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Home My WebLink About0309DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -5 BOX 4 Ll 1 - I. .■' �. ' XL ■ I , ' ■ 00118 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # a -12 - 9 8 Locatedat Sinkwirh Prniapr .y_Carnl inP 1)r.Townor )fix Pattt�rsnn Owner /Applicant Name M^ �? � r r Darrylin Sinkwich Tax Map 13 Block Lot Formerly_ same Subdivision Name G I Del -1, Arthue & Regina Subd. Lot # 5 Mailing Address 23 -17 Sound Street, Astoria, New York Zip 11105 Date Construction Permit Issued by PCHD 8'-3-98 Separate Sewerage System built by Modern Designs Address RR2 , Box 203, Germond Rd. o hevin Kruse -Clinton Corners. N.Y. 1251 Consisting of 15 0 0 Gallon Septic Tank and 11 laterals x 571 p l a. a l 1�atPf anaivcic r��>>lt fc;r .r,n. - �, , _..._� -��s � ,m. m�/I.• Other Requirements: Water containing :plc e th r i ` � 21d lnAort'oe used for -wr Containing - -mater Supply: n' �[1 �i��l mof sodium shoulld not li ; used S ogle on moderately stricted sodium dieter —r ° A i r � . PT. OF f 1EAEFH or: Private Supply Drilled by R nyri A r t A c i a n Well Address R.... ,, r-oR> - mc! -i Y. Building Type Residential Has erosion control been completed? vo G Number of Bedrooms 5 Has garbage grinder been installed ?,, I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accor ce with the issued PCHD Construction Permit and approved plans and the standards, rules and regulatigJ kklf4 P14nam CpW*y Apartment of Health. Date: q 9 9 Certified by c J VV11W (Design rofess Address 1065 State RntutP 82. Rnnt -vpll J Any person occupying premises served by the above system(s) shall P.E. xxx R.A. lkircense # 07-4-666 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 .vocatio, , o ificatio or change is necessary. 1 By: Title: Date: 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 CONSTRUCTION PERMIT FOR SE PERMIT #'� Located at Subdivision name O t>c- A- Subd. Lod # Date Subdivision Approved 10 .a3- R r7 Owner /Applicant Name DA rt,c )e j, o S► u kW ► c h GE TREATMENT SYSTEM Town or Village PA- +e-r So,.! Tax Map / ?> Block _> Lot a_ Renewal . Revision Date of Previous Approval Mailing Address 0 & - i rl S (3 cj, ,.) cl S- - A S+0 (-► a_ /-J V Zip 1110 5- Amount of Fee Enclosed osoo .n 0 Building Type I .-P6,,,,; ►1�� Lot Are .O 4 No. of Bedrooms � Design Flow GPD QO c) Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of / -<b O gallon septic tank and // I_A45 @ %- l / l.Jther Requirements: To be constructed by Address Water Supply: Public Supply From Address or*. . Private Supply Drilled by 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 t eret . Signed: P.E. 4 � R.A. Date Tol I Address lZn, rte- -JL+ vY License # APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or nodified n considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new p i Appro for discharge of domestic sanitary se ge only. J a� L� - ` �(�� Date: 3 By: � Title: � C G l 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 WELL COMPLETION REPORT Well Location Street Address: i Town/Village: / J7fe/300 Tax Grid # Map Block Lot(s) Well Owner: Name: Address: Use of Well: 1 -primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing --X Open hole in bedrock _ Other Casing Details Total length 1 ft. Length below grade Z(, ft. Diameter b in. Weight per foot alb /ft. Materials: '*>C Steel _ Plastic _ Other Joints: Welded Threaded _ Other Seal: ><Cement grout _ Bentonite Other Drive shoe: �C 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 _ Compressed Air Hours Yield -,:rgpm Depth Data Measure from land surface - static specify ft) During yield test(ft) Depth of completed well in feet 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 ' )� ./Ili �/✓V1.4 If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information ' ,aJ1A4 Pump Type Capacity Depth Model Voltage HP Tank Type Volume Date Well Completed 1 2L? 19 -" Putnam County Certification No. 00 Dat of Report 1. qW I Well Driller (signature) AV ��, NOTE: trxact location of well with distances to at least two permanent landmarks to be prow a selSaifte sheetTplan. Well Driller's Name -t, M,4AI ��j 11�/�, Address: /'�40vljr Signature: `� Date: White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 Mark A. Day, PE Robert V. Oswald, LS Michael E. Gillespie, PE ■ 10 -65 Route 81 Hopewell At., NY 12533 (914) 117 -6227 Fax 216 -1315 DAY, OSWALD & GILLESPIE Consulting Engineers & Land Surveyors . January 7, 1999 Putnam County Department of Health Attn: Mr. Gene Reed Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 SENT VIA MAIL Re: Sinkwich — Caroline Drive Town of Patterson Dear Mr. Reed: Please find attached the following: • Copy of completed Cert. of Construct. Compliance • Check for $200.00 • Three (3) sets of as -built plans in conformance with Section 6 of the PCHD Program Review and Policies — Sewage Treatment and Water Supply Facilities for Commercial and Multi - Family Residential Projects If you have any additional questions, please do not hesitate to call. Thank you. y urs, r el E. Gilles ' , . cc: K. Kruse, odes Designs . file r, J ' r r J r 1 , 2 27. Is any portion of this project located within a designated Town or State wetland? AU 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? .. ............................... A o/� 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 Nb 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? ......................... ^Xe� 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? . ............................... AI& 36. Tax Map ID Number ........................................... I.............. Map __Z,5 Block_ 5— Lot �. 37. Approved plans are to be returned to ..... Applicant X Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization. (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on 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 Section 210.45 of t ie Penal Lat. SIGNATURES & OFFICIAL TITLES: Mailing Address: 7 l'-71 r 7.ig S6 75' a NORTHEAST LABORATORY of DANBURY CT Cert: PH -0404 39 -3 MILL PLAIN ROAD - DANBURY, CT 06811 NY Cert: 11471 (203) 748 -7903 - FAX (203) 748 -0652 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: MS. DARRYLIN SINKWICH 7 CAROLINE DRIVE PATTERSON, N.Y. 12563 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: TEST PERFORMED PHYSICALS: CHEMISTRY: DATE SAMPLE COLLECTED: 1/4/99 & 2/5/99 TIME COLLECTED: 10:00 A.M. & 8:00 A.M. COLLECTED BY: S. BOYD & D. SINKWICH DATE RECEIVED @ LAB: 1/4/99 & 2/5/99 TESTED BY: LAB #11471 & 11301 REPORT DATE: 2 /5/99 7 CAROLYN DRIVE, PATTERSON, N.Y. KITCHEN WELL NONE RESULT: Color 0 2/5/99 -Odor ND pH 7.82 Turbidity 0.46 NTUs Nitrite N <0.005 1,1301 - Nitrate N 0.06 Alkalinity 156.0 Hardness 98.0 Iron 0.077 Manganese <0.01 Sodium 25.5** Lead 0.003 ml = milliliter mg/L = milligrams per Liter * *Notification Level ** *Action Level MAXIMUM CONTAMINANT LEVEL no designated limit 5 NTUs mg/L as N 1 mg/L as N mg/L as N 10 mg/L as N mg/L no designated limits mg/L no designated limits mg/L 0.30 mg/L mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] mg/L. 20 mg/L ** mg/1— 0.01..5 * ** ND = none detected NTU =Units RESULTS BASED ON SAMPLES SUBMITTED: 1/4/99 & 2/5/99 (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 BRUCE R FOLEY Public Health Director Michael Gillespie, P.E. 10 -65 Route 82 Hopewell Junction NY Dear Mr. Gillespie: 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 January 26, 1999 12533 Re: Proposed Compliance: Sinkwich Caroline Drive, Lot #15 (T) Patterson, TM# 13 -5 -2 n Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: 1) Water analysis results dated January 22, 1999, for the above - regarded project indicates chlorine was present. If a chlorine disinfection unit has been installed, verification of the installation must be confirmed by an inspection by a representative of this Department. Otherwise, a bacteriological test must be reconducted with the results indicating no chlorine present. 2) It is requested that a short cover letter is attached to all separate submissions. This would assist this Department in keeping track of all submissions, and is effect, decrease the response time. Thank you, in advance, for your assistance with this request. Upon receipt of a, submission, revised to reflect the above comments, this application will be considered further. Very truly yours, Robert Morris, P.E. Senior Public Health Engineer RM:tn BRUCE R FOLEY Public Health Director LORETTA MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 �6 Michael Gillespie, P.E. 10 -65 Route 82 Hopewell Junction NY 12533 Re: Proposed Compliance Sinkwich Caroline Drive. (T) Patterson Dear Mr. Gillespie, P.E.: January 22, 1999 S 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: Results of a well water analysis has not been submitted guidelines are enclosed. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, Robert Morris, P.E. Senior Public Health Engineer RM:tn BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (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 i PROJECT STREET: COVER SHEET Owners Name): sn ( C-a g ::, D1 MUNICIPALITY: l"-pa4krolob TAXI\/Lq NUMBER: 7 Aba DESIGN PROFESSIONAL: DATE: /9 REVISION 0 REQUESTED ADDITIONAL INFOICIIATION 11 OTHER 6__. . - 17 3. If the water supply is from a drilled well: a. Satisfactory results of a water analysis, for the parameters in Table I below, conducted and reported by a NYSDOH approved laboratory under the "Environmental'Laboratory Approval Program (FLAP)." CONTAMINANT MCL (1)(4)(5) Coliform bacteria Any positive result is unsatisfactory Lead 0.015 mg/1 (15 ug/1) Nitrates 10 mg/1 as N . Nitrites 1 mg/1 as N Iron 0.3 mg/1 Manganese 0.3 mg/1 Iron plus manganese 0.5 mg/1 Sodium No designated limit (2) . pH No designated limit Hardness No designated limit Alkalinity No designated limit Turbidity 5 NTU (3) NOTES: (1) Maximum contaminant level. (2) Water containing more than 20 mg/1 of sodium should not be used for drinking by people on severely restricted sodium diets. Water containing more than 270 mg/1 of sodium should not be used by people on moderately restricted sodium diets. (3) NTU means Nephelometric Turbidity Units. (4) mg/1 means milligram per liter. (5) ug/1 means microgram per liter. NORTHEAST LABORATORY OF DANBURY CT Cert: PH -0404 39 -3 MILL PLAIN ROAD - DANBURY,' CT 06811 NY Cert: 11471 LAW 1 (203) 748 -7903. - FAX (203) 748 -0652 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: BOYD ARTESIAN WELL COMPANY Rt. 52 CARMEL, N.Y. 10512 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: DATE SAMPLE COLLECTED: 1/4/99 TIME COLLECTED: 10:00 A.M. COLLECTED BY: S. BOYD DATE RECEIVED @ LAB: 1/4/99 TESTED BY: LAB #11471 & 11301 REPORT DATE: 1/11/99 5 CAROLYN DRIVE, PATTERSON, N.Y. , 1 &5_&.3 KITCHEN WELL NOT STATED TEST PERFORMED RESULT: PHYSICALS: Color 0 Odor 5- CHLORINE pH 7.82 Turbidity 0.46 NTUs CHEMISTRY: Nitrite N <0.005 mg/L as N 11301 -Nitrate N 0.06 mg/L as N Alkalinity 156.0 mg/L Hardness 98.0 mg/L Iron 0.077 mg/L Manganese <0.01 mg/L Sodium 25.5 ** mg/L Lead 0.003 mg/L m) = milliliter mg/L = milligrams per Liter ND = none detected * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED: 1/4/99 MAXIMUM CONTAMINANT LEVEL no designated limit 5 NTUs 1 mg/L as N 10 mg/L as N no designated limits no designated limits 0.30 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] 20 mg/L ** 0.015 * ** NTU =Units (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) � o Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 FACILITY NAME' SAMPLING POINT. ;'SOURCE: ` 9 DRINKI TREATMENT ❑ CHL COLLECTED I ,DELIVERED BY: A TER; F:SURFACE WATER;. QED PPM El FREE RE ❑ TOTAL R 51DUAL _SIDUAL-1 ❑ UV DATE SAMPLED TIME 7tICED :< ^REEEIVED Y TIME" ICED_ ' EXAMINED .. - : -TIME x ;REPORTED ' TECHNICIAN(S) YES' -. .. `W J� NO ❑MFT ` ❑'MPN [PA = TOTAL'COIIFORMS�in - FER100ML. ❑ MFT ❑ MPN .' . ,.< -FECAL COLIFORM COUNT -r a PER 100.ML, MFT FECAL'STREF': COUNT PER 100 ML' ❑ HETEROTROPHIC PLATE'COIINT - - CO LONY FORMING UNITS PER 1 ML ❑ E: COLT Q OTHER " THESE INDICATE'THAT THE °WATER SAMPLE :RESULTS p DID NOT. REPORT NOrVALID - " 'DRINKING _ WITHOUT CORPORATE MEET SATISFACTO YS SEAL .% WASTEWATER EFFLUENT t r- WHEN'THE SAMPLE WAS COLLECTED. FOR INFORMATION,CONCERNING UNSATISFACTORY . . -. .. SAM7LES. ,__., ' PLEASE -CALL. "SMITHIABORATORY At--(914),-'229 6536 LAB DIRECTOR BACTERIOLOGICAL XAMINATION OF WATER Cl1STOMEWS; COPY N.Y.S. APPRCWED LAS. NO. 10924 Mark A. Day, PE Robert V. Oswald, LS Michael E. Gillespie, PE ■ 10 -65 Route 82 Hopewell Jct., NY 12533 (914) 227 -6217 Fax 226 -1315. DAY, OSWALD & GILLESPIE Consulting Engineers & Land Surveyors January 7, 1999 Putnam County Department of Health Attn: Mr. Gene Reed Division of Environmental Health. Services 4 Geneva Road Brewster, New York 10509 SENT VIA MAIL Re: Sinkwich — Caroline Drive Town of Patterson Dear Mr. Reed: Please find attached the following: • Copy of completed Cert. of Construct. Compliance • Check for $200.00 • Three (3) sets of as -built plans in conformance with Section 6 of the PCHD Program Review and Policies — Sewage Treatment and Water Supply Facilities for Commercial and Multi- Family Residential Projects If you have any additional questions, please do not hesitate to call. Thank you. y urs, . r lael E. Gilles ' . cc: K. Kruse, oder Designs file 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of DAM. k w S%'P u W 1C1 Located at C A Ro x i,5 L U i? \Uf T/V PA,-}ec- so p Tax Map # 13 Block S Lot a Subdivision of Au4hu r Subdivision Lot # a Filed Map # o-AA 7 t _ Date Filed Gentlemen: This letter is to authorize A V I (,� g �„r,41 �, g__,3A C� ► �e� of 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. Countersigned: P.E., R.A.., Mailing Address jo. S' State Telephone: ,7- 6 --DLa Very truly yours, Signed: • (Owner of Pr rv) ` Mailing Address: g 3` 1% J t3 Lf N 41 J/ S io ,A State AN Zip aSo— Telephone: �24 4712-4-5(o %J O00" Form LA -97 -`SVAp' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: L111 Sgt Inspected by: C;, Street Location , ',A Q,4aVC Y?j-zn /,rr Owner _ /NK Uric Town pAl2ro Permit # p— 12 — 98 TM r Subdivision Lot # `` 0 1. Sew•age.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 .................................................. d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/ wetlands ..... ............................... II. Sewage System ; a. Septic t t size - 1,000 ......... 1,250 ......... oth�r ... b. Septic tank installed level ................ .................:::.:......... c. 10' minimum from foundation .......... ............................... d. Pistribtuign Box 1. All outlets at same elevation -water tested.......... 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches Junction Box - properly set.............. ........ ...........................�... engtFi required 6 ; Length installed 7 2. Distance to watercourse measured -h- x -,•9 Ft.......... 3. Installed according to Ian ......... ............................... 4. Slq�jf��ch ac'e table6 - 1/32" /foot ............. 5. l O fr m rope line ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7.R llo d or xan 10 % ......................... 8. Si e� 4 �" e r cl an .................... 9. Depth o gravel in trenc 12' mini um ................... 10. Pipe ends capped ........................................................ g. Pump or Dosed Systems I. Size of pump c am er ................ ............................... 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. House/Buildin a. house located per approved plans.. .. b. Number of bedrooms ............... s . IV. Well ��: r� n,�s a. —Well located as per approved plans . ............... -` - ............ b. Distance from STS area measured -f /O D ft ........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship - a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate .............................. i. Erosion control nrnvided ................................................ YES NO COMMENTS X y -io X, u x X� X X ' well oGGt `fioH J� OL'C'� See- r k i v u X X X , n vev / ici lot ao xxi ar : a r rAA 1114 ZZS 1315 Mark A. Day, P6 R06W Y, OSW4W,, L5 Mickad 8. Gutq^ PS 9 t063 X81 tk��s,kx, ivrusss (914)221--027 Par 126 -1119 0 AVy Os wtiLD & GiLLEspiE Consulting Engineers & Land Surveyors December 17, 1998 Putnam County Department of Health Attn: Mr. Gene Reed Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 SENT VIA FAX Re: SM*wich — Care Me,PIMwi Town of Pas"on . Dear W. Reed: 0ooi As per our conversation, please find attached a copy of the stamped .house plans for the above referenced project: Additionally, as understood the following modifications are required to the installed system: 1. The fetnco fitting at the septic tank location is to be replaced with a bell fitting. 2. The laterals exiting the distribution box are to be adjusted to insure proper negative pitch. A test on the distribution box shalt occur upon your next field visit to insure proper functionabik. Upon the resolution of the above, you shall be informed as to allow for a subsequent field visit. If you have any additional questions, please do not hesitate to call. Thank you. 1 O ' -VAJ?jr P—ol gw ~A"40 Moms tt mature &Tttl,e Date N O O 19=18- 14.8111 49' bNZ 6 12 rV2• Vern. 3 18�7DVZ -,y � arQ 4C"tn- �� b�• � &am 4 EM� 9,¢' 7Yi t8 A• ReB(t•Im s0,rw r•Sy0 ��OffE�7r�8 t 8• ��' 209E am �' asm p�aw° SOY r OWING ROOM °'° r SR7"H q a m e a ewr°r �° ►� � 7.1►. awanl a• B iii N afn.oau►c�,w HA ,,. g BEDROOM #1 aATH � a►r. wrvwuwnlducmM t rru►NNtt� � ��srrryEe • (�)11?•M•N'O OfIYARt(•)rN�a`iMCIq.1� 7 (0 y,fpC1 •�i�4NAS RIOtliCr•IOCgr � aeouRtrl, 9 ` q '" • =rlyG O.OYTA /�OIf.�N)AN9a) �y�. a t,` /� � � � s" YOIESfplObti lrr,Nf �r1'•�.V. 1MLOItmtpR RLIMNIf{+W aorrrorTwsi. a+� )210 Yit' 7,61td' ol �-• -1. fw r' 6tn i ma►o a 4' -0Y4• Oti111%• IC•RIQ•. • - �' 'J'•O! Y' -Bth►- t. 2ri t:4•p [9.O• 'JQ'•Ab1 1?9 A4' 8'8 2••sr�• .1P.9WR4Yypyf -,Uwaw CRAY UOICy1•f1Rt wvorww. • INt1'wlt=dN CRi ttat� tlba.ru=a►t OMB t+•Ni.CgR3rCNt �•- •ry `'•i' - M -2 W' �. D/CNas6�GlnOr LIMNG ROOM ►74 RM Y 1,9 . � tr�vt• All w w a uer a eeRl mw."raaJ w + g BEDROOM #3 9EDROOM#2 t�tpp{r i 5' g b t►SA I •(�!�— •�"'�•fSfrstltES C'•=AS'NI. a 47- &S Ws1MY.m01'QIMOt6 �: Ifi 4-u vnyrnr.a�fy� (�� Cr¢O ' .•t -' sss��.ppp��,,,� !, � tY R.Cfb{ !gip s6 TI,p Mf. orra(tj (S� 1ef2,,t►ee(�srr�� 10'•tt4• MR�Oe[rwRied'�f+y�i+ws �ra�u►ftwrwla!•Ia 6 N18r ttQ• sr -0q'N!, Y3�'s�`•'• -•P PB62 �� - u as 1• tn• eevz•' stn• x e• �s Yt• tz•711l• 4ea� Po N )A%X CQ�} �EPAt tl! OF IQ x®• etn• 2rrz• r•r tn- � 4 :Qm'tlMIC147rCtlGUS@6 M1YnOS IMy 94N "M = .*MGM To 4r-• •7jQ PMMS A K•A 8ECL=." COOT MY; �• )� 'C�:rS 1 � ►dam !�*461t� � ��.. �d�EC. '!". turetTitls n (0 !•'' Sir;", ;0,9 IAW A= !717'1758 -5916 �• (7171 � �yg �stc�ars lcel01 Apr. id. 1996 49:d6:d3oM. p 8- 96w.tlgn M0. alatoMm '► att[ OriWM G2ctm SWUM v' i ma .1 , O zz J z�t Z!o 3� 1043 By SU�JLDER GAGE �sz F wm 2860 k - SPECIAL W1E ORIMl1 � 4A%TS I itdt. Mark A. Day, PE Robert V. Oswald, LS Michael E. Gillespie, PE ■ 10 -65 Route 82 Hopewell At., NY 12533 (914) 227 -6227 Fax 226 -1315 DAY, OSWALD & GILLESPIE Consulting Engineers & Land Surveyors July 28, 1998 Robert Morris, P.E. Public Health Engineer Putnam County Health Department Division of Environmental Services 4 Geneva Road Brewster, New York 10509 Re: D. Sinkwich SDS and Water Design Tax Map # 13 -2 -5 Lot 5 Dear Mr. Morris, With this letter I have enclosed revised plans as per your July 17, 1998 comment letter for the above referenced project. Enclosed you will find a . revised letter of authorization with the correct tax # along with the design data sheets corrected. It is my understanding that our client has submitted to your office a set of house plans for the project. If you have any questions or comments please contact me at our office. Sincerely Michael Farrell File enc. DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 July 17, 1998 Day, Oswald and Gillepsie 10 -65 Route 82 Hopewell Junction NY 12533 Re: Proposed SSTS: Sinkwich Caroline Drive, Lot 5 (T) Patterson Dear Sir: BRUCE R. FOLEY Public Health Director 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 constriction 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 Environmental or the Putnam County Department of Health on this lot, percolation test must be witnessed by a representative of this Department. 1) SSTS hydraulic profile has not been shown. 2) Footing drain discharge has not been shown 3) Soil type boundaries are to be shown. 6"' 4) Footing drain discharge has not been shown. 5) Title block is to note the access street to the above regarded property and the tax map number. 6) Datum source is to be referenced on the plan. 7) Proposed finished floor and basement elevations a to noted. 8) House is to be labeled as 5 bedroom on plan. 9) Current codes requires the minimum scale of the SSTS plan is 1" = 30'. 10) Erosion control methods for the house and the well are to be shown. 11) SSTS is to be shown a minimum of 10 feet from the rock out crop. 12) House sewer is to be noted as cast iron. 13 Septic tank size is to be labeled as 1500 allon. P g 14) Dimensions from the well to the property lines are to be shown. ��- 15) Service connection from the well to the house is to be shown. (J C BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 July 17, 1998 Day, Oswald and Gillepsie 10 -65 Route 82 Hopewell Junction NY 12533 RE: Application to Construct a Subsurface Sewage Treatment System at Sinkwich Caroline Drive, Lot 6 (T) Patterson Dear Sir: The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on July 7. 1998 is incomplete. Please be advised that the following information is required before the Department may commence its review. i Design data sheet does not note date of pre -soak and percolation test. (Enclosed) • 2 sets of house plans have not been submitted. 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 Dept. Of Health�regulations. Should you have any questions or care to discuss this matter, please contact me at (914) 278 -6130 ext. 166. RVIUM Very ly yours, y� Robert Morris, P. E. Public Health Engineer Letter to: Day, Oswald and Gillepsie - July 17, 1998 -2- 16) Trench cover is to be noted as grotexvile material or equiv nt. 17) Well casing is to be a minimum of 18' above grade. ,t Upon receipt of a submission, revised to reflect that above comments, this application will be considered further. RM:tn Ve ly yours, Robert Morris, P.E. Public Health Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Dam/ it w Sc N kW V-6 Located at E A RO t,,% 1J E_ 2\ V T/V Pa-�+e . Tax Map # ► 3 Block oZ Lot Subdivision of Au}LNLjr :S G.,ic-1 Subdivision Lot # oZ Filed Map # 5Qr7L Date Filed Gentlemen: This letter is to authorize J)AV s "k cl. a,j l (, ` \mac �. 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. Countersigned: fl '1 ' l P.E., R.A., # . Mailing Address S State Zip its-3 Telephone: (3/ K) ;7- 6 ,DLA Very truly yours, Signed: (Owner of Pr rty) Mailing Address: ..0 3`% f 0 Lt N J State A/ Zip rim Telephone: Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 4 DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner 'i7�,rt' �,.� S� u1r4 w �L. Address Q z- l n sa,cA s+ A s6 r►� N Y 11 ioS-- Located at (Street) C,a2a 1, v& -lr�� 31 Tax Map 1� Block _ Lot (indicate nearest cross street) Municipality P_4Aker•s00 Drainage Basin CRO- iZ�1.� SOIL PERCOLATION TEST DATA Date of Pre - soaking -JL)oe- GL.5,\`9q$ Date of Percolation Test _$y0e.oZ6.l.`►`R 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 Alin/Inch 1 qo - 10 1 S', ", 1.5"', o7b 2 3 Ing.1- it 11 30 17,51, .S" " 0 4 5 1 q U 3 a 2 1011 , 9'2 36 ao If/ 42311 /; o .r /' �3�i � // 4 C 5 3 // 3 2 104 _ . l 3 .. 3 3 03 —1105- r s ii 3 4 pF NEW y NOTES: 2. Tests to be repeated at same depth until approxii percolation test hole. (i.e. < 1 min for 1 -30 min) submitted for review. Depth measurements to be made from top of hol rates are obtained at each Zin/inch) All data to be -Form DD -97 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA 0) DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. - Toso, 1 HOLE • r/ • HOLE NO. Indicate level at which groundwater is encountered A/4), j �. Indicate level at which mottling is observed �✓oN�� Indicate level to which water level rises after being encountered Deep hole observations made by: (,c,�,� ,Q� PC. D Date a6 Design Professional Name: Address: /D•GS- ,�v g�,� Signature: Design rofessionalIs Seal / OF NEW y� �� D�ARD �� 9•f � N c rr? s 07 4 6,0 �OFESS�� DegR 2-� '26 ff 'Ple-leP PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address e,4'T2o LINT^ 'T�VE Located at (Street) Tax Map 3 Block ZZ Lot 5- (indicate nearest cross street) Municipality ' Drainage Basin E 57- At cH SOIL PERCOLATION TEST DATA Date of Pre - soaking G/Z Date of Percolation Test Hole No. Run No. Time Start - Stop Elapse Time Olin.) Depth to Water rom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch - 1 2 r j" 3 P r - 0 VIZ.- 17 20 4 5 1 :.0" 9'17 10147 3a 4 5.. 7 2 10 14- 1037 — 7,� 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtainea at eacn percolation test hole. (i.e. <_ 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 PROFILES Hole # _� Lot # 6- Hole # Lot # -� Hole # Lot # Depth to water N vA 2 Depth to water Al,o y? -e Depth to water Depth to mottling Al e jl e Depth to mottling. Depth to mottling Depth to rock/imp. lflop /,e Depth to rock/imp.^, Depth to rock/imp. . G.L. G.L. G.L. 0.5 o i 0.5 % D '� vs� 0.5 1.0 1.0 1.0 Mec� 8rouerl !�h $roW4 °t)f y 2.0 2.0 2.0 3.0 3.0 3.0 4.0 000n own 4.0 z2at r 4.0 5.0 yr aQ. 5.0 av 5.0 6.0 e-jn-vj'eh 6.0 Gla- 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 Hole # Lot # Depth to water Depth to mottling Depth to rock/imp. G.L. 0.5 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0 Hole # Lot # Depth to water Depth to mottling Depth to rock/imp. G.L. 0.5 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0 Hole # Lot # Depth to water Depth to mottling Depth to rock/imp. a G.L. 0.5 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner —(C Y� I1L,LS T U� Address CA-ao c.>N, 3;x-ri vF .J Located at (Street) "5 11 Tax Map (3 Block 0"Z_— Lot_ (indicate nearest cross street) Municipality ER!5 O Al Drainage Basin .x,457- Li XR N c H SOIL PERCOLATION TEST DATA Date of Pre - soaking -, /A // 9 S Date of Percolation Test 5- `7 a /�'8 Hole No. Run No. Time Start - Stop Ela�'se Time (Min.) De th to Water rom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 1 10"n- lv a 11 r7" 2 3 4 5 1 2 .3 4 ti 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are ootamea at eacn percolation test hole. (i.e. 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 IN .1/ I(. --;• vm ..I F 13 83.92 AC. CAL. so $/1/.3 Pi :•7.3.71 3/11. PJ L.71 V•? ! 141. Ij w/va Pi 338 % V 21.7 AC. V: 1. IF I(. --;• vm ..I F 13 512M3 � so $/1/.3 Pi :•7.3.71 3/11. PJ L.71 V•? ! 141. Ij w/va Pi 338 COURITT LINE TOWN LINE VILLACC LINE BLOCK LIMIT PROPERTY LINE ORIGINAL LOT 'ew 1.83 AC 13 w % V 177 1. IF 1.17 C I V qot—z 5 T I A Y5 34.42 AC. 3 LEGEND .7777777= WETLANDS L!Nr A' 'Of -- OLVELDPERS 0T ?"'j, Ho DIMENSIDU SCALED 011.'EhS,04 ULCULATEO AICA ^S71 v RSUAL CENTRDIO PA CEL NINDEn RECORD OF PHONE CONVERSATION Time: I Date- I P Person calling: ir"/ - Phone 6 2a7 Reason ( ) Inspection: kteps nd/o ercs, Scheduled Field Nfeetinq Time-. Date- Y N Tentative/to be confirmed To% N-n: Road/Street.- Tax Map 9: Comments- .IA�_ VL, PPrCS 0 reps (-Wl--:-z �,-Z----�-1-----�re-�-- - RECORD OF PHONE CONVERSATION Time: 9" 67 p Date: zlz ey Person calling: 1� ��C � �� y e j Phone #: 7— 6 2 :2 7 Reason ( ) Inspection: Dee d /or errs: Scheduled Field `Ieetina )Dre — s &P Time: _05_61 Date: Y N Tentative /to be confirmed ( ) ( ) Town: Road�Street: �fez r p Tax `Map #: Comments: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS VIEW SHEET FOR CONSTRUCTION PERMIT STREET LOCATION i;C NAME OF OWI\ REVIEWED BY RM, G AS, MB, BH TAX MAP # Y DOCUMENTS Y N PERMIT APPLICATION MPERC EROSION CONTROL:HOUSE;WELL, SSDS PC -1 & DEEP HOLES LOCATED PERMIT_ PWS LETTER R O ORIZ TION N ATA SHE DS) Q l SOLUTION SETS TCE REQUEST q SUBDIVISION SUBDIVISION FISION APPROVAL CHECKED RATE I--- REQUIRED DEPTH TAIN DRAIN REQUIRED ,NDPIPES GENERAL ;ATED M NYC WATERSHEIS V NS SUBMITTED TO DEP EGATED TO PCHD ' APPROVAL, IF REQ'D ;PLL.TEST HOLES OBSERVED tiS TO BE WITNESSED APPROVAL SSDS ADJ. LOTS TLANDS (TOWN/DEC PERMIT REQ'D ?) CA ON DDS PLANS & PERMIT SAME 1969 NEIGHBOR NOTIFICATION TER BI/ZBA YR. FLOOD ELEVATION AGE SYSTEM REPRESENTATIVE OF PRIMARY & EXPANSION LOCATION MAP EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE IF PUMPED, PIT & D BOX SHOWN & DETAILED WELLS & SSDS'S W/IN 200' OF PROPOSED SYS. PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HQUSE`SEWER I/_4.' FT 4 "0; TYPE-PIPEN eMi NO BENDS; MAX.BENDS 455° W /CLEANOUT ALL SYSTEMS CLAY BARRIER 10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE FILL SPECS FILL NOTES FILL _CERTIFICATION NOTE PROFILE & DIMENSIONS (FILL IN EXPANSION AREA TRENCH LF TRENCH PROVIDED 6+2-- 60 FT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED ON PLAN - FROM SSTS o 10 00' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL 0' TO FOUNDATION WALLS 15'WELL TO PL 0' TO WELL, 200' M DLOD, 150' PITS 00' TO STREAM WATERCOURSE LAKE (inc. expan) ' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (pits -20') 50' INTERMITTENT DRAINAGE COURSE 200' /500' RESERVOIR, ETC. _150' GALLEY SYSTEMS • NNaLIC-TIONNOT ( 15'MIN to CDS= >5 %,10'- 4 %,25'- 3 %,30'- 2 %,35' -1 %,100' - <I% ES RC & DEEP RESULTS 20'MIN to CD discharge /100'with 182 cons day discharge T CONTOURS EXISTING & PROPOSED SEPTIC TANK E"Y & SLOPES, CUT 10' FROM FOUNDATION; 50' TO WELL GUTTER/CURTAN DRAINS WELL -PE BOUNDARIES =` DIMENSIONS TO PROPERTY LINE ITLE'- BLOCK; OWNERS NAME,ADDRESS�® LOCATION OF SERVICE CONNECTION TM #,PE/RA; NAME,ADDRESS,PHONE# DATE OF DRAWING/REVISION Ifl DAT[JM- REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET mPROPOSED:FMISH= FLOOR =AND'- BASEMENT EL. COMMENTS:- ,x/4,j 61-,4, 4 �� Mark A. Day, PE Robert Y. Oswald, LS Michael E. Gillespie, PE ■ 10 -65 Route 82 Hopewell At., NY 12533 (914) 227 -6227 Fax 226 -1315 DAY, OSWALD & GILLESPIE Consulting Engineers & Land Surveyors July 1, 1998 Robert Morris, P.E. Public Health Engineer Putnam County Health Department Division of Environmental Services 4 Geneva Road Brewster, New York 10509 Re: D. Sinkwich SDS and Water Design Tag Map # 13 -5 -2 Lot 2 Dear Mr. Morris, With this letter I have enclosed plans for the above referenced project. l Enclosed you will find: ♦ One (1) Letter of Authorization LA -97 ♦ One (1) Application for Approval PC -97 ♦ One (1) Design Data Sheets ♦ One (1) Short Environmental Assessment Form ♦ One (1) Construction Permit Forms CP -97 ♦ One (1 ) $300.00 Check ♦ Three (3) Sets of Plans If there are any questions or comments please contact me at our office. Michael File GG enc. ts Jl,�r tljdlt� 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: 'pa �� l►� S►,a1Cw«L; 2. Name of project: S� � Kw:�h 3. Location T/V: 4. Design Professional: D_AILOS AID 5. Address: to_&5 6. Drainage Basin: Bong S -+ /.A S3 7. TYpe of Project: _ 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 c-c- 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... ,moo 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? ......................................................... ............................... 13. If so, have plans been submitted to such authorities? ........ ............................... 1r °S 14. Has preliminary approval been granted by such authorities? Date granted: /l 15. Type of Sewage Treatment System Discharge ................. surface water Xgroundwater 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? ....... ............................... /Jb 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ wo 21. Name of sewage system Distance to sewage system -- 22. Date test holes observed 6,1?lo�rri 23. Name of Health Inspector ��,y�. ke 4 24. Prcjec� design ff ow (gallons per day) ../.0.0. 0.6,PL> ....... .5`'�,� 25. Is STS fly �l 10't I_40arge Elimination System (SPDES) Permit required ?... A 26. Has SPD�S "Apprication been submitted to local DEC office? ......................... A L 4> PC -97 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. ❑YesAwo 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. kes ❑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: No C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: No C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: No 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: No C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: No C6. Long term, short term, cumulative, or other effects not identified in C1 -05? Explain briefly: A/0 C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly: Now- /CA)Owy D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? []Yes j^L+- If Yes, explain briefly: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? []Yes AMa If Yes, explain briefly: r 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 Date 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) 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only Part 1 - PROJECT INFORMATION (To be completed by Applicant or Project sponsor) a 1. APPLICANT /SPONSOR: 2. PROJECT NAME: DACII)l It Css k wi D lukw► s� 3. PROJECT LOCATION: Municipality County P,4, ,—J j 4. PRECISE LOCATION: (Street address and road intersections, prominent landmarks, etc., or provide map) flrt l 5. PROPOSED ACTION IS: >Vew ❑Expansion ❑Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: SSTS C.. a d. W,a } ac- 7. AMOUNT OF LAND AFFECTED: Initially ?.Og1 acres Ultimately-,��acres 8'. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ges ❑No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? )iesidential ❑Industrial QCommercial ❑Agricultural ❑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)? Dyes If yes, list agency(s) name and permit /approvals 1.1. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? �es ❑No If yes, list agency(s) name and permit /approval Subd►vlstow Appao"r ,k 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑Yes (No I CERTIFY THAT THE INFOR ATION P VII D D ABOV IS TRUE TO THE BEST OF MY KNOWLE GE Applican OSpD s�.�1aA Date: Signature If the action is in a Coastal Area, and you are a state agency, complete a TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH. HOLE NO. G.L. Tao so 1 0.5' { 1.0' Leah -� 8rt�w� IS 2.0' x,•.�, 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' HOLE NO. r 1 • HOLE NO. Indicate level at which groundwater is encountered /(/21y e-- Ind y,c� icate level at which mottling is observed AIp Indicate level to which water level rises after being encountered X110,✓ Deep hole observations made by: �jG ,Q��1 Pc TI) Date a6 Design Professional Name: pr4,i ��swAl d -t-G l l Address: 10_ ,65- Signature: 0 -.1 t rw):� Design fessional's Seal l OF NEW y\ AR 0 Go G v T z 0746 \\ �CFEsa� // I 51CAL SOUNOS WALL Y R L /NES 20 FOUND O WELL N AMP MAP AIER/O/AN JO E -- 95.09 " A A, ,1A _\ \ 1 'CO 1 \ i i i TH /S /S A SURVEY OF L OT No 5 AS SHOWN ON A MAP ENT/TLEO 'F /NAL PLAT PREPAREO FOR ARTHUR ✓. & REC /NA T. OOELL ' ANO F/LEO AT THE PUTNAM COUNTY CLERKS OFFICE ON OCTOBER 2J 1987 AS F /LEO MAP No 2271. TOPOGRAPHY SHOWN HEREON TAKEN FROM F/LEO MAP No. 2271. 2 F7. CONTOUR INTERVAL. .� -,C.s..,r.�.�.�.r• -c- - -� - Jp•�nrza�x - /� �°o,. l�O �9�E` 'CATIONS INOICATEO HEREON SIGNIFY THAT THIS I WAS PREPARED /N ACCORDANCE W/TH THE 1C MOE OF PR4CACE FOR LAND SURVEYS AS O RY THE NEW YORK STATE ASSOCIATION OF SS/ONAL LANO SURVEYORS. SVO CERT/F /CATIONS RUN ONL Y TO THE PERSONS FOR WHOM THE 0' /S PREPARED AND ON HER BEHALF TO THE :OMPANY, GOVERNMENTAL AGENCY AND THE C INSTITUTION LISTEO HEREON ANO TO THE FES OF THE LEND /NG INSTITUTION. (CATIONS ARE NOT TRANSFERABLE TO ADDITIONAL IRONS OR S!/BSEOUENT OWNERS. WHEN MS. ^H SELLS THE PROPERTY SHOWN HEREON ALL (CATIONS SHALL BECOME NULL AND VO /O. K /NO /CATEO HEREON. WAS PREPARED WITHOUT 017 OF AN / /P -TO -DATE ABSTRACT OF .097 ACRES _ jX550 ` LOT No S FILED MAP No. 2271 \ \ N71;9000-;Y 419 \ \ \\ \ N/F LANDS OF \ �\ SKEETER DE7/ELOPERS /NC. L/6ER 1215, PACE 285 _LOT No. 4, 17LE0 MAP No 227,1 ,SV.�i'Tl.V"�' 1L1�4P \ \ V / pOrE' l ; I `W a �/ ! S3274 00'1Y i .•;/ 4.•89 A / 4 c- r.� IE Gl V� 'CATIONS INOICATEO HEREON SIGNIFY THAT THIS I WAS PREPARED /N ACCORDANCE W/TH THE 1C MOE OF PR4CACE FOR LAND SURVEYS AS O RY THE NEW YORK STATE ASSOCIATION OF SS/ONAL LANO SURVEYORS. SVO CERT/F /CATIONS RUN ONL Y TO THE PERSONS FOR WHOM THE 0' /S PREPARED AND ON HER BEHALF TO THE :OMPANY, GOVERNMENTAL AGENCY AND THE C INSTITUTION LISTEO HEREON ANO TO THE FES OF THE LEND /NG INSTITUTION. (CATIONS ARE NOT TRANSFERABLE TO ADDITIONAL IRONS OR S!/BSEOUENT OWNERS. WHEN MS. ^H SELLS THE PROPERTY SHOWN HEREON ALL (CATIONS SHALL BECOME NULL AND VO /O. K /NO /CATEO HEREON. WAS PREPARED WITHOUT 017 OF AN / /P -TO -DATE ABSTRACT OF .097 ACRES _ jX550 ` LOT No S FILED MAP No. 2271 \ \ N71;9000-;Y 419 \ \ \\ \ N/F LANDS OF \ �\ SKEETER DE7/ELOPERS /NC. L/6ER 1215, PACE 285 _LOT No. 4, 17LE0 MAP No 227,1 ,SV.�i'Tl.V"�' 1L1�4P \ \ V / pOrE' l ; I `W a �/ ! S3274 00'1Y i .•;/ 4.•89 A / 4 c- r.� W �O RV Zo�O h�?0� N W� X14 tt- w� v� 0 0 N t h' sW 0 O �J 00' 0,13' • X4.3 4 �o �A, a I 9 I I R� I, 2 Iv I I I I J NN c I / V 3' � 185.5 1p N1118 Np5 AN E 265 0 FRE 0 PAG 120 FIBER N 1G•3 36, i 0 0 ON 0 R CK �0� o. v O� Lm o� zo 0 �o QO L Q �O