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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -4 -103 BOX 16 46 ` i rl L I 14; � ` LL 'Am 01764 0 ;a PUTNAM COUNTY DEPARTMENT OF HEALTH r DIVISION OF_ENVIRONMEN.TAL HEALTH SERVIC CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT PCHD CONSTRUCTION PERMIT # J P-23-04- Located at 1Z QUAIL LANE Owner /Applicant NameV ' d D d Am HomES Formerly __N Town or Village PATTE R SQ1 Tax Map 3 5 Block Lot 7/0 Subdivision Name W, N DSOg ODDS Subd. Lot # ,1 Mailing Address O Gn I W WDD p Dam=_- Ear=W sTE P &Y Zip I osol Date Construction Permit Issued by PCHD -7 _ 5 -25 Separate Sewerage System built by AmAX-C Wc)sc -APF_ a Address 1Z R-TE ZZ 2�TEp- fl Consisting of (Z �50 Gallon Septic Tank and 4-4 5 L,F Or 9-4"1 I v\/ I D*,-- Other Requirements: I R..o• b. F I L.L, Water Supply: Public Supply From Address los4- PI-re 15a 2 ` or: Private Supply Drilled by j`(p/ 1 �T 1�1� %/E:L , AddressGA IZNI E:-L-, ICI Y 105 I _.__:Building_ Type - i:Ahri.- t2�1Q Has_ erosion.. control- been,completed ?.... -:-.(.-,* Number of Bedrooms 4� Has garbage grinder been installed? N I certify that the system(s), as listed, serving the built plans (copies of which are attached), in plans and the standards, rules and regulations/0 Date: 3- 8 -O Co Certified by Address I N�O-F s'- Any person occupying premises served by the above constructed essentially as shown on the as- I PCHD Construction Permit and approved )enartment of Health. P.ElC R.A. License # &95451-18 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 change is necessary. By: Title: Date: White copy - HD F le; Yello copy - Building Inspector; Pink copy - er; range copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF' HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT V6'e1l Locatno»: _: Sreet:Address: - 1 TownNillage: _ . -.Tax Grid.#. Map�S Block 4-- Lot(s) 03 Well Owner: Name: Address: ' Use of Well: 1- primary 2- secondary Residential Public Supp y Air cond/heat pump Irrigation Business Farm . Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length I ZI ft. Length below grade ft. Diameter _G�_in. Weight-per foot lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded y 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 _.y Compressed Air Hours Yield "�Q) 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 jtil/L� If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information ' Pump TypeLLL Capacity Depth 9a 69 11 Model 101 Voltage 22j HP Tank Type pV,4 /,eVolume �J/ IN ' Ns� O i0,A ' Date Well C mple Z71; � Putnam County Certification No. o� ate o Report L'�L4n!� Well Driller ignatu NOTE: Exact location of well with distances to at least two permanebt landmarks to be provided on dparate s eVplan. 17 jr Well Driller's Name ul�w /�- I'' �ieY/;? Address: Signature: / J14 flo Date:: 112 //)S White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Or ge copy -Well driller Form WC -97 2006 -01 -24 15:51 4RUC.E R FOLEY DEP 8452792332 WM N .3/ 1 1 � 10IMT'1`A MOLWAM R.N., M.S.N. Y Anodak Public lfaaA Dbww Dlrsaar of reff t SarAM EALTH V. a ROM York IM SMAMMON 8=0 (91fAP •suo fact (914) rn - MI Nadi saavts. 014)2U-on ,, 014) 279.667t . FS, (014) ;74 - was E lane tfas (9!4)478.6014 P im1 014) 21i� M Fu t314) 27S -6618 E911 A D R ft IFi TION FORM O'WN'ERS NAM.- TAX MAP NUMM193L E911 ADDRESS: TOWN: AIJTSORIZED TOWN OFFICIAL, (Signature) DATE: Putnam County Department of Health will not issue a Certificate of Construction Compliance unless &e above' form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a CerdScate of, Construction Compliance. •4 " n'a: RALPH G. MASTROMONACO, P.E., P.C. Consulting Engineers 13 Dove Court, Croton -on- Hudson, New York 10520 _.:.,L91,4) 271. -4762 ^_.(91.4) 271- 2820_FaxT _ Mr. Michael Budzinsky, P.E. March 8, 2006 Director of Engineering Putnam County Dept. of Health 1 Geneva Road Brewster, NY 10509 Client Pickup Re: SSTS AS -built for Wyndham Homes, Inc. Quail Lane, Patterson, NY (Map 35 - Block 4 - Lot 103- R.S. Lot 11) Dear Mike: Please find enclosed the following materials: 1. Five (5) signed and sealed copies of the drawing entitled SSTS As -Built Plan R.S. Lot 11 of Deer Wood Subdivision (Map 35, Block 4; Lot 103) Prepared for Wyndham Homes Inc., Located at Quail Lane, Town of Patterson, NY, dated March 8, 2006 2. Four (4) signed and sealed copies of the Certificate of Construction Compliance dated March 8, 2006 3. Four (4) signed copies of the Well Completion Report 4. Three (3) signed copy of the Guarantee of Subsurface Sewage Treatment System dated March 8, 2006 5`. - -One (1) copy of the Well Water Analysis dated February-21, 2006 6. One (1) copy of the E911 Address Verification Form 7. Check #490360 payable to PCDH in the amount of $300. We are requesting your review and approval of the completed works. Please call me if you have any questions. S' rely, Ralp G. Mastromonaco RGM /jl Enclosures Cc: Joe Darnell ^ ` - . YML ENVIRONMENTALSERVICES'^ ` 321Kear`Street Yorktown Heights, N.Y. 10598 -19141 245-2800'=—~-- Albert H. Padovani, Director LAB #: 9.600226 CLIENT #: 57197 STAT PROC PAGE: 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ WYNDHAM H811ES DATE/TIME TAKEN: 02/16/06 12:45 8 COLLINWO0D DRIVE DATE/TIME REC'D: 02/16/06 01:50 RALPH TEDESCO REPORT DATE: 02/21y06 BREWSTER, NY 10509 PHONE: (845)-279-2022 SAMPLING SITE: LANE, BREWSTER, NY SAMPLE TYPE..: POTABLE �Nd�^��v�~^��6M� PRESERVATIVES: NONE ^' "- ~~~~ �r .~�� COL'D BY: JOSE�[---- TEMPERATURE..: < 4C NOTES...: WELL TANK COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE ` 02/16/06 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 02/21/06 LEAD (IMS) 13.0 ppb 0-15 ppb 9003 02/17/06 NITRATE NITROG 2.95 MG/L 0 - 80 9052 02/16/06 NITRITE NITROG <0.01 MG/L N/A 9162 02/20/06 IRON (Fe) <0.08{) MG/L 0-0.3 mg/l 9002 02y20y06 MANGANESE (Mn) <0.010 MG/L 0-0.3 mg/1 9002 02/20/06 SODIUM (Na) 7.76 MG/L N/A 9002 02/16/06 pH 6.5 UNITS 6.5-8.5 9043 02/20/06 HARDNE8S,TOTAL 172 MG/L N/A 02/21/06 ALKALINITY (AS 118 MG/L N/A 9001 02y21y08 TURBIDITY (TUR <1 NTU 0-5 NTU COMMENTSg BACT THESE RESULTS INDICATE THAT THE WAT NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDSv 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. dzlic 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.Q 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 28 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 Y` o r`- k t 'ow n � -He.i / ht s.,'N ^Y . -1' 05�98 914, Y245-2E)( Albert H. Padovani, Director LAB #: 9.600226 CLIENT #: 57197 STAT PROC PAGE: 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ WYNDHAM HOMES 8 COLLINWOOD DRIVE RALPH TEDESCO BREWSTER, NY 10509 SAMPLING SITE: 12 QUAIL LANE, BREWSTER, : LOT 11 7�M 00����~*����� COL`D BY: JOSE Q. NOTES...: WELL TANK ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE is sugges;�.ed. DATE/TIME TAKEN: 02/16/06 12:45 DATE/TIME REC'D: 02/16/06 01:50 REPORT DATE,-, 02/21/06 PHONE: (845)-279-2022 NY SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD 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 SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. GOFT'WATER:. 0_��0 MG/L VERY HARD WATER: ABOVE 300 1v18/L - '---MODER'TErY'H#RDrWATER�7O=140 -MG/L.^- - Ma/�-=---MILLIGRAM' -PER 'LITER'' HARD WATER: 148-300 MG/L (1 grain/gallon = 17.2 M8/L) SUBMITTED 8Y: Albert H. Padovani, M.T.(ASCP) Director EL.AP# 10323 Mar -08 -06 12:21P Ralph G. Mastromonaco PE 914 271 4762 P.02 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM WYt�D�IAM �E� Owner or Purchaser of Building Building Constructed by 12 6ZUA1 L LA NIE Location - Street C/t lr--- PAYAIL -f i='e2-.J>Eh6!S Building Type 3S 4 03 Tax Map Block Lot PA-rr ; Town/Village ` A f Ir P5oP_ W Subdivision Name 11 Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. 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 ocr•----' system. D ed: o 3 Day & Year ZOO e �`S EfiO General Contractor (Owner) - Signature 1, W04AM He)Aeh f Corporation Name (if corporation) Address: G2ullre 3 ©�A State �F�nl I oa.1G Zip 1 0509 Signati Title: A M A)(9- CA M Eon LA4ok-,,41� 4 Corporation Name (if corporation) T1-L-1 Address: State N,1 Zip J 25 Form GS -97 SHERLITA AMLER, MD, MS, FAAP Co+rrrimissioneeof Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Ralph Mastromonaco 13 Dove Court Croton -on- Hudson, NY 10520 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 March 8, 2006 ROBERT.I. BONDI Gounty Executive ROBERT MORRIS, PE Director of Environmental Health Re: Field Inspection — Barnes Quail Lane, Lot 11 (T) Patterson, TM # 35.4-69 Dear Mr. Mastromonaco: A re- inspection at the above referenced lot has been completed. The SSTS can be backfilled. There are no further comments to be addressed at this time. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. GDR:kly Sincerely, 79— Gene D. Reed SR. Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax(845)278-7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early InterventioniPreschool (845) 278 -6014 Fax (845) 278 -6648 Mar -03 -06 03:10P Ralph G. Mastromonaco PE 914 271 4762 P -01 Fax Transmittal Sheet RALPH G. MASTROMONACO, P.E., P.C. Date ?j• 3� C�Co Consulting Engineers 13 Dove Court, Croton -on- Hudson, New York 10520 lNumberof pages including cover sheet () (914) 271 4762 TO: G1� C) Fax No: 045 - 2 7 8 --7X12 I Cc: FROM: M 1 y-e 56L e F- Re: W N050� Wob oS S51"5ASBUMT 1-11 Phone Fax Phone (914) 2714762 REMARKS: Urgent XF6r your review Reply ASAP Please Comment ICE �"u,.l �o� eox�s �.a.VE ( �r•� AOjusTEDAS NOTED. LET r-le K00*J I F`KOU 4Avc-,,n,, f;z 0 EST I . GT -- Ti-1E StA 1. t ►.� ��- I�AS F3E � � � �'ALI.'�. If there is a problem with this fax, please cal/ us at (994) 2714762 MAR- 3 -20 06 FRT 14:217 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Ralph Mastromonaco 13 Dove Court Croton -on- Hudson, NY 10520 Dear Mr. Mastromonaco: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 March 1, 2006 Re: Field Inspection — Barnes Quail Lane, Lot 11 (T) Patterson, TM # 35. -4 -69 The following comments must be corrected in the field. - •- • - 1- ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health --It- appears-some of the- junction boxes are not level and/or the trench pipe pitches coming into the boxes differ, causing an unequal flow. 2. Junction box No. 4 needs to be sealed at the outlet pipe. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. GDR:kly Sincerely, Gene D. Reed SR. Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax(845)278-7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 Feb -24 -06 10 :47A Ralph G. Mastromonaco.PE 914 271 4762 P_01 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES U TF, T FO& ONAL INSPECTION For: Fill 7� Date: Zr 24 -0(v Trenches PCBD Construction Permit Located: Q UAi L LAt (T) (V) ,PATTERSor1 Owner/Applicant Name: _ iJDHAM H • Tm 35 Block /�_ Lot � 03 Formerly: WA _ Subdivision Name: L AnsoQ `WU�DS AKA Q Ep-Voo O Subdivision Lot # Is system fill completed? _ _ Date: 2 - 7,4- ' uo Is system complete? Date: Is system constructed as per plans? `(lam Is well drilled? Date: - 2.4 -C(v Is well located as per plans? 75� Are erosion control measures in place ?_ i certify that the syste*s), as fisted, at the above premnes has been constructed and I have inspected and verified 'heir completion in accordance with the issued PCED Construction Permit and approved plans. and the Standards, Rules and Regulations of the Putnam County Department of Health. Date: Certified by: _ `PE _ A . Design Professional Igo 50771M.12 WA r ; i FOR: i-7 ADAM ❑ GENE ❑ . (NANE) Form FIR 99 FEB -24 -2006 FPJ :10:00 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 D`TVISION OFENY�iNINAI, �XTH'�EYCS 7E'IlV L SITE m- iisCTiON Date ;inspected by, Street Locationvel I'�iinit# �p a: :Subdivision lot # �! 1. Sewaae,S�s'tem; x6a K k 5 N t 1�IlY MN ' a STS area located41s pP'914 proved plans �.oea �s d rt b Fill section ,date of placement 31 barrier I�gth width Avg Dpth c latural soil not stripped ..: .... 5 ..: .. . -. ... d Stone, brush,, etc., greater than 1:3,.- from�;S'IkS ,area ::- �� - e 10' from water course /wetlands :.. a Sepfic tankXsize 1,000 other b Septic iankansfalled level c 1- 0':minimum from,foundatlon :,,:: 41 Bistribafionoz 1. All outlets at same elevation water tested. Protected•belowfrost .................. 3 Nfininum 2 ft Orguial soil between,box &trenches e unctaon wog properly set .................................. b. Tenn es 1 Len re uired Len msta7led 2 lstance o w3tercOUtse meagurd 3 ' Installed accordug to 'lan ., P. .. Slope oftrench acceptable 1/16 ."1 /32 "Ifoot S.; 10 ft. from.property hne 20.ft foundations.......... f Depth of.:trench X30 inches.from surface ..:....:.......:.. 7.:, Room allowed for expansion, 100 %0 :....:..:............. } S. Size of.gravel 3/4 .1?%2" diameter clean ...;,............. ,. ��: 9.; Depth of gravel .,in trench 12 MMMUm ......:........... > 1D: Pipe °.ends ca pppp g. PtligiuSor:Dosed.Systeans . a..... ... _.. _ _....,.__ 1: Siztibfpump ,chamber: ............ .... 2 fJvertlowtank ..... ,..; did'; ..;: : ' . ,: �f .... Pump easil3� accessible, manhole to grade ...... 5.:.•First ° box, baffled :: ....:..................... ti .• 6. C cle witnessed .by H D estimated .flow /cycle...:..:...: 'I>•r.H�ouse�uil$ing , a Iouselocateder approved plans ..... b Numberr of be ooms.... .... i 3Z ............... ol 1-, well, Well located as;per approved plans .............. b . i)istanee from;STS.z ea..measur-ed .. / �® ft ;'.....:..: c asing 8 a oe ae .:. :." l v . . . ...... d aurface:;drainage ,aroun&well ,acceptable ................. V. +Overall Wi 6&kianshiu . a... Boxes:properly grouted. .. b All pipes partially backfilled .........:......... c.]1 pipes flush: with onside. of box. - ' a i ^.IG 06 1 IN �d d • B�acl�l<matefi contains stones <4".:diameter .. e.urtaindrain. -standpipes installed according to plan:. zoo f Curtain drain :outfall .protected & dz.,to:.e ' st watercourse c g. :Footing: drains discharge: away; from :STS:area ...........:... h. Surface water_protection adequate .... ....:............... ............ . y . i. _Erosion coiitrol provided .......................... Rev: '12/02 Form =3 O PUTNAM COUNTY DEPARTMENT OF HEAL XTIVISION OF ENVIRONMENTAL HEALTH SERVI�` CONSTRUCTION PERMIT FOR SEWAGE TR A TMENT SYSTEM � �" " Located at Q oA i L L. A Na Town or Village FA'TT E R 50� Subdivision name \//I � QSQQ WCoaNubd. Lot # I Tax Map 35 Block _4_ Lot 69 p vwq> DEEF_ Wei Date Subdivision Approved 3 1 O Owner /Applicant Name lA& t D H A m Homee7-G�_ . Renewal Revision Date of Previous Approval Mailing Address 0L->-o L t 1 N WOOD Ikely ff2pr=\N S TEP_ N Zip Amount of Fee Enclosed 1�iIJemLP, FAP1IL_( Building Type Q PF�j _ Lot Area�o,35WTo. of Bedrooms � Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 12 SO gallon septic tank and �-S L F of MS& ioe 4n5o RPTi oo -nzEI 4,- 0 Other Requirements: ( 20 L.F. o f % I PEE p G u IZTA I N D 2A1 : �� •O• B. F ILL To be constructed by Water Supply Public Supply From Address Address or:. .Private Supply. Drilled by T2 gF,.pEi'EP_.l!!1I.�E 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 C ion Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a wr 1 be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in nor 'on any part of said sewage treatment system during the period of two (2) years immediately follo g a , e., t 'the it a of the approval of the Certificate of Construction Compliance of the original system or any re vs der ;T �' C { Signed: P.E. R.A. Date 5 l© OS RA CIO Address 125 D -o - l '!' 05 W License # 05449 S APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatm system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w en c nside d necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe 1 i . pro for discharge of domestic sanitary sewage only. — N �J By: , Title: Date: % White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH IDIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRIJC'1<'.A WATER WE1L1L, .... , .........:... > please print or type PCHD Permit # Well Location: Street Address: f Town/Village Tax Grid # O UAI L LA NF PA 50 Map 35 Block4- Lot(s) (�vq Well Owner: Name: Address. H0dE�718C__-'_--,L_L1tom!VV000 P21VE- . @I, 10 Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought S+ gpm # People Served Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason g 12 o P-0-5 E 2 p for Drilling Well Type _� Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No ><' Is well located in a realty subdivision? .......... ..........................11...)) ............................ Yes No Name of subdivision �•✓rJ o VJ00 Lot No. Water Well Contractor: -r-e2 of . IDETFV=N I VJE'Q 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 be provided on separate sheet/plan. Date: D U� Applicant-Signature:--- RA L ST l 0 O A Co 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. FOIL CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. revision or alteration of the approved plan requires a new permit. Well to be constructed by a water ,w 11 lle ertified by Putnam County. Date of Issue J 1' Permit Issui 'Offic' Date of Expiration Title: Permit is Non -Trans e r le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 a RALPH G. MASTROMONACO, P,E„ P,C, Consulting Engineers 13 Dove Court, Croton -on- Hudson, New York 10520 _ (914) 271 -4762 (914) 271 -2820 Fax Mr. Robert Morris, P.E. May 11, 2005 Public Health Engineer Putnam County Dept. of Health 1 Geneva Road Brewster, NY 10509 Via UPS Re: Proposed SSTS for Wyndham Homes, Inc. Quail Lane, Patterson, NY (Map 35 - Block 4 - Lot 69 - R.S. Lot 11) Dear Robert: Please find enclosed the following materials: 1. Five (5) signed and sealed copies of the drawing entitled SSTS Plan R.S. Lot 11 of Deer Wood Subdivision (Map 35, Block 4, Lot 69) Prepared for Wyndham Homes Inc. Located at Quail Lane, Town of Patterson, NY dated October 13, 2004, revised November 9, 2004 2. Four (4) signed and sealed copies of the Construction Permit Application dated 5/10/05 3. Four (4) signed copies of the Application to Construct a Water Well dated 5/10/05 4. One (1) signed copy of the Corporate Affidavit dated (submitted earlier) 5. One (1) signed and sealed copy of the Letter of Authorization 6. One (1) signed and sealed copy of the Application for Approval of Plans for A Wastewater Disposal System 7. One (1) signed copy of the Short Environmental Assessment Form dated 5/10/05 8: -One (1) signed-and sealed copy of-the Design Data Sheet 9. One (1) copy of the original Design Data Sheet for the subdivision approval (submitted earlier) 10. Two (2) sets of architectural plans for a four - bedroom house (submitted earlier) 11. Check #16593 payable to the PCDH in the amount of $400 (submitted earlier) We have enclosed copies of previous correspondence for your file. We are requesting your review and approval of the submitted materials. Please call me if you have any questions. Si rely, Ralph G. Mastromonaco RGM /jl Enclosures Cc: Wyndham Homes w /copy of plan SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Ralph Mastromonaco 13 Dove Court Croton -on- Hudson, NY 10520 Dear Mr. Mastromonaco: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 May 23, 2005 ROBERT J. BONDI County Executive Re: Proposed SSTS: Wyndham Homes, Inc. Quail Lane, Lot # 11 (T) Patterson, TM # 35 -4 -69 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. Fill is required to extend 10 feet horizontally past the edge of any trench. 2. Absorption trench detail is to show the side view. Furthermore 2 feet of solid pipe is to be shown between the junction box and perforated pipe. The plans view of the SSTS is to shown the 2 feet of solid pipe. 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 test 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. RM:kly Ve ly you Robert Morris, P.E. Senior Public Health Engineer 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 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 Ralph Mastromonaco 13 Dove Court Croton-on-Hudson, NY 10520 Dear Mr. Mastromonaco: ROBERT J. BONDI County Executive November 4, 2004 Re: Proposed SSTS: Wyndham Homes, Inc. Quail Lane, Lot # 11 (T) Patterson:, TM # 35-4-69 Review of plans and other supporting documents submitted at this time relative to the above- projecthas been completed. Comments are offer.-A-as-follows-....- 1. House plans are considered to have 5 potential bedrooms. 2. Is the curtain drain existing or proposed? The approved plat shows an 80 ft. curtain d a�n. T he submitted individual plan shows - a - 0 f t ' _curtain �3: T g requ ire4 t _�x 0 t h 0 n t a C th6 4d �4. n P m County the direct me 0 drainage straight lines tangent to the 100 ft. radius curve and connecting these lines to the ends of the 100 ft. line drawn 200 feet from the well. 5. Erosion control measures should not be shown perpendicular to the contours. This only enhances erosion. Erosion control measures should be shown directly below the primary SSTS. 6. The minimum of I ft. of fill is to be provided for the entire SSTS (primary & expansion). Fill is to extend 10 feet horizontally past the edge of any trench and then slope 3:1 to 77-- ; Absorption ti lor i -ftefibb etAifis to'shoWthe side Vi6V.--_F;11rtherm0i 14o'sh�o_w'.th-e 2-f6et, so_ l id pipo - - -- 8 . Fill notes _I and 5 are not applicable to this project and should be crossed out or removed. The�co tructu_of thisy✓�ge..dsp.sal,system_xnay: be. subject -to. local _,wetland:regulations._._..:_., ,........�. _. You should contact local wetlands officials in this regard. If percolation test 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. Very truly yours, Robert Moms, P.E. Senior Public Health Engineer FIMM LORETTA MOLINARI Public Health Director _77., ..... ROBERT J. BONDI County Executive 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 November 4, 2004 Ralph Mastromonaco 13 Dove Court Croton -on- Hudson, NY 10520 RE: Wyndham Homes, Inc. Quail Lane, Lot 11 (T) Patterson, TM # 35 -4 -69 Reservoir Basin Dear Mr. Buschynski: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on October 27, 2004 is complete. The Department will notify you by November 17, 2004 of its determination. 0 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 project, such as stormwater plans 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. Rau !�ii1 Ve ly Robert Morris, PE Senior Public Health Engineer RALPH G. MASTROMONACO, P.E., P.C. Consulting Engineers 13 Dove Court, Croton -on- Hudson, New York 10520 (914) 271 -4762 (914) 271 -2820 Fax Mr. Robert Morris, P.E. Public Health Engineer Putnam County Dept. of Health 1 Geneva Road Brewster, NY 10509 Re: SSTS for Wyndham Homes, Inc. Quail Lane, Patterson, NY (T.M. 35 -4 -69) Dear Robert: November 9, 2004 Via UPS Please find enclosed five (5) signed and sealed copies of drawing entitled SSTS Plan R.S. Lot 11 of Deer Wood Subdivision '(Map 35, Block 4, Lot 69) Prepared for Wyndham Homes Inc. Located at Quail Lane, Town of Patterson, NY dated October 13, 2004, revised November 9, 2004. As per your review memo dated November 4, 2004, we offer the following responses: 1. 2. 3. 4. 5. .._._..6. 7. 8. We have revised the house plans to reflect four (4) bedrooms The proposed curtain drain is located above the SSTS Fill is shown extending 10 feet beyond end of absorption trenches The well keyhole has been revised as noted Erosion control has been adjusted AII.slopes arounc+.SSTS,are shown..3 on.1.- ...._...__.....__ _ _.. _... __ ,.. ........._ �_. Absorption trench detail has been revised Fill notes 1 and 5 have been removed At this time, we are requesting your continued review and approval of the submitted materials. Please call me if you have any questions. Sinc ly, Ralph G. Mastromonaco RGMriI Enclosures I DESIGN DATA SHEEIT -SUBSIUFACE SEWAGE DISPOSAL: SYSTEM FILE N0. Owner �c Yf PHA M H OM E5 3;6 Address 1 t N wacD I) 2. BP_E Located at (Street) QyAJ L• L A Je Sec. 3�5 Block Lot"ral 0SCY9 ( indicate nearest cross street) P..5 O. I , Municipality A'i'T' rz.Sot-1 Watershed Bc—, SOIL PEROOLATION TEST DATA RDQUIRM TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking Date of Percolation Test HOLE NUMBER CLOCK TIME PERa0=0N PSICOIATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches ll�l� 1W 18 20 2 3 Co 2 1: 5 I 3152' 2'• 13 21 20 23 - 4 5 21:3(a - 2 :c, Z•4 2 0 Z 3 3 g 3 2.0o- 2:24- 2.4- 20 .23 3 8 4 5 1 2 3 4 NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. ' 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST .PIT DATA RDQUIRED.TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES, - HOLE N DEPTH G.L. TO-P5,01 L_ =C I L� 3i1 ;1ZI S 1� LOA M I_ rzo D ©w i e �, pir LO�F'I bV �.fx�s 2' V21,1 : OLo.IVE �( LL® 48 Fit4r= SA CP( LOAM 2-711 OLIVE L o M/ Cm 61 71 ICI O (BOG 8° 9' 10' 11' 12' 131 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED m) O INDICATE LEVEL TO WHICH WATER LEVEL RISES. AFTER BEING ENCOUNTERED N.M. ° 1 z -h> 4 — EP DEEP HOLE OBSERVATIONS MADE BY:C. LWYD(VE -E %.buM!KJV)DATE: IZe IZ•94° ft,0H - -- DESIGN Soil Rate Used ��� Min/1" Drop: S.D..Usable Area Provided %, * No. of Bedrooms :p �L Septic Tank Capacity ���7C� gals. Type q Absorption Area Provided.By L.F. x 241' width trench Other -7 P p NE Name 2ALPd HA:7 0 AW Signature Address SEAL N°. 05449 •�� THIS SPACE FOR USE BY HEALTH DEPARTMEtTP ONLY: ROFESSIO� Soil Rate Approved sq.ft /gal. Checked by Date PC -1 PUTNAM COUNTY DEPARTMENT O F H EAY °wrn "APPLICATION FOR APPROVAL OF PLANS '50-A A'WASTEWATER'DISPOSAL- SYSTEM 1. Name and.Address of Applicant: W- rNDHAM r10 2. 4. 0G0L u1JWoor> D-P- Iy�-- Name of Project: W I NJDr�DLL W 3. Project Engineer: RA►�.1� -� �,IJ:K2-rRoM5. Address: sm� Location T /V /C: 1-.7 r-S, __ License Number: 4�I-�1S Phone 6. Type of Project: Private /Resident Apartments Office Building 7. Is this project subject Type Status .(Check One) ial. Food Service Commercial Institutional Mobile Home Park Realty Subdivision Other (specify) to State Environmental Quality Review (SEQR)? Type I.. Exempt .Type II. Unlisted B. Is a Draft Environmental Impact Statement (DEIS) required? ............. o ,I 9. Has DEIS been completed and found acceptable by Lead Agency? ........... r 0. Name of Lead Agency ic)52C 1.. Is this project in an area under the control of local planning, zoning, or: other officials, ordinances? " ............................ ....9 2. If so; have plans been submitted to such authorities? .................. 3. Has preliminary approval been granted by such authorities.? Date Granted: /4 4. Type of Sewage Disposal System Discharge._..... Surface Water,Ground Waters 5. If surface water discharge, what is the stream class designation ?........ 6. Waters index number (surface) ... ....... ............................... A 7. .Is project located near a public water supply system? 8. If yes, name of water supply �iA _ Distance to water supply- =A- 9. Is project site near a-public sewage collection or disposal system ?..... O I :0. Name of sewage system /A Distance to sewage system N Q :1. Date observed:.;_ ( 8 mil% 23. Name of Health Inspector: M. EJ)M 6m 4. Project design flow (gallons per day) ..... 2. 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. a 26. Has SPDES Application been submittedto local DEC Office ?. ............... d/A 27. Is any portion of this 'project located within a designated Town or State � wetland ?........ .. ... ............ ............... 1 28. Wetland ID Number ........................ ...o............................. 1� 29. Is Wetland Permit required? ...................... I� Has application been made to Town or Local DEC Office? N 30. Does project require a DEC Stream Disturbance, Permit. ........ ...:...:... �� V 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 or NO 32. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or NO DESCRIBE: 33. Is there a local master plan or file with the Town or Village? ...........� _ 34.,Are community water, sewer facilities planned to be developed within 15 years? iV O 35..Are any sewage �disposall areas in excess of 15% slope? ...................... F 36. Tax Map ID Number ........................................................... 35-4,W/Q1 37. Approved Plans are to be returned to: .......... Applicant Engineer If the application is signed by a.person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty -of perjury, form is true to the best of my knowledge herein are punishable as a Class A Nisdein� the Penal Law. SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: C.---'90,roh4 Off° -`" i de d on this p Fa ements made t t on 210.45 of 05� A 4 14.16.4 095) —TW 12 PROJECT I.D. NUMBER 61720 SEAR Appendix State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. PP CANT PONSOR 2. PROJ NAME Y D M O I IJ 3. PROJECT LOCATIOW ^ ,f —r � Municlpallty E: L County A I�' 1 A. PRECISE LOCATION (Street address road intersections, prominent landmarks, eta. or provide map) 7-, Arr L[ H ILL I_OA.fl 5. IS PROJ30SED ACTION: ❑ Evanslon ❑ Modificationfalteration S. DESCRIBE PROJECT BRIEFLY. Go IJ sTp ucT I o IJ op ,a. o>J E PAM I L.Y F es) v��cE w jT� ---E PSG/ W gU, I PIZ [ ,&TED G"ICI IJ 6q . 7. AMOUNT OF LAND AFFECTED: ^7 3.2-_ 3,Z Initially acres Ulumately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ❑ No If No, describe briefly 8. IS PRESENT LAND USE IN VICINITY OF PROJECT? �1 sldenuai ❑ Industrial �Gommercial ❑ Agriculture ❑ Park(Forsst/open space ❑ Other esedbc.... _.. -....� .. -.. .......» .... -.. .... .. r �.... -. ... -.mm v.. w. .rte....- ...........r .. ..�.. r.�_ .....�..^ .__..a - ..,.... -.. ..�. ... .... .. ..P _ 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL. STATE OR LOCAL)? �&es ❑ No If yes, Ilst agency(s) and permillapprovals PG P H - SC I G A` 14'C%'/06'G A T So _ 1 1 H; IT 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? 54es ❑ No If yes, Ust agency name and permitl proval PA1rrE PtWl4 - S�e>Djvi SifON pP ��- 12. AS A RESULT OF QROPOSED ACTION WILL kISTING PERMmAPPROVAL REQUIRE MODIFICATION? ❑ Yeslle I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE I....... Cam..S Date: AppucanUsponsor name: Signature: V If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART 11— 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 wiidllfe species, significant habitats, or threatened or endangered species? Explain brlefiy: 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? f cT�Paln tI 4i {N C5. Growth, subsequent development, or related activities likely -to be Induced, by the proposed action? Explain briefly. C6. Long tern, short tern, 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 THERE" OFMV THEREUKELY? O" BECUNTROVERSY'A ELATEDTO" POTENTIALADVER SE'ENVIRONMI=NT3iCfFAPXCM7` `_._.._.__._... ❑ Yes ❑ No If Yes, explain briefly PART III— DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTION& 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 ¢.e, urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility, (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed. If question D of Part If was checked yes, the determination and significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY 'occur. Then proceed directly to the FULL EAF and /or prepare a positive. declaration. ❑ Check this. box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result In any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (if different from responsible officer) Date OA RALPH G. MASTROMONACO, P.E., P.C. Consulting Engineers 13 Dove Court, Croton -on- Hudson, New York 10520 (914) 271 -4762 (914) 271 -2820 Fax Mr. Robert Morris, P.E. Public Health Engineer Putnam County Dept. of Health 1 Geneva Road Brewster, NY 10509 Re: Proposed SSTS for Wyndham Homes, Inc. Quail Lane - Lot 11, Patterson, NY (T.M. 35 -4 -69) Dear Robert: February 17, 2005 Please find enclosed two (2) signed and sealed sets of architectural plans for the proposed four (4)- bedroom house. At this time, we are requesting your continued review and approval of the submitted materials. Please call me if you have any questions. Sincerely, Ralph G. Mastromonaco RGMriI Enclosures RALPH G. MASTROMONACO, P.E., P.C. Consulting Engineers 13 Dove Court, Croton -on- Hudson, New York 10520 - - ,_(91.4) 271 - 4762.. • (914) 271- 72820 Fax_.-_ Mr. Robert Morris, P.E. Public Health Engineer Putnam County Dept. of Health 1 Geneva Road Brewster, NY 10509 Re: SSTS for Wyndham Homes, Inc. Quail Lane, Patterson, NY (T. M. 35 -4 -69) Dear Robert: November 9, 2004 Via UPS Please find enclosed five (5) signed and sealed copies of drawing entitled SSTS Plan R.S. Lot 11 of Deer Wood Subdivision (Map 35, Block 4, Lot 69) Prepared for Wyndham Homes Inc. Located at Quail Lane, Town of Patterson, NY dated October 13, 2004, revised November 9, 2004. As per your review memo dated November 4, 2004, we offer the following responses: 1. We have revised the house plans to reflect four (4) bedrooms 2. The proposed curtain drain is located above the SSTS 3. Fill is shown extending 10 feet beyond end of absorption trenches 4. The well keyhole has been revised as noted 5. Erosion control has been adjusted - 6. All slopes around SSTS are shown 3 on 1 7. Absorption trench detail has been revised 8. Fill notes 1 and 5 have been removed At this time, we are requesting your continued review and approval of the submitted materials. Please call me if you have any questions. Sinc ly, Ralph G. Mastromonaco RGM /jl Enclosures 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 Ralph Mastromonaco 13 Dove Court Croton -on- Hudson, NY 10520 Dear Mr. Mastromonaco: ROBERT J. BONDI County Executive November 4, 2004 Re: Proposed SSTS: Wyndham Homes, Inc. Quail Lane, Lot # 11 (T) Patterson, TM # 35 -4 -69 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. House plans are considered to have 5 potential bedrooms. 2. Is the curtain drain existing or proposed? The approved plat shows an 80 ft. curtain drain. The submitted individual plan shows a 120 ft. curtain drain. Please clarify. 3. Fill is required to extend 10 feet horizontally past the edge of any trench. 4. In Putnam County the direct line of drainage keyhole is shown by connecting straight lines tangent to the 100 ft. radius curve and connecting these lines to the ends of the 100 ft. line drawn 200 feet from the well. 5. Erosion control measures should not be shown perpendicular to the contours. This only enhances erosion. Erosion control measures should be shown directly below the primary SSTS. 6. The minimum of 1 ft. of fill is to be provided for the entire SSTS (primary & expansion). Fill is to extend 10 feet horizontally past the edge of any trench and then slope 3:1 to grade 7. Absorption trench detail is to show the side view. Furthermore 2 feet of solid pipe is to be shown between the junction box and perforated pipe. The plans view of the SSTS is to show the 2 feet of solid. pipe. 8. Fill notes 1 and 5 are not applicable to this project and should be crossed out`vr removed. .. the• construction of -this sewage- disposal system may b6= subject to local wetland regulations: You should contact local wetlands officials in this regard. If percolation test 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. RM:km 4 Very truly yours, Robert Morris, P.E. Senior Public Health Engineer t. - ' 10/06/2004 19:46 8452792332 WYNDHAM HOMES INC. PAGE 03 P'UTNAM COUNT'S' DEPARTMENT OF HEALTH DIVISION OF ENVIRO N'rA► ...HEAL7CR SER ICES _ DESIGN.-DATA SHEET - SUBSURFACE SE WAGE�•T1ZEA�_- , I1 . SYSTEM z Owner -M 1 G 4 Aa _ � Address _ Lgi Y �- Located at (Street) �njNAg !2 gQgp. , Tax Map A6 Block _ Lot _ (indicate nearest cross street) Municipality _pa,- Drainage Basin _ ing pe;aok,. SOIL PERCOLATION TEST DATA Date of Pre - soaking 8� - (i 4 & Date of Percolation Test 8 -12 -G1lQ = ilole..No... _._Run. No..... Time . Start -Stop El a se Time . . 91n.) Nth to Water om Ground Surface (I qches) Start stop Water Level Dro p In Inc es Percolation Rate Min/Inch �. . .. I}•o�- l'.I�' 2�.. �J 3 2 ►'.��- r'. to. cols' 3'ly 2. 3 161 4 5 - -7.7 5 3. q. 5 VU-1 E5: 1. -1-ests to be repeated at same 4epta unni.approx�mazeiy equal percoiativn. rajas kUG. WUL81116V a� P ercolation test hole. (i.e, s 1 min for.1 -30 mWincb, s 2 min for 31 -60 mintinch) All data to be submitted for review. - . 2. Depih measurements to be made from top of hole. -97 Form DD 10/06/2004 19:46 8452792332 WYNDHAM HOMES INC. PAGE 02 3., t�77N XX 7 DES Cp UpTxorf OF SOItS ]ENCOUNTERED IN TEST ]ROLES HOLIE, AtlQs -L HOLENO. S G.L. 0.5 (y 2.0 2.51 Ulf] 5.5 21 7.5 8.5L 9.0 9.5'. Indicate level at which groundwater is encountered Indicate level at which mottling is observed :'1fidfdRirCVd60welch water level rises after being encountered 51LO Deep. hole-Pbsemdons macTeby. Wst4l-CAO) Date jsj -M 0 Sig Dedgm �jrofesslomzlls Seal 6f. HEM Y Cm 9m i RALPH G. MAST( OMONACO, P.E., P.C. Consulting Engineers 13 Dove Court, Croton -on- Hudson, New York 10520 (91,4.) 271 4762�;...(914)- .271 =2820 Fax Mr. Robert Morris, P.E. October 19, 2004 Public Health Engineer Putnam County Dept. of Health 1 Geneva Road Brewster, NY 10509 Via UPS Re: Proposed SSTS for Wyndham Homes, Inc. Quail Lane, Patterson, NY (Map 35 - Block 4 - Lot 69 - R.S. Lot 11) Dear Robert: Please find enclosed the following materials: 1. Three (3) signed and sealed copies of the drawing entitled SSTS Plan R.S. Lot 11 of Deer Wood Subdivision (Map 35, Block 4, Lot 69) Prepared for Wyndham Homes Inc. Located at Quail Lane, Town of Patterson, NY dated October 13, 2004 2. Four (4) signed and sealed copies of the Construction Permit Application dated 10/14/04 3. Four (4) signed copies of the Application to Construct a Water Well dated 10/14/04 4. One (1) signed copy of the Corporate Affidavit dated 9/24/04 5. One (1) signed and sealed copy of the Letter of Authorization 6. One (1) signed and sealed copy of the Application for Approval of Plans for A Wastewater Treatment System copy. of :the Shock .EnyirotJ_(nentel,Assessment Form dated 10/14/04 -- - -- 8. One (1) signed and sealed copy of the Design Data Sheet 9. One (1) copy of the original Design Data Sheet for the subdivision approval 10. Two (2) sets of architectural plans for a four - bedroom house 11. Check #16593 payable to the PCDH in the amount of We are requesting your review and approval of the submitted materials. C4, 1 'C_ 1� Please call me if you have any questions. G�,.*_ � Q i Ralph G. Mastromonaco RGM /jl Enclosures Cc: Wyndham Homes w /copy of plan CA( V'\ 019 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and. address. of applicant: c� �.OL.L_I fJWO ©fl EDIZI\1FZ 2. Name of project: REeL? 3. Location TN: " 4. Design Professional: AL T Jd�ACc�. Address: _13 6. Type of Pr_ oject: Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subidvision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ..................... 9. Has DEIS been completed and found acceptable by Lead Agency? ............... 1 1 L. If this project is an area under the control of local planning, zoning, or other . officials, ordinances? ..................... ............................... ................:.............. I 12. If so, have plans been submitted to such authorities? ......................................... 13. Has preliminary approval- been granted by such authorities? t4 Date granted: 14. Type of Sewage Treatment System Discharge ................. surface Water --'< groundwater 15. If surface water discharge, what is the stream class designation? .................... 16. Waters index number (surface) . ............................... ........ ............................... I /A 17. Is project located near a public water supply system? ....... ............................... I b 18. If yes, name of water supply 4A Distance to water. supply 19. Is project site near a public sewage collection or treatment system? ................ O 20. Name of sewage system Distance to sewage system NJH 21. Date test holes observed 21 Name of Health Inspector M`.DZI I�S1L1 Form PC -97 �a 23. Project design flow (dons per day) ........................ 2 24. Is State Pollutantischarge Elimination System (SPDES) Permit required ?... 25. Has SPDES , 41ication been submitted to local DEC office? ......................... _ 26. Is any port M of this project located within a designated Town or State wetland? 27. Wetlands ID Number .....................................:.....::....:..... .......I....................... 28. Is Wetlands Permit required? ..... ..................... .............. ...................................... Has application been made to Town of Local DEC office? ............................... 29. Does project require a DEC Stream Disturbance Permit? ............ P 30. 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 O 31. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any �Z) other potential known source of contamination? ... ............................... Yes/No DESCRIBE: 32. Is there a local master plan on file with the Town or Village? ......................... 33. Are community water and/or sewer facilities planned to be developed within I 15 years iii or adjacent to project site ? ....................... ............................ .....: NO 34. Are any sewage treatment areas in excess of 15 % slope? .............................. 35. Tax Ma p ID Number .......................... ............................... Map 3S Block Lot 36. Approved plans are to be returned to ..... Applicant Design Professional If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure _to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & ®FFIC24L TITLES. Mailing Address: ............. ....................... S 'F_� . 14-154 W01 —TOM 12 PROJECT I.D. NUMBER 617M SEAR .. Appendix- C . . State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I-- PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APMW MION R I MAS Z. PROJECT NAME• Su L -G. oMoNACO plViSl 3. PRojEcr LOCA ON; I I PUTj Munkdpality �, E 25o1•I County A M 4. PRECISE LOCATION Peet address and Inierse 3000, Prominent taedmarks, eta, or per" "PI Lcc�Trio oll-I E o > L fJ (2 CAD T s. IS PfIOP.OSED ACTION; JYaw Q Expansion ❑ Modiflcadonlaltcraton 6. DESCRIBE PROJECT BRIEFLY: GotJST' R.c 'T'IoN o A orJ� M I l.-( DES I D E f�IGE W 1 T� PAv e O D I\IF -\ ,SU f3S U F�c.E5r__W A4r= tDl nf05A1_ sYSTE M, pP-1 I.LEi> L4L, �►r�1�D �1s5c 1�. �p C� �j t-�G 7. AMOUNT OF LAND AFFECTED: InittaPty I • Z lama ultimately . 21 laces a. ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE Rt: MC IONS? %:0783 ❑ No If Nq desarlbe briefly 8. IS PRESENT LAND USE IN VICINITY O PROJE= ❑ 0 Q.Otber sideattai IrMustsiat 0 Agrlct; t" .... ParkrorasilO;cece. Spate... _ . _ Describik ._ .... _ ... _ 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OA FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY WEDEIVJ , STA E ¢R LOCAQ? . ❑ No If yes. list agenc*1 and penniUl�ap�prevafe �II _- Tc>NiJ Of CATTE[ .pSot4 &UI Loil ���. F3u I L.DI1- C IT PUT14AH CovIJ F,:-A L P�,- Pr - f o. t-E . A p:o vii L- 11. DOW ANY OF THE ACTION HAVE A GWERMY VALID PERMIT OR APPROVAL? ❑ Yes t o If yes, JIM agency name and parmWappmal 12. AS A RESULT OF PROPOSED ACTION WILL SWNG PERMIT/APPROVAL REQUIRE MODIFICATION? ❑ Yea I CERTIFY THAT THE INFORMATION PROVIDED ABOVE 18 TRUE TO THE WMT OF MY KNOVYI.®G(: P—A L • ApplicanUbponsor 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 OVER PART 11-- ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.8? If yes, coordinate the review process and use the FULL EAF. ❑ Yea Cl No IL Wi1.L R(i716N REGENE IrbO'FiDINATf:D REVIEW AS PROVID ®' FOR UNLISTED Adi IONS IN 6 NYCRR, PART 617.6? It No, a negative decimation 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, soUd waste production or disposal, potential for eroalon, draimge.or flooding problems? Explain brWir. M, Aesthetic, agricultural; archaeological; historic, or other natural or cultural resources; or cnrurrrunity or neighborhood characten a4min briefly; Ca. Vegetation or fauna, fish, shellfish or wildlife species, significant labltata, or threatened or endangered species? Explain brtefty: C4_ A community's existing plans or goals as officially adopted, or a change In use of intensity of use of land or other natural resources? Explain briefly Cb. Growth, subsequent development, or related activities Welp to be Induced by tits proposed action? Explain busily. C6. Lang Win, short tenn, caniulative, or other effects not Identified In C1-05 7 . Explain briefly.: V-1 C7. Other bnpaets (Including changes in use of either quantity or type of energy)? Explain briefly. � 0. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CFA? ❑ Yes ❑ No - E.•'iS TtiER12,41t 1S. THERE.L.IKELY TO BE; CONTROVERSY REiA7ED TO-PO'i WIAL- ADVERSE- ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No ff Yes, sapfain briefly PART RI--- DETERNUNATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effex t identified above, determine,whether it is.substantlaf, large, important or otherwisesignificant Each effect should be assessed in connection with its, (a) setting (i.e' . urban or rural); (b). probability of occurring (q duration; (d) irreversiblifty; (e) geographic scope; and (f) magtritude. If necessary, add attachments or reference supporting materials. Ensure that explartatfons contain sufficient detail to show that all relevant adverse impacts have beers identified and adequately addressed If question 0 of Part 11 was chocked yes, the determination and significance must evaluate the potential Impact of the proposed action on the environmental characteristics of the CEA. ❑ Check this box If you have identified one or more potentially large or significant adverse Impacts which MAY "occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result In any significant adverse environmental impacts' AND provide on attachments as necessary, the masons supporting this determination: or rWe Name or Respovallife O rca In Lad Ai OCY Sigeature of Resp=ibie Officer 6r Lead Agency Date 2 4 e a Resparm a bRIM iasrature of Preparer (If diffetew from fib ofikaj t i PUTNAM COUNTY DEPARTMENT OF HEALTH 7.1� __ _J) M, SION...OF ENVIROINMENTAL IIE-ALTH-SERAWE'S DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner P Hom G Address E)CoLL \N*00-01)P., WsT Located at (Street) a QA I L LA e, Tax Map -36 Block Lot (indicate nearest c' ' ss street) pa Le-r Municipality Tr Watershed SOIL PERCOLATION TEST DATA Date of Pre-soaking 'Date of Percolation Test NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. -,< I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2.. Depth measurements to be made from top of hole. Form DD-97 .......... . . . . . . . . . . . �4. M 0 Ka .......... .......... . . . . . . . . . . . . . . . . . 1'05 - 1: 1y- 28 31 2 1:14 - -124 10 Z-7 3()'/2 �/2 2, c-1 3 1.28- 1 :38' 10 28 Y2- 31'/Z 3.3 4 5 Z 3 28 31 -7-7 2 1'35-2:05 30 2S 31 3 10 3 2:o(,,-Z:3(p .3o Z& 31-- 10 4. 5 2 3 4 -5 —_ NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. -,< I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2.. Depth measurements to be made from top of hole. Form DD-97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST DOLES DEPTH HOLE NO. HOLE NO. 2- HOLE NO. G.L. To f �o I L L .25 . .. P. rn o e,PoLid I.oAPfi 1.0' , a 2111 ®L.IVE '(eLLO\AJ R.r-,p @&Vj� 1=W 2.0' I �� SAhIO'i LOAN[ t-A�Di LOAM 2.5' 3.0' 3.5' 27" OLIVE 4.0 F19E 0 Y LOL 4.5' 5.5' = - cr) - cv 7.09 CD 7,51 r- 8.5' 9.5' 10.0' iK A 11 F ELD ca�'rA o VIDEO r 4As BE TAKEN FROM 1 FOP -P Tic)N Pao Dec) t3-!' NY Nl�l�ols���P�. Indicate level at which groundwater is encountered Indicate level at which mottling is observed tJ 0� Indicate level to which water level rises after being encountered 5�•(0 U E• . ' S F- 0 Deep hole observations made bar: A. LLOYD CIJ'1'GT�EP,�.gUDZI�151Ci� ate 12. - 4 � Design Professional Name: ✓ f _AQT WMC*JAco P. �. Address: Signature if 2 PUTNAM COUNTY DEPARTMENT OF HEALTH.'.. DIVISION OF ENVIRONMENTAL HEALT I .•SER`CESI::,. _ LETTER OF AUTHORIZATION RE: Property of�c�c�hc�,.cr� C __....._.. _ Located at T/V R4T'f'ERSDAI Tax Map # Block _Lot R.S: La,- 11- - Subdivision of :_ DEERWOoD 5UBDIV1-5'10d Subdivision Lot # C Filed Map # Date Filed. 311410 z. Gentlemen: This letter is to authorize kA49W /IlASMOA QA/ ,4C.,6 a duly licensed Professional Engineer � or Registered Architect to apply for the, required wastewater treatment and/or water supply permit(s) to serve 'the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of,tt e•Putnacri County Health Department, and to sign all necessary papers on my behalf in connection. witli -this matter and to supervise the construction of said wastewater, tretment and/or water supply systems in -conformity with the provisions. of Article„ 145 and/or 147 of the Education: L- aw;.the..Publie Health .Law, and the Putnam Coun ary Code. - F_NEW y y Q a, 1f.4$,rR Very truly yo s, Countersigned: Signed: P.E., R.A., #:.:, w to er of Property) �cr� I►l�c, V. P Mailing Address C— i20Toro - oti- r Upson State yeu Zip l 05 ZO Mailing Address: CQo—\ \\ t.,woc.1--irA State ��2 Zip Telephone: 27 (-47(a Z Telephone: 2` n- 2S) 2; Z Form' LA -97 rill 1 AFFIDAVIT - CORPORATE OWNER APPLICATION ... FOR PERNET APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: MINE V. P. . C> N represent that I am an officer or employee of the-corporation and am authorized to act for: Name of Corporation: \-X-, Having offices at: 57-Is v 0 t Whose Officers Are: President - Vice President - Name: Address: Secretan' 7N a m C- Addtess:� Treasurer - Name, tl]LA 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 ther Signed: Zil 41 Title: Swom to before me this 2t day of (mont (year)' JEANNETTE ROSADO Notary Public, State of Now York Corporate Seal No. 01806103335 Qualified In Putnam County commission Expiras 12122/2007 Fo;-m CA-97 PUTNAM COUNTY DEPARTMENT OF*HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location - Street - Address: "" " ' ,�e --/ � �1A /G TownNillage: �� 1, Tax Grid # Map2j�j Block �-- Lot(s) O3 Well Owner: Name: Address: Use of Well: 1- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm I Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion X/ Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length I ft. Length below grade Oft. Diameter in. Weight per foot lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded V Threaded _ Other Seal: 4X Cement grout _ Bentonite Other Drive shoe: X Yes No Liner: ' Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped 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 Depth From Surface Water Well Formation Description ft. ft. j;Bearing;lDiameter(in) Land Surface descriptions or sieve analyses are available, please attach. tit''c ,G,y �7 - If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Inforn]ition �n =: , ' ' ,s Pump TypLe, Capacity Depth �'- Model /d_ Voltage HP Tank Type p //,4 /,eVolume �(1U W� !p/ ' Date Well Cymple�d Putnam County Certification No. l3ate of Report Well Driller (ignatu / NOTE: Exact location of well with distances to at least two permanefit landmarks to be provided on dparate sh eVplan. Well Driller's Name Address: Signature: Date: /2 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner;Or g a copy-- Well driller Form WC -97 ar/ II�.. 34• _ JB 37- — k It L4 JB5 — L10 LS - - =5 - -- —37 -- I I — JB6 - - -L9 1 35' -- 37_— � =ALL LATERALS HAVE y I1 L8 34' - - -JB7 — \ 'CAPPED ENDS (TYP.) 111 L? — J68 ? III LS 111 \ ! x III \ 100% EXPANSION AREA u �F \ SSTS AREA 6,000 s.f. i c \ ry ROOF DRAIN j AND \� DISCHARGE • l i DISCHARGE INTO EX. C.B. a \ s \ / / / P- �10 R v ` IM p J J 0 l / 4" PVC SCH40 ` 96.4' EXISTING ,f /,,e 4" SOLID PVC �� 0 l;`k* 'B' � ry' .f� WELL / J % L1 26' JB1 TIE POINT L2 19' J62 -- — L�3. 7' DEEP CURTAIN DRAIN Q�G L3 26' - -JB3 L3 WITH MONITORING PIPES j6. 0. 37_x_ L12 SEPTIC TANKONC. Lll a A, aOj�\Vr II�.. 34• _ JB 37- — k It L4 JB5 — L10 LS - - =5 - -- —37 -- I I — JB6 - - -L9 1 35' -- 37_— � =ALL LATERALS HAVE y I1 L8 34' - - -JB7 — \ 'CAPPED ENDS (TYP.) 111 L? — J68 ? III LS 111 \ ! x III \ 100% EXPANSION AREA u �F \ SSTS AREA 6,000 s.f. i c \ ry ROOF DRAIN j AND \� DISCHARGE • l i DISCHARGE INTO EX. C.B. a \ s \ / / / P- �10 R v ` IM p J J 0 LOT 13 t f i 5 N { , , i TRENCHES REQUIRED = 445 L..F. E TRENCHES PROVIDED = 445 L. F. t PI ITNAM r n! im'CV Mr"P, ",4TIVIE SIT OF HEALTH A B T1 30.7' 35.9' T2 22.4' 44.7' J131 23.1' 61.1' J B 2 31.3' 71.4' J133 35.4' 65.2' J134 41.0' 65.4' JB5 46.7' 66.6' J86 52.1' 67.3' J137 57.7' 68.7' JB8 63.1' 69.4' L1 39.6' 88.6' L2 45.8' 91.6' L3 50.3' 92.2' L4 59.4' 99.7' L5 64.2'--- 101.2' L6 67.8' 101.3' L7 70.9' 100.8' L9 65.6' 38.9' L10 60.0' 35.4' L11 53.7' 31.8' L12 48.7' 28.7' L13 39.3' 34.2' L14 28.2' t47.0' t f i 5 N { , , i TRENCHES REQUIRED = 445 L..F. E TRENCHES PROVIDED = 445 L. F. t PI ITNAM r n! im'CV Mr"P, ",4TIVIE SIT OF HEALTH