Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0034
DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 1-1-52 -1 -52 BOX 1 r T . ,�, I T ` ' I , L 16 r r • UL 00034 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREAT PCHD CONSTRUCTION PERMIT # - 0'Z?' Located at 1?27/ P vTr-/i Z 17/. Town or Village FATT6p:-S 6 K) Owner /Applicant Name A. MASI SON A(LD t Tax Map -20— Block I Lot Formerly Subdivision Name Subd. Lot # Mailing Address %�©rV S t L,�/ SLAP. ZOSSPA U6 N1,/ U 2Z- Zip � i 7iTi Date Construction Permit Issued by PCHD 0 Separate Sewerage System built by I GO GF-FLL-I G4+ Address f!g GA R- I ly 5L-VD ( MsTSP- Consisting of (° ° o Gallon Septic Tank and /�D t> L I o o o G A � S EP T r e. TAN 1- t S 60 1- F o f 2� w ipe, STD Tgt.NGLlr- -S Other Requirements: 1 ZS V GAL pvM r C-Mm oa' Water Supply: Public Supply From Address or: k--- Private Supply Drilled by Address Building Type 1 ! f`f KS I pEKZfi Has erosion control been completed? Number of Bedrooms Has garbage grinder been installed? N r0 I certify that the system(s), as listed, servin h ove premises were constructed essentially as shown on the as- built plans (copies of which are attache itiFa with the issued PCHD Construction Permit and approved plans and the standards, rules and re o s`bf County Department of Health. o / Date: Z Zo ! I Certified y ;� P.E. ✓ R.A. { ign f onal) License # D Z x00 Address � r V Any person occupying premises served b ystem(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 revocat'on, modificat• or change is necessary. f Title: Date: jp —6 Z White copy- HD F le; Ye w c py -Building Inspector; Pink copy -Own r Or copy - Design Professional Form CG97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM _ A, NK. NAB 1 S Owner or Purchaser of Building Tax Map Block Lot Building Constructed by T TownNillage Location - Street Subdivision Name Building Type _ -AM t t,\( j6S D'ENi 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. p � re: Dat Zknth 6 Zi Day � Year 2-0/2, Signature: Title: General C actor (Owner) - Signature Ji �✓2a -s _,�r'� Corporation Name (if corporation) Corporation Name (if coTorati- .3,), Address: /j�'�ft 33 �a,---,1 /��- // Address: ,C4ez 7ge: /Urfa -0c State Sc,�c�� ✓�/ y Zip Z?— State ^Zip . Form GS -9? I-- . r REBECCA WITI'ENBERG, RN, BSN Public Health Diredor ROBERT MOR.RL% PE Director ofEnviromnad l Health John Kalin, PE DC Engineering 3 Memorial Ave. Pawling, NY 12564 Dear Mr. Kalin: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 MARYKU&N ODELL Qnvo Fxecudw February 14, 2012 Re: Construction Compliance for Mastronardi at 232 NYS Route 292 (T) Patterson, TM # 3.4-52 This Department has received and reviewed the application for the above referenced project and the following comments are offered for your consideration. . A well completion report for the well was not included with your construction compliance submittal. V/2. A Putnam Profile water analysis was not included with your construction compliance submittal. 3. Has the Town of Patterson been contacted for verification of the E -911 address? Upon completion of the above, this Department will cgntinue its review. Kindly advise us if there are any questions. Respectfully, Michael J. l Director of MJB:cw V YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovani, Director ** TEST REPORT ** LAB #: 1.201479 CLIENT #: 61120 NON STAT PROC PAGE: 1 of 2 HAVILAND, WARREN 152 OLD PAWLING RD PAWLING, NY 12564 DATE /TIME TAKEN: 04/24/12 11:00 DATE /TIME RECD: 04/24/12 12:16 REPORT DATE: 05/03/12 PHONE: (845)- 855 -3834 SAMPLING SITE: 232 RT 292, PATTERSON, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: HNO3 COLD BY: WARREN HAVILAND TEMPERATURE..: <20 >4.00 NOTES...: COLIFORM METH: MF ----------------------------------------------------------------------- -- ---- ----- .--- ----- - -- --- START DATE /TIME END DATE /TIME FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 04/24/12 0400 04/25/12 0400 MF T. COLIFOR ABSENT /100 ML ABSENT SM 18 -20 9222B 04/27/12 LEAD (IMS) 3.9 ppb 0 -15 ppb SM 18 -19 3113B 04/25/12 0315 04/25/12 0340 NITRATE NITRO. <0.23 MG /L 0 - 10 SM18- 20450ONO3 04/25/12 0345 04/25/12 0415 NITRITE NITRO <0.01 MG /L 1.0 MG /L SM18- 20450ONO2 04/30/12 IRON (Fe) <0.06 MG /L 0 -0.3 mg /1 SM 18 -20 3111B 04/26/12 MANGANESE (Mn 0.01 MG /L 0 -0.3 mg /1 SM 18 -20 3111B 04/27/12 SODIUM (Na) 10.18 MG /L N/A SM 18 -20 3111B 04/24/12 0335 04/24/12 0338 * pH 7.8 UNITS 6.5 -8.5 SM18 -20 4500HB 04/30/12 HARDNESS,TOTA 48 MG /L N/A SM 18 -20 2340C 04/30/12 ALKALINITY (A 58 MG /L N/A SM 18 -20 2320B 04/24/12 0100 04/24/12 0100 TURBIDITY (TU <1 NTU 0 -5 NTU SM 18 (2130B) COMMENTS: MFTC a Coliform = This result indicates that the water (was), (was not) of a satisfactory sanitary quality according to ew York State and EPA federal drinking water standard for this parameter. This comment applies to the Total Coliform test only. Pb /Cu LEAD limits for public schools are set at 15 ppb. EPA Lead & Copper Rule for Public Systems requires that no more than 10% of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg /L, else water treatment must be undertaken to reduce the waters corrosive potential. Fe /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. IMS = IMMEDIATE METAL SAMPLE.(INTERPRETATION: WATER SAMPLED AFTER SITTING UNDISTURBED A MINIMUM OF 6 HOURS OR OVERNIGHT) NMS = NORMAL METAL SAMPLE. (INTERPRETATION: WATER SAMPLED AFTER RUNNING FOR 10 -15 MINUTES MINIMUM) YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovani, Director ** TEST REPORT ** LAB #: 1.201479 CLIENT #: 61120 NON STAT PROC PAGE: 2 of 2 HAVILAND, WARREN 152 OLD PAWLING RD PAWLING, NY 12564 DATE /TIME TAKEN: 04/24/12 11:00 DATE /TIME RECD: 04/24/12 12:16 REPORT DATE: 05/03/12 PHONE: (845)- 855 -3834 SAMPLING SITE: 232 RT 292, PATTERSON, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: HNO3 COL'D BY: WARREN HAVILAND TEMPERATURE..: <20 >4.00 NOTES...: COLIFORM METH: MF ----- ; ------------------------------------------------------------ ---------- ----- -- ---- --- -- - - - -- START DATE /TIME END DATE /TIME FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 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 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. pH IS A FIELD MEASUREMENT AND IS TESTED OUTSIDE THE HOLDING TIME. pH REPORTED FOR REFERENCE ONLY. 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 MG /L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0 -70 MG /L VERY HARD WATER: ABOVE 300 MG /L MODERATELY HARD WATER: 70 -140 MG /L MG /L = MILLIGRAM PER LITER HARD WATER: 140 -300 MG /L (1 grain /gallon = 17.2 MG /L) ALK (ALKALINITY REPORTED AT pH 4.5) IMS IMS = IMMEDIATE METAL SAMPLE. (INTERPRETATION: WATER SAMPLED AFTER SITTING UNDISTURBED A MINUMUM OF 6 HOURS OR OVERNIGHT) THE ABOVE TEST PROCEDURES MEET ALL REQUIREMENTS OF NELAC, AND RELATE ALY TO HE SAMPLES RECEIVED BY THE LAB SUBMITTED BY: �' VI Albert H. Padov mi, M.T.(ASCP) Director ELAP# 10323 t. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL ABANDONMENT REPORT PCHD Well Abandonment Permit # please print or type Well Lgcat><on ; Street Address: TownNillage Tax Grid # 2,2 2 TMOO Map �j .Block � Lot�j� Well Ovrner Name: Address: TAV_-p I S4- 33 �r�o[cvl u-a✓ gwo Well Type ""Drilled Driven Dug Gravel Other Depthof, ell. Well Depth ft Static Water Level ft Date Measured P;' -ok(M ITY 74, SEPTL v pt>ton of z v G w' c4aAVr SSE LV7 5f b k/ GP-A� p ou7 kjFI>e >fleted Work �< ; r ` �`i•I_�1 �[4 ::001 ► ZAB► I, undersigned, hereby certify that the abandoment of the above - referenced water well has been accomplished and completed in accordance with the methods described in Permit # to abandon said water well. Date: Signature: Print Name: S D Eke A - Mt -I r, j I P 1 Address: 141 �AwL-l"c, NY «61 Form WAR -97 OC ENGINEERING, F ot• February 1, 2012 Mr. Michael Budzinski, P.E. Putnam County Department of Health 4 Geneva Road Brewster, N.Y. 10509 Re: Mastronardi Residence SSTS 232 Route 292 Patterson, New York TM# 3 -1 -52 Dear Mike: This letter is offered to provide the certification of the septic and pump system for the above referenced project. I hereby certify that I am a professional engineer licensed to operate in the State of New York and have performed a site visit for the above referenced project relative to the trenches and pump system for the subsurface sewage treatment system. Prior to the installation, I confirmed the location and installation requirements with the Contractor. I found the system to be installed in the location staked out by the project surveyor. It is with this understanding that to the best of my knowledge, information, and belief, the septic was completed in general conformance with the design plans and specifications as approved by the Putnam County Health Department. Should you have any questions regarding this matter, feel free to call me at your convenience. I can be reached at (845) 855 -2000. , P.E. D E S I G N C O N C E P T S E N G I N E E R I N G P C 3 MEMORIAL AVE. SUITE 1 01, PAWLING, NY 12564 PH: 845 -1355 -2000 • FX: 845 -855 -2605 E: JKALIN @VERIZON.NET PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CO STRU TION PERMIT FOR SEWAGE TREATMENT SYSTEM K-0:6 PERMIT # Located at Z- ?jZ peopr v1 z, Town or Village PAJT Pf- Subdivision name °— Subd. Lot # °'°° Tax Map Block i Lot Z- Date Subdivision Approved Renewal Revision Owner /Applicant Name A, h6e> IFTNA �-Pl Date of Previous Approval 0 C4 Mailing Address 33 +,� pv, l� 9 mot, '��V vs �1 4 toy Zip % f Amount of Fee Enclosed RP_C -V1CT> t i c,' ()gE,t t ; jr4:;7 i Building Type i PAM t 7,6Q Lot Area 4j7A CS No. of Bedrooms Design Flow GPD 10 0 0 Fill Section Only Depth Volume PCIID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of B ©UO gallon septic tank and a, h I ove) G A tr Lvo s 6 P n t, %itv ; 5(00 L- r a r. 2' iti, r Q- s T G> 1 V yi3 6_0 1✓ -_l' Other Requirements: 1'7, 5O CfA L- v n ��1kRMQ To be constructed by L efl CM- .L. l tAt Address 4s _e CAI ?__e c -r_r OLV_n Ic k S'7 NY Water Sup"I : Public Supply From --_1 or: Private Supply Drilled by 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 Director /Commissioner 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 immediatel 198 / date of the issuance of the approval of the Certificate of Construction Compliance of the original system o r a� 0 2 Siane �r " P. E. 1/ R.A. Date 1-71. Z. I r ' tn/ !Sur %jwLtiOC, NY 12� . License # 0 V00 L F 10. 07( .079 Fes- RUCTION: 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 nec ary by the Director /Commissioner. Any revision or alteration of the approved plan requires a new per#iit. Approved for di4charge of domestic sanitary sewage4nly. By: White copy - HD F el Title: - Building Inspector; P /Z / &� 7z) Design Professional Form CP -97 4'0 PVC SDR -35 PIPE FOUNDATION & ROOF LEADER DRAINS 1000 GAL CONC. SEPTIC TANK CONCRETE DIST BOX EXISTING WELL EXISTING WELL LINE�� I �A� 22 18 O� \ IX. 5 BORN. DMEWNG DT -2 .0000• 4 "0 SOLID PVC PIPE t � 1.5'0 PE 160 PSI FORCE MAIN 1,250 GAL. CONC. PUMP CHAMBER — 560 LF OF ABSORPTION TRENCHES— (10 LATS 0 56') ENT SYSTEM N AND THAT WAS COVERED ;ORDANCE WITH iE PUTNAM V YORK STATE 4 END CAP (TYP) SEPTIC AS -BUILT PLAN SCALE: I Inch a 30 fee! m A81 1000 GAL CONC. v� SEPTIC TANK c Ps \ P)._ I \ \ •C'ps \ \ �Q \ \ Y � DT-6� NOTE: ALTERATION OF THIS DOCUMENT, UNLESS UNDER THE DIRECTION I \� I �I N III O •Noo�Ieo WE1-�- �ry �O 100% RESERVE AREA ii LATS 0 57' EA. D.C. ENGINEERING. PC OFFICE: 3 MEMORIAL PAWLMCs, NT 12564 PHONE: 18451 855 -2000 JOHN A. KALM, PE FAX: 18457 855 -2605 NY$ LIC. NO 019004 EMAIL: JKALINeVERIZONW1 NO. I 5Y REVISION DATE POINT NUMBER DIST. FROM "All 97 B92 SEPTIC TANK 1 49.5' 16.0' SEPTIC TANK Z 57.7' 19.0' PUMP. CH. 3 64.3' 26.8' DIST BOX 4 53.1' 30.5' % LAT 5 61.5' 36.0' LAT 6 51.1' 71.5' LAT 7 67.0' 41.5' LAT 8 55.0' 77.5' LAT 9 73.0' 47.0' LAT 10 59.0' 83.5' LAT 11 79.0' 53.0' LAT 12 63.5' 89.5' LAT 13 85.0' 58.5' LAT (14) 68.5' 95.5' LAT (15), 90.5' 64.3' LAT 16 73.0' 101.5' LAT 17 65.5' 43.3' LAT 18 71.5' 80.5' LAT 19 71.8' 48.5' LAT 20 76.0' 82.6' LAT 21 77.5' 54.0' LAT 22 80.7' 85.0' LAT 23 83.5' 55.7' LAT 24 85.7' 87.9' MARK A" IS THE NORTHWEST CORNER OF RESIDENCE. MARK B" IS THE SOUTHWEST CORNER OF RESIDENCE. MARK C" IS THE SOUTHEAST CORNER OF RESIDENCE. S6 >.\ O 56' R1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES NOTE: Exact Location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 �We',11'Permit # WELL COMPLETION REPORT Well Location Street Address: Town/Village: Tax Map # GPS .., e := �r✓i{,1�, ei) � Rt_.X','rwh Map 3' Block/ Lot(s � Well Owner: Name: Address: ']Jt (%L V I 1 D (fl i> Use of Well: Residential _Public Supply Air cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Institutional Standby Drilling Equipment Rotary _Cable percussion Compressed air percussion Other(specify) Well Type _Screened _Open end casing Oplih hole in bedrock Other Total Length 50 ft. Materials: A Steel Plastic Other Casing Details Length below grade 4t. Joints: Welded Threaded Other Diameter -7 in. Seal: _Cement grout XBentonite Other Weight per foot Ib/ft Drive shoe: X Yes _ No Liner: . Yes ANo Diameter (in) Slot Size Length ft . De t to Screen (ft) Developed? Screen Details First I _No Second I __d—Yes I Hours Well Yield Test _Bailed _Pumped A Compressed Air Hours 6 Yield /Jr gpm Depth Date Measure from land surface - static (specify ft) / �{- During yield test (ft) =Dept complete well in ft. O ��1 �� di�3 �C1 'r✓ Well Log Depth From Surface Well Diameter If more detailed ft. ft. Water Bearing (in) Formation Description information Land surface B° �; . .f 55 ;' descriptions or sieve analyses �. 26d7 are available, please attach. If yield was tested Feet Gallons Per Minute Pump /Storage Tank Information at different depths Pump Type Capacity during drilling Depth Model list: Voltage HP Tank Type Volume Date Well Completed 1Nell Dnller PC Certificate # ,` NY State # Date, f Report Rump lnst8IIer;PC Certificate(# ' NY State # *tr Well Dr(Iler Name 8r!Addre'ss _ Well Driller (s griature) CAA.. Pump Installer Name & dress. Pump Installer (s ature) ._. _ra ... ..T �.. ..,' -.., .,. .-, ti .: ''r ._, •'4 .:.. ., As„ ' . i °i � • .. %?rXM'1., a.z.w „tee NOTE: Exact Location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 SHERLITA AMLER, MD, MS, FAAP Commissioner ofHealth ROBERT MORRIS, PE . Director ofEnvironmental Health . May 4, 2011 John Kalin PE DC Engineering 3 Memorial Avenue Pawling, NY 12564 Dear Mr. Kalin: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Office (845) 808 -1390 Fax (845) 278 -7921 or (845) 808 -1937 Re: Field Inspection- Mastonadi 232 Route 292 (T)Patterson, TM # 1-1-52 PAUL ELDRIDGE County Executive A re- inspection at the above referenced site has been completed and found to be in compliance with the approved plans. There are no further comments to be addressed at this time in reference to this Department's open work inspection. If you have any further questions, please contact me at (845) 808 -1390, ext. 43261. Sincerely, Gene D. Reed Sr. Environmental Health Engineering Aide GDR:cw MAY -2 -2011 08:33A FROM:OUTDOOR CONCEPTS INC 845 - 724 -4459 TO:2787921 P.2/2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION 13 JOSEPH GENE REQUEST FOR FINAL INSPEC110 For: kill All information must be fully completed prior to any Trenches inspections being made. PCHD Construction Permit # .,- Located; (V) Owner /Applicant Name: M&SI Ra l-2'% I _ Block . �.-_ Lot Formerly: Subdivision Name: Subdivision Lot # Is system fill completed?- -r-� Is system complete? Is system constructed as per plans? Is well drilled? 'S Is well located as per plans? F,c.S Are erosion control measures in place? .� Date. Date: q12--111 t Date: PW(OVII& IMT ro 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 Re ulations of the Putnam County Department of Health. Date: Certified by: PE ZRA esi Professional Address: 3 AC0&o0 -( V W L tj cl Lic. # �� Comments: Form FIR -99 p BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK ELECTRICAL INSPECTION SERVICES 150 White Plains Road, Suite 104, Tarrytown, NY 10591 CERTIFIES THAT Upon the application of: Tom Acerno - Tom Acerno 51 Tonetta Lake Way Brewster, NY 10509 Upon premises :owned by: Vincent Mastronardi - 232 Rt 292 Patterson, NY Located at: 232 Rt 292, Patterson, NY Application Number: 10089216 Certificate Number: 10089216 Section Block: Lot: BDC: 104 Permit Number: 298 -11 A visual inspection of the electrical system at this premise described as a Residential occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located inlon the premises at: 232 Rt 292, Patterson, NY Garage, Outside was inspected in accordance with the NYS and NFPA 70 -99 and the detail of the installation,.as set forth below, was founded to be in compliance therewith on the 25 Day of April 2011. Officer: Nick Morabito This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location Indicated. This certificate is valid for work preformed before date of inspection only. jsullivan Wednesday, April 27, 2011 20 Page I of 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVMONMMNTAL HEALTH SERVICES FINAL SITE INSPECTION Date: Inspected byQ Street Location Owner a , ,,1 Town Permit # -_ TM # ?, l Subdivision Lot. # 4L`/* 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 ............................. :....... IL Sewage System a. Septic tank size - 1,000 1, 250 ......... other ................ b. ' Septic tank installed level ................ ............................... c. 10' minimum from foundation ........................... ......... . d. Distribution Box 1. All outlets at same on -water tested. ... -- 2. Protected frost......... 3. .. 2 ft.Original soil between box & tre ches e. Junction Bog - properly set .................. 6. Trenches / a 1. Length required t, Length installed��(� 2. Distance to watercourse measured . Ft.,�,1� 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7• Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 11/2" diameter clean ...................: 9. Depth of gravel in trench 12" minimum .......:........... 10. Pipe ends capped ........................ ............................... g. Puma or Dosed Systems 1. Size of pump chamber..... .. 2. Overflow tank ....................... 3. Alarm, visual /audio... ............. :.. 4. Pump easily acce si151e, manhole to grade ................. 5. First box b 6. C�yycle nessed by H.D.estimated flow /cycle........... III. House/Buil 'di a. House located per approved plans ......................::... b. Number of bedrooms .................................. IV., Well Well located as per approved plans......:. Q b. Distance from STS area measured 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 & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate .... ............................... i. Erosion control provided ................. ............................... Rev. 12/02 b �n�cej �r r %0 - - � BOOM. MMIN �r�r MM MM MM Me MM MM r� NO b �n�cej PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLH SERVICES FIELD ACTIVITY REPORT Street Town State' Zip PERSON IN CHARGE (1R TNTFR VTFV FTI: if n y K ?,: r� le L. - T)att, (� PUMP TEST DOSE TEST REQUIRED GALLONS o2 %Q I acknowledge receipt of this report 02/96 T) - SIGNATURE; Title: � J REQUIRED GALLONS o2 %Q I acknowledge receipt of this report 02/96 T) - SIGNATURE; Title: Dear Mr.Kalin: Robert J. Bondi County Executive The above referenced separate sewage treatment system can be backfilled. The following needs to be addressed. • The distribution box and all pipe connections to and from it need to be inspected upon completion. If you have any further questions, please contact me at (845) 278 -6130, ext. 43261. Sincerely, r Gene D. Reed Sr. Environmental Health Engineering Aide GDR:cw UG Sherlita Amler, MID, MS, PAAP Commissioner of Health 4' •C Robert Morris, PE �L Director ofEnvironmental Health Donartme�nt of Health 1 Geneva Road, Brewster, NY 10509 Office (845) 808 -1390 Fax (845) 808 -1937 January 10, 2011 John Kalin PE DC Engineering 3 Memorial Avenue Pawling, NY 12564 Re: Field Inspection - Mastonadi 232 Route 292 (T)Patterson, TM # 1 -1 -52 Dear Mr.Kalin: Robert J. Bondi County Executive The above referenced separate sewage treatment system can be backfilled. The following needs to be addressed. • The distribution box and all pipe connections to and from it need to be inspected upon completion. If you have any further questions, please contact me at (845) 278 -6130, ext. 43261. Sincerely, r Gene D. Reed Sr. Environmental Health Engineering Aide GDR:cw MkIRWFE Environmental Protection Caswell F. Holloway Commissioner Paul V. Rush, P.E. Deputy Commissioner Bureau of Water Supply prush @dep.nyc.gov 465 Columbus Avenue Valhalla, NY 105951336 T: (845) 340-7800-- F: (845) 334 -7175 December 16, 2010 Michael Budzinski, P.E. Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 Re: Mastronardi Residence — SSTS 232 Route 292, (T) Patterson East Branch Reservoir Drainage Basin DEP Log # 2009 -EB -0715- DJS.1 Dear Mr. Budzinski j New York City Environmental Protection (DEP) has determined that the above- referenced application, received by the DEP on December 15, 2010, is complete. The DEP has no objection to the approval of the above - referenced regulated activity. This determination is based on the review of submitted documents including the plan titled "Subsurface Sewage Treatment System Plan for Mastronardi Residence, 232 Route 292, Town of Patterson, Putnam County, New York ", prepared by Design Concepts Engineering, P.C., dated July 16, 2009, last revised August 25, 2010. Please have the applicant contact David Alderisio at (914) 742 -2010 at least two days prior to start of construction of the SSTS so that the DEP may inspect and monitor the installation. c: Roger Sokol, NYSDOH Sincerely, O ��L Danny Shedlo, P.E. Civil Engineer III Wastewater Design Review BRUCE R. FOLEY If- Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New. York 10509 Environmental Health (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 TO: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM JOINT REVIEW PROJECT. TOWN: REVISION (TrREV2) DATE: OC ENGINEERING. PC December 7, 2010 Mr. Michael Budzinski, P.E. Putnam County Department of Health 4 Geneva Road Brewster, N.Y. 10509 Re: Mastronardi Residence SSTS (T) Patterson TM# 1-1 -52 Dear Mike: I have reviewed your comment letter dated November 9, 2010 regarding the above referenced project. As requested, I have modified and/ or provided additional information on the attached plans and in this letter. To facilitate your review, I have keyed the following responses to your original comments: 1. The septic system has been redesigned for a 5 bedroom residence. 2. The well has been labeled as existing and its as -built location was confirmed on the plan 3. The locations of the installed trenches, tank and pump chamber were confirmed by this office and then depicted on the attached plan. Attached please find four (4) sets of the plan for your consideration for approval. If you have any questions, feel free to call me at your convenience. I can be reached at (845) 855 -2000. A in, P.E. C: \design concepts\ projects\ mastronardi \120710.resp.Itr.wpd D E S I G N C O N C E P T S E N G I N E E R I N G P C 3 MEMORIAL AVE. SUITE 1 01 , PAWLING, NY 12564 PH: 645 - 655 -2000 • FX: 645 -655 -2605 E: JKALIN (gVERIZON.NET ENGINEERING REPORT PROPOSED SEWAGE TREATMENT SYSTEM MASTRONARDI RESIDENCE 232 ROUTE 292 TOWN OF PATTERSON, PUTNAM COUNTY, NEW YORK SEPTEMBER 2009; Revised 9/25/10 WARNING: IT IS A VIOLATION OF SECTION 7209, SUBDIVISION 2, OF THE NEW YORK STATE EDUCATION LAW FOR ANY PERSON, UNLESS ACTING UNDER THE DIRECTION OF A LICENSED PROFESSIONAL ENGINEER OR LAND SURVEYOR TO ALTER IN ANY WAY, ANY PLANS, SPECIFICATIONS, PLATS OR REPORTS TO WHICH THE SEAL OF A PROFESSIONAL ENGINEER OR LAND SURVEYOR HAS BEEN APPLIED. COPYRIGHT 2010 JOHN A. KALIN, P.E. Prepared by: Design Concepts Engineering, P.C. John A. Kalin, P.E. 3 Memorial Avenue Pawling, NY 12564 Submitted herewith is a report containing the engineering design data relative to the revision of a recently approved and constructed Subsurface Sewage Treatment System (SSTS) to serve a private residence within the Town of Patterson, Putnam County, New York. PROJECT DESCRIPTION: The parcel being serviced by the SSTS is located at 232 Route 292 in the Town of Patterson. The parcel is identified on the Town Tax Maps as Grid # 1-1 -52. The project previously involved the removal of an abandoned commercial building, paved parking area, well and septic that was once used for a radio station. The building did not meet the needs of the current owners who wished to use it for a single family residence. As a result, the owners removed the building and constructed a new residence in the same general footprint. The replacement residence was designed to be a three (3) bedroom, single - family dwelling. In the course of construction, without consent or knowledge from this office, the owners finished the attic space creating an additional potential bedroom. During the final inspection of the installed SSTS, representatives of the Health Department noticed the discrepancy and directed the Owner to remove the stairs or increase the septic size. This revised report reflects the increase in bedroom count to five and the larger septic system required. The house is supplied with water from a new well that was constructed on site. The property slopes down from the existing driveway to the rear of the lot. The entire parcel is wooded less the area around the existing building. There is a stream in the rear portion of the property. There are no proposed disturbances within 100 ft of the stream. GENERAL DESCRIPTION OF SSTS: The previously approved SSTS is undersized to accommodate five bedrooms. The current septic is sized for three bedrooms. To upgrade the septic the following actions are proposed: • Connect the septic tank to the reserve area pump chamber. Convert the new and unused pump chamber to a second septic tank (net capacity is 2,000 gallons) • Install a new 1,250 gallon concrete pump chamber and upfit with pump to address dosing requirement • Replace gravity line to fields with force main • Reuse existing drop boxes • Reuse existing absorption trenches (336 LF) and expand fields with 4 new laterals each 56 LF for a new system total of 560 LF. • Rearrange and expand 100% SSTS Reserve Area (625 LF) Engineering Report- Proposed SDS September 28, 2009; Rev'd 9/25/10 Mastronardi Residence Page 2 Test holes were excavated and witnessed by representatives of the Putnam County Health Department (refer to location on plan). During our soils investigation, the SSTS area was found to be composed of silts and loam. Rock and water was noticed in the bottom of some of the holes. Mottling was not noticed in any of the test pits. Utilizing the soil test data, the best area was selected for the expansion of the treatment system (refer to plan). The new SSTS design shall supercede the previously approved and installed system. Attached please find the revised plans for the layout of the sewage treatment system. The need for dosing will require the use of a pump chamber to deliver effluent to the primary and reserve area. A pump chamber has been sized and detailed on the plans and within the attached engineering report. The Design Flow utilized to design the SDS is 200 GPD /Bedroom, or 1000 GPD (based upon a 5- bedroom design) Noting the soil percolation rate of 8 -10 minutes per inch, and associated application rate of 0.9 GPD /SF, the required length for standard 2' -wide absorption trenches is 556 L.F. For this design, the system shall be arranged using ten (8) rows of trenches each 56 L.F. for a total absorption trench length of 560 L.F. This represents adding an additional 4 laterals to the existing system. They shall be tied into the existing drop boxes (refer to plan) The 100% reserve area was also tested and found to perc at a slower rate (1115 min /in) which requires 625 LF of fields. The reserve area has been redesigned with eleven (11) laterals each 57 L.F. for a total of 627 L.F.. WATER SUPPLY: The recently drilled will has been located with sufficient separation distance to the proposed expansion of the SSTS. All work was performed by a Putnam County licensed contractor. Prior to use, the well shall be disinfected and tested in accordance with Health Department Standards. Q SSTS Design Calculations Revised 11/25/10 Project: Mastronardi Residence �o�� E ,1 . r�15 Location: Route 292 Patterson, New York �� �'ti � o 1. DESIGN CONSIDERATIONS NO cFysFO P- o�9L��� 5 Bedroom Single Family Dwelling Upgrade of new septic system from 3 bedroom design to 5 bedrooms. Note: Garbage Grinders Shall Not Be Used 2. DESIGN FLOW (Per PCHD Design Standards) 5 bedrooms x 200GPD / bed =1000 GPD Use: 1000 GPD 3. SEPTIC TANK SIZE Provide 1,500 gallon capacity. Combine existing 1,000 gallon concrete tank with existing and unused 1,000 gallon pump chamber to achieve 2,000 gallon capacity. The effluent filter shall be removed from the septic tank and placed in the new outlet of the pump chamber (refer to plan details). Provide watertight riser with lockable lid and Zabel A -300 effluent filter on the second tank (former pump chamber). 4. CONVEYANCE AND DISTRIBUTION • New 1.5" PE 160 PSI force main from new pump chamber to drop boxes. • Existing and unused concrete (6) drop boxes to remain to distribute effluent to fields. 5. TREATMENT FIELDS Perc Rate: 8 -10 min /inch Design Flow: 1000 GPD (5 bedroom) Method of Treatment: Standard Trenches Fields Req'd: As per PCHD Appendix H, provide 556 LF of fields 556 LF / 10 rows = -56 LF /row D E S I G N C O N C E P T S E N G I N E E R I N G P C 3 MEMORIAL AVE. SUITE 1 01, PAWLING, NY 12564 PH: 845- 855 -2000 • FX: 845 -655 -2605 E: JKALINQVERIZON.NET Mastronardi SSTS Calculations Page 2 September 28, 2009; rev'd 11/25/10 336 LF of fields are existing and unused, therefore provide an' additional 220 LF of fields to the primary system. Provide: 4 additional rows of 56 LF standard absorption trenches 6. EXPANSION DESIGN In the future, a 100% SSTS expansion area has been created. The perc rate in that area was 1115 min /in. The resulting trench length per Appendix H is 6251-F. It shall be arranged in 11 rows each 57 L.F. for a total of 627 L.F.. To utilize the reserve area, the pump chamber and a force main will be required. 7. PUMP CHAMBER: PUMP DESIGN Pump calculations (Reserve area controls design): Daily design flow: 1000 gpd Dose volume: .65 gal /ft x 556 LF x 75% = — 270 gallons (primary) .65 gal /ft x 625 LF x 75% = —305 gallons (reserve) Friction Head: Pipe type /size: 1 %" polyethylene Length: 90 LF H -W coefficient: 120 Assumed flow rate: 30 gpm Loss ( @30GPM): 6.26/100' (per Goulds) Equivalent Lengths: Straight Length 90 LF Fitting loss (use 1 %" dia) 90° elbow (2): 4.3 x 2 450 elbow (2): 2.0 x 2 Quick disconnect (1): 4.3 x 1 Discharge (1): 1.5 x 1 Gate Valve (1): 1 x 1 Total length: 107.4 LF = Use: 107 LF Total Dynamic Head: Total dynamic head = static head + friction head Friction Head: Friction head = Equivalent length x Head Loss /100 ft of pipe D E S I G N C O N C E P T S E N G I N E E R I N G P C 3 MEMORIAL AVE. SUITE 1 01 , RAWLING, NY 12564 PH: 545 -655 -2000 • FX: 845 -855 -2605 E: JKALINOVERIZON.NET Mastronardi SSTS Calculations Page 3 September 28, 2009; rev'd 11/25/10 107LF x 6.26FT = 6.69 ft 100FT Static Head: Static head = Elev at High Point - Elev. at Pump 99 -88 = 11.0 ft Total Dynamic Head: 6.69 + 11.0 = 17.69 FT Use: 18 ft Pump specifications: Using the total dynamic head of 18 ft, a Goulds Effluent Pump Series PE, Model PE31, .33 HP, 115V, has been selected. This pump can deliver approximately 21 gal /min against 18 ft of total head. Refer to attached sheets for pumps specifications and chart. Cycle time: Primary: Reserve: Dose = 270 GAUCYCLE Dose = 305 GAL /CYCLE Pump rate = 21 GPM Pump Rate = 21 GPM 270 gal /cycle / 21 gal /min = 12.86 min 305/21 = 14.52 min Drawdown / Float Switches: Tank capacity: 37.84 gal /in (1,250 gallon tank) Drawdown = DoseNol per Depth of tank Primary: Reserve: 270gal / 37.84 gal /in = 7.13" — 7 inches 305/37.84 = 8.06 — 8" Per draw down calculation, set mercury float switch for 7" drawdown. The float switches should be set at 3" o and 10" on above the floor of the 1,250 gallon pump chamber. The alarm switch should be set at 12.0" above the tank floor. Emergency storage volume capacity is about 980 gallons. Additional storage capacity exists above the invert of the inlet pipe. In the future, the floats will be reset at 3" (off) , 11" on and 13" (alarm] for the reserve area. D E S I G N C O N C E P T S E N G I N E E R I N G P C 3 MEMORIAL AVE. SUITE 1 01 , PAWLING, NY 12564 PH: 845 -855 -2000 • FX: S45 -855 -2605 E: JKALINOVERIZON.NET 1► ITT Goulds Pumps PESubmersible Effluent Pump �RGOULDS PUMPS Goulds Pumps is a brand of ITT Water Technology, Inc. - a subsidiary of ITT Industries, Inc. www.goulds.com Engineered for life Residential Water Systems FEATURES • Corrosion resistant construction. • Cast iron body. • Thermoplastic impeller and cover. • Upper sleeve and lower heavy duty ball bearing construction. ■ Motor is permanently lubricated for extended service life. • Powered for continuous operation. • All ratings are within the working limits of the motor. ■ Quick disconnect power cord, 20' standard length, heavy duty 16/3 S1TW with 115 or 230 volt grounding plug. ■ Complete unit is heavy duty, portable and compact. ■ Mechanical seal is carbon, ceramic, BUNA and stainless steel. ■ Stainless steel fasteners. ITT APPLICATIONS Specially designed for the following uses: General: • Mound Systems • Single phase • Effluent/Dosing Systems • 60 Hertz • Low Pressure Pipe Systems • 115 and 230 volts • Basement Draining • Built -in thermal overload protection with automatic reset. • Heavy Duty Sump/ • Class B insulation. Dewatering • Oil- filled design. • High strength carbon steel shaft. PE31 Motor: • .33 HP 3000 RPM • 115 volts • Shaded pole design P 1 Motor: 0 HP 3400 RPM • 115 and 230 volts • C design 51 Motor: • .50 HP 3400 RPM • 115 and 230 volts • PSC design MOTOR GOULDS PUMPS Residential Water Systems SPECIFICATIONS Pump — General: • Discharge: 11/2" NPT • Temperature: 1040E (40 °C) maximum, continuous when fully submerged. • Solids handling: Y:" maximum sphere. • Automatic models include a float switch. • Manual models available. • Pumping range: see performance chart or curve. PE31 Pump: • Maximum capacity: 53 GPM • Maximum head: 25' TDH 1 Pump: • M mum capacity: 61 GPM • Maximum head: 29' TDH Pump: ximum capacity: 70 GPM • Maximum head: 37' TDH METERS FEET 0 a W x _V a Z Y J F H M1 AGENCY LISTINGS s�® c uS Tested to UL 778 and CSA 22.2 108 Standards By Canadian Standards Assodation File AR38549 0 5 10 15 m3/h CAPACITY Goulds Pumps is ISO 9001 Registered. ITT PERFORMANCE RATINGS -4, PE31 P 1 Total Head (feet of water) GPM 5 52 10 42 15 29 20 16 25 0 47 Tota Head (feet of water) GPM . 8 61 10 57 15 46 20 33 25 16 PUMP INFORMATION Tota ead (feet of water) GPM 10 67 15 59 20 50 25 39 30 26 35 8 GOULDS PUMPS Residential Water Systems DIMENSIONS (All dimensions are in inches. Do not use for construction purposes.) i CHARGE Minimum Float Switch Cord Discharge Minimum Maximum Shipping Order No. HP Volts Amps Circuit Phase Basin Solids Weight Breaker Style Length Connection Diameter Size Ibs /kg PE31 M 0.33 / 115 12 20 1 Manual / No Switch 20' 1.5" 18" 5" 31/14.1 PE31 Pt Piggyback Float Swit E41 5 1 anual / No Sw P 41 1 Pig back Floa witch PE M ; 7 'A l Ma al / 0 Switch PE 1 Piggyba Float Switch P 51 � Ma al / o Switch E51 P1 \ Pi back Flo Switch PE52M anual / No Sw h PE52P1 Piggyback Float Swit PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL .HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: AN I 2. Name of project: U6j� NAB 3. Locatioio/v: P^T TWytr 4. Design Professional: jz>tir4 ,�a• V -AL-iN p�- 5. Address: S Mr-MvF4A- Auf,'- 6. Drainage Basin: E,`^s7 gyANCA 7. Type of Project: — Irivate/Residential Food Service Apartments Institutional Office Building Realty Subdivision p6m,i Nc.- o y agol Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ........................... :............... ........... Type I Exempt :. Type II Unlisted ✓ 9. Is a Draft Environmental Impact Statement (DEIS) required? .......................... alp 10. Has DEIS been completed and found acceptable by Lead'Agency? ............... 11. Name of Lead Agency ►v A 12. Is this project in an area under the control of local planning, zoning, or other . officials, ordinances? ......................................................... ..:............................ ES 13. If so, have plans been submitted to such authorities? ........ ...........................:... NO 14. Has preliminary approval been granted by such authorities ?NL Date granted: N 15. Type of Sewage Treatment System Discharge ................. surface water oundwater 16. If surface water discharge, what is the stream class designation? .................... 17. Waters index number (surface) ......... .................................... . .......................:....... 1414.. 18.. Is project.located near a public water supply system? ....... ...................:........... NO 19. If yes, name .of water. supply N /AS Distance to water supply 20. Js project site near a public sewage collection or treatment system? ............... NO 21. Name of sewage system N It Distance to sewage system 22. Date test holes observed 6/Z LO 23. -Name of Health Inspector Joc prY -AV^,T I 24.. Project design flow (gallons per day) ................................. .............. :................ l,0 n0 o Pp 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... NO 26. Has SPDES Application been submitted to local DEC office? ......................... NO Form PC -97 2 -27. Is any portion of this project located within a designated Town or State wetland? NO 28. Wetlands ID Number .......................... .............................. ............................ 4........ N 29. Is Wetlands Permit required? .............................................. .................. :............ ND 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 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 N 0 'DESCRIBE: 33. Is there a local master plan on file with the Town or Village.? ....................... ... � 34. Are community, water and/or sewer facilities planned. to be developed within 15 years in or adjacent to, project site? ............:......... ............................... 35. Are any sewage treatment areas in excess of 15% slope? .................. ... N _ 36. Tax Map ID Number............................................................ Map 3 _ Block_ Lot G2— 37. Approved plans are to. be returned to ..... Applicant 4 Design'Professional NOTE:.AU applications.for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review, and approval of other aspects of 'a project,. such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, hat in 'on provided on this form is true to the best of my knowledge and belief. Fid ode herein are punishable as a Class A misdemeanor pursuant to Sect! t al Law. CID 0 2 SIGNATURE t OFFICIAL TITLES: c Mailing Address: .............:........} L�......A 3M04 vEAJ,AV6 I� WWNG N 1,56 f Sherlita Amler, MD, MS, FAAP Commissioner of Health Robert Morris, PE Director of Environmental Health John Kalin, PE DC Engineering 3 Memorial Ave. Pawling, NY 12564 Dear Mr. Kalin: Department of Health 1 Geneva Road, Brewster, NY 10509 Office (845) 808 -1390 Fax (845) 808 -1937 Re: Proposed SSTS Mastronardi at 232 NYS Route 292 (T) Patterson, TM # 3.4-52 Robert J. Bondi County Executive November 9, 2010 This Department, in conjunction with the NYCDEP, has received and reviewed the revised plans for the above referenced project and the following comments are offered for your consideration. 1. The house plans are considered to contain five (5) potential bedrooms, therefore the SSTS is to be designed for a five.- bedroom system. The well is to be labeled as existing and the as -built location shown on the plan. a/ 3. The locations of the installed absorption trenches, septic tank and pump chamber, under permit P- 03 -09, are to be shown on the plan. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. Respectful. Michael J. Director of MJB:kly cc: D. Alderisio, DEP NVC Environmental Protection Caswell F. Holloway Commissioner Paul V. Rush, P.E. Deputy Commissioner Bureau of Water Supply prush @dep.nyc.gov - - 465 Columbus Avenue Valhalla, NY 10595 -1336 T:(845)340 -7800 F: (845) 334 -7175 November 5, 2010 Michael Budzinski, P.E. Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 Re: Mastronardi Residence — SSTS 232 Route 292, (T) Patterson East Branch Reservoir Drainage Basin DEP Log # 2009 -EB -0715- DJS.1 Dear Mr. Budzinski: New York City Environmental Protection (DEP) has determined that the above - referenced application, received by the DEP on October 29, 2009, is complete. The DEP has no objection to the approval of the above - referenced regulated activity. This determination is based on the review of submitted documents including the plan titled "Subsurface Sewage Treatment System Plan for Mastronardi Residence, 232 Route 292, Town of Patterson, Putnam County, New York ", prepared by Design Concepts Engineering, P.C., dated July 16, 2009, last revised August 25, 2010. Please have the applicant contact David Alderisio at (914) 742 -2010 at least two days prior to start of construction of the SSTS so that the DEP may inspect and monitor the installation. c: Roger Sokol, NYSDOH Sincerely, Danny Shedlo, P.E. Civil Engineer III Wastewater Design Review 2Y, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM r Owner: �3 '�d" r' Address: Located at (street): �'':� ��' `'Z� 2 TM # Section: Block Lot- Municipality: o " s °w Watershed: r SOIL PERCOLATION TEST DATA t Witnessed by:, Date of Pre - soaking: 1 b �% Date of Percolation Test: _� /� k% S 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 1 : G. : 3� 4. 5 Pi J 1 1 "9 -P3tf 3v f6 , 9 1® 2 13 d: 0S 3�D r o2 3 l� 3 :05 - 3 4 5 I3 1 I.c$ 1 3 2 r'o7 3 1; a, Wit- 7 4 5 2 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 minfinch, < 2 rein for 31 -60 min /inch). All- data to be submitted for review. 7 nenth measurements to he marie.. frnm tnn of hnly TEST PIT DATA 1)I:SC Atll'Ti0 N OF S0iLS ENCOUN-TER I:I) DEPTH HOLE r i HOLE qQ'T 1- HOLE # ar HOL= #QTY HOLE 0' G.L. �" 8 11.01 2.0' 2.5' 3.0' 0 � T .. 4.0' 4.5' - �i ✓D'� "�^� - - - - -- 5.5' 6.0' 7.5' 8.0' 8,5' 9.0' 9.5' 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 Deep hole observations made by: Date Design Professional Name: Address: Signature: Design Professional = Seal DEC -11 -2004 05:55A FROM:OUTDOOR CONCEPTS INC 845 7724 -4459 TO:92787921 P.1/3 DC ENGINEERING, RC To: Joe Paravati Company: PCHD From: John Kalin Subject: 232 Route 292 Plan FACSIMILE Fax Number: (845) 278 -7921 Date: May 27, 2009 You should receive, page(s), including this cover sheet. If you do not receive all the pages, please call 845 - 855 -2000. Comments: Joe, Attached please find the plan for 232 Route 292 in Patterson as requested. Thanks, l n�uiok'e �Pm John , - 'Pa Co IC'° D E 'S I G N C O N C E P T S E N G I N E E R I N G P C 3 MEMORIAL AVE. SUITE 1 01 , PAWLINS, NY 1 26e4 PH: 645- 655 -2000 • FX: 645 - 855 -2605 E: JKALIN®VERIZON.NET PROPOSED LOCATION OF WELL EXISTING AS_ PHALT DRIVEWAY PROPOSED ASPHALT - Ln N W `(-T► DRIVEWAY APPROXIMATE LOCATION ' OF EXIST. SEPTIC TANK &.\�\ •a , FIELDS TO BE ABAN. `�\ . dNE IF STORK" FRAME r �c a) cv. 1 • � 1 1 wksmfoNA*1° I. ,, 5 O . PROPOSED SSTS AREA I r APPROX. LOCATION OF. EXIST.. WELL TO BE ABAN/ LOCATION OF EXISTING DWELLING TO B / 0o RENOVATED i !�Q'r� �. D- -4 (U Q1 N DJ I` 0-1 Q� O H W O� 1 �•,�` r � PROPOSED J IOCAPION OF 1 `��. WELL "�,r.�_"'�• -� �, +. �EXISTINGALT PROPOSED SSTS AREA ; 1 DRIVEWAY - PROPOSED ASPHALT j DRIVEWAY i APPROXIMATE LOCATION + OF EXIST. SEPTIC TANK FIEIDS TO BE ARAN. STORK i FRAME APPROX. LOCATION OF EXIST. WELL TO BE AB AN/ �1_ NORTH ��`,�_ LOCATION OF EXISTING DWELLING TO BE ` RENOVATED " MASTRONARDI RESIDENCE 232 ROUTE 292 (T) PATTERSON SCALE: 1"=l 00' 6 JAN -7 -2011 09:45A FROM:OUTDOOR CONCEPTS INC 845 - 724 -4459 TO:2787921 P.2/2 oul7t7i- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION: ❑ Michael J. Budzinski, PE ® Joseph S. Paravati, Jr. REQUEST FOR FINAL INSPECTION For: Fill All information must be fully completed prior to any Trenches inspections being made. Pump Test PCHD Permit # P- 03 —07 Located at: 197i 1 (T (V) Owner /Applicant: A� Sec. 3 Block _Lot Sy Formerly: Subdivision Name: Subdivision Lot #: Is system rill completed? Date: Is system complete? 114cNo►k" Date: ' /-1i I Is system constructed as per plans? %,s Is well drilled? le,S Date: Is well located as per plans? `iEs Are erosion control measures in place? �eZ Is Underwriters Certificate attached for pump pit inspection? tJOT FLOAa l YET 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 Stan dar s -; 90es.,and Regulations of the Putnam County Department of Health. Date: 1/711 t Certified by,: u a ; A le V" PE ! Sherlita Amler, MD, MS, FAAP Commissioner of Health Robert Morris, PE Director of Environmental Health July 13, 2010 John Kalin, PE DC Engineering 3 Memorial Ave. Pawling, NY 12564 Dear Mr. Kali-n: Department of Health 1 Geneva Road, Brewster, NY 10509 Re: Field Inspection - Mastonadi 232 Route 292 (T) Patterson, T.M. # 1 -1 -52 A site inspection was made for the above referenced project on July 2, 2010. The following comment must be corrected in the field. Robert J. Bondi County Executive 1. The potential bedroom count for the new house is S. The septic system is designed for 3 bedrooms. If you have any further questions, please contact me at (845) 808 -1390, ext 43157. JSP:kly ty, S. Paravati, Jr., PE lmental -Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845.).225-5418 Nursing Services (845) 278 -6558 Fax (845) 178 -6026 Nursing / Home Care Agency (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 FEB -6 -2004 11:28P FROM:OUTDOOR CONCEPTS INC 845 -724 -4459 TO:927e7921 P.1/1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION E JOSEPH 13 GENE REQUEST EQR FINAL TNSPECT�I-ON For: rill All information must be fully completed prior to any Trenches --�� inspections being made. PCHD Construction Permit # p 0 3 O Located: 1-2 Z r=TE Zq "-- ((1-Y(v) Owner /Applicant Name: A4ASTRaN ^-p.-j2 t I TM Block Lot Formerly: Subdivision Name: -- Subdivision Lot # -- Is system fill completed? N/A Date: Is system complete? Date: (_`'" 7 Is system constructed as per plans? t;5 Is well drilled? No-r % Date: Is well located as per plans? Are erosion control measures in place ?__ 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. 2 !4110 Certified by: PE �RA Design Professional Address: Design Concepts Engineering PC Lic. # a7-- °� memorial Ave. suite.301 Comments: Pawling, New York 12564 Form FIR -99 k (: AND R.TO IK EX. 12' W DRIVEWAY I ' I PROP. SILT FENCING REFER TO DETAIL. N MINOR MODULAR BLOCK (UNILOCI�PISAE RETAINING WALL EX. 4'0 PVC SDR -35 PIPE TO REMAIN - IN SERVICE TO TANK FOUNDATION & ROOF LEADER DRAINS DRAIN TO DAYLIGHT. PROVIDE RODENT GUARD AND 1' STONE DISSIPATER 3'Wx6'Lx18'D W/ GEOTEXTILE BELOW EX. 1000 GAL CONC. SEPTIC TANK TO REMAIN IN USE CONCRETE DIST BOX ON FIRM, UNYIELDING GROUND (REFER TO DETAIL) PROVIDE 8" CONNECTION PIPE ANDS 4" VENT PIPE. REFER TO DETAILS EX. AND UNUSED 1000 GAL CONC. PUMP STATION SHALL BE CONVERTED TO A SEPTIC TANK. REFER TO DETAIL PR. 2' WIDE ABSORPTION TRENCHES TO BE Sly ADDED TO EX. SSTS (4 LATS 0 56') 7.E 313.0000 i a 4 "0 SOLID PVC PIPE —,� 01% MIN; 45' MAX BENDS 1.5 "0 PE 160 PSI FORCE MAIN. - ��yc�oo OF REFER TO DETAIL. 1,250 GAL CONC. PUMP CHAMBER. REFER TO DETAIL EX. AND UNUSED 2' WIDE ABSORPTION TRENCHES (6 LATS 0 56') TO REMAIN IN SERVICE o o \\ 11 �n+iS-�40 II \ 1 \ \\ , -MAX, s S \ END CAP (TYP) cP \ 0. \ \5 \ - \ 70 DT-1 6\ 701 D/ \ 95.75 EX. 5 8M. DWEWNG FF. ELEV. y EM. - 18066.0 �\ NSE. 07V. = 95.0 DT- i \ DT -2 � X70 \ \ \ \ \\ \ \ s�.� P B�T'3 \ \ \ \ Y \ V S \\ \ \ \ \yfX \\ 1� 70 S 0 � �__ \ \sue \sue \sys� \ \ 95 \ 0 100% RESERVE AREA- SURFACE SWALE O _ 11 LATS ® 57' EA REFER TO DETAIL ti PROVIDE GRAVEL PAD AT SWALE END oho ,F T � PUTNAM COUNTY DEPARTMENT OF HEALTH r- ® SION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM;., PERMIT # Located at 1-37- f20Q TC- Sj%'- Town or Village P/NTT� -00 Subdivision name Subd. Lot # Tax Map 3 - Block 9 Lot 5-'Z- Date Subdivision Approved Renewal Revision Owner /Applicant Name .4• MAST90t4 APp 1 Date of Previous Approval Mailing Address ftwo vs c-( SL-Yp Ko .pA NY zip 11 qn Amount of Fee Enclosed Soo Building Type I PAMi LY "S.. Lot Area q U Ay No. of Bedrooms 3 Design Flow GPD b OO Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of j od 0 gallon septic tank and 33 F O F Z" w ( O6 VT E>. 7CHCA's Other Requirements: I ono G•AwQr, fVAtP e KAntkCt- For, p UTvg-l�, u< To be constructed by P. G. 0 c!NSeD Coo jr- AC.Tof�. Address -r&P Water Supply: Public Supply From Address or: Private Supply Drilled by Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment s,, stem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the 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 theret . Signed: P.E. ✓ R.A. Date lulol Address DV it4SO -i "(n 'S Mftog.t ,kl. AV/ pawV, NY 17TO License # 07MV 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 n essary by the Public Health Director. Any revision or alteration of the approved plan requires a new p rmit. Approved f6j.,ischarge of domestic sanitary sew ge on By: Title: C' Date: & White copy - HD F' e; Y low opy - ilding Inspector; Pink copy - Owner; r e py - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type Well Location Street Address: Town/Village: Tax Map # Fom2 y rA-T 00 Map 3 - Block I Lot(s) ��- Well Owner: Name: Address: hone #: 1 l$) A. MASTF -oo AR1 8F00"ll.lf,6(,,'VD P4,I)AIA,,1`41T ed ZZ— 52.g -1vi Use of Well: ✓ Residential _Public Supply Air /cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield Sought 5-0 gpm # People Served Est. of Daily usage VO gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason Ek W6L.A— I 5 Too GWSf- To ml&# SS-CS 7, e for Drilling Well T pe Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes _ No Is well located in a realty subdivision? ........................................... ............................... Yes _ No Name of subdivision H /A Lot No. -°- Water Well Contractor: TBG Address: Is Public Water Supply available on site? ....................................... ............................... Yes _ No Name of Public Water Supply: 14/ Town/Village -- Distance to property from nearest water main: Proposed well location & sources of contamination to b rovi d on separate sheet/plan. Date: vm 101 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 Departmel 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 Commissioner of Health. Any revision or alteration of the approv d plan requires a new permit. Well /too be constructed by a water well driller certified by Putnam Coypty. Date of Issue ! [ "Z Permit Issuin Official: G Date of Expiration I Z -7/ Title: Permit is Non - Transferable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -9T Rev. 3/06 OC ENGINEERING, RC October 31, 2009 Mr. Michael Budzinski, P.E. Putnam County Department of Health 4 Geneva Road Brewster, N.Y. 10509 Re: Mastronardi Residence SSTS (T) Patterson TM# 1-1 -52 Dear Mike: I have reviewed your comment letter dated October 28, 2009 regarding the above referenced project. As requested, I have modified and/ or provided additional information on the attached plans and in this letter. To facilitate your review, I have keyed the following responses to your original comments: Silt fencing has been added directly below the proposed well location as requested. 2. The absorption trench detail has been modified to depict the laterals and the trench bottom being level for the reserve area dosed system. 3. The septic tank detail has been revised to include a riser with a lockable, water tight lid for access to the effluent filter. Attached please find four (4) sets of the plan for your consideration for approval. If you h ve any questions, feel free to call me at your convenience. I can be reached at (845) 8A5-2000. Since John Al Kalin, P.E. cc: riie C: \design concepts\projects\mastronardi 1103109.resp.ltr.wpd D E S I G N C O N C E P T S E N G I N E E R I N G P C 3 MEMORIAL AVE. SUITE 1 01, PAWLING, NY 125B4 PH: 645 -655 -2000 • FX: 645 -655 -2605 E: JKALIN@VERIZON.NET SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health John Kalin, PE DC Engineering 3 Memorial Ave. Pawling, NY 12564 Dear Mr. Kalin: DEPARTMENT OF HEALTH 1 Geneva Road..Brewster, New York 10509 Re: Proposed SSTS Mastronardi at 232 NYS Route 292 (T) Patterson, TM # 3.4-52 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health October 28, 2009 This Department, in conjunction with the NYCDEP, has received and reviewed. the revised plans for the above referenced project and the following comments are offered for your consideration. 1. Silt fencing should be considered immediately down gradient of the proposed well. 2. The absorption trench detail is to be revised to specify the trench bottom and perforated laterals being installed level for a dosed system. 3. The septic tank detail is to be revised to indicate a maximum backfill cover depth of 12 inches over the top of the tank. If the tank is greater than 12 inches below grade ;than an access to grade manhole is to be.provided. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. Respectfully, Michael J. Bu Director of Et MJB:kly cc: D. Alderisio, DEP 6\ Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 �r New YorK[Ity Department of Uvinamnardai•4Rrxtection ww:uv.oy.c.gov /dep jull�tio�'.Boiloard Flushing, -NY 11373 �- •S[��'err'W:�Lawltts- Acting. Corni ssioner Tel. (118) 595 -6565 Fax (718) 595 -3557 Bureau' -of Wator'suppty , `FMI V:RUsh, RE, - ' DWt ty Commissioner ass Columbus Avenue .Valhalla, New York 10595 -1338 Tel "(§j4) 742 -2001 FaJC'(9i4) 741 =0348 . Oct 27 2009 13:53 P.02 27, 2009 achael Budziuski,. P.)✓. itnam County Depaa=ent of Health Geneva Road rewstez, New York 10509 Mastronardi Residence — SSTS 232 Route 292, (T) Patterson East Branch Reservoir Drainage Basin DEP Log #.2009 -E$ -0715- Drs. I Mr. Budzinsld: j he New York, City Department of Environmental Protection. (DEP) has determined that the above - referenced application, received by the DEP ' an October 19, 2009, is complete. The DEP has no objection to the'approval of the !above- referenced regulated activity. This determination is based on the review of submitted documents including the plan titled "Subsurface Sewage Treatment System Platt for Mastronardi Residence, 232 Route 292, Town of Patterson, Putnam County, New York", prepared by Design Concepts ezigineering,. P.C., dated July 16, 2009. , [Please have the applicant contact David Alderi,sio at (9.14) 742 - 2:01.0 'at least'two ;days prior to start of construction of the $STS so that the DEP may irispeet��and ImonitoI the installation. I Sincerely, Damy. Shedlo, P.E. Civil Engineer III Wastewater Design Review xc: Roger Sokol, PhD., NYSDOH SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Mr. John Kalin, PE DC Engineering 3 Memorial Avenue Pawling, NY 12564 Dear Mr.Kalin, DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 Re: Mastronardi SSTS @ 232 Route 292 (T)Patterson, TM# 3 -1 -52 East Branch Reservoir Basin ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health October 16, 2009 The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on October 13, 2009 is complete. The Department will notify you by November 04, 2009 of its determination. O The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. U/ 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 Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of -impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 43148. Respectfully, Michael Bt Director of Environmental Health (845) 278 -6130 Fax (845) 278 -7921L MB /jmg Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 TO: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM JOINT REVIEW `-��(/� � PROJECT: 3� . TOWN: �",rl ! ! SUB'D APP DATE NOTICE OF COMPLETE APPLICATION: s� ,r Zf2---_ DATE: 6 /s-- C—) 9 0 Within the .drainage basins of West Branch, Boyds Corner Reservoirs or Croton Falls. ❑ Within 500 feet of a reservoir, reservoir stem or control lake. Within 200 feet of a watercourse or a DEC wetland and appearing on a subdivision map approved after December 31, 1992. ❑ Design flow greater than 1000 gallons /day. ❑ Commercial SSTS. trevlew Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 . WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 ro b'y ENGINEERING REPORT PROPOSED SEWAGE TREATMENT SYSTEM MASTRONARDI RESIDENCE 232 ROUTE 292 TOWN OF PATTERSON, PUTNAM COUNTY, NEW YORK SEPTEMBER 2009 WARNING: IT IS A VIOLATION OF SECTION 7209, SUBDIVISION 2, OF THE NEW YORK STATE EDUCATION LAW FOR ANY PERSON, UNLESS ACTING UNDER THE DIRECTION OF A LICENSED PROFESSIONAL ENGINEER. OR LAND SURVEYOR TO ALTER IN ANY WAY, ANY PLANS, SPECIFICATIONS, PLATS OR REPORTS TO WHICH THE SEAL OF A PROFESSIONAL ENGINEER OR LAND SURVEYOR HAS BEEN APPLIED. COPYRIGHT 2009 JOHN A. KALIN, P.E. Prepared by: Design Concepts Engineering, P.C. John A. Kalin, P.E. 3 Memorial Avenue Pawling, NY 12564 OF NEOW/ Y C'0 � s L; 'a r� Submitted herewith is a report containing the engineering design data relative to the proposed Sewage Disposal System (SDS) to serve a private residence within the Town of Patterson, Putnam County, New York. PROJECT DESCRIPTION: The parcel to be serviced by the proposed SSTS is located at 232 Route 292 in the Town of Southeast. The parcel is identified on the Town Tax Maps as Grid # 1-1 -52. The project is developed with an abandoned commercial building, paved parking area, well and septic that was once used for a radio station. The building does not meet the needs of the current owners who wish to use it for a single family residence. The building was investigated and found to be unsafe. As a result, the owners shall remove the building and construct a new residence in the same general footprint. The proposed residence will consist of a three (3) bedroom, single - family dwelling. The proposed dwelling will most likely be two stories high with a full height basement. The house will be supplied with water from a proposed well that will be constructed on site. The property slopes down from the existing driveway to the rear of the lot. The entire parcel is wooded less the area around the existing building. There is a stream in the rear portion of the property. There are no proposed disturbances within 100 ft of the stream. GENERAL DESCRIPTION OF SSTS: The existing SSTS is undersized by current standards. The septic tank shall be pumped by a NYSDEC licensed septage hauler and then crushed in place. The existing fields shall be abandoned in place. Attached please find the proposed plans for the layout of the sewage disposal system. The disposal system is proposed to consist of the following components: • 1,000 Gallon Precast Concrete Septic Tank • Precast Concrete Drop Boxes • 336 L.F. of Absorption Trenches for primary SSTS • 1,000 Gallon Precast Concrete Pump Chamber for future use of reserve area • 100% SSTS Reserve Area (378 LF) Test holes were excavated and witnessed by representatives of the Putnam County Health Department (refer to location on plan). During our soils investigation, the SSTS area was found to be composed of silts and loam. Rock and water was noticed in the bottom of some of the holes. Mottling was not noticed in any of the test pits. Utilizing the soil test data, the best area was selected for the treatment system (refer to Engineering Report- Proposed SDS September 28, 2009 Mastronardi Residence Page 2 plan). The new SSTS design shall replace the previous existing system. Attached please find the proposed plans for the layout of the sewage treatment system. The elevation of the proposed residence will require the use of a pump chamber to deliver effluent to the reserve area. A pump chamber has been sized and detailed on the plans and within the attached engineering report. The pump chamber shall be installed at the time of the initial house construction. It shall be upfitted with a pump, controls and force main in the future. The Design Flow utilized to design the SDS is 200 GPD /Bedroom, or 600 GPD (based upon a 3- bedroom design) Noting the soil percolation rate of 8 -10 minutes per inch, and associated application rate of 0.9 GPD /SF, the required length for standard 2' -wide absorption trenches is 333 L.F. For this design, the system shall be arranged using six (6) rows of trenches each 56 L.F. for a total absorption trench length of 336 L.F. The 100% reserve area was also tested and found to perc at a slower rate (1115 min /in) which requires 375 LF of fields. The reserve area has been designed with seven (7) laterals each 54 L.F. for a total of 378 L.F.. WATER SUPPLY: The existing well is too close to the proposed SSTS. As a result, the existing well shall be abandoned per County and State standards by filling the casing to within 10 ft of the surface with gravel. The casing shall be cut level with grade and the void will be filled with concrete. All work shall be done by a Putnam County licensed contractor. Water will be provided through a new well and submersible pump. Refer to the plan for its' location and associated details. It has been located with the appropriate separation distances to the property lines, existing adjacent and proposed septics. Prior to use, the well shall be disinfected and tested in accordance with Health Department Standards. V SSTS Design Calculations Project: Mastronardi Residence Location: Route 292 Patterson, New York 1. DESIGN CONSIDERATIONS 3 Bedroom Single Family Dwelling Replacement of existing radio station building and SSTS with a three bedroom residence and SSTS. Note:.Garbage Grinders Shall Not Be Used 2. DESIGN FLOW (Per PCHD Design Standards) 3 bedrooms x 200GPD / bed = 600 GPD Use: 600 GPD 3. SEPTIC TANK SIZE Replace existing tank with 1,000 gallon concrete tank. Provide new watertight riser with lockable lid and Zabel A -300 effluent filter. 4. CONVEYANCE AND DISTRIBUTION • New 4" PVC SDR -35 effluent pipe from tank to new drop boxes. • Cleanout assembly at bends in line. • Provide six (6) concrete drop boxes to distribute effluent to fields. 5. TREATMENT FIELDS Perc Rate: 8 -10 min /inch Design Flow: 600 GPD (3 bedroom) Method of Treatment: Standard Trenches Fields Req'd: As per PCHD Appendix H, provide 333 LF of fields 333 LF / 6 rows = 55.5 LF /row Use: 6 rows of 56 LF standard absorption trenches D E S I G N C O N C E P T S E N G I N E E R I N G P C 3 MEMORIAL AVE. SUITE 1 01, RAWLINS, NY 12564 PH: 845 -B55 -2000 • FX: B45 -BSS -2.605 E: JKALIN@VERIZON.NET P Mastronardi SSTS Calculations Page 2 September 28, 2009 6. EXPANSION DESIGN In the future, a 100% SSTS expansion area has been created. The perc rate in that area was 1115 min /in. The resulting trench length per Appendix His 3751-F. It.shall be arranged in 7 rows each 54 L.F. for a total of 378 L.F.. To utilize the reserve area, a pump chamber and force main will be required. At this time only the pump chamber tank will be installed. 7. PUMP CHAMBER: PUMP DESIGN Pump calculations: Daily design flow: .600 gpd Dose volume: .65 gal /ft x 378 LF x 75% = 184.3 - 185 gallons Friction Head: Pipe type /size: 1 %" polyethylene Length: 90 LF H -W coefficient: 120 Assumed flow rate: 30 gpm Loss ( @30GPM): 6.26/100' (per Goulds) Equivalent Lengths: Straight Length 90 LF Fitting loss (use 1 1/z" dia) 90° elbow (2): 4.3 x 2 45° elbow (2): 2.0 x 2 Quick disconnect (1): 4.3 x 1 Discharge (1): 1.5 x 1 Gate Valve (1): 1 x 1 Total length: 107.4 LF z Use: 107 LF Total Dynamic Head: Total dynamic head = static head + friction head Friction Head: Friction head = Equivalent length x Head Loss /100 ft of pipe 107LF x 6.26FT = 6.69 ft 100FT Static Head: D E S I G N C O N C E P T S E N G I N E E R I N G P C 3 MEMORIAL AVE. SUITE 1 01, PAWLING, NY 12584 PH: 845 -655 -2000 • Fx: e45 -655 -2605 E: JKALIN@VERIZON.NET Mastronardi SSTS Calculations Page 3 September 28, 2009 Static head = Elev at High Point - Elev. at Pump Total Dynamic Head: 6.69 +9.0 =15.69 FT Use: 16 ft Pump specifications: Using the total dynamic head of 16 ft, a Goulds Effluent Pump Series PE, Model PE31, .33 HP, 115V, has been selected. This pump can deliver approximately 27 gal /min against 16 ft of total head. Refer to attached sheets for pumps specifications and chart. Cycle time: Dose = 185 GAUCYCLE Pump rate = 27 GPM 185 gal /cycle / 27 gal /min = 6.85 min Drawdown / Float Switches: Tank capacity: 24.69 gal /in (1,000 gallon tank) Drawdown = DoseNol per Depth of tank 185 gal / 24.69 gal /in = 7.49— 7.5 inches Per draw down calculation, set mercury float switch for 7.5" drawdown. The float switches should be set at 3" (offl and 10.5" on above the floor of the 1,000 gallon pump chamber. The alarm switch should be set at 12.0" above the tank floor. Emergency storage volume capacity is about 850 gallons. D E S I G N C O N C E P T S E N G I N E E R I N G P C 3 MEMORIAL AVE. SUITE 1 01 , PAWLING, NY 1 2564 PH: B45 -B55 -2000 • FX: B45 - B55 -2B05 E: JKALINOVERIZON.NET 0 ITT Goulds Pumps Submersible PE Effluent Pump �RGOULDS PUMPS Goulds Pumps is a brand of ITT Water Technology, Inc. - a subsidiary of ITT Industries, Inc. www.goulds.com Engineered for life Residential Water Systems FEATURES • Corrosion resistant construction. • Cast iron body. • Thermoplastic impeller and cover. • Upper sleeve and lower heavy duty ball bearing construction. ■ Motor is permanently lubricated for extended service life. • Powered for continuous operation. • All ratings are within the working limits of the motor. ■ Quick disconnect power cord, 20' standard length, heavy duty 16/3 SJTW with 115 or 230 volt grounding plug. ■ Complete unit is heavy duty, portable and compact. ■ Mechanical seal is carbon, ceramic, BUNA and stainless steel. ■ Stainless steel fasteners. 0 ITT PERFORMANCE RATINGS PE3151 Total Head (feet of water) GPM 5 52 10 42 15 29 20 16 25 0 )T41 T I Head (feet water) GPM 8 61 10 57 15 46 20 3 25 16 PUMP INFORMATION To Head (feet o ter) GPM 10 67 15 59 20 50 25 3 30 26 35 8 GOULDS PUMPS Residential Water Systems DIMENSIONS (All dimensions are in inches. Do not use for construction purposes.) iCHARGE Order No. HP Volts Amps Minimum Circuit Phase Float Switch Cord Discharge Minimum Basin Maximum Solids Shipping weight Breaker Style Length Connection Diameter Size lbs /kg PE31 M 0.33 115 12 20 ! Manual / No Switch PE31 P1 iggyback Float Switc PE41 W 7,Y anual / No Swi E41 1 Pigg ack Floa tXwitch 20' 1.5" 18" .5" 31 / 14.1 HP 4 M 2 _ Manu / N Switch EkPl Piggybac oat Switch P 5 - JIM R �v Man / N witch 51 0V Pig ack Float witch /PE52A 236 4-1 1y anual / No Swit PE52P1 iggyback Float Switc FEB-8 -2005 03:12A FROM:OUTDOOR CONCEPTS INC 845 - 724 -4459 QJ � Lzmt)(�111 TO:917185287014 P.1111 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of ".,v1726ti s1c3 / Y .✓/f /L N Located at V ep?119 (N fA,71R4N _ Tax Map # �' Block _ Lot Subdivision of Subdivision Lot # Filed Map # Date Filed Gentlemen: This letter is to authorize JOHN A KALIN, PE A duly licensed Professional Engineer X or 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 Commissioner of Health 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 Law, and the Putnam County Sanitary Code. OF �^✓ Countersign Signed: P.E., R.A., # : ' (Owner of roperty) Mailing Add ' . �` `a Mailing Address. � l2o., r 3 MEMORIAL A31E PA;ING lJr 33 yi cJ�11 State: NEW YORK Zip: 12564 State: / 6L' lcatk Zip: Telephone: (845) 855 -2000 Telephone: 5°2 s "' 6 7 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL .HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: ANTONY ht�4ST(f�N t:5 `�.`.3_� 6ftookd6t -L� .BbJD. �o� rvn� N`l l I �111i 2, Name of project: LJ W N6r=e C 3. Locatio�/V: p^T TWO4 4. Design Professional: Jar+ , kaL-iN PE 5. Address: 3 MV,'MAL Auf 6. Drainage Basin: V As-' 1sR y4C! -4 tj OV N 1Z)E bd 7. Type of Proiect: _kf:ffrivate/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 ✓ 9. Is a Draft Environmental Impact Statement (DEIS) required? ..:............ 10. Has DEIS been completed and found acceptable by Lead Agency? ............... — NZA . 11. Name of Lead Agency f 4 hj 12. Is this project in an area under the control of local planning, zoning, or other. officials, ordinances? ' 13. If so, have plans been submitted-to such authorities? ...:............... :............... :... p N 14. Has preliminary approval been granted by such authorities ?NL Date granted: N 15. Type of Sewage Treatment System Discharge.........,......:. surface water ✓groundwater 16. If surface water discharge, what is the stream class designation? .................... 17. Waters index number (surface) ... . ............. ............... ............................... N 18.. Is project.located near a public.water supply system? ............................. N 19. If yes; name .of water supply N % Distance to water supply 20. Js project site near a public sewage collection or treatment system? ............... NO 21. Name of sewage system N Distance to sewage system. 22. Date test holes observed. 6/Z /'O 23.. Name of Health Inspector Joc rA�AV ^T I 24. Project design flow (gallons per day) ................................. ..............:................ 600OPD 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... NO 26. Has SPDES Application been submitted to local DEC office? ......................... N D Form PC -97 2 27. Is any portion of this project located within a designated Town or State wetland? O 28. Wetlands ID Number ......................... ......................... ...... :..................................... N 29. Is Wetlands Permit required? .............................................. ............................... ND Has. application been made to Town or Local DEC office? .............. .................. 30. Does p ro'ect 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, landflling; 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? ......................... . 34. Are community,water and/or sewer facilities planned to be developed within 15 years in or adjacent to. project site? .......... ....................................... . ............ .... Nth 35. Are any sewage treatment areas in, excess. of 15% slope? ................................. NO 36. Tax Map ID Number .......................... ............................... Map __;3 - Blocky_ Lot 5 2 37. Approved plans are to. be returned to ...... Applicant _ Design'Professional NOTE:. All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of aproject,.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 to the best of my knowledge and belief. False, a Class A misdemeanor pursuant to Section 91 _, . . SIGNATURES 'AT I , F IAL TITLES: 4 /f �i r Mailing Address' ........... on this form is true °n are punishable as W k vJ ti � 0 go i7F�4r,�rJ �NC�'c���A�N�BiNG 3M�v�tl���E ��4WUNG.N� I7J56 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH .SERVICES DESIGN DATA SHEET.- SUBSURFACE SEWAGE TREATMENT SYSTEM Owner. Address V'2-: E2VM M Located at (Street) 7-3Z �oyTE ZQ'L Tax Map 3 Block Lot 5Z (indicate nearest cross. street) Municipality p ^Tjt .t Drainage Basin "sj -iNNC4 SOIL PERCOLATION TEST DATA Date of Pre - soaking 7 /1,5-1 o1 Date of Percolation Test 7 16'0 1 Hole No. Run No. Time Start - Stop Ela se Time Min.) De th to Water rom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch pT- 2o� 74, 2 i'-33Z, 0 3 - - -- 3 2:01- 7 -.14 N 01 IS ►ti.�ih 4 - 5 F T� Z .l i �. o- �. 3 30 1 l V Zg, 2 1,.15- 2 -o`� 3 4 5 FT-3 1 Hog - I I� qwl lS`' - 21`� 3 2s" 2 3 4 Y 5 1r V l r, J: i . r ests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, < 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 2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUI`NTERED IN TEST HOLES DEPTH HOLE NO. 0T. l ; DT, Z HOLE NO. 1DT'r : ' T' 6- G.L. PT, 3 0.5' ,��� Tam t, v "— q'' T Aso r c, 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6:5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' 9 - Z " t T OW -S1 L1'{ wm 10 "� 30N �T SW`4 S �i`( WAM �rJh gW [){L OF4.4 SI L41 21q_bqV t? K- 5?-,j S I �rY nt v No WAT15�f- N MoTWo-40 No V(,( 0 •. Indicate level at which groundwater is encountered t)1, I ; 5'0, DT. Z. q' q" (S pl bT, I s 12" Indicate level zt which mottling is observed w r o 6sEwYA Indicate level to which water level rises after being encountered DTI I s'a vim• Z �'q4 ; DT1 7ti�'S�P Deep hole observations made by: Job rte+ -Ir, m, 4of, PAyAVAt1,_ PE Date Z PT � e ; ,Professional Name: JoNN A-. pAt-i ri, r6 Address: M (( �� -� r � o Y� �-= '' N Y tz5 CO(- YV Signature:" ` Pp J, Design Professional's Seal 1(�, BRA �rf NGI PUTNAM COUNTY DEPARTMENT OF HEALTH DMI SION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner. ]L4 AZ�'jP r-', �Ryl Address .1732 FoVjt '1A Z_ Located at (Street) 73Z ( 2y-fF_ 241- Tax Map 3 Block ( Lot 5Z . (indicate .nearest cross. street) Municipality pi�Tl saN Drainage Basin MST 1�NC*4 SOIL PERCOLATION TEST DATA Date of Pre - soaking 7' 1 s jvl Date of Percolation Test 7 (I 6 l d Hole No. Run No. Time Start - Stop Ma se Time Min.) Depth to Water From "Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch S 4 5 1 2 3 Per of Al�� I I lT' f 5 I ,� 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtatnea at each percolation test hole. (i.e. s 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. -97 Form DD Indicate level .,at which groundwater is encountered Indicate level at which mottling is observed. Indicate level -to which water level rises after being encountered'. Deep Bole observations made by: Date Design Professional Name: j V-A - -� ' PC- OF Address:. 'X� e_cA` q ✓f P� r,�F�` O Signature: "' Design Professional's Seal �' — S t�' �W PROJECT I.D. NUMBER 14.16. 4(9/95) -Text 12 617.20 Appendix CSEQR State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I - PROJECT INFORMATION (To be completed by Annlicant nr Prniect .S oncnr) 1. APPLieANT /SPONSOR DC ENGINEERING, PC 2. PROJECT NAME Mastronardi Residence 3. PROJECT LOCATION: Municipality Town of Patterson county Putnam 4. PRECISE LOCATION (Street address and road intersection, prominent landmarks, etc., or provide map) 232 Route 292 5. IS PROPOSED ACTION: ® New ❑ Expansion ❑ Modification/Alteration 6. DESCRIBE PROJECT BRIEFLY: New single family residence. 7. AMOUNT OF LAND AFFECTED: Initially 0.5 acres Ultimately 0.5 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 ❑ Commercial ® Agriculture ® Park/Forest/Open Space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ® Yes ❑ No If yes, list agency(s) and permit/approvals Town of Patterson - building permit, Putnam County Health Department - SSTS and Well 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 CERTIFY THAT THE INFORMATION P 6V4E TO BEST OF MY KNO WLEDGE ` K AppkcartdSponsor John" b Name: P.E. 4` Date: L Signature: ' ( !r If the act ion`i?&- in: -t•he Costal Area, and you are a state agency, complete the Costal Assessment form before proceeding with this assessment cccc Cw,',`/T_ L n_._A L.. A ___ _..1 A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 If yes, coordinate the review process and use the FULL EAF. ❑ Yes ® No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTION IN 6 NYCR, PART 617.6? If No, a negative declaration maybe superseded by another involved agency. ❑ Yes ® No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers maybe handwritten, if legible) CI. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waster production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: No C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: No C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: No 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: No C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: No C6. Long term, short term, cumulative, or other effects not identified in CI -05? Explain briefly: None C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly: None D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA? ❑ Yes ® No E. •IS THERE, OR IS THERE LIICELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ® 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 sbould be assessed in connection with its (a) setting (i.e. urban or Waal): (b) probability or occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. Ifnecessary, add attachments orreference 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 II was checked yes, the determination and significance must evaluate the potential impact. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Office in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (if different from responsible officer) PUT I'M AM COUNTY DEPAK I IVIENT OF I1EA.0 I DIVISION OF ENVIRONMENTAL HEALTH SERVI CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEMI PERMIT # t" o�, - cF1 Located at 2271 F-Tl; 1-17/ Subdivision name —' Subd. Lot # — Date Subdivision Approved — Owner /Applicant Name A. M ASTV=QWA0-t0 ( Town or Village PttT�[�►� Tax Map 3 . Block Lot S ?i Renewal Revision V-*-- Date of Previous Approval ii Z O Mailing Address IS--+--33 gwyLu4,, BLVD F�,g�,�, N`f Zip — LLf2iz!�' Amount of Fee Enclosed t1so Building Type J t-^M 1 t.`{ J. Lot Area +, OA(/ No. of Bedrooms _1� _ Design Flow GPD E0 Fill Section Only Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of I2c10 gallon septic tank and D� Z� W1I STD -t-7G%iS C� AK- Ex(StIN�� 1 Other Requirements: loon GAL PUMP C -,MMSW For-- FVTUer-- VSE To be constructed by 1G4 05-9 --,t Gtk Address 1{54AKI:I -J�( gWp g :fff N� lam_ Water Supply: Public Supply From or: Private Supply Drilled by 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 Director /Commissioner 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 followitg�he�date of the issuance of the approval of the Certificate of Construction Compliance of the original system or,iiy repairs there o ; Signed,- i Fr P.E. v1" R.A. Date 10.1 S• i D License # 017,9-Of APPROVEp FOR C.ONSTRUCTION: 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 Director /Commissioner. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only. 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 FOR APPROVAL OF PLANS FOR- A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: A&Ny NAsT 1.5 I Name of project: .3. LocatioiGN: 'r/4-T TWVtA 4. Design Professional: KAI-i N PE 5. Address: 3 MVMORA, - q-vt,- 6. Drainage Basin: As7 AN 8,K G ('�wN N N Y 1,Sb'� 7. Type of Project: _v-1frivate/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 ✓ 9. Is a Draft Environmental Impact Statement (DEIS) required? .................... alp 10. Has DEIS been completed and found acceptable by Lead'Agency? ............... 11. Name of Lead Agency N A 12. Is this project in. an area under the control of local planning, zoning, or other. officials, ordinances? ......................................................... .. ......... ............. .......... ES 13 If so, have plans been submitted-to such authorities? ... : ............... : ............... :... 14. Has preliminary approval been granted by such authoriti es? N4LA Date granted: N 15. Type of Sewage Treatment System Discharge ................. surface water Ygroundwater 16. If surface water discharge, what is the stream class designation? .................... _l_ 17. Waters index number (surface) .... . ............. ............. ............................... tJ 18. Is project. located near a public water supply system? ....... ...................:........... NO 19. If yes, name .of water. supply P /AS Distance to water supply 20. Js project site near a public sewage collection or treatment system? .............,.. ND 21. Name of sewage system N Distance to sewage system 22. Date test holes observed 6/Z LO 23.. Name of Health Inspector JcApAVNT 24. Project design flow (gallons per day) 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... N12 26. Has SPDES Application been submitted to local DEC office? ......................... N 0 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 29. Is Wetlands Permit required? .............................................. ............................... NO Has. application been made to Town or Local DEC office? ..............:................ 30. Does project require a DEC Stream Disturbance Permit? .. ............................... 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? ......................... 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? . ............................... N0. 36. Tax Map ID Number .......................... ............................... Map 3 Block_ j_ Lot 5 Z 37. Approved plans are to be returned to ..... Applicant _ Design'Professional NOTE:.All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False st bents- herein are punishable as a Class A misdemeanor pursuant to Section X45; o er3n \Law. SIGNATURES &OFFICIAL TITLES: ° T{ i t X, A Mailing Address: ..................................... 3 M04vF�At- AVV, -MW UNG N J)5 (P Sherlita Amler, MD, MS, FAAP Commissioner of Health Robert Morris, PE Director of Environmental Health Mr. John Kalin, PE DC Engineering 3 Memorial Avenue Pawling, NY 12564 Dear Mr.Kalin, Department of Health 1 Geneva Road, Brewster, NY 10509 Office (845) 808 -1390 Fax (845) 808 -1937 Re: Mastronardi SSTS @ 23 2 Route 292 (T)Patterson, TM# 3 -1 -52 East Branch Reservoir Basin Robert J. Bondi County Executive October 27, 2010 The Putnam County Department of Health (Department) has determined that the .above referenced .application, including fee, and received by this Department on October 26, 2010 is complete. The Department will notify you by November 16, 2010 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. t.r Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection . regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 808 -1390 ext. 43148. . Respectfully, Director of MB /kly PE / SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health TO: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM AN V JOINT REVIEW PROJECT: AA-S-lPo r�cP-Fs I TOWN: NOTICE OF COMPLETE APPLICATION: 3Z �7 292.. SUB'D APP DATE .DATE: ID —Z -� v ❑ Within the drainage basins of West Branch, Boyds Corner Reservoirs or Croton Falls. ❑ Within 500 feet of a reservoir, reservoir stem or control lake. Within 200 feet of a watercourse or a DEC wetland and appearing on a subdivision map approved after December 31, 1992. ❑ Design flow greater than 1000 gallons /day. ❑ Commercial SSTS. J treview Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648