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HomeMy WebLinkAbout0257DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 5. -1 -21 BOX 3 lirm IA% - . . . I � 5 6 T ' h�l L.r �1 '"� I' S-11 a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT it — l Z -� Located at & e- Ac Owner /Applicant Name t°_ Formerly deew Mailing Address Z/t; 'O Date Construction Permit Issued by PCHD Town or Village Tax Map 6- Block r Lot 0/ Subdivision Name .,9,0d/& 6eidr e 64-k S Subd. Lot # �p Zip Ibly-1115, Separate Sewerage System built by jg W GdA/ -S j Address 21f /° le 17'Ve, A!- &r ? Consisting of 1*2-50 Gallon Septic Tank and 5�9 aG Z ' GEC/)& 0kWP0J Other Requirements: <2 Sy 1I,a x & o Water Sup"I : Public Supply From Address or: Private Supply Drilled by eF L -&P ' ltvt Address ��'�7T,1 . S -wz7z Building Type 6k.&- 61" 45Y. Has erosion control been completed? Number of Bedrooms Has garbage grinder been installed? 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 L*uued PCHD Construction Permit and approved plans and the standards, rules and r e n Co partment of Health. Date: a?y/JZ00 / Certified by P.E. Peo' R.A. (Design Nofessional) Address 1f f Z—AA!!1 ALL License # O �o , --o LV 6 A-A j 60 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 ubject to modification or change when, in the judgment of the Public Health Director, such revocation, ifcatio change is necessary. By: ���i✓ Title:CCRAI Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 - BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETfA MOLINARI R.N., M.S.N. Associate Public Health Director Dire4or of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6,648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 CERTIFIED RETURNED RECEIPT REQUESTED August 28, 2001 George Badnik 42 Bridle Ridge Road Patterson NY 12563 Re: Dear Mr. Budnik: Revocation of Certificate of Construction Lompnance Budnik (P- 12 -99) 42 Bridle Ridge Road, Lot 6 (T) Patterson, TM# 5 =1 -21 On August 27, 2001, I, Robert Morris, P.E., Senior Public Health Engineer, conducted a field inspection on Lot #7 of Bridle Ridge Estates, Bridle Ridge Road, Town of Patterson. It appears that approximately 60 feet of the sewage effluent line from your septic tank to the absorption fields crosses onto Lot #7. Current Putnam County Health Codes requires that the effluent line be minimum of 10 feet to your property boundary. The as -built survey submitted with the Certificate of Construction Compliance by your engineer shows effluent pipe at 30 feet within your property boundary. This is clearly incorrect. I . - .... Therefore, based on the information noted above, please be advised that the Certificate of Construction Compliance, P- 12 -99, has been REVOKED. The following items must be addressed before this Department will consider reissuing the permit: 1) The effluent line must be relocated onto your property and be located the minimum of 10 feet within your property line. 2) A Certificate of Construction Compliance and revised as -built plans showing the actual locations of the house, septic tank, effluent line and the septic system must be submitted by the supervising design professionals, Putnam Engineering. Letter to: George Badnik - August 28, 2001 -2- Please be advised, that Lot #7 is private property and therefore, permission must be granted to go onto the property by the owner. Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130 ext. 2166. RM:tn cc: John Calbo, (T) Patterson Building Inspector Gary Tretsch, Putnam Engineering bc: Lorraine D. Xavier, Bridle Ridge Estates Very truly yours, I AOX� Robert Morris, P.E. Senior Public Health Engineer PUTNAM ENGINEERING, PLLC 4 Old Route 6 Brewster, New York 10509 Phone: 845 - 279 -6789 Fax: 845- 279 -6769 e -mail: puteng @bestweb.net TO: f7VTV Aa.• 1y- _ MT. i3 iKllYLr�S We are sending you / attached U.S. Mail, Overnight, Originals Prints Colored Prints LETTER OF TRANSMITTAL Date: f1k /o/ RE: Vpjj)ck P/E Job: 113 3 Z LINN under separate cover, the following items via Hand Delivery, Reports Photographic Exhibit Other: Pick Up: Copies Date Dw . No. Description ►u LI W. Si 04 AS 1W Plans Specifications These are transmitted: For approval _ Approved as submitted _ For your use _ Approved as noted _ As requested _ Returned for corrections _ For review /comment _ Resubmit copies for approval _ Submit — copies for distribution Remarks: 4( 4&4 S 4 � v:. _ CO Copies to: K. If enclosures are not as noted, kindly notify this office. i► �!fi u2 0 W CL Q Q LL ujQ ` W T is cc rrQ^ vJ V Z O m� O 4 .. �o o OW�w�2N WW O p� zyNO a y x cc 2 O UpO VIM jo O 3A 0 � ryh >�aV W�a�G�W id i cc W °° <�° mad y�y$i Q iH3 W lt) yail �t°aa0W 3z L_��037 II wA01 -U4yy )'a N��y a� =� Z J Qa 2iW2 �3AU Q� '�,2c h 0 r^ Fmjy §tuO W W2 vJ Wy_F " WFq �a W4F <6R3 WmU04�yog R 0�2 in h0 'WI §!'« b �y Jai Q. Gop \ \ N Vils u d A. �0 o, O Oz. S, df A. N M I O N h . C „ 0 OW V1 W� m Q2 � m 23 V jd V O WU N W� �j �O y4, 50 GALLDN �6PTIG TANK + nn � ��CC�` GRAVE •� d'ti i � /�, ✓'� C Y r0 n r r . li rS rS r� CL£A'N U 1970 ?)11 2f 26 h / 21 ' w o° 3.89•... 1 t Zti *;'•' .s... }1�� �tO �`) . • r 3.k _ Yet t Baas 3 37v {-v t 5. _i �p ? K t r': 'm .' . �� •" -.: �:, \ .: � ,.,, t:.r i� ;'.cam `L + _ i .r; ' • . �� � eft �t� .. ., _ -SC ALE,- . AS BUI -LT MEASUREMENTS N. FEAT ) 3 4: 5 ,: 6 7 8: 9' 10 11 1; 2 1,3 .1 �4 15 16 .. 17 'T 19 2 0 ; • 21 .. A N/. 112` 1.::1 �- 23 28.3:0 36Q 364 366 375 382 38� 393 3;9 8 405 411 352: 3,6,1 367 372 .. .. a. ;.. 70 335 341 3'4:7 353 3:60 366 371. 378: 383 331 340 345 352' } l l i -. - REVISIONS:,'. - . P L TN AM EN G- I -N E R N G P U 0. ' A E . D CPoP710N J 777' to SEP of E. P U . '!_ f .,0Y - �c : P, ' . "soc, • o�t g , , o , - ENGINEERS'- - ;'PLA %NNERS ; - 777 4 'OLD -: ROUTS BRMWST.ER NSW X:ORK 10508 r (84`5j 37;8 6788, FAX (845) 278 6769 -T 711 giz 777 77 SIONS V0. DAT I to SEA A440'L, , DktEfl ' 4 s • r,- X) t t SSDS.t PREP AREb . FOR ..., 9 10 11 12 13 14 15 16 17 18 19 20 21 BRIDLE 3 .24 25 26 364 366 375 382 387 393 398 405 411 352 361 367 372 37 ;9i' 385 390:396 :40 335 341 347 353 360 366" 371 8 37383 331 340 345 352 i 35t37y 363 ::369 375 38;3 SIONS V0. DAT I to SEA A440'L, , DktEfl ' 4 w5 7 V, t:.� �( Y}q1 ryi x�� t! _if � �� �t �t z � T K ��• ) 5S3h {. J -1 •~ i Imo, }ak)SJ � V N i Tth )r t y � r ) s • r,- X) t t SSDS.t PREP AREb . FOR ..., BUDNI`K BRIDLE .RIDGE,ESTATES LOT #fi s BRIDLE RIpGE TOAD , f'ATTERON tat t l f w5 7 V, t:.� �( Y}q1 ryi x�� t! _if � �� �t �t z � T K ��• ) 5S3h {. J -1 •~ i Imo, }ak)SJ � V N i Tth )r t y � r ) 09/06/2001 12:51 FAX 845 2796769 PUTNAM ENGINEERING @002/003 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION ❑ ADAM GENE AEQUEST EQR FINAL INSRECTION For: Fill All information must be fully completed prior to any inspections being made. Trenches Ufiwe . 65 l cV%r-,V L,✓bsl-iL- Gam' PCFID Construction Permit # P— /�2 Located: `f Z 13iewL44' OVI a 4/ AP Owner /Applicant Name: T� V D u 1 cam, TM Block Lot Formerly: Subdivision Name: ge4nr /Z,rn 664 Subdivision Lot # Is system fill completed? Is system complete? Is system constructed as per plans? Is well drilled? Is well located as per plans? Are erosion control measures in place? Date: Date: Date: I certify that the systems), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of -t a Putnam County Department of Health. —� — Date: Certified bye Design Pr essional Address: Lic. # Comments: Form FIR -99 09/06/2001 12:52 FAX 845 2796769 \ s d? 0.9 N ti .. '••.58'6£! ME ••. Ix SSA.. � �,• ..� 1� a \+ .4 vok w � �c •o �r 1 /0001' ova c � r� PUT-NAM ENGINEERING Af I I / Y/ 1 ; � • a oy y I I 1►. ►�I; i /101, / looe de 100 O � Z'' O Q003/003 O 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 CERTIFIED RETURNED RECEIPT REQUESTED George Badnik 42 Bridle Ridge Road Patterson NY 12563 I Dear Mr. Budnik: August 28, 2001 Revocation of Certificate of Construction Compliance Budnik (P- 12 -99) 42 Bridle Ridge Road, Lot 6 (T) Patterson; TM# 5 -1 -21 On August 27, 2001, I, Robert Morris, P.E., Senior Public Health Engineer, conducted a field inspection on Lot #7 of Bridle Ridge Estates, Bridle Ridge Road, Town of Patterson. It appears that approximately 60 feet of the sewage effluent line from your septic tank to the absorption fields crosses onto Lot #7. Current Putnam County Health Codes requires that the effluent line be minimum of 10 feet to your property boundary. The as-built survey submitted with the Certificate of Construction Compliance by your engineer shows effluent pipe at 30 feet within your property boundary. This is clearly incorrect. Therefore, based on the information noted above, please be advised that the Certificate of Construction Compliance, P- 12 -99, has been REVOKED. The following items must be addressed before this Department will consider reissuing the permit: 1) The effluent line must be relocated onto your property and be located the minimum of 10 feet within your property line. 2) A Certificate of Construction Compliance and revised as -built plans showing the actual locations of the house, septic tank, effluent line and the septic system must be submitted by the supervising design professionals, Putnam Engineering. Letter to: George Badnik - August 28, 2001 -2- Please be advised, that Lot #7 is private property and therefore, permission must be granted to go onto the property by the owner. Should you have any. questions or care to discuss this matter, please contact me at (845) 278 -6130 ext. 2166. Very truly yours, Robert Morris, P.E. Senior Public Health Engineer RM:tn cc: John Calbo, (T) Patterson Building Inspector Gary Tretsch, Putnam Engineering 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 CERTIFIED RETURNED RECEIPT REQUESTED George Badnik 42 Bridle Ridge Road Patterson NY 12563 Dear Mr. Budnik: August 28, 2001 W1 Re: Revocation of Certificate of Construction Compliance Budnik (P- 12 -99) 42 Bridle Ridge Road, Lot 6 (T) Patterson, TM# 5 -1 -21 On August 27, 2001, I, Robert Morris, P.E., Senior Public Health Engineer, conducted a field inspection on Lot #7 of Bridle Ridge Estates, Bridle Ridge Road, Town of Patterson. It appears that approximately 60 feet of the sewage effluent line from your septic tank to the absorption fields crosses onto Lot #7. Current Putnam County Health Codes requires that the effluent line be minimum of 10 feet to your property boundary. The as -built survey submitted with the Certificate of Construction Compliance by your engineer shows effluent pipe at 30 feet within your'propertj boundary. This is clearly incorrect. Therefore, based on the information noted above, please be advised that the Certificate of Construction Compliance, P- 12 -99, has been REVOKED. The following items must be addressed before this Department will consider reissuing the permit: 1) The effluent line must be relocated onto your property and be located the minimum of 10 feet within your property line. 2) A Certificate of Construction Compliance and revised as -built plans showing the actual locations of the house, septic tank, effluent line and the septic system must be submitted by the supervising design professionals, Putnam Engineering. l Letter to: George Badnik - August 28, 2001 S0A Please be advised, that Lot 47 is private property and therefore, permission must be granted to go onto the property by the owner. Should you have any questions or care to discuss this matter, please contact me at (845) 27&6130 ext. 2166. RM:tn cc: John Calbo, (T) Patterson Building Inspector Gary Tretsch, Putnam Engineering bc: Lorraine D. Xavier, Bridle Ridge Estates Very truly yours, hwl /U,,� Robert Morris, P.E. Senior Public Health Engineer BRIDLE RIDGE ESTATES CIO Brewster Business Park 1944 Route 22 Brewster, New York 10509 (845) 279 -6111 (845) 279 -7410 August 24, 200 Mr. Rob rt Morris Putn County Board of Health 1 Ge va Road Bre ster, New York 10509 Mr. Morris: losed is the .survey showing lot #7 border line and Mr. Budnick's waste on lot #7 property. Please call if you have any questions. Very truly yours, BRIDLE RIDGE ESTATES rraine D. Xavier L :nc Enclosure NO.- TYPE• CODE#: YES INFORMATION FOR REQUEST FOR SERVICE Complainant: NAME: 011-v � STREET: lgfl.. dd TOWN: PuL� i%- PHONE: Violator (Name): Violator Address: Problem: /v (No anonymous request) ro Telepbone: i Directions: Taken By: Referred to: Date: ''J-24 (1) COWLFRM Complaint Information Log # 439 -01 -22 Complaint Recieved August 21, 2001 Received By: Foley, Bruce Assigned To: Morris, Rob Complainant (Person Making Complaint) — First: LORRAINE Last: XAVIER Phone: 845 - 279 -6111. Address: BRIDLE RIDGE EST. City: PATTERSON State: NY Zip: Source of Complaint Source: BUBNICK Associated Facility/Operation Address: BRIDLE RIDGE EST. Phone: - - Facility Address: Location: PATTERSON Operation Type: Residential Sanitation Sub LHU: Category: Indiv Household Sewage Treatment System Risk Level: Complaint Nature of Complaint Date Complaint Health Concern Status Needs Investigation .Resolved Description: ActionTaken: VIER LIVING IN HOUSE WITHOUT CO. MAY OR MAYNOT HAVE CO FROM US. Page 1 of,1 Date Printed August 21, 2001 NO.: CODEN: TYPE: YES INFORMATION FOR REQUEST FOR SERVICE Complainant: NAME: STREET: TOWN: P� �—+ PHONE: 9 q L l 1 , ink L f (No anonymous request) Violator (Name): 12Uv v ro i,c-b Violator Address: r '/ Telephone: Problem: /V Directions: Taken By: ""vp Cp Referred to: P Date: '2-t (ID 1 IL CONTURM vim^ I-x (da�-6,- o "-4- CO Gv� i S-L I.,- / 0 OOIV7 j-'ej O,te4 -PUP - - - -- - - -------------- - - - - -- - -- - - - - - - - -- A-4 Aw 'ScM1rlMMsftA1M7MI IAA: 1MiM1MIMSM(MIM;AALMIMSMRIMONM". I 1 11M1MIMIIIAI IVhwJ.VAA[MSM!IIb.HAiMIMt. _fMIMRM:AATMZM�MSM7M °M?M5M C (, ® .►. />r` as � • ?� ( livtil Y/ b /Y1yI"'iY'i111%[ "(y'IIl1/fW£I!Y - .1y11t L I/ i/ t1/ 11[ IiliCH11t"I WYiHF( 11 1i711 1% iVY7yyGyy; ww" r"ll/ yf" It oliyli/ Ii: YVSK11ti /Y1H111Hi/2iiliiWlVli(V11F IVS�/ySH111111/:NYEV1/� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR TMENT SYSTEM PCHD CONSTRUCTION PERMIT # 1p" / 2 '- q I - 0 Located at 2— 'zozz- aec,5- amo Town or Village p rT��2sc�N Owner /Applicant Name 6_ 6W _ 6�JDA)l Af Tax Map .5, Block / Lot 2-1 Formerly �mr' 840-141r- Subdivision Name Bogwc �ZzKr_- Subd. Lot # Mailing Address S_ �d i 4US� /2D �r�+?E'�"c S' 61 Zip /0 S4 Date Construction Permit Issued by PCHD Separate Sewerage System built by Address Consisting of 12-50 Gallon Septic Tank and 50¢ 6-F off' GtliQE 4faw rrl"o Other Requirements: 046 16WT Co .60 'AI.14:c avAcC ©%SJ4- 0' 77diy &K W646r-Ca- Water Supply: Public Supply From Address a or:_ Private Supply Drilled by , Address ¢tivT /V3 451_27e Building Type D► AVI Has erosion control been completed? Number of Bedrooms Has garbage grinder been installed? /V0 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 Cry Department of Health. Date: O Certified by P.E. V" R.A. (Design Professional) Address QG'�V'. �illGl�% �� iNG-, ,�'r && License # 06 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 approva?1n,difi subject to modification or change when, in the judgment of the Public Health Director, such revocatica or cha nge is necessary. By: Title: �/ I Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 V it UTNAM NEINEERING Pic. Engineers and Architects SEPTIC SUBMISSION FORM TO: A&'-fl Al/Y/ /r AC- DATE: 3 PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: (f -e�ll�i��c��e ENCLOSED, PLEASE FIND: .4—COPIES OF THE SSDS PLAN �tCC, T ❑ 2 COPIES OF THE HOUSE PLANS CONSTRUCTION jT APPLICATION Lt's' WELL g TION HEALTH DEPARTMENT FEE ($� 13 101 REMARKS: LETTER OF EXPLAINATION COPIES TO: 6j oYz� t'_ SIGNED: A� A 4 Oro RouTE 6, BREWSTER, NEW YORK 10509 • (845) 279 -6789 • Fax (845) 279 -6769 • EMAIL: puteng @bestweb.net PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: 42 Bridle Ridge Rd, Lot #6. Town/Village: Patterson Tax Grid # Map 5^__ Block j Lot(s) Well Owner: Name: Address: George Budnik, P. 0. Box 367, 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 X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 21 ft. Length below grade 20 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: X Steel Plastic Other Joints: _ Welded X Threaded Other Seal: X Cement grout _ Bentonite Other Drive shoe: X Yes No Liner: Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed X Pumped X Compressed Air Hours 6 Yield 15 gpm Depth Data Measure from land surface- static (specify ft) 30' During yield test(ft) 240' Depth of completed well in feet 325' 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 3 Drillinc in over urden clay and boulders 3 Hit rocii at 3' 3 21 Drillinc in rock set casincf, arouted 21 325 Drillinc in rock granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity lOgpin Depth 260' Model 10GS10412 Voltage 230 HP 1 Tank Type Vol e Date Well Completed 7/11/88 Putnam County Certification No. 002 Date of Report 3/29/01 Well dl a iV V i r:: Exact location of well wttn aistances Zweast two permanent ianamarxs to De provic��a on a separate snccvpIM1. Well Driller's Name P. S nc. Address: 4 Pttnarn Ave., Brewster,NY 101509 Signature: Date: 3/29/01 Perry L. al White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 NE LABS NORTHEAST LABORATORY of DANBURY 39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404 (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 REPORT TO: P.F. BEAL & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 SAMPLE SITE: SANIFLE POINT: SOURCE: TREATMENT: LABORATORY REPORT DATE SAMPLE COLLECTED: TIME COLLECTED: COLLECTED BY: DATE RECEIVED @ LAB: TESTED BY: LAB LD.# REPORT DATE: J. BUDNIK, 42 BRYDAL RIDGE RD, PATTERSON, N.Y. KITC =v WELL NOTSTATED TEST PERFORMED RESULTS METHOD # BACTERIAL: • Total Coliform (Bacteria) 0 per 100 ml SM 9222B PHYSICALS: • Color (Apparent) 1 0 - EPA 110.2 • Odor ND - - • pH 5.73 - EPA 150.1 • Turbidity 0.27 NTUs EPA 180.1 CHEMISTRY: • Nitrite Nitrogen <0.005 mg/L as N EPA 354.1 • Nitrate Nitrogen 10.8 mg/L as N SM 4500D • Alkalinity 13.0 mg/L SM 2320B • Hardness 78.0 mg/L EPA 130.2 • Iron 0.050 mg/L EPA 236.1 • Manganese <0.01 mg/L EPA 243.1 • Sodium 5.3 mg/L EPA 273.1 • Lead <0.001 mg/L EPA 239.2 3/15/2001 3:00 P.M. P.F. BEAL 3/15/2001 LAB# 11471 PFB035 3/16/2001 MAXIMUM CONTAMINANT LEVEL (MCL) OR STANDARD 0 per 100 ml 15 3 Units No designated limits 5 NTUs 1.0 mg/L 10 mg/L No defined limits No defined limits 0.30 mg/L 0.50 mg/L Combined limit for Iron plus Manganese = 0.50mg/L 20.0 mg/L ** 0.015 mg/L * ** ml= milliliter mg/L= milligrams per Liter ND =none detected MCI-- Maximum Contaminant Level TNTC =Too Numerous To Count * *Notification Level * "Action Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: X❑ OTABLE or ff-711NOT POTABLE RESULTS BASED ON SAMPLES SUBMITTED: Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 APR -03 -01 02:26 PM TOWN OF PATTERSON 9148782019 v91'UZ /ZUU1 11:19 FAX 846 2798769 PUTNAM ENGINEERING BRUCE R. FOLEY Public Reallb Dlrrelor DEPART NMNT OF HEALTH I Geneva Road Brewster, New York 10509 P. 02 IM 002/002 LORETTA MOLINAM R.N., M.S.N. Atsociale Public 9#911h Director Dbwear qj AWeal SwWcdj Environmental He■llb (414)271 -6130 Fix(914) 278.7921 Nursing Servitei (914) 278.6558 WIC (914)271 -6673 Fax (914) 272 - 6483 Emir Intervention (914) 278.60:4 Fratchool (914) 278 -6082 fax (914) 278.6648 OWNERS NAME; TAX MAP NUMBER: E911 ADDIOCSS: W is : i► 0:lt TOWN: AUTHORIZED TOWN OFFICIAL: G� (Signature) DATE: The Putnam County Department of Health Nvill not Issue A Certificate of Construction Compliance unless the above forth 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. X911 VERFlt2vt) PUT NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAG9 TREATMENT SYSTEM to ro T. Owner or Purchaser of BbAlding Tax Map Block Lot (SLrjr ( C'L.. Building Coridtructed by Location - Street i Building Type T0.T4- rr" Town/Village &�'j �t-e V2 aj Fcjv-� Subdivision Name 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 ne, Day c-),. Year aiw General Contractor (Owner) - Signature Corporation Name (if corporation) Address: Z `Z � ca e._ r State Zip Signature: ;a�"> 3a,Zjam�� $ryli Title: Owni.� ?.�ri�u s . Corporation Name (if corporation) Address: ft)aje _W, s%sn, State N 1-A Zip 1 =S�r33 Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: /a ii o0 Inspecte y: c, Zo Street Location _Fxj tic r- 7?, nG o 7cc7A h Owner 13vD,11/r Town Permit 4 P- 12 - of TM s -1 - Subdivision Lot 4 4 "3rr,nLE trjogg sr.' 1. Sewa re Systein Area YES N0 COMMENTS a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................. ... II. Sewage Svstem a. :Septic tank size - 1,000 ��1,2550....other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. Alt outlets at same elevation -water tested ................. 2. Protected below frost ................. ............................... - 3. Minimum 2 ft.Original soil between box & trenches e. Junction B x - properly set ........... ............................... f. Trenches 1. ngt required _ o o Length installed S oy ` K l 2. -- Distance to watercourse measured + too 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 .................. �- t 2l� 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 1 %Z" diameter clean .................... r 1 7. v 9. Depth of gravel in trench 12" minimum ................... 1 / N S-Z 10. Pipe ends capped ......................................................... t g. PumR or Dosed Systems 1. Size o pump chamber tt 11 !L . ................ ............................... 2. Overflow tank ............................................................ 3. -Alarm, visual/ audio ................................................... - IQ 4. Pump easily accessible, manhole to grade ................. = - 5. box baffled ......................... _First 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Building i9 /fe4rs ekk, a .Houscated per approved plans ....................... - - - - br Number.:of bedrooms 1- a.-JVell located as per approved plans...... --� ......................... b. Distance from. STS area measured 4- ft ........... c Casing 18 above grade .... ............. _ �" - _ -'� dSurface drainage around well acceptable:.:...,...... V. Overall Workmanship , RrG� vii er coast rum— .sv 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_protedtion adequate: :... .............. ..... i. Erosion control provided ................................................ - �- - — -- -� - O O 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 /.2- //ZOle, d Date: 1;7- A/ /O� To • ?WuL L }ih/G!f i From: Gene D. Reed Putnam County Department of Health ' For your information. For your review As discussed ■ Fax #: X79 -6767 No. Pages (Including cover sheet) Please respond Attached as requested Please call Notes/Messages O. K, 7-0 73 A-C K r-1 L G In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 2261. L FROM PUTNAM ENGINEERING PLLC PHONE NO. : 914 225 2955 Dec. 08 2000 01:26PM P1 d PUTNAM COUN'T'Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES REMjES I FOR FINAL INSPECTION For: Fill. Trenches X PCHD Construction Permit # Located 6010�� Rf or. Rwa r� (T) (V) — .04rbao%4 Owner /Applicant Name JiJn/i!<. TM .S� Block / Lot a 1 Formerly /3Vprw !e- Subdivision Name _ 1.�2tOL� Subdivision Lot # �o Is system 511 completed? Date Is system complete ? Date / 2 Is system constructed as per plans? �I-7-Ir Is well drilled? Date Is well located as per plans? Ae Are erosion control measures in place? Y I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion 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: 1 8 0 Certified by: PERA Design Profess10 Address pUtrwr" Lic. # 4 d4 r?..ez b �jL[�sJ3r'Z-'L Comments: FOR. 0 ADAM KGENE Form FIR-99 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: 1;2- j / //O d To: ?WuL L Zn/C)* $Rarer- - Tzii)4 E From: Gene D. Reed Putnam County Department of Health jFor your information For your review As discussed Fax #: 279-6767 No. Pages (Including cover sheet) - - Please respond Attached as requested Please call Notes/Messages O. 3 A-C lc G! L G COil.�E✓t/TS � fit'�RoilF_ 17 Zo�.�T /oN. S /GT —S5A6CF- fii15 A107— NEF-A/ / O Gcn,,y, �.1'lT5 73 ST7�� it/�E27 To �� In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 2261. r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL � HEALTH SERVICES CONSTRUCTION PERMIT FOR SEW GE TREATMENT SYSTEM PERMIT Located at l 17th 12t l Town or Village,} Subdivision name BfrlZ ZP66 i�--STSubd. Lot # (D Date Subdivision Approved Tax Map _ Block I Lot Renewal Revision Owner /Applicant Name F7u DN 1 k–" Date of Previous Approval Mailing Address 4G S`T (4EHeu5e -PD Sorn.*fZS N1 Zip I 05 Amount of Fee Enclosed * -CZ) a" Building Type 51 N6 LF PA*f ILY Lot Area S•D910 No. of Bedrooms 4— Design Flow GPDJ� Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1"2-5D gallon septic tank and 1�0q L-. F. oIF2! Other Requirements: eL- FAA40l t?-15 l0 �ja lam[ .( . S� VVE jM430 --RCV4 '1" N K 1 /F3ptErL5-: To be constructed by 1-0 $ C j? F q,- i cV4E DAddress Water Sunaly: Public Supply From Address or: C Private Supply Drilled by M –6C-- VE7E -2 c 1 ?,l e-C> 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 treatments stem 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 sysem or any repairs thereto. _ Silted: + ° P.E. '>– R.A. Date ln7f TJ FkM E INL-i AdJress I PL-Le -, ( i CA prn E t- tJ y I h5 1 ':;i- License # G�Ca-7q (e AP ?ROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the seNnge treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or molified when nsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a nrw permi . roved f ischarge of domestic sanitary sewage only. By; Title: Date: lZ r W6te copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 Na Y U TN AM L O U N "1T Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 1 DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner L&T- ' /14 l Address /J& Located at (Street) F_(I � J DbAp Tax Map Block Lot 2 (indicate nearest cross street) Municipality Drainage Basin VAST _3 C+4 SOIL PERCOLATION TEST DATA Date of Pre - soaking DCP `01 q Date of Percolation Test Hole No. Run No. Time Start - Stop Ela se Time Min.) Depth to Water rom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 2 1 Ila.og - 0Y.38> r 2 10'• 1- /I Dq -30 2-3 2_6 Z" 15 3 ", 2 ZA. 1� 4 5 721 1 [7:11 -/ �,7.g /-7 3 w,.g -r- t 4 li og- tI :-ZA�' 1 Zi '- ��� 3�� 5 1 2 3 4- 5 NOTES: I. Tests to be repeated at same depth until approximately equal percolation rates are obtained at eacn percolation test hole. (i.e. s 1 min for 1 -30 min/inch, < 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 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' 1 r•� 1 ri I UAJ A DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. .- HOLE NO. ' 2- -, . �,- M-1Tb P� C771 HOLE NO. Z4: Indicate level at which groundwater is encountered `/z Indicate level at which mottling is observed /V/A Indicate level to which water level rises after being encountered Deep hole observations made by: k.Ek� p Date (-0&Z qq Design Professional Name: pPcTMpM gE j Address: 7 .z wd Signature: ,, A , , _ l ALMOO �d �rVll?d 03/I13P3bi esign Professional's Seal b PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL �j please print or type PCHD Permit # --/1) _ 0 —fl Well Location: Street Address: Town/Village Tax Grid # 5F LP LC-- ?IMF- 1?&AT,7 Map Gj Block Lot(s) Z Well Owner: Name: T3 u,D " i Address: sro aUsr-- R soM er'-c L o 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 SoughtMIA15 gpm # People Served k Est. of Daily Usage _06�Og al. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling K New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type _ C Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No X Is well located in a realty subdivision? ...................................... ............................... Yeses No Name of subdivision -0 P- 10 [.-E l 21 DG E S I ,AT S Lot No. Co Water Well Contractor:: (j -OF, -47�- t - P_.h-i i N ED Address: Is Public Water Supply available to site? .................................. ............................... Yes No X, Name of Public Water Supply: tJIA Town/Village Distance to property from nearest water main: n-i i 1-e. Proposed well location & sources of contamination to be prov'd o alsheet/plan. Date: :&-21 Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED_ FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue 12 q Permit Issui Official: Date of Expiration / Title: Permit is Non - Transfer able 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 E\ti'IRO\,IENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SENVAGE TREATMENT SYSTEMS /Q REVIEW SHEET FOR CONSTRUCTION PER.Nlrr Q a / STREET LOCATION J�i +c�.C2 n' �°' ' NAME OF OWNER l� Lt.(J� 11- REN'TEWED Bl' RBI, GR, AS, NIB, B $ K AT TAX MAP 9 Y N DOCUMENTS Y N / PERMIT APPLICATION PC -1- Pc q7 WELL PERMIT _ PWS LETTER LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) f CORPORATE RESOLUTION / SHORT EAF PLANS - THREE SETS HOUSE PLANS - TWO SETS / VARIANCE REQUEST FEE SUBDIVISION /!> % S/o tZ LEGAL SUBDMSION r SUBDIVISION APPROVAL CHECKED PER RATE FILL REQUIRED /,5- DEPTH CURTAIN DRAIN, REQUIRED STANDPIPES GENERAL EROSION CONTROL:HOUSE,WELL, SSDS PERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY & EXPANSION LOCATION MAP EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE PiJZIPED, PIT & D BOX SHOWN & DETAILED HOUSE -NO.OF BEDROOMS WELLS & SSDS'S WAN 200' OF PROPOSED SYS. PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER -1/4" FT. 4 "0; TYPE PIPE NO BENDS; MAX.BENDS 45° W /CLEANOUT FILL SYSTEMS 1CLAY BARRIER FILL SPEC FILL FILL CERTIFI TE E & DIMENSIONS / LOCATED N NYC WATERSHED =OLU`SE PLANS SUBMITTED TO DEP I I IFILL IN EXPANSION AREA DELEGATED TO PCHD TRENCH �y � / DEP APPROVAL, IF REQ'D LF TRENCH PROVIDED�'! 60 FT MAX. DEEP TEST HOLES OBSERVED / PARALLEL TO CONTOURS 100% EXPANS IONPROVIDED PERCS TO BE WINESSED / EX- APPROVAL SSDS ADJ. LOTS SEPARATION DISTANCES SPECIFIED / WETLANDS (TOWN/DEC PERMIT REQ'D ?) ON PLAN -FRONT SSTS . r DATA ON DDS PLANS & PERMIT SAME / 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL PRE 1969 NEIGHBOR NOTIFICATION 20' TO FOUNDATION WALLS _15 -WELL TO PL / LETTER BIVLBA 100' TO WELL, 200' N DLOD,150' PITS 100 YR. FLOOD ELEVATION 100' TO STREAM WATERCOURSE LAKE (inc. expan) OTHER REQ'D PERMITS) / 50' TO CATCH BASIN, 35' STORMDRAN, PIPED WATER REQUIRED DETAILS ON PLANS / 10' TO WATERLINE (pits -20') � SEWAGE SYSTEM PLAN,-(NORTH ARROPn l 50' INTERMITTENT DRAINAGE COURSE Lt_LjSSDS HYDRAULIC PROFILE '/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS GRAVITY FLOW ,2D % CONSTRUCTION NOTES IIN to CDS= >5 %JW- 4 %,25'- 3 %,30'- 2 %,35' -1 %,100' - <I% DESIGN DATA: PERC & DEEP RESULTS 20',IIN to CD discharge /100'with' 182 cons day discharge 2' CONTOURS EXISTNG & PROPOSED SEPTIC TANK / DRIVEWAY & SLOPES, CUT m 10' FROM FOUNDATI TO WELL ` / FOOTNG /GUTTER/CURTANDRAINS WELL• �►+�la --a- SO[LTYPE BOUNDARIES I l£NS10NS TO PROPERTY jD TITLE BLOCK; OWNERS NAME,ADDRESS LO CONNECTION TMn,PE/RA; NAIvtE,ADDRESS,PHONE'� DATE OF DRAWING/REVISION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET PROPOSED FINISH FLOOR AND BASEMENT EL. %J 74'//7'v v S ke� l4W pA �� CO.lI11ENTS: /V e_ S - "` rU'I'NAM 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: -kLog- ;k -bCr20ri-lY K- g-'C� TOr-Jt5'140vsr-- R. o 2. Name of project: I K SSb5 3. Location TN: 'P,4 rreTZ!!;� 4. Design Professional: P AM F-P4G 1E GAddress: 1 o -:�- &-� L- e—N1 f-,: t (-->A A 0 E- 6. Drainage. Basin: F � ` d 4 7. Type of Project: X Private/Residential Food Service Apartments Institutional Office Building Realty Subdivision Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type. 11 Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... Iq 0 10. Has DEIS been completed and found acceptable by Lead Agency? ............... Y-014- 11. Name of Lead Agency Yzzi 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? .................... ... /qo 13. If so, have plans been submitted to such authorities? ........ .............. .................. N A 14. Has preliminary approval been granted by such authorities? Date granted: Ly 15. Type of Sewage Treatment System Discharge ................. surface water groundwater 16. If surface water discharge, what is the stream class designation? .................... f� �- 17. Waters index number (surface) ........................................... ............................... ti1 18. Is project located near a public water supply system? ....... ............................... N L�� 19. If yes, name of water supply -f"� Distance�o water`supp'�y k 20. Is project site near a public sewage collection or treatment system? ................ 21. Name of sewage system �� Distance to sewage system 22. Date test holes observed L'40-z&R19 23. Name of Health Inspector JAI C tr �,GK- 24. Project design flow (gallons per day) ................................. ............................... eeno 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... A] � 26. Has SPDES Application been submitted to local DEC office? ......................... 6 A- n-` -. -- -- 2 27. Is any portion of this project located within a designated Town or State wetland? 28. Wetlands ID Number ........................................................... ............................... f,4 29. Is Wetlands Permit required? .............................................. ............................... NO Has application been made to Town or Local DEC office? ............................... N/A 30. Does project require a DEC Stream Disturbance Permit? .. ............................... /VD 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 active Yes/No 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 A10 DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... 0 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? . ............................... /y 36. Tax Map ID Number .......................... ............................... Map S Block_ Lot Z 37. Approved plans are to be returned to ..... Applicant X_ Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the 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 dais form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to SIGNATURES & OFFICIAL TITLES.- Nd IENnr66 Mailing Address: ', L��.AR.:.. o.3A1303 G � 92-y✓1 � t� v�! Y l O�1 Z FROM : PUTNAM ENGINEERING PLLC PHONE NO. : 914 225 2955 May. 11 1999 11:01AM P3 R111NAM COUNTY DEPARTMENT OF HEALTH Date 5> 1c /9 q RE: property of 1.Z -C) Ja 1 Located at ('Town) Ptr IMS m`'ii-! "-mction t--> Block Lot Subdivision of 122&10 i l� 1 � I C.-!'s- -g-', n . = '� 's Subdv. Lot # . C_„0 Filed Map # 95<9 3 Date j O Gentlemen': This letter is to authorize PU'TNAM ENGINEERING PLLC, a duly licensed professional engineer to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulgated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the lth Law, and the Putnam County Sanitary Code. OF NE;V Countersigned: 'nom • �t �sF 0 8 7446 P.E., R..A.., # �. 7l17 �lp.,.�:.a� 0��rnnP Carmal NY 1(151 ?. Address 914- 225.3060 Telephone Very truly yours, Sign 1 —� O �r f Property q t-1. &- " . - - -* ro. 1 IV i Telephone 14 -16.4 (2/87) —Text 12 PROJECT I.D. NUMBER 617.21 SEOR 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 /SPONSOR 2. PROJECT NAME 3. PROJECT LOCATION: Municipality County 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) 5. IS PROPOSED ACTION: Z New ❑ Expansion ❑ Modification /alteration p� 6. DESCRIBE PROJECT BRIEFLY: LL► C 1 1 hI ,4/�l ,0+�'i �� — 'brLk,'E7 1;704. i 510 7. AMOUNT OF LAND AFFECTED: �' © ` Initially Co CA —5j—(!)7 —acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Ryes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? 12-Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ❑ Yes 9No It yes, list agency(s) and permlUapprovals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? 11 Yes �l No If yes, list agency name and permitlapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑ Yes No I CERTIFY THAT TH RMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant /sponsor n�mee -=� —�" �' u Date: Signature: If the action is in the Coastal Area, and you.:are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER r ti G uti COmpiel8.- uy rigency) A. DOES ACTION EXCEED ANY TYPE 1 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 briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intenslty of use of land or other natural resources? Explain briefly to . C5. Growth, subsequent development, or related activities likely to be induced.by the proposed action? Explain briefly. rn G r1a _CIF IF C6. Long term, short term, cumulative, or other effects not identified in C1-05? Explain briefly. "C7 C! ifs C:.. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. x-� Cif cat 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: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agencv Signature of Preparer (it different from responsible officer) Date K Up Arm NEINEERINEPLLC. Englneers and Planners SEPTIC SUBMISSION FORM TO: Ko� DATE 2`J PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: E U 13 FQ jS2.iDL-r— gipt:�,Es govc) -"M� ENCLOSED, PLEASE FIND: )s( 5 COPIES OF THE SSDS PLAN u COPIES TO: 2 COPIES OF THE HOUSE PLANS CONSTRUCTION PERMIT APPLICATION WELL PERMIT APPLICATION HEALTH DEPARTMENT FEE ($ 500 -) SHORT EAF DESIGN DATA FORM. LETTER OF AUTHORIZATION APPLICATION FOR WASTEWATER TREATMENT (PC -97) LETTER OF EXPLAINATION SIGNED:" 102 GLENEIDA AVENUE, CARMEL, NEW YORK 10512 • PHONE (914)225 -3060• FAX (914) 225 -2955 6. It 1/2' I'- 2 3 4' 5 1/2' (- 15'- 4 3/4' --1 I- -3 1/2' 13'- 4' 1 C1'- 6'� 2'- B' I'- B 3/4' 1'- 2' 4'- 2' r __-- - -_ -'i t'____ ____ __ _ __ ___ -- T` i�t1' -51/4' 48' 0' COUNTY DEP- kRTIIFNT OF FMA IS APPROIYED FOR BY: BLS UNT ONLY; TO THE BEST OF MY KNOWLEDOE,BELIEF NO PROFESSIONAL JUDMMFNT Ms .. /•, Q X174 a & Tl- Dat- ATTACHED B' MALLS NOTES: PROJ NO: 97 -097 BY: BLS 1. 2.6 EM I OR WALLS 124' O.C. TO THE BEST OF MY KNOWLEDOE,BELIEF NO PROFESSIONAL JUDMMFNT D BY: 13, S 2. B' -0'CEILINGS. I. THIS FACTORY MNAIFACTIFED HOME (FNH) PLAN HAS BEEN APPROVED .REVERSED WILLIAMSBl1RC 3. ANDERSEN WINDOWS. FROM A SYSTEM SET OF FNH PLANS PREVIOUSLY APPROVED BY NY. D.O.S., LEVEL: 6,7 4. 7/12 TRUSS ROOF / 16-O.C. APPROVAL NO. HO 361- 96-010, EXPIRATION DATE 03 -19 -99 RATER TEAT. 5. TER BA 5. WHICH FIRS NOT BEEN MODIFIED IN ANY MANNER. RATING NATO FLOOR JOISTS WILL BE FLOOR 1 3/4' LARGER: THM FLOOR JOISTS. --------------------------- 2. THE ENERGY PORTION OF THIS FNH PLAN HAS BEEN PREPARED USING PMT ® R \�Jj jjll�� \ \�IIj ®JS SEE SHT. 1U OF SUB-SET. 5 OF THE NEW YORK STATE ENERGY CONSERVATION CM61IMT10N CODE JS V 7. 24 O.C. INTERIOR WALLS. (ENERGY CODE) AND IS IN FULL CO0'LIANCE WITH THE DUZY COOE. HOMES CC)RMR TMN B. HASCOR FLOOR JOISTS. PO BOA 27, AIRFW RD, SELINSGROVE. PA 17870 Ill 374 -4004 I- BOD- 798-4754 k CONFIRMATION OF 0 BUILDERS SIGNATURE DATE: Ci11 FLITED JUL 0 3 1997 SPEC. PROJ NO: 97 -097 BY: BLS DATE: 05 -14 -97 DISK NO: 1214 D BY: 13, S JDATE: _ STATE: NY. .REVERSED WILLIAMSBl1RC SCALE: 3/16* =1' - IC: SECOND STORY FLOOR PLAN LEVEL: 6,7 9'- 1 1/2' B'- 2 1/4' 7'- 7 t/2' - 1. THIS FACTORY MANJFACTINED HOME (FIH) PLAN HAS BEEN APPROVED - -- -- -- ---- --- -- - -- - - -- •f'1/2- MATTLINE BY gj� 7'- 3 3/4• 12'- 0 1/4' PLYWOOD OMISSION '- 0 1/2• 10'- 2• WHICH HAS NOT BEEN MODIFIED IN ANY 900. 0 M 1P is E T E D JUL 0 3 ., . 'r.. LEC. jo VILL 6. FLOOR MATING JOISTS HILL BE 13 13'- 2 3/4• DROP 13' 0 1/4' PREJULED 13' BATH 3/{' JISE — 7. 24' O.C. INTERIOR WALLS. 1p1:f- 2A ZPG Q R.O. 59 3/4 t A G B. NAM FLOOR JOISTS. 13 FILL PO BOX 27, AIRPORT IRO, SELINSGROVE, PA 17670 ' 717 374 -4004 1-000- 786 - +754 137 1/4' 1 r--- —� 3610 10.10 OMIT I -� I BREAKFAST OR Pt — 6 — NOOK e1e es+ w $ _� az4 tp_ sir 3' MAIN VENT 111 C' I II) I 3- RMBi R.O. 67���7 1/{'H 2' FUTURE �C= T — — — — � � lo' o' UTILITY e I/4' OMIT Ist BAY OF GYPSUM I F,�� I — — — _ FOR LIRE DROP--,,_ — —, 6' 9 314' 1 1 OADr +' a' crosa ' I KITCHEN 7'- 5 In. I (� OMIT cm (3) SLPPOHI� — — — — — — — STUDS PER MODULE 2' 0' (2ND FUR. SUPPORT) o FAMILY — ROOM 836 3. a•r DINING ui 0. 40.11 : ROOM 41 3 /4'H 1 to FILL WALL 15'- 13/4' I I, ' " 1 1/2' FILL 4'- 6' iO IO S' 0" I e' 6'• 8'- 11 3/4' I 0 t /4' 4' O' 4'- 0 1/4' B'- 3 3µ4'f 6'- 3 3/404''- HIGH MALLS �. 9'- 1 1/2' 4'- 5' 21- 10' - 15'- 3 3/4' - 1. THIS FACTORY MANJFACTINED HOME (FIH) PLAN HAS BEEN APPROVED - -- -- -- ---- --- -- - -- - - -- •f'1/2- MATTLINE BY gj� 4. 7/12 TR15S ROOF 1 16.O.C. APPROVAL NO. NO 361- 96-010, EXPIRATION DATE 03 -19 -99 PLYWOOD OMISSION SCALE: 3/16NY' 48' 0' WHICH HAS NOT BEEN MODIFIED IN ANY 900. 0 M 1P is E T E D JUL 0 3 ., . 'r.. VILL 6. FLOOR MATING JOISTS HILL BE 13'- 6 1/4• 13'- 2 3/4• i 3/4' LARGER THAN FLOOR JOISTS. LARGE 13' 0 1/4' PREJULED 13' 7 3/4' 7'- 1 1/2' JISE .d if 7. 24' O.C. INTERIOR WALLS. (ENERGY CODE) AND IS IN FULL COMFLIAIEE WITH TI[ ENERGY CODE. R.O. 59 3/4 t A G B. NAM FLOOR JOISTS. PO BOX 27, AIRPORT IRO, SELINSGROVE, PA 17670 ' 717 374 -4004 1-000- 786 - +754 137 1/4' 3610 10.10 1030 C? 1W:1 ID SPf /I e1e es+ w $ _� az4 tp_ sir �' 3- RMBi R.O. 67���7 1/{'H 24174, L � — WME - - -� KITCHEN gW (� OMIT cm i. I- 836 3. a•r DINING 213 ELEC ROOM FILL WALL " 1 1/2' FILL 4'- 6' REFER eat rOMIT 46_--- — — — — — — — — ulc acao I I PANTRI' FLR: (6) 1.5. 19.25'N.L. ` c❑ i 51WPORT STIA)S PER IpgAE _ _(4) — — — — — - (3) SUPPORT SIM PER MME 0 5 11/2' .� (3) SI mT 1-TED IL SnD5 PER M0D1E ". (218 RR. SUPPORT) LIVING li PLH , I CO's ROOM ENTRY It 11 II 13' 3• 17'- 6 1/4• 1nM:2 -2 uc a ® 1O 1 O IB' 6• 12 �_ l0' 6• I B' 6• I S' 0• 6' 2' 6' 2' 3' 1' 8' 1 1/2' 8' 1 t/2' CINDER 11. 2.6 EXTERIOR CALLS 1 24' O.C. 'TO THE BEST OF MY KNOILEDCE,BELIEF AND PROFESSIONAL JUDGEMENT 2. 8' -0'CEILINCS. 1. THIS FACTORY MANJFACTINED HOME (FIH) PLAN HAS BEEN APPROVED DRAWN BY: BLS 3. ANDERSEN tV6 .. FROM A SYSTEM SET OF FNH PLANS PREVIOUSLY APPROVED BY NY. D.O.S., BY gj� 4. 7/12 TR15S ROOF 1 16.O.C. APPROVAL NO. NO 361- 96-010, EXPIRATION DATE 03 -19 -99 MODEL REVERSED WILLEIAMSBURG SCALE: 3/16NY' 5. HOT WATER BAMARD HEAT. WHICH HAS NOT BEEN MODIFIED IN ANY 900. 0 M 1P is E T E D JUL 0 3 ., . 'r.. VILL 6. FLOOR MATING JOISTS HILL BE - ------------ __-- ---- -- -BEEN----- - -- - -- S7 i 3/4' LARGER THAN FLOOR JOISTS. LARGE PORTION OF THIS FMH PLAN HAS BEEN PAEPARED 2. THE FT✓HE CO PART it \ \VR \fS� SEE SRI. IIA OF 518 -SET. N W VA ON 5 OF THE NEW Ypl( STATE ENERGY CONSERVATION C0161R1CTION WOE JISE .d if 7. 24' O.C. INTERIOR WALLS. (ENERGY CODE) AND IS IN FULL COMFLIAIEE WITH TI[ ENERGY CODE. EIDRillES CC)RpORATM B. NAM FLOOR JOISTS. PO BOX 27, AIRPORT IRO, SELINSGROVE, PA 17670 717 374 -4004 1-000- 786 - +754 cF 51Ct1 &RETURN A: CONFIRMAT BUILDERS SIGNATURE DATE: BUILDER: CLIENT: SPEC. PRDJ NO: 97 -097 DRAWN BY: BLS DATE: 05 -14 -97 DISK N0: 1214 BY gj� -n7-q7 STATE: MODEL REVERSED WILLEIAMSBURG SCALE: 3/16NY' DRAWINC: FIRST STORY FLOOR PLAN LEVEL: 1,2 0 M 1P is E T E D JUL 0 3 ., . 'r.. 2•x10• P WOGD Uman BOLTED I TO TO S 7URE SEE DECK DETAIL x ' 48 AT THE BELO BOTTOM To BE ry � A MIN. 48' BELOW I O✓H:lE/ID LL'a01lS FINISFHED fTYP) Ll 4• VIA. x 326• THK, STEEL COLUMN, PRECAST NEW. GONG..LINTS. / SFILLED KKTH OW— A RE� TO i ABOVE WIN=m (71T) ---- GONG FOOTING (SEE COLUMN DETAIL, 3/8' TYPE -X Wr. C". ABOVE STEP Ancm*6.AI� I I I ?. mwam C Ari SpA ( TO 2x4' STUD WALL • 16. O.G. OVER }Z6F( FROM ENT ("y PAGL' TO 25x4• P.T. SILL PLATE. INSULATE B�'�•�T f71T') BETYAMN STUDS WITH 4' FIEURSLASS UNFINISHED BASEMENT BATT I'B'L. PROVIDE "• TYPE--x u I 1 I AYVLSPAGE i I MHI$ATEDI GYP. BD. • EACM SIDE GR F 24'-0' 24' -0• 2 GAR GARAGE I II NOf>d IF BAS&CW 15 TO BE O C40W.. SLAB OVER HEATED, OWNCIV6.G. SHALL. PITCH SLAB Z• 6•MI� VAPOR BARRIHi 2'-6' PROVIDE 2' R1610 INSULATION x IOVER 4' COMPACTED ROB. BOARD ^40 MIN) UNDER THE TOWARDS O.H. DOORS I I GRAVEL BASE �H DING► TION 2' -0• MIN. \ L F— GENTBtLINE OF PREJ•UWrAGTUiED ' I I HOME ABOVE W IZ x 45 STL BEAM W/ BRACING AT W IZ x 45 STL. BEAM W/ BRAGIN6 AT _ — y W 12x43 STL !'�/yi ►y/ BRACING AT j J _ I I -9' OG. MAX BOLTED TO STRUCTURE A W S' -TOG. MAX BOLTED TO STRUG7UR BpV jI I 5 O.G. MAX BOLTED TO STRUCTURE ABOVE Z' -0' x 2'-8' GRAM-SPACE (4) MS VERT. REBAR UNDER BEARING UF• ACCESS DOOR I PLATE f rm) I I 6'xl2•xl/2• TMC'JTL BEAppo KATE KTH (2, 1/2' VIA. xIr Lip ANCHOR BOLTS OVER 1/2• I ` THK. NON - SHRINK EPDXY SETTING BED. I I \ PROVIDE 6- 1/Zyd2- V2'xI2• DEEP BEAM 8' POURED GONG. FNDN. WALL INTERIOR STAIRS BY OWtfi!F/6.G. GONG 6. L �P) I I —� OVER 8'n x 16•w REINF. VERIFY LOCATION IN FIELD PRIOR TO POURED WWI. FOOTING (YYP \ FABRICATION INSTALL 2 LAYERS OP S/8" TYPE -X I AT GRAN�SPAGE ONLY, I I GYP. BD.. UIHDER' IVE OF STAIRS ; 8'x16' A0.WTABLE �'� I EAPOSED IN GARAGE I F I CRAWLS SCREEN E VENT WITH I I bxb q OVER b MIL TM STEP SLAB 6' ENT11fL' LENGTH OF Lo INSECT SCREEN (7YP) POLY VAPOR BARRIER OVER 4' PARTITION p I I I I COMPACTED R 0.8. 6RAVEi BASE POURED GONG. "CW- WALL OVER 9' -0'xb' -0' SELF CLOSING FIRE REINF. POUT® GONG. FOOTING. SEE RATED STEEL DOOR (B- LABEL) i BAGKPILL SGHtXXLE FOR SIZE (TYP. I I STEP N6 AND FOUNDATION r IV,2H CRAWLSPACE TO 2"x10' P.T. WOOD LED&M BOLTED TO -- IL STRUCTURE. SEE DECK DETAIL fCL OF STEPS O A EIRI WITH N y OF ENTRY DOOR. VERIFY IN ry O —(S) Z'xtO' P.T. WOOD BEAM GOVT. FIELD BY 6.0 /OH"B R j P.T. WOOD STEPS WITH / L _f L LINE OF PRESSURE TREATED HANDRAIL AT EACH SIDE WOOD PORCH ABOVE IR�6— 5 ..b °r : -y0OD °OST 4Tr4GHFD . QECIU ... DO RAVE AS .L PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner K Address Located at (Street), (� ► � t-7 k' T) Tax Map Block Lot _ (indicate nearest cross street) Municipality -,I9 Watershed SOIL PERCOLATION TEST DATA Date of Pre-so aking % / � / % Date of Percolation Test . ......... ............ ..... ............... ..... ......... Depth to Water '4%Vater No TatueIa se'Time ` Tom: Gaud F r a .Surface (Inches) ev L el trap In Percola on ti Rats Hole No Rnn Mart Stop:..:.; ,.bn) Start Stop Inches Mn/Inch 1 late' G 2 j� 3 11,` 9 -70 _ rE C l S 4 5 10; 1', 10;�'3 �- 2 l)f� /0 :Y-' 17 3 10IN 7 i 1: 07 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 min/inch, s 2 min for 31 -60 min/inch) All data to be t 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. T HOLE NO. HOLE NO. �s / ao , 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 t Date i m Street Name and Title TYPE' OF FACILITY OWL_ R, �--- ®. ,.. fi i` d FtNDINGS s <r 66 +4 Al _ .t'.: f -, Pte„ � iaff.. c. IL � §• �' - i Signature and Title RFPnRT RFC''F.TyPn Ry. _ /-- I acknowledge receipt of this report: ° SIGNATURE; ' 02/96 Title; Rev. FOR ADJOINING AREA SEE HAGSTROWS DUTCHESS COUNTY ATLAS MAP NO.39 e (' R v HILL \ RD OJ U COUNTY PUTNAM COUNTY ! 2 1 �9p 8 'q0 Q Kok m s4 BY0 r OP Fxr 1 4 Et t - IN /,yD ',�t'kTi �'ij^l'�i�• ...f �.k��1 v•e.NS�'�M -�� i P °A x Granberry Mdun ta►n fManagement `W►ldl►fe ' y �r p Area cc r Lu 12563 -" POD � °OX �`.I� V IC ` i; m Y m im RD I i i IVII� f uj DR U. �- Hollow N C ILL ;m9 9'V R; yA--- - XENIA Y v m oO O [ 6J O - Z PE H 2¢ Eon YOUNG o p 9 a m O IN PO DEN d R NILES. �� I ° O 1 P Q KEN �9p ES D 4P I fah r� ZN� I T0nUWU ER Zt ROM "f ZO E 9 CO .,On °,1 O s m I RD ZaLRC An I D O 0 Z C) . a m� D x D <7 Cn a O .N D A m m 0 y N 0 1 I �I WI PAWL I NG. DUTCHESS CO. PUTNAM CO. _ 31 I 03 j J 267.+1 181.10 16.94 AC. CAL. A c r ARE j .' /. s 31 I3 31279 10$67 227.10 19303 287.0E L 200 •- \..��IL-•jam. •\ - 291.l6 G' �° 29.2 � f �'.� $ 11.41 AC. 'a = 37 5.2r 09zT 29.1 d 1 AC CAL 58.44 AC. 29 4a III flIPt3Gt9 , zu 4.44 AC CAL. C 203.00 t+e7 27 2223 S 24 26 251 / 26 x ' �' • ; ' • -2 25 AC. a ? : u 2 56 ' 1.73 AC. 1.84 AC 139 .6 71 2.91 AC... sa x• 1 qAG w .k �a 5.10 AC-� ` AC. 99 1391.11 CL- 2°'' .tea 1� *'� 16• p • N 219 AC..� 9 1.39 -- ti � // � 1.93 AC, 7.40 I6a i 40 i3 � 18 $ p 1:' AC. is V3.87 AC. `O A • X1.97 6`P 5`18 710.19 AL 323.83 I 3 ,6114 a s � 15 � I zr76o 5.32 AC. �1 --= 10.24 AC. . .121360 1963 e^ r- ' r" �. >< \ L-tflBS %\ .. 13 / / 14 \lxoz 8 a \4 11sc0e 10.84 AC. 278 AC.� « / f _ 24.36 AC. CAL. I 12 ' 4+oo (I' 1 +53 10.92 AC. {ts roso o ras ror3u B e 178$ 19 191.14 I 9 •AC. 0-- II H 42 40 20.37 AC. CALK. 2.79 R o 40.70 AC. CAL. 0 I %L ROAO ' sctl s IOr1i30 588.29 i. 4r� n m y 43 0 16. �7B 16.55 AC. CAL) m7 8 - ' z 2.59 °+'� �c 28.44 AC. CAL. tir.21 AC. o I� o . ..a•° ,...s, f T. - - -_ -- ° 1•.�e 216 _.. 6 a 9 • : S ° I 7.89AC � PAWLING CDm. SCHOOL. DI STRICT 5 ' 161.01 IB12 21SCH ams 13 2m3 717,8 7.78 AC. CAL. J��r !l ' I BREWSTER I ICT CENTRAL SCHOOL DISTRICT � s 4 +O(51 •� 960A 7.67 AC. CAL.}` _ _ .,�• 3 17 la 11.94 AC. CAL. Ikt9 45 I a a 3710 tom .1 46 • � 92.77 AC. AC.. 3 8 3 s5CAL' I 961.10 a� ��+- L 0 RECORD OF PHONE CONVERSATION DATE: /� zu TIME: PERSON CALLING: 1<e" NUYI y PHONE #: REASON ( ) Inspection• eeps nd /or eres: SCHEDULED FIELD MEETING I::-r-e -6,ejk DATE: TIME: ROAD /STREF TOWN: P,4E / TAX MAP #: SUBDIVISION:y', `f errs dr C� COMMENTS: LOT #: BRUCE R. FOLEY Public Health Director Paul M. Lynch Putnam Engineering 102 Gleneida Avenue Carmel NY 10512 Dear Mr. Lynch: 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 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 RE: Budnik, Bridle Ridge Road Bridle Ridge Estates, Lot #6 (T) Patterson, TM# 5.4-21 Reservoir Basin East Branch July 9, 1999 The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on July 6, 1999 is complete. The Department will notify you by July 26, 1999 of its determination. ® The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ❑ Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Dept. of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation Letter to: Paul M. Lynch - July 9, 1999 -2- 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