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HomeMy WebLinkAbout0103DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 3.19 -1 -87 BOX 2 00103 } JT �r 00103 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF, ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building . Tax Man Block Lot Building Constructed by TownNillage Location — Street Subdivision Name , Building. ype Subdivision Lot # I represent. that I am wholly and completely responsible for the location, workmanship, material, . construction and drainage of the sewage treatment system serving the above- described property, and that it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance, with the _standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner,, his successors, heirs or, assigns, to place in good. operating condition any part of said system constructed by me which fails to operate for a period ` of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repair made by me to. such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of .the building utilizing the system. The. undersigned further agrees to accept as conclusive the determination of the Commissioner of Health of the Putnam County Department of Health as.to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the. system. Dated: Month � Day Year' /S Signature: ptic Sy em I a ler) . Title: �:✓5�� G eral Contractor (Owner) — Signature PCHD License # C�( x j9t Corporation Name (if corporation) Corporation Name (if corporation) Address:(l 0t �`"(� Address:-.!�� State: " zip CU`-� . Zl /0. S �� I? p -97 Form GS PUTNAM COUNTY DEPARTMENT OF HEAL 3o DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COP/MPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # �7 " ^�-- Located at (,r t ()0 CL/"'( <S r Village Ps S -a- Owner /Appli an"t Name J- b i G &- m AJ't� Tax Map �t Block Lot �_ Formerly Cj, l 1-elis e% �'� 1� C'Oe / Subdivision Name Mailing Address TTI(ct- Subd. Lot # Date Construction Permit Issued by PCHD Separate Sewerage System built by p Llb� AAA Address k3p' (CT'- Consisting of 1250 Gallon Septic Tank and 6- C2f �,(� �y,� ,/� 1 i, -a / a 1' Other Requirements: Water Supply: Public Supply From Address or: x Private Supply Drilled by �a.�S�QC�S��_ Address Building Type .Si N G c r i Has erosion control been completed? td Number of Bedrooms ¢ Has garbage grinder been installed? W° 'Mr 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 of the tnam C un Department of Health. Date: s� Certified by P.E. A--- R.A. Address ��° �r'a"A 9- /1 r�ai �/ (R� P ofess aq `� License # Ie 4, 0 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Director /Commissioner, such revocation, modification or change is necessary. By. =% �P 1'. Title: /}7°14 Date: / ! :� 3 i 1 Wh'itS,ibopy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address Town /Village: Tax Map # Xtrri W. Pi er,5D A Map I Block 1 Lot(s)S 7 a,.. Well Owner: Name: Address: Use of Well: Residential _Public Supply Air cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Institutional Standby Drilling Equipment Rotary _Cable percussion Xcompressed air percussion Other(specify) Well Type _Screened _Open end casing Open hole in bedrock _Other Total Length °�% ft. Materials: Y Steel Plastic Other Casing Details Length below gradgWt. Joints: Welded Threaded Other Diameter -in. Seal: Xcement grout Bentonite Other Weight per foot • Ib /ft Drive shoe: X Yes _ No Liner: 'Yes No Diameter in Slot Size Length ft Dept to Screen ft Developed? Screen Details First I Yes No Second I Hours Well Yield Test _Bailed _Pumped A Compressed Air Hours Yield ra gpm Depth Date Measure from lana surface static (specify ft)w _ During yield test ) Depth of completed well in ft. vveu t_og If more detailed information descriptions or sieve analyses are available, please attach. ue to rrom surrace Water B ft. ft. Land Surface / 0 go 176 f yield was tested Feet Gallons Per Minute at different depths luring drilling ist: 5©0 meter 1 I Formation Descri Pump /Stor ge Tank Infor Pump Type acit Depth Model Voltage 700 HP Tank Tv Volume NOTE: Exact Location of well with distances to at least two permanent landmarks'to be provided 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 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovani, Director ** TEST REPORT ** LAB #: 1.502703 CLIENT #: 60486 NON STAT PROC PAGE: 1 of 2 JBM CUSTOM HOMES, INC 3135 COURT ST YORKTOWN HEIGHTS., NY 10598 DATE /TIME TAKEN: 09/23/15 09:30P DATE /TIME RECD: 09/24/15 12:30P REPORT DATE: 10/22/15 PHONE: (914)- 906 -0615 SAMPLING SITE: 18 BURTON FARM RD, PATTERSON NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: HNO3 COLD BY: JOHN MERCURIO TEMP RECEIVED: 9C ON ICE NOTES...: COLIFORM METH: MF START DATE /TIME END DATE /TIME FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 09/24/15 0430 09/25/15 0330 MF T. COLIFOR ABSENT /100 ML ABSENT SM 18 -20 9222B 10/16/15 LEAD (IMS) <1.0 ppb 0 -15 ppb SM 18 -19 3113B 09/25/15 0130 09/25/15 0200 NITRATE NITRO 1.57 MG /L 0 - 10 HACH 10206 09/25/15 1245 09/25/15 0115 NITRITE NITRO <0.01 MG /L 1.0 MG /L SM18- 20450ONO2 10/04/15 IRON (Fe) 1.16 MG /L 0 -0.3 mg /1 SM 18 -20 3111B 10/08/15 MANGANESE (Mn 0.14 MG /L 0 -0.3 mg /l SM 18 -20 3111B 10/16/15 SODIUM (Na) 2.84 MG /L N/A SM 18 -20 31113 09/28/15 0405 09/28/15 0408 * pH 7.5 UNITS 6.5 -8.5 SM18 -20 4500HB 09/28/15 HARDNESS,TOTA 250 MG /L N/A SM 18 -20 2340C 10/13/15 ALKALINITY (A 202 MG /L N/A SM 18 -20 2320B 09/24/15 0100 09/24/15 0105 TURBIDITY (TU 7.26 NTU 0 -5 NTU SM 18 (2130B) O S: MFTC To )ameter. form = This result indicates that the water (was), s not) of a satisfactory sanitary quality according to e Nerk State and EPA federal drinking water standard for this 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 100 of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg /L, else water treatment must be undertaken to reduce the waters corrosive potential. Fe /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. IMS = IMMEDIATE METAL SAMPLE.(INTERPRETATION: WATER SAMPLED AFTER SITTING UNDISTURBED A MINIMUM OF 6 HOURS OR OVERNIGHT) NMS = NORMAL METAL SAMPLE. (INTERPRETATION: WATER SAMPLED AFTER RUNNING FOR 10 -15 MINUTES MINIMUM) YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovani, Director ** TEST REPORT ** LAB #: 1.502703 CLIENT #: 60486 NON STAT PROC PAGE: 2 of 2 JBM CUSTOM HOMES, INC DATE /TIME TAKEN: 09/23/15 09:30P 3135 COURT ST DATE /TIME RECD: 09/24/15 12:30P YORKTOWN HEIGHTS,, NY 10598 REPORT DATE: 10/22/15 PHONE: (914)- 906 -0615 SAMPLING SITE: 18 BURTON FARM RD, PATTERSON NY SAMPLE TYPE..: POTABLE KITCHEN TAP PRESERVATIVES: HNO3 COLD BY: JOHN MERCURIO TEMP RECEIVED: 9C 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. `iid 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 OCEDU ES MEET ALL REQUIREMENTS OF NELAC, AND RELATE L TO TH S SAMPLES RECEIVED BY THE LAB SUBMITTED BY: Albe Pad ani, M.T.(ASCP) Director ; ELAP# 10323 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovani, Director ** TEST REPORT ** LAB #: 1.503238 CLIENT #: 64913 NON STAT PROC PAGE: 1 of 1 JBM CUSTOM HOMES, 463 JILL CT. YORKTOWN HGTS, NY INC 10598 DATE /TIME TAKEN: 11/17/15 01:OOP DATE /TIME REC D: 11/17/15 02:5OP REPORT DATE: 11/20/15 PHONE: (914)- 906 -0615 SAMPLING SITE: 18 BURTON FARMS RD, PATTERSON NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: HNO3 COL'D BY: JOHN MERCURIO TEMP RECEIVED: 8C ON ICE NOTES...: COLIFORM METH: N/A ----------------------------------------------------------------- ----- --- ----- ---- ---- ---- - - - - -- START DATE /TIME END DATE /TIME FLAG PROCEDURE 11/19/15 RESULT IRON (Fe) <0.06 MG /L NORMAL - RANGE METHOD 0 -0.3 mg /l SM 18 -20 3111B COMMENTS: 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) J C THE ABOVE TE URES MEET ALL REQUIREMENTS OF NELAC, AND RELAT N Y 0 T SE SAMPLES RECEIVED BY THE LAB SUBMITTED BY: Albe H. Pradovani, M.T.(ASCP) Director ELAP# 10323 ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT. MORRIS, P.E., MPH Director of Environmental Health November 13, 2015 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 Daniel J. Donahue, P.E. 120 Breckenridge'Road Mahopac, NY 10541 Dear Mr. Donahue: MARYELLEN ODELL County Executive Re: Construction Compliance — JBM Custom Homes 18 Burton Farm Road (T) Patterson, T.M. 3.19-1 -87 This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your review and consideration. 1. The E -911 address is to be provided on the plans. 2. The source of the survey is to be provided on the plans. 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, oseph S: Paravati, Jr., P.E. Assistant Public Health Engineer JSP:cml ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E., MPH Director of Environmental Health October 1, 2014 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: MARYELLEN ODELL County Executive Re: Field Inspection — Patterson Development Boston Farm Road (T) Patterson, TM 3.19 -1 -87 The above referenced separate sewage treatment system can be backfilled. The following comment must be corrected in the field: • A bedroom count needs to be performed by this Department. If you have any further questions, please contact me at (845) 808 -1390, ext. 43261. GDR:cml Sincerely, w Gene D. Reed Principal Environmental Health Engineering Aide PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Dater L2Z.30 / Inspected by: Street Location �r,-4'on farm2 Owner �e� -so►� Town_ o4e-c ri Permit # P-04-1,-/3 TM # 3,/,7—j--97 Subdivision Lot # 1. Sewage System Area a. STS area located as per approved plans ..........:................ b.. Fill section date of placement 3 :1 bairier Lgth. ' Width . Avg.Dpth c. Natural soil not stripped ................::. ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 1 00' from water course / wetlands...... .... : .......................... IL Beware System � ' a. Septic tank size.- 1,000 .... 1,25 .:....other ................. b. Septic tank iristaned level ........... ............................... c. 10' minimum from foundatign ....................... .............. d. Distribution Boz 1. Aoutlets at same elevation- water,tested ................. 2. Protected below frost .................. ............................... 3. . Minimum 2 ft. Original soil between box & trenches e. Junction Box properly set .......................... :................ 6. Trenches 1..Lengih required 336. Length installed 3 3G 2. Distance to watercourse measured+ l cao Ft.......... 3. Installed according to plan ....:.... ............................... 4. Slope of trench acceptable 1116 - 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, 10.00/0 ......................... 8. Size of gravel 3/4 -1'A" diameter clean ...............::..: 9. Depth of gravel in-trench 12" minimim ...: 10. Pipe ends capped ..................... ........................... g. Pum n orDosect8vitems 1. Size of pump chamber ................. .............................. 2. Overflow tank ... .................. .............. .................. 3. Alarm, visual / audio .......:........... ............................... 4. Pump easily accessible, manhole to grade ......... ...... .. 5. First bOx baff ed ...:....................... .......... ...I.................. 6. Cyxcle witnessed by H.D.estimated flow /cycle........... III., HouselBujldiu a. House ocated er approved plans :.. ............................... b Number of bedrooms ................... ............................... -'j IV..Well Weil located as per approved plans . ......:........................ b. Distance from STS area measured /Do ' ft ........... c. Casing. 18" above grade ........... ............................... d. Surface drainage around well . acceptable ......... .. ............. V. ' OveraR Worlonanshi A.- Boxes properly grouted .................. ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfdl 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 riIMON OF RMY CIMOM" MMALIM MBUVM= Foc vuj AL! * AaWiwr a* be My p Uw % my TNVAh r �rstpi� doer Init� n++Mle- I'M C 1 hro* o (V) OWFAWA~ NNW, a � u7 �ri- .....«- n.�... Date! 37, ;oi I� h►rt�rA ewo�w�lri r p�p1 9 ' Is wiNl 4efdMd? Orme: �+C /y 11 "a I #A ps =? r�Flr�gIYAU r��M9r��� i c�rp1.fj dwvhm ry�r*). diiiM 4 al*c w w" pwnr�ilrr im 1�w►� sod I hove iopsctod ed vrN ided dm* o mplod�oa In oc+orrdow with tho irwd PCHD C.aundon Penod wd wvmved AM and dr Stud . Rut" ow kqpdowo of ter riam Cowtty D"W"m of Kati .•�. Dry. camiaw RA irw�rYw ..rr..rw Ad*m , // V� riw. I 4 I I 0 9 9 SSTS AS BUILT ON ciNE `� SITUATE IN THE TOWN of PATTERSON PUTNAM COUNTY NEW YORK SCALE: 1 "= 30' SURVEYED: SEPTEMBER 4, 2015 O PREMISES ARE DESIGNATED ON THE TAX MAPS FOR THE TOWN OF PATTERSON SECTION; 3.19 BLOCK; 1 LOT; 87 I COUNTY DEPARTMENT OF HEALTH I OF ENVIRONMENTAL HEALTH SERVICES. 'As NOTED FOR CONFORMANCE WITH ►BLE RULES AND REGULATIONS OF THE I COUNTY HEALTH DEPARTMENT. r a3 < r !RE & TITLE 11-10 SSTS TIE IN (MEASURED) 0ANAffl, J,� .oONti1i(JE P,E, GONSUL7-lN6 ENGINEEPS I20 Dl.'EGKFNI.'1D6f POt}D MhhOf'/iG, NY, /054/ (845) - <Z8 - 75-76 UNIT A B SEPTIC TANK 1250 GAL P. C. 1 21.3 43.8 D -BOX 2 29.9 46.5 END OF PIPE 3 57.0 98.3 END OF PIPE 4 33.0 52.5 END OF PIPE 5 34.9 43.5 END OF PIPE 6 68.0 23.8 END OF PIPE 7 1 61.3 100.0 END OF PIPE 8 40.0 55.7 END OF PIPE 9 41.5 47.4 END OF PIPE 10 71.6 END OF PIPE 11 66.1 102.2 END OF PIPE 12 47.0 59.6 END OF PIPE 13 48.3 51.9 END OF PIPE 14 75.8 37.0 END OF PIPE 15 55.1 56.9 END OF PIPE 16 80.3 43.8 LENGTH OF PERORATED PIPE 48.0 FT TYPICAL TOTAL LENGTH OF FIELDS: 336' 0ANAffl, J,� .oONti1i(JE P,E, GONSUL7-lN6 ENGINEEPS I20 Dl.'EGKFNI.'1D6f POt}D MhhOf'/iG, NY, /054/ (845) - <Z8 - 75-76 R �oD Ln 1*1 Q) K Ln N 100% EXPANSION AREA 4" PVC SOLID 4y) PVC PERORA TED 15 7� - — — — — — — — — — 8 9 C) 31---- - - - - -- 4 5 1250 GAL 2 D—BOX SEPTIC TANK 1 SLATE /v1 45,00. 84.0' 70 00 JOPEN - c ------ M-� A 61 co '14 TWO Y TO 5R 5 FRAME DWELLI O NG G V, 0 Io v- 00 0 ry' S2 16 CAPPED 10 ENDS ti STEPS RAISED S 0 0 0, 0-5, WOOD DE oo���_M,9� •9- 3p 9 <01 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5O6 °00'58 „W 30 0 3'00"W now or formerly the lands belonging to EPISCOPAL CHURCH. of PA7TERSON FR P H A L T L T D R I V E W A Y 52.7' ,•O kv WELL 115.18; Oo Q) Q) ri LINE PUTNAM COUNTY DIVISION OF ENVH Ars 6 CONS U LTING-E NGI KMER 9 0- D*alJ-L)onjkhut.P.E. 200 STeCk-enridge Road Mahopac. N.Y. j 0341 914.629-7575 TO IIE717LEY3 TF MUNS5,19117al WE ARE SENDING YOU C. Attached El -Under separate cover via Mkw1.njj items: Z], Samples C:j SPVCJfiC4hon3 -Shop drawings C' Print: 0- Plans C. Copy of dotter Q Choose order THESE ARE TRANSMITTED as chocked below: (i For approval Cl Approved as submitted Resubmit—cop4w for approval 0 For your use 0 Approved as noted Cl Submit —.—copies for distribution kft' 0 Returned for corrections F) Return corrected Prints 0 For revWtv and comment C., FOR BIDS DUE 19 PRINTS RETURNED A."ER LOAN tO US lenclOW442 are got as ftmee, hjnmy *4440 mo at once. 6ATE THESE ARE TRANSMITTED as chocked below: (i For approval Cl Approved as submitted Resubmit—cop4w for approval 0 For your use 0 Approved as noted Cl Submit —.—copies for distribution kft' 0 Returned for corrections F) Return corrected Prints 0 For revWtv and comment C., FOR BIDS DUE 19 PRINTS RETURNED A."ER LOAN tO US lenclOW442 are got as ftmee, hjnmy *4440 mo at once. ALLEN BEALS, M.D., J.D. Commissioner of'Heddi .ROBERT MORRIS, P.E.9,N PH Director 4bwironmerdd Health November 15, 2013 Dan Donahue, P.E. 120 Breckenridge Road Mahopac, NY 10541 Dear Mr. Donahue: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 MARYELLEN ODELL COW* Executive Re: Proposed SSTS for Lot #3 - Paddock View Estates (T) Patterson, TM 3.19 -1 -87 This Department, in conjunction with the NYCDEP, has received and reviewed the submitted application and plans for the above referenced project and the following comments are offered for your consideration. (� The USDA Soil Conservation Service soil type boundaries are to be shown and identified / on the site plan. 612. The construction permit and septic notes on the plan specify 333 LF of absorption �trenches although 336 LF are shown on the septic site plan. . The existing topographic contours on the site plan are to be labeled with numeric elevations The submitted SSTS design does not provide any soil testing in the SSTS reserve system area. 5. The proposed house location encroaches upon the previously approved SSTS area as Jshown on the subdivision filed map. . The septic site plan is to specify a minimum separation distance of 100 from the proposed well to the stormwater infiltration system. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions.. _['9 m!� MJB:cw Michael J. Bus P Director of En ' een DANIEL J. DONA HUE, P.E. CONSULTING ENGINEERS 120 Breckenridge Road Mahopac, N.Y. 10541 845- 628 -7576 November 22, 2013 Putnam County Department of Health 1 Geneva Road. Brewster; N.Y. 10509 Att: M Budzinski, P.E. RE: Proposed SSTS — Lot #3 Paddock View Subdivision Patterson (T) Dear Mr. Budzinski: Enclosed are four copies of revised plans which reflect the comments raised in your November 15th letter. Please note the following: 1.. The soil classification is shown on the plan. 2. The notes now reflect the 336 LF of trench 3. Additional existing topo is now shown. 4.—.The perc test P71 was not located in the exact location as shown on the subdivision map. The design now has .testing in both the primary and reserve area. 5. The reduction of the flow for the design of the system allows some latitude in locating the house and ssts. The proposed location of the house complies with code requirements. 6. The minimum distance from the infiltration system to the well is shown. We hope the above addresses all your concerns. Regards, . Do .E. Site • Sanitary • Environmental ALLEN BEALS, M.D., J.D. Commissioner ofHealth ROBERT MORRIS, P.E.,,MPH Dkwator Obvvironmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 November 15, 2013 Phone # (845).808-1390 Fax # (845) 278 -7921 Dan Donahue, P.E. 120 Breckenridge Road Mahopac, NY 10541 Dear Mr. Donahue: MARYELLEN ODELL . C=0 K oft RE: Complete Application Determination for Lot #3 Paddock View Estates (T) Patterson, TM3.19 -1 -87 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 November 8, 2013 is complete. The Department will notify you by December 5, 2013 of its determination. ® The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ❑ 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. Director of MJB:cw WS2 1 ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E., MPH Director of Enviromnental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 MARYELLEN ODELL County Executive TO: NYC DEPARTMENT OF ENGINEERING AND DESIGN REVIEW Ate: FROM: DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM DELEGATED New Application Revision ❑ Renewal ❑ PROJECT: WT'j ' " f }� !) Clr— V , EA r� G Zrf 7E� LOCATION: TOWN: 6950 DATE SUB'D APPROVAL: S— TM #: NOTICE OF COMPLETE APPLICATION DATE: DELEGATED i November 5, 2013 DANIEL J. DONAIIUE, P.E. CONSULTING ENGINEERS 120 Breckenridge Road Mahopac, MY 10541 845- 628-7576 Putnam County Department of Health 1 Geneva Road Brewster, N.Y. 10509 Att: J. Paravati RE: Proposed SSTS — Lot #3 Paddock View Subdivision Patterson (T) Dear Mr. Paravati: Enclosed please find: ` 1. Application for SSTS 2. Application to drill a well 2. PC -97 Form 3. EAF Form 4. Design Data Sheet 7. Filing fee of $500.00 8. Letter of Authorization 9. Three sets of plans 10. Two sets of house plans Your prompt attention would be appreciated. Regards Daniel . Donahue, P.E. Site • Sanitary • Environmental i u_tea.e (2187f_Text 12 PROJECT I.D. NUMBER 811.21 SEAR App*ndlx C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART t— PROJECT INFORMATION (To be completed by Applicant or Project 8pcnsar) 1-. AP LICANT /SPONSOR fECT Z. PA ���f(h1 !i�� "" 3. PROJECT LOCATION: Municipality 'Z�YSr�h County PP�I e, PRECISE LOCATION t add ss and road Intaraecilona, prominent landmarks, etc., or provide map) S. IS PROPOSED ACTION: rr�att iLir ae•or ❑ Exaansion LJ Modificationlalleration b.DESCRI ®: PROJECT ERIEFLY: C'Q'q'f'-T/o 0C'Vo/v 7. AMOUNT OF LAND AFFECTED: _ In10814 of] scras Ultimately �• •�� a:re3 9. Y1I4 PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes 4r! No it No, deseNbe briefly 9..WHA..T iS PRESENT LAND USE IN VICINITY OR PROJECT? WRssidentist G indust►ial 0 Commercial u Agriculture O Park/Forest/Open apace Other Describe: 1C. DOES ACTION INVOLVE A* PERMIT APPROVAL. OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL STATE R LOCAL)? Yes ❑ No It yes, list agency($) and psrmiUapprovals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes t_1 No 11 yes, list agency name and permlUspprovel 12. AS A RESULT xOFr+, PROPOSED ACTION WILL EXISTING PERMR/APPROVAL REQUIRE MODIFICATION? Dyes +r i No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE AppticanJsponsor name: Date: ' Siynattlrll: - _ __ , It the action Is In the Coastal kes, and you are a state agency, complet® the Coastal Assessment Form before proceeding with this assessment OVER 1 '6. PART 11— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE! THRESHOLD IN 6 NYCAN PART 617.121 it yes, coordinate the review process and use the FULL EAF. Yes ONO S. WILL ACTION RECEIVE COORDINATED RIEMEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 It No, a negative declaration may be supersedraae,��,d by another Involved agency. , ❑ Yes . M Nil C. COULD ACTION RESULT IN ANY ADVERSE,EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) Cl. Existing. air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposai. potential for erosion, drainage or flooding problems? Explain brlefly: C2. Aesthetic, agriculture), archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: �l 6 /V C3. Vegetation or fauna, fish, ahetlfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: A/ C4. A community's existing plans or goals as officially adopted, or a change !n use or intensity of use of land or other natural resources? Expialr' briefly NaNl CS. Growl!+, subsequent development, or related activities likely to be induced.by the proposed action? Explain briefly. o/vr C8. Long term, short term, cumulative, or other effects not identified In C1-CS? Explain briefly. /%/ C7. Other impacts (Including changes In use of either quantity at type of energy)? Explain briefly. I:. IS THERE. OR IS THERE LIKELY TO BE-,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ON* If Yes, explain briefly i 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 (Q magnitude. If necessary, add attachments or reference supporting materiats;..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 deciaratlan. Check thW.box If you have determined, based on the Information and analysis above and any supporting documentation; that the proposed action WILL NOT result In any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency rent or Type Name of esponsi a Officer in l ad Agency TOW sponsigle Off Isar ry +gnature of esponsi a t5ificer in Lead Aeency SipStWe of parn fit different rem responsible officer! �'� ate r PUTNAM COUNTY DEPARTMENT Off'HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICAiTION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM I . Name and address of applicant: dl 7._, _ ��.e f e 2. Name of project: 3. Location/: 4. Design Professional: 'dc,*..v 5. Address: l ;?-e 6. Drainage Basin: N 7. T e of Pralect: Private/Residential I~ ood Service Commercial Apartments _ Institutional Mobile Home Park Office Building _ Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type Ii Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... r 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 1 I . Name of Lead Agency 1� 101".x.4.' 1 12. Is this project in an area under the control of local planning, zoning, or other officials ordinances? .................................. ............................... .... s 13. If so, have plans been submitted to such authorities? ......... ..............................r 14. Has preliminary approval been granted by such authorities? Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water groundwater 16. If surface water discharge, what is the stream class designation? .................... 17. Waters index number (surface) .................................................... ............. I ......... /I 18. Is project located near a public water supply system? ........ ............................... 6 _LN 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ..... AIA..... 21. Name of sewage system Difance to sewage system 22. Date test,holes observed Id "I.6 3 23. Name of Health Insp or; 6d 24. Project design flaw (gallons per day) ........ .................. ............................... ... 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required?.:,,g 26. Has SPDES Application been submitted to local DEC office? ........ d...... Form PC -97 t, 2 27. Is any portion of this project located within a designated Town or State wet] and ?__ A' _-_ 28. W'etlan& ID Number ......... ....................,........ ............ ............................... - -- 29. Is Wetlands Permit required'? ............................. .....:....... ............................... Has application been made to T©wn or Local DEC office? ............................... 30,. Does project require a DEC Stream Disturbance Permit? 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landflling, sludge application or industrial activity? ............................ Y q 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 DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... Ems' 34. Are community water` and/or sewer facilities planned to be developed within. 15 years in or adjacent to project site? ................................ ............................... - 35. Are any sewage treatment areas in excess of 15% slope? . ............................... -- 36. Tax Map ID Number ......................... ............................... Map _j /'I Block_- Lot Y7 - 37. Approved plans are to be returned to ..... __ Applicant _ k Design Professional NOTE: All applications fc r review acid approval of a new SETS 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 f nal approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater,plans or the creation., of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirart, under penalty of perjury, that information provided on this form is true to the best pf my knowledge and belief. false statements made herein are puniskable as a Class A misdemeanor pursuant to Section 210. of th P at Law. SIGA,A TU.I,IES; & OFFICIAL 77TLES- Al /d Mailing Address: ....... ; ............................ -f ,. SJ 44 a I PUTNAM COUNTY DEPARTMIENT OF HEAL DIVISION OF ENVIRONMENTAL HEALTH SERVI CES . DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner _Address If-re.02- f.2 Located at (Street) oe fF, 97), Tax Map Block Lot �jiczte nearest cross Street) municipality Watershed 4 P4� F11, '-s- Date S011L PERCIOLATION TEST DATA — y i f- Date Date of Percolation Test . e • L-1 � —J- NUTEW 1. MIS To Do repeama ax same Gopm Until "Frur-unawLy %411-- pwaWwam"w" percolation test hole. (i.e. :g I min for 1-30 min/inch, !g 2 min for 31-60 mintinch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 0 ze� 0213 .2 4 5 2 A 2 Ilk y, 2, 3 4 5 2 3 .5 NUTEW 1. MIS To Do repeama ax same Gopm Until "Frur-unawLy %411-- pwaWwam"w" percolation test hole. (i.e. :g I min for 1-30 min/inch, !g 2 min for 31-60 mintinch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 DEPT14 G.L. 0.51 1.01 1.51 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.01 5.5 6.0' 6.5' 7.0' 7.5' 8.00 8 . .5' 9.01 9.51 10.01 11 TEST Prr DATA I DESCRIMON OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. HOLE ISO. Indicate level at which groundwater is encountered N r- 0 Indicate level at which mottling is observed Indicate level to which water level rises after being encountered og Deep hole observations made by: DJ 0 Poe RWOM Date /A/1 Design Professional Name: [Jk/ a M #4 Address- 1-- ra A4,45ko C 40. ­ I /c, MW P-Idr� Signature: Design 2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES RE: Property of LETTER OF AUTHORUATION Located at 4c?yot -Tax Map# Block __2.L.f Lot Subdivision of 104 al./Lllel Subdivision Lot #_._,9 Filed Map 'Date Filed Gentlemen: This letter is to authorize a duly licensed Professional Engineer or Registered Architect to apply for the required W&Stiwitcr ftairritnt and/or Nv Mr. supply pemit(s) to I serve thef above-noted property in accordance WAh the sten&rds, Pules or regulations as prorn . ulgated by :the Public Health Director of the Putnam Courtv Health Department, and to,sign all necessary pap pts on my b6hilf in co w connection 10h this matter and to supervise the construction of said w .wasteater treatrilent"a"indl/,or water supply systeiyis. IT), conformity with the provisions of Article 145 ind/or 47 of the Education Law, the Public He* j1%Eh Law, and the Putnarn County Sanitary Code. Very truly yours, Countersigned. Signed: P.E.,..RA, (041%er of Propem Mailing Address la 6. a av ...bailing Address State -zip Z Telephont:.`i .r� 71 �,e' state Telephone: 4- Fors. f -A -97 PUTNAM COUNTY DEPARTM T OF HEALT DIVISION OF ENVIRONMENTAL HEALTH. SER ' ' D �p6z ° CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at 13 y r Im C--4 /h. 0ea gr / To r Village le-:a9 a Subdivision name A-� // /.1(`// QtSubd. Lot # 3 Tax Map3� p' Block--/ Lot 09 Date Subdivision Approved d Renewal Revision Owner /Applicant Name PQ � �i f c"t X"4elo p 'N - Date of Previous Approval Mailing Address T! d, 13-6)e 0a 3 f AA A sue/ Zip Amount of Fee Enclosed 0 Sao Building Type 51 4G F 1`4AAgc y Lot Area No..of Bedrooms 4t- Design Flow GPD 0160 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED to consist of I;-r6 a/f 4, gallon septic tank and r Other To be constructed by -7-13y Address Water Supply: Public Supply From Address or: /,-," Private Supply Drilled by ! /3 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 Address /02-.6 �.ec_ e,, 4. 45i e 'l4 4 Ogg. 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 when considered neqessary by the Public Health Director. Any revision or alteration of the approved plan requires a'new:p`' it. A proved f ischarge of domestic sanitary sewaq only. By: OF — Title: Date: White copy - HD F"Yell co - Building Inspector; Pink copy - O er Orang py - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL .x please print or type Well Location Sheet Address: own illage: Tax Map # �j z ✓fig � k/ � /1 jocZ �'��/ d'o't Map .N/fBlock Lot(s) Well Owner: Name: A (d�es$eX f `3 _ Phone #� Use of Well: esidentlal _Public Supply Air /cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring Other(specify) 2- Secondary Industrial ti tional Standby Amount of Use Yield Sought gpm # rued Est. of Daily usage gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason N&54- /ees', for Drilling Well Type rille Driven Gravel Other Is well site subject to flooding? ....................................................... ...................:........... Yes —No y Is well located in a realty subdivision? ........................................... ............................... Yes y No Name of subdivision q�.Ilalccl /1// rte, 1�s VOL 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 be provided on separate shoot/plan. Date: Applicant Signature: dell 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) Disinfec6he well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Departmei take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any revision or alteration of the approved an requires a new permit. Well to be constructed by a water well driller certified by Putnam Cougo. , _n Date of Issue z?'? — Perm Date of Expiration_ Title: Permit is Non - Transferable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner{ Orange copy :Well driller U Form WP -97 Rev. 3/06