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HomeMy WebLinkAbout1777DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -4 -116 BOX 16 .4 , 17. I t'' Ir I ' ' T, 01777 Aas 03:17PM FROM - ENVIRONMENTAL HEALTH sHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associote Commissioner of Health 8452787921 T -043 P.004/005 F-102 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONN County Executive ROBERT MORRIS, PE Director of Environmental Health ADDITION APPLICATION RESIDENTIAL ONLY STREET A (?0 e_ t V) ^�CO J TOWN Ra %)i-SO n TAX MAP# �)!S. °__4 �p N.siMEo You Lee C1 e.,( ruoNE9/7-743t81SPc HD# MAILING ADDRESS .126 op) . 0611 DESCRIPTION OF ADDITION (-1 X11 S�'lpl rl!2� s-e'me of NUMBER OF EXISTING BEDROOMS-3 PROPOSED # OF BEDROOMS 3 (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) "Any addition which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Pumam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, Brewster, NY 10509, Phone: (845) 278 -6130. 1 � ,� -. -hurl- nr mnnav nr,iar far nn nn (,70011 ,FPMR,0Yf-i(._ r 2. Sketches of existing floor plan (drawn to scale, all living area 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 office with any questions. 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS 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 Intervcntion/Prmchool (8.15) 278 -6014 Fax (815) 278 -6648 Em SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Karen Lee Grolier 129 Apple Hill Road Brewster, NY 10509 To Whom It May Concern: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health November 12, 2008 Re: Addition- A- 210 -08 No Increase in Number of Bedrooms 129 Apple Hill Road (T) Patterson, T.M. # 35.4-116 I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated November 12, 2008. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at three without prior approval by this Department. 2. The area of the existing sewage disposal system and its expansion area must be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets etc. 4. The approval is for the proposed changes only. This approval does not validate any construction shown as existing that has not obtained proper approvals Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Patterson. If you have any questions, please contact me at (845) 278 -6130, ext. 2261. Sincerely, '' / P Gene D. Reed Senior Engineering Aide GDR:kly cc: BI, (T) Philipstown 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 I CERTIFICATE OF OCCUPANCY AND COMPLIANCE To of 'attmon "Iefu 0"Tork No THIS IS TO CERTIFY THAT Wtindham Homes- Inc. 3911 20 06 DATE ISSUED June 23, ON THE - PROPERTY OF Same LOCATED ON 129 Ajopte Hitt 'Road HAS BEEN SUBSTANTIALLY CONSTRUCTED TO THE REQUIREMENTS OF THE BUILDING CODE, ZONING ORDINANCE AND LOCAL LAWS OF THE TOWN OF PATTERSON, NEW YORK AND MAY BE OCCUPIED AND USED AS Three Bec(Aoom,' Sinate Famity Dwetting w/UnAinished Basement, Wood BuAning FiAeptace, 12 x 20 Rear Deck 9 3-CoA GaAage UndeA �' -'.4 :) Building Permit Dated Permit No. Application) pplication No . z! m ........... SECTION ........35-.- ......... BLOCK ......... A ........... LOT ....... A .... t # ) . M FEE $ 50.00 BUILD(KG INSPECTOR " ' Gt UC'. �'1 (_ u �� C —..j X27 ► e— f- Zcj Sv,; •, � �J�12 �-o c� tea/ b /z-- (o plo r +N o I s n c Se w, eon Clan a C�� 4- PUTNAM COUNTY DEPARTMENT OF HEALTH V HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY _ BEDROOMS A - _ ALL SUBSEQUENT REVISION /ALTERATIONS TO THESE HO J E PLANS MUST BE SUBMITTED TO THE PCDOH FOR APPROUL SI NAT =..)RE &. TITLE DAT A 21S' !o' ► 1' Icc�(► ,fv i 2Z'811 S -ttyv IFCI vii-v 1 v,,i' tin c-I osef 0 + Vi l swcl S-fT vac c- lr'-u vnkicc- m brPalce.'- o, ly. wak-Af wkicv 4z-o Pump ALo Eva Qgr 5� b y H O z z M 0 :4I 1-4 1 Z1 0 W 0 D �:N O %cc yi �o w� � O 2 y � co c� Q o ti Z b � er u1 PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY . -3 BEDROOMS ALL SUBSEQUENT REVISION, /ALTERATIONS TO THESE HOUSE PLANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL -- - 't- DATE " R'CI 1! sib � olr�o 0 O O a y m 0 a � �:N O %cc yi �o w� � O 2 y � co c� Q o ti Z b � er u1 PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY . -3 BEDROOMS ALL SUBSEQUENT REVISION, /ALTERATIONS TO THESE HOUSE PLANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL -- - 't- DATE " R'CI 1! sib � olr�o a 0 °a a 1� s • � O !� I co RI Z a b � H H rn pd O z �m z w 0 o � o O 2 � t0 �f Q N j o Zo b ■ i',,; i ivh+ul COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY 3 BEDROOMS ALL SUBSEQUENT REVISION/ALTERATIONS TO THESE HOUSE PLANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL 9A / L 09 SIGNATURE Y, TITLE DA, Tt 71 ANN � b oo�� Q L u_. V-n Veal 1. e. Ci yo) ' ew 122G EXISTINC-� F�c>�P��l Some items shown are optional. All dimensions are approximate. Floor plans vary with elevation. Subject to change without notice. Artist's Concept Wyndham Homes, Inc. Homesite 32 N The Kensington II N Country Colonial Elevation ■ W I N D S 0 R W 0 0 D S ■ ® 1999 -2005 r .m Hamea iae en rlyhb re.ar.aa ■ p A T T E R S 0 N ■ N E W Y 0 R K ■ u eatmre oar 4P ; IInaathmhed ms o1 l6ees plero and eleubms. area 1f modl6ad. b a wldatlm of ledmel lo. Printed on September 08, 2005 MAIN LOCATION — VAR= Trra GRM FAMILY ROOM 18' a 35' Wyndham homes, Inc. Some Items shown are optionaL All dimensions are approximate. Floor plans vary with elevation. Subject to chance without notice. DECK 20' s 12' o� D„ era KITCHEN 13' s 17' ' HOME opno am OFFICE 12' z 14' ]BREAKFAST o �/ 14' s 11' LRNWY LIVING ROOM 2 STORY DINING ROOM 13' a 18' 1 FOYER 13' s 18' POHM Homesite 32 — The Kensington II — First Floor Ilan ® W I N D S 0 R W 0 0 D S ® tees -zoos Tndh m A— Ian. An rlxhts rea,ed ® P A T T E R S 0 N ■ N E W Y O R K ■ Te edom our mprr%bls. 0nauUmi ed we of U ee pima sad elpstlm& an H moll" Is a ddaU n et hdaal L. Printed on September 08. 2006 MASER II MI BEDROOM 2 ISM MASTER BEDROOM 13' s 19' BEDROOM 3 13' s 13' Some items shown are optional. dll dimensions are approximate. Floor plans vary with elevation. Subject to change without notice. Wyndham Homes, Inc. Homesite 32 o BLOM Second MASTER ■ W I SITTING N D S 12' a 17' W 0 0 8101,111) wam—in 0 Closet MASER II MI BEDROOM 2 ISM MASTER BEDROOM 13' s 19' BEDROOM 3 13' s 13' Some items shown are optional. dll dimensions are approximate. Floor plans vary with elevation. Subject to change without notice. Wyndham Homes, Inc. Homesite 32 N The Kensington II N Second Floor Plan ■ W I N D S 0 R W 0 0 D S ■ © 1M -2006 wham Unmes bm All ale `'esm. is P A T T E R S 0 N ■ N E W Y O R K ■ Re enforce cor eopyx%bt . OmatLmhed me of time plans std dmaft^ an H modified Is a ddetJm of federal law. PrWed an Septrn"r 08. 2005 �? ei-, C. rN to '1 i ;s, Inc. Homesite 32 � The Kensington II N Basement Floor Pl( N D S 0 R w 0 0 D S PUTNAM COUNTY DEPARTMENT OF HEALTH VISION OF ENVIRONMENTAL HEALTH SERVIC.X." CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # F - U 04 Located at M-1 M ?a {-k 1l,L f -O ND Town or Village Owner /Applicant Name Wy HD*(t 01 lf6 1M(f Tax Map � '5, Block Lot Formerly Subdivision Name D950-W wo Subd. Lot # t�- Mailing Address '� G4 j. k i4.�'J p ®� D -!`� I� -- ; Zip i Q Date Construction Permit Issued by PCHD Separate Sewerage System built by i f t \�` Vn �' �' Address ) cril' X44 1� DA' &L - 1o�4N Consisting of IM Gallon Septic Tank and (a61 i-,F I • -S HUNT' Other Requirements: N��' 6 ''3�� Water Sup"I : Public Supply From Address or: X Private Supply Drilled by Al. *- •Address �� bwu1 '5TM--Ny it` p� Building Type �' 1 ���L Has erosion control been completed? "As n Number of Bedrooms Has garbage grinder been installed? VII 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 regulations of the Putnam County Department of Health. 4 Date: Certified by Ar_" P.E. X R.A. _2e /ii _2es/ii Professipnal) Address ��`�© ^9�� `I' 1_ 1 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 revoca 'on, modificatio r change is necessary. G Title: Date: � 2 By: E- White covv - HD FAe; Ykowcopy - Building Inspector; Pink copy - bwner; Orange copy - Design Professional Form CC -97 August 31, 2004 Putnam County Health Department 1 Geneva Road Brewster, New York 10509 ATT: Robert Morris, P.E. Re: Proposed SSTS - Lot #32 Deerwood Subdivision Apple Hill Road Town of Patterson T.M. # 35. -4 -116 Dear Mr. Morris: Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 Tel: (845) 2794003 Fax: (845) 279 -4567 Email: hnengineer@aol.com In response to your August 17, 2004 review letter, we note the following: 1. New corporate affidavit enclosed. 2. The plat approved by PCHD shows the residence 20' from the SSTS with 2.5' of fill specified in the schedule. 3. Minimum distance of 50' to high water level of Basin # 33 is being maintained. 4. Existing contours extend beyond property line. 5. SSTS expansion area is in one location. 6. Contour line 656 corrected. 7. Contour line 654 corrected. 8. Minimum 2.5' fill provided. 9. High water level of Basin #33 noted as 637. 10. Copy of wetland permit for all wells and septics previously forwarded to PCHD. 11. Fill extends 10' beyond all trenches. 12. Clay barrier added to SSTS profile. Reflecting the above, we are enclosing the following: Two (2) prints SS -32 "Trench Plan ", rev. 08/24/04. Five (5) prints SF -32 "Fill Plan ", rev. 08/24/04. Corporate Affidavit. Kindly continue with your review and issuance of the Construction Permit. Very truly yours, Harry W. Nichols Jr., P.E. HWN:gav 03- 056.32 �030321000q6t- ARTICLES OF ORGANIZATION OF WYNDHAM DEVELOPMENT AT WINDSOR 1 Y OODS9 LoLoCm Under Section 203 of the. Limited Liability Company Law C STATE OF NEW YORK DEPARNENT OF STATE MAR 2 12003 FILED UX S Filer: Hankin, Hanig, Stall, Caplicki, Redl & Curtin LLP 319 Main Mall Poughkeepsie, NY 12602 REF. 07015620 DRAVMONVN CO, Rd LO Z (Z VVK NIS -27 0 A13-03 03032,10 APR 10 2003 PUTNA*..:CQ,,UN OFHEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES r. DESIGN DATA SHEET - SUBSURFACE SEWAGETREATM.ENT SYSTEM Owner: AY0 Address l CAkAN\VOOD F ye - A Street A Located at (S' et) Tax Map­ Bloch (indicate nearest'cross street) Municipality ATT-�.6- ` Watershed k0(q 0-00�- Date of Pre - soaking Date of Percolation Test 1. tiY ... .... ............ . ......... . T :..:...:..:.:............. r..: .,,...............:.::....:.:.. ..... rom-1. . .......... "SA' - r ........... :,sta: Stmt H. V t ...... ..... "T"'...N. J11.11-1 -K, ..2 3 4 0 3 4 7 2 3 NOTES: 1. Teftsto be repeated at same depth until approximately equal percolation rates are obtained at each SOIL. EACOLATION TEST DATA �-4 '2. percolation test hole. (i;e-; :; I min for 1-30 atWinch, s 2 min for 31-60. min/inch) All,.data to be. submitted for review. Depth measurements to be made:from-top .of hole. 12 Form DD-97 DEPTH G.L. 0.5' 1.01 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5" 5.0' 5.51 6.0' 6.5' 7.0' 7.5. 1 8.01 8.5' 9.01 9.5' 10.01 at w I— Indicate level which: encountered (o Indicate leveLat which. mottling is observed Indicate level to which water level rises after bei'n.g.e.nc.oun.tered Deep hole observations made by: NO) M -61003MM Date. Design Professional Name: ►-t V\I, Nccil ill, � Address: 0 ltd Signature Design Profess'sioinal's Se'a:1 a I �E�Oh N!l C ..CIA NO, 24. Frs 1. 2. 4. 6. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM Name and address of applicant: )N y)4V0 " Name of project: LOT- Design Professional: qJ Drainage Basin: �QG P7WL . �•d ta5o� 3. Location TN: � ' C�-� 0 5. Address:. 7. Type of Proiect: �► Private/Residential Food Service Apartments Institutional Office Building. Realty Subdivision Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? . Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted x 9. Is a Draft Environmental Impact Statement (DEIS) required? ................... tjc. 10. Has DEIS been completed and found acceptable by Lead'Agency? ............... V N 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning,- or other. officials, ordinances? ......................................................... ....:.......................... G 7 1.3. If so, have plans been submitted-to such authorities? p 14. Has preliminary approval been granted by such authorities? Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water 'A groundwater 16. If surface water discharge; what is the stream class designation? .................... 17. Waters index number ( surface) :......:.......................::.......:... .......................::...... N . 18. Is project located near a public water supply system? ................ ........... :............ 0 19. If yes, name .of water. supply N Distance to water supply O & 20. Is project site near a public sewage collection or treatment system? ................. N 21. Name of sewage system ON Distan ce to sewage system rA 22. Date test holes observed OG) 0(0 `�� 23.. Name of Health Inspector bdo) i H14 24. Project design flow (gallons per day) r,c0 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? ......................... N � Form PC-97 2 27. Is any portion of this project located within a designated Town or State wetland? t_� LOc.X) 28. Wetlands ID Number ........................................................... ............................... JA 29. Is Wetlands Permit required? ............... ............................... A 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? ............................ Yes/No c�0 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 9 'DESCRIBE: . 33. Is. there a local master plan on file with the Town or Village? ......................... Y� 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... �ID 35. Are any sewage treatment areas in excess of 15% slope? ......... : ..................... ::. 36. Tax Map ID Number ................ ... ............................. .......... Map nth •• � Block Lot I� 37. Approved plans are to be returned to ..... Applicant X Design'Professional NOTE:.Afl 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 an d 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 appliqgion must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply.with thi ro rsivn may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is4uew_ to the best of my knowledge and belief. False statements made herein are punishaW as a Class A misdemeanor pursuant to Section 210.45 of the Penal L �°•' �= - �. SIGNATURES & OFFICIAL TITLES. Mailing Address: ..................................... RZ110 Z: 14.16.4 (2/87) —Text 12 PROJECT I.D. NUMBER 617.21- SEAR• Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART 1— PROJECT INFORMATION.(To be completed by Applicant or Project sponsor) 1. APPLI ANT /SPONSOR f • � NI' 0 �r 2. PROJECT NAME _ 3. PROJECT LOCATION: P ���� Municipality " �/r dO County 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) 5. IS PROPOSED ACTION: . gNew - ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAU D A�F�F CTED: 1 I 1 Initially —lcJ1 acres Ultimately acres 8.. WIL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes ❑ No If No, describe briefly 9. WN T IS PRESENT LAND USE IN VICINITY OF PROJECT? �tesidential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: L '7�1-q� F tT` `��� • . 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? Yes ❑ No If list yes, and permit/approvals (agency(s) 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? 81Yes ❑ No . If yes, list agency name and permll/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? .❑ Yes o I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE N9 � N1V '� A% Applicant/sponsor n me: Date: Signature: If the action is in the Coastal Area, and you are a state agency, complete'the Coastal Assessment Form before proceeding with this assessment OVER PART II— ENVIRONMENTAL. ASSESSMENT (To be completed by Rgency) _ A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? 11 yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another Involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten. Illegible) 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. C:) a 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. ra co 11> D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether It Is substantial, large, Important or otherwise significant. Each effect should be assessed In connection with Its (a) setting ().e. urban. or rural);. (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly.to the FULL EAF and /or prepare a' positive declaration.. ❑ Check this box it you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental Impacts AND provide on'attachments:as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible O icer in Lead Agency Title of Responsible Officer r Signature of Responsible Otlicer in Lead Agency Signature of Preparer (if different rom responsi e officer) Date 2 7 July 28, 2004 Putnam County Health Department 1 Geneva Road Brewster, New York 10509 ATT: Robert Morris, P.E. Re: Individual SSTS Deerwood Subdivision - Lot # 32 Apple Hill Road Town of Patterson T.M. # 35.4-116 Dear Mr. Morris: Enclosed are the following: Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 Tel: (845) 279 -4003 Fax: (845) 2794567 Email: hnengineer@aol.com 1. Five (5) prints of SF -32, "Preliminary Design Fill Placement Study", dated 07/28/04. 2. Two (2) prints of SS -32 "Proposed SSTS ", dated 07/28/04. 3. "Short EAF ", dated 07/28/04. 4. "Application for Approval of Plans for a Wastewater Disposal System ". 5. "Construction Permit for Sewage Disposal System, ", dated 07/28/04. 6. "Application to Construct a Water Well ", dated 07/28/04. 7. "Design Data Sheet ". 8. "Letter of Authorization & Corporate Resolution ", dated 07/28/04. 9. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only". 10. Review Fee in the amount of $400.00. We would appreciate your review; approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, Harry W. Nichols Jr., P.E. HWN:gav 03- 056.32 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: Town/Village Tax Grid # /f fl-f- kI W OAP PAIT060H Map %• Block 4 Lot(s) Well Owner: e: Address: PYAWN F 0454A NL, °? C e4- t4i",vw 9,t14 c Od re a' 3' io4t 9 Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5 f- gpm # People Served 4- 6 Est. of Daily Usage 606.1 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 X Is well located in a realty subdivision? ...................................... ............................... Yes 3 No Name of subdivision peep w 0 D ig Lot No. 17%2 - Water Well Contractor: 7-13 0 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 separate sheet/pP lans Date: ®7 b 4' Applicant Signature: f 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. 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 Date of Expiration Permit is Non - Transferrable Permit Issuing Official: Title: White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 September 30, 2004 Harry Nichols, P.E. Patterson Park, Ste 106 2050 Route 22 Brewster, NY 10509 Re: Proposed SSTS: Wyndham Homes, Inc. Apple Hill Road, Lot 32 (T) Patterson, TM # 35.4-116 Dear Mr. Nichols: ROBERT J. BONDI County Executive Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: 1. Corporate affidavit notary stamp signature and stamp is a photocopy. Corporate seal is to be applied. When proposing a fill section greater than 2 feet the entire fill pad is considered the SSTS. Therefore the minimum distance from trench to the house foundation is 37.5 feet. 2. If a wetland permit is required from the town it is to be submitted prior to approval. If a wetland permit is not required to construct the footing /gutter drain discharge ; in the wetland buffer, a letter from the town must be submitted stating such. 3. House plans are considered to have 4 potential bedrooms. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very ly yours, Robert Morris, P.E. Senior Public Health Engineer RM:km 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: represent that I am an officer or employee of the corporation and am authorized to act for: 'game of Corporation: Having offices at: Q� Whose Officers Are: President - Name \xz-yNx�d Vice President - Name: Address: Secretan, -N .r► 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 ther#o. „ /*) ^ Sworn to before me this day of (month (year) �Iotar -y- ublic Form CA-97 JEANNEM ROSS Nowy PubgA State of New York No.01RO0103M Quaffed in Putnam County Eton aKPIMS 12/22!200'7 Signed: Title :. Corporate Seal PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: TREET LOCATION: REVIEWED BY: RM, OR, AS, SRDATE: TAX MAP #: (CONFIRMED) N DOCUMENTS (__))PERMIT APPLICATION )(_,)WELL PERMIT OR PWS LETTER UUPC -97 (__)(_)LETTER OF AUTHORIZATION C__)C_)DESIGN DATA SHEET (DDS) (--)C--)CORPORATE RESOLUTION U(__)SHORT EAF (--))PLANS -THREE SETS C--)(--)HOUSE PLANS - TWO SETS (_yVARIANCE REQUEST SUBDIVISION LEGAL SUBDIVISION _)SUBDIVISION APPROVALJCHECKED PERC RATE DJ �e (�(�FILL REQUIRED DEPTH UUCURTAIN DRAIN REQUIRED GENERAL LOCATED IN NYC WATERSHED ( �(—' )PLANS SUBMITTED TO DEP EGATED TO PCHD APPROVAL, IF REQ'D P TEST HOLES OBSERVED CS TO BE WITNESSED ►PPROVAL SSDS ADJ, LOTS 'LANDS (TOWN/DEC PERMIT REQ'D ?) A ON DDS PLANS & PERMIT SAME 1969 NEIGHBOR NOTIFICATION LETTER BI/ZBA 100 YR. FLOOD ELEVATION W/I200' C-) )SOIL TESTING LOTS >10 YEARS OLD EQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE ( (--- ) RGRAVITY FLOW )NSTRUCTION NOTES 1 -15 TKSIGN DATA: PERC & DEEP RESULTS CONTOURS EXISTING & PROPOSED AY & SLOPES, CUT [;/GUTTER/CURTAIN DRAINS SOIL TYPE BOUNDARIES TITLE BLOCK; OWNERS, NAME ADDRESS TM#, PE/RA; NAME, ADDRESS, PHONE# DATE OF DRAWING/REVISION DATUM REFERENCE iLOCATION OF WATERCOURSES, PONDS LAMS,WETLANDS WITHIN 200' OF P.L. 1PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS SWELLS & SSDS'S W/IN 200' OF SSTS (PROPERTY METES & BOUNDS C! ))EROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE COMMENTS: (REVMEET)09 /01 /00 YN (REQUIRED DETAILS ON PLANS CONT'D) ✓HOUSE SEWER -1/." FT. 4 "0'; TYPE PIPE CAST IRON _)( __,,,-)NO BENDS; MAX BENDS 45° W /CLEANOUT RENEWALS ZC--) (NO CHANGE) FILL SYSTEMS 10' HO ONTAL; PAST TRENCH SLOPES 3:1 TO GRADE L SPECS/ FILL NOTES 1 -5 U ILL PROFILE & DIMENSIONS FILL IN EXPANSION AREA FILL GREATER THAN2 FEET CLAY BARRIER (_C)Lt:�:)FILL CERTIFICATION NOTE (_ff( DEPTH GAUGES VOL. ON PLAN FOR RO.B., UNCLASSIFIED & IMPERVIOUS SEPARATION DISTANCE FROM TOE OF SLOPE TRENCH LF TRENCH PROVIDED 60FT MAX. (_)(_)PARALLEL TO CONTOURS (__)100% EXPANSION PROVIDED CDETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL _)GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS aP.L. DRIVEWAY, LARGE TREES, TOP OF FILL FOUNDATION WALLS O WELL, 200' IN DLOD,150' TO PITS O STREAM, WATERCOURSE, LAKE (inc. eapan) (x(__)50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 1 2 10' TO WATER LINE (pits - 201) 50' INTERMITTENT DRAINAGE COURSE 00' /500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS 10' MIN TO LEDGE OUTCROP SEPTIC TANK 10' FROM FOUNDATION; 50' TO WELL WELL (�DIMEN NS TO PROPERTY LINES (j_)LOCATI N OF SERVICE CONNECTION(d 1/ TO PROPERTY LINE SLOPE LOPE IN SSTS AREA 520 %) vUREGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS PUMP NOTES DOSE 75% OF PIPE VOLUMEMOSE VOLUME NOTED U DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) PIT AND D -BOX SHOWN & DETAILED L� 1 DAY STORAGE ABOVE ALARM CURTAIN DRAIN 1STANDPIPES, 5' BOTH SIDES, DETAIL 15' MIN to CDS = >S %, 20'-4%,25'-3%,35'-i%, 100%-<I% 20' MIN to CD DISCHARGE /100' with 182 cons day discharge 10'MIN to NON - PERFORATED PIPE YML Ell IV RONMENTAL SERVICES 321 Kear Street York-town Heights, N.Y. 10598 (914) 243-2800 Albert H. Paduvani, Director LA B#: 1.6 03 290 CLIENT #- 57197 NON s,rATPROC PAGE: 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~^~~~~^~ WYNDHAM HOMES 8 COLLlNWOOD DRIVE RALPH TEDESCO BREWS-TER, NY 10509 DATE/TlME TAKEN: 06/06/06 09:30 DATE/1'111E REC'D: 06/06/06 10:10 REPORT DATE: 06/06/06 PHONE: (845)-279-2022 SAMPLING SITE: 129 APPLE HILL ROAD SAMPLE TYPE..: POTABLE : BREWSTBR PRE SERVATlVES: NONE COL'D BY: JOSE TEMPERATURE. .x < 4C NOTES...: KITCHEN TAP COLlFORM METH: N/A DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 06106/06 TURBIDITY (TUR 4.e NTU 0-5 NTU SUBMITTED 8Y: 10� a6c -e Director ELAPI* 10323 T To 5v PA 1!2 In VEL�OQTY ; r . 01651PATION ' FX ST910--rure X. WELL (TYPI , CAL)' -eea ve-rAu- Vol, 10 P r) ld TOP Cof".5-5 INV. &tpO. A),6 A ?Tz rp OT &4 we -ILA= Iz r LAM U. : July 18, 2005 Putnam County Health Department 1 Geneva Road Brewster, New York 10509 ATT: Robert Morris, P.E. 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 RE: Proposed SSTS — Wyndham Homes, Inc. - Lot #32 Apple Hill Road Patterson, NY T.M. # 35.4-116 Dear Mr. Morris: In response to your September 30, 2004 review letter, we note the following: 1. New corporate affidavit enclosed. Minimum distance from trench to house foundation is 37.5 feet. 2. Copy of overall site wetland permit from Town of Patterson Planning Board previously submitted. (One permit issued for total project). 3. Revised three (3) bedroom plans enclosed. Kindly sign and return three (3) full sets. Reflecting the above, the following is enclosed: Five (5) prints SF -32 "Fill Plan ", rev. 07/13/05. Two (2) prints SS -32 "Trench Plan ", rev. 07/13/05. Kindly process the enclosed permit at your earliest convenience. Very truly yours, ' Harry W. Nich' oI's Jr., P.E. HWN:gav 03- 056.32 "K, ti � LETTER OF AUTHORIZATION RE: Property of VV ND �+MA 4 0 � 5� Located at A R-6 141 IA" �0 AD T/V PikrTl �- N Subdivision of Tax Map # DE5WMD Subdivision Lot # � J)1 Gentlemen: This letter is to authorize � wP4 Block 4 Lot - 11 Filed Map # �_% `1 Date Filed 001ho l l V b Hwy ko�_s A."m, a duly licensed Professional Engineer - )— or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam 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 of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putna - qp _ ' ary Code. Counter; P.E., R.E Mailing State N Zip Telephone: �4ZD Very truly yours, Signed: (Owner of r perry Mailing Address: State 1 Zip p p Telephoner ` !�0'n Form LA -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health 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 August 18, 2005 Re: Proposed SSTS: Wyndham Homes, Inc Apple Hill Road, Lot # 32 (T) Patterson, TM # 35-4 -116 Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: 1. A side view profile sketch is to be submitted for the master bedroom sitting room. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:kly Ve tru yours, Z Z/V /P� Robert Morris, P.E. Senior Public Health Engineer 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 a SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health 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 August 9 2005 ROBERT J. BONDI County Executive Re: Proposed SSTS: Wyndham Homes, Inc. Apple Hill Road, Lot # 32 (T) Patterson, TM # 35-4 -116 Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: 1. House plans are considered to have 4 potential bedrooms. The sitting room is considered a potential bedroom. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:kly V y yours %W Robert Morris, P.E. Senior Public Health Engineer 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 s 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: represent that I am an officer or employee of the corporation and am authorized to act for: 'game of Corporation: Havin; offices at: Whose Officers Are: President - Name: Vice President - Name: Address: Secretary, -Name- Treasurer - Name: Address: and that I am and will be individually responsible for any and all acts of the rporation with respect to the approval requested and all subsequent acts relating thereto. Signed: _ Title: V Sworn to before me this. day of ---(month)-=,Q,, year) . 'N-otary`= Public JEAMME RGSA00 ;'&yo,81ate,4w9W Corporate Seal KAOIRC8 OMS NOW In Putnam County ,;rmm sdom eVirw 12/22!2007 Form CA -97 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 matt er of application for: PE�WDOD Llor �} represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: Having offices at: Whose Officers Are: President - Name: Address: Vice President - Name: Address: Secretary -Name: Address: Treasurer -Name:.. Address: D9Av4,�_ . 5 and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. oevr�.` Signed: ^ ti�wrli enbltc, tom.. of w.r. lt�rh: -- rro.atei� : Title: sworn to before me this �' , day of (month) 7M3 (year); N Public Corporate Seal Form CA -97 Oct. .0 ;4 05 C4: 57P TOWN OF— PRTTERSO 845 - 878 -%'* A9 P.1 P. 02 OCT-03 -20®: 04:03 PM HARRY INICNDLS 914 279 43 :, gRucal P. TOLBY. L99MA— MOUNARi it.N.," M.s.N, Pvltra I #MA PirmaP Anot"w lublrt Health Dktarar.: DEPARTMENT OF HEALTH ' 1 4anaw Rod 8rowiter, New York 10509 • t.,vnd.�.w�awa��,a:l•si }o r�atvi�l��I.�sny Monks sastla 910271.011, wic cm)211.6678 'FAX(114) III- 661S - 1;�rtr"1iu!vtrgua•piuiTB'•�oi1 rrWebeo� pul =� :d4q r�.t411 }nr6811 :, J211 ADDR .,$S VERTEI .ATI M FOR 4'Wt�ERS DAME: N9t+l s{DAt� Tkx mi Y.NmMsp- III • 4 i! Az OF 42f I AUTSO=ED TOWN OMCL4.L -. 'DATE, - -° T6e'A13t6am Como Department o4 Health will not issue a Ceilificate- of . Cc astr ction C6niplinnce unless tlu Above form is COMpleted; i.e.; a legal- 611, address 16 assigned by nu ntiithodud toms official. Mis forgo is to be sub mined witb the application for a Cer0cate of Construction CompliHnce. (83111r1tRF3U�1� L PUTNAM COUNTY DEPARTMENT OF HEALTH ]DIVISION OF ENVIRONMENTAL HEALTH' SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map Block Lot Building Constructed by Location - Street Building Type.' TownNillage pf5l�,�-o 00p Subdivision Name ,�i7_1, Subdivision Lot # I represent that I am wholly" and completely responsible for the location, workmanship, material, const=tiorr anT'drainage of the sewagelreatment 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 prart-of said System coris`fructed 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. _ u Dated: M 067 Day Year ( N r* al Contractor'(Owner) - signature y . Corporation Name (if corporation) Address: 1 C-4-LAO w (Wt b jL\A5 -' w`$ - State N b Zip 0 , p Signature: �' Title: Gott yT WYtJ 0M ROMO , ))-A1„ Corporation Name (if corporation) Address: e1 CN-WNWDOD 'Klggr Ner- State ` Zip 105-ol Form GS -97 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 1.601818 CLIENT #: 57197 NON STAT FROC PAGE: :1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ WYNDHAM HOMES 8 COLLlNWOOD DRIVE RALPH TEDESCO BREWSTER, NY 10509 DATE/TIME TAKEN: 03/23/06 04:30 DATE/TIME REC'D: 03/23/06 05:00 REPORT DATE: 03/28/06 PHONE: (845)-279-2022 SAMPLING SITE: 129 APPLE HILL ROAD SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COL'D BY: JOSE TEMPERATURE..: NOTES...: COLIFORM METH: N/A ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~-~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 03/28/06 IRON (Fe) <0.060 MG/l... 0-0.3 mg/l 9002 COMMENTS;: Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. SUBMITTED BY: Albert H. Padovani, M.T.(ASCP) Director ELAP# 10323 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovani, Director LAB #: 1.601437 CLIENT #: 57197 NON STAT PROC PAGE: 2 WYNDHAM HOMES DATE /TIME TAKEN: 03/08/06 04:30 8 COLLINWOOD DRIVE DATE /TIME RECD: 03/08/06 05:10 RALPH TEDESCO REPORT DATE: 03/15/06 BREWSTER, NY 10509 PHONE: (845)- 279 -2022 SAMPLING SITE: 129 APPLE HILL ROAD SAMPLE TYPE..: POTABLE : MASTER BATHROOM SINK PRESERVATIVES: NONE COLD BY: JOSE TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF ---------- ----------------------- - - - - -- ------------------------------- w- - - - - -- DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD is suggested. pH pH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG /L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG /L, DEPENDS ON THE 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: UUQ Albert H,,/ Padovani , M . T . (ASCP) Director ELAP# 10323 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovani, Director LAB #: 1.601437 CLIENT #: 57197 NON STAT PROC PAGE: 1 WYNDHAM HOMES 8 COLLINWOOD DRIVE RALPH TEDESCO BREWSTER, NY 10509 DATE /TIME TAKEN: 03/08/06 04:30 DATE /TIME REC'D: 03/08/06 05:10 REPORT DATE: 03/15/06 PHONE: (845) - 279 -2022 SAMPLING SITE: 129 APPLE HILL ROAD SAMPLE TYPE..: POTABLE : MASTER BATHROOM SINK PRESERVATIVES: NONE COLD BY: JOSE TEMPERATURE..: < 4C NOTES...: - COLIFORM METH: MF ----------------------------- - - -- --- ~ ------------------- ~~- ~------------ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 03/08/06 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 03/14/06 LEAD (IMS) 1.4 ppb 0 -15 ppb 9003 03/10/06 NITRATE NITROG 2.55 MG /L 0 - 10 9052 03/08/06 NITRITE NITROG <0.01 MG /L �?�� N/A 9162 03/13/06 °.3RON (Fe) 1.32 MG /L 0 -0.3 mg /l 9002 03/13/06 MANGANESE (Mn) 0.047 MG /L 0 -0.3 mg /l 9002 03/09/06 SODIUM (Na) 8.44 MG/L' N/A 9002 03/08/06 pH 6.1 UNIT rip 6.5 -8.5 9043 03/15/06 HARDNESS,TOTAL 156 MG /L N/A 03/15/06 ALKALINITY (AS 90.0 MG /L `t Q` N/A 9001 03/13/06 TUR$IDITY,,(TUR 7.3 NTU — 0 -5 NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER (WAS),(WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDI HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb /Cu LEAD limits for p, EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. ablic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg /L, else water undertaken to reduce the waters corrosive Fe /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg /L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg /L of Sodium r� OG WEL�,_JMPLETION REPORT nff-[ n„1, �' w •� O DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH WELL LOCATION STREET ADDRESS: TOWN IVIL I Y TAX GAIO NUMBER:­-. Well #2, Old Route 22 Brewster,NY WELL OWNER NAME: ADDRESS: Mahhattan Realt a 7BIVATE UBLIC USE OF WELL 1- primary 2 - secondary Q RESIDENTIAL ❑ PUBLIC SUPPLY O AIR /CONO. /HEAT PUMP O ABANDONED O BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify) O INDUSTRIAL O INSTITUTIONAL 0 STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING ® NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 54.1S ft. I STATIC WATER LEVEL to ft. DATE MEASURED 5/11/89 O-RILLING EQUIPMENT ® ROTARY f9 COMPRESSED AIR PERCUSSION ❑ DUG O WELL-POINT O CABLE PERCUSSION O OTHER (specify): WELL TYPE ❑ SCREENED . .O OPEN END CASING.. 13 OPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH 31_ tt MATERIALS: (2 STEEL O PLASTIC O OTHER CASING DETAILS LENGTH.BELOW GRADE 30 tL JOINTS: O WELDED ® THREADED O OTHER DIAMETER in. SEAL: 0 CEMENT GROUT O BENTONITE OOTHER WEIGHT PER FOOT ' . i9 Ib3IL DRIVE SHOE: Q YES O NO I LINER: O YES ® NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (It) DEPTH TO SCREEN (ft) DEVELOPED? FIRST 0 YES ❑ 640 HOURS SECOND GRAVEL PACK O YES O NO GRAVEL SIZE DIAMETER OF PACK in. TOP OEM tL BOTTOM OEM It. WELL YIELD TEST ' It detailed pumping MEiH00: O PUMPED 1 tests were done is in- Q COMPRESSED AIR , formation attached? O BAILED O OTHER ; 0 YES 0 NO WELL LOG It more detailed formation descriptions or sieve analyses are available. please attach. DEPTH FROM SURFACE water u2r. ��y W :n Oia. In FORMATION OESCRIFTION not It. IL WELL OErFf It. DURATION hr. min. ORAVIOONN It.. YIELD gCm. Su,,ice Frock at 18' 545 6 2 20 8 [kr3illing ck set casin route 31 545 in rock granite. WATER O CLEAR TEMP. QUAUTY O CLOUDY HARDNESS O COLORED ANALYZED? OYES. ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE CAPACITY MAKER DEPTH MODEL VOLTAGE HP WELLORILLERNAME P.F. Beal & Sons, In OaT /. 1/89 ADDRESS PO BOX B :. StG? RE Brewster, NY 10s0 May 19, 2006 Michael Budzinski, P.E. Putnam County Health Department 1 Geneva Road Brewster, New York 10509 Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 Tel: (845) 2794003 Fax: (845) 2794567 Email: hnengineer @aol.com Re: Individual SSTS Compliance — Wyndham Homes, Inc. 129 Apple Hill Road - Lot # 32 Deerwood (Windsor Woods) Subdivision Town of Patterson, NY T. M. # 35.4-116 Dear Mr. Budzinski: Enclosed are the following: 1. Five (5) prints of Drawing S -32, "As -Built SSTS ", dated 05/19/06. 2. "Certificate of Construction Compliance for Sewage Treatment System" dated 05/19/06. 3. Three (3) copies of "Guarantee of Subsurface Sewage Treatment System ", dated 05/19/06. 4. Laboratory Reports, dated 03/15/06 & 03/28/06. 5. "Well Completion Report", dated 07/21/89. 6. Application Fee in the amount of $300.00 payable to Putnam County Health Dept. 7. "E -911 Address Verification Form ", dated 10/04/05. If there are any questions concerning the enclosed, please call. Very truly yours, Harry W. fi(hols Jr., P.E. HWN:gav 03- 056.32 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 May 24,.2006 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health L Re: Construction Compliance Permit for Wyndham Homes, Lot # 32 129 Apple Hill Road (T) Patterson, TM# 35 -4 -116 This Department has received and reviewed the submitted application and plans for the above referenced project and the following comment is offered for your consideration. • The submitted water quality results indicate the turbidity result exceeds the maximum containment level. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. MJB:cj Respectfully, r I 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 � U T'1� �:Ni tt; U iJ�TY DEPARTIYIENT flF �+ ALTH. DIVISION OF E ` ONN -NTAL IiEzAL�TH SERVICES vy MAL ST 'E INSPECTION Date Ins P eCted b. ' , Y Sheet Locations ®lam, / /T1� T1VI # .Sub 1 'Sewage System Area NO CONIlNTS a STS area located asper�appr<ovedlans 'of placenment b Fill section date : 3 1 banner Zgth :: :width Awg D— Ili' c Natural soil not d Stone 'lrus etc eater than 15' froiri STS area e 1:'00' from water couf e /vcitland ,: I. Sewage System . size 1,OOa 1,250 a Septic tank : low other b {6Eptictankmstalledaeuel ..... :� 4 ., i c `10' minnmum from foundation _ ' distribution Boz 1 All outlets at same elevation= =water 2 Protected.3bel :... ow, frost..: 3 Ivlii imum 2 ft O.ngmal, so'R between box & trenches e J4unction $ox properlyset .. 6 ;;; r ftc es 1 Length squired .Length installed 2 Distance to watercourseneasure'd 3 Installed according to plan - 4 ope onacce . "Ifo.ot1 5 10 ft from properly line 20 ft foundations b Depth of trench ` <30 chesfrom suface ..: .............. 7 Room allowed for.expansion, 100% : ........ 8 ±Size of gravel 3%4 - VA" diametef ::clean ...................: 9 Depth of:gravel °.1n trench 12" ,uunimum .... m or.. osed.S +stems 1 .. fpump ;chamber. ............... 2 Oveio,ow tank::. ............, ....... R1 3� i arm ; uual /audio h , 4 Pump easily accessible, manhole to grade. 5. ,.Fast boxbaffied ... .............. 6 C -cle vv tressed by H.D estimated"fl ow /cycle,:. :....... y IIL H use7Bu Aing a: Iiouseaobated era roved 'fans P PP P b Number of bedrooms .... ... .. .. V. Well Well located ;as per approved lans...... ...... ............ P' - u Cif b Distance from STS areameasured ft SOO c Casing 18" :above _grade .. ...... d, °Surface drainage around well,,acceptable...... �4D V Oyer0Vorkman9hip a..: Boxes #-O per erl outed.. ..... .; ............................. p .:p y, gr. ......... b.: All:,. .partially backfilled.................................... c.. All pipes flush.with mside .of box..,..,.. .............:... t A. Rackfill material contains stones <4" :diameter ....... Ll e.. `Curtain drain &'��standpipes installed::accofd ng to plan.. f. Curtain drain outLfill protected: &ditto :exist watercourse g. .F.00ting drams .discharge:away<ffoni STS:area.........:. :... h. Surface water protection adequate, ........................ a .......... i. Erosion. control:' prodded ................. ............................... 1/-5 z .Rev. .12/02 orm' =3 0 Pm HARRY W NICHOLS 914 279 4567 P.01 52e PUTNAM COUNTY DEPARTMENT OF HEATH DIVISION OF ENVIRONMENTAL HEALTH SERVICES RFQ1 JEST. FOR FINAL INSPECTION For: Fill Date-, ILA - C& Trenches PCHD Constmctlo Permit # P 2=0 -6 q -ij Located: 4VI �r 91t1j&CLej vLTTd S (T), Owner/App.lirant. Name- 1A 4ij- 101 A fl Block :1 W Lot _j Subdivision Name.--. Subdivision Lot # Is systej) fill c.0 'mpleted? Date: Is complete? Date: Is syste-ol constructed as per plans? . Is well d.hjled-I yy-) Date: Is well located as per plans? V<--f Are ='66n control measures in place? I certify 'cba;.1, thi system(s), as.listed, at the above premises has been constructed and I have inspected and v�rified their completion in 'accordance with the issued PCHD Construction Permit and appro-vcd pia-) and the Standards, Rules and Regulations of the Putnam County Department of Healtb. Date ., 117. UC Certified by ) 4111"_ PE RA D4 professional Address am. A rg- CIL Comments- FOR:: 13 ADAM )(G.ENE O (NAME) Form FIR-99 APR-4-20&'. TEL:845-278-7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health 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 ROBERT MORRIS, PE Director of Environmental Health March 31, 2006 Re: Wyndham Homes, Inc. Apple Hill Road, Lot 32 (T) Patterson, TM# 35.4-116 An inspection of the fill pad at the above referenced project has been completed. Comments are offered as follows: e It appears the fill pad is not installed to the proper width and length. Please note that field measurements by this Department in no way suggest the exact size, depth and location of the fill pad. If you have any further questions, please contact me at 845- 278 -6130, ext. 2261. GDR:kly Sincerely, Gene D. Reed f Sr. Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 MAY-05-200E. 1.0-03 14-1 HARRY W NICHOLS 914 279 4567 P.01 PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONWNTAL HEALTH SERVICES For: Fill Date: Trenches.- PCHD Construction Permit # 10 ;2-0 - C) ,q Located: Owner/Applicant Name: TM 3 r* Block Lot ll Formerly: Subdivision Name: — L C, Subdivision Lot # Is system fill completed? Is system complete? c i Is system constructed as'per plans? Y—e- j Is well drilled? I Is well located as per plans? Are erosion control measures iii place ?, p Date: Date: Date, I certify that the system(s), as fisted, at the above premises-has, been, constructed and I have inspected and verified their completion in 'accordahce with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. Date: Cer4ed by: Ila-A Ad & PE --BRA DesiggProfessional Address: , x rJ 4 Comments, FOR: ADAM G, Ebm- (NAME) Form FM-99 MAY-9-200E. TUE OcJ:-.70 TEL:845-278-7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health May 10, 2006 Harry Nichols, P.E. Patterson Park, Ste 106 2050 Route 22 Brewster, NY 10509 Dear Mr. Nichols: DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE . Director of Environmental Health Re: Field Inspection — Wyndliarn. Homes Apple Hill Road, Lot 32 (T) Patterson The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. 1. Grading around the well head needs to be graded away from the well. 2. Erosion control fence needs repair. If you have any further questions, please contact me at (845) 278-6130,. ext. 2155. JD:kly Sincerely, Joseph 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 MAY-11-2006 1-41•1 HARRY W N I CHOLS SHERLITA A MLER, MD, MS, FAAP Commissioner of fHeahh LORETTA MOLINARI, RN, MSN Associate Commissioner of Health 914 275 4567 P.01 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10549 REQUEST FOR FIELD TESTING All information below most be fully completed prior to any scheduling. ROBERT J. 9ONDI County &ecative DATE: �.' 1� `D6 ENGINEERING FIRM: HAW W HkOh.t�- ► J�- Q6 PHONE #: PERSON TO CON'T'ACT: NEW CONSTRUCTION ❑ REPAIR PROGRAM ❑ ADDITION PROGRAM REASON; DEEPS: 0­ GcPERCS: ❑ PUMP TEST: ROAD /STREET: Im tk4kw _} 1 � l�L PAD TOWN: P Ik � OM TAX MAP #: 3 , 11(P SUBDI14SION:_ -W00� - LOT OWNER: NYCDEP CRITERIA rgk JOINT REVIEW AND WITNESSING OF SOH, TESTING YES NO ❑ Proposed BSTS within the drainage basin of West Branch or lioyds Corner & Croton Falls Reservoirs. ❑ Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. 0 Proposed SSTS.Within 200 feet of a watercourse or a DEC wetlAnd. v Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. C� Proposed SSTS fora Commerclal Project. It is the responsibility of the design professional to provide the above information prior to soil testing. The Department will determine the NYC I)EP-project status (Joint or Delegated) based on the response. If you answered yes to any,of the questions, NYCDEP must witness the soil tests. This Department will coordinate a mutually suitable time.for field testing with the Design'Professional and NYDCEP. If a project has been determined.to be Delegated based on the above response and then subsequent information indicates NY ME)? is'requ.ired to witness the soil tests, it will be the sole responsibility of the design professional to schedule re- witnessing.of the soil testing with NYCDEP. _ POR r.�UNT'YUsr ONLY _ DATE:----- - - - -- TWE• COriiMEt�tTS; . RBQ. Poa P1#* _e TRO14— P Environmental Health. (845) 278 -6130 Fax (845) 278 -7921 Water Sup' ply Section (845) 22S -5186 Fax(945)225-5418 Nursing Services (845) 278.6558 Fax (A43)27&6026 WIC(845)278-6678 Nursing Home Care Fax (845)278-6085. Early Interveation/presehool (845) 278.6014 Pax(845)278-660 MAY -11 -2006 '.HI_1 cl:Or, TEL:845 -278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P MAY-11-200E. 1, N ,: 40 1-411 HARRY W N I CHOL:_ 9 1 4 27.3 4567 P. 02 ._ Iwo* M it BY THIS CEF 1 PICATII OF COMPLIANCE THE oft NEW YORE" . PARR OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STRE97 M NEW YORK, NY 100393 OiEIRTIFIRS THAT Upon the applicetlon..of:.. upon premises owned by PMELeR ELECTRIC WYNDHAM HOMES 151 GRASV PLAIN STREET C -1 129 APPLE HILL BETHEL,.CT. Of36ol,: : BREWSTER, NY 10509 Located at 129 APPLE HILL .gRP- WSTEk, NY 10510 Application Pdut9lber. 2094820 Cerllftcate Number! 2094620 Section: 4 Block: 118 Lot: 38 8#ding Parmlt:396.06 BDC: W104 Described as a Residandal 0.599.4quere-ft occupancy; wherein the premises electrical system consisting of electrical devices and wiring, described below, located In /on the premises at; Basement, Outside, . A visual Inspeetioh of the premises electrical systern, limited to electrlCal devices and wiring 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 earn pliance therewith on the loth Day of April, 2006. ft ILA On= Mlerellaneow SzPT1C PLW3 Alvirm And Smergeney Equipment Panal Roard. , 1 0 SSMC Alarm pump Motor - 2 0 ssmc F.H.F_ Wiring and devices 015connetx ... 1 D. Motor Conttol Center l 0 9EPTlC Special M as buiN'irigypottott, of the dolitreAad ploCtri�si h irl ioe, ds emend th a an,' t*Iou1 haz W Is not present Ord ft Ir *11stion Is believed to he in camforrnance with the appfiiatble rolbreri standard for the esdir►I W Period of eonswcdw of the ptWIM wiring vatan. seal 1 or i This catlficift may not be altered In any way and Is valitfated'only by the peserrce of a raised seal at the loWion Indicted. MAY -11 -2006 TH1.: ta:G1: TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL I1EATLH SERVICES FIELD ACTIVITY REPORT _sit �.,• ._ I Street Town PERSON IN CHARGE 'I&k4 State PUMP TEST DOSE TEST I EL. START 0 O g' A A . STOP - _..... Zi,o cul( wkat �(ow�►- ail Zip REQUIRED GALLONS. 3201— 3 3 3 �r , �o O , 8 3 -Drm� 7 8 vo S o GQt � mve„ Signature and Title RFPoRT RFrFT<FT) RY' I acknowledge receipt of this report: SIGNATURE; 02/96 Rev_ Title: m �0 Q 0,, EL. START 0 O g' A A . STOP - _..... Zi,o cul( wkat �(ow�►- ail Zip REQUIRED GALLONS. 3201— 3 3 3 �r , �o O , 8 3 -Drm� 7 8 vo S o GQt � mve„ Signature and Title RFPoRT RFrFT<FT) RY' I acknowledge receipt of this report: SIGNATURE; 02/96 Rev_ Title: U 11 CM COUNTY DEPARTMENT OF HEALTH � V DIVISRON OF ENVIRONMENTAL HEALTH SERVRC CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # P' 1-0'.04 Located at AM6 h l Ll, RAO Town or Village FA 'OH Subdivision name 06159 -WOAD Subd. Lot # 'Vr- Tax Map �0 6 , Block 4 Lot Date Subdivision Approved o W D U l, Owner /AnDlicant Name ON �ke\ 0 J HL j Mailing Address I`w�l�'�►Q Amount of Fee Enclosed tit \1 Renewal Revision' Date of Previous Approval 0 t Zip 3 �� Building Type *0 Ha Lot Area 1,X6 No. of Bedrooms 11 Design Flow GPD boo Fill Section Only Depth L b Volume 11;, �' ' PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage sY teen to consist of 6 gallon septic tank and 66-1 W�- Other Requirements: To be constructed by Water Supply: or: 5� Private Supply Drilled by 'TbQ Address Public Supply From Address 0 I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatmentsystem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system o Signed: Address R.A. Date License # tyt A- 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 ermit. Approved for discharge of domestic sanitary se age only. By :I Title: t Date: White copy - Fil ; Y flow copy - Building Inspector; Pink co O n ; Orange copy - Design Professional Form CP -97 April 21, 2006 Putnam County Health Department 1 Geneva Road Brewster, New York 10509 ATT: Michael J. Budzinski, P.E. Director of Engineering Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 Tel: (845) 279-4003 Fax: (845) 2794567 Email: hnengineer@aol.com RE: Proposed SSTS Trench Permit - Lot # 32 Deerwood Subdivision Apple Hill Road Patterson, N.Y. T.M. # 35.4-116 Dear Mr. Budzinski: In response to your April 20, 2006 review letter, we note the following: 1. Distribution of trenches has been revised, 2. All trench lengths are now labeled. 3. Distribution system has been simplified with the revision. A 20 scale drawing of this can be provided if requested. 4. Force main trench detail now specifies a minimum burial depth of 3' -6 ". 5. Gate valve and union is now shown to be accessible on the detail. 6. 900 elbow is now shown on the detail. 7. Correct pump pit notes have been added to the detail. We trust the enclosed have addressed your concerns and request that ,you continue with the review and approval. Very truly yours, 0 1 Harry W. Nic ols Jr., P.E. HWN:gav 03- 056.32 t. f a 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 April 20, 2006 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Proposed SSTS Trench Planf for Lot # 32, Deerwood Subdivision (T) Patterson, TM# 35 -4 -116 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. 1. The submitted trench plan does not provide equal distribution to the trench laterals from all of the distribution boxes. 2. All trench lengths are to be labeled. �3. A larger scale schematic of the proposed distribution scheme is to be provided on the plan. ti 4. The force main trench detail should specify a minimum burial depth of 3.5 feet. c/ The gate valve and union in the pump chamber are to be accessible and operational without having to enter the pump pit. 1,,-6. The force main entering the additional box should terminate with a downward facing 90° elbow. Please refer to the enclosed sheet for the correct pump pit notes. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions: MJB:cj Respectfully, f�zijnki, Michael J. Director of neenng 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 13 Trench detail for force main, specify pipe type and rating, bedding and cover. Note stating, "All electrical work and material for pump installation shall comply with the National Electrical Code." Note stating, "An electrical Underwriter's Certificate for the pump chamber must be provided to the Department prior to the Department conducting a final inspection on the pump chamber. Note stating, "The pump control panel and alarms shall be located inside the house." s. Delineation of United States Department of Agriculture Soil Conservation Service soil type boundaries. 8. Two (2) sets of house plans with title block as specified in 7(k) above, one of which must accompany copy of approved Construction Permit to the Building Inspector of the local municipality. Upon approval of the Construction Pen-nit, the house plans will be signed and stamped: "Approved For Bedroom Count Only' . 9. If water service is from a public supply or community supply, a letter from the water supplier will be required stating that they will be able to supply the property with water at adequate pressure. 10. Well Permit Application, if required. (Appendix K) 11. Applications for Construction Permits for lots created prior to 1969 will not be reviewed until such time as the Department is provided with proof that notification of the application for construction was made to all property owners contiguous to the property in question. A location map, showing the contiguous properties along with the property owner's name and tax map number, must also be provided to the Department. Notification shall mean receipt by each contiguous property owner of a copy of the notification form in Appendix E along with a copy of the latest site plan. Proof of receipt of notice by contiguous property owners can include either of the following: 1. Copies of registered mail receipts. 2. Copies of the notification form signed by the contiguous property owners. --'----- -'----- '' -- .`--.— �,P_. 'Patterson Park, Suite 106 205O Route 22 Brewster, NY 10509 278-4003. Fax 27S-4507 '8NGULT|NQi SITE ENGINEERS . � ........... ___�'_~� ' /5(0 .COMPUTED BY DATE CHECKED BY _DATE-±1 '-� Sr w ______ _ TD 4 LU - Harry W. Nichols Jr., P.E. 'Patten6n.P'' k :'Suite 106, 2050 R oute 22 .. �. ;. -; . • ..... ..: , 8rciWater, NY 10509 ($ f - Z79-4003, Fax 279 -4567 CONSULTING SITE ENGINEERS JOBNo.- 04j "o5�� SHEET No. COMPUTED BY �M CHECKED BY �N OE Z DATE 01 11' 06 _. — _.._ ..... ---- ......__....... DATE of I`►.0w :Q s t v a :vim E ' . 7s /v o S7' 5 �rc). saT lo>= _�S__X lZ X . 68 b(�s , { i , { i Al _ -- -- — — -- — _M�9 (ail,. –` - -- -- - - - - -- � -- . -- — ----- - - - - -- h� 0 Harry V/. Nichols Jr., P.E. Pets mn Parr, Suiic 706 2050 ROUIc 22' Brcwstcr, 14Y 10509 Tv1CPhonc (8.45) 279=4003 Fax (&45) 279 -4567 Date: To: Job No.: P'L .Project -t f.. , S 75 Attention: %U4 ,vc�2�S 1� +' % .' ► GC 1i�� - Ia`! Gentlemen: We enclose (tj� copies of. Y✓ J3(W Prints Reprodticibles Reports .Tracings Specifications Memorandum Copy of letter. Description. RevisionlL)ate No. r�G i v��, 0 "'? ✓ ya Tj�.�G4_��c� Gf fG� D PUTNAM COUNTY. DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM �� ° a Owner Address Located at (Street) 14o, L A G t 1�&J Tax Map Block Lot ..(indicate neare t cross street) s Municipality Watershed &, Z2, I SOIL PERCOLATION TEST DATA Date of Pre-soaking -3 f 'go 0� Date of Percolation Test 3 f -5) f '0 ...... ... ...... . . ... .... ........... ;;..:,::. >::;:::; :.> .... ...... ... .................................. ... .. ..... .. ................... . .... .. .. ....... .... .. . .......... ... ........ .......... ... .... .... . . . ............. ..... . .... . ... ..-. a . - e »::>«::<. >:<;<: <.. .... .. ................... . .. . ..... . .... ... ......... .. rcc .. . .... ... . ..... .... ... .. p ....... .. .......... .. . . . .... . t ....... ... .......... .. ........... t MW J-1 1 0 3Z: 1 d "q 2 /0 2-i 2 1 &1 CIO 3 i 0 2-- 7 1 21-1 .4 5 2— 2 iM'7 -W, 5-cl 3 12- 4 5 2 y W, 3 4 5 i. tests to be repeatecl at same depth until approximately equa► percolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, :5 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 January 17, 2006 Robert Morris, P.E. Putnam County Health Department 1 Geneva Road Brewster, NY 10509 Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 Tel: (845) 2791003 Fax: (845) 279-4567 Email: hnengineer@aol.com RE: Individual SSTS Revision - Lot # 32 129 Apple Hill Road Deerwood (Windsor Woods) Subdivision Town of Patterson, NY T.M. # 35. -4 -116 Dear Mr. Morris: Enclosed are the following relative to Pump System Design: 1. Five (5) prints of SS -32 "Trench Plan ", rev. 01/17/06. 2. "Construction Permit ", dated 01/17/06. 3. Revision Fee in the amount of $250.00. Kindly process the enclosed at your earliest convenience. Very truly yours, Harry W. N'. hols Jr., P.E. HWN:gav 03- 056.32 MAP.- 22- 20C::- 'L -4 HARRY W NICHOLS 914 279 4567 P.01 IPUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL ONMENTAL HEALTH SERVICES " REQIMSIPS?R FINAL, INSPECTION For: Fill Date: Trenches PCHD Construction permit # P :10" 0 Located: �� (T) -�i' �''" 4 Owner /Applicant Name: TM 3F,' Block _ Lot 1 FormF rly ._..__.... Subdivision Name,: Subdivision Lot # _ Is system fill completed? Date: " �1 I's system complete? Date: Is system constructed as per plans? Is well drilled? Date: Is well located as per plans ? , Are erosion c6htrol measures in place? I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and ,verified their completion in 'accordance with the issued PCHD Construction permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. 1 i '"1. t7 A Date::. Certified by: Address: Comments: FOR: G ADAM YGENE 0 (NAME) PE �RA Professional Lic. # 4�t Cpl Form FM -99 MAR- 22 -200i: 11 -1 LfiZI :q:= TEL:845 -278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health 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 February 14, 2006 Re: Proposed SSTS: Wyndham Homes, Inc. Apple Hill Road, Lot # 32 (T) Patterson, TM # 35 -4 -116 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. Revised plans have also been submitted showing a pump system. However, only trench plans have been submitted. A review of this Departments files indicates that the fill section has not been approved. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:kly V ly yours �/ /41yo Robert Morris, P.E. Director of Environmental Health 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 IVISION OF ENVIRONMENTAL TAL H EAILTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM � PERMIT # O- O Located at F 141 T—' ,&p Town or Village FA 6 � Subdivision name � � '�� Subd. Lot # Tax Map t�, Block 4 Lot Date Subdivision Approved (2111-41 n - Owner /Applicant Name V� o� IA-W` Hy') iW - Renewal Revision Date of Previous Approval Mailing Address 11LA" CX)D I Zip _ Amount of Fee Enclosed 4 ;n Building Type P156 *1v4li5- Lot Area= A No. of Bedrooms Design Flow GPD CPV3 Fill Section Only X Depth V- 6" Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL, IS COMPLETED Separate Sewerage System to consist of k I D � C�4 Other Requirements: IL I COO gallon septic tank and G G-7 i-F . To be constructed by T B D Address Water Supply: Public Supply From Address or: Private Supply Drilled by a by Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date -7) !�-& I V+ License # 5 61 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 considerednecessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit:; Approved�ld` )discharge (/ domestic sanitary sewag( /e o}rly. By. ; °,., A� `'�� Title. Dater 0-1 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: Town/VAITge Tax Grid # �� sd k-J /0 Map Block -4 Lot(s) 11 Well Owner: Name: . (/L� Aml edress: 6 Gdthwcod yJ v► /nta e,3 l v e, Div 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 5157 Est. of Daily Usage dal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling `New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type __I,,�-brilled Driven Gravel Other Is well site subject to flooding? .......... ............................... Yes No Is well located in a realty subdivision? ..................... ... ............ ............................... Yes__),,' No Name of subdivision - �G�r> -ax ✓U Lot No. Water Well Contractor: TAD Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: _ &I /- Proposed well location & sources of contamination to be provided on separates eet/plan. Date: Applicant Signature: 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. 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. ,` r Date of Issue / % Permit Issuing, Official: Date of Expiration �;' 'i. ��t `?� Title: Permit is Non- Transfirralile White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 0 � h M t M ti i X36' 6Z' - - --� 7 --t 1 00 GAL. %oo S Pnr--(Asi PUMP r -"KOER X55 EXPAN6%ON Z0, QO (u A O rr� Z o I -P 8 Qz cu u N k'm bolter 56' ` PVC SD2.36 ' 22, 9 ' ZI G� 4 "� so61D PYC C'fYP) ' 19 ZS -5 " s9' is :Jts -f Sox 16 '474 6 1YP i5 GOD J o N n °Q . m 1 �= tO°o6'SO 502 °31'10° F io.4 R = 1025.Ob' APPLE HILL. ROAD r, i Z' ._ ...._... ,- �. I �',, �, �, �? N �.�': � .; O I