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01785
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01785
MM19
AM COUNTY DEPARTMENT OF HEALTH
IVISION OF ENVIRONMENTAL HEALTH SERVICES
ICATE OF CONSTRUCTION COMPLIANCE
PCHD CONSTRUCTION PERMIT # — - 0-'
Located at U APFI eE RIW- 12JAP
Owner /Applicant Name Vy7 HDNA 1�0 %-� I W,-
Formerly
o'
U,
FOR SEWAGE TREATMENT SYSTEM
Town or Village f A -r -rEF-60H
Tax Map P*7 5 ' Block T Lot
Subdivision Name
Subd. Lot #
pap-w000
421
Mailing Address 1 "L-f H W Q40 pp-lgf5 B r4 W i B7p rj Zip 10,5-01
Date Construction Permit Issued by PCHD i l IM 04
Separate Sewerage System built by VU ` OKV Kpela7 11JU, Address 1 ±OU-It�1�MY
Consisting of `�O Gallon Septic Tank and &72- 1+ ° TN NAbj ►
Other Requirements: 2 i L c >� �-'� ('�-o p r01,t_ , PUMP
Water SuuBly:
Public Supply From
Address
or: 5( Private Supply Drilled by 8OYP A&R!K1W WELL, Address 10Jr;4 PM Cat J6-t, td, tniliL
Building Type « % Has erosion control been completed?�
Number of Bedrooms Has garbage grinder been installed? N
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 regulaligns of the Putnam Cgqnty Department of Health.
Date: O q --'� 0 -t 50
Address%5 0
Certified by
License #
P.E. R.A.
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 sect to modification or change when, in the judgment of the Public Health Director, such
revocation, r ' di ication,4}1 change is necessary.
By: Title: Date: fl 7-r v f
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
Street Address:
Town/Village: ,
Tax Grid #
M Block + Lot(s) l�+
WellOwner:
Name: Address:
�p V4 /Z D a
Use of Well:
1- primary
2- secondary
Residential Public Supply Air cond eat pump rrigation
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 X Open hole in bedrock _ Other
Casing Details
Total length _,Rj ft.
Length below grade eft.
Diameter 6" - in.
Weight per foot 14 lb /ft.
Materials: X Steel _ Plastic _ Other
Joints: —Welded 3e Threaded _ Other
Seal: _XL Cement grout _ Bentonite Other
Drive shoe: Yes No
Liner: Yes _C No
Screen Details
Diameter (in)
Slot Size
Length(ft)
Depth to Screen (ft)
Developed?
First
_ Yes No
Hours
Second
Well Yield Test
_ Bailed _ Pumped X Compressed Air
Hours
Yield gpm
Depth Data
Measur e 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
Z
_
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump /Storage Tank Information
/
Pump Type Capacity 1$—
Depth I Model 1 u Ir j 16 41
Voltage 23o HP
Tank Typet -Z.. Volume _(P
iS
`
°
,I,i
Date Well C pmplet d
Putnam County Certification No.
Date of po
Well Driller (signature)
NOTE: Exact location of well with distances to at least o permanent landmarks to be provi on a separat LIrs eet/plan.
('Well Drillees Name Address:
Signature: Date:
Yellow copy - Building Inspector; Pink copy - Owner; Or a g e D) l driller White copy: HD W
Form WC -97
jun 16 05 11:47a TOWN OF PRTTERSO
845- 878 -2019 p -5
BPXC'a R FOL Y LOR"TCA. MOLSi ARI'
,� Pu5f:e hrzal±A. A:iec:c. -. - _. • . �1w , - .�ssac:aie' Pyoilc 'Xaaltf� alrr�ar -
t DU+ttror � ?at:¢nt Srrviets
DEPARTNEENT OF HEALTH
I crcneva Road
Browexr, Now York 10509
'Ear;renmentd RWth (914)278.6130 Pme(914) 272 -7921
MI:IUM 39MC.S (P14)272-6519 WX (914j 278.6478 Fit (914) 278 - eo81
Tarly Ieterreartaa (8:4)278 -oo1= rrestlool (914) 278-6082 F=(91d)278' -6"1
TA-X- HAP:KUNMER: 3S — h' —•? y
E911 ADDRUS; % 0��� %�.CG L �G•�!7
TOWN: A47 -7-", SO'J
(Sianature)
DATE; G 1 G d
The Putnam- Cou ty--DepartmetLt °of •Health will ' not iss 'ae a Certificate of -
Construction Compliance wAess fhe above form is completed, i.e., a legal E911
addms.9s assigned by an aufho:^ized town official. This :orm is to be submitted
-ovith the applicatiou for a Certificate of Construction Con iplia'nce.
'1911bWx "M)
-PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH' SERVICES
GUARANTEE OF SUD.SURFACE SEWAGE TREATMENT SYSTEM
w� ��•� -�� I� om�5 lip � • 3 5' � (24
Owner or Purchaser of Building Tax Map Block Lot
Btiildirig Constructed by TownNillage
n E5,F,� R—w 0 p p
Location- Street Subdivision Name
Building Type.' Subdivision Lot #
I represent that I am wholly and completely responsible for the location, workmanship, material,
constractiorf and'diaina'ge of the sewageireatment system serving the above- descnbed'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 �sterh coris1ructed by 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.
D ed: M Day Year %a� Signature: t/
�/ Title:
I VP C o.v�i7s
en ral Contractor (Owner) ' ignature
Corporation Name (if corporation)
Corporation Name (if corporation)
Address:
GoWWWWO 04
Addressl CoWoOml
NK PW;76k-
State
Zip � ® 5A
State
Zip
Form GS -97
YML ENV]RONMENTAL SERVI CES
321 Kear Street
Yorktown Heights, N.Y. 10598
(914) 245-2800 -
Albeet H. Padbvani, Di r ec', lr'^
LAB #: 9.501857 CLIENT'#: 57197 NON STAT PROC PAGE: 1.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
WYNDHAM HOMES
8 COLLINWOOD DRIVE
RALPH TEDESCO
BREWSTER, NY 10509
DATE/TIME TAKEN: 08/10/05 10:15
DATE/TIME REC'D� 08/10/05 10:50
REPORT DATE: 08/17/05
PHONE: (845)-279-2022
SAMPLING SITE: 128 APPLE HILL ROAD SAMPLE TYPE.,: POTABLE
: LOT 42 PRESERVATIVES: NONE
COL'D BY: TEMPERATURE..:
NOTES...: WELL TANK COI lFORM METH: N/A
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD
PUTNAM CNTY PROFILE
08/1O/05 MF T. COLIFORM ABSENT /100 ML ABSENT 1008
08/12/05 LEAD (IMS) 4.0 ppb O-15 ppb 9003
08/11/05 NITRATE NITROG 2.67 MG /1 0 - 10 9052
08/10/05 NITRITE NITROG <0.01 MG /L N/A 9162
08/11/05 IRON (Fe) <0.060 MG /L 0-0.3 mg/l 9002
08/15/05 MANGANESE (Mn) 0.044 MG /L. 0-0.3 (11g/l 90x)2
08/14/05 SODIUM (Na) 22.3 MG /L N/A 9002
08/10/05 pH 6.1 UNITS 6.5-8.5 9043
08/15/05 HARDNESS, TOTAL 190 MG /1 N/A
08/15/05 ALKALINITY (AS 68.0 MG /L N/A 9O0J.
08/12/05 TURBIDITY (TUR <1 NTU 0-5 NTU
COMMENTS:
BACT THESE RESULTS INDICATE THAT THE WATE WAS NOT) OF A
SATISFACTORY SANITARY QUALITY NEW YORK STATE
AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS
TESTED, AT THE TIME OF COLLECTIONi,
Pb/Cu LEAD limits for p
EPA Lead & Copper
than 10% of their
than 15 ppb and a
treatment must be
potential.
mblic schools are set at 15 ppb.
Rule for Public Systems requires that no more
distribution points have a LEAD value of more
COPPER value of 1.3 mg/L, else water
undertaken to reduce the waters corrosive
Fe/Mn If both iron and manganese are present, their total value
combined shall not exceed 0.5 mg/L.
Na No limits for Sodium are proscribed. Suggested guidelines state
that for people on a sodium restricted diet,the water should
contain no more than 20 mg/L of Sodium. For those on a
moderately restricted diet, a maximum of 270 mg/L_. of Sodium
Yhil._ ENVIRONMENTAL SE: RV I CIE15
321 St.reet
`(orI::town Heightia4 N.Y. :Ec:}5''7f:3
t X71. a;. } C?t.; C- •RC3[:t(:>
LAD # 9.501t.'157 CL..I ENT ft;, 57197 NON STAT P ROC PAGE ; 2
WYi`IDI-I(.*)M HOMES DATE: /TIME TAi. -.'E r! 00/10/05 10::15-
#:3 COL.1...IIVWOOD DRIVE 13AT1 /1'Ilvil:°
RALF'F -I TE DES)CCI Rr1°'CIRT I }ATI-" 00/1,7/05
E3REWSTF R , NY 10509 PHONE ( £:34'5 3 r 79— i''(}r• 2
SAMPLING SI'Tl : ; 3.2£=1 Aff"LE: H.IL-L. ROAD SAP- IF`LE. 'T'YF' PEE :.. F'CI : AI3L E.
LOT 42 PIRE::11:3E '1WAT T Vl :: ", NCINE:.
COL. ' I3 Ilya TLhIF•1:F" AT URiE' . .
NOTES. . . n Wk °1-1- TANK C£71-_ I F'OIR11
DAIT--" I =L.AG F'RCICEDL1FiL :: RESULT '1I[1RMAL.. -- RANGE l�il: 'TI-fC113
is suggested.
pl-I pl -i SCALE IN WATER RANGES F' R011 1-14. MEASUREME: NT OF pI--I IS ONE OF
T'l -Ili T. l"IF'ORT'AI'4T A'i,11) f"ftEQL.JE P%I -('L.Y EJSf•::1} TESTS WATER R CE-li:: N I S"VI iY .
WATER W I'1'1.4 A LOW l:)l•i l" i I GH-F I:3E:: CORROSIVE TO METAL F' I PIE."S AND
F"IXTUfiE_S. THE PIORi"lAL RAINIGE:. OF' pF-I IS 6..5 'TO 8.5.
Hd TOTAL HAFtI?l:ll:_ S IS DEF- I IWED AS THI SUM OF' THE C:AL..0 I L1I,'l f'.: IvIt=iGNE::S T L)II
CONCENTRATION, BOT -1.1 EXPRESSED SSED AS CALCIUM CARBONATE, I iNI Ibll_; lL. Tl• IE
HARDNESS MAY IRANGI:' FI- 011 0 TO HUI+DIREDS C11:° l�ll� /I._, IIE'f'I:::I�II3£:i ON •THIS:
SOURCE: AND TRf. °:A- ThlENT 'TO WHICH TF-IE: WATER I-IAf:3 BEEN SUBJECTED.
SOFT WA -fER -. 0- -'7( ") MG /L VI::RY HARD WATER a ABOVE -': Sc: 0 PIG /1_.
_ ... hli:: DERATEL Y . HARD WATER,-. 70--140 11G /L. - -- 1`'II_; /L. - hl.I LL T GRAl l F'1_R LITER '
HARE} WATER',. 140-- 30(i - MG /I.. - t:i grain /gG-1 Ton '= :£7n2' I'IG /!_.}
SUBMITTED BY,-,
Albert H
I3i.rec:: ,oi
u
P aclovan i, M. T �. t ASCF' 3
E::LAF`* 10323,
September 30, 2005
Robert Morris, P.E.
Putnam County Health Department
1 Geneva Road
Brewster, New York 10509
Harry W. Nichols Jr., P.E.
Patterson Park - Suite 106
2050 Route 22
Brewster, NY 10509
Tel: (845) 279 -4003
Fax: (845) 2794567
Email: linengin"eer@aol.com
RE: Individual SSTS Compliance — Wyndham Homes, Inc.
128 Apple Hill Road - Lot # 42
Deerwood (Windsor Woods) Subdivision
Town of Patterson,. NY
T. M. # 35. -4 -124
Dear Mr. Morris:
Enclosed are the following:-
1. Five (5) prints of Drawing S -42, "As -Built SSTS ", dated 09/30/05.
2. "Certificate of Construction Compliance for Sewage Treatment System ",
dated 09/30/05.
3. Three (3) copies of "Guarantee of .Subsurface Sewage Treatment-
System ", dated 0(9/ 30/05.
4. Laboratory Report, dated 08/17/05.
5. "Well Completion Report", dated 08 103/05.,
6. Application Fee in the amount of $300.00 ayable to Putnam County..
Health Dept.
7. "E -911 Address Verification Form ", dated 06/16/05.
If there are any questions concerning the enclosed, please call.
Very truly yours,
Harry W. hots Jr., P.E.
HWN:gav
03- 056.42
DIVISION OF ENVIRONM[ENTAL HEALTH SERVICES
FINAL SITE INSPECTION /O LylvS
Date: C/ z 40 L5
c. Inspected by: G. 11?.
Street Location 42 AL 441-2w-1
.-To,Rm - Permit # 9,-
TM#- /Z1/ Subdivision Lot #
1. Sew'aee Svstem Area
a, STS area located as per approved plans.......... : * .............
b. Fill section - date of placement
3:1 barrier Lgth. Width Avg.Dpth
c. Natural soil not stripped......... ........... ...............................
d. Stone, brush, etc., greater than 15' from STS area......
e. 100' from water course/wetlands .... ............................
IL Sewage System
a. Septic tank size - 1,000 ..... ... 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. 1'renches-,-,
—7 I
"
L.eh e d 'LL -en -ms 91
2. - Distance to watercourse measured Ft....
I-
5. 10 ft. from property line - 20 ft.- foundations..........
6. Depth of trench <30 inches from surfice .................
9. Depth of gravel in trench 12" minimum ....... w ...........
10. Pipe ends capped .......................................................
S ize of pump : chamber .. -P
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 ...........
EOL House/Buildini!
a. House located jejappEoved plans, ... .. . .. ......
-
�b��-:�Numb er-
of l* o
IV. -Weller
�dd--plag-,
Well located z-
MafVNPRY ri
from 9T area measured-
- / 0 0--
c. Casing. 18" above grade ............... ro ... Y,,-. -c- fie.-Lp. +1
d. Surface drainage around well . acceptable .......................
V. Overall Worlananship
a. Boxes properly grouted ...................................................
b. All pipes partially backfilled ..........................................
c. All pipes flush with inside of box ..................................
d. Backfill material contains stones <4" diameter ..............
e. Curtain drain & standpipes installed according to plan..
f. Curtain drain outfall -protected & dir.to exist watercourse
g. Footing drains discharge away from STS area ...............
h. Surface water protection adequate .......... * * ...... ****'*** ... *****'*
i. Erosion control provided .................................................
Rev. 12/02
•
COADIENTS
li I - MRI
rya
V4
Mk
IMAM
M
i
Fill pad located per the approved plan 4
Fill Pad Length Z,, 3 Required Length 163
Fill Pad Width . ,v '3 Required Width 0 3 3o11oa
r �
Fill Pad Depth 5 Required Depth
Run -of -Bank Fill Quality �lC
Slope from Top to Toe Q (C j
Impervious Layer Installed /e 12
trosion Control Installed y�
Sieve Test Results (if applicable)
Additional Comments:
Reserved for Field Sketch if Applicable
Y
O
SHERLITA AMLER, MD, MS, FAAP
Gonim'lisioher of Health-, -_--- W- --
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
September 1, 2005
Harry Nichols P.E.
Patterson Park, Suite 106
2050 Route 22
Brewster, NY 10509
Dear Mr. Nichols:
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ROBERT J. BONDI
Re: Field Inspection — Wyndham Homes
Teal Lane, (T) _Patterson
Lot #42, T.M. 35. -4 -124
An inspection of the fill pad at the above referenced project has been completed.
Trench plans must be submitted to this Department for final approval of construction
prior to the installation of the separate sewage treatment system.
Please note that field measurements by this Department in rio way suggest the exact size,
depth and location of the fill pad.
If you have any further questions, please contact me at (845) 278 -6130, ext. 2261.
GDR:cw
Sincerely,
0�� -0. vz_e'�
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
CHARGE PERSON IN
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL IIEATLII SERVICES
FIELD ACTIVITY REPORT ":.... ".....-.,._,.
Towh State Zip
PUMP TEST
DOSE TEST
REQUIRED GALLONS
Signature and Title ` T
RFPORT RFrFTVF.T) BY:
I acknowledge receipt of this report: SIGNATURE:
02/96 Title:
Rev.
HARRY W NICHOLS 914 279 4567 P.01
SEP-14-2005 10:45 AM
PUTNAM
,�
..1im��fojR,bFENVMONMENTALIffEAL17RSPRWCES
Date: .Allot — -
For: Fill
Trenches
PCHD Construction Permit# —P-ji-a&
Located:
J1 - (T) (V)
Owner /Applicant Name: Q6Qk1kii gim"ri-jar., TM Block- Lot 1.19
Formerly: Subdivision Name:
Subdivisiou Lot 0,
Is system fill completed?
N system complete? VIA
Is system constructed as per plans? Vre
is well drilled? --y"
Is well located as per plans?
Are erosion control measures in place?
Date:
134te.
Date:
I certify that the system(s), as listed, at the above premises has been constructed and I have inspected
and verified their completion in accordance with the issued PCHD Construction permit and
approved plans and the Standards, Rules and Regulations of the Putnam County Department of
Health.
Date: Certified E
by. . . W.-� k, 4 -L_ RA
Deli -A posional
Address: -212W 120,4ft 21 jAjjQ9—Lic.#
Comments:
FOR- ❑ ADAM GENE a
Form FM-99
DEPARTMENT OF P
CERVIPPIES THAT
Upon the application of upon promises owned by
D1VER$1FIEV ELRCTR4 WYNDHAM IHOMES
1681 FRONT ST 128 APPLE WILL ROAD
UNIT 4 BREWSTER, MY Icl000
YORKTOWN HEQKTS, NY 10698,.
Located at 128 DAPPLE HILL ROAD 8REWSTER, MY t 0=
APplication `tumber :47d140 Cv f eefe Number: ' 209
Section, Block. Lot: 8uiidittg Permit., I
Dc- :A,104
DescrIbed as a 'Ptizidadal 2400 -.2999 aq%we ft. oCcupency, wherein the promises electrical syst
rt consisting or
1
eleGtriCel devices; eocl hiring, described betior/, located inlcn the premi3es vl: '
DAMMent, F'irsl .Minor, Second Floor, AttaChied Garage, Outslde, Attic,
A visual inspectlor, of the ptemises aactrical system, limiter to electrical devices anc. wir',ng to th
extent detalied
i
herein, was conducted in accordance with the requirernents of the applicable code
ndfor stan&rd
promulgated by the Stits of New York, Department of State -ode Enforcement and Adrrlinis
ation, or othe3r
�
a0hvri Kevin , r :.ciir`ia: , and found to ue in compliance therewI0.on the IDs of
tY g ! P 12th Suit
er, 2005.
�f�r? "Q& Cara I=
8e'i16Lief1S
1
Mlscell,aeous . - :.,
..
..
PUTNAMCONTRO1,0733.05
.....:...., $ri.4C
1 SEPTIC PV1 G
513.OU
Appumserm end Accesmd a
Exhsud Pon 3 F.H.P.
Air Conditianer 2 36,600 DTU
Fara.&Ce 2 o
{
Dish Washer I 12 KW
I
Oven I 71 KW
Hell Tnsrtsihrmar I
i
Motors
4 F
I
Panr>t
1 200 41:
1 12$ Ia
Wiring rind Devion
r
Fix=* 61. hrodascant
Roceptacie 66 Ohasrnl Purpose
RCteptlsci0 20 opct
{
Corbacd an Tract Fav 1 of 2
}
1
This certificate may tat De alte and in any way and A va'idaW only by the presence of a raised seal atthe locca
ind'Cated.
NRt1E: n1 fTt,1AI r0114T`,' DEPARTMENT OF P. 2
914 279 4567 P.03
.CEP -1:1 -2005 19:46 AM HARRY W NICHOL6 — �—
. __—., .,soar -M DIVERSIFIED 914862018 p,3
13Y .,. T, Hz.I. S � W_ (:T: IMqA
:. .
..b .. �. -. Yok
BOARD OF FIRE' UNDER RM ERS
BUREAU OR EL OCYRICITY
40 F:ULTON STREET - NEW YOW, NY 10038
C ERTI P I1ES THAT
Upon the applicatlgh of upon p•amises owned by
DIVERSIF'IW ELECTRIC WYNDHAM HOMER
1581 FRONT ST 128 APP0 HILL ROACH
UNIT BREWSTER, NY 10509
YORKTOWN HEIGHTS, NY 10598,
Located at 128 APPLE WILL ROAD BREWSTER. NY 1050
Application Numbers 2070149 Ce:rtMeah Number. 20701412
Section; 81ock; Lot: Suliding Permit: DC: W1104
beserload as a Residential 24004909 square R. occupancy, whereln the prernNQ5 electrical cyst consisting of
electrical devices and wiring, dexei bed below, located Won the premises at:
ftasarneni, First Floor, Second Fl~ or, Attached Garage, Duiaide, Attic,
A Visual Inspection of the premiss alievIcal system, limited to electgcal devices and wiring to thi
i extent detailed.
I
herein, was coed& ted in accorciewce
with the requirements at
the applicable code andler
standerd
promulgated by the State at New York,
Department of State Cede Entorcoment and Administption,
or other
authu -ity having }ur;s(lJittinr., and found tv
be in compliance therewith en
the Day Day of s4ptem
, 2065
NMI
9= BW so'.Jfi Srwi'e$
TYim
switch
39
deters! Purpose
Miler.
_.. A _ ..__. _..
-GATv
Nilot
4
Telepbme'
1Ua*tucic .
4 24A
Appliance
Receptnetc
2
Lna+dry
SwAce
i
1 Phaoe M Sarvice P -Ating 200 .Ampetes
94.00
I
service Diecosnoot;
I 204
C$
l
:Kates: 1
InvoiO4 ToW
2 of 2.
This certificate may not be altered In any-way and is validated ordy try the areaam0 of a raised Sea) Atha
$21 6.00
rrn_4:'I- Jf1G1 =C L.IFI"? 1 1 : G] TEL:845 -278 -- 7921
NAME:RUTHAM COUNT`-' DEPARTMENT OF P. 3
SHERLITA AMI,ER,- MD,.MSI' FAAP.
",�,....�.....<- -...�, �CommissionerofHealth R�..�,..M
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
October 19, 2005
Harry Nichols P.E.
Patterson Park, Suite 106
2050 Route 22
Brewster, NY 10509
Dear :Mr. Nichols:
.... , ...,t..: _. aR_OBER_T.I.- B_ONDI.
County Executive
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Re: Field Inspection — Wyndham Homes
Apple Hill Road, (T) Patterson
Lot #42, T.M. 35.4-124
An inspection at the above referenced lot has been completed. The following comments
must be corrected and/or addressed in the field:
1. The fill pad 3 on 1 slope needs to be completed along the driveway, along with
the clay; barner-.properly- installed.
2. A bedroom count needs to be performed by this Department.
If you have any further questions, please contact me at (845) 278 -6130, ext. 2261.
GDR:cw
Sincerely,
ve)' -6 Few
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
SHERLITA AMLER, MD, MS, FAAP
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
October 24, 2005
Harry Nichols P.E.
Patterson Park, Suite 106
2050 Route 22
Brewster, NY 10509
Dear Mr. Nichols:
ROBERT J. BONDI
_ ... .... ,. � ..........- ., _.Gatsnty Executive. _...._.. _ - _...... _........ .
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Re: Field Inspection - Wyndham Homes
Teal Lane, (T) Patterson
Lot #42, T.M. 35. -4 -124
A re- inspection at the above referenced lot has been completed. There are no further
comments to be addressed at this time.
"If.you h06 aiiy further 4iiesti0-ns; please contact me at (84:5) 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
r. ,�...�r.�G1�1S'I'RITCTI ®l�T PE1�IT' F ®� SEWAGE 'I'IIEA'y'il�'�'- SYS'Y�I� �".
PERMIT # P ",`� -f�
Located at -e v La, d, e__
Subdivision name &C"o&C/0) Subd. Lot # Z
Date Subdivision Approved t - yq' -0 2-
Owner /Applicant Name
Mailing Address
Town or Vie A#;elr -s C �
Tax Map 3 5" Block _1— Lot
Renewal Revision .___
Date of Previous Approval V- 2_6 0 j
Zip 12"'K,3
Amount of Fee Enclosed :zoo '-
Building Type k C_ i j Gi Lot Area /,100 No. of Bedrooms It Design Flow GPD 9474
Fill Section Only Depth Volume
PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Separate Sewerage yysem to consist of 7_5"0 gallon septic tank and
Other Requirements:
To be constructed by
Water Supply: Public Supply From
Address
Address
®r..._ Private Supply Drilled by r .A .�............. ...,. , ..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. A
Signed:
Address
R.A. Date 9-;2_77-0S—
License #
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 c nsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires
a new pe prove discharge of domestic sanitary sew), only. /
By; Title: Date: �
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CP -97
SHERLITA AMLER, MD, MS, FAAP
-`"C " 'i — isioner of Hi i&kh7�-:-_,.:..__.;..:;s::,
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
Harry Nichols, P.E.
Patterson Park, Ste 106
2050 Route 22
Brewster, NY 10509
Dear Mr. Nichols:
ROBERT J. BONDI
_._.. � . � .:....., ;._.�::..�aunty£xecutiere..-�•. > ., - ... - �......_.
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
October 5, 2004
Re: Field Inspection — Wyndham Homes
Apple Hill Road, Lot # 42
(T) Patterson, TM # 35. -4 -124
An inspection at the above referenced lot has been completed. The following comments must be
corrected and/or addressed in the field:
1. Due to changes in the SSTS design and installation, revised plans must be submitted to
this Department for review.
2. It appears the fill pad cannot entertain 100% expansion.
3. The fill pad 3 on 1 slope needs to be completed along the driveway, along with the clay
barrier properly installed.
4. The pumped dosing volume needs to be re- adjusted to meet the proper specification as
shown on the approved plans.
5. A bedroom count needs to be performed by this Department.
If you have any further questions, please contact me at (845) 278 -6130 ext. 2261.
GDR:kly
Very truly yours,
Gene D. Reed
Sr. Environmental 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
NSTRUCTIONTERMIT FOR SEWAGE T ATII ENT"SY- STI E-M,:_.-
PERMIT # P /t3164
G-
Located at ( d11) U Town or V i �� -�5 d
Subdivision name &ertu0c,,j- Subd. Lot # -12— Tax Map Block I Lot
Date Subdivision Approved Z Renewal Revision
Owner /Applicant Name q L,, &,,, 5, L Date of Previous Approval 4 )0/0�7
Mailing Address ` L , J ;, ? �, ^ Zip
Amount of Fee Enclosed
Building Type / � i rri / Lot Area 1, 1,0, Z No. of Bedrooms 4— Design Flow GPD 9 a d
Fill Section Only Depth Volume
Separate Sewerage _System to consist of gallon septic tank and _ �% Z.
rV
Other Requirements: )01/ -44 l4 S l
To be constructed by ( AD 4 Address
Water Supply: Public Supply From Address _
or: 1,1� Private Supply Drilled by , 'T"„8 —, Address -
I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the
separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion
thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the
Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said
builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years
immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original
system or any repairs thereto.
Signed:
Address
R.A. Date I —0 �
License # a"Ci ( 2-4
APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the
sewage treatmen stem has been completed and inspected by the PCHD and is revocable for cause or may be amended or
modified wh con idered n cessary by the Public Health Director. Any revision or alteration of the approved plan requires
a new pe tf roved ischarge of domestic sanitary sewage only.
By: Title: dX" Date: - v r
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CP -97
TEST PIT DATA 2
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. HOLE NO. HOLE NO.
G.L. -
0.5'
1.0'
1.5'
2.0'
2.5'
3.0'
3.5'
4.0•
4.5'
5.0'
5.5'
6.0'
6.5'
7.0'
7.5'
8.0'
8.5'
9.0'
10.0'
Indicate level at which groundwater is encountered
Indicate level at which mottling is observed
Indicate level to which water level rises after being encountered
Deep hole observations made by: Date
Design Professional Name:
Address:
Signature
Design Professional's Seal
Harry W. Nichols Jr., P.E.
Patterson Park - Suite 106
2050 Route 22
Brewster, NY 10509
Tel: (845) 279-4003
Email: hnengineer@aol.com
September 7, 2004
Putnam County Health Department
1 Geneva Road
Brewster, New York 10509
ATT: Robert Morris, P.E.
Senior Public Health Engineer
RE: trench Permit - Lot # 42
Apple Hill Road
Patterson, N.Y.
DearNr. Morris:
Enclosed find the following relative to the required Trench Permit for Lot # 42 of
the Deerwood Subdivision:
1. "Trench Permit", dated 09/01/05.
2. "Design Data Sheet", Percolation Tests performed in fill.
3. Five (5) prints SS -42 "Proposed SSTS", rev. 09/01/05.
Kindly issue the Trench Permit.
Very truly yours,
Harry W. Nwic ols Jr., P.E.
HWN:g4 * v
03-056.42
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN 'DA SHEET - SUB . SURFACE SEWAGE TREATMENT SYSTEM
EM
Owner Address
0 AL do
Located at ( Street) Tax Map Block Lot
(ind' ate nearest cross street)
Municipality 10 '-v c, Watershed
SOIL PERCOLATION TEST DATA
Date of Pre-soaking 9-3 -d 5— Date of Percolation Test C; 57-
NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at ea0h
percolation test hole. (i.e. !g I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be
submitted for review.
2. Depth* measurements to be made. from top of hole.
Form DD-97
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NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at ea0h
percolation test hole. (i.e. !g I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be
submitted for review.
2. Depth* measurements to be made. from top of hole.
Form DD-97
AUG-31-2005 01:30 PM HARRY W NICHOLS 914 279 4567
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVMONMENTAL HEALTH SERVICES
&EQjM5jX-Q&FIN INSPFA--TION For; Fill
Date: Treaches
PCHD Construction Permit # )0
Located:(T rIA-1 LAL-
- -,� - ) Opf
Owner /Applicant dame: IM Block Lot -%—ZW,
Formerly: Subdivision Name:
Subdivision Lot 2—,
Is system fill completed? Date:
Is system complete? Date;
Is system constructed as per plans?
Is well drilled? Date. —C-S-
Is well located as per plans?
Are erosion control measures in place?
I certify that the-"em(s), as listed, at the above premises has been constructed and I have inspected
and verified their completion in 'accordance with the issued PCHD Construction Permit and
approved plans and the Standards, Rules and Regulatioris of the Putnam County Department of
Health.
Date
Certified b4i PE 4--'KA
P professionav
Address-, g Lic. #
Comments:.
FOR: Cl ADAM XGYNE
13
(NAME)
Form FIR -99
P.03
AUG-31-2005 WED I-EL:845-278-7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 3
PUTNAM COUNTY DEPARTMENT OF r7r, ♦ r T77
SION OF ENVIRONMENTAL HEALY
. -... CONSTRU TION PERMIT FOR SEWAGE TREATME
Located,,at
Subdivision name_ �� ry�,:� Subd. Lot # —2-
Date Subdivision Approved j L� 0'2—
Owner /Applicant Name � , 01 s
Town or Village
Tax Map -3 5 �
Renewal
Block_ Lot
Revision
Date of Previous Approval I I - -0
Mailing Address 101* ( X111 1!!j PY1 ye— %v�T-;evsscs %� T�s Zip ) 2-5q
Amount of Fee Enclosed 3 4 d
Building Type P -r, s1 d e,,, Ut,, Lot Area ,1 uZNo. of Bedrooms Design Flow GPD fi C C
Fill Section Only Depth Volume 0�ifiG,
PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPL TAD
Separate Sewerage System to consist of / �2 gallon septic tank and L 7 /-C
Other Requirements:
S,
To be constructed by -F % 0 Address
Water Supply: Public Supply From
U , .13,
Address
or: _ Private Supply Drilled_by j 1 Y) 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 s,, sum 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 /— 0 �,
License # � � ( y
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 onsidere cessary by the Public Health Director. Any revision or alteration of the approved plan requires
a new pe 't Approv r discharge of domestic sanitary sewage only.
By: Title: Date: J D
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 priritortype -,. ; ._ . -_. .. :�. r. PCH-D- Permit #
Well Location:
Street Addres : TownNillage Tax Grid #
INC, � Map 3 Block -f Lot(s) 0:51
Well Owner:
Name: /
Address: 11 AT--
Use of Well:
_�, )Zesidential Public Supply Air /CondlHeat 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 _6g_6 gal.
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
New Suppl (new dwelling) Deepen Existing Well
Detailed Reason
for Drilling
Well Type
_ j/ Drilled Driven Gravel Other
Is well site subject to flooding? ................................................. ............................... Yes No
Is well located in a realty subdivision? ...................................... ............................... Yes ,/ No
Name of subdivision Lot No. -f 2—
Water Well Contractor: 2 8 n Address:
Is Public Water Supply available to site? ....................... Yes No
Name of Public Water Supply: TownNillage
Distance to property from nearest water main: X:
Proposed well location & sources of contamination t be provided on separate ,- e�t/plan.
i
Date: - - Applicant Signature:
�.lJ El.�i Pp g
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 11 dril certified by Putnam
County.
Date of Issue 9-k J., b r Permit Issuing 'al•
Date of Expiration Title:
Permit is Non- Transferr bl
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
F)
Harry W. Nichols Jr., P.E.
Patterson Park, Suite 106
2050 Route 22
Brewster, NY 10509
'" elep�one (g45}'i79 =400 :.
Fax(845)279 -4567
Date:
To: Job No.:
�- mac Project f S Z
Attention:
Gentlemen: We enclose( 5�copies of
3/W Prints Reproducibles Reports .Tracings
Specifications Memorandum Copy of letter
Description:
D
Revision/Date No.
6C
Sent Via:
Our Messenger Blueprinter First Class Mail Special Delivery
Your Messenger Hand Delivery
Copy to
Very tell yours
Harry Yr:UNicho r., P:E.
lCc., 1G tNN'�cL^ I �j
CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM
Located at
Subdivision name P Subd. Lot #
Date Subdivision Approved 6.1 / Z,410 2c,.:
Owner /Applicant Name W - d k-, 9"'Ver I
Mailing Address 8 Ar► e
Town or T' ge _ A&Z40.111
Tax Map '35. Block -_ Lot /2-
Renewal Revision
Date of Previous Approval
Zip
Amount of Fee Enclosed A- D Q ° °
Building Type P�-F 1 6 rA Q5 Lot Area 6 ' NI-No. of Bedrooms At Design Flow GPD UO
Fill Section Only Depth Volume
PCIID NOTIFICATION IS REQUIRED WHEN FILL, IS COMPLETED
Separate Sewerage System to consist of gallon septic tank and
Other Requirements: F y S (\Q
To be constructed by
Water Supply:
Public Supply From
Address
Address
or: Private Supply Drilled by Tb % 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 sum 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 01) 161 DA-
License # '5 �,1-kr
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 wheqcTsidered n cessary by the Public Health Director. Any revision or alteration of the approved plan requires
a new perm' / pro /ved ischarge of domestic sanitary sewage ply.
By: ' .:�`1�' Title: Date: a
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
plisse pririE "v;i type v... �:r.. -_.. .: PCHD Perinit-#- ...
Well Location:
Street Address: Town/Village Tax Grid #
4-
TEAL- L-) r-HfF PAIT�F -60H Map %, Block Lot(s) 1�4
Well Owner:
Name:
WHQANA 140c lk-1
Address:
I &Owl r4wp No
Use of Well:
_A 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. J,_ gpm # People Served Est. of Daily Usage $Qal.
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 _ C
Is well located in a realty subdivision? ...................................... ............................... Yes X No
Name of subdivision Lot No. 4f�--
Water Well Contractor: by Address: --
Is Public Water Supply available to site? .................................. ............................... Yes No
Name of Public Water Supply: `` Town/Village
Distance to property from nearest water main:
Proposed well location & sources of contaminatio to be provided on separat sheet/plan.
Date: �i ���� 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 (3 0) 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
i amended or modified when considered necessary by the Public Health Director. revision or alteration
of the approved plan requires anew permit. Well to be constructed by a water ell iller ce 'fled by Putnam
County.
, Date of Issue l ° Permit Issuing icial:
Date of Expiration"/ 11"[141A [L Title:
,Permit is Non - Transfe
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
LORETTA MOLINARI
Public Health Director
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648
August 13, 2004
Harry Nichols, PE
Patterson Park, Ste 106
2050 Route 22
Brewster, NY 10509
Re: Proposed SSTS: Wyndham Homes, Inc.
Apple Hill Road, Lot #42
(T) Patterson, TM # 35 -4 -124
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 is a photocopy. If a corporate seal 8
exists, the document is to be sealed with the stamp. N1 yJ
_ P.,qs
6'
3 Distribution lines from the D -box cannot run through the trenches. pp4t' p r I? U_�d
4. Trench lengths should be approximately equal. Furthermore, it appears that the system WfIrto
can be designed with the primary above the reserve system. The primary trench lengths C-I
will be longer and fewer. 5�d1 f %r" 'I
5. All the expansion trenches are to be shown in the SSTS profile.,9a�
6. The profile vertical scale is to be shown to the 665 elevation.
7. Depth of fill is to be noted in the fill profile.
8. Fill is shown channeling runoff through the middle of the fill pad.
9. Expansion trench lengths are to be noted.
The construction of this sewage disposal system may be subject to local wetlands regulations.
You should contact local wetlands officials in this regard.
a'
M percolation tests..were,- not-.witnessed by a- representative. -of- the-;.New York City Department . •
Environmental Protection on this lot, percolation tests must be witnessed by a representative of
this Department.
Upon receipt of a submission, revised to reflect the above comments, this application will be
considered further.
Ve ly yours,
/U / AO) '-'V
Robert Morris, P.E.
Senior Public Health Engineer
September 7, 2004
Putnam County Health Department
One Geneva Road
Brewster, New York 10509
Aft: Robert Morris, P.E.
Senior Public Health Engineer
Re: Proposed SSTS - Lot # 42
Deerwood Subdivision
Apple Hill Road
Patterson, N.Y.
T.M. # 35. -4 -124
Dear Mr. Morris:
Harry W. Nichols Jr., P.E.
Patterson Park - Suite 106
2050 Route 22
Brew -ter, NY 10509.
—Tel: (845) 2791003
Fax: (845) 2794567
Email: hnengineer@aol.com
In response to your August 13, 2004 review letter, we note the following:
1. New. corporate affidavit enclosed.
2. A four (4)- bedroom system is allowed for this lot.
3. Distribution revised.
4. -System .redesigned .as suggested.
5. Expansion trenches added to profile.
6. Vertical profile revised.
7. Depth of fill noted on profile.
8. The "vee" is pointing down slope.
9. Expansion trench length, added to plan.
We trust the enclosed have addressed your concerns and request that your
continue with the review and approval.
Very truly your,
H rry W. Ni 9 Is Jr., P.E.
HWN:jmm
03- 056.42
,mac-. ,-r
f^ - J
k0303210►06(
ARTICLES QFDRGA� - ., 10
T, N,
OF
WYNDHAM DEVELOPMENT
AT WINDSOR WOODS, L.L.C.
Under Section 203 of the Limited Liability Company Law
STATE OF NRq YORK
r
!' i ITE
ST
D E PA R Tfili LE N T o .1-
MAR 2 12003
RLED-
Ux S
L:alk-
Filer:
Hankin, Hanig, Stall, Caplicki, Redl & Curtin LLP
319 Main Mall
Poughkeepsie, NY 12602
REF. 07C 15620
DRAWDOWN
Cos Hj LO NIS-27
APR 1 0 2003
0 A 13) 0
0303 210uoq�q
,a,.
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: PeE�W W9 W�r 0-
represent that I am an officer or employee of the corporation and am authorized to act for: -
Name of Corporation:
Having offices at:
Whose Officers Are:
President - Name �Lcv�,Q,. SL
Vice President - Name:
Address:
Secretary -Na
Address:
Treasurer - Name:
Address:
and that I am and will be individually responsible for any and all acts of the c ration with respect
to the approval requested and all subsequent acts relating thereto. � A
Signed: _
Title: V:
Sworn to before me this \c� . day of
(month) (year)
,—No Iary--PubIic
,40taryPPu R New
ub9c,WedNewYork Corporate Seal
No. OIROB103336
t UW!ffsd In Putnam County
4 asa s"Ey 12,%ww
Form CA -97
c 4
€
f a
• :� ? :Sheet
. of
PUTNAM COUNTY DEPARTIVIENT'OF HEALTH
•:.
-
.. ,.
AIVTSION nF ENVIR NME VT �T_.;`HFATLH SERVICES•..
_. _
FIELD ACTIVITY REPORT.
N ANTF :
TPI:
A F.�.
Street
F
.'Town'--. - State.'
Zip
PERSON IN CHARGE
/ //' // /]
Y_ Y
Name and Title >
,
FINDINy-GS
®'7.."_, (i
_ L f
-
_
7777
77
z
,
f
e..
J r
t
n-
2
^t=s L
Y
�
�•
l H
J, il zx_ nra .
Signature and Title
I�FPCIRT °RFC?FTVF.17`RYt
�
"
{
I acknowledge r "eceiptofthis report SIGNATURE;
f
02/96
Title,
-
Rev.
ti
;.)
FEATURES
1. Impeller
3. Mechanical 7�
Seal
4. Shaft
5. Motor
6. Bearings —
Upper &
Lower
7. Power Cable
8. 0 -Ring
ED
!d
Performance
Curves
METERS FEET
25F
a°
X 20
Q
O
H
im
10F
5F
0L
Submersible L
.Pump.' f:-ro was
•'
:
ENNEEMENNEENN■■ME■■0
_
110
100
30
90
25
80
$ 1 i i
I of
,EEMENEEMENEENEENEEN
Q
70
uX
20
J
H
60
0
50
15
40
10
30
20
5
10
0
0
MINNEOU
mom
0 10 20 30 40 50 60 70 80 90 100 110 120 GPM
L L i i
0 10 20 30 W/h
CAPACITY
[gGOULDS PUMM INC.
SE ECA FANS NEW YOW 13148
METERS FEET
120 mnnp:l 'ERR;
.0 10 20 30 40 50 60 70 80 90 100 110 120 GPM
L L i i
0 10 20 30 m3/h
CAPACITY
01985 Goulds Pumps, Inc. Effective July, 1985
35
_
110
100
30
90
25
80
Q
70
uX
20
J
H
60
0
50
15
40
10
30
20
5
10
0
0
.0 10 20 30 40 50 60 70 80 90 100 110 120 GPM
L L i i
0 10 20 30 m3/h
CAPACITY
01985 Goulds Pumps, Inc. Effective July, 1985
Harry W. Nichols Jr., P.E.
Patterson Park, Suite 106
V RAAV
2050 Route 22
_ .._ Brewster, N1y -1 Q59 :_° ti
CONSULTING SITE ENGINEERS
JOB No. 0
SHEET No.
CHECKED BY
3-OSCe,�2-
"Of Z
DATE
_
L. Sr-AM sue 1EAD : --
.1:?1S.T_R aZ'Iot4 80X_._ I R V E T j —=— —__ 180- - -- - - --
tit P c IAAt B E 2 L3o rTO M- E E V. - DSO , 0 0 - --
go --
FriT i ry cs , . �Dt �vt4 �.E1��_PI l�� L �r�tG^r1h - - -_— -
As! LBO w
qL
- - - - -- `� Z z- i
_ r
_j tf,'T10&1 !ohs -447 'L, F, X 1ZJ`=T %loO�,F, --
---- ..... - --
TD H R t r I d A tit: —_
w tw cow, r t
Harry W. Nichols Jr., P.E. JOB No. 03 _03141-12
- Patterson Park; Suite 106.
2050 ..Route 22, _ ..: SHEET No. ;-OF ':z
Brewster, NY 10509 COMPUTED BY DATE
i$95j 279=4003, Fax 279 -4567 -..... ..- _- _.... - -- .. .
ONSULTING'-SP i E'ENGINEERS - -; CHECKS IW '" -"d_ *j DATE
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES _
_ � e.ti<..' .... r��.,.,i:�wa.w.n w.+. s..!+i'.::..?!+✓ct�-.a.: a,sC �'tf -. .,. ..• �....�_- -xv
AFFIDAVIT - CORPORA'T'E OWNER APPLICATION
FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT
To: Public Health Director
In the matter of application for:
represent that I am an officer or employee of the corporation and. am authorized to act for:
Name of Corporation:
Having offices at:. cat- VAN000 0(2445 10�6�
Whose Officers Are:
President - Name:
Address:
Vice President - Name:
Address: L ®r�itJ000 ..... iQe'D _._....
Secretary -Name:
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.
tf�..r P1Ibk, Seaba o: IiM► cwt' -- . .
-� worn to* before me this �' . day of
(month) 2IV3 _ (year).
N?..r Public
Form CA -97
Signed: 4u
Title: `J o P UGH 17T,
Corporate Seal
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
LETTER OF AUTHORIZATION
RE: Property of
Located at (e� I La" e_
T/� G rirco� Tax Map # 3; , Block �. Lot /-
Subdivision of �-c-C r r4100
Subdivision Lot # L Filed Map # I -M ` Date Filed �� 0
Gentlemen:
This letter is to authorize
a duly licensed Professional Enginegr Registered Architect to apply for the required
wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance
with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam
County Health Department, and to sign all necessary papers on my behalf in connection with this
matter and to supervise the construction of said wastewater tretment and/or water supply systems in
conformity with the provisions of Article 145 and/or 1.47 -of the Education Law, the Public Health
Law and ttiie Putnam � ry Code. .
N1CI40
¢� Very truly yours,
s
Countersigned:. � f, � Signed: 62.,*4
P.E., R.A., # IS i 2q �� (Owner of Property)
v
X9
g
Mailin Address 9-0 0 S1 ONP Mailing Address: r...,oa� Dl^ I V e_
C' W- �a YWo!:3
State _ V Zip o �a
Telephone. ?-?9 - /t as 3
State _.N Zip 1 �.
Telephone: 5 '�Ld 3-ta
Form LA -97
1�
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, P.E.
Patterson Park, Ste 106
2050 Route 22
Brewster., NY 10509
September 30, 2004
Re: Proposed SSTS: Wyndham Homes, Inc.
Apple Hill Road, Lot 42
(T) Patterson, TM # 35.4-124
ROBERT J. BONDI
County Executive
�.__:..., Dear-Ivir: Nichols: _ 7_... _ _ �... _ -.. _____........___.. _.___ . - -•- b _...�
Review of plans and other supporting documents submitted at this time relative to the above -
regarded project has been completed. Comments are offered as follows:
1. Please be advised that the deep hole data in both holes indicate that weathered rock
was encountered. Please be advised that weathered rock is not suitable for sewage
treatment and therefore, cannot be used for soil depth.
Upon receipt of a submission, revised to reflect the above comments, this application will be
considered further.
Ayours,
rris, P.E.
Senior Public Health Engineer
RM:km
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELD, Cn?!! I.E�'C1N,?1',P,ORT.�.r..:...�..
Well Location
Street Address:
Town/Village: I,
Tax Grid #
lMapbS- Block 4 Lot(s) 174
Well Owner:
Name: Address:
AJ)W'4�411 24 o
Use of Well:
1- primary
2- secondary
_,k' Residential Public Supply Air con eat pump rrigation
Business Farm Test/monitoring Other(specify)
Industrial Institutional Standby
Drilling Equipment
Rotary Cable percussion )e Compressed air percussion Other (specify)
Well Type
Screened Open end casing Open hole in bedrock Other
Casing Details
Total length ;� / ft.
Length below grade ft.
Diameter in.
Weight per foot ��Ib /ft.
Materials: is Steel _ Plastic _ Other
Joints: _ Welded Threaded _ Other
Seal: _XL Cement grout _ Bentonite Other
Drive shoe: Yes No
Liner _ Yes X No
Screen Details
Diameter (in)
Slot Size
Length(ft)
Depth to Screen (ft)
Developed?
First
Yes No
Hours
Second
Well Yield Test
_ Bailed _ Pumped Z Compressed Air
Hours
Yield gpm
Depth Data
Measur e from land surface - static (specify ft)
During yield test(ft)
,,11
Depth of completed well in feet
o?D 5
Well Log
If more detailed
information
descriptions or
sievearialyse §'
are available,
please attach.
Depth From
Surface
Water
Bearing
Well
Diameter(in)
Formation
Description
ft.
ft.
Land Surface
�iy
' y, : - � 4Ar, .
1,
J..
c
t i i1w, !�
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump /Storage Tank Information
`
/
Pump Type_ Capacity % S"
Depth I roA Model 10 CJ )0 41
Voltage 23G HP
Tank Type gl& -302 Volume go
s
`
f
Date Well C mplet
Putnam County Certification No.
Date of po
;
Well Driller (signature)
NOTE: Exact location of well with distances to at least o permanent landmarks to be provi9j;et on a separat s evpian.
Well Driller's Name Address:
i
Signature: Date: . S.
White copy: HD 7e;Yellow copy - Building Inspector; Pink copy - Owner; Oran g e c � Wel driller���
Form WC -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION FOR APPROVAL OF PLANS FOR
W&T19WATER 'TREATMENT SYSTEM
1. Name and address of applicant:
2. Name of project:
4. Design Professic
6. Drainage Basin:
3. Location T/x
5. Address:. aVSb
7. T_yue� of Pro.igct,
_1,-,,�—Private/Residential Food Service Commercial
Apartments Institutional Mobile Home Park
Office Building. Realty Subdivision Other (specify)
8. Is this project subject to State Environmental Quality Review (SEQR)? .
Type Status (check one) ....................... ............................... Type I Exempt
Type II Unlisted _L�
9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... d
10. Has DEIS been completed and found acceptable byLead'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 preliminary approval been granted by such authorities? Date granted: i AJ
15. Type of Sewage Treatment System Discharge ................. surface water /groundwater
16. If surface water discharge, what is the stream class designation? ........... .......
:.
V-ZA
17. Waters index number (surface) ... . ............. .......... ............................... .
18. Is project located near a public water supply system? ....... ...................:...........
19. If yes, name .of water. supply IZA Distance to water supply
20. Is project site near a public sewage collection or treatment system? ..... ............. kl C)
21. Name of sewage system Distance to sewage system
22. Date test holes observed 23.. Name of Health Inspector
24. Project design flow (gallons per day) .........:....................... ............................... 600
25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... d
26. Has SPDES Application been submitted to local DEC office? .........................
Form PC -97
7
27. Is any portion of this project located within a designated Town or State wetland? PO
28. Wetlands ID Number. ................. -- - ., ...................
�i+�•w., -.v ... w f.f _ rr.. .i i _. . .. _.'.macs. . .� .�.�.. .. era :. �.... ...�!.+•nq �+ ^ .. ...._. _
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? ..................:............
'DESCRIBE:
Yes/No
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? ........ .......................................... .................
.
35. Are any sewage treatment areas in excess of 15% slope? . ............................ .... .
36. Tax Map. ID Number ........................................................... Map 3 5 , Blocky_ Lot ra
37. Approved plans are to be. returned to........ Applicant. Z.,� Design'Professional
C�TE:.All.applicatioiisfor- -.review -and- approval oft new- SS- TS--to b6-locatedwithinthe NYC W;aterslied shall°
be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP
approval of the SSTS prior to final approval. by the Department. Projects within -the watershed may also
require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of
impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from
DEP and submit those forms to DEP for review and approval.
If the application is signed by a person other than the applicant shown in Item 1.,the application must
be accompanied by a Letter of Authorization (Form LA -97). Failure to comply.with this provision
may be grounds for the rejection of any submission.
I hereby affirm, under penalty of perjury, that information provided on this form true
to the best of my knowledge and belief. False statements made herein are punish�le as u
a Class A misdemeanor pursuant to Section 210.45 of the Penal La
/) n
SIGNATURES & OFFICM TITLES.
Mailing Address: .............. * ..................... ID �-_ ) Y, Q 7 �
k: rt
14.164 (2187) —Text 12 . . . . _ I I
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.(ro be completed by Applicant or Project sponsor)
1. APPLICANT / NSOR .-1.
W4
2. P OJECT NAME
r-%
o 136 �;�j
3. PROJE T LOCATION:
*,e �
Municipality %�a V, 10 County . V 1 lnG[
4.' PRECISE LOCATION (Street address and road Intersection , prominent landmarks, etc., or provide map)
If 0-0-C ��1Y1SiGy
2— 1-1.004
5. IS PRQPOSED ACTION: .
U5New ' 0 Expansion 0 Modification /alteration
6. DESCRIBE PROJECT BRIEFLY: J I
/'1- o��CGd ►'C.s tr�e�c�If
.
7. AMOUNT OF LAND AFFECTED: J 1
Initially 161,92— acres Ultimately ll ! 2-- acres
a.. WILL P POSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
ij es ❑ No It No, describe briefly
S. WF}AT I4 PRESENT LAND USE IN VICINITY OF PROJECT?
esidential C3 Industrial 0Commercial 0A ricultur pens ace -._ .. .
..... _ . _ ._..._.9 e,..._ ..._ __[]_P_arklForest/0 p 0 Other
Jy '
.. _ -_
I
10. DOES ACTION INVOLVE A PERMIT APPROVAL., OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL,
STATE OR LOCAL)? �j ,(� I\
VKs 0 No. If yes, list agency(s) and permit/approvals �TS t�pt..S /, . Q -�r�^, . '': �C J
/JUI���+ -� 1!�•r"`+t� — �t7lN'7 O� /- �(J�►7t7�
.
11. naFS ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
0.No . If yes, list, agency name and permillapprovanl j
Tcslb✓fCA1 P1- ;.tiKttiS '- S�SvttYtscaL.. j�
No�tr�. . 0 V&w i,
12. AS A RESULT OF PR OSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION?
.0 Yes 0<0
1 CERTIFY THAT THE INFORMATION PROVIDED A60VE'IS TRUE TO THE BEST OF MY KNOWLEDGE
"� ' 4r, /0 4
Applicant/sponsor name: r_ Date:
Signature:
V v
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 If— ENVIRONMENTAL.ASSESSMENT (To be completed by 4gency)
A. DOES ACTION EXCEIwD ANY TYPE I"THRESHOLD IN 6 NYCRR, PART 617.127 If yes, coordinate the review process and use the FULL EAF.
❑ Yes ❑ Na
TION.'RECEIVE:COOFlDINATED REVIEW AS PROVibED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? It 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.
C6. Long term, short term, cumulative, or other effects not Identified In C1-057 Explain briefly. vr�
1�
C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly.
... _ _. .. _ __ .....- .... *. .... -..
7 p.. s ...
D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ��Oe
❑ 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 Identif led 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:
Name of Lead Agency
Print or Type Name of Responsible Ofijcer in Lead Agency Title of Responsible Officer
Signature of Responsible Otlicer in Lead Agency Signature of Preparer (If different from re'sponsi e o icer)
Date
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH: SERVICES
DESIGN DATA-SHEET-7 SUBSU)2FACE. SEWAGE TREAT1kIEN.T. SYSTEM -
Owner m i 6 4 Ar,-t_ M g AMI�o Address L, g6 o t711T `j
Located at.(Street) gwaA wb5 1,d,1 Tax Map 35 Block Lot
(indicate nearest cross street)
Municipality Drainage Basin .13G(5;� . SEC,.
SOIL PERCOLATION TEST DATA
Date of Pre= soaking 10 - 23 =q(o Date of Percolation Test
NOTES:: ` 1. Tests to be repeated at same depth until approximately -equal percolation rates are obtained at each
percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2.min for 31 -60 min/inch) All data to ue
submitted for review.
2: Depth - measurements to be made from top of hole:'"
Form DD -97
Hole No...
Run No.
Time
Start - Stop
ElapseTime
(pMin:)
D,e th :t'W ater
From Ground
Surface (Inches)
Start Stop
:Water
Level
Drop In
Inches
Percolation: .
Rate ..
Min/Inch .
�o
i
2
l0 -, a., 2�
�0
2 !�z 2 21Lz
I
�p
i.....
3 .....
(0'. 2-1 = 10, -2-7
1
4.
2
3 "
11'41 1'S
I1
20
4
..
5
2
3
4..
5'
NOTES:: ` 1. Tests to be repeated at same depth until approximately -equal percolation rates are obtained at each
percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2.min for 31 -60 min/inch) All data to ue
submitted for review.
2: Depth - measurements to be made from top of hole:'"
Form DD -97
..5'
3.0'
3:5':=
4.5'
'5.0'
Lip
Design Professional Name: i� , N tit,�ol_� J�p.r.L .
Address:
2n ui L.L�'�iW N ►2 1�i�12 .m� �J 1 r I
af NEWYp�
it
Q
W
No. 56124
ARQFESSI fl�
6:0
7.0'
_ ................_..._.
_ ...
......... .
. ,.
.5 _ .... - .. .
10.0'
, ..:.
CRI_..
Indicate level at-which groundwater is encountered - ° --
Indicate level at which mottling is observed
Indicate level to which water level rises after being encountered
. . : ,. ..
Deep hole observations made by, LA . LLbj o 6i7r-P) .1.Ji.1-W 0Z N hZ
G ?)
Date a 12-g4 -��+�)
Design Professional Name: i� , N tit,�ol_� J�p.r.L .
Address:
2n ui L.L�'�iW N ►2 1�i�12 .m� �J 1 r I
af NEWYp�
it
Q
W
No. 56124
ARQFESSI fl�
i
J
kWEiV
1.06,
0
r X
d
EXISTING ¢ BEDROOM
RES I DR NCE
6
M
r
N
'FO
5oti a PJC SD -
PUMP cHAb(gG (250 G L ` \
2 "!b Solib SCN- RO CC- MAIN — SSM c Nk
'd• Q• Q of 1 MOO+ � ,•� -��\ �\ �` �\ \ �` �` -r� D o
r• N t0 M Q' \ . \ Op �. \
� � V N M
i
mr
i $ �
Q 7 �
o.
i
96.3�r�
'App 7 ,az.so'
1
POtnam CountT Department of Health
DIMENS =ION ° CHART --( n feet)
Number I A I a
1
65
1
2
SO
26
3
65
95
4
48
$3
5
52
81
6
62
82
7
68
82
g
78
84
9
78
79
10
85
81
Ii
85
76
12
97
84
13
99
81
14
103
$1
1 5
1 10
86
I6.
112
83
17
117
85
is
123
89
I9
125
87
20
130 _
89
21
140
95
22
142
95
23
147
98
2q.
123
66
25
119
64
26
114
b2
27..
109
58
28
103
;: 56
29
98
53
30
92
51
31
88
50
32
83
So
33
l8
51
34
'i 3
52
35
68
53
36
49
40
37
44
44
38
39
4.9
39
36
54
40
32
59
41
30
65
+2
t9
71
43
29
76