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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.31 -2 -7 BOX 18 ? r� 14 -'�m FL ",I- rmr ki :;; Ll fiL , L44 r 16 .,,1_ , - , L11 %P 01982 PUTNAM COUNTY DEPARTMENT OF HEALTH s:.DI ION- OF - ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE ,_ TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT #' P- �6 - 00 Located at 9 J 1500TH L4 Town or Village Owner /Applicant Name -J 9 W 6 L0 H H�Ll- Formerly J05 . O K�-60-4Tl H 0 Tax Map 9)(0' � I Subdivision Name Block 9- Lot - 1 NNW Lp(� Subd. Lot # 10" 1 " 109-r-A I 10'PA L 10 9,14 Mailing Address kQ > Zip ( 6� Date Construction Permit Issued by PCHD ('s J(p 100 Separate Sewerage System built by Joy 0`C -fJOW , Address'N n IWIMAW R9i mf,wkjt� Consisting of 1 000 Gallon Septic Tank and 2K)o Other Requirements: � LI. Water Supply: Public Supply From. Address E � Private Supply Drilled by ��U, Q� -;�1N� NHL Address-76 Building Type 1 Has erosion control been completed? Number of Bedrooms Has garbage grinder been installed? Ho - T_certify. that .the system(s), as listed, serving the above premises were constructed essentially as shown on the as- - with the issued PCHD Construction Permit and approved " -^ ► _nt_o£Health. PUTNAMnCOUNTY HEALTH DEPT. - _ R.A. __ . Road N'Y ) 29 "30 Brewster, 50 0 V J O - _ � - 3 Received of .V.? 3 / (/,Q 9i Date .. � ©� �% The Sum'Of r. Imay be necessary - � e separate sewage r Dollars X00, SID _ e and the approval qR 's available. Such 9- foz io:) lath Director, such ❑ Cash / Zq HANK YQ(Jl i Check C1M0. {:.. /OQ�Y Cl Credit Card BY , By. - A/ _ _ White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - DesiW. Professional Form CC -97 BRUCE R. FOLEY LORETfA MOLMARI RN. M.S.N. - PuNjW. tt :Diiigior - - - :Mtociors` solth Davmr of iZii Servlaa DEPARTMENT OF ' HEALTH 1 Geneva Road • " Brewster, New York 10509 Eavlroomeotal Health (914)271-61'30 Fax (914) 278.7921 Nurdag.Servlea (914)271.6358•-• WIC (914)271--667$ .F1x(M) 278.6083 Early" Ioterviodoo'(914) 211'• 6014 Preschool (914) 278-6012 Fax (914) 279% 6641 E911 ADDRESS VERIFICATION FORM �fl�M GJ� C - OWNERS NAME: pNl•IE)_L • • �► - -� TAX.' P. N[JNIBER..:... .. ._ ....... .. .. " .._.. __......... - -- - E911 ADDRESS,. .. ... 7 S p u ?"/ L X 1<,6 TOWN: _..��pl -@ _ .....:...... AUTHORIZED TOW - rfl0 glCIAL:. :...... (Signature) ...... . ............7 foes .. _ .... __. . DATE: The- -Putnam -County- Department of •Health will not issue a Certificate of Construction Compliance unless the above form is. completed, i.e., a legal E911 address.is assigned by an authorized town official. This form-is to be submitted'- ., ...._. with the application for a Certificate of Construction Compliance. (E91 I VERFRK �- PUTNAM COUNTY DEPARTMENT OF HEALTH ' DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT. Well Location Street Address: South Lake Drive �� Town/Village: jMfap%A1 Patterson Grid # Block Lot(s)1 Well Owner: Name: Address:. Joan O'Connell 13 Interlaken Drive Patterson, NY 12,63 Use of Well: 1- primary XXXX 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 46 ft. Length below grade 45 ft. Diameter 6 in. Weight per foot 17 lb /ft. Materials: X Steel Plastic _ Other Joints: _ Welded X Threaded _ Other. Seal: _ Cement grout 1XI 'Bentonite Other Drive shoe: X Yes No ILiner 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 20 gpm Depth Data Measure from land surface- static (specify ft) 60 During yield test(ft) 340 Depth of completed well in feet . 3n0.. Well Log If more detailed information descriptions or sieveanalyses __.: are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft.. Land Surface 3 6 Packed Cla 3 200 o Black & White Granite -._ ..- .z.08__.. -,_ _..:_.3 -6-0.._..... .20 . 6- -Granite wi ih seams quartz white - If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 300 3 Pump Type s l, h Capacity 10 Depth 240 Model 10GS10412 Voltage 230 HP 1 hp Tank Type B1 adder Volume 360 20 Date Well Completed 5/17/02 Putnam County Certification No. 2 Date of Report 10/331/02 Well Drille ature) NUTS: Exact location of well with distances to at least two permanent landmarks to be j!Yovided on a separate sheet/plan. Well Driller's Nam DuLLTNG,INC. Address: 75 Putnalz Ave., Brewster, NY " - Signature: Date: 10/ 31 / 02 White copy: HD File; Yellow copy- Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 Harry W. Nichols Jr.., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Telephone (845) 279 -4003 �_._ .:.•_..... t. _. _ - .12-....-,-Feiji-(845)'279-4567-- December 5, 2003 Robert Morris, P.E. Putnam County Health Department One Geneva Road Brewster NY 10509 RE: Individual SSTS Compliance - O'Connell 97 South Lake Drive Patterson, NY T.M.-# 36.31 -2 -7 Dear Mr. Morris: Enclosed are the following: 1. Five (5) prints of Drawing S -1, "As -Built SSTS ", dated 10/29/03. 2. "Certificate of Construction Compliance for Sewage Treatment System ", dated 12/05/03. - 1 - .. Three-(3) copies of "Guarantee of Subsurface Sewage Treatment System?' - dated 12/05/03. 4. Laboratory Report", dated 11/05/02. 5. "Well Completion Report", dated 10/31/02. 6. Application Fee in the amount of $200.00 payable to Putnam County Health Department. 7. "E -911 Address Verification Form ", dated 07/10/03. Very truly yours, r Harry W. Nichols Jr., P.E. HWN:gav 00 -037.00 -- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH. SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENt SYSTEM tiJ aAM 0` Go.HHEL_ Owner or Purchaser of Buuilding . .JQ A-4 01 coo OG[�,I,- Building Constructed by Location - Street Building Type 2 Tax Map ,Y Block Lot TownNillage Subdivision Name Subdivision Lot I represent that I am wholly and completely responsible for the location, construction and drainage of the sewage treatment system serving the above that is has been constructed as shown on the approved plan or approved an accordance with the standards, rules and regulations of the Putnam County D hereby guarantee to the owner, his successors, heirs -or assigns, to place .in € any part of said system constructed by me which fails to, operate for immediately following the date of approval of the- "Certificate of Construct sewage treatment system, or any repairs made by me to- such system, exc operate properly is caused by the willful or negligent act of the occupant of 1 s Y ..._ stem. The undersigned further agrees to accept as conclusive the determinatic Director of the Putnam County Department of Health as to= whether or not I to operate was caused by the willful or negligent act of the occupant of tl system. )rkmanship, material, :scribed property, and idment thereto, and in srtment of Health, and d operating condition period yof two years i Compliance" for the t where the failure to building utilizing the of the Public Health failure of the system building utilizing'the Dated: Month Day 5 Year 200 Si gn afore: � Title: : GV Contractor (Owner) - Signature Corporation Name (if corporation) - Corporation N (if corporation) Address:-lb- 1 �fEQ-� Y-V j 1?'NT04XJ� Address: I$ I P - Maso o State 1" zip ►`� P� State IVY Zi I'�Wh P Form GS -97 JMS ENVIRONMENTAL SERVICES, INC. 1500 SUMMER STREET STAMFORD, CONNECTICUT o6905 NELAC, CT and NY State Certified. Environmental Laboratory Mailing Information: Name: Mill Drilling Co. Address: 75 Putnam Ave City: Brewster State: NY Telephone: Sample's _Information: Client: Joan O'Connell Zip: 10509 Fax: 845 - 279 -5075 Collector's Information: Name: Bob Address of site: South Lake Dr City: Patterson State: NY Zip: Telephone: Site: water tank Date Collected: 11/4/02 Date Received: 11/5/02 Preservative: HNO3 Time Collected: 16:45 Time Received: 12:00 Temperature: <4C Lab No.: J024202 Date Analyzed Test Name Result MCL Method 11/5/02 15:00 Total Coliform Absent Absent SMWW 92228 11/5/02 Chlorine Free Residual <0.1 mg /L N/A SMWW 4500CIG 11/6/02 Color ND 15 Units SMWW 2120 B 11/6/02 Odor ND 3 TONs SMWW 2150 B 11/6/02 Iron <0.03 mg /L 0.3 mg /L SMWW 3111B 11/6/02 Manganese 0.016 mg /L 0.3 mg /L SMWW 31118 11/6/02 Sodium 23.7 mg /L N/A SMWW 3111B 11/6/02 Chloride- _ - -- - . 40.0-mg /L - 250 -mg /L SMWW 4500-0 C -- -- 11/6/02 Hardness 196 mg /L N/A J SMWW 2340 C 11/6/02 Nitrate 1.84 mg /L 10 mg /L SMWW 4500 NO3E 11/6/02 12:00 Nitrite <0.1 mg /L 1.0 mg /L SMWW 4500 NO3E 11/6/02 pH 6.80 S.U. 6.5 -8.5 S.U. SMWW 4500 H B 11/6/02 Sulfate 24.4 mg /L 250 mg /L SMWW 4500 SO4F 11/6/02 Turbidity 0.80 NTU 5 NTUs SMWW 2130 B 11/6/02 Lead 1.70 ug /L 15 ug /L SMWW 3113 B At the time of analysis the sample was acceptable for total coliform N/A = Not Applicable mg /L- milligrams per Liter t ND- None Detected S.U.= Standard Unit NTU- Nephelometric Turbidity Unit MCL- Max. Contaminant Level TON- Threshold Odor Number ug /L- micrograms per Liter Signature. '" '�'`t- State #: PH -0218 Michael Lapman ELAP #: 11715 President Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION hKM11 E TREATMENT SYSTEM PERMIT # Located at HWMA1 x, Town or Village P "rHW LAW jo2Ai -wAz ���3r � i Subdivision name Subd. Lot # ta2gt- 1o'tq�Tax Map Block Lot Date Subdivision Approved 2i 1®l ')l Renewal Revision X Owner /Applicant Name J o AH Q'C()00SL4- Date of Previous Approval G/4r-/00 Mailing Address 19) 1 WA k" ? � � j H Zip Amount of Fee Enclosed Ir3o 00 12,563 Building Type R�WI�HLE Lot Area p >S4 No. of Bedrooms �5 Design Flow GPD 600 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1000 gallon septic tank and 600 l-F 06 Other Requirements: To be constructed by -'OD Address _ Water Supply: Public Supply From __.. ._. _ Address._ or: Private Supply Drilled by Address _ I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment a stem 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 I Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date 01 License # 5619,4 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued. unless construction of the sewage treatme tem has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified whe ns' ered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Avioved fo ischarge of domestic sanitary sewage only. By: Title:D k Date: ?- d Z White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM. COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE. TREATMENT SYSTEM `1vd"-11;', '. :':4J�Nli ..'..►J{V�J .14{r11W - -111fW 1U�i1'.:': Tb 3 � �, - 2�� � � �� 2 �0 Li . 4 i 0 3. -1q�'� 4 5 2 .3. 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each 'percolation test hole'. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2: Depth. measurements to be made from top of hole. Form DD -97 Indicate level at -which groundwater is encountered " Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: 04A Date to Design Professional Name: VA kW UP Kuy-h, JN @� Address: r3F NEW Signature: ' No. 56124. Design Professional's Seal 9aFESS+a� TEST PIT DATA - 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO, HOLE NO. G.L. - 0.5' . .... -ro? OA -q-,y, 1.0' 1.5' 2.0' d� l 2.5' 3.5' _ 5:0' 5.5' T. ..... ; 6.0' 6.'51 7.0' 7.5. cD _; -, 10.0' .. Cn n� Indicate level at -which groundwater is encountered " Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: 04A Date to Design Professional Name: VA kW UP Kuy-h, JN @� Address: r3F NEW Signature: ' No. 56124. Design Professional's Seal 9aFESS+a� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL p please print or type i Vf CHD Permlt # Well Location: Street Address: f Town/Vill a Tax Grid # 11 QH�/ ����"1 ' [' Map lG -'JJ lock t Lot(s) Well Owner: Name: Jp� 0 kcc)OKIL Address: Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5+ gpm # People Served '6-- 5 Est. of Daily Usage °o gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No X Is well located in a realty subdivision? ...................................... ............................... Yes x No Name of subdivision PvrHAw 1-NZ Lot No. 14q -`Aq -Io1v Water Well Contractor: 1V Address: 10 `" - ° Is Public Water Supply available to site? .................................. ............................... Yes No X Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contaminatio tLerovided on separates et/plan. Date: M - -1-°1" C'I- Applicant Si nature: M PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (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. revision or alteration of the approved plan requires a new permit. Well to be constructed by a water ell 'ller certified by Putnam County. � AA Date of Issue Permit Issuing Date of ExpirationZ a Title: Permit is Non- Transferrabl &IJ White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 + PUTNAM COUl\"TY DEPARTINIENT-OF. HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES � s /� '710 3 FI\i'AL SITE INSPECTION / eorcMe+e Date: 02 Inspecte y. ! ', ?Fr Street Location xrrs� G,¢kE �2, Owner 4 z Town Permit 4 2P—' TM P -36, 3 / — 2 — ? Subdivision Lot 4 1,o2fe9 1. Sewage Svstein 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 ...... ............................... a. z)epzu-xanK_svze r ....... ;t�t�......... ....... b. Septic tank inst vel ................ :.............................. c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ......... ..... 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. f. Junction Box - properly set ........... ............................... I . Zength required 3 ov Length installed 30g 2. Distance to watercourse measured+1 o o Ft.......... I. 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 3/4 -1'/:" diameter clean .................... - 9. -Depth of gravel -in trench -'12 "'minimum ................... 10. Pipe ends capped .................................. :.................... g. Pump or Dosed Systems 1. Size ot pump chamfer ................ ............................... 2. Overflow tank ......:...................... ............................... 3. Alarm, visual / audio ..................... ............................... .. 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ......................................... : .................. . 6.- Cycle witnessed by H.D.estimated flow /cycle........... III. HouseBuildin a. House located per approved plans ... ............................... b. Number of bedrooms ....................... ............................... . IV. Well a. Well .located as per approved plans . ............................... b. Distance from STS area measured 11�20 ft ........ .�. . 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 & dirAo exist watercourse g. Footing drains discharge aw from STS area..... .► COMMENTS Por, /, S`. ell I ?5 G/O 1. JUN -04 -2002 03:31 PM HARRY W NICHOLS 914 279 4567 ?UTHAM COUNTY DI.PART11iW OF UALTS Drmw ow mmumnAL m g's amts ATTEN'Y'xON 0 ADAM JaGENL •' R CC)ST FOR: II��iSP.C�YON Fort- Fill _ A!1 Wormatloa must be faytiompicted prior to my TrU4e1 �._..�. laspewoas bole$ made. p= ConsUVedon Permit # •r" %- to Hoa.�►ow. IL NTrEIL PM Located: ,.�.�., �Pd -t•— a' ,� HrE1 -1r �� ��1 l Bloeic ...,.� Owner /AppUcaut Name• Ti j e* - rot ' Pormaly: bl bM9 k W0 _ Subdivision Name; p "A'O I��I�i4 Sabdiviuon Lot t0"61 Is systt a Fil completed? Ds1t0: is ayi= compute? �� T, Dato; .�„�.,,,.. 10 �T _ Is q%0M eoaatrtioted.aa por plus? , Is weB drllied7 �„�...� �� . —.r..l Date: Is weD boated su par pleas? _ _..— , Are erosion control measures In place? �db�...... I carts tbet the syg4gs), as HWA as the Owe pre mbas btu bone coastr acd sad I hm Inspected ea ._verified t cir mplodon in accordauce with the issued PCHD Canis cdon permit snd _......_.__._..4.� ._Y �apProv'ed-piaas- and- th&Steaderds,. Rule aad,Regul uoas oftho_Pum= County Deputtaout of Dur,: L � d� Cwllad by: PE ,,, RA • D i' pro[esslocel � r Addreu: ,2oSb �- �; 10 og L.ia. u - 6Q16 Force M-99 P.03 BRUCE R FOLEY Public Health Director June 12, 2002 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 * Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509. Re: Field Inspection - O'Connell South Lake Drive, (T) Patterson TM# 36.31 -2 -7 Dear Mr. Nichols: The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. _ A., - The first distributiori.box needs to. be cleaned _out: - 2. Replace 900 elbow from tank to SSTS with two 45° elbows. 3. The well casing needs to be raised to 18" above grade. 4. Re- install silt fence below well area. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. GDR: cj Sincerely, e Gene D.. seed b Environmental Health Engineering Aide SENDING CONFIRMATION DATE : JUN -13 -2002 THU 04:34 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 92794567 PAGES : 1/1 START TIME : JUN -13 04:33 ELAPSED TIME 0014011 MODE : G3 RESULTS OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... BRUCE R. FOLEY LORETrA MOL2MRI RN., MAN. A6N. H-0 Dbex> Areaelar AWk D..NN Dpirctor Db 4f A6Mr dorrtu DEPARTMENT OF HEALTH I Geneva Road Brouster, Naw York 10509 sswenmw eoes (e.st171.6ta0 s- (ws)2re -tsa1 a.r+.t wW- P0)= -65X1 WIC (243)273-6M aap4s1n1.6a5 ray r.a...w.(145)sn -6014 Ws(sA7)an•6661 time 12, 2002 PatMainPark, Suite 106 2050 Route 22 Brewstor, New York 10509 Re: Feld lmpeclion - O'COMMI . South Take Drive, (1) Patterson TM# 36.31 -2 -7 Dear N k. Nichols: The above rdWanood separate sewage treahaeot system can be bacldilled. The following comments muse be corroded in the field I. I'm Bret distribution box needs to be cleaned out 2. Replete 90° elbow from tank to SSTS with two 45" elbows 3. The well casing weds to be raised to 19" above grade. 4. Re- install sift Bence below well area. If you have any fiuow 4uesdonx please contact we at (845) 2794130 md. 2261. Sincerely, I. A. to Oeoe D. Deed GDR:ef Enviromrte.nal Health Eagincming Aide r . LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early InterventioNPreschool (845) 278 - 6014 Fax (845) 278 - 6648 December 19, 2003 Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Re: Field Inspection - O'Connell South Lake Drive, (T) Patterson TM# 36.31 -2 -7 Dear Mr. Nichols: ROBERT J. BONDI County Executive Upon re- inspection at the above referenced lot it did not appear that comments from my original letter dated June 12, 2002 have been addressed. The original comments are as offered. 1) The first distribution box needs to be cleaned out. 2) Replace 90° elbow from tank to SSTS with two 45° elbows. 3) - - The well casing-needs to-be- raised- io-18' -above-grade. 4) Re- install silt fence below well area. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Sincerely, Gene D. Reed Environmental Health Engineering Aide GDR :jc fieldins ' PUTNAM COUNTY- DEPARTMENT OF HEALTH DIVISION -OF ENVIRONMENTAL_ HEALTH. SERVICES LETTER OF AUTHORIZATION RE: Property of _ J 0 �M �� Go j 4 W Located at �� ;NO:jL . TN Tax Map # Block Z Lot Subdivision of L— ,r" Subdivision Lot # to1A'L- lo'YgH Filed Map # Date Filed. Gentlemen: This letter-is to authorize 1+P'W W , i4vmi.� I j— QE duly licensed Professional Engineer X 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. M si iovi ty p �Q.as~of Article T45- and/or l4� of the Education )✓aw, the Public Heal( Law, and the Putnam Ja No Code. NIC A� *�,IN � 1` Very trul ours, Q. LU x W Countersigned: - �' = Signed: - (� 106 P.E., R.A., # No.56 2 t�, (ow rofProperry) Mailing Address 9-b State Zip 10 Sod Telephone: (845) Mailing Address: 19) 1MTE34-+� R0�0 PAT7EP-60H State H `'1! Zip 115 �'b Telephone: Ns l -19 819 Fomi L.-\-S- January 29, 2002 Mr. Robert Morris, P.E. Putnam County Health Department 1 Geneva Road Brewster, NY 10509 Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Telephone (845) 2794003 Fax (845) 2794567 RE: Individual SSTS - Revision/ Name Change O'Connell (Formerly Joe Nargentino) South Lake Drive, Patterson, NY T.M. # 36.31 -2 -7 Dear Robert: Enclosed are the following: 1. Five (5) prints of drawing S -1, "Proposed SSTS," revised 1- 29 -02. 2. "Short EAF," dated 1- 29 -02. 3. "Application to Construct a Water Well," dated 1- 29 -02. _4 "Construct on,Pernit fpr_S�wage.Disposa�.S.ysxem, ". dated. --2 9 -02. 5. "Application to Construct a Water Well," dated 1- 29 -02. 6. "Design Data Sheet." 7. "Letter of Authorization," dated 1- 29 -02. 8. Two (2) copies of Residence Floor Plan(s), for `Bedroom Count Only. 9. Revision Fee in the amount of $150.00. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, Harry W. Ni ols Jr., P.E. HWN:his 00- 036.00 11 104 WW -Tact 12 PROJECT LD- R •, a. O 20 :......... S.EQ R NUM :..BE� -----Append State State Environmental Quality Ravlew' SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PRO.IECT INF6RUATION fro be completed by Applicant or Project sponwo 1: APPLICANT (SPONSOR _ �0AH o' �ON� AI✓ 2. PROJECT NAME J. PROJECT LOCATION., Jr �P� o1-R ' h Mww4pal county 4. PRECISE LOCATION (Street addr sa and road Intwswtlona, prorNnsnt landmarks, etc., or provide n►ap) 5. IS PROPOSED ACnM:, o Now .:::......o EXP&N W ._. ® Modlll"Uonialtsratlon 6. DESCRIBE PROJECT BRIEFLY. 7. AMOUNT OF LAND AFFECTED. 0- ';�° °'s0 InlUalty acne U!"Alsly aarw 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OROMER EXISTING LAND USE RESTRICTIONBt gy" ~ ` ONO 11 No, dwfft Melly 9. WHAT lS PREW LAND USE IN VICINITY OF PROJECT? ReakfanUah_,_._ -. D wusb6al --- �- C."Wwolav Q Phis -' -- _.- .__..._., _ ..-._ ❑ti► r'iot+ItWi' " ""� "�" ilOpan spat. �Otttar Deacrlb« Lj)MUII„E . F{!(�11� . 10: DOt a ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL. STATE OR LOCAL)? ❑ Ya t3No It yea, Ilat &GW& ( +) and PWWU&pprovala 11. DOES ANY ASPECT OF THa ACTION HAVE A CURRENTLY V" PEW OR APPROVALT %Yeti. :: 0N9 ; • If Wt "my W. W ub P"tiappmal tY04 12. AS A RESULT OF PRO� ACTION WLL ESNG PMff/APPOAL QWRE,M0KA o a _ I CERTIFY THAT THE I.NFORMA 'if ION PROVIDED AWE IS TRUE TO THE BUT OF MY KNOWLEDGE ApP1k4LnUtponw nww ' J ' j`J1 L�j I Q� QE �J. •tc�'J�j�tr O j' Z�'pt- Date: Slpnature: IJ ... If thtti-action l 111111`10' .Coastal Area, and you are a state agency, complete the . Coastal Assessment Form before proceeding with this assessment OVER PART I'1- ENVIRONMENTAL ASSESSMENT (To be.completed by Agency) __. . 'IK DOES ACTION EXCEED ANY TYPE t THRESHOLD IN 6 NY.CWPART 517.47, If yes; coordinate'tho_tevtew prowrlt..and- use _ qi NLL EAF. ❑ Yes ONO B. WILL ACTION, RECEIV.E'•000RDINATE0 REVIEW AS PROVIDED FOR UNUSTED ACTIONS IN 6 NYCRft, PART.b17.69. If No.a_neQalb� deelusllgn may w superseded by snother,btY01W4 EO!MA ❑ Yes . 0 No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED. WITH THE FOLLOWING: (Answeri may be handwritten, If leg lion or disposal, C1. Exlstlnp air quatlly; surf6as or grouadwa1fr quality or quantity, nolae level's, existing traffic pattern*, Eotb'waste production. potential IQ( erosion, drainage or flooding problems?'Expialn briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood characteR`Explaln briefly: CJ. Vegetation or launa; -11411, shellfish Or wildlife species, significant habitats, or threatened or endangered - splcles9.Edtplaln btlelly: _ I. C-4. A community's existing plans or goale U ofllcltlly adopted, w a change in use or Intenelty of use of land or other natural resources? Explain,lxislly C5. Growth, suosequsnt development, or elated activities IlMly to be Induced by the proposed eotlon7 gxplaln bristly, ti C6. Long term, irsorl term, oturwlathre, or other elleots not identified In C1-057 Explain briefly. tom' • C7. Other Impacts (Including changes In use of elthu quantity or type of energy)? Explain briefly.. o. WILL THE PROJECT av" AN IMPACT ON THE ENVIRONM ❑ Yes ❑ NO E is THERE, OR IS THERE LIKELY TO BE, CONTROVERSY REI D Yes ❑ No If Yes, -ixplaln briefly 0 PART Ill— DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTION &....For each adverse effect Identified. above, determine whether it Is substantial, targe, Important or othe0w..lse,slgnlficant. Each affect should be as asaed In oonneotloIn With its (a) sitting (l. , urban w nraq; ',(b) probability of, 000yrrinp; (c)_durstlon; (d) Irreversiblllty;'(s) geographic scope; and M magnitude. If necessary, add attachments *r referenos supporting materials. Ensure that explanations contain sufflclent detall to show that all relevant adversa,impaoti haw been Identified and adequately addressed. If question D of Part II was checked yes, the determination and:aignifidance must evaluate the potential Impact of the proposed action . on the environmental charactedstica of the CEA. O 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 def laratlon. O Check this box If you h&ve.determined, pqried on the Information and analyelvabovs-md any supporting . documentation, theft the - proposed action WILL. NOT result In any slgnlficant adverse environmental Impacts AND provide on attachments ;as' necessary, the reasons supponing this determination: Name 61 ea envy Print or' Yps Namq 0'_ Tsa KY .: e r rputure of ss tun of Fripaw cram.. ran responsible officer) • .. 9999.. PUTNAM COUNTY DEPARTMENT- OVHEALTH -.- ......._- DIVIKOMOX EN RONMENTA.L HEALTH;SERVICES` 9999. _ ' APPLICATION•FOR�APPRO'VA.i�•OF PLANS •FOR ` • • " ' A WASTEWATER •TREATMENT SYSTEM . 9990 0999.. ., �o�� 0 ,G o; 1. Name and address of applicant; � - PA imiii' �otJ . i -' 2. Name of ro'ect: s11-`t� DQ�� 3. Location TN:'�'0. P J ►,: o� 4. Design Professional � !� `� ���' ' S• Address: 5.. 6. Drainage Basin. P`� • .. � _- . � . •. , ..,. - 999_9.__ ._._ 7. T S?j�i ,. Private/Residentlia Food Service Commercial Institutional Apartmapts „ Mobile Home Park 9:999 -�.' 9999... .............. Office Building Realty Subdivision Other (specify) 8. Is this project subjsct tQ State�Euvironmontol Quality ReAew'(SEQR)?, Type Status .. .9. Is.a Draft .EnAronmentafImpact Statement (DEIS) required? ......tv.a;9:.......9tt. 1� "fV 10. Has DEIS been•eoriipletcd and found accepta.ble by Lead Agency? ............... • H. Name of Lead 'Agccy; N A Y 2. . Ii this project in'_an area under thi control of local planning,;oning, or other, , officials ,. or ?f :::::..........::.::.....::...:.::.... ..... :.!.:..I'.,.......a..;...: �.:.....:...... �,.�.:. •' -iy(. 1`: �... ;4 .�1��.iL••j•AS'F. .'.'. •.,.�:. I -•r 9_999 ... .. .. . 13. If so •haye.plans bceg :submitted to-such authorities? ' �•�ii�1 '1. •.. 'pan �rt•1 ' 'i.'J �i,. 1• .'. '•l �.T)•y.. jti.r .. _. •� _,. 14: Has preltminary};�va� beCi.ted by suc;authoi'itles ?�%: Date granted:p 15. Type of Sewage Treatment System Discharge:.......:: : :;_ surface water groundwater 16. If surface water c�iscrg what isrtliastreaaa class designation? . .. ., r ei Rttt9ttlttt.u9t11t! ' �, 17. Waters index nuiitbei ....: .:..........atttt9tt91t91919991 119199 .. :...,........................ - -- (�J•/k• {, .. .. .. 9999 _ ... ..,.,'i.!•..... ... .. .. 9999 1" TT .._ .. 18. Is project located near a public water supply system? .........ata...a , t9...1a9a9;99,9, N p.. 19. If yes, name of water supply` :' ' ;' �`„�- Distance to vr►ater su► ` .,•; •, --- : ►,,••; 99,;09.. . •. , 20. Is project site near a public s'ewge,collection or treatment system? +` �`p ` ........:....... 21. Name of sewage system �j rA _ Distance to savage: °system 22. Date test holes observed lA 12A q 1 23. Name of Health Inspector 6EH6 24. Project deli Aow allons er da 1 .......::.......a..a..::.. •D.� �... 8n _ G8 . P Y) .: 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... Njy 1i% UAW 0 DT'1ee. A.Kw�fAA�S A.� �.Aw� wt.i: �:.Y_� •G' 1_ . .. At,w M State 7. Is any portion ord.11s Otoject located within "'a designated,Town.or S ? WdtI:ands ID -N ete'099e't ItOR99#99too I off *A 9 googol off $*logo gets 99409 to #to evot.90.9 0 Is Wetlands Permit req*ed? i:99*1 *.-Vote 094499 too. 0 1 o,,;.,,,,,,., 11, 0. ........ Has application been made to Towh or Local DEC office? ......... Does project require a DEC Stream Disturbance Permit? ........................ . Is or was project site U36"id 6 agricultural activity involving applWation of pesticides to orchards or other crops,'011d or hazardous waste disposal, landfilling, sludge application or industrial activity ?`.......:.... :............. Yes/No Is project located wift'l, 0001e6t'of0xisun'g.or abandoned landfill - hazardous waste site, salt stockpile, landfill, sludge disposal,site or any ocher potentially Yes/No tentially known U1 -3-ourcc of contamination? ation? .......... DESCRIBE: I s there a - local M aster plan on file with, the To or Village? ......... wa Are conununity,,water and/or sewer facilities planned to be developed within- 15 Years in or adjacent to project ...... .......... Are'any sewage e treatment areas in excess of 15% slope? .......... Map ---Bioqk --Lot-. Tax Ma Number MapU i�l slo TE: All applications for review mid . approval I of- a now SSTS to be located wit== NYC, Watershed . shall', ;ent to the Dep"on"44nd-need-not be sent , twduplicateid the DEP, al I though-the quire'DEP project may,re royal of the SSTS prior to final approval by the Department. Projects within the watershed m . ay " a, I- so i►re DEP review and approval of othotas, 'e' f p ct3 Q a. project, such as 3torrnwator-Vlan:s or the weiao" n" of envious surfaces, and the project t applicant should obtain the appro . pr1a,te"forM*3,. for. such activities from and submit-those forms to' DEP t6r r*cvlc- w -and approval. `-, must e applicatiori1s sl S'ned by a person oth or than the applicant shown W em L,the app .._.. cation ccompanied,by a Letter ofAuthorization (Form LA-97). Failure to comply with this provision CQ:, C_ be g.r6uhds for tke rejection Of any�submlssion.. I hereby affirm, under penalty of perjury, 1/1 at in n th Is form .1 formation proyided*o lo r he best of MY and belief, False statements made herein are-punishable. as a Class A -Mlidim ea pursuant to Section 210.4$ of the Penal dw. 4— MATURES 9FJ7JgULXTLES,-, ing Address: .......... ...... LS D 6 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT TREATMENT SYSTEM PERMIT # 1) Located at � oQ�r 14 LPY-e DP-�y Town or Village g pPrTTE 0�1 Subdivision name pUfMRcc� l.Pc� -E 7 Subd. Lot #te`1�1-►oti°IU1Tax Map 006 3` Block �_ Lot I Date Subdivision Approved Owner /Applicant Name Mailing Address )Olt Renewal Revision J05 O—) 4rroRG9G(L, L-& Ha Date of Previous Approval _ old v455TBjk NY Zip 116 Amount of Fee Enclosed � /� m — Building Type �M Lot Area tjSO No. of Bedrooms 4 Design Flow GPD 8�3'0 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of Tka-m-'m Other Requirements: To be constructed by I A-61 f144- TtD 0-60 gallon septic tank and Address Water Supply: Public Supply From Address. or: Private Supply Drilled by T' �,� A ess I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date 011 U I OD License # 5 C W4 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w n nsidered ecessary by the Public Health Director. Any revision or alteration of the approved plan requires a new perrfiit.. Approved/0 discharge of domestic sanitary s�e age nl . By: Title: U // Date: �� �i/ White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 !9 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _. :. APPLICATION TO CONSTRUCT A WATER WELL.... please print or type PCHD Permlt # ` Well Location: Street Address: Town/Village Tax Grid # -)111 '50UT -1 Map %,) I Block Lot(s) 1 Well Owner: Name: JDE HA(9-Gt5HTi Mo Address: 9- hTc--K c0(*- LArs 00 WW&V� � 115b3 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 __25+ gpm # People Served Est. of Daily Usage dal. 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? ...................................... ............................... Yeses No Name of subdivision PUS" UN-(La Lot No.161Aq-1fl255 Water Well Contractor: T b o Address: r 1° Is Public Water Supply available to site? .................................. ............................... Yes No Y— Name of Public Water Supply: m t Town/Village Distance to property from nearest water main: Will Proposed well location & sources of contamination to be provided on separate hee plan. Date.... V I/ -- 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 11 driller ertified by Putnam County. Date of Issue PermXt/ AXC Iial: Date of Expiration d Title Permit is Non-Transfipfagle White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 L% Harry W. Nichols Jr., P.E. 311 Clock Tower Commons Route 22 Brewsid, NY 10509 Telephone (914) 279 -4003 Fax (914) 279 -4567 Neighbors List Joseph Nargentino South Lake Drive Town of Patterson TM #'s (36.31 -1) (36.31 -2 -7) (36.31 -2 -17) Tax Map Owner 36.31 -2 -5 Turtenwald, Stephen & HoffinanGail 36.32 -1 -2 453 Warburton Avenue Hastings on Hudson, NY 10706 36.31 -2 -6 Garabo, Anthony & Linda RD3 Norfolk Road Brewster, NY 10509 36.31 -2 -8 36.31 -2 -16 Lieberman, Jason & Adrienne RD3 Norfolk Road Brewster, NY 10509 r: 3.6.31- -2 -1�0 elly, Dennis & Sh Elizabeth ... ,. _ _- -- T RD3 Norfolk Road Brewster, NY 10509 36.31 -2 -11 Maier, John & Denise 36.31 -2 -15 RD3 Norfolk Road Brewster, NY 10509 36.31 -2 -19 Haigh, Cynthia 36.31 -2 -20 3 Eastwood Road Brewster, NY 10509 36.31 -2 -21 Bailey, Leon 36.31 -2 -22' Spring Street South Salem, NY 10590 36.31 -2 -40 Smith, Robert & June 1 Redwood Place Brewster, NY 10509 7a 36.31 -2 -42 Shields, Theresa 14 Linden Street New Hyde Park, NY 11040 36 •' LAKE -- .•• ... a"' \ 47� . \,, .\.. -1: .,...1uJ„g+J«�.,,wviw.:,_:� /. /. _. /' /.: : /'. _ - '\;�;'.-� -:._r. .- /a.v /- T4.o.. _ .. ...- \ < \. /av! W o / / / acv //acrJ \ mall .o K k t / / "v/ :% v 4 / \ / / /,3 / /4r 8 / 8 / 9 / tut• /auri mev / / / mw / / mar Mw / / / / lq,�F �e e / / la/ n / AM /as y ay , / o SHORE , mv ! ,qtr 1 I7 I I l lam / /an \ to Vo /aa\ `�- , /AV/7 /a W/ 39 / " — — — — _ //air Alin — ur.yt IOAW AOM \ \ 31 30 r \ \ 22 / / 20 +�4 144 /ma » — 19 \16 ____ r- , - - -__ /oar - .� \\ �• /aa — ZwT % -7 \ Cl) 95.63 1030 •� Alai \ I JJY 'yt \ - - -- 0 12 196W th on —_ — eete - - — — , i w \� — — P/0 36.39 -1_2T 13 -- P/0 36.39-1 _ 36. 9-1- ■ „�,°„ fZCa" A - - OM NY _. ___ - . _ - 26 APPENDIX E FORMAT CONSTRUCTION PERMIT NEIGHBOR NOTIFICATION LETTER Date HAY 24 1 2bc* RE: Department of Health Review of Proposed SewageTreatment System for Property Name: JOWI{ NO-kSHflrAv Address: Np + 60vfk LML Town: PArMP-10 K Tax Map #: SG-Ib1-1- I 1 36.31 -2- n Dear pkgEV4� 0WHEP` Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the -Putnam Courity Department. of Health. Attached find a, copy_of the latest site plan. - If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at 278 -6130. Received By: Address: Tax Map #: Very truly yours, By: . Title: P(�or�co� EKl.�1n1 August 1997 BRUCE R...FOLEY _ - . __...- .. _ _. -.... - . Public Health Director DEPARTMENT OF 1 Geneva Road Brewster, New York .�r..- LORETTA. MOLINARI RN,, _M.S.N.. Associate Public Health Director Director of Patient Services Lf .` I we 10509 Environmental Health (914).178 - 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 February 22, 2000 Harry Nichols Laurent Associates Millbrook Office Centre Route 22 & Milltown Road Brewster NY 10509 Re: Proposed SSTS: Nargentino South Lake Drive (T) Southeast, TM# 67. -1 -33 Dear Mr. Nichols: 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_lo.cal wetlandg:officials in this.regard. If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. 1) Please check the vertical and horizontal' scales on the SSTS profile. Furthermore, profile is to note minimum depth of file. 2) Neighbor notification is required. 3) Driveway cut and fill are to be shown. 4) All SSTS's within 200 feet of the proposed well location and all wells within 200 feet of the .SSTS location are to be shown. 5) It is requested that the maximum distance between the proposed well location and the existing well be obtained. Upon receipt of a submission, revised to reflect the above comments, this application will be consider further. RM:tn Vlrruly yours, Robert Morris, P.E. Senior Public Health Engineer THE CITY OF NEW YORK DEPARTMENT OF ENVIRONMENTAL PROTECTION JOEL A. MIELE, SR., P.E. Comm_issionQr,,, -, `stir, �o� William N. Stasiuk, P.E., Ph. D. RO ""f"r"L PR °``�` Deputy Commissioner Phone (914) 742 - 2001 Fax (914) 742 - 2027 Mt. Robert Morris, P.E. Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: Joseph Nargentino - SSTS South Lake Drive (T) Patterson; ©Putnam East Branch Reservoir Basin DEP Log # 1009 (Joint Review) Bureau of Water Supply, Quality and Protection February 14, 2000 Dear Mr. Morris:_ This letter is to inform you that the New York City Department of Environmental Protection • — Department) - has -deter fined• that• the- abov_ &refelei need- 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 "Proposed SSTS prepared for Joseph Nargentino," dated 1 -20- 2000, prepared by Laurent Engineering Associates, P.C. 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 Erigirieering Design Review xc: James Covey, RE.,, NYSDOH 465 Columbus Avenue, Valhalla, New York 10595 -1336 PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS - REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: A& r t AID REVIEWED BY: RM, GR. AS, Y N DOCUMENTS (� j/ (PERMIT APPLICATION. ()(_)WELL PERMIT OR PWS LETTER (ZJC__)PC -97 ( )(__)LETTER OF AUTHORIZATION (,e)(__)DESIGN DATA SHEET (DDS) U(Z)CORPORATE RESOLUTION (,,6(_JSHORT EAF (_ /)(_)PLANS -THREE SETS UHOUSE PLANS - TWO SETS UUVARIANCE REQUEST �SUBDIVISION C�LEGAL SUBDIVISION C-:fDC_JSUBDIVISION APPROVAL CHECKED C__3C_,::::5PERC RATE (�CdFILL REQUIRED DEPTH UC.2CURTAIN DRAIN REQUIRED � CCaSTANDPIPES GENERAL �(_J LOCATED IN NYC WATERSHED ( J( JPLANS SUBMITTED TO DEP ( _J(fJDELEGATED TO PCHD (_JUDEP APPROVAL, IF REQ'D . CUUDEEP TEST HOLES OBSERVED(, PPRCS TO BE VkTTNESSED (,/)EX - APPROVAL SSDS ADJ, LOTS (_J( /)WETLANDS (TOWN/DEC PERMIT REQ'D ?) CUC_)DATA ON DDS PLANS & PERMIT SAME (LjULETTER BI/ZBA (ZjU100 YR. FLOOD ELEVATION WA 200' REQUIRED DETAILS ON PLANS (,J(_JSEWAGE SYSTEM PLAN - (NORTH ARROW) (U( _JSSDS HYDRAULIC PROFILE ( /jUGRAVITY FLOW (�(�CONSTRUCTIONNOTES 1 -13 (_/JUDESIGN DATA PERC & DEEP RESULTS (,,-JU2' CONTOURS EXISTING & PROPOSED C f)C_)DRIVEWAY & SLOPES, CUT (_/)(__JFOOTING /GUTTER/CURTAIN DRAINS (- /)(USDA SOIL TYPE BOUNDARIES (f)( _JTITLE BLOCK; OWNERS NAME ADDRESS �� TM #, PDRA; NAME, ADDRESS, PHONE# (_/)( JDATE OF DRAWING/REVISION (ZjC_JDATUM REFERENCE C/J(_)LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET (fj(—JPROPOSED F)NISH FLOOR AND BASEMENT-EL. S (�( JSITE NOTE CHANGE) COMMENTS: STREET LOCATION: DATE: 3 TAX MAP #: Y N (REQUIRED DETAILS ON PLANS CONT'D) 36,3 hR r �j 1 } C/)(--)PERC & DEEP HOLES LOCATED . (�UREPRESENTATIVE OF PRIMARY & EXPANSION �L_)LOCATION MAP (MIDI SCALE 1 " =2000) 100% EXP. AREA; SHOWN; GRAVITY FLOW, SUFF. SIZE I L_)HOUSE - NO. OF BEDROOMS 7 (_)WELLS & SSDS'S WAN 200' OF PROPOSED SYS C�UPROPERTY METES & BOUNDS (/-)UHOUSE SETBACK NECESSARY (TIGHT LOT) (/)CUHOUSE SEWER - W' FT. 4 "0; TYPE PIPE (/_)(_)NO BENDS; MAX BENDS 45° W /CLEANOUT FILL SYSTEMS UU CLAY BARRIER L��)10-FT. HORIZONTAL; SLOPES 3:1 TO GRADE CS(_ )FILL SPECS / FILL NOTES (_j( /)FILL CERTIFICATION NOTE (_j )DEPTH GAUGES (UUFILL PROFILE & D4MN&IGM (zj(_)VOLUNE UUFU,L IN EXPANSION AREA TRENCH (:!!�jC-)LF TRENCH PROVIDED 60FT MAX. (�(�PARALLEL TO CONTOURS �)(�100% EXPANSION PROVIDED (!!�_)C__)DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL (_,�OL_)GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN -FROM SSTS )1,' TO- P.L.DRIV.EWAYTLARGE lREES; TOP -OF FML-- (_If)C_)20' TO FOUNDATION WALLS / 15 WELL TO PL )0100' TO WELL, 200' IN DLOD, 150'PITS (,/J(___)100' TO STREAM WATERCOURSE LAKE (inc. expan) (,/JL_)50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER (�(_)10' TO WATER LINE (pits - 20) C___)50' INTERMITTENT DRAINAGE COURSE — (}260'/500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS +:=D)(=mJ+5' M N to CDS = >5 %, 20'-4 %, 25' -3 %, 35' -1 %,100 % - <1% _(! 1 0' MIN to CD discharge /100' with 182 cons day discharge SEPTIC TANK 10' FROM FOUNDATION, 50' TO WELL WELL (�(_JDIMENSIONS TO PROPERTY LINES ((__)LOCATION OF SERVICE CONNECTION SLOPE C J( )SLOPE IN SSTS AREA 'IIX0 520% U(ZJREGRADED TO 15 %, IF REQUIRED UUPUIviP NO CSC JDOSE 75% PIP 0 OSE VOLUME NOTED U(__)DETAIL FOR CE , (PIPE TYPE; ETC.) UUPIT AND D- S & DETAILED _)I DAYS RAGE ABOVE ALARM BRUCE R. FOLEY. _ Public - Health" Director .LORETTA._MWL ARI..RN.,_M.S.N. Associate `Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New. York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 Harry Nichols Laurent Assoc. Millbrook Office Center Rt 22 & Milltown Rd. . Brewster NY 10509 Dear Mr. Nichols: February 3, 2000 Re: Nargentino, South Lake Dr. (T) Patterson Reservoir Basin East Branch The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on .Feb. 1, 2000 is complete. The Department will notify you by Feb. 21, 2000 of its determination. is Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. the Departmentfails,.to notify you within the above referenced time frame - .._ ........__....__ -- __- You.may_noiify 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 contactthe 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 (914) 278 -6130 ext. 2159 Very truly yours, (mac Shawn Rogan Public Health Technician SR:kg Public Health Director DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 .URIETTA.;.MOLL'�tARI..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 T0: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW PROJECT: MGM DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM 561k SUB'D APP DATE: NOTICE OF COMPLETE APPLICATION• DATE: a'c 30 0 • Within the drainage basin of West Branch or Boyds Corner Reservoirs. • Within 500 feet of a reservoir, reservoir stem or control lake. Within 200 feet of a watercourse or a DEC wetland and appearing on a subdivision map approved after December 31, 1992. o Design flow greater than 1000 gallons /day. (QV) Date: T0: . j, APRV W/ du (T) Al��sc-' Reservoir Basin Dear If 94 S The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on R� /� k)Vv is complete. The Department will notify you by W 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 .�ttegtion-at.the.above address: - =ThE noti ice- must-include = your'name, -tl location of the project; tlte- - 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 -e U 1 C-U Usti J. Y DEPA.R IMEitiT OF HEALTH M -MIONT OF EN'VIRONMENTA.E HEALTH SERVICES LETTER OF AUTHORiZATIQ.i`�„ _.. _... _ RE: Proper -ty of JoSEV'r� 1-'NP -(45H tWJ Located at 15rj<+ LA� QP-I II % jA'K-OLAL- P-,D NQ TfV Tax Map 1 Block. I Lot d Subdivision of Subdivision Lot r Filed M-P F Date Filed Gentlemen: This letter is to authorize 14in � a duly licensed Professional Engineer x, o, Registered Architect to apply for the required wastewater treatment and/or water supply pecmit(s) to serve the above -noted property in accordance %-rith the standards, rules or reo Iatio�ns 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,supecvise the construction of said wastewater treatment and/or v,ater supply systems in the provisions of Aricle 145 an(i/or 147 of the Education Law, the Public Healcn Lati4•, and the Pi!tna;ry� - itary Code. Very tr;lly y -ouCS, Countersigned: s;' Sizied WaAAA- P. R. A., ti©tj� Mailin; Address 2- W� N/faili.na Address: 6 L io Stare Zio 0 50°� S., �� Zip O ` (0) 3�y- Tel° ho ne: C F L... •S1 _ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION ;F.,O..R APPROVAL,OF.PLANS FOR A WASTEWATER TREATMENT SYSTEM , 1. Name and address of applicant: J015EP 14 N PSI Eh►rl ND V 4►TG14 C,o C4,L- L-AMF oL-0 WF sr &JRZ� N; 11,6G13 2. Name of project: 3. Location TN: 4. Design Professional: �� W' Nib ��" 5. Address: 6. Drainage Basin: EA6T 7. Type of Project: Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEAR)? Type Status (check one ) ........................................................ Type I Exempt Type II Unlisted X 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... HO 10. Has DEIS been completed and found acce table b Lead Agency? N A P p Y g Y ................ 11. Name of Lead Agency N 12. Is this project in an area under the control of local planning, zoning, or. other officials, ordinances?._'.-....,* .... ........ .................... ::....................... : 13. If so, have plans been submitted to such authorities? fl 14. Has preliminary approval been granted by such authorities? NO Date granted: N-N 15. Type of Sewage Treatment System Discharge ................. surface water ✓groundwater 16. If surface water discharge, what is the stream class designation? .................... 4, 17. Waters index number (surface) ........................................... ............................... N A 18. Is project located near a public water su° -. =y system? ....... ............................... NO 19. If yes, name of water supply N Distance to water supply 20. Is project site near a public sewage collection or treatment system? ... :............ 21. Name of sewage system Distance to sewage system r'A 22. Date test holes observed 1r*)- W6 23. Name of Health Inspector; �1 � 24. Project design flow (gallons per, day) 8� 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... NQ 26. Has SPDES Application been submitted to local DEC office? ......................... W4N 8/99 Form PC -97 27. Is any portion of this project located within a designated Town or State wetland? No 2.g. `�'Vetlands ID'Number:.;::....... .. .. . NA FA 29. Is 'Wetlands Permit required? ......................................... ............................... Has application been made to Town or Local DEC office? Ho 30. Does project require a DEC Stream Disturbs 'ze Permit? ................................... 31. Is or was project site used for agricultural activity involving application of pesticides' to orchards or other. crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No �A ko 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, silt stockpile, landfill, sludge disposal site or any other potentially known source of contamination'? Yes/No � DESCRIBE: 33. Is there a local master nlan on file with the To am or Village? ......................... YE� 34. Are. community water and/or sewer facilities planned to. be developed within 15 years in or adjacent to project site? ................................ ............................... _ �p 35. Are any sewage treatment areas in excess of 15% slope? . ............................... N D 36. Tax Map ID Number .......................... ............................... MO&$l Block ► Lot 37. Approved plans are to be returned to ..... Applicant Desi &-1 Professional NOTE: All applications for review and approval.of a new SSTS to be located wFu inthe NYC Watershed shall be sent to the Department, and need not be sent in dr-p&ate 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 I .,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 herehy affirm, under penalty of perjury, that information provided on this form is true to the best of tray knowledge and belief. False statements made herein are punishzhle as a, Class A misdemeanor pursuant to Section 210.45 of the Penal aw SIGNATURES & OFFICIAL TITLES. j'0 6 W Z � t'z00 1+ /'W cry - H1 JIV, Sl 145 K-F —�(' Mailing Address ` s H. Z ':au.fil- ... �-� ('�1L(�'S`oyyN P4 ASS �06o-or\ 14.164 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 SEAR V_ -State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM...- For UNLISTED ACTIONS Only. PART I— PROJECT INFORMATION (Fo be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME. JuSi:PN. N�R-�- +ENT' ►NO _ . ... _ 3. PROJECT LOCATION- Municipaiiry PON County PVT"NAri t. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) ,54 VT4� LAlLf o i;+\e: l Hr*r -ooL "I 5. IS PROPOSED ACTION: New ❑ Expa.is.on ❑ Mcdilicationlalteratlon e. DESCRI3S PRO :_CT BRI =PLY: l hjg1 -\11 -jNL, hs'rl) , 7. AMOUtrT OF LAND AFFECTEO: Initially 0.60 acres Ultimately C) .4 G4(� acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTH_R EXISTING LAND USE RESTRICTIONS? &yes CI.No It No, describe briefly S. WHAT IS PRESEN7 LAND USE IN VICINITY OF PROJECT? 8Residentia! G.Industrial C) Commercial DAgriculture "OParklForesVOpen space tJOther 'Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL STATi OR LOCAL) ? fit El Yes KNo It yes, list agency(s) and permitlapproyals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? Yes 0 No It yes, Iist.agency name and permltlapproval .. . 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ❑ Yes &o I CERTIFYeTHHA�T THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE AppticanUsponscr name: RN � � N) wJ �� � A6 R (A � Date: Signature: If the action Is in the Coastal Area, and you are a s_ tate agency, complote•the Coastal Assessment Form before proceeding with this assessment N PART 11— ENVIRONMENTAL ASSESSMENT (To be completed by Rgency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the.review.process end,tue the.FULL-EAFi :., -- []Yes.. ❑N01 a........ __. o,._......__ a. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS 14 6 NYCRR. PART 617.61 If No, a negative declaration may be superseded by another Involved agency. • - ❑ Yes ' ❑ Nb ' C. COULD ACTION. RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WiTH THE FOLLOWING: (Answers may be handwritten, if legible) Cl. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character! Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: s C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities likely to be Induced ¢y the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified In CI-05? Explain briefly. C7. Other impacts (including changes In use of either quantity ortypii of energy)? Explain briefly. lxt. yr'n D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? < -4 ❑ Yes ❑ No If Yes, explain briefly 'ART 111 — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether It Is substantial, large, Important or otherwise significant. Each effect should be assessed in connection with Its. (a) setting (i.e. urban or.ruran;.(b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (i) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or- significant adverse Impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result In any significant adverse environmental impacts ' AND provide on attachments as necessary, the reasons supporting this determination: ` Name of Lead Agency Print or Typr Name of Responsible Officer in Lead Agency Title of Responsible Offic.er Signature of Responsible Officer in Lead Agency SiSnature of reparer (Ir different from responsible officer) LAURENT ENGINEERING \ ASSOCIATES, P.C. 20 Milltown Road - - — ,:;..- ..,- .,.._,� ;:;.;.;:.. -:. .. - ...- -�... _ ._ .. .._.�..�.... -. BrewstefNewYo?k10509 _ '..._ -- _-•- - --- -• - - - Harry W. Nichols Jr., P.E. \ CONSULTING SITE ENG _?INFERS January 26, 2000 , Mr. Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Joe Nargentino South Lake Drive Patterson, NY TM: 36.31 -1 -1 36.31 -2 -7 36.31 -2 -17 Dear Robert: Enclosed are the following: 1: Five (5) prints of drawing S -1, "Proposed SSDS," dated 1- 26 -00. 2. ; "Short EAF," dated 1- 26 -00. 3.:.: "Application for Approval of Plans for a Wastewater Disposal- System." 4. "Construction Permit for Sewage Disposal System," dated 1- 26 -00. 5.., :'.Application to Construct a Water Well," dated 1- 26 -00. .6:. ; `Design Data Sheet." 7. -"Letter of Authorization," dated 1- 26 -00. 8. Two (2) copies of Residence Floor Plan(s), for `Bedroom Count Only." 9. Review Fee in the amount of $300.00. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, LA NT ENGINEERING ASSOCIATES, P.C. H chols Jr., P.E. HWN: JM: 's 99047 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN.DATA SHEET-- . SUBSURFACE .SEWAGE TREATMENT SYSTEM Owner JOE H N9_rAE1-+TI HO Address $- N h _C_0" .IL b&H6 00 WOVJM/HN Located at (Street) Sour LP4- " DF-IN 6�- Tax Map Block �_ Lot (indicate nearest cross, street) Municipality PA'l�'Eg -ZjOF� Drainage BasinT -ANL}4 SOILyPERCOLATION TEST DATA Date of Pre - soaking �1 I °i� Date of Percolation Test Hole No. Run No. Time Start - Stop Ela se Time. (p1Vlin.) NDe th to Water rom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Miri/Inch U 2 3 Z' — 2 ��, ti� �6 �, 431, 4 �e .. �`► 13 ti� 26 3 431 5 3 2., �_ ZV! 4 5 1 2 3 ,.• 4 5 I\ u i L. is i. i ests to be repeated at same aeptn. unto approximately equal percolaton rates are ootamcu at percolation test hole. (i.e. s .1 rain for 1. min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. ; K' 2. Depth measurements to be made from top of hole. . ' . ..' Form DD -97 2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST. HOLES T DEPTH.,_ r _:HOLE,NC-�- "`" HOLE NO. _ HOLE NO. . ... G.L. 0.5' 1.01 4.5' bpiS�t B 1.5' r 2.0' SPtA' 1 -04'x` 2.5' 3.0' a -G1, C- VA 3.5'. 5 -� 4.5' i'lHE SRS 5.5' 6.5' 7.0' 7.5' 8.0' 8.5' ,'�EA915� �4-• fiIHE 5i�,'° S AtsO LQRM �go�Sc� ('Ili SA�o LaWE 9.0 _ 9. X10.01 Indicate level at which groundwater. is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Date .l • W w do- C L-E A Design Professional Name: W \w VJ i �A 1Ukk 01 -S SN � Address: U - �-o ('SD �\r AT6p— N tp5o� Signature:. -- ` Design Professional's Seal CH Ir rv L Wj Uj en No. 56124 r-sSO PUTNAM COUNTY DEPARTMENT OF. HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM -/A Address VIZ, Owner AlAg6ely7 /p Located at (Street) 122.1 Tax Map jmW Block Lot 17 (indicate nearest cross street)' Municipality Watershed "!5 SOIL PERCOLATION TEST DATA Date of Pre - soaking r 9 'Date of Percolation Test Z?7- NOTES: 1. Tests to be repeated at same depth until, approximately equal percolation rates are obtained at each percolation test hole. (i.e. :5 1 min for 1-30 min/inch, s 2 min for 31-60 min/ifich) All data to be submitted for review. 2. Depth measurements to be mad, b from top of hoje..' Form DD-97 rr ;56 -2;06 J09 3— 9. 19 3 2 3 l 13Y awl 4 �5 Z --Q 2 a3 0-6 3 4 ..5 2 .3 4 5 NOTES: 1. Tests to be repeated at same depth until, approximately equal percolation rates are obtained at each percolation test hole. (i.e. :5 1 min for 1-30 min/inch, s 2 min for 31-60 min/ifich) All data to be submitted for review. 2. Depth measurements to be mad, b from top of hoje..' Form DD-97 rr TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. I HOLE NQ... _ HOLE NO... G.L. 0.5' 1.0' 1.5' ? rt ®{l 2.0' `r,, b.e 3.0' 3.5' 4.0' 45' 5} 01 S':5' - 7.0' 7.5' 8.5' 9.0' •10.0' _. Indicate level at which groundwater is encountered 7 '° 0 Indicate level at which mottling is observed 'Fa 75 e- Indicate level to which water level rises after being encountered 7 f — © �Y Deep hole observations made by: 4; Date io a Q R G, 73. A44. Design Professional Name: Address: Signature: Design Professional's Seal �� 6 . _.. 1....... X2ECO'RD`OF PHONE CONVERSATION DATE: /67A TIME: PERSON CALLING: L 4u trf y 4 PHONE #: 2.7 9) ° G Ao REASON () Inspection• ee nd /or eres: SCHEDULED FIELD MEETING DATE: %,rl TIME: Z/ : 3 O / / i 3 0 ROAD /STREET: K cj ¢'r TOWN: �-; TAX MAP #:,� SUBDIVISION: LOT #: OWNER: ♦ ® /► COMMENTS: Z 0 AW Mir /AM peti / /v '44 / /tar, XyJ 36 X 34. I / . U.64 A 0 42 wm M/a e4 39 oo 4 IAW 101,11 /Aw lxfe nLS3 /am /32/ 48.3• /mss /aas3 N /X?j .0 �5 40 _30 Am /vim /mm'7 is. tea ol, F 21 7 aw 22 20 — ..28 /as/ 17 Rl- /MV —.t — — — — -1_1 16 19 — e 14W A&M 10 — — — — — — — — — MMi' — — — — — — 7—T ;&-W-i -7 — — — — — — — - cl, /A�,, ,r — — — — — — — - Zwl vi 7 U- 7,2aF U- A 15 a-- - - - - -- 18 98.12 - - — — — — — — — - 14 — — — — — — — — -- — — — — — — — - F/0 36.39-1-27 13, /0 36. 9-1-29 958000 36.22 36.23 MAP ku PRELIMINARY SCALE r-Z 36.30. 36.32 TOWN OF PATTERSON 1.34 it, m p 50 0 50 36.39 36.40 PUTNAM COUNTY. NEW YORK DAW W AMIAL MMOVAM.. CAR W WAP-1-IT-W NT 5161E KA1E WOIIDIN►iFS Ni 111083 IN !4T ,. 475 i ;. DA f aviland f r 011OW d ND 'i w v� cor N RD FO J C flo r .�. a I1. r lulu t Lake ° A; arnum a °irn :Lost jf l' } 1Ake t �r'w 1 <EY m ,Charles . °9 22 �' "� � ° ®° .. I ,NAY Yi � C� •i o ...vela s# ,ed r Mount Ebo Rti, rs ; Corporate y A' DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New. York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 1M, 11� Date: l z f Z 0 9 To: '5/6-5e 7)a La 0:56A From: Gene D. Reed Putnam County Department of Health BRUCE R FOLEY Pub7ic °°"1raTili""birector Fax #: 773 —O3-'1'3 No. Pages 7 (Including cover sheet) for, your,��fo,rmatlon, - �lease.r_ .. _.:�. For your review As discussed Attached as requested Please call Notes/Messages here- `Da+e5 J 10.12-0 @ /0,10,o 2—'-"n r1 c a G�Ca rwtel In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 157. I I _. _.. -N CHART nI'eet DIMENSION ( ) Number A g 1 I8 38 2 32 51 3 36 54 4 41 5-7 S 33 21 6 31 28 7 41 33 g -i8 100 9 80 101 10 g2 103 I� i I I P-= 312.49 L: 6-7.'83 O ll ir N ISO ss,os';,E 4n No I SIT I W 4 io- fo �i—Eywlao=al a NL- LF ABS 10 0 .Box (Tyf,) to r Z 0 AY, 16 3;-7'0 0 VJ T L A 1--< ISJ 6' N 13* 59'05"B OR NE