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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -4 -101 BOX 16 01762 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # I 3,,"e-03 5 141 13 -0`f Located at 7 App I 9,, i/ RoJ Town or �e 409 � Subdivision name Aelg�y,L„porj Subd. Lot # Tax Map 3S, Block -f_ Lot I d Date Subdivision Approved 5 2. p 3 Renewal Revision Owner /Applicant Name � �� r{ ,n� vtir i Date of Previous Approval -2 Mailing Address 39 col t k wood Dj j ize— 6 a ! Zip / ��� 3 Amount of Fee Enclosed Building Type k , J Lot Area —19 I No. of Bedrooms _ '5_ Design Flow GPD fe-06 Fill Section Only Depth 3,5� Volume S'O c, PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of (Q 0 0 gallon septic tank and 30d Other Requirements: To be constructed by „, k �� a, Ikn SC, 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. n Signed: Address R.A. Date 7-/2-04 License # 5Cr l;M 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 whe sidered necessary by the Public Health Director. Any revise or alteration of the approved pl r uires a new pe p ved f ischarge of domestic sanitary sewage only. 131 /r oy llus 0/06 By: Title: ( /�-� Date: v White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 2'78 - 6678 Fax (845) 278 - 6085 February 23, 2004 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Dear Mr. Nichols: ROBERT J. BONDI County Executive Re: Proposed SSTS — Wyndam Homes 78 Apple Hill Road, Lot # 9 (T) Patterson, TM# 35 -4 -101 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. There is no record in the file that the deep test hole was re- witnessed by a representative of this Department. Furthermore, NYCDEP records of the soil testing during the subdivision approval recorded 3feet 3 inches for deep test # 1. NYCDEP does not have a --- reso-pd -af -the- deep -test hole being reopened. 2. For fill sections greater than 2 feet, the entire fill pad is considered as the SSTS. Therefore, `hole # 1 is within the SSTS area. Percolation rates greater than 2 min/inch are acceptable. 3. Fill is shown at depth of just over 4 feet. The maximum depth of fill allowable is 3.5 feet. A waiver can be requested. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. V truly yours, Robert Morris, PE Senior Public Health Engineer RM: cj P Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 _.. 2050 Route 22 . .. - Brewster, NY 10509 Telephone (845) 279 -4003 Fax (845) 279-4567 February 10, 2004 Putnam County Health Department 1 Geneva Road Brewster, New York 10509 ATT: Robert Morris, P.E. Re: Proposed SSTS - Wyndham Homes 78 Apple Hill Road, Lot #9 Town of Patterson, TM# 35. 4 -101 Dear Mr. Morris: In response to your February 2, 2004 comment letter, we note the following: 1. The type and volume of the fill material is now noted on the-plan'. 2. Deep test hole # 1 was subsequently re- opened and witnessed by Mike Budzinski, and a depth of 3'6" was recorded 3. Roof/footing drains have been extended to discharge below the SSTS. 4. _ _Grading has been .re-designed to eliminate fill depth over 3'6". 5. Revised grading eliminates the depression in the middle of the fill plan. 6. Percolation test #1 is now located outside of any SSTS trenches. Kindly continue with your review and issuance of the Construction Permit at your earliest convenience. • Very truly yours, Harry W. Nic , ols Jr., P.E. HWN:gav 03 -0 56.09 June 22, 2004 Putnam County Health Department 1 Geneva Road Brewster, New York 10509 ATT: Mr. Robert Morris, P.E.. Senior Public Health Engineer Harry W. Nichols Jr., P.E. Patterson Park Suite 106 2050 Route 22 Brewster, NY 10509 Tel: (845)2793003 Fax: (845) 279 -4567 Email: hnengineer @aol.com RE: Proposed SSTS -Wyndham Homes 78 Apple Hill Road — Lot # 9 Patterson, NY T.M. # 35 -4 -101 Dear Mr. Morris: In reference to your review letter dated February 23, 2004, we note the following: 1. Re- excavation of hole # 1 was completed and witnessed by Mike _ Budzinski of PCHD on July 12, 2000 (copy enclosed). - 2. Area of trenches now reflects the three (3) bedroom design proposed. Hole # 1 was re- tested on April 9, 2004 (copy enclosed). 3. A waiver is requested for placement of fill exceeding 3.5 feet. We trust the above adequately addresses your concerns, and request your continued review and approval of the above referenced application. Very truly yours, Harry W. Nicho Jr., P.E. HWN:gav 03- 056.09 PU rNAM COUNTY PEPARTM-ENT OF HEAL'T'H DIVISION OF ENVIRONIIIEWA L. HEAL'I, "H SER VICES DESIGN DATA. SHEET - SUBSURFACE. SEWAGE TREATMENT SYSTEM Otimer M IG aA>✓1_ t,iit✓ �,d,j��t?... Address Located at (Street) 1lbU�1�.12C�S, �Q>? Tax Map 35 Block Lot (indicate nearest cross street). Municipal-it -Basin pzT Drama e I� 1L SOIL PERCOLATION TEST. bATA:. Date ofPre- soaking -,.,. :i? .g.!,.:..5..2_ -7- 'Date ofPercolationTesty.i�.�/.,, De t1i to Water Water From Ground Irer.�61 Percolation Time...., Ela se Time Surface (Inches)" Dro�In Rate Hole No. Start - Stop �I in.) Start Stop Inc es MinAnch l , 4 41 .. 7'�. 5 3 5 - �_•. 54 :� NOTES ' 1: Tests to be iepeated. at same depth until-approxim s ae obtne aed at each percolatromtest Bole. (i.e.'s l min for 1 -30 min/- h, s 2 min for:,31 -60 min/inch) All'data to be, .: . subm:rtted for review. 2. D* f``rneasurements to be made from topof'hole. - F orm DD 97 P'U'I'NAIVI. COUNNT'�. DE. PARTTVI.�I`�TT`;�1�'.:I�EALT]FI ,.. DIVISION 'OF ENVIRONMENTAL HEALTH SERVICES -- DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner'° bJYNba 4m- "4>w s Address" 2y AR6oegtw CAz"tL gy 1051z Located at Street Tax Map.. (Street) � �Y4�t� - � Et Yt� Q,oAD .. ....... ..........::... (indicate nearest-cross street) Municipality. Watershed ZA5i 6�A►iGN . SOIL. PERCOLATION TEST DATA Date of Pre - soaking Date of Rercola'tion Test . eti. oq -oti v�A '0000, pr o ss�a PUTNAM COUNTY DEPARTMENT OF HEALTH O DIVISION OF ENVIRONMENTAL HEALTH'SERVICES -- DESIGN DATA SHEET -SUBSURFACE SEWAGE TREATMENT SYSTEM F01:Z60 MA ft( K -A_ Owner M I G j� A5-,1_ W!%LAMId 52 ..... Address LA�G Located at (Street) 5-06Al2DS 12 p Tax Map 35 Block _�_ Lot (indicate nearest cross street) Municipality i�,a� —(- �5� Drainage Basin 13 p�i2�K SOIL PERCOLATION TEST DATA Date of Pre-soaking s Date of Percolation Test, . a . cr Z le No. Time . Start - Stop . Ela se Time �lYlin.) Devpth to Water From Ground Surface (Inches) Start Stop Water Level Dro In Inches Percolation Rate Min/Inch 77YN� . 2�'l, 12 ; 12 I 2 10: 5 0- ra' r 2 2 I 0 5 2 2 10'40 - 10 q.. 14 2►� '��. 3 `.-7 3 4 5 J 1 2' �� �' �► e 21'x; 24'l � 5 J �.2' 4 'S . wu i r.b: t. i ests to be repeated at same depth until approximately equal percolation -rafdt atf obtained at each percolation test hole. (i.e. s I min for 1 -30 miri/inch; 2; r3t4 � -,rrti Nl All data to be. :im. p submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 . J U DEPTH G.L. 0.5' 1.0' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' - 7.5' 8.0' 9.0' 9.5' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE N0. I HOLE NO. HOLE NO. �r 42� W, 0 61, S4" Indicate level at which groundwater is encountered - Indicate level at which mottling is observed Indicate level to which water level rises after being encountered p) _ Deep hole observations made by: 1„ i , LLQ'(- (Or--P) , M t4sKi' Lq-) Date X64 P 7 -�Z -00 (HO) Address: 0 Design Professional's Seal pF NEW y W yJ'F No. 56124 oAROPESSIfjl ~ )fL, ss ional h, as I ed the A) 0 B-/ -I I I i I,,; I t .., r I'a I u i I & h —It certify! It'I iIt S11 Ch III WL7i(I 111 (IS 1) cCll J)hICCII (IIIII Stabill'Ze-'J �I'Ih the rcquircmcnts of 1,he ;\TSJ)C11(IT1't?ICIIt ol-Health, 11tv DCpC,,rrP;Cn1 oulcal[II 01111 the (II)IT70 lVil Jill 1.)11111. lilt C as been tested and at this tiinc is coitsidcrcd suitable for Ice SCIW(Ifle treatment s"i•stem. Th c soil percolafioli rate in 5-ed on percolation t(,.qS aller stal);liz-L-Ition is ,WG,,VE-D:. DesiA,ii Prol-C.ssio n (I I -I-) X012 PG-HC) APP12OVAL- STAMP EXIST. STONE WALL TO BE REMOVE1 g-F )) �F 117 V. �, - 1 kvl,50 Tgb-e-A L-P,�OJT 'r 0 ��?ZCT ' b$L - IL F-V'q- 02-09-04 PF-F-- 02-OZ-04 PC017 MEMO PROPOSED -55T5 L-07 'b WIND 5012 WOODS 5U00141-21 CI-4 -15 AMPLE HI"- P-0,AP .PNTTIERSON ...NE-W YO.fZK- WYWb14AN\ HOMES 24 ARBOrMEW C.;AP.-.M- E L - NEW YOIZK Harry. W-N ichols. Jr., P. E.- Suite 106, Patterson Park 2050 Route 22 Brewster, NY 10509 (545) 279-4003, Fax 279-4567 CONSULTING SITE ENGINEER PROPOSED SSTS LOT 9 pF NEW tl.. M1CH,,74 L� I"= '30' MC 14 W 14 03-056-09 SS-9 PROPERTY LINE EDGE OF PAVEMENT/ROAD EXISTING BUILDING -C -s2-)- EXISTING GRADE PROPOSED GRADE PROPOSED.SPOT GRADE PROPOSED ROOF & FOOTING DRAIN Pr. PERCOLATION TEST LOCATION � TES TEST PIT LOCATION EXISTING WELL PROPOSED WELL EXISTING SSDS PROPOSED SSDS EXISTING TREE LINE EXISTING STONE WALL F. 4 PROPOSED SILT FENCE - PROPOSED STRAW BALE DIKE EXIST. STONE WALL TO BE REMOVE1 g-F )) �F 117 V. �, - 1 kvl,50 Tgb-e-A L-P,�OJT 'r 0 ��?ZCT ' b$L - IL F-V'q- 02-09-04 PF-F-- 02-OZ-04 PC017 MEMO PROPOSED -55T5 L-07 'b WIND 5012 WOODS 5U00141-21 CI-4 -15 AMPLE HI"- P-0,AP .PNTTIERSON ...NE-W YO.fZK- WYWb14AN\ HOMES 24 ARBOrMEW C.;AP.-.M- E L - NEW YOIZK Harry. W-N ichols. Jr., P. E.- Suite 106, Patterson Park 2050 Route 22 Brewster, NY 10509 (545) 279-4003, Fax 279-4567 CONSULTING SITE ENGINEER PROPOSED SSTS LOT 9 pF NEW tl.. M1CH,,74 L� I"= '30' MC 14 W 14 03-056-09 SS-9 d r 1 LORETTA NIOLINARI. ROBERT J. BONDI Public Health Director County Executive DEPARTMENT OF' - HEALTH 1 Geneva Road, Brewster, N`ew York 10509 Environmental Health .(845).27a - -6130 Fax(845)278-792.1. Nursing Services (845) 278 - 6558 ' WIC (845) 278 - 6678 Fax (845) 278 - 6085, Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 February 2, 2004 Harry. Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Re: Proposed SSTS — Wyndham Homes 78 Apple Hill Road, Lot 49 Town of Patterson, TM# 35 -4 -101 Dear Mr. Nichols: Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials-in this regard. .-.•..f percolation -tests ,were -not yvitnessed.by a representative of the New. York- City Department Environmental =- Protection on this lot, percolation tests must be witnessed by a representative of this Department. 1. The type and volume of the fill material is to be noted on the plan. 2. Deep test hole # 1 notes ledge at 3'3 ". The minimum of 3'6" or in situ soil must be available for the area to be acceptable. 3. Roof/footing drains must be shown discharging below the SSTS. 4. Fill is shown at depths of just over six feet. A waiver must be sought for fill depths greater than 3.5 feet. 5. The proposed fill placement is shown with 4 depression in the middle of the fill pad. This is unacceptable as it will create a drainage channel. 6. NYCDEP has records that a percolation hole had a rate of 2 min/inch. The minimum acceptable percolation rate is ,.3 min/inch. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:cj Ve y yours Robert Morris, PE Senior Public Health Engineer Percolation Test Report New York city D&PDepartment of Project Name: Deer Wood Subdivision Environmental Protection Owners Name: George Mayer and Michael Melam6d r Owners Address: Essex, CT. And Marmaroneck, NY Tax Map Number: Date: .? TIME i ? DEPTH TO WATER FROM GROUND SURFACE HOLE NUMBER RUN NUMBER START STOP ELAPSED TIME IN MINUTES START INCHES STOP INCHES CHANGE, INCHES SOIL RATE MINJINCH f y i Soils Test Report Project Name:____' Permit No.:. - - -- ------- __�._--- - - -�.– Date: - - - -— - -- Soil Test No.:_--- --- Owners Owners Name: -_ z Owners Address: i E Tax Map No.:- _ - -_ -_ Building Permit No.:. ^_ P D "01"AWW P Percolation I est Uata Clock Time ` Depth to water from ground surface Hole No. Run no. Start Time Stop Time Elapsed Time minutes Start inches Stop inches Change inches Soil Rate min /in i } b R 1 Soils Test Report Project Name:-----.----.'! Permit Soil Test Owners Name:.--.------- Owners Address:_ Tax Map No.: Percolation Test Data DAP 9 I Clock Time Depth to water from ground surface Hole No. Run no. Start Time Stop Time El apsed Time minutes Start inches Stop inches Change inches Soil Rate min/in 7, 1,4 t. 9 I TEST PIT AT Ncw Fork City. DEPDepartment ®f -Env-ironintntal Protection PROJECT Deer Wood Subdivision - Patterson CONTACT R. Laurent, Laurent Engineering Associates DATE _ 1 ;F _. ;- LOT HOLE LOT HOLE Depth Description Depth Description i' lz AI Depth Description F' i' lz F' a TEST PIT DATA New York City DOartment of Environmental Protection PROJECT Deer Wood Subdivision CONTACT HarDv Nichols, Laurent Engineering Associates DATE -j " LOT HOLE 2 LOT HOLE--i- Uepth Uescription /,j j Uepth Description PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: STREET LOCATION: REVIEWED BY: RM, GR, AS, SRDATE: TAX MAP #: (CONFIRMED) Y DOCUMENTS D(_)�•- PERMIT APPLICATION WELL PERMIT OR PWS LETTER UUPC -97 (_)(_)LETTER OF AUTHORIZATION L_)C__)DESIGN DATA SHEET (DDS) (_)L_)CORPORATE RESOLUTION L_)USHORT EAF L_)(_)PLANS -THREE SETS (_,(_)HOUSE PLANS - TWO SETS (_) VARIANCE REQUEST SUBDIVISION ( a(� )LEGAL SUBDIVISION (, � SUBDIVISION APPROVAL CHECKED LPERC RATE (_)(__)FILL REQUIRED -L —DEPTH (_J(_JCURTAIN DRAIN REQUIRED GENERAL (_� LOCATED IN NYC WATERSHED PLANS SUBMITTED TO DEP (� DELEGATED TO PCHD DEP APPROVAL, IF REQ'D a�DEEP TEST HOLES OBSERVED PERCS TO BE WITNESSED EX- APPROVAL SSDS ADJ, LOTS fWETLANDS (TOWN/DEC PERMIT REQ'D ?) DATA ON DDS PLANS & PERMIT SAME PRE 1969 NEIGHBOR NOTIFICATION LETTER BI/ZBA _wQ.XR.. FLQOD ELEVA.'ION WQZQQ' _,.�,__. SOIL TESTING LOTS >10 YEARS OLD AGE SYSTEM PLAN - (NORTH ARROW) 'HYDRAULIC PROFILE VITY FLOW ( z) CONSTRUCTION NOTES 1 -15 DESIGN DATA: PERC & DEEP RESULTS ((� T CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT ( FOOTING /GUTTER/CURTAIN DRAINS (USDA SOIL TYPE BOUNDARIES (�JC__)TITLE BLOCK; OWNERS NAME ADDRESS (� TM #, PE/RA; NAME, ADDRESS, PHONE# )DATE OF DRAWING/REVISION / DATUM REFERENCE ( _,(_)LOCATION OF WATERCOURSES, PONDS � �LAKES,WETLANDS WITHIN 200' OF P.L. CAL)PROPOSED FINISH FLOOR AND *EROSION BASEMENT ELEVATIONS WELLS & SSDS'S W/IN 200' OF SSTS PROPERTY METES & BOUNDS CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE COMMENTS: (REVSHEET)09 /01 /00 Y N (REQUIRED DETAILS ON PLANS CONED) ( < )HOUSE SEWER -1 /a" FT. 4 "0'; TYPE PIPE CAST IRON (_)(__)NO BENDS; MAX BENDS 45° W /CLEANOUT RENEWALS (� SMITE NOTE (NO CHANGE) FILL SYSTEMS C _210' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE (FILL SPECS/ FILL NOTES 1 -5 FILL PROFILE & DIMENSIONS FILL IN EXPANSION AREA FILL GREATER THAN FEET CLAY BARRIER FILL CERTIFICATION NOTE Cn DEPTH GAUGES OL. ON PLAN FOR RO.B., UNCLASSIFIED & IMPERVIOUS 66s, PARATION DISTANCE FROM TOE OF SLOPE TRENCH �LF TRENCH PROVIDED 60FT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED L_)DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL ( )( )GEOTEXTILE COVER 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FELL 20' TO FOUNDATION WALLS �) 100' TO WELL, 200' IN DLOD,150' TO PITS 100' TO STREAM, WATERCOURSE, LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATERLINE (pits - 201) 50' INTERMIT -TENT DRAINAGE- COURSE 200'/500' RESERVOH2, ETC. _ 150' GALLEY SYSTEMS (_)x)10' MIN TO LEDGE OUTCROP SEPTIC TANK (�10' FROM FOUNDATION; 50' TO WELL WELL (ZDIMINSIONS TO PROPERTY LINES LOCATION OF SERVICE CONNECTION MIN 15' TO PROPERTY LINE SLOPE (__)( SLOPE IN SSTS AREA 520 %) (REGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS )(_)PUMP NOTES (__)C__)DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED (_)C__)DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) C_)(__)PIT AND D -BOX SHOWN & DETAILED (_)L_)1 DAY STORAGE ABOVE ALARM CURTAIN DRAIN UC__)STANDPIPES, 5' BOTH SIDES, DETAIL (_)x)15' MIN to CDS = >5 %, 20' -4 %, 25' -3 %, 35' -1 %,100 % - <1% (_)(_)20' MIN to CD DISCHARGE /100' with 182 cons day discharge x)(___)10' MIN to NON - PERFORATED PIPE 'Harry W. Nichols Jr.., P.E. Patterson Park, Suite 106 2050 Route 22 rV Brewster, NY 10509 Telephone, (845) 279 -4003 - Fax (845) 2794567 December 8, 2003 Putnam County Health Department One Geneva Road Brewster, New York 10509 ATT: Robert Morris, P.E. Re: Individual SSTS Deerwood Subdivision - Lot # 9 .78 Apple Hill Road Town of Patterson T. M. # 35.-4 -101 Dear Mr. Morris: Enclosed are the following: 1. Five (5) prints of SF -8, "Preliminary -Design for Fill Placement Only ", dated 12/08/03. 2. Two (2) prints of SS -9, "Proposed SSTS ", dated 12/08/03. 3. "Short EAF ", dated 12/08/03. - - 4. "Application for Approval of Plans for a Wastewater Disposal System ". 5. "Construction Permit for Sewage Disposal System, ", dated 12/08/03. 6. "Application to Construct a Water Well ", dated 12/0.8/03. 7. "Design Data Sheet ". 8. "Letter of Authorization & Corporate Resolution ", dated 12/08/03. 9. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only". 10. 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. ols Jr., P.E. HWN:gav 03- 056.09 1416 -4 (9195) —Text 12 PROJECT I.D. NUMBER 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be corripieted by Applicant or Project sponsor) SEQR 1. APPLICANT /SPONSOR V�1T V I.40 ` fT M - f7�� E� t IN L` 2. PROJECT NAME Loll, 3. PROJECT LOCATION: + r G PAMP-60H Munlcipalily County 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) 5. IS PROPOSED ACTION: K New ❑ Expansion ❑ Mod it lcatlon/alteratlon 1 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LA 1) AFFECTED: Initially ��QQ acres Ultimately �') acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR-OTHER EXISTING LAND USE RESTRICTIONS? 0/ yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? WResidentlal ❑ 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)? ❑ Yes 9No If yes, list agency(s) and permit/approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes KNo If yes, list agency name and permitlapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes ®'No . CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE 5 (A8'" • Appiicant/sponsor name, Date:. Signature: , If the action is in the Coastal Area, and you are a. state agency, complete the . Coastal Assessment Form before proceeding with. this assessment 1 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 B. WILL ACTION RECEIVE COORDINATED REVIEW A_ S PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, -PART 617.6? .. If No, a negative declaration may be superseded by another involved "agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise. levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species-, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explain briefly. C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not Identified in C1 -05? Explain briefly. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA? ❑ Yes ❑ No E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY, RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑'Yes ❑ -No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For.each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) .probability. of occurrirng;..(c). duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary; add attachments or reference supporting m fails. 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 tfie 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:. Print or Type Name of Responsible Officer in Lead Agency Signature of Responsi le Ofticer.in.Lead Agency Name of Lead Agency Title of Responsible Officer Signature of PreRwer (if different from responsible officer) to 11� N ..PUTNAM COUNTY DEPARTMENT OF-HEALTH -= . DI=VISION: -OF ENVIRONMENTAL- HEAL,TH•.SERVICES`'-* -APPLICATION FOR APPROVAL OF PLANS FOR = �...�...... -A: WASTEWATER TREATMENrf SYS -TEM ` . _ ... . 1. Name and address of a licant: "'WWA-AM 40 FS . ��.�. `.•� -: ``: ".....:.:' . 14 4&MI5,vJ CA 2. Name of project: �� �5 3. Location TN 4. Design Professional: 1" W,..OIl fta fK5.. Address: '2'0�.o.. 1 ZZ. 6_.: Drainage Basin: SOL) 07 7. Type of Pro'ect:. Pnvate/Residential Food Service Commercial Apartments': Institutional Mobile Home -P-ark . Office Building Realty Subdivision __ . Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)?' Type..Status ( check - one) :.......................... I......................... Type I Exempt:'. Type II Urilisted-;' X. 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... ND 10. Has DEIS been completed and found acceptable by Lead Agency? .... . . 11. Name of Lead Agency - - 04- _12' .Is this. project in an area under the control of local planning, zoning, or other _._ - officials, ordinances? .... .......... ... ...... .................... : ::.. ...................... 13. If so, have plans been submitted to such authorities? ........ ............................... r►Q .. . 14. Has preliminary. approval been. granted by such authorities? 00 Date* granted: JA --- -15: Type of Sewage Treatment- System Discharge.. - .............. surface water groundwater 16. If surface water discharge;-what is the stream class designation? ....::.:: :::::.:::.: N_ 17. Waters index number (surface) ............................. ............................... . ... N+4 1.8... Is project located near a public water supply system? ....... ...... .......:.................. N10 �. 19.- If yes, name ofwrater supply Na Distance-to wa"'Mr:supply l`l� 20: Is .project site near a public sewage collection or treatment system? ::..:.:.:::..:. - - 140 . - --2-i-. Name of sewage-system :Distance;to _sewa e s stem �. Y �A 22. ...g . _.... Date test-hol -es- observed- 23. Name of Health Inspector �� �JD21M�i1�l 24. Froject- design flow (gallons per day) .............. ............ . ................................. 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?:.. �JO_ _ 26. Has SPDES Application been submitted to' local DEC office ` Form PC -97 29. Is Wetlands Permit required?-..., ........................... Has application been made to Town or Local DEC office? ................................ PA 30. Does project require a DEC Stream Disturbance:_Permtt? .. ............................... r1 @ 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? ............................... Yes/No DESCRIBE: J. Is there a local master plan on.file with the Town or Village? .......................... 34.. Are community water and/or sewer facilities.planned to be developed.Within 15 years in or adjacent to project site ? ................ ...........:. 35. Are any sewage treatment areas in excess of 15% slope? . ..........................:.... 36. Tax Map ID Number .......................... ............................... Map t5. Block Lot 1©1 37. Approved .plans are to be returned to ..... Applicant_ Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be.sem to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the-SS-TS 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, un der penalty of perjury, that information provided on this form is trice to the best of my knowledge and belief. False statements k ma r i e i able as -- a Class A misdemeanor pursuant to Secti n 210.45 of the Pa SIGNATURES"& OFFICIAL TITLES: Mailing Address: ..... ........... PUTNAIYI:CO:UN'T. DEPARTMENT OF. HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES a DESIGN DATA SHEET - SUBSURFACE SEWAGETREATMENT SYSTEM 'VJYJ4j) RNtA jioME� Owner: Address' 24 ARD"IeNJ J(A 16,WV0a ®L 4 -qe Block 4 Lo-U-4Located at (Street) Tax ap (indicate nearest cross street) Municipality. UZC3� Watershed SOIL. PERCOLATION TEST DATA Date of Pre- soaking X)l Date of- Percolation Test a7�mw i�UEMMEME4 T: T, 4 ..2 0 ILI I 3 X0143 (0 4 2.. 101-11-, [61L1. fill 7-111 3- 4 5 2 3' Utv tL 4.. NOTES: 1. Tefts to be ro 'at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i&:5'l min for 1-30 inin/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 Indicate level at which--. groundwater-is encountered Indicate level at which. mottling is observed Indicate level to which water level rises after being.encountered Deep hole observations made by: l,�Vo ��IY� ob'�) 1\ • t0l,w* ( p UvO Date . Design -Professional Name:-. Address:pSo Signature: Design Professional's Seal F� � TEST..PIT DATA 2 DESCRIPTIONT OF SOII;S ENCOUNTERED:INT TEST HOLES. DEPTH iOI,E A10: I =HOLE NO. HOLE NO G.L. - - -- 0.5' O -Ss ToQ�acii. 4 -f3 TS 0_� SS 1.0' �' " Q-E0 5 "�t7 -" b�'� 1.5' :....... -N l wed'' ��-� � 44, 2.5' Compa 3.5 _.........:... 4W 4.0' � 4.51 .u�v 5.0' 5.5' Sc� 6.5' ��s 7.0' 7.5' 8.0' 8.5' .: 9.0' 10.0' Indicate level at which--. groundwater-is encountered Indicate level at which. mottling is observed Indicate level to which water level rises after being.encountered Deep hole observations made by: l,�Vo ��IY� ob'�) 1\ • t0l,w* ( p UvO Date . Design -Professional Name:-. Address:pSo Signature: Design Professional's Seal F� � To: Public Health Director . dt 4010p_ WOW S La i In the matter of application for: '- - represent that I am an officer or ,employee of the corporation and am authorized to act for: - - Name of Corporation: tN`i �`0,�(rM Having offices af: P+!�4L4� 6w CN�CLt N I Q �� Whose Officers Are: President - Name: Address: Vice President - Name: Treasurer - Name: Address: and that I am and will be individually responsible for any and all acts of the co oration with respect to the approval requested and all subsequent acts relating thereto. - - ,ter Ak vemo Signed: "Way Public, 4 ' Title: S«yorn to before me this / 'day of - f1%1Y(month) 2-003 (year).. N Public Corporate Seal Form CA -97 i i / I v` __._... PUTNAM COUNTY DEPARTMENT OF HEALT7"r DIVISION OF ENVIRONMENTAL HEALTH -SERWCES.... LETTER OF AUTHORIZATION RE: Property of Located atQl.� T/V NO �o Tax Map # Block Lot Subdivision of l 8ubdivision'Lot # Filed Map oi Date Filed.. ILA 10'' Gentlemen: 9 f This letter is to authorize t U vm' Ttv a duly licensed Professional Engineer X or Registered Architect to apply for the. required wastewater treatment and/or water supply permit(s) to serve the above-noted-pr oP erty:in ' accordance with the standards, rules or regulations. as promulgated by the Public Health Dir e*cto'** of. County Health Department, and to sign all necessary papers on my behalf in connection', ihis matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity yith- the'pTQ'n51QAs'q.f.Article,1 45 and/or 147 -of the Education-Law, e.-Public Health, Law, and the Putnanjo � J, Code. -C-ountersigne P.8., R.A., # Mailing Addy State zip 15() Telephone: '4001V) Very truly y rs, Sighed: _ (oWner Xopeqy) Mailing Address: f) A. State Teleplfbne:(�` ) . ... .. Form LA -97 LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 July 23, 2004 Harry Nichols Patterson Park, Ste 106 2050 Route 22 Brewster, NY 10509 Re: Proposed SSTS: Wyndham Homes 78 Apple Hill Road, Lot #9 (T) Patterson, TM # 35 -4 -101 Dear Mr. Nichols: ROBERT J. BONDI 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. A revision fee in the amount of $200.00 is to be submitted. 2. Grading is shown off the property onto the adjacent property and into the Apple Hill Road. R.O.W. -Contour lines-are shown converging, this is not'p6ssible: Furtlierniore, `the side+- � slopes of the fill section are proposed at excessive depths. A waiver was granted for the fill at a depth of just greater than 4 feet. 4. The side slope of the fill is proposed at a grade greater than 3:1. 5. Revised House plans must be submitted. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ve ly yours, v Robert Morris, P.E. Senior Public Health Engineer RM:km July 29, 2004 Putnam County Health Department 1 Geneva Road Brewster, New York 10509 ATT: Mr. Robert Morris, P.E. RE: Proposed SSTS - Lot # 9 Wyndham Homes 78 Apple Hill Road Patterson, NY T.M. # 35 -4 -101 Dear Mr. Morris: Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY .10509 Tel: (845) 2794003 Fax: (845) 2794567 Email: hnengineer@aol.com In response to your July 23, 2004 review letter, we note the following: 1. Revision Fee of $200.00 previously submitted. - _Grading. of Lot has..been.revised.and does-not-extend-onto- adjacent parcel. 3. Grading has been revised to eliminate excessive depths. 4. Fill side slopes for SSTS system are 3:1. 5. Revised House Plans submitted under separate cover. Reflecting the above, enclosed are the following: Five (5) Prints SF -9 "Fill Plan" rev. 07/29/04. Two (2) Prints SS -9 "Trench Plan" rev. 07/29/04. Kindly continue your review and issue the necessary Construction Permit. Very truly yours, CA Harry W. Ni is Jr., P.E. HWN:gav 03- 056.09 Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050.Route 22 r Brewstor; NY 10509 Telephone (845) 2794003 Fax (845) 27911567 Date: To: GJob No.: %.0 % 6'��y ,. I'd Project rv�Jas�{ ..SST� -•� O]' 1 ��=,;c � Attention: I Gentlemen: We enclose (4copies of �,/13fW Prints Reproducibles Reports .Tracings Specifications Memorandum Copy of letter Description: Revision/Date No. Sent Via: Blue P rinter First Class Mail Special Delivery Your Messenger Hand Delivery Copy to Very, trnlly yours - Harry Yr: chols Jr., F.E. Attention: Wy+4 A, J0 C Gentlemen: We enclose (J ) copies of B/W Prints Reprodueibles Specifications Memorandum Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Telephone (845) 279-4003 Fax (845) 279AS67 Date: Job No.: t . Project W t Jra ►^ cc�c%t '�rtt;ClJ� Reports .Tracings Copy of letter r/ Afp Crc:-CI,G Description: Revision/Date No. Sent Via: Aur Messenger Blueprinter First Class Mail Special Delivery Your Messenger Hand Delivery Copy to Ve truly yours v - Harry V*C ichols Jr., Ft. July 14, 2004 Putnam County Health Department 1 Geneva Road Brewster, New York 10509 ATT: Mr. Robert Morris,.P.E. RE: Proposed SSTS - Lot # 9 Windsor Woods (Deerwood) Apple Hill Road Patterson, NY Dear Mr. Morris: Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Tel: (845) 2794003 Fax: (845) 279 -4567 Email: hnengineer@aol.com The proposed residence for Lot # 9 has been revised by the purchaser which required a - - change to the building shape and ,a minor-shift-in the-location.--- _ .._ ..- The previously approved septic and well locations have not been altered. A copy of the well and septic as shown on the prior submitted plan is enclosed. We are requesting that when the approval for the Construction Permit is signed and issued that the enclosed drawings, which reflect the shift in the residence, be utilized. Any question, please call. Very truly yours, a C r - arty W. Nic ols Jr., P.E. y HWN:gav < F 03- 056.09 F q ..... Q °ti ".1 S 1 b Q -- 1-3-04 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM fO- P IL ERMIT # P- 36- 03 A-0-3 Located at ,40 Town or Village Subdivision name DEMW o * Subd. Lot # I Tax Map rl) S% Block -4 Lot 101 Date Subdivision Approved 5 0.' m Renewal Revision Owner /Applicant Name WY 00 J-0 M VAmL-) i HL` Date of Previous Approval Mailing Address 1 Zip Amount of Fee Enclosed Building Types Lot Area �4-11 No. of Bedrooms _*� Design Flow GPD IoW Fill Section Only X Depth h, 4 Volume 50P &Y PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1000 gallon septic tank and 1,12 00 LF Other Requirements: To be constructed by W_1'00 AAM ME� i I Hb Address Water Sunnl4: Public Supply From Address or: Private- Supply Drilled by T6P P 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 04 910 License # -5 4'! 2G/ APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new p it. Approved for discharge of domestic sanitary sage only. By: Title: ��'�t a White copy - HD ile; Y Ito copy - Building Inspector; Pink copy weer range copy - Design Professional Form CP -97 y }` LJ NEW YORK STATE DEPARTMENT OF HEALTH Specific Waiver Bureau of Community Sanitation and Food Protection fr4.m Requirements of Part 75 and Appendix 75- A,1.ONYCRR forindivldual Household Sewage Treatment Systems 1. Reason why site does. not meet 10NYCRR Appendix 75 -A (check appropriate box(es)): ...... l Separation distance cannot be achieved. Excessive slope. High groundwater. Inadequate depth to bedrock or impermeable layer. Soil unsuitable. i O A..... NT M ther (explain) ............�...... ...................... .. .............. ..T ..... ........ ........... ............................... ................................................................................................................................................................................................................. ............................... .................................................................................................................................................................................. ............................... ....... _........_.... ......................................................... : ................. . ......................................................... : . . . . . . . .. . . . .. . .. . . . . . . . . . .. . . .. .. . . . . . . .. . . . . . . . . . .. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . .. . . . . .. . . . . . .......................................... . . 2. Proposed design or conditions of waiver: ................................................................................................................................................................................................................. ............................... ................... "` 1....... ...G...!........4�.�c.......... �"....... fc................................................................................................... . . . ... . .. . . . . . . . . .. . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . .. . . . . ... . .. . . . . . . . . ... . .. . . . .. . . . . . . . .. .. .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . .. . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . .. . . . . . . . . . . .. . . . . .. . . . . . . . . . . . .. . . 3. The proposed design may have the following limitations (check appropriate box(es)): Increased risk of well or spring contamination. Increased risk of surface water contamination. Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. Other(explain) ............................................................... :................ ........ ..... ................................................................ Additional Information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked by the issuing official for a change in conditions for which this waiver was granted. hRtdaIVE OF OMMIss NE OF HEALTH ORIGINAL - Local Health Agency a7. ...................................... . ............................ I.......... COPY - Applicant/Design Professional nnu , ooc 17/00% (GEN -152) SEt? j PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE (THRESHOLD IN 6 NYCRR, PART 617:12? If yes, Coordinate the review process and use the FULL EAF. ❑ Yes ED No B. WILL ACTION RECEIVE COORDINATED.REVIEW.AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.0' 'If No, a negative declaration maybe 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: NO C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: NO , C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: NO 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. NO C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. NO C6. Long term, short term, cumulative.. or other effects not Identified in C1-05? Explain briefly. NO C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. NO' D. IS THERE, OR IS THERE LIKELY'TO 81,-CONTR6VERSYRELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes No If Yes, explain briefly PART 111 — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it Is substantial, large, important or otherwise significant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural); (b) probability of. occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a'positive'declaration. Check this box If you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on "attachments as necessary, the reasons supporting this determination: PUTNAM COUNTY DEPARTMENT OF HEALTH Name of Lead Agency /tQlGi%d%L �f/DZ1�15,Ll DI R OF G AI F.,F IAIL rint or jype Name o esponsi le Officer in Lead Agency Title o Re le O , is ;r Signature OM icer in Lea Agency % ign lure o Preparer(I different rom responsible officer) / / r sow 2 BRUCE R. FOLEY Public Health Director . �, ADDRESS: 3,aq LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAVIER SITE LOCATION: -ffj o k- K Lk R l tit VJA U (� ► > DATE: STAFF PRESENT: SPECIFIC WAVIER REQUEST: 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 DENIED REASON FOR DENIAL DIRECTOR OF H (SPECWAIVER) OV DENIED DATE: `% '� I oj- DrEc - 9 N-1 12: 0 3 PUTNAM COUN"i'l: DEPARTMEENT OF dEALTIT HOUSE PLANS APPROVED FOR PEDROO!l COIJI-IT ONLY, BEDROOMS ALL TO THESE HOUSE PLANS PSI, HE SU/ 17 TED TO THE P-CDOI-I FOR APPROVAL ZI of ,,�:ATURE & TITiJ-', DATE' Uni arc F.- ui-- ... j. o Cl m H-10 IM b. 13 :11 Bi 1 a WINDSOR W 0' WOODS Plon H - —Lot Zll� 00 PATTERSO N NEW SON, NEW YORK ml The Hamilton FheS H Ito" M1 Y1YNDHA "Y' M HOMES n T LO FIRST FLOOR FRAMING PLAN R FLOOR FRAMING I I- Imo!_ ��� � . ............ OII b. 13 :11 Bi 1 a WINDSOR W 0' WOODS Plon H - —Lot 00 PATTERSO N NEW SON, NEW YORK ml The Hamilton FheS H Ito" Y1YNDHA "Y' M HOMES n T LO FIRST FLOOR FRAMING PLAN R FLOOR FRAMING I ' 2 +:,t ®@ 9 WINDSOR WOODS Plan H N Lot I �, The Hamilton BASEMENT PLAN " . 8 t gyai•y��� }ia c PATTERSON, NEW YORK /� ° 1 %'�, B Ps WYNDHAM HOMES °�" .. - . I .. .. .-I-. - , '... --,LOT WINDSOR WOODS THE HAMILTON if WYNDHAM HOMES FOUNDATION PLAN (73 I " I i 1 1 1/8" I ff ---------- J", FIF -1, : L L______ L J L - - - L ----------- - ------- -t '-p- L -i 1JI L -i Lt-j L 4Ill -.- - - - - - - - - - - - - 11-H - - - - - - - - - - - - - u 61 ------------ L --------- ___________ __J = = --,LOT WINDSOR WOODS THE HAMILTON if WYNDHAM HOMES FOUNDATION PLAN (73 I " I i 1 1 1/8" d� PUTNAM COUNTY DEPARTMENT OF HEALTI� DIVISION OF ENVIRONMENTAL HEALTH SERVI CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEN PERMIT# �' 'C�j SW' 14)-04 t! "j C N Located at Ar W LL PAP Town or Village Subdivision name MaE _W40D Subd. Lot # Tax Map Date Subdivision Approved 0 610 2) 011) Renewal PArT���bH Block 4 Lot Revision Owner /Applicant Name WYH9RW F}0( 56 1N11 - Date of Previous Approval Mailing Address $ u1.1.I H VJ1 OF4v0 5 � 611 Rv' N1 Amount of Fee Enclosed ion 000 .64.04 _Zip 105'0 °I Building Type Ff4'9EN44E Lot Area '5•?R7 No. of Bedrooms * Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 0 600 gallon septic tank and -,:�M L� 048 • TIeENGH Other Requirements: To be constructed by w rAwNaP N4MO I NG• Address ? 60044 ✓wA9P 9W Vt' 81 w5t �As�`I Water Supply: Public Supply From or: V Private-Supply Drilled by frolp Address 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 s� 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. Address 20 1V iz T 2L PO&W572M, ,j 1l tdfro 4 R.A. Date 0+/22/o License # S 6 f 2-+ APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified wh nsider ecessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe t. pprov or discharge of domestic sanitary sewa only By: / Title: Date: Zo White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNA M;COkUNJXDE1 ME OF�A4H F" DIVISION OF ENVIRONMENTAL HEALTH SERVICES TPm DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner': Address '—i Located at (Street)' CoWtivIODUL Tax Map . Block' Lo-1-101- (lndicate nearest cross street) Municipality Watershed SOIL. PERCOLATION TEST DATA Date of Pre - soaking Date of -Percolation Test 6-4111 [69' `40 tole -0 • 2 14— 3 +t- 4 5 10- 3- 0 I.Mj 1 ...... 4 5 .4 7-7 2 3` 5 NOTES: 1. Tefts'W bo rdp;eWd• at same depth until'approximately equal percolation rates are obtained . at each percolation test hole. . (Le-.; :5 1 min for 1-30 mWinch, :5 2 min for 31-60. min/inch) All-data to bi7 submitted for review.. 2.' Depth measurements to be made firom -top.of hole. Form DD-97 Indicate level at which` groundwater-is encountered — Indicate level.at which. mottling- is observed Indicate level to which water level rises after being.encountered Deep hole observations-"'ma'de by: late. Design Professional Name w . n1\v tf JV l; Address: so Signature: n e , l Design Professional's Seal b. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 5/7- /o ff FINAL SITE INSPECTION e Date: a Ins eesed by: Street Lo .cati e, �.� Owner .. _ _ '. (/Ll �dNL+ 11ZC'j Town Permit # TM # 3 '> ©/ Subdivision Lot # 9 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 not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course /wetlands. .. IL Sewage System a. Septic tank siz - ,00 .........other.....:::... b. ' Septictank inst evel ........... ............................... . c. 10' minimum from foundation ...................................... Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. .. Minimum 2 ft. Original soil between box & trenches e. Junction Bog properly set .... :.................................... 6. Trenches 1. Length required 3 oe7 Length installed 3 2. Distance to watercourse measured -(- ( Pa Ft.......... 3. Installed according to plan. - eoe w(. ....... 4. Slope of trench acceptable 1116 - 1/32" /foot ............. 5. 10 ft: from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 11/2" diameter clean ...................: 9. Depth of gravel in trench 12" minimum ....... :........... 10. Pump Pipe ends ca d .......... . ........................................... .: Svstems g. or�Dosed 1. Size of pump chamber ................................................... 2. Overflow tank ............................. ............................... 3. Alarm, visual/ audio ........:........... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Building a. House located per approved plans Well located as per approved plans . ......:........................ b. Distance from STS area measured /3 © • - ft c. Casing.18" above grade ..... ........................ ........ V. Q . ?ax a.. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box .. ............................... d Backfill material contauis stones <4" 'diamet e °-Curtain'drain &standpipes installed accoid' o an f. Curtain drain outfall protected & dir.to exist waterc rs( g. Footing drains discharge away from STS area.. h Surface water protection. adequate i. Erosion control provid`ed.....::.::.. ..................... ....... Rev. 12/02 COMMENTS ea-1 S 6VI orm ' T i 9 Slit IPtSPECTg ®la1 FAR FI]GL PAD' Date: c07- Inspected by: Fill pad located per the approved plan. Fill Pad Length / Required Length Fill Pad Width A� 5- i 2- S Required Width Fill Pad Depth Required Depth Run -of -Bank Fill Quality Slope from Top to Toe Impervious Layer Installed Erosion Control Installed Sieve Test Results (if applicable) Additional Comments: Reserved for Field Sketch if Applicable t 2- 4 cleee 7 3 F11/ SDJ `\ ` \\ \`\ `.♦ `\ � <��i�iii \ \ Iii \ \ \\ `\ `\ ` \\ '\\ `; ;\\ \. `\ \ ♦`; ♦;` \`; \ \. 1 I oo \ , m 1 \ , � i 1 I , i I \ 1 1 1 \ ♦ / I I 14 / °. 1 Y N.. 15 1 h� ♦` \ \ \ \\ 1\ � I 1 � I v, '- / 1/ �I � ! is % to °1 1 i i 11 I I I \ \ 1\ I \\ ♦ BF \69 .00 \`\ \\ I II r6 co k \ 1 \ \ X06. oo'\ \ \ 1 � \ \ � \\ ♦\ e 1302 8\ El A SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health April 13, 2005 Harry Nichols PE Patterson Park, Ste 106 2050 Route 22 Brewster, NY 10509 Dear Mr. Nichols: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Field Inspection — Wyndham Homes Apple Hill Road, Patterson Lot #9, T.M. #35.-4 -101 ROBERT J. BONDI County Executive An inspection of the fill pad at the above referenced project has been completed. Comments are offered as follows: ...._.., 1. It.appears the, fill.pad,is short in width and length. 2.• It appears the fill pad is in excess of 3.5' depth at the bottom and less than 3.5' at the top. 3. It appears the slope from the top of fill pad to the toe is in excess of the required 3 on 1 slope. Please note that field measurements by. this Department in no way suggest the exact size, depth and location of the fill pad. If you have any further questions, please contact me at 845 278 -6130, ext. 2261. GDR: cw Sincerely, c Gene D. Reed Sr. Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 APR -08 -2005 10:54 AM HARRY W NICHOLS 914 279 4567 PUTNAM COUNTY DEPARTMENT OF HEALTH DTYISION.OP ENVIRONMENTAL HEALTH SERVICES RFQ1 JERT FOR PM(A't, rNSPRCTION For:. Fill Date:. ems; a Trenches PCHD Construction Perurit # P- 36 -01 ` Located: 1'r APPS „ u� u. aoAb (T) M P.MOM0 Owner /Applicant Name: u1 j akaA L wawm& (Ns. TM 35 - „ Block 4 Lot 101 Formerly' :Subdivision Name: _ J gg jgjagg> Subdivision Lot # °1 • Is 'system'fill completed?,., Is$ Date: e4 -m- gs- Is system complete? Date: Is system consunacted as per plans? Is well drilled? Date: Is well located as per plans? Are erosion control. measures iu p1906? I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified' their pompletion in accordance v�* the issued PCHD Construction permit and approved plans and' the Standards, Rules and Regu rh utnam County Department of Health. 0,�0 .. Date; Q9.07 ;o„ Certified by: C -` PE,- RA P.01 MAR -29 -20015 10:06 AM HARRY W NICHOLS 914 279 4567 P.01 PUTNAM COUNTY DEPARTMENT OF REALTE DTV* SION.OF ENYLRONMENTAL EMALTH SERVICES J Et _nt 1 .�T I�nR F Arr INSPECTION For: Fill Date: _Q3.74-0__ Trenches-4 ...,,_„_ - kHD Construction permit # p. 11A . o* Located: 1 � avPj u 1 &2� (T) (V) Owner /Applicaut Name: oxhju"iw -"=A- Z"- TM — 131bek Lot AQI ' Formerly. Subdivision Name 3e0j aa.Saeb - �w Subdivision Lot' # � is'systedu'fill completed?' Date: Is system complete?: UQ_ Date: Is system constructed as per plans? err.rr�� Is well dtilled7 ,.. —YA Date- Is well located as por - lans? _ Ylts Are erosion control measures in place? I certify that the syste6w: as listed, at the above pramises has been Constructed and I have inspected ; and ,verified their: Conmpletion in accordance with the ' ad.. CHD . Construction Perri* and approved plans and' the Standards, Rules and Rego `` am County Deparunent of Health. Ceiti&ed-by: * `B PLA ....V.r•_••� �• •men p, �, -ter �� Address:~ 2 # /�� , : I�r�ll i �ir���r//r.e% ^v..•nvq�.- _ _ __ 1 , 1 FOR: .0 ADAM . ' KGFNE 17 orm FIR-99 - _ ____ T[ I . ❑d�_a�s� -7tl ?1 N. 10F: PUTNAM COUNTY DEPARTMENT nF P. 1 MAY -02 -2005 02:20 Pro HARRY W NICHOLS 914 279 4567 PUTNAM COUNTY DEPARTMENT OF HEALTH DMSXON OF XNVMONMNTAL HEALTH SERVICES " For: Fill Date; QA•02•Ot5 Trenches PCHD Constriction Permit # I. 3A - 03 H� Located: a sr w iLL _ _ ._ (T) Owner/Applicant Name: QA&K ^tL 10+K LQG. TM —6. Block 4 _ Lot lO1 Formerly: _z Subdivision Name:.._ bWgQ2gb Subdivision. Lot # 4 Is system fill completed? . It system complete? Is system constructed as per plans? Is well drilled? yes Is well located as per plans? • Are erosion control measures in place? use. Date; :Date' - _x -22- jam_.._. Date:, ofi•oz-gi w I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified etvir completion in accordance with the. issued PCHID Construction Permit and approved plans find the Standards, Rules and Regulations of the Putnam County Department of Health: Date: 05-Q2-11-4 Certified by: kA .. Design Pp ssional Address. 2020 Zola, 2z Lic. # _ .SQ?4 Comments: FOR: ❑ ADAM GENE (NANE) Form FTR -99 P.01 -- Tr[ . .!uF +iC' • DI !TFJr)A1 : -r1! l.JTV nr - w SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health May, 2005 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 OFFICIAL NOTICE OF VIOLATION Mr. Harry Nichols Patterson Park, Ste 106 2050 Route 22 Brewster, NY 10509 Dear Mr. Nichols: ROBERT J. BONDI County Executive Re: Wyndham Homes Apple Hill Road, (T) Patterson Lot #9, T.M. #35. -4 -101 The following item is in violation of Article III, Section 2C of the Putnam County Sanitary Code: • Erosion control measures not installed below the well construction area. The violation may lead to an enforcement hearing and subsequent fines. The violation is to be immediately corrected to minimize the number of days you are out of compliance. Please note that fines may be issued for every day the violation is not coreected. GDR:cw Sincerely, Gene D. Reed Environmental Health Engineering Aide Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health May 5, 2005 Mr. Harry Nichols Patterson Park, Ste 106 2050 Route 22 Brewster, NY 10509 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive Re: Wyndham Homes Apple Hill Road, (T) Patterson Lot #9, T.M. 435. -4 -101 Dear Mr. Nichols: An inspection at the above referenced lot has been completed by this Department. The system cannot be backfilled at this time. The following comments must be addressed. large? rocks must be removed from the -ba k fill -material -- - _ . _.. _ _ ..._ _.....:..... _.._. _., 2. A bedroom count needs to be performed by this.Department. 3. A cleanout needs to be added at half way point from septic tank to septic system. 4. Silt fence needs to be added below the well construction area. 5. Grading around well needs to be completed to ensure surface water drains away from the well casing. The well casing needs to be 18" minimum above final grading. If you have any further questions, please contact me at (845) 278 -6130, ext. 2261. GDR: cw Sincerely, Gene D. Reed Environmental Health Engineering Aide Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 SENDING CONFIRMATION DATE MAY -6 -2005 FRI 16:46 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 92794567 PAGES : 2/2 START TIME : MAY -06 16:44 ELAPSED TIME : 01'17" MODE : G3 RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... I I SHERLITA AMLER MR Ma, FAAP R086RT 1. SONDI Commt ++bnu afXrafdl Cmmry E--W LOR&TTA MOLINARI, kN, MSN AJraCI&C Canun4rlanuofHecW DEPARTMENT OF HEALTH 1 Gonovo Road, Brewster. New York 10509 May 5, 2005 Mr. Harry Nichols Patterson Park, Ste 106 2050 Route-22- Brewster, NY 10509 Re.' Wyndham Homes Apple Hill Road, (1) Patterson Cot 49, T.M. N35. -4101 Dear Mr. Nichols: An inspection at the above rckrenced lot has been completed by this Department. The system cannot be backfrlled at this time. The following comments must be addressed. I. All large rocks trust he removed from the back fill material. 2. A bedroom count needs to be performed by this Department. 3. A clennout needs to be added at halfway point from septic tank to septic system. 4. Silt fence needs to be added below the well construction area. 5. Grading around well needs to be completed to ensure surface water drains away from the well casing. The well casing needs to be 18" minimum above final grading. If you have any fluther Questions, please contact me at (845) 278 -6130, ext. 2261. Sincerely, Gene D. Rced Environmental Health Engineering Aide ODR:cw Woa &"IyAerea t645) 5955186 Fa (84a) 715.5418 2 .1 ..maoWljaW (845)7784190 Fax(845)178 -791, Vnntq s.Mm (845) 7)84S58 - WIC (865) 7784678 Fax (845) 278 -6aa5 Early latmea lodPrealkeal (N5) 7704MIl Fax (845)1784648 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT _ Well Location Street Address: 1_19,7-- r / Town/Village: /v Tax Grid # Map 3 S. Block 4- Lot(s) lOt Well Owner: Name: Address: � � Q Use of Well: 1- primary 2- secondary Residential Public Suppl Air cond /heat pump rrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling. Equipment Rotary Cable percussion; Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length `71 ft. Length below grade eft. Diameter _bin. Weight per foot Ib /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded -:�d Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: _ N&es No I Liner: Yes _vpNo Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped Compressed Air Hours -A�- Yield gpm Depth Data Measure from land surface- static (specify ft) / During yield test(ft) in Y / Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses._..._...._._F., are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 1- If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type 5 Capacity �— Depth -t�-6 Model "7 E 1*10+1 Z Voltage �L70 . HP r1 Tank Type 4)5L--3P2- Volume 4,9M Date Well Co pleted Putnam County Certification No Date of Report Well Dr' ligna ture) 1VUm: LXaCt LOCaiIOn Ojwitn f/ aistances le >' lanamarxs to oe pr��aec�n a s'ep� Ta��rle� ptan. Well Driller's Name Address: ✓6. Q � Signature: Date: A 11r/ White copy: HD ile; Yellow cop - Building Inspector; Pink copy - Owner; Orange coy ="Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES o 7- 'DESIGN DATA SHEET '- "SUBSURFACE gEWAGE TIATIVIN' .SYSTEM Owner 14.1 11oug to Address XP Pl— 6� / /LZ %U� Located at (Street) Tax Map Block Lot (indicate nearest cross street) Municipality �� r Watershed / Z— LLI,0� SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test `l ® 4/ 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 ............:..............:: ;.;:. ;.::.::..:....:. . `'aa <`:.'' >:> ?<� ........... . .:.:::...:.:......... Ru.aib;..;;:::.:::;.Sxat::ta :<:»>«<;<::<:<:<:»::::>>;:::<::::::::<:::>:::<:::»::>::::> r:..:..: :: » >: ><::._: >;: >:::::::..;:...F : >g:. : F. om:.. rutzd::>::<>;: ..e... ::<::< >;Le.:et::::; >:: >:: .:.:,::::...: .> >;: >;. .. ...:.....;.. Percotat�an:: <: >::;;.::::•; <. < >:;.;.. :....:..:.................. ............................... ;:<.:; >: >;:... �n;:::::<::<: ....<: :: »<::::tarC::: >:::<;Stb :;:;:.:;. >; >:<.:«:IrtEes::.::::::::: >::1� ; : ,::;:> 4 ; 0 7 12- 3 5 1 2 3 4• 5 . 1 . 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 Sheen° of ;. #, * PUT-..NAM COUNTY - DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLH SERVICES . FIELD ACTIVITY REPORT s jAMF' % 1]i/N1 IfJ%YI'J TPI A% I , Street Town State Zip RERSON Ilv CHARGE r ra a :.: w " Name and Title = TYPE OF FACILITY l�o� a r' Vool r is S FINDINGS. E: e > - _ f - n #. — _ x: ° ' 1 .eEl' ~' - Signature and Title p .y ''RFPCIR'F R- C-PTV,M, RV: .: I acknowledge receiptaof this report SIGNATURE: �. M N 02 19 6 - - Title Rev. - APR -05 -2004 12:50 PM HARRY W NICHOLS BRUCE IL. FOLEY Public Ffealth...Director 914 279 4567 P.01 03-0 76e LORETTA MOLMARI R.N., M.S.N. ��,frroctetr 0 A11 Xealth Director _ Director oJ. Pollens Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 REQUEST FOR FIELD TESTING aTTENTI0,N: o ADAM STIEBELIN.G GENE REED All information below must be ju completed.prior -fo any scheduling, �.L.�. DATE: ENGIIiIEER OR FIMI: CA Ynq f- &j ' 1'�X PHONE. #: REASOir: - DEEPS: 0 PERCS ;X. PUMP TEST: Q TOWN., � ' ` TAX MAPN: l SUBDIVISION: ��er•tzioc )LOT#: OWNER, UCDEP CRITERIA FOR JOINT REVIEN`ANb" ] NgsSiNG slln, YES NO o Proposed SSTS-within the drainage basin of West Branch or Boy_ds_Corn..er Reservoirs. o Oro posed SSTS within 500 feet of a reservoir, reservoir stem or control lake, 0 Proposed SSTS within 200 feet of.a watercourse or a DEC wetland. o Proposed SSTS design flow greater. than 1000 gailonslday-or SPDES Permit required. 0 Proposed SSTS for a.Commerical Project. It is the responsibility of the design professional to_providc the above information prior to soil testing. This Department will determine the NYCDEP project stsitus (Joint or Delegated) based on the response. lr you answered= to any of the questions, 1NYCDEp.must- witness the soil testing. This Department will coordinate a mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP, If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is. required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witriessing.of the soil. testing with NYCDEP. (FlELDTEST) 79 Mama! P1 I' DIMENSION CHART (in feet) Number A 1 29 25 2 133 118 3 137 1 21 4 141 1 25 5 146 129 G 150 133 7 155 136 8 121 96 9 1 15. .90 10 110 86 1 I 1.05 81 12 99 76 13 94 72 Y% Y r�� Llt1 AAa' ryb wr:m ocv N� ,o. � Ai21:A:..143,6 � 3,2 I 3 a ' �a _s N '1'J J`ij n QO m :p 3z Q- ' o 0 by 2 1 W 0 IN O 0 a� r AV . . . . . . . . . . . . . . . . dell- - ------------------------------------------------- ---------- SEP CIj K-10 C C 1 CL Lo 0 ®® SEP CIj K-10 C C 1 CL '�P. ^ &Kv A '. '"y t%a.i �I:�r `^�k }r u'�.:s Yv".�n �'•Lt1 a t T*y'�a'um ,awl, vF s 1 �v i �' ,• rr w �' ,� � &.. �� � &f A . y ,� � i .h V ,.. ". cE�.,� a. C ,,wrZ,• %, rw+: is �" 3"als��r"- n31�yaS��E�r,•:'�±�� +e;e"��''�d.�e�. Tc•u• ,. � ,.x ,�n, - ... � �.... � .v_ �. S �.. s it ,. �W.� �� >?^�..si� .. .+s �.. a .�.,. , e • �. �°. _y y ri iC�f m bz Windsor Woods Patterson. New York The Kensington s FIRST FLOOR PLAN t /8' ��'✓.y..f.. N`f�'I l.` }ta+9ri d1 r bM�),�r. +:�,.^ i. 3. �_£ 4Z. 1�`' ta g" Rd �... .. + 4 M A Windsor Woods Potterson, New York *F&-ik� Lot 09, Plan K The Kensington BASEMENT PLAN 'x'0'4 O `�1 i i O i i O O © © -© t /a' �