Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
1781
DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35.-4 -120 BOX 16 I ti ill. ir :jl Jr t9F L, ' I .0i1 I' 01781 'UTNAM COUNTY DEPARTMENT OF HEALTH TSION OF ENVIRONMENTAL HEALTH SERVICES <.L' 1\ 1 11' ivATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at Town or Village PA , r E-60 11 Owner /Applicant Name WtQ'AN�A Formerly Tax Map ')) �) n Block Lot Subdivision Name Subd. Lot # Mailing Address CID 1-LA O V3 rd 00 V 1P�' 4F � ' 1 - 1� j� Zip U� Date Construction Permit Issued by PCHD 10 J (7i 6 �' y r� r Separate Sewerage System built by WNi7i IV Address I cow"(�Nw DPAV� REWWO- Consisting of d0 Gallon Septic Tank and fir— AP-65- TP-r--H Other Requirements: !y0 0 r t lr� I P U M P Water Suoaly: Public Supply From Address or: X Private Supply Drilled by B6'f D A,-MQ)�-H W5u-4 Address fi05'A' F-r 'qy C a'ry� ldjit, Building Type �) �� �E Has erosion control been completed? � f� Number of Bedrooms '+ Has garbage grinder been installed? HD 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 Dlypartment of Health. Date: G, —1 t - 0 S Certified by Address P.E. A R.A. .OFX License # 561 .�-k Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are ject to modification or change when, in the judgment of the Public Health Director, such revocation, m di cation ange is necessary. By: Title: Date: J '& White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Well Owner: Street Address: Town/Village: Tax Grid # I � MME Map's �I: Block 4 Lot(s) Name: Address: �1 5�. i // Use of Well: 1- primary 2- secondary ,� Residential Public Supply' Air cond /heat pufap Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion __)( Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length / / ft. Le}}gtlt eJ,ow grade /D(�ft. Diameter in. Weight per foot _d_lb /ft. Materials: _X Steel _ Plastic _ Other Joints: _ Welded Threaded Other Seal: 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 �C 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 Diameter(in) Formation Description ft. ft. Land Surface G 7 °"' M % `" If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Informatidn Pump Type 5v , Capacity Depth 00 Model 10LJ1r1f17- Voltage'Z30 HP 1 t�Z Tank Type Lv X- 307-- Volume (9(e- J&v &�"j 0Z Clf i Date Well Completed Putnam County Certification No. Date of Rep Well Dri er (s•gna re) NOTE: Vxact location of well with distance to at least two permanent and—irk-, to be provided a separ a sheet/plan. Well Driller's Name Address: Signature: Date: White copy: File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 t*t M 1� M PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Town/Village: Tax Grid # Map' 7F Block 4 Lot(s) Well Owner: Name: Use of Well: 1- 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 __)( Compressed air percussion Other (specify) Well Type Screened Open end casing )C Open hole in bedrock Other Casing Details Total length i / ft. L h �x ow grade �ft. Diameter�t o in. Weight per foot lb /ft. Materials: Steel _ Plastic _ Other Joints: _Welded Threaded _Other Seal: Cement grout _ Bentonite Other Drive shoe: Yes No Liner: Yes -,k 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 �46 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 Diameter(in) Formation Description ft. ft. Land Surface i f If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information r 10 Pump Type S u , Capacity~ Depth _LOO Model 10 CJ 13 4( Z Voltage'2-i0 HP 1 r1a-- Tank Type Lux -307 -- Volume c96-1 21 Date Well Completed &/A 6 .6 Putnam County Certification No. Date of Rep Well Dri er (s'gna re) NOTE: Exact location of well with distancea to at least two permanent*iandm;frks to be provided " a separ a sheet/plan. Well Driller's Name Address: 4 c Signature: % Date: White copy: File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 May 6,6 05 021: DIP �" .TOWN OF PRTTERSO 845 -878 -2019 P•1 MAY-46-2096 AI:aS PM HRRRY W NICHOLS 914 279 4567 P.02 fF• ' Bitum tL FOM 1AR8t•[1l MOWNARI•FtR, M.S.N. ' ' Pv31te K,alrll Okvala• ••.. — . - � •• .Airoeters �vbtf��tXrndlh L1�wcor.: ' I � .... ..- , _ •" 04ralor qr %'evflN &+'rkrl • ...r... �.... •wMPARMNONT OF 1jMaTH � ....,. ..,. 1 QQneve •Rood... _ � .. .�..... .. . . • Browner, New Yolk '10509 - Lrrlrasaesul HIa1Ve (9i4)lTt•1110 Fa¢U) 373.1!11 . x1r4u&usr4u jOSI)SlmssB..•ineV11 }111-gill ,Pupt)1I1•106] . -• ' L111jlillevioil"ir "(4tQSTt.i01f 4rla,rwlll161r7f•fOp imIf714)ITE'.66d! - Z211 ADDRF.M-YERIFi('_ATION RQEM,� • GWd�iERS NAbSI�t _� �1vs�1®a� ®ea rdn��s -- L G i .*� � � .. 4 � � 5:9I 2 A1iAR�SS:,. _ _ d►1„q�.��}_, ���� - __. TO*K, �V 4ATZEp 1'4'uYAi S?FRICII :. r _ t ' DATE: • — �� i'' � ''� it ,.,_ • �_N.... .. ... - .. Th e Putnam County Departmat .of Health wm pot issue a °Ceitlflcate of Coustrutfio'n CompU nce•uldws the above form is.cozapteted; i.e„ a tags! 911 • address 6s �?;IZaed by �n 4ilhorized town official. TW5.for*is to besubml ' with the application far $ Certificate of Cootmetiou Gompllance. June 22, 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) 2794003 Fax: (845) 2794567 Email: hnengineer@aol.com Re: Individual SSTS Compliance — Wyndham Homes, Inc. 26 Teal Lane - Lot # 38 Deerwood (Windsor Woods) Subdivision Town of Patterson, NY T. M. # 35.4-120 Dear Mr. Morris: Enclosed are the following: 1. Five (5) prints of Drawing S -38, "As -Built SSTS ", dated 06/02/05. 2. "Certificate of Construction Compliance for Sewage Treatment System" dated 06/14/05. 3. Three (3) copies of "Guarantee of Subsurface Sewage Treatment System ", dated 06/02/05. 4. Laboratory Report, dated 05/13/05. 5. "Well Completion Report ", dated 06/22/05. 6. Application Fee in the amount of $300.00 payable to Putnam County Health Dept. 7. "E -911 Address Verification Form ", dated 05/06/05. If there are any questions concerning the enclosed, please call. Very truly yours, Harry W. Nichols Jr., P.E. HWN:gav 03- 056.38 - PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF. ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUIBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map Block Lot Building Constructed by Location - Street Building Type.' TownNillage Subdivision Name 1�1� Subdivision Lot # I represent that I am wholly- and completely responsible for the location, workmanship, material, construction and"draina'ge of the sewage Ireatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition.__ any parr-of said - -system confs1ructed l y me which fails to operate for ,a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system,..except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. . _ _. -- y •:»- Da led: Mon Wo Day .0 �� Year Signature: Title: eneral Contractor (Owner) = signature 144 .v iA/ j f�D _W t- M6, wby Corporation Name (if corporation) Corporation Name (if corporation) Address: COWAA 0 �Q*1 6�FOLiEf State k;avj l W Zip Address : ] L' O WAU WM W\15 WV�i�— State W&O 'YOH, Zip Form GS -97 f' Harry W. Nichols Jr., P.E. PEA Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Telephone (845) 2794003 Fax (845) 2794567 Date: To: Job No.: �C � 03- ����,38 Project sL) iy'tS10 Lit Attention: i2o a r �; �' . �—�-„ 47 f Gentlemen: We enclose (�.� copies of BIW Prints Reproducibles Specifications Memorandum Description: r/ Reports Tracings Copy of letter Revision/Date No. Sent Via: Our Messenger-,""' Blueprinter Your Messenger Hand Delivery Copy to First Class Mail Special Delivery Very. truly yours Harry Y': ols Jr., F.E. Z-d YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovani, Director LAB ##: 1.504303 CLIENT #: 57197 NON STAT PROC PAGE: 1 WYNDHAM HOMES DATE /TIME TAKEN: 06/27/05 10:30 8 COLLINWOOD DRIVE DATE /TIME REC'D: 06/27/05 11:55 RALPH TEDESCO REPORT DATE: 06/29/05 BREWSTER, NY 10509 PHONE: (845)- 279 -2022 SAMPLING SITE: 26 TEAL LANE, BREWSTER SAMPLE TYPE..: POTABLE .: WELL TANK PRESERVATIVES: NONE COLD BY: JOSE TEMPERATURE..: NOTES...: COLIFORM METH: N/A DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 06/29/05 IRON (Fe) <0.06 MG /L 0 -0.3 mg /l 9002 COMMENTS: Fe /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. 1 SUBMITTED BY: L' i G ✓�`�V y�li`� l/ "` Albert H. Padovani, M.T.(ASCP) Director ELAP# 10323 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 9.500894 CLIENT #: 57197 NON STAT PROC PAGE WYNDHAM HOMES DATE/TIME TAKEN: 05/04/05 09:00 8 COLLINWOOD DRIVE DATE/TIME REC'Ds 05/04/05 10A15 RALPH TEDESCO REPORT DATE: 05/13/05 BREWSTER. NY 10509 PHONE: (845)-279-2022 SAMPLING SITE: 26 TEAL LANE, PATTERSON SAMPLE TYPE..: POTABLE : WELL TANK PRESERVATIVES: NONE COL'D BY: TEMPERATURE..: NOTES...: COLIFORM METH: N/A ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFI1 05/04/05 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 05/06/05 LEAD (IMS) 9.6 ppb 0-15 ppb 9003 05/06/05 NITRATE NITROG 2.82 MG/L O - 10 9052 05/06/05 NITRITE NITROG <0.01 MG/L N/A 9162 05/11/05 IRON (Fe) 0.359 MG/L 0-0.3 mg/l 90 02 05/04/05 MANGANESE (Mn) <0.010 MG /!... 0-0.3 mg/1 90;2 05/11/05 SODIUM (Na) 7.56 MG/L N/A 9000.'.1 05/04/05 pH 6.6 UNITS 6.5-8.5 9043 05/10/05 HARDNESS,TOTAL 144 MG/L N/A 05/10/05 ALKALINITY (AS 98.0 NO/I... N/A 900j. 05/05/05 TURBIDITY (TUR 2.6 NTU 0-5 NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WA TE WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDIP:::f�7HE 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/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 .(914) 245-2800 Albert H. Padovani, Director LAB ~#:~9�5O0894~~~ CLIENT ~t�:~57197~~~~~~ ~~~~~~~~ NON ~STAT~PROC PAGE: ~~,~~~~~2~~,~ WYNDHAM HOMES B COLLINWODD DRIVE RALPH TEDESCO BREWSTER, NY 10509 DATE/TIME TAKEN: 05/04/05 09100 DATE/TIME REC'D: 05/04/05 10:15 REPORT DATE: 05/13/05 PHONE: (845)-279-2022 SAMPLING SITE: 26 TEAL LANE, PATTERSON SAMPLE TYPE..: POTABLE WELL TANK PRESERVATIVES: NONE : COL'D BY: TEMPERATURE : ^^ COLIFORM METH: N/A NOTES���:~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~,~~~~, DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD is suggested, pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.570 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 MGM- 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: Albert I Director ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH 61 / ola s �u DIVISION OF ENVIRONMENTAL HEALTH SERVICES /-3 / /o S , We FINAL SITE INSPECTION 5 � p l l 61010 Date: �" o In ct d b spe e y Street Location 7';j� 1 L� L, .e Owner /rU,, Lik-kl k/OdICs Town 'ec ersvtro Permit # TM # t - A/ - /;?- C► Subdivision Lot #. 1. Sewage System Area a. STS area located as per approved plans .......... .. ................ b Fill section date of placement 3 1 bain er ` Lgth. Width . Avg.Dpth c. Natural soil not stripped ................. .. ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course /wetland ........... ........................ 11. Sewage System a. Septic tank size - 1,000 ........1,250 .....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. Trenches 1. Length required s 7z Length installed 7z 2. Distance to watercourse measured,;/®0 Ft.......... 3 Installed- according to plan.... ... 4. Slope -of trernch; acceptable' 1/16 1132" /foot 5. 10 ft. from r e- - foundations::: 6 hes from s Ro m allowed for expansto 1001° Size of gravel 314 - 11/2" h1 ench 12" minimum ................... 10. Pipe ends capped........ .... .. ..... .............. g. Pump or- Dosed Systems 1 `Sie of pump chamber.... . ............................... ... 2. Overflow tank ............................. ............................... 3. Alarm, visual/ audio ........:........... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box balled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Buildina a. douse located per approved plans ... .....:..............:.......... b. Number of bedrooms ...................... .............. . IV. Well Well located as per - approved plans:: Q, _ b. Distance•froih STS area'measured .yt-IOD.: C. Casuig 18" above grade .....:...........: d. Surface drainage around well acceptable ....................... V. Overall Workmanship . a.. Boxes properly grouted ................... ............................... b. All pipes partially back& lied ........... ............................... c. All pipes flush with inside of box..... I ............................ 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 COMMENTS x_ -2 To 6•z T . orm ss MAY -05 -2005 02:49 PM HARRY W NICHOLS 914 279 4567 P.01 0 3 `© 3`< PUTNAM COUNT' DEPARTMENT OF REALTH DMSION OF ENVIRONMENTAL HEALTH SERVICES R IMST FOR MAI 21SPEC For; Fill Date, ' Trenches M PCHD Construction Permit # -0 Located: Owner /Applicant Name: ��� k �� �. c TM 3 5 . Block Lot _dc) Formerly: _- Subdivision Name: O we Subdivision Lot # Is system fill completed? I's system. complete? Is system constnmcted as per plans? Is well drilied? Is well located as per plans? Are erosion control measures in place? -elf Date; Date: Date: I certify.thar the systern(s)7 as listed, at the above premises ha_, been constructed and I have inspected and verified their completion in accordance with the .issued PCHD . Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. J 4DeProfessional Date: = Certified by: P Address: Lic. # i Conuuen;ts: . .FOR: 0 ADAM -ENE ❑ (NAME) Form FIR -99 TWI i i 1= P, FFI ; s X45 -278 -7921 !-;iME : PUTNAM COUNTY DEPARTMENT OF P. 1 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health May 13, 2005 Mr. 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 #38, T.M. #35. -4 -102 The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. 1. The SSTS was not installed as equal distribution. 2. The fill pad expansion area appears short in size. 3. Septic tank and pump tank have been backfilled and have not been inspected. 4. A pump test needs to be witnessed by this Department once the electrical inspection has been completed and notification of such has been submitted to.this- Department. 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 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 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 SENDING CONFIRMATION DATE MAY -13 -2005 FRI 15:43 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 92794567 PAGES : 1/1 . START TIME : MAY -13 15:42 ELAPSED TIME : 00'42" MODE : G3 RESULTS : OK FIRST PAGE.OF RECENT DOCUMENT TRANSMITTED... SHERLITA AMPLER, MD, MS, FAAP Commt++lanv ofHeddr _ LORE2TA MOLINARI, RN, -MSN Atweia(t Comma• +loarroJHtdeh May 13.2005 W. Harry Nichols P.& Patterson Pack Ste 106 2050 Route 22 Brewster, NY 10509 . . 0 DEPARTMENT OF HEALTH 1 Geneva Road, Btewner. New York 10509 ROBERT 4. BONDI Garay E—dw Re: Nic;d Inspection - Wyndham Homes Trat Lane, (T) Patterson I.nr s('i 'I' Nl. 435 .-4-102 Dcar Mr. Nichols: . The above referenced separate sewage: treatnncut •`v ht -11 be backftllcd. The following comments must be corrected in the field. 1. The SSTS was not installed as equal distribution. 2. The fill pad expansion area appears short in sizr.• 3. Septic tank and pump, tank have been backfilled and have not been inspected. 4. A pump test needs to be witnessed by this Department once the electrical inspection has been completed and notification of such has been stibmitted to this Department. If you have any further questions, please contact : nc at f845) 27&6130, ext. 2261. Sincerely. Gene r). Reed Sr. Environmental 11calth Engineering Aide GDR:cw W�Ar9y1S8reEen(MS)235.5I5b I.u(145)M -3416 iArlro�ret11tal Holt! (815) 278.61]0 Pa (815) 278.7921 NuninBSirvim(94S)278.6158 wIC(R45)278 -6678 Fu(845)272-MS 8ar151n1orvmltlon/Prmehoel (R4])27RIdl1n Pnr !849)278.6648 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL IIEATLTI SERVICES FIELD ACTIVITY REPORT NAZyM., 9& ld&, W1 P- 5 A n T) TZESS Street Town State zip //0 PERSON IN CHARGE 6- . nR TNTFRVTF T)� PUMP TEST E] DOSE TEST REQUIRED GALLONS 2-72 03 iU= 09� 0 �7T 0y -2 7-7 EL. START t14 EL. STOP ('�,0/0 4- - 01� � I - � /', '/,- Signature and Title REPORT RPC.FTVFT) BY: I acknowledge receipt of this report: SIGNATURE: 02/96 Titl Rev. SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN .4ssociate Commissioner of Health June 1, 2005 Mr. 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 #38, T.M- #35. -4 -102 Per our meeting at the above referenced lot on May 31, 2005, the following comments must be addressed. 1. The fill pad expansion area appears short in size. 2: A pump test needs to be witnessed by this Department once the proper adjustments have been made. 3. A survey needs to be submitted to this Department showing the location of the existing fill pad and SSTS trenches. The survey must be from a New York State Licensed Land Surveyor. 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 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 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 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health June 13, 2005 Mr. 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 #38, T.M. #35:4-102 Per our meeting at the above referenced lot on June 10th, 2005, the following comment must be addressed. • The clay barrier needs to be added at the top of the fill pad per the approved plans. 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 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 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 MAY -27 -2005 03:47 PM HARRY W NICHOLS 914 279 4567 I lead 0 2.005 8t29RM DIVERSIFIED 9149621715 95/1712005 ®9'.41 171 84945029 my THIS CWTIMATH x r 1 tTT F,. NEW YORK BOARD OF Fift v d SURFAU OF r; G9R'n °f°II4AT Upon the application of upon prerrilm owned by 01AFORSIFIED ELtECTRIC ' ' WYNDHAM HOM11 6 1661 FRONT ST 9 COLLINMOD OR Uf4Ii 4 e1qE�WSTER, NY 1060 YORKTOM h1E13h s, w 1o9S8, Located at 26 TEAL LANE PAiTERBOWNY 1ZFA3 AppOlcation Numbet; 2042148 CM111atfs Nuakon 20421 Sectiom 34 Bloch: A lot: i3o Building Permit. S Described as a ocusrtcy, wherein the prernisa electrical electrical devices and wiring, described below, located inlos iii prernisae at: �tasetmcnt, w+dds, - - A visual inspection of the prernlsn eteebictll srswm, Iirnitul to Motrical Oftees oP4 wiring to the her ®in, was r:anducted in * accordance . with the rogly4m OMS of the applicable code e promulgated by the State of New York, Department of Cade Ettforcernent and Administi authority having jurisdiction, end found to be in complipnce therewith on the 13d, ®ay of Msy, y4 Him S >i! JIB Slotiah hZ tVtirmeallmtea:pue PERMTI°s 3 7" -04 SEPTIC PUMP AND ALARM Alarm and tomygeney Equipawat lieaset 3 '0 110 Se�oke Seaear 7 0 Ito waft:i& Appll*oe" and AeeeeMMO R®eas 1 0 it MW Dish ve uh r t 0 t .3 )KW Fwas`t: Z 9 $3B8 Aix canditigaer. 7 0 1360t10 tif'Y4! Mown 4 t PIE P l pet�� 1 Z00 40 Wirlso stoat Dwilcee P.01 p. 2 PACE 04 W104 consisting of sea/ deteiled 106derd a other outlet 220 0 Continaed aT NOXI ate• of Z -this eertit,cate may not be altered In any �jwy and Is Midetiad only *the press ate raked OW MR the rocrticn I led9d, MAY -27 -2005 FRI 15:05 TEL:845- 278 =7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 MAY -26 -2005 10:29 AM HARRY W NICHOLS 914 279 4567 P.03 t9aw, L i guua b: idwim u 1 YLK6 i F l £D 9149621715 p.3 83/17/21396 09:41 17184946839 � PAGE 06 MAY -P6 -2005 THU 10:47 TEL:845 -278 -7921 t•IAME:PUTNAM COUNTY DEPARTMENT OF P. 3 BY TH1* C 111MIMICAM4 fW GOMIaUMCle THE IVE1Al YORK BOARD OF PIM UNDERWRITERS SUR"U OF ICrrY 40 FULTQN . STRr&KT - NRW YOMIK, NY 1 0039 CERTIIRM THAT Upon the eppliodon of upon premiss owned by 6Ib1:RNFiE6 EiEiCTNO WYNDHAM HOMES 1t3d1 FRONT 3T. b CCriL1 INWObp DR UNIT 4 114EW11TER, NY 10609 YORKTOWN H1116.14M NY - 10598, Located at 20 TEAL, LANE PATTLRSW NY 12669 . Appllicatlen Number. .. 20"146' COOkW Number. 204214 Section: block: 4 Loh' 120 8talding Permit: DOC W104 Described as a oetw panoy, whst�ein the premises e1eCtNca1 ,system onslstlrS of eteCtrical *vices Attd wiri ng, de�cwibed below, Iocalled Irmn ttla plendafs at: >lasowrn, Otict►ide, A visual inspectkm of the prq:mlS" t loetricel systern, ►ImlMd to electrical deevicm and wiring to the s ent detailed herein, was' conducted' in accottmnce tiwith .fhb ra%&Wn♦Me of t11e -applicable code an standard Promulgated by the State of :New ,York,. Qapartment of btdts. Cody Enlor4wriant and Adminiatrat n, or other authority having Jurisdiction, and found to be' In compliance therewith on the 1Sth pay 01 May, 2"$ SM "8 611111111118 101 Flftlwe 79' 0 110 llaamdeatew Receptacle 00 1110 Gaaenl 11VOW itva4ge1erle to 0 110 OFCa ftseepf�ote 4 0 110 Spew bwitei� 48 0 110 Ggatil Puepoee Outist d t) CATS► 1 Circlet S 0 7�ehpftnee servbm 1 Phaee 3W 8"V ice Rating 100 A *.nvs . 11micc P1t"' omwot; 1 .200 C� _ i Metttxas 1 i M1 I a or 2 This certificate may net be altered in any way end Is validsttd only by the preelepee of a raised seal at the location I d MAY -P6 -2005 THU 10:47 TEL:845 -278 -7921 t•IAME:PUTNAM COUNTY DEPARTMENT OF P. 3 MAY -26 -2005 10:25 AM HARRY W NICHOLS .BRUCE R. FOLEY Public K.Wth_.Dtrector DEPARTMENT OF HEALTH 1 Genova Road Brewster, New York 10509 914 279 4567 P.02 LOREiTA MQL1N0J ILK, MR Auoclate Public Health Director birector oj. Pa:lant Savteer ATTENTION:, o AAANI STIEBELING a GENE REED All information below inust be fuiU;ompleted'prior to any scheduling. ENGIiNEERORFIRM: A W. NrGeioL PE PHONE E10: _%?-I. !toga REASON: - i EEPS: o PERCS: 4 PUMP TEST: , ROAD /STREET: TOWN: _ p�� {��� `�l TAX MApN:S. ®� - SUUDIYISION: LOTS: 31r OWNER: YES NO 0 o Proposed SS' - within the drainage basin of West Branch or 1B.oyds Corner Reservoirs. o to Proposed S.St-S within 500 feet of a reservoir, reservoir stern or control Ink-e, 0 o rropose&StS within 700 feet of a ♦watercourse or a DEC wetland.' 0 o Proposed SS�S desigrk flow greater than 1000 gallons /dayorSPDES Permit required. 0 o Proposed SSiTS fora Commerical Project. It is ttie responsibility of the.design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. if you answered: to any of the questions, NYCDEP must witness the soil testing. This Department will coordinate a mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. If a project has been determined.0 be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. fop, Cou' "Ty USE bi,Lv DATE; T11IE (FFELL11�S7) .. MAY -26 -2005 THU 10:46 TEL:845- 278 -7921 HAME:PUTNAM COUNTY DEPARTMENT OF P. 2 AM COUNTY DEPARTMENT OF HEALTH IVISION OF ENVIRONMENTAL HEALTH SER CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at TKA _ Subdivision name pEtWv)v Date Subdivision Approved Owner /Applicant Name Mailing Address Subd. Lot # _ Amount of Fee Enclosed \Am) ti Town or Village W'a'` _60' d Tax Map Block .4 Lot I �,V Renewal Revision Date of Previous Approval Zip 5 Building Type K5 ��liL Lot Area No. of Bedrooms i Design Flow GPD doly Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of i x-60 gallon septic tank and I-) �- � '1� M Other Requirements: �/-� �' 1 vi— ► 4 6�,6�M To be constructed by lu Address Water Supply: Public Supply From - Address or: _ Private Supply Drilled by Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the 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 A A 4- b1l E. _� R.A. Date 011 &3 ')OA License # S till FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatme stem has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified whp�idered ecessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe ty�l proved di a of domestic sanitary sewage only. t� �� Date: jam' 7 By: �1 Title: y .S �� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUT NAM COUNTY DEPARTMENT ENT O F HEALTH DEWSION OF IENWRONMIENTAL HEALTH S ER VE C1ES APPLICATION TO CONSTRUCT A WATER WiELL V� please print or type PCHD Permit # "�' 1 —1 /, Well Location: Street Address: . Town/Village Tax Grid # _ _ TEAL- FINTT�9 t' Map 1� 5 9 Block' 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 gpm #People Served '� 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 Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? .:... ................. ............................... Yes No Name of subdivision D Lot No. Water Well Contractor: nD Address: Is Public Water Supply available to site? ........... Yes No >Z,_ Name of Public Water Supply: `° Town/Village Distance to property from nearest water main: °�- Proposed well location & sources of contamination to be provided on separate s et/p i Date: Applicant Signature: 4,,0 , 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 wate w 11 drille certified by Putnam County. Date of Issue h ° ( O'v Permit Issuin > , fficial: Date of Expiration /') To y Title: Permit is Non - Transferral White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 8 . ro September 7, 2004 Putnam County Health Department One Geneva Road Brewster, New York 10509 Att: Robert Morris, P.E. Senior Public Health Engineer Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 Tel: (845) 279 -4003 Fax: (845) 279 -4567 Email: hnengineer@aol.com Re: Proposed SSTS: Wyndham Homes, Inc. Teal Lane, Lot # 38 (T) Patterson, TM # 35 -4 -120 Dear Mr. Morris: In response to your letter dated August 12, 2004, we offer the following: 1. Original Corporate Affidavit is enclosed. 2. Comment noted. This has been incorporated into the revised design. 3. Expansion has been revised to provide for equal distribution. Extensions from existing primary trenches have been eliminated. We trust the enclosed have addressed your concerns and request that you continue with the review and approval. Very truly yours, L Harry W. N' hols Jr., P.E. HWN:jmm 03- 056.38sept LS :1 yid 6-'S X10 {� ` �v •� # x, �` `1 �` i1� `1�e x °° i d/t t lip l t • l �i 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: �El✓ —pop �� represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: \-A-,,, j �pc• �, t�y�, Having offices at: tt�N �� ..' , � �. Nl� \Uzz Whose Officers Are: President - Nam`e -R • � � � � .i _ .S _' Fes. "` ' �� Vice President Name: Address: Secretan! -Nam6: 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. A Signed: Title: Swom to before me this � . day of month (year)* r (month) � cR�,c . °� -� ear 'Nola Public rY' J AMNUTE RoaADc '�oawr� Public, State of Naw To; 3; No.01R0610= Corporate Sea] F',;zilflad In Putnam Count, t m- ;Ms. €v 'chin ^s 12J=9-0-0 Form CA -97 �030321000qoj ARTICLES OF ORGANIZATION OF W`YNDHAM 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 Co. Rd LO Z I HVK 0 A1303� C STATE OF N Rq YORK DEPAPTA'�ENT ��� JT iE MAR 2 1 2003 FILED APR 10 2003 DRAWDOWN NIS -27 ?0% 43032100 (-qyl LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 August 12, 2004 Harry Nichols, PE Patterson Park, Ste 106 2050 Route 22 Brewster, NY 10509 Re: Proposed SSTS: Wyndham Homes, Inc. Teal Lane, Lot #38 (T) Patterson, TM # 35 -4 -120 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. The Corporate Affidavit Notary Stamp and Signature appears to be a photocopy. If a Corporate Seal exists, the document is to be sealed with the stamp. 2. The primary and expansion system should typically be interchangeable, i.e., the same codes are applied to the construction of both systems. 3. The expansion SSTS is not shown on an equal distribution system. Furthermore, the extension of the primary trenches with expansion trenches creates distribution lines from the D -box supplying trench lengths greater than 100 feet. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very ly yours, obert Morris, P.E. Senior Public Health Engineer RM:km .f July 8, 2004 Putnam County Health Department 1 Geneva Road Brewster, New York 10509 ATT: Robert Morris, P.E. Re: Individual SSTS Deerwood Subdivision - Lot # 38 Teal Lane Town of Patterson T.M. # 35.4-120 Dear Mr. Morris: Enclosed are the following: Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 Tel: (845) 279 -4003 Fax: (845) 2794567 Email: hnengineer@aol.com 1. Five (5) prints of SS -38, "Proposed SSTS ", dated 07/08/04. 2. "Short EAF ", dated 07/08/04. 3. "Application for Approval of Plans for a Wastewater Disposal System ". 4. "Construction Permit for Sewage Disposal System, ", dated 07/08/04. 5. "Application to Construct a Water Well ", dated 07/08/04. 6. "Design Data Sheet ". 7. "Letter of Authorization & Corporate Resolution ", dated 07/08/04. 8. Two (2) copies of Residence Floor Plan(s), f "Bedroom Count Only". 9. Review Fee in the amount of $400.00. 10. Pump Design We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, Harry W.1�'chols Jr., P.E. HWN:gav 03- 056.38 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: 'v- o STREET LOCATION: L4t—t- REVIEWED BY: RM, GR, AS, SRDATE: a TAX MAP #: (CONFIRMED) Y DOCUMENTS PERMIT APPLICATION L �( )WELL PERMIT OR PWS LETTER U PC -97 LETTER OF AUTHORIZATION )DESIGN DATA SHEET (DDS) C__)C__)CORPORATE RESOLUTION (_J(_)SHORT EAF (,))PLANS -THREE SETS (`)(_)HOUSE PLANS - TWO SETS j ,r (.UUVARIANCE REQUEST (p. D O (_(_)LEGAL SUBDIVISION (__)(JSUBDIVISION AP OVAL CHECKED ( _)(_)PERC RATE O C__)C__)FILL REQUIRED _"?,— DEPT U(_JCURTAIN DRAIN REQUIRED I� GENERAL ( )LOCATED IN NYC WATERSHED vS SUBMITTED TO DEP EGATED TO PCHD APPROVAL, IF REQ'D P TEST HOLES OBSERVED CS TO BE WITNESSED APROVAL SSDS ADJ, LOTS (f WETLANDS (TOWN/DEC PERMIT REQ'D ?) ( /)(� )DATA ON DDS PLANS & PERMIT SAME C_.,6(e)PRE 1969 NEIGHBOR NOTIFICATION (__)LETTER BI/ZBA C__)C__)100 YR. FLOOD ELEVATION W/I200' TESTING LOTS >10 YEARS OLD REQUIRED DETAILS ON PLANS (—)(___)SEWAGE SYSTEM PLAN - (NORTH ARROW) (_ _)C__)SSDS HYDRAULIC PROFILE L,(_)GRAVITY FLOW (_ -)C__)CONSTRUCTION NOTES 1 -15 (__)(___)DESIGN DATA: PERC & DEEP RESULTS (___) (_)2' CONTOURS EXISTING & PROPOSED UUDRIVEWAY & SLOPES, CUT ,UFOOTING /GUTTER/CURTAIN DRAINS (__)(__)USDA SOIL TYPE BOUNDARIES (_)(_)TITLE BLOCK, OWNERS, NAME ADDRESS TM#, PE/RA; NAME, ADDRESS, PHONE# CAUDATE OF DRAWING/REVISION C_) _)DATUM REFERENCE (_)C_)LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. UUPROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS (,)(_)WELLS & SSDS'S W/IN 200' OF SSTS (--)(___)PROPERTY METES & BOUNDS (__)vEROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE COMMENTS: (REVSREET)09 /01/00 Y N (REQUIRED DETAILS ON PLANS CONT'D) UUHOUSE SEWER - %" FT. 4 "0'; TYPE PIPE CAST IRON (_)(__)NO BENDS; MAX BENDS 450 W /CLEANOUT RENEWALS (_)L__)SITE NOTE (NO CHANGE) FILL SYSTEMS (_)(_)10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE U(_)FILL SPECS/ FILL NOTES 1 -5 U(_)FILL PROFILE & DIMENSIONS (_)(_)FII.L IN EXPANSION AREA FILL GREATER THAN 2 FEET CLAY BARRIER (__)(FILL CERTIFICATION NOTE U(_�_)DEPTH GAUGES C__)(^)VOL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS (_)(_)SEPARATION DISTANCE FROM TOE OF SLOPE TRENCH C-_)C-_)LF TRENCH PROVIDED 60FT MAX. (__)(__)PARALLEL TO CONTOURS (_)(_)100% EXPANSION PROVIDED (__)( )DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL C__)(__)GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS x)(_)10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL (__)(__)20' TO FOUNDATION WALLS C_)C___)100' TO WELL, 200' IN DLOD,150' TO PITS (__)( _)100' TO STREAM, WATERCOURSE, LAKE (inc. eapan) (_ )C,j50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER (_)(_)10' TO WATER LINE (pits - 20') C_)(__)50' INTERMITTENT DRAINAGE COURSE C__)C__)200'/500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS C_)(___)10' MIN TO LEDGE OUTCROP SEPTIC TANK (_)(_)10' FROM FOUNDATION; 50' TO WELL WELL (__)C—)DIMENSIONS TO PROPERTY LINES (_)C,)LOCATION OF SERVICE CONNECTION UUMIN 15' TO PROPERTY LINE SLOPE (__)C_)SLOPE IN SSTS AREA (520 %) ((,)REGRADED TO 15 %, IF REQUIRED (__)(PUMP NOTES UC__)DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED C--)C-)DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) UUPIT AND D -BOX SHOWN & DETAILED DAY STORAGE ABOVE ALARM • � ; -,W (_)(_)STANDPIPES, 5' BOTH SIDES, DETAIL MIN to CDS = >5 %, 20' -4 %, 25' -3 %, 35' -1 %,100 % - <1% (_)(_)20' MIN to CD DISCHARGE /100' with 182 cons day discharge (_)C__)10' MIN to NON - PERFORATED PIPE 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: PGO� w wo + represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: Having offices at:-. %��,,j,(tJ��a� � � N) Whose Officers Are: President - Name: Address: Vice President - Name: Joao Address: Secretary -Name: Address: Treasurer - Name:.. Address: and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. in, MOWN worn to before me this �' . day of _(month) d3 — (year).. N� Public Form CA -97 Signed: 94J.- Title: Corporate Seal TN Tax Map # —Block Lot 12- Subdivision of 8ubdivision•ot 4 Filed Map # Date Filed_ '__.' OTI -to Gentlemen: This letter is to authorize \rj, J PE, a duly licensed Professional Engineer '7, or Registered Architect to-upjy for the. required wastewater treatment and/or water supply permit(s) to serve the above-noted.property in aqc6`i&fi'q'e;'..:..;..-: with the standards, rules or regulations.as promulgated by the Public Health Dire'cto'r County Health Department. and to sign all necessary- papers on my behalf in connection .with-. Us 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 County Sanitary Code. -Countersighed: PI., R.A., # _ Mailing Address Very truly yours, V Sighed: I (Owner property) Mailing Address: mu State Zip. 10 � 0 Telephone: (��-s) gO0'ri State Teteplfbne:. LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Harry Nichols, PE Patterson Park, Ste 106 2050 Route 22 Brewster, NY 10509 RE: Wyndham Homes, Inc. Teal Lane, Lot 38 (T) Patterson, TM # 35 -4 -120 Reservoir Basin Dear Mr. Nichols: ROBERT J. BONDI County Executive August 12, 2004 The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on July 15, 2004 is complete. The Department will notify you by August 30, 2004 of its determination. 0 The Project has been delegated to the Putnam County Health Department 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 Letter to: Mr. Harry Nichols, PE stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2166. Very 1 our Robert Morris, PE RM:km Senior Public Health Engineer 14 -16-4 (2/87) —Text 12 PROJECT I.D. NUMBER 617.21- SEQR Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR +. 2. PROJECT NAME 3. PROJECT LOCATION: �(i '^� ��� � Municipality I��L � County 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) 5. IS PR POSED ACTION: New I ❑ Expansion ❑ Modificationlalteration 6. DESCRIBE PROJECT BRIEFLY: 9� oi�t�5�� 1- ��� , G��i tl ► 6�2 I 7. AMOUNT OF LAND A ECTED: j �` °' Initially ° acres Ultimately 1 acres 8. ILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes ❑ No If No, describe briefly 9. W T IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑ Industrial Commercial ❑ Agriculture ❑ Park/ForestfOpen space ❑ Other Describe: U A' 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? U5 Yes ❑ No If yes, list agency(s) and permlVapprovals I ovg 0(- �fll �E9 -S0� � Ic. i% (CgArr 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? 5D Yes ❑ No if yes, list agency name and permlVapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? .0 Yes MPO I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant sponsor name. Date: Signature: AA If the action is in the Coastal Area, and you are a state agency, complete* the Coastal Assessment Form before proceeding with this assessment OVER PART II— ENVIRONMENTAL. ASSESSMENT (To be completed by agency) A. DOES ACTION EXCEED ANY TYPE 1 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) Cl. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly. C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly. C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified In C1-05? Explain briefly. O 1....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? ;� L ;Z- 0 Yes ❑ No If Yes, explain briefly C17 C :,!_;; PART 111 — 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 (i) 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 of Lead Agency Date Title of Responsible Officer Signature of Preparer (if different from responsible officer). _.1 V, 11 \l llil \i'V V1 1 1 A Yi�i 111. \11111/1 \ A VA:' jj.1.:.1C],jJ. J_ jj -- �- -••- .. -� DIVISION -OF- ENVIRONMENTAL - HEALTH• SERVICES` - - —APPLICATION FOR APPROVAL OF PLANSJFOR - • •A:.•VYA:•STEWATER TREATIYIENFT SYSTEM �� : '" �'• - - - 1. Name and address of applicant: ini'`IdORW �'M(�`a � � (�. 2. Name of project: O 3. Location TIV. 4_ :Design Professional: 5. • Address: n h _, . .... fi�rr,_,• :� .. 6% Drainage Basin: Y��� =B �� -- • . ' ...1���� 7. Type of Project:: - Private/Residential Food Service Commeicial -, Apart ments•-: - Institutional Mobile•H©me- P-ark,. - Office Building Realty Subdivision _ . Other (specify) ' . — ` 8. Js this project subject.to State Environmental Quality Review (SEQk.) ' ` - TYPestatus ( check one)**...*-............... I ................................... Type I Exempt " Type II - Unlisted 9. Is a Draft Environmental'Impact Statement (DEIS) required? ................ t�0 - . 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. 13. If so, have plans.been submitted- to. such authorities? ....................................... • . �,,.�•.:-• � • • 14. Has•prelimmary.approval been•grarited by such authorities? Date granted: YE 15 e of Sewa e•Treatment System Discharge:. .::............. surface water roundwater - YP g _Y_ - _g . u .. 16. ..-If surface watet discharge;: what is the stream class•.designation? 17. Waters index number (surface). .................... ...:..... ..:..............:..:..:....... 1.8... Is project located near-a public water supply system? ......................... 1.9.- If yes, name -of water• supply Distance to waTer: su . p 1 1 P PP Y 30: Is.project site near a public sewage collection or tkeatment•sy e' Mr'9 - '3•i. Nameofsewage•system :. =Q; Distancefo_sewage`system` 22. Date test- observed H4 H.1 J 23•: Name of Health.Ins ctor . . 24. Froj'ect'designf flog( gall' ons. perday)..... ............................................. .:...... -... 25. Is State Pollutant Discharge Elimination .System. ( SPDES) Permit .required? 26. Has SPDES Application been submitted to. local DEC office? ..........::.:...... ...... Form PC -9� 2 I any :- .1"cate .1. . I a . tl and? s-ai portiomofth.isp'roi.e�.L'o esign�,t�d Town* or State We 2: 28. Wetlands ID.2-qbrhbpr ...... .................. ..... .. ........................ 29'. ---Is Wetlands Permit required!?-...,:'..� ......................................................... : ...... Has application been made'to Town or Local DEC office? .................................. . 30. **Does project require a DEC Stre6m•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, Jandfilliq',•8ludge application-or in . dustrial activity? ............................ Yes/No 32." Is project located within 1,000 feet -.of existing or abandoned landfill, Cr hazard ous.waste site, salt stockpile, landfill., '0 e disposal- site or any other potentially known source-of contamination? ............................... Yes/No DESCRIBE: Is there a local master plan on -file with the Town or Village? ......... 2 ............... 34.. Are community 'water and/or sewer- facilities.planned to be.deve'lop6d.-Withln, 15 years in or. adjacent to projieict site? ... .................................................... 5. Are any sewage treatment areas in excess of 15P/0 slope? ............................. 36. Tax Map ID Number ............ ................................................. 'Map BlockAL Lot 37. Approved plans are to be. returned to ..... Applicant Design Professional NOTE: W .N. All applications far review and approval ofa new 8STS--to be located within the NYC Watershed shall he.serit to the Department,. and need not be sent in duplicate to the DER, although the, project may require DE-P' .'.-approval of the-1-SSTS'prriar10 fint&,appro'v'a1*by- the Department. Projects- withili,ft Wat6rshed.ma y also Vi�w and'App�oval. of other aspects of a as stormwaterplahs-or require DEP - ie the' creation of impervious-s * U:r.ac—es, and the project applicant should obtain the appropriate forrns,for. such... activities from: DEP and submit those forms to DEP for review and approval.. If the application is signed by ap'erson other than the applicant shown-in Item 1 :,the application must be accompanied by.a Letter of Aut'ho'rizatio'n (Form LA -97): Failure to comply with t'his,'provision. may ay -grounds for the rejection of any subniission. I h ereby'flffrtnj.under penally of perjury, fhat•informatioir pro.viderl'on iliis form. is te to the best of my knowledge andbelief. False itatemenis-in'ade herein are punishablF.-as, a ClassA misdemeanor. pursuant to Sedlon 210.45 of -tire P8napLyaw, L SIGN -TURES-& -OFFICIAL TIT ES. A A�AAAI A�.:P� tileM ArN 1^ 0 . a Mailing .................. . 1 11,0�- 0 :HEALTH PUTNAM, 1"HE DIVISION bF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner,: WND",: MM5� to&,. Address' CDL&(!qVJ000 Located at Street U (\ONPL6.N1u, Fin. -tax Ma p--,9,)5:1, Akick' 4 LO-1-I.Ef... (indicate nearest'cross street) 11Y.P-4 • Municipality Eft Watershed SOIL.. PERCOLATION TEST DATA Date of Pre - soaking M(o Date of ercolation Test ml "g MI. TO. a .ro S' WI. ILI JAI 3 5 VQ Mo -2. w 3- 4 5 2 3" NOTES: 1. Tegts'td be r6ndAdd-at same depth until approximately equal nere6lation rates are obtained at each percolation test hole. (he7:5 I min for 1-30 min/inch,.:5 2 min for 31-60 min/inch) All.data to . be. submitted for review.*, 2.' Depth measurements to be made from -top .of hole. Form DD-97 DEPTH G.L. 0.5' 1.0' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7 5' ® - !nif SPc1�0 �-© . -,. ..-I- - V w MTOANOA 0 -0� Indicate level-at which. groundwater"is encountered °0 Indicate- leveLat 'Rich. mottling. is observed A- _ Da t kAp Indicate level to which water level rises after being.encountered Deep hole observations made by: M A/i � O CM) N, t)J 7�AAA (�O j) Date . l Design Professional Name:-- Address: Signature Design Professional's Seal of, NEW Y Q x' W, .. 1 W 14 .¢61124 0) 8.0' _ -U, =- 17� 8.5' =:4 9.0' 9.5' - 0 0' -� . -,. ..-I- - V w MTOANOA 0 -0� Indicate level-at which. groundwater"is encountered °0 Indicate- leveLat 'Rich. mottling. is observed A- _ Da t kAp Indicate level to which water level rises after being.encountered Deep hole observations made by: M A/i � O CM) N, t)J 7�AAA (�O j) Date . l Design Professional Name:-- Address: Signature Design Professional's Seal of, NEW Y Q x' W, .. 1 W 14 .¢61124 0) 0 ki . ro b 00 s� �o ils ME L \l0 \o � 86 `x,T \9 `\ \ \ �J a po �oyu b R = L = g3A0 co DIMENSION CHART (in feet) Number A I 17 32 2 G2 z 3 129 1 13 4 1 25 1.09 5 119 105 G 114 In 7 III 101 8 107 loo 9 103 99 1 0 100 100 II 100 103 12 98 104 1 3 95 104 14 94 105 1 5 93 106 16 58 58 17 63 59 18 66 51 19 1Z 60 20 18 61 z1 S3 61 22 90 6 5 23 96 49 24 102 74 25 108 116 26 1 14 85 27 120 91 28 155 20 L .l0 0 02 2 le ,6 y0 \.9