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HomeMy WebLinkAbout0075DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 3.16 -1 -1.2 BOX 1 f ,1L ., : ; r ■ L i 00075 PUTNAM COUNTY DEPARTMENT OF HEALTH \ DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRC�U TION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT Located at LISA COURT Town or Village PATTERSON Subdivision nameR E I S ER /GRUNDMAN Subd. Lot # 2 Tax Map 1 Block 4 Lot 2.23 Date Subdivision Approved � 9/27/89 Renewal Revision Owner /Applicant Name WALTER HORN Date of Previous Approval Mailing Address P.Q. BOX 700 MAHOPAC, NY XORKI Zip 10541 Amount of Fee Enclosed $300.00 Building Type WOOD ,FRAME Lot Area 1 .08 No. of Bedrooms 3 Design Flow GPD 600 Fill Section Only Depth Volume Separate Sewerage System to consist of 1, 0 0 0 ABSORPTION FIELD LENGTH Other Requirements: To be constructed by Water Supply: 5 JUNCTION BOXES To be deterir:ined Public Supply From gallon septic tank and Address Address or: Private Supply Drilled by To Be Determined Address 300 LF 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. 'N R.A. Date i Addr License # 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 w)wrhconsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe Approved discharge of domestic sanitary seyrahe only., L L- By: Title: y" � ` Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 T 'a Mr. Robert Morris, P.E., PCHD Revised Application - Walter Horn April 30, 1998 Page 2 8. Will comply. 9. Will comply. 10. Will comply. 11. The drainage basin is the Croton River; this has been added to the application form. 12. Per our discussion, we have contacted the NYSDEC and Town of Patterson and found no enforcement actions on record. You already indicated there are no enforcement actions on file in Putnam County. 13. Will comply. 14. Revised house plans are enclosed. 15. Will comply. 16. Will comply. 17. See General Note 1. 18. Same comment as No. 5. 19. Will comply. 20. Same comment as No. 8. 21. Will comply. Should you have any questions or comments regarding this revised submittal, please call us. MQ /jmm cc: W. Horn File Very truly yours, Michael Quinn, P.E. Project Engineer , PUTNAM COUNTY DEPARTMENT OF HEALTH HVISION OF ENVIRONMENTAL HEALTH SERVICES C TRU TION PERMIT FOR SEWAGE TREATMENT SYSTEM Located at � I a 0 O .,L Town or Village J?AT';I-'r&. .20 Subdivision name F. I S E.R /'- RUNDxv;:.AN Subd. Lot # 2 Tax Map 1 Block 4 Lot 2. 2 3 Date Subdivision Approved 09/27/809 Renewal Revision Owner /Applicant Name ',JWUTE.R HORN Date of Previous Approval Mailing Address P.O. LOX 700 P AH.OPAC, NY Zip 10541 Amount of Fee Enclosed $ 3 0 0.0 0 Building Type WOOD t R A M E Lot Area 1 .0 8 No. of Bedrooms 4 Design Flow GPD 8 0 0 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1 , 2 5 0 gallon septic tank and 4 0 0 L r �.BSORPT'IO!V FIELD LENGTH Other Requirements: To be constructed by Water Supply: 4 JUNCTION BOXES TO BE :DETERMINED Address Public Supply From Address or: X Private Supply Drilled by TO BF nETFRMTNFn 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. X R.A. Date �? ROBE° FOLCHETTI & ASSOCIATES, L.L.C. Addre s 247 P.oUTE 100 SOMERS, NY 10589 License 0 -5 1 ,7 1 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 considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new p t •Approve discharge of domestic sanitary only By: Tit le: � Date: f 7 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: Walter Horn Post Office Box 700 Mahopac, NY 10541 -0700 2. Name. of Project: Reiser /Grundman Subdivision 3. Location TN: Town of Patterson 4. Design Professional: J.R. Folchetti & Assoc., L.L.C. 5. Address: Lisa Court 6. Drainage Basin: Croton River Patterson, NY 7. Tyne of Protect: X 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 X 9. Is a Draft Environmental Impact Statement (DEIS) required? ............. NO 10. Has DEIS been completed and found acceptable by Lead Agency ?. ........ N/A 11. Name of Lead Agency ............................................. 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? .......... ............................... YES 13. If so, have plans been submitted to such authorities? ................. YES 14. Has preliminary approval been granted by such authorities? Y Date Granted: 9/27/89 15. Type of Sewage Treatment System Discharge .... surface water X ground waters 16. If surface water discharge, what is the stream class designation? ............. N/A 17. Waters index number (surface) ........ ............................... N/A 18. Is project located near a public water supply system? ........................ NO 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ............. NO 21. Name of sewage system N/A Distance to sewage system 22. Date test holes observed: 4/10/98 & 4/16/98 23. Name of Health Inspector: Gene Reed 24. Project design flow (gallons per day) ... ............................... 800 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required? ........ NO 26. Has SPDES Application been submitted to local DEC Office? .................... N/A Form PC -97 .2 27. Is any portion of this project located within a designated Town or State wetland? NO 28. Wetland ID Number ....................... N/A 29. Is Wetland Permit required? .............. ............. ............. NO Has application been made to Town or Local DEC Office ?................... N/A 30. Does project require a DEC Stream Disturbance Permit ? ................... NO 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? .................. Yes/No See Note 32. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ................. Yes/No See Note DESCRIBE: 33. Is there a local master plan or file with the Town or Village? ....... ........ Draft Only 34. Are community water, sewer facilities planned to be developed within 15 years in or adjacent to project site? ........ ............................... NO 35. Are any sewage treatment areas in excess of 15% slope? ................... NO 2,23 36. Tax Map ID Number ........................ Map 1 Block 4 Lot Sub Lot 2 37. Approved Plans are to be returned to:..... Applicant X 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 creations of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 ofAe Penal Law. SIGNATURES & OFFICIAL 247 Route 100 Mailing Address: ... ................. Pinewood Business Center Somers, NY 10589 Note for Questions 31 and 32: Per Robert Morris of the Putnam County Health Department, we have confirmed through the Town of Patterson, Putnam County and NYSDEC that there are no enforcement actions of record for this site. To the best of our knowledge and belief, the project location has not been the site of any potential contamination sources described in Questions 31 and 32. 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 # .Lisa Court Lot 2 Patterson Map 1 Block1l Lot(s )2 , 23 Well Owner: Name: Address: Walter Horn P.O.Box 700, Mahopac, NY' 10541 Use of Well: 1 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 4 Est. of Daily Usage 5 0 0 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling x New Supply (new dwelling) Deepen Existing Well Detailed Reason Potable t7ater supply to new residential dwelling. for Drilling Well Type x Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No x Is well located in a realty subdivision? ...................................... ............................... Yes x No Name of subdivision Reis ` r /G r u n d m a n Lot No. 2 Water Well Contractor: To Be D e t-a rm i n e d Address: Is Public Water Supply available to site? .................................. ............................... Yes No x Name of Public Water Supply: NA . Town/Village Distance to property from nearest water main: NA Proposed well location & sources of contamination to be on separate sheet/plan. /prrovided Date: 3-1649 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 . Permit Is ffici Date of Expiratio Title: Permit is Non - Transfer a e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 J. ROBERT FOLCHETTI & ASSOCIATES, L.L.C. CIVIL/ ENVIRONMENTAL ENGINEERS J. ROBERT FOLCHETTI, P.E., D.E.E., Principal WILLIAM J. McGIMPSEY, P.E., Senior Associate April 30, 1998 Mr. Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: REVISED APPLICATION TO CONSTRUCT A SUBSURFACE SEWAGE TREATMENT SYSTEM PROPERTY OF WALTER HORN LISA COURT LOT NO.2 TOWN OF PATTERSON, TAX MAP 1 -4 -2.23 Dear Mr. Morris: Enclosed for your review and approval are revised engineering plans for the above referenced project. We are also transmitting the following supporting documentation: • House plans that specify a four bedroom house. The new plans supersede the previous submittal of a three bedroom house. • Revised PCHD application form (PC -97) to reflect selection of four bedroom house. 0 Revised construction permit (CP -97) to reflect selection of four bedroom house. • New soil percolation test data sheets that have been witnessed by the PCHD. • Revised letter of authorization with filed map number. In response to your letter of March 24, 1998, we offer the following responses: 1. As required by the health department, percolation tests have been redone and were witnessed by Gene Reed. 2. Will comply. 3. Will comply. 4. SCS soil type "Riverhead Loam" has been added to the drawing under "Design Data ". 5. Will comply. 6. Will comply. 7. As previously noted, the footprint of the house has been revised to indicate four bedrooms. ❑ 40 RAILROAD AVENUE 9247 ROUTE 100 ❑ 1849 ROUTE 6 MONTGOMERY, NY 12549 Pinewood Business Center CARMEL, NY 10512 914 - 457 -5318 SOMERS, NY 10589 914 - 225 -1510 914- 232 -2500 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Walter Horn Located at Lisa Court T/V Patterson Tax Map # Subdivision of Reiser / Grundman Block 4 Lot 2.23 Subdivision Lot 2 Filed Map # 2440 Date Filed 9/28/89 Gentlemen: This letter is to authorize J. Robert Folchetti, P.E., DEE a duly licensed Professional Engineer X 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. Very truly yours, Countersigne Signed: P.E., R.A., 51 1 (Owner of Property) Mailing Address 247 Route 100 Mailing Address: P.O. Box 700 Pinewood Business Center Somers Mahopac State NY . Zip A0589 State NY Zip 10541 -0700 Telephone: X914) 232 -2500 Telephone: (914) 628 -3747 Form LA -97 DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Walter Horn Address P.O. Box 700, Mahopac, NY 10541 Located at (Street) Lisa Court Tax Map 1 Block 4 Lot 2.23 (indicate nearest cross street) Municipality Town of Patterson Drainage Basin Croton River SOIL PERCOLATION TEST DATA Date of Pre - soaking 4/15/98 Date of Percolation Test 4/16/98 Hole No. Run No. Time Start -Stop Elapse Time (Min.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 4 1 10:02 - 10:15 13 2111 24" 3 4.3 2 10:18 - 10:33 15 21" 24" 3 5.0 3 10:37 - 10:54 17 21" 25" 4 4.2 4 10:55 - 11:08 13 21" 24" 3 4.3 5 5 1 10:05 - 10:45 40 17" 20" 3 13.3 2 10:46 - 11:16 30 17" 19" 2 15 3 11:17 - 11:47 30 17" 19" 2 15 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. < I 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. Soil Percolation Testing performed by: Michael Quinn, P.E. Putnam County Health Department Witness: Gene Reed 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 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. HOLE NO. Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Date Design Professional Name: J. Robert Folchetti, P.E.. DEE Address: J. Robert Folchetti & Associates. L.L.0 247 Route 100 Pinewood Business Center Somers. New York . 1#n9 Signature: Design Professional's Seal PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Walter Horn Address P.O. Box 700, Mahopac. NY 10541 Located at (Street) Lisa Court Tax Map 1 Block 4 Lot 2.23 (indicate nearest cross street) Municipality Town of Patterson Drainage Basin Croton River SOIL PERCOLATION TEST DATA Date of Pre - soaking 4/9/98 Date of Percolation Test 4/10/98 Hole No. Run No. Time Start -Stop Elapse Time (Min.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min /Inch 1 1 1:32 - 1:35 3 21" 24 3" 1 2 1:28 - 1:42 4 19" 22" 3" 1.3 3 1:43 - 1:46 3 20" 23" 3" 1 4 1:49 - 1:52 4 19.5" 22.5" 3" 1.3 5 2 1 1:40 - 1:54 14 22" 26" 4" 3.5 2 1:54 - 2:06 12 22" 25" 3" 4 3 2:09 - 2:22 13 22" 25" 3 4.3 4 5 3 1 1:58 - 2:01 3 20" 23" 3" 1 2 2:02 - 2:05 3 20" 23" 3" 1 3 2:11 - 2:15 4 19" 22" 3 1.3 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. < I 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 DEPTH G.L. 0.5' 1.0' 1.5' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. DH -3 LOAM (TOPSOIL) LOAM (TOPSOIL) BROWN GRAVEL BROWN GRAVEL 2.0' BROWN GRAVEL 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' BROWN GRAVEL BROWN GRAVEL BROWN GRAVEL BROWN GRAVEL BROWN GRAVEL BROWN GRAVEL BROWN GRAVEL BROWN GRAVEL BROWN GRAVEL BROWN GRAVEL BROWN GRAVEL BROWN GRAVEL BROWN GRAVEL BROWN GRAVEL BROWN GRAVEL HOLE NO. DH -4 LOAM (TOPSOIL) LOAM (TOPSOIL) BROWN GRAVEL BROWN GRAVEL BROWN GRAVEL BROWN GRAVEL BROWN GRAVEL BROWN GRAVEL BROWN GRAVEL BROWN GRAVEL BROWN GRAVEL BROWN GRAVEL BROWN GRAVEL BROWN GRAVEL BROWN GRAVEL BROWN GRAVEL BROWN GRAVEL BROWN GRAVEL 10.0' Indicate level at which groundwater is encountered Not Encountered HOLE NO. Indicate level at which mottling is observed None Indicate level to which water level rises after being encountered None Deep hole observations made by: Greg Folchetti Date 5/16/88 Design Professional Name: J. Robert Folchetti, P.E., DEE Address: J. Robert Folchetti & Associates, L.L.C. 247 Route 100 Pinewood Business Center Somers New YorJ§ 10589 Signature: Design Professional's Seal Fol��, � z , o3toy\ 'p DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 218-7921 I Robert Folchetti & Associates 247 Route 100 Somers QTY 10589 Dear Mr. Folchetti: BRUCE R. FOLEY Public Health Director February 27, 1998 RE: Application to Construct a Subsurface Sewage Treatment System at Horn, Lisa Court, Lot 92 (T) Carmel TM# 1. -4 -2.23 The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on February 23, 1998 is incomplete. Please be advised that the following information is required before the Department may commence its review. ® Permit application for the construction of a well has not been submitted. O Two sets of house plans have not been 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 Dept. Of Health regulations. Should you have any questions or care to discuss this matter, please contact me at (914) 278 -6130 ext. 166. RM /tn Very truly yours, . R�ak Avow Robert Morris, P. E. Public Health Engineer ae,ep r,, a".5" / 9r,we l 3o It a9" Deep 1 't,_ 3 o 6,rau el 2,9" PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES r DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner %A/Aj_ -0tz Address 1-/t5A 6,©c'g-7- Located at (Street) MAp j_g A Vim, Tax Map :, 14 Block j Lot I (indicate nearest cross street) Municipality PATi'_;=.7, to ,W Drainage Basin �,45-T BKA94d !N Neal ATZr;A SOIL PERCOLATION TEST DATA Date of Pre - soaking !Z//&- Fe Date of Percolation Test g - I8 Hole No. Run No. Time Start - Stop Ela se Time Min.) Didto Water rom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 2 3 i o'3 - 0' 4 5 1 10:0"'r-40'.'t6- 0 1 11:17 _ 11!17 r 4 ti 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are ootainea at eacn percolation test hole. (i.e. < 1 min for 1 -30 min/inch, <_ 2 min for 31 -60 min/inch) All data to'be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT. SYSTEM Owner WA LT�5R /- og& Address 13,4 Gov�T Located at (Street) M A p1 �c � � Tax Map 3, /6 Block f Lot ! (indicate nearest cross street). Municipality P,A 7�`?i Sin/ Drainage Basin 0 -57 R RA NG H SOIL PERCOLATION TEST DATA Date of Pre - soaking y II Pz f P Date of Percolation Test !9//2/ipo Hole No. Run No. Time Start - Stop Ela se Time (pMin.) De th to Water from Ground Surface (Inches) Start Stop Water Level Dro In Inc�es Percolation Rate Nfin/Inch 2lf 1 5 1 : ,Yo - IS- 2 , - ')" �. � � — 3 ley 4 5 3 1 111�5e _X101 3 ;L 3 9 I 2 `o -X0,5- 3 2 r 3 3 I 3 2: - a(/� 4 5 IvUTES: 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, 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 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. HOLE NO. 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: Design Professional Name: Address: Signature: Design Professional's Seal Date ----------- .�r RECORD OF PHONE CONVERSATION Time: 10 ; 5- 7 Date: Person calling: N1 ' lzhd Phone #: Reason () Inspection: I kj DgcQs eres: Scheduled Field MeetinC7 Time. r re 50 o-1 Date: $ pX �:e Y N Tentative /to be confirmed () ( ) Tow-n- 12451- PV `� e ✓l Road /Street: Tax Map Comments: DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 March 24, 1998 J. Robert Folchetti and Associates 247 Route 100 Pinewood Business Center Somers NY 10589 Re: Proposed SSTS: Horn Lisa Court Lot 92 (T) Patterson TM# 1 -4 -2.23 Dear Mr. Folchetti: BRUCE R. FOLEY Public Health Director Review of plans and other supporting documents submitted at this time relative to the above captioned project has been completed. Comments are offered as follows: "The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." 1) If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection, tests must be witnessed by a representative of this Department. /, j, 2) SSTS profile must be to scale. fz'�/ 3) Footing /Gutter drain discharge has not been shown. 4) Delineation of USDA Soil Conservation Service soil type boundaries are to be shown. 5) Proposed basement elevation is to be noted with SSTS profile. 6) Erosion control measures for the house, well and SSTS is to be shown and el detailed. 7) The house is to be labeled as three bedroom. 8) Property metes and bound have not been provided. 9) Dimensions from the well to the property lines are to be shown. 10) Location of the service connection from the well to the house is to be shown, furthermore, "approximately future location" of the w9A is not acceptable. 11) Drainage basin has not been noted where applicable.] 12) Form PC -1 has not been adequately completed. Questions 31 and 32 do not have a satisfactory answer "unknown" is not acceptable. (Enclosed) Letter to: I Robert Folchetti and Associates - March 24, 1998 -2- 13) Letter of Authorization is not complete. Filed map number and dated filed has a not been noted. (Enclosed) 14) House plans show 5 potential bedrooms, therefore, they are not acceptable for a three bedroom house. 15) SSTS profile is to be shown to scale, furthermore, the expansion area is to be shown in the profile. 16) The minimum distance from the house to the septic tank is to be noted. 17) Topographical information must be referenced on the plan. 18) Basement elevation is to be noted on SSTS profile. 19) Wells and SSTS within 200 feet of the proposed system are to be labeled as existing. or proposed. ed. 21) Wetland on property is to be designated as town or state wetland. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Very truly yours, i Robert Morris, PE Public Health Engineer RM:tn enc. 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: WALTER HORN POST OFFICE BOX 700 MAHOPAC, NY 10541 -0700 2. Name of projeCtRE I SER/GRUNDMAN SUDBDIV3. Location TN: TOWN OF PATTERSON 4. Design Professional: J . R FOLCHETTI &ASS005. Address: LISA COURT 6. Drainage Basin: PATTERSON, NY 7. Type of Project: x 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 _x 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... NO 10. Has DEIS been completed and found acceptable by Lead Agency? .............. 11. Name of Lead Agency N/A 12. Is this project in an area under the control of local planning, zoning, onother officials, ordinances? ......................................................... ............................... YES 13. If so, have plans been submitted to such authorities? ........ ............................... YES 14. Has preliminary approval been granted by such authorities? Y Date granted: 9/27/89 15. Type of Sewage Treatment System Discharge ................. surface water x groundwater 16. If surface water discharge, what is the stream class designation? .................... N/A 17. Waters index number (surface) ...................: ....................... ............................... 18. Is project located near a public water supply system? ....... ............................... N/A NO 19. If yes, name of water supply Distance to water supply N f A 20. Is project site near a public sewage collection or treatment system? ................ NO 21. Name of sewage system Distance to sewage system —�VA 22. Date test holes observed 5/20/88 23. Name of Health Inspector UnkrLown 24. Project design flow (gallons per day) ................................. ............................... 600 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? ......................... N/A Form PC -97 27. Is any portion of this project located within a designated Town or State wetland? . No 28. Wetlands ID Number ........................................................... ............................... N/A 29. Is Wetlands Permit required? .............. Has application been made to Town or Local DEC office? ............................... N/A 30. Does project require a DEC Stream Disturbance Permit? .. ............................... NO 2. 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 UNKNOWN 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 UNKNOWN DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... DRAFT ONLY 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... NO 35. Are any sewage treatment areas in excess of 15% slope? . ............................... No 36. Tax Map ID Number .......................... ............................... Map 1 Block 4 Lott , 2 3 LOT 2 37. Approved plans are to be returned to ..... Applicant x 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 stormwaterylans 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 Z to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Pena Law. 6 C3� SIGNATURES & OFFICIAL TITLES: Q0��1: ROBERT FOLCHETTI & ASSOCIATES, L.L.C. 247 ROUTE 1 Mailing Address: ................................... PINEWOOD BUSINESS CENTER SOMERS, NY 10589 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Walter Horn Located at Lisa Court T/V Patterson Tax Map # Subdivision of Reiser / Grundman Subdivision Lot 2 Filed Map # Gentlemen: Block 4 Lot 2.23 Date Filed This letter is to authorize J. Robert Folchetti P.E. DEE a duly licensed Professional Engineer X 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 Count), 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. Countersign P.E., R. 9; =911 l Mailing Address 247 Route 100 Pinewood Business Center Somers State NY Zip 10589 Telephone: (914) 232 -2500 Very truly yours, Signed: OA a9v__Z_11L (Owner of Property) Mailing Address: P.O. Box 700 Mahopac State NY Zip 10541 -0700 Telephone: (914) 628 -3747 Form LA -97 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 DATE_ TO: J Pgw � RE: a0 1 L SA j (T) Tint' I `' d r"110- Reservoir Basin Dear BRUCE R. FOLEY Public Health Director The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on 3l (I Kk is complete. The Department will notify you by q 112 of its determination. 4-7.23 If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a .decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Dept. 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 Dept. of Environmental Protection regarding such activities to see if Dept. of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (914) 278 -6130 ext. 166. Very truly yours, Robert Morris, PE RM:tn Public Health Engineer ws2 AR -02-1998 10:44 FROM J R FOLCHETTI ASSOCIATES TO SOMERS P.02 .. o a GSi`p Q D' ;u;�a Kluw L'AsEIyE.�I � i C1�5 M Q�C'Xtd1p' � 0 , . �i �►M1zY �� v. �� 4.00n d . oFf:cf M CP fC yon CotlUi d )"ORC H Yd�o' V PPE R L. EVES Rout• 5z� � ��lavr„Mr�D AR-02-1990 10:44 FROM J R FOLCHETTI ASSOCIATES TO LOWER LEVEL 005 (0)c yp C-oof 4 -a powc lgli -S ri: SOMERS P.02 ..... ... .... .... "'rP,,,L sumo mss, UPPER LEVEL k]00.SE PLAN TOTAL P-02 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner WALTER HORN Address P.O. Box 700, MAHOPAC, NY 10541 Located at (Street) LISA COURT Municipality Tax Map 1 Block 4 (indicate nearest cross street) TOWN OF PATTERSON Drainage Basin SOIL PERCOLATION TEST DATA Lot 2.23 Date of Pre - soaking 5/19/88 Date of Percolation Test 5/20/88 Hole No. Run No. Time Start - Stop Ela se Time Min.) Depth to Water rom Ground Surface (Inches) Start Stop Water Level Drop In Indies Percolation Rate Min/Inch DH -3 1 2:45 -3:10 25 19 25 6 4.1 2 3:12 -3:30 18 16 20 4 4.5 3 3:35 -3:53 18 19 23 4 4.5 4 3:55 -4:08 13.5 12 20 3 4.5 5 DH -4 1 2:45 -2:49 5 20 24 4 1.25 2 2:50 -2:55 5 20 24 4 1.25 3 2:55 -3:00 5 18 22 4 1.25 4 Y 5 1 2 3 4 5 iv VMS: 1. "bests 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, 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 • 2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. DH -3 HOLE NO. DH -4 HOLE NO. G.L. LOAM (TOPSOIL) LOAM (TOPSOIL) 0.5' LOAM (TOPSOIL) LOAM (TOPSOIL) 1.0 BROWN GRAVEL BROWN GRAVEL 1.5' BROWN GRAVEL BROWN GRAVEL 2.0' BROWN GRAVEL BROWN GRAVEL 2.5' BROWN GRAVEL BROWN GRAVEL 3.0' RRnwm GRAA_` ET. RRnwN nRAMPT. 3.5' BROWN GRAVEL BROWN GRAVEL 4.0: BROWN GRAVEL BROWN GRAVEL 4.5' BROWN GRAVEL BROWN GRAVEL 5.0' BROWN GRAVEL ': BROWN GRAVEL 55 BROWN GRAVEL BROWN GRAVEL 6.0' BROWN GRAVEL BROWN GRAVEL 6.5' HRnWN GRAVET:— BROWN aRA14r T._— 7.0' BROWN GRAVEL BROWN GRAVEL 7.5' BROWN GRAVEL BROWN GRAVEL 8.0' BROWN GRAVEL BROWN GRAVEL 8,5' BROWN GRAVEL BROWN GRAVEL 9.0' BROWN GRAVEL 9.5' BROWN GRAVEL 10.0' Indicate level at which groundwater is encountered NOT ENCOUNTERED Indicate level at which mottling is observed Not Encountered Indicate level to which water level rises after being encountered N/A Deep hole observations made by: G. L. FOLCHETTI Date 5/16/88 Design Professional Name: J. ROBERT FOLCHETTI, P.E. Address: J. ROBERT FOLCHETTI & ASSOC., L.L.C. —10 9 PINEWOOD BUSINESS CENTER SOMERS, NY 10b89. Signature-. Design Professional's Seal PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT j V5A OIJ STREET LOCATION C NAME OF OWNER REVEEN . D �GR, AS, MB, B11 DATE Z TAX MAP # 1 r F 7.2.3 I, DOCUMENTS Y N PERMIT APPLICATION :HOUSE,WELL, SSDS PC -1 PERC & DEEP HOLES LOCATED WELL PERMIT_ PWS LETTER REPRESENTATIVE OF PRIMARY & EXPANSION LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) 7 LOCATIQAi- MAP-- -_'\ EXP. ##AFT- VITY FLOW, SUFF.SIZE CORPORATE RESOLUTION IF ' C!57 T­&, D BOX SHOWN & DETAILED SHORT EAF OUSE - - EDROOMS LANS - THREE SETS S'S /IN 200' OF PROPOSED SYS. HOUSE PLANS - TWO SETS ROPERT S & BOUNDS VARIANCE REQUEST I1 E SETBACK NECESSARY (TIGHT.LOT) FEE D4_ !OUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE 6 t SUBDIVISION LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED PERC RATE FILL REQUIRED DEPTH CURTAIN DRAIN REQUIRED STANDPIPES GENERAL LOCATED IN NYC WATERSHED PLANS SUBMITTED TO DEP DELEGATED TO PCHD DEP APPROVAL, IF REQ'D DEEP TEST ITOLES OBSERVED PERCS TO BE WITNESSED F,�OV}Fb,SSDS ADJ. LOTS WETLAND /DEC PERMIT RL'Q'D ?) ON DDS PLANS & PERMIT SAME PRE 1969 NEIGHBOR NOTIFICATION LETTER BI/ZBA 100 YR. FLOOD ELEVATION OTHER REQ'D PERMIT(S) REQUIRED DETAJI&ON PLANS SEWAGE S EM PLAN -(N TH ARROV�) SSDS HY ULIC PROF -'Z GRAVIT ' CONSTRUCTION NOTES DESIGN DATA: PERC & DEEP RE ULTS T CONTOURS EXISTING & PROPOSED DR] A S, CUT OTING /GUTTER/C JtTAIN DRAINS TITLE BLOCK; OWNERS NAME,ADDRESS T,N,1 #,P ;- NA,E,ADDRESS,PHONE# DA OF DRAWING /REVISION NO BENDS; MAX.BENDS 45° W /CLEANOUT FILl" SYSTEMS AY BARRILR 10- FT. I IORIZONTAL;SLOPE 3:1 TO GRADE FILL SPECS FILL NOTES FILL CERTIFICATION NOTE DEPTH GAUGES F L PROFILE & DIMENSIONS LUME L IN EXPANSION AREA TRENCH FflLF TRENCH PROVIDED 60 FT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED ON PLAN - FROM SSTS 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS _15'WELL TO PL 100' TO WELL, 200' 1N DLOD, 150' PITS 100' TO STREAM WATERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STOI�iDRAIN, PIPED WATER 10' TO WATERLINE (pits -20') ( , 50' INTERMITTENT DRAINAGE COURSE 200'/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS FROWIN 5'MIN to CDS= >5 %,10'- 4 %,25'- 3 %,30'- 2 %,35' -1 %,100' - <1% to CD discharge /100'with 182 cons day discharge SEPTIC TANK al10' FROM FOUNDATION; 50' TO WELL VIQNST ROPERTY LINE RVICE CONNECTION =LOCATION OF ATERCOURS S, LAKES AND 200 FEET =PROPOSED FINISH FLOOR A k2AS - 'N" EL.' COMMENTS: 14 -16-4 (2/87) —Text 12 PROJECT I.D. NUMBER 617.21 SEOR 4.. Appendix C State Environmental Ouality 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, WALTER HORN 3. PROJECT LOCATION: Municipality PATTERSON County PUTNAM 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) LOT 2, LISA COURT, OFF MAPLE AVE IN THE TOWN OF PATTERSON 5. IS PROPOSED ACTION: ® New ❑ Expansion ❑ Modlficationlalteratlon 6. DESCRIBE PROJECT BRIEFLY: CONSTRUCTION OF SUBSURFACE SEWAGE DISPOSAL SYSTEM 7. AMOUNT OF LAND AFFECTED: Initially 1. 0 8 acres Ultimately 1. 0 8 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ® Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ® Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ® Yes ❑ No If yes, list agency(s) and permlVapprovals i. PUTNAM COUNTY DEPARTMENT OF HEALTH 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ® Yes ❑ No If yes, list agency name and permlUapproval GRUNDMAN /REISER RESIDENTIAL SUBDIVISION APPROVED BY PATTERSON PLANNING BOARD ON 9/27/89 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes ® No 1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant /sponsor name: Walter Horn Date: 2/5/98 Signature: If the action is in the Coastal Area, and you are a state agency, complete'the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II— 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 IN 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: NO ADVERSE IMPACT ANTICIPATED IF CONSTRUCTED TO CURRENT REGULATIONS GOVERNING INSTALLATION OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS. C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: NONE ANTICIPATED C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: NONE ANTICIPATED 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 NONE ANTICIPATED C5. Growth, subsequent development, or related activities likely to be Induced by the proposed action? Explain briefly. NONE ANTICIPATED C6. Long term, short term, cumulative, or other effects not Identified In C1-057 Explain briefly. NONE ANTICIPATED C7. Other Impacts (including changes In use of either quantity or type of energy)? Explain briefly. NONE ANTICIPATED 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 2 Title of Responsible Officer Signature of Preparer (If different from responsible officer) l J. ROBERT FOLCHETTI & ASSOCIATES CIVIL/ ENVIRONMENTAL ENGINEERS J. ROBERT FOLCHETTI, P.E., D.E.E., Principal WILLIAM J. McGIMPSEY, P.E., Senior Associate March 17, 1998 Mr. Robert Morris, P.E. Public Health Engineer Division of Environmental Health Services Putnam County Department of Health 4 Geneva Road' Brewster, NY 10509 RE: APPLICATION TO CONSTRUCT A SUBSURFACE SEWAGE TREATMENT SYSTEM PROPERTY OF WALTER HORN LIST COURT, LOT NO.2 TOWN OF PATTERSON, TAX MAP NO. 1 -4 -2.23 Dear Mr. Morris: As requested by your department, we are sending the following supplemental data for review and approval: • Application to construct a water well • Two sets of house plans If you have any questions regarding the enclosed, or require additional information, please call us. Very truly yours, J. Robert Folchetti & Associates, L.L.C. Michael Quinn, P.E. Project Engineer MQJmm cc: File ❑ 47 ROUTE 17K ® 247 ROUTE 100 ❑ 1849 ROUTE 6 NEWBURGH, NY 12550 Pinewood Business Center CARMEL, NY 10512 914 - 562 -0153 SOMERS, NY 10589 914 - 225 -1510 914- 232 -2500 I ' a � i . i Denton / Lake o��... s 292 LL 3j :Soloman Lake Lake t ! r \ ,' �S� I ( 51�q;wcw 8 311 0. ee°° p AI.G&wA , ` a � -"l C, �-w-• VaD 1\.1- -_-__� •—_� Ste NEWE Es 0 I ao i M Awe f �✓ i 4 _.. o I 311 d Moult TA !� '•. \\ ro may'. ^'� e 1 i ,� ---- i T'-"'------ 84 21 \ 1 1 own.. ' ,I 164 +! I ;Mendel Pond 3 - 164 i o� 4 I / 311 e t wt� I 46 J 4 bbA ice ondl} cC➢�T3^cis 22 . F v 1 i' ~ , :'' W 1'nsers 84 0 (� i wu j Bro "ok' ` \ It1' ,'Un -• ul Mount Ei am✓ ` ique Area Corpora Hill' ! 1� 0� .` 61 - erne, and Dale Hs » ~ ti PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANC_ TREATMENT SYSTEM PCHD ONSTRUCTION PERMIT it Located at b s 4 coo yz_T Town or Village PATTr l 0 l (T) -^,�I Owner /Applicant Name ice' Tax Map Block Lot Formerly Subdivision Name 4/C /1014,01 2Z— Subd. Lot # �-- Mailing Address !J 0 6t'x -7 0C) .41+0 Zip 16-541 Date Construction Permit Issued by PCHD 95 Separate Sewerage System built by Address fd 60-x ?/ �' U ✓i �/ �'c,�C' I 16,S-6 Consisting of p 1,S f% Gallon Septic Tank and LfOO LP -� I M-0i C4 Other Requirements: Water Supply: Public Supply From Address 101 7y or: Private Supply Drilled by Address 17�� VlKivry (1/y Building Type Has erosion control been completed? L/ Number of Bedrooms Has garbage grinder been installed? A,1 C 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 re lati s of the Putnam County Department of Health. Date: 0% L. L L Certified by P.E. � R.A. (Desi n Professio �l) Address 1i-�_C ��i- 1� I� � _ P�'T] WsIdAl �I�+Y /7,A-Z3 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 Public Health Director, such revocat'on, modification or change is necessary. By: Title: Date: White copy - HD File; Yell py - Building Inspector; Pink copy - Ow r; Oran copy - Design Professional Form CC -97 6:0 CEBMFICATE OF CONSTRUCTION CO) PL1AiM-P, Before a Certificate of Occupancy for a dwelling is issued by the local Building Inspector, a Certificate of Construction Compliance for the SSTS must first be issued by the Department. The Department must be notified before the system is backfilled in order that an inspection of the completed system can be made. Open work inspections may be omitted Q* at the discretion of the Director or his designated representative. In order for the Department to issue a Certificate of Construction Compliance, the following must be submitted: (Note: All submitted Department application forms shall contain Qdglnal signatures (no photo copies)). I , Certificate of -i.{ 3�- ;: :t...�.:�'.y. 1. ._: ._.._L,...._.x. h` +a2. "__ �.+t b'5 n. 'k.. a° fhe Construction Compliance Permit is to contain the assigned` "E 91`1" address issued by the respective municipality. The "E 911" address is to be provided ate' ----— the "Located at " section on the permit form. The following" CONTAMINANT telephone numbers are offered for the agency assigning the "E 911" addresses' within the municipality- T Any -rcsult.is.unsatisfkctory- R,;— ,, Carmel: Building Department Philipstown: Building Department 628 -1500 265 -3929 Kent: Building Department Putnam Valley: Town Planning .)Lead .)Lead 225 -3900 526 -3740 Patterson: Town Planning Southeast: Building Department 10 mg/1 as N; 878 -6319 279 -5698 1. Nitrites A Construction Compliance permit will nM be issued without the current "E 911" address. ' 2. 3. Three (3) copies of a two (2) year guarantee, signed by the installer, and/or general contractor, or the owner. (See Appendix K) If the water supply is from a drilled well: a. Satisfactory results of a water analysis, for the parameters in Table I below, conducted and reported by a NYSDOH approved laboratory under the "Environmental Laboratory Approval Program (ELAPJ." }:b �a:'a`,Y.�a..` wig Q s.....s c .�cs.. ..�. ... .. .. ... ... .. CONTAMINANT MCL (1)(4)(5) Colifonn bactena Any -rcsult.is.unsatisfkctory- o ,, .)Lead .)Lead 0.015 mg/l (15 ug/1) INitrates 10 mg/1 as N; 1. Nitrites 1 mg/1 as N L Iron 0.3 mg/1' j Manganese 0.3 mg/1 EJ Iron plus manganese 0.5 mg/l F:*1 � Sodium No designated limit (2) pH No designated limit :a Hardness No designated limit -;Alkalinity No designated limit 5 NTU.(3) NOTES: (1) Maximum contaminant level. (2) Water containing more than 20 mg/1 of sodium should not be used for drinking by people on severely restricted sodium diets. Water containing more than 270 mg/l of sodium should not be used by people on moderately restricted sodium diets. (3) NTU means Nephelometric Turbidity Units. (4) mg/1 means milligram per liter. (5) ug/1 means microgram per liter. b. A Well Completion Report signed by the well driller, including the results of at > k-v,� least a 6 -hour pump test (See Appendix K). A minimum well yield of 5 gpm is required. For yields less than 5 gpm see Appendix F for procedures on performing a 24 -hour well pumping test. The results of the 24 -hour pump test are to be submitted to the Department for review and a determination will be made regarding utilization of the well for supplying potable water to the dwelling. If the new well is found acceptable, then the procedures for determining the minimum potable water storage requirements, located in Appendix G, are to be utilized 4. If the water supply is from a public water supply, satisfactory results of a coliform / a bacteriological analysis of a A water sample taken from the service connection, performed by a laboratory approved by the NYS Health Department "Environmental Laboratory Approval Program." 5. Three (3) sets of "as- built" plans, signed and sealed by a. Design Professional, licensed and registered to practice in New York State. These plans shall be to scale (minimum 1 inch to 30 feet horizontal) and shall include: a. Surveyed house location with respect to property lines. The plan shall make reference, by note, to the source of survey. b. Metes & bounds description of property lines. c. Actual locations of installed SSTS and water supply improvements. d. The distances necessary to locate the septic tank, distribution boxes, junction boxes, ends of the SSTS and well from two fixed points, preferably the comers of the building. e. The plan must include a legend, which reads as follows: "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." f. The "as- built" plans must also include a title box, giving the information required on the original design drawings. Minimum size of "as- built" plans should be 11 inches by 17 inches with a minimum scale of 1 inch to 30 feet. g. Space for Putnam County Health Department approval stamp (minimum 3" x 5" preferably at the lower right hand portion of the plan(,/ �. Fee See Appendix I.���:.�� � �,�..�.'' °= ��_��� ate.._ t_.. � __.�, � �:_ � �..,. _�:�:(�� <<•�, . %t,� After the Certificate of Construction Compliance Permit is issued by the Department, a copy of the Certificate of Construction Compliance Permit, Well Completion Report and approved` "as- built" plans should be brought to the local Building Inspector for processing the (" Certificate of Occupancy. The local municipality should be contacted for their particular requirements for a Certificate of Occupancy. 2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location rStr t Address: Town/Village :. Tax Grid # Map Block Lot (s) Well Owner: Na e: Address: i Use of Well: 1- primary 2- secondary ,2!!�- Residential Public Supply Air cond /heat mp Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length % �;A. Length below grade ft. Diameter G o` in. Weight per foot alb /ft. Materials: X Steel —Plastic _ Other Joints: _ Welded :;K Threaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: x' Yes No Liner _ Yes ;>4Vo Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes No Hours Second Well Yield Test Bailed _ Pumped -,,,—Compressed Air Hours Yield gpm 'le Depth Data Measure from land surface- static (specify ft) 0 r During yield test(ft) Depth of completed well in feet 5 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 �- 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 Date Well Completed Putnam County Certification No. Date of Report 7//� Well Driller (signature) N E: Exact location of well with distances to at least two permanp6t landm ks to be provided on a separate sheet/plan. Well Drilier's Name 1 -r-- (. � x- .�Gc Address./3I�- C� Signature: Date: t) � . y . /a -S'7 ? White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Yutnam County Department • �� Divi ion f En al vironment of I[oali;h goa orvicen the S wags disco "Tres is to certify that .that the syst insp -inspected bytm_ before it was covered over. The 1P roved an noted for confnrmar. and �� `' S a1.Plicablt lulee and RegulAti.o:•a 00 with system has constructed 'in accordance with all standard rules and }' "enam County Health Dep,rtmant. regulations of the Putnam County Department of Health and the V_ Yorc .. �/ State Derh�� .of Health." s.. e, It Dat,� �ivc�— TicNsu,P— vA-r61 7� 3 . �our,vs ro l29 /99 Vii_' � .. ... `!i � e .. .. � _ � - �, _ _ �' �•�'J . N w :o• r 6,J ( O 1 • O 7V�ti c. ell N. .�: - :� . �' ..mom - � jiS � •� ::t�'� '�; : - •.:,. 1. .,.. ...; ..... . tr r< IL ' ' to •!6 . ; � ' y.: .'�. , ..," "� • � : �..- 1 Ot ?:. ' '•4 • I� ly :n`11 t;. ^ 4 y c �l- IS ✓t�' ; �� � � �r' ''rc. .:f '+��'tr �r.�.. Y'� t('. il�i' •Y:•i:; '`: ,.. �Yj ��jY,� 4�.• � .:�, -AS—BUILT MEASUREMENTS - No D REMARKS LI Z1 :�Z G,CoN� 3 -73 &9• t J2_ 7G SboK q0 83. 5V, 01, b 10"1 'S 'F-N-0 1 101 (9£f 8 a1j to 1 9 91- S5 l0 10 9 5 i� -�q lol • a lb� r, 93 111 14 (oZ 6 S`F WO'L 13 p �— cizUNOMgN I�,ISG/� T < -4/ 3 RM�pN9 JOHN KAkt!L.L, JR. P.E. I!q 121 CUSHMAN ROAD PATTER/S�ON, NEW YORK 12563 W L'�E(Z I Ic F—I • , NCpNr LASA COU PA re;c�p1 N`I It5b3 A aarrrrn IC�f !7L- T `. ;'? M PUMV VY Slav HALTF, FAC Ni l9{ 12 FUTNANI COUNTY DEPARTMENT OFF RI LT1I DA'ISION OF Elf - IRONMENTAL REALTH SERVI:CES GU V<JUNTE It OF SU'RSURFAC)E SEWAGE TREATMENT SYSTEM ner or .P ?.:ro ►tastsr oil Building Tax Map Block Lol. Building C(,,:as:r,!cted b-,, TOWL-Nillag-4 0 t v✓C� llvP l���s�f' Lozation - ' trier Subdivision Nwre ©�V, It-C. — -* oa Building Ty p�; Subdivisio:j Lot # I represent that i urr, v.holl;; and cmnpletely responsible for the location, workmanship, material, construction and drainage of the sewage ireatnent system serving the above- described property, and that ` .5 has -Ieen constructed as shown wi the approved plan or approv4d amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County L►epartment of Health, and hereby guarantee to the owner, his suceessozs, heirs or t) place in good operating condition any part of said system. constructed by n!e which fails to upccrate for a period of two years imrr..- ;iatP',;r following the date of approval of tht, "Certia ":cat° of C.onst'llction Compliance" for the sewage ti :atment system, or any repairs made by m° tc mlch system, except where the failure to operate properly is caused by the willful or lj�vgligent e-ct c:Jthe c sciapant ofth a !wilding utilizing the system. The undersigned further agrees to accept as conclusive the Jelertrinatior of the puh.i:^ Jq calth Director of the Putnam County Departmenk of Health as to whether cr not tLe fatili= of the system to operate was caused by the willful or negligent act c;.. the occupai t of tote bu3ljing utilizing the. system. Dated: Month _ 0 77 Day . Year a General Contractor (Owner) - Signature Cot or tatat on Name (if corporation) Address: A-M -Ism State IU Zip Signature:_ Title: ti Corporation Name (if corporation) Address: State "Lip Form GS -97 Sent By: TOWN OF CARMEL ENGINEERING; 9146287085; Nov -27 -00 10:20; Page 111 ' NOV -2T-00 09:16 AM TOWN OF PATTERSON 9148762019 P.01 � * SRUM R FOLBY LONMA MOLD" LN, MS.N. sera ftem oet► Awalft #60A AWcw 10 Oewarw d/ 1osm iw+vrv' D$PARTMMT OF JU ALTH I Oman And anwoca, New Yael: tosGQ lswroaaw Sam (i14j311 -file F0014) !tf -Ml �•TM•r tA1+�rn• alt wtoMym -fete rupwim.eeu s.ry nhrn.e a 1e1�lfr•6f1a VM$6wl pl4)itt4! ?w fVM3t1.`" OWAEla NAM$; W NuTelt, Uj TAX MAr A'V':N EX: • a-� E911 ADDAE$S: sip TOWN:7'0 ATJTEiQT4=D TOWN OFFICIAL: DATE: a The Futnam County Deportmeat of Health wi11 not lssae a Cer" ate of Construtdon Compliatice unlen the above form ie ealmpleted, i.e., a legal E911 addms is amleaed by to authodad torn official. 'This farm is to be submieted with the application for a Certificate of CoustructioA Compliaiace. wilmuffiq t/t eBrd. :EZ:e 00-LC °no,v !secteastm .10MSts3wetl3 73irav3 .4n jAjhl !Aa III** Nov -01 -00 e9v�e At'YJM TOWN OF P 9146287085; a BRUCK R. F'OLISY FUNIO H101th DWeaor • DEPARTWNT OF MALTH 1 Oaatva Road Erewstct, New Yak 10309 9148782019 P.01 0ct•31.01 0:23, Page iii - 7 :%*'V% CA. 4 n LORETTA MOLINARI RNA, M.S.N. Auaelaa f0116 HgdA J*wor Atttetur of Paden? &nkw Kerlro•m•■al H"146 (4u) M • 6110 Fw ()1 4j !71.7921 Nrniet 8thicq (il11Z71•t!!i WIC C1It317A."Is 1="1934) 291.600{ ttu+a 7eNreaKus (411�17J -aoi� haaeoo! pul :tl4aa t��lq�a•e6~I OWhMS NAME: TAX iV1AP NUMBER: E911 ADDRUS: TOWN; _.I1: •\ AUT ROR=D TOVM OFFICIAL: %Signature) / D o DATE: The Putonin County Departmeat of Health wiA not issue a Certificate of Construction Compliance unless the above fom is completed, Lt., a legal E911 address is assigned by an authorised town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (6911:iuw N� LABS k NORTHEAST LABORATORY OF DANBURY 39 MILL PLAIN ROAD - DANBURY, CT 06811 (203) 748 -7903 - FAX (203) 748 -0652 REPORT TO: MR. WALTER HORN P.O. BOX 700 MAHOPAC, N.Y. 10541 SAMPLE SITE: SAMPLE POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: 10/4/2000 LABORATORY REPORT DATE SAMPLE COLLECTED: TIME COLLECTED: COLLECTED BY: DATE RECEIVED @ LAB: DATE(S) TESTED: TESTED BY: REPORT DATE: 4 LISA COURT, PATTERSON, N.Y. BATHROOM FAUCET WELL WATER SOFTENER CT Cert: PH -0404 NY Cert: 11471 8/3/2000;10/3/2000 & 11/5/2000 9:14 P.M. W. HORN 8/4/2000;10/4/2000 & 11/6/2000 8/4/2000 — 11/8/2000 LAB# 11471 11/8/2000 MAXIMUM CONTAMINANT RESULTS METHOD # LEVEL (MCL) OR STANDARD • Total Coliform (Bacteria) 0 per 100 ml SM 9222B 0 per 100 ml PHYSICALS: 8/4/2000 • Color (Apparent) 25 - EPA 110.2 15 • Odor ND - - 3 Units • Ph 6.94 - EPA 150.1 No designated limits • Turbidity 4.1 NTUs EPA 180.1 5 NTUs CHEMISTRY: 8 /4/2000 • Nitrite Nitrogen <0.005 mg/L as N EPA 354.1 • Nitrate Nitrogen 3.82 mg/L as N SM 4500D • Alkalinity 340.0 mg/L SM 2320B • Hardness 394.0 mg/L EPA 130.2 • Iron (11/6/2000) 0.647' mg/L EPA 236.1 • Manganese. 0.036 mg/L EPA 243.1 • Sodium (8/4/2000) 59.4 ** mg/L EPA 273.1 • Lead 0.006 mg/L EPA 239.2 1.0 mg/L 10 mg/L No defined limits No defined limits 0.30 mg/L 0.50 mg/L Combined limit for Iron plus Manganese = 0.50mg/L 20.0 mg/L ** 0.015 mg/L * ** ml= milliliter mg/L--milligrams per Liter ND =none detected MCL= Maximum Contaminant Level * *Notification Level * "Action Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: MOTABLE or DOTPOTABLE RESULTS BASED ON SAMPLES SUBMITTED:8 /4/2000;10/4/2000 & 11/6/2000 Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 10 -27 -2000 09 :24AM FROM NORTHEAST LAB OF DANBURY TO 19146287085 P.01 NORTHEAST LABORATORY or DANBURY 39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404 LAW (203) 748 -7903 - PAX (203) 748 -0652 NY Cert. 11471 LABORATORY REPORT MR, WALTE HORN DATE, SAMPLE COLLECTED: 8/3/2000 & 10/3/2000 P.O. BOX 701 ► TIME COLLECTED: 9:14 P.M. MAHOPAC, Y. 10541 COLLECTED BY: W. HORN DATE RECEIVED @ LAB: 8/3/2000 & 10/4/2000 TESTED BY: LAB# 11471 REPORT DATE: 10 /27/2000 SAMPLE SI rE: 4 LISA COURT, PATTERSON, N.Y. SAMPLING POINT: BATHROOM FAUCET SOURCE: WELL TREATMENT: NONE RESULT: MAXIMUM CONTAMINANT LEVEL IJAI-: t EXI : tU /31.L000 Total C liform (Bacteria) 0 per 100 ml 0 per 100 ml PHYSICAL ': Color 25 15 Odor ND 3 Units pH 6.94 no designated limit Turbidity 4.1 NTUs 5 NTUs CKEMIS Y: Nitrite N <0.005 mg/L as N 1 mg/L as N Nitrate N 3.82 mg/L as N 10 mg/L as N Alkalinity 340.0 mg/L no designated limits Hardness 394.0 mg/L no designated limits Iron 0.591 mg/L 0.30 mg/L Manganese 0.036 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium 59.48- mg/L 20 mg/L ** Lead 0.006 mg/L 0.015*** Ml = millilitel mg/L = milligrams per Liter ND = none detected NTU =Units * *Notification revel — Action bevel RESULTS BASED ON SAMPLES SUBMITTED:8 /4/2000 & 10/3/2000 SAMPLE, AS TESTED ABOVE: OTABLE or NOT POTABLE (PER NEW YO1 K STATE DErr. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Post -it" Fax Note 7671 1 Date IV ,2 7 p► TT- oratory ire r co./tpL co. v d ' BERLIN, CT 06037- (860)828 -9787 - FAX (860)829 -1050 Phone # Phone s2b- 0105.OUTSIDE CT: 800 -654 -1230 Fax #r1 / ~�a 0 70 $5 Fax # 77 TnT01 P ni .NE NORTHEAST LABORATORY OF DANBURY 39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404 ]TABS ; (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: MR WALTER HORN DATE SAMPLE COLLECTED: 10/3/2000 P.O. BOX 700 TIME COLLECTED: 9:17 P.M. MAHOPAC, N.Y. ,10541 COLLECTED BY: W. HORN DATE RECEIVED @ LAB: 10/4/2000 DATE(S) TESTED: 10/4/2000 TESTED BY: LAB #11471 REPORT DA'Z'E: 10/10/2000 SAMPLE SITE: 4 LISA COURT, PATTERSON, N.Y. SAMPLING POINT: BATHROOM FAUCET; .:.. SOURCE:`:.. WELL TREATMENT: NONE TEST PERFORMED RESULT: RECOMMENDED LIMIT BACTERIAL:' Total Coliform (Bacteria) 0, per 100 ml 0 per 100 ml CHEMISTRY: Chlorine Residual " ND mg/L - - -- ml _:milliliter. . . . v mg/L = milligrams.per Liter ND' = none detected .:RESULTS BASED ON SAMPLES SUBMITTED: 10/4/2000 SAMPLE, AS TESTED ABOVE: AMP OTABLE . or OT POTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) ' HEAST LABORATORY, 129 MILL STREET, BERLIN; -CT 06U37•_ ($00)828-97r'- FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE'CT: 800 -65..4 -1230 BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 Environmental Health (845) 278 -.6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 November 20, 2000 Jack Karell, Jr., P.E. 121 Cushman Road Patterson NY 12563 Re: Horn Lisa Court, Lot #2 (T) Patterson, TM# 1 -4 -2.23 Dear Mr. Karell: The above regarded application is and cannot be processed. This means the project cannot be forwarded to a Putnam County Department of Health reviewer for comments or approval until the following has been received: 1) ®Standard E911 Address Form is incomplete. (Enclosed) 2) ❑ Construction Permit Application. 3) ❑ Certificate of Construction Compliance Application. 4) ❑ A certified check or money order in the amount of: ❑ $300 for a Construction Permit. ❑ $300 for a renewal of a Construction Permit.. ❑ $150 for a revision of an approved Construction Permit. ❑ $200 for a Certificate of Compliance. ❑ $100 fora Well Permit. ❑ Other If you have any question regarding this matter, please call me at (914) 278 -6130 ext. 2152. Very truly yours, Theresa Nemeth Senior Typist BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 . Geneva Road Brewster, New York 10509 LORETTA MOLINARI- RN., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (914) 278 -6130 Fax (9.14) 278 - 7921 Nursing Services, (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 preschool (914) 278 -6082 Fax (914) 278 - 6648 E911 ADDRESS VERIFICATION FORM OWNERS NANIE: �v �`� `�- P� Pfo 1�-N( TAX MAP NUMBER: E911 ADDRESS: TOWN: �A'� -SO AUTHORIZED TOWN OFFICIAL: (Signature) DATE: The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERFRND PUTNAM COUNTY DEPARTMENT OF HEALTH'' f DIVISION OF ENVIRONMENTAL HEALTH SERVICES f �L7 a FINAL SITE INSPECTION Date: 7 /o Inspecte y: Street Location GlsA G? Owner Ao z it Town S eW Permit # 7 —,2-. •- p $ TM #_ ­44— -2 , a 3 Subdivision Lot # ',L 1. SewaLye Svstem Area COMMEATS 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 ...... ............................... II. Sewage System 6�9)...other........ a. Septic tank size - 1,000 ..... .f. b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......................................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ....... ............................... ,... f. reT —ncI es eL ngth required It2o Length installed 2. Distance to watercourse measured -f- 100 Ft.......... 3. Installed according to plan ......... ................................ 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ..................... . 8. Size of gravel 3/4 - 1' /z" diameter clean .............. 9. Depth of gravel in trench 12" minimum .................. 10. Pipe ends capped .................................................. f . g. Pump or Dosed Systems Size o pump chamber ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .....................:.... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle.......... III. House/Building a. House I ocated per approved plans ............. b. Number of bedrooms .................... 77.1......... . IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured /,0,9 / (.1; 9. - c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted .................................................. b. All pipes partially backfilled :...... ............................... c. All pipes flush with inside of box ............................... d. Backfill material contains stones <4" diameter ............. e. 'Curtain drain & standpipes installed according to plan. f. Curtain drain outfall protected & dir.to exist watercour g. Footing drains discharge away from STS area .........1 h. Surface water protection adequate .. ..............:................ i. Erosion control provided ................ ............................... nh ie WE IC� IUD.! nh . d JUN -16 -00 SAT 9 :07 AM PUNAM CTY ENV HEALTH FAX 90. 19142787921 PUTRAM COUNTY DEPARTMENT OF HEALTH AMSION OF ENMONMENTAL HEALTH SERVICES ATil N110N fl ADAM All information must be hilly completed prior to any inspections being made. PCHD Coamuction Permit # 9 GENE For: Fill Trenches ). P. I Located: LISA r00PT 6 L %'i .& (T) M ��% a-J Owner /Applicant Name: W Auj�f 11L /j _ TM ,, t —4-- of �3 Formerly: Subdivision Name: t/u Subdivision Lot 9 D2 is system fill completed? Date:_, is system complete? Y-C- _ Date: Is system constructed as per plans? Is well drilled? 4 Is well located as per plans? Are erosion control measures in plm? Date: --- Z& ko I certify that the system{sl as listed, at the above premises has beta consuueted end I have inspected and verified ibeir completion in accordance with tlu issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. Date: rl 11 0 Certified by: M. Address: Z .f Lie. # eM3*. 06 L Form FIR -99