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HomeMy WebLinkAbout0398DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -3 -41 BOX 5 00207 !N7- ;, ff �',. ' AT I , 7 it @%60 i �r , 00207 PUTNAM COUtM HEALTH DEPARTMEW DvISIOET OF ENVIRONMENTAL HEALTH SERVICES DISPOSAL SYSTEM REPAIR PROPOSAL Fit S . OHM'S NAME � SITE I=TION ic.�� j f/ MAILING ADDRESS t/05 PEMM WrERVIEWED f pS �, do PCHD Complaint # ip i.e, cwner,tenant, etc.) Nm;& Relationsh DATE TYPE FACIL T 44, n r 2 =e PROPOSED IlZSTAIIER PHONE REGISTRATION # Proposal (include sketch locating ;all adjacent wells): NOTE: Repair must be same location and of same type as: original sewage .disposal system. Different location may require sutmittal of proposal from licensed professional engineer or registered architect..',,,. f FA Ii Z MAI ���► ....... oo> Inspector's Signature & Title- to Proposal approved witfi ihelfollvwin9'conditions: r 1. Procurement of any Town peYmit, if applicable. -, 2. Submission of as "built It repair;,sketch in duplicate showing: a. Owner's name. b. Site :Street. Flame, Town and,, Tax Map number. c. Location -of installed components tied to two fixed points (e.g. "house corners). d. -System` description (e.g.1.1250 gal, concrete septic tank, three precast 61'diazt; x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to.be performed in accordance with the above proposal and conditions. I, as owner, or reported agent of owner agree to the above conditions. SIGNk URE . --F- - TITLE DATE ,>® ,` S: Mite (POD); YelWa Moon St); Pink (kliicsnt) PUTNAM COUNTY DEPARTMENT OF HEALTH . DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIV[JDAL A.DDITION%REPAIR FORM SECTION A: GENERAL INFORMATION Name of Project ���'��� (T)(V) TM9_ Year of Construction Size of Parcel SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. ❑Hilly ❑Rolling ID Steep Slope Amentle Slope ❑Flat ?. ❑Evidence of wetland ❑Low area subject to flooding ❑Bodies of water ❑Drainage ditches Mock outcrop J. Property lines evident? ❑ 4. Water courses exist on, or adjacent to parcel: ❑ __- 5. Existing ndividual wells within 200ft of the existing SSTS? , ❑ l g C, SECTION C. EXISTING SUBSURFACE SEWAGE TREATMENT SYSTEM(SSTS) 1. Physical character of existing SSTS area. A. ❑Level f�e e Slope [)Steep slope B. ❑ Well drained ierately well drained ❑ drained nPoorly drained C. Area available for SSTS. (Primary & Reserve --"`� ❑Extremely limited ❑Somewhat im' e Mequate ft x ft D. L'SPECTION Date / Inspector nNo evidence of failure ClEvidence o' failure llvidenc6 of seasonal failure ---.---------------------------------------------------- �` (Indicate North) O HOGS_ 2- ` 4 -------------------------------------------------- (1) Indicate location of SSTS A. Size and type of septic tank gallons Metal Cloncrete oplastic B. Type of absorption area 1. Fields ft. 2. Pits 3. Gallies C (2) bdicate setbacks, front street, backyard, and side yard dimensions (3) Show location of well (4) Show location of driveway (5) Note physical features (steep slopes, rock outcrops, streams /wetlands) SECTION E. EMSTING WATER SUPPLY CIPWS CjShared well 01-Mvival well DDrilled MDug 0Casing*abovekround CONTENTS : PUTNAM COUNTY DEPARTMENT OF. HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Cornwall Hill Road Town/Village: Patterson Tax Grid # ��, -3 Map Block Lot(s) Well Owner: Name: Address: Paul Kessman, Cornwall Hill Road, Patterson, NY 12563 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 50 ft. Length below grade 49 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 _ Yield 12 gpm Depth Data Measure from land surface- static (specify ft) 30' During yield test(ft) 100' Depth of completed well in feet 155' Well Log If more detailed information descriptions or sieve analyses are available, please attach. n c Q. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface prillina in ove �urden clay and boulders Hit rock at 35' 35 50 Drilling,in rock set casing, grouted 50 155 priliirta in rocklaranite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type 5v , Capacity _LLyZ Depth 12-5' Model '7Q415--4 j Z, Voltage 2.30 HP ! Tank Type WX- -302, Volume �! Date Well Completed 4/1/88 Putnam County Certification No. 002 Date of Report 10/2/03 Well Drille si a 1pe a NUTS: Exact location of well witn aistances to at least Well Driller's Name Signature: Perry L. permanent lanamarxs to oe proviaeu orreparate snuct/ ian. Address: 4 Putrw Ave., Brewster, NY 10509 Date: 10/2/03 White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH . DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE'OF CONSTRUCTION COMPLIANCE FOR SEWTMENT SYSTEM PCHD CONSTRUCTION PERMIT # P -2- 3-- p Located at C r h weo i t 9 c 11 d ld .J Town or g o Owner /Applicant Name Pa, 1 loss k,,-� Tax Map / Block " 3 Lot 11 Formerly i(/(a t t kr.0 vu , Subdivision Name k c ss c,,,ca, I3 nos _ Subd. Lot # f Mailing Address R. 0 , 6„ X -t 0� 1 e#e c L, M %` Zip 1 2-513 Date Construction Permit Issued by PCHD '7123 /0 Separate Sewerage System built by Pct,i, % loss. L-,a n Address Consisting of 10U U Gallon Septic Tank and -f-to Other Requirements: Water Suouly: Public Supply From Address or: Private Supply Drilled by x 1_d IU d I Address Building Type I-A I i g I Has erosion control been completed ? -G Number of Bedrooms 3 Has garbage grinder been installed? /QC) 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 epartment of Health. Date: 103 Certified by P.E. r,-' R.A. 1 (D s' n Professional) Address 26 e.- License # !;4 l 2 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 subject to modification or change when, in the judgment of the Public Health Director, such revocatio , ObPcati o change is necessary. By: Title: (- Date: ��� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 N PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Cornwall Hill Road I Town/Village: Patterson Tax Grid # Map Block Lot(s) Well Owner: Name: Address: Paul Kessman, Cornwall Hill Road, Patterson, NY 12563 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 50 ft. Length below grade 49 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 _ Yield __U gpm Depth Data Measure from land surface- static (specify ft) 30' During yield test(ft) 100' Depth of completed well in feet 155' Well Log If more detailed information descriptions or sieve analyses are available, please attach: Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 35 prillincr in overturden [:lay and hMIders Hit rock at 35, 35 50 Drilling in rocki set casing, grouted 155 Drilling in roc!k granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type 5v Capacity _1 L'/Z_ Depth 17-5' Model '7EI4 1 5-.5}12 Voltage 2.30 HP ! Tank Type iuX -3o _ Volume ( Date Well Completed 4/1/88 Putnam County Certification No. 002 Date of Report 10/2/03 Well Drille si a IPe a NOTE: Exact location of well with distances to at least Well Driller's Name P. F Signature: Perry L. permanent landmarks to be provided onAeparate sheet/flan. Address: 4 Putnam Ave., fir, NY 10509 Date: 10/2/03 White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 -- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM k �_ssl 73 �cLy �u� Owner or Purchaser of 'Biiilding . Tax Map 'Block Lot Building Constructed by Town/,li4&ge cc, r', P1 w ca, l� Location - Street Subdivision Name Building Type 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 th6 building utilizing the system. N 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 thO building utilizing'the system. Dated: Month Day Year 94G 3 Signature: Title: eneral Cont a ' or (Owner) - Signature y Corporation Name (if corporation) Address: f�� , �,s� ew 5 i State Zip Corporation Nam'p (if corporation) Address: State Zip Form GS -97 1- Harry W. Nichols Jr., P.E. Patterson Paris, Suite 106 2050, Route 22 IM Brewster, NY 10509 xJ . Telephone (845) 2794003 Fax(845)2794567 To: PC D Attention: rr L Gentlemen: We enclose (' copies of B/W Prints Reproducibles Specifications Memorandum Description: Dt'rit (Ak ' Sent Via: C/ Our Messenger Blueprinter Your Messenger Hand Delivery Copy to Date: l6 — -7 —0 2, Job No.: 0) - _ 1 Project CC i C4----LC -e— Reports Tracings Copy of letter t/ Revision/Date No. 4 First Class Mail Special Delivery Very truly yours, Harry W: Nichol �Jr., P'. 1. WA DEC -19 -02 02:08 PM TOWN OF PATTERSON 9148TS2019 Ki 1 h I q�y r1.•z� 4�r q: IR, . . ;fit• .. BRUCE P. VOLBY * * L4DAB7TA- MOt.MAX'- LN., MS.N. /uabr MemA Da+iefar AUQd* hW19 lleetth &'Ww Dwkw 4r PaRlw S�►vfe�t DEPARTM3K OF HEALTH 1 CioneYa Road OrtWer, New York 10309 ` R�rlroYnlwW 11a1u (914)3N•i130 fnt{pIQ 716.1971 xutltuj eerrka p14)211 • ifii WIC (914)711.6618 IM 014 718.6085 9&MyTdkrriaffW(V14)M'•6014 Prucbcol(914)7114082 Fu(914)17t•6441 MEli$ Nom: - a TAX MAP NUMBIR: E911 ADDR1531. ;221 Cl ll ki' :,PIP TOWN: AUTHORIZED TOWN OFFICIAL: (Slgnsiture) DATE; The Putnam County Department of HeAlth A not issue a Certificate of Con3tructio4 Compliance unless the Above form is completed; i.e., a legal E911, address 13 assigned by an authorized town ofliclal. This form is to be submitted with the application for a Certificate of Construction Compliance. (i9I I YERFRM) P.01 i f i i 4 A 06 -22 -1999 09 :32PM FROM NORTHEAST LAB OF DANBURY TO 19148783011 P.01 ( 6 NORTHEAST LABORATORY OF DANSURY CT.Cert: PH -0404 LAW 39.3 MIL PLAW ROAD - DAN tw,. CT 068..1 1N Cert: t 1471 L (263) 748 -7903 - TAX (203) 74(1 -0652 LABORATORY REPORT -- WATER SUPPLY TESTING ),WORT TO MR. PAUL A.KESSMAN P.O. BOX 115 PATTERSON, N.Y. 12563 DATE SAMPLE COLLECTED: 5/3199 & 6/15/99 TIME COLLECTED: 4:30 P.M. & 1:30 P.M. COLLECTED BY: P. KESSMAN DATE DECEIVED A LAB: 5/3199 & 6/15/99 TESTED BY: LAB #11471 & 11301 REPORT DATE: 6122/99 SAMPLE SITE: laSSMAN FARMS, CORNWALL HILL RD., PATTERSON, N.Y. SAMPLING PQTNT: WELL SPIGOT: SOURCE: WELL TREATMENT: NONE TEST pERFOMAND RESULT: MAXY1NWM CONTAMINANT LEVEL RACTERIAL:6/!/ Total Coliform (Bacteria) 0 per 100 ml 0.per 100 ml PHYSICAL_ Color 0 Odor' ND pH 7.61 no designated limit Turbidity 2.9 NTUs 5 NTUs CHEWY TRY: Nitrite N 0.007 mg/L as N 1 mg/L as N 11301- Nitrate N 0.91 mg/L as N 10 mg/L. as N Alkalinity 250.0 mg/L no designated limits Hardness 255.0 mg/L no designated limits Iron 0.109 meL 0.30 mg/L Manganese 0.028 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese - 0.50 mg/L] Sodium 3.2 mg/L 20 mg/L** Lead 0.005 mg/L 0.015 * ** ml = milliliter mWL =milligrams per Liter ND = none detected NTU =Units "Notification Level ***Action Level RESULTS BASED ON SAMPLES SUBMITTED:5 /3/99 & 6/15199 SAMPLE, AS TESTED ABOVE: OPOTABLE or aOT POTABLE (PER NEW YORK STATE DEPT. OF REALT14 SERV)CFi S'rA\pARDS FOR POTABLE WATER) kaww"Ibla� , Laboratory Director WORTHEAST LABORATORY, 129 MILL STREET, BBRLM. CT 06437• (860)828•07$7 -FAX (860 )829 -1050 TOLL FREE WITHIN CT; 800 -826 -010,5 a OUTSIDE CT: 800.654 -1230 TOTAL P.01 PUTNAM Ckj UNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at e • i~3 i Li.. L!'JoAl Town or Village ?Ao 11Q,600 Subdivision name k T sSH A &�j Subd. Lot # Tax Map Block .: Lot fl s Date Subdivision Approved S /15. Renewal � Revision Owner /Applicant Name Date of Previous Approval `if 'i Mailing Address (; J. Zo %_ 41 115 T ¢ °sC,1,0 Zip Amount of Fee Enclosed zi~? Building Type ki Lot Area` r, °. No. of Bedrooms Design Flow GPD�, Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage -System to consist of i V'00 gallon septic tank and 44 l­F, ABS Other Requirements: To be constructed Water Supply- -r. , fl. Address Public Supply From, Address or: X Private Supply Drilled by S)t I t 4 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 s m 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 2 0 B n P.E. i( R.A. Date ZA0 0;3 VZ lt)IS 0 License # 56 �` s` 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 anew permit, Approved for discharge of domestic sanitary sewage'only. � ' //,VTkt7� Date: . 2 By: Ti tle: � 5� r t� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 9X Ub Z" r F-- -18 0 PROF, 3epr- IRV. OUT bo -3 Z I 31 TL _10 L.F. 0 Puthgohi C'b6ty Department of Health Division of Envi'' ' rohmental Health Services 0`p!r0 8 noted for conformance with 1, cab Rules nd Regulations of the u a —Co ea th Npartm t A SI.g V n tur & iiie ".J c::) PROJECT.7. PROPOSED 5ST5 CORWWA" H4-L. POAP NE-: w YO RK MARTIN KE1215 ►A14 P.O. sox I15 9(—,\N YO i2 -K. Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 A Brewster, NY 10509 (84.5) 279-4003 Fax 279-4567 CONSULTING SITE ENGINEERS DRAWING T1 T1 f PROPOGar.) 55TeD LOT NEW 17 -06 DATE [a 014 W/V 91': AIM 4. 0 2 1.10 - DA, zcX15,rIN6 61?AOE 620 PR SED GRADE +650-011 PROP037ED SPOT 6R,49E RAO &AA9 PROPOSED A700F#)r00T11V6 OVA /NS Pr. PERCOLATION TC5,r LOCATION T TEST PIT L OCATION j - E'X15T11V5 Wzr-LL PROPOSED WELL j x EX15 T11V6 SSDS PROPOSED 5505 k rvvy-yyyyy-n --x15r1N6 TREE LINE 1 j EXIST/1V6 STONE W,4Z1 V V W oq000seo s1LrFr1vcr 10.- AfOROSED STRAW BALE A91II(E REV. 01-03-03 IRV. OUT bo -3 Z I 31 TL _10 L.F. 0 Puthgohi C'b6ty Department of Health Division of Envi'' ' rohmental Health Services 0`p!r0 8 noted for conformance with 1, cab Rules nd Regulations of the u a —Co ea th Npartm t A SI.g V n tur & iiie ".J c::) PROJECT.7. PROPOSED 5ST5 CORWWA" H4-L. POAP NE-: w YO RK MARTIN KE1215 ►A14 P.O. sox I15 9(—,\N YO i2 -K. Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 A Brewster, NY 10509 (84.5) 279-4003 Fax 279-4567 CONSULTING SITE ENGINEERS DRAWING T1 T1 f PROPOGar.) 55TeD LOT NEW 17 -06 DATE [a 014 W/V 91': AIM 4. 0 2 1.10 - DA, 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 Harry Nichols, P.E. Patterson Park Suite 106 2050 Route 22 Brewster, NY 10509 Re: Proposed Compliance: Kessman 291 Cornwall Hill Road, Lot # 1 (T) Patterson, TM# 13 -3 -41 Dear Mr. Nichols: ROBERT J. BONDI County Executive September 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: 1. Original water analysis report is to be submitted. 2. Three copies of the SSTS guarantee is to be submitted. 3. Well log is to be submitted. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, 4'r�� m6kA-L LrT�J) Robert Morris, P.E. Senior Public Health Engineer KIT30i1 Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 A Brewster, NY 10509 Telephone (845) 279 -4003 Fax (845) 279 -4567 September 19, 2003 Robert Morris, P.E. Putnam.County Health Department 1 Geneva Road Brewster, NY 10509 Re: . Individual SSTS Compliance - Kessman 291 Cornwall Hill Road Patterson, NY T.M. #13. -3 -41, P23 -98 Dear Robert: Enclosed are the following: 1. Five (5) prints of Drawing SS -1, "As -Built SSTS," dated 09/19/03. 2. "Certificate of Construction Compliance for Sewage Treatment System," dated 09/19/03. 3. Three (3) copies of "Guarantee of Subsurface Sewage Treatment System," dated 09/19/03. 4. Laboratory Report, dated 06/22/99. 5. Application Fee in the amount of $200.00 payable to Putnam County Health Department. 6. E911 Address Verification Form, dated 12/18/02. If there are any questions concerning the enclosed, please call. Very truly�yours, H dry W. Nic rlsJr.iP.E. HWN:gav 02- 110.00 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # i-aa -a3 Located at co a a� L3 A LL iA t LL 2 okh Town or Village ?A-oTf Q-SQ P Subdivision name kT -sStiA L) b2a5 . Subd. Lot # Date Subdivision Approved 5 / 1 51;'5 Owner /Applicant Name Tax Map i 3 • Block 3 Lot Renewal Revision " J5; Date of Previous Approval Mailing Address P.O. a ®'x # HS 5 PA' : fS Q,5 © 6-s 01 Zip Amount of Fee Enclosed * -aoo `"'' Building Type Q g s i 'b;i &I e- f- Lot Area A-1. -4 5 No. of Bedrooms 3 Design Flow GPD '600 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 'Taf -toc w Other Requirements: ..+ gallon septic tank and 440 L.F. ABS To be constructed by •T 8. P. Address Water Supply: Public Supply From Address or: X Private Supply Drilled by 9X 1 04 • 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 treatments stem 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:I,IC,t±.,�v3,a -1 .�( P.E. X R.A. Date 5A�5 ©3 fo3 Address 2 ©S D 0 cf Z2 M i U 5 C 9 License # 561 2-11 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,�r cause or may be amended or modified whe sidered necessary by the Public Health Director. Any revision or alt tibn of the approved plan requires a new pe rt A roved f ischarge of domestic sanitary By: Title: Date: U White copy - HD File; Yellow copy - Building Inspector; Pink copy - Own er ;,.Orange, copy - Design Professio al l Form CP -97 0 Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Telephone (845) 279 -4003 Fax (845) 279 -4567 September 19, 2003 Robert Morris, P.E. Putnam County Health Department 1 Geneva Road Brewster, NY 10509 Re: Individual SSTS Compliance - Kessman 291 Cornwall Hill Road Patterson, NY T.M. #13. -3 -41, P23 -98 Dear Robert: Enclosed are the following: 1. Five (5) prints of Drawing SS -1, "As -Built SSTS," dated 09/19/03. 2. "Certificate of Construction Compliance for Sewage Treatment System," dated 09/19/03. 3. Three (3) copies of "Guarantee of Subsurface Sewage Treatment System," dated 09/19/03. 4. Laboratory Report, dated 06/22/99. 5. Application Fee in the amount of $200.00 payable to Putnam County Health Department. 6. E911 Address Verification Form, dated 12/18/02. If there are any questions concerning the enclosed, please call. Very truly yours, iryW. H Nic Is Jr., P.E. HWN:gav 02- 110.00 PUTNAM COUNTY DEPARTMENT OF HEALTH., DIVISION OF ENVIRONMENTAL HEALTH -SERV.ICES_;:":1;,,.,: LETTER OF AUTHORIZATION RE: Property of M Alit O l�T_SS"AO Located at COG-010ALL MLL V-OAb- T/V P. so o Tax Map # i3. Block 3 Lot Subdivision Of._ kfsS"Aa.S bQVS, Subdivision . ubdivision Lot# I Filed Map # 2016 Date Filed. 0. 0-6 f 03 Gentlemen: This letter is to authorize 14 A Q Q_,/ 0, 0 % C"0 LS T(... P F a duly licensed Professional Engineer d1 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 Dire'cto'r'* of.thq.Pti AM 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. Countersigned: P.E., R.A., # _ Mailing Address N111-1 C, f- 4t LU State 'Zip WSOLI Very truly urs, Signed: (Owner of Property) Telephone:- &4S-.-21c1--4003 Tel6plfbn�.-, C1 14 - Form LA-97 PUTNAWCOUNTYDEPARTMENT OF HEALTH DIN ISION,�-OF-.::ENV—IRONMENTAL- HEALTH ..SERVICES DESIGN DATA SHEET .-.SUBSURFACE SEWAGE TREATMENT SYSTEM Owner . H ACT i V!�SS 11 A Address F. o. Box. iis­ ?A: i T-t a w'o )0y 12s 6,3 Located at (Street] Tax Map.. Block. 3 Lot' 4j1-­- (indicate nearest cross street) Municipality PAvS-itsoO Watershed.. ­SOIL PERCOLATION TEST DATA.• . ;TA-Z. oz_�03 03/0 • Date of Pre-soaking _%tc% 6.s JD Date of Percol ' at ion Test Izz 06107- Form DD-97 :D t: "th. :_. n d ro .. e c '- ............. . Time llm.e. -4! he$) "'K Ho' e V ut, X . M-10 t :X :i . .. . ....... . ..... 04nc 01 1 Q.. 2 q 2 -7 3 2 -1 P 3 -10, 10 _"i I 4 5 10,' 13 td 2LI - 2-) 2 3 4 .5 V'4 10 4 2 4 - .'27 2. 1,011S— 10,'33- 19 2q 2-7. 3 4.. - ------ 5 N TES: 1. Tests 'to be,.rep*eated at same depth until approximately equal peF cqatl6h'rates1ke obtained at each percol;'ttitQn.test hole. (i.e. s I min for 1-30 min/inch, s li"31-60' mift'/irfcfi) 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. 1 8.0' 8.5' 9.0' 9.5' 10.0' - -2 LOA ti . Indicate level at which groundwater is encountered Ivas Indicate level at ., which mottling is observed Indicate level to which water- level rises after being.encountered �' Date (a- a� Deep hole observations\made by: LXJ4 n r r Design Professional Name: �) p¢ NEW. y Address: 2:)� Q�� NicHO�9,f 5� Signature: Design Pr'ofessional's Seal d' NV .5612d'�`` 0 h �'�`� F ES u'+!t 00 V a y .p (u A O k a L -D ON THIS '-TED BY ME IRDANCE LTIONS OF EW YORK Patnam. 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", 4,:, . . - _ '. .�,_ .- I , , ..'� ".., ­­­ , . -�­ - ____'7_�_4._`.��­�_`__ 1_1�._ "I-, 1, - - 1.7 �-_._,V., . .. � - — t: - --,"-"- �* --7,- - aT'1: - . .. : 7" " 7' .. . .., . . , K. ,-- 777 a . : �. .: , 1 -4-�' - - - - ` ..�� %.,,� ­F I - . . � ... I I . I . . i . I . I _`,:� L Ub \ I I � , / / / I I 1 I I I I I I I I i t I 1 1 i I 40" i i I / 1 I i 1 r 1 . 1 ... 1 I S O /[ 'RAT ,4PPL /L`A7 I ASSORPT. REGUIA TEST i FT– I PT– 2 C 5 PT –A PT– B 6 -c PT– C C f / l +550.00 I / RDBfO I 1 Pr 1 I �T.P I I I - 1 1 1 lwrrvw�- I I I _580.x. 1 1 REV. C 1 -0 l PROJECT: 11 PF 1 � 1 PATTER — m FATTE�SC Coro \ yon \ a ' I h 0 I z \ \ i I wp 11 a l II I 11 \ \\ \ 1 Ub 1 �•v�� N le 1 n` 1 I \I \\ \ \ 1 �, I aF 1 LC m l 1 \ \ 1 1 I� I \\ \\ \I I 1 d 1 4H .0 PROP 3bR �\ i N M m - NV.OUT CI ' Li Q . S O /[ 'RAT ,4PPL /L`A7 I ASSORPT. REGUIA TEST i FT– I PT– 2 C 5 PT –A PT– B 6 -c PT– C C f / l +550.00 I / RDBfO I 1 Pr 1 I �T.P I I I - 1 1 1 lwrrvw�- I I I _580.x. 1 1 REV. C 1 -0 l PROJECT: 11 PF 1 � 1 PATTER — m FATTE�SC PUTNAM COUNTY DEPARTMENT OF HEALTH d A DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address rz/v�v !7 Located at (Street) Tax Map 13. Block 3 Loth (indicate nearest cross street) Municipality, >E7z5Oi9 / Watershed G'.m951Pr��ar'. Date of Pre - soaking /;L SOIL PERCOLATION TEST DATA I J A -) - 1-1,1, 4 3 Date of Percolation Test / L 3 �o: �. -7 -la ; 7 3 5 4 5 3 4 G' G. L- 5 2 /a v 5- — io; 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. A /�bo ✓e Syg�...� HOLE NO. - 2 HOLE N0. c S 7'5 Indicate level at which groundwater is encountered Indicate level at which mottling is observed A/10V Indicate level to which water level rises after being encountered ---� Deep hole observations made by: e;, W i5 7 ,. t', , �`` Date J&Zcz Design Professional Name: Address: Signature: Design Professional's Seal J �o L 21 IN 51 (Out) i TP -2 i J— I 7P- i V N I /o ice UNCTION 150x (T`fP) irvv 46 ABS rr -ENGH 1t`tV• Out) ) �H- /0,. _� - - - - -- _ - - - _ 1 \ INV.� ,out N _ tNV. q 0. 3 a(4 3 lNV O y� (�N) S _ — jLp4c'(IDN o• � \\ INV.4 ?3.20 OW) / IOGU &ALA YAN.K OCT -18 -2002 03:07 PM HARRY W NICHOLS 914 279 4567 PUTNANI COUNTY ]DEPARTMENT OF HEALTH DMSION OF ENVERONMENTAL GEALTH SER'V>10ES lt, QUEST FOR EINAL INSPECTION For: Date: 10 _ 19 -0 Z PCHD Constructioa Permit # 10 Located: Co_tI 9611 &nj (T' �[ Owner /Applicant Name. TM Formerly; Subdivision Name: Subdivision Lot # Is system fill completed? Is system complete? Is system constructed as per plans? Is well drilled? Is well located as per plans? Are erosion control measures in place? .Date: Date: Date: P.01 484-( RWc. Fill Trenches i--' 1� Block Lot I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. Date: 16-1 0-07— Certified by: PE BRA Desi professional Address: Comments: FOR: ❑ ADAM ❑ GENE d (NAME) Form FIR-99' k ieNMC . of 1_r1JnM rni u.iTY n9:P0RTMFNT nF P. 1 OCT -29 -2002 05:59 PM HARRY W NICHOLS BRUCE R. FOGSY P ;.,M; Health- DWelor --' 914 279 4567 P.01 LORETTA MOWNARI R.N., M.S.N. Asooclale Mile Health Dlrecror Dkeetor o1,Parlenl Servlees DEPARTMENT OF HEALTH • - I deneva Road 3 p Brewster, New York 10509. A'.'TEN"T -1ON: o ADAM STIESELWG GENE REED .-xJl information below must b &4 completed prior to any scheduling. DATE: �� ",�- '� 2— E�'G1iNE)rR OR FIRM CLrr 11/l PHONE ff: REASON: ' ' _ DEEPS: PERCS: PiJllrlp TEST: o ROAD' STR-EIET., V H Wt TOWN; a � .�. ' TAX NW O: SVBDIV1S10N:' ��-�S Pry 4 LOT#: NE R YES NO 01 t- Proposed SSTS-within the drainage basin of West Branch or B.oyds Corner Reservoirs. 0 Q� Proposed SSTS wlthln 500 feet of a reservoir, reservoir stem or control lake. C I( Proposed SSTS within 200 feet of a watercourse or a DEC wetland, Proposed SSTS design flow greater than 1000 gallonsldayor SPDES Permit required. 0 .Proposed SSTS fora Commerical project. It is the responsibility of the design protteaslonal t o p rovide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the. response, tf 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 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 NYCnEF- 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 CQUISTY USE OttLY • (F!=LD MST1 . ntT- 00-onno T11G 40.47 TP1aA41:;— ?7R -79 ?1 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 t Y J 1 y �✓. x J r '" s\ k10 -.. =rte lL is i,•� " � �. / �` '• /!a x t N \ SWELL zo 'Y r v� a� i _.•, / a F t 1 1 �. ! N •• � i; i , u , Ah I ry, 5 .. Ub I�. I � ° ub 1 PQyP ; i f 1 \ ' :� I I��'- I _ vii. • I 1. 1 'ti �\ I 13 ., I III .� � 1 � � t; 5 �•�\ '�,� FF' O d tit\ , c f • ;. } � � z o z c l h' �� .Y '.�l'1 30 - �zoq. iozo_ - 'ter p00 1— 7 � uu P' 'q •E� .'Q•. .} Q. . //� .:.•e o ''fire ll: {. .' .y11— IDLE 4Q�G[ Ri AP. N4 O • - i�_/)LF '.�I ���� y� I' S` ' ; :�'�� l` �� ti� { �'ti ,, AFMWX. i tiXI5iIN6 GKAOE LF. '4.0 P.V.G. e 9.0 /e (TYP) ; t :; PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION X0 /2 0 Al w- Date: Inspected by:�, c�UA Street Location Zni;yALt N /GI% Owner Town _ P4 z: A/ Permit # P — 2.3 — y 0 TM # j3 — 3 _ zt./ Subdivision Lot # 1. SewaLye Svstem Area a. STS area located as per approved plans ...:..................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil. not stripped......... ......... ............................... d. Stone, brush, etc., greater than 15' from STS area........ e. 100' from water course wetlands .... ............................... II. Sewage System a. Septic tank siz - 1,000 ..... other ............. b. Septic tank inst evel' . ............. ............................... c. 10' minimum from foundation ....... ............................... d. Distribtuion Box outlets at same elevation -water tested .............. 2. Protected below frost ............... ............................... 3. Minimum 2.ft.Original soil between box & trench, Junction Box - roperly set .................... ............................... ength required �_ Length installed �f 2. Distance to watercourse measured t I a,:v 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 - 1' /Z" diameter clean ................. 9. Depth of gravel in trench 12" minimum ................. 10. Pipe ends capped ..................... ............................... g. Pump or Dosed Systems 1 Size ot pump chamber .......:..... ............................... 2. Overflow tank .......................... ............................... 3. Alarm, visual / audio ................. ............................... 4. Pump easily accessible, manhole to grade ............. 5. First box baffled ...................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle....... III. House/Building a. House located per approved plans ............................... b. Number of bedrooms ................:.. ............................. ... IV. Well a. Well located as per approved plans ............................. b. Distance from STS area measured ft........ c. Casing 18" above grade ............... ............................... d. Surface drainage around well acceptable .................... V. Overall Workmanship a. Boxes properly grouted ................ ......:......:................: b. All pipes partially backfilled ........ ............................... c. All pipes flush with inside of box ............................... d. Backfill material contains stones <4" diameter.......... e. Curtain drain & standpipes installed according to pla f. Curtain drain outfall protected & dir.to exist waterco g. Footing drains discharge away from STS area........... h. Surface water protection adequate .............................. i. Erosion control provided ............. ............................... Rev. 1/97 Form - Harry W. Nichols Jr., P.E. TIMOTHY J. CURTISS WILLIAM A. SHILLING, JR CRAIG T. BUMGARNER �( October WWI � E721, ii �- � 'N'T MR07,029- 20 CHURCH STREET CARMEL, NE YORK 10512P 1 � 13, 1998 7 to V, Bruce Foley, Director of Public Health Putnam County Health Department Geneva Drive Brewster, New York 10509 Dear Mfr-: --y_: We rjp esent Kessman Farms ho as you know have been trying to construct',a; modular ho their property for the past several months. Due to circumstances beyond their control, at the approximate time they were to do their Perc Test for their subsurface.septic disposal system, the county placed a moratorium on all tests because of the dry weather conditions. Unfortunately, their house had already been ordered and is now on site and exposed to the elements because they have been unable to proceed any further due to their inability to obtain a septic. approval. They are also experiencing a financial hardship because they have had to pay for the house but they cannot close on their mortgage financing until construction is complete and-a Certificate of Occupancy is issued.. In addition, the lending bank, who lent the construction financing, is becoming concerned that the house is exposed to the elements and that, in fact, further delays could cause not only a severe financial hardship but extensive damages to the structure. We are writing to request a hardship exception to perform the Perc test to enable us to proceed with the septic approval and construct the subsurface septic system and proceed with construction. Your assistance would be greatly appreciated. If AREA CODE 914 TEL: 225 -5500 FAX: 225-5946 VINCENT L. LEIBELL, III ,Q' V / OF COUNSEL We rjp esent Kessman Farms ho as you know have been trying to construct',a; modular ho their property for the past several months. Due to circumstances beyond their control, at the approximate time they were to do their Perc Test for their subsurface.septic disposal system, the county placed a moratorium on all tests because of the dry weather conditions. Unfortunately, their house had already been ordered and is now on site and exposed to the elements because they have been unable to proceed any further due to their inability to obtain a septic. approval. They are also experiencing a financial hardship because they have had to pay for the house but they cannot close on their mortgage financing until construction is complete and-a Certificate of Occupancy is issued.. In addition, the lending bank, who lent the construction financing, is becoming concerned that the house is exposed to the elements and that, in fact, further delays could cause not only a severe financial hardship but extensive damages to the structure. We are writing to request a hardship exception to perform the Perc test to enable us to proceed with the septic approval and construct the subsurface septic system and proceed with construction. Your assistance would be greatly appreciated. If t. Page - 2 - you would be kind enough to contact me concerning your decision, I would appreciate it. Ver truly yours, S TI 0TH J. CURTISS TJC /aws cc: Marty Kessman i i o.r r Ic a c Wetlands / ands � See note 2 / NOTE: No disturbance of lo this but zone ad beyond o permit from the N. Y. S. LOT l A i thout � I _ will occur w C, N buffer zone AREA = 47.4453 acres U Dept of Environmental Conservation. ca M ' W c � 3 o J O N -- m .3. Q ti � 3. o � � M ' o 2 0 Q) . 3 o . g A y S64 38 93' s� a 3� IN/F /E - I TOWN OF PATTERSON ( Town Garage ) 23ay9 u' M r N 22 00 5k0' LOT 2. FILED MAP No. 2016 m 0 o 343.75' F �s, -P - CORN W AL s .514,- 16 -50E 8Z93' S33-- 45 -40E 1731' S 41-53-30E 36.80 N 12 - 46 L 3 AREA = O D � large barn /�F 515.00 -H / L HARRY M/. NICHOLS JR., P.E. October 23, 1998 Mr. Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Martin Kessman Kessman Subdivision -Lot #1 Cornwall Hill Rd. Town of Patterson Dear Mr. Morris: Enclosed are the following: I. Five (5) prints of SS -1 "Proposed SSDS," dated 10/23/98 2. "Application for Approval of Plans for Wastewater Disposal System." 3. "Construction Permit for Sewage Disposal System," dated 10/22/98 4. "Design Data Sheet" 5. "Letter of Authorization." dated 10/23/98. 6. Two (2) copies of Residence Floor Plan(s), For Bedroom Count Only." 7. Money order in the amount of $300.00, review fee. Very truly yours, LA T ENGINEERING ASSOCIATES, P.C. NNN�:JM:hs . Nich s, Jr., P.E. 98021 09 :C I4d L 100 86 3M1', , j.-i'v' 111 AN3 AiNnoo wvNind. a3AII��4, c. LAURENT ENGINEERING jy; ASSOCIATES, P:C. MILLBROOKE OFFICE CENTRE I Ill \ -NN. Route 22 6 Milltown Road Brewster, New York 10509 278.2558 1. \� (914)278.6108 • (FAX) V CONSULTING SITE ENGINEERS I. Five (5) prints of SS -1 "Proposed SSDS," dated 10/23/98 2. "Application for Approval of Plans for Wastewater Disposal System." 3. "Construction Permit for Sewage Disposal System," dated 10/22/98 4. "Design Data Sheet" 5. "Letter of Authorization." dated 10/23/98. 6. Two (2) copies of Residence Floor Plan(s), For Bedroom Count Only." 7. Money order in the amount of $300.00, review fee. Very truly yours, LA T ENGINEERING ASSOCIATES, P.C. NNN�:JM:hs . Nich s, Jr., P.E. 98021 09 :C I4d L 100 86 3M1', , j.-i'v' 111 AN3 AiNnoo wvNind. a3AII��4, c. 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only 'art 1 - PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR: M�N U ,� f—�'��S(�f�N 2. PROJECT NAME: - 3. PROJECT LOCATION: Municipality P�Tfi�� County f 4. PRECISE LOCATION: (Street address and road intersections, prominent landmarks, etc., or provide map) e��-►w'�vt� t1i� R.oP� 5. PROPOSED ACTION IS: ?$New DExpansion OModificationlaiteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially a acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Dyes ONo If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? gResidential Olndustrial._ _ OCorn ercial Agricultural OPark /Forest /Open space OOther Describe:��� -���� J� 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM,ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ❑Yes kNo if yes, list agency(s) name and permit /approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? OYes R�No If yes, list agency(s) name and permit /approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑Yes tNo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE. I- 1'A -0_�iY tier l�il�.a6ni v �e �c e.. 1�1 n, ir.9n Sic na ture n,or nam° " , 1 ', r - . I , �V —• 1 ✓ 1; 'a' By L'1 IV I v If the action is in a Coastal Area, and you are a state agency, complete a Coastal Assessment Form before proceeding with this assessmer:z 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: ��Rtira��M�N C:0?_44 WRw Au- 'fox ' 05 2. Name of project:t'��N 4. Design Professional: 1 +40 inl 6. Drainage Basin: E�W" 3. Location TN: � p-4 a rA 5. Address: ft), Tow 7. Type of PrQ ect: :x 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 X Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? .................... 10. Has DEIS been completed and found acceptable by Lead. Agency? ............... l� A 11. Name of Lead Agency NP 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? Na 14. Has preliminary approval been granted by such authorities? K Date granted: N 15. Type of Sewage Treatment System Discharge ................. surface water x. groundwater 16. If surface water discharge, what is the stream class designation? .................... 17. Waters index number (surface) ........................................... ............................... N R 18. Is project located near a public water supply system? ....... ............................... IIQ 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ...:............ NQ 21. Name of sewage system a Distance to sewage system 22. Date test holes observed 10, S!)-- `1 23. Name of Health Inspector C ieHi5- RZEP 24. Project design flow (gallons per day) ................................. ............................... 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? ......................... HA Form PC -97 2 27. 'Is any portion of this project located within a designated Town or State wetland? No 28. Wetlands ID Number .............. ....................................... ............................... NR 29. Is Wetlands Permit required? . ........................ ............. ............................... �! 0 Has application been made to Town or Local DEC office? ............................... NA 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, No (tiv-%An 0 0 landfilling, sludge application or industrial activity? ............................ Yes/No rav } 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? Yes/No No p DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... rE6 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ....................... ............................... No 35. Are any sewage treatment areas in excess of 15% slope? .. ..............................� 36. Tax Map ID Number ............. Map Block 47 Lot 41 37. Approved plans are to be returned to ..... Applicant )C Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a. project, such as stormwater,plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the P�nakLap- . , SIGNATURES & OFFICL4L TITLES. Mailing Address ... U tIiVLTUw M Hy oqm V - PUTNAM COUNTY DEPARTMENT OF HEALTH SIGN OF ENVIRONMENTAL HEALTH SERVICES ONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM Located1 t �,-o P-N O A I-L H 1 Ll- PX AP Subdivision name kZ5y M /W Subd. Lot # i Date Subdivision Approved J/4 48 Town or Village PAT`iri-60H Tax Map D Block Lot 41 Renewal Revision Owner /Applicant Name HAP:P N i�-E615 MA N Date of Previous Approval � Mailing Address P' �� '"i ®� � rtGP-��© SIT Zip I9-so Amount of Fee Enclosed' Building Type R-C'`i 106NLE Lot AreaAI, 4j No. of Bedrooms 3 Design Flow GPD Cr0O Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1000 gallon septic tank and 4- 40 L-F A 6 5 Other Requirements: To be constructed by + ` b ' P , Address Water Su Public Supply From Address or: t.rPrivate Supply Drilled by X i /a I N► (.1 Address C - to I r wholly and completely responsible for the design and location of the proposed system(s) and that the e ' ewa a lheatment aystem described above will be constructed as shown on the approved amendment thereto and in accffi rri ! wifNthe standards, rules and regulations of the Putnam County Department of Health, and that on completion thereoCeidfficate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, affa 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: I A A P.E. X R.A. Date W "I q B Address 2D H1 Tpw,,t goAp - i NK ioy -47 License # 5611-4 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 w considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. pprove discharge of domestic sanitary sewage only. By: Title: Al, Date: A ) White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 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 Harry Nichols Laurent Associates Millbrook Office Centre Route 22 & Milltown Road Brewster NY 10509 Re: Existing SSTS: Kessman Cornwall Hill Road (T) Patterson Dear Mr. Nichols: August 4, 1999 COPY On July 1, 1999, a representative of this Department conducted an SSTS as -built inspection of the above - mentioned lot. Comments are offered as follows: 1) The system absorption trenches were measured at a depth of 4 to 5 feet below grade. The maximum allowable depth for absorption trenches is 1 foot below grade. 2) The system laterals appeared to have a reverse pitch. 3) Building paper was used to cover trenches. The plans call for filter fabric. 4) The septic tank was also installed deep riser is required for future access. It is this Departments position to notify you that the requirements of the approved plan must be met. Please notify this Department when these comments have been addressed. II _kTj Robert Morris, P.E. Senior Public Health Engineer M1 . "tom BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 November 3, 1995 Jeff Moore Laurent Associates Millbrook Office Centre . Route 22 & Milltown Road Brewster -NY 10509 Re: Proposed SSTS: Kessman Cornwall Hill Road (T) Patterson Dear Mr. Moore: 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 on this lot, percolation tests must be witnessed by a representative of this Department. 1) Entire property is to be shown at any convenient scale. Metes and bounds are to be provide. 2) All wetlands, ponds, lakes and watercourse on or within 200 feet of the property are to be shown. Furthermore, wetlands are to be designated as town or state: Upon receipt of a submission, revised to reflect that above comments, this application will be considered further. Very truly yours, Robert Morris, P.E. RM:tn Public Health Engineer DEPARTMENT OF Division of Environmental Health Services 4 Geneva Road . Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 Harry Nichols Laurent Associates Millbrook Office Centre Route 22 & Milltown Road Brewster NY 10509 RE: Kessman Cornwall Hill Road (T) Patterson Reservoir Basin East Branch Dear Mr. Nichols: Drum BRUCE R. FOLEY Public Health Director November 3, 1998 The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on October 27, 1998 is complete. The Department will notify you by November 21, 1998 of its determination. The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ❑ Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Dept. of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Dept. of Environmental Protection regarding such activities to see if Dept. of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (914) 278 -6130 ext. 166. V ly your Robert Morris, PE RM•tn PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner 4L � A/ 5 A Address. ���W412 �ZL f0190 Located at (Street) Tax Map *_ Block (indicate nearest cross street) Municipality Drainage Basin v r c Lot SOIL PERCOLATION TEST DATA Date of Pre - soaking % �l' ? Date of Percolation Test o — �°� ~, Hole No. Run No.� Time Start - Stop Ela se Time �iVlin.) NDe th to Water rom Ground Surface (Inches) Start Stop Water Level Drop In . Inches Percolation Rate Min/Inch 2 4 5 2 2 /o;as -loss 30 a3i% 1, l311 07 3 /0, 9 - ll; a& 30 4 �. 5 �= 1 2 ,:= 0 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' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' 2 TEST PIT DATA Y DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. HOLE NO. Mn o. Opo wt✓ AM YRIY %� ' Sai / II Indicate level at which groundwater is encountered A/0A/E Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: nm 55 9j W)Y17rr Date Design Professional Name: 49tipaq- F14iAIFFRIA6 yq ss o�1� TD'S � , � • - Address: -� �F OF NEW yo EwsTFi2 �1iEr� ,�2 NB*� � C ti °d co, Signature: Design Professional's Seal ,`.� r:as.�• %I?M s�s9 iS� II Indicate level at which groundwater is encountered A/0A/E Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: nm 55 9j W)Y17rr Date Design Professional Name: 49tipaq- F14iAIFFRIA6 yq ss o�1� TD'S � , � • - Address: -� �F OF NEW yo EwsTFi2 �1iEr� ,�2 NB*� � C ti °d co, Signature: Design Professional's Seal ,`.� r:as.�• 7es--N TEST PIT PROFILES xp2 y Depth to water py, i W1G• Depth to water Depth to mottling Hole # Lot Hole #' �_ Lot # Hole # Lot # Depth to water .I Depth to water, Vj 14 e Depth to water Depth to mottling /1/ f� „ Depth to mottling Depth to mottling Depth to rock/imp. - e Depth to. rock/imp. o - Depth to rock/imp. . G.L. G.L. G.L. 0.5 �' 0.5 / 0.5 1.0 1.0 1.0 2.0 2.0 7 2.0 3.0 3.0 3.0 4.0 4.0 4.0 5.0 = 5.0 Pe 5 c?C- 5.0 6.0 Gr�y�g h 6.0 6.0 7.0 7.0 , 7.0 8.0 �.+� '09 % ' � 8.0. V o'-0C1,,jj /0 7 '� 0 ' 8.0 9.0 9.0 9.0 10.0 10.0 10.0 Hole # Lot # Hole # Lot # Hole # Lot # Depth to water Depth to water Depth to water Depth to mottling Depth to mottling Depth to mottling Depth to rock/imp. Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L. 0.5 0.5 0.5 1.0 1.0 1.0 2.0 2.0 2. 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 Y'y 7 � fo PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM (x Owner Kes5 e ; o Address �� �� won't R0, Located at (Street) K. +j Tax Map Block Lot `( (indicate nearest cross street) Municipality P-A feos &o Watershed C-7,4s -7- ! o�� �/� 8 SOIL PERCOLATION TEST DATA 012 a/ Date of Pre - soaking Date of Percolation Test (VOTES: 1. Tests to be reneated at same denth until annroximately eaual nercolation 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 _ pv�' -- 6 3 (, % 2 Oaf i . r 4 5 2 17 3 4 5 1 2 3 4 5 (VOTES: 1. Tests to be reneated at same denth until annroximately eaual nercolation 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 LETTER OF AUTHORIZATION RE: Property of MAP-riH Located at G� WAL-L- V-z 4-",5HA<N T/V PPS) rF-i--'GoN Tax Map # Subdivision of '1-"Ihm, il� a Block Subdivision Lot # Filed Map Date Filed Gentlemen: This letter is to authorize HP'P-�Lq W " �k.& R0i,5 , )1' P�i' Lot a duly licensed Professional Engineer �C _ or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards; rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all, necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putria' Cou _nty Sanitary Code pV N EIV. YD CO sti � f i Countersigned: r�?�> / P.E., R.A., Mailing Address Val tA State i Zip Telephone: `Ai'A ' 'I'A - (01Q Very truly ours,. Signed ;LA / (0Wner f Property) % 4 4 1- v Mailing Address:— 4�l 7 f Stag %� ip 12 �L(-3 Telephone: 0 Form LA -97 a q e,, , $ .;EBB ' 5 . t' g*. 9 {' S' r' ` "{ 3 y ' k zk _ C;. a ;.a `; u,v a.`'. ,_i ire J,�: r s } ' f' ; z. { °' va s �: '" z, r € `� . j r h 5 ^'.may } a, �- -,w.. ,� x r r s 11 a a _.� _� y �� 5 � , # - - Shat�of �' f PUTNAIVI COUNTY DEPARTMENT 0—F HEALTH a - 3 ryj� , g DIVISION OI±' ElV{VRONMEN�`AI� HEATER SERVICES W rt YO m z FIELD ACTIyII REPORTS g T 'J' x e:v A `3-A" sx s`. er. i -n' v a z.:' ..,i4 .�,.. M+: _,f .,. J" .,9 "='5F rah' ys $. - C: , F 94 4 tF S u fiV x g Y .'•A'-1' �.. '' ,; J.. ' x T; �! a?• � i, ., - 3 c 2 J x . 3 It I. ""'tz","A-1 & LY i--3 2' 1. � � �`ls' Lt'`�- -' . x r '` s XR^ '� ' s w `° s- C :'" �'P} nd� � if t f r 11. 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'rah -4 s F � ,� r J s ,t *, "' a n �Taeknowledgelrece'ipt )fthis r6port SIi N "AtIR - 1� �� I- _-_ , -) 4� 1 - I , � ,,, �',. � �._) �f �, -,;,-, ,, � . . 1, , I , 02/96 3 Tttle, �'t: r e 4 Rev.., E -. 1. RE: Kessman Property Cornwall OR Road. Town of Patterson, New York TM # 11-3 -41 Dear Mr. Reed: Enclosed are two (2) copies each of the site plan and tax map for the above - referenced property Kindly contact our office at your earliest opportunity for= scheduling of deep test pit and percolation test witnessing for this. project. This parcel does not appear to fall under joint review with NYCDEP. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. i ols, Jr., P.E. HWN:TR: d 98021 IS -Z t;j 6- jc G6 7 J.c�r ` LAURENT ENGINEERING ASSOCIATES, P.C. j MILLBROOKE OFFICE CENTRE W, \ Route 22 & Milltown Road / Brewster, New York 10509 (FAX) 278 -2658 HARRY W. NICHOLS JR., P.E. \\(914)278-6108,- CONSULTING SITE ENGINEERS July 8, 1998 Mr. Gene Reed Putnam County Health Department 4 Geneva Road Brewster NY 10509 - t RE: Kessman Property Cornwall OR Road. Town of Patterson, New York TM # 11-3 -41 Dear Mr. Reed: Enclosed are two (2) copies each of the site plan and tax map for the above - referenced property Kindly contact our office at your earliest opportunity for= scheduling of deep test pit and percolation test witnessing for this. project. This parcel does not appear to fall under joint review with NYCDEP. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. i ols, Jr., P.E. HWN:TR: d 98021 IS -Z t;j 6- jc G6 7 J.c�r RECORD OF PHONE CONVERSATION Time- 5 11 5 S Date: _ 7/-,2,7,,/ '22 g Person calling: U�L(4 zi&re Phone #: 0-7 0 — 610'0 Reason (�L�cv Y' tyl fi� ( ) Inspection: eep and /or erc Scheduled Field Date: I y Tentative /to be confirmed ( ) Town: ?ei , Road /Street: C ®rn Lil_j/ 1/ 2d Tax Map #: Comments: - ICe _95� - �v e'DoLe5 Kra 292 63 ri est T Akins 3 0. . ......... B100 (mmE AV) TO o st. Cranberr 'Wildlife ti `y4 ES 4 m AwA , JI 4 3 n1l k 12 563 % e 22 EW� v a/ own OR o 164 3 t aines Corners II prm a teinbeck Pond Corners 60 I g Lake Charles Q feral CB 0 22 \Fj ners TI; i DM ML ue Area MountEbo 4- 2 62 HS Corporate 6entei "I VA 'in ree PRIVATE W= bb C a °'.7 13.07 13.08 5 4 .366Al. '\ `Jr•: ` y ��� � 1519.)3 a 1 +� y 514 z \� 9.16 AC. CAL. 10 _.1 0 Ixos.9u 53 51.42 AC. CAL. I ` 1 ��r3j y3 5.9 AC. 1Jt .� 1 \" 1x51.92 )10.16 PII 52 cn9.)9 \ 21 y 55 11 y v t ,1 7 AC. 47 7.9 AC. CAL. t t S: 0 - .,r- ..._..,� d y y 7 AC. 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N 1937�61RN a 16L6I 137.99 101.19 2x0.J3 1Po N 9f6060 K OEVON , r. n PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH - INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYST MS hEVIEW SHEET FOR CONSTRUCTION PERMIT STREET LOCATION ! /w` ^`� O, . NAME OF OWNER REVIEWED BY RBI, GR, AS, MB, BH DATE TAX MAP # Y N DOCUMENTS Y PERMIT APPLICATION PC- I WELL PERMIT _ PWS LETTER LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) CORPORATE RESOLUTION , SHORT EAF PLANS - THREE SETS HOUSE PLANS -.TWO SETS VARIANCE REQUEST I—flFEE i � SUBDIVISION �RJBDILA SUBDIVISION - VISI ON APPROVAL CHECKED RC RATE ,L REQUIRED DEPTH iRTAIN DRAIN REQUIRED ANDPIPES .GENERAL CATED IN NYC WATERSHED $UBMITTED TO DEP LEGATED TO PCHD P APPROVAL, IF REQ'D EP TEST HOLES OBSERVED i.CS TO BE WITNESSED - APPROVAL SSDS ADJ. LOTS ;TLANDS (TOWN/DEC PERMIT REQ'D ?) TA ON DDS PLANS & PERMIT SAME E 1969 NEIGHBOR NOTIFICATION ITER BI/ZBA YR. FLOOD ELEVATION I REQ'D PERMIT(S) AGE SYSTEM PLAN - (NORTH ARROW) 3 HYDRAULIC PROFILE VITY FLOW EROSION CONTROL:HOUSE,WELL, SSDS PERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY & EXPANSION LOCATION MAP EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE IF_.PUMPED. PIT & D BOX SHOWN & DETAILED & SSDS'S W/IN 200' OF PROPOSED SYS. HOUSE SETBACK NECESSARY (TIGHT LOT) FIOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE NO B NDS; MAX BENDS 450 W /CLEANOUT FILL SYSTEMS CL Y BARRIER - FT. HORIZONTAL;SLOPE 3:1 TO GRADE ILL SPECS FILL NOTES S FILL CERTIFICATION NOTE DEPTH GAUGES FILL PROFILE & DIMENSIONS VOT TIMP FILL IN EXPANSION AREA 1 TRENCH �F TRENCH PROVIDED 60 FT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED ON PLAN - FROM SSTS i0' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL 30' TO FOUNDATION WALLS _15'WELL TO PL AV TO WELL, 200' IN DLOD, 150' PITS k00' TO STREAM WATERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (pits -20') 50' INTERMITTENT DRAINAGE COURSE 200'/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS 0 0 0 o . o o ONSTRUCTION NOTES 15 MIN to CDS = >5 /0,10 -4 /0,25 -3 /0,30 -2 /0,35 -1 /0,100 - <1 /o I ESIGN DATA: PERC & DEEP RESULTS 20'MIN to CD discharge /100'with 182 cons day discharge CONTOURS EXISTING•& PROPOSED SEPTIC TANRIVEWAY & SLOPES, CUT 10' FROM FOUNDATION; 50' TO WELL OTING /GUTTER/CURTAIN DRAINS WELIL TYPE BOUNDARIES DIMENSIONS TO PROPERTY LINE TLE BLOCK; OWNERS NAME,ADDRESS LOCATION OF SERVICE CONNECTION M #,PE/RA; NAME,ADDRESS,PHONE# TE OF DRAWING/REVISION TUM REFERENCE LOCATION OF WATERCOURSES, PONDS KES AND WETLANDS WITHIN 200 FEET PROPOSED FINISH FLOOR AND BASEMENT EL. COMMENTS: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS %�� X IEW SSH�EET FOR CONSTRUCTION PERMIT STREET LOCATION Yom""'-" 1 NAME OF OWNER REVIEWED BY I, GR, AS, MB, BH Y TS PERMIT APPLICATION PC -1 / WELL PERMIT _ PWS LETTER LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) CORPORATE RESOLUTION SHORT EAF PLANS - THREE SETS HOUSE PLANS - TWO SETS VARIANCE REQUEST , FEE SUBDIVISION LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED PERC RATE FILL REQUIRED DEPTH CURTAIN DRAIN REQUIRED STANDPIPES % GENERAL I Y ILOCATED IN NYC WATERSHED PLANS $UBMITTED TO DEP DELEGATED TO PCHD DEP APPROVAL, IF REQ'D DEEP TEST HOLES OBSERVED PPRCS TO BE WITNESSED I I IEX- APPROVAL SSDS ADJ. LOTS WETLANDS (TOWN/DEC PERMIT REQ'D ?) �fl DATA ON DDS PLANS & PERMIT SAME PRE 1969 NEIGHBOR NOTIFICATION LETTER BI /ZBA 100 YR. FLOOD ELEVATION OTHER REQ'D PERMITS) REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE GRAVITY FLOW CONSTRUCTION NOTES :SIGN DATA: PERC & DEEP RESULTS CONTOURS EXISTING & PROPOSED AY & SLOPES, CUT IING /GUTTER/CURTAIN DRAINS TYPE BOUNDARIES TITLE BLOCK; OWNERS NAME,ADDRESS TM #,PE/RA; NAME,ADDRESS,PHONE# DATE OF DRAWING/REVISION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES AND.WETLANDS WITHIN 200 FEET Y N ATE �� �. TAX MAP CONTROL:HOUSE,WELL, SSDS & DEEP HOLES LOCATED ESENTATIVE OF PRIMARY & EXPANSION TION MAP T. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE PUMPED, PIT & D BOX SHOWN & DETAILED )USE - NO.OF BEDROOMS ELLS & SSDS'S W/IN 200' OF PROPOSED SYS. .OPERTY METES & BOUNDS )USE SETBACK NECESSARY (TIGHT LOT) )USE SEWER - 1/4" FT. 4 "0; TYPE PIPE ) BENDS; MAX.BENDS 45° W /CLEANOUT FILL SYSTEMS CLAY BARRIER 10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE FILL SPECS FILL NOTES FILL CERTIFICATION NOTE DEPTH GAUGES FILL PROFILE & DIMENSIONS VOLUME FILL IN EXPANSION AREA TRENCH LF TRENCH PROVIDED 60 FT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED ON PLAN - FROM SSTS 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS _15'WELL TO PL 100' TO WELL, 200' IN DLOD, 150' PITS 100' TO STREAM WATERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (pits -20') 50' INTERMITTENT DRAINAGE COURSE 200'/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS 15'MIN to CDS= >5 %,10'- 4 %,25'- 3 %,30'- 2 %,35' -1 %,100' - <1% F-TTOMIN to CD discharge /100'with 182 cons day discharge SEPTIC TANK m 10' FROM FOUNDATION; 50'. TO WELL WELL ®DIMENSIONS TO PROPERTY LINE LOCATION OF SERVICE CONNECTION PROPOSED FINISH FLOOR AND BASEMENT EL. COMMENTS: FRO'ATE CAI 1,3:.07 13.08 12 4 4.0; A' z 54 10 9. 16 ;c. c 1 51,42 ;C. CAL 5 ' 3 5.9'AC 0. 52 Sit j C, CAL. IG 70.90 4C. 22 cl 0.02 . At. I AC. 2" A 14 4 AC. a.q 19 At »ea 53.66 AC. 10.OZ Ar 24 59 11.97 AC CAL 91 29.6 IL. 'AL. o'.o .4 25 L 0,. _ - ' - '� .� \` 5.46 AC 7 56 RU* 4.32 AC A 81.4; AC. 3.17 AC Bt 3.85 AC V1 AC. .03 .,6,5 A. oI 34.42 AC.. 40.16 AC. so AC. 34 67 AC. CAL. C. At CAL AC. 1.5 AC CAL. 2 A Zqa AL 4.0; A L_ —_ —_— - — - — - — - — - — P16, AC. 337 P/0 Z3.1 .11 23-1-16 now I LEGEND 3 . 4 1' 400' oil" lima ................ PRELIMINARY SCALE 94 La —'i ".1 .. — 12 14 TOWN OF PATTERSON o`­`tM'K lWill—Im lop roe e U. �m- melmlauK ".m i3W`ii. 22 2-4 24 PUTNAM COUNTY, NEW YORK cau • —.4, mo "",m SN �'�' �� MACARTNEY V F. M. 2016 LOT 2 �; tiad -1 qj �a S 99 0 3B '00 k ex . wet! cap 2q6, op . Portion of F. M. 2016 LOT / 58-21 t AC. n. /f. K` SSMAN ? CORT4WALL i4i1-L I�OAP VA' - M5I2--WN, N'( ) SURVEY Mores: Scbjecy ro rights ofwoy, easements, covenoas B restrictions of record i/ any exisr, and any stole of /acts on occurcte exominolion of Ill /e may disclose. on/y copies -from #w criq#W of #ms swveV mor*ed with on orpino/ of me /and 1 0 F E Pelt; i ;. i Chi "IT' r;1 gd JUL - 9 NI 2: 51 Certif,colions herein sronifv that this survey wos preoored in occordonce w fh the SW iif 7-n IAIAi