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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.23 -1 -52 BOX 17 01932 r Ll J r Fliv .� jW d, I , 01932 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at 1'34 Town or Vil F-3--i2 9-J Owner /Applicant Name V00At43 M) LL -ot Tax Map X,. Z3 Block Lot 5 Z Formerly 'PA-rJc•y Dom' LUCIA Subdivision Name Fu -10JOA 64V-6 Subd. Lot # 21-71 - '2-7)9-6 Mailing Address O A S Y- i rJ S 61-6l OJ i N (;1 At c- � rJ i Zip �-- Date Construction Permit Issued by PCHD 212E -�QO Separate Sewerage System built by ';JkM0 CAC t:i,'V -p i e A,A-- Address 0SIX -`t Consisting of 1,OC Gallon Septic Tank and 324- Lr- Of- `2' Wi D Other Requirements: f Lh AP P i C , QIS TV- 0 J -P,50 I�C x VI O -AIEFLt,' Water Sunaly: Public Supply From Address or: Private Supply Drilled by ALL 00-i o--i ^3 6- Address -6 M7W ^"t AZ-= A96%J5'1b�Z- ��r Building Type OWJ rAy"iI" ALL& -kr Has erosion control been completed? 'Number of Bedrooms 5 Has garbage grinder been installed? lNJO 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 Count -Department of Health. Date: *cj 60 �&-L Certified by P.E. X R.A. (Design Professional) Address PitTWPA -N E1 6Ir1E- Z:l?i►.��, PC.(, C- License # 06'744G 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 subject to modification or change when, in the judgment of the Public Health Director, such revocatir m dificat' or change is necessary. By: i Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 I NEERI1 a/L.0 Engineers and Architects SEPTIC SUBMISSION FORM TO: � Holl m S PUTNAM COUNTY HEALTft DEPARTMENT PROJECT: H ILA- ,li odz, 1 t D &Y2, . j �Zrl P.-55- DATE: ENCLOSED, PLEASE FIND: COPIES OF THE SSDS "AS- BUILT" PLAN CONSTRUCTION COMPLIANCE CERTIFICATE WELL LOG HEALTH DEPARTMENT FEE ($200.00) WATER ANALYSIS GUARANTEE FORMS - 3 ORIGINALS E 911 ADDRESS FORM ❑ LETTER OF EXPLANATION REMARKS: Y COPIES TO: N� DEL L)u 3G,23 - ) _ G'2- SIGNED: 41, ,/ � 061*1 (SapShinrn.:001M11 '.D ROUTE 6, BREwsrER, NEw YORK 10509 - (845) 279 -6789 - Fax (845) 279 -6769 -, EMAIL: puteng ®bestweb.net 1 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 (914)279-6130 Fax (914) 279-7921 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 E911 ADDRESS VERIFICATION FORM OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS: TOWN: .6Ba Mill _ 1 AUTHORIZED TOWN OFFICIAL: (Signature) DATE: ° Z J -- U L 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. (E911 VERFRlvi) PUTNIAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Haviland Rd. Putnam Lake, N Town/Village: Southeast Tax Grid # Map Block Lot(s) Well Owner: Name: Address: Donald Mill - 10 Askins Rd., WIngdale, NY 12594 Use of Well: I- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock _ Other Casing Details Total length 41 ft. Length below grade 40 ft. Diameter 6 in. Weight per foot 17 lb /ft. Materials: X Steel _ Plastic _ Other Joints: _ Welded X Threaded _ Other Seal: _ Cement grout X Bentonite Other Drive shoe: X Yes No Liner _ Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield Test Bailed _Pumped x Compressed Air Hours 6 Yield 30 gpm Depth Data Well Log If more detailed information descriptions or sieve analyses are available, please attach. Measure from land surface- static (specify ft) 14' Depth From Surface Water ft. ft. Bearing During yield test(ft) Depth of completed well in feet 180 205 Well Formation Diameter(in) ]Description Land Surface 8 Loose Sandy Soil - Brown 8 12 Soft Crust Ledge 12 205 lGrey Granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 1.80 30 Pump Type sub_ Capacity 7 Depth 160 Model 7GS05412 Voltage 230 HP 1/2 Tank Type b1 adder Volume 62 Date Well Completed 12/12/01 Putnam County Certification No. 2 Date of Report 1:2/19/01 'Wey9filler a ) G � NOTE: E: rxact location of well with distances to at least two permanent landmarks to be provided on a sekarate sheet/plan. Well Driller's N t :M.. i.l l , ,lr. Signature: AAZ ( IM A 4 04 Address: 75 Putnam .AVe. , Brewster, NY Date: 12/19/01 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 )MS ENVIRONMENTAL SERVICES, INC. 15oo SUMMER STREET STAMFORD, CONNECTICUT o6905 Mailing Information: Name: Mill Drilling Co. Address: 75 Putnam Ave . City: Brewster State: NY Telephone: Sample's Information: Client: Donald Mill Jr Zip: 10509 Fax: NELAC, CT and NY State Certified Environmental Laboratory Collector's Information: Name: Bob Mill Address of site: Haviland Dr City: Putnam Lake State: NY Zip: Telephone: Site: water tank -Date Collected' 4/16/02 Date Received: 4/17/02 Preservative: HNO3 Time Collected: 8:24 Time Received: 11:15 Temperature: <4C Lab No.: J021434 Date Analyzed Test Name Result MCL Method 4/17/02 Total Coliform Absent Absent SMWW 9222B 4/17/02 Chlorine Free Residual <0.1 mg /L N/A SMWW 4500CIG 4/17/02 Color ND 15 Units SMWW 2120 B 4/17/02 Odor ND 3 TONs SMWW 2150 B 4/18/02 Iron 0.060 mg /L 0.3 mg /L SMWW 3111 B 4/18/02 Manganese <0.01 mg /L 0.3 mg /L SMWW 3111 B 4/18/02 Sodium 49.2 mg /L N/A SMWW 3111 B 4/17/02 Chloride * 329 mg /L 250 mg /L SMWW 4500 Cl C 4/17/02 Hardness 322 mg /L N/A SMWW 2340 C 4/17/02 Nitrate 0.649 mg /L 10 mg /L SMWW 4500 NO3E 4/17/02 Nitrite <0.1 mg /L 1.0 mg /L SMWW 4500 NO3E 4/17/02 pH 6.79 S.U. 6.5 -8.5 S.U. SMWW 4500 H B 4/17/02 Sulfate 17.5 mg /L 250 mg /L SMWW 4500 SO4F 4/17/02 Turbidity 0.63 NTU 5 NTUs SMWW 2130 B 4/17/02 Lead 12.2 ug /L 15 ug /L SMWW 3113 B Comments: *Above MCL At the time of analysis the sample was acceptable for total coliform N/A = Not Applicable mg /L- milligrams per Liter ND- None Detected S.U.= Standard Unit NTU- Nephelometric Turbidity Unit MCL- Max. Contaminant Level TON- Threshold Odor Number ug /L- micrograms per Liter A Signature: - State #: PH -0218 �. . Micha ELAP #: 11715 President Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com PUTNAM COUNTY DEPARTMENT OF HEALTH GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM A64- e Owner or Purchaser of Buil ing Building Constructed by Location - Street 2 3 'I -- S- S-2--, Tax Map Block Lot TownNillage Subdivision Name f. C-2-72Z G:2 7 PP 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 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 system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month Day,(� YearJCQ Signature: ,. Title: General Contractor (Owner) - Signature Corporation Name (if corporation) /'Corporation Name (if corporation) Address: /CS 6h s R Address: 27 Statehj V Zip State %r `l�r %,_ Zip Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES . / FINAL SITE 11SPECTION '�° Tv �vssi p Date: Z z2 < O_2 Inspecte y: g,_�EED Street Location �tg y /G,qy '�7, Owner Zp,EGUG�. Tom F�T�- Permit # P_ 6-0 - €32 TM r _ 36, f - 5" , Subdivision Lot # ----- 1. Sewage System Area YES 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. Sewue Svstem --�-.;--�` a. �iepticjanK. siz -- -1;uuU :.:::: ,-Z.)U ......... other :: b. Septic tank insta a evel ......................... a..................... c. 10' minimum from foundation .......... ............................... 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... ............................... f. renc es 1. Length required "3eng,- Length installed 3� 2. Distance to watercourse measured+ /od Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 -1/32" /foot ............. 5. 10 ft. from property line - 20 ft: foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100% ......................... 8. Size of gravel 314 -1 %:" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. ends capped ..................... g u`mo o Do ed vstems u - e =o -pump c am er...:..- - ........: 2. Overflow tank ............................. ............................... 3. Alarm; visual/audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ........................ ................::........:... - III. ouseBuilding -y` ' _ a— oA sse located per approved plans.......... ................ b. Number of bedrooms... ............................ . IV. Well a Well located as per app edplans ..U� ....:................ b. Distance from STS area measured - ft........... c. Casing 18" above grade ................:... r11................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ..:............................ d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area . h �� Surface =water protection -adequ to _ x _ �` I. Eros'ian control-provided ........... :.................................... D 001 . COMMENTS e5vear5 o,L� f'o r .9r."'41,45 c1cPc cd i�i,�v 5 T 3 kk ' INA-M 02/25/2002 15:59 FAX 845 2796769 PUTNAM ENGINEERING PUT C0 HEALTH R' P8J i l\AM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENV=NbEMAL HEALTH SERVICES ATTENTION ADAM GENE ;. � f f Ala: 1► �•� • All information must be fully completed prior to any Trenches inspections being made. Q001/001 PCHD Construction Permit # Located: A V iLIl N U 1J 2i JC ) (V') Owner /Applicant Name: -36.23 Block �_ Lot s" z_ Formerly: A40 Subdivision Name: &UjA4 c.f?L't Subdivision Lot # 3, 7 71 Is system fill completed? IV1,4 Date: L.5 a Is system complete? Date:. 5: 0 Z: - Is system constructed as per plans? ' L -" -- Is well drilled? ):= Date: Z.5 _ d25!2UOP_;� 0 2 Is well located as per plans? V 5 Are erosion control measures in place? I cm* that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in owdance with the issued PCHD Construction Permit and approved plans and the Standards, Rifles and Regulations • Putnam County Department of Health. Date: ?6 f=t8au o CArtifiedbTj E" RA Design Pro sional Address: Form FIR 99 FEB -25 -2002 MON 03:54 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 A 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 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 February 26, 2002 Paul Lynch, PE Putnam Engineering 4 Old Route 6 Brewster, New York 10509 Re: Field Inspection - Delucia Haviland Drive, (T) Patterson TM# 36.23 -1 -52 Dear Mr. Lynch: The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field: 1. Needs cast iron pipe connection to septic tank. 2. Expose pump tank for measurements. 3. Install silt fence. 4. A pump test needs to be witnessed by this Department once the electrical inspection has been completed and notification of such has been submitted to this Department. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. GDR: cj Very truly yours, "�" ✓ , 2%� Gene D. Reed Environmental Health Engineering Aide DATE : FEB -27 -2002 WED 00:03 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 92796769 PAGES : 1/1 START TIME : FEB -27 00:02 ELAPSED TIME : 00'22" MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... BRUCE IL FOLBV .LORMA MOUNARI R.N, bE.B.N. h4firc Arad D(7rerar Ana(am Faber NWA ONar DEPARTMENT OF HEALTH ' 110—ft R," Brewster, New Yolk 10509 FOAM nhl KOM (143)271.6130 F. OM 278.7921 XMIUR Bnft"(145) 271 -6330 WIC(143)271 -6676 Fa P45)276.6013 Fry hwrft"M (163)271 -6614 Frr(W) 2711.666{ 1, 9k0d(443)=-"12 Ftr(613)221.61u YcbMary 26, 2002 Paul Lynch, PE Putnam Engineering 4 Old Rote 6 Brewster, New York 10509 Re: Field Inspection - Delucia Haviland Drive, (1) Patterson TM# 36.23 -1 -52 Dear Mr. Lynch: The above referenced separate sewage treatment system can be backfillod. The following comments must be corrected in the field: 1. Noods cast iron pipe oonnection to septic tank. 2. Expose pump tank for measlmments. 3. Install silt fence. 4. A pump test nods to be witnessed by this Department once the electrical inspection has been completed and notification of such has been submitted to this Department. If you have any further questions, please contact me at (845) 278 -6130 on 2261. Very truly yours. Ocnc D. Reed GDR:cj Enviromnental Health Engineering Aide BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 LORETTA MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services ATTENTION: 13 ADAM STIEBELING In GENE REED All information below must be fu4 completed prior to any scheduling. DATE ENGINEER OR FIRM: _ �i�FrNCtc- ��y�tu` -W �,t p G PHONE #: REASON: DEEPS: o PERCS: a PUMP TEST: � ROAD /STREET: _ � %1; K1,, I A i i7 TOWN: f�i �%L'''% Oju TAX MAP #: '3C- 2. SUBDIVISION: _ OyT'" /��'1 1 R,4&- LOT #: G'. 771 OWNER: NYCDEP CRITERIA FOR JOINT REVIE3Y ,AND WITNESSING OF SOIL TESTING YES NO ❑ Proposed SSTS within the drainage basin of West Branch or Boyds Corner Reservoirs. ❑ 0 Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. Cl 09 Proposed SSTS within 200 feet of a watercourse or a DEC wetland. Q Proposed SSTS design flow greater than 1000 gallons/day or SPDES Permit required. ❑ l;i 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 yep to any of the questions, NYCDEP must witness the soil testing. This Department will coordinate a mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. If a project has been determined 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 ONLY DATE: / 0 i 30 TIME: C ti MGiVTS; (FIELD T EST) APR -24 -2002 WED 21:03 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION Or ENVIRONMENTAL HEATLH SERVICES FIELD ACTIVITY REPORT AT�T�RFRR; HAUr�.¢ivr'� �iZ, �.sz7T.:P�`✓ rt/,.� Street Town PERSON IN CHARGE ;.fir.- iii State Zip PUMP TEST E], DOSE TEST to w q� EL. START EL. STOP V REQUIRED GALLONS % 5D TN- gpFC'TOR! 1(ZL � / TFT Signature and Title RFPCIRT RFC'.FTVFn RV: I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Rev. x7• Nc, r 7, gam' mMo 0 o m to w q� EL. START EL. STOP V REQUIRED GALLONS % 5D TN- gpFC'TOR! 1(ZL � / TFT Signature and Title RFPCIRT RFC'.FTVFn RV: I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Rev. x7• Nc, r 04/16/2002 10:06 FAX 845 2796769 PUTNAM ENGINEERING -) PUT CO HEALTH IA003 /003 THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 300942? BUREAU OF ELECTRICITY F 40 FULTON STREET, NEW YORK, NY 10038 Date APRIL 10, 2902 Application No. on file 33788302/02 N 589666 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of DON MILL .7R., HAVILAND DRIVE, PUTNAM LAKE, NY in the following location; ® Basement ❑ lit Fl. ❑ 2nd Fl. OUT Section Block Lot was examined on APRIL 01 , 2002 and found to be in compliance with the National Electrical Code. FIXTURE OUTLETS RECEPTACLE SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS HiCANDESCf nuouSCENT OTHER AMT. X.W. AMT. K.W. AMT. KX AMT. K.W. AMT. H.P. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT TRANS. HEATERS MULTI -OUTLET N0. OF SYSTEMFES ET DIMMERS MAT. C.W. OIL M.P. OAS H.P. AMT. NO. A. W. 0. AMT. AMP. AMT. AMPS. AMT. N.P. AMT. WATTS SERVICE DISCONNECT NO. OF S E R V I C E NO.Of CC CON0. A. W. G. A. W. O. A. W. O. 1 � 2W 1 f JW J / JW 3#4W pEQ 0 Of CC. COND. N0. Of X11E0 � NI,UG N0. Of NQUTQALI Of NEUTRAL AMT. AMP. TYPE METER EQUIP. 7. OTHER APPARATUS: SEVIA.GE EJECTOR PUMP &ALARM CABINET -1 MOTORS-1-0.50 H.P. 2., TURNERSONS ELECTRIC, INC. LIC. #5377 l.. PO BOX 426 /RT 311 PATTERSON, NY, 12563 GENERAL MANAGER 104 Per This 0edl0cale MUSt not be altered In any manner; return to the office of the Board It Incorrect. Inspectors may be identllled by thelr credentlals. APR -15 -2002 MON 22:00 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 3 _ _. __. ,.,o mss„ i our ua rut vam r_vlillvriSKllVli PUT CO HEALTH 4001 /002 TNAM mama 1 \1ENEIC -RI Al1-1 p P1 Le Engle ears and Architects DATE: T®: RE: _- C 25-- 0 -- /,��� l C FAX.- it-RND k�211�r PAGES: . Including this cover sheet. r R C- CrI21C13E- w5jOV-r-1 -loA} WYdS 0(.2oppbr -P ON:f-- From the desk of... ROBERT L. ORAIM 4 Ow ROUTE 6, SREWSrCR, NEW YORK 90509 • (845) 279 -6789 a Fax (845) 279 -6769 - EMArI.: putengCbestweb.net APR -24 -2002 WED 21:03 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at—LIAV 1 LA AP --PFe-% Vf - Town or Yill e FA tr Subdivision name l urt�N LA K(E. Subd. Lot #7-"t Tax Map Block �_ Lot Date Subdivision Approved 3 Renewal —� Revision Owner /Applicant Name NAN Ll( Dt; L t ,(, A, Date of Previous Approval i -3 I 0i Mailing Address jf o Pe" emu., J d r► ezto a N�g Zip j S 33 Amount of Fee Enclosed 360-0gevlasty / S ovhar& O) l. Building Type 5) (•e— Frn Lot Area Nro. of Bedrooms _3_ Design Flow GPD_ &50 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of fO /Vb gallon septic tank and 2' Vu 1171-z 7t91S0fz-t (0r4 `Y =en&J + Other Requirements: VO4wt 7 ?L1—i P L5r91 a Ji.,no w FwY, To be constructed by M —,O�EF- m rO EC) Address Water Supply: Public Supply From Address or: L Private Supply Drilled by —M E5t� r ��`t I i� f ✓c7 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 treatments sv 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 oft ce of the approval of the Certificate of Construction Compliance of the original system otanre Signed: P.E. R.A. Date A r r:�C u Address c oZ�1.ci�4E1 k ASE r ura l— &C/. /OS- t7;)— License # APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe t. Approv for discharge of domestic sanitary sewage only. By: Title: Date: 1/ White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 P>l TNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # P� Well Location: Street Address: Town/Village Tax Grid # 144 I L-AN TA �/"� � f0 ., 4 Map�3 e Block Lot(s) (!p Well Owner: Name: Address: L_ • (-I "'k III bokivt_--, �wiw_ SILT 11533 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 MIN gpm # People Served � )V Est. c,f Daily Usage aQQgal.. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type _ Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No _ Is well located in a realty subdivision? ...................................... ............................... Yes X No Name of subdivision 'P&;t N A o-k Lq Lot No. 2-7'11- 2-7 EC> Water Well Contractor: -rp Address: _ Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: NIA Town/Village `PA Tr"F�Sp,*,l Distance to property from nearest water main: Cci:-x� `7P,," -M , Proposed well location & sources of contaminatio on separate :et/plan. Date: 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 wate Al driller certified by Putnam County. Date of Issue .n Permit Issuing lc' _ Date of Expiration 2 Title: V _ Permit is Non - Transfer able White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 P UTNAM NGINEERINEALE. Engineers and Planners SEPTIC SUBMISSION FORM TO: Cp-t�cgc m( lzg(,5 DATE_: 12-h-4 PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: -De- I ik--1 8 RAVI LAND Di_7W� �-� -FA 71 -00�av 38 - I - (o ENCLOSED, PLEASE FIND: COPIES TO: s COPIES OF THE SSDS PLAN 2 COPIES OF THE HOUSE PLANS CONSTRUCTION PERMIT APPLICATION WELL PERMIT APPLICATION HEALTH DEPARTMENT FEE ($ SHORT EAF DESIGN DATA FORM LETTER OF AUTHORIZATION APPLICATION FOR WASTEWATER TREATMENT (PC -97) LETTER OF EXPLAINATION SIGNED: 102 GLENEIDA AVENUE, CARMEL, NEW YORK 10512 -PHONE (914)225 -3060 AX (914) 225 -2955 CITY DQMZVP" THE CITY OF NEW YORK DEPARTMENT OF ENVIRONMENTAL PROTECTION / JOEL A.' MIELE, SR., P.E. Commissioner Phone (914) 742 - 2001 Fax (914) 742 - 2027 Mr. Robert Moms, P.E. Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: Nancy Delucia SSTS Haviland Drive (T) Patterson; © Putnam East Branch Reservoir Basin DEP Project # 9924 ( joint Review) Dear Mr. Morris: William N. Stasiuk, P.E., Ph. D. Deputy Commissioner Bureau of Water Supply, Quality and Protection February 1, 2000 The New York City Department of Environmental Protection ( NYCDEP) has determined that the above Subsurface Sewage Treatment System (SSTS) project is complete. However the following items must be addressed before NYCDEP can issue its approval: 1. The SSTS design note # 1 must be revised to include the appropriate: soil percolation rate. 2. The tax map and lot number on the site plan and the PCDH construction permit do not coincide. The review of the SSTS project will not proceed until NYCDEP receives the required information. Should you have any question, please, do not hesitate to call me at 773 -4461. Since ely, Lucie Lops Associate Project Manager Engineering Design Review xc: James Covey, P.E., NYSDOH 465 Columbus Avenue, Valhalla, New York 10595 -1336 D o0ato P J T) THE CITY OF NEW YORK DEPARTMENT OF ENVIRONMENTAL PROTECTION JOEL A. MIELE, SR., P.E. Commissioner Phone (914) 742 - 2001 Fax (914) 742 - 2027 Mr. Robert Morris, P.E. Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: Nancy Delucia - SSTS Haviland Drive (T) Patterson; © Putnam East Branch Reservoir Basin DEP Log # 9924 (Joint Review) Dear Mr. Morris: William N. Stasiuk, P.E., Ph. D. Deputy Commissioner Bureau of Water Supply, Quality and Protection February 17, 2000 This letter is to inform you that the New York City Department of Environmental Protection (Department) has determined that the above - referenced Subsurface Sewage Treatment System (SSTS) 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 "SSDS prepared for Nancy Delucia," dated November 1999 and revised 1/14/00, prepared by Putnam Engineering, PPLC. The applicant must contact Lucie Lops of my staff at (914) 773 -4461 at least 2 days prior to the start of construction of the SSTS so that the Department may inspect and monitor the installation. Sincerely, Margaret Lloyd, P. E. Supervisor Engineering Design Review xc: James Covey, P.E., NYSDOH 465 Columbus Avenue, Valhalla, New York 10595 -1336 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 (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 Ken Hurley Putnam Engineering 102 Gleneida Avenue Carmel, NY 10512 Re: Proposed SSTS: Delucia Havilan Drive, Lots #2771 -2780 (T) Patterson Dear Mr. Hurley: February 4, 2000 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. SSTS design note #1 must be revised to include appropriate soil rate. (NYCDEP) 2. Current tax map number must be noted on the plan. Upon receipt of a submission, revised to reflect the above comments, this application will be consider further. RM:tn V ly yours, Robert Morris, P.E. Senior Public Health Engineer IS AID ELEVAnM OF ALL 06-W MOOII.AR WM ° ARE COPYRXii1E0. WE WILL ENFORCE ALL COPyWa TO PROTECT OW CONSOERMLE l MIME (T H OEYBOPfM, TiM PLANS AND aEVATM DOLLAR HOMES RESERVES THE ma"r TO MAKE ~R CHANGES IN DMIENSIONS AS REOLERED BY MODULAR CONSTRUCTION METHODS. PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPRO'j'ED FOR BEDROOM COUNT ONLY, ALL ROUSE PLAlyR.b,liS d' :: PCL OIi FOR APPROVAL BUILDER: SITE LOC.: ---- �Er -�qa ; paQa Z `23018q 23 °�35fOO GIST SHEE i w A -3a ADDRESS: I APP.' BY PW PROJ. I N 06/07/96 MY D #: C666 SERIAL #: - - -- 60,9m Dr:(,Lx-I A HAQ i L-ANP newE �Artr�E� -sue 3S. -� -co PLANS AND ARCHITECT'S STAMP VALID ONLY FOR MODULAR CONSTRUCTION BY CHELSEA MODULAR HOMES. INC. ■ MANUFACTUIMM INFORMATION CHELSEA MODULAR HOMES. INC. P.O. BOX 1108 ROUTE 9V FnMARLBORM N.Y. 12542 914- 236 -3311 (E)COPYRIGHT 1996 CHELSCA MODULAR HOMES - n L QIGHri RCSERVED TK • ffrr.Tio.. . �...�..... - -.— .__ _ —. J �1 Q ✓ UNS AND aEVATMUS OF AFL GMSFA F+=LAR k00ffs ' AF E CORYWDEO. WE WILL OFORM ALL CWYFMM TD PHDIECT OEM CMJSMS LE 1'lRMU NT IM DEVELM nM KANS AND aOA704L MODULAR MOME9 RESERM THE RtGNT TO MAKE AdMOR CHANOM IN CR ENSION9 AS REOU.MED BY MODULAR CONMMUOTTON AffTMOD8. i rig,. \\\��� Q 11J1 •• LAMS AND ARCHITECT'S STAMP VALID ONLY FOR MODULAR MTRUCT ION BY CHELSEA MODULAR HONES. ING BUILDER: - - - -- SITE LOC.: �— QQ(r��4 QaO�IQ P[4L1G7 W Z MAMUFAGTUFtM IFORMATTON CHELSEA MODULAR HOMES; INC. ADDRESS: `Mes -s `l3 °�340G1r1 PROJ. ID #: C666 SERIAL #: ---- SHEET a A -3 DWN. BY: PW APP. BY: 1 PA BOX 11 N. ROI3TE 9v MARLHORp KY. 1232 911- 236-7311 ®C13PTRIGHT 19% OELSEA MUMJLAR Hm1ES - ALL RIGHTS RESERVED TMI AWWITMMAL we: awrAUrn •- ss• -u va — 1..6 BEDROOM #3 11-11' X 9' -5' 112 SF A Q N I� t LI • -1rre�r- �1�� -� r---r- �.-- -i MB I 1 j 43 SF B -2 46 SF 1 I 1 1 I 1 I 1 I I I I aeM \ \xn IEaDE. / BEDROOM #2 10' -11' X 13-0' 141 SF MASTER / /BE�R❑ ❑M 13'-V' X / 232 S=' \ / SLOPED \ / CCILM LS,, J L--,,l, � I --- IT-Sr �6 z ...— . A are HE ROORPLAMS AND ELEYATM OF ALL OEM N=JAR NOMES ARE COPYRL WM WE WLL ENFM ALL COPYWn TO PRDW CUM COfMBABLE NVESTLOU N DEYaOPHO 2RFR SFA MODULAR H HAN HOMES RESERVES THE RWff TO MAKE MNOR CHANGES IN N DIMEIN9IOS AS REOUIRED BY MODULAR CONSTRUCTION W HODS. THESE RJM AND ELEYATTOM3 PLANS AND ARCHITECT'S STAMP VALID ONLY FOR MODULAR CONSTRUCTION HT CHELSEA MODULAR HOMES, INC. 'WENT.• jpQ�y BUILDER: SITE LOC.: -- o o �Q�O� ° ° Q pdQb to Z ■ MANUFACTURER UFORMATKRR CHELSEA MODULAR HOMES. INC. OGRESS: ADDRESS: C� �1 E� r7 I�1M Me" @°G u Ow U PROJ. ID #: C666 SERIAL q: 0666 SHEET # DWN. BY: APP. BY: DATE; A -3a PW 05/29/96 -+ P.O. BOX 1108 ROUTE 9V MARLBORO. N.Y. 12542 914 -236 -3311 ®CDPYRIGMT 196 CHELSEA MODULAR HOMES - ALL RIGHTS RESERVED TIE A4LUITECTURAI I. 1 CONTAINED S WA (S PROTECTED IMK. SC[ilpl id' 6 TIE C➢PTRICMT .[i. 3) USL..S uEM E➢ illlf .vlMi SYAl Mli K YEOV.g1Q0 I° .Ir v.T QI UIIO td (yr6iMilllG .n unapt :i_ft.IN ccczc. aua. oco 06/07/96 MY C MH w OF /05/9F PW r u 1'N A1Vl C u u N T Y .DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES k ' DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner N A-1\l C-Y fi,7c l✓tA-C._ ` t k . ` Address I/ y 2Sf t2,et vE. Located at (Street) jA\1 1 LEA "U pRNE Tax Map 3 Block Lot ( o (indicate nearest cross street) Municipality Drainage Basin Date, of Pre - soaking SOIL PERCOLATION TEST DATA .� dIto Date of Percolation Test r i /mss/ Hole No. Run No. Time... Start - Stop Ela se Time Min.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Dro In Inctes Percolation Rate Min/Inch 10.0-1- /v;1-1 ltd z3 "- Zco' 3•� 3 21-7 4 5 2 /01171- 10', -8 l co ?--;5, - ax;' 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 eacn 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. .,U �1 .- DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.5',. 4.0' 4.5' 5.0' . 5.5' 6.0' . 6.5' 7.0' 7.5', 8.0' 8.5' 9.0' 9.5' 10.0' aa.s�a a as sJt�at"� DESCRIPTION OF SOILS ENCOUNTERED IN TEST DOLES HOLE NO. I HOLE NO. - $ -5 HOLE NO. --I_ Indicate level at which groundwater is encountered ,,/A Indicate level at which mottling is observed IVIA Indicate level to which water level rises after being encountered A Deep hole observations made by: � Yeed. wgtu ,,. cg-,, -Y Date 10 Design Professional Name: kk-4AWA�AM Address: j Cp,,g--- Cr, L C'r�� 2f't ,4JF: t. Signatun Design Professional's Seal if I R X?; 3.e 1p1`i 3' 4 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner 215z, 41 1A Address IIAVII- A N D Located at (Street) ._ �A �'i2 F% G 7? 172, Tax Map - 36,23Block. _L Lot 5 �Z . (indicate nearest cross street) Municipality PATTY 7ZS eft Watershed A ST b pA mole_ H SOIL PERCOLATION TEST DATA Date of Pre - soaking / Date of Percolation Test 9!2 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 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLD; NO. � Ci.L. 0.5' 1.0' 1.5' ._... 2.0' 2.5' 3.0' 3.5'. 4.0' 4.5' 5.0' 55 6.0' 7.0' 8.0' 8.5' 9.0' 9.5' 10.0',_ 4` y Indicate level at which groundwater is encountered IVO 14E. Indicate level at which mottling is observed /0 f 1.0 Indicate level to Which -water level rises after being encountered Deep hole observations made by: Date liesign rroressionai Name: Address: Signature: Design Professional's Seal Signature and I acknowledge receipt of this ieport .SIGNATUR] 02/96,:: Rev:, . BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 �1 LOREn'A 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 Ken Hurley Putnam Engineering 102 Gleneida Avenue Carmel, NY 10512 Re: Proposed SSTS: DeLuca Haviland Drive (T)Patterson, TM# 38 -1 -6 Dear Mr. Hurley: January 7, 2000 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: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regards. 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. 1. The SSTS is proposed on slopes greater than 15 %. All slopes greater than 15% and less than or equal to 20% must be reduced to 15% by the addition of R.O.B. fill. All slopes greater than 20% are unacceptable. 2. Neighbor Notification is required. 3. Minimum distance from the d -box to a property line is 10 feet. This is to be clearly dimensioned. 4. The proposed driveway's imperious surface is prohibited within 100 feet of Putnam Lake. (NYCDEP) 5. The proposed well must be located so that is not in the general path of the SSTS (NYCDAEP). Letter to: Ken Hurley - January 7, 2000 -2- Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ve ly yours, h, 4A/ 9PI Robert Morris, P.E. RM:tn Senior Public Health Engineer sstsproposed PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMMIT STREET LOCATION IVv�� fi.J n ` NAAIF. OF OWNER REVIEWED BY RBI, GR, AS, DIB, BH(J D /� 2a i9 TAX NIAP Y N DOCUMENTS Y N.-- . �` M z` a�- a o APPLICATION WELL PERMIT_ PWS LETTER LETTER OF AUTHORIZATION DEAN DATA SHEET (DDS) CORPORATE RESOLUTION SHORT EAF PLANS - THREE SETS HOUSE PLANS -TWO SETS J PAARIANCE REQUEST �� ►� 3 3 FEE /� SLBDIVISION Np�' LEGAL UBD� ti SUBDM 0 APPROV L CHECKED PERC RA FILL RE RED DEPTH CURT DRAIN REQUIRED ST PIPES GENERAL LO ATED N NYC WATERSHED PLANS SUBMITTED TO DEP DE EGATED TO PCHD EP APPROVAL, IF REQD DEEP TEST HOLES OBSERVED �Q FAD CS TO BE WITNESSED APPROVAL SSDS ADJ. LOTS S TLANDS (TOWNIDEC PERMIT REQ'D ?) TA_0 jN D DS PLAN_S_&PERNLITSANIE RE 1969 NEIGHBOR NOTIFICATI R% tTTERBI/ZBA �j ;} 00 YR. FLOOD ELEVATION )THER REQ'D PERMITS) REOUIRED DETAILS ON PLANS EWAGE SYSTEM PLAN - (NORTH ARROW) SDS HYDRAULIC PROFILE ;RAVITY FLOW EROSION CONTROL:HOUSE,WELL, SSDS PERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY & EXPANSION LOCATION MAP EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE: 4F PUMPED, PIT & D BOX SHOWN & DETAILED HOUSE - NO.OF BEDROOMS LLS & SS S'S W/N 200' OF PROPOSED SYS. PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) OUSE SEWER -1/4" FT. 4 "0; TYPE PIPE NO BENDS; MAX.BENDS 450 W /CLEANOUT FILL SYSTEMS CLAY BARRIER 10- FT. 0RIZON ;SLOPE 3:1 TO GRADE FILL SP S FILL NOTES FILL CER ICATION NOV, M L�FILb IN EXPANSION AREA TRENCH LF TRENCH PROVIDED :3%' 60 FT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED SEPARATION` DISTANCES SPECIFIED ON PLAN - FROM SSTS M10' TO P.L., DRIVEWAY, LARGE , TOP OF FILL 20'TO FOUNDATION WALLS _15'WELL TO PL 0' TO WELL, 200' N DLOD, 150' PITS 100' TO STREAM WATERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAN, PIPED WATER 10' TO WATER LNE (pits -20') 50' INTERMITTENT DRAINAGE COURSE -NW/500'PESERVOIR, ETC. _150' GALLEY SYSTEMS ao' CONSTRUCTION NOTES 'MIN to CDS= >5 %,g- 4 %,25'- 3 %,30'- 2 %,35' -1 %,1100' - <1% D SIGN DATA: PERC & DEEP RESULTS N to CD discharge /100'with 182 cons day discharge 2'.CONTOURS EXISTING & PROPOSED SEPTIC TANK DRIVEWAY & SLOPES, CUT 10' FROM FOUNDATION; 50' TO WELL FOOTNG /GUTTER/CURTAN DRAINS WE SOIL TYPE BOUNDARIES DIMENSIONS TO PROPERTY LINE TITLE BLOCK; OWNERS NAME,ADDRESS LOCATION OF SERVICE CONNECTION TM�,PE/RA; NAME,ADDRESS,PHONE� DATE OF DRAWNG/REVISION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET . PROPOSED FINISH FLOOR AND BASEMENT EL. COMMENTS: t Z 353 193 696 US Postal Service Receipt for Certified Mail William Miller P.O. Box 186 Brew*' X05 pg Z, 353 193 699. US Postal Service Receipt for Certified Mail Maureen Cowhey 4 Martine Avenue Whi Pa si NY NS, Postage Certified Fee Special Delivery Fee [[ r7 Restricted Delivery Fee in rn Return Receipt Showing to " Whom & Date Delivered 1.25 a Return Receipt Showing to whom, Q Date, & Addressee's Address 0 TOTAL Postage & Fees n $ 3.42 € Postmark oi Date Store: L Clerk: KWON a ! 01 /19 /00 - - -- — Z 353 193 697 Z 353 193 700 US Postal Service US Postal Service Receipt for Certified Mail Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail (See reverse) _ Jerry & Marguerite Short - 2 Sharon Road Frank Patte%j W5� & Lorraine RD pii� 1 rn rn .Q O O Co c� U9 rn a Postage O Postage $ O. Certified Fee �J Speci" al hbe !r /�` Special Delivery+Fee n Res DegV*y Fee U) :. rn Rat eceip i o l /t - 1.25 = Wh & ate Deliv a Reo Stowing to ' Q Date, & essee essil 0 TOTAL Postage ees $ .42 M Postmark or Date v. wora o Clerk: KP146PN n 01/19/00 o. Z, 353 193 699. US Postal Service Receipt for Certified Mail Maureen Cowhey 4 Martine Avenue Whi Pa si NY NS, Postage Certified Fee Special Delivery Fee [[ r7 Restricted Delivery Fee in rn Return Receipt Showing to " Whom & Date Delivered 1.25 a Return Receipt Showing to whom, Q Date, & Addressee's Address 0 TOTAL Postage & Fees n $ 3.42 € Postmark oi Date Store: L Clerk: KWON a ! 01 /19 /00 - - -- — Z 353 193 697 Z 353 193 700 US Postal Service US Postal Service Receipt for Certified Mail Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail (See reverse) _ Jerry & Marguerite Short - 2 Sharon Road Frank Patte%j W5� & Lorraine RD pii� 1 rn rn .Q O O Co c� U9 rn a Postage O O. Certified Fee 1 1. Special Delivery+Fee n n b N C, C Return Receipt Show! 1.25 Whom & Date Delivered 1 Z 353 193 697 Z 353 193 700 US Postal Service US Postal Service Receipt for Certified Mail Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail (See reverse) _ Jerry & Marguerite Short - 2 Sharon Road Frank Patte%j W5� & Lorraine RD pii� 1 rn rn .Q O O Co c� U9 rn a Postage O O. Certified Fee 1 1. Special Delivery+Fee n n b N C, C Return Receipt Show! 1.25 Whom & Date Delivered 1 Patterson, NY 12563 0,77 PO -1; 7-f C Certified Fee 1.40 Special Delivery Fe C Restricted Delivery fte CAM + Z in rn Retum Receipt Sho 9 1.25 m _ Whom & Date Delive = Return Receipt Slowing to L 1 S Date, &Addressee's Address 3 ` i 0 TOTAL Postage & Fees $ y j , 3.42 C Postmark Or Date Store: USPS U Clerk: KWAPN a 01/19/00 h i� l k a: =•t o rvl -fix✓ V, ,}1"Y•;:: sv f.,y f { i Er a ] 'Yr A i, � 2 4 S 1 5 t �;, Pty •' � s . ur +' � s- r }Yr k`�•��S S I t t�t� �2t t it r ' z 3 f 11, �� ,Q7 - ]s _ t r�i? r,I�r I��C ,xi 1� xn�� hi y!yI YS ,�., tyS f.�,, !�; �•�'. �f.> -J li ft' ! r F ,� ,i" Y2 ° rte+ i I L 11, i a1. t f 4 }. f > i M1, ij}Y t 'D t : ! rh - xr r• 1 i 4 i}i + �F^iv� it r, fy. f�i r �'+ c ,+ O h {1 6 nA O . t i ;a _yx �- tj � f�a ,_ +.' ;y fi r � srJ r• �M (D,..+ CY '.4 6 -4 ,, 5r y z r F. f �� rt t I f <- `F i ,i1;s 14 , ' r + 1: ro �• tt ,C F '. °ty s 't 3�1'' CD� CL <�, i ! r + j x at r, ,r'r a d i • tf s S fi< t> d� v ga # g,t r r f r.. ''t }112° \ i PF?It 5. Sl ,. 4 ff_r• t�,{r_EI }� �,t \.. ST }r�..p„a�e 1X' .,J >cl; En. (D �. -i f ' � 3 t G} - �, �' 41t, � i � � � • ? 1+ p� }itt' i � �r ✓v i V j ti. 6, YY r It i a I'rt rt`i]mPN'tt� fJl` , r r TOTAL ✓� x �.:J T s''t� +� � F xt,�j7, tF M�s M ? , fry t 'tC l;l' i7 ''r;lv{� T , t� I, +, -t, � t. +, a ;• " +'}. ted�ft t t1 d S ( p ,t, v ,N 1 tib �' ',z t J F A'; ty Postage QW r In � Id t.�r il�w L��.4 I 1 i. i F•,i,i i i t +t S ik J CJs r + .(�tr��,. •ts w I tz ry t 1 � I , t - sv3•Jr Z Sf t of x� t t �7 h h 43...t ti f2 :, It 7' tf lY ,bhy t ! r + i�rt i. s Y r{ Fe`"1` +.+ y}y r<� � f�tn �' y r 1�t�• L�.}�x w�ki4v. r ry5�' , A nj; J�� � " k . i w,.r �:^ 4 .r. :'`� ,. �: � t h 4 r <'� ,t a. Ft . w+ i 4 j, +1• -' �.' "y d .�;� '' ii r:,l _ fi: ti , ��t. f � � T S `r y T �`} ,} n z t t _� y � _- i "t tr r � °¢r N�.r �� � •07� i � f f f�. ,,y v �i� e Y t { k�' ' i' s �:• .' "' �'i� ..� LITVAM NEINEERIM LLE. January 14, 2000 EEnglneers and P Robert Morris, P.E. Putnam County Department of Health Geneva Road Brewster, New York 10509 RE: Delucia F^ D Haviland Drive _ Town of Patterson a 1 0 Dear Mr. Morris: This office is in receipt of your latest comments regarding the above referenced property, and we offer the following response: 1. R.O.B. fill has been proposed to reduce the existing 15% - 20% grade to the proposed 15% grade. 2. Neighbor notifications have been sent out. Enclosed are copies of the return receipt cards. 3. The distribution box has been labeled to maintain a ten (10) foot separation from the property line. 4. The driveway has been relocated outside the 100 foot buffer from Putnam Lake. A note has been provided stating that no impervious surfaces are to be placed within 100 feet of Putnam Lake without prior approval of the New York City Department of Environmental Protection. 5. The proposed well has been relocated uphill to avoid the general runoff direction from the septic area. At this time we would ask for your continued review and/or approval of this project. Very truly yours, PUTNAM ENGINEERING, PLLC By: �--r Ken Hukev KH:rk Enclosure (File L0015) 102 GLENEIDA AVENUE, CARMEL, NEW YORK 10512 • PHONE (914)225 -3060• FAX (914) 225 -2955 �et J THE CITY OF NEW YORK DEPARTMENT OF ENVIRONMENTAL, PROTECTION JOEL A. MIELE, SR., P.E. Commissioner Phone (914) 742 - 2001 Fax (914) 742'- 2027 Mr. Robert Morris, P.E. Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: Nancy Delucia SSTS Haviland Drive (T) Patterson; © Putnam East Branch Reservoir Basin DEP Project # 9924 ( joint Review) Dear Mr. Morris: William N. Stasiuk, P.E., Ph. D. Deputy Commissioner Bureau of Water Supply, Quality and Protection January 4., 2000 The New York City Department of Environmental Protection ( NYCDEP) has determined that the above Subsurface Sewage Treatment System (SSTS) project is incomplete. Please instruct the applicant to provide the following information before NYCDEP can start its review: 1. The SSTS ( both primary and expansion area ) must.be located in an area with a ground slope not exceeding 15 %. 2. Verify that the distribution box will be located at least 10 feet away from the property line. 3. The proposed well must be relocated so that it is not in the general path of the SSTS. 4. The proposed driveway's impervious surface is prohibited within 100 feet of Putnam Lake. The review of the SSTS project will not start until NYCDEP receives the required information. Should you have any question, please, do not hesitate to call me at 773 -4461. Sincerely, Lucie Lop Associate Project Manager Engineering Design Review xc: James Covey, P.E., NYSDOH 465 Columbus Avenue, Valhalla, New York 10595 -1336 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 Paul M. Lynch Putnam Engineering 102 Gleneida Avenue Carmel NY 10512 Re: Delucia, Haivland Drive (T)Patterson, TM# 38. -1 -6 Reservoir Basin East Branch Dear Mr. Lynch: December 23, 1999 The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on December 17, 1999 is complete. The Department will notify you by January 6, 2000 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 filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Dept. 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 Letter to: Paul M. Lynch - December 23, 1999 -2- 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 (914) 278 -6130 ext. 2159. Very truly yours, a�' 01- — - - Shawn Rogan SR:tn Public Health Technician Date: TO: Ptc•C,,Q'�` RE: 3 (T) Reservoir Reservoir Basin 6r Dear The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on ( 2i 1 f5'7 is complete. The Department will notify you by c„ ) (o of its determination. L 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 complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Dept. 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 meat (914) 278 -6130 ext. 2159. Very truly yours, Shawn Rogan SR:tn Public Health Technician ws2 Io- avfland p. -Mendel Pond F6 5-1 Haines itu tembeck I Corners Lake eys. 'Ch le 'Unique Area Corporate HS Fill GIES Corner r- Pond atfon Pond > ms State OR Police DOW Southeast Church 312 1 Unners m > Corn em m Woods Ilk / •o 4 ' cP ' f / ' `P9! C•Pff! / / Cv� / C•r99D / / / C•H!e / pwrir�M � OW Ike* m • �a 6 teen �' N \ 16 \ \ r ` \ \ !si �./ s Pier �e•r� c \ \ \ /C•Z:fe/ B-1 /eJ �. \ 27 \ / \ \ / C•Ieft \ \MCP' / / / /B•r //C �o B•? /OD\ \ \ / ��' cress \ / / / B•rin \ \ ; \ \ Q4 �l / • /� \ / C•rem / / / q e•Pin\ \26 / 47T / ' ' / / / COQ / CPn9 m / / /�'` •I /!r /�° \ \ . •1SrJr•:rr�'1YNIs�L I I ! °, aqy� / / ' °/ '� ierJ / / / / !B•taa \ 25 \ 1 1 30 1 1 / / \ 55 00 / `'\ 56 c•Pau czm / / : / �� ,� WATERFORD rx ' I 0 te/a c nv / ' 9p B•rin\ q. c e / / ' / � C•tdVD •IAJ / I C -PdJe C•1791 / 54 j / �• an // / 57 ° / •Zree / c -r9ii 9 \ ` c•PIJI _ iZrw 1 czeu rJJ az9ie _ 58 53 _ / _ 8 crBry curs w t f� �' - / �. . / /f•19/e� - - — — — — — — — — — f C•PetJ clvn - 1 'r/ �______60 � i �; / c•19// f-rsri °- / / - - - - - - - - - / C•19 /t — rt aaw C tni - f Ak L 15T.84 / •o 4 ' cP ' f / ' `P9! C•Pff! / / Cv� / C•r99D / / / C•H!e / pwrir�M � OW Ike* m • �a RECORD OF PRONE CONVERSATION DATE: TIME: PERSON CALLING: �//TZ/. ,�/ PRONE #: — REASON ( ) Inspection: Deeps and /or eres• SCHEDULED FIELD MEETING DATE: TIME: 1 e2 ROAD/STREET:— A V/ MZA%% 2 1:2 2 TOWN: TAX MAP #: d SUBDIVISION: OWNER: l/ e-- /0 C, 1 Ci - COMMENTS: LOT #: FROM : PUTNAM ENGINEERING PLLC PHONE NO. : 914 225 2955 Sep. 17 1999 09:10AM Pl s' qua S r r7 T L4 -A- aa� rkvm wa (OWAI 0 / < Ken ifwc / C.- , I i oa+e5 f ItI7 6/7 0 lloo 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 (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 Paul M. Lynch Putnam Engineering 102 Gleneida Avenue Carmel NY 10512 Re: Delucia, Haivland Drive (T)Patterson, TM# 38. -1 -6 Reservoir Basin East Branch Dear Mr. Lynch: December 23, 1999 The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on December 17, 1999 is complete. The Department will notify you by January 6, 2000 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 filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will'be deemed complete, subject to standard terms arid conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Dept. 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 — ., JL A. . -L ai. i .o v v A.1 i 1 1/1J1 ISAX A iv lr 1 V I' . 11L11 U 111 DIVISION OF ENVIRONMENTAL ]HEALTH SERVICES { APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM I. Name and address of applicant: /`! A td L ,�e A 2. Name of project: M Lei A S Stv S 3. Location TN: 4. Design Professional: FuGrA(AI-1 FW6ihlE��rtit�, 5. Address:1cD7 6. Drainage Basin: f A 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 2< 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... A10 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... ! \J c� 13. If so, have plans been submitted to such authorities? ........ ............................... 14. Has preliminary approval been granted by such authorities? Date granted: 1\' 15. Type of Sewage Treatment System Discharge ................. surface water groundwater 16. If surface water discharge, what is the stream class designation? .................... '=! 17. Waters index number (surface) 18. Is project located near a public water supply system? ....... ............................... N 19. If yes, name of water supply IVIA Distance to water supplyG,uaLm-71� ! -w� 20. Is project site near a public sewage collection or treatment system? ................ /\1 D 21. Name of sewage system ��� Distance to sewage system 6°```` 22. Date test holes observed 0 -7 23. Name of Health Inspector G e�-P- 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? ......................... A-11A_ 27. Is any portion of this project located within a designated Town or State wetland? NO 28. Wetlands ID Number ............................................:....... .......................,....... ....... IVIA 29. Is Wetlands Permit required? .......................................:...... ............................... NO Has application been made to Town or Local DEC office? 30. Does project require a DEC Stream Disturbance Permit? .. ............................... 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, ,, f landflling, sludge application or industrial activity? ............................ Yes/No " 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... 35. Are any sewage treatment areas in excess of 15% slope? .. ............................... 1\1D 36. Tax Map ID Number .......................... ............................... Map Block / Lot (0 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 L,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, tit at 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 SIGNATURES & OFFICIAL TITLES Mailing Address• .... ............................... lD-�- e l;nl Poe) ,A�l '-. 1416.4 (2187) —Text 12 SEAR PROJECT I.D. NUMBER B1i.Z1 k Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART i— PROJECT INFORMATION (ro be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR WT/ V AV-A 2. PROJECT NAME I V E_:�U S —k A 3. PROJECT LOCATION: _w1 A e,e� Municipality PLA'jr�(� �jQ /� County V � I 1 �►1('- � 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) 1,0 GA7-1txl 5. IS PROPOSED ACTION: CaNew ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: 1 D C t-t_-4 /Q &r 0A1 A14 QPF'PtV S iN6 L E 7. AMOUNT OF LAND AFFECTED: 01(.5' r,5 dos Initially • acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? iKYes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? � Iaesidentlal ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/ForesVOpen 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 yes, list agency(s) and permlVapprovals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes ,®No If yes, list agency name and permitlapproval 12. AS A RESULT PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? IOFF Yes No El �a.!_ I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant /sponsor name: PUTNQ%'n F/6 I N Cj5i-__ I NG i_LL �' Date: - Signature: v 1 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 PART 11— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? It yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another Involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may tm handwritten, If legible) C1. Existing air quality, surface or groundwater quality or quantlty, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or.culturat resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goats as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities likely to be induced. by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified In ClwdW Explain briefly. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III— DETERMINATION OF SIGNIFICANCE (ro be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether It Is substantial, large, important or otherwise significant. Each effect should be assessed in connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a positive declaration. ❑ Check this box if you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency "0 : i-1 j'.�i i I — Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer—(ITW!fferent from responsible of icer): Date 2 Goulds Suboners6ble Effluent Pumps �G 3 VV a '4q'.b1°•w^�3TT:r - Goulds FEATURES a.m-. 1. Impeller HP " "Y � Suomersibie 2. Casing 3. Mechanical 7 z W Solids Y Welghf Seal __s_"�' ". � �G•'wrJ.',a:4Z.1�1 . kt 4. Shaft ?.�i'.Yu�..sc+ : :GT� r ry` --'.4i .i 5. Motor a .•'*�.rm s s s- •.-.,+++s. _ Fumoolhs 6. Bearings — Upper & ��n w w� ®® Lower 7. Power Cable r ' � 8. O -Ring. f 6. f; 5�7 x � 4 .x _y- d 47�xJtQ] 6 z 4 .3885 r� r x a r 2 z {� 4 vY 'a•4`-i- ' '4q'.b1°•w^�3TT:r - -4"'. yrn" S ST`i ,_/i` a a.m-. _ v HP " "Y � �r M Max z z W Solids Y Welghf .y_.e .,�. _ __s_"�' ". � �G•'wrJ.',a:4Z.1�1 . . >�J�> . .5.........�',...%.e ? ?.�i'.Yu�..sc+ : :GT� r ry` --'.4i .i j a a .•'*�.rm s s s- •.-.,+++s. _ _sz" ` `ti"^^ _rnrs � ��n w w� r ' '4TM f f; �E0312M r f + 4 " "°el•1i+ . .x _y- d 47�xJtQ] 6 d• V �_ r� r x a r 2 z {� 4 13 0 i i 34 a 6 t t� X �Oki HT a ` a 1 �E0532H n nc 2 208/230 3 3`" 3 3 4` A Nw A�� E0534H 1 1!2 r r 460 r r 1 17 ,y �E0511HH : : z 115 1 130 E0512HH a , ,w E0532HH r r a y� !E0534HH � rt r . � 3 3 , , r•�, - -' � �,�`:'�:, r r ��z X230 1 E0712H c c "� X 1 Y Y9 0 T T EO_732H f f3 /4 X X8/230 3 3 4., 'STEM ` x TLP 18��"60 ;f 33 -- 4 �•� n k' r Sti a�i'S�Y <' r x Y X K r r b ROTA .1 F 2 ease.of:orderingand',instaila `:`sWE0311L„12Lor,WE0311M 12M � , , N tion: A single ordering number : ` WE0511 HH,12HH - .specifies a.complete system-, Mercury Level Control Switch = ' ,'i designed for most residential 62 -5 (115.4), A2�6 and commercial sump and -Basin A7 -1801S + effluent pump. applications 3/e Basin Cover Aa 1822 Check Valve A9-2P " .KICK BACK Order No.: SWE0311L, SWE0312L, D; ,% ,� '�� and 1 HP 15 "" t for model °WE0712H & WE1012H = 18'; f SWE0311M, SWE0312M, a P SWE0511HH, SWE0512HH. 1 /2 HP 18' Available Certilicatlorre:. SA' Canadian Standards Association P� Pennsylvania Bureau. of Mines for non -face applications — BOTE 91. -- 4 �•� n k' r Sti a�i'S�Y <' r x Y X K r r b ROTA .1 F 2 ease.of:orderingand',instaila `:`sWE0311L„12Lor,WE0311M 12M � , , N tion: A single ordering number : ` WE0511 HH,12HH - .specifies a.complete system-, Mercury Level Control Switch = ' ,'i designed for most residential 62 -5 (115.4), A2�6 and commercial sump and -Basin A7 -1801S + effluent pump. applications 3/e Basin Cover Aa 1822 Check Valve A9-2P " .KICK BACK Order No.: SWE0311L, SWE0312L, D; ,% ,� '�� and 1 HP 15 "" t for model °WE0712H & WE1012H = 18'; f SWE0311M, SWE0312M, a P SWE0511HH, SWE0512HH. 1 /2 HP 18' Available Certilicatlorre:. SA' Canadian Standards Association P� Pennsylvania Bureau. of Mines for non -face applications — BOTE 91. Performance Curves METERS FEET 25 0 = 20 a 0 P- 15 10 5 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM I L - II 0 10 20 30 m'/h CAPACITY �GOULDS PUMPS. INC. Se4KA FANS NEW YORK 13148 METERS FEET ! 120 MODEL 3885 35 i4 VVIlu� 110 WE15HH 100 30 90 25 80 c 70 Z 20 J FQ- 60 H 15 50 WE05HH 40 10 30 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM L L j 0 10 20 30 m3 /h CAPACITY ^ - Effective July, 1985 MENNEN , ME Omni����������������������� 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM I L - II 0 10 20 30 m'/h CAPACITY �GOULDS PUMPS. INC. Se4KA FANS NEW YORK 13148 METERS FEET ! 120 MODEL 3885 35 i4 VVIlu� 110 WE15HH 100 30 90 25 80 c 70 Z 20 J FQ- 60 H 15 50 WE05HH 40 10 30 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM L L j 0 10 20 30 m3 /h CAPACITY ^ - Effective July, 1985 ��( so-2ss561 3273 � C. CRESCENZO L. OR NAELUCIA 219 11 HENRY DqWL-I, fl- HOPEWELL JUNCTIOt R a I Ff RR 12 Id • �O PAYABLE ONLY A ORIGINALLY WN • A =EN PEj�LY Ejj��IID ED ,( PAYER THE �»t/ ,�b( � I Q, ;{-7, D� ORDER OF , � -C�C�. _''�/ .v d v!/ DOLLARS El BANKOF _ S�F ls7S N}V Romeel AUTHORIZ G RE YORK xepe.eu)unaion KY Iu73 DO NOT DES OY ,5� MEMO ,ddf4BRANCH NO. 0U ur i 0 0 2 b 9 0 2 3 5' CIRnRICATIO 1 u►eEL 3 II ®6 7Lg 9999908 4 11' 3 S 2 26 - nn wm osrnv" -- Tm o 38 - a —Co - UTNAM NGINEERING,PLLE. Engineers and Planners December 14, 1999 Mr. Robert Morris, P.E. Putnam County Department of Health Geneva Road Brewster, New York 10509 RE: Delucia SSDS Haviland Drive Patterson, TM #38 -1 -6 Dear Mr. Morris: This letter is to inform you, at the request of the client, this office is now the engineer for the above referenced project. Our client has previously paid the review fee (copy enclosed) and we have revised the plans and septic locations in order to address your comments to Petruccelli Engineers dated January, 27, 1999. At this time, we would ask for your offices continued review of the above project. Very truly yours, PUTNAM ENGINEERING, PLLC By: Z� Ken Hurley KHA (File 990710) 102 GLENEIDA AVENUE, CARMEL, NEW YORK 10512 -PHONE (914) 225 -3060- FAX (914) 225 -2955 b, 6 r 2 y�� 9 Mail - i,,f 3 �'�4 5'. �. ,'- ':. 3't ��' �; `ci. '■� A �` ; a i ?�, F 7 LETTER OF AUTHORIZATION RE: Property of i ANC- V 6 L UC-t/-% Located at 1+ A,,., i L A?--j t=> - T:.- >P, iy� T/V �� -rrsd� Tax Map # 3 S Block . I Lot � Subdivision of l°,„ rt -a. &r-1 Las ---a Subdivision Lot # 21-71 - 2--1 %o Filed Map # 14-1 ...1 Date; Filed 3/ z.o/ 35 Gentlemen: This letter is to authorize. Furt,,,,r., fR.a_. e- 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 treatment and/or water supply systems in conformity with „th�,e p signs of Article 145 and/or 147 of the Education Law, the Public Health Law, and P.E., R.A., # itary Code. Mailing Address 162 &t.Er -►agaas 4,,L&- C -/-MmrsL State Ny Zip 105(a- Very truly yours, Signed: U, i (Owner of Pr perr ) Mailing Address: 64 flice lcG (J� State 9/�� Telephone: 22,5 - 30a-o Telephone: o� -a ° Zip say 0 4 714 C5 11 62.001 8 STOGY I 11- 12- 11 DIS T/118U 43 oX Wh T Ml W i ,Sr - ,. t i .1 � i 4; - T ,, z k 4".�105W Fi4 AN" 14 26 FUE ,.-ENGINEERS` ARCHITECTS 4.. OLD ;ROUTE 6, BREWSTER, NEW YORK 10509 FAX (445) 2.19 -6169 -CNq!NM 20 RING PLLC 01 REVISIONS N a 1-1 0 4 7 '4 I IWELL ENLARG[ A 47 D 30 1 2 3 4 5 6 7 9 10 11 11 12 A 100 121 118 115 Ili 86 80 74 78 32 34 72 83 78 73 68 63", 79 72 70 65 14 26 FUE ,.-ENGINEERS` ARCHITECTS 4.. OLD ;ROUTE 6, BREWSTER, NEW YORK 10509 FAX (445) 2.19 -6169 -CNq!NM 20 RING PLLC 01 REVISIONS N a 1-1 0 4 7 '4 I IWELL ENLARG[ A 47 D 30