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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -4 -119 BOX 16 y S , i 2 rr n it , i r 01780 TNAM COUNTY DEPARTMENT OF HEALTH ION OF ENVIRONMENTAL HEALTH SERVICES E OF CONSTRUCTION COMPLIANCE PCHD CONSTRUCTION PERMIT # F - 1 � - 04 Located at M 'MAC - 1-- A )4f-- Owner /Applicant Name Wo k� rt' Formerly FOR SEWAGE TREATMENT SYSTEM'S Town or Village ?A�trE "(:)f'i Tax Map 14b d a Block �' Lot I Subdivision Name 1)e!15�wwlo Subd. Lot # Mailing Address Zip Date Construction Permit Issued by PCHD Separate Sewerage System built by WRII MM k ff� 1 NL` Address 1 (AkAPly J0'0 W-NF i►- tt�lE% -�! Consisting of d �i-�JG Gallon Septic Tank and / 1 Other Requirements: Water Supply: Public Supply From Address or: ?C Private Supply Drilled by Address 164 t2f�2 64,9 ^ -LA' A 1 `'5( 2 Building Type Has erosion control been completed? yt� Number of Bedrooms 4 Has garbage grinder been installed? w Q 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. Date: t�' C Certified b P.E. � R.A. �— Y (Desi rofession 1) Address 10'T 0 "� !J . icense # l� 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 a su ject t modification or change when, in the judgment of the Public Health Director, such revocation; o ZM7 is necessary. Y� B Title: Date: Z C3 s White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALT14 DIVISION OF ENVIRONMENT, HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: 14- T�Aj_ j Al-i G jTownN;illag6: .l Tax. Grid # Map s, 45 B lock Lot(s) Well Owner: Name: ',Address: ` .tom ` Use of Well: 1- primary 2-secondary. d/heat pump rigation Residential Public Supply Air con ' Ir Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing _:�CL Open hole in bedrock Other Casing Details Screen Details Total length Length below grade _,�2J ft. Diameter _g _in. Weight per foot lb /ft. Diameter (in) Materials: _Z, Steel _ Plastic _ Other Joints: _ Welded __,LQThreaded _ Other Seal: Cement grout _ Bentonite _Other Drive shoe: _,�L Yes _ No Liner:_ Yes K No Slot Size Length(ft) Depth to Screen (ft) Developed? First _Yes—No Hours Second Well Yield Test _ Bailed _ Pumped �,Compressed Air Hours Yield gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well. in feet Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing. Well Diameteron) Formation Description ft. ft. Land Surface . IZ "1 CD ... I y lv1 If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information ' 1 Pump Type Capacity Depth .7.0© Model 10'J 16 -112 Voltage Z3 D B? i_ Tank Type Lyk-362- Volume #11AII l Date Well ompl ted Putnam County Certification No. Date of R ort ' a)h'' Well Drill r i natun:) NOTE,! Exact location of well with distances to at least two permanent landfnarks to be provtq Well Driller's Name +/� ;� . y %� Address: 41. Signature: Date: —y White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Ong a separate sneevptan. f - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTA>V HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: ' - T 1- �MG Town/Village: r Tax Grid # Map 76, Block 4 Lot(s) i Well Owner: Na e. Address: Use of Well: I- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Y Compressed air percussion Other (specify) Well Type Screened Open end casing .< Open hole in bedrock Other Casing Details Total length ft. Length below grade Diameter in. Weight per foot ' Ib /ft. Materials: X Steel _ Plastic _ Other Joints: _ Welded Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: � Yes _No Liner _ Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes—No Hours Second Well Yield Test _ Bailed _ Pumped Compressed Air Hours Yield 12 gpm Depth Data Measure from land surface- static (specify ft) N / During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information ' 1 Pump Type v Capacity Depth .Z �� r' Model f (� -J 16-02— Voltage Z3 D HP Tank Type'tuX`3 Z- Volume (ti 1 Date Well ompl ted s Putnam County Certification No. Date of R ort nn ��� L� Well Dri 1 r i ature) NOTE -/ ExaCtt location of well with distances to at least two permanent landfrtarks to be Well Driller's Name / %� Addres Signature: Date: _ IN White copy: HD File; Yellow copy -Building Inspector; Pink copy - a separl3te sheettplan. 71'A9L Form WC -97 December 14, 2005 Robert Morris, P.E. Putnam County Health Department 1 Geneva Road Brewster, New York 10509 Harry W. Nichols Ji., 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: Individual SSTS Compliance — Wyndham Homes, Inc. 24 Teal Lane - Lot # 37 Deerwood (Windsor Woods) Subdivision Town of Patterson, NY T. M. # 35. -4 -119 Dear Mr. Morris: Enclosed are the following: 1. Five (5) prints of Drawing S -37, "As -Built SSTS ", dated 11/30/05. 2. "Certificate of Construction Compliance for Sewage Treatment System dated 12/14/05. 3. Three (3) copies of "Guarantee of Subsurface Sewage Treatment System ", dated 12/14/05. 4. Laboratory Reports, dated 10/26/05 & 11/11/05. 5. "Well Completion Report", dated 09/20/05. 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, Har HW 03- 056.37 P.E. -P-UTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH' SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM \NYHM�AO Ph, Owner or Purchaser of Building Building Constructed by _2,4 _ T Location - Street F45 I D�� Building Type Tax Map - �Blocck Lot TownfVillage ' Subdivision Name Sobdiv'ision Lot # I represent that I, am wholly and completely' responsible for the location, workmanship, material, constr�rctiori and clfainage of the sewage reatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition..__ any part—of said 'S�sterim constructed 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 thefailure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system:. %1 Dated: s Day Year �G' Signature: Y �' Title: - \i F 00 NyT" - ene l Contractor (Owner) = �ignature . Corporation Name (if corpbration) . Address: �J State �`� 3 Zip �CQ Corporation Name (if corporation) State Zip Form GS -97 YML ENVIRONMENTAL SERVlCES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 9.502460 CLIENT #: 57197 NON STAT PROC PAGE: 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ WYNDHAM HOMES 8COLLINWOOD DRIVE RALPH TEDESCO BREWSTER, NY 10509 DATE/TIME TAKEN: 10/26/05 10:15 DATE/TIME REC'D: 10/26/05 12:00 REPORT DATE: 11/05/05 PHONE: (845)-279-2022 SAMPLING SITE: 24 TEAL LANE SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COL'D BY: JOSE W. QUICENO TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF --l- --- - --- I., - -1 - - Ile������ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 10/26/05 MF T. CDLIFORM PRESNT /100 ML - ABSENT 1008 11/01/05 LEAD ([MS) 2.0 ppb 0-15 ppb 9003 10/27/05 NITRATE NITRO8 4.34 MG/L 0 - 10 9052 10/28/05 NITRITE NITRO8 <0.01 MG/L N/A 9162 10/28/05 IRON (Fe) <0.060 MG/L 0-0.3 mg/l 9002 10/28/05 MANGANESE (Mn) 0.043 MG/L 0-0.3 mg/1 9002 10/31/05 SODIUM (Na) 7.99 MG/L N/A 9002 10/26/05 pH 6.6 UNITS 6"5-8.5 9043 10/31/05 HARDNESS,TOTAL 136 MG/L N/A 10/27/05 ALKALINITY (AS 76.0 MG/L N/A 9001 11/02/05 TURBIDITY (TUR <1 NTU 0-5 NTU 10/26/05 E. COLI (CONFI ABSENT 100/ML ABSENT COMMENTSt -1j, BACT THESE RESULTS INDICATE THAT THE WATER (WAS) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO RK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION, Pb/Cu LEAD limits for p/ EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. �blic 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 YML ENVIRONMENTAL SERVICES '321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 9.502460 CLIENT #: 57197 NON STAT PROC PAGE: 2 ~~~~~~~~~~°~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ WYNDHAM HOMES 8 COLLINWOOD DRIVE RALPH TEDESCO BREWSTER, NY 10509 DATE/TIME TAKEN: 0/26N5 1O:I5 DATE/TIME REC'Dt 10/26/05 12:00 REPORT DATE: 11/05/05 PHONE: (845)-279-2022 SAMPLING SITE: 24 TEAL LANE SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COL'D BY: JOSE W. QUICENO TEMPERATURE..: < 4C NOTES...: COLlFORM METH: HF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD contain no more than 20 mg/L of Sodium. For those an a moderately restricted diet, a maximum of 270 mg/L of Sodium is suggested. pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY., WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE 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: Director ELAP# L0323 YNL ENVIRONMENTAL SERVICES 321 K:ear Street Yorktown Heights, N.Y. 10598 ( 914) 245-2800 0 Albert H. Padovani.:, Di.rechar. LAD #; 1.507742 CL. I ENT #: 57197 NON STAT PROC PAGE V 1 WYNDHAM HOMES 8 COLL. I NWOOD DRIVE RALPH TE DESC O BRE:WSTE :R , NY 10509 DATE /TIME TAKEN: 11/11/05 n4 05 DATE: /TIME:: REC ` D : 11/11/05 05 00 REPORT DATE: 11/15/05 PHONE: (845)-279-2022 SAMPLING SITE: c24 TEAL L.ANE". SAMPLE:: TYPE..: POTABLE DREW STER PRESERVAT I VEG e NONE C OL. ` D BY: JOSE': W. QU I C:END TEMPERATURE..: < 4C; NOTES 4 a ., 4 KITCHEN TAE-' CLIL.IFORM METH: MF DATE:: FLAG PROCEDURE RESULT NORMAL - -• RANGE METHOD HOD 11/11/05 E'!1= T. COL. I FORM ABSENT /100 ML_ ABSENT 1008 08 BACT THESE RESULTS INDICATE THAT THE WAT'E t (WAS) (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD EHE:: NEW YORK: STATE: AND EPA FEDERAL DRINKING WATER STANDARDS„ FOR THE . PARAMETERS TESTED, AT THE TIME OF COLLECTION. SUBMITTED BY: L 0 Albert: I., Padovan i. ICI., T„ (ASCP ) Director ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL I1EATLII SERVICES FIELD ACTIVITY REPORT AnT?RFCR, 7-2-a-L Z�avL Street Town State 3 7 PERSON IN CHARGE ,, OR TNTFRVTFWF�: �`f, /N + /V � � /�oCS U � TlatP PUMP TEST DOSE TEST 'o 0 o' REQUIRED GALLONS Zip --5 7, !K _._.. 7, l 6 TNSPF('TQR, TFT Signature and Title REPORT RF-CFTVFD TRY: I acknowledge receipt of this report: SIGNATURE: 02/96 Titl Rev. NOV-21-2005 HARRY W NICHOLS Harry W. Nichols Jr.0 P.R. P91ttersm Park - Suite 106 2050 Route 22 -Brmter. NY 10509 Tel: (845) 27"003 Fax: (945) 279-4567 Erna& hoonginea@aol.com FAW_ do - A 914 279 4567 P.01 6 MUMMY To: t":, K, From: J Pages., Phone: Dais: R e Lt-4 e: CCI O Urgent ❑ For Review 11 Please Comment .0 Please Reply 0 Please Recycla • Comments: Ir L+,-,C t f_ i-C &-k -FEL-845-278-7921 NAME: PUTNAM DEPARTMENT OF P. 1 '20 :N . t NOV - -2001:� i ir i NOV-21-2005 10,.,01 "N HARRY W N I CHOL.c 914 279 4567 P.02 till, I 11 .20 la 68.30 '. �20Z73181'310 642792 O �CM10 %NO � P� 3�3 BY THIS CENTIFIC ATS OF. 00MIPWANDE"n-M NEW 'CORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELGCTR1CrrY 40 FUL'rON WrREET - NEW VOW, NY 100W GER71PM TRAY Upon the appi101it10'1 of upon premiins owned by KWI.gR SLECTRiC 'ArYWDHAM HOMES 151 aFtARlSY PLAIN STREET C.1 8 C&LINW000 OR 81" mm, OT. M01, DROW111MER, I+dY 10009 Looted at 24 TEAL LN SREWSTER, NY 10508 . Appllestlstt ftmll erc 2079741 COTWI104 t NWnbW: 2078741 sodlono 4.114 Blom 36 Leta U Building Permit! 169", IeDOt wicA Descriwl as a Raii dal Occupancy, wherein the premises electrical system conslstlnp; of sloctriCal dAVmand wi?.mg, descrlbed below, located lNon the prenlaefi at: Sassment, riimt 1Ploor. Se cad Floor, AeWW Gars o, , Aft, A visual lropetotlon of the- prern!$ ll piccb'icai zotam, limited to electrical devices end Wirin$ to the exter' detailed WOW, was conduete9 Ir: Zordence with toe r8qulrQMenU a the appltcabf -j• Code andlor standaro pramul"d by the State of New York, Depsdwnt of State Code Enforcement and Administration, or other authority having Jurisdiction, a ^d found tp be In compliance therewlih on tael ft Day of Navetnber, 2005, Wall Q1Y Bees Pia Coe a Ttms 6e�ttS "twit 10 0 l3Rf'[ $0.00 R.00qdwla 3 0 120 V 2 Landry $0.00 Rase Mle 2 0 120V 20 Appliance $0,00 Motor Control Carrier 1 0 SSMC $1114ow $0,00 swibek t 0 �►SLL lulo>�j' Cantrpl_ . E0.60 z 0 Telapillam so-so s 0 CATV 80100 4 0 TeVCA-rV $oleo 1 Aheee 3 W service Rift 200 Ar_,pam $6.00 9er km DIs m e= 1 300. C13 Meters: l 1"CP1 a TOW 565.00 An W tufttteamft. ahhe dutfttsd elsaoW ireedv.bv, ft m peas 80 etwloui>+aNd 19 eat pteeent cad tho lnswtlauon is bollcv-d to bd,n edntlbt w=wM Me opplim1 k nfffenee oper.derd SrVm salt W period of cAeMWon ofthe pmmiW-whiq eYtnnam, not .2 Of 2 This catiflMs tif+ net be a twos in any ** end Is vB 1400 only by the pruance of a raieed seal ut this Iowdion Indicafti. NOU -20 -2005 =1.11 TEL:845- 278 -7921 NAME:PUTNAN COUNTY DEPARTMENT OF P. 2 NOV-21-2005 10-.01 t- 9N6 HARRY W N I CHOLS 914 175 4567 P.03 ! ZOQ 21 %ZOf'fY Q8: 8��35'i937J0Q31fl B4S2ig2 -mxLjp FJ ECTRIC Ise WN PAGt W i BY THIS =TIF10A"M OF OOMPLIAt= "M NEW YORK BOARD 'OF FIRE UNDERWRITERS BUREAU OF IILICTRICITY 40 FUL.TM STREET - NW YORK, NY 10036 10191M IBIS THAT Upon thb application of upon premises ownsd by KEEI MEC'TRIC WYHDHAM Home 151 QRABSY PLAIN STREET C-1 6 COLLINW005 OR 1i35`rNEL. DT. 06801, 13R8WSTER, NY 10600 . I Located at 24 MEAL LN,13i VN6'fEFt, NY 10M Application Numner7 2075741 Cw*la to Alter: 2079741 Sidon: 4.119 Qlook! 38 Lot: 34 Building Permit- lWg* W: W104 described as a Realdential accupandy, wtooln the prarnlsee ellect 1091 oykerr► consisting at electrinal d@0res an_i wiring, described below, located Inlon the pnem$" at. 8asxye11t, Ytrst Floor, Sesand Flom. Attached Garage, Outside, Attic. NOV- 20 -2Q05 :;;.JI 2 ' , TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 3 A visual inspeedon of the pre.Miaas alacbtcal system, limited to electrical devices and wiring to tliG extant dataile0 'Ir herelh, wea conducted in awardanca with the rW' mltis taf the applichble code and/or 3tenderd pMMtjj$atled Sy the State of New York, Dapartment of State Code Enforcement and AdministratioO' or Other authority having jurisdict +on, and food to be in romplianes therewlti. en thaisa Day of Womber,2 ;5. s me SzTiC lAft tmb 211% 4 Alarm and Vnew p uy Xq%dpmeat BMW 2 0 Ctar>VtetUdenoi� 50.OD 1 tisnspT 4 6 S�nol¢ SO,OD Panel Board I 0 SSP9'IC ALrm $0.00 Appliances and Aeamaries f oven- t 0 40 ,�treps - 50,00 Dish Washer 1. 4 PIMP. SQ.OD tLydro Message Tub 71hierapeudc 1 0 10 Amps Putdaao 1 4 0" 50.60 Air Candtdoneo 2 0 )0 AMPS $0.00 c mwo Feuk Praveetian, FBI 1 0 Ptah" ... $0.00 i3aanp Meta 3 0 Map P..x4ieust Pan 4 0 F.HP. 50100 Pan& 1 200 40 $O,f10 V"Amg a24 DeVlpeA Fbew" 70 0 ]ntiendeaan►; $of/ $0,00 X"twle 6� 0 (Settetal Ftnpose So.W switt+b 10 0 04mol purpose- of 2 i This cwtif itarte rrwy r& be altered In "way and h vdldaLvd' arty by flea prmnce of a rslssd seal at the lttm IndICa1>ed. NOV- 20 -2Q05 :;;.JI 2 ' , TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 3 DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: i I / 1 g /o7 Inspected by: % jZa�4 Street Location 'JZ-�yc( Z_411,9 Owner ,i4/j) /tnWn l,loyneS Town Pot#ec�o Permit # P - /g -0,/ TM # 3 ;�; , - // q Subdivision Lot # 3-7 1. Sewaze 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 Sewaee System a. Septic tank size - 1,000 ...:....1,25 .........other ................ b. 'S eptic'tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. .. Minimum 2 ft.Original soil between box & trenches e. Junction Box properly set .......... ............................... 6. renc es 1. Length required 5- 7.2 Length installed S ?2 2. Distance to watercourse measured 4- loo 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 %.................... L 8. Size of gravel 3/4 - 1112" diameter clean ...................: 9. Depth of gravel in trench 12" minimum ....... :............. 10. Pipe ends cappped ........................ ............................... g. Pump or Dose 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........... III. House/Buildina a. House located per approved plans .............. . b. Number of bedrooms ............................ ..��.J. .......... IV. Well Well located as per approved plans . ......:........................ b. Distance from STS area measured 4-'! ©a 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 pl f. Curtain drain outfall protected & dir.to exist waterc0 s g. Footing drains discharge away from STS area ............. . h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 12/02 YES NU C:OMNIEt'NTS *Y2en r-_',, VV `ia v4 ,vKOVt d VCr. 'y 6 o cJ�.s�r+e � d o Form _ 314 279 4567 P.01 No''r'- 17- 2GtE�+$ 4Y'-� � .1 _. 1-11.1 HF1RRti' W N I CH oLS I' PUTNAM COUN'T'Y DEPARTINIZNT OF RFAil.,'TR DTMIONI OF ENMONWNTAL HEALTIR SERVICES r RF, i TROT Fbit FIN,e;L INS ?tON For: Fill Date: 11,j _ �G --0 Trenches , , lam" PCHD Construction: Permit # Located: I Lat,.4 (T)&,r Owner /Applicant Name: w H,,,o14a,.., _ IL -sr.r TM 3. Block Lot -1-Ift Formerly: Subdivision Name: _ A- ra l.1,0GJ Subdivision Lot # `T Is system fill Completed?_�_,,,�„ is system complete? ._ Is system constructed as per plans? Is well drilled? Is well located as per plans? Are erosion control'measures in place? Date; Date: i Gam_ bate: It ;� j4 -D - 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 ujd the Standards, Rules and Regulations of the Putnam County Department of Health, Date: li__.:r Certified by: PE RA Des' rofessional. Cornmmts: FOR: 11 ADAM 16 /GENE IJ (NAME) Norm FIR-99 G 'v`t r DEPARTMENT OF P. NOk) -16 -2005 1; =C i TEL :845 -276 -7921 NAME:PUTNAM COUNTY 1 4 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health November 23, 2005 Harry Nichols P.E. Patterson Park, Ste 106 2050 Route 22 Brewster, NY 10509 Dear Mr. Nichols: DEPARTMENT OF. HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive Re: Field Inspection — Wyndham Homes Teal Lane, (T) Patterson Lot #37, T.M. 35. -4 -119 The following comment must be addressed: • It appears the expansion area cannot maintain the required 100% replacement. It is also this Department's concern that the SSTS trenches may not be installed per the approved plans. Therefore this Department is requiring the submission of a survey by a licensed professional surveyor showing the exiting house, well and SSTS boxes and trenches and fill pad in order to confirm actual field conditions. 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 DEC -15 -2005 01:08 PM HARRY W NICHOL�- Harry W. Niebols Jr., P.E. Fattex'eon ?sit - Suite 106 2050 Roato 22 ,Brm$W,NY 10504 TrI: (845) 299-4003 F ®z: ($45) 279 -4567 Email. hnongieee @Iol.com I °id: 914 279 4567 P.01 Fromm ' 3"' -1 A .1 -7,9:2.I Pages. l Phone: Dates r t,�c�p Re: 1��. u.. A T,. �'� .� 1 �1... CC. Q Ur+geott ❑ For Review 0 Please Comment ❑ Please Reply i3 Pleaase. Recycle a Commelitss LA AfV 1� Cl vtr tJ %u� lY 2 . DEC -15 -2005 THU 12:35 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 ►5,,.-y Nichol5,�lr., P.E. Fromm ' 3"' -1 A .1 -7,9:2.I Pages. l Phone: Dates r t,�c�p Re: 1��. u.. A T,. �'� .� 1 �1... CC. Q Ur+geott ❑ For Review 0 Please Comment ❑ Please Reply i3 Pleaase. Recycle a Commelitss LA AfV 1� Cl vtr tJ %u� lY 2 . DEC -15 -2005 THU 12:35 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH t 1 Geneva Road, Brewster, New York- 10509 LORETTA MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services 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 - 60.14 Fax (845) 278 - 6648 �Iilt'Y i�%fr�l,d j5 Dear Re: Field Inspection - it: fc)ffu 7t)--e_ Ao -Arve- !of AIL Cc7wt ji 1°1% Lr�ere v,il e_ ne, �r �� d G4r�'! l PUT NAM COUNTY DEPARTMENT 07 HEALTH IIDWIfSION OF ENVIRONMENTAL IHIIEAIL'II'H SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # to 1 U _( A Well Location: Street To ge Tax Grid # ! `Address: e- q Lavy e, At f, L, Map es Block f Lot(s) Well Owner: to % to ' 4u� t��,ti lAddressj: l c. �i y �V �v� z Use of Well: __IKesidential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondalry Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served _±-<- Est. of Daily Usage o gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason , for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ........................... .................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes 1/ No Name of subdivision .ojr, rev wc,.,/c,d Lot No. Water Well Contractor: 'T b)) Address: a Is Public Water Supply available to site? Yes No _4Z Name of Public Water Supply: -- Town/Village Distance to property from nearest water main: - Proposed well location & sources of contaminatiou to be provided on separate heet/plan. Date: v Applicant Signature: M 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 we driller ified by Putnam County. Date of Issue 1-% Permit Iss i Official: ✓'" Date of Expiratio t Q'J Title: /✓ Permit is lion -Tire sfer able White copy- HD file; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WP -97 To: PC / In Attention: gd t- d Ao r%rtS Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Telephone (845) 279 -0003 Fax (845) 279 -4567 Date: Job No.: Project &.r-t c15 -er- )OaeI5 �i•P Zrz4lz, J L.G- ;t- 3.7 ` l G J, doer" r+M r Gent emen: We enclose (A)) copies of /W Prints O Reproducibles O Reports O Specifications O Memorandum _ ❑ Copy of letter Description: 5 � -37 Pr- 42 , �� S'� IS Sent Via: �ur Messenger 0 Your Messenger Copy to • Blueprinter • Hand Delivery O First Class Mail ❑ Tracings Revision/Date No. -7114t /0 q . t O Special Delivery VAtl rs, H ols Jr.; P.E. 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 I— PROJECT INFORMATION.(fo be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR a(� , 2. PROJECT NAME 3. PROJECT LOCATION: P Municipality, County 4. PRECISE (Street address and road Intersections, prominent landmarks, etc., or provide map) (LOCATION 5. IS PR,0POSED ACTION: New - ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: f� 7. AMOUNT OF LAND AFFECTED: 0 n �� 00 Initially acres Ultimately acres 8.. VVIL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? es ❑ No If No, describe briefly i 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? c,.i`1 nResidential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: L� t• 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? SYes ❑ No If yes, list agency(s) and permit/approvals tl - CQ1 TF6hk i ©(ell' O� ��II, VS'�`�'• .". 4�1 \%'�'� •Q V�"�, \,� .. .. 11. D9ES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? LRyes ❑ No If yes, list, agency name and permlUapprovai- 12. AS A RESULT OFF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? y ❑ Yes 9No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ` t� y ` \Aw, `4L �` 'W� Date: ApplicanUsponsor na e: A fjj Signature: A?- .44" 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 PART II— ENVIRONMENTAL. ASSESSMENT (ro be completed by agency) A. DOES ACTION i:XCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by.another Involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or 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) C6. Long term, short term, cumulative, or other effects not identified In C1-05? Explain briefly. G CIN i C7. Other Impacts (including changes In use of either quantity or type of energy)? Explain briefly. 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 (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. ❑ 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: Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Name OFL—ead Agency Title of Responsible O ficer h Signature of Preparer (11 different from re'sponsi e officer) Date 9 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: W W OMM RD M6� i L 2. Name of project: l-Dl_ 1� 1 T/D 3. Location TN: 4. Design Professional: 5. Address:0�0 6. Drainage Basin: P-1 Bi�o� � c y 7 i o _ 01 7. Type of Protect: K_ Private/Residential Apartments Office Building Food Service Institutional 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? ......................... NQ 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... '{Es 13. If so, have plans been submitted-to such authorities? ... :............... : ............... :... 0 14. Has preliminary approval been granted by such authorities? 0 0 Date granted: (� � 15. Type of Sewage Treatment System Discharge................. surface water k groundwater 16. If surface water discharge, what is the stream class designation? .................... 17. Waters index number (surface) ...... ................................................................. ..... fJQ. 18.. Is project located near a public water supply system? ....... ............................... 1'j p - 19. If yes, name .of water. supply �� Distance to water supply h 20. Is project site near a public sewage collection or treatment system? ..............:. o 21. Name of sewage system iJ a Distan ce to sewage system l�C 22. Date test holes observed 0 �i � 23. Name of Health Inspector M�C- 94(i JfPl 24. Project design flow (gallons per day) ................................. ............................... K o o 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? ......................... Form PC -97 27. Is any portion of this project located within a designated Town or State wetland? 0 28. Wetlands ID Number ........................................................... ............................... 29. Is Wetlands Permit required? .............................................. ............................... Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ..........................:.... 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling; sludge application or industrial activity? ............................ 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: O0 33. Is. there a local master plan on file with the Town or Village.? ....................... ... 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? .................. ............................... rJ 35. Are any sewage treatment areas in excess of 15% slope? c 36. Tax Map ID Number .......................... ............................... Map Block Lot 1 37. Approved plans are to be returned to ..... Applicant �_ Design'Professional NOTE:.All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. 2 If the application is signed by a person other than the applicant shown in Item l .,the applic go n-nmst be accompanied by a Letter of Authorization (Form LA -97). Failure to comply.with thi4�rovfsioii= may be grounds for the rejection of any submission. �. I hereby affirm, under penalty of perjury, that information provided on this form to the best of my knowledge and belief. False statements made herein are punishaRe ag5, . a Class A misdemeanor pursuant to Sections 210.45 of the Penal Lafi I) ! i /1 SIGNATURES & OFFICIAL TITLES. l Mailing Address: .................................. �� �� PUTNAM:COXINTY DE PARTIVIENT,OFBEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner'; ROME� (tJL- Address-1 UL,44�40--O-' OW-6 BX�J i l 1p�c)'A Tax Map B*10**ck* + L65F-] Located at (Street) (indicate neares cross ptreet) Municipality Watershed Cc, SOIL PERCOLATION TEST DATA Date of Pre-soaking Date of Percolation Test 3 -4 5 2. �0. 9— 3 4 5 2 3 4.. 5 NOTES: 1. Tests be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (Le-; s I min for 1-30 min/inch, :5 2 min for 31-60 min/inch) All.data to bi.— submitted- for review. 2.' Depth measurements to be made. from -top.of hole. Form DD-97 DEPTH G.L. 0.51 1.01 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.51 5.0' 5.51 6.0' 6.5' 7.0' 7.5. 1 8.0' 8.51 9.01 9.5' 10.01 Indicate level at which. groundwater "is encountered Indicate level. at which. mottling is observed 4 = fl Indicate level to which water level rises after being.e;icounteredAl-� Deep hole observiti6fi- s*ma'de by: 0 Design Professional Nai e: klip y-4 N �u t-�Tju, j v yr. Address: /�Xzs- VO � M - A 5 : AN Design Professional's Seal AI MM Date . �� I � A I A O T.�_ ZLO 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: DE- OQ� I represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: '��`5 �� � rci (cJL Having offices at:. �-��pQ �(�t���1�r . 10 S D1 Whose Officers Are: President - Name: Address: Vice President - Name Address: Secretary -Name: Address: Treasurer - Name: . Address: J-0 -a �v �A� \PJ(Da %,t\,�5 b 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. ►io.. it :: .a.., t t`2r3 .. worn to before me this �' . day of -4 (month) :3 (year)"'. Public Form CA -97 Signed: ` Title: Corporate Seal _. - -- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH S ERViCES_ : w LETTER OF AUTHORIZATION RE: Property of Located at WV Tax Map # Block _Lot Subdivision of �-� 0 0,1 Subdivision Lot # Filed Map # Date Filed.'—' iled — Gentlemen: ? This letter is to authorize o r a l V�" Jig PG 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 c�;,,:. with the standards, rules or regulations.as promulgated by the Public Health Director of the..Putii -i" County Health Department, and to sign all necessary papers on my behalf in connecti0' ri-;wi6 -this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the proYisions. of Article 145 and/or. 147 of the Education. Law, the Public Health Law, and the Putnam,Cl,Sanitary Code. -C:ountersigned: P.E., R.A., # — Mailing Address State 1 �� Zip' 0 50�I Telephone: LQt'1� i Mailing Address: State Zip Telepnne: W, FommLA•97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # `� I Located atrl -- Town or Village�'�� Subdivision name t?Ei�P-�J (�' O Subd. Lot # Tax Map �S- ° Block 4 Lot l� Date Subdivision Approved 01 ! �-4 101. Renewal Revision Owner /Applicant Name 'V�l``N i7► 1 r(� J H b ° Date of Prev•vious Approval Mailing Address (-- "i'�1���;'i�1 F, 1'-j� �-'J Zip 1;0 f, 17 Amount of Fee Enclosed Z[ � o 0 F , Design Flow GPDi Building Type �°`"� 1 i Lot Areal ,500 No. of Bedrooms g Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 11-5 gallon septic tank and S -7:�- Lf- P Other Requirements: 1,q ► j�L D - I-1 . J7} To be constructed by ry+ Address Water Supply: Public Supply From Address or: ),� Private Supply Drilled by T 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 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 or any repairs thereto. Signed: Address R.A. Date b -3 1 !(104 License # I 6 1 ' 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 n c nsidere ecessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it prove r discharge of domestic sanitary sewage only. By: Title: Date: 31 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 urint or type PCHD Permit # Well Locations: Street Address: Town/Village Tax Grid # , Map -. Block 1" Lot(s) Well Owner: Name: Address: 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_±:- gpm # People Served 4 "G Est. of Daily Usage !S gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ...................................... .......................................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes X No Name of subdivision !0 Lot No. Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No -y` Name of Public Water Supply: Town/Village Distance to property from nearest water main: .... Proposed well location & sources of contamination to be provided on sepMan. Ai44,A 1 Date: 0.1 i � 1 0A Applicant Signature: ko 1 PERMIT TO CONSTRUCT A WA'V'ER 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 ell driller g lertified by Putnam County. "d 4 Date of Issue zhikl Permit Issui fficial: i Date of Expiration 0 Title: Permit is Non- Transferrals e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 To: L CYCir..Gy�. �a� Attention: Gentlemen: We enclose (3) copies of _.❑ B/W Prints ❑ Reproducibles Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Telephone (845) 2794003 Fax (845) 2794567 Date: '; -, L Job No.: 0 -7 Project s—Ts - LA 31 ❑ Reports ❑ Specifications ❑ Memorandum — ❑ Copy of letter Description: Sent Via: ( ur Messenger O Your Messenger Copy to O Blueprinter O Hand Delivery 5'r,- O First Class Mail O- ❑ Tracings r f"i .+ �S Revision/Date No. ❑ Special Delivery VY'/w. y yours, H �Nichol., P.E. January 4, 2005 Putnam County Health Department One Geneva Road . Brewster, New York 10509 Aft: Robert Morris, P.E. Re: Wyndham Homes - Lot # 37 Teal Lane Patterson, N.Y. T.M. # 35. -4 -119 Dear Mr. Morris: Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 Tel: (845) 279 -4003 Fax: (845) 279 -4567 Email: hnengineer @aol.com We are enclosing five (5) prints of the following Drawing: SS -37 "Proposed SSTS," revised 01/04/05. In accordance with our prior discussions, the curtain drain for Lot # 37 has been extended within an easement onto Lot # 38 to provide protection from groundwater upslope of the SSTS. Kindly continue with your renewal and issuance of the permit. Very truly yours, Harry W. N c ols Jr., P.E. HWN:jmm 03- 056.37 ���s© July 16, 2004 Putnam County Health Department 1 Geneva Road Brewster, New York 10509 ATT: Robert Morris, P.E. Re: Individual SSTS Deerwood Subdivision - Lot # 37 Teal Lane Town of Patterson T.M. # 35.4-119 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) 2794003 Fax: (845) 2794567 Email: hnengineer @aol.com 1. Five (5) prints of SS -37, "Proposed SSTS ", dated 07/16/04. 2. "Short EAF ", dated 07/16/04. 3. "Application for Approval of Plans for a Wastewater Disposal System ". 4. "Construction Permit for Sewage Disposal System ", dated 07/16/04. 5. "Application to Construct a Water Well ", dated 07/16/04. 6. "Design Data Sheet ". 7. "Letter of Authorization & Corporate Resolution ", dated 07/16/04. 8. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only". 9. Review Fee in the amount of $400.00. / .. V, We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, 1' i Harry W. Ni ols Jr., P.E. HWN:gav 03- 056.37 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 Tel: (845) 2794003 Fax: (845) 279 -4567 Email: hnengineer@aol.com RE: Proposed SSTS Wyndham Homes, Inc. Deerwood Subdivision - Lot # 37 Teal Lane Town of Patterson T.M. # 35. -4 -119 Dear Mr. Morris: In response to your August 13, 2004 review letter, we note the following: 1. The system has been designed per the approved subdivision plat. 2. System has been revised to eliminate expansion trenches between the primary system and the curtain drain. 3. Curtain drain has been revised to be .parallel to the trenches. A 15' minimum separation has been noted on the plan. We trust the enclosed have addressed your concerns and request that you continue with the review and approval. Very truly yours, Harry W7io Jr., P.E. HWN:gav 03- 056.37 PUTNAM COUNTY DEPARTMENT OF REALTH _._. DIVISION OF ENVIRONMENTAL HEAL'T'H SERVICES AFFIDAVIT - CORPORATE OWNER APPLICATION _., FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: E12.wo0b� represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: S��y.��p���_ Having offices at:'PS ��� _ .� �.'-- . �� 1�� Whose Officers Are: President - Nam`e-R-,ch��e�L Vice President - Name: Address: Secretan, -N 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 thereto. Signed: Title: Sworn to before me this day of (month) (year) --Notary ublic JEANNETTE RosrDt;' !oSaiy Public, State ofNa iYbrt, Corporate Seal Flo. OI R0610=5 Qualllled In Putnam County Form CA-97 P0303210006( - 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 LO Z I Z and 0�-AI?0�� )(L STATE OF NEW YORK DEPARTMENT 0E T E MAR 2 1 203 APR 10 2003 DRAWD OWN NIS -27 ?0-4 03032,100 (q511 CHART (in feet) E==C 24 IB 71 IGo IOO 120 127 126 88 80 73 {l6 {12 100 65 G4 6Z 91 88 84 59 61 61 79 77 75 G I 64 67 72 7Z 71 67 72 75 68 69 L9 112 110 107 110 109 log I06 104 102 log 109 109 101 100 100 Ill 112 115 100 100 102 IIG I18 121 {07 113 1z ,27 133 134 III 135 AGE DISPOSAL � IICATED ON THIS NSPECTED BY ME ACCORDANCE 7GULATIONS OF 'HE NEW YORK /E Y 'COLLIN5, L.S. "" 'd j Z5 E a Jn� S5 G4 4 � 0 a J 0 Q •U 6 = 49 °07 45" R s 7` i c 1 t• 5. r o f ,3 n� o% c ro� T DIIt/IENSION CHART (in feet) r^ 5 21 Number A L. cc8 � a + 24 !- z 22 1e _wbN4 3 4. 100 121 0 y 100 i 26 a /�t 1 S`- G 88 i 16V 80 112 e� 4 73 - too a� r3 � � k 45 91 I Z 59 79 J 1 3 14 1 5 1 i� 671 l f3 67 68 8 = 49 °07 4S" 1 9 12 6 9 R= 225.00— 20 15 G 9 �- = 192.93 - `•`� 21 112 110 z2 1l0 109 23 10- 109 24 106 109 N gr 25 104 109 26 102 109 27 101 111 28 100 1 1z 29 100 1 15 30 100 { 16 3{ 100 i 18 32 102 121 33 1011 127 34 1 13 133 35 3G f l 1 135 a` %