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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -5 -1 BOX 16 ., Al. I I , � � r' .tip. 16 a 01791 U G J PUTNAM COUNTY DEPARTMENT OF HEALTH 3 DIVISION OF ENVIRONMENTAL HEALTH SERVICES .% CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD PERMIT CONSTRUE O l� �� � �. - ^ � .'�I " (S Located at /U _r 2oAe, 22. a,J Town or Village Ail erso C4rl .Alba -o and /or Owner /Applicant Name got,.' tr_x+ Tax Map 3 C. Block _,� Lot Formerly_ N Subdivision Name od te>, Il FA -In Subd. Lot # i Mailing Address 11 G IGr )c P144,- '_4 4,94C '44-w York Zip l dS41 Date Construction Permit Issued by PCHD 1/7/11 Separate Sewerage System built by oe'NM Address Consisting of i, o v v Gallon Septic Tank and ? o o I-, F 0* p r, r• a r, aL iron ^�ren�l�2s Other Requirements: /Von e,- Water Supply: Public Supply From Address or:_ ( Private Supply Drilled by 8o50'-*t— Address si�K -F N Building Type �e�;�, l Has erosion control been completed? Y es.. Number of Bedrooms 3 Has garbage grinder been installed? I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: S I " ► Certified by Z_ 141 P.E. )( R–A. (Design Professional) P. C. Address In-;.,4, Fr`�t ne�r��c 1'�r�ev �'_�+; . �- 1GhL�t.,.r� 4,,(,J, License # –77 9 <0 2 Farr -4- P10,:c.l ' C,;rN+,e-( /vZ 1 sS'tz- Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to, modification or change when, in the judgment of the Director /Commissioner, such 0 White copy - HD Y change is necessary. Title: - Building Inspector; P Date: - Design Professional Form CC -97 MEMORY TRANSMISSION REPORT _ h1AY -14 -2013 1 t : 03AM _ ... r. Tax Map Yf Ma 35 . Block -5 Lot s -1 TEL NUMBER 8452787921 Well Ownar: NAME ENVIRONMENTAL HEALTH FILE NUMBER 216 DATE MAY -14 11:02AM TO 86287421 DOCUMENT PAGES 001 START TIME MAY -14 11:02AM END TIME MAY -14 11:03AM SENT PAGES 001 STATUS OK FILE NUMBER 216 * ** SUCCESSFUL TX NOT ICE * ** A% 17 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES W-11 Permit 0 O C6A OT Well L.ocatlon Street Address: 24 Old' Road TownN:lIage: Pat:tarson Tax Map Yf Ma 35 . Block -5 Lot s -1 43P - 41 27' 20' 73° 34' 48' Well Ownar: Name: Carl Albano, 11 Clark Atltlress: Placa, Mattopmc, NY 10541 Use of Well: I - Primary 2- Secondary x Residential Bualness Industrial _Publlc Supply Alr cond /heat pump _Irrlgation Farm TestJmonitortng —Other(specify) Institutional Stanclb Drlliln Equipment Rotary Gable per=uaalon _X=orrt ressad air percussion Others acl Well Type Screenecl O an and casing X O an hole In bedrocK Other _ .... _ _ Casing Details YotaS- t -ength _eft. Length below grade 51ft. Olamator 6 in_ Irseulz melo Fat par foot 19 IbHt Materials: X Steal. Plastic _Other Joints: Welded Threatletl Other X Cement rout Bentonite Other Drive Shoe: Yes — N o Liner: Yas No Screen Details Diameter In Slot Slae Lan th ft Dept to Screen R evelo ed'? First _Yes No Second I Hours Wall Yield Test Sailed Pum etl X Com ressad Alr Hours ra IvIala 3 Qzt m Depth Date «,au•., •e... e.. .�. ono -o op 10, • ••o r y 50' �n wo 90' Well Log If more detailed Da th From Slurfa ce Water Bearin a ameter in Formation Descri tion ft. ft. Information descrlptlons or u ®.,a s...f— 30 Drxllln 1.m o t sieve analyses 30 52 Drl1 are available. plaasm attach. 52 90 Dr,:L3L3-:5Lmz- If yield was tested at different depths during drilling list: Feat Gallons Per M nuts Pump Sto raga an nformat on ump Type R 1 �Gapaclty Depth Modol pa Voltaga Tanis TYPO 4A rv.N Vole e L once weit . complotoa 1/30/13 wall Dr Iler C ert..cate 71f 13019 SQL° NYRD].0105 F. Installer PC Cartificat¢ 0 NY State $A Dat° of Report Well Driller Name 8. A rase: P_ F'_ Baal g Soma. Inc., 4 Putmaan Ave., Brews er, NY 10509 W um Ans." Name 8t Address: vmp n ®ta (signsture) . Whites copy: Ile: $a`iTi copy - BltStld[ng Inspa K c - O nefr� CArange copy - well drular Form WC -97 12ev. 3/06 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Town/Village: Tax Map # 1Map35- 24 Old Road Patterson Block -5 Lot(s) -1 730 34' 48' Well Owner: Name: Address: Carl Albano, 11 Clark Place, Mahopac, NY 10541 Use of Well: X Residential _Public Supply Air cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Institutional Standby Drilling Equipment X Rotary _Cable percussion _XCompressed air percussion Other(specify) Well Type Screened _Open end casing __L Open hole in bedrock Other Total Length 52 ft. Materials: X Steel Plastic Other Joints: Welded X Threaded Other Casing Details Length below grade 51ft. Seal: X Cement grout Bentonite Other Diameter 6 in. Weight per foot 19 lb /ft Drive shoe: X Yes _ No Liner: _Yes 5No Diameter (in) Slot Size Length ft Dept to Screen ft Develo ped? Screen Details First _Yes No Second ]Hours Well Yield Test _Bailed _Pumped X Compressed Air Hours 6 Yield 10+ gpm Depth Date Measure from land surface - static (specify ft During yield test ft Depth of completed well In ft. 10' 50' 90' Well Log Depth From Surface Well Diameter If more detailed Water Bearing in Formation Description ft. ft. information _ Land surface 30 'Drilling- in - -ov rbu den --clE y and boulders descriptions� it rock at 30 sieve analyses 30 52 DrillinR in ro k set casing. grouted 52 90 Drillin are available, please attach. If yield was tested Feet Gallons Per Minute Pump /Storage Tank Information at different depths during drilling Pump Type A /" a CapacityLff DepthF Model O pa list: -QD Voltage HP ,/. Tank Type cLwv Voha e Dare Well Completed =* 1IVeIIDrtller PC Certificate # l 3019 ;ANY State #NYRD10105� Date of Report r Purnp;Installer PC Certificate NYState _ /12/13 Well Driller Name 8� Address �4 :. . '.' { X k .ieN,yk yY �p Y' ^ WR Y F Bea'1 &Sons ; Inc 4 Putnam Aver Brewster NYC 05 x y it 0� um Inst Name Adtlress yz ` 8� d. >g T „ 4 ', S t P,L 4�gF.P y � }_� hr' pum Ins Iler(signature)3 '� R'mx 1 r ➢ryx ':, �, .3�vmr NU i t: txact t_oc ion of w i witn istances to at least o permanent land + arks o e provided n a separate sheet/plan. U White copy: lie; ;P k co' Owner; Orange copy - Well driller Form omWC- 97 Rev. 3/06 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF. Eli 'SIR ®NMENTA, ..I3EAL,TH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Carl Albano Owner or Purchaser of Building Building Constructed by NYS Route 22 & Edwards Road Location - Street Residential Building Type 35. 5 1 Tax Map Block Lot Patterson Town/Village Old Wall Estates Subdivision Name 0 Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed 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 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 i ding tilizing the system. Dated: Month U Day a Signature. L Title: �2y � General Contractor (Owner) - Signature n,.....,....,�:..� ter....,.,. r:�,.,...._,._..�:,...� Corporation Name (if corporation) I Address: /State Zip Form GS -97 BRUCL R. FOLEY Pubtle Realth Director L LORETTA MOLINARI R.N., M.S.N. Associate Pablle ffealth Director Director of Patient Servicer DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, Now York 10509 Environmental Health (843) 278 - 6130 Fax (845) 278 - 7921 Nu rsiag Servias (843) 276 - 6538 WIC(943)278-6678 Fax(845)279-6085 Early interveation/Pmichool (845) 278.6014 Fax(845)279-6649 E911 ADDRESS VERIF1!QA'EI0N FORM OWNERS NAME: Carl Albano TAX MAP NUMBER: 35.-S-1 E911 ADDRESS: 02'y 0 /d /1 0x b TOWN: Patterson AUTHORIZED OWN OFFICIAL T FFI (Signature) DATE: The Putnam County Department of Health will not issue a Certificate of construction Compliance_ unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (6911 rccfrm) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: 24 Old Road Town/Village: Patterson Tax Map # Map35 • Block -5 Lots) -1 :GI? o 20 .. 730 34' 48' Well Owner: Name: Address: Carl Albano, 11 Clark Place, Mahopac, NY 10541 Use of Well: 1- Primary 2- Secondary X Residential _Public Supply Air cond /heat pump _Irrigation Business Farm Test/monitoring _Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary _Cable percussion _XCompressed air percussion_Other(specify) Well Type Screened _Open end casing % Open hole in bedrock _Other Casing Details Total Length 52 ft. Length below grade 51ft. Diameter 6 in. Weight per foot 19 lb/ft Materials: X Steel Plastic Other Joints: Welded X Threaded Other Seal: X Cement grout Bentonite Other Drive shoe: X Yes No Liner: _Yes Y_No Screen Details . Diameter (in) Slot Size Length (ft) Dept to Screen ft Develo ped? First _Yes _No Hours Second Well Yield Test: _Bailed _Pumped X Compressed Air Hours 6 lyield 10+ gpm Depth Date Measure rom an surface - static specs 10' Sunni P test n) 50' Dept o. completed well in ft. 90' 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 _ -_ ._- 30 Drilling in overburden, cl and boulders . Hit rock at 30 _. -. -- ..- _ ..- 30 52 Drilling in ro k set casing. grouted 52 90 Drilling If yield was tested at different depths during drilling list: Feet. Gallons Per Minute Pump /Storage Tank Information Pump Type j eCapacity Depth�gO —F f Model O LiQ Voltage D HP +� Tank Type aw. l Vohs a o` C1�ate��We���Completed �N�L . z� Lrk � ell�DrlllerPCx�Certtficate'�# + rt ,4a,le..�l?�Crertitic ' ,Y� , r °� �t�te� ` i r ,���' � te>Ga #Repo � � ;� Mi x T 3Y re. i,: � .+. 1iu! f•..- — — 1 �n. 4r. -- .. t``�� '" rM ^ya'sKl.'�.'. a'. :ISKi WeYI c� IelrNa e�, gyps f•r x� w� 'b�a MR. '�'z''.'�"1, M `�• #`x .: .k� 4 Y;..1"I`+ Y L um nst i,,Yr�► 'idt ss`mx } Is �" a. � �` '� � ry r °"` v. � r m 1{�(sls�atl�e) x4' 'x, ''i ..�i y�•C.� � i'k .7�u.. NOTE: Exact Loc ion of w I with ;stances to at least o perms nt land arK o e a separate sneetipian. White copy? ile; el ow copy - Buil�ng Inspe ; P k c - O n Orange copy Well driller Form WC -97 Rev. 3/06 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 _... _.._._...._ �.. ......t,.....A_:.,_, Albert. H.,- .Radouani,-Director: �......�.. ,___-..,,. .. .....0 ** TEST REPORT ** LAB #: 9.300311 CLIENT #: 4862 NON STAT PROC PAGE: 1 of 2 ----------------------------------------------------------------- --------------- ---- ------ - - - - -- ALBANO, CARL 11 CLARK PLACE MAHOPAC, NY 10541 DATE /TIME TAKEN: 04/30/13 11:00 DATE /TIME REC'D: 04/30/13 11:34 REPORT DATE: 05/10/13 PHONE: (845)- 621 -1000 SAMPLING SITE: 24 OLD RD, PATTERSON, NY SAMPLE TYPE..: POTABLE KITCHEN TAP PRESERVATIVES: HNO3 COL'D BY: CARL ALBANO TEMPERATURE..: <20 >4.00 NOTES...: COLIFORM METH: MF START DATE /TIME END DATE /TIME FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 04/30/13 0330 05/03/13 0330 MF T. COLIFOR PRESENT /100 ML ABSENT SM 18 -20 9222B 05/03/13 LEAD (IMS) <1.0 ppb 0 -15 ppb SM 18 -19 3113B 05/01/13 0350 05/01/13 0420 NITRATE NITRO 8.91 MG /L 0 - 10 SM18- 20450ONO3 05/01/13 0325 05/01/13 0350 NITRITE NITRO <0.01 MG /L 1.0 MG /L SM18- 204500NO2 05/01/13 IRON (Fe) 1.46 MG /L 0 -0.3 mg /l SM 18 -20 3111B 05/06/13 MANGANESE (Mn 0.02 MG /L 0 -0.3 mg /l SM 18 -20 3111B 05/07/13 SODIUM (Na) 43.67 MG /L N/A SM 18 -20 3111B 04/30/13 0405 04/30/13 0408 * pH 6.6 UNITS 6.5 -8.5 SM18 -20 4500HB 04/30/13 HARDNESS,TOTA 276 MG /L N/A SM 18 -20 2340C 05/07/13 ALKALINITY (A 146 MG /L N/A SM 18 -20 2320B 04/30/13 0300 04/30/13 0302 TURBIDITY (TU <1 NTU 0 -5 NTU SM 18 (2130B) --10.5/-02/13 ._0.33 0.. ,0.5./3 /3.3 03.3 Q- .. _ E .,, .COLL,..(.QF __• •_A$�SENT . 1Q 0, /ML_ ; ABSENT __._.. .. . COMMENTS: MFTC Total C = This result indicates that the water (was), (was not)" of a satisfactory sanitary quality according to the New ate and EPA federal drinking water standard for this parameter. This comment applies to the Total Coliform test only. 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. IMS = IMMEDIATE METAL SAMPLE.(INTERPRETATION: WATER SAMPLED AFTER SITTING UNDISTURBED A MINIMUM OF 6 HOURS OR OVERNIGHT) YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovarii, .Director'- ** TEST REPORT ** LAB #: 9.300311 CLIENT #: 4862 NON STAT PROC PAGE: 2 of 2 ALBANO, CARL 11 CLARK PLACE MAHOPAC, NY 10541 DATE /TIME TAKEN: 04/30/13 11:00 DATE /TIME REC'D: 04/30/13 11:34 REPORT DATE: 05/10/13 PHONE: (845)- 621 -1000 SAMPLING SITE: 24 OLD RD, PATTERSON, NY SAMPLE TYPE..: POTABLE : K:ITCHEN TAP PRESERVATIVES: HNO3 COLD BY: CARL ALBANO TEMPERATURE..: <20 >4.00 NOTES...: COLIFORM METH: MF START DATE /TIME END DATE /TIME FLAG PROCEDURE RESULT NORMAL - RANGE METHOD NMS = NORMAL METAL SAMPLE. (INTERPRETATION: WATER SAMPLED AFTER RUNNING FOR 10 -15 MINUTES MINIMUM) 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 is suggested. * pH pH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. L.._ pH--. -I S- A - FIELD. MEASUREMENT •AND•, -IS- TESTED OUT SIDE—THE HOLDING- -TIME. - .• -- pH REPORTED FOR REFERENCE ONLY. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG /L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG /L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0 -70 MG /L VERY HARD WATER: ABOVE 300 MG /L MODERATELY HARD WATER: 70 -140 MG /L MG /L = MILLIGRAM PER LITER HARD WATER: 140 -300 MG /L (1 grain /gallon = 17.2 MG /L) ALK (ALKALINITY REPORTED AT pH 4.5) IMS IMS = IMMEDIATE METAL SAMPLE. (INT:ERPRETATION: WATER SAMPLED AFTER SITTING UNDISTURBED A MINUMUM OF 6 HOURS OR OVERNIGHT) THE ABOVE TEST PROCEDURES MEET ALL REQUIREMENTS OF NELAC, AND RELA ONLY TO H SAMPLES RECEIVED BY THE LAB SUBMITTED BY: �p Albert Pad6vani, M.T.(A CP) Directo ELAP# 10323 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H Padauani, Director ** TEST REPORT ** LAB #: 9.300344 CLIENT #: 4862 NON STAT PROC PAGE: 1 of 1 ALBANO, CARL 11 CLARK PLACE MAHOPAC, NY 10541 DATE /TIME TAKEN: 05/08/13 10:00 DATE /TIME REC'D: 05/08/13 12:30 REPORT DATE: 05/10/13 PHONE: (845)- 621 -1000 SAMPLING SITE: 24 OLD RD, PATTERSON, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: HNO3 COLD BY: CARL ALBANO TEMPERATURE..: <20 >4.00 NOTES...: COLIFORM METH: MF START DATE /TIME END DATE /TIME FLAG PROCEDURE RESULT 05/08/13 0400 05/09/13 0400 MF T. COLIFOR ABSENT /100 ML NORMAL - RANGE METHOD ABSENT SM 18 -20 9222B COMMENTS: MFTC Coliform = This result indicates that the water (was), (was not) of a satisfactory sanitary quality according to ew York State and EPA federal drinking water standard for this parameter. This comment applies to the Total Coliform test only. THE ABOVE TEST PROCEDURES MEET ALL REQUIREMENTS OF NELAC, AND RELA NLY TO/'\TH E SAMPLES RECEIVED BY THE LAB SUBMITTED BY: Albert . Padovani, M. .(ASCP) Director ELAP# 10323 7F17ENOBVEERING, SURVEY /NG & L4NDlSCAPEARCH/TECTURE, P.C. 3 Garrett Place (845) 225 -9690 Camel; "New'York 10512 Faz (845Y'226-9717 TO: Mike Budzinski, P.E. Director of Engineering Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 WE ARE SENDING YOU ❑ Shop Drawings ❑ Copy of Letter LETTER OF TRANSMITTAL Date: 5 -10 -13 Job No. 03212.300 Attn: Mike Budzinski t rc Re: SSTS for Slafani and /or Albano NYS Route 22 and Edwards Road Patterson, New York 12563 ® Enclosed ❑ Under separate cover via ❑ Prints ® Plans ❑ Change Order ❑ the following items: ❑ Samples ❑ Specifications COPIES DATE NO. ; DESCRIPTION i.yCC-97 1 Certificate of Construction Compliance for Sewage Treatment System _1 1 ; ! E911 Address Verification Form 3 I GS -97 Guarantee of Subsurface Sewage Treatment System - - - - -- Water Test Results WC -97 ; Well Completion Report 4 ' 5 -10-13 i AB -1 -------- ------- -_____...____._.___ ..___._..____.._._..____..__... As -Built Drawing 1 ; $300.00 Fee THESE ARE TRANSMITTED as checked below: ® For approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ Asrequested ... .. - ._..--, ❑.13�etumed for corrections ❑ For review and comment ❑ REMARKS: COPY TO: File Carl Albano with enclosures 051013mbdoc ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return- - - corrected prints- SIGNED: M. Watson, P.E. President, Sr. Project Manager IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE /NS/TE tLEAaSCAPEARCH17-ECTURE, INEERING, SURVEYING A LETTER OF TRANSMITTAL P.C. 3 Garrett Place (845) 225 -9690 LLCarmel, New York 10512—,. Fax: (845) 225 -971 _ TO: Mike Budzinski, P.E. Director of Engineering Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 WE ARE SENDING YOU ❑ Shop Drawings + ❑ Copy of Letter Date: 5 -13 -13 Job No. 03212.300 Attn: Mike Budzinski Re: SSTS for Slafani and/or Albano NYS Route 22 and Edwards Road Patterson, New York 12563 ® Enclosed ❑ Under separate cover via ❑ Prints ® Plans ❑ Change Order ❑ the following items: ❑ Samples ❑ Specifications COPIES DATE i NO. ! DESCRIPTION _4.._____._. 5,13 -13 AB -1 ; As -Built Drawing t ! 1 s i THESE ARE TRANSMITTED as checked below: ® For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution :.: - :..... ❑.As_requested __ _.. _ . ❑ Returned for corrections, ❑_Return _ _ _ __ .. corrected prints ❑ For review and comment ❑ REMARKS: Mike, rt. J09i COPY TO: File 051313mbdoc Carl Albano with enclosures SIGNED: 14—Xl 4ohn M. Watson, P.E. Vice President, Sr. Project Manager IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE U 11 x ,jilrAKIA LNT OF HEALTIB DIVISION OF ENVIRONMENTAL HEALTH-SERVICES iAL SITE 9NSPECTION Date. /� Inspected by: ', Street Location YS.7+, a %,�rc�s 5Z� Owner ,QJ�vv, _s ,own.. - gj/ p ,� TM # 3E-, Subdivision Lot # q 1. Sewage Area YE NO COMMENTS 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. 1 00' from water course/wetlandss ...... ............................... II. Sewage System,ou� /T�,� /� a. Septic tank size. 000 ........ 1,250 ......... other ..... . ...... b. - S eptic tank installed level ............ ............................... C. 10' m� mom im -from foundation .......................................... d. Distribution Box 1. All outlets at same elevation- water.tested .................. 2. Protected below frost ............................... 3. .. Minimum 2 ft. Original soil between box & trenches e. Junction Box properly set .......... ............................ .... 6. 'renc es 1.1ength required 3 Length installed 3 ©o 2. Distance to watercourse measured -, - loo Ft.......... 3, Installed according to plan.... 4. Slope of trench acceptable 1116 -1/32" /foot ............. 5. 101 from .property line - 20 ft.- foundations.......... 6.. Depth of trench <30 inches from surface .................. 7. ' Room allowed for expansion, 10.0 % ......................... ,Q 8.. Size of gravel 3/4 - 1' /2" diameter clean ...................: 9. Depth of gravel in-trench 12" minimum......::........... 10. Pipe ends ca v ped.......... ........... ............................... g. Pum or Dosed Systems 1: Size of ppum� amber ................ ............................... 2. Overf=low tank .......................... ............................... . 3. Alarm, vmuallaudio ......:........... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baked .................................. I........................ 6. Cyycle witnessed by HD.estimated flow /cycle........:.. HouselBuildiriQ a. House located per approved plans . ............................... 27F b. Number of bedrooms ...........................' ...1 ............ IV. Well n Well located as per approved plans...... . -��svv o 5" eve b. Distance from STS area measured ..... c. Casing. 18" above grade ... ............ d. Surface drainage around well acceptable .....:................. V. Overall Worinnanshin . a. Boxes properly grouted .................... ............................... b. All pipes partially backfilled .......................................... c. All pipes flush with inside of box ... ............................... d. Backfdl 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 ALLEN BEALS, M.D., J.D. Commissioner ofHa ttfl ROBERT MORRtL% P.E. Director of Environments( Heatth January 18, 2013 Insite Engineering John Watson, P.E. 3 Garrett Place Carmel, NY 10512 Dear Mr. Watson: ELLEN OM U mty Executive DEPARTMENT OF HEALTH: I Geneva Road, Brewster, New York 10509 Telephone: (845) 808 -1390; Fax: (845) 278-7921 Re: Field Inspection — Albano NYS Route 22 & Edwards Road (T) Patterson, TM 35. -5 -1 The above referenced separate sewage treatment system can be backfilled. The foll comments need to be corrected in the field: 1. The sewer line from the house to the septic tank needs a clean out to service elbows. =2. The- well needs to-be inspected `by this 'Department upon completion. If you have any further questions, please contact me at (845) 808 -1390, ext. 43261. GDR:cw Sincerely, Gene D. Reed Sr. Environmental Health Engineering Aide PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATE`WWE'LL please print or Woe CY Well Location Street Address: Town/Village: Tax Map # NYS Route 22 and Edwards Road Patterson Map 35 Block 5 Lot(s) 1 Well Owner: Name: Address: Phone #: Sj,af� � Y 11 Clark Place, Matwpac, New York 10541 Use of Well: 1 Residential _Public Supply Air /cond /heat pump_ Irrigation 1- Primary Business Farm Test/monitoring _Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield Sought 5 gpm # People Served 5 Est. of Daily usage 600 gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drillin X New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes _ No X Is well located in a realty subdivision? ........................................... ............................... Yes X No Name of subdivision Old Wall Estates Lot No. 9 Water Well Contractor: To Be Deternnined Address: Is Public Water Supply available on site? ....................................... ............................... Yes No X _ Name of Public Water Supply: N/A TownNillage N/A Distance to property from nearest water main: N/A Proposed well location & sources of contamination to be provided on separate sheet/plan. �l Date: Applicant Signature: _ . _.. _. :... (iLt4l Watson - ITIS EnJineeringr Surveying & Landscape Architecture, P.C. 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. 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 Commissioner of Health. Any revision or alteration of the appro plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. _ Date of Issue Z' 7'^`% Permit Issui Official: Date of Expiration 2 -3 :::4(. �!) Title: Permit is Non- Transferable White copy - HD file; Yellow copy - Building Inspector; Pink copy - OwnerVOrange copy - Well driller Form WP -97 Rev. 3/06 PUTNAM COUNTY DEPARTMENT OF HEALTH � DIVISION OF ENVIRONMENTAL HEALTH SERVICES NST1 UCtION-PERMIT FOR SE WAGE'FREA`I`MEN`lt- SYSTEM PERMIT # P -24-04 Located at NYS Route 22 and Edwards Road Subdivision name Old wall Estates Subd. Lot # 9 Date Subdivision Approved June 12, 1981 Carl Albano or Owner /Applicant Name Mani Fwdly Trust Mailing Address 11 Clark Place, Mahopac, New York Amount of Fee Enclosed Building Type Residential $500.00 (Previously Submitted) Town or Village Patterscn Tax Map 35 Block 5 Lot 1 Renewal x Revision 3/14/05 P,ppraved Date of Previous Approval 7/24/05 Revision 7/8/08 Renewal Zip 10541 Lot Area 2'8 +/- No. of Bedrooms 3 Design Flow GPD 600 Fill Section Only Depth Volume PCHD NOTIFICATION L IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1,000 primary absorption trenches and 100% expansion trenches Other Requirements: To be constructed by Water Supply: None gallon septic tank and 300 L.F. of 2' wide To Be Deterffdrea Address Public Supply From Address �ddr�ss: To Be Detemdned _ I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatmentsystem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Director /Commissioner 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 'J,,44, M. Watson, P.E. P.E. X R.A. Date / /� Z r I f License # 77950 Place, Carmel, New York 10512 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered neces ary by the Director /Commissioner. Any revision or alteration of the approved plan requires a new pe t. Approved for di arge of domestic sanitary sewag only. By: *Title: ate: White copy - HD File; Ye ow c y Building Inspector; Pink copy - Owner; Or (7 co y Design Professional Form CP -97 • z .. �.. .. At .:,I VAN0 .�,.; v &.t..'c5r_"e!•:, �:�,i��r'�.ra, ... .. a�`..Yid?. _a.•F'S'k l 3 ? ,....... � � D 0 � � .. .. .. ;1 its :;t .. ,'�. �, i 'i j �. v c, i . ® °o Av 34a41 s "f� €�` °^� A. 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PCHD Construction Permit 9 - P-2f-04- - Located: & S 2.2-f- EA.4 -dr A, r-i 0 ti Ovmcr/Applicant Name: if A, I AU-i2 e, ITA 3 r Block S- Lot Formerly: —Subdivision Name: IcA WA Subdivision Lot # 9 Is system fill completed? Date: Is system complete? Y e r Date: A -LaIL- Is system, constructed as per plans? Ye x Is well drilled? /v A- Date: Is well located as per plans? .— Are erosion control measures in place? jer -_0 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 PCH D Construction Pe=t and approved plans and the Standards, Rules and Ftegulations of the Putnam County Department of Health. I-- LA'*V. Certified b, gn Professional Ens irow_64j, -JL*rveriqj Address: 3 ----- - Cec'r^ C4 I or I IL Lie. . I Comments: Form FIR-99 . /NS/ TE ENGINEERING, SURVEY ING & LA . N SCAPEARCH/TECTUR£L _P.! February 3, 2011 Mr. Mike Budzinski, P.E. Director of Engineering Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 RE: SSTS for Albano NYS Route 22 & Edwards Road Town of Patterson, Putnam County Tax Map # 35.- 5 -1 Dear Mr. Budzinski, Enclosed please find the following for your review: • Drawing CD -1 "Construction Drawing," last revised January 31, 2011. (5 Copies) • House Floor Plans (2 Copies). The enclosed documents are provided for your continued review for the renewal of the Well Permit and Construction Permit for the subject lot. The drawing has been revised to provide a footing drain for the proposed dwelling. House Floor Plans have been provided as requested. If you have any questions or comments regarding this information, please do not hesitate to contact our office. Very truly yours, INSITE ENGINEERING, SURVEYING & LANDSCAPE ARCHITECTURE, P.C. By: : [//1 John M Watson, P.E. Vice Pqbsident, Sr. Project Manager JMW /e Enclosure cc: Carl Albano Insite File No. 03212.300 3 Garrett Place, Carmel, New York 10512 (845) 225 -9690 Fax (845) 225 -9717 www.insite- eng.com 2011 -01 -31 mb.doc Caswell F. Holloway Commissioner Paul V. Rush, P.E. Deputy Commissioner Bureau of Water Supply prush @dep.nyc.gov 465 Columbus Avenue Valhalla, NY 10595 -1336 T:(845)340 -7800 F: (845) 334 -7175 _...� _. .. - w�.._ n.�..�..__..v--- ............_._ , :. January 28, 2011 Michael Budzinski, P.E. Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 Re: Old Wall Estates Lot # 9 — SSTS Edwards Road/ Rt. 22, (T) Patterson TM# 35 -5 -1 Bog Brook Reservoir Drainage Basin DEP Log # 2005 -BB -0057- DR.1 Dear Mr. Budzinski: New York City Environmental Protection (DEP) has determined that the above - referenced application, received by the DEP on January 20, 2011, is complete. The DEP has no objection to the approval of the above - referenced regulated activity. This determination is based on the review of submitted documents including the plan titled "Subsurface Sewage Treatment System Plan for Sclafam /Albano Residence, Edwards Road/Rt. 22, Town of Patterson, Putnam County, New York ", prepared by Insite Engineering, P.C., dated December 23, 2004, last revised January 12, 2011. Please.have.the applicant contact David Alderi.sio at (914) 742-20 10 at least two cia`ys_prior io'start of construction of the SSTS so that the DEP may inspect and monitor the installation. c: Roger Sokol, NYSDOH '.1 Sincerely, Danny Shedlo, P.E. Civil Engineer III Wastewater Design Review /NS/ TE !Mr�ENGINEERING, SURVEYING & DAIDSCAPEAROHITEC.Tq�7k P.C. >, Mr. Mike Budzinski, P.E. Director of Engineering Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 RE: SSTS for Albano NYS Route 22 & Edwards Road Town of Patterson, Putnam County Tax Map # 35.- 5 -1 Dear Mr. Budzinski, Enclosed please find the following for your review: January 12, 2011 P - �11 ✓ dq 0 Drawing CD -1 "Construction Drawing," last revised January 12, 2011.(5 Copies) • Construction Permit for Sewage Treatment System, (CP -97 Form) dated January 12, 2011. • Resolution for a Wetland/Watercourse Permit dated January 6, 2011. The enclosed documents are provided for your review for the renewal of the Well Permit and Construction Permit for the subject lot. The drawing and construction permit have been revised from a 2- bedroom design to a 3- bedroom design. The Specific Waiver previously submitted for the 2- bedroom SSTS is no longer applicable. The wetland permit for the expansion trenches located within the Town Wetland Control Area is enclosed with this submission Please note <that the application fee wash previously�provided� If you have any - questions or' comments -regarding tiiis'infa�mation; please to not hesitate to contact our office. Very truly yours, INSITE ENGINEERING, SURVEYING & LANDSCAPE ARCHITECTURE, P.C. By: -� _ John M. Watson, P.E. Vice President, Sr. Project Manager JMW /e Enclosure cc: Carl Albano Insite File No. 03212.300 3 Garrett Place, Carmel, New York 10512 (845) 225 -9690 Fax(845)225-9717 www.insite- eng.com 2011- 01- 12mb.doc BRUCE R FOLEY \ �� M.S.N. Public Health Drrertor .•Y © n:. .w =- _k r LORETTA MOLINARI RN., M S N rlsscciaie f ubiic Health Directo A Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 o4����se� TO: 44ELrTMENT OF ENGINEERING AND RESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM JOINT RE VIEW /lr�S �Z7 Z z-. PROJECT: I [:/�JO [:y. ..� ©m GUA1"-'1 .E91j G TOWN: ve esco - X ENT/7I.SION G DATE: (rrREV2) /NS/ TE ENG /NEER /NG; SURVEYING & 1ANDSCAPEARCH/TECTURE, P.C. Mr. Mike Budzinski, P.E. Director of Engineering Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 RE: SSTS for Albano NYS Route 22 & Edwards Road Town of Patterson, Putnam County Tax Map # 35.- 5 -1 Dear Mr. Budzinski, Enclosed please find the following for your review: January 12, 2011 Drawing CD -1 "Construction Drawing," last revised January 12, 2011. (5 Copies) Construction Permit for Sewage Treatment System, (CP -97 Form) dated January 12, 2011. • Resolution for a Wetland/Watercourse Permit dated January 6, 2011. The enclosed documents are provided for your review for the, renewal of the Well Permit and Construction Permit for the subject lot. The drawing and construction permit have been revised from a 2- bedroom design to a 3- bedroom design. The Specific Waiver previously submitted for the 2- bedroom SSTS is no longer applicable. The wetland permit for the expansion trenches located within the Town Wetland Control Area is enclosed with this submission.Please note that the application fee was previously provided.' ; If.: youhave .arsy_ouestiens. or. comments. regarding: this: anf _ormaton,:Please4o.npt.hesitate our office. Very truly yours, INSITE ENGINEERING, SURVEYING & LANDSCAPE ARCHITECTURE, P.C. By: ilk -ka� Joh M. Watson, P.E. Vice President, Sr. Project Manager JMW /e Enclosure cc: Carl Albano Insite File No. 03212.300 ` r1 3 Garrett Place, Carmel, New York 10512 (845) 225 -9690 Fax (845) 225 -9717 www.insite- eng.com 2011- 01- 12mb.doc PLANNING DEPARTMENT P.O. -Box 470 .1142 Route 311 Patterson, NY 12563 Micheiie Rus'sbr ...... - Sarah Wagar ,Secretary Richard Williams Town Planner Telephone (845) 878 -6500 TOWN OF PATTERSON FAX (845) 878 -2019 PLANNING & ZONING OFFICE PLANNING BOARD OF THE TOWN .OF.PATTERSON, NEW YORK Resolution for a Wetland/Watercourse Permit Carl Albano Old Wall Subdivision, Lot 9 Motion introduced by Member Charles Cook; Motion seconded by Member Thomas E. McNulty; ZONING BOARD OF APPEALS Howard Buzzutto, Chairman Mary Bodor, Vice Chairwoman Marianne.Burdick Lars Olenius ='Gerald Herbst PLANNING BOARD Shawn Rogan, Chairman Charles Cook, Vice Chairman Michael Montesano Thomas E. McNulty Ron Taylor AT a duly noticed meeting of the Planning Board of the Town of Patterson, held on January 6,2011; W-'�EIUM AS --a- Wetlan ds- and�VIatereour'sb• giermit• applicatiorNo: -iUW�1- i• f% 01- httss-beetr .-..- _._.:.._..,.._._.. submitted by Carl Albano for property located at 24 Old Road, also identified as Tax Map Parcel No. 35. -5 -1, and WHEREAS, said application proposes to use approximately 0.025 acres of area within the wetland controlled area for a portion of the subsurface sewage disposal area 100% expansion area in order to construct a 3- bedroom house, as shown on a Site Plan prepared for Sclafani/Albano, and prepared by Insite Engineering, Surveying and Landscape Architecture, PC, dated October 28, 2010, and WHEREAS, the Planning Board has complied with the requirements of Article 8 of the Environmental Conservation Law ( "SEQRA ") and 6 NYCRR Part 617, and has duly filed all appropriate SEQRA determinations in accordance with 6 NYCRR Part 617.10; WHEREAS, the Planning Board of the Town of Patterson, pursuant to Chapter 154 of the Resolution of Wetland/watercourse Permit January 6, 2011 Carl Albano - Old Wall Subdivision, Lot 9 Page 1 of 4 --Town Code has considered the application of Carl Albano for approval of a Wetlands and Watercourse permit No. WWI I 10-0 1, and WHEREAS, the Planning Board has determined that the proposed alteration of the wetland buffer will have a minimal impact on the character and functions of the wetland, and WHEREAS, the Environmental Conservation Inspector has reviewed the application, and has raised no objections to the proposed activities, subject to certain conditions included herein, and WHEREAS, the Planning Board opened a duly noticed public hearing on the subject application and final site plan at its meeting on January 6, 2011 and closed the public hearing on that same night after receiving comments from the public. NOW THEREFORE BE IT RESOLVE THAT in the application of Carl Albano for approval of Wetland and Watercourse Permit Application No. WW 1110 -01, pursuant to Chapter 154 of the Town Code, the Planning Board finds that the subject application and plans, as modified in accordance with any applicable conditions set forth in this resolution, complies with all requirements of the Town Law and Chapter said wetland . . _pter 154 of the Town Code, and. hereby grants approval to s d we and watercourse permit application, subject to the applicant's compliance with the following general and special conditions, GENERAL CONDITIONS: 1. No activity shall be permitted within controlled areas except as identified in the approved application and plans. I -*bik -slM lje -0&fdffiidd ' in '4c66fdMed'-,�� JhTMW Yolk - SlAnft& and - Specifications for Erosion and Sediment Control. 3. The Permit Holder shall notify the Environmental Conservation Inspector (E.C.I.) in writing, at least five business days in advance of the Date on which project construction is to begin. 4. The Permit shall be prominently displayed at the project site during the undertaking of the activities authorized by the permit. 5. The boundaries of the project shall be clearly staked or marked and maintained. In addition, any wetlands contained within the boundaries of the project shall also be staked or marked. 6. The Environmental Conservation Inspector (E.C.I.) or his designated representative shall have the right to inspect the project. Resolution of Wetland/watercourse Permit January 6, 2011 Carl Albano - Old Wall Subdivision, Lot 9 Page 2 of 4 -- - 7.. The Permit shall expire on either the- completion.of..the_ acts specified, or unless otherwise indicated shall be valid for a period of one year from the date of issuance. 8. As a condition of the issuance of this permit, the applicant has accepted expressly by the execution of the application, the full legal responsibility for all damages, direct or indirect, of whatever nature, and by whomever suffered arising out of the project described herein and has agreed to indemnify and save harmless the town from Suits, Actions, Damages, and costs of every Name! and description resulting from the said project. 9. In the event that any of the material submitted in relation to this application is inaccurate or misleading, or the owners of the project do not have the legal right to develop or use the property where and as shown on the material submitted to this Board, then any approvals herein granted are deemed null and void. SPECIAL CONDITIONS: 1. The Applicant shall have the Town of Patterson Environmental Conservation Inspector post Town of Patterson wetland identification signs along the outer edge of the 100' controlled wetland buffer, except in the area of the subsurface expansion area where the markers shall be placed along the limits of disturbance line. 2. A stonewall, or line of large boulders shall..be.placeri.along the. edge of the .limits of disturbance. 3. The deed, and all subsequent deeds for the property shall contain the following .. _ statement: "This _property contains areas classified as wetlands by the . Town of - " °'' ' '� " ° - 'Pattetsoii: Eiriyiaria " "�stii- rbance or- activities ot�ier tliari passiveactivifiestliatoccur� within the wztland or 100'.adjacent.controlled buffer.mayiirstrequire a permit from the Town of Patterson in accordance with the Patterson Town Code ". BE IT FURTHER RESOLVED that this wetland and watercourse permit approval shall be deemed null and void if the applicant fails to comply with all conditions stated above and/or construction is not completed within one year of the issuance of this permit, and any extension thereto granted by the Planning Board; A copy of this Resolution shall be filed with the Town Clerk and the applicant upon adoption. VOTE: Charles Cook: Yes Thomas E. McNulty: Yes Michael Montesano: Yes Ron Taylor: Yes Resolution of Wetland/watercourse Permit January 6, 2011 Carl Albano - Old Wall Subdivision, Lot 9 Page 3 of 4 s.�F .�.......r... Shawn Rogan: _ Recused from Voting DATED: January 6, 2011 STATE OF NEW YORK} :SS} COUNTY OF PUTNAM) I, MICHELLE RUSSO, Secretary ofthe Planning Department of the Town of Patterson, do hereby certify that the foregoing is a true and exact copy of a Resolution adopted by the Planning Board of the Town of Patterson at a meeting of said Board of the Town of Patterson held on January 6, 2011. MICHELLE RUSSO I, .ANTOINETTE KOPECK, .Town Clerk of the.Town of Patterson, do hereby certify that the foregoing.Resolution was filed in the Town Clerk's Office on January 7, 2011 � � I �"V' M/, on 112071 A� ,I Eli 12 111 to '7111 I Resolution of Wetland/watercourse Permit January 6, 2011 Carl Albano - Old Wall Subdivision, Lot 9 Page 4 of 4 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAIVER ROBERT J. BONDI County Executive =ROBERT MORRIS,'PE'- Director of Environmental Health NAME: L ' � >bAL.b ) . ADDRESS: �� cil��lG p%CP & 44,1VC SITE LOCATION: Z CGS C�GNr� DATE: STAFF PRESENT: D. Michael Budzinski P.E. Gene Reed Joe Paravati & SPECIFIC WAIVER REQUEST: 7 /Jie 4 DOES THE PROPOSED VARIANCE REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? YES ❑ NO ..WIL'Itb!-SAPPROVAL RESULT-IN A SIG'N'IFICANT "HARDSHU YES DISCUSSION RE UES APPROVAL O DENIED REASON FOR DENIAL 17' NO ,3-,o APPROVED DENIED ❑ DIRECTOR OF ENVIRONMENTAL HEALTH DATE /' L, DATE COMMISSIONER OF HEALTH Environmental Health (845) 278 -6130 Fax (845) 278 -7921 (SPECWAIVER) Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool(845)278 -6014 Fax(845)278 -6648 J UL-Cb -I- 11 '1J - r0M: HLt%HNU JUN-25-2008 01'; EN FROM- EA111ROMWAl HEALTH b4ZO -best IO : (fc:J7(Ir 84OZ787921 r-. Cl c T-938 P.001/001 F -788 --.$rJMCI11C WAIVER APPLICAUON DEPARIISN T 01T HEALTH Regnest for Approval of Nobcornp iaiwee with Bureau of Water supply Prvbepdon. tle ad ox INCR Appenx 7S-A VawTr"ea standards..i uRAdual Household Systems Name of 4ppIt=uo t 70:Y�404Q . q r Addren saes j r a spa, z4+ 1 a gl Contact infosmation ?how S 7 �� b (_ 1006 FA* Stec I.ucaaon . 22 . e A eoene, aoo 12 S6 The f offewft infonnatim & Aging subnairv4 in swppon ply 9DpEradna for a spetdk xWP&r ji-vm eeml liancc ieith vne or r,W standards of IONYCAR Appdxdfx 71-A, ai1►'ctStm0er Trennnrxt 3 lards- L,dttitdua1 JZ#u= Vjd'TYM S-t I" The w- stewster trectgrtant Mttw cannot rueei the faliowing 5tand2rds of 1dNYCRR Appendix M5 - o SPP9=162 dMinces eAha6t be sehieved (75-AA(b)t Table 2, Separation R= i 4g=11t4) C1 Ecesslve SlaPe (75-A.4(1). Soil and SIte APPrafs4 O Design is not addrmad in Apgeb fix 75-A cl TeehnoloMr is not addressed in Appendix 7r Ail M Other: v 2. The followfng design is proposed to rmittgate nonconiplisnoe With Appendix 79-A (brief desgiptioa): M e. rJ4n g! lei n4me-f- of -He. ,Ik rep -u?.eo a 3° -Aedrop.2.+, fn .n xy-t, A a 2 e'frv0't .a(ES a i t p /ages '.( _ ra- 7—ro T /- l�ze 3 i_ een 3. Suppot#iag information provided. OC Detailed Site FEw Deisiled Design Sari and Site ES►sluation Nefg4boring eoladit;ons of comcern (e-g., lwejl% watwbodies, wetlands. etc.) O Other: F.,�Qlsia: ; (aPPh fl ` � D (type�owiedgc that tbw taatber request is necessary bcesnse it is not procdad for nit onsite wastcwn ter treatmvnt to meet ►e.re_f cod staudar& of I ONYCRIY. ,A ..penfc -7;5;-A on 4(engineer) -lZ� n M. 1n/a [�O n E �. (type or priest) aclmowleclge tb= tw6 wan -ver request i9 necessary because it is not practical for ab onsilte wutewatc1r treatment systam to awe the rti aw4d sbndards of IoNyC'pR. Appendix 794 on this ProPartY-14 MY Professional epintao, the plropoted design described In thig applimtion will provide a degree of praterbon equivalent to the onAte wastewater trewunent sisadard(s) that MY not be met for petty and wai not createan inerea�sed risk to public h88ith ar the environment. 7775-0 f tt� _ Lase P *For Real* Depw m at use Based hpon the informattiou provided in this APplieatfott to ware the referenced standards of Appendix 7S A and in aceordnce with 10NYC-9R§§ 753 and 75.6 (b), the waiver requested is hereby: ❑ Approved nsproposad. A Approved with folbwing conditions: O Not acted on, because oddidonal inloramdoaa is regnireth ❑ Deemed. beeaoae+ Notes MY waiver may be rawked &!could any enndltloas eo-PaUcred bafore approVfigg (fib waiycr change g)ter ,0jW PvaL Representative Sigwsture Plate rwf r+ �dl� Caswell F. Holloway Commissioner cholloway@dep.nyc.gov Paul V. Rush, P.E. Deputy Commissioner prush @dep.nyc.gov 465 Columbus Ave. Vaihaila, New York 10595 Tel. (845) 340 -7800 Fax (914) 741 -0348 .. Augqqt Michael Budzinski, P.E. Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 Re: Old Wall Estates Lot # 9 — SSTS Renewal Edwards Road/ Rt. 22, (T) Patterson TM# 35 -5 -1 Bog Brook Reservoir Drainage Basin DEP Log # 2005 -BB -0057- DJI.1 Dear Mr. Budzinski: New York City, Environmental Protection. (DEP) has determined that the above - referenced renewal application, received by the DEP on June 30, 2010, is complete. The DEP has no objection to the approval of the above - referenced regulated activity. This determination is based on the review of submitted documents including the plan titled "Subsurface Sewage Treatment System Plan for Sclafani /Albano Residence, Edwards Road/Rt. 22, Town of Patterson, Putnam County, New York ", prepared by Insite Engineering, P.C., dated December 23, 2004, last revised July 23, 2010. Please have the applicant contact David Alderisio at (914) 742 -2010 at least two days prior to start of construction of the SSTS so that the DEP may inspect and monitor the installation. c: Roger Sokol, NYSDOH Sincerely, Danny Shedlo, P.E. Civil Engineer III Wastewater Design Review BRUCE R. FOLEY _r `"` Public Healtk Dii ector L_ ORETTA MOLINARI RN., M.S.N. `Ass6ciate-Public Health - Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130, Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (9I4) 278 - 6648 Auee c �� TO: PARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM JOINT REVIEW IV Y5 Je7 zz 156't!44&5 PROJECT: L jN 9! Al 7lg�S .. TOWN: 614-1glk -il'so Aj /'"I 35--�s -✓ RE VISION (JTREV2) DATE: 2 �— to /NS/ T ENGINEERING,. SURVEYING & ,- ,IANDSCAPEARCHITECTURE,' P.C. July 23, 2010 Mr. Mike Budzinski, P.E. Director of Engineering Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 RE: SSTS for Sclafani Renewal NYS Rt. 22 & Edwards Road Town of Patterson Tax Map No. 35. -5 -1 Dear Mr. Budzinski, Enclosed please find the following for your review: • Drawing CD -1 "Construction Drawing," revised July 23, 2010 (5 Copies). • Drawing WL -1 "NYSDEC Wetland Map," dated November 10, 2005 (1 Copy). • Specific Waiver Application. With regard to the comments offered in the NYCDEP's July 12, 2010 comment letter we offer the following: 1. A NYSDEC Wetland Map is enclosed with this submission as requested. 2. The Junction Boxes are labeled as such on the SSTS profile on drawing CD -1. 3. A stabilized construction entrance detail is provided on drawing CD -1. 4. The proposed septic tank has been revised to have a minimum cover opening of 20 inches as shown on drawing CD -1. 5. The proposed septic tank has been revised to show the inlet baffle extending to a minimum of 16 inches below the liquid level on drawing CD -1. With .regard to the comments offered in your July 13, 2010 comment letter we offer•the following: - - °- "1': -W 06ci is waiver application has been included as requested. 2. The NYCDEP comment letter has been addressed above. We trust you will find the enclosed information in order, and request the application be deemed complete, and approved. If you have any questions or comments regarding this information, please do not hesitate to contact our office. Very truly yours, INSITE EN IIINEEERRING, SURVEYING & LANDSCAPE ARCHITECTURE, P.C. By: vrt�/ ` -c rJoh M. Watson, P.E. Vic President/Sr. Project Manager Enclosure cc: Carl Albano Insite File No. 03212.300 3 Garrett Place, Carmel, New York 10512 (845) 225 -9690 Fax (845) 225 -9717 www.insite- eng.com LOT072310mb.doc Sherlita Amler, MD, MS, FAAP Commissioner of Health _ Robert Morris,. % KNrector of Einiironmentaf &,e th John Watson, PE Insite Engineering & Survey 3 Garrett Place Carmel, NY 10512 Dear Mr. Watson: Department of Health 1 Geneva Road, Brewster, NY 10509 July 13, 2010 Re: Proposed SSTS Renewal for Lot # 9 — Old Wall Estates Sclafani Family Trust (T) Patterson, TM # 35 -5 -1 Robert J. Bondi County Executive This Department has received and reviewed the revised plans for the above referenced project and the following comments are offered for your consideration. 1.. A specific- waiver applicaton.is to ?•e submitted for the two = bedroom, design..-._... ........_4r ... .... 2. Please refer to the NYCDEP letter of July 12, 2010 for additional comments. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. Respectfully, Michael J. Director of MJB:kly Enc. cc: D. Alderisio, DEP Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845.).225.-54 18 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing / Home Care Agency (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 0 protection Caswell F. Holloway Commissioner cholloway@dep,nyc.gov Tel. (718) 595-6565 Fax (7t'9�'595.4557 Bureau ofwater supply Paul V. Rush, P.E. Deputy Commissioner ' prush @dep.nye.gov ..... 465 Co►umbus Aventie V lhalha,' Nett York 10595 -1336 s •Tel . (9 .4).742- 2001 .,.....,. Fax(914)741 -0348 Jul 12 2010 10:12 P.02 July 12,.2010 Putnam County Department of Health 1 Geneva .Road Brew*r, New York 10509 Re: Old Wall Estates Lot # 9 — SSTS Renewal Edwards Road/ Rt, 22, (T) Patterson TM# 35 -5 -1 Bog Brook Reservoir Drainage Basin DEP Log # 2005 -BB -0057- DJI.1. Dear Mr. Budzinsld: New York City Environmental Protection (DEP) has determined that the above - referenced application received by the DEP on June 30, 2010, is incomplete. The following information is required before the DEP may commence its review: ® As the site plan shows a NYSDEC wetlands, provide a completed NYSDEC Freshwater Wetlands Stamp on the site plan. d Drop bores are shown in the SSTS profile. A Junction Box typical. 'drawing is_..shown -on the. site plan.._ Please clarify. -. - _..__._..__ _......... _....... • Provide a detail showing a stabilized construction entrance on the site -plan. e Provide a detail showing the cover for the proposed septic tank with a minimum coven opening of 20 inches. - .®- - .Provide a detail showing the inlet baffle for the s epti c.tankextendi ng a muumum of,, 76 inchesbelow the licluid�level. ' If you have any questions regarding this matter, please contact the undersigned at (914) 7422010. c: Roger Sokol, NYSDOH Sincerely, David Aldexisio Associate Project Manager Wastewater Design. Review NYC Environmental °- Protection. ° • - _ ...._.. . Caswell F. Holloway Commissioner cholloway @dep.nyc.gov Tel. (718) 595 -6565 Fax (718) 595 -3557 Bureau of Water Supply Paul V. Rush, P.E. Deputy Commissioner prush @dep.nyc.gov 465 Columbus Avenue Valhalla, New York 10595 -1336 Tel (914) 742 -2001 Fax (914) 741 -0348 July 12, 2010 Michael Budzinski, P.E. Putnam, County- Department-ofHealth:. 1 Geneva Road Brewster, New York 10509 Re- Old Wall Estates Lot # 9 — SSTS Renewal Edwards Road/ Rt. 22, (T) Patterson TM# 35 -5 -1 Bog Brook Reservoir Drainage Basin DEP Log # 2005 -BB -0057- DJI.1 Dear Mr. Budzinski: New York City Environmental Protection (DEP) has determined that the above - referenced application received by the DEP on June 30, 2010, is incomplete. _The following information is required before the DEP may commence its review: • As the site plan shows a NYSDEC wetlands, provide a completed NYSDEC Freshwater Wetlands Stamp on the site plan. • Drop boxes are shown in the SSTS profile. A Junction Box typical drawing is shown on the site plan. Please clarify. • Provide a detail showing a stabilized construction entrance on the site plan. • Provide a detail showing the cover for the proposed septic tank with a minimum cover opening of 20 inches. • Provide a detail showing the inlet baffle for the septic tank extending a minimum of 16 inches below the liquid level. If you have any questions regarding this matter, please contact the undersigned at (914) 742 -2010. c: Roger Sokol, NYSDOH Sincerely, 06V�w (IUZU�Z IV David Alderisio Associate Project Manager Wastewater Design Review Sherlita Amler, MD, MS, FAAP Commissioner of Health _RoberC Morris, PE - - _ Director of Environmental Healthy r' John Watson, PE Insite Engineering & Survey 3 Garrett Place Carmel, NY 10512 Dear Mr. Watson: Department of Health 1 Geneva Road, Brewster, NY 10509 June 29, 2010 RE: Proposed SSTS for Lot # 9 — Old Wall Estates NYS Route 22 & Edwards Road (T) Patterson, TM # 35 -5 -1 Bog Brook Reservoir Basin Robert J. Bondi County Executive The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on June 25, 2010 is complete. The Department will notify you by July 19, 2010 of its determination. ❑ 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 ".. iny, attention at the above address. This notice must include your name, the location oft the project, the office with which you filed the application originally, and a statemeftt -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 approved, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should 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)808 -1390 ext.43148. MJB: kly M j;nvtronmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845.).225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing / Home Care Agency (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 SHERLITA AMLER, MD, MS, FAAP . Commissioner of Health LORETTA MOLINARI, RN, MSNy N w Associate Commissioner of Health ROBERT J. BONDI County Executive _ �-• ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 TO: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM JOINT RE VIE W A-V PROJECT: LY/7"Ct- TOWN: �/��� -S6.✓ SUB'D APP DATE NOTICE OF COMPLETE APPLICATION: DATE: ❑ Within the drainage basins of West Branch, Boyds Corner Reservoirs or Croton Falls. ❑ Within 500 feet of a reservoir, reservoir stem or control lake. Within 200 feet of a watercourse or a DEC wetland and appearing on a subdivision map approved after December 31, 1992. ❑ Design flow greater than 1000 gallons /day. ❑ Commercial SSTS. j treview Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 05/07/2010 FRI 14:57 FAX INSITE ENG. 1a003/003 DIVISION OF ENVIRONMENTAL HEALTH SERVICES LE17ER OF AUTHORIZATION RE: Property of C ar l A 1 vino Located at IVYS 2-2- 1- F�wa,Axs no -jA tV QS 4erso L Tax Map # 3 S' Block ,S Lot -- -1— Subdivision of O l Wa I i E S �kfes Subdivision Lot # Filed Map # 160 Date Filed (2 l ? 8 Gentlemen: This letter is to authorize Insite Engineering, Surveying, & Landscape Architecture. P.C. (John Watson P.E.) a duly licensed Professional Engineer X 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 theprovisions -of.- Article ,145, and/or_ 147. of the Education Law, the Public-Health--- - ;- Law, and the Putnam- ..iint'Sitaty Code. Very truly urs, Countersigned:;,": Signed: r rV° , P.E., R.A., #( 0 (Owner of ProPedY) Mailing State New York P. C. Carm� r— Zip 10512 Telephone: (845) 225 - 9690 Mailing Address: �/ C�i5 �1 t 8 State Zip Telephone: Form LA -97 t /NS/ TE ENGINEERING, SURVEYING & :/ June 24, 2010 Mr. Mike Budzinski, P.E. Director of Engineering Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 RE: SSTS for Sclafani Renewal NYS Rt. 22 & Edwards Road Town of Patterson Tax Map No. 35. -5 -1 Dear Mr. Budzinski, Enclosed please find the following for your review: • Drawing CD -1 "Construction Drawing," dated May 10, 2010. (5 Copies) • Letter of Authorization. (Form LA -97) • Application to Construct a Water Well, (WP -97 Form). • Construction Permit for Sewage Treatment System, (CP -97 Form). • Check #80352293 -5 for $500.00 Fee. The enclosed documents and drawings are provided for your review for the renewal of the SSTS construction permit and well permit for Sclafani. If you have any questions or comments regarding this information, please do not hesitate to contact our office. Very truly yours, INSITE ENGI E _ ING, URVEYING & LANDSCAPE ARCHITECTURE, P.C. _ By: J n . Watson, P.E. ice resident/Sr. Project Manager JMW /e s jk Enclosure cc: Carl Albano Insite File No. 03212.300 3 Garrett Place, Carmel, New York 10512 (845) 225 -9690 Fax (845) 225 -9717 www.insite-eng.com LOT062410mb.doc DIVISION OF ENVIRONMENTAL HEALTH SERVICES��� /� 7 CaMg> RUCTION PERVi " FM SEWAGE T ATMEi °& STEM PERMIT # 1— z" - O 4-. �)Uj, d Located at NYS R"\ t 2l t 54woueAr- a Py GO) Village - P4+R.1r;56^ Subdivision name old. WoM 5, � t c, Subd. Lot # cl Tax Map 35' Block S Lot I Date Subdivision Approved Jot-. l2, 1 1 8 1 Renewal A— Revision X C xv l A\Io?-" 3 -1 f - o6' AypWo -1 Owner /Applicant Name S o3 1 �,w��l�q 1 ris+ Date of Previous Approval -7- 7,1- ob ��vstain Mailing Address. / 0 #, CIT Amount of Fee Enclosed Zip o6Y7o Building Type Ws t dLA% &A Lot Area l -a l k- No. of Bedrooms Z Design Flow GPD 400 "A41S Fill Section Only Depth Volume PCIiD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sevveratne Systean to consist of I, 67D gallon septic tank and Othe Requirements: W svL To be constructed by �v lot AxAex w1,tr -e Address VVa�r Su ®ulv: -- Public Supply From Address oa°: Private Supply _ Drilled. by +-o Vat- - AA)re*Mt` -4 Address Zoa L . F: I repesent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment sy them described above will be constructed as shown on the approved amendment thereto and in accodance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion therof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Depstment, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said bunker will place in good operating condition any part of said sewage treatment system during the period of two (2) years irnrl diately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original sYstm or any repairs thereto. S vd: /0' P.E. X R.A. Date �� o b� %1,5 , 600f i-i , AJ� Scatr AvtJs�lV" p, G. Access` °:�, t e �lattx (Akrk ll , P1Y toS11 Z- License # ?°� SO A-1211ZOVE1D FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sevge treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or mc ,died when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a x3ea efmit. Approved r discharge of domestic sanitary sew e only. �y (///0 Title: Date: 7-9-02 fi copy - HD F' e; Y to opy - Building Inspector; Pink copy - Own ; Or& copy - Design Professional Form CP -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health .._: - ;(7kff- fkMOCINARI; RN-, MSN - Associate Commissioner of Health ADDRESS: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAIVER i� I ;:ni.• 'S cu -o ?.-(r-- ROBERT J. BONDI County Executive ROBERT MORRIS, PE { Director of Environmental Health SITE LOCATION: DATE: %--% STAFF PRESENT: Michael Budzinski P E Gene Reed Joe Paravati & Larry Werper SPECIFIC WAIVER REQUEST: 2 oge DOES THE PROPOSED VARIANCE REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? YES o NO WILL DISAPPROVAL- RESUET 'IN'A- SICCNIFICANTIIARDSHIP? YES NO , U DISCUSSION RE UEST AL R DENIED .4-0 APPROVED '-�C DENIED o REASON FOR DENIAL DIRECTOR am DATE 7 --7"t-)? DATE ! D COMMISSIONER OF HEALTH Environmental Health (845) 278 -6130 Fax (845) 278 -7921 (SPECWAIVER) Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 JUN -26 -2008 07:26AM FROM - ENVIRONMENTAL HEALTH DEPARTNJIENT OF HEALTH I Bureau of Water. Supply. Protection Name of Applicant I L., AddreSS Street Contact Information phone. — ( OC°X FAX: 843278TO21 T -939 P.001 /001 F -T66 arivtaric; wAIVER APPLICATION Request for Approval of Noncompliance witb . ' 1 the Standards of IONYCRR Appendix 75.A z wmll: ""�'iTJ�111101 Site Location f?AVk L t 6 1Fd.� m a �u�?XSav� �caena � zyp I Z S� 3 The followfng informal" fs behrg submitted fn support of cry application for a spec' x waiver from comphaROe NW) one or more standards of IONYCRII Appendix 75`A, "Wastewater 7- matment Standards- Individual A'ouWhvld Systebts': 1_ The wastewater treatment system cannot meet the following standards of 10NYCRR Appendix 75-A: O Separation distances cannot be achieved (7S- A.4(b), Table 2, Separation Requireutents) O Excessive Slope (754 -4(1), Soil and Site Appraisal) ❑ Design is not addressed in Appendix 75-A i] Technology is not addressed in Appendix 75-A Other: 2. The following design is proposed to .tig to n�contpliance with App radix 75-A (brief description)-.-N- Of- iti• �. 3-IAJWWK 1M%Mt MUM -V �ti^@ 3. Supporting information provided: X Detailed Site Plan Detailed Design J11 Soll and Site Evaluation Neighboring conditions of concern (cg., wells, waterbodies, wetlands, etc.). L) Other: Explain: (type or print) acimowledge that this waiver request is necessary because it is not practical for an onsite wastewater treatment.system to meet the referenced standards of 1ONYCRR, Ap ends 75-AAti on -_. -._ Signature Date I, (engineer) 11102, to -_ E. (type or print) acknowledge that tires waiver request i9 necessary because it Is not practical for an onsite wastewater treatment system to meet the referenced standards of 10NYCRR Appendix 75-A on this property_ In my professional opinion, the proposed design described In this application will provide a degree of protection equivakeat to the onsite wastewater treatment standard(s) that wilt no be met for this property and will not create an increased risk to public health or the environment. � Aso Sigtta PE License # 'For Health Department use only * Eased upon the information provided in this application to waive the referenced standards of Appendix 75-A and in J a cordance with IBNYCRR§§ 753 and 75.6 (b), the waiver requested is hereby: Approved as proposed. Approved, with following conditions: D Not acted on, because additional information is required: q Denied. because: Note: This waiver may be revoked should anyeanditions I _ -&A2A (w�4 ktw ealth Department Representative Signature before approving this waiver change after apnrovaL �r _ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL PCCHD Piirmit.;dd: Well Location: Street Address: illage Tax Grid # ��� Jws 4m 22 j e-oho PA-5y5eso),► Map 3 S. Block S Lot(s) Well Owner: Name: ckgi_ AL6bt4c Address: 4L t4 .-( -or /o LO U �C pI 6t� NA Cam' 0& -1 ?0 Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 1-sect mdary Industrial Institutional Standby Amount of Use Yield Sought S gpm # People Served S Est. of Daily Usage vU gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling X New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type X Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes X No Name of subdivision ULD WALL, Lot No. Water Well Contractor: -rD 13a Address: - Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: tj 1 h Town/Village JA Distance to property from nearest water main: pi 1A, Proposed well location & sources of contamination to a provided on separate sheet/plan. Date: -7 Iq Applicant Signature: 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 te approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. / Date of Issue '-X- Date of Expiration __2 _ -- Permit is Non -Trap erra le Permi Title: White copy - HD file; Yellow copy - Building Inspector; Form WP -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health John Watson, PE Insite Engineering & Survey 3 Garrett Place Carmel, NY 10512 Dear Mr. Buschynski: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT 3. BONDI County F_xecutive fROB EIZT M®RRIS, Director of Environmental Health March 1, 2007 RE: Proposed SSTS for Lot # 9 — Old Wall Estates NYS Route 22 & Edwards Road (T) Patterson, TM # 35 -5 -1 Bog Brook Reservoir Basin The Putnam County Department of Health (Department) has determined that the above - referenced application, including fee, and received by this Department on February 28, 2007 is complete. The Department will notify you by March 21, 2007 of its determination. ❑ The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. E 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 stdtertient brat a deoisi�rr 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 approved, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the. project applicant should 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. 2148. VJA Michael J. Director of Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early InterventioniPreschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN y r Associate Commissioner of Health John Watson, PE Insite Engineering & Survey 3 Garrett Place Carmel, NY 10512 Dear Mr. Watson: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health March 21, 2007 Re: Proposed SSTS Renewal for Lot # 9 — Old Wall Estates Sclafani Family Trust (T) Patterson, TM # 35 -5 -1 This Department has received and reviewed the submitted application and plans for the above referenced project and the following comments are offered for your consideration. he- septip--tank detail is to be revised t&show -the access cover - having a- minimum:_- dimension of 20 inches. 2. The exact location, not approximate, of the existing. well on the opposite side of Edwards Road is to be shown. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. Respectfully, Michael J. B zi ki, E. Director of gin MJB:kly cc: S. DeLaOssa, NYCDEP Environmental Health (845) 278 -6130 Fax(845)278-7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 15; 2007 i evv� iya,i� , Department of Environmental. ` 'Protection . Michael Budzinski, P.E Putnam Co. Health Dept. 465 Columbus Avenue _ 4 Geneva Road 10595. 1336., York,. 10595 - 1336..:. Brewster NY 10509 , Re: Old Wall Est. Sub. Lot 9 /Sclafani and /or Albano - RENEWAL Emily Lloyd Edwards Road/Route 22 Commissioner`: Patterson, Putnam Bog Brook Reservoir Fax(18)59 -35 7 Fax (718)- 595 3557 ,. DEP Lo # 2005 -BB- 0057 -SS. 1 g Dear Mr. Budzinski: This letter is to inform you that the New York City Department of Environmental Bureau of water Supply Protection (Department) has determined that the above - referenced application is Paul V. Rush -, P.E.. complete. In addition, the Department has no objection to the approval of the Deputy 666mssioner above- referenced regulated activity. This determination is based on the review of TO (914) 742 -2001 ; submitted documents including the plan titled "SSTS prepared for Sclafani and/or Fax (014 )74 -0348. ` . Albano ", dated 12/23/04 and last revised 2/21/07. -- ..__T.he' ap. Plicaiit ..mw,st.contac.t.Sissy..De La.Ossa of my staff at (91.4)..773,4416-at-..- -- - least 2 days prior to the start of construction of the SSTS so that a Department representative may inspect and monitor the installation. Sincerely, Z. Danny Shedlo, P.E. Civil Engineer II Engineering Review Group xc: NYSDOH Jeffrey J. Contelmo, P.E. Insite Engineering SHERLITA AMLER, MD, MS, FAAP LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI ROBERT MORRIS, PE Director of Environmental Health TO: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM JOINT REVIEWS ,AJI roe PROJECT: � % � 10 LN Uk1 - &S t� TOWN: E SUB'D APP DAT _ .__.. __. ( _77j..? �- -_ _1_ NOTICE OF COMPLETE APPLICATION: DATE: 3'—t ��7 ❑ Within the drainage basins of West Branch, Boyds Corner Reservoirs or Croton Falls. ❑ Within 500 feet of a reservoir, reservoir stem or control lake. Within 200 feet of a watercourse or a DEC wetland and appearing on a subdivision map approved after December 31, 1992. ❑ Design flow greater than 1000 gallons /day. ❑ Commercial SSTS. j treview Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early InterventioniPreschool(845)278 -6014 Fax(845)278 -6648 ENG /NEER /NG, SURVEY /NG & �_... ..:.... ,-4 LETTER OF TRANSMITTAL 3 Garrett Place (845) 225 -9690 Carmel, New York 10512 Fax: (845) 225 -9717 TO: Putnam County Health Department 1 Geneva Road Brewster, NY 10509 Date: 02 -27 -07 Job No. 03212.300 Attn: Michael Budzinski, P.E. Re: SSTS for Sclafani Renewal NYS Rt. 22 & Edwards Road Town of Patterson TM# 35. -5 -1 WE ARE SENDING YOU ® Enclosed ❑ Under separate cover via ❑ Shop Drawings ® Prints ❑ Plans ❑ Copy of Letter ❑ . Change Order ❑ the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION _ Y 5 02- 21 -07� CD -1 Construction Drawing 1 –� -�� � 1 02 -21 -07 02 -21 -07 I CP -97 WP -97 Construction Permit Well Permit 1 06- .12 -06 i 372720846 $500.00 Fee 2 — ` — 3 Bedroom House Plans 1 7 LA-97 ` ett'er of Authorization THESE ARE TRANSMITTED as checked below: ®For approval ❑Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested []Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ REMARKS: Mr. Budzinski, The enclosed items are being submitted as part of an application for a renewal of the SSTS and well permits issued for the referenced property in 2004 (permit # P- 24 -04). Please contact our office if you have any questions or comments. COPY TO: I0072107.doc SIGNED:d� J ioM. Watson, P.E. r Project Engineer, Associate IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE 1. 'TN 1�I COPT DEPARTMENT OF HK : T •" DIVISION OF ENVIRONMENTAL HEAI.'TH SERVICES LET TER' OF AUTHORIZATION RE: Property of 5C1_AFA N z FA WrL.,`< T1C.)S1- *1-0/0 z- C' Ar A-L_ A c--X A-e`'D Located at N _'S 20 yTV_C ZZ P_0_ArAeDS (Z 0 4 P &V AAN_:�_ZSO/� Tax Map # 3S Block S Lot Subdivision of D&D WAS.. CE:5r)1,r155 Subdivision Lot # I Filed Map # (.9 / 3 Date Filed Gentlemen: This letter is to authorize Insite Enemeerina Surveying & Landscape Architecture P.C. (7eiirey J. Contelmo, P_E.) a duly licensed Professional Engineer-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 Putnarn 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 treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Educational Law, the Public Health Law, and the Putnam County Sanitary Code. Very Truly Yours, Countersigned: Signed: P.E. # 6193 e ff (Owner of Property) Mailing Address: Insite Engineering, Surveying & Landscape Architecture, P.C. 3 Garrett Place Carmel State New York Zip 10512 Mailing Address: 5'(v(o ,eo k/p (, f3c�G it 2 /V1f�NvP� -C. State AJ Zip 10 J'zf Telephone: (845) 225 -9690 Telephone: Ls 41 � &2-1- l yoy nrrinh cant Form LA -97 ® ®T r% ENGINEERING SURVEYING & LANDSCAPE fl�CHIT`EC%'Un �: r.,.• _...... . - July 2, 2008 Mr. Michael J. Budzinski P.E. Director of Engineering . Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 RE: SSTS Renewal for Lot#9 - Old Wall Estates Sclafani Family Trust Town of Patterson, New York Tax Map No. 35 -5 -1 Dear Mr. Budzinski: The enclosed materials have been revised according to your June 4, 2007 comment letter. Specific responses are as follows: 1. The plan has been revised to show the recent testing witnessed by your department, which includes one deep test and one percolation test in the SSTS expansion area. 2. A specific waiver application for the two- bedroom design of the subject project was submitted to your department for your review on June 25, 2008. 3. The septic tank detail on the enclosed plan has been revised to specify an access to grade manhole if the top of the tank is more than 12 inches below finished grade. If you have any questions or comments regarding this information, please do not hesitate to contact our office. Very truly yours, - - - Ii3SIi LIE NGINEERINV;'SURVEYING•& LANUSGAPE ARCH ITEC,1'URE, -P.0 __...._. __� ..... ...... .., ____.. By: John-P. Watson, P.E. Vice resident / Sr. Project Manager JMW /zmp Enclosure(s) cc: Carl Albano Insite File No. 03212.300 3 Garrett Place, Carmel, New York 10512 (845) 225 -9690 Fax (845) 225 -9717 070208mb.doc TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. D1 HOLE NO. HOLE N0. G,L. 0.5' 1.0' 1.5' 0-V VAIAJrn, 41141�-j 2.0' brawh loam 2.5' 3.0' 3.5' 3e- gi,+ 4.0' b,"V\ 5w,/\A 4.5' vw wc�c. 5.0'a wa 5s 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' indicate level at which groundwater is encountered N/A indicate level at which mottling is observed N/A hdicate level to which water level rises after being encountered N/A Deep hole observations made by: Zac Pearson dnsitel. Mike Budzinski P.E. (PCDOH) Date 6 -27 -08 Design Professional Name: John M. Watson P.E. Address: Insite Engineering. Surveying, & Landscape Architecture P.C. 3 Garrett Place, Carmel NY, 10512 signature: Design Professional =s Seal of NEW � y�P l+�4 �g�. x No. 77 gy0 FUTNAM COUNTY DEPARTMENT OF HEALTH _ DIVISION. -OF ENVIRONMENTAL -HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Carl Albano Address 566 Route 6 Building #2, Mahopac, NY 10541 Located at (Street) Edwards Road & NYS Route 22 Tax Map 35. Block 5 Lot 1 (indicate nearest cross street) Municipality Town of Patterson Watershed East Branch Resevoir SOIL PERCOLATION TEST DATA Date of Pre - soaking 6 -26 -2oo8 Date of Percolation Test 6_2Z_2oos NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. _< 1 min for 1 -30 min/inch, <_ 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 Pg. 1 of 2 Depth to Water From Ground Water Level Percolation ole Run No Time Elapse Time Surface (Inches) Start Stop Drop In: Inches Rate Mm/Inch NH .' Start Stop P1C 1 "'2� - °j'.3� �Z_ '.jam" 'L4f 2 q0- = 1i z�' T'+ 4 5 1 3 4 5 1 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. _< 1 min for 1 -30 min/inch, <_ 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 Pg. 1 of 2 INSITE ENGINEERING, SURVEYING & L ANDSCAPEARCHITECTURE, P.C. LETTER OF TRANSMITTAL L Garrett Place (845) 225-9690 `0ar`m6l"N6W-Y6rk- 10512',- r-�-:.�!Fax:-(845)-225-9717--- TO: Mr. Michael J. Budzinski P.E. Director of Engineering Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 WE ARE SENDING YOU ❑ Shop Drawings [:1 Copy of Letter Date: 6-25-08 Job No. 03212.300 Attn: Mike Budzinski Re: SSTS Renewal for Lot#9 Old Wall Estates Sclafani Family Trust Route 22 and Edwards Road Patterson, New York ❑ Enclosed ❑ Under separate cover via ❑ Prints ❑ Plans ❑ Change Order ❑ the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION 6-26-08 Specific Waiver Application THESE ARE TRANSMITTED as checked below. ❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑-Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ REMARKS: Mike, attached please find a Specific Waiver Application for the 2-bedroom subsurface sewage treatment design for Lot #9 of Old Wall Estates, Sclafani Family Trust COPY TO: lot062508mb doc SIGNED: Zac arson IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE SHiERLITA AMLER, MD, MS, FAAP Commissioner of Health .. . LORETTA MOLINARI, RN, MSN Associate Commissioner of Health John Watson, PE Insite Engineering & Survey 3 Garrett Place Carmel, NY 10512 Dear Mr. Watson: ROBERT J. BONDI ..........,,, .,...m, t.... CountvExeculive.,._>v..._ DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT MORRIS, PE Director of Environmental Health June 4, 2008 Re: Proposed SSTS Renewal for Lot # 9 – Old Wall Estates Sclafani Family Trust (T) Patterson, TM # 35 -5 -1 This Department has received and reviewed the revised plans for the above referenced project and the following comments are offered for your consideration. _X..—The revised plan does not provide any soil testing in the SS T S' fd "serve area: A minimum of one percolation test and one deep test hole are to be conducted in the reserve area and the tests shall be witnessed by a representative of this Department. specific waiver application is to be submitted for the two- bedroom design. The septic tank detail is to be revised to specify an access to grade manhole if the top of the tank is more than 12 inches below. Upon completion of the above, this Department will continue its review. Kindly advise.us if there are any questions. MJB:kly Respectfully, Michael J. Director of Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 PUTNAM .COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET — SUBSURFACE SEWAGE TREATMENT SYSTEM 0 Owner: A � � Located at (street):. 01 j �I Municipality: 70�— Address: TM # Section• Block Lot Watershed: / t & -cp,- A SOIL PERCOLATION TEST DATA pp� ��/J Witnessed by: Date ofrPre- soaking: UI ' "�l`� Date of Percolation Test: — A ` XIX Hole No. Run No. Time Start — Stop Elapse Time (gin •) a Depth to ��'ater from Found surface (inches) Start Sto K water level drop in inches Percolation Rate min /inch 1 i h 4r 2 • 4 5 1 2 3 4 5 1 2 3 4 5 1. 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., < 1 min for 1 -30 min /inch, < 2 min for 31 -60 min /inch). All data to be submitted for review. 2. Depth measurements to be made from top of hole. 9.0' 9.5' 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises aft r being encountered Deep hole observations made by: Date —2.7 —� Design Professional Name: Address: Signature: Design Professional = Seal TEST PIT DATA DESCRIPTION OF SOILS ENCOUN'ITEREI) IN TESL' HOLES Y# DEPTH HOLE HOLE # HOLE # HOLE # HOLE # G.L. 0.5' -- —. 1.0' _ - 2.5' - - -- - 3.0' Ilp - �- 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' d 4 7.5' 8.0' rY 8.51 _ Q 9.0' 9.5' 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises aft r being encountered Deep hole observations made by: Date —2.7 —� Design Professional Name: Address: Signature: Design Professional = Seal /NS/ TE ENGINEERING, SURVEYING & -_L NDSCAPEAfPCH/TECTURE, P.C. .� .. - -. _�..o,,..s.. --Z -'- .... -.� May 29, 2008 Mr. Michael J. Budzinski P.E. Director of Engineering Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 RE: SSTS Renewal for Lot#9 — Old Wall Estates Sclafani Family Trust Town of Patterson, New York Tax Map No. 35 -5 -1 Dear Mr. Budzinski: --- The enclosed materials have been revised according to your March 21, 2007 comment letter. Specific responses are as follows: 1. The septic tank detail has been revised to show the access cover having a minimum dimension of 20 inches. 2. The exact location of the existing well on the opposite side of Edwards Road is shown on the drawing. The exact location of the well is closer to the subject property than what was shown on the previous plan. The new setback distance from the well has limited the size of the proposed subsurface sewage treatment system (SSTS). The current proposal is for a 2- bedrrom house and SSTS on Lot #9. The enclosed construction drawing and house plans have .been revised to depict the revision to the proposed 2- bedroom house. Additionally a new construction permit is enclosed for the 2- bedroom SSTS design. If you have any questions or comments regarding this information, please do not hesitate to _. contact our office. Very truly yours, INSITE ENGINEERING, SURVEYING & LANDSCAPE ARCHITECTURE, P.C. By: 1p`" John I. Watson, P.E. ce P esident / Sr. Project Manager JMW /zmp Enclosure(s) cc: Carl Albano Insite File No. 03212.300 3 Garrett Place, Carmel, New York 10512 (845) 225 -9690 Fax (845) 225 -9717 052908mb.doc O COUNTY DEPARTMENT OF HEALTH rte. R � CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # t9- Located at W/.5 120uP-1: 22 Dyy Ku4D T6 or Village IOAii"—e-.5 bf^ Subdivision name 0t.d WAU- ESi S Subd. Lot # I Tax Map 35- Block S Lot I Date Subdivision .Approved j UNr /�Z . OP ( Renewal Revision Owner/Applicant'Name 5CI-A r_ F*AXt V j)0--,j;5r Date of Previous Approval / oS Mailing Address _ /U 611.ovee 4ve Ert N6n►fynl C-1- Zip Amount of Fee Enclosed 251J Building Type k 65%J6�1 rPV - Lot Area ?. 81 t'No. of Bedrooms 3 Design Flow GPD 600 Ae- Fill Section Only Depth Volume PCIID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of / vUU gallon septic tank and -3oy Other Requirements: NyNQ To be constructed by Tu 1315: D--.Z Address Water Supply: _ — Public Supply From — Address or: Pnvafe Su 1-- Drilledb Tv 3c ��►� Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewagg 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: P.E. X R.A. Date Address �`'' s.n- �E��vc� ` Aw License # 61,731 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new p it. Approv for discharge of domestic sanitary s wage only. By: Title: i Date: White copy - " e; ello copy - Building Inspector; Pink copy - er; Orange copy - Design Professional Form CP -97 li ,J PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please punt or type ° `" kflb Permit #" ' Well Location: Street Address: illage Tax Grid # `( V-V 22 �pw�s Onl Map 3S Block S' Lot(s) I Well Owner: Name: Address: SaArAt-j� ,.,,, /D 6"WX AVE t1 eA4Tvw,n1 C.-1- 0& q 70 Use of Well: t Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- second- Industrial Institutional Standby Amount of Use Yield Sought �'5" gpm # People Served _� Est. of Daily Usage Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type i Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No )( Is well located in a realty subdivision? ...................................... ............................... Yes X No Name of subdivision 0-,p wAo- Lot No. 9 Water Well Contractor: -iV Address: - — Is Public Water Supply available to site? .................................. ............................... Ye No Name of Public Water Supply: _� N Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: (a 23 Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue -0 (::;:7 Permit ) �uingicial: Date of Expiration = : , -D Title: Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 —. Z.� I X 3 1/341 . First Floor 327 i• 1' FAMILY ROOM 131-O "X I8 =6• o •1 r xtrctttrk &thin* n00er 131 -00 X 10:0' ROOM to X 2T8' S •,"01 QW0 ►•p /k t I 94 'O• 32'0" SeOnd Floor BEDROOM ts' -o-x II• -a• `liiti t ttid� , ! 1. h S T C If E S T E R HOUSE MO NS A] _J_ BE?JI] ALL SUBSEQUEN PL4&t WJW BE I3 JO• x III-a, N1 O D 1: L A R I{ 0 Nt 6� Ty DEPARTM ITT OF HEALT ,D FOR B C�/" ® SIONIAL ATIO THESE TTFP&Q 11)1 P OH FORA RO Optional Master Bath i 21f/ o& ° 3 Spacious Bedrooms • "Cottage We" 3056 Lower Level Front Windows • 2 1/2 Baths ° Fireplace Options Avallable • Master Spite Features Prh%e Bath • "Boxed -Out" and "Anoc-&y" Options Available y " with talk -In CIOSCt o" " �`�°'+�° Andecsect� _ • cowull an Authorized,weslchester Blulder for a TJa1 \'rLa�i \15r,drnat S 9-0mm IffR INi • Formal Dining Room Complete list of Options [ ° Formal II-v1ng Room • .1nijrs rr"etibip WO Aanr r�iw Us cnSons arr vpro>aajie. 30 Reagans Mill Rd. - Wingdale, NCH, York 12594 Ut ,a<.fiC"CO3 MIA t,r aru. , in Cnnwut Va c c.maeer . Eat-In (HQO) 832 -3888 • (914) 832 -9400 • al -ln Country KitcJtcn uw��.�cestchcyter- modtJar.com Departmentb Environmental _ Protection Emily Lloyd Commissioner Tel.'(718)_595 6565: '. Fax'(718) 595 -3557: Bureau of Water Supply 465 Colurripus.Avenue , Valhalla, New York 10595- 1336.. David S. Warne Acting Deputy Commissioner Tel (914):742 2001.:: Fax,(914)74'1 -0348; .• Joseph Maggio P.E..' • Deputy.Director-',- _ pigin .ering.Division EOH , Tel (914).773 4470 Fax' (914) 773,- 0343. Robert Morris, P.E Putnam Co. Health Dept. 4 Geneva Road Brewster, NY 10509 Re: Old Wall Est. Sub. Lot 9 /Sclafani Family Trust Edwards Road/Route 22 Patterson, Putnam Bog Brook Reservoir DEP Log # 2005 -BB -0057 Dear Mr. Morris: This letter is to inform you that the New York City Department of Environmental Protection (Department) has determined that the above - referenced application is complete. In addition, the Department has no objection to the approval of the above - referenced regulated activity. This determination is based on the review of submitted documents including the plan titled "SSTS prepared for Sclafani ", dated 12/23/04 and last revised on 6/20/06. The- applicant must contact Sissy De La Ossa of my staff at (914) 773 -4416 at least 2 days prior to the start of construction of the SSTS so that a Department representative may inspect and monitor the installation. Sincerely, Margaret O'Co f-P.E. Supervisor Engineering iew Group xc: Roger Sokol, NYSDOH Jeffrey J. Contelmo, P.E. Insite Engineering SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health John Watson, PE Insight: Engineering 3 Garrett Place Carmel, NY 10512 Dear Mr. Watson: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 June 28, 2006 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Sclafani SSTS Revision Edwards Road (T) Patterson, TM # 35 -5 -1 Bog Brook Reservoir Basin The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on June 26, 2006 is complete. The Department will notify you by July 17, 2006 of its determination. ❑ The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. o 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 ofce.with .which you filed the application originally, and a statement that a decision is sought _ in accordance with senion 'f8'- 23'(d) (6) of the NYC Department of 5iNironmentafProtection ^- 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 approved, subject to standard terms and conditions 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 storm water 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. 2148. MJB:mcb Respectfully, ba . I R Michael J. Director o Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early InterventioniPreschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 SEA L&o ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health TO: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM JOINT REVIEW Lcsl 0' 0 %I 35 —— / PROJECT. TOWN: Son� SUB'D APP DATE NOTICE OF COMPLETE APPLICATION: DATE: ❑ Within the drainage basins of West Branch, Boyds Corner Reservoirs or Croton Falls. ❑ Within 500 feet of a reservoir, reservoir stem or control lake. Within 200 feet of a watercourse or a DEC wetland and appearing on a subdivision map approved after December 31, 1992. ❑ Design flow greater than 1000 gallons /day. ❑ Commercial SSTS. j treview Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early InterventioniPreschool (845) 278 -6014 Fax (845) 278 -6648 /NS /TE I ENGINEERING, SURVEYING & LANDSCAP.E.AR.CHITEC.TU,4E, P.C.. 3 Garrett Place (845) 225 -9690 Carmel, New York 10512 Fax: (845) 225 -9717 TO: Putnam County Health Department 1 Geneva Road Brewster, NY 10509 LETTER OF TRANSMITTAL Date: 06 -20 -06 Job No. 03212.300 Attn: Michael Budzinski, P.E. Re: SSTS for Sclafani NYS Rt. 22 & Edwards Road Town of Patterson TM# 35. -5 -1 WE ARE SENDING YOU ® Enclosed ❑ Under separate cover via the following items: ❑ Shop Drawings ® Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of Letter ❑ Change Order ❑ COPIES DATE NO. DESCRIPTION 5 i 06 -20 -06 CD -1 Construction Drawing _......._......._._..._..._......_......._..__._....,_....... 1 t_....__...._ ...... ...... ....._... 06 -20 -06 ................_._..................___.... .._..............._...,........ j CP -97 ..._..._...._..........._......_._..........__.................._............__............_..............._...._........................___._......_......._......_.................._......_..........................._..... ............................... Construction Permit _._..... .._ .......... .............„.,_...,_.._....._....... 1 3.........__.._......._..._....._._....,....,..__....... ' 06 -12 -06 .....,................_........ _.........._ 342283914 .........._..........._._.._............. ww,............_...._.._,.._»..._.............._........_,_................_,..._....._.._ . .... ........ ......... ................_ ... . ...... ......._ ... ,_ .... ............ .. ........... ................. $250.00 Fee 2 .................................._.........._..._.............._........__......_......._........................................_..............:......,..._........._. i - - - -- - - - -- 1................................................................................................................._........................._................... 3 Bedroom House Plans ............................... _................................._.................................... ..................._...._...... _..._............... ........ ......_._._....._........._:.._ ................_.............. .........................._.... i _ ....... ..................................._..._........................._..................................._...................................._............._...................................................................................................................._..........................................._...... ............................... ........ .......... . ........ THESE ARE TRANSMITTED as checked below: ®For approval ❑Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑Returned for corrections ❑ For review and comment ❑ REMARKS: ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints COPY TO: SIGNED: Jo n M. Watson, P.E. Project Engineer, Associate IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE r lot2002.dot �` ?1 PUTNAM COUNTY DEPARTMENT OF HEALTH IVISION OF ENVIRONMENTAL- IJEALTH SERVICES - CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM E_ PERMIT # R Located at W5 RQU4- )L,' A dwacda k wd Gwn )orVillage R442rson Subdivision name 01 a Qq �_L 6Subd. Lot # _C Tax Map ,35 Block _ Lot Date Subdivision Approved lltne 12,198 Renewal Revision 'r Owner /Applicant Name Pxmi�4 Tr�� Date of Previous Approval /y /fF Mailing Address (� (�IDVer ye�e N Q o 'own, GT Zip _ Amount of Fee Enclosed -4p0, o v Building Type gQ5j&Cjj:6aQ, Lot Area 2- B1 t&No. of Bedrooms _ Design Flow GPD jQ,2 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1,,00 gallon septic tank and ()0 L. F- 2 wtde Other Requirements: To be constructed by --�p 1�14 R p kp ,r rn , ,.,; rK Address Water Supply: Public Supply From . - p ddress - or: - Pi aie 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 treatmentsystem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. R.A. Date I Z - Z1—O,- License # (0 1 q,31 -3 czarr -c1 Pi-ce, earn+ -e(,V y ) sld- 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 wh onsider necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe t. ppro for discharge of domestic sanitary sew only. By: Title: Date: O f White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional PUI'NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO.CONSTI8UCT.A- WATER. WELL - - - please print or type PCHD Permit # Well Location: Street Address: k1o223JVillage Tax Grid # P, Re( a Map Block S Lot(s) Well Owner: Name: Address: 1 a i t 10 Et l ve e., -1' y 70 Use ®f 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 r gpm # People Served Est. of Daily Usage V. 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 C) rA It call l S+afes Lot No. Water Well Contractor: -To -bF 7pe2Z r.Ma io ,—C� Address: Is Public Water Supply available to site? .................................. ............................... Yes No A_ Name of Public Water Supply: WA Town/Village NIA Distance to property from nearest water main: u & Proposed well location & sources of contamination to be provided on separate sheet/plan. Ddte. _- �.�- ;'�3.; i... Applicant. Signature: �WAI PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate, surface or groundwater. APPROVED. FOR CONSTRUCTION.: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water iller ce ' ied by Putnam County. Date of Issue s Z ° Permit Iss g Off ial: Date of Expiratio �' Title: Permit is Non- Transf r able White copy - HD file; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WP -97 32' 27'8° First Floor e 2 27"8'X 32V34'9 1,848 Sq. Ft. FAMS� Y Room ta' 0/2°X(6' -5t/2' �trc�c�a i Optional Master Bath 27'8" PU _TNAM COUPT`1 Y it i � iTT<_EN:T OF HEALTH PLANS APPROVED O s DI'O011o COUNT. ONLY, BEDRCt G S `TLt i '. ` ,� ,� TO THESE HOiISE NI, 51 Is:. �. _.�.....� , , .. i _ .. _ 1011 APPRQ AI, .... ___... �.I URE & TITLE - ATE STANDARD RICHMOND FEATURES a 3 Spacious Bedrooms ® Fireplace Options Available ® 2 %2 Baths ® Boxed-out". and "Angle -Bay" Options e Master Suite Features Private Bath with Available Walk -in Closet ® Consult an Authorized Westchester Builder © Formal Dining Room for a Com ,fete List of Options a Formal living Room d Ards *.'s renderings and Floor Pion Dimensions are e Eat -in Couniry Kitchen arproxfmate. At ecifications must he Written in ire Contract. No crat conditions. ® "Cottage-St pie" 3056 Lower Level From Windows yt: ESTCHE `�E� DOULA 0MES, INC. . . � P. O. Box 900 e Doer Hain, NY 12522 -: (914) 832 -9400 © (800) 832 -3888 r5' -0 /P°x t0' -0° 6 34• p� o.On . \e. �a091. .Do J � Optional Master Bath 27'8" PU _TNAM COUPT`1 Y it i � iTT<_EN:T OF HEALTH PLANS APPROVED O s DI'O011o COUNT. ONLY, BEDRCt G S `TLt i '. ` ,� ,� TO THESE HOiISE NI, 51 Is:. �. _.�.....� , , .. i _ .. _ 1011 APPRQ AI, .... ___... �.I URE & TITLE - ATE STANDARD RICHMOND FEATURES a 3 Spacious Bedrooms ® Fireplace Options Available ® 2 %2 Baths ® Boxed-out". and "Angle -Bay" Options e Master Suite Features Private Bath with Available Walk -in Closet ® Consult an Authorized Westchester Builder © Formal Dining Room for a Com ,fete List of Options a Formal living Room d Ards *.'s renderings and Floor Pion Dimensions are e Eat -in Couniry Kitchen arproxfmate. At ecifications must he Written in ire Contract. No crat conditions. ® "Cottage-St pie" 3056 Lower Level From Windows yt: ESTCHE `�E� DOULA 0MES, INC. . . � P. O. Box 900 e Doer Hain, NY 12522 -: (914) 832 -9400 © (800) 832 -3888 Department of, Environrnental Protects ®In 465 ColumbusAvenue Valhalla, New York - '10595 -1336 David B. Tweedy- Acting - CQmlnissioner Bureau of Water Supply Michael A. Principe; P6.D. ,Deputy Commissioner Tel (914) 742 -2001. 109 Al 77a WaAa - - January. 203:'2005'_ Robert Morris, P.E Putnam Co. Health Dept. 4 Geneva Road Brewster, NY 10509 Re: Old Wall Est, Sub. Lot 9 /Sclafani Family Trust Edwards Road/Route 22 Patterson, Putnam Bog Brook Reservoir DEP Log # 2005 -BB- 0057 -SS. 1 Dear Mr. Morris: This letter is to inform you that the New York City Department of Environmental Protection (Department) has determined that the above - referenced application is complete. In addition, the Department has no objection to the approval of the above - referenced regulated activity. This determination is based on the review of submitted documents including the plan titled "SSTS prepared for Sclafani ", AntPA �. /NS/ TE — - - E/V!� /NEAR /NG, SURVEYING LANDSCAPEARCHITECTURE, P.C. February 7, 2005 Mr. Robert Morris, P.E. Senior Public Health Engineer Putnam County Health Department Division of Environmental Health Services 1 Geneva Road Brewster, New York 10509 RE: SSTS Sclafani Town of Patterson Dear Mr. Morris: Enclosed please find the following comments to your January 28, 2005 letter regarding the above referenced property. 1. The well location has been revised to provide a minimum separation distance of 15 feet from the property line. 2. Note # 3 has been revised to include the house and well to be survey staked by a Licensed Land Surveyor prior to construction. Note #25 has been provided stating that if the house location is changed, the PCHD will receive revised plans with the new house location. 3. The roof and footing drain discharge location has been revised to discharge below the proposed SSTS. 4. The existing and proposed SSTS's and wells within 200 feet of the proposed well and SSTS are provided on the plan. Should you have any questions or comments regarding this information, please feel free to contact our office. Very truly yours, - INSITE ENGINEERING, SURVEYING & LANDSCAPE ARCHITECTURE, P.C. BY 4ro ect Engineer, Associate JMW /mdm Enclosures Insite File No. 03212.100 3 Garrett Place, Carmel, New York 10512 (845) 225 -9690 Fax (845) 225 -9717 www.insite-eng.com 020705rm.doc SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORET.TA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Insite Engineering & Survey 3 Garrett Place Carmel, NY 10512 Dear Sir. or Madam: January 28, 2005 - ROBERT J. BONDI County Executive Re: Proposed SSTS: Scalfani NYS Route 22 & Edwards Road (T) Patterson, TM # 35 -5 -1 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. Minimum distance from the well to the property line is 15 feet. 2. The following notes are to be added to the plan. a) The house, well and SSTS are to be staked by a licensed surveyor prior to construction. b) The house is to be located as shown on this plan. If the house location is changed, revised plans are to be submitted to the PCDOH. 3. The rood/faotifig-drain-is to-discharge -below •the•SSTS:= 4. All existing and proposed SSTS and wells within 200 feet are to be shown on the plan. 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. RM:ky Ve ly yours, Robert Morris, P.E. Senior Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET;F?R CONSTRUCTION PERMIT- NAME OF OWNER: STREET LOCATION: REVIEWED BY: RM, OR, AS, SRDATE: Y DOCUMENTS PERMIT APPLICATION WELL PERMIT OR PWS LETTER ( )(/)PC -97 OF AUTHORIZATION DATA SHEET (DDS) ZATE RESOLUTION ORT EAF ANS -THREE SETS iUSE PLANS - TWO SETS RIANCE REQUEST SUBDIVISION GAL SUBDIVISION BDIVISION APPROVAL CHECKED RC RATE (� FILL REQUIRED DEPTH �) URTAIN DRAIN REQUIRED GENERAL LOCATED IN NYC WATERSHED (� PLANS SUBMITTED TO DEP DELEGATED TO PCHD DEP APPROVAL, IF REQ'D DEEP TEST HOLES OBSERVED L�.)PERCS TO BE WITNESSED EX- APPROVAL SSDS ADT, LOTS 17�WETLANDS (TOWN/DEC PERMIT REQ'D ?) DATA ON DDS PLANS & PERMIT SAME PRE 1969 NEIGHBOR NOTIFICATION LETTER BUZBA U(_)100 YR. -FLOOD ELEVATION-W/1200!, L��)SOIL TESTING LOTS >10 YEARS OLD 'AGE SYSTEM PLAN - (NORTH ARROW) i HYDRAULIC PROFILE NITY FLOW (_) CONSTRUCTION NOTES 1 -15 ESIGN DATA: PERC & DEEP RESULTS (_) T CONTOURS EXISTING & PROPOSED U DRIVEWAY & SLOPES, CUT L FOOTING/GUTTER/CURTAIN DRAINS _ USDA SOIL TYPE BOUNDARIES (_)TITLE BLOCK; OWNERSNAME ADDRESS TM #, PE/RA; NAME, ADDRESS, PHONE# U�DATE OF DRAWING/REVISION . (( LQDATUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. (�(�PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS WELLS & SSDS'S W/IN 200' OF SSTS PROPERTY METES & BOUNDS 4 (EROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE COMMENTS: (REV91EET)09 /01 /00 TAX MAP #: (CONFIRMED) . Y �N` (REQUIRED DETAILS ON PLANS CONT'D) �(� HOUSE SEWER -' /" FT. 4 "0'; TYPE PIPE CAST IRON NO BENDS; MAX BENDS 451 W /CLEANOUT � ; RENEWALS CJ6SITE NOTE (NO CHANGE) FILL SYSTEMS 'HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE F L SPECS/ FILL NOTES 1 -5 (_) F LL PROFILE & DIMENSIONS ILL IN EXPANSION AREA FILL GREATER THAN FEET (� LAY BARRIER (_) ILL CERTIFICATION NOTE (� DEPTH GAUGES L� L. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS (__) SEPARATION DISTANCE FROM TOE OF SLOPE TRENCH IF TRENCH PROVIDED 60FT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED DETAIUDUST FREE CRUSHED STONE OR WASHED GRAVEL GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS 'TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL (_) 20! TO FOUNDATION WALLS 00' TO WELL, 200' IN DLOD, 150' TO PITS (_) 100' TO STREAM, WATERCOURSE, LAKE (inc. espan) C--) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10'70 WATER LINE (pits. 20') - 50' INTERMITTENT DRAINAGE COURSE 200'/500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS 10' MIN TO LEDGE OUTCROP SEPTIC TANK (� 0' FROM FOUNDATION; 50' TO WELL WELL DIMENSIONS TO PROPERTY LINES (_))LOCATION OF SERVICE CONNECTION (_ -(MIN 15' TO PROPERTY LINE SLOPE LOPE N SSTS AREA (S20 %) (�( )REGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS I MP NOTES OSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED ETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) T AND D -BOX SHOWN & DETAILED DAY STORAGE ABOVE ALARM CURTAIN DRAIN STANDPIPES, T BOTH SIDES, DETAIL �,O'MIN 15' MIN to CDS = >5 %, 20'4 %, 25' -3 %, 35' -1 %' 100 % - <1% 0MIN to CD DISCHARGE /100' with 182 cons dy discharge (_) to NON - PERFORATED PIPE Ns ®rE _ENGINEERING, SURVEYING & !t?NDSCAf'EA�iCH /TECTURE PC.,, 3 Garrett Place (845) 225 -9690 Carmel, New York 10512 Fax: (845) 225 -9717 TO: Putnam County Health Department 1 Geneva Road Brewster, NY 10509 WE ARE SENDING YOU ❑ Shop Drawings ❑ Copy of Letter LETTER ®F TRANSMITTAL Date: 12 -23 -04 Job No. 03212.300 Attn: Robert Morris, P.E. Re: SSTS for Sclafani NYS Rt. 22 & Edwards Road Town of Patterson TM# 35. -5 -1 ® Enclosed ❑ Under separate cover via ® Prints ❑ Plans ❑ Change Order ❑ the following items: ❑ Samples ❑ Specifications COPIES DATE i N� O. DESCRIPTION4- 5 12 -23-04 ; CD -1 Construction Drawing 1�2 - -2- 3---04 -� �CP -97 � �Construction Permit 1 j 1' 2 -23 -04 WP -97 Application to Construct a Water Well LALA 97 _ ;Letter of Authorization 1 PC -97 j Application for Approval of Pla 12 -9 -04 �_. i—Sh EAF 1 ~j 0 10- �� DD -97 ort Design Data Sheet 12 -9 -04 -� 100073622 i $400.00 Fee 2 ! -- i 3 Bedroom Modular House Plans THESE ARE TRANSMITTED as checked below: ®For approval ❑Approved as submitted ❑ Resubmit ❑ For your use ❑ Approved as noted ❑ Submit ❑ As requested ❑Returned for corrections ❑ Return ❑ For review and comment ❑ REMARKS: COPY TO: Iot2002.dot copies for approval copies for distribution corrected prints SIGNED: -' -� Ohn M. Watson, P.E. IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE �Q �• �t PUTNA.M COUNTY DEPARTMENT OF HEALTH DP aSI "N OF ENVIRONMENTAL HEALTH. SERVICES 4.. DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Fami (u TrotS-f- Address )o Avenue IUtwf0wo, LT Located at (Street) IV, J5. R7 da It s toad. Tax Map 35 Block 5 Lot ) (indicate nearest cross street) Municipality 41444 -ars6n Drainage Basin 5oC-, -a n6x SOIL PERCOLATION TEST DATA Date of Pre - soaking J jq /o y Date of Percolation Test l oh,31 ot4 Hole No. Run No. Time Start - Stop Ela se Time min.) De th to Water rom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 1 10 zo - l: 3-1 3 tO 2 ,3 - to 6`1 I 1 a 3 ro 33 3 o: sb - tl: 1-1 3 b 3 4 5 2 - a0 21 3 3 o:s - 11''l 190 iR 1� 4 5 1 2 3 4 NOTES: 1:, Tests to be repeated at''same depth until approximately equal percolation rates are ootainea at each percolation test hole. (i`.e. s 1 min for 1 -30 min /inch, s 2 min for 31 -60 min/inch) All data to be submitted• for review. 2. Depth measurements to. be made from top of hole. Form DD -97 DEPTH 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 5' 9.5' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST MOLES - HOLE NO. HOLE NO. ' 19 HOLE NO. Indicate level at which groundwater is encountered A/DNE Indicate level at which mottling is observed AtI rv6 Indicate level to which water level rises after being encountered NaltlCr Deep hole observations made by: (= �t1,v_ �p� � 5i �`` ice, rssy ate Design Professional-Name: Jeffrey J. Contelmo, P. E. Insite Engineering, Surveying & �F N Address: Landscape Architecture, P.C. 3 Garrett Place, Carmel, New York 10512 Signature: Design Professional's Seal NM 14� PROJECT ID NUMBER 617.20 SEAR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW __........ _ _ _ SHORT ENVIRONMENTAL ASSESSMENT FORM, for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1. APPLICANT/ SPORS'OR 2. PROJECT NAME Sclafani Family Trust SSTS For Sclafani 3.PROJECT LOCATION: Town of Patterson Putnam Municipality County 4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide map N.Y.S. Route 22 and Edwards Road. See location map. 5. IS PROPOSED ACTION: New ❑ Expansion ❑ Modification / alteration 6. DESCRIBE PROJECT BRIEFLY: A proposed Single Family Residence. Construction of a single family residence, driveway, SSTS, well and appurtenances. 7. AMOUNT OF LAND AFFECTED: Initially 2.81± acres Ultimately Z.&It acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ❑✓ Yes ❑ No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ❑/ Residential ❑ Industrial ❑ Commercial ❑Agriculture ❑ Park / Forest / Open Space ❑ Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) Yes ❑No If ves, list agencv name and permit / approval: Patterson Highway Dept. - Driveway Permit; NYCDEPZ SS'PS Town of Patterson Building Dept. - Building Permits; Putnam County Health Department: SvrS I wez-- 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes ❑V No If yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ❑Yes ❑✓ No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE John Watson, P.E. q ,App ieaW --t Sponsor Name Insiitte_Enngineering, Surveying and Landscape Architecture, P.C. Date: Signature If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT (To be completed by Lead Aaencyl A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL ;EAF. Yes C] No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another involved agency. ❑ Yes [:] No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: L_ C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: F-- C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: i i 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. Longterm, i short term, cumulative, or other effects not Identified in C1 -05? Explain briefly: I C7. Other impacts including changes in use of either quantity or type of energy? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CEA ? If es, explain briefl -, iJo" E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If es ex lain: Yes F� No PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes, the determination of significance must evaluate the potential impact ofthe proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the F 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 ai WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting determination. Name of Lead Agency Date Print or Type ame o Responsible Officer m Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer PUTNAM COUNTY DEPARTMENT OF HEALTH _ r _ .. : , I�LVISI.ON.OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: Ja.-�n i 1 �i Tc��`t' 1O Glover yMLASF, �i F.u�W n , � Ti'Il��l Z O 2. Name of Project: S5� 2 SCIAF'A -M� 3. Location: TV: ��n,� .=n s � fr p-�,tncenie ,.si+rrc:��n,,, 4. Design Professional: �"P C� - ���r}�tmo P, 5. Address: ,an e� .re, v�. 6. Draina a Basin: 3Czu.n^.e f+- Piet ce. g ��2ncjk Ca-rn► -rat, N V losi� 7. Type of Project: X 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) ? .............. Yes/No `IES Type Status (check one) ...................................... ............................... Type I Exempt Type H Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required ? .................... Yes/No N 0 10. Has DEIS been completed and found acceptable by Lead Agency ? ............. Yes/No 6\10 11. Name of Lead Agency `P�'4nC,„� (ay �n — f.���� h °i�orvAmte,'�' 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ::..:....:.......,......... ............................,.. .... Yes/No .. - _..._ -- -- __--- _ - 13. If so, have plans been submitted to such authorities? .. ............................... Yes/No A10 14. Has preliminary approval been granted by such authorities? WA Date granted: &/A 15. Type of sewage treatment system discharge ........................ surface water �� groundwater 16. If surface water discharge, what is the stream class designation? .......................... &1A- 17. Waters index number (surface) ............................................. ............................... "VlA 18. Is project located near a public water supply system? . ............................... Yes/No /VO 19. If yes, name of water supply MA- Distance to water supply N 20. Is project site near a public sewage collection or treatment system? .......... Yes/No n! 0 21. Name of sewage system Nipr Distance to sewage system iv /A' 22. Date test holes observed �c��15 �� 23. Name of Health Inspector 6:Cne dZad 24. Project design flow (gallons per day) ............................. ............................... 4100 d � (�. 25. Is State Pollutant Discharge Elimination system ( SPDES) Permit required? ... Yes/No /JO 26. Has SPDES Application been submitted to local DEC office? ......................... Yes/No tyht Rev. 1 l /02 Form PC -97 Pg. 1 of 2 27. Is any portion of this project located within a designated Town or State wetland ?... Yes/No NO 28. Wetlands ID number ....................................................:.............. ............................... g lA 29. Is Wetlands Permit required? ............................ ............................... JJ .......... Yes/No . 0 Has application been made to Town or Local DEC ........................... Yes/No IyIA 30. Does project require a DEC Stream Disturbance Permit? ..... .........................Yes/No N� 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 ISO 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ................................... ............................... Yes/No of (1 DESCRIBE: 33. Is there a local master plan on file with the Town or Village? .........................Yes/No Ui�14VOwc� 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? .................................. .........................Yes/No if�i4 35. Are any sewage treatment areas in excess of 15% slope? .............................. Yes/No t46 36. Tax Map ID Number .............. ............................... Map � Block _ r Lot 37. Approved plans are to be returned to ................ Applicant _ Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. 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 is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES. Iec/urc,P �. Mailing Address: !'armeA1, NY 10S, Form PC -97 DEC -9 -2004 08:47 FROM:INSITE ENGINEERING 8452259717 TO:62e7421 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISIONi Off' ENVIRO- NNE -TTAI HEALT SERVIC Es Z ]LETTER OF AUTHORIZATION RE: Property of .3a - ark.; 1r;xM J4 T -i, t Located at _ N I $ xb"g— as A Gck 0-r4s :„end, 9 2. JAVM ON Tax Map # _ � Block Lot j Subdivision of n1r%, kl C�QS Subdivision Lot # filed Map ## _ 1 9S (3 Date Filed, p 12 961 Gentlemen: P:2 2`,' 'M.is letter is to authorize jnsite Enl incerine. Survevinz & Laoc�cca e Architecture. P.C. (Jcffrcv J. Contelmo P.E.) a duly licensed Professional Engineer to apply for the required wastewater treatment and/or water supply pezmit(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 witb this matter and to supervise the construction of said. wastewater treatment and/or water -Li-r i.1 °itCM— i.^ C ^nfnr- .ity with the provisions of Article 1.45 and/or 147 of the Educational Law, the Public Health Law, and the Putnam County Sanitary Code. Very Truly. Yours, Countersigned: Signed: P.Z. # 6193 Mailing Address: Insite Engineering, Survcyinp, & Landscape Architecture, P.C. 3 Garrett Place Carmel State New York Telcphonc: (Owner of Properly) Mailing Address:? Zip 10512 State (845) 225 -9690 Telephone: Zip &LI -Iopo pcdoh.dot Form LA -97 DEC -9 -2004 08:47 FROM:INSITE ENGINEERING 2452259717 TO :6227421 P:2/2 Pi TNAM COUNTY DEPAR7[MENT Off' HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of ,A�ah_� n Mj(u n13I,t. Located at N IS x pl .4 'Cigk3u rLds I,,"aA 9V � p oR Tax Map # BIock Lot Subdivision of Subdivision Lot # Piled Map # J A_ Date Filed Line- 12, IMI Gentlemen: This letter is to authorize Insite Enrinccnp -ty Surveying & Lain,d-rca e c ' ectu e C. (Jcffrcy J. Contelmo, P_E.1 a duly licensed Professional Engineer 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.Direci:or 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 treatment and/or water suppl, systems ?^ Conformity with the provisions of Article 145 and/or 147 of the Educational Law, the Public Health Law, and the Putnam County Sanitary Code, Very Truly Yours, Countersigned: Signed: P.E. # 6193 Mailing Address: I~n,site Engineering, Survc) n,8 & Landscape Architecture, P.C. 3 Garrett Place Carmcl �1 (Owner of Properly) , Mailing Address: zj) — oC State New York Zip 10512 State Zip Telcph.oac: (845) 225 -9690 Telephone: 000 pcdoh.dot Fozm LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH a DIVISION OF ENVIRONMENTAL HEALTH SERVICES �® 7- 9, DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address�/s Located at (Street) Tax Map 3 Block Lot (indicate nearest cross street) Municipality Watershed &a ®�c SOIL PERCOLATION TEST DATA Date of Pre - soaking Zig Date of Percolation Test a 1,4 1 /0;20 -/0;37 17 / - 2- 2- 2 /9 - 3 6, 3 3 4 5 2 10; 3 6 , T . 3 1d. s - ; / - �-1 -3 6,7 4 5 1 2. 3 4 5 1. Tests to be repeated at same depth until approximately rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 TEST PIT DATA 2 1. DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEl?TH = MOLE NO.:. HOLE X10., - - Li4L�10 G.L. 1.0' _ 1.5' �P 2.0' !S 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' INA 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 / i 4' Design Professional Name: Address: Signature: Design Profess onal's Seal 4 PUTNAM COUNTY DEPARTMENT OF HEALTH N DIVISION OF ENVIRONMENTAL HEALTH SERVICES. INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project Z,�, � O(V) P,,+}17-ocre 50,61 County jJrr�' Site Location yS ,� 22— Building construction begun 1!.10 Extent Is property within NYC Watershed ? ................. E47yes No a SECTIONS. TOPOGRAPHY (Please check all appropriate boxes) 1. 1`y 0 Rolling 0 Steep slope Gentle .slope Flat 2. Evidence of wetlands Low area subject to flooding a Bodies of water Drainage ditches 0 Rock outcrops 3. Property lines or corners evident ....................... ............................ :.. es No s a 4. Do water courses exist . on or adjoin the property? .................. .......... Y No 5. Will these affect the design of the sewage system facilities ?. /.a ... S, 3 Y § No 6. 'Do watershed regulations apply in this development ?................... Yes N 7 Will extensive grading be necessary? .................. ............................ .... Yes 8. Will extensive -fill be necessary for SSfiS ?:::. Yes 9. Do filled areas exist within the SSTS area? ........ ............................... 0 Yes No If yes, what is the condition of the fill? SECTION C. SOIL OBSERV.KTIONS 10. Appearance of soil: Sand a Gravel Loam lay -E] Hardpan E:] Mixture 11. Observed from: a Borings a Bank cut Backhoe excavations 12. Soil borings /excavations observed by �� �; -, }� _ . on 13. Depth to groundwater A OA_) on 14. Depth to mottling AJ©�?r on 15. Are test holes representative of primary & reserve areas ...... ................:............... 16. Soil percolation tests made by ..YJ'I TE on 17. Soil percolation tests witnessed by on a SECTION D (on back) R Form ST -1 f, 2 y SECTION.D. ' DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? a Yes 19. Will groundwater or surface drainage require special consideration? ...................... ..... 1.7. Yes 5 N 20. Will gullies, ditches, etc., be filled'and watercourses be relocated ? ......................... Yes No SECTION E. REMARKS. 21. If a common water supply is proposed; has an inspection been made of the existing or proposed source and facilities ? .............:. :......... ' F7 Yes No Inspection data 22. Do adjacent wells and /or sewage systems exist ?..... ' ....� !qr ...................... Yes .No 23. Additional comments 24. Site observer /inspector and title s Tr- CA R 25. Dates) of observation(s)inspection(s) to TEST PIT PROFILES Hole # Lot # Hole # 'Lot # Hole # Lot # Depth to water _ Depth to water Depth to water Depth to mottling Depth to mottling Depth to.mottling Depth to rock/imp. Depth to rocklimp. Depth to.rockJimp. G.L. G.L. G.L. s 0.5 .0.5 0.5 1.0 1.0 1.0 2.0 2.0 2.0 3.0 3.0 3.0 4.0 4.0 4.0 5.0 5.0 'S.0 6.0 6.0 6.0- 7.0 7.0 . 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 i� BRUCE R. FOLEY 'ublic Health Director •^ ° - DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARL.RN., M.S.N. Associate PuMc � Edith' "Director Director of Patient Services REQUEST FOR FIELD TESTING- ATTENTION: o ADAM STIEBELING GENE REED All information below must be fully completed prior to any scheduling. DATE: IZ10 ENGINEER ORFIRM:.Znst ff rzy ' PHONE N: BgS'-<�Ps 962© dsca J+M,114 f Urf^ P.c. REASON: G %P� r'Vt�cheile �nr�oci DEEPS: J$( PERCS: PUMP TEST: ❑ ROAD /STREET: TOWN- ►r��,n TAX MAPS: SUBDIVISION: Dld LA &dJ 651file S LOT#: OWNER: 1Cc C"Ccn i pct l NYCDEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING YES V9 ❑ Proposed SSTS within the drainage basin of West Branch or Boyds Corner Reservoirs. . . . = ❑' - X- - . `.. Pro osed,SSTS-within 500 feet of a resei-voir,-reservoir stem or`controlTaki.-" - - -'._ ❑ Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. ❑ Proposed SSTS for a Commerical Project. It is the 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 yes to any of the questions, NYCDEP must witness the soil testing. This Department will coordinate a mutually suitable tire. for field testing with •the PCDOPI, the Design Professional and NYCDEP. If a project has been determined to 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. FOR COUNTY USE O\'LY DATE: 40 0® TINME: COIINIENTS: Ot+e 6mC1� (✓ @Y'G�j C �'i°�%S (FMLDTEST) 1 P/0 24 2 I B P%0 7- 24 2.19 25 24 2 17 L° Y s A 6.92 AC. 1510.24 \ 212.0! 35.07 7 219.90_ G' 4`� 7.10 o At 26 23.57 AC. 37 ' 1 0 8,25 AC. CAL. \ i ?\ 14, 00 AC • % \�N �a 39 I j a o CAL. I r*, Js9.i6 g 40 �\ '4o g i 1 so 14.561 1 73 a 12 t Ile . j 06 Ioa 3B AC. I 1 g 5.96 AC. 72• ec' °1.0eAG t 293s5A / 28 22.88 AC. CAL. I i 71x S11 . IO,, 1 125 ` . \ 10.13 AC. CAL. Ie1.4z I 1 "� 15p`s G 8 1.66 AC. °9 dF 36 %h S, Woks \ JL 6 31 ° AC. 43 • �/ ° 3.17 ; 17.02 AC. CAL. h A�.?`° +�*m 166y2 �' O % \ 96 N CAL \ c� N 2.77 �o ° 8 32 ° 1.93 AC. P �� � • \ h• D , 5 2.22 AC. CA tT 45 % 33 \� 1.66 ACM ° 26 14 ' a 46.2 �'i °r `�JB 3' p6 AC. /.• e 4 292.16 °, p1.59 AC e n 25AC.� we,� r C N 46.1 e ' 03 s �n /.. 1.74 AC. Qv 313 AC. u 2 ° ; X34 1° � .• EXEMPT i . 68 ° >Y 1.50 A a..1° ` EDUCATIONAL 42 �� X11.59 \ 1 ��b ALLIANCE INC. 1 95.58 AC. CAL. z4>be "o 2.74 AC. CAL. 35 4 1 > 44 - 67 2.Q ' CAL: 1.76 c� °aa 645'-_ _ _ .... _...__._ ..�.... .. ` =�- 90 ac: .�...__...._ �____.._ . . 67.1 m 4a 25299 Q �• aac. a . fi5 `q O 7.22 AC. 255 48 , a 49 a y 52 Q ct / 64 G -1.30 c- 27.40 AC. Ie4s.00 I. 14.00 AC. CAL. m / 91 `rra� °- 43965 456.T1 1 1 AL r . 1006 SI '� \ `� �•'1 5.00 C. 52563 \•• -••�., w 550.25 0 �! .f., 31.54 AC. CAL. 49sT4 54 c 62 3 g4.00 AC.� 22.79 AC. CAL. g 136.44 394.7e N \ J9A79 56 ' e15<s e 61 94L� 21.12 AC. CAL. 1 ` ! 3.67 AC. ` 55 I'\ 5B A x4.2z60 0 ° 14.91 AG. GAL. 8.92 AC. CAL. �,�, 3.6B AC. ¢ \ is IIS.o9� 4g1.sa 59 x I.e2 A0. CAL E AS1 r ... Mound°`¢ - G _ ._ „_... - , J '00 , y�_ .1.2663. i_ 1 T. I Pond G Q t! v $ m gar P Putnai lake tf QJOLL C4 s Corners H �L _ 1 HS town • o po •ES u D Lake / � Mount Ebo Corporate .....rte..,, ° 2 F801d 'N tat utheast , A! M O BRUCE R. FOLEY ° "Public -Health -Director--` DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public- Health Director ^ ' Director of Patient Services Environmental Health (845) 278 -.6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558. WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Date: /D Z V/ a!5� To: -511, a- Lcz 20 La'. Fax #: % 7.3 —0 3; V3 No. Pages (Including cover sheet) From: Gene D. Reed Putnam County Department of Health - : For your information - Please respond For your review As discussed Notes/Messages .e /D:©q 0 Attached as requested Please call In the event of transmission /reception difficulties, please contact this officelt (845) 278 -6130 ext. 2261. IE SENDING CONFIRMATION DATE : OCT-6-2004 WED 10:12 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845-278-7921 PHONE 919147730343 PAGES 4/4 START TIME OCT-06 10:10 ELAPSED TIME 0114111 MODE ECM RESULTS OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... BRUCE PL FOIXY LIDREM MOUNAEU &N., KS.N. Publk HmIlh Dfmnm A,..-(.,, AM-. HldlA Dimao. / Po W s..,w1. DEPARTMENT or, IM-ALTH I cloneva Road -Browsw, Now York 10501.) RMranmubl Nulty IN6) 779.6110 Fn (0141 /7/ 7421 M..W.g WIC(945)779-667" Fn(MS)219 -6091 r-ty fatmeetl6a (116)271.6014 PlIa9.4 01[ ? ?7.44002 Fm(Nf127s.6949 Date:., /0 e No. Pages (lueludingcovm4heet) Vnim.Gtan D. Reed Putnam County Department of 11 ea It h For your haformation _"Ieamr respond For your review' Alfached ms requested As discumed please rail NotesMessagas p:._ VyX �z / s-- iii V4 IL 0– 1� C5 Ja the event of transmission/reception difficultles. please contact this offirellt (845) 279-6130 exL 2261. 9'45'50" 127.67' / a5 Iron Rod Set N 00 49'30" Iron Rod Set N 17 26'50" W -9-5.48-' Spike Set Odd N 35*12'00" W aEANOL 61.69' 4*0 PVC St 35 PIPE 1.000 V4. SLCP77C TANK JJNC770N 4* SDR 0 PVC--, 35 BOX (TYP.) pip, 4 7 EXPANSION ABSO77ON 7RENCH RP AWL-T2 / /. �� WL- T Town Wetlands Flags Lot 9 T3 (02-27-06) V&- WL-1 Areo WL-2 2.8183 Acres WL-3 .4 D D''e4fe'' W -T5 O 'M� IL 0 WL-7 WL- WL-8 \WL-T7,-- WL-6 NY; '1 ifc 25-00) 4.8, 288 60' :!!�ulvert TC7!T, r-_ Grovel I ABSORP77ON TRENCH , WL--L8 WL-T9 WL-9 ilL a (/)I 0 N N3 of ME WL-T1 WL-10 NYSDEC *VL4ND BR-9 IL Stream End culvert over I' 1074'40-1—W7,—, A S -BUIL T MEA SUREMEN TS PUTNAM COUNTY D`-- PA0T 'krF:"T pF HEALTH DIVISION OF ENVIRONMEN.: l N SERV APPROVED AS NOTED Fn .;'; "L�RTANCE! APPLICABLE RULE At'ID i� i LA110�JS OF PU NAM COUNT EALTHI DEPARTN+ENT. A B C N0. CORNER OF CORNER OF CORNER OF REMARKS HOUSE HOUSE HOUSE 1 17• 22' 1,000 GALLON SEPTC TANK 2 36' 26' JUNCTON BOX 3 42' 32' JUNC77ON BOX 4 49' 39' JUNCnON Box 5 56' 47' JUNCnON BOX 6 64' , 55' JUNCnON BOX 7 71 62' JUNCnON BOX 8 32' 21' END OF . TRENCH 9 3J' . 28' END OF TRENCH 10 35' 35' END OF TRENCH 11 _ ,jT 42' E04D .OF TRENCH 12 41' 49' END OF TRENCH 13 45' 56' END OF TRENCH 14 9' 21' CLEANOUT PUTNAM COUNTY D`-- PA0T 'krF:"T pF HEALTH DIVISION OF ENVIRONMEN.: l N SERV APPROVED AS NOTED Fn .;'; "L�RTANCE! APPLICABLE RULE At'ID i� i LA110�JS OF PU NAM COUNT EALTHI DEPARTN+ENT.