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Home My WebLink About0073DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdoes.com 631- 589 -8100 3.15 -1 -35 BOX 1 �ollo ., . IN I # , E �r I or , ' p 11116. P� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES x YeIIPermit # Paz WELL COMPLETION REPORT Well Location Street Address: j� /�� To n/Village: X00 Tax Map # j Ma p3� Block ` Lot(s GAPS °1 Well Owner: Name: bG V i4„Address: i � G W Use of Well: 1- Primary 2- Secondary _XXesidential _Public Supply Air cond /heat pump _Irrigation Business Farm Test/monitoring —Other(specify) Industrial Institutional Standby Drilling Equipment otary _Cable percussion Compressed air percussion —Other(specify) Well Type Screened _Open end casing _ Open hole in bedrock _Other Casing Details Total Length _jLft. Length below gradelyt. Diameter 1n. Weight per foot lb /ft Materials: teel Plastic Other Joints: Welded j hreaded Other Seal: , Cement grout Bentonite Other Drive shoe: Yes No Liner: _YesLCNo Screen Details Diameter in Slot Size Length (ft) Dept to Screen (ft) Develo ed? First I I __d_Yes _No Hours Second I I Well Yield Test _Bailed _Pumped Acompressed Air Hours 7-t– Yield 5n gpm Depth Date Measure from land surface-static specify ) uunng yield test (ft) Depth orc—o—mpi—et—el well in ft. Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter in Formation Description ft. ft. Land Surface y S t-0 If yield was tested at different depths during drilling list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth 1 L Model '��'777- Voltage Q HP 3 1 1f' Tank Type 'lN aS0 Volume 474- DateWell'Completedk� D -F P � �� ,� WeII,Dflller P.i 1NKy.e p 'K Pump lnstaller:P�C PC Ce'rt�ficate# , jrNYcState #E3Gto'f 4es - 'c Y Certiftcate # xi1-"� NY�State # 1 Date of Repo V W II Driller Name &`Address° D 5 + a ' 3 . -' s �x.n : . ' °° `' f t "'4` '->r . x?' ': a *s v.� Wgll Drilleri(stg ture} s ar d y ✓ g p Pu p Installer,Name 8�Address :. _ FP`x t Y Y' Pt.. m y` STc IN ., u' h mr„A ! Pumpinstaller (s nature) �,. .,.,�'5'"` NOTE: Exact Location of well with distances to at I ast two permanent landmarks to be pr vided 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 ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E., MPH Director of Environmental Health December 27, 2013 DEPARTMENT OF HEALTH 1 Geneva Road;. Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 Dan Donahue, P.E. 120 Breckenridge Road Mahopac, NY 10541 Dear Mr. Donahue: i MARYELLEN ODELL County Executive Re: Field Inspection — Patterson Development Burton Farm Road (T) Patterson, TM 3.15 -1 -34 The above referenced separate sewage treatment system can be backfilled. There are no open comments to be addressed at this time in reference to this Department's open work inspection. If you have any further questions, please contact me at (845) 808 -1390 ext. 43261. Sincerely, Gene D. Reed Principal Environmental Health Engineering Aide GDR:cml i I I PUTNAM COUNTY O81PARTMRNT OF IWAAL= DIVISION OF XN VER0 81 'tA1L EMALTH SERVICZA ATTFIV'"iTON FJOSEPH GZNZ For: I pill A1! Wwou bw mw be fi:tiy completed prior to any sts a �aev batinS rrtWe. it , >?CHD Cow Perm M v� Locaw., G�►�, I� ( % r T.�l f V ne /Appel" N •, ii•I Y 7i R�.b�.wl� I�..a � rllnw! Formally: I 9ub�lrniei� Nc: ,F.4 ■y J•i� Subdivision Lot M ! 9' Is iyrt+m fill pomplatrd? Is system mow? ..�,. Is system counructed as pat plans? " Is well drilled? Is weu lowad as par plans? _ Are atmion watr+al =mum in placs? N` , IIIMII�IIIN �i�Y iaY bl .��I*WYII.IMI �r Date: Date: .,_.,..........w 1 r,.Cr fy Vhk tW aysbae10), a& li ted, at tho sbw m prsmicras hm beep Abed and I love inspected and veriW their completion in acomdsa co with the !issued POW Cation Permit and aappmved piaaw ad the Standaurds, Rules and Regulshow of the Putnam County Deportment of Health. Csrti iod by: PE RA Addr acs : Com�acttts: ,,,, )~Clm PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL E09A ,TH -SERVICES FINAL SITE 1NSPECTTON Date. 311 Inspected by: Street Location ur -to 0 Axrm 12A Owner Town Permit # P- o ;2- T 13 TM # 3,16- / --3-/ Subdivision Lot # 9 1. Sewage System Area a. STS area located as per approved plans .......... :................ b.. Fill section date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped.....:. ............ ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands... .... ....:...................... :... IL Sewn 6 SLx em a: eptic tank size.- 1,000 ........ , 250 ... ..... other ................ b. "Septic tank installed level ................. .........:..................... c. 10' minimum from foundation. .......................... o' ............. d. Distribution' Boa 1. Alt outlets at ssme elevation- water.tested .... * ............. 2. Protected below frost ............. ............................... 3. . h ni,, u 2 ft. Original soil between box & trenches e. Junction Box properly set .......... ............................:.. 6. Tr_ 1. .Length required 3 9 Length installed 3 do 2. Distance to watercourse measured 4- / o ® Ft.......... 3. Installed according to plan...... .... ............................... 4. Slope of trench acceptable 1/16 - 1./32" /foot ............. 5. 10 ft. from property he - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. t Room allowed for expansion, 10.0 % ........................ 8. Size of gravel 3/4 - 1'he diameter clean ............... :..: 9. Depth of gravel in trench 12" minimum......:,........... 10. Pipe ends. .capped ................ ........................................................ g. Pumn or Dose& Systems 1. Size of pump chamber ................. ............:.................. -2. Overflow tank ....................... ..............:................ 3. marm, visuaVaudio ......:......... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baded .:.:....................... .......... ...................... 6. Cycle witnessed by H.D.estimated flow /cycle........... IIL Houseffluingn a. House locatedper approved plans .... ............................... b. Number of bedrooms ....................... ............................... iv. Well Well located as per approved plans .......:............ b. Distance from STS area measured ft........... c. Casing. 18" above grade ................................................ d. Surface drainage around well acceptable ..... : .............. :.. V. Overall Workmanshio . a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ....... :.......................... i. Erosion control provided ................................................ Rev. 12/02 __�p r� ok �s as •r•s�� 1 "M W/OW VMWE M= r� r� ok r �l July 24, 2014 DANIEL I DONAHUE, P.E. CONSULTING ENGINEERS 120 Breckenridge Road Mahopac, N.Y. 10541 845- 628 -7576 Putnam County Department of Health 1 Geneva Road Brewster, N.Y. 10509 Att: Joe Pavaratti, P.E. RE: As built SSTS — Lot #9 Paddock View Subdivision Patterson (T) Dear Mr. Pavaratti: Enclosed are the following for your approval: Enclosed please find: 1. Certification of Construction Compliance 2. Bacti Results and well log 3. Guarantee and two copies 4. Four copies of the as built plan 5. Filing fee of $300.00 6. E911 Verification Letter Your prompt attention would be appreciated. Regards D94G—onahue, P.E. 0 Site • Sanitary • Environmental PUTNAM COUNTY DEPARTMENT OF HEALT - - �'Y DIVISION OF ENVIRONMENTAL HEALTH SERVICE i, � .vti CERTIFICATE OF CONSTRUCTIO OMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT it 2 — 43 Located at 6. /-0,7 �own r Village Ae2 i6 Owner /Applicant Name Yet � ale <, 0 eel5cl �ax Map Block Lot Formerly Ste'.. Subdivision Name Subd. Lot # Mailing Address / !Y Zip Date Construction Permit Issued by PCHD •�� r3 Separate Sewerage System built by Address ff/,�i� Consisting of Gallon Septic Tank and / ✓ �%`�`'� Other Requirements: / -- cI /f�'(X> /i Water Sunnly: Public Supply From Address or: Private Supply Drilled b f�,r� -:� ? ,, �. Address -AlAa� -76 _ PP Y Y Building Type' Has erosion control been completed? Number of Bedrooms � Has garbage grinder been installed? M I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations o Putnam County Department of Health. Date: ` Certified by P.E. �-'° R.A. _i�yC (Design Professional) Address License # Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Director /Commissioner, such revocat' n, odificNmge is necessary. By: Title:/ "x Date: Z l White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovani, Director ** TEST REPORT ** LAB #: 9.400406 CLIENT #: 64219 NON STAT PROC PAGE: 1 of 2 PATTERSON DEV PO BOX 839 MAHOPAC, NY CORP 10541 DATE /TIME TAKEN: 07/07/14 10:30 DATE /TIME RECD: 07/07/14 11:02 REPORT DATE: 07/23/14 PHONE: (914)- 403 -6220 SAMPLING SITE: 53 BARTON FARM RD, PATTERSON, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: HNO3 COLD BY: MARK PORCELLI TEMP RECEIVED: 6c ON ICE NOTES...: COLIFORM METH: MF START DATE /TIME END DATE /TIME FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 07/06/14 0450 07/07/14 0400 MF T. COLIFOR ABSENT /100 ML ABSENT SM 18 -20 9222B 07/14/14 LEAD (IMS) <1.0 ppb 0 -15 ppb SM 18 -19 3113B 07/09/14 0320 07/09/14 0350 NITRATE NITRO <0.23 MG /L 0 - 10 HACH 10206 07/09/14 0315 07/09/14 0345 NITRITE NITRO <0.01 MG /L 1.0 MG /L SM18- 20450ONO2 07/21/14 IRON (Fe) <0.06 MG /L 0 -0.3 mg /l SM 18 -20 3111B 07/21/14 MANGANESE (Mn <0.01 MG /L 0 -0.3 mg /1 SM 18 -20 3111B 07/22/14 SODIUM (Na) 2.57 MG /L N/A SM 18 -20 3111B 07/10/14 0332 07/10/14 0335 * pH 7.2 UNITS 6.5 -8.5 SM18 -20 4500HB 07/22/14 HARDNESS,TOTA 4 MG /L N/A SM 18 -20 2340C 07/23/14 ALKALINITY (A 18 MG /L N/A sM 18 -20 232013 07/07/14 0250 07/07/14 0252 TURBIDITY (TU <1 NTU 0 -5 NTU SM 18 (2130B) COMMENTS: MFTC otal oliform = This result indicates that the water (was) (was not) of a satisfactory sanitary quality according to New 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 #: 9.400406 CLIENT #: 64219 NON STAT PROC PAGE: 2 of 2 PATTERSON DEV. CORP PO BOX 839 MAHOPAC, NY 10541 DATE /TIME TAKEN: 07/07/14 10:30 DATE /TIME RECD: 07/07/14 11:02 REPORT DATE: 07/23/14 PHONE: (914)- 403 -6220 SAMPLING SITE: 53 BARTON FARM RD, PATTERSON, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: HNO3 COLD BY: MARK PORCELLI TEMP RECEIVED: 6c ON ICE NOTES...: COLIFORM METH: MF START DATE /TIME END DATE /TIME FLAG PROCEDURE RESULT' NORMAL - RANGE METHOD Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg /L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg /L of Sodium is suggested. * pH pH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. pH IS A FIELD MEASUREMENT AND IS TESTED OUTSIDE THE HOLDING TIME. pH REPORTED FOR REFERENCE ONLY. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG /L. THE. HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG /L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0 -70 MG /L VERY HARD WATER: ABOVE 300 MG /L MODERATELY HARD WATER: 70 -140 MG /L MG /L = MILLIGRAM PER LITER HARD WATER: 140 -300 MG /L (1 grain /gallon = 17.2 MG /L) ALK (ALKALINITY REPORTED AT pH 4.5) IMS IMS = IMMEDIATE METAL SAMPLE. (INTERPRETATION: WATER SAMPLED AFTER SITTING UNDISTURBED A MINUMUM OF 6 HOURS OR OVERNIGHT) THE ABOVE TEST PROCEDURES MEET ALL REQUIREMENTS OF NELAC, AND RELATE-'\ONLY TO /1 f ESE`.SAMPLF„S /$ZECEIVED BY THE LAB SUBMITTED BY: adovani, M.T.(ASCP) Director I ELAP# 10323 i now or formerly LENTEX CO. (Libor 528; c.P. 281) I formerly the lands belonging to PETER 0•HARA TAX LOT 3.15 -1 -1 F- 0 1 N54 °2 ''846 "E 17.81' t\ m I .......... r ..... • N67045152T now or formerly TOWN of PATTERSON (liber 1117; c.l formerly the lands belonging to PETER 0HARA TAX LOT J. 15 -1 -25 257.08' s LC 98.0 A S O�U D 103,361 7 •ISO � � �»y o r�C B R•p p e k, J17 f S oa /9 0 :MISES ARE DESIGNATED ON THE TAX MAPS FOR THE. ' WN OF PATTERSON :CTION; 3.15 BLOCK; 1 LOT; 35 :EPARED FOR: PATTERSON DEVELOPMENT CO. OANIEL J, OON IUE Ff CONSULTING ENGINEEIPS 17-0 O,PECKM PID6f IPOAD MAHOFAC, N.Y. 10541 (840-628 -95576 's A j4WA ,."POSED o 68�,OpINN SSTS AS BUILT SITUATE IN THE TOWN OF PATTERSON i PUTNAM COUNTY NEW YORK . SCALE: 1 "= 30' PREPARED: JUNE 23.2014 UNIT SEPTIC TANF END OF TREA JUNCTION -BC END OF 7REA END OF TREA JUNCTION -BC END OF TREt END OF TREK JUNCTION -BC END OF TREE END OF TREI, JUNCTION -BC END OF TREE ADDITIONAL NOTES SURVEY AND TOPOOF NO STREAMS WATER SHORN. THERE ARE THIS IS TO CERT6Y I �R1�WAY LT IE f ERSON NTY SS TS TIE IN SURVEYED UNIT R1 A B LENGTH OF TRENCH SEPTIC TANK 1 39.4 35.5 END OF TRENCH 2 34.1 82.4 42 JUNCTION —BOX 3 41.1 38.4 END OF TRENCH 4 91.1 375 42 END OF TRENCH 5 41.0 85.9 42 JUNCTION —BOX 6 55.5 43.4 END OF TRENCH 7 92.9 42.5 42 END OF TRENCH 8 47.4 88.8 42 JUNCTION —BOX 9 60.4 48.9 END OF TRENCH 10 95.5 1 47.6 42 END OF TRENCH 11 55.2 79.1 24 JUNCTION —BOX 12 64.4 54.4 END OF TRENCH 13 84.3 53.6 24 RESERVE LENGTH R1 90 R2 90 R3 90 R4 45 TOTAL 315 aDDlnoNac NOTES: TOTAL LENGTH OF TRENCHES 300 L.F SURVEY AND TOPOGRAPHIC INFORMATION OBTAINED FROM LINK LAND SURVEYORS. THERE ARE NO STREAMS, WATERCOURES OR WETLANDS WITHIN 200 FEET OF THE PARCEL EXCEPT AS SHOWN. THERE ARE NO FEMA DESIGNATED 100 YEAR FLOOD PLAIN 2014 THIS IS TO CERTIFY THAT THE SEWAGE TREATMENT SYSTEM WAS CONSTRUCTED AS INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS INSPECTED BY ME BEFORE IT WAS COVERED OVER. THE SYSTEM WAS CONSTRUCTED IN ACCORDANCE WITH ALL STANDARD RULES AND REGULATIONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND THE NEW YORK STATE DEPARTMENT OF HEALTH- __ Lu �l �y°• 48, �C) SIT'" •; -F! � 1�nn� DIMS& APPROY 2N 1k ;1 KI seRriiTa r,. ••� "�I,•� r':�1D. Ms. ►AIt� C4i04448t14yo �f G • dAwwry ble?rk. PS �:+errH a�E+ +y +�tDea�Mid/YIM(tw Department of H"Ith 1 Ga wwo Read, fit. NY IOW Offs" (w) So: -1100 FIX (044) 005 -1947 Q YY /IYI ° 1#4 lRsbrt d. 10*01m Como" &Oew7ve 1' ®1944: �� ........... o...... »...............e.,..._ -tea.. /wrxcrnzdrD Tovan ®D'F!C Iwt,: ._._.... _�.. _ _ .�.,.. (ftsartrre) The Ntea m Covacy Ooport ost of i "kb will set is ®so ae ComftsM of CewetrW1"i& * C.O*jp lanane Vol"# ** obove tors to comp +oted, Lv., o 1%S1 2011 &"MO Y MOISMad byes seatborbed TOWN el CIAL This teas it to M OUL%NkfvA wit` The UPPSO We hr o CertitlSelf et Ceoi ncow comphasee. R� AGG "l�`f�U uA �, , 1234567 ; Oct -1 01 7:57 ti. 34 A19 rUfiAld �1 Y ENV gJALTH FAX No. 19142767921 Page �,� �. 3 PU TNAM COUNTY DEPARTMENT OF BEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMINT SYBTEM )ad /i Z?•ea: a Owner or Purchaser of Building ' LJ� /,/, , &V ? building Construmd by &v.4ah rpm' Location - Street Building Type Tax Map Block Lot Towr✓Yillage Subdivision Name C Subdivision Lot # 1 represent that I am wholly and completely respoaslbla for the locatim workmanship, material, consteuctkw end drainage of the sewage traatment system serving tine abov&described property, and that is has been cousbWed as shown on the approved plan or approved amendment thereto, ad in accordance with the standads, rules and regulations of the Putwu County Aepauum of Health, and hereby gwrantoe to the owner. his suwessors, heirs or assigns. to Plata in goad openntiug condition any part of said system constructed by me which sails to operate for a period of 00 years immediately following the date of approval of the " Certilleate of Goaatcvctiou Co9tpliewce" for the sewage tresumt system, or any repairs made by me to such system, except where the failure to operate properly is =used by the willful or negligent act of the o=gmt of the building utilizing the system. The undersigned furthor agree' to accept as wn,clusive the determination of the Public Holt Director of the Putnam County Department of 1Health 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 b ullft& utilizing the system. Dated: Mouth _ ^ ey J�� - Year Gen Z `oint'ractoc (Owner) - Sipatuoe 8PS6 L_,0944 b . Corporation a {if corporals ) Address: ,�..........�..zip sigaaturet r Title: 4 0 y �7 oil a (if corporation) 9tatc : �L zip l Form 05.97 am W-1 INA, 'To' , \so / 00, Ul fv I � ENDS OF PIPES BE CAPPE �� (t�picd) I 1 R= 53.00' 1 xj�' / /' X 538.7 L= / 29.5 / ' 6 =140 °19'56" 1 43- Ar o / / 11. // Q � i F �000�Q .: - CrC 'A < e PROPOSED WELL - t IYAIP X533.2 — — 537. I i 538 54/2\.5 1 q. 2. 28 A res 31.3 X I N12�p 530 i -uo 460 X 527.7 21e !). PUTNAM COUNTY DEPARTMENT OF HEA DIVISION OF ENVIRONMENTAL HEALTH SERVICES ��` CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # �—Oa- k-� Located at S i1Y'i 7'Jo.1i lee ff o Town r Village Y04 yti(ee -s'O., Subdivision name A"e le— III e,4411, ubd. Lot # % Tax Map . / S- Block _� Lot y Date Subdivision Approved Renewal Revision Owner /Applicant Name ." + 'vale , -Date of Previous.Approval Mailing Address je �9 3 Zip Amount of Fee Enclosed &ill Building Type /y f '°"' /y ' Lot Area-2,3 4 f o. of Bedrooms * Design Flow GPD-e' Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of Id- ,x"73 gallon septic tank and 34d 4 oc 6 - 4.,_,,,4 Other Requirements: To be constructed by J Address Water Supply: Public Supply From Address or: � Private Supply Drilled by _Z ,22 Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: `-- P.E. R.A. Date 9 d Address / ®v �� , 2/j �P✓ �r,�_ License # �f 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 permit. Approved for discharge of domestic sanitary sewage only. By: �� Title: /�i'/� Date: &,93117 ri- to c y - HD File; Yellow copy - Bui ding 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 _ please print or type IRE-140 Permlf.:# Well Location Street Address: own illage: Tax Map # GI tjs�„� Map,3 4"Block Lot(s) ,5 7 Well Owner: Name: ®Q'f��rse�y ,D�'rr•� /r��a Address: � Phone #: /- /-y' fs Use of Well: Residential _Public Supply Air /cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Jnstitutional Standby Amount of Use Yield Sought___,j°^ gpm # d'S`erved_ _ Est. of Daily usage Zg gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason 7 tY a for Drilling Well T pe Drille Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes No Is well located in a realty subdivision? ........................................... ............................... Yesf! No Name of subdivision Lot No. Water Well Contractor: "" Address: Is Public Water Supply available on site? ....................................... ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to 6e provi5V on separate sheet/plan. Date: % % 3 Applicant Signature: PERMIT TO CONSTRUCT A WA 1 tK 1IVtLL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Departmel take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. w — Date of Issue f/,93// 3 Date of Expiration 1 S , Permit is Non - Transferable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Rev. 3/06 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of ,a" A A4464— Located at af fr4l ,*/A, 101� Tax Map #ice-- Block Lot Subdivision of -P4 ��. A/- ew 9-�E 7i A' Subdivision Lot # �' Filed Map # Date Filed ,5 q_ Gentlemen: This letter is to authorize _ � / e / q �U�G a duly licensed Professional Engineer nor 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. Very tr20f , Countersign Signed: P.E., R.A., # � �i ftpvty) Mailing Address /62e) „� /Mailing Address: - �J Stale ,/ Zip ley/ Telephone: /-�' '� 7�t% e State Telephone: Zip p� L2,% D PUTNAM COUNTY DEPARTMENT OF IlfRAsI TU DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR Ao. WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: VAN 4 . . . . . . . . ..... K 2. Name of project: S�l� �Q �/ ' r&: ....,.,�1�� ''i° ,y�CE"�r -��•- �. 1.00at10 4. Design Professional: ,t. 4 . zgly,� 5. Address:�,�. 6. Drainage Basin: s _...._ ..cr`� !'I_".,;" 7. C Qf ExQJegt: X Private/Residential Food Service Commercial Apartrments Institutional - � Mobile Home Park Office Building Realty Subdivision Other (specify) - 8. is this project subject to State Environmental Qualiry Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type 11 Unlisted _Y. _ 9- Is a Draft Environmental Impact Statement (DEIS) required? ............. .. 10. Has DEIS beer: completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... 13. If so, have plants been submitted to such authorities? ....... ............................... .,„( &_____ -_ 14. Has preliminary approval been granted by such authorities? Date granted: — _ 15. Type of Sewage Treatment System Discharge .................. surface water groundtivater 16. If surface water discharge, what is the stream class designation? .................... 17. Water index. number ( surface) ......................................... ............................... �A44V 18. Is project hwated near a public water supply system? ....... ............................... 3.9. If yes, name of water supply �._. �. _..._ ..._ Distance to water supply 20. Is project site near a. public sewage collection or treatment system? ................. —_ m 21. Name of sewage system Distance to sewage system _ N 21 Date test holes observed? 1;_4 /Y 23. Name of Health Inspector¢v�:�afr 24. Project design flow (gallons per day) .................................. ............................... 'e"'6.0 _- ._a._... 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... 26. Has SPDES application been submitted to local DEC office? .......................... Form PC -97 2 27. Is anv no.rt on of this project located within a designated Town or State wetland ?!?�aI_ 28. Wetlands ID Number ...................................................... .................. .I............ ��/14 _._. 29. Is Wetlands Permit required? ............................ ............. ............................... Ifas application been made to 'Dowel or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Perxnit? .. ............................... /Sly 3.1. is or was project site used for agricultural activity involving application. of pesticides to orchards or other crops, solid or hazardous vvaste disposal, landfilling, sludge application or industrial activity? ............................ Yes, Rio) 32. is project locatrd within 1,041; feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes o DESCRIBE. 33. Is there a local master plan on file -with the Town or Village? ......................... _ � 34. Are Are community water arid/or sewer facilities planned to be d+evtloped within 15 ;years in or adjacent, to project site:' ... ................................. .... ... .... ....... ..... ... .: _/Vd _ 35. Are any sewage treatment areas, in excess of 15% slope? . ............................... NO 36. Tax Map lei Number...., .......................................... .......... Map: f ,f`Block _ / Lot 3* 37. Approved plans are to be returned to ...... Applicant _ Design Professional N0 l"E: All applications for review and approval of a new SETS to be located within the NYC Watershed shall be sent to the Department, and need riot be sent in duplicate to the DEP, although the project may require DEP appruval of the SSTS prior to final approval by the Deparment. Projects within the watershed znay also require DEP review and approval of other aspects of a project, such as storrnwaterVplans or the creation of impervious surfaces, and the project applicant .should obtain the appropriate forms for such activities from DEP and submit those farms 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 hereb , a, fir^ under penalty gf'pe jveyry that in ormaatlen provided on this form is true to the best o, f my knowledge and belief. False statements made herein are punishable as a Class A misdarmeanor punuaant to Sarcdion 210.4 the Penal Law. .V1G'AA7i"UREES A OFFICIAL TITLES: Ma ling Address: ... ........................ � l01 -6 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner 014 ek -Address Located at (Street) Tax Map 3- Block Lot (medicate nearest cross street) Municipality n, r 4d -%/ Watershed SOIL PERCOLATION TEST DATA Date of Pre-soaking Date of Percolation Test NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, s 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 . . . . . . . . . . . . . . . T z I." ............ ............... 2 3 4 ST 5 Olt 2 zzog 3 z 4 0 5 3 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 I min for 1-30 min/inch, s 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 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2:5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. HOLE NO. re ?'U i4 AM ccUU i Y Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: u¢."�� Date =�( Design T) ,.�. , .. __ -1 T►T_ -_. ,r-1 . A- - .,4T! .� I �., a �a .�: � .. . Address: Signature .PROJECT I.D. NUMBER 617.21 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 I 2. PROJECT NAME 3. PROJECT LOCATION: Murilcipality County 19 4x 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) 5. IS PROPOSED ACTION: WNew ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: 7, AMOUNT OF LAND AFFECTED: Initially d m- 1— acres Ultimately �, l� acres B. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 57Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑ Industrial ❑ Commercial ❑Agriculture ❑ Park/Forest/Open space ❑ Other Describe: SEQR 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 permiUapprovals 13 1 d.p�6fj�ic,•r7►- 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? C1 LE Yes No If yes, list agency name and permlUapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Appiicant1sl Signature: Date: '! 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 June, 1993 PART II— ENVIRONMENTAL ASSESSMENT (To 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) 91. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: Ca. A community's existing plans or goals as officially adopted, or a change in use or intensity of use or land or other natural resources? Explain C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified in C1-05? Explain briefly. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. !i3 D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III— DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially, large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Name of Lead Agency Date Title of Responsible Otficer Signature of Preparer (it different f rom responsible officer) Time 1093 ONSt fiIN ENGINEERS %J Daniel J. Donahue, P.E. 200 Brerkeividge Road Mahopac. N.Y. 10541 914. 628-75-,,6 TO (0117 YRUJISAP., 70 UAT4 I? Jpa NO - •• -�� J-17 A0, WE ARE SENDING YOU, 'Ll Att*Chod r--' Under -separate cover via -.-_-tho ftflowing items: C Prints 0 Plans Shop drawings . -D Samples [3 Spoellications C, Copy of Wtor Champ order Cj THESE ARE TRANSMITTED as chocked Wow; !7j For approval 0 Approved as submitted Ll For your us* [71 Approved as noted 0 As requested 0 Returned for torrections 0 for review and comment C� f- j Resubmit, copes for approwsl Submit_.._._., for distribution L? Return corrected print& C, FOR BIDS DUE PRINTS RETURNED 07ER LOAM Tel US REMARKS.-_ . . ......... ......... - ----- COPY S It oftelatwif 8% not so helad, kindly not* ua at eato f DESCRIPTION THESE ARE TRANSMITTED as chocked Wow; !7j For approval 0 Approved as submitted Ll For your us* [71 Approved as noted 0 As requested 0 Returned for torrections 0 for review and comment C� f- j Resubmit, copes for approwsl Submit_.._._., for distribution L? Return corrected print& C, FOR BIDS DUE PRINTS RETURNED 07ER LOAM Tel US REMARKS.-_ . . ......... ......... - ----- COPY S It oftelatwif 8% not so helad, kindly not* ua at eato ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E., MPH Director of Environmental Health August 19, 2013 Daniel Donahue P.E. 120 Breckenridge Road Mahopac, NY 10541 Dear Ms. Donahue: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 MARYELLEN ODELL County Fxe=tive Re: Proposed SSTS — Patterson Development Burton Farm Road (T) Patterson, TM 3.15 -1 -34 This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your review and consideration. • Please provide the latest PCDOH construction notes from Bulletin ST -19. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 43157 if any questions arise. Sincerely, Joseph S. oParava�ti, Jr., P.E. Assistant Public Health Engineer JSP:cw ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E., MPH Director of Environmental Health August 2, 2013 DEPARTMENT Daniel Donahue P.E. 120 Breckenridge Road Mahopac, NY 10541 Dear Mr. Donahue: OF HEALTH Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 MARYELLEN ODELL County Executive Re: Complete Application Determination for Patterson Development Burton Farm Road (T) Patterson, TM 3.15 -1 -34 East Branch Reservoir Basin The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and revisions received by this Department on July 28, 2013 is complete. The Department will notify you by August 22, 2013 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) 808 -1390 ext. 43148. oph S. Paravati Jr., P.E. Assistant Public Health Engineer JSP:cw ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E. Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 MARYELLEN ODELL County Executive TO: NYCDEP DEPARTMENT OF ENGINEERING AND DESIGN REVIEW ATTN: FROM: DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM DELEGATED New A PP 11 lication I,d' Renewal PROJECT: LOCATION: 1"A TOWN: DATE SUB'D APPROVAL 5 �6f/ck T TM #— z-04"— 1-5 4( NOTICE OF COMPLETE APPLICATION DATE: 51 L i3 DELEGATED CONSULTING ENGINEERS vJ Dmid J. Dortahut, 2.00 Breckettridge Road M&M, ac N.Y. ",0541 914-628-15776 TO FLEMEM (OF TIMPOK2,000177XIL WE ARE SENE)ING YOU LC Attached 0 Under ssoarate cover via-- Sliap drawings C" Prints, C Plans C Copy of lettgr C Chants order fallowing items: M Samples 0 Specifications 1- f Comes DAre NO. 4 All /1' fallowing items: M Samples 0 Specifications 1- f Comes DAre NO. All /1' THESE ARE TRANSMITTED as chocked below; &IF'or approval r. I Approved as submitted Resubmit,—Coples for approval 'D For your use 0 Approved as noted 0-1 Submit copies for distribution C As requested 0 Returned for corrections Return—correctrd prints 0 For review sod comment FOR BIDS DUE ----..,—, 19 0- PRINTS RETURNED AFTER Lom ro us REMARKS_- tt 11fitloswis art rm as IV066, 101%div %wiffy Us at onto