... r..p ........,,.f.` IV. Well �``'� Well Well located as per approved plans . ............................... b.. Distance from STS area measured / v 6 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 pl� f. Curtain drain outfall protected & dir.to exist waterc g. Footing drains discharge away from STS area .............. h. Surface water protection adequate ........................ .... i. Erosion control provided .............. .........................:..... COMMENTS a x`t're , ti car— w'/ 5 7 4i,+01,jnN4 4A K eez V'S 4r- 04/24/01 16:25 PW SCOTT 4 19142787921 NO.136 002 . _.... ._ _..: IPUT �A13� C ®IJNTSI IBIEPARTI�IENT t�F HEALTH IDWISId BN OF ENVIRONMENTAL HEALTH SERVICES ATTENTION 0 ADAM ENE All information must be ft fly completed prior to any inspections being made. PCHD Construction PC it # Loma- Owner/Applicant Name- _ Formerly: I Is system fill completed? Is system complete? _ Is system constructed as per plans? Is well drilled? Is well located as per plat s? Are erosion control measi rres in place? For: Fill Trenches Subdivision Name: On division Lot # Date: Af,f_ Date: Date: Block _41-- Lot I certify that the systems), as listed, at the above premises has been constructed and I have inspected and verified their comp) etion in accordance with the issued PCI D Construction Permit and approved plans and the ;standards, Rules and Regulations of the Putnam County Department of Health. Date: _ - Certified by: Plr 4K Design Professional . All Address: R&kco Lic. # �� t Comments: _.. L• s 3 • Ce1w I rotL*y 8 L4 °C i K s f t -% (ACe PCr Form FIIt -99 ?a cz . 04/24/01 16:25 PW SCOTT 4 19142787921 NO.136 001 P.W. SCOTT email pm@bestweb.net ENGINEERING & ARCHITECTURE, P.C. 3871 ROUTE 6 (845) 278 -2110 FAX (845) 278 -2tS6 FAX TRANSMITTAL PROJECT: TO:. TO: FAX: 'Z, JT Z I FAX: TO: TO: FAX' FAX: NO OF PAGES INCL. TR MI MITTAL: 2- FROM S (; t-C. Comments: r DATE-2/a, Z1 Please c; dl 845- 278 -2110 if this transmission is illegible or unclear I 'acknowledge receipt of this report SIGNATURE; �. Title, — x Rev. _ P. W. Scott email: pws @bestweb.net Engineering & Architecture, P.C. 3871 Route 6 (845) 278 -2110 BrevftteF -'NY= "-- 0509 _ ..� r.W 84 ) 278.2f66 May 18, 2001 Gene Reed Putnam County Health Dept. 4 Geneva Road Brewster, NY 10509 RE: Rosewood Lot #9 Dear Gene: Please find enclosed a revised septic design plan which reflects the surveyed (Specer S. Hall, L.S.) as -built location of the SSTS trenches. To this plan I have depicted reserve laterals and have located their locations in the field. Please schedule a date to review the field condition so an as built can be completed and the existing SSTS approved. Wi gards, Pe . Scott, P.E., R.A. President A R C H I T E C T U R E ` E N G I N E E R I N G ` S I T E P L A N N I N G C'.:1it�y foc± mentst;)rlei� Projects'rRosewood\LTR Lot 9 (Reed.8- 18- 01).doc =0 RESERVE SYSTEM LENGTHS R1 20 R8 24 R2 20 R9 23 R3 15 R10 18 R4 70 R11 15 R5 65 R12 10 R6 56 R13 10 R7 50 R14 66 R16 43 R15 66 338 232 b A R C H I T E C T U R E * E N G I N E E R I N G * S I T E P L A N N I N G C:: Nly Docurnents\Open Prc jects\Rosewood\LTR Lot 9 ((deed 5-18 -01) doc 4 .BRUCE :: =R::- FOLEY' Public Health Director 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 April 25, 2001 Early. Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 Peder Scott, PE PW Scott Engineering 3871 Route 6 Brewster, New York 10509 Re Dear Mr. Scott: Field Inspection - Palumbo Tammany Hall Road, (T) Patterson TM# 34 -4 -87, Lot 9 The following comments must be corrected in the field: 1. The fill in the expansion area was not installed as per approved plans in size, depth and slope. 2. The furrlco connection from the cast iron pipe to plastic is not approvable and need to be replaced. 1 The septic tank has no connection to the separate sewage treatment system. - 4. The SSTS trench gravel appears to be less than the required 12 inches. 5. Duct tape is not sufficient for plugging the ends of the SSTS trench pipes. 6. A bedroom count needs to be performed (house locked). 7. The curtain drain and stand pipes need to be installed. 8. The roof leader /footing drain was not found. 9. Silt fence has not been installed as per the approved plans. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. GDR:cj Very truly yours, Gene D. Reed Environmental Health Engineering Aide - -- BRUCB -R: _'F0LEY—' Public Health Director _.__- ._.__. - ORETTEi4 N10LINARI 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 (945)278-6130 Fax(845)278-7921 Nursing Services (845)278-6558 WIC (845)278-6678 Fax(845)278-6085 April 25, 2001 Early Intervention (845)278-6014 Preschool (845)228-6108 Fax(845)278-61648 f Peder Scott, PE PW Scott Engineering 3871 Route 6 Brewster, New York 10509 Re: Field Inspection - Palumbo Tammany Hall Road, (T) Patterson TM# 34 -4 -87, Lot 9 Dear Mr. Scott: The following items are in violation of Article III, Section 2C of the Putnam County Sanitary Code: G Silt fence has not been installed as per the approved plans. _. CiviLpenalties.up to_$.1,OD.0_1or a single violation, per:day,.c i be assessed if found liable for the violation, and a formal notice of hearing may be issued if the violation is not corrected within 5 days. It is truly hoped that the above violations are corrected without having to take legal action. Very truly yours, Gene D. Reed Environmental Health Engineering Aide GDR:cj ro BRUCE R. FOLEY DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. ,. 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 Date: TZA- d Zo I To: 7'. w '5 -r7- `t WIM-eR5g2A T14.A'3 - - V-87 G�7" 9 �120St;i!/Oc�i�'r From: Gene D. Reed Putnam County Department of Health - - For your information _ For your review As discussed Notes/Messages Fax #: a76- No. Pages 3 (Including cover sheet) , Please respond Attached as requested Please call In the event of transmission /reception difficulties, please contact this office at (845) 278 -6130 ext. 2261. ;BRUCE- R:�---FOLEY Public Health Director LS9RETTA . LINARL:.R.N;; <M.S.N. _ Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH A 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 May 14, 2001 PW Scott Engineering 3871 Route 6 Brewster, NY 10509 Re: Field Inspection: Polumbo . . Tammany Hall Road Lot #9, TM #34 -4 -87 (T) Patterson Dear Mr. Scott: The following comments must be corrected in the field: The expansion area appears to be short in depth and size. It also appears that adjustments to-the expansion trench design may be necessary to avoid ledge rock. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. _.__......... �..._...._...__........._..._., .- ..._.. __..._......._......�.._._ _.s.___........._ _._ Very- truly -yours -; Gene D. Read - Environmental Health Engineering Aide GDR/jp b4i27i01 13:17 PW SCOTT a 8458326431 -APR -26 -01 FR1 -4 =29 PM PUXJM CTY ENV HEALTH BRUCE IL FOLEY Pubtte Ntafth Me Mor NO. 152 FAX K0, 19142787921 P. 3 LORETTA MOLINARI MN, M.S.N. Agwtau Public mearth Dtrsater Dtrsetor of Patreat Servka DEPARTMENT OF 14EALTH I Geneva Road Hrswster, Now York 10509 Ba►iromaestal Health (0=6-6130 Fa(645)276.7921 N uT%la { Serrk a (845) 378.6558 WIC (645) 216.6679 Fox(845)279-6095 April 25, 2001 Haely U1 xmitioe (845) 27E - 6414 traeshool (845) 228,61011 Fex (80) 278.6..649 Peder 5cotl, PE PW Scott Engineering 3871 Route b Brewster, New York 10509 Re: Field inspection - Palumbo Tammany Hall Road, (T) Patterson TM# 34.4 -87, Lot 9 Dear Mr. Scott: The following items w a in violation of Article III, Section 2C of the Putnam County Sanitary Code: Silt fence has 1 tot been installed as per the approved plans. Civil penalties up to 31,000 for a single violation, per day, can be assessed if found liahla for the_ violation, and a formal notice of hearing may be issued if the violation is not corrected within 5 days. It is truly hoped that the above violations are corrected without having to take legal action. very truly yours, Gene D. Reed Environmental Health Engineering Aide GDR-gj r. `_.:k 0426/01 13:54 PW SCOTT 4 19142787921 NO. 145 001 P.W. SCOTT email t�Seb.nei ENGINEERING 1: ARCHITECTURE, P.C. 3871 ROUTE 6 - -- - .....� •: .,. .: � ... _ ......_ .....18.451.. 7_ - %110 PROJECT: _ a _W s r, r 40t. I � ��j * lC Ac & u1 (t . FAX: �"� �-`?� -- . 7 FAX: TO: TO: FAX: FAX: NO OF RAGES /IVCL. TRAP ISMITiAL: FROM ��°� �' d _tom DATE: t ox"x s e wt1l( i Please call 845 -278 -2110 if this ttansWssion is illegible or Aaalcicay ` c "4A YOZA - lk c vMI-YARfa. N� . 1 �v PUTNAM COUNTY DEPARTMENT OF HEALTH DATISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # 1`" V- q3- 00 Located at _ 176 Tammany HallRoad Subdivision name Rosewood Subd. Lot # 9 Date Subdivision Approved 1/ l 1/ o 0 Owner /Applicant Name Anthony Palumbo TownorVillage Patterson Tax Map 3 4 Block 4 Lot :8 7 Renewal Revision Date of Previous Approval Mailing Address Fih.otwe<) g�.c Co an "--W, r:Vg t`iA<,6- eel dwex_ P-WAU05 Zip Z N� Amount of Fee Enclosed $ 3 0 0. o 0 Building Type Residence Lot Area 1,81 No. of Bedrooms 4 Design Flow GPD 8 0 0 Fill Section Only Depth Volume PCIID NOTIFICATION IS REQUIRED VVIIEN FILL, IS COMPLETED to consist of I -1-t'6 gallon septic tank and 0 / L T 4 .9�r Other Requirements: 1 61 fil k ('o D X To be constructed by T" 6 D Address Water Sun ®Iv: Public Supply From Address .. `oLr: _ _'P1`ivate Supply Drilled by e _ ._ _ .....,....- .....:. - Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the sgparate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date License # 059346 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 c nsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe rt proved ischarge of domestic sanitary sewa a only. By: Title: / Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please pnnt Well Location: Street Address: Town/Village Tax Grid # 176 Tammmany Hall Road,Patterson Map 34 Block 4 Lot(s) 87 Well Owner: Name: Anthony Address: Palumbo Block Co. Palumbo Dover Furnace Road Dover Plains Use of Well: X Residential _' Public Supply Air /Cond/Heat Pump Irrigation 12 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5 gpm # People Served 5 Est. of Daily Usage _450 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling _X_ New Supply (new dwelling) Deepen Existing Well Detailed Reason New Residential Lot for Drilling Well Type �_ Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No X Is well located in a realty subdivision? ...................................... ............................... Yes X No Name of subdivision Rosewood Lot No. 9 Water Well Contractor: Address: Is Public Water Supply available to site? Yes No X Name of Public Water Supply: N/A Town/Village Distance to property from nearest water main: N / A Proposed well location & sources of contamination to be provided on s arate sheet/plan. Date: 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. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a wat we driller c ified by Putnam County. Date of Issue 1012- 0,4 1 Permit Issu fficial: Date of Expiration U07 Title: ( Permit is Non-Transferiafilet White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 NY 22 BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of -PatieiA 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 PW Scott Engineering 3871 Route 6 Brewster NY 10509 Re: Proposed SSTS: Palumbo Tammany Hall Road, Lot #9 (T) Patterson, TM# 34 -4 -87 Dear Mr. Scott: 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 local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York. City Department. Environmental Protection on this lot, percolation tests must be witnessed by a representative .of this Department. /-I The minimum of 2 feet of R.O.B. fill is required for the primary and expansion area. This is to be noted on the permit application and SSTs profile. Furthermore, the / grade change is to be reflected in the proposed contours in the plan and profile views. v Erosion control measures for the proposed well is to be shoivn. 3 the location of the well is to be dimensioned from two property lines. 4) fill is to be shown extending 10 feet horizontally past the edge of the trench and then sloping 3:1 to grade. subdivision plat requires a curtain drain 7 feet deep. Standpipes and curtain drain detail is to be provided. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:tn Ve ly you , ./T zl 41— {' e Morris, o !s, P.E. Senior Public Health Engineer once. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR,CONSTRUCTION•PERMIT.. NAME OF OWNER: STREET LOCATION: � �� 1/L'a' Tt' REVIEWED B . RM, AS, SRDATE: co TAX MAP #: (CONFIRMED) Y DOTS Y� H(REQUIRED DETAILS ON PLANS CONT'D) PERMIT APPLICATION �' OUSE SEWER - 4" FT. 44% TYPE PIPE CAST IRON WELL PERMIT OR PWS LETTER L�LJNO BENDS; MAX BENDS 450 W/CLEANOUT C -97 RENEWALS LETTER OF AUTHORIZATION SITE NOTE (NO CHANGE) J ESIGN DATA SHEET (DDS) FILL SYSTEMS CORPORATE RESOLUTION 0' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE HORT EAF �lf LL SPECS/ FILL NOTES 1 -5 U � PLANS -THREE SETS (� ILL PROFILE & DIMENSIONS czl )HOUSE PLANS - TWO SETS( L. DILL IN EXPANSION AREA ((_)VARIANCE REQUEST FILL GREATER THAN2 FEET SUBDIVISION (DE AY BARRIER (_)`� )LEGAL SUBDIVISION / (� L CERTIFICATION NOTE L _)(_)SUBDIVISION APPROVAL CHECKED �/ LU PTH GAUGES U(_)PERC RATE 'Z_ L�VOL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS (_j FILL REQUIRE - -I) !A= _DEPTH L)SEPARATION DISTANCE FROM TOE OF SLOPE (CURTAIN DRAIN REQUIRED - R� ENCH GENERAL LF TRENCH PROVIDED 60FT MAX. OCATED IN NYC WATERSHED PARALLEL TO CONTOURS i, PLANS SUBMITTED TO DEP 100% EXPANSION PROVIDED EGATED TO PCHD �DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL EP APPROVAL, IF REQ'D f20'TO EOTEXTILE COVER EP TEST HOLES OBSERVED SEPARATION DISTANCES ON PLAN FROM SSTS FRCS TO BE WITNESSED ' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL X- APPROVAL SSDS ADJ, LOTS FOUNDATION WALLS ETLANDS (TOWN/DEC PERMIT REQ'D ?) 0' TO WELL, 200' IN DLOD,150' TO PITS DATA ON DDS PLANS & PERMIT SAME 0' TO STREAM, WATERCOURSE, LAKE (inc. expan) PRE 1969 NEIGHBOR NOTIFICATION ' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER LETTER BI/ZBA ' TO WATER LINE (pits - 20') 100 YR. FLOOD ELEVATION W/I200' 50'•INTERMIT7ENT DRAINAGE- COURSE _. Z,- SOIL; TES`T'ING LOTS >lU YEARS OLD C 0'/500' RESERVOIR, ETC. 150' GALLEY SYSTEMS REQUIRED DETAILS ON PLANS ' MIN TO LEDGE OUTCROP SEWAGE SYSTEM PLAN - (NORTH ARROW) SEPTIC TANK a SSDS HYDRAULIC PROFILE FOUNDATION; 50' TO WELL GRAVITY FLOW WELL CONSTRUCTION NOTES 1 -15 NS PROPERTY LINES DESIGN DATA: PERC & DEEP RESULTS SERVICE CONNECTION J;Dl CONTOURS EXISTING & PROPOSED PROPERTY LINE RIVEWAY & SLOPES, CUT SL OPE OOTING /GUTTER/CURTAIN DRAINS IN SSTS AREA (520 %) SDA S OIL TYPE BOUNDARIES ADED TO 15 %; IF REQUIRED ITLE BLOCK; OWNERS NAME ADDRESS 9F4 NAME, ADDRESS, PHONE# DOSE/PUMP SYSTEMS DATE OF DRAWING/REVISION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. (� PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS WELLS & SSDS'S W/IN 200' OF SSTS (_)PROPERTY METES & BOUNDS )(_)EROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE COMMENTS: (REVSIIEET)09 /01/00 'UMP NOTES IOSE 75% OF PIPE VOLUMEMOSE VOLUME NOTED IETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) �T AND D -BOX SHOWN & DETAILED DAY STORAGE ABOVE ALARM CURTAIN DRAIN TANDPIPES, T BOTH SIDES, DETAIL T MIN to CDS = >5 %, 20' -4 %, 25' -3 %, 35' -1 %,100 % - <1% 0' MIN to CD DISCHARGE /100' with 182 cons day discharge 0' MIN to NON - PERFORATED PIPE P. W. SCOTT Engineering & Architecture, P.C. 3871 Route 6 BREWSTER, NY 10509 E -Mail: pws @bestweb.net _- �'WI4)'278 =213M— FAX -(914) '278 -2166 4 Geneva Road Brewster, NY 10509 WE ARE SENDING YOU CXAttached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ DATE JOB NO. ATTENTION RE: R% L©•r, 1 Subsurface Sewage Treatment System (SSTS) Application for Approval of Plans (PC -97) 1 ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION 1 Application for Approval of Plans (PC -97) 1 1 Construction Permit for Sewage Treatment System (CP -97) 1 1 I Letter of Authorization (LA -97) 1' 2 Design Data Sheet (DD -97) 1 House Plans (2 sets) Q 1 }� Pt I i Ci9 f% 1 'f (" t nACT 1 1 Check # for the amount of $ S� 1 1 Short Form EAF THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ For your use ❑ As requested X1 For review and comment ❑ FOR BIDS DUE REMARKS List Continued: 4 1 Septic Site Plan Drawings ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ ❑ Resubmit copies for approval ❑ Submit copies for distribution Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US 1 1 E911 Address Verification Form (E911 Verfrm) COPY TO SIGNED: P If enclosures are not as noted. kindly notify us at once. PUTNAM COUNT'S DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Anthony Palumbo Located at 176 Tammany Hall Road T/V Patterson Tax Map 34 Subdivision of Rosewood Block 4 Lot 8 7 _Subdivision Lot # 9 Filed Map. # .. 2 8 14 . .._ Date-Filed.. _ / t _!loo_.._ Gentlemen: This letter is to authorize P e d e r Scott a duly licensed Professional Engineer. X or Registered Architect X to apply -for the required wastewater treatment and/or water supply permit(s) to serve the above- noted property in *cordance 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. Very truly yours, Countersigned: Signed: ad, /,,a- P.E., R.A., # 059346 (Owner of Prope ) Mailing Address 3871 Route 6 Mailing Address: Dover Furnace Road Brewster, NY 10509 Dover Plains, NY 12522 State Zip State Zip Telephone: 914-278-2110 Telephone: 914-832-610 Form LA -97 FGIN Li C✓G'NI"_' DEAIMEN CF Ur -=M: Dr7T-SICN OF D`N=CR =-%L =--.LT-H1 - =,-Zv -r= APP END 7' DESIGN DLL AL, SrS=.. caner .F -E ' 0-14 Mdress' V3O PML• MF L- to 1(.,°l E ;cater at (S treat) I AH OAHY HM-L•. F-OADOW? THJMWS,-- (iadicate nearest c_oss st :eat) 3`i Blcc:� y Lot 5�• , Cica1 i tv ! AT-r 150!4 Wat ersi e=- coM PERCc)= -CN T£_ST DAZ'a PZZ'( LRED TO BE STLJE 2a �'J . wZT:? APPLIC'CT NS Dat_ of Pre - Soaking HI �b Date of Pe=wlaticn Test Ib HOLE ` NU= PE.RCI=GN P�COLr�TICN Run Elapse Depth to .mater From Water Level No. T21M Ground Surface. In Inches ' Soil Rate Start-Stoo Y-:n. Start- Stc_0 Drop In Mir./L'I DrcD inches ?ndles :Inches - ' J 7..5 __ __.:.._.. __ _ _ __._ .... __..._... . _........ _.... _..... _ ......... . Ulf Am NOTE: 1. Tests to be repeated: at sane depth until approximately equal soil rates are • obtained .at each percolation test hole. ' All data to' be s abnitted for review. 2. Depth measurenents -to be made fran top of hole. r_P•�_ 9/A5 - TFST PIT DATA REQUIRED TO BE SM'M 1 = W-LM -bTICN P a DISCRE'T'ION OF SOILS E.''`N`I'= IN TEST HOLES DEPTH HOLE NO _ A, HOLE NO � g HOLE NO. G.L. 1' 21 3' 41 51 6' 71 8' 0- 2•H" fa �NV40 oft J,A" b► " Slu`i SAN u*N CJW MA 1 f0 �.-Mf orb LME SILT] ,)'I•lM1..Dnc(� .tiJt�� -�0� LOT- 9C 91. �Jp rv'w - 10' h`><=M'�`.� boa .... � cne1�C;;• .... .:. ............................ .... . 11' INDICATE L= AT M11CH GRMU1,r,r -= IS EN=UNTERED - INDICATE I= TO WHIG' MMR IZV-a RISES AFTER BEING UNTE ED DEEP HOLE OBSERVATIONS MADE BY: PL�� DATE: DESIGN -Soil Ratc Used Min /l" Drop: S.D. Usable Area Provided Q00 No. of Bedroars L4 Scptic Tank Capacity �Zri� gals. pipe ",'4qJ Absorption Area Provided By L.F. x 24" width trench Other PvmQ, oJt; To �r�p� �' r-ILL �J�c,�o� GuN�Aw of NE or Nam Q W 5C OT7. EHG'NEFP! Znt A94-N. PL Signature -3 e� ;, e Address �� �o SEAL THIS SPACE FOR USE BY HEALTH DEPAPMER2 ONLY: Soil Rate Approved sq.ft /gal. ' Checked by " ' Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 'J ��:._ .... _..__ ..... ....... . APPLICATION FOR,APPROVA_L OF. PLANS.FOR. _. y A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: Anthony Palumbo Palumbo oc o. Dover Furnace Road Dover Plains, NY 2. Name of project: Rosewood 4. Design Professional: P e d e r S c o t t 6. Drainage Basin: East Branch Reservoir 7. Type of Pr_ Ject: X Private/Residential Apartments Office Building 3. Location TN: Patterson 5. Address: 3 8 7 1 Route 6 Brewster, NY 10509 Food Service Institutional Realty Subdivision Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ........a .............. ............................... Type I Type II 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency Town of Patterson Planning Board Exempt _ Unlisted X No N/A 12. Is this project in an area under the control of local planning, zoning, or other officials _ __ Y ordinances_ ......,- _.._,— _...... _... ....... ... ..:. ) .. a.. ti., a. aaa. aa.. a. a. ww.... ya. oa. a. w. w�... waw... aaa .�.. ..a...wa.r.�.aa.a.aa..a'a a.a.saa aaaaaaa. a... iaaaaa�aaa _ _ . 13. If so, have plans been submitted to such authorities? Yes-subdivision 14. Has preliminary approval been granted by such authorities? Y e sDate 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) ........................................... ............................... 18. Is project located near a public water supply system? ....... ............................... N/A M 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 Individual 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) ................................. .............. .................. 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? ......................... 800 GPD No N/A Form PC -97 OA 27. Is any portion of this project located within a designated Town or Statevetland? °No 28. Wetlands ID Number .......................................................... ............................... NIA _ 29. -..Is Wetlands Permit req uired? .......... ................... .....:....... ............................... N o Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ............................... N/A 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, N o 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 ............. Yes/No N o other potentially known source of contamination? ................. - DESCRIBE: 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 No 35. Are any sewage treatment areas in excess of 15% slope? . ............................... 36. Tax Map ID Number .......................... ............................... Map 34 Block 4 Lot 87 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 tfie' project may require DEp approval of the SST prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater,plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the enal Law. SIGNA ORES & 4FFICUL TITLES: Feder W. Scott, P.E., R.A. 3871 Route 6 Mail in A. ddress :.... ............................... B r_ a w s t e r, NY 10509 _ r 15.16.4 (?!87) —Text 12 PROJECT I.D. NUMBER 1617.21 SEQR _A _ ... . __... .., ppendlx •C. State'Environmental duality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT 1.SP0N1t6fi 2. PROJECT NAME i :An,tho:n.y Pa_lumbo._. Palumbo Septic 3. PROJECT LOCATION: Municipality Patterson County Putnam 4.. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) 176 T- ammany Ha1.1 <Road -__. s•.; 5. IS PROPOSED ACTION: r I.n New ❑ Expansion ❑ Modificationlalteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: I Initially ' 2 acres Ultimately 2 acres S. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 1J Yes ❑ No it No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? X-I .Ot6r- LJ lesiCzntial ❑Industrial Commercial Agriculture • p t!dFgre lQpeQSpace.. ___.... - - �scriSe 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? In Yes ❑ No It yes, Ilst agency(s) and permitiapprovals Putnam County Health Department 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? 11 Yes U No it yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? C1 Yes ❑No i N/A I . CERTIFY THAT THE INFORMATI PROVIDED ABOVE IS T UE TO THE BEST OF MY KNOWLEDGE AppiicanUsponsor name: Date: 00 Signature: Fin s co—n— 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 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by agency) A. DOES ACTION 1EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes LJ No 8._ WILL,Ai;,7ION, RECEIVE COQRDINAiED RREVIEW AS PROVIDED FOR UNLISTED ACTIONS aN 6 NYCRR, PART 617.61, IS No, a negative declaratloo may be superseded -by another Involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH 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 for erosion, drainage or flooding problems? Explain briefly: No 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 at 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 briefly. No C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. No C6. Long term, short term, cumulative, or other effects not identified in C1-05? Explain briefly. No C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. No D: IS TFIER'c Oil I THERE LIKELY TO BE, CONTFiOVEA Y RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes O No If Yes, explain briefly ;T PART` -114— DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether it Is substantial, large, important or otherwise significant. Each effect should be assessed in connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF andlor prepare a' positive declaration. 0–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: Name of Lead Agency Ly 1 Phnt;or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) Date 1 BRUCE R- FOLEY Public Health Director LORE'ITA MOLINARI R.N., M.S.N. ti Associate Public Health Director__, Director 'of 'PatienF Services 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 9 TAX MAP NUMBER: 34 -4 -87 E911 ADDRESS: TOWN: 176 Tammany Hall Road Patterson AUTHORIZED TOWN OFFICIAL: (Signature) DATE: G Gy ;2 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 VERFRI f) ri z Q Q WE 0 +00 ; C.ntedin. Rood @ Gold"' Drlw 0 +00 Lot #10 'x' at Found /�5 E a.'S� t [ Hd. _5DOU Slone W.II O O _ N WIN I'M t Spencer S. Hall 3+45 - Gwoq. Floor Licensed Land Surveyor o.wtwn(512e') 6244 Route 82 Stonfordville, NoW York 12581 NYSLS 49138 (845) 868 -1262 Driveway Slope Not To Exceed 14.5% M Sketch Showing Driveway Location /Profile Sewage Disposal System 3 for P A L U M B 0 Town of Patterson Putnam County, New York Scale: 1"=50' May 2, 2001 [ Hd. _5DOU Slone W.II O O _ N Spencer S. Hall 3+45 - Gwoq. Floor Licensed Land Surveyor o.wtwn(512e') 6244 Route 82 Stonfordville, NoW York 12581 NYSLS 49138 (845) 868 -1262 Driveway Slope Not To Exceed 14.5% M Sketch Showing Driveway Location /Profile Sewage Disposal System 3 for P A L U M B 0 Town of Patterson Putnam County, New York Scale: 1"=50' May 2, 2001 rAMM A N Y N07 °57 37 "E 54.41' O co\ W 0, 4— H q L L 7 2719121 "E \� OS' N1236 S0 „E 78.12, CO � 07 µ� 0 O a O p co co ® O ® ::j Frame N 4 Dwelling v Ui/ O - o e s L =39.79' R =200.00 Z W� �G C —O -O 0 µ N O N sa Ov �q�IF 14 02 ' oa 4'4 3F s S15-40,,10,,W N7g•4 o e 62.17' Stone wall�� 65.2. Lot 222 00, N � N �I I+ D CD U) N7 --._ 95.42. Ii 11 10%