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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 44. -3 -3.1 BOX 18 No Noo IN No . No or � r � . No j T .� i, • , IN No i r F1 f �, -. �� kc �. �- . No 02114 1 PUTNAM COUNTY DEPARTMENT OF HEALTH f DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE Fka ATMENT SYSTEM PCI�ID CONSTRUCTION PERMIT # P - 9 - 9 8 l Located at FAIR STREET Town or PATTERS ON Owner /Applicant Name NDUE GELAJ Tax Map 4 4 Block 3 Lot 3.1 Formerly LA MORTE Subdivision Name LA .'MORTE Subd. Lot # 1 MailingAddress 2 PINESBRIDGE RD., P.O. BQX 1920 AMAWALK, N.Y. Zip 10501 Date Construction Permit Issued by PCHD 8/19/98 P.O. BOX 192 Separate Sewerage System built by NDUE GELAJ Address AMAWALK ,L N.Y. 1 0 5 01 Consisting of 1250 Gallon Septic Tank and 420 LF OF LEACHING TRENCHES Other Requirements: Water Supply: Public Supply From, Address ROUTE 52 or• xxx Private Supply Drilled by HENRY BOYD Address t'ARMEL , N.Y. 1 0 51 2 Building Type RESIDENCE -- -Has erosion control been completed? YBS. Number of Bedrooms 4 Has garbage grinder been installed? NO I certify that the system(s), as listed, serving the; built plans (copies of which are attached), in aecc plans and the standards, rules and rewatiblis of Date: 7 / 3 0 / 01 Certified by Address remises were with the issue nam County PAV. N.Y. 1054 5nstructed essentially as shown on the as- PCHD Construction Permit and approved ;nartment of Health. P.E. R.A.xXx License # 11056 Any person occupying premises servelLtAe agove 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 ar subject to modification or change when, in the judgment of the Public Health Director, such revocatio , o ificatio change is necessary. B Title: Date: 2. 4 Y• 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:Locatirata__ ... Street Address: - - Tourn/Village: - - ° °' sd� Tax-Grid Map Block Lots) / Well Owner: Name: Address: G 'o n . Gp la j L, ae,4 "'q Pd, hLAaujdk M1 LOPH Use of Well: 1- primary 2- secondary )V Residential V Public Supply Air cond/heat pump Itrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened , Open end casing Open hole in bedrock Other Casing Details Total length -jjo-�_ft. Length below grade ( ft. Diameter _�in. Weight per foot_lb /ft. Materials: _ Steel _ Plastic _ Other Joints: _ Welded A Threaded _ Other Seal: _)L Cement grout _ Bentonite Other Drive shoe: 1CYes 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 Compressed Air Hours � Yield _y gpm Depth Data Measure Mm an surface-static ispecify ft) During yield test(ft) Depth of completed well in 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 a , 15' A -� tv �' -� ,y1,a,T� If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth Model Voltage HP Tank Type Volume Date Well Competed 4 -i x-99 Putnam County Ni i nation No. b Date of Report tl- )ao Well Driller ignature) NOTE: Exact location of well with distances to at least two permanent landmarks to be provide a sepafate srplan. �,��(,� AvLt'" t" uj mil. Co �e ' <?1 � ass Q ire // Well Driller's Name -H Address: ��' S t IV [D'E al Signature: Date: l —If—'00 White copy: FMTile; Yellow copy - $uilding Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 JOEL GREENBERG, RA, NCAw ARC WMC RPL: . 2 NUSCOar ROAD NORTH WIA"iAIC; Ylilft „if1 47 °; " " (846) =4M3 FAX (845) 628,2907 EMAfL: gwd dbedweebM August 17, 2001 Robert Morris Putnam County Health Department 4 Geneva Road Brewster, New York 10509 Re: Ndue Gelaj Fair Street Carmel, New York 10512 T.M. # 44. -3 -3.1 Dear Mr. Morris, Enclosed please find drawings and application for a Certificate of Construction Compliance for Mr. Gelaj. Please note the following with regard to Gene Reed's inspection: 1. The cast iron pipe was installed and inspected by me prior to being backfilled. t ough.the,fields.werejnt the. lengths shown on -th =drag the construction permit, the total exceeds the required 400 lineal feet. 3. The as -built drawing shows that 100% expansion is possible. 4. The house was constructed close to Fair Street and a•variance was granted by the Patterson Zoning Board of Appeals. 5. Filter fabric was installed over the leaching fields prior to being backfilled. 6. A silt fence was installed and remained in place until the lawn was established. 08/21/2001 10:36 8456282B07 JOEL GREENBERG PAGE 01' JOEL. GREENBERG, R.A., NCAR6 2 Muscaorr Roan NORTH MAHOPAC, NEW YORK 10541 845 * 628 - 5613 FAX 845 - 6W 0 AML• �garc#��;tvu�e�.n� DATE: TO: RE: ATTENTION: FAX NUMBER: FROM: COMMENTS: F- 2.Z--- Z-60 / �a7,? -2q2 1 TOTAL NUMBER OF PAGES INCLUDING THIS TRANSMITTAL SHEET. IF YOU DON'T RECEIVE ALL PAGES OF TRANSMISSION, PLEASE CALL US AS SOON AS POSSIBLE. AUG -21 -2001 TUE 10:35 TEL:845- 278 77921 NAME:PUTNAM COUNTY DEPARTMFNT nF P_ 1 08/2/2001 10:36 8456282807 JOEL GREENBERG PAGE 02 9145782019 P -91 puG -21 -91 10 _16 .AM c TOWN 2Ui PgTTER30hl JOEL t WENBERr PA% 02 n►Ata LoMTA poi ARI st,ra., US.R. A Omn coed &9w9", New York 14509 " car» e>:�x�rt.>�s �v>in �u•�: tiur:oi 8rrrlFa �tq 27t •snit 'pR,d (e�M 715 • eete t��i� 7ri .se1z - pa�b tnhe7arlbd (93�)2'!i•dp ;4 Re:t>he�f tpl4k17i6032 plaa�t4)t7e -16ii O'OVftM YAM. NDUR SELAC TAX IVII#p NUMl3Elt: 44,-3-3,1 011 ADIMM.- 3 42:PAiR STR=T TOWN: PATTLRGON �.. U'iUOYtiZED IQW!�" flMCLAY.: 43 ��rr��•,,,,� Mpawlre} DATE: 8120/1001 Co=ty Department of Health will not issue a Cerocnte of Ca3>I,st 01" CoMplianoe unless the above form is compleed, i.e., a legal E91 I address ie' Wped by an authorked town 4&L-d. 'fhb form is to bt s amitied With the appZlcatiou for a Car mi cite of Coumctioa Compuute. _ -mm (24 TIIC TFI:R45- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: 114e/9y Street L-ocatior��• ' _. :�.- .�:,.;::, � e Y�,.��.1.�.r�►� =..� -. /�'Z Owner !Fj�A,T Town Permit # -P - q - S TM # Subdivision Lot # 1 "z.�.�►or2T� " 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 System a. Septic tank size - 1,000 .........1, SO....... other ................... b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box . All outlets at same elevation -water tested ................. 2. Protected below frost .................. ....: ........................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ...................................... f. Irenches T e) ngth required * ADO Length installed jfoo 2. Distance to watercourse measured .t l4. d Ft.......... 3. Installed according -lo plan ....... .. ..............................: 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. frorn property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7 Room allowedfor expansion 100% 8 -S zef of gravel `3�/4�= 1' %2" diameter cl'eari .:.......... why 9. Depth of gravel in trench 12" minimum ................... capped .::..... ..:..:.::.:.:. ............................... - g Prize or oDosed ump chamber Systems m er .................. ............................. 2. Overflow tank ............................. ............................... 3.. Alarm, visual/ audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ....................:..... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Building a. House lo cated per approved plans ... ............................... b. Number of bedrooms ........................ /.. E�A�� m.3..... IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured - - o v ft........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanshi.p a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled .........................:. c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir:to exist watercourse g. Footing drains discharge away from STS area ............... 1. rosion con ro prove e ................. ............................... Rev. 6/97 T" J INU UU1VllY EN I S 2 w F e .rem ..,.� ... �� ...�.. .�.w.._. Mbvl.L To.:w el s 7&4 X X X x _ _x NE NORTHEAST LABORATORY OF,: D UTTDV # 39 MILL PLAIN ROAD - DANBURY, CT 06811 A13Sm0j (203) 748 -7903 - FAX (203) 748 -0652 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: MR. GJON GELAJ 2 PINES BRIDGE ROAD/BOX 192 ARMWALK, N.Y. 10541 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: 10/20/2000 Total Coliform (Bacteria) PHYSICALS:3 /9/2000 CT Cert: PH -0404 NY Cert: 11471 DATE SAMPLE COLLECTED: 3/9/2000 & 10/20/2000 TIME COLLECTED: 11:30 & 3:30 P.M. COLLECTED BY: G. GELAJ DATE RECEIVED @ LAB: 3/9/2000 & 10/202000 TESTED BY: LAB# 11471 REPORT DATE: 10 /24/2000 FAIRE STREET, LOT #1, PATTERSON, N.Y. HOLDING TANK WELL -NEW NONE RESULT: MAXIMUM CONTAMINANT LEVEL 0 per 100 ml 0 per 100 ml Color 8 Odom 3- METALLIC_ pH. 7.75 Turbidity 2.1 NTUs CHEMISTRY:3 /9/2000 . Nitrite N <0.005 mg/L as N Nitrate N <0.20 mg/L as N • - _ ... __ . _:._ .__ _.....: _ Alkalinity -.._ 40:0_. .._ mg/L .. _ . Hardness 124.0 mg/L 3/20/2000 -Iron 0.256 mg/L Manganese 0.065 mg/L Sodium 8.3 mg/L Lead 0.002 mg/L 15 3 Units no designated limit 5 NTUs 1 mg/L as N 10 mg/L as N -no-designated-limits`_..._...� •- -...:. �. _..___ b, . . no designated limits 0.30 mg/L 0.30 mg/L (Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] 20 mg/L ** 0.015 * ** ml = milliliter mg/L = milligrams per Liter ND = none detected NTU =Units * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED:3 /9/2000 & 10/20/2000 SAMPLE, AS TESTED ABOVE: AMPOTABLE or ONOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) r Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060370 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 NORTHEAST LABORATORY of DANBURY 39-MILL -PLAI1v RoAD— �"APT8t1KY; CT` "„ 0681`1""'" ` "� CT Cent: 7 1�I'�404 (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 INTERPRETATION OF LABORATORY RESULTS In New York, the Department of Public Health (DPH) uses a combination of standards and advisory levels to help consumers interpret their water test results. Their excess does not necessarily mean that the water is harmful, but it might indicate that the source of the problem be found and corrected. For specific questions concerning your analysis, or any treatment your are considering, contact the Laboratory or your local Health Department. Coliform (Bacteriological Test): This test is made to detect organisms of the so -called coliform group, found mostly in the intestinal tract of rnan and otlier-ar mais. The presence of calif -arms indicates the'possibill-ty, that disease produchig organisms may also be present in the water. Limit: 0 /100 ml. Color: Color may result from iron, manganese, humus, plankton, weeds, or industrial wastes. No designated DPH MCL limits. Odor: Odor is a subjective evaluation of acceptability of the water. Not to exceed a value of 2 on a scale of 1 to 5. PH Value: pH defines the hydrogen -ion concentration in water and represents the aggressiveness of the water toward pipes, etc (a low pH being more corrosive). Recommended Limit: 6.4 to 10.0 range. Turbidity: This test measures the light scattering property of solids in water as compared to a standard clay suspension. Limit: 5 Units. Nitrogen Constituents: These may indicate sewage or other nitrogenous organic contamination. Nitrate Nitrogen in excess of 10 mg/L is potentially dangerous, particularly for infant feeding. Limits: Nitrate: 10 mg/L as N; Nitrite: 1 mg/L as N, lalAW4linity isameasure of alkainesubsta�ces- such -as hy4roxides, carbonates,and4caibonateswith�y capacity for neutralizing acid. No designated limits Hardness: Hardness is primarily a measure of calcium and magnesium in water and is related to the soap - consuming power of water. No designated DPH MCL limits Iron: Excess iron results in color and trubidity. Iron stains laundry and fixtures orange brown and promotes iron bacteria which can impact a taste and odor. Iron can be removed with a water sofener, iron filtration or I ion exchange. DPH MCL:0.30 mg/L Manganese: Manganese causes black stains on laundry or fixtures. Manganese is removed with a water softener, iron filtration or ion exchange. DPH MCL: 0.30 mg/L Iron plus Manganese: DPH MCL: 0.50 mg/L Sodium Persons with high blood pressure, hypertension, congestive heart disease or persons on a low salt diet should consult their physician before consuming a source with a high sodium level. DPH GUIDE:20 mg/L for people on a severley restricted sodium diet. 270 mg/L for people on a moderately restricted diet. Lead: Lead is a metal formerly used in soldering joints in plumbing systems. It is now prohibited, but many houses still have lead in their plumbing systems. Lead can build up gradually in the body and can have effects on the brain and nervous system. Action Level: 0.015 mg/L. Note: mg/L = Milligrams per liter N= NitrogeN ml= Milliliters NTU= Nephelometic Turbidity Units DPH = Department of Health •r_s' � s. 0. ;n _. }�,y -s.. R Y k /�C 4� iuCt S rj,7 r< s? F >rlr.e $.. .f ..c`. 1- >: a '..r::, F ..: N''a Yr ^� :_� ►��� r y �/ P.:f'_r .. yi -iJ \ cfen po �,, '`¢f, •V , k ;4. f� �e_ -1�i►k ��1° �b .t- WE, , P; gr St6/-Y py�c i`� yV �v' X1 a t mot{ r -ter. wa„ I 4 6R -M't. a `er 5e 11 — In I Fr�P*' �. "S X 370 I o i use if 0 ( 2 ; �� e A �nrm 7th `�� H 7. 570 AL wood 4 "c.l. / 57001° 0a ec; q� pecK i •% t. J DeBartment of Health I $ ° (p2° Putnam County 3. C �`,.• �o . �:.. ? kF�`► c S °' 1086 Z �Y' �e�j°�`��9 ?p �•s- P 2 ?ate' ` � Division oY EnviroTtmental Health services 13 856 f02° ith i . y H . _ �J ?n. �'' �o?o.o, = t r ��/, ABPT se noted for aonforl" Y the 4 25° 0 L_ lations �' ♦. �o, y,; 9` 20. °' 3 0 O �Or V ap ea a and Regulations f 10 °i0° / ' f Co Health Dep 64P $°P `j 9 IT " a° s •�, •, h _ \8' \ F �• \� \moo. /�, i&nature Title 1$ 516` ll° W Gr ° ajo lL Cb LU i ! 24 t, CO P. I n SURVEY REFERENCE 5go 1 —1 L mss Zd. F o- 4Y s P `qy AS BUiIT SURVEY. PREPARED 8Y 15UNMk Y :ASSCl 0• ' N.Y STATE UCENSFD LAND SURVEYOR.NO 4�1,398DATED S /YS/oo.'; foe V 91 ° Ilp° THIS IS - O'CERTIFY THAT THE SEWAGE DISPOSAL SYATEM n' HAS'BEEN CONSTRUCTED'AS INDICATED ON THIS PLAN AND �O°. THAT I`INSPECTED THE SY�TEM BEFORE IT WAS COVERED OVER. THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE WITH ALL STANDARD kUkEDS AND REGULATIONS`OF THE PUTNAM COUNTY DEPARTMENT;OF HEALTH: 4. i° h (� 1 Il I• i 1 1 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM NDUE GELAJ 44 3 3.1 Owner or Purchaser of Building Tax Map Block Lot NDUE GELAJ Building Constructed by FAIR STREET Location - Street RESIDENCE Building Type PATTERSON TownNillage LA MORTE Subdivision Name Subdivision Lot # I. represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and. hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month JULY Day 9 Year 2001 ff - 6d__1 , General Contractor (Owner) - Xgnature DDDB POND INC. Corporation Name (if corporation) Address: 2 PINES BRIDGE RD., P.O. BOX 192 State AMAWALK , N.Y. Zip 10541 Signature: I)IQti( Title: PRESIDENT DEER POND INC. Corporation Name (if corporation) Address:2 PINES BRIDGE RD., P.O. BOX 192 State AMAWALK , N.Y. Zip 10501 Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH r DIVISION OF ENVIRONMENTAL HEALTH SERVICES. FINAL SITE INSPECTION Date: In spec a y: c,,125 Town Permit # TM # yy — 3 — 3,) Subdivision Lot # 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 System a. Septic tank size - 1,000 ..... .l, 50. other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost ................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... .............................. . f. Trenches es _ Len required W B Length installed moo 2. Distance to watercourse measured-f- to m 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 - 1%" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... ..._g. 10. Pipe ends ca ed:::::.:................................................ a..._.. - _ _ _ _ .. _.._ .g.. P' or Dosed stems 1. Size ot 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.......... III. House/Buildin a. House located per approved plans ... ............................... b. Number of bedrooms ........ ................'.e...'1��°�^� : �.... IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured f- / o e> ft........... c. Casing 18" above grade ............ ............................... d. Surface drainage around well acceptable .................:..... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ........... ..................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan. f. Curtain drain outfall protected & dirAo exist watercour g. Footing drains discharge away from STS area .............. h. Surface water protection adequate .. ............................... i. Erosion control provided ................. ............................... Rev. 6/97 Y r DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 TeL (914) 278-6130 Fax (914) 278-7921 1 Date: BRUCE R. FOLEY Director To: r©CL 4k94--f1-1r29-726 Fax th 2 07 No. Pages 2 (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 —A— . Please call aPe u �aM GL TION Notes/Messages Cc M M j6 ► 7-5 ®N FA LTZ '51-- T M5 P1 G7/ 61A,/ In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 157. LC4 -1J -1777 C!O. 1`y . i.Ue- a R LTNAM COUNTY DEPARTMENT BT HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - -. ... ......� ... . i INSPECTION. Trenches X PCHD Q Located Owner /Aj Formerly. Is syetein fall a Is system coml Is system cons9 Is well drilled? Is well located Are erosion coi N I certify that the inspected and vt and approved pi of health. t Permit # P -9 -98 AIR STREET (T) (`/) PATTERSON . ame . WON GELAJ TM 44. Block 3 Lot 3.1 D LAMORTE Subdivision Name LAMORTE Subdivision Lot # 1 eted? Date i YES Hate 11/29/99 A as per plans? YES YES r plans? YES measures in place? YES. Date 9/15/99 n(s ), as listed, at the above premises has been. Constructed and I have their completion in accordance with the issued PCHD Construction Permit d. the, Standards, Rules and ReNlations of the Putnam County Department i Date: 12/13/99 Certiftedt Address MUSCOOT ROAD . e 1 Comments: - I PLEASE INSPECT AT FOR: ® AD*M Q GENE ' PE RA X I Professional . Lic..# 1 056 EARLIEST CONVENIENCE AND CALL,ME Form FIR -99 TOTAL P.02 11Cl. -1J -1777 CJC!• 1J i . } O 'tl JOEL GRE Two Musc _ . _.Mahopa ,Pf 91-628 -6613 e-mit )LGAR DATE- TIML: TO: RB:'`�:j FAX NI FROM: r.Wl NBERG, Architect t Road North York. 10 541 Fax 914 - 629.2807 I sol.com », IF YOU AO "Y RECEIVE ALL PAGES U;F ?'RANSMISSION, PLEASE CALL US AS SOON Al POSSIBLE. TOTAL NUh, IBER OF PAGES (INCLUDING TRANSMITTAL SHELL'): 2. F A-, CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PE r(L y -E�i PArr6f -17014 Locat at Town or Village Subdivision name LA.. MOP-Tf-E Subd. Lot # Tax Map 44 Block '�5 Lot 154 9 Date Subdivision Approved �' 2�' `� Renewal Revision Owner /Applicant Name V IT% LMNpR-IF Date of Previous Approval Mailing Address G V U tr'f ER— A\15 PA W LI HC, N Zip Amount of Fee Enclosed Building Type P1661 1 (At.. Lot Area O ilh No. of Bedrooms Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of TAEOME6 Other Requirements: To be constructed by T 16i Water Supply: Public Supply From oil:' Supply Drilled by MAD gallon septic tank and 400 LF /11"85 Address Address 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 repairs thereto. Signed: Address P.E. X exo5oL- I050� R.A. Date C'' ?w License # 11;56 12 Il APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w onsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe r i prove discharge of domestic sanitary s ge only. By: Title: ��` Date: [ [ White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL PCHD Permit.# Well Location: Street Address: Town/Village Tax Grid # f A I P, lc> I 1 PAT-I EfR'a0 M Map -44 Block '9J Lot(s) • I Well Owner: Name: Address: ? Use of Well: X Residential Public Supply Air /Cond/Heat Pump Irrigation primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought IC7> gpm # People Served N Est. of Daily Usage 9 oa gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling X New Supply (new dwelling) Deepen Existing Well Detailed Reason NEW P'e'WEhcr for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No X Is well located in a realty subdivision? ...................................... ............................... Yeses_ No" Name of subdivision V 1TO 1-A mPTF- Lot No. Water Well Contractor: T 6 D Address: Is Public Water Supply available to site? .................................. ............................... Yes No X Name of Public Water Supply: W //, . Town/Village r' Distance to property from nearest water main: MIA Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: (P'aq Aqo Applicant Signature: ''t-•- PERMIT TO CONSTWCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a watepwq 1 driller certified by Putnam County. r Date of Issue j// Permit I ' g Offici Date of Expiratio Title: 1 L ' Permit is Non- Transf rra le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 0 NE (W4) 742-201 FAX (914) 742-2027 THE WV OF NEW YORK DEPAR NEWT of FWARO NEWst. PRWF nM JOEL A. NIEM SR., P.E. Commassaoner July 22, 1995 Robert Morris,-P.E. fatnarn Co. Health Dept. 4 Geneva Road . nrewsier,14Y 10509 Re: Larnorte Subdv. Lot #1 SSTS (1) Patterson; Fair Street Middle Branch Resen oir DEP Log #7567 (Joint Review) Dear Mr. Morris: Bureau of WaW supply, Wits and Probicdw This letter is to inform you that the New York City Department of EnviromnentaI Protection (Department) has determined that the above - referenced application is complete. In addition, the Department has no objection to the approval of the above- referenced regulated activity. This determination is based on the review of submitted doctunents ,including the plan titled "Proposed SSDS, Lamorte Subdivision Lot #1 ", dated-06/24/98. The applicant must contact Matthew Giannetta of my staff at (914) 742 -2028 at least two days prior w &� suut of Wasuut-Wu of the BSTS su that the Vd parmitmt May tY qWT and n9MW W i�stallata9aa. Sincerely, Margaret )LOYd. P. . Supervisor Engineering Design Review xc: James Covey, P.E., NYSDOH 465 Columbus Avenue, Valhalla, New York 10595-1336 7n'a QC,: QT RF, 77 1 n 5'V5'n- W- bi6:xPA 9NRIAW N3 d3Q 3AN tAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 8 Milltown Road Brewster, New York 10509 (914)278 -8108 - (FAX) 278 -2858 ^TiWG'SITE'ENGINEERS "` Date: To: Job No.: Project: ST� (G-eival Atten n: Gentlemen: We enclose ❑ B/W Prints ❑ Specifications copies of: ❑ Reprodt ❑ Reports ❑ Tracings Copy of Letter Description: 9 Sent via: ❑ Our Messenger ❑ Blueprinter ❑ First Class Mail ❑ Your Messenger and Delivery Copy to: 'z Yid OZ 10- e6 C ❑ Revision /Date No. ❑ Special Delivery Very truly yours, LAURENT ENGINEERING ASSOCIATES,P,C. Per: - - - -- - -- - -- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES k `'DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner\tl_-rp LAM,0&jt✓ Address Located at (Street) t,, 1 _5 � -r Tax Map +,+. Block Lot 3A (indicate nearest cross street) Municipality Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test -7 -11 _Gj f3 Hole No. Run No. Time Start - Stop Ela se Time �1VIin.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 22 29N � 2 � 3 4 5 2 2 2 3j - 0:00 25 4 5 1 2 3 4 5 2. 1 ests. to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s t%girrf ►y�� -39344 I K s 2 min for 31 -60 min/inch) All data to be submitted for review. Depth measurements to be mod 1fifbrnttop of 3 l`- � C1 Form DD -97 2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES .DEPTH HOLE NO. HOLE NO. HOLE NO. 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' __._._ _.._ �.._.._ ...... _... ._. . w.. ... .. , 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 (tole observations made by: G. Date-1-11 Design Professional Name:,��{ Address: 2 L TI' I S Signature: Design Professional's Seal FAQ. N I Ch'0 ^ Ir / Q. cc w �F M1ic. E'iF12�4 �t� / �- OFESS0�? %, � eo BRUCE R. FOLEY Public Health Director_ u= w DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 July 9, 1998 Harry Nichols Laurent Associates Millbrook Office Centre Route 22 & Milltown Road Brewster NY 10509 RE: Lamorte Fair Street, Lot #1 (T) Patterson Reservoir Basin Middle Branch Dear Mr. Nichols: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on July 9, 1998 is complete. The Department will notify you by July 29, 1998 of its determination. ❑ The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. 0 Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement: If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Dept. of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Dept. of Environmental Protection regarding such activities to see if Dept. of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (914) 278 -6130 ext. 166. V, y tr y your Robert Morris, PE j?l�/1'•tn A„l,lir %1Palt1i Fnrr;noo+• LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE e ..<...� . — ----- - Route 22 & Milltown Road- Brewster. New York 10509 (914)278 -6108 - (FAX) 278 -2658 HARRY W. NICHOLS JR., P.E. \ CONSULTING SITE ENGINEERS June 30, 1998 y Robert Morris, P.E. - Putnam County Health Department 4 Geneva Road - Brewster, NY 10509 = RE: ' Individual SSDS - Lot 1 { LaMorte Subdivision Fair Street s Patterson, N.Y. Dear Mr. Morris: Enclosed are the following: 1. Five (5) prints of SS -1 "Proposed SSDS ", dated 6/24/98. 2. "Short EAF", dated 6/24/98 3. "Application For Approval of Plans For a Wastewater Disposal System ". _.. -4.. "Construction Permit for Sewage Disposal System ",. dated 6 /24/98. 5. "Application to Construct a Water Well ", dated 6/24/98. 6.. "Design Data Sheet ". 7. "Letter of Authorization ", dated 6/24/98. 8. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only ". _ 9.:- Review Fee in the amount of $300.00. It appears that this project will fall -under joint review in that the project is within. 200 feet of a.' stream. We will contact Gene Reed to schedule witnessing of the percolation tests. 1 June'30, 1998 Page 2 98004 -1 We would appreciate your review, approval and issuance of the Construction Permit at your - earliest convenience. , Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. i hols, Jr., P.E. HWN:JDM:bd 98004 -1 t . i h . 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES.''. LETTER OF AUTHORIZATION Property of V I YO L, M,9 9,-(ir-, Located at _ -A1 g T/V rA.-T: j e RS0 N Tax Map # 44. Block .j Lot 3.1 Subdivision of V rr/' L.4m a rZ- T� Subdivision Lot # 1 Filed Map # 2-ry 17 Date Filed .3 _�► Gentlemen: This letter is to authorize 4A19 (L�( �_ 1 , "L T a duly licensed Professional Engineer _ �,_ or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147..of.the Education -Law; the. Public Health; -..._ ary Law, arid*the'P�utnam it � Code. . C ntersigned: JE.R.A., # .Mailing Address NiC Q. C* s Very truly yo Uj Signed: Mi 24 J,' (owner of Property) 90FESS%O_ State( Zip 10 Telephone: JI A - 2-7b -6108 Mailing Address:] 1 C- oOLie-JZ A45. �. IN State Wj Zip Telephone: qI+- - 1 22 Form LA -97 . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES •J APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM . 1. Name and address of applicant: V i J y LAS 1 i COULTE21 14vlr 2. Name of project: PPPOScD 65'S 1 3. Location TN: j'AT�RSdN 4. Design Professional: RAP42j' �' ���°� -'� �'� 5. Address: 20 n11L TOWO 6. Drainage Basin: C/iCToi-i �o Q°i 7. Tvoe of Proiect: 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 X 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... No 10. Has DEIS been completed and found acceptable by Lead Agency? ...............� 11. Name of Lead Agency 141 A 12. Is this project in an area under the, control of local planning, zoning, or other _ officials, ordinances? ., ........... _ ..... .................. ....... ..................,..... _Y 6 13. If so, have plans been submitted to such authorities? ........ ............................... M0 14. Has preliminary approval been granted by such authorities? W Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water X groundwater 16.. If surface water discharge, what is the stream class designation? .................... 14)R 17. Waters index number (surface) ........................................... ............................... HIN 18. Is project located near a public water supply system? ....... ............................... 0 19. If yes, name of water supply N1 A Distance to water supply k�A 20. Is project site near a public sewage collection or treatment system? ................ NO 21. Name of sewage system MI Distance to sewage system WA 22. MEL- � Date test holes observed �) �� cif 23. Name of Health Inspector ,nI .@u Nswk 24. Project design flow (gallons per day) ................................. ............................... 8 p0 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... N' 26. Has SPDES Application been submitted to local DEC office? N/ Form PG97 27. Is any portion of this project located within a designated Town or State wetland? 28. Wetlands ID Number ........................................................... ......................:........ "29`.`KIs Wetlands Permit required? ............................. ............ .... ............................ Has application been made to. Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ............................... 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, 'sludge application or industrial activity? ............................. Yes/No .2 N/A i4 A No NO 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 No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... `(ES 34. Are community water and/or sewer facilities planned to be developed within 15.years in or adjacent to project site? ................................ ............................... µa 35. Are any sewage treatment areas in excess of 15% slope? . ............................... ND 36. Tax Map ID Number. .......................... ............................... Map � ' Block '� Lot dal 37. Approved plans are to be returned to ..... Applicant X Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be-sent-to the Department, and need not-be sent in duplicate to the-DEP; although the project may require'DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater,plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms"for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item I .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Secton 210.45 of the.Penal Law. SIGNATURES & OFFICIAL TITLES: Mailing Address: ................................... LAU" EH(n+HEE -AA(4 IgTf;S PC . nlu,)OVJA P-00 4ua 1� aptm-(&N- Wi low PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES V DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT-:SYSTEM Owner .._-V T-0 .. Y L �M Q -T Address IN "Lk -TOL AVE rAKA14 NY 1mo Located at (Street) Tax Map Block Lot (indicate nearest cross street) Municipality l'ArreAON Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre- soaking Date of Percolation Test ` �a Hole No. Run No. Time Start - Stop Ela se Time Min.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Dropp In Inches Percolation Rate Min/Inch 1 9 sti 00f. 2 3 4 5 411 - - 3 io�.� I o�� 11 4 Y 5 l 2 3 4 5 INUTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are omamea at eacn 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. 1 Depth measurements to be made from top of hole. Form DD -97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH ~HOLE NO. 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' 10.0' HOLE NO. i oP�.D iL HOLE NO. .2 � Indicate level at which groundwater is encountered 0 .. ` Indicate level at which mottling is observed -fApNE Indicate level to which water level rises after being encountered Deep hole observations made by: (A , N Date Design Professional Name: r}h(Z)4- W, N)LNay5 JP c rt- Address: U MIAT044 4 I2-OAV ljiOti£ 16 bR-FWsj &� N)/ j o � a 1 Signature: 91— Design Professional's Seal NEW �O Nicly X p w w No. 56124 op�OFESSIONP� 1416-4 (2/87)—Text 12 PROJECT I.D. NUMBER 617.21 SEOR k Appendix C State Environmental Duality Review �. SHORT •!ENVIRONMENI`AL'ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (ro be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME. L . SS S - WIT j 3. PROJECT LOCATION: Municipality S6r County Fy 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) 5. IS PROPOSED ACTION: t� New ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially g acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? LEI Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/ForesVOpen space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? Yes ❑ No If yes, list agency(s) and permlVapprovals PAn15 -KWH M11,491 H& PE12M IT 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? r�� ❑ Yes triryp No If yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant sponsor m Date: Signature: If the action is In the Coastal Area, and you are a state agency, complete* the Coastal Assessment Form before proceeding with this assessment OVER 1 PART 11— ENVIRONMENTAL ASSESSMENT (ro be completed by tigency) 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.anotherInvolved agency.. Y e s- ❑ 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, or other natural or cultural resources; or community or neighborhood character? Explain briefly: 03. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain. briefly C5. Growth, subsequent development, or related activities likely to be induced.by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other.effects not Identified in C1-05? Explain briefly. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE,.CONTROVERS,Y.RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? as ❑ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether It is substantial, large, Important or otherwise significant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (Q 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: Print or Type Name of. Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Name of Lead Agency Date 2 Tit e o Responsib e Officer Signature of Preparer (If different from responsible officer) e. � -- - - ::: -- •!Y'ri:• :•�!� :•:�•: :v::•i: :•:': Jfi:•' r: C�: v:•: �•:: �:•:• ::•::ati:•a•ai�:v:��X�:::?`t,�• U : r..... BATH` 01 BEoAOOM t y'•8" +c 12'4" .� •-� % DRESSING. BEDROOM 1. 13' -0" x 10, -o — WALK' IN } CLOSET - u e BEDROOM 2 13' O" x 15'•8 "' v Tf j N MASTER SEDAOOM j OPEN 17'-0 HOUSE PLANS APPRO. '1) 1 OR BE, DP OOM COUNT 0NXN. . SECOND FLOOR i 28 = 1344SF natUrp & KITCHEN ' ►t/.KN a DINING ROOM p �' MORNING ROOM ~� 13' 0" w 12.,0•• 1=. FIT . r , -t O F E N 1i ABOVE LIVING ROOM I 1 �'•0" r 1 �'•0" FOYER FlRSTFLOOR - ql, FAMILY ROOM 13,02 17.0.• 4828 = 1:14a.q F :\:�:�:•:•: ' vi:. ": :' ..•"T....... .i� -fir r: :.. •.�•::•: iv:'::•:: . r.. . �•: : v •.i•::••. . .: :. '•: ': i. � ::` :: :•. •i: � , � • , :: Vii " : ', A ' ••YlI: :� :' %,• Aii: \•JIJ :••5 :1 :•: % :' •: \titJr:�:: :•1: '. �::L :i:�i:: i : \'A •�'.:• .1 . ._. —..,:. •:�•.io :aa ^x..v e..., ::. . +a e.s -e. w.. .. __ .. .. .. . _.��•. .. <ar!t....q .. s �-. v , BATH j f� • L'�CrJ l . • •...J � 1 BEOROOM 4 �` •�1 y' 8" a 12'O'• L ORESSING- BEOROOM 3. WALK 13• -0•• x 10'-0'„ IN CLOSET — � -r r•ii r �.l "•. 1, MASTER BEDROOM BEDROOM 2 _ OPEN N 17•-0 A 16'•8•• 11• o•• x 1 5••8•• i Q HT.;PAPTI�, NT OF <: 'H USE PLANS APPROVED FOR TOM COUNT ONTL 3 ROOMS AA SECOND FLOOR Gr x$28 = .-1344SF 1 �na�iiro Title Data 3 KITCHEN DINING ROOM MORNING DOOM 12' 0" 12••0.• N ••-}.: _ OPEN ' 1 ABOVE LIVING AOOAI LIP FAMILY ROOM FOYER �• Fl RST FLOOR r 4828 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH 'i' I I•r3Uz4ir� rl PER S�tPPL1 &c SUBSURFACE SEWAGE 1 kEATA1E \T SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT Lei tt/ STREET LOCATION NAME OF OWNER EV W D Y R-,i, GR, AS, NIB, BH T TAX IyIAP # l " L ' �- Y N CUMENTS Y PERMIT APPLICATION EROSION CONTROL:HOUSE,WELL, SSDS PC -1 RC & DEEP HOLES LOCATED WELL PERMIT _ PWS LETTER PRESENTATIVE OF PRIMARY & EXPANSION LETTER OF AUTHORIZATION CATION. MAP DESIGN DATA SHEET (DDS) EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE CORPORATE RESOLUTION F PUMPED, PIT & D BOX SHOWN & DETAILED SHORT EAF � OUSE - NO.OF BEDROOMS PLANS - THREE SETS 7 LLS & SSDS'S WAN 200' OF PROPOSED SYS. HOUSE PLANS - TWO SETS EHOPSE OPERTY METES & BOUNDS VARIANCE REQUEST SETBACK NECESSARY (TIGHT LOT) FEE HTJSE SEWER - 1/4" FT. 4 "0; TYPE PIPE SUBDIVISION NIP BENDS; MAX.BENDS 45° W /CLEANOUT EGAL SUBDIVISION FILL SYSTEMS SUBDIVISION APPROVAL CHECKED LAY BARRIER PERC RATE` 10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE FILL REQUIRED DEPTH FILL SPECS FILL NOTES TAIN DRAM REQUIRED FILL CERTIFICATION NOTE TANDPIPES DEPTH GAUGES GENERAL FILL PROFILE & DIMENSIONS LOCATED IN NYC WATERSHED VOLUME ANS SUBMITTED TO DEP FILL IN EXPANSION AREA El 'DELEGATEDM PCHD 7 TRENCH W DE ROVAL, IF Q'D " LF TRENCH PROVIDED 60 FT MAX. EEP TEST HOLES O SERVED PARALLEL TO CONTOURS P �VAL SED 100% EX PANSION PROVIDED ADJ. LOTS SEPARATION DISTANCES SPECIFIED WETLANDS (TOWN/DEC PERMIT REQD ?) . - 'ON PLAN - EROINI SSTS DATA ON DDS PLANS & PERMIT SAME 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL PRE 1969 NEIGHBOR NOTIFICATION 20' TO FOUNDATION WALLS _15'WELL TO PL ETTER BIIZBA 100' TO WELL, 200' IN DLOD, 150' PITS 100 YR. FLOOD ELEVATION 100' TO STREAM WATERCOURSE LAKE (inc. expan) OTHER REQ'D PERMITS) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER REQUIRED DETAILS ON PLANS 10' TO WATERLINE (pits -20) WAGE SYSTEM PLAN - (NORTH ARROW) 50' INTERMITTENT DRAINAGE COURSE DS HYDRAULIC PROFILE 200' /500' RESERVOIR, ETC. _150' GALLEY SYSTEMS rp RAVITY FLOW ONSTRUCTION NOTES 15'MM to CDS= >5 %,j0'- 4 %,25'- 3 °/q30'- 2 %,35' -1 %,100' - <1% )ESIGN DATA: PERC & DEEP RESULTS 2WMIN to CD discharge /100'with 182 cons day discharge ''CONTOURS EXISTING & PROPOSED SEPTIC TANK DRIVEWAY & SLOPES, CUT 10' FROM FOUNDATION; 50' TO WELL FOOTING /GUTTER/CURTAIN DRAINS WELL TOIL TYPE BOUNDARIES DIMENSIONS TO PROPERTY LINE IITLE BLOCK; OWNERS NAME,ADDRESS LOCATION OF SERVICE CONNECTION TM #,PE/RA; NAME,ADDRESS,PHONE# )ATE OF DRAWINGIREVISION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET PROPOSED FINISH FLOOR AND BASEMENT EL. COMMENTS: NO. IFIED TO: 6L10V GELAa OKDANCL: WITH THE EXISTING CODE OP PRACTICE NO SURVt[YS ADOPTED BY THE NEW YORK STATE ATION OF PROFESSIONAL LAND SURVEYORS. ATIONS SHALL RUN ONLY TO THOSE INDIVIDUALS 01TUTIONS SHOWU HEREON UNDER THE TITLE POLICY SHOWN ABOVE. SAID CERTIFICATIONS ARE NOT ERABLE. , COPYRIGHT (D /999 -2000 VEy ASSOCIATES/ ALL RIGHTS 1?E5ERVED Pau thorizedduplicaf16n1'5a v10 /a71ioh of Opp /icob /e lows n 1'se5 Shown hereon being Lot /OS /n on "Firx>l Subo1/vlsion Mao )Orel for Vito Z-arnorte ". Sold filed in 117e Pufnom County �'s Office on Sept 23, 1991 OS NO. 2517. ications hereon are valid for the map and copies mIV it said map or copies bear the m1pressed seal urveyor whose signature appears hereon. SURVEYED &'PREPARED BY 6UNNEY ASSOCIATES LAND SURVEYORS 301 FIELDS LANE BREWSTER, NEW YORK 10509 PAIR srf? �` YF � ` r iPOIe E. B0, 70' N53°38 50'E .89.80' v °O%e a. is 'Wo,,. p f r °.<n p Story I- 2 \ 6 9' O o frame i tc� 5 yti g e i /louse ., wood cnlm- R 40t 1 / G0 d�� ey LOT Fence 'I { n Kennel \ ° \a° 1' 5 Q� AREA = 0.98/ AC. 5 Gr u 99.9 44 f e r y 6 r �' SfioQe3� yJ/ or F° SURVEY OF PRORERT -v $ Zvi i O SITUATE 11V THE 4,1 TOWN OF I®A TTER S OAl Pu rNAM COUNTY 3 /VEIN YORK SCALE: I"=50' DATE: MAYS, 1999 8RoUGN7 TO DATE DEC.-01, /999 Unauttionzed aeration or ar(,ibon to a survey.hiap bear- r JUNE 09 0000 my a licensed land surveyor's eal rs a vinlatioo of Section AUG. e5 e000 7209, sub - division 2, of the Nev., York State Education Law. The location of undmyi•ound improvements or encroachments, it any o.'st.: arc not cenihed. y{ s irl t d I �f pr/nWry '5,011 4z . "rave xp' . i.0 ;Nve) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .... - di..i. ,....: � a • -«tom .++� DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address rA1g -s-r, Located at (Street) T &4h S ;m Q soy 2?'A Tax Map *it# Block 3 Lot 3, j (indicate nearest cross street) Municipality _ A7 r E ®� Drainage Basin d/ ZZ`ll-jg B124 NG I SOIL PERCOLATION TEST DATA Date of Pre - soaking :Zzl-6z ? q Date of Percolation Test -7.z / 7/ � 6 Hole No. Run No. Time Start - Stop Ela se Time 61in.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 2 q, y° Ig 1 13 PL— al 3 3 3 llio3 2 3� 3 4 5 311 6 .13 - /D`OD 3 1 �/a - 5'�P" 3 3 4 5 1 2 3 4 5 IN UTES: 1. ON 2. Tests to be repeated at same depth until approximately equal percolation rates are obtamea at eacn percolation test hole. (i.e. <_ 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to'be submitted for review. Depth measurements to be made from top of hole. Form DD -97 c4 Sheet_of M' # PUTNAM COUNTY DEPARTIVIENT- OF HELTi = Divisioli - r3.1 'r'� Y140 �Y NT�,Ii. HEAT i,H SERVICES FIELD ACTIVITY REPORT A F- "- r v�. Streef To State Zip PE'RSOl IN CHARGE: Y. 4 l dR Name an&Title TYPE OF,FACIIITY , r. P%L e S �• f b . FIN I�GS` Q ,7 , -�� , . «; _ s , , t 9 _ Y W. fi �if Z c 3 s Y ' s a signature -, itle s RF -,1 .o. - ., ;i` •; 0 S ., ,�. < ".i<.. ';, .^ ,.+5 _fig ♦ ..fi., Ic6owledge receipt' of this report SIGNATURE; -, 02/96 Title 4 �,