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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -4 -4.3 BOX 15 ir .� : re ,. 11 IN 1.6 see 1 le �16 ri - , 01691 PUTNAM COUNTY DEPARTMENT OF HEALTH :.S_T Rp ICES .. CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # F' M - q4 ' hw 14 -0 i Located at 161 � I y F11 Town or Village Owner /Applicant Name 14006 � �� � w Tax Map �l'�' ° Block Lot Formerly Subdivision Name VY0�,rf- Subd. Lot # z Mailing Address j Q p M46 L-,k H}✓ bA-f_W N 1 Zip 1 KI Date Construction Permit Issued by PCHD 600 ' Separate Sewerage System built by i IAOM V4 - ta"r* J�-- Address 10 Ws (A, 611 -WI- - t� lO q? Consisting f i �O 'b 1 � 1,F • ; " W ti(A g Gallon Septic Tank and � Other Requirements: Water Sup&: , j)Dpiiau iP rm N Public Supply From. c) ' 1 ��' �t l•l. Fob LaJS W.:il 4 Address or: X Private Supply Drilled by f F k-- {" 641b ,1H L' Address 4 fkl 14's* kV : iM 0" ktl Building Type tN �ti�L _......_ _.._ �..._. erosion controi -been compietea } Number of Bedrooms Has garbage grinder been installed? H0 I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam Co )mty department of Health. Date: Certified by It P.E. % , R.A. es n Professional) Address 4WSp � �� `*� ► 1Q � 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 are subject to modification or change when, in the judgment of the Public Health Director, such revocati n, modification pr change is necessary. By: Title: Date: Ca, -7K3 �1 White copy - HD F e; Ye w c py -Building Inspector; Pink copy - Own; Orange copy -Design Professional Form CC -97 May 26 06 02:00p TOWN OF PRTTERSO 845 - 878 -2019 p.1 MAY- 23 -2 086 88:85 Art HARRY W NICHOLS 918 279 4$67 P_82 �RVC6 R POLBg ' LOWMA "MOLWArit ?LwN - A{.SR ®rlka Nialrbt •�iri�t� .: ' ', d+►aatWr YrlfA NrofrA Dtwrar.•; . ; .• ' 01nelo� Pnt1+w SoVkr1; }. ' 1 Ooneva Rbnd Bnwitor, Now York lose? ii whinaw UWA (910!71.4110 1w (91+) 371.71+x1 • . Q[oNai kfldee �91f)tli•i!!i .W1C (9ly211•idi , ➢a(0l1) 878.608q . . r.rlq'Tn4f3'ii6br'(Qly'!71 ".60H Pruclaol QI {)17F64R ➢u1 (911)17. i616 :, E911 �.DDttE.SS YRRiFf CATION R0= °TAX Milt' N�Jb!iD�R: • _. 6911 ADDIit;S3 TOWN: '. A•UTSORMWTOWN OMt "-' . DATE,�• Z ` � � . - —' 'Tile- Putaialai County Department of( Health *M not issue a C°ertiiicate:of:`' . Co»strl�Mtoa Camptts>aee valeaa the above Corm is completed; (.e.e p Iegat E911 •. "•' ' address is a�sienea by sa amthotized town ofitctat..Tisb form Is to be submitted• •' Wit tie- AppUcadon for a Cerghcjlte 4f_C+v IN=�s�b� P ... PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT WeILLocation._ 159 Big Elm PAD Patterson -... .1 . T�? . .. I—— _1_'_. .- - :G rid Map J45, Block `+ Lot(s) 0 Well Owner: Name: Address: Bennett Builders, 312 Barrett Hill Road, Mahopac, NY 10541 Use of Well: 1-primary 2-secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary _ Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 144 ft. Length below grade 143 ft. Diameter _6 in. Weight per foot 19 lb/ft. Materials: - X Steel ' Plastic Other Joints: Welded X Threaded Other Seal: X Cement grout Bentonite - Other Drive shoe: - X Yes. No ILiner: Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First — Yes No Hours Second Well Yield Test Bailed X Pumped __L Compressed Air Hours _6 Yield X gpm Depth Data Measure from land surface- static (specify ft) 100, During yield test(ft) 560' Depth of completed well in feet 600' Well Log If more detailed information descriptions or sieve analyses wt-available, -- please attach. Depth From -Surface "Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 100 Drillin in overturden clay and bouldeLs Hit rock at 100'. 100 144 Drillin in rock] set casing, grouted- 144 60 0 -' I W ihi-i n _e I "i _n' " r . n . r . k .... g . ra . n tp - If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump/Storage Tank Information Pump Type 60 Capacity S- Depth SZC) Model 'i E H I S4 1Z Voltage 2_3 HP _L111 ITank Type V! 25o Volume Date Well Completed 3/31/06 Putnam County Certification 004 Date Report 75 0 6 Well si Phi ip . Beal NOTE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. Well Driller's Name IF A pal & s Inc. Address: 4 Putnam Ave., Brewster, NY 109M . s 5 Signature: /= lolff • Date: 5/17/06 AV AP J. Beal White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC-97 June 8, 2006 Michael J. Budzinski, P.E. Putnam County Health Department 1 Geneva Road Brewster, NY 10509 RE: Individual SSTS Compliance Wolff - Lot #X3 159 Big Elm Road Patterson, NY T.M. #35.-4-4.3 Dear Mr. Budzinski: Enclosed are the following: Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 Tel: (845) 279740.03 Fax:. 50— Email: hnengineer@aol.com 1. Five (5) prints of Drawing. $-2,.'A$7BUiItPIan", dated 05/24/06. —1:. -`Certificat& of -Con siru ctio i i- C on,ipiiaice-fui--S--ewaye7Dispo-sai-SysL-erri'L, dated 05/23/06. 3. Three (3) copies of "Guarantee of Subsurface Sewage Disposal System", dated 05/31/06. 4. Laboratory Report, dated 05/17/06. 5. Well completion report dated 05/17/06. 6. Application Fee in the amount of $300.00 payable to Putnam County Health Department. 7. "E-911 address verification form", dated 05/26/06. Kindly process the enclosed at your earliest convenience. Very ruly yours, Harry W;. hols Jr., P.E. HWN:g 00-119.02 -PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF. ENVIRONMENTAL HEALTH* SERVICES GUARANTEE OF SU$SURFACE SEWAGE TREATMENT SYSTEM TN n1k; 4A Owner or Purchaser of Building Building Constructed by Tax Map Block Lot Town/Village ' I ELM P-d 10 Location - Street Subdivision Name Building Type.' Stibdivision Lot # I represent that I.. am wholly and completely responsible for the location, workmanship, material, constractiori and - 'drainage of the sewageireatment system serving tlie'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 parr—of said 'S)�stem constructed 6T* me which fails to operate ' fora 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 . _. 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 systems Dated: Month (35 Day � Year / General Cofitract or (Owner) -Irdno6re . Corporation Name (if corporation) Address: I 0 ' k144 WY150 -- State T 0J Zip 0'91` Signature: Title:- Corporation Name (if corporation) Address: /Q State %� Zip / 01-S 6 _. 27 7 IM L C) �� Form GS -97 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown. Heights, N.Y. 10598 .. _- ..fi.._..... -.. ..<.�.....�.... ,._. .. _, o, .._., ..,, L...�...��41:.4•. >; : �s��A =2'Ei' �1 ._..: - �.:::....... �. �.:. -,. <_._-..._ _...� ...�_w. _ , a q..�-.� , .._d... , Albert H. Padovani, Director LAB #: 9.600763 CLIENT #: 59405 NON STAT PROC PAGE: 1 BENNETT BUILDERS 312 BARRETT HILL ROAD MAHOPAC, NY 10541 SAMPLING SITE: 159 BIG ELM ROAD : BREWSTER COL'D BY: GEORGE NOTES...: KITCHEN TAP DATE FLAG PROCEDURE DATE /TIME TAKEN: 05/25/06 10:00 DATE /TIME RECD: 05/25/06 10:10 REPORT DATE: 05/26/06 PHONE: (914)- 843 -4266 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ------------------------ RESULT RESULT NORMAL - RANGE 05/25/06 MF T. COLIFORM ABSENT /100 ML COMMENTS: PICK UP IN CARMEL ABSENT COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER (WAS), (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDI HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. SUBMITTED BY: umkj e Alber H. Padovani, .T.(ASCP) Direct METHOD ELAP# 10323 YML ENVIRONMENTAL SERVICES 321 Kear Street Yn kt Hei hts, . 10598 ~~'' 'c�. �. Albert H. Padovani, Director LAB #: 1.603219 CLIENT #: 59405 NON STAT PROC PAGE: 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~-.~~~~~ BENNETT BUILDERS 312 BARRETT HILL ROAD MAHOPAC, NY 10541 DATE/TIME TAKEN: 06/01/06 04:00 DATE/TIME REC'D: 06/01/06 04:35 REPORT DATE: 06/06/06 PHONE: (914)-843-4266 SAMPLING SITE: 159 BIG ELM DRIVE, BREWSTER SAMPLE TYPE..: POTABLE : KITCHEN TAP ' PRESERVATIVES: NONE COL'D BY: GEORGE BENNETT TEMPERATURE..: NOTES...: ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ COL}FORM METH: N/A DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNMM CNTY PROFILE 06/05/06 LEAD (lMS) 1.0 ppb 0-15 ppb 9003 06/02/06 NITRATE N{TROG 0.64 116 /L 0 - 10 9052 06/02/06 NITRITE N}TROG <0.01 MG /L N/A 9162 06/06/06 IRON (Fe) <0.060 MG /L 0-0.3 mg/l 9002 06/06/06 MANGANESE (Mn) 0.013 MG /L 0-0.3 mg/l 9002 06/02/06 SODIUM 'Ma) 3.32 MG N/A 9002 06/01/06 pH 7.4 UN]TS 6.5-8.5 9043 06/05/06 HARDNESS, TOTAL l34 MG /L N/A 06/02/06 ALKALINITY (AS 124'11G /L N/A 9001 06/06/06 TURBIDITY (TUR <1 NTU 0-5 N711 COMMENT'S: PICK UP COMMENTS: Pb /CU LEAD limits for public schools are set at 15 ppb. EPA Lead & Copper Rule for Public Systems requires that no more than 10% of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg/L° else water treatment must be Linder ta/oen to reduce the waters corrosive potential. Fe/Mn Jf,both iron and manganese are present, their total value cOmbined shatl riot 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 shuuld contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L-. of Sodium is suggested. / Yljll... ENVIRONMENTAL SERVICES (91.4) 245-2800 Albert H. P-:td vani q Director tor• LAB # #: 1..60 321.9 CLIENT ## ' 59405 NON S T•AT F'Rt: C PAGE a 2 wwn.N/aNn Nn. ArNw Nn. eY w.wn NNw NNn.N.v n..awry rs.w A, r+. n. •ure Nw New n.n.rs. nr rs.wn.wn. n.Nn. nr /s. n.'n. n.wwn n.wn n. w.v n•wnr n +rvwn•A..a n..0 BENNETT BUILDERS e312 BARRETT HILL ROAD i11AHOPAC ,, NY 10541 DATE: /T 111 : 06-10J_/06 04 :00 LATE /TIME RE::C' D: 06/01f06 01f :2 RE='P'ORT DATE: 06 /06/06 . PHONE: (914)--843---4F266 SA11PL. is NG SITE.- 1.59 BIG ELM DRIVE., F1RE1pJSTE R I -4 -41` PLE TYPE—: PO'TABL_E : KITCHEN TAP PRESERVATIVES. NONE COL.' D BY: GEORGE BENNE•:TT TEilIPERATURE.+ a a NOTES... COL..IFC)RM METH: N/A NNrV.+•AINNNJYNrV IVNrV NIV.+r ry AINNrV N.0 .Y naNN NN wN NrV ..a ru.+. .V n♦ r\ r. al Yl.l Vn. rVN+ Y., Jw.a.uN+un•N.a.+.aa.u,+a.aNnln. n. r+ar ♦. a+l.rr+,.+, n..r. ... +. /N DATE = FLAG PROCEDURE RESULT NORMAL. – RANGE METHOD pH pH SC:AL..1E. IN WATER RANGES FROM 1-14. I104iaURE::11ENT OF ro-i IS ONE 01= THE IMPORTANT AND F'RE QUE:.NTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW p I-! MIGHT DE:. CORROSIVE TO h'IFTAL PIPES AND E I XTURE_S .. THE NORMAL.. RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL.. HARDNESS IS DEFINED AS THEE SU11 OF THE: CALCIUM 8.- i''Ir'tGhiES I UI °! CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE :: q IN MG/L. THE HARDNESS MAY RANGE: FROM 0 TO HUNDREDS OF MG /L., DEPENDS (IN THE SOURCE: AND TREATMENT TO WHICH 'T'HE WATER HAS BEEN SUBJECTED., SOFT WATER.- 070 MG /L VERY HARD WATER.- ADOVE:: 3oO MG /L_ MODERATELY HARD WATER-. 70- -1417 MU /L. 1,11E /I... = M I I. L.A EiRAI'll PER LITER -HARE WATER,- 14- 0-300 � 17, 11,16- /L:) SUBMITTED BY: Albert. H,. Paclovan i ., M,, T., (ASCF' ) Director E:LAP #k 10-''c'_3 P °UTNAM COUNT' DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET'- SUBSURFACE SEWAGE TREAT1VIENT SYSTbf 1 0 .�_ ' �g Owner d1 s�-..� �,�, ee �� Address 11790 ji±, )4�7 l/ k. . Located at (Street) Tax Map Block Lot (indicate nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA C3 C., Date of Pre-soaking b/ / 0 G ate of Percolation Test ii l percolation test.hole. (i.e. s I min for 1 -30 min/i submitted for review. 2. Depth measurements to be made from top of hole. nch, s 2 min for 31 -60 min/inch) All data to be Form DD -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM -------------- Owner Ckc-4 n-4 - CJfz —Address 17 Located at (Street) Tax Map Block Lot (indicate nearest cross street) Municipality Date of Pre-soaking Watershed SOIL PERCOLATION TEST DATA If 0/0 C Date of Percolation Test NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. .g I 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 11 e .... .... F r-rour, i Tm T .:.SSu fa h ...... .... ... . .. . .. . P:;....;;;:.;; :;:.::: ...... tart Q P ........... UPI- /j,'31 2, 7q 2 t"101 30 ✓h �.2_ 215 3 12: 39 30 n1r n 22 ` Z`f %( Z 4 5 0; 11 3 0 2— 0 2 to 30 2-2— go 3 30 22- I 30 4 5 2 3 4 5. NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. .g I 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 11 PUTNAM. COUNTY. DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Zo77 DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner CA/,_--sZ6j&r —.Address Located at (Street) Tax Map Block Lot (indicate nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA Date of Pre soaking 0 a of Percolation Test NOTES: 1. Tests to be repeated at same depth until approximately equal, percolation rates are obtained at each percolation ' test hole. (i.e. s I min for 1-30 min/inch, ,5 2 min for 31-60 min/inch) All data to be submitf6d for review. 2. Depth measurements to be made from top of hole. C9 Form DD-97 M .. ..... ..... X.: ........... . ............... ......... IM ...... EA . ...... . . n.; .. . ..... . . . . 30 2-o 2 2-0 3 Z itqj L L% Z. 2-0 4 2 2 jj'V? 30 11111;1 2,5 2-f 2- l 'L_ 2_.0 3 4 5 2 3 4 5. NOTES: 1. Tests to be repeated at same depth until approximately equal, percolation rates are obtained at each percolation ' test hole. (i.e. s I min for 1-30 min/inch, ,5 2 min for 31-60 min/inch) All data to be submitf6d for review. 2. Depth measurements to be made from top of hole. C9 Form DD-97 M PUTNAM COUNTY DEPART M. ENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ©T DESIGN DATA SHEET SUBSURFACE SEWAGE TREAT NT -SYSTM __.. - - - -- Owner UT ���FL Addresso�,�y k Located at (Street) Tax Map Block Lot (indicate -nearest cross .street) Municipality TZSQn) Watershed �S7' 3A? AICu SOIL, PERCOLATION TEST DATA Date of Pre- soaking Date of Percolation Test �ttirtage;:: 1 2 3 n .l NOTES: 1. Tests to be reheated at same depth until aooroximately 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 PUTNAM COUNT' DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES L©?- ope DESIGN DATA SHEET - SUBSURFACE SEWAGE -TRa� Ar— M-- ENT -SY ST—EM - = Owner jiyUi JL 1 T7 Address���Y /GL 7Zod D k Located at (Street) Tax Map Block Lot (indicate nearest cross .street) Municipality y7�gT-7 -�7� jam) Watershed j� J 23Re&ZjLtj SOIL PERCOLATION TEST DATA Date of Pre- soaking Date of Percolation Test tiarfac 7 I I I I . I I I I NOTES: 1. Tests to be repeated at same depth until avoroximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 'l -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 Inc UTNAM COUNTY DEPARTMENT OF HEALTH DM,SION OF ENVIRONMENTAL HEALTH SERVICES Z-©�- DESIGN DATA SHEET - SUBSURFACE SEWAGE T AT-M— ENT- SYS =r] m Owner? NUT 7� i n �_ Address t Located at (Street) Tax Map Block Lot (indicate nearest cross street) Municipality Watershed O o} �57- 23,i e4d,6 SOIL PERCOLATION 'TEST DATA Date of Pre- soaking Date of Percolation Test 1 El 5 1. Tests to at same depth until approximately equal percolation rates are at percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 PUTNAM COUNTY DEPARI'1VIENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Z-©T DESIGN DATA SHEET - SUBSURFACE SEWAGE TREAT -MENT- SYSTEM - - Owner Address k Located at (Street) Tax Map Block Lot (indicate nearest cross .street) Municipality P r,7- ;61Z.SOn) Watershed "!57- 23 SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test NOTES: .1. Tests to be repeated at same depth until approximately equal percolanon rates are voiainea aL Caen percolation test hole. (i.e. s I min for 1 -30 min/inch, s 2 min for 3140 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of.hole. Form DD -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LoT DESIGN DATA SKEET SUBSURFACE SEWAGE TREA-TXEN- T- SYS-T- -F1VI __._...... -- Owner C,[/NU�- 1F_ Address�,iGL k Located at (Street) Tax Map Block . Lot (indicate ,nearest cross .street) Municipality Watershed 0,,V i57- 23 SOIL PERCOLATION TEST DATA Date of Pre- soaking Date of Percolation Test percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 =60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES G©-- DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATA- WNT-SYS -T -FM - - - Owner Address,��Y /GL k Located at (Street) Tax Map Block Lot (indicate- nearest cross.street) Municipality . PAZ;!]6ZZ'50A) Watershed i5,0 S77 73J4''A Gy SOIL PERCOLATION TEST DATA Date of Pre- soaking Date of Percolation Test P) M 3 �n:rtace; 3 4 5. 1 1 - 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 mm/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 PU TNA.M COUNTY DEPARTMENT OF HEALTH DIISION OF ENVIORONMENTAL HEALTH SERVICES Z-©7- :. -. � ....._ _ , .. .:. w_:.:..:_...�..... - DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SY9`g'1ffM :.__ 1., Owner G,�, � NUi- 7z 117 - Address M©ogg-: T�o,�i D —r t Located at (Street) Tax Map Block Lot (indicate nearest cross .street) Municipality TZSp� Watershed �S7 SOIL PERCOLATION 'PEST DATA Date of Pre - soaking Date of Percolation Test NOTES: 1. Tests to be repeated at same depth until aooroximately equal percolation rates are obtained at each percolation test hole. (i.e. s l min for 1 -30 min/inch, s 2 min for 31 -60 minlinch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 ._. - .__.- -� W ®® 503° 10 OD Q . m 8L N r m L ..• _ �•. � ... -- .• : .:" -., .. ° _�.,. ._ - Fir•`- 'i;)- Fes:.- i•;;v�ti.° ^r :�iiF,ui . - .. .. .� - �.. . ..... _" _,. . - ' t� ;..... .. .; Lac y'Iq t ?�• .av7r•-••' ?,;.` "` >,� ' 1 E�C4 SI.TE LOC. SCALE: 1 41.19 ' An s� PROPERTY SHOWN ON m d TAX MAP: i v+ t° P n 84.96' w L \t � 0 \ G� O 4 \ a 1250 cal Do ' SING .. ._. ..... � ri 40$ Sobb Pdc S + D¢.34 N SOX U) sG'-AY D. Box .Q L.F ASS, T/1BNCN T y 35'.. SoL,D PJc (TYPy b4 PROdEG7 E �1 133 wS ' 8 -WAY a. eox a� - o RATRICK Bc UORIS( � W r. P _�� - W ~� ~ z5 A RTOW GF,PAF[EASU CLtET y c ,� ---, < THOMA ikk ' 7 � T 25 - 244 - i (I; C DRAWIN6,.TITLE 1 A►to.m counts D�pyrtsent of Health AS BL Divielon of ravironmental Health Servioee L wee, f Approved as noted for oonformenoe with applicable Haled and 8egulatione of the0* Y . Pu nam coua+t9 H lth Dep�taent. I slete Suture ntl c r I {Zo uva�1 for PCN.D Approval 5famp `` .. 11 ` r} iv t Sheet 0f * PUTNA VI COUNTY DEPARTiVIENT OF HEALTH .y DIVISION OF ENVIRONMENTAL HEATLH SERVICES - Ir'R�t'� iiZ�t NAMF,f _ Street' _ _ Towri- . State Zip z - PERSON IN CHARGE/ s nR TNTFRVTFWRi-I -. ... - -.yam � °.Marne` and _Title: TYPE OF FAGILIT.Y �(i ✓ , c o FINDINGS �• -- � '...' -au � ° -a.. -!. -. ... - -.yam T .H xN d Ih � a Sign ure d Tit t A e vlrmvp I acknowledge = receipt of this :report SIGNATURE: , S _ r 02/ 96 Title T11TR111C ?9AMIT 70R Et v n t N MQ off, PERMIT # - `O' tv M -fJ Located at 464J Town or V' ge 1 2Piy�G Subdivision name Subd. Lot # Tax Map 35', Block Lot -'1 Date Subdivision Approved D-1 Jam, 1 ql j Renewal Revision _4ef:� Owner /Applicant Name T� jo cos (�d/ Till Date of Previous Approval 14:0- Mailing Address 2 � ,t4atir & e-c e-r- KQ -i-d LS hc- -L C4 PC-)- k zip.. 16:7.6.9 Cr Amount of Fee Enclosed 200 Building Type !e r r�, Lot Area, S�-No. of Bedrooms Design Flow GPD �d0 Fill Section Only Depth Volume PCH D NOTIFICATION IS REQUIRED WHEN FILL. IS COMPLETED Separate Sewerage Ustem to consist of 12-� Q gallon septic tank and &3 C /-, �1 Other Requirements: r) - ( 0 e4 Z LJ To be constructed by % h 1) Watez SUAPflue Public Supply From Private Supply jDrilled _by__ 7- , Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment s, sy tem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date 2 - 23 -Q S' License #G 12..4 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 wKe—n onsiderqonecessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe (r7rX1is charge of domestic sanitary sewage ly. By: Title: Date: 'eh 0f 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 Well Location: Street Address: Town/V' ge Tax Grid # Map 3,5,, Block Lot(s) �f Well Owner: Name: /1A �`44 Address: 1 AaK d �Jn a rd C14 e' �L J�-r 16 71 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 S' * gpm #People Served Est. of Daily Usage 02g 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 t,/ No Name of subdivision C fair V- Lot No. Water Well Contractor:" lFi Address: Is Public Water Supply available to site? ............... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: /+ Proposed well location & sources of contamination t be provided on separate s et/plan. Date: 72 .7n 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. An revision or alteration of the approved plan requires a new permit. Well to be constructed by a water wel 'ller certifie by Putnam County. Date of Issue J i Permit Issu' ic' d�►-d' Date of Expiration 3 Title: Permit is Non-Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 SHERLITA AMLER, MD, MS, IiAAP c.. x. .r.. v—.. w.n.:rl.•.ri'm1: `':'�.�.L�i��...�liJ`i'IEisiL /I _. ._.. ..... ..r ca...._.w .- LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Harry Nichols, P.E. Patterson Park, Ste 106 2050 Route 22 Brewster, NY 10509 Dear Mr. Nichols: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 August 26, 2005 Re: Proposed SSTS: Wolff Big Elm Road, Lot # 3 (T) Patterson, TM # 35 -4-4.3 County Executive Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: 1. The sewer line is to be shown with (2) 45° elbows. 2. The number of bedrooms is to be- labeled t ... ........ .._ . _ _ � _ .,.. on-the p.ar, view.- - � - -• - � -- - _. _ _ . Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:kly V y yours, /lam/ obert Morris, P.E. Senior Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 TNAM COUNTY DEPARTMENT OF HEALTH ION OF ENVIRONMENTAL HEALTH SERVICE s _,:CO ?ST J.!Q.TTi�N ��: RMT�':: F. y Located at 13 9 ko�rj Town or V... c Subdivision name w Subd. Lot # 3 Tax Map 3 S- ; Block Lot Date Subdivision Approved a- C1 Renewal �� Revision Owner /Applicant Name 71. o kqS 001 `W Date of Previous Approval -f -11- G L Mailing Address 6 4-� � cv� �� � cn ��k- .�- dt � (� RS �.�L , �s �-c° r Wzip a Amount of Fee Enclosed !10 I Building Type Lot Area 2,526 -No. of Bedrooms - Design Flow GPD aoCJ Fill Section Only Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of O gallon septic tank and r is Other Requirements: y -- 1,9 " l'1 To be constructed by Address Water Supply: Public Supply From Address or: Private Supply Drilled by Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date ` °-4 —O'S' License # S'6 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. Approve r disch ge of domestic sanitary sewage only. j By: Title: Date:, 3 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 ?UTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL - <v - Y�l.:1YD..1'e Mir if' Well Location: Street Address: Town/Village Tax Grid # 131 C7 ,� 1-o7*,evfo&i Map -3S, BI ot(s) 4) 3 Well Owner: Name: Address: /J Use of Well: 4.-,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 5-+ gpm # People Served 4 - Est. of Daily Usage 90Q gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling 4,-"'New Supply (new dwelling) Deepen Existing Well Detailed Reasons e,r� /� zS, �"� ►` for Drilling Well 'Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes L11, No Name of subdivision Lot No. _ Water Well Contractor: % Q t) Address: Is Public Water Supply available to site? ................................ ............................... Yes No Name of Public Water Supply: /�- Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on s par to sheet/plan. Date: 3 -�-� - Q Applicant Signature; . G 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 waterw 1 driller certified by Putnam County. Date of Issue a Permit Issui a 1 f� J Date of Expiration l Title: Permit is Non- Transfer ble White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 R ou to 22 Brewster, NY 10509 4 citphQu (9431279�3 WGI To: ff D' OCA Attention: Gehtlem'en: We enclose copies of 81-W Prints Reproducibles Specifications Memorandum Description: Date: Job No.: Project 'Ig mafd kJO 3 A V Reports Tracings Copy of letter Revision/Date No. F-I Sent Via: Y"'Our Messenger Nueprinter First Class Mail Special Delivery Your Messenger Hand Delivery Very t I y.yours m�,�. P"E. Ham W'UNi ols Jr., P' T March 7, 2005 Robert Morris, P.E. . Putnam County Health Department I Geneva Road Brewster, NY 10509 Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 Fax: (845) 279-4567 Email: hnengineer@aol.com RE: SSTS Renewal — Thomas Wolff, Jr. Clarke Subdivision — Lot # 3 Big Elm Road Town of Patterson T.M. # 35.-4-4.3 Dear Mr. Morris: Enclosed are the following: 1. Five (5) prints of SS-3, "Proposed SSTS", rev. 03/04/05. 2. Construction Permit-for Sewage Disposal- System",,. dated 03/04/05. 3. Application to Construct a Water Well", dated 03/04/05. 4. Review Fee in the amount of $400.00. The SSTS System was installed and inspected by the PCHD. Since the well was not installed prior to the expiration date on the permit, we are submitting for renewal of the permits. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, Harry W. ichols Jr., P.E. HWN:gav 00-119.00 PUTNAM COUNTY DEPARTMENT OF HEALTH �� HEALTH SERVICES DIVISION OF ENVIRONMENTAL H .__. @- ...,....__._..."- :CONS- `TRUC'lION*'PE 'T-" O _:E °TREA�n tw- sVSTEi i:....._ ... _,::..... . 0 SR PERMIT # - o) q � S� -- / Y 0 l a, l `� 00 Located at r9 I ©PtD Town or Village Subdivision name —� Date Subdivision Approved Owner /Applicant Name _ Subd. Lot # Tax Map R.A. Date i 101w Block 4 Lot 4" � 1 1� i i I Renewal X Revision -n' Q m �y5 JP-' Date of Previous Approval Mailing Address J5 (v MMAC AL"�J 95�L POP�D FWCftel& R� Zip Amount of Fee Enclosed Building Type Lot Area 1-1 No. of Bedrooms '4 Design Flow GPD X300 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of I'�'�d gallon septic tank and q W_ T41AWA Other Requirements: ` 1 b, FIL FO_ LEV��� M(A ) 00 11 9 1p To..be constructed by T-60 Address Water Supply: Public Supply From Address or: ;...._ Private- Supply- rilled by ...__� _: Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatments sy tem 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: r,d P.E. ;)e R.A. Date i 101w Address �L-D Q �-�- ADTIEV_ j H o 70 i License # %1/11 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 modifiep when considered necessary by the Public Health :Director. Anyrevision or alteration of the approved plan requires a new dermit. Approved hr discharge of domestic sanitary s age only. By: Title: Date: -� .r2 White copy - HD File Yell opy - Building Inspector; Pink copy - Own. ; Oran a opy - Design Professional Form CP -97 {� ,.� �- . -, , i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION. TO CO.NS.T.RUCT A. WATER WELL n ,...c...,M�............�, ..... .-.. -r. .,_••please •print or type ,......_.....:_..... PCHD Permit #`JW '"/'f .01 ,._.... l� Well Location: Street Address: TownNillage ' Tax Grid # 016 E✓ K PATT6P - /D1D Map + Block 4 Lot(s)�• Well Owner: Name: f I J �- Address: 6 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 r gpm # People Served '� Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling X New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No x Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Lot'No. 3 Water Well Contractor: To Address: r Is Public Water Supply available to site? .................................. ............................... Yes No A Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date:y �� I i'�� �� Applicant Signature': ".. ,.. _..�� PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue ` Permi Date of Expiration Title: Permit is Non- Transf rrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 r' e a Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 Tel: (845) 279 -4003 (845).378.--4367,"t - �i Email: hnengineer@aol.com August 24, 2005 Putnam County Health Department 1 Geneva Road Brewster, NY 10509 ATT: Robert Morris, P.E. RE: Proposed SSTS Revision — Thomas Wolff, Jr. Clarke Subdivision — Lot #3 Big Elm Road Patterson, NY T.M. # 35. -4 -4.3 Dear Mr. Morris: Mr. Wolff wants to shift the location of the proposed residence which will require a change to the well and septic line servicing the residence. The SSTS system was previously installed, including the septic tank, and inspected by the PCHD. RefleEt lg -tlae above, -we are enclosing the;foalowitZg;....:x_:. �.... o 1. Five (5) prints SS -3 "Proposed SSTS ", rev. 08/22/05. 2. "Construction Permit ", dated 08/23/05. 3. "Well Permit ", dated 08/23/05. 4. Revision Fee in the amount of $200.00. 5. Print of Dwg. A -1 "Foundation Plan ", previously stamped by PCHD. Kindly process the enclosed at your earliest convenience. Very truly yours, Har W. Nicho Jr., P.E. HWN:gav 00- 119.00 NEW YORK STATE DEPARTMENT OF HEALTH Specific Waiver Bureau of Community Sanitation and Food Protection from Requirements of Part 75 and Appendix 75- A,10NYCRR for Individual Household Sewage Treatment Systems Name of Applicant No.. Street City/Town State Zip. Address 11149 (Wi r �R r- e4twM & Q» ar 01 No. Street City/Town State Tip Site Location %14 aot 04 1. Reason why site does not meet 10NYCRR Appendix 75 -A (check appropriate box(es)): Separation distance cannot be achieved. €xcessive slope. E] High groundwater. Inadequate depth to bedrock or impermeable layer. Soil unsuitable. Other (explain) 2. Proposed design or conditions of waiver: ................................................................................................................................................................................................................. ............................... SWV96 41-oft .............................. ............................... ............... ®........... pP.. .� ►..t��t .....�9... °ea......`�.........e Vd............................. .��....... &.......6 six" �. � ...............®. �....... �. �®. �... �......: �1................................................. ............................... 3. The proposed design may have the following limitations (check appropriate box(es)): JIncreased risk of well or spring contamination. Increased risk of surface water contamination. Expected design life of the system will be diminished. i Operation of sewage system is subject to mechanical problems. Other(explain) ................................................................................. ............................... .................................... ............................... Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health.Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked by toe issuing official for a change in conditions for which this waiver was granted. r J&W ION OF EALTii OR IGINAL - Local Health Agency COPY - Applicant/Design Professional / ................ ............................... r DOH -1326 (7/92) (GEN -152) PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I'THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes %0 B,. tNll� ACTION RECEIVE;COORDINaTw REVIEW ASRROViOED r 3R UNcfSTEiiCTiONS IN 6 NYCRR, PART 617.61 If No, a negative declaration " ri5ay`be Vl another Involved agency. ❑ Yes o 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-, WO 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: MCI, 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 U C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. ME C6. Long term, short term, cumulative, or other effects not identified In C1-05? Explain briefly. L► C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. M u: fS'THERE; OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes %No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS, For each adverse effect identified above, determine whether It Is substantial, large, Important or otherwise significant. Each effect should be assessed in connection with Its (a) setting (i.e. urban or rural);.(b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts Which MAY occur. Then proceed directly to the FULL EAF and /or prepare a*positive declaration. heck 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: � - t l rc` (_ or Type Name esponsi le Officer in Lea d ncy ^ Title of Res nsi6T Officer Signature Resporis fficer in Lead Agency Signature of Preparer (If different from responsible officer) =�1_-0/ Date 2 BRUCE R.. FOLEY : ..:...: . ... . . Public Health Director LOR ETTA M0LIN.W . R.N.; Nf.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914)278-6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAVIER NAME: ADDRESS: kA (C 0 67� A® EAT r. W95 fu b SITE LOCATION: DATE: STAFF PRESENT: Bruce F., Rob M., Nfike B.. Adam S.. Gene R.. Shawn R., Bill H. SPECIFIC WAVIER REQUEST: or- DOES THE PROPOSED VARIANCE REQUEST POSE A.HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? YES NO WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? YES NO DISCUSSION REQUEST APPROVAL OR DENTED APPROVED DENIED REASO FOR DX=W DIRECTO _OF PUBLIC JEALTH PUTNAM COUNTY DEPARTMENT. OF HEALTH .DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner —D+ o TP6 Address. � Located at (Street) &0 ELJ \ FAP'VQ "� Tax Map ;-S Block 4 Lot (indicate nearest cross street) Municipality Watershed, SOIL PERCOLATION TEST DATA Date of Pre - soakin g Date of Percolation Test NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, 12 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Fdm DD-97- ..... ....... ....... .... ... ... ..... E . ........ -p Tom:' rg"..6"45 ;Water .... .. .. . .. :fin.:::' : ... .. .... ...:...Rate . ... .... . in. tjo t ne 2 fi o► �, A 2�4ti %�� Q j 3 01 4 -711 2 -711 3 2j 4 .5 2 �3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, 12 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Fdm DD-97- TEST PIT DATA 2. DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES , L1 "HOLENO' .- DEPTk G.L. 0.5 1.01 1.51 2.0' 2.5' 3.0' 3.5' 4.01 4.51 5.01 5.51 6.01 6.51 7.01 7.5' 8.01 8.51 9.5 10.0' k P--t WkTn", U- 01 "TUNkA� 1- A'—V W m MmN t, /),,— Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encou tered Deep hole observations made by: 'Date Design Professional Name: H(OWLS jq- PE Address: Signature: JVflw Design Professional's Seal N qA N IC11 C�/ No. PUTNAi�I COUNTY DEPART�IE -T OF HEALTH DMSION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS, „ P.E 'MW 5TiFE3 OR COrSTRUCTIOlY PE/R��TTT.•i .:........__.. _ .,. ... .r.,.. �_ NANtE OF OWNER: G�JC� / FF STREET LOCATION: lQ /6 ElA 904h REVIEWED BY: R`L OR, AS, .GTE: TAX MAP #: (CONFIRMED) Y N DOCUMENTS (,,( JPER:-vlTT APPLICATION (ZUWELL PERINffT OR PWS LETTER UUPC -97 ()(LETTER OF AUTHORIZATION (e!!�)(_JDESIGN DATA SHEET (DDS) (__)(-/JCORPORATE RESOLUTION UUSHORT EAF (�(JPLANS -THREE SETS UHOUSE PLANS - TWO SETS UUVA.RIAN CE REQUEST SUBDIVISION ULULEGAL SUBDIVISION (j--)LJSUBDTVISIO.i APPROVAL CHECKED UUPERC RATE UL!)YMLREQUIRED DEPTH ()LJCURTADi DRAL\ REQUIRED GENERkL U( _JLOCATED Iii NYC WATERSHED (�U(_JPLANS SUB` ITTED TO DEP (LjUDELEGATED_T O.PCHD . ( )v_)DEP APPROVAL, IF REQ'D (f/JL___)DEEP TEST HOLES OBSERVED of UPERCS TO BE WITNESSED (/)UEX- APPROVAL SSDS ADJ, LOTS L j(_e:�-)WETLANDS (TOWN/DEC PERbffr REQ'D ?) (/) )DATA ON ER DDS PLANS & PvIlT SAME (_-)UPRE 1969 NEIGHBOR NOTIFICATION (. J.(.ULETTER BI/ZBA ' "(�)Y�100 Y'R' F1:0OD ELEVATION FVR 200' UUSOTL TESTING LOTS >10 YEARS OLD REQUIRED DETAILS ON PLANS UUSEWAGE SYSTEM PLAN - (NORTH ARROW) ( JLJSSDS HYDRAULIC PROFILE UUGRAVITY FLOW VJLJCOi iSTRUCTION NOTES 1 -15 (%j(__)DESIGN DATA: PERC & DEEP RESULTS (:!!�)(_j2' CONTOURS EXMVG & PROPOSED (/ (�DRTVEWAY &SLOPES, CUT - �(__)FOOTING /GUTTER/CURTAINbRAINS (�USDA SOIL TYPE BOUNDARIES L_/ L jTTTLE BLOCK, OWNERS NAME ADDRESS TM #, PE/RA; NAME, ADDRESS, PHONE ((__)DATE OF DRAWING/REVISION (__,g( _JDATU1l REFERENCE U(_JLOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. (JLJPROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS (}UWELLS & SSDS'S W/IN 200' OF SSTS (—/J(_ jPROPERTY METES & BOUNDS Y IN (REQUIRED DETAILS ON PLANS CONT'M (,/J( )HOUSE SEWER -' /" FT. 4 "0'; TYPE PIPE CAST IRON (_, jUNO BENDS; MAX BENDS 45° W /CLEANOUT RENEWALS )LjSTTE NOTE (NO CHANGE) FILL SYSTEMS vU10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE (__)UFILL SPECS/ FILL NOTES 1 -5 (/S )FILL PROFILE & DIYIENSIONS (_ZUFILL IN EXPANSION AREA FILL GREATER THAN2 FEET X_)DH RRIER UTIFICATION NOT E AUGES UPLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS ION DISTANCE FROM TOE OF SLOPE r TREN C (�/ (__)LF TRENCH PROVIDED TSUI 60FT MAX. LJPARALLEL TO CONTOURS (�_)U100% EXPANSION PROVIDED. — (Zj( JDETAIL/DUST FREE - CRUSHED STONE OR WASHED GRAVEL (__)GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS (,ZLJ10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL L320' TO FOUNDATION WALLS .. 0100' TO WELL, 200' L i DLOD,150' TO PITS 0100' TO STREAM, WATERCOURSE, LAKE (inc. espan)- (__)50' TO CATCH , BASIN, 35' STORMDRAIN, PIPED WATER ....:.U10' -TQ WATER LIIYE'(Pits (�)LJ50' INTERMITTENT DRAINAGE COURSE ( JLJ2007500' RESERVOIR, ETC. —150' GALLEY SYSTEMS (�U10' i4W TO LEDGE OUTCROP SEPTIC TANK (ZjU10' FROM FOUNDATION; 50'. TO WELL -. WELL (%(__)DVylENSIONS TO PROPERTY LINES ([,(LOCATION OF SERVICE - CONNECTION - - U(_)MRN 15' TO PROPER L ' (n( JSLOPE IN SSTS AREA (520 %) (!_)(REGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS U(�r U14P NOTES (,�6LJDOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED (/,(DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) . ((__)PTT AND D -BOX SHOWN & DETAILED (ZJ(__)1 DAY STORAGE ABOVE ALARM CURTAIN DRAIN �(_)STANDPIPES, 5' BOTH SIDES, DETAIL _L j15' MIN to CDS = >5 %, 20'4%,25'-3%,35'-l%, 100%-<I% (:::�)(_j20' ML( to CD DISCHARGE /100' with 182 cons day discharge _J10' MIN to NON- PERFORATED PIPE COMMENTS: (REVSHEET) Harry W. Nichols Jr.,T.E. Patterson Park, Suite 106 M, WA •- = �050 Route 22i _ Brewster, NY 10509 Telephone (845) 2794003 Fax (845) 2794567 February 21, 2001 Department of Health One Geneva Road Brewster, New York 10509 Aft: Robert Morris, P.E. Senior Public Health Engineer Re: Proposed Construction Permit:. Wolfe Big Elm Road, Lot #3 (T) Southeast, TM #35. -4 -4.3 Dear Robert: In response to your letter dated February 14, 2001, we offer the following: L A waiver is hereby requested for approval of an SSTS on a slope greater than 15% for this project (Approximate slope of SSTS is 18 %). Please place this project on the next available waiver meeting for consideration. If you have any further questions please call. Very truly yours, Harry W. ichols Jr., P.E. HWN:JM:jm �'alfe -- ., -- BRU'CE -R-- F©LESS... . _._....,.... ...... -.. _ , Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LOREi -A ' M0LiIlVlilC - R- N- ,-TV1`S.1Y: • :.:r.-: ti 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 Preschool (845)228-6108 Fax(845)278-6648 February 14, 2001 Harry Nichols, P.E. Patterson Park Suite 106 2050 Route 22 Brewster NY 10509 Re: Proposed Construction Permit: Wolfe Big Elm Road, Lot #3 (T) Southeast, TM# 35.4-4.3 Dear Mr. Nichols: Review of plans dated November 9, 2000 last revision dated January 12, 2001 and other materials relative to a construction permit for the above captioned property has been completed by the Department. Based upon such review, and pursuant to the provision of Article III of the Putnam County Sanitary Code, you are hereby advised that the proposed method providing water supply and sewage disposal are considered inadequate as set forth below. Therefore, approval of these plans cannot be granted. 1) The SSTS is proposed on a slope of approximately 18 %. Current codes do not allow the construction of a SSTS on a slope greater than 15 %. It is your legal right to request a waiver of the denial based on item(s) noted above. The denial request must be submitted in writing fie, the receipt of this letter. The request must specifically state the waiver being sought. If you have any questions, please call me at ext. 2166. Very truly yours, 4�� tqw"k.� CTI�) Robert Morns, P. E. Senior Public Health Engineer RM:tn BRUCE _ R. FOLEY ..`�.., - ^Public ��tii °Dir`ec7or="�.._ ...:�.•� ._ _,..,.:_:.. .. r LORETTA MOLINARI R.N., M.S.N. • « —�- . - � r :-`.alssoriategsPublic: , lealth -Director ._„ _ .- a_, _ r, Director of Patient Services DEPARTNIENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Harry Nichols, P. E. Patterson Park Suite 106 2050 Route 22 Brewster, NY 10509 Re: Wolff, Big Elm Road (T)Southeast Dear Mr. Nichols: December 19, 2000 Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed.. Comments are offered as follows: 1. Provide north arrow for septic plan. 2. Provide- fill- specifications and fill. notes where applicable. 3. Current Putnam County Sanitary Code d6es'n6t a110W the con`structiori of-an`SSTS "oii-' °" -- -__ slopes greater than 15 %. 4. The septic area for the proposed residence is approximately 18% slope. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Sincerel e7- 6Shawn Rogan Public Health Technician SR/jp Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 -;.z--'z205O,Route�Q7..' - Brewster, NY 10509 Telephone (845) 2794003 Fax (845) 279-4567 January 12, 2001 Putnam County Health Department I Geneva Road Brewster, NY 10509 ATT: Shawn Rogan RE: Wolff, Big Elm Road Town of Southeast Dear Shawn: In response to your letter dated December 19, 2000, we offer the following: 1. North Arrow is now provided. 2. Fill specification and notes have been added to the plan. 3. Comment noted. It is anticipated that a waiver will be required. 4. Comment noted. Thank you. V truly yours, ur Harry W. Nirols Jr., P.E. HWN:JM.jm 00-119.00 BRUCE R. FOLEY Public DEPARTMENT OF B EALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. ealth • 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 Preschool (845) 278 -6082 Fax (845) 278 - 6648 December 19, 2000 Harry Nichols, P. E. Patterson Park Suite 106 2050 Route 22 Brewster, NY 10509 Re: Wolff, Big Elm Road (T)Southeast, TM #35. -4 -4.3 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 December 18, 2000 is complete. The Department will notify you by January 7, 2001 of its determination. The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. 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•tt�e above, addl`ess: -This notice must -rric lode your lame; 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 -6130 ext. 2159. Sincerely, Shawn Rogan SR/jp Public Health Technician December 8, 2000 Robert Morris, P.E. Putnam County Health Department 1 Geneva Road Brewster, NY 10509 RE: Individual SSDS - Thomas Woff, Jr. ?atnck & Doris Clarke Subdivision Big Elm Road - Lot #3 Town of Patterson Dear Robert: Enclosed are the following: 1. Five (5) prints of SS -3, "Proposed SSDS," dated 11- 10 -00. 2. "Short EAF," dated 11- 10 -00. 3. "Application for Approval of Plans for a Wastewater Disposal System." 4. Construction Permit for Sewage Disposal System," dated 11 /10 /00. 5. "Application to Construct a Water Well," dated 11 /10 /00. E. "DCs.ign Data Shcek" . 7. "Letter of Authorization," dated 11 /10 /00. 8. Two (2) copies of Residence Floor Plan(s), For Bedroom Count Only." 9. Review Fee in the amount of $300.00. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, Harry W. Ni ols Jr., P.E. HWN:his 00 -119.3 ,Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 • Brewster, NY 10509 Telephone (845) 2794003 Fax (845) 279-4567 December 8, 2000 Robert Morris, P.E. Putnam County Health Department 1 Geneva Road Brewster, NY 10509 RE: Individual SSDS - Thomas Woff, Jr. ?atnck & Doris Clarke Subdivision Big Elm Road - Lot #3 Town of Patterson Dear Robert: Enclosed are the following: 1. Five (5) prints of SS -3, "Proposed SSDS," dated 11- 10 -00. 2. "Short EAF," dated 11- 10 -00. 3. "Application for Approval of Plans for a Wastewater Disposal System." 4. Construction Permit for Sewage Disposal System," dated 11 /10 /00. 5. "Application to Construct a Water Well," dated 11 /10 /00. E. "DCs.ign Data Shcek" . 7. "Letter of Authorization," dated 11 /10 /00. 8. Two (2) copies of Residence Floor Plan(s), For Bedroom Count Only." 9. Review Fee in the amount of $300.00. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, Harry W. Ni ols Jr., P.E. HWN:his 00 -119.3 14.16.4 (9195) —Text 12 PROJECT I.D. NUMBER 617.20 S EQ R Appendix C State Environmental Quality Review ; ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME 3. PROJECT LOCATION: nn F H Pt M RNITr= � JrH Municipality County 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) R1 G E�-m -o Pub 5. IS PROPOSED ACTION: (gNew ❑ Expansion ❑ Modlficatiordalteratlon 6. DESCRIBE PROJECT BRIEFLY: ►N1���i�pv�L. �T� 7. AMOUNT OF LAND AFFECTED: 2 � 5 �' �� Initially acres Ultimately acres B. WI L PROPOSED ACTION COMPLY WITH EXISTING ZONING OR-OTHER EXISTING LAND USE RESTRICTIONS? ILYY03 ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ❑ &o list Yes if yes, agency(s) and permitlapprovals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes t&o It yes, list agency name and permll/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes INo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE I 109 Appllcant/sponsor name: Date: Signature: V If the action is In the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No 8.. Y.;}.I ;4CT I.Ot4,FRECEIVE:COORD!NA.TSD.J MIEW.A&PAOL VIDED FOR.WL ISZEE2 AyTiGNS >IN•c NYlrRA; PART 517:6? •; •H %NO; s r�atd+Fadeolaraitrin= 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: Ca. 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. C6. Long term, short term, cumulative, or other effects not Identified In Cl -CS? 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 CEA? ❑ Yes ❑ No E.: IS�TH ERA- c t _ . fi......Q.9..IS T�iERE_tJ.KEI.y T0_BE,. CONTROY_RSY .gEI.A._EL' TO- POTENTIAL AD` -!ERIE ERlLrlROl�lM£N -T. ".L I1 ",P.^,C ?S? ;._.._. ..._._. _ .._ ❑ Yes ❑ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed. If question D of Part II was checked yes, the determination and significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. ❑ 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 Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) Date 2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIW$10N,,OUNWRONMENTAL HEALTH: SERVICES APPLICATION' FOR APPROVAL OF PLANS FOR 1 Ft`TRIE j9917 SYSTEI f ._ . ..a.., ..,_7........ , 1. Name and address of applicant; :.,T 0 T, S. K01tr I j 0101 .2. Name of project: `.l '� 3. Location TN: 4. Design Professional: N VJ HIGWf'i14C 5. Address: �_D� ZZ 6; Drainage Basin: 7. Tyne of _Project: .., _ Private%Residential Food Service Commercial A artments 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 xempt Type II Unlisted X 9. Is a Draft Erivironniental Impact Statement (DEIS) required? .......................... Np 10. Has DEIS been•completed and m found acceptable by Lead Agency? ......... .. � .............. 11. Name of Lead'Agency N A 12: Js this project in an area under the"control of local planning, zoning, or other•„ 13.. If so, have..plans beenisubmitted'to such authorities? :.:... :..:...:.. K p ary pprovP . .. be5 n granted by, such authorities?. Date granted: � fl ,,.......:.1;..,... 15. Type of Sewage Treatment System Discharge...::: :..:: :..... surface water X groundwater 16. If surface., water discharge,;what is:the stream class ' designation? ..............:.... N P,' 17..: Waters index:number ( surfaced` ........................................ ... .: : :....... : ................... R 18.- Is project located near a public water supply system? ....... ............................... 19. If yes; +name of water' supply' I Distance to water supply NA 20. Is project site near, a.public,sewage collection'or treatment'system? : ............ 0 21. Name of sewage system -Distance to sewage system 22. Date test holes observed 23. Name of Health Inspector M t J9 1,l K5 .... ..... . . 24 Project design flow (gallons per day) ................................. ............................... ...9-00 25. , Is State Pollutant Discharge•Elimination System (SPDES) Permit required ?... HO 26. Has SPDES Application been submitted to local DEC office? .......................... t Form PC -97 8/99 2 27. Is any portion of this project located within a designated Town or State wetland? N Q 28. Wetlands ID Number ...... ............................... ,.......,_� 29. -Is Wetlands Permit required? ...:..................................... .......... ...................... Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance. Permit? .. ............................... � 31. Is or was project site used for'agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... 34. Are community water and/or sewer facilities planned to be developed within. .4 5 years. in or adjacent to project site? ................................ ............................... HO 35. Are any sewage treatment areas in excess of 15% slope? . ............................... 36. Tax Map ID Number ......................... ............................... Map /bi•- Block Lot 37. Approved plans are to be returned to ..... Applicant . x Design Professional NOTE: All applications for.revie-w..and;appro val_.:of ann' SSTS -to -ba located �vvi`u�in-tlic-NYC watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities -from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l.,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, Ili at 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 =45 of the Penal Law. A , SIGNATURES & OFFICIAL TITTLES: Mailing Address: ......................... >✓' f6AWT PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of I �i�l�y W O'vi%�=1 J • Located at T/V F NW��� 0 N Tax Map # rP Block �' Lot Subdivision of Subdivision Lot # Filed Map # ) W ^ A Date Filed 4 - i , 1i Gentlemen: This letter is to authorize 4A 1(_�J w ` H l L k L� ` if—, P .a duly licensed Professional Engineer or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers'on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education. Law,. the Public. Health _ ...r . . Law; and-the- Putnam - County SanitaryCode. Countersign P.E., R.A., # Mailing Add Very truly yours, l , Signed. (Owner of Property) Mailing Address: 5 G MPS 4CAESkR- J State I Zip. State NC—VJ `(OMt- Zip 01 (I Telephone: ( �� %'� J0� Telephone: �q I Form LA -97 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 105.09 Tel. (914) 278-6130 Fax (914) 278-7921 Date: To:" From: Shawn Rogan Public Health Technician VS :,I. Wx I Fax #: 49-1 No. Pages (Including cover sheet) -nd For your information Please resDo For your review —7 As discussed Notes/Messages X> Attached as requested Please call In the event of transmission/reception difficulties, please contact this office at (914) 278-6130 ext. 159. BRUCE. R. FOLEY PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION A-11/1A Date: %" Inspecte .. �. lr ! - ._ .- ..Street Location*, ,� � ,� :: _ : r._... - :Owner ` L�G✓.lL Town Permit # -� Y TM # 3 S, - Y - •' 3 Subdivision Lot # 3 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 qot 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 ........ ..........other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box . 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 � � T -�gth required f� Z Length installed &� 2. Distance to watercourse measured °�Ft.... 3. Installed according to plan ...:..... ............................... 4. Slope of trench acceptable 1/16 - 1/32" 7foot ............. 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. Depth of gravel in trench 12" minimum ................... . .. _....:..:':.4. .0: Pip� .ends- capped.....::.:: .::.:::..:: ::.................:....::::... g,,.P -uit D or Dosed Systems �>P'v 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/Building a. House orated per approved plans ... ............................... b. Number of bedrooms ....................... ............................... IV. Well a. -/ell located as per approved plans . ............................... b. Distance from STS area measured ft........... c. Casing 18" above grade ........................... ...................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ....... ............................... * c. All pipes flush with inside of box ... .........:.......... .I.......... 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 I _'t /".All RA RTTkT fl Y "I 1V V l.V1V11VUAN l �1 .f N AJ N <, a/ o E5 1 vrui ai -j DEC -07 -2000 02:07 PM HARRY W NICHOLS 914 279 4567 P.01 �6- trq.ad Is well Imled co per Ili Are erosion control aaaeM=$ in place? - Ica* j► tbaft sy s ), uLvA at be ftva pmmWs l» been cowtmctad and % have Inspected and verified their os Wcm In aacordWe '%Rth the iasued PCHD C=Adion Psuat ad approved plm Sdzd &a Swdanb, RWa and AegWations of the Puts Coin► Dep eae of . Heel um Faxes 9� D UTNAM COUNTY DEPARTMENT OF HEALTH SION OF ENVIRONMENTAL HEALTH SERVICES CONSTRU TION PERMIT FOR SEWAGE TREATMENT SYSTEM PE W 4 _ Located at ��� Town or Village P&T'r5p-,SaH Subdivision name Subd. Lot # 'lb Tax Map Block ffi Lot Date Subdivision Approved rW oA N Renewal Revision Owner /Applicant Name rPfl IqL*-+ D ()Wl'? L- LItFPC Date of Previous Approval Mailing Address gik I�1-F1 P-0A,0 9P -4 N� Amount of Fee Enclosed 4 47t )o�� Zip ) 6401 Building Type Pk-� 100 %4& - Lot Area of Bedrooms + Design Flow GPD _R(V Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of T'(L6- fX0 Other Requirements: 10, 0 -(� ri", FO f- )1EVELION4 To be constructed by T -9 ` p. gallon septic tank and $16 LF A-65 iDo'1NGt 61pt+oH Address Water Supply: _ Public Supply From Address or: Private Supply Drilled by i7. Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the se crate 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: P.E. X R.A. Date p) I qjr Address fU H 1 l- -' W 4 P-0 419 iii ` d "7 U °� License # 6 611 q APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w onsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe pprove discharge of domestic sanitary se We only. tc By: Title: 1�lM Date: �,' y A k 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 ,!ewe prin t . or type - PCT:T) Per: ^a Well Location: Street Address: I` A Town/Village Tax Grid # Ma aWA RND pAV 5�0H Map rbS e Block 4 Lots) 4e-) Well Owner: Name: Address: �44- eLA B41 EUA kAD BFZWI j Eft. Ni 10,561 Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation I -gar imary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought - gpm #People Served 4 -- Est. of Daily Usage 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 A Is well located in a realty subdivision? ...................................... ........................:...... Yes No Name of subdivision FAJ'RAU�- CLA94-e Lot No._ Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No 'A Name of Public Water Supply: — Town/Village --- Distance to property from nearest water main: -- Proposed well location & sources of contamination to be provided on separa sh t/pIan. Date: In!�A 4 Applicant Signature: u 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 ell driller certified by Putnam County. Date of Issue Permit I Offi Date of Expiration Title: fit, Permit is Non- Transffer a le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 TeL (914) 278-6130 Fax (914) 278-7921 November 3, 1998 Harry Nichols Laurent Associates Millbrook Office Centre Route 22 & Milltown Road Brewster NY 10509 Re: Proposed SSTS: Clarke Big Elm Road, Lot #3 (T) Patterson, TM# 35 -4 -4.3 Dear Mr. Nichols: BRUCE R. FOLgY Public -Kealw Directory "M 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 °oul. c ntact'l.oc21_ wetlsiids oflici -als in this reg�ed 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) Standpipes for monitoring the curtain drain have not been shown. 2) Actual siphon dose is to be provided. Upon receipt of a submission, revised to reflect that above comments, this application will be considered further. RM:tn Ve ruly yours, Robert Morris, P.E. Public Health Engineer BRUCE R. FOLEY DEPARTMENT OF BEEA,TH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 November 3, 1998 Harry Nichols Laurent Associates Millbrook Office Centre Route 22 & Milltown Road Brewster NY 10509 RE: Clarke Big Elm Road, Lot #3 (T) Patterson, TM# 35 -4 -4.2 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 24, 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. ..CL . _. Joint review with..the.NYCDEP will commence pursuant to the-guidelines set forth. _... in the WafersYied*Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to. notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Dept. of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the 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. Very t ly yours ✓zxx� Robert Morris, PE Tl .1 1' - TT_ _1A 1 . _ LAURENT ENGINEERING ASSOCIATES, P.C. j� MILLBROOKE OFFICE CENTRE I Rout* 22 & Milltown Road Browstsr. New York 10509 - ,.':..: '.... .. - :- .: • - iii ,. � ` \ _ (99dj2TO�fi106�- •(FAX; "279 -25:d ..:..�...::._; . _v -_..-: .., . HARRY W. NICHOLS JR.. P.E. V CONSULTING SITE ENGINEERS December 2, 1998 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Proposed SSTS Clarket,9 � °"3d',ct Xis v��ui Y Big Elm Road, Lot #3 Town of Patterson Dear Mr. Morris: In response to your review letters dated November 3, 1998, we offer the following: 1. Standpipes are now shown. 2. Siphon dose is now provided. We trust the above adequately addresses your concerns and request the issuance of the Construction Permit at your earliest convenience. - n Very truly yours; LAURENT ENGINEERING ASSOCIATES, P.C. �J Harty 'WNichols, Jr., P.E. HWN:JM:hs 98033 -3 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS _..... ... ._. >. t.. ..., r� rya... _,. �... REVIEW SHEET FOR CONSTRUC [;tiRT ERR T-.. STREET LOCATION NAME OF OWNER REVIEWED BY RM, GR, AS, MB,, BH DATE TAX MAP # Y N I DOCUMENTS 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 rl_lSTANDPIPES (� GENERAL OCATED IN NYC WATERSHED LANS $UBMITTED TO DEP LEGATED TO PCHD EP APPROVAL, IF REQ'D EEP TEST HOLES OBSERVED PERCS TO BE WITNESSED EX- APPROVAL SSDS ADJ. LOTS WETLANDS (TOWN/DEC PERMIT REQ'D ?) DATA,O.N.DDS PLANS & PERMIT SAM_ E . PRE 1969 NEIGHBOR NOTIFICATION LETTER BI/ZBA 100 YR. FLOOD ELEVATION OTHER REQ'D PERMITS) SEWAGE SYSTEM PLAN- (NORTH ARROW) $SDS HYDRAULIC PROFILE GRAVITY FLOW Y ROSION 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 OUSE - NO.OF BEDROOMS WELLS & SSDS'S W/1N 200' OF PROPOSED SYS. PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE NO BENDS; MAX.BENDS 450 W /CLEANOUT FILL SYSTEMS CLAY BARRIER 10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE FILL SPECS FILL NOTES FILL CERTIFICATION NOTE DEPTH GAUGES FILL PROFILE & DIMENSIONS VOLUME FILL IN EXPANSION AREA TRENCH L TRENCH PROVIDED 60 FT MAX. ARALLEL TO CONTOURS 100% EXPANSION PROVIDED ON PLAN - FROM SSTS 1'0' TO-P.L:; DRIVEWAY,, LARGE TREES, TOP OF 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' STORMDRAIN, PIPED WATER 10' TO WATER LINE (pits -20') 50' INTERMITTENT DRAINAGE COURSE 2007500' RESERVOIR, ETC. _150' GALLEY SYSTEMS CONSTRUCTION NOTES 15'MIN to CDS= >5 %,10'- 4 %,25'- 3 0/o,30'- 2 0/o,35'- I %,100' - <I % DESIGN DATA: PERC & DEEP RESULTS 20'MIN to CD discharge /100'with 182 cons day discharge T CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT SEPTIC TANK r7f'_"j 10' FROM FOUNDATION; 50' TO WELL FOOTING /GUTTER/CURTAIN DRAINS WELL SOIL TYPE BOUNDARIES m DIMENSIONS TO PROPERTY LINE TITLE BLOCK; OWNERS NAME,ADDRESS LOCATION OF SERVICE CONNECTION TM #,PE/RA; NAME,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: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES RE: Property of pATl4LJL t P09-�eD Located at 161 81�1 CL�A P- (AP T/V Tax Map # f W Block Lot ��- Subdivision of Gl-' Subdivision Lot # Gentlemen: Filed Map # I BG� -A Date Filed 4 * 16 -1 I This letter is to authorize I4AF-k W' Nt(,NV7 ; JIL P'E- - .a duly licensed Professional Engineer 'A 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 County Sanitary Code. %p� Y'` '.i ^�0 NEW Mailing A Very truly yours, Signed: (o« er of Property) PLOD Mailing Address: State Zip 0 X0"1 Telephone: 0m) 211� - 1�� ©� � !q el�H PAD State NEW 1OHL Zip 10W_ Telephone: (11`-i) 2i t - 41-1(o Form LA -97 6 PUTNAM COUNTY DEPARTMENT OI' HEALTH DIVISION OF ENVIRONMENTAL. HEALTH SER VICES Leoy- DIESI {GN DATA SHEET - SUBSURFACE SEWAGE TREATMENT *SYSTEM 'Owner C k OR F Address ' 5 F r, E/,&/ knA2) Located at (Street) FA gr, iyA gkr- �?p;� n Tax Map BB 7 , Block 4Z Lot 16,3 (indicate nearest cross street) Municipality PA- r- ro-es,� ry Watershed 7s'i2ANew SOIL PERCOLATION TEST DATA Date of Pre-soaking 9L2 S/9 g Date of Percolation Test 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 a 0 Sheet_ of�_ PUTNAM COUNTY DEPARTMENT OF HEALTH:._-_.. DIVISION Ot" ENVIRONMENTAL HEATLH SERVICES FIELD ACTIVITY REPORT N MR: G LEI `lZ k TPI• -�- Annu.4R> Street Town State Zip PERSON IN CHARGE V/z Name and Title TYPE OF FACILITY : FINDINGS: �5i ?C Z-,94 S ) -- I acknowledge receipt of this report: SIGNATURE: 02/96 Title: 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: KF4C*t G*i,r"f+ 2• PROJECT NAME: 3. PROJECT LOCATION: Municipality PWEP-60 H County PUT —1AM 4. PRECISE LOCATION: (Street address and road intersections, prominent landmarks, etc., or provide map) 61% Ap` 5. PROPOSED ACTION IS: RVew ❑Expansion OModification /alteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: L I* 2'yZS Initially - acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR -OTHER EXISTING LAND USE RESTRICTIONS? fames ONo if No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? %Residential Olndustrial._ .-_ OCommercial ❑Agricultural OPark /Forest /Open space 00ther Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ❑Yes XNo If yes, list agency(s) name and permit /approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? OYes Q!k4o If yes, list agency(s) name and permit /approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? OYes CAlo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE •�;�c::��:ntS.:;,•n�or Warn °: Sicnatur RAR s ?a- AS hL+,W Date: z9T kA i z 130 86 If the action is in a Coastal Area, and you are4. Coastal Assessment Form before proceeding er; a HARRY VV. NICHOLS JR., P.E October 22, 1998 Mr. Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSTS Patrick & Doris Clarke Big Elm Road -Lot #3 Town of Patterson Dear Mr. Morris: Enclosed are the following: 1. Five (5) prints of SS -3 "Proposed SSTS," dated 10/22/98 2. "Short EAF," dated 10/2.2/98. 3. "Application for Approval of Plans For a Wastewater Disposal System." 4. "Construction Permit for Sewage Disposal System," dated 10/22/98 5.. "Application to Construct a Water Well, ". dated 10/22/98 6. "Design Data Sheet" 7. "Letter of Authorization," dated 10/22/98. 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, LAURENT ENGINEERING ASSOCIATES, P.C. Har -`� . Ni ols Jr. P.E. �titi HWN: JM: hs 98033 -3 AN A114 o Wv lad 03A 13338 LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE IJ� Route 22 3 Milltown Road' Brewster, New York 10509 M (914)278.6108 - (FAX) 278.2558 % CONSULTING SITE ENGINEERS 1. Five (5) prints of SS -3 "Proposed SSTS," dated 10/22/98 2. "Short EAF," dated 10/2.2/98. 3. "Application for Approval of Plans For a Wastewater Disposal System." 4. "Construction Permit for Sewage Disposal System," dated 10/22/98 5.. "Application to Construct a Water Well, ". dated 10/22/98 6. "Design Data Sheet" 7. "Letter of Authorization," dated 10/22/98. 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, LAURENT ENGINEERING ASSOCIATES, P.C. Har -`� . Ni ols Jr. P.E. �titi HWN: JM: hs 98033 -3 AN A114 o Wv lad 03A 13338 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: 159 kg'ftm' 4A%d" TowtVVitl4ge• .. Patterson 14a Tax Grid # Lot(s) "to Block 4 Well Owner: Name: Address: Bennett Builders, 312 Barrett Hill Road, Mahopac, NY 10541 Use of Well: 1-primary . 2-secondary X Residential Public Supply Air cond/heat pump Irrigation . Business Farm* Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary _ Cable percussion __X_ Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 144 ft. Length below grade 143 ft.. Diameter _6 in. Weight. per foot 19 lb/ft. Materials: X Steel — Plastic . Other Joints: Welded X Threaded Other Seal: X Cement grout Bentonite Other Drive shoe: X Yes No Liner:_ Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test Bailed X Pumped X Compressed Air Hours _6_ Yield _5_ gpm. Depth Data Measure from land surface-static (specify ft) 100, During yield test(ft) 560' Depth of completed well in feet 600' Well Log If more detailed information descriptions or sieve analyses please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 100 Drilling in overburden clay and boulders Hit rock at 100' 100 144 Drilling in rock, set casing, grouted 1— 600 - -Drilling --rbck ani te' If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump/Storage Tank Information Pump Type i0 Capacity 57- Depth 4?,6 Model -1 EH I S-4 1Z_ Voltage 23 0 HP . it _LIZ— Tank Type 0V.- 2g0 Volume 140 C. o Date Well Completed 3/31/06 Putnam County Certification No. 004 Date of Report 5/17/06 Well 4 sign Philip . Beal NOTE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. Well Driller's Name F , al & 01/ Inc Address: 4 Putnam Ave., Brewster, NY ingm �E SWs , Signature: _ J-10,4211000, / 11-11Peo, Date: 5/17/06 .41 ^i)Ap J. Beal White copy: HD File; Yellow copy -Building Inspector; Pinkcopy - Owner; Orange copy- Well driller Form WC-97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR ..,..... ......w__..,_.: ' A WASTEWATER TTtEATNi'NT-'Y°S'1'E1VI _ .. . 1. Name and address of applicant: pPtNuL + DoRa� ail k EWA P-00 Bp-E1J;"1St- ► 2. Name of project: Lei ` iSlO` INkL 661-4 4. Design Professional:'` �`� �J4' �E• 6. Drainage Basin: EFN i E�7-AVCM 3. Location TN: pAITa PX60H 5. Address: 1-0 M\1- om "n 7. Type of Project: X Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building . Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted X 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... �d t N 1t�as .nEIS been completed and found acceptable by Lead Agency? ............... Nu I E :Jam of Lead Agency N tIQ proj ect in an area under the control of local planning, zoning, or other Ce =pffils,_ardinances? ::: - .. _ o ` NO 13. LK so$have plans been submitted to such authorities? ........ ............................... 14. Has preliminary approval been granted by such authorities? RQ Date granted: AA 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) ..................... ... ............................. NA 18. Is project located near a public water supply system? Na 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 kA 22. Date.test holes observed io 23. Name of Health Inspector M�1iiN ylC-d 24. Project design flow (gallons per day) ............ ......... ..... ................... 000 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... i-t o 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 .... ............................... .................... ............................... NA 29.. .Is Wetlands Pa n 'requir�d :: . ... K� : Has application been made to Town or Local DEC office? ............................... BSA 30. Does project require a DEC Stream Disturbance Permit? VA 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 he 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 HO DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... it`S 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? ... .............................ti 36. Tax Map ID Number .......................... ............................... Map '�';, Block 4- Lot 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 Department ,.and.n�.�J:not:he-sent in 3iplcate o the REF; althuugli`tne project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater,plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief' False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL 7TIITLES. Mailing Address: ................................... 0-0 �\tA.ToVIS �oA� �D PUTNAM COUNTY DE" EPARTMENT OF HEALTH # DIVISION OF ENVIRONMENTAL HEALTH SERVICES { ., : ... ...., �.;FwDESI N• A'Y�A S I ET SUB SSURRACK 3�AGE`' ATMENT'SYSTEM __.. New yoa4� Owner ed %G Address g /`G Rini g)-425 Ai0. D�J'Tt'�Soq. Located at (Street) 9/� / 4' //�-1 Ra,�I-D , Tax Map (indicate nearest cross street) Municipality 4A ?` Drainage Basin SOIL, PERCOLATION TEST DATA Block 4 Lot Date of Pre - soaking / "— "'� Date of Percolation Test 0/— Hole No. Run No. Time Start - Stop Ela se Time i In.) Depth to Water. rom Ground Surface (Inches) Start Stop Water Level Dro In Incles Percolation Rate nonch 2 3l --- Via! 361 a3" �3� ►' 2 �® 3 a�4 4 5 3 %�� --a /U a 0'23 3 4 5 2 3 ,= 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test'hole. (i.e. 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 Lo 7— 2 TEST PIT DATA Y (DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE N0. HOLE N0. G.L. 0.5' - 70i`L 54iL 1.5' 2.01 ... ........ ..... 2.5' 3.0' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' No 8.0, 8.5'rvT7'I,NG =�� v�►r�Tr�%%G ( ° °dur�� i° 3' . G„ 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed 3 �--6" 70 Indicate level to which water level rises after being encountered Deep hole observations made by: Date D a Design Professional Name: ��9�1RFiv% �NC71AiEf fl Address: Signature: Design Professional's Seal. pF NEW yo9 C �t sQ 9 w w �IVo.55124 AAOFESSO�P�