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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.57 -1 -3 BOX 18 16"m or r PUTNAM COUNTY DEPARTMENT OF HEALTH IO�(F ErIVTTAI� IIEA,,']LRVC_ -..... CERTIFICATE OF CONSTRUCTION COMPLIANCE FO WAGE T)�REATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at ? j „y E- Town or Village 5- Owner /Applicant Name j, (L='b Tax Map �_ X0-5 -] Block �_ Lot _ Formerly y Subdivision Name Subd. Lot # y Mailing Address Zip Date Construction Permit Issued by PCHD DrJL Separate Sewerage System built by QVI tj C,0!MAh dress'-j�Qg V jnib Consisting of Gallon Septic Tank and 1 S� ,, N L- la) M P - - LL-7 1_ V CF 6,14' W t 7=7 `�MWZ V I bago 121:si�y JE Other Requirements: 1 " l" alp �--I L%— Water Sup"I : Public Supply From Address. or: Private Supply Drilled by :tp,V -Address '7 N- 7[W (4" PnVV - Building -=Type 2 ena> Has erasion control been completed? Number of Bedrooms S Has garbage grinder been installed? I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accor with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations. e P tram County Dep t of Health. Date: 7 -21 -per, Certified by P.E. R.A. (Design Professional) Address License # r,5 q --�q IE' 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 air ubject to modification or change when, in the judgment of the Public Health Director, such revocation, mo ificatio or change is necessary. By: Title: � Date: Z1 6 E, White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: ose Lane wn/Village: ratterson .._.. _._1_______..,___ - - .- _. Tax Grid # Map36 S?Block ( Lot(s) Well Owner: Name: Address: Austin Custom Homes - P.O. Box 525 - Brewster, NY 10509 Use of Well: I- primary XXXX 2- secondary 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 121_ft. Length below grade 120 ft. Diameter 6 in. Weight per foot 17lb /ft. Materials: __L 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 50 gpm Depth Data Measure from land surface- static (specify ft) 30 During yyield test(ft) NO Depth of completed well in feet 265 feet Well Log If more detailed information descriptions or sieve analyses. _:..: are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface .20 Sandy Clay 20 80 Hard Pan z, 80 - 100..::.....,..., -.- S.oft. Bt^on: ke:cge .:.. :.:......:.:._ IOU 265 Md, Hard Grey Granite If yield was tested at different depths during drilling, list: Date Well Completed 10/21/02 Feet Gallons Per Minute Pump /Storage Tank Information 265 50 Pump Type r, u b_ Capacity __I" pm Depth 200 Model .10GS10412 Voltage 230 HP 1 Tank Type D i a ph Volume 82 Putnam County Certification No. Date of Report e 2 10/28/02 NOTE: txact location oI weii wiTn Qlsmnces to at ieasi iwo permanent ia[1uularxs w uc lijvviucu vii a acpaiaw all �vUF.a... WellDriller's M Address: 75 Putnam Ave., Brewster, NY Signature: I Date: June 10, .2003 White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 JMS ENVIRONMENTAL SERVICES, INC. 1500 SUMMER STREET m s STAMFORD, CONNECTICUT o6go5 NELAC, CT and NY State Certified Environmental Laboratory Mailing Information: Collector's Information: Name: Mill Drilling Co. Client: Austin Custom Homes Name: Robert Mill Address: 75 Putnam Ave Address of site: Lot 4 11 Rose Lane City: Brewster City: Patterson State: NY Zip: 10509 State: NY Zip: Telephone: Fax: 845- 279 -5075 Telephone: Sample's Information: Site: water tank Date Collected: -- 6/30/03 Date Received: —7/11103 Preservative: HNO3 Time Collected: 15:30 Time Received: 11:45 Temperature: <4C Lab No.: J034575 Date Analyzed Test Name Result MCL Method 7/1/03 15:00 Total Coliform Absent Absent SMWW 9222B 7/1/03 Chlorine Free Residual <0.1 mg /L N/A SMWW 4500CIG 7/9/03 * Color ND Units 15 Units SMWW 2120 B 7/2/03 Odor ND 3 TONs SMWW 2150 B 7/9/03 * Irdn 0.198 mg /L 0.3 mg /L SMWW 3111B 7/2/03 Manganese 0.043 mg /L 0.3 mg /L SMWW 3111 B 7/2/03 Sodium 11.3 mg /L N/A SMWW 3111B 7/2/03 Chloride 25.0 mg /L 250 mg /L SMWW 4500 Cl C SMWW. .2340. C ...... 7/2/03 Nitrate 1.56 mg /L 10 mg /L SMWW 4500 NO3E 7/2/03 10:00 Nitrite <0.1 mg /L 1.0 mg /L SMWW 4500 NO3E 7/2/03 pH 7.22 S.U. 6.5 -8.5 S.U. SMWW 4500 H B 7/2/03 Sulfate 33.5 mg /L 250 mg /L SMWW 4500 SO4F 7/9/03 * Turbidity 0.56 NTU 5 NTUs SMWW 2130 B 7/2/03 Lead <1.0 ug /L 15 ug /L SMWW 3113. B Comments: * Collected 7/6/03 at 17:55 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 Signature: State #: PH -0218 Michael Lapman ELAP #: 11715 President Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com P. W. SCOTT Engineering & Architecture, P.C. 387I Route 5 BREVVSTER.NYlO5O9 E'K8ai|: pwo@heatweb'nat -7 -`-`A914),��8'���O�,-FAX.'(910`278'ZIG6_—'---,'-`'�—'- TO Putnam County Dept of Real th 4 {|eoevo Road Brewster, New York 10509 xVE ARE SENDING YOU O Attached O Under separate cover via O Shop drawings O Prints O Plans CI Copy of letter 0 Change order .0 � ��F�) (�\�� ����u u ��uz\ \�/ur DArE ca t JOB NO. NO. RE: Septic As-Built For your use O Approved as noted I Certificate of Construction Compliance [] Returned for corrections O �— Samples the following items: 0 Specifications COPIES DATE NO. DESCRIPTION For your use O Approved as noted I Certificate of Construction Compliance [] Returned for corrections O I Well Comple*tbo.n Report 3 FORBIDS DUE Guarantee of Subsurface Sewage Treatment System 3 As-Built Septic Plan Fee: $200 THL�E)ATRANSm[TTED������k�6`b��w� REMARKS COPY TO [] For approval O Approved as submitted ff For your use O Approved as noted O As requested [] Returned for corrections O For review and comment O O FORBIDS DUE [] Resubmit —copies for approval C Submit ______ copies for distribution E., Return -_----_--correctedprints 0 PRINTS RETURNED AFTER LOAN TO US / \ ' 07/12/2003 11:11 9142421909 UNITED SEPTIC SYSTEM PAGE 01 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL° EM'I`R SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Ali& ,o tn. /11 6 v 5; (: Building Constructed by Location - Street Building Type �w. S7? ( �3 Tax Map Block Lot eq TrA— <-o.ti..,, TownNillage d. Subdivision Name Subdivision. Lot # 1 represent that T 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 sb.own 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 property is caused by the willful or negligent act ofthe occupant of the building utilizing the system. The undersigned furthef - 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. �J- W Dated: oath L Da tri Year D�j Signature: _ Title: y�(-/P �j C' nt actor {Owner} - Signature MoD *Apo obg &,P./ ?,*E l.,v- Corporation Name (if corporation) Comoration Name (if corooration) Address: State Zip 4 �) U(Alfr�� AVGL Donn GS -97 X114 `r PUTNAM.COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Jj}/ a FINAL SITE INSPECTION N Inspected Street Location Owner .--7?1 Town R, 77E? Son/ Permit # p -- — TM # 5G, 5.7 — — 3 Subdivision Lot # !Z 1. Sewage System Area a. STS area located as per approved plans ........................... b. Fill section - date -of placement 3:1 barrier Lgth. Width Avg.Dpth C. Natural soil.not stripped.....,.: .....:..... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100'. from water course/ wetlands ...... ............................... II. Sewage S stem a. Septic tanic size 1,000 .... h 50........other....... . b. Septic tank installed level .............:.. ............................... Q. 10' minimum from foundation .......... ............................... d. Distribtuion Box 1. AlI outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box &, trenches Junction Box - properly set ....................... ............................... ength required 6 6 7 Length installed 66 2. Distance to watercourse measured -t- 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 3/4 - 11 /z" diameter clean .................... 9. Depth of gravel in trench 12" minimum .................. 10 Pipe ends capped ... ............................... . . gPum or DosednS_ stems F ize o pump chamber ................ .......................... ...... 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........... M. HouseBuildin a. House located per approved plans ......� IV. Well'a , - ,— -Well located as per approved plans . ............................... b. Distance from STS area measured f/ o ft.........., V. a. Boxes properly grouted ............................. :................ .I... b. All pipes partially backfilled ............ ............................... c. All pipes flush with inside of box ...................... :........... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installedsaccording_pla g. Footing drains discharge away from STS area.......... .. h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 1/97 COMMENTS c %_v r 1'bt:�_' 0 Form 10/25/02 09,48 PW SCOTT 4 845-278-7921 NO. 076 P02. PUTNAM COUM DEPARTMENT OF IffALTH DIVISION OF ENVMONMENTAL HEALTH SERVICES ATTENTION. 13 ADAM GENE QIL FMI&L INULCTION For: Fill Ali information must be fully completed prior to any Trenches . inspections being made, PCHD Construclion Permit # Located: 11 (Cose Owner/Applicant Name: —9 Formerly: . 606 f W Is system fill completed? nn Is system complete? qrT Is system constructed as per plans? Is well drilled? — _71 Is well located as per plus? Are erosion control measures in place? SCLAJ Block Lot -Subdivision Name: Subdivision Lot 9. Date' Date: ('0 Date: I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and raved plam wo the Standards, Rules �aad- RegWations of the Putnam County Department of Health, Date: (P (24�tf�_ Certified by: z PE X, .RA A V Design Professional Form FIR 99 no "OTTIq MEMO'' - _ - ___ __ . –1 — I^– rnl a 1-rk" mr- - mno - rmmrr n M 0 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/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 October 29, 2002 Peder Scott, PE PW Scott Engineering 3871 Route 6 Brewster, New York 10509 Re: Field Inspection - Peri Rose Lane, (T) Patterson Lot # 4, TM# 3.6.57-1-3 Dear Mr. Scott: The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. 1:.:_:'._.. Cast iron_ pipe - connection to-septic tank reeds tq-D - completed::.:. ::.;. �.____ ,._ .. _.. .— o.... _ -- . 2. A bedroom count needs to be performed by this Department upon further construction completion. 3. The well casing needs to be raised to a minimum of 18 inches above grade. 4. The curtain drain outlet was not found at the time of inspection. 5. 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. Sincerely, Gene D. Reed GDR: cj Environmental Health Engineering Aide SENDING CONFIRMATION. DATE : OCT -30 -2002 WED 14:01 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE 92782166 PAGES 1/1 START TIME : OCT -30 14:01 ELAPSED TIME 00'22" MODE ECM RESULTS OK -FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... BRUCE It. FOLEY IARMA MOUNMU A.N., M.S.N. Prbrr Hwah Dascror A4r A= PO& H-sa t ft" . Dnuner dr Pwk Srnfen DEPARTMEW OF HEALTH t Ganeva Road, Bmwstw, New York 10509 6mbuNNm -n1 IIsa116 (NS)27a -e1Ja Rae (fi{S)47a .7411 Nunl.a &wleu (145)271.65511 WIC (a43)Y)a.aa7a Pu(MS)27t.a83 YAM 11VMnloidPmcFw1 (845)1711-6814 4u(947)172 -6641 October 29, 2002 Pedcr Sion, PE' PW Scott Engineering 3971 Route 6 Brewster, New York 10509 Re: Pidd Inspection • Peri Rose Lsoe, (T) Patterson Lot k 4, Tlvlk 36.57 -1 -3 Deer W. Scott: The above referenced separate sewage treatment system can he hackfilled, The following cwmmetua must be corrected in the field. 1. Cast iron pipe connection to septic tank needs to be completed. 2. A bedroom count needs to be performed by this Departrncat upon further construction completion. 3. The wall casing needs to be raised to a minimum of I$ inches above grade. 4. The curtain drain outlet was not found at the time of inspection 5. Apump test needa 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 (945) 279 -6130 ext. 2261. Sincerely, Gene D. Reed GDR:cj Environmental Health Engineering Aide * PUTNAM COUNTY DEPARTMENT OF. HEALTH .: DIVISION OF ENVIRONMENTAL .HEA.TLII_SERVICES,: , W YD FIELD ACTIVITY REPORT NAMF•' A nnR F.R C Street Town State Zip PERSON IN CHARGE OR TNTEIRYTR.WF.TI: PUMP TEST [] DOSE TEST r r' REQUIRED GALLONS-3 3 / EL. START a O o. A - - - - - - EL. STOP Signature and Title RFQRT RFC FTVFT) RV: I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Rev. JUL -14 -2003 21:51 P.W. SCOTT 8452782166 P.02i02 Jul -15 -08 '09:14a Fro-CENTURY 21 +uaa cru oeur 11494 r.uulivu► r -uve Y._._..... .__r..._ .__._. ..._ 'ATE -COMPLIANCE THE, THIS CwRTIFl F NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET - NEW YORK, NY 10038 CERTIFIES THAT Upon the application of WILLIAM PICARELLA PO BOX 158 BREWSTER, NY 10509, upon premises owned by SKEETER DEVELOPMENT PINE VIEW DRIVE - LOT #4 SOUTHEAST, TN +, NY 10509 Located at PINE VIEW DRIVE - LOT #4 SOUTHEAST, TN +, NY 10509 AWiieation Number: 1149217 Certif v*e Numbew: 1149217 Section: Block: Lot Building Perm: QbC: W107 Described as a R=idea" occupancy, wherein the premises electrical system consisting of electrical devices and whin described below, located inlon the premises at: was inspecW In accordance.with the. National Electrical Code and the detail of the installation, as set t00 below, was a0ib..:_.r_ °-. - July; 2003..: .. _ ...,.... �_..._ _ :..... • . - found to be in compliance therewittl on rye bay of QTX I� =13 A MW I Motors � C 4 p! y a �„ 40 Cz M 1 1bp .v a CI A rd a A i I d e6 This certificate may not be altered in anyway and Is validated only by the presence of a raised U Iv 1903 seal 11 at the location hkated. TLII -15 -PAR3 TI IF AR:.-39 TFI :R4S- ?7R -79 ?1 NAME: PIIT140M rnIIMTV r=nDTMCAIT nc' 0 0 PUTNAM COUNTY DEPARTMENT OF HEALTH _ DIVISION OF ENVIRONMENTAL HEALTH SERVICES ° DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner 71 ? Address 7Z%0s6 L Ow,6 Located at (Street) _._._,7A::5, p `ZAP; Tax Map 3 �7 lock _� Lot - (indicate nearest cross street) Municipality Watershedir zany �O SOIL PERCOLATION TEST DATA Date of Pre - soaking 12 /f Z.00 Date of Percolation Test 12 be ih From .� 3 4 F-1 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 I min for 1 -30 minhnch, s 2 min for s -ou mmiincn) H►i data to oe submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 g3 '� � 2 - 3 3;a7- ;�Z 4 5 2 ;a-1 -;2t51 30 i3-- 3 30 02 3 — 21 Ga:1 tigO� K 4 oZ i TV - -3 -. 5 4 60 .� 3 4 F-1 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 I min for 1 -30 minhnch, s 2 min for s -ou mmiincn) H►i data to oe submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 a TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST BOLES - -. . � ..�..�:HOLE go- -9,-s HOLE NO.. -T `I ...�..�..., -..� �OL_ NO. Nb G.L. P,4A 1.0' Ale 1.5' MW a 9. 2.0' r_1 11 . 50, m A7-x 2.5' mu 3.0' 3.5' .. e. %"/eel r'. 4.5' 5.0' s V1 5.5' ,✓ 5L--,F r RmcINS 6.0' 6.5' Indicate level at which groundwater is encountered ` - g g a = -� - — - - -- --- - - - - -- - -- - Indicate level at which -mottling i-s observed Indicate level to which water level rises after being encountered t3 Deep hole observations made by: G'.vr_� �. 7Pr: ��c .n H _ Date Design Professional Name: Address: Signature:- Design Professional's Seal . PUTNAM COUNTY DEPARTMENT OF HEALTH w ..� 3D 01 F"E TVIRONIVIEN' Ai_, I�EALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM ...SECTION A. .,GENERAL INFORMATION- Name of Project��I Countyi�Tn/./"/ Site Location Building construction begun lVd Extent Is prgerty within NYC Watershed ? ................. Yes No SECTION -B.- TOPOGRAPHY (Please - check —a— boxes) 1. Hilly Rolling__ _-_ ._Steep..slope_— _� ._Gentle- slope -- -- - Flat - - = - -- -- - - - 2. D Evidence of wetlands --1 Low area subject to flooding -Bodies of water Drainage-ditches Rock outcrops 3. Property lines or corners evident ...................................................... 0 Yes No - - -4 —Do water courses exist on or adjoin the property? ........... ............. ....... w Yes No 5. Will these affect the design of the sewage system facilities ? ............ 0 .. _.- -_ -. Yes _ No 0 _. - -.. -- 6. - -Do watershed regulations apply 'in this development ?:..T .`.... Yes No - 7 Will extensive grading be necessary ?..:.::- :...... ... ............................... Yes ... _ No. 8. Will extensive fill be necessary for SSTS ? ......................................... Yes -- 9. Do filled areas exist within the SSTS area?... 0 Yes No yes, e what _ y -- �- h t_is_the condition of.the fill ?. - - - - -- ----- - - - - -_ _ __ - - - - -- --------- - -__ -- - - - - -- _: _--- - - - - -- - - -- - ----- - - - - -- - - - - -_ ._ . . SECTION C. SOIL OBSERVATIONS._ :. :.: 10. A earance of soil - �,S and Gravel Loam.._ Cla Hardpan Mixture pP - - 0 0 Y -- 0 11. Observed from: -- 0 Borings -- Bank cut - ED":Backhoe excavations �. 12. Soil borings /excavations observed by /,w \-- lj - - -`� 7 - - , - on c) 13. Depth to groundwater !� �% :• (P� r " ) on 14. Depth to mottling iVo,.�/c 15. Are test holes representative of primary & reserve areas ...... ............................... 16. Soil percolation tests made by et/; on on 17. Soil percolation tests witnessed by _ 0 on SECTION D (on back) no Form ST -1 F) n• SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? Yes No 19. Will groundwater or surface drainage require special consideration? .....::............ a Yes No . ... 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ........................: Q Yes ffNo SECTION E. REMARKS 21. • If a common water supply is proposed, has an inspection been made of the i existing or proposed source and facilities? ................. :........... :.................................. Yes ffN0 4ection data ` - -- - . Yes . 0 No - - - -22 -Do adjacent..wells and/orsewage systems exist?....................................... .......... 23. Additional comments 24. Site observer /inspector and title C�aF- n a:.4. 25. Dates) of observation(s)inspection(s) / -2 TEST PIT PROFILES :. -... _. Hole # Lot # - -- _ : '.._...:- Hole..# -- - - - - -- Lot # - - ' - - - -- Hole #--- .-- ......_..Lot Depth to water - _.- __:Depth.to_water _ _ ___ _____ _ _ _:___ :: -::.- _:Depth to water _- Depth tomottling .. _. Depth to mottling - 'Depth`to mottling Depth to rock/imp: -- - Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L. -.. 0.5 .. 0.5 0.5 1.0 1.0 _... _ . .__ . _ 1.0 - - - -- - - -' - - - -- - - - - - -- - - - 3.0 '3.0 . 3.0 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6.0 6:0 7.0 7.0 °- 7.0 8.0 8.0 - 8.0 9.0 9.0 9.0 10.0 10.0 10.0 11/17/00 J� O O 11:59 PW SCOTT -J� 19142787921 BRUCE R. FOLEY Public Her!th Director DEPARTVENT 1 Geneva Brewster, New OF Road York LORETTA MOLINARI R.N -, til.S.N Associate Public Health Director Director of Patient Services HEALTH 10509 FEQUEST FQR FIELD TESTING :ATTENTION: 0 A')A�NI STIEBELING 0 GENE REED AM information below must be fully completed prior to.anr scheduling. ENGINEER OR FIRM: e cis LD DATE: 11117100 PHONE st: 979EF-11 0 �}NGh a f` 0l5 ? REASON: _ DEEPS: X PERCS PUMP TEST: o • - 7— 4;- A;46 s SUBDIVISION: v t ►r elf► a �r NYCDEP CRITERIA FOR .IOINT I&EVIEW AND WITNESSINQ OF SOIL TESTING a YES NOS - -t'��'VGf� d Proposed S!:TS within the drainage basin of West. Branch or Boyds Corner Reservoirs. - Proposed SSTS within 500 feet of.a reservoir,_reservoir stem or control ` o ❑ Proposed S3TS within 200 feet,of a watercourse or a DEC wetland. ❑ 0 Proposed SSTS design flow greater than 1000 gallons /day or SPD£S Permit required. 0 a Proposed SSTS fora ommerical Project. It is the responsibility of the design. professional to provid4e . above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Dclegated) based on the response. If you answerei; . to any of the questions, NYCDEP must witness the soil testing. This Department will.coordina e 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 MY(MEP is required to witness the soil testing, it will be the sole responsibility of the design professional to sched'ule'-re-witnessing of the soil testing with NYCDEP. FOR COUNTY USE ONLY DATE: TIME: l / r% % •�� O (FMLDTEST) LU z 0 011 Q f 12563 J Haviland 011ow 1 --- \ --- Nendel Pond 164 65 alnes _-Cornersr- U* na Lake -Ornum rn Corners ArM:L4ffR 22 0 If 0 _QeFor St - - - -- ---- ------ iq a Area Mount Ebo C orate L HS -0 1 corner Pond-- —OES ------ Brewster,_.- Pon a MS State on Police M 0 Old Southeasl > Church 3 z s > -ners iL m m am > (won OR) G) V) m Brewster i 0 CV" Woods CA Y, 54 B 23 m r 0 �a< r 0 L11-1A - 1610 L r. -- ? - NANCY LANE --- " ---- -- ..... — 146.16 ........... _ .. - -... _...... - -- —5 ._.... - - .. N 950000 FOR ASSESSMENT PURPOSES ONLY NOT TO BE USED FOR CONVEYANCES S. JAMES W. SEWALL COMPANY Lill— — — !N av 21 —T' —T;n L u/ w I 1 W 1 I I$ I i I al I. .i . .. I , u 1 I L 19L0y ( I « L c .... tl LL Q UJ 0 o '-, 9 � W Z 5 REVISIONS SPECIAL � au- 1a«l•tl M.IS•tl f /1 /M At0 ��' '� . 116i BRUCE R. FOLEY - " "' Public - Heali .Director' DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. - Associate TuW 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 - 6.085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 Date: !10 /o a NO . . v Fax #: 7 7':f? O �" No. Pages -1/ -- . - - - -_ --.---- .__..._.__------------- . - - -. -- (Including cover sheet) From: Gene D. Reed Putnam County Department of Health For- your.- information '� Please respond.---.--- For your review Attached as requested As discussed Please call Notes/Messages -_.._c,,V 7A 5 LIF7K &49,:2 Z? S L T In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 2261. 11/17/00 11:59 PW SCOTT 4 19142787921 NO.002 902 BRUCE R. FOLEY Public Hechh Director DEPARTiIENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., I.S.N. Associate Public lfenith Director Director of Pottent Services : QUIES1 F0R FIELLD TE TWG ATTIENTION: a A'.)dY STIEBELI ?:G a GENE ]REED .%II information below must be h"I completed prior to nny scheduling. DATE: 7 ENGINEER OR FIRM:. E Lis PHONE R: REASON: DEEPS: X PERCSX PUMP TEST: O TOWN: • SUBDIVISION. V, A LOTH: 09 TO 6 NYCDEP QUTERI A FOR JOIN) aQaEW AM WITMSSING mF SOIL TES - ", . YES NO j a Proposed S`.;TS within the drainage basin of West Branch or Bovds Corner Reservoirs. fl O Proposed S3TS withiri•S00_feet,of a-reservoir resew ir.Atemgr control.la -e..._ � :; :` - - --- _ _ �.,_.._._ P'ropos'edS -TS within 200 feet of a watercourse or a DEC wetland. 0 O Proposed SSTS design flow greater. than 1000 gallons /day or SPDES Permit required. O ❑ Proposed SETS 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 KYCDEP project status (Joint or Delegated) based on the response. If you answerei,gi to any of the questions, NYCDIEP must witness the soil testing. This Department will coordina e a mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. If a project has been dete=ined to be Delegated based on the :above response and then subsequent information indicates L YMEP 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 NYCDIEP. FOR COUNTY USE ONLY 11aTE: a- 4d TIME: l `� / -�. % "3,c> �O \1111 � X75: (FMLDTEST) 11/17/00 11:59 PW SCOTT 19142787921 NO.002 D03 Pon- . _..- ..a.'s: .O. ... .: .rc•.ws•u•..svrw.a•- wc...r'.z, o-s...... ....r ...:_... r.. �w sj: .eTv *IMF . a; J ;o C4 �r I if cc i lop/ cm-J /�W P 11/17/00 11:59 PW SCOTT 4 19142787921 =5711 e M P.W. SCOTT email pws@bestweb-net ENGINEERING & ARCHITECTURE, P.C. 3871 ROUTE 6 (845) 278-2110 -t -;z�4AX48450I&V 66 BREWS-7 � f TO: FAX: PgOJECT: A0 OF PAGES INCL. TRANSMITTAL: - 3 F.M. 2-f* ,3 00"I"Isaft: TO. FAX: PROJECT: TO: FAX: PROJECT: DATE. II /11106 Please c all 845-278-2110 if this transmission is illegible or unclear PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES PERMIT # - 0 .- ic -may -�� Located at Subdivision name �IftYP(J00P 5 Subd. Lot # 4 Tax Map 1,57 Block I Lot Date Subdivision Approved t f 2,1 68 8 Renewal Revision Owner /Applicant Name or cRia5°(w P i Date of Previous Approval Mailing Address 47 6D(-r,- NA60M rcW ReA N .; Zip s Amount of Fee Enclosed C56 "t lPd W 2<, l Qa Building Type Lot Area d No. of Bedrooms !T Design Flow GPD front Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 2-60 gallon septic tank and /fl /A, 0 /-/e n - . n0-r7 / / / r--' 72A 11 / .! Ke 00/A. , Other Requirements: (r% `` (j,_ To be constructed by 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(§) 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 syste Signe Addr m or any reps' eto. d: P.E. R.A. � Date (f L71, ess I EJY f M, Mq License # n_ 6�'_r APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatme stem has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified whe ons dered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permi . Ap oved f r ischarge of domestic sanitary sewage onl . By: A Title: Date: 1 1410 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 P. W. Scott email: DwscottCa)rcn.com Engineering & Architecture 3871 Route 6 Brewsterr;'`NY- �1b5'09T.': `p: December 21, 2001 P.C. Shawn Rogan Putnam County Department of Health Re: Proposed SSTS -Peri 11 Rose Lane, (T) Patterson Dear Shawn, The following is a response to your letter of December 14, 2001. (845) 278 FAX"1845) 278 1. The D -Box has been relocated as requested. 2. The plans depict 12" of fill and 12" of topsoil in the section, which has been clarified for review. 3. The subdivision approval date has been revised as requested on the new forms. 4. There are no septics or wells within 200 feet of the property line at this time. The subdivision map was provided to reflect future approved construction activities. 5: The plan has been amended to junction (overflow) boxes as requested. Since this is a fill package, the use of equal distribution is usually provided - - - - -- - ---to. compensate for potential settling of the distribution boxes. This is compensated with concrete blocks provided beneath the junction boxes extending to existing grade. 6. The fill extends 10 feet beyond the trenches. 7. The contour 670 extends into the proposed dwelling. This completes our response at this time. With regards, AderW. ot t, P.E., R.A. President A R C H I T E C T U R E * E N G I N E E R I N G * S I T E P L A N N I N G i'e.rriUtr Reed ;h ::.......:..::. PUTNAM CO #TY DEPARTMENT OF LTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES • M_ w.., .� ..�.., _ApPT:�C` ���r �� `A�ROwa� �i�°�L���i� A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: �n Pe/ri 47 (Z-.)IY Nti cM13 At5i:x -1 Mot% Don c N Y I °S 4 2. Name of project: r woncls 1 oT_ * S=,c3. Location T/V: Phrtrtf rS'ni 4. Design Professional: P4_,c e r S 5. Address: ?R-71 Roti-rt 6. Drainage Basin: Ens-t_ , /Y 7. Type of Project: Private/Res 1 dent 1 al Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted k 9. Is a Draft Environmental Impact Statement (DEIS) required? ........................ 10. Has DEIS been completed -and found 'acceptable by Lead Agency? ............... 11. Name of Lead Agency T,rw• .i � � P6 t � (' ter, rs 1 ( n � 1.2. Is this project.in an area under lhe.control of,local planning, zoning, or gthe, officials; ordinances ...................................................... ............................... -Y" 1Yn C� i"C{ 13. If so have plans been submitted to such authorities ......... ............................... Y ep - S �� 14. Has preliminary approval been granted by such authorities? Y�-s Date granted: I I I2 fw' 15. Type of Sewage Treatment System Discharge ................. surface water X groundwater 16. If surface water discharge, what is the stream class designation? .................... N A 17. Waters index number (surface) ............................. /A 18. Is project located near a public water supply system? ....... ............................... N11) 19. If Yes, name of water supply /\' /fN Distance to water supply i1' J1 20. Is project site near a public sewage collection or treatment system? ................ /V� 21. Name of sewage system T �� �� �� Loz S Distance to sewage system /V//9 22. Date test holes observed 23. Name of Health Inspector iT, 24. Project design flow (gallons per day) e n 67 L p 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... 1A10 26. Has SPDES Application been submitted to local DEC office? ......................... /v 1/A Form PC -97 2 irtion of this Proiect located within a designated Town or State wetland? Aori k.-?1's ads:Pe" iffequired? ......................:. ............................... No made to Town or Local DEC office? .............................. 30. Does project require a DEC Stream Disturbance Permit? N ................................. �Y o 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No /, -, 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... I &� 34. Are community water and /or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... Y-1) 35. Are any sewage treatment areas in excess of 15% slopes ..................... A/� 36. Tax Map ID Number ....... ................. ............................... Map. E6 S % Block / Lot .3 37. Approved plans are to be returned to ..... Applicant X Design Professional till- applications: for ,review`andapproval:of..a..nev+ ASSTS .to- b�lo6atcl= wtluiieN' WatPr�hed 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 stomwater 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, that information provided on this form is true to the best of my knowledge and belief. False tatements m herein are punishable as a Class A misdemeanor pursuant to Section 10.45 o to Penal Law. SIGNATURES & OFFICIAL TITLES: r Mailing Address: .................... ,W -17 ,-t C ,`(l; /I j P. W. SCOTT Engineering & Architecture, P.C. 3871 Route 6 BREWSTER, NY 10509 E -Mail: pws @bestweb.net TO WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ 1� [EVET[EW @[ 1V ° lJV@W0VVQIL DATE _ JOB NO. ,ATTENTION...._, -.:..._ RE: lk .J the following items: ❑ Samples ❑ Specifications THESE ARE TRANSMITTED as'checked.bel'ow: ❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FORBIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO SIGNED: If enclosures are not as noted, kindly notify us at once. ' ESCRIPTION THESE ARE TRANSMITTED as'checked.bel'ow: ❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FORBIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO SIGNED: If enclosures are not as noted, kindly notify us at once. PUTNAM COUNTY DEPARTMENT OF HEAL'T'H DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONS'T'RUCT A WATER WELL Well Location: Street Address: Town/Village Tax Grid # (I f2z6 -u- I.-/VNc -T PA ,c+ru Map 34�.r7 Block 1 Lot(s) 3 Well Owner: Name: . F3oJ'b CM.'" N t_s 1'imi 1q7 �aL� 1iJIICvn1 lLt�,• tj< l 05'�¢ln Use of Well: -7>" 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 Est. of Daily Usage _y' 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 Is well located in a realty subdivision? ...................................... ............................... Yes, No Name of subdivision .l Act 9LYL W cxa io s Lot No. _ ! Water Well Contractor: 7-6 D Address: Is Public Water Supply available to site? ................... ............................... Yes No .�- Name of Public Water Supply: Pith, Town/Village Distance to property from nearest water main: N I A- Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: LO ( 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. vision or alteration of the approved plan requires a new permit. Well to be constructed by a water well dril er ceiAified by Putnam County. f 14 Date of Issue 112#- 42—, Date of Expiration d Permit is loon- Transfe rable Permit Title: White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 P. W. SCOTT Engineering & Architecture, P.C. 3871 Route 6 BREWSTER, NY 10509 E -Mail: pws @bestweb.net ,.,. ... ..... . 2166 _(%14) 27%2-1. oEA .( 147.278 - TO Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 WE ARE SENDING YOU C Attached ❑ Under separate cover via • Shop drawings ❑ Prints ❑ Plans • Copy of letter ❑ Change order ❑ d `=44IMQ O(P C_T a G`1;�_1'W0Cr4nd DATE DATE ..ATTENTION _- .. .,. ....�_.-. y RE: E R 1 '(,T ( .L 7 Sp-E Subsurface Sewage Treatment System (SSTS) Application for Approval of Plans (PC -97) 1 ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION 1 �a�o Application for Approval of Plans (PC -97) 1 2a �a 1 Construction Permit for Sewage Treatment System (CP -97) 1 I Letter of Authorization (LA -97) 1 2 Design Data Sheet (DD -97) 1 House Plans (2 sets) 3o�a� '-c —a r Crn& W& - (e 1 1 Check # *913 for the amount of $ 1 Short Form EAF THESE ARE TRANSMITTED as checked below: -. ❑ For approval ❑ Approved as submitted ❑ Resubmit ❑ For your use ❑ Approved as noted ❑ Submit _ ❑ As requested ❑ Returned for corrections ❑ Return _ X1 For review and comment Cl copies for approval copies for distribution —corrected prints ❑ FORBIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS List Continued: 4 1 Septic Site Plan Drawings I 1 E911 Address Verification Form (E911 Verfrm), COPY TO SIGNED: If enclosures are not as noted. kindly notify us at once. e COMPUTED BY: CYP _... �__ _� , .- „,,Ew?r ©�ect�< Names- 1����.U.��ot.�= t- .L.��.:.� -.. S�ri-� C.� _. �-� ;DATE: ” °.� .8. �..: _s.:::: • - - PUMP, ANALYSIS WORKSHEET Effluent production for `4" bedroom = 600 gallons Dosing Volume = 75% of trench volume = .75(.6gal/If.)(S/81 If.) = 331gallons Propose dosing ofa7ogal /cycle. Therefore 3 dose is /are proposed on a daily basis. The pump chamber is sized for dosing plus 24 hour emergency detention period of the daily production( SW gallons). A precase tank of !S"06 gallon(s) is proposed. Capacity of pump chamber = Interior dimension of chamber l� ft X ft _ �® sf/ ft of depth /too gallons Use depth = 41" ® Chamber inside top to pipe inv. = 5" minimum Pump chamber capacity check: 6 " Sump = /97 gallons Dose Vol. _ ° , 0 gallons "Alarm Vol. = lg7 gallons '24 Hours = ire ® gallons Total Required `� gallons Pump. Calculations: Descripti6n -1365 rnV. In 1&V on Pump Pit Elevation = SW c Head = to l I C =150 D= 1.5" L= ?o Equivalent L = Total L Pump Rate Estimation: Dose in 20 minute intervals = ,36 gpm Dynamic Head Loss = 10.44 (total L) (gpm)1.85 (C)1.85 D)4.865 10.44 ( �) (,36 )1.85 wto )1.85 (�a g )4.865 l� It D Dynamic Head Loss @ 36 gpm Total Head (tdh) = �� ` ( + 10 '�'� _ .7,0' 3t Pump Model -- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of i, Located at l ( Rases Layi4-, T/V- Path o-. -s m Tax Map # 3 6, k 7 Block Lot 3 Subdivision of Tag p±j - C/j ©o cjS Subdivision Lot # Filed Map # 19 4 Date Filed Gentlemen: This letter is to authorize Pe d" Vv < <SCbrtcr a duly licensed Professional Engineer )_ or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment.and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law;..the Public Health . Law, and the Putnam County Sanitary Code. Countersigned: P.E., , # 0 S9 3 1f(� Mailing Address State %y `( Zip ia_S -01 Telephone: Very truly yours, Signed: (Owner of Property) Mailing Address: 2+7 Not c �ym j OOA L MA 4 o p4 c State M y Zip Telephone: CKI) , 6--)( ' l 3 � Form LA -97 I/ BFL CE R FOLEY :Public. ; - Health •Dtrecxr . .. 1.A: -. !l' . - I -- L QRETTA . MOLNARI - _ - ' ' ,: 'rtrJOCiaie P,�nitc Nealrh Dlractar pfrgCtpr of PatfBn! Servlcas DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Eaviruamcatal Health (914) 278.6130 Fier (914) 278 - 7921 NurslnA Services (9141 278 -6558 WIC (9t4)273 •6678 FIX (M) 4) 278 -6085 Early Intervention (914) 2118 - 6014 Preschool (914) 278.6082 Fax (914) 278 - 6648 OWNERS NAINIE: TAY MAPNLINIBER: E911 ADDRESS: TOWN : a0,d a (f heTsrr 'V'f z- 3 4, 3 QArrl -'ieS o "-) AUTHORIUD TOWN OFFICIAL: (Signature) DATE: �pv 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 vvith the application for a Certificate of Construction Compliance. (E911-v'EU N) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS _REVIEW SHEET FOR.qW� T.RKC7IONPERMrr 7 NAIVIE OF OWNER: rET LOCATION: it P( SAS, SRDATE: 01) TAX MAP#: (CONFMIvMD REVIEWED BY _3 17 ,, DOCUMENTS Y/ DETAILS ON PLANS CONT'D) L.-.-nPERMIT APPLICATION 6-(__)HOUSE SEWER FT. 4"0'; TYPE PIPE CAST IRON •( )C—)WELL PERMIT OR PWS LETTER (__)(::=)N"ENDS; MAX BENDS 450 W/CLEANOUT (—)LJPC-97 RENEWALS C -TER OF AUTHORIZATION NOTE (NO CHANGE) SIGN DATA SHEET (DDS) - k�ps , FILL SYSTEMS SHORATE RESOLUTION 10' HORIZONTAL; iASi TRENCH SLOPES 3:1 TO GRADE ORT EAF FILL SPECS/ FILL NOTES 1-5 PLANS-THREE SETS FILL PROFILE & DIMENSIONS �2LJHOUSE PLANS - TWO SETS Lj( .( H __)FILL IN EXPANSION AREA _)C__,)VARIANCE REQUEST S . UBDIVISTO FILL GREATER TAFA IV 2 FEE -,LEGAL SUBDIVISION -CLAY BARRIER FILL CERTIFICATION NOTE // SUBDIVISION APPROVAL CHECKED DEPTH GAUGES C PERC RATE I/ r E Lj VOL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS FILL REQUIRED I DEPTH EPARATION DISTANCE FROM TOE OF SLOPE (_)CURTAIN DRAIN REQUIRED TRENCH GENERA LOCATED IN NYC WATERSHED LF TRENCH PROVIDED 60FT MAX. I. PARALLEL TO CONTOURS )"YPLANS SUBMITTED TO DEP 1(�"' 100% kLEGATEDTOPCHD EXPANSION PROVIDED DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL DEPAPPROVAL, IF REQ'D WC--)GEOTEXTILE COVER )*DEEP TEST HOLES OBSERVED PERCS TO BE WITNESSED SEPARATION DISTANCES ON PLAN FROM SST EX-APPROVAL SSDS ADJ, LOTS (—f—/JlO'TO P.L. DRIVEWAY; LARGE TREES, TOP . FILL ("")WETLANDS.(TOWN/DEC PERMIT REQ'D?) Z0.l)'jL__)20' TO FOUNDATION WALLS DATA ON DDS PLANS & PERMIT SAME C6C_JIOO'TO WELL, 200' IN DLOD, 150'TO PITS C.3) 100' TO STREAM, WATERCOURSE, LAKE (inc. expan) PRE 1969 NEIGHBOR NOTIFICATION 50' TO CATCH BASIN, 351 STORMDRAIN, PIPED WATER (T LETTER BI/ZBA LD QJOWATERIANE itslz20_')___..___, Ao� 'Qq�D TjQNyVj.200.'. -DRA C_J( _gj;EVA )x)50' JN*GE-COURSE _JSOIL TESTING LOTS>10 YEARS OLD of LJ REQUIRED DETAILS ON PLANS x)(_)10' 200'/500' RESERVOIR, ETC. _ 1501 GALLEY SYSTEMS MIN TO LEDGE OUTCROP /v SEWAGE SYSTEM PLAN-(NORTH ARROW) L/i DS HYDRAULIC PROFILE __610 SEPTIC TA L'FROM FOUNDATION; 50' TO WELL C_j GRAVITY FLOW WELL CONSTRUCT-ION NOTES 1-15 (LOCATION DIMENSIONS TO PROPERTY LINES ,DESIGN DATA: PERC & DEEP RESULTS OF SERVICE CONNECTION 2' EXISTING & PROPOSED MIN 15' TO PROPERTY LINE DRIVEWAY & SLOPES, CUT SLOPE LJ(FOOTING/GUTTER/CURTAIN DRAINS USDA SOIL TYPE BOUNDARIES SLOPE IN SSTS AREA 20 %) TITLE BLOCK; OWNERS NAME ADDRESS C_6( .)REGRADED TO 15%, IF REQUIRED _7 TM9 PE/RA; NAME ADDRESS PMONP41 v DOSE/PUMP SYSTEMS CZ/ )k- )DATE OF DRAWING/REVISION �cli DATUM REFERENCE �ELOCA'TION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. C26( PROPOSED FINISH FLOOR AND � � BASEMENT ELEVATIONS (C WELLS & SSDS'S W/IN 200' OF SSTS PROPERTY METES & BOUNDS C–JC_JEROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE COMMENTS: (REVSHEET)09/01/00 'UMP NOTES )OSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED )ETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) 'IT AND D-BOX SHOWN & DETAILED DAY STORAGE ABOVE ALARM CURTAIN DRAIN ;TANDPIPES, 5' BOTH SIDES, DETAIL 51 MIN to CDS-->5%,20'-4%,25'-3%,35'-1%, 100%-<1% 0' MIN to CD DISCHARGE/100' with 182 cons day discharge 0' MIN to NON-PERFORATED PIPE 14 -16-4 (2/87) —Text 12 PROJECT I.D. NUMBER 617.21 'SEOR Appendix C State Environmental Ouality Review SHORT ASSESSMENT- FORM: :.,:. •r, �, . For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION fro be comDleted by Applicant or Project sponsor) 1. APPLICANT /SPONSOR >A b C rl Y i S't i ve PAC' Y t 2. PROJECT NAME / !, �GI.S 'PiV W 'On �t� % s` T S �' . t/, C 3. PROJECT LOCATION: lAt of Municipality 1`"f`QiY�71'i County t 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) L-t -4 4r Jol S p-ey- Wor, s SLa bC�i'v� S +;SYI 5. IS PROPOSED ACTION: . New ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: I r Cz.K S-t Y Lt Ct 1 fi' t� �i Si�'i t'Gt C �E' :S pig t/ 2 'ire�tM *41 t- S/ S fe," Si kyle. �cLlvl7,c� y�f' -S de-i'tC G V1d Go P1wec' -fi o I'l -fo i Lt 6li'Vr` a440 I wsrrerOU t,lp ry C we to 7. AMOUNT OF LAND AFFECTED: �' S �` '� Initially acres Ultimately acres 8. WILD. PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes ❑ No If No; describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Xpesidential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest /Open space ❑ Other Describe: 10'. DOES ACTION INVOLVE A, PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE,OR LOCAL)? ❑ Yes KNo If yes, list agency(s) and- permit/approvals . 11. ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? �ES es ❑ No If yes, list agency name and permit/approval B (ioez S��c i`Ir I S Gt pfryvc� T� o pcifri8gT.,;)'I P(�� r i re 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes No 1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ��� (�� a Applicant/sponsor na ° ` Date: Signature: L� 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 II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If 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•invol4ed agency''• El Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, ..potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, of other natural or cultural resources; or community or neighborhood character? Explain briefly: O ` n7 C3. Vegetation of fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain bri N . tZ - 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 resod s? �9Aefly. C- `< 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-Cl-05? Explain briefly. C7. Other Impacts (including changes In use of either quantity or type of energy)? Explain briefly. D: aS THERE, -•OR IS -THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL, ADVERSE- ENVIRONMENTAL_ IMPACTS ?., ❑ Yes ~ [:]'No"-' No If Yes, explain briefly J9~ PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether it is substantial, large, important or otherwise significant. 'Each effect should be assessed in connection with its (aj 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 Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible O icer in Lead Agency Signature of Preparer (if diffeyent from responsible officer) Date 2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR . AWASTEWATER* TREATMENT'SVSTEM_`_ ....a�,. 1. 14ame and address of applicant: 0A V I S-f r at e Pe* -1'-. U C:y(,e /Vkcl�rm O pac r to y 2. Name of project: -ltl-m Woods Ln 1C3. Location TN: R- tltI -ST 4, Design Professional: PeAer 0. SCb- , 5. Address: ,�k7( Rowte- b 6. Drainage Basin: T AS-f, vWAc , � — "'e vo i r 1 e t/v s fir , )YY (D��'� 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 (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted V 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... /Yo 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency Tvw ri -4 rg t*V irS v1,l P (ct " vi ," w, 12. Is this project in an area under the control of local planning, zoning, or other _:officials, ordinances ? - - _.... ..._........ _ ......... 13. If so, have plans been submitted to such authorities? ........ ............................... 14. Has preliminary approval been granted by such authorities? Yvs Date granted: . It ` I cl Eby 15. Type of Sewage Treatment System Discharge ................. surface water K groundwater 16. If surface water discharge, what is the stream class designation? .................... N A 17. Waters index number (surface) ........................................... ............................... NSA 18 Is project located near a public water supply system? ....... ............................... /16 19 If yes, name of water supply Distance to water supply �/1 2(1 Is project site near a public sewage collection or treatment system? ................ No LL 21 Name of sewage system IIA6 Via dl tt"�( Distance to sewage system IVIfj r 2, Date test holes observed ff$ 23. Name of Health Inspector M .. �uJ l Ksk 21 Project design flow (gallons per day) ................................. ............................... $"00 C7p D 2. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No 2i Has SPDES Application been submitted to local DEC office? ......................... IV LA Form PC -91 r' 2 27. Is any portion of this project located within a designated Town or State wetland? Nz, 28. Wetlands ID Number +. . .�........,..- .....•... .................... .. �.:. �V— .......,..F._....._ 29. Is Wetlands Permit required? .............................................. ............................... 8,0 Has application been made to Town or Local DEC office? N IA- 30. Does project require a DEC Stream Disturbance Permit? .. ............................... Ill 0 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site,'salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ...............:............... Yes/No DESCRIBE: ®. ®:. rn � .cc t0. 33. Is there a local master plan on file with the Town or Village? ......................... at 34. Are community water and /or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... &/10 35. Are any sewage treatment areas in excess of 15% slope? .. ............................... /V-0 36. Tax Map ID Number .......................... ............................... Ma 36 p_Z Block, / Lot : 37. Approved plans are to be returned to ..... Applicant X Design Professional 10T aAll agpli0atinbs -f5 - e`view and.�pproval of a new SSTS..to b-6'6' lated within th6NYC'IF /aiershed'shal? 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, that information provided'on this form is true to the best of my knowledge and belief. False tatements m erein are punishable as a Class A misdemeanor pursuant to Sectio011445 o e Penal Law. SIGNATURES & OFFICIAL TITLES: Mailing Address: ................................... &7/ Rpuf °e 6' 8r?Av Y /o ° i rl' BRUCE R. FOLEY AuRic Health Director _.._LORETTA MOLINARI R.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 Preschool (845) 278 -6082 Fax (845) 278 - 6648 PW Scott Engineering 3871 Route 6 Brewster NY 10509 RE: Peri 11 Rose Lane (T) Patterson, TM# 36.57 -1 -3 Reservoir Basin Dear Mr. Scott: October 13, 2000 The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on September 27, 2000 is complete. The Department will notify you by November 2, 2000 of its determination. - -- The -Project has- -been delegated to the Putnam County 'Health� Deparfiner t for = review pursuant to the guidelines set forth in the Watershed Agreement. O Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the 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 to:. PW -Scon,Engineering -z-,October.13,200.0-- of impq0ious,sVrfa6es, and the project applicant. should contact the Department of Environmental- Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 278-6130 ext. 2166. Ve ly yours, Rob * ert Morris, PE RM:tn Senior Public Health Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at Subdivision name i`lt'���'✓ Subd. Lot # r 1.... Date Subdivision Approved (# t # Owner /Applicant Name Town or Village Tax Map Block ; Lot Renewal Revision Date of Previous Approval Mailing Address ,` i ---;I ?�1 ►f ' r�, I' + l -�' /r ..� Zip Amount of Fee Enclosed Building Type f' ; ...E.. rr' ,� Lot Area �`; :�fi No. of Bedrooms Design Flow GP r `_. Filpection Only Depth Volume PCHDIIOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Seerage Svs em to consist of gallon septic tank and Other Requirements:- i (, To be'con 61; ted bye "� r 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 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. repa -thereto. Signed: --,-- "- - -,.,s P.E. R.A. Date 1 -' Address' 15., ! License # APPROVED FOR. CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatmentsystem has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when pons6 �dered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved ff jioischarge of domestic sanitary sewage only. By: ' (,4 l .� It Title: , + Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy, - Owner; Orange copy - Design Professional Form CP -97 J PUTNAM COUNTY DEPARTMENT OF HEALTH ` DIVISION OF ENVIRONMENTAL HEALTH SERVICES 4 APPLICATION TO CONSTRUCT A WATER WELL . Permit, #. ;(ration: Street Address: Town/Village Tax Grid # _ - It -Ro S t ; t_ A N L N r�T -5 chi Map L- �7 Block Lot(s) 3 J Owner: Name: Cwo- n NLs J PLC 1 Address. rKr1 ti-o PaG N.y. �7 G ti NAC o m R-0. ) of Well: Residential Public Supply Air /Cond/Heat Pump . Irrigation ,,Ilse 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought'' gpm # People Served �_ Est. of Daily Usage al. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling __k` New Supply (new dwelling) Deepen Existing Well Detailed Reason L,a A Z j e V9 L r 2. S to L:�� e_� for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................ ............................. ............................... Yes No _, Is well located.,in a realty subdivision? ...................................... ............................... Yes _)C No Name of subdivision J A-- C�L'YL_ i,.l ov Io s Lot No. LJ Water Well Contractor:. T Q� D Address: Is Public Water Supply availatlle to site? .................................. ............................... Yes No >< Name of Public Water Supply: N.1 14t. Town/Village N %n- Distance to property from nearest' water main: N % A- Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: 11 7 _ iApplicant Signature: c�.�- -s 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 vision or alteration of the approved plan requires a new permit. Well to be constructed by a water well dril ler ce 'f d by Putnam County. is Date of Issue Af b Z Permit Issuing ial: Date of Expiration 2 D 'Title: Permit is Non- Transfe rable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 rrj a> 00 W� e I im H 4 I ' ADDRESS: 675 670 E911 # T. M. #- PROPERTY ADDRESS: J cv 00 !C N Y 47 ,GOLE NACOM ROAD M AH OPAC NY, 10546 11 ROSE LANE 36.57 -1 -3 11 ROSE LANE PATTERSON, NEW YORK - Putnam County Department of Health r, 665 Division of Environmental Health Services Appr d as noted for conformance with app a le Ru s and Regulations of the u C v Health DepaOD nt./ 660 . Z 1 1 +80 2+10 2+40 ignature & Title ate ' h vHV.+Q k (12.14•al' * RESERVED FOR PCHD APPROVAL STAMP °'¢ V"' SEPTIC SITE PLAN'- r.Y F Y pm* 7ft LOT 4 — JASPERWOODS SUBDIVISION s o� 00-200 �► -10 -2000 C YP AS NOTED G.3 * a rn w cz M tip/ O S ST -1 P. W. SCOTT Engineering & Architecture, P.C. 3871 Route 6 BREWSTER, NY 10509 E -Mail: pwscott @rcn.com (845) 278 -2110 FAX (845) 278 -2166 TO � Cyr s'1►s1�✓� ��'1'Ci'1t..1�� WE ARE SENDING YOU ❑ Shop drawings ❑ Copy of letter ❑ Attached ❑ Under separate cover via ❑ Prints ❑ Plans ❑ Change order ❑ RJEUVG( Samples following items: ❑ Specifications COPIES DATE NO. DESCRIPTION 1.- c 11 ,r` ,.' r.. THESE ARE TRANSMITTED as checked "below: • For approval ❑ Approved as submitted • For your use ❑ Approved as noted • As requested ❑ Returned for corrections • For review and comment ❑ ❑ FOR BIDS DUE REMARKS ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO SIGNED: ff enclosures are not as noted, kindly notify us at once. -... •.: =. , 'LORETTA MOLINARI--A2 ,W -' M -.9:1 -- Acting 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 i' Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 July 24, 2003 Peder Scott, PE PW Scott Engineering 3871 Route 6 Brewster, New York 10509 Dear Mr. Scott: Z,.,/ Re: Field Inspection — Peri Rose Lane, (T) Patterson Lot # 4, TM# 36.57 -1 -3 County Executive A re- inspection at the above referenced lot has been completed and the separate sewage treatment system can be backfilled. There are no further comments to be addressed. - - If you have any further questions, please contact me at 845- 278 -6130, ext. 2261. Sincerely, Gene D. Reed Environmental Health Engineering Aide GDR: cj BRUCE R. TOLEY Public Health Director DEPARTMENT 1 Geneva Brewster, New OF HEALTH Road . York 10509 . LORETiA MOLINARI--R N- ;-K&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 December 14, 2001 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Peder Scott, PE Scott Engineering 3871 Route 6 Brewster, New York 10509 Re: Proposed SSTS - Peri 11 Rose Lane, (T) Patterson Dear Mr. Scott: Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: 1. The D -box needs to be a minimum 15 feet from the curtain drain. 2. Two (2) feet of R.O.B. fill has been shown yet only one (1) foot is required. Please revise plans accordingly. 3. Subdivision approval date is 1/12/88 by John Karell of.th_ is Department. Please revise your documents accordingly. - 4. Provide location of all septic and wells within 200 feet of the property line. 5. Robert Morris of this Department suggests using a simpler design such as a baffled D -box with a series of drop boxes. 6. Fill must extend 10 feet horizontally past the edge of any trench. 7. Contour line 670 is incomplete. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Sincerely, Shawn Rogan Public Health Technician SR:cj ' P. W. SCOTT Engineering & Architecture, P.C. 3871 Route 6 BREWSTER, NY 10509 E -Mail: pws @bestweb.net (845) 278 -2110 FAX (845) 278 -2166 µ TO � �0 to [LIEV J IEn OF 1I ° ° MMOT IL DATE ` JOB NO. - 'A TENTfOMI "_..,....�,......_�.... , ....... r... x _..m . .., .. __.....,_...�...,....- ,�_ -�- -�. RE: DATE NO. WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items: • Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications • Copy of letter ❑ Change order ❑ COPY TO DESCRIPTION ❑ Resubmit copies for approval • Submit copies for distribution • Return corrected prints ❑ PRINTS RETURNFb AFTER LOAN TO US I if enclosures are not as noted, kindly notify us at once. COPIES DATE NO. L r THESE-ARE ❑ ❑ ❑ ❑ ❑ REMARKS SMITTED•as- checked below: or approval El Approved as submitted r your use [I Approved as noted requested ❑ Returned for corrections F r review and co' ❑ F R BIDS DUE ' e COPY TO DESCRIPTION ❑ Resubmit copies for approval • Submit copies for distribution • Return corrected prints ❑ PRINTS RETURNFb AFTER LOAN TO US I if enclosures are not as noted, kindly notify us at once. email: ngineering & Architectu B71 _Route 6 ___ __ _. December 7, 2001 .C. Mr. Shawn Rogan Putnam County Department of Health 4 Geneva Road Brewster, NY 10509 RE: Peri Septic 11 Rose Lane, Patterson, NY Dear Shawn, Our septic site plan has been revised and the following changes have been made. 1. Enclosed is portion of subdivision map showing all wells in the vicinity of proposed septic field. There are no wells in radius of 200' from the proposed field, A respective note has been added to the plan 2. State boundary line has been added to the plan 3. Silt fence has been added to the plan to protect the well. 4. Elevations shown on Dose Tank have been corrected. 5.' Distribution box'is shown on'the-plan. -� If you have any questions, please call. With read-rd�V, ftffe—rlff. 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PW Scott Engineering 3 871 Route 6 Brewster NY 10509 Re: Proposed SSTS: Peri 11 Rose Lane (T)Patterson, TM# 36.57 -1 -3 Dear Mr. Scott: 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 mould °cogtact local wetlands ofcials.in this- regard. 1 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 /D J3 by a representative of this Department. .-1Zj 'Th& State boundaries are to be clearly. delineated and labeled. �11 p Expansion trench lengths are to be notes on plan. All existing and proposed wells and SSTS's within 200 feet of the property are to be shown andiabel6d, l.e. .�exis mg of proposed You may cross out fill note #1 it is not applicable to this application. Road name is to labeled on SSTS plan. 7) . Design Data Sheet has not been completed. (enclosed) Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, Robert Morris, P.E. RM:tn Senior Public Health Engineer Pnr. ip" --..s PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address Located at (Street) Tax Map Block Lot (indicate nearest cross street) Municipality Watershed -it 4-co to Aum apps &-_7/_77(,n7 SOIL PERCOLATION TEST DATA ? T�k 4 Date of Pre-soaking Date of Percolation Test ................ .... .. ....... NOTES: 1. Tests to be reneated at same death until annroximatelv eaual nercolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch,':5 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 14C t, vtt - - --- Depth ti r ..... ................. .. ...... ... rom 0u][k G, d lerc d-laftdow Ho1eNo,::, R"'N Time 'SUA lla sk*.Time surface_ U.c t, a Inches h 2 3 4 5 2 3 4 5 2 3 4 5 NOTES: 1. Tests to be reneated at same death until annroximatelv eaual nercolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch,':5 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 14C t, vtt - - --- TEST PIT DATA 2 DESCRIPTION Og SOILS ENCOUNTERED IN TEST HOLYS ' P//7// �k7 �t rep _..,,. DEPTH_-" , :� _ .. _.:- HOLE "NO: .- ._ 1 HOLE NO:. ,'w >... —._._ ;"i4bO E 1V0: = � ��e � ql G.L. o 0► 0 0.5' TDB, <c 2.0' 2.5' {o iv 11% <--- 3.0' Loam cn `n 3.5' 4.0' ZraaCsS Ctc�y �Z�ccm . 4.5' 5.0' 5.5' 6.0' 6 6.5' 7.0' 7 7.5' 8.0' No L•Q ++ - 8g 1.�ktgwe 6 8.5' LyOct W10(ten 6 9.0' 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered r Deep hole observations made by: Design Professional Name: P er �V�. �crr�z Address: 3971 $?a ,e_ 6 Rpe w s t e* Signature: Design Professional's Seal Date �0F NEkl � UJ LU m )� E PUTNAM COUNTY DEPARTMENT OF..HEALTH ,.- .])IVISION .OF- E.NVIRONMFNTAL.HE'.L-TIv,- - Ce .- iwer- I�..,fE�= .s= -.mc-ws+.a.h •se-- v�- [:_�a.V�1 '.+s'!t .a- �aT•A�w- 'f?I:.Oem 'cnp .:i,wr. t..A6 +�.la/sn.i ":tea.. - .Mi+�A:.+- r+.rvr .+r..9 c +a l��! ��%.kYa+�s�wN%.a }} w .. <.... DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM' -# 114 _TF Owner Address Located at (Street) ,r 6-pg" qz e, Tax Map3 ,57 Block i Lot 3 (indicate neatest cross street) Municipality p.�rrE�s ©,,� Watershed E,467: V-5,1 orj9%%% halms a-t ��ilc� rio p d�G k U SOIL PERCOLATION TEST DATA Date of Pre - soaking fo i Date of Percolation Test Hof 3110 Depth to Water Water .: _. From r n _. G ou d L vet e Percola* ou ti Ho]e No No Time E1 Time Surface (Inches) Dro In Rate Run Mart; StoVLn:) p:. .:... . Start Stop Incpp es h M�n/Inch 1 z 3 4 M 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 10/1.9/01 09:47 PW SCOTT 4 845 - 278 -7921 BRUCE R FOLEY Public Health Director ATTENTION: DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 a . kDAM STIEBELING a GENE L EED TA MOL1NAM ".. M.S.N. :iate Public Health Director rector of Patient Services All information below mut t be Lift completed prior to any scheduling. DATE: 10IL4161 ENGINEER OR FIRM: j ,tj /• Lail PHONE XtEA$ON: DEEPS: a PERCS: x PUW TEST: o A ' * • " - LOT#: WUM YES NO _............ - _ - - Proposed S: M within the drainage -basin of West Branch or Boyds Corner Reservoirs. o Proposed.5STS within 500 feet of a reservoir, reservoir stem or control lake - o Proposed' STS within 200 feet of a watercourse or a DEC wetland. o Proposed S STS design flow greater than 1000 gallons/day or SPDES Permit required. o Proposed S STS for a Commerical Project It is the responsibility of tb a design professional to provide the above information prior to soil testing. This Department will det -trmine the NYCDEP project status (Joint or Delegated) based on the response. If you answere I;�u to any of the questions, NYCDEP most 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 NYC DEP is required to witness the soil testing, it will be the sole responsibility of the design professional ti - schedule re- witnessing of the soil testing with NYCDEP. FORCOUN2YWE -ONLY �� d DATE 130a 3"13 0 Ct�1N!�rE175: (Ft�l.DTEST) I ISM N E, W F A I R F I -E L D , CT �.- •.� � 'ti �a,•z' "iliCidJ�l- lICS:$'7"r '•ff1Yi[�1- :iS,1�..ArrS'h_:�1': PUTNAM CO *TY DEPARTMENT OF IOLTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ySX�r�"✓.• "�.`?';.. M,c " rrr., `..•..t.,:.,,.,.`t.., ; "'' - .,,.,..' -. ...uz_.c._ . —._ ..- %ICATION FOR'APPROVA1 0F'P1 ANS'F0R- A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: �o � � L 1, V IS-f i vl t Peiri 47 Y NcA cmi, PRomEt Mott) Opel C DIY 2. Name of project: Ltio,els Lo-c S r-c3. Location T/V: 4. Design Professional: P.-ec',Pr 5. Address: Rovwrt�. 6. Drainage Basin: sf� r iYY °'S °7 7. Type of Project: X Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted k 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... /Y. 10. Has DEIS been completed -and found acceptable by Lead Agency? ............... 11. Name of Lead Agency T7w• .,) j e� t-tlip- r S fill P Ci v, E'', ; t' r 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? ....... Yep 5Ac v,'.S -',n., 14. Has preliminary approval been granted by such authorities? i5 Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water X groundwater 16. If surface water discharge, what is the stream class designation? .................... N 1A 17. Waters index number (surface) ........................................... ............................... Nlll 18. Is project located near a public water supply system? ........................... ill. 19. If yes, name of water supply n' /1� Distance to water supply /f 20. Is project site near a public sewage collection or treatment system? ................ /YJ 21. Name of sewage system 7 v� �� L' ; �� L`J`� S Distance to sewage system 22. Date test holes observed 1?- 23. Name of Health Inspector 24. Project design flow (gallons per day) ................................. ............................... 6o cl P.pl 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office'? ......................... %v / /? Form PC -97 5!99 2 etated within a desi ated Town or State wetland? HIAa l �.. .1 re ...' .. ..:....:..... ...................................... 7 a app lcation been made to Town or Local DEC office? .................. ............. N n x 30...Does project require a DEC Stream Disturbance Permit? .. ............................... 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No /Y 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 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? ................................. ..............................o 35. Are any sewage treatment areas in excess of 15% slope? .. 36. Tax Map ID Number ......................... ............................... Map36SJ Block / Lot 3 37. Approved plans are to be returned to ..... Applicant X Design Professional = y = NO-=E: All applications for review and -approval .of.a.new_SSTS to- be.W -cated within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate'to the DEP; alf>Zough tfie'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, that information provided on this form is true to the best of my knowledge and belief. False tatements m rein are punishable as a Class A misdemeanor pursuant to Section ..el 0.45 o ie Penal Law. SIGNATURES & OFFICIAL TITLES: Mailing Address: ................................... 471 6 N Y /oS °`j PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DES lGl DX 1 Owner A 0k,2- :,-ns-JL pey_i Address &. -1 G c �L Nemec �u i ,�to Located at (Street) i Tax Map 94.51 Block t Lot 3 (indicate nearest cross street) Municipality Lr P/rw o d.S Lo-� T Watershed C! 5 1 2 P? 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates t each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, <_ 2 min for 31 -60 m* a e submitted for review. tiA`.Y``.. 2. Depth measurements to be made from top of hole.' "' j SOIL PERCOLATION TEST DATA Date of Pre - soaking p�� Date of Percolation Test 0 1311 ° Hole No Run No. Time St a r : Sto p EIa se Time „ (Min:) D_eppth to Water From Ground Surface (Inches) . 'Drop Start Stap Water Level In Inches Percolatton Rate 1 n/Inch :.. 2_, , rtJ 1 1 IR -1 Yq 30 �� - zo 1 3o �rnw�l 2 1,�1- 60 o - -),0,1�7 (P7 � 3 �. � — 31 6 0 (1 — *;, old (, I-It ' C! 5 1 2 P? 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates t each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, <_ 2 min for 31 -60 m* a e submitted for review. tiA`.Y``.. 2. Depth measurements to be made from top of hole.' "' j 0 PUTNAM COUNTY DEPARTMENT OF HEALTH s•— w_ro.z�6...y�A'.n': ' I- $��.oC-tOFnrvwENm_ns+vM..u4.WEN .. ... HEALTH .. .sin. ...- .a....sSw..E... -... ZVIC.... - -. E S �T- cyru..:.N�[s- �+F�..i 'P�R.eS- .- wniY'WY.n �r.�t.x �.ec >.W S•.w..t+w+['L qX .�_..:t.�c+..wv.-. wf.�sw�nw -ws. DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner J3 vF> $ Address 6,7 "A rte PAS., ►-= � ( 1 O ��'-/ k Located at (Street) i 1 l._�t5- - Tax Map &.5 7 Block �_ Lot (indicate nearest cross street) Municipality A-1�-,-f &rj Watershed SOIL PERCOLATION TEST DATA Date of Pre- a l q lop Date of Percolation Test f J/ 5'1C, L Hole No. Run NO.. Time . Start -Stop: Ela se Time Min.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch a,, e } W. z CD 2 �Z 1;-i - SI 3 v ;4"3 29 t 3 3 ;sy 0a d ) ;�H.75' 3 4 PLUM, 2 3. z,7 _ 2375" 3 4 5 1 2 3 4 5 �F NElid NOTES: 2 Tests to be repeated at same depth until approximately equal percolation percolation test hole. (i.e. s I min for 1 -30 min/inch, s 2 min for 31 -60 n submitted for review. Depth measurements to be made from top of hole. i.ed,at e a,, e } W. z CD r����� d ' TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES Indicate level at which groundwater is encountered sOL- Ai3oL�.= Indicate level at which mottling is observed — N 1A Indicate level to which water level rises after being encountered Deep hole observations made by: Rc- ep (� L pc , Date i no Design Professional Name: P. �,;, se--a t i Address: 35"7 i f'. -�Lh -L i3 Y2-0 NN io5 c� Signature: Design Professional's Seal HOLE�N 49 G.L. i iZ.1' 'o 0.5' 1.5' 2.0' 2.5' 3.0' 4.0' 4.5' r 0� 5A-*Jo 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' iAj A- rt---rc. y- 8.0' 8.5' _ .. 9.0' 10.0' Nc Ao TT UN) 1q0 1A.0T[RI Q� Indicate level at which groundwater is encountered sOL- Ai3oL�.= Indicate level at which mottling is observed — N 1A Indicate level to which water level rises after being encountered Deep hole observations made by: Rc- ep (� L pc , Date i no Design Professional Name: P. �,;, se--a t i Address: 35"7 i f'. -�Lh -L i3 Y2-0 NN io5 c� Signature: Design Professional's Seal 2 ro ec ocated within a designated Town or State wetland? of ...;.F.. .,,1...___ ........................ as app ication been made to Town or Local DEC office? ............................... 0. ..Does project require a DEC Stream Disturbance Permit? .. ............................... 31. Is or was. project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No 1�l a 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 n 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? ................................. ..............................o 35. Are any sewage treatment areas in excess of 15% slope? . ............................... /Y.Zt., 36. Tax Map ID Number ....... ................. ............................... Map36,Q Block / Lot 3 37. Approved plans are to be returned to ..... Applicant X Design Professional N9TEr All applications for review and approval -of anew 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, that information provided on this form is true to the best of my knowledge and belief. False tatements m rein are punishable as a Class A misdemeanor pursuant to Section 10.45 o to Penal Law. SIGNATURES & OFFICIAL TITLES: Lv' Mailing Address: .... ............................... W71 AOLt'f C rC PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner bott) Address G c LL Located at (Street) o Tax Map Block t Lot 3 (indicate nearest cross street) Municipality �a,�errwoo �s Lo-t, �f- Date of Pre -soaki Watershed SOIL PERCOLATION TEST DATA 1%0/0 f Date of Percolation Test /D 131101 Ell 6 2 0 a e ►_ 15 NOTES: I. Tests to be repeated at same depth until approximately equal percolation ;rate percolation test hole. (i.e. s 1 min for 1 -30 min/inch, _< 2 min for 31 -60 m' submitted for review .P e each '. Depth measurements to be made from top of hole. ' F rm . •J f R Depth to Water Water From Ground Level Percolation Hole No.:` : Run,No.: ;. Time `.;.Start:- ,Stop Ela se Time Min.) Surface (In.ches) . Start Stop .: <Drop:In ' :Inc es Rate. -Min/Inch: 30 2-0 1 3v alz�C ( 2 (PT Z, 3 d 1. Ell 6 2 0 a e ►_ 15 NOTES: I. Tests to be repeated at same depth until approximately equal percolation ;rate percolation test hole. (i.e. s 1 min for 1 -30 min/inch, _< 2 min for 31 -60 m' submitted for review .P e each '. Depth measurements to be made from top of hole. ' F rm . •J f R ._ d PUTNAM COUNTY DEPARTMENT OF H[EA]LTH UAA -4� _ � CE. DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner 13 3 $ p &=-rc.c Address 67 6- &&L, NBC'. g%A-0 Mih r+_ P Ate _ I ti= Lt 10.3x/ k Located at (Street) it gz!�25i5 t Tax Map,15 7 Block �_ Lot 6 (indicate nearest cross street) Municipality 1' / Watershed SOIL PERCOLATION TEST DATA Date of Pre - soaking ► a I y /00 Date of Percolation Test t �2, S, c� Hole No. Run No.. Time Start- Stop Ela se Time (pMin.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate MinAnch z Y h;: 2 rt:�1- �1 3� 1-43 2y t 3(D 4,LT l-cz p,Z 2 • Y (G 3 4 5 1 2 3 4 NEW -0 NOTES: 1. Tests to be repeated at same depth untie approximately equal percolation rz percolation test hole. (i.e. :- I min for 1 -30 min/inch. <_ 2 min for 31 -60 mi submitted for review. ?. Depth measurements to be made from top of hole. ' a ed at s a e u► z Y h;: DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. L F- F) w 5.r J li.W SOwtl: '' GK-S �ry ct „ NC MO rr u N � /q P wV OTrL M V1 HOLE NO. Indicate level at which groundwater is encountered s O-e- Indicate level at which mottling is observed NIA Indicate level to which water level rises after being encountered Deep hole observations made by: a, cz,C-OD (PL oc�,+ ) Date a ' vo PA1z-x c!-k C— c Pw s kFN A Design Professional Name: P. c,;. sciz Address: 3,K 71 p -.o�j- L Y2– Nj Signature:r Design Professional's Seal 2 P. W. SCOTT Engineeririg & Architecture. P.C. 3871 Route 6 BREWSTER, NY 10509 E -Mail: pws @bestweb.net (914) 278- 211U °� EAiX (914) 278 -2166 TO Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 J X3 /0 :; j WE ARE SENDING YOU ffAttached ❑ Under separate cover via _ • Shop drawings ❑ Prints ❑ Plans • Copy of letter ❑ Change order ❑ 1r-ZVCTT2FQ @17 DATE _7 U JOB NO. �{ ) ATTENTION.. RE: ►` �YZ-i S c� n G Subsurface Sewage Treatment System (SSTS) ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION 1 Application for Approval of Plans (PC -97) 1 1 Construction Permit for Sewage Treatment System (CP -97) f { Fu m P C&i-cs 1 2 Design Data Sheet (DD -97) ►Ls rfE` 3 House Plans (2 sets) 2 5c(- P?,+J��s (!k! VV1-tL-A_-"4',t -1 Z't� LL. { I Cf�iPi e3 OF=' Foa-&L6 i= R���vl �(zcr�l�c�; s /+cC�f�i.� c C� c.i� 5`cb&.t5 1 c1W THESE ARE TRANSMITTED as checked be;ow;_ C For approval ❑ Approved as submitted ❑ Resubmit copies for approval n For your use ❑ Approved as noted ❑ Submit copies for distribution As requested ❑ Returned for corrections r Return corrected prints X1 For review and comment C FORBIDS DUE _ n PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO SIGNEC: GL? If enclosures are not as noted. ;dndly notify us at once. fi 02/14,-01 12:12 PW SCOTT 4 19142787921 NO.032 P03 December 5, 2000 Peder W. Scott, PE Peder W. Scott Engineering & Architecture, P.C. . 3871 Route 6 Brewster, New York 10509 Department of Environmental Probiction Re; Jasper Woods Subdivision Project Log No. 2952 465 Columbus Avenue East Branch Rew voir Basin Valhago, New v °rt 10595595..11 336 Town of Patterson, Putnam County Joel A. Miele Sr., P.t:. Commissioner Bureau of Water Supply Michael & Principe, Ph.l 1. Acting Deputy Commissioner Tel (914) 773 -4438 Fax (914) 741 -0431 Loot to raw. t i. uyc. ny. vs /tj e p) 0181 DEP -HELP Dear Mr. Scott, In accordance with the New York State Department of Environmental Protection SPDES General Permit for storm water discharge from construction a Notice of Intent (NOI) should be filed for this project. According to a list of projects filed with the NYSDEC the Jasper Woods Subdivision in not included. Therefore in accordance with the City of New York Rules and Regulations for the Protection from Contamination, Degradation and Pollution of the New York City Water Supply and its Sources section 18- 39(b)(3)(1i) states that the construction of a subdivision will require a Stormwater Pollution Prevention Plan. Such plan shall be prepared and implemented in accordance with the New York State Department of Environmental Conservation SPDES permit GP- 93 -06. Such plans shall be submitted for review and approval by the NYCDEP. The project is located within the East Branch Reservoir Basin, a phosphorous restricted basin; therefore, the runoff from a 2 -year, 24 -hour storm event shall be captured and treated. If you have any questions, please contact the undersigned at (914)742-2068, Sincerely, nnine M. McColgen taff Engineer Engineering Design Review xc: Ernst R. Wunner, owner /applicant Patrick Ferracanc, NYSDEC Michael Budzinski, PE, Putnam County Dept. of Health Richard Williams, Town Planner, Planning Board S.Jackson, DEP Legal H. Meltzer, Corp. Counsel RECEOVE 02/14/01 12:12 PW SCOTT 19142787921 NU.Wd Wad December 21, 2000 Jannine McColgan, Staff Engineer NYCDEP 485 Columbus Avenve Valhalla, NY 10595 RE. Jasper Woods Subdivision Project Log No. 2952 East Branch Reservoir Basin Town of Patterson, Putnam County Dear Jannine: The project was filed with the County Clerk's Office in 1988 as completed by the firm of Laurent Engineering. The road was constructed and is in place at this time. The application currently pending is for a septic plan for Lot # 4. - If you have any fpglh r questions, please call. With regards, Peder W. Scott, P.E., R.A. President A R C H I T E C T U R E ` E N G I N E E R I N G • S I T E P L A N N I N G N�d� ANI lei C7 1 /� ' s , Ift 4 � _ o 01 LOCATION CHART LOCATION DESCRIPTION FROM POINT A B 1A TRENCH- 103' -0" 121' -9" 1B TRENCH- 131' -4' 140' -4" 2A TRENCH- 95' -0" 114' -5' 2B TRENCH- 123' -10" 132 -7' 3A TRENCH- 87' -2` 107' -0" 36 TRENCH- 116' -5" 124' -8" 4A TRENCH- 79' -5' 99' -8' 48 TRENCH- 109' -0" 117' -0" 5A TRENCH- 71' -8" 92' -6" 5B TRENCH- 103' -5' 110' -5' 6A TRENCH- g3' -11' 85'-4" 6B TRENCH- 96' -2' 102' -7" 7A TRENCH- 56 -2 ". __. _ 78' -4' . _.7B - TRENCH- . _ _. ..89' =2" '' 94' =10' 8A TRENCH- 48' -6" 71' -7" 8B TRENCH - 82' -0" 87'-0' 9A TRENCH- 40' -10" 65' -0' 98 TRENCH- 75' -2" 79' -3" 1 O TRENCH- 183' -6" 182' -2" 10B TRENCH- 150' -11" 155' -2" 11A TRENCH- 180' -4' 177' -9" 11B TRENCH- 147' -3' 150' -3" 12A TRENCH- 168' -8' 166' -0' 12B TRENCH- 135 -6' 138 -11" 13A TRENCH- 161' -5" 158' -0" 13B TRENCH- 127' -11" 130' -9' 14A TRENCH- 154' -2' 150' -0' 148 TRENCH- 118' -6' 121' -3' 15A TRENCH- 147' -0" 142' -0" 15B TRENCH- 111' -0" 113' -1' 16A TRENCH- 140' -0' 134' -0' 16B TRENCH- 103' -8" 104' -11' 17A TRENCH- 133' -1" 126' -0' 17B TRENCH- 96' -5" 96' -10' 18A TRENCH- 126' -4" 118' -1" 18B TRENCH- 89' -4" 88' -8" LOCATION CHART LOCATION DESCRIPTION FROM POINT A B D1 D -BOX 141' -7' 150' -4 D2 D -BOX 148' -4" 155' -1 D3 D -BOX 148' -5" 158' -A Tl -A SEPTIC TANK 1250 GALLONS 18' -8" 36' -1( T1 -B 14' -10` 42' -8' T2 -A PUMP CHAMBER 1250 GALLONS 14' -5" 48' -6' T2 -B 15' -2` 54' -6' LP Sr-T 5F--r ;T 1, 7- to C 9 O O O 90 57 0 4 .0 sot /0 Pvc /NV 665 0 C 185 LF 4, P£RF P1p f o, j 0 Ok ox 0