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HomeMy WebLinkAbout1763DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -4 -102 BOX 16 ., I AO 16j' )IN ' , ',, '' ■ -- ' 1 IN 01763 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at 'Z. A,a A— A L I / a 0-j Subdivision name e. r 1, Subd. Lot # / Date Subdivision Approved 2 O Owner /Applicant Name Mailing Address Town or Village Tax Map Block Lot 16 Z Renewal Revision Date of Previous Approval Zip i 0 S, CJ 7 Amount of Fee Enclosed Building Type Lot Area /, 0085 No. of Bedrooms Design Flow GPD 80 Fill Section Only Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 12,5-,0 gallon septic tank and Other Requirements: c ( . C,- To be constructed by 1 6 D Address Water Sup"I : Public Supply From or: Private Supply Drilled by 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 treatmentsystem 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. A Signed: Address R.A. Date License # 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 permit. Approved for discharge of domestic sanitary sewage only. UO-A Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 I' , Harry W. Nichols Jr., P.E, Patterson Park, Suite 106 2050 Route 22 Brewster, NY 1 a509 -- Telephone (845) 279 -4003 Fax (845) 279-4567 Date: To: Job No.: - Project S� �, /d Attention: rvLJ f f I �y - . ��` `I a j Gentlemen: We enclose( copies of: 13/W Prints. Reproducibles Reports .Tracings Specifications Memorandum Copy of letter ;f (r` s� Description: Revision/Date No. Sent Via: Our Messenger Blueprinter First Class Mail Special Delivery Your Messenger Hand Delivery Copy to Very truly yours Harry W'.UNichols Jr., R.E. DEC -02 -2004 01:33 PM HARRY W NICHOLS 914 279 4567 i PUTNAM COUNTY DEPARTMENT OF HEALTH DngSION OF ENVIRONMENTAL HEALTH SERVICES P.01 o s -O , 10 • RE Lam? -EQ& FINAL . INSP (F.�, TYO For:. Fill Ll Date: �--.� I C1 '`� , Trenches PCHD Construction Permit Located : (T) ( I V✓1 V71 - Owner /Applicant Name: TM 3 5- Block Lot -LO-2— Formerly: Subdivision Name: ti Subdivision Lot* U is'system fill completed? 4D 1 -1 Is system complete? ' Date: Is system constructed as per plans? Is well drilled? --r,77 -_ Is Weil located as per plans? Are erosion control measures in plaae? -I Certify that the system(s), as listed, at the above premises bas been. constructed and I have inspected and .veriiyed their completion . in 'accordance with the issued PCHD Construction Permit and, . approved plans and the - Standards, Rules and Regulations ofthe Putnam County De partment of - Health. `ice D Professional Address: Sid Comments:. FOR: ❑ ADAM GENE ! (NAME) - -- Form FIR-99 NAME:PUTNAM COUNTY DEPARTMENT OF PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PE E TREATMENT SYSTEM PERMIT # L-3 %O 3 - Located at APPI11' 14 I L L- gvA fl Town or Village Subdivision name 9-0 VID Subd. Lot # Tax Map r,� �' Block 4 Lot I Date Subdivision Approved �- 0 Renewal Revision Owner /Applicant Name VJ R04NA Date of Previous Approval Mailing Address �Jl- .AWOH P� L ome�, i P1, Zip I P51 �L Amount of Fee Enclosed Building Type Lot Area l' t G 5 No. of Bedrooms Design Flow GPD % tO Fill Section Only ( Depth 'L, 5" Volume � "-- a PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and Other Requirements: To be constructed by Water Supply: Go��mlA N -1}--1 q-00 L r- A ?%, WT810I��M 0 M07 i l Address Ei' MLA 0N(N C-!- NI)II' Nl*-' l� � 1-- Public Supply From 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 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: Ej Address U J�o P.E. I i la'S0 R.A. Date 1,2-110 `p License # 50N APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage trea nt system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w en onsidereA necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe t. pprov or disch of domestic sanitary sewa,%p only. i By: Title: Date: o White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEAL'T'H DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # Well Location: Street Address: Town/Villa e Tax Grid # nil- Af f L RILL R. f A��Tq1,;0 N Map '� 5 a Block 4- Lot(s) 10t)_ Well Owner: Name: Wi MOM OPMEb; A -, Address: 1A Pc NEiTJ CAWEL r 1 10 i t Use of Well: X, 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 lc3t gpm. #People Served "(d Est. of Daily Usagegal. 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 Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision' Lot No. Water Well Contractor: 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 separa sheet/plan. Date:... _.1.0 -� !�� r� ..._.Applicant Sigrature:...- - - - - -- 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 Directo y revision or alteration of the approved plan requires a new permit. Well to be constructed by a water el driller c ified by Putnam County. Date of Issue �- .B Permit Issuin Icial: Date of Expiratio a62 Title: Permit is Non- Transfer able White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; - Orange copy - Well driller Form WP -97 2. One Deep and one Percolation. Test is now located in each of the primary and expansion systems, 3. 400 L.F. of expansion tren(Als now provided. We trust the above adequately addresses Y�Vr concerns, and request your continued review and approval of the above reference application. Very truly yours, s Harry W. Ni hols Jr., P.E. ' HWN:gav 03- 056.10 Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 _.. ... , . w. ,._20501Rcxite-227� -w _ Brewster, NY 10509 Telepb6ne (845) 279 -4003 Fax (845) 279 -4567 •, s , March 26, 2004 r y7% Putnam County Health Department; , 1 Geneva Road Brewster, New York 10509 ATT: Mr. Robert Morris, P.E. c Senior Public Health Engineer , RE: Proposed SSTS -Wyndham Homes.' 62 Apple Hill Road — Lot # 10 Patterson, NY = `r. T.M. # 35 -4 -102 Dear Mr. Morris: ` In reference to your review letter dated Feb '4ry 23, 2004, we note the following: _..... _- ___.:.... _ ....._._...1..:....._._ 15.' .is.,now proposed..b,etw-een.the cui taia drain and primary SSTS. 2. One Deep and one Percolation. Test is now located in each of the primary and expansion systems, 3. 400 L.F. of expansion tren(Als now provided. We trust the above adequately addresses Y�Vr concerns, and request your continued review and approval of the above reference application. Very truly yours, s Harry W. Ni hols Jr., P.E. ' HWN:gav 03- 056.10 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 February 23, 2004 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 — Wyndham Homes 62 Apple Hill Road, Lot #10 Town of Patterson, TM# 35 -4 -102 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 curtain drain must be maintained at a distance of 15 feet to the SSTS. The expansion area cannot be proposed between the curtain drain and the primary SSTS. 2. Soil testing is not representative of the entire SSTS. Additional soil testing is required in the prunRr SSTS area`. The miftinl •of onl; 'dmp test-hote-and -one percolatiorriest -are tobewitnessed: -- -- - 3. It appears 375 L.F. of expansion trenches are, provided. However, 400 L.F. of trench is required. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ve y ours, Robert Morris, PE Senior .Public Health Engineer RM:cj PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS ,.... :_.._.. REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: I- h'W"g STREET LOCATION: REVIEWED BY: RM, GR, AS, SRDATE: Y N DOCUMENTS (_�( )PERMIT APPLICATION ��WELL PERMIT OR PWS LETTER � PC -97 LETTER OF AUTHORIZATION (_) DESIGN DATA SHEET (DDS) )CORPORATE RESOLUTION () SHORT EAF C_JC_)PLANS-THREE SETS L —))HOUSE PLANS - TWO SETS y UUVARIANCE REQUEST SUBDIVISION LEGAL SUBDIVISION ( �lr_ )SUBDIVISION APPROVAL CHECKED (� )PERC RATE �) FILL REQUIRED DEPTH C10(­)CURTAIN DRAIN REQUIRED GENERAL LOCATED IN NYC WATERSHED PLANS SUBMITTED TO DEP LEGATED TO PCHD ( �{ )DEP APPROVAL, IF REQ'D DEEP TEST HOLES OBSERVED PERCS TO BE-WITNESSED EX- APPROVAL SSDS ADJ, LOTS WETLANDS (TOWN/DEC PERMIT REQ'D ?) DATA ON DDS PLANS & PERMIT SAME PRE 1969 NEIGHBOR NOTIFICATION LETTER BFZBA 0100 YR. FLOOD ELEVATION W/I200' L REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) ( ( )SSDS HYDRAULIC PROFILE )CO FSTRUCTION OTES 1 -15 RC & DEEP RESULTS )2' CONTOURS EXISTING & PROPOSED )DRIVEWAY & SLOPES, CUT )FOOTING /GUTTER/CURTAIN DRAINS )USDA SOIL TYPE BOUNDARIES )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. )P P, ISH FLOOR AND SEMEN EVATIONS SSDS'S W/IN 200' OF SSTS )PROPERTY METES & BOUNDS )EROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE COMMENTS: (REVSHEET)09 /01/00 TAX MAP #: (CONFIRMED) N F (REQUIRED DETAILS ON PLANS CONT'D) -HOUSE SEWER - Y." FT. 4 "0'; TYPE PIPE CAST IRON C­D(�NO BENDS; MAX BENDS 45° W /CLEANOUT I/ RENEWALS STTE NOTE (NO CHANGE) FILL SYSTEMS L10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE SPECS/ FILL NOTES 1 -5 L�FILL PROFILE & DIMENSIONS �) FILL IN EXPANSION AREA FILL GREATER 7NAN2 FEET CLAY BARRIER FILL CERTIFICATION NOTE DEPTH GAUGES C_)VOL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS ( �)(L)SEPARATION DISTANCE FROM TOE OF SLOPE TR NCH TRENCH PROVIDED 60FT MAX. (_� LLF ; PARALLEL TO CONTOURS 100% EXPANSION PROVIDED ( _)DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL (_)LJGEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL C,, )20' TO FOUNDATION WALLS 0(_)100' TO WELL, 200' IN DLOD,150' TO PITS )100' TO STREAM, WATERCOURSE, LAKE (inc. eapan) 7 ,' 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (pits - 20') 5.0: INTER31ITTENT .DRAI14AGE.COURSE.•.....•.,__, .. 200'/500' RESERVOIP, ETC. _ 150' GALLEY SYSTEMS ~ ---)10' MIN TO LEDGE OUTCROP SEPTIC TANK Z��LOCATION 10' FROM FOUNDATION; 50' TO WELL WELL DIMENSIONS TO PROPERTY LINES OF SERVICE CONNECTION L MIN 15' TO PROPERTY LINE SLOPE (SLOPE IN SSTS AREA (S20 %) ((__)REGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS PUMP NOTES DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) (pl 6,PTT AND D -BOX SHOWN &DETAILED (_1 DAY STORAGE ABOVE ALARM CURTAIN DRAIN S TANDPIPES, 5' BOTH SIDES, DETAIL 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 LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive Environmental Health (845)278-6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschoo1 (845) 278 - 6014 Fax (845) 278 - 6648 February 2, 2004 Harry Nichols, P.E. Patterson Park Suite 106 2050 Route 22 Brewster, NY 10509 RE: Wyndham Homes 62 Apple Hill Road, Lot #10 (T) Patterson, TM# 35 -4 -102 Reservoir Basin Dear Mr. Nichols: The Putnam County Department. of Health (Department) has determined that the above referenced app�'icafion; in6 tiding fee, -and received-by thus Department on Decettibbr 29,-2003-is-complete:' The Department will notify you by February 17, 2004 of its determination. ® The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a proj ect, such as stormwater plans I W Letteito: Harry Nichols,-P -.E. - February 2, 2004 = = " -2= or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2166. Ve my yo 1 Robert Morris, PE RM:tn Senior Public Health Engineer Ha" W. Nichols Jr.., P.E. Patterson Parr, Suite 106 2050 Route 22 Brewster, NY 10509 Telephone (84S)• 279 -4001 _ Fax (845) 2794567 December 10, 2003 Putnam County Health Department One Geneva Road Brewster, New York 10509 ATT: Robert Morris, P.E. Re: Individual SSTS . Deerwood Subdivision - Lot # 10 62 Apple Hill Road Town of Patterson T.M. # 35.4-102 Dear Mr. Morris: Enclosed are the following: 1. 2. 3. 5. 6. 7. 8. 9. 10. Five (5) prints of SF -10, "Preliminary Design for Fill Placement Only", dated 12/10/03. Two (2) prints of SS -10, `.`Proposed SSTS ", dated 12/10/03. "Short EAF ", dated 12/10/03. `Application for Approval of Plans--for a Was+ewater Disposal - System ". "Construction Permit. for Sewage Disposal System, ", dated 12/10/03. "Application to Construct a Water Well ", dated 12/10/03. "Design Data Sheet ". "Letter of Authorization & Corporate Resolution ", dated 12/10/03. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only". 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. Nicho s Jr., P.E. HWN:gav 03- 056.10 14 16-4 (9195) —Text 12 PROJECT I.D. NUMBER 617.20 SEQ R Appendix C State Environmental Quality Review. SHORT ENVIRONMENTAL'ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be conipleted by Applicant or Project sponsor) 1. APPLICANT /SPONSOR ,' 1 i ; � �n i 2. PROJECT NAME 3. PROJECT LOCATION: n Municipality l I County 4. LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) //PRECISE 5. IS PROPOSED ACTION: New ❑ Expansion ❑ Modlficatlon /alteratlon 6. DESCRIBE PROJECT BRIEFLY: W 1i- 1fl►�rp�P�i.- a i , OLi. 7. AMOUNT OF LAND AFFECTED: i ` $001, i ° has Initially acres Ultimately acres S. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR-OTHER EXISTING LAND USE RESTRICTIONS? IL �I Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? 2SResidentlal ❑ 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 CKNo If yes, list agency(s) and permittapprovals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? El Yes ]K No If yes, list agency name and permit/ approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑ Yes Cdlo . I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE 10� -ty, � � I - p� A� A Lgpz Applicantlsponso. ame: Date:. Signature: If the action is in the Coastal Area, and you are a. state agency, complete the . Coastal Assessment Fdrm before proceeding with. this assessment ..OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD. IN 6 NYCRR, PART 617.4? If yes, coordinate' the review process and use the FULL EAF. ' ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by- another involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise. levels, existing traffic patterns, solid waste. production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species-, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly. C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. 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? 0 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 occurriag;.(c). duration; (d) irreversibility; (e) geographic scope; and (f) rhagnitude'. if necessary, add attachments or reference supporting rri -itc 'vials. 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:. Name of Lead Agency Print or Type Name of Responsible OfiiceFin Lead Agency 6 Ti Ie s ible Officer Signature of Responsible Office r in Lead Agency Signature of Treparet (If di( erent from responsible officer) Date 2 _,PUTNAM COUNTY- DEPARTMENT OF-HEALTH - -= DI`?ISION:DF ENVIRONMENTAL- HEALTH�.SERVICES` - -APPLICATION FOR APPROVAL OF PLANS FOR — Y -A,WASTEWATERTREATMtN7T-SYS EM'' 1. Name and address of applicant: AW 000 11 v_����� 2. Name of project: }0 4..Des.ign Professional: 1rJ,�t,t�ol -� �E 6-. Drainage .Basin: 0700— 7 T e of Protect- phi 3. Location `I'/V 5.. Address: 9-050- BP Pnvate/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 : Type--Status ( check - one) * .......... ............................. .. T YP I .:Exem P t Type II t'-­ :-Unlisted-: 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... PJa 10. Has DEIS been completed and found acceptable by Lead Agency? ......:..,..... '.11-... Name of Lead Agency - -- _rJA :.12: Is this project in an area under the -control of local planning, zoning,.or other _ ........ ^.. _ _ officials, ordinances? .......I.... ......... .......I...................I. .............. ` .... ; ..... 13. .If so, have plans been submitted to such authorities? ........ ............................... .. . 14. Has preliminary, approval been granted by such authorities? No Date-granted: A� _-15. Type of Sewage Treatment- System Discharge....; .............. surface water" X - groundwater "' 16. If surface water discharge,-what is the stream class designation? ....:.....:::....... 17. Waters index number (surface) ............................. ............................... . IV. .... . 1.8... Js project located near a public water supply system? ........ .....•......:.................. ;. 19.' If yes, name of water' supply Pk Distance to wa-Mr: supply-. -20: Is .project site near a public sewage collection or treatment system? ::...::...�.::..:. � .­2~t. Name of sewage,*system NA Distance;to _sewage systemO K -- 22. Date test --holes- observed- 61 wis�_ 23. Name of Health Inspectdr ' PJJU�i4. 1- 24. Frojectdesign flow (gallons.per day) ............................................... : ........... :... -- .:: .d?k:. ;___:. 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?:.. 26. Has SPDES Application been submitted to local DEC offices . .......................... r Form PC -97 47: Is. any portion: of this ptoj.eQt. located within a designated Town or State wetland? . — 28. Wetlands ID-Number ...... ..............................: ......... ............................. iy p 29. -Is Wetlands Permit required?-...; ................ ............................................... Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream. Disturbance._Perrrtit? 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 - vvaste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No 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.'w.ithin 15 years in or adjacent to project site? ..........................:..... ............................... 1 . 35. Are any sewage treatment areas in excess of 15% slope? . ..........................:...: 1�© ;6: Tax Iv1ap ID Number .........:.:. :. ....- ........ ... : : :..: :.. : : :... :. :. Map ��5, Block ' + Lot 37. - Approved .plans are to be returned to ..... Applicant �_ Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall 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 lirior 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 storinwater.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. 1 hereby affirm, cinder penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements kWd,' h, ei c�a y un fishable as a Class A misdemeanor pursuant to Section 210.45 of the Pen a1 aw. SIGNATURES -& OFFICIAL TITLES: Mailing Address:.....:..::: PUTNA,11%l:COUNTX.bEPARTMENT OF. HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE- TREATMENT SYSTEM ownert XK *M 5�) INC,, AddressAWLVIEW C4MELI Located at (Street) tax Mai-..Block* (indicate nearest cross street) Municipality. Watershed SOIL. PERCOLATION TEST DATA Date of Pre-soaking Date of-Percolation Test .0 3 5 QY�-- .- 2 IVA l ZZ Zs���'w �. �l i 3 VL 2,5 4 5 2 - 3' 5 NOTES: Tots'to-bd repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i;,e-;:5 I min for 1-30 min/inch, :5 2 min for 31-60 min/inch) A. ll..data to be— submitted fot,,re.View. I .' =Depth measurements to be made. from -top.of hole. Form DD-97 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5. 1 8.0' 8.5' 9.0' 9.5' 10.0' TEST. PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED.IN TEST ROLES . HOLE NO. '9 HOLE NO. '. HOLE NO. S i_o(�rlr\ 1% 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: M, �L6' D (OaQ �► ���Lts� � (��`�o� Date. t b.. Uft Design Professional Name:-. M Address: Z2 6ew Signature:, Design Professional's Seal: NEW yo9 KICHp�� yJ •�. w To: Public Health Director In the matter of application for: *41* \t4 "Os L07 to ........... . represent that I am an officer or employee of the corporation and am authorized to act -for: - -- Name of Corporation: -OAE� Having offices at: CAr,�-nOrL, 0j, l D's ,t., - Whose Officers Are: President - Name: Treasurer - Name: Address: and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. - Ak new" r pw�k` Soli a "we yak �wrrn to before me this ' day of (month) 63 (year)'. N Public Form CA-97 Signed: Title: Corporate Seal c��rpu c PUTNAM COUNTY DEPARTMENT OF HEALTH: DIVISION OF ENVIRONMENTAL HEALTH •S ERN CES : LETTER OF AUTHORIZATION, RE: Property of Located at (o°y Af &G NL,(, R-4n TN -�a Tax Map # �° _ Block _Lot o Subdivision of pt`-W ua Subdivision Lot # t D Filed Map # 2-VI 1 Date Filed,-.'' 0' % ` 2— Gentlemen: This letter is to authorize = -- a duly licensed Professional Engineer X or Registered Architect ter-Apply for the required wastewater treatment and/or water supply permit(s) to serve the above- noted - property :in accordai7ce with the standards, rules or regulations.as promulgated by the Public Health Director of:the..Putnai .: County Health Department, and to sign all necessary papers on my behalf in connection witfi -this . . matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the ipns..of Article. 145-and/ox-14.7. Qf the. Education.Law.,-tthe Publie. Health== '.,.-_.. Law, and the Putnam County Sanitary Code. Countersigned: P.E., R.A., # Mailing Address &���ir r ( State Zip p Telephone: (.��s� V71-- 41DA Very tru V.-Sighed: Mailing Address: State P Tele P B Ills- Form- C� S� lls- Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES /,rf //_�P WELL COMPLETION REPORT Well Location Sireet Address: "- " -% '__,_.e.= Town/Village: Tax Grid # Map Block . Lot(s) Well Owner: Name: Address: Use of Well: 1- primary 2- secondary Residential Public Supply Air cond/heat p mp Irrigation 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 Open hole in .bedrock Other Casing, Details Total length _02ft. Length below grade ;�?f ft. Diameter in. Weight per foot lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded _e Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: Yes ..No ` Liner: Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield Test _ Bailed _ Pumped Compressed Air Hours Yield gpm Depth Data Measure from land surface - static (specify ft) During yield test(ft) Depth of completed well in feet' Well Log If more detailed information descriptions or sieve analyses_ are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface / w S _._._..__.... -- S4. If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information ' Pump Type 3� 4, Capacity Depth S—tJ Model 7 a ID41 Z Voltage x-36 BF 1 Tank Typetc)Xy3e,2— Volume 2V 41.41h ife f —' fir Date Well Completed Putnam County Certification No. Date o Re ort I Well Driller (signature) ivv i m Lxact location of welt wim aistances to at least two permanent fanamarKS to be provlaqVon a separate sheet/ Ian. 412. ,n'� Well Drillers Name 1.tA1jty Address: e , Signature: Date: White copy: HD 19 �e Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 F n DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OF PUTNAM -STATE OF NEW YORK IN THE MATTER OF THE COMPLAINT AGAINST ea RESPONDENT(s), Arising out of the Alleged Violations of the Public STIPULATION OF DISCONTINUANCE Health Law of the State of New York, the Sanitary Code . CASE NO. C,1616 VO of the State of New York, the Sanitary Code of the County : Facility No. of Putnam, and Administrative Rules Regulations and 602 �P��E�6� /• Standards Promulgated Pursuant Thereto i ry P IT IS HEREBY STIPULATED AND AGREED by and between the respective parties hereto that the within matter is hereby terminated upon the following terms and conditions. 1. The Respondent(s) admit the truth of the allegations set forth in the Statement of Charges. 2. That espondent(s) represent: it is in compliance with the Code(s). it will be in compliance with the Code(s) by 3 4. That Respondent(s) understand an appropriate civil penalty may be imposed by the Commissioner of Health by Order which amount will be determined at the discretion of the Commissioner of Health. That in mitigation Respondent(s) 1M DATE: Brewster, New York 10509 Health Department Administrative Law Judg - STIPULDISCONTAFFDV yi, DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OF PUTNAM -STATE OF NEW YORK ., -.._ ..__ IN THE M'AnTTER OF. THE• C.OMP."NT- AG.kINS-Ta: STIPULATION PA SPONDENT(S), OF DISCONTINUANCE � �r c2Q Y jDI�9 "sm U73At �1e ed Vio7aiions of the Public g g Health Law of the State of New York, the Sanitary Code CASE NO. aD ? '19 of the State of New York, the Sanitary Code of the County Facility No. I�L of Putnam, and Administrative Rules Regulations and 62 �}P k �// ��� Standards Promulgated Pursuant Thgreto ©� ' C(� 95. D2 RP—t4 p/ 3 `i -03 IT IS HEREBY STIPULATED AND AGREED by and between the respective parties hereto that the within matter is hereby terminated upon the following terms and conditions. 1. The Respondent(s) admit the truth of the allegations set forth in the Statement of Charges. 2. That�espondent(s) represent: it is in compliance with the Code(s). it will be in compliance with the Code(s) by 3. That Respondent(s) understand an appropriate civil penalty may be imposed by the Commissioner of Health by Order which amount will be determined at the discretion of the Commissioner of Health. 4. That in mitigation Respondent(s) Asserts:C�� . 4Cy�,t) jtioLt +(Aa P:�p �r1Y 6 Cc4 -V r DATE: Brewster, New York 10509 Administrative Law Judge STIPULDISCONTAFFDV DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OF PUTNAM -STATE OF NEW YORK IN THE MATTER OF THE COMPLAINT AGAINST HARRY NICHOLS, JR., P.E. RESPONDENT(s), : Arising out of the Alleged Violations of the Public NOTICE OF HEARING Health Law of the State of New York, the Sanitary Code CASE NO. 007 -05 -19 of the State of New York, the Sanitary Code of the County :. Facility No. of Putnam, and Administrative Rules Regulations and Standards Promulgated Pursuant Thereto TO: Harry Nichols, Jr., P.E. PREMISES: 62 Apple Hill Road,. Patterson Suite 106 Patterson Park Lot # 10, T.M. #35.4-102 2050 Route 22 Permit # P -39 -03 Brewster, NY 10509 PLEASE TAKE NOTICE THAT CHARGES have been preferred against you to the effect that you have violated the health laws as more fully set forth on the reverse side of this notice: YOU ARE HEREBY SUMMONED TO APPEAR at a hearing to be held under the provisions of the Putnam County Sanitary Code and Public Health Law of the State of New York before Eric S. Zaidins, Esq., an Administrative Law Judge of the Department of Health of the County of Putnam on the 2nd day of March, 2005 at 9:30 A.M., in the Hearing Room, located at Route 312, 1 Geneva Road, Terravest Corporate Park, Brewster, New York, at which time the charges will be informally discussed, and such adjourned dates as may be designated. A-T ALL- TIMES- YOU -WILD." HAVE THE RIGHT to b-e represented by °counsel and the right -to -deny the charges, in whole or in part, following which the matter will be rescheduled to a date certain and a Formal Hearing will be conducted thereon, and a record of all the proceedings will be made, witnesses will be sworn and examined and cross examined, and documentary evidence maybe offered and received, and you may produce witnesses and evidence in your behalf; AT THE HEARING, IN THE EVENT YOU WISH TO ADMIT TO THE CHARGES, the Hearing may be terminated by written stipulation of discontinuance provided the violations have been corrected; UPON YOUR FAILURE TO APPEAR, a warrant compelling your appearance may be issued or an Inquest Hearing conducted and a determination made; CIVIL PENALTIES up to $1,000 for a single violation, per day, may be assessed against you, and such further orders may be made herein, as the circumstances may warrant; THE BOARD OF HEALTH may issue a warrant to any Peace Officer of the County, pursuant to Section 309 of the Public Health Law, to bring .to its aid the power of the County whenever it shall be necessary to do so, with the same force and effect as if such warrant had been issued out of a court of record. DATED: Brewster, NY 10509 PUTNAM COUNTY BOARD OF HEALTH BY: Sherlita Amler, M.D. Commissioner of Health JAN -25 -2005 01:39 PM HARRY W NICHOLS 914 279 4567 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES For: Fill Trenches 1/ P.01 p3�pS'4 �lQ PCHD Construction Zr111i;1 f Located: tl/ Owner /Applicant Name: H J ,.14- /LS �rTm _ Block Lot 102 Formerly: Subdivision Name: 44,60 Subdivision Lot # f Is system fill completed? Ys system complete? Is system constructed as per plans? Is well drilled? Is well. located as per plans? , Are erasion control measures in place? Date: I -;L41 37 Date: 1-2-1 - 0S� Date: 1: Z.l - ash - I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Pernut and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health, -.- Date:- _i S -..a.� � `Certified b� -- - E De ' ° Professional a Addr e§s' LOIC, e r Lic. # Comments: FOR '0 ADAM XGENE 0 (NAME) Form FIR -99 JAN -25 -2005' TUE 13:56 TEL:845- 278-7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION F Date: l Z Inspected by: Street Locationn� /,r _ . Town��I� ... Permit # TM # } /o Subdivision Lot # /o 1. Sewage Svstem Area a. STS area located as per approved plans .......... :.................. b.. Fill,section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped ................'... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. Sewage System W_w a. Septic tank size - 1,000 r °' ,..... ther.......... ..:......1 250.... o ... b. ' Septic tank installed level .............:.. ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3... Mnimum 2 ft. Original soil between box & trenches e. Junction Box properly set ........... .......................:... ..... 6, rent es 1. Length required Length installed _4�670 2. Distance to watercourse measured .- (po Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface ................:. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 11/2" diameter clean ...................: 9. Depth of gravel in trench 12" minimum................... 10. Pipe ends capped ........................ ............................... w _ Pump or Dosed Systems, 1. Size of pump chamber ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual/ audio ........:............ ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Building a. house located per approved plans::::::.... ,� ................... b. Number of bedrooms .................. �................ IV. _ Well Well 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 ... ............................... d. Backfll material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate .... ....:.......................... i. Erosion control provided ................. ............................... Rev. ?2/02 ..t� yj 10711 Rig: 5 0 dM WAe . AWAM "'AM rn,ffu G� I jr, E 4 rim NA ..t� SITE INSPECTION FOR FILL PAD 0 /� /fir/ Date: Inspected by: Fill pad located pet the approved plan Fill Pad Length Required Length Fill Pad Width qq Required Width Fill Pad Depth '' ceil 1eci Required Depth Run -of -Bank Fill Quality Slope from Top to Toe Impervious Layer Installed trosion Control Installed Sieve Test Results (if applicable) Additional Comments: Reserved for Field Sketch if Atmlicable C. Iq Cti-t E.i ✓� -A E.i ✓� / ` ro O r / moo 1 ! a ►� r / / r / / ✓ t- le F P A "� 01.\ / Q / -TO / / / Ali / / fy N l l f 1 � / f i t u Pi f -v fPri TAIHK. ® Tw VL !}� }V� ✓�cl� v, .S, clv1 112-o /to . LORETTA- MOLINARI Public Health Director DEPARTMENT OF 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 January 19, 2005 Harry Nichols P.E. Patterson Park, Ste 106 3050 Route 22 Brewster, NY 10509 Dear Mr. Nichols: ROBERT J. BONDI County Executive Re: Wyndham Homes Inc. Apple Hill Road, (T) Patterson Lot #10, T.M. #35.4-102 Per our meeting on January 18, 2005, in reference to the above referenced lot, the following comments are offered. ~ It was determined that the fill pad has not been constructed in accordance with the plans approved by this Department (re: in excess of 3.5 feet in depth). Therefore, a waiver must be sought from this Department or the fill pad must be corrected in order to conform to the approved plans. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Sincerely, Gene D. Reed Environmental Health Engineering Aide GDW:cw k SENDING CONFIRMATION DATE JAN -25 -2005 TUE 11:05 NAME PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE PAGES START TIME ELAPSED TIME MODE RESULTS 92794567 : 1/1 JAN -25 11:03 00'41" G3 OK . FIRST PAGE OF RECENT DOCUMENT '!.'RANSMTTTED... C? k #4, tOUTrA MOUNAP.1 nnmfa'r r. RONDI ?Wlflr 11•did Utrcav 0-W F—M. i DEPARTMENT (0- id `1Ai:I II i 1Genava RgaA, Hnnvst,:.'c:. '•itrl -Into? iYi' k:9van9menml Peaff9 6.51: ?8 'a -t6i' ' /721 14—t., srrvtes (945) 279 6539. 27R 60:1:• Bury Llwe9tlo;VPrnr9nnl IPA 1!!;r w January 19, 2005 •1'15itv'�li,ilwlsP,F.: ..P. Pa1w...son Park, Ste 106 3050 Route 22 i Brewster, NY 10509 A } ndhnm l fomcv Inc. anplr Rill Road. (T) Patterson I Dcar B'ir. Nichols: �,.,...::,,.t tc�k:.•:r.ccd l.,P., he , Prr, Onr mecitng nn January ] tl, 21i0:�.:•. �•:( ! following comments are offered. ft was determined that Uw rill pio ha; n•!. i'e:,: 1 m a:cor,.lonec with the plans . approved by this Dcpartn ew (. a: in cwe-i ni laptli). 'I lyre, a waiver mast he sought from this Depalimcnt or the dl i.:,,t r:;v. 11c 01112r(cd in older to conform In the approved plans. If yeu have an V'fmithcr lluestiens, plonse c mtlef -it, .!1 Q&1 }, 30 "t. 2261. SlllCel't'l" Pu ^ "- .;•:n >rea! b.,lih 14n.•,inecrin_r, Aide (A)W:cty a SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health January 28, 2005 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 ROBERT J. BONDI County Executive Re: Wyndham Homes Inc. Apple Hill Road, (T) Patterson Lot #10, T.M. #35.4-102 An inspection of the fill pad and SSTS trenches at the above referenced project has been completed. .Comments .are offered as follows. - - - -- - - -- The SSTS trenches can be backfilled at this time in order to protect the system. Please refer to my previous letter dated January 19, 2005 for comments that have not been addressed. Please see attached. 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. GDW:cw Sincerely, f%) f26 '�' Gene D. Reed 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 � C OPUT,AM COUNTY DEPARTMENT OF HEALTF -DIVISION -OF ENVIRONMENTAL HEALTH SERVI CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMEN PCHD CONSTRUCTION PERMIT # .V 3 9' -o3 Located at . Ao,je- Owner/Applicant Name lel ti i,, u ak, f ra"A cs 1h� Formerly Mailing Address : — 'a 1 I t "t Town or ge�c�t Tax Map 35 y Block Lot 102-- Subdivision Name be'CT- vim! Subd. Lot # % ) ? f j; Zip / �S Date Construction Permit Issued by PCHD cd/1!34joali Separa te Sewerage System built by � v..t„ � , Address —7 ri ✓cl- Consisting of Gallon Septic Tank and FOCI Other Requirements: 2 .S' n 41"1 Water Supply: Public Supply From. Address or: Private Supply Drilled by Address Building Type /; tK ��'-� to Has erosion control been completed? Number of Bedrooms Has garbage grinder been installed? Nd 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 regulatiop/ of the Putnam Count Department of Health. Date: - -� Certified by Address '�LO S 6 kt-' )a B rz w P.E. 4,'-' R.A. License # ;412-1 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 revocat' n, modificatio or c7/05r is necessary. By: Title: Date: White copy - HD F e; Yu copy'- Building Inspector; Pink cop j_ Owner; Orange copy - Design Professional Form CC -97 PUTN1AM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES //,;, WELL COMPLETION REPORT- Well Location Street Address: ' Town/Village: Tax Grid # Map Block Lot(s) Well Owner: Name: Address: . i Use of Well: 1- primary 2- secondary Residential Public Supply Air cond/heat p mp Irrigation 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 Open hole in bedrock _ Other Casing Details Total length ft. Length below grade , Diameter _ "in. Weight per foot lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded _)e Threaded _ Other Seal: Cement grout — Bentonite, Other - Drive shoe: Yes "No Liner Yes ` No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield Test Bailed Pumped Compressed Air Hours Yield _&- gpm Depth Data Measure from land surface - static (specify ft) r During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses--­----- are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation (Description ft. ft. Land Surface A4 IJI A&V 1f—AJ - If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 11 Aol i Pump Type S-- 4, Capacity 1-1-el P", Depth / S'G Model 7 a 14 0.41 y Voltage X36 HP 1 Tank TypetUX --:302_ Volume f —` w Date Well Completed Putnam County Certification No. Date o Re ort Well Driller (signature) nu i r;: exact location of well witn aistances to at least two permanent landmarks to be provideVon a separate sl*et/plan. Well Driller's Name Address: %.0 ,Y Signature: /� Date: q White co py : HD e Yellow co py - Building Inspector; Pi nk copy - Owner�; Orange copy �cop' y -� Well driller Form WC -97 BRUCE R. FOLEY ti �. LORETTA MOLTNARI• RN., M.S.N. Public Ntalth Dlrtclor- - _ ,tuocfalt Publl�;•Nrollh ,Q!ltcfor.•_ Dlrrclor -of Paifrnt DEPA�tTN1ENT- OF HALrI'H ....:......._, _ -. __...... 1 Otncva - Road - — -- - Browster, New York '10509 Eariroamcntri Hcsll>t (914)27! -6070 Fcx(914) 271.7921 Hurtlar- Strrica j914)27!•655!•••WIC(914j27i =667! .M(M)271 -6011 .. " Lcr1y'Ialcriiaaoa-(914)77t -6014 Prachool (914)271 -M Fax(914)77r -Wi - 8911 ATMERSS••V ,RF TFTCATION FORM - OWNERS NAME: lr3VtZ,5HAK iNoat£� Ia3t: - - - . ' TAX' M�,P. DUMBER;.. " - — �-o� � i t� 3 S . ,_ 4- - i c� •Z _ E911 ADDRESS;, - . - �P.� A to F,i_ L WILL V_QAh TOWN: - - -.. P-A 1-212, SO JJ i 2 36 AUTHORIZED TOWN .0MCIAL: (Signature) DATE: _.. The Putnam County Department of Health will not. issue- a'Ceitificate of = . Constructio*n-Complia)nce•unless- the above form is: completed, i.e., a Iegal E911 . address i_s a-ssigned by an authorized town official. This form is to be submitted--"- with the application for a Certificate of Construction Conipliauce. (E911 VERFRM _ . _ _ .. . • _ PUTNAM COUNTY DEPARTMENT OF HEALTH Y3IVISION OPI%iVIRONIVIEN'I'AL HEALTFY SERVICES : GUARANTEE OF SUIBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map Block Lot Building Constructed by C, 2-- AJU L Location - Street ki-X Building Type - TownNillage Subdivision Name lG Subdivision Lot # I represent that I am wholly- and completely responsible for the location, workmanship, material, construttioff and "drainage of the sewage treatment system serving th'e' '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 part7of said `9ystem confs1ructed by me which failsto operate for ±a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system,..except where the failure to _operate. properly. is_caused:by the willful or negligent act of the occupant of the building utilizing.the:...— . system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system_ Day 7 Year geo en ral Contractor (Owner) = signature Corporation Name c ,�1 f(if corpbr tion) Address: ? C 11 tl411 .40i_ ,,, C State Zip 2• Signature: • Go�/�; Title: &:24 Corpo ation Name (if corporation) Address: 0 cr i pct 6.1 vim. State Zip 2j Form GS -97 � YML EW�rRONMEN�AL SERVICES ' ��l near �treet Yorktown Heights, N.Y. 10598 ^~ - 7 � � - ' -- '7914)`'245-288O-' `��� ' Albert H. Padovani, Director LAB #: 93.402736 CLIENT #: 58066 NON STAT PROC PAGE: I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ TEDESCO, RALPH (WYNDHA DATE/TIME TAKEN: 12/01/04 11:00 8 COLLINWOOD DR DATE/TIME REC'D: 12/01/04 11:35 BREWSTER, NY 10509 REPORT DATE: 12/09/04 PHONE: (914)-874-3078 SAMPLING SITE: 62 APPLE HILL RD SAMPLE TYPE..: POTABLE PRESERVATIVES : LOT # 1O : NONE COL'D BY: TEMPERATURE..: NOTES...: KITCHEN-T#�---------------------`---------'-CO[IFORM METHE-KF-- DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 12/01/04 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 12/01/04 LEAD (IMS) 2.0 ppb 0-15 ppb 910l 12/01/04 NITRATE NITROG 4.96 MG/L O - 10 9139 12/01/04 NITRITE NITROG <0.01 MG/L N/A 9146 12/01/04 IRON (Fe) <0.060 MG/L 0-0.3 mg/1 2037 12/01/04 MANGANESE (Mn) 0.029 MG/L 0-0.3 mg/1 2037 12/01/04 SODIUM (Na) 10.8 MG/L N/A 12/O1/04 pH 6.1 UNITS 6.5-8.5 9043 12/01/04 HARDNESS,TOTAL 152 MG/L N/A 12/01/04 ALKALINITY (AS 72.0 MG/L N/A 12/01/04 TURBIDITY (TUR <1 NTU 0-5 NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION., Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. iblic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium - - � YML ENVIRONMENTAL SERVICES 321 Kear Street 5 50 0.0 York Albert H. Padovani, Director LAB #: 93.402736 CLIENT #: 58066 NON STAT PROC PAGE: 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ TEDESCO, RALPH (WYNDHA 8 COLLINWOOD DR BREWSTER, NY 10509 DATE/TIME TAKEN: 12/01/04 1t:00 DATE/TIME REC'D: 12/01/04 11:35 REPORT DATE: 12/09/04 PHONE: (914)-874-3078 SAMPLING SITE: 62 APPLE HILL RD SAMPLE TYPE..: POTABLE : LOT # 10 PRESERVATIVES: NONE COL/D B0 TEMPERATURE..: NOTES ... : KITCHEN TAP COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD is suggested. pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCEQND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. . SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L MODERATEiY HARD WATER: 70040 MG/L M91L A-W]L(IGRAM-PER LITH HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) ' ' SUBMITTED BY: DirActor Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 Tel: (845),279-4003 . Fax: (845) 2794567 Email: hnengineer@aol.com February 16, 2005 Robert Morris, P.E. Putnam County Health Department One Geneva Road Brewster, New York 10509 Re: Individual SSTS Compliance - Lot # 10 Deerwood (Windsor Woods) Subdivision 62 Apple Hill Road Town of Patterson, NY T. M. # 35.4-102 Dear Robert: Enclosed are the following: 1. Five (5) prints of Drawing S -10, "As -Built SSTS ", dated 01/27/05. 2. "Certificate of Construction Compliance for Sewage Treatment System ", dated 02/16/05. 3 --Three7(3) copies of "Guarantee of Subsurface Sewage Treatment System", dated 02/07/05. 4. Laboratory Report, dated 12/09/04. 5. "Well Completion Report ", dated 02/01/05. 6. Application Fee in the amount of $300.00 payable to Putnam County Health Dept. 7. "E -911 Address Verification Form ", dated 02/10/05. If there are any questions concerning the enclosed, please call. Very truly yours, i W. Nic s Jr., P.E. HWN:gav 03- 056.10 S,2 DIMENSION CHART (in feet) Number A 13 13 1 17 33 2 29 41 73 713 3 '79 I bl n 68 75 129 153 07 1 27 10 929 lco, 13 131 73 713 9 68 75 29 1 5 Z lco, 130 153 13 1-33 IS-+ 14 134 59 15 13+ 15S I 134 58 1'7 138 Ise 18 178 198 19 171 19 1 rr a 21 170 188 9 / s / tv %6 2a ao PV 5�� .zl Nei 0o PSG /� P% in [n [j) [n In 0 2 \ a \\ Y 'off i rr� P U • No 4 J / s Q a y / 7 b a 9 P 0 / .O 5 B' L ? F� / / O 9 / s / tv %6 2a ao PV 5�� .zl Nei 0o PSG /� P% in [n [j) [n In 0 2 \ a \\ Y 'off i w N O m 2 0 B rr� U w N O m 2 0 B