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HomeMy WebLinkAbout0413DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -3 -67 BOX 5 00222 I,titi � ti 00222 i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH,.SERV_ICE,S. .. ,., .�. .. >-r. ... � _.. CERTIFICATE OF CONSTRUCTION COMPLIANCE _ TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at�+i'� 1 Town or Village PA-rTE-7�,Od Owner /Applicant NameTC& P C+M5;5 Z) Tax Map Block 3 Lot 67 Formerly Iy) A- Subdivision Name Mailing Address 6f-3174V 3/t Date Construction Permit Issued by PCHD Subd. Lot # — U Zip ?_SZ3 Separate Sewerage SXstem built by Address )0477.41 Consisting of f Gallon Septic Tank and Other Requirements: Water Supply: Public Supply From. Address or: X Private Supply Drilled by Address �ak"y Building..TYPe�.�' =1- "' _ . eted .w. .... Has erosion control beep: cc�mpl �J, Number of Bedrooms 1 �- Has garbage grinder been installed? I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulati of the Putnam County Department of Health. Date: �� Certified by P.E. 11 R.A. Address 17,31 � W4(4_ _ ��Sass� n f ZfRLicense # ��Z��— Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available:. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revoca 'on, modification or change is necessary. P By: Title: _ Date:'" White copy - HD ile; 00w copy - Building Inspector; Pink copy - caner; Orange copy - Design Professional Form CC -97 rutnam County Department or uealtn rivisionnypEav[iirgm n al Health Servicb, .pproved as notVa for conformance with applicable Rules and Regulations of the tnam County Health Department:. .� i -e 2 . r / W, roo 0, n X/ POST y,WW _ °17� fis is tp certify that the that the system s�� system was constiv.ted as indicated•on this plan and syste!i!6s onntructedsincaccordannce with all standard rules and regulations of the Putnam County Department of Health and the irc,, York a ^ ^tatsprttr�nk of Health.° � "�,4, / G O K R u„ n p!i 494 494 f /.F. 474 U6 498 470 472 s I 1 of /ter WIU.W \ 4T 4 498 -AS —BUILT MEASUREMENTS No A $ REMARKS t 3l R3 ; 8 bl -71 9 5.1 70 fy 14 ,4u 1,W,VoNs uAv6 6y �ar0 Omzi 4, S, �,lZ8ID0 tw NSTA2��� z 474 47L 4To TA* 13- 2, G I xr/mGM9 JOM KA W. JR. • P -M �z� cusHn�rZ4 RQAD g1481P PATTERSON, NEWYORK 12563 '189y ,� �• /OWNEt1Z 9GtCti 1XL4t PUTNAM COUNTY DEPARTMENT OF HEALTH" ..: DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM __TA N S� Owner or Purchaser of Building v Building Constructed by CnfF 3 3 Location - Street Woe() ri-el Building Type I3 67 Tax Map Block Lot P(, J��, A) TownNillage tvd) —le -- 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 Day d Year a Signatl Title: de er 1 Cdfitractor (Owner y- Signature Corporation Name (if corporation) Address: Corporation Name (if corporation) Address: State Zip State Zip Form GS -97 ca i. f PUTNAM COUNTY DEPARTMENT OF HEALTH ° DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT 'deli )<.oirntsii;n -.; :: ;...r, Sheet Address: c ;;lf Towtli/Village: M s-- c1 Tax Grid'# Map / 3 Block -3 Lot(s) 6 3 Well Owner: Name: Address: Use of Well: 1- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary , Cable percussion _V_ Compressed air, percussion Other (specify) Well Type Screened Open end casing lid Open hole in bedrock Other; Casing Details Total length ft. Length below grade _ft. Diameter Tin. Weight per foot 171b /ft. Materials: _ Steel ^ Plastic'- _ Other Joints: _ Welded 7Threaded _ Other Seal: _ Cement grout Bentonite Other Drive shoe: Yes No Liner: Yes Y No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test , Bailed _Pumped Compressed Air Hours _jd� Yield L gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet 3 �� Well Log If more detailed information descriptions or sieve analyses ,, are available, please.attach. Depth From Surface Water Bearing, Well Diameier(in) Formation Description ft. ft. Land Surface d C . i If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information O Pump Type u �pacity Depth -3CX) Model Voltage K DO. IR Tank Type Volume �-`1�7 /Yl Date Well Completed ylal �T Putnam County Certification No. Date of Re ort Well Driller (signature) 1 Awl- NU"(l E: gxact location of well with atstances to at least two permanenr ianaparxs to ne proviaea on aa��separate pneeupian. Well Drillees Name , t.'i& A/ Address: /0/f k1461 S% &CIrs6h /t/T Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 MON, DEC -22 -97 8:46AM TOWN OF CARMEL 914 628 2087 P.01 U'D 0 L--fl-A 19" t' � � j {� � � . � � m -r C. xr .�. wx<ait ;' � �..uK,.._.�_.•f..ne .rkT.. ^.y:• Y t AYPLI (4P,7- KJ 7-5 7V Ul ( 614. .j I MON, DEC -22 -97 '8:48AM . TOWN OF CARMEL_ 914 628 2087 P.03 VV Cal jw of I � I './ 1 � � �Kj Vii•: ^+ y it nt--1 w �' � •' �' ��^^(( k 4; _ uY 1 tq q M :..M11 ri te r N i ►. atfr . � °.a " '` :.;:•.. • I'M v••`' i4 t fe ffs t I ,'S iaOA�,,.►. rr i ! ,� e � << •�� era.;.. r�:. 1fOT23." t' R."'. �: �S:: �rY. 4::NiY- z.++::W�:^�v_s..LV1�:.�_ _ �- �...a, v; �Wg'..P+fL'iFt+' a ✓�'�1e0'�.�3- .'t"• ,• �"..7a:�+.:+!'::.ww --:ri. �'� �. ri:: MON, DEC-'22-97 8:47AM TOWN OF CARMEL 914 628 2087 Py i'•�j. t ,� P. 02 t . i `�iy�i di, • ••, _, +Z`\ •fin c TIN w C4 4 to 0 fa ipk -fir! 'ii, _ ••�''•'' •' '' .�. MLEV %.� i • � • rr . MON, DEC -22 -97 '8:49AM TOWN OF CARMEL 914 628 2087 P.04 Contlnwd On Map Nab TOTAL P.04 v P F F P F S d B P 0 f k k k I F I 7 7 T, /1 4-41 / 3 - 3 - 6 7 - ------_ . TEST PIT PROFILES Hole # ,Q Lot # Hole # B Lot # Hole # C Lot # Depth to,water. 3.: ` , ? �� -Depth to water-:-,--- `Deptff'to water d' Depth to mottling Ale jr e Depth to mottling Alone Depth to mottling Depth to rock/imp. None Depth to rock/imp. /V© n e Depth to tock/imp. G.L. Tvo goy`/ G.L. -rO/75 ®i1 0.5 0.5 SQ yt �/ oa tv� w �.z�vt y oa wr w 1.0 rave 1,4 a&e 41:he-5 1.0 .4 r 'A ve Aa�.s 2.0 2.0 3.0 3.0 4.0 4.0 5.0 5.0 .5.0 . 6.0 7.0 G.L. 0.5 1.0 2.0 3.0 4.0 6.0 7.0 8.0 .i 7.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 Hole #_ Lot # Hole #_ Lot # Hole # Lot # Depth to water wy1 Depth to.water. Depth to water' Depth to mottling, Alon e Depth to rock/imp, A we G.L. -7; io5�il 0.5 L AvId y loam w/ 1.0 rave 2.0 3.0 Gnvs,e Sorry -twn,?e 4.0 zna-m 5.0 6.0 8.0 9.0 10.0 Depth to mottling Depth to mottling Almoa e- Depth to rock/imp. /Von e G.L. !TTo-o a5o; / 0.5 ryVlf brown tiRN y l -uw 1.0 �'d 116eM,v 2.0 3.0 1, 4.0 e cam ;• %6ane9- 5.0 0 6.0 7.0 8.0 9.0 Depth to rock/imp. m e G.L. 0.5 Olive brau3n /-00-M 1.0 :~- -54u1 C fi`N�5 2.0 3.0 4.0 5.0 & `° 5awdy ©!I've brown /oe h� 6.0 1 7.0 8.0 M 10.0 10.0 TEST PIT PROFILES Hole # Lot # Hole #. Lot # Hole # Lot # Depth awater 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 2.0 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 Hole # Lot # Hole # Lot # Dole # Lot # Depth to water - = - ~ Depth to water Depth - W'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 1. 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 P, 2' TY HV u--A*l TH 4 "79 - BRUCE R,..: FOLEY. LORE-rrA MOLINAR1 - R N., M.S.N. Public &ath Director Associate Public Hdalih Dbwelar Pfroctor of plaugm swrvices DEPARTNWNT OF HEALTH I Geneva Road Brewster, Now York 10509 Environmental Health (914)278-6130 Fax(914)278-1921 Nursing Service$ (914)270-6538 WIC (914)279-6679 Fax (914)278-6095 Early Intervention (914)2118.6014 Prochoal(914)27NO82 Fax(914)278-6648 OWNERS NAME: TAX MAP.NUMBER: E911 ADDRESS: TOWN- AUTHORIZED TOWN OFFICIAL: (Signattire) DATE- I'M . /J7 The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official, This form is to be submitted with the applica�tion for a Certificate of Construction Com'Pliance. (E91 I-VERFERM) _ � �.«. � xz o �.. .t. ._ t. � .S.. i-i ♦ .� .� .fix �`_�- _ ,y �... . � r_ t. .ss s. �i -� w. -� � - - �.v �Sw yr � _ ��q.x' .. 4= . ";z NORTHEAST LABORATORY of DANBURY '39- /IId:L='PLAIN�R0AD' DANBURY� =CT •;--068.1I , �. ti = =e1= Cer "t: PH -0404 (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: HYATT PUMP SERVICE :DATE SAMPLE COLLECTED: 4 /17/2000 .229 SOUTH ROAD JIME COLLECTED:11:30 A.M. HOLMES, N.Y. 12531, . COLLECTED BY: C. HYATT DATE RECEIVED @ LAB: 4/17/2000 TESTED BY: LAB# 11471 REPORT DATE: 4/20/2000 SAMPLE SITE: CAPPASSO, Rt. 311, PAT:TERSON, N.Y. SAMPLING.POINT: KITCHEN FAUCET SOURCE_ WELL. TREATMENT: NONE TEST PERFORMED BACTERIAL: . Total Coliform (Bacteria) PHYSICALS: Color Odor PH Turbidity CHEMISTRY: Nitrite N Nitrate N Alkalinity Hardness - Iron Manganese RESULT: 0 0 ND 7.17 1.2 <0.005 0.53 240.0 280.0 0.109 0.027 MAXIMUM CONTAMINANT LEVEL per 100 ml 0 per 100 ml _ 15v ... 3 Units no designated limit NTUs 5 NTUs mg/L as N ' 1 mg/L as N mg/L as N 10 mg/L as N mg/L no designated limits mg/L - no designated'limits mg/L 0.30 mg/L mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium 6.6 mg/L 20 mg/L ** Lead 0.005 mg/L 0.015 * ** ml = milliliter mg/L = milligrams per Liter ND =none detected NTU =Units **Notification Level * * *Action Level RESULTS BASED ON SAMPLES SUBMITTED:4 /17/2000 SAMPLE, AS TESTED ABOVE: X❑ OTABLE or DOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) 1 Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826- 0105.OUTSIDE CT: 800 - 654 -1230 :W {� - i ,NORTHEAST LABORATORY OF DANBURY . 39 MILL PLAIN .ROAD DA NBU 2Y,, 7'... Of : ..,. , _ ._n... . ..C1,Cert.,. -P.H -0404 ,(203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: HYATT PUMP SERVICE DATE SAMPLE COLLECTED: 4 /17/2000 229 SOUTH ROAD TIME COLLECTED: 11:30 A.M. HOLMES, N.Y. 12531 COLLECTED BY: C. HYATT DATE RECEIVED @ LAB: 4/17/2000 TESTED BY: LAB# 11471 REPORT DATE: 4 /20/2000 SAMPLE SITE: CAPPASSO, Rt. 311, PATTERSON, N.Y. SAMPLING POINT: KITCHEN FAUCET 'SOURCE: WELL TREATMENT: ` . NONE TEST PERFORMED RESULT: MAXIMUM CONTAMINANT LEVEL BACTERIAL: 'Total Colifoim (Bacteria) 0 per 100 ml 0 per 100 ml PHYSICALS: Color 0 15 Odor ND 3 Units pH 7.17 no designated limit Turbidity 1.2 NTUs 5 NTUs CHEMISTRY: Nitrite N <0.005 mg/L as N 1 mg/L as N Nitrate N 0.53 mg/L as N 10 mg/L as N Alkalinity 240.0 mg/L no designated limits Hardness 280.0 mg/L _ no designated limits Iron 0.109 mg/L 0.30 mg/L Manganese . 0.027 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg /L] ...Sodium 6.6 mg/L 20 mg /L ** Lead 0.005. mg/L 0.015 * ** m1= milliliter nig/L = milligrams per Liter ND = none detected NTU =Units * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED:4 /17/2000 SAMPLE, AS TESTED ABOVE: POTABLE or NOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) 0 Laboratory Director -NORTHEAST LABORATORY, 129 MILL STREET, f3ERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITIIIN CT: 800 -826 -0105 •OUTSIDI CT: 800 -654 -1230 �.�._� �- .- d....� =- :rya:. - - BRUCE -R. 'r0tV' Public Health Director c .. LORETI'A. MOL--INARL,RNr, Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278.6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 1 John Karell, P. E. 121 Cushman Road Patterson, NY 12563 Dear Mr. Karell: December 7, 2001 Re: Proposed SSTS: Compliance Capasso, Route 311 (T) Patterson TM #13 -3 -67 Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: 1. Three copies of the two (2) year guarantee signed by the installer, and/or general contractor, or owner. 2, Well completion report signed by the well driller. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Sincerely, C Shawn Rogan Public Health Technician SR/jp 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 (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 - Preschool (845) 228 - 5912 Fax (845) 228 - 6113 December 7, 2001 ohn Rarell, E. 121 Cushman Road Patterson, NY 12563 Re.: Proposed SSTS: Compliance Capasso, Route 311 (T) Patterson TM 413 =3 -67 Dear Mr. Karell: 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. Three copies of the two (2) year gaara' ��P. signed by the installer, anNor general contractor, .or- owner: , 2. _Well completion report signed by the will driller. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Sincerely, , C Shawn Rogan Public Health Technician '100L° - ---/- KVce . vh PUTNAM COUNTY DEPARTMENT OF HEALTH � f 3 fd � � l � I DIVISION OF ENVIRQNMENTAL HEALTH SERVICES ' FINAL SITE INSPECTION Date: 1:7-12.2Z 9 Inspect, y: xr-gr) Street Location Town Permit # TM # �' �; 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.Dpth c. Natural soil not stripped ........ .............................:. d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands....... ............................... II. Sewage S stem a. Septic c siz = ,4,000 ) ..... 1, 250 ......... other ................ b. Septic tank install, level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box outlets at same elevation -water tested ................. 2. Protected below frost .................. ..... ........................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Bo - properly set ...................................... f. 'Trenches Length required k ,TC2 Length installed 2 5.a 2. Distance to watercourse measured4- 0_c:� 3Ft.......... 3. Installed according to plan ........ ..............................0 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 16. 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 %s" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ..................... ..........................:.... -g -_Puma or Dosed Systems' 1. Size o pt ump 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.HouseBuildin a. House located per approved plans ... ............................... b. Number of bedrooms .................... ...•Z.......................... IV. Well i. Well located as per approved plans . ............................... b. Distance from STS area measured - - /0 0 ft........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship i. Boxes properly grouted .................................................. b. All pipes partially backfilled ........... ............................... All pipes flush with inside of box ............................. d. Backfill material contains stones <4" diameter .............. t. Curtain drain & standpipes installed according to plan.. Curtain drain outfall protected & dir.to exist watercourse ;. Footing drains discharge away from STS area ............... I. Surface water protection adequate ... ............................... i Erosion control provided ................. ............................... lev. 6/97 rums SM OWN I� ICi INUMM IM-M IMM I0m 'IBM ICS lid IE9 100 IBM Iv= of rums SM M DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278 - 6130 Fax (914) 278 - 7921 Date: To: ,[<AP1kGi From: Gene D. Reed Putnam County Department of Health BRUCE R. FOLEY .._._.Public- Health- Director No. Pages o2 (Including cover sheet) . __For. your; information Please respond.— For your'review Attached as requested As discussed Please call Notes/Messages I, In the event of transmission /reception difficulties, please contact this office at (914) 278-6130 ,ext. 157. P, 01 ¢_- TRANSACTION REPORT DEC -27 -99 TUE 10:18 AM 'FOR PUNAM., TY ENV. HEALTH .1.91.42787:92.1 -_ r DATE START RECEIVER TX TIME PAGES TYPE NOTE DEC -27 10:17 AM'6287085 1'22" 2 SEND OK PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION.OP ENVIRONMENTAL HEALTH SERVICES u C NST1tiJCThON PERMIT FOR SEW�t ENT SYSTEM. ' V PERMIT # -� Located at 9.OQ T7&_ -511 Town or Village=P/4-7TM50!`) ;;. Subdivision name Subd. Lot # Tax Map Block 3 Lot (0-1 Date Subdivision Approved Renewal Revision Owner /Applicant Name L04 5 C7 Date of Previous Approval Mailing Address Zip / Zfci Amount of Fee Enclosed $l-3. 00.0 6 Building Typ Lot AreaLi3ewof Bedrooms a-Z, Design Flow GPD 4/06 Fill Section Only Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1000 gallon septic tank and ZS 0 Ue 26- %)?-� C-4 Other Requirements: To be constructed by Address N y Water Supply: Public Supply From Address or: Private- Supply-Dplled-b_y___ j li ''(.r - 'Address 6P_&Vj7L XNy I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the sgparate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations. of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written ''guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. , Date S_hLO� License # N y %Z 56-3 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 wh onsidered cessary by the Public Health Director. 'Any revision or alteration of the approved plan requires a new pe 1 pproved discharge of domestic sanitary sewage only. By: Title: k==::� Date: :V/U/w White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design P ofessional Form CP -97 PUTNAM COUNT' DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type_.. PCHD _.. . _' (J J Well Location: Street Address: Town/Village Tax Grid # / %0 61 3 /% /PW7&5- ' --,5aA Map Block 3 Lot(s) (o% Well Owner: Name Address: CAPA r--,s o (W31<0v71E- 31/ A.%27&-,ZSeA) A1y /zs6 Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought _A= gpm # People Served Est. of Daily Usage ��gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason 6 LE L c for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Lot No. ---� Water Well Contractor: •--- -► Address: �---_ Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply:. Town/Village Distance to property from nearest water main: i( f lj f — Proposed well location & sources of contamination to be provid on separate sheet/plan. Date: �/ Z( Applicant Signature: nature: PP g 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 0611 driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water driller certified by Putnam County. Date of Issue Permit Issuing ?;<cial: lk�l Date of Expiratio v ZrrO Title: /'^ `- Permit is Non- Transfe able White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 f PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES �DESiON � A�'A SMET - SUBSURFACE SEWAGE 'T1 ATMENT SXSxEIvX' - Owner CA Address 7.6-0 5 3 r Located at (Street) -R4- 311 4 #R+ Tax Map 15, Block 3 Lot 7 u` (indicate nearest cross street) 1061 Municipality Drainage Basin -FA-6-r' 5CRAN4,y SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test Role No. )Stun No. Time Start - Stop Eli se Time Min.) Depth to Water From Ground Surface (Inches) Start Stop , Water Level Dro In Ync�es Percolation Rate bun/Inch 1 10; //,,/g 2 J5 3 S , 3 - 5 2 %2 Z:";/ 3 9 4 5 2 1 ;O 3c a 3r2- 26'- 2� /. 9 3 , 5 1.� 2 3 4 5 i•,farr�: 1. icsu 10 oe repeaiea at same aepm until approximateiy equal percoiation 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 D PUTNAM, COUNTY DEPARTMENT OF HEALTH,* : DIVISION. OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS. FOR ......:_ y ...... - "" A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant:7— 3 X60r�,- 3 2. Name of project: 4. Design Professional:�r,��i�°-� (� 6. Drainage Basin: 5. Address:,/?/ C14��"-,V Aays6�2 7. Type of Project: Privatea6.sidential .Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted PC-- 9. Is .a Draft Environmental Impact Statement (DEIS) required? ......................... A-) 0 10: Has DEIS been completed and found acceptable by Lead Agency? ............... �---� 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other o_ .officials, orinar�ces? :..:....:.:....:.::.:::::::..::.:.:::::.:::.:.: ::.::.�::�..:..:.:::.::::::.::: NO 13. If so, have plans been submitted to such authorities? ........ ............................... 14. Has preliminary approval been granted by such authorities? Date granted: •-- 15. Type of Sewage Treatment System Discharge ................. surface water �Cgroundwater 16. If surface water discharge, what is the stream class designation? .................... 17. Waters index number (surface) ............................................ ............................... 18. Is ro'ect located'n p � ear a public water supply system? ....... ............................... 19. If yes, name of water supply Distance to water supply ­7 20. '7 Is project site near a public sewage collection or treatment system? ................ 21. Name of sewage system Distance to sewage system- 22. Date test holes observed 23. Name of Health Inspector ILe 24. Project design flow (gallons per day) .............. "................................................ 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... IJ d 26. Has SPDES Application been submitted to local DEC office? �- 2 27� Is any portion of this project located within a designated Town or State wetland? 28. Wetlands ID Number .. ............................... 29. Is Wetlands Permit required? ......... .. ............................... . U Has application been made to Town or Local DEC office? 30. Does project require a DEC Stream Disturbance Permit? .. ............................... i 31. Is or was project site used for agricultural activity involving application of j Q pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, 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, landf ll, sludge disposal site or any other potentially known source of contamination? DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... 1° 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site ?......... ......... V 35. Are any sewage treatment areas in excess of 15% slope? . ............................... 36. Tax Map ID Number ....:..................... ............................... Map l3 Block_ Lot 37. Approved plans are to be returned 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 tosthe DEP; although- the.projeet may require DEP = approvat ofthe'SaTS- pri&— to�inal approval by the Department.. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwaterplans 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 p fb y, a ClassA misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES. r =Z w1 w Mailing Address: ................................... Z,m PUTNAM COUNTY DEPARTMENT OF HEALTH ADIVISION OF ENVIRONMENTAL HEALTH SERVICES D_ ESIGN DATA, SHEET - SUBSURFACE- SEWAGE TREATMENT SYSTEM Owner 55� 0 Address NY Located at (Street) Tax Map 13 Block 3 Lot 67 Indic to nearest cross street) Municipality G,' ,C j'� r� Drainage Basin ky4 SOIL PERCOLATION TEST DATA Date of Pre - soaking �� 2--4 Q k' Date of Percolation Test Hole No. Run No. Time Start - Stop Ela se Time Min.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Dro In Inc�es Percolation Rate Min/Inch z�I /z ..3 1I0 jr 2-7 ZivZ _z 'y2, 3 % 4. 5 3 �1 �- / ZtiD 2-6 7,V/y F, 4 ) 22 �- s -L 13/1 _,z q icy ` 3 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 1?4 2 4 b TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES 2 2.0' 2.s' 1.0' 15' 4.0' 4.5' 5.0' 5.5' 6.0' , 6.5' 7.0' 7.5' 8.0' 8.s' 9.0' 10.0' o v w- i�UV� Indicate level at which groundwater is encountered Indicate level at which mottling is observed Aah ,� Indicate level to which water level rises after being encountered Deep hole observations made by: 1C_(` -�—� %�C Date Design Professional Name: Address: Signature Design Professional's Seal vow L .'w' hT Q MUM.— � Na 0 G.L. 0.5' +i N 1.0' 1.s' 2.0' 2.s' 1.0' 15' 4.0' 4.5' 5.0' 5.5' 6.0' , 6.5' 7.0' 7.5' 8.0' 8.s' 9.0' 10.0' o v w- i�UV� Indicate level at which groundwater is encountered Indicate level at which mottling is observed Aah ,� Indicate level to which water level rises after being encountered Deep hole observations made by: 1C_(` -�—� %�C Date Design Professional Name: Address: Signature Design Professional's Seal vow TO- Dear: r -.:.: i. � DEPARTMENT OF HEALTH Division of Environmental Health Services 4. Geneva Road Brewster, New York 10509 Tel. (914) 278 - 6130 Fax (914) 278 - 7921 Date: BRUCE. R. FOLEY Y F Public Health Director Re: Proposed SSTS: c+-"ov (T /%— 3 — . �r A4, s,- Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: 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 Erivironriierital'Proteeiion c5ri�this lot, percolation tests must-be witnessed by a representative of this Department. /. kefv, "e 54f dzis cev '�O a, ��rn5 4 /D d 1'" " TO nt'�Ilit / •.,.� ct�Q �iv��J�e� Upon receipt o a submission, revised to reflect the above comments, this application will be considred further. c) >b o w d) /� hziJ V ply yors,� ✓�. a et G. A/V � SSTS d.4iS N ; 5 � � Ala � 4 ,,�,, � � f�— u2�fc s P", �,,�Robert Morris, P.E. Senior Public Heafth Engineer �%moo w + �ulP� 4k e,#WJ CF�c R1VI:tn / � sstsproposed PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PER.NIIT STREET LOCATION `NANIE OF OWNER P'q SAO ^ ; REVIEWED BY RINI, GR, AS, NIB, B $ K DATE l TAX NIAP # 11L � Y �' DOCUNIENTS Y ILL PERMIT APPLICATION PC -1- Pc 9qt YELL PERMIT_ PWS LETTER LETTER OF AUTHORIZATION D IGN DATA SHEET (DDS) CORPORATE RESOLUTION SHORT EAF PLANS - THREE SETS HOUSE PLANS - TWO SETS VARIANCE REQUEST FEE SUBDIVISION >LEGAL DIVISION N AP AL CHE CKED DEPTH RAIN UIRED S I fw a&.' GENERAL LOCATED IN NYC WATERSHED PLANS SUBMITTED TO DEP DELEGATED TO PCHD EP APPROVAL, IF REQ'D DEEP TEST HOLES OBSERVED PPRCS TO BE WITNESSED E PPROVAL SSDS ADJ. LOTS WETLANDS (TOWN/DEC PERMIT REQ'D ?) ATA ON DDS PLANS & PERMIT SAME PRE- 1969- N€IC,HBOR NOTIFIGATION- E R BUZBA 0 YR. FLOOD, ELEVATION OTHER REQ'D PERMIT(S) LO REOUiRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE n� GRAVITY FLOW CONSTRUCTION NOTES u DESIGN DATA: PERC & DEEP RESULTS 2' NTOURS EXISTING &PROPOSED DRIVEWAY & SLOPES, CUT FOOTING /GUTTER/CURTAIN DRAINS SOIL TYPE BOUNDARIES TITLE BLOCK; OWNERS NAME,ADDRESS TM#,PE/RA; NAME,ADDRESS,PHONE# ED DATE OF DRAWING/REVISION ATUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET PROPOSED FINISH FLOOR AND BASEMENT EL. EROSION CONTROL:HOUSE,WELL, SSDS PERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY & EXPANSION LOCATION MAP EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE MTUMPED, PIT & D BOX SHOWN & DETAILED HOUSE -NO.OF BEDROOMS WELLS & SSDS'S WAN 200' OF PROPOSED SY PROPERTY METES & BOUNDS er- a Sur HOUSE SETBACK NECESSARY (TIGHT LOT) ` ,HOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE NO BENDS; MAX.BENDS 45° W /CLEANOUT Q.AY BARRIER 10- FT. ZONTAL;SLOPE 3:1 D FILL SPECS FILL NOTES FILL CERTIFICAa & DIMENSIONS FILL N EXPANSION AREA TRENCH LF TRENCH PROVIDED °2� 60 FT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED LARGE TREES, TOP OF FILL T� . , y N-1VAL S <WELL T0-PL EbI 200' IN DLOD,150' PITS 100' TO STREAM WATERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATERLINE (pits -20') 50' INTERMITTENT DRAINAGE COURSE 200'/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS .2v. 15'MIN to CDS= >50/ojW- 4 0/o,25'- 3 0/o,30'- 2 %,35' -1 %,100' - <I% 61 20'MIN to CD discharge /100'with 182 cons day discharge / SEPTIC TANK E"16'^F- I_QIvI�0tI1�iDATM; 50' TO WELL WELL DIMENSIONS TO PROPERTY LINE LOCATION OF SERVICE CONNECTION COMMENTS: AI AA � a — �� BRUCE, R Public Health Director John Karell, P.E. 121 Cushman'Road Patterson NY 12563 Dear Mr. Karell: LOREZTA .._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) 279-7921 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 May 28, 1999 Re: Proposed SSTS: Capasso Route 311 (T) Patterson, TM# 13-31-67 Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: 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. 1) Required separation distances from SSTS are to be specified on plans. a) 10 feet to property line and driveway. b) 20 feet to foundation walls. c) 100 feet to well. d) 10 feet between septic tank and foundation. 2) Please note that the SSTS design is to be based on a minimum of three bedrooms per house and consideration of less will require the approval of the Public Health Director. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. V truly yoA--'— eobert Morris, P.E. RM:tn Senior Public Health Engineer c tl BRUCE R `- �FOLE-Y.L:,... Public Health Director John Karell, P.E. 121 Cushman. Road Patterson NY' 12563 Dear Mr. Karell: - .-LURET;TA,, 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 RE: Capasso, Route 311 (T) Patterson, TM# 11-3 -67 Reservoir Basin East Branch May 28, 1999 The Putnam, County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on May 18, 1999 is complete. The Department will notify you by June 7, 1999 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 I 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 A­ ' , . Letter to: -John: Karel-1,- 1,,:E.- . -May 2.8, ,1999 of impervious ;surfaces, and the project applicant should contact the Department of Environmental. Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (914) 278 -6130 ext. 166. RM:tn Very truly yours, �91.A-o `2yw Robert Morris, PE Senior Public Health Engineer @PLRNNING DEPT'. PUTNR TEL.No.914- 878 -6721 Dec 31,97 9 :48 No.004 P.02_ tpN A` p �M90 `�n_` '• p�� m CO - DP-22 �MS NT •� FV PAR to 0 t4 i��`k• m •S[lilHYtllY! � 5521. 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LI�y�.�.�„1( rvirasT•.�>rY -:v;. ,. �' /.-.. ♦ ��, /, it � �� :%" :I��'��j ,� • /r- ••., �� �i G \t��r '. �,. ��%yr= a7���� �1 ��' l i � r • '� `i' /I r '✓ '.•!Y�� •�•�� • "e?'.: -. � �,.,. �' '� ..��, •max �i�.i • � {/,.�. 1r ✓;�. r ��,% �w��.'�_,t� it * - .t• t ��r !'O. ;7��..;.T' ,j %y•:riws,r, ::'`.yI.'►�i+ -/ti � - '$wr.: 7 ,.r���JY...,' >;; •.f,• F � ; .1 � �•. .�it7. "./4.;~,_-r�`t-,'. r.� _ � / -.w _c L. .. _ '7.Ji]ES:.a_-_:r.. -. ... __' .::= ,ii�.w!•:...I,- _ •:i:%I_••• ..`I�� 14.16.4 (2/o7) —Text 12 PROJECT I.D. NUMBER 617.21 SEQR Appendix C _ State Environmental Quality Review -SHORT ENVIRON.M,ERTAL ASSESSMENT FORM. For UNLISTED ACTIONS Onl'yr PART I-- PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT ISSPQNSOR � � 2.PFj,OJECT NAME � 3.' PROJECT LOCATION: Municlpallty C County P�r� 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks. etc., or provide map) "U k 12,1 5. IS PROPOSED ACTION- KNOW ❑ Expansion ❑ Modlllcetlonlalteratlon e. DESCRIBE PROJECT BRIEFLY. 7. AMOUNT OF ND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ova$ ONO if No, describe briefly ' t t 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Mesldential ❑ Industrial D Commercial ❑ Agriculture ❑ ParklForest /Open space ❑ Other Describe: ` 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY &RER GOVERNMENTAL• AGENCY (FEDERA4., STATE OR LOCAL)? ❑ Yes %NO It yes, list agency(s) and pormitlapprovals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes 1 5wo 11 yes, Ilst agency name and permit /approval 12. AS A RESULT F PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REOUIRE MODIFICATION? ❑ Yes o I CERTIF'Y AT THE INFORMATION PROVIDED ABOVE 1S TRUE TO THE BEST OF MY KNOWLEDGE �TH� ` V U C'— v� Data: AppllcanUsponsor na e: Signature: L_ 49�� FA If the action Is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART Ii- ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? if yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No S. •WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 611.6? 11 No, a negative declaration may, be, superseded by another Involved agency. ❑ Yes ❑ No =. - C_. COULD ACTION RESULT IN ANY ADYEf)SE EFFECTS ASSOCIATED WITH THE FOLLOb1�INGf (An3Wef3 may be handwritten, Il legltilo} Ct. Existing air quality, surface or groundwater quality or quantity, noise . levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, signlllbant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change In use or Intensity of use of land or other natural resources? Explain briefly. C5. Growth, subsequent development, or related activities likely to be Induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not Identified In CI-05? Explain briefly. C7. Other Impacts (Including changes In use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No . If Yes, explain briefly PART 111 — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it Is substantial, large, Important or otherwise significant. Each effect should be assessed In connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detall to show that all relevant adverse Impacts have been Identified and adequately addressed. ❑ Check this box If you have Identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a. positive declaration. ❑ Check this box If you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental Impacts AND provide on attachments as necessary, the reasons supporting this determination: PI T111 ur tYh• N.01111• of Itrthrnl r rrr In Irat AKrra•y Signature of Responsible Officer in Lea Agency Name of Lead Agency Date 2 TII o lif Itrsponsf o n e•rr . ignature of Preparer (If different from responsible officer) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Pro a rty Located at >9�SQ TN Tax Map # 13 Block 3- Lot ( .1 Subdivision of Subdivision Lot # Filed Map n Date Filed Gentlemen: This letter is to authorize ,a duly licensed Professional Engineer to apply for the required or RqjAcreAA;ghkeet.�. 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 sip 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.con1orLWty with th UTYIslons of Artiole 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Very truly yours, Countersigned: igned: Gyu� P.E., R.A.. # (Oncr of Property) /'8� -t-Q�P Mailing Address ailing Address. A �� ��d,� State y --Zip le2,5Z 3 state Zip Telephone: -b/�- Z Telephone'. 7 7- 7' E 1�ffl W 0 THE CITY OF NEW YORK DEPARTMENT OF ENVIRONMENTAL PROTECTION jor-L A. uml-r, SR., P.E. Carnmictionor ?H0NE--(914) 742-2001 PAX (914) 742-2027 - July 28, 1999 �..Robert Morris, P.E -'Putnam Co.,. Health Dept 4 Geneva Road .'Brewster, NY 10509 . R - Capasso Res Re: I Routc 311 Patterson, Putnam -DEP Log # 9395 (Joint Review) Dear Mr. Morris: WILLIAM N. STASIUK, P.F-,Ph.D. Deputy Commissioner Bureau of Water Supply, Quality and Protection This letter is to inform you that the New York- City Department of Environmental Protection (Department) has determined that the above-referenced application is complete. In addition, the -Department,has.fto-Dbjeftion to the approval of the above-referen ; ed regulated activity. This c di- 6n is bisect 6h 6*'6 f submitted docum ents in. c I W.' d--g-fthe - p­ lia. -n`ti-t--1'e&" S­S D S ..prq mred for Joseph Capasso, dated 05/05/99 and last revised 06104/99. The applicant must contact Sissy Do La Ossa of my staff at (914) 773-4416 at least 2 days prior to the start of construction of the SSTS so that a Department representative may inspect and monitor the installation. ' Sincerely, Margaret Lloyd, P.E. Supervisor Engineering Design & Review xc: James Covey, P.E., NYSDOH 465 Columbus Avenuel Valhalla, New York 10595-1336 0-- R PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGNbATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address �•�� �, �-r-�1L,_l_-i". I%,�'�/ ©lil Located at (Street) _ :9 - 3 j l Tax Map i �3 , Block 3 Lot 7 �` (indicate nearest cross street) 105 Municipality /`-' -, y-�- �TZSon� Drainage Basin BAST ��Aae SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test 3 1,9-4/ �? g Hole No. RunNo. Time Start - Stop Ela se Time Min.) NDe th to Water rom Ground Surface (Inches) Start Stop Water Level Dropp In Inches Percolation Rate Min/Inch . 4: 5 2 23 - il: 3 0 3' 2- 2 6` 2 3 3 �� —26 3 0,7 Y 5 1, 2 3 4 5 NOTES: 1. 2. � 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. Depth measurements to be made from top of hole. Form DD -97 r j\ TEST PIT. DATA .DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE N0. 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' 9.0' 9.5' 10.0' 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: Date Design Professional Name: Address: Signature: Design Profess: PUTNAM- COUNTY HEALTH DEPFii BOW DIVISION OF ENVIRONMENTAL HEALTH SERVICES Jotn1 M. Simmons, M.D. Deputy Camnissioner of Health - FIELD ACTIVITY REPORT - Sheet _ I of INSPECTION NAME eAF.A s : a Orig. Routine N9• IN -23- MAILING ADDRESS P.O. Box Post Office Zip Code Orig. Complain Orig. Request Compliance Complaint Comp Final Group Illness Construction Reinspection PERSON IN CHARGE I� Gam.. Field, Sampling Only OR INTERVIEWED r`G' Field Conference Name and Title Other *ppr =16LjjQ4 DATE `'..� Z 6 TYPE FACILITY TIME ARRIVED ;C> r7 TIME LEFT 0 Explain FINDINGS: e P- INSPECTOR: AA9= � � >r� l�t2P�`1tG_ -"J TELEPHONE: Signature and Titl PERSON IN CHARGE OR INTERVIEWID: I acknowledge this Field Activity Report. SIGNATURE: 6/86 TITLE: f, , -t J Brewster'` P d on 43 Drew ' Lake C 1'2531 .......... 1 01 S tse %Ce F'i 84 164. 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CAL 14� � ` p 4i85 At 1.83v At 9 N r� m 13� �s 344 A `a \ •� � 10.58 AC /:>'•aa fF I.S9 : 1 � _ ¢ 68 65 s „ \s 9.78 At r2N «p 12='� $ / / -� 32.13 C. 18.88AC. $ . e s ` upst / yKat 66 235 aS J i * &82 AG CAL Ac \ 1 (,► `..i'" t - - - -- 1 Ka +l. _ 1 s s 1 67 6 178 41.2 AG 1 1 -14.57 AC au>. S •, p24C sa K 1 1 38 \ j • a l +1 K 15 AC CAL �.• t 84 I 1 t; 3 g 253 J 068 :0 1. 2 AC. 1 . a s69p 1.43 1 ql•,7 / �• � � ; ', — a�Q • 9 1 /0 23_1 P/0 23-1 -10 _ v • t F /• +_TO • i34 - P %0 -- -- — ----------------- 23.1.11 - -1 -16 CAP SSO I°o�S ol�%t t`/ NEIGHBOR NOTIFICATION LETTER vAS- CD V , VjW tw, Aq�(a p6.4'evSOf' P'� 12 Dear . _. Date RE: Department of Health Review of Proposed SewageTreatment System for Property Name: SSO Address: ROUT& 3// Town: /'�¢-r7S o'x/ Tax Map #: 1-3-3-4o7 Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department-of Health. Attached please find a copy of the latest site plan. .If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at 278 -6130. Very truly yours, Title:��� Received By: Address: Tax Map #: % 3.— 3 "— q() . . August 1997 NEIGHBOR NOTIFICATION LETTER �l� SSv1it. C�v. V 7S boy 40 C001W &H P(A44s" Dear S 1 K S Date , S j 2A q q RE: Department, of Health Review of Proposed SewageTreatment System for Property Name: Address: ROUTS 311 Town: jo'f 7 &7 S aAJ Tax Map #: 13 -3 -167 Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at 278 -6130. Very truly yours, - "By: Title:��� -��" Received By: _ Address: Tax Map #: August 1997 r .� NEIGHBOR NOTIFICATION LETTER UUp s-cA -e sAe-r Q-dt i' " . c/o (�. � � � � T %S-e tl cp V ry i e)44-4 4&4 J. Dear �� �'✓ Date 151 12A q RE: Department of Health Review of Proposed SewageTreatment System for Property Name: CV,-S.SO Address: ROUT& 3// Town: /-'f 77&-5kz-S M/ Tax Map #: 13-3-4o7 Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at 278- 6130.- . � Very truly yours, By: Title: Received By :. Address: Tax Map #: August 1997 NEIGHBOR NOTIFICATION LETTER 50X 4;L fi4aSo A) P 12" 3 Dear 1MV M v'kptl ,Date S 112A q 9 RE: Department of Health Review of Proposed SewageTreatment System for Property Name: ChAASSO Address: ROUT& 3// Town: /*17&-7'- -S 0A1 Tax Map #: /3— 3 -4,17 Please be. advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at 278 -6130. Very truly yours, B •. Title:����� Received By:: Address: Tax Map #: 6 3 R-fo 3 August 1997 r NEIGHBOR NOTIFICATION LETTER (A vt1e elk 511 r4wsm A�`( 11 SV� Date 151 12A q RE: Department of Health Review of Proposed SewageTreatment System for Property Name: CAPS 5SO Address: ROUTS 3✓/ Town: Af//- EW-SaA✓ 4 Tax Map #: 13-3 - Dear � � Nl.4tv.,Q.�. 1 Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at 278 -6130. Received By: Address: Tax Map #: Very truly yours, By: Title: kworN-�`" August 1997 . NEIGHBOR NOTIFICATION LETTER Date � ! 12 q 9 s et4( 6 �C� 9-k' 3/1 f��rre�s rZJ-6 27 Dear d_'� ,, RE: Department of Health Review of Proposed SewageTreatment System for Property Name: Address: ROUTS 3// Town: Tax Man #: 13-3-4o7 Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please'find a copy of the latest site plan. If you have any questions, concerns or information which may bear on the Health Department's :review of this application, you may call the Health Department at 278 - 6130. Very truly yours, By: - Title:��y -'' Received By:. Address: Tax Map #: 3 " 2'-13 August 1997 NEIGHBOR NOTIFICATION LETTER Date- 44.PVf- (4416-fie // ��tt� E"S U �✓ l`'y t 2 Dear RE: Department of Health Review of Proposed SewageTreatment System for Property Name: CO}}- "SS O Address: ROUT& 3// Town: A4-77&-,P?-S OA1 Tax Map #: /3- 3 —i7 Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at 278 -6130. Very truly yours, Title:14`' F Received By: Address: Tax Map #: August 1997' . . 1 NEIGHBOR NOTIFICATION LETTER (.� St-e-YV IgP'F� PA �eVfu n) Dear Bate RE: Department of Health Review of Proposed SewageTreatment System for Property Name: C14P SSO Address: ROUT& 3✓/ Town: 1-0,f T7&7zSO1t1 Tax Map #: 13- 3—ro7 Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any questions, concerns or information which may bear on the Health Department's review of this application, you maycall the Health Department at 278 - 6130. I. Received By: Address: Tax Map #: f ;�'- 3 M Very truly yours, llke�� By: Title: August 1997 idav, 16 r4o R$ 4*1110 m iew fib 1 zi 6zi 0 Ao .X 2���OaK CITY DENRTMF � ENTAL PA�SE�`O PHONE (914) 742 -2001 FAX (914) 742.2027 July 21, 1999 THE CITY OF- NEW_ YORK - DEPARTM NT.:PF ERA /,,Zgk!m EN, ,TA.I, P.rzQT. nTEG.N' .. ... - :..... JOEL A. MIELE, SR., P.E. Commissioner WILLIAM N. STASIUK, P.E.,Ph.D. Deputy Commissioner Robert Morris, RE Putnam Co. Health Dept. 4 Geneva Road Brewster, NY 10509 Re: Capasso Res. Route 311 Patterson, Putnam DEP Log # 9395 (Joint Review) Dear Mr. Morris: Bureau of Water Supply, Quality and Protection The following information is necessary to complete the above - referenced application: • Delineation of the reserve area; • Delineation of United States Department of Agriculture Soil Conservation Service Soil type_ Additionally, please note, the following comment regarding the system design: • A stream is shown on the GIS map crossing this lot, if it is within 250 feet of the septic system, it should be shown on the plan. If you have any questions regarding this matter, you may contact me at (914) 773 -4416. Sincerely, ,4-f Sissy De La Ossa Assistant Civil Engineer Engineering Design & Review xc: James Covey, P.E., NYSDOH 465 Columbus Avenue, Valhalla, New York 10595 -1336 RECEIVED PUTNAM COUNTY ENV HEALTH SRVCS ' .. / ' RECEIVED PUTNAM COUNTY ENV HEALTH SRVCS ' ..