Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0261
DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 5. -1 -25 BOX 3 ,yam � -� , 6 L I kP A 00070 j ' PUTNAM COUNTY DEPARTMENT OF HEALTH 4170 DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FO EWA SYSTEM PERMIT y Located at Subdivision name a bile - 4j, ,+ Subd. Lot # 2- Date Subdivision Approved / —pi q Owner /Applicant Name c� � h �3 � �I QC I Mailing Address :..dam Town or V�14ge Ae. �vs c Tax Map a 5�; Block 1' Lot - 7– Renewal Revision Date of Previous Approval Zip 12,M+ c� Amount of Fee Enclosed -3 G o Building Type ficj,_.J Lot Area 1,-73k -.No. of Bedrooms Design Flow GPD 6,0 G Fill Section Only P/ Depth 3•,s Volume. PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLE ED Separate Sewerage System to consist of 16 o 6 gallon septic tank and Cg Other Requirements: To be constructed by I /3 /) Address Water Supply: Public Supply From Address or: L,,- Private Supply Drilled by 7-6 I) 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 S 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. T Signed: N,�4 P.E. R.A. Date �L -2-S" -00 Address i C- 4 To wiYP– C 10VA0 h DANG 1410 License # �6 l Z"f APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. pprov for discharge of domestic sanitary sewage onlykhl, . % By: Title: ( `'V 4A Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 i [V1lFI 1 f:r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # / Q (I Well Location: Street Address: Town/Village Tax Grid # 61-1.01te— /(!, y Map q-, Block J Lot(s)2 -�' Well Owner: Na)ame: Address: I j� /I r1CI�h U'JtVC'j (�-a set -S Jow) j� ' A/ -1we- 2w /t �. Use of Well: i-- Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought EY gpm # People Served S Est. of Daily Usage �,k_gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling /New Supply (new dwelling) Deepen Existing Well Detailed Reason f� p for Drilling Well Type 1/Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? .......ii .............. .............. ............................... Yeses No Name of subdivision 13 r- dr Lot No. Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: /u A- Town/Village �- Distance to property from nearest water main: Jd! . Proposed well location & sources of contamination to be provided on separate s eet/plan. Date: Applicant Signature: L 11 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 11 driller certified by Putnam County. Date of Issue xlo Permit I ui ici . Date of Expirati o L Title:✓ Permit is Non-Transferialble White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 _ I .,I I -- .. _� Imo— �� ...+ I.� _- 1 i •J ' + 1 I : © I °1:11 /4 © . � i• Ifol•lo�L PUTNAM COUNT' DEPARTMENT OF HEALTH .MOUSE PLANS APPi,O['rD FOR I:EI3r001{i COUNT ONLY, ----- -____ BEDROO ,IS ' T TON` TO THESE H OUSE PCDOI-I FOR APPROVAL DATE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: cJ 411 a I y c J .l 2. Name of project: Pi-,, P, <J 5-5--%S 3. Locatlor6N: Aj�— 4. Design Professional: Lt vve -f '7c, PCS. Address: 6. Drainage Basin: LL A 81-1al" 6.4 7. Type of Project: Z Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 14/'0 10. Has DEIS been completed and found acceptable by Lead Agency? ............... X//4 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... 13. If so, have plans been submitted to such authorities? ........ ............................... Ato 14. Has preliminary approval been granted by such authorities? Date granted: NO 15. Type of Sewage Treatment System Discharge ................. surface water groundwater 16. If surface water discharge, what is the stream class designation? .................... /+ 17. Waters index number (surface) ........... ............................... . 18. Is project located near a public water supply system? ....... ............................... '/y1-1 19. If yes, name of water supply ./U A Distance to water supply -- 20. Is project site near a public sewage collection or treatment system? ................ iV,.. 21. Name of sewage system 1U )A- Distance to sewage system '- 22. Date test holes observed 0- 23. Name of Health Inspector PC 41) 24. Project design fl ow (gallons per day) ................................. ............................... Lea 6 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... /I/ a 26. Has SPDES Application been submitted to local DEC office? ......................... N4 Form PC -97 8/99 2 27. Is any portion of this project located within a designated Town or State wetland? 28. Wetlands ID Number ........................................................... ............................... 29. Is Wetlands Permit required? .................................................. :.......................... /V,� Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ............................... 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No 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 /t%a DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... z 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... 35. Are any sewage treatment areas in excess of 15% slope? . ............................... �%✓ 36. Tax Map ID Number .......................... ............................... Map G', Block_ Lot :2- �- 37. Approved plans are to be returned to ..... Applicant 4.,'- 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 A misdemeanor pursuant tc SIGNATURES & OFFICIAL TITLES: 0 Mailing AA: ............. Nnjoj 14 01 f)d 14.16 -4 (2/87) —Text 12 PROJECT I.D. NUMBER 61741 SEQR Appendix C State Environmental Ouallty Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT (SPONSOR // ►7c�, 2. PROJECT NAME. 5` 3. PROJECT LOCATION: Municipality PI.. Aso' County 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) 5. IS PROP ED ACTION: New ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially /,%3 acres Ultimately %1, acres B. WILL P OPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? esidential ❑ 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 ❑ No If yes, list agency(s) and permit/approvals Pc 1TD I awe G vpc' l�w!SoL-) �r (�� �, • � ��. 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes om If yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes o L I CERTIFY THAT THE INFORyM�ATION ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE / /PROVIDED ( G r -'U G Applicant /sponsor name: 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 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. C6. Long term, short term, cumulative, or other effects not identified In C1-05? Explain briefly. a. G C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. -_r i;a ..p -1w C, r n D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? GO ❑ Yes ❑ No If Yes, explain briefly C7"< • � CJZ' 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 Agency Signature of Preparer (if different from responsible officer) Date 2 Harry W. Nichols Jr., P.E. 311 Clocktower Commons Route 22 MA Brewster, NY 10509 Telephone (914) 279 -4003 March 14, 2000 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS - Lot #2 Bridle Ridge Estates Bridle Ridge Road Patterson, N.Y. TM #5. -1 -25 Dear Robert, Enclosed are the following: 1. Five (5) prints of Drawing SF -2, "Fill Plan," dated 1- 31 -00. 2. One (1) print of Drawing SS -2, "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 )11" chols Jr., P.E. HWN: JM: his 00- 014.00 PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER:.? ��'A STREET LOCATION: REVIEWED BY: RM, OR, AS, ATE: TAX MAP =: (CONFIRhfED) Y N DOCUMENTS (/(__)PERMTT APPLICATION /)WELL PERMIT OR PWS LETTER (%UUPC -97 ( /))LETTER OF AUTHORIZATION (/,L_)DESIGN DATA SHEET (DDS) (_)CORPORATE RESOLUTION C_6C__)SHORT EAF ((_)PLANS -THREE SETS LJ(____)HOUSE PLANS - TWO SETS C_)(__BVARIANCE REQUEST SUBDIVISION ((_)LEGAL SUBDMSION (.,/)LJSUBDIVISION APPROVAL CHECKED CZ_)(_)PERC RATE 60 (,(_)FILL REQUIRED ✓' —, 37' DEPTH a VJL_)CURTAIN DRAIN REQUIRED 34t GENERALI` L_)L_)LOCATED IN NYC WATERSHED � C__)PLANS SUBMITTED TO DEP 2(_)DELEGATED TO PCHD L_)L/)DEP APPROVAL, IF REQ'D (4)L_)DEEP TEST HOLES OBSERVED (1)L_)PERCS TO BE WITNESSED UUEX- APPROVAL SSDS ADJ, LOTS CZ)L_)WETLANDS (TOWN/DEC PERMIT REQ'D ?) (f�(__)DATA ON DDS PLANS & PERMIT SAME Lam( )PRE 1969 NEIGHBOR NOTIFICATION L_) LETTER BI/ZBA L�100 YR. FLOOD ELEVATION W/I200' ( _)SOIL TESTING LOTS >10 YEARS OLD REQUIRED DETAILS ON PLANS ( J(__)SEWAGE SYSTEM PLAN - (NORTH ARROW) (Qe)L_)SSDS HYDRAULIC PROFILE (vL,GRAVITY FLOW (_/) _CONSTRUCTION NOTES 1 -15 (Z)L _)DESIGN DATA: PERC & DEEP RESULTS ()(_)2' CONTOURS EXISTING & PROPOSED (_!!�)L)DRIVEWAY & SLOPES, CUT C /,(FOOTING /GUTTER/CURTAIN DRAINS CZ)L,USDA SOIL TYPE BOUNDARIES (Z(__)TITLE BLOCK; OWNERS NAME ADDRESS TM#, PE/RA; NAME, ADDRESS, PHONE# (_/)L_)DATE OF DRAWING/REVISION (/)(_)DATUM REFERENCE (Z)L_)LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P. L. (v )PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS (�L_)WELLS & SSDS'S W/IN 200' OF SSTS ((_)PROPERTY METES & BOUNDS 707kniTuf "20 (REVSHEET) Y N (REQUIRED DETAILS ON PLANS CONT'D) U( U)(__) 8-EEIt�7" F1` "0'; TYPE PIPE CAST IRON JIE S;S;'I Y�E 45° W /CLEANOUT RENEWALS: SITE NOTE (NO CHANGE) FILL SYSTEMS (zj(--)10' HORIZONI•AL; PAST TRENCH SLOPES 3:1 TO GRADE (JLJFILL SPECS / FILL NOTES 1 -5 (_Z) __)FILL PROFILE & DIMENSIONS (,f )UFILL IN EXPANSION AREA FILL GREA TER TA.4 N 2 FEET L/�(_j CLAY BARRIER (/)(__)FILL CERTIFICATION NOTE OL _)DEPTH GAUGES E/ )LJVOL. ON PLAN FOR R. O.B., UNCLASSIFIED & IMPERVIOUS (_ZJL_)SEPARATION DISTANCE FROM TOE OF SLOPE TRENCH 9 (_tj( JLF TRENCH PROVIDED in 60FT MAX. (__)PARALLEL TO CONTOURS (Z)L—)100% EXPANSION PROVIDED (_4)L )DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL C_t_)L_)GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS C_Jj j 10' TO P.L AY;`LARGE TREES, TOP OF T�LI1 U %% �0' WALLS L_) 00' TOs: ' j ' IN DLOD, 150' TO PTIS ( �� A1�I, WATERCOURSE, LAKE (inc. upan) V)Lj50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER (,�LJ10' TO WATER LINE (pits — 20') ( _J50' INTERMITTENT DRAINAGE COURSE 0200' /500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS UU10' MIN TO LEDGE OUTCROP SEPTIC TANK (/J(___)10' FROM FOUNDATION; 50' TO WELL WELL C_)UDIMENSIONS TO PROPERTY LINES (Z)( _)LOCATION OF SERVICE CONNECTION ((_)MIN 15' TO PROPERTY LINE SLOPE L /�(�SLOPE Pt SSTS AREA `f %� (S20 %) L _)(/REGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS (_)(PUMP NOTE UUDOSE 75% OF P LUME/DOSE VOLUME NOTED (� )DETAIL FOR FO IN (PIPE TYPE, ETC.) UUPIT AND D -BO HO RETAILED UUl DAY STORAGE ABOVE ALARM CURTAIN DRAIN UUSTANDPIPES, 5' BOTH SIDES, DETAIL ( JLJ15' MIN to CDS =>5 %, 20'-•I %, 25' -3 %, 35' -1 %,100 % -<l% (ZJL_)20' MIN to CD DISCHARGE /100' with 182 cons day discharge (j/)LJ10' MIN to NON - PERFORATED PIPE 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 March 20, 2000 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: Belluci, Bridal Ridge Road, Lot #2 (T) Patterson, TM# 5. -1 -25 Reservoir Basin - East Branch The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on March 15; 2000 is complete. The Department will notify you by April 4, 2000 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 Department of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. . Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans 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. 215.9. Very truly yours, awn Rogan Public Health Technician SR:cj 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 Re: Proposed SSTS: Belluci, Bridal Ridge Road (T) Patterson, TM# 5. -1 -25 RS Lot #2 Dear Mr. Nichols: Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department of Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. 1. Provide a junction box at the 90° bend above the first junction box. 2. Provide for and label the separation distance from the toe of the slope to the property line, driveway and foundation. 3. The proposed well is within 100 feet of the absorption 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 �(�j(��+� «�-a U I'A I x .u,�,ra rc a lti��t� .l' OF HE 4LTH Dx . J.. IONI OF ENVIRONMENTAL HEALTH SERVICES RE: Propeny of LETTER OF AUTHORIZATION Located TX ��.�t r � Tax Map # Block _ Lot ;Z S— Subdivision of Subdivision Lot r 2 Filed Map �_ Date Filed Gentlemen: This letter is to authorize IJ , I a duly- licensed Professional Engineer _ or Registered Architect 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 with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity <<<ith the pro"risions of Aric;le 145 and /or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Countersio ed: P.E., R.A., r _ Mailing Addres }� e- e, "" Zip 1( Sd Telephone: .,-7 g - 4!:" , Very C . Sipe Mailing Address: C,6 &" S�� /r �rrve Stage, Zip_ 12S"6 `f Telephone: FO.— LA.9 r CHO& ' I BRUCE R FOLEY Public Health Director. TO: 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)278-61 30 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 DEPARTMENT OF ENGI \EERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM DELEGATED v TOWN: C SE J�* PV DATE SUB'D APPROVAL:, NOTICE OF COMPLETE APPLICATION DATE: l�" Date: T0: /�Iyq. //1 G Nd L,5 i Dear Reservoir Basin The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and r ceived by this Department on XM) /3' .� is complete. The Department will notify you b, l'i 24n 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 aproject, 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 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEAL'T'H SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner � ��� ' Address �0 n Located at (Street) - �' Tax Map �T,_ Block_ Lot Z�- (indicate nearest cross street) Municipality P,4} -.sv-, Drainage Basin F4-,;t bra "C SOIL PERCOLATION TEST DATA Date of Pre - soaking - jZ- d� Date of Percolation Test %-13 -dd Hole No. Run No. Time Start -Stop Ela se Time 1(�IIII.) Depth to Water rom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate MinAnch - 1 W61 61 -- rt : 31 -36 23 2-4 3j 2 11: 39 - 1Z' O9 36 2-44 z�3��. X31 y 1-0, 3 121; i6 - )Z.'9 0 30 2-4' 2- 4 LY4 � 10 , 4 5 Z 1 ir:63-- 11,33 30 2- %2. .24% , 41; 2 i1:3S- IZ ',3 3 12 :41 - 1 `.41 66 Z-3Yi 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are ootatnea aL ce,- 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. Fo rm DD -97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. G.L. 0.5' 1.01. 1.5' 2.0' 2.5' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' ' 011 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' / / -- /Z U Gk- HOLE NO. Indicate level at which groundwater is encountered— HOLE INTO. C) r �A G� C-0 .. _- Q &e c Indicate level at which mottling is obsen•ed /o-,e- Indicate level to which water level rises after being encountered Deep hole observations made by: /0 CI41) Date 9 Design Professional Name: L4, L. P,C, Address: ao � / /`�w�, JZ,J NIX,. Signature: Design Professional's Seal NE' MV '\ t', N ii0 556;74 tyC PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM -? Owner r e -LC>Cl Address 5g -1zz1 Located at (Street) Tax Map Block Lot (indicate nearest cross street) Municipality �',q? T�;zs� Watershed E4s7- A,gtre_1,( SOIL PERCOLATION TEST DATA Date of Pre - soaking >,A �4zon Date of Percolation Test "2 eo NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 Rev 2 �. ,C •mod - �2G ?Xg 3 rc - 4 5 +G13 Q 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 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 ,•.rk' _ 4 Nli CCASSARELLA / . al S7/° 32 "E ; \ =vim �! 172 - --- S 72 °56 00 £ Ma. 9 , /' / 3 �• ' F PRDP.WEU_ 5.6 g r T �RDPo*IEb ,•I' �1' - BcDRoo RESID IIBro `- a'Rrn -�`° ,y `ll'C/� /• ,��: 1180.0` 20` _� •�- /• / FFs IIS9•a' rll- e N zf /• _ v ✓ PR Ry y' y 2 u. n llBO� /`\911, / • h U / T �• ® �IU_ Ft�: 5�77�,vEr. I s - �• ; •♦ ar 6L A "s IQ .o 1 =x s, t ¢ P�RF Pv.G. +'� r5 rm r• - °- — GrG ` I qo Asa- ♦ P*n �� DEPTH VARI✓ NP(e5'. !I,' SEE PLAN .•f iau nP.PF L1.0 r,nN wiloe� I ��' / /� S` \ • - Sheet of PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLII SERVICES FIELD ACTIVITY REPORT NAME: Tel: A AnnRFsq: R-VrZ� Street Town State Zip PERSON IN CHARGE OR TNTF.RVTFWF.T): la d Name and Title TYPE OF FACILITY: j !LL Pi47 .7--t157- FINDINGS: ��DS /=7 -7 -7 /6, 5— L),-- Signature and Title RFPnRT 1RFCF7VFn BY., I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Rev. PUTNAM COUNTY DEPARTMENT OF HEALTH 2- DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Jo lluc, t Address alve- Plqijva w Loca ted at (Street) fi J4,e, Tax Map T, Block Lot 2-G-- 'I (indicate nearest cross treet) Municipality ft:elv 5 CIL, Watershed a SeAlo" SOIL PERCOLATION TEST DATA Date of Pre-soaking 11— :2-0 -0 0 Date of Percolation- Test Ij 2-� -0 0 ........ ....... bi: th".f :W Water . .... ........ uwg: �i;�..U. 00114C es): ...... ....... "S .. y1p L T Nt . ..... hil t i:i!!�RAP .90 12C -2 2 '3) 3;4 Cl G6 '1 '1 4 5 13 Fj I 2 4.10 1 14 3 4 2 3 4 ...... ... ... .5 NOTES: 1. Tests to-be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. :5 1 min for 1-30 min/inch, :5 2 min forl,31-60 mi'dinch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMI R SEWAGE TREATMENT SYSTEM PERMIT # i3 U z , ► c (,� u Located at 0 Town or Vifage r ' -� ° -vi e- Subdivision name R�ri l le- J? j.,e_ &$ubd. Lot # 2- Tax Map Block Lot Date Subdivision Approved —� 2„ 1 - Owner /Applicant Name tl «kin I ed l u c- i Mailing Address to 6 �g," C S o A D t , ✓e.. Pet c Amount of Fee Enclosed --"" Renewal Revision Date of Previous Approval Zip /�� -- Building Type Lot Area i;-.3 /'hNO. of Bedrooms 3 Design Flow GPD 600 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of ®b gallon septic tank and Other Requirements: To be constructed by T R D Address Water Supply: Public Supply From Address or: _i / Private Supply Drilled by T B )) 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 /1 r2-2 _00 License # �1CeI �2--f 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 whe sidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pernyit. A roved f 'scharge of domestic sanitary sewage only. By: Title: Date: f� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 November 29, 2000 Robert Morris, P.E. Putnam County Health Department 1 Geneva Road Brewster, NY 10509 RE: Individual SSDS - Lot #2 Bridle f6dge Estates Bridle Ridge Road Patterson, N.Y. T.M. #5. -1 -25 Dear Robert: Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Telephone (845) 279 -4003 Fax (845) 279 -4567 Enclosed are the following: 1. Five (5) prints of Drawing SS -2, "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, i Harry W. Nichols Jr., P.E. HWN:his 00- 014.00 < ---- —..A- f 11 NHKK T W H l UHUL5 914 279 4567 P.01 ?=AM COUNTY DEPARTWNT Old MLALTS DMION Olt IMMONMEnAL WALTH SERVICES ATTENTION Ca ADAM w6En ' RMN6421SPECTIPS For:. Fill -..� All ithrima bon =d bs fAy 4ompteted prior to aay Trancb m imspeexloas beltsg made. PCHD CONUUttion P 9AW Owner /Apphoant Name: 17AL,, T141 Sw Lot Postirly: 5ubdivltwon Name: !'' Is 5y5tfM completed? a .�.�T��r Date :� _ ra ■1 is systis oomAge? Date: h system a msudded as per pleas? Is wsn drinsd? Date: Is wen located to pet plans? Are eicosioa control aieasyres in place? -- -.��L- 1 ca* tbu the sy sl as W4 st ft above pr mists has boar constructed and I have lospected and verified thebr "letlott Lt wwrdatme with the issued PCl iD Cons=cdon Pamfd and approved plMs ad the Standards, Roles and Eeguhbu of the Putnam Coal DtPutment of Heah� Date. ,.�! :QUO � .�,. CattiBed by: PE "� RA • - D Profeasin Address: ,. k g• s 1 11, .._ — - 1rOrID �� _ PUTNAM COUNTY DEPARTMENT OF HEALTH d DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: Inspecte y: e-,,, reo F D Street Location 67cl,2z 7j!,naF ;e�c>A T) Owner pAa4z ac l Town 7,4 rrgreno iv Permit # p- i 3 -.9 0 TM # --5- - �_ — a 5 Subdivision Lot # 1. Sewage System Area YES, NO COMMENTS a. STS area located as per approved plans ................... b. Fill section - date of placement '). . 3:1 barrier Lgth. Width Avg.Dpth -��=� \ w��lt� cJ _aa Nw /e'f c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course /wetlands. II. Sewage System iVET. a. Septic tank size - 1,000 ......... 1,250 ......... other .......... b. Septic tank installed level ....... ............................... c. 10' minimum from foundation .......... ............................... -_ -- -- d. istribution 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 1. Length required Length installed? 2. - Distance to watercourse measured + t a ° Ft.......... rCL LQGG O if1'o`✓ Ta K1t (=v +5b 3. Installed according to plan .... .............................�� . z 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 ................................... :.................... IX 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.estimated flow /cycle........... III. HouseBuildin a house located per approved plans ...... ............. b`_ Numbe of bedrooms..b'�....�.... r'...........® s - '_ �ug� . u �I�►- IV. Well. a. Well located as per approved plans . ............................... b. Distance from. STS area measured / G 5' ft........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship , a. Boxes properly grouted ................... ............................... b All pipes partially backf lled_ ................ c All: pipes flush wrth aside of box :.:� ...................... n d. Mckfill material contains stones <4" diameter..... e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... n___ el- a' 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: i;7- %/l AOo YOa' l&T 9- "9'tz1DL6 7ZIDlE EST. " From: Gene D. Reed Putnam County Departmenf of Health For your information For your review As discussed Fax #: V-7?-q5-60-1 No. Pages 2 (Including cover sheet) Please respond Attached as requested Please call Notes/Messages 0 K, 7-0 B.4cPcFizL 'T?zE�G1-F�S ©aPL� In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 2261. DEC -05- 2000.03:26 PM HARRY W NICHOLS Q9 914 279 4567 P.01 PUTNAM COUNTY DEpmabtm OF BEALTS DIVISION OX ZNVMONMMNTAL wALTS 9BRVICZS ATTFNTXON 0 ADAM GENE • ' . pSaL,jg,ST FQA,MAL T jcP . ION For: Fill All kforatadon must be Aiily complued prior to uiy Trenches iaspec cons being me4e. PCHD Conswa etlon Pe 3 -U Located: (T) pole 7�•o rte � Owner/Applicant Name: M71uc TAI _ S �_ Blook Lot Z pormerly SubdM ioa Name: • Subdivision, Lot f 7-- Is system fill completed? Date: Is system complete? Date: ._,.jyQ-00 Is eyattm constrtivtad as per plant? if Is wall drilled? V. Data: Is well located as per plow? Are erosion control measures in place? 1 certify tbat the syoom(s), ss list4 at the above premises has been cowwcted and I have inspected and verified their completion in accordance with the issued PCHD Constmetion Permit and approved pleas and the Stud&*, Rules aad Regulatlons of the Pumam County Department of Health- Due: f =i =� Certified by: PE f izA.__ _ Dog Profcuional r Address: � ...�r�wr� _1 ,�� Lic. l?zd Commoaw Form M-99 � _ G 1-1 166 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: %iL �/ O .: / 1 .From: Gene D. Reed Putnam County Department of Health For your information For your review As discussed Notes[Messages Fax 9: 9- 71- G7 r— No. Pages (Including cover sheet) ------ - -- ._ ... Please respond Attached as requested Please call o ►r r In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 2261. S 05 4 1:�bOGA� 1 12F S� �NCs SE��cTnN jai E�SNo N 6� SO%-lb PSG 6DR35 3-_ 807( T Q� A65 -TREW0AMP) i� 17 1� 119 �7D 421 422 � qg' 44 gam_ -- 10(A. 4g' — — �— DIMENSION CHART (in feet) Number A B 2 3 1' S V, Qo3' (o IDS' -1 g q 43' 13' 10 3I.5' �-� ► I I 32' 12 2 -7' S5' 13 2�' 4T 1(0 122' 13�' l7 120 ;�' 130,5' 100 11q' 12�' 20 11 123.5' D 117' 1 21.5► .il a ! 1 1.5' l I •5' 0 r, :r�UTNAM COUNTY DEPARTMENT OF HEALTH ;u ►_t Y,'TJNVISION OF ENVIRONMENTAL HEALTH SERVICES EI ;I)I.JCATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # P — 1 -� 0 0 Located at _ 1 4- K% G L . R06 Town or V illage MT V G 1` S O N Owner /Applicant Name J IN J\i REILU LC I Tax Map ; % Block 1 Lot 215 Formerly Mailing Address Subdivision Name�� Subd. Lot # LkU C�, NwD 2 Zip 4 Date Construction Permit Issued by PCHD 12/100(j Separate Sewerage System built by ) U 0 N GK— LL U CC I Address Consisting of ,1 Q0 Gallon Septic Tank and (o Ll LV— TCZ�--) 'U C Other Requirements: Water Supply: Public Supply From Address or: X Private Supply Drilled by M I L L M 1--LI A/6— O VC+ Address -75 PUTNAM AVM, �.. WEW � - r Building Type RV—: � Has erosion control been completed? � Number of Bedrooms Has garbage grinder been installed? ND 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 regulatio s of the Putnam Co Department of Health. 0�a Date: Certified by P.E. )' , R.A. �16 d DU— Mt n Prof nal l 24 Address < License # Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals a ubject to modification or change when, in the judgment of the Public Health Director, such revocation, ificatio r change is necessary. By: Title: Date: �` d White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 4 1 M Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Telephone (845) 279 -4003 Fax (845) 279 -4567 July 16, 2001 Mr. Robert Morris, P.E. Putnam County Health Department One Geneva Road Brewster, New York 10509 Re: Individual SSTS Compliance Bridle Ridge Subdivision Lot # 2 14 Bridle Ridge Road Patterson, New York 12563 T.M. # 5.1.25 Dear Robert: Enclosed are the following: 1. Five (5) prints of Drawing SS -2, "As -Built SSTS," dated 5/8/01. 2. "Certificate of Construction Compliance for Sewage Treatment System," dated 5/8/01. 3. Three (3) copies of "Guarantee of Subsurface Sewage Treatment System," dated 5/4/01. 4. Laboratory Reports, dated 6/8/01 and 6- 28 -01. 5. Application Fee in the amount of $200.00 payable to Putnam County Health Department. 6. "E -911 Address Verification Form," dated 5/8/01. 7. "Well Completion Report," dated 5/3/01. If there are any questions concerning the enclosed, please call. Very truly yours, Harry W. Nichols Jr., P.E. HWN:DC:jmm 00- 014.00june PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building -,- 12 L. A. & U ��_c c,, Building Constructed by /L/ 6"dl, k9l`j-,e Location - Street 19,01" Tax Map Block Lot i? 05 TownNillage Subdivision Name 4-st CA- Buildin Type 6 1 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. r Dated: 11 nth Day' Year Gene*Contractor (Owner) - Signature t Corporation Name (if corporation) r / Address: Z4 State , /LGu r Zipp Signature: Title: Corporation Name (if corporation) Address: State Zip Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well L`ocati&i - - `�-! i �Stree #"Address: IDLE RIDGE ROAD TPATTERSON, wn/Village: NY Tax Grid # �y Map P-), Block 1 Lot(s) 2 Well Owner: Name: Address: JOHN BELLUCCI SAN SOUCI DR. PAWLING, NY 12.564 Use of Wells 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 Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock _ Other Casing Details Total length 41 ft. Length below grade 40 ft. Diameter 6 in. Weight per foot 17 lb /ft. Materials: X Steel _ Plastic _ Other Joints: _ Welded X 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 100 -gpm Depth Data Measure from land surface- static (specify ft) 24 During yield test(ft) 240 Depth of completed well in feet 265 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 6 SANDY SOIL 6 30 SOET SEAMY SANDSTONE 30 265 HARD SHALE If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 265 100+ Pump Type S Capacity J S Depth 7-4 U 6Model 13 SM 15 � 12- Voltages HP I h- Tank Type 41X_302- Volume Date Well Completed 12/.1/00 Putnam County Certification No. 2 Date of Report 12/8/00 17/ r' a re) NOTE: Exact location of well with distances to at least two permanent landmarks to be provided on alseparate s1%et/pfah. ILL DRILL N , INC. 75 PUTNAM AVE. BREWSTER, NY Well Driller's Address: Signature: Date: '30': White copy: HD File; Yellow copy- Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovani, Director LAB #: 93.101288 CLIENT #: 13066 NON STAT PROC PAGE 1 N N N N N N N N N N N M N N N N N N M~--M NNNN NNN - NNN N N/V AI N N N N N N N NNNN N N N N N N N N N N N N N N N N N- N-- --- N NNN N BELLUCCI, JOHN & KATHL 60 POPPY'S LANE PAWLING, NY 12564 SAMPLING SITE: 14 BRIDLE RIDGE RD. : PATTERSON, NY, 12563 COLD BY: JOHN A. BELLUCCI NOTES...: KIT TAP -------------- N N N N N N N N N N N N N N N N N N N N N N N N DATE FLAG PROCEDURE DATE /TIME TAKEN: 05/20/01 07:30A DATE /TIME REC'D: 05/31/01 09:OOA REPORT DATE: 06/08/01 PHONE: (845) -855 -1059 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF N N N N N N -------------- N N -------- N N N N M N N N N RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 05/31/01 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 05/31/01 LEAD (IMS) <1 ppb 0 -15 ppb 9101 05/31/01 NITRATE NITROG 0.43 MG /L 0 -.10 9139 05/31/01 NITRITE NITROG •x:0.01 MG /L N/A 9146 05/31/01 IRON (Fe) 1.13 MG /L 0 -0.3 mg /l 2037 05/31/01 MANGANESE (Mn) 0.070 MG /L 0 -0.3 mg /1 2037 05/31/01 SODIUM (Na) 5.07 MG /L N/A 05/31/01 pH 6.5 UNITS 6.5 -8.5 9043 05/31/01 HARDNESS,TOTAL 48.0 MG /L N/A . 05/31/01 ALKALINITY (AS 16.0 MG /L N/A 05/31/01 TURBIDITY (TUR 7.6 NTU 0 -5 NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE (WAS WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDI O THE NEW YORE: 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 a COPPER value of 1.3 mg /L, else water treatment must be undertaken to reduce the waters corrosive potential. Fe /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. 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 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovani, Director LAB #: 93.101288 CLIENT #: 13066 NON STAT PROC PAGE 2 N NNNN ----------------- N N N N ----- N N ------ N N NNN NNNNN N NNNN N ------ N N N N N ------ W-- M- BELLUCCI, JOHN & KATHL 60 POPPY'S LANE PAWLING, NY 12564 SAMPLING SITE: 14 BRIDLE RIDGE RD. : PATTERSON, NY, 12563 COL'D BY: JOHN A. BELLUCCI NOTES...: KIT TAP N NNNN NNNNNN N N NNNNNN N N N ----------------- DATE /TIME TAKEN: 05/20/01 07 :30A DATE /TIME RECD: 05/31/01 09 :00A REPORT DATE: 06/08/01 PHONE: (845)- 855 -1059 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: MF ----------- NNNNNNNNNN N N NNN N NNNNN N NNNNN N DATE FLAG PROCEDURE 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 805. 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 14ARD WATER: 140 -300 MG /L (1 grain /gallon = 17.2 MG /L) SUBMITTED &Y: V 1 Albert H. Padovani4 M.T.(ASCP) Director FLAP# 10323 YML ENVIRONMENTAL SERVICES 1 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 93.101751 CLIENT #: 13066 NON STAT PROC PAGE 1 BELLUCCI, JOHN & KATHL DATE/TIME TAKEN: 06/28/01 08o00A 14 BRIDLE RIDGE RD. DATEITlME REC'D: 06/28/01 10:15A PATTERSON, NY 12563 REPORT DATE: 07/11/01 PHONE: (845)-878-7440 SAMPLING SITE: 14 BRIDLE RIDGE RD. SAMPA TYPE..: POTABLE : PATTERSON, NY, 12563 PRESERVATIVES: NONE COL'D BY: JOHN A. BELLUCCI TEMPENATURE..: NOTES...: KIT TAP COLIFORM METH: N/A DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD .J/1 2037 COMMENTS: Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. SUBMITTED BY: Albert 0H.Q dovani, H.T.(ASCP,- Directt�- ELAP# 10323 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 Servica (914) 278.6558 WIC (914) 278.6678 Fax (914) 278.6085 Early'"Iotervea6a -(914) 278.6014 Preschool (914) 278.6082 Fax (914) 27f- 6648 E911 ADDRESS VERIFICATION FORM OWNERS NAME:t��..l TAX MAP NUMBER: E911 ADDRESS: TOWN: AUTHORIZED TOWN QFFICIAL- : (Signature) DATE: 8/e / 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)