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HomeMy WebLinkAbout3167DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 72. -1 -23.1 BOX 26 Is pis p Lo '� �I 6 Me I �� T J . I p' L T ILIf ' T. ' • r ' 1■ r 7 i i' 's '� If 6' � � T f h I ol Is 03167 PUTNAM COUNTY DEPARTMENT OF HEALTH _ DIVISION OF ENVIRONMENTAL_ HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE. 7LAI, TMENT SYSTEM PCHD CONSTRUCTION PERMIT # PV ` i 3 -©i - "" ! L ocated at �.e,rg �.. It m N Omp Town or Village T :a mkt-'1 V ALLr-_ if Owner /Applicant Name 3Z�Aaa c t kyvc- ptSo" Tax Map `� Block ( Lot - .1 Formerly Subdivision Name Subd. Lot # Mailing Address ®. ��,,� Cs»$ ?L>T�� V'�E� Zip y05 rd�I Date Construction Permit Issued by PCHD z-z 1 0 1 Separate Sewerage System built by 0 W N1z'r;,' Address Consisting of 1 L ®'O ® Gallon Septic Tank and 5 015 LF o F "T VJ ior-Z a O � Cewrsfz Other Requirements: Water Supply: Public Supply From Address or: X Private Supply Drilled by kogme,tj A r>*2-5o c-4 Address PUTT I%f-t V&i j 14 Y i S'11 m.Buildin&Typl esx- bctaz`y Has erosion control been completed? � ..a -_• _ .._...._... _ .: _....- Number of Bedrooms Has garbage grinder been installed? ki I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the PutnamSounty Department of Health. Date: i © 3 Certified by & �&t (Des Professional) Address '&�.c)e_ � WA -CS ©sr 36xal f P.E. R.A. License # 0 t6 Z S0 S Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. By: /'` Title: AP14f, Date: ' 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 � eYl°° l)l 1tlU D b l N i1'esJ. __ - ld9G : "= Map 7j . Block O Lots) A3. Well er: / Address-s(//J, -v Use of Well: 1- primary 2- secondary _ Residential Business Industrial Ploic Supply Air cond/heat pump gation Farm Test/monitoring Other(specify) Institutional Standby Drilling Equipment _�,Z Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock _ Other Casing Details Total lengthft. Length below grade Diameter G in. Weight per foot lb /ft. Materials: Steel _Plastic _Other Joints: _ Welded ><Threaded _ Other Seal: }� Cement grout _ Bentonite Other Drive shoe: X' Yes _ No Liner Yes X 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 t Yield !�Q gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve ana arses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft... ft. Land,Surface Z If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type'l, Capacity Depth 2 Model ®`a Voltage C HP Tank Type V'�'P Volume - Date Well Completed Putnam County Certification No. Dates of Report Well Driller (signature) 64-4 NOT act location of well with distances to at least two permaneixt landmarks to be provided on a° separate sheeuplan. Well Driller's Name , u Address: Signature: / = /1 f%, Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heightp, N.Y. 10598 Albert H. Padovani, Director LAB #: 87.300449 CLIENT #: 57077 N ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ NON S STAT PROC P PAGE 1 PATTERSON, JOANNE D DATE/TIME T TAKEN: 11/04/03 1 10:17 PO BOX 628 D DATE/TIME R REC'D: 11/04/03 1 11:15 PUTNAM VALLEY, NY 10579 R REPORT D DATE: 11/12/03 PHONE: ( (914)-469-1329 SAMPLING SITE: 10 CAMP COLLINS RD, P PUTNAM VALLEY, NY S SAMPLE TYPE..: P POTABLE : KITCHEN TAP P PRESERVATIVES: N NONE COL'D BY: JOANNE PATTERSON T TEMPERATURE..: < < 4C NOTES...: C ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ COLIFORM METH: M MF DATE FLAG PROCEDURE R RESULT N NORMAL - RANGE M METHOD PUTNAM CNTY PROFILE 11/04/03 MF T. COLIFORM A ABSENT / /100 ML A ABSENT 1008 11/04/03 LEAD (INS) 8 8.5 p ppb 0 0-15 ppb 9 9101 11/04/03 NITRATE NITROG 1 1.71 M MG/L 0 0 - 10 9 9139 11/04/03 NITRITE NITROG < <0.01 M MG/L N N/A 9 9146 11/04/03 IRON (Fe) < <0.060 M MG/L 0 0-0.3 mg/1 2 2037 11/04/03 MANGANESE (Mn) 0 0.812 M MG/L 0 0-0.3 mg/1 2 2037 11/04/03 SODIUM (Na) 1 15.0 M MG/L N N/A 11/04/03 pH 6 6.1 U UNITS 6 6.5-8.5 9 9043 11/04/03 HARDNESS,TOTAL 9 98.0 M MG/L N N/A 11/04/03 ALKALINITY (AS 6 62.0 M MG/L N N/A 11/04/03 TURBIDITY (TUR < <1 N NTU 0 0-5 NTU Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. /blic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese are present, their total value combined'shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium YML ENVIRONMENTAL SERV]CES 321 Kear Street a��c Y tl��9�8 ���� -� Albert H. Padovani, Director LAB #: 87.300449 CLIENT #: 57077 NON STAT PROC PAGE 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ PATTERSON, JOANNE DATE/TIME TAKEN: 11/04/03 10:17 PO BOX 628 PATE/TIME REC'D: 11/04/03 11:15` PUTNAM VALLEY, NY 10579 REPORT DATE: 11/12/03- PHONE: (914)-469-1329 SAMPLING SITE: 10 CAMP COLLINS RD, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE ALrD BY: JOANNE PATTERSON TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD is suggested. ' -- - pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. ~ WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. - Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF M8/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. MG/L _ BOV _30O .MG/L ��-�--- �HA�hB'��ATl��:����^�4t�-M[�+F����-c�ff�/�r-='�Y�fcL�'GRAM'f`���-t�IT�R--�~-_'----^--- HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) SUBMITTED BY: Albert Padovani, Director ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Joanne Patterson Owner or Purchaser of Building J A Building Constrkt6d by Camp Collins Road Location- Street Residential 72. 01 23.1 Tax Map Block Lot (T) Putnam Valley Town/Village Westchester Holding Co., Inc. Subdivision Name Building Type Subdivision Lot # 1 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:_onth 12 Day 24 Year 2003 General C tr for ( Ownjr) - Signature N/A Corporation Name (if corporation) Address: 1 n Camp Collins Road State New York Zip 10579 Signature: - Title: Corporation Name (if corporation) Address: State Zip Form GS -97 \� BAD ELY & WATSON 1973 3063 Route 9, Cold Spring, New York 10516 Fax: (845) 265 -4428 January 29, 2004 Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County Department of Health 1 Geneva Road Brewster, NY 10509 Re: Certificate of Construction Compliance Patterson - Camp Collins Road (T) Putnam Valley, TM #72. 71 -23.1 Dear Mr. Paravati: Surveying and Engineering P C _ 0 (845) 265 -9217 (845) 225 -3312 (914) 628 -1800 (914) 739 -3577 (877) 3.141593 Glennon J. Watson, LS. John P. Delano, P.E. Peter Meisler, LS. Stephen R Miller, LS. Jennifer W. Reap, L.S. George A. Badey, L.S., Senior Consultant Mary Rice, R.L.A., Consultant ,Julius I. Cesare, P.E., Consultant Pursuant to your request be advised hereby that on December 4, 2003, this office made a i field inspection'at th6 above referenced residence, and found all subsurface sewage t't ?�_�'1 ,5.... -- _._ :3__. e.�� photographs taken the following day of the exposed absorption trenches. We trust at this time that all concerns regarding the issuance of the subject approval have been addressed.. cc: File UA98- 105BUP29JA4L.doc Owners of the records and files of Joseph S. Agnoli, Burgess & Behr, Roy Burgess, Vincent Burruano, Hudson Valley Engineering Company, Inc., James W. Irish, Jr., J. Wilbur Irish, Douglas A. Merritt, E.B. Moebus, Reynolds & Chase, Taconic Surveying & Engineering, P.C. and D. Walcutt _ __.._ . yam- �N�. �- i``•� __. ���� :, s� CpG a �'a .e BRUCE FOOLEY k * LORETTA MOLLINARI RL.N., M.S.N. Tiir�nt�r Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 E911 ADDRESS VERIFICATION FORM OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS: TOWN: AUTHORIZED TOWN OF DATE: Joanne Patterson 71-01 -23.1 10 Camp Collins Road (Signature) The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911verfni) BADEY & WATSON LETTER of TRANSMITTAL Surveying & Engineering, -P.C., _ Date: 22 Jan 2004 File No. 98 -105 W. O. # 16091 RE: Certificate of Construction Compliance Patterson TO: Camp Collins Road Mr. Joseph S. Paravati, Jr. Westchester Holding Co., Inc. Subd. Lot No. 1 Tax Map 72:1 -2 ..1 Putnam County Department of Health Permit/I'it1eJP0 # PV -13 -01 1 Geneva Road Brewster, NY 10509 Sent via: US MAIL © UPS -NIGHT MESSENGER ❑ UPS -2 DAY E PICK -UP F� UPS -3 DAY E FAX ❑ UPS -GRND We are sending: UPS -COD ❑ copies date description of document 1 17- Jan -04 I A lication Fee Additional 100.00 Dollars For C.C.C. ❑ ❑ I _❑ - - J1 - REMARKS: Dear Mr. Paravati, Please find the additional 100.00 dollars for Joann Patterson application for Certificate of Construction Compliance. Please excuse my oversight of the increase in the application fee. Copies to: File Yours truly: John P. Delano, PE Tel: (845) 265 -9217 ext 12 Fax: (845) 265 -4428 Email: jdelano @badey - watson.com 40 40.05 499800 623800 23286 BADEY & WATSON LETTER of TRANSMITTAL 3063 Route 9, Cold Spring, New York 10516 Date: 12 Jan 2004 File No. 98 -105 W. O. # 16091 RE: Certificate of Construction Compliance Patterson TO: Camp Collins Road Mr. Joseph S. Paravati, Jr. Westchester Holding Co., Inc. Subd. Lot No. 1 Tax Map 72.4-2.1 Putnam County Department of Health Permitll'itle/PO # PV•13 -01 1 Geneva Road Brewster, NY 10509 Sent via: US MAIL El UPS -NIGHT ❑ MESSENGER El UPS -2 DAY Ll PICK -UP ❑ UPS -3 DAY E FAX ❑ UPS -GRND We are sending: UPS -COD El copies date description of document l 23- Dec -03 7 lCertificate of Construction Compliance for Sewer Treatment System O 1 30- Dec -03 JE911 Address Verification Form ❑ F 05-May-03 Well Completion-Report - F1 12- Nov -03 lWell Water Test Results F3 24- Dec -03 IGumantee of Subsurface Sewage Treatment System ® 04-Dec-03 ISSTS "As- Built" REMARKS: Copies to: File Yours truly: John P. Delano, PE Tel: (845) 265 -9217 ext 12 Fax: (845) 265 -4428 Email: jdelano @badey- watson.com 40 40-05 499800 623800 23209 DEC -05 -2003. 10 :17 BADEY & WATSON, PC P.01i01 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION JOSEPH n GENE REQUEST FOR FINAL. - INSPECTION For: Fill _.. Date: 12/5/9003 Trenches PCHD Construction Permit # PV -13-01 Located: Camp Collins Road (T) (Y) (T) Putnam valley _. _y Owner /Applicant Name: Joanne Patterson „ TM Block 1 Lot 23.1 Formerly: n/a Subdivision Name: Westchester Holding Co. Psroel If Subdivision Lot # _ 1 Is system fill completed? n/a _ Date: Is system complete? Yes _ _ Date: Is system constructed as per plans? Yes Is well drilled? Yes Date: Is well located as per plans? Generally Are erosion control measures in place? — Yes n/a 12/412003 � 8/11/2003 I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued.PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. Date' _ ��rr�u�,.� Cerrtited by:. ,ichn r: roano� "rE`a "ti — Design Professional Address: 13adey & Watson, P.C. 3053 Route 9, Cold Spring, NY Lic. # Co ents: Form FIR -99 062505 TOTAL P.01 P. 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL. HEALTH SERVICES Aso.: -:c;: �! - ,_.:w- ._.;.v.�� <.; ;•:�2 _ � . au- .�::;:*�'.�= vs..w- Q`,.,1�:..�v .:�..,;:'.:.T.-,.;e`. ;: �: -� - . ":.: -,.:..`. r- _. .: _.-= =: -" - . -...�. . $._ ..� -r °._ ::�...e_.Q- .. -,... .._ \ - ®., = .tea..- „. >.- :'�..... :se;';..'.;r:,” '�?:'.S�:a_v. »`.:..... .: .=.".� :� -•. CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM 0 PERMIT # V-1 3—O Located at CVt S 20 Town or Village e(t?"jU M' V& I E&j 44 ewe NtiOJJ6 Subdivision name Go. , NC. PAgM.T Subd. Lot # . I Tax Map %a Block ( Lot c)3,1 Date Subdivision Approved .3 11(gLoo Renewal Revision Owner /Applicant Name •7�4oM4.Sd TomiNg PArrEaigogl Date of Previous Approval Mailing Address UJD SON Vf" DR rVE } P -&I&d VA's I,E J_ NO foS7r9 Zip jpS 7 Amount of Fee Enclosed 30 o° o z Building Type 9j9!i62EAIrrA'(_ Lot Area 4, S; No. of Bedrooms 3 Design Flow GPD 600 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage Ustem to consist of /C70 o gallon septic tank and SO O j_,e_0 9 4 ZAlC i4 W.T DC J4 0- S0RP71i2 V TAEN'C06 5 SPA -CCD AT 6 FT D. C Other Requirements: 151) O ,, oG 4 , 0_6 . 'Cr L °3a ra To be constructed by A�,LD t, yoNS d1- Sty A1S Address 20arC °I C ,94D SP R-iN 6, Nj io SI 6 Water Supply: Public Supply From Address or: _Private Supply i3*i1Ted by ��"� ��O��T - 7Li►77+° �) - �Atia e5 DT. j �'[' ' "°i�s�b "' 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 ,2NJ6 P.- P.E. Xl R.A. Date qL4Lol License # 005-6-5 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Pqblic Health Director. Any revision or alteration of the approved plan requires a new pe ' . Approv for c rg f d estic sanitary sew a a only. By: - Title: Date: �7 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 r- ...a..- :... r• _ t..i. r. - �7.a.'_.r..Y fir: U�.r.,ry.... ►. • e� r.- ...n_r.. .1T '1 T, pie'asC°peifi"br Hype ti.n -., .. ,:. _ y °�.,�'D 1s �ZFlil s -,' . • .,.,;.. 4 Well Location: Street Address: Town/Village Tax Grid # cA-14P Go`tZvS "A-0 ofta..y Map 7 Block / Lot(s) 02,E Well Owner: Name: -rl�DmA -.s Address: 'okMVE TTYi/ZSoN NUDSoN V,- 641J 0/U V'5/ PU 11AM OfU16y NJ toS7 Use of Well: I Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought �5 gpm # People Served _ 6 Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling X New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling #-0 v,9 C POTA t , 57 PPL !v Alc J w F L Well Type_ Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No X Is well located in a realty subdivision? ...................................... ............................... Yes X No Name of subdivision (NESictf6srE2 b�aLnZN& L0. , 1,"C PA"t T1 Lot No. I_ Water Well Contractor: 0U4K51Dtv 64 v7-NE/LS Address: Co m© sP/zi-r 6 NVJ toSLL Is Public Water Supply available to site? .................................. ............................... Yes No 5G Name of Public Water Supply: Town/Village Distance to property from nearest water main: > / ,n; /e Proposed well location & sources of contamination to be provided on separate sheet/plan. iDatt: boce/OLz.. Applicant.Signature:_� PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless ' construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well dril r certified by Putnam County. Date of Issue Z� �� Permit Issuin Official: Date of Expiration . 7-(7 V Title: Permit is Non-TransferriSle White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 BADEY & WATSON LETTER of TRANSMITTAL eying qqring, P.C. ew York—"U—' 3063Route9, Cold Spring,,K,---- �6 1 1 Date: 06 Apr 2001 (845) 265-9217 (914) 628-1800 (914) 739-3577 File No. 98-105 (845) 225-3312 FAX (845) 265-4428 W. 0. # 14004 RE: Proposed SSTS Patterson TO: Camp Collins Road Adam Stiebeling Westchester Holding Co., Inc. Subd. Lot No. I Putnam County Department of Health Tax Map 72.4-23.1 Permit # I Geneva Road Brewter, NY 10509 Sent via: US MAIL ❑ UPS-NIGHT ❑ MESSENGER W UPS-2 DAY ❑ PICK-UP E-1 UPS-3 DAY ❑ FAX ❑ UPS-GROUN ❑ UPS-COD ❑ We are sending: copies date description of document r-1] 06- Apr -01 lConstruction Permit for Sewage Treatment System F71 106-Apr-01 ILetter of Authorization F11 106-Apr-01 7­1 jApplication for Approval of Plans for a Wastewater Treatment System l 105-Apr-01 Short Assessment Form ❑ F-1] 114-Apr-99 IDesign Data Sheet 105-Apr-01 —7 ISeparate Sewage Treatment System Sheet I of I I-A A 1Fjq,,?LM F-11 106-Apr-01 jApplication to Construct a Water Well F-11 02- Mar -01 lApplication Fee F I F-1 I REMARKS: Signed: John P. Delano, P.E. Copies to: File 4878 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES RE: Property of , F.TTER.0F ANTI- R1Z TION Thomas & Joanne Patterson Located at Camp Collins Road T/V Putnam Valley Tax Map # 72 Block 1 Lot 23.1 Subdivision of Westchester Holding Co., Inc. Parcel H Subdivision Lot # 1 Filed Map # 2824 Date Filed Gentlemen: 03/10/00 This letter is to authorize John P. Delano, P.E. a duly licensed Professional Engineer X or Registered Architect _ to apply for the required wastewater treatment andlor water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public H ealth Director of the Putnam County H ealth 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 m conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public H ealth Law, and the Putnam County Sanitary Code. truly °yours;.�.� : i ed: Countersigned S Signed: 062505 er of Property) Mailing Address Badey & Watson, P.C. 3063 Route 9, Cold Spring State New York Zip 10516 Telephone: (845) 265 -9217 Mailing Address: 35 Hudson View Drive State New York Putnam V Zip 10579 Telephone: (845) 526 -5461 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH IND UAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PE 1T 7. iV.it`t�r1)�viVl"IC. ; %'� wcitt%S� sl rocarlo' VIEWED BY: RNi, G�SRDATE: TAX MkP=: (CONFIRIvMD) -41 11 f Y DOCUITEN"FS (REQUIRED DETAILS ON PLANS CONT'D) PERINFIT APPLICATION � W OU-SE SEER -'VV FT. 4 "0'; TYPE PIPE CAST IRON WELL PERMIT ORPWS LETTER � BENDS; MAX BENDS 45° W /CLEANOUT ( PC -97 RENEWALS (�ULET UTHORIZATION r SITE NOTE (NO CHANGE) U G'DATA SHEET S} 5 FILL SYSTEMS U CORPORAT a SOLUTION 5 �,EN rd�U 10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE SHORT EAF (FILL SPECS! FILL NOTES 1 -5 • �/ � PLANS -THREE SETS 2 ( L PROFILE &DIMENSIONS o U USE PLAINS ! T WO SETS 7 ( FILL L\ EXPANSION AREA U VARLAltiCE REQUEST I ` S s / FILL GREATER TARN 2 FEET o i ON C. .)Lt. CL-.Y BARRIER LEGAL SUBDIVISION "_ i FILL CERTIFICATION NOTE SUBDIVISION APPROVAL CHECKED DEPTH GAUGES (�( )PERC RATE _ � VOL. ON PLAN FOR RO.B., UNCLASSIFIED & IMPERVIOUS FILL REQUIRED 2 / DEPTH SEPARATION DISTANCE FROM TOE OF SLOPE. UUCURTAri DRAIN REQUIRED TRENCH GEN -ERAL LF TRENCH PROVIDED 60FT MAX. C vU ATED Lti NYC WATERSHED PARALLEL TO CONTOURS (��NS SUBMITTED TO DEP 100% EXPANSION PROVIDED GATED TO PCHD ETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL ,7JGEOTEXTII.E COVER ES OBSERVED SEPARATION DISTANCES ON PLAN - FROM SSTS (� ERCS TO BE i 10'0 P.L. DRIVEWAY, LARGE TREES, TOP OF FILL X- APPROVAL SSDS ADJ, LOTS (?0' TO FOUNDATION WALLS TLANDS (IOWN/DEC PERbIIT REQ'D ?) (_��100' TO WELL, 200' IN DLOD,150' TO PITS DATA ON DDS PLANS & PERMIT SAME 100' TO STREAM, WATERCOURSE, LAKE (inc. expan) 1969 NEIGHBOR NOTIFICATION L�(�_ _40' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER LETTER BUZBA j (f.e� 1S0A0 J YR FLOOD ELEVATION W/1200' _ (�_)((( -� 1_00' TO J WATER R L /INGE ;R (, p Li' t s 1 �- .2. _ 0') )50'_L`TERMFITENT DRAINAGE COURSE JES I OFYA.�'OLF " *- 'i. liL� I _ .._ . E UIRED DETAILS O LANS 10 i•ILN TO LEDGE OUTCROP WAGE SYSTEM PLAN - (NORTH ARROW) SEPTIC TANK DS HYDRAULIC PROFILE (�(�10' FROivI FOUNDATION; 50' TO WELL RAVITY FLOW WELL NSTRUCTION NOTES 1 -15 (__)(�DIirIENSIONS TO PROPERTY LINES DESIGN DATA: PERC & DEEP RESULTS U(�LOCATION OF SERVICE CONNECTION CONTOURS EXISTING & PROPOSED (___•)(wiDi 15' TO PROPERTY LINE DRIVEWAY & SLOPES, CUT SLOPE CZ( DOTING /GUTTER/CURTAIN DRAINS (�USDA SOIL TYPE BOUNDARIES U(�SLOPE IN SSTS AREA 520 %) TFFLE BLOCK, OWNERS NAME ADDRESS U(– REGRADED TO 15 %, IF REQUIRED 1, PE/RA; NAbIE, ADDRESS, PHONEk DOSE/PUMP SYSTEMS DATE OF DRAWING/REVISION U(�PU3IP NOTES DATE O REFERENCE ( _)( _JDOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED LOCATION OF WATERCOURSES, PONDS UUDETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) LAKES,WETLANDS WITHIN 200' OF P.L. (_J(_JPIT AND D -BOX SHOWN & DETAILED UUPROPOSED FINISH FLOOR AND U(___)1 DAY STORAGE ABOVE ALARM CURTAIN DRAIN ASEMENT ELEVATIONS (�( _JSTANDPIPES 5' BOTH SIDES DETAIL WELLS & SSDS'S W/IN 200' OF SSTS ' (PROPERTY METES & BOUNDS— )(�15' i�IL�i to CDS = >5 %, 20' -0 %, 25' -3 %, 35' -1 %,100 % -d% J20' iv1IN to CD DISCHARGE /100' with 182 cons day discharge (_J(___)10' NIIN to NON- PERFORATED PIPE (REVSHEET) w PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT `srPrrr ti�_3 {l-�w l0 a ?� pC �."dit s - - ilage: ! Tax Grid # Map' , Block O Lot(s)d3 , WellO er: Nom: Addres�s:/�� der► L�ir�= -�-r -o � ` �r � :. Use of Well: 1- primary 2- secondary j,.--.Residential P16fic Supply A it cond/heat pump gation 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 _2!!:'�: Open hole in bedrock Other Casing Details Total lengthft. Length below grade 2. ✓ft. Diameter G in. Weight per foot 40 lb /ft. Materials: _ Steel _ Plastic _ Other Joints: _ Welded 24,Threaded — Other Seal: YL,_ Cement grout _ Bentonite Other Drive shoe: Y Yes No Liner _ Yes X 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 56 gpm Depth Data Measure from land surface- static (specify 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 Z ')i a jp c/ If yield was tested at different depths during drilling, list: Feet F. Gallons Per Minute Pump /Storage Tank Informatio Pump Type $ 4,t. Capacity Depth ?sfU ®'a a Mod Model De p t Voltage B? Tank Type 7 Volume Date Well Completed Putnam County Certification No. Date of Report Well Driller (signature) We NOT,& "act location of well. with distances to at least two permanettt landmarks to be provided on a separate sneevpian. Well Driller 's Name L Address:/ Signature: Date: _y- White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION / . Date: � ,�^ Inspected by: - Street Location 6� t.kn� '� r _. - - - 11' O rmit TM #— 02 - i _ �2 2. 1 Subdivision Lot ir 1. Sewaze System Area y 601- 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 ...... ............................... H. Sewage System a. Septic tank size - 1,000 .......... 1, 250 ......... other ................ b. 'S eptic'tank installed level ................ ...... .......................... c. 10' minimum from foundation .......... ............................... d. Distribution Bog 1. All outlets at same elevation a r tested ..., 2. Protected.below frost ....... ............................... �......... 3.,N iriiinum 2 ft. Original soil between box & trenches e. Junction Box -properly set .......... ............................... 6. renc es 1. Length required Length installed 2. Distance to watercourse measured 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. Sizg9f- g�avel_3 /_4.– VA2' diameter _clean ..............• AV Depth of ravel in trench 12" minimum.. �.. .`� 1 ipe ends-ca pped ..................... .............................:. -. g.. bimn -or Dosed. Systerns _ .�. L�..... 2. Overflow tank ..� .,_. ..... ............ 3. Alarm, visual/au ........................ ................ 4. Pump eas' ccessible, manhole to grade ................. 5. Firs x baffied .......................... ............................... 6 �y cle witnessed by H.D.estimated flow /cycle........... III. useBuilding a. house located per approved plans ... ............................... b. Number of bedrooms ..................... ............................3.. IV. Well Well located as per approved plans . ......:........................ b. Distance from STS area measured fi /,90 * - ft........... c. Casing. 18" above grade ................ ............. ................... d. Surface drainage around well acceptable ....................... V. Overall Worlunanshiu . 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.. N f f. Curtain drain outfall protected & dir.to exist watercourse/ g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ........ :........................... i. Erosion control provided ................. ............................... Rev. ?2/02 r � _ �J .+ ._r a.....:., -;.o i•'...'...c ...`r -- ,.. - v- � �...• ....':;e: :.....,aVi`Y'11 \�►�i 1J "�i�il"i'Y`' Vim` Y`iur'.L"Jli .�'[iil':, .Q. .. , ...' a ?.:.v ._n;y.. .... ...__:... ,. .,.. ",._. .y ". Date: Inspected by: Fill pad located per the approved plan Fill Pad Length Required Length . Fill Pad Width Required Width Fill Pad Depth Required Depth Run -of -Bank Fill Quality Slope from Top to Toe Impervious Layer Installed rosion Control Installed Sieve Test Results (if applicable) Additional Comments: .i -. ... ... � .. - -.. ... -,. ... zr. ..c.aa. ...s�v- a- �.�._.... .-- .i....r. ... .."....... v.. �.�...- ...... ... ..e......;p...,x .. ...T .. >. :.. a -s. ^... �..- .-�... Reserved for Field Sketch if Applicable PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - ::1":g�'l:llv.' -�Tl�� Fnn.. ,��nn �•��- �,?�,.�F.'��r -,;� ?�� -�OI2 - - . . iu`t•c.....� w _ �i�.. .. -. ::_.... r:.a � \l.)_ 'X� D .3.l. ..i $.n_. r i:a.�Ab r -�:a -a .�. .. _ . -. ,..- ...- .v,_...;:d::r�. -_ A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: Thomas & Joanne Patterson Hudson View Drive Putnam Valley, NY 10579: ; 2. Name of project: Patterson 3. LocationT /V: Putnam Valley 4. Design Professional: John P. Delano, P.E. 5. Address: Badey & Watson, P.C. 6. Drainage Basin: Hudson River . Rt.9 Cold Spring, NY 10516 7. Type of Proiect: X Private/Residential Apartments Office Building Food Service Institutional Realty Subdivision Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) --------------------------- - - - - -- - - - -= Type I - Type II 9. Is a Draft Environmental Impact Statement (DEIS) required? _____________________ __ Exempt Unlisted X No 10. Has DEIS been completed and.found acceptable by Lead Agency? ----------- -------- : N/A 11. Name of Lead. Agency Putnam County Department of Health 1-2. Is this project in an area under the control of local planning, zoning, or other olEcials, . . ' .... = - - - -- 13. If so, have plans been submitted to such authorities? ------------ _......... _ -------------------- ______ Yes 14. Has preliminary approval been granted by such authorities? N/A • Date granted: N/A 15. Type of Sewage Treatment System Discharge_____________ _ ___ __ surface water groundwater 16. If surface water discharge, what is the stream class designation? __________ ____ ___ _____ N/A 17. Waters index number (surface) ________ ______ _________________ N /A. 18. Is project located near a public water supply system? ______________ ________________________ __ _ _ _ __ No 19. If yes, name of water supply N/A Distance to water supply N/A 20. Is project site near a public sewage collection or treatment system? __ _________________ No 21. Name of sewage system N/A Distance to sewage system N/A A. Stiebeling 22. Date test holes observed 6/10/99 23. Name of Health Inspector P.C.D.H. 24. Project design flow (gallons per day) 600 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required? 26. Has SPDES Application been submitted to local DEC office? No N/A Form PC -97 2 27. Is any portion of this project located within a.designated Town or State wetland? No 28. Wetlands ID Number N/A 29�Is Wetlands Permit required ?. -------------------------------------- - -_ -- - - - -- _ ----------- - - - --- - --- - No --------------- - - - - -- - -------------- - - - - Has application been made to Town or Local DEC office? _ _____ __ ______ _____ _______ __ ___ N/A 30. Does project require a DEC Stream Disturbance Permit? ------------------------------------- No 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 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? __ ___ ______________________- No 34. Are community water and/or sewer facilities planned to be developed within 15 years, in or adjacent to project site? ---------------------------------------- - - - - -- - - - - -- No 35. Are any sewage treatment areas in excess of 15% slope? -------------------------------- _ No 36. Tax Map ID Number = Map 72 Block 01 Lot 23.1 37. Approved plans are to be returned to :____ Applicant Design Professional N_ OTE: All applications for review and of a new SSTS to be located within the NYC Watershed shall t, :�.ln dun—.- _nn ri_.i^^a L. o, nn}�t i..+ A- Z_ 77 l�nn n ((��. +Mc� Tll.:`�, n� +�/� ?� 4�.� . n �fnF,i+�n.+ li V- JVll'1.tV..11 LVp11`14111V11L� iUilY 11Vc�111V V�i/V. JVrl� a . MiAr./1 %catV-tV tl'ly DID , GL1�.11V�b11 Llly p ccl 111"011 -1 Vl1�li1V I�L`1 � 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 statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES &, OFFICIAL TITLES: . Bac�ey- -I& Watson, P.C. 30 Mailing'Address- ------------- - - - - -- ----------------- 63' Route 9 C61d'4ring, NY 10516 1416.4 (11/95) - Ted 12 PROJECT I.D. NUMBER 617.20 SEQR Appendix C -State Env ronmental Quality Review - _ f C NIVfi NT'AtxS�SES§1 EN ' FOFW For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) I. APPLICANT /SPONSOR 2. PROJE&NAME THOMAS AND-JOANNE PATTERSON THOMAS AND JOANNE PATTERSON 3. PROJECT LOCATION: Municipality PUTNAM VALLEY County PUTNAM 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) CAMP COLLINS ROAD (SEE MAP PROVIDED) 6. IS PROPOSED ACTION: ® New ❑ Expansion' ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: CONSTRUCTION OF RESIDENCE, SEPTIC SYSTEM, AND WELL 7. AMOUNT OF LAND AFFECTED: Initially LESS THAN 5 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? ® Residential ❑ Industrial Commensal ❑ Agriculture ❑ Park/Forest/Open space ❑ Other. Describe: SINGLE. FAMILY HOME ON 6.5 ACRES � 2 n3 P _ "1D2INI^ , rnn 0 vL STATE OR LOCAL)? ®Yes ❑ No if yes, list agency(s) and permit/approvals PCDH WELL & SEPTIC PERMITS; PUTNAM VALLEY BUILDING AND DRIVEWAY PERMITS 11, DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes ®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 name: JOHN P. DELANO P.E. NGINEER/APPLICANT Date: 4/5/01 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 . FNVIRONMENTAL ASSESSMENT (To be completed by Aaencv) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR PART 617.4? If yes, coordinate the review process and use the FULL EAF. - B. WILL A O RECEIVE C08RDINA��D ��VIE1%i%"A�' PROVibEb Ft3'�iGNL'IS`9`�B A" C1i�lY'�Ti�FIP2Z�R; `b`f7�6? - ff°Fta; a rie�a4i!eit€cia�n' may be superseded by another involved agency. ❑ 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, or other, natural or cultural, resources: or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: 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. r C7..Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A QF-A? ❑ Yes ❑ No — E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? - ❑Pyc -- ❑Yes_. 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 (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. If question D of Part 11 was checked yes, the determination and significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. ❑ 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 2 we of Responsible.Of per Signature of Preparer (If different from responsible officer) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES „_....._.:. --_. -.. ; DPS>< G'-_":= DAT<T,RP;'Ai�I``SSfi1VI..�....y 35 Hudson View Drive Owner THOMAS & JOANNE PATTERSON Address Putnam Valley, NY 10579 Located at (Street) CAMP COLLINS ROAD Tax Map 72 Block 1.. Lot 23.1 (indicate nearest cross street) Municipality PUTNAM VALLEY Drainage Basin HUDSON RIVER SOIL PERCOLATION TEST DATA Date of Pre-soaking 04/13/99 Date of Percolation Test 04/14/99 Hole No. Run No. Time Start - Stop Elapse Time (Min.) . .Depth to Water. From Ground Surface (Inches) Start - Stop Water Level Drop In Inches Percolation Rate Min/Inch A 1 10:30 11:00 30 19 - 21 2 15 A 2 11:00 - 11:30 30 19 - 21 2 15 A 3 11:30 12:00 30 19 - 21 2 15 4 5 - - B 1 10:30 - 11:00 30 19 -. 21 1 30 R. 2 11:00 .11:30 30 _ + _-`..I -__ -- ..2 --J.-- B 3 11:30 12:00 30 19 - 21 1 30 4 - - 5 - - 1 .' - 2 3 - - 4 - - 5 - - NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. < 1 min for 1 -30 min/inch, < 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to. be made from top of hole.- Form DD-97 TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED. 'IN TEST HOLES r �'•L'i'Lii,'2�' �'7..- rs' 9 •-4,-- •- -d7 r, n_ �2•c.t';:, .� Y�J u.ii+� - lYal'�vL'a'iY ...1: `1♦�: ✓� ���' - - G.L. TOPSOIL (4 ") TOPSOIL (4 ") 0.5' SAND & SILT SAND & SILT 1.0' V V V V 2.0 `V V 2.5' SAND & GRAVEL W/ SAND & GRAVEL W/ 3.0' COBBLES & COBBLES.& 3.5' BOULDERS'' BOULDERS 4.0' V (x20) V 4.5' V V (H20) V V 5.5'- , 6.0' 6.5' 7.0' �-, 8.0' 8.5' 9.0' 10.0' Indicate level at which groundwater is encountered 5' -0" Indicate level at which mottling is observed NOT OBSERVED Indicate level to which water level rises after being encountered (1) 4'- 0 "'(2) 41-6" Deep hole observations made by: John P. Delano, P.E., Badey &Watson, P.C. Date 06/10/99 Witnessed By A. Stiebeling, P.C.D.H. Design Professional Name: John P. Delano, P.E. Address: Badey & Watson, P.C. 3063 Route 9, Cold Spring, PTY 10516 Signature: Design Professional's Seal