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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -3 -9 BOX 5 I I r I I I L. -1 111 1 wq t . T y :6 -6 ■ i 1 , L 37sm , I , 1 ,_ 1 00195 ,v TNAM COUNTY DEPARTMENT OF HEALTH IVISION OF ENVIRONMENTAL HEALTH SERVICE CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYS PCHD CONSTRUCTION PERMIT # P -- 0-) Located at �� f2d)Od) Town or Village -104TH i0-i Owner /Applicant Name VJICI,kA�-L 46s -W Tax Map ��j Block 3 Lot Formerly M ic�fft`L 105 �QXC�3Z3� Subdivision Name CASS (' -OAQS Subd. Lot # Mailing Address 146 t5q (.AYZ . KT- Ur l S" , Zip ,105" Date Construction Permit Issued by PCHD Separate Sewerage System built by LJO 11W S&OT)C. &`PS� Address S Add ', 1142Al LrZOA0 F-ep Mc t s ^, 105011 Consisting of 1 'Zr9Q Gallon Septic Tank and 4-6c) Lr- Coir- :2A,!, Other Requirements: Water Supply: Public Supply From Address or: !/ Private Supply Drilled by ft 4t $;cW S 1 K4- Address 4r- euix ih-,- AgzzW Building Type - l Has erosion control been completed? . qe�; Number of Bedrooms �- Has garbage grinder been installed? pj 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 PP am Coun artment of Health. Date: S Uzb4certified by P.E. y -R.A. (Design Professional). Address ,J rS Lc- License # O r6.1 Nx, 1050. 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 subject to modification or change when, in the judgment of the Public Health Director, such revocati n, odific " n or change is necessary. �0By: % Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -91 Aug 12 04 10:05a TOWN OF PRTTERSO 845- 878 -2019 p,2 06/12/2004 THU 10:49 FAX 002/002 r BRUCE R FOLEY Public HeaUk Director LOPEnA MOLlNAR! R.N., M.S.N. Affac de Public 094kk Director Dineror of Patient Sean" DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Eovireameatsl Health (914)271-6130 Fox (914) 279.7921 Nursing Servke r (914) 278 - 6331 WIC (914) 278 - 6678 Fax(914)272-6085 Early ladervmtloa. (914) 279.6014 TrinKhool (914) 2786082 1:a (914) 271 - 6618 OWNERS NAME: f` <(AAEL TAX MAY NUMBER: E911 ADDRESS: 12, PAS+ g6 ft7 TOWN: " r LY2SV& -; r G'Y AUTHORIZED TOWN OFFICIAL: (Signature) DATE: Z le y — The Putnam County Department of Health will not issue a Certificate of Construction CompFumce tmless the above form is completed, i.e., a legal E911 address is assigned by an authorized tmm official. This form is to be submitted with the application for a Certificate of Construction Compliance. � . (E9) IVERR" PUTNAM COUNTY DEPARTMENT. OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map Block Lot -5 o/0 13ul&� TAG- ,5 .S S Building Constructed by / � 2 /0110/ia, Location - Street Building Type TownNillage . Subdivision Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above- described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and., hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years; immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by. me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month uL Day Year 2004- General Contractor Owner) - Signature Corporation Name (if corporation) Address: �/� l3f',� ZIc State Zip 16j Signatur������� �•d Title: v + cf_ — UtN s TED SF -pT►4 S X17F_ _S Corporation Name (if corporation) Address: 3i► State ►vE-w� y u _Zip 1 o S o °7 Form GS -97 ' UTNAM NGINEn NG, PLLE Engineers archltects SEPTIC SUBMISSION FORM TO: Rams ee�_ DATE: m )� PUTNAM COUNTY HEALT14 DEPARTMENT PROJECT: M IC- EL O_A A e61 (?-m , -F t -vim aj I3 -3-c' ENCLOSED, PLEASE FIND: COPIES OF THE SSDS! "AS- BUILT" PLAN l!d CONSTRUCTION COMPLIANCE CERTIFICATE L7 WELL LOG HEALTH DEPARTMENT FEE ($300.00) WATER ANALYSIS LY GUARANTEE FORMS - 3 ORIGINALS �E 911 ADDRESS FORM ❑ LETTER OF EXPLANATION REMARKS: COPIES TO: SIGNED: (3��l A (SepSubFmm -2004) 4 OLD ROUTE 6, BREmTER, NEw YORK 10509 • (845) 279 -6789 • Fax (845) 279 -6769 • EmAic putnamengineering @rcn.com JMS ENVIRONMENTAL SERVICES, INC. 1500 SUMMER STREET STAMFORD, CONNECTICUT o69o5 Mailing Information: Name: PF Beal & Sons Client: Michael Rosatorte Address: 4 Putnam Ave City: Brewster State: NY Zip: 10509 Teleph one: 845-279-2460 Fax: 845-279-6613 Sample's Information: Site: Bathroom Tap Preservative: HNO3 Temperature: ' <4C NELAC, CT and NY State Certified Environmental Laboratory Collector's Information: Name: Matt Beal Address of site: 12 Pan Road City: Patterson State: N.Y. Zip: Telephone: Date Collected: 6/29/04 Date Received: 6/30/04 Time Collected: 2:30pm Time Received: 3:00pm Lab No.: J046885 Date Analyzed Test Name Result MCL Method 6/30/04 16:00 Total Coliform Absent Absent SMWW 9222B 6/30/04 Chlorine Free Residual <0.1 mg /L N/A SMWW 4500CIG 6/30/04 Color 10 15 Units SMWW 2120 B 6/30/04 Odor �ND 3 TONs SMWW 2150 B 7/2/04 Iron *0.322 mg /L 0.3 mg /L SMWW 3111B 7/2/04 Manganese <0.050 mg /L 0.3 mg /L SMWW 31116 7/2/04 Sodium 8.25 mg/L,- N/A SMWW 3111B 7/2/04 Chloride 42 mg /L 250 mg /L SMWW 4500 Cl C. 7/2/04 Hardness 118 mg /L N/A SMWW 2340 C 7/2/04 Nitrate 2.39 mg /L 10 mg /L SMWW 4500 NO3E 7/2/04 10:00 Nitrite <0.1 mg /L 1.0 mg /L SMWW 4500 NO3E 6/30/04 pH 7.42 S.U. 6.5 -8.5 S.U. SMWW 4500 H B 7/2/04 Sulfate 25.0 mg /L 250 mg /L SMWW 4500 SO4F 6/30104 Turbidity *7.44 NTU 5 NTUs SMWW 2130 B 7/2/04 Lead **27.7 ug /L 15 ug /L SMWW 3113 B At the time of analysis the sample was acceptable for total coliform COMMENTS: *ABOVE MCL * *ABOVE MCL AND ACTION LEVEL N/A = Not Applicable mg /L- milligrams per Liter ND- None Detected S.U.= Standard Unit NTU- Nephelometric Turbidity Unit MCL- Max. Contaminant Level TON- Threshold Odor Number ug /L- micrograms per Liter Reviewed by: t Sharon Houlahan, Director Signature: �'i!o`"'t• State #: PH -0218 Michael Lapman ELAP #: 11715 President Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com 0 1 )MS ENVIRONMENTAL SERVICES, INC. 15oo SUMMER STREET STAMFORD, CONNECTICUT o6905 Mailing Information: Name: PF Beal & Sons Address: 4 Putnam Ave City: Brewster State: NY Telephone: 845 - 279 -2460 Client: Michael Rosaforte Zip: 10509 Fax: 845 - 279 -6613 NELAC, CT and NY State Certified Environmental Laboratory Collector's Information: Name: Perry Beal Address of site: 12 Pan Road City: Patterson State: NY Zip: Telephone: Sample's Information: Site: Hose Bibb @ Tank Date Collected: 7/15/2004 Date Received: 7/16/2004 Preservative: HNO3 Time Collected: 10:00am Time Received: 2:30pm Temperature: <4C Lab No.: J047449 Date Analyzed Test Name Result MCL Method 7/20/2004 Lead <1.0 ug /L 15 ug /L SMVW1l 3113 B N/A = Not Applicable MCL- Max. Contaminant Level Signature: ug /L- micrograms per Liter Reviewed by: Sharon Houlahan, Director i State #: PH -0218 Michael Lapman ELAP #: 11715 eresident Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com LORETTA MOLINARI R.N., M.S.N. Acting Public Health'Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Putnam Engineering 4 Old Route 6 Brewster, NY 10509 RE: Proposed SSTS: Rosaforte Pan Road, Lot #6 (T) Patterson, TM# 13 -3 -9 Dear Sir: ROBERT J. BONDI County Executive March 6, 2003 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. Fill is to be shown extending 10 feet horizontally past the edge of any trench and then - sloping 3:1 to grade. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, Robert Morris, P.E. Senior Public Health Engineer 1.7►TiRRi1 P1UTNAM.�C "TY PA.. EALTH DIVISION 'OF iNOMONMEENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner �e Address .12&f noq)u Located at (Street) . P,9W Ron y 4.o—j&-4 Tax Map /.'5 Block 3 Lot (indicate nearest cross street) Municipality Ag17 � 2,,r Drainage Basin /7 a SOIL PERCOLATION TEST DATA Date of Pre - soaking P ot✓To i.'' a Date of Percolation Test r wr Hole No. Run No. Time Start - Stop Elapse Time (Min.) Depth to Water From Ground Surface (Inches) Start Stop Water )Level Drop In . Incites Percolation Rate Min/Iach 3 3 2 /v•'jr— �6' =dry" 3 3 3 3 9 26' -�9 � � 4 $ 00 1 /nw? _ /0: �w /07 07/ _'47 2 lela?V- 10,'37. 13 a/ —9� 3 33 4 , 5 1 2 i 3 I: 4 5 'd ch NOTES: 1. Tests to be repeat6d at,sanle depth until approximately equal perco*960 rates are obta.,me at ea percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31-60 m:in/inct),?►II' iiata to be submitted for review. 2. Depth measurements to be made from top of hole. '" DEPTH G.L. 0.5' 1.0' 1.5' 2.01 2.5' 3.0' 3.5' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' DSCITC11 OF ' 's L`' CtEri VIM HOLES HOLE ,NO. A HOLE N0. HOLE NO. 1> Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after- being encountered Deep hole observations made by: ,��•n o G� r� p.Date 23vci o Z Design Professional Nsme,. Address: iJ?i1G�i�5T% Signature: -t- j RING, PLLC. Engineers and Architects SEPTIC SUBMISSION FORM TO: Off? PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: ? i3- 3 =9) ENCLOSED, PLEASE FIND: COPIES OF THE SSDS PLAN COPIES OF THE HOUSE PLANS CONSTRUCTION PERMIT APPLICATION C� WELL PERMIT APPLICATION HEALTH DEPARTMENT FEE ($300.00 ) SHORT EAF DESIGN DATA FORM La' LETTER OF AUTHORIZATION DATE: /' %• '740'5 . r U APPLICATION FOR WASTEWATER TREATMENT (PC -97) ❑ LETTER OF EXPLANATION REMARKS: — COPIES TO: SIGNED: 4 OLD ROUTE 6, BREWSTER, NEW YORK 10509 - (845) 279 -6789 • FAX (845) 279 -6769 - EMAIL: net 1416.3 0877 —Text 12 L PROJECT I.D. NUMBER I 617.21 x 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) SEOR I . APPLICANT /SP!901,4SOR 2. PROJECT NAME 3. PROJECT LOCATION: , / �a �rAlko 1 Municipality / A L jQ/C6 County 4. LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) _fP5EQS,.E 70 1 -"A4W 10411> oa a rS I44AI 5. IS P,RRO/POSED ACTION: L�J New ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Dp Initially -1,345 acres Ultimately j0� acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 12 Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? C� Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)?�� El Yes GO No If yes, list agency(s) and permlt/approvats 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes L�J No If yes, list agency name and permll/approval 12. AS A RESULT OF PftOPOSED ACTION WILL EXISTING PERMIT /APPROVAL REOUIRE MODIFICATION? ❑ Yes KrNo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: © E J %t/,diy ��l�xl l Date: r Signature: I If the action Is In the Co a Area, �iyi u are a state agency, complete the I Coastal Assessn> t@rl bom %ef�re proceeding with this assessment OYE 08/29/2002 13:59 FAX 845 2796769 13RUCE R. FOLEY Public Health Director PUTNAM ENGINEERING -* PUT CO HEALTH Q001/001 DEPARTMENT OF HEALTH 1 Geneva- Road Brewster, . New York 10509 LORErTA MOLINARI. R.N., M.S.N. Associate Public Health Director Director Of Patient Services RE!2UEST FQR FIELD MT M(-., ATTENTION: ❑ ADAM STIEBELING ✓,GENE REED All information below must be fu4 completed prior to any scheduling. DATE: ENGINEER OR FIRM: eu 11iam 6i C PHONE REASON: DEEPS: x PERCS X PUMP TEST: o ROAD/STREET: _ -9GLI k ecajC 7 •.- 1 TOWN: _ +(SOn TAX MAP#• 8 SUBDIVISION: _ GbSS S LOT #: OWNER: �'I � a ( Cosa -r4<P_ M=P CRITERIA FOR JOINT REVIEW AND Z ; SSIN G OF SOIL YES �N? o j�� Proposed SM within the drainage basin of West Branch or Boyds Corner Reservoirs. C3 Proposed SSTS within 500 feet of a reservoir, reservoir stem-or control lake. o Proposed SSTS within 200 feet of a watercourse or a DEC wetland. E3 Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. O Proposed SSTS for a Commerical Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered yAt 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. _51 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 COUM USE ONLY K1QMF - PI ITwam rrn WTY nFPARTMFNT OF P. 1 JMS EN VI h!0N1NAi Nf,",I.. L:RVICES, I1ti 1500 50AAMEI; P1 I -T JM S STAMFORD, Mailing Information: Name: PF Beal & Sons Client: Michael Rosatorte Address: 4 Putnam Ave City: Brewster State: NY Zip: 10509 Telephone: 845-279-2460 Fax: 845-279-6613 Sample's Information: Site: Bathroom Tap Preservative: HNO3 Temperature: <4C NELAC C7 and NV Siote Certified Environme"fal 1aUor'oto!j; Collector's Information: Name: Matt Beal Address of site: 12 Pan Road City: Patterson State: N.Y. Zip: Telephone: Date Collected: 6/29/04 Date Received: 6/30/04 Time Collected: 2:30pm Time Received: 3:00pm Lab No.: J046885 Date Analyzed Test Name Result, MCL Method 6/30/04 16:00 Total Coliform Absent Absent SMWW 9222B 6/30/04 Chlorine Free Residual <0.1 'mg /L N/A SMWW 4500CIG 6130/04 Color 10 15 Units SMWW 2120 B 6/30/04 Odor ND 3 TONs SMWW 2150 B 712104 Iron *0.322 mg /L 0.3 mg /L SMWW 3111B 7/2/04 Manganese <0.050 mg/L 0.3 mg /L SMWW 3111 B 7/2/04 Sodium 8.25 mg/L N/A SMWW 3111B 7/2/04 Chloride 42 mg/L 250 mg/L SMWW 4500 Cl C 712/04 Hardness 118 mg/L N/A SMWW 2340 C 7/2/04 Nitrate 2.39 mg/L 10 mg/L SMWW 4500 NO3E 7/2/04 10:00 Nitrite <0.1 mg /L 1.0 mg /L SMWW 4500 NO3E 6/30/04 pH 7.42 S.U. 6.5 -8.5 S.U. SMWW 4500 H B 7/2/04 Sulfate 25.0 , mg/L 250 mg/L SMWW 4500 SO4F 6/30/04 Turbidity *7.44 NTU 5 NTUs SMWW 2130 B 7/2/04 Lead **27.7, ug/L 15 ug /L SMWW 3113 B At the time of analysis the sample was acceptable for total coliform COMMENTS: *ABOVE MCL **ABOVE MCL AND ACTION LEVEL NIA = Not Applicable mg /L- milligrams per Liter S.U.= Standard Unit NTU- Nephelometric Turbidity Unit MCL- Max. Contaminant Level TON- Threshold Odor Number ug/L- micrograms per Liter Signature: Michael Lapman President ND- None Detected E Reviewed by: Sharon Houlahan, Director State #: PH -0218 ELAP M 11715 Tel 20, 961 990 Toil t }•Ye 1 866 567 5097 Fax 203 961 9919 imsenvironmentaL.com JM FNV!R() N ; !i ... ..,V1 ; "11 f. >, 1Nr ). . L J._ M S NLLAC, 0* rind NY State Certified F:nviranrrrental Uibornto V Nailing Information: Collector's Information: Vame: PF Beal & Sons Client: Michael Rosaforte Name: Perry Beal 4didress: 4 Putnam Ave Address of site: 12 Pan Road ,,ity: Brewster City: Patterson State: NY Zip: 10509 State: NY Zip: Telephone: 845 -279 -2460 Fax: 845 -279 -6613 Telephone: Sample's Information: Site: Hose Bibb @ Tank Date Collected: 7/15/2004 Date Received: 7/16/2004 Preservative: HNO3 Time Collected: 10:00am Time Received: 2:30pm Temperature: <4C Lab No.: J047449 Date Analyzed Test Name Result MCL Method 7/20/2004 Lead N/A = Not Applicable MCL- Max. Contaminant Level Signature: Michael Lapman President <1.0 ug /L 15 ug /L ug/L- micrograms per Liter Reviewed b : Sharon Houlahan, Director SMWW 3113 B State #: PH -0218 ELAP #: 11715 Q J 20.1 9(;'I 997'i roll t r'r?P 1 866 'i6/ 5097 Fox 203 961 991.9 jmsenvironmental.com jMS ENVIRONMENTAL SERVICES, INC. F), , �� �� i5oo SUMMER STREET i , J M S STAMFORD, CONNECTICUT o69o5 NELAC, CT and NY State Certified Environmental Laboratory Mailing Information: Name: PF Beal & Sons Address: 4 Putnam Ave City: Brewster State: NY Telephone: 845 - 279 -2460 Sample's Information: Client: Michaael Rosaforte Zip: 10509 Fax: 845 - 279 -6613 Collector's Information: Name: Matt Address of site: City: State: Zip: Telephone: Site: Bathroom Tap Date Collected: 8/3/04 Date Received: 8/3/04 Preservative: HNO3 Time Collected: 6:30am Time Received: 1:30pm Temperature: <4C Lab No.: J048086 Date Analyzed Test Name Result MCL Method 8/4/04 Iron <0.050 mg /L 0.3 mg /L SMWW 3111B 8/3/04 Turbidity 0.29 NTU 5 NTUs SMWW 2130 B N/A = Not Applicable S.U.= Standard Unit MCL- Max. Contaminant Level ug /L- micrograms per Liter mg /L- milligrams per Liter ND- None Detected NTU- N,ephelometric Turbidity Unit TON- Threshold Odor Number Reviewed by: Sharon Houlahan, Director Signature: State #: PH -0218 Michael Lapman ELAP #: 11715 President Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmentat.com PUTNAM COUNTY DEPARTMENT OF HEALTH Duffs G� / /�dy — DIIG . DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Dater G 2 16 el Inspected by.: G. 7e,� E n Street Location Y. 4 1 Owner Town � ,, °'� -', _f it/ Permit # P — TM # / 3. 3 Subdivision Lot # 1.. Sewage System Area a. STS area located as per approved plans ................. b. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dptb c. Natural soil not stripped. d. Stone, brush, etc., greater than 15' from STS area e. 100' from water course / wetlands ........................... II. Sewage System a. Septic tank size - 1,000 ...:....1,250......other..... b. Septic tank installed level ...... .. .. ............................. c. 10' minimum from foundation.......... I ............:....... d. Distribution Box 1. All outlets at same elevation -water tested....... 2. Protected below frost ....... ............................... 3... Minimum 2 ft. Original soil between box & tre: e. Junction Box - properly set ............................... 6. Irenches 1. Length required X00 Length installed 2. Distance to watercourse measured -Fido Ft...... 3. Installed according to plan ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot.... 5. 10 ft. from property line - 20 ft.- foundations., 6. Depth of trench <30 inches from surface......... 7. Room allowed for expansion, 100 % ................ 8. Size of gravel 3/4 - 11/2" diameter clean........... 9. Depth of gravel in trench 12" minimum.......:... 10. Pipe ends ca pped ............. ............................... g. Pump or DosedpSystems 1. Size of pump chamber ...... ............................... 2. Overflow tank .................. ............................... 3. Alarm, visual/ audio ........:. ............................... 4. Pump easily accessible, manhole to grade........ 5. First box baffled ............... ............................... 6. Cycle witnessed.by H.D.estimated flow /cycle.. III. House/Building a. House located per approved plans' b. Number of bedrooms ...... :..........................��. . IV. Well Well located as per approved plans . ......:........................ b. Distance from STS area measured / 3 g . ft.. c. Casing 18" above grade f... .. d. Surface drainage around well acceptable .............. V. Overall Workmanship . a. Boxes properly grouted ......... ............................... b. All pipes partially backfilled .. ............................... c. All pipes flush with inside of box .......................... d. Backfll material contains stones <4" diameter...... e. Curtain drain & standpipes installed according to f. Curtain drain outfall protected & dinto exist wate g. Footing drains discharge away from STS area...... h. Surface water protection adequate ........ .... ............. i. Erosion control provided ...... ............................... Rev. 12/02 05/27/2004 T U 15:12 FAX 44-► PCHD x- 'PUTNAM COUNTY DEPARTMENT OF HEALTR DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION L1 JOSEPH GENE REQUEST FQR FINAL INSPECTION For: Fill r All iuformation must be fully completed prior to any Trendbes inspections being made. PCHD Construction Permit Located: (T) Owner/Applicant Name: Pi\ 4A�. Re:g�xaf_ TM _ Block , 5 _ Lot c' Formerly: Subdivision Name: r Subdivision Lot' # - (P Is system fill completed? Date: 27 a Y Is system complete? Date: S/Z7 fa i Is system constructed as per pl ? Ems' Is well drilled? F� Date: Is well located as per plans? �_ Are erosion control measures in place? I certify that the system(s), as listed, at the above premises has been constructed and I have.inspected and verified their completion in accordance: a ith the , issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the ,Department of Health. r , J Date: � � I �'� �`�'� Certified by: PE RA Desiga Profes oval Address: Cif' `4x� ( �_ zE, AaS Lie. # 0 �v'T Comments: Form FIR}99 MAY -27 -2004 THI 1 1 S: 17 TFI ! A4S- a7P -7ga1 MOW: - PI ITKiom rni MTV nCD0DTMCAIT nC 0001/001 0 .y.. LORETTA MOLINARI 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 June 3, 2004 Paul Lynch Putnam Engineering 4 Old Route 6 Brewster, New York 10509 Dear Mr. Lynch: ROBERT J. BONDI County Executive Re: Field Inspection — Rosaforte Pan Road, (T) Patterson Lot # 6, TM# 11-3 -9 The following comments must be corrected in the field. 1. It appears fill in the expansion area may not meet the required depth of 2 feet per the approved plans. An appointment must be made. with this Department for deep test holes in order to prove out existing depth. 2. It appears the well was not installed in the approved location. If you have any further questions, please contact me at 845- 278 -6130, ext. 2261. GDR: cj Sincerely, ,$4� VJ, Gene D. Reed Sr. Environinental Health Engineering Aide SENDING CONFIRMATION DATE : JUN -4 -2004 FRI 10:25 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845- 278 -7921 PHONE : 92796769 PAGES : 1�1 START TIME : JUN -04 10:24 ELAPSED TIME : 0012111 MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... a – LORSTTA MOLINARI. P-wk Nm114 D6-1 DEPARTMENT OF HEALTH l Ge —Road. Bmwm, New York los09 Ravlenenralm-NI(145)271-6130 Put (643) 276.792, N--bg BMW ( 145) 276 -6351 WIC(645)276.6678 Fa(845)A1-6015 > 't7 hNmol6e/Ptrx4wt.(6B) ]76.6014 Pm(945)2M-d641 ROBERT J. BONDI C-wrj• &mtf r In= 3, 2004 Paul Lynch Pudmm Engineering 4 Old Route 6 Brewster, New Yolk 10509 Re: Field Inspection — Ronfotte Pan Road, Cr) Patterson Lot # 6, TAM 13A-9 Dear Mr. Lynch: The following comments must be corrected in the field. 1. It appears 611 in the expansion area may not meet the required depth of 2 feet per the approved plans. An appointment umt be made with this Dopattment fbr deep test holes in order to prove out existing depth. 2. It appears the well was cot installed in the approved location. If you have any further questions, please contact me at 845- 278 -6130, ext 2261. Sincerely, Gene D, Reed Sr. Eaviromncnod Health Engineering Aide GDR:oj LORETTA MOLINARI 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 June 15, 2004 Mr. Paul Lynch Putnam Engineering 4 Old Route 6 Brewster, NY 10509 Re: Field Inspection — Rosaforte Pan Road, (T) Patterson Lot #6, M.M. #13. -3 -9 ROBERT J. BONDI County Executive Dear Mr. Lynch: A re- inspection at the above referenced lot has been completed. There are no open comments to be addressed at this time. If you have any further questions, please contact me at (845) 278 -6130, ext. 2261. Sincerely, Gene D. Reed Sr. Environmental Health Engineering Aide GDR:cw SENDING CONFIRMATION DATE : JUN -16 -2004 WED 15 :19 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH . TEL 845 -278 -7921 PHONE : 92796769 PAGES : 1/1 START TIME : JUN -16 15:18 ELAPSED TIME : 0012011 MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... LOWMA MOLHJAN ROBMLT J. BOM ' /ii6!!e 1rm0A pxew Can4 8axw@, DEPARTMENT OF HEALTH I Gcm Rmd, Biaw6ter, Now Ymk 10509' ■ lft-m al HW% (10)278 -6170 Pu045)276 =7921 - 14nsY8 5".(845) 278 -6558 WtC (845)278.6678. .Fa(845)271.6U5 . EMy lmrv6 .omrmh w (843)278 -6014 Fm(84.J)271.6648 June 15, 2004 i Mr. Paul Lynch Putnam Enoneming 4 Old Route 6 Brewster, NY 10509 liar•Field li spoction— Romfbft Pen Road, (T) Patatsan Lot p6; IvLh1. q13: 3.9 ' , Dear Mr. Lynch A minspection at the above retbtenced lot has been completed The are no op® oo=wnm to be oddne6aed at this date.. if you have any fluther questions, please coated maat (845) 27&6130, exL 2261. sincerely, Dane D, Reed i St. Euv(rorimemal Health Engineering Aide ODR:cw x't -fr t,-5:4 - ❑Cash Olbh' 0 PUTNAM' COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT It f Located at ` AI Wad b Town r Village ), cES'O(,1 Subdivision name 6ZZ?,5FFF0AbS Subd. Lot # /v Date Subdivision Approved /a, i 9- 19b'O Owner /Applicant Name.gle.40AZ35A6OeO Mailing Address Amount of Fee Building Type . Tax Map 1.3 Block. Lot 9 Renewal Revision Date of Previous Approval 1-.4kE , Or, d ► A O .5 Zip 10 AMA Enclosed ®O Lot Area moo. of Bedrooms Design Flow GPD ko Fill Section Only Depth Volume Separate Sewerage System to consist of kP50 gallon septic tank and AWI ,t: O,& .1jWle Other Requirements: To be constructed by Ty 13C L],�7,-1/OEv Address Water Supply: Public Supply From Address or: 1✓ Private Supply Drilled by 7D S& L),Er,0W1X&b Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system, described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: P.E. Address /0V7W- 40 4�1&,to�IAlly' — 401-D PCfTE 69 R.A. Date License # ,lit AW972W9 IV, Y,10 erl APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatme system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified wit - co sidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new perms prove discharge of domestic sanitary sewage only. By; Title: CA� - Date: �(' f ' 3 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 ENVIRONMENTALHEALT111. SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: , A41614gl � ) o5-A Ag2e-rgr SR. 'Al 2. Name of project: R99W97ZF- 3.. Loca, tio4$V 7- 77%*.'50W 4.. Design Professional: .5. Addrel ss: 4 04D Phlrw to 6. Drainage Basin: 9&Y' ele A-77 - i-) ie-699 7. TWe of PWiect: L,/ Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Rialty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Rdview',,(SEQR)? Type Status (check one ................. * ............................. o ........ Type I Exempt Type II Unlisted __WA ' 9. Is a Draft Environmental Impact Statement (DEIS), required? .. ....................... 0 10. Has DEIS been completed and found Acceptable by-Lead'Agency? ................. A I)A I L Name of Lead Agency 12. Is this project in. an area under the control of local planning, zoning,- or other. officials, ordinances? ............................................ ............................................. 1.3. If so, have -plans, been subs Wed-to such authorities? ... ...... ............ 14. Has preliminary approval been :granted by such authorities? Date granted: ki 0 15. Type, of Sewage Treatment Syitein'Dischargd ...... * ........ surface water __v/groundwater - 16. If surface water discharge-, what is'the stream class designation? .................... .17. Waters index number (surface) ........................... ............... .................... ..... 18. It project located near a public water supply system.? ............................ ........... 19. If yes, name .of water suppiy Distance to water supply 20. -Is project site near a.publio sewage collection or -treatment system! ................ hlD 2.1. Name of sewage -system Distance.to sewage system /Aft ,9 22. Date test holes observed 14- Naps 23.. Name of Health Inspector a�VJE �eb 24. Project design flow (gallons per day) .............................. ...................... r 25. Is State Pollutant Discharge Elimination Syster�@��S Permf,f,64uired? ... Ali 26. Has SPDES Application been submi........................ A10 submitted to local ,!D Form PC-97 2, -27. Is any portion of this project located within a designated Town or State wetland? A10 28. Wetlands ID Number ........................................................... ............................... 29. Is Wetlands Permit required? ...........................:.................. ............................... ,cIQ Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ............................... AID 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 �c10 32. Is project located within 1,000 feet of existing or'abandoried landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No JJD '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? ............................... ............................... �0 35. Are any sewage treatment areas in excess of 15% slope? ....... .- ......................... /1/0 . 36. Tax Map ID Number ...... 1. O. R. A ........ ............ .................... Map l 3 - Block 1 Lot 9 37. Approved plans are to be returned to ..... Applicant Design'ProfessionaI NOTE:.AII 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 better of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby afrm, an der penalty of perjury, that information provided on this form is true to the best of my knowledge and belief.. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: Mailing Address: .................................... 11 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 Faz (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Putnam Engineering 4 Old Route 6 Brewster, NY 10509 RE: Proposed SSTS: Rosaforte Pan Road, Lot #6 (T) Patterson, TM# 13 -3 -9 Dear Sir: January 30, 2003 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. Engineers authorization is not complete. Filed map number and date filed has not bee provided. 2. The Putnam County design data soil information notes groundwater seepage and mottling in one deep test hole. The design data sheet does not note this information. Revise as warranted. 3. The PC -97 notes the date of test holes observed as November 26, 2002. This does .not correlate to the date the deep test holes where observed on record in this Department. 4. The location of the percolation test hole cancelled on October 22, 2002 is to be shown on the plan. 5. The minimum of one percolation test in the expansion area is required. s op en ��:; v<w�graue A 7. Title block is to note subdivision lot number. 8. Fill note #1 is not required for fill section 2 feet or less in depth. q P� 9. The proposed well location is to be dimensioned fro .two property lines. 10. Title block is to note street address of property. Letter to: Putnam Engineering - January 30, 2003 -2- The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, Robert Morris, P.E. Senior Public Health Engineer RM:tn BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278.7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Putnam Engineering 4 Old Route 6 Brewster, NY 10509 RE: Proposed SSTS: Rosaforte Pan Road, Lot #6 (T) Patterson, TM# 13 -3 -9 1 Dear Sir: February 24, 2003 Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ve truly yours, vltuel /// Robert Morris, P.E. Senior Public Health Engineer RM:tn BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Putnam Engineering 4 Old Route 6 Brewster, NY 10509 RE: Rosaforte Pan Road, Lot #6 (T) Patterson, TM# 13 -3 -9 Reservoir Basin Dear Sir: January 30, 2003 The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on January 14, 2003 is complete. The Department will notify you by February 20, 2003 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 asset 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.proj ect, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of A r Letter to: Putnam Engineering - January 30, 2003 -2- 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. Ve9kVY Yours, /WOO Robert Morris, PE RM:tn Senior Public Health Engineer 1 PUT N' t1EALTH DIVISION oV _� TY NMENTAL HEALTH 'SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner aNAi%, - 205 r..� r r Address P4A( /to .4,u Located at (Street). Pw>/ QoA v �� � Tai'Map _ Block 3 Lot I (indicate nearest cross street) Municipality �iaiT�r/ ,�/ Drainage Basin )9 �f C ? Voi2 SOIL PERCOLATION TEST DATA Date of Pre - soaking Date "of Percolation Test-- A3, ° o� Hole No. Run No. Start - Stop Ela se Time �1VIIn.) Dept4'to VKater From Ground �Surfaee (Inthis) Start Stop Water Level rop In Hales Percolation Rate Afinfluch 2 10'31— o ...(n 26'= q" 3 3 4 . 2 101,9V- 10,37 i3 v 3 4 5 . 1 2 i 4 J 777=5 nv i za; i. nests to oe repeatoa ao. some aeptn until approximaiery Cqua, pun;UJU vu .•V ��•�••• -- -- - -- :percolation"test hole. (i.e. s t min for 1 -30 min/inch, 12 min for 31 -60 min/inch) All data to be submitted for rayieiv. 2. Depth measurements to be made from top of hole. 4 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.5' 5.0' 5.5' ' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' t. CIF HOLE NO. A HOLE NO. HOLE NO. Indicate level at which groundwater is encountered Indicate level at which M'ottlinris- observed Indicate level to which water.:levpt rises after-being encountered Deep hole observations made by: , '27' oe�� -r P reatr e�= acid & Date z3 Design ProfessionalNtnc:,._PvTi�R�1 r�u6►�tsG-rz�,u c:;. y,� Address: .1412 4--ii 16 "�- lf tW S Signature: 6 06744 �� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF -ENVIRONMENTAL HEALTH SERVICES APPLICATION FUR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: IW- 1c9 E'L 6 oSA tt� *� S(?• 1410.9_>'R.4o 44k- IoAID 2. Name of project: gL61QCt vsa, TE 3. Locatio jArr Al y _ 4. Design Professional:.p 5. ,Address: 4 041) 6. Drainage Basin: GYy 0040K 7. Type of Project: - �/ Private/Residential Food Service Commercial ^' Crj Apartments Institutional Mobile Home Park .Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review.:(SEQR)? Type check one YP Status . ( ) ................... ...:.................................. Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS), required? ........... :...... ....... p 10. Has DEIS been completed and found acceptable by1ead'Agency3 .............. :. AI 11. Name of Lead Agency WA 12. Is this project in. an area under. the control. of local planning; - zoning,' or other . officials, ordinances? ......................................................... ............................... E�5 13. If so, have-plans been subtiiitted46 such authorities? ...:..:.: ... :. : ....:...............:.... 14. Has preliminary approval been granted: by such authorities ?, Date `granted: D 15. Type. of Sewage Treatment sferri'Dischar e ................. surface water groundwater yP 8 �• 8 �� 16. If surface water discharge; what is the stream class designation? .:.................. 17. Waters inde'c number (surface} .. ......:.............:.. . 18. Is project located near a public water supply stem? tiJ0 P J pu. sy ::..... ............................... - 19. If yes, name .of water, Distance to water supply . 1,4ia 20. -Is project site near a•publicsewage collection�,*or treatment system? . .......:........ e 2.1. Name-of sewage - system" ` Distance.to sewage system, //*4� 22. Date test holes observed ©� a �?c7c,w 23. Name of Health Inspector aeUF � 24. Project design flow (gallons per day) ................................. ............................... X00. 25. Is State. Pollutant Discharge Elinaimation. System ( SPDES) Permit required ?... AJ0 26. Has SPDES Application. been submitted to local DEC office? ......................... A10 Form PC =97 —. 2' -27. Is any portion of this project located within a designated Town or State wetland ?_;�t14 28. Wetlands ID Number ...... ... ................. ............ ............... ........... ...:................. ........ 29. Is Wetlands Permit required? ......... ............... ......... ........ ..... ............................ ..: ;ut7 Has application been made to -Town or Local DEC office? ............................... WA 30o 30. Does project require a DEC Stream Disturbance Permit? .. ..........................:.... /16n 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or.other crops, solid or hazardous waste disposal, landflling; sludge application or industrial activity? ...: ............. ............ Yes/No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any D other potentially known source of contamination? .........:.................. ... Yes/NO, �l 'DESCRIBE: 33. Is there a local master plan on file with the Town or Village.? .................:::...:: -- -°— 34. Are community water and/orsewer facilities planned to be developed within 15 years in or adjacent to project site? ............................... :................................... ,Jo 35. Are any sewage treatment areas.,inexcess of 15 %o- slope? ....... : .......................... ,c{0 36. Tax Map ID Number ....... /. P.. I.R 4 ........ ............................... Map 13 Block 9 Lot 9 37. Approved plans are to be retupeti to ..... Applicant 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 Ogther.aspects of'a project, such as stormwater plans or the creation. of impervious surfaces,-and the project applicant should obtain the appropri ate forms for such activities from DEP and submit those forms to DVI- or'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 Fetter of Authoriimtion (Form LA -97). Failure to comply .with this provision may be grounds for the rejection of any submission. I hereby Wrm, under. pen altyi perjury, that information provided on this form is true to the best of my kno Wedge, and belief.. False statements. made herein are punishable as a Class A misdemeanor pursuant to Section SIGNATURES & OFFICL4L Mailing Address: .................................... kZkJAIVI �i�Y i�cl F� %t1Ly OLD 'urn �o BPc_ WS72�F2. d V 10509 PUT, T,NAM .COUNTY P RT'MENT OF JKEALTH DIVISION OF ENVIONTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner N//C1/11EL ds a-re Address t,'41,1 Located at (Street) eAaO,SWbADSS 1,1137- Tax Map 13 Block Lot (indicate, nearest oss street) � Municipality. )6 T1`aieSc /✓ Drainage Basin ?-X0 ���` i�r � ✓��F� SOIL PERCOLATION TEST DATA Date of Pre - soaking i���:vo,.. ;._ Date of Percolation Test. Water Level )pro In Incites Percolation Rate Mi ilInch Hole No. Run No. Time Start =Stop Eta a Time "Min) De th to Water Tom Ground Surface (Iachgs) Start . Stop Z 3 4 -�- a6 5 2 3 4 5 :.., 1 4 5 NOTES: 1. Tests to be repeattld atrsame 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. 0.51 1.01 1.51 2.01 2.51 3.0' 3.51 4.01 4.5' 5.0' .0 5.51 6-.01 6.51 7.0' 7.51 8.01 8.51 9.01 9.51 10.01 PY - S YIT D A AT m9i IN TEST HOLES DESCRIPT101 MOT . P WO_ HOLE NO: HOLE 'NO. Indicate level at which groundw: ate:r is encountered Indicate level at which nf6ttflh "'ii : h9eived Indicate level to which witor,44 -41.,rises after being encountered Deep hole observations .made )cd L) �WOWCMM Design Address Signatu Idesign Professional's Seal PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of aza- _ z s° Located at 1,9, 2�2 A 1 , /) � '�, M � /,�, 6-6A TN Pa*tYM Tax Map # j 3 _ Block Lot q_ Subdivision of �/ios -s �zo�QC Subdivision Lot # 6' Filed Map # 101aA Date Filed 19 80 Gentlemen: This letter is to authorize e 111 Alien A-g a duly licensed Professional Engineer X or Registered Architect to apply for the required wastewater treatment and/or water supply permigs) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Pumam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise ction of said wastewater treatment and/or water supply .systems in conformity with Article 145 and/or'147 of the Education Law, the Public Health Law, and the Pu� Code. Very truly yours, .V Countersigned: ,o�� sP� Signed: 3. f ��i P.E., RA., # \ _/ (Owner of Properc ) Mailing Address PU �2 �im AL- Mailing Address: g W,44_ I )O 4- m��l State —P Zip 10501 Telephone: 216) 0 State , d L Zip S y Telephone: 69/ 1) �6 41 6- ti 9 / 6 P LITNAM NGINEERING. PLLE. Engineers and Architects SEPTIC SUBMISSION FORM TO: G l - E. DATE: a ' /07' ,�70D3 PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: ENCLOSED, PLEASE FIND: C� COPIES OF THE SSDS PLAN ❑ COPIES OF THE HOUSE PLANS ❑ CONSTRUCTION PERMIT APPLICATION ❑ WELL PERMIT APPLICATION ❑ HEALTH DEPARTMENT FEE ($300.00) ❑ SHORT EAF DESIGN DATA FORM (eg ll sr) `D !1jD,c4v mora rAjer � L�d���- TEST> ❑ LETTER OF AUTHORIZATION: Gil" APPLICATION FOR WASTEWATER TREATMENT (PC -97) (eahgrD p42 3 1, 3o•'7003 P614D 4EM9 ❑ LETTER OF EXPLANATION I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES r DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner 7e, 5w r-e7 Address Located at (Street) Tax Map 13,e7 Block I Lot (indicate nearest cross street) Municipality �,¢��,/>� Watershed 7- �7zi9NG, SOIL PERCOLATION TEST DATA Date of Pre - soaking 0 Date of Percolation Test 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 3 71 4_ 5 2 1 v- 2o- /L';:io D — 5 3 4 5 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 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH G.L. �— 0.5' 1.0' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' . 5.5' Q 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' HOLE NO. •A HOLE NO. /�_ HOLE NO. G 41 .µ 2 Indicate level at which groundwater is encountered 6 , c " A't—to R Indicate level at which mottling is observed 6 " Indicate level to which water level rises after being encountered Deep hole observations made by: 6T Yge, P, c H, �' Date la 3102 Design Professional Name: Address: Signature: Design Professional's Seal -ps R vi Street Town- -SW _Z Ap PERSON IN CHARGE 2: nIg_ TNT:P-R VTIEW'91) n t N e and & Title TYPE FACILITY ..I,QF , , ,i.' 7-5 A, _4 FINDINGS Zt -2 .; 41 4, 777777 771 7 7-, A -K 0. Tll�l TVIRPRCTQI�! S at and I' ign ure. a RlP.C-F.TVF-T)-RV-.' t of-this rep6rc-, ,,acknoW. �dg�,r�qeip. SIGNATURE, 7 02/96. Tit 6 .;" ■ D {1 PUTNAM COUNTY DEPARTMENT OF HEALTH • DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project 7Z ri—::,- &V) Pi 7"�� 7fOeWnty P-UZ:&I� Site Location ,/'/ / .07— l _ 2 Building construction begun A/ Extent Is property within NYC Watershed. Yes a No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. Hilly - 0 Rolling F7 Steep slope © Gentle slope F7 Flat 2. F7 Evidence of wetlands 0 Low area subject to flooding F7 Bodies of water F--] Drainage ditches Rock outcrops 3. Property lines or corners evident ....................... ............................... F7.� Yes - 4. Do water courses exist on or adjoin the roe F7 Yes [-Z64o 5. Will these affect the design of the sewage system facilities ?............ 0 Yes �No' 6. Do watershed regulations apply in this development ? ....................... Yes F I o 7 Will extensive grading be necessary? ................. ............................... F--] Yes . No 8. Will extensive fill be necessary for SSTS? ......... ............................... F--J Yes d o 9. Do filled areas exist within the SSTS area? ........ ............................... Yes No If yes, what is the condition of the fill? a SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: ffSandF—J Gravel Loam F-� Clay F--J Hardpan F-I Mixture 11. Observed from: F7 Borings 0 Bank cut ©Backhoe excavations 12. Soil borings /excavations observed byi )2��n {�, G %�� on 13. Depth to groundwater _ on 14. Depth to mottling 15. Are test holes representative of primary & reserve areas ..................................... No F No 16. Soil percolation tests made by "Zo Y uTiy�iY! i�4f on T— 17. Soil percolation tests witnessed by i� [7 �G�H�T�. on SECTION D (on back) Form ST -1 SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? 0 Yes ©No 19. Will groundwater or surface drainage require special consideration? ..................... Yes F-1 No 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... Yes ffNo SECTION E. REMARKS 21. If a common water supply is proposed; has an inspection- been made of the existing or proposed source and facilities? ............................... ............................... 0 Yes No Inspection data 22. Do adjacent wells and/or sewage systems exist ? . �'r �.7� .1.`?. ..... Yes F__] :No 23. Additional comments 41/` 24. Site observer /inspector and title 4:�', 7�n 7 J6�, `t G-� 25. Date(s) of observation(s)inspection(s) /v /xtp 2. TEST PIT PROFILES r Hole # Lot # Hole # 'Lot # Hole # Lot # Depth to water v Depth to water Depth to mottling SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? 0 Yes ©No 19. Will groundwater or surface drainage require special consideration? ..................... Yes F-1 No 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... Yes ffNo SECTION E. REMARKS 21. If a common water supply is proposed; has an inspection- been made of the existing or proposed source and facilities? ............................... ............................... 0 Yes No Inspection data 22. Do adjacent wells and/or sewage systems exist ? . �'r �.7� .1.`?. ..... Yes F__] :No 23. Additional comments 41/` 24. Site observer /inspector and title 4:�', 7�n 7 J6�, `t G-� 25. Date(s) of observation(s)inspection(s) /v /xtp -2-. TEST PIT PROFILES Hole # Lot # Hole # 'Lot # Hole # Lot # Depth to water Depth to water Depth to water Depth to mottling Depth to mottling Depth to mottling Depth to rock/imp. Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L. r 0.5 .0.5 0.5 1.0 1.0 1.0 2.0 2.0 2.0 3.0' 3.0 3.0 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 i. . %.; �.1. .,":V,.f � ..x '• .n+q°J .: r f. ) ,r. r•. ',f r t . i.� rs,. 4 ••� �` T / / /0000 •. 1' IMP dw I N r S 46 lip) LA1 / PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ' LETTER OF AUTHORIZATION RE: Property of -S-21 Located at 02 2jQLU ,.% c ,� TN PO&6 l Tax Map # Block 2, Lot Subdivision of Clgos -s ieo _g/ Subdivision Lot # 6• Filed Map # Gentlemen: This letter is to authorize Date Filed &Lc a duly licensed Professional Engineer X or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations, as promulgated by the Public Health Director of the Put,-iam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise construction of said wastewater treatment and/or water supply systems in conformity withal Article 145 and/or 147 of the Education Law, the Public Health Law, and the Pu i4 IW it* Code. Countersigned: P.E., R.A., # Very truly yours, Signed: �,.,.G? l�< - 4zo � , (Owner of Property) Mailing Address &st''U Mailing Address: 4— (Qmk s - State Zip O�0 State ,A) �'. Zip /C) s `/ ? Telephone: �` r <. �, ;.� is � Pephone: 69/ `/i PUTNADI COUNTY DEPART,NIE \T OF HEALTH DMSION OF ENVIRONNIE \TAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAIL E OF OWNER: I SA" STREET LOCATION: REVIEWED B AS, SRDATE: TAX l V%P =: (CONFIRINIED) Y \ DOCUMENTS Y (�UiRED DETAILS O \PLANS CO \�'D) - - UUPER�IIT APPLICATION ' U OUSE SEWER -' /�" FT. 4"0'; TYPE PIPE CAST IRON. "L_)WEdPERM CJf IT OR PWS LETTER ON0 BENDS; IIA\ BE ENDS a5° NY /CLEANOUT• (—JL- -)PC-97 RENEWALS _),__)LETTER OF AUTHORIZATION U� )SITE NOTE (0 CH XhGE) UUDESIGN DATA SHEET (DDS) FILL SYSTEMS UL—)CORPORATE RESOLUTION �. 10' HORIZO\T.�L; PAST TRENCH SLOPES 3:1 TO GRADE L_•,L_JSHORT EAF C_) FILL SPECS! FILL NOTES 1 -5 L —)LJPLANS THREE SETS U • FILL PROFILE & DIMENSIONS C_)L JSE PLANS - TWO SETS (FILL D; EXPANSION AREA VARIANCE REQUEST FILL GREATER TH.d \ 2 FEET SU$DMSION ( CLAY BARRIER LEGAL SUBDIVISION FILL CERTIFICATION NOTE . SUBDIVISION :APPROVAL CHECRtD DEPT$ GAUGES PERC RATE 'OL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS (� FILL REQUIRED DEPTH SEPARATION DISTANCE FROM TOE OF SLOPE UCURTAIN DRAIN REQUIRED RENCH GENERAL LF TRENCH PROVIDED LOFT b'IAX. LOCATED IN NYC WATERSHED . UL-- -) D (�PaRALLEL TO CONTOURS U PLAN S.SUBMITTED TO DEY - 9 j, EXpp \SIOr PROVIDED - _ _ j DELEGATED TO PCHD (� DETAIL/DLST FREE CRUSHED STO \'E OR WASHED. GRAVEL. (- DEP APPROVAL, IFREQ'D, UGEOTEXTILE COVER (� DEEP TEST HOI:ES'bBSERVED SEPAR�TIO`t DI57 AtiCES 0\ PLAN =ijal I S .' PERCS'TO BE WITNESSED 10' TQ P.I. DRIVEWAY, LARGE TREES, TOP OF FILL . . EX- APPROVAL SSDS ADS, LOTS- 20' TO FOU\'AATION WALLS �Y$ FL?;NDS'�TOWI`iIDEC 1'ERbIFi ;REQ'D ?) 100` TO'WELL, 200' D(.DLOD; X50' TO PIIS GDATA-Ol`I DDS:PLANS.&'PERIVIII SAZr� U 100' TO STREAM, WATERCOURSE, LAKE (iac expan) YRE IyG9 NEIGHBOR'NOTTFICATION (�50' TO CATCH BASIN, 35' STOR`IDAAL\, PIPED WATER LETTERBVZBA ( 10'TO WATERLINE (pits -20') (__)100 YR. FLOOD ELEVATION W/I200' ( 50, I�'TgILMITTENT DRAINAQE-COURSE . ULDSOILTESTING LOTS>10 YEARS OLD �� 00' /500' RESERVOIR, ETC. _ 150' GALLEY SYSTEiti1S. REQUIRED DETAILS ON PLANS UU10'.bILYTO LEDGE OUTCROP -} SEWAGESYSTEMPLAN- (NORTI�ARROW), SEPTICTANK , L_L)Z jSSDS HYDRAULICPROFILE Z(—)Io' FRO}I FOUNDATION; 50' TO WELL GRAVTTY FLOW WELL, DESIGN DATA: PERC & DEEP RESULTS LnV 2' CO}'` OURS EXISTING & PROPOSED jCX- DRNEWAY &SLOPES;, CUT ' (U FOOTING /GUTTER/CURTAIN DRAINS (:USDA SOIL TYPE BOUNDARIES TITLE BLOCK; OWNERS NAME ADDRESS ,TM," , PE/RA; NAME, ADDRESS, PHONE# DATE OF DRAWING/REVISION DATUM REFERENCE . (LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN200' OFM f 6LPROPOSED FINISH FLQOR AND *(—)(BASEMENT ELEVATIONS WELLS & SSDS'S W/IN 200' OF SSTS --J) PROYERTY METES & BOUNDS EROSI(j► {,CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE . COMMENTS: (1mvSHEET)09101/00 - -- GDISiENSIO,-iSTO•PROPERTY'LL`1ES He'JOCA TION OF SERVICE CONNECTION' I:`(155 TO PROPERTY Lhli E . SLOPE. .(.$LOPE IN SSTS AREA (520 %) • 4 U(�}REGRADED TO 15 1/6, IF REQUIRED << DOSERUbTP SYSTEMS (�PUI NOTES OSE 756/6 OF PIPE VOLUINIE/DOSE VOLUME NOTED. (_,, IETAIL FOR FORCE rum, (PIPE TYYq, ETC) U IT AND D -BOX SHOWN & DETAILED i DAY STORAGE ABOVE ALAMI CURTA RATTN _ STANDPIPES, 5' BOTH SIDES, DETAIL •(_,) 20'b to CD DISCHARGE/100' with 182 cons day discharge T( )10' MIN to NON - PERFORATED PIPE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL C-03 please print or type PCHD Permit # — Well Location: Street Address: To PN illage Tax Grid # /04,c,/ FOdD Ai'T�'S'Cy� Map /,3 Block 3 Lot(s)�% Well Owner: Name: Address: ,QaA�11-QkE,bdD /►/�J: l(rgc0 , i ' Use of Well: ✓ Residentiaf 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, X gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling t/ New Supply (new dwelling) Deepen Existing Well Detailed Reason && LL L 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 GOV95 9OADS- Lot No. ry Water Well Contractor: TO RE /7e—IZ5WWO Address: Is Public Water Supply available to site? .................................. ........................... ..... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: /Nd 14Ef Proposed well location & sources of contamination to be provided on sep heet/plan. Date:_jg,0d3 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 wate e driller c rtified by Putnam County. Date of Issue ,S Permit Iss VPP ialD ate of Expiration Title: ( Permit is Non-Transferkatfe White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 LORETTA MOLINARI R.N., M.S.N. Acting Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Putnam Engineering 4 Old Route 6 Brewster, NY 10509 Re: Proposed SSTS: Rosaforte Pan Road, Lot #6 .(T) Patterson, TM# 13 -3 -9 Dear Sir: ROBERT J. BONDI 'County Executive April 8, 2003 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. The minimum of two feet of fill is to be provided for the entire SSTS, including the expansion area. 2. It appears the proposed contour line is El. 490 is not complete. _3. Fill is to extend 10 feet horizontally past any trench. Proposed contour line E1.492 does not. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. 0 Very truly yours, Robert Morris, P.E. Senior Public Health Engineer LORETTA MOLINARI R.N., M.S.N. Acting Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Putnam Engineering 4 Old Route 6 Brewster, NY 10509 Re: Proposed SSTS: Rosaforte Pan Road, Lot #6 (T) Patterson, TM# 13 -3 -9 Dear Sir: ROBERT J. BONDI County Executive April 1, 2003 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: 2. The slope of the fill appears to be going into the area shown for the proposed driveway. 3. The slope of the fill appears to be going onto the adjacent lot to the east. The construction of this sewage disposal. system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. 20 Ur 04'0-s Pup 6,a al fL Vie'7�yyo S, 3) rin A, Robert Morris, Re RM.tn7?21 14 01 t PA Q dg" R �Irvvx CIL Senior Public Health Engineer I)vi r Ak r eEnglTneers TNAM NE�RING, PLLE and Architects SEPTIC SUBMISSION FORM TO: Z & dmq� PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: ENCLOSED, PLEASE FIND: COPIES OF THE SSDS PLAN (&/j ec ❑ COPIES OF THE HOUSE PLANS ❑ CONSTRUCTION PERMIT APPLICATION ❑ WELL PERMIT APPLICATION Ll Ll Ll ❑ Ll REMARKS: COPIES TO: HEALTH DEPARTMENT FEE ($300.00) SHORT EAF DESIGN DATA FORM LETTER OF AUTHORIZATION APPLICATION FOR WASTEWATER TREATMENT (PC -97) LETTER OF EXPLANATION i1/ r` SIGNED. 4 OLD ROUTE 6, BREWSTER, NEW YORK 10509 • (845) 279 -6789 • FAx (845) 279 -6769 • EMAIL: puteng @bestweb.net BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N Associate Public Health Director. Director of Patient Services , DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Date: TO: Re: Proposed SSTS: (T) Dear: Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed' by a representative of the New York City Department 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 considred further. Very truly yours, Robert Morris, P.E. Senior Public Health Engineer RM:tn sstsproposed LORETTA MOLINARI R.N., M.S.N. Acting Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Putnam Engineering 4 Old Route 6 Brewster, NY 10509 Re: Proposed SSTS: Rosaforte Pan Road, Lot #6 (T) Patterson, TM# 13 -3 -9 Dear Sir: ROBERT J. BONDI County Executive March 17, 2003 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: 2. Proposed contours cannot be tied into existing contours. Furthermore, the proposed design must approximate the final actual construction, i.e., fill will not be placed that. The construction of this sewage disposal system maybe subject to local wetlands regulations. You should contact local wetlands officials in this regard. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ve truly yours, .. R"�- Robert Morris, P.E. Senior Public Health Engineer RM:tn UT'VAM IVCCIIVEERING, PLLC. Engineers and Architects SEPTIC SUBMISSION FORM 2121; 5 PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: hAl /3 DATE: g'� ENCLOSED, PLEASE FIND: u =f' COPIES OF THE SSDS PLAN ❑ COPIES OF THE HOUSE PLANS ❑ CONSTRUCTION PERMIT APPLICATION ❑ WELL PERMIT APPLICATION ❑ HEALTH DEPARTMENT FEE ($300.00) ❑ SHORT EAF ❑ DESIGN DATA FORM ❑ LETTER OF AUTHORIZATION ❑ APPLICATION FOR WASTEWATER TREATMENT (PC -97) ❑ LETTER OF EXPLANATION I REMARKS: � COPIES TO: _ f SIGNED: 7 4 Oro RouTE 6, BREWSTER, NEW YORK 10509 (645) 279 -6789 • FAX 45) 279 -6769 EM lu puteng@bes 0 b.net PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: 12 Pan Road Town/Village: Patterson Tax Grid # Map j l Block 3 Lot(s) Well Owner: Name: Address: Michael Rosaforte, 146 Byram Lake Road, Mt. Kisco, NY 10549 Use of Well: 1- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock _ Other Casing Details Total length 52 ft. Length below grade 51 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: X Steel _ Plastic _ Other Joints: _ Welded X Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: X Yes No Liner:_ Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes No Hours Second Well Yield Test _ Bailed X Pumped X Compressed Air Hours 6 Yield 5 gpm Depth Data Measure from land surface - static (specify ft) 2' During yield test(ft) 500' Depth of completed well in feet 705' Well Log If more detailed information descriptions or sieve analyses are available, please attach. �ti i t�ll Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 21 Drilling in ove )urden clay and boulders Hit rock at 21' 21 52 Drillincil in rock set casina, cfrouted 52 705 Drillinq in rock granite 1 If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 5qm Depth 660' Model 5GS15412 Voltage 230 HP 165 Tank Type WX302 lum llons Date Well Completed 5/19/04 Putnam County Certification No. 006 Date of Report 7/8/04 Well Dr er p Beal NOTE: Exact location of well witl distan�s tgat least o permanent landmarks to be provi on,a separate she.puplan. ZI Well Driller's Name P. Signature: et Perry L. White copy: HD File; Ye Address: 4 Patmai Ave., NY 109M D. 0' copy - Building Inspector; . Pink copy - Owner; Orange copy - Well driller Form WC -97 A MAP \lv Z® z� 0� 6ALLON SEPTIC / TANK 1 \ \ \ \ 966, 015TRIBLMON 5 \ \ BOX t") \ \ \ AD \ \ \ 10 qd 1 f i 14 15 I6 11 124 12a 134 13q 111 111 123 128 14 � 15 " pP Putnam Count Division of Envi 1A dasn ap � �a ignatu" d T' 5 A5 -BUILT MEASUREMENTS ( IN FEET) U AM EERINE Pup ENGINEERS - ARCHITECTS A nl n ��,��� i. pgn�,.V ��rf ♦Ir,�l �.I��V �i+CM PURSUANT TO NEW YORK STATE EDUCATION LAW, REVISIONS ARTICLE 145, SECTION •7209 SUBDIVISION 2, -IT IS NO. A VIOLATION OF THIS LAW FOR ANY PERSON UNLESS HE IS ACTING UNDER THE DIRECTION OF A LICENSED PROFESSIONAL ENGINEER, TO ALTER AN ITEM IN ANY WAY. IF AN ITEM BEARING THE SEAL OF AN ENGINEER IS ALTERED, THE ALTERING ENGINEER SHALL AFFIX TO THE ITEM HIS SEAL AND THE NOTATION "ALTERED BY" FOLLOWED BY HIS 1 2 3 4 5 6 7 8 1 10 II 12 13 14 15 16 11 A 17 51 12.2 q5 101.5 107.5 111.5 56 012 18 104 112- Iiq 124 121 134 131 B 53 71 100- 106 112 118 124 113 115 123 125 133 105 111 117 123 128 U AM EERINE Pup ENGINEERS - ARCHITECTS A nl n ��,��� i. pgn�,.V ��rf ♦Ir,�l �.I��V �i+CM PURSUANT TO NEW YORK STATE EDUCATION LAW, REVISIONS ARTICLE 145, SECTION •7209 SUBDIVISION 2, -IT IS NO. A VIOLATION OF THIS LAW FOR ANY PERSON UNLESS HE IS ACTING UNDER THE DIRECTION OF A LICENSED PROFESSIONAL ENGINEER, TO ALTER AN ITEM IN ANY WAY. IF AN ITEM BEARING THE SEAL OF AN ENGINEER IS ALTERED, THE ALTERING ENGINEER SHALL AFFIX TO THE ITEM HIS SEAL AND THE NOTATION "ALTERED BY" FOLLOWED BY HIS