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HomeMy WebLinkAbout1874DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36. -3 -14 BOX 17 01874 641 LED; PUTNAM COUNTY DEPARTMENT OF EALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICE93 CERTIFICATE OF CONSTRUCTION }COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at 30 S !4 tL 1 " LAkjz:' Town op*ifte- PA c,�J Owner /Applicant Name -iqj j tU,u Tax Map 3 & Block 3 Lot 14 Formerly P4 ti, J5 Subdivision Name ✓/s /r►Zi Subd. Lot # .T Mailing Address 5757 &J , i,�vp- j j 5 -r 12,e4p— ryW W 5TWL IJ +Y Zip I of,(") Date Construction Permit Issued by PCHD Separate Sewerage System built by _4Ars11U 4 6,Srw t Pak J Address 153 &7VS r- I W141'r 6 srz- Nay Consisting of 15& Gallon Septic Tank and 56 (, L F cX Z,' Li 1 r; a A Tm"4 Other Requirements: t zee �,& - 17u" r C%1, ">3 E'1z j b 1 s TM ftVn4 u r5i ra Water Supply: Public Supply From. Address or: Private Supply Drilled by' 6yP AVTR51M U./jztiL Co Address 10 Sii tW 52 G1sVwL -'L 4, >'° Building Type fir'5 i of wnA1-- Has erosion control been completed? "OE-57- Number of Bedrooms Has garbage grinder been installed? N 0 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 regulati u ep !of Health. Date: _ Certified by P.E. R.A. (Desi n Professional) Address 4 0to R-� r� C3 j' pws rbn— ,iJ t v ; License # 0 6_7 W6 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 Public Health Director, such revocation, modification or change is necessary. 0 B it opy - HD File; Yellow copy - Buildin Inspector; Pink copy - Owner; Date: 3 r!L Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH V DIVISION OF ENVIRONMENTAL HEALTH SERVICES NeIIPerr��y . .. WELL COMPLETION REPORT Well Location Street Address: 44 /Lj/ti/{� Town/Village: Tax Map # Map Block Lot(s) aGPS„ Well Owner: Name: Address: f r Zl� ` � Use of Well: 1- Primary 2- Secondary Residential _Public Supply Air con /heat pump _Irr' ation Business Farm Test/monitoring —Other(specify) ' Industrial Institutional Standby Drilling Equipment Rotary _Cable percussion gCompressed air percussion _Other(specify) Well Type Screened _Open end casing Open-hole-in bedrock::.- Other . Casing Details Total Length q6 ft. Length below grade�ft. Diameter AC* in. Weight per foot /I lb/ft Materials: U.Steel Plastic Other Joints: Welded Threaded Other Seal: Cement grout Bentonite Other Drive shoe: _V Yes _ No Liner: Yes)! No Screen Details Diameter (in) Slot Size Length ft Dept to Screen ft Developed? First _Yes No Hours Second Well Yield Test _Bailed _Pumped _ Compressed Air Hours Yield gpm Depth Date Measure from land su ace - static (specify ft) During yieli test (ft) ;;;�17of completed we in ft. Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter in Formation Description ft. ft. Land Surface -' If yield was tested at different depths during drilling list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type C 3y'W107 Depth' odel Voltage ' HP_� Tank Typ VOlume l, ::l / Date WeII Cpmplt fetl Well Driller PC Gertlflcate # ' Nr as a e ep K yr ,y n '!'S".""ai 3y31.'�•P R'i .: a P °umpInstalle t y 7 We I Dr'fler Name 8r dress ,�;✓% , z* Well r er t nat L FVA•x xx. Ins Ile Na ress �'' R Pump s r( A ''" _ MOTE: -Exact Locat' n of w '-t ces to, at least two permanent landmarks to b ovi on a s a�atVsheet/pIV. -L White copy: HD File; Yellow co - Building Inspector; Pink copy - O err; Orange co y - Well driller Form WC -97 Rev. 3/06 il PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 3d4-1 jj Owner or Purchaser of Building Tax Map Block Lot Building Constructed by Town/Village Location — Street Subdivis on Name ,0n! ,6j Z7AA Building Type 3 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 it 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 repair made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Commissioner of Health of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month _�_ Day 20 Year 47 Signature: (Septic System Installer) Title: _ nL, At& General Owner) — Signature PCHD License # j 06 ion Name (if corporation) Corporation Name (if corporation) Address: Address: !�3 �j ra,)'5�ate: Zip (? � State: N Q,w `q v e V� Zip \ -J �2 Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map Block Lot (Li '�,iJA a f a/( zl� Building Constructed by Town/Village 4I�M Location ion — Street Subdivision Name Building Type 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 it 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 repair made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Commissioner of Health of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. ,�J r7 Date ' Year 2/,o Signature: /1% ( /`�', (Septic System Installer) Title: ow U � ene�ral, .on wner) — Signature PCHD License # i Corporation Name (if corporation) Corporation Name (if corporation) Address: 503"7 Aj, ?,rte iA-- Address: �_ State: Zip 4a) C State: Zip l i Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Building Constructed by Location — Street Building Type 3 6o S /+ Tax Map Block Lot Town/Village Subdivision Name 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 it 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 repair made by me. to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Commissioner of Health of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month Day Year ontractor (Owner) — Signature Corporation Name (i corporation) Address: State: /V /-zip d 410 Signature: 4/0" (Septic System Installer) Title: ow ner� PCHD License # 16 (o � cz ea' (\c. Corporation Name (if corporation) Address: s--j ejmA f-me ,A- State: 'N2w Yor%, Zip �as31 Fnrm GS -97 BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK ELECTRICAL INSPECTION SERVICES, INC 150 White Plains Road, Suite 104, Tarrytown, NY 10591 914 - 347 -4390 CERTIFIES THAT Certificate No. 145351. Job Location 30 Shailin Ln, Brewster, NY, 10509 Unit/ Apt. Number Upon the application by: Princeton Electric LLC 12 Princeton Rd Carmel, NY 10512 Inspection Date: 05/09/2016 Permit Number 1069 -1509 Parcel Number 36 -3 -14 Certificate Date 5/9/2016 Upon the premises owned W. Martin Parenti 30 Shailin Ln Brewster, NY 10509 Building Department: Southeast Type of Occupancy: 1 or 2 family A visual inspection of the electrical system at this premise described above, wherein the premises electrical system consisting of electrical devices and wiring, described herein. All inspections are in accordance with the NYS and NFPA 70 -08 and the details of the installation, as set forth below, was found to be in compliance therewith on the date of the inspection. Certificate Notes Items and devices Location Room Device Item Count Attic Attic Fixture 01- Incandescent 6 Attic Attic Receptacle Convenience 2 Attic Attic Switch Switch 3 Basement Basement Fixture 01- Incandescent 14 Basement Basement Switch. Switch 5 Basement Basement Receptacle GFCI 1 Basement Basement Pumps Well Pump (Assoc. Wiring) 1 Basement Storage Area Fixture 01- Incandescent 3 Basement Storage Area Switch Switch 2 Outside Outside Septic Alarm & Pump 1 Outside Outside Receptacle GFCI 1 Outside Outside Receptacle Special 20 Amp 1 Outside Outside Service 201 - 400 amp 1 ,`� i,'��' INSP �P\GP......... RAT `W: V� 9•LA 2004 v. Mo- -a.b•ifn- '�''.,,�NE�y'iOP�,�.�`� Officer: Domenic Morabito This certificate may not be altered in any way and is valid for work performed before date of inspection only. YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovani, Director ** TEST REPORT ** LAB #: 1.602047 CLIENT #: 65273 NON STAT PROC PAGE: 1 of 1 PAARENTI, MARY DATE /TIME TAKEN: 07/28/16 05:OOP 39 FARM LAKE CT DATE /TIME RECD: 07/29/16 10:30A CARMEL, NY 10512 REPORT DATE: 08/04/16 PHONE: (845)- 629 -2906 SAMPLING SITE: 30 SHAILIN.LANE, BREWSTER NY SAMPLE TYPE..: POTABLE PRESERVATIVES: HNO3 C -0L'D BY: MARY PARENTI TEMP RECEIVED: 8C ON ICE TTOTES...: COLIFORM METH: N/A START DATE /TIME END DATE /TIME FLAG PROCEDURE RESULT NORMAL - RANGE METHOD = 08/01/16 IRON (Fe) <0.06 MG /L 0 -0.3 mg /1 SM 18 -20 3111B a1 COMMENTS: 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) " NMS = NORMAL METAL SAMPLE. (INTERPRETATION: WATER SAMPLED AFTER RUNNING FOR 10 -15 MINUTES MINIMUM) NG!i THE ABOVE TEST P RES AND RELATE ON TZITHESE SUBMITTED BY: Albert H. Padova /it. . Director ALL REQUIREMENTS OF NELAC, f RECEIVED BY THE LAB CP ELAP# 10323 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovani, Director ** TEST REPORT ** ,.'3 #: 1.601910 CLIENT #: 65273 NON STAT PROC PAGE: 1 of 2 ,�. >.(-- ---- --- -- ---------------------------------------------------------------------------------- 07,,.2ENTI, MARY DATE /TIME TAKEN: 07/14/16 04:OOP '!3 FARM LAKE CT DATE /TIME REC'D: 07/14/16 04:39P .'"EL, NY 10512 REPORT DATE: 08/02/16 k, PHONE: (845) - 629 -2906 r `r ,MPLING SITE: 30 SHAILIN LANE, BREWSTER NY SAMPLE TYPE..: POTABLE : SPICKET PRESERVATIVES: HNO3 COLD BY: MARY PARENTI TEMP RECEIVED: 6C ON ICE DOTES...: COLIFORM METH: MF .',TART DATE /TIME END DATE /TIME FLAG PROCEDURE RESULT NORMAL - RANGE METHOD e: �•r i PUTNAM CNTY PROFILE 07/14/16 0430 07/20/16 0400 MF T. COLIFOR PRESENT /100 ML ABSENT SM 18 -20 9222B �" 07/18/16 LEAD (IMS) <1.0 ppb 0 -15 ppb SM 18 -19 3113B 07/15/16 0330 07/15/16 0400 NITRATE NITRO 0.26 MG /L 0 - 10 HACH 10206 07/15/16 0300 07/15/16 0330 NITRITE NITRO <0.01 MG /L 1.0 MG /L SM18- 20450ONO2 07/18/16 IRON (Fe) 0.38 MG /L 0 -0.3 mg /l SM 18 -20 3111B 07/19/16 MANGANESE (Mn <0.01 MG /L 0 -0.3 mg /l SM 18 -20 3111B 07/20/16 SODIUM (Na) 2.61 MG /L N/A SM 18 -20 3111B 07/19/16 0320 07/19/16 0323 * pH 7.6 UNITS 6.5 -8.5 SM18 -20 4500HB 07/19/16 HARDNESS,TOTA 118 MG /L N/A SM 18 -20 2340C 07/15/16 ALKALINITY (A 80 MG /L N/A SM 18 -20 2320B 1000 07/15/16 1005 TURBIDITY (TU <1 NTU 0 -5 NTU SM 18 (2130B) ;f.07/15/16 T107/18/16 0400 07/19/16 0400 E. COLI (CONF ABSENT 100 /ML ABSENT COMMENTS: 7 -,? Total ifDe his result indicates that the water (was) (was no f a satisfactory sanitary quality according to the Ne and EPA federal drinking water standard for r• 'this parameter. This comment applies to the Total Coliform test only. Pb /Cu LEAD limits for public schools are set at 15 ppb. r' EPA Lead & Copper Rule for Public Systems requires that no more than 1OW of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg /L, else water sr treatment must be undertaken to reduce the waters corrosive potential. :_VMn 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) NMS = NORMAL METAL SAMPLE. (INTERPRETATION: WATER SAMPLED AFTER RUNNING FOR 10 -15 MINUTES MINIMUM) YML ENVIRONMENTAL SERVICES 321•Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director TEST REPORT ?,,A.B #; 1.601910 CLIENT #: 65273 NON STAT PROC PAGE: 2 of 2 ---------------------------------------- ------------------------------------------------------ �ENTI, MARY DATE/TIME TAKEN: 07/14/16.04:OOP FARM LAKE CT DATE/TIME REC'D: 07/14/16 04:39P ,.;,,RMEL, NY 10512 REPORT DATE: 08/02/16 .7 PHONE: (845)-629-2906 SAMPLING SITE: 30 SHAILIN LANE, BREWSTER NY SAMPLE TYPE..: POTABLE SPICKET PRESERVATIVES: HNO3 )LID BY: MARY PARENTI TEMP RECEIVED: 6C ON ICE - TES ... COLIFORM METH: MF ----------------------------------------------------------------------------------------------- -` *;'ART DATE/TIME END DATE/TIME FLAG PROCEDURE RESULT NORMAL RANGE METHOD No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should 4 j 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 C11- 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. pH IS A FIELD MEASUREMENT AND IS TESTED OUTSIDE THE HOLDING TIME. pH REPORTED FOR REFERENCE ONLY. 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) (ALKALINITY REPORTED AT pH 4-.5) IMS = IMMEDIATE METAL SAMPLE. (INTERPRETATION: WATER A MIND THE ABOVE TEST M, AND RELATE ONL.WT SUBMITTED BY: Albe-rt U- Direc or 6 S SITTING UNDISTURBED OR OVERNIGHT) M.-T.(ASCP L REQUIREMENTS OF NELAC, RECEIVED BY THE LAB ELAP# 10323 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director NIP TEST REPORT --?AB #: 1.602046 CLIENT #: 65273 NON STAT PROC PAGE: 1 of 1 ------------------- -------------------------------------- ------------------------------------- PARENTI, MARY DATE/TIME TAKEN: 07/28/16 05:OOP 39 FARM LAKE CT DATE/TIME RECD: 07/29/16 10:30A CARMEL, NY 10512 REPORT DATE: 08/02/16 PHONE: (845)-629-2906 -, t,,-4PLING SITE: 30 SHAILIN LANE, BREWSTER NY SAMPLE TYPE..: POTABLE KITCHEN TAP PRESERVATIVES: NONE 'D BY: MARY PARENTI TEMP RECEIVED: 8C ON ICE "")TES ... ----------------------------------------------------------COLIFORM ---------METH: ------MF ----------------- 'TART DATE/TIME END DATE/TIME FLAG PROCEDURE RESULT NORMAL RANGE METHOD 07/29/16 0430 07/30/16 0330 MF T. COLIFOR ABSENT /100 ML ABSENT SM 18-20 9222B C NlIFT Total iform = This result indicates that the water (was), s not) of a satisfactory sanitary quality according to the New ork State and EPA federal drinking water standard for aram eter. This comment applies to the Total Coliform test only. t . I THE ABOVE TEST URES T ALL REQUIREMENTS OF NELAC, AND RELATE 0 TO T ESE LES RECEIVED BY THE LAB ,:.:'JBMITTED BY: Albert OV6��11 M.T.(ASCP) Di' ELAP# 10323 i` s 5 icQe K2 , 7s IA 3 , 7 7 vi OLJ A,5 4 � w s +4' s � RECORD MANAGEMENT . PUTNAM COUNTY RECORDS CENTER And MICROGRAPHICS BUREAU RECORD RETRIEVAL REQUEST FROM DEPARTMENT OF HEALTH TO: Records Management FROM:r, 1, Fv ✓ DATE: 6 I RECORD REQUESTED (circle one) LOCATION# 1 V\% yy d Commercial' Realty Subdivision Addition/Repair Asbuilt Other Name of Original Owner (if available) 2 Street: h G ` , , � Town: << Tax Map# Year built: Other Identifying Information: Special Instructions: Received by: Person Receiving File RECORDS MANAGEMENT USE ONLY Processed by: Returned to Records Management: Filed: lm 12/14 h Bate: Date: Date:— Date: L�f 3 ^1 R JOB STATUS REPORT E TIME : 07/26/2016 15:57 NAME : FAX# : 8452786026 TEL# : SER.# : 000009110223 DATE DIME 07/26 15:56 FAX N0. /NAME RECORDS DURATION 00:00:38 PAGE(S) 01 RESULT OK MODE STANDARD RECORD MAMA GEM[EN 'T Pi< TNAM COUNTY RECORDS CENTER And NUCROGRAI'IUCS BTl'R.EAU RECORD RETRIEVAL REQUEST FROM DEPARTMENT OF HEALTH T®: Records Management 1 RECORD REQUESTED (circle one) JA'D'E: LOCAT1ON# VVl \6-1A Commercial' Realty Subdivisions Addition/Repair Asbuilt Other 2 Name of Original Owner (if available) r Street: yh c, , , .n�. ,�.�. Town. Tax Map# �j _ . ..-- Fear built: Other ldenatiffying Information. i Special Instructions: Received by: I Date: — Person Receiving File - -_ -- -r4w f%%TT V -v -' ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E., MPH Director of Environmental Health October 29, 2015 Putnam Engineering Paul Lynch, P.E. 3 Garrett Place Carmel, NY 10512 Dear Mr. Lynch: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 MARYELLEN ODELL County Fxecutive Re: Field Inspection — Putnam County National Bank 30 Shailin Lane (T) Patterson, , TM 36. -3 -14 An inspection at the above referenced property has been completed. The following comments are offered: • The SSTS was not installed per the approved plan. Revised plans need to be submitted for approval. • A bedroom count needs to be performed by this Department upon completion of construction. • A pump test needs to be witnessed by this Department once the electrical inspection has been completed and verification of such has been submitted to this Department. If you have any further questions, please contact me at (845) 808 -1390 ext. 43261. Sincerely, oe x-->t Gene D. Reed Principal Engineering Aide GDR: cml L, ),j (_AJJF �o,O-Q,s 1-40or c F4 Cowl— -0 .. k WF Li Ij ------------- 14 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION_ OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Street Location 3 © v kg; I , „ I_gLo e Town 'k70- er:!,B✓I TM# -3 6. - v - /yt 1. Sewage System Area a. STS area.located as per approved plans .......................:.. b. Fill section - date of placement 3 1. barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped...... ....:...... .....:................:........ d. Stone, brush, etc., greater than 15' from STS area.......... e..100' from water course / wetlands ........................... II. Sewa.ae System a. Septic-tank size - 1,000 ... rho her g��e... b. Septic:tank installed level .... ....... _.. ......... c. 10' minimum from foundation ......... ............................... d. Distribution Boa 1.. Alt outlets at same elevation -water tested.... ............. 2. Protected below frost .............. :........ ......................... 3. •.1Vfinimum 2 ft. Original soil between box & trenches e. Junction Box properly set .......... ............................... 6. JUrenches 1. Length required Length installed . 2. Distance to watercourse measured Y/ oo Ft.......... 3. Installed according to plan ........: ............................... 4. Slope of trench acceptable 1/16 -1/32" /foot ............. 5. 1:0 ft. from property he - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................'. 7. Room allowed for expansion, 10.0 % ......................... 8: Size of gravel 3/4 -1lk" .diameter. clean ...................: 9. Depth of gravel in trench 12" minimum ................... 10. Pipe -ends .. capppped ........................................................ g. Pump or-Dosed Systems L Size of pump chamber........ //* A". X.. ;F $ ........:....:... 2. Ov llow tank.... .................... ............................... 3. Alarm, visual/ audio .......:........... ............................... 4. Pump easily accessible, manhole to grade .......:......... 5. First box bated .................... ............................... 6. Cy witnessed by H.D.estimated flow /cycle........... III. HouseBufldids . a. House located er approved plans ................................... b Number of bezooms ..... ............. ............................. IV. WeII Well located .as per approved plans . ......:........................ b. Distance from STS area measured 4 ft........... C. Casing. 18" above grade ................ ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanshin . a.. Boxes properly grouted ................:.. b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. BackE material contains stones <4" diameter ............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto exist watercours g. Footing drains discharge away from STS area ............... h. Surface water protection adequate.... ........................ i. Erosion control provided ................. ...... :........ :.......:......, Rev. 12/02 ' Date: Inspected by: Owner �..��z.h�T �a- �.•,..g,� _ �. Permit # _ 7 Subdivision Lot # Michael Budzinski From: Paul Lynch <plynch @putnameng.com> Sent: Thursday, November 05, 2015 3:06 PM To: Michael Budzinski Subject: FW: Attached Image Attachments: 2277_0001.pdf. Mike, Attached is the sketch. Based on the perc rate 469 feet of fields are required for a 5 bedroom. Combining the first two rows into one. for calculating purposes I end up with 6 rows. 469 divided by 6 is a little over 78 feet and the shortest single length of field is 79 which should be alright if I'm thinking about this properly. Paul From: Putnam Engineering [rnailto:info @putnameng.com] Sent: Thursday, November 05, 2015 3:14 PM To: Paul L. <plvnch @putnamene.com> Subject: Attached Image 10/28/2015 16:39 FAX 845 279 6769 Putnam Engineering fJ0001 /0001 y , PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION i GCTI�Tz f ,. 'emu G� Tips "l� REQUEST FOR FINAL INSPECTION For: Fill All information must be full .com leted prior to an Trenches Y P P Y Inspections being made. PCHD Construction or Repair permit # C),7 0 Located-,-3o Jj r=- M045 Owner /Applicant Narne:'-Ti�-'; '. U4 -X�-P-sTrwr s , - TM 3 Block 3 Lot I `+ Formerly: i' c . N . c3 ,.,..�..1 -T,►u ("��nz� acs Subdivision Name: -Mi Pi-Z- 'S' S v¢rr1 V151 1-J Subdivision Lot # =3 Is system fill completed? qtr 5 Date: Is system complete? �K3 0 Date: Is system constructed as per plans? flo Is well drilled? Date: Is well Iocated as per plans? '11Lr. Are erosion control measures in place? 1`r 10-� S I certify that the system(s), as listed, at the above premises has been constructed.and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. Date: 7 Certified by:V PE RA Design Professional Address: 4 c:.,Laa 4ZZOUa Co F,,7 -4, .4S-Tzz. lu .Y.. Lic. # ` cp1 L4 Comments: -rgr rt-fr rm T ML V5 1w T14,rr- €�c' �,s� as tvr.► rum isLv u�[r'eru► -+� gm —"Seq swcra,., p2� nrr�z.��NC;s . ' r"'1lr-- Gw�jte42 1,aAsry�I 1"I crcww'::) Form FIR -99 R viSc� pL�LiS� , A U TTLLr t- cz4b -ru�� , ;c,c� c._, r -. C.11 r1r�az_s L.. -��r- t kStaM uzrr -' jG4t f o vws TAI Zc>o 4r►c -/ MP- PC -_ f ZA TZ7s +-.A5 µ+Xo lv�r7Ft -r�r 4�wvs Pu�u� t r.i LrT l t� v X N �7zOS l3► �j� i.'.[i eta, MICHAEL NESHEINVAT, M.D Interim Commissioner of Health ROBERT MORRIS, P.E., MPH Director of Environmental Health August 16, 2016 Putnam Engineering Paul Lynch, P.E. 4 Old Route 6 Brewster, NY 10509 Dear Mr. Lynch: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 MARYELLEN ODELL County Executive Re: Construction Compliance — Shailin Development Corp. 30 Shailin Lane (T) Patterson, T.M. 36 -3 -14 This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your review and consideration. a A completed well completion report is to be submitted. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 43157 if any questions arise. Sincerely, J eph S. Paravati, Jr., P.E. istant Public Health Engineer JSP:cml PUTNAM COUNTY DEPARTMENT OF HEALTH - Z " DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # (� — 6-7 — 0(o Located at So S i4AI Ll O L_A JF.'_ Town a'g'e' 17X)PLF_ .1 Subdivision name SeS p t "s t csg Subd. Lot # Tax Map 3(a Block --S Lot �- Date Subdivision Approved _ ' Cat Z �z�, f Renewal %C. Revision �S �w Owner /Applicant Name. ► b iL10 DeVlU�t� C of Date of Previous Approval - 3 Mailing Address S 5 fj W. INA.&t u T7'.. Zip I O C09 Amount of Fee Enclosed S U-0 , o o Building Type C4,f_-S1 t- ?7,di._ Lot Area 3 &Vo. of Bedrooms 5 Design Flow GPD % o Fill Section Only Depth Volume Separate Sewerage System to consist of �s gallon septic tank and Zt Wi019,� A 9 gf-na1-j Other Requirements: sz yr U- ►44 To be constructed byCAr3Tajtgvu e5�ywart.19L-W- .� /,"Address 5 3 6�4,ST r:!Aa ST Water Sup&: Public Supply From n Address or: _�;K Private Supply Drilled by Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the sgparate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: P.E. (Y, R.A. Date Address t-(- fzm G i�d z %��l /o,�'45 License # &C- -1V6 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 pe it. Approved for d arge of domestic sanitary sewage only. By`. Date: W ite JPy - HD File; Yellow copy - Buildin nspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 MICHAEL NESHEIWAT, M.D Interim Commissioner of Health ROBERT MORRIS, P.E., MPH Director of Environmental Health August 12, 2016 Putnam Engineering Paul Lynch, P.E. 4 Old Route 6 Brewster, NY 10509 Dear Mr. Lynch: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax 4 (845) 278 -7921 Re: MARYELLEN ODELL County Executive Complete Application Determination for Shailin Development Corp. 30 Shailin Lane (T) Patterson, TM36 -3 -14 East Branch Reservoir Basin The Putnam County Department of Health (Department.) has determined that the above referenced application, including fee, and revisions received by this Department on August 8, 2016 is complete. The Department will notify you by September 2, 2016 of its determination. 0 The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. 0 Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section .18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed 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. 43157. R ectfully, Y..seph S. Paravati Jr., P.E. tant Public Health Engineer JSP:cml Michael J. Nesheiwat, M.D. Interim Corn. missioner of Health' Robert Morris, P.E., MPH Director of Environmental Health q Department of Health 1 Geneva Road, Brewster, New York 10509 (845) 808 -1390 MazyEllen Odell County Executive TO: NYCDEP DEPARTMENT OF ENGINEERING AND DESIGN REVIEW ATTN:�v�c� FROM:, / v DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM DELEGATED New Application ❑ . Renewal ❑ 7y, L'u' PROJECT: V f� i LOCATION: )o TOWN: DATE SUB'D APPROVAL, -1 TM # NOTICE OF COMPLETE APPLICATION'DATE: DELEGATED PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION .OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of_ %bra 59,4-i'l,' Located at TN Subdivision of Tax Map # Block Lot Subdivision'Lot # Filed Map # Z ft r Date Filed Gentlemen: This letter is to authorize�;�1.ii>Ji�'fu� a duly licensed Professional Engineer ' or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance 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 behalfin connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or'147 of the Education Law, the Public Health Law, and the Putnam Cou ode. ry truly your Countersigned: Sign P.E., R.A., # d G7 44f wnero roperty) Mailing Address 1+ !f V er & State Zip %U© Telephone: ;F./ y f- - Z � `- - V1 Mailing Address: State_ AN Zip /�� Telephone; 41. Form LA= * PUTNAM COUNTY DEPARTMENT OF HEALTH. DIVISION OF ENVIRONMENTALEALTg SERVICES AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application M '4j represent that I am an officer or employee of the corporation and am authorized_ to act for: Name of Corporation:,,' /„ Having offices at: E X President - Name:. 1� kZ7,_7 4) rAr, Address: Vice President - Name: Address: Secretary -Name: Address: Treasurer - Name: Address: and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Title: S orn to before me this Yday of., ( nth (yea.) Notary corporate Seal. Form CA -97 DENINE M TIMLIN NOTARY PUBLIC -STATE Of NEW YORK No. 01 TIV 28827 Qualified In. WestChester County My Commission Expifee June 20. 20 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYST PERMIT # D 0 Located at � S*A it_ i � LA-,4 E Town or Village PAT -r F—F-S n � 'n2 -tpLe 3 Subdivision name J?2 ,Pr=rL r S Subd. Lot # 3 Tax Map Block 3 Lot l Date Subdivision Approved Renewal '<i' Revision Owner /Applicant Name Puy jt, -r-i C u4rY tJar%-,orjA- &,A r- Date of Previous Approval -7 Mailing Address P 0, E�px- 10, (::�AjZ-rnEl— /.l Y Zip /o S/ 2 Amount of Fee Enclosed SUO. 00 Building Type ryes i t-> E,.,c.,�-- Lot Area 10,37A.--No. of Bedrooms 14 Design Flow GPD 000 Fill Section Only Depth Volume PCHD NOTIFICATION L IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of /2So gallon septic tank and 600 L. F or Other Requirements: Vi r if, P, T- D i S-t -;z-, 6v 7 i o,..► f' o,c 2 " r5[.LcE MA-,J To be constructed by To f3� i��'�F_�� -► Address Water. Supply: Public Supply From Address or: _ C Private Supply Drilled by-re, be, Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the 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: P.E. R.A. Date �% 6 Address 4 OL P A� l� License # O(�"1-4I4<0 69--6L -j s T la? - /j .Y /0 50 9 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 Director /Commissioner. Any revision or alteration of the approved plan requires a new pe it. Approved foor/rjjdischarge of domestic sanitary sewage only. By: �./rL�es e��•.�,.�. p,s.1�5' Title: 4-e b< Date: % Whi py - HD File; Yellow copy - Buil ing Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHDPerm Well Location Street Address: Town/Village: Tax Map # SO St+P►uN► LAJF- j�p.T'c E�Sor1 Map3(0 Block 3 Lots) 14 Well Owner: Name: Address: Ph on 649 # _ nlo:f'lo � 1 rs� P. o. i3ox ►D�CA(zl ��- ,r-t`( to S/2 v5 -31o6a Use of Well: _ C< 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 6.O gpm # People Served Est. of Daily usage SC gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drilling < New Supply (new dwelling) Deepen Existing Well Detailed Reason WpTap- SuPPL.�I 06-J 4 5Cc -moor+ Pu6Lu1JC0 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 No Name of subdivision Itz- tF►...c J PRoP r-ES Lot No. 3 Water Well Contractor: To 156 DeTE9-t, i4 ;Q Address: Is Public Water Supply available on site? ....................................... ............................... Yes_ No >< _ Name of Public Water Supply: 1Aps Town/Village Distance to property from nearest water main: I r\ i L.G Proposed well location & sources of contamination to be provide e Dater <<i % 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 Departmei ia, k W 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 approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue l Date of Expiratio Permit is Non- Transf rabl White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Rev. 3/06 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: ' Property of 1_� C,0 y &--)T—t 1\./lA�T70I -AL (FAQ k. Located at 3o 50,A L-i r-t L.-,&, � E- TN Tax Map # ,?>(a Subdivision of T�2-►PU_r- J Block 3 Lot 64 Subdivision Lot # 3 Filed Map # 2a85 Date Filed 6Z2 Zd 5 Gentlemen: This letter is to authorize PuTrjArj F_r'j6'l►J6eFL1rS6 a duly licensed Professional Engineer _< or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance 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 superyis_e -the construction of said wastewater tretnient and/or water supply systems in conformityar�e p �''% ibns of Article 145 and/or 147 of the Education Law, the Public Health Law, andm. vutm1gr e. 9 Very truly yours, 9.Countersi 1 � Signed: R.A., # (Owner of Property) Mailing Address 4 ©Lp Cl-ou'i(E 6 Mailing Address: Z' ° 45 Y— '-0 1 State (_j Zip ICS09 State Zip C) Telephone: Telephone: Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: I, pr,4 as- .R represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: .g,- e� Having offices at: �-f*� �•-, d L4 Whose Officers Are: President - Name: �b Atk Address: -� o Vice President - Name: _- Address: Secretary -Name: Address: Treasurer - Name: Address: and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. S rn re me this �� � day of (year) N.ot -.P:ub _.:..:_.._.. _.. ..� .... - CYJ-M OLLOY ii Notary ulaic, State of NewYo ?; No. 4969766 Qualified in Putnam County. Commi.9sion Expires February 26, 20 Form CA -97 Signed: Title: Corporate Seal PUTNAM ENGINEERING, PLLC 4 Old Route 6 Brewster, New York 10509 Phone: 845- 279 -6789 Fax: 845 - 279 -6769 e -mail: putnameng.com TO: l�trt �o s � I�ia�z a -r� Jrc. RC-1 LETTER OF TRANSMITTAL Date: Co I t z. f 1-3 RE: Pexe- P/E Job: 777z„3 We are sending Y ou ached under separate cover, the following items via U. S. Mail, Originals Prints Colored Prints Copies Date Overnight, Hand Delivery, Pick Up: Reports Plans Photographic Exhibit Specifications Other. • N• Description These are transmitted: For approval _ Approved as submitted _ For your use _ Approved as noted _ As'requested _ Returned for corrections For review /comment _ Resubmit copies for approval Submit _ copies for distribution fM &IFiT.W%,13 s�/ '41a Copies to: SIGNED. TOWN SIGNATURE ALLEN DEALS,1VLDy J.D. Commissioner ofHeahh ROBERT MORRL% P.E. Director of Environmeotd Health May 24, 2013 Putnam Engineering Richard Zapp 4 Old Route 6 Brewster, NY 10509 Dear Mr. Zapp: DEPARTMENT ' HEALTH 1 Geneva Road, Brewsta, New York 10509 Telephone: (845) 808 -1390, Fax: (845) 278 -7921` MARYF.i EN ODLLL County Exemdve Re: Proposed SSTS (Renewal) — Putnam County National Bank 30 Shailin Drive (T) Patterson, TM 36 -3 -14 This office has received and reviewed the most recent set of plans for the above - mentioned project. We would like to offer the following comments for your review and consideration. 1. The size of the pump chamber is to be labeled in the plan view. 2. There appear to be elevation errors in the profile, specifically with the pump location and inverts. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. Very truly yours, (Joseph S. Paravati, Jr., P.E. Assistant Public Health Engineer JSP:cw ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT. MORRIS, P.E. Director of Environmental Health April 22, 2013 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Telephone: (845) 808 -1390; Fax: (845) 278 -7921 Putnam Engineering Richard Zapp 4 Old Route 6 Brewster, NY 10509 Re: Complete Application Determination for Putnam County National Bank 30 Shailin Lane (T) Patterson, TM 36 -3 -14 East Branch Reservoir Basin Dear Mr. Zapp: MARYELLEN OD19LL County Executive The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and revisions received by this Department on April 18, 2013 is complete.. The Department will notify you by May 13, 2013 of its . determination. 0 The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ❑ Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed 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. spectfull oseph S. Paravati Jr., P.E. Assistant Public Health Engineer JSP:cw ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRM, P.L. Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 MARYELLEN ODEL,L County Executive TO: NYCDEP DEPARTMENT OF ENGINEERING AND DESIGN REVIEW ATTN: L)1"wl" �( FROM: DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM DELEGATED New Application 0 Renewal PROJECT: JU 1�w� ��w� i i11, ;; v, l y ok LOCATION: TOWN: DATE SUB'D APPROVAL TM # 3 `� NOTICE OF COMPLETE APPLICATION DATE: DELEGATED UTNAM NGINEERING, PLLC Englneers and Architects SEPTIC SUBMISSION FORM TO: MlC4A6(- &jj>Z.ijJSK( DATE:_ 113 PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: RuTiJAM C..outjrY t, lWrtpt, �L, 1zmr: -A-yj joµ,! P6T'Rlt -+.o� j tPt-� i -LoT" , 65 QATTER-Soj 5lbN LW LA4p- Tr� 34 - ENCLOSED, PLEASE FIND: S COPIES OF THE SSDS PLAN ❑ _ _ COPIES OF THE HOUSE PLANS CONSTRUCTION PERMIT APPLICATION WELL PERMIT APPLICATION HEALTH DEPARTMENT FEE ($500.00) ❑ SHORT EAF ❑ DESIGN DATA FORM LETTER OF AUTHORIZATION Go(jPoF�►TE i�Fi IUAJ� T- ❑ APPLICATION FOR WASTEWATER TREATMENT (PC -97) ❑ LETTER OF EXPLANATION REMARKS: COPIES TO: SIGNED: (SepSubFmm -2001) 4 OLD ROUTE 6, BREWSTER, NEW YORK 10509 • (845).279-6789 • FAX (845) 279 -6769 • EM,vL: info @putnameng.com PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SER S CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT #�' �- fj `7 -0 tP Located at 3 0 5�4 A 1 L t 1.l LA Nrz__ Subdivision name 1"144pe- ja2vP—r,R.-r-i azs Subd. Lot # Date Subdivision Approved c I `005. Owner /Applicant Name U" LW Mailing Address 34o LL i ✓A I.D. -� 2i� Amount of Fee Enclosed P �5o0 • 0-0 Town or-*rliW�o� Tax Map Block 3 Lot .Renewal _ ` Revision Date of Previous Approval 4P I'i ti t> %TIC- +2 -SC,i i 0%'( Zip % Z5(3 Building Type Si p � 'Lot Area 10,37m No. of Bedrooms Design Flow GPD_,6�,v _4 Fill Section Only Depth Volume Separate Sewerage System to consist of I "ZS t� gallon septic tank and 5 00 4-,r Or Other Requirements: Puuw [Pir , t)1 L 77y6 , ff4U,d�- 14J To be constructed by .T 13w- QgFnx bAw+oy*c- Address Water Supply: Public Supply From Address or: Private Supply Drilled by T 9*-; `DmrLu,iiso . Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the 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: P.E. R.A. Date (Er l i .10 Address aiI- R-r 4 License # to % LILICD 7 1✓► y APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered pecessary "by the Director /Commissioner. Any revision or alteration of the approved plan requires a new pe it. Approved Ar discharge of domestic sanitary sewagk only. A�, By: Title: Date: White copy - HD Fil ; Yel w opy - Building Inspector; Pink copy- Owner; ran a co y- Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type fl Permit #4% .r � �z ri Well Location Street Address: Town/Village: Tax Map # 3O wMIU0 rI'AtMK-400 Map 3& Block 3 Lot(s) Well Owner: Name: Phone #: oi�N 1��r'�.I�Go Tddress. �a 50W VQJ '5D.. '�� �� �1,�jZS63 4.03 4 (00 Use of Well: Residential _Public Supply Air /cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring —Other(specify) 2- Secondary, Industrial Institutional Standby Amount of Use Yield Sought 5 . G gpm # People Served Est. of Daily usage _gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drilling. New Supply (new dwelling) Deepen Existing Well Detailed Reason 1L 5( re- K -FVYZ we-Li 'I? , k1 Lr 1141J for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes No Is well located in a realty subdivision? ........................................... ............................... Yes KNo Name of subdivision Tj14rPLr- - rWg0W4 -W - Lot No. Water Well Contractor: -12' TF- Address: Is Public Water Supply available on site? ....................................... ............................... Yes _ No Name of Public Water Supply: 1.r"% Town/Village Distance to property from nearest water main: VOATM u ) i L415 Proposed well location & sources of contamination to be provided on to Date: d �l 1 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 Departmei 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 alteption of the approvo plan requires a new permit. Well to be constructed by a water well driller certified by Putnam Date of Issue '— -- I Permit Issui g Official:_ Date of Expiration Title: Permit is Non -Trans erable White copy - HD file; Yellow copy - Building Inspector; Pink copy - -Well driller Form WP -97 Rev. 3/06 Sherlita Amler, MD, MS, FAAP Commissioner of Health Robert Morris, PE Director of Environmental Health July 9, 2010 Richard Zapp Putnam Engineering 4 Old Route 6 Brewster, NY 10509 Dear Mr. Zapp; Department of Health 1 Geneva Road, Brewster, NY 10509 RE: Proposed SSTS for John Petrillo Lot # 3, Triple J Properties (T) Patterson, TM # 36 -3 -14 Robert J. Bondi County Executive 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. 1. Note # 7 on the plan is to be revised to reflect current conditions. 2. Erosion control measures for the site disturbances are to be shown on the plan. 3. A stabilized construction entrance is to be provided. 4. The applicant's address is to be revised on the plan. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. MJB:kly Y, 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) 2.78 -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 C^ Sherlita Amler, MD, MS, FAAP Commissioner of Health Robert'Morris, PE Director of Environmental Health Richard Zapp Putnam Engineering 4 Old Route 6 Brewster, NY 10509 Dea; Mr. Zapp: Department of Health 1 Geneva Road, Brewster, NY 10509 June 29, 2010 RE: Proposed SSTS for John Petrillo Lot # 3, Triple J Properties (T) Patterson, TM # 36 -3 -14 East Branch 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 16,k 2010 of its determination. El The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ❑ Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section -18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to. notify you within 10 days of the receipt of the notice, your application will be deemed 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 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 Nursing / Home Care Agency (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 BRUCE R FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services 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 4 � T TO. D RTME�iT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM 5 DELEGATED -7 1 3& -3 PROJECT: Ci 3D SffA)W/J LhA TOWN: C S I' K PV DATE SUB'D APPROVAL:? �2 NOTICE OF COMPLETE APPLICATION DATE: , —7 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of J u Located at TX'' Tax Map # 3 (o - 3 - 14 Block - Lot Subdivision of I yZ4 PL-r J ���rMrz�yn Subdivision Lot # 3 Gentlemen: Filed Map # !� �1 d'� Date Filed & Z cl This letter is to authorize �FIVrWX— uG 1 2 a duly licensed Professional Engineer or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Countersigned: P.E., R.A., # �`}L4 H iv Mailing Address 4 oz.,n Relvvr Ca State 1v Zip /UJ U Telephone: `Z71 - 67 y� Very truly y urs Signed: �. (r of Property) r Mailing Address: rJ e V (�. -�•� -AA 9 2� State 1 - Zip Telephone: ��'�' '� ­q60 Form LA -97 " L ir "AM COUNTY DEPARTMENT OF HEALTI DIVISION OF ENVIRONMENTAL HEALTH SERVI CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # 1— Di —OCv Located at "&p f>AAi Lirl L. fAe- Town or Village F, Subdivision name Paca?wR-r i ES Subd. Lot # Tax Map 3CA Block 3 Lot Date Subdivision Approved &A 161g Renewal X Revision Owner /Applicant Name Jo W4 Pf;T lL moo Date of Previous Approval S -�Yo Mailing Address 55 C 6,me- rA -,—1 Rc�e c�' , P,4WL4rJG n.4 _ Zip /2 Amount of Fee Enclosed 600.00 16)14"s FA-MIL-Y Building Type F-aSiye dc-S Lot Area /0, No. of Bedrooms 4_ Design Flow GPD 4 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of /2,GQ gallon septic tank and !Et�p L, f , of i __ 2 �ir»R. A�6SoRb'-rrOrJ �R -�I�h} Other Requirements: Pokf Pi-r . Vi 5M% 6t1T10 /,J epic . Z r( fb0-r_r_ /")A l,.I To be constructed by -T-0 fr> Address Water Supply: Public Supply From Address or: Private Supply Drilled by T— EC T_>g= tn. J Eta Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment ay stern 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. _ R.A. Date Address �cn-� 1;rJG�nIEEe rr.lCs �t c L, [� ot.r_> Roym Co License # O�o� SR8�5rER -% /o so9 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 rmit. Approved r discharge of domestic sanitary s age only. f J By: Title: Date: `'[ l — White copy - HD F' e; Y to copy - Building Inspector; Pink copy - Ow r; ra ge copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type MCI HDPermlf'# Well Location Street Address: Town/Village: Tax Map # 310 -s0AILIrJ ?A.- n-Ef_50,J Map S& Block 3 Lot(s) I Well Owner: Name: Address: JPhone #: .b►�,.� 'P�rR -I SS C-A - F' FA4?-m Rv. , I?AW L-I rJ& rJ Y. 57 Ss5 -9 I � o Use of Well: Residential _Public Supply Air /cond /heat pump_ Irrigation 1- Primary Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield Sought S,D gpm # People Served 5 Est. of Daily usage filat� gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason WA;M_X- ityPPLY PhE rJ164 for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes _ No ?� Is well located in a realty subdivision? ........................................... ............................... Yes LC No Name of subdivision - M%fL.wr_- .S ftopeirmeS Lot No. 3 Water Well Contractor: Ta > Address: Is Public Water Supply available on site? ..................................... ................................ Yes No _ Name of Public Water Supply: Ili AI Town/Villa e Distance to property from nearest water main: (59e>,r>Eft TIb%.rJ Onll✓ M ILE Proposed well location & sources of contamination to be Drovi n. Date: 5 10e Applicant Signature: `J 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 Countv Health Deoartmel 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 approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam Bounty. A Date of Issue 11W Permit Is ing Date of Expiration — C% Title: Permit is Non - Transferable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Rev. 3/06 UTNAM NGtE RI/ NEnPLLE E Engi and Arts July 14, 2010 Mr Michael Budzinski Putnam County Health Dept 1 Geneva Road Brewster, NY 10509 RE: John Petrillo Triple J Properties — Lot #3 (T) Patterson TM# 36 -3 -14 Dear Mr Budzinski: Please be advised this office is in receipt of your letter dated July 9, 2010 and has addressed your comments as follows: 1. Note #7 has been revised to indicate no site conditions have changed as of 7/13/10; 2. The plan has been revised to reflect already completed site grading associated with the subdivision infrastructure and drainage work previously completed; 3. Silt fence erosion control has been shown on the plan for the proposed site disturbances; 4. A stabilized construction entrance has been shown and a detail added to the plans; 5. The applicant's address has been updated on the plan. I am enclosing five sets of the revised plans for your review and approval. Please contact me at this office if you have any questions. Sincerely, PUTNAM ENGINEERING, PLLC Richard J. RJZ /eh Enclosures (L1098) 4 Oro RouTE 6, BREWSTER, NEW YORK 10509 ' (845) 279 -6789 • FAx (845) 279 -6769 • EmAm info@putnameng.com UTNAM l- NEINEERINE, PLLC. Engineers and Architects June 10, 2008 Michael Budzinski, P.E. Director of Engineering Putnam County Health Department 1 Geneva Road Brewster, NY 10509 RE: John Petrillo Triple J Properties — Lot #3 Town of Patterson TM #36 -3 -14 Dear Mr. Budzinski, We are in receipt of your letter dated June 4, 2008 regarding the above referenced project and have revised the plans as follows: 1. The separation dimensions to the level spreader and house have been labeled. 2. The septic tank detail has been revised to show a maximum of 12" cover and a note added stating that access to grade manholes will be required if more than 12" of cover is placed. Enclosed for your approval are five sets of the revised plans. Please contact me at this office if you have any questions. Sincerely, PUTNAM ENGINEERING, PLLC rX RJZ /ea Enclosure (L08108) 4 Oro RouTE 6, BREw8TER, NEw YORK 10509 • (845) 279 -6789 • Fax (845) 279 -6769 • EMall: info @putnameng.com SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health June 4, 2008 Richard Zapp Putnam Engineering 4 Old Route 6 Brewster, NY 10509 Dear Mr. Zapp: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 RE: Proposed SSTS for John Petrillo Lot # 3, Triple J Properties (T) Patterson, TM # 36 -3 -14 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health 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. ./tom The dimension arrows from the SSTS to the level spreader and from the house to the expansion trenches are not dimensioned. The septic tank detail is to be revised to specify a maximum cover depth of 12 inches or an access to grade manhole provided if there is more than 12 inches of cover over the top of the tank. 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 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Richard Zapp Putnam Engineering 4 Old Route 6 Brewster, NY 10509 Dear Mr. Zapp: ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH June 3, 2008 1 Geneva Road, Brewster,,New York 10509 RE: Proposed SSTS for John Petrillo Lot # 3, Triple J Properties (T) Patterson, TM # 363 -14 East Branch 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 2, 2008 is complete. The Department will notify you by June 23, 2008 of its determination. z The Project has been delegated.to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ❑ Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed 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. MJB:kIy 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 BRUCE R FOLEY Public Health Director TO: 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 (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 iRR MENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM DELEGATED7� PROJECT:3._ TOWN: C S P K PV DATE SUB'D APPROVAL: /Z� ©S NOTICE OF COMPLETE APPLICATION DATE: --Z -c %► PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of �a, ���-E2 Il.�l -C Located at ()EL_ TN Tax Map # 3Co Block 3 Lot _ Subdivision of TtL�P�cP�� rS Subdivision Lot # 3 Filed Map # 2.96S Date Filed Gentlemen: This letter is to authorize Qv , JA r-\ ('LL-c- a duly licensed Professional Engineer or Registered Architect. to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance 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 su ervise, -the construction of said wastewater tretment and/or water supply systems in conformityi --_ ns of Article 145 and /or 147 of the Education Law, the Public Health Law, andIi'iiiow anitary Code. Countersi p 7 4 P.E. R.A., '� Mailing Address 4 6t-P. 9g:Q-r51 Co a S T6 ,-z-- State Zip (o So `?► Telephone: ���{ �� '2 'j 9 - (S., -1 a9 c IV /I�► iLl A ner of Property) iling Address:' State Zip Telephone: ��A —?-)'7 Form LA -97 TO: n c,kj�-F L, la ' - -�S r-4 DATE: PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: .Jobl'f'�► ��.0 —T2 t PL J - Lcrr`� (T� �,p.-r -r�az �o,J 30 5N-a� t L-"- L,A�E 'j i� 3Co - 3 - t'� . 'PLWD Pr-y-r� n- p- 0-1- cleD ENCLOSED, PLEASE FIND: COPIES OF THE SSDS PLAN ❑ COPIES OF THE HOUSE PLANS tJ CONSTRUCTION PERMIT APPLICATION "LL PERMIT APPLICATION U HEALTH DEPARTMENT FEE ($500.00) ❑ SHORT EAF ❑ DESIGN DATA FORM LETTER OF AUTHORIZATION ❑ APPLICATION FOR WASTEWATER TREATMENT (PC -97) ❑ LETTER OF EXPLANATION REMARKS: COPIES TO: SIGNED: (SepSu6Form -2001) 4 Oco ROUTE 6, BREWSTER, NEw YORK 10509 m (845) 279 -6789 o Fax (845) 279 -6769 • EMAIL: info@putnameng.com P YNAM COUNTY DEPARTMENT OF HEALTH r � VISION OF ENVIRONMENTAL HEALTH SERVICESy�j CONSTRUCTION _PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located. at _Wf- LF5% � (Z p Town or Village f'AT TE R-S CVJ Subdivision name'rjz eL& J. f, offs Subd. Lot # 3 Tax Map SG Block 3 Lot _ Date Subdivision Approved Renewal Revision Owner /Applicant Name Jc)H�3 Date of Previous Approval A Mailing Address C rn FAR r� (zp, . Q^ w j-j Jc, t Zip / 2 SZP Amount of Fee Enclosed 4 Soo, cc >. Sid« f�'*M, L--1 Building Type r-esXPer►c.6 Lot Area 10.31Ac.No. of Bedrooms-4—Design Flow GPD 24-2-450 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 12-G:!--) gallon septic tank and t-, f_ o r Other Requirements: Fbcnp P,- _ ip , 5TP -,5g n ar-j Bpy�, . 2" pcit . t z& „J To be constructed by -r, ?�6 pE-,�� Address Water Supply: Public Supply From Address or: Private Supply Drilled by ! tE Ste, rzi2 nt -J a D Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment s, sY tem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs Signed: P. E. R.A. Date IZ,-f'c✓ b Address pur IAo -m eo- � ,-A Er -j'k. rl-L -e- oc.a 9-�L r Co License # o&-741(c 5F4%„JS-TF-1z /-Ja°. /a42:1 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified wen considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires anew pe it. Approved fo scharge of domestic sanitary sew a only. By: �- Title: Date: cam% White copy - HD File; &ellow Building Inspector; Pink copy - Owne , Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # Well Location: Street Address: Town/Village Tax Grid # 1..1F.t.F /�R-G R�� PA'f't'ER�So,J Map SG Block Z Lot(s) 1 1� Well Owner: Name: Address: JOK'J PEA R►►_�o SSC -'AVnC– FPq__`1 Rte, ifottJU,Jc_ rA`l, Use of Well: esidential 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. ,0 gpm # People Served S Est. of Daily Usage _gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling ✓New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type rilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes L­�No Name of subdivision 3. Lot No. 3 . Water Well Contractor: ?je Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: r1J/A Town/Village Distance to property from nearest water main: r-1, L-6 Proposed well location & sources of contamination to be arate s Date: `ZJ u 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. I A Date of Issue (0 —W -% ('0 Date of Expiration ro -- 7C'. Permit is Non - Transferrable Permi Title: White copy - HD file; Yellow copy - Building Inspector; copy - Well driller Form WP -97 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I - PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1. APPLICANT /SPONSOR NAME John Petrillo E.2PROJECT J Properties Subdivision - Lot #3 3. PROJECT LOCATION: Municipality Patterson County Putnam 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) Welfare Road 5. PROPOSED ACTION IS: Q✓ New [:] Expansion Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: Construction of new 4 bedroom single family residence with associated SSTS , drilled well and site improvements. 7. AMOUNT OF LAND AFFECTED: 10.37 Initially 10.37 acres Ultimately acres S. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? �✓ Yes No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ❑Residential F-1 Industrial El Commercial Agriculture Park/Forest/Open Space Other Describe: R -40 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? E] Yes R✓ No If Yes, list agency(s) name and permit/approvals: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? r] Yes Fv] No If Yes, list agency(s) name and permit/approvals: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? Yes ❑✓ No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS RUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor na J _ �Z Date: Signature: If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 Vf,, UTNAM NEINEE4INE, PLLC. Engineers and Architects June 15, 2006 Michael Budzinski, P.E. Putnam County Health Department 1 Geneva Road Brewster, NY 10509 RE: John Petrillo SSTS Lot #3, Triple J Subdivision Town of Patterson TM # 56 -3 -14 Dear Mr. Budzinski, Putnam Engineering is in receipt of your letter dated May 25, 2006 regarding the above referenced application and has addressed your comments as follows: 1. The floor plans have been revised to make the sunroom a screened in room with no heat and no insulation and therefore should not be considered a bedroom. The revised floor plans have been forwarded to you under separate cover. 2. Fill notes have been added to the SSTS Plans. 3. Pipe sizes and types have been specified on the SSTS Plan. 4. The PVC pipe from the septic tank to the pump pit has been specified as SDR -35 on the SSTS Plan and Profile. 5. Pump sizing calculations have been added to the plans. 6. An access to grade manhole detail has been added. I am enclosing five copies of the revised SSTS Plans for your review and approval. - Please contact me at this office if you have any questions. Sincerely, PUTNAM ENGINEERING, PLLC Richard J. Z p RJZ /ea Enclosure (L06218) 4 Oro RouTE 6, BREWSTER, NEW YORK 10509 • (845) 279 -6789 • FAx (845) 279 -6769 • EMAIL: info@putnameng.com SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH - I Geneva Road, Brewster, New York 10509 May 25, 2006 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Richard Zapp Putnam Engineering 4 Old Route 6 Brewster, New York 10509 Re: Proposed SSTS for Petrillo Lot # 3, Triple J Subdivision (T) Patterson, TM# 36 -3 -14 Dear Mr. Zapp: 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. 1. The sunroom will be considered a potential bedroom since it is over and above the allowable rooms on the first floor. 1.00"'�2. Since fill is proposed for grading, the PCHD fill notes and detail are to be added to the plan. ✓�, The pipe sizes and types are to be specified on the site plan for all proposed piping. The PVC pipe from the septic tank to the pump pit should be specified as SDR -35. . 115. The calculations for the sizing of the pump are to be submitted. ,A The pump pit access to grade manhole detail is not shown on the plan. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. MJB: cj 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 j 4 Old Route 6 Brewster, New York 10509 Phone: 845 - 279 -6789 Fax: 845 - 279 -6769 e -mail: putnamengineering @suscom.net TO: ii/`i, L. , t v s I-C We are sending you ��tached U. S. Mail, Overnight, Originals --:::2— Prints Colored Prints es Date LETTER Y,d'tl ,' d F' 6. .R' S lcPtlM ,Y H L Date �'2- _ © G RE: P/E Job: under separate cover, the following items via Hand Delivery, Pick Up: Reports Photographic Exhibit Other: No. Descri Plans Specifications These are transmitted: _ For approval — Approved as submitted _ For your use ____ Approved as noted As requested Returned for corrections For review /comment _ Resubmit copies for approval Submit, copies for distribution Copies to: SIGNE SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Richard Zapp Putnam Engineering 4 Old Route 6 Brewster, New York 10509 Dear Mr. Zapp: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health May 25, 2006 Re: Proposed SSTS for John Petrillo Lot # 3, Triple J Properties (T) Patterson, TM# 36 -3 -14 East Branch Reservoir Basin The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on May 24, 2006 is complete. The Department will notify you by June 14, 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. ❑ 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 fled the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the New York City Department 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 New York City 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. Respectfully, Michael J. MJB:cj 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 BRUCE R FOLEY Public Health Director LORETTA MOLINARI RN., M.S.N. OQ Associate Public Health Director Director of. Patient Services DEPARTMENT OF HEALTH I 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 LkOSSA TO: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM DELEGATED PROJECT: TOWN.: C SE gyp' K PV DATE SUB'D APPROVAL: V NOTICE OF COMPLETE APPLICATION DATE: / d PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of 30k_�, ! . Tf_-T 1 L_L_C--:) Located at 0 eL F � j2,e>^,-_-) T/V -wiz -Sod Tax Map # 3G Block 3 Lot 1,V- Subdivision of Tf -tet_E J RZ,_nfP sx t iES Subdivision Lot # .3 Filed Map # 2985 Date Filed Gentlemen: This letter is to authorize Qom, , ,_►,4�� 1=,�!G i r�E cC� JG P L t-c_ a duly licensed Professional Engineer or Registered Architect, to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance 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 su ervis the construction of said wastewater tretment and/or water supply systems in conformity of Article 145 and/or 147 of the Education Law, the Public Health Law, and Countersi 0674 nPE.R.A., anitary Code. Mailing Address 4 csc.D Co 's R-G 1_j5 Ta � Z-- State `f Zip (o 569 Telephone: Cj ±>> ?'19 — (.,-I a9 Very tru ours f Signed: our of Property) Mailing Address: v�Q, State r` Zip - Telephone: ��5� �SS ' �� 7 r7q) Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: . 3©vk,s PET(24u:_© �:> 04 Li L4 n� hI 125 9' 2. Name of project:.. - z,a,¢ J P TEES- LarOr3 .3. Location TN: 4. Design Professional: foT,sarr-x 5. Address: 4 oLp (zovrs G 6. Drainage Basin: 7. Type of Project: Private/Residential Food Service Apartments Institutional .Office Building Realty Subdivision Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review;(SEQR)? Type Status (check one) ....................................................... Type I Exempt Type II Unlisted X 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... tdo 10. Has DEIS been completed and found acceptable by Lead'Agency? ................ L A 11. Name .of Lead Agency tJ /� 12. Is this project in an area under the control of local planning, zoning, or other. officials, ordinances? ......................................................... ............................... 5 13. If so, have plans been subnutted-to such authorities? 5 14. Has preliminary approval been .granted by such authorities? YES Date granted- A,S 15. Type of Sewage Treatment System Discharge........- .........: surface water groundwater 16. If surface water discharge; what is the stream class designation? .................... rjl,,Ll .17. Waters index number (surface) ..... ..: .......... * ................ 18. Is project located near a public water supply system.? rid. 19. If yes, name .of water supply..- t J1A. Distance to water supply 20. Is project site near a public sewage collection'or treatment system? ................ �•!o 2 -L Name 'of sewage system �T�A Distance.to sewage system 22. Date test holes observed -t i o3 23.. Name of Health Inspector ,Ie*_-- PA,2avn 'r( 24. Project design flow (gallons per day).; ................................................ 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... O 26. Has SPDES Application been submitted to local DEC office? ................... r-1 Form PG97 nmn 410 ! k` `V PUTNAI JUNTY DEPARTMENT OF HEALTH DIVISION (. E_ � VIRONMENTAL HEALTH SERVICES � Y DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner L �` I/)t 4vw Address Located at (Street) kl rA2, ,ZQ44j Tax Map 36 Block 3 Lot (indicate nearest cross street) Municipality! �, _ SQ Drainage Basin ' Kt4L) -,5o6 �.4k x-07 - 3 SOIL PERCOLATION TEST DATA ► &P MA V C- iAu vc"7%4 Date of Pre - soaking 5412 �e a -- t 3 Date of Percolation Test -7,.) - 5-6.3 Hole No. Run No. Time Start - Stop Ela se Time (Min.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Incites Percolation Rate Nfin/iach 2 °0 �i� - a S 3 3,33 3 1�i9_��3z l,3 - 2 S 3. �3 5 a 2 1113-11 30 rd c 4 5 1 2 3 s 5 NU t hb: .t. Tests to be repeated at same depth until approximately equal percolation rates are obtatnea at eac,► percolation test hole. (i.e. _< I 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., TO: Mica,^%F —L .sSK 1 DATE:�T?3�6� PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: !?E ILL-o 7P►Pt:-c. J. t om(LT,rsS !�zjoi>w,siotj — L >T43 ENCLOSED, PLEASE FIND: COPIES OF THE SSDS PLAN 2. COPIES OF THE HOUSE PLANS CONSTRUCTION PERMIT APPLICATION WELL PERMIT APPLICATION HEALTH DEPARTMENT FEE ($500.00 ) SHORT EAF DESIGN DATA FORM LETTER OF AUTHORIZATION APPLICATION FOR WASTEWATER TREATMENT (PC -97) ® LETTER OF EXPLANATION REMARKS: COPIES TO: (SepSubForm -2001) SIGNED: 4 OLD ROUTE 6, BREWSTER, NEW YORK 10509 • (845) 279 -6789 m Fax (845) 279 -6769 o EmAiL: info@putnameng.com