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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 5. -1 -17 BOX 3 00062 16 1 is ism .1 Phil 6.2 m oil 00062 PUTNAM COUNTY ' DEPARTMENT OF HEALTH :VISION OF ENVIRONMENTAL HEALTH SERVICES ICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT PCHD CONSTRUCTION PERMIT # P - bbl - 61- Located at I 1 by pLe P-ADO-r�- kND Town or Village P ASp-6o H Owner /Applicant Name JAN)SZ � AJ'HEiTR 60GU5 Tax Map 6- Block Formerly Lot I-7 Subdivision Name 6 P DLE P P (1l; ES Subd. Lot # Mailing Address I GO F, A6 'I 1,.A\41 5 $OUI,EVPc" HAFT O PAf✓ N7 Zip l© 541 Date Construction Permit Issued by PCHD Separate Sewerage System built by +OkA Cb FiSf (,T10 4 1"L-. Address �-4 5 44 H 0L1 ,-%J P4, Aw"I 0 Consisting of 1 9A Gallon Septic Tank and Other Requirements: irOV-1-AY V�NK , /Z00. rl i-L- Water Sunuly: Public Supply From. or: ,Y- Private Supply Drilled by Building Type�1�i'� Number of Bedrooms WD 5 «' \.4GVk- e-0 k4u. Address Address 10% P�SZ CAQ�(4$.► lo�(i. Has erosion control been completed? YE5 Has garbage grinder been installed? Na 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 County Depprtmgnt of Health. Date: Certified by / P.E. R.A. Address (Desi ��✓S / rofessional) tJ � 1 d 5.1 License # Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocat941: fica ' nor chan a is necessary. Y• B Title: Date: tllzf White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTT VI COUNTY DEPARTMENT OF L LTH 6�t-�S / DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: i 1 'DR I�iC T wn/Village: Tax Grid # Map Cj Block 1 Lot(s) -7 Well Owner: Name: Address: o —7-11 k2 Use of Well: 1- primary 2- secondary Residential Public Supply Air cond/heat p Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing �\' Open hole in bedrock _ Other Casing Details Total length - D ft. Length below grade o°�� _ft. Diameter in. Weight per foot lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded _Threaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: Yes No _ Liner Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield Test Bailed _ Pumped _)L Compressed Air Hours Yield_ gpm Depth Data Measure from land surface- static (specify ft) � During yield test(ft) Depth of completed well in feet 3 Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(m) Formation Description ft. ft. Land Surface y If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 1Z IV- - 61) Pump Type a Capacity JO �h epth 56-0 Model 13amZ -04 /Z. Voltage 230 HP 2, Tank Type wX -3t7Z Volume 862 g� -3 d /al Date Well Completed Putnam County Certification No. A03 Date of R po 6klyldzl Well Driller (signature) NOTE: 'Exact location of well with distances to at least two permanent landmarks to be pro on a separa;dsheet/plan. Well Driller's Name p h Address: o'j4 & $2 q Signature: - Date: 41974 1OS /°Z' White cop HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 Oc,t 29 ,04 03:44p TOWN OF PATTERSO 845 -87.8 -2019 P.1 OCT -29 -2004 10:51 AM HARRY W NICH04S 914 279 4367 P.02 SRUCL .R FOLEY - * fOKMA MOLIIMARI.IM. M.S.N. ' P04110 Xrd6 Dwao►p .. .tataelatr PrAffC.�ra{(h LNrttto►,,,_..., . • ^• Armor P IN.S(ft . •. •__._ . - - - DEPARTMENT OF ' HEALTH � , ...... ...__ il ; ... .... .......•. Srawster, New Yori '10509 ..•.,_...... .. -. - ... .. ..Y.,n..r.r.i►i it►.;u tstq =f� -a�10 t�pua l�f.tn� . . Hrr►1rf.trrrlra (att)!7t•iflt•.wiC p1g17F••!i!d . /ltptg7ll•i01f . . .. ".' c►rt7'>a►r►�:�e.(o1�71�•aou ��ru1m1(11o171•f012 rumr)27r•aa+�1 - 8911 AIDT)RESS'Y .RIFT UI .H FORM t7WNERSN. ; JAWU67- 006U'j _.... W- ' xhg Futaam County Department of Health will not issue a Cettif Cate of Constmettoll Compliance•unless the above form is.compieted; i_e., a legal E911 address is tp3 tntd by qn sLuthor;zed form official, This form. is to be sub m9tted wltb the application for a Certifieste of Constmotiou Complialice, . ,1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF. ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM JAH AHO��,A. DbU Owner or Purchaser of Building Building Constructed by Location - Street P-5 61 Building Type Tax Map Block Lot TownNillage BPOL5 'P966 E5 i ATT--6 Subdivision Name 11 _ Subdivision Lot # �3 I represent that I am wholly and completely responsible for the location, workmanship, material; constractiorl and'dfainage of the sewageireatment system serving the' above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto; and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition.. any parr -of said 'ss -ystem coffs'tructed by 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 ne1 ' ure of the system to operate was caused by the willful or negligent act of the occupant ore u' ding utilizing the system:. Dated: Month % ci Day IS- Year WO 4 t7 -` Genei 1 Contractor'(Owner) ' gnature . Corporation Name (if corporation) Address: / 7 ? s i_c( ?_�d Qp State � �E�rso►� AhJ Zip ) 2,6 G 3 Signature: Title: U FU-eyL,ICA C � c.J?Vt-JZ- Corporation Name (if corporation) Address: `2. L-( M C k 0 State N , • Zip / G J- Form GS -97 November 17, 2004 Robert Morris, P.E. Putnam County Health Department 1 Geneva Road Brewster, NY 10509 Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 Tel: (845) 2794003 Fax: (845) 279 -4567 Email: hnengineer@aol.com Re: Individual SSTS Compliance - Bogus. Bridle Ridge Estates - Lot # 11 17 Bridle Ridge Road Patterson, NY 12563 Dear Mr. Morris: Enclosed are the following: 1. Five (5) prints of Drawing S -11, "As Built SSTS "., dated 11/17/04. 2. "Certificate of Construction Compliance for Sewage Treatment System ", dated 11/15/04. 3. Three (3) copies of "Guarantee of Subsurface Sewage Treatment System ", dated 10/25/04. 4. Laboratory Report, dated 09/28/04. 5. "Well Completion Report", dated 02/09/04. 6. Application Fee in the amount of $300.00 payable to Putnam County Health Department. 7. "E -911 Address Verification Form ", dated 10/29/04. If there are any questions concerning the enclosed, please call. Very truly yours, Harry W. Nichol Jr., P.E. HWN:gav 04- 059.00 YML ENVIRONMENTAL SERVICES 321 Kear Street � Yorktown Heights, N.Y. 10598 (914) 245-2800 ` Albert H. |,adovani, Director LAB ON 93.482161 CLIENT ON 57877 NON STAT PROC PAGE: 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ BOGUS, AMETTA 17 BRIDLE RIDGE RD PATTERSON, NY 12563 DATE/TIME TAKEN: 09/18/07 10:30P DATE/TIME REC'D: 09/18/04 10:10A REPORT DATE: 09/28/04 PHONE: (845)-878-7079 SAMPLING ~ SITE: SAME SAMPLE TYPE..: POTABLE 1008 : KITCHEN TAP PRESERVATIVES: NONE COk'D oY: AMETTA BOGUS TEMPERATURE..: < 4C NOTES...: ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 0 - 10 COLIFORM METH: ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~-~~ Ml----- NITRITE NI N G <0.01 MG/L N/A 9146 PUTNAM CNTY PROFILE 09/18/04 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 09/16/04 LEAD (INS) � ll^9 ppb 0-15 ppb 910J. 09/18/04 NITRATE NITROG 0.34 MG/L 0 - 10 9139 09/18/04 NITRITE NI N G <0.01 MG/L N/A 9146 09/18/04 :]RON (Fe) <0.060 MG/L O-0.3_mg/1 2037 09/18/04 MANGANESE (Mn) <0.O1O MG/L O-O.3 mg/l 2037 09/18/04 SODIUM (Na) 34.8 MG/L N/A 09/18/04 pH 6.4 UNITS 6.5-8.5 9043 09/18/04 HARDNESS,TOTAL <2 MG/L N/A ' 09/18/04 ALKALINITY (AS 74.0 MG/L N/A 09/18/04 . TURBIDITY (TUR <i NTU ` 0-5 NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER T) OF A ^ SATISFACTORY SANITARY QUALITY ACCORDI E NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 p'b and a treatment must be potential. �blic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 md/L, else-water undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium � that for people on a contain no more than moderately restricte is suggested. are proscribed. Suggested guidelines state sodium restricted diet,the water should 20 mg/L of Sodium.. For those on a I diet, & maximum of 270 mg/L of Sodium PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Street Location -t Town TM # (— 17 1. Sewage Svstem Area a. STS area located as per approved plans .............. I ............. b. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped ................: .. ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... H. Sewage System a. Septic tank size - 1,000 ...:.... ,250. ......other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Bog 1. Al outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft. Original soil between box & trenches e. Junction Box properly set .......... ............................... 6. I renc es . 1. Length required (0 7 Length installed 2. Distance to watercourse measured 4-149--p Ft.......... 3. Installed according to plan........ .. ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft_- foundations.......... 6. Depth of trench <30 inches from surface ................:. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 1'A" diameter clean .................... 9. Depth of gravel in trench 12" minimum ....... :............ 10. Pipe ends capped ........................ ............................... g. Puma or Dosed Systems 1. Size of pump chamber ................. ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual/ audio ........:........... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... M. House/Building a. house located per approved plans ............... ...... . b. Number of bedrooms ....... ...................��: : : :... : :. IV. Well Well located as per approved plans . ......:........................ P. Distance from STS area measured e 0 - ft. :......... c. Casing.18" above grade ................ ............. ................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship . a.. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate.... .... : .......................... i. Erosion control provided ................. ............................... Rev. ?2/02 Date: •/O Inspected by: Owner Bow, vS Permit # 3 -7 — 0;;.L Subdivision Lot # / / OCT -.12 -2004 04:05 PH HARRY W NICHOLS 914 279 4557 P.01 6 PUTNAIY1 COUNTY DEPARTMENT OF HEALTH DMSION.OF ENVIRONMENTAL UtALTH SERVICES &EQUE5T FOR FINAL INSPECTION. For: Fill Date: to, 12,04,: .. Trenches ✓ ....... PCHD Construction Permit # Located: 1541DIX' 9ttD4.e A0A1> (T) ('V) PA$TL .so0 Owner /Applicant Name: Q&1b .a'Q!ACW AGftC4AiW3 TM _ S. Block 1 Lot 17 Formerly: Subdivision Nam' e: 541pix Q+ Subdivisiou Lot # 11 s system comp ete . Is 'system complete? Is system constructed as per plans? YO Is well "led?.r YsS Is well located, as per puns? Are erosion control. measures in place? ...... ate. Date: to -vz•o4 Date: to. %2 -ft I certify that the system(s), assisted, at the above premises has been constructed and.I have inspected and .verified their completion in accordance with the issued PCIiD .Construction Permit and approved plans and the Standards, Rules and kegula'.ibr:is of the Putnarm County Department of Health. Daie: _Pc C 12 ot Certified by: PE RA Des' Professional Address: 26.56 IQoA -az 112§09_ Lic. # 56124 _ Comments:. FOR: D ADAM 1K GENE D (NAME) Form FIR -99 A" LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 -6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 October 28, 2004 Harry Nichols, P.E. Patterson Park, Ste 106 2050 Route 22 Brewster, NY 10509 Dear Mr. Nichols: ROBERT J. BONDI County Executive Re: Field Inspection — Bogus Bridle Ridge Rd., Lot #11 (T) Patterson, TM # 5. -1 -17 The above referenced separate sewage treatment system can be backfilled. There are no open comments to be addressed at this time. If you have any further questions, please contact me at (845) 278 -6130, ext. 2261. GDR:km Sincerely, , 4 L Gene D. Reed SR. Environmental Health Engineering Aide TNAM COUNTY DEPARTMENT OF HEALTH r ION OF ENVIRONMENTAL HEALTH SERVICES O� CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT it 11 7 - Located at t i d Subdivision name a Subd. Lot # -- Date Subdivision Approved -,:w - ie ! Owner /Applicant Name : ir, J4 N ass' 2 �J ? 0.4 u-5 Mailing Address e— 8�• ] Town ory4HTg'e _ ., r; a�3 Tax Map 4.7 Block I Lot —1 :1 Renewal Revision 1--' Date of Previous Approval Zip Amount of Fee E,ncclosed'f Building Type JC ii) Lot Area ?,-400 No. of Bedrooms -4 Design Flow GPD ea6 Fill Section Only Depth 3 arS 1 Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of l 2-9;�-U gallon septic tank and Cz47 % '1 Other Requirements: ✓j- nd ti�� y To be constructed by Address Water Sunnly: Public Supply From Address or:/ Private Supply Drilled by . -F ( 1--) 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 treatmentsystem 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 License #4 l 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 en onsidere necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new p i . pprov r discharize of domestic sanitary sewag only. By: Title: rix— Date: C� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # — 3�'' Located at eQb UP— Town or Village Subdivision name ��`i,� (Z\N %ubd. Lot # Tax Map Block Lot 1� Date Subdivision Approved 2 —Z1'–� °I Renewal Revision Owner /Applicant Name 9��� �10GE, Arses �� \Date of Previous Approval Mailing Address N y Zip Amount of Fee Enclosed Building Type MF S1b �—D40CLot Area "1401 No. of Bedrooms --k Design Flow GPD� A C2F S Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of VIS `V gallon septic tank and (DU–? L-•�, QcQ S Tu--NC 1�1 Other Requirements: �J ®C�j1u- To be constructed by Address Water Supply: Public Supply From Address or: '�)� Private Supply Drilled by TQ Address 4 represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the sgparate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in #ccordance 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 P.E. 1/_1 R.A. sl-m N1 101;0� License # Date 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 ^n considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new p i . Appro. for discharge of domestic sanitary sewn a only. By: Title: Date:�i White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Bitwster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 FAX COVER SHEET Date: j I'D To: . P, iJA From: Robert Morris, P.E. Senior Public Health Engineer Emergency Response Coordinator For your information For your review As discussed Notes/Messages Fax #: �/ 2 No. Pages (Including cover sheet) Please respond f/ Attached as requested Please call In the event of transmission /reception difficulties, please contact this office at (845) 278 -6130 ext. 2166. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # 37-0 Z Well Location: Street Address: Town/Village Tax Grid # Map Block Lot(s) \� Well Owner: Name: Address: R6 F 2Z, WbuL e-\1ba AsSo'ONIZ ge.Ew s-N F (z I N1� Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served _�-U Est. of Daily Usage 30D gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ............................... Yes No ................................................. Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision I -F 5 U gD \ V \ s %N Lot No. Water Well Contractor: T 66 Address: �- Is Public Water Supply available to 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 sheet/plan. Date: -2:3 - V�Applicant Signature: lt, PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED _FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a wate 1 driller ertified by Putnam County. Date of Issue 12,16 d Z Permit Issui cial: Date of Expiration — 2-/13/0 Title: Permit is Non- Transferra le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Located at Tax Map # Block �. Lot Subdivision of B i- i Subdivision Lot # i i Filed Map # Date Filed 2 - �Z 1 _e Gentlemen: This letter is to authorize a duly licensed Professional Engineer z,4J' 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 Pulna.nitary Code. Mailing Address t . State Aj Zip 101 —o 7 Telephone: ;-7q - 4ea `3 Very truly yours, Signed: 0 64 (Owne Property) � 11 Mailing Address: r_ State /0/ Zip 16 Telephone: 4e? 'R — 3 S'O j Form LA -97 August 5, 2004 Putnam County Health Department 1 Geneva Road Brewster, New York 10509 Att: Robert Morris, P.E. Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 Tel: (845) 279-4003 Fax: (845) 279 -4567 Email: hnengineer@aol.com Re: Individual SSTS Lot # 11, Bridle Ridge Subdivision Town of Southeast T. M. # 5. -1 -17 Dear Mr. Morris: Enclosed are the following: 1. Five (5) prints of SF -11, "Preliminary Design for Fill Placement Only ", rev. 08/03/04. 2. Two (2) prints of SS -11, "Proposed SSTS ", rev 08/03/04. 3. "Letter of Authorization ". 4. Revision Fee in the amount of $200.00. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, Harry W. Nichols Jr., P.E. HWN:gav 03- 018.00 I acknowledge receipt of this report :'SIGNATURE: 02/,96. Title, == PERSON IN CHARGE -Oh NTF-RVTFWF v 'Name and Title-. T`i7PE`QF FACILITY A/ 1,: -_PA 19 T 77 FI.NDINGS:' Pet( G m o_ ZA TWORC, R., 'TPL!, Signature a pre and Title RC RTVF R V., C_ of this SIG. .""I a�kno:wledg6 re eipt 02/96 Title.i I acknowledge receipt of this report .'- SIGNATURE: 02/§-6 Title: i :Sheet " of PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLH.SERVICES F IE LD-ACTIVITY REPORT NAMR.��� TPt i Street - ° .Town State Zip PERSON IN CHARGE pN`: J Name and - .Title TYPE OF FACILITY F, FINDINGS': = we e °. rh- 10 0 a .1V 5 :7 �- �e9 AJ6 Poe .f , n' p .. TRT Signature and TI e 'nT -nf. M rr, 'n 7.-1- IT7T<ry -T% :. nXTr I acknowledge receipt of this report .'- SIGNATURE: 02/§-6 Title: 4. BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Date: 61 Orm / W, From: Gene D. Reed Putnam County Department of Health F your information For your review As discussed Fag #: �- ?6 " V 6�� - No. Pages (Including cover sheet) Please respond Attached as requested Please call Notes/Messages PL e � V1,65&,1 /,�� 2 12ES %- AZ6 A67Z Z6r�evJZ T7C> 6/4/ 216EP2 .-19 In the event of transmission /reception difficulties, please contact this office "At (845) 278 -6130 ext. 2261. LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 September 3, 2004 Harry Nichols, PE Patterson Park, Ste 106 2050 Route 22 Brewster, NY 10509 Dear Mr. Nichols: ROBERT J. BONDI County Executive Re: Field Inspection — Bogus Bridle Ridge, (T) Patterson Lot # 11, TM# 5 -1 -17 Per our meeting in on the above referenced lot on August 25, 2004, the following comments are offered. 1. Deep test holes in the fill pad indicate a lack of proper fill depth (i.e., 3.5' minimum required). 2. Revised plans must be submitted to this Department for review showing existing conditions including curtain drain, topography and septic tank. A re- inspection of the fill pad is required by this Department once the R.O.B. fill has been placed to obtain 3.5' depth. If you have any further questions, please contact me at (845) 278 -6130, ext. 2261. Sincerely, 4'c'� -0. --&-4 Gene D. Reed SR. Environmental Health Engineering Aide GDR:km Q t s BRIDLE RIDGE ASSOCIATES BRIDLE RIDGE ROAD, TOWN OF PATTERSON Go 7L �l SIEVE TEST RESULTS / Starting weight — 91.0 g. Retained in # 10 Sieve 32.8g. = 36.04% Retained in # 20 Sieve 21.5g. = 23.63% Retained in # 50 Sieve 16.8g. = 18.46% Retained in #100 Sieve 4.8g. = 5.27% Retained in #200 Sieve 4.5g. = 4.94% Retained in Pan 10.4g. = 11.43% � 9 ` d 1 ©o 0 0 loo cra 90 � � BRIDLE RIDGE ASSOCIATES BRIDLE RIDGE ROAD, TOWN OF PATTERSON SIEVE TEST RESULTS Starting weight — 91.0 g. Retained in # 10 Sieve Retained in # 20 Sieve Retained in # 50 Sieve Retained in #100 Sieve i Retained in #200 Sieve Retained in Pan 32.8g. = 36.04% 21.5g. = 23.63% 16.8g. = 18.46% 4.8g. = 5.27% 4.5g. = 4.94% 10.4g. = 11.43% SENDING CONFIRMATION DATE : APR -22 -2004 THU 14:21 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 96283509 PAGES 1�1 START TIME : APR- 22.14:20 ELAPSED TIME : 00137". MODE : G3 RESULTS :. OK FIRST PAGE OF .RECENT DOCUMENT TRANSMITTED.. P BRIDLE RIDGE ASSOCIATES . BRIDLE RIDGE ROAD, TORT( OF PATCERSON e SIEVE TEST RESULTS Starting weight — 91.0 g. Retained in # 10 Sieve 32,8g. 36.046 Retained in # 20 Sieve 21.5g• 23.63% Retained in # 50 Sieve 16.88. _ 18.46% Retained in #100 Sieve 4.8g. m 5.27% Retained in #200 Sieve 4.5g. = 4.94% Retained in Pan 10.48. _ 11.43% APR -12 -2004 10:32 AM HARRY W NICHOLS 914 279 4567 Co. o• ?VMAM COUNTY DEPARTMENT OF HEALTH DY'W_ $10N.OF ENVIRONMENTAL HEALTH SERVICES ACES? xgT FUR EZ" IU-qPE=Q For: Fill Date: Wz j� "IA4 Trenches PCHD Coastrucdon Permit # Located: l lhA r. (T) (V) �� tt�i Owner /Applicant Name: ►y sZ .eca -q TM 'Block �.� Lot ■L_ Formerly: , � „Li-haz •AAWI&U Subdivision Name: _ eat z ,. -- Subdivision Lot # �",,,_■._-- ----.. Is'systern fill completed? _,, �„ , ,._III Date: 0-a%-j2!4 ' I's system complete? Date: Is system constructed as per pleas ?. Is well drilled? Date: Is well located as per -plans? Are erosion control measures in p1.8e07 -- I certify that the syst w(s), as listed; at the above premises has been constructed and I have inspected and .verified their cosnpletion in accordance with the issued PCHD Construction Permit and approved plates and the Standards, Rules and Regulations of the Putnam County Department of Health. Dace: _ Ls.___. os *Jmg Certified by: PF RA _/_/41 :14�adI6 Desi ofessional Address:` .. �S �.sE`a��L..[1�xSQS� Lic. # Comments;. FOR: 0 ADAM GENE D (NOM) Form FIR -99 LORETTA MOLINARI Public Health Director April 16, 2004 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Dear Mr. Nichols: ROBERT J. BONDI County Executive Re: Bridle Ridge Associates Bridle Ridge Road, (T) Patterson Lot # 11, TM# 5.4-17 An inspection of the fill pad at the above referenced project has been completed. Comments are offered as follows. 1. It appears the fill used for the SSTS is not suitable run of bank material. A sieve test will be performed by this Department on material collected at the above - mentioned site; and results will be forwarded to your office for your review. 2. Upon inspection, it was noted that a high amount of water was seeping out from under the fill pad. A dye test indicated the water is flowing from under the pad to the wetlands. Measures must be taken to eliminate any and all water that may have a negative effect upon the operation of the septic system and the environment. Please note that field measurements by this Department in no way suggests the exact size, depth and location of the fill pad. If you have any further questions, please contact me at 845- 278 -6130, ext. 2261. Sincerely; Gene D. Reed Sr. Environmental Health Engineering Aide GDR:cj , AM: Cp ti CAW " * PUTNAM DIVISION COUNTY OF ENVIRONMENTAL FIELD:ACTIVITY.RE"PORT DEPARTMENT OF HEATLH. v ".Sheet HEALTH SERVICES ";Y. of �t - N AMF • .- TPI: a - AT)T)RF:CQ: Street Town. .State Zip; :.,PERSON-'IN CHARGE (7R T�TTF.RVTF.WFT)-. _Name and Title. TYPE OF FACILITY FINDINGS w . .1 t4l A0 ve o - d/n - s D o i COQ 9'0' =, 71 14 ia e� - . 7, 1NQPFrT0'R Signature and Title." . I- acknowledge receipt; of this report: SIGNATURE:. 02 49 6 ,Title 72, :5Ampt-E -*Ia -7 70� 1.4 3q 70 . Pe;-, 7, q,77 S (-7° 7, 5, BRIDLE RIDGE ASSOCIATES BRIDLE RIDGE ROAD, TOWN OF PATTERSON Lot # 11, TM# 5.4-17 SIEVE TEST RESULTS Starting Weight — 140.9g. Retained in # 10 Sieve 69.6g. = 49.40% Retained in # 20 Sieve 34.3g. = 24.34% Retained in # 50 Sieve 20.5g = 14.55% Retained in #100 Sieve 5.9g. = 4.19% Retained in #200 Sieve 4.8g. = 3.41% Retained in Pan 5.2g_ = 3.69% 140.3 99.58% Total Weight Passing # 100 Sieve 10.Og = 7.10% Total Weight Passing # 200 Sieve 5.2g = 3.69% BRIDLE RIDGE ASSOCIATES BRIDLE RIDGE ROAD, TOWN OF PATTERSON Lot # 11, TM# 5.4-17 SIEVE TEST RESULTS Starting Weight- 171.1g. Retained in # 10 Sieve 65.45g = 38.25% Retained in # 20 Sieve 42.40g = 24.78% Retained in # 50 Sieve 35.7g = 20.86% Retained in #100 Sieve 9.90g = 5.79% Retained in #200 Sieve 9.20g = 5.38% Retained in Pan 7.1Og. _- 4.15% 169.75g 99.21% Total Weight Passing # 100 Sieve 16.30g = 9.53% Total Weight Passing # 200 Sieve 7.10g = 4.15% LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 -.7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 May 20, 2004 Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Dear Mr. Nichols: ROBERT J. BONDI County Executive Re: Field Inspection — Bridle Ridge Associates Bridle Ridge Road, (T) Patterson Lot # 11, TM# 5. -1 -17 As per our meeting at the above referenced lot, the following sieve test results for the on- site run of bank fill are as offered. • The first sample resulted in a failure with 9.53% passing a#100 sieve and 4.15% passing a #200 sieve. • The second sample also resulted in a failure with 7.1% passing a#100 sieve and 3.69% passing a 9200 sieve. As per the results, the existing fill is not acceptable for a septic system and needs to be removed and replaced with a more suitable run of bank fill free of fines. If you have any further questions, please contact me at 845- 278 -6130, ext. 2261. Sincerely, Gene D. Reed Sr. Environmental Health Engineering Aide GDR:cj DEC, -23' 02 (MON) 10:18 190 -23 -2002 e9 9156 AM TEL :8452197410 P. 002 HARRY W NICi-OC 914 279 456'7 P.01 PUTNAM COUNTY DEPARTMENT OF IMALTIf D "EQN OF ENVIRON'MNTAL fMALTH SERVICES .. iCONSTRUCTION PERMIT FOR OBWAGE TIMATMENT SYM11+ 3 -96 . OJI t �i ����`' .� .� •� • , Located at �, Town ar YltZaga ' Pty , •Subdivision zulnsa .. �1 tad, Lot # —, \ Tax Map _ BW* Lot Date Subdlv48loa,Approved Rezuwat Revidon Owrfer /Appi t -1a a ,; r... .t-. �:� 'rr ai te i of Previ' ou_s . �Approval Mail a .-f�0 V r ?Ap ©0 .4 Amount of FSaalosed.L� Building Typq', ,h rc N Lot Axe iI No. of Bodrooms Design now A COX .t r '_ t1u11]rlf ,.,. iM Neoas O1Y � Deph ATfT AWVAAT 12 L1Pf%VWUr11 V VAI WI S. ?Q [V I&MV I!Ti''' + amp a& ftifi6a to consist of i i��� Saban sqpda Upk aid %L � ��F " ►,:..: Ir+rr�ww�w rr. . - .•- •- �+�..�... :�w+r+ i�rr� •.r...+++r�r�iwi rero� 00 y (iT�l To �s tai b ..... �....,�. :Address • �' .' "to SupplyTrom Address all ? , Prkt+atie Supply Drilled by ,` 3� _ f , Addtrtaa —••� ' ; �' ' : ' i i ropresrttt th 1 sin wholly and eompletety ft4x risible for the desip and location of ft proposed m(a) and ih� the ff�� desatibW above will bo coh ilrup ed w ekowa an the appmved owl a at iat aQaarda+e~e *a Ms, rules and regaWons of the P5u6 iim County Dept Went of Heald, wad'tluit 44-; the=aof a "C fiaato otVastruction Compliance" satisfiftry to the Pnb1lo Health Director �lU be'subinilw tbe.ft D**rWw� d a wrium Suou tee Will be furnished the ownw, leis siwmimso h$6 or a W10i by f W,14141 that sod builder wttl place In good operating condition any putt of said sewage Ventmant system during we petted 4* '10, 'a, im sdiataly fatittwing the date of the b mwA of *94,pproval of tt�e Cerdt aft of Cotwtt'ttadon Compliance bf t *rig�nal• " system or any repaize thereto, SlgW: P.>~r LA. Date ,'�,�i.' . , y •: .I:.t • ,,i; . APP' 0VZD,P01K CONSTRUCTION; 'I%h approval expires two years fltcm the date lesued'unless conseimlgzr of the sawaga troem Ont uyetom has been completed and impaled by the PCHD and is revocable for cause or may ba'+iet" 'OT modlf�nd eansidered neseesary by the Puhlta It%idt Dleeator. Any revision at after man of the approvod•plsrt-rpgilWS . a new i Appro for discharge of dornestic sanitary " a only. By, b Titie� Data: 22 9 THE LAW FIRM OF WILLIAM G. SAYEGH, P.C. The Sayegh Building 65 Gleneida Avenue, Carmel, New York 10512 (845) 228 -4200 SayeghLaw.com William G. Sayegh James F. Reitz Martin N. Ashley Andrew W. Humphreys Giuseppina R. Lita Robert A. Weis Office Manager Regina Shaw Ali January 22, 2003 Robert Morris Putnam County Environmental Health Services 1 Geneva Road Brewster, NY 10509 Re: Board of Health Approval Premises: Bridle Ridge Estates Dear Rob: Paraleeals Barbara Spiridigliozzi Lisa McCabe Leona DiMase Patricia Manente Marie Paprocki Administrative Assistant Terri Ann Caputo As per our conversation on January 21, 2003, enclosed please find the sewage treatment system plans in connection with the above referenced. Please affix your approval stamp to these plans and return them to this office at your earliest convenience. I appreciate your assistance in this matter. Please feel free to contact me, should you have any questions. Sincerely G' eppina R. Lita For the Firm The Law Firm of William G. Sayegh, P.C. _ GRL /lmd encl. cc: Mr.& Mrs. J. Bogus FALeonaTETTERHEAD.doc PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICE mom. * DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address in! i rGg z, n6ja Located at (Street) 3z&;,e_g Tax Map Block Lot 7 (indicate nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA Date of Pre-soaking s _L1 2 1-42- . Date of Percolation Test 03 -9-1- ... .. .... . .. ... ........ . .......... ............. .... . ........................ ...... I ep ef .......... .. .............. .......... . ....... . G Dn ....... v . ...... P 1RA tt ..... m .. .... ....... ........ ... ....... . . .. UNT; tA 6 . ............ n. St a: 0 . . . ....... . M'63* h .. .. ......... #- 17 /Z 3 1'027 24 IZZ/ - 0_7 4 2— 1,150-Altol 13 -a-3XV al.,4 77 2 "�7 3 4 5 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. :5 1 min for 1-30 min/inch, --q 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. A HOLE NO. HOLE NO. N Indicate level at which groundwater is encountered VQAJ6 Indicate level at which mottling is observed a-'-- Indicate level to which water level rises after being encountered Deep hole observations made by:. G, 7tii�f- b Date P, G, H, D, Design Professional Name: Address: Signature: Design Professional's Seal ,. ' PUTNAM COUNTY DEPARTMENT OF HEALTH M ' DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project ,u county fJT,�J Site Location-- ZFZ4tYE MbS,6 ZEZ 7 11J � % Building construction begun _ o Extent Is property within NYC Watershed ? ................. Yes a No SECTION B. TOPOGRAPHY (Please check all appropr=slope xes) 1. a Hilly- Rolling Steep slope 0 Flat 2. F-1 Evidence of wetlands 0 Low area subject to flooding Bodies of water F:Z/Drainage ditches 0 Rock outcrops 3. Property lines or comers evident ....................... ............................... -es No :.... 4. Do water courses exist on or adjoin the property? . P ....... Yes a No c "r��nc In 5. Will these affect the design of the sewage system facilities ?............ F7 Yes No Ta be // . 6. Do watershed regulations apply in this development ? ....................... rzfyes Q No 7 Will extensive grading be necessary?... N o 8. Will extensive fill be necessary for SSTS ? ........................................ Yes No- 9. Do filled areas exist within the SSTS area? ........ ............................... a Yes E�<o If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: dSand a Gravel Loam Clay Hardpan Mixture 11. Observed from: 0 Borings F_� Bank cut Ea Backhoe excavations 12. Soil borings /excavations observed by C& K60 n P, G H,J� on 4-a o 13. Depth to groundwater _I% M on 14. Depth to mottling —,6 on 15. Are test holes representative of primary & reserve areas ...... ............................... 16. Soil percolation tests made by on 17. Soil percolation tests witnessed by , 7Z" t:> on SECTION D (on back) C Form ST -1 r. 2 SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? a Yes 19. Will groundwater or surface drainage require special consideration? ..................... AS 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... rZY F No SECTION E. REMARKS 21. If a common water supply is proposed; has an inspection been made of the existing or proposed source and facilities? ...................:......... F Yes ................................... No Inspection data 22. Do adjacent wells and/or sewage systems exist ? ...................... Yes F-1 No 23. Additional comments 24. Site observer /inspector and title. ' E6/_T 25. Dates) of observation(s)inspection(s) / TEST PIT PROFILES Hole # Lot # Hole # 'Lot # Hole # Lot # Depth to water Depth to water. Depth to water Depth to mottling Depth 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 1.0 1.0 1.0 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 f IV SPOWN K"V f ! � I � t , .qo �• "I �Jj . I .(ij. A / � � 175 .. rr� prarr - I Al 7- m— L: T AL . . . . . . . . . . g-,"kc, jr 4A: .Z.77 tv -�t i� %�i Ile 7.4 1. rc /170 loll 4j toor Gr JUL -17 -2002 04:35 PM HARRY W NICHOLS a BRUCE R. FOLEY Public Health... Dlreotor -� 914 2794567 DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 P.01 LORETTA MOUNAW R.N., M.S,N. Avociate P&Wk Health Director Director of . Patient I Sdrvfcel RFdQ]UESJ FQH'I LD TESTING ATTENTION: o ADAM STIEBELING 5GENE REED All information below must be fik completed prior to any scheduling. DATE; EXCINEER OR F101: 4Pt T J w ` p�umj VP PH *0 #: VI REASON: _ DEEPS: FRCS: >� PUMP TEST: a ROAD /STREET; $AM IUQV k AD TOWN: SUBDIVISION: OWKER: � J 4 611 ($r 0 TAX MAPif: 5 - — I — 11 LOT4: i1 NT MEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL. TESTING 1'ES NO a C proposed SSTS-within the drainage basin of West Branch or B.oyds Corner'Reservoirs. Proposed SSTS within $00 feet of a reservoir, reservoir stem or control lake. C Proposed SSTS within 200 feet of a watercourse or a DEC wetland. c Proposed SSTS design flow greater than 1000 gallons /dayor SPDES Permit required, 4 ❑ Proposed SSTS for A Commerical Project. I- is the' responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated)`bbAsed on the response. If you answeredya to any of the questions, NYCDEP must witness the soil testing, This Department will coordinate a mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the Above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility or the design professional to schedule re-witnessing of the soil testing with NYCDEP. FOR co*rY tlsE ONLY DAM // y (e7)T 3 ' ° <n TIME; e soantF,�YS, . (MLDTEST) T 'd AO 1N3W1NUd3a AINnoo WdNind :3WUN 5RUCE R. FOLEY Public f t0h..Direc/or Z26L- 8L2 -968: X31 b2:60 NOW 2002- 62 --inf LORE17A MOL1NARi R.N., M.S.N. A.aociare Publfr Nealrh Direcior Artelor oj.Padaw Service) DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 REQUEST E-QR FIELD JESENG ATTEN710 : Q ADAM STIEBELING 4ENE REED ,VI information below must be � completed prior to any scheduling, DATE: r ENGINEER OR 171101: ' V I O P P�TOi #: , i� REASON: DEEPS: o FERCS: 0 PUMP TEST: 4 ROAD /STREET: x C (A� ,...._,. TOWN! TAX MAP #: SMIVISION: LOTC UW ER,- YES NO o Proposed SSTS-within the drainage basin of West Branch or Boyds Corner Reservoirs. ❑ Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. `d o Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ Proposed SSTS design flow greater than 1000 gallons/day-or SPDES Permit required. ❑ �i Proposed SSTS for a Commerical Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered Xa to any of the questions, KYCDEP must witness the soil testing, This Department will coordinate a mutually suitable time for field testing with the FCDOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP It required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. rroa coorry ust my DATE; TD11- .....�_ .� Ssil�ea'I,S: _ (MLDMT) _. Told L99V 6LZ bT 6 SlOH0I N 11 J1880H WV 0Z: 60 ZOOZ- 6Z —inr P A W L I N G IUTCHESS CO. PUTNAM CO., 31 a A, / err; 267N 7812p 16.94 AC. CAL. A = AREA IN DISPUTE "GORE 38 i 11IS 31279 laaes 22r.IO 19&03 26LOB - \''�.. 1 - l �; -�, •1 6 Af % 31a 13 112 200 ` 30 291.!6 -L', •\ �'' . ~..-�/ 13 . 29.2 x 37 11.41 AC. •°" - 0 5.21 ac �n 29.1 a 58.44AC. / CAL. * 28 4M to C I 200.10 13&79 z1S9B 2ASeo 44 AG CAL.1 27 C 1� ` 22= s ;72 qj� 25p 26 a�au 1' 3 21 • 225 AC ' 1.7 1.8 1.84 AC4� = 307.37si AMC 2.56 i A 2.91 AC. JAL Ixn 8' 4- 5.10 AC. ��s AC. ` e` !easy& m 39 I351.n r +3 e1 \� ` 16 ; 2.19 Ac.. CL �� 20� a 17 Ar . 13sen 19 1.39 ti 1.93 AC. i 40�FI i i 7.40 AC. 16a Ts 004y1 Y i�' sales x'3.87 AC. 10 AL .97 `�`6�P �•Iq 18 IS * =+ 14 f 71&.60 5.32 AC. N *.10.24 AC. >< a; 12/&60 lea r \ ` i. rl ae 10.84 278 AC."f OO ' - 24.36 AC. CAL. O 12 we I •aT 10. AC, m '� I0S0 1010.35 pAWLING CENTR - AL SCHOOL Sir $ Irea19 191. wl;siEH CENTRAL SCHOO 9 II 42 40 AC. 0 40.70 AC. CAL. 20.37 AC. CALK- 2 719 a 496 EXE /X joND 1 �SCH / . /• IBS NI •gin 68&29 7- - - - - - - . N_ \ 43 1 7 ire 16.55 AC. CAL -1 / I° 8 ! 28.44 AC. CAL. AC. I� ••aao 14•46 Z \6 1 a 6 n 1 7.89AC •I 1 g II I I-� PAWLING CENTRAL SCHOOL DISTRICT 16101 167.2 214.3 3SCH ads '�9 y rtCe .78 AC. CAL. �v .�� �T' !�• '` .• .I . 1 8B£WSTEB CENIAAL SCHWL DISTRICT 4 +rors7 ,r►i 4+ I 1121.06\ � 7.67 Ac. CAL. 1_ !� ..• CAL. 1 ' Z¢3t 45 1194 AC \ �! 4fi .1 i Di 371 0 .. 2.4 AC.4 92.77 AC. 1 ` n,IW I Tlsl.lo /. CAL o !1 I P10 4-1-71 P/0 15-1-19 1 326.33 le e 1160oD - -_ I PURPOSES ONLY REVISIONS SPECIAL DISTRICT INFORMATION I aua•+su,su 3blal 9avM SWK •Sbh FARIS9 UXM& SOM DISTRICT ••• 131001 STATE LINE OR CONVEYANCES a a.I.a -m-212 FUM aA,n w. e6ER5TER mRRU eoa0► oISTRITa ... moo1 couNTr ule To" LINE I By a ar•t •e NaAa w F11a F. PI RWIERIOa 69181 IR VILLAW I. I* 41 1 MAAOAAIV • d- I -a•U7r UPS Aa1. At eAT /aaaw mt BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Date: V L0 2 To: 614 'tea 2-A- ©�A Fax #: 7? -3 SS From: Gene D. Reed Putnam County Department of Health ZFor your information For your review As discussed No. Pages (Including cover sheet) /Please respond Attached as requested Please call Notes/Messages le 2 10 In the event of transmission /reception difficulties, please contact this office at (845) 278 -6130 ext. 2261. ➢.EC•. -2-T 02 (MON) 10 ;18 TEL: 8452797410 P-002 Ise_23 -2Hi82 69L$6 AM HARRY W NICHOL.S 914 279 4567 P.01 Y PUTNAM COUNTY DEPARTMENT OF HEALTH l]MSION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PEUMIT FOR SEWAGE TREATMENT SYST M Located at ,_ I �. `ZMG &0 "_ T'owa ar village .. Sr). -Subdivision name ubd. lot Tax Map _ Block Lot Date SvWvjslon,Approved 2 A g Renewal ._ Revision_.__�_.___rr. Owncr /Applicant game ��.��L�. ��n �, � d ate of reVious Approval 7+ilaitiug Addretis PCQ7r 2 tic► 5- �1V or.'• 1. O Artiattat of FEnclosed 3W,.LO _ ' ' • . . ,. :'.' , .. BaildiAg Tyge','.�,_.�1D 11�C. Lot Area? ►�iQ1 1 No. of Design Flow GPD van 111 beation Only Depth ' Volume • 5.! :, "AMWFWU 1T� A nnr1W^ ♦ T1t1► TO, 12"O%WIMM -Win Is Ott • • 9 04^1 MIt up"Im '1�'• '.° " �>~4 to consist of-� gallon septic tsidc ssred c. other �W i � „��: _ 13 � , 1r.r •.r��.row�- r r -'- -..Ir�rrw.rr� r�r To bd constructed by Address'''""`"'" �Ngtar ®u� lvr Public Supply-From 'Address . Private Supply Drilled by _ Address 1 reprosont that Y am wholly and completely responsible for the doaign and location of the pioposed systom(s) and thet!ft ' seamm am described above will bit aasstrvated as dwwrt on the approvod am"ilm"t dwivi o'add'in 'tsacordosslca with the etas ards, rules and reguladons of thc'Pntxtinn County Depaftent of XWth, atid't'hst ova cmplethtmi thereof a "Cortiflaato oftonstruction Compliance" sattsfaohory to tho Public ialth Director -Ali be. submitMI t6i'Ahi • Depatinteat, snd a written gusnantee will be Nrr&W the ov�es�or, his s3 mmsots, heirs or assign► by flee bi ildirr, OW a4ld binder will place in good operstin$ condition any p�,rt'of said sewage ftetment systom during the period of two (!).yei i s hnm$d1Wy f ttpwins tU data of the W msnce of the •epprovsal of thus Cardf eatai of Coteamctlon Complianoe df the�iljlna1 ' symm or any repairs_ thereto, Siped. P.19, R. A. Date —'�. .' Aad:e�a t �t� 7 APPROVED FOIL CONSTRUCTION; This approval expires two yearn fMm the ditto issued'unloss construadtin of flee saysraga ft went rot= hoc been completes and inspected by the PCHD and is revocable for cause or may bs�•atlt pr ' madit4iy, consider asusasary by the Public RWth Direcor. Any mvieion at alteration of the approveti•plan t�"tiirpsa anew Appr o for discharge of domestic sanitary 6e only. By P Title: Ditto; • I Y a i BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. - Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 FAX COVER SHEET Date: 111 t3 [ 0*- To: Fax #: S 1' 4S41' From: Robert Morris, P.E. Senior Public Health Engineer Emergency Response Coordinator For your information For your review As discussed Notes/Messages IN No. Pages Z"r (Including cover sheet) Z Please respond Attached as requested Please call In the event of transmission /reception difficulties, please contact this office at (845) 278 -6130 ext. 2166. aZ Z 'd AO 1N3WiNUd30 AiNnoo WUNind:3WUN T26)L-e)_2-st7e:131 92:02 03M 2002-2T-AON Ed Re: Bridle Ridge Associates Lot 11, S STS Bridle Ridge Road Patterson, Putnam DEP Lo g# 13 309(7oint Review) Al Irl Dear Mr. Morris: W" bxc,. Simroc LloydOe La Ossa File Please note the following comments regarding the system design: 1. Profile shows 5' of fill. 2. Pump model and pump curves must be shown on plan, 3. The toe of slope of fill must be at least 10' from property line. 4. Show a realistic footprint of residence. If you have any questions regarding this matter, you may contact me at (914) 7734416, 4, Sincerely, T. October 3, 2002 Assistant Civil Engineer ngineenn g Design & Review Robert Morris, P.E Putnam Co. Health Dept. 4 Geneva Road Brewster, 10509 Re: Bridle Ridge Associates Lot 11, S STS Bridle Ridge Road Patterson, Putnam DEP Lo g# 13 309(7oint Review) Al Irl Dear Mr. Morris: W" bxc,. Simroc LloydOe La Ossa File Please note the following comments regarding the system design: 1. Profile shows 5' of fill. 2. Pump model and pump curves must be shown on plan, 3. The toe of slope of fill must be at least 10' from property line. 4. Show a realistic footprint of residence. If you have any questions regarding this matter, you may contact me at (914) 7734416, 4, Sincerely, Sissy De La Ossa Assistant Civil Engineer ngineenn g Design & Review xc: James Covey, PE., NYSDOR zo *d St7: OT Z6, 21 A ON 2V'20-2Z2-VT6:x-eJ 9NRJ33NI9N3 d3G DAN NYC DEP ENGINEERING Fax:914- 773 -0343 Nov 13 '02 10:45 P.01 ,R (hays JanoO Bulpnpu� }' :.. :saftd ;o as (8-f -z o� ;�uasuE�l FpFD S5.T F TLV ,4 - Bh.If.—i'C.Iet ' ,Yr Y� 7 . i/L y / I . '.., ,r�' 311l7S .6VW3A Y 517.9'/'W 700 S91� H0l)3aj0JJ JBIHOUJU01TAU PAW o ug ua lu da WED 10:26 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 ors �r f°� °�' °� •� � ,�' �' ��l��S. xu (hays JanoO Bulpnpu� }' :.. :saftd ;o as (8-f -z o� ;�uasuE�l FpFD S5.T F TLV ,4 - Bh.If.—i'C.Iet ' ,Yr Y� 7 . i/L y / I . '.., ,r�' 311l7S .6VW3A Y 517.9'/'W 700 S91� H0l)3aj0JJ JBIHOUJU01TAU PAW o ug ua lu da WED 10:26 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 S BRUCE R. FOLEY Public Health Director LORETTA MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085_ Request for Status of Joint Review Project Date "tl / & /07, On an Individual SSTS Construction for 1 t0 up- tax*_ t T- l( C -T) __PATCf�sa� was deemed to be complete. Plans were forwarded to the New York City Department'of Environmental Protection for review /comments /approval as required for joint review projects. Under the Watershed Agreement a determination must be made within 20 days after an applicants submission is deemed complete. At this time the 20 day period is; 1) Almost ver 2) Has past A determination has not been received by this Department. It is important that you notify. this Department as to the status, of this project. Please respond by fax (914) 278 -7921, or call Robert Morris, P.E., Senior Public Health. . Engineer at (914) 278 -6130 ext 166, at your earliest convenience. Thank you, in advance, for your assistance in this matter. WA W1_ 9 F GALLS dep fax# 773 -0343 . BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public, Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 October 11, 2002 Harry Nichols, P.E. Patterson Park Suite 106 2050 Route 22 Brewster, NY 10509 Re: Proposed SSTS: Bridle Ridge Associates Bridle Ridge Road, Lot 411 (T) Patterson, TM# 5 -1 -17 Dear Mr. Nichols: Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: 1. SSTS profile shows five feet of fill. Maximum dept of fill allowed is 3.5 feet (Department of Environmental Protection). 2. Pump model and pump curves'must be shown on plan (Department of Environmental Protection). 3. Toe of slope must be 10 feet from property line (Department of Environmental Protection, and Putnam County Health Department) fill is shown graded off of property. . 4. Show a realistic foot print of residence (Department of Environment Protection). 5. Force main detail has not been provided on plan. 6. The toe of the fill will extend into the wetland buffer as shown. A wetland permit must be submitted or redesign the fill pad. 7. The dose volume is to be noted on plan along with dose calculations. 8. Elevations are to be noted for pump chamber. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:tn ZIS4'1 yo � Senior Public Health Engineer 'd AO 1N3WiNUd3G AiNnoo WUNind:3WUN �"x October 3, 2002 Robert Morris, P.E Putnam Co. Health Dept. 4 Geneva Road Brewster, NY 10509 T26)L-8,L2-9t,8:-131 t70 :60 NOW 2002-,L-100 Re- Bridle Ridge Associates Lot 11- SSTS Bridle Ridge Road Patterson, Putnam DEP Log # 13309(loint Review) Dear Mr. Morris:. Please note the following comments re-gar din g the system desi gn 1. Profile shows 5' of fill. 2. Pump model and pump curves must be shown on plan. 3. The toe of slope of fill must be at least 10' from property line. 4. Show a realistic footpxint of residence. If you have any questions regarding this matter, you may contact me at (914) 773-4416. t. Sincerely, Sissy De La Ossa Assistant Civil Engineer Engineering Design & Review xe: James Covey, P.E., NYSDO H ZO'd ZZ:6 zo, z 130 2V20-,2ZZ-b%: XeJ 9NIN33NI9N3 d3G DM d BRUCE K. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 September 17, 2002 Harry Nichols, P.E. Patterson Park Suite 106 2050 Route 22 Brewster, NY 10509 RE: Bridle Ridge Associates Bridle Ridge Road, Lot #11 (T)Patterson, TM# 5 -1 -17 Reservoir Basin Dear Mr. Nichols: The Putnam County* Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on September 10, 2002 is complete. The Department will notify you by October 2, 2002 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 1 -8 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department .of Environmental Protection review and approval of other aspects of a project, such as stormwater plans Letter to: Harry Nichols, P.E. - September 17, 2002 -2- or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2166. Ve my yours, Robert Morris, PE RM:tn Senior Public Health Engineer JO iN3Wi8Ud3G AiNnoD WUNind:3WUN This letter is to inform you that the New York City Department of Environmental .2UNW, SUP* Protection (Department) has determined that the above-referenced application is complete. In addition, the Department has no objection to the approval of the prInGIM Ph.D. above-referenced regulated activity. This determination is based on the review of submitted documents including the plan titled "Proposed SSTS for Bridle Ridge December 12, 2002 Estates Lot I I", dated 8/21102, and last revised 10/25102- Of The applicant must contact Sissy De La Ossa of my staff at (914) 773 -4416 at `: `IPOtectiprr obe Robert Morris, PI representative may inspect and monitor the installation. Putnam Co. Health Dept. 9" Yo* 4 Geneva Road .3W Brewster, NY 10509 Re: Bridle Ridge Associates Lot 11, SSTS Bridle Ridge Road Patterson, Putnam DEP Log# 13309(Joint Review) Dear Mr. Morris. TT:,LT .nHl 2002-2T-030 I-M Sincerely, Danny Shedlo, P.E. Project Manager Engineering Design & Review xc: James Covey, P.E., NYSDOH C7181' D L F - it i' I it 02:zT ZO, ZT 39a 9ND133NI9N3 d3G DAN This letter is to inform you that the New York City Department of Environmental .2UNW, SUP* Protection (Department) has determined that the above-referenced application is complete. In addition, the Department has no objection to the approval of the prInGIM Ph.D. above-referenced regulated activity. This determination is based on the review of submitted documents including the plan titled "Proposed SSTS for Bridle Ridge .742-2001 .741-030 Estates Lot I I", dated 8/21102, and last revised 10/25102- The applicant must contact Sissy De La Ossa of my staff at (914) 773 -4416 at least 2 days prior to the start of construction of the SSTS so that a Department representative may inspect and monitor the installation. Sincerely, Danny Shedlo, P.E. Project Manager Engineering Design & Review xc: James Covey, P.E., NYSDOH C7181' D L F - it i' I it 02:zT ZO, ZT 39a 9ND133NI9N3 d3G DAN Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Telephone (845) 279 -4003 Fax(845)279-4567 October 24, 2002 Department of Health One Geneva Road Brewster, New York 10509 Aft: Robert Morris, P.E. Senior Public Health Engineer ° Re: Proposed SSTS: Bridle Ridge Asso Bridle Ridge Road, Lot #11 (T) Patterson, TM# 5 -1 -17 Dear Mr. Morris: In response to your letter dated October 11, 2002 we.offer the following: 1. Plans have been revised to illustrate a maximum fill depth of 3.5 feet. 2. Pump designed has been eliminated with the revised Plan.. 3. Toe of slope is now shown 10' from property line. 4. A more comprehensive house design has been added to the Plan. 5. See comment # 2. .6. Toe of fill has been revised so as not to encroach into the wetland buffer. 7. See comment # 2. 8. See comment #2. If there are any questions concerning the above, please call. Very, truly yours, Harry W. Nic ols Jr., P.E. HWN:JM:jmm 02- 064.00 ..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: 21DLE 2N O G Pts5 2. Name of project:OQ6SU SSTS \\ 3. Location T/V:. :SdN 4. Desi gn Professional:��Z�WN OO S R,5. Address: 20s() (LY. 22 .. . 6. Drainage Basin: 7: Type of Project: 7 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 Type Status-(check--one) Type I Ekem t - Type II Unlisted 9. Is -a Draft Environmental Impact Statement (DEIS) required? - 10. Has DEIS been completed and found acceptable by Lead Agency? .............. ;L . N. 11.. Name of Lead Agency., 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ....... .... ............................ ............................... 13. If so, have plans been submitted to such authorities? ........ ............................... �— 14. 'Has preliminary approval been granted by such authorities? N D Date granted: 15. Type of Sewage Treatment System Discharge .................. surface water oundwater 16. If surface water discharge, what is the stream class designation? ........::::: :...:.: 17. Waters index number (surface) ............................ ............................... N/. 18. Is project located near a public water supply system? NO. 19. If yes, name of water supply N Distance to wa -mr: supply ° -N)A 20: Is project site near a public sewage collection or treatment system? 21. Name of sewage system N Distance to sewage systemh_ /.A 22. Date test holes observed 23. Name of Health Inspector G E N (�ZV�s 24, Project design flow (gallons per day) .................................. ............................... 2.5. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... N6 26. Has SPDES Application been submitted to local DEC`office? Form PC-'T7 _.:.. 2 27. Is any portion of this project located within a designated Town or State wetland? 28. Wetlands ID Number .............. ............................... ...... L—O C •AL_ 29. Is Wetlands Permit required? ....................................................... I..................... Has application been made to Town 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, landfilling, sludge application or industrial activity ? ............................. Yes/No N 32. Is project located Within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any __ _._._ O other potentially known source of contamination? ............................... Yes/No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... YES 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? . ............................... NO 36. Tax Map ID Number ......... ........... . ......................... .....::..... Map. _Block.. Lot 37. Approved plans are to be returned to ..... Applicant Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC-Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed.Stay also require DEP review and approval of other aspects of a project, such as stormwater plans..or the �Matip _gf impervious surfaces, and the project applicant should obtain the appropriate forms for such actiEgies fTM DEP and submit those forms to DEP for review and approval. 1 _'1 If the application is signed by a person other than the applicant shown in Item l .,the appligio u-t, be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with thr prcKi 0 may be grounds for the rejection of any submission. � I hereby affirm, under penalty of perjury, that information provided on this form is true OV . 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. S GNATURES & OFFICIAL TITLES: Mailina Address .... (�Q y j �. `2 ...... (3czFWs-� 'P_@1 /\J \0.0C-) o - 14.16.4 (9195) —Text 12 PROJECT I.D. NUMBER 617.20 SEAR Appendix C _ State EnvlronmQntal Quality Review. - SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only -- PART 1= PROJECT-IN FOR MATION'(To be OOmDleted by Applicant or Protect sponsor) - - 1. APPLICANT /SPONSOR 9V- o No c,E f SocVpNF 2. PROJECT NAME ec�oPdsFD ss TS Lc�t \..N .: 3. PROJECT LOCATION:n _ /� n►� Municipality \ �i F es County e O T 1 U M 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) 5. IS PRO SED ACTION: . New ❑ Expansion .❑ Modlficationlalteratlon 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED:: . —7, —71 40 Initially 0\ 0 acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR -OTHER EXISTING LAND USE RESTRICTIONS? ®.Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? •Q Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: N GLE eA " )L_j 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? &Yes - ❑ No -- If yes, Ilat agency(s) and permlt/approvals 11. DOES ANY ASPECT, OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes ®.No If yes; list agency name and permitlapproval _ 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑ Yes ti�No 1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE I N ZAA 01-! N, Z ti Date: App I lean U sponsor n me: 1, "" Signature: b4� 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 PUTNAM COUNTY DEPAR'T'MENT OF HEALTH..., DIVISION OF ENVIRONMENTAL HEALTH SERVICES,, "DESIGN DATA SHEET'- SUBSURFACE SEWAGE TREATMENT SYSTEM (,aUfif_- 22 Owner (�CZ\��LF CZj Gc-. bSSOCI,AJ _SAddress , Located at (Street) P69 \r _E 2 \6 GE Tax Map Block 1 Lot (indicate nearest cross street) ..... Municipality _e����25 Watershed G(RA NCV} SOIL PERCOLATION TEST DATA Date: of Pre- soa-kin g Date of Percolation Test Hole No..: :. :..R,pu No :.: . < >:.: Time Staart.'Sto ...... .::,Elapse Time (PNSin. De t6 to Water From Ground Surface (Inches) Start Sto Water ;Level Drop:In Inches .Percolation Rate. 1VIiu/Inch; . :. 27'' 2. _((� -7 .210k 11 2.71 3, 3 - Z�G 2,27 Z._i 2 ��t - -27 4 2 22 2�" 2_71 `' 3�.i' - �1.1- s l� 2701 7,r7 2. 2;02 2;29 "IG 2 � ` 2i9 3 " ,-7 3 2;24 251 26 4 1 ......__.. - 5 ' NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, 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. 8.5' _......_.. 9.5' - - - Indicate level' -at which .groundwater is encountered N d. E -- Indicate level at which mottling is observed 2.2 6 � � Indicate level to Which water level rises after being encountered !VIA Deep hole observations made by: G�m eFyn k b4N \EL O`CaroN0(Z Date =02 Design Professional Name: Add s • 2 Sq -2�- ; 22 z RR4.I Signatur( Design Professional's Seal LU Lu 'CIO No.5692d� O a�; pAOFESSION_ 3.5' 5.0 ......... Cn 6.0' _... -- -� . F -� -3 7.0 8.0' 8.5' _......_.. 9.5' - - - Indicate level' -at which .groundwater is encountered N d. E -- Indicate level at which mottling is observed 2.2 6 � � Indicate level to Which water level rises after being encountered !VIA Deep hole observations made by: G�m eFyn k b4N \EL O`CaroN0(Z Date =02 Design Professional Name: Add s • 2 Sq -2�- ; 22 z RR4.I Signatur( Design Professional's Seal LU Lu 'CIO No.5692d� O a�; pAOFESSION_ Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Telephone (845) 779 -40013 Fax (845) 2794567 August 23, 2002 Putnam County Health Department One Geneva Road Brewster, New York 10509 Aft: Robert Morris, P.E. Re: Individual SSTS Lot # 11, Bridle Ridge Subdivision Town of Southeast T.M. # 5. -1 -17 Dear Mr. Morris: Enclosed are the following: 1. Five (5) prints of SF -11, "Preliminary Design for Fill Placement Only," dated 8/21/02. 2. Three (3) prints of SS -11, "Proposed SSTS" dated 8/21/02. 3. "Short EAF," dated 8/23/02. 4. "Application for Approval of Plans for a Wastewater Disposal System." 5. "Construction Permit for Sewage Disposal System," dated 8/23/02. 6. "Application to Construct a Water Well," dated 8/23/02. 7. "Design Data Sheet." 8. "Letter of Authorization." 9. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only.' 10. Review Fee in the amount of $300.0V We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, Harry W. lic Is J r., P.E. HWN:DO:jmm 02 -064.11 PUTNAM COUNTY DEPARTMENT OF HEALTH `DIVISION OF ENVIRONMENTAL HEALTH SERVICES,.'. :' ; .. LETTER OF AUTHORIZATION RE: Property of G F 4 S S oC I i 7- �_S . _......_._ - Located at e�CZmbLC 9)) S G E Czb A� TN e 1--'�7 E_(2SONTax Map # �T Block j- _Lot i Subdivision of S U Q b 1y �s ION Subdivision Lot # _ Filed Map # `Z� �� Date Filed_ 2__2 — Gentlemen: This letter is to authorize F a" duly licensed Professional Engineer Y_ 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 "41iis 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 Cou Code. D� NEW y0g Q. �.NICHO CO < Very truly yours, 9 Countersigned. Signed: P.E., R.A., # i W 2 (Owner of Property) Mailing Address Mailing Address: C_0 u "- P_ 22 FK_: State N... Zip `���4 State ] Zip Telephone: `z6 A5 2� q —AN Telephone: Fora LA -97 DIMENSI ®N CHART (in feet) Number A L--B 1 54 48 2 63 54 3 103 98 4 151 I50 5 144 145 6 138 139 7 131 131 9 125 126 9 119 120 10 113 114 1 1 108 1 10 12 103 IOG 13 97 101 14 .91 97 15 87 9 2 16 82 9a 17 (24 140 IS 126 141 19 129 143 20 133 146 21 136 148 2z 140 151 23 144 154 24 148 156 25 153 16Z 26 159 168 i i o"10— Is o o % to a L- C.O. ftft ftw# "-,vp c C.O. oc 3 LlRrA, 4po Ll 7z. 06, • R- 17S.00 L 91.9 & = 32.02 1(0" � 5�( MG 4 gR 1'44 (zoA'V RIDGE I I j i. PROPC BRIDLE RIDGE BRIDLE IR TOWN OF PATTERSON cl-iENT JAN M 160 E. LAKE TOWN OF MAHOPAC Hari u t( A- NEEE95M COM