Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
1776
DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -4 -115 BOX 16 VIA 17-- 01776 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVI..ION..OF ENVIRONMENTAL HEALTH - SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENTYSTEM PCHD CONSTRUCTION PERMIT # -�- �. '' '" Located at - a (e. P111 LJ Town or Village P4 J Owner /Applicant Name 1V" i_ -,, _, t'fr S GTax Map Block _ Lot I Formerl Subdivision Name t"'/00) Subd. Lot # 31 Mailing Address Zip ' 0 I Date Construction Permit Issued by PCHD -CJ `2 Separate Sewerage System built by ,�� © J � Address S�'-� �- jj Consisting of 1( Q Gallon Septic Tank and 2`°? l A . - �c �ti VL Lit Other Requirements: Water Super: Public Supply From. Address or: Private Supply Drilled by R F V J cl�ks Address 12 r e Building Tylpe /� u a �� Has erosion control been completed? Number of Bedrooms 7 Has garbage grinder been installed? A") 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 regulation4 of the Putnam County Popa�tment of Health. Date: 1 `d 9 - 01 Certified by Address P. E. 6,1R. A. License # Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are-subject to modification or change when, in the judgment of the Public Health Director, such revocation; mo 'ficatio r change is necessary. By: Title: Date: 11101v White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 �� C'OG GIRT 'r1MPT RTT(1N RRp(1RT ) >, a. -< Y W `l DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only (WELL LOCATION STREET AOURESS: WN /V1 I UY TAx GA10 NUMBER: Well #1, Old Route 22, Brewster, . NY j WELL OWNER NAME: ADDRESS: Manhattan Realty Grou 689 Mamaroneck Ave. ,Mam.NY10549 ❑ P81VATE O PUBLIC USE OF WELL 1 - primary 2 - secondary ❑ RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED O BUSINESS O FARM ❑ TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL 0 STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING ® NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION O REPLACE EXISTING SUPPLY :,0 DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 405 ft. STATIC WATER LEVEL 5 it. GATE MEASURED 5/9/89 DRILLING EQUIPMENT ® ROTARY : f9 COMPRESSED AIR PERCUSSION ❑ DUG 0 WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED ❑ OPEN END CASING. ❑. OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH 41 ft MATERIALS: IR STEEL O PLASTIC 0 OTHER LENGTH.BELOW GRADE 4o ft JOINTS: ❑ WELDED ® THREADED ❑ OTHER DIAMETER 6 in. SEAL: El CEMENT GROUT ❑ SENTONITE ❑OTHER WEIGHT PER FOOT 19 Ib. /ft. I DRIVE SHOE DYES ❑ NO I LINER:OYES 13NO SCREEN DIAMETER (in) SLOT SIZE LENGTH (It) DEPTH To SCREEN (It) DEVELOPEO? DETAILS FIRST ❑ YES 0 14 HOURS SECOND GRAVEL PACK O YES O NO GRAVEL + - - _ J SIZE: DIAMETER OF PACK in. TOP OEM tL BOTTOM DEPTH it. WELL YIELD TEST It detailed pumping METHOD: O PUMPED 1 tests were done is in- , IT COMPRESSED AJR , formation attached? ❑ BAILED ❑ OTHER O YES O NO WELL LOG It more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FaOtil SURFACE water gear. ing W =11 Oia- In FORMATION DESCRIPTION C30E It. ft. WELL DEPTH It. DURATION hr. min. ORAWOOWN It, YIELD gpm. Surt,ce 25 Drill in in overburden clay & bldr �' H t r ock at 25' 405 6 385 50+ 25 41 D it ing.in rock,set casing,groute . 405 ILLUling- in rock granite, WATEr O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? ❑ YES O NO STORAGE TANK: TYPE CAPACITY GAL. WELL DRILLER NAME _T7777 Beal & Sons, ric . DATE /21/89 ADDRESS P 0. BOX B t . RE Brews ter, NY 10561r PUMP INFORMATION TYPE CAPACITY MAKER DEPTH MODEL VOLTAGE HP PUTNAM COUNTY HEALTH DEPT. a. . O 2 6 4 31 1 Geneva Road (845) 278-6130 Brewster, nnr 10509 at Received Received of 'L The -'Sum Of a el /� Dollars $ 3D Fore 1 s! ! 3,4 THANK YOU! ❑ Cash ❑ Check Credit Card By i „ , i a i i i , . . , , . , . . , J DEER WOOD SUBDIVISION PATTERSON, NEW YORK. Water -Level Data Well 1 24 -Hour Pumping Test November 30 to December 1, 1989 Date Hour 11- 29 -89 1607 11 -30 -89 1135 10.05 1152 1214 0 1219 10.06 1220 1221 0 1222 -- 1223 Start up 1224 1 1225 21.60 1226 34.5 gpm 1227 3 1228 28.72 1229 123.0 5 1231 31.38 1234 -. .. -... �. 1237 7 1240 33.63 1245 1250 9 1255 35:15 1301 1305 11 1310 1315 1320. 17 1330 39.15 1340 1355 25 1400 40.94 1410 1420 35 1430 11 -30 -89 1440 Depth to Water (feet) Time (minutes) Remarks 9.69 0 10.05 0 10.07 0 10.06 0 10.00 0 -- 0 Start up 20.00 1 21.60 2 34.5 gpm 27.00 3 35.0 gpm 28.72 4 30.12 5 31.38 6 32.26 7 33.63 8 34.38 9 35:15 10 35.38 11 14.. 38.16 17 39.15 20 40.03 25 40.94 30 41.66 35 42.40 41 42.70 45 43.32 50 43.90 55 44.05 60 34.5 gpm 44.76 70 45.21 80 45.89 95 46.19 100 46.68. 110 47.02 120 47.32 130 47.67 140 34.0 gpm A156 LFGGETTE, BRASHF.ARS & GRAHAM, INC. DEER HOOD SUBDIVISION PATTERSON, NEW YORK Water -Level Data Well 1 24 -Hour Pumping Test November 30 to December 1, 1989 Date Hour Depth to Water Time Remarks (feet) (minutes) 11 -30 -89 1450 47.91 150 34.0 gpm 1500 48.01 160 1515 48.32 175 1530 48.72 190 34.5 gpm ' 1545 _48.81 205 1600 49.16 220 1615 49.39 235 1630 49.59 250 1648 49.74 268 1700 49.86 280 1715 49.98 295 1745 50.24 325 1815. 50.46 355 1845 50.63 385 . 1915 50.70 415 35.0 gpm 1945 50.88 445 2010 51.00 470 2045 51.15 505 = - - - -- _ 2115 _ _...._ 51.28... _ _ 535 2145 51.32 565 2215 51.48 595 2242 51.55 622 2312 51.60 652 2345 51.64 685 12- .01 -89 0018 51.72 717 0100 51.76 760 0145 51.82 805 0235 51.84 855 0300 51.95 880 0345 52.02 925 0415 52.02 955 0445 52.06 985 0515 52.10 1015 0545 52.12 1045 12 -01 -89 0615 52.15 1075 35.0 gpm A157 L.F.GGF.TTE, BRASHEARS c& GRAHAM, INC. r DEER WOOD SUBDIVISION PATTERSON, NEW YORK Water -Level Data Well 1 24 -Hour Pumping Test November 30 to December 1, 1989 Date Hour Depth to Water Time Remarks (feet) (minutes) 12 -01 -89 0645 52.17 0715 52.23 0745 52.20 0815 52.26 0845 52.25 0915 52.33 0945 52.34 1015 52.32 1045 52.36 1115 52.38 1145 52.40 1215 52.44 1245 52.45 1308 52.45 1312 -- 1313 39.05 1314 37.45 - 1315 35.28 1316 32.87 1317 31.16 1318 30.00 1319 28.93 1320 28.10 1321 27.20 1322 26.25 1323 25.98 1325 25.00 1327 24.31 1329 23.77 1331 23.24 1333 22.75 1335 22.21 1338 21.72 1342 21.15 1345 20.77 12 -01 -89 1350 20.21 A158 1105 35.0 gpm 1135 1165 34.5 gpm 1195 1225 1255 1285 1315 1345 1375 1405 1435 1465 1488 34.5 gpm 1492 Shut down 1493 Recovery 1494 1495 1496 1497 1498 1499 1500 1501 1502 1503 1505 1507 1509 1511 1513 1515 1518 1522 1525 1530 LF.GCETTE. BRASHFARS &c GRAHAM, INC. f • .. DEER STOOD SUBDIVISION PATTERSON, NEW YORK Water -Level Data Well 1 24 -Hour Pumping Test November 30 to December 1, 1989 Date Hour Depth to Water Time Remarks (feet) (minutes) 12 -01 -89 1352 20.00 1532 1357 19.54 1537 1403 19.06 1543 1413 18.41 1553 1418 18.06 1558 1428 17.76 1568 1438 17.01 1578 1448 16.68 1588 1456 16.35 1596 1509 15.94 1609 1624 14.38 1684 A159 LFGGET -rE, BRASHFARS & GRAHAM, INC. Inorganics Analysis Data Sheet Client Name;. Manhattan Realty Group Sample Number: 82350 -001 Project Name: STANDARD Date Collected: 01- DEC -89 Matrix: 1 DrinkH2O Date Received: 01- DEC -89 Sample Location: WELL A Comments: I MANTIA /MANHAT.. Analysis Result Units Method Analyzed AG <0.01 MG /L EPA 200.7 05- DEC -89 ALK 43 MG /L EPA 310.1 06- DEC -89 AS <5.0 UG /L EPA 206.2 05- DEC -89 BA <0.05 MG /L EPA 200.7 05- DEC -89 CAHARD 49 MG /L EPA 215.2 05- DEC -89 CD <2.0 UG /L EPA 213.2 04- DEC -89 CL 2.9 MG /L EPA 300 07- DEC -89 CO-WR 10 PT -CO EPA 110.2 04- DEC -89 CR <0.01 MG /L EPA 200.7 05- DEC -89 CU <0.01 MG /L EPA 200.7 05- DEC -89 F <0.2 MG /L EPA 340.2 07- DEC -89 FCOLI <10 /100 ML SM 909C 01- DEC -89 FE <0.03 MG /L EPA 200.7 05- DEC -89 HG <0.4 UG /L EPA 24.5.1 06- DEC -89 LI -1.67 SM15 -203 11- DEC -89 MN <0.01 MG /L EPA 200.7 05- DEC -89 NA 3.1 MG /L EPA 200.7 05- DEC -89 NO3 0.34 MG /L EPA 300 07- DEC -89 315 Fullerton Avenue rr-t. Newburgn. NY 12550 Envi oTest 1: A191 (9141562-0890 Laboratories Inc. FAX (91415432.0841 NYSD6N )C42 NiCEF 735:.: C1CCn5 P-005: Sample Number: 82350 -001 continued Analysis Result Units Method Analyzed ODOR 1 EPA 140.1 04- DEC -89 PB. <5 . UG /L EPA 239.2 04- DEC -89 PH 7.1 EPA 150.1 04- DEC -89 SE <5.0 UG /L EPA 270.2 05- DEC -89 SO4 14 MG /L EPA 300 07- DEC -89 TCOLI <1 /100 ML SM 909A 01— DEC -89 TDS 72- MG /L EPA 160.1 04— DEC -89 TURB 0.20 TU EPA 180.1 04— DEC -89 ZN <0.01 MG /L EPA 200.7 05— DEC -89 Remarks: EnviroTest Laboratories Inca A192 NYSOOH 10142 73537 CT00-1s ?n x''04+ 315 Fuuenon Avenue Newourgn,'NY 12550 (914( 562.0890 FAX (9141562 -0841 Y'. Ln; LL' Ui:.i i:i/ir� i:.l (1JLJ Jl1, is �iiC'Li V1:G • k:--G L17U prcje,. ,a-p: ; ,13-n;a /:V . anhd t Sanpie Location: Well A Matrix: n20 Method: EPA 502.1 E 503.1 Lai 1;�a 82.�CI -00 Date : ;lected: !2/1/89 Date Received: 12/1/89 Data Anal %:lzd: 12/6/69 Date. Rerurted: 12/11/89 NYSOOM 101 a2 K10EP 73wT A193 CTDOMS PnyOW - EnviroTest 0 Laboratories Inc. Detection Detection Limit Corn Cori Data Li:lait Cc ^c. Cava CAS NO. Cull vv`D ug /1 ug /1 Gualifier CAS fiC. COMPOUND ,n �.1J11 f. u�j, 1 ,' - y11 --------------------------------------------------------------------------------------------------------------------------------------- 11:: G 11 1 71-43-2 BenZcna D.5 u ,2 -1in I: : _ .r v y e j 108 -86-I SiJ ;Libenterle 0.5 u 142-28 -9 l,3-Dichlcropropaoe 0.5 u /14-97-S er�aocaicr met .,an e 0.5 u 590 -20 -1 2,2-D-1ch rcrr0Pai -,8 v i -L v.5 ', - •• 15-25 -2 ni UlltNl or 1-0 D.J' 0 aV� -al -i 1VI.�I I.G :t Vill- �nl �� 0.5 (� % 4 -83 -? �1 � U:I:L:: �. C��: 0 � � tl V b7 -6o -L {� I _ � _ .v I:E AO VItIt;i Vr�I iJ.J: ��.0 i/s+- .J 1JJ -9V -C JGV - lyU:,y r:1,C vl.e D.J U /'I C/ .. 11 1v Vl+l l'p r�rl .o u!,j 1.1 ii.: ch Jl .da �.� V 0._ = r J lvv-i �-7 �iGruu "�iI a:11G �.,, v 1vJ-65-1 n-rrir %:vii ;:cii °_ �. i /5-JU3 oroetla.ne i00-42- Siyia^ 74 -51 -34 ,. t -i6 ric - _ .. .. .,._.,... .: �.. iu 0.5 J4 J 111,..,{:. 17'rll t::i V. r 106 -4a -1 "t-Ch l ;oi�e ;:a Oro 0., ff U /9-D1 -17 el r achllor l/C�IG ne /J�._ C.5 J i06-93 -; .,2 -C`. �- i1:Uri.:e, ale. 0.J J 12C -92 -! ? s- C._ L 1i -35 -6 .. I ! -iI ;_h . r C. J,1 -IJ -1 ',J- .rail 07....G.iI: .,.. 'J._ u 7? -vv ,. •131'2 II._:,1 C I_ G.II Gi I a V.1 i06 -46 -1 "14-0"2 ^lor•o,er. e 0.5 v 79 -C1-6 Iricfi croa a„Q 75 -71 -8 Dich1orodif1uoromet;,are 0.5 `; 75 -69 -4 T r i c 1orcfiuorca�t iaiie J C i v v 75 -34 -3 l,i - Cici,tvruet aiic 0.5 LI 95 -i6 -4 ^ ^ -- 'n`' -~ - 11'21." Ir l+I11_-r 0: �•+�': 0 S .J , a .. v ; ! , 1, -i l a:-:I;:r i: v v 2/ - Lvl.:i, Jr D. J G -1 /�17: 2Cl..iC 31_ �nC5YU , a,r 71�.r V.J 75-325 -4 •,1 J:vl.:l lilll .l V, V 1 -� II / � .J V lJG -v9 -C� V._ N 9: -4/ -.: Ct- ,�•%1��1': �I 540 -J7 -d �r 1., 1,2-3 ;1 1'or Ce ,,:;ier V.J U lV(i JJ -v YI -A�I a11G ({In O.0 V 10061 -01 -5 cis- 1,3- Dich!cropropene 0.5 u 106 -42 -3 p- Xylene 0.5 u 10061 -02 -6 trans-1,3- Dichloropropene 0.5 u NYSOOM 101 a2 K10EP 73wT A193 CTDOMS PnyOW - EnviroTest 0 Laboratories Inc. VOLATILE ORGANICS ANALYSIS DATA SHEET Client Name: LBG Project Name: Manha /Manhat . Sample Location: Well.A Matrix: Water Method! EPA 504 Lab Number: 823 Date Collected: Date Received: Date Extracted: Date Analyzed: Report Date: 50 -001 12/1/89 12/1/89 12/.8/89 12/22/89 1/5/90 Detection Limit Conc. Data CAS NO. COMPOUND ug /l ug /1 Qualifier -------------------------------------------------------------------------- 106-93-4 1,2- Dibromomethane 0.02 U 96 -12 -8 1,2- Dibromo -3- chloropropane 0.02 U EnviroTest '- A194 Laboratories Inc. NYSOOti 1014,^ NJOEP 73507 C'.',;DHS P.1.0054 315 Fuuenon Avenue Newouegn. NY 12550 (914) 582.0890 FAX (91A1562 -084` PESTICIDE /HERBICIDE ORGANICS ANALYSIS DATA SHEET Client Name: LBG Project Name: 1 MANNA /MANHAT Sample Location: Well A Matrix: Water Method: Std Methods 509 A &B Report Date: 12 /21/89. Lab Number: 82350 -00.1 Date Collected: 12/1/89 Date Received: 12/1/89 Date Extracted: 12/8/89 (Pesticide) Date Analyzed: 12/13/89. (Pesticide) Date Extracted: 12/8/89 (Herbicide) Date Analyzed: 12/20/89 (Herbicide) A195 NYSOOM 1o,. EnviroTest . Laboratories Inc. '' `��' '� Avenue NewO� k�' �'1i �o2;d C7DO -s P- Detection Limit Conc. Data CAS NO. ------------------------------------------------------------------------ COMPOUND ug /1 ug /l Qualifier 58-89-9 gamma -BHC (Lindane) 0.05 U "2 -20 -8 Endrin 0.05 U 2 -43 -5 Methoxychlor 0.50 U 8001 -35 -2 Toxaphene 1.0 U 94 -75 -7 2,4 -D 0.05 U 93 -72 -1 2,4,5 -TP (Silvex) 0._05.. U A195 NYSOOM 1o,. EnviroTest . Laboratories Inc. '' `��' '� Avenue NewO� k�' �'1i �o2;d C7DO -s P- Jan 09 04 10:39a TOWN OF PRTTERSO 845 - 878 -2019 P.1 JAN- 09 -2e94 10 :02 AM HARRY W NICHOLS 914 275 4567 P,y2 BRUCE I POLRY LOFE'iTA MOLRIM- R.N., MAN, " tn6fle Xealldi O&�Wa• �• � .. .••• did10C%i0 ldlllQ 4elw .nVK1or...... ... ,.__.. .. "" DfI4Qter •Qf P N S4rYkOt . • - ._.. _ _ , DB'ARTMENT OF HBALT i . _.. .... _ .. .... a armor, New Yoke ' 10$09 _.,...._ .., . .. .. ' • "ito+ieaoowQaa uwu pt4yaae•ti>Io va(99q an.7�a! NwdAj. Gar 4x(0141214 -f H- ,wic0141111-fin .vbsp14)m -4c11 rrrly'in�aeeioHio "(tIQ!!f•d414 .9raul001 (f1�t9i6DR ?upid)4tt.4�+t OWftRS NAiY 1 - ..... ..,��'t�tm�a�;•'.. 'hy �' III ......_'.........,,,..... 126 APfL-.i5 I i1t L F oA� A 'j.U0V=jDT0WN.QirI c AL:. (signature) e�ettnaa� Cofmiy Department of Realth will not issue 1B 'Ce tiftcate of Coustmetlon Campli>1,Dee-wdesa 1114 above form is. completed; Le., a legal E911 • addm" Is LP41lZned k 44 authorized town offklalr Phis form is to _ . be subunitted:• - "•�: ��•..,, , _ `A the appUcatlon for'o �Ceirt!licate mt Coalsttrotctioa Compliance. .. J Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Routc 22 Brewster, NY 10509 Telephone (845) 2791003 Fax(845)279-4567. Date. " To: Job No.: C. Project Attention: �,V� /fi E. 12,1 A , �e- ��'G1 t Gentlemen: We enclose ( ) copies of B/W Prints Reproducibles. Reports Tracings Specifications Memorandum Copy of letter Description: Revision/Date No. rct JA Ft' -e rT) toy t -,,4f 1), 'A—&J a. C'GV �I Li ��e: C� �ot, i�rvi c�'-1 a-k'o (�i tc-c <- f Grp j '� "0 i I 1/✓1 fL pit (J (� �i oy /1 IA/ t (� Fu I 1 -_ /---�''1^ �COorl , �21_ ....'��11 �U 1 mil CU li Y .f.SayTt� 1 l Sent ia: Our Messenger Blueprinter First Class Mail Special Delivery Your Messenger Hand Delivery Copy to / T 1 / / vMW' �r, J � �4rn, :4 tv/ei c H Jr., P:E. —01 PUTNAM COUNT" Y DEPARTMENT OF HEALTIH DIVISION OF ENVIRONMENTAL HEALTH .SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 1N kA9 o I-4o rc� Owner or Purchaser.of Building v ,. Building Constructed by III OgL6 wt L, �-O erD 1�)51 4 1i5 Tax Map Block Lot TownNillage �Dtq��WD Location - Street Subdivision Name Building Type. Subdivision Lot # I represent that I am wholly" and completely responsible for the location, workmanship, material, construction and "drainage of the sewage treatment system serving the'above- described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition. any `parr --of said -system coris�iructed by me which fails -to operate fora period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system,-.except where the failure to operate properly is. caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the'failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system_ Dated: Mxth I Day I Year en ral Contr ct F ' a or (Owner) - �tgnature vy'v ail, kloxr;, lec, Corporation Name (if corporation) Address: g- 6()a14,1k1, yy pf, VE State �4PfC19L /t/_f. Zip )0..�e Signature: X Title:'. kAA1PYA ;q 1106U- INC, x Corporation Name (if corporation) Address: g COI L ZL�% Wove State L1TP pI I've - Zip 10 0 Form GS -97 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 014> 245-2800 Albert H. Padovani, Director LAB #: 93.303253 CLIENT #: 57197 NON STAT PROC PAGE 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ WYNDHAM HOMES 8 COLLINWOOD DRIVE BREWSTER, NY 10509 DATE/TIME TAKEN: 12/19/03 10:25 DATE/TIME REC'D: 12/19/03 12:45 REPORT DATE: 12/29/03 PHONE: '(845)-279-2022 SAMPLING SITE: 121 APPLE HILL RD, BREWSTER, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COL'D BY: KAREN SAMPERI ' TEMPERATURE..i: < 4C NOTES...: COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL -- RANGE mE-ri-icjr) Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium 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 BECORROSIVE TO METAL PIPES AND - `FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO'845.. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS,CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 800 MG/L MODERATELY HARD WATER: 70-140 MG/L MG/L = MILLIGRAM PER LITER HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) SUBMITTED BY: �ow Albert H. Padovani, M.T.(ASCP) Director ELAP# 10323 YML ENVIRONMENTAL SERVICES 32f Kear Street Yorktown Heights, N.Y. 10598 '. - - (914Y24SK1300`~^`` Albert H. Padovani, Director -- _ --__- C PAGE � LAB On 93.303253 CLIENT On 57197 NON STAT PRO________________~~~ WYNDHAM HOMES DATE/TIME TAKEN: lH/lV/oA zo:0-D 8 COLLINWOOD DRIVE DATE/TIME REC'D: 12/19/03 12:45 BREWSTER, NY 10509 REPORT DATQ 12/29/03 PHONE: (845)-279-2022 SAMPLING SITE: PROFILE 121 APPLE HILL RD, BREWSTBR, NY SAMPLE TYPE..; POTABLE 12/19/03 : KITCHEN TAP NITRITE NITROG PRESERVATIVES: NONE COL'D BY: KAREN SAMPERI SODIUM (Na) TEMPERATURE..: < 4C NOTES ��� : HARDNESS,TOTAL 12/19/03 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ COLlFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~,,~~~ E. COLT (CONFI PROCEDURE RESULT NORMAL - RANGE METHOD DATE FLAG PUTNAM CNTY PROFILE 12/19/03 MF T. COLIFORM 12/19/03 LEAD (IMS) 12/19/03 NITRATE NITROG 12/19/03 NITRITE NITROG 12/19/03 IRON (Fe) 12/19/03 MANGANESE (Mn) 12/19/03 SODIUM (Na) 12/19/03 pH 12/19/03 HARDNESS,TOTAL 12/19/03 ALKALINITY (AS 12/19/03 TURBIDITY (TUR 12/19/03 E. COLT (CONFI COMMENTS: FAX TO 845-279-2332 ` PRESNT /100 ML 1.7 ppb 3.52 MG A.- <0.01 MG /L <0.060 MG/L <0.010 NS AL 2.82 MG/L 6.4 UNITS 64.0 MG /L 52.0 MG /L <1 NTU ABSENT 100/ML ABSENT 1008 0-15 ppb 910� 0 - 1O 9139 N/A 9146 0-0.3 Mg/1 2037 0-0.3 Mg/1 2037 N/A 6.5-8.5 9043 N/A N/A 0-5 NTU ' ABSENT COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER (WAS F A SATISFACTORY SANITARY QUALITY ACCORDING TO THE—���-YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for public schools are set at 15 ppb. EPA Lead & Copper Rule for Public Systems requires that no more than 10% of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg/L, else water treatment must be undertaken to reduce the waters corrosive potential. � YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800~ --` Albert H. Padovani, Director LAB #: 93.303253 CLIENT #: 57197 NON STAT PROC PAGE 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ WYNDHAM HOMES 8 COLLINWOOD DRIVE BREWSTER, NY 10509 DATE/TIME TAKEN: 12/19/03 10:25 DATE/TIME REC'D: 12/19/03 12:45 REPORT DATE: 12/29/03 PHONE: (845)-279-2022 SAMPLING SITE: 121 APPLE HILL RD. BREWSTER. NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVE& NONE COL'D BY: KAREN SAMPERI TEMPERATURE..: < 4C NOTES...: COLIFORM METH: Ml:,- ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium is suggested. pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS TN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND —FIXTURES. THE-NORMAL RANGE-OF-pH !S-Z.540-8.5w - '--- -^ --~ ---- Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. 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: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) SUBMITTED BY: A, Albert H. Padovani, M.T.(ASCP) Director ELAP# 10323 01/09/2904 62:57 8452792332 WYNDHAM HOMES INC. PAGE 61 _ _, ui f amr Lt7G4 , 23;d'!54 914245317®' YORKTOWN LAB PAGE 01 YIhL I NV I RONII NTAL SERVICE'S 3el Kmar St E3 t: w. . YorPE t•O6rm Hexghtiz, N.Y. 1031;I R C °)1 yo-) 245 —e8OO Alhf-,*c,t, H. Padauank, Dirmctor _AB #. 93.44)04)53 CLIC14T #; .x'7197 � STAT F'ROC PAGE a A YIWIY ...�•Ar.v/MN1�.Vwi/VNfYN.rlr lV lV /YN•VNNNNN.Y /UNINrM 1Y w. i. Yl M M.NNwY+.•.vr/M IUNIVN.Y.JVNIVNNr..N.. 1.V IY IV M. w1 .4NNn. r.N.. WYN[+4AM I-4UlFS DATE./TIME' 'rAKJ,--Nit 01eiOFI/014 1+2100 9 CCLLINWOOL) /'RIVE XDh E /'I'll NE, REr"p., CirQR /bra eRE~WSTt R, DIY 10509 Fet✓•PORT DATE, 01/09/04 PHONE (04"1- ) —rd79" 2022 SAMPL -INO SITEg T21 AF'P'Lf- ,_HX'LL RD SAMPLE TYPE_- POTABLE )r REWSTENR , NY , PRESIERVAT 7 VE n 9 EdONE C13L.' 0 DY: KAREN ` TE*MPERATORE.. � r: 4C. NOTES.., KIT TAP I CQL.1'f:--QRM METWp MF' DATE~ FLAG PRONE 1?URE RESULT NORmAl- - RANsE. I•iF;. T Har, 01 /08.104, NF T. ECUL IFORN ABSENT /1.01) HL ABSENT 1009 .. COMMENTS BAC:T THESE' MESQLnT'S INDICATE THAT THI- WATI= SATISFACTORY SANITARY QUALI i Y ACCORD AND l=MA FEDERAL. DRINKrNS WAT5:k STAND. -TE5TE D'f* AT THE" TIME OF QUI- LECTTON. SUWIT-rFM SYn F Director or WAS)4 ( S NOT) OF A TR I' K NEW YC R),c STATE 97 r-OR THE PARAMPETERS k.LAP# 10323 - — ili n"t.1 \.+V uvi 1 2 Lr.rti.tc11v EIN 1 Utz• UEALltt DMSION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: I&IVel Inspected by: Street Location 4ple- 14:11 Teel, Owner , eclat Town Permit # p - 2- 5 r �2; T'M #' Subdivision Lot # 3. 1. Sewaee Svstem Area a. STS area located as per approved plans .......... .. ................ b.. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped ................. d. Stone, brush, etc., greater than 15' from STS area.......... e. 1 00' from water course / wetlands ...... ............................... H. Sewage System a. Septic tank size 1,000 ... ..... 1, 250 ......... other ................ b. ' Septic tank installe evel ................ ............................... c. 10' minimum from foundation . ............................... I........ 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. Trenches 1. Length required ���_ Length installed f2. 2. Distance to watercourse measured -/- / o O Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 11/2" diameter clean ............ . ....... : 9. Depth of gravel in trench 12" minimum .......:........... 10. Pipe ends capped ........................ ............................... g. Pump or Dosed Systems _. 1, - Size•of pump chamber :........:..:.. ..:.::....:.:.................. 2. Overflow tank ............................. ............................... 3. Alarm, visual/ audio ........:........... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .....:.................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... M. House/Buildhig a. house located per approved plans ..................... b. Number of bedrooms ......................... -:.. i3. ........... IV. Well Well located as per approved plans .. ............................... b. Distance from STS area measured 4- / od ' • ft........... c. Casing 18" above grade ................ ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship . a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ........ :........................... i. Erosion control provided ................. ............................... Rev. 12/02 DEC -18 -2003 11:46 AM *HARRY W NICHOLS 914 279 4567 P.01 Date: —he- t 1rin, _ Trenches ✓ PCHD Construction Permit # , P-257.2- ; Located: „ 611P E u►L &xz ,. (T) M PA=9=4 Owner /Applicant Name: G - *S• 72F Vt-Lop►, YOT- e—g9P TM 35 Block 4 Lot t l 5 Formerly: Subdivision Name: 61993k Subdivision Lot' # 31 , Is system fill completed ?" Date: is system complete? Date: lice. it -&I Is system constructed as per plans? v �s Is well drilled? Dater .1s well located as per'plans? .yes Are erosion control measures in place ? — 1 certify that the system(s), as listed, at the above premises has been constructed and I have inspected and .verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. .� -,._._ Certified by: E �_ RA Desi rofessional FOR: O ADAM .9 OEM DEC-18 -2003 THU 12:03 Q (Nka) TEL:845- 278 -7921 Form FUR-99 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 a e 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 12, 2004 Harry Nichols, PE Patterson Park Suite 106 2050 Route 22 Brewster, New York 10509 ROBERT J. BONDI County Executive Re: Field Inspection — G.J. Development Corp. Apple Hill Road (T) Patterson Lot #31, TM #35.4-115 Dear Mr. Nichols, PE: The: above referenced separate sewage treatment system _can be backfilled... There_ato rio. _.. open comments to be addressed. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. GDR: hn fieldins Sincerely, Gene D. Reed SR. Environmental Health Engineering Aide PUTNA_M COUNTY DEPARTMENT OF HEALTH.... DIVISION "OF .ENVIRONMENTAL HEALTH SERVICES. DESIGN DATA SHEET'- SUBSURFACE SEWAGE TREATMENT SYSTEM Owner & I D'�U J:_�-LO PM F_Nl Address eo v ND.... R `b G jjv. . Located at (Street) _AM �-E. 'A 1 L-L K0 P) Tax Map Block 4 Lot 11'' (indicate nearest cross street) Municipality AT7 � RZ'�'o N Watershed SOIL PERCOLATION TEST DATA Date of Pre-soaking 1/ 2 / `�(� Date of Percolation Test n Hole No, . Run No : Time Start S. op p: Ela se Time �11!Iin.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop:In h Inc. es ...Percolation Rate jVliu/Iach . -:: 1 2,o 2 12 ;10 \2,4u 1-7`lz I l 2 2 3 20 4 - 5 0 2 s'12 50 e.1- 26 23/� of 3 �,oZ L;-;z �� 2 G(�t12 2`/2 12 4 5 1 2 - -.. 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 DEPTH--- G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.51: 5 5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA 2 DESCRIPTION ®F'S®ILS ENCOUNTERED IN TEST HOLES HOLE NO. 3 HOLE N0. HOLE NO. Indicate level. at which - groundwater is encountered -- Indicate level at which mottling is observed - Indicate level to which water level rises after being encountered ... � - 5 -�1(� CACPI Deep hole observations made by: (V1,L1_O�ID (�EP�, M. 6Ub i,N SKI C RD) Date C IA16) Design Professional Name: L\C IDOLS J�, Address: 20% (LT. 22 Signature Design Professional's Seal N' r C A�b�ESS Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 - - - 2050 Route.22: ,.. _ _ ...... Brewster, NY 10509 _ Telephone (845) 2794003 Fax (845) 2794567 Date: - 2-3-0 Z To: PC /i J7 Job No.: 62: -00Ce Project / ✓� c� lt�r�d1 -cy�'3 l Attention: _ v -,,x E sccl 2- ns7 Gentlemen: We enclose (f) copies of )B/W Prints Reproducibles Reports Tracings Specifications Memorandum Copy of letter Description: Revision/Date No. tXit-'a! / 0L1 �-e-q1r,�f c' 7 Sent Via: ur Messenger - Blueprinter Your Messenger Hand Delivery Copy to First Class Mail Special Delivery Very rely yours, Harry W, ols Jr., P.E. f I t ; _ PITI'NAM COUNTY DEPARTMENT bF HEALTH, i DIVISION OY ENVIRON M.E N`i'AL MEAL TH SERV., ICES ' f CONSTRUCTION PERMIT FOR SEWAGE TREAT'ME , YSTEM PERK I y. Town or Village��'.Sn�% 4 Su division name �)�_ E��w QO ts', Siubd_ ioit # Tax Map - Blocle Lot Date Subdivision Approved , 4' - "'��2- Renewal Revision Owner /Applicant Name G . T Dt y u Lx-,MV-0 f 'NP, Date of Previous Approval M lin Address t i � ��U � Rn iii PC�I Zi g p i � Amount of Fee Enclosed 1 ' QOSO ('- : Building Type GS�h ,N C Lot Area2��12 h�RT f Bedrooms Design Flown Fill Sectio® Only IDepth • Volume ... - PCHD NOTIFICATION IS RE UIRED WHEN FILL IS'COMFLETED Se rat w to cor#sist of i C C gallon septic aiik and Other Requirements: �, C�,C .Q • 11-� To be constructed by Address W t Su D Public Supply -:From Address or: Private Supply Drilled by T' -) Address --- J, r : .. .•y .. •. rr t X14 . S 1 ' iii Ufa y >t r I•. I1 represent that I am wholly and completely responsible, for the design and location Of.., the proposed systein(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto :and m .....accordance with the standards, rules -and regulations of the Putnam County Depat-nefi of Health, and,,that o complehnn thereof a "Certificate of Construction Compliance" satisfactory';to"the Public.Health Director will be submrtted`to Department, and a-wxitten.guacantee will be furnished the owner; his successors, heirs or. assigns by the builder, that said • . "builder willplace in good o raUn condition arty, part of said-`,sewage t*atment system d the - i of two, (2) years - ...-immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of:tl�e ong�nat • system or -any repairs thereta. - _ - .. !'Signed: P.E. _ R.A. Date v 2 ; t Address. G C CJ. 2'Z .E . S' _ 05 License # APPROVED FOR CONS :. This approval expires two years from the. date issued unless constnict�on'of the sewage tr� e { and inspected by the PCHD and is revocable for cause or may be amended or .- i.* r modif ed whe i�er >i b�;tlie Public Health Director. Any revision or alteration of the approved plan requu es a new permit: Ap roved duce of domestic sanitary sewage only = ti r Title: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design. Professional :: Form CP -97 03 b� n DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # f a5- 0 0-k Located at A9 C-) LL– �A \ 1m-,1, (,OA Subdivision name UE -E'-\ QQS Q Subd. Lot # Date Subdivision Approved _ 2 ��- Owner /ApplicantName G, 'own or Village WV-VE-Q S()N Tax Map Block _A_ Lot Renewal — Revision Date of Previous Approval Mailing Address i � W MTE- CAD A% POW06 K GV--1 hj Y Zip �gS �l? Amount of Fee Enclosed lv3 oc) ,O o Building Type t-,--, Lot Are a21O \2� No of Bedrooms 9k Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1000 gallon septic tank and �2ci L,F, Other Requirements: 1' 011 (Z,Q .�. �--IyL To be constructed by I &� Address Water Su Public Supply From Address or: Private Supply Drilled by 5 � Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said bui).der 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. ii Signed: P.E. X Address R.A. Date 2. License # f; b i =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 whe sidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new perm' . Ap roved discharge of domestic sanitary sewage only. By: Title: Date: j ®Z- White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy. - Design Professional Form CP -97 .r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL - - -- - please orintor•Woe- _ ...._- . -• _ PCT -TT) Permit H- �. i- • , Well Location: Street Address: Town/Village Tax Grid # y l AePLF wLL f ATT �i�.SOt4 Map ---,�'> Block Lot(s) Well Owner: Name: Address: i i W CT E n i C <C � nAD �. �ELoPP��NA C� F (DVNV) N�q 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 5 4- gpm # People Served _� - 6 Est. of Daily Usage al. 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 No _\/ Name of subdivision 'UP- '�-f- W 0 0� Lot No. Water Well Contractor: T6V---) Address: --- Is Public Water Supply available to site ................................... ............................... Yes No Name of Public Water Supply: Town/Village ---- Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separat sheet/plan. Date: 7l L1 alt Applicant Signature: 9114 A PERMIT TO CONSTRU T 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 driller certified by Putnam County. Date of Issue D Z Permit Issuin cial: Date of Expiration o Title: Permit is Non- Transferr ble White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 BRUCE R. - FOLEY = Public Health Director r LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 July 19, 2002 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Harry Nichols, PE Patterson Park, Suite 106 _. 2050 Route 22 / Brewster, New York 10509 Re: G.J. Development Corp. Apple Hill Road, Lot 31 (T) Patterson, TM# 35 -4 -115 Dear Mr. Nichols: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on 7/08/02 is complete. The Department will notify you by 8/12/02 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 would 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 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 complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if DEP review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2166. V y yours, ATW A " V k4"'l Robert Morris, PE Public Health Engineer RM: cj - ummN- Lcod.=Ju AINI IUD WdNlnd 3WUN T26L- 8L2- Stb8:131 80:0T 3m 2oo2 -9 -9nd _ - 6,;L `Z 44 ..._- ........ _ .. May 8,. 2007 Department of Robert Morris, P.E nvironmentai PrvteottonPutuam Co. • Health Dept. 4 Geneva Road Brewster, NY 10509 Christopher b. Ward Commissioner Re: Deer Wood Subd. Lot 5 Old Road.. " eumu a VOW 9QWl ► 465 Wumbus Ave+nu6, sum 3bo East branch Reservoir 'Valhalla, New'Ywk,10M _ ._ DEP. Log # 12392 (Joint Review) 111110 rN A. Pdnaqn, Ph.D. .... Do" commlaslenw Dear Mr, Morris: F•' (M) 74343 F" (e�4) rrs -oa�e This letter is to inform you that the above referenced project is Joint Review as Y P the septic area is located within 200 feet from a waterbody. In ad(Ution, the following other lots from Deer Wood Subdivision, are considered as Joint review projects; 1, 4, 5, 6, 7, 8, 13, 17, 21, 22, 24, 26, 28, 29, 30, 33, 36. - If you have any,questions regarding this .matia,- you-may-chritact-me-ii (914) ". . • Sincbrely, • Sissy Do Le Ossa Assistant Civil Engineer .. Engineer* Design & Review Y � �TM o 'DtP - _ C►w++.c�+ nyc.w,uei ep R�eloerP_HBbP .. ZO ' d L99V 64Z V T 6 �^ n. �r SlOHO I N M AN60H wo SS : 6e Z00Z -90 -ono AUG -06 -2002 09:54 AM HARRY -W NICHOLS 914 279 4567 P.01 Meft" d Aid" *"old L7 aaeµ� ao�11 wo�� p Ica OOH) + a7 tow 7164 — 8 i• t- �l AQ7 AI 1f - A - ?AA? TI IF 1 A: SA TP : Raq- P7P -7QP1 __.... 00,61.Z (opt) slid ro0i'66a (S08) soogd 6WI AN USISALSis tt sinoV FAZ _.._ ,8'41 "if gogPIN 'M A"NR hInMC • O1 ITA1<1M ('fll IA ITV nr-MnnTrark IT nr M PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of _ GJ Development Corp. Located at 31 old Road T/V Patterson Tax Map # 35 Block 4 Lot 1 Subdivision of Deer Wood Subdivision (AKA Windsor Woods) Subdivision Lot # ` Filed Map # �--Vl @ Date Filed _ '%V 1'� 1 02, Gentlemen: This lever -is to authorize Harry Nichols a dul}' licensed Professional Engineer _ or Registered Architect to apply for the required %. Wastewater treatmerit and/or water supply permit(s) to serve the above -noted property in accordance .'Vith the standards, rules or regulations as promulgated by the Public Health Directbr of the Putnam. County Health Department, and to sign all necessary papers on my behalf in connection with this ^natter and to supervise the construction of said wastewater tretment and/or water supply systems if. .._._._..�.o:t:ormity.with the prouis.ions of Articlea145- -and/or 1.47- af•the Education-Law, the-Publ-ic -Heal`t and the Putnam County Sanitary Code. OV NEW yo C2 � NJCN0�'S'.f Very truly.yours, -- -..... �Q ��* GJ Develop ent Corp. Col:ntersigned: r� °' Signed: P.F., R.A., # wncrofProperty) Pr s dent 56124 .Mailing Address `� oc�a�' Z Mailing Address: 11 White Birch Road �" ►"`� _ Pound Ridge A f� Zip State New York Zip 10576 Telephone: I'll 4X19? Telephone: (914) 764 -4080 _. ... Four. LA -3' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERNIIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: 1) 1n1��11 U� I 'r 9 I, Gilbert. Johns.on....... represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: GJ Development Corn Having offices at: . 11 White Birch Road, Pound Ridge, New York 10576 Whose Officers-Are: _....__.. . President - Name: Gilbert Johnson Address: 11 White Birch Road, Pound Ridge, New York 10576 Vice President - Name: Address: Secretar}; -Name: Eleanor Johnson _ AddreSs;......_.._. 1 -1. -White Birch -RoadTFPouiid Ridge, New York 10576 Treasurer - Name: Gilbert Johnson Address: 11 White Birch Road, Pound Ridge, New York' 10-57,6-, 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 therety)r Sworn to before me this 7 day-of l-(i.; -_,-i ti mont d.,yo 3 (year)" Notary Public ISOBEL G. ANTONIO NOTARY PUBLIC, STATE OF NEW YORK"" NO. OIAN5012117 0Ij!!I_IRED IN_VESTMESTER C011PIIT" ... r Form CA -97 Signed: Title: Corporate Seal Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Telephone (845) 2794003 Fax (845) 2794567 July 2, 2002 Putnam County Health Department One Geneva Road Brewster, New York 10509 Att: Robert Morris, P.E. Re: Individual SSTS Lot # 31, Deerwood Subdivision Deerwood Lane Town of Patterson, T.M. # 35.4-115 Dear Mr. Morris: Enclosed are the following: 1. Five (5) prints of SS -31, "Proposed SSTS," dated 7/2/02. 2. "Short EAF," dated 7/2/02. 3. "Application for Approval of Plans for a Wastewater Disposal System." 4. "Construction Permit for Sewage Disposal System," dated 7/2/02. 5. "Application to Construct a Water Well," dated 7/2/02. 6. "Design Data Sheet." 7. `Letter.of..Authorization & Corporate Resolution" -dated 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, Jr. P.E. HWN: JM: jmm 02 -006.31 14.16.4 (9)95) —Text 12 PROJECT I.D. NUMBER 617.20 SEQR Appendix C State Environmental Quality Review - SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR G'1, I o M� I� Cc al 2. PROJECT NAME 3. PROJECT LOCATION: _ Municipality P E �`J(—"! V County V 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) APPLE WU_ K�W�s 5. IS PROPOSED ACTION: U New ❑ Expansion ❑ Modl(Ication /alteration 6. DESCRIBE PROJECT BRIEFLY: T` 7. AMOUNT OF LAND AFFECTED: Initially '�_+ () i ?i ?- o),2- _ acres Ultimately , acres 8. Wll_ PROPOSED ACTION COMPLY WITH EXISTING ZONING OR-OTHER EXISTING LAND USE RESTRICTIONS? EA Yes ❑ No If No, describe briefly 9. WHT IS PRESENT LAND USE IN VICINITY OF PROJECT? *9 Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/ForesUOpen space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? LOCAL)? ❑ Yes If yes, list agency(s) and permit/approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes In No If yes, list agency name and permlUapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? El Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MYtyKNOWLEDGE Applicant/sponsor `E C� `�`"V° na e: Signature: If the action Is In the Coastal Area, and you are a state agency, complete the . Coastal Assessment Form before proceeding with this assessment OVER 1 PUTNAM .COUNTY DEPARTMENT OF HEALTH: DI'VISION:� OE EN.VIRO.NMENTAL=HEALTH '"SERES'� -APPLICATION ' FOR APPROVAL'OF PLANS FO�t A, WASTEWATER TREATMENT SYSTEM " 1. Name and address ..of.applicant:' ,�T t - REV D -D P 2. Name of project:Q MSO-1.SSi�•. T � 3,' Location TN-,,. 4. Design Professional:UA�SZ�! 0�,1,�I1C1Jia.�'S. Address: 20'50 CSC" ZZ , 6. Drainage Basin: ?O 7. Type ofProie Private/Residential Food Service Commercial-;,::: Apartments........., . _ .._ ..............._.. _.- Institutional • MobileEome Park_ Office Building Realty Subdivision s eci 8. Is this project subject to State:Envir mi nental Quality'Review (SEQR) ?'" Type Status:.(.check ° one).. ...:::..................' Type I` ; .:Exempt.: ::., ... :.r. r T Unlisted: v 9. Is a Draft Environmental Impact Statement (DEIS) required ? ....................... _.. 10. Has DEIS been completed and found acceptable by Lead Agency? 11: Name of Lead Agency 1-2. Is this project-in an under the control of-local planning; ;oning,.or other ; � 4 officials; ordinances? ,,- ,, Ili .13 .If so, -have plans' b•een'subrhitte'd to' such authorIties9 '•�; -14. Has preliminary; approval, been,granted.by such authorities? NO D ate' granted ' :. 15. Type of Sewage Treatment System Discharge ..........:..:.:. surface w" aii-e"'r groundwater ii 16. ; If surfaee;water discharge `_what is:-the stream class designation? . .... ... , r.,� L.�J •Yr:: ... .+r , 17. WAters'index nu'mb'er surface ...:.. ....... .. 18. Is project located near a public water supply system? 19. ' If yes,'name`of wa'ter�supply , Vf K Distance to iwater�supply ' +. 20. Is project site near a public•sewage collection or treatmentsystem7• : .-'-.',,,...-.M.?.... 21. Name of sewage system g g y � � " Distance `fo. sewa e s stem •'' � ' -� 22. Date test holes observed �^ .. � ups nlsY\ (Q -� � •-- l� 23. Name of Health Inspector_ 1, 24. Project design flow (gallons per day) ....................... __ 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?..: IV 0 ...- .... _... . 26. Has SPDES Application been submitted to local DEC office? ......................... Form PC -91 I 27. Is any portion of this project. located within a designated Town or State-wetland? 28. Wetlands ID Number::.:.:: :..........:..:....:......................,.......... ............................... AJO N 29. Is Wetlands Permit required? ........... .................................... ............................... Has application been made to Town.or Local DEC office? ................... ............. )Vf Q 30. Does project require a DEC. Stream Disturbance Permit? .............. ...... (� 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal;-, landfilling, sludge application or industrial activity? ............................ Yes/No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? UNl -NOVIN 35. Are any sewage treatment areas in excess of 15% slope? .. ............................... 36. Tax'Map ID'Number ................................................. I....... Map Block Lot. 115 37. Approved plans-are to be returned to ..... Applicant DesioD.Pro.fess.ional -_.. . NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department: Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for'such activities from DEP and submit those forms to DEP for review and approval. If the,application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure.to comply.with this provision may be grounds for the rejection of any submission: -... I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False 'statements made her are punishable as a Class, A misdemeanor pursuant to Section,210.45 of the Penal LaW) /� SIGNATURES & OFFICIAL TITLES: 2'GoK ! Mailing Address: ................................... ` u ✓ 3 \ o q Z +` QE SOV o \ r � 56 „ 6 Sot °3t'10 "E 50.87 R = 9 ?5.00` 96.85` Az 0.5041' 28" APPLE HILL ROAb W M r 0 to z v Ln N Al u ✓ 3 \ o q Z +` QE SOV o \ r � 56 „ 6 Sot °3t'10 "E 50.87 R = 9 ?5.00` 96.85` Az 0.5041' 28" APPLE HILL ROAb W M r 0 to z CHART'in feet)- Number A I NO2 °4Z'2 "W f 16 17 2 63 73 3 69 80 q lb 87 5 84 94 6 90 100 7 97 107 8 104 114 9 111 IZI 10 111 126 II 100 103 2 93 97 13 52 69 14 58 74 1 5 64 80 1 -70 94 i 77 93 18 .82 98 19 90 104 20 98 112 ZI 109 121 NO2 °4Z'2 "W f