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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -5 -17 BOX 15 lr �,S' ' : . t7 lair 16 1 llr IN .t all L 01575 „. aQlllAtt CD�lfl Y DMAM28MOF MILUT r : Dleltla� 1 �teYe�aail�l Hnh� 9enbe�: Caaool, N,Y. lai9t . ' Mlrwlde let�lt • aot CENRUIICAYS OF COIISMUM ran* oorenwcro�e Mme: root SWAM DmsoGat, SYS= P-19-88. it adaiat Ice Pond Road � rs T � °Pa tt on Brenner 10110L W l 3 79 Bit 3 -� �_ ltswural, !eloiaa , otli.nr/Appilea.gN..: Richard L rape Jr 4 i n.� of PeevOsu / - 5cout_`Realty, Ltd:.; Rte 6 &22 Tom,” Brewster, N.Y. 10509 t lna`re ubdivision A roved Fee. End osed'0 Amn„nf YhD� hN Frame "het �.. 2.843`. Acres . P s«u,,o.b,` yt V +�u. ds. M1 — Iitltier .LD•i.aaM T h re @ Deetp Fbw G P D 6 0 0 PC® N.ttOeaM.d to Detp4ed Wye. Fm r e.-waa S..r SirRa�p.s�awa w e.w.e .t 10 0;0'r�.tt.o gp(� .rf 4 2 9' X 2 4v w .: x 1 water Std Fae� j .1r Adds... ` ion X. p,1,,.t,�;�ITP..F_ A ' 1 ��.,, R. Box B', Brewster, N.Y. 10509, bdair4 ie.a.ga R -0 -B' Fill' Section inch 100:8: ex8arision;. area f I reo►etnit'.that_I'arn'wholly and comoletely:respontible fo • he Aiiign and location of the, - Proposed iyttem(s)a 1) that the $* rae ewer • dit osal�ty �torn 'above described will be constructed at shown on the approved amenament-theie to and in'aecordsnce with the standards, rut-11191-19. Irm lriiiiiirr!e oo�ncy. oapertm.tt ., of sfeatth, and that on completion thereof a �Certifica"te, or Construction Compliane}" tatisfaetory to the Commissioner of Mualthwill S.. Y• ` ';: 1 Ya 'iudrellted •to fie Depirtmant, -and a written giraiantee wilt"•furniYwd -toe oeiner, gis'wcoianrs, „helis or aoiins by the builder, that said builder will ttleu i - `flood operating condition any part of �aaid saiarage dhpof♦1 system during vie period 40j".(2) years Nnendletsly following thedate of'the Isau- arnse of the approval, of • the. Certificate of Construction .Compliance of the original, system or any tapirs thereto; 2) that the drllled well.deswlOild' adove i ww, M bcatod 4obo” omit app►ereal plan and -that Laid well will tie installed M acobrdanca, with fin ttanclards, rules and regu nt of the PutMm � Ceurrttl Oegrtm�wt of, MMMh. � �� � � l February ..,19 9 0 Simms !LN /u�Lr�Ct P.E: —X_ R,A. e.n..MO Add►esa RD9= Fair St 29206 t . APPROVED FOR COPATRUCTION: Thh approui expires two years Iran the date {stue0 unNtt con;truttbn of the. building has been unde►trtksrn and it r `• •' revocable fW causo me 64 annnnOsO or modified when :considered neeeuary py':th �COrnmissiohar of'Maalth. ' Any charge or alterstbn of coniltructbn - requNes.a new ben Appoved -for disposal of aomestic tanitary sewalN, and /a'.W{vate mater supply :only. Rev : _ c " � i .' f '� ��� � `'� , �` " � i .' f '� ��� � `'� , �` PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION,. OF- ENVIRONMEN.TP►L_ :.HEAL.TH_ SERVICES - Date 1- February 1990 Re: Property of Mr. Richard L. Rapp, Jr. Located at Ice Pond Road (T) 79 Section 3 Block 8.13 Lot #3 Subdivision of Brenner Subdivision Subdv. Lot # 3 Gentlemen: Filed Map # 2189 Date 11/21/86 _ This letter is to authorize John H. Prentiss a duly licensed professional engineer X or registered architect__ (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in cg nection_with...tYl �w t,_ter_.an.d_t.o., supervi.s6 .the .construction, o.f_._%ai.tl._.. system or systems in conformity with the provisions of Article 145 or' 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Aj 1� untersigned: E. , R.A. , ## QRpFESS10ryq� F PREIvT/s����� Very truly yours, ND• 292 &0 F 0FrHE STATE Address JOHN H. PRENTISS, P.E. R09 FAIR ST 914 -878 -6170 CARREL, NE i YOtgK 1051 Telephone Signed _ Owner of Proper _�rc a doOilO�? Address Town Telephone PUTNAM COUNTY DEPARTMENT' OF HEALTH DM, SIGN.:. OF ENWRGNMENTAIL- HEALTH 9ERVICCES CERTIFICATE OF CONSTRUCTION COMPLIANC E TREATMENT SYSTEM[ PCHD CONSTRUCTION PERMIT # Located at C� �Q fv Q �� Town or Village -SQ'" l T Owner /Applicant Name 'Tv P-t�) BA-er-A- Tax Map 34 Block 5 Lot I_ Formerly k ICI+W &ff e , 3 4' I Subdivision Name A 91WP Mailing Address 2--� I Potd Subd. Lot # 3 Date Construction Permit Issued by PCHD b 12-q 13 Zip /05b f Senarzte Sewerage _System built by ty.eg- ,.4.o- -fie S CU, Address f reki 0fdc Ly l o f'& I Consisting of k 00 O Gallon Septic Tank and �Z. &e ZZ2 �e � ��n ► o , f Other Requirements: watt SUPPRY: . Public Supply From. Address or: Private Supply Drilled by e d 0A11Y1# � .�� Address ,�d'�dVD4fi- � /O0 0 Building Type -N pw -�- Has erosion control been completed? Number of Bedrooms Has garbage.grinder been installed? _ I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- 'built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Date: d Certified by Address / Z( C County Department of Health. P.E. A R.A. Z 3 License # IS-7 3 Z % 2— Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals ubject to modification or change when, in the judgment of the Public Health Director, such revocati , ,jmo ificati9Qpr change is necessary. By: '� Title: U �-�- Date: Z Zt U' White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location_ $treet Address :.. ,.. - • -. -- = = - = : --: 232 Ice Pond Road Town/Village = _ Southeast Tax Grid # Map 34 Block 5 Lot(s) 17 Well Owner: Name: Address: John Baffa Jr. Same as above Use of Well: 1- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion X _ Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 41 ft. Length below grade 39 ft. Diameter min. Weight per foot 17 lb /ft. Materials: X Steel _ Plastic _ Other Joints: _ Welded _X _ Threaded _ Other Seal: _ Cement grout—,',, Bentonite Other Drive shoe: Yes A No Liner: Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped X Compressed Air Hours 6 Yield 5 glom Depth Data Measure from land surface- static (specify ft) 103. During yield test(ft) 5 Depth of completed well in feet 950 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 4 6" Fill 4 950 Kard - �"edi ur;; Granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 700. 2 Pump Type Submer. Capacity 5 Depth 7 2 0 Model G o u l d s Voltage 230 HP 1 1/2 ITankTypeBlad er Volume $6 gallons .950 5 Date Well Completed 7/25/01 Putnam County Certification No. 2 Date of Report , 8/30/01 W� ° ) '� rlvr>r : txact locatton of wen wtm atstances to at least two permanent lanamarxs to De provtaea on a separate sneevpian. J Well Driller's ,,, %Hl ' 11 i ng Signature: Address: 75 Putnam Avenue Brewster, NY Date: 11-05--01 White copy: HD File; Yellow copy- Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 T 'd d0 1N3WiNW30 AlNn00 WdNlnd:34dN NOV .e5 -91 92:17 PM TOWN OF PATTERSON T2GL- 8L2-St,8 :131 ST :ST NOW T002 -S -nuN 9148782019 P.91 r s' =s JL MLVAY �« &A D.&VO& MOMAN LN, jux hoanm D?d? OF IM&TH I Cbwvm bm"Or, Now York fl�S6� - �wes�aus �� r�iga�o•sioe ce��a� ara�y�ee RuK41w4m omm -mio vne M143211.G $ �� �.a�.a ©a �ta�ara•raP® peoevb09! (�IO1849�88 �teaa�eaa -t�� a 'TAX 1 iA TOWN: o A$iM16it ED OwN®S6C$'bBAILa smcra c� -yowa- �me�.ALO'e�^y a . The lafmrm County DepertmejA of Health wad noe iaaivQ m cgrHfjcgte of �o ®suct��o�pl6aacs o�l�ss aae sic :: ad figeb:eda ff.�.d 9�gsl ��fl11 "d1dmw is 23APed by as authorized tore :;.Midal. Ws form h to be subwltW Mtb the application hr a C®rtiiles to Of COP. 3 tvachwt campusace. M81 E/Z v4ad 4041 ?` 60-$-AON G/ G abed `•LV:11l L0-9 -AON •` L95 m e�9 °• CAI aUog `•lll :Aq }Ue$ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT NOTE: Exact location of well with distances to at least two permanent landmarks to be prdvided on a §e ftate'sheeflplan. ` .75 Putnam Avenue Well Drill s e Address: Brewster. NY 10509. — Signature: Date: LIZ L White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 StceetAddress::. ._- -• .... .- 232 Ice Pond Road TownNillage:' Southeast TakGri Map 34 Block 5 Lot(s) 17 Well Owner: Name: Address: John Baffa Jr. Same 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 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 41 ft. Length below grade 39 ft. Diameter min. Weight per foot lb /ft. Materials: Steel Plastic Other Joints: Welded X Threaded Other Seal: Cement grout _X _ Bentonite Other Drive shoe: x _No Liner: Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped Compressed Air Hours 6 Yield 5 - glom Depth Data Measure from land surface- static (specify ft) 103 During yield test(ft) 5 Depth of completed well in feet .7/25/01 Well Log If more detailed information descriptions or sieve analyses are please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 4 6" Fill 4 950 Hard - filed Granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 700 2 Pump Type Submers fARacity l5 Depth 720 Model Goulds Voltage 230 HP 6 Tank Type B1 adder Volume 950 5 Date Well Completed 7/25/01 Putnam County Certification No. 2 jDate of Report 8/3.0/01 11 ) A4f NOTE: Exact location of well with distances to at least two permanent landmarks to be prdvided on a §e ftate'sheeflplan. ` .75 Putnam Avenue Well Drill s e Address: Brewster. NY 10509. — Signature: Date: LIZ L White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 a RUCE R- FOLEY Vle Health Dlrectar I Geneva stand Brewster, Ntw Yodk 10509 LOREITA MOLINAM I .N., MSK Asroelats Public Realth DWetor Merter of Padont SeMaei Zctrriroamtarsl 83eai16 (914)29 @ -6134 F�rl(914) 2TY -7921 l+lardag Services (914)271 -6558 WIC (914)278.6672 1'2x(918) 276 -MOS Early InicrveaMaa (914)278-6014 Prexbeal (914) 278-6082 i£ax(9l4) 278 -6648 O WARS NAME: TAX MAP NVMBER: E911 ADDRESS: 'OWN: a: AUTHORIZED TOWN OMML; DATE- 4 The Putnam County Department of Health wilt not Wu>e a Certificate of Construction Complinuce unless the above form is completed, i.e., a legal ]E911 address as' assigned by an authored town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 N1rRF'R. ' ZIZ e6ed `BL ZG 10 -9 -noN ` L9917CZG •`11 :As ;Ue5 DEPARTMENT OF HEALTH I Geneva -Road Brewster'.* New York 10509 Environmental Keskltb (945) 278 -'6130 ', Fax (845) 278 - 7921 facsimile tm m'mittal To: —flat@ Fax: 8Z? -V93Y From. Date: % Re: Pages: CC: In the event of transmittal difficulties, please contact this office. a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF. ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well1;oeaiti6n--- ' ` Street Address: - 232 Ice Pond Road Town/Village: Southeast =MaP ck 5 Lot(s) 17 Well Owner: Name: Address: John Baffa Jr. Same 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 IDrilling ]Equipment Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 41 ft. Length below grade 39 ft. Diameter. 6 in. Weight per foot lb /ft. Materials: X Steel Plastic Other Joints: Welded X Threaded Other Seal: _ Cement grout _X_ Bentonite Other Drive shoe: _L_ Yes _No Liner: Yes No IScreenDetals 11 Diameter. (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes —No Hours Second Well Yield Test _ Bailed'— Pumped X Compressed Air Hours 6 Yield. 5 : gpm IIDepth Data Measure from land surface - static (specify ft) 103 During yield test(ft) 5 De e I in feet 7/25/01 Well Log If more detailed information descriptions or sieve analyses ... _ _ .. are available, please attach. Depth From Surface Water Bearing well: Diameter(in) For "' 7 Description ft. ft. Land Surface 4 6" Fi 11 4 950 Hard - hied Granite _ - ----- .... If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 700 2 Pump Type SilhmarsfMRacity 5 Depth 720 Model Goulds Voltage 230 "P Tank Type B1 a d d e olume 950 5 Date Well Completed 7/25/01 Putnam County Certification No. 2 Date of Report 8/30/01 I ) Nu,i t: txact location of well with distances to at least two permanent lanamarKs to Ue proviaea on a separate sneevpian. .75 Putnam Avenue Well Dril s e n a JlVc Address: Brewster, tlY 10509 Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - .Owner; Orange copy - Well driller Form WC -97 BRUCE R. FOLEY .3 "' � ' ` ' � Pu`61ic Health "Director "° "' " � •_ _ .. ;- -LORE TTA MOLINARI R.N., MS.N: Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health •(845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 John Karell, Jr., P.E. 121 Cushman Avenue Patterson, NY 12563 Re: Proposed Compliance: Baffa Ice Pond Road, Lot #3 (T) Patterson, TM# 34 -5 -17 Dear Mr. Karell: November 26, 2001 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. All details not relevant to the as -built plan are to be removed. 2. Distances to the J -boxes and ends, o£all.trenches are .to. be.noted on the plan: - - 3. Revision dates not relative to the as -built plan are to be removed 4. R.O.B. certification note is to be removed. 5. "Trench layout" is to be removed from title block Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ve truly yours, Robert Morris, P.E. Senior Public Health Engineer It'll�Ri�1 NORTHEAST LABORATORY OF DANBURY %N ACCC9oA� 39 'MILL PLAIN ROAD - IDANBURY, C`I' 06811 CT Cert: PH -0404 203) 748 = 7903 ="FA -X (20 -3 748 =0652 NY Certi 1147T' n - IIsAW www.NORTHEAST LABORATORIES.com < REPORT TO: MILL DRILLING, INC. DATE SAMPLE COLLECTED: 8/31/2001 75 PUTNAM AVENUE TIME COLLECTED: 11:00 A.M. BREWSTER, N.Y. 10509 COLLECTED BY: ROBERT MILL DATE RECEIVED @ LAB: 8/31/2001 TESTED BY: LAB# 11471 LAB I.D. # MD -22 REPORT DATE: 9/11 /2001 SAMPLE SITE:. JOHN BAFF JR., 232 ICE POND ROAD, BREWSTER, N.Y. SAMPLE POINT: TANK HOSE BIB SOURCE: WELL TREATMENT: NONE MAXIMUM CONTA UNANT TEST PERFORMED RESULTS METHOD # LEVEL (MCL) OR STANDARD BACTERIAL: o Total Coliform (Bacteria) ABSENT per 100 ml SM 9223 ABSENT PHYSICALS: • Color (Apparent) 5 - EPA 110.2 15 • Odor ND - - 3 Units • pH 7.32 - EPA 150.1 No designated limits • Turbidity 2.0 NTUs EPA 180.1 5 NTUs CHEMISTRY: o Nitrite Nitrogen <0.005 mg/L as N EPA 354.1 1.0 mg/L 0 ` o Nitrate Nitrogen_ 0.21 ` irig/L a§ N - EPA 353:3 • Alkalinity 118.0 mg/L SM 2320B No defined limits • Hardness 156.0 mg/L EPA 130.2 No defined limits • Iron 09/17/01 <0.03 mg/L EPA 236.1 0.30 mg/L • Manganese 0.025 mg/L EPA 243.1 0.50 mg/L Corn bared 1sr: rt for Iron plus Manganese = 0.50 mg/L • Sodium 5.3 mg/L EPA 273.1 20.0 mg/L ** • Lead 0.007 mg/L EPA 239.2 0.015 mg/L * ** ml= milliliter mg/L--milligrams per Liter ND =none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count — Notification Level ** *Action Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: MIPOTABLE or aOT POTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) RESULTS BASED ON SAMPLES SUBMITTED: 8/31/2001 Laborat ' F °NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037o (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 o OUTSIDE CT: 800 - 654 -1230 I� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICE GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM II PX-F 4 -:3-0 to ft PGr4' Owner or chaser of Building 1 1 rn� rte/ LL Building Consffmcted by 3 ) Location - Street %a a AI 12,V r } � Jae 1 oro-S t.34—" — 7 Tax Map Block I --fte /t/,Y. � kzrw J, TownNillage Subdivision Name 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, �nnd in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guaraitee to the owner, his successors, heirs or assigns, to place in good operating con4it:ion 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" i'or -the sewage treatment system, or any repairs made by me to such system, except where the faitWe to operate properly is caused by the willful or negligent act of the occupant of the building utilizi}g -the system. The undersigned further agrees to accept as conclusive the determination of the Public �ea.lth 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 utilizir g the system. Dated: Month Day A Year 0 1 General Co tractor (Owner) - Signature 1'4,04r' Corporation Name (if corporation) Address: State \1 Zip Signati Title: Corporation Name (if corporation); — Address: State Zip -fir-- - i' Ford; GS••97 Ii ♦e >t 'k \ i, h k,r :fir �' ! y .1 ! V,� 1 1J DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RIE: Property of Located at (C 6 POND P4 . T/V Tax Map # /Block Lot Subdivision of 1% n h P/d Subdivision Lot # -5 Filed Map # Date Filed Gentlemen: This letter is to authorize 76 �C—t -- a duly licensed Professional Engineer _ X 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 Sdnitary Code: Countersigned: P.E., R.A., # Mailing Address State Telep Very Signed: of Property) Mailing Address: -2- _ State (j Zip 0 Telephone: Form LA -97 .. d ._.- .._. 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICE GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM � PAT o tt� 6n-PFW )or OS I. S14 4 � 1 Owner o)Zc haser of Building n� Building Con Acted by — A ) 'le-At / a �,q Location - Street 1Za o lz lame# ? 4)em Tax Map Block L, �Pt (��" (if r, z ti% [ 0 Town/Village Subdivision Name Building Type Subdivision Lot # j I represent that I am wholly and completely responsible for the location; workmanship, megerial, 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 Healt, 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" �or 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 utilizi}g the system. The undersigned further agrees to accept as conclusive the determination of the Public Kealth 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 utilizir}g the system. Dated: Month �o _ Day �( Year 0 General Cdlift&actor (Owner) - Signature Corporation Name (if corporation) Address: State \I Zip Signati Title: Corporation Name (if corporation) Address: State Zip Fore GS -97 a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONNIEI\ TAL HEALTH SERVICES � FINAL SITE INSPECTION `1 �lO o N ". To 'Shy Xis• TremiAir it Date: _ Inspecte' : < VT'to�\To TtECT) � ev Street Locatioir � - /2 E Po,v n' Owner . E XlN,� lao A! Town & 4! �Z - �sov Permit # P - TM # 3 = S- 7 Subdivision Lot # 3 1. SeNtiage Svstein Area YE O COMMENTS a STS_area located as,per- approved plans. .. r AO e r Q M b mill sectionµ date .of placement -" Y, .) .1 barrier Lgth. Width Avg Dpth gee c. Natural soil not stripped .............. ............................... d. Stone, brush, etc., greater than 15' from STS area.......... _ e. 100' from water cours etlands ...... ............................... _ II. Se�kaQe System a. septic t si -1,000 ........1,250 .........other ................ b. Septic tank in evel .............. ............................... — c. 10' minimum from foundation .... ..............................s d. Distribution Box 1. All out ets at same elevation -water tested ................. 2. Protected below frost ........................... :..................... —_ 3. Minimum 2 ft.Original soil between box & trenches _ e. Junction Box - properly set ........... ............................... f. J renc es Length required 1{a 9 Length installed �2 114 _ 2. Distance to watercourse measured -f / o Ft.......... _ 3. Installed according to plan ......... ............................... — 4. Slope of trench acceptable 1/16 -1/32" /foot ............. - 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface ........ :......... — 7. Room allowed for expansi on, 100 % ....................Q e ' ��,'w, 8. Size of gravel 3/4 - 1 %2" diameter clean .................... au ct -4 �. -3 slow . Depth of gravel -in- trench 12" ....................................... minimum ............... • � - -• � - _ - _ 10. Pipe ends capped .... ........... _ g. Pump or Dosed Systems Size -o pump c am er ................ ............................... 2. Overflow tank ........................... ............................... _ 3. Alarm, visual/audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ........................................ ; .......... ...... . 6. Cycle witnessed by H.D.estimated flow /cycle........... III. Houseffluilding a. house located per approved plans .... .................... — b Number of bedrooms ...............:3...: ....... IV. Well a. Well located as per approved plans ...................... _ b. Distance from STS area measured 4- io O ft ........... _ c. Casing 18" above grade .................. ............................... — d. Surface drainage around well acceptable ....................... V. Overall Workmanship , a. Boxes ro erl grouted ............................ P P Y� b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... _ d. Backfill material contains stones <4" diameter .............. — e. 'Curtain drain & standpipes installed according to plan.. _ f. Curtain drain outfall protected & dir.to exist watercourse _ g. Footing drains discharge away from STS area......... .... h. Surface water protection adequate ..::.......... .......... .....0 ^ i. Erosion control provided ...........:..... ............:.................. De 4ro7 MMP .. ` �` -.:u {' BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public c Health Director. Director of Patient Services DEPARTMENT OF HEALTH • 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 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 October 11, 2001 John .Karell,PE 121 Cushman Road Patterson, New York 12563 Re: -Field Inspection Brenner Ice Pond Road, (T) Patterson Lot #3, TM# 34-5-7 Dear Mr.- Karell: The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field: No further comments. -If you -have any-furtheri. quiestion's, c6ntakt..meat (84-54-278-613.0_e*X' t, .226 1 Very truly yours, V. Gene D. Reed GDR:cj Environmental Health Engineering Aide Sent 8y: LLL; 1234587 ; Aug-2-01 13:23; Page 1/1 !U9 -16-00 SAT 9:07 AM PURAM CH ENV HEALTH FAX AD. 19142787921 P. 1 E iiy that systm(s), as lstt4 at the above premises bu beet = cted ud I have inspected md . vCdfiEd thek- 6o etion in &midi sm the imed PCM clou#=Gdotl Petsit wu l �e�1eb. Aa Dar Gestured by. /AW4",OE PP, RA . � Piofessio� do d t tic. � _ X PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTI��JC'TIOIaI PERM GE TREATMENT SYSTEM' - PERMIT # f l 1' Y? Located at V-4 96 PO fL4:AD Subdivision name Subd. Lot # Date Subdivision Approved 11 _Z 1- 0 b Town or Village �/¢'S(i A) Tax Map Block Lot 7 Renewal Revision (�J Owner /Applicant Name f l C AMA &&P P TI& Date of Previous Approval f=2 Mailing Address (1, 174 h-0 MWS &>7t /�y Zip 10,17 TV Amount of Fee Enclosed Building Type OUL-A4L— Lot Area No. of Bedrooms Design Flow GPD 60-0 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 100 G gallon septic tank and 41A L-�- 2 u T-lLvp C 14 Other Requirements: *S P4-6 )Fi l_l-- 600'1051: To be constructed by7:ln_ j Q -,11=-7Z IWLA1 p Address Water Supply: Public Supply From Address or: Private_ Supply Pril.led,b y_ d7G ._. _ Ad ess_. ��JP�5` I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: �° l�� E. R.A. Date Address i d �y License # 5 Z] 7 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w n co sidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe 't. A roved f scharge of domestic sanitary sewage only. By: � 1� Title: Date: r d White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Fonn CP -97 1UTNAM COUNTY DEPARTMENT OF BlEALTH HEALTH SERVHCES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner.. 9 (Cff"& Address 2-13'A&_Cl 6m.,354ey 1k, Y.: 1 0 Located at (Street) —Tax Map Block -5 Lot /7 nearest cross street) Municipality Drainage Basin Date of Pre•soa SOIL PERCOLATION TEST DATA S-1 -LI 10 Date of Percolation Test 5 rZ 7 16 Hole No. Run No. Time Start -Stop Dv)th to Water rom Ground ]Ela&se Time Surface (inches) in.) Start Stop Water Level Drop In Inches Percolation - Rate Ifflulluch 41/q 2 V? 3 3 Zo 5- 'L.3 �, Z7 3� -,a 4 5 2 13 Zoe Z 2-9 3 '2�6 1130 zj 4 5 2 0 3 4 F71, 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 I min for 1-30 minlinch, :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. Z. Form DD-97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES " "CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM 0 PERMIT # - zY 6 Located at Town or Village PrT �St� �( CT) Subdivision name Subd. Lot # 3 Tax Map Block S Lot i Date Subdivision Approved P —7.l —910 Renewal Revision Owner /Applicant Name k( 0113�D &Aft i J/z - Date of Previous Approval Mailing Address vZJ S (2-4-0EX!�11f29 Amount of Fee Enclosed `� 3 Building Type Lot Area No. of Bedrooms 3 Design Flow GPDr�C Fill Section Only __ Depth 3P-7—Volume (r OO 05 PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of / 000 gallon septic tank and Other Requirements: To be constructed by 8LD f ?W Gy' Address Water Sunnly: Public Supply From Address ... -10r: - - Private - Supply. Drill ,6d:6�.; 4 --Address:. I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or repairs thereto. Signed. P.E. R.A. Date Address ' .� 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 modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new p i .Approved for discharge of domestic sanit ,s%ew ge on By: Ti � . -,/ Date: q1 161 60 White opy - HD A; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Profes Tonal Form, CP -97 PUTNAM COUNTY DEPARTMENT OIF HEALTH IIDMS RON ®IF IENVRROIMlENTAIL HEALTH SIERVRCIES _ ,._........_.:_.. , ....._ ._. _ ..:APIEnLICATION TO C®NSTRUCT.A WA7.CEllBWE L1L,_ please print or type PCHD Permit # Wellll Location: Street Address: Town/Village Tax Grid # AV, P F '0 f J( Map3 Block 5 Lots) WeR Owner: N�me: � Address: r V " Use of WeIl: Resid ntial Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2-secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served J Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply 1(D>riliing New Supply (new dwelling) Deepen Existing Well I<Detafled Reason for )fDrilllling Well Type ,�. Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes X No Name of subdivision PIN ak A Lot No. Water Well Contractor: Address: LN2 5+e-'r- Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contami atio t be provid o separate sheet/plan. ate: - — - ApP�icarit'Slgnature: - .. _ V PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROYIEIlD.IF®R 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 ater well driller certified by Putnam County. Date of Issue) 6 1 6i Permit Isstina Offici Date of Expiration' ) � T Title: V_� ( , � I �-- v ( J -y y Permit is Non- Ttraniffe>rrhble White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 NEW YORK STATE DEPARTMENT OF HEALTH Specific Waiver Bureau of Community Sanitation and Food Protection from Requirements of Part 75 and Appendix 75- A,10NY(:RR - for Individual Sewage Treatment Systems tt» Name of Applicant No. Street City/Town State Zip �K Address -Zl Sr AAt No. Street City/Town State Tip Site Location �(,� 1 +L) OA 0 1. Reason why site does not meet 10NYCRR Appendix 75 -A (check appropriate box(es)): Separation distance cannot be achieved. Excessive slope. High groundwater. Inadequate depth to bedrock or impermeable layer. Soil unsuitable. Other (explain) ................................................................................................................................................................................................................. ............................... ...................................................................................................................................................................................................................... ............................... . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . .. . . . . .. ... . . . . . . .. . .. . . . . . . . .. . . . . . . . . . . . . . . . . . . ..... . . .. .. ... .. . . . . . . . . . . . .. . . . ..... . . . . . ... . . . . . ................ . . . .. .. . . . ... ... ... . .. . . ... . . . . . .. . . .. . . . . ... . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ................................................ 2. Proposed design or conditions of waiver: ................................................................................................................................................................................................................. ............................... �.r........1��1'r�T.....e 1`......'�r..l .............'� �!E ...o......'S�,a.�....t�.. i��y....... ............................... t !........... a r.......QF....... ...........:............... ............................... ............................................................................................................................................................................................................................................................ ..............................: 3. The proposed design may have the following limitations (check appropriate box(es)): J 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 Construction 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, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked by 1,1 _04uing official for a change in conditions for which this waiver was granted. .............. ............................... �SENTfiTI OF�CO• M •SiONEFi OF HEALTH 1.0 ..I.O.d ................................................ ............................... DOH -1326 (7/92) ORIGINAL - Local Health Agency COPY - Applicant/Design Professional (GE:N -152) s 24' x 40' o 960 Sq. Ft .3 SjrALj&qAjWbjUrANS APPROVED FOR BP,%Rn*W ter lluilder for a • Gmtmst ' t-ill Mtchert DROOMS, ID 14-t n-4 Va. • firepk te 14ma Tih-V ALL SUBSEQUENT REVISION/ALTERATIONS TO THESE PLAN�UST BE SUBMITTED TO THE PENH FOR API M-01 TITLE OVAL /aq° ®D jo gT5 i 01, V �zj ...... ...... . H o 1: N� 2,111�opz TM 5--J-7 ��CR A-P-0 *+PPS Z-1 S7-C) *r 0,S :rcE� Po' 10tv MINAW,ZL-17z, Plel-. 1i -Wq 1-2-1 custO44A) fj<)A-0 - -P A-rreTZO A) ivy Z-5 b 3 J.A iii iii I lii 0 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes 09No B. -WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another Involved agency. ❑Yes Wo C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may*6e'•handwiltfe6, if• leglblo)'- Ct. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: K� C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: Ma C3. Vegetation or fauna, fish, shellfish or wildlife species, signifit:ant habitats, or threatened or endangered species? Explain briefly: ND 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 pt a C5. Growth, subsequent development, or related activities likely lobe Induced by the proposed action? Explain briefly. 140 C6. Long term, short term, cumulative, or other effects not Identified In C1 -05? Explain briefly. No C7. Other Impacts (Including changes In use of either quantity or type of energy)? Explain briefly. 1%10 D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes No 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: ;UWA r Ca jAm t7wo Na migo T of oeot y no of Lead Agency — Agency RevGc. FyAm I !- 1'111 r ryPo Namc o Re%lion%l c Officer ht It:at Aat•ury TII u o I tp.aul n rcr eg a r 7 sponsible Officer in Lead Agency Signature of Preparer (Ff different from responsible o icer ILot o� Vale 2 {! {\��D 9+ .,.r`y� �`� +`� pq COUNTY DEPARTMENT (,i 1 HEALTH �t �a) 1 t Il a �'I \''A' S. ENVIRONMENTAL l `� 1 SERVICES RE: Property of Located at LFITTIER OF AUTHORIZATION 't-__0b0'0 f'ZZA-D T/gi Gi -Pll/S 0 Tax Map �� Block J� Lot Subdivision of Subdivision Lot # Piled Map n ]date Filed Gentlemen: This letter is to authorize a duly licensed Professional Engineer or Registered Architect to apply for the required wastewater treatment andlor `ti ater 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 systeins - --- in conformity with -the provisions.of Arucle 1.45- and/_or -147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. P.E., R.A., # ►W1 Si Mailing Address: �� V/ •L -'VV ��� State ivy Zip Oj'd Telcphone:7' ._� r .� ":..:', .. `� 'r .. -.V .Jl:a�•_i'?titCJ1f.'ic.0\= «i'���:IIi%:,M' ~� - .i. �l•�:. .►•..�fy.'Y'•: {...:5: �• '� _ - \. 15; �:a�:•.. Zf l`j. iJ. -�`��- - put,," OODIf!! DEFA11'l3UM OF IBM= DQahla et Bite ae�aolil Ilfadl� 9eevfeba. Caaiaaall. N.Y 11512 Bag)Iilea to FnwEala 1•aaesft d a CMUPWAIN OF COMPUAM eo FOl61 !oR UWAE$ D1eeo�aL Sisi®it [rat #-P19..;.88 1 e: Pond Road T. 'P.atterson, 79: 3 8.13 Richard .L. Rapp, Jr. >:.�.:' • c/ 5125f9-9 -4 4/5%88 Ada Crniit 'Raait L, 't tfj r..R'nlltps :6 R 22, rewster, NY 10509 ZIP Date Subdivisio]i.Apnroved 1988. Fee Enclosed ❑ AM* Mint suft T�p ,Frame _ Lot Aria 2.843 AcresFm yds. seaelMo.4 .. ��„ ve iQ u, t ree � :[�. c r .n 600, rc®xelms.ua. d saaatred sure. Fm h. a.ap.eea _ s. .r&"MmvSi.� IS,0=o. 1000 "*.-,I`,: ..a 129' X24" w. X 1,811 W. Ube WeW s .t s: - tk.a■ . Ad&�= .� X ••a..fe it of Denea en ..�... 1 represent .that I.am'wholly and completely responsible for the dosign and location of the proposed, system(s)''. ]) that ttta separate sew dl sal stem ' above described will be constructed as shown on the approv".Aw ondmant thve to ano -in sca:ordence.with the standards, rules a regu ns o m caunly, Depakment Of Noah, and that on complet".!hereof a '-COrtoica!te of Construction Coanplis"W! satisfactory to the Commissioner of Healthwill be "MOW tip "'the Department. and .a written. guarantee will be' fomidaed the owm►, his weesaors, heirs o►, assigns by the builder, that said. builder will . place In pdd .operating condition any Celt of Old sawatae.dispos i system durin,'.fhe period of two (2) yoa►a bnmedlately following t"datsi of the Issu• MCe of the approval of- tAe CertNieats, of Const►uction� cOmpllania of thi,orginal tystei mi of any iepeks tha►etol 2) that the drilled well described above WIN be loeated.as shown on the sail v d Plan avid that Said welhwitl li Insta In a0001Aanos •with .the standards; 'rules, and reg—MIM91M,0t - the' Putnam County paprtsnent of Mealth y wt. 8 May. 1993 Signed / V.E.` X A.A. _ 'Adds.. "RD9 Fair Street arfflel , NY :- 10512. ' ].kelp. No: 292.06., APPROVED FOR CONSTRUCTION: This apooial'empNas two'yews from the date issued unless, construction of the building .has been undertaken and is ►evocat%is for urns or may ba amended or modified when considered necessary. by .the,Comniiaaonw -of Neafth. Any change or, anerstion of construction Mu as nnow. permit. Aoao�iM to dlspoui..et domeak sanitarY MW�p: a. ' prWaft wasp Wp01y Only. 1. 0 88 Date -,! l •yf`.�` � .% �i'?` too l 'ff ' F "'�'',i�'C � 4' '•Ri: iD" o � j.e �+ r' :U�'..h.E T?1 Y L,?� ^raS.vs� ad 'tir � ud r F t v:c : t•y�d. �' - Y i � D' F,mv,±i.c., >a.; C�.+Pj +$Fk . k:r ?.:'u,7 f►i4hsj•••iiA`ii►p: Pvca�adc E►rD;' �'.': �'1i P=W M MWAW iWilT„ ! MM - - - -' • • Road %bO : • M•. Sads�i :.0 I T • 6? ap 6'S•, =k I ..0 irw.c.,a1 �'. his =.b•ine ■ Bab C2 PEGVLM AROWd t -pato Subdivision A.R=ved fee Enclosed-13 Asnntint Three P "a rbve rE 03 tnrwwas. D3-%p rl• • 0 i ;P 600 €` +Mj:'IOD ♦o v..mAl+nr• LV Y cnn+rrr,.d Wbm Do 1% onewsubd i 3 -•ah::.rx 7• cK.wtite d f &,a:i,� tic.ut�r ? �z.>•a u.md Deep To karar�awi 1e q ... C31 X f3t�xa4o by ? 4Ad&= ? R -Q -B Fill , Section inc1...lob% expansion area 1 roprownuthat 1 'am raho{ly.Dnd completely rouponsiblo for tho i4sign tired location of tho prOpas d 'systom(a); 1) that thO O6 taariag0r di8 po871: tiydtom Dbow awiboal. will be oonstrieetad a1111h6wn on the approi ameWment thore.to and in aeeor®onco with tho standards. rules or►ag —u ns o ,, Comnty .Q @Fa @ O@ GC"h. 8n6` hat on;canplelian;thaveof at ,Constneetion Compliaoxo" I;aWIMItory 20 the Commisalonev of Hoi.Cth, will ' io s "Mm to, tho Depoe@geent; and: a .whit& t "iontoa, will '� furhildiod tho, oarnev, his CUa A*S=a. h©irs oa aesi e6 by Iho ®di�P; IhOt 116{9 bulklor win Mw tW i �� oIDSaAl36on: �rry, ter@ 08 mid l ±aso ola�eal 11yciom during tho period o4 @a�0 (8D ym ra Easaca le@mly 4o110orileg @ho®ato ®4'tho {aeu- 06ic6' O@ the'app" I all. @cab :CDe@itiSDto of. Constvlaeti . Coaojp0iaiim. of the oripinel.svoteea ov env IM176 26=0@0{ 3) that tho dvilled troll datt86@ abovo t9 M W U464W be on tke6 qjj o ism Pon a�,that solsw ©If Mill 6 6® 60toi in accov lovscb with tho aiiroidaras, vum Data fcau ns of the FWAOm Courvty.be"rem== o0 Ps.ro08@J. onto 1 February. 1990' Skincs X RD9 -Fair Street. rmel, N.Y. 10512 29206 t.teonso Pfd a0PROVED Rota C(MSTRUC'TION:This approvel.Dapbtu11 taro yekig11. from two"dato isssuod unbss construction of, tho building .has 6>Can urrdertakon and 15 ravocablo 107 Couto �tZ tl. get antende�i or modioiasl arh3n.eo z necewry by the CoMmissionov of 6�hth. Any ehorW or 'oncration of eonstvuetibn fG �luroo11 a pCaAc�trosi..POr Aiical 04 dowrost sa a.y /or p.hrato aotor twpply only. Rev • � 10 88 Dato try TWO � =. - - <•PDTNAM COUNTY DEPARTMENT OF HEALTH 1ti .. —� � • /�, Division of Envhaamentel Health SaMm Carmel, N'Y 1051? V: �eerto Prove Pert& t0 j` on CERMCATE, OF COMPLIANCE • Permtt `M / •Q CONSTIZUCIION FOIL SEWAGE DISPOSAL SYSTEM' T. ,•- Patterson ' Lee, W st Ice Pond Road o— .0-ir vm ge - Brenner �. v 3.... suutivWoq Name _ sobd; Lot M � . ." Tax Mp 79.:, �, 3 8'.13 ' Lot owner/Applkant Name Richard - L. Rapp, Jr. - Renewal_ ❑ .. Revision ❑ Date of Previous Approval M,WugAdd" Scout Realtp.; Ltd.,. Rotites..:6 & 22 . Town' Brewster; NY Zlp 10509 Bapkg Type }:Frame �� Area 2.843 Acres. Fill Section Daffy I X Depth 36 ' volume 500 C Yd Number of Bedieomi' -Three Deeign'Flow G, p D 6000, PCHD NoN9cadon l0 Required Wben Fill is completed Sepsxste sewerage, sytatem to eonsbt of G,Don Septic Tack =&—z 429' x 24't w . R 18" `Dee p To be constructed by Address Water Suopb'; Fdbile S*.* Isom Addreae on X. Poveft Supply Drilled by Addreso , OthaReg,amm,ato R -O -B 'Fill' Section inc'1. 300% :'Exvans ion 'Area. - I'rep►esent that I 'arh whop and completely letel y p y responsible for'fhe design'and lou. '- of °the proposed sy tem(g 1) that the separate sewage isposil system above described will tie constructed as shown on the approved amendment there to antl.,in accortlance with the standards; rules an ►egu a ens .7 e, Putnam County Department 'of' HaaKh,'and that on- completion thereof i" Certificates of Construction Compiiance" utiitacfory to the Commissioner of HealthwilP be submitted to the Department,: and a written guarantee will be, furnished the . owner'. his successors, heirs or assigns by the builder, that paid builder will place in good operating condition. any part, of. :s&id sewage •disposal. 'sy tem during the period :of two (2) years Immediately following thedate of the issu- ante of the approval of the Certificate of COnttiuct {ori Complbnce of the original; system or'any re irs thereto; 2) that the drilled well described above W w114 be located'&$ shown on' the. approved pun and "that Yi •well w1114e,11nstilled in accordihce with the standards, rules "'and regu sTrons : of the Putnam County Department of,'MSalth;. ' 'Date < 18 March 1988 sa9�ea r P.E. P.A. A R9 -Fir St armel 1 29206 Jan$e No APPROVED FOR CONSTRUCTION This approvel,expues; wo yeai,,from a •date issuetl, unless.•c nstruction of. the building has been undertaken and is revoca le for. cause or may Deamended or modified when a nsider 'neces ry by'ttie m iss on r. of Health Any change or alteration of construction reouires a per it. `�p'ppgroval - fo'r'disposal of do'mest sanl r sswa a �a or 'p s t 'supply only. Rev. �� -�/Y Rev Date ll BY Title =J � �► " _1 <' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date 6 May 1993 Re: Property of Richard L. Rapp, Jr. Located at Ice Pond. Road (T) Patterson Section 79 Block 3 Lot 8.13 Subdivision of Brenner Subdv. Lot # 3 Filed Map ## 2189 Date Gentlemen: This letter is to authorize John H. Prentiss a duly licensed professional engineer or registered architect_ (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the - Putnam County Department of Health, and to sign all.necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly your , Signed ' 0 er of Prope y JMU W. PRENTISS, P.E. R09 FAIR ST 914 -878 -6170 emet Telephone ° Scout Realty, Ltd. - Rtes. 6 & 22 Address Brewster, NY 10509 Town 914 - 279 -3712 Telephone DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 _. AP,PLICATION. TO CONSTRUCT A WATER WELL - __ PCHD PERMIT WELL LOCATION Street Address Ice Pond Road Town/Village/City Tax Grid Number T. Patterson 79 -3 -8.13 WELL OWNER Name Richard L. Rapp, Address OPrivate Jr., Ice Pond Road, Patterson, NY 12563 []Public USE OF WELL 1 - primary 2 - secondary f] 'RESIDENTIAL ❑ BUSINESS ❑ INDUSTRIAL ❑ PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION 0 OTHER (specify, 0 INSTITUTIONAL O STAND -BY 0 AMOUNT OF USE YIELD SOUGHT Five gpm /# PEOPLE SERVED Six /EST. OF DAILY USAGE .400 gal REASON FOR DRILLING GNEW SUPPLY ❑PROVIDE ADDITIONAL SUPPLY ❑TEST /OBSERVATION ❑REPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING Residential Supply WELL TYPE ®DRILLED DRIVEN [jDUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES __X _NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name IS PUBLIC WATER SUPPLY AVAILABLE TO SITE:. Address: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: Over one mile LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED(See Dwg. #1, Job No. S.0.2395 by John H. ON REAR OF THIS APPLICATION []ON SEPARATE S EET Prentiss, P.E.; 17 March 198$ (date) (signa ure) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of 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 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 attached to this permit. 3. Submit a Well Completion Report on a form pr vide by the Putnam County Health Dep rtm�.' Date of Issue: iS 19— � Date of Expiration: 19 a it Iss i g OfficiAl Permit is Non - Transferrable 8/86 n.-J' 1119 &. PLMIAM COUN'T'Y DEPARTMENT OF HEALTH - DIVISION OF E NVIROD EMU HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS (Name f Owner) .. REVIE`W SHEET CONSTRUCTION '-PEIZMIT' DATE: REVI E-WED ; BY: (Street Location) �-r - YES ,NO DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth • �E 7� LF trench provided required .1 - ' _ ' "•P 100% IMMIM MISM .- - .= .. r r�r of ... -EMEMI 200 ft�reservoir, mom EMIM 150 •- 4- EM_ s/s SUBDIVISION Pere VC --?,a (3) Fill 11 cd House Plans - Two sets Well permit; 1xXS letter Variance Request Q�RAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Tewn /DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAILLS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volul-Lz D or J Box;Trench /Gallery; Pump pit details - Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes (grinder rate) Design Data: Perc and deep results Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing/Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area; shown; gravity flow,suff. size If Pty Pit & D Box Shown & Detailed House - No. of Bedroans Wells & SSDS's w /in 200 ft. of Proposed System= Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pip-- No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLkN Fields 10' to P.L., Driveway, Large Trees, Top of fil 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. exixn 15' to Drains - Curtain, Leader, Footing 351to catch basin, stormdrain,uiped watercours 10' to Water Line (pits -20') 50' intermittent drainaqe course Septic Tanks 10' fran Foundation; 50' to well 15' well to PL 9 J ip jp � t 1 I all .t QI J� PUTNAM COUNTY HOUSE PLANS qtr PROV3JD ka BEDROOl'i COL" zT ONLY I 4'-'DR0 M'.S S gnature & Title Date KI 1 UHLN `I s { . i Thm (3e-[ roow, Pwe..l ( y ' For- Po„ 9( T, PSK-C In CTM 7-9 t3 -e. �Brea,,,e,. Sib c>i f � Lo�31 z • �. I � ,�i Vim. 1 % \ \1 0 c -t:, Doo ��o%���i� -,l OPP, 1 1 , LJ cj ... ....... ro I 410. 100' k1b PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CUUNT1 UF'FICE BVILDINU, CARMEL, 11. Y. 10512 DESIGN DATA SHEET- SEPARA7 SEWAGE DISPOSAL SYSTEM FILE NO. Owner Address Located .at (Street - �/Z Sec .7 Block_ _Lot lndica e neares cross s ree °- Municipality /59q-(ter Sah Watershed �yb 6 7 SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS oe Number CLOCK TIME. PERCOLATION PERCOLATION 'Elapse p o a er a er ve ryo> Time From Ground Surface in Inches Soil Rate• Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 11 (OG, J O K 20 3 2 (off (0 C) I �- 0 2 IG- �i1(� (a 10;2- ZZ 7-7 - 2.3 3 v 3f1�L I(3- 3D. �-. 2 3 �t 5 F Notes: 1) Tests to be repeated at se.me depth until approximately equal soil i rates are obtained at each percolation test hole. A11 data to be submitted j for review. 2) Depth measurements to be made from top of hole. o TEST TIT DATA REQUIRED TO BE.SUBMITTED WITH. APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEP'T'H HOI,E ..M0.:.> -....f _ 'HOLE- N0. 2-. HOLE- N0. -- . 6n 12° 18" VII 2411 30" 36" 42" 48" 54" 60" 66" 7211 7811 5qKjx C 0 C1 a, l- �dgero c.k . 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED 0616 INDICATE LEVEL TO WHICH WATER LEVEL. RISES AFTER BEING ENCOUNTERED ohN fi�ST MADE . By ... -Date g _ Soil Rate Used 1640 . Min/l "Drop: DESIGN S.D. Usable Area Provided 60 10 y' No. of Bedrooms Septic Tank Capacity p Gals. Type o Absorption Area Provided By_�L.F.x24" "— width rent . Other -0 Fil I Smk,6,,: G X y a s Warne Signature Address JOHN N �,,,. S `'�0 N' PRF FbS-i .r'. R09 FAiR VIMML, NEW YORK 10512 THIS SPACE FOR USE BY HEAITH DEPARTMENT ONLY: GZ Soil Rate Approved Sq. Ft /Cal. Checked b i�OrTHE S1 kit APP: -16-98 THU 9:00 AM PUNAM CTY EN Ent TH FAX Nu. 191427$7921 P. 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION bF ENVfRONNIVNTAL HEALTH INDIVIDUAL WATER SUPPLY & SUMUKFACE SEWAGE TREAT61ENT SYSTEMS REVIEW SHEET FOR COSSPKUCTION PERMIT STREET LOCATION - NAME OF OWNUR R ,V1EXU,9 B1' TLM, Gil, AS, NIB, BIl 1 a 6 7 8 9 10 11 12 13 X N gQCLlit+lEbT6 PERMIT APPLICATION 37 PC•1 38 WELL PERMIT_ PWS LETTER 39 LETTER Of AUTHORIZATION 40 DESIGN DATA SHEET (DDS) 41 CORPORATE RESOLUTION 42 SHORT EAF 43 PLANS - THREE SETS 44 1IOUSE PLANS -TWO SETS 45 VARIANCE REQUEST 46 FEE 47 mmmisloti 48 LGGAL SUBDIVISION SUBDIVISION APPROVAL Cl II:CKlit3 49 PERC RATE 50 FILL REQUIRED Detri'I1 51 CURTAIN DRAIN REQUIRED 52 STANDPIPES 53 rtt , lsmrtt6lrm � lrla=S l LOCATED IN NYC WATERSHED 55 s PLANS SUBMITTED TO DEP 56 DELEGATED TO PCHD DEP APPROVAL, IF REQ'D 57 ?- 1 F TREK. DEEP TEST HOLES OBSERVED 58 'S ' r PERCS TO BE WITNESSED 14 15. 16 17 18 19 20 21 22 23 24 25 26 27 28 29 39 31 32 DA-U TAX. NIAR 0 q GENERAL 54 rtt , lsmrtt6lrm � lrla=S l LOCATED IN NYC WATERSHED 55 s PLANS SUBMITTED TO DEP 56 DELEGATED TO PCHD DEP APPROVAL, IF REQ'D 57 ?- 1 F TREK. DEEP TEST HOLES OBSERVED 58 'S ' r PERCS TO BE WITNESSED 59 100 F,)(-APPROVALSSDS _ADJ_LOTS_ ._........_ - ..'..-.... - " 1YL;'fLANDS ('I.OWN/DEC PL'RM1T 12LQ'C)71 -..T QN I',LAN - I"HOM g5'I'S" _... _..... _ DATA ON DDS PLANS & PERMIT SAME 60 10' TO P.L., DRIVEWAY, LARGE TRE TOP OF FILL PRE 1969 NCIGNBOR NOTIFICATION 61 20' TO FOUNDATION WALLS TWELL TO PL LETTER BIfLBA 62 100''CO WELL, 200' IN DLO , 50' PITS 100 YR. FLOOD ELEVATION 63 1 00' TO STREAM WAT COURSE LAKE (im cxpan) OTHER REQ'D PERMIT(S) 64 30' TO CATCH CIA I , 33' STORMDRAIN, PIPED WATER REQUIRED 1)E'rAlL�4 2 PLAiNC 65 10' TO WATER 'E (pits•20) i SEWAGE SYSTEM PLAN- (NORTH ARRON% 50' INTERINII ENT DRAINAGE COURSE SSDS HYDRAULIC PROFILE 67 2007500' R ERVO,IR, ETC. _150' GALLEY SYSTEMS GRAVITY FLOW CONSTRUCTION NOTES 68 t5'j � o DS= �3%, 10'• 4%, 2g '•3 ° /a30'•2 ° /a35'•t %,100'•�I�e° DESIGN DATA: PERC & DEEP RESULTS 69 20 : IN w CD discharge /10Vwith 182 cons day discharge T CONTOURS EXISTING & PROPOSED SEPTIC TANK DRIVEWAY & SLOPES, CUT 70 I - ' UK )EMQQV 9lCURTAIN DRAINS ' - A ■■. - .,,..r - --- . r,..uL•�t��lil[I.�.lt.1i7:•ri. COMMENTS: 4.0 CONSTRUCTION PERMITS r%'a'rr Prior to any construction of a SSTS, plans for such system must first be approved by the Department. There are generally two types of construction permits reviewed by the Department; those requiring 2 feet of fill or less, and those requiring greater than 2 feet of fill. The submission requirements for each type are specified below. A. Construction Permit Submission Requirements For Lots Requiring No fill or Fill Two -Feet Deep or Less IK Construction Permit Application. (Appendix K) Letter of Authorization for Design Professional. (Appendix K) Application for Approval of Plans For A Wastewater Treatment System. (Appendix K) Short Environmental Assessment Form (EAF).(Appendix K) Design Data Sheet. (Appendix K) NOTE: All submitted Department application forms shall contain original signatures (no photo copies). Three (3) sets of plans bearing the seal and signature of a Design Professional, licensed and registered to practice in New York State. These plans shall be to scale:(minimutn. l inch to 30: feet.horizontaI and 1 inch to 10 feet vertical) and gall include, as a minimum, the following: Two (2) sets of house plans with title block as specified in 7. k. above, one of which must accompany copy of approved Construction Permit to the Building �ispector of the local municipality. Upgn approval of the Construction Permit, the house plans will be signed and stamped: "Approved For Bedroom Count Only' 9. ommunity supply, a letter from the water supplier will be required stating that they will e a e o �D/operty with water at adequate pressure. ' ell Permit Application, if required. (Appendix K) rior to 1969 will not be reviewed until tt�ch —* ,P as the Dena�ment, i_R vided wi pro Fee - See Appendix I. ' AL 14.70 AC. 197.07 e_` n i 12 ,�. 71.91 AC. 14 >' - ° s 14 75.91: 97 Ac. v � II 0.74 16410 - =•- 60 25 40.73 AC. CAL 13 1.90 ' C. A 74.41 AC. /CE POND vi 14 14P IQ 4.49 At 15 \ 28 166.07 Q4 10 '�. �..9`: ''. ' a 43.46 AC. \ v ° = 9 8 'yc� ° 3.79 AG c' 4, 9.39 AC. 3.09 AC.'' a •+ ' .B� ''io 5,Atp f '° k ' 19 1 n m CAL I 4.45 At 7.76 AC. \`b 16 H e N 12.66 1n f ' 400 E87 At ""' 22.26 AC. CAL TA �\ 2.87 AG '4283 A4= JL IL o '+B z2 v 2,57AC. T.3 1.04 5O stall 34 A At 4.15 AQ ° 32 20 � 24 ^ 15.51 AC. ° � . � s. 49.02 . Les 10.71 AC \ 6 At \ CAL. $ 7.94 AC. ?16.48 1 21 93.50 a ='= 93.50 AC. 4 5 �% ° - / .a 'Sw�� 00606 �rJ 3.61 AG �\Jpa v .. 3 491.90 411 t 4 1 22_1 y+b 252i, o 29 s 1 / ,t !� 8,24 AC. �3 35.98 AC. CAL. ? ► 12.63 AC. CAL �1 4. sel.w 23 1 n v 20.87 AC. ✓ �• NIL \ 7.65 At 457• J *� zoo A 455.Es I aJ 21.2 75 $, zlI AC N mswl� LEGEND 24 PRELIMINA �cnam ° a MEas ............... aEnuaDS u� um si7eDl t ='i �� 23 33 35 TOWN OF PATTERSOI �g�Q1 ONIUtJgS OgIEAAfIP �+ °EYE DIM LOT MF.®FA 100107 irivlh GEED DI►O610N �.. D7�0.0.q. IOOI SI _. &eta Go . 77FAN7gATE71LIM stA<ED 01 E34 aG Ex 5 PUTNAM COUNTY, NEW YORK Sol >igldl DISTRICT LIhEi -F GLLCi"M MA a 44 45 PeDI Q X x 01s7NICT Lill vim CFM001D TL �.. IM OF PMM OMART PARCEL Kaw i 14•16.4 tZlull —toxt u PROJECT I.D. NUMBER 617.21 SEQ R Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM. For UNLISTED ACTIONS Only PART I PROJECT INFORMATION (TO be completed by Applicant -or' Project sponsor) 1. —APPLICANT /SPONSOR 2. �IJ�qT NA E v L 3. PROJEC LOCATION: Munielpality County 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) l 5. IS P 0POSED ACTION: *LNOW ❑ Expansion ❑ Modllicatlonlaltoratlon 6. DEqCRIBE PROJECT BRIEFLY:_^ t� C 7. AMOUNT OF LAND AFF CTED: Z Initially acres Ultimately _ acres 6. W<ROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? s ❑ No It No, describe briefly 9. WIS PRESENT LAND USE IN VICINITY OF PROJECT? esldentlal ❑ Industrial ❑ Commercial El Agriculture El Park/Foresl /Open space El Other Zscibe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, _...STATE OR LOC L)? -^•- .I• ��• _ ^ _ .._._..._ ....... _.......... �.....__ ., .,� . ,.., . ❑Yes No If yes, list agency(s) and permit /approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes No If yes, list agency name and permit /approval 12. AS A RESUL OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑ Yes VNo I CERTIFY THAT THE INFORM TION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE pp Dale: A Ilcantlspo o na Signature: M If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APIPLICAT'WN IFOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: 2. Name of project: 0 4. Design Professional�a \ dk�_ 6. Drainage Basin: w '// lelu'-o y 3 Location TN: 5. Address: 7. Type of Project: Private/Residential .Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subjectlo State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ..... ........................... Type I Exempt Type II Unliste 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... d 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency -12: Is this- project in an area under the control of local planning, zoning; or,other officials, ordinances? ......................................................... ............................... 13. If so, have plans been submitted to such authorities? ........ ............................... 14. Has preliminary approval been granted by such authorities? Date granted: A% &7 15. Type of Sewage Treatment System Discharge ................. surface water groundwater 16. If surface water discharge, what is the stream class designation? .................... 17. Waters index number (surface) ........................................... ............................... 18. Is project located near a public water supply system? ....... ............................... A� 19. If yes, name of water supply Distance to water supply 1- 20. Is project site near a public sewage collection or treatment system? ................ A) 0 21. Name of sewage system Distance to sewage system-F`� 22. Date test holes observed 11 q ` 23. Name of Health Inspector 24. Project design flow (gallons per day) ..... I........ rt., ............... ........ ........................ 600 / 0 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... D 26. Has SPDES Application been submitted to local DEC office? ......................... 2 27. Is any portion of this project located within a designated Town or State wetland? 28. Wetlands ID Number ........................................................... ............................... ...29: Is Wetlands Permifrequued? ... .. ................... ...........:...... ............................... Has application been made to Town or Local DEC office? ............................... 30. , Does project require a. DEC Stream Disturbance Permit? ................................. 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ..:......................... Yes/No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any A I } other potentially known source of contamination? ............................... Yes/No fy U DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... 34. Are community water and/or sewer facilities planned to be developed within , 9 15 years in or adjacent to project site? ................................ ............................... _ !� 35. Are any sewage treatment areas in excess of 15% slope? . ............................... Jv . �. Map ....... Map 3 S Block Lot 36. Tax Ma ID Number ................... ............................... 37. Approved plans are to be returned to ..... Applicant_ Design Professional NOTE: All applications for review and approval of a new SSTS to be located witb ftNYC Watershed-shall - - - - -- 'be sent Lathe Department; "anilffetd'ii6t 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, underpenalty 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: Mailing Address: ................................... T0: �ccy RE: lew -- �4j /Q (T)Y��/'soo-4 Z3 Y —S`=!7 Reservoir Basingc d- Dear Date: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on 1,,y / a, jeytyD is complete. The Department will notify you by J;.. 30, ic7fp 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 must include your name, the. location of the project, the office with�whichyou filed-the applicat on,otiginally, arict "a "staferrierifthaf a- decisiori'is `sought m 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 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 Dept. 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 (914) 278 -6130 ext. 2159. Very truly yours, Shawn Rogan SR:tn Public Health Technician ws2 BRUCE R FOLEY Public `XealFfi Di'iector LORETTA -MOLIN-M4 R.N ; V.SN: - - Associate Public 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 TO: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM DELEGATED 4 PROTECT: , TOWN: - C SFr f -K- W . -....' - DATE'SUB'D-APPROVAI : . NOTICE OF COMPLETE APPLICATION DATE: C / B„RUCE..R. _FOLEY Public Health Director .. LORETTA MOLINARI R.N., . M.S.N.- Associate Public Health Director Director of Patient Services DEPARTNMNT OF FMALTH 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 January 19, 2000 John Karell, Jr. Cushman Road Carmel NY 10512 Re: Proposed SSTS: Rupp Ice Pond Road (T)Patterson, TM# 34 -5 -17 Dear Mr. Karell, Jr.: 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 yyere_ not. witnessed by a .representative of, the New York .City. Department _ _ ' .. _ _. . �._ `Environmental- Protection on this lot, percolation tests must be witnessed by a representative of this Department. 1) Construction notes have not been completed. 2) Fill certification note lacking from plans. 3) The proposed toe of slope for the fill pad is to be 10' from the property line. 4) Three feet of fill has not been provided over the entire SSTS area. 5) Remove the clay barrier that has been proposed at the bottom of the primary area. 6) Cuts are not permitted in the SSTS area. 7) House sewer line is to note 1/4" per foot slope in the trench plan. 8) Show the necessary pipe between the septic tank and the first j -box, and all needed cleanouts on the trench plan. 9) Separation distances are to be specified on the plan. a) 10' from septic tank to house. Upon receipt of a submission, revised to reflect the above comments, this application will be consider further. SR:tn Very truly yours, R&cf gan Public Health Tec 'cian BRUCE R. FOLEY = Publict'Health Director= LORE?TA MOLINARI R.N., M.S.N. Associate- ,.Ppb1ic ,Health ,Director• .. . u 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 January 19, 2000 x -y -ao John Karell, Jr._.: Cushman Road 03 ' Carmel NY 10512 Re: Proposed SSTS: Rupp Ice Pond Road 14*4A W ,�,r- WdhJA0` Mtr,oel (T)Patterson, TM# 34 -5 -17 Dear Mr. Karell, Jr.: Reviews of plans and other supporting :documents submitted at this time relative toi the above- regarded project has been completed.:Corriibents 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 Departmert "'- Envfrorimentai Protection on--this 4ot; -percola.tim tests -must be- witnessed by-'a Fepresen4tive: of this,... -�' :• d Department. Construction notes have.not been completed. ' Fill certification note lacking from plans. Three feet of fill hasno'I"l een provided over the entire SSTS area. Remove the clay barrier that has been proposed at the bottom of the primary area. Cuts are not permitted in the SSTS area. House sewer line is to note' 'W' per foot slope in the trench plan. �( Show the necessary pipe between the septic tank and the first j -box; and all needed cleanouts on the trench plan. Separation distances are to be specified on the plan. a) 10' from septic tank to house. Upon receipt of a submission, revised to reflect the above comments, this application will be consider further. SR:tn Very truly yours, Shawn Rogan Public Health Techl ician PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address Located at (Street) ::ree, Tax Map Block Lot (indicate nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA Date of Pre-soaking Date of Percolation Test NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, ig 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 Depth W oA a 'Water Irom roun d A. v 'el ti Percola on No R UW ..... S.. . t . IV. , ... .. ...... E a Stop n Inches Rate 10 93 d6 2 P5 3 14,•13 - 11"33 /Y - as Id 4 2 0:3' ,3Y a 1 3 Z2 CR:a 4 5 C_S016V 2 P67 )OC6 - r 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 I min for 1-30 min/inch, ig 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 Sent By: TOWN OF CARMEL ENGINEERING ; a � 9 a l/ (9 Q ' of at D o ' 0 914 628 7085; Mar -1 -00 8:11; 9 i 0 � t �0%0 ° .� o o. %Al q r 1 / d d A �. Q a � e e � • " "�' q. •;gyp °Do Q , �D ,`� a 0 % vo r 0 ' a °% a� loob a Page 111 1 .,\.\0 e � � 0 of ' .,\.\0 1001, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address L EN Located at Street C PO AJ)Pei Tax ma- .3 Block' Lot (indicate nearest cross street) Municipality _� Watershed O SOIL ID IERCOLATION TEST DATA 33 0 Date of Pre - soaking ! b 71900- Date of Percolation Test L9/ �� TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES Indicate level at which groundwater is encountered Indicate.level at which mottling is observed, Indicate level to which water level rises after being encountered 4. Deep hole observations made by: Date Design Professional Name: Address: Signature: Design PirofesMonal's Seal �>Cu 2? �, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address T e. c 7>Q,tt Z2 'b Located at,(Street) , Tax Map Block Lot (indicate nearest cross street) Municipality Soc,; y�,E,��?- Watershed E.4 -5r 13.izN1Vc4 SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test 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 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made fro to of hole. �a 0.1 1Go� 14 Form DD -97 2 8 a7- 3% — �?-5! 2% 3 4 5 ,:.. �.� �..-.:. _.._ 1.. -.., ,'ter -• ; 3= :-..::.:� - _ _ --. - - -� � .�::�...3/ _ _�j .... s . . 2 3 4 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 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made fro to of hole. �a 0.1 1Go� 14 Form DD -97 1,r Pe9 ^1D �W 3rd —5-1-7 TEST PIT DATA 3 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES I)EPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 10.0' _ .._ _.. HOLE NO. HOLE NO. ` -.. HOLE NO. 3 V 2 JE, 131:6,14, /') 5 tedo �A 42. � .e Indicate level at which groundwater is encountered AZ2 Indicate level at which mottling is observed /VCg vie. Indicate level to which water level rises after being encountered 4Ze Deep hole observations made by: Lam' 'I Date Design Professional Name: Address: Signature: Design Professional's Seal REICORD OF PHONE CONVERSATION DATE: TIME: ]PERSON KCAL LING: Gl� �Ci9 �Z� PHONE #: 62=6— 2 O �:3 i REASON () Inspection: �eeps nd /or Peres: SCfIEIDU LEID FIELD MEETING DATE: TIME: / D a-a ROAD/STREET: 'po'y E) p� _ ® -: - ° _ '. f� ". -.-TAX MAP #.:. 3 �._., _ 1.7 7. T SUBDIVISION: may? yiv k F lLOT #: .S COMMENTS: ry REOORD OF PHONE CONVERSATION T . , .- _ — u__ DATE: /�� /� TIME: '� p PERSON CALLING: �_ KAY?G L PHONE #: REASON () Inspection• Deeps and /o SCHEDULED FIELD MEETING `Pre - Sena-k DATE: TIME: ROAD /STREET: L _ TOWN:-.-'' 5 _ TAXTNIAP #: _.... _,. _ Z 7_ SUBDIVISION: / C LOT #: 3 OWNER: COMMENTS: ToSM 118 b 10 Z16.29AC. 72 4.00 AC. ° 95�' • mgE 6 AC. 1 1.06 l 9zo.00 9 48 64.98 AC. s< 2T3 4' \ ° 75 1 �6T AC. Q ° 1 , I 1 CAL � 70.06 AC. CAL ` IOO 01 /: I 360.63 621.17 1 e: AL 4 I S J1��h 26.60 AC. !19.02 49 .OT 164.80 119.) ' 12 °7 60 I zs3/o 25 59 71.91 AC. 9s.s3 • 0 40.73 AC. CAL 74.41 AC. �Qv 3.4 49 !. / -25 AC 47�s3� 392!1 h ° o L24 At><ab 656 14 �°`° p ` n Q .A 10.09 AC. CAL•. 39 F . 44 4.49 AC. 8 � ,z tOhwOF • �•.29 \ �' 15 6� �' cY A3T7ER s �Y'• ' 5.18 AC. 43 g g , �� s,A A9 ` Ci 28 le6.e!` \ !4 �+ •� 3.79 AC. e :�� y • ' \ n 4 . c syano r 1 `-! v X43.46 AC. .y. 1 3oasa a 49 AC 7.76 AC. �`b 16 19 9.39 AC. �` 37.3 �. r , ¢, L' '1.' .. CAL. 0soo ., 2.87 A$ �7 3rtt 22.26 AC. CAL - ! 21.05 AC. * c wru +�. z.etAC. ?Aei 1 �JL 35 7,2 \�'n ° Z57AC. _.7.3; 1:64.. - - a - a At c lots) v L0 r r 4.15 AC ° p o I M aF r !L 34 e IL Tt ~ wN 20- PAT7ERSON vo.aa oa° s 37.57 � I , k ° «. h 24 15.51 AC. r' I.8! w • 32 a l P 5e94C Y0 �� Ac 10.71 AC 22.27 \, 49.02 AC. \ e ;v CAL. • 9' 3 I �r ''iJ 12.7PA o �•i • \ J 9.39AC. ` ,� 21 o /'22.26 33 \ At 1 X3.02 cl, a \ Jr a e . g 4 °ao. m y � 22.25 . v �a 806.86 /• \ ft }6 2.28 °0 8 3.09AC. r V' 4 .28AC. = oaa.n ° y4. m t95 ✓ .• A4 asa.oa a °e 22.24 y' ° �8 2521 30 31 G 815 Sol .03 8.24 AC. -0; 3 22.29 2.42AC. 29 ul.n- LE ° e 7o329AC. vent, 1263 AC. CAL. sl T.65 AC. N 457.05 81 Q ?2 .4 o g 23 20.87 AC. �- � 8 J $ LOO AC S e 455.66 .ys9 22.22 a of 2.At1 a x915 0 LII 4c , N .85A . S 1° 5 kj LEGEND .•.... - VLANOS LINE #A STABOL � �„ ^;j OEYELOPEAS 22 23 24 PRELIMINARY LOT NIA•ffiF4 : f. `m0 i 01mis' 100fO1 load TOWN OF PATTERSON 33 35 CALCOI.ATEo m 2.34 AC CAL Y1xk Li) mIO ,B p - -- ° PANIf>il -An 44. 45 $ PUTNAM COUNTY, NEW YORK oATe w Oil _ T2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES : - ,.DESI N DATA SHEET- SUBSURFACE SEWA!Q]K T- RWMENT_SYS.TEM Owner A, 6, Adaress Located at (Street) AD Tax Map. Block Lot Indicate nearest cr ss . eet) Municipality _. ' 54 M Drainage Basin SOIL PERCOLATION TEST DATA J1J/9f Date of Pre - soaking 12-12- lQq A46 f O- L Date of Percolation Test Hole No. Run No. Time Start - Stop Ela se Time Min.) De th to Water rom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 2 0 3 L) 7,31N 2 ! Z'� 13 3 [ 10 3 -, 3 3Y Zsyti Z<< r 3 4 5 1 jcat —161, 3o �,I z131Y V 3 i� ��'1� tj b �- i a-�-- p bo 4 5 1 Qf Z - oz-'-- -3 0 24- -2,4'1Y 2 U' Z I 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 PU TNAM COUNTY DEPARTMENT OF HEALTH DII VRSION OF ENVIRONMENTAL HEALTH TH SERVICES SUBSURFACE SEWAGE. TREAThM Owner Address Located at (Street) Tax Map Block Lot (indicate nearest cross street) Municipality Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre- soaking Date of Percolation Test � o. stun loo. Time Start - Stop IEla se Time �Iin.) IDe th to Water 1 rom Ground Surface (I[nches) Start Stop dater Level Drop gn IInches Percolation Mate Min/Inch 2 z� 1 a VL_ 3 lof 7a'-) 4 5 1 3 4 5 1 2 3 4 5 rdu i tb: i. t ests to be repeated at same deptn unm approximateq equal percolation raics arc uuLaii►vu as 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 TEST PTT DATA DESCRIPTION OF SOUS ENCOUNTERED IN TEST HOLES .. �:.. ,. DEPT7�i -. • -:. - . - ) r0%E ISO:=.: :.:�: ... -.. _ . ,.._. _�OLE-I�TO:.. _ ... -- . � HOLE-N0.".:.� .........,.... ,, ...� . ,. w, _ , _. - 0.5' l.o' .rJ n'q r 1.5' 2.0' , 2.5' SAV 3.0' 3..5' 4.0' 4.5' :. 5.0' •� 6.0' , 6.5' 7.0' ' 7.5' 8.0' 8.5' 9.0' ... ... .- •ru.s .} ..v.. .�_r. �. ... .. ..•a ..- .. -. .. r -.. ...... ..... _.... .... ... ,�..... �..r .. r.--19 o..... as -.. �.. .. ✓ .. .......... ..s +.. ..+- �. -........ 9.5' 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: \L Date t k �. Design Professional Name: Address: 1)A 0 k n \r Signature: Design Professional's Seal r PUTNAM COUNTY DEPARTMENT OF HEALTH G � DIVISION OF Ei VIRONNIENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS ' PREVIEW SHEET FOR`-CON CT 5TRUIO\ PERSIIT ' Y STREET LOCATION _l G2- I� )( u1, oak NAME OF OWNER RE%'LEWED BY RNI, GR, AS, INIB, BHr� DATE Y TAX-MAP Y N DOCUMENTS N #,.3 PERMMIT APPLICATION PC -1 WELL PERM IIT _ P WS LETTER / LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) CORPORATE RESOLUTION SHORT EAF / PLANS - THREE SETS HOUSE PLANS - TWO SETS VARIANCE REQUEST FEE SZBDNiSION 9 ( LEGAL SUBDIVISION (/ SUBDIVISION APPROVAL CHECKED PERC RATE 16—)-Z> FILL REQUIRED -3' DEPTH CURTAIN DRAIN REQUIRED 17STANTPIPES = GE \'ER4L I ATED N NYC WATERSHED NS SUBMIITTED TO DEP EGATED TO PCHD APPROVAL, IF REQ'D P TEST HOLES OBSERVEDG CS TO BE WITNESSED APPROVAL SSDS ADJ. LOTS TLANDS (TOWN/DEC PERMIT REQ'D ?) TA ON DDS PLANS & PE%WT.SAMEE 199 NEIGHBOR NOTIFICATITTER BUZBA YR FLOOD ELEVATION HER REQ'D PERMIT(S) REOUIR£D DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE GRAVITY FLOW ;ROSION, CONTROL:HOUSE,WELL, SSDS ;ERC & DEEP HOLES LOCATED �FPRESENTA FIVE- OPPRIMARY -k :ACATION MAP XP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE rPUNIPED, PIT & D BOX SHOWN & DETAILED HOUSE -NO.OF BEDROOMS WELLS & SSDS'S WiIN 200' OF PROPOSED SYS. PROPERTY METES & BOUNDS HOUSE SETBACKNIECESSARY (TIGHT LOT) FILL SYSTEMS "LAY BARRIER 10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE FILL SPECS '9PS FILL NOTES L PROFILE & DIMENSIONS 1/1 IFILL N EXPANSION AREA n THE LF TRENCH PROVIDED 60 FT MAX. PARALLEL TO CONTOURS �� �(� -a 0 PPS C- 00% EXPANSION PROVIDED. 7 d Gj , ?F- SEPARATION DISTANCES SPECIFIED / N - , EV tDRIV AY, LARGE TREES, TOP, 'er. FILL 0 FOUNDATION WALLS _15'WELL TO PL 100 TO WELL, 200' N DLOD,150' PITS 100' TO STREAM WATERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAN, PIPED WATER 10' TO WATER LINE (pits -20') 50' INTERMIITTEN I DRAINAGE COURSE /500' RESERVOIR, ETC. _150' GALLEY SYSTEMS ao' YS?BVCpO,N &NOTES A ��,P� 15' MNtoCDS= >5°/a,g-4 %,25'- 3 %,30'- 2 %35' -I %,100' - <I% DESIGN DATA: PERLI& OfOlt-MSULTS ,✓ A 20'MN to CD discharge /100'with 182 cons day discharge 2' CONTOURS EXISTING & PROPOSED SEPTIC TA?�'K DRIVEWAY & SLOPES, CUT m 10' FROM FOUNDATION; 50' TO WELL FOOTNG /GUTTER/CURTAIN DRAINS WELL SOIL TYPE BOUNDARIES DIMENSIONS TO PROPERTY LINE TITLE BLOCK; OWNERS NAME,ADDRESS � LOCATION OF SERVICE CONNECTION ,� (, TMX,PE/RA;NANIE,ADDRESS,PHONER _'J i DATE OF DRAWING/REVISION �� S bi �U .0 DATUM REFERENCE PAC / LOCATION OF WATERCOURSES, PONDS 1 tr F.-• �� LAKES AND WETLANDS WITHIN 200 FEET PROPOSED FNISH FLOOR AND BASEMENT EL. &c..lC ..v L9 N �icS GY2Q, COMMENTS: =s 5al- BRUCE E R FOLEY Pu9ic Healtih Director T0: J Dear: - LORETTA MOLINARI RN.,. M.S.N.. _ Associate Public 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 Fax (914) 278 -6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Re Date: Proposed SSTS: &�P, _1 ., /06J 4- (T) (' mss,/ 3q- / :7 Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. 'Comments are offered as follows: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. .� 4-P CZr - /6-__1 3. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. n ./,L // `10e .S k „,� �. /D Ve rY trul Y Y o�rs � ���►� y�Pu Vo`- (G\.)iCL� ",I-e— SSTs cacti. v Shawn Rogan SR:tn Public Health Technician sstsproposed �o �Se S�� . / „�•�e i s ,7� ,�� (.e � ” � � �,� � s f�. W. �- �n�►. -c.1� Ply,. . Y-4 A.. r . 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 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 Jack Karell, P.E. 121 Cushman Road Patterson NY 12563 Re: Rapp, Ice Pond Road (T)Patterson, TM# 34 -5 -17 Reservoir Basin East Branch Dear Mr. Karell: January 14, 2000 The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on January 10, 2000 is complete. The Department will notify you by January 20, 2000 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. O 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 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 Dept. 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 o- Letter to: Jack Karell,, P.E. - January_14, 200.0 ...... _. _ e -2- 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 (914) 278 -6130 ext. 2159. Very truly yours, Shawn ogan SR:tn Public Health Technician (M iAAI!lAIMIAAIAAMAIA AIAAIAAIA117A0 IMIADIM'e A nNA 1AAIAAfAA1/lni (( MIAn: nA1�/ A1AAr, �nT^/ AfAA1MTMIftATAA [n�11!1/.11AA /MPRIM n AAfn_IAAIM AAtM:nnlnn^nniM`An- '0 0 0� /a;A saves . ► (® ® a ( ®o r�WlyylytilyVlyyl/ y[ i/' ViVyIVlIIVHINyI VMINylY1111y1A�( yl�/ y1V111NllIVMIry7wwM6 'ut— xuu..,, .. __ -.. 11 �Np r POO 31 '';', ♦ a ,, Cl 1 fi D� �! x'1$0 0 14 z o �� �5► ti' �� ` ► P p ij PpEP L�f v N V. 4 ► i Ecp Zr F ss b \ TI - to °`Av) it < — S H N i sa 13 -1 y s 19 �t o 17 lb `14 O pi,4'CE-4 OA* PDX 20 o IL `1,70 - --- --- do baw~ MEASUREMENTS' pdo No A AS —BUILT S . TFASUREMENT O P�01�. TOnX 1.0 AS —BUILT 53 MEASUREMENTS' pdo No A x D IS6� ►Dv• 11 ID I �a 2l fov b g. REMARKS AND, 1� rlgl�. �b 53 1 ti S5 s r _g, 1 c uz �g 31 1� rlgl�. �b