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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 1 -1 -60.1 BOX 1 IIloom ;I` go I :ji J I� L , f i ` + i to I �. , _ A goo 00037 go or II� 00037 00 11A PIJTNAM COUNTY DEPARTMENT OF HEALTH ')- , 5` l DIVISION OF ENVIROl� MENTAL HEALTH SERVICES Go �3 CERTIFICATE OF CONSTRUCTION-COMP .'I - -ANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at .12Z liCE 24,�_7 Town or Village Owner /Applicant Name tq i t R W 1 NO, Tax Map —9 Block _ Lot _ 1 Formerly. Mailing Address Subdivision Name Subd. Lot # Zip LQG (0-5 Date Construction Permit Issued by PCHD 5 —8—is I Separate Sewerage System built by &7a-& kNAms Ap, Address lgr 219214,01A 1 ES 42551 Consisting of Joe& Gallon Septic Tank and Z Fr Other Requirements: Water Supply Public Supply From Address Private Supply Drilled by ALAr--9rM- PYArr°�SopNs Address / w Building Type 511444-,F_ r-dk1 4Z:R9; Has erosion control been completed? \/ Number of Bedrooms 'Z7 Has garbage grinder been installed? I certify that the system(s), as listed, serving the a ve premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accord c with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the qS County Department of Health. Date: Certified by P.E ./N� R.A. (D,Ktgr Pro%essional) Address S MF_ NInRJ4LAVF_." WLW0,. N\/ License # c-7900 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Director /Commissioner, such revocation, modification or change is necessary. B /��i �. Title: %} Ply Date: �0 6 ite opy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 Aa PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT w Well Location Street Address: 110 2Ovff VIZ TownNillage: PrA e a Tax Map # Map 3 Block Lot(s)(P.l :GPS ",r Well Owner: Na�me: Address: ( J J ' ° r. fia Use of Well: 1- Primary 2- Secondary j Residential _Public Supply Air cond /heat pump _Irrigation Business Farm Test /monitoring —Other(specify) Industrial Institutional Standby Drilling Equipment _Rotary _Cable percussion Xcompressed air percussion _Other(specify) Well Type Screened _Open end casing X Open hole in bedrock Other Casing Details Total Length -ft. Length below Qt. Diameter -7i n. Weight per foot Ib/ft Materials: Steel Plastic Other Joints: Welded AThreaded Other Seal: _Cement grout Bentonite Other Drive shoe: Yes _ No Liner: _Yes _XNo Screen Details Diameter (in) ISlot Size Length ft Dept to Screen ft Develo ed? First I _Yes No Hours Second I - Well Yield Test _Bailed _Pumped A Compressed Air Hours Yield 6 gpm Depth Data Measure from and surface - static (specs ft) g -Ee During yield test (ft) i8ell' t, Depth of completed well in ft. Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter (in) Formation Description ft. ft. Land Surface 197 V, 6 r X it ylew was testea t-eet tjanons ver minute vumpiworage i anK information at different depths ITI Pump Type M�r�d0, apacit '^ during drilling Depth Model S� list: Voltage HP Tank Tvne 3< <Cl -L1Aw,4olum NOVI: Exact Lo4ation of will with distances to at least two permanent landmarks to be provided do a separate Oeet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Buildin Building Constructed by t E G ?, 4-e 2�i2 Location - Street Building Type 37?24w S. -I - GD .) Tax Map Block Lot TownNillage N i1 Subdivision Name Subdivision Lot # I represent that I am wholly and completely responsible for the .location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the ow_ ner, 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. Qatod, Month Day Year '000) General Contractor (Owner)W-aY5' - Signature ptVIVI taig (VI Corporation Name (if corporation) Address: Q_ _ 0, 70 l Lcfo � +4rol State V)-'I _ Zip I?Ab I Signature: Title: e I ('�� Asafvc Corporation Name (if corporation) Address: 6 ry Chi' W©(MP.s State N, v Zip la 57 ( Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Dok DU A/a I " Owner or Purchaser of Buildin p '91,11 O e Building Constructed by II-)LL M Z -1 -603 Tax Map Blocl Lot TownNillage kSo &cR Z°�2 1J Location — Street Subdivision Name Building Type 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 it 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 repair 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 Commissioner of Health 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 bui ding utilizing the system. D : Month ��j Day 2 �' Year V5 General Contractor (Owner) — Signature g\itICE -QL? Corporation Name (if corporation) .� Address: pc 0. 90},14 -b � ` "n �v4w State: Zip IZ63 Signature: ( ept Title: _0� PCHD License # f7� Corporation Name (if corporation) ,� �C Address: �%j� (47' 02ga 4L41 % State: Zip Form GS -97 i-, PHOEV.IX Environmental laboratories, Inc. Wednesday, June 04, 2014 Attn: Ms. Madelyne Hyatt Hyatt Pump Service 229 South Road Holmes, NY 12531 Project ID: DAN DUNNING HARMONY FARM PATTERSON Sample ID#s: BG50932 This laboratory is in compliance with the NELAC requirements of procedures used except where indicated. This report contains results for the parameters tested, under the sampling conditions described on the Chain Of Custody, as received by the laboratory. A scanned version of the COC form accompanies the analytical report and is an exact duplicate of the original. If you have any questions concerning this testing, please do not hesitate to contact Phoenix Client Services at ext. 200. Sincerely yours, C,/ Gw Ak L Phyllis Shiiler Laboratory Director NELAC - #NY11301 CT Lab Registration #PH -0618 MA Lab Registration #MA -CT -007 ME Lab Registration #CT -007 NH Lab Registration #213693 -A,B NJ Lab Registration #CT -003 NY Lab Registration #11301 PA Lab Registration #68 -03530 RI Lab Registration #63 VT Lab Registration #VT11301 587 East Middle Turnpike, P.O. Box 370, Manchester, CT 06040 Telephone (860) 645 -1102 Fax (860) 645-0823 t PHOEVIXIIR.t� Environmental Laboratories, Inc. 587 East Middle Turnpike, P.O.Box 370, Manchester, CT 06045 Tel. (860) 645 -1102 Fax (860) 645 -0823 Analysis Report June 04, 2014 Sample Information Matrix: DRINKING WATER Location Code: HYATT Rush Request: Standard P.O. #: FOR: Attn: Ms. Madelyn Hyatt Hyatt Pump Service 229 South Road Holmes, NY 12531 Custody Information Collected by: JH Received by: LK Analyzed by: see "By below Laboratory Data Project ID: DAN DUNNING HARMONY FARM PATTERSON Client ID: KITCHEN g C^ CO u u .e s NY N 11301 Date Time 05/29/14 17:00 05/30/14 16:58 SDG ID: GBG50932 Phoenix ID: BG50932 Parameter Result RU PQL Units DW MCL Sec Goal Date/Time By Reference Escherichia Coli Absent 0 /100 mis 0 05/30/14 18:50 RS /RM SM 9223B Total Coliforms Absent 0 /100 mis 0 05/30/1418:50 RS/RM 92238 Hardness (CaCO3) 241 0.1 mg/L 06/03/14 E200.7 Chloride 6.0 3.0 mg /L 250 05/31/14 BS /EG 300.0 Color < 1 1 Color Units 15 05/30/14 20:00 DH /KDB SM 2120B Nitrite as Nitrogen < 0.01 0.01 mg /L 1 05/31/14 00:27 BS /EG 300.0 Nitrate as Nitrogen 2.06 0.05 mg/L 10 05/31/14 00:27 BS /EG 300.0 Odor at 60 Degrees C 1 1 T.O.N. 3 06/02/1411:30 -MA SM 2150B pH 7.97 0.10 pH Units 6.5 -8.5 05/31/14 06:11 BS/KDB 45MH B Sulfate 19.0 3.0 mg/L 250 05/31/14 BS/EG 300.0 Turbidity 0.23 0.20 NTU 5 05/30/1418:09 SM2130B Calcium 83.2 0.050 mg /L 06103/14 EK E200.7 Iron 0.008 0.002 mg /L 0.3 06/03/14 LK E200.7 Magnesium 8.04 0.01 mg /L 06/03/14 LK E200.7 Manganese < 0.001 0.001 mg/L 0.05 06103/14 LK E200.7 Sodium 1.41 0.05 mg /L 06103/14 LK E200.7 Total Metal Digestion Completed 06/02/14 AG E200.7 Page 1 of 2 Ver t Project ID: DAN DUNNING HARMONY FARM PATTERSON Phoenix I.D.: BG50932 Client ID: KITCHEN RU DW Sec Parameter Result PQL Units MCL Goal Datelrime By Reference 1 = This parameter is not certified by NY NELAC for this matrix. NY NELAC does not offer certification for all parameters at this time. RUPQL= Reporting /Practical Quantitation Level ND =Not Detected BRL =Below Reporting Level (less than the reporting level, the lowest amount the laboratory can detect and report.) MCL =Maximum Contaminant Level MCLG = Maximum Contaminant Level Goal Comments: Maximum Contaminant Level (Lower of): 40 CFR Part 141; Public Health Law, Section 225 Part 5, Subpart 5 -1. The highest level of a contaminant that is allowed in drinking water. MCLs are enforceable standards. Secondary DW Maximum Contaminant Level Goal (MCLG): 40 CFR Part 143. The level of a contaminant in drinking water below which there is no known or expected risk to health. MCLGs are non - enforceable public health goals. The regulatory hold time for pH is immediately. This pH was performed in the laboratory and may be considered outside of hold - time. If there are any questions regarding this data, please call Phoenix Client Services at extension 200. This report must not be reproduced except in full as defined by the attached chain of custody. AOL Phyllis hiller, Laboratory Director June 04, 2014 Reviewed and Released by: Bobbi Aloisa, Vice President Page 2 of 2 Ver 1 P HOEVX V Environmental Laboratories, Inc.' r 587 East Middle Turnpike, P.O.Box 370, Manchester, CT 06045 NY a 11301 QA/QC Report Tel. (860) 645 -1102 Fax (860) 645 -0823 June 04, 2014 QA/QC Data SDG I.D.: GBG50932 r = This parameter is outside laboratory rpd specified recovery limits. Page 1 of 2 Sample Dup Dup LCS LCSD LCS MS MSD MS Rec RPD Parameter Blank Result Result RPD % % RPD % % RPD Limits Limits QA/QC Batch 275925, QC Sample No: BG50651 (BG50932) ICP Metals - Aqueous Calcium BRL 9.69 9.69 0 93.8 NC 75-125 20 Iron BRL 0.057 0.073 24.6 98.2 100 75 -125 20 r Magnesium BRL 2.73 2.65 3.00 97.4 NC 75 -125 20 Manganese BRL 0.021 0.041 64.5 97.7 101 75 -125 20 r Sodium BRL 18.7 19.2 2.60 106 NC 75 -125 20 r = This parameter is outside laboratory rpd specified recovery limits. Page 1 of 2 PHO WAIX Environmental Laboratories, Inc. 587 East Middle Turnpike, P.O.Box 370, Manchester, CT 06045 ANY N 11301 j QA/QC Report Tel. (860) 645 -1102 Fax (860) 645 -0823 June 04, 2014 QA/QC Data . SDG I.D.: GBG50932 QA/QC Batch 275895, QC Sample No: BG50658 (BG50932) Chloride BRL 27.5 27.4 0.40 95.5 99.0 85-115 20 Nitrate as Nitrogen BRL <0.05 Sample Dup Dup LCS LCSD LCS MS MSD MS Rec RPD Parameter Blank ResuR Result RPD % % RPD % % RPD Limits Limits QA/QC Batch 275891, QC Sample No: BG50658 (BG50932) 93.9 85 -115 20 Chloride BRL 27.5 27.4 0.40 95.5 99.0 85-115 20 Nitrate as Nitrogen BRL <0.05 <0.05 NC 102 98.3 85-115 20 Nitrite as Nitrogen BRL <0.01 <0.01 NC 99.0 98.0 85 -115 20 Sulfate BRL 5.4 5.5 NC 94.3 93.9 85-115 20 QA/QC Batch 275895, QC Sample No: BG50658 (BG50932) Chloride BRL 27.5 27.4 0.40 95.5 99.0 85-115 20 Nitrate as Nitrogen BRL <0.05 <0.05 NC 102 98.3 85-115 20 Nitrite as Nitrogen BRL <0.01 <0.01 NC 99.0 98.0 85 -115 20 Sulfate BRL 5.4 5.5. NC 94.3 93.9 85 -115 20 QA/QC Batch 275833, QC Sample No: BG50662 (BG50932) pH 8.81 8.76 0.60 98.7 85-115 20 If there are any questions regarding this data, please call Phoenix Client Services at extension 200. RPD - Relative Percent Difference LCS - Laboratory Control Sample 9,2014 �� ,, LCSD - Laboratory Control Sample Duplicate r,•, f,C(GJ/JG�. MS - Matrix Spike MS Dup - Matrix Spike Duplicate Phyll, Laboratory Director NC - No Criteria June Intf - Interference Page 2 of 2 Wednesday, June 04, 2014 Sample Criteria Exceedences Report Page' of 1 Criteria: None GBG50932 - HYATT State: NY RL Analysis SampNo Acode Phoenix Analyte Criteria Result RL Criteria Criteria Units "- No Data to Display "" Phoenix Laboratories does not assume responsibility for the data contained in this report. It is provided as an additional tool to identify requested criteria exceedences. All efforts are made to ensure the accuracy of the data (obtained from appropriate agencies). A lack of exceedence Information does not necessarily suggest conformance to the criteria. It is ultimately the site professional's responsibility to determine appropriate compliance. l� � '1r C O.gp41 PHOE V '- Environmental Laboratories, Inc.' j NY # 11 1 587 East Middle Turnpike, P.O.Box 370, Manchester, Cl 06045 Tel. (860) 645 -1102 Fax (860) 645 -0823 NY Temperature Narration June 04, 2014 The samples in this delivery group were received at 4 °C. (Note acceptance criteria is above freezing up to 6 °C) Page 1 of 1 SDG I.D.: GBG50932 Cooler. YNo Coolant IPK A .Cr F No RHOENYX&,�Ict Environmental Laboratories, Inc. NY /NJ CHAIN OF CUSTODY RECORD 587 East Middle Turnpike, P.O. Box 370, Manchester, CT 08040 Email: lnfaCphoenbdabs.com Fax (880) 845 -0823 Client Services_ (860) 645.8726 ' Temp • C Pg or °�' °na: Fes; Phone: Emall: customer ' Address: Project: Report to: Invoice to: 4nmefl Project P.O: This section MUST be completed with Bottle Quantities. Ghent Sample - Information - Identification Samplers � Signature P/ DaW Z� Analysis Request � `1 D = DVN rinktng Wetsr aW=Ground Water SW.Sutface Water WW=Waste Water DW RW -Raw Water 8E =Sediment SL-Sludge BaSoU 80--Solid NhWipe OIL-011 B =bulk LaLiquld prtoENIX USE Customer Sample Sample Date Time SAMPLE A klenWication Matrix Sgmpked Sampled u Turnaround: Cl 1 Day' 171 2 Days' ❑ 3 Days* ❑ S Days ❑ 10 Days ❑ Other • SURCHARGE APPLES NJ ❑Rea. Criteria ❑ Non -Res. Criteria ❑ Impact to GW Soil Cleanup Criteria ❑ GW Criteria ❑ TAOM 4048 GW ❑ TAGM 4048 SOIL ❑NY375 Unrestricted Use Soil ❑ NY375 Residential Soil ❑Restricted/Residential ❑ Commercial ❑ Industrial Data Format _ ❑Phoenix Std Report Excel ❑ PDF ❑ GIS" ❑ EQuIS NJ Hawke EDD g NY EZ EDD (ASP) ❑ Other Data Packmw ❑ NJ Reduced Deliv. ❑ NY Enhanced (ASP B) ❑ Other 5 O 1100 Comments, equl ants or Reputations: State where samples were collected: N ` OC ENGINEERING, PC LETTER OF TRANSMITTAL To: Putnam Co. Dept. of Health Date: March 18, 2015 Job No: 010513 4 Geneva Rd. Attention: Joe Paravati, Jr., P.E. Brewster, NY 10509 RE: Dunning Cottage —122 Rt. 292, (t) Patterson We are sending you: X Attached 0 Under separate cover via The following items: o Shop Drawings 0 Prints 0 Plans 0 Samples 0 Specifications O Copy of Letter 0 Change Order O Report Copies Date No. Description 1 01/31/14 Well Completion Report These are transmitted as checked below: X For approval O As requested O For your use 0 For review and comment Remarks: Signed: cc: File John A. Kalin, P.E. DESIGN CONCEPTS ENGINEERING, RC 3 MEMORIAL AVE. SUITE 301, PAWLING, NY 12564 PH: B45- BSS -2000 • FX: B45- 855 -2605 E: JKAUNgVERIZON.NET OC ENGINEERING, PC March 18, 2015 Mr. Joseph Paravati, Jr., P.E. Putnam County Department of Health 4 Geneva Road Brewster, N.Y. 10509 Re: Dunning Construction Compliance 122 Rt. 292 (T) Patterson TM# 3 -1 -60.1 Dear Joe: have reviewed your comment letter regarding the above referenced project. As requested, I have provided additional information in the attachments and in this letter. To facilitate your review, I have keyed the following responses to the original comments from your department: 1. The well completion report is completed and enclosed. 2. The well completion report is signed. If you have any questions regarding the revisions made, please feel free to call me at your convenience. I can be reached at (845) 855 -2000. incerely, John"A. Xalin, P.E. Enc cc: File DESIGN CONCEPTS ENGINEERING, PC 3 MEMORIAL AVE. SUITE 301, PAWLING, NY 12584 PH: E45 -B55 -2000 • FX: 84555 -2605 E: JKAUNOVERIZON.NET ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E., MPH Director of Environmental Health February 28, 2015 DC Engineering John Kalin, P.E. 3 Memorial Avenue Pawling, NY 12564 Dear Mr. Kalin: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 MARYELLEN ODELL County Executive Re: Construction Compliance — Dunning 122 Route 292 (T) Patterson, T.M. 3 -1 -60.1 This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your review and consideration. 1. The well completion report is not complete (street address, tax map #, depth data capacity). 2. The pump installer is to sign the well completion report. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 43157 of any questions arise. Very truly yours, S. Paravati, Jr., P.E. nt Public Health Engineer JSP:cml OC ENGINEERING, PC LETTER OF TRANSMITTAL To: Putnam Co. Dept. of Health Date: February 24, 2015 Job No: 010513 4 Geneva Rd. Attention: Joe Paravati, Jr., P.E. Brewster, NY 10509 RE: Dunning Cottage —122 Rt. 292, (t) Patterson We are sending you: X Attached 0 Under separate cover via The following items: 0 Shop Drawings 0 Prints X Plans. 0 Samples 0 Specifications 0 Copy of Letter 0 Change Order 0 Copies Date No. Description _ 3 07/15/14rev.2/23/15 Dunning Cottage Septic As -Built Plan (1 of 1) 1 02/24/15 Response Letter 2 02/24/15 Guarantee of SSTS 1 01/31/14 Well Completion Report 1 06/04/14 Water Test Results These are transmitted as checked below: X For approval 0 As requested 0 For your use 0 For review and comment Remarks: Signed: John A. Kalin, P.E. cc: File O E S I G N CONCEPTS ENGINEERING, PC 3 MEMORIAL AVE. SUITE 301, PAWLING, NY 12564 PH: B45- 855 -2000 • FX: 045 -B55 -2605 E: JKALIN (PVERIZON.NET OC ENGINEERING, PC February 24, 2015 Mr. Joseph Paravati, Jr., P.E. Putnam County Department of Health 4 Geneva Road Brewster, N.Y. 10509 Re: Dunning Construction Compliance 122 Rt. 292 (T) Patterson TM# 3 -1 -60.1 Dear Joe: have reviewed your comment letter regarding the above referenced project. As requested, 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 the original comments from your department: 1. The well completion report is enclosed. 2. The water test results are enclosed. 3. The well has been located from two fixed points. 4. Two more guarantee forms are enclosed. 5. The scale has been changed to 1 inch =30 feet. 6. The cottage has been located with respect to the property line. If you have any questions, regarding the revisions made, please feel free to call me at your convenience. I can be reached at (845) 855 -2000. S John A. Ka`An, P.E. Enc cc: File DESIGN CONCEPTS ENGINEERING, PC 3 MEMORIAL AVE. SUITE 301, PAWUNG, NY 12564 PH: 645 - 655 -2000 • FX: S45-855 -2605 E: JKAUNOVERIZON.NEf ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E; MPH Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 February 18, 2015 Phone # (845) 808 -1390 Fax # (845) 278 -7921 DC Engineering John Kalin, P.E. 3 Memorial Avenue Pawling, NY 12564 Dear Mr. Kalin: MARYELLEN ODELL County Executive Re: Construction Compliance — Dunning 122 Route .292 (T) Patterson, T.M. 3 -1 -60.1 This. office has received and reviewed the most recent set of plans for the above mentioned project: We would like to offer the following comments for your review and consideration. 1. A well completion report is to be provided. 2. A water test per Bulletin ST -19 is required (Section 6 -0.3. Table 1, Page 18) 3. The well is to be located from two fired points. 4. Two more guarantee forms with original signatures are to be provided 5. The minimum scale is to be 1 inch = 30 feet. 6. The cottage location with respect to the property lines is to be provided. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 43157 of any questions arise. Very truly yours, oseph S. eParavati, Jr., P.E. Assistant Public Health Engineer . JSP:cml DC ENGINEERING, PC LETTER OF TRANSMITTAL To: Putnam Co. Dept. of Health Date: January 13, 2015 Job No: 010513 4 Geneva Rd. Attention: Joe Paravati, Jr., P.E. Brewster, NY 10509 RE: Dunning Cottage —122 Rt. 292, (t) Patterson We are sending you: X Attached 0 Under separate cover via The following items: O Shop Drawings 0 Prints X Plans 0 Samples 0 Specifications O Copy of Letter 0 Change Order 0 Copies Date No. Description 5 07/15/14 Dunning Cottage Septic As -Built Plan (1 of 1) 1 07/16/14 Certificate of Construction Compliance for STS 1 Guarantee of SSTS These are transmitted as checked below: X For approval 0 As requested 0 For your use 0 For review and comment DESIGN CONCEPTS ENGINEERING, RC 3 MEMORIAL AVE. SUITE 301, RAWLING, NY 12564 PH: 645 -855 -2000 • FX: 84S -BSS -2605 E: JKAUN9VERIZON.NEr ALLEN. BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E., MPH Director of Environmental Health DEPARTMENT 'OF HEALTH 1 Geneva Road,. Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 April 16, 2014 DC Engineering John Kalin, P.E. 3 Memorial Avenue Pawling, NY 12564 Re: Field Inspection — Dunning 122 Route 292 (T) Patterson, TM 3.4-60.1 Dear Mr. Kalin: The above referenced separate sewage treatment system can be backfilled. MARYELLEN ODE LL County Executive 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 PUTNAM COUNTY DEPARTMENT OF EF,,ALTH DIVISION OF ENVMONNMNTAL HEALTH SERVICES FINAL SITE INSPECTION Date: « hy Inspected by: Street Location i + 9 Owner v n 'v_ Town - er:�vt Pe Subdivision `� o - ! 3 Subdivision Lot # �j 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 Sewaee System a' tank size. 1,00 .......... 1, 250 ....:....other ................ b. 'Septic tank iristalle level.:-, .... 11-1,111 ................. . c. 10' minimum from foundation .......... .................:............. d. Distribution Box 1. Alt outlets at same elevation- water.tested .... * ............. 2. Protected below frost .................. ............................... 3. . Minimum 2 ft. Original soil between box & trenches e. Junction Box - properly set .......... ............................... 6. r- 1. Length required 15?;' Length installed 2. Distance to watercourse measured + ! ©D Ft.......... 3, Installed according to plan ....:.... ............................... 4. Slope of trench acceptable 1116 - 1./32" /foot ............. 5. 101 from property he - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. ,Doom allowed for expansion, 10.0% ......... :............... 8. Size of gravel 3/4 - 1W diameter clean ...................: 9. Depth of gravel in trench 12" minimim ...... :,......... .I.. 10. Pipe ends. cappped ........................ ............................... g. Pump or.DosecrSvstems 1. Size of pump chamber ................ ............................... -2. Oviaow taiik ...:................... ..............:................ 3. Alarm, visual/audio .. ..:. ......:........................ 1111... 4. Pump easily accessible, manhole to - grade ................. 5. First box baffled ........................... .......... ...................... ime witnessed by H.D.estimated flow /cycle........... III. Hodias a. catedper approved plans, .. ............................... b Number of bed - rooms .................... ............................... Iv. well Well located as per approved plans . ......:...................:1111 b. Distance from STS area measured �-/ oO ft..:........ c. Casing. 18" above grade ............ ................. . ............. . 1111 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....... i. Erosion control provided ................. ............................... Rev. 12/02 twose vt /f - PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION El JOSEPH R.EOUEST FOR FINAL INSPECTION All information must be fully completed prior to any inspections being made. For: Fill .- Trenches --' PCHD Construction Permit #— OI 1-3 . Located: /Z Z "Or Z (T) ('V) N Owner /Applicant Name: `i�Ati _ ' Nti�a�c _ TM Block I Lot &Q.� F o_rmerly- Subdivision Name: — Subdivision Lot # Is system fill completed? Date: Is system complete? Date: W-1-14 Is system constructed as per i lans? Is well drilled? r Date: Is well located as pe, plans? Are erosion control measures in pl ce? 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: 4-7 -1� Certified by: ` ��` `!^ �' "� '`PE , —RA sigh•_ rofessional = 'A Address: ;6- -L" ` 'Lie.; #;' Comments: ti L - "-u n ' Form FIR -99 C,hislif ''- 4eaa30Y (33 R, A4:E fl 200. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL -��' please print or type 10— Perm�t,i ,x Well Location Street Address: Town/Village: Tax Map # 20 PAT r ��� Map Block Lot(s) .. i Well Owner: Name: bA�-s T:>V t-.) (A Address: Phone #: 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_ �gpm # People Served_j,_ Est. of Daily usage gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason rACr'J . to S VI(* A9 for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes _ No Is well located in a realty subdivision? ........................................... ............................... Yes No Name of subdivision Lot No. y Water Well Contractor: T SD Address: Is Public Water Supply available on site? ....................................... ............................... Yes No t' Name of Public Water Supply: -- Town/Village "- Distance to property from nearest water main: Proposed well location & sources of contamination to rovided n se a to sheet/plan. Date: l i 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 Departmei 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 approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue l l 3 Permit Issu'ng Official: P'- Date of Expiration r Title: 55's Permit is Non - Transfer bl White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Rev. 3/06 OC ENGINEERING, PC LETTER OF TRANSMITTAL To: Putnam County Dept. of Health 4 Geneva Rd. Brewster, NY 10509 We are sending you: X Attached O Under separate cover via O Shop Drawings O Prints X Plans O Copy of Letter O Change Order Date: Novemebr 6, 2013 Job No: Attention: Mike Budzinski, P.E. RE: Dunning Cottage - 122 Rt. 22, Patterson, N.Y. The following items: O Samples O Specifications e Copies Date No. Description 3 10/10/13 Dunning Cottage - Proposed Well Plan 1 Letter of Authoiztion 1 11/01/13 Signed: Application to Construct a Well 1 10/24/13 cc: File Cover Letter I d These are transmitted as checked below: X For approval X For your use Remarks: O As requested X For review and comment DESIGN CONCEPTS ENGINEERING, PC 3 MEMORIAL AVE. SUITE 1 01 , PAWLING, NY 12564 PH: 845- 055 -2000 ! FX: 845 -855 -2805 E: JKALIN @VERIZON.NET Signed: lin, P. cc: File O As requested X For review and comment DESIGN CONCEPTS ENGINEERING, PC 3 MEMORIAL AVE. SUITE 1 01 , PAWLING, NY 12564 PH: 845- 055 -2000 ! FX: 845 -855 -2805 E: JKALIN @VERIZON.NET OC ENGINEERING, PC April 3, 2013 Mr. Mike Budzinski, P.E. Putnam County Department of Health 4 Geneva Road Brewster, N.Y. 10509 Re: Dunning Cottage SSTS 122 Route 292 Patterson, New York TM# 1-1 -60.1 Dear Mike: Please consider the following application for a proposed well for the above referenced project. The project involves the construction of a well on an existing parcel. The parcel is currently occupied with an existing single family residence and several out buildings. Attached, please find an application and three copies of the plans. If you have any questions or comments, please feel free to contact me at (845) 855 -2000 at your earliest convenience. Sin DESIGN CONCEPTS ENGINEERING, PC 3 MEMORIAL AVE. SUITE 1 01 , PAWLING, NY 12584 PH: 645 -855 -2000 ! FX: B45 -B55 -2605 E: JKALIN @VERIZON.NET o "`P. A:, Kaiin; i Dan'Dunning DESIGN CONCEPTS ENGINEERING, PC 3 MEMORIAL AVE. SUITE 1 01 , PAWLING, NY 12584 PH: 645 -855 -2000 ! FX: B45 -B55 -2605 E: JKALIN @VERIZON.NET PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of 1D�A- N '® y t4 r4 I N 64 Located at 12Z ?- n V T t✓ 1-11,, /�'� �- o r� . N'f I Z S /0 3 T/V Phi i9 EESO H Tax Map # 3 . Block I Lot &C, Subdivision of Subdivision Lot # — Filed Map # Date Filed -' Gentlemen: This letter is to authorize "mil n++N �► ��` '- N , P� a duly licensed Professional Engineer ✓ or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and /or water supply systems in conformity with the provisions of Article 145 and /or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Countersigned: P.E., R.A., # _ Mailing Address State'( Zip 12 Telephone: $. S S 1, 0 ® C Very trul ours, Signed: (Owner of Property) Mailing Address: I Z2 R o v I a'� j V State N4 Zip 17-5 6'3 Telephone: 5-7 o - j181 Form LA -97 OC ENGINEERING, PC Dec. 6, 2013 Mr. Joe Paravati, P.E. Putnam County Department of Health 4 Geneva Road Brewster, N.Y. 10509 Re: Dunning Cottage SSTS 122 Route 292 Patterson, New York TW1 -1 -60.1 Dear Joe: Please find enclosed a revised well plan for the above mentioned property. As per our discussion, I have corrected the well locations. If you have any questions or comments, please feel free to contact me at (845) 855 -2000 at your earliest convenience. lee `. Kali*h, P.E. Dan Dunning DESIGN CONCEPTS ENGINEERING, PC 3 MEMORIAL AVE. SUITE 1 01 , PAWLING, NY 125B4 PH: B45 -855 -2000 ! FX: B45 - 855 -2BO5 E: JKALIN(PVERIZON.NET DC ENGINEERING, PC LETTER OF TRANSMITTAL To: Putnam County Dept. of Health 4 Geneva Rd. Brewster, NY 10509 We are sending you: X Attached O Under separate cover via 0 Shop Drawings O Prints X Plans O Copy of Letter O Change Order Date: December 6, 2013 ' Job No: Attention: Joe Paravati, P.E. RE: Dunning Cottage - 122 Rt. 22, Patterson, N.Y. The following items: O Samples O Specifications Copies Date No. Description 3 Rev 12/06/13 Dunning Cottage — Proposed Well Plan 1 12/06/13 Cover Letter These are transmitted as checked below: X For approval X For your use Remarks: Signed: cc: File O As requested X For review and comment DESIGN CONCEPTS ENGINEERING, PC 3 MEMORIAL AVE. SUITE 1 01 , PAWLING, NY 12564 PH: B45 -BSS -2000 ! FX: B45 -B55 -2805 E: JKALIN@VERIZON.NET \ \a\ \ \ \ \\ \ \ \ Ix 1� XX<'_ 1111 ao ('\ X emu', L J I 1 I � / I � /�• / I 1 �I / � d � n I �I I / , I x ,. 1 1 �� I / Z to \ LO \ \ I LO PUTNAM COUNTY DEPARTMENT OF MEAL H - i DIVISION OF ENVIRONMENTAL HEALTH SERVIC _ CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # 0 l (3 Located at 122 F-o v1 t< Zq V Town or Village P &T LPysvt4 T Subdivision name — Subd. Lot # Tax Map Block ( Lot 60. Date Subdivision Approved Renewal -- Revision — Owner /Applicant Name >q4 tbv N N I t4 n Date of Previous Approval Mailing Address JT-1- "yfl�,- 2°l7i Pi4,71!�FSON , NeN YoL1c..- Zip IzS63 Amount of Fee Enclosed -0 D, Building Type RCS(GyCi-1 I AL, Lot Area 70.5-1 No. of Bedrooms 'f/ Design Flow GPD 'h 00 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of loco gallon septic tank and 15-0 L-F Or STS►— �A�lzb 2fFT wtD*,:: A-B.svF -P[►ON T$91,3Uk6S Other Requirements: To be constructed by TBD Address Water Supply: Public Supply From \ Address or: Private Supply Drilled by rMVS4� E�-X , WEL-� 1 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 following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or riy(repatr "s Y Chet O� co Signe� D'a P.E. R.A. Date q •3.13 oP�-IAL- ,'�v6 PAWL-0,-)ti License # 014001 \, "< -, -O' �;�,•:- , ,- APPROtD...FOR CON,ST RUCTION: This approval expires two years from the date issued unless construction of the sewage treat�ii ant -s� stei{ 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. T(te - , Title: Date: <-/K // -3 �- py - HD File; Yellow copy - Buil 'ng Inspector; Pink copy - Owner; Orange copy - Design Pro essi nal Form CP -97 ALLEN B EAILS, M.D., J.D. Commissioner of Health ROBERT 1VM0IRR1S, P.E. Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 508 -1390 . Fax # (845) 278 -7921 MARY ELLEN OEDELL County Executive TO: NYCDEP DEPARTMENT OF ENGINEERING AND DESIGN REVIEW ATTN:, DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM DELEGATED New Application PROJECT: Njkmi LOCATION: jdd- [L k— Renewal ❑ TOWN: DATE SUB'D APPROVAL TM # 3 / - i NOTICE OF COMPLETE APPLICATION DATE: 6 1� L DELEGATED AL JM BEALS, M.D., J.D. CmMissioner omealth ROBERT MODEM P.E. Director ofEnvii+o mmW Haft April 16, 2013 John Kalin P.E. DC Engineering 3 Memorial Avenue Pawling, NY 12564 Dear Mr. Kalin: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Telephone: (845) 808 -1390, Fax: (845) 278 -7921 i MARVFt[. XN OIDPLL . Coudy Executive Re: Complete Application Determination for Dunning 122 Route 292 (T) Patterson, TM 3 -1 -60.1 East Branch Reservoir Basin The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and revisions received by this Department on April 5, 2013 is complete. The Department will notify you by May 6, 2013 of its determination. D The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ❑ Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my 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 approved, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Deparhnent 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. spectfully, oseph S. Paravati Jr., P.E. Assistant Public Health Engineer JSP:cw PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of D,4- N t'> V N N I W Gr Located at 12 Z- g.aVT C— I- p ^-rIr--F -SoN , NY IZS4 T/V P^-1T6r•S0H Tax Map # 3 , Block I Lot Subdivision of Subdivision Lot # -- Filed Map # Date Filed Gentlemen: This letter is to authorize o+vw. A , Woo- L, I H , PE a duly licensed Professional Engineer ►' or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam Coun - ' ry Code. Countersigned: P.E., R.A., # Mailing Address o� N``4l .C/D $ w i -Ll n ? � Al \1 State N'( Zip j ss b Telephone: $. S S- Z o 0 0 Very truly Signed: (Owner of Property) Mailing Address: I ZZ R O V T E. 237-- rAj T 'spN State tNY Zip l ZS 63 Telephone:7� Form LA -97 OC ENGINEERING, PC April 3, 2013 Mr. Mike Budzinski, P.E. Putnam County Department of Health 4 Geneva Road Brewster, N.Y. 10509 Re: Dunning Cottage SSTS 122 Route 292 Patterson, New York TM# 1-1 -60.1 Dear Mike: Please consider the following application for a proposed subsurface treatment system for the above referenced project. The project involves the construction of a two bedroom cottage on an existing parcel and a subsequent construction of a subsurface sanitary treatment system. The parcel is currently occupied with an existing single family residence and several out buildings. Attached, please find an application fee in the amount of $500.00 in addition to the application forms, a report and three copies of the plans. If you have any questions or comments, please feel free to contact me at (845) 855 -2000 at jenience. E. cc: Dan Dunning DESIGN CONCEPTS ENGINEERING, PC 3 MEMORIAL AVE. SUITE 1 01 , PAWLING, NY 12564 PH: 645 -855 -2000 • FX: B45 -655 -2605 E: JKALINQVERIZON.NET 1 2. 4. 6. 7. 8. 9. 10. 11. 12. 13. 14. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM Name and address of applicant:. DP N D V N N I N G IZZ P -�ut� Za7r- PA1 i N! I Z3 4,3 Name of Project: jaVNt40441 Cp.T'TJ-�6 3. Location:gN: 1'1AJ76f5+t4 Design Professional: ,1oua V-AL,1V-1 pE 5. Address: 3 Mt✓MoRinl, tA-V6 Drainage Basin: t;�,kSr gPAK" PEs. P�WL� �� NY IZS 6L( Type of Project: ✓ Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) Is'this project subject to State Environmental Quality Review (SEQR) ? ............. es o Type Status (check one) ...........................:.......... ............................... Type I xempt Type II Unlisted ✓' Is a Draft Environmental Impact Statement (DEIS) required ? .............. ....... Yes/No 1,4O Has DEIS been completed and found acceptable by -Lead Agency ? ............. Yes/No Nd N Name -of Lead.Agency Is this project in an area under the control of local planning, zoning, or other officials, ordinances? :.. ...........::........:::................................... ..:...........................( No. If so, have plans been submitted to such authorities? .............. ............... (SONO Has preliminary approval been granted by such authorities? Date granted: T i`'�A 15. Type of sewage. treatment system discharge ........................ surface water —Z groundwater 16. If surface water discharge, what is the stream class designation? .......................... 17. Waters index number (surface) ........................................................... Is project located near a public water supply system? . ............................... Yes/No 1Jfl 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage . collection or treatment system? , ......... Yes/No j 40. 21. Name of sewage system Distance to sewage system r 22. Date test holes observed IZ�� 0 12 23. Name of Health Inspector._Jflb PAgAV 1 P� 24. Project design flow (gallons per day) ....:.....:.................: ..... ........................... 300 Cf PD 25. Is State Pollutant Discharge Elimination system (SPDES) Permit required?.... Yes/No NO 26. Has SPDES Application been submitted to local DEC office? ............ :............ Yes/No. NO Rev. 11/01 Form PC -97 Pg. 1 of 2 27. Is any portion of this project located within a designated Town or State wetland ?... Yes/No N0 28. Wetlands ID number ..... .. .............. .............. ... ............................... ....... . 29. Is Wetlands Permit required? ..... Yes/No N D Has application been made to Town or Local DEC ..::......................... Yes/No NO 30.. Does project require a DEC Stream Disturbance Permit? .... .........................Yes/No 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 N b 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 t40 DESCRIBE: 33. Is there a local master plan on file with the Town or Village? .........................Yes/No Yes 34. Are community water and/or sewer facilities planned to.be developed within 15 years in or adjacent to project site? .................................. .........................Yes/No no 35. Are any sewage treatment areas in excess of 15% slope? .............................. Yes/No NO 36. Tax Map ID Number ...... ............................... .... Map 3 Block Lot 60.1 37. Approved plans are to be.returned to ................ Applicant 1/ 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 1, 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 my knowledge and belief. False statements made herein are punishable pursuant to Section 210.45 of the Penal Law.. SICNAT URES & OFFICL4L TITLES. o A N K.tl L 10, l � F- � N,V,A COUNTY Mailing Address :.....................:..... CIT5TS ngineerft 2013 Pawling, New York 12564 D3 M E N T OF HEAJH to the best of 2 9� Form PC -97 Form PC -97 PUT NAM COUNTY DEPARTIrIENT OF HEALTH DIVISION OF ENVIRONI1IENTAL HEALTH SERVICES DESIGNT DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner: 1D AN 1=> V FA I" I (� G Located at (street): 122 FTE Zqy Municipality: Address: si`�ME TIM # Section: S. Block ( Lot 60.1 Waterst ed: R2At---mN T-41r, - SOIL PERCOLATION TEST DATA Witnessed by: 6C,-NC mo Date of.Pre- soaking: ! q� (3 Date of Percolation Test: I /I o (( 13 Hole No. Run No. Time Start - Stop Elapse Time (min.) Depth to water from round surface (inches) Start - Stop Water level drop in inches Percolation Rate min /inch Z6'' 2 3 ( 4 5 pr12 I 2" 2 28 30 A l Le-JO D 3 KO L,6 4 5. PY,3 I tay -Z:os 3e,� l2 - Zl" 3,0„ 2 z:o6- Z:LZ 3 r:zK_1:49 it 4 \�, t3 `• r, A k 41r l 4 O7q -,' Notes: I. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole, (i.e., _< l thin for I -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 Note. DEPTH G. L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA , DESCRIPTION OF SOILS ENC0UNTERED IN TEST HOLES HOLE # bT' 1 d'6" TONIV N 7— you LPN s ^�oY v-oAM 31"- W hI< RW 5+11.1JDi �9�M. Y�e 64 M0C, (At4 T PAM HOLE # Dl' Z HOLE # .D ?'3 HOLE # HOLE # <- 1 " -tiy" ewe y�N,oy �e ^M t s4 -'i8° pie, 6g" SAN1P'f VVAA4 moo eOMPA.&f wAM o.q tvPso lo''- OW, BI?," SAt4c 'j t-OAM W I co 0s%X's �"/4 191 M Indicate level .at which groundwater is encountered Nor o:tr e-oo"Teg.3n .Indicate level at which mottling is observed No-t o esmvbio Indicate level to which water level rises after being encountered 14 A Deep hole observations made by: J- kAL-10 Pb, J. P,%aAVN -ri PO Date 12 10 IZ Design Professional Name: A n "N A. IFA1 -I N, P6 Address: Design Concepts Engineering PC '1Merno a Ave. Suite -501 Pawling, New York 12564 PUTNAK e: APP 01 2013 DEPART�IMESNTOF HEALTH Design Professional = Seal- N ENGINEERING REPORT PROPOSED SEWAGE TREATMENT SYSTEM DUNNING COTTAGE 122 ROUTE 292 TOWN OF PATTERSON, PUTNAM COUNTY, NEW YORK APRIL 2013 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 2013 JOHN A. KALIN, P.E. Prepared by: Design Concepts Engineering, P.C. John A. Kalin, P.E. 3 Memorial Avenue Pawling, NY 12564 Al �� O CID �, Z �J b� Submitted herewith is a report containing the engineering design data relative to the proposed Sewage Disposal System (SDS) to serve a proposed cottage within the Town of Patterson, Putnam County, New York. PROJECT DESCRIPTION: The parcel to be serviced by the proposed SSTS is located at 122 Route 292 in the Town of Patterson. The 70.51 acre parcel is identified on the Town Tax Maps as Grid # 3. -1- 60.1. The project involves the construction of a two bedroom cottage. There is an existing single family residence on the property as well as several other out buildings. The existing SSTS operates without incidence however is not large enough to accommodate the potential additional flows generated from the cottage. The residence receives water from an existing onsite well. Water will be provided to the cottage through a new 1" PE water line from the existing house. Refer to the plan for its' location. The property slopes from the cottage down to the ssts area. The parcel is mixed open meadow and woods. GENERAL DESCRIPTION OF SSTS: 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 150 L.F. of Absorption Trenches with 100% reserve area Several 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 loam and sands. No rock, water nor mottling were noticed in the holes. Utilizing the soil test data, the best area was selected for the treatment system (refer to plan). Attached please find the proposed plans for the layout of the sewage treatment system. The Design Flow utilized to design the SDS is 150 GPD /Bedroom, or 300 GPD (based upon a 2- bedroom design) Noting the soil percolation rate of 1 -7 minutes per inch, the required length for standard 2' -wide absorption trenches is 150 L.F. For this design, the system shall be arranged using three (3) rows of trenches @ 50 L.F. A 100% expansion area has been tested and reserved on the parcel. The reserve area had 20 min /in soils so the design required 214 LF. The reserve design provides 5 laterals each 44 LF (220 LF). �r 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 Aoolicant or Proiect Soonsor) 1. 7kPPLieANTr/SPONSOR D.C. Engineering, PC (JOHN A. KALIN, P.E.) [2.pRojEcTNAmE DUNNING COTTAGE 3. PROJECT LOCATION: Municipality Town of Patterson County Putnam 4. PRECISE LOCATION (Street address and road intersection, prominent landmarks, etc., or provide map) 122 ROUTE 292 5. IS PROPOSED ACTION: ® New ❑ Expansion ❑ Modification/Alteration 6. DESCRIBE PROJECT BRIEFLY: Creation of an SSTS for a two bedroom cottage 7. AMOUNT OF LAND AFFECTED: Initially 0.3 acres Ultimately 0.3 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)? N Yes ❑ No If yes, list agency(s) and permit/approvals SSTS approval — Putnam County Health Dept. 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? , ❑ Yes ® No If yes, list agency name and permitlapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTIN G P AL REQUIRE MODIFICATION? ❑ Yes ® No ` F �` !� CERTIFY THAT THE INFORMATION PROVIDED 9E T BE �O�F Y KNO WLEDGE ? ftppiicmrt/Sponsor Name: John A. Kalin P.E. _ - Date: 3 �� r r t Signature: v`� +. If the action is in the Costal Area, and you are a state agency, complete the Costal Assessment form before proceeding with this assessment 'l.io d' PART II - ENVIRONMENTAL ASSESSMENT (To be completed by Aeencv) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. ❑ 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) Cl. 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 C1 -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 LIKELY 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 should be assessed in connection with its (a) setting (i.e. urban or rural): (b) probability or occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part 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) DEC -10 -2012 09:53A FROM:DC ENGINEERING 845- 8552605 TO:2787921 P.1/3 OC ENGINEERING, PC FACSIMILE To: Joe Paravati, PE Company: PCHD. From: John A. Kalin, P.E. Subject SSTS Test Sketch Fax Number: 278 -7921 Date: Dec. 10, 2012 You should receive 3 page(s), including this cover sheet. If you do not receive all the pages, please call 845 - 855 -2000. Comments: Joe, Have a look at the attached sketch. I want to set up soil testing with you for a two bedroom building. Give me a call at the office at 855 -2000 or on the cell at 914 - 447 -5749. Thanks, John O E S I G N C O N C E P T S E N G I N E E R I N G , PC 3 MEMORIAL AVE, SUITE 101, PAWUNO, NY 12SS4 PH: 645 -855 -2000 • FX:845-855 -2W5 E, JK.AUNOCCENO.COM DEC -10 -2012 09:53A FRON:DC ENGINEERING 845 - 8552605 T0:2787921 P.2/3 BRUCE R FOLEY Public Health Director ATTENTION: DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10504 LORETTA MOLINARI RN., M.S.N. Amoelate Public Health Director Director of Patient Servicea )w JOSEPH PARAVATI ❑ GENE REED All information below must be f& completed prior to any scheduling. ENGINEER OR FIRM: 40 tk" [LA I' I K3 29 PHONE #• N YY7 S • Fjs'Sr 20OD REASON: DEEPS: W'l PERCS: ar / PUMP TEST: ❑ DATE: 17" 10 •17/ ROAD /STREET: TOWN: C'/�T�"E�orJ TAX MAP#: SUBDIVISION: LOT #: y OWNER: Ar-� T�y► -� +yl N� NYCDEP CRITERIA FOR JQX NT REMW AND WITNESSING OF SOIL TESTING YES NO ❑ Proposed SSTS within the drainage basin of West Branch orBoyds Corner Reservoirs. ❑ Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. Proposed SSTS within 200 feet of a watercourse or a DEC wetland. C3 Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. ❑ Gr`� Proposed SSTS for a Commercial Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered Les to any of the questions, NYCDEP must witness the soil tests. This Department will coordinate a mutually suitable time for field testing with the Design Professional and NYCDEP. If a project`has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP Is required to witness the soil tests, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. FOR CnUNTV TEAR /.TN1T.V DATE: f 4�4 //ol- COMME�TS: TOM /0 : 3 -!) �<�-i DEC -10 -2012 09:54A FROM:DC ENGINEERING 845- 8552605 TO:2787921 P.3/3 e� �Vh3NfN 5 AN NA PUNNING M�1A. I �/j/��# 1920 f � 1� �t 59" ARAGe P�AMe •� Vin)!. �, `;' !; ^,s .� /:;' '/ . W/ Cruz Ex NG. NIP P012f L i; / ; RiP RAP WAL& O k _ •,, ... _ J., ,::.. / ,�" �J -7O L.P. � )i012Y ON R/ , ' f / �! o� N ;20';1 1M1r , . , , ADO. ' �, 40. • ,. . ,;`' .BRAS IJA- J ' �: P�'ORAINAGE ' ...... APFROY. � � j O EA9EME T 177.6' RIP RAP QUTLer t P2 / t� • r fA1NING" x 4d). ... 4V �N1P.f� ro ; ..=-- • -33' S3' w gq W !? h96BI,APSUM�n Dp -, vc w Y , .4St� 587• q5 IOCAV - � �t�'G�•,pAV�N1�NT PUTINANI COUNTY DEPARTNE- NT OF HEALTH Dn-ISIONJ- OF EN1-V1RO-1N7,'-YfE- -N-T-41 HEALTH SERVICES DES ION DATA S HEr- E T = S U3 5 URFA CE SEWAGE TRE ATIVIE N-T S --/-S'1 EIM D-,vntr: —bVA1A11Zj!a kddress: IA62. Looted at (stree•t): TiV1 M` Section Bloc", Lot Municipality: PyTre& /1l Watershed:• AST ;37 SOIL PERCOLATION TEST DATA Witnessed by,. Date of Percolation Te's.t:—,:— Date of Pre-soiklnrT. F- Hole No Run No. Time Starr Stop Elapse Tim e (min.) Depth to witer from round Surface i (i I nizhes) Start - stoP NV2ter level drop in inches percolation Rate min/inch IJ-:o9 - t; 1,? 1 3r--,) z A 1- 0 la " 110 – &/,.od 3,P I l 7 AL 1 f :/1- -4 1 5 4;"5-7- .1-wj 30 1 / -7 A I 31 /7 4 3 -3 /10 .3 2 1 el A 9: 21 _3;7 4 1 X;!Ly --1 ;40 e. I /13 2 1 T-IZ7r rr) it rrn,—r:-? nr ;P.-n,- rienrh iinr:( 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 TEST PIT.DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE #1_1__-c HOLE X HOLE # HOLE # HOLE # G.L. 1.0' 2.0' 3.0' =� 3.5' 3o-119 a � oh-L U 4.0' lip rl� n� 4.5'� 5.0' 5.5'. 6.5' 7.0' 7.5' Lvww. 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 -17 -2012 03:02P FROM:DC ENGINEERING 845 - 8552605 TO:2787921 P.3 41 �� �Vr•�Nr1V�� ��' NTS • . � 4 k�ANNA I�UNNiN� yy i Mf: X ) I j i A. STALI. - EXIS 1G, WI F I. + t�I r W/ G i WAIF *alf PORE YTOl.P. --r -6 i Box AIL ft"rl� c O F.C:. ADO ' -Y ✓' , �' a0. �� •`PO12r✓N . ,,,. ��/ 140' f ' DRAINAGE APp12O X ; '. .' , _r b �. eAn SeM r 177 V ATION o' \ " ^ r i ! RIP �U'[ler RAP +.t G nn ! r ._ ... ... _. • Wl �.�.... • - 3' S3 W 8A , C '- u'"'.;�,- i• �N�°I.Pd� � .1.,. ---� -- � GEN�t�I.lN4r> 122 5 RO -' - -_ - - _ -_ x•87' ��•G�.pA�IN�N , -- -- - .: =�` -- (, DEC -17 -2012 03:01P FRON:DC ENGINEERING 845 - 8552605 TO:2787921 P.2 BRUCE R FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 ATTENTION: JOSEPH PARAVATI C103 GENE REED All information below must be Ift completed prior to any scheduling, LOREWA MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services DATE: +7-r j. ENGINEER OR FIRM: Ao Aa t`A L I +J T p� PHONE 9.S9 ` -'20 0V REASON: K.RCS: PUMP TEST: o ROAD /STREET: TOWN: I'ATMFR so r3 TAX MAP #: _*' r SUBD"ION: LOT #: OWNER: `�•Qry bUt� rut t�U NYCDEP CRUERIA FOR JOWT REVIEW AND WITNESSING OF SOIL TESTING YES NO 0 Proposed SSTS within the drainage basin of,WestBranch orBoyds Corner Reservoirs. 0 of Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. Proposed SSTS within 200 feet of a watercourse or a DEC wetland. Q er" Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. ❑ ' CK" . Proposed SSTS for a Commercial Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered yes to any of the questions, NYCDEP must witness the soil tests. This Department will coordinate a mutually suitable time for field testing with the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP Is required to witness the soil tests, it will be the sole responsibility of the design professional to schedule re-witnessing of the soil testing with NYCDEP. FOR COUNTY USE ONLY DATE: / TIME: ! Z i ' ® 292 e � 0 I 0 i; 0 WNGS I' R! N 43 I1 8 o y 1� _f/ e §t q6Phhlqv 3 f . Smith Pond 7 I 16 > c < p Akins Corners 3UCAR i em 04 311 Little Re ' aaattersa -- - - out IVV/1wu 2 a �\•�' AgFI I u x LE DUARRy ES `o i I � . 6.4 Z rc T fp DEy N 0 r 90 { The Great F- L/ v Swamp 12563 r 9L(Mendel Pond 62 ' Q