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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -1 -11 BOX 4 TLm 11 �I I' .; .. ti ,,, . , I,yL ' ' '■ I ' 1 � � T . I ' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Cushman Road * 4jol Town/Village: Patterson Tax Grid # Map 1'l- Block i Lot(s)) 4g. Well Owner: Name: Address: JGC Associates, LLC 22 Tulip Road Brewster, NY 10509 Use of Well: -primaar5y> 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 121 ft. Length below grade 120 ft. Diameter 6 in. Weight per foot alb /ft. Materials: X Steel _ Plastic _ Other Joints: _ Welded X Threaded _ Other Seal: _ Cement grout X Bentonite Other Drive shoe: X Yes No I 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 _Pumped X Compressed Air Hours 6 Yield 10 gpm Depth Data Measure from land surface- static specify ft) .30' During yield test(ft) .340 Depth of completed well in feet 365 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 20 Sand /with spots gravel 20 100.. Hard Pan ( grey) 100. 365 Black medium hard granite yl• �u5 "i i'=�01� If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information .300. 2 Pump Types i lAtpacity _]Q Depth 260 Model 10GS10412 Voltage 230 HP 1 hp Tank Typediph, Volume 86 365 0 . Date Well Completed 1/3.0/03 Putnam County Certification No. 2 1 Date of Report 2/1.1/03 - - - Well Dril r (signature) IZI-t� NOTE: Exact location of well with distances to at least two permanent landmarks to be pr on a separate sheet/plan. Well Drillers N ILL pRILLIIG IC o � Address: 75 Putnam Ave. , 'Brewster, NY Signature: Date: '5'/3.'Q/'03 White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIAN GE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT it P Located at W) C,44, RMa'H 900 Town or Village P AfiTl✓R -6oH Owner /Applicant Name J 6C, � o�lA`t �� Tax Map ��� a Block 1 Lot ! a Formerly P-+- �L 1'EVf�VPmd l Subdivision Name J 1h LIB-- M VJT( 1A N 0— Subd. Lot # 4 Mailing Address 1-' — 'TU W 9 R-C) (�'Q ?�p-ew 5-r6p. / f'J Zip 106 ()19 Date Construction Permit Issued by PCHD L l � I Dr)� Separate Sewerage System built by eT- FVN)4 abO `IW�Address 5-10"14,6 0 j 2,&`�� Consisting of 1`�-60 Gallon Septic Tank and 9 cc� Lf— Pt rtz , a P-0 " Other Requirements: "'N P Ito � L R 0, MtEQ ' - Water Supply: Public Supply From Address, or: Private Supply Drilled by IKA , D H Lt A 11 U H L,° Address-1 � p'�t W PA ° bWi t�D1 Building Typed �� �d't Has erosion control been completed? D D Number of Bedrooms Has garbage grinder been installed? No 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 regulatign* of the Date: 6 / it J 00,) Certified by Address 1--o6, o P-1, of Health. J P.E. R.A. �C"s0� License # 5W-1 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocati0 , m dificat' or change is necessary. n By: Title: Date: C White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Cushman Road * ?col Town/Village: Patterson Tax Grid # Map l�1• Block J Lots) 4g Well Owner: Name: Address: JGC Associates, LLC 22 Tulip Road Brewster, NY 10509 Use of Well: - 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 121 ft. Length below grade 120 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 X 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 o Yield 10 gpm Depth Data Measure from land surface- static (specify ft) 30' During yield test(ft) 340 Depth of completed well in feet 365 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 20 Sand /vi th spots gravel 20. 100 Hard Pan ( grey) 100 365 Black Tedium hard granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 300 2 Pump Typesubl,ersi gqpacity 10 Depth 260 Model 10GS10412 Voltage 230 Hp 1 hp Tank Type !d i a ph. Volume 86 365 10 Date Well Completed 1/3.0/03 Putnam County Certification No. 2 Date of Report 2/1.1/03 Well Drill r (signature) zy�� NOTE: Exact location of well with distances to at least two permanent landmarks to be pr on a separate sheet/plan. Well Driller's Na i SILL DRILLING, INC. Address: 75 Putnam Ave. , Brewster, NY Signature: Date: 5/3.'0/03 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM.COUNTY DEPARTMENT OF HEALTH DIVISION .OF ENVIRONMENTAL HEALTH SERVICES . SOO;13 162 lc, P o FINAL SITE INSPECTION t Date: 3 0 Inspected by: c', 2�F Street Location Owner Town ,Pa. �,,s� „� Permit # P-2- vv TM # 13 a / / = l/ Subdivision Lot # 1. Sewage Svstem Area 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 .:..... s ::......... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. Sewage System a. Septic tank size - 1,000 ........ :1, 250 ......... other ................. . b. Septic tank installed level ................ ............................... c. 10' minimum from foundation ........ ................:.............. d. Distri tuion Bo outlets at same elevation -water tested ................. 2. Protected below frost ..... :........................................... .3. Minimum 2 ft.Original soil between box &.trenches Junction Box - roperly set ................... .... ............................... en required pa Length installed 2. Distance to watercourse measured Ft........ q 3. Installed according to plan..... ...... ............................... 4. -Slope of trench acceptable.1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface.................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 11/2" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 0:... �Dv ........ .......... ............................... . terns am er..... ........ - ................ ... ... 1, 2. Overflow tank....................� 3. Alarm, visual /audio........ 7.. .......�.. .... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle....,...... M. ouse/Build a. house located per approved plans ... ............................... b. Number of bedrooms ................:...... .........................:..... IV. �yye_ll� . a. Well located as per approved plans ...... .................. - b. Distance from STS area measured ft.... c. Casing 18" above grade ................... .............................. d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ...:......:................:... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto exist watercourse g. Footing.drains discharge away from STS area............ h. Surface water protection adequate ... .............................:. i. Erosion control provided .....:........... ............................... Rev. 1/97 . Form ST- /1�3 1„ COMMENTS ■ ff� I, I� I�r��1T rr 1■■ Elm . Form ST- /1�3 1„ NOV -27 -2002 01:49 PM HARRY W NICHOLS 914 279 4567 4 1 PI"AM COUNTY DEPARTMENT OF HEALTH DI WON OF ENVIRONMENTAL AEALTR SERVICES BF,0j EqT.EOZ.IrD�A]L RISE . lON For: Fill Date: :. G` �.. Trenches PCHD Construction Permit# ;Z—oz ,gyp Located: •�, +''�1. /�a.o" (T) 94 Owner /Applicant Name: TM �!:.,� Block Lot Formerly: otleat-ra C42 Subdivision Name: eJ _A�• ,� �= tK Subdivision Lot # r '4 Is'system fill completed? Date: Is system complete? Y164, Date: 1 - ;14 -02-- - Is system constructed as per plans? Is well drilled? Date: Is welt located as per plans? Are erosion control Measures in place? 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 i- G Certified by: PE , / RA D Professional Comstients: FOR: 13 ADAM kr ENE O (NANS) Fonu FIR -99 v" 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/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 December 4, 2002, Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Re: Field Inspection - J.G.C. Associates Formerly F & R Development Cushman Road, (T) Patterson Lot # 4B, TM # 13.1 -1 -11 Dear Mr. Nichols: An inspection at the above referenced site has been completed. The following comments must be corrected in the field. 1. Expose end caps on all laterals. 2. Inspection of the house and well need to be performed upon notification of completion. 3. The distribution box shown on the plan was not found upon inspection. 4. The cast iron pipe from house to septic tank needs to be installed. 5. The roof leader /footing drain with rip -rap needs to be completed. 6. Please note that erosion control measures must be in place prior to construction of the well. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Sincerely, Gene D. Reed GDR: cj Environmental Health Engineering Aide +/ e e SENDING CONFIRMATION DATE DEC -6 -2002 FRI 10:22 NAME PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845- 278 -7921 PHONE : 92794567 PAGES : 1�1 START TIME : DEC -06 10:21 ELAPSED TIME : 00'42" MODE : G3 RESULTS OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... . e. BRUCE R. FOLEY IARMTA MO1,WAR1 R.N., M.B.N. ! P.M. NWra Deem. W .l000lare POW X160 A• I)&— f P.Vb SaiMeu ! DEPARTMENT OF HEALTH 1 Gera Reed, Brewster, New York 10509 Bavlreameabl KvAM (/45)178.6170 n.(145)278.7921 N.n n a. , (645)213-6358 wrC (64P 27a - 6678 Fm (a4* 278 -6065 Bary lahrsar*wPrwhed (143) 278.6011 Fat (845) 271.6618 , December 4, 2002 Barry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Re: Field Impaction - I.G.C. Associates Formerly F & R Development Cushman Road (T) Patterson Lot #4B,TM# 13.1 -1 -11 Dear Mr. Nichols: An inspection at the above referenced site has been completed. The following comments roust be corrected in the field. 1. Expose end caps on sll laterals. 2. Inspection of the house and well need to be performed upon notification of completion. 3. The distribution box shown on the plan was not found upon inspection 4. The cast iron pipe tivm house to septic tank needs to be installed. 5. The roof leader /footing drain with rip -rap needs to be completed. 6. Please note that erosion control measures must be in place prior to construction of the well, If you have any 8uther questions, please contact me at (845) 27"130 exr. 2261. Sincerely, Gene D. Reed GDR:cj Environmental Health Enngin"nng Aide AUG -10 -2003 10:42 AM HARRY W NICHOLS 914 279 4567 P.02 Harry Nichols Jr., P.E. Pattersoa Park, Suite 106 2050 R=c 22 Bmw$W, NY 10509 Ph" (914.9794003 Fax (91 4) 2794567 Fax To: From Va 1;--) a - 7 � o� � Pages: t Phanm Oats$ � cc: Harry W. Nichols Jr., P.E. CI urgmt • ❑ For Rw1ew O Piamm camnant 13 Plemw Reply ❑ Plsfte Raeyelw • CommenM A0 1A o i. -4� w -a� v j m /--? lk' f -f T7 �a1� Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Telephone (845) 279 -4003 Fax(845)Z79 -4567 June 24, 2003 Robert Morris, P.E. Putnam County Health Department One Geneva Road Brewster, New York 10509 Re: Individual SSTS Compliance - JGC Associates 307 Cushman Road Muchnick Subdivision - Lot #413 Town of Patterson, NY T.M. #13.1 -11 Dear Robert: Enclosed are the following: 1. Five (5) prints of Drawing S -413, "As Built SSTS ", dated 05/28/01. 2. "Certificate of Construction Compliance for Sewage Treatment System ", dated 06/17/03. 3. Three (3) copies of "Guarantee of Subsurface Sewage Treatment System ", dated 06/20/03. 4. Laboratory Report, dated 06/04/03. 5. "Well Completion Report", dated 02/11/03. 6. Application Fee in the amount of $200.00, payable to Putnam County Health Department. 7. "E-911 Address Verification Form ", dated 12/18/02. If there are any questions concerning the enclosed, please call. Very truly yours, �J Harry W. Nicho s Jr., P.E. HWN:gav 02- 114.00 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION -OF ENVIRONMENTAL HEALTH =SERVICES jGC GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM f Owner or Purchaser of Building Tax Map Block Lot __J 61L, OW Building Constructed by ' 01 C"W9 W Location - Street . � cOC-nc Building Type Town/Village NJT4 k -y Subdivision Name 4 Subdivision Lot # I represent that I am wholly and completely responsible for the location, construction and drainage of the sewage treatment system serving the above that is has been constructed as shown on the approved plan or approved an accordance with the standards, rules and regulations,of the Putnam County D hereby guarantee to the owner, his.sucoessors, heirs or assigns, to place in € - -any part of said system constructed by me which fails to operate for immediately following the date of approval of the "Certificate of Construct sewage treatment system, or any repairs made by me to such system, ex( operate properly is caused by the willful or negligent act of the occupant of 1 system. )rkmanship, material, :scribed property, and dment thereto, and in u1ment of Health, and d operating condition period of two years Compliance" for the t where the failure to building utilizing the 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 dt not the 'failut'e of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing'the system. Dated: Month Z- ,�j Day 2A Year �J e—C i., - {general C tr for (Owner) - Signature UGC✓ Assam l_L-C. Corporation Name (if corporation) Address: Z ` i �,`� , ;,, Signature: Title: —� Corporation Name (if corporation) Address: State d Zip I oZ5 1 State t:,[� \) t k_', l_. Y �c+z Zip 12-Sd, r Form GS -97 V t u JMS ENVIRONMENTAL SERVICES, INC 1500 SUMMER STREET ri M S STAMFORD, CONNECTICUT o6905 Mailing Information: Name: Mill Drilling Co: Address: 75 Putnam Ave City: Brewster State: NY Telephone: Sample's Information: Site: bottom of water tank Preservative: HNO3 Temperature: <4C Client: JGC Associates Zip: 10509 Fax: 845 - 279 -5075 Date Collected: 6/2/03 Time Collected: 17:10 NELAC, CT and NY .State Certified Environmental Laboratory Collector's Information: Name: Bob Address of site: Cushman Rd City: Patterson State: NY Zip: Telephone: Date Received: 6/3/03 Time Received: 12:45 Lab No.: J033723 Date Analyzed Test Name Result MCL Method 6/3/03 15:00 Total Coliform Absent Absent SMWW 9222B 6/3/03 Chlorine Free Residual <0.1 mg /L N/A SMWW 4500CIG 6/4/03 Color ND 15 Units SMWW 2120 B 6/4/03 Odor ND 3 TONs SMWW 2150 B 6/6103 * Iron <0.03 mg /L 0.3 mg /L SMWW 3111B 6/4/03 Manganese 0.059 mg /L 0.3 mg /L SMWW 3111 B 6/4/03 Sodium 13.2 mg /L N/A SMWW 3111B 6/4/03 Chloride 34.0 mg /L 250 mg /L SMWW 4500 Cl C 6/4/03 Hardness 144 mg /L N/A SMWW 2340 C 6/4/03 Nitrate 1.33 mg /L 10 mg /L SMWW 4500 NO3E 6/4/03 10:00 Nitrite <0.1 mg /L 1.0 mg /L SMWW 4500 NO3E 6/3/03 pH 7.09 S.U. 6.5 -8.5 S.U. SMWW 4500 H B 6/4/03 Sulfate 20.0 mg /L 250 mg /L SMWW 4500 SO4F 6/4/03 Turbidity 1.37 NTU 5 NTUs SMWW 2130 B 6/4/03 Lead <1.0 ug /L 15 ug /L SMWW 3113 B Comments: * Sampled on 6/4/03 at 15:30 At the time of analysis the sample was acceptable for total coliform N/A = Not Applicable mg /L- milligrams per Liter ND- None Detected S.U.= Standard Unit NTU- Nephelometric Turbidity Unit MCL- Max. Contaminant Level TON- Threshold Odor Number ug /L- micrograms per Liter Signature. State #: PH -0218 Michael Lapman ELAP #: 11715 President Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com BRUCE R. FOLEY.• LORETTA "MOLINARJ�R.N., M.S.N. wblic Nwlth Director MrOOraa- Pub k Xaalth Director . OtrYbra Q/ Patknr Sarvtcu . — DEPARTMENT OF HEALTH - 1 00neva Road' Brewster, New York 10509 - -- ZoMemcaW HgWtb (914):71-6130 Fax (9N) :79 7921 Nurslas Scrrlca (91/) 3]i • 63Si wl_C (9(./) 371.6671 -.Pa (9141 371.600 "7 6arly'lokr 416o'(RI 4)171••6011 Frudool (91J37W42 .Fsx(91{)171�.66 {1 ..__....: 1211 ADDRESS VERIFICATj N FORM OWtVERS NAME: J taG ��o�� t9— 4 - TAX MAP NUMBER; E911 ADDRESS :' 30 7 G0, R t- A P-VYD TOWN;T�"v41 –+ --AUTHORIZED TOWN OFFICiAI,; - (Slgnature) DATE:'. 42 The Putnam County- Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed,4.e., a legai-1911 address is assigned by an authorized town oicial..TW form is to be submitted )Yitb the application for a Certificate of Construction Compliance. (E9 i I VERF�tJvf) i I a 3 / ti i. �P /.ox (b / Ex1STI O b I NG 4 �l '' P ro g5 /j! RESIDENCE Exist' - /2 WEI.I �� 3. 8 C 3 Q 9 ��. CNAM6E fi � 1 1250 $EPTIG TANK m / / ,y^ ro 4' §¢ SOLID PJc SDR 35 N N M � N ry N i t L' 40" E 107. I CUSHMAN ROM) I I t l 539,` og" E Putnam County Department of Healt Division of Environmental Health Ser, ATmroved as noted for conformance I DIMENSI ®N CHART (in feet) Number A G I 13 40 2 20 SL 3 85 81 4 90 86 5 94 92 6 99 96 7 104 1 04 8 log 110 9 114 116 10 120 1 22 1 I 125 127 12 87 101 13 .191 94 14 74 88 5 67 8 I 16 61 75 1 7 S5 69 IS 49 62 19 43 56 20 32 4$. 2 r 120 105 22 128 114 23 132 I 1 8 24 135 123 25 139 1219 26 143 132 27 1,48 138 28 152 143 29 156 147 I v, 00 moo FiWI VARON TO -SSTs \ - -, / • __ _ MAINTAIN ID' -�0' NIhC t� ` i - - - - __ _ - 6' PVC ROOSR pRAW / r / \ / - - - W/ NO RAP A "/D{S A SEPARA n0N' FOAWVA n0N . �y _ / ' / i ' / . \ \. / 1D- - / ARC 7w0£ .SYL T FENCE sr ABSORMAXV SF PROPOSED ML / cS as FxA /l I / l / r//e` V AREa: SF N39 45 4° CI.P. WAS7E LINE \ \ \ ' • ~ �, 11 I MIN. PITCH 7/4' PER FT ED HEAVY DUrr � \ � �- \ \ -�— 1 `�' � w7H GAME \ \ \\ \Sr r \4 11 \ PROPOSED 2 COMPARTMENT EAYSANG U7IUrY 10.1 Y; U SI PRO wOr 57Lr Ff7VCE POLES i NAINMIN _.THE fLOWiG MIN DISTANCES PRECAST CONCRE7E SYPHON - r0 =q SaPnC rANK TO FOUNDA77ON OR AX CHAMBER 6'X 6' X 4' AS BY — 2010" ABSORP79W. IREWH 7D Ft7f/ W nT 0 SWD PVC MANUFACAVA D BY ROn NDO — 200 =0° A$SY wmv nwmw 70 9mMAMlXl' MIN P/nN .l /B ' PER. FT._ ExsnNC CONGd7E EMS74VG. LIMITY POLES NOW Na SCSXB - 7oD;0' AB,sawnoN 7rN0ar t0 'uvHds' wi 70`BE REMOVED ' — 70 =0' -WPnC s>s7EM TO 7REE3 190L FOR DEEP TEST HOLE ExsnNC a.�u. _ 10 -OOH P i� TY LIAW Putnam C unty Department of Health — 75 =q' ABSORPnoN 7RENGH To 'TW'OF Ste l00'0' 9PA0 S*7W M-WnANDS .n. n —, m no.arn—,W, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMI E TREATMENT SYSTEM PERMIT # 'Jo- r, - :4 _3/- Located at Cushman Road Subdivision name Jack Mutchnick Subd. Lot # 4B - Date Subdivision Approved Owner /Applicant Name 01/03/87 F. &R Decelopment Town or Village Patterson Tax Map 13.1 Block 1 Lot 11 Renewal Revision Date of Previous Approval Mailing Address 66 Argyll Ave . , New Rochelle, NY Zip 10804 Amount of Fee Enclosed $300.00 Building Type Residence Lot Area 2.0 5 6 No. of Bedrooms 4 Design Flow GPD 8 0 0 A-Cr - Fill Section Only Depth Volume (F00 e- PCHD NOTIFICATION IS REQUIRED WHEN FILL IS CONED Separate Sewerage System to consist of 1250 gallon septic tank and 90OLF absorption trench, 24" wide, 710" oc, siphon chamber & D -Box Other Requirements: To be constructed by united Septic Systems Address 311 Railroad Ave. ,Bedford Hills, Water Suoaly: Public Supply From Address NY or: x Private Supply Drilled by P.F. Beal & Son Address 4 Putnam Ave. Brewster, NY 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. L: : ice: � ...... ,....., �:�.,.> : , ._:'...... �.... Signed: Address 113 S, R.A. Date /1//,? o I License # D 7 / Z (v 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 ons ered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. p oved fo scharge of domestic sanitary sewage only. By: Title: Date: Z 6 V- I White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # Well Location: Street Address: Town/Village Tax Grid # Lot 11 Cushman Road Patterson Map Block 1 Lot(s) 4B Well Owner: Name: F &R Development Address: 6 6 Argyll Avenue . New Rochelle, NY 10804 Use of Well: X 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 5 gpm # People Served 4 - 5 Est. of Daily Usage Lo 0 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling X New Supply (new dwelling) Deepen Existing Well Detailed Reason Single family residence. for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No X Is well located in a realty subdivision? ...................................... ............................... Yes X No Name of subdivision Mutchnik, John Lot No. 4B Water Well Contractor: P. F. Beal & Son Address: 9 Putnam Ave. ,Brewster, NY Is Public Water Supply available to site? .................................. ............................... Yes No X Name of Public Water Supply: - Town/Village - Distance to property from nearest water main: Miles Proposed well location & sources of contamAation)# vid e n separate sheet/plan. Date: 05/21/01 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. Vy revision or alteration of the approved plan requires a new permit. Well to be constructed by a water el I driller certified by Putnam County. Date of Issue �� Permit IssU icial: Date of Expiration o Title: Permit is Non - Transfer a 1 White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 KEANE COPPELMAN ENGINEERS, P.C. CIVIL & ENVIRONMENTAL CONSULTANTS 113 SMITH AVENUE - MOUNT KISCO, NEW YORK 10549 December 24, 2001 Mr. Shawn Rogan, Public Health Technician Putnam County Health Department 1 Geneva Road Brewster, NY 10509 } RE: Proposed SSTS: F &R Development Cushman Road, Lot 4 (T) Patterson, TM# 13. -1 -11 Dear Mr. Rogan: (914) 241 -2235 We are enclosing herewith three (3) copies of the Sewage Disposal System Plan as well as a revised Construction Permit and design data sheet for the above referenced application. The following items have been addressed as per your memo dated November 27, 2001: The construction permit indicates the proper tax map number, trench length of 900 feet, and the siphon chamber. 2. Roof and footing drains are now shown on the plans. 3. Soil information has now been provided on the plan. 4. A site map, datum reference and erosion control has been shown on the plan. 5. Property Line metes and bounds are shown on the plan. 6. Separation distances have been shown on the plan. 7. A distribution box detail has been provided. 8. The plan now reflects 1' -6" fill over the entire ssts area. Should you have any questions regarding the above, don't hesitate to contact me. Very ly rs, Peter J. Greg P. g rY, Department of Environmenta_I Protection 465 Columbus Avenue Valhalla, New York 10595 -1336 Joel A. Miele Sr., P.E. Commissioner Bureau of Water Supply Michael A. Principe, Ph.D. Deputy Commissioner Tel (914) 742 -2001 Fax (914) 741 -0348 �uRK Ci7Y o/ INMENTAL Flt__ { www.nyc.gav /dep 018i DEP-HELP February 1, 2002 Robert Morris, RE Putnam Co. Health Dept. 4 Geneva Road Brewster, NY 10509 Re: F & R Dev./ Mutchnick. Lot 4B Cushman Road Patterson, Putnam DEP Log # 12151 (Joint Review) Dear Mr. Morris: This letter is to inform you that the New York City Department of Environmental Protection (Department) has determined that the above - referenced application is complete. In addition, the Department has no objection to the approval of the above - referenced regulated activity. This determination is based on the review of submitted documents including the plan titled "SSDS prepared for F & R Development Corp. ", dated 5/29/01, and last revised 12/04/01. The applicant must contact Sissy De La Ossa of my staff at (914) 773 -4416 at least 2 days prior to the start of construction of the SSTS so that a Department representative may inspect and monitor the installation. Sincerely, Margaret Lloyd, E. Supervisor Engineering Design & Review xc: James Covey, P.E., NYSDOH BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH I 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 November 27, 2001 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 Peter Gregory, PE Keane Coppleman Associates 113 Smith Avenue Mount Kisco, New York 10549 l:Za Dear Mr. Gregory: Proposed SSTS - F & R Development Cushman Road, (T) Patterson TM# 11-1 -11 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 new construction permit application with the proper tax map number (11- 1 -11), the proposed trench length of 889 feet, and the siphon chamber. 2. Show the location of footing and gutter drains. 3. Provide USDA soil boundaries. 4. Provide a site map, datum reference, and erosion control measures for the construction of the house, well and SSTS. 5. Provide the property metes and bounds. 6. Separation distances are to be provided on the plans. A. 10 feet from the septic tank to the foundation. B. 50 feet from the septic tank to the well. 7. Provide the distribution box detail for the proposed dosing system. 8. Design data shows mottling at 4' -6 ". This will require a minimum of l' -6" ROB fill over the entire SSTS area. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Sincerely, ec Shawn Rogan Public Health Technician SR:cj 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 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 , WIC (914) 278 - 6678 Fax (914) 278 - 6085 Request for Status of Joint Review Project Date // / /6 / 01 On ��� �v� an Individual SSTS Construction for e— uS W"t) was deemed to be complete. Pla s were forwarded to the New York City Department of Environmental Protection for review /comments /approval as required for joint review projects. Under the Watershed Agreement a determination must be made within 20 days after an applicants submission is deemed complete. At this time the 20 day period is; 1) Almost over Has past ' A determination has not been received by this Department. It is important that you notify this Department as to the status of this project. Please respond by fax (914) 278 -7921, or call Robert Morris, P.E., Senior Public Health Engineer at (914) 278 -6130 ext 166, at your earliest convenience. Thank you, in advance, for your assistance in this matter. dep fax# 773 -0343 PUTNAM COUNTY DEPARTINIENT OF HEALTH DMSION OF ENVIRO\11E\TAL HEALTH ] ` LN- DIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHE T FOR CONSTRUCTION PERMIT NAIAE OF OWNER: f "'` STREET LOCATION: d REVIEWED BY: R`L GR, AS &ATE: °2'f TA-X t iAP : (CONFIRMED) y N DOCUMENTS // 'Y Ni (REQUIRED DETAILS ON PLANS CONT'D) (ZLJ.PERMIT APPLICATION iii _ �/Q ' (�(UHOUSE SEWER - Y." FT. 4 "0'; TYPE PIPE CAST-IRON LZ(•UWELL PERMIT OR PWS LETTER (tUUNO BENS; NLAX BENDS 450 W /CLEANOUT ( _JUPC -97 RENEWALS UULETTER OF AUTHORIZATION C ~ UUSTTE NOTE XC�RANGE) (�)UDESIGN DATA SHEET (DDS) �Sa % I S EI S (f�UCORPORATE RESOLUTION -�� LUU10' HORIZONT. ST T ENCH SLOPES 3:1 TO GRADE (�USHORT EAF (U )FILL SPECS/ FIL NOT 1 -5 LAUPLAN, S -THREE SETS LU(__)FILL PROFILE • D i NSIONS (,U(/)HOUSE PLANS - TWO SETS C)(�FILL I\ EXPANS N AREA UUVARLkNCE REQUEST SUBDIVISION 4V2 EE LJ ULEG.A,L SUBDIVISION UU CLAY BA UUFILL CERT tES NOTE (fUUSUBDIMION APPROVAL CHECKED (�UDEPTH GA _)PERC RATE 1 L,ULUV0L. ON P O.B., UNCLASSIFIED & IMPERVIOUS UFILL REQUIRED DEPTH __)SEPARATIOCE FROM TOE OF SLOPE (_J(UCURTAIN DRAIN REQUIREI) GENERAL , - {�}(__JLOCATED L`i NYC WATERSHED Vj( JPLANS SUBMITTED TO DEP L U(,,6DELEGATED_TO PCHD UUDEP APPROVAL, IF REQ'D r 1° ( g)UDEEP TEST HOLES OBSERVED N�M ()U0 (UPERCS TO BE WITNESSED (�UU )EX APPROVAL SSDS ADJ, LOTS WETLANDS (TOWMDEC REQ'D ?) (�UDATA ON DDS PLANS •PERK SAME ( _J(�PRE 1969 NEIGHBOR NO CATION (�( )LETTER BI/ZBA (-J(�/ 100 YR FLOOD ELEVATION WQ 200' U(__)SOIL TESTING LOTS >10 YEARS OLD REQUIRED DETAILS ON PLANS (.�LUSEWAGE SYSTEM PLAN - (NORTH ARROW) (l USSDS HYDRAULIC PROFILE (ZU(,UGRAVTTY FLOW (')(__)CONSTRUCTION NOTES 1 -15 (IU(_JDESIGN DATA: PERC & DEEP RESULTS _)2' CONTOURS.EXLS -MG & PROPOSED (_DRIVEWAY & SLOPES, CUT (�(!)FOOTlNG /GUTTER/CURTAINDRAINS (� < USDA SOIL TYPE BOUNDARIES' ( j0 C_)(UTITLE BLOCK; OWNERS NAME ADDRESS TM;', FE/RA; NAME, ADDRESS, PHONE# (,Z( _JDATE OF DRAWING/REVISION _JDATUM REFERENCE (,v(___)LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. (�)LUPROPOSED FINISH FLOUR AND BASEMENT ELEVATIONS (_/J (SWELLS & SSDS'S WAIN 200' OF SSTS ( _J(_!�)PROPERTY METES & BOUNDS COITiIENTS: (,6 U TRENCH D .. . ?� 60FT MAX. (1UU,PARALLELT0 CONTOURS WU100% EXPANSION PROVIDED " rL JDETAnMUST FREE CRUSHED STONE OR WASHED GRAVEL UGEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS tH20'TO 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL FOUNDATION WALLS 100' TO WELL, 200' IN DLOD,150' TO PITS Z ( (_)100' TO STREAM, WATERCOURSE, LAKE (mc- ezpaa) U/)LU50' TO CATCH BASIN, 35' STORIwIDRAIN, PIPED WATER (e::�)LU10' TO WATER LINE (pits - 20') (/)U)50' INTERMITTENT DRAINAGE COURSE - L%LU200' /500' RESERVOIR, ETC. -150' GALLEY SYSTEMS (fjU10' TO LEDGE OUTCROP 0M FOUNDATI ; 50' TO WEL (UUDIIIIENSIOYS:TO.PROPERTY LINES - _- — - -- - - -- -)LOCATION OF SERVICE CONNECTION_._ (�U11Pi 15' TO PROPERTY LINE - - / SLOPE C/-)C-)SLOPE IN SSTS AREA _&j(S20 ° /a) � LU(4)REGRADED TO 15 %, IF REQUIRED cif "fin"` DOSE/PUMP SYSTEMS (/)(DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED FO IN (PIPE TYPE, ETC.) - OX_`SHOWN &`D AILED �1 DAY ARbi '_(_(_STANDPIPES, 5'N UL U15' bIL'i to CDS= >! UU20' ML`i to CD DIS LUU10' MIN to NONi , 25'-3%,35'-l%, 100%-<I% P' with 182 cons day discharge ED PIPE . (REYSHEET) Ali,� Department of Environmental Protection 465 Columbus Avenue Valhalla, New York 10595 -1336 Joel A. Miele Sr., P. E. commissioner Bureau of Water Supply Michael A. Principe, Ph.D. Deputy commissioner Tel (914) 742 -2001 Fax (914) 741 -0348 DEPARFIIF www.nyc.gov /dep� (718) DIP-HELP November 13, 2001 Robert Morris, RE Putnam Co. Health Dept. 4 Geneva Road Brewster, NY 10509 Re: F & R Dev./ Mutchnick. Lot 4B Cushman Road Patterson, Putnam DEP Log # 12151 (Joint Review) Dear Mr. Morris: The following information is necessary to complete the above - referenced application: • Delineation of the USDA soil boundaries; • Site location map. Please note the following comments regarding the system design above referenced: • The profile indicate approximately 1 1/2' of fill. This must be clearly labeled in the drawing. If a 30 " deep trench is used, the fill must be increased to provide adequate separation to the observed mottling at 4' 6 "; • The engineer should consider keeping the primary and expansion areas as two distinct areas, not divided into many parts. If you have any questions regarding this matter, you may contact me at (914) 773- 4416. Sincerely, Sissy De La Ossa Assistant Civil Engineer Engineering Design & Review xc: James Covey, P.E., NYSDOH 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 October 26, 2001 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 Peter Gregory, PE Keane Coppleman Associates 113 Smith Avenue Mount Kisco, New York 10549 �r Re: F & R Development, Cushman Road (T) Patterson, TM# 11-1 -11 Reservoir Basin - East Branch Dear Mr. Gregory: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on June 1. 2001 is complete. The Department will notify you by November 15, 2001 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. 0 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 would 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 New York City Department of Environmental. Protection Watershed Rules and.Regulations. Ifthe Department fails to notifyyou 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 DEP review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 =6130 ext. 2159. Sincerely, q52, Shawn Rogan Public Health Technician SR:cj KEANE COPPELMAN ENGINEERS, P.C. CIVIL & ENVIRONMENTAL CONSULTANTS 113 SMITH AVENUE - MOUNT KISCO, NEW YORK 10549 October 19, 2001 Mr. Robert Morris, Senior Public Heatlth Engineer Putnam County Health Department 1 Geneva Road Brewster, NY 10509 RE: Proposed SSTS: F &R Development Cushman Road, Lot 4 (T) Patterson, TM# 11;14H' Dear Mr. Morris: .END (914) 241 -2235 We are enclosing herewith three (3) copies of the Sewage Disposal System Plan as well as a revised Construction Permit and design data sheet for the above referenced application. The following items have been addressed as per your memo dated June 19, 2001: 1. The construction permit has been completed to include the subdivision information. 2. The tax map number has been corrected. 3. Testing was observed by a representative from your office only 31, 2001. 4. The design data sheet indicates the drainage basin as Hudson. 5. Trenches remain spaced at 7' -055 . Should you have any questions regarding the above, don't hesitate to contact me. Very truly yours, P.E. Peter J. Gre , i 20 740.45 3.71 P/0 3-1-22 - - 170.56 rsz.7s 183 170.47 + ° 6n.o6 ° ° AC. a 24 ' s 3/0 . X28 29200 P/0 3 iNAD i a► 1 AC. I-p 7.97 319.09 235.34 # 25 26 27 s 1.� ° 3�4 / N 38 : P/0 3-1- I-- - ° . 23 ac. / 2 °I /, �. so 19 .4.e 22.2 , 23 . 1019.x5 H,CL ACICA 2.27 1.88 �l�c48 z/ �a°u 3.65 AC.4� I ' \6q IBO 7 =9 r� C. CAL 2p0 1.84 AC `6 !ss zzo 160.2016'.'6 / ` 41 40 L4si4Ce• 23 , 1 r� 4 42 425 „ 44 a 4 386.09 §a 4 e 2.67 AC. 2-q 45 ° . ��,v r q 216 CAL AC. a,ozaC \471 4fi 1 761.65 41 40 a r 1 a ac CAL. 23zz7 48 7y 4 1.14 1.50 A' AG. G x , 8' ° 138 :�1 $ 46 n 1.46 AC. 200, f y N � 1.2�AG $ L: 51696 ALA x6536 dy0 AGC r.1 95 I 5.41 AC 37° 9°+69 9.86.4C. 1.13 Atad 2 12 AC. lye a 1>t "0 I . a "� 2.2 n e0T.1z ac. aC. , -34 .,.,. 2 n CA 3.99 AC. 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L01 • l23 AG i� 1.29G 1 \ y ' 15.2 w 13 3.36 AC 6 20` AC. 5.41 AC. ao 40956 g2 °56 2 \s B 2 06 AC � � 53 T5 '. s 9 523.2 9 54 2615 4C. 0 79 L68 17 ¢ 8 /�1a 55 6.21 AC. CAL. 8 l « ! J 10 , «s L45 AC. CAI/. 290.65 50 96 AC. 1.71 AC. q28 5 15.4 15.3 ° 5.24 AC �Sv'4,1.5+AC. 366.56 Y 2Tt?° 7 •. AC. ' 3 L93x z.oe 5.59 AC. 8o7.A4 n l 88 eC. 62209 1 - \ AtZ 57 _ t ! recd' I 4.69 AC. �x °`°58 23 1 y? ; 1.94 ACX R / yo\ 4.95 AC. Aso ?x59 ,�, 27.52 Af/ Iszso 26 / I / •'��� 4p \�� .B6 AC ° rj -\ !/- 25 , 1.44 AL. a 1 5.35 AC. CAL. I! 38.34 v� I // , r 26 x 56 ,\ 578.2 +612: � C / 2.0 AC O 58 a i Y ~ / / O 61,1 In To y 4 %Y 7.47 AC. � O �� 167. ./ I / / / xo°o // x 1 st eoxx 194.1 mg / = 32 9145 / ' n 21 2.7 AC. I / 33.35 22.2 '� 3p4.66 250 20.89 AC. 20 60 4 4.73 AC. 8 61 :s '�•-� 426. T9 I �'e3• s. 1 /V 4.r ��1 62 8 6 1 45.54 AC \ 19.86 AC. �soo 40235 18 19 AC ��� -• -� ` 19 $206 AG .1 } 4.12 10 + , _ s 39&44 f 1 i , ',y 16.64 AC. g 17 It. x 1 SAC. 11 I A ` 18.92 , 11 .' 1.00 E' AC. a 16 8 +na0 r CAL. 1.73 AC f.W 4G� 1 454.22 / 1 i es..A 63 7 AC_ ' 1 1 I 690.96 1.7 , e I uQ Ile ey.s 11.10 AC. CAL. 3" l N 3.2 1578 AC 1 64 1.883„AC.1 13 10.58 AC. CAL � o § 1.59 AG, 1276.010) .`1 042 65 0 2 ° z83 I AC . °lm � i( 1 e a 9.78 . 12 Q • / 18.884C. \ � . { 66 2.3:, PUTNAM COUNTY DEPARTMENT-OF HEALTH- DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address c&!5#.,fAA1 Located at (Street) ;, A, &�y j�, 41 j Tax Map iz Block. Lot 1,,z (indicate nearest cross street) Municipality P Watershed SOIL PERCOLATION TEST DATA Datebf Pre-soaking -7 Date of Percblation Test -7 J 3 /,/o A 01/ percolation test hole. (i.e. :5 1 min for 1-30 min/inch, :5 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 to- from Ground W, .2. Water Level .... Percolahai� ....... T* rface'll. ii es. X... ............ Stop : Start ........... I?rop In Inches Rate I nc 0 731 0 X oe 'y - 2 V 3 3577— 417 7 Xq 4 5 a,,/ 2- 30 � — 2 4 3 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 for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97. Indicate level at which groundwater is encountered Indicate level at which mottling is observed .' . -.lo -: -:_ �_ "_.: . - ? © /e.; Indicate level to which water level rises after being encountered Deep hole observations made by:. e t i) f-t , Date 7 ,Design Professional Name: Address: Signature:. Design Professional's Seal TEST PIT DATA -DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES , DEPTH HOLE NO. HOLE NO. Z5 HOLE NO. G G.L: 0.5' 7''raCe 7Z_j. 7,�i^ctc� 7; 5, Trace 1.0' 2.0' E/ae__,5aa1v lea 2.5' { 3.0' 3.5 73 r 4.0' 5.0' 5.5' 6.0' 7.5' 9.5' 10.0' / Indicate level at which groundwater is encountered Indicate level at which mottling is observed .' . -.lo -: -:_ �_ "_.: . - ? © /e.; Indicate level to which water level rises after being encountered Deep hole observations made by:. e t i) f-t , Date 7 ,Design Professional Name: Address: Signature:. Design Professional's Seal I acknowledge receipt-.of this _report: , SIGNATURE,' 02/96 Title Rev. , PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Projects Mu rGUU1e k %, County -RU rl%mM Site Location C-y5fi/►1/ �1 ?Zd , /�I = j� — l / f Levi¢ 4e, Building construction begun A/a Extent Is property within NYC Watershed ? ................. Yes No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. Hilly 0 Rolling a Steep slope ffGentle slope F] Flat 2. F--J Evidence of wetlands Q Low area subject to flooding Bodies of water ` F--J Drainage ditches = 0 Rock outcrops 3. Yes., lines or corners evident ..................... o �xr����(....... d Yes a No 4. Do water courses exist on or adjoin the property? ..................... 5. Will these affect the design of the sewage system facilities ?...3Y... ice, dYes 0 No 3=-r8 A K 6. Do watershed regulations apply in this development ? ....................... dYes No 7 Will extensive grading be necessary? ........ ....................... I................ Yes �No 8. Will extensive fill be necessary for SSTS? ......... ............................... Yes No 9. Do filled areas exist within the SSTS area? ........ ............................... a Yes �No If yes, what is the condition of the fill? SECTION C. -SOIL OBSERVATIONS _ 10. Appearance of soil: Sand Gravel �oam Clay 0 Hardpan Mixture 11. Observed from: a Borings ED Bank cut Backhoe excavations 12. Soil borings /excavations observed by �, 7� Env `P. c 7�!-f . on 7 Q 13. Depth to groundwater A/D N E on 14. Depth to mottling ' ( "a��" on 15. Are test holes representative of primary & reserve areas ... :................................. 16. Soil percolation tests made by ,J<Egm6 6oJ7P ,-J-eJ 1 j Nf on 17. Soil percolation tests witnessed by 4, QED ?I G, D., L on SECTION D (on back) 0 Form ST -1. 0 m 6 SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas?[ Yes dI 19. Will groundwater or surface drainage require. special consideration? ..................... 0 Yes RNo o 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? .............. ............ a Yes SECTION E. REMARKS 21. • If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities? ............................... ............................... F__J Yes ©No Inspection data 22. Do adjacent wells and/or sewage systems exist ?......... ?tl. 23. Additional comments Tl.N .. .............. Yes No _ 24. Site observer /inspector and title A 25. Date(s) of observation(s)inspection(s) 3 1 /a TEST PIT PROFILES Hole # Lot # Hole # Lot # - Hole # - Lot # Depth to water Depth to water Depth to water Depth to mottling Depth to mottling Depth to mottling Depth to rock/imp. Depth to rock/imp. Depth to rock/imp. G.L. G.L. - G.L.. 0.5 0.5 0.5 1.0 Lo _1.0._ - - -- 2.0 2.0. 2.0- - 3.0 3.0 3.0 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 ' 9.0 10.0 10.0 10.0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner. F &R Development Corp. Address 66 Argyll Ave. New RnchP11P,Ny tl Located at (Street) Cushman Road Tax Map �kb, Block 1 Lot as, (indicate nearest cross street) Municipality Patterson Drainage Basin Hudson SOIL PERCOLATION TEST DATA Date of Pre - soaking. 30/01 Date of Percolation Test 7/31/01 Hole No. Run No. Time Start - Stop Ela se Time Min.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 1 1 1:40 -2:10 30 233/4 - 243/4 1 30 2 2:12 -3:12 60 233/4 - 25 1 1/4 48 3 3:17 -4:17 60 233/4 - 25 1 1/4 48 4 5 2 1 1:42 -2:12 30 22 - 231/4 1 1/4 24 2 2:13 -2:43 30 22 - 223/4 3/4 40 3 2.44 -3.44 60 2 4 5 1 2 3 4 5 NOTES: 1. 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, 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 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' 2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. 1 HOLE NO. ' 2 HOLE NO. 3 Med. Br... Fine Sandy 'Med- jar, Fin Sandy Med. Br. Fine Sandy Loam Loam Loam _Med. Br. Semi -Comp Fine Sandy Loam Med. Br. Semi -Comp Med, Br. Semi -Comp. Fine Sandy Loam Fine Sandy Loam Mpd _ Br_ Semi - c'_nmp Fine Sandy Loam w /trace of mottling Med. Br. Semi -Comp Fine Sandy Loam w /traces of mottling Indicate level at which groundwater is encountered NA Indicate level at which mottling is observed NA Indicate level to which water level rises after being encountered NA Deep hole observations made by: Keane Coppelman Engineers Date 7/00 Design Professional Name: pPtpr T- c;rPcjnrU Address: 113 Smith Avenue Mount Kisco, NY 10549 ;, j ' _ Signature: Design Professional's Seal A, u1 iuc t.-1't AT; BRUCE R. FOLEY Public Hauhh Dimmer runtnt.s :� t-NV HEALTH Fi;% IY. 19I42 787921 Y. I o ti Y DEPARTMENT OF HEALTH I Genova Rand Rrewstw. New York I0SQ9 LORRITA MOLINARI R.N.. M.S.N. Aneelea Public HOWSA Dbwcror Dlmtar qr PaAew Serw"$. ATT]EMON: ADAM STIRSMING 4GENE REED AD information below must be ftit, completed prior to any scheduymg. DA's; 6/25/01 ENGINEERORFIRM: Beane Coppelman Engineers PcpgpNEll: 914 -201 -2235 REASON: DEEPS. B PERM. l0 PUMP TEST: 0 ROAD!STREET: Cushman Road TOWN: Patterson TALC MAP#: 13 -1 -11 6 SUBDIVISION: Jaex Mutchniek tOT #-. &-,c_ tam OWNLR: FiR Development YES NO a W PropmedSM wftWx the drainage basin of West Branch or Boyde Corner Rewmirs. V a yQ, Proposed SSTS within 300 feet of a reservoir, reservoir scans or control Woe. o Proposed SSTS within 200 fat of a watercourse or a DEC wetlanA D- yL Proposed SSTS design flow greater than 1000.gagensiday or SPDES Permit required. o % Proposed SSTS for a Coma►erical Projea It is the resp**Abilety of the design protodonat to provtde the above Warmation prior to soil testing. This Department well deterudne the NYCDEP project status (Joint or DdegM4 based on the response- If yon answered yes to any of the questions, NYCDEP mast witness the soil testing. Thu Department will coordinate a matuaily suitable time for field testing wM the PCDOH, thh Design Professional and NYCDO. If a project has ban determined to be Delegated based on the above response and then subsequent infornwtion indicates NYCDEP to required to witness the soil testing, it wtil be the sole respons9ft of the design protasional to schedule re wisnasing of the sod testing with NYCDEP. WOK count' CSr.ONLY DATR, / 3 v . 3�0 TIML: '713Z Q- Z r 3 0 AM r Y,4 S 7:: /Zor V10a S 7] °-mss i IMgq 10"d dZO =TT TO -TO -LAC BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOMNARI R.N., M.S.N. Associate Public Health Director Director of Patient Services REQUEST FOR FIELD TESTING ATTENTION: 4 ADAM STIEBELING GENE REED All information below must be fully completed prior to any scheduling. DATE: 6/25/01 ENGINEERORFIRM: Keane Coppelman Engineers PC PHONE #: 914 - 2412235 IU V: YIl, DEEPS: 6 PERCS: N PUMP TEST: ❑ ROAD /STREET: Cushman Road TOWN: Patterson TAXMAP #: 13 -1 -11 • SUBDIVISION: Jack Mutchnick LOT #: R. S _ 4,B OWNER: F &R Development NYCDEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING YES NO ❑ ❑ Proposed SSTS within the drainage basin of West Branch or Boyds Corner Reservoirs. ❑ ❑ Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. ❑ Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ ❑ Proposed SSTS design flow greater than 1000.gallons /day or SPDES Permit required. ❑ . ❑ Proposed SSTS for a Commerical Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered yes to any of the questions, NYCDEP must witness the soil testing. This Department will coordinate a mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. FOR COUNTY USE ONLY DATE: COMMENTS: ev (FIELDTEST) TIME: 1 9 4re • \ Denton .-.1 F101 8 . ^►- \ \ . lake ` 292 F631 r - a ..'Solomon est Coll ac o. �.. w lake sa w ^.� L gtonvill Brews t.L ES 4 'bo Ponde X?:.ry \ .v t °j 1 `� °yo Lak AD c 1' 12531 -_.. 2 __— .__•- -._- •`Yale _ .. .... ,. � ` ,. 64 v)j t Book Corner a 1 311 1 'i a i .. _ S.C. ESO 52 �{ 64� � J OWII F�U� ` � � j i � WA 9 / I 164 May E 1 e s Corn I 3 ,3 $ - --- . .. -- P - { _ Town - --� 311 � 19 62 A d / pis v � - a ICar 4 6 FoY Q ¢ V §'w E Pond t\ ' I d _ g ru 5 1: mo Sri P i / BFI rners 64 44 HS . g 48 a end. 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X1.46 AC, g e o 9.86 AC. ?34' �+`'0 •'q7 °?,! o seo• +° 140 AC.p 47 1.50'1L..7 aG c . I . a I tF o rn 90A.69 4� . , ►, i .33 ° 1.95 .1 1.80 -5.12 IAC.CAL. 3.99 AC. CAL " - 44 1 Al « ''•1.12 A if 1 3.4AC. p pG nc. 0 � S 48 $ AC. 1s • ., e9 , 32 1. a .v •. 607.12 Dk CFAL q, r "� 37 016 Z6 . as a •a \ ° gi°• p ae ,Q � a 5Q Izo 360' b AGCA: 36 Ng3.64 AC. CAL. 49 " o s58AC. 1.68 r, 1.60 .0x ;G 1.9 AGCAL ` 606' a AC. 90 91 a �, `19 e 51 s y ,• �,� 35 3.3 AC. CAL. �� s c, I.o3 1.12 164 ac.�° .30'0 4.09 AC. 4a?" SAC.. w° »34 $ a21.96 0 8T °r t� ►ao �AC. 3 I I. ?G AL. d` 295 A o 9j s 13.83 AC. CAL. o N -211 accAL!, \x3.59 AC40CA S.o1AC 16 0%}I 'zi o0 8 . b `°c 161• 51 S 65 a� yr4 s s� 405. 33 Pn AC. / I $1.93 AG 5.12 oti .05 AC Iq �6, gym, zi 2 :222 AL.CAL gen F, �61e93 26 u4AC. 1.25 w \ Cpl ) 52 zz s e 32 4� . 4 C. CA ac. B4 , 5 29 3 0 SILK 8 52 - 81 S° 82,2 103A 1.27 AC. ^� .� �oA•, 6 y► 201' n 3.8 AC. CAS^' 6* 3.50 C. 216 AL.CAL N °5 53 x A,v 497 , g `!6 2.34 1.72 83 „ s • 1.29 �C,` r' .24 v °'6 15.1 J 462 AC. 120.10 43A19 39591 iJ�� *���1.8T/AG Y.�jd $�Gte1`e 30 P� ' 4.67 �C. zCAL. 8 AC. AC. 1.44° x123 ACN a� 9` 12 11a 9, •y' $q �j $ ,1.4 .`� 6 r' y I T I2 s II +r, ad'' zi Ac.cA 53 ., 92 .« • ie 1.2Q� AC. Ise 13 3.36 AC. 2.06 �, .� 5.0>9'AC. a6 "654 z� . 2675 AC. 8 .i 79 t68 028 � 202 AC- 5.41 AC. 15 1! 300.6 '' s°A' ' G. AC. CAL. $ - 96 AC. 1.71 AC c" 2 xe y a 3aee 55 y ° 2.45 AC. CAL. 290.65 P all qo •. AC. B8 �1C. I . �� i 8 • 5.2 AC e^ 1.44 A M4 15.3 5.59 AC. e01.A4 J _ _ \ $b�; , 57 at101 a 23 ' r ..» G 193aC 208 26 ' .g j.+ / C. � °�58 69 A , 27.52 A . Iszso n - gat° �/ 25. 1.aa ac a - J'' �.• � , 9 p\ 4.95 AC. 15C -� 59 � •� .X 6' p in 8 firo.09 CA 66 AC 61.`'19. •./ �� 2� S 600.00 7 J / / X5.35 AC. CAL. ^ 'rol.04 ° 7.34 /, / `� 510.2 °6IZ ' 58 « 6.49 AC. �• / •.2.0 AC. p ' Z. a 633.16 CAL. AL , / 1 163.20 163.0 °0.o6.6s 1 / / O 1ga 19 59 7.47 AC. ° G e 5 / 1 193.4] r a�..0wx 1 21 o f r 21.97 AC. 103.86 AC. ' CAL. ssalx �'+ 2.7 AC. L ' 30 xs0 22.2 66 20.89 AC,_.. 20 :' 60 1 / 4.73 AC. S za S 1 1 / / / --../ _ •� •• 426.79 1 Z3 02 02 1 &99 / J••� •,'f. 62 , 4: 6cs.°6 a0z]s /,�.. •�` e ^ I N 506.62 206 I 1 \ tic 19.86 AC. 18 19 2.06 AC." I' 6 1 I . rae. 217.°2 i �, 10 . r'�1 16.64 AC. ° I so °nc ^' ..tl 1 63 BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 FAX COVER SHEET Date: 7A to / To: Sissy De Za ©sscr- From: Gene D. Reed Putnam County Department of Health ,,/For your information For your review As discussed Fax #: 7 7 3 ° © -3 No. Pages (Including cover sheet) Xplease respond Attached as requested Please call Notes/Messages / Gy s H M.�/✓ 10 ' In the event of transmission /reception difficulties, please contact this office at (845) 278 -6130 ext. 2261. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of F &R Development Located at Cushman Road TN Patterson Tax Map # _ 13 Block 1 Lot 11 Subdivision of Mutchnik, John Subdivision Lot # 4B Filed Map # 2 2 0 7 Date Filed 01/30/87 Gentlemen: This letter is to authorize Daniel P. Coppelman a.duly licensed Professional Engineer '_ or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Countersigne P.E., R.A., # Mailing Addi ;fit. �j���`r�. �t'�TEfV(J�•' :O, N.Y-'1650 _ State (914,) 241 -u35. P r. Telephone: Very tru yo , Signed: �� " (Owner of Prope Mailing Address: 66 Argyll Avenue New Rochelle State NY Telephone: Zip (914) 632 -3046 10804 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner F &R Development Corp. Address 66 Argyll Ave -, New RnnhPlle,NY Located at (Street) Cushman Road Tax.Map 13 Block 1 Lot 11 (indicate nearest cross street) Municipality Patterson Drainage Basin Hudson SOIL PERCOLATION TEST DATA: Date of Pre - soaking 7-19-00 Date of Percolation Test 7-20-00 Hole No. Run No. Time Start - Stop Elapse Time (Min.) De )th to Water )rom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 1 2 0.47 -10.50 3 8— 1 3 0:55:11:01 6 17 -20 3 2 4 1:04 -11:15 11 18 -21 3 4 5 1 2 .,11: 16-11: 32 16 14 -17 3 5 2 3 11:40 -11:4 8 18 -21 3 3 4 11:53-12:1C 17 18721 `3 6 5 12:12 -12:3 18 18 -21 3 6 1 2 3 4 5 _J -L NU I Lb: 1. . lests to be repeated at same aepm unm approximatny uquai pCrwIauvu 14wa euv VULQAI_...,.... 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 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. 0.51 organic 1.01 1.51 2.0' 2.51 3.0' 3.5' 4.0' 4.5' 5.01 5.5' 6.0' 6.5' 7.0' 7.51 8.01 8.5' 9.01 9.5' 10.0' Brown..Mod. Comp. Loam W/Cobbles HOLE NO. - 2 Organic Brown Mod. Comp. Loam W/C6bbles HOLE NO. 3 Organic Brown Mod. Comp. Loam W/Cobbles 2 c2o M :Z-0 Cn C- C: Indicate level at which groundwater is encountered NA Indicate level at which mottling is observed NA Indicate level to which water level rises after being encountered NA -7 Deep hole observations made by'.Keane coppelman Engineers Date -A 7 lbo L Design Professional Name: Daniel P. Coppelman ro Address: 113 Smith Avenue Mount Kisco, NY 10549 Signature: Design Professional's Seal KEANE COPPELMAN ENGINEERS, P.C. 113 Smith Avenue J MOUNT KISCO, NEW YORK 10549 (914) 241 -2235 • DATE (P Z & O/ JOB NO. ATTENTION 0,6aR r DESCRIPTION AN �A Q E 25�/v tv P4As4J d'Aa /cd WE ARE SENDING YOU Attached ❑ Under separate cover via the following items: > ❑ Shop drawings & Prints ❑ Plans ❑ Samples ifications D ❑ Copy of letter ❑ Change order ❑ -a, COPIES DATE NO. DESCRIPTION P4As4J d'Aa /cd Dq ,4 THESE ARE TRANSMITTED as checked below: m4 ®r approval • For your use • As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS COPY TO • Approved as submitted ❑ Resubmit copies for approval • Approved as noted ❑ Submit copies for distribution ❑ Returned for corrections ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED:. ff enclosures are not as noted, kindly notify us at m KEANE COPPELMAN ENGINEERS, P.C. 113 Smith Avenue MOUNT KISCO, NEW YORK 10549 P1, (914) 241 -2235 To _ -T e r baip4 � TM F N i ei✓1A/ L�1EVVIER J LJ o e UVIWLJ ���L� -�!� DATE 5 a DATE JOB NO. ATTENTION 1 RE: AX 0,- a `it 5.51-5 WELL c/f C:,sij/4.7 , N kb Lo— 1 o F /% -' ?rs't 5 O)v P� - WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items: • Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications • Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION 1 WELL c/f DOS iv pA AC 4—T P� - OA o 7� 0,L &,- Drs G cl{c arc 0- !L303095 THESE ARE TRANSMITTED as checked below: / For approval ❑ For your use ❑ As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS COPY TO • Approved as submitted • Approved as noted • Returned for corrections • Resubmit copies for approval • Submit copies for distribution • Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: C✓ if enclosures are not as noted, kindly notify us at once. R BRUCE R. FOLEY Public Health Director r LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early. Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 June 19, 2001 Keane Coppelman Engineers 113 Smith Avenue Mount Kisco NY 10549 RE: Application to Construct a Subsurface Sewage Treatment System at Ferreria Cushman Road, Lot #4 (T) Patterson, TM# 11 -1-4B . Dear Mr. Coppelman: The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on June 1, 2001 is incomplete. Please be advised that the following information is required before the Department may commence its review. • Construction Permit has not been fully completed, i.e., subdivision data has not been noted. • Tax map number appears to be incorrect, revise accordingly, on all documents (enclosed). • There is no record that a representative of this Department witnessed soil testing. Please be advised that a New York City Department of Environmental Protection will have to be present. • Design Data Sheet notes incorrect drainage basin. • Please be advised that in Putnam County, trenches can be designed 6 feet o /c. The review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information as to the completeness of your application. Please be advised that failure to submit information to the Department or to follow procedures is sufficient grounds to deny approval, pursuant.to the New York City Department of Environmental Protection Watershed Regulations and Putnam County Department of Health regulations. Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130 ext. 2166. e&e�� Aurs, \ �� CTS RM:tn Robert Morris, P. E. enc. Senior Public Health Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # ° Located at Cushman Road 5` Town or Village Patterson Subdivision name Subd. Lot # . Tax Map Date Subdivision Approved Owner /Applicant Name F &R Development Mailing Address Renewal 11.. - Block 1 Lot 4B Revision Date of Previous Approval 66 Argyll Ave., New Rochelle, NY Zip 10804 Amount of Fee Enclosed $300.00. Building Type Residence Lot Area 2.056 No. of Bedrooms 4 Design Flow GPD 800 Ac. Fill Section Only Depth Volume Separate Sewerage System to consist of 1250 gallon septic tank and 5 0 01 f Of absorption trench, 24" wide, 7' -0" oc Other Requirements: To be constructed by United Septic Systems Address 311 Railroad Ave . Bedford Hills , NY Water Supply: Public Supply From or: Private Supply Drilled by Address 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 thgp4o. Signed: P.E. 07142-6 R.A. Address License # . Date 5 Z 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 permit. Approved for discharge of domestic sanitary sewage only. I� Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print ortype PCHD Permit # Well Location: Street Address: Town/Village Tax Grid # Cushman Road Patterson Map ll Block 1 Lot(s) 4B Well Owner: Name: Address: 66 Argyll Avenue F &R Development I.. New Rochelle, NY 10804 Use of Well: X 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 5 gpm . # People Served 4 -5 Est. of Daily Usage 800 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling X New Supply (new dwelling) Deepen Existing Well Detailed Reason Single family residence. for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ................•.............. Yes No X Is well located in a realty subdivision? ...................................... ..............4................ Yes X No Name of subdivision Mutchnik, John Lot No. 4B Water Well Contractor: P. F. Beal & Son Address: 9 Putnam Ave. ,Brewster, 'NY Is Public Water Supply available to site? .................................. ............................... Yes No X Name of Public Water Supply: - Town/Village - Distance to property from nearest water main: Miles Proposed well location & sources of contami ation be provide n separate sheet/plan. Date. 05/21/01 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 Date of Expiration Permit is Non - Transferrable Permit Issuing Official: Title: White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of F &R Development Located at Cushman Road TN Patterson Tax Map # 11 Block 1 Lot 4B Subdivision of Mutchnik, John Subdivision Lot # 4B Filed Map # 2 2 0 7 Date Filed 01/30/87 Gentlemen: This letter is to authorize Daniel P. Coppelman a.duly licensed Professional Engineer -X or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Countersigne P.E., R.A., # Mailing Addi 1 O, N.Y. 10 49 State (914) P Telephone: Very tru you , Signed: (Owner of Prope Mailing Address: 66 Argyll Avenue New Rochelle State NY Telephone: 10804 Zip (914) 632 -3046 .Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 4 . DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM - Owner F & R Development Corp . Address 66 Argyll Ave . , New Rachel 1 e , NY Located at (Street) Cushman Road Tax Map 11 Block 1 Lot 4B (indicate neatest cross street) Municipality Patterson Drainage Basin SOIL PERCOLATION TEST DATA: Date of Pre - soaking 7-19-00 Date of Percolation Test 7-2-0.-00 Hole No. Run No. Time Start - Stop Ela se Time Min.) Depth to Water from Ground Surface (Inch ' Start Stop Water Level In Inches Percolation Rate Min/Inch 1 2 0.47 -10.50 3 18-21 3 0:55:11:01 6 17 -20 3 2 4 1:04 -11:15 11 18 -21 3 4 5 1 . 2 11:16 -11:3 16 14 -17 3 5 2 3 11:40 -11:4 8 18 -21 3 3 4 11:53 =12:1 17 18 -21 3 6 5 12:12 -12:3 .18 18 -21 3 6 1 2 4 5 NOTES: 1. ; Tests to be repeated at same depth until approximately equal percolation rates are ootainea at Caal 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 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. 1 HOLE INTO. 2 HOLE NO. 3 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' Organic Brown..Mod. Comp. Loam W /Cobbles Organic Brown Mod. Comp. Loam W /Cobbles organic Brown Mod. Comp. Loam W /Cobbles 2 Indicate level at which groundwater is' encountered NA Indicate level at which mottling is observed NA Indicate level to which water level rises after being encountered NA Deep hole observations made by -Keane Coppelman Engineers Date 07 00 Design Professional Name: Daniel P. Coppelman Address: 113. Smith Avenue Mount Kisco, NY 10549 Signature: Design Professional's Seal r" -- - o 3 o D f a t cx� Cn • N c!� Indicate level at which groundwater is' encountered NA Indicate level at which mottling is observed NA Indicate level to which water level rises after being encountered NA Deep hole observations made by -Keane Coppelman Engineers Date 07 00 Design Professional Name: Daniel P. Coppelman Address: 113. Smith Avenue Mount Kisco, NY 10549 Signature: Design Professional's Seal PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: represent that I am an officer or employee of the corporation and am authorized to act for: Name of P F/2- Having offices at: Colo Whose Officers Are: President - Name: / Alf Address: (� 0 la' Vice President - Name: (JAS /1S A,60't-- Arm J Address: Secretary-Name: Address: Aw- %2tt) Treasurer - Name: <�e- !fT 1�-6 ollte Address: and that I am and will'be individually responsible for any and all aF4s of the corporation with respect to the approval requested and all subsequent acts relatin& thereto ) Sworn to before me this day of (month) - / (year) otary Public HELEN A. KING NO" Public State Of New Yo* No. 4798339 n Westchester ftNse�i Expires August 31�,�Q/ Form CA -97 Signed: Title: per-ate Seal Seal 617.20 Appendix .0 State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only Part 1 - PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR: 2. PROJECT NAME: F &R Development Permit Application 3. PROJECT LOCATION: Municipality Patterson County Putnam 4. PRECISE LOCATION: (Street address and road intersections, prominent (andmark , etc., or rov de map) T. 2000' South of the intersection of Mooney.Hill on Clusman Rd. i 5. PROPOSED ACTION IS: New ❑Expansion ❑Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: ` i Single family residence w /septic system & well. 7. AMOUNT OF LAND AFFECTED: Initially , 3 3 acres Ultimately . 3 3 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? )]Yes ❑No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? 'IbResidential ❑Industrial ❑Commercial ❑Agricultural ❑Park /Forest /Open space ❑Other Describe: i 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ❑Yes ;C)No If yes, list agency(s) name and permit /approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? )Ixes ❑No If yes, list agency(s) name and permit /approval Subdivision Approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? .-Mes JJNo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ^' 'jV L) ft�-Pu 05/21/01 (onso 4—//�A— Applicant /S me: Date: j Signature: If the action is in a Coastal Area, and you are a state agency, complete a Coastal Assessment Form before proceeding with this assessment OVER PART II- ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. ❑Yes ❑No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another involved agency. ❑Yes ❑No. C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible.) 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 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 brie: .r.T7 C6. Longterm, short term, cumulative, or other effects not identified in C1 -05? Explain briefly: W rrr2.ZD C7 rri " 4 C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly: �Q C D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTAB ISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? ❑Yes ❑No If Yes, explain briefly: E. 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. If question D of Part II was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. • Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a positive declaration. • Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Date Title of Responsible Officer . Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) 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: F &R Development 66 Argyll Avenue New Rochel'le,.NY 10804 2. Name of project: F &R Development 3. Location TN: Patterson 4. Design Professional Keane coppelmari- Engrs5. Address: 113 Smith Avenue' Mount Kisco, NY 10549 6. Drainage Basm: 7. Type of Project: X Private/Residential Apartments Office Building Food Service Commercial Institutional Mobile Home Park Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ...................................................... Type I Exempt x Type II Unlisted _ 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... No 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... Yes No 13. If so, have plans been submitted to such authorities? ........ ............................... 14. Has preliminary approval been granted by such authorities7yeS Date granted: 01/30/87 15. Type of Sewage Treatment System Discharge ................. surface water x 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? ....... ............................... No 19. If yes, name of water supply - Distance to water supply - 20. Is project site near a public sewage collection or treatment system? ................ No 21. Name of sewage system - Distance to sewage system 22. Date test holes observed 1986 23. Name of Health Inspector Subdivision Review 24. Project design flow (gallons per day) ................................. ............................... 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? ......................... 800 No Form PC -97 2 27. Is any portion of this project located within a designated Town or State wetland? No 28. Wetlands ID Number ......................................................... ............................... - 29. Is Wetlands Permit required? No Has application been made to Town or Local DEC office? ............................... - 30. Does project require a DEC Stream Disturbance Permit? .. ............................... No 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity. 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 No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... No 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? No 35. Are any sewage treatment areas in excess of 15% slope? No 36. Tax Map ID Number .......................... ............................... Map 11 Block 1 Lot "4B ' 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 I .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to ction 0.45.of thg Penal Law. SIGNATURES & OFFICIAL TITLES: Me WV 0C AN 10 Mailing AddreAOAA S li i'1 3"rl AN3; 66 Argyll Avenue New Rochelle, NY 10804\` 3