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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35.-4 -104 BOX 16 'q .:� I or 1 , 1 6 f 01765 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Locatiiotr= - -' 'Street Address:/- % = To /Village: Tax Grid-# - — - Map Block Lot(s) Well Owner: Name: 'Address: Use of Well: 1- primary 2- secondary >(- Residential -Public Supply Air co d /heat pump Irfigation 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 X Threaded _ Other Seal: Cement grout_ Bentonite -Other Drive shoe: Ai 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. �pm Depth Data Measure from land surface - static (specify ft) w / During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses__ are available, please attach. De th From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface // y 3 C= If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information = -' / Pump Type 5 Capacity J 1 l4l\ `3 r Depth Z7 5- Model l0 64/ Voltage Z36- HP l ; Tank Type W X -3oZ Volume „�, Date Well Completed Putnam County Certification No. Clf Date of eport Well Dril r (signature) NOTE: Exact location of well with distances to at least two permanent landmarks to be prov" d on a sepafate s eet/plan. Well Driller's Name Address: Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health_ LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Jeff Moore Harry Nichols Engineering Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Dear Mr. Moore: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 March 2, 2006 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Addition — Schwartz, A -09 -06 67 Apple Hill Road (T) Patterson, TM# 35.4-104 I have received and reviewed the revised plans for the proposed addition at the above mentioned residence. Based on the information submitted and received by this Department, the above mentioned addition cannot be approved for the following reasons: 1. The legal bedroom count for the dwelling is four. The potential bedroom count of your proposed addition is five. 2. The addition of potential bedrooms requires this Department's approval of a revised septic system plan from a professional engineer. Please revise the proposed floor plan to reflect no more than four potential bedrooms, or have a professional engineer or registered architect design a sub - surface sewage treatment system meeting present code requirements for five bedrooms. If you have any questions, please contact me at your convenience. Sincerely, r Gene D. Reed 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 IlV AREA CALCULATIONS. BASE BOX SIZE: (46) 16; 14, 16 x 34 1ST FLOOR 2026 S.F. 2ND FLOOR 1788 S.F. TOTAL 3814 S.F. D CVR L.1 13 W&KOUT/ ma BSMT. 673 S.F. GARAGE — — — — — — — — — — — ; Z- PORCH 64 S.F. _ __z = - -__ _ - _ _ m ME E goal logo _ =8_l^ =_- WINE logo l =1 loll i =1 w _ II 1�1 11 Milli AREA CALCULATIONS. BASE BOX SIZE: (46) 16; 14, 16 x 34 1ST FLOOR 2026 S.F. 2ND FLOOR 1788 S.F. TOTAL 3814 S.F. D CVR L.1 13 W&KOUT/ ma BSMT. 673 S.F. GARAGE 792 S.F. PORCH 64 S.F. f i 1 ! 'kLOF E n• V4 -f W-w 0- M 1' -f 1 1' -} ilr 1' -} G /}' DECK HOME OFFICE f-11 1/2• 14) 2 o- 3 (41 BFEWA9 : L L40M -- ------ a c, I FAMLY ROOM, MMEN KffCm w-" /r r-. 1/2- q i Eel. all C) "T Of Co i I - 14 - WWI 7 T lz ONM ROOM 3 M GARAGE APPROVED CD FORM r jUL 204 �RTMFNT EdA DER 4'W n'4 'kLOF E ja ®9ZW4 W IpMRC11PL. Y.L WIbC M O J t p E z c v W v d d � N CD zx � a D -06 Lol 13 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health :::L�RETTA: MOLINARI; RN MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 February 9, 2006 ROBERT J. BONDI County Executive Mr. Jeff Moore c/o Harry Nichols Engineering Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Re: Addition - Schwartz, Permit # A -09 -06 67 Apple Hill Road (T) Patterson, TM# 35.4-104 Dear Mr. Moore: This Department has received and reviewed the photo copies for the proposed addition in the basement at the above mentioned residence. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons: 1. The room in question titled unfinished storage (16' x 8') is considered a potential bedroom by this Department. 2. The legal bedroom count for the dwelling is four. The potential bedroom count of your proposed addition is six. 3. The addition of potential bedrooms requires .this Department's approval- of.a- revised - - - _- .__._- . septic - system -piatrfm =professional efigi>ieeir Upon receipt of a submission, revised to reflect the above comments, this addition application will be considered further. If you have any questions, please contact me at your convenience. GDR:cj Sincerely, aAr"- i✓ . X� Gene D. Reed 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 (843) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 FEE -14- 2006 04 :02 PM HARRY W NICHOLS i i i i v 3� 914 279 4567 P.02 FEB -14 -2006 UE 15:29 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 Ck VZ\ �171' vl- d W FED-14-2006 ►4:01 PM HARRY W NICHOLS . 914 279 4567 P.01 Harry W. Nichols Jr., P.E. Patterson Park - Suitt 106 7cl: (845) 2794003 Fax: (945) 279-4567 Emil: F,nengincer@aol.com Fau Td., From.- Fax Payer: Date: .cc. ❑ UrUoit ❑ For Rev-tow 13 111cane, comment ❑ Please Reply ❑ please, K"ycic Gummonfm ro FEB-14-2006 FUE, 15:29 TEL: 845-278-79211. NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 i a.t �; s C ➢.�kr°d mod. _ ��� v i a.t �; %/A C- Ooor Sete far: Harry W. Nichols Jr., P.E. Patterson Park, Suite 706 2050 Routc 22' Brewster, NY 10509 Telephone (&45) M -4003 -_ .._, �_...; F X279•- 4567 =_. _ Date: 0 r,.l To ' Job N o.: Pro J • ect Attention: Qom" Gentlemen: We enclose (, copies of_ B/W Prints Reproducibles Reports .Tracings Specifications Memorandum Copy of letter. Description: Revision/Date No. Sent Via: Our Messenger Blueprinter First Mass Mail Special Delivery . Your Messenger Hand Delivery . Copy to Very truly yours _ .. Harry Yr'.Vichols Jr., P".E. _ . SHERLITA AMLER, MD, MS, FAAP Commissioner of Health . ..- ... ...:.,_.. .. .. .> .mss . ... ...... . 00kkTTA MOLIIVARI, RN, MSN Associate Commissioner of Health Harry Nichols, P.E. Jeff More Patterson Park, Suite 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 January 23, 2006 Re: Addition Application Schwartz, 67 Applehill Rd. Patterson, TM #35. -4 -104 This Department is requesting the submission of the original house plans (or copies of) with the Health Department bedroom count,stamp -ondt. _. _r __ _ . _ -� _ ._•�.� _.......__...�r . _ _ .. ,. . - Upon receipt of the above requested information, review of the addition proposal will continue. Sincerely, GDR:Im Gene D. Reed Environ. Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 ---------- -------------- UNFINISHE STORAGE UNDER OPTIC BILLIARD RC ABOVE --------- ----------- ---------- WATER HEATER LACE TIOS YARY C)-- -- -- ---0 0 o ---------- ---- ---------- f U rr 'IV Ales st�^�5ed 6,�s #'yndham Homes, Inc. W I N D S Lj'l CC 1996—Z�0 Wpoita.n Homes, lac Ad rights reserved P A T T I R We er!crce our copyrlgits. Ura.ULh2:'iZCa LSe Of ttleSt plans 4 and exiaU.-.S, even ii mf 6L led, 'is i ai h4grdt Lav- Some items shown ALII dimeftSions are appTvij, Is's Floor pla, vary With eleva Suhject 1o� change without no ti,- -------------------------- ---- "0 0 0 pro'? LJNE ABOVE' ABOV91 Z= F; Area- L UNFINISHED STORAGE ? UIUM91RD a. OTORAGIE OPTIONAL CAME ROOM 28' x 14' UNFINISHED Qt STORAGE 73 M - - - - - - - - - - - - - - - — - - - - - - - - -- i - The Dartmouth Basemen i Floor Plc W s 0 N m N E W Y 0 R K is Printed on June 13, ---------- . J AL opr[OkAL DOOR: 0 WATER HEATER FURNACE L1 ` LOCATION MAY WARY o JECTOR Ulm NIOHED qTORAGIE >. "As - ---------- ---- ---------- f U rr 'IV Ales st�^�5ed 6,�s #'yndham Homes, Inc. W I N D S Lj'l CC 1996—Z�0 Wpoita.n Homes, lac Ad rights reserved P A T T I R We er!crce our copyrlgits. Ura.ULh2:'iZCa LSe Of ttleSt plans 4 and exiaU.-.S, even ii mf 6L led, 'is i ai h4grdt Lav- Some items shown ALII dimeftSions are appTvij, Is's Floor pla, vary With eleva Suhject 1o� change without no ti,- -------------------------- ---- "0 0 0 pro'? LJNE ABOVE' ABOV91 Z= F; Area- L UNFINISHED STORAGE ? UIUM91RD a. OTORAGIE OPTIONAL CAME ROOM 28' x 14' UNFINISHED Qt STORAGE 73 M - - - - - - - - - - - - - - - — - - - - - - - - -- i - The Dartmouth Basemen i Floor Plc W s 0 N m N E W Y 0 R K is Printed on June 13, J° ae books Wyndham Homes, Inc. ;�O 0 1 LINE OF DECK ABOVEt �-,�UNFINISHED STORAGE OPTIONAL CIAME ROOM 28' x 14' . Lcoder �°'Y ' y�tlleiovJ f � i I D S 0� It Some items shown aea.,_ All dimensions are appr Floor plans vary with elev Subject;to change without note, Mq Qlr„�osed2 orc AF0- �i UNFINISHED ; OTORAC[E C� 1 ; , 1 UNFINISHED ` - STORAGE T , 1 I , I , , 1 , 1 1 1 1 1 1 , I , I I 1 I • 1 1 1 1 1 . 1 ------------------------=i----------- The Dartmouth — Basement Floor Pl( W 0 0 D S 'lJ'S Cc 1999 -E'G7 Wyndham Homes, ',ac All rights reserved z P A T T E R IS 0 N S N E W We er.:Grce Onr Mpyeg ts. GraulhO izea ase Of these plans �} add e:aratics. even it MW A. is a �ial(a 01 f0crat La Y 0 R K e Printed On June 13, -------------------------------- 1 1 1 - - - - -- ----------- 1 1 1 1 1 { 1 , , 1 - - - - -, , I 1 I PT �J , OAL- n00R� ' 1 � WATER ; , 1 , ' -O WATER - HEATER 1 - 1 �r HEATER � Q LOCATION � 1 F' 1 .[ FURNACE 1 MAY VARY � LOCATION NAY VARY UNFINISHED • SEWACE- (� JEC OR STORAGE ; ` UNDER OPTIONAL , 1 ROOM BILLIARD ABOVE $ED • 1 ' 'OTOI?,ACE 1 4 C ' �eoRs ; 1 1 1 1 ; . J° ae books Wyndham Homes, Inc. ;�O 0 1 LINE OF DECK ABOVEt �-,�UNFINISHED STORAGE OPTIONAL CIAME ROOM 28' x 14' . Lcoder �°'Y ' y�tlleiovJ f � i I D S 0� It Some items shown aea.,_ All dimensions are appr Floor plans vary with elev Subject;to change without note, Mq Qlr„�osed2 orc AF0- �i UNFINISHED ; OTORAC[E C� 1 ; , 1 UNFINISHED ` - STORAGE T , 1 I , I , , 1 , 1 1 1 1 1 1 , I , I I 1 I • 1 1 1 1 1 . 1 ------------------------=i----------- The Dartmouth — Basement Floor Pl( W 0 0 D S 'lJ'S Cc 1999 -E'G7 Wyndham Homes, ',ac All rights reserved z P A T T E R IS 0 N S N E W We er.:Grce Onr Mpyeg ts. GraulhO izea ase Of these plans �} add e:aratics. even it MW A. is a �ial(a 01 f0crat La Y 0 R K e Printed On June 13, SHERLITA AMLER, NID, NIS, FAAP Commissioner of Health - - LORET -T -A MOLINARI, RN •1VISN` Associate Commissioner of Health January 30, 2006 H.W. Nichols c/o Jeff More Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Dear Mr. More: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Addition — Schwartz 67 Apple Hill Road (T) Patterson, T.M. 35.4-104 ROBERT J. BONDI County Executive I have received and reviewed the plans for the proposed addition at the, above mentioned residence. Based on the information submitted and received by the Building Department the above mentioned addition cannot be approved for the following reasons: 1. The legal bedroom count for the dwelling is four. The potential bedroom count of your proposed addition is six. '2:�' Tlie addi iori of potential- Bedrooms requires this Department's approval of a revised septic system plan from a professional engineer. Please revise the proposed floor plan to reflect no more than four potential bedrooms, or have a professional engineer or registered architect design a sub - surface sewage treatment system meeting present .code requirements for six bedrooms. If you have any questions, please contact me at your convenience. GDR:cw Sincerely, Gene D. Reed 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 C (CA- v\ s Some items shown are op Ex 'S r f N 6— Gj {� - - " + All dimensions are approxl A j �(� J Floor plans vary with elevavto STAIR LOCATION OPTIONAL Subject 'to change without ootie VARIES WITH GRADE DOORS P, DECK HOME OFFICE — LAITNDftY 26' x 12' 13' x 13' ----------------------------- - - - - -- ------- - - - --, lg. 1' Lower - -� i t I I 1 I I 1 I I r —W77 I t l DW 9 It LF - - -- OPTIONAL I i i WALL ! t [t ,F ROOM z8 SINK FRENCH DOORS ' BRlitlLlr!' I ; w/ TRASOM i FAY R042►� , 10 x 12 OPTIONAL `%.c)' X 15 OPTIONAL— ;; SINK F Y ENTRY COLUMN I i O , EN a Cl 1' Lower 'I ;1 1 I � AIIHA u 1 t I ( SiffS Y3AES 1 I 1 Wal ffi..� +I . OPTIONAL ; �r —OPTIONAL DOORS �r�1(''�v�, ! y UPGRADE WtLK —IN a1.1 'HE • POWDER 1 ANTItY 1 a5 X 1 %' I i / I 1 - i OPTIONAL t-- - - - --* _ -- BILLIARD + 1 ROOM 14' x 19' 3 CAR (#ARA([E .IVIN0 ROOM DINING ROOM 22' x 36' t 15' x la' 2- 51TORY 15' x 16' 1 FOYER I 1 , 0 II I t t PORCH �! OPTIONAL ! ; (VARIES WITH . FRENCH DOORS TRATRANSOM t ELEVATION) i i i Tyndham Homes, Inc. The Dartmouth N First Floor Plar ■ W I N D S 0 R W 0 0 D S 3 � ' 1999 -2003 Wyndham Homes. Inc. a3 rights reserved. ■ p A T T E R S 0 N ■ N E `'Y Y 0 R K ■ We enforce 3 -r copyri;nts Csautnorized use of these plans T— and Coatis :,s, e,en if =a;fied• is a Ylo!atian of Federdl Law. , mom i ri I O I I OPTIONAL TERROR 14' x 19' REQUIRES OPTIONAL BILLIARD ROOST BELOW i i LOFT 15' x 15' I � 1 1 i HALF WALL ; I ; OPTIONAL ' i i YANr I i ' 1 i I t_____________ J, i OPTIONAL LOFT i i 1 1 1 i Some iteYhs shown are c All dimensions are approtii Floor plans vary with elevl Subject to change without I, ' BATHOOM --------- - - - - -- ----- - - - - -- ® - -- I WALK—IN CLOSET i .r ---- - -----i r - ------ ------ ----------0--- - - - - -- ----- ' - 1 , ' ' aJ BEDR00$� i a! r-_., ___ �. _ ' _ i 5 —7 WALL -_ 9 I TER 15' x 12' ' 1 i WALK —IN I I p BATH ; ; ; ; o II& Er CL SET It ' i SLOPED Li Q BEDROOM- 2 - - -- Linen — — — — — i - - - - -2 il- -- fi h OPTIONAL -, `________ 4_� 1 EDROOM F RERAN DOOR -- i L ti71TH OPTIONAL BATH UPGRADE ' i ' -, i- ; 16' x 17' ( ' ( ZION ---- --- - - - -0 ------ --- - - - - -� 7_ ________;__________SLOPED _________ � I LAUNDRY 16' x 17' OPTIONAL �rITIx(I Rood "TER '- - - - 5' -7" WALL ' 14' x 19' BEDROOM J ' REQUIRES OPTIONAL ' ' BILLIARD ROOM BELOW 15 X 21 i OPTIONAL 1 Foyer Below BEDROOM 4 ; � � 15' x 12' ; 1 1 I Plant Plan1t i d Shelr Shelf � I 1 Wyndham Home', Inc. The �artmouth —' S'econ Floor Plar o W I N D S 0 R W ® ® D CC 1999 -2003 Wyndham Homes. Inc All rights reserved © p A T T E R S 0 N ® N E W Y 0 R K �\ We enforce ocr copyrights. Unauthorized -:se of these plans and elevators, even if rttce:fied. I$ a v :oa oa of eederal Law \� A I r' O LINE OF----). DECK ABOVE: •------------------------------------- --------------- OPTIOt DOOR; 0 WATER HEATER FURNACE F-71 LOCATION MAY VARY UNFINISHED • STORAGE UNDER OPTIONAL BILLIARD ROOM ABOVE ----- ------------------------- : 3 ----------------- 0 0 Some items shown are All dimensions are apps Floor plans vary with elevi Subject eo change without I Wyndham Homes, Inc. The Dartmouth N Basement Floor Plan ■ W I N D S 0 R W 0 0 LJ'S CC 1999-2L03 Wpanarn Homes. !nC All nghts reserved ■ P A T T E R S 0 N ■ N E W Y 0 R K n We er.!orce o6r copyr:j ' - ' LS. Una�tho.izec Ue Of these plans a=, C:b1.LLC:.5, even if mllil:14, is IL of 1,1,ra, lac v.-DEC-29-2005 15:34 FROM:PUTNRM COUNTY DEPART 845 -278 -7921 SHERLITA AMER, MD, MS, P'AAP Commissioner of Hcalt>, LORETTA MOLINARI, RN, MSN Associate Commissioner ofifealth TO: 912128131981 P:3/4 ROBERT 1'. BONUI. ... . County Expcutive DF-PARTMENT ' OF HEALTH p 1 Geneva Road, Brewster, New York 10509 . ID TION APPLI NTII. el STREET T®wNJ, TAX "# NAME � � �,,t� tZ 1PHONEJ(4 2 - 1- J g od PCIIID# MAILING ADDRIESS 1 Cole 1411( Al. bre."Sk rq 10S0cl D SCRIM. ON nIS 44 eir'p- refs -z cf e- -'e. NUMBER OF EXISTING BEDROOMS-14—PROPOSED # OF BEDROOMS' (PROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) "Any addition which is eomidered a bedroom requires formal Approval of plans (Construction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable seetious of the Putnam County sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, Brewster, NY 10509, Phone: (845) 2786130, 1. Certified check or money order for $100.00. 2, Sketches of existing floor plan (drawn to scale, all living aren including basement) 3, Two sets of proposed floor plan (drawn to scale - with name, street and tax map #) *Non-professional sketches are acceptable 4. Copy of survey showing well and septic locations to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this of-flee with any questioias. S. Copy of Certificate of Occupancy from Town or Certification from Building Dept, with legal bedroom count of dwelling, OFFICE LTSE COMMENTS Environmental Healtb (845) 278 -6130 Fax (845) 276,7921 Numiog Servieos (845) 278 -6558 WIC (845) 278,6678 Fax (845) 2786085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278.6648 �. DEC -29 -2005 15:34 FROM :PUTNAM COUNTY DEPART 845 -278 -7921 TO:912128131981 P:4/4 SHERLITA AMLER, MD, MS, I!AAP '"`' ` -" "� CnnrntlssionerofHeallh LORETTA MOLINARI, RN, MSN Associate Commissioner of Meal!, DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 TOM! egal .Bedroom Count ROBERT J. BONDI County &ecurlyP Re: ��, wart i L (Owner's Name) Tax Mall #: -- z >s Address:_ � 4e Town,: � %f D'.) Year Built: According to records maintained by the Towri, the above noted dwelling, is DL in compliance with Town Code, is not in compliance with. Town Code. The Legal. Redroorn Count is; This information has been obtained from: Certificate of Occupancy: Other: . s tr Building Cnspector. D& Environmental Health (845) 278'6130 F,-ix (845) 278 -7921 Nursing Sorvices (845) 2786558 fax (845) 278.6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preachool(845)278 -6014 Fax f84S) 278-6648 Marc A. Schwartz 67 Apple Hill Road Brewster, New'York 10509 January 12, 2006 Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 Attn: Mr. Reed Dear Mr. Reed: In accordance with our meeting earlier in the week, enclosed please find my package requesting approval of my basement plans, including the $100 money order. Please call me at my office, 212- 813 -1900, if you have any questions or comments. Thank you very much for your cooperation. It is greatly appreciated. Very truly yours, Marc Schwartz SHERLITA AMLER, MD, MS, FAAP Commissioner of Health ,LORETTA" MOLINARI,:[tNM.SN,:. Associate Commissioner of Health April 3, 2008 Harry Nichols, P.E. P.O. Box 252 Brewster, NY 10509 Dear Mr. Nichols: ROBERT J. BONDI County Executive - -, .......- ROBERT MORRIS' ' Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Field Inspection — Schwartz, A- 009 -06 67 Apple Hill Road (T) Patterson, TM # 35 -4 -104, Lot 13 The above referenced separate sewage treatment system can be backfilled. The following comments were noted in the field. 1. Instead of adding an aclditiona1750 gal septic tank in series with the existing 1250 gal septic tank, the 1250 gallon tank was replaced with a new 1500 gallon concrete tank. 2. The trench lengths varied slightly from the plan, however the total length required remained the same. If you have any further questions, please contact me at (845) 278 -6130, ext. 2155. JD:kly Sincerely, oseph Digit Environmental 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 FINAL SITE INSPECTION / Date: 3 lt7 7 % R� Owner M. Inspected by: Street Location ��'L��'�I1��L- S'�A^ ✓Q1z?z, Town {'�17'T '...0 // Permit # _ _ Subdivision Lot # 1. Sewage Svstem Area a. STS area located as per approved plans ........................... b.. Fill section - date of placement 3:1 barrier Lgth. )ATidth . Avg.Dpth c. Natural soil not stripped ................. d. Stone, brush, etc., greater than 1 S' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. Sewage Svstem a. Septic tank size-- 1, 000...:..... 1,250 ......... other.. U.. 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. .. Minimum 2 ft, Original soil between box & trenches e. Junction Box - properly set .......... ............................... 6, Irenches � / 1. Length required Length installed 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ..... ............................... 4. Slope of trench acceptable 1116 - 1/32" /foot ............. S. 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 ........................ :.............................. g. Pump or Dosed Systems 1. Size of pump chamber ................................. I.............. 2: - Overflow tank ....... ...........I .............................. 3. Alarm, visual / audio ....... .:........:.. ............... ................ 4. Pump easily accessible, manhole to grade ................. S. First box baf led .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Building a. mouse 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 backfdled ........... ............................... c, All pipes flush with inside of box ............................. . .... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. i Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate.... .... .... ........................ i. Erosion control provided ................. ............................... Rev. 12/02 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES_. _ - - _ CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # A-01-04, �r AD D I a b G H °X Located at e F,9FL�-- 1+ 1LI— �-w Subdivision name VC-OZ-W 0' 0 Subd. Lot # 1 Date Subdivision Approved Owner /Applicant Name 1't, Mailing Address ` PLO 4+i � (`D kD Amount of Fee Enclosed ��� "�' �+�1 OQar- �� r &,4 A-) No. of Bedrooms I W Design Flow GPD f ry roar,, Building Type fLe4-' i 0 -r5 H L,0 Lot Area Town or Village Tax Map �45� Block 4 Lot i Renewal Revision jeW,,PJ- Date of Previous Approval 64w,�,Ivp' N r`; ' Zip S T�cf�U Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of N1F W 15 o gallon septic tank and Other Requirements: U K�y i 5 i 7 f(% To be constructed by TU Address Water Supply: Public Supply From "Ari., i� Private Supply Drilled by 9X(6-111 ;011 . - -- Address Address ADPI11 Art KG W I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment s, sy tem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: P.E. R.A. � ')A'r ©fir. Date Address * P, K/ V1— KV� M O i 1 License # 6 C e r 4 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new. termit. Approv for discharge of domestic sanitary s wage only. By: r _ Title: Date: `'bite copy - HDt , ello copy - Building Inspector; Pink copy - O er, ge copy - Design Professional Form CP -97 � 1 t PUTNAM COUNTY DEPARTMENT Or HEALTH HOUSE PLANS APPROVED FOIi DEDROO1-1 COUNT ONLY, YIpJ BHDAOOIIS — / ,,�V � ALL SUIIS Otis' ^;T is '1?. O \( „! -TIAI ATION;t TO':TI ?ESE HOUSE P NS h4UST BE TO TUE PC!.)OiI L.JR APi'P.OVAI SIGNATURE & I'I DATE Harry W. Nichols,Jr., P.r. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 (845) 279 -4003 Fax 279 -4567 CONSULTING SITE ENGINEERS -- - - �r<4?r?�2. PhD► -'fr _ f'r .: pa _ i ,r z A i ni Y1 -c r I w Y'V L , J f milf p 9 2004 D -06 lol 6 .=Ut/ W40 _ Harry V.J. Nichols Jr., P.E. FA Patterson Paris, Suits .7 06 _ 2050 Route 22 BTMA er, t•rY 10509 -- Fax (845) 279 -4567 Date: To: Job No.: n01 13 -Project lotico is —. ,a, r z Attention:Ale, & 21t fe. A v en Gentlemen: We enclose (5Tcopies of: ' B/W Prints Reproducibles Reports .Tracings Specifications Memorandum Copy of letter. Description: ReYJSIOn/DaIe No. va. Sent Ya: kl our Messenger Bluepririter First Ci ass -Wif Special Delivery. 'Your Messenger HandDelivery . Copy to Ve t ly yours H rrv':jii is Yr., P:E. _ . SHERLITA AMLER, MD, MS, FAAP Commissioner of Health_ ., LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Dear Mr. Nichols: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 March 22, 2006 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Proposed SSTS for Schwartz 67 Apple Hill Road, Lot 13 (T) Patterson, TM# 35 -4 -104 This Department has received and reviewed the submitted application and plans for the above referenced project and the following comments are offered for your consideration. 4. With respect to the septic tanks in series, in addition to the two (2) six -inch connecting pipes, a four -inch minimum vent pipe is required between the two tanks. t/2. Some of the proposed expansion system trenches are shown less than 50 feet to the catch basin which is unacceptable. �3. The pump pit detail is to be revised to reflect the increased dose required by the additional trenches. 4. A minimum of one day's storage past the high level alarm is to be provided. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. MJB:cj Respectfully, i' Michael Jongin—eeninpg udz'rnski E Director 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 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Dear Mr. Nichols: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 March 22, 2006 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health �l Re: Proposed SSTS for Schwartz 67 Apple Hill Road, Lot 13 (T) Patterson, TM# 35 -4 -104 Bog Brook Reservoir Basin The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on March 21, 2006 is complete. The Department will notify you by April 10, 2006 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.astatement that a decision is sought in accordance with- section -18 -23 (d) (6) of the New York City Department 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 approved, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the New York City 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. 2148. Respectfully, Michael J. udz' ski, E MJB:cj Director of nginee ' g Ws2 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 March 21, 2006 Putnam County Health Department 1 Geneva Road Brewster, NY 10509 ATT: Mike Budzinski, P.E. Senior Public Health Engineer Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 Tel: (845) 279-4003 Fax: (845)= 27§*4567 Email: hnengineer @aol.com RE: Application to Construct a SSTS - Schwartz 67 Apple Hill Road — Lot #13 Town of Patterson Dear Mr. Budzinski: The following is a response to your review memo dated March 17, 2006: • Two (2) sets of house floor plans for the existing and the proposed are - -. enclosed.for _the basement.' There -are no- changes proposed to the first or second floor. • The length of the proposed absorption trenches is noted on the plan. A detail for connecting: septic tanks in series is now provided. If there are any questions Very truly yours, Harry W. Nichols Jr., P.E. HWN:gav 06- 002.00 . SHERLITA AMLER, MD, MS, FAAP Commissioner of Health, LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Dear Sir or Madam: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 March 17, 2006 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Application to Construct a Subsurface Sewage Treatment System for Lot 9 13, Deerwood Subdivision 67 Apple Hill Road, (T) Patterson ' The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on March 6, 2006 is incomplete. Please be advised that the following information is required before the Department may commence its review. • Please provide two (2) sets of house floor plans for the existing condition and for the proposed condition. • The lengths of proposed absorption trenches are to be specified on the plan. • A detail is to be shown for connecting the septic tanks in series. w The review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information as to the completeness of your application. Please be advised that. failure to submit information to the Department or to follow procedures is sufficient grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed Regulations and Putnam County Department of Health regulations. Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130 ext. 2148. MJB:cj Wsl Michael J. Budiinski, PE ti Director of Engineertiv -- 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 Ha.ry Vl. Nichols Jr., P.E. Patterson Paris Suite 106 2050 Routc 22, Brcwsta, NY 10509 — - - --` Tclephionc {�tsj 279 4003., _. ! Fex (&45) 279 -4567 I Date: To.— Job No.: PC.l�� Project YKIKImo.. "%y1110d Attention:1�-t'iW;?IV'1'"' Gentlerrien: We enclose (�� copies of: B/W Prints Reproducibles Reports Tracings Specifications Memorandum Copy of letter. Description: Revision/Date No. Sent Via: -Our Messenger Blueprinter First Class -Mail . Special. Delivery. . Your Messenger jHan.d.Dellvexy. Copy to . -Very truly yours Affols Jr., P:E. _ . PUTNAM COUNTY DEPARTMENT OF HEALTH � � DIVISION OF�- ENVIRONMENTAL HEALTH SSERVICE `�; CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYS PCHD CONSTRUCTION PERMIT # ]2 0:3 Located at &-7 / 1 r �' ��a�l Town or Village 899b%I226 Owner /Applicant Name & A6 i ►, _s ._r Tax Maps ; Block_ Lot % G 9 Formerly Subdivision Name De- r- w o Subd. Lot # ? Mailing Address (9 Cv //1 W406 ire—, Zip i sx" Date Construction Permit Issued by PCHD Separate Sewerage -S sy tem built by r Address eg G l In vv Il, v e, Consisting of S `2, i`6 Gallon Septic Tank and -r- Other Requirements: Water Supply: Public Supply From Address. or: i/ Private Supply Drilled by s' es l) if; Building Type ary y Has erosion control been c Address _G f fHe-T 2- A/ Number of Bedrooms - Has garbage grinder been installed? 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 regulatign� of the Putnam County Dep9a)tme t of Health. Date: / -2 0 a Certified by Address P.E. 1,.-' R.A. #C� /Z 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 privatt�e�jater supply shall become null and void when a public water supply becomes available. Such approvals aireubject p modification or change when, in the judgment of the Public Health Director, such revocation' ificat' or change is necessary. By: Title: Date: 111irk White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: / IT%nNillage: lox A% Tax Grid # Map Block Lot(s) Well Owner: Name` dress: a6��v 1 0 awn, ae&A, Use of Well: 1- primary 2- secondary Residential Public Supply Air co d /heat pump _Irfigation 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 Detains Total length ft. Length below grade Diameter in. Weight per foot lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded ,V' Threaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: ,X Yes No Liner: Yes _2!� 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 7 gpm Depth Data Measure from land surface- static (specify ft) 3 During yield test(ft) J ep Dth of completed well in feet We ll Log If more detailed information descriptions or siev analyses . _..._ e are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation (Description ft. ft. Land Surface ... _..__ _ _ -- ......_ �_ .. _......� . �4 _ -_. _ - _. - --- -' If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information / Pump Type 5� Capacity / I qP zoo Depth 27 S' Model 16E;TI6417_ Voltage 2.36, HP J Tank Type wx -3vZ Volume 949 - /j Date Well Completed Putnam County Certification No. Date 7,� eport Well Dril er (signature) 1dUTE: Exact location of well wan aistances to at least two permanent ianamarxs to Well Driller's Signature: Addr Date: / - -- 0 "140- White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 j BRUCE R_ FOLEY LORETTA MOLINA,RI•RN., M.S.N. y " Public Nta/tb Dfrrcla� ••• _ ,. . _ •.... 4.• •• i p HEALTH aNriil'�- Sirvlcu a �... :_.. _� ..._...._ ...� __. - __ DEpARTMEN'I' OF . .. .__ . . _�.... 1 Gcncva - Road' - _ .. __ ...... Browster, New York 10509 __ ____ _ • __ Eartronz aW He4th (910 271 -6130 Fa(914) 27:.7921 xur+ lit. Ssrrtcal9tt )27i•6555••WIC(91ij17F =667F M(9t4)271 -6016 _ -• EviyTolcrriod"oo- (914)171 -6014 Fresdool (914) 271-6022 Fix(914)27r -W1 - E911 Al2DRESS-VERIFICATION FORM OWNERS NAME: 11 - -wl dk11_1 C_ TAIX'I1�AP. DUMBER: "_ 3 G E911 ADDRESS;, ---- / AUTHORIZED TO.WI�__0 C (Signature) DATE: l a �._ d _... _.. The Putnam County Department of Health will not issue aCertificate -of... _. -. -- -- Constructiot Compligace7unless the above'form is- completed* i.e., a legal E911 address is assigned by_ an authorized town official. This'for�m is to be submitted -• - " • " - with the - application for a Certificate of Construction Compliauce. (E911 VERFR34) PUTNAM COUNTY DEPARTMENT OF HEALTH DTVISIO _O +'. NVIItONMENTAE: EALTI-I SERVICES: GUARANTEE OF SUIBSURFAOE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Buildin Tax Map Block Lot Building Constructed by Location - Stree"t / 2 vYSo -zi - - - .TownfVillage Subdivision Name k `GS ( Jeti, I i "i, ) /3 Building Type.' Subdiv -ision Lot # I represent that I am wholly" and completely responsible for the location, workmanship, material, constratiori and °draina'ge of the sewage-treatment system serving 66'above- described' property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition. _ any parr-of said - 'Kysteni coris1ructed 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.ca�i�sesi.by- .themillful or negligent act.of-the occupant of the building utiliz�ing.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 systems _ D ted: M h Day Year 200x' Signature: dzellf 7, U.P. UNIT, -Pe&edl Contractor (Owner) - gignaturJ "V L"11� v w, C_S ; Corpo ation Name (if corporation) Address: 7��1 t �► w�r�� ���� �� - State aae, q � L � Zip I;-Sle_ 3 -7 Title: 061 4a-, Corporation Name (if corporation) / 11 Address: 7: �G /c State Zip t Form GS -97 o YML EN�TR n IAL SERVlCES u�z ear S treet Yorktown Heights, N.Y. � 1O598_` , _, ` (9141 245F-2B00'' ' . Albert H. Padovani, Director ` LAB #: 93.402830 CLIENT #: 57197 WYNDHAM HOMES 8 COLLINWOOD DRIVE RALPH TEDESCO BREWSTER, NY 10509 NON STAT PROC PAGE: 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE/TIME TAKEN: 12/09/04 12r45 DATE/TIME REC'D: 12/09/04 02:00 REPORT DATE: 01/21/05 PHONE: (845)-279-2022 SAMPLING SITE: 67 APPLE HILL RD, PATTERSON, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COL'D BY: JOSE GUICERO TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE PUTNAM CNTY PROFILE 12/09/04 MF T. COLIFORM 12/09/04 LEAD (INS) 12/09/04 NITRATE NITROG 12/09/04 NITRITE NITROG 12/09/04 IRON (Fe) 12/09/04 MANGANESE (Mn) 12/09/04 SODIUM (Na) 12/09/04 pH 12/09/04 HARDNESS,TOTAL 12/09/04 ALKALINITY (AS 12/09/04 TURBIDITY (TUR 12/09/04 E. COLI (CONFI RESULT PRESNT /100 ML 4.0 ppb 17.5 MG /I... <0.O1 MG /L <0.060 MG /I... 0.141 MG /L 15.1 MG/1_ 6.1 UNITS 154 MG /L 30.0 NO /L <1 NTU ABSENT 100/ML NORMAL - RANGE ABSENT 0-15 ppb 0 - 10 N/A 0-0.3 Mg/1 0-O.3 Mg/1 N/A 6.5-8.5 N/A N/A O-5 NTU ` --' ABSENT COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER (WAS) F A SATISFACTORY SANITARY QUALITY ACCORDING TO T RK 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 METHOD 1000 9003 9O52 9162 9002 9002 9002 9002, 900 i ^ YML ENVIRONMENTAL SERVICES 321 Kear Street rl-�..own (914) 245-2800 Albert H. Padovani, Director LAB #: 93.402830 CLIENT #: 57197 NON STAT PROC PAGE: 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ WYNDHAM HOMES 8 COLLINWOOD 'DRIVE RALPH TEDESCO` BREWSTER, NY 10509 DATE/TIME TAKEN: 12/09/04 12:45 DATE/TIME REC'D: 121091104 02::00 REPORT DATE: 01/2 05 PHONE: (845)-279-2022 SAMPLING SITE� 67 APPLE HILL RD, PATTERSON, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATI NONE COL'D BY: JOSE 8UICERO TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 Mg/L. of Sodium is suggested. 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'-AUD TREATMENT~TG-WHICH'THE -WATEk- i-iA8_����'���)������~'-~^ ~`—^---'--- SOFT WATER: 0-70 MG /L VERY HARD WATER: ABOVE 300 MG/L MODERATELY HARD WATER: 70-140 MG /L MG/L � MILLIGRAM PER LITER HARD WATER: 140-30O MG/L (1 grain/gallon = 17.2 MG/L) SUBMITTED BY: Director ELAP# 10323 ^ ^ YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 ` (914) 245-2800 Albert H. Padovani, Director, LAB #: 9.500058 CLIENT #: 58066 NON STAT PROC PAGE: 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ TEDESCO, RALPH. (WYNDHA DATE/TIME TAKEN: 01/07/05 11:08 8 COLLINWOOD DR DATE/TIME REC'D: 01/07/05 1040 BREWSTER, NY �1O509 REPORT DATE: 01/11/05 � PHONE: (914)-874-3078 SAMPLING SITE: LOT #13 SAMPLE TYPE..: POTABLE APPLE HILL ROAD PRESERVATIVES: NONE TENPERATURE..: < 4C NOTES...: .. COLIFORM METH: Ml-' DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 01/07/05 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 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. IJN i �j �j SUBMITTED BY: Albert H. tadovani, M.T.(ASCP) Director / ELAP# 10123 January 26, 2005 Robert Morris, P.E. Putnam County Health Department One Geneva Road Brewster, New York 10509 Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 40509 Tel: (845) 279 -4003 Fax: (845) 2794567 Email: hnengineer @aol.com Re: Individual SSTS Compliance — Wyndham Homes, Inc. 67 Apple Hill Road - Lot # 13 Deerwood (Windsor Woods) Subdivision Town of Patterson, NY T. M. # 35.4-104 Dear Robert: Enclosed are the following: 1. Five (5) prints of Drawing S -13, "As -Built SSTS ", dated 01/14/05. 2. "Certificate of Construction Compliance for Sewage Treatment System ", _. ..... dated 01-/25/05._ _ 3. Three (3) copies of "Guarantee of Subsurface Sewage Treatment System ", dated 02/23/04. 4. Laboratory Reports, dated 01/11/05 and 01/21/05. 5. "Well Completion Report", dated 01/24/05. 6. Application Fee in the amount of $300.00 payable to Putnam County Health Dept. 7. "E -911 Address Verification Form ", dated 02/24/04. If there are any questions concerning the enclosed, please call. Very truly yours, Harry W. Nichol r., P.E. HWN:gav 03- 056.13 AJTNAM COUNTY DEPARTMENT OF HEAL ISION OF ENVIRONMENTAL HEALTH SER r I CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYS] # - �)--)aot) Located at ( '7 ,� /P / 4,11 �Q � Subdivision name /. e— 'r- WO o J Subd. Lot # Date Subdivision Approved S�Z C) -3 Owner/Applicant Name — 1 Mailing Address ac Amount of Fee Enclosed Town or Ve so Li Tax Map 3 5, Block _- Lot 16 Renewal Revision / Date of Previous Approval % — ) �-- 04 Zip 1,21M3 Building Type /?Cs I d,, Lot Area '36 No. of Bedrooms 4— Design Flow GPD god- Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of / Zoo gallon septic tank and Other Requirements: To be constructed by Water Supply: I - a Public Supply From Address Address or:_ Private Supply Drilled by !,7 - . 4 Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatments stem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. „ Signed: Address F-? - Date i - 3 °-f7 d1 License # 5'4 121 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 Nye considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires anew pe pp ove dischar of domestic sanitary sew a o ly. By; Title: ir Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ....... -::. APPLICA'I'I ®N T.® CONSTRUCT A WATER WELL please print or type PCHD Permit # — Well Location: Street Address: Town/VJ e Tax Grid # / 6,% /40W/e, � ,111?r i�� ���, Map -3 �— Block -t Lot(s) l0 Well Owner: Name:. j�]] ltl Ad ressl1s* nn n44� /�111% 0 . ltt J C�l�ihtveisd Uttvei � a�Nft+� Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served :1 --4 Est. of Daily Usage de al. Reason for Replace Existing Supply Test/Observation Additional Supply DriWmg 4,1' New Supply (new dwelling) Deepen Existing Well Detailed Reason ;! for Drilling Well Type _Ioo" Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes r/ No Name of subdivision I��,cr -w�L� Lot No. l Water Well Contractor: T-6 D Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: /t(/+ Town/Village Distance to property from nearest water main: A11A Proposed well location & sources of contamination be provided on separates eetlp an. Date: ° _ �L3 —0_f -- Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED) FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. y revision or alteration of the approved plan requires a new permit. Well to be constructed by a water ell driller. rtified by Putnam County. Date of Issue Permit Iscial: Date of Expiration 06 Title: Permit is Non - Transfers •a f e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, 14Y 10509 _::.(845)-2794003,--FajK--279-4%7 CONSULTING SITE ENGINEERS JOB No. SHEET No. l OF .....COMP-UTEDBY—J--J4--- -.-,PATE–, CHECKED BY DATE i DIST-RIguTIPrte B6X---]-g v "-T—.--b..- 7/3,6 PUMP (-,W-AAlL3ER BOTTOM 7701L 40 cl 1.0 IRL `-642111VA4� 1pj L- F- r 6�ATE VAL-)Zr-- 2, s" 62-) 6� ------- - d-rA4-' Rou i jeAL - jj . P PC LP-N 4 _& 2--3c)L.F, X_1.47 F-r Z1.06L,F, ............... - - 31- -TAT-A-4---0-Y M- MKI i -c- 1+-Fl- AD. ... ...... - 7,lb 14 ::--STATLCL-A-6AD--t FRIGTIOAt 1+8-A)) AF N�6 . .............. 9.0 . ............ .... . .... ....... — --------- . ......... ............. FESSIO A Harry W. Nichols Jr., P.E. JOB No. 63 —eSCe , ► 3. Patterson :Park, Suitg 106 2050 Route 2.2. SHEET No. 2-' OF 2 Brewster, NY 109 COMPUTEDBY_ . M. _ _DATE _ .(81Q,�79-4.003; Fax 279-4567..... _. ,... �_z._.., - CONSULTING SITE ENGINEERS CHECKED BY DATE '723 -0' VaI -QIAB ' C7s" /o dr sYs-r8ti� 'vt�.bmi1 —; 7 LE A35oRETIo THE Hgs _ R 7,�9 �D85E. ti Gl1-A-MR�IZIIU6 -L � d bSt. �. ��•.�. memp-w W-40 n�� _ - �IfYiKiWk • , 6 4 3885 rs .•r§ t "' r : .3.^'.Y:f�s3i1.•.6t PE =RATIGS n�ttbtie du�rn}r Pill _ 4 ..�e a��x��� �WE�12t!1W�9Tal�x�I��t012V„, eWE3 5� �Hi�W�Q51�H�1�. Performance Submersible E Curves Pumps 25f 0 X 20 a 0 I- im 10E 5F OL ,��� ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■■ ■■a ■ ■ ■ ■� ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ GPM 120 .0 10 20 30 40 50 60 70 80 90 100 110 120 GPM L L i 0 10 20 30 m'/h CAPACITY 01985 Goulds Pumps, Inc. Effective July, 1985 35 110 100 30 90 25 80 Q 70 w 2 20 J H 60 0 15 40 10 30 20 5 10 0 0 .0 10 20 30 40 50 60 70 80 90 100 110 120 GPM L L i 0 10 20 30 m'/h CAPACITY 01985 Goulds Pumps, Inc. Effective July, 1985 CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEA S PERMIT # - (-) Located at _g�zzpple All n,,,j Subdivision name a, t , r) Subd. Lot # Date Subdivision Approved 5 -12,101 Owner /Applicant Name 4)!, k Mailing Address Town or yi-f ge Tax Map 1 S' Block -1 Lot /G G% Renewal Revision_ Date of Previous Approval 1 , Zip % 0 312--, Amount of Fee Enclosed rZ0 0 Building Type r Lot Area 6,3 41 No. of Bedrooms Design Flow GPD OC Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and C 47 1; r � Other Requirements: e} To be constructed by � � , �,�„ a . ��, r_ Address r Q f ki Ur t r Water Sup Iv: Public Supply From __ Address ._._._ ...or:. .. >._. ...-Private Supply Drilled .by..... '�','�,./� . _ _.... ..._. .. ,._ •-•Address.. I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the sgparate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. A Signed: Address R.A. Date :7-2-0 License # 2¢ APPROVED, FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revs ion or alter;tio o the appro yd pin requires a new permit. Approve r dischar of domestic sanitary sewage only. ��./421T "l`✓ /W .3 4 By: Title: L Date: f s �� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ?� -�� -APPLICATION TO CONSTRUCT A WATER WELL - •- . please print or type PCHD Permit # Well Location: Street Address -- j' Town/V' Tax Grid # yagge (.� A ; le, X��� "1I1_r oh (, Map -3S-- Block Lot(s) lC3 Well Owner: jName: Address: t Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served 6 Est. of Daily Usage W gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling /New Supply (new dwelling) Deepen Existing Well Detailed Reason f 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. 1 Water Well Contractor: T19 0 Address: Is Public Water Supply available to site? ................................. ............................... Yes No el Name of Public Water Supply: /U + Town/Village — Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separa sheet/plan. Date: - - t` �G Applicant Signature: - - -d - - PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue 1 `` Permit Issuin icial: / Date of Expiration Title: Permit is Non- Transferr ble White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 July 9, 2004 Putnam County Health Department I Geneva Road Brewster, New York 10509 ATT: Robert Morris, P.E. Re: Individual SSTS - Revisions Lot # 13 - Deerwood Subdivision 67 Apple Hill Road Patterson, NY T.M. # 35.4-104 P 25-02 Dear Mr. Morris: Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster; NY 10509_-__: Tel: (845) 279-4003 Fax: (845) 279-4567 Email: hnengineer@aol.com The tentative purchaser of Lot # 13 has requested a shift in the residence which impacts the ...... Accordingly, we are enclosing the following: 1. Five (5) prints of SS -13 "Proposed SSTS" rev. 07/08/04. 2. "Construction Permit Application", dated 07/09/04. 3. "Well Permit Application", dated 07/09/04. 4. Revision fee, $200.00 money order. Kindly review and approve at your earliest convenience. Very truly yours, Harry W. Nichols Jr., P.E. HV,7N:gav 03-056.13 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # )0-',3,Y-01\3 - W Well Location: Street Address: Town/Village Tax Grid # 6-1 AQN5 Ai w PW FNVT'6 �6 00 Map Block 4 Lots) Well Owner: Name: vq'lr Dmm kecam,Ipb' Address: I t- F-4i6�j Cry , 1-4, - Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought + gpm # People Served -47(o Est. of Daily Usage '; 00 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ......................................:.......... ............................... Yes No Is well located in a realty subdivision? ............. ::.. ..................... ............................... Yes .�C No Name of subdivision- Obi) Lot No. 14_ Water Well Contractor: TK Address: Is Public Water Supply available to site? .................................. ............................... Yes Noi_ Name of Public Water Supply: d Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separa sh t/plan. Date. _ 6`)A 1, I.0� Applicant.Signature: s . V v PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director y revision or alteration of the approved plan requires a new permit. Well to be constructed by a water wel drille ertified by Putnam County. Date of Issue Permit Issuing al: Date of Expirati Title: Health l Permit is Non - Transfer able White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # —L3 S— 0� y Located at �kpFLg I41 t-4- P-0 ft)? %illage P OTTER -120N RC Subdivision name 0' W On® Subd. Lot # i� Tax Map '4 > t Block A' Lot (_ Date Subdivision Approved ZI�'� Renewal Revision Owner /Applicant Name 140M F,(T1 I- - ' Date of Previous Approval Mailing Address' ©�� IEti1 6�1— Zip Amount of Fee Enclosed�� vy Building Type fZE51 D6N'4 Lot Area6 °170 No. of Bedrooms + Design Flow GPD ?4 1—Fill Section Only Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of l - d- gallon septic tank and o � I c.. 60 1,F ,. Other Requirements: Q V N LL q" To be constructed. by W �Oi -SAM �OlnE6, 1 �1 Address 14 AF-0 "Ni i/ OVARl r-�/Ibilt Water Sunnly: Public Supply From Address or: Private Supply Drilled by i -- -_.__. ___ _._ Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the sepazate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. n Signed: Address R.A. License # Date l i11 a'� r7 bf12,q APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatm nt stem has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified whe co idered cessary by the Public Health Director. Any revision or alteration of the approved plan requires a new perm' . prove discharg f domestic sanitary sewage nly. /0 XBy: (J Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 I, P.UTMAM eOUMW'HEAL H BEPT ` 1 Geneva Road , (845) 278 -6130. 026399 Brevusber. NY 10 3y3 /i�a 93 Date Received of. .C. 3 The Sum Ofi/ _. Dollars $ a� For All I THANK YOUR Cash 0 Check VA.0. ❑ Credit Card B)/ gyp ` , 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 67 Apple Hill Road, Lot #13 Town of Patterson, TM# 35 -4 -104 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. It appears that 643 L.F. of expansion trench is provided, however 667 feet is required. Revise accordingly. Further more please note expansion trench lengths. 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 continents, this application will be considered further. Ve ly yours, yy Robert Morris, PE Senior Public Health Engineer RM: cj Harry W. Nichols Jr., P.E. _ Patterson Park, Suite 106 . - 2050 Route 22 Brewster, NY 10509 Telephone (845) 2791003 Fax (845) 719 -4567 January 12, 2004 Putnam County Health Department 1 Geneva Road Brewster, New York 10509. ATT: Mr. Robert Morris, P.E. Senior Public Health Engineer RE: Proposed SSTS: Wyndham Homes 67 Apple Hill Road — Lot # 13 Patterson, NY T.M. # 35 -4 -104 Dear Mr. Morris: In response to your memo dated January 7, 2004, we note the following: Trepch lengths now are, limited to less _than 60. feet. jrenches.. are now approximately equal in length. - Please continue with the above referenced application. . Very ly yours, ,.:� Harry W. yours' is Jr., P.E. _. HWN: gav L;703-056.13 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 January 7, 2004 Harry Nichols, P.E. Patterson Park Suite 106 2050 Route 22 Brewster, NY 10509 Re: Proposed SSTS: Wyndham Homes 67 Apple Hill Road, Lot #13 (T) Patterson, TM# 35 -4 -104 Dear Mr. Nichols: ROBERT J. BONDI County Executive Review of plans and other supporting documents submitted at this time relative to the above - _...._.:.r g ded.projeGt )gas b.eeii.eQmpleted...Comments are offered.as 1. Utilizing a gravity system the trench length cannot exceed 6 0 feet. Furthermore, the trench lengths should be as equal in length as possible. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ve t y your Robert Morris, P.E. Senior Public Health Engineer r ,10 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/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 January 7, 2004 Harry Nichols, P.E. Patterson Park Suite 106 2050 Route 22 Brewster, NY 10509 Dear Mr. Nichols: RE: Wyndham Homes, LLC 67 Apple Hill Road, Lot #13 (T) Patterson, TM# 35 -4 -104 Reservoir Basin The Putnam County Department of Health (Department) has determined that the above referenced . -- -- _ • application; including fee,.and received by this Department on December 12, 2003 is complete. - The - Department will notify you by January 28, 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 p Letter "io: Harry Nichols, P.E. Januaiy 7, 2004 ~` -m= -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. Very truly yours, Robert Morris, PE RM :tn Senior Public Health Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUC .ION.PERMM :::._. NAME OF OWNER: STREET LOCATION: REVIEWED BY: RM, OR, AS, SRDATE: TAX MAP #: (CONFIRMED) Y N DOCUMENTS PERMIT APPLICATION Ln7� )WELL PERMIT OR PWS LETTERS-^ i 7->r--N p 0- 0 17 LETTER OF AUTHORIZATION L %DESIGN DATA SHEET (DDS) (_) CORPORATE RESOLUTION SHORT EAF PLANS -THREE SETS HOUSE PLANS - TWO SETS (_)(_)VARIANCE REQUEST SUBDIVISION Lzlc' LEGAL SUBDIVISION ( ��SUBDIVISION APPROVAL CHECKED �PERC RATE FILL REQUIRED DEPTH (_)L�CURTAIN DRAIN REQUIRED GENERAL LOCATED IN NYC WATERSHED PLANS SUBMITTED TO DEP M DELEGATED TO PCHD DEP APPROVAL, IF REQ'D (�DEEP TEST HOLES OBSERVED �PERCS TO BE WITNESSED (EX- APPROVAL SSDS ADJ, LOTS WETLANDS (TOWN/DEC PERMIT REQ'D ?) DATA ON DDS PLANS & PERMIT SAME PRE 1969 NEIGHBOR NOTIFICATION (� LETTER BI/ZBA ... -... - -.. 100YR FLOOD ELB %rATION W/I200' - (_)SOIL TESTING LOTS >10 YEARS OLD (_/ / REOUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) �SSDS HYDRAULIC PROFILE yi )GRAVITY FLOW ( %) CONSTRUCTION NOTES 1 -15 )DESIGN DATA: PERC & DEEP RESULTS 2' CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT C )(-)FOOTING /GUTTER/CURTAIN DRAINS USDA SOIL TYPE BOUNDARIES _)TITLE BLOCK; OWNERS NAME ADDRESS / TM#, PE/RA; NAME, ADDRESS, PHONE# A DATE OF DRAWING/REVISION DATUM REFERENCE (_) LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. ✓ ✓ ✓ ✓ ✓ ✓(_) PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS WELLS & SSDS'S W/IN 200' OF SSTS (^) PROPERTY METES & BOUNDS (_)EROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE COMMENTS: (REVSHEET)09 /01/00 (REQUIRED DETAILS ON PLANS CONT'D) HOUSE SEWER -1 /" FT. 4 "0'; TYPE PIPE CAST IRON L _)(_,NO BENDS; MAX BENDS 45° W /CLEANOUT RENEWALS (.(SITE NOTE (NO CHANGE) FILL SYSTEMS (__)t__)10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE (FILL SPECS/ FILL NOTES 1 -5 J��FILL PROFILE & DIMENSIONS (FILL IN EXPANSION AREA FILL GREATER THA2V2 FEET YDEIPTH AY BARRIER L CERTIFICATION NOTE GAUGES L. ON PLAN FOR RO.B., UNCLASSIFIED &IMPERVIOUS ARATION DISTANCE FROM TOE OF SLOPE TRENCTRENCH PROVIDED 60FT MAX. PPPARALLEL TO CONTOURS 100% EXPANSION PROVIDED C--)DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL C,6(_)GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS �10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS 100' TO WELL, 200' IN DLOD, 150' TO PITS (_)100' TO STREAM, WATERCOURSE, LAKE (inc. ezpan) �50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATERLINE (pits - 20') 50''INTERMITTENT - DRAINAGE - COURSE 200'/500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS C_)U10' MIN TO LEDGE OUTCROP SEPTIC TANK (_)(_)10' FROM FOUNDATION; 50' TO WELL WELL A�MIN DIMENSIONS TO PROPERTY LINES LOCATION OF SERVICE CONNECTION 15' TO PROPERTY LINE SLOPE SLOPE IN SSTS AREA 520 %) (___)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.) T AND D -BOX SHOWN & DETAILED 1 DAY STORAGE ABOVE ALARM CURTAIN DRAIN STANDPIPES, 5' BOTH SIDES, DETAIL 15' MIN to CDS = >5 %, 2014%,251-3%,35'4%, 100%-<l% 20' MIN to CD DISCHARGE /100' with 182 cons day discharge 10' MIN to NON - PERFORATED PIPE /1 Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 ...2050 Route 22 _ Brewster, NY 10509 ME Telephone (845) 279 -4003 Fax (845) 2794567 February 27,2004 Putnam County Health Department 1 Geneva Road Brewster, New York 10509 ATT: Mr. Robert Morris, P.E. Senior Public Health Engineer RE: Proposed SSTS: Wyndham Homes 67 Apple Hill Road — Lot # 13 Patterson, NY T.M. # 35 -4 -104 Dear Mr. Morris: In response to your memo dated February 23, 2004, we note the following: 1. .. 667 L.F. of expansion trench is now provided and labeled on the plan. Please continue with the above referenced application. Very truly yours, Harry W. Nichols Jr f P.E. HWN:gav 03- 056.13 `:�1, �f:�` Harry W. Nichols Jr.., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Telephone (845) 279 -4008 Fax. (8.45) 2794567 _ December 11, 2003 Putnam County Health Department One Geneva Road Brewster, New York 10509 ATT: Robert Morris, P.E. Re: Individual SSTS Deerwood Subdivision - Lot # 13 67 Apple Hill Road Town of Patterson T.M. # 35.4-104 Dear Mr. Morris: Enclosed are the following: 1. Five (5) prints of SS -13, "Proposed SSTS ", dated 12/11/03. 2..° "Short EAF ", dated 12/11/03. 3. "Application for Approval of Plans for a Wastewater Disposal System ". 4. "Construction Permit for Sewage Disposal System, ", dated 12/11/03. 5. "Application to Construct a Water Well ", dated 12/11/03. e _ F 6. "Design Data Sheet". 7. "Letter of Authorization & Corporate Resolution ", dated 12/11/03. 8. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only". 9. Review Fee in the amount of $300.00. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, Harry ichols J , P.E. HWN:gav 02- 006.13 PUTNAAVl :COUNTY. DEPARTMENT OF -HE AALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES -- DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner` 1N i/ 0'1i* 4W-, Address' 9,4 AWPIEW - C 1L 0� 105-1L Located at Street %� �4' i- �,L V k'L L* Tax Map'' a S �, Block Lot (Street) '� P - (indicate nearest cross street) Municipality - {1i Watershed 06 by -� SOIL. PERCOLATION TEST DATA Date of Pre - soaking b� Date of- Percolation Test t percolation test hole. (ix; -5 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All. data to be. submitted fbix. view. 2.". Depth, measurements to be made. from -top.of hole. - Form DD -97 10.0' Indicate level at which` groundwater"is encountered - Indicate level at which.mottling is observed -� Indicate level to which water level rises after being.encountered Deep hole observations made by: M bJD7_0 Date. Design Professional Name:-- Address: f1,0 a10 PT- ` L Signature l� Design Prof'essional's Seal New V CO Cr r U3 1 rQ PA p ESSO TEST: PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED .IN TEST HOLES . HOLE NO. - :. ' HOLE NO HOLE NO: •• e: G.L. -- 0.s'��' 1.0'� 2.0` 2.5' 3.0' 3.5' f-toe a . 4.0' " 4dC s as _. 4.5' 5.51 x" 6.0' till 6.5' 7.0'. 7.5. 1 v JPIA 8.0' 8.5' 9.0' 10.0' Indicate level at which` groundwater"is encountered - Indicate level at which.mottling is observed -� Indicate level to which water level rises after being.encountered Deep hole observations made by: M bJD7_0 Date. Design Professional Name:-- Address: f1,0 a10 PT- ` L Signature l� Design Prof'essional's Seal New V CO Cr r U3 1 rQ PA p ESSO 14w%4 (9195) —Text 12 PROJECT I.D. NUMBER 617.20 Appendix C :State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (TO be completed by Applicant or Project sponsor) SEOR 1. APPLICANT /SPONSOR AtJ�DH;-AM JjOr. ; f A V T"r 2. PROJECT NAME 3. PROJECT LOCATION: (� Pry Municipality t County 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) 5. IS PROPOSED ACTION: t� New ❑ Expansion ❑ Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED:) r' 45 61 Initially acres Ultimately acres a. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR-OTHER EXISTING LAND USE RESTRICTIONS? 9 Yes ❑ No if No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? X Residential ❑ industrial ❑ Commercial ❑ Agriculture ❑ ParklForest/Open space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAU? ❑ Yes P!LNo If yes, list agency(s) and permiUapprovais 14. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ &o Yes If yes, list agency name and permitlapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑Yes 91No. I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: RAl'"I—► w ` 0 DLJ� 1 3- Qa �i Date I'lln :. 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 II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD 'IN 6 NYCRR, PART 617.47 If yes, coordinate'the review process and use the FULL EAF. ❑ Yes ❑ No 8.- WILLACTION.REC €I.VE COORDINATED - FtEVIEW AS:PROVID_ED FOR UNLISTED ACTIONS-IN 6 CR NYR,,PAPT, 617,6? If -No, a negative declaration may be superseded by another involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species; significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly. C5. Growth, subsequent development, or related activities likely to be Induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not Identified in C1 -05? Explain briefly. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA? ❑ Yes ❑ No E; IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATEb TO POTENTIAL ADVERSE ENVIRONME_ NTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For.each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability. of occurring;. (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude: If necessary, add attachments or reference supporting rri&rials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified. and adequately addressed. If question D of Part II was checked yes, the determination and significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. U 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 ��ya Print or Type Name of Responsible Officer in Lea Agency. Title of Responsible OrtfIc& Signature of Responsible Officer. in Lead Agency Signature o %Pr parer,tif drf erent from responsible officer) 2 , _.PUTNAM COUNTY DEPARTMENT OF-HEAL.TH DIVISION: -OFD ENVIRONMENTAL- HEALTH•SERVICES` -' -APPLICATION FOR APPROVAL OF PLANS FOR = A. WASTEWATER TREATMENT' SYSTEM 1 1. Name and address of applicant: - - JA A � � � � �•�-•� • "`• ` °'�-' � -_ 2. Name of project: �`� 3. Location T/VAS1QlJ•4 4. - Design Professional: RAW \1i >.. WWOV Jr (1�5.. Address: f050 :- ....6..: Drainage _Basin: 7. Type of Project: Pnvate/Residential Food Service Commercial 'Apartrrients . - Institutional Mobile Home-Park. Office Building Realty Subdivision . Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR) ?' Type (check- ....... p" YP ( :.................. .............I................. Type I � Exem t Type II : -Urilisted ` 3� 9. Is a Draft Environmental Impact Statement (DEIS) required? .........................0 . 10. Has DEIS been completed and found acceptable by Lead Agency? ..........,.:,,,- 11. ..Name of Lead Agency ._OX ...J 2... Is this. project in an area under the -control of local planning, zoning, .or other _ _.. officials, ordinances? _ . ........... .........I........................................ ` ..:: ` ..... 13. If so, have plans been submitted to such authorities? !✓u. 14. Has'preliminary.approval been - granted by such authorities? 00 Date granted: 14, 15: Type of Sewage Treatment- System Discharge.:::............. surface water -groundwater 16. If surface water discharge -, -what is the stream class designation? .....:.: ::::::..::.:: 17. Waters index number (surface) ............................ ............................... 1.8... Js project located near a public water supply system? ........................... :.. ......... ... No 19.- If yes, name of water supply Distance to WaMr: supply° NQ __. -20: Is.project site near a public sewage collection or treatment system? ;,....:.'..::..:. Nc 21 -. Name of sewage'system +�:a Distance to_sewage system 22. Date test-hol-es- observed IS,/ KJ 94 23. Name of Health Inspector h1 .4447 4. ► 24. Project'design flow (gallons per day) ................................ ............................... its 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.... _ 26. Has SPDES Application been submitted to local DEC office? .............. :............ N 4 Form PC -97 29. Js Wetlands Permit required?-...; ................... ...........................: ...... -- Has application been made to Town or Local DEC office? ................................ . �- 30. Does project require a DEC Stream Disturbance:_Permit? .. ............................... �►� 31. Is or was project site used for agricultural activity 'involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............. D 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous.ivaste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No DESCRIBE: 33. YO 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* ithin 15 years in or adjacent to project site? ........ .................. :.................................... 35. Are any sewage treatment areas in excess of 15% slope? ..........................:.... No 36: Tax Map Ilj Number ....: ...:............... .......................... :.... Map y. Block e4- Lot 104 37. Approved .plans are to be returned to ..... Applicant X Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall he.sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the- SSTS prior to final: approval by the Department. Projects within..the. watershed may also require DEP review and approval of other aspects of a project, such as stormwater. pl=s.-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 Ite -m 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, underpenally of perjury, that information provided on this form is true to the best of my knowledge and belief. False statemetyEteq her ig re unishable as -- a Class A misdemeanor pursuant to Section 210.45 of I/re Penal" W. SIC:NATURES-& OFFICIAL TITLES: r Mailing Address: ..... .................. /wry ?i� �l� -E�✓ �`� �'j`'._.J ����`� PUTNAM COUNTY DEPARTMENT OF' HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIDAVIT - CORPORATE OWNER APPLICATION__-- FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for:����'°-QOQ� represent that I am an officer or employee of the corporation anal am authorized to act -for: -- Name of Corporation: w IQ }l'� �-ifli > I �V• Having offices at: ��'� N`Y Whose Officers Are: President - Name: Address:- - Vice President - Name: Secretary -Name: _ ---- ---- . : -- Address:- 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 the - i" a Signed: Title: . C'0 5�,� l7 J S«vorn to before me this / day of (month) ?3 (year)" i' Public Corporate Seal Form CA -97 WI; { }. PIUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH -SERV- I ES.; Located at Al 416 W UL kkp T/V Pc, Tax Map Subdivision of Subdivision Lot # Gentlemen: ... I1� Block _Lot 1 Filed Map # '�-��I Date Filed','.-. This letter is to authorizeP4 a duly licensed Professional Engineer. _ or Registered Architect to apply for the, required .ti. • k•• y .4..;:..:... . wastewater treatment and/or water supply permit(s) to serve the above - noted - property in aceord c` e with the standards, rules or regulations. as promulgated by the Public Health Director oftle�Putiiairi . County Health Department, and to sign all necessary papers on my behalf in connection - :with- -this . matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the_provisions.,pf A. ticle 145 and/or-147 of the _Education:Lawythe- Public Health", - Law, and the Putnam County Sanitary Code. - - Countersigned: P.E., R.A., # Mailing Address �i State . Zip C)"� Telephone�� Very truly .Signed: (0 cr of roperty) Mailing Address: x.11 -_ . �' ��`r� ( State Telephone: S45�`�i" Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH ' DIVISION OF ENVIRONMENTAL HEALTH SERVICES A FINAL SITE INSPECTION Date: o Inspected by: Street Location .. -1111-4- /-i/14- ze4p Owner 6(/Y,,yVFl/1M 1&045 Town Permit # p •- 3 f - e?3 TM # 35, -- - 104, Subdivision Lot # 13 1. Sewage System Area YES `NO COMMENTS a. STS area located as per approved plans .......... .. ................ b.. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth > g y c. Natural soil not stripped. d. Stone, brush, etc., greater than 15 from STS area.......... e. 100' from water course / wetlands ..... ............................... ; II. Sewage System r /._tae ►troy` a. Septic tank size - 1,000 . 1 25 .........other.......... b. 'S eptic'tank installed level .......... ..............................� _ Sn 5teeue C. 10' minimum from foundation. ''.r ► <ve d ,°Distribution BozY y .- AU,- outlets -at same elevation -water tested......... . .... 2. Protected below frost .................. ............................... 3. Minimum 2 ft. Original soil between box & trenches e. Junction Box properly set ......................................... 6. Z enc es 1. Length required_ Length installed 641, ` 2. Distance to watercourse measured 4- / a67 Ft.......... 3 Installed. - according to-plan y =- —71T - e s zp s ads -F 4 Slo ccept pe of= trench.aable-�1 /16 1/32" /foot 6 Depth of trench <30 inches from surface. 7 Room allowed for�expansion, 100 %a��.` e,/ _ S - _ 8. Size of gravel 3/4 - 1V2" diameter clean .................... 9. Depth of gravel in trench 12" minimum .......:........... ; 10 �pE�pe dptsRtcca ed .... _ -�� ulLL ; or �V.7G��`.�lGlllJ � '1L11 PL pumpt amber..... 1.0..x.. r .' `� _ ^ 4 A^ 2. Overflow tank ........................... ............................... o 3. Alarm, visual/audio........ :.......... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... I II House /uilding a. house located per approved. plans:,..:.,, �r b - Number ofbedrooms - - - t �;H Well located as per approved plans . ......:........................ b. Distance from STS area measured - - to o ft........... C. Casing. 18" above grade ................ .............:................. d. Surface drainage around well . acceptable ....................... V. Overall Workmanship . a.. Boxes properly grouted ................... ............................... b. All pipes partially back filled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ........ :........................... i. Erosion control provided ................. ............................... Rev. 12/02 Form -3 JAN - 12-2005 11:26 AM' HARRY W NICHOL'S 914 279 4567 P.01 v pUTNAM COUNTY DEPARTMENT OF HEALTH DM, SION.OF ENVIRONMENTAL HEALTH SERVICES Rfi..�IMI PbR_FWAL 1USPEMON For:, Fill Date: ;A-1. t2 6 s .,,,... Trenches ,% _.... PCHD Construction Permit # P 5- Located: 67 AC EL (T) CV) �a I Owner /Applicant Name: Wj0%'A614 No"&2. L, c..:_.— 'I'M 3Block . Lot Formerly Subdivision''>'Name: Subdivision Lot # 1 � Is'systeui fi11 completcd7" Date: Is -system complete? vas Date :. Z %•x lms Is system constructed as per plans? ors Is well drilled? ; Y" Date: U% 12. 10,5 Is Well,located-as perplans7 vas Are erosion control . measures in place? I certify that th system(s), as listed, at the above premises has been constructed and I have inspected and .verifie(,:* it cdmpittiob in 'accordance" with trio wvv d PMdD Construction Permit and approved plans :aad• the Standards, Rules and' l+;eguia 'rol.1:. nf the Putnam County Dppartmedt of Healthy ,. �.. .. �...�. air a ..� —. .- i �_ _ ... . ..- - •.p .r airyp r ...�. �. ' - -- -.._ -. .. a. .. w.. .._ .. Date: �2 66 Cet�ified. by: t,:,,`: E Desig rotessional Address: 2690 •RDJ-VA 13 AQs ggz 13 Y —t�Q-!5 .� .� LiC. # 124 Comments:. FOR: .ADAM WGENE Form FIR-99. • •mow+. ...• r , , .., ;�,�� • „�� . a . ,,4- . . TC71 . 04rZ._0-70 _. ,�.- t ! ,' ^''•1' . •! ITNAM rnuNTY DEPARTMENT OF P. 1 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health - .GDW:cw - _ -. LORETTA MOLINARI, RN, MSN Associate Commissioner of Health January 14, 2005 Harry Nichols P.E. Patterson Park, Ste 106 3050 Route 22 Brewster, NY 10509 Dear Mr. Nichols: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive Re: Field Inspection — Wyndham Homes Apple Hill Road, (T) Patterson Lot #13, T.M. #35. -4 -104 The above referenced separate sewage treatment system can be backfilled. The following comments must be addressed. 1. Replace fernco on pipe from house to septic tank with plastic connection. - - - - �2 -- t- pump -test must be witnessed by -this Department once the electrical inspection has been completed and verification has been submitted to this Department. 3. A bedroom count must be performed by this Department. 4. Expansion trenches below the existing system need to be staked out in the field in order to prove out proper placement. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. GDW:cw Sincerely, 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 . Y SENDING CONFIRMATION DATE : JAN -14 -2005 FRI 11:39 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH . . TEL 845- 278 -7921 PHONE 92794567 ^ PAGES 1�1 START TIME : JAN -14 11:37 ELAPSED TIME : 0014211 . MODE : G3 RESULTS : OK FIRST PAGE OF RECENT 'DOCUMENT 'TRANSMITTED... 9HBRLITA AMLES. MR M9, FAAP ROBERT•1, RONDI Cnmmir/bner ofHeefa * coanty E'—. Hn GDW:cw . t.ORETPA MOLINARI, RN, MSN Aamcinte Cn,nmimenerelHeaWi '_ j DEPARTMENT CAF ; P-AL T H !I ... I Geneva Road- Drewster. N, 7•,:1: ,nsan January 14, 2005 finny Nichols P.E. Paltecso+l Park Stn 106 c 1050 Route 22 Brewster, NY 10509 hr: Field ius�_clion - Wyndham Humes apple -. Hill Road. (T) Patterson i >Inir,[3.T.M.'135. -4 -104 , Dear Mr. Nichols: ` The above referenced separate sewage treatment sytr:m r.:1n he hxcklilled. The following comments must be addrnased 1. Replace fetnco on pipe from house to septic tank �ith plastic connection. 2. A pump test must be witnessed by this Department uncc the electrical inspection has been completed and verification Itas b_rn submitted to this Department. 3. A bedroom count must be performed by dpi:: Department. II 4. Expansion trcncbes below the existing system ,:aed to be ;ia -d out ut the field in order to prove out proper pineement. if you have any further questions, please comma m:'..:: Os,. S; 278-617,0 cxL 2261. I Gene D. Rc;:,. ' Envinmm.:ul Eugmca'ingAidc 1 GDW:ew 3ovirotupenml ttman (945)27lM'�)'•'Iw (R:1 .j 7.78.7921. Nun41p 9eMas1a43)179 -65311 WICtM! ;.,'74,U.7a Vnx(MS)178.6085 ,. - EerlY lelervendae /Praohm9(R4`_);; ) ?.Fits^ ru iY.<9)77P.66tifl SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health January 27, 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: Field Inspection — Wyndham Homes Apple Hill Road, (T) Patterson Lot #13, T.M. #35.4-104 This Department has received your submission for construction compliance related to the v - -- -- above- referenced•lot: Per•mry comment- letter•dated•January 14;200-5- the- folloNving - - -- _._._._ _..,_.__..�...... comments must be addressed prior to the review of your submission. (Please see attached.) If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. GDW:cw Sincerely, 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 SY THIS CZRTiFt0ATz 0E-'c0MPL1ANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STiREEi , NEW YORK, NY 10038 CERTIFIEG THAT Upon me application of upon premises owned by DIVERSIFIED ELECTRIC WYNDHAM HOMES 9861 FRONT ST 8 COLLINWOOD RD. UNIT d BREWSTER, NY 10609 YORKTOWN HEIGHTS, NY 10596, Located at 67 APPLE HILL RD. BREWSTER, NY 10509 Application Number. 2028319 Certificate Numben 2026398 Section: ,35 Stock; 4 Lot: 104 Building Permit: 8DC: W107 Described as a Residential 3000.4000 square ft. occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located Won the premises at: Basement. First Floor, Second Floor, Aitsclted Garage, Outside, Attic, A visual inspection of the premises electrical system. limited to electrical devices and wining to the extent detailed herein, was conducted in accordance with the requirements of the applicable code and /or standard promulgated by the State of New York, Department of State Code Enforcement and Administration, or other authority having jurisdiction, and found to be In compliance therewith on the In Day of Fobtuasy, 2005. V.-Me - -... = 811E &I= QWW LIM ... .... _ __ ..... ., ..._� __.._.... . W1Nn$ and Devices ._ ._ _ .., a ..._._ ..._..._� .__ ...._.. _� --- ._.._......_. ___ Outlet 229 0 Fixture 67 0 110 Incandescent Receptacle 78 0 110 general rulpose Receptacle 10 0 110 OFCI Switch 59 0 110 General Purpose Receptacle 4 0 110 Special Dimmers 2 0 600W laceadeseent Service 1 Please 3W Service Raring 200 Amperes Service Disconnect: 1 200 ca Meters: 12 C1,; 1 2 of 2 seal This certificate mad+ not be altered in any way and is validated only by the presence of a raised seal at the location indicated, E'd SILT296t1t6 a3IAIS83Aia Wd92:E S002'20 Sad PUTNAM COUNTY DEPARTMENT OF HEALTH _,..DIVIS.ION OF ENVIRONMENTAL IIEATL1I .SERVICES_;.•__:.:: - - FIELD ACTIVITY REPORT AT)T)RFC4' 8 &4- ` Z"D P,4'1r. ,Z 50M 1V Street Town State Zip PERSON IN CHARGE C 0, PUMP TEST E] DOSE TEST REQUIRED GALLONS �• V x 7, Signature and Title BF-P()R r TZF- rFTVF —T) nor. I acknowledge receipt of this report: SIGNATURE: 02/96 Pam, I a `%, 3' �• V x 7, Signature and Title BF-P()R r TZF- rFTVF —T) nor. I acknowledge receipt of this report: SIGNATURE: 02/96 Pam, T- et MAR, n feet ---DIMENSION C - Number A 215 zo-7 200 2 94 54 3% 5 6 25 7 35 8 2-1 -7 9 32 G 39 29 10 31 45 52 34- J ��. 39 13 43 14- 49 1.5 104 107 55 93 Be 2.0 86 O 21 22 70 24 is 03 25 1 1 1 8 5 26 85 114 2-7 DISPOSAL NTED ON THIS PF.c.TF.r) BY ME PARCE L PL.Anj E),IS-rl,46 4 BEDP-0• RESIDENCE (n tb I 14 WELL cr% U) 'a ago 2.4 T, P) 00 v 10 19 19 Lo V SO I-Lso GAL. p U rlo 2"40-5cw-40 PVC roac N I F 'FAF 2. V(Al A 258.2 ❑ 7 7 7"V---fto ..,000P' A 55.-F 3 p- L - --------- Putnam County Department of Hea Servicei