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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -4 -88 BOX 14 {ti `� ■, jr . . . r FN '■'' ,� . 1 ?F T 1 I , 01567 � a PUTNAM COUNTY DEPARTMENT OF DEAL &:!� � DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHID CONSTRUCTION PERMIT # Located at ($ /y "I ^MMANY f+A i-L FYifl Town or Village PAJTC-,V-s°-� Owner /Applicant Name vAF2IA14 AoW Fvt i,�gZ Tax Map -Li. Block 9" Lot S b Formerly Subdivision Name P�CGt_--Nop p S/16 Subd. Lot # 10 Mailing Address 10 ' I,,-A70f-J^4A t-NI Zip lm,;; fINSCOIT Date Construction Permit Issued by PCHD 0 ' (01zl41tiA, (o ' 7, 1 Dr, E�'`'u�U Separate Sewerage System built by 4vA�nj Address (p�1"�' -��1- sT. MTu► )A4,'�i Consisting of ( 2 '�7fl Gallon Septic Tank and -�bO° '' if O F- y -TA N 0,A 9-19 2 T:--J w i r soVrfto0 rtW---3C,+W-o Other Requirements: M I r-' GF: F- f L- i- PA C> f a G� D W61 Water Supply: Public Supply From Address or: V Private Supply Drilled by F.F. 6eA t__ Address ^'Y - Building Type - izE-'- t tEE�NGc Has erosion - control been completed? . %S Number of Bedrooms 3 Has garbage grinder been installed? No I certify that the system(s), as listed, serving the above premises were cted essentially as shown on the as- built plans (copies of which are attached), in accordance with the i ID truction Permit and approved plans and the standards, rules and regulations of the Putnam Co e g� �� ealth. � o 2 Date: 11 1-7- t y Certified by J *4" A I a C '''`z" P.E. R.A. (Design Address 3 Mgt V-lAL, A-9f-,- -PAkM I-I N34 N'{ (Z 0-n Do �::e Any person occupying premises served by the above system(s) sha�p� uch 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 Zhange dification or change when, i the judgment of the Director /Commissioner, such revocatiob, modification is necessary. By: Title: Date: White copy - HD File Yel w c y - Building Inspector; Pink copy wne • range copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF'ENYIRONMEI` TAL HEALTH-SER'V'ICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM G t/A?-bf A►J 4'U l-(`C/ -7q. l � Owner or Purchaser of Building Tax Map Block Lot 6AVAV,,j1ArJ Nf y((,hG2S trti f/ PA776LL�Qrf Building Constructed by TownNillage Location - Street Subdivision Name Sl tJc4 t,6, FAM t t-`( Fa t DG�Cei ( D 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 system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month _ Day Year General Contra r (Owner) - Signature r .5hA ) t)(t :E 5 .I Corporation Name (if corporation) Signature: Title: Corporation Name (if corporation) Address: f _�� 1 (r Address: State 001-MES Al P Zip 19- 3) State Zip Form GS -97 F BRUCE R FOLEY Pubic ffeahA ►Dtrec:cr _ l� LOR=A MOQ.NAA1 P-Nh ,. &U.N:, -- itiiociau PMaki Health Director Director of Patient Serviers DEPARTI r= OF HEALTH , 1 Geneva. Road , Brewster, Now York 10509 "L 'Ealriroameattl Health (914) 278.6130 Fmr (914) 278 - 7921, Sutnlnq SoMea (9141270 .6358 WIC (914) 271 •667.8 Fax (914) 278 .6003 Urty Ioterreaclaa (914) 2,73 -6014 Preschool (914) 278 -4082 Fax (914) 273- 6648 E91 I ADDRESS VER'fFTCATT(7N FCIRM OVVI ERS NAME: Gua4dian Home BuitdeAA, LLC TA -x MAP A.-VI B E R: 3 y — 1 a E911 ADDRESS: 4 AV ^14 � ✓/ . It j44e t�o f p TOWN: AUTHORIZED TOWN OFFICIAL: (Sipature) 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 E9'11 address is assigned by an authorized town official. This form is to be submitted -*ith the application for a Certificate of Construction ConipUance. cE� i V1) PUTNAM COUNTY DEPARTMENT OF HEALTH ... __,.. _ ....., DIVISION. OF ENVIRONMENTAL HEALTH. SERVICES . dIIeIIPermt; #w WELL COMPLETION REPORT Well Location Street Address: 186 Tammany Hall Rd Town/Village: Brewster Tax Map # Map 34 Block 4 Lot(s)88 GPS 41044.836N 73 °63.152 Well Owner: Name: Address: Guardian Homebuilders, LLC, 10 Mekeel Street, Katonah, NY 10536 Use of Well: 1- Primary 2- Secondary X Residential _Public Supply Air cond /heat pump _Irrigation Business Farm Test/monitoring —Other(specify) Industrial Institutional Standby Drilling Equipment XRotary _Cable percussion _jCompressed air percussion _Other(specify) Well Type _Screened _Open end casing ___L Open hole in bedrock _Other Casing Details Total Length 42 ft. Length below grade41 ft. Diameter 6 in. Weight per foot 191b /ft Materials: X Steel Plastic Other Joints: Welded X Threaded Other Seal: X Cement grout Bentonite Other Drive shoe: X Yes _ No Liner: _Yes X No Screen Details Well Yield Test Diameter in Slot Size Length (ft) Re pt to Screen ft Developed? First _Yes _No Hours Yield 5 1/2 gpm Second _Bailed Pumped X Compressed Air Hours 6 Depth Date Measure from land surface - static (specify ii 60' During yield test (ft) 220' De pt o completed well in ft. 305' Well Log If more detailed .. information- ,, ...... descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter in Formation Description ft. ft. land surface.._..._.... _ 23' Drilling in -.ov rb�urden ._..c and-boulders Hit rock at 23 23 42 Drilling in rokk. set casilicy- 42 305 Drilling If yield was tested at different depths during drilling list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type gulL Capacity 5 -,r„ Depth 240' Model 5GS05412 Voltage 230 HP - 1/2 Tank Type WX250 Volume .44 gal. Date Well Completed 12'/6/10, Well Driller PC Certificate # 019 NY State # Date of Report F -jj� NYRD10105 Pump `Installe�;'PC,Certlficate;#024 : 'NY State# 12/17/19. Well Driller Name 8� Address P F' Beal &Sons; Inc 4 Putnam, Ave , ,!Brewster , ,NY 10549 ;3?s,, 21 Wel (signature) ,Ghrlsto; - h r =..Be Y Pump Installer Name & 3Address' PFD, ur T P, Beal am &Sons I T, nc 4 Putn Ave Brewster ANY 10093.. �,, . „.....,, kv.?.a NOTE: ^Exact Location of well with distances to at 166 ftiNo'p6rmianent landmarks to be provided on a separate sheet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - 'Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 A'b PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: 186 Tammany Hall Rd Town/Village: Brewster Tax Map # Map 34 Block 4 Lot(s)88 WN 41 °44.836 73 °63.152 Well Owner: Name: Address: Guardian Homebuilders, LLC, 10 Mekeel Street, Katonah, NY 10536 Use of Well: 1- Primary 2- Secondary X Residential _Public Supply Air cond /heat pump _Irrigation Business Farm Test/monitoring —Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary _Cable percussion X;Compressed air percussion _Other(specify) Well Type _Screened _Open end casing X Open hole in bedrock _Other Casing Details Total Length 42 ft. Length below grade41 ft. Diameter 6 in. Weight per foot 19lb /ft Materials: X Steel Plastic Other Joints: Welded X Threaded Other Seal: X Cement grout _Bentonite Other Drive shoe: X Yes _ No Liner: _Yes X No Screen Details Diameter in Slot Size Length (ft ) Dept to Screen ft Develo ped? First I 1—Yes _No Second I lHours Well Yield Test _Bailed Pumped X Compressed Air Hours 6 Yield 5 1/2 gpm Depth Date Measure from land surface-static spec ft 60' ur ng y eld test ft) 220' ueptn oT comp e e we in ft. 305' Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter in Formation Description ft. ft. Land surface 23 Drilling in overburden, cl and boulders - - Hit: rock at 23 ___ 23 42 Dri o 42 305 Drilling If yield was tested at different depths during drilling . list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type aub Capacity 5g rte, Depth 240' Model 5GS05412 Voltage 230 HP 1 2 Tank Type WX250 Volume 44 gal. Qafe weq >Cgr>lpletedY 1(eIG Duller PYCert�ficate# Olc� ` ° ANY State # k* _ ANY °ItDZ0195 !1.4,01 Pump InsiallgrG #E1er#ificate/02�+ Y'S e`# °# a ' ft Date Qf Report4{ 12/1710. R nY N# k llatU e Well Drlllef NteAc�dr�ss= IIleila� ar r. � w - ' s r,5,.° &'Ho I c�€'uie t3rew si ...j..3..�s. a turd e \ /g Pump r � -. :% y � ' .' ('Y _"� - n i .' x . , t� .kk. � .;`w p .� Instalalel r �tNit �BS�dde amAn r ew£ � sx � s � P TP , NOTE: Exact.Location of well with distances to at I'bAtt'tWo'06rmanent landmarks to be provided on a separate sheetlpian. White copy: HD File; Yellow copy - Building Inspector; Pink copy = 'Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 Sherlita Amler, MD, MS, FAAP Commissioner of Health Robert Morris, PE Director.of Errvironmentzl..Health.__ July 27, 2011 John Kalin PE DC Engineering 3 Memorial Avenue Pawling, NY 12564 Dear Mr. Kalin: Department of Health 1 Geneva Road, Brewster, NY 10509 . Office (845) 808 -1390 Fax (845) 278 -7921 or (845) 808 -1937 Re: Field Inspection 186 Tammany Hall Road (T) Patterson, TM 34.4-88 Subdivision Lot #10 The above referenced separate sewage treatment system can be backfilled. Paul Eldridge County Executive There ar`e`no open c6mmerits to be addressed at this'tiirie'in'F feferice tb this D'epartment's-open ` work inspection. If you have any further questions, please contact me at (845) 808 -1390, ext. 43261. Sincerely, W-r-, Gene D. Reed Sr. Environmental Engineering Aide GDR:cw i PLJTNAM COUNTY DEPARTMENT OF EMAL DIVISION OF ENVIERONMMNTAL HEALTH -SERVICES FINAL SITE INSPECTION Date: Inspected by, i,:Street Location:- own Town Permit# P— 2-7 3 TM # —3 ill,, I? ig Subdivision Lot # /0 I., Sewage Svstem Area a. STS area located as per approved plans .......... p ................. 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...... ...... ......................... n SewaZ6 System a. Septic tank size-- 1,000 ......... 1,250 ......... other ................. b. 'S eptic'tank installed level .............................................. c. 10' minimum from foundation ........................... ............. d. Distribution Box 1. Alt outlets at same elevation-water.tested .................. 2-. Protected below frost ................................................. 3. .. Minimum 2 ft. Original soil between box & trenches . e. Junction Box - properly set .......................................... 6. 'Jurenches f . —Length required 3,v cp Length installed 3c0 2. Distance to watercourse measured .. f- goo Ft ........... 3. Installed according to plan ......................................... 4. Slope of trench acceptable 1116 - 1/32"/foot ............. 5. 1011. from property he - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surfice ................. I . 7.,.,Room allowed for expansion, 100% ......... z ............... 8. Size of gravel 3/4 - 11/2" diameter clean .................... 9. Depth of gravel in'trench 12" minimum......;; 10 .Pipe ends,cayped ...... g. Pumig or Dosed bvstems 1. Size of pump chamber ................................................ -2. Overflow tank .* ...... ' .......... : ................................. 3. Alarm, -,� '-�au 0 .......... * .......................................... 4. Pump easily accessible, manhole to grade........ :........ 5. First box baffled .... * ....................................................... 6. Cycle witnessed by. H.-D,estimated flow/cycle ........... Iii. House/Build' a. House located per approved plans ..................... b, Number of bedrooms .................... * ............... IV. Wen Well located as per approved plans ................................. b. Distance from STS area measured /00 ' - ft........... c. Casing. 18" above grade ................................................ d. Surface drainage around well acceptable ........................ V. Overall Workmanshin a. Boxes properly grouted .................................................. b. All pipes partially backfilled .......................................... c. All pipes * flush with inside of box ................................... d. Backfili material contains stones <4" diameter .............. e, Curtain drain & standpipes installed according to plan.. f Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area ............... h- Surface water protection adequate......_ : ................ i. Erosion control provided ......................................... I ...... Rev. 12/02 CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYST PERMIT # �" �� ° 0 Located at F �& 'rWMARY HA U_ PM2 Town or Village Subdivision name P-0 V`-) 0 OV Subd. Lot # 10 Date Subdivision Approved 01 / i 1/ yv Owner /Applicant Name 6(jA1ZVJ,4J i4'-H15 La r A i"n o" Tax Map °) 4. Block 4 Lot 6 9 Renewal X Revision Date of Previous Approval 06- i 0 ° 06 Mailing Address 10 J<47-oP4 N A%C-W ` *0Xr• Zip %65 Amount of Fee Enclosed Building Type ,mac Lot Area No. of Bedrooms ?� Design Flow GPD 600 Fill Section Only Depth Volume PCIID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 79140H p czar✓ gallon septic tank and ' 00 Lr-•• Ao5, Other Requirements: '�' f=ib �� P H49Y �✓` J f 70 f ;. j C� 9646 l��+ To be constructed by "rep Address Water Supp]j: Public Supply From or: X - Private - Supply Drilled by- . li3. p.. Address ,. . 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 therdate of the issuance of the approval of the Certificate of Construction Compliance of the original system or any rep irs;thereto. Signed: ti. ,, P.E. Address �� I' .. ` i " j He)Z roc- A vG- PA W4 R.A. Date 0'5 /Z5 /fie License # o l -1004 APPROVED / 'ON: This approval expires two years from the date issued unless construction of the sewage treatment ;i ste has -be n completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. Approved f af4ischarge of domestic sanitary sezz B y: Title: Date: White copy - HD File' Yel ow c py - Building Inspector; Pink copy -n Owgor; Oiante copy - Design Professional om CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL ^ A % w AA please print or type Well Location Street Address: Town/Village: Tax Map # / s� 186, l AIHHA' °a KA" R- F�` Fpt� �4 Map`;,4� Block 4 Lot(s) 00 Well Owner: Name: Address: Phone #: ` ?p 3IdSg Use of Well: _Residential _Public Supply Air /cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield Sought 61' gpm # People Served ' � " , Est. of Daily usage (at to gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drilling `4 New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes No )X Is well located in a realty subdivision? ........................................... ............................... Yes No Name of subdivision P°b4�6%V4 Lot No. 10 Water Well Contractor: Tbp Address: Is Public Water Supply available on site? ....................................... ............................... Yes _ Nom_ Name of Public Water Supply: TownNillage •° Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate she' et/pl n. 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 Departmei 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 Commissioner of Health. Any revision or al eration of the ap ved plan lequires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue Permit Issu' Official: Date -of Expiratio Title: Permit is Non -T nsfer ble White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; - Well driller. Form WP -97 Rev. 3/06 $herlita Amler, MD, MS, FAAP 1. 'C- ommissioner of Health Robert= Morris, PE Director of Environmental Health June 1, 2010 John Kalin, PE DC Engineering 3 Memorial Ave. Pawling, NY 12564 Dear Mr. Kalin: Department of Health 1 Geneva Road, Brewster, NY 10509 Robert J. Bondi County ,Lrecutive Re: Proposed SSTS Application for Guardian Home Builders 186 Tammany Hall Rd, Lot # 10 at Rosewood R.S. (T) Patterson, TM # 34.4-88 Middle Branch Reservoir Basin The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on May 28, 2010 is complete. The Department will notify you by June 21, 2010 of its determination. 0 The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ❑ Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my - attention at-the above-address. This notice must include your name; the location of the project, the- - office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed. Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed approved, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 43148. Y, Michael J. Bu inskil, Director of E gineerin MJB:kly Environmental Health (845) 278 -6130 Ffic (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845,).225 75418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing / Home Care Agency (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 { PUTNAM COUNTY .DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH. SERVICES LETTER OF AUTHORIZATION RE: Property of G vAF-D i AO fl- omc-1E V 1 t-r_,-x�y-S Located at I b G TAMAW -SY A- X41 -V r.D ONV FAIlf - '00 Tax Map # Block Lot 8v Subdivision of j�aSEWDOD Subdivision Lot # 1 O Filed Map # Date Filed 00 Gentlemen: This letter is to authorize � p N-+-- 4-. V-A L- I !-� 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-Putn4mq ty Sanitary Code. w A, h� yp9 CO o Very truly yours, Countersigned Signed: �p P.E., R.A., # zs�;. t� �\ >�� o 1700 y (Owner of Property) Mailing Address *12 IfI A, L- AV f-5 State N I Zip 12-S (, Telephone: g- S- Z Mailing Address: j(� ��. ST State N Zip 0's-L Telephone: � Pj Form LA -97 i BRUCE R • -F0LPY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTft - 1vfE)I'INA� - P I : M 9*.N' Associate Public Health Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 WIntervention (914) 278 - 6014 Preschool (914) 278-6082 Fax (914) 278 - 6648 r- &Ae e(,sl C) TO: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM DELEGATED -j�t'q e3 * izrr 0-to 1�20sf��� PROJECT: TOWN- C _.S : P .If . PV ..._..-- 'DATE-SUByD APPROVAL:.. �._����� _ .__.._.�.._ -- ._.._.....�_........_ NOTICE OF COMPLETE APPLICATION DATE: C - -E N. G _I...N:.E E ..R: -.I. N G- g..R C LETTER OF TRANSMITTAL To: Putnam County Health Department 4 Geneva Road Brewster, NY 10509 Date: May 27, 2010 Job No: Attention: Mike Budzinski, PE RE: SSTS Submission - Rosewood Lot 10 Renewal We are sending you: ✓ Attached 0 Under separate cover via The following items: • Shop Drawings 0 Prints ✓ Plans 0 Samples ❑ Specifications • Copy of Letter 0 Change Order Copies Date No. Description 5 - 5/1/10 Rosewood Lot 10 SSTS Renewal Plans 1 5/10 Application Papers 1 5/27/10 Renewal Check These are transmitted as checked below: ✓ For approval ❑ As requested ✓ For your use ❑ For review and comment Remarks: Attached please find the SSTS renewal for Rosewood S/D Lot #10 owned by Guardian Homebuilders. Signed: cc: File D E S I G N C O N C E R T S E N G I N E E R I N G R C S MEMORIAL AVE. SUITE 1 O 1 , RAWLING, NY 12564 PH: B45 -B55 -2000 • FX: 645 -855 -2605 E: JKALINOVERIZON.NET NEW Y6;tK STATE DEPARTMENT ' QFHEALTH " Bbreau of-Community Sanitation and Food Protection Specific Waiver from Requirements of Part 75 and Appendix 75-A, I ONYCRR for Individual Household Sewage Treatment Systems Name of Applicant 0 No, /,7 S".. — Wo*" . . 5tw . zo Address I 1 2 653kooey-( Nz- Lo I+r-a--- ?LA-, as fij L4 I oo 04 Site Location L'of 91 C-) 1. Reason why site does not meet 10NYCRR Appendix 75-A (check appropriate box(es)): Separation distance cannot be achieved. 1/ slope. High groundwater. Inadequate depth to bedrock or impermeable layer. Soil unsuitable. Other (explain) . . . . .. . .... . .. . .......... 2. Proposed design or conditions c.' waiver: `7D /, F—T A::e)� -H cc- .............. - -.... _............................................................................................................................................................................: . .. ................ ...................................... The prcposed design may have the following limitations (check appropriate box(es)): i Increased risk of well or spring contamination. Increased risk of surface water contamination. Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. Other (explain) . ... . ..... ... []Additional information attached Construc!;on pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations. Parl'75.6 (b), a waiver is hereby granted. This waiver may be revoked by the. issuing official for a change in conditions for which this waiver was granted. bF, 6F'PEALTH .. .. . .... .... ORIGINAL - Local Health Agency COPY - Applicant/Design Professional (GEN •152) OkTNAM COUNTY DEPARTMENT OF HEALTH `� ON OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM 1 PERMIT # Located at j" Am, 4 A) AdU- i�'� Town or Village IC A717 e__10,4,1 Subdivision name0SCVl%in Subd. Lot # /d Tax Map Block 4- Lot Sg Date Subdivision Approved %%� j Renewal Revision ✓ Owner /Applicant Name,,/ %Gi Date of Previous Approval Mailing Address �� N% �E� �'f" �T , k= Lrz;A, )A-# /t-z Zip 1063.(v Amount of Fee Enclosed `0�0. c�D (�Mc�clt��ej7t� Building Type 6t�� Ieten C' Lot Area3_ _59 No. of Bedrooms 3 Design Flow GPD 00 Fill Section Only Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and 500 LF OF i�7%7'7T.17T 5��7.70'��fS Other Requirements: To be constructed by 'r 9,0 Address Water Supply: Public Supply From Address or: ` L""',-'Private Supply Drilled'by '" I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewagg 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 v owner, his successors, heirs or assigns by the builder, that said builder will place in good operating co s sewage treatment system during the period of two (2) years immediately following the date of the 'St e f the Certificate of Construction Compliance of the original system or any repairs thereto. c w Signed: �� R.A. Date Address 7 r C/t-e } 'O9 A License # 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 mod"e� ary by the Public Health Director. Any revision or alteration of the approved plan requires a neharge of domestic sanitary se a ge only. ff By: (4 46t Title: Date: White copy - HD Fil , Yel w opy - Building Inspector; Pink copy - O er; ge copy - Design Professional Form CP -97 P.W. SCOTT ENGINEERING & ARCHITECTURE, P.C. r 3871 Route 6 ' Brewster, NY 10509 E -Mail: pwsc®tt @rcn.c®m (845) 278 -2110 FAX (845) 278 -2166 TO �- WE ARE SENDING YOU J Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ DATE JOB NO. - 4 ATTENTIONy RE: 41,0 ❑ Samples COPIES DATE NO. DESCRIPTION `THESE ARE'TRANSMIITTED as checkbd'below: ;2' For approval ❑ Approved as submitted ❑ Resubmit • For your use ❑ Approved as noted ❑ Submit • As requested ❑ Returned for corrections ❑ Return _ ❑ For review and comment ❑ REMARKS the following items: ❑ Specifications —copies for approval —copies for distribution corrected prints ❑ FORBIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO SIGNED: If enclosures are not as noted, kindly notify us at once. SHERLITA AMLER, MD, MS, FAAP Commissioner. of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health June 2, 2008 P.W. Scott Engineering 3871 Route 6 Brewster, NY 10509 Dear Mr. Scott: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Proposed SSTS Renewal for Guardian Home Builders Lot # 10 — Rosewood R.S. (T) Patterson, TM # 34 -4 -88 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health This..Department has received and reviewed the revised plans for the above referenced project `arid fhe following comments are offered for your consideration: `� ,I-'The PCHD SSTS notes are to be revised in accordance with Bulletin ST -19, revised July 2007. 2. e function box detail is to be revised to show a minimum of 2 feet of solid pipe out of the box prior to the start of the perforated pipe. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. MJB:kly Respectfully, A ftineeri ichael J. Bu Director of E Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 P.W. SCOTT ENGINEERING & ARCHITECTURE, P.C. 3871 Route 6 Brewster, NY 10509 (845) 278 -2110 FAX (845) 278.2166 [� TO LLIEUT212 OCR o e LJV�LJVLJ���Lr-.\I� DATE jj -7 _', - SS L/ '• 0�.. y. JOB NO. ATTENTION RE: JJ >: 0A vc7 / ;- ❑ Returned for corrections • For review and comment 10 RRIF WA W WE ARE SENDING YOU " Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans 0 Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ THESE ARE TRANSMITTED as checked below: For approval ' ❑ For your use ' PTION ❑ As requested ❑ Returned for corrections • For review and comment 10 RRIF WA W • FORBIDS DUE THESE ARE TRANSMITTED as checked below: For approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections • For review and comment ❑ • FORBIDS DUE REMARKS COPY TO ❑ Resubmit copies for approval • Submit copies for distribution • Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: If enclosures are not as noted, kindly notify us at once. P.W. SCOTT ENGINEERING & ARCHITECTURE, P.C. 3871 Route 6 Brewster, NY 10509 a« E -Mail: pwscott @rcn.com (845) 278-2110 FAX (845) 278 -2166 TO _eC.�.IiLC WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via • Shop drawings ❑ Prints ❑ Plans • Copy of letter ❑ Change order ❑ LEVV1913 MIF 4 ° HQ M 044ad r �%r ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION `- • TFIESE ARE TRANSMITTED as checked below: AFor approval • For your use • As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS ❑ Approved as submitted ❑ Resubmit copies for approval ❑ Approved as noted ❑ Submit copies for distribution ❑ Returned for corrections ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US /zk 5-e.2- ✓-� cc%,'C- .- �r1� -e . I 40,,P9L ir- n ✓J : 4-iv7 e— 41 L 11 1 �Y %G-- 411.1 Yom' COPYTO �^� if enclosures are not as noted, kindly notify us at once. ��� 114P 683 685 GSio I at 07 Go rlo 6 �Gj M PE -s6R 2I p�iar! � �I r is i c� 1�M�M�' u IA ER 17KIvF,WAY Earl, f I� -rol 0 Toy i / oy G iP UW ! I j I // MIN EE �i�EPl�iJi LIJp'1P>ING1 It MIS NI 7 4 @ ► tUII��W6G c rL4MI- - IIJJOUT 701.o boo GAS Grp rT MIN• plr�F �'�, � ���F � • 698.0 GB►5 e9 < X95 L � e`�' i i � ptr 12�o6°fJU r� � ' �j1 -5YK 3� ��N Gor{i• 58 tl D 1° Nk. '— 2�f t N O � i i � N►tN �L12H (rN1y�% (iclp GOP'11'WN ICOffi � IOG 683 685 GSio I at 07 Go rlo 6 �Gj M PE -s6R 2I p�iar! � �I r is i COUNTY DEPARTMENT OF HEALTH ON OF ENVIRONMENTAL HEALTH SERVIr'V CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM # � c) 7 0 3 Located at i f ( 'r�- 1MYKPr4 y #94,, '�� Town or Village `-f'' we—V-5c Subdivision name za1myp Subd. Lot # 0 Tax Map2+ Block Lot o Date Subdivision Approved I /u/00 Renewal ,L/ Revision Owner /Applicant Name -6.jkj J,44 &JJ 09 Date of Previous Approval Mailing Address h'� c- ��l✓� �t.,�6► �+ , %S - �/ /�� Zip Amount of Fee Enclosed Building Type g& " ?7Ge Lot Area No. of Bedrooms'_ Design Flow GPD 6040 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of i 11�t) gallon septic tank and 4" &/A-44 1=6'' i7--/u- 1400 T°%QJ, Other Requirements: To be constructed by I-elD Address -�5 ®o 4'r o Water Supply: Public Supply From Address or 'Private'Supply-Drill "ed "by T- 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 b owner, his successors, heirs or assigns by the builder, that said builder will place in good operating con ' tg S sewage treatment system during the period of two (2) years immediately following the date of the i e a �jEl the Certificate of Construction Compliance of the original system or any repairs thereto. F • e$ t a � Signed: R.A. Date Address I^ � Ste` `' 14 License # -0!!5 23 !'-6 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. Approve or discharge of domestic sanitary sew ge only. —0z t By: — Title: Date: White copy - HD Ve; Ye ow opyl- Building Inspector; Pink copy - O ; Or ge copy - Design Professional Form CP -97 0 z A k PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT WATER WELL: - please print or type PCHD Permit # Well Location: Street Address: Town/Village Tax Grid # / 6 6 .7""A13?M -441 AWL. )'�OAO, Map 34 Block 4- Lot(s) Well Owner: Name:4!5,}zJi.'p /.nJ Address: Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought _ gpm #People Served Est. of Daily Usage 6O gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes_ No Name of subdivision Lot No. /0 Water Well Contractor: /? OE A55-A-41 Address: A ®7Czcd '/4CL�- /L/ X Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: AJ *A- Town/Village Distance to property from nearest water main: lA- Proposed well location & sources of contamination to be provided on ate sheet/ Date: __1 I : - Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. B 'If Date of Issue 2,—,9-02 Permi Date of Expiration ' 7 -lu Title: Permit is Non - Transferrable white copy - till tile; Yellow copy - 13uilding inspector; Fink copy - uwder; urange copy - well driller Form WP -97 P.W. SCOTT ENGINEERING & ARCHITECTURE, P.C. 3871 Route 6 Brewster, NY 10509 E- Mail := wscott @rcn:com (845) 278 -2110 FAX (845) 278 -2166 TO WE ARE SENDING YOU � Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ DATE JOB NO. _ATTENT N_ RE:,' IC) the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION .THESE ARE TRANSMITTED as- checked below:-. For approval • For your use • As requested • For review and comment ❑ FORBIDS DUE REMARKS • Approved as submitted • Approved as noted ❑ Returned for corrections • Resubmit copies for approval • Submit copies for distribution • Return corrected prints L] PRINTS RETURNED AFTER LOAN TO US SIGNED: if enclosures are not as noted, kindly notify us at once. P.W. Scott ;- Engineering & Architectw " . 3871 Route Cz..._ . Brewster, NY 10509 February 18 2008 Mr. Mike Budzinski PCDOH I Geneva Road Brewster, NY. 10509 Re: Proposed SSTS Renewal For Guardian Home Builders Lot #10 — Rosewood R.S (T) Patterson, TM #34 -4 -88 Dear Mike: P.C. email: W /_ 278 -2110 278 -2166 The following comments have been addressed per your February 13, 2008 review letter: Item #1: PCDOH Note #4 has been revised in accordance Bulletin ST -19, revised July 2007. Item #2: A note has been added to the plan construction notes and SSDS profile stating "All four -inch PVC piping beyond the septic tank shall have a minimum pipe slope of 1 %." Should you hdve' any questions, please feel free to contact our office'af your earliest convenience " With Regards, rwe Peder W. Scott, P.E., R.A. President A R C H I T E C T U R E * E N G IN E E R I N G * S IT E P L A N N I N G .G Si a.00.( .�> aiJ " i Et Rea�) .d E-M , SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA-MOLINARI; *N_; MSM= -a Associate Commissioner of Health February 13, 2008 P.W. Scott Engineering 3871 Route 6 Brewster, NY 10509 Dear Mr. Scott: ROBERT 1 BONDI County Executive _.. WOBERT-MORRRIS, PE- Director of Environmental Health DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 Re: Proposed SSTS Renewal for Guardian Home Builders Lot # 10 — Rosewood R.S. (T) Patterson, TM # 34 -4 -88 This Department has received and reviewed the revised plans for the above referenced project and the followin comments are offered for your consideration. ' PCHD note # 4 must be revised in accordance with Bulletin ST -19, revised July 2007. All four -inch PVC piping beyond the septic tank shall have a minimum pipe slope of 1 %. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. MJB:kly Respectful) 17 U11U Michael J.1 Director of 1' u Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 I P.W. SCOTT ENGINEERING & ARCHITECTURE, P.C. 3871 Route 6 Brewster, NY 10509 ��isc ®���n:c ®aria (845) 278 -211® FAX (845) 278 -2166 TO Ae lV�c: Pv /USt� i WE ARE SENDING YOU A Attached ❑ Under separate cover via _ • Shop drawings ❑ Prints ❑ Plans • Copy of letter ❑ Change order ❑ LETTER OF TRANSMITTAL the following items: . ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION 'THESE ARE TRANSMITTED as checked below 'Yor approval • For your use • As requested • For review and comment • FORBIDS DUE REMARKS COPY TO • Approved as submitted ❑ Resubmit copies for approval • Approved as noted ❑ Submit copies for distribution • Returned for corrections ❑ Return corrected prints Ll PRINTS RETURNED AFTER LOAN TO US SIGNED: If enclosures are not as noted, kindly notify us at once. d SHEkLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health P.W. Scott Engineering 3871 Route 6 Brewster, NY 10509 Dear Mr. Scott: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 \3 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health January 31, 2008 Re: Proposed SSTS Renewal for Guardian Home Builders Lot # 10 — Rosewood R.S. (T) Patterson, TM # 34 -4 -88 This Department has received and reviewed the submitted application and plans for the above referenced project and the following comments are offered for your consideration. .e The proposed driveway contour labels from 486 to 494 are incorrect. ,21 A sleeve is to be provided for the septic tank effluent pipe under the driveway. s3! The size and type of piping from the yard drain to the proposed drainage manhole is to be specified. In addition, invert elevations for the manhole and end section are to. be specified. The water line from the well to the house is not shown in its entirety. �5! A water /sewer crossing detail is to be provided on the plan. - /• -The ?CHD SSTS notes• are to be- revised in accordance with Bulletin ST -19, revised July 2007. Upon completion of the above, this Department will continue its' review. Kindly advise us if there are any questions. MJB:kly Michael J. Budnskitp Director of En ineerin Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 P.W. Scott ri = Engineering & Architecture, P.C. _, .. 3871 Route 6 -- � Brewster, NY 10509 February 4, 2008 Mr. Mike Budzinski PCDOH 1 Geneva Road Brewster, NY. 10509 Re: Proposed SSTS Renewal For Guardian Home Builders Lot #10 — Rosewood R.S (T) Patterson, TM #34 -4 -88 Dear Mike: The following is in response to your review letter dated 1/31/08: email: FAX L The proposed driveway contours have been revised accordingly to 686 to 694. 2. An 8" PVC SDR 80 pipe sleeve has been added to the septic effluent pipe under the driveway. 3. The drainage pipe sizes and inverts have been added. See drainage structure invert schedule. water line has "been shown *conriectirig to the gear= of tfie-liouse -To provide additional separation from the septic tank, a sleeve is proposed around the waterline extending 15' beyond the septic tank. 5. There are no water /sewer crossings shown. 6. The PCDOH SSTS notes have been revised in accordance with Bulletin ST -19, last revised July 2007. Should you have any questions, please feel free to contact our office at your earliest convenience. ith Re 1'ider W. Scott, P.E., R.A. Pft;Odent 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 ,, .: ., .: .t -: *rY" -: s:':,i i. i, �:.3 �Si %3 C; ti'F .i <42a ,, .L.'• ��..'I : :t1 t t S (;� i e 021 �.,�r:.Z. U .v �. 278 - 2110 278 -2166 BRUCE R FOLEY Public' Health Director;- LORETTA.,_ MOLINARI .R.N., M.S.N. Associaie-'i'ublic Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 �( ALA 1�51 TO: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM DELEGATED PROJECT: 6rvi4ieki ! c40"F_ '_& -L&=�5 �7 94 r % A . lea TOWN: C SE�)K PV DATE SUB'D APPROVAL: a J NOTICE OF COMPLETE APPLICATION DATE: " -2 %"�U SHERLITA AMLER, MD, MS, FAAP Commissioner of Health �- LORETTA MOLINARI, RN; MSPd =� Associate Commissioner of Health DEPARTMENT OF HEALTH January 29, 2008 1 Geneva Road, Brewster, New York 10509 P.W. Scott Engineering 3871 Route 6 Brewster, NY 10509 Dear Mr. Scott: ROBERT I BONDI County Executive "ROBERT-MORRIS, -PE • Director of Environmental Health Re: Proposed SSTS Application for Guardian Home Builders 186 Tammany Hall Rd, Lot # 10 at Rosewood R.S. (T) Patterson, TM # 34 -4 -88 Middle Branch Reservoir Basin The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on January 29, 2008 is complete. The Department will notify you by February 18, 2008 of its determination. The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ❑ Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my -- - �- —attention -at• the- above•address: This notice-mustinelude- your - name; -the location, of- the-project the -- - office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed approved, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2148. Michael J. Bu ins , P Director of E inee MJB :kly Environmental Health (845) 278 -6130 Fax ( 45) 278 -7921 Water Supply Section (845) 225 -5186 Fax (8 ) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL. HEALTH SERVICES AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTN ENT To: Public Health Director In the matter of application for: _ I, t A.4- aA represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: 6CL - 1ty4(1rN NCIVVVZbUIUP4 L Having offices at: P, C9, X30' % Whose Officers Are: PMr t - Name: � �� f'/�n+ `i't Address: P'O- 150t - ��G�- k 4 2¢ N W t - Name: 1,,%V %.A +,0FVV%A1'M Address: (Z 4iJp�_r-_ 1A , GCS" II-irrlvtic.� Secretary -Name: Address: Treasurer - Name: Address: and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Signed: Title: 4 agZ74 S orn to before me this day of mo 24a) (year) Notary Public ROBERT R MORINI Notary Public, State of New York No. 01 M04600360 Qualified in Putnam County,, Form CAT5F Expires August 15, 20 Corporate Seal 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: �l �-v�i' is ,ti 001-e 2. Nameofproject: Rosewood Subdivision 3. Location TN: Patterson P.W. Scott, Engineering 4. Design Professional' & Architecture, P. c - 5. Address: 3 8 7 1 Route 6 6. Drainage Basin: Brewster, NY .10509 7. Tvne of Proiect: X Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted X 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... No 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency Town of Patterson Planning Board N/A 12. Is this project in an area under the control of local planning, zoning, or other _ .._ .- .__... -- . - .officials,- ordinances? ....:........ Yes e 13. If so, have plans been submitted to such authorities? ........ ............................... Yes - S u b.d i v i s i o n 14. Has preliminary approval been granted by such authorities ?Y e s Date granted: %1 CO 15. Type of Sewage Treatment System Discharge ................. surface water X groundwater 16. If surface water discharge, what is the stream class designation? .................... N/A 17. Waters index number (surface) ............................................ ............................... N/A 18. Is project located near a public water supply system? N o 19. If yes, name of water supply A�) 6- Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ N o ... 21. Name of sewage system Individual Lot Distance to sewage system 22. Date test holes observed IS - 6, c5' 23. Name of Health Inspector 24. Project design flow (gallons per day) ............. 800 cP n 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? ..................... N/A Form PC -97 2 27. Is any portion of this project located within a designated Town or State wetland? No 2 N A 8. Wetlands ID Number ........................................................... ............................... / 29: Is Wetfands`Perm'it -iequired? .......................................:...... ............................... 90, Has application been made to Town or Local DEC office? N/A 30. Does project require a DEC Stream Disturbance Permit? .. ............................... N o 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............... Yes/No N o 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... Yes 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................. ............................... Yes 35. Are any sewage treatment areas in excess of 15% slope? . ............................... No 36. Tax Map ID Number ............................. Map 54" Block 4- Lot 37. Approved plans are to be returned to ..... Applicant X Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent-to-the !Department-;, and. need-not-be•sent in duplicate to the DEP, although the project may require DEP--- approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES. Peder W. Scott, P.E., R.A. - Agent for Applicant Mailing Address: ................................... 3871 Route 6 Brewster, NY 10509 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENV1R0TNNMNTAL HEALTH SERVICES DESIGN DATA'SilkET" -SVtSURFACE SEWAGE !" TREATMENT SYSTEIM Owner f+6� p-sm�-c,_ VAY40 ("Lo. Address Located at (Street) 196 TA-v—t, � H-At LR0Rr0 Tax Miap �q Block Lot S (indicate nearest cross street) Municipality pA -TTL::; sow — Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test 2- (4 J to - - -- - Hole No. Run No. Time Start - Stop Ela&se Time in.) Dipth to Water om Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate iWmqnch 10 A 7-71" 2- a 2-7 1 t' H I I:q(. � o % 17,6 1 :50z, 3 1 1..qs i at (8 30 9-0 Y2- Q7- 4 5 0 2-0 Olt I jXq 3 C�j 3 11*5Z 12,�?-L)j 3b 7,� I 4 5 4 5 I" UTES: 1. Tests to be repeated at same depth until aoDroximatety equal percolation rates are obtained at each I I I percolation test hole. (i.e. -e, I min for 1-30 min/inch, < 2 min for 31 -60 min/inc,h) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form, DD-97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST MOLES DEPTH HOLE NO. A I O A HOLE NO. O 6 HOLE NO. 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 -�ay- O 7.5' 112 151F r Vr 8.0' T%5 T- 8.5' 9.0' 9.5' 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed No -R-L) Ni Indicate level to which water level rises after being encountered Deep hole observations made by: M, �-Lo D . -P kE- P Date 3 acd cl � Design Professional Name: Address: z Signature: JZw Design Professional's Seal y� =� 2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - ..::. - -L ,DESfGN DATA sHEiE? SuggURFACE SEWAGE`T12EATMENT SYSTEM Owner 166W U1WAa Address I S(:. YA.MMAt1j 1e-0Ar;' Located at (Street) 'Z l k4"tF g. 12, zPA,5P. Tax Map Block Lot (indicate nearest cross street) Municipality Drainage Basin 6KA -064 Mo- x SOIL PERCOLATION TEST DATA Date of Pre - soaking \TA-m . /! i 2,00 Date of Percolation Test Hole No. Run No. Time Start - Stop Ela se Time 111,n.) De th tobWgter rom Ground,. Surface (Inches)' Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 10 I� i 1 d I 22 2S li3 1 �� t 5� ,� 'D 5 3 5 1 2 3 4 5 NU "TES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtamea at eacn percolation test hole. (i.e. _< 1 min for 1 -30 min/inch, <_ 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -91 DEPTH G.L. 0.5' 1.0' 1.5' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES-!_ HOLE NO. 10 HOLE NO. 100i HOLE NO. Tolms f��D/ (�I�N� 1=►a 2.0' 14" 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' t 7.5' 8.0' 8.5' 9.0' 9.5' 10.0" M r i►je. To w4J6121 UM 5 AT,112 #N2 1 TO OWILAM T P ID1° I� Indicate level at which groundwater'is encountered A (, 6 P Indicate level at which mottling is observed Doe, Indicate level to which water level rises after being encountered Deep hole observations made by: Date jDesign Professional Name: Address: o C., Signature: Design Professional's Seal P• `v I ® W M t rn oo 0059 Are R0FfSSt 0 BRUCE R. FOLEY Public Health Director...._....... LORETTA MOLINARI R.N., M.S.N. _ Associates Public- .Health. Director__-... _• ... Director of Patient 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: 0wA4,a14,,;v i`� «{.E��i��� S Z'� TAX MAP NUMBER: f3�' 4 VO E911 ADDRESS: r g TOWN: cxz�•- AUTHORIZED TOWN OFFICIAL: (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 l VERFRM) 13.16 -4 (2/87);, Text 12 PROJFPT I.D. NUMBER 617' 21 SEAR Appendix C State Environmental ®uallty Revievd SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS-Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME 6 A411Celd /tom %� Peder Scott /° 3. PROJECT LOCATION: Municipality Patterson County Putnam 3. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) 2 n y 5. IS PROPOSED ACTION: 0 New 'I] Expansion ❑ Modiflcation/alteration 6. DESCRIBE PROJECT BRIEFLY: Septic System with 1250 gallon septic tank and .jprows of 5-01 x 2' trenches = rG® lineal feet. Installation of a well. 7. AMOUNT OF LANO AFFECTED: Initially ` 7 acres Ultimately ' �% acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? El Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? �I Residential ❑ industrial ❑ Commercial ❑ Agriculture ❑ Park/ForestlOpen space Cl Other Describe. 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? Yes ❑ No If yes, list agency(s) and permlUapprovals Putnam County Health Department – (XeAJaOIA -� 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? XYes L' I No It yes, list agency name and permitiapproval p�j r•-tjl -� �.��vrf'y ���¢ L am.L -C %�• /`�"�i�i G A Ate ►n/i': i:�, ���/L,r.al Jv�"l.� 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑ Yes No I. CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ApplicanUsponsor aas+e: ` O IEV _ S C 2T71— Date: Signature: 4 I If the action is In the Coastal Area, and you are a state agency, complete* the I Coastal Assessment Form before proceeding with this assessment OVER 1 PART If— ENVIRONMENTAL ASSESSMENT (To be completed by F,gency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. C3 Yes L- ,J No ° H. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS ll P gXCRR,,PART fat? 62 _,. _.tfNo,.a aegative_-declaration: < " rrmA : be- superseded -by another invotved agen'q. _.' :> - ❑ 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 pattems, 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 CJ. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly. No C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain 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-CS? Explain briefly. No C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. No 0. IS THERE. OP, IS THERE LIKELY TO BE: 031+T- ReVE;-RS"ELATED TO POTENTIAL"ADVERSE ENVIRONMENTAL IMPACTS? El Yes ONO If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether it Is substantial, large, important or otherwise significant. Each effect should be assessed in connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF 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 ate I P, Title of Responsible Officer event from responsible ottic P.W. SCOTT ENGINEERING & ARCHITECTURE, P.C. 3871 Route 6 Brewster, NY 10509 E-Mimill: tbtt@rcn.com (845) 278 -211® (845) 278-2166 TO ra�Z_ A) > WE ARE SENDING YOU XAttached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ 112VU Rn @[� DAI E JOB NO. WfTEN-nbN All- 7, RE: ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION ov 'Z'L_ -THESE ARE TRANSMITTED•as checked below: 'A For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit - copies for distribution > ❑ As requested ❑ Returned for corrections ❑ Return -corrected prints ❑ For review and comment ❑ ❑ FORBIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US TO SIGNED: If enclosures are not as noted, kindly notify us at once. 4j-j 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION A doi. f RE: Property of r Located at T/V Av -SOAJ Tax Map # Block _ Lot _ Subdivision of 1. esc o�' Subdivision Lot # j © Filed Map Date Filed (o 0 Gentlemen: This letter is to authorize a✓ YL �u 4jl _-P t a duly licensed Professional Engineer_ or Registered Architect . to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145- and/or 147 of the Education Law, the Public Health _.._ Law; -and the Putnam County Sanitary Code. _`� _..__... .__ ..._:_,. _ , _.._.._ ,...._ .:. __ . _ ._,..._ ..... _._._ Very truly yours, Countersigned: Signed: P.E., R.A., # (Owner of Property) Mailing Address Mailing Address: ILee, 1 S'f✓1e -ef State Telephone: 10 Zip - 'i10 State Telephone: 0F .NEW a W. w le 2 N �3 Zip J Form LA -97 I ° I O I I ° �^ , it W La'4J W �l I 0 �� \ PUTNAM COUNTY DEPARTMENT OF HEALTH 1 DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PE GE TREATMENT SYSTEM PERMIT # 5- a Located at I(� -y�,n^ Subdivision name Pe,se-t.��v� Subd. Lot # 1 n Date Subdivision Approved 1 0 p Owner /Applicant Name , tjAmpseo ac, 1-t� o co . Town or Village '' C) iy Tax Map 3 it Block Lot & B Renewal Revision Date of Previous Approval Mailing Address 2- QA,4JNeM 0 (2AUE; Wt-"lL PL 1cJ b, N `-( Zip 0(104 Amount of Fee Enclosed 30 u. QZ) Building Type Lot Area 3,31A No. of Bedrooms 3 Design Flow GPD &Q0 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 19ts-Q gallon septic tank and 5-00 LE CE ;ytt( -to" F I I..L ADD ITl an n4�. F��L V u c1 Other Requirements: To be constructed by TF3 tj Address Water Supply: Public Supply From Address or: _ Private- SiipPly Drilled'by `_ — -Ti5.D I represent that I am wholly and completely responsible, for the design and location of the proposed system(s) and that the separate sew- age 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: - P.E. ( R.A. Date `2-7 o Address _3SS7 t P-v0`' Ny 10 `j License # 05-23q(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 when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new ermit. A*;Ilo arge of domestic sanitary sewage only. By:t Title: Date: White copy - HD y - Building Inspect or; Pink copy - Owner ir ge copy - Design Professional Form CP -97 SHERLITA AMMER, MD, MS, FAAP Commissioner of Health: ; LORETTA MOLINARI, RN, MSN Associate Commissioner of Health NAME: ADDRESS: SITE LOCATION: DATE:. STAFF PRESENT: SPECIFIC WAIVER REQUEST: ROBERT J. BONDI . - County Executive , DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAIVER i nis 61 10co0� Sherlita Amler, M.D. Michael Budzinski, P.E., Robert Morris, P.E. Gene Reed, Joe Paravati & Larry WMer DOES THE PROPOSED VARIANCE REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? % IS 9C, - -- . _ _ - _ ..._ . - YESf- . ❑ -. -NO WILL DISAPPROVAL RESULT IN A SIGNIFICAANT HARDSHIP? YES M/ NO ❑ DISCUSSION REQUEST APPROVAL OR DENIED APPROVED W1 DENIED ❑ REASON FOR DENIAL DATE COMMISSIONER OF HEALTH (SPECWAIVER) Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool(845) 278 -6014 Fax (845) 278 -6648 14-16-A CM7) —Text 12 PROJECT I.D. NUMBER 617.21 SEAR Appendix C State Envlronmetrtil flugllty'Revlow �- - SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS-only PART I-- PROJECT INFORMATION (fo•be completed by Applicant or Project sponsor) t. APPLICANT /SPONSOR 2. PROJECT NAME Peder Scott Rosewood 1. PROJECT LOCATION: Municipality Patterson County Putnam a. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc„ or provide map) 186 Tammany Hall Road 5. IS PrrRXOtt POS °_D ACTION: l New 0 Expansion 0 Moditicationralteration 5. DESCRIBE PROJECT BRIEFLY: Septic System with 1250 gallon septic tank and 5001LF of 24" wide trenches and 1.5" of fill. Installation of a well. 7. AMOUNT OF LAND AFFECTED: Initially ' 2 acres Ultimately • 2 acres S. YAALLL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? El Yes 0 No It No, describe briefly 9. VIYH-tAT IS PRESENT LAND USE IN VICINITY OF PROJECT? r-1 rrtt �! Residential 0Industrial 0 Commercial. 0 Agriculture 0 ParklForesL'Open space U Other .Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATES OR LOCAL)? L7 Yes 0 No It yes, list agency(s) and permitlapprovals Putnam County Health Department 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? 0 Yes U No If yes, list agency name and permltlapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? 0 Yes 0 No K N/A I. CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicantls Si;nature: Dale: 0 �- It 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 EXCEED ANY TYPE1 THRESHOLD IN 6 NYCAR, PART 617.12? It yes, coordinate the review process and use the FULL EAF. ❑ Yes L'.1 No 8. WILL ACTION RECEIVE, COORDINATED REVIEW AS.PROVIDED FOR UNLISTED: _gIONS IN.6,NYCRR, :PART 617.67 It No; -a negative' decraratiod -- may be'•supifteded•by' anotfier'Involved'aQenry. ❑ Yes No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, It legible) C1. Existing air quality, surface or groundwater quality at quan'tlly. 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 CJ. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: No Cs. 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 CS. Growth, subsequent development, at related activities likely to be induced by the proposed action? Explain briefly. ., C:) PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether it Is substantial, large, important or otherwise significant. Each effect should be assessed in connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility, (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant. adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. Check this box If you have determined, based on the information and analysis above and any supporting I 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 or Type Name *Responsible Otticer in Lead Agency Title esponsib e O icer VA _ • Tm 5ignature i cer in Lead Agency Due Signature of Preparer(t different -responsible ofticeo 3/& Ne N o C G C6. Long term, short term, cumulative, or other effects not identified in CI-CS? Explain briefly. - N o Ujc C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. < No ` S TlierRc, OA IS THEAE LIKELY TO 8E, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? POT-, C1 Yes O No It Yes. explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether it Is substantial, large, important or otherwise significant. Each effect should be assessed in connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility, (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant. adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. Check this box If you have determined, based on the information and analysis above and any supporting I 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 or Type Name *Responsible Otticer in Lead Agency Title esponsib e O icer VA _ • Tm 5ignature i cer in Lead Agency Due Signature of Preparer(t different -responsible ofticeo 3/& Ne P.W. SCOTT ENGINEERING & ARCHITECTURE, P.C. 3871 Route 6 Brewster, NY 10509 r E -Mail: pwscott@rcn.com (845) 278.2110 FAX (845) 278 -2166 TO WE ARE SENDING YOU XAttached ❑ Under separate cover via _ • Shop drawings ❑ Prints ❑ Plans • Copy of letter ❑ Change order ❑ DATE. JOB NO. NO. RE: /iew/Se ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION /iew/Se THESE ARE �For TRANSMIT as checked below: approval ❑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: if anrincimpR ara not as noted. kindiv notifv us at once. P.W. SCOTT ENGINEERING & ARCHITECTURE, P.C. 3871 Route 6 Brewster, NY 10509 E -Malf. pwsco44 @rcn.coen . . (845) 278 -2110 FAX (845) 278 -2166 TO t2 r WE ARE SENDING YOU > Y 1 1 Attached ❑Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ 00 / I / � L.._ IE L! L.1 ER12 @I U D e RMOVUL IJ DATE JOB NO RE: ❑ Samples COPIES. DATE NO. DESCRIPTION to Sit< 2[24n THESE ARE TRANSMITTED as checked below: For approval ❑ For your use ❑ As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS COPY TO ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections the following items: ❑ Specifications ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: /I e.ni. /nc..roc an- not aS nntRlf kindiv nntifv jia At nnr_a_ P.W. Scott email: pwscott@S,', Engineering & Architecture, P.C. 3871 Route .6 L-211 Brewster, NY 10509 FAX'i February 1, 2006 To: Mike Budzinski PCDOH Fax: (845) 278-7921 Re: Rosewood Lot #10 Dear Mike: I Please accept this letter as a formal request for a waiver to grade the reserve area of Lot #10 from 20% to 15%. The approved reserve septic area for Lot #10 was eliminated through a road taking after approval of said lot layout. With Regards, P der W. Scott, P.E., R.A. President ARCH ITECTURE*ENG I N E E R I N G * S I T E PLANNING net 278-2110 278 -2166 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES d DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner 4A IIZ� LAN12 Gv• Address 86o TA•MMAr -t� }+AL -L, Located at (Street) Z 44"t�- _ /Z oM-p Tax Map Block $_ Lot 8$ (indicate nearest cross street) Municipality i6 Ti fL�4� Drainage Basin rA M SOIL PERCOLATION TEST DATA Date of Pre - soaking \TAti - R, Zook Date of Percolation Test JA.-,J• /Z , 2Ao� Hole No. Run No. Time Start - Stop Ela se Time �Iin.) Depth t G� ter From Ground... Surface (Inches) - Start Stop Water Level Drop In Inches Percolation Rate Min/Inch Io FI 1 10,47 2Z 2S 4.3 2 1 4 1133 11: 491 15 nZ 5 2 : 0 ; 20 22 ZS 3 a 3 }: 23 3� j 5 2 Z ZS . 0 4 '. ,�� I� Z� 2> 5.o 5 1 2 3 4 5 NOTES: 1. pests to be repeated at same depth until approximately equal percoianon rates are ootameu at earn percolation test hole. (i.e. s 1 min for 1 -30 min /inch; s 2 min for 31 -60 mintinch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -91 2 TEST PIT DATA � DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH G.L. 0.5' 1.0' 1.5'. 2.0' 2 2.5' 3.0' 3.5' 4.0' 4.5' 5.5' 6.0' 6.5' 7.0' g 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' HOLE NO._ (nl� TO h-Aflb l U M 5 � n a►�� 6r�v�1�, HOLE NO. 10 01 HOLE NO. :;;Ii WM ✓e.{,', Indicate level at which groundNN-ater is encountered Ei. 6 Ft Indicate level at which mottling is observed Lloje, Indicate level to which water level rises after being encountered i �� 00"0 -- Deep hole observations made by: iNl .A Date l Z , • OS Design Professional Name: Address: 3 0, 7 / TLS ¢� C., Signature: 17�;L � tc/ S Tr'i 2 JJ • ��/Os�9 Design Professional's Seal Of NE{�rY� /CO�PQ ova w� Sc 09 C-1 Uj •- �3 �C, 069*1 � ROFESStO 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner-. M ps l l'LG LANs 6a- Address 1 810 TA-M MAr-t� i+ALL, jk-�ar;, Located at (Street) Z 1 k1Mt:,;7/L- /Z oA c9- Tax Map Block �_ Lot 8Q� (indicate nearest cross street) L c> r Municipality ri ����o,�j Drainage Basin rd ova SOIL PERCOLATION TEST DATA Date-of Pre - soaking \-TAti . // , 7c�o Date of Percolation Test JA^J- /z A 2A0G Hole No. Run No. Time Start - Stop Ela se Time �Iin.) De th hater rom Ground.. Surface (Inches)" Start Stop Water Level Drop In Inches Percolation Rate Min/Inch I® �I 1 10 �5 13 22 2S 4.3 2 a [VIA. I 12 3 : ly II ; 3 15 .1*19 -21 `Z5 6.0 4 s 2 : o. ; ZQ 15 22 ZS a 3 1 23 3� 15 22 ZS ;o 4 ', ;�� I� Z2 Z� 3 5.o 5 1 2 3 4 5 NU -! DES: I. ! ests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 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 -91 �S�INDO� I.O-%. � ► Q TEST PIT DATA ° DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH 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' 9.5' 10.0' Is HOLE NO. 10 HOLE NO. 1001 To � I nlel To MAePI UM HOLE NO. fin! �aw� 1►•• -:E To M�iuni fp I 16 A '\ Indicate level at which groundNvater is encountered � E Indicate level at which mottling is observed a►�irG Indicate level to which water level rises after being encountered Deep hole observations made by: Date Design Professional Name: Ul Address: Q :2 f )Z") ¢� ;/Z, Signature: Design Professional's Seal V- otiq% NE W' S W y �PQ CO c �9 # r O 059 9�FESS1flNP 1. 2 ��,0_s� P.W. SCOTT ENGINEERING & ARCHITECTURE, P.C. 3871 Route 6 Brewster, NY 10509 E -Mail: pwscott @Pcn.com..,..._:.� - - -- (845) 278.2110 FAX (845) 278 -2166 TO AJ- WE ARE SENDING YOU X Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ ..DATE . Q I JOB NO ATTENTION! ,r r RE' Ste'- • / G : ��. %Z Gc/ � � the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION Ste'- • / G : ��. %Z Gc/ � � THESE ARE TRANSMITTED as checked below: AFor approval • For your use • As requested ❑ For review and comment ❑ FOR BIDS DUE REMARKS • Approved as submitted ❑ Resubmit copies for approval • Approved as noted ❑ Submit copies for distribution • Returned for corrections ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO SIGNED: 0 TUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address TA- WWAP,4> 14A4L- Located at (Street) 2 ��1M��- /Z� Tax Map Block �_ Lot � (indicate nearest cross street) �7;u 3 Lp t 1 Q Municipality Drainage Basinr�,d -,�,�¢ SOIL PERCOLATION TEST DATA Date of Pre - soaking Q-ti . l/� ZOO 6, Date of Percolation Test JA ^J• /Z 4 2.00G Hole No. Run No. Time Start - Stop Ela se Time (p11in.) De th tosWater ?prom Ground.... Surface (Inches)" Start Stop Water Level Drop In Inches Percolation Rate Min, Anch la >~I I 104 1007 13 2Z 25 4.3 2 11-.14 1 !�7 .K . D 3 11; 3 I�j �LZ y5 D 4 113 11: f91 5 2 3 4 ', .5� I Z2 2� 3 5.0 5 1 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. s 1 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 hale. - -. Form DD -91 .2 TEST PIT DATA _ o DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. 0 HOLE NO. HOLE NO. G.L. 0.5' �� ToPyc�1 L 1.0' 1.5' Lak M 2.0' 14" 2.5' 3.0' 1 NE To M51o! LN 3.5' S A 1j p A-N t) 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' � 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' Indicate level at which groundNvater is encountered rte, Indicate level at which mottling is observed aorta Indicate level to which water level rises after being encountered &�o►_►E Deep hole observations made by:,6 64 1 ga '�," -I Date A 7 . 0s", Design Professional Name: j2 ul Address: 27 f ebIr f� Design Professional's Seal PUTNAM COUNTY DEPARTMENT OF HEALTH , . DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner ' T e � Address Located at (Street) Tax Map Block Lot (indic to nearest cross street) Municipality (-I - Watershed SOIL PERCOLATION TEST DATA ine Date of Percolation Test -/ Z -O("- Hole i�i.6 Rug No True Start Sto P se Tome NUn) Surface ()[nches� Start Stop X?rop In Indies Rite 1vlrnlInch 2 1 y 3 ,� J221 4 5` 2 ,� = 1 3 5 1 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. s 1 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 Ica, =:- 0. 067 C& NV �jr- • P.W. Scott Engineering & 3871 Route 6 June 17, 2005 To: Robert Morris Fax: (845) 278 -7921 itecture, P.C. 9-_ . ... - Re: Proposal SSTS: Hampshire Land Company 186 Tammany Hall Road, Lot #10 Rosewood Patterson, NY — TM# 34 -4 -88 Dear Robert: email: FAX Please find enclosed a proposed septic plan with the inclusion of the new reserve area on the south end of the property. The proposal is to provide fill in the area of the reserve to create slopes less than 15 %. The primary achieves the proper grade without extra fill for grading purposes. The reserve area design is based on a 7- minute percolation rate with 3041f of 24" wide trenches. A retaining wall is required for the driveway grading that is proposed without a curtain drain and is therefore located more than 25 feet below the SSTS reserve area. Please review this proposal and call with any questions or comments. Wit gar, s, eder W. Scott, P.E., R.A. President .net 278 -211,0 u.. _. . 278 -2166 i i i i r f; ARCHITECTURE "ENGINEERING`SITE PLANNING 1 +4,:'I'i 'ai'C;!::�G .0 I ReL'SeLnJ 0Qc ,1 BRUCE R: TOLEY.. Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINAM 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 Fax (845) 278 - 6648 December 3, 2001 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Peder Scott, PE Scott Engineering 3871 Route 6 Brewster, New York 10509 I Dear Mr. Scott: Proposed SSTS - Hampshire Land Company 186 Tammany Hill Road, (T) Patterson Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: 1. The above referenced application is denied because 100% expansion has not been provided. This Department has received your request for a waiver dated October 31, 2001. The waiver committee will discuss this request on December 3, 2001 and notify you of the result. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Sincerely, Shawn Rogan Public Health Technician SR:cj BRUCE ...R. FOLEY. :<...:.- Public Health Director v. . `LORET TA MOLINARh 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 December 4, 2001 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Peder Scott, PE Scott Engineering 3871 Route 6 Brewster, New York 10509 Re Dear Mr. Scott: Proposed SSTS - Hampshire Land Corp. 186 Tammany Hill Road, (T) Patterson Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: The waiver committee discussed the above referenced project on December 3, 2001. The committee determined that Gene Reed of this department will visit the site to visually check the proposed expansion area for signs of ledge. - The,committee stated'that -you may explore. other.areas_of..lhe lot that. are less than 20% slope_for the purposes of increasing the expansion area to 100% for the three (3) bedroom design. The alternative two (2) bedroom design would be acceptable to the committee. Please notify me of your clients decision so that we may arrange for field testing if needed. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Sincerel Shawn Rogan Public Health Technl ian SR:cj ___. �... BRUCE . k. FOLEY.•. _... ..... w,... Public Health Director "LORE77A- MOLINATU 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 December 4, 2001 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Peder Scott, PE Scott Engineering 3871 Route 6 Brewster, New York 10509 Re: Dear Mr. Scott: Proposed SSTS - Peri, 11 Rose Lane (T) Patterson, TM# 36.57 -1 -3 Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department of Environmental .Protection on this lot, percolation tests, mu_ st be witnessed by a representative of this Department. 1. Show all wells and septics within 200 feet of the property line and add a note to the plans stating that all have been shown. 2. Clearly delineate the state boundary on the septic plan. 3. Provide erosion control for the construction of the well. 4. The elevations shown for the dose tank are not correct. Please verify the pump on/off elevations for a 12 inch dose and revise accordingly. 5. Show the D -box detail in the plan. Upon receipt of.a submission revised to reflect the above comments, this application will be considered further. Sincerely, Shawn Rogan Public Health Technician SR:cj P. W. Scott email: pws @bestweb.net Engineering & Architecture, P.C. 3871 Route 6 (845) 278 -2110 Brewster;..NY `10509 -;'FAX(845) 278= 2166 April 26, 2001 Robert Morris P. E. Putnam County Health Dept. 4 Geneva Road Brewster, NY 10509 RE: Rosewood Subdivision (T) Patterson Lot #10 - Waiver Request Dear Robert: Please find enclosed a Septic Site Plan for a 3 bedroom residence to be located on Lot #10. Due to a roadway taking at the base of the hillside by the Town of Patterson and the elimination of the Putnam County Department of Health waiver for construction of septics on slopes over 15 %, the septic cannot be constructed in compliance with the Putnam County Department of Health regulations. The plan submitted includes 500 LF of primary and 300 LF of reserve - 24" wide trenches. The original design included additional area along the base of the hillside, which afforded more area for the driveway and reserve septic area. The waiver therefore is to reduce the amount of reserve as noted on the plans. If steeper -of- the -site could be utilized - (over- 45- 1Xry; -the"dditional trenching could---be added. The final alternate would be to use a gallery for septic disbursement in the reserve area, which would create additional reserve capacity. For a tri- gallery, the effective area is 5.0 SF /LF x (55)2 =550SF +4(15.5) for ends equals 612 SF. Added to R1 /R2 & R3, the equivalent length is 392LF of 24" wide trenches. Please review the concept plans and schedule a meeting to discuss the septic plan. With regards; Peder W. 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 }'ros ,10 ontilL i - I. S 0 4.26- 01.doc BRUCE R.FOLEY": Public Health Director LORETU' Associate Public Health Director Director of Patient Services DEPARTI-vENT OF HEALTH I 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)278-6M May 24, 2001 Peder Scott, P.E. PW Scott Engineering 3871 Route 6 Brewster NY 10509 Re: Dear Mr. Scott: Proposed SSTS: Hampshire Land Company 186 Tammany HallRoad, Lot.AIO-,.-- (T) Patterson, TM# 34-4-88 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. Waivers cannot be requested until a complete application has been denied. 2. The SSTS should be designed with a 100% reserve area. Any. slopegreater than 15% must be reduced to 15% by the addition of R.-G.B. fill. 3. The reserve area should not be designed within primary trenches. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this rega'rds.'--- - ---- - ----- Upon receipt -of a submission, revised -to reflect the above -comments, this -application will be considered further. Very ly yours, Robert Morris, P.E. Senior Public Health Engineer RM:tn P.W. SCOTT ENGINEERING & ARCHITECTURE, P.C. 3871 Route 6 Brewster, NY 10509 E- Mail:. pwscott @rcn.com `' (845) 278 -2110 ' FAX (845) 278- 2168 -' " - TO DAT� JOB NO. AiTEN • ; WE ARE SENDING YOU C Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION ......THESE ARE TRANSMITTED as.checked below;-- ,r� For approval ❑ Approved as submitted ❑ Resubmit copies for approval • For your use ❑ Approved as noted ❑ Submit copies for distribution • As requested ❑ Returned for corrections ❑ Return corrected prints • For review and comment ❑ ❑ FORBIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS 1 SIGNED: /f enclosures are not as noted, kindly notify us at once. May 24, 2000 Mr. Robert Morris, P.E. r Putnam County Department of Health Geneva Road Brewster, New York 10509 RE: Saddle Ridge Homes Rosewood Subdivision Lot 10 Tammany Hall Road Dear Mr. Morris: Engineers and Planners We would like to submit the above referenced individual lot to your office for review at the next waiver meeting. The lot is from the January 11, 2000 Filed Map #2814. It appears that approximately 9000 SF of septic area is required by code for a 3 bedroom SSDS and the Final Plat has provided only 5000 SF. Upon review of the attached sketches, it is determined that placing fill over the primary and expansion areas would result in a 14 foot depth fill section (at the deepest point) and require over 2700 CY of fill (the Final Plat specifies 444 CY would be required). If the fill for only the primary system is initially placed on the lot, the maximum depth of the fill section would only be 3Y2 feet. The primary fill pad section would require approximately 490 CY which is comparable to the Final Plat's required 444 CY. It is proposed to provide fill in the primary septic area upon construction and note that if the expansion areas is utiliied;`the fill woiild-be placed -atAhat time: - - We would ask for your office's review of the following waivers: 1. Place fill in only the primary septic area (instead of the primary and expansion). 2. Allow a 0 foot setback from the property lines to fill section grading (instead of the 10 foot requirement ). Thank you for your consideration of this matter. Please feel free to contact this office should you have any questions or comments. Very truly yours, PUTNAM ENGINEERING, PLLC By: Ken Hurley Rrk 'achment Saddle Ridge Homes 4209) - — ^. __ . PA OMFI NFw VnRK 1 (151 7 • PHnNE (9141225-3060-FAX (914) 225 -2955 rr '3 . \1 -, ...: a rri z[.� ♦ ,� �'t; ^b.-^tr+ Pt' "^ s { '`ra a r S rt'. v �{ - r",ta,, ? n 2 9 i _ 123 - 30 1 '/2' PLC. r� i AP Zzz �x Sy�l�/l�Slol�� 'ILep MAP Zg� .WN 11 1 20mv J i 1 t Mig 670 O { = 23.23'3 ,200.00' L = B>. 65' Road N'ideninQ total Area= 2,93f SF--,4 = 0.067 Acrm t , P.W. SCOTT ENGINEERING & ARCHITECTURE, P.C. 3871 Route 6 Brewster, NY 10509 ._.. _, . _ -.. E•Mail:� pwscott @rc�.corn -- - -- - -• - -- .. -.... _ . - (845) 278 -2110 FAX (84 278 -2166 TO Ct)a f4_� f. ImIfful2 3 OCR �3 DATE / j.10B.N0. 1 WE ARE SENDING YOU blAttached ❑ Under separate cover via _ • Shop drawings ❑ Prints ❑ Plans • Copy of letter ❑ Change order ❑ the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION 1 �r Ll ---- THESE - ARE- TRANSMIT-l'ED•as- checked below: -- L For approval ❑ Approved as submitted ❑ Resubmit copies for approval • For your use ❑ Approved as noted ❑ Submit copies for distribution • As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FORBIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO SIGNED: _ If enclosures are not as noted, kindly notify us at once. PUTNAM COUNTY DEPARTMENT OF..HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES z, r DESIGN DATA SHEET.- SUBSURFACE. SEWAGE TREATMENT SYSTEM __C� Owner -,Z—,4,v-o �Address Located at (Street) 17W, Tax Map 3/-/ Block Lot -S-6' (indicate nearest cross street) Municipality Watershed -, &,pj2z'g 8 2,4AJe—_1j1 -SOIL. PERCOLATION TEST DATA- Date of Pre-soaking Date of Percolation Test /0 16 /o 2, 97„ NOTES: 1. Tests to be repeated at same depth untll approximately equal percolation rates are obtained at each percolation test hole. (i.e. -.q I min for 1-30 min/inc . h, -.q 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from to p of hole. Form DD-97 . ... 11' at .. W. .... . . ........ . . .. ...... .. .......... ,:* to'' Time F rom. ro.0 e .-eve ViQ ered a 6. e o. 1111: : 16, >:: >:: <: .'s 41 3 .4 5 Q —Z73 7j 2 /0;23 - /a; // 3 /0;43 -// :07 4 . /8/0 - //:2 0. 0 -3 5 2 3 4 NOTES: 1. Tests to be repeated at same depth untll approximately equal percolation rates are obtained at each percolation test hole. (i.e. -.q I min for 1-30 min/inc . h, -.q 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from to p of hole. Form DD-97 TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN.TEST HOLES :HOLENOt " ;.. -;, HOL-E N{&: ,, G.L. . . 0.5' 7 race T.. s. 1.5' e�P 2.0 e. 56tyl 2.5' 3�y 3.0' 3.5' 4.0' /✓IetQ, 8 r , 8„ 4.5' &VL 5:0' 6.0 (68") 6.5' 7.0' 8.0' f 8.5' 9.0' . 10.0' Indicate.level.at which groundwater is. encountered -- A/6A Indicate level at which . mottling is observed ,i/oIV Indicate level to which water level rises after being encountered - Deep hole observations made by: 1, c-p `P, G,�� H . Date s o Design Professional. Name: . Address: Signature: Design Professional's Seal d� G 1 Q� Laa r .,1 PUTNAM COUNTY DEPARTMENT OF HEALT111 Q DIVISION F ENVIRONMENTAL- 4IEALT =SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM, SECTION A. GENERAL INFORMATION Name of Project ��'.tl �(T)(� f�', %"� k 2 ��i� County Site Location 7"Anrl; guy 4ZI --i Building construction begun Extent Is property within NYC Watershed ? ................. 77 Yes No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) I. Q Hilly F-1 Rolling F—,J J Steep slope F--� Gentle slope F-� Flat 2. Q Evidence of wetlands Low area subject to flooding F-� Bodies of water Drainage ditches Rock outcrops 3. Property lines or corners evident ....................... ............................... F71 +Yes.. ❑ No. 4. Do water courses exist on or adjoin the property? ................: ........... � Yes .7 No 5. Will these affect the design of the sewage system facilities ?. ',,....:.:::: Yes No a a 6. Do watershed regulations apply in this development ? ....................... EE'-.Yes' F--J No 7 Will extensive grading o be necessary? No - 8: Win extensive fill be necessary for SSTS? .......... ............................... a ^ Y s e No 9. Do filled areas exist within the SSTS area? .......................... I............ Yes No If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: F71 Sand F� Gravel Q,-Loam 0 Clay F--J Hardpan 0 Mixture 11. Observed from: Borings F-� Bank cut F7f Backhoe excavations 12. Soil borings /excavations observed by on�� 13. Depth to groundwater Nn n C _.. on 14. Depth to mottling ,Z P A - . on � / 15. Are test holes representative of primary reserve eas ...:.. ............................... EaYes No 16. Soil percolation tests made by f i on 17. Soil percolation tests witnessed by (, c SECTION D (on back) Form ST -1 I A SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? .Yes o No El. . 19. Will groundwater or surface drainage require. special consideration? ..................... a Yes No O 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... Q Yes F No SECTION E. RE! 'S 21. • If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities? ................................ ..............................: Yes ,O No Inspection data 22. Do adjacent wells and/or sewage systems exist? ..................... ............................... ElYes ,F--J No 23. Additional comments 24. Site observer/inspector and title 1 � � C;. D 25. Date(s) of observation(s)inspection(s) s li. 5" A7 TEST PIT PROFILES Hole Lot n Hole 9 Lot r Hole 9 Lot # Depth to water Depth to water Depthtovater- Depth to mottling Depth to mottling Depth to mottling Depth to rocVimp. Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L.. i 0.5 0.5 0.5 ' 1.0 1.0 1.0 2.0 2.0- 2.0 - 3.0 3.0 3.0 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 .9.0 10.0 10.0 10.0 - BRUCE Rr - $Of:EY- rf, �C �`� .:: � -- - LORETTA :_MOLINARI --R.N: Public Health Director W 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 Fax (845) 278 - 6648 December 3, 2001 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Peder Scott, PE Scott Engineering 3871 Route 6 Brewster, New York 10509 Re: Proposed SSTS - Hampshire Land Company 186 Tammany Hill Road, (T) Patterson, TM# 34. -4 -85 Reservoir Basin - East Branch Dear Mr. Scott: The Putnam County. Department of Health (Department) has determined that the above referenced application. including fee, and received by this Department on November 5. 2001 is complete. The Department will notify you by December 23. 2001 of its determination. ® The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ❑ Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by Certified Mail, Return Receipt Requested. The notice would be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with Section 18 -23 (d) (6) of the New York City Department of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if DEP review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2159. Sincerely, �Y Shawn Rogan Public Health Technician SR:cj o_ 673 - -June 9, 2002.- ;Departmeoti ®f Robert Morris, RE Environmental Putnam Co. Health Dept. i�r ®tectaon 4 Geneva Road ass Columbus Avenge Brewster, NY 10509 Valh81'la', Now York: , 1.10595- .13.38 This letter is to inform you that the New York City Department of Environmental Protection (Department) has determined that the above - referenced application is Bureau of Water Supply complete. In addition, the Department has no objection to the approval of the iV1ichael A. Principe, Ph.D. above- referenced regulated activity. This determination is based on the review of Deputy Commissioner submitted documents including the plan titled "Proposed Septic System Lot 10" Tel (spa) 742 -2061 prepared for John D'Allessandro ", dated 03/08/02. - 'Fax (014) 741 -0348 The applicant must contact Sissy De La Ossa of my staff at (914) 773 -4416 at least 2 days prior to the start of construction of the SSTS so that a Department _..._. _... representative may inspect and monitor the installation.:.�- - - www.nyc.gavldeP_) (7 18) 0EP -HELP Sincerely, Dann hedlo, P.E. Project Manager Engineering Design & Review xc: James Covey, P.E., NYSDOH r ; ki Z 10 0 16i P. W. Scott email: pws @bestweb.ni P. W. SCOTT Engineering & Architecture, P.C. 3871 Route 6 BREWSTER, NY 10509 E -Mail: pws @bestweb.net (845) 278 -22110 FAX (`845) 278 -2166 TO ��1 Ls WE ARE SENDING YOU ❑ Shop drawings ❑ Copy of letter ❑ Attached ❑ Under separate cover vi ❑ Prints ❑ Plans ❑ Change order ❑ ti [LCECT UIRn @IF 4 ° ° HII GMU44Lad ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION tG - -THESE-ARE TRANSMITTED a's checked below: ❑ For - approval ❑ For your use ❑ As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS ❑ Approved as submitted ❑ Resubmit copies for approval ❑ Approved as noted ❑ Submit copies for distribution ❑ VAQ9 P-r corrections ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO SIGNED: —�2GJ�,� � /f enclosures are not as noted, kindly notify us at once. SHtWS T tH, NY 1 UbWJ LETTER OF AUTHORIZATION Re: . Property of HAVV� ps I*A fZ4:-;- L.An,110 co Located at 112 (& TA-w,wyk-tj 4 J44 �L� (2.0 ,AcQ T/V PATt-c.,_,rJfax Map # 31-1 Block ZL Lot Subdivision of R_12�>4t- i,.3cDo10 FAX (914) 278 -2100 Subdivision Lot # 10 Filed Map # 9N Date Filed t b o o Gentlemen: This letter is to authorize Peder W. Scott, P.E., R.A., 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 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 treatment and /or water supply systems in conformity with the provisions of the Public Health Law and all applicable Sanitary Codes. Co to si Peder W. Scott, P.E., R.A. P.E., R.A. #: o.sq 3 y 6 Mailing Address: 3871 Route 6 Brewster, NY 10509 (914)268 -2110 Very truly . o F rs, Signed- ( er of property) AgA 1 MA �AMEiJ 1, j�¢+F�SD� Mailing Address: �/D CAR) -YI_c A550C. A C-rW1.1ETC DKly!F--, Sut►1 =Zgl 1 ,0 4�-\C-_ PI -AWNS, N`( 10 (0 014 Telephone: 9 1 L'- 6gL4- (6 7{o� A R C H I T E C T U R E • E N G I N E E R I N - S I T E E P L A N N I N G 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: Hampshire Land Company 2 Gannett Drive White Plains. NY 10604 2. Nameofproject: Rosewood Subdivision 3. LocationT/V: Patterson 4. Design Professional, & Architecture , 1 P e c r 5. Address: 3 8 7 1 Route 6 6. Drainage Basin: East Branch Reservior Brewster, NY 10509 7. Type of Project: X . Private/Residential Food Service 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 x 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... No 10. Has DEIS been completed and found acceptable by Lead Agency? ............... N/A 11. Name of Lead Agency Town of Patterson Planning Board 12. Is this project in an area under the .control of local planning, zoning, or other officials, ordinances? ...., .................................................... ............................... Yes 13. If so, have plans been submitted to such authorities Yes — S ub d i v i s i o n 14. Has preliminary approval been granted by such authorities ?Y e s Date granted: 8/197 15. Type of Sewage Treatment System Discharge ................. surface water x groundwater 16. If surface water discharge, what is the stream class designation? .................... N/A 17. Waters index number (surface) ........................................... ............................... N /A 18. Is project located near a public water supply system? ....... ............................... No 19. If yes, name of water supply N/A Distance to water supply N/A 20. Is project site near a public sewage collection treatment system? ................ No 21. Name of sewage system Individual Lot Distance to sewage system 22. Date test holes observed 4/2/96 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) ................................. ............................... 600 GPD- 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? ......................... N/A Form PC -97 27. Is any portion of this project located within a designated Town or State wetland? No 2S. Wetlands ID Number .......................................................... ............................... NIA .. 29. Is Wetlands Permit required? .................... N o Has application m been ade to Town or Local DEC office? ............................... N/A ' 30. Does project require a DEC Stream Disturbance Permit? .. ............................... No 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No N o 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 N o 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 35. Are any sewage treatment areas in excess of 15% slope? . ...........................:... No 36. Tax Map ID Number .......................... ............................... Map 3 4 Block 4 Lot 88 37. Approved plans are to be returned to ..... Applicant X Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to.final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of Y ,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 affrrm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: �1 Peder W. Scott, P.E., R.A. - Agent for Applica Mailing Addrelh.:6..�...i.m.�.�.o...... 3 8 7 1 Route 6 Brewster, NY ]0509 SOA6 ,-�.i1V3H ANA 03A M38 ' is P. W_ SCOTT Engineering & Architecture, P.C. 3871 Route 6 BREWSTER, NY 10509 E -Mail: pws @bestweb.net (914) 278 -2110 FAX (914) 278 -2166 TOn..« __ e, - ..—... n_ —.. _r v 1 +- 1, 4 Geneva Road Brewster, New York 10509 WE ARE SENDING YOU Attached ❑ Under separate cover via ❑ Shop drawings Prints ❑ Plans ❑ Copy cf letter ❑ Change order u OA f C• Job No. ATTENTION RE: floc- L.�ck, IJ %-vT I n the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION % I Application for Approval Construction Permit for Sewage Treatment System (form CP j Letter of Authorization (form LA -97or CA -97) Design Data Sheet (form DO -97) Short Form EAF 5 House Plans*(2sets) Application to Construct a Well (form WP -97) Check # q.SS-0 for th•e -- amount of $ OD ^T THESE ARE TRANSMITTED as heckegEelo i n s ❑ For approval ❑ Approved as subm!tted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections For review and comment ❑ ❑ FOR BIDS DUE REMARKS _ ;? - ❑ Resubmit copies for approval ❑ Submit copies for distribution El Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US PUTNAM ENGINEERING, PLLC 102 Gleneida Avenue Caravel, New York 10512 -,Phone: 914 -225 -3060 Pax: 914- 225 -2955 e -mail: www.puteng @bestweb.net LETTER OF TRANSM17TAL Date: -'2 / Z P/E Job: TO:-r✓ I We are sending you attached under separate cover, the following items via Certified Mail, Overnight, Hand Delivery, Pick Up: Originals Reports Plans Prints Photographic Exhibit Specifications Colored Prints Other: Copies Date Dwg. No. ilarOWMAT Description These are transmitted: _ For approval _ Approved as submitted _ For your use _ Approved as noted As requested _ Returned for corrections For review /comment _ Resubmit copies for approval _ Submit ` copies for distribution Copies to: SIGNED:_ )a�qall If enclosures are not as noted, kindly notify this office. 9t a i BRuQE.:R. -. FOL-.EY.: Public Health Director w LORE ITA - IvMOLINARl R.N., M-S'N. Y Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 REZUEST FOR FIELD TESTING ATTENTION: ❑ ADAM STIEBELING YkGENEREED All information below must be full completed prior to any scheduling. DATE�}t" O ENGINEER OR FIRM: S PHONE #: v 760 �f- REASON: As S(J �t r 'w (31 Took Ce�.5t�j AIZ4 01,1 y DEEPS: PERCS x PUMP TEST: ❑ ROAD /STREET: % �� /�, l\Ab TOWN: TAX MAP #:� — 4- SUBDIVISION: �� oCJ� LOT#: OWNER: fl ( A/\ J P U67ffW1- -- NYCDEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING YES NO ❑ A. - Proposed SSTS within the drainage basin of West Branch or Boyds Corner Reservoirs.... - - - -- -• - - -❑"— ---- �_. " "" Proposed SETS within 500 feet of a reservoir, reservoir stem or control lake. ❑ 13L Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. ❑ Proposed SSTS for a Commerical Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered :,es to any of the questions, NYCDEP must witness the soil testing. This Department will coordinate a mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. FOR COUNTY USE ONLY DATE: // `J ' ' 3e2 TIME:T� COMN- 1ENTS: (FMLDTEST) 1 y ]B2e0 1.16 AG J 31 ^' y\•-.v .vp /` A'2�� N aG..x 50 34� i.J, ice. ,FS '0F rr', /e 0 g * j 4.92 AC. q �p 44 E 1 F: ' T .t� 2.32 AC. 43 •' �r ' t 6.i7AG r 414.. r N 6 32 r' 1 , t�•+� 51 S 2.49 ACd' 'ter 3' ' \'a • 22 a,+� WSJ a C6 a �d, 6• 4 0 1� X9.,, 2.63 AG _: �F d`r9 ~L 1.�4z 61 j ° - p et 28 •.• • At' IB ^ 6 r 0 9 • 11 23 _ + r� . ° � , u At. ' • 19 . . , lr � ...I 99'At: 95 2.49 38.70 AC. CAL ? � sy 93228, xe AC AC. E34 A ` 54 Js.11a Ac. R /* r� : 34 33 • 1.92 •1 , F a Jr. s� .46 2.00 AC. x • r 3'29 ' / , • , 1.74 AC I, 9 a Ip t 0'i 5.51 AC.+ ,. ` r` 1.91 AC. 1.59 yC, 1u a, C. 4 AC. 10Gl1 *� r*,�A, ` u1.m AC. 10 's •�s 1 �• 1`•' 3544 Yv, 1.68 N a � q'rR V36 12 ) G 1d.• =f 93,8 I a 1 ��e �I/ - 22 y 221.9] _ • 38 .• 3 At % - 1 1 1 o. 40 44. 0 AC. ^ e f 0x0 31A1 : / 2.45 At.� 4.10 ACS 25.77 AC. GAL. R I ✓'\ 15 19.50 AC. 41 w , ^ ] 60 57.9.AC. CAL. 1627.32 n5.0 x n•10 21 x / ' 1.70 At ?1 « * 22 ( \ 119.4] ; 20 qs1s.9? ].9�8^IAC. 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CAL. n. 3 2 0 � 1 I / 4.17 A � 9.46AC. eel 1 * 6V \ 1.4 56f I I a I * \ 21,95AC. % * 24.42 AC. ti f / 541.7e @ 93.50 6 46 / 66.90 AC/ * \ .as' �� !.' 19fq ^ -fix /.- * JL �y � % o9letse . v •..++ _P /O 45 -3-4 P /00 3 1 o P/0 45-3-2 _ i -- .... ..�I - WrrIAl OISTRIGT INFORMATION J i r 4 BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York :1,0509.. 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 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAVIER Aa 1,1�iAe_ 1-11hIS- hzo W ADDRESS: <u %''�i LA��elel SITE LOCATION: DATE: STAFF PRESENT: Bruce F Rob M. Mike B., Adam S.. Gene R., Shawn R., Bill H. ' SPECIFIC WAVIER: ; / UZ}YYi. i-A REQUEST-.' DOES THE PROPOSED VARIANCE REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? YES NO WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? YES.. NO . DISCUSSION REQUEST APPROVAL OR DENIED APPROVED REASON FOR DENIAL DIRECTOR OF PUBLIC HEALTH (SPECWAIVER) DATE: DENIED Via Qalywaina OAT o; mq AT( )( ) ad tegas.p jCUp SQ03 Z8T tIa?Ak ,OOT1A0 J QJ ul )dIIq ,ozc A t% <- a3 o3 KII4 ,Sinn ' IYlaQ `S s ,s'saalaQ)aYIS(�(� - -vi 'I ' AAY 39 ois AYQ IC--)M Qa'IIYla(l '8 HS Oa-a agy i- TdC�C� . ('0la `adAl adid) `AII 3 3 )io3'IIY.L3QMC� QalO)4 3WMOA aSO(CIV 11 OA d 30 %SL 3S000�C� . SaI.OAI dI"UIdO�n S a SO Qa2Hnaax 3I ` %ST of Q3QY2io3umc;;/� . 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SnOHC�� Si3S aTau-SmTTriac s% 3Y3 i2i0HS(� /� &,owri osa-a 3.L ,v- doa- aOJ(7-C-) (SQQ) .L3aHS YI.YQ .KOISaQnP;7) KOU'V- MOHI_f1Y 30 - d3LI31(--)(7) L6 uc X7) X3 al S.i1d 110 Ill \'2i3d T I341C�Ci 7 KOIiYJI'IddY III \'II3dC�(� SL\ OQ \✓ .i (Q3Y�II3I�OJ) �dbi X'v'I o o/ 31 `Sty `2IrJ Z\'2i A8 Q3'�13IA32I :I\IOLLYJOl i3mS c�^) , s 7„+� f/ 2 at -Ilt0 30 al%- N - III \PiI3d A?OII �n2i LS \00 2iO3 ams Mamil SI43i SAS imaik.LY32Ii 3JYM3S 3JY32If sans b' Auafts uaI.YM ZYAQLUQNT H.LTY3H'I`i'L \31C \02HAt�3 30 KOISLAIQ HllY3H 30 LNalVIdYd3Q AiKfi00 I1TYMIna 4 LA DATE: / l FAX N®.: RE•�c�rJ L�vi 1 PAGES: IZ , including this cower sheet. 1 �S -e2HO-w rI e>rJ your,-- -T-�+Orr-,A 1:�, ye> v From the desk of.... KEN HURLEY j - i L' ►71 A as aia��a+► DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES l Q D NO. DEPTH HOLE NO. HOLE NO. HOLE _ .._ 1.0' 1.5' . 2.0' 2.5' I l� 3.0' 3.5' 4.0' 4.5' _ ...... _... 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' ... 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed 1.-i/,,&. Indicate level to which water level rises after being encountered 1�1 Deep hole observations made by: (Z�t —� PG�D Date (,o D o Design Professional Name: Address: ID2 �L -OA 1� Signati ai Q� 11 llk� N A�. y �A, , 2 N A0 N87" O6' I O "E 98.28' ;E TREATMENT ATED ON THIS iSPECTED BY ME SYS- ��iZfrA� ' � N63'37'40 "E � N46 "95'00" E 13.41'_ N81'5i5030 'E 21.07' .9 WELL 1250 GAL CONC. S\ 4' PVC SDR -35 PIPE- S' PVC PIPE SLEEVE — CONC. DROP BOX (TYP) 300 LF STD TRENCHES 3 D s 7 9 N28"07,20 "E 16.95' 11 �- N63' S9' 40 "E 12.39' 573' 16' S0 "E 6.81 ' 506"56'10 "E 10.10' 571'42'30 "E N20" 28' 25 E 45.76' EX CATCH DA51N — TANK \ DECK w 'A' r 0 8A Ao m B -d L END CAP (TYP) 5LA1� WALK o _ CUY O _?e'_K___46' 1100% RESERVE AREA 8 LAM ®56' EA -2 LATS 0 28 EA 0 NORTH 4'0 PVC SDR -35 PIPE ROOF LEADER DRAINS DRAINAGE SYSTEM - 2 CULTEC RECHARGER 280 O — POST & KAIL FENCE POLY,MR MT. WALL <Typ) t?- 200,Op L- 41.86 't NIO' 46'40 "W i C 17e1ta- 31'15'05" 105.53' � �) � - "AMMANY HALE pOAl2 SEPTIC A5 -8UILT PLAN a D.G. EWGINEERING PC "�`� PAM Ws, ` PALLI.ING NY P -, 6N19, rAY-- :(843) 868- 9 4, ` � JG-0J A KALM, FE FAK !8437 899 -2E NYS LIC. NO 019miD4 EMAIL, JKALIN VERI: j J POINT NUMBER DIST. FROM »A„ „B» SEPTIC TANK 1 12.4' 27.0' DROP BOX 2 39.5' 26.2' LAT END 3 90.5' 88.7' DROP BOX 4 42.0' 22.5' LAT END 5 87.0' 83.0' DROP BOX 6 46.0' 21.6' LAT END 7 84.8' 78.3' DROP BOX 8 51.2' 24.4' LAT END 9 83.3' 74.0' DROP BOX 10 57.3' 29.0' LAT END 11 82.6' 70.4' MARK A" IS THE NORTHEAST CORNER OF RESIDENCE. MARK "B" IS THE NORTHWEST CORNER OF RESIDENCE. AREA RESERVED FOR HEALTH DEPARTMENT APPROVAL CERTIFICATION NOTE THIS IS TO CERTIFY SYSTEM WAS CONS' PLAN AND THAT TF BEFORE IT WAS CO' CONSTRUCTED IN A RULES AND REGULA DEPARTMENT OF HE DEPARTMENT OF HE JOHN A. KALIN, PE