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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -4 -117 BOX 16 01778 III all Xf T ,1 01778 D ' O PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF. ENVIRONMENTAL HEALTH . SERVICF-;! CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # P- 1 d Located at 1q, TI�A - L-A Owner /Applicant Name Formerly Mailing Address 1 cw" No %cio Date Construction Permit Issued by PCHD Town or Village _ Tax Map ' 1 Subdivision Name Subd. Lot # Block 4 Lot j)F51�p--woo® P-w4 wW5i 5F- 0� Separate Sewerage System built by W09WAM M 1kL` Address Zip o u� i cow dd jmo D�W 84AVA 0 Consisting of 15-60 Gallon Septic Tank and ftj �-F N66.' I P-I�H &4 Other Requirements: 3� , / %W Ly P-'0'6; Pllw Water Supply: Public Supply From Address or: X Private Supply Drilled by B 0 f V M -Z% 10 \XU Address l Bch KSti 1- P(MfLt i D ......t _ .. .. .._ _�........ ye;. Has Prostnn �ontrnl beenromplQ�d ?. Number of Bedrooms A Has garbage grinder been installed? �40 IVjgkti 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 regulationp of the Putnam County? Department of Health. Date: 0q- 2,(- Dj Certified by P.E. k R.A. Address f�0 S c) � `'?/ � [JV]- -!'`!� W f•� � ,�.1�, j p 5 Q License # 5 (v) 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 bject to modification or change when, in the judgment of the Public Health Director, such revocatio , o ificatio r change is necessary. B /i,G4 Title:` "' Date: Y� p White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 Sep 06 06 09:34a TOWN OF PRTTERSO 845- 878 -2019 P•! S6P -86- 2005 09:04 AM HARRY W NICHOLS 914 279 4967 P -02 i-� �....6'_ BRUC>B Af• POLBY.. .. * * tAAFJTJ1.,jrtOLJPfNU`RN.. M.S._ .. F PON i4wllk DWater P" mak &.11w DEPA.Mv NT OF MALTH 3 Osr4ve Raid Browner, New York IM ie�fnssuw H640 (914) VA - fil7C (txtil /} i ?i•i93d ' xu9>� e++Yiw �lut)t•a�e>t wlc ioa}��i•aatl .i�(i)q rt •ao:: . I�rly'lSkrria'�de'{9)fj7rr.60)� ®ro+46wt (91gi7t10i2 Ywp14�T7P.bs19 :. . _ F911 D��'4,�_VF,�4�I . 'i'f j�'r_ nk�Vt .. • — bWt4E S Nom: �i>'t �rAi°'y �usvt�5 e.. ►r- TAX Ml r MUMER '1y ° 11•i E917 ADiiRlr$Si !2- To • .. (Sltneturel s � :. .. . DR'IE: The•Putiieto• Couaty Department o� Health will not Issue a Certlsicate.of Construtdon Compliance unle3s the above form 13 completed; I,o., a legal' E9I l . addres* Is assigned by on authorized town officta). Tbls.form is to be submitted with the appti ation for a CortbffcatP.of Co.= net:on ti(�mpilance.. September 21, 2005 Robert Morris, 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) 279 -4003 `t Faxs ^(8 :5) 2^ r3�z•.__.,,..__.r...._..w«._�,. _.. _ . . Email: hnengineer@aol.com RE: Individual SSTS Compliance — Wyndham Homes, Inc. 12 Teal Lane - Lot # 33 Deerwood (Windsor Woods) Subdivision Town of Patterson, NY T. M. # 35. -4 -117 Dear Mr. Morris: Enclosed are the following: 1. Five (5) prints of Drawing S -33, "As -Built SSTS ", dated 09/21/05. 2. "Certificate of Construction Compliance for Sewage Treatment System ", dated 09/21/05. 3. _ �Three.(3)_copies.,o_f_" Guarantee of.Subsurface Sewage.Treatment -_ -..- System", dated 09/21/05. 4. Laboratory Report, dated 08/17/05 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 09/06/05. If there are any questions concerning the enclosed, please call. Very tr ly yours, Harry W. Nichols Jr., P.E. HWN:gav 03- 056.33 YML ENVIRONMENTAL SERVlCES 321 Kear Street Yorktown Heights, N.Y. 10598 ' - ' '- --' ----'----- T9i4T 245-2600'^-~~~~~�~~'~ Albert H. Padovani, Director LAB #: 9.501856 CLIENT #: 57197 NON STAT PR[C PAGE: l WYNDHAM HOMES 8 COLLINWOOD DRIVE RALPH TEDESCO BREWSTER, NY 10509 SAMPLING SITE: 12 TEAL LANE : BREWSTER COL'D BY: JOSE NOTES...: WELL 'TANK ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE DATE/TIME TAKEN: 08/10/05 J.0:05 DATE/TIME REC'D: 08/1O/05 1O:5O REPORT DATE: 08/17/05 PHONE: (845)-279-2022 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE.,: < 4C COLlFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ PUTNAM CNTY PROFILE 08/10/05 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 08/12/05 LEAD (INS) 9.9 ppb 0-15 ppb 9003 08/1I/05 NITRATE NITROG 2.21 MG /1 0 - 10 9052 08/1O/05 NITRITE NITROG <0.01 MG) /L N/A 9162 08/11/05 IRON (Fe) <0.060 MG /L 0-0.3 mg/l 9002 08/15/05 MANGANESE (Mn) <0.O10 MG /1... 0-0.3 mg/j. 9002 08/11/05 SODIUM (Na) 10.3 MG /L N/A 9002 08/1O/05 pH 6.2 UNlTS 6.5-8.5 9043 08/15/05 HARDNESS, TOTAL 118 MG /L N/A 08/15/05 ALKALINITY (AS 68.0 MG /L N/A 9001 - _ 08/12/05 TURBlDITY (TUR 2.B NZU 0-5 NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDI�����THE NEW 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. 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/I.- of Sodium. Fur those on a moderately restricted diet, a maximum of 270 mg/L.. of Sodium u~ � YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown He ights, kt H i ht N Y 10598 or e , . . Albert H. Padovani, Director LAB K 9.501856 CLIENT #: 57197 NON STAT PROC PAGE: 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ WYNDHAM HOMES 8 COLLINWOOD DRIVE RALPH TEDESCO BREWSTER, NY 10509 SAMPLING SITE: 12 TEAL LANE : BREWSTER COL'D BY: JOSE NOTES...: WELL TANK ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAB PROCEDURE is suggested. DATE/TIME TAKEN: 08/10/05 10:05 DATE/TIME REC'D: 08/10/05 10:50 REPORT DATE: 08/17/05 PHONE: (845)-279-2022 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATEp 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 WATBRj 0-70 MG/L _ VERY HARD WATER: ABOVE 300 MG/L _ HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) SUBMITTED BY: () �)W'o 'e � , .,/+ ELAP# 10323 Robert J. Bondi PUTNAM COUNTY EXECUTIVE 40 Gleneida Avenue Carmel New York 1051 }2 Frank J. Del Campo Deputy County Executive March 8, 2005 Mr. Michael Meyer New York City Department of Environmental Protection 465 Columbus Avenue Suite # 350 Valhalla, New York 10595 -1336 Dear Mr. Meyer, Theresa M. Giovanniello Chief Of Staff The Putnam County Septic Repair Program (SRP,) as you are aware, will be done in -house to make the program more.efficient and cost effective so that repairs can be made to the greatest amount of .septic systems that are in failure or whose performance is substandard. We here, in Putnam County, have been combining the appropriate elements of the previous plan, to sub- contract the work to an outside provider, with this new format. One of the things that were requested was a commitment to ran the Septic Repair Program for at least five (5) years. We think it unwise to specifically state this in the Septic Repair Program Plan. We do not want to announce a cut -off date or anything that would compromise the integrity or undermine the public's confidence in the SRP or their responsibility for ongoing maintenance. The County fully intends to run this program for as long as the funding is available to address these pressing environmental needs. Yes, Putnam County will run this program for a minimum of five (5) years as long as funds are available. The SRP will forward any and all inspection reports to NYCDEP on a weekly basis. If any unusual situations arise that require NYCDEP's presence for an inspection, the SRP program personnel will contact the NYCDEP by phone, fax or E -Mail. Annual reports and the funds expended under the program will be forwarded to NYCDEP, the County Executive, Watershed Information Coordinator and the Putnam County Commissioner of Finance. In the contract between the County and the NYCDEP (August 27, 2003) for County acquisition of the Airport and Golf. Course, it is stated, under Section 4, (iv) Septic Maintenance Program; "annually, but not later than each July 31 (starting with July 31, 2004), a report summarizing the activities of such program during-the preceding fiscal year (July 1 — June 30) including the number of systems inspected, number of systems rehabilitated, and funds expended." It is our preference that the Septic Repair Program's fiscal year, run from.January 1" to December 31St: The annual report will be presented in January of the following year. The reasoning behind this is that the winter months, due to weather, will be a slow period for septic repair installations and inspections. This will allow the SRP personnel to concentrate on the annual report much better than in the busy summer months. It appears that the use of the word "annually," in the above quote, could allow for this request. As indicated previously, we have agreed, to and made part of the SRP program plan, the "Priority Phase List." This includes the suggested time frames that are useful as guidelines that may need to be adjusted, up or down, depending on how many septic systems are replaced or repaired. We will be able to assess this better, when the SRP personnel are "on the ground." The question of payments to eligible parties is outlined in the paragraph, "Payment: Installer,' ' on page 6 of the program plan. Our payment structure is simplified by not having to create a corporate mechanism to channel public money to the homeowner. The installer will be paid, after appropriate inspections and in accordance with the previously agreed to, "Delegation Agreement." The Delegation Agreement is included in the Putnam County Septic Repair Program Plan. It was indicated in your correspondence that certain program elements would be otherwise ineligible for WQIP reimbursement, specifically advertising and office equipment. Since these items are necessary to public outreach and the functioning of the Septic Repair Program, .we respectfully maintain that they are eligible. Your request for cost projections is reasonable, however, at this juncture, it would be difficult to ascribe any degree of accuracy in estimating a cost projection. Any expenditure for the program will be transparent and if the NYCDEP feels - _the. need Jo. review this prior to any outlay of funds; we will be happy to accommodate such a regaest:_ To address your specific comments: "Personnel" The 'County SRP personnel will utilize tax map numbers to list each parcel. If the NYCDEP requests and would prefer GIS coordinates in addition to tax. map numbers; this can be accommodated. This would necessitate the acquisition of sub -meter GPS equipment for best accuracy. "Legal Documentation for the SRP," please refer to page 5 of the SRP. "Certified Installers," please see page 5 of the SRP. "Cost- per - Item," please refer to page 5 of the SRP and refer to # 14, "Septic System Repair Cost Guide." This is a list of the repair materials, installation elements and a range of their costs. We do not want to include the range of costs in this document. Our reasoning is that we do not wish to make it public so that we can maintain the fiscal integrity of the SRP. It would not be in the best interests of the SRP for installers to.be aware of the allowable range, to preclude going to the high side of the cost range. If you want a copy on separate cover please let me know. At least three (3) contractors will be asked to make a bid on each repair or upgrade. 2 "Standards for Installation," see page 5 of the SRP that refers to the "Individual Residential Wastewater Treatment Systems Design Handbook" that is made part of the SRP. "Appeals Process" The appeals process is covered on page 6 of the SRP. "Public Outreach," see page 4 of the SRP and refer to # 5. There will be an initial public outreach as each Phase of the "Phase Priority List" schedule indicates. Additional public outreach will be repeated as necessary if the SRP personnel, the Watershed Information Coordinator or the Putnam County Department of Health, thinks that the failure rate may be higher than the amount of residents requesting inclusion in the SRP. The initial outreach letter is marked as a "Draft," this letter will be finalized once we are in a position to get more details, such as appropriate SRP telephone numbers, the established location of the SRP, stationery and other relevant program information. "SRP Equipment," see attached "Cost Estimate For A County Run Septic Repair Program (SRP.) "Flexibility" see page 7 of the SRP. "Administrative Reimbursements" The MOA outlines what WQIP expenses are eligible and these costs are included in the attached "Cost Estimate For A County Run . Septic Repair Program, (SRP.) Section 140 (c) (vi) relates to the costs to administer the EOH WQIP fund an d earnings itself and is not for costs associated with implementation of specific WQIP projects. Section 140 (c) (vii) states, "Any other purpose approved by NYCDEP. NYCDEP shall base its orl "whether 'to"approvc -such-pi:rpese an- liet yr the- proposed- us% of :,X.ungs: v t Eop, r - - Water Quality Funds is designed to protect and improve water quality in the Watershed and is consistent with the terms and conditions of this paragraph. This program plan is a combination of relevant elements of the previously proposed sub- contracted format with a more cost effective County run program. Please review this at your earliest convenience and if you have any further questions please do not hesitate to call me at 845- 225 -3641, ext. 298. Sincerely, Edward A. Barnett Putnam County Watershed Information Coordinator cc: Robert J. Bondi, Putnam County Executive Frank J. Del Campo, Deputy County Executive John Lynch, Putnam County, Director of Planning Michael Budzinski, Director of Engineering, Putnam County Department of Health R1 0 b } COST ESTIMATE FOR A COUNTY KU SEPTIC REPAIR PROGRAM (SRP) • Engineer, (per year) • Field Technician (per year) • Data Management Clerk (per year) $75,000.00 to $85,000.00 $50,000.00 to 60,000.00 $40,000.00 to 50,000.00 Estimate (low) $165,000.00 Plus benefits as per (Bill Carlin) — 40% Vehicles purchase 2 Pick -up Trucks , (cost equivalent to 2, 4 dr. sedans) 66,000.00 $231,000.00 (high) $195,000.00 78.000.00 $273,000.00 $14,000.00 to $18,000.00 each. $28,000.00 $36,000.00 Fuel/Maintenance Estimated @ $2000.00 per vehicle per year x 2 $4,000.00 Telephone (office) per month $10.0.00 x 12 mos. $1,200.00 Nextel 3 units purchase. $150.00 each $450.00 $450.00 Nextel (per month $60.00 ea.) $180.00 x 12 mos. $2,160.00 Software (Customized) $12,000.00 to $18,000.00 Fax Machine $1,200.00 $1,200.00 Office Space (Tilly Foster ?) $0.00? $0 Office Furnishings and Misc. $2500.00 $4,500.00 Computer Est. $1500.00 each 1 Desk Top Est. $1500.00 (office) $1500.00 $1,500.00 2 Lap Tops (portable for field work) 3000.00 3,000.00 First Year Est. Total Expenses - Including Equipment (low) $287,010.00 (high) $345,010.00 2nd Year Projected Costs - Less Equipment & Start -up Expenses (low) $238,360.00 (high) $280,360.00 AUG -31 -2005 01 :29 PM HARRY W NICHOLS 914 279 4567 P.01 V PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES RMQLMS.T.Q& FINAL.INSPFSTION -For: Fill Date: wU Trenches PCHD Construction Permit # located: `--c w 1,w C— (T) =a Chimer /Applicant Name: ��Asaaa TNI Block :1 f (_ Formerly: _ �.. Subdivision Name:. r C.4da!z�.., Subdivision Lot # , Is system fill completed? Date:: Is system complete? Date: Is system constructed as per plans? Is well drilled.? _ -- Date s2 Is well located as per plans? Are erosion control measures in place? I certify that the iystem(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 an d. approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. A n Date: Address: Comments: FOR: O ADAM 0 G13NE (NAW) PE � RA _ Form FIR -99 N u,- � - :�r��a� i.ir r, i :° TP �4�. -27R -7921 "DAME: PI.JTNAM COUNTY DEPARTMENT OF P. 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION ° Date: Os Inspected by: Street J.ocation. ..:. T� Q _._ - , - _- a �._ Owner_. . ..... Permit TM Subdivision Lot # 33 1. Sewage Svstem Area a. STS area located as per approved plans .......... :................ b.. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course /wetlands .... ............................... IL Sewage System a. Septic tank size - 1,000 ........ ,250 .......other ................ b. ' Septic'tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Bog 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. .. Minimum 2 ft. Original soil between box & trenches e. Junction Bog properly set .......... ............................... 6. renc es 1. Length required Length installed 2. Distance to watercourse measured 4- / pU 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 - 1l /z' diameter clean ............... *....: 9. Depth of gravel in trench 12" minimum....... ............. 10. Pine ends . caned ......................... .......................... g..P sm p or Dased1 uV stems 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........... IIL House/Building a. house located er approved plans........... . b. Number of bedpooms ............................. .. �... ... IV. Well Well located as per approved plans . ......:........................ b. Distance from STS area measured _* 9,16 . 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 & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate .... ....:.......................... i. Erosion control provided ................. ............................... Rev. 12/02 P n _.�... f � � .-...� . ..4 _ .. _. __ _ - .ji � uv Sr�C`i �.�iIV � "�R �+'.i_i:,L PA.i3:.: �.. �� � to _� �.� .� �� �_✓ -:. _ _ . Date: 8Z3 f Inspected by: Fill pad located per the approved plan 08 0� p J.5 eK x ,Z i?,'c% 8, Fill Pad Length ?.2 Required Length C, Fill Pad Width l2.M a L15,ft 4. Required Width Fill Pad Depth 2' Q Required Depth 3, �2_ :5 ` Run -of -Bank Fill Quality O A Slope from Top to Toe Impervious Layer Installed 5 Erosion Control Installed Sieve Test Results (if applicable) Additional Comments: Reserved for Field Sketch if Applicable 47- . f . _ SHERLITA, AMLER, MD, .1VIS, FAAP `- °'Commissioner o�I!e�f� LORETTA MOLINARI, RN, MSN Associate Commissioner of Health September7, 2005 Harry Nichols P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 . Dear Mr. Nichols: ..ROBE -11 .J._ -BONDI . _ .........._.. -- ... -. .._....,.�_ _,,. r- •County Executive ���� _.,o.- _.._..._...._......_.,. DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Field Inspection — Wyndham Homes Teal Lane, (T) Patterson Lot #33, T.M. 35.4-117 An inspection of the fill pad at the above referenced project has been completed. The following comment is offered: • Trench plans must be submitted to this Department for final approval of . cnristn :l�tion.nrnr..to -ti,P. instal. iation.. cftll�e .SPpsra_te <aewa�e'.trPatnae?�.t sysrPm:;...._- _:.:.__- : - ::_. �:._:;�.- .��_: :. 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:cw Sincerely, Gene D. Reed Sr. Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 *1.. a SENDING CONFIRMATION DATE SEP -9 -•2005 FRI 09:05 NAME PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845- 278 -7921 PHONE PAGES START TIME ELAPSED TIME MODE RESULTS 92794567 1/1 SEP -09 09:03 00'41" G3 OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... SRERIJTA AMLER, MD, Mti, FAAr ROBEIrr J. BOND! r misalnner of Health 6 C'—,y E', t.OREWA MOUNAR4 [IN, HSN .t. +snr:lnlr (:Ommitd1011ar Of /fea!!h —. DEPARTMENT OF HEALTH I Geneva Rood. Rmwstw. New York 10509 SeptcmbeO, 2005 I ferry Nichols P.H. Patterson Park. Suite 106 1050 Routc 22 Re: Field Inspection - Wyndham Homcv Peal Lane, (T) Farretslrn Lot 433, T.M. 3�.-4 117 , Clear Mr. Nichols: Ao inspection of the fill pad of the above i eferenchl pro /oct has h,rn completed. 'fhe following comment is offered: • Trench plans must be submitted to this Depnrtmeut for find nppi oval of construction prior to the installation of the separate xwage treatment system. Please note that field measummtent by this Department to no wa% sligge,t the cxact cive, depth and location of the fill pad ff you have any further questions, please contact me at (845 t Z'/ of .10, cm 2161. ti1nl:,Te'IV. �- �9 zn2e4 Okne 1). Rccd Sr. Fo%imnmcntal flenith Enpir,tamg Aidc (iDR:PW 2avloa hd tfeaah 1241127!{-6130 Y.. 194%) M, IRnr0a0641A— (245)27"1"8 q, (045)2 ?R•6076 Wll'(Pe r))72.1i5 rY Narq•R NOmr l'Rn FRx (245) 270.6081 Eorlyinterventiena'rnrh 194$)27Pfiola Fn(0d')770.y540 s S_ HL_ RLITA AMI k M_S yFA_ AP; s ~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 September 28, 2005 Re: Field Inspection — Wyndham Homes 12 Teal Lane, (T) Patterson TM # 35.4-117, Lot # 33 The above referenced separate sewage treatment system can be backfilled. There are no open If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. GDR:kly Very truly yours, rn MK mm. Gene D. Reed Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845)278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 a--:. Sheen o f _ -_�- . * PITTNAIYI T DEPARTMENT OF HEALTH TC�QUN /♦ N1A EA i,, vkk I —I, E'N = :Y04 FIELD. ACTIVITY REPORT I�iO UVGt�i rya lb TelL, gn1)RF"L1�� sm y, Street Town -State Zip - PERSON IN CHARGE DR TNTFRVIP, D Name and T_ itle ..- - TYPE OF. FACMITY : y ` FINDINGS.-.. 3� - :a "er a { ?` -•.s -. (`; .:�J - ?^ r-a C^. -��-` d'J?'^ C +J.�::L 1�i �.r... ]�t..iTdtC.a : ^ "�f��>'��'y�.,'��v-- EZ_•.� -^^- ^•�r,vi`7 v s.: -y.Y. - _ _-. ^.v 'a^ w r .. 44;z ILI y i Signature. land "Title FVF.T) RY _'G,- .REP(1RT$F( I -ackn' 6Wledge.rece !pt ofthis report: _ SIGNATURE; 02/96 ", t ` ` .Tile, , PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 'r � r <ti�- CONSTRUCTION PERMIT VOR� SEWAGE fiitE AT1VIEN1' SYSTEM PERMIT # f' 14 — o,4 "k- T PE 1-4 G V4 L 6 Located at i i, _re A �- l—A H15 Subdivision name Di�'FEP wtJ00 Subd. Lot # i5-j Date Subdivision Approved Town or Village Tax Map ^� 5 Renewal PAT TEI --60H Block 4 Lot � 1� Revision Owner /Applicant Name W-f NOAPIM HOW ) iHC' , Date of Previous Approval Mailing Address Go Lt.► M w o o p OP-1,415 8P-0 �I�1 -- j Zip j 0 Amount of Fee Enclosed Building Type Lot Area is `� No. of Bedrooms Design Flow GPD X00 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of i P4HLIA iy5o gallon septic tank and Soo vF A,65. Other Requirements: ��ZS i Atit 1W, To be constructed by OYNt4Pt\ ES c ���' Address ri COLLAPWMe 045 46\410- NKMO� Water Supply: Public Supply From Address _A ddress . _.. - I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment s sy tem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. L �- Signed: P.E. X R.A. Date Address S o �7— � iJ� ®5 0 tl License # �— APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless, construction of the sewage trea system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified en c nsidere ecessary by the Public Health Director. Any revision or alteration of the approved plan requires a new perm . pprove f discharge of domestic sanitary sewage only. By: Title: Date: �l White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 P11- HARRY W NICHOLS 914 279 4.567 P.01 TY PUTNAM COUN DEPARTMENT OF REALTIR D"ION OF ENVIRONMENTAL MLTE1 SERVICES For: Fin Trenches PCHD Construction Permit #_Q Located—_ (T) M pocyt"126� Owner/Apphcant Name: jA*mUAm Hae%eu 1W.- TM AS, Block A- . Lot -jj3- Formerly: Subdivision Name. Subdivision Lot # 3% Is system fill completed? Is system Complete? Is system comaructed as per pious? Is well drilled? Is well located as per plans? yes Are erosion control measures in place? Date: Date: at-tim-01 Date- M-I&- 0A I cenif,, that tbe-",�exn(s)) as Wed, at the above premises has been constructed and I have inspected and vcrified 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. Date, — -:56A.-I it. (>5 _Certified by: L E RA Address- 9050 "CIS-L ZZ 0-1 1092ILic.# S612!!j Comments: FOR: 0 ADAM W.GENE (3 (NAME) W1,0U. �::l SEP-16-2005 F!7-"L- L.7:0c' TEL:845-278-7921 NAME: 1 UTf 1AM COUNTY DEPARTMENT OF P. i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner W� NON P�cn N01�1�� IHL,, Address �1 bOLI tt\j\ c o W, hwV4GtT,41, 10S07 Located at (Street) i2 TEL �-P`I MR U6 MU, � (\fl Tax Map °5�� Block 4 Lot i �� (indicate nearest cross street) 0% Municipality Watershed �1 SOIL PERCOLATION TEST DATA Date of Pre - soaking / i D S Date of Percolation Test 44 o �� 2� `� M, n / I 2 946 941 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal pdrAi ion- 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 2 4 3 f4�� loss �� Za 23 III NOTES: 1. Tests to be repeated at same depth until approximately equal pdrAi ion- 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 Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 Em 2050 Route 22 r _ . F!,P'Iv 'r T; NV 1 G ^0 Telephone (845) 279-4003 Fax (845) 279-4567 Date. To: P (114.9. (aEH5VN DoP� Attention: Job No.: Project bar Gentlemen: We enclose (S) copies of 3/W Prints Reproducibles Reports .Tracings Specifications Memorandum Copy of letter Description: Revision/Date No. 1 12 _314 0 Sent Via: Rur Messenger Nueprinter Your Messenger Hand Delivery Copy to First Class Mail Special Delivery Very chols Jr., PIE. O PUTNAM COUNTY DEPARTMENT OF HEALTH SION OF ENVIRONMENTAL HEALTH SERVI CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM OsY, PERMIT # - Located at T u Lcz Town or Village Nl 1 � e ►r S'cr Subdivision name J'.�w� ����� �� Subd. Lot # '3 3 Tax Map 35', Block -4 — Lot -7 '�Y Date Subdivision Approved U 2 Renewal Revision Owner /Applicant Name Date of Previous Approval Mailing Address :2 �v 1-twood D i- j ve__ r t�tyi ull /V Zip �1 3 Amount of Fee Enclosed 5�Z o o Building Type k c, �e,,JZ'tj Lot Area No. of Bedrooms - Design Flow GPD Fill Section Only !,,� Depth a , Z.q' Volume 8 oG C. Y PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage 51stem to consist of 1 2-7 gallon septic tank and Other Requirements: To be constructed by % � � 6,)o )o Address Water Supply: Public Supply From Address __..... _ .._...... -Address ellf 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 License # q c APPROVED FOR CONSTRUCTION: This approval expires two years. from the date issued unless construction of the sewage trea system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified en nsider necessary by the Public Health Director. Any revision or alteration of the approved plan requires anew pe x. A prov d or discharge of domestic sanitary sewage only. By: Title: Date: l? White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 5 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES please print or type PCHD Permit # Well Location: Street Address: Town/Village Tax Grid # o Map '3 " — Block Lot(s) Well Owner: Name: &KcSZ1 &)i Addres'1 //I ' A-i YQ- GJ 'C -r�'o k N k !'n l k r.vaoJ vei 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 1 gpm # People Served !f" 4 Est. of Daily Usage %0-0 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling L/" 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 il' No Name of subdivision Lot No. 33 Water Well Contractor: T 6 D Address: Is Public Water Supply available to site? .................................. ...................... .......... Yes No t/ Name of Public Water Supply: A � A--- Town/Village — Distance to property from nearest water main' : Proposed well location & sources of contamination a provided on separat heet/ Ian. PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Directo y revision or alteration of the approved plan requires a new permit. Well to be constructed by a wat wee" drille ified by Putnam County. J f Date of Issue r� / �(' �> Permit Issgi Official: Date of Expirations R f 2 3 f() I— Title: Permit is Non- Transfefrabie White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -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 March 15, 2005 Re: Proposed SSTS: Wyndham Homes Teal Lane, Lot # 33 (T) Patterson, TM # 35 -4 -117 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. Fill must extend 10 feet horizontally past the edge of any .trench. 2. Side slope of fill is to be a minimum slope of 3:1 expansion trench lengths are to noted. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:kly Ve) ly yjo�urs, Robert Morris, P.E. Senior Public Health Engineer 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 March 14, 2005 Robert Morris, P.E. Putnam County Health Department 1 Geneva Road Brewster, NY 10509 RE: Proposed SSTS - Lot # 33 Teal Lane Patterson , NY T.M. # 35A-117 Dear Mr. Morris: Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 Fax: (845) 279-4567 Email: hnengineer@aol.com In response to your March 7, 2005 review letter, we note the following: 1. Fill shoulder extends 10' min. from proposed trenches. 2. Grading adjusted to 3'-2" minimum fill. uir r-r- e e Reflecting the above, enclosed are the following: Five (5) prints SF-33 "Fill Plan", rev. 03/11/05. Two (2) prints SS-33 "Trench Plan", rev. 03/11/05. Kindly continue with your review and issuance of the permit. Very truly yours, Harry W. Nichols Jr., P.E. HWN:gav 03-056.33 Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 ® 2050 Route 22 Brewster, NY 10509 Fax: (845) 2794567 Email: hnengineer@aol.com February 28, 2005 Robert Morris, P.E. Putnam County Health Department 1 Geneva Road Brewster, NY 10509 RE: Individual SSTS Revision - Lot # 33 Teal Lane. Deerwood (Windsor Woods) Subdivision Town of Patterson,, NY T.M. # 35.4-117 Dear Mr. Morris: Enclosed are the following relative to a shift in the building location: 1. Five (5) prints SF -33 "Fill Plan ", rev. 02/23/05. 2. Two (2) prints SS -33 "Trench Plan", rev. 02/23/05. 3. "Construction Permit dated- 02/25/05: - ,. _.. _ _..... _ . . _ _._.... �4. "Well Permit ", dated 02/25/05. 5. Revision Fee, $200.00. Kindly process the enclosed at your earliest convenience. Very truly yours, Harry W. Nic ols Jr., P.E. HWN:gav 03- 056.33 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ` CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT it I —� Located at -e � �ct Town or Vil e /�h(z' ,,rSG Li Subdivision name A&C -rw00i Subd. Lot # Tax Map _ Block _-t_ Lot 7_ Date Subdivision Approved ! — a-1 -O Z Renewal Revision Owner /Applicant Name W LA t-j Gyt.,., 9°�%,rv,� r� 1� c, Date of Previous Approval Mailing Address n d e l woc � fi y-, �e / Q e.�r /V �,� Zip Amount of Fee Enclosed Building Type lt,; Lot Area No. of Bedrooms _ Design Flow GPD4) Fill Section Only l/ Depth %26� Volume 8 00 G, Separate Sewerage System to consist of 17_ gallon septic tank and Other Requirements: 312.5 F, I I � - 9 1 To be constructed by 6 /) Address Water Sunnly: Public Supply From Address or: 1�rivate Supply iled by --Address ...... _a.._ _ ��..:. 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 o Signed: Address R.A. Date 1 —.0 —6s— License # �'4 ( 26 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 w onsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. Led f scharge of domestic sanitary sewage only. r By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design rofessional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .1 AT ATIQ ? TO CONSTI hL�T A�.WATER WELD: -- - _ _ _ ^, please print or twe PCHD Permit #� ^ �+ Well Location: Street Address: To N ge Tax Grid # e L h e- 10' a orre", Map ,s"', Block Lot(s) / Well Owner: Name: 1uJL.% Address: Use of Well: —L,,,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 "T gpm # People Served Est. of Daily Usage 66& gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling 4,.- 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 A.,-- No Is well located in a realty subdivision? ...................................... ............................... Yes Name of subdivision Lot No. 3— Water Well Contractor: 71610 Address: �- 1� Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination be provided on separates et/ lan. Signature: ._Applicant - - - - - 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 ller certi ed by Putnam County. �r- Date of Issue J Permit Issuincial: Date of Expiration Title: Permit is Non-Transferilable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 I acknowledge..eceipa of this report S:,IGNATURE; 02/96 Title; September 9, 2004 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 TO: (845) 279w4C'03... �. Fax: (845) 2794567 Email: hnengineer@aol.com RE: Proposed SSTS Wyndham Homes, Inc. Deerwood Subdivision - Lot # 33 Teal Lane Town of Patterson T.M. # 35.4-117 Dear Mr. Morris: In response to your August 13, 2004 review letter, we note the following: 1. Impervious barrier for fill pad is now shown top be keyed into the existing soil. Please refer to fill section detail. 2: Cleanouts have been added to all pipe connections. 1IVe trUSt the enclosed have addressed` your concerns 'and ^request that you continue with the.review and approval. Very truly yours, o J-,3 .:4 Harry W. Ni hols Jr., P.E. `D HWN:gav 03- 056.33 C Zn J! PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES„ _ ... AFFIDAVIT - CORPORATE OWNER APPLICATION "" FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: PFF_�_WDW represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: Having offices at: )S � Whose Officers Are: President - Nam`e`7 , ���� Vice President - Name: Address: Secretan, -Nam Treasurer - Name: I Address: and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating the. o. i rJA Signed- Title: Sworn to before me this day of (month)- _)0 (year) <Notary� ublic J N2172 OZADO Corporate Seal No� ry Public, State o4 Near York No. 01R0610333s Chmlffi®d In Putnam coujIty ornm'ssfor: F sln 3 _12/2=007 Form CA -97 k0303 2100061 , ARTICLES OF ORGANIZATION OF WYNDHAM DEVELOPMENT AT WINDSOR WOODS, L.L.C. Under Section 203 of the, Limited Liability Company Law Filer: Hankin, Hanig, Stall, Caplicki, Redl & Curtin LLP 319 Main Mall Poughkeepsie, NY 12602 REF. 07C15620 Cos Rd LD Z I HVW 0 - Al?0�� STATE OF NEW YORK MiLE tiT OE , #ATE DEPART MAR 2 12003 _ FILES APR 10 2003 DRAWDOWN NIS -27 �' 0303210u6q'.T1 LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Enyironmental 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 Harry Nichols; PE Patterson Park, Ste 106 2050 Route 22 Brewster, NY 10509 RE: Wyndham Homes, Inc: Teal Lane, Lot # 33 J) Patterson, TM # 35 -4 -117 Reservoir Basin Dear Mr. Nichols: ROBERT J. BONDI County Executive August 10, 2004 The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on July 9, 2004 is complete. The Department will notify you by August 30, 2004 of its determination. ._ .Q: _ P pC.1ect *tit s 1'+ nn__a n�n4nea. .F. .. Tf+ -„ _J�. �„ ..a„ .,e.,.� del„t,u�..14 t3 c:C Pii`�T'i;iiii Cvuiity leaitii 2)5ai$iTiGli'c for review pursuant to the guidelines set forth in the Watershed Agreement. 0 Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should Letter to: Harry Nichols, PE '-ErivirbrimeriLal�-Pii)feafbii re4g-*a*ra'in--g'-'s'u6tflz-activities�-to-see ^ Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 278-6130 ext. 2166. Y ry ' -ly Yours Robert Morris, PE Public Health Engineer RM:Ian July 2, 2004 Putnam County Health Department 1 Geneva Road Brewster, New York 10509 ATT: Robert Morris, P.E. Re: Individual SSTS Deerwood Subdivision - Lot # 33 TEAI,. Lane Town of Patterson T.M. # 35.4-117 Dear Mr. Morris: Enclosed are the following: Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 „ Tel: 1845Yw 79 -41 -103. Fax: (845) 2794567 4• 4W .Email: hnengineer@aol.com 1. Two (2) prints of SS -33, "Proposed SSTS ", dated 07/02/04. 2. Five (5) prints of SF -33, "Preliminary Plan for Fill Placement Only". 3. "Short EAF ", dated 07/02/04. 4. "Application for Approval of Plans for a Wastewater Disposal System ". 5. "Construction Permit for Sewage Disposal System, ", dated 07/02/04. "Application to Construct a Water Wefl ', dated 07/02/04. - .. 7. "Design Data Sheet ". 8. "Letter of Authorization & Corporate Resolution ", dated 07/02/04. 9. Two (2) copies of Residence Floo lan(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. N' ols Jr., P.E. HWN: gav 03 -056.33 14 -164 (9/95) —Text 12 PROJECT I.D. NUMBER 617.20 SEOR Appendix C State Environmental Quality Review "ENVIRONMENTALPASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) . 1. APPLICANT /SPONSOR ' N! + �9 t� 2. PROJECT NAME pro ?a�GD 6 IG) Loy 3. PROJECT LOCATION: P�TV�C) Munlclpailty County 4. PRECISE LOCATIO1 (Street address and road Intersections, prominent landmarks, etc., or provide map) 5. IS PROPOSED ACTION: New 0 Expansion 0 Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LANDAjF /F�ECTED: y � � y acres Ultimately acres .Initially 8. WJ}L{L, PROPOSED ACTION COMPLY WITH EXISTING ZONING OR-OTHER EXISTING LAND USE RESTRICTIONS? ayes ❑ No If No, describe briefly 9. W�H,{AT IS PRESENT LAND USE IN VICINITY OF PROJECT? Xesldential 0 Industrial ❑ Commercial ❑ Agriculture 0 Park/Forest/Open space ❑ Other Describe: H(o 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? Kyes 0 No If yes, list agency(s) and permit/approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? aYes 0 No If yes, list, agency name and permitlapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? CgNo. ❑Yes I CERTIFY THAT THE PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE INFORMATION ' ' ` rD \1 " � ', " " W' ' 02A6 ` N4' Date: Applicant/sponsor ame: Signature: I/ U If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617A? If yes, coordinatethe 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,pegati q declaration _ may 6e'superseded- by'a'6-6fhe involved agency' :.,rw_ :... ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise. levels; existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly. ©� C5. Growth, subsequent development, or related activities likely to be induced by the proposed'actionOWjain briefly.' C6. Long term, short term, cumulative, or other effects, not identified in C1 -05? Explain briefly. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA? ❑ Yes ❑ No E. IS THERE, OR IS THERE, LIKELY TO BE, CONTROVERSY RELATEb TO POTENTIAL ADVERSE, ENVIRONMENTAL IMPACTS? ❑'Yes_.... < <,❑ No-.. .if'Ye "s, explain briefly y —_ PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For.each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should. be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability, of occurring;. (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part II was checked yes, the determination and significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a positive declaration. ❑ Check this .box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer, in Lead Agency Signature of Preparerr(If different from responsible officer) Date v 1 1 \ 1-11 f 1 V l A 1 A. A-, J.J1. -4 11\ 1 1i* 11.:11 \' 1 V 1' 11J.:JPXJL •1.11 " - --- •- _ DIVISION . ENVIRONM ENTAL -HEA LTH•.SERVICES`: APPLXCATION FOR APPROVAL OF PLANS.fOR - A 'VASTEW:ATER --REATIYIEN S' - Si'EM!: _,..Y.�... _...1...N.ame and'addrs °s or ^applicant: ,.. i 2. Name of project: _ L�D 1 '71 2�31 3. Location T-fV 4. Design Professional: �_ W. tt�t 01-S j(t- F'�, 5.. Address: K11. ..� 6-. Drainage Basin: 7. Typ e of Protect: Private%Resdenfial Food Service Commercial -, Apartments : - Institutional iviobile Home,1 k. -. - = Office Building Realty Subdivision _TOther (specify) ` 8. 'is this project subject.to State Environmental lity Review (SE Qua QIZ) ?' Type•Status (check-one)-.-.: - Type Type II ` - = Urilisted jC 9. Is a Draft Environmental•Impact Statement (DEIS) required? ............ 10. Has DEIS been completed and found acceptable. by' Lead. Agency? ...:...;.r, 11. -Marne of Lead Agency _ .Is this.project in an .area under the control of local placating, zoning,,or other = = officials ordinances? ...... :................................................. '11' - ,Lf so; have plans •been su(;mitted-to.such authorities? ........ ............................:.. 14. Has preliminary• approval been- grarited by such authorities? 0 1Date granted:^ • 15 Type of Sewage. Treatment System Discharge:....;....* ......... surface'urater Xground,Yfate-r 16. If surface•wafer dish e-:what is the stream class; &si ation? :...::.::' :::. a , gt? 1 17. Waters index number (surface) 1.8... Is project located near-a public water supply system? ............ 19. If yes, �ofviater -su 1 Distance to wadi' su 1 Y 1 PP Y lei Pp Y -2-0: is - pfo'ect site near a public sewage collection or tieafinent'systern? :- - ::...e - " Name of sewage-system :.I`1' - Distance;ffl i. e age sysfe -M — 22. Date.test-h�ol�es obstrved 1 23: Name of Health.Irisgector 1�L� g 1,c��yir 24. Fro _ j` ecfdesignfflog( gallonstierday.)..... .................... ...... ..........:. :.:..: :�.:..... -:.. `t Q = -- 25. Is State Pollutant Discharge Elimination System. (SPDES) P rm% t.requ'1` d' : _ fr 26. Has SPDES Application been submitted to local DEC office? ............ _ Form PC -97 tt^•.>�y: �. ,i' .. a 0., .. - . °b'•.. .. _ .. •- 47; Is �a�dT_ or m i, of this pioj•ei;t located- vrathin aidesignated Town or State wetland? e� T4vlo) —' 28. Wetlids. Number ........................ .............: .............::. ........::.:.... :.:..... : :....• 29. Is Wetlandg Permit required? ...:::.:....... � , Has application been made'to Town or Local DEC office? ` 30. • Does project require aDEC Stream. Disturbance:Peftit? L 3 1 : Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfillin, sludge application or industrial activity? ............................ Yes/Nq 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 0 DESCRIBE: - -- . 33. Is. there a local master plan on .file with the Town or,Village? .......................... 3 34.. Are commuriity water and/or sewer faciIities.pIanned to be.developed:within 15 years in or. adjacent to project site? ................................................................. t i Q 35. Are any sewage treatment areas in excess of 15% slope ?. .............. 36. Tax Map ID.- Number ..............:........ ............................... Map's Brock" Lot in 37. Approved plans are to bereturned to ..... Applicant Design•Professlonal All applications fovreview and approval of•a new SSTS to be located within the NYC Water :shed shall he.serit to the Department,. and need not be sent in duplicate to the DEP-, although the' project may require DEP' _ "approval o'f the"SS7S priur to final =approval by the Department. Projects vAthin the watershed.-ma also require DEP'ren ew: and approval. of other aspects of a project, such as stormwater pt'a xs_or the crea[ion of impervious.surlaces, 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 aperson other than the applicant shown-in Iteia l:,the application must be accompanied by•a Letter of Authorization (Form LA -97): Failure•to comply with this .'provision. maybe grounds for. the rejection of any submission. I hereby :affirm; .under penalty of perjvry, that.informationr provided -on -ill-is form. is true _ to the best of m' knowledge and betief. False statements mate' erein: are punishable'as -� a Class A misdemeanor ursuantioSe6tIO7210.45oftlaP enal La SIG.NAYURES -& 'OpFICIAL TIT I;FS; ' W .4EK Mailing Address :.... .....:..............:... :...... ...( PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at Town or Village P/4i1'E��a�P Subdivision name - Subd. Lot # '64-) Tax Map'h"�) , Block 4, Lot Date Subdivision Approved E i 1 i- Owner/Applicant Name W"DkW AOO�P5 3 WG Mailing Address 1 Amount of Fee Enclosed Building Type i C,DlAA0'vJdC)fl D p*15 �Q Renewal Revision Date of Previous Approval Zip i Lot Area No. of Bedrooms Design Flow GPD U0 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and 15 00 Lf Other Requirements: '1, i pip, To be constructed by D Address Water Supply:. Public Supply From Address er:_ yl . pr,vatP c,�FPly Llrilled_b�y _ _. _ 'T"Gc ._ nad:ess 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 _ .E. i� R.A. Date i4 � License # %114 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only. Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL . please print or ripe - PCHD Permit # _. Well Location: Street Address: Town/Village Tax Grid # H Map Si; + Block A Lots) 11 Well Owner: Name: f Address. M115 PAII (y 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 'fir– gpm # People Served !L�( Est. of Daily Usage _gal. Reason for Replace Existing Supply Test/Observation _ Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type X Drilled Driven Gravel Other Iswell site subject to flooding. ........................................... ............................................... ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yeses_ No Name of subdivision Lot No. Water Well Contractor: Address: – Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village — Distance to property from nearest water main: Proposed well location & sources of contaminatio- to be provided on separates et/plan. Date: Ap p _e. r! , _ ..nah _ e. - 1. 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 PUTNAM -COUNTY DEPARTMENT OF . HEALTH: DIVISION OF •ENVVIRONMENTAL HEALTH -SERVICES : ::::' LETTER OF AUTHORIZATION, RE: Property of Located at T/V PA-�M-�tJ Tax Map ## 06 Block _Lot � = Subdivision of�-'�� Subdivision*Lot # Filed Map # 2-00V Date Filed_ _. Gentlemen: T This letter is to authorize a duly licensed Professional Engineer >< or Registered Architect to aMply for the. required wastewater treatment and/or water supply permit(s) to serve the above - noted - property :in :ac"'cor" ;-I c— with the standards, rules or regulations.as promulgated by the Public Health Director cTthe,- Putharri,- County Health Department. and to sign all necessary papers on my behalf in connectiort;witli this matter and to supervise the construction of said'wastewater tretment and/or water supply systems in conformity with the pro�cisions. of Article .145 and/or.147_of the Education Law., the Public Health*-"-. and •ih8 P utilain _ .�.... z_ .. _ ..___._..._. 4 �f NEW 1,09 -Countersigined: P.E., R.A., # _ Mailing Address State . Zip. 5b 11\ Telephone: Very truly yours, Signed: ((Dl cr or Prooperty) Mailing Address: State `i Zip �J . Telephone: (%,T�lj -.. Farm LA -97 i,ETTER OF ATJTHORIZATTON RE: Property of1���- F��Ci1�'J Located at T/V � Tax Map # Block _Lot � := Subdivision of�� Subdivision'Lot # �0�5 Filed Map # Z 1 Date Filed..-." iled. —. Gentlemen: This letter is to authorize . �1L�� -- a duly licensed Professional Engineer >< or Registered Architect to ply for the required :.I . §.•ice..::•.:,. 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..Putiiairi County Health Department. and to sign all necessary-papers on my behalf in connection.,wiff- 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: Vie, Public Lug; aiiU a rutnarri County`Sariitary Code. _ _ _ _ - r' gn Mailing Address State Zip. Telephone: � � �.-� w Very truly yours, . Signed: (0 cr of Prooperty) Mailing Address: i ?� pp State O "J Zi ..,` P Telephone: L U. 11YtJ.lY1 1._A 4-) IN 1 1 1JL' Xii1t11Y1:GlY• 1 lJr. -11L' filJ1'Xl DZ= TSION-Oli: ENVIRONNMENTAL- HEA:LTH•SER'VICES" - •-- APPLICATION FOR APPROVAL OF PLANS.-FOR IY-A WASTEWATER THE ATYESYSTEM _.., 1. 6""" � and address pplicant J :�= .,"::�..�.........w ., ._,..- ..�.., i ame_ 2. Name of project: J - i ��1'3 j 3. Location T/V 0 i 4,_.-Design Professional: 6v 5. • Address: . � . Er. •Drainage Basin: �� �� ��. .. ����� --, .�i.. "i0� ©�. . 7. Type ofPro'lect:: Privai. % es dential Food Service Commercial >; Apartments"-: - Institutional Mobile Home- gark,. , -• -. - = �Office Building Realty Subdivision _ . Other (specify) ` 8. is this project subJ ect.to State Environmental Quality Review ( SE R)'� .. TYPe Status ( check one)*.-..*.-....: ............... * ......... ........... I .......... Type I :Exempt . Type II : •.. : Unlisted X 9. Is a Draft Enviroamental'Impact Statement (DEIS) required? NO 10. Has DEIS been completed and found acceptable. by-Lead Agency? .........:;;,,,.T 11. Name of Lead Agency - -•- _ .�J �• J 2:.Is this. project in an -area under the control of local planning, zoning, .or other officials, ordinances? ......:............:.. :... :......................:::. ............... ' ..:_ �.......- _- 13. If so, have plans .been submitted to.such authorities? ... ............................... :T• -° _ 14. Has - preliminary approval been - granted by such authorities? '0 .Date granted:•. 15: Type of Sewage. Treatment- System Discharge:... ......... surface water" oun water 16. :If sur€ace-waier disci arke -:what is the stream class'.designation? ' ....::.:::::::. 17. Waters index number ( surface). ................................................. .................. :......... ..... 1.8.- . Is project located near-a public water supp'ly system? .................... _ 19. If yes, name of Water- supply 'Distance•to.:` :a s . � 1 A . _ . w��r: suPP Y �. -2-4: Is .project site near a public sewage collection or. treatment•systern? ::.:..:,::::.:: - " --2t. Name of sewage-sysiem Distancefo_sewage sysfem 22. Date test-h-o1•es-obs•erved ' 21' Name of Health.Inspectdr &0tw* 24. Frcj '-rct designflow (galfons.per�d y .............................. .............. :.:..: :5:.......= 25. Is State Pollutant Discharge Elimination System. (SPD)✓S)- Perinit.required? .: 0 26. Has SPDES Application been submitted to local DEC office? ........... " Form .PC -97 r .. :. 2 ? ally prvjis '3>3'Vy'all;n a dCSl�ilati:i �iG'tid'i t3r".S'icclt�; h`e tlai ?`: F� 28. Wetlands ID. Number .............. .......... ........ .............. ...................................... ... f�I 29. Is Wetlands Permit required?• ....... ............................... ...............•........ Has application been - made-to Town or Local D"EC office? ............................... 30. Does project require a DEC Stream- Disturbance4Permit? ' 3 l: Is or was project site used for agricultural activity involving application of pesticides to .orchards or other crops, solid ox hazardous waste disposal, landfiiliri ,g,•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 developd:witliiri 15 years in or adjacent to project site? ................................. ............................... Q 35. Are any sewage treatment areas in excess of IS% slope? (� Number 'Mai). 3 , .�S wB "lock = Lot_ o be returned to ..... Applicant_ Design Professional 37. Approved plans are t ..'OTE: All applications for.review and approval of•a new 8S3'S to be located within the NYC W' atershed shall he "sent to the Department,. and need not be sent in duplicate to the DEP, although the. project may require DEP' .-approval of tW-SSTS' yfiar io final :epproval'by the Department. Projects within•.the watershed.'may also _ require DE)j iev ew: and:approval. of other aspects of a project, succh as stormwater.plans -or the cr f o f impervious.suri aces, and the project applicant should obtain the appropriate forms: for such activiles -fiW_ 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 Iterm 1:,the application must.: ) , �, �. be accompanied by -a Letter of Authorization (Form L- A -97): Failure-to comply with this: provi -!&n ,�? may be -grounds for, the rejection of any submission.'' Ihereby.affrtn; .under penally of perjury, tlrat.informat orr pro.vidert on ifiis form is trite _ to the hest Hof my knowledge and belief False statements made'l erein: are punishable -as -= a C1assA misdemeanor. pursuant io Section 210.95 of the Penal'La SIGNATURES -& - OFFICIAL TIT -LES X t: Mailing Address: .... .....:......................... ()__01) / r u l -NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURF TMENT SYSTEM Own6ef -Vy ' 00w, 40ct? I NL • Address -7 C-O WN1 000 4p-lyE Wmatii tpSm Located at (Street) mt�E Tax Map • Block 4 Lot (indicate nearest cross street) Municipality Watershed-- SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test 24 q4 1 :.:;.::,: �::.::;: �: :.:m::;:;:r.:::<::: r.o-:: o-:::co-:;r: r:;r>::::;::;:rri::i::: isi ?:;::;:; >:a::'::: :::>::•:;; +q: i:i >::d;;i: :.iy;:::: �:•:::';S: nit,. . ;;:: .W ..�m ro n G d... ............LeveL..........Perc S.u.. f . �.::.... n�c... �s :. :::..:.X)ro 't ;:;.;:..:::::: :.. ....p•.:.:.::.::.:.::: � ::......... Inc. <IncI�ntIn¢it: ::::.:::. ,.:.....: t� >;:: >:: :..:::::.:.::..:::.:..:::...... 2 [�n 2ti— i 3 4 .5... IV -. 2 J -� 12`x. c� A—" ip VZ`�2 t2 j I L12 141 11A, 4 1 ' 3 4. 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. 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 TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. 4 HOLE NO. G.L. 0.51 1.01 /5 2.0' io fM 2.51 3.0 3.5' 4.0' 4.51 5.01 5.5 6.0' V —0 V, 7';6, &A C� 8.- 9.0 VA cam; 1 9.51 10.0 Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to Which water level rises'after being encountered Deep hole observations made by I : M LLqP (0 P) M , RuUUA�ITPO Design Professional Name: Address: q.05-0 R ( Signature Design Professional's Seal Date 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: ( Vh DEE�WQQ represent that I am an officer or employee of.the corporation and am authorized to act for: Name of Corporation: Wob�-P�m 4mfe6 Having offices at: Whose Officers Are: President - Name: Address: O(ztO oar DP \J� 8,'p=EW6 Vice President - Name: jma (A rs � Address: oLL, W000 Vme .. kw;— tO Q _ - Secretary -Name: .. .. ...�..- .r.... �. ._....._.... iei `�l d'rl4+JJ: � e _. _., .. -•�. r .. .. -.. .. .... ..._. _... -.. .. .._-- ... -,... ... ......._.. ... >...... -..... a .. .....- _s sr . -. .._. :..... .- ..........._... Treasurer -Name: Y Address: and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. anemi M, oe v+ess Signed: �►r bkc se. of Fftw Yak. W. Title: N worn to before me this day of (month) 3 (year). N Public Corporate Seal Form CA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS RE S T+ E _ F .. R CONSTItL IQ1�1TER , NAME OF OVVNER: STREET LOCATION: REVIEWED BY: RM, OR, AS, SRDATE: TAX MAP #: (CONFIRIv1ED) Y DOCUMENTS Y N (REQUIRED DETAILS ON PLANS CONT'D) SEWER /." FT. 4 "0'; TYPE PIPE CAST IRON PERMIT APPLICATION UUHOUSE -' WELL PERMIT OR PWS LETTER (_)LINO BENDS; MAX BENDS 45° W /CLEANOUT PC -97 RENEWALS (� LETTER OF AUTHORIZATION (�(�SPTE NOTE (NO CHANGE) (DESIGN DATA SHEET (DDS) Flu L SYSTEMS CORPORATE RESOLUTION (_)(_)10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE SHORT RAF (_)(_FILL SPECS/ FILL NOTES 1 -5 PLANS -THREE SETS (_)L_)FILL PROFILE & DIMENSIONS (HOUSE PLANS - TWO SETS (__)(FILL IN EXPANSION AREA (_) VARIANCE REQUEST ,FILL GREATER THAN2 FEET SUBDIVISION (__)(_) CLAY BARRIER UC_)LEGAL SUBDIVISION ((__)FILL CERTIFICATION NOTE (__)(__)SUBDIVISION APPROVAL CHECKED L_)(__)DEPTH GAUGES PERC RATE UU(_)(_)VOL. ()( ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS C__)L__)FILL REQUIRED DEPTH (_)(_)SEPARATION DISTANCE FROM TOE OF SLOPE (_),CURTAIN DRAIN REQUIRED TRENCH GENERAL ( _)(_)LF TRENCH PROVIDED 60FT MAX. (_ _)(_)LOCATED IN NYC WATERSHED (_))PARALLEL TO CONTOURS (__)(_)PLANS SUBMITTED TO DER x,(_)100% EXPANSION PROVIDED (_)( _)DELEGATED TO PCHD , ._ (_) (_)DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL L__)(_)DEP APPROVAL, IF REQ'D (_)(_ _)GEOTEXTILE COVER (_)(__)DEEP TEST HOLES OBSERVED SEPARATION DISTANCES ON PLAN -FROM SSTS . (_)(_)PERCS TO BE WITNESSED (__)(__)10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL (__)C_)EX- APPROVAL SSDS ADJ, LOTS (_)(__)20' TO FOUNDATION WALLS (_)C__)WETLANDS (TOWN/DEC PERMIT REQ'D ?) (_)0100' TO WELL, 200' IN DLOD,150' TO PITS UUDATA ON DDS PLANS & PERMIT SAME (__)U100' TO STREAM, WATERCOURSE, LAKE (inc. eapan) (__)(_)PRE 1969 NEIGHBORNOTIFICATION C__)C__)50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER (___)(__)LETTER BUZ:BA ._ (_)(_,10' TO WATER LINE (pits - 20') _.... ...... ..... .: .. t 00 .'R: M COD yLEN� k -TIFON V,',q 200'.... U� . _ _.., (�( X50'' liii' PER1�iPi 'TENT`DRAR�AGE'Cf)�TItSE'_ U(__DSOIL TESTING LOTS >10 YEARS OLD (_)0200'/500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS REOUIRED DETAILS ON PLANS (_)x)10' MIN TO LEDGE OUTCROP L��)SEWAGE SYSTEM PLAN - (NORTH ARROW) SEPTIC TANK UUSSDS HYDRAULIC PROFILE (�(_)10' FROM FOUNDATION; 50' TO WELL (__)(_)GRAVTTY FLOW WELL ((__)CONSTRUCTION NOTES 1 -15 (_)(DIMENSIONS TO PROPERTY LINES (__)(__)DESIGN DATA: PERC & DEEP RESULTS C__)ULOCATION OF SERVICE CONNECTION (_)(_)2' CONTOURS EXISTING & PROPOSED (U(UMIN 15' TO PROPERTY LINE U(__)DRWEWAY & SLOPES, CUT SLOPE (__)C__)FOOTING /GUTTER/CURTAIN DRAINS �)( _)SLOPE IN SSTS AREA 520 %) ((_)USDA SOIL TYPE BOUNDARIES 15%, IF REQUIRED UU REGRADED TO /o (�UTITLE BLOCK; OWNERS NAME ADDRESS DOSE/PUMP SYSTEMS TM#, PE/RA; 'NAME, ADDRESS, PHONE# (�(�pUMP NOTES UUDATE OF DRAWING/REVLS'ION OUDO5E 75% OF PIPE VOLUME/DOSE VOLUME NOTED UUDATUM REFERENCE (�UDETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) (__)C__)LOCATION OF WATERCOURSES, PONDS (U(UpIT AND D -BOX SHOWN & DETAILED LAKES,WETLANDS WITHIN 200' OF P.L. (�Ul DAY STORAGE ABOVE ALARM (�UPROPOSED FINISH FLOOR AND CURTAIN DRAIN BASEMENT ELEVATIONS (__(___)STANDPIPES, T BOTH SIDES, DETAIL L�(__)WELLS & SSDS'S WAN 200' OF SSTS (_)(_)15' MIN to CDS = >5 %, 20'4 %, 25 -3 %, 35' -1 %, 100 % -<l% UUPROPERTY METES & BOUNDS (_)(U20' MIN to CD DISCHARGE /100' with 182 cons day discharge UC_DEROSION CONTROL FOR HOUSE, WELL & UU10' MIN to NON - PERFORATED PIPE. SSTS, EROSION CONTROL NOTE COMMENTS: (REVSHEET)09 /01 /00 ,v.....,.., .� LUItr;YFA 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 3, 2004 Harry Nichols, PE Patterson Park, Ste 106 2050 Route 22 Brewster, NY 10509 Re: Proposed SSTS: Wyndham Homes Teal Lane, Lot 33 (T) Patterson 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. Please refer to NYCDEP comments enclosed and revise accordingly. . -T>,e construction of this sewage disposal system may be subject to local wetlands regulations. -... ` You should contact local wetlands officials in this regard. - If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ve ly yo Robert Mortis, P.E. Senior Public Health Engineer RM:km Enc. G Robert Morris, P.E Putnam Co. Health Dept. 4 Geneva Road Brewster, NY 10509 Re: Deerwood Sub. Lot 33 SSTS. Teal Lane Patterson, Putnam Co., NY East Branch Reservoir DEP Log # 2004 -BB- 0701 -SS.1 (Joint Review) Dear Mr. Morris: The following information is necessary to complete the above - referenced application: 1. Show impervious barrier for fill pad and keyed into native soil. Show all details. 2. Show cleanouts at all pipe direction changes. f ynt). have. �,ny rn � -1a.gt ins regard; cr f� k,o � :ra t«t- „r, you.�w .; conta;t�nc at -(9 14)) - _.. 742- 2055. Sincerely, Danny Shedlo, P.E. Civil Engineer II Engineering Review Group xc: John A Dunn, P.E., NYSDOH Harry W. Nichols Jr., P.E. Patterson Park, Suitt 106 - ,............ RtrVf 10-01, 2050 22 �.. Ere�rti�;tr; Telephone (845) 279-4003 Fax (845) 279-4567 Date. To: C- !) GV9L /La Aj Attention: d�n,'&I-�t5i Job No.: ® 3- ash. 3-3 Project Gentlemen: We enclose (1;j copies of B/W Prints Reproducibles Reports Specifications Memorandum Copy of letter Description: Tracings RevisionfDate No. = 33 LY433 C��7 .. -7-p_ � o1_03,o Sent Via: 1/115ur Messenger Blueprinter First Class Mail Special Delivery Your Messenger Hand Delivery Copy to Very t „y yours 6 Harry Jr., ch I Jr., R.E. PUTNAM COUNTY DEPARTMENT.. OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - .S"$URFACE SEWAGE TREATMENT SYSTEM Owner wyflIMAbIt tioelzs - Address r ,- i C,4,J Located at (Street) -RCA L LAOS Tax Map 3s. Block 4 Lot 1 (indicate nearest cross street) Municipality ?At���.a - Watershed Bn6i Iv t-o SOIL PERCOLATION TEST DATA Form DD -97 Indicate level at which groundwater is encountered NO Indicate level at which mottling is observed /VCIL c, Indicate level to which water level rises after being encountered �✓ n c� Deep hole observations made by: �j-' { Date lgoolol Design Professional Name: HA2Qj► W. 131CROLs -All., PE Address: Signature: W OV'NEW ru r.. W Pia X6124 w no� EXIST WELL 0 0 no ®� 449.91' z Poa ^ss n �6 J�5 ®N 4", 4,2 D° ZhSd °3 0. : yo -00 TEAL LANE A- 88° oBoo a � I I ty ,alai% 9 51 / I �x I / \4 � i L. i:. t 0. 9 a : io °z2 5a' R: t'IS•oo� • 9a i r� H• t' 4� Number A $ C i 28 18 2 74 82 3 8o g4 - 4 81 82 5 82 79 6 84 78 85 78 8 $8 78 9 90 -1g 10 93 80 1 I 94 80 12 99 8l 13 103 83 14 107 g� 1 5 III Be 6 1 13 113 1 -1 49 57 18 49 53 19 48 46 20 51 45 21 53 42 22 5G - . - ZJ 24 63 42 25 61 42 26 70 42 27 73 42 26 78 46 215 83 .51