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Home My WebLink About0357DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -67 BOX 5 00166 Ll ., .T 00166 PUTNAM COUNTY DEPARTMENT OF HEAL DIVISION OF ENVIRONMENTAL HEALTH SERVI n CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT PCHD CONSTRUCTION PERMIT # P" O6 " 05 Located at 44 (,U,5HMAH PAD Town or Village Owner /Applicant Name GI+Q1yi�P1l yi�N Tax Map Formerly _... Subdivision Name L Block Lot 61 Subd. Lot # s Mailing Address i1 1HT'99-L-X-)+6iu 12P, CA -WE11 IJLe Zip 10",1 L Date Construction Permit Issued by PCHD / '�D/ab Separate Sewerage System built by Address Consisting of 1-000 Gallon Septic Tank and 1 000 ��'• A- ��D(�Y T�c,� r'l�ac�+� Other Requirements: Water Supply: Public Supply From Address or: C Private Supply Drilled by H Ii L DH I N (4+ 1 H C ' Address 15 P VrNkA\ f41 PXW'n0? W!61 Building Type Has erosion control been completed? y6l1 Number of Bedrooms Has garbage grinder been installed? 14 I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County ep e t of Health. Date: Qq Ll 10 Certified by y.� P.E. X R.A. (Des Pro essional) Address F •O • 6�K 2� Z �' id o License # 5ra 11,4 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage 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 revocatio modification o hange is necessary. By: Title: Date: r zz- —/o White copy - HD Fi ;Yell w py - Building Inspector; Pink copy - wner; Zge copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WellaPerm�t�# - sz,, 77 ssSi :':aXCR'wvi.`Y9s 11.1. ..H Sn43i ... WELL COMPLETION REPORT Well Location Street Address: Q 4 Gv O "� � • TownNillage: PA ('50 6 Tax Map # Map 0% Block `� Lot(s) 61 ,. G =` �q j� t T ft1se '11's 0 81 Well Owner: Name: Address: 06812- A140 `lKIIn 4 Chol SZ avvcx • a DOW RA, N07AAPiELA,Cl Use of Well: _t__' Residential _Public Supply Air cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Institutional Standby Drilling Equipment Rotary _Cable percussion Compressed air percussion Other(specify) Well Type _Screened _Open end casing _,�_ Open hole in bedrock _Other Total Length b.Z ft. Materials: Steel Plastic Other Joints: Welded X Threaded Other Casing Details Length below gradeloft. Seal: Cement grout $ Bentonite Other Diameter & in. Drive shoe: { Yes _ No Liner: _Yes V No Weight per foot AlIb /ft Diameter (in) Slot Size Length (ft) Dept to Screen ft Develo ped? Screen Details First , _Yes No Second I I Hours Well Yield Test Bailed _Pumped V. Compressed Air Hours Yield g gpm Depth Date Measure from land surface-static (specify n ) During yield test (ft) Depth of complet;d well in ft. Too Well Log Depth from Surface Well Diameter If more detailed ft. ft. Water Bearing in Formation Description information Land Surface 147 44 M 16 25 •t descriptions or ZY 316 MG e- . sieve analyses '►Op I are available, please attach. If yield was tested Feet Gallons Per Minute Pump /Storage Tank Information at different depths bbo $ Pump Type "35 Capacity Q ! 1I` during drilling Depth G(90 Model Vhf -'l�E 1 list: Voltage K -0/460 HP 3 Tank Type 5 GZ Q?4E�,h )✓)Volume 5 p DatetWell Completed - Y Well Dr(Iler PC' Ce "rtlficate # D1 NYzSfate # k foot t Pump Installer' PCCertlficateF# l fVl NY States #k Dateof Report1 .. y� Well Driller Name 8� Adtlress * * �� ' �' 3 l V3? R 43 i yi,� it M a 1 ��. �t N, .N.s .:.f P G .IfR.. 1 S :;,r ,ar< . .��' £V� /7;µz Pump Installer Namen8� Adtlr�ess' '', «5 3• j/q ry �? ''. A �.r x` 3 1i 'n36 �9 c'Y ''�L�Mr,` g '� r' t 224Z Well Dfirilleri stg at D Q ' :. � ,w "'H ! : i ''" i PaYy'xq NOTE: Exact Location of well ith distances to at lea two permanent landmarks to be provided on a p, 'ate sheet/pla . i White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy Well driller j Form WC -97 Rev. 3106 07/16/2010 14:'17 8458782019 PATTERSON PLANNING JUL -16 -2010 �11 :4 -a NM HARRY W H;CHOL S 914 a7v 4867 a � Sherlita Arnier, NID, MS, F.W fi . Comrnlssloner of Health *; .e Robert Morris, PE 01recrar of Environreental Health p Department of Health 1 Geneva Road, Brewster, NY 10509 MI AMUS.N VERYI'+'ICATION_FC RM OWNER'S NAME- CPA -►', T#FHF1L * 5 -HOP A TAX MAP NUMBER- 601 1 r z - Cpl Equ ADDRESS; __ 4+ _ cou4wKikw $4A* TOWN: FWrFMPQ1 ► PAGE 01/01 P. e12 Robert J. Bondi County Exea+Nve AUTHORIZED TOWN OFFICIAL: (Sipature) The Putnam County Department of Health will .not Issue a Certificate of Construction Compliance unless the above form is completed, I,c., a legal E9111 address is assigned by an authorized Town official, This farm Is to be submitted with the application for a Certificate of Construction Compliance. Eay.rOnmental Hoalth (845) 278 -6130 Fax (84S) 278 -7921 Water Supply Section (845) 2L*-5186 foot (845),325 -5418 Kuning Services (841) 278.0559 Fax (841) 178-6026 Nursing r tktne Cure Agency (845) 27$.6085 WIC (845)279-6678 Early Tntervtntion ! Premboal (M) 228 -2047 Fax (845) 22S•1580 F-X ►15'f W IEIL G ll-� 7/ - i DELE.P GuPZTAIN PPLA 4 e Iouc ?4r- 5GF1 • 3 A" ENS C�2.S e-A A" TPLSHc4•►C• YP) d GAPPAD C ryp) _;L., i d Q J D 2,5 24 25 96 a ri DIMENSION CHART (in feet) Number ' A � 1 54 25 2 • �° 28 3 ►'70 128 5 I� 120 (o I (oaf � 115 -7 ! I <02 I I I $ too 10'1 9 158 104 l0 15� 100 II 155 98 • 12 112 91 13 I o8 85 14. 105 79 15 I o2 73 NO 99 67 1'7 IS 94 55 19 20 2a4 I"11 21 aaz I�O1 22 221 IG,S 23 2.3.0 1612 24 2.18 1(00 26 a.17 I5'1 ?10 21 Co I � 2? 215 153 PUMP TP- .ST RF—SU LTS T):gT • STAPUT: 3. so TFrST .'STOP : 2. 82 (o'(w) x II.5'(1 -) if 05907'=P)x 740:905 GAL.. NOTES F.x )sr. wfEl-1= ,, o/ 1 f r- ;fir l 1 f Harry W. Nichols Jr., RE P.O. Box 252 Brewster, NY 10509 Tel. (845) 279 -4727 Fax (845) 279 -4728 October 6, 2010 Michael J. Budzinski, P.E. Director of Engineering Putnam County Health Department 1 Geneva Road Brewster, New York 10509 RE: Individual SSTS Compliance — Sciarra 44 Cushman Road Patterson, NY T. M. # 13. -2 -67 Dear Mr. Budzinski: Enclosed are the following: 1. Five (5) prints of Drawing S -1, "As -Built SSTS ", dated 10/06/10 2. "Certificate of Construction Compliance for Sewage Treatment System ", dated 09/22/10. 3. Three (3) copies of "Guarantee of Subsurface Sewage Treatment System ". 4. Laboratory Reports, dated 06/03 /10;06/07/10;06 /10/10;06/27/10. 5: "Well Completion Report", dated. -04/09/09. 6. Application Fee in the amount of $300.00 payable to Putnam County Health Dept. 7. "E -911 Address Verification Form ", dated 07/16/10. 8. Underwriters certificate for'pump dated 09/03/10. If there are any questions concerning the enclosed, please call. Very truly yours, Harry W. N ols Jr., P.E. HWN:jdm 05 -013 i .P -UTNAM COUNTY DEPARTMENT OF HEALTH DIVISION Of ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map Block Lot r / Building Constructed by Town/Village Location - Street Subdivision Name n P�� — Building Type.' Subdivision Lot # I represent that I. am wholly and completely responsible for the location, workmanship, material, coristrnrctiorc and "drainage of the sewage reatment system serving the 'above -des 'i 'bed property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition.._ - - - -- any garr–of said � *sterrm constructed by'me which fails-to operate fora period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, ..except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive .the determination of the Public Health Director of the Putnam County Department of Health:as tow eth .fir not the"failure of the system to operate was caused by the willful or negligent act of the obcupanf"cf the building utilizing: the system. . , tc r� Dated: Month Day V -� Year s Signature: �� ► A � / Title:' -- eral Contr or'(Owner) = signature Corporation NaA (if corpbration) Corporation Name (if corporation) 3i ; ri+e W - Address: 1= 9�'�'► State ,,,'1rn �' Zip Address: State '/�-'' fry ,•.J J .Zip '' ^� Form GS -97 ND = None Detected Units = Units Signature: �+ti�G G1_ Reviewed By: alb 4n�_ Michael Lapman Michael Lapman, President State #: PH -0218 ELAP M 11715 CONNECTICUT. NE'.V YORK AND NELAC CERTIFIED Tall Free 866- JMS -5097 I Corporate Fax 203.798 -2408 1 Lab Fax 203 -798 -2107 1 w%v%v.jmsenAronmental.00rn Page 1 of 1 iffisEnvironmental Services Inc. 41 Kenos/ A:renue WATER, SOIL AND AIR ANALYSIS Danbury, Conn9CUCUt 08810 1 Telephone 203 -798 -2229 I Allan J Finn Mailing Information: Collector's Information: JMS ID: 096921 Name: Allan J Finn Name: Allan Finn Address: 249 Ball Pond Road Address of site: 44 Cushman Road City: New Fairfield City: Patterson State: CT Zip: 06812 State: NY Zip: 12531 Phone: (845) 222 -3161 Fax: (203) 312 -9412 Phone: Sample's Information: Sample ID: 1 Site: Kitchen Tap Date Collected: 10/1312010 Date Received: 10/13/2010 Preservative: N /A'. Time Collected: 4:00:00 PM Time Received: 4:30:00 PM I Temperature: Lab No.: J1007417 Matrix: Water Date Analyzed Test Name Result Method 10/13/10 Color ND SMWW 2120 B ND = None Detected Units = Units Signature: �+ti�G G1_ Reviewed By: alb 4n�_ Michael Lapman Michael Lapman, President State #: PH -0218 ELAP M 11715 CONNECTICUT. NE'.V YORK AND NELAC CERTIFIED Tall Free 866- JMS -5097 I Corporate Fax 203.798 -2408 1 Lab Fax 203 -798 -2107 1 w%v%v.jmsenAronmental.00rn Page 1 of 2 imsEaYfrannten>tal Services, fttc. � 41 Kenosia Avenue WATEA, SOIL AND AIA ANALYSIS Danbury, Connecticut Ocalo I Telephone 203 -798 -2229 Mill Drilling Co: Chris Sciarra Mailing Information:' Collector's Information: JMS ID: 093394 Name: Mill Drilling Co Name: Rob Mill Address: 75 Putnam Avenue Address of site: 44 Cushman Road City: Brewster City: Patterson State: NY Zip: 10509 State: NY Zip: Phone: (845) 279 -5041 Fax: (845) 279 -5075 Phone: Sample's Information: Sample ID: 1 Site: Hose, Bibb Date Collected: 6/3/2010 Date Received: 6/3/2010 Preservative: N/A Time Collected: 12:00:00 PM Time Received: 1:45:00 PM Temperature: 22.2° C Lab No.: J1004234 Matrix: Water Date Analyzed Test Name Result MCL Method 06/08/10 Iron *5.74 mg /L 0.3 mg /L 200.7 Rev. 4.4 06/08/10 Manganese 0.02 mg /L 0.3 mg /L 20017 Rev. 4.4 06/08/10 Sodium 57 mg /L N/A 200.7 Rev. 4.4 06/03/10 3:00 PM E. Coli Absent Absent Colitag 06/03/10 3:00 PM Total Coliform ** *Present Absent Colitag 06/15/10 Lead <1 ppb 15 ppb E 200.7 06/03/10 Color 150 Units SMWW 2120 B 06 /03 /10 Turbidity *41.2 NTU 5 NTU SMWW 2130 B 06/03/10 Odor ND 3 TON SMWW 2150 B 06/11/10 Alkalinity 164 mg /L N/A SMWW 2320 B 06/08/10 Hardness 100 mg /L N/A SMWW 2340 C 06/07/10 Chloride 42.8 mg /L 250 mg %L SMWW 4110 B, 06/07/10 Nitrate 0.65 mg /L 10 mg /L SMWW 4110 B 06/07/10 Nitrite <0.05 mg /L 1 mg /L SMWW 4110 B 06/07/10 Sulfate 34.5 mg /L 250 mg /L SMWW 4110 B 06/03/10 pH 7.8 S.U. 6.4 -10 S.U. SMWW 4500 H B Comments: *ABOVE MCL ** *ABOVE ACTION LEVEL At the time of the analysis the sample was Unacceptable for Total Coliform At the time of the analysis the sample was Acceptable for E. Coll pH was received and analyzed after the EPA required 1 hour holding time. CFU = Coliform Forming Units MCL = Maximum Contaminant Level mg /L = milligrams per Liter NIA = Not Applicable ND = None Detected NTU = Nephelopmetric Turbidity Unit ppb = parts per billion S.U. = Standard Unit TON = Threshold Odor Number Units = Units CONNECTICUT. NEW 'YORK AND NPLAC CERTIFIED Tall Free 886- JMS -5097 I Corporate Fax 2o3- lee -24o8 I Lab Fax 203 - 798 -21o7 I www.jmsenvironmental.com qT r Page 2 of 2 Environmental Services, Inc. 41 KenoslaAvenua 4i ms WATER, SOIL AND Alp ANALYSIS IAI Danbury, Connecticut 06810 I Telephone 203 - 7913 -2229 Mill Drilling Co: Chris Sciarra Mailing Information: Collector's Information: JMS ID: 093394 Name: Mill Drilling Co Name: Rob Mill Address: 75 Putnam Avenue Address of site: 44 Cushman Road City: Brewster City: Patterson State: NY Zip: 10509 State: NY Zip: Phone: (845) 279 -5041 Fax: (845) 279 -5075 Phone: Sample's Information: Sample ID: 1 Site: Hose Bibb Date Collected: 6/3/2010 Date Received: 6/3/2010 Preservative: N/A Time Collected: 12:00:00 PM Time Received: 1:45:00 PM Temperature: 22.2° C Lab No.: J1004234 Matrix: Water Signature: =4 a4y� _ Reviewed By: m4e, Michael Lapman Michael Lapman, President State #: PH -0218 ELAP #: 11715 CONNECTICUT. NEW YORK AND NELAC CERTIFIED Toll Free 886 - MS-so97 I Corporate F3x203- 798 -24os I Lab Fax 203- 798 -2107 I wivw.jrn9environment3l.ccrn Page 1 of 1 eimsEnvironmental Services, Inc. I ft41KenosiaAvqnue MATER, SOU AJYD AIA ANALYSIS Danbury. Connecticut 08810 1 Telephone 203 -798-2229 Mailing Information: Name: Mill Drilling Co Address: 75 Putnam Avenue City: Brewster State: NY Phone: (845) 279 -5041 Mill Drilling Co Collector's Information: JMS ID: 093499 Name: Rob Mill Address of site: 44 Cushman Road Zip: 10509 Fax: (845) 279 -5075 City: Patterson State: NY Phone: Zip: Sample's Information: Sample ID: 1 Site: Hose Bibb Date Collected: 6/7/2010 Date Received: 6/7/2010 Preservative: N/A Time Collected: 9:00:00 AM Time Received: 10:30:00 AM Temperature: 190C Lab No.: J1004338 Matrix: Water Date Analyzed Test Name Result MCL Method 06/07/10 Turbidity 0.78 NTU 5 NTU SMWW 2130 B MCL = Maximum Contaminant Level NTU = Nephelopmetric Turbidity Unit Signature: _ Reviewed By: Michael Lapman Michael Lapman, President State #: PH -0218 ELAP #: 11715 CONNI= CTICUT, NUW YORK AND NGLAC C ERTlREn Toll Free 866 - JMS -5097 I Corperate Fax 203 - 796 -2408 1 Lab Fax 203 - 798 -2107 1 .vww.jmsenvironmant3l.ccm inVirenrrtsrrtaf Ssrtrfces� irrc. lit 4-1 KonosieAvenue Pa 9 e 1 of 1 � 1 WATER, Sa1L AND AM ANALYSIS Danbury, Cionnactioutoeaio I Telephone 203 -798 -2229 Mailing Information: Name:, Mill Drilling Co Address: 75 Putnam Avenue City: Brewster State: NY' Phone: (845) 279 -5041 Sample's Information: Site: Not Specified Preservative: N/A Temperature: Matrix: Water Mill Drilling Co: Scierra Collector's Information: JMS ID: 093636 Name: Rob Mill Address of site: Cushman Rd City: Patterson Zip: 10509 State: NY Zip: Fax: (845) 279 - 5075. Phone: Sample ID: 1 Date Collected: 6/9/2010 Date Received: 6/10/2010 Time Collected: 12:00:00 PM Time Received: 1:00:00 PM Lab No.: j1004460 Date Analyzed ,Test Name Result MCL Method 06/10/10 3:00 PM E. Coli Absent Absent Colitag 06/10/10 3:00 PM Total Coliform Absent Absent Colitag Comments: At the time of the analysis the sample was Acceptable for Total Coliform At the time of the analysis the sample was Acceptable for E. Coli i CFU = Coliform Forming Units MCL = Maximum Contaminant Level Signature: _ Reviewed By: Michael Lapman Michael Lapman, President State #: PH -0218 ELAP #: 11715 CONNECTICUT, NOW YORK AND NELAC CERTIFIED Tall Free 866- JMS -5097 1 Corporate F3x203- 796 -2408 I Lab Fax 203 - 796 -2107 1 wwwirnsenvironmentsl.cam x:`,= m Page 1 of 1 limsEnvironmentat Services, Inc. 41 Kenosia Avenue iVATEA, SOIL AND AIA ANALYSIS Danbury, Connecticut 06810 1 Telephone 203 -798 -2229 Mailing Information: Name: Mill Drilling Co Address: 75 Putnam Avenue Mill Drilling Co Collector's Information: JMS ID: 093920 Name: Rob Mill Address of site: 44 Cushman Road City: Brewster City: Patterson State: NY Zip: 10509 State: NY Zip: Phone: (845) 279 -5041 Fax: (845) 279 -5075 Phone: Sample's Information: Sample ID: 1 Site: Hose Bib Date Collected: 6/21/2010 Date Received: 6/21/2010 Preservative: N/A Time Collected: 12:00:00 PM Time Received: 12:50:00 PM Temperature: 21.8° C Lab No.: J1004717 Matrix: Water Date Analyzed Test Name Result MCL Method 06/22/10 Iron <0.05 mg /L 0.3 mg /L 200.7 Rev. 4.4 MCL = Maximum Contaminant Level mg /L = milligrams per Liter Signature: Reviewed By: Michael Lapman Michael Lapman, President State #: PH -0218 ELAP #: 11715 CONNECTICUT. NEW YORK AND NELAC CERTIFIED Toll Free 866 -JMS -5097 1 Corporate Fax 203- 798 -2408 1 Lab Fax 203 - 798 -2107 I %vww.jmsenoironmental.corn BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK ELECTRICAL INSPECTION SERVICES 150 White Plains Road, Suite 104, Tarrytown, NY 10591 CERTIFIES THAT Upon the application of: William Picarella Electric - P O Box 158 Brewster, NY 10509 Located at: 44 Cushman Rd., Patterson, NY 12563 Application Number: 10084553 Section: Block: Lot: Upon premises owned by: Chris & Sandy Sciarra 44 Cushman Rd. Patterson, NY 12563 Certificate Number: 100849'61'-'-- BDC: 104 Permit Number: 998 -09 A visual inspection of the electrical system at this premise described as a Residential occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located inlon the premises at: 44 Cushman Rd., Patterson, NY 12563 Basement, 1st floor, 2nd floor Garage, Outside was inspected in accordance with the NYS and NFPA 70 -99 and the detail of the installation, as set forth below, was founded to be in compliance therewith on the 03 Day of September 2010• Name Date Quantity Rating Circuit Type P -RES Service 1 300 -699 P -RES Air Conditioned 7 Over 15,000BTU -Over 3 Tons P -RES Air Handler 7 120/240V P -RES Well Pump I All Associated Wiring P RGS'Septic Yiiinp & Scpttc Alarrti; '.: 1 Motor Fractional 5 Vacuum System I Fan Box 6 P -RE'S Panel 4 Service & Others P- Circuit Breaker -All Sizes 82 Receptacle 25 GFCI P -RES GFCI- Circuit Breaker 2 15 & 20 Amp P -RES AFCI Circuit Breaker 6 P -RES Range I Gas or Electric Receptacle 146 Convenience This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. This certificate Is valid for work preformed before date of inspection only. jeannie 16 Friday, September 03, 2010 Page 1 of 2 .r-,__ PUTNAM COUNTY DEPARTMENT OF. HEALTH / 1711,9 4 DIVISION OF ENVIRONMENTAL -REALTH SERVICES ► FINAL 'SITE INSPECTION A P4 /c. 1.7;4 � Date: . 3 Inspected,�y: c,-j ZL_� -Street Location 44' C d"04111 Town TM!ff 45 z Subdivision Lot * .1.. Zewagebysitem Area .a. - STS -area 'located as per: approved: -Wans ............................ - b... Fill section ,-: Aa' te 6 ftlicenefit 3 -1 barner Lgth. Width Avg.Dpth z. aturdl;soil :stnpped ................... ............................... A -Stone.-bru§h,%etc..�-,:gteater..t.han..15'.from.' STS ;ar-ea.... e.. water: course/ wetlands ....................................... IL Sewage System -.1. :89ptic.tahks''ize - :.1,000 .......... 1,250 ......... other... b. !SPpt1c'.tahk'mstalled4ev6l ............................. C. 10' :'minimumi.from 'floundation. ............................................ d. Distfibution�'Box 1. tested:'. .2. Protect ed-blelow= &ost ........................ ............. um 2' ft 0"' ngm ' dl soil betwden box & trenches. e. Jitnctidn`Zox properly set .......................................... 1: .6. TrencFes 1. Length required 44!e-;,0 .Length installed .,/ 2. Distance to- watercourse measured 4 Ft.......... 3. Installed accord 'to plan ........................................ .4. Slope ',bf.trerich acceptable "1/1-6 - * 1/3 2 'Waot.: ........... . 5. .10 ft. ftom:prop6r-ty:line - 20 ft;'foundations .......... 6. Depth of trench <30:inches from'surfice ................. 7. koom:a1lowed for expansion, .100% ........... ; ............. 8. Size of gravel 3/4 - 11/2" diameter clean ........ 9. Depth of gravel in trench 12" minimum ....... ; ........... 10. Pipe ends -capped.-.... * ........ ........ g. Pump or Dosed Svstem's 1. 1 :'Size .6f pump chamber .... .............. 2. :Ovefflow-taiik ... ....................... ............................... 3.-Alarm* visual/ vi -a • ...................... ... 4. P=p'easi1y7.accessible ' manhole tograde ................. 5, First box.baffied ......................................................... 6. Cycle: witness'ed:by H.D.estimated flow/cycle ........... . EOL Iffouse/BdUdifig .a. 'Houselocatedger: approved �plans• ........... r b. ofbe rooms ............................... . ............. IV, Well Well. located as,pef�approved plans ............................... b. Distance. from STS area measured /,9 c) ........... . c. Casing. 18" above grade ............................................... d. -Surface -drainage around well : acceptable ....................... V. - Overall Woikmanghin a.. Boxes properlygrouted .................................................. b.. All-pipes partially-badkEed ............... I .......................... c. Akpipes flush withinside. of box .................................. d. Backfill material -contains. stones <4" diameter .............. e. Curtain drain standpipes installed according to plan., f Curtain.draiii outfdll protected &,dir.to. exist watercourse . g. Footing -drains discharge away from STS Area ................ h. Surface water protection adequate ..................................... i. Erosion control, provided ................................................ Rev. E/002vi Ic- vt� D S 0 , :'COMMENTS sj-m_ewe 6. J IZ A,- ro j s 4-ir ye- -Ae d 6,.:J6 a 7 Form ST-3 Ic- vt� D SEP -14 -2010 02:10 PM HARRY W NICHOLS 914 279 4567 PUTNA.m COUNTY DEPARTIMENt' ' OF HEALTH DI VISION O>r ENVIRON`NIENTAL HEALTH SERVICES X2FC1iSE� T FORXINAL NSP,EC ON For: Fill - Trenc�►es-- ,��- . - -... PCHD Construction penr.+it AE' P� off ' 0 5 Located L GU6Jl+%1 - -- i�"p.• — GT ,fy) p�'p _ . R .� Owner /ApplicantNanie GRM�l"AtW �— 4S44"4#' TM (44 _Block-1— Lot �►� Formerly Subdivision Name.____, Is system fill completed? A Date Is system complete YE6 Date 0°i 1�l I0 Is system constructed as per plans? Yeh Is well drilled? Date OI 41I8 Is well located as per plans? �y Are erosion control measures in placa`7 I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and veri ed their completion imaccbrdl with the issued PC14D Construction permit and approved plans and the Standards, Rul s of the Putnam County Department Of Health. r. it Date:_ Oil N J i g _Certified bye ti v Address p • a 160A commcnts:, Y�,'1 M aT r �+c,HC� �w � MtiQE�c 8+�►U�- tu. D y\1,-1t wLq GoMQOwt;<h ( 56% tpUof , C AN 0 PM f OTC- form FIR -99 P. 03 b SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORE TTA MOLINARI, RN, MSN Associate Commissioner of Health March 17, 2009 Harry Nichols, PE P:O. Box 252 Brewster, NY 10509 DEPARTMENT OF HEALTH 1 Geneva Road,, Brewster, New York 10509 Re: Field Inspection 44 Cushman Rd. (T)Patterson, TM #13. -2 -67 ROBERT J. BONDI' County Executive ROBERT MORRIS, PE Director of Environmental Health Dear Mr. Nichols: The above referenced separate sewage treatment system, can be backfilled. This Department's open work site inspection pertains to the SSTS trenches only. All other components of the SSTS as well as bedroom count and general site construction will need to be inspected upon completion. Also noted upon inspection was the installation of the well location and the curtain. drain. Grading around the well needs. to be completed. The curtain drain appears to ,be partially completed along with the required standpipes. If you have any further questions, please contact me at (845) 278 -6130, ext. 2261. Sincerely, ene Reed Sr. Envir. Health Engineering Aide GDR:Im Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845)278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 Sherlita Amler, MD, MS, FAAP 'Commissioner of Health e_ Robert Morris, PE Director of Environmental Health September 29, 2010 Harry Nichols, PE P.O. Box 252 Brewster, NY 10509 Dear Mr. Nichols: Department of Health 1 Geneva Road, Brewster, NY 10509 Office (845) 808 -1390 Fax (845) 808 -1937 Re: Field Inspection 44 Cushman Road (T) Patterson, Tm # 13. -2 -67 Robert J. Bondi. County Executive A re- inspection at the above referenced lot has been completed. Other than the pump test results, there are no further comments to be addressed at this time in reference to this Departments open work inspection., If you have any further questions, please contact me at (845) 808 -1390, ext. 43261. Sincerely, .".) V)-t74- Gene D. Reed Sr. Environmental Health Engineering Aide GDR:kly MAR -:12 -2009 04:23 PM HAF2RY W NIGHOLS'. 914. 279 4567 P.01 PUTNAM COUNTY DEPARTMENT OF- HEALT)i DIVISION OF ENVMONMENTA.L HEALTR SERVICES . For: Fill Date, d Trenches PCHD Construction Permit P OT 0 Located: /} Owner /ApplicantName:..�V .s �Fo ke VW (Ctrl t TM i3 Block 2 Lot — .,.,._ Formerly: Subdivision Name — , Subdivision Lot #—�-� Is system fill completed? Date: Is system complete? A1l�,F:.0.S Y.:r � Date: Q CY Is system constructed as per plans? Is, well drilled? - .....,, r Date: Is well located as per plans? Are erosion control meastfres in place? I certify that the system(s), as listed, at the above premises has been constructed and l 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. Rate: a`fi Gertificd b LMOIL PE _/RA Address: 2.4 , 86 Comments: Hany W. Nichols Jr., P. E. P.O. Box 252 Brewster, NY 10509 Tel. (845) 279 -4727 Fax (845) 279 -4728 October 21, 2010 Putnam County Health Department 1 Geneva Road Brewster, NY 10509 Aft: Michael J. Budzinski, P.E. Director of Engineering Re: Construction Compliance - Sciarra 44 Cushman Road (T) Patterson T.M. # 13. -2 -67 Dear Mr. Budzinski: - In response to. your October 8, 2010 review letter, we note the following: 1. A new water analysis result for color is enclosed., Reflecting ',the above, enclosed is the original report from "JMS Environmental Services dated 10 /13/10. Kindly continue with your review of this Application. Very truly yours, Harry W. Nye�ols Jr., P. E. HWN,Jdm 05 -013 Sherlita Amler, MD, MS, FAAP Commissioner of Health Robert Morris, PE Director of Environmental Health I Harry Nichols; P.E. P.O. Box 252 Brewster, NY 10509 Dear Mr. Nichols: Department of Health 1 Geneva Road, Brewster, NY 10509 Office '(845) 808 -1390 Fax (845) 808 -1937 October 8, 2010 Re: Construction Compliance for Sciarri at 44 Cushman Road (T) Patterson, TM # 13 -2 -67 Robert I Bondi County Executive This Department has received and reviewed the construction compliance application for the above referenced project and the following comment is are offered -for your consideration. • The water quality analysis reports the value of water color at 150 units which exceeds the allowable standard of 15 units. Please resubmit a water analysis for a new water color water sample. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. Respectfully, Michael J. Director of MJB:lm I PUTNAM COUNTY DEPARTMENT OF HEALT DIVISION OF ENVIRONMENTAL HEALTH SERVIC CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # P 0S- C'T- . Located at L�Laij 902 Town or ge PmiW-v.VSg!:j Subdivision name Date Subdivision Approved Owner /Applicant Name' Mailing Address 1 % Subd. Lot # ', L-i r c A c ir > � 1 y. ►rrf Tax Map V-3 Block 2, Lot 6- Renewal Revision Date of Previous Approval 6 1'7/C'7 l.ar�, e-, AJ,Y . zip -tD S12- Amount of Fee Enclosed �'Z 5d r / Building Type Lot Area 1f,S- No. of Bedrooms CD Design Flow GPD V100 0 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage S stem to consist of '2-000 gallon septic tank and —1000 I Other Requirements: Pu mJ_ s To be constructed by ® n Water Suooly: Public Supply From Address Address ` or: !/ Private Supply Drilled by ]� I� Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to th Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address i AJA, - P.E. R.A. Date "7 - 2- - 0 P, 0 r' License # APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. Approved for ' charge of domestic sanitary se age only. By: ' .. Title: Date: White copy - HD File ello . cop - Building Inspector; Pink copy - Ow r r; �e copy - Design Professional (1 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 # J V d� anti ka � '1& 60!3 Map Block 2- Lot(s) C� Well Owner: Name: Sr7 C Address: Civr"4ewl %l ira e tea oj t. Use of Well: -r/Re idential 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 Est. of Daily Usage _gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling y New Supply (new dwelling) Deepen Existing Well Detailed Reason e for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ....................................:............ ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Lot No. Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No L-� Name of Public Water Supply: Town/Village -- Distance to property from nearest water main: Proposed well location & sources of contaminatio to be provided on separatesheet/plan. Date: '7-02--,68 Applicant Signature: , Cz 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. 1 A Date of Issue /0730-06 Permit Iss ing Official: Date of Expiration 10 Title: Permit is Non - Transferrable / \) White copy - HD file; Yellow copy - Building Inspector; Pink copy - Own ; Orange copy Y - Well driller Form WP -97 , / \t Ortl -, GR __ — T -- I J I / NOTES' 1 J / / 1. N4tNTAIN NONITORIN6 � \': SGO� _ — It V . C / / 5DKJIfIWNG LUMD WHEN � , Z Z CV.rtNN CCs.M JIL\Ll��. � D MONRO4ED ✓ONTNLY t I /' <I g6I I / `I' It P b I .wo YGDEF: V, t `� l 13. PERJAIyDION >NAI.I- De 1 / I �14.RE0 TO x�D Pn4TIE7 , MONITORING; /PIPE p. 07.,ORI ICE 1 \\ '\ luv.sq ,00 "� .BAFFLE (5ECTION OF -1st CMP)) WITH 4ROWS @3 "O•C. ' CONC. ANCHOR" -- - --- i B LTS W/WA5HE�R� / - ,' Ji I 5ECON`D U OUTLET EMERGEN VERFLOW ToPo�BZRIVI -- __ _ I' o °I3 ELEV. 556,00 ELEV. 551.00 "- G' N a� rNLE '�SE�.D Plk ± 1 I 2MIN. 1NV, 547.30 1 �— ` qa• J a`a 12• RIPRAP p -50 ON FILTER PA-6 -P C t�� N 'i -- --- - - - - -_ CM1Rgi15�OXOREQUAq � o m i PR)MAKY OUTLET SYRUCTURL TO tCALE;' in - ° r n c I GRA55 r/ 'k 5WALE 5 .0'7- v v xA I 55 ,' 1 aT�u p � I + �, A •� s T 1 , . r�L �B RR ACS j O Ili 1 � • �. i / 1. I I?. R �� jo.5 O 4 F/r. ELEV, 555.00 . / g 1Y11 19 1 1 7 11f1111111117 )�1N ,�dUll JI J 549 •�S F �lllSllU11 I � �JJJJ i I G R A 5 5 �111A� 0 I J�/ 7IlJlJ Id; 1J) 1)l 7J 13l tJY7 11)•7�(�(illli1R111(1(ltiltlllt L' 111H 1 ptSft(i[i,' 4{}4Vt1' SR14SS44 mw 7 L }11 111``11 fig°' + P �'05�D US X � � � 1 tZ�✓I�..NCE 111\ \1111 �(: t I GARAGE - 1f1 5 f f I PORCH I ; 1+ 1 111111111 \2 `� J � O S111u iS 55 &Ji4. ' 55u +5s7.6J ( h N O I PnOt •tITEMPORRRY sW ALE t (Tb WELD PRO 1 O w6t t � 4 . p w , I h m i 5� 5x5 -a"T tCK j y (z��} "STcNE RIPRAP OW MlPAFI 50OX pi i � � FILTER FABRIC. I rMEM Harry W. Nichols Jr., P.E. VAY P.O. Box 252 AR Brewster, NY 10509 Tel (845) 855 -9275 Date: _-351 —C� To: , l Job No.: PC/7� 43�a13 Project Ro►oo semi 5-5-TS ` Attention: A&4,I J I Gentlemen: We enclose (S) copies of O B/W Prints O Reproducibles 0 Reports O Tracings O Specifications O Memorandum O Copy of letter O Description: Revision/Date No. P6 c) SS TS r v. 10 '27 --08 1. flu k � V tin cGr IU r l�fi►r! HayY' l0- l'��D��vl�•v �-G rr' Sent Via: -Our Messenger O Your Messenger Copy to • Blueprinter • Hand Delivery ❑ First Class Mail 0 Special Delivery O Very truly yours, Harry W. i ols Jr., P.E. FA SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Harry Nichols, P.E. P.O. Box 252 Brewster, NY 10509 Dear Mr. Nichols: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health October 14, 2008 RE: Proposed SSTS Revision for Sciarri at 44 Cushman Road (T) Patterson, TM # 13 -2 -67 This Department has received and reviewed the revised plans for the above referenced project and the following comments are offered for your consideration. 1. The septic: tank and pump chamber sizes indicated on the SS T S profile differ from the site plan and details. The proposed curtain drain is to be shown on the SSTS profile. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. MJB:lm Respectfully, 0 Michael J. Director o Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6626 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 m M Attention: Harry W. Nichols Jr., P.E. P.O. Box 252 Brewster, NY 10509 Tel (845) 855 79275 Date: /0- t 0 - O 8� Job No.: 02 - 6 i 3 Project SETS Rr-rrislbtic 'SC►grV'CI- Gentlemen: We enclose (5) copies of YB/W Prints ❑ Reproducibles ❑ Reports O Specifications O Memorandum _ ❑ Copy of letter Description: PI VP (S1 n%nIL4 V 11LA 14 �� —) `1 A- 5 11 -_ Sent Via: 0 Our Messenger p Your Messenger Copy to O Blueprinter d O First Class Mail [N] O Tracings Revision/Date No. Vey. Vey, ! 0 Special Delivery Very truly yours, Harry W. chols Jr., P.E. 4 9 MODEL Motor• mechanical:; APPLICATIONS . Single Ph HO 15 or 2� :Appq"... for sm N,r V6 C I HP` '15' 0 8.4 _V .6 M p6dii (I e �6rffi6- Hz, 3500 --"FlPrthed,11/z '43`2 39'V 6' 0 Hz maximum of �e as..; • 1713mes" OUUUZ RPM ..chot,90 adaptable ford's • Farms Ul t I6'0v&l& Automatic: systems' p rail • ai pr; Courts Reset Me hamcaltSeal Ceramic vs • , Motels B Insulation carbon sealib�jabbs .S tan • Schools . T : r e'e,P,h A� !/�`HR:th u 1� H P, metal parts, BUNA _jq,�q ,qs q,mprs pi a s 208 X301 qs!s t ant . s t 3500 RPM n readed, design th" 14§'� ,,S,!jj6s) la Loc qp rpp,: p asemo( e s to Protection must ibe! Pr' id d-in .�.gqar against component Id ih% • S Pit: :,on:.,: ddi enta I reverse rotation: -F th- ft --,T.h'r'�d'a 0 ihigh i' , ps;. Motor: Fully submerged inr SPECIFICATIONS Stainless Steel , � :9ra e -turbine oil for l0 bric6tion an • Bearings Ball Bearings Wp 0 e effiO eht heat transfer. U, np an d :1L Designed for Continuous Opera - '• S611 d'a ed ratings e are within 6' Foot t, � ion: Pump YI aximum- Len 'ith manufacturer recommended t: t'k g P1. T� motor manfacture igc'h' S'-_z'-e:,.2 INIPT:"' Available) J, - ' ' '7I ' ' j* - `,. ' ,-, M:.; .'. , .i .. . . . . _ ..,.:...Wo rkin'g . limits, can n be e .. , operated • Capacities Up 1144j RV Single A6&/�`HR I cqn tj u6usly withou t dam . .a .. ge • T ota VHdAdsIU06: TDH ,Rngqpr! Upp er and lower • SWth jri 4jk W 4 i3, T AM c hdhidal'S6Al eavy uty 9. ball bearng con 66-ea s 7ar h3dtaN,Se4t/Qq(ami - struction y e_60'sogs 1600stoermota pi an ppxy , ,'sea -,N'E Attorbrs o n-�g 6 dels-20' ommq t or- gpd provides secondary • T Le ngthl& TWA ST UV _ , a"r '6 ure a outer - - aximum Standard jacket damage and to prevent_oil Wick FA§t&6 Series , Stainless s�s hq ., '- -0 Ri�§. - Assures o.sitiv' e;seali, n ag ins;contaminants a d Capable of Dry ithbUt s* 7 arn' t akage agei O,t s I pump-6ut vane n 16 "'th or ©1986 Goulds Pumps Iric Effective July 1986 FEATURES 1 . Impeller 2. Casing 3. Mechanical Seal 4. Shaft 5. Motor 6. Bearings Upper & Lower 7. Power Cabl S. 0 -Ring 1 • MODELS or p Vo is: 115 113 2.018112.30�' :i j2 230 208;tb`;• 3/4 208/236- 230"-- iN 4.112"' ti ti MODEL 0 0 • 0 1 lit WE1532HH (All dimensions m inches) (Do not M 4 §p�, qr, construction .53 14 EFFLUENT Ok&64.0"' Em. Package Includes: Effluent pjector system offers Submersible Effluent Pump, of ordering and installs- PT ease WE031 1 L, 12L or WE031 1 M. 12M, ordering number 81/2 WE051 1 HH, 12HH specifies a complete system Mercury Level Control Switch qq§igqed for most residential A2-5 (115 V), A2-6 (230 V) &W commercial sump and Basin A7-1801S effio6ht pump applications. Basin Cover A8-1822 Check Valve A9-2P KICK'El Order o.: SWE0311 u, SWE0312L, SWE031 1 M, SWE0312M EY '/,,1/2, 3/4 and 1 HP W' except:46'rmodel' -,WE0712 SWE0511 HH, SWE0512�11,1. 11h HIP = 18" Avo Ila Old certif lcitior Cariaalin'i Pe.n nsylvania , Bureau - of Und6..for- non, f ce app!.i SENECA .FA NEW DPK 13148'. SPECIFIdATIONS.ARE.SUBJECT to 614A14dit WITHOUT NOTICE: t16L S If 10,12H OV or PRINTED IN'*U. ENNEEMENNEENEENEENEEMOD IU 25 80 Q Z 20 7011 60 O 15 50 40' 10 30 5 20 I�a-- 10 0 L 0 ENNEEMENNEENEENEENEEMOD 35 11( 101 30 91 25• EL 3885 1 1 ,■■■■■■■■■■■■■■■■■■■ Q 71 W S 20 J 61 O `'■■■■■■■■■■■■■■■■■ 51 15 41 10 31 21 5 11 �i ■ice ■ \ ■i \■ ■ ■ \ ■ ■ \ ■ \ \ ■ ■ ■ ■■ ■ ■ ■ ■■■■��! �\■R■■\■N■■■■ 121 0 .0 10 20 30 40 50 60 70 80 90 100 _ 110 120 GPM L I I I 0 10 20 30 m'/h CAPACITY 01985 Goulds Pumps, Inc. EHecUveJuly, 1985 35 11( 101 30 91 25• 81 Q 71 W S 20 J 61 O F- 51 15 41 10 31 21 5 11 0 .0 10 20 30 40 50 60 70 80 90 100 _ 110 120 GPM L I I I 0 10 20 30 m'/h CAPACITY 01985 Goulds Pumps, Inc. EHecUveJuly, 1985 Harry W. Nichols Jr., P.E. P.O. B6x 252 Brewster, NY 10509 Tel (845) 855-9275 CONSULTING SITE ENGINEERS JOB No.- 09- -013 SHEET No. 2- OF .:z COMPUTED BY 1_7 DATE 67 -Q Z09_ CHECKED BY DATE I%V-Vl '10-01- 05'146:-; VQ1_b1AjF! C-n% dam_ 5j5 rgkVQ4,,u1k1 7119 0 4D 05 F_ _P_gMp C_AFA-Aekffeg JZI N6-4' NOW 0(i 00 GAL, TAN A. F:RV AIP Ile_ 6 NE -3 . ..... . ... SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner bf Health Harry Nichols, P.E. P.O. Box 252 Brewster, NY 10509 Dear Mr. Nichols: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health August 12, 2008 RE: Proposed SSTS Revision for Sciarri at 44 Cushman Road (T) Patterson, TM # 13 -2 -67 This Department has received and reviewed the revised plans for the above referenced project and the following comments are offered for your consideration. V1. The pump chamber detail specifies a one day storage volume of 1000 gallons which is less than the design flow of 1200 gallons per day for a six - bedroom dwelling. ,/2. The revised pump pit calculations specify tank dimensions which are different than the dimensions specified on the plan view details. I/3. The pump' pit calculations do not specify the size of the pump chamber. ,.-4.' The pump curve was not included with the pump calculations. The pump chamber detail is to be revised to show an all- weather junction box with an outlet and screwed cover at or above grade to allow for a plug -in connection the pump. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. 18-111-1 .1 mt, Respectfully, Michael J. Bu Director of Er Environmental Health (845) 278 -6130 Faz (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 r Harty W. Nichols Jr., P.E. P.O. Box 252 Brewster, NY 10509 Tel (845) 855 -9275 Date: Q 8 01-00 To: ' Job No.: ( -e VOL gaa a( Project a o o5-J SSTS t5tC-tj'SfId! 165-02 S C I oocr—o� Attention: ,/1/(L % 4 �� r� Zl ti SKJ l ,�F- � C u s iAA A14!►, /2 G CL CJ1r'eG�or o` �l�ee{-�� 1 pat 7 , A. Gentlemen: We enclose copies of ®B/W Prints O Reproducibles O Reports O Tracings O Specifications O Memorandum O Copy of letter Description p, SS T-S- J 0 -f�f o �� ; o1) a= j / t L l 3 tid jo r r. j W Sent V' Our Messenger 0 Blueprinter O First Class Mail O Your Messenger 0 Hand Delivery O Copy to O ✓ Revision/Date No. htv, pB- O-g -df rcv, U7 -ZI -Df? O Special Delivery Ve ly yours, arty W. 'chols Jr., P.E. Ha7y'.W. Nichols lr_,P.E_ P.O. Box 252 Brewster, YJYl05O9 Tel (845)Q55-9275 ' CONSULTING SITE ENGINEERS SHEET No. OF 2, CHECKED BY -DATE F3 ER Am c__J+6jAD ................�� K'---�-'---- -- ------------ -------- -'----'---' 8 --------'--'---r------------'� - � ____--_-_-_-'-_---_---'_-_-'- -7 '-p-�_- O�� LIZ 7= -- -- A "51- -'______5. ___4___4-_�_ � � �� _ � � � �� U----'------'--'---�---�--�-------�---'-- - ' ' � -�-`�--�----�-----�--------�---- - ,~^_ � ___ � �_ �� . ....... ---'--' U | _ ...... ..... ... | � Harry W. Nichols Jr., P.E. P.O. Box. 252 Brewster, NY 10509 Tel (845) 855 -9275 CONSULTING SITE ENGINEERS JOBNo. C, 4r►,S lamer ':�c►o,rr SHEET No. 2- .OF -Z COMPUTED BY `LII-,, T,• . ' :_DATE 7`.2-f -Oe CHECKED BY J DATE 7-21-08 1 0 ,M E ' 7-S %_ 6 51S "T C k'!—yoi- u})dE) -- �pc�E3 X 6-41-, /b GS L - _ - -G GII-A-M13Q? aiNG -.� - of c. - -- Z''3 3 - - -- - - - - - -- - ... ------ -._..— - -- - - - - - -- — — -- -- -- _ -_- PL..5"' ' - - ..... ..... -- - -- -- -- -E3� S'. SHERLITA AMLER, MD,`,MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Harry Nichols, P.E. P.O. Box 252 Brewster, NY 10509 Dear Mr. Nichols: .DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 July 25, 2008 RE: Proposed SSTS Revision for Sciarri at 44 Cushman Road (T) Patterson, TM # 13 -2 -67 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health This Department has received and reviewed the revised plans.for the above referenced project and the following comments are offered for your consideration. 1. The pump chamber detail specifies a one day storage volume of 1000 gallons which is less than the design flow of 1200 gallons per day for a six - bedroom dwelling. 2. The revised pump pit calculations were not included with your resubmission. Upon completionof the above, this Department will continue its review. Kindly advise us if there are any questions. Respectfully, Michael J. Budki Director of En ii MJB:kly Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 w L J July 21, 2008 Harry W. Nichols Jr., P.E. P.O. Box 252 Brewster, NY 10509 Tel (845) 855 -9275 Putnam County Health Department 1 Geneva Road Brewster, N.Y. 10509 Att: Michael I Budzinski, P.E. Director of Engineering RE: Proposed SSTS Revision – Sciarra 44 Cushman Road Patterson, N.Y. T.M. #13.-2-67 Dear Mr. Budzinski: In response to your July 8, 2008 review letter, we note the following: 1. Revised Standard Notes per latest edition of Bulletin ST -19. 2. Scale added to Site Plan. 3. Contour elevations added to Site Plan. 4. Septic Tank corrected to read 2000 gal. 5. SCS soil symbols added to Plan. 6. Garage drywell noted to be 50' minimum .from proposed well. 7. Curtain Drain outlet revised. 8. Revised dimensions of pump chamber to reflect 2000 gal. tank. `-9. Revised pump pit c culations enclosed. 1D u,aC_i q-f Reflecting the above, enclosed are five (5) prints of Drawing SS -1 "Proposed SSTS," revised 07- 21 -08. Kindly continue with your review. Very y yours, Harry W. ols Jr., P.E. '? HWN:his 05- 013.00 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Harry Nichols, P.E. T.O. Box 252 ' Brewster, NY 10509 Dear Mr. Nichols: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 July 8, 2008 RE: Proposed SSTS Revision for Sciarri at 44 Cushman Road (T) Patterson, TM # 13 -2 -67 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health This Department has received and reviewed the submitted application and plans for the above referenced project and the following comments are offered for your consideration. /1. The SSTS construction notes are to be revised in accordance with the latest revision of Bulletin ST -19. The site plan is to be shown to scale. The contour elevations are to be added to be site plan. The septic tank detail incorrectly specifies a 1500 gallon tank. The S.CS soil symbol is to be defined on the plan. The garage drywell is to be specified as being a minimum of 50 feet from the proposed /^ell on the SSTS plan. /1 curtain drain outlet location is not shown on the SSTS plan. XThe pump chamber detail reflects tank dimensions for a 1500 gallon tank. 9. For a six- bedroom residence, the daily design flow is 1200 gallons. The pump pit calculations and pump pit detail are to be revised accordingly. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. MJB:kly Respectfully, Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD „MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Harry Nichols, P.E. P.O. Box 252 Brewster, NY 10509 Dear Mr. Nichols: ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH July 8, 2008 Geneva Road, Brewster, New York 10509 RE: Proposed SSTS Revision for Sciarri (T) Patterson, TM # 13 -2 -67 East Branch Reservoir Basin The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on July 7, 2008 is complete. The Department will notify you by July .28, 2008 of its determination. ❑- The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ❑ Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed approved, subject to standard terms and conditions,as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental- Protection review and ' approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if Department of Environmental' Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2148. MJB :kly Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 BRUCE R FOLEY Public Health Director LORETTA MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 tyAcsl C) TO: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM DELEGATED rROECT. TOWN: C SE POK PV DATE SUB'D APPROVAL: - NOTICE OF COMPLETE APPLICATION DATE: �a r v l i I A.1Y1 U U U NTY DEPARTMENT OF Y7EALTH DIVISION OF El.. i1RONMENTAL HEALTH. SERVICES. APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM. 1. Name and address of applicant: 2. Name of project: J�k T a sm <�S T-S 3. 4. Design Professional: t ., 5. 6. Drainage Basin: Location T Address:. 0- ,0 , J30x ��` 7. Type of Project! Private/Residdntial Food Service Apartments Institutional .Office Building, Realty Subdivision Commercial Mobile Home Park Other (specify) 8: Is this project subject to State Environmental Quality Review -(SEQk)? . Type Status (check one) ....................... ............................... Type I Exempt Type YI Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ........................... 'Alo 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? ......................................................... ............................... t; 13.. If so, have plans been subniitted-to such authorities? .. .:.....::.:.... p 14. Has preliminary approval been granted by such authorities? Date granted: iL1 15. Type of Sewage Treatment System Discharge ................. surface water. _;groundwater 16. If surface water discharge; what. is the stream class designation? .................... . A 17. Waters index number" (surface) :.................. ... ...................... _ ... _- 18-. Is project located near a public water supply system? a 19. If yes, name .of water. supply Distance to waterssupply /V/A-. 7. 20. Is project -sit 6-near a'public sewage collectionor treatment system? ...... No 21. Name of sewage•system Distance to sewage system /(//A- 22.- Date test holes observed 4- 20 - o5— 23.. Name of Health Inspector /t4 24. Project design flow (gallons per day) ........:........................ ............................... i o 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?:.. 26. Has SPDES Application been submitted to local DEC office? .........................- orm PC -97 -27. Is any portion of this project iodated within a designated Town or State wetland? o 28. Wetlands ID Number ...............:... ::.... ............................... ............ ......... . 29. Is Wetlands Permit required? ..:............ ............ Has application been made to Town or Local DEC office? 30. Does project require a DEC Stream Disturbance Permit? ..................:... 31. Is or-was project site used for agricultural activity involving application of - pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling; sludge application or industrial activity? ... Yes/No. o 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 0 �DESCRiBE:. • � • 33. Is.there a local master plan.on file with the Town or Village? .:::..................... 34. Are community water and/or sewer facilities planned to be developed within 15 years:in or adjacent to project site? ...........:.............,.....: .............................:: 1 Llvk;n 35. Are any sewage treatment areas in-excess-of 15% slope? . ......... ...:.............:.::. 36. Tax Map ID Number ..........................: ............................... Map 1 3 Block -,-2— Lot h 37. Approved plans are to be. returned to..... Applicant b,--'�Desigri Professional NOTE:.All applicationsfor review and'approval of anew SSTS to be located within theNYC 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 frorri 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.,tlie application must be accompanied by a better of Authorization (Form LA -977. Failure to comply with this provision may be grounds for the rejection of any submission. 1 hereby affirm, under penalty of perjury, that information provided'on this foriti-4 ' 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 the Penal Law. SIGNATURES &OFFICIAL TITLES: Mailing Address :.............:................ . PUTNAM COUNTY .DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of ' ( . Ig 1, t s Located at Gl T/� Tax Map .#, 13. Block -2 Lot Subdivision of Subdivision Lot # Gentlemen: Filed Map # - - Date Filed This letter is to authorize r a `� - 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 tretment and/or water supply systems in conformity with the s s.„ of�� Article 145' and/or 147 of the Education Law, the Public Health Law, and the Putt :.,ary Code. . Very truly yours, Countersigned: X124 `. Signed: P.E., R.A., (Owner ofPrope ) Mailing Address 'p ,1 o y- 2-5�2; Mailing Address: .1`7 State � Zip. W TO Telephone: State L �. Zip 10 S 12 Telephone: Form LA -97 4, Harry W. Nichols Jr., P.E. VA Y P.O. Box 252 Brewster, NY 10509 Tel (845) 855 -9275 Date: 7-03-09 To: PG I+ D Attention: u�1•c.c,�'dr 4� �kglheCP�� Gentlemen: We enclose (5j) copies of -0164 Prints O Specifications Job No.: noS -o 13 Project f 1� te-j sS —IS (: a a ,E. p 13, 2 -(7 O •Reproducibles O Reports O Memorandum O Copy of letter, Sent Via: D Our Messenger O Blueprinter O Your Messenger 0 Hand Delivery Copy to O First Class Mail ❑■ O Tracings O Revision/Date No. rcy a-16-00 v ev 7 -02- -a 8 702 -Og' 7-O�-OFi -0 2 - ag 7 -o 2- -66 D Special Delivery Very t ly yours, H W. Ni is Jr., P.E. O. Harty W. Nichols Jr., P.E P.O. Box 252 Brewster, NY 10509 Tel (845) 855-9275 CONSULTING SITE ENGINEERS JOB No. 0 13 SHEET No. OF 2 COMPUTED BY I- T DATE 01-f)7_-QFj CHECKED BY DATE 0'7 -OX-66 . ............... --.3Q'X -J.9 'T . ...... ................ 57r, 4 Ti C L ...... ... .. ...... ........ .......... ---- ----------- i2 TT 11v 6'-5 5 q0 ....... ....... ... . ..... . ............. Ht- - - - - -- - Harry W. Nichols Jr., P.E. P.O. Box 252 Brewster, NY 10509 Tel (845) 855 -9275 CONSULTING SITE ENGINEERS JOB No. O G" — U 13 SHEET No. 2 OF Z COMPUTED BY L.? -DATE 67 o2-op- CHECKED BY DATE 02LQ � _ C ♦ ,' ------- - - - - -- - -- --- ..._.... — - ' • ss�, gas ff++ � P TNAM COUNTY DEPARTMENT OF HEA ON OF ENVIRONMENTAL HEALTH SE CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # O S' U c,,, a, ck, /Urz„,e ��. `1 Located at '14 CU Town or Vj'le Subdivision name Subd. Lot # Tax Map 13 Block- 2 Lot 67 Date Subdivision Approved Renewal _� Revision Owner/Applicant ant Name G g �r hI 1 Date of Previous Approval %— Mailing Address 1:7 n a V we, %_ Zip ! Q U ?,..._ OG Amount of Fee Enclosed 'h, 0 0 Building Type h Lot Area ] ,57No. of Bedrooms 5- Design Flow GPD /0 D 0 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 00 gallon septic tank and �S' Other Requirements: To be constructed by Water Supply: Public Supply From Address Address or: _Z Private Supply Drilled by 7-)3 j- Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the ,, separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance ". satisfactory to. the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date 13-07 License # APPROVED FOR CONSTRRUCTION: 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 p rmit. Approve for discharge of domestic sanitary sewa only. 492 By: Title: Date: / White copy - HD e; ello copy - Building Inspector; Pink copy - ne - ange copy - Design Professional Form CP -97 V PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # P OS'-05— Well Location: Street Address: Town/Village Tax Grid # +f C,54 ,;ha c,, Q e, 601, /U, Map J Block 2. Lot(s) <�; Well Owner: Name: Address: C41,J1a ker SClctrrj In lhtierl oc4e , /9CeJ Carixel 9 y /OS'/ Use of Well: 1,;,R6idential 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 S gpm # People Served 11(p Est. of Daily Usage LaQ.6 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling //%ew Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type rilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Lot No. Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public.Water Supply: y %A, Town/Village -- Distance to property from nearest water main: Proposed well location & sources of contaminatio to be provided on separate sheet/plan. Date: 9 -13 —U % Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL Ws 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 Yell driller shall take, appropriate action to assure that any and all water and waste products from such Yell drilling operations be contained on this property and in such a manner as not to degrade or otherwise ontaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless onstruction of the well has been completed and inspected by the PCHD and is revocable for cause or may be anended or modified when considered necessary by the Public Health Director. Any revision or alteration d the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam (ounty. Date of Issue Date of Expiration -0 Permit is Non - Transferrable Permit Title: Vhite copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; copy - Well driller Form WP -97 / Harry W. Nichols Jr., P.E. P.O. Box 252 T Brewster, NY 10509 Tel (845) 855 -9275 August 15, 2007 Putnam County Health Department 1 Geneva Road Brewster, New York 10509 ATT: Michael J. Budzinski, P.E. Re: Individual SSTS — Name change/ renewal Cushman Road Town of Patterson F T.M. # 13. -2 -67 dear Mr., Budzinski: Enclosed are the following: 1. Five (5) prints of SS -1, "Proposed SSTS ", revised 7- 20 -07. 2. "Short EAF ", dated 08- 13 -07 -. 3. "Application for Approval of Plans for a Wastewater Disposal System ". 4. "Construction Permit for Sewage Disposal System," dated 08- 13 -07. 5. "Application to Construct a Water Well ", dated 08- 13 -07. 6. "Design Data Sheet ". 7. "Letter of Authorization. 8. Review Fee in the amount of $500.00. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience: Very trulyyours, aA Harry W. Ni ols Jr., P.E. HWN:gav 05- 013.00 14 -16.4 (9/95) —Text 12 PROJECT I.D. NUMBER SM20 SEAR Appendix C ' State •Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For, UNLISTED ACTIONS Only PART I— PROJECT INFORMATION, (To be completed by Applicant or.Project sponsol) 1. APPLICANT /SPONSOR 1 AA eli L_ �G Gr J'►^( 2. PR Zroa6r5_ ECT NAME _ Y, vts Jd 1 3. PROJECT LOCATION: }, Palfi Municipality rgcaL, County 4. PRECISE LOCATION (Street Intersections, and road Interse)tions, prfominennt landmarks, etc., or provide map) ad 13 '2- -C7 5. Is P�R �ED ACTION: -,rO, W'New ❑ Expanslon ❑ Modificatlordalteratlon S. DESCRIBE PROJECT BRIEFLY: rT y "i/•C '� �'Y.S � Y�h•C �, �) C s 7i UfPif' � yQpS 0i't 14,S 7 Ac vt P4"r_�l 7. AMOUNT OF LAND AFFECTED: Initialy '01-7 S acres Ultimately O t t acres • 8. WILLOPOSED ACTION COMPLY WITH EXISTING ZONING OR•OTHER EXISTING LAND USE RESTRICTIONS? tldYes No If No, describe briefly ., 9. WHAT PRESENT LAND USE IN VICINITY OF PROJECT? Residential 11 nduitd Cl Commercial ❑Agriculture ❑ Park/ForestlOpen space 0 Other Describe: °. C�s 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OA LOCAL)? • 6 Tolvh U ` /0 RllbrtG�1U11 1-1 If list Yes No yes, agency(s) and permittapprovals p "' �% ►lid e.Pu.r -Lt/�1 �' / 11. DOES ANY ASPF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? PYes o If yes,-113t, agency name and permivapproval ". 12. AS A RESULT OF�P MMSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? , ❑ Yes WNo CERTIFY THAT THE,, INFORMATION PROVIDED. ABOVE IS TRUE TO THE BEST OF MY' KNOWLEDGE ; Appllcantfsponsor 'na ✓ " `� + ��t G. �i G C Date: (' ° 0 Z Signatures U ° " If the "action is In the Coastal Area, and you are a. state agency, complete the . Coastal Assessment Form before proceeding with this assessment OVER T PART II— ENVIRONMENTAL ASSESSMENT (To -be completed by Agency) A: DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate, the review process and use the FULL EAF. ❑ Yes ❑ No 6. 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 of fauna, fish, shellfish or wildlife specles; significant habitats, or threatened or endangered species? Explain briefly: C4. A comMunity's existing plans or goals as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities likely to be Induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not Identified In C1-05? Explain-briefly. C7. Other Impacts Qncluding changes . in use of either quantity or type of energy)? Explain briefly. GG"7 t!'1 D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT_CAUSED THE ESTABLISHMENT O( `CEA? ❑ Yes ❑ No E. IS THERE, OR IS THERE LIKELY TO BE,-CONTROVERSY RELATED TO POTENTIAL. ADVERSE ENVIRONMENTAL IMPACTS? 'AA ❑ Yes ❑ No If Yes, explain briefly PART 111— 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 '(Le. urban orruraQ;'(S) probability of occurrin$; (c) ddratioh; (if) 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 and 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' informati d on an •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 Responsigle Officer in Lead Agency title of Responsible Officer Signature of O icer. in Lead Agency Signature of. Preparer (if different from responsible o ices Date IN i 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: 2. Name of project: r6 Y0.40 5V T 3: Location Td. p�Z7 .�.'l 011 4. Design Professional: l a. 5. Address:. i��0 E J30x 6. Drainage Basin: + S, 7 T f P o'ect• .. , te,,"Private/Residential Food Service Commercial Apartments Institutional_ Mobile Home Park Office Building. Realty Subdivision Other (specify). 8. Is this project subject to State Environmental ;Quality Review -(SEQR)? Type Status .(check one) ....................................... ........... :..... Type I Exempt .TYPe.II -Unlisted 9. Is a Draft Environmental impact Statement (DEIS) required? ......................... .10. Has' DEIS been completed and found acceptable by Lead*Agency? ............... IV 11. Name of Lead Agency 12. Is this project in. an -area under the control of local planning, zoning,-or other. t officials, ordinances? ........:................................................ ............................... Q. If so have plans been submitted-to such authorities?• ...... ....: : ....:............:..:..:; p Z14- 14. Has preliminary approval'been granted by such. authorities? Date granted: 15. Type ofSewagee Treatment System Discharge :...::........... surface water groundwater 16. If surface water discharge; what. is the stream class designation? ... ,................. 17. Waters index number (surface) _ :................ ................................................ 18-. Is project••located near a public water supply system? �. 19. If yes, iiame .of water supply. Distance to water supply N 20. Is project•sitenear. apublic sewage collection or treatment 21. Name of sewage-system - Distan ce:to sewage system' 22. Date test holes observed + 20 - o 5' 23.. Name of Health Inspector A v, r r, e, nt 24. Projec design flow (gallons ay) .................................. ............................... 1006 , 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?,.. 26. Has .SPDES Application been submitted to local DEC office? ......................... 1+ form PC -97 2 -27.. Is any I portion- of this project locate . d . Within: a designated Town or State wetland? Wetlands ID Number.:.........:.. ....................................................................................... A-- 29. Is Wetlands Permit required? ................................................................................ Has application been made to Town or Local- DEC office? ................................. . AJ 30 . Does project require a DEC Stream Disturbance Permit? ................................ *.... 31. Is or was project site used for agricultural activity involving application of .pesticides to orchards or other crops, solid or hazardous waste" disposal, . landfillingi sludge a pplication'or industrial activity? ............................. Yes/No 32. Is project located within 1,000, feet of existing or abandoned- landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ................... ............ Ye's/No DESCRIBE: 33. Is.there a local master plan'.on file with the -Town 'dt Vill.agV .............................. Y-CS 34.: Are community Water and/or-sewer facilities planned to be developed within 15 dears -in or adjacent to project site ?. .. .............. h 35. Are any sew' age treatment area's in. excess -Of 15% slope? ................................. . /UO" - 36. Tax Map ID Number ........................ ...................... ........... Map 13 Block! 2 L ot 31. Approved plans are to be. returned to...... Applicant _.-�Design . Professional NOTE:.Afl- 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. . re%N q DEP he approval of the SSTS prior to final approval. byte, Department: -Projects w ithifilt' watershed day also requir:e DEP review and approval of other.aspects ofa proje6t, such as stormwater p! ' ans or.the- cation 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 applicatibn must comply. with this'j`fo,�i* i be accompanied by a Letter of Authorization (F9rm,LA-97.) Failure to ision may be grounds for the rejection of any submission. Ihereby affirm, under penalty ofterjury, that informatio'nprqvide&on this forjtris 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 th e Penal Law. SIGNATURES & OVFICIATITLES: 4, Mailing Address : ...................................... PUTNAM COUNTY. DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner vri ( Q S t Address Located'at (Street) �t� , �s„ ,,,� gy c Tax Map 43 Block 2 Lot C (indicate nearest cross street) Municipality Watershed ' � Uc�' fo 1-1 SOIL PERCOLATION TEST DATA Date of Pre- soaking /51 - 0 'g— Date -of Percolation Test Form DD -97 ::::.................................:.........:..:...:............................:.::::: ::::..�:::::..:::::::::..::�).. o ter ............... P �.....� . . ..'S?t'.. to .. ::.:.:. �. � .:.::.:::::.:.............. :::......: :....:::..::......:::.:.:...::.:::::::::.::::: ....:....:...:::::.:.�:::::.�:: RtYrr:> ..::........................ ..:::::.;:.:;.:::;.::.:.::. <.:;:.a ....................... .se:T.ae: .. ..:..:....:....:.:.::::::: ...::. > : x :.::...:....::..:....:.... ..::.:::.::.:::.....e�!el..:: .prf ce... uc es ......:...ray >.:........::::..:..:::. >» .:.Iu::..::: pp date....::::.:::: Na: >::; »:> N+ n:::::::::»:: :::.::::..:::.:::..........:.............. :: >tnrt..fo ..:..:..:.:::.:::::. ..:..:::...:::::::.:.::::.:::.. .:::::...........:: �n....::.:::. ...........:::..:::...;::fit .. :... :: a .:.::: rY..:.::.:: Cp :::.:::;:;:. :..:::..... :......... Inches :;.....:.... >lYbnlInci�;;:::.;; ...........: .............::. 2-9 —2-3-4 3 2-3 .4 3 .3 z 2 Z 2-3 -30 3: Z ; 3 5-7 3 ; o..S "3 4 2 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s l 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. HOLE NO. 2- HOLE NO. G.L. 0.51. Tc So t 1.0' 1.5' 41 9r-, 2.0' h 2.5' 3.0' 3.5' 4.0' 4.5' Dl�v` 13r 5.5' A o 7 d rN s�K 6.0' 6.5' . . 8.0' ; 8.5� . 9.0' N 9.5' 10.0' 2 Indicate level--at which groundwater is encountered- /VG k Indicate level at which mottling is observed Indicate level to .which water level rises after being encountered J� e Deep hole observations made by: 6 . % 1,,, kj',L' jc.^ bate Design Professional Name: Address:,. 6 ; An Signature: 7j Design Professional's Seal At u 56124 JUL -10 -2007 01:35 PM HARRY W NICHOLS 914 279 4567 P.01. t PUTNAM COUNTY .DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Located at �' % C +-c S w► c� �ry �� lo k ffY f s c, 7 T Tax Map # 3 'Block Lot Subdivision of Subdivision Lot # Filed 11!Iap # • —.Date Piled Gentlemen: This'letter is to. authorize rl .-� 64-0/r a duiy licensed Profe'ssior al Enginee? _k,`0o'r.Regisfcrcd Arcliitcct to applifor-the required wastewater treatment and/or water supply pertriit(s) to serve the above -noted property in accordance E 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 c_onstntctlon of said wastewater tretment and/or water supply systems in '° f the Education Law, the Public Health conformity w►th �V�t� Article, 1470 _ Law; and the Rift bit ry Code.:. f Very truly yours, Countersibme, P.E., R:A., # OA Mailing Address ar of State Zip 0 Telephonc: 86i L;� S Signed • (:Owner of Prop ) Mailing Address: I 7 OL_ Ale/ oc. v ✓K-PX � .,... F State iN ( Zip / OS l Telephone: 2,y S 3 ° 9( 2 E, r Form LA -97 1 - -- - - - -y; eCfK1D.t0 DA{LIGIiT • c V%VT►TILT A It K rN A-%YTILT►Tt7 71T11'1 "'rMElVT ®r HEALTH . Subdivision name Subd. Lot # — Date Subdivision Approved �� Owner /Applicant Name �`�t, ,�, S �� ` '1 , Mailing Address AL HEALTH SERVICE AGE TREATMENT SYSTEM Town or ' age Pe Tax Map 13 Block 2 Lot Renewal Revision Date of Previous Approval Zip i Amount of Fee Enclosed i,:r' 6Cl Building Type XL I` --� 4'� Lot Area!`f,7 No. of Bedrooms Design Flow GPD l� 00 4 Fill Section Only Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 5-0 C) . gallon septic tank and lip r 12 /'1,414, % Y eM c 4�;f Other Requirements: To be constructed by Water Supply: I Public Supply From Address Address or: Private Supply Drilled by 7-6 JO Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed Address R.A. Date 4 %Xoo License # 5'4:A2 -4 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 c sidered ecessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit rove discharge of domestic sanitary sewa only. By: �C/� Title: Date: (2�� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professio• . 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 `�ddress: To e Tax Grid # �� C/A�t'�+��► ��h Map 13 Block - Lot(s)4e Well Owner: Name: J� S +e S r Address: �• ✓ 2 =� if t%�VL� e F Use of Well: �Zesidential 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 !I-f Est. of Daily Usage UOd gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling _kl' New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Z/ Name of subdivision — Lot No. Water Well Contractor; T_ A'0 Address: Is Public Water Supply available to site? ............... ............... ............................... Yes No Name of Public Water Supply: A/ Town/Village Distance to property from nearest water main: Proposed well location ,& sources of contaminatio t 'be provided on separate she pl . Date: -� �'�U� ; Applicant Signature: MA 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. y revision or alteration of the approved plan requires a new permit. Well to be constructed by a water � ll ller mortified by Putnam Date of Issue f ZC Permit Date of Expiratio Title: _ Permit is Non -Trans rab e �41 White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Harry Nichols, P.E. Patterson Park, Ste 106 2050 Route 22 Brewster, NY 10509 Dear Mr. Nichols: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive July 12, 2005 Re: Proposed SSTS: Seifert Cushman Road (T) Patterson, TM # 13 -2 -67 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. Attic areas are to be labeled as unfinished. 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 Environmental. Protection on this lot, percolation tests must be witnessed by a representative of this Department. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:kly Very truly yours, f Robert Morris, P.E. Senior Public Health Engineer Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early InterventioniTreschool (845) 278 -6014 Fax (845) 278 -6648 May 31, 2005 Putnam County Health Department 1 Geneva Road Brewster, New York-1 0509 ATT: Robert Morris, P.E. Re: Proposed SSTS - Siefert Cushman Road Town of Patterson T.M. # 13. -2 -67 Dear Mr. Morris: Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 1 Tel: (845) 2794003 Fax: (845) 2794567 Email: hnengineer@aol.com In response to your May 12, 2005 review letter comments, the following items have been addressed: 1. Corrected deep hole description of hole # 2. on plan. 2. Attic area labeled as unfinished on architecturals. 3. Neighbor notification submitted. Attached copies of Certification of Mailing, 4. Silt fence added to plan. 5. Proposed well added to plan and dimensioned. 6. Water line from well to house added to plan. 7. Sewer line is noted on plan as being 2.0% or ' / "/ft slope. 8. The maximum length of dose to any trench is 10OLF not limiting each distribution box to 50 LF per side. 9. Detail and note has been added to plan. 10. A natural- saddle runs through the SSTS system directing flow away from system to the west and the north. Kindly review the attached plan for approval and issuance of the Construction Permit at your earliest convenience. gY SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI,'RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive May 12, 2005 Harry Nichols, P.E. Patterson Park, Ste 106 2050 Route 22 Brewster, NY 10509 - Re: Proposed SSTS: Seifert Cushman Road (T) Patterson, TM # 13 -2 -67 Dear Mr. Nichols: Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: 1. Deep hole description on the plan is not correct. 2. Attic areas are to be labeled as unfinished. 3. Neighbor notification is required. 4. Erosion control methods for the house, well and SSTS are to be shown and detailed. 5. Proposed well location is to be shown and dimensioned from two property lines: 6. Water line from the well to the house is to be shown. 7. Sewer line is to be noted as having a minimum slope of 8. Each D -Box outlet may dose a maximum of 100 L.F. of trench: 9. Curtain drain standpipes are to be shown and the detail provided. 10. How will the SSTS be protected from ground water from the hill on the southeast? 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 Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ve} - ily yours, RM:kly Robert Morris, P.E. Senior Public Health Engineer Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 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 April 29, 2005 Putnam County Health Department 1 Geneva Road . Brewster, New York 10509 ATT: Robert Morris, P.E. Re: Individual SSTS - Siefert Cushman Road Town of Patterson T.M. # 13. -2 -67 Dear Mr. Morris: Enclosed are the following: Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 Tel: _(845) 2794003 Fax: (845) 279 -4567 Email: hnengineer@aol.com 1. Five (5) prints of SS -1, "Proposed SSTS ", dated 04/28/05... 2. "Short EAF ", dated 04/28/05. 3. "Application for Approval of Plans for a Wastewater Disposal System ". 4. "Construction Permit for Sewage Disposal System," dated 04/28/05. 5. "Application to Construct a Water Well ", dated 04/28/05. 6. "Design Data Sheet ". 7. "Letter of Authorization. 8. Three (3) copies of Architecturals. 9. Review Fee in the amount of $400.00.. 10. Pump Design We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very tr ly yours, �r Harry W. Nic s Jr., P.E. HWN:gav 05- 013.00 r� cam' April 29, 2005 Putnam County Health Department 1 Geneva Road . Brewster, New York 10509 ATT: Robert Morris, P.E. Re: Individual SSTS - Siefert Cushman Road Town of Patterson T.M. # 13. -2 -67 Dear Mr. Morris: Enclosed are the following: Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 Tel: _(845) 2794003 Fax: (845) 279 -4567 Email: hnengineer@aol.com 1. Five (5) prints of SS -1, "Proposed SSTS ", dated 04/28/05... 2. "Short EAF ", dated 04/28/05. 3. "Application for Approval of Plans for a Wastewater Disposal System ". 4. "Construction Permit for Sewage Disposal System," dated 04/28/05. 5. "Application to Construct a Water Well ", dated 04/28/05. 6. "Design Data Sheet ". 7. "Letter of Authorization. 8. Three (3) copies of Architecturals. 9. Review Fee in the amount of $400.00.. 10. Pump Design We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very tr ly yours, �r Harry W. Nic s Jr., P.E. HWN:gav 05- 013.00 h, P a� Reflecting the above, we are enclosing five (5) prints of the following: • SS -1 Proposed SSTS, rev. 05/31/05. Very truly yours, Harry W. Nichols Jr., P.E. HWN:gav 05- 013.00 '0 PUTNAM.:CQIINTY...Dj��,ARTKE�i!TQF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE. TREATMENT SYSTEM Owner,. 5TEvc- ScjFE'12� Address' 66' - Located at (Street] Tax Map 1$:._, ..816ck 2- L6t (indicate nearest'cross street) -- Municipality Watershed 64 SOIL PERCOLATION TEST DATA Date of Pre - soaking `--o4jq-05 Date of Percolation Test o± • zo o umi g p > M0 g U.7 �- X #7 4 1"30-1,100 30 2 —3- so 2z — 1`37- 30 22— Z . _'S *75 5 777 04 Z 0 -2- 3, 4 ! .5 . ............................... . . . .. . 51 NOTES: 1. Tats to be re'pe"g6d'at same crepta untie approximately equal percolation rates are obtained at each min/ pero6lidigii.t6st hole.' x;.�'l rniriforlm.X in6hjs 2 mih•for,3 -60-pinAnch 1-d submitted for review.. 2..* Depth measurements to lip. m*Ade.ftem top of h9.1;- Form DD-97 DEPTH G.L. 0.5' 1.0' 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' TEST. PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED .IN TEST HOLES. HOLt NO. HOLE NO. HOLE NO. b otTLua14 9.5' 10.0 . Tndicat'e.level :at- which$rQUYdwafieEis. encountered Indicate level at whirl ,mottling is observed - Indicate'level to which water level.rises-aftvr:being encountered Deep hole observations made by: P_11,, Dafa,.. Design 'Professional Narn j-r� 1;, i11 sir Address::... Signature DesigQ Professional's $eal. PUTNAM COUNTY .DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Located at T/V Tax Map.# Subdivision of VC/L-k Sy,- * 1'r, 1,5 Block 2 Lot 6e Subdivision Lot # Filed Map # Date Filed Gentlemen: This letter is to authorize 4ca r,-., �j . /UiG 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 tretment 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. Countersign P.E., R.A., # ( 2 -j Mailing Address ' A— ,.:) J— State /U Zip L0 SO Telephone: 813,-2:79- 4003 Very truly yours, Signed: (Owner of operty) Mailing Address: Z OLA4ZI State IV Zip 12-5 37 Telephone: Form LA -97 z. a- LIST OF PROPERTY OWNERS Project Number: 05- 013.00 Date Obtained: April 13, 2004 Cushman Road Patterson, New York T.M. # 13. -2 -67 (Seifert - 05- 013.00) Hutton, Timothy c/o B. Kaufman Thompson Inc. - Suite 2500 2049 Century Park East Los Angeles, CA 90067 13. -2 -3 - Maslosz, Dariusz 3 Caroline Drive Patterson, NY 12563 13. -2 -4 - . McHugh, William Jr. & Judith 5 Caroline Drive Patterson, NY 12563 13. -2 -5 - Sinkwich, Darrylin A. 7 Caroline Drive Patterson, NY 12563 13. -2 -6 - Pace, Peter Jr. & Yolanda 9 Caroline Drive Patterson, NY 12563 .13. -2 -66 - Blumberg, Lawrence & Robin Lynn 521 Fifth Avenue - 24th Floor New York, NY 10175 13. -2 -68 - Putnam Co. Nat. Bank of Carmel 13. -2 -70 P.O. Box 10 Carmel, NY 10512 23. -1 -10 - Powe, Reginald & Colleen 107 Upper Mountain, Avenue Mountclaire, NJ 07042 Project Number: 05- 013.00 Date Obtained: April 13, 2004 9 0 a �° ru 1031 L USI ru ru Postage $ 0.83 UNIT IN 0012 Ln ° tti fA &Fy-11 r9 Certified Fee 2.30 ru ru Postage $ Postmark ru O Return Receipt Fee (Endorsement Required) 1.75 Here ° ° Restricted Delivery Fee (Endorsement Required) .�J Clerk: 97FSRO ° Total Por - 4.88 06 /01 /05 o sent To McHugh; William Jr. & Judith ru st;t,t 5 Caroline Drive ------ ° or PO Box Ciry Patterson, NY 12563 � State, - - -- Ali a co ru 77PAME, E I 1256 I. L ru ru Postage $ 0.83 UNIT III: 0012 Ln ° tti fA &Fy-11 r-i Certified Fee 2.30 ru ru Postage $ Postmark ru Return Receipt Fee 1.75 Here ° (Endorsement Required) .�J Certified Fee ° ° Restricted Delivery Fee Clerk: 07FSRO (Endorsement Required) Postmark C3 r� Total Post - 4.88 06/01/05 Ln c/o B. Kaufman ru ° Sent To Sinkwich, Darrylin A. Iv O 2049 Century Park East k 7 Caroline Drive City, State, ZIP or PO Box 1 ° ° "state." Patterson, NY 12563 06/01/05 Ln ° ra —1 N Cook LOAN EF A �9ook L ru a ru ru Postage $ 0.83 UNIT III: 0012 Ln ° tti fA &Fy-11 ,-R Certffied Fee 2.30 ru ru Postage $ Postmark t1J Return Receipt Fee 1 Here ° (Endorsement Required) .�J Certified Fee ° ° Restricted Delivery Fee Clerk: 97FSRO (Endorsement Required) Postmark ru ° Total Postagr 06/M/05 Hutton, Timb y p Sent To c/o B. Kaufman ru stmt, ,aF No Thompson Inc. - Suite 2500 0 or Po sox " °. 2049 Century Park East � City, State, ZIP Los Angeles, CA 90067 ° TotaLPosta ^^ ° �___ c Cc n- ° tti fA &Fy-11 631- A L ru ru Postage $ 0.83 UNIT IU: 0012 Lr) `=1 Certified Fee 2.30 Postmark ru ° Return Receipt Fee (Endorsement Required) 1.%5 Here °o Restricted Delivery Fee Clerk: 97FSRO (Endorsement Required) ° TotaLPosta ^^ ° �___ c . 4.89 06/01/05 Ln ° Sent To Maslosz, Dariusz f 1J -- --- - -- Street, t. - i - � 3 Caroline Drive O or PO Box h ciiy state: Patterson, NY 12563 o - PS Form 38 ,lions :I F ` 0,��1Y' 131. A L U rd Postage $ 0.83 UNIT ID: 0012 Ln rq Certified Fee Postmark ru Return Receipt Fee 1.75 Here ° (Endorsement Required) ° Restricted Delivery Fee Clerk: A7FSk0 (Endorsement Required) Total Pos' - `^ 4.88 06/01/05 o Sent To Pace, Peter Jr. & Yolanda ru street, ^Pt. 9 Caroline Drive ° or PO Box CO "City State, Patterson, NY 12563 - - - -" R ru NSY�, 1v'Ir,, -WI AL USA c.jv Postmark ru Postage $ 0.83 UNIT ID: 00I2 tr7 ° (Endorsement Required) rq Certified Fee 2.30 ° ° Restricted Delivery Fee Postmark 1.75 ru Return Receipt Fee ° (Endorsement Required) Here ° Restricted Delivery Fee ° Clerk: WSRO ° ,..q (Endorsement Required) a 4..88. 06/01/05. ° Total P - (� . 4.68 06101/05 t-n 0 Sent To Blumberg, Lawrence & Robin Lynn ru Street; A 521 Fifth Avenue - 24`h Floor -------- 0 or Po Bc New York, NY 10175 ru R' �50�lTCLfIR. J 0704' ru ru Postage $ 0.83. UNIT IU: 0012 L rq Certified Fee 2.30 Postmark ru Return Receipt Fee 1.75 Here ° (Endorsement Required) ° Restricted Delivery Fee Clerk: O7FSk0 ° (Endorsement Required) ° Toter Pa.• 4.88 A6 /01/05 o sent To Powe, Reginald & Colleen ru street, ;�, 107 Upper Mountain Avenue O or PO Box C3 -� ;ry State Mountclaire, NJ 07042 u7 M N COAL UI ru ru Postage $ 0.83 UNIT III: 0012 Ln r q Certified Fee PS 1-orm.38UU IN ,ng _i c.jv Postmark ru Return Receipt Fee Here ° (Endorsement Required) 1.75 ° ° Restricted Delivery Fee Clerk: 97FSRO (Endorsement Required) ° ,..q Total Postage " ____ a 4..88. 06/01/05. Ln ° sent To Putnam Co. Nat. Bank of Carmel ru street, "Vt; "e P.O. Box 10 ° or PO Box No. ° "Ciry State, - ZIP Carmel, NY 10512 PS 1-orm.38UU IN ,ng _i 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: 1 '�C-►• 24 2. Name of project: SS Z S 3. Location TX. s 4. Design Professional: �v�v Address: jai v X)� 9-A— A c 6. Drainage Basin: __r =5'� 7. Type of Proiect: Private/Residential Apartments Office Building Food Service Institutional Realty Subdivision Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ................ .I.............. Type I Type II 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 10. Has DEIS been completed and found acceptable by'Lead'Agency? ............... 11. Name of Lead Agency Exempt Unlisted _JC y� 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? ... : ................ ................ :... 14. Has preliminary approval been granted by such authorities ?k Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water /;..;— _groundwater 16. If surface water discharge; what is the stream class designation? .................... NIA 17. Waters index number (surface) :...................................... ..........:...................2 ..... 18. Is project located near a public water supply system? ....... ...................:........... 19. If yes, name .of water. supply Distance to water supply. 20. Is project site near a public sewage collection or treatment system? ................ NO I. Name of sewage-system Distance to sewage system -- 22. Date test holes observed .4 - av -o T- 23.. Name of Health Inspector 24. Project design flow (gallons per day) 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... 6 26. Has SPDES Application been submitted to local DEC office? .......................... orm PC -97 2 -27. Is any portion of this project located within a designated Town or State wetland? -e-- 28. Wetlands ID Number ........................................................... ............................... .,�G' I 29. Is Wetlands Permit required? ............................................. ............................... N cJ Has application been made to Town or Local DEC office? ............................... VZ4- 30. Does p roject require a DEC Stream Disturbance Permit. ..................... 31. Is or.was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, e landfilling; sludge application or industrial activity? ............................ Yes/No 1� ) 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 d DESCRIBE: . 33. Is there a local master plan on file with the Town or Village? ......................... 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? oil ................................ ..........................:.... �r, 35. Are an sewa a treatment areas in excess of 15 /o slo e. /U 0/ Y . g ° p: 9 . ............................... 36. Tax Map ID Number ........................... ............................... Map / I Block -2— Lot 47 37. Approved plans are to be. returned to ..... Applicant z,-"' 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, 10.45 of the Penal Lawn SIGNATURES & OFFICL4L TITLES. Mailing Address: * .................................... i�- MODEL Harry W. Nichols Jr., P.E. JOB No. Patterson Park, Suite 106 20.5.0-Route 22... SHEET No. 2. OF 2 Brewster, NY 10509 COMPUTED BY DATE (840 279 -4003, Fax 279 -4567 CONSULTING SITE ENGINEERS CHECKED BY DATE Harry W. Nichols Jr., P.E. Patterson. Park, Suite 106 2050 Route 22 Brewster, NY 10509 (845) 279 -4003, Fax 279 -4567 CONSULTING SITE ENGINEERS JOB No. SHEET No. 1 `OF 2 COMPUTED BY_ DATE c% CHECKED BY DATE — 1,��jQ -TI G E�4-� '• - . -- A, P 1 PL L- E.C'-rl+ �(:z PvG_ - -- == -rT I V 6-S7 1FNT P __� I Pti "L aUT T 1+ - - - - -� - — - - - -.. C :2-' Vim., vr_- - - - -- - -- - - -- - - - -- - - i' _ = 1 9 a C i�-� ztv4L- MT_.-P 1 P LAN TH _ —_ AS< v,�, E D' P u,44 P -- RAT (—= - spa &pM_ - - -- F X lq0 ET 1,01ODLA�� — — -- - -+ --AT 77,0 h - - - - - - -- - .. -- -- - -- - - - - - -- - -- — __........__.. - ....... ............ _ ........ - �. sG 14 =16 -4 (9195) —Text 12 PROJECT I.D. NUMBER 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) SEQR 1. APPLICANT /SPONSOR 2. PROJECT NAME /� . 1 , T5 3. PROJECT LOCATION: (� )00 'J Municipality )021Y.,r County kLA_ 0%1\' 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) T. ,- .2. -6,,-7 C e-�,lwh� 5. IS P,,R-O,,P�SED ACTION: 1p ew ❑ Expansion ❑ Modlfication /alleratIon 6. DESCRIBE PROJECT BRIEFLY: A- oc' ej �u `e- +..i SSTs. 7. AMOUNT OF LAND AFFECTED: Initially ©, r acres Ultimately acres 8. WILL PPOSED ACTION COMPLY WITH EXISTING ZONING OR-OTHER EXISTING LAND USE RESTRICTIONS? lldYes ❑ No If No, describe briefly 9. WHAT PRESENT LAND USE IN VICINITY OF PROJECT? 4/J Residentlal ❑Industrial 11 Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? .( Yes 0 No If yes, list agency(s) and permit /approvals PC, %4 D Cc TUw� �f P�tso•, #49"./9)� 11. DOES ANY ASPE OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? E3 Yes No . If yes, list agency name and permit/approval 12. AS A RESULT OF PPZPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? Yes o I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE �� 0 ApplicanUsponsor n me: ✓ v"1 Date: �" Signature: If the action is in the Coastal Area, and you are a. state agency, complete the . Coastal Assessment Form before proceeding with this assessment OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I 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 briefly. i C6. Long term, short term, cumulative, or other effects not identified in C1-05? Explain briefly. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA? ❑ Yes ❑ No 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 it was checked yes, the determination and 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 Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF. ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner S € »TZ-i' Address t Located at (Street) Tax Map _I Block _ 2 Lot :1 (indicate nearest cross street) Municipality Watershed A �-5 ;g 7.,4,&/&4 SOIL PERCOLATION TEST DATA Date of Pre - soaking ' . Z 2 f � 5 .Date of Percolation Test q Z2-0 o :T- NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 I X30 ; o� 3 a - :7- f2 o2.a 3 x; 32 —3:01 3 U 3 G 4 ��. ©�- 3 t 3.9- 73.0 2a-- 1 3 c> 5 r � 2 3 '11, 35"- 3"0 5- O Via- 4 5 1 2. 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. 7 O ,/ 7 `�o" HOLE NO. 2 Indicate level at which groundwater is encountered A I (- 2. , XJ Indicate level at which mottling is observed 3 r C Indicate level to which water level rises after being encountered °'"-- Deep hole observations made by: �, rE p , G� Date go Design Professional Name: (� Address: I Signature: Design Professional's Seal 'PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH. SERVICES INITIAL. INDIVIDUAL /COMMERCIAL SITE 'INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project �'�1 �' ) &En s 0A.3 County Pu r-?v Site Location- e-uS AM. A ; XDB4'G7 Building construction begun 'Ahl Extent Is property within NYC Watershed ?..... ............. Yes F-� No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) I. � Hilly- :0 Rolling a Steep slope 0 Gentle.slope Flat 2. Evidence of wetlands 0 Low area subject to flooding 0 Bodies of water a Drainage ditches a Rock outcrops 3: Propertyy lines or corners evident.: ............:........ .............................I� des No 4. Do water courses exist on, or adjoin the property? Yes No 5. Will these affect the design of the sewage system facilities ?.......... ... es No 6. Do watershed regulations apply in this development ?....................... Yes No 7 Will .extensive grading be necessary? ................. ............................... Yes r�No 0 8. Will extensive fill be necessary for SSTS� .......... ............................... D Yes o 9. Do filled areas exist within the SSTS area? ........ ............................... a Yes No If yes, what is the condition of the fill? SECTION C: SOIL OBSE ATIONS 10. 11. 12 Appearance of soil: Sand = Gravel Loam Clay Hardpan Mixture Observed from: a Borings Bank cut Backhoe excavations Soil borings /excavations observed by �G on 13. Depth to groundwater jr%Je-1 A-)j��- on 14. Depth to mottling _ ` on 15. Are test holes representative of primary & reserve areas ...... ................:.............. 16. Soil percolation tests made by 1101-5 on 17. Soil percolation tests witnessed by i::� , on SECTION D (on back) fo Form ST -1 2 SECTION D. DRAINAGE = 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? 0 es L (No 19. Will groundwater or surface drainage require special consideration? ...'d.1t'� j.... Yes WNo 20. Will gullies, ditches, etc., be filled'and watercourses be relocated ? ..:....................... (� 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 Yes No Inspection data 22. Do adjacent wells and/or sewage systems exist ?..... x0a ......... Yes No 23. Additional comments r A y 24. Site observer /inspector and title C c ;Ee 25. Date(s)- of observation(s)inspection(s) a cP to TEST PIT PROFILES Hole # Lot # Hole # 'Lot # Hole # ' Lot # Depth to water Depth to mottling Depth to rock/imp. G.L. Depth to water Depth to mottling Depth to rock/imp.. G.L. 0.5 .0.5 1.0 1.0 Depth to water Depth to mottling _ Depth to rock/imp. G.L. 0.5 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 8.0 9.0 10.0 8.0 9.0 10.0 l f Sheet ! of PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLH SERVICES FIELD ACTIVITY REPORT Tel: /V / ADDRF4q: CC!!5-14malV L�'�i i, A Street Town State Zip PERSON IN CHARGE 'a, _ aG. / ld Name and Title TYPE OF FACILITY: P7z47, FINDINGS: . 7A" Signature and Title REPORT RFC..F.TVFT) RV: I acknowledge receipt of this. report: SIGNATURE: `/96 Title; BRUCE R. FOLEY Public Heolth...Director DEPARTMENT OF . HEALTH 1 Geneva Road Brewster, New York 10509 ATTENTIOi\': ❑ ADAM STIEBELING 'AGENE REED # 05.013 LORETTA MOLINARI RN., M.S.N. Associate Public Health Director Director of . Patient Services All information below; must be fuU completed prior to any scheduling. DATE: o4.09-05 ENGINEER OR FIRh1: EIAR¢`t 0 u%G.NOLC. ;22_ PHONE #: 2'741.4003 REASON: _ DEEPS: PERCS: PUMP TEST: ❑ ROAD /STREET: CLUMMA03 P461, TOWN: 1?A.TrtQSny ►J ll . TAX NIAPH: M-2-617 SUBDIVISION: Q"f0SV WUXJst�,IAL LOTH; MVNER: DEP CRITERIA FOR JOINT REVIEW YES NO o R Proposed SSTS•within the drainage basin of `Vest Branch or B.oyds Corner Reservoirs. o 0 Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. o K Propose&SSTS within 200 feet of a `watercourse or a DEC wetland. o M Proposed SSTS design. flow greater than 1.000 gallons /day'or SPDES Permit required. ❑ O Proposed SSTS fora 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 answeredya 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 COU.1 rY USE ONLY DATE: � 00 TIME: / 30 — CO >JMRSTS: _ (FELDT'EST) NOTGJ:'. . F MONITm., ' 1W ! 1 / urxFwNOPwwd uMEr�l Z p MONRO N uONTHLY '. 9ER(ROTONDO 850N INC. (K:O LOADING }. . /}YN'• 1\ _ .. I AnD IYG DeP. ER(CN sEUI,Om OR WEOS12L _ / 1 `\ ♦\ ( m eNTert TiNe erte' e� • � 1 t ( MONITORING .fVR/UDGJ .. ` I f?ERE � MQN1T01 )N, OFFBlIIGN LIATE0. ALARAL / '' \ ` . 1 1 ♦ ♦♦ W i +(560.5) ♦♦. \♦ \ 1 \ o 7r I .6XPANyION +(558.7) - vi 5 - -- - - - - -- - / y Soh' . v ` 6? !/ s•' L N � •. N �. tC557.3) I O 1 m S A p ii ♦ �. ca �N Z F° Sp I j' ". 1. O w :71LEMEN7 ' • 1 v�7e I / / 1 lid �; ��F lUpullut}lil.'�7mlllt��y?o�l. ,, lu,U 1 _ 7ll? � 6! „p,n11i1Ht17]lltliD1p7717),1 I,t( (U(((t(Il(li(({ ((((((((((tl{ SI{1111St11 uivv \"� \�\ PIZO�'05�P .5 MDRL�fii 11111 S9 1 1 Ujj1 1F. EI�V. 559.00! ev.c \UU. ru(ma{tnullxcicl tllslluulillullll 2� i 6. ENV. 550.04 ! t ; +(550.9) / 00' A PROP• i 1 � I F eXTSKP TO DA L -16A4T . it ID ' r . o a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SE TMENT SYSTEM PERMIT # 3 I " 1 _ Located at Cvz; ).MNH �LO AQ Town or Village PA ► T �� Subdivision name `— Subd. Lot # Date Subdivision Approved Owner /Applicant Name liar✓ `��OGI P��G N�-L1� Mailing Address 2y NL4 P-o No Amount of Fee Enclosed i 1�1 0 p b t Tax Map a Block 9— Lot G1 Renewal Revision Date of Previous Approval Zip 10 501 Building Type K' 1ti EH(,9 Lot Area 101. No. of Bedrooms 6 Design Flow GPD 1000 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 15,00 gallon septic tank and 1 L � 6 L6. Other Requirements: To be constructed by Address Water Sup IV: ; Public Supply From Address or: — �4_ Private Supply Drilled by fop 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 s,, sum 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. OA 51211'��101 �< R.A. � 0501\ License # _Date APPROVED FOR CONSTRUCTION: This approval expires two years from, the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w onsidere necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new perm pprove r discharg f domestic sanitary sewage ly. By: Title: Date: 0 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 # f- 31— 03 Well Location: Street Address: Town/Village Tax Grid # (1 -0 ? NT H V � � G1 . Map ,Block Lot(s) Well Owner: Name:GP�, "H WH Address: 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 S fi gpm # People Served - 5 Est. of Daily Usage � 1 000 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type ' ' Drilled Driven Gravel Other Is well site subject to flooding o ? Is well located in a realty subdivision? ' ...................................... ............................... Yes No � Name of subdivision — Lot No. Water Well Contractor: ` - iy p Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: — Town/Village -- Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate eetlplan. Date: 11 li d 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 w 11 driller ce ified by Putnam County. Date of Issue Permit Issui ial: �y!+ Date of Expiratio p Title: Permit is Non- Transf rra le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 i \ \ o J 1 O • vuMP R� 4 "m PGRP.. PJG \\ FN4N \ \Z ,.'p, ` SIAK6S \ ®® 0 PT_1 nEra L Pn 6 scp lo, c�4\ lygY rP_, - - - - - - - - - - �® \ k q �RQ �'V �S _ ` �� 3Q \\ PROPOSED 5 SR. RESIDENCE SF - 533.00' FF- 54Z.Od :HUMBER i 590.33' D -PJC V 1500 .(.A - 35 SEPTIC TANK —4 E �55 1` \ \ � I Z5 - `i d_ I'1' r 1p j j 6l gl �o P 2' SO"d 4 Pvc I jy ..IZ• I'! O FW _mp Au 4= J PUTNAM COUNTY DEP ARTIN'ENT OF HEALTH HOUSE PLANS APPROVED FOR, EEJDROO'J COUNT ONLY, A . BEDROOTIIT3 -NoRmstrr RO l ALL UBSEf�ETENT Ft? a ',' :;.:., f ;TIES HOUSE t #, ;*4'* 1�..... PLANS i' PE SUs?daii A E' _..,'uil �'li FOR j,PPROVAL K 3 T1CHSN low- UT l4l TV PIM tr- -; 47 FAM ELIr WMA ZIP a" ..x PT. 57 .f 3psy qR.- PLAN $r '46' X 5T -T. 1741 .30 FT 0 r� ON 6° oPN'y. LiXf�� fd�i -� Ir -I'* X. Le -Lcf a. o o 5 $� R . x o- VASTER, 0 0 Pr sm 1741 '50 FT j BEDM%l #2 oX I.Z"lcF . evwum A o� LORETTA MOLINARI R.N., M.S.N. Public Health Director 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 /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 December 18, 2003 Harry Nichols, P.E. Patterson Park Suite 106 2050 Route 22 Brewster, NY ! 10509 Re: Proposed SSTS: Conklin Cushman.Road (T).Patterson, TM #.13. -2 -67 Dear Mr. Nichols: ROBERT J. BONDI County Executive 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. Erosion control meaures -forthe house.ha- ve::rio t'beeri: shown.' 2. - The shown location of the soil testing does not correlate to the location shown on this - Departments field notes. 3: A twelve outlet d -box is required, at the minimum a six outlet d -box. 4. The minum distance between a junction box and the expansion trenches is 6 feet. 5. Pump chamber size (volume) is to be noted in the plan view and detail. 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 Environmental Protection on this lot, percolation test must be witnessed by a representative of this Department. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ve ly yours, Robert Morris, P.E. Senior Public Health Engineer RM:tn LORETTA MOLINARI R.N., M.S.N. Public Health Director ROBERT J. BONDI County Executive 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/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 December 18, 2003 Harry Nichols, P.E. Patterson Park Suite 106 2050 Route 22 Brewster, NY 1 10509 - - RE: Conklin Cushman Road (T) Patterson, TM# 13. -2 -67 Reservoir Basin Dear Mr. Nichols: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on November 25, 2003 is complete. The - Department will notify you by January 8, 2004 of its determination. ® The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ❑ Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice'should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the . notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans Letter to: Harry Nichols, P.E. - December 18, 2003 -2- or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2166. V ly yo Robert Morris, PE RM:tn Senior Public Health Engineer Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Telephone (845) 2794003 Fax (845) 279 -4567 December 24, 2003 Robert Morris, P.E. Putnam County Health Department 1 Geneva Road Brewster, New York 10509 Re: Proposed SSTS: Conklin Cushman Road Patterson, NY T.M. #13. -2 -67 Dear Mr. Morris: In reference to your memo dated December 18, 2003, we note the following: 1. Erosion control measures for the house are now shown. 2. TP # 1 has been relocated to correspond to the location in the field. 3. A twelve (12)- outlet d -box is. now provided. 4. Six;(6) feet is now shown between the d -boxes and 100% expansion area. 5. Pump chamber size is now noted. Please continue with your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, Harry W..Nichol Jr., P.E. HWN:gav , 01- 052.00 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Z, r_. DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner r—azk Z441 _ - Address c- v5 Hiy XA,1' Located at (Street) Tax Map _ Block 2- Lot (indicate nearest cross street) Municipality � .MaE�OAZ Watershed 0�S T T, gVC--g SOIL PERCOLATION TEST DATA Date of Pre - soaking o I Zo 3 Date of Percolation Test .3 . 1, /0 "00 , -a 30 .30 2If — 16- % 30 2 /0: 31-1/S'/ 60 ;L l 60 3 "31 o �� - 60 4' 5 1 2 3 4 5 f 1 2 3 4 5' NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES /o7- 3 DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner C©il/kL In1 Address CUS ,Y1v/ ,4A; ,-p4p Located at (Street) Tax Map J-S Block 2 Lot P� G (indicate nearest cross street) Municipality PA777— j syAj Watershed l6TUA1Gi4 SOIL PERCOLATION TEST DATA Date of Pre - soaking �0-3 Date of Percolation Test 9 Z30Z03 4 1 /0: 0D o L`f .° .,a �2 �� O 2 r ®; 31 - 11;o 1 '3 4=) ;2 f ' • f/a 2� 3 %/.02 1031 30 �- - �� % %2 ;zo 4. 5 3 4 5 1�. 2 3 4 5' NOTES: 1. Tests to be repeated at same depth until approximately equal. percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth'measurements to be made from top of hole. Form DD -97 � 1 4 l � 1 � i I s � 1' t \ ROP WELL\I\ \\ ' O N \ 1 \ ' \ LO \ \ \ (47+ 68) 4> RESIDENCE \ ` ® � � � ; a � � PROROSEO �43 + 6 6 1 \ J \ \ \ 595 \ `, cr HMaN ROAD Aotg +zs �47 + 2e) I — PUTNAM -COUNTj(1pE1r. O1F..:HE,,4LtH DIVISIONPF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE. TREATMENT SYSTEM Owner: Af- CA H,��A, �H Address' .C-W,; o 701 (Street] Blkk' 1, L-dF-41— Located at (S' et) ax ap (indicate nearest cross street) Municipality. Watershed SOIL. PERCOLATION TEST DATA 0 Dateod.Perc'olatioja Test Date of Pre-soaking NOTES:: 1. Te 156 repeated TeaI; at same depth until approximately equal percolation rates are obtained at each -kh6le. '(i;,e-; I min for 1-30 min/inch, 2 min for 31-60 'in/in h) All. data to be-7 k f5empikibn te In c submitted Det)th measurements to be made from -top.of hole. Form DD-97 XX X % ............ . ..... -1,34 2y:`►ti I'L'L .. ?� .12 3 4. V11 4 5 cmA) 3 4 5 2 0 klf -0 NOTES:: 1. Te 156 repeated TeaI; at same depth until approximately equal percolation rates are obtained at each -kh6le. '(i;,e-; I min for 1-30 min/inch, 2 min for 31-60 'in/in h) All. data to be-7 k f5empikibn te In c submitted Det)th measurements to be made from -top.of hole. Form DD-97 Indicate level at which groundwatdi-is encountered Indicate level at which. mottling. is observed Indicate'level t6 which water level rises after being.encountered NA Deep hole observations -made by: H '\4, N;UM\.S J$v @t �, . C Date. Design Professional Name: - nrju�A �Lj N �� N-Ot� P Address: 6TO P4.1 Signature: Design Professional's Seal NEW. yo9 W � 't dip No.-6024 v '°ROFESS1��P -- . TEST, PIT DATA 2 DESCRIP'T'ION OF SOILS ENCOUNTERED-IN TEST HOLES. DEPTH HOLE NO. HOLE NO._ _ HOLE NO. G.L. _.... -- 0.5' T5 . Tb 1.0' 1.5' 2.01 Sa�rtaC}� 2.5' (-fl rcg RuT 3.0' 3.5 4.0' 4.5' �o �ni� 5.5' 1 _ 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 10.0' Indicate level at which groundwatdi-is encountered Indicate level at which. mottling. is observed Indicate'level t6 which water level rises after being.encountered NA Deep hole observations -made by: H '\4, N;UM\.S J$v @t �, . C Date. Design Professional Name: - nrju�A �Lj N �� N-Ot� P Address: 6TO P4.1 Signature: Design Professional's Seal NEW. yo9 W � 't dip No.-6024 v '°ROFESS1��P -- . Harry W. Nichols Jr.., P.E. Patterson Parr, Suite 106 2050 Route 22 Brewster, NY 10509 Telephone. (845) 2-79 -4003 Fax (845) 279 -4567 November 11, 2003 Robert Morris, P.E. Putnam County Health Department 1 Geneva Road Brewster, New York 10509 Re: Individual SSTS - JZG Associates Cushman Road Patterson, NY T. M. #13. -2 -67 Dear Mr. Morris: Enclosed, are the following: 1. • Five (5) prints of Drawing SS -1, "Proposed SSTS ", dated 11/11/03. 2. "Short EAF ", dated 11/11/03. 3. "Application for Approval of Plans For a Wastewater Disposal System" 4. "Construction Permit for Sewage Disposal System ", dated 11/11/03. 5. "Application to Construct a Water Well ", dated 11/11/03. 6. "Design Data Sheet ". 7. "Letter of Authorization ". 8. Two (2) copies of Residence Floor Plan(s) for "Bedroom Count Only". 9. Review Fee in the amount of $300.00. 10. Pump calculations. 11. Nearest Neighbor Notifications. We appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly,yours, Harry W. Nicho s Jr., P.E. HWN:gay. 01- 052.00 1416 -4 (9/95) —Text 12 617.20 SEAR PROJECT I.D. NUMBER Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT' FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (ro be completed by Applicant, or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME 3. PROJECT LOCATION: �i LIT Isi 1) rq\ P r r �- c Municipality County 1 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) C. IMAM . �-o PO 5. IS P1r,SED ACTION: d!'New ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: IMpty10�•�"1: 5�1 �7 7. AMOUNT OF LAND AFFECTED: iA • 61– Initially acres Ultimately 1�' acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR -OTHER EXISTING LAND USE RESTRICTIONS? 19Yes [:],No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? P9 Residential . ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: �JiHl�Lli� �'F1Cl�1li"Ia 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL) ? ��• ❑Yes No If yes, list agency(s) and permitlapprovals ut 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes - No If yes, list agency name and permlUapproval 12. AS A RESULT PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? TOFF El Yes t=YNo. I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE A RWI 0- R 0V? " t !� -`� K. Applicant/sponsor ame: . Date: Signature: U If the action is in the Coastal Area, and you are a. state agency, complete the . Coastal Assessment Form before proceeding with this assessment OVER . 1 ..PUTNAM COUNTY DEPARTMENT OF-HEAL -H = _. DhVISION:-OF ENVIRONMENTAL- HEALTH'SERVICES.:"•' ' APPLICATION FOR APPROVAL OF PLANS FOR . A WASTEWATER TREATMENT SYSTEM'= 1. Name and address of applicant: 2. Name of project: 1 N P1 V l Py4c 1557 3. Location T/V 'ATTE • I`�± 4.:Des.ign Professional: 1-IA,942),' Ly, Al LH4t"dLLI-'5.. Address: 2446- :......6:... Drainage Basin: �� l i 012-A)41-14' �12E TL's. q56 1 7. Type of Project :. Pnvate%Resi dent ial Food Service Commercial Apartrnents - Institutional Mobile Heme -Park . Office Building Realty Subdivision _.. Other (specify) 8. Is this project subject to State Environmental Quality Review (SEAR) ?' Type . Status (check one)-.-.. ....................... ............................ Type I Exempt . Type II —Unlisted` X 9. Is a Draft Environmental Impact Statement (DEIS) required? .........................� 10. Has DEIS been com p leted 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? ........ ............................... 14. Has 'preliminary. approval been granted by such authorities? O. Date granted: 15: Type of Sewage Treatment- System Discharge ...::............. surface , afer•�groundwater 16. If surface water discharge;-what is the stream class designation? :...::.:: :::::...:.:: 17. Waters -index number (surface) ....... . ..................................................... ............... •.....:.t,J.Q: 1.8.. "Is project located near a public water supply system? ........ ............:.......:.......... ,tJ� 19. If yes, name of water supply Distance to WaMr: supply �r -20: Is .project site near a public sewage collection or treatment system? 2-i-. Name of sewage-system -.N IN Distance: to _sewage system '0A - 22. Date test-holes- observed- 1) .10IP. 23. Name of Health Inspector 66A 9-EED" . 24. Frojecf design flow (gallons .per day) .................................. .............:..........: .:...— -- 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.... 0 26. Has SPDES Application been submitted to local DEC office? ..............:..........__ Form PC -97 2 , 27: Is any portion: of this proj.eirt.aocated within a designated Town or State wetland? . 0 28. Wetlands . ID. Number ...................... .............................................. .. ..................: :.Nk 29. Js Wetlands Permit required ?..... .................... . .................................. .. .._ ... ? _- ' Has application been made to Town or Local DEC office? 30. Does project require a DEC Stream Disturbance:. Permit? .: ............................... 1 31. Is or was project site used for agricultural activity 'involving application of.. pesticides to_brehards or other crops, solid or hazardous waste disposal, landfillifig, sludge application or industrial activity? ....... :.................... Yes/No N G 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 DESCRIBE: 33. Is there a local master plan on.file with the Town or Village? ......................... 34.. Are community water and/or sewer faciIities.planned to be developed.Within 15 years in or adjacent to project site ? .................. Q 35. Are any sewage treatment areas in excess of 15% slope 36. Tax Map ID Number .......................... ............................... Map 1i 9 Block Lot (v� 37. Approved plans are to be returned to ..... Applicant Design Professional VOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall he.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 withirr..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.penally ofperjury, tlrat information provided on tliisf.n F& to the best of my knowledge and belief. False statements made her a �*n\ hable. as -- ix a Class A misdemeanor pursuant to Sectio 210.45 of the Penal Law. SICNATURES—& OFFICIAL TITLES: Mailing Address:.... 2�5� ''1 Z`L�nl�7l�.: �1`J..._ j 0 V(�� PUTNAM COUNTY DEPARTMENT OF HEALTH-. DIVISION OF ENVIRONMENTAL HEALTH SER'VICES.,;;K::; LETTER OF AUTHORIZATION RE: Property of Aa�T ;' 't �'_. _ ;•';;�;: ' Located at T/V� °`� Tax Map # Block ? _Lot Subdivision of Subdivision Lot # Filed Map. # Date Filed.__. Gentlemen: This letter is to authorize WL. L oro�A a duly licensed- Professional Engineer or Registered Architect to_ pply for the, required wastewater treatment and/or water su 1 permit (s) to serve the above - noted roe in acc .'� �'" e`!!:�,". pp y p () p p rty ordance with the standards, rules or regulations as promulgated by the Public Health Director of,the_Puhiani County Health. Department, and to sign all necessary papers on my behalf in connectior�:with this matter and to supervise the construction of said wastewater tretment 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. - - pF NEW P - -' nicHO Very truly yo s, . . Countersigned: r Signed - P.E., R.A., # her of Pr 96 ) N 124 Mailing Address YI'+ Mailing Address: State '"' 1 Zi p 4 P �y, Telephone: f�n State Zip Tele 1' Bone: Form LA -97 . 26 APPENDIX E FORMAT CONSTRUCTION PERMIT NEIGHBOR NOTIFICATION LETTER RE: Department of Health Review of Proposed SewageTreatment System for Property Town:.._ Dear:D�► ©�N►- ±ra':.:PTkJ* Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan., If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at 278 -6130. Very truly yours, X4 Received By: Address: Tax Map #; Title:_ -_ ..P :r.E4;1i; _JCL -;►K -- ___ _ .. ___._.- NEw ro,� NICH0. W r- w 2 mod' No. 56124 �OpROFESSIO�P� August 1997 r LIST OF ABUTTING PROPERTY OWNERS of Cushman Road Patterson, New York T.M. # 11-2-67 13.-2-66, - Blumberg, Lawrence & Robin Lynn 521 Fifth Avenue 24h Floor New York, NY 10175 11-2 -6 - Pace, Peter, Jr. & Yolanda 9 Caroline Drive Patterson, NY 12563 11-2 -5 - Sinkwich, Darrylin A.. 7 Caroline Drive Patterson, NY 12563 13. -2 -4 - McHugh, William, Jr. & Judith 5 Caroline Drive Patterson, NY 12563 11-2 -3 - Maslosz, Dariusz 3 Caroline Drive Patterson, NY 12563 13. -2 -70 - Putnam County National Bank of Carmel P.O. Box 10 Carmel, NY 10512 13. -2 -68 - Putnam County National Bank of Carmel P.O. Box 10 Carmel, NY 10512 11-2 -1 - Hutton, Timothy c/o B. Kaufman Thompson Inc. - Suite 2500 2049 Century Park East Los Angeles, CA 90067 21-1 -10 - Powe, Reginald & Coleen 107 Upper Mountain Avenue Montclaire, NJ 07042 I �I •I m ilk � �' .n phi II i III I I � III � `j I M - ® - ra CO CO 'E Ln use .. $ UNIT III: 0012 M Q rtltied Fee ; ° ° ti Return Xklept Fee (Endorsem equired) 1. ; Postmark Here ° M Restricted bAery Fee (Endomemert &,quired) w r Clerk: KQ18Rb O rU Total Postage &�?-,-+ 11/13/03 ru Sent To '� ` <: ove, Reginald & Coleen ° NI:ae�:a�cNo.; X107 Upper Mountain Avenue or PO Box No. cny sr�i�,'zia' Montclaire, NJ 07042 P, cc .. �For delivery inforniation visit bur website at n COf Ln ry oho � , 0.$ ' UNIT ID: 0012 0 Cehified Fee , Q ° !C) Retum Red. t Fee Postmark Here (Endorsement Rtyed) v� 1.75 ° m Restricted Deliver {Endorsement Requi _` Clerk: KQ189b ,`x{.88 RJ Total Postage & Fees $ ,_ 11/13/03 ru Sent To -A �faslosZ, Tlarlusz lYl w C3 N sue' arc No:; - 3 Caroline Drive or PO Box No. ----- w �� ---- _Y[ Patterson, NY 12563 _o co . . -D CO F L ostage G 0.83 UNIT ID: 0012 p Corti'e�Fee 0� . ° Retum Reci &-e Postmark ° (Endorsement Requ -*b 1.75 E de D t RM (6rsm neq ired) ... Clerk: KQ18% ° N Total Postage & Fees $ 4.88 11/13/03 C3 ern To Blumberg, Lawrence & Robin Lynn 0 521 Fifth Avenue r' 3`tree4lipt'No :; or PO Box No. 24th Floor Ciry State ZIP +4 New York, NY 10175 :rr PUTNAM COUNTY DEPARTNIE \T OF HEALTH _ DMSION OF Eh -v'IRO \MZNL TAL HEALTH INDIVIDUAL HATER SUPPLY & SUBSURFACE SENV..GE TREATtIENT SYSTEMS REVIEW SHEET FOR CO \STRUCTION PERMIT' NA NE OF OWNER STREET LOCATION: REVIEWED BY: RBI, GR, AS, SRDATE: - TAX 1,-1kP =: (CONFT WEED) Y / DOCUti1ENTS; N. (REOUTRED DETAILS ON PLANS CO \`T'D) �L_f) . PERb1IT APPLICATION tiVELL PER,IIIT OR PWS LETTER PC -97 ' LETTER OF AUTHORIZATION DESIG\ DATA SHEET (DDS) CORP OR..TE RESOLUTION SHORT EAF PLANS•THREE SETS UUHOUSE PLANS - TWO SETS UUVARLkNCE REQUEST SUBDIVISION LEGAL SUBDMSION 'SUBDIVISION APPROVAL CHECKED LAE�PERC RATE - L FILL REQUIRED DEPTH CURTA N DRAIN REQUIRED GENEFLk LOCATED IN NYC.WATERSHED ' PLANS.SUBMITTED•TODEP - tL DELEGATED TOPCHD ' f DEP APPROVAL; IF *aQ'D• DEEP TEST $OLES'OBSETtVED - L )PERCS'TO BE WITNESSED U — EX- APPROVAL SSDS AD,I, LOTS- L� L NVET LP�NDS '90W,N/DEC.PERrYUT.,EQ'D ?) ( D�ATt1 C +ii I?DS:P'LAI`(S.&'PERIYIIT SAX.4 PRE 1969 NEIGHBOR'NOTIFICATION ( )� )LET'EERBI/ZBA /( )0100 YR. FLOOD ELEVATION W/I200' L�3SOILTESTING LOTS >10 YEARS G D E UTRED T)ETAILS ON PLANS SEWAGE SYSTEMPLAN- (NORtRARROW), (ASSDS HYDRAULIC PROFILE GRAVITY FLOW CONSTI ,sUC'1'j4�Y.ILQTES_1:15__ DESIGN DATA: PERC & DEEP RESULTS (.< 11/ )2' CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES;, CUT FOOTING /GUTTEIVCURTAI`I DRAINS USDA SOIL TYPE- tOUKDARIES (_l J(_)TITLE BLO CK; OWNERS NAME ADDRESS / TNIR, PE/RA; NAME, ADDRESS, PHONES (. DATE OF DRAWING/REVLSIQN DATUM REFERENCE . LOCATION OF WATERCOURSES, PONDS L•AKES,WETLANDS WITHIN 200' OFP.L. L( PROPOSED FINISH FLQ OR AND BASEMENT ELEVATIONS [ WELLS & SSDS'S WAN 200' OF SSTS PROPERTY METES & BOUND$ (vEROSION CONTROL FORHOUSE, WELL & SSTS, EROSION CONTROL NOTE COti1yIENTS: - HOUSE SENti ER -'/�" FT. 4"0'; TYPE PIPE CAST IRON . UUNO BENDS; MAX BE \DS 45° \S7CLEANOUT- RENE« ALS U�)SITE NOTE (NCO CH_aNGE) FILL SYSTEMS U w O' HORIZONTAL; PAST TRENCH SLOPES 3.1 T0. GRADE (� FILL SPECS! FILL NOTES 1 -5 Lj FILL PROFILE &: DIMENSIONS U ILL L`I ExPAN SION ARE )L ,�. FILL GREA TER THAN 2 FEET (� CLAY BARRIER U FILL CERTIFICATION NOTE . DEPTH GAUGES ' 'OL 0\ PLAN FORRO.B., UNCLASSIFIED & IMPERVIOiUS L�JSEPaRATION DISTANCE FRONITOE •OF SLOPE TREIN CH ��•�.�LF TREN CH PROVIDED LOFT MAX. 8LPARALLEL TO CONTOURS fi . 100'% nn- sioN, PROVIDED DETAILfDUST FREE CRUSHED STONI OR WASIiED- GRAVEL. - UUG.EOTEXTILE COVER SEPAR &TION•DISTANCESOI PLAN _,FRONISSTS .; _J10' 14 R.L. DRIVEWAY, LARGE TR:EESJ OP. OF FILL . 20' TO FOUNDATION WALLS •�.((100`TO'V,'ELL,200' I\i'.DLOD, I50' TO P.IIS •:" '• . ,•, . : • • (�( ` )100' TO STREA:`I,'WATERCOURSE, LAISE ('Lqc. tzp5tij ,5O' TO CATCHBASLi4,35'-STOiZti1DPAL!, PIPED WATER 10' TO WKIERL NE (pits -20') U 50' MEP LNI TENT DRAINAG•E•COURSE . 00'1500' RESER 'VOIR, ETC. 150' GALLEY SYSTEMS. ( O'.IIINTO LEDGE OUTCROP ..,.. SEPTIC TANK t' 10' FROM FOUNDATION; 50' TO WELL WELL -- (DIi�1Eii510NST0PROPERTYLL`iES -- — - - �LOCATION OF SERVICE C6igN,- ECIIO`i IIR`I.15' TO PROPERTY LIl`IE ' SLOPE ',$LOPE LN SSTS AREA (520 %) • _ . ^ . 4 REGRADED TO 15 %, IF REQUIRED DOSETUNTP SYSTENTS ( PUMP NOTES O—JD 75' /6 OF PIPE VOLUIIEMOS•E VOLUME NOTED (jL jDETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) UUPIT AND D•BOX SHOWN & DETAILED L(L JIDAYSTORAGEABOVEALARK CURT&=P A,TN _ ((((STANDPIPES, 5' BOTH SIDES, DETAIL' ((((I5' IR`I to CDS = >5 %, 20' -� %� 25 =3 %, 3�'•1 °�,100%><1% U(_)20' IIR`i to CD DISCHARGE1100' with 182 cons day discharge (_•,,L�J10' hIIN to NON- PERFORATED PIPE .I PUTNAM COUNTY DEPARTMENT OF HEALTH RECD OCT 2 G 2010 DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Town /Village: Tax Map # Map Block Lot(s) 61 G.P� ° 43 Well Owner: Name: Address: 0,68 t� No 1�169 d C61 sc At�'a - �� Nl\paAj N rAAPi " C-r Use of Well: 1- Primary 2- Secondary __Residential _Public Supply Air cond /heat pump _Irrigation Business Farm Test/monitoring _Other(specify) Industrial Institutional Standby Drilling Equipment _Rotary _Cable percussion Compressed air percussion Other(specify) Well Type Screened _Open end casing Open hole in bedrock _Other Casing Details Total Length 6.2 ft. Length below grade&Dft. Diameter min. Weight per foot nib /ft Materials: Steel Plastic Other Joints: Welded }A Threaded Other Seal: Cement grout I Bentonite Other Drive shoe: _ Yes _ No Liner: _Yes 'A No Screen Details Diameter (in) Slot Size Length (ft) Dept to Screen (ft) Developed? First _Yes No Hours Second Well Yield Test _Bailed _Pumped J Compressed Air Hours Yield ' gpm Depth Date Measure from land surface - static (specify ft) 9® During yield test (ft) (0� te O Depth of completed well m ft. D 4710 Well Log If more detailed information descriptions or Depth From Surface Water Bearing Well Diameter in Formation Description ft. ft. Land Surface 147 , ; (� Wl 10 25 A, ,r. A .�. sieve analyses - &W 11 me< 4AV) e are available, Ce, i A please attach. If yield was tested Feet Gallons Per Minute Pump /Storage Tank Information at different depths $ Pump Type *Ufll Capacity q 6rH during drilling Depth GCgo Model 'iTE5' list: ® Voltage 111* 4W HP r r.;a3�:�t� Tank Type 5 &AL 1 I'l el"'J 4)Volume 4 Date Well Completetl Well Drill Date of Report NYState.# Pump Jnstaller PC Certificate # .. 1; - NOTE: Exact Location of wellyith distances to at lea -A two permanent landmarks to be provided on a , p ate she t/pl s U White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy -'Well driller Form WC -97 Rev. 3/06 i 2 JTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES L07- DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner C42Al L /N Address Cc_5, 4_ 4A% t::' Located at (Street) Tax Map 17S Block 2 Lot P� 7 (indicate nearest cross street) Municipality PA77TTr Watershed SOIL PERCOLATION TEST DATA Date .of Pre - soaking / 2 2%:3 Date of Percolation Test 9 Z3 0 z0:3 1 /;L" OQ • -�0�1+ 3 4 5 /;35 3 ® 2-V 2- 6 3 t:o6 -,Z,-54 p - `f -- 27 % 4 5 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch,.s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 IT DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES God DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner C_ Address ew:51-14,4AI ;1i'fa412 9?Ak4 1A1 Located at (Street) 1271-; Tax Map I—S Block Z Lot "&4;7 (indicate nearest cross street) Municipality VA777-,ef2Se7A,/ Watershed 44 -57- lam. SOIL PERCOLATION TEST DATA Date of Pre-soaking 2/---3 0 /0-73 Date. of Percolation Test /0 Z/ Jeg . . ... . . . . ....... . ... ..... ... ........ . .... .... ...... ....... ... ... r. A D :::.;; >: ... . .......... .................. Fiom 8 W ... evei`�` Hole .. No . . . ......... .. I ....... . . p I 10,00 -1,0,'3e,> 30 # 1 2� le13 A131 0 2 z5- 1 el) 0 0 .4 5 3o 2- Z/ - az/ 2 3 136 6 l 0 4 5 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. :5 1 min for 1-30 min/inch, 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 SEP -15- 2003 -09:27 AM HARRY W NICHOLS y _ . BRUCE R Z:OLEY Publir Nfallh..DlreCror -� 914 279 4567 P.01 0 / -O T2- LORETTA MOLINAIZI R.N., M.S,N. Attoelate Publle Health Director biroctor of. Pallfnt. Services DEPARTMENT OF BEALTH 1 Geneva, Road Brewster, New York 10509 REQUEST EQR FIELD TESTING aTTENTIO\': o ADAMS STIEBELX G NE REED All information below must be G1lly completed prior to any scheduling. _ ENGPTER OR FIitbi: A, r, 1° REASON; ROAD /STREET: TOWM SUBDIVISION:, DA'C'E: PHONE #: DEEPS: C PERCS: Oe'PU'NIP TEST: o Qar�, file- i' ..s .46 1%J&1e0 TAX MAN: f3 2-47 h • J(ts LOT#: OWNER: kit ` NICDEP CRITERIA ME 10iNT RE OTNESSING.OESQILTESTIN G. YES NO o Proposed SSTS-within the drainage basin of West Branch or Boyds Corner Reservoirs. 0 q Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. 0 9th Proposed SSTS within 200 feet of a watercourse or a DEC wetland, 0 Proposed SSTS design flow greater than 1000 gallons/day-or SPDES permit required. Q 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 IYYCDEP project status (Joint or Delegated) based . on the response. If you answeredyn 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. (FTLI)TEST) SEP -15 -2003 MON 09:43 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 i „ 3.8 AC CAS'' 6 3.50 AC. a L 10 A' 'Al- - u - -' Isl * 53 = 436.45 • 43 �, o • , A LI 9'q, r�� i 8 •/�- °1 J v J l03 L Al.. 454.14 ,7 rr;7 0 00 I7 \ •', • $ 2,34 1.72 B3 aJ 6 n 462 AC• 120.70 / �3gy.9T (,b �i' • -' 1.Ijg j AGC4 ea SD py s 4.67 AC. CAL Ae. AC. I.01 8123 A / �4�1'xe►e� . a 7, r i.ei A Y - e1. �8 J 13 � 12 �� 1, � �. 11p°Ie' � $4, � �' $ACS 4.�� `r • � u , ` r' _•�,• ys I �CTa Ise 3.36 AC 2.06 SAC. 5.0 'AC. e W 92 XC. zC¢AC 5.41 ALa 2 rs )oO.D ��,tls/ 1°°'54 � 26.75 AC. 0 7s I69 ( qq 4r28 a I `y 523.x6 9 )ate / 0 55" 6.21 AC. CAL. $ sc 96 AC. 1.71 A� e . 4tHy6 67AS° s 8 ' i` r a� 2.45 AC. CAL. 290,65 p e ' 10 1 • ° . �SI 1 I 366.56 a ; 211.90 /� �, AG. I ' i ai.4i'C. I S • 5.24 AC ' + yY - is4 Is3 eoT.44 57 $ 23 1 a .93AC Zoe 5.59 AC. .�,p . 'I%LO s i 26 62ZB9 91 °' 0158 < ' ,/ 4.69 AC. g1� �M g1,O1 27.52 Af/ Iszso 4.95 AC. 1x' S9 x 25. 1.44 AC e1' 67aos 66 A CA 611 N'/ `� Z4y g' 600.00 5.35 AC. CAL. ' 57 560« 6.49 AC. ' .2.0 AC p 1 q • ~ 635.16 •y / ^ /�, / /// � • 61.1 163.20 �`b163.o ue.63 I / / �• 10 59 e $ A0A // / O / 0 .7.47 AC. 4T. 4oxr 194y 2 I ! i // 5 1 193.45 /s� � 21.97 AC. 103.86 AC, CAL. 568.12 �� 2.7 AC. / // / \'•\: I 1 22.2 304.66 I 250 - / 20.89AC. J,. 20 P 1 60 W 4.73 AC. S 24.61 / / � �'•,�.. � 1 P' � 426.79 1 �u•al I &99 a4e.e65.7! i' 62 506.62 of 1 19.86 AC. 18 _a 19 206 I 1 I 1 ` "' eAC. • J eaa 217.02 I I ` 10 16.64 AC. 0 17 • I q 4 1.59 AC. 3. N I 1 63 18.92 0` 16 g _mm65 J 4 ` o �� AC. I a • I� II 5.71 A • ,� o, CAL, 1.73 A 1 03 AC.B 83.92 AC. CAL. \ 454.21 .�' ,�o , F' awa l A 1 9 63 I I I I �r • tenor - 1, 1.77 A I 1 \ 690.96 3, a 311.01 11,10 AC. CAL. 14 eay�e 11 / 5 B5 AC AC. 1. 3„ . \. 1 1 ' 64 � • s 1 � „' 11 s 10.58 AC. CAL 1.59 AC. 11 s 1210.101 0 206.2 • 9.78 AC. 12e3.4101 12 L Jgo 11 18.88 AC. \ ° ' IZ 11 \ / 509.42 N 66 2AC 1 661.45 8.82 AC. CAL. \ 1 I \ r - - - - 1061.23 I)6.x5 71.)0 /I ' I 1 1 ,s $6 7a II 67" 1.77 / 224 AC. 27 AC. / AL i' 41.2 AC � J337,s8 , u C� a I 14.57 AC. CAt. 5 4, ems, p'& 8 f ` 0 °3 21 AC i+ ffe 1.15 AC 121.TAC. �' /b Y \ � 2 93 .'�253'`� �. / / ,•,•` �.�' ,1 e•68�A 70 a149 - #2 AC. I 69'�dla3 'h•1'7 �� AL st le 1 /� . 435.63 ey 23•Q/�A 7D J� P/O 23.1 -10 r • Jv� T' ' 3.34 A_ -�- -------- - - - - -- -- - - - - -- -- - - - -- 681.33 AC. / - -- REVISIONS SPECIAL DISTRICT INFORMATION r e4i•fa•ui.:ff ,rf4ro 04M AM • u•e,feem wo enAS A•r SCHOOL •SCN• CARAQL CENTRAL Sdg0. DISTRICT 372002 STATE LINE COUNTY LINE -- TOWN LINE - -- VILLAa LINE - -__ BLOCK LIMIT - - - PROPEAIY LINE I ORIGINAL LOT LINE - - - DISPUTED AREAS CONTINUOUS OWNER ROAD R.O.W. STRE WWATCIA.IIIE SPECIAL DISTRICT SCHOOL DISTRICT I PART OF PARCEL & f e61- 22.12A.fit a /fAr Ame a fu2,&ljf 1sl0furifenT IO/a•We I lv- w-w.e,wt f /Urn "O"am ro u•7L'•rAIMU98P•2360e ..re anA• 4A3 FIRE •F• FIRE PROTECTION DISTRICT N0, I 4 of -lA alm.0 7f: 123 10 At owl. a e¢a+•f.sU,a.e SNee 09001H is -ml -3W f /Ve0►J e fLe.ss.ae.eA f/ssAi AreX na•m an /w rJ ewe- ia.wlr4ula.4 FrffaA fn/rf Are M su-36 w. YU7e' Yer loll •eb l•1•A7 f FJ % 1e ert- •A.e•Taa lta ryfOAeC •e /fe/91 re•I ,� 344e•41 r n 11.0- 4e.47.4e 3/1 /MM 338 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 Date: 0 Z 3 %O To: AW R-/Z `f From: Gene D. Reed Putnam County Department of Health For your Information For your review As discussed Fax #: ;2- 7 i _ 5-6 7 No. Pages 3 (Including cover sheet) Zplease respond Attached as requested Please call Notes/Messages ° xrl -- -5 W /;r/-/ 1zeQU/in�p_ f G �i�1 s G ZG TD Cn/n t //7F/f-/ In the event of transmission /reception difficulties, please contact this office at (845) 278 -600 ext. 2261. SEP -15 -2003 091:27 AM HARRY W NICHOLS 914 279 4567 BRUCE R. FOLEY Public Health - Director. -- DEPARTMENT OF HEALTH 1 Geneva ' Road Brewster, New York 10509 P.01 0 l -- 0 S 2-- LORETTA MOLINAItI R.N., M.S.N. Associate Pu6Uc Health Director birtcty oj.hirmt Services ATTENTIO`': o ADAM STIEBEV G A4<NE REED All information below must bs It 4 completed prior to any scheduling,' DATE: ENGINEER OR FIRM- Or it-, P, � PHONE #: REASON; D� hI.— -rw-f' r &A4eo .1 DEEPS: o PERCS: Oe'PUMP TEST: a - b, Ale, I3ud�tis ' xoAnisTRrET: _ d.- _ 4- J TOWN: TAX MAPS: 2 -47 S� S [S}3 D11�T5�I p N:. IaOTP: MYNER: 1t , UCDEP CRITFR16 10H 10INT REVIEW An MTNESSING OE SOIL TESTING YES NO 0 Proposed SSTS-within the drainage basin of West Branch or Boyds Corner Reservoirs. o Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. 0 ' Proposed SSTS within 200 feet of a watercourse or a DEC wetland,' 0 Proposed SSTS design flow greater than 1000 gallons/day-or SPDES permit required. ❑ Proposed SSTS for a Commerical Project. I t is the responsibility or 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, z you answered yz to any of the questions, NYCDEP must witness the soil testing. This Department will coordinate a mutually suitable time for field testing jvith- 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 coukry Vs e ONLY DATE- FELDTEST) SEP -15 -2003 MON 09:43 TEL:845- 278 77921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 PROP. WELL I i 12 310' , o _..r. _ - 1 . 1 ter.. -�x �, 71.xn. ;•,S� - ,.aa �� •�� 1 i �A4. 154 I I % � I 1 PROPOSED 5575 I I I