Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0204
DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 4.15 -1 -6 BOX 3 ' T J 161 L Ll ' 16 61L. I t�61- 21 ow r 9 JL.L;! pi ;ti A 00013 V PUTNAM COUNTY DEPARTMENT OF HEAL z DIVISION OF ENVIRONMENTAL HEALTH SERVICES s 3� e — CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at k ? -'7 Town or Village PAT T JE P_ /__7 0;-4 Owner /Applicant Name Frei 4 H r&A 6L.9 i=ll' "s A► Tax Map 4, 1 J�P Block I Lot 0 Formerly Subdivision Name qy A l IZ1 N49 E t A Subd. Lot # 0 Mailing Address (5� ';7u.P`56 1° PP-1'46: PAi71 h'; AJ Zip 19'*6r1 Date Construction Permit Issued by PCHD Separate Sewerage System built by JXH9r &AtALt4M, 6XC= Address 1') GMM FAQ! 19, rww* 1a 1 1"5(A Consisting of 10' Gallon Septic Tank and c ia G i -ra. AM. 1`�HCA Other Requirements: Water Sunnly: Public Supply From Address or: X Private Supply Drilled by Ey' 1 47- 11-1 CR Address .-.. Building Type FAAH (W, rte- Has erosion control been completed? yob Number of Bedrooms Has garbage grinder been installed? Vim! 0 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 Putnam Cooty Dep"ent of Health. Date: OS / °1 1 Certified Address PO 0" i-�; I— P.E. X R.A. Professional) c/ '% 1.0 t Q hod License # Any person occupying prises 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 revocation, modification or change is necessary. B �} ,Title: Date: o� it copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 /ra? �.( 4, f�'r t �?*t i f�-' z F u 1 ?v',: r t �,� s i< �Y b x;'t' 3 �ii�. S' `.F�'' ` a ,y f 4 n 8,. �- - r r F i. F .� t �,, i„ September 14, 2012 Michael J. Budzinski, P.E. Directdr of Engineering Putnam County Health Department 1 Geneva Road Brewster, New York 10509 r'4 Harry W. Nichols Jr., P.E P.O. Box 252 Brewster, NY 10509 Tel. (845) 279 -4727 Fax (845) 279 -4728 RE: Individual SSTS Compliance Dan & Michele Kuchta- Permit P -01 -12 Quaker Ridge Estates- Lot 4 63 Sunset Drive (T) Patterson -T. M. # 4.15 -1 -6 Dear Mr. Budzinski: Enclosed are the following: 1. Five (5) prints of Drawing S -1, "As -Built SSTS ", dated 08/01/12. 2. "Certificate of Construction Compliance for Sewage Treatment System ", dated 08/01/12. 3. Three (3) copies of "Guarantee of Subsurface Sewage Treatment System ". 4. Laboratory test report for coliform, dated 08/23/12. 5. Application Fee in the amount of $300.00 payable to Putnam County Health Department. (tellers check dated 09/13/12). If there are any questions concerning the enclosed, please call Very truly yours, t Harry W. N hots Jr., P.E. HWN:jdm 11 -038 -PUTNAM COUNTY DEPARTMENT OF HEALTH )DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map Block Lot Building Constructed by TownNillage ro'.� r'31✓� Q,d A-y F- x-14 kI5 E6_jA_rA Location - Street Subdivision Name Building Type -' Subdivision Lot # I represent that I.. am wholly and cbmpletely' responsible for the location, workmanship, material, constractiorf and dfaina`ge of the sewage ire'&ment'systein serving the 'above- descnbedpropei7y, "and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition:. = airy 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 s -ewage treatment system, or any re pairs made by me to such system,..except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the .System. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the"failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the systems Dated: Month �_ Day Year 2e 11�— Signature: 4� Title:-- 01,���. -- neral Co actor (,Owner) - signature ¢'orporationXame (if corporation) Address: State l� -zip ?orporation Name (if corporation) Address: 6witc- /Kw,4! rq_�4%Aj State zip Form GS -97 - PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF. ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map . Block Lot Building Constructed by Location - Street Building Type-' Town/Village ad C-' f 4 E6 ,- -rXA,7 Subdivision Name Subdiv'is'ion Lot # I represent that I., am wholly and completely responsible for the location, workmanship, material, con5tnrctiorr and - drainage of the sewageireatment system serving tlie'above- described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition.._ -- - -- any part- -of said *stem constructed 1:33r, me which fails- to operate " fora period of two years immediately following the date of approval of the "Certificate of Construction Compliance" .for the sewage treatment system, or any repairs made by me to such system, .except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive -the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the"failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing: the system. Dated: Month Day - I Year 20 i�-- ` -- neral Co actor (Owner) = nignature oration ame (if corporation) Address: ? State Zip , Signature: 4n. o Warne (if corporation) Address: 6wn, curl�l State Zip Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH )IVISION OF. ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Building Constructed by Location - Street Building Type. ` Tax Map, Block Lot Town[Village Subdivision Name 4 Subdivision Lot # I represent that I. am wholly" and completely responsible for the location, workmanship, material, construxtiori and drainage of the sewage-freatment'system serving tl0above- described` property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition.._ - any parr--of said -stem constructed 6T7 me which fails, to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system_ The undersigned further agrees to accept as conclusive .the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the`failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing: the system. Dated: Month Day j Year 20 iy neral Co actor (Owner) - signature r . /orporat' ame (if corpbration) Address: 3 (z r cr'.r? State Zip r Signature: Title:, ;orpmora/tion ame toifrporation) Address: 6q/n, ru m r 014,11,41 State Zip r) Form GS -97 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovani, Director ** TEST REPORT ** LAB #: 1.203255 CLIENT #: 12765 NON STAT PROC PAGE: 1 of 1 ----------------------------------------------------------------------------------------------- KUCHTA, DAN DATE /TIME TAKEN: 08/21/12 09:30 63 SUNSET DR. DATE /TIME RECD: 08/21/12 10:25 PATTERSON, NY 12563 REPORT DATE: 08/23/12 PHONE: (914) -319 -5322 SAMPLING SITE: 63 SUNSET DRIVE, PATTERSON, NY SAMPLE TYPE..: POTABLE OUTDOOR FAUCET PRESERVATIVES: NONE COLD BY: DAN KUCHTA TEMPERATURE..: <20 >4.00 NOTES ...: - - -- COLT -FO :M - METI-1: MF .. - ... START DATE /TIME END DATE /TIME FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 08/21/12 0400 08/22/12 0400 MF T. COLIFOR ABSENT /100 ML ABSENT SM 18 -20 9222B COMMENTS: MFTC T a Coliform = This result indicates that the water was') : (was not)- of a sat'isfa'ctory sanitary quality according to e. York State and EPA federal drinking water standard for this'parameter. This comment applies to the Total Coliform test only. THE ABOVE TEST, ,PF AND RELATE "' LY I 1. S MEET ALL REQUIREMENTS OF NELAC, ,SAMPLES RECEIVED BY THE LAB SUBMITTED BY: SAY v Albert H. adovani, M.T. ASCP Director ELAP# 10323 ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E. Director of Environmental Health September 21, 2012 Hang Nichols, P.E. PO Box 252 Brewster, NY 10509 Dear Mr. Nichols: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 MARYELLEN ODELL County Executive Re: Construction Compliance - Kuchta '63 Sunset Drive (T) Paterson, TM 4.15 -1 -6 This office has received and reviewed the most recent plans for the above - mentioned project. We would like to.offer the following comments for your review and consideration. • The "A" and "B" locations are not labeled on the plan. 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:cw To: ,/� ,,}}.�� Q JaSe p Para v o �(` 1', P• E PG,-�J a r G1&V.t yo�- go o'- d Attention: A-r— 4a ff *erj Harry W. Nichols Jr., P.E. P.O. Box 252 Brewster, NY 10509 Tel. (845) 279 -4727 Fax(845)279 -4728 Date: Job No 11 — ©38 Project S-S i1(UCAft, G3 Su Gentlemen: We enclose (SI copies of )WY-En nts O Reproducibles O Reports O Tracings O Specifications O Memorandum _ O Copy of letter O Description: Revision/Date No. S -1 `A5 A o t 55 i S Rot,. `?= Z1 12r Sent Via: O Our Messenger O Blueprinter O First Class Mail O Special Delivery 0 Your Messenger Hand Delivery O _ Copy to Very truly yours, Harry W. ols Jr., P.E. Putnam County Department of Health Division of Environmental Health Services SSTS Repair — Final Site Inspection Inspected by: T��-,J Installer. Street Location: 4 -3 5147 sZ-,I- Dr Owner Town: P0, Repair Permit #: — TM # , 1. Type of System: Conventional Alternate O Comments: 2. Septic Tank Yes No N/A Comments L Septic tank size 1,000 .1,250 ... other ..... b. Septic tank installed level ...................... c. 10' minimum from foundation .................. d Distribution Box i. All outlets at same elevation (water tested) ... ii. Protected below frost ............................. iii. Minimum 2 & Original soil between box & trenches e. Junction Box —properly set ............................. f. Trenches i. System completely o ed for inspection ii. Length required_ Length installed 2 d iii. Pipe slope checked ... ....................:.......... iv. Installed according to plan ..................... v. 10 ft. from property line — 20 ft — foundations ... G- vi. Size of gravel % - 1 '/z " diameter clean ......... vii. Depth of gravel in trench 12" minimum ......... viii. Ends capped . g. Pumn ow Dosed Systems 3. Sewage System Area a. SSTS Area located as per approved plans b. Fill section — c. Distance From water course /wetlands 4. Overall Workmanship a. Boxes properly grouted and installed correctly ........... b. All pipes flush with inside of box ......................... 1/ C. Backfill material contains stones <4" diameter ......... Ll d. Curtain drain & standpipes installed according to plan / V e. Curtain drain outfall protected & dir to exist watercourse f. Footing drains discharge away from SSTS area ......... g. Erosion control provided ............................ Additional Comments: /fig —BSI Rev - 011312 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES- CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYST PERMIT# f�-0( -I Z - Located at Gt 50H ,661' P�-JY1 - Town or Village PA -rT,EF,!�A H Subdivision name OUAV49- F 94 EW, Subd. Lot # 4 Tax Map Block � Lot � Date Subdivision Approved I al 29 6q Renewal Revision Owner /Applicant Name MiG- FW V-"ATA Date of Previous Approval Mailing Address 455 PATT'j:,E�L�14 NEB ljpFJL Zip Amount of Fee Enclosed Building Type Areal61%1� . No. of Bedrooms H A Design Flow GPD � Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of A66, 'rPt5koiA Other Requirements: ► 0'00 gallon septic tank and r 9J 0 To be constructed by -r H Address Water Supply: Public Supply From Address or: Private Supply Drilled by VXI Xyre H& Address I-F 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: Address R.A. Date 01106112- License # T.' a f J.,+ APPROVED FOR CONSTRUCTION. This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new ermit. Appro d for discharge of domestic sanitary sew a t3 G� 2D By: Title: only. B Date: White copy - Fi e; Ye ow co y - Building Inspector; Pink copy - Own O ge copy - Design Professional Form CP -97 ICES NCES P 1' 1' 1' Y I' r I' awn on the plan. Subdnislct Plat : unless sho" the site unless MENT SYSTEMS ESIDENCES. item (SSTS) shall be am County Health �% building materials. onstuction and must red. lions thereto, and the State Health minimum of 6 hours t immediately reported rbage grinder. Such ntmty Department of the SSTS, well, Aodifications are :d modifications made rovals voids said :o their entire depth is plan. in of 6 inches of Compliance Ith Department is pan of the Id all other required from the date on the i date. The approval. necessary by the at municipaliry, when :alth Department to Licensed land CDEP the Design 9tc commencement SILT FENCE DETAIL NOT TO SCALE _135. 64 f$ ° "�v zo. oo, 50 ' -9oN E X73. i2 0 n o � o 1 / � PP.OP / 55 Te, I � I / ' A% s� R G E: Lo F L- A NJ r —__—_ SCr�L,E 1 I o= 100, 0 0 f!1 0) N Z 0 LATERAL , 4B R EQUAL) JOINT LONGITUDINAL SECTION ' NOTE: DO NOT INSTALL TRENCHES IN WET SOIL RAKE SIDES ' AND BOTTOM OF TRENCH PRIOR TO PLACING GRAVEL. '> OUTLET ENDS OF ALL DISTRIBUTORS SHALL BE CAPPED.. LK OINT TYPICAL ABSORPTION TRENCH a NOT TO SCALE ANGLE STAKES NOTES TOWARD WATER SqT I. USE 2': 2'K 3 STAKE' OF WOOD OR METAL SPACED AT fi TO 10 APART. GMATERIAL 2. SECURE FABRIC TO OED EQUAL 'p EACH STAKE 3. SILT FENCING KHALL BE REMOVED AT ALL .� PIPE OUTLETS ONCE THE END SECTIONS .,AND RIP- RAPjAPRONS _1_ ARE INSTALLED BIC ON, •0 UDE, 6 DEEP WIC CURLED TLL. ICES NCES P 1' 1' 1' Y I' r I' awn on the plan. Subdnislct Plat : unless sho" the site unless MENT SYSTEMS ESIDENCES. item (SSTS) shall be am County Health �% building materials. onstuction and must red. lions thereto, and the State Health minimum of 6 hours t immediately reported rbage grinder. Such ntmty Department of the SSTS, well, Aodifications are :d modifications made rovals voids said :o their entire depth is plan. in of 6 inches of Compliance Ith Department is pan of the Id all other required from the date on the i date. The approval. necessary by the at municipaliry, when :alth Department to Licensed land CDEP the Design 9tc commencement SILT FENCE DETAIL NOT TO SCALE _135. 64 f$ ° "�v zo. oo, 50 ' -9oN E X73. i2 0 n o � o 1 / � PP.OP / 55 Te, I � I / ' A% s� R G E: Lo F L- A NJ r —__—_ SCr�L,E 1 I o= 100, 0 0 f!1 0) N Z 0 Harry W. Nichols Jr., P.E. I Vr X P.O. Box 252 Brewster, NY 10509 Tel. (845) 2794727 Fax (845) 279 -4728 February 21, 2012 Putnam County Department of Health One Geneva Road Brewster, New York 10509 ATT: Michael J. Budzinski, P.E. Director of Engineering RE: Proposed SSTS- Kuchta 63 Sunset Drive (T)Patterson, TM # 4.15 -1 -6 Dear Mr. Budzinski: The following is a response to your February 14, 2012 review letter; . 1. The dimension of the barn /garage has been added to the plan. 2. The floor plan now specifies that no floor drains are proposed. 3. The location of the manure dumpster has been added to the plan. Reflecting the above, enclosed are four (4) copies of the following: "Floor Plan- Kuchta Barn" rev. 02/21/12 Dwg.. SS -1- "Proposed SSTS" revised 02/21/12 If you have any further questions, please call. Very truly yours, Harry . Nichols Jr., P.E. HWN:jdm 11 -038 CC: Mr. D. Kuchta P 4 _ _f►REA..... '- a„ p i i i S C n � DAr H " 5� x 4D NoT� (= u7U0 -� I 6.�DR -Odr�l APtaP- T►•'�Eh+T � UPPGR- I..��IEL ��J. 0�-• I0• ('y. 0 M _ �jy. F- ►-+ / to � R�-,h G�- .. II L U = TAc� 0 N ^ Z P 6AT H ► - OP--►,4 F- - CT) PA-rrF q-�a-a TM -9 . i - I - Note ruTUO-r-- I �. OR-oe►'1 .PAP-- r"F-NT a uPPr--p, I.k�tEL �v• d�' 10" IZ p=w . off• 21 • M . `o l0 VI .._. .�� Su�.,SE.T Dp -Iy�. - CT) P�� "-r��- moo!• --a TM -9.I� - I -�� ,,��� � ��� ��,,� NoT� j= u7U0 -� I 6. OR-oc, AFLTµEI-iT @ uPPI^R- �2- - OIL:• �J I • 17= 7 c 4 0 ZO -13?-S'l _--d--Jd.L4n T s-oni-n-1 c;7 62 L H GD J'\ "ZI 00 'I L16 - .. . . �. . 1. . r;+ REBECCA wITTENBERG, RN, BSN Public Health Dkedor ROBERT MORRIS, PE . Director ofEnviromnead Health February 14, 2012 Harry Nichols, P.E. PO Box 252 Brewster, NY 10509 Dear Mr. Nichols: DEPARTMEN , T OF HEALTH 1 Geneva Road, Brewster, New York .10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 " MARYELLEN ODELL Coway EwczWw Re: Proposed SSTS for Kuchta @ 63 Sunset Drive (T) Patterson, TM 4.15 -1 -6 This Department has received and reviewed your revised submission for the above referenced project and the following comments are offered for your consideration. The dimensions of the barn/garage are not specified on the floor plan. The floor plan shall specify that floor drains are not proposed in the barn/garage area. 3. The location of the manure dumpster is to be shown on the plans. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. Michael J. B,� E. Director of MJB:cw cc: D. Alderisio, DEP P—(-) \ 12- M. Harry W. Nichols Jr., P.E. VAY P.O. Box 252 Brewster, NY 10509 Tel. (845) 279 -4727 Fax (845) 279 -4728 February 10, 2012 Putnam County Department of Health One Geneva Road Brewster, New York 10509 lk ATT: Michael J. Budzinski, P.E. Director of Engineering RE: Proposed SSTS- Kuchta 63 Sunset Drive (T)Patterson, TM # 4.15 -1 -6 Dear Mr.Budzinski: The following is a response to your February 6, 2012 review letter; 1. The engineers report now includes soil testing information. 2. The proposed shower location is now shown on the floor plan. 3. Room dimensions have been added to the floor plan. 4. No floor drains are proposed for the stable area. 5. Manure will be deposited in an on site dumpster for removal by a licensed carter. Reflecting the above, enclosed are four (4) copies of the following: "Floor Plan- Kuchta Barn" rev. 02/10/12 If you have any further questions, please call. Ve truly yours, Harry W. ols Jr., P.E. HWN:jdm 11 -038 CC: Mr. D. Kuchta - ENGINEER'S REPORT DAN KUCHTA PROPERTY 63 Sunset Drive (T) Patterson T.M. 4.15 -1 -6 Date: 01/24/12 Rev. 02/10/12 Project No. 11 -038 A. Proiect Description The site is a 7.96 acre parcel with an existing 4 bedroom residence and horse barn. There is an existing well providing water service to both the residence and barn. The existing SSTS services only the residence. B. Proposed SSTS The applicant proposes to construct a separate SSTS to service the existing barn. A one (1) bedroom apartment is proposed in the future. Initial construction would consist of a heated tack room, washing machine for horse blankets and a bathroom with a shower stall and sink. The estimated SSTS flow consists of the following: 1 Bedroom Apartment - 200 gpd. 1 washing machine - 25 gpd. Toilet and shower - 25 gpd. Total usage - 250 gpd. Soil conditions were determined by digging deep test pits in the area of the proposed SSTS. The soil consists of 6 inches of topsoil, followed by dark brown loam/ sand to a depth of 30 inches, and dark brown loam to a depth of 84 inches. Groundwater was found at a depth of 72 inches. Percolation tests were then performed. (Refer to attached design data sheets for perc. and deep tests results)., Based on a percolation rate of 1 in. /60 min., 2781.f. of absorption trenches and a 1000 gallon septic tank will be required for the 250 gal. /day design flow. , r\ PUTNAM CG JNTY DEPARTMENT.,-jF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner 'K-VC-141-A, Address G*' 5',)H,55r Di`� ?PTT FPCH f 1%L'-" Located at (Street) 0449 f FAH*(VW', DP414-r Tax Map. -4,15 Block i Lot lP (indicate nearest cross street) Municipality PAV-5F-1:)Q1H -Watershed EA4-r 69-JkHe, t SOIL PERCOLATION TEST DATA Date of Pre Date of Percolation Test I Ij 1-i I ti NnT FS - 1- Tests to be reneated at same depth until approximately coual nercolafion rate- are r)htqTnPri nt enrh percolation test hole. (i.e. --5 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-9? .......... .. . .......... . . . .......... .............. rn.e. .. ..... . ...... ..... -x aip ih.el. .... . . . . . . . . . . . . . . . . . -p� 2 11'2- 3 4 5 2 C) 3 4 5 2 3 4 5 NnT FS - 1- Tests to be reneated at same depth until approximately coual nercolafion rate- are r)htqTnPri nt enrh percolation test hole. (i.e. --5 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-9? 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 v,.g SOILS ENCOUNTERED IN T�,ST HOLES HOLE NO. watt. I e" 0- c HOLE NO. '5A i•aD DAh- HOLE NO. Indicate.level at which groundwater is encountered �`- oil I -1 Indicate level at which mottling is observed �A Indicate level to which water level rises after being_ encountered G'- -o Deep hole observations made by: Nab --V W. Date GN P-1'9 Pf- .l ,A P-A'A (pC H O ) Design Professional Name: JJAr =i�=, . iN� i�,r;�o�h ' `ice; �(� Address: . k)() Y- yti� w.. �F--���i �, i-{-� 1 ��o � • ����o �. �� N�,, °fig. Signature: Design Professional's Seal 2 Op m watt. I e" 0- c HOLE NO. '5A i•aD DAh- HOLE NO. Indicate.level at which groundwater is encountered �`- oil I -1 Indicate level at which mottling is observed �A Indicate level to which water level rises after being_ encountered G'- -o Deep hole observations made by: Nab --V W. Date GN P-1'9 Pf- .l ,A P-A'A (pC H O ) Design Professional Name: JJAr =i�=, . iN� i�,r;�o�h ' `ice; �(� Address: . k)() Y- yti� w.. �F--���i �, i-{-� 1 ��o � • ����o �. �� N�,, °fig. Signature: Design Professional's Seal 2 REBECCA WHI MBERG, RN, BSN Public Health Director ROBERT MORRIS, PE Director of Enviromnental Health February 6, 2012 Harry Nichols, P.E. PO Box 252 Brewster, NY 10509 Dear Mr. Nichols: DEPARTMENT Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 MARYEi•i" ODELL County Executive Re: Proposed SSTS for Kuchta @ 63 Sunset Drive (T) Patterson, TM 4.15 -1 -6 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. 1. The engineer's report is to "be revised to include the soil testing information. 2. The engineer's report references a proposed shower although it is not shown on the floor plan. / 3. Dimensions for the building and rooms are to be provided on the floor plan. /4. Are floor drains proposed within the stable area? 5. Where & how will manure be stored and disposed? Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. Michael J. B P.E. Director of na' ee MJB:cw cc: D. Alderisio, DEP -I _ � � � ` _ ` �r��r�^��_---,�ee�*�-_- ----_---------------- o ' : y . PUTNAINI COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH SERVICES DESIGNT DATA SHEET — SUBSURFACE SEWAGE TREATIVIE�tT SYSTEM 5 Owner: it Address: Located at streeet : e" TM i* Section: Block Lot Municipality: t &'i�e'/'-5tw'l Watershed: Date of Pre - soaking: SOIL PERCOLATION TEST DATA Witnessed by: (�C�, .°�!. e '`�.a�i {'r Date of Percolation Test: , f'a / o'kQ � �, Bole No. Rutz No. No. Time Start — Stop Elapse Time (min.) Depth to water from ground surface (inches) Start - Stop ' }w" mater e[ drop M inches Percolation Rate min /inch '/0 2 U4 /M 30 3 fj �. I 4 s 2 /A c236 ,a a 3 toff —4v 4 5 -� 1 2 • 3 4 5 I 2 3 4 s Notes: I. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e., < I rain for 1-36 min/inch, < 2 min for 31-64 miniinch). All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97• pe 1 of? �2 s /U+�A. a 2 s a,,�y ► �c,� l 1/el air pc'� n( 1 oc r" 6 t,j►C(� ��� 1 EST PIT PROFILES Hole # D_ Lot # Depth to water Depth to mottling Depth to rock/imp. G.L'. 0.5 1.0 2.0 ' i Hole #_ Lot # Depth to water Depth to mottling Depth to rock/imp. G.L.' .0.5 _ � (1 / 1.0 1�'� 4 -/- Oro" Sc..J � 2.0 /o ar►� 3 Cr key 10,.f.• 4,0 0r 5.0 5. 6.0 1.�Ja 2 ��v-- a � � 6 1 70 8.0 8.0. e . Hole # Lot #---- Depth to water Depth to mottling Depth to rock/imp. G.L. 0.5 1.0 2.0 3.0 4.0 . 5.0 6.0 7.0 8.0 9.0 - _.... _.. 9.0 _......__ 9:0 - 10.0, 10.0 10.0 Hole. Lot 4 Hole # Lot # Hole # Lot .# Depth to water Depth to water Depth to water Depth to mottling ' :'.. -- ' Deptli to mottling ° - " = --_"- Depth to mottling Depth to rock/imp. Depth to rock/imp. Depth to rock/imp. -- G.L. - - - -- ... G.L. - - . _ _ .... G.L. 0.5 0.5- ._.._._ ..:.... _ . - - - ...:....:....._..___0.5 _: 2.0 2.0 2.0 3.0 . _ - -- ._ 3.0 ......_......_... -- -..... 3,0 4.0 4.0 4.0 5.0 - - 5:0 . 5.0 6:0 6.0 6.0 7.0 -- - 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 To: n , .. Gentlemen: We enclose (1) copies of OB/W Prints O Reproducibles O &0 ecifi cations O Memorandum cJ D escn ption: I S S- 2.. I Harry W. Nichols Jr., P.E. P.O. Box 252 Brewster, NY 10509 Tel. (845) 279 -4727 Fax (845) 279 -4728 Date: p Job No.: Project I�ra o -J_ �S 15' Ce3 SvUX 5 �Q ,G►.c u t1 O Reports • Copy of letter GY Sent Via: J Qur Messenger O Blueprinter O First Class Mail O Your Messenger O Hand Delivery O Copy to O Tracines O Revision/Date No. J O Special Delivery eekry ours, Haichols 7r., P.E. Am opf"n 111-Al !Woo KW:&F, m- --k—um is" an V-Q- lot J2 "WIVEN, of W-t A INS oil W a TAM f lot, 41- se, t Tom", 'ZZ. W_ R.— MIN ORR, Inv iw' 1, "A T gn A W- 100 Vol ""Amy; ymy "0, W-0, "D go owl 1 TAX mr— Oct 9W own Vol Ina 30i 0 44, rl Iowa, yu? Wy REBECCA WIZTENBERG, RN, BSN Public Health Director ROBERT MORRIS, PE Director ofEnvironmental Health DEPARTMENT OF HEALTH 1 Geneva Road., Brewster, New York 10509 January 26, 2012 Phone # (845) 808 -1390 Fax # (845) 2787921 Harry Nichols, P.E. PO Box 252 Brewster, NY 10509 Re: Complete Application Determination for Kuchta at 63 Sunset Drive (T) Patterson, TM 4.15 -1 -6 East Branch Reservoir Basin Dear Mr. Nichols: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and revisions received by this Department on January 24, 2012 is complete. The Department will notify you by March 11, 2012 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. ❑O Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. MARYELLEN ODELL County Executive 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 IMF 1 J. Bu&dinskil P REBECCA WITTENBERG, RN, BSN Public Health Director ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 MAI2YELLEN ODELL County Executive TO: NYCDEP DEPARTMENT OF ENGINEERING AND DESIGN REVIEW arrrr: ���(L ALbEZi S f O FROM: �AZJ05VJ DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM JOINT REVIEW New Application �( PROJECT: LOCATION: ID3 sc7 Renewal ❑ TOWN: -SUB'D APP DATE 10 -2 -ci j TM # 4, NOTICE OF COMPLETE APPLICATION: DATE: ❑ Within the drainage basins of West Branch, Boyds Corner or Croton Falls Reservoirs. ❑ Within 500 feet of a reservoir, reservoir stem or control lake. ❑ Within 200 feet of a watercourse or a DEC wetland and appearing on a subdivision map approved after December 31, 1992 ❑ Design flow greater than 1,000 gallons /day. '( Commercial SSTS. JOINT REVIEW Harry W. Nichols Jr., P.E. P.O. Box 252 Brewster, NY 10509 Tel. (845) 279 -4727 Fax (845) 279 -4728 ENGINEER'S REPORT DAN KUCHTA PROPERTY 63 Sunset Drive (T) Patterson. T.M. 4.15 -1 -6 Date: 01124/12 Proj ect No. 11 -03 8 A. Project Description The site is a 7.96 acre parcel with an existing 4 bedroom residence and horse barn. There is an existing well providing water service to both the residence and barn. The existing SSTS services only the residence. B. Proposed SSTS The applicant proposes to construct a separate SSTS to service the existing barn. A one (1) bedroom apartment is proposed in the future. Initial construction would consist of a heated tack room, washing machine for horse blankets.. and a bathroom with a shower stall and sink. The estimated SSTS flow consists of the following: 1 Bedroom Apartment - 200 gpd. 1 washing machine = 25 gpd. Toilet and shower - 25 gpd. Total usage - 250 gpd. Based on a percolation rate of 1 in. /60 min., 2781.f, of absorption trenches and a 1000 gallon septic tank will be required for the 250 gal. /day design flow. 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:; PA H 19L..4 Ms _1 &RIA ._ 6,27 '50H6el' pkw of 2. Name of Project: 66r47 FOF- bth� -N 3. Location: TN: PAT-%9-120H 4. Design Professional: i� W - N F0 ` 5. Address: N. • VQ 6. Drainage Basin: 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) ? .............. Yes/No W Type Status (check one) ...................................... ............................... Type I Exempt Type H Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required ? .................... Yes/No N 0 10. Has DEIS been completed and found acceptable by Lead Agency ? ............. Yes/No H A 11. Name of Lead Agency N A 111- Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ..................... ............................... ..... ............................... Yes/No 13. If so, have plans been submitted to such authorities? .. ............................... Yes/No N 14. Has preliminary approval been granted by such authorities? ND Date granted: N p 15. Type of sewage treatment system discharge ........................ surface water X groundwater 16. If surface water discharge, what is the stream class designation? ........................ ... PJ A 17. Waters index number (surface) .. ..................................... ............................... N A 18. Is project located near a public water supply system? ............................... Yes/No H0 19. If yes, name of water supply Distance to water supply N A 20. Is project site near a public sewage collection or treatment system? .......... Yes/No N 0 21. Name of sewage system I-AN Distance to sewage system Np 22. Date test holes observed / 11 23. Name of Health Inspector C-10415, 0E-L,-AP-{PA, 24. Project design flow (gallons per day) ............................. ............................... 9.60 25. Is State Pollutant Discharge Elimination system ( SPDES) Permit required? ... Yes/No N 0 26. Has SPDES Application been submitted to local DEC office? ......................... Yes/No 14,4 Rev. 11/02 Form PC -97 Pg. 1 of 2 27. Is any portion of this project located within a designated Town or State wetland ?... Yes/No No 28. Wetlands ID number .................................................................. ............................... NA 29. Is Wetlands Permit required? ...................................... ............................... Yes/No 00 Has application been made to Town or Local DEC ........................... Yes/No NA 30. Does project require a DEC Stream Disturbance Permit? .... ....................:....Yes/No No 31. Is or was project site used for agricultural activity involving application of pesticides to orchards,or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? .......................................... .........................Yes/No 1\l� 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 Na DESCRIBE: 33. Is there a local master plan on file with the Town or Village? .........................Yes/No Y66 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? .................................. .........................Yes/No NO 35. Are any sewage treatment areas in excess of 15% slope? .............................. Yes/No lal p 36. Tax Map ID Number .............. ............................... Map 4 ` 16 Block I Lot �O 37. Approved plans are to be returned to ................ Applicant_ Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item 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 of the Penal Law n n SIGNATURES & OFFICIAL TITLES Mailing Address:...... Form PC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH .o DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of ()AHIr -- I" F, LE K-Uu4TA Located at T/V PAtr&-JZfow Tax Map # .4115 Block , I Lot a Subdivision of 6LV M-5� P19.00 0)�rrAT"95-"l Subdivision Lot # - Filed Map # k3i5 A Date Filed Gentlemen: III* rq 161 This letter is to authorize 144V \k, W l "O V5 ; J t� P , F-�' 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 tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law,, the Public Health Law; and the Putnam CountxSanitary Code. . , PO ; Countersigned: P.E., R.A., # _ Mailing Address State e:ss Zip �, tr Very truly yours, Signed. (owner of Property) Mailing Address: 64) 6JH 60 Dp-IvF-: PA-rfl��-/Vo H F prJ State r' J Telephone: Zip 11�66� Telephone: Form LA -97 PUTNAM COUNTY DEPARTMENT: OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN. DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM k oH - - Located_ _(- (Street)_ .Lot_ (indicate nearest cross street) SOIL PERCOLATION TEST DATA Date of Pre-soaking 124."_$ J it Date of Percolation Test - -461 �i ............ ... 4 2 3 5: NOTES: I Tests to be'repeated at same depth until approximately equal ,,-Oer`colAtion,,,rq tes ire obtained at. each ' l percolation test hole. (i.e. I min for i -30 m n/ nch,'s 2"m n f6 3 1 O min/ inch) ric fi) 'All data to be .submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 1A 4 2 3 5: NOTES: I Tests to be'repeated at same depth until approximately equal ,,-Oer`colAtion,,,rq tes ire obtained at. each ' l percolation test hole. (i.e. I min for i -30 m n/ nch,'s 2"m n f6 3 1 O min/ inch) ric fi) 'All data to be .submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 - --------- - 4 2 3 5: NOTES: I Tests to be'repeated at same depth until approximately equal ,,-Oer`colAtion,,,rq tes ire obtained at. each ' l percolation test hole. (i.e. I min for i -30 m n/ nch,'s 2"m n f6 3 1 O min/ inch) ric fi) 'All data to be .submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 6.5 7.0:' IV 7.5' 8.0' 8.5' 9.5' 10.0' Indicatelevel at which groundwater is encountered G.- O (TP-1 Indicate level at which mottling is observed HA Indicate level to which water level rises affter.being encountered Coy- 0" Deep hole observations made by: NAP - LY W, Jig- • • Date Design Professional Name: i- tAH-4. W. H +Coi.5 jh Qj� Address: Signature* ZS Design Professional's Seal R�F A t Q TEST PIT DATA 2 0 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES' DEPTH HOLE NO. I HOLE NO. HOLE NO. G.L. _ Rik 1.0'. DA u 2.0' 2.5' 5A I-4P 3.0' 3.5' 00-t 4.5' . -:0 l.-DR� -p" I.OflN1 5.0' 5.5' 6.0' 6.5 7.0:' IV 7.5' 8.0' 8.5' 9.5' 10.0' Indicatelevel at which groundwater is encountered G.- O (TP-1 Indicate level at which mottling is observed HA Indicate level to which water level rises affter.being encountered Coy- 0" Deep hole observations made by: NAP - LY W, Jig- • • Date Design Professional Name: i- tAH-4. W. H +Coi.5 jh Qj� Address: Signature* ZS Design Professional's Seal R�F A t Q REBECCA Wn ENBERG, RN, BSN Public Health Director ROBERT MORRIS, PE Director of Enviromnental Health January 17, 2012 DEPARTMENT 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 Harry Nichols, P.E. PO Box 252 Brewster, NY 10509 Dear Mr. Nichols: MARYELLEN ODELL County Executive Re: Incomplete SSTS Application Determination For Kuchta at 63 Sunset Drive (T) Patterson, TM 4.15 -1 -6 The Putnam County Department of Health (Department) has determined that the above referenced project, which was received by the Department on January 13, 2012 is incomplete. Please be advised that the following information is required to be submitted before the Department can determine the application complete and commence its review: • Two (2) copies of an engineer's report for the proposed project. Review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information as to the completeness of your application. Please be advised that failure to submit information to the Department or to follow procedures is sufficient grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed regulations and Putnam County Department of Health Regulations. Should you have any questions or care to discuss this matter fiarther, please contact me at (845) 808 -1390, ext. 43148. MJB:cw SSTS -NOI i f Harry W. Nichols Jr_, P.E. P.O. Box 252 Brewster, NY 10509 Tel. (845) 279 -4727 Fax (845) 279 -4728 Date: 1 1Zp To: p GIGv. I.. VOW_ R o LI Attention: A ICIAe.l eu Z0 L_AF, tMe��or m� t1,�eertitL Gentlemen: We enclose (�) copies of: OB/W Prints O Reproducibles O S:pecif cations O Memorandum _ Description: Sent Via: Our Messen er O Your Messenger Copy to /64,r, 13, Kuck —tA, 01 M. O Blueprinter O Hand Delivery Job No.: 11-03 Project prG Aos �S?S _ k u� �► Ca 3cLSv vi2tj' a r i v A: I bvsa 21 1 Y. Report s O Tracings O Copy of letter O O First Class Mail G Revision/Date No. J O Special Delivery eery truly yours, Harry W. hols Jr., P.E. Harry W. Nichols Jr., P.E. P.O. Box 252 IF "Mk Brewster, NY 10509 Tel. (845) 279 -4727 Fax (845) 279 -4728 January 6, 2012 Putnam County Health Department 1 Geneva Road Brewster, New York 10509 ATT: Michael J. Budzinski, P.E. Re: Individual SSTS for Barn Kuchta Property 63 Sunset Drive Town of Patterson T.M. # 4.15 -1 -6 Dear Mr. Budzinski: Enclosed are the following: 1: Five (5) prints of SS -1, "Proposed SSTS ", dated 01/06/12. 2. "Short EAF" dated 01/06/12. 3. "Application for Approval of Plans for a Wastewater Disposal System ". 4. "Construction Permit for Sewage Disposal System", dated 01/06/12. 5. "Design Data Sheet" dated 01/06/12. 6. "Letter of Authorization" 7. Two (2) copies of Barn Floor Plan. 8. Review Fee in the amount of $500.00. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, Harry W. Nic is Jr., P.E. HWN :jdm 11 -038 1416 -4 (9195) —Text 12 PROJECT I.D. NUMBER •617:20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM ,For UNLISTED ACTIONS Only, PART [—PROJECT INFORMATION (To be completed by Applicant or Project sponsor) SEQR I. APPLICANT /SPONSOR DANIF1- 4 MI u�Ey� �vtl�-> -A 2. PROJECT NAME PPP069D 61r;Pr,-5 - 004H 3. PROJECT LOCATION: �j , rr PArmP-10 7 p H HAM Municipality County f . `� r 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) 5. IS PROPOSED ACTION: ® New ❑ Expansion ❑ Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: Pji0J90t C,0460hr* OF A P"PO/ =o nth To t5o:PF .A. NEW j%N"" jH AH �w �, t Kc� �aP�► 7. AMOUNT OF LAND AFFECTED: 0,%0 0' I® Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR-OTHER EXISTING LAND USE RESTRICTIONS? KYes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? N 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 (90o If yes, list agency(s) and permitlapprovals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL ?. RYes ❑ No if yes,11st agency name and permlt/approvai TQwA 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? &o ❑ Yes I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST MY KNOWLEDGE �OF ° I iJ �i r fl- A45 A451 ° Appllcant/sponsor name: Date: Signature: V 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 11— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate'the review process and use the FULL EAF. ❑ Yes ❑ No ' B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) Ct. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species; significant habitats, or threatened or endangered species ?Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities likely to be Induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not Identified In C1-05? Explain briefly. . C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA? ❑ Yes ❑ No E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATEb 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 occurrin- ,(c),duration; (d) irreversibility; (e) geographic scope; and (f) magnitude: If necessary, add attachments or reference supporting mafe�ials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been Identified and adequately addressed. If question D of Part II was checked yes, the determination and significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. ❑ 'Check this box if you have identified one or more potentially large'or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a positive declaration. ❑ Check this box if you have determined, based . on the information. and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments.as necessary; the reasons supporting, this determination:. Name of Lead Agency Print or Type Name of Responsible Officer in Lea Agency Title of Responsible Officer Signature of Responsi e Officer. in Lead Agency Signature of. Preparer (Itclifferent from responsible officer) Date iA wr4Lja t� \iL-IL Ljj.;#.L.LwLN &1 L VL1L DEPARTMENT OF HEALTH* Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office'Use Only V 1Z LY2� WELL LOCATION WELL WNE 7STREET ADDRESS: TOWN/ViLLACLIC117 TAiGRIO NUMBER: Qw at kv- r Rig e-Piew, t/p- 77f--r,56 V.I el ADDRESS: I W I — C 0 AIj Vy 1—yjCU0 PRIVATE L-UM10 PUBLIC USE OF WELL 1 - primary ' 2 - secondary 05E S If On E N T I j (L 0 P LIC SUPPLY 0 AIR /COND. /HEAT PUMP IJ/48ANOONED ❑ BUSINESS ❑ FARM 0 TEST/OBSERVATION O' OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY 0 AMOUNT OF USE YIELD SOUGHT gpm./NO. PEOPLE SERVED --Y-1 EST. OF DAILY USAGE!�6 _6 gal. REASON FOR DRILLING r NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST/08SERVATION' ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 1600 ft.: STATIC WATER LEVEL o o ft. OATE MEASURED gd DRILLING EQUIPMENT ❑ ROTARY COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELLVOINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. PI/OPEN HOLE IN BEDROCK 0 OTHER CASING DETAILS I TOTAL LENGTH _ZY-7ft. MATERIALS: 9STEEL . OPLASTIC 0 OTHER LENGTH .BELOW GRADE —LI _6 fL JOINTS: ❑ WELDED THREADED 0 OTHER DIAMETER ---7— in. SEAL: 9CEMENT GROUT 0 BENTONITE ❑ OTHfR WEIGHT PER FOOT lb./ft. DRIVE SHOE: 9YES ONO LINER:OYES IINO SCREEN . DETAILS DIAMETER (in)_ 'SLOT SIZE LENGTH (ft) DEPTH TO SCREE N (It) DEVELOPEDT FIRST I OYES ONO HOURS SEC-ONO GRAVEL PACK OYES ❑ NO 1 GRAVEL' I SIZE. DIAMETER OF PACK in. T FD�% ft. BOTTOM OEM It. WELL YIELD TEST 1. If.detailed pumping �JTHOO: 0 PUMPED tests were done ae is h. 16 COMPRESSED AIR formation attached? 0 BAILED 0 OTHER ❑ YES ONO It more detailed formation descriptions or sieve analyses 'WELL LOG are available, please attach.. rDE DEPTH FROM SURFACE Water Bear- i.g Well Dia- M Meter e I FORMATION DESCRIPTION CODE ft. IL WELL DEPTH DURATION hr. min. DRAWOOWN ft. YIELD 9PM. Land Surface /46. rdn aim '316 0 /0- MKO 00 EA le- WATE9 ❑ CLEAR TEMP. - ------ QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? 0 YES 0 No STORAGE TANK: TYPE CAPACITY GAL.. PUMP INFORMATION TYPE CAPACITY MAKER DEPTH MODEL VOLTAGE — HP WELL DRILLER NAME I DATE I 16 ADDRESS SIGFnMRE 44- &X 4V Mmmmn.'= �Gi /G 4 7t4 Izzr'-, -3 ac— oe-r. Ow6? 7sa —784.__.._ P :!5 %JOMN. PRENTISS, P.E. 09 FAIlt ST 914878-6170 CMU. NEW YORK 10512 Al o THE $ Putna4 County Department of Health DiVision of Environmental Health Serviceg Approved as noted for conformance with s. -Llc ab i Rules i e Appl cabl Rules and 'Rejulat�ons of the pp De t. u t mCo �y Healt S gnature I& itle pa -e ur !& itle &X 4V Mmmmn.'= �Gi /G 4 7t4 Izzr'-, -3 ac— oe-r. Ow6? 7sa —784.__.._ P :!5 %JOMN. PRENTISS, P.E. 09 FAIlt ST 914878-6170 CMU. NEW YORK 10512 Al o THE $ 46 COUNTY DEPARTMENT OF HEALTH ; '. 31 lihisiono #UTNAM CO Y 10511 Eaglneer to Pt on`CERTIFICATE OF 4 VI V �GEJP!SPOSAJ; CONSTRUCTION SYSTEM,. z 'JI 4 c., Sabdlvision Name Snbd. Lot R j::AJE _4mq pEl A _ w i7/r/ , Revision Nmir/AOpHeafit w Name Date *mg Addrei Ballding Type - Uf .1 Aj* a, L>g 'i. FlAw Nambe of bedrooms ` Separate Sewerage v: System to consietgof Gallon Septic lr A .0, tie cqnkl tifi(ledli p 31. W&Wr Sdo I Fjolb Address or: ipAv S N., 4. OtwerRequirements_, eu T 7 F a p —r,e, a s A t thaYa,am "'01-1 Y, an andjocifioi� "of I — _ (S);`.j)'.",t"t the. Separ constructed lh-d in kcor�lince!�,ith-tfia iiinai�Ldi;',r,blislaW.1 on�the��p arfifhldin�nttt��!q,.�b County .Department of Health .`:antl that on completion thereof -to the) be submitted Ao. the beparfrnent-;an- and ." " a" w . r- 3tie" p ,gua�, a.j - e,e, %y i !,be ,um7is"hed. the' cces r s, 11r, assigns by t. he,i in 606i -oieriting' - iur ar s-lnn6d lately' f o 66ci adf the approval of' the ��oj;the% — thil'thw - wilibe'ilocatetli'asshownron th a ved i a. , as a � 0o County,Departmient ofl Heann Date vt v Address Lic nse N 0,F3_CP.NST one i� f `41 'rite -7-issuedlunless- construction nuiide�rtak6n -anil, is APPROVED F. -W�knbw."T-s is'appi3O�6 kepirps,o 4il in year 0 - 9 le: foi . caujk 0; ins Pe-aT ffi§ d i f_i 1�6 aces 7 6iv a! c'o n6tr,uCt ion !TCP�� requires ye r, i po ta -.aoe a djo, d s sal = sant Data � Volnme " " e�; 2 �Fffl is cowl sposal'.sysipm lat ions of 'the,! Putn8M i inq. thj c!ate of the W; well. described "b"' qns _'Ir of the �,! utna!lnl County,Departmient ofl Heann Date vt Address Lic nse N 0,F3_CP.NST one i� f `41 'rite -7-issuedlunless- construction nuiide�rtak6n -anil, is APPROVED F. -W�knbw."T-s is'appi3O�6 kepirps,o 4il in year 0 - 9 le: foi . caujk 0; ins Pe-aT ffi§ d i f_i 1�6 aces n 6iv a! c'o n6tr,uCt ion !TCP�� requires ye r, i po ta -.aoe a djo, d s sal = sant Data PUTNAM .COtRJ'!'Y... DEPARTMERr OF HEALZH DIVISION OF` :.HEALTH .'SERVICES. DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. owner % 1 rbl 0657 her. Sct IV i c Address Dr, .Ve - v?�akerR a Es •6es tKb�(., i- &i*4,KA4 Hop* Located at (street) Su tee Dri ✓P' Sec. Block' 9 ]Lot A_ (8 (374 (indicate nearest cross street) Municipality rd'fbvrs v v, Watershed, -� M • • • �+• �• r �. v • a• r Die • �� v • Date of Pre - Soaking ap t AU Date • of Percolation Test HOLE NUMBER CI= TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level No. Time ;Ground Surface In Inches Soil Rate Start -Stop Min: Start Stop Drop In Min /In Drop. Inches Inches Inches Ckee- 1 1 0! .:13i j '30 2-7 243a jf� 30 u . 3140E 43s 2-7 u�� 13 /f NOTES: 1. Tests to be repeated at,same'ddpt.' -until approximately equal soil rates- are obtained at each percolation test hole:' Ail data to'be subnitt�d for review. -2..- Depth measurements to be made from top of hole. rev. 9/85 TEST PIT DATA .-REQUIRED TO .BE SUBMITTED WITH. APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO.. HOLE NO. HOLE NO. G.L. 2' 3' o 4' Aft 7' 10'. -- 11' 12' 13' 14' INDICATE LEVEL, AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH DATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil. Rate Used Min/1" Drop: S.D. Usable Area Provided g 0001 No. of Bedrooms FOUr_ Septic Tank Capacity Z x 10 0 .a gals. Type Absorption Area Provided- By 800 L.F. x 24" .width trench (!}9e T-6,10 lets `320' ko 6c.�+QnB Soil Rate Approved sq.ft /gal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIELD INSPECTION REPORT (Name of Owner) Street Location) INITIAL SITE INSPECTION YES NO Wetlands on /or proximate to property .............. Property lines or corners found ................... Can estimate house location ....................... Willdriveway need cut ............................ Must trees be removed - note these.. ....... o—o.. Deep holes representative of entire SDS area...... Additional deep holes needed............. .... .... Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacent wells/ septics ............................ D.H. 1 Lot _ Depth to G. W. _ Depth to rock Soil Descr 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. D.H. 2 Lot Depth to G. W. Depth to rock Soil Descri tia 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. DATE: j-v ►+ INSP. BY: j COMMENTS D.H. - Deep Hole G.W. - Groundwater D.H. 3 Lot Depth to G. W. Depth to rock soil Descri t 0 ft. [— 3 ft. 6 ft. 9 ft. 12 ft. C C- DATE: FINAL SITE.INSPECTION INSP.BY: YES NO CHI'S House SSDS located per approved plan.. ....... .. Length of trench measured G' Width of trench average Slope of tile line and trench acceptable......... Roan allowed for expansion trenches .............. Over 100 ft. fran watercourse .................... Natural soil not stripped or SDS area unnecessarly graded........... ... .......... 10 ft. maintained fran property line and 20 ft. fran house.... ........................ Distance well to SSDS (ft.) ......... ...... Number of bedrooms checks .................1...... Stones, brush, stumps, rubble, etc., greater than 15 ft. fran nearest trench ................ 15 ft. of peripheral soil horizontally fran trench ................. ?............ . Boxes properly set.. . ..... ........ .......... 2ould surface runoff fran driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... (mil FINAL GRADNG OF SITE ACCEPTABLE.. In �� 5 k 0' C" W: I C C� c! '� DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # f_* WELL LOCATION Street Address ua ier R% To /Village City Tax Grid Number or, Mt t,(1150 15-9-11 WELL OWNER Name C k CStU 4. ,- Address 101 a SI I Vi,) Clarqymnt La Wrivate ❑ Public USE OF WELL 1 - primary 2 - secondary (])RESIDENTIAL ❑ BUSINESS ❑ INDUSTRIAL ❑ PUBLIC SUPPLY Q AIR /COND /HEAT PUMP 0 FARM ❑ TEST /OBSERVATION b INSTITUTIONAL O STAND -BY ❑ ABANDONED ❑ OTHER (specify, ❑ AMOUNT OF USE YIELD SOUGHT j gpm /# PFOPLE SERVED /EST. OF DAILY USAGE (000 gal REASON FOR DRILLING EW SUPPLY []PROVIDE ADDITIONAL SUPPLY []REPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING p F WELL TYPE DRILLED DRIVEN E]DUG ® GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Q u d � Kida; Statf'S Lot No . 14 WATER WELL CONTRACTOR: Name AIhc�f �y 1fi� + sm Address:goat r_ .311 N f tgrsan 01 IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES (/ NO NAME OF PUBLIC WATER SUPPLY: DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: TOWN /VIL /CITY LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ❑ON REAR OF THIS APPLICATION doqr SEPARATE SHEET (dat ( ignature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of 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 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 attached to this permit. 3. Submit a Well Completion Report on a form pr v'd by a Putnam Cou ty Health Den art ent. Date of Issue: _� 19 I.-Y. Date of Expiration: 19 Pr&il Iss ing Official' Permit is Non - Transferrable 6vacz f �� Lad - 'f PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS S (U 0 (Name of Owner) COMMENTS ME REVIEW SHEET - CONSTRUCTION PERMIT 'A' DATE REVIEWED: BY: 91 x_ NO DOCUMENTS Permit Application 31 4 f Corporate Resolution (00a) 20 Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Z Deep Hole Log Consistent Perc Results (3) �-- 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions.- Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Z)/Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area;shown;gravity flow,suff. size If Pumped Pit & D Box Shown & Detailed ouse - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Setba c (Tight lot) House Sewer 1 /4 "/f 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains- Cartain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' from Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked _f Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same v T k PM -DEPARTMENT :Rev 3 ,D IvIsItn'if En ' Health Services, lilrex. I031 2 tr -M"t Provide :Engldeer _4 Hi ,Patterson ; f %, CONSTRUCTION �COMPWCE.FOR SEWAGE DISPOSAL SYSTEM CE -J, -W T E- 5 e Located at i� t s�&te 4 R e Sa v Sbl Hi:wt Plant Forittiti Itti apo Ndw 10956 Mailing Address o me s.', Rte 5 H Betto6dhi, & Son *01imiteSe�vera W&�Itat-by Address .. ge Sys 4 k, 18. Deep FToilets E Consisting 801 x 2 4!' wide 6 6aHon.S and of,,1*7c,- -1 060 ejfl� T _�n/Laundry a: S M� , e �x, 8 �,d AND 320' x 24., vi I Public 'Stloply Pr6ni Address Y:� - - 6. .. - 7�, �, att- -3 IT5 P` 'erson,, 12563 77777 S X Private -Aibe'-rt%H'yatt Ons' . f:6 'SuovikTOW , ori Address* Building Type Frame ' roslol Control Aie h Completed? F66r. No 113 0�, Number of Bedrooms 06 dei Installed? 450 + '6 64 Ft 2 4 Older Requirements , a,- v � (��;7 ` essenti*,lW,ashown , ri'th�p_p;aps, oi,tti,e comp;etea, work copies -I certify that the system_(s) as listed serving the above .premises.�were constructed of 1ph are attached) -lca6idiice and ,r` 'and .t'he'.p-pi7Oit�issued by the -�, iUt nam q6unty ,Depart#enfq� Health , X R.A. anuary 10 P E;7 Date 7, ITM -,.9 s-4., Fair si r 2066 , el ,'Carmel , I , I , - I . w o: % , Add License N Any person -occupying; y the above --,sys!6m(%).shall promptly a Wch action as may be necessary to P pro lies so " rved b wati, stiwi . gi�je system ! 'b!!: siiliii�:_iiwer becomes .conditions resulting li" h: rovi'l- 6f-_,thi io� iti4i'Ifiall b4come.qyl!,and:vp, ss,soon�,ac. a. P4 , ip avallable.'� __.,;hfpprovals are h" oitbilc.,*4t0_ _Oy. -avillabi ace t of the .!COM101s51oner -o Health ..-A gh A', if 1"tion or change If necessary. subject •to Al n'.thezjudgmen Date a a Title 0 . (5hester Salvia Owner or Purchaser of Building Building Constructed by Quaker Ridge Drive- Location - Street T Patterson Municipality Frame Building Type S Section Block . Lot :ar. * dse 4"e Subdivision Name 4 Subdv. Lot # GUARANTEE OF SEPARATR SEWAGE SYSTEM I represent that I am wholly and completely responsible.for the location, workmanship, material, construction.and drainage of.the sewage disposal 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.success- ors, heirs or assigns, to place.in good operating condition any part of said system constructed by me which fails to operate for period of two years immediately following the date of initial use.of the sewage disposal system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determin- ation of the Director of the Division of Environmental Health Services of the Putnam County Department of Health as to whether or not the fail- ure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system Dated this 28 day of January 19 87 Signature T Title p G..<<✓� Corporation Name (f Corp. Address THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. - IGUARANTOR IS REQUIRED TO FILE NOTICR OF DATE OF FIRST USE OF SYSTEM.. ,Division of Environmental Health Services, Putnam County Department of Health PUTNAM COUN`T'Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Chester Salvia. Owner or Purchaser of Building Building Constructed by Quaker Ridge Drive Location — Street T. Patterson Municipality Frame Building Type 5 9 4. Section Block Lot _ Quaker Ridge Estates Subdivision Name S vision Lot # 4 GUARAN= OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location., workmanship, material, construction and drainage of the sewage disposal 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 disposal system, or any repairs made by me.to °such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environinental Health Services of the Putnam County ,Department of Health as to whether or not the failure of the system to operate was caused by, the willful or negligent act of the occupant of the bui ding utilizing the, system. 28 January 87 Dated this day of 19 Signature / n General Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk Title Owner Corporation Name (if Corp.) New City, NY 10956 Address Yorktown Medical Laboratory, Inc. •� 321 Kear Street ` 'Yorktown Heights, N. Y. 10593 (914)•245 -3203 Director: Albert H. Padovmi AL T. (ASC P) . LAB /: GA:003744' Collection -Station Used: Carmel 4 .Peekskill Mt. Kisco _ New City _ T_ 1 Date Taken:? . S� Date Received: Date Reported: _2 Collected Byr Referred By: L�Cu YI J Sample Source: . . LABORATORY REPORT ON- BACTERIOLOGICAL QUALITY OF--WATER_ GENERAL BACTFRIA Standard Plate .Count per 1.0 ml 24 0 (Agar plate .@ 35 °C) YEMBRATTE FILTRATION TECHNIQUE (MFT) Total Coliform per 100 ml_ Fecal Coliform ner 100 rl Fecal Streptococcus per 100 ml `?OST PROBABLE NUMBER TFCHNIQUF. (MPN) Total Coliform: Fecal Coliform: OTHER ANALYSES MPN Index ner 100 ml MPN Index per 100 ml THESE RESULTS INDICATE THAT THE WATER SAMPLE.. AS (WAS NOT) (NOT APPLICABLE) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO THE NEW YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED,. AT THE TIME OF COLLECTION. WL CA f' Albert H. Padorani, M.T. ASCP),.Director LEGEND RDS . Recommend Disinfect - ing Water Source < = less than TNTC a Too Numerous Too Count