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631- 589 -8100
35. -4 -4.2
BOX 15
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PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
CERTIFICATE OF CONSTRUCTION COMPLIANCE . -SEW TREATMENT SYSTEM
PCHD CONSTRUCTION PERMIT # "- ���,��_
Located at I6-1 64 f5LH PAP Town or Village � ng RRADH
Owner /Applicant Name 1 Qh wbi_ff �'
Formerly C LA W-
Tax Map �) 6 Block 4 Lot 4 ° 2-
Subdivision Name i✓l -804f,
Subd. Lot #
Mailing Address 5& F0- -1 C-1 ' 6 6TO— SAD 1✓A,()TL45 NY Zip 1610"1
Date Construction Permit Issued by PCHD
Separate Sewerage System built by P eIL_ Address P-0 `' WC 1 005 W-10- 1, togq
Consisting of I I-S 8
Gallon Septic Tank and (o6 I L-f- K�6
Other Requirements: I 0 EQ M )A C W H
Water Supply: Public Supply From Address
or: Private Supply Drilled by M10-0H W01T Address O L '�1j1 W WW O Ai
Building Type Has erosion control been completed?—
Number of Bedrooms 4 Has garbage grinder been installed?
0o
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 f the Putnam County De nt of Health.
Date: �`�_ Certified by P.E. X R.A.
rofes ional)
Address �p %�-- e)}�`td Des' 10,701 License #
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 subject to modification or change when, in the judgment of the Public Health Director, such
revocatio , dificatio change is necessary.
` Z-
By: Title: Date. a G
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CC -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT
x' 19 Uozation :
Street Q.ddress: l "l
TownN`11a er
<° f1 1
Tax = Grid #i _ . : •... ..
Map r0 � Block 4 Lot(s)
Well Owner:
Nam - Addressj%:. 1 ���\ ,('�'1A \J t(�/ Vt 0%
Use of Well:
1- primary
2- secondary
Residential Public Supply Air cond /heat pump Irrigation
Business Farm Test/monitoring Other(specify)
Industrial Institutional Standby
Drilling Equipment
Rotary Cable percussion C mpressed air percussion Other (specify)
Well. Type
Screened Open end casing Open hole in bedrock Other
Casing Details
Total length ft.
Length below grade 4�ft.
Diameter _7in.
Weight per foot /7 lb /ft.
Materials: Steel _ Plastic _ Other
Joints: _ Welded __X Threaded _ Other
Seal: _ Cement grout I . Bentonite _Other
Drive shoe: Yes No
I Liner: Yes No
Screen Details
Diameter (in)
Slot Size
Length(ft)
Depth to Screen (ft)
Developed?
First
Yes—No
Hours
Second
Well Yield Test
_ Bailed _ Pumped -X Compressed Air
Hours _6
Yield J gpm
Depth Data
Measure from land surface- static (specify ft)
During yield test(ft)
Depth of completed well in feet
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
7
7
7"C7
.
... ...
J
f
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump /Storage Tank Information
400
() -
Pump Type 54- Capacity _1
Depth `?4D Model ib J
Voltage �`�n HP � 1_
Tank Type 17,,P< 02- Volume
TL7d
Date Well Completed
Putnam County Certification No.
Date of Report
SO
Well Driller (signature)
NOTE: Ekact location of well with distances to at least two permanent'landrftarks to be provided on a separateevplan.
j 1
Well Driller's Name /> 6 AddressI6 ? ft V L1.. n�en,
Signature: Date:
White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC -97
PUN COUNTY DEPARTMENT OF ALTH
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner or Purchaser of Building Tax Map.... Block,__, Lot
551
Building Constructed by TownNillage
1316 -
Location.- Street ' Subdivision Name..
Buildin g Type Y -- ' Subdivision Lot #
1 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 Depart. nent..of Health., and
hereby
guarantee to the ovmer, his successors, heirs or�assigns, to place to 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. '
rp e _i caused b - the v illful cr -ne- I ,t� aet-of the-occu * t oft%e-budl-din utiliiin th.e.__�,_.. _.._
P P} ly.. Y g g l g g
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:. MonthA %± 'Day oaf Year ..
General Contractor (Owner). - Signature
Corporation Name (if corporation) -
Address:
State.._ .. Zip Zo, S-3
Signature:
Title: t a
�/ %L PLIE
Corporation Name
_ . (if corporation)
Address: LCD (nX 6V _
State L /o,S'� rr/ .r ... zip
Form GS -91
Harry W. Nichols Jr., P.E.
Patterson Park, Suite 106
2050 Route 22
Telephone (845) 279-4003
Fax (845) 279 -4567
September 20, 2002
Robert Morris, P.E.
Putnam County Health Department
One Geneva Road
Brewster, NY 10509
RE: Individual SSTS Compliance
Wolff- Lot #1
167 Big Elm Road
Patterson, NY
T.M. #35.4-4.2
Dear Robert:
Enclosed are the following:
1. Five (5) prints of Drawing S -1, "As -Built Plan," dated 6- 28 -02.
- 2. "Certificate of Construction Compliance for Sewage Disposal System," dated 9-20-.
02.
3. Three (3) copies of "Guarantee of Subsurface Sewage Disposal System," dated 8-26 -
02.
4. Laboratory Report, dated 6- 11 -02 -02 & 6- 27 -02.
6. Application Fee in the amount of $200.00 payable to Putnam County Health
Department.
7. "E -911 address verification form," dated .9- 20 -02.
Kindly process the enclosed at your earliest convenience.
Very truly yours,
Harry -W. Nichof Jr., P.E.
HWN:his
00- 119.01
-
YML ENVIRONMENTAL SERVICES
321 K Street
St�et
Yorktown' ' ` � / � 'g' ' - - Y.-'1 5.
(914) 245-2800
Albert H. Padovani, Director
LAB #: 93.201564 CLIENT #: 55592 NON STAT PR8C PAGE 1
WOLFF, THOMAS W DATE/TIME TAKEN: 06/04/02 10:00A
56 MANCGESTER RD DATE/TIME REC'D: 06/04/02 11:30A
EASTCHESTER, NY 10709 REPORT DATE: 06/11/02
PHONE: (845)-277-0805
SAMPLING SITE: 167 BIG ELM RD
: PATTERSON NY 10509
COL/D BY: THOMAS WOLFF JR
NOTES...: KITCHEN TAP
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
-
DATE FLAG PROCEDURE
SAMPLE TYPE..: POTABLE
PRESERVATIVES: NONE
TEMPERATURE..: < 4C
COLIFORM METH: MF
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
RESULT NORMAL - RANGE METHOD
PUTNAM CNTY PROFILE
06/04/02 Ml:-" T. COLIFORM ABSENT /100 ML ABSENT
06/04/02 LEAD (IMS) 3.2 ppb 0-15 ppb
06/04/02 NITRATE NITROG 0.32 MG/L 0 - 10
06/84/02 NITRITE NITROG <0.01 MG/L N/A
08/04/02 IRON (Fe) 0.3B4 MG/L 0-0.3mg/l
06/04/{)2 MANGANESE (Mn) 0.027 MG/L 0-0.3 mg/I
06/04/02 SODIUM (Na) 5.20 MG/L N/A
06/04/02 pH 6.9 UNITS 6.5-8.5
06/04/02 HARDNESG,TOTAL 128 MG/L N/A
06/04/02 ALKALINITY (AS 78.0 MG/L N/A
..'`{)6/04/02—,--~7URB�ZDITY-�TUR-'
COMMENTS:
BACT THESE RESULTS INDICATE THAT THE WATE WAS NOT) OF A
SATISFACTORY SANITARY QUALITY ACCORDI���[�~7HE NEW YORK STATE
AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS
TESTED, AT THE TIME OF COLLECTION.
Pb /CU LEAD limits for p
EPA Lead & Copper
than 10% of their
than 15 ppb and a
treatment must be
potential.
.iblic schools are set at 15 ppb.
Rule for Public Systems requires that no more
distribution points have a LEAD value of more
COPPER value of 1.3 mg/L, else water
undertaken to reduce the waters corrosive
Fe/Mn If both iron and manganese are present, their total value
combined shall not exceed 0.5 mg/L.
Na No limits for Sodium are proscribed. Suggested guidelines state
that for people on a sodium restricted diet,the water should
contain no more than 20 mg/L of Sodium. For those on a
moderately restricted diet, a maximum of 270 mg/L of Siodium
1008
9101
9139
9146
2037
2037
`
YML ENVIRONMENTAL SERVICES
- 321 Kear Street
�--- -
-Yorktown
(914) 245-2800
LAB #: 93.201564 CLIENT #: 55592 NON STAT PROC PAGE 2
~~~~~~~~~m°~~~-~~~~~~~~~~~~~~~~~~~~~~~~ °~~~~~~~~~~~~~~~~-~~~~~~~~~~~~~~~~~~~~~
W8LFF, THOMAS W
56 MANCGESTER RD
EASTCHESTER, NY 10709
DATE/TIME TAKEN: 06/04/02 10:00A
DATE/TIME REC'D: 06/04/02 11:30A
REPORT DATE: 06/11/02
�
PHONE: (845)-277-0805
SAMPLING SITE: 167 BIG ELM RD SAMPLE TYPE..: POTABLE
: PATTERSON NY 10509 PRESERVATIVES: NONE
C8L'D BY: THOMAS'WOLFF JR -''`~TEMPERATURE..: <'41:
NOTES...: KITCHEN TAP COLIFORM METH: MF
DATE FLAB PROCEDURE RESULT NORMAL - RA14BE METHOD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
is suggested.
PH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF
THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY.
WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND
-FIXTURESv--THE-NORMAL RANGE-OF pH-IS-665 TO 80.--
Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM |
CONCENTRATION9 BOTH EXPRESSED
HARDNESS MAY RANGE FROM 0 TO
SOURCE AND TREATMENT TO WHICH
---°-GQFT-WATER*'8-7010'L=-~"'-......
MODERATELY HARD WATER: 70-140
HARD WATER: 140-300 MG/L
SUBMITTED BY:
AS CALCIUM CARBONATE, IN MG/L. THE
1UNDRBDS OF MG/L, DEPENDS ON THE
THE WATER HAS BEEN SUBJECTED.
--- ' HAR[>WATERvABOVE.30(>-M--'-
MG/L MG/L = MILLIGRAM PER LITER
(1 grain/gallon = 17.2 MG/L)
Albert
Direc*f
ELAP# 10323
YML ENVIRONMENTAL SERVICES
321 Kear Street
Yorktown Heights, N.Y. 10598
Albert H. Padovani, Director |
LAB #: 93.201853 CLIENT #: 55680 NON STAT PROC PAGE �
WDLFF, THOMAS DATE/TlME TAKEN: 06/26/O2 04:OO
10 KING LANE DATE/TlME REC'D: 06/27/02 10:0O
BREWSTER, NY 10509 REPORT DATE: O7/O2/O2
PHONE: (845)-277-O850
SAMPLING SITE: 167 BIG ELM RD, PATTERSON, NY SAMPLE TYPE..: POTA8LE
: KITCHEN TAP PRESERVATIVES: NONE
COL'D BY: THOMAS WOLFF TEMF�RATURE..:
NOTES...: COLIFORM METH� N/A
DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD
06/27/02 IRON <Fe> <0.060 MG/L 0-O.3 mg/l 2037
COMMENTS:
Fe/Mn If both iron and manganese are present, their total value
combined shall not exceed 0.5 mg/L.
SM IT TED BY
UB :
ELAP# 10323
.�� ,_.. . ,....... �,..:..a��;;�r �R ��'1:.�:�,�ti -; -... . , .. -. _ � - .. �. .,�:.- ,..�F.:�'�I•� "� +G;:�f:1-� tied.; M.S'� - -
�ublic Hralrh- Dl rotor AaccWt- Public Ktaltl� Dfreeta
' 04r'cra of Palttnr Savrcu
DEPARTNIENT OF HEALTH
1 Geneva Road'
Browster, New York 10509
- - - $orkvomititi) ricaltb (914) 2N • 6170 Fit (941) 271.7921
NunWI Scrvica (914)271.6151 WIC (914)271.6671 .Fax(914) 271.6095
9Wriy *toU MoB6o'(914)271*•6014 Pracbool (914)271-6012 Put(914)171'•6641
E211 ADDRESS VERIFICATION FORM
_ OWNERS NAME:
TAX MAP NUMBER:
E911.ADDRESS:
TOWN:
AUTHORIZED TOWN OFMC1AL:
(Signature) -.._
DATE: �1;2 0 b5
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'. --
- witb the application fo-r:_a C.irtificate of Construction Compliance.
(E91 I VERFRM)
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
CONSTRUCTION PE
PERMIT #
7 S
Located
Subdivision name
Ed.M PAD
C- L-PkWF-1
Date Subdivision Approved
Owner /Applicant Name
Subd.
'd.il 111
PATP -%Ci- C LA
Mailing Address 1�1`'' EWN
Amount of Fee Enclosed
Town or Village
# ri Tax Map!
Renewal
PArtcR&�4
Block I' Lot 44-
Revision
Date of Previous Approval
R iYD ' W Zip 15��
,t00°o
Building Type f207'1061'44e Lot Area 14 -7 ANLo. of Bedrooms 4 Design Flow GPD
Fill Section Only Depth Volume
PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Separate Sewerage S sy tem to consist of 00 gallon septic tank ands 1-�65
Other Requirements: d ' �' LJ, V:O�, 1.648 W H (n
To be constructed by T'b 0 • Address
Water Supply: Public Supply From
or: Private Supply Drilled by T �D
Address
Address
I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the
sgparate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion
thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the
Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said
builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years
immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original
system or any repairs thereto.
Signed: y
Address
P.E. X
�,rhFr t4)1 1-0d
R.A. Date to // °i J 9�
License # % r if
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 PC eia ause or may be amended or
modified whe sidered necessary by the Public Health Director. AIV,s i on or aIt r nnoof the approved plan requires
a new permi ro ved f ischarge of domestic sanitary sewage olMil €.,. Iw 3H A13
By: Title:
1134023d �%�
1134023d I
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CP -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
M: DIVISION OF ENVIRONMENTAL HEALTH SERVICES
.. FINAL SITE INSPECTION
Inspecte y: G, yo
Street Location r Owner .c,- I' e- ZAas E
Town *? ,....y �. �� Permit # 'P- X1'2 ....�
TM r ~ - .� �.�, Subdivision Lot #
1. Sewage Svstetn 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 not 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 .......50 .)......6ther ................
b. Septic tank installed level ..:..., .:....... ...............................
c. 10' minimum from foundation .......... ...............................
d. Distribution Bo
. 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
I . eL ngth required 6 r 7 Length installed
2. Distance to watercourse measured #- /dv® Ft..........
3. Installed according to plan ......... ...............................
4. Slope of trench acceptable 1/16 -1/32" /foot .............
5. 10 ft. from property line - 20 ft: foundations..........
6. Depth of trench <30 inches from surface ..................
7. Room allowed for expansion, 100% .........................
8. Size of gravel 3/4 -1 %" diameter clean ...................:
9: cpitrc3fgravel n`tfdTich`l2 "iniriimuni:..::. ::: :::.:..
10. Pipe ends capped......... ................ ...............................
g. PumR or Dosed Systems
Size ot 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.estumted flow /cycle...........
III House[Buildi
a` Mouse ocated'� er a roved_ Tans...... .... ?.......:
P� - -R _ p
b Dumber of bedrooms ....................... ............................... .
�-==-a V+�ell�locate' "d as per approved plans ............................
b. Distance from STS area measured 4- 10 I 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 & dir.to exist watercour%
COMMENTS
>C X s ' �
V-A� C? - )c , I . "i - -
See P14 dl
k,
See P14 dl
PMAM COUNTY DUARTUM 07 MALTI.K
DIVMCM OT? YMDMMrALUQTKSVMCZS
AWENUON ADAM Van
RZQIMST fat: Flu
All Wormsdon must be Aly cmplcted prior to UY TftwUl
impecdoms W* =do.
PC At
o C:45 4
L :-
Lot Owner/Appiow am
L
. . cam SubdIvWco NLMCI
SubdMd
a Lot
. is system a campkie AV14 Date:
Is syst,cm, somms? — Yx a I Dec: 2:3
is "em comuVowlas Pee Phu?
Is won drilled?
Is well imild 0A par PIM?
Are trosiotco*U01 MOM 12 F6W?
Date:
I ca* that the #y$sm(sX- a AuA et the above pmm4es has been conmeW ad I have ippeted
sod verMad their cmVWdou in socordwe with the bsued -PCHD, Coamcdon Permh and
approved plan and the Studu&, Rules and Regulations of the Pumam County Dopuwat of
HcAltk
--0
C"ad by". �.,� E RA
ID 66-P -W
p, facs5kaj -
Addtcu.- 90 1 %. 12-1
C4r)MOMW
Form m"
BRCJCE R: ' FOLEY "" `
Public Health Director
_.., "LORETTA�MOLINARI R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
DEPARTMENT ®F HEALTH
1 -Geneva Road
Brewster, New York 10509
Environmental Health (845)278-6136 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845)228-6108 Fax (845) 278 - 6648
Harry Nichols, P. E.
Patterson Park
Suite 106
2050 Route 22
Brewster, NY 10509
Re: Field Inspection: Clarke
Big Elm Road, Patterson
Lot #2, TM #35 -4 -4.2
Dear Mr. Nichols:
The following comments must be corrected in the field:
1. Install the silt fence in the ground.
2. No house or well at time of inspection.
May 29, 2001
If you have any further questions, please contact me at (845) 278 -6130 ext. 2261.
Very truly yours,
Gene D. Reed
Environmental Health Engineering Aide
GDR/jp
Public Health Director
DEPARTMETIT OF HEALTH
1 Geneva Road
Brewster, New York 10509
LORET A l�fOLI1 AR1� RN.,: IvI.C:N..
Associate Public Health Director
Director of Patient Services
Environmental Health (845)278-6130 Fax(845)278-7921
Nursing Services (845)278-6558 WIC (845)278-6678 Fax(845)278-6085
Early Intervention (845)278-6014 Fax (845) 278 - 6648
Preschool (845) 228 - 5912 Fax (845) 228 - 6113
December 27, 2001
Harry Nichols, P.E.
Patterson Park
Suite 106
2050 Route 22
Brewster, NY 10509
Re: Field Inspection: Clarke
Big Elm Road, Lot #2
(T) Patterson, TM# 35 -4 -4.2
Dear Mr. Nichols:
The following comments must be corrected in the field:
No further comments.
-
If you have any questions, please contact me at (845) 278 -6130 ext. 2261.
Very truly yours,
Ae-� 0,
Gene D. Reed
Environmental Health Engineering Aide
GDR:tn
LAURENT ENGINEERING
\ ASSOCIATES, P.C.
MILLBROOKE OFFICE CENTRE
Route 22 & Milltown Q C9
\ R (914)278-6108 - (FAX) 278 -265a
HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS
December 7, 1998
Robert Morris, P.E.
Putnam County Health Department
4 Geneva Road
Brewster, NY 10509
RE: Proposed SSTS
Clarke - L 7 IL
Big Elm Road
Town of Patterson
Dear Mr. Morris:
In response to your review letters dated November 3 and 9, 1998, we offer the following:
1. Groundwater was monitored by the Putnam Countv Health Department
2. Standpipes are not
3. Well dimensions ai
4. Curtain Drain Deu
We trust the above adequf
Construction Permit at yoi
Very truly yours,
LAURENT ENGINEERE
Harry W. ichols, Jr., RE
HWN:JM:hs
98033
M
Sk Kr
BRUCE_ R. FOLEY
Pu6 is Heiahh bifddtor
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road
Brewster, New York 10509 November 3, 1998
Tel. (914) 278-6130 Fax (914) 278-7921
Harry Nichols
Laurent Associates
Millbrook Office Centre
Route 22 & Milltown Road
Brewster NY 10509
RE:, Clarke
Big Elm Road, Lot #2
(T) Patterson,
Reservoir Basin East Branch
Dear Mr. Nichols:
The Putnam County Department of Health (Department) has determined that the above referenced
application, including fee, and received by this Department on October 28, 1998 is complete. The
Department will notify you by November 23, 1998 of its determination.
The Project has been delegated to the Putnam County Health Department for
review pursuant to the guidelines set forth in the Watershed Agreement.
❑ Joint review with the NYCDEP will commence pursuant to the guidelines set forth
M tl:e ��'utc.shcd �;greameat.
If the Department fails to notify you within the above referenced time frame, you may notify the
Department of its failure by certified mail, return receipt requested. The notice should be sent to my
attention at the above address. This notice must include your name, the location of the project, the
office with which you filed the application originally, and a statement that a decision is sought in
accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed
Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the
notice; your application will be deemed complete, subject to standard terms and conditions as set
forth in the regulations.
Please be advised that projects within the NYC Watershed may also require Dept. of Environmental
Protection review and approval of other aspects of a project, such as stormwater plans or the creation
of impervious surfaces, and the project applicant should contact the 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 76130 ext. 166.
Very t ly yours
.:.'t oelll 04-:7
Robert Morris, PE
TT. 10 r
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONINIENTAL HEALTH
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT S STERIS.
"-RiMEiV SHEET FOR CONSTRUCTION PERMIT
STREET LOCATION NAME OF OWNER
REVIEWED BY RNI, GR, AS, MB, BH
Y N DOCUi1ENTS
PERMIT APPLICATION.
PC -1
WELL PERMIT _ PWS LETTER
LETTER OF AUTHORIZATION
DESIGN DATA SHEET (DDS)
CORPORATE RESOLUTION
SHORT EAF
PLANS - THREE SETS
HOUSE PLANS - TWO SETS
.VARIANCE REQUEST
FEE
SUBDIVISION
LEGAL SUBDIVISION
SUBDIVISION APPROVAL CHECKED
PERC RATE
FILL REQUIRED DEPTH
CURTAIN DRAIN REQUIRED
STANDPIPES
11
GE—NERA
LOCATED N NYC WATERSHED
PLANS SUBMITTED TO DEP
DELEGATED TO PCHD
DEP APPROVAL, IF REQ'D
DEEP TEST HOLES OBSERVED
PERCS TO BE WITNESSED /
EX- APPROVAL SSDS ADJ. LOTS
WETLANDS (TOWN/DEC PERMIT REQ'D ?)
DATA ON DDS PLANS & PERMIT SAME.
PRE 1969 NEIGHBOR NOTIFICATION
LETTER BI/ZBA
100 YR. FLOOD ELEVATION
OTHER REQ'D PERMITS)
REQUIRED DETAILS ON PLANS
SEWAGE SYSTEM PLAN - (NORTH ARROW)
SSDS HYDRAULIC PROFILE
GRAVITY FLOW
CONSTRUCTION NOTES
DESIGN DATA: PERC & DEEP RESULTS
T CONTOURS EXISTNG & PROPOSED
DRIVEWAY & SLOPES, CUT
FOOTING /GUTTER/CURTAIN DRAINS
SOIL TYPE BOUNDARIES
TITLE BLOCK; OWNERS NAME,ADDRESS
TM #,PE/RA; NAME,ADDRESS,PHONE#
DATE OF DRAWNG/REVISION
DATUM REFERENCE
LOCATION OF WATERCOURSES, PONDS
LAKES AND WETLANDS WITHIN 200 FEET
(PROPOSED FINISH FLOOR AND BASEMENT EL.
DATE
EROSION CONTROL:HOUSE;WELL, SSDS
PERC & DEEP HOLES LOCATED
REPRESENTATIVE OF PRIMARY & EXPANSION
LOCATION MAP
W. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE
IF PUMPED, PIT & D BOX SHOWN & DETAILED
HOUSE - NO.OF BEDROOMS
WELLS & SSDS'S WAN 200' OF PROPOSED SYS.
PROPERTY METES & BOUNDS
HOUSE SETBACK NECESSARY (TIGHT LOT)
HOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE
TJi0 BENDS; MAX.BENDS 45° 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
ILL IN EXPANSION AREA
BENCH t
LF TRENCH PROVIDED 60 FT MAX.
PARALLEL TO CONTOURS
100% EXPANSION PROVIDED
COMMENTS:
TAXNIAP#
ON PLAN - FROM SSTS --
'.C'
DRIVEWAY, LARGE T'KEES,•TOPOF FILL -
20' TO FOUNDATION WALLS _15'WELL TO PL
100' TO WELL, 200' IN DLOD, 150' PITS
100' TO STREAM WATERCOURSE LAKE (inc. expan)
50' TO CATCH BASIN, 35' STORMDRAN, PIPED WATER
10' TO WATER LINE (pits -201)
50' INTERMITTENT DRAINAGE COURSE
2007500' RESERVOIR, ETC. _150' GALLEY SYSTEMS
15'MN to CDS= >5 %,10'- 4 1/o,25'- 3 1/o,30'- 2 %,35' -I %,100' - <I%
20 'MIN to CD discharge /I00'with 182 cons day discharge
SEPTIC TANK
10' FROM FOUNDATION; 50' TO WELL
WELL
DIMENSIONS TO PROPERTY LINE
LOCATION OF SERVICE CONNECTION
L� #� PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
y
DESIGN DATA SHEET - SUBSURFACE Sl!,WAG. TATMENT_S''IrE11 _, ......� .::
_. -Owner^ - -. �.� ..��_� _..���� .Address Tk>S�t//v
Located at (Street) �j l � d��J Tax Map ' • Block 4 Lot
indicate nearest cross street)
Municipality - 7-),rR Drainage Basin
—V
p,S®r1, �? M E
COLATION TST DATA
Date of Pre - soaking / —&� 4? S/ Date of Percolation Test
Hole No.
Run No.
Time
Start - Stop
Ela se Time
i I n.)
Depth to Water
from Ground
Surface (Inches)
Start Stop
Water
Level
Drop In
Inches
Percolation
Rate
Min/Inch
1
/,
Z t-
2
4
5
4
5
1
2-
3
4
5
NOTES:: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each
percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be
submitted for review.
2.' Depth measurements to be made from top of hole.
Form DD -97
OT* 2
TEST PIT DATA
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
HOLE NO.
--HOLE
G.L.
0.5'
1.01
1.51
2.0'
2.51
3.0'
3.5'
4.01
4.51
5.0'
55
6.0'
6.51
7.0'
7.5'
8.0'
8.5'
9.01
10.01
f y
/V,/) goe-ik Na
Rack Ala AO4,t
my 77Z-)AI
Ao7
Indicate level at which groundwater is encountered 0 7-0
Indicate level at which mottling is observed 31,0p/ 7'61 54L4
Indicate level to which water level rises after being encountered D -0
Deep hole observations made by: 6, /i/;r"- Ileo 4 Date /0
Design Professional Name: 119-14iF10- f1V(Wx/F_16e1,,06
Address:
Signature
Design Professional's Seal
15
NEW
MICH
NO. 56124
�OAAOFESSIO�P
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road .
Brewster, New York 10509
Tel. (914) 278 - 6130 Fax (914) 27g - 7921
November 3, 1998
Harry Nichols
Laurent Associates
Millbrook Office Centre
Route 22 & Milltown Road
Brewster NY 10509
Re: Proposed SSTS: Clarke
Big Elm Road.
(T) Patterson;- -TM# 35=4=4-:2
Dear Mr. Nichols:
MCE '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.
If percolation tests were not witnessed by a representative of the New York City Department
Environmental on this lot, percolation tests ' must be witnessed by a representative of this
Department.
1) An acceptable method of lowering groundwater must be provided as outlined
in bulletin ST -19. Groundwater levels must be monitored during the seasonal
high ground water period of March. I5th - June 15th.
2) Curtain drain standpipes have not been provided.
3) Dimension from the well to the property lines are to be noted.
Upon receipt of a submission, revised to reflect that above comments, this application will be
considered further.
Ve ly yours,
atv
Robert Morris, P.E.
RM:tn Public Health Engineer
i
IFUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPWA_ ')7ION TO CONSTRUCT A WA'$EllB.WELlI, .. __..
please print or type PCHD Permit #
Well Location:
Street Address: 16� Town/Village Tax Grid #
1Cg eL4A PAD Rh'TY 0-60N Map •
Block 4 Lot(s)44—
Well Owner:
Name:
Address:
FAMU--C Cw k
OK 151-M F-0,P 8lZ&h,,ey,
tq>' 101a0el
Use of Well:
X Residential Public Supply Air /Cond/Heat Pump Irrigation
I- primary
Business Farm Test/Monitoring
Other (specify)
2- secondary
Industrial Institutional Standby
Amount of Use
Yield Sought gpm # People Served Est. of Daily Usage &eO gal.
Reason for
Replace Existing Supply Test/Observation
Additional Supply
Dirlllinng
New Supply (new dwelling) Deepen Existing Well
Detailed Reason
for Drilling
Well Type_
Drilled Driven Gravel
Other
Is well site subject to flooding? ................................................. ...............................
Yes No X
Is well located in a realty subdivision? ...................................... ...............................
Yes A No
Name of subdivision fA?IZ 1 Gad Gib x.96
Lot No. IL
Water Well Contractor: T-6.A Address:
Is Public Water Supply available to site? .................................. ...............................
Yes No 3Y
Name of Public Water Supply: Town/Village
Distance to property from nearest water main:
Proposed well location & sources of contamination to be provided on separat sheet/plan.
1
patew -
�� J: _� Applicant. Srgnature::..
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: l) Pump the well until the water is clear. 2) Disinfect the well in accordance with the
requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form
provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or
well driller shall take appropriate action to assure that any and all water and waste products from such
well drilling operations be contained on this property and in such a manner as not to degrade or otherwise
contaminate surface or groundwater.
APPROVED_ FOR CONSTRUCTION: This approval expires two years from the date issued unless
construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be
amended or modified when considered necessary by the Public Health Director. Any revision or alteration
of the approved plan requires a new permit. Well to be constructed by a water driller certified by Putnam
County.
Date of Issue % Permit Issuin g 0 c'al
Date of Expiration Title:
Permit is Doan- Tlraansffe 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
UftER OF AUTHORIZATION
RE: Property of
Located atiA 4Q E LNs P4 W
T/V PA-60 N Tax Map #5 " Block 4 Lot '�` 2-
Subdivision of Cl'
Subdivision Lot #-
Gentlemen:
Filed Map # 109A Date Filed
This letter is to authorize 14fl \N " N1 CIML�, . J�" Fe
4-16-%
a duly licensed Professional Engineer k or Registered Architect to apply for the required
wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance
with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam
County Health Department, and to sign all necessary papers -on my behalf in connection with this
matter and to supervise the construction of said wastewater treatment and/or water supply systems
in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health
Law, and the Putnam --
�; PIE Lid y
Countersigned
P.E., R. A., # -1
v
Mailing Address
F)P-5-�'�rF5 �_
State N5%4 ' cjq-- Zip l Q Z6\
Telephone: �q)q )
Very truly yours, 1
Signed:
(Owner of Pro
Mailing Address: l(:4 eLH P D.Ap
SA_F=Mri >*P,
State NF-W d Qom- Zip
Telephone:
i
Form LA -97
F.
MIMI!l!1MA7MIIlIAA IMVlM� P4j&
.617.20 `
,_Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED, ACTIONS Only
'art 1 - PROJECT INFORMATION (To,be,.completed by Applicant or Project'sponsor)
1. APPLICANT /SPONSOR: P TR��Ii G�n f/
1`— �Y-�►
2. PROJECT. NAME: LJOT. I '114M IDEAL. 6o05
3. PROJECT LOCATION: ' '+
PT��� -6,d1� ��, n�
Municipality County
4. PRECISE LOCATION: (Street address and road intersections, prominent landmarks, etc., or provide map)
5. PROPOSED ACTION IS:
tKNew OExpansion OModification /alteration
6. DESCRIBE PROJECT BRIEFLY:
7. AMOUNT OF LAND AFFECTED:
Initially. �(p J"� acres Ultimately U41
acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
6Ves ONo If No, describe briefly
9. WHAT IS PRESENT LAND USE IN VICINITY OF, PROJECT?
AReSideritial ❑Industrial_, ,_,_ OCoMcnercial OAgricultural OPark /Forest /Open space 00ther
Describe: Ab)H61L -a
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (FEDERAL, STATE OR LOCAL)?
Oyes ANo If yes, list agency(s) name and permit /approvals
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
OYes IgNo If yes, list agency(s) name and permit /approval
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION?
OYes gNo
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE 1S TRUE TO THE BEST OF MY KNOWLEDGE
711 w ».J t.1 / ..�1 1L� �/ •/ �AI 1rhI tin 1
ppi,,r -n i•`_:;::cnsor game: 1 '41ynu ter—, ,L; -i•%a 7"r-r-+I w
►TI'ri., i. 1
If the action is in a Coastal Area, and you are a state agency, complete a
Coastal Assessment Form before proceeding with this assessment
PART II- ENVIRONMENTAL ASSESSMENT (To be completed by Agency)
A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR; PART 617.47 If yes, coordinate the review process and use
the FULL EAF. OYes ONo '
B. WILL ACTION RECEIVE COORDINATED .REVIE`AI.AS.PPOVISDED FOR UNLISTED ACTIONS'IN`6"NYCR"i,RPAR1 617.67 If No, a F
negative -debratkion may be superseded by another involved agency. ❑Yes ❑No
C. COULD. ACTION RESULT IN ANY.-, ADVERSE, EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers maybe 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'brie'fly:
C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly:
C6. Long term,. short 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. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT
OF A CRITICAL ENVIRONMENTAL AREA (CEA)? ❑Yes ❑No If Yes, explain briefly:
E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTFNTIAI. ADVERSE E,%-f AL IMPACTS?
❑`!es . ❑No If Y&s,-exp) in b"riefiy:
i
Part III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise
significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring;
(c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add art; chments or reference supporting
materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and
adequately addressed. If question D of Part II was checked yes, the determination of significance must evaluate the potential
impact of the proposed-action on the environmental characteristics of the CEA.
i
❑ 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:
Name of Lead Agency Date
Print cr Type Name of Responsible Officer in Lead Agency
Title of Responsible Officer
Signature of Responsible Officer in Lead Agency Signature of Preparer(If different fronn responsitle c-::
PUTNAM COUNTY DEPARTMENT. OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
J
APPLICATION FOR APPROVAL OF PLANS FOR _
A WASTEWATER TREATMENT SYSTEM
1. Name and address of applicant: PAts�CV_ CLAk -a
fiG U-�A P—ON1D
2. Name of project: i or 2- 3. Location TN: PArraP-60f'+
4. Design Professional: 14A* 5. Address:
6. Drainage Basin: EpeT 4
7. Type of Project:
�t Private/Residential Food Service
Apartments Institutional
Office Building Realty Subdivision
Commercial
Mobile Home Park
Other (specify)
8. Is this project subject to State Environmental Quality Review (SEQR)?
Type Status (check one) ....................... ............................... Type I Exempt
Type II Unlisted X
9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... No
10. Has DEIS been completed and found acceptable by Lead Agency? ...............
11. Name of Lead Agency
No
NA
12. Is this project in an area under the control of local planning, zoning, or other
officials, ordinances? ........... ...:.. ...... .............. : ......
'o
13. If so, have plans been submitted to such authorities? ........ ............................... N
14. Has preliminary approval been granted by such authorities? NO Date granted: N �
15. Type of Sewage Treatment System Discharge ................. surface water �( groundwater
16. If surface water discharge, what is the stream class designation? .................... NA
17. Waters index number (surface) N A
18. Is project located near a public water supply system? No
19. If yes, name of water supply NA Distance to water supply NA
20. Is project site near a public sewage collection or treatment system? ................ No
21. Name of sewage system NA Distance to sewage system NA
22. Date test holes observed 23. Name of Health Inspector r i� h►�
24. Project design flow (gallons per day) $a°
25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No
26. Has SPDES Application been submitted to local DEC office? ......................... NA
Form PC -97
2
27. Is any portion of this project located within a designated Town or State wetland? NO
28.
Wetlands ID Number
HA
..........................................................: ......................:....:..: ..
.
-. 9.
Is Wetlands Permit required? ......................................:....... ... .............................
k o
Has application been made to Town or Local DEC office? ...............................
KA
30.
Does project require a DEC Stream Disturbance Permit? .. ...............................
14
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? .................... I........ Yes/No
�
32.
Is project located within 1,000 feet of existing or abandoned landfill,
hazardous waste site; salt stockpile, landfill, sludge disposal site "or any
other potentially known source of contamination? ............................... Yes/No
MO
DESCRIBE:
33. Is there a local master plan on file with the Town or Village? ......................... YC-15
34. Are community water and/or sewer facilities planned to be developed within
15 years in or adjacent to project site? ................................ ............................... ND
35. Are any sewage treatment areas in excess of 15% slope? ..........................
36. Tax Map ID Number .......................... ............................... Map ' 6, Block '4 Lot 4,� &-
37. Approved plans are to be returned to ..... Applicant A Design Professional
NOTE:_ All applications for review and approval of anew SSTS to-be located within-the NYC V!iatershe. shall
Ue 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 this form is true
to the best of my knowledge and belief. ,False statements made herein are punishable as
a Class A misdemeanor pursuant to Section 210.45 of the P;pa4aw.
SIGNVATU ES & OFFICIAL TITLES:
RA14-61 W, 441 G 0LA, JP PE . Al� AG,ENr
Mailing Address: ................................... 'Lo 90AP
yr, N loi�oq
j� \ ASSOC A EIS P.C.
ING
.,:; I1IjzLBROOKF OFFICE. CENTRE_-._..
Route 22 d Milltown Road
Brewster, New York 10509
October 14, 1998 (914)279 -610e • (FAX) 278-2658
HARRY W. NICHOLS JR., P.E. V \ CONSULTING SITE ENGINEERS
Mr. Robert Morris, P.E.
Putnam County Health Department
4 Geneva Road
Brewster, NY 10509
RE: Individual SSTS
Patrick Clarke
Big Elm Road -Lot #2
Patterson
Dear Mr. Morris:
Enclosed are the following:
1. Five (5) prints of SS -2 "Proposed SSTS," dated 10/13/98
2. "Short EAF," dated 10/13/98
3. "Application for Approval of Plans For a Wastewater Disposal System."
4. "Construction Permit foi Sewage Disposal System," dated 10/13/98
5. "Application to Construct a Water Well," dated 10/13/98
"DegigwData,Sheet" ' -
7. "Letter of Authorization." dated 10/13/98
8.. Two (2) copies of Residence Floor Plan(s), For Bedroom Count Only."
9. Review Fee in the amount of $300.00.
Very truly yours,
LAUREN ENGINEERING ASSOCIATES, P.C.
cam•
Harry W. Nichol Jr., P.E.
HWN:JM:hs
98033 -2
S :£ lid L Z 100 86
AN3
03A 1303?
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS _
REVIEW.SHEET FOR CONSTRUCTION- PE,111,•T -. -- 77
STREET LOCATION NAME OF OWNER
REVIEWED BY RM, GR, AS, NIB, BH DATE TAX MAP #
Y N DOCUMENTS Y N
PERMIT APPLICATION EROSION CONTROL:HOUSE,WELL, SSDS
PC -I PERC & DEEP HOLES LOCATED
WELL PERMIT PWS LETTER REPRESENTATIVE OF PRIMARY & EXPANSION
TM #,PE/RA; NAM E,ADDRESS,PHONE#
DATE OF DRAWING/REVISION
DATUM REFERENCE -
LOCATION OF WATERCOURSES, PONDS
LAKES AND WETLANDS WITHIN 200 FEET
=PROPOSED FINISH FLOOR AND BASEMENT EL.
COMMENTS:
LETTER OF AUTHORIZATION
DESIGN DATA SHEET (DDS)
CORPORATE RESOLUTION
SHORT EAF
PLANS - THREE SETS
HOUSE PLANS - TWO SETS
VARIANCE REQUEST
FEE
SUBDIVISION
FILL SYSTEMS
LOCATION MAP
EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE
IF PUMPED, PIT & D BOX SHOWN & DETAILED
HOUSE - NO.OF BEDROOMS
WELLS & SSDS'S WAN 200' OF PROPOSED SYS.
PROPERTY METES & BOUNDS
HOUSE SETBACK NECESSARY (TIGHT LOT)
HOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE
BENDS; MAX.BENDS 450 W /CLEANOUT .
SUBDIVISION APPROVAL CHECKED
CLAY BARRIER
PERC RATE
10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE
FILL REQUIRED DEPTH
FILL SPECS FILL NOTES
CURTAIN DRAIN REQUIRED
FILL CERTIFICATION NOTE
STANDPIPES
MNO
GENERAL
FILL PROFILE & DIMENSIONS
TM #,PE/RA; NAM E,ADDRESS,PHONE#
DATE OF DRAWING/REVISION
DATUM REFERENCE -
LOCATION OF WATERCOURSES, PONDS
LAKES AND WETLANDS WITHIN 200 FEET
=PROPOSED FINISH FLOOR AND BASEMENT EL.
COMMENTS:
LEGAL SUBDIVISION
FILL SYSTEMS
SUBDIVISION APPROVAL CHECKED
CLAY BARRIER
PERC RATE
10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE
FILL REQUIRED DEPTH
FILL SPECS FILL NOTES
CURTAIN DRAIN REQUIRED
FILL CERTIFICATION NOTE
STANDPIPES
DEPTH GAUGES
GENERAL
FILL PROFILE & DIMENSIONS
LOCATED IN NYC WATERSHED
VOLUME
PLANS $UBMITTED TO DEP
FILL IN EXPANSION AREA
DELEGATED TO PCHD
TRENCH
DEP APPROVAL, IF REQ'D.
LF TRENCH PROVIDED 60 FT MAX.
DEEP TEST HOLES OBSERVED
PARALLEL TO CONTOURS
PERCS TO BE WITNESSED
100% EXPANSION PROVIDED
EX- APPROVAL SSDS ADJ. LOTS
SEPARATION DISTANCES SPECIFIED
WETLANDS (TOWN/DEC PERMIT REQ'D ?)
ON PLAN - FROM SSTS
DATA ON DDS PLANS & PERMIT SAME
10' TO P.L.; DRIVEWAY, LARGE-TREE$; TOP. OF FILL_'
P PE 46 A..,I"HBOr NO IF'CA T ivN ' " --- --"'
20-TO FOUNDATION WALLS _15'WELL TO PL
LETTER BI/ZBA
100' TO WELL, 200' IN DLOD, 150' PITS
100 YR. FLOOD ELEVATION
100' TO STREAM WATERCOURSE LAKE (inc. expan)
OTHER REQ'D PERMIT(S)
50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER
REQUIRED DETAILS ON PLANS
10' TO WATER LINE (pits -20')
SEWAGE SYSTEM PLAN - (NORTH ARROW)
50' INTERMITTENT DRAINAGE COURSE
SSDS HYDRAULIC PROFILE
2007500' RESERVOIR, ETC. _150' GALLEY SYSTEMS
GRAVITY FLOW
CONSTRUCTION NOTES
15'MIN to CDS= >5°/g10'- 4 %,25'- 3 %,30'- 2 %,35' -1 %,100' - <1%
DESIGN DATA: PERC & DEEP RESULTS
20'MIN to CD discharge /100'with 182 cons day discharge
T CONTOURS EXISTING & PROPOSED
SEPTIC TANK
DRIVEWAY & SLOPES, CUT
= I O' FROM FOUNDATION; 50' TO WELL
FOOTING /GUTTER/CURTAIN DRAINS
WELL
SOIL TYPE BOUNDARIES
DIMENSIONS TO PROPERTY LINE
TITLE BLOCK; OWNERS NAME,ADDRESS
®
LOCATION OF SERVICE CONNECTION
TM #,PE/RA; NAM E,ADDRESS,PHONE#
DATE OF DRAWING/REVISION
DATUM REFERENCE -
LOCATION OF WATERCOURSES, PONDS
LAKES AND WETLANDS WITHIN 200 FEET
=PROPOSED FINISH FLOOR AND BASEMENT EL.
COMMENTS:
DIMENSION : CHART (in feet):
Number
A
8
125
137
2
140
136
3
146
142
.4
152
148
5
1 59
154
6
1 64
160
7
1 70
1.66
8
i 76
1 72
9
1 81.
1 79
10
1 87
1 85
1 1
.193
190
1 2
200
1 196
13
206
2`02
14
138
150
15
144
155
17
156
166
I8
162
171
19
168
177
20
174
182
21
180
188
22
186
194
23
.192
200
24
198
206
2s
Z04
2.12
I
M
O
Q
p
Oo
►0,00" w
0
. I
0 125
SEPTI
-k
I M
. ............
G 03. 10,00" w
74 11
- -- - —=77-7
Ex I ST. 4 BR.
RESIDENCE
A
4 PVC ON
0 o�E N b (7Y P
DCEP P.7 All tRA1t4
�.0 �
0 1250 r.AL.
SE 4'71 C TA N 0
3bea,
J4 36 LF ASS Tq.,C,
15
Ifil
17
is,
0/ 1
Izo
20 _7 (--0
X LVA
P NS:IbN
a I A 9 E A 4�
P,/c 'ry
22
Z3 10
if
25 12
0.J.
—ry—P
EXIST. W ELL
Putnam County Department of Hei
Division of Environmental Health S
Approved as noted for oonformanoi
app 10 Pul and Regulations
Co Health Departmez