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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34.13 -1 -61 BOX 15 01647 ,i ', 11'6 '. L 01647 PUTNAM COUNTY DEPARTMENT OF HEALTH _ _DIVISIQN .O..F :ENVIRONMENTAL.HEALTH .SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR TMENT SYSTEM PCHD CON TRUCTION RMIT # Located at Town or Village 'Pq 77`pcP-6U14 Owner /Applicant Name 46 L e; \\J pp IQ Tax Map 3-4,/--3 Block _�_ Lot �L Formerl Subdivision Name Subd. Lot # Mailing Address Date Construction Permit Issued by PCHD -7/► 01'q0 Separate Sewerage System built by )2rAtT�( Address 'PD OoX (.ol O CAxmoc-- Consisting of Gallon Septic Tank and 5-7(o L.,1- Dim T;lr AZW0FTcYNJ Other Requirements: Tit STS i t��url o� 'Fac (1.2 oz,,T ► ti'� Water Supply: Public Supply From Address or: X Private Supply Drilled by FOn AJ2TTS i Ak,� Address 721- i�Z CAern GL ) o5;'i -.-x- B.uilding_Type _6► m i -e 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 reg latio ment of Health. Date: Certified by P.E. 2L R.A. (Design Profession Address 7PAkiai ,A < _ In2en( inA f4vfECAe" License #D(.a%Q Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation; mo 7;ange is necessary. By: ' � Title: � Date: 1 2. O� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 i 1' _i �T,MIMfMfABIMIM[MIMiA/ "10RAMAIMIMfM[AAIA. r�l Tip..'_. T 5!.®:!P � OPY6 M® �i�AiMIM t NE, NORTHEAST LABORATORY OF DANBURY 39. MILL.PLAIN ROAD... - DANBURY, CT _ 06811 CT.Cert% PH -0404 LABS (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 N + LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: McGLASSON REALTY INC. P.O.. BOX 610 CAREML, N.Y. 10512 DATE SAMPLE COLLECTED: 12 /21/99 TIME COLLECTED: 3:00 P.M. COLLECTED BY: ED. McGLASSON DATE RECEIVED @ LAB: 12/21/99 TESTED BY: LAB #11471 REPORT DATE: 12/28/99 SAMPLE SITE: CANNON & BULLETHOLE ROAD, PATTERSON, CT SAMPLING POINT: KITCHEN SOURCE: WELL TREATMENT:. NONE TEST PERFORMED RESULT: BACTERIAL: '. 3.42 Total Co liform (Bacteria) 0 PHYSICALS: - ...25.0 0.--.. Color 0 Odor ND pH 6.57 Turbidity 0.26 CHEMISTRY: Nitrite N <0.005 Nitrate N 3.42 Alkalinity 165.0 Hardness... - - ...25.0 0.--.. Iron 0.032 Manganese <0.01 per 100 ml NTUs mg/L as N mg/L as N mg/L _mg/L'__... . mg/L mg/L Sodium 13.5. mgfL Lead <0.001 mg/L N1AXD4UM CONTAMINANT LEVEL 0 per 100 ml 15 3 Units no designated limit 5 NTUs 1 mg/L as N 10 mg/L asN no designated limits no :designated limits __..._ _.._�........._....� _. 0.30 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 m_�./L] 20 mg/L ,** 0.015 * ** ml = milliliter mg/L = milligrams per Liter ND = none detected NTU =Units * *Notification Level ** *Action Level . RESULTS BASED ON SAMPLES SUBMITTED: 12/21/99 SAMPLE, AS TESTED ABOVE: DOTABLE or AMNOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) 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 PUTNAM COUNTY DEPARTMENT OF HEALTX DMSTGN OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OE SUBSURFACE WAGi TREATMENT SYSTEM 4:; 4 fAIL.,0MerjA G L. E.-f-j 00 r--] -3-4• I-3 l . Owner or Purchaser of Building Tax Map Block Lot Building Constructed by Town/Village Location - Street Building Type Subdivision Name 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: _ ___.._.. u..._...._._......._..____._� ........�.... ._ ___.__.._ __._ . _ .. _._....._.._..._.,...._.._... 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 ui ; g utilizing the system. Dat ,�i Day Co Year � General Contractor (Owner) - Signature 9 Corporation Name (if corporation) Address: �® 1i. & 1 C) State Zip Title: F.r. -a . Corporation Name (if corporation) Address: 4Gb4,AC=_ State Zip Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location . -� . Street Address:. }• - - µ C6m n Town/Villa e P9+4 -Cr_ Tax Grid # Map Block Lot(s) Well Owner: Name: ffb-C-1 l rn Address: (Zea i tu. PO t X 10 Cp l IUY r65-12- Use of Well: 1- primary 2- secondary Residential Business Industrial Public Supply Air cond/heat pump Irrigation Farm Test/monitoring Other(specify) Institutional Standby Drilling Equipment Rotary Cable percussion )� Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock _ Other Casing Details Total length 2-1 ft. Length below grade 26 ft. Diameter ( in. Weight per foot jLq__lb /ft. Materials: _Steel _ Plastic _ Other Joints: _ Welded )(Threaded _ Other Seal: _�, Cement grout _ Bentonite Other Drive shoe: X 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 t Compressed Air Hours Yield Zb gpm Depth Data Measure from land surface - static (specify ft) A? i During yield test(ft) Depth of completed well in feet T —) 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 %V C Z . Ar If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity _jAt,-,M Depth _ =' Model Voltage 2�y HP el Tank Type L Volume -= &1, / ZO Date Well Completed Putnam County Certification No. (•AU3 Date of Report I 1 10C) WeII Driller ignature) "k �/ z'� NOTE: Exact location of well with distances to at least two permanent landmarks to be provi a s;paXte she plan. Well Driller's Name 51'cy l deg �0 Address: Signature: Date: j. p I �� IV 7 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 U10- ` (11� All f( ro f gy pp ' ! 1 TO: VvADL -e— l'� Co 4'4- i Date:- 1�0- -? (&0- . RE: 0L, 0 NDvtl MCG .,- ,S-D.A fz�At,-t P/E Job # We are sending you . attached under separate cover, the following items via 1st Class Mail, Overnight, Hand Delivery, Pick Up: Originals Reports Plans Prints Photographic Exhibit Specifications Colored Prints Other: Copies Date Dwg. No. Description "A P -A roc PC tl W 07 L-L-- o LAJ el-7 0- z - S u. 9\/ E�fS VA These are transmitted: _ For approval , Approved as submitted _ For your use , Approved as noted _ As requested ` Returned for corrections — For review /comment _ Resubmit copies for approval _ Submit _ copies for distribution REMARKS: Copies to: SIGNED: If enclosures are not as noted, kindly notify this office. (UrTransnUt.wp3.2) id, OAK 5'86*17'50"R 4f.67' PCLE (b /Z PCLE MM ou, VMS I)OD ®„e4 SOS . 0�?, LAw5 N/ r- c LANP5 N/ F OF IAMK7A&AN C . --_- 7� p, -11� 's, 0&. 7,T 4. 110 LANP5.N/ F OF ACM RA&AN SS6 5•56'33"E 43.51 ' r O9 57,"I CO Lo rRo 4?. N50.27'25" W 259 5 f. PUTNAM COUNTY DEPARTMENT OF HEALTH k e ._T w &p -,, DIVISION OF ENVIRONMENTAL HEALTH SERVICES / /�� FINAL SITE INSPECTION Date: 0 2 - ....._. nspecte y: Town p��rzso� Permit # TM # 3t ! 3 / — / Subdivision Lot # ..�-- 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 ...... ............................... II. Sewage System a. Septic tank size - 1,000 ... 1;25 .......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 & trench f. e. J Junction Box - properly set ........... ............................... 71—eng—th required Length installed 56 2. Distance to watercourse measured-/- /V o Ft.......... 3. 'Installed according to plan ........................................ 4. Slope af accept /32 /foot ............. 5. loft forty line 2�foundations.......... 6. Depth of trench <30 inches s rfa 7. Ro o, Q nsl 0 /o ........................ - i` 8. Siz of r = 2" d unet r c ean ................. 9. De of gravel in trench 12" minimum ................... -1 -0: Pipe -ends capped .:.::... ..... 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........... III. House/Buildin a. House located per approved plans ............... ...:..::........... _ IV. Wellumber of bedrooms ...................:. �l.... e, r4 ........... w� h �JH a. Jell located as per approved plans . ............................... -b. Distance from STS area measured ft........... c. Casing 18" above grade .................. ............................... d- drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away.from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 6/97 t or[ri c =.n ✓, N �L 7 Y VA a �Imm �- - Imm imm imm _ imm Imm INN ♦ . M.; t or[ri c =.n ✓, N �L 7 FROM : P&NAM ENGINEERING PLLC O� PHONE NO. : 914 225 2955 Oct. 28 1999 09:44AM P1 I-.. .__.. .. .... .w. .. .. ^w.,.u. -�... ..., .. - ....... ....,..c .... �.r..r.c..�>t... a�.�, ... � < �, :w. .... ,w,rt .. .... r r. MEMO TO: FROM: PUTNAM ENGINEERING, PLLC DATE: j ()�2 RE: REQUEST FOR SSDS AS BUILT INSPECTION PROJECT TITLE: STREET ADDRESS:V TOWN:'��' TAX MAP #: PERMIT #:. - 1 PLEASE NOTIFY THIS OFFICE AFTER YOUR INSPECTION AT (914) 225 -3060, IN BACKFIL-LING - THE SYSTEM MAY BEGIN. I Lm 7' DEPARTMENT OF BEA,TH Division of Environmental Health Services 4 Geneva Road Brewster,, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 June 15, 1998 Ken Hurley Putnam Engineering 102 Gleneida Avenue Carmel NY 10512 Re.- Proposed SSTS: McGlasson Realty, Inc. Bullet Hole Road (T) Patterson Dear Mr. Hurley: BRUCE R. FOLEY Public Health Director 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. I have been contacted by contiguous property owners to the above regarded lot. The property owner stated that access to the property requires an easement. Furthermore, the Town of Patterson denied a request -from McGlasson Realty, Inc. to have a private driveway declared _a town road to allow access to the property. Please advise the writer on the following: 1) How will the property be accessed.? 2) If the neighbors statements are true, what is the current position of the Town of Patterson with respect to road access to the property.? Upon receipt of a submission, revised to reflect that above comments, this application will be considered further. Ve truly yours, bw gOV4 Robert Morris, P.E. RM -tn Public Health Engineer DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-.6130 Fax (914) 278-7921 May 12, 1998 Ken Hurley Putnam Engineering 102 Gleneida Avenue Carmel NY 10512 RE: McGlasson Bullet Hole Road (T) Patterson, TM# 34.13 -1 -61 Reservoir Basin Middle Branch Dear Mr. Hurley: ► o, BRUCE R. FOLEY Public... Health Director - • The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on May 7, 1998 is complete. The Department will notify you by June 2, 1998 of its determination. 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 shouldbe sent to my .attention at the above address. This notice must include your name, the location of the project, the �_... _._.._... offi'ce"withvhich y'oa,filed'the appli -6ation originalry;' and a stat -eifi ndi* i 9 'a decision 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 Dept. 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) 278 -6130 ext. 166. r lly yours, 1�✓ 1&"ko Robert Morris, PE RM:tn Public Health Engineer It Carmel, NY 10512 Phone: (914) 225 -0554 June 23, 1998 Mr. Robert Morris, P.E. Public Health Engineer Department of Health Four Geneva Road Brewster, NY 10509 RE: McGlasson Realty Inc. Bullet Hole Road (T) Patterson, TM # 34.13 -1 -61 Dear Mr. Morris: Regarding the proposed four bedroom residential home adjacent to our property by Mr. McGlasson, I have the following concerns: 1. How will this structure's septic system and well affect the wells of our property and our neighbors? - " - 2:- Will the pro------ -di health hazard due to the steep incline? As you know, this area experiences some brutal winters and ice storms. Specifically, what is the angle of pitch for that driveway and does it comply to code? 3. Since the proposed structure is directly up hill from a wetland area, a natural reserve for local birds and wildlife, what will be the environmental impact? 4. Eight years ago, when Mr. McGlasson attempted to put multiple structures on this property, he was denied. One of the facts that surfaced during the inspection of the site, was the illegal dumping of construction materials. In light of his past actions, how can we be assured that this will not reoccur? r I 1 5. Since Mr. McGlasson specializes in modular homes, how will these structures be moved to that area without the proper roads? Access through Cannon Road and adjacent common driveways would be impossible without major damage to property. I look forward to your reply regarding each of these five points prior to any approvals granted to Mr. McGlasson. Thank you in advance for your, help. Sincerely, Pius Elaine M. Provenzano Salvatore Provenzano /emp _ x _ _ ® . MIAAIIIMM: MiMCM�Mil 1AiMSMiMaM1M ]M1MYMiM1ANIMIMTMaA!!I�AIMIM2M. i..IMIAAIM ' ?AAIMFA. �: MIMIMeM3MIM1AA 7MSMIM'MiAAtMIM7MxMe } � � • .. � ��� S •1- a �� /,, y' ® o y y t1 s � 0 ! � � � � � � � � � � C � � �� i� i 1�, / � �® � o � ,�'�� �41 � � � D � i ) � � x � � � I� 'I 4 t d -. / j ® 1 ,� S � /I , > r 21111Vi1711l WIVl1?YNU lN:1/111�1y111NSf111.4H111 i' �F.1i111 "6yyI' �t.Nli 1/1/t1l I' �FYV'.FiISyY'� I� R.�VI�71�/31(1/EI/ 111 - 111( 1% 4�1 1/ 1VYR�% li lY1( V] Vlll�7" Vf�/ Y1i1l NI N111Y�SYVIM111�1111�f1�111 /NIY111VY /~ -1-1. � BAN '`, '(!l (I �' �� ° �'� `�u 1 '0, I . f I I �, �' v � �. � �1 7 7 CONSTRU(C' m PERMIT FOR SEWAGE TREATMENT SYSTEM PE T-# ' Located at B U Lt-� H eLe—,- keep Town or Village Subdivision name z2f Subd. Lot # Tax Map Block I Lot Date Subdivision Approved Renewal Revision Owner /Applicant Name SSQr� 8SAL-A4,I G Date of Previous Approval Mailing Address F&:> &:> -904 (0 L 0 Zip Amount of Fee Enclosed Building Type ?\ &tf -f:M Lot AreaoaU P'Z-No. of Bedrooms + Design Flow GPD FM Section Only Depth VoRumme PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMIPLIETEID Segairate Sewerage System to consist of 90 gallon septic tank and 57� 2! VV l D6 Atssokfot 1 Other Requirements: D IST ZI 9xTLO- � To be constructed by Ta E6 -DLT • Address wage° Saab Public Supply From Address _ 41� Private Supply Drilled by I& ... }.���.. _.� Address _ I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the seoara^ to 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 n pars- e 9 Signed: P.E. �. R.A. Date PUT;wKm MNW V�3G� P 1, G Address I o2. G1 P 1�4 ej CIA &- License #0(o-7446- APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe t. pprove r discharge of domestic sanitary se ge only. / By: Title: << - `-— Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy.- Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL ll-� :please print or.type. - PCHD Permit, r Well Location: Street Address: Town/Village Tax Grid # L2x)L Er fi PA JegSzzj,I \ Map3+, (3Block I Lot(s) (01 Well Owner: Name: Address: R i �t , >a RtL:l (� Boy, 4Pl() G&RffiAGL 107911'—' Use of Well: — Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought f11t� 5 gpm # People Served LAM Est. of Daily Usage $D-C) gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type . Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No _ Name of subdivision Lot No. Water Well Contractor: `ty r3e Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: lr' IJ /,d Town/Village Distance to property from nearest water main: �2Eb� I Proposed well location & sources of con o e d n separates plan. Date: 4-1:(-> lie, Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a wate well driller certified by Putnam County. Date of Issue Permit I Offici Date of Expiration Title: 1( C Permit is Non- Transfe bl White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 T - i�®RPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: Me G LASSc J RF_Ai_-f 4 , Irle — buum'i i{uL-,,a_ I, M Gf LAssc)r-1 represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: C-, 45 50' ��,4 Te`C - Having offices at: I;f e,4 5 (-t V �qy Q - CWW e f Whose Officers Are: President - Name: �14 U-01 C Address: �t (� �Ll t w Vice President - Name: Address: Secretary -Name: Address: Treasurer - Name: Address: and that I am and will be individually responsible for any and all acts to the approval requested and all subsequent acts relating them Sworn to before me this 64J day of (month) (year) Notary Pub is ANN GRAY NOTARY PURUC State of New York Qualified in Putnam County Commission Expires March 30,19 Form CA -97 Signc Title: Corporate Beall e Y corporation with respect PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET -SUBSURFACE SEWAGE TREATMENT SYSTEM Owner �MG1_.A SSo-�l EE6 J � I ts c Address Po FOX 616 Located at (Street) Su u.-'T tt FRcaap Tax Map ', (3 Block I Lot Co 1 (indicate nearest cross street) Municipality FA77QRS= 1 Drainage Basin tbbL� 31e.•��' <.t-} SOIL PERCOLATION TEST DATA Date of Pre- soaking 2 6 $ /mot g Date of Percolation Test Hole No. Run No. Time Start - Stop Ela se Time 6 Time De th to Water' ' ' rom Ground . , Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch I 1 1`08 1'39 3d , 2.4 25`/2 I '/z 20 2 1:39 2 - n17 '30 'Z-� 25J2 3 2V 2.40 '30 2A Z5,/?- % 2 � 4 5 2 1'4D -3o 22 2233/4 314 17 x:4.1 2'/( 3C - - ....2� %2 23 1 Iz 20 3 2:12 2' 42 30 Z(' /? 23 ( (/2- 2-O 4 5 1 . 2 3 4 5 �f 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 TEST PIT DATA (DESCRIPTION OF SOILS ENCOUNTERED IN TEST DOLES _... _ . DEPTH - ..:"_:.i._.:.1 _ = HOLE -NO. �. G.L. 0.5' S 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' Li44s : sgow-j 5✓6 N cx1 i- -o,�►� W G>Arj r) L.oa" �� G►2av all 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 10.0' 2 L. ((�:,h11" ►3 y.�r.l 5AXr1f9,,4 bCA M SoN LAM VV/ 6rr1Z.A.v4r--A— i Indicate level at which groundwater is encountered 7+ Indicate level at which mottling is observed N /"A— Indicate level to which water level rises after being encountered Deep hole observations made by: {4 - PC- . P c. H. D. Date 2 l8 t T Design Professional Name: ��T �r xU►� , tt,LC Address: I b'Z C�& Signature Design Professional's Seal of NE6y yo9 4 n � 1 �`r�OA 467446 R�ES510��'� .a.ta Le) -C) C,O i Indicate level at which groundwater is encountered 7+ Indicate level at which mottling is observed N /"A— Indicate level to which water level rises after being encountered Deep hole observations made by: {4 - PC- . P c. H. D. Date 2 l8 t T Design Professional Name: ��T �r xU►� , tt,LC Address: I b'Z C�& Signature Design Professional's Seal of NE6y yo9 4 n � 1 �`r�OA 467446 R�ES510��'� DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 May 12, 1995 Ken Hurley Putnam Engineering 102 Gleneida Avenue Carmel NY 10512 Re: Proposed SSDS: McGlasson Bullet Hole Road (T) Patterson, TM# 34.13 -1 -61 Dear Mr. Hurley: BRUCE R. FOLEY Public Health Director Review of plans and other supporting documents submitted at this time relative to the above - captioned 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." 1) Basement elevation is to be noted on plan. 2) Location of the service connection from the well ,to' the house is to be shown. 3) Neighbor notification is required. 4) Roof and footing drain is to be protected under the driveway at 6 inch diameter c.m.p, is acceptable. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Very ruly yours, Robert Morris, P. E. Public Health Engineer RM:tn BRUCE R. FOLEY, R.S. Acting Public .Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 FORMAT \'EIGHBOR NOTIFICATION CO 'NSTRUCTION PER °UT DATE. RE: Department of Health Review of Proposed Sewage Disposal System andior Well NAN IE: ADDRESS: MINN: TAX -N LAP: Dear Please be advised that an application for a Construction Permit relative to the construction of a sewage s,�°stem and'or well proposed for the above captioned property has been made to the Putnam County Department of Health. attached please find a copy of the latest site plan. If you have any questions, concerns or information which may bear on the Health Department's review of this application. you may call Mr. Morris of the Health Department at 278 -6130. Very truly yours, BY TITLE: RECEIVED BY: .ADDRESS: TAX -1-vLaP: BRF /jp sysWell G�I D m DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 NEIGHBOR NOTIFICATION APPLICATIONS SSTS PERMIT BRUCE. R. FOLEY Public Health Director Beginning August 12, 1995 applications to the Department of Health for SSTS Permits will not be reviewed until such time as the Director of Environmental Health Services of the Department of Health is .provided with proof that notification of the application for construction was made to all property owners contiguous to the property in question. A location map (a tax map would suffice) with contiguous properties shown along with the property owners name and Tax Map # must also be provided to the Department. Notification shall mean receipt by each contiguous property owner of a copy of the attached notification form along with a copy of the latest site plan. Proof of receipt of notice by contiguous property owners can include either of the following: 1. Copies of registered mail receipts. (Return receipts) 2.. Copies of the notification form signed by the contiguous property owners. Failure to provide the Department with adequate documentation of the performance of the notice will result in our delaying action on the application until proper notice is executed. Transmittal of this notification should be sent to the contiguous property owners by the applicant or well driller. A format of this notification form is attached for your use. BRF/RM /tn AWP DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 Ken Hurley Putnam Engineering 102 Gleneida Avenue Carmel NY 10512 Re: McGlasson Bullet Hole Road (T) Patterson Dear Mr. Hurley: May 26, 1998 ~ BRUCE R. FOLEY Public Health Director I acknowledge receipt of your fax dated May 20, 1998. You asked if notification only to Mr. and Mrs: Ackerman would satisfy the requirement for the neighbor notification. I have enclosed the guidelines for neighbor notification. I respectfully request that the requirement is satisfied as per the current guidelines, i.e., all contiguous property owners are to be notified. _.............,... Very truly yours, -�b a A�*o Robert Morris, P.E. Public Health Engineer eRM:tn f _ OaAIA t-` �(j�l a Yv-� ' � sly G-� ✓,uV �nor� L) rk.( Cr k" OL St-le d (F,,�V, � DEPARTMENT OF HEALTH Division of Environmental Health Services 4. Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 May 28, 1998 A. J. Ackerman RD #6 Bullet Hole Road Carmel NY 10512 Re: McGlasson Realty Inc. Bullet Hole Road (T) Patterson, TM# 34.13 -1 -61 Dear Mr. Ackerman: I acknowledge the receipt of your letter (not dated) on May 27, 1998. BRUCE R. FOLEY Public Health Director . . The above regarded project is currently under review by this Department. All current standards will be required to be met before a permit is issued by this Department. The site in question is fairly large (8.74 ac) therefore it is reasonable to assume that the minimum set backs can be acquired, e.g., 100 feet separation distance from a well to a septic system or 200 feet if the well is direct line of drainage; 100 feet separation distance from a wetland, water course or pond. It is the responsibility of this Health Department to enforce the codes mandated to protect public health. Please be assured that all current requirements will be met prior to the issuance of a construction permit from this Department. If you have any questions, please contact me at 278 -6130 ext. 166. Very truly yours, j�- , ,4'. Robert Morris, P.E. Public Health Engineer RM:tn Robert Morris Public Health Engineer Putnam Cty Dept of Health Dear Mr. .Morris RD #6 Bullet Hole Rd. Carmel, N.Y.10512 May 25th,1 998. <. Re; Dept of Health Review of Proposed Sewage Treat System for Property McGlasson Realty Inc. Tax Map 34.13 Blk 1 Lot 61 Twn of Patterson I am in receipt of a letter, titled Appendix E. notifying me that an application for a construction permit for a sewage system for' the property adjoining mine has been received by the Putnam County Dept of Health. I did contact your office but I was told you were in the field. I have not called again because 'I prefer a written record regarding my concerns in'this matter. I believe the Appendix E letter came from Putnam Engineers PLLC, since it was enclosed with the Blue Print of the intended construction. -M concerns are as follows: M house and well are in,- direct._..,,,.,_._., . y line, down hill and south of the intended construction. There would seem to be an adequate distance from the site, but, having lived here for 33 yrs, I am aware of the rapid run -off of water to the swampy area ,immediately, adjacent to the south edge of my acre plot. One has only to observe the transected view of this terrain provided by the 35 feet cut made on the east side of my property for the passage of I 84. Solid rock from surface to base..., During its construction, neighbor's wells were contaminated with oil from the construction site, indicating the ease of passage thru this, seemingly, solid rock. More specifically, however, .my well is extremely shallow. Beal Bros. of Brewster within the last 3 months replaced my submersible pump and informed 'me that the well depth was 30 xl� ,� t, I to 40 feet. ....The . well. has .-s,erved with distinc_tiQr1,1,_.qqypr, going dry and providing excellent drinking water for 33 years, to us and also, those previous occupants. It would be an inexcusable crime if it were in any way . diminished by the . Realtors willingness to erect houses anywhere a quick buck can be made regardless of .its impact on the environment and the established " neighbors or for that matter the intended buyer. The plans as indicated on the Blue Print provides for a four bedroom house, indicating it has the potential occupancy for a.large family with a'heavy demand on any.septic system. I am sure the Blue Prints cover the requirements for a safe septic system,, but Blue Prints alone do not make a safe and reliable end product. No one has inquired of me as to type of well existing on my property which antedates the current practice of filing plans with your department... Equally important is the reliability of the builder who in ,this case, has by word of mouth a shaky record. One only has to review the records of your department some years back when the same Realtor was cited for multiple infractions for not conforming with health code regulations on his own residence parcel which adjoins the site in question ..on_.the'north - side wh-ich.-lies- on--much --higher - ground-' acid will not lie in the effluent path .... I, also, feel that since the present owners of the property are in the home building and real estate business, which has frequent need for engineering services, a careful assessment of the testing would.seem prudent. Therefor my neighbors and I turn to your department to protect our interests against those who thru long experience in these. situations might subordinate ..minor or major health hazards to expedient business practices, i L.Ze. 2 PUTNAM ENGINEERING, PLLC 102 Gleneida Avenue Carmel, New York 10512 914- 225 73.060 Fax: 914- 225 -2955 WE ARE SENDING YOU Attached the following items: Shop drawings _( Prints _ Plans _ Copy of letter , Change order IRT47-ml WCF111711-11ff Date: RE: Z.0 L--L--E!,1- VA C> may. Under separate cover via Samples _ Specifications Copies Date No. Description # THESE ARE TRANSMITTED as checked below: For approval _ Approved as submitted Resubmit _ copies for approval _ For your use Approved as noted Submit , copies for distribution > As requested Returned for corrections _ Return _ corrected prints For review and comment _ Other FOR BIDS DUE '19 PRINTS RETURNED AFTER LOAN TO US REMARKS: '111 0 1� R� lib I�. tau i✓ �T' L 1 N 'F12AZIl'" "il 7IE0-- 5 'k)"271 5-- \...In? COPY TO: SIGNED: �.►_I���- If enclosures are not as noted, kindly notify us at once. H' BRUCE R. FOLEY - .....: _ ... _ ......... .Public Health Director. - DEPARTN ENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 April 29, 1998 Ken Hurley Putnam Engineering 102 Gleneida Avenue Carmel NY 10512 RE: Application to Construct a Subsurface Sewage Treatment System at McGlasson Bullet Hole Road (T) Patterson. TM-r4- 34.13 -1 -61 Dear Mr. Huley: The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on April 20, 1998 is incomplete. Please be advised that the following information is required before the Department may commence its review. o Corporate Resolution has not been submitted. The review of your application will commence once the Department receives the requested �..... a..information- acrd 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 Dept. Of Health regulations. Should you have any questions or care to discuss this matter, please contact me at (914) 278 -6130 ext. 166. V ly yours, Robert Morris, P. E. RM/tn Public Health Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ .,_...DESIGN,DAT�:,S.I�ET - SUBSURFACE SEWAGETREATIVIENT SYSTEM Owner Zjc- 6LA5So_ 1 Xg y� ry 7:A/e,Address u1_c.�T Hoz-F P_ 4 e!5ov Located at (Street) $,ll-� Tax Map 34, t3 Block Lot (indicate nearest cross street) Municipality ',4Tr�r��sov�v Drainage Basin _M ]7).DLt_ &jz,4 yeN SOIL PERCOLATION TEST DATA Date of Pre - soaking //6Z Date of Percolation Test : /I Fzf e Hole No. Run No. Time Start - Stop Ela se Time (pMin.) Nth to Water om Ground Surface (Inches) Start Stop Water Level' Drop In Inches Percolation Rate Min/Inch 1 I r38 3U Jr /� j,s 20 2 ' 3 - 3 cg ). - 2,6 1. z 1,6- Z.0 3 - g 1#0 0 2 - 2.5 %z 115- a.0 4 5 1 I'M 1j, 1q0 3� ��-- 3� 3 %y� 7 2 . l 3 0 �> �� - �3 ,z 3 4 ti 5 1 2 3 4 5 NOTES:' .1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to'be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 TEST PIS' PROFILES Hole # _�_ Lot # Hole # 02 Lot # Hole # Lot # Depth to water Ale t4 e i Depth to water Alog Depth to.water . _r Depth to mottling Depth to mottling. n P Depth to mottling Depth to rock/imp. ,A104e Depth to rock/imp. Depth to rock/imp. G.L. 7 '' -�, ° " G.L. 11 Tv,� - o G.L. 0.5 0.5 0.5 1.0 1.0 . t 8 rte- 1.0 2.0 2.0 -3-'-V1dV 2.0 3.0 w15.:Mz 6rave1 3.0 zv1 -3,9 ofY Avel 3.0 4.0 4.0 4.0 5.0 sav,�. j /o�xtyl 5.0 !'°�Me�7� Lo.v✓1 5.0 in e 6.0 6.0 6.0 TO 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 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 rockhmp. 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 3.0 3.0 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 ...... PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Camnissioner of Health FIELD ACTIVITY REPORT Sheet of INSPECTION NAME /� C 6 0A1 9,41- 7- v Orig. Routine ADDRESS -EuZ149-1- &2Le V, TaAey-�,-,n No. Street Town w-m 9-12T239mic TM No. Orig. Complain Orig. Request. Compliance MAILING A DDRESS 3 ©� ,AM, 'R lP0 1041)- Complaint Comp Final P.O. Box Post Office Zip Code Group Illness Construction TELEPHONE 79 0 6 Reinspection PERSON IN CHARGE OR INTERVIEWED Field, Sampling Only Field Conference Name and Title DATE TYPE FACILITY Other TIM ARRIVED TIME LEFT je,13eq Explain FINDINGS: • 4e- �., INSPECTOR: Signature and Ti PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. SIGNATURE.. wm TITLE: -TTLEPHONE: �7-7�3-(o130 REC ®RD OF PHONE. CONVERSATION _._.._ Time: ' /1' ,' 3 5 Gi /yL Date: /i�z %9q) Person calling: K',y l�yiZL Phone Reason () Inspection: eeps and /or Peres: Scheduled Field Meeting Time: Date: Y N Tentative /to be confirmed () ( ) Town: SPY d Road /Street: `3� 1 /�.�- - ��C� . _ 2�P ..._ ..... . Tax Map #: Comments: `7C! °yn i �,,�� ✓ I v 2 / / AW /'q � H G &,S T o/! dome-:5 In /- P" 't-NI'm ru '.te: 11 b alle, Lake �a I ` I // \ '.: l % `" Char les and 0 IR Fenn 2 I\ Bog Bro6rok- .......... 84 F VAIque Area Mount Ebo �^�+ Corporate Center-- - A'A4 Pj_ 65 sz Hill ...... and, HS Countr Data y OES 4, r e E, r %N Brewster 4. ( 9,1 Pond OW MS \Y C3 State Pohce 0 Old Southeast I Church 60 k%R ,FEL HrS ,ourthouse Wice Building t em 9_0 -AMC 1,"Cem o� ngt o n 2 ont Bjc Brewster -,fill Woods to ;F calf 8—ter No" SI.h Plaza Bog Brook T. Loingridge Reservoir Tree in...... .... ... rk' co'l'fy % at a RD eight LV 0 KA 9 05 A- Ri t IT F3 51 54 27 S 13ya 361 ....... Ea�t I. .101 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 4 APPLICATION FOR APPROVAL OF PLANS FOR WASTEWATER TREATMENT SYSTEM 1: Name and address of applicant: M. G Gu}s's DrJ -T�6L, - .i G p� k co o xn 2- 2. Name of project: McGiAS5a4 (� 8uu t- Nom. Location TN: 1Pxrr �Sr�rJ 4. Design Professional: 5. Address: toe �'�- � ►�,b �'� 6. Drainage Basin: l`�,� DDLF,-' g QA-r JC t L--Z— N Y 10 - 7. Type of Project: _ Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status.(check one) ........:.............. ..:............................ Type I Exempt Type II Unlisted ( 9. Is a Draft Environmental Impact Statement N (DEI5) required? ......................... 0 10. H as DEIS been completed and found acceptable by Lead Agency? ............... N 2A 11. Name of Lead Agency rJ'11A 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:' 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? ....... ............................... o 19. If yes, name of water supply ,Distance to water supply n+Qa a- 20. Is project site near a public sewage collection or treatment system? ................ t� o 21. Name of sewage system Distance to sewage systemic L4- 22. Date test holes observed 2 ►� . .23. Name of Health Inspector 6spig eas--p 24. Project design flow (gallons per day) ..........................:...... ............................... go 0 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... IJ 0 26. Has SPDES Application been submitted to local DEC office? W14. Fnrm Pr-07 27. Is any portion of this project located within a designated Towfli or State wetland? r'J D M 28. Wetlands ID Number .......:.................................................. ......................:........ 29. Is Wetlands Permit re uired ?. ........................... - ...............:..::..:� ::;:: Has application been made to Town or Local DEC office? ............................... N 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 within1,000 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 DESCRIBE: ND No 33. Is there a local master plan on file with the Town or `Tillage? ......................... �_] O 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? . ............................... 36. Tax Map ID Number ........................:: ............................... Map l3 Block f Lot to t 37. Approved plans are to be returned to ..... Applicant --- Design Professional NOTE: All applications for review and approval of anew SSTS to be located within. the NYC_Watershed shall- . - ... _ ._ _ _ be sent to.the-De nent, and °need -not be� sent -m 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 stormwatertiplans 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, awarder penalty ofterjury, that information provided on this form is true to -the best of my knowledge and belie,. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 21 0.45 o, f'the Penal Law. SICNA7 URES OFFICIAL TITTLES. 9£.l� 0 .�d�8 Ma' 1' 0 A �T,f �r 41 V i" � .... ............................... ,k 4 �inoj WVN L ilcl. 03AI331d. C�EQ_ 4� /D I� 14 -16.4 (2/87) —Text 12 PROJECT I.D. NUMBER 617.21 SECIR 4 Appendix C State Environmental Quality Review SHORT.ENVIRONMENTAL ASSESSMENT FORM Only PART 1- PROJECT INFORMATION (To be completed by Appllcant.or Project sponsor) 1. APPLICANT /SPONSOR ('v-r1�.�M �11`� -ir•)G 2. PROJECT NAME , MaG� -A�1 (� - f3uw�r I-bU� 3. PROJECT LOCATION: �%S Municipality \ CF �7�v County 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) 'FW � 9MS:a1_ Ta By "_r_-1- �h c>L.,1 P ,a p vJ sr i SCo-rE �- GgP55 trJ . SE�E FLArJ Fo rz Lex�i Lori M,4 P 5. IS PROPOSED ACTION: New 11 Expansion ❑Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: t 74 Ae-- L.or 7. AMOUNT OF LAND AFFECTED: ,1 +' S_ 7`T Initially, I3 .7 acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? lye Yes , ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑ ❑ ❑ ❑ ❑ Industrial Commercial Agriculture Park/Forest/Open space Other Des ribe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL ? ❑ Yes No If yes, list agency(s) and permitlapprovals 11. DOES ANY ASP CT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes ,I If yes, list agency name and permitiapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes No I- CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor UTNidI �16(f�St"b2�1� —� Date: name: Sionature: If the action is in thlil-Co6astal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II—ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? It yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No N' 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 ❑ No - -- ...._.... .. _. .,. . _ C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) C1. Existing air quality, surface or groundwater. quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities likely to be Induced..by the proposed action? Explain briefly. —0 .. CD E�_t771 C6. Long term, short term, cumulative, or other effects not identified in C1-05? Explain briefly. CDM GJ C_ — Lf? 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 - -• Nn ItYes,-explaln 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 (Q magnitude. If necessary , add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a positive declaration. ❑ Check this box If you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result .in any significant adverse environmental Impacts AND provide on attachments as necessary, the reasons supporting this determination: Print or Type Name of Responsible Officer in Lea Agency Signature of Responsible Officer in Lead Agency Name of Lead Agency Date 2 Title of Responsible Officer Signature of Preparer (if different from responsible officer) DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 June 26, 1998 Elaine and Salavtore Provenzano 15 Cannon Road Carmel NY 10512 Re: McGlasson Realty Inc. Bullet Hole Road (T) Patterson, TM# 34.13 -1 -61 Dear Mr. and Mrs. Provenzano: I have received your certified letter dated June 23, 1998. Please find below answers to the questions in the order presented in your letter. BRUCE R. FOLEY Public, Health Director 1) Current Health Department guidelines are being used during the review process. Therefore, if the proposal is approved, there should not be any negative impact to the surrouridirig wells. - - 2) It is not under the jurisdiction of this Department to regulate driveways. Driveways permits and the slopes allowed are the responsibility of the Town of Patterson. I do not believe the construction of the driveway could create an environmental health hazard. 3) The project must meet current Health Department guidelines for the protection of wetland areas. 4) I cannot guarantee anything with respect to illegal dumping. I can guarantee that the project, if approved, will meet current Heath Department guidelines. Furthermore, a Department representative will make field inspections to insure that the construction complies with the approved plans 5) How a modular home is brought onsite is not regulated by this Department. It is assumed that in accessing the property with a modular home the adjacent property owners will not be affected, i.e., unless the adjacent property owner gives permission. Letter to: Elaine and 'Salavtore Provenzano -"June'--2-6-,- 1998 _... . -2- Please be advised, the Putnam County Health Department primary responsibility is to protect.human health. This is implemented through the permitting process for a Subsurface Sewage Treatment System (SSTS) and a water well. In closing, it must be repeated that if the plans submitted meet current Health Department guidelines for a SSTS and water well the plans will be approved by this Department. If you have any questions regarding this matter, please call met at (914) 278 -6130 ext. 166. RM :tn Very truly yours, i?kalgo� Robert Morris, P.E. Public Health Engineer P UTNAM MA NGINEERING,PLLC. _• • - - . .: - -• - Engineers and Planners .. June 12, 1998 Mr. Robert Morris, P.E. Putnam County Health Department •4 Geneva Road Brewster, New York 10509 RE: McGlasson:SSDS Bullet Holei Road Patterson Dear Mr. Morris: Enclosed are copies of the neighbor notification for the above referenced project, as requested in our May 12, 1998 memorandum. Copies of the certified mail and returned receipt cads are also enclosed. At this time, we would ask for your continued review and/or approval of this application. Very truly yours, PUTNAM ENGINEERING, PLLC By: Ke1 KWedb Enclosures File980318 102 GLENEIDA AVENUE, CARMEL, NEW YORK 10512 • PHONE (914)225 -3060• FAX (914) 225 -2955 9� APPENDIX E FORMAT CONSTRUCTION PERMIT NEIGHBOR NOTIFICATI ®N LETTER Dear I "t� �C�t �14ma L Date �p ((vh<s RE: Department of Health Review of Proposed SewageTreatment System for Property Name: EVP\/ Address: Su uL,,6-r Town:,- Tax Map #: ! , i (D Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any questions. concerns or information which may bear on the Health Department's review of this application. you may call the Health Department at 278 -6130, Very truly vours. Title: FBI rs-L-1C 'e iq (�rl= '-Y Received Bv: Tkt1 -)Oj Address: OrjZ �L��1 ��"� 4 C}►'�M Tax Map �: r August 1,00- Z 113 965 678 US Postal Service i Receipt for Certified Mail No insurance Coverage Provided. Do nonuse for Intemational<Mail (See reverse ai SENDER: •o ■Complete items 1 and/or 2 for additional services. se t to r . 2&�z/r -7,crna Q I also wish to receive the Stre & Nu r ii5cr.1 Z Post 01jim State, 411JF C Postage $ Certified Fee eXtra fee): ' Special Delivery Fee card to you. ■Attach this forth to the front of the mailpiece, or on the back if space does not 1. ❑ Addressee's Address Restricted Delivery Fee d U) 2. ❑Restricted Delivery rn Return Receipt Showing to r �- Whom & Date.Delivered ' 44 Retum Receipt Showing to Whom, Date, & Addrem-s—Akhm ^: D TOTALPostage& Fees• 4a. Article Number 0 Posifnarkot:Ela �� �% U) J ai SENDER: •o ■Complete items 1 and/or 2 for additional services. I also wish to receive the Z ■Complete items 3,4a, and 4b. following services (for an ■ Print your name and address on the reverse of this form so that we can return this eXtra fee): ' card to you. ■Attach this forth to the front of the mailpiece, or on the back if space does not 1. ❑ Addressee's Address ai d Wn e'Retum Receipt R e uested' on the mail piece below the article number. 2. ❑Restricted Delivery r ■The Return Receipt will show to whom the article was delivered and the date delivered. Consult postmaster for fee. .. , a ; r 3. Article Addressed to: 4a. Article Number ..._.....r.. �.,.._. �.(;�.��r��J-�^�7..._.r."'��L -Z - Z%-91s, ,+�' y�,.�17�.�A�....._.. v ��', p ,ss e ...� tered L3Certified ._.... ¢ Mail ❑ Insured Receipt for Me andise ❑ COD ;} 7. at of De' e ; n i1 `;.. p 5. Receive By: (Print Name) :. �`! t3. ddressee's Addr s (Only if requested c w and fee is paid) t 6. Signature: (Addressee or Agent) o X ar PS Form 3811, December 1994 Domestic Return Receipt I. 25 APPENDIX E FORMAT CONSTRUCTION PERMIT I�EIGI�� ®R ICATION LETTER Date (� / I RE: Department of Health Review of Proposed SewaseTreatment System for Property Name: E7W,e1:7� �G'�bq5< Address: Su Lt.i5-'T" HOL r, Raaf- Town: FAT -r5iq,,j Tax Map #: I _ I c Dear M � 1-��R �"' V —�..� ese the construction Please be advised that an application for a Construction Permit relative to c the of a sewage system and/or well proposed for the captioned property has been made t Putnam..Countv.Department _of Health. Attached please find a_copy of the latest site_plan. If you have any questions. concerns or information which may bear on the Health Department's review of this application. you may call the Health Department at 278 -61310) Very truly yours. 0 i ♦ Title: Received Bv: Address: D G IsCL,L -T RM--= Are Tax Map auuust l9Q- 9 i A '=t Q Ln =- O-a .11 m a Er ai tm M . >m .Z ,0 S rq %ice Uw may a°C>t�a d — c MMZa f +1 + + m SENDER: i also, wish to receive the v ■Complete items 1 and/or 2 for additional services. a► ■Complete items 3, 4a, and 4b. following services (for an at ■ Print your name and address on the reverse of this form so that we can return this extra fee): card to you. ■ Attach this forth to the front of the mailpiece, or on.the back if space does not 1. ❑ Addressee's Address .9 m permit. $■ Write'Retum Receipt Requested' on the mailpiece below the article number. 2. ❑ Restricted Delivery N The Return Receipt will show to whom the article was delivered and the date a C delivered. Consult postmaster for fee. d -a 3. Article Addressed to: 4a. Article Number. Cc d 1 � Co '7 , l Z I 13 �iCO c E .r• �I��S V Q�'Qaose- 4b. Service Type c0i ❑ Registered Certified . of ❑ E less Mail ❑Insured 5 � etum Receipt for Merchandise ❑COD 7. Date of Delivery , r 0 p 5. Received By: (Print Name) 8. Addressee's Address (Only if requested and fee is paid) ' t 6. Signature: (Addressee or Agent) c r -X PS Form 3811, December 1994 Domestic Return Receipt Q O I g LL U. o — o' 9661 IudV 'nnor ttuo-4 sd f +1 + + m SENDER: i also, wish to receive the v ■Complete items 1 and/or 2 for additional services. a► ■Complete items 3, 4a, and 4b. following services (for an at ■ Print your name and address on the reverse of this form so that we can return this extra fee): card to you. ■ Attach this forth to the front of the mailpiece, or on.the back if space does not 1. ❑ Addressee's Address .9 m permit. $■ Write'Retum Receipt Requested' on the mailpiece below the article number. 2. ❑ Restricted Delivery N The Return Receipt will show to whom the article was delivered and the date a C delivered. Consult postmaster for fee. d -a 3. Article Addressed to: 4a. Article Number. Cc d 1 � Co '7 , l Z I 13 �iCO c E .r• �I��S V Q�'Qaose- 4b. Service Type c0i ❑ Registered Certified . of ❑ E less Mail ❑Insured 5 � etum Receipt for Merchandise ❑COD 7. Date of Delivery , r 0 p 5. Received By: (Print Name) 8. Addressee's Address (Only if requested and fee is paid) ' t 6. Signature: (Addressee or Agent) c r -X PS Form 3811, December 1994 Domestic Return Receipt 25 FORMAT CONSTRUCTION PERMIT NEIGHBOR NOTIFICATION LETTER Date (_p / (0/41g RE: Department of Health Review of Proposed SewageTreatment System for Property Name: F_Dbbt1) Address: Su LL_j_= i Town:�,j�� Tax Map Dear . S�LA /A ���t✓ti ZASQ0 Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the ..Putnam County Department of.Health..- Attac.hed.please.,f nd-a ,copy of the latest site plan. ; If you have any questions. concerns or information which may bear on the Health Department's review of this application. you may call the Health Department at 278 -6130) Received By: GA`— VA'r, %i2� Very truly vours. al i Title: ii & c �+e m Address: KI -D4(o � (. kZ) 2�a 4D Tax Map =: ?4 i' I -- 6G Ausust 1997 - Z 113 965 676 d s US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail /San ►atlamal 61 t . rS . A2 0XnWjj �t �Nurt��ber SENDER: ■Complete items 1 and/or 2 for additional services. POSt,Q1111ce, State, & ZnIPpode I also wish to receive the Postage $ •Complete items 3, 4a, and 4b. • Print your name and address on the reverse of this form so that we can return this Certified Fee Special Delivery Fee 1. ❑ Addressee's Address a; Restricted Delivery Fee permit. ■ Write'Retum Receipt Requested' on the mailpiece below the article number. LO to r w Rettrm Receipt Showing to Whom & Date Delivered U CL Q ROW ReCeoSho* 1000 Date, &Addr= - - TOTAL/ P & 0O „osrage ' E Postmark or Date jjj LL C A j - L ELI Q� 4b: Service Type p Registered p'Certified 61 PS Form 31511, December 1994 c Return Receipt I SENDER: ■Complete items 1 and/or 2 for additional services. I also wish to receive the t •Complete items 3, 4a, and 4b. • Print your name and address on the reverse of this form so that we can return this following services (for an extra fee): card to you. ■Attach this form to the front of the mailpiece, or on the back if space does not 1. ❑ Addressee's Address a; ; i permit. ■ Write'Retum Receipt Requested' on the mailpiece below the article number. 2. ❑ Restricted Delivery to r ■The Return Receipt will show to whom the article was delivered and the date delivered. Consult postmaster for fee. a ;. 3. Article Addressed to: 4a. Article Number C .; j - L ELI Q� 4b: Service Type p Registered p'Certified � Im f ❑ Exx ss Mail ❑ Insured etum Receipt for Merchandise ❑ COD S a; 7, ate of Delivery ° -. S. Received By: (Print Name) i 8. Addressee's Address (Only if requested i. and lee is paid) t ': ~ 6. Sign dssl e or Age t) X PS Form 31511, December 1994 c Return Receipt N 25 APPENDIX E FORMAT CONSTRUCTION PERMIT NEICHB ®R NOTIFICATION FETTER Date �A ! ( O q,:s RE: Department of Health Review of Proposed SewageTreatment System for Property Name: E WArg. � Address: Su L. L,6- ' Town:�Z`C�r�J Tax Map #: SL4 I -_2 (0 Dear Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County- Department of Health. - Attached please find a copy of the latest site plan.- If you have any questions. concerns or information which may bear on the Health Department's review of this application. you may call the Health Department at ?78 -6130 Very truly vours. Title. Received Bv: RMOS V(Oni�;;CLL, Address:Z.b.(0 &JLU�T' j 6 FATTO - 1� Tax Map August 199,7 un 0) kn .Q Q C O O ch 0 LL U) n Z 113 965 675 us Postal Service Receipt for Certified Mail No Insurance Coverage Provided. D o not use for n erna o f I t ti nal (See S e reverse a c A-�pf,- + ai SENDER: C ■Complete items 1 and/or 2 for additional services. Sent to �� r•. e( Street ENumher I Q Jai �lp� JZ, Post (Ace, State, & Code l cos! a Postage $ Certified Fee �. 3J Special Delivery Fee ai Restricted Delivery Fee ■Attt c i this form to the front of the mailpiece, or on the back if space does not 1. [1 Addressee's Address Return Receipt Showing to % C) Whom & Date Delivered N Return Receipt Showing to Whom, ■The Return Receipt will show to whom the article was delivered and the date delivered. Consult postmaster for fee. Date, & Addressee *dit"� C o TOTAL Postage & Fee 4a. Article Number Postmark or Date �!'• r�^rtrS OI�YI��,,Il 4b. Service Type A-�pf,- + ai SENDER: C ■Complete items 1 and/or 2 for additional services. I also wish to receive the u► ■Complete items 3,4a, and 4b. following services (for an .. ■ Print your name and address on the reverse of this form so that we can return this extra fee) card to you. ai d ■Attt c i this form to the front of the mailpiece, or on the back if space does not 1. [1 Addressee's Address Z ■ Write'Retum Receipt Requested' on the mailpiece below the article number. 2. ❑ Restricted Delivery N r ■The Return Receipt will show to whom the article was delivered and the date delivered. Consult postmaster for fee. ed °- C o 3. Article - Addressed to: : ,...._- - . - .:.... 4a. Article Number ' d �!'• r�^rtrS OI�YI��,,Il 4b. Service Type E B 0 ) /7 ' ! � I2 % b� ❑Registered Certified � o, w�'✓ �� `.. V/' C4 10,5/ C), ❑ Express Mail ❑ Insured 2<etturn Receipt for Merchandise ❑ COD 5 0 7. Date of elivery z p 5. Received By: (Print Name) / 8. Addressee's Address (Only if requested a°• and fee is paid) g 6. Signature:, a Went) N X PS Form 1811, December 1994 Domestic Return Receipt A 25 FORMAT CONSTRUCTION PERMIT NEICHB ®R NOTIFICATI ®N LETTER Dear MCN144&r,� Date (p / (vhcs RE: Department of Health Review of Proposed SewageTreatment System for Property Name: F-7k.hwg� Address: SU t_,(.6'[' Town: FAIT �°�,�r-j Tax Map #: SL4 , ( � _ I , co I Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a_ copy_ of the latest site plan. If you have any questions. concerns or information which may bear on the Health Department's review of this application. you may call the Health Department at 2 78 -6130 Very truly vours. MONOOMS"'Im Title: f , r fir''E t� ? (f�,tln 'YL Received Bv���`''��l`' ����� Address: Tax Map # : 4, Is ! 1 - -S] Ausust 199- kn 0 rn .Q C 0 Co V) E 0 u- rn o_ Z 113 965 674 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for Intamational Mail (See reverse) Serf N r M a kon Stre t Nurser d ` .o SENDER: ■ Complete items 1 and/or 2 for additional services. Postage I also wish to receive the following services (for 8t1 Certified Fee is m 0 ■Complete items 3, 4a, and 4b. ■ Print your name and address on the reverse of this form so that we can return this extra fee)' a of 2 a card to u. ■Attach this forth to the front of the mailpiece, or on the back if space does not 1. ❑ Addressee's Address . 0 -- permit. ■ Write,'Retum Receipt Requested' on the maiipiece below the article number. 2. ❑ Restdcted.Delivery ry J), __ _ _ The Return Receipt will show to whom the article was delivered and the date Consult postmaster for fee. a ' C 0 delivered. d 3. Article Addressed to: 4a. Article Number 9Cg- (o`-) E r, (". �E n n��C �� `Ord (3 E 4b. Service Type 1 ❑ Registered 01&rtified to Cn I j� �w ss Mail ❑Insured ❑ E e S ' c n r �l �( UJC. ` O l etum Receipt for M andise ❑ COD o t 1 7a, ate 3 Z a • ?er� o n 5. Received By: (Print Name) X31` Address Ad ess (Only if requested W and fee is paid) t 6. Signature: (Addressee or ent) ; 25 APPENDIX IE FORMAT CONSTRUCTION PERMIT NEIGHBOR NOTIFICATION LETTER Dear M?— F-eu Y, S P,&-1.4yeo Date �p / I r/4qg RE: Department of Health Review of Proposed SewageTreatment System for Property Name: EVWA6q � Address: SL) x,1.6T Town: FA-rT -°�2Sqr_J Tax Map #: SL4 . 13 _ i Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County - Department. of Health._ Attached please find a copy of the latest site plan. If you have any questions. concerns or information which may bear on the Health Department's review of this application. you may call the Health Department at 278 -6130 T-. 1 (_0 Ca , Received Bv: l�F L1 iL � ,& -Tp r Very truly yours. Title: i GL4c - - tj 9,4; l Address: HLGH V1 ow capo'1in-, Tax Map ' : J°'f o � D August 19Q- r Z 113 965 673 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail (See revers Sent to r . l C) streetigiNumber ffiO v, uj fir-, Gn.)- Postage $ ` Certified Fee Special Delivery Fee Restricted Delivery Fee Ln rn Return Receipt Showing to _ Whom & Date Dalivemd. O Rehm Receipt Showir Date, b Nddressee`Fliddress C = <, O TOTAL Postage & Fees it �--t'j jT O O Postmark orDatf e a m SENDER: I also wish to receive the V ■Complete items 1 and/or 2 for additional services. a ■Complete items 3, 4a, and 4b. following Services (for an m ■ Print your name and address on the reverse of this form so that we can return this extra fee): card to you. , ■Attach this form to the front of the mailpiece, or on the back if space does not 1. ❑ Addressee's Address d ermit. m • Write'Retum Receipt Requested on the mailpiece below the article number. 2. ❑ Restricted Delivery ca @The Return Receipt will show to whom the article was delivered and the date .- delivered. Consult postmaster for fee. .T , o v 3. Article Addressed to: 4a. Article NumIt 4b. Service Type _ .. _._.. E - _._.._. "� (� [I Registered ,rtified W LJ ADate ressMail ❑ insured S w ' ��� ra m Receipt for Merchandise [3 COD ; 0 a of Delive o 5 5. Received By: (Prin t Name) essee dd e s my if requested fee is paid) C . 6. Signature: ddressee or ent) PS Form 3811, Dec ber 1994 Domestic Return Receipt i O TOTAL Postage & Fees it �--t'j jT O O Postmark orDatf e a m SENDER: I also wish to receive the V ■Complete items 1 and/or 2 for additional services. a ■Complete items 3, 4a, and 4b. following Services (for an m ■ Print your name and address on the reverse of this form so that we can return this extra fee): card to you. , ■Attach this form to the front of the mailpiece, or on the back if space does not 1. ❑ Addressee's Address d ermit. m • Write'Retum Receipt Requested on the mailpiece below the article number. 2. ❑ Restricted Delivery ca @The Return Receipt will show to whom the article was delivered and the date .- delivered. Consult postmaster for fee. .T , o v 3. Article Addressed to: 4a. Article NumIt 4b. Service Type _ .. _._.. E - _._.._. "� (� [I Registered ,rtified W LJ ADate ressMail ❑ insured S w ' ��� ra m Receipt for Merchandise [3 COD ; 0 a of Delive o 5 5. Received By: (Prin t Name) essee dd e s my if requested fee is paid) C . 6. Signature: ddressee or ent) PS Form 3811, Dec ber 1994 Domestic Return Receipt ti 25 APP ENDU IE ]FORMAT CONSTRUCTION PERMFr NEIGHBOR NOTIFICATION LETTER Dear M Z * M j?,5 Date RE: Department of Health Review of Proposed SewageTreatment System for Property Name: EVVV Address: SL) L.,'r Town: FATT50rlj Tax Map #: I a— I p co I e Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached_.please -fnd a.copy of the latest site plan. If you have any questions. concerns or information which may bear on the Health Department's review of this application. you may call the Health Department at ?78 -6130) Very truly yours. Title: Cj &,,r Received By: 441H®Ny 4 SCF1115 Address: -9-uu er Hach ROA f� Tax Map -: 34,13 1— 402 * 6 3 Auzust 1,997 ti 9 • _ ?I+j:i�• If ;. A•:,t ..11'�'�'. l..L't: :';L'_; I•' �, .•t�,: +:d �.,... ... .. @" ' \;:y( -w �:..•� ni� .�,..• t Jit �e� ��• Z 113 965 672 us Postal. Service Receipt for Certified Mail No Insurance . , ., .- coverage Provided... _ . Do not use for Intemational Mail (See reverse n iinln n11 Return Recei d Whom 3 Date D91reWhom. �Y Return Rec�ptSh Date, it pees O TOTAL postage & F co) Postmark or Date o }` SENDER: 1 also wish to receive the e V •Complete items t and/or 2 for additional services. m ■Complete items 3, 4a, and 4b. following services (for an d ■ Print your name and address on the reverse of this form so that we can return this extra fee): card to you. d •Attach this form to the front of the mailpiece, or on the back if space does not 1, ❑ Addressee's Address :. Z 3, . m ■ permit. e'Retum Receipt Requested' on the mailpiece below the article number. 2. ❑ Restricted Delivery N t 0Th e Return Receipt will show to whom the arli was delivered and the date « delivered. Consult postmaster for fee. rs 0 3. Article Addressed to: 4a. Article Numb r 113 Cjb' 7- (0 7 C - ._._.� 1..(J W 4b. Service Type, u ❑ Registered C9'GeRifted c, `^"e i ❑— `Express ❑ Insured 5. W i�� 1 Q I tetum ldefchandise ❑ COD lJ�i! r n a 7. Date D 00 cc 1' sw cc 5. Received By: (Print Name) 8. Addre a 's Add (t?�yl I requested C'� w and /e is lSQ� f, 0 c6. Signature: d ess orA nt) a. X PS Forn,(38ff, December 1994 Domestic Return Receipt I' ` 1 •' i i {�F ( �' R ° ` ?i ' i+� I ' i i 1 tit f i i •, 9 ' it `I 6 Iil I` s I �1 ', s�; i `� `r i '" �� ,� i •� 6 E i I. •� i i! I `� i x � L RE: Property of I I LETTER OF AUTHORIZATION LA55c>j Ke_/_s.L.7y I I ti G Located at 55)1 -- _ 'T rte' TN � ��' �� Tax Map # 54 a 13 Block I Lot (:�) I Subdivision of Subdivision Lot # Filed Map # Date Filed Gentlemen: This letter is to authorize �jt PL' a duly licensed Professional Engineer 2_ or Registered architect to apply for the required wastewater treatment and/or water supply permits) 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 ction of said wastewater treatment and/or water supply systems "in conformity with M F A�w y icle 145 and/or 147 of the Education Law, the Public Health Law, and the Put ode. Countersigned: P.E., R.A., # UCv Mailing Address `nom Ct,SN P-J r,),& Mailing Address, �)0 (?�,C) X Co I D__-.______ CA State N �% _Zip o State N_�( Zip` Telephone: ��-� r � Telephone: a-as PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SY.STENIS . REVIEW SHEET FOR CONSTRUCTION PERMIT ^ STREET LOCATION ++"R^"'� . NAME OF OWNER'S �✓�`.`� y' a "[ REVIEWED BY RM, AS, MB, B11 DATE '7 S TAX MAP # Y DOCUMENTS PERMIT APPLICATION Y/ N 1 �; 3 7 PC -t 38 3 WELL PERMIT_ PWS LETTER 39 4 LETTER OF AUTHORIZATION 40 5 Dx ES[•GN_DATA S.IiEET(DDS) 41 6 CORPORATE RESOLUTION 42 7 ate, <.�, SHORT "EAF 43 8 PLANS - ,.THREE SETS 44 9 HOUSE PLANS -TWO SETS 45 T 46 FEE 47 SUBDIVISION 48 LEGAL SUBDIVISION QUIVISION APP' L Cl PER TE 50 11 FILL D DEPTI'I 51 12 TAfN DRAI - QUIRED 52 1 STANDPIPES 53 GENERAL die 54 LOCATED IN NYC WATERSHED,,..' vltl 55 — PLANS SUBMITT ED TO DEP 5 DELEGATED TO PCHD DEP APPROVAL, IF REQ'D 57 14 DE TEST HOLES OBSERVED S8 15 PERCS TO BE WITNESSED 59 16 X- APPROVAL SSDS ADJ. LOTS 17 WETLANDS (•TOWN /DEC PERMIT REQ'D ?) 18 DATA ON DDS PLANS & PERMIT SAME 60 iG amOT1.FIG Qw 62 63 2.2 0THER,REQ'D PERMIT(S) 64 REQUIRED DETAILS ON PLANS 65 23 SEWAGE SYSTEM PLAN - (NORTH ARRO%6 24 SSDS HYDRAULIC PROFILE 25 GRAVITY FLOW 26 CONSTRUCTION NOTES 27 DESIGN DATA: PERC & DEEP RESULTS 28 CONTOURS EXISTING & PROPOSED 29 DRIVEWAY & SLOPES, CUT 30 FOOTING /GUTTER/CURTAIN DRAINS 31 SOIL TYPE BOUNDARIES. 32 TITLE BLOCK; NAME, RES TM #,PE/RA; NAME,ADDRESS,PHONE# 33 DATE OF DRAWING /REVISION 34 DATUM REFERENCE 11.0GATIGN-04LWATERCOURSES,PONDS LAKES AND WETLANDS WITHIN 200 FEET 36 m1'R01'OSED FINISH FLOOR AND`€Q EROSION CONTROL:HOUSE,WELL, SSDS PERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY & EXPANSION LOCATION MAP EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE IF PUMPED, PIT & D BOX SHOWN & DETAILED HOUSE - NO.OF BEDROOMS WELLS & SSDS'S W/IN 200' OF PROPOSED SYS. kOPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE . NO BENDS;, MAX.BENDS 45° W /CLEANOUT FILL SYSTENIS CLAY 13ARRIER - FT. I IORIZONTAL;SLOPL 3:1 ADE FILL S ILL NOTES FILL CERTI O1 E FIL FILE & DIMENSI LUME FILL IN EXPANSION AREA TRENCH / LF TRENCH PROVIDED ✓ 60 FT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED ON PLAN - FROM SSI'S 10' TO P.L., DRIVEWAY, LARGE T EES, TOP OF FILL 20' T�FOUNDATIdN'WALLS• 'S'WELL TO PL 100' TO WELL, 200' IN DLOD, I50' PITS 100' TO STREAM WATERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (pits -20') 50' INTERMITTENT DRAINAGE COURSE 2007500'�ESERVOIR, ETC. ^150' GALLEY SYSTEMS t5'`[v W to CDS= >5 %,101- 4 %,251- 3 %,301- 2 %,35' -I %,100'. <I% 27'MTN to CD discharge /I00'with 182 cons day discharge 5EP1IC TANK 10' FROM FOUNDATION; 50' TO WELL WELL DIMENSIONS TO PROPERTY LINE 1 L , i i I e 5 4cow (' c?te, 4f 1 +S-' �J T SAM June 18, 1998 Engineers and Planners Mr. Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: McGlasson Realty Inc. Bullet Hole Road Town of Patterson Dear Mr. Morris: This office is in receipt of your most recent memo um concerning the above referenced property, and we offer the following co ents: 1. The property will be accessed by the private road and common drive that is a already existing and enters the subject property. 2. This property was in front of the Patterson Zoning Board in 1987. It was decided that the Town would not allow this parcel to be subdivided any further. As confirmed with John Calbo, Town of Patterson Building Inspector, the Town has no objections to the development of this lot with one house. Mr. Calbo also mentioned that this parcel contains right of way access to Bullet Hole Road in the filed deed. �.... •... - ...-.,At this time; we would -ask for -your continued review and/or approval of this referenced project. Very truly yours, PUTNAM ENGINEERING, PLLC By: G� Ken Hurley KH :jt 980332 PO :Z W Z 14" li11, W5 ''i: > ; V .a', i raid.:, 102 GLENEIDA AVENUE, CARMEL, NEW YORK 10512 ° PHONE (914)225-3060-FAX (914)225 -2955 Putnam County Department of Health Division-of Environmental Health Servioee Approved as noted for oonforman.oe with app b1e.Rulee and Regulations of the am C ty Health Departm nt. Signature & Title I Da e� WELL G 110 ,, F 10-,3- M REV151ON5 DESCRIPTION `N1 ♦N, Q .. NO. DATE GLE `DOi F BULLET HOLE ROAD M .I G. Fop GLA550N REALTY N RpFES g ;.TAX MAP # 34:13 BLOCK I LOT .61 TOWN OF PATTER50 Alt I 1