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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -5 -77.1 BOX 15 1 ru 7, I1��1 �1� 1 1■ 1 1 � � 1 � i� 1, � � ■ � 1 J1 1 JIM 1 �1 1 1■'■ 1 , 1 I . _1 bob 1 - �� 01605 PUTNAM COUNTY HEALTH DEPARTMENT V,/ Ra ffx1,,_DLfD AQ C, it DIVISION OF ENVIRONMENTAL HEALTH SERVICES ___ PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR YES NO/ _ Internal Use Only PERMIT # U L'I/ Repair Permit issued in last 5 years �U/Not in Watershed ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. t10 Delegated ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION ), TW O ' ---' - TM # _3 '71, OWNER'S NAME _k I % rh &d I, ONE # Ell' -611�20 MAILING ADDRESS APPLICANT I Name & FOlationship (i.e./owner, tenant, contractor) DATE FACILITY .TYPE r' e% PCHD COMPLAINT # PROPOSED INSTALLER ( PHONE # k&M??-@ a ADDRESS Q r REGISTRATION /LICENSE # Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) ,q NOTE: The Department may require submittal of proposal from licensed professional depending on the a 5 '� nature and extent of the repair. I, as owner,agree to the conditions stated on this form SIGNATURE ��� �� TITLE DATE (owner) I, the septic installer, agre to comply with conditions. of .th is. perm it. for the septic system repair SIGNATURE TITLE DATE (installer) 1. Procurement of any Town Permit, if applicable. 2: Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. No completed work is to be backfilled until authorization to do so has been obtained from the Department. INTERNAL ERNAL USE ONLY Proposal Approved Q Proposal Denied ❑ In pector's Signature & Title Date Jf / Explratio Date ,Repair proposal is in compliance with applicable codes Yes No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 Dec 1714 05:25P Tyndall S.eptio Systems 8452795989 PUTN►M COUNTY HEALTH: DEPARTMENT 0VIS-IOR OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEMGE TREATMENT SYSTEM REPAIR PA R „sue, UE- ,,bl P , _. .7 SITE LOCATION OWNER'S NAME MAILING APPLICANT TM # ZZI DATE. FAQ.1bTVITV0E PRCWOSED -h 1 S ADDRESS Y`S .PCHD COMPLAINT T #_ .PHOUEW&—,s Y ,REdI.STAATjQN/'LIC'E E'#,�4?� WS Proo6tal.l(include 6 .0.60ira*skokh locating She house; property:81n0s., all),sidifteht Welfit within !96 96. 8 61 reo'alr. and. the location of existing and propo.sed syst NOTE: The Department may require q4bm. Nal.of prqposAI'#orft licdns(W: orollisslohal dep end-i wor the nature and iaktient. of the repair. I, as owner,auree to the conditions stated on this form SIO'NATUAE TITLE DATE /,;z (owner) . ell .---I, the -sepjic:lnstalIW, agree to comply with the Conditions of this,permit for the septictysto repair SIGNATURE TITLE DATE Qnstalled BMWOAU=g�ad Wth :the JbIld'vVida conditions s. 'Prdcuriament I ot, any ie. 2. Subirilstion.6f as bulltrepaW sketch by the septic system installer within 30 days of the repair, In duplicate showing: 6. Owner's name, Site Street Name, T6wn and Tex Map number b. LoWldn of nstdiled components Ned to, two fixed points a. S*OM description (04.. iM.ow. Concrete septic tafik, etc.) d. InstallerWAimeand phone number S. S with the above proposal and conditions 0tamrepa to be performed inaccordan 4. The proposed 58TS'repair is considered a best fit design and there is no guarantee to the duration at which the Completed -SSTS repair YAII function. 5. No completed workla to be backffllad until authorliation io.dQ so has 'been obtained from the DepartmeiriL INTERNAL USE ONLY Proposal. Approved ❑ Proposal Denied n Inspector's.Zignature 8; Title Date Expiration Date Pe pair proe2sal. is in complianc6 with aplicable (;odes Yes 0 No 0 COPIES' 00HD; Owner, Installer PC -RP 99ML Rev. 2J07 Repair Permit issued in'lest 5 years *tin Watershed Repair !I Brzin4► pir,0m1,6n;F2*k11s 'Res. ❑ beleg d 0 Repair within w6kof a- wateremrsear-DECrmappedve . dand, ❑ joint Review SITE LOCATION OWNER'S NAME MAILING APPLICANT TM # ZZI DATE. FAQ.1bTVITV0E PRCWOSED -h 1 S ADDRESS Y`S .PCHD COMPLAINT T #_ .PHOUEW&—,s Y ,REdI.STAATjQN/'LIC'E E'#,�4?� WS Proo6tal.l(include 6 .0.60ira*skokh locating She house; property:81n0s., all),sidifteht Welfit within !96 96. 8 61 reo'alr. and. the location of existing and propo.sed syst NOTE: The Department may require q4bm. Nal.of prqposAI'#orft licdns(W: orollisslohal dep end-i wor the nature and iaktient. of the repair. I, as owner,auree to the conditions stated on this form SIO'NATUAE TITLE DATE /,;z (owner) . ell .---I, the -sepjic:lnstalIW, agree to comply with the Conditions of this,permit for the septictysto repair SIGNATURE TITLE DATE Qnstalled BMWOAU=g�ad Wth :the JbIld'vVida conditions s. 'Prdcuriament I ot, any ie. 2. Subirilstion.6f as bulltrepaW sketch by the septic system installer within 30 days of the repair, In duplicate showing: 6. Owner's name, Site Street Name, T6wn and Tex Map number b. LoWldn of nstdiled components Ned to, two fixed points a. S*OM description (04.. iM.ow. Concrete septic tafik, etc.) d. InstallerWAimeand phone number S. S with the above proposal and conditions 0tamrepa to be performed inaccordan 4. The proposed 58TS'repair is considered a best fit design and there is no guarantee to the duration at which the Completed -SSTS repair YAII function. 5. No completed workla to be backffllad until authorliation io.dQ so has 'been obtained from the DepartmeiriL INTERNAL USE ONLY Proposal. Approved ❑ Proposal Denied n Inspector's.Zignature 8; Title Date Expiration Date Pe pair proe2sal. is in complianc6 with aplicable (;odes Yes 0 No 0 COPIES' 00HD; Owner, Installer PC -RP 99ML Rev. 2J07 :1 Putnam County Department of Health - Division of Environmental Health Services . SSTS Repair - Final Site Insp 'on Date:2 Inspected by: Installer: Street Lodation- fif ALL, 4:j,e&t,5, I-,&, Owner: $o:S5e Town: _... Repair Permit #:. 2 -1;7 �! TM ,# - �• 1. Was System inspected? YesI( No ❑ If not, explain: 2. Type of System: Conventional Alternate ❑ Comments: 3. Septic Tank - 9 Y\ �r Yes No N/A Comments a. Septic tank size - 1,000 ... 1,250.. .. er .. .. b. Septic tank installed level ...................... 4. Distribution Box a. All outlets at same elevation (water tested) ... O 5. Junction Box - properly set ........................... 6. Trenches a. System completely opened for inspection b. Length required Length installed c. Pipe slope checked ... ............................... d. Installed according to plan ..................... e. Size of gravel N - 1 % " diameter clean ......... f. - Depth-of gravel igtcench 12" minimum,.___. . __. - ....... ......... „ __ g. Ends capped ..................................... 7. Pump or Dosed Systems 8. Sewage System Area a. SSTS Area located as per approved plans b. Fill section - c. Distance from water course/wetlands 9. Overall Workmanship a. Boxes properly grouted and installed correctly ........... b. Backfill material contains stones <4" diameter ......... c. Curtain drain & standpipes installed according to plan d. Curtain drain outfall protected & dir to exist watercourse e. Erosion control provided ............................ ` RFSI Rev - 010515 DIMENSION 6HAKT LIH FEET) I 30 18 2 107 g3 3 114 9� 4, 151 140 5 Ig$ 1.44 6 65 57 7 -71 41 6 U2 94 g 154 14z- 10 76 5t 4 NOTE 5 : • THiS 15 ceKTIPY THAT THE 6EWA6E 060fiNL j� ST51V,M WA3 C4W6W-LC AS INPrATEV ON p� Ss ,p l TNI5 PLAN AND TMT -Mgr S IrU WAS, WS_ CJ 1, PEC(P.D BY ML' BEFORE IT W95 COV KOP OVeKK . :• TH 'S j5f N1'WAci` CW0!P(0 (r:;P IN' ACC OALV " WLTH ALL 5'(ANoARD QULf* AND KEcUL.A -rt � OP TkE R)TNAM caVMJ'f MPAKTIAVNT OF HE4LTH AMP THI° 91W YORK STaWE DEPpK(MAJ'r Pf 6VAL;fN . • 9UP, f INftMaTION FK -OM A FLAW NXXAKeO 6`( 9e-RGBNVOKFP c»wI, , L. S. W &LL e 4 l�I D �7 Gamy wust Crrr°) �P 0 0 0 `O Ory 0 O 0 a 5& /9 DIMENSION GHAKT C In FUT) O A n 11115 PLAN AND THAT YNe- 3Y5Tf.1A WAS INS- 30 l8 2 107 93 3 114 96 4 151 14D 5 156 1,44 6 85 57 7 '71 ql 6 uL 54 g l54 �4Z 10 76 �t Noo gok Soy cei, dw g = f.3 r NOTES: O • THI5 15 Ce4UIFY THAT TNC BCWA -- 06R;V�L- 5'f5,10M WAS C0),6V-X.TW AS INDI'AT60 ON n 11115 PLAN AND THAT YNe- 3Y5Tf.1A WAS INS- 0 o P'eGTE0 DY Mr, E1>6;091B IT WAY "K . a, • Tkt;`5(5T�1- WAy 'CONSTKI�'t�D IN ACIQROtitvC2,. _ . WITH ALL STANOAKD RULCO AND Kg*VLATIpNS , _ _ . _ ,.:. ._.._ .� .. _ o2y ,fie OF TkE PUTNAM COUNTY v0PAFTMENT OP HEALTH AND THt; NSW 'FORK STATE MOAKTMZNT OF iW -AUTN . J✓'`� ✓' • SUNe/ Y Wr'M0ATVW *:CeU A PLAN PREPARED !3Y (�RRY 6r(tGBIy00RFF Gt�t UN3 , L.. S. ./" / �A� S �j � � � 77 4 2 WELL 41, P Yyd/j fauy kneir Cayp) Pb*44 P° 0 1 0 Q 0 3 9 �N se 19 P O 0 o a, 0 0 Q 0 3 9 �N se 19 P MEMORY TRANSMISSION REPORT FILE NUMBER DATE TO DOCUMENT PAGES START TIME END TIME SENT PAGES 014 DEC -22 09:10AM 82795989 : 001 : DEC -22 09:10AM DEC -22 09:11AM 001 TIME .r.__. :. DEC- 2'2- 2014_.09:.12AM --------- TEL NUMBER 8452787921 x s NAME :ENVIRONMENTAL HEALTH STATUS OK FILE NUMBER 014 ** SUCCESSFUL TX NOT ICE U ✓,/I �1—� I� i f r �� PUTN^M C GOUNT'Y }HEAL -'" MEPARTMENT T a QIVISION C)F ENVIFtON,MENiAL HEALTH SERVICES t+ tea+ PRQPKTS.*saL- 6=®Fi SEWSA(ME "rD�IEJRVRAERiV SVSVEIRfiI �tIE��.Ai� � � intornaa use onr �EUaiaoav et IR— d Y'j -t �+ Repair Permit e issa.d In last S yearn of in Wal had Repair within Boyd's com-, W_ Brancn or Croton Fs110 Ras. i7elagated O Repair within 20o ft. of m wate}rcourae or OEc -map as weLand C:3 Joint ReVle SITE LOCAT /ON TOW _ i •rM # a, 40r. --!r- �' y OWNER'S NAME S`�",��rs.r/ i _ $"�/¢%i %yyCINE N MAILING A00RESS seC APPLICANT : Via -4, 6I ' �- nse S latlonship p_a,�ownar, tenant, contractor) PATE ,t /S'� /! FACILITY TYPE C.--c PCHO COMPLAINT 0 PFloPOSEO INSTALLER PHONE 0 AQORESS REGISTRATI _ . /LICENySE Pro osal (incgude a -separate siteta t gocating 46te u'touno, pr=,pmv y pines, ago acogacent wells within 200 fE ®II of repair anon the location oir exiatingl and proposeel systsrn) NOTE: The department may require submittal of proposal from licensed professional depending on the" nature and extent or the repair. I, as owner.agree to the conditions stated on this form SK NATURE �� TITLE GATE (otrovoer) 1, the septic installer, agro to comply wit a conditions of this permit for the septic system repWrJ SIGNATURE - TITLE GATE }J /��� ( InsQalger) TT 7. Procurement of any T m own Per tf applicable. 2. . Submission of as built repair sketch by the septic system installer within 30 days of the repair, In dupllrate showing- a. Owner's name. Sita Street Name, Town and Tax Map number b. Lacatlon of installed components tied to two fixed points c. System description (e_g_, 1250 gal. Concrete septic tank. arc_) d. installers' -tame and phone number 3. System repair to be performed in accordance with the above proposal and eonditionm 4. The proposal SETS repair is consibared a best fit design and there is no guarantee to the duratlon at which the oomplatad SSTS repair will functlon. S. No completaci work is to be backfillad until autnorization to do so has been obtained from the E>apartmant. IP17ERlNAL USE 01NI..Y Proposal Approved Proposal Oeniod Cj In nPCtnWR SlOnature ak Title ' Date F�to tin carp, CQPIES: PCHO; Owner; Installer PC -RP 9911nL _ Rev. 2/07 DIMENSION GNAT A 8 3o to z 107 93 3 I14 96 4 151 140 5 158 144 G 8� 57 111 54 g 1.54 19Z 10 7$r 1 �r J o� 4 NOTc6 : TH15 15 Ce2T(FT THAT TNIf 5t✓WA4,e Ol5Pa*,4t- SYSTt°M WA-5 CONSTCLCTr--D AS INDI:ATED ON TN15 PLATT AND TttAT Tkli SYSTsN1 Wqs INS- isPGiED 6Y me, TFt� �iYST�M WAS CONSTKIY.(�D IN ACCOKOhI WITH ALL 5'fAtXARD 2ULE5 AND REGULATOt15 OF TFt6 ?UT�,LAM COUNTY WAK-WNT Or' H?.ALTH AND THF- We-W YORK STAT5 DEPAK'fMENT of RVAL; N . SUC�/EY INr,O' N TOW Vf; M A PLAN PKePARZD BY TBR2'f OERGENDO? -F �ZLL(Wo , L.S. 0 vY J S 0 m P Warr lil owlf Wier Crn°) AI h �P p 0 .O� �N r . 7�/�7MIMIMfMIM KAAM AInkMORAIORMM AIMI",I MIMIi!.AI� C lit QQ_ C r A � r t i � (V V 11iK11{V 11[1/111 W11(N{1I1111/1i1 1111{ I/ 11i1f 11{111/{V111Y1131(SIIi{11IifNl m 1 ® 0 0 I) s y S 'I � y d 1{1111IV II11111t 111111111[1/ 1111 1i111/111111iNtililu[�7V"Ti1L' 11( 1tI' Yll[ GL- 717 1iii/uTilll'7�711:�! \dG'MT1'yTJ V [V 1'liilliEi/Vtill'Ylil V 1 a� PgTTNAM (COITN'd"`I' DEPAt'II'IYIIEN'd' OF HEALTH IIDbMiMON: OF:IEiYV1R0NM]EN1["AIC, II3iEAIL'B'II3I SERVICES CERTIFICATE OF CONSTRUCTION COMPLL4NCIE FOR ATMENT SYSTEM PCHD CONSTRUCTION PERMIT # - Located at'4 /�B r(e� L--A-H� Town or O wner /Applicant Name Tax Map 'b 4 ® Block `�J Lot Formerly Mailing Address mp'd�(ew 1'NHE Date Construction Permit Issued by PCHD Subdivision Name boseH Subd. Lot # U Zip 101brA Sepairate Sewerage &stem built by Address k8W F1P Q LPrHE BWV-1 A � Consisting of 0 Q Q Gallon Septic Tank and U0 1✓P *5 Other Requirements: " Water Sunully: Public Supply From or: X Private Supply Drilled by flu- 'DPLL -Iv-k t Number of Bedrooms Address Address 4VE A)WiTOkY 10 fo Has erosion control been completed? Has garbage grinder been installed? )S5 H9 I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County D� p ent of Health. Date: 4-11 1 U Certified by P.E.'X R.A. 1 �LQ Wca, gii/r�vic�ivua�! !/ Address (�- 1���- �- �('���3`� ��i License # 15 C11-- BRE�Y%59 -- , 114Y � a spy Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocatio , dificatio r change is necessary. By: Title: sy - & /iC /"— DateJ z &b 79 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 e q BRUCE Public Health Director .> Y LORETTA._.MOLINARL 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 OWNERS NAME: 9L6,4a - Foss--eLl TAX MAP NUMBER: S -- 77, 1 E911 ADDRESS: y 14 /.q'-oyl y e' G 1-f xa r TOWN: A 11V�vs 6'1 AUTHORIZED TOWN OFFICIAL: (Signature) 0 _. _ _...... _ _ _._..__..._.__..__._.........._ .._ .,.__ _ ... _._ _ _ . _ _......._ ._ _ __.._ ... _..__,..... __...... ,... _... DATE: The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the applicafion for a Certificate of Construction Compliance. (E911 VERFM Harry W. Nichols Jr., P.E. 311 Clock Tower Commons "Route ,12 - Brewster, NY 10509 Telephone (914) 279 -4003 Fax (914) 279 -4567 April 7, 2000 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSTS Compliance Bossen Subdivision, Lot A Abbeyfield Lane Town of Patterson Dear Robert: Enclosed are the following: 1. Five (5) prints of Drawing S -A, "As -Built Plan" dated 1 -4 -00. 2. "Certificate of Construction Compliance for Sewage Disposal System," dated 4 -7 -00. 3. "Guarantee of Subsurface Sewage Disposal System," dated 4 -7 -00. 4. Well Completion Report, dated 11- 24 -99. 5. Laboratory Report, dated 3- 27 -00. 6. Application Fee in the amount of $200.00 payable to Putnam County Health Department. - If there are any questions concerning the enclosed, please call. Very truly yours, Harry W. Nirols ., P.E. HWN:JM:his PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM pCRkq -D Owner or Purchaser of Building F4 PsR B0436EM Building Constructed by * NIB �I Et,D Location - Street Building Type '))46 I t Tax Map Block Lot PATTG— (40H TownNillage &666 H Subdivision Name A Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, -and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system,. except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. - ...:. _...... __...... - - - - .....:�_ __..�.._..:..... The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month %WK� Day Year 2000 General Contractor (Owner) - Signature Corporation Name (if corporation) Address: *WN5LV 1�ME tp- ewi—MAL U State N 10 "L Zip 0�061 Signature: Title: 0 V MCR- Corporation Name (if corporation) Address: %i 0 (.Pr �R State Zip Form GS -97 1PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION- REPORT Well Location Street Address: Abbeyf i el d Lane Town/Village: Patterson Tax Grid # IMapMBlock 15 Lot(s) '71•, Well Owner: Name: Address: Richard Bossen 40 Abbeyfield Lane, Brewster, NY Use of Well: I- primary 2- secondary xx Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling ]Equipment Rotary Cable percussion XX Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing )(Details Total length 41 ft. Length below grade 40 ft. Diameter 6 in. Weight per foot zii_]b /ft. Materials: xx Steel Plastic Other Joints: Welded _XX Threaded _ Other Seal: xx Cement grout _ Bentonite Other Drive shoe: XX . Yes _ 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 ix Compressed Air Hours 6 1. Yield 60 gpm Depth Data Measure from land surface-static (specify ft) 30 During yield test(ft) 225 Depth of completed well in feet 265 Well Log If more detailed information descriptions or sieve-analyses - are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description fft. fft. Land Surface 15 6" Sandy soil & cobbles 15 30 Medium to hard seamy bedrock - 310-° - X65 6" Medium to hard grey & wh1te granit If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 265 60 Pump Type su mers1 104acity Depth 200 Model .10GS07412 Voltage 230 BF 3/4 Tank Type DiaphragWolume 86 Date Well Completed 1.1/24/99 Putnam County Certification No. 2 Date of Report 11/27199 Well Driller (signature) 1dQDTE: Exact location of well with distances to at least two permanent lanamarKS to be provtaea on a separate sneevptan. Well Driller'sName MILL DRILLING, INC. Address: 75 Putnam Ave., Brewster, NY Signature: Date: 11/30/99 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 NE NORTHEAST LABORATORY OF DANBURY _. 39. MILL -P.LAw:.RoAD . - , DANBURY, ,CT -. 008,1.1; _ .; _ , _ r . CT Cert:.PH -0404 n y LABS (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: MILL DRILLING, INC. 75 PUTNAM AVENUE BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: Total Coliform (Bacteria) PHYSICALS: CHEMISTRY: Color Odor pH Turbidity DATE SAMPLE COLLECTED: 3/22/2000 TIME COLLECTED: 10:30 A.M. 'COLLECTED BY: RUSS DATE RECEIVED @ LAB: 3/22/2000 TESTED BY: LAB #11471 REPORT DATE: 3/27/2000 BOSSEN, 40 ABBEV FIELD LANE, BRkWSTkA, N.Y. BOTTOM OF TANK WELL NONE I RESULT: per 100 ml 0 ND 7.41 0.77 NTUs MAX MUM CONTAMINANT LEVEL 0 per 100 ml 15 . 3 Units no designated limit 5 NTUs Nitrite N <0.005 mg/L as N 1 mg/L as N Nitrate N 1.02 mg/L as N 10 mg/L as N Alkalinity 168.0 mg/L no designated limits Hardness 182.0 .- . o -mg/L __ ..,............no designated. limits . Iron 0.035 mg/L 0.30 mg/L Manganese <0.01 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium 8.4 mg/L 20 mg/L ** Lead <0.001 mg/L 0.015*** ml = milliliter mg/L = milligrams per Liter ND = none detected NTU =Units <Less Than * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED: SAMPLE, AS TESTED ABOVE: MOTABLE or AMNOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) e a Laboratory Director •NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 a.,... . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES • FINAL, SITE INSPECTION Date: ® Q 9 5 to Town Permit# TM # 3 el — �'— 7 i Subdivision Lot # A ` a,,r5s 6,y " 1. Sewage System Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil riot stripped ...... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... 11. Sewage System a. Septic tank size - 1,000 ......... 1, 250 ......... other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1.All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... ............................... f. Trenches length required 30 8 Length installed 3 Oa 2. Distance to watercourse measured-!-/ o o Ft.......... 3. Installed ac ording tom, .. 4. Slope f r c accept#le l - 1/32" /foot ............. 5. 10 ft. rom property line - 20 ft.- foundations.......... 6. Depth och 0 inc eon, o su ce .:............. loll 7. RooYee d *,a 1 /o....,..... 8. Size l ' diame er clean .................... 9. Depth of gravel in trench 12" minimum ................... - 1-0.. -.Pipe ends capped ...... ::.:.:...:.... . .. g. Pump or Dosed Systems 1 Size of pump chamber ................ .............. .................. 2. Overflow tank ...........................:. ............................... 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... 111. House/Buildin a. House located per approved plans ... ............................... b. Number of bedrooms ....... ............. ...... - a-= tiVela loca ed as per approved plans . ............................... b. Distance from STS area measured ft........... c. Casing 18" above grade ........................... d. Surface drainage around well acceptable ...................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box .. ....................... * * *..... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f: Curtain drain outfall protected & dinto exist watercours g. Footing drains discharge away from STS area ............... h. Surface water protection adequate .. ............................... i. Erosion control provided ................. ............................... Rev. 6/97 411f1!"1 l�TA l \AA/JA .STATT[1 10-20 -1999 09:42AM FROM TO 927M21 P.01 v� )PVTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES For: Fill Trenches X PCHD Construction Permit # Located / emm LA Ft^ FMS Ta ` P oHD� ((Ty (V) pi► � N Owner /Applicant Name Rtc,HAFV + bSM9 cE B°'%BKTM 'A- . Block Lot ,1 Formerly Subdivision Name `him Is system fill completed? Is system complete? Is system constructed as per plans? YCi Is well drilled? tj 0 Is well located as per plans? 5 "1M I" 1 L*r WJ&3 Are erosion control measures in place? *5 Date Date to X19' ir1 Date I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accord ued PCHD Construction Permit and 'approved plans and the Standards, Rules ims-tnam County Department of Health. Q Date: 19''L°' q4 Certified by: Address 2• HIL-VP 4 FO" #W%t*- HY lcse 5 6124 PE x RA _ _.. _..._..._.�._.__ Comments: Form FIR -99 TOTAL P.01 Town or Village Locate at Farm X2118 !/ . �� Section Block owner Mr: t.ehar_d - :got Job S0615 Separate Sewerage System built by BBC.. £xcavat i nq ':) nc Address R.5 =,, Woterme I on HI 1 -1 Rd. Mahopac Consisting ote 1,250 Gal. Septic lank <L 160' lineal Feet' X 36'-Inc . h .. width trench Other requirements` 3611 R =O =g :F 111, Over :Area Water Supply: ,Public Supply From, X - 7 Prrvat@ Supply. ;Drilled -• b .`. Address Frame_` rame 10/28/71. Builtlmg Type No, of Bedrooms) `Date Permit Issued Has Erosion ,Control Bean Completed - NOhe-.Req l -d,. ` f: certif that the system(s): as listed serving` the above premises were constructed essentialiy as shown on the plans of the completed work (copies of which are Y attached), .and •in accordance with the standards, rules and reg4lat16ns,',_plans filed, and�the permit issued by Putnam County Department of Health. 12/28/72 X Date Certified by P.E. R.A. Address R • p., 6=' 8Qx =35 rme l New lb'r 10512. 2.9206 License No. 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: arage•system . ali.become null and void as soon as a public sanitary sewer becomes available and.the approval of the,.priv8te water;supply shallbecome.nulf, and void when'a public water suppl mes available. Such approvals are subject to modification or change when, ;in 'the;;judgment.,of ;the` er`, f, Healtn;. such -revo ification or, change is necessary. Date -off a: r - BY f.t'..'"Title J WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEA,`�/ Division of Environmental Health Services COUNTY OFFICE BUILDING . CARMEL, NEW YORK This' report" is -to'be'completed 'by -We l"drilterarid submitted io Courity Health Department together with laboratory report -of analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME ADDRESS ® e' LOCATION OF WELL (No. 8 reet) (Town) (Lot Number) PROPOSED USE OF WELL DOMESTIC ❑ SUPPLY BUSINESS ❑ ESTABLISHMENT F1 INDUSTRIAL ❑ FARM E] CONDITIONING ❑ TEST WELL ❑ O(Specify) DRILLING EQUIPMENT ❑ ROTARY COMPRESSED AIR PERCUSSION ❑CABLE PERCUSSION ❑ OTHER (Specify) CASING DETAILS LENG (feet) DIAMETER (inches) WEIGHT PER FOOT THREADED ❑ WELDED DRIVE S O ❑YES kNO WA C SING T JUT D4 �IYES LJ NO YIELD TEST ❑ BAILED HOURS ❑ PUMPED COMPRESSED AIR G.P.M. S YIELD (G.P.M.) WAVER LEVEL MEASURE FROM LAND SURFACE— STATIC (Specifyfeet) DURING YIELD TEST fleet) Depth of Completed Well in feet below Land surface: SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS . SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (Inches): GRAVEL SIZE (inches) FROM (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks: •. FEET to FEET If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE D TE WELL COMPLETED I 0—ATE OF REPORT m WELL DRILLER (Signature) W r _ BREWSTER LABORATORIES WATER ANALYSIS REPORT SAMPLE NO. 2899 SOURCE: Richard L. Bossen - faucet - well supply Farm To Market Road Sec, 71 Brewster, N. Y. Block 1 Lot 4 COLLECTED: I-larch 10, 1973 BY: Richard L. Bossen BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 0 per 100 ml. This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. March 14, 1973 C � � R4,ldickwit P. E. Director i / r ., .. ... _ .. _ _ P,. O.; BOX 261 MT. KISCQ ;N, Y•�1Q59� 2 - �.- m > - <�;_- _�r,.,.._..,..- _....... ��_Y..._.�.�.,. . December 29, 1972 Mr, R. L. Bossen Farm To Market Rd, Brewster, DT. Yo Dear- Mr.-Bossen: The result of a bacterialogical examination of a sample of well water received from you on December 28th is as follows: Total Coliform Count = 3/100 ml Federal Drinking Water Standards allow for an average Coliform concentration of one per 100 ml based. on a number of standard samples per month. Maximum allow- able concentration is 4/100m1. Therefore, while the water is potable, it is borderline and should be checked again. Very truly yours, solidated?_Technology,.Inco ohn Po McGuire, P.E. JPM:i I_ .._�. Y• � - _ .• r,. ..� rr r..r �. .... � . .... — �.. aM. . isx .•ia�.'C. J.- tr. .._ra' 1 _ ♦ • v ...n. ��.,n x ..a ..a . a`.. a�a..� _ y,. '� ;may a.• x. M.K'�. .r�..uACp ~I Mr. & Mrs. Richard L. Bossen Owner or urc aser of Building Building Constructed by Farm Lane Location - Street Frame Building Type Patterson Municipa ity Section Block Lot GUARANTY OF SEPARATE SEWAGE-SYSTEM I represent that I am wholly and completely responsible for the location', workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has-been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department. of Health, and hereby guaranty to the owner, his succes- sors, 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 .initial use of the sewage disposal 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 occu- pant of the building utilizing the system., The undersigned further agrees to accept as conclusive the de- termination of the Director of the Division of Environmental Health Ser- vices of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. �— cam._ Dated this ,� % day of 19'%?— Signature �,,. (A.�d �. $.,C. Excavating Ina-Title R. Y. D. 5, WL: ermelon Hill Rd, (If corporation, give name Rahopac , N. Y. 10541 . � and address) ,Tel. 628 -3967 THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health f i _ 7 PUTIV AM CgUNTY DEY'A }RTMEIVT. OF HEALTH } UZ. :. > Division of, Environmental Health Services, 'Carmel N Y -10512 ' CONSTRUCTION PERMIT DF_,OR SEWAGE' DISPOSAL SYSTEM' y 11 .:at �Ih i Sec ,Villa toon orBlock Located 9 ;own, e Subdwision c� Lot Job Owner " ddress A 7, ,Build-ng Type Cot Area `d'g@ P641 Number iBeo rooms `A Total aHab-table Space Square feet Al h X. Separate Sewerage System to consis of� ��' -Gal iSeptic.Terik lineal feet 'X �i �! width trench To be constructed by A :Water Supply Y Public Supply aFrom F1/ L ti. Prnrate Supply ao be drilled by. .Address - ._ Other Requirements' 12-re-present.-that, 1 am wholly and completelyg dspons I�for the tl sign and location of ,the proposed ;ystem(s),; 1) that the separate sewage disposal system above. described will be constr ucted as shown on the eppovetl; County ; Department of „,Health; :and that on compleLon,thei be submitted to the'Department, and awweotten,`guarantee place m: -good operating condition any '_part;of said sewage ance of 'the• approval, of the Certificate of Construction •C w: :will be locafed,as shoanrn on the approved an andafiat said,wi - County Department -H - Ith {{ M t..j fjr,C t-i.e•, .'Date Address APPROVED FOR.CONSTRUCTION.- This approval expires_ revocable or :cause or. may be amended or: modified when coo requires a new `per �t . Approved- for disposal of domestic �V., By Q2 ie furnished the owner,. is successors local system_ during the period of 'two ance of the= original,sysiem or`any repa I be installed in' accordance; with ,the st -T y is k ifr �5 i d ,ear from.tihe date- oseued. unless - r ed necessary y. the Commi sroner of _age �r-vat afar :supp e' satisfactory tothe Commissioner of Health will hers.or assgni "by.the'builder, that said builder_ will 2).�years. immediately following thedate of the issu- iis thereto;;2) ' ttiat the,drilled';wel ( descritied above an tls; ,rules and'regulaions oof °the Putnam • P E �R A. ® License .NO, _ uction of the bUilding has been undertaken Arid is Nealth.' Any change-6'r 'alteration.of construction ly only z I. - - - - 7 Dry. S.I O�,i 0 ,VI: J_;' , .E ." I f Ti --"T - - :' 1, D. 17, - LA —LL- - - -1- -.%- PTLE NO. DESIGN DaT Z =7.7 2� ,.�E, DTZ .-ZZ.AL SYSTL.-' Adf e s Fair.. L -L cc a E. a'- I i-.L A B 1 o Lot • -M ra Sec. C 3 H r, p al tj a e r sh e d L I ic i, MAO , ^-. T " D "71 TH POL.T(, TT C)' 0 S . k T'Lofe 1. 1 "T, C' L CC 1 71 PrI PIC 0 L-A --2r e-e A: n I, 1 :5 z? Dect' to 7- T NO. T i e Fro- -J-Z,oum� I Soil R-t--- S -a . S -r Stoo D-03 im Min/im Inc' lrc:. 2 Y10 4w7 4 S i. 2 00 2 3. 's Notes 1) Test "s. to - be r e 2 1 sa d e- -D =tl unti-I ec:ual So-'*I- r'= _t 2S F-e tame 0 E- co 1. 1 d 0P rev;m- 2) Deoth -S r. e - -2 n t s to I) e 7., d e f,-- o 7, to of 14-1 a I LEST PIT D +T ?�GL'!. ?.;.='D _O '� � ^ ^= _ =� ' DPLIC�.TIO\ Vi.7 L :i_LL:., Li 'L :1L DESCRIPTIO�, 07 LS DEPTH RODE. `0: .. eHOL7- \0 G. I, �, --- - - -- Err 12'' 18 rt — Q�1 2 4; 30` _ 36'! 4S'' _ SW' --- 6'0. 66'r— P/�7Yfl//(y — A (� q no- 2:. 8 4'` r n i r .. ]r1vT I �•IC�TE �E�'�.0 Al S•L CAL .0 .` \D Tj TJ-t j ^�'(+ t r ✓- ., ti Out r. _ T /� 1 =��,! r, �� *{ T,_�TJD TE1:`rj '?T =_` r��TER -�\; �CGU \T= I\ ICaTE TO ,;[I r :, _,_ �� �__ 5E� LDc9c9OW• °'✓ ° TESTIS KADE L).Y 5011. L � `i i /l• 11.. D=v1' S. D. `T'C=�!.n 1»n� �i0 `ori�UIJFJ �° Y' OL _.00. S °�:C Absorptio ea Eli, ovidend Syq qcm ! c � _ S . -. . L F.x2 3.5 �vid —Ln trencrn. — Other z N John Ne Prentiss, P.E. ?i:16 SS.q: � ; =' e �F � 11eUa 6, .ge 353 Address now York I ... SFiu - 9 ' Pli ,` ?'iv?,_•I CC��` i � DEP�.R � " \>>�, t OF i- iET -i So -1 Sq. Ft ./Cal Check -ed Poo. 2g P"' Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES C ©ONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at C/',.;-) ryI �Lus�ra Qovvi or Village T1)9--77�eSc>1L1 Subdivision name Subd. Lot # _ Tax Map Block �5 Lot 1✓41,. enewal Date Subdivision Approved Owner /Applicant Name Mailing Address 6&& Amount of Fee Enclosed _ Building Type Date of Previous A cad, � ` 20-S AL Area �j Z No. of Bedrooms Revision Design Flow GPD Zip �Z> Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of /L 5-0 gallon septic tank and goo JI Other Requirements: To be constructed by Address Water Supply: Public Supply From Address or: Private Supply Drilled by 77' ' 2 y Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date Irz 11 License # %� 3S APPROVED FOR CONSTRICTION: 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 whe co sidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new percr� . roved discharge of domestic sanitary sewage only. C% By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 F7 PUT NAM COUNTY DEPARTMENT ®1F HEALTH DIMMN OF IENWRONM ENTAL HEALTH H S E ,RWCES . CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM Located at iLp R a.�/� Town or Village L W /-- 775 jeS en,4 name ,Wee8 "did on Approved Subd. Lot # Tax Map 3� Block 5' Lot 7 Renewal Revision Owner /Applicant Name RiCi4AQ) B055 EA) Date of Previous Approval Mailing Address '�A R iyl r n MR,C_ ICGT" z2v a) 9 R 6,,-u S rQ, A)�_ Zip _tL2<Zj j Amount of Fee Enclosed —5")0.0 6 &, � :7 AC,26 s- Building Type & PMEAe n A2r Lot Area No. of Bedrooms Design Flow GPD (W MIR Section Only Depth VoRume PCHD NOTIFICATION IS REQUIRED WHEN FILL IIS COMPLETED Segnarate Sewersage ysteffi to consist of % gallon septic tank and 3oQ [ „v , r r. Other Requirements: To be constructed by �i B , .—i_:) , Address WatE SURP_Rva Public Supply From EYe-6r Goo e- se !l6!tow s" Address ®fievate Supply Drilled by T' , i 7 Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the soarate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address P.E. v R.A. Date ZA41— Ad I License # 7Y 63 f 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 wh nsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe i . roved for charge of domestic sanitary sewage only. By: Title: EA� Date: Tt White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 ' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # R V" r Well Location: Street Address: �illage Tax Grid # C ®T r-- at- F! % 1 - �yJ Map Blocks Lots) Well Owner: Name: 1&# Address: 4594,4 7D �� .�/✓ ITT �SDrJ IV 5-D Use of Well: esidential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage ,gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling _,4�,dw Supply (new dwelling) Deepen Existing Well Detailed Reason U-g� for Drilling Well Type rilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No L-•—' Is well located in a realty subdivision? ...................................... ............................... Yes L--,—No Name of subdivision B��1%� -� Lot No. Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No L_-- Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well l cation & sources of contamination to be provided on separate she lan. Date: _ Z Applicant Signature:. L/ PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under prov ' ns of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York Stat Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a wate 11 driller certified by Putnam County. Date of Issue Permit Issuing Pfficial: a"_6V Date of Expiration J A-0 Title: Permit is Non- Transfe abl White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner �G f�j�,Ql� BvSS,E�t/ Address rw,a2,rl NY Located at (Street) 0/_,7 9;VX,•.-7 ,Va/1LD Tax Map Block Lot (indicate nearest cross street) Municipality Drainage Basin . i SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test Hole No: Run No. Time Start - Stop Ela se Mi Time n.) Dep th to Water )From Ground Surface (Inches) Start Stop Water Level Dropp In Incles Percolation Rate Min/Inch 2 ro i07 Zo -L3 " 311 3 10,'3 °oZ 'z 3 ZO 233 /V !� . 31 7 4 11, 093 I ,' 3� L Z Z 3 5 3 /.<P. 1 . A 4 ; 5 1 2 3 4 5 N V I tb: 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 TEST PIT DATA ,P] E5 OY SOILS- ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. r HOLE NO. ' HOLE NO. G.L. 0.5' 7 911— 1.01 1.51 2.0 2.5' 3.0 3.5 4.0' 4.5 5.01 5.5 6.0 6.5' 7.0 7.5 8.01 8.5 9.51 10.0 Indicate level at which groundwater is encountered Al I Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: _771) Date Design Professional Name: Address: . 770. B*ep-le Signature: 11 i' pfd QA') oZ!9 A �% ww * , 0 07 2 BRUCE R. FOLEY Public Health Director Shawn Daly P.O. Box 418 Shenorock NY 10587 Dear Mr. Daly: .:LORETTA` MOLINAM 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 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC. (914) 278 - 6678 Fax (914) 278 - 6085 March 24, 1999 Re: Proposed SSTS: Bosson Old Farm Road (T) Patterson, TM# 34 -5 -77 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. 1) If deep test holes were performed greater than ten years ago, the tests must be rewitnessed by a representative of this Department. 2) Basement elevation is to be noted. 3) Dimensions from the well to two property lines are to be noted. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. V t ly yours, Robert Morris, P.E. RM:tn Senior Public Health Engineer BRUCE R. - FQLEX: 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 Heal "th (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 PROJECT (Owners Name): STREET: TV MUNICIPALITY: 1� �'° d� TAX NIAP NUMBER: -�"� ►-- DESIGN PROFESSIONAL: DATE: _ �.. S16 REQIJESTED ADDITIONAL INFORIIIATIOr1 OTHER PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION. F.OR APPROVAL-OF PLANS. FOR_ _ A WASTEWATER TREATMENT SYSTEM L Name and address of applicant: �GfyA/�1� �flSS Eit% 474-0 7V 2. Name of project: Zt 7-? 4p'� L' 3. 4. Design Professional: 64 ti J j:� 7E.5. 6. Drainage Basin: Locatio&: Foqf,77_,_°.y Address: l7 p ol 7. Type of Pr ' ct: rivate/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ........................ ............................... Type I Type II 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency Exempt Unlisted L—" 191-4 1X 12. Is this project in an area under the control of local planning, zoning, or other officials,. ordinances?. ..........................:....>.:.::...:...::....:..:. ..:: :.......:..:...:.:..::..:.. .BCX 13. If so, have plans been submitted to such authorities? ........ ............................... _ 14. Has preliminary approval been granted by such authorities? Date granted: 15. Type of Sewage Treatment System Discharge. �''�.. �`'. o 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) 0 19. If yes, name of water supply Distance to water supply -- 20. Is project site near a public sewage collection or treatment system? ................ VD 21. Name of sewage system Distance to sewage system 22. Date test holes observed 23. Name of Health Inspector 24. Project design flow (gallons per day) ................................. ............................... CIRO 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... d 0 26. Has SPD&Application been submitted to local DEC office? ......................... Form PC -97 .2 27. Is any portion of this project located within a designated Town or State wetland? l� 28. Wetlands ID Number...............: x. -.. ..:... . .. 29. Is Wetlands Permit required? .............................................. ............................... Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ............................... Nr� 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, 9 landfilling, sludge application or industrial activity? ............................ Yes/No /V 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No Al y 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 15 years in or adjacent to project site? ............................................................... 35. Are any sewage treatment areas in excess of 15% slope? . ............................... pJ J 36. Tax Map ID Number .......................... ............................... Map_ Block 5- Lot 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 within the.NYC Watershed shall - - 6e sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item I .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on thisform 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._ 11 ATURES & OFFICIAL TITLES: Mailing Address :.... ............................... /V�%. dO�� 7 z, 14.164 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 SEAR : -_�. Appendlx- 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. APP CANT /SPONSOR j 2. PROJECT NAM / i Gam.. �r,a 'r>ZSd( 3. FrR6JECT LOCATION: Municipality C01 County 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) 77 5. IS PROPOSP4CIION7 : ew 0 f—t Expansion L_ Modification /alteratlon 6. DESCRIBE PROJECT BRIEFLY: ���� sr/1i�� ter' s - �v5A ��- 7. AMOUNT OF LANO AFFECTED: Initially . r acres Ultimately 10r �(r�• 7 acres 8. WILL PROPOS ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ential 0 Industrial 0 Commercial ❑ Agriculture ❑ Park/Forest/Open space 0 Other Describe: / r r // (eo #77 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL" STATE OR CAL)? ,�ji'T es C No If yes, list agency(s) and permit / ovals ,�/Vl� /�•%��.�r"�L.. G7�/ .�4�I� ✓ /L�,�' 11. DOES ANY ASPECT E ACT, �rl HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes If ye:•, 'iSl ac ency name and permit/approval 12. AS A RESULT OF PRqP0S1rD ACTION WILL EXISTING PERMITIAPPROVAL REOUIRE MODIFICATION? 0 Yes o I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE G Applicant /sponsor r name: �� Date: Signature: r If the action is in the Coastal , and you are a state agency, complete the Coastal Assessment For afore proceeding with this .assessment OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) As DOES 'ACTICN`EXCEED ANY TYPE'i THRESHOLD !N 6 NYCRR, PAR' 9. 7 12? If,yes..coorcinate, tne.,ev ew•crocess.an.c use !ne FULL EAF fes _ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, DART 617.57 :f No. a negative eec:arahon may cie superseded by another involved agency. (es r No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be nanowntten. -f legit: et, CI Existing. air quality. surface or groundwater quality or quantity. noise levels, existing traffic patterns. solid ovaste production or c sposal, :ctential for erasion, drainage or flooding prcclems? Explain briefly: C2. Aestnetic. ag ^cultural, archaeological, historic. or other natural or cultural resources; or community or neighborhood character? Explain briefly: tr3. Vegetatiun ur tau.. , fisn, enenrl9n or wilaltfa species, giyn:':__a1 nao:!ats, or ,.IIresten.erl or ?ndangerec species? Explain briefly: Ca. A community's existing plans or goals as officially adopted, or a c -arge in use or intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development. or related activities Ilkely to to induced by the proposed action? 'Explain briefly. t C6. Long term, snort term, cumulative, or other effects not identified in C1 -05? Explain briefly. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? Yes (.._i No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be,.compieted. by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significL.1t. 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 ;flat explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. 0 Check this box if you have identified one or more potentially large or significant adverse impacts which AWAY 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 imps it:i AND provide on attachments as necessary, the reasons supporting this determination: Print or Type Same or Responsible Officer in Lead Agency . Signature of Responsible Officer in Lead Agency Name or Lead Agency Date Title of Responsible Officer Signature of Preparer (if diiierent from responsible or iced L . . I DIVISION. OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Located at mil- Z7 Cam" f ol/ Tax Map # .3_ lock Lot S ision of A AA Su ' igr6n_Lot # Filed Map # Ite Filed Gentlemen: -56AP- This letter is to authorize a duly licensed Professional Engineer or 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 M Law, and the Putnam County Sanitary Code. :, Countersigned: , R.A., # Mailing Address . S bi�OxOC14� Very truly yours, Signed:/ �-��- ' (Owner of Property) Mailing Address: ,/% .M 197AeW4T0?> State L Zip S State Zip® Telephone: �2 t� a -SD7 Telephone: L/!/ Q`/ 7D5 13 0 fie' S�� ISM 03/1 r I l! Form LA -97 • All of the rooms in the home are IF expanded by 9 -ft. -high ceilings. The use r of 2x6 exterior +walls allows for c i additional insulation, making the home v more energy efficient. - l Plan V -1214 3 b I Bedrooms: 3 Baths: 2 Living Area: Main floor 1,214 sq. ft. Total Living Area: 1,214 sq. ft. Carport 400 sq. ft. Exterior Wall Framing: _ 2x6_ Foundation Options: Crawlspace (All plans can be built with your choice of foundation and framing. A generic conversion diagram is available. See order form.) BLUEPRINT PRICE CODE: A CARPORT 20X20 _KI•TCHEI`{ . DINING, e x 10 -6 0 s x 10-6/ ° J r� GREAT ROOM 15.6 X 18.0 S CALL TOLL-FREE THIS BLUEPRINT, 'S EE 1 800 547 -5570 Plan V -1214 t 42-0 .... a ... _... _. MAST.9K. - - - - BEDROOM 11.6 X 13.6 BEDROOM 1 11.0 X 11.0 I ,/.1 MAIN FLOOR 14 BEDROOM 10.0 X 11 -0 i I _ PRICES AND DETAILS ON PAGES 12 -15 23 French Cottage for Today • Although the exterior detailing reflects the architecture of yesteryear, this one - story French cottage has an interior designed to accommodate the needs of today's lifestyles. • The inviting entry porch ushers guests into the huge Great Room, which converges with an open dining room /kitchen combination. "I' • • The efficient U- shaped kitchen and the bay- windowed dining"room offer an easy- living atmosphere, with direct access to the carport. • The sizable master suite boasts a private bath and two walk -in closets. ) • • The front bedrooms are serviced by a another bathroom, and a laundry closet -: -_ -. - -- _---- ....:.rs- c centrally - located I Bedrooms: 3 Baths: 2 Living Area: Main floor 1,214 sq. ft. Total Living Area: 1,214 sq. ft. Carport 400 sq. ft. Exterior Wall Framing: _ 2x6_ Foundation Options: Crawlspace (All plans can be built with your choice of foundation and framing. A generic conversion diagram is available. See order form.) BLUEPRINT PRICE CODE: A CARPORT 20X20 _KI•TCHEI`{ . DINING, e x 10 -6 0 s x 10-6/ ° J r� GREAT ROOM 15.6 X 18.0 S CALL TOLL-FREE THIS BLUEPRINT, 'S EE 1 800 547 -5570 Plan V -1214 t 42-0 .... a ... _... _. MAST.9K. - - - - BEDROOM 11.6 X 13.6 BEDROOM 1 11.0 X 11.0 I ,/.1 MAIN FLOOR 14 BEDROOM 10.0 X 11 -0 i I _ PRICES AND DETAILS ON PAGES 12 -15 23 BRUCE R:"FOLEY. - .:.:............ .:. Public Health Director Sean J. Daly P.O. Box 243 Shenrock NY 10587 Dear Mr. Daly: RV,_ DEPARTMENT ENT ®F HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA - MOLINARF R.N.', KS.N. Associate Public Health Director Director of Patient Services 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 February 23, 1999 RE: Application to Construct a Subsurface Sewage Treatment System at Bossen, Old Farm Road, Lot #77 (T) Patterson, TM# 34. -5 -77 The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on February -10, 1999 is incomplete. -Please be advised that the following information is required before the Department may commence its review. 0 Well Permit needs to be submitted. o Short EAF needs to be submitted. o Permit Application incomplete. m PC -1 missing - (Application for Approval of plans for. a Waste Water Treatment System - old PC -97). y�i �,,/J o Two sets of house plans need to be submitted. (Only 1 set was submitted). 05� o Letter of Authorization incomplete. The review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information as to the completeness of your application. Please be advised that failure to submit information to the Department or to follow procedures is sufficient grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed Regulations and Putnam County Department of Health regulations. Should you have any questions or care to discuss this matter, please contact me at (914) 278 -6130 ext. 166. RM /tn Very.-t;uly yours,� /y� Robert Morris, P. E. Senior Public Health Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY &SUBSURFACE SEWAGE TREATMENT SYSTEhIS••; ,- . -wt- • v '- - ' REVIEW SHEET FOR CONSTRUCTION PERMIT F STREET LOCATION LLD �" U ' NANIE OF OWNER N �s REVIEWED BY RNI, GR, AS, NIB, BH SSE DAIIE ' % TAx mAP # Y N FEE S'nc�s..yo %�c :Ili _ PWS LETTER OF AUTHORIZATI�I�I�,ti, "'`iL� , DATA SHEET (DDS) :ATE RESOLUTION REQUEST SUBDIVISION �L SUBDIVISION qG ) IVISION APPROVAL CHECKED :RATE Nd i — s, by ' REQUIRED DEPTH FAIN DRAIN REQUIRED GENERAL LOCATED IN NYC WATERSHED PLANS SUBMITTED TO DEP DELEGATED TO PCHD DEP APPROVALJF REQ'D EX- APPROVAL SSDS ADJ. LOTS LANDS (TOWN/DEC PERMIT REQ'D ?) AEA_ ON• DDS PLANS, &. PERMIT SAME - . t ARE 1969 NEIGHBOR NOTIFICATION ER BI/ZBA YR. FLOOD ELEVATION R REQ'D PERMIT(S) AGE SYSTEM PLAN - (NORTH ARROW) i HYDRAULIC PROFILE .VITY FLOW Y N EROSION CONTROL:HOUSE,WELL, SSDS ERC & DEEP HOLES LOCATED PRESENTATIVE OF PRIMARY & EXPANSION OCATION MAP XP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE W-PUMPED, PIT & D BOX SHOWN & DETAILED OUSE - NO.OF BEDROOMS ELLS & SSDS'S W/IN 200' OF PROPOSED SYS. ZTY METES & BOUNDS USE SETBACK NECESSARY (TIGHT LOT) SE SEWER - 1/4" FT. 4 "0; TYPE PIPE 0 BENDS; MAX.BENDS 450 W /CLEANOUT FILL SYSTEMS CLAY BARRIER 10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE FILL SPECS FILL NOTES FILL CERTIFICATION NOTE DEPTH GAUGES FILL PROFILE & DIMENSIONS VOLUME FILL IN EXPANSION AREA INCH LF TRENCH PROVIDED% 60 FT MAX. ARALLEL TO CONTOURS 100% EXPANSION PROVIDED ON PLAN - FROM SSTS TOP:L.; DRI•VEWAY;•LARGE•TREES, TOP'OF'FIILL• TO FOUNDATION WALLS _15'WELL TO PL )'TO WELL, 200' IN DLOD, 150' PITS Y10 STREAM WATERCOURSE LAKE (inc. expan) TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER TO WATER LINE (pits -20) INTERMITTENT DRAINAGE COURSE )'/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS 0 10'-4%,251-30/%30'-2%,35'- o o CONSTRUCTION NOTES 15 MIN to CDS = >5 /0, 1 /0,100 - <1 /o DESIGN DATA: PERC & DEEP RESULTS 'MIN to CD discharge /100'with 182 cons day discharge 2' CONTOURS EXISTING & PROPOSED SEPTIC TANK DRIVEWAY & SLOPES, CUT m I ' FR] 2 F ----- 50 WEL'L"7 7r_ 71 FOOTING /GUTTER/CURTAIN DRAINS V SO PE BOUNDARIES 104PERTY -LINE TLE BLOCK; OWNERS NAME,ADDRESS �LOCATION F S ERVICE CONNECTION #,PE/RA; NAME,ADDRESS,PHONE# MDATE OF DRAWING/REVISION REFEREN LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET =PROPOSED FINISH FLOOR AND�MENT'EL�] COMMENTS: �ew q_ A G •-t /a/ gR C.g..:R;.,. Oi, fir:.: Public Health Director Shawn Daly P.O. Box 418 Shenorock NY 10587 Dear Mr. Daly: ,._..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 (9,14)278-6558 Fax(914)278-6085 Early Intervention (914)278-6014 Fax(914)278-6648 WIC (914)278-6678 Fax (914) 278-6085 March 24, 1999 Re: Proposed SSTS: Bosson Old Farm Road, Lot# A (T) Patterson Reservoir Basin The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on March 16, 1999 is complete. The Department will notify you by April 13, 1999 of its determination. .._ --"-The 'Project has-been-delegated -to--t e Putnam Colinty Health Department for- review pursuant to the guidelines set forth in the Watershed Agreement. ❑ Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed 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 ���........._: -._.,_:; LetterLto .- :Sha,vn.Daly:z�:Maych.2:4; 1;999..:��.....,�,:.. ...:.._.... �. �T�.. �... _U.._...,..,.,...__�,.......... 2���....��.... of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if Dept. of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (914) 275 -6130 ext. 166. Ver it yours, Robert Morris, PE RM:tn Senior Public Health Engineer w PUTNAM (COUNTY DEEARTM ENT OF HEALTH DEWSION OF ENVIRONMENTAL ENTAIL HEA1LTH SERVHCES �o .1 �jp i -f o DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address /A-g,41. 7-,c, MA-r? k AE7- Located at (Street) J- j, _ ) Tax Map -3 f Block 5- Lot 7, / (indicate nearest cross street) MunicipalityE��� Watershed���-�� y SOIL PERCOLATION TEST DATA Date of Pre - soaking all? 98 Date of Percolation Test 042_0719 1 1 ea0 '� 3 2 /01,116 — , 3 6. 2 ®" .. 3 2 4 ;0 o "- 3 5 2 ti 1 5-6 16" - 3 e/' ,6 3 16 ,,� 4 1 1 5 1 I I I I NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at 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 5 j 1 2 4 1 1 5 1 I I I I NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at 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 PUTNAM COUNTY' DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address A Ar,4 rQ iMAIRK6 7- -RA Located at (Street) Z:f� 144 Tax Map '5 If Block Lot 7 Z (indicate nearest cross street) Municipality FA-rT025,ePtj Watershed SOIL PERCOLATION TEST DATA Date of Pre - soaking /� -o / 9,9 - Date of Percolation Test - —JMQ* 111110199 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, :5 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 ............... . ... ......... .. . .................................. .. .. ........ ...................... .... ... :rom::. ro.un .. ...... .. ......... . .. ... - : im . .... . Time c * e s: Start .Stop 1Qrop)ln hate hole. :. . ............. ...................... ... ..... ..... .. .... 4MniInch ;; . ...... .... t0f3l -/0!'38 7 q Ya - ;Z;LXX" 2 4 5 + 2 3 4 5 I 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, :5 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 RECORD OF PHONE CONVERSATION Time: �� Q Date: / / A lq ,?, Person calling: �e yo )T� JA ' Phone #: Reason ( ) Inspection: (Deeps and /o eres Scheduled Fi( Time: Date: ?-P rG S .Y N Tentative /to be confirmed () ( ) Town: Road /Street: R 75 A- F/EL 2 -)- /I 1 Tax Map Comments: ow✓� �r - � � � l< `ice as � e [� - r�fM o ,^�%r °kF t 7`® -i ;/ ✓axe -c �.� / - & P,0t7_ _6,R s ✓At TEST PIT PROFILES pr,m �k�Jccnsr'vv� ary Hole # Lot # Hole #_ Lot # Hole # Lot # . Depth -to, water - -,= 7Vz3 h- = : Depth to`water �' 1/y 11 e " Depth to water Depth to mottling Al,; 3 Depth to mottling, A;�d -,4 e Depth to mottling Depth to rock/imp. A/v Depth to rock/imp. A1,g a �e Depth to rock/imp. . G.L. G.L. fie G.L. 1.0 1.0 1.0 2.0 2.0 1 2.0 3.0 ui 3.0 1 3.0 4.0 4.0 :5A V, 4.0 5.0 5.0 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 Vow �,dWn - wit 10.0 1j�t1;10.0 10.0 Hole # Lot # Hole # Lot # Hole # Lot # Depth.to_water - - - - _ Depth-to water-- --•-- - ° ° °' °' - "'Depth -to water Depth to mottling Depth to mottling Depth to mottling Depth to rock/imp. Depth to rock/imp.. Depth to rock/imp. G.L. G.L. G.L. 0.5 0.5 0.5 1.0 1.0 1.0 2.0 2.0 2.0 3.0 10 3.0 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 a v )(ivnn� A �i I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner 5d 55 e�1 Address f /2� Located at (Street) f h. Tax Map Block c5 Lot .Cindijoate nearest cross street) / Municipality fa oa14 Watersheds SOIL PERCOLATION TEST DATA Date of Pre - soaking V31't Date of Percolation Test Fa 3 4 1 1 5 1 1 NOTES: 1. Tests to be repeated at same depth until 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 1 i,3� - 7.31 l %i - zi /Z a _ 3 "1 1`y� -q -53 4 ;57- /o.00 'a l 3 :L 2 71 G'` — -2i( 3 4 9J 5 5- 1'57 3 0,7 5= 5 0? 1 Fa 3 4 1 1 5 1 1 NOTES: 1. Tests to be repeated at same depth until 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 lip I I k '? . �� PUTNAM COUNTY DEPARTMENT 07 HEALTH DffVISION OF ENWRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner '0 5'5et'\ Address, Fo_rn T,;, Located at (Street) he- Tax Map Block 5 Lot (i icate nearest cross street) Municipality Pa; lr_�Ok\ Watershed 'F'Tyf SOffL PERCOLATION TEST DATA Date of Pre-soaking 3Z -Date of Percolation Test #q I g . . ... ... ....... I ... .... . ..... .. .......... ........ d 1" G' .... ......... ........... .............................. . rom ... .......... ... ......... ....... ......... .. NOTES: 1. Tests to be repeated at same depth until approximately -equal percolation rates are obtained at each percolation test hole. (i.e. :5 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 .......... _ ... . ...................... . ..... :::: .. ........ flHli® 31me u EdOT 0*6`�.-'��.-_:��: ............. ........... ............ ... K ......... ....... #* Z :� �: # ...... I ...... . ........ .... ...... ta t .... ... . .......... .. ........ .. ...... ... . ...... . . Ane .. ..... ................. .... .......... ................ ........ I .... ....... . . .... . .......... 1 ... . ..... ...... �� -� -1 "l5 - � -3 2 12 3 4 36 3 6 t 5 IdO 7- /0' 3 2 3 4 5 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. :5 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 �- `\ p�(y g ' SSolomon I V "1� _ em 311 l 1 Lake 1 ` S'dest co:.Qa •0• \ f Breutstp lop N% II l ,� Pond - • . 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Time: la- ; go Date: %z Person calling: Gayer �'4 Phone #: = '- is -- X 6- 919 Reason () Inspection: eeps d/o Peres: --- r�C Scheduled Field Meeting ,N_ _ — r-0 . ime: Date: Tentative /to be confirmed ( ) ( ) Town: j?,A r 25©PW vihh/ Tax Map #: -341 — 15� — 77,11 Comments: ���►� �=a a r e k- In E :2, M 1, k1l 10 10 O f3A iq A/ RAR OF NEW SUPVE�' OF PF OPEAT�`. � + PREPARED FOP, P(IfPAPID L, BOSSEdV 51 SITUATE I N 0 klidv OF PA T FEE ON SFO LAND SuP P u MA (!V! NEW YDAK SCALE pt .= 50' v e 0, c/. hlerp.4v, C e lelkfm 4,,. q, /Z/ -r, P'e e 6oa—�;ly ENM HEMCCON ARZ VAUD POR TH /V eqj-4 /Y y MAP A" COP;Z Ttrilrl ONLY +;F SAID MAP 01 0/a/s7/—& 8/7,c Al COMO @ZAfl THE IMPRZSZZa OZAL'OF TNE-SURVEM � W#@§9 DIGNATUR9•FIKARS'HEMON."