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HomeMy WebLinkAbout0045DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 1 -1 -80.2 BOX 1 L r. i T 00045 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES W WELL COMPLETION REPORT Well Location . Street Address: 41 a Town/Village: �1r ��e r s° ►L 1► Y Tax Map # V Map Block Lot(s) Well Owner: Name:3O2 j4c% wS Address: Use of Well: 1- Primary 2- Secondary esidential _Public Supply Air cond /heat pump _Irrigation Business Farm I Test/monitoring = Other(specify) Industrial Institutional Standby Drilling Equipment otary _Cabe percussion Compressed air percussion Other(specify) Well Type . _Screened _Open end casing _ Open hole in bedrock _Other Casing Details Total Length #t. Length below gradelP ft. Diameter � in. Weight per foot t � lb/ft Materials: ✓Steel Zastic Other Joints: Welded Threaded Other Seal: Cement grout Bentonite Other Drive shoe: Yes _ No--**' Liner: _Yes No Screen Details Diameter (in) Slot Size Length ft Dept to Screen (ft) Develo ped? First _Yes _No Hours Second Well Yield Test _Bailed _Pumped ompressed Air Hours '74' Yield % e gpm Depth Date Measure from land surface - static (spec 3 a During yield test (ft) -A— �0 Depth of completed well in ft. 1*­ C1 ('P 0 Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter (in) Formation Descri tion ft. ft. Land Surface t7 s 0 V1 If yield was tested at different depths during drilling list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type , ,{' Capacity fi. t, ,0Aj Depth /6O Model PP- .2222 -1.- Voltage �,?. HP -Yrri Type C-2 7125 Volume ECG ]Tank Date Weil ompI i6 Well Duller PC` Certificate # � © °l ( * NY State # i t ump Installer PC Certificate Date of R port q. V a " '`.. F � �I�iJ r a .� n try• i �M LN f` s � ." .w ..: v,:l :< Ts�. Lr! Pump Installer Narne *8�Address' �j /y�/ /, /_ £,' Pumap Instal er(slgnaturej� 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 t< (9 PUTNAM COUNTY DEPARTMENT OF HEALTH d DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT #p Located at 2 7 3 t./ aO I C. K- Town or Village P,r� / % L- �Y�vA) Owner /Applicant Name Jc -%c-r— f ¢4iz? ,6 OS Tax Map _ ',3 Block j Lot 60-'Z- Formerly Subdivision Name M1 u,. St 6b i L1i S 10 tJ Subd. Lot # Mailing Address C� - �1 ��`i 7�-3. �% ,/� //� r.; e� i���4 JC Zip Date Construction Permit Issued by PCHD (� • /C� ° / 0 c7 - 3 p-7z� A-1 L Separate Sewerage System built by Address koC, ), - / 1 3 I Fss Consisting of /01 Sd Gallon Septic Tank and 4100 �-F X �2�t I b0iOy 7-r6,&AJC#&`S 604Jwtfl- ) � c�2� LF �Y1�L�YL ✓G Other Requirements: POMP ChM—MB '/' I' /2A /�' . �/ u Water Supply: Public Supply From. Address or: Private Supply Drilled by /VD>Z 1KfiW Moon 90 ;J Address 15-a J Building Type 2� � t 0 c.=r1 c_C Has erosion control been completed? ye5 Number of Bedrooms Has garbage grinder been installed? /Vo I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regula ' of the Putna7ounty Department of Health. Date: 5- / Z- Certified by P.E. _X' R.A. (Design Professional) Address .�f �' 12�JST K License # a Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocat n, modification/4r change is necessary. F By: Title: Date: White copy - HD F' e; ellow opy - Building Inspector; Pink copy - Own r Oran a copy - Design Professional Form CC -97 FEB -23 -2012 17:41 PW SCOTT P.03 1124 BRUCE R. FOLEY LORETTA MOLINARI RN., M.S.N. :blic Health Director Associate Public Health Director yy��•�y�A�yy **+�•tnn r��-��++ Director of Patient Services „ ,, ' , 1 Geriea�'it ;•.Road ; ,,�,;;�', • 'Brews'kbr, Nevir " 'ork 10509 Tn*onmebtrl Heailtbi-$1472.' -'130 Fax(914) 278 7921 Nutt $etV'im (9Y4)'i12 -.A653$ 1YI ,(414) 276 -6678 Fax (914) 278 - 6085 ;•`;. °" EnrlY,'I�itaseven4idri (91,4)'�78� 6Q14 PtmItool (914) 278 -6082 Fax(914)278-664a VV • RM OWNERS NA1V,i>E: ����,� '; �i4 IJ e_J 7-A f +e-fz 54 15 0 _S TAX MAP NVMB. 1 R; 11'1 � &_0 C. r- L �-,D7' 9,0 2 E911 ADDRESS: TOWN: A UTHORIZXD TD • ;'dF -P1a -A L: (Signature) DATE: The Putnam ,Cq»ty'Deo *' "ent• ti 41ealth will not issue a Certificate of Construction CQih' pla hce ihldss the above form is completed, i.e., a legal E911 address is assigned'by an authotitzed to *n official. This form is to be submitted with the applicatf bit for a Certificate of, Construction Compliance. ; (E911 VZMM) TOTAL P.03 13 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: O&Y dii a Town/Village: re-r `so ti Tax Map #,3,-1- 80 -,2 Map Block Lot(s) Well Owner: Name .102q a V u3 Address: Use of Well:' I- Primary 2- Secondary esidential _Public Supply Air cond /heat pump _Irrigation Business Farm Testlmonitoring —Other(specify) 41ndustrial Institutional Standby. Drilling Equipment otary _Cabe percussion Compressed air percussion Other(specify) Well Type _Screened Open end casing _,,, Open hole in bedrock _Other Casing Details Total Length lt. Length below graded ft. Diameter � in. Weight per foot ? f lb /ft Materials: f/ Steel lastic Other Joints: Welded Threaded Other Seal: Cement grout Bentonite _Other Drive shoe: Yes _ No-,*" Liner: _Yes No Screen Details Diameter in Slot Size Length ft Dept to Screen ft Developed? First `Yes _No Hours Second Well Yield Test _Bailed _Pumped JzCompressed Air Hours Yield gpm Depth Date Measure frorn lana su ce -state ispecify R) During ylew test ft Depth of completed well in 4 O Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter in Formation Descri tion ft. ft. Land Surface t7 61-0 V1 If yield was tested at different depths during drilling list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type fF -/Z Capacity 4. I' ry,oJK Depth /6a Model P- 2212 -✓Z Voltage .s? � HP A 4 Tank Type 2 Volume 50 v� i _ a , T. i a$ 3 NOTE: Exact Location of well with aistances to at le j, two permanent lanamarks to be proviaea on a separate sneevpian. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -9T Rpv_ -VnR 1 I h0 �0,a ALARM MO ON 81JUM X00 b PROPOSED WELL 0. \ \ \ 00 "►v 18d-50 �' OSED ZON EX /ST. WELL OO EX /ST. WELL AS -BUILT NOTES: 1. THE SSTS CONSISTS OF THE FOLLOWING: 1250 GALLON PRECAST CONCRETE SEPTIC TANK, 400 L.F. OF 24' WIDE ABSORPTION TRENCH. ADDITIONAL REQUIREMENTS: 1250 GAL PUMP CHAMBER to 0 1 SO' 0l / �o • / /- FF. -443.0 18kj 61 ' �I 722.11 ' 20'COMMON O SERIF LOIS 7 & 2 CU j� O - 4 O BOO ZON 4 4 LOT 2 SEPTIC AREA PLAN SCALE: 1;"=30' ]l!ENEGINEE SURVEY NOTES: 1. SURVEY AND TOPOGRAPHICAL INFORMATION TAKEN FROM 'FINAL SUBDIVISION PLAT OF MILL SUBDIVISION' PREPARED BY TERRY 3871 RD BERGENDORFF COLLINS, FILED AS MAP 1 2880 ON 9 -28 -01 BREWSTEI PATTER � wa _ _ - /v/1. ,� N - 414191AL S C ELLS 0,9 SEPT GOB ACCESS PATH SEPTIC SYSTEh YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovani, Director ** TEST REPORT ** LAB #: 1.105672 CLIENT #: 62807 NON STAT PROC PAGE: 1 of 2 --------------------.,-___----___-----__--_-----_---___----_-----_ _-- __- _- _-- _- _--------- _- - -- - -- JOZEF, HARTABUS 60 -39 GATES AVENUE APT 3F RIDGEWOOD, NY 11385 DATE /TIME TAKEN: 12/15/11 DATE /TIME RECD: 12/15/11 01:46 REPORT DATE: 12/29/11 PHONE: (917)- 460 -5572 SAMPLING SITE: 29 BURDICK RD, PATTERSON, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: HNO3 COLD BY: HARTABUS JOZEF TEMPERATURE..: < 4C NOTES...: A.M. COLIFORM METH: MF --------------------------------------------------------------------- ------- --------- -- -- --- - --- START DATE /TIME END DATE /TIME-FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 12/15/11 0250 12/16/11 0130 MF T. COLIFOR ABSENT /100 ML ABSENT SM 18 -20 9222B 12/19/11 LEAD (IMS) <1 ppb 0 -15 ppb SM 18 -19 3113B 12/15/11 NITRATE NITRO 1.29 MG /L 0 - 10 SM18- 20450ONO3 12/15/11 NITRITE NITRO <0.01 MG /L 1.0 MG /L SM18- 20450ONO2 12/20/11 IRON (Fe) <0.06 MG /L 0 -0.3 mg /l SM 18 -20 3111B 12/21/11 MANGANESE (Mn <0.01 MG /L 0 -0.3 mg /l SM 18 -20 3111B 12/16/11 SODIUM (Na) 11.03 MG /L N/A ' SM 18 -20 3111B 12/15/11 0438 12/15/11 0441 * pH 7.4 UNITS 6.5 -8.5 SM18 -20 4500HB 12/28/11 HARDNESS,TOTA 240 MG /L N/A SM 18 -20 2340C 12/23/11 ALKALINITY (A 284 MG /L N/A SM 18 -20 2320B 12/15/11 0215 12/15/11 0215 TURBIDITY (TU <1 NTU 0 -5 NTU SM 18 (2130B) COMMENTS: MFTC To Coliform This result indicates that.the water Q(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 #: 1.105672 CLIENT #: 62807 NON STAT PROC PAGE: 2 of 2 -----------------------w--------------------w_------------------- _------ _----------- _----- - -_ --- JOZEF, HARTABUS 60 -39 GATES AVENUE APT 3F RIDGEWOOD, NY 11385 DATE /TIME TAKEN: 12/15/11 DATE /TIME REC'D: 12/15/11 01:46 REPORT DATE: 12/29/11 PHONE: (917)- 460 -5572 SAMPLING SITE: 29 BURDICK RD, PATTERSON, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: HNO3 COLD BY: HARTABUS JOZEF TEMPERATURE..: < 4C NOTES...: A.M'. 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 ONLY TO THESE SAMPLES RECEIVED BY THE LAB SUBMITTED BY: aklLo_ Albert RJ Padovani, M. .(ASCP) Director ELAP# 10323 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: Upon premises owned by: Tom Acerno - Tom Acerno Josef Hartabus - 51 Tonetta Lake Way Brewster, NY 10509 Located at: 29 Burdick Rd., Patterson, NY 12563 Application Number: 10091018 Section Block: Lot: 29 Burdick Rd. Patterson, NY 12563 Certificate Number: 10091018 BDC: 104 Permit Number: 795 -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 in /on the premises at: 29 Burdick Rd., Patterson, NY 12563 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 15 Day of August 2011. Name Date Quantity Rating Circuit Type Control Panel 1 Septic Pump 2 4P 2v.-t 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. isullivan 4 Tuesday, August 16, 2011 Page 1 of 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE'SEWAGE TREATMENT SYSTEM A/C Owner or Purchaser of Building Building Constructed by Location - Street Building Type ,3 - /-,A10 o2 `'Tax Map Block Lot Town/Village Subdivision Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The. undersigned further agrees to accept as conclusive the determination of the Public Health Director -of -the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated:. Month 0.9 Day H Year 0// Signature: 1-Q'6 "_5, i/19, c; Title: 0.1 —)4& General :Contractor (O (Vner) - Signature Corporation Name (if corporation) Address: yd 39 6aa State CL 0 /I,/ / : -Zip 1131F Corporation Name (if corporation) Address: 60 -3 State )&/o /U% Zip 113,�FJ Form GS -97 m P. W. SCOTT Errvsonaering & Ave itect ve, P.C. 3571 Route 6 BREWSTER, NY 10503 Email: pwscott2 @comcast.net (845) 278 -2110 FAX (845) 278 -2166 TO WE ARE SENDING YOU �1 Attached ❑ Under separate cover via ❑ Shop drawings Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ 11-9v L1 lmQ W U U MOUVEL DATE '/y - 2— JOB NO. ATTE I N RE: P/f --tn.- "YL..s oyJ w, the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DES�CRIIPTIIOON� w, IV l =LCD T72< C4-L- e.---n -n 4- t c . PUA,q 5 146 I — h5tL)rci-- -11;7- :#-�-2 At (LL- onjY3oi ✓/s / &A) THESE ARE TRANSMITTED as checked below: For approval • For your use • As requested • For review and comment ❑ FORBIDS DUE REMARKS COPY TO • Approved as submitted • Approved as noted • Returned for corrections El • Resubmit copies for approval • Submit copies for distribution ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: J U 9P enclosures are not as noted, kindly notify us at once. n tt Engineering & 845- 278 -2110 www.pwscott.com ................... _..._.............__....... . April 5, 2012 Mike Budzinski, P.E. Putnam County Dept of Health 1 Geneva Road Brewster, NY 10509 Fax: 845- 278 -7921 Re: Hartabus Septic 29 Burdick Road Patterson, TM 3 -1 -80.2 Dear Mike, Fax: 845 - 278.2166 pwscott2 @comcast.net ..._ ...._ ....... _ ..._ Per the attached review memo from your office, I include the following: • Well completion report with required information • Points C & D on the as -built are corners of the property line that are marked by steel pins. Please contact our office is you have any questions. With Regards, .Melanie Ancin Melanie Ancin, RA. SAOpen Projects\Hartabus\Ltr .Budzinski.4.5.12.doc /:�./REBECCA WITTENBERG, RN, BSN Public Health Director ROBERT MORRIS, PE Director of Environmental Health .March 13, 2012 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 Peder Scott, P.E. P.W. Scott Engineering 3871 Route 6 Brewster, NY 10509 MARYELLEN ODELL County Fxecuttve Re: Construction Compliance for Harbatus at 29 Burdick Road (T) Patterson, TM 3 -1 -80.2 Dear Mr. Scott: This Department has received and reviewed the revised plans for the above - mentioned project and the following comments are offered for your consideration. • The well completion report is being returned for incompleteness. The well completion report has been labeled with red asterisks ( *) where required information has not been provided. • How are as-built points "C" and "D" identified in the field? Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. MJB:cw Respectfully, Michael J. Budz' ski, P Director of Endnberin2 4 A: - REBECCA WIITENBERG, RN, BSN Public Health Director ROBERT MORRIS, PE Director ofEmftmxental Health March 13, 2012 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 Peder Scott, P.E. P.W. Scott Engineering 3871 Route 6 Brewster, NY 10509 Dear Mr. Scott: MARYELLEN ODELL Cowlty Executive Re: Construction Compliance for Harbatus at 29 Burdick Road (T) Patterson, TM 3 -1 -80.2 This Department has received and reviewed the revised plans for the above - mentioned project and the following comments are offered for your consideration. (/• The well completion report is being returned for incompleteness. The well completion report has been labeled with red asterisks ( *) where required information has not been �provided. • How are as -built points "C" and "D" identified in the field? Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. Respectfully, Michael J. Bu ki, P Director of En eying MJB:cw PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES F, a .e � glai m ( WELL COMPLETION REPORT Well Location Street Address: TownNillage: �D �}r �/ er`s° l I Tax Map # 3 .- r - 80. Ma Block Lot s ��: Well Owner: Naccmme :,02q 1 i1f/ w1 Address: �V d ry cs#a � Q,v �q� �S �„� �t.Y#N� � �c✓I le,rso y►� Use of Well: 1- Primary 2- Secondary esidential _Public Supply Air cond /heat pump _Irrigation Business Farm Test/monitoring —Other(specify) Industrial Institutional Standby Drilling Equipment otary _Cabe percussion Compressed air percussion Other(specify) Well Type _Screened _Open end casing _ Open hole in bedrock _Other . Casing Details Total Length -Vet. Length below grad4b.ft. Diameter in. Weight per foot ? lb/ft Materials: ✓ Steel -Plastic . Other Joints: Welded Threaded Other Seal: Cement grout. B.entonite Other Drive shoe: Yes _ N Liner: _Yes No Screen Details Diameter in Slot Size Length (ft) Dept to Screen ft Developed? First I _Yes No Hours Second H. I Well Yield. Test _Bailed _Pumped ompressed Air Hours 1-f- Yield / jD gpm Depth Date Measure from land surface-static spec ft 3 a During y-reld test ft) IDept o f 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 Descri tion ft. ft. Land Surface If yield was tested at different depths during drilling list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth Model Voltage HP Tank Type Volume a x : k ,�. w' ',�, p . �". ,A4:.,•3< S. "�w,��a'�`r^i� �:, 3w5�t�i» � "�' ?s,w, v 4�:��g"zs�j'. -7 n t IM i l& x � 3 n REM Puma7nstatla` a gg{� ,lam Ilt fa rs v : ^ at x NOTE: E: 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 :;r.: OCT -13 -2011 14:18 PW SCOTT P. 01 P Scott'E.� meering & Architectute, PC 3871 Route 6, Brewstet, NY 10509 845- 278 -2110 Fax: 845.278.2166 WWW'pwscott.cOm pwscou2 @comcast.net FAX TRANSMITTAL PTOject: �-, Date: Prom: No. Pages Incl. Transmittal ❑ URGENT 0 For Review ❑ Please Comment ❑ F'YI '❑ For your Files /Records Comments: XPlease Reply A R C H I T E C T U R E * E N G . I ' N E E R I N G * S I T E P LAN N I N G S: T0RMS- 0xFNLRA1AF0RMTFMPLXTESTaa Covershe*4 Rolsed 6.13.11 doc OCT -13 -2011 14:19 PW SCOTT SHERLITA AMLER, MD, MS; FAAP Commissioner ofHeellh LORETTA MOLINARI, RN, MSN Associate Commissioner of Health -DEP ARTMENT -OF HEALTH .1 Cneva Road, Bteroi►ster, New York 10509 REQUEST FOR FIELD TESTING All information below must be fully completed'prior to any scheduling. ENGINEERING 1 iFft dv c PERSON TO CONTACT: G 'O "NEW CONSTRUCTION O1 REP,ATR PROGRAM REASON: DEEPS: ❑ PERCS: `❑ ROAD /STREET:. P.02 ROBERT J. BONDY County Execulive DATE: PRONE #: - Z Z2go 0 ADDITION PROGRAM PUMP TESTX 4" �f& TOWN:_ fp TAX MAP SUBDIVISION: Alle _.. _" LOT #: Z A OWNER: NYCDIEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL 'TESTING YES NO Cl ❑ Propo$ed. SSTS within -the drainage basin of West Branch or Boyds Corner & Croton Falls Reservoirs. ❑ ❑ Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. 0 ❑ Proposed SSTS within 200 feet'of a watercourse or a DEC wetland. ❑ ❑ Proposed SSTS design flow greater than 1000. gallons /day or SPDES Permit required. ❑ ❑ Proposed SSTS for a Commercial'Frroject. It is the responsibillty.of the *Agn professional. to provide the above information prior to soil testing. The Department will determine the NYCDE+ P-tproject status (Joint or Delegated) based on the response, If you answered vesto'any-of the questions, N.VCDEP must witness the soil tests. This Department will coordinate a mutually suitable time for field testing with the Design Professional and NYDCEP. If a project has been determined to be Delegated-based on the above response and then subsequent information indicates NYCDEP is required to Mtness the soil tests, it will be the sole responsibility of the design professional to schedule re- witnessing -of the soil testing with NYCDEP. DATE: ,OMMENTS= POP, COUNTY USE ONLY T: 180. FOR FIELD rF"M K4r Eovlimmental- ReaM (W) - 278.6130 Fax(845)278-7921 Water Supply Settlon (845) 225 -5186 Fax (845) 225 -5418 Nursing S+erviees (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fox (845) 278-60B5 Early ?ptervbntkWP'rdsebool'($45) 278 -6oI4 F'a3r(845) 278 -6648 4. r 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: Upon premises owned by: Tom Acerno - Tom Acerno Josef Hartabus - 51 Tonetta Lake Way Brewster, NY 10509 Located at: 29 Burdick Rd., Patterson, NY 12563 Application Number: 10091018 Section: Block: Lot: 29 Burdick Rd. Patterson, NY 12563 Certificate Number: 10091018 BDC: 104 Permit Number: 795 -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 in /on the premises at: 29 Burdick Rd., Patterson, NY 12563 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 15 Day of August 2011. Name Date Quantity Rating Circuit Type Control Panel 1 Septic Pump 2 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. isullivan Tuesday, August 16, 2011 4 Page 1 of 1 Sheet 1 of 1 Putnam County Department of Health Division of Environmental Health Services Field Activity Report Name:._Jozef Hartabus Telephone: _278 -2110 Address: 29 Burdick Rd Pat. NY. Street Town State Zip Person in Charge or Interviewed: Name and Title Date: 10/19/11 Findings: Went to site and observed a septic pump test. I watch and monitored that it worked as per design. I did an inspection of SSTS and it also complied with design. OK for back fill. I witnessed the pump alarms work. Inspector: Telephone: Signature and Title Report Received by: I acknowledge receipt of this report: Signature: Title: Field Activity Report: cw Date: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL IIEATLII SERVICES FIELD ACTIVITY REPORT NAME' J o � � � i�� � �- � �v> • .. A�!L1B.E.SS: � °� � yr d �` � • �, �_�.. - 1. � � � . Street Town State Zip PERS ON IN CHARGE nR TNTFRVTRWFTl- akf J PUMP TEST DOSE TEST 1 REQUIRED GALLONS ww+� w t---3 EL. START EL. STOP RFPQRT RFrFTV -ED RY• I acknowledge receipt of this report: SIGNATURE: 02/96 Title: w (D ww+� w t---3 EL. START EL. STOP RFPQRT RFrFTV -ED RY• I acknowledge receipt of this report: SIGNATURE: 02/96 Title: �. >6 •- �ai•71 hs:� �' y tea. ; �t o MIT -1'Y 9 .....:. �.. P a r _..., .c+_'�.,��_i �.;���"'-.•r~' -�^'"' � _. ter_: �� _�_�`- ''"`tea � •'- ,'V• T -nom i,. ._ f t�. 3 , �� 4 3 �,� i� '•� �v \! 313 r< R ti :c �. >6 •- �ai•71 hs:� �' y tea. ; �t o MIT -1'Y 9 .....:. �.. P a r _..., .c+_'�.,��_i �.;���"'-.•r~' -�^'"' � _. ter_: �� _�_�`- ''"`tea � •'- ,'V• T -nom i,. ._ f t�. 3 , �� 4 3 ... ­­t AND 4' PERFORATED PIPE �. TO BE SET LEVEL 3/4' TO , 1/2" WASHED GRAVEL OR CRUSHED STONE UST (D FREE) - ACING OF SORM14 TRENCH O.C. GITUDINAL VIEW Z NO 4' PERFORATED PIPE � r� PLACING GRAVEL. ,'ED UNLESS INTERCONNECTED :E DETAILS CTIONS OF SF— LOWER PERIMETER OF THE SITE. ZION THE POSTS AGAINST THE BACK r7 CInc Au,• 4' PNC 1 1/2' FORCE MAIN O in (2)GoU{pS PUMPS MODEL 38Ba WEO81,W1 /3HP W/ NON— CDRROSME CHAN DUAL ALTERNATING PUMPS I.ACARO MANWAY OVER DANGER (USES 10' -0' DANGER GASES TOP VIEW POSTS SECTION 0 TOP VIEW SECTION A ONCRETE COUPLER . A111111=11 SECTION B SECTION A ,ML�_ ,B• CTIONS OF SF— LOWER PERIMETER OF THE SITE. ZION THE POSTS AGAINST THE BACK r7 CInc Au,• 4' PNC 1 1/2' FORCE MAIN O in (2)GoU{pS PUMPS MODEL 38Ba WEO81,W1 /3HP W/ NON— CDRROSME CHAN DUAL ALTERNATING PUMPS I.ACARO MANWAY OVER DANGER (USES 10' -0' DANGER GASES TOP VIEW • %,� i 1 • (2)r,OUi.OS PUMPS i e' OF STONE—/ I MODEL 3M WE0011N.1 /3HP (' 9 _B. �7 DUAL ALr. PUMPS SECTION PROPOSED FILL SECTION DETAIL 1. FILL MUST BE STABILIZED BY 1 OWING THE FILL MATERIAL TO SETTLE NATURALLY FOR A PERIOD OF AT !FAST 6 MONTHS IN APPROOXIIMMA�Y 66IINCH ELIFlS TO THE APPROXIMATE DEENSISITTY OF�THE UNDISTURBED UNDERLYING UNHD�YINGYSOIL �I� COMPACTION 2. SITE MODIFICATION ACTMTIES INVOLVING PLACEMENT OF FILL ARE TO BE CONDUCTED DURING RELATIVELY ORY PERIODS TO MINIMIZE SOIL SMEARING AND EXCESSIVE SOIL COMPACTION. 3. THE REQUIRED DEPTH OF FILL WITHIN THE SEWAGE TREATMENT SYSTEM AREA IS 2.5 FEET WHICH APPROXIMATES TO 900.0 CUBIC YARD. FILL SHALL BE RUN OF BATIK GRAVEL SUITABLE FOR SEWAGE ABSORPTION, BE FREE OF FINES OR OTHER UNSUITABLE MATERIAL. AND SHALL HAVE AN IN -PLANE PERCOLATION RATF aT I Fact r , UNDERLYING SOIL AFTER TNF RFroeorn cr•o,,,,..,..•. - -__ 11 L_ _ __J _ LOCATION STAKE PLAN VIEW GROUND ---\ 0 AV CO{ ----I COVER f COATINGI \I Ia O BED OF PEA GI SECTION A -A N3AY M N4AT,EA PROOF ENOpNY a,AOMaA,o[ 12' MAXiEMERGOCY FINISHED GRADE ONCRETE W GRADE —.F�— A-- • ABN. DIA OPENINGS ,ML�_ ,B• ,' 800 GAL. w 4P 2N y ,I N DQ-M — e' -1 PUMP CYCLE 200 GAL • %,� i 1 • (2)r,OUi.OS PUMPS i e' OF STONE—/ I MODEL 3M WE0011N.1 /3HP (' 9 _B. �7 DUAL ALr. PUMPS SECTION PROPOSED FILL SECTION DETAIL 1. FILL MUST BE STABILIZED BY 1 OWING THE FILL MATERIAL TO SETTLE NATURALLY FOR A PERIOD OF AT !FAST 6 MONTHS IN APPROOXIIMMA�Y 66IINCH ELIFlS TO THE APPROXIMATE DEENSISITTY OF�THE UNDISTURBED UNDERLYING UNHD�YINGYSOIL �I� COMPACTION 2. SITE MODIFICATION ACTMTIES INVOLVING PLACEMENT OF FILL ARE TO BE CONDUCTED DURING RELATIVELY ORY PERIODS TO MINIMIZE SOIL SMEARING AND EXCESSIVE SOIL COMPACTION. 3. THE REQUIRED DEPTH OF FILL WITHIN THE SEWAGE TREATMENT SYSTEM AREA IS 2.5 FEET WHICH APPROXIMATES TO 900.0 CUBIC YARD. FILL SHALL BE RUN OF BATIK GRAVEL SUITABLE FOR SEWAGE ABSORPTION, BE FREE OF FINES OR OTHER UNSUITABLE MATERIAL. AND SHALL HAVE AN IN -PLANE PERCOLATION RATF aT I Fact r , UNDERLYING SOIL AFTER TNF RFroeorn cr•o,,,,..,..•. - -__ 11 L_ _ __J _ LOCATION STAKE PLAN VIEW GROUND ---\ 0 AV CO{ ----I COVER f COATINGI \I Ia O BED OF PEA GI SECTION A -A PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVI CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT Located at !Zq f5cAr-.1J V.1 lizaAj) Town or Village ize- Subdivision name N" 5.i)57 Subd. Lot # Z Date Subdivision Approved G Owner /Applicant Name q7d Z�� Mailing Address et4 -725 A- VOAJZ1E F1 Amount of Fee Enclosed `%f , a© Building Type 96&p ,tJ Lot Tax Map .�; Block _L_ Lot ,2 Renewal V Revision Date of Previous Approval jl� ' 5-, Zip /130S No. of Bedrooms -�— Design Flow GPD bao Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1950 gallon septic tank and +V I-F X 24`/ Other Requirements: I'/ To be constructed by %', F5 C ) Address Water Supply: Public Supply From Address or: Private Supply Drilled by Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam Cdunty 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 hed the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating I¢nii f said sewage treatment system during the period of two (2) years immediately following the date of t val of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: E. X R.A. Date Address q (� License # 05� APPROVED FOR CONSTRUCTION- "7`fii °`app'roval 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 ne essary by the Director /Commissioner. Any revisiop or alteration of the approved plan requires a new Oerm it. Approved f ischarge of domestic sanitary se t age only. 7 By: Title: Date: White copy - HD F'; Ye low c py - Building Inspector; Pink copy - Ow r; OraQ copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL )Z,!J6/1kL- P lease print or t yp e .. '" PHPN, , ! Well Location Street Address: Town/Village: Tax Map # °;I rVg0J6X (<V" f�I -79_ .'>1-1 Map 3 Block Lot(s) � ©,2 Well Owner: Name:�� wpr Address: w.�v �� � ve�xju-F one #: 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 Est. of Daily usage gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes ` No_X_ Is well located in a realty subdivision? ........................................... ............................... Yes No Name of subdivision _ /L.L12, v115 /O6% Lot No.�_ Water Well Contractor:_6� Address: Is Public Water Supply available on site? ....................................... ......:........................ Yes _ NoA- Name of Public Water Supply: N A Town/Village f4 AI- Distance to property from nearest water m in: d NEW , Proposed well location & sources of contamination t be provided on separate sheet/pla � Date: Applicant Signature: ,.0 m PERMIT TO CONSTRUCT A WATER WELL NN -A >;s'�„ This permit to construct one water well as set forth above, is granted under provisions of Article 10 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 applicarit or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. 4 The well driller shah abide by afl conditions of`the permit5)s Dunng all well dulling o erationsth'ewelldnller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any revision or alteration of the appr ved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam 40unty. Date of Issue l� Permit Iss g Official: Date of Expiration Title: Permit is Non - Transferable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Ow Orange copy - Well driller Form WP -97 Rev. 3106 Sherlita Amler, MD, MS, FAAP Commissioner of Health Robert'Morris, PE Director of Environmental Health P.W. Scott Engineering 3871 Route 6 Brewster, NY 10509 Dear Mr. Scott: Department of Health 1 Geneva Road, Brewster, NY 10509 June 11, 2010 Re: Proposed SSTS for Hartabus at 29 Burdick Road (T) Patterson, TM # 3 -1 -80.2 Robert J. Bondi County Executive This Department has received and reviewed the submitted application and plans for the above - mentioned project and the following comments are offered for your consideration. ,1.-' Please provide this office with the results of the percolation tests conducted in the fill / material on PCHD design data sheets. �L The two certification statements on Sheet SP -1 are not signed by the design professional. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. MJB:kly 0 Michael J. Director of Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845).225 -5418 Nursing Services (845) 2.78 -6558 Fax (845) 278 -6026 Nursing / Home Care Agency (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845)228 -2847 Fax (845) 225 -1580 P.W. Scott email: pwscott2(d�comcast.net Engineering & Archi 3871 Route 6 Brewster, NY 10509 May 27, 2010 Michael Budzinski Putnam County Dept of Health 4 Geneva Road Brewster, NY. 10509 Re: - Mill Subdivision Lot #2 39 Burdick Road Patterson, NY. Tax Map # 3 -1 -80.2 Dear Michael: P.C. The following is a response to your memo of May 25, 2010. (845) 278 -2110 FAX (845) 278 -2166 1. The locations of the fill percolation testing have been added to Sheet SP -1: trench plan. 2. The Fill certification Note has been added to Sheet SP -1. 3. The septic tank detail amendment has been amended on Sheet SP -3. 4. The pump detail has been amended on Sheet SP -3. 5. Drawing SP -2, "Preliminary Design for Fill Placement" has been removed from the submission since the fill is in place and the trenches shall be installed with approval of the installed fill. Submitted, Peder W. Scott, P.E., R.A. President A R C H I T E C T U R E * E N G I N E E R I N G * S I T E P L A N N I N G Sherlita Amler, MD, MS, FAAP Commissioner of Health Robert'Morris, PE Director of Environmental Health P.W. Scott Engineering 3871 Route 6 Brewster, NY 10509 Dear Mr. Scott: Department of Health 1 Geneva Road, Brewster, NY 10509 May 25, 2010 Re: Proposed SSTS for Hartabus at 29 Burdick Road (T) Patterson, TM # 3 -1 -80.2 Robert J. Bondi County Executive This Department has received and reviewed the submitted application and plans for the above - mentioned project and the following comments are offered for your consideration. o' 1. The locations of the percolation test holes conducted in the ROB fill are to be shown on the plan and numbered to coincide with the results on the submitted soil data sheet. >s' 2. Please refer to Section 4.B.13.c of PCHD Bulletin ST -19 for the note regarding certification of fill which is to be provided on the plan. The septic tank detail is to be revised to specify a maximum cover depth of 12 inches. The pump chamber detail is to be revised to show an all - weather junction box with an outlet and screwed cover at or above grade at the pump chamber to allow for a plug - in connection for the pumps. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. Respectfully, Michael J. Director of MJB:kIy Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845.). 225 75418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing / Home Care Agency (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 P.. W. SCOTT IEngOneering & Architecture, P.C. 3871 Route 6 BREWSTER, NY 10509 Email: pwscott2 @comcast.ne•t (845) 278 -2110 FAX (845) 278 -2266 TO 'T-'c 'D ana WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via _ ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ _ [LIEVVIEn OF 1T RM@ v1�1 04lV 1 DATE . . _ 2 EVE Lf M IN ❑ Samples the following items: ❑ Specifications THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ For your use ❑ As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS COPY TO ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ Resubmit copies for approval • Submit copies for distribution • Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: If enclosures are not as noted, kindly notify us at once. BRUCE R FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA . MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (9I4) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 TO: D ARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM DELEGATED PROJECT: 11A10,-1A',0A2 S A24 TOWN: C SE (./ f)K PV DATE SUB'D APPROVAL NOTICE OF COMPLETE APPLICATION DATE: Sherlita Amler, MD, MS, FAAP Commissioner of Health Robert Morris, PE Director of Environmental Health P.W. Scott Engineering 3871 Route 6 Brewster, NY 10509 Dear Mr. Scott: Department of Health 1 Geneva Road, Brewster, NY 10509 Re: Hartabus SSTS Lot # 2 — Mill Subdivision (T) Patterson, TM # 3 -1 -80.2 East Branch Reservoir Basin Robert J. Bondi County Executive May 17, 2010 The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on May 20, 2008 is complete. The Department will notify you by June 9, 2008 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 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. R pectfully, Michael J. Bud in i, Director of E ine ' b MJB:kly 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 Agency (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 DIVISION OF ENVIRONTMEENTAL HEALTH SE RR"VICES LL-1 T%8-, It 0 F fiLIJ TIL3!U- IZATuGr'� RJEo property of__� r Located at ! it % �� ° Tax Map # ,.:_J dock Lot _� ' r.. Subdivision of '` ' �'� Lr Gj t6) IV r _ A" � Subdivision Lot # Filed Map # hate piled Gentlemen: This lever is to authorize _ �r /V��'r�f'` ~ 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 Depai-tinent, and to sigh all necessary papers on my behalf iii cC}mnec._Gr. tvidl "_is matter and to supervise the construction of said wastewater tretment-aM/or water supple systems in conformity with the provisions of Article 145 and/or 147. of the Education Lar�v; the l='�btic glealth Law, and the Putnam County Sanitary Cade. i� countersigns Mailing address State' ft: Zip _' Telep hone: 0.+ ° "f '°z Om' Vera i L 'iy yours, (Owner of Property) Mailing Address: 6eZAe5 reT � C State— & y zip // 3<Ps Telephone: (71 > % .3 % – 0 � - Fong LA -9-j r u t i N Ain %-,u U IN I' Y 1JE-PARI'MENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES, DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Vow jkvtz tqqS Address 6o. J vAltts ✓�F Located at (Street) ✓f� tom -ial� Tax Map 7j Block �_ Lot (indicate nearest cross street) Municipality A-' Drainage Basin g,A�r A��� %�CS�IZ✓vlL_. SOIL PERCOLATION TEST DATA Date of Presoaking 4:: Date of Percolation Test 113 3 to Hole No. Run No. Time Start - Stop Ela se Time �Nlin.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Incb I 1 10:47010:10 10 Zj 2� 4- 3 " 2 10"11 41 7-1 -11, -516 3 0 3 ( Y1 + 4 5 3 10;30 0;4-3 4 5 10106, 10 47 !' I f� e` 2 ` 0+1 lr yo ` 3 IQ % 4-L 4 5 NUTES: 1. Tests to be repeated at same depth until approximately equal rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 1 N inch) All data to be submitted for review. cv eta W s 2. Depth measurements to be made from top of hole.` e�� ' r w rn DD -97 ;3� PRODUCT 240 P. W. SCOTT Engineering & Architecture, P.C. 3871 Route 6 BREWSTER, NY 10509 E -Mail: Pw cotter rL ( CZA'n ca _:Sr. (845) 278 -2110 FAX (845) 278 -2166 TO �� d WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via • Shop drawings ❑ Prints ❑ Plans • Copy of letter ❑ Change order ❑ Q To Reorder: 1-800-2254W or www.nobe.com M J `GIRL W M ° K @WUUUQd DATE .� /0 • /o JOB N0. ATTENTION RE: ,✓ w the following items: ❑ Samples ❑ Specifications GIN DESCRIPTION MM THESE ARE TRANSMITTED as checked below: xFor approval • For your use • As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS • Approved as submitted • Approved as noted • Returned for corrections - • Resubmit copies for approval • Submit copies for distribution • Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US MILL `_ jb-D Vl SIOA) Lu iZ uU DINING ROOM o KITCHEN '- ' MORNING ROOM 12'10" X 12'11" 10'3" X 12'11" 12'9" X,12'11" - - -- ------- 27's" --------- - - - -- LIVING ROOM 17'4" X 12'11" FAMILY ROOM FOYER 14'2" X 12'11" 0 W UI BATH O BEDROOM 4 BEDROOM 3 1 10'0" X 9'6^ 10V X 13'0" 27'6" BEDROOM 14'11" X 13'0" OPEN TO FOYER BELOW The Manchester Plan No. 544 ■ 2420 SQ. Fr. Large rooms provide more than adequate space in this four bedroom home featuring open foyer, first floor laundry, area, formal living and dining rooms and master bedroom suite with private bath. J PILE SJ���ulSlo�i Lu t �Z �7--BAl 3 '0 o DINING ROOM KITCHEN "' ORNING ROOM 12'10" X 12'11" 1013" X 12'11^ 12'9" X 12'11" 27 6" LIVING ROOM 17'4" X 12'11" FAMILY ROOM FOYER ;• 14'2" X 12'11" UM i 81 44'0^ 9BATH BATH BEDROOM BEDROOM 3 1 0 10'0" X 9'6" 10'6" X 13'0" 27'6" � -::: :: BEDROOM 2 14'11" X 13'0" OPEN TO FOYER BELOW The Manchester Plan No. 544 ■ 2420 SQ. Fr. Large rooms provide more than adequate space in this four bedroom home featuring open foyer, first floor laundry area, formal living and dining rooms and master bedroom suite with private bath. BEDROOM 1 14'2" X 16'6" COUNTY DEPARTMENT OF HEALTH VWISION OF ENVIRONMENTAL HEALT] ICONSTRUCTION PERMIT FOR SEWAGE TREATME PERMIT # Z Located at Subdivision name FA i LL Subd. Lot # Date Subdivision Approved oq % `1 �t--)1 Owner /Applicant Name Mailing Address Amount of Fee Enclosed :a?£? , Building Type Lot Area Town or Village Tax Map Block i Lot Renewal z Revision Date of Previous Approval 4::;A/clo Zip 1 L)S E)LI No. of Bedrooms -4 Design Flow GPD —&t-,� Fill Section Only Depth Volume gallon septic tank and Other Requirements: t • le311 To be constructed by Address Water Supply: Public Supply From Address or: _ Private Supply Drilled by � � 1 �j I Oa Address 'r�����. �s�� �A V 1b .I I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repair"a*Jhereto�, Signed: Address P.E. R.A. Date " License # n 5q 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 causg or- may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. A proved for 'scharge of domestic sanitary s age only. By: Title: Date: White copy - HD File; Y '/llow(cop�- Building Inspector; Pink copy - OwAr; an copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL j__tv please print or type PCHD Permit # - k 07— Well Location: Street Address: illage Tax Grid # Map . Block Lot(s) Well Owner: Name: Address: tip 1 f ► ILI— Z Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigati n 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5 gpm # People Served Est. of Daily Usage al. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New. Supply (new dwelling) Deepen Existing Well Detailed Reason for.Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No _ Is well located in a realty subdivision? ..................................... ............................... Yes_X No Name of subdivision Lot No. Water Well Contractor: Address': lr'' 11 i Is Public Water Supply available to site? . .......................... Yes No_ Name of Public Water Supply: WA Town/Village Distance to property from nearest wate main: Proposed well location & sources of contamination to i e n separate heet/plan. Date: b Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. / A Date of Issue` Date of Expiration Permit is Non- Transferrable Permi Title: White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; copy - Well driller Form WP -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health P.W. Scott Engineering 3871 Route 6 Brewster, NY 10509 Dear Mr. Scott: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health May 30, 2008 Re: Proposed SSTS for Mill at 29 Burdick Road (T) Patterson, TM # 3 -1 -80.2 This Department has received and reviewed the submitted application and plans for the above - mentioned project and the following comments are offered for your consideration. . The note regarding site conditions is to be included on Sheet SP2 and signed by the design professional. The longitudinal view on the absorption trench detail is to be revised to show the trench bottom and perforated pipe being installed level for a dosed system. The distribution box detail is to be revised to show a minimum of two feet of solid pipe on the outlet pipes rather than the inlet pipe as shown. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. MJB:kly Y, Michael J. Director of 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 P.W. SCOTT ENGINEERING & ARCHITECTURE, P.G. 3871 Route 6 Brewster, NY 10509 E -Mail: gwscott @rcn.com (845) 278- 110 FAX (845) 278 -2166 TO WE ARE SENDING YOU Attached ❑ Under separate cover via _ > ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ DATE JOB NO. , ATTENTION r RE: g the following items: ❑ Samples ❑ Specifications- COPIES DATE NO. DESCRIPTION - z, THESE ARE TRANSMITTED as checked below: i�For approval /❑ For your use ❑ As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS COPY TO • Approved as submitted • Approved as noted ❑ Returned for corrections • Resubmit copies for approval • Submit copies for distribution • Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: P.W. SCOTT ENGINEERING & ARCHITECTURE, P.C. 3871 Route 6 Brewster, NY 10509 E -Mail: pwscott @rcn.com (845) 278 -2110 FAX (845) 278 -2166 TO WE ARE SENDING YOU Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ PROMOTE!! OF TRANSMITTAL ❑ Samples COPIES D TE NO. DESCRIPTION THESE ARE TRANSMITTED as checked below: For approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ ❑ FORBIDS DUE REMARKS COPY TO JOB NO. the following items: ❑ Specifications ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: if enclosures are not as noted. kindiv notffv us at once. P.W. Scott email: pwscott2@comcast.net rF, Engineering & Architecture, P.C. 3 871 Route 6 (845) 278 -2110 _ a _ Brewster, NY 10509 FAX (845) 278 -2166 May 27, 2008 Mike Budzinski, PE Department of Health 1 Geneva Road Brewster, NY. 10509 Re: Proposed SSTS for Mill At 29 Burdick Road (T) Patterson, TM #3 -1 -80.2 Dear Mr. Budzinski, Irn response to your review letter of 5/21/08, the following comments have been addressed: l . PCDH SSTS notes have been revised in accordance with Bulletin ST -19, revised July 2007. 2. The 45 degree elbows on the raw sewer line have been eliminated. 3. The proposed "456" and "454" contours have been extended to the top of the fill pad. 4. The trench detail has been revised to indicate the trench bottom and perforated pipe are to be installed level for a dose system. 5. The distribution box detail has been revised to specify a minimum of 2 feet of solid pipe out of the distribution box prior to the perforated pipe. This concludes our response. Should you have any questions, please feel free to contract this office at your earliest convenience. W 'Feder W. Scott, PE, RA. President A R C H I T E C T U R E * E N G I N E E R I N G " S I T E P L A N N I N G SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health P.W. Scott Engineering 3871 Route 6 Brewster, NY 10509 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health May 21, 2008 Re: Proposed SSTS for Mill at 29 Burdick Road (T) Patterson, TM # 3 -1 -80.2 Dear Mr. Scott: This Department has received and reviewed the submitted application and plans for the above - mentioned project and the following comments are offered for your consideration. -,I" The PCDH SSTS notes on the fill and trench plans are to be revised in accordance with Bulletin ST -19 revised July 2007. The 45 degree elbows on the raw sewer line are to be eliminated. The proposed "456" and "454" contours in the ROB fill pad should extend to the top of fill pad, otherwise a 20% slope is being created between the ends of the trenches and the clay barrier. 4. The absorption trench detail is to be revised to specify the trench bottom and perforated pipe being installed level for a dosed system. 5. The distribution box detail is to be revised to specify a minimum of 2 feet of solid pipe out of the distribution box prior to the perforated pipe. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. MJB:kly l.M,.PFUM- -W . 1 ( I 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 76014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health . P.W. Scott Engineering 3871 Route 6 Brewster, NY 10509 Dear Mr. Scott: DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 RE: Robert Mill SSTS Lot # 2 — Mill Subdivision (T) Patterson, TM # 3 -1 -80.2 East'Branch Reservoir Basin ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health May 21, 2008 The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on May 20, 2008 is complete. The Department will notify you by June 9, 2008 of its determination. 0 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 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.. 2148. MJB:kly 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 P.W. SCOTT ENGINEERING & ARCHIT'ECT'URE, P.C. 3871 Route 6 ' Brewster, NY 10509 E -Mail: pwscott @mn.com (845) 278 -2110 FAX (845) 278.2166 TO WE ARE SENDING YOU Attached ❑ Under separate cover via 'I ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ RE: ❑ Samples JOB NO. the following items: ❑ Specifications THESE ARE ,TRANSMITTED as checked below: For approval /❑ For your use ❑ As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS • Approved as submitted • Approved as noted ❑ Returned for corrections • Resubmit copies for approval • Submit copies for distribution • Return corrected prints L PRINTS RETURNED AFTER LOAN TO US COPY TO SIGNED: if enclosures are not as noted, kindly notify us at once. RIPTION THESE ARE ,TRANSMITTED as checked below: For approval /❑ For your use ❑ As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS • Approved as submitted • Approved as noted ❑ Returned for corrections • Resubmit copies for approval • Submit copies for distribution • Return corrected prints L PRINTS RETURNED AFTER LOAN TO US COPY TO SIGNED: if enclosures are not as noted, kindly notify us at once. P.W. SCOTT ENGINEERING & ARCHITECTURE, P.C. 3871 Route 6 Brewster, NY 10509 E -Mail: pwscott @rcn.com (845) 278 -2110 FAX (845) 278.2166 TO ` �C WE ARE SENDING YOU XAttached ❑ Under separate cover via > ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ 1194IffIgQ OCR DATE �. JOB NO. I ATTENT N RE: i the following items: ❑ Samples ❑ Specifications THESE ARE TRANSMITTED as checked below: For approval ❑ For your use ❑ As requested ❑ For review and comment ❑ FOR BIDS DUE REMARKS COPY TO ❑ Approved as submitted • Approved as noted • Returned for corrections El • Resubmit copies for approval • Submit copies for distribution ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: z5r.- /f enclosures are not as noted, kindly notify us at once. NO,= INS P.W. Scott email: Dwscott2(a-)comcast.net Engineering & Architecture, P.C. 3871 Route 6 (845) 278-2110 Brewster, NY 10509 FAX (845) 278-2166 May 19, 2008 Mr. Michael J. Budzinski, PE PCDOH I Geneva Road Brewster, NY. 10509 RE: Mill Subdivision — Lot #2 (T) Patterson, TM #3-1-80.2 Dear Michael: In response to your letter of May 15, 2008, enclosed please find 3 copies of the Trench Plans you requested. Should you have any questions, please feel free to contract this office at your earliest t, PE, RA. ARCH ITECTURE *ENGINEERING *SITE PLANNING SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health May 15, 2008 P.W. Scott Engineering 3871 Route 6 Brewster, NY 10509 Dear Mr. Scott: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health RE: Application to Construct a Subsurface Sewage Treatment System for Robert Mill at Lot # 2- Mill Subdivision (T) Patterson, TM # 3 -1 =80.2 The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on May 15, 2008 is incomplete. Please be advised that the following information is required before the Department may commence its review. �wo (2) sets of "Trench Plans" are to be submitted to accompany the "Fill Placement Plans" previously submitted. The review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information as to the completeness of your application. Please be advised that failure to submit information to the Department or to follow procedures is sufficient grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed Regulations and Putnam County Department of Health regulations. Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130 ext. 2148. MJB:kly 7ichael pectfull J. Director of 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 BRUCE R FOLEY Public Health Director LORETTA MOLINARI RN., 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 DELEGA TED ---5�5 PROJECT: 0 V I 1 TOWN: C SE P�K PV DATE SUB'D APPROVAL: q_-Z( :12Z NOTICE OF COMPLETE APPLICATION DATE: PUTNAM COUNTY DEPARTMENT OF * MALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of _ 111 arx iI t1 "L Located at OV 04m1C ( . 0 V- j &t„j Tax Map # 5 Block ��� Lot 90. 2- Subdivision of N i tj- 9J1Z `- Subdivision Lot # 2„r, Filed Map # Date Filed Gentlemen: This letter is to authorize Q_ lJ. S,o-tL.yZ4 a duly licensed Professional Engineer or Registered Architect to apply for the required wastewater treatment and/or water supply permits) 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. Countersigne . Mailing Address .81 f .gQet, g State Zip j_aA Telephone: 1q5' --.1 &-- a i 10 Very truly yours, Signed: (Owner of P,opm Mailing Address: a Rocco 4bv i ye.• StatcG✓ Zlp 1 Telephone: 8 I.1 Q -� FcM LA -97 L .n {�1 AM COUNTY DEPARTMENT OF HEALTH N OF ENVIRONMENTAL HEALTH (�L SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at 6012pl A04D Town or Village pA- 772--'yLSO-A) Subdivision name Al IL t, St)6 Subd. Lot # 2 Tax Map 3 Block / Lot 86. Z Date Subdivision Approved O q ZaffLo / Renewal V/ / Revision Owner /Applicant Name 4013e7e -r Nei t u, Date of Previous Approval &41 o Mailing Address , Z KQC,-_0 DP,_j I%LT 6t&-- .J S 7Z-,-Y . /IJ V Zip v 5-0 C1 Amount of Fee Enclosed Building Type &�3 roc C— Lot Area 3. 03 (� No. of Bedrooms q Design Flow GPD U C7 A� Fill Section Only Depth -� , 5 , Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and /,a SLR G ate. Other Requirements: To be constructed by % S D Address Water Supply: Public Supply From Address or: _ Private Supply Drilled by M iLL, I7let L_c_i AJ Address N y /050 I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewagg 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 thereto. Signed: c-�` - P.E. 2!C. R.A. Date f 5-11 k Address g-71. ,ed d 7Y 13 P2eZJ S T LEK License # Q S 2.3 y(� -- APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. Approve or discharge of domestic sanitary se age only. By: ( Title: Date: Y'� White copy - HD Fi e- Ye ow copy - Building Inspector; Pink copy - O e copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL Aron -�A-T, please print or type PCHD Permit # P % - O 2— Well Location: Street Address: Town/Village Tax Grid # Date of Expiration _. ­0 V -cl /30"icic. AV PA -77Z�-�hJ Map 3 Block / Lot(s)30, L Well Owner: Name: Address: X0106-)e.r- Jm < Lt- /vGC.0 99J tk5 62.a—,o/ 57��2) J Use of Well: _ Residential Public Supply Air /Cond/Heat Pump rrigafion 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5— . gpm # People Served 5- Est. of Ddily Usage JS gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision. ...... Yes ?c No Name of subdivision M i w 5060 i Ji s t Lot No. 2 Water Well Contractor: m tt_c, U124t.4_, ,,t1�, Address: ponVA-r, Pry&- , ✓5 2 1 sh -�P, �', x I - `114 -blic Water Supply available..to site? .................................. ............................... Yes No >e Name of Public Water Supply: /iA Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: 5 1 (� Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. . / X - Date of Issue `b Perini Date of Expiration _. ­0 V Title: Permit is Non - Transferrable White copy - HI) file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller i Form WP -97 �ttti, 5vc-Diul6100 27'6^ ►I 27'6" a4'o^ BATH BEDROOM 4 BEDROOM 3 1 O 10.0" X 9'6" OI BATH 10'8" X 13'0" BEDROOM 1 BEDROOM 2 14'2" X 16'6" 14'11" X 13'0" OPEN TO FOYER BELOW G B T H A3 FKITCHEN o The Manchester DINING ROOM - MORNING ROOM Plan No. 544 ■ 2420 SQ. FT. 12'10^ X 12'11 ^ 10'3^ X 12'11 ^ 12'9" X, 12 11 ^ Large rooms provide more than adequate space in this four .__. ....... ... ... bedroom home featuring open === = = = = == _: ` - - - - - -- foyer, first floor laundry area, formal living and dining rooms i and master bedroom suite with LIVING ROOM private bath. 17'4" X 12'11" FAMILY ROOM FOYER 14'2 ". X 12'11°" ' PUTNAM COUNTY DEPARTMENT OF HEALTH BO E PLANS APPROVED FOR BEDROOM MCOUNT UINLY, BEDROOMS ALL SUBSEQUENT REVISIONJALTERATIONS TO - r,:,SE HOUSE cc P NS MUST BE SUBMITTED TO THE PCDOII CUR JAPi•i(OVAL i ��f . SIGNATUR & TIT DATE. > • OF NE��. P.W. SCOTT ENGINEERING & ARCHITECTURE, P.C. 3871 Route 6 Brewster, NY 10509 E -Mail: pwscott @rcn.com (845)x, 2`78 -2110 FAX (845) 278 -2166 TO 61 1�h/L� r0lffulgQ OF VnZr, H@W0UU,%1L ,_ ` ��'yy DATI5: / / V JOB NO. ATTENTION RE: // It 04 WE ARE SENDING YOU PiOttached ❑ Under separate cover via the following items: ❑ Shop drawings �< Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION // It 04 P sor - seq �- 1-14ZJ5 p co O-G 41W72 e- THESE ARE TRANSMITTED as checked below: ❑ For approval For your use s .. ❑ As requested ❑ Edr review and comment ❑ FOR BIDS DUE REMARKS U-) • Approved as submitted ❑ Resubmit copies for approval • Approved as noted ❑ Submit copies for distribution • Returned for corrections ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: ' !f enclosures are not as noted, kindly notify us at once. ICI l L - - 04/28/2006 , 15.:.53. 84527954/5 8452782166 P. 02/02 Nr►t- i= 2i0t�b 03* 13 P.J. SCOTT PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of lZa�rr l� �u Located atQ Ov P Tax Map # ?j Block _,I Lot ?0. 2 Subdivision of h&t t.a. sot, Subdivision Lot # Filed Map # Date Filed Gentlemen: This letter is to authorize IE 0. S<p-m e;04, -(. A1W a duly licensed Professional Engines 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. Countemigne . P.E., R.A., # -- Mailing Address d,�7 f 1?&Mr (d' State Zip 570 Telephone: _ y5=a. a - a i 10 Very truly yours, Signed: (Owner or pmpaw) Mailing Address: a RO c o �✓ , �� State GWs✓ N Zip 10 S Telephone: Form LA -97 TOTAL P.02 s, 711 PUTNAM COUNTY DEPARTMENT `OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ` :";,CONSTRUCTION PERMIT FOR SEWAGE TREATMENT" SYSTEM PERMITr 1 N Town or Village < ';' "` 4! o rte. Subdi sion name 1-4 / t,, '5c16 Subd. Lot # Tax Map Block _ Lot : Date Subdivision Approved' .';ti ;r Renewal Revision Owner /Applicant Name ; > t:..4r Mid Date of Previous Approval �� „�» Es'.e =� t�'`.► `'r°w' i� Zip Mailing Address ,G. , �`j � �:�?�� i ` ;tom ?f Amount of Fee Enclosed Building Type Lot Area 4 ,0 No. of Bedrooms 4— Design Flow GPD s Fill Section Only Depth Volume - PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED =Separate Sewerage System tem to consist of 1� gallon septic tank and / ;� 5 A Other Requirements:,' To be constructed, by r % Address Water Subnly: Public Supply From Address or: Private Supply Drilled by `° /7, . ,,, -, t', a 7 Address i 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 sy tem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or, assigns by the builder, that said builder will place in good operating condition any. part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. .P ned: �,� P.E. r r R.A. Date t c. Address 645 . + 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 iiay'be amended or modified when cote idered necessary by the Public Health Director. Any revision or alteration of the approved plan .requires• .. a new permit:'` proved for )4t charge ofd mestic sanitary sewage nl a. By: Title: JA Date: A d White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 . ,o. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL ? please print or type PCHD Permit # �10-- �' Z Well Location: Street Address: TownNillage Tax Grid # IN ( "Ij ; P?�r,6( Map 3 Block Lot(s) e'c , Z Well Owner: Name: Address: %`', l�= 'c -tom. f..- � °ilL,%.- �7 j`GGC � �:��2 /V f ��r���_.,.�..� iT�- � '� • ;�'' 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 Est. of Daily Usage`j a, f al. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling Y., New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type: Drilled Driven Gravel Other Is well site subject to.flooding? ..... ............................... .......... ............................... Yes No y Is well located in a realty subdivision? ...................................... ............................... Yes __L_ No Name of subdivision �� �' - -+.- ;, � -` cJ � %. /'�;! ..� Lot No. `�- Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No T� Name of Public Water Supply: 1A)'/ ;f� TownNillage Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: * q Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED _FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well: driller certified by Putnam County. /�' Date of Issue 6 //a/c, , Permit Issuing Official-. - / Date of Expiration f (> ! - Title: Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller 4 Form WP -97 Y TO P.W. SCOTT ENGINEERING & ARCHITECTURE, P.C. 3871 Route 6 Brewster, NY 10509 E -Mail: pwscott @rcn.com (845) 278 -2110 FAX (845) 278 -2166 WE ARE SENDING YOU Attached ❑ Under separate cover via • Shop drawings ❑ Prints ❑ Plans • Copy of letter ❑ Change order ❑ MUTE 193 @T U � ° LNULI'Lly OUITZ UL DATE •� D JOB NO. ATTENTION RE: ❑ As requested ❑ For review and comment ❑ the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION S; -5 I -o V /S5v G.4>- -3I �h e I,- THESE ARE TRANSMITTED as checked below: fx For approval ❑ For your use ❑ As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS COPY TO ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: If enclosures are not as noted, kindly notify us at once. 91191FROM P.W. Scott email: pwscott(iDsuscom.net OffffifflISM Engineering & Architecture, P.C. 3871 Route 6 845 278 -2110 Ilk Brewster, NY 10509 - FAX (845) 278 -2166 May 3.1, 2006 To: Mike Budzinski, PE PCDOH Fax: (845) 278 -7921 Re: Robert Mill Subdivision Lot #2 (T) Patterson TM #3 -1 -80.2 Dear Mike: Enclosed are revised plans in response to your review letter of May 24, 2006. 1. Soil legend coordinated between legend and plan. The soil demarcation is along the front of the site with the soil line approximately parallel to frontage. 2. The absorption field layer is turned off. The plans have been reprinted with 6/3/06 revision date. Should you have any questions, please feel free to contact this office at your earliest convenience. With gards, Peder W. Scott, P.E., R.A. President A R C H I T E C T U R E * E N G I N E E R I N G * S I T E P L A N N I N G SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Peder Scott, PE 3871 Route 6 - Brewster, New York 10509 Dear Mr. Scott: DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 May 24., 2006 ROBERT J. BONDt . County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Proposed SSTS Renewal for Robert Mill, Mill Subdivision, Lot # 2 (T) Patterson, TM# 3 -1 -80.2 This Department has received and reviewed the submitted application and plans for the above referenced project and the following comments are offered for your consideration. �-/L The soil legend identifies two soil types although the soil boundaries and types are not identified on the plan. 2. The absorption trenches are not to be shown on the "Preliminary Design for Fill Placement" plan. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. MJB:cj Respectfully, Michael J. ] Director of 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 a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREA- TMI&N -T, TEM PERMIT # 7 ©Z L;` j31o��iJ Located at Town or Village Subdivision name A4 f 1,� 5y,6 Subd. Lot # 2 Date Subdivision Approved Owner /Applicant Name 40, 2f MfL(� Mailing Address 12 )R-0C&,9 yxi y f. , ,812� Tax Map -3 Block Lot 90,'Z Renewal ✓ Revision Date of Previous Approval .J Zip D5® Amount of Fee Enclosed �t 5OO. ov Building Type Lot Area3, 03A, No. of Bedrooms Q- Design Flow GPD 9J' Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System tem to consist of /',-5�tq gallon septic tank and /'750 6 -L - Other Requirements: To be constructed by T 15 P Address Water Supply: Public Supply From Address u a f� , ,a,o ,4- �/ or: _Private Supply Drilled by N%; LL %2`i / % /vLp Address 7-iv - e =n-4a I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: P.E. R.A. Date h ko c Address 3 671 F OL/R s 6,2QdS1-6X A -1 License # 05 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 �a idered nece sary by the Public Health Director. Any revision or alteration of the approved plan requires a new permi . A :je/ f harge of omestic sanitary sewag nly. By: Title: JA:� Date:' a 6 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL 9-P-1VQ4✓Ak.' please print or type PCHD Permit # P / Z Well Location: Street Address: Town/Village Tax Grid # 1/Gjl(iiL gAp 2'1�� Map 3 Block % Lot(s) g©. Z Well Owner: Name: Address. �L��IZT Hitt' 'z /ROCCO 'Opawc ; .8gaL"" _tZ Al 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 _� Est. of Daily Usagej5A gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No_ Is wel located in a realty subdivision? ...................................... ............................... Yes No Nameof subdivision M i i.L 5L/j6,0/ u'JS /CK1 Lot No. Water Well Contractor: _bQ t6i' o!- / & Address: ea:':A ,Qry ,4yf, Is Public Water Supply available to site? .............................. Yes No Nam €of Public Water Supply: d ht Town/Village Distance to property from nearest water main: ljz Propped well location & sources of contamination to a provided on separate sheet/plan. Date: 5 'f U q Applicant Signature: Yo S,� PERMIT TO CONSTRUCT A WATER WELL This iermit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putran County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that vithin thirty (30) days of the completion of water well construction, the applicant or their designated reprv-,ntative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requiements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provied by the Putnam County Health Department. During all well drilling operations, the applicant and/or well triller shall take appropriate action to assure that any and all water and waste products from such well'a'illing operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. "IROVED_FOR CONSTRUCTION: This approval expires two years from the date issued unless consuction of the well has been completed and inspected by the PCHD and is revocable for cause or may be ameied or modified when considered necessary by the Public Health Director. Any revision or alteration of thapproved plan requires a new permit. Well to be constructed by a water 6 driller certified by Putnam Coury. Date>f Issue /0,/ (� Permit Issuing Offs Datof Expiration- b Title: Perit is Non- Transf raby Whi;copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 y 27's M r;: 44'0" - —� - EX 3 DINING ROOM MORNING ROOM 12'10" X 12'11^ ' KITCHEN 12'9" X 12'11" 10'3" X 12'11" LIVING ROOM 17'4" X 12'11" FAMILY ROOM FOYER 14'2" X 12'11" 44'0" UBATH2 L EDROOM 4 BATH BEDROOM 3 '0" X 9'6" OI 2 10'8" X 13'0" of !7'6" ■ ��----- BEDROOM 1 BEDROOM 2 14'2" X 16'6" 14'11" X 13'0" P..FO'YCVER PEN TO BELOW The Manchester Plan No. 544 ■ 2420 SQ. Fr. Large rooms provide more than adequate space in this four bedroom home featuring open foyer, first floor laundry area, formal living and dining rooms and master bedroom suite with private bath. ?LANS AM COUNTY DEPARTMENT OF HEALTH APPROVED FOR BEDROOM COUNT ONLY, qFCDROOMS _ \�l 4; Q ALL SUBS JL•NT RFVh'ON A:.. ( ?: TO T11C., H IS a _ PLANS b*" SUIT •' 1'EI1 'i:i ,_. PCDOii FOR A' li 1 J < STCNAT Rl's 4 TITLE ll• OF ZAZ N vj\ Ill lz 41 a � 1 \ tv, 00 14 :. •, "� / rr! I t I t� V �A / / /' � � : \ � \ � � i •� ' I j / / IV � � 1,1 � ! OL? /* 00 141 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT. # fJ� / > 2—_ Located at i"' t;, 1) ; <_ �e ;,:L oA t Subdivision name �� , t ti.,. s�; Subd. Lot # Date Subdivision Approved on Z Town or Village i 11, -� --.. , Tax Map -'-�^ Block i Lot - �,, i ?- Renewal Revision Owner /Applicant Name ; - Date of Previous Approval `e, Mailing Address . ..,.,. —' P.� 4 Zip =-` T C) , Amoun ;of F# Enclosed a Building Ty *- s ;3, �:.�' Lot Area o- t; No. of Bedrooms Design Flow GPD t A� Fill Section Only Depth 2 . Volume Y� ;u PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED y . 1, co Senarati Sewerage System to consist of i 2 c3 ,n gallon septic tank and i .,_:; c A 1 010 Ci A�10 io 1 ;eF i;y't�lt" `;1CF Ci.i=a j l.7 N r, d- � .. t •,_,r7 r Other Requirements: - C' ; �� 4� C. To be constructed by ; t .,�, Address .� Water Supply: Public Supply From Address or :_ Private Supply Drilled by Address rte, h A J X07 I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished thb owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period, of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs. thereto. Signed: P.E. R.A. Date i Address License # ? C 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 ecessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved discharge of domestic sanitary sewage only. By: ` /'?/a/ , %'f/i� Title: Date: ';a I t White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 ... .�..1 dvr.,� � ,ib'"`tcvrt'q w;,t.! -iY �i^:.+•- eyjcr ^O:+tiM;`ieo:2ci'- 'is...vl';. ;.J.,. .... .- .:+«,. - ...... o .- .. . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # Well Location: Street Address: Town/Village Tax Grid # Map 3 Block % Lot(s) E?O. I Well Owner: Name: Address:. Use of We1F '' a Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- sec ondarf-^ Industrial Institutional Standby Amount of Vse Yield Sought gpm # People Served _5 _ Est. of Daily Usage 430 gal. Reason for Replace Existing Supply Test/Observation Additional Supply CA Drilling:: >- New Supply (new dwelling) Deepen Existing Well Detailed Rekibn 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... Water Well Contractor: ail l L.1. -DR 11.4-1 V C. Address: 1' Vf w a Pi A vfc hit,;' r ,► S i—e R NJY + Is Public Water Supply available to site? ..........................:....... .........:..................... Yes No Name of Public Water Supply: ly 1 A Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to; be.provided on separate sheet/plan. Date: 7-12aloZ Applicant Signature: t PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water,is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the` Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue O Permit Issuin Ocial: L4-1 Date of Expiration Tf �' (d' Title: Permit is Non- Transf rrabk b -; White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Fnrm WP -97 `1 Wilbert W. c, Faith Will 2 Rocco Drive Brewster, N Y10509 .845- 279 -2418 May 17, 2004 Putnam County Health Department 1 Geneva Drive Brewster, NY 10509 To Whom It May Concern: Re: Mill Septic Renewal Peder W. Scott requested that I send the balance of $100.00 for Mill Septic Renewal, file # P -7 -02 directly to the Health Department. This is for Lot #2 - 29 Burdick Road Patterson, NY 10563. If you have any questions, please do not hesitate to call. Thank you. Sincerely, , Robert M. Mill £0 -*Z1 Wd L I AN W 11 ,q I:fid P.W. SCOTT ENGINEERING & ARCHITECTURE, P.C. 3871 Route 6 Brewster, NY 10509 E -Mail: pwscott@rcn.com (845) 278 -2110 FAX (845) 278 -2166 TO WE ARE SENDING YOU Attached ❑ Under separate cover via • Shop drawings ?' Prints ❑ Plans • Copy of letter ❑ Change order ❑ d guullg n W DATE a JOB NO. ATTENTION RE: SOP775: `2_eXJ0 .J/q­(_) 44-)7_ #- - oz the following items: ❑ Samples ❑ Specifications THESE ARE TRANSMITTED as checked below: • For approval • For your use ❑ As requested For review and comment ❑ FORBIDS DUE REMARKS • Approved as submitted • Approved as noted • Returned for corrections • Resubmit copies for approval • Submit copies for distribution • Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO SIGNED: if enclosures are not as noted, kindly notify us at once. �• DESCRIPTION 94M im THESE ARE TRANSMITTED as checked below: • For approval • For your use ❑ As requested For review and comment ❑ FORBIDS DUE REMARKS • Approved as submitted • Approved as noted • Returned for corrections • Resubmit copies for approval • Submit copies for distribution • Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO SIGNED: if enclosures are not as noted, kindly notify us at once. RE: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION Property ofi�'r Located at ov fz�ma4 Tax Map # , Subdivision of M 1 w 15'(A62, Subdivision Lot # Gentlemen: J Block Filed Map # Date Filed Lot s This letter is to authorize r L (Io ik. a duly licensed Professional Engineer V 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. Very truly yours, r Countersigned: Signed: P.E., R.A., # _� (Owner of Property) Mailing Address 50-71 rmfe- (o' State Zip 0 � 0 Telephone: 0 45 - 2 M .. I j ho Mailing Address: $- x(160 PJZtVIt, �ew,�e� ,�✓��py�J State Telephone: Zip Form LA -97 BRUCE R. FOLEY Public Health Director TO: DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of . Patient Services Environmental Health (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 DEPARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM DELEGATED PROJECT: 1Hl // �fi z TOWN: C S P PV DATE SUB'D APPROVAL: /�Z —Z —�� NOTICE OF COMPLETE APPLICATION DATE: v s� f PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL p please print or type PCHD Permit # ! Ci Well Location: Street Address: Town/Village Tax Grid # Xq bU aD LC (- "A-f) P &TTW--�) Q 0 Map 3 Block / Lot(s) 196.2 Well Owner: Name: Address: 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 gpm ' # People Served _. Est. of Daily Usage Jgal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason N C-_w 9�e--s k p L:3.� A-t_ w :50 P p for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No >x ...................................... ............................... Yes No Is well located in a realty subdivision ?_ Name of subdivision m t l i_ Lot No. _ Water Well Contractor: M1 LL, �bR.lLj_1NG Address: rur>J A," P(Vt . Bim_k , —E2rNY 10, Is Public Water Supply available to site. Yes No Name of Public Water Supply: N I fir Town/Village Distance to property from nearest water main: A' Proposed well location & sources of contamin:VZded on separate sheet/plan. Date: Z ?.� o 2 Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a watLedriller certified by Putnam County. D Date of Issue Permit Issuing ial: Date of Expiration Title: Permit is Non- Transferr ble White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENti'IRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: STREET LOCATION: REVIEWED BY: P-M, OR, AS, SRDATE: _ Y Ni DOCUMENTS PERMIT APPLICATION )WELL PERMIT OR PWS LETTER PC -97 LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) ( "CORPORATE RESOLUTION (SHORT EAF (� PLANS -THREE SETS TAX bLAP =: (CONMNIED) Y%, ( REOUIRED DETAILS ON PLANS CONT'Dl HOUSE SEWER -' '/�" FT. 4"0'; TYPE PIPE CAST IRO_ N NO BENDS; M.AX BENDS 451 WICLEANOUT RENEWALS OSITE NOTE (NO CHANGE) FILL SYSTEMS —) 10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE d )FILL SPECS! FILL NOTES 1 -5 UUHOUSE PLANS -TWO SETS FILL PROFILE & DIMENSIONS UUWARLANCE REQUEST iti EXPANSION AREA / SUBDIVISION FILL GREATER TH4: \'2 FEET CZ LEGAL SUBDIVISION SUBDMSION APPROr CHECKED i�PERC RATE _ U(�FILL REQUIRED DEPTH Z U(DCURTAI1N DRAIN REQUIRED GENERAL LOCATED IN NYC WATERSHED PLANS SUBMITTED TO DEP DELEGATED TO PCHD $DATA DEP APPROVAL, IF REQ'D DEEP TEST HOLES OBSERVED PERCS TO BE WITNESSED EX- APPROVAL SSDS ADJ, LOTS WETLANDS (IOWN/DEC PERMIT REQ'D ?) ON DDS PLANS & PERMIT SAME UPRE 1969 NEIGHBOR NOTIFICATION LETTER BUZBA 100 YR. FLOOD ELEVATION W/I200' (—)(--,)SOIL TESTING LOTS >10 YEARS OLD (_-V JSEWAGE SYSTEM PLAN - (NORTH ARROW) (-__) ODS HYDRAULIC PROFILE . RAVITY FLOW _ ONSTRUCTION..Iv'OTES 1- 15.... _---- _- - -. - -- -. -- (� D SIGN DATA: PERC & DEEP RESULTS CONTOURS EXISTING & PROPOSED If DRIVEWAY & SLOPES, CUT FOOTING /GUTTER/CURTAIN DRAINS USDA SOIL TYPE BOUNDARIES )TITLE BLOCK; OWNERS NAME ADDRESS TNM, PE/RA; NAME, ADDRESS, PHONEN DATE OF DRAWING/REVISION (L) DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS (� LAKES,WETLANDS WITHIN 200' OF P.L. PROPOSED FINISH FLOOR AND 9C_JEROSION,CONTROL ASEMENT ELEVATIONS ELLS & SSDS'S WIIN 200' OF SSTS ROPERTY METES & BOUNDS FOR HOUSE, WELL SSTS, EROSION CONTROL NOTE CObIlN1ENTS: (REVSHEET)09 101 100 CLAY BARRIER FILL CERTIFICATION NOTE. (� DEPTH GAUGES VOL. ON PLAN FOR RO.B.,UNCLASSIFIED & IMPERVIOUS USEPAR.ATION DISTANCE FROM TOE OF SLOPE 01�vLF TREN TRENCH PROVIDED 6OFT MAX. PARALLEL TO CONTOURS - - a 1001TEXPA\SION PROVIDED DETAIL/DUST FREE CRUSHED STONE OR WASHED. GRAVEL I GEOTMILE COVER SEPARATION DISTANCES ON PLAN = FRONT SSTS . 10' TO P.L. DRIVEWAY, LARGE TREES,.TOP OF FILL 20' TO FOUNDATION. WALLS 100' TO WELL, 200' L`i DLOD,150' TO PITS C�100' TO STREAM, WATERCOURSE, LAKE (inc. exp,ati) 50' To CATCH BASIN, 35' STOR- •IDRAIN, PIPED WATER 10' TO WATER LINE (pits - 20') CZZLj50'INTERmrrTENT DRAINAGE COURSE 200'/500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS UU10' MhN TO LEDGE OUTCROP SEPTIC TANK (�� 10' FROIl FOUNDATION; 50' TO WELL WELL _..__.. __. }TENSIONS TO PROPERTY-LINES LOCATION OF SERVICE CONNECTION MEN 15' TO PROPERTY LINE SLOPE SLOPE IN SSTS AREA (520 %j UUREGRADED TO 15 %, IF REQUIRED DOSE/PU'NlP SYSTEMS PUMP NOTES (� DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED /)DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) PIT AND D -BOX SHOWN .& DETAILED C__)L,jl DAY STORAGE ABOVE ALARM CURTA ' DRAIN U STANDPIPES, 5' BOTH SIDES, DETAIL (�1, AIIN to CDS = >S %, 20'4 %, 25' -3 %, 35' -1 %0,100 % -<1 %. & (_J(J20' bIIN to CD DISCHARGE /100' tivith 182 cons day discharge ( J( )10' NO to NON - PERFORATED PIPE P. W. SCOTT Engineering & Architecture, P.C. 3871 Route 6 BREWSTER, NY 10509 E40all: pws @bestweb.net (845)278 -2110 FAX (845) 278 -2166 TO M-1 Cy WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ RAcTUMQ OF U n ° 1M WU 0 L� I DATE JOB NO. G ATTENTICJIN RE: ISO the following items: ❑ Samples ❑ Specifications I THESE ARE TRANSMITTED as checked below: ❑ For approval • For your use • As requested • For review and comment ❑ FORBIDS DUE REMARKS COPY TO • Approved as submitted ❑ Resubmit copies for approval • Approved as noted ❑ Submit copies for distribution • Returned for corrections ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED:C�/ 4:r� If enclosures are not as noted, kindly notify us at once. r DESCRIPTION • • ,16 a _ s _ I I THESE ARE TRANSMITTED as checked below: ❑ For approval • For your use • As requested • For review and comment ❑ FORBIDS DUE REMARKS COPY TO • Approved as submitted ❑ Resubmit copies for approval • Approved as noted ❑ Submit copies for distribution • Returned for corrections ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED:C�/ 4:r� If enclosures are not as noted, kindly notify us at once. r IWO P. W. SCOTT Engineering & Architecture, P.C. 3871 Route 6 BREWSTER, NY 10509 E -Mail: pws @bestweb.net (84,,5;P278 -2110 FAX (845) 278 -2166 TO X11 \1�s? �iC'�Zc�1SIG� . c. LA WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via _ ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ a0 _' a LLIETTIgn O V o V @V0VVR A[L DATE � a� o JOB NO. ATTENTION RE: o .G �_. the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION o J THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted • For your use • As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS ❑ Approved as noted ❑ Returned for corrections • Resubmit copies for approval • Submit . copies for distribution ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO SIGNED: if enclosures are not as noted, kindly notify us at once. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES RE; Property of Located at LETTER OF AUTHORIZATION 0 T/V p,gr p�_ Tax Map # 3 Block I Lots 2--- Subdivision of WU SUAXAS Subdivision Lot # c Filed Map # Z960 Date Filed Cq z8 /,'/ Gentlemen: This letter is to authorize pc' - (,j a duly licensed Professional Engineer _�< or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Cou fined: P.E., R.A., # Mailing Address��% State Zip (os Telephone: 75 -a 7$ r)1/ Very truly yours, Signed: (Owner of Property) Mailing Address: GCC Uc^ y State I J Zip 10 �Q Telephone: N -d 7q :S©"'' 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: R'z', (b 02-7 VV'_ k L-L.- �2_ 2 oc DQA("(E ,3r e�ki s N (o 70 9 2. Name of project: Mir 5'cPRC_ I_oT-tt= 2 3. Location T/V: �� << t�-�e5 0A], 4. Design Professional: F. ua . s ccrg —F7J c, 5. Address: _3 8' 7 I rZ-dor 6 6. Drainage Basin: EA,,5r 13RANC.AF pe, e;e uo�iZ f�C �s i z , ►Jy to sU Cl 7. Type of Project: _ Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... ►.�o 10. Has DEIS been completed and found acceptable by Lead Agency? ..........:.... 0 11. Name of Lead Agency PA �� p L +,�N i nt 1B 0 2� 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... L S 13: If so, have plans been submitted to such authorities? ........ ............................... Y� s 14. Has preliminary approval been granted by such authorities? L�j Date granted: s 2,O Co 15. Type of Sewage Treatment System Discharge ................. surface water __,X, groundwater 16. If surface water discharge, what is the stream class designation? .................... LS A 17. Waters index number (surface) ........................................... ............................... N A 18. Is project located near a public water supply system? ... . ............ :...................... �j o 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ 90 21. Name of sewage system 0 /A Distance to sewage system *IA- '/ 22. Date test holes observed 23. Name of Health Inspector H, 24. Project design flow (gallons per day) ................................. ............. ................... x1010 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... NO 26. Has SPDES Application been submitted to local DEC office? ' ,4 Form PC -97 t, It 27. Is any portion of this project located within a designated Town or State wetland? No 28. Wetlands ID Number ............................................................ ............................... LI 29. Is Wetlands Permit required? .............................................. ............................... N Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ............................... t3 c) 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 0 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 �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? ................................ ............................... t4o 35. Are any sewage treatment areas in excess of 15% slope? . ............................... N10 2 36. Tax Map ID Number .......................... ............................... Map 3 Block I Lot. 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 statements made herein are punishable as a Class A misdemeanor pursuant to Sectli)210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: g��) r9.C. Mailing Address: ................................... 3 � 7 I 20 o-r-c-- Co 1320 PUTNAM COUNTY DEPARTMENT OF HEALTH ^ l DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner ^� f� ff' %:Ain4 114tLL Address s .vas cs��,,,E, -• s Located at (Street) ��,,_�,;�K .�'��n Tax Map _ Blocky_ Lot LW, L (indicate nearest cross street) Municipality /,�'rr�f'�,^, Drainage Basin Ldr 2 SOIL PERCOLATION TEST DATA Date of Pre - soaking i /�/ /c7�- Date of Percolation Test /�Z9/I�' Hole No. Run No. Time Start - Stop Elapse Time (INfin.) Depth to Water rom Ground Surface (Inches) Start Stop Water Level Drop n Inches Percolation Rate Min/Inch _ 1 !nom - vyle - ; /Z. / Z5'% .4 5 Z 3 2 n 2 2 — , 1z 3 12, —f2; rr Z 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. 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 , ft D== G.L. 31 41 51 71 81 10, r1l 1,LX S GD 11' TTY T PIT DATA RE00= TO BE S-uEMI• APPIrIC-ITION DES"—=ION OF SOILS a\1CCUNT= IN 'MST HOLES HOLE NO HOLE NO. '2- Z H= NO. r. L°AN ToPSCI1. -P, LZ4M -ro1L- 5,A�Hc> Y 441z1kVa-- IZeo seowl'i txAm -7-0 V-F- D 6V-g\i1 N LiAM . F-50T-fom o F F I T 4:f 1 SANDY cnizAvr-L- '27.Ti iZQLI� TTv M 121 13' 14' n7DIC= I= AT WHIG GRXMZ = IS ENCOUNTERED nMj= I= m walca wA= IZVM RISES AF= BEING E=UNMPM DEEP HOLE OBSERVATIONS MADE BY: M 7 %JDZjHe�,V--1 FI-40 J V-,NwrA F*S DATE: DESIGN .Soil Rate Used Min/l'- Drop: S-D. Usable Area Provide-4 o No. of Bedrcans Septic Tank Capacity 1Z 5-J gals. Type 6,ce, c Absorption Area Provided By L.F. x 24" width trencin Other V. f j 10. Name Ze,,-g. Signature Address 50 5 'pop r THIS SPACE FOR USE BY sEALTH DEPAEM= ONLY: Soil Pate Apprcv(ar-4 sq-,f t/gal. Checked by Date P.W. SCOTT ENGINEERING & ARCHITECTURE, P.C. 3871 Route 6 Brewster, NY 10509 E -Mail: pwscott@mn -com (845) 278-2110 FAX (845) 278 -2166 TO WE ARE SENDING YOU ❑ Shop drawings ❑ Copy of letter [Attached ❑ Under separate cover via _ ❑ Prints ❑ Plans ❑ Change order ❑ DATE A JOB NO. ATTENTION RED. G i r—_.D_�L__ -P the following items: ❑ Samples ❑ Specifications COPIES DATE NO.. DESCRIPTION G i r—_.D_�L__ -P THESE ARE TRANSMITTED as checked below: ❑ F r approval For your use • As requested • For review and comment ❑ FORBIDS DUE REMARKS ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints C.] PRINTS RETURNED AFTER LOAN TO US COPY TO ;.r SIGNED: if enclosures are not as noted, kindly notify us at once. 14-164 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 SEOR Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME iY 3. PROJECT LOCATION: Municipality 0.IV County 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) 5. IS PROPOSED ACTION: New ❑ Expansion ❑ Mod if icationlaiterat ion 6. DESCRIBE PROJECT BRIEFLY: l 2,,E�o 6.4l— s °Tl G TA t V--, 1273v CAL- -F U M P C4A, C_51r-tZ Q A1i� 40,0 L r 24 +� bt)1 Ui_ —(�fNC 5 Z ' (D n Ot t.t_ �ui2V tzGL) 7. AMOUNT OF LAND AFFECTED: 0 4-6 0, 4-10 Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING.OR OTHER EXISTING LAND USE RESTRICTIONS? lYes ❑ No It 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 11. DOES ANY ASPECT OF THE ACTION HAVE A,CURRENTLY VALID PERMIT OR APPROVAL? ® Yes ❑ No If yes, list agency name and permlUapproval Vj� Y rLI 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑ Yes ONO I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicantisponsor l �'� �-�� Date: 9,100 10 Z- name: 1 Signature: lh�� If the action Is In the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER PART 11 ENVIRONMENTAL ASSESSMENT (ro be completed by agency). A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? if No, a negative declaration may be superseded by another Involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: 0 C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified in C1-05? Explain briefly. CZ N M' < C Co C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. � P (� 9 9 Y YD g Y --c r�r? ' 1 CD D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE_ ENVIRONMENTAL IMPAC6 ?'?af CO 71F ❑ Yes ❑ No If Yes, explain briefly ixY. ' Vii,....::.... PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether it Is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (I) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on` attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title of Responsib e Officer Signature of Responsible Officer in-Lead Agency Signature of Preparer (if dif terent from responsible officer) Date 2