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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 5. -1 -19 BOX 3 ,. cr , a' 'i 0 T } r7 .} 'm f ' 111.E PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT F SEWAGE TREATMENT SYSTEM D PERMIT # o- 1-1- 00 Z' a r 6(4 l � � Located at L - :a Town or. yikl-,rg-e �2�► S m h Subdivision name Subd. Lot # _ Tax Map Block / Lot / Date Subdivision Approved T'Z —21 _- P, q Owner /Applicant, Name t! c e 13, llu c Mailing Address Zv J a 'l5- E'd v /I I Ir Dv Amount of Fee Enclosed - Renewal Revision Date of Previous Approval Zip / a, � -j Building Type j )Lot AredjgL71 No. of Bedrooms Design Flow GPD 8 00 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1 Z1;0 gallon septic tank and S_7 / Other Requirements: To be constructed by F 13 /) . Address Water Supply: Public Supply From Address or: � Private Supply Drilled by 'TJ3 0 Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date J'I -Gy —UO License # APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w nsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit proved discharge of domestic sanitary sewage only. i By: Title: Date: d 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 DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Zoe- R-r-duL� Address a& Located at (Street) ?v-�d Tax Map Block _Lot J? 0 L- - J it air (indicate nearest cross street) Municipality P-t*:wion Watershed c,. &-4"C4. -SOIL PERCOLATION TEST, DATA C) Date of Pre-soaking 11- 2�e -0 6 Date of Percolation- Test tl —2 -CI O ........ . ... . Dv 'b"I"'IN, . ..... . ef .... ......... .Time U Ae: ...... ... t 0 In. -S ....... ....... 3 —2) -3 77 2 1 -3 4 2— 2 3 -2 30 )G /Z, 3 3 33 —3:03 '30 1 0c, Y; L /2 3 4 2 3 4 ty, NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. & I min for 1.30 min/inch,:5 2 min for 31-60 iniffihnch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 BRUCE R FOLEY 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 Date: TO: �f �/j/Cr ,Alit" Re: Proposed SSTS: (T), Dear: 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: leAt;lw / ivy lat.. /4_41. c Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, Shawn Rogan SR:tn Public Health Technician sstsproposed PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PEEnRMIITf� NAME OF OWNER: STREET LOCATION: REVIEWED BY: RM, GR, AS, bATE: � TAX MAP #: (CONFIRMED) Y N DOCUMENTS (Z)C--)PERMIT APPLICATION L/-)C-JWELL PERMIT OR PWS LETTER (Z)(—)PC-97 C/ ))LETTER OF AUTHORIZATION (()(_)DESIGN DATA SHEET (DDS) l_�/)CORPORATE RESOLUTION CSHORT EAF (_))PLANS-THREE SETS ( /,(__)HOUSE PLANS - TWO SETS CSC /)VARIANCE REQUEST SUBDIVISION `"- CZ JC�LEGAL SUBDIVISION (()(_)SUBDIVISION APPROVAL CHECKED �) _)PERC RATE (!�)C_)FILL REQUIRED DEPTH C--)(_)CURTAIN DRAIN REQUIRED GENERAL (U) JLOCATED IN NYC WATERSHED ((_)PLANS SUBMITTED TO DEP (-/)(_)DELEGATED TO PCHD (_)(L)DEP APPROVAL, IF REQ'D C JL _)DEEP TEST HOLES OBSERVED ( )(_) PERCS TO BE WITNESSED (4)L_)EX- APPROVAL SSDS ADJ, LOTS (_)( /WETLANDS (TOWN/DEC PERMIT REQ'D ?) (C__JDATA ON DDS PLANS & PERMIT SAME C � JCL)PRE 1969 NEIGHBOR NOTIFICATION (_)L2 )LETTER BUZBA LU )UI00 YR. FLOOD ELEVATION W/I200' C/ )(_)SOIL TESTING LOTS >10 YEARS OLD REQUIRED DETAILS ON PLANS L/ )(_)SEWAGE SYSTEM PLAN - (NORTH ARROW) J _)SSDS HYDRAULIC PROFILE ( -)C--)GRAVITY FLOW C,XjlUCONSTRUCTION NOTES 1 -15 )(_)DESIGN DATA: PERC & DEEP RESULTS / C�2' CONTOURS EXISTING & PROPOSED (DRIVEWAY & SLOPES, CUT C-:�)C_JFOOTING /GUTTER/CURTAIN DRAINS UUUSDA SOIL TYPE BOUNDARIES (,f�C_jTTTLE BLOCK; OWNERS NAME ADDRESS . TM #, PE/RA; NAME, ADDRESS, PHONE# (UL_)DATE OF DRAWING/REVISION ()(_)DATUM REFERENCE CZJC_)LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. (% )(_)PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS ((_)WELLS & SSDS'S W/IN 200' OF SSTS (/)(_JPROPERTY METES & BOUNDS COMMENTS: (REVSHEET) Y N (REQUIRED DETAILS ON PLANS CONT'D) (/) /)HOUSE SEWER - %" FT. 4 "0'; TYPE PIPE CAST IRON (-,')C—)NO BENDS; MAX BENDS 451 W /CLEANOUT RENEWALS SITE NOTE (NO CHANGE) FILL SYSTEMS C/)(___)10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE �IFILL FILL SPECS/ FILL NOTES 1 -5 � PROFILE &DIMENSIONS (__)//)FILL IN EXPANSION AREA FILL GREATER THAN FEET ((_) CLAY BARRIER C,9(___)FILL CERTIFICATION NOTE C-nC_)DEPTH GAUGES (_)VOL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS -g�)C_)SEPARATION DISTANCE FROM TOE OF SLOPE TRENCH (r )ULF TRENCH PROVIDED 60FT MAX. C-�J(_)PARALLEL TO CONTOURS C ✓)0100% EXPANSION PROVIDED J(_)DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL L/J _)GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS (x(____)10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL UL_)20' TO FOUNDATION WALLS (Z)U100' TO WELL, 200' IN DLOD, 150' TO PITS 6!E50'TO 100' TO STREAM, WATERCOURSE, LAKE (inc. espan) CATCH BASIN, 35' STORMDRAIN, PIPED WATER C / )(_)10' TO WATER LINE (pits - 20') (Z)C-_)50' INTERMITTENT DRAINAGE COURSE 0200'/500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS CbC--)10' MIN TO LEDGE OUTCROP SEPTIC TANK C/(--)10' FROM FOUNDATION; 50' TO WELL WELL (�DIMENSIONS TO PROPERTY LINES U LJC__)LOCATION OF SERVICE CONNECTION O(_)MIN 15' TO PROPERTY LINE SLOPE - (SLOPE IN SSTS AREA 520 1/6) C_%)C__)REGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS UUPUMP PD- (_)C�DOSE 7E V /DOSE VOLUME NOTED (_)C�DETAI MAIN, (PIPE TYPE, ETC.) UUPIT ANHO & DETAILED _,C�1 DAY S ABO LARM CURTAIN DRAIN C--)C_ _)STANDPIPES, OTH S Tom - bETAIL �)C_)15' MIN to CDS=> '-4%,25'-3%,35'-l%, 100 % -<1% L�C_)20' MIN to C SC GE /100' with 182 cons day discharge C-)L j10' MIN t9fiTON- PERFORATED PIPE BRUCE R. FOLEY Public Health Director March 20, 2000 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 (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 . Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 Harry Nichols, PE 311 Clocktower Commons Brewster, New York 10509 Dear Mr. Nichols: Re: Proposed SSTS: Belluci, Bridal Ridge Road (T) Patterson, TM# 5. -1 -25 RS Lot # 8 Review of plans and other supporting documents submitted at this time relafive to the above regarded project has been completed. Comments. are offered as follows: 1. Please provide all design data for this lot. Furthermore, please note that deep test hole 43 failed as per subdivision field data. This test hole lies in the primary area. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Very truly yours, Shawn Rogan Public Health Technician SR:cj U. /3 /1-1 ote:- 'e" U ' c--? Elrsv 4z'X,RE.QU11!ED TO B-T;; ouu..f.,imm APPLICATI011 rn-;kED 1111 TE-T 110LE-3 I'TiQII ox.soij-z _3 0 1\110LEI NO. 110LE. 110. It "Po TC It ff 1.5 NO 1A) M. IDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED IDNATE LEVEL TO WILICH WATER LEVEL RISES AFTER BEING ENCOUNTERED 'STS MADE BY Date DEMON )il Rate Used buivilfDrop: S.D. Usable Area Provided of Bedrooms Septic Tank Capacity Gals. Type -)sorption Area -Tr—ovided By L.F.X24" width tren fi. Other mue Signature 1dress SEAL 1113 SPACE FOR USE By IU=fjl DEPAITV4ENT ONLY:. oil Bate Approved Sq. Ft/Gal. Checked by Date Of IVE141 rill C) 37-9 U OF ESS] 0 el N\- TEST PIT DATA REQUIRED TO BE SUBLmIT M WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES G� DEPTH HOLE NO. D ' HOLE NO. V, Z HOLE NO. G.L. l0gp1 5, 0/0q 2, 3, 41 ►- C' 51 6' 71 - i 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS EN K)UNTERED S INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING EN:JOUNTERED DEEP HOLE OBSERVATIONS MADE BY: `� `J + P(- .D DATE: DESIGN Soil Rate Used Z Min/1" Drop: S.D. Usable Area Provided 7000 s� No. of Bedroans Septic Tank Capacity �2...,..:gals. _Type Co� Absorption Area Provided By S72- L.F. x 24" ld�£Ee�t ,��P�� of NEw y i n� BA Other 3' ► I I S ZS c .Q'b P �Rp� Name A gna Q0 tUra3 , r L1,• -- ,� ;n Address THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUN'ITRED IN TEST HOLES DEPTH HOLE NO. �.� HOLE NO. HOLE NO. � G.L. mil'ao 10CLV'\ 5cwiul loam oars i 1' 2' 3' 4, o-r0e- ir CC 6' 7' - 8' 9' 10' 12' 13' 14' INDICATE LEVEL AT WHICH GROONDWATER IS ENOOUNTERED 0 N.1 INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING EN=JNTERED DEEP HOLE OBSERVATIONS MADE BY: ws!-r �G DATE: �l DESIGN .Soil, Rate Used 'Z.v Min/1 "'-Drop: S.D. Usable Area Provided 6 �� No. of Bedrooms. �' Septic Tank Capacity (2 5b gals. Type Cm, C. Absorption Area Provided By S 4 L.F. x 24" width trench .,uuuuu_`+I r eg ci i Other ,R /V 1 �-- 4- Name - - 'O " Signa Address � co' SEAL a 43 av e THIS SPACE FOR BY HEALTH DEPAR` MU ONLY: � Soil Rate Approved sq.ft /gal. checksd'by Date Harry W. Nichols Jr., RE 311 Clock Tower Commons Route 22 Brewster, NY 10509 Telephone (914) 2794003 Fax (914) 279 -4567 March 14, 2000 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS - Lot #8 Bridle Ridge Estates Bridle Ridge Road Patterson, N.Y. TM #5. -1 -19 Dear Robert, Enclosed are the following: 1. Five (5) prints of Drawing SF -8, "Fill Plan," dated 1- 31 -00. 2. One (1) print of Drawing SS -8, "Proposed SSDS," dated 1 -3 -00. 3. "Short EAF." 4. Application for Approval of Plans for a Wastewater Disposal System. 5. "Construction Permit for Sewage Disposal System," dated 2- 25 -00. 6. "Application to Construct a Water Well," dated 2- 25 -00. 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 $300.00. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, Harry W. ichols Jr., P.E. HWN: JM: his 00- 013.00 April 18, 2000 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSTS: Bridle Ridge Road, Lot #8 Town of Patterson TM# 5 -1 -19 Dear Robert: Harry W. Nichols Jr., P.E. 311 Clock Tower Commons Route 22 Brewster, NY 10509 Telephone (914) 2794003 Fax(914)279 -4567 L ND In response to your review letter dated April 12, 2000, we note the following: 1. Any trenches within 20' of the foundation have been removed. 2. Trenches have been moved 10' from DT #3. 3. Well location has been revised. 4. Entire SSTS profile is now provided. 5. SSTS profile scale is now provided. 6. 10' minimum distance is now provided. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Thank you. Very truly yours, ti S 3 i Harry W. Nichols Jr., P.E. HWN:JM:his 00- 013.00 14.16 -4 (2/87) —Text 12 PROJECT I.D. NUMBER 617.21 SEQR r Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT ISPONSO / �� 2. PROJE T NAME. 3. PROJECT LOCATION: t� Municipality >�ri e G %� County PC, f L.L" 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) 3 U-L d «l� e- 5. IS PROP SED ACTION: New ❑ Eipansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: /'y 'J 7. AMOUNT OF LAND AFFECTED: Initially 3, 97-f acres Ultimately 3, gr 7 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Z1 es ❑ No If No, describe briefly 9. WHA TJS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/ForesVOpen space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATES 0 ,JR LOCAL)? IlQ Yes El If yes, list agency(s) and permlVapprovals /0C {� �G �, 5' J 1'1. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes No if yes, list agency name and permiVapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes L�J No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant /sponsor name: ""�� �� c Date: Signature: ;C41 I if the action is In the Coastal Area, and you are a state agency, complete the I Coastal Assessment Form before proceeding with this assessment OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (ro be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by ,another involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain brlefly: 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. O C6. Long term, short term, cumulative, or other effects not identified In C1-05? Explain briefly. --= EC . C C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. C-) 1 _ 3 D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether it Is substantial, large, Important or otherwise significant. Each effect should be assessed in connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope, and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed. ❑ Check this box If you have Identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result In any significant adverse environmental Impacts AND provide on attachments as necessary, the reasons supporting this determination: Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Name of Lead Agency Date 2 Title of Responsible officer Signature of Preparer (If different from responsible officer) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 10. Has DEIS been completed and found acceptable by Lead Agency? ............... %+� .- 11. Name of Lead Agency f erg. 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? .......................................................... ............................... �s 13. If so, have plans been submitted to such authorities? ........ ............................... /Va 14. Has preliminary approval been granted by such authorities? Date granted: y .A- 15. Type of Sewage Treatment System Discharge ................. surface water r/ groundwater 16. If surface water discharge, what is the stream class designation? .................... iU 17. Waters index number (surface) ........................................... ............................... i4 18. Is project located near a public water supply system? ....... ............................... 19. If yes, name of water supply /l/�/4- Distance to water supply --- 20. Is project site near a public sewage collection or treatment system? ................ /VO 21. Name of sewage system z4 A Distance to sewage system — 22. Date test holes observed 's 8 23. Name of Health Inspector PC 4D 24. Project design flow (gallons per day) ................................. ............................... 806 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... A 0 _ 26. Has SPDES Application been submitted to local DEC office? ......................... WIA Form C -91 8/99 APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: �� 13 •e.�� b c, c 2. Name of project: —y-ao o; e-j SS j S' 3. LocatioOTV.. �� '�e,c p 4. Design Professional: P, C. 5. Address: 6. )/43co, Drainage Basin: L-,a-J 7. Type of Project: t"Private/Residential Food Service Commercial o rn Apartments Institutional Mobile Home mo° Park i T Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (.SEQR)? Type Status (check one) ....................... ............................... Type I Exempga ti o Type II Unlist 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... e) 10. Has DEIS been completed and found acceptable by Lead Agency? ............... %+� .- 11. Name of Lead Agency f erg. 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? .......................................................... ............................... �s 13. If so, have plans been submitted to such authorities? ........ ............................... /Va 14. Has preliminary approval been granted by such authorities? Date granted: y .A- 15. Type of Sewage Treatment System Discharge ................. surface water r/ groundwater 16. If surface water discharge, what is the stream class designation? .................... iU 17. Waters index number (surface) ........................................... ............................... i4 18. Is project located near a public water supply system? ....... ............................... 19. If yes, name of water supply /l/�/4- Distance to water supply --- 20. Is project site near a public sewage collection or treatment system? ................ /VO 21. Name of sewage system z4 A Distance to sewage system — 22. Date test holes observed 's 8 23. Name of Health Inspector PC 4D 24. Project design flow (gallons per day) ................................. ............................... 806 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... A 0 _ 26. Has SPDES Application been submitted to local DEC office? ......................... WIA Form C -91 8/99 2 27. Is any portion of this project located within a designated Town or State wetland? No 28. Wetlands ID Number ........................................................... ............................... 29. Is Wetlands Permit required? .......................................... ............................... /C/O Has application been made to Town or Local DEC office? ............................... NIA- 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 AJO 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 /f/0 DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... 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? . ............................... A/0 36. Tax Map ID Number .......................... ............................... Map q, Block 1 Lot ! I 37. Approved plans are to be returned to ..... Applicant i/ 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 l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class misdemeanor pursuant tc SIGNATURES & OFFICIAL TITLES: Mailing Address: .......................... ......... ON .V u J_ 1�AQr'1 C:Olil,� fY DEPARTMENT OF HEALTH DIVISIONT OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION Property of t/o Located at __.�.�.�t✓ Tax Map r', Block .! Lot Subdivision of Subdivision Lot r Filed Map 2-383 Date Filed :Z -2.1'— 8 Gentlemen: This letter is to authorize a v- Y-W (v ICJ a duly licensed Professional Enj neer or Registered Architect n to apply for the required wastewater treatment and/or water supply permits) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and'to sign all necessary papers on my behalf in connection Nvith this matter and to supervise the constriction of said wastewater treatment and/or tivater supply systems in conformity with the provisions of Article 145 and /or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Countersia ed: P.E., R. A., F _ Mailing Address Arm f- k-1- v Nicii, <�:aav- / � Q N 02 ' `r � S to :e ✓U � .._____—Z ip Very truly yours, l Sired - (0giI of Flope,: /) l o. Mailing Address: N. Y, S to to kl Zip Telephone: 6l oU Telephone: FO":: LA.9 `f 30e r PUTNAM COUNTY DEPARTMENT OF HEALTH _ DIVISION OF ENVIRONMENTAL HEALTH SERVICES �d DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address 5 *g (V&,5 r Located at (Street) 5rA 6 c coAC # Z?Z Tax Map 6— Block _� Lot _ (indicate nearest cross street) Municipality,�iT��,�j�{( Watershed.�5,� c SOIL PERCOLATION TEST DATA - Date of Pre - soaking / /Z d /©d Date of Percolation Test Zan lvu,mb: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 IIepth to Water Water From Ground Level Percoiatton Hole l�io Run No T�iueIaps_e Mart Trme Surface (Inches) Start Dro In Rate -Stop [pro) Stop Inces MtulInch ; 2 (/ 3 -'YJ r•� -30 . ., ` 4 5 2 », 13 . 1c, gs 3 :3 4 5 1 2 3 4 5 lvu,mb: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep. hole observations made by: Design Professional Name: Address: Signature: Design Professional's Seal Date 2 a �- TEST PIT DATA k 3 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 3w-/ -r 0.5' a ..z r, ., ;zz LC 1.5' 1`t% 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' Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep. hole observations made by: Design Professional Name: Address: Signature: Design Professional's Seal Date 2 a - ' PUTNAM COUNTY -= DEPARTMENT bF,fIEALTH -. DIVISIONOF ENVIRONMENTAL HEATLH_ SERVICES ' FIELD;ACTIVITY-.REPORT n r" ., w , I' AT)i RF444_} 5,!5? .! � Street Town, State k � Z 1pi PER SON IN CHARGE - '/ QR TNTFR VTp.. n �/`�I /,�' � Harp r "mil t TYPE OF FACILITY /�/lZ f iUi/ y `Y - FTNDINGS. ti. 3, m 4i Y 4 ;h a r d - N I I I % .I Ij i I i to Ia I I 1 I N 3e12 16.94 AC. CAL. 26123 31279 loan 227.10 31(13 139 D3� II t 20 8 30 291.66 _ $ 1 29.2 11.41 AC. "" EZ3T 29.1 121 AC CAL . 4.44 AC CALI 2T I+rdlo 26,93 1x19 z+a90 ?!23 306.67 21 22f2� 8 24j�, 251 / 26 '" 1.73 �C 1. e ' 25 6 '225 A; 84 AC 291 AC.'Y ` kir+i X5.10 AC. ►, At 'T3 �� 14s 161 � 3x + 7.40 AC. Isla 1.93 Ac �3 87 AC ��s1' 19 1 AL 18 n° 15 71T.6o 5.32 AC. _ : 10.24 AC. 121160 1663. 13 / 9 / 14 \1002 8 1166ae 10.84 AC. 278 At.� r , x9063 •- 12 m. s7 10.92 AC, 9 40 •AC. I I_ I° la I I =1NG CEMiPAI- SC1100L DIVRICT i j Iua fns zIO 2m3 CoffM OISiRICf I BREiISTER 1= 10 Ick- I I / 11 :0 N 20.37 AC. CAL.. 2.7 AC %i a0A0 _ 8 28.44 AC. CAL. .391 31 1.6Z, 39 401 _\ s< 8 24.36 AC. CAL. 40.70 In 43 T �11a 1'6.55 AC. CI 21L21 AC. w z.4 s+ C 11.40 1 � 6 0 = °9 I i t2 ze9AC M" 5 T47',e 7.78 AC. CAL. 4 r L .67 AC. CAL. `3 1 1.94 AC., CAL. I L ma 1¢46 ' a °zse AG 24 AC. I -- s': CALsr ��69 961.10 RECORD OF PHONE CONVERSATION DATE: ��� TIME: PERSON CALLING: ,ff -7-L PHONE #: REASON ( ) Inspection: 6 ' Deeps SCHEDULED FIELD MEETING DATE: TIME: ROAD /STREI TOWN: ?A - T TAX MAP #: .6--1 —1,9 SUBDIVISION: ,jS CZ I D G 9.. �i ;� _ LOT #: OWNER: 73 97Z- COMMENTS: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM O«,ner 13,e-11 roc Address Located at (Street) vlj I� i�w Tax Map '� , Block / Lot indicate nearest cros street) Municipality Rey Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre-soaking 1' 2-0 - oo Date of Percolation Test % - -)-cc Hole No. Run No. Time Start - Stop Ela se Time �ilIin.) Depth to Water- From Ground Surface (Inches) Start Stop Water Level Dro p In Inches Percolation Rate Nlin/Inch 1 1 IU,aa- 161:3 36 2-2.4" 2)4" 13 2 4 5 .2 1 l0?0- f -i0:i7 13 20 ,, y 3113 2 1D bc , 23, 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 rn"q 2 min for 31 -60 min/inch) All data to be submitted for review. " ' '" wd � 18&00 2. Depth measurements to be made from top of � -�S 1 1 J 1,'14 M A_tP t103 t'r�WJ Ind Form DD -97 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 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' M DESCRIPTION OF SOILTEST PIT DATA S ENCOUNTERED IN TEST HOLES HOLE NO. F��� TlaT HOLE N0. t HOLE NO. Indicate level at which groundwater is encountered f Indicate level at which mottling is observed _Q Indicate level to which water level rises after being encountered Deep hole observations made by: P Date OL- g Design Professional Name: If C Address: 0 A 1;.4 A — Signature: Design Professional's Seal Ij to �9�FESS10��� 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 wIC'(914) 278.- 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 TO: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW. DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM DELEGA TED PROJECT: _ [/�;LCP,( f ),a6t w ^ 4fy_ /(-&C"� TOWN: C SE (P) K PV DATE SUB'D APPROVAL: �- NOTICE OF COMPLETE APPLICATION DATE: Z14 4 13 9 •.� .I, . 1 • - .. `1f ~ �.� Y�= •_ -...rte tip' ` ±/� • DINING ROOM 14'11 ".X 13'1" , ,o , KITCHEN 12'2" X 13'1 " N I 'V t. ffPA r-D�.IOUSEII'7A �' M Xli f II OR BooAl CffON EMLY, " 12't' X 6'8' BEDROOMS AT T STTRgT?nt TNT it %I:SICiVi 1L`(;llt +'1':t(� +6 'ir -'SE HOUSE ' a FAMILY ROOM 19'4 "X13'1" ®Gad STUDY 137 X 13'1 " ' l Date: T0: (T) Xx Reservoir-Basin 9 �r Dear G� The Putnam County Department of Health (Department) has determinf d that the above referenced application, including fee, and rece'ved y this Department on 26y� , /5- -W is complete. The Department will noti fy y ou b y / l rb of its determinaTtion. — The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ❑ Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Dept. of Environmental Protection review and approval of other aspects of a proj ect, 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 (914) 278 -6130 ext. 2159. Very truly yours, Shawn Rogan SR:tn Public Health Technician ws2 .Harry W. Nichols Jr., P.E. Patterson Park, Suite 106' EMN 2050 Route 22 Brewster, NY 10509 Telephone (845) 2794003 Fax (845) 279 -4567 November 29, 2000 Robert Morris, P.E. Putnam County Health Department 1 Geneva Road Brewster, NY 10509 RE: Individual SSDS - Lot #8 Briiite -Mdge Estates Bridle Ridge Road Patterson, N.Y. T.M. #5. -1 -19 Dear Robert: Enclosed are the following: 1. Five (5) prints of Drawing SS -8, "Proposed SSDS," revised 11- 27 -00. 2. "Construction Permit for Sewage Disposal System," revised 11- 29 -00. 3. "Design Data Sheet," for Fill Section Percolation Tests. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, k Harry W. Nichols Jr., P.E. HWN:his 00- 013.00 PUTNAM COUNTY DEPARTMENT OF HEALTH t� DIVISION OF ENVIRONMENTAL HEALTH SERVICES e CONSTRUCTION PERMIT F GE TREATMENT SYSTEM 0 PERMIT # }�'-/ 00 ;�_�S' -�o Located at �r i - c l �c,� Town or ya9+ag—e P� / 1 ors al, Subdivision name R V11d - 9d, Subd. Lot # 8 Tax Map 5`, Block I_ Lot Date Subdivision Approved Renewal Revision Owner /Applicant Name rI o ,-, /3 r�Jlu C- i Date of Previous Approval Mailing Address 1)-6 �a " r �G �� d i-, v r ) *1�, AA /3 Zip Amount of Fee Enclosed 3 0 O �� Building Type I ' Lot Area j .077-f No. of Bedrooms Design Flow GPD 8M0 Fill Section Only Depth 31 Volume 16 5"0 PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of l 2-S--O s71 LP —rt-etiv Other Requirements: gallon septic tank and To be constructed by -1i B, 0, Address Water Sunnly: Public Supply From Address or: —L,,," Private Supply Drilled by j ,, B, f) 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 -�.5 = ® d License # &�, %24 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe t. Approv for discharge of domestic sanitary sewag By: ��TN Trtle: y l/��/� Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit Well Location: Street Ad o resss:: To �' age Tax Grid # J9 ! � 8 i c-- c /' jr.�s o�, /J. Map S ~ ►' Block ( Lot(s) % Well Owner: Name: J� ) r/v � 3 r/ t i C; t Address: [� I D-0 -(;� h5 Use of Well: Residential Public Supply Air /Con&Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought S" gpm # People Served & Est. of Daily Usage 9 6' gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling V- New Supply (new dwelling) Deepen Existing Well Detailed Reasonr� 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 �t 1 %��� �' Lot No. Water Well Contractor: ! R 0 Address: Is Public Water Supply available to site? ............:..................... ............................... Yes No Lam' �- Name of Public Water Supply: 4 Town/Village �- Distance to property from nearest water main: Af A- Proposed well location & sources of contamination to be provided on separate heet/plan. Date: ) - al �- G 0 Applicant Signature: 1�a,44" OVA PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water w driller certified by Putnam County. Date of Issue `f n Permit sui >i ial: Date of Expiration 6 L Title: V �C Permit is Non - Transfer •able White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 A > 2 > y NIF 11. F. FARMING CORP. �\ \ rl Za \\ \ \\ \ ti \ °J � Lg•btil\ \ J A � v 225.63" a F z A A •• sEO o - \ / ri266 ti�g ae e \ � m �2 ' so �Qo J �tl i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FO ' ATMENT SYSTEM PCHD CONSTRUCTION PERMIT # A >�� Located at ��� L� �1T�� (�� A Town or Village A TT E '� S�J / y Owner /Applicant Name ) QST-- R \ gEL-1 -O W Tax Map _ Block �_ Lot Formerly Mailing Address Subdivision Name Subd. Lot # 2 9SMM, Date Construction Permit Issued by PCHD / D /00 Separate Sewerage System built by ,� QS�� jCLLD CL lAddress Consisting of 1 ,�`�J Q dlon Septic Tank and ` L F T1� Other Requirements: Water Suunly: Public Supply From Address Zipa56`( or: _%� Private Supply Drilled by M U N01-U N G MC Address i 5 PUT IVA M hV E { g yP R � M� —NC p C�rfS�€ 2a�U Building T e Has erosion control been completed? � Number of Bedrooms �E Has garbage grinder been installed? IV DI 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 Department of Health. Date: O k Certified by Address P.E. R.A. License # S L 12-4 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 treatrnmt 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 subject to modification or change when, in ,the judgment of the Public Health Director, such revocei odifi ion or change is necessary. By: Title I Date: �r Whiwopy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 93.100863 CLIENT #: 13283 NON STAT PROC PAGE 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 8ELLUCCI, JOSEPH P. 53 BRIDLE RIDGE RD. PATTERSON, NY 12863 SAMPLING SITE: 53 BRIDGLE RIDGE RD. : PATTERSON, NY COL'D BY: JOSEPH BELLUCCI NOTES...: BATHROOM (UPSTAIRS) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE DATE/TIME TAKEN: 04/16/01 11:00A DATE/TIME REC'D: 04/16/01 12:50P REPORT DATE: 05/02/01 PHONE: (914)-848-3454 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4| COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L MODERATELY HARD WATER: 70-140 MG/L MG/L = MILLIGRAM PER LITER HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) SUBMITTED BY: Dir��tor . ELAP# 10323 YML ENVI ENTAL ICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: ?3.10OB63 CLIENT #: 13283 NON STAT PROC PAGE I BELLUCCI, JOSEPH P. DATE/TIME TAKEN: 04/16/01 11:00A 53 BRIDLE RIDGE RD. DATE/TIME REC'D: 04/16/01 12:50P PATTERSON, NY 12863 REPORT DATE: 05/02/01 ` PHONE: (914)-848-3454 SAMPLING SITE: 53 BRIDGLE RIDGE RD. SAMPLE TYPE..: POTABLE : PATTERSON, NY PRESERVATIVES: NONE COL'D BY: JOSEPH BELLUCCI ---' ' TEMPERATURE..: < 4C NOTES...: BATHROOM (UPSTAIRS) COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 04/11/01 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 04/16/01 LEAD (IMS) <1 ppb 0-15 ppb 9101 04/16/01 NITRATE NITROG 0.34 MG/L 0 - 10 9139 04/16/01 NITRITE NITROG <0.01 MG/L N/A 9146 04/16/01 IRON (Fe) 0.783 MG/L 0-0.3 mg/1 2037 04/16/01 MANGANESE (Mn) 0.050 MG/L 0-0.3 mg/1 2037 04/16/01 SODIUM (Na) 5.48 MG/L N/A 04/16/01 pH 6.5 UNITS 6.5-8.5 9043 04/16/01 HARDNESS,TOTAL 58.0 MG/L N/A 04/16/01 ALKALINITY (AS 32.0 MG/L N/A 04/16/01 TURBIDITY (TUR 11 NTU 0-5 NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDINB~��iTHE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, .FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for public schools are set at 15 ppb. ` EPA Lead & Copper Rule for Public Systems requires that no more than 10% of their distribution points have a LEAD value of more than 15 ppb and aCOPPER value of 1.3 mg/L, else water treatment must be undertaken to reduce the waters corrosive potential. Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium is suggested. - YML ENVIRONMENTAL SERVICES 321 Fear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovani, Director LAB #: 32.102968 CLIENT #: 13283 NON STAT PROC PAGE 1 N N N N N N N N N N N N N -------------------- N N N M N N N M M N N --------- N N N N N M N N N N N M N-------- N N N N BELLUCCI, JOSEPH P. DATE /TIME TAKEN: 05/07/01 06:30 53 BRIDLE RIDGE RD. DATE /TIME REC D: 05/07/01 09:50 PATTERSON, NY 12563 REPORT DATE: 05/11/01 PHONE: (914)-848-3454 SAMPLING SITE: SAME SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COL'D BY: JOSEPH BELLUCCI TEMPERATURE..: < 4C NOTES—: COLIFORM METH: MF N N W M M N M N N N N N -------------------- N ----- N N NNN N N N N N N N N N NNN N NNNN N N N N N N N N N N N N N NNN N DATE FLAG PROCEDURE RESULT NORMAL -- RANGE METHOD 05/07/01 IRON (Fe) 0.262 MG /L 0 -0.3 mg /1, 2037 05/07/01 TURBIDITY (TUR <1 NTU 0 -5 NTU COMMENTS: Fe /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. SUBMITTED BY: Alb Wt H. Padovani, M.T.(ASCP) Director ELAP# 10323 BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI- RN., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (914) 278.6130 Fax (914) 278.7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early " Mtervin6a (914) 278.6014 Preschool (914) 278 -6082 Fax (914) 27ff - 6648 OWNERS NAME: jO� ,5p�k BF_44"�'j TAX MAP NUMBER: G. I — m (B iA%e V-Ia4 Lai 8� E911 ADDRESS: 5S B! _IVY TOWN: PATr 0H AUTHORIZED TOWN OFFICIAL: (Signature) DATE: The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERFRM) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: BRIDLE RIDGE ROAD Town/Village: PATTERSON, NY j Tax Grid # 1 Map 25t Block l Lot(s) 8 Well Owner: Name: Address: JOSEPH BELLUCCI SAN SOUCI DR. PAWLING, NY 12564 Use of Well: 1- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary X Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock _ Other Casing Details Total length 34 ft. Length below grade 33 ft. Diameter 6 in. Weight per foot 17 lb /ft. Materials: X Steel _ Plastic _ Other Joints: _ Welded _ Threaded _ Other Seal: _ Cement grout X Bentonite Other Drive shoe: X 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 X Compressed Air Hours 6 Yield 65 gpm Depth Data Measure from land surface- static (specify R) 1) 104 During yield test(ft) 140 Depth of completed well in feet 285 Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 1 TOP SOIL 1 285 HARD SHALE If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 285 65 Pump Type L tea Capacity 9 p •, Depth P2 45— Model 5 Cro7,q -2-., Voltage 23 SHP_�_Y5A Tank Type - irA Volume 04 I Al Date Well Completed Putnam County Certification No. 2 DM(sigre 12/.8/00. !:�W12/.4/00 tau i m t;xact location of well with distances to at least two permanent landmarks to be provbded on a §eparate sheeglatf. WellDriller'sN MILL DRILLI INC. Address: 75 PUTNAM AVE. BREWSTER, NY Signature: Date: .:: 3 -o/ White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 _ Telephone (845) 2794003 Fax (845) 2794567 May 14, 2001 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road - Brewster, NY 10509 - RE: Individual SSTS Compliance Joseph Bellucci 53 Bridle Ridge Road _. Patterson T.M. - Dear Robert: - Enclosed are the following: 1. Five (5) prints of Drawing S -8, "As -Built SSTS," dated 5 -8 -01. 2. "Certificate of Construction Compliance for Sewage Disposal System, dated 5 -8 -01. 3. "Guarantee of Subsurface Sewage Disposal System," dated 5 -8 -01. 4. Laboratory Report, dated 5 -2 -01. 5. Well Log dated 12 -4 -00. 6. Application Fee in the amount of $200.00 payable to Putnam County. Health Department. 7. E -911 Compliance Form dated 5 -8 -01. If there' are any questions concerning the- enclosed, please call. = - Very truly yours, l Harry W. Nichols Jr., P.E. HWN:his 00- 013.00 A B I` GO. O co 2. O� ro 5. 5� G 9. 0 74.0, 78.0 54-0 48 0� 42-0 30. O 110.0 112. 5� I12.o 124.5 � N �9 N N N IN N N \O �l- a C7 ® N 86° 52' 5T W — 565.14 Q N 14° 22' o4' E— 195.50! i ©N 19° 0 N 15° 40 25° E — 225.65° f, Elk i = DIMENSION a CHART (in feet) ti R 1� ` Number, A B , r 2 2 Fo 5 Ea 3 3 1 O r 8' 25i G 74 .O - 5' �� •48 O _ N � _ X12 G8'° Or '3U �0r N s - 4 4 8= o 1 'I' 8 Co O r j 2 4 I rs 41 r '1 L.. ?i5u..= 5i l A W .. ... _- _.:..- .....,.:ate_..._..... „_ . a i i 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM j 0 66914 1baL4,v CC1i Owner or Purchaser of Building Building Constructed by 51b R-tinb� P-o oo Location - Street E) t i I Tax Map Block Lot P AT"r5�9 -,,0H TownNillage Subdivision Name 9 Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that 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 system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any 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 Year Signature: aLlxax, /Lfi &A-,c � Title: 4 LUM-t2 General Contffctor (Owner) - Signature Corporation Name (if corporation) Address: 4s 5AN i 5 wck 99m �%ka'� State Zip 12,56 q Corporation Name (if corporation) Address: 46 SNIT imnf DEW FWAA A State NW Y04 Zip t2s� Q- Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: 12 ii oo Inspecte y: Street Location B-R1 DL F_ 7z i O d F_ g,,4 p Owner. 8,- zi LG / Town Permit # p—/,/-d70 TM # 5 — — 9 Subdivision Lot # s "BT?,r,cE 1. Seivage System Area 'YE `NO a. STS area located as per approved plans ............................ b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. SQ System a. Septic tank ize - 1,000 .. 5 .......other ................ b. Septic tank installed level ................ ............................... _ c. 10' minimum from foundation .......... ............................... _ d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost ............... ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Bo -properly set ........... ............................... f. Trenches —Length required •a 7 / Length installed 57/ 2. Distance to watercourse measured 4 /ors 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 %" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ........................ ............................... g. PumR or Dosed Systems 1. Size ot 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.esfumated flow /cycle........... III. House/Building a. House located per approved plans ..: ................:.......:...... b. Number of bedrooms . .....................�......... .........L'" -1f. IV. Well a. Well located as per approved plans . ............................... --� b. Distance from. STS area measured 11 / ft........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ..... ............................... �. K— c. All pipes flush with inside of box... ... .. ........................... d. Backf'ill material contains stones <4" diameter .............. e. 'Curtain drain & standpipes installed according to plan.. f. Curtairi drain outfall protected & dir.to exist watercour g. Footing drains discharge away from STS area..... h. Surface water protection adequate . ............................ ::. i Frncinn rnntrnl nrnvirlPrl COMMENTS 5cr F ;/l P<,d �Neperllo� F.>:r� 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 (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 Date:—,/ ■ Fax #• 2 7q — #-5-6 7 No. Pages �2- - -- (Including cover sheet) From: Gene D. Reed Putnam County Department of Health ZFor your information Please respond For your review Attached as requested As discussed Please call NotesMessages -B&c K -rReA1,-1vim S ow4y /l Ah-5ED A BEDR 0 oM coc/e,/T W#0^1 7rzACL?"ll/ ) }CTEtV 7� FomZZAL4 IDX&zZ RA:S% 61,4G Iii} t In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 2261. 1JGV �ClJ�GrJ YJ Cr Q7J:G0 Y'1.1 MMKKT W NIUHUU`s 914 2-'19 4567 P.02 06-013, ad PUTNAM COUNTY DEPART11iENT OF ZZALTB DIMION Of ENVMONMENTAL BTALTB szxvICES ATTENTION 0 ADAM Q�6rENE FQ,ggjhjj9ljNg=10 For:. Fill All informatiaa must be 'Ay compIcted prior to say Trenches 440,� inspections being =do. PCM Cons=tioa P rtnit -d� Located: Owner /Applicant Name; R.-I(oci rif_ Lock Lot ! i'oranesly: Subdivision Name: • Subdivlsioa Lot # is systm IM complated4 Date: Is system eoauplete? Date: Is system constnicted as pet pleas? Is well drilled? Date: - Z 4-' a a Is well located as pet plaw7 Are erosion control measum in place? I cq* tbat tba sys;em(s), a.s listed, at the above prec4es has been cow=ard and I have inspected and verified their completion In accorda=e with the issued PCf D Construction Permit tad approved plans and tha Standards, Rules and Regulations of the Putnam County Department of Health. Date: Certified by; �RA LeProfessional Address: -S'rJ Or ni _ ►1�..���%- /�% 1`, Lic. # S.a l z± Co=uw. Form M-99 ' Z. PERSON IN CHARGE Naffie and Title 4" JRT 02/96. Title: ;I rr..�...•i M N,K K T W N l U M U L ti 914 279 4567 P.02 nTNAM cOVNTX DywRnzn of DEALTs DMSION Olr EMUONMEN'M B%QTR SERVICES AT'rwUON ❑ "AM pWzn $E MST MR MJAL TRARECTION For :. Fill All iatbr WWs trout be MY coMMW prior to say 7rawba iaspecsioru balms mach PCHD Co wrr oup erm* # p OwmerlAppU=M Naaae: Hoc I TM ._L_., Brock _.-L— Lot gay. SubdivWoa Noma: _, j3r.1.(,�. q Subdivlslon Lot # ..� is system im completed? ,, , Yr. 9--- Date: is sptexn complete? Date: Is "am o nsuticted as per pLas? U wen dad? Date: U wen located as pot plans? Are erosion control tueasxw in place? 3 cu* that tbo sygagsk as llsK at the above Femises has bow cam acted and 1 bave inspected and verii'ied their a mpledon In aecorduue with the .issued PCM Construction Permit sad approve4 plws sand die Standards, Rules and Reguhtlons of the Putnam County Dgautmeat of Heelth. . Duce: .1! - ` er ,_ Cwt Ad by: /YTE I/ RA .__.. . - De Profeuioml _ 1 Address: .i3t_%� .,,LOrav 7 l- , Liz. ..,4,,412 -+ Form FIR-"