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HomeMy WebLinkAbout0418DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -3 -76 BOX 5 00227 �IL1 -' � ` 00227 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL i _ ��.-- please print or type PCHD Permit # Well Location: Street Address: pillage Tax Grid # 65 vi5 ?H 4AIV6 PA7727 SbN Map 13 Block 3 Lot(s) 76 Well Owner: Name: gs��,ATcs Address: qZ -so QvECiv -S govLLvARZ AsM:, o uls PASCA cXCE 2EGo PAiZX , NY //3-21f- Use of Well: Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5 gpm # People Served �_ Est. of Daily Usage 30o gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling < New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type X Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No >d Is well located in a realty subdivision? ...................................... ............................... Yeses No Name of subdivision ,gSTiZo ASSoc, /AYES Lot No. 6 Water Well Contractor: Td X34 ID --raft niN6,p Address: IVA Is Public Water Supply available to site? .................................. ............................... Yes No X Name of Public Water Supply: /V /J.\ Town/Village /y1 A ' Distance to property from nearest water main: y I A Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: Applicant Signature: waz t PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take, appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified;when considered necessary by the Public Health Director. revision or alteration of the approved plan requires a new permit. Well to be constructed by a water ell iller ce ifled by Putnam County. /M Date of Issue J /or, Date of Expiration o j b Permit is Non- Transferra e Permit Title: White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 UTNAM COUNTY DEPARTMENT OF HEALTH p DIVISION OF ENVIRONMENTAL HEALTH SERVIC] ONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # 1 -05 Located at AS V /sue LA/Srf ow or Village PA -1-TE; -scIV Subdivision name AsTgz> Assouq'TES Subd. Lot # 6 Tax Map 13 Block 3 . Lot 7,� Date Subdivision Approved /o -.5 - Do Renewal Revision '- ,AS7RO ASSOGI1q7E:5 Owner /Applicant Name 4,�2 zovjs PESCAmp gr Date of Previous Approval Mailing Address 612- - 5o Q UEgNVS AoUGEyARD -, RUGO PARK -, NY Zip 11374 Amount of Fee Enclosed 400. o 0 Building Type R-ESIDe-1,q1 PL. Lot Area 0SA-No. of Bedrooms 5 Design Flow GPD l,000 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1. S-oo gallon septic tank and 71 f L.f OF Z% w/Dc AQSORPTb�y - IM-NeNa' Other Requirements: Do sl v c, n1vt K,EQL,►TzW To be constructed by To gE D T2ZwNE D Address N/A Water Supply: Public Supply From Address or: X Private Supply Drilled by To AF ,Do6 �R uve:D Address N/A I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatmentsystem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: P.E. X R.A. Date 2d 5/7E C,� b, SUIZvL -�' /N6 bLMDSGHPEAzr- H1T &a1, i&_Pf- Address 77"' FIX,67 c.AR&,cL., Ny L o5ty License # 61q31 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified whe con 'dered ne sary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe rmit. pp oved fo d' harge of domestic sanitary seTX By; Title: Date: 1121(0 ®J White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL p P lease print ortype PCHDPermit #1i 3�Z`0'� Well Location Street Address: Town/Village: Tax Map # 65 Vista Lane Patterson Map 13 Block 3 Lot(s) 76 Well Owner: Name: Address: 92 -50 Querns Boulevard Phone #: Astro Associates c/6 uis Pescatore Rego Park, NY 11374 Use of Well: x Residential _Public Supply Air /cond /heat pump _Irrigation ri-111rimary Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield Sought 5 gpm # People Served 5 Est. of Daily usage 300 gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drilling x, New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Tye K Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes _ No x Is well located in a realty subdivision? ........................................... ............................... Yes _X_ No Name of subdivision Astro Associates Lot No. 6 Water Well Contractor: To be determined Address: N/A Is Public Water Supply available on site? .............................. ............................... .... Yes _ No x Name of Public Water Supply: N/A Town/Village N/A Distance to property from nearest water main: N/A Proposed well location & sources of contamination to be provided on separate sheet/plan. 3 "S�OiI Date: Applicant Signature: ite Engineering 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. 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 Commissioner of Health. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue Permit Iss i g Official: Date of Expiration—<-- c7 Title: Permit is Non - Transferable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Ow Orange copy - Well driller Form WP -97 Rev. 3/06 � \ \ 4t ~ / / / T J7 ' PROPOSED o ' ~ VIRLV ' Oro cob WRE VT Pom- ?N Fil fAGCEI� ALOE 77 � \ —V—�—'—�—f-~ " --� ' PLA UTNAM COUNTY DEPARTMENT OF HEALT ' 4 SION OF ENVIRONMENTAL HEALTH SERVIC CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # P -12 -05 Located at (;,; v1Gta TanP Town or Village Patterson Subdivision name Astro Associates Subd. Lot # 6 - Tax Map 13 Block 3 Lot 76 Date Subdivision Approved 10 -540 Renewal x Revision Owner /Applicant Name Astro Associates c% iouis Pescatore Date of Previous Approval 10/6/05 Mailing Address 92 -50 Weens Blvd., Rego Park, NY Zip 11374 Amount of Fee Enclosed $500.00 Building Type Residential Lot Area 1.45 Ac No. of Bedrooms 5 Design Flow GPD1,nnn Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of i,5oo gallon septic tank and 714 rF of 2' wide Absorption Trenches Other. Requirements: Dosinq . Tank To be constructed by 11b be determined Address hj/A Water Supply: Public Supply From Address or: x Private Supply Drilled by To be determines Address N/A I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatmeni s, sY tem 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: Insite Address 3 c el P.E. $ .E. x R.A. Architecture P C — Date License # 77950 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 ecessary by the Public Health Director. Any revision or, alteration of the approved plan requires a new pe/mit. Approvedfir discharge of domestic sanitary sew4e only. By: —r White copy - HD Title: ; YolloNAcopy - Building Inspector; Pink copy - - Design Professional Form CP -97 /NS/TE ENGINEERING, SURVEYING & LANDSCAPEARCHITECTURE, P.C. 3 Garrett Place (845) 225 -9690 Carmel, New York 10512 Fax: (845) 225 -9717 TO: Putnam County Health Department 1 Geneva Road Brewster, NY 10509 WE ARE SENDING YOU ❑ Shop Drawings ❑ Copy of Letter LETTER OF TRANSMITTAL Date: -� _ 157- c7$ Job No. 98105.306 Attn: Mike Budzinski, P.E. Re: SSTS for Astro Associates, Lot 6 65 Vista Lane, Patterson TM# 13 -3 -76 ® Enclosed ❑ Under separate cover via ® Prints ❑ Plans ❑ Change Order ❑ the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION 5 Revised 10 -30 -07 CD -1 Construction Drawing 1 3-5-08 CP -97 Construction Permit 1 -3 - <-08 WP -97 Well Permit 1 --------- LA -97 Letter of Authorization 1 12 -27 -00 CA -97 Affidavit V1 $500.00 Fee THESE ARE TRANSMITTED as checked below. For approval ❑Approved as submitted ❑ Resubmit Copies for approval ❑ For your use ❑ Approved as noted ❑ Submit Copies for distribution ❑ As requested El Returned for corrections ❑ Return Corrected prints ❑ For review and comment ❑ REMARKS: This submission is revised for a permit renewal. COPY TO: Louis Pescatore lot 2- 29- 08.dot SIGNED: dA ef'(. Joh). Watson, P.E. Vice President / Senior Project Manager IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of _A f R A soc jkrgl; Located at N Y S 60V II 311 T&V AfTE9 50 Tax Map # j 3 Block Lot Subdivision of Q$ p A SSoc 6 Subdivision Lot # V Filed Map # Date Filed Gentlemen: This letter is to authorize Lnsite ragineering, surveying & Landscape Architecture, P.C. a duly licensed Professional Engineer x_ or =daOr e xxxxxto 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 pr icle 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam qn' _ t ode. . Countersigned: P.E.,., # �� VVq1`, 7111* V.91V s 07 Mailing Address incite Lhgu�ina, surveying & Landscape Architecture, P.C. a Clot Paw- , 6VA%e1 State New Yorke, Zip _[0 II- Telephone: 5° ` ZF- c100 Very truly yours, Signed: ��i LM (Owner of Property) A5190 ASW IATE5 Mailing Address: G/o 1001S PESCAT -W 92 -50 6LUEEr 5 &OULCVAKO) EO PNRK State WEV ft K Zip ) + ` q Telephone: _1 -719 q ?b -2600 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DT'V7tSION OF ENVIRO .MENT.A.]L HEALTH SERVICES AFFIDAVIT - CORPORATE OWNER APPLICATION. FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: ` T S5��� � I, Louis MCA IO&L represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: A S90 A SSO (if} E S Having offices at: 92-50 QUEENS 9OULEVAKO , UP WK i N,Y 1l3 Whose Officers Are: President - Name:, OU15 �ESCA'iDR z Address:. SAME Vice President - Name: Address: Secretary -Name: Address: Treasurer -Name: Address: and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Signed: Lia Title: Sworn tq before me this day of PM�W (month) (year) Notary Public CARL M. fir;; Qlary PUu0 o. '`' ` Corporate Seal N � �; r.;3 Qualified Commission F;:pi +,. C,• _.. .:rs, _ Form CA -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner, of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health TO: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM JOINT REVIEW PROJECT: /-2>- -3 -7 TOWN: A" t l6esoJ SUB'D APP DATE 0 � NOTICE OF COMPLETE APPLICATION: DATE: 3 ❑ Within the drainage basins of West Branch, Boyds Corner Reservoirs or Croton Falls. ❑ Within 500 feet of a reservoir, reservoir stem or control lake. Within 200 feet of a watercourse or a DEC wetland and appearing on a subdivision map approved after December 31, 1992. ❑ Design flow greater than 1000 gallons /day. . ❑ Conunercial SSTS. jtrevlew Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 John Watson, PE Insite Engineering & Survey 3 Garrett Place Carmel, NY 10512 RE: Lot # 6 — Astro Associates R.S. at 65 Vista Lane (T) Patterson, TM # 13 -3 -76 East Branch Reservoir Basin Dear Mr. Watson: ROBERT J. BONDI County F_xecutive ROBERT MORRIS, PE Director of Environmental Health March 7, 2008 The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and revisions received by this Department on March 4, 2008 is complete. The Department will notify you by March 27, 2008 of its determination. ❑ The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ❑D Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed approved, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2148. Y, Michael J. B duns , P Director of nginee ng MJB:kIy Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 •i � •�::� Mar 7. Mici ?eptt'ent "o _ �r Putn ..Ert�i�vncn•en��i1��,�_�' •..f:� -�-: .1 GE y;. .Fr lreHoiti Brea _, ... 465 Cojui11bus Akenue• • - . . ' ' N�w Yoik ,c..: e. 1,0595 1336':'. Emily Libyd' Deat tel. ,(718)"595 -6565• f' (7XSj'SSS;35sT- x?.,•� •. °..: The - - -: - �- 'dete the If yo ..� Bur. Bair &�vllaf�ccSuARGY,- ""- ��.�:a�; - Paul:)F.rRuslr;� i':a,; :. -;;� `�:: •-�4m ::x,42 Zbo'•I�•'� w , ,.Fai:;(914')�?1�= 0348:.• :�•}�siL.'� • frmr>b yy�ar�an�b�r^eene�e��•a�k:�d�Ju� i�lllC - :� -- :: _y . •;•w ,mow:.• -- Davi1 Asso Wastter.• �c •SAL•Y k:. Fax:914- 773 -0343 Mar 31 2008 8:31 P.02 31, 2008 Budzinski, P.E. County Department of Health "a Road r, New York 10509 Astro Associates Lot # 6 — SSTS 65 Vista Lane, (T) Patterson East Branch Reservoir Drainage Basin DEP Log # 2008 -EB- 0146 -bJS.1 Mr. Budzinski: ew York City Department of Environmental Protection (DEP) has lined that the above - referenced application received by the DEP on 11, 2008, is incomplete. The following information is required before T may commence its review: Provide a detail showing an alarm for the dosing eharnber. Show the location of the DEC wetlands on the site plan. In addition, provide a completed DEC wetlands validation stamp on the site plan. Provide a detail showing a baffle at the inlet for the proposed drop box. Provide a copy of'the Putnam County Department of Health witnessed soils testing results. L have any questions regarding this matter, please contact the undersigned 4) 742 -2010. Alderisio ate Project Manager water Design Review Roger Sokol, P.E., NY'SDOH Ir SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health John Watson, PE Insite Engineering & Survey 3 Garrett Place Carmel, NY 10512 Dear Mr. Watson: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health March 31, 2008 Re: Proposed SSTS for Astro Associates — Lot # 6 for 65 Vista Lane (T) Patterson, TM # 13 -3 -76 This Department has received and reviewed the submitted application and plans for the above referenced project and the following comments are offered for your consideration. The dosed system should provide for equal distribution of the dosed volume to all of the absorption system rows. 2. Please refer to the NYCDEP letter, dated March 31, 2008, for additional comments. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. Respectf Michael Director MJB:kly cc: D. Alderisio, DEP Environmental Health (845) 278 -6130. Fax (845) 278 -7921 Water Supply Section'(845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 ' t `71ze, •16 1"Of March 31, 2008 ewer Department of Michael Budzinski, P.E. Putnam County Department of Health Environmental 1 Geneva Road Protecfion Brewster, New York 10509 465 Colu, N& ork . Re: Astro Associates Lot # 6 — SSTS Valhalla, New York ,: - ' : ' 1o595 =1336 65 Vista Lane, (T) Patterson East Branch Reservoir Drainage Basin DEP Log # 2008-EB-0 146-DJS. I Ermily'Lloyd Commissioner Dear Mr. Budzinski: '. Tel "(718) 595- 6565 Fa_(748) 595'-3557: The New York City Department of Environmental Protection (DEP) has determined that the above - referenced application received by the DEP on March 11, 2008, is incomplete. The following information is required before the DEP may commence its review: Provide a detail showing an alarm for the dosing chamber. . Bureau of.,Water Supply • Show the location of the DEC wetlands on the site plan. In addition, :Paul V'.,Rush, P.E. provide a completed DEC wetlands validation stamp on the site plan. Deputy Commissioner Provide a detail showing a baffle at the inlet for the proposed drop box. Tel (91.4),742-2001 348 -, • Provide a co of the Putnam County Department of Health witnessed Fax(914)741- 0348-.. � by � p soils testing results. If you have any questions regarding this matter; please contact the undersigned at (914) 742 -2010. Since ely, David Alderisio Associate Project Manager Wastewater Design Review '° xc: Roger Sokol, P.E., NYSDOH 2 V . a , f S Jl CT - . i y . •rti :3 -' 1 ••.. .. P1`T DATA , S.OLGS ENCOUNTERED IN..'Z'ES'Z'. DEPTH HOLE N0. 6 A G.L. 0.5' TOP So. L 1.0' 2.0' ADD 8/�aw,✓ 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.5' 9.0' 9.5' 10.0' F}n�' s,1 4 O -xrN 4AovEL HOLE NO. 6 1 i A {v s r+--,o w,p'rN C-44V,!cL HOLE NO. Indicate level at which groundwater is encountered A Indicate level. at which mottling is observed Indicate level to which water level rises after being encountered 4//6 Deep hole observations made by: :TV k1A —,+7--! C-A-1 Date 63 , Design Professional Name: Jeffrey J. Contelmo., P.E. Address: invite awirk--rinq, azvevim & C A zM b,-[. NY, l asm- S ignature: CO �� p F� W 7 AS r O C LI 6193 F�c� Design p�SIQ� SM al PUTNAM, COUNTY DEPAR'T'MENT OF HEALTH D SION= OF ENV]R0N M.NT' HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM ; q,7 3d Owner�s7`/�o /�SSdcy/}�i�5 1�.lG, Address Arz o 04RK , ti` Y //371 Located at' (Street) 65 Y /STA..l_iM&, , Tax Map, - 13 Block 3 . Lot 76 (indicate nearest cross street) Municipality�G,.•,�? �� p��-rRs���j Drainage Basin exxwcll �/�iEK5s1�/J SOIL PERCOLATION TEST DATA Date of Pre - soaking Iz 8/c g, Date of Percolation Test 1zZml /4 , Hole No. Run No. Time Start - Stop Ela seTirne (Min.) DSppth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 1 30"06— 3:36 30 ;20310 --'2 3 13 2 30 2 I" . _ z��z I '�z" ZO 3 �i�o� - 4r3� �Q Zi" — ;v_ Vz �' /1'' ZO 4 5 2 3' O 3 il 3 C2 �-2 "' .— L� '` 3 1 C7 4 o3 3O 2�` —2S•11 -3 10. �5 1 2 3 4 *TnTTn. .5 1 \V A.K01J. 1. ic,u w U.G icpcaMu aL same aepm untui 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 =4Lik/NS/ T ENGINEERING, SURVEYING & LANDSCAPEARCH/TECTURE, P.C. May 6, 2008 Mr. Michael J. Budzinski, P.E. Director of Engineering Putnam County Health Department Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 RE: SSTS for Astro Associates Lot # 6 65 Vista Lane, Patterson TM# 13 -3 -76 Dear Mr. Budzinski: Please find the following enclosed: • 5 copies of Drawing CD -1 "Construction Drawing ", last revised May 5, 2008. • 1 copy of Drawing WL -1 "Wetland Validation Map ", dated April 14, 2008. • 1 copy of Design Data Sheets dated December 23, 1998. The enclosed plans have been revised in accordance to your March 31, 2008 comment letter, we offer the following: 1. Dosing has been incorporated into the system design. In response to the NYCDEP comment letter dated March 31, we offer the following: 1. A high level alarm has been shown on the dosing tank detail. 2. DEC wetlands have been shown on the site plan, and approved with DEC wetlands validation stamp 3. The drop -boxes have been replaced with a baffled 10 -way distribution box. 4. PCDOH witnessed soils testing results are enclosed. Please also note that the location of the trenches, septic tank, dosing tank and pool have been revised since the last submission. If you have any questions or comments regarding this information, please do not hesitate to contact our office. Very truly yours, INSITE ENGINEERING, SURVEYING & LANDSCAPE ARCHITECTURE, P.C. t -n By: r''' John .Watson, P.E. ce resident / Senior Project Manager JMW /es /amh Enclosures cc: Lou Pescatore Tony Ferreira Insite File No. 98105.306 3 Garrett Place, Carmel, New York 10512 (845) 225 -9690 Fax (845) 225 -9717 www.insite- eng.com 4 -2 -08 mb.doc BRUCE R. FOLEY .T 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 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 SID Y TO: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM INT REVIEW PROJECT: TOWN: REVISION (]TREV2) a /J. DATE: �� —W Ma� Iiiv fon�mental,. i. ; -ry 1 C ;.:.:.A u....t:.;... -:• a85Catu ?nnus�toenti�,_.-�;,.._._`'; � —'Re_ Ffelhsfls `Ydainr^1''vric ^�: •- =•'p•'• -� •�• — E iity•,IJ.oyd T9 {91}7424'pM ;�°* Ple, Faz:(J 14;)'.741 -348' tw0 and �:�:• ;: ��:; °::gip, =' •��;,':�E - _. ..�•, ..� <.:.. •..�ti.,.A ..ITS, .:' W xc i :�'+i! °.� ;p ^.•Vi•:1.' r.T •n vp • cttiroFragr,�� �. • s .4n r,. ' EP, -HEE'P . Fax:914 -773 -0343 5, 200.8 Budzinski, P.E. County Department of Health 'a Road r, New York 10509 May 15 2008 10:34 P.02 ,Astro .Associates Lot ## 6 — SSTS 65 Vista Lane, (T) Patterson. East Branch Reservoir Drainage Basin DEP Log ## 2008-EB-0 146-DJS. I Budzinski: ew York City Department of Environmental Protection (DEP) has lined that the above - referenced application received by the DEP on May 8, is complete. The DEP has no objection to the approval of the above - iced regulated activity. This determination is based on the review of aed documents including the plan titled "Subsurface Sewage Treatment a, A,stro ,Associates, Lot # 6, 65 Vista Lane, Town of Patterson, Putnam y, Ne* YorW', prepared by Tnsite Engineering, dated September 23, last revised May 5, 2008- have the applicant contact David Alderisio at (914) 742 -2010 at least ys prior to start of construction of the SSTS so that the DEP may inspect mitoz the installation. y> Shedlo, P.E. agineer JU rater Design Review Sokol, P.E., NYSDOH Tci :.(71.8) 5�5 -65b5 az,(118j, 595 -3 �7._ i�•:I_.•�t' `X a (( �•;4g fur ®au'a�er"'u'�°py Ci T9 {91}7424'pM ;�°* Ple, Faz:(J 14;)'.741 -348' tw0 and �:�:• ;: ��:; °::gip, =' •��;,':�E - _. ..�•, ..� <.:.. •..�ti.,.A ..ITS, .:' W xc i :�'+i! °.� ;p ^.•Vi•:1.' r.T •n vp • cttiroFragr,�� �. • s .4n r,. ' EP, -HEE'P . Fax:914 -773 -0343 5, 200.8 Budzinski, P.E. County Department of Health 'a Road r, New York 10509 May 15 2008 10:34 P.02 ,Astro .Associates Lot ## 6 — SSTS 65 Vista Lane, (T) Patterson. East Branch Reservoir Drainage Basin DEP Log ## 2008-EB-0 146-DJS. I Budzinski: ew York City Department of Environmental Protection (DEP) has lined that the above - referenced application received by the DEP on May 8, is complete. The DEP has no objection to the approval of the above - iced regulated activity. This determination is based on the review of aed documents including the plan titled "Subsurface Sewage Treatment a, A,stro ,Associates, Lot # 6, 65 Vista Lane, Town of Patterson, Putnam y, Ne* YorW', prepared by Tnsite Engineering, dated September 23, last revised May 5, 2008- have the applicant contact David Alderisio at (914) 742 -2010 at least ys prior to start of construction of the SSTS so that the DEP may inspect mitoz the installation. y> Shedlo, P.E. agineer JU rater Design Review Sokol, P.E., NYSDOH /'NS/ T —TM7 ENGINEERING, SURVEYING & LANDSCAPEAROH/TECTURE, P.C. 3 Garrett Place (845) 225 -9690 Carmel, New York 10512 Fax: (845) 225 -9717 TO: Putnam County Health Department 1 Geneva Road Brewster, New York 10509 LETTER OF TRANSMITTAL Date: 5/16/08 Job No. 98105.306 & 308 Attn: Mike Budzinski, P.E. Re: SSTS for Astro Associates, Lot 6 and 8 Vista Lane, Patterson TM # 13 -3 -76 & 78 WE ARE SENDING YOU ® Enclosed ❑ Under separate cover via ❑ Shop Drawings ® Prints ❑ Plans ❑ Copy of Letter ❑ Change Order ❑ the following items: ❑ Samples ❑ Specifications COPIES ^ DATE NO. DESCRIPTION �— 5 Rev. 5/15/08 CD -1 Construction Drawing 1 4/14/08 WL -1 'Wetland Validation Map THESE ARE TRANSMITTED as checked below: ® For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ REMARKS: Mike, Please find the Lot 8 CD -1 revised per your comment and a Wetland Validation Map for the Lot 6 file. COPY TO: Louis Pescatore (-to emc o.s-&6) SIGNED: fit. File Joh . Watson, P.E. Vice President/Sr. Project Manager IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE doc 05/13/2010 THU 10:39 FAX INSITE ENG. ATTENTION PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES a JOSEPH EkGENE REQUEST FOR FINAL INSPECTION For: Fill All information must be fully completed prior to any Trenches k inspections being made. t Q002/005 PCHD Construction Permit # 1° .1 2 —OE- Located: 6 S- V .JA l.an e, 0 (V) ms o^ Owner /Applicant Name: --An fio nj- v Fe ff ai r TM 17 Block 3 Lot _k_ Formerly: L av i i Pe ac.4fo.0 Subdivision Name- � s�r� A.ss r c-,-�4e s Subdivision Lot # Is system fill completed? /L.,tif Date, Is system complete? eXcl.,,tl'^a 4w j,- Date: '521g J 1 v Is system constructed as per plans? Yej Is well drilled? ^/es Date:. 2,11 a Is well located as per plans? Are erosion control measures in place? Y e's I certify ihat the system(s), as Ustod, 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: S I *5 + c Certified b : � PE X RA Y Inske, Engineering, Surveying & Landscape Address: 3 Garrett Place, Carmel, New York 10512 Design Professional Pi John M. Watson, PE Lie. # 77950 Comments: fcv%L r)(,)- in 41,." ft LS ��,a � 4re r, IV`�`� � ��'�i.� E1 ►_. __... �?� 1l <_, Alp- Form FIR-99 i 05/13 /2010 THU 10:39 FAX INSITE ENG. SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 REQUEST FOR FIELD TESTING All information below must be fully completed prior to any scheduling. 121003/005 ROBERT J. BOND1 County Executive DATE: ; " 13 o ENGINEERING FIRM: n r,` �n� ;nec /�� PHONE #: 8tS- 225'- ?6`to PERSON TO CONTACT: Fr; c. S GI•► 1 robe m) [ K NEW CONSTRUCTION ❑ REPAIR PROGRAM ❑ ADDITION PROGRAM REASON:' DEEPS: ❑ PERCS: ❑ P TEST: X ROAD /STREET: TOWN: &+47 _Jon TAB'. MAP #• 13 - 3 SUBDIVISION: LOT #: OWNER: o� i.l Pe- 5C- "+r,1e- NYCDEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING YES NO O Q Proposed SSTS within the drainage basin of West Branch or Boyds Corner & Croton Falls Reservoirs. ❑ Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. Proposed SSTS within 200 feet of a watercourse or a DEC wetland. o p5 Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. ❑ 0 Proposed SSTS for a Commercial Project. It is the responsibility of the design professional to provide the above information prior to soil testing. The Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered ves to any of the questions, NYCDEP must witness the soil tests. This Department will coordinate a mutually suitable time for field testing with the Design Professional and NYDCEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil tests, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. FOR COUNTY USE ONLY DATE: TIME: COMMENTS: rtso.roaaIecnrasrmc:iuv Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 05/20/2010 THU 9:06 FAX INSITE ENG. Z002/004 /NS/ TE ENGINEERING, SURVEYING & LA AtDSCA PEA RCHITECTURE, P.C. May 19, 2010 Mr. Gene Reed Assistant Public Health Engineer Putnam County Health Department 1 Geneva Road Brewster, New York 10509 RE: Astro Associates 57 Vista Lane Patterson, Putnam County, New York Tax Map No. 13 -3 -78 Dear Mr. Gene Reed: As you requested, the following are the results of the dosing tank dose volume for Astro Associates Subdivision Lot 8 as witnessed by Eric Kingsbury of our office on May 12, 2010: Inside Dimensions — 8ft x 4.1ft Dosing Tank The Dosing Tank Dose Volume = 368 gallons (18" draw) If you have any questions or comments regarding this information, please do not hesitate to contact our office. Very truly yours, INSITE ENGINEERING, SURVEYING & LANDSCAPE ARCHITECTURE, P.C. By. /-�- - John to. Watson, P.E. V' e P esident, Sr. Project Manager JMW /ems�k Insite File No. 98105.100 3 Garrett Place, Carmel, New York 10512 (845) 225 -9690 Fax (845) 225 -9717 www.insite- eng.com Lot 8- 051920109r.doc Sherlita Amler, MD, MS, FAAP Commissioner of Health Robert-Morris, PE Director of Environmental Health May 21, 2010 John Watson, PE Insite Engineering 3 Garrett Place � Carmel, NY 10,512 Department of Health I Geneva Road, Brewster, NY 10509 Re: Field Inspection-Vista Lane (T)Patterson, TM # 11-3-76, Lot 6 Robert J. Bondi County Executive I Dear Mr. Watson: The above referenced SSTS can be backfilled. The following comment needs to be addressed. • A final inspection is required by this Department upon completion of construction and grading. If you have any further questions, please contact me at (845) 278-6130, ext. 43261. . GDR:kly Sincerely, Gene D. Reed Sr. Environmental Health Engineering Aide Environmental Health (845) 278-6130 Fax (845) 278-7921 Water Supply Section (845) 225-5186 Fax (845), 225 -5418 Nursing Services (845) 278-6558 Fax (845) 278 -6026 Nursing / Home Care Agency (845) 278-6085 WIC (845) 278-6678 Early Intervention / Preschool (845) 228-2847 Fax (845) 225-1580 PUTNAM COUNTY DEPARTMENT OF HEALTH ����, ►,,` DIVISION OF ENVIRONAIENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: AIZ16 Inspected by: Street Location & Vls f ai LqK e— Owner fro m, Town Permit # TM #_ 13 1 3 Subdivision Lot # 1. Sewage Svstem Area a. STS area located as' er 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. 1 00' from water course / wetlands...... ...... ......................... II. Sewage Svstem _ a. Septic tank size.- 1,000 ........ .1,250 ......... other..r:�.°..°. . b. 'Septic tank installed level ............ ............................... c. 10' minimum from foundation ........ ...................:........... d. Distribution Box 1. All outlets at same elevation- water.tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft. Original soil between box & trenches e. Junction Bog properly set .......... ............................:.. 6. Trenches 1, Length required _ 7/4l Length installed ;71 2. Distance to watercourse measured -/- / O° Ft.......... 3. Installed according to plan.... .. .......................................... 4. Slope of trench acceptable 1116 - 1/32" /foot ............. 5. 10 ft. from property line - 2.0 ft.- foundations.......... 6. Depth of trench <30 inches from surface ................:. 7. ' ` Room allowed for expansion, 10.0 % ......................... 8. Size of gravel 3/4 -1Ile diameter clean ...............::..: 9. Depth of gravel in trench 12" minim? ................... 10. Pipe exff7c<a ed .................... ............................... g. Pum o . ose vstems 1. Size o p chamber ...................... I......:.................. 2. Overflow tank .....:.................... ..............:................ 3. Alarm., visual/ audio .................... ............................... . 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ............................ .........:...:............... 6.. Cycle witnessed by R.D.estimated flow /cycle........... III House/Buddima a. douse located er approved plans .................:.. b. Number of bedrrooms ..... ............................... IV. Well Well located as per approved plans . ......:........................ b. Distance from STS area measured oo ft ........... c. Casing. 18" above grade ............ ............................... d. Surface drainage around well acceptable .....:................. V. Overall Worinna.nshin . a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled .......................................... c. All pipes flush with inside of box ... ............................... d. Backf ll material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area ................ h_ Surface water protection adequate... .... :.......................... i. Erosion control provided ............... .. ............................... Rev. 12/02 /NS/ TE -f ENGINEERING, SURVEYING & LANDSCAPEARCHITECTURE, P.C. September 2, 2011 Mr. Joseph S. Paravati, Jr., P.E. Assistant Public Health Engineer Putnam County Health Department Division of Environmental Health Services 1 Geneva Road Brewster, New York 10509 RE: Construction Compliance for SSTS and Well Astro Lot 6 65 Vista Lane Town of Patterson Tax Map # 13-3-76 Dear Mr. Paravati: Enclosed please find the following in support of the SSTS Construction Compliance for the above referenced project: • Five (5) copies of As -Built Drawings ABA, dated August 31, 2011. • Form CC -97, " Certificate of Construction Compliance for Sewage Treatment System ", dated September 2, 2011. . • Three (3) copies of form GS -97, "Guarantee of Subsurface Sewage Treatment System" dated August 12, 2011. • Water Quality Test Results. • Check for $300:00 Fee. • Well Completion Report. • E911 Address Verification. If you have any questions or comments regarding this information, please do not hesitate to contact our office. Very truly yours, INSITE ENGINEERING, SURVEYING & LANDSCAPE ARCHITECTURE, P.C. By: John . Watson, P.E. \(ice resident, Sr. Project Manager JMW /enisMmh Enclosures cc: Antonio Ferreira Insite File No. 98105.306 3 Garrett Place, Carmel, New York 10512 (845) 225 -9690 Fax (845) 225 -9717 www.insite- eng.com 090211jp.doc Analytical Report Page 2 of 2 ims WATZR $OIL AND AfA A ,ALf,,,A Hyatt Pump Service: Ferreira Mailing Information: Collector's Information: JMS ID: 102977 Name: Hyatt Pump Service Name: Charles Hyatt Address: 229 South Rd Address of site: Vista Court City: Holmes City: Patterson State: NY Zip: 12531 State: NY Zip: Phone: (845) 855 -5136 Fax: (845) 855 -5136 Phone: Sample's Information: Sample ID: 1 Site: Not Specified Date Collected: 6/23/2011 Date Received: 6/23/2011 Preservative: N/A Time Collected: 10:00:00 AM Time Received: 1:05:00 PM Temperature: 17.6° C Lab No.: J1103701 Matrix: Drinking Water Signature: Reviewed By: M Michael Lapman Michael Lapman, President State #: PH -0218 ELAP #: NY 11715 Ref Lab(s): Analysis by JMS NY ID 11715 a CONNECTICUT.- NEW YORK AND NELAC CERTIFIED 41 Kenosia Avenue I Danbury., Connecticut 06810 1 Telephone 203- 793 -2229 1 Lab Fax 203 - 798 -2107 'vQ��;� Analytical Report YVATERA01t AND AJA aSALYSrS Mailing Information: Name: Hyatt Pump Service Address: 229 South Rd City: Holmes State: NY Phone: (845) 855 -5136 Sample's Information: Hyatt Pump Service: Ferreira Collector's Information: Name: Charles Hyatt Address of site: Vista Court Vito k-,5,06. City: Patterson Zip: 12531 State: NY Zip: Fax: (845) 855 -5136 Phone: Site: Not Specified Preservative: N/A Temperature: 17.6° C Matrix: Drinking Water Date Analyzed Test Name 06/24/11 Comment Sample ID: 1 Date Collected: 6/23/2011 Time Collected: 10:00:00 AM Result Page 1 of 2 JMS ID: 102977 (I 7— C Date Received: 6/23/2011 Time Received: 1:05:00 PM Lab No.: J1103701 MCL Method Comment 06/23/11 2:00 PM E. Coli Absent Absent Colitag 06/23/11 2:00 PM Total Coliform Absent Absent Colitag 06/24/11 Metals Prep EPA 200.5 Prep 06/29/11 Iron <0.05 mg /L 0.3 mg /L EPA200.5 06/29/11 Manganese <0.015 mg /L 0.05 mg/.L EPA200.5 06/29/11 Sodium <5 mg /L 28 mg /L EPA200.5 06/23/11 1:30 PM Color (Apparent) 5 Units SMWW 2120 B 06/23/11 1:30 PM Turbidity 2.97 NTU 5 NTU SMWW 2130 B 06/23/11 Odor ND 3 TON SMWW 2150 B 06/23/11 Hardness,Total 370 mg /L N/A SMWW 2340 C 06/23/11 Chloride 37.3 mg /L 250 mg /L SMWW 4110 B 06/23/11 5:03 PM Nitrate 7.11 mg /L 10 mg /L SMWW 4110 B 06/23/11 5:03 PM Nitrite <1 mg /L 1 mg /L SMWW 4110 B 06/23/11 Sulfate <20 mg /L 250 mg /L SMWW 4110 B 06/23/11 1:30 P.M pH 6:97 S.U. 6.4 -10 S.U. SMWW 4500 H B� Comments: At the time of the analysis the sample was Acceptable for Total Coliform kt the time of the analysis the sample was Acceptable for E. Coli )H was received and analyzed out of holding time. pH needs to be analyzed mmediately upon collection. (over 0 day(s) for pH) Comments regarding. Total Coliform and E. Coli are interpretations of the data based on the results of the sample. MCL refers to the NYS Part 5 Sanitary Code CFU = Coliform Forming Units Comment = Results relate only to samples MCL = Maximum Contaminant Level mg /L = milligrams per Liter N/A =Not Applicable . ND = None Detected. NTU = Nephelopmetric Turbidity Unit S.U. = Standard Unit TON = Threshold Odor Number Units = Units COt~ NXCTI.CUT.. NEW YORK..AND NELAC CERTIFIED 41 Kenosia Avenue i Danbury, Connecticut 06810 1 Telephone 203- 793 -2229 1 Lab Fax 203 - 798 -2107 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Building Constructed by 65 V l S I'/pr (e:t �-- Location - Street le ��O Building Type 13 3 7(/0 Tax Map Block Lot Town(Village Subdivision Name 9 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: Mont1v ay Year�Q j General ontracto wn - Signature Corporation Name (if corporation), Address: GS_ V1 S'%` State ,/V a,J Zip Signature: Title: Pr,4Sr ,0 el,rr L1e1�'- /©?; utj 17C Corporation Name (if corporation) Address: 3` &,AaIN ftv-C State r? �� Zip�� 7 Iv Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM A- , 7� Owner or Purchaser of Building Tax Map Block Lot I&Ple M �9 ( 1 (5 Building Constructed by TownNillage L2,-e- A,/ -o Location - Street Subdivision Name Building The, 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 0 Year d N/ Signature: Title: PITui-pewr General Contr'acto Owne � Signature /C t�7ywev %lei✓ Corporation Name (if corporation) Corporation Name (if corporation') ­T Address: 13�M Ga/ S Address: I PA rGl State State &A� c�i '�l 113 Zip 5� 7 �r p; NY Form GS -97 09/01/2011 15:57 8458782019 09/01/2011. THU 15 :41 FAX T.NSITE ENG. BRUCE R. FOLEY Public Health .Dir¢eror PATTERSON PLANNING PAGE 02/02 1@002/002 C LORETTA MOLINARI XN., M.S.N. Associate Public Health Director Director of Pativir .Services DEPARTIENT Or HEALTH 1 Comm Road Brewster, New York 10509 £avirunmental Health (914)278.6190 rac(414) 278 -7921 NurAng Services (9)4)718-6559 WIC 0) 4) 278 - 6678 Fax (914) 278.6085 Early Inter mdtrtt (914) 278 - 6014 Preschool (914)27616082 rxx (914) 278 - 6648 E91- CDR —ESa) iurZC.&I UN ARV OWNERS NAME: Arita io TAX MAP NUMBER- _ _ 13-3-76 E'911 ADDRESS: TOWN: _ ��#fNs" —tn _ AUTHOME,1) TOWN OFFICIAL: +t5igl�at�e) . DATE: _� / f �� The Putnam County Department of Health will not issue a Certificate of Consh- uction Compliance unless the above form is completed, i.e., a legal E911 address is assig ed by an authorized town official; This form is to be submitted with the application for a Certificate of Construction Compliance. (6;911 VERMIVI) PUTNAM .COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 3 3 7(. Tax Map Block Lot Tolw Nillage 457-9 -6 /-r5 Subdivision Name �r`7ivTv,✓f 1%99-��� lgedge 144 Owner or Purchaser of Building ��' %(do ✓� � �,'� owe i � ,� Building Constructed by 65 VISTA Location - Street - Building ype l®r 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: Mon U Da (02 Year �'C l r Signature: Title: DDS r p� ^b t '� Z t c /0 7) General -Contractor Ovfifiery- Signature Corporation Name (if corporation) Address: 65 V1 5,7-A C of e- State Zip, V y d X Corporation Name (if corporation) 4 *.YP-p Address: 3 l � (� A ►.c- �OA� AVe- State &J4,fl q11ISZi P 5D Form GS -97 I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Town/Village: Tax Map # 1 �3 �- V . 64H kA ►'r Map Block Lot(s) Well Owner: Na//m��e: Address: Use of Well: esidential _Public Supply Air cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Institutional Standby Drillinq Equipment `Rotary Cable percussion Compressed air percussion Other(specify) Well Type _Screened 1,lllpen end casing — Open hole in bedrock _Other Casing Details Total Length 7a 1, ft. Length below grade�ft. Diameter 4 in. Weight per foot _lb/ft Materials: ✓Steel Plastic Other Joints: Welded --Threaded Other Seal: _ ement grout Bentonite Other Drive shoe: Yes %-- 1 o Liner: _Yes `'No Screen Details Diameter (in) Slot Size Length (ft) Dept to Screen ft Develo ped? First _Yes No lHours Second Well Yield Test _Bailed _Pumped !- Compressed Air Hours 7 Yield ls�i" gpm Depth Date Measure from land surface - static (specify ft) 3V During yie test (ft) Depth of compete we m ft. : Q,v 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 D (P o vL,✓6 c, ,-d et.- 3 o If yield was tested at different depths during drilling list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type :y�,i h/.r_ Capacity 6r— Depths Model .SOS Voltage �L60 HP / /a,, Tank Type Jatr 3 6 Volume s'___ NOTE: Exact Location of well with distances to at least two permanent landma�Ks to bd provided on a separate sheet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3106 Sherlita Amler, MD, NS, FAAP Commissioner of Health i Robert Morris, PE Director of Environmental Health i Department of Health 1 Geneva Road, Brewster, NY 10509 Office (845) 808 -1390 Fax (845) 278 -7921 or (845) 808 -1937 i September 13, 2011 Insite Engineering John Watson, P.E. 3 Garrett Place Carmel, NY 10512 Re: Field Inspection Vista Lane (T) Patterson, TM 13. -3 -76, Lot 6 Dear Mr. Watson: A re- inspection at the above referenced lot has been completed. There are no further comments to be addressed at this time in reference to this Department's open work inspection. If you have any further questions, please contact me at (845) 808 -1390 ext. 43261. Sincerely, GDR:cw Paul Eldridge County Executive Gene D. Reed Sr. Environmental Health Engineering Aide i PUTNAM COUNTY DEPARTMENT OF HEALTH 3 DIVISION OF ENVIRONMENTAL HEALTH SERVICES . Z CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM n PCHD CONSTRUCTION PERMIT # P— i A - OS Located at Cji ,j y6foa Lane_ k �or Village Owner /Applicant Name Anton, o Fa fr2; t a Tax Map Pa t¢ers o n Block 3 Lot 7 Formerly LayisPe- "&t-e_ Subdivision Name Astro Associato Subd. Lot # 6 Mailing Address 311 Palm Ava. G2 aid 111AS, N � Zip USO Date Construction Permit Issued by PCHD 9--IS--09 Separate Sewerage System built by (Jp fe.d Se pry L &Ay4t;un tio, Address 3 11 Ra i kp J A ✓e Bed tk jail S N '0907 Consisting of 1�SOD Gallon Septic Tank and 7) 0 L. F. a' W,*A- abs q rr-e„ ",A Other Requirements: Oos� n n k Water Supply: Public Supply From Address is a Galyel, Sr. or:_ Private Supply Drilled by Notmaj) Anrl ea�on Address Pu-rnam i 11ax Alt Building Type ReSl Has erosion control been completed? reS Number of Bedrooms Has garbage grinder been installed? No 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 Date: 6 1 I 11 Certified by Address utnam Coun epartment of Health. P.E. -- R.A. -sign Professional) y�; t�FJ ;tiivG� ;n,� r L4ndx,pe An.k t�cta� P, G, License # -71 q sr 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 m dification or change when, in the judgment of the Public Health Director, such modification gr4hange is necessary. White copy - HD Ye Title: - Building Inspector; F Date: - Design Professional Form CC -97 -P I NSl TE ENGINEERING, SURVEYING & LANDSCAPEARCHITECTURE, P.C. 3 Garrett Place (845) 225 -9690 Carmel, New York 10512 Fax: (845) 225 -9717 TO; Putnam County Health Department 1 Geneva Road Brewster, NY 10509 WE ARE SENDING YOU ❑ Shop Drawings ❑ Copy of. Letter LETTER OF TRANSMITTAL Date: 09 -26 -05 Job No. 98105.306 Attn: Robert Morris, P.E. Re: SSTS for Astro Associates — Lot 6 65 Vista Lane, Town of Patterson TM# 13 -3 -76 ® Enclosed ❑ Under separate cover via ® Prints ❑ Plans ❑ Change Order ❑ COPIES DATE i NO. 5 ....._... . ......................... ......... ' 9 -23 -05 i.... .... . ...._.._.__.._._......_.._..... CD -1 1 _. ... ._ ............ -_ ........... _..._._...._._.._.... 9 -23 -05 - .;_.._.._:__._...... .._.._ CP -97 .. .... . .... ............._... 1 .... .... ..... ....: > ....... .._..;.. _ ......... ._._ .... _.. .................. t --- '- - - - - -. ..__......... __.._..._...... ............. __ LA -97 1 12w27-00 CA -97 _.... . ........ ;... _ .......... _ ......... ........... _..._...... .... . ........ ..... ....... ..... ......._... WP -97 _. .......... ............................ _... _ ................. 1_....... 12 -29 -98 ! DD -97 -- _^ 1 1 9 -7 -05 ...... _. ........... j 458715175 _ .... _. _._. ... _ ............ .. ......... _.._... 2 -=- -? - - -- -- - - - - -- ....._ ..............._. 1 ..._....._._..._..�_.._...__._. I ---= - - - - -- r PC -97' Construction Drawing Construction Permit Letter of Authorization Corporate Affidavit . ......_..._ ..... ........ _ -- - -- ................ ...- ..... ............. . Short EAF the following items: ❑ Samples ❑ Specifications DESCRIPTION $400.00 Fee _ ._._... _ ......... ....... _..._ ...............___..._........ ............................... 5 Bedroom Floor Plans Application for Approval of Plans .. ......... . .... . ..... ... _ ........ ..... _.__ ...... ,...._ ......... _._. ..... _ ..... _..__. _._.__.._.__..__....... _.. ..... _ ...._._..__..._._..._- ._._...._ _ __......_........... ...._.........._..............__......-........._.............._ ..... ...__ ........... . ... .. .............. .............. THESE ARE TRANSMITTED as checked below: ®For approval ❑Approved as submitted ❑ Resubmit copies for approval �1 ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ REMARKS: COPY TO: SIGNED: (:)�hn Jo M. Watson, P.E. IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE Lot022205.dot W PUTNAM, COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM ; Owner 4,5rAo - 4.55j?Gyf��r Address Rjf4— o P4^K , A/ Y Located at(Street) 65 ymrA..4Ay,. Tax Map .. /3 Block 3. Lot 76 (indicate nearest cross street) Municipality __7c ,4,a73 sc� ./ Drainage Basin �ftsi ,��eci� (..-ATeRSs�E'p SOIL PERCOLATION TEST DATA Date of Pre - soaking 12--A &4 j2 Date of Percolation Test /tiz /a b Hole No. Run No. Time Start - Stop Ela se Time kgin.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch � � 1 3 �D 6 - 3 36 3 0 7r� j1�'' -- '2 3 `� a '114 13 2 3 036 - 14; e761 3 O 21'` zz /z �` 7'J�. �� ZO 3 q �Q Z /` �2 �2 �� 2-0 4 5 �14 3 40001— 419,31 3 C2 4 33 -s�v3. 30 it 3;f 5 1 2 3 4 5 1 \V 1.V10: 1. 105[5 to oe repeated at same depth until apprQximately equal percolation rates are obtained at each percolation test hole. p (i.e. s 1 min for 1 -30 m'ii/iti'ch,'-s 24Yin 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 2 TEST PIT DATA ,..DE8CRIPTION.07 SOTGS ENCOUNTERED IN._ . �_�.._._._.._.�_..�.._.._..� _...�_.. DEPTH HOLE N0. 64­ . HOLE N0. 6`60- HOLE NO. 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' aSn Re"wjj "el &,� .54or0 4- I BRo�•.�% suy „A V s r+-0 w rN c -4,4v u- Indicate level at which groundwater is encountered A! IA Indicate level at which mottling is observed Indicate level to which water level rises after being encountered ,v/14 Deep hole observations made by: :TV Fl,-' Date zg q Design Professional Name: Jeffrey J. Contelmo., P.E. Address: insite Ehgir�.ring, surveying & g _ ire, P. 3. cc 0 w 5- Signature: ° tW v �`p .61931 Design pLsgl PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION Property of � �S�l�d ASS0001 -25 Located at N Y.5oV &V fAff " S0 Tax Map # 2j Block Lot 76 Subdivision of AS69Q 5 0 6-5 Subdivision Lot # 6 Filed Map # Z-24 b Date Filed Gentlemen: This letter is to authorize insite axiineering, surveying & landscape Architecture, P.C. (Jeffrey J. Contelzm a duly licensed Professional Engineer x a�amd.Axghftwlxxxxxto 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_ r , of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Countersigned: P.E., X A., # 6 Mailing Address & Landscape Architecture, P.C. .3 &Ake- EIrP/-Pc F- Cf;rMF1. State New York Zip ►vsit Telephone: ( 914) 278 -4990 Very truly yours, Signed: (Owner of Property) q5 'eO ASW /A -rE5 Mailing Address: 0/0 1ouI5 PESCA00kE 92 j �Q 6LUEE� 5OUt_E�/AK0,1 GU PA K State f IEV Y06 K Zip j i3 7q Telephone: 1-16 � -2600 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: S SO C I A T'r5*, «T G s S r5 represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: A09.0 AS LASES Having offices at: q2750 auags 6OULEVAge ego Whose Officers`Are: President - Name: toU) S T ESCA1"0 l Address: SANE Vice President _".Name: Address: Secretary -Name: Address: Treasurer --Name: Address: and that I am and,will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Signed:/ Title: Sworn t before me this '171 day of month) U.Q0 (year) { Notary Public CAR �,i w YCAK Pd�,i�ry M -AiC, ` r�•� Form CA -97 Corporate Seal u4 2 27. Is any portion of this project located within a designated I owu or State wetland? 0 28. Wetlands ID Number-* ........................................................................................ 29. Is Wetlands Permit required? . ............................... ... A/o Has application been made to Town or Local DEC office? ............................... LV.& 30. Does project require a DEC Stream Disturbance Permit? .. ............................... KO 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes o` 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes o 1�C DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... (f <A /0-,r Af 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site ? ............................. U1LKHOWiV 35. Are any sewage treatment areas in excess of 15% slope? . ............................... >,1- 36. Tax Map ID Number .......................................................... Mapes_ Block Lot _76 3 7. 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 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 ofperjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are puAkduz&e as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. p F N F � y SIGNATURES & OFFICIAL TITLES: //% P .��� .; , c o c� CO Mailing Address: ................................... 3 Garrett Place PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES i APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: LG2 P4 9 K A/, V 11.3,71 2. Name of project: : ar'63. Locatioi ]OrV: l jr�So Insite Engineering, Surveying & Landscape 4. Design Professional: Jeffrey J. Contelmo, P.E. 5. Address: Architecture, P.C. 6. Drainage Basin: 9,6;1 [Ax E a as 3 GFl�Q�� P�cc 7. Type of Pro,iect: G AVftL M lds) z Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... . Type I Exempt Type II Unlisted X, 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 114 12. Is this project in an area under the. control of local planning, zoning, or other officials, ordinances? ....................................................... ............................... yts 13. If so, have P lans been submitted to such authorities? ........ ............................... 1�(� 14. Has preliminary; approval been granted by such authorities? ,UO Date granted: 15. Type of Sewage, Treatment System Discharge ................. surface water groundwater 16. If surface water; discharge, what is the stream class designation? .................... 17. Waters index number (surface) ..............................:............ ............................... 18. Is project located near a public water supply system? ....... ............................... Q 19. If es name of water supply �I � ' yes, PP Y I�� Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ AJO 21. Name of stem sewage system Y �%� Distance to sewage system 22. D* ate test holes observed / -23 -q� . 23. Name of Health Inspector a '� S -688 _. 24. Project design flow (gallons per day) .................. ............ I ............................. I,000 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... V0 26. Has SPDES Application been submitted to local DEC office? ......................... 1U/� Form PC -97 14.16.4 (11195) —Text 12 PROJECT I.D. NUMBER 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) SEAR 1. APPLICANT (SPONSOR 2. PROJECT NAME ,=) 5 5 3. PROJECT LOCATION: Municipality PA 77CM5�/y Count P NAM 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) S E9-f- LoGAT /GIN / ,9P ON CoN 5?ZI-,GTi0t4 DRAW /N G 5.. IS PROPOSED ACTION: IgNew ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: �ol�l STILvGT/oN o1-� oNC- FHMJL`J kEESJOON66, D21vew'91Y, SS75, WE4, 7. AMOUNT OF LAND AFFECTED: Initially 114-S acres Ultimately ¢S acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? j4Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest /Open space Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ❑ Yes ❑ No If yes, list agency(s) and permit /approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ® Yes ❑ No If yes, list agency name and permit /approval 12. AS A RESULT PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? TOFF ❑ Yes (5.No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: JON/2 M VVA7SoN P & Date: //VSIIV AN 61NL2 N`, SU/ZVCY //V (, L LAN/JSG°� AQGN /Tgc,6 Signature: If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment. OVER 1 PART 11— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) . A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR PART 617.4? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative• declaration may be superseded by another involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) 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, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities likely to, be induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative,.or other effects not identified in C1 -05? Explain briefly. t: C7. Other Impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. WILL THE PROJECT HAVE AN.IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF•A CEA? ❑ Yes ❑ No E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III— DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of.occurring; (c)'duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part II was checked yes;.the determination and significance must evaluate the potential Impact of the proposed action on the environmental characteristics of the CEA. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this.box if you have determined, based on the information and analysis.above.and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental Impacts AND provide on attachments as necessary, the reasons supporting.this determination: Name o f Lead Agency y ^ Print or Type Name of Responsible Officer in Lead Agency O jjjV WwesPbhtifflU-Mticer Signature of Responsible Officer in Lead Agency. &nure y Q er) 1 Date►_ L May 15, 2008 �lewrrl�, Michael Budzinski, P.E. 'Department of Putnam County Department of Health 1 Geneva Road Protection" -Brewster, New York 10509 .465 Colufiibu's Avenue Re: Astro Associates Lot # 6 — SSTS - Valhalla „ New York 10695-Q'36 65 Vista Lane, (T) Patterson al. East Branch Reservoir Drainage Basin DEP Log # 2008-EB-0 146-DJS. I Einily,06, yd ._C6rnrilitsioner Dear Mr. Budzinski: T 61. (718)'595 -6565 Fax . (718) 595-1557 The New York City Department of Environmental Protection (DEP) has determined that the above-referenc'ed application received by the DEP on May 9, 2008, is complete. The DEP has no objection to the approval of the above- referenced regulated activity. This determination is based on the review of submitted documents including the plan titled "Subsurface Sewage Treatment System, Astro Associates, Lot # 6, 65 Vista Lane, Town of Patterson, Putnam B.Preau of YVater Supply County, New York”, prepared by Insite Engineering, dated September 23, Paul V. kus'h, P.E.. 2005, last revised May 5, 2008. Deputy Commissioner - Tel (914) 7427'2001 Please have the applicant contact David Alderisio at (914) 742 -2010 at least Faxlr(914) 141-0348 two days prior to start of construction of the SSTS so that the DEP may inspect and monitor the installation. Sincerely, Danny Shedlo, P.E. Civil Engineer III Wastewater Design Review CITY DFPgRT LU-)p 2 =1P ('7 18) D E P - H E. L. P xc: Roger Sokol, P.E., NYSDOH 9 1 'J I CJ1 1 . ?i TV PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location iWell Street Address: j" 4� Vd kA r<6 Town/Village: Tax Map # �3 �3. IMap Block Lot(s) 'G� Owner: Nam e: Address: -S + 1,01 C, � c4s 'K JJ Use of Well: esidential Public Supply Air cond/heat pump Irrigation' 1- Primary Business Farm Test/monitoring —Other(specify) 2-Secondary Industrial, Institutional Standby Drilling Equipment �- otary _Cable percussion —Compressed air percussion Other(specify) Well Type —Screened ­� I6pen end casing _ Open hole in bedrock Other Total Length W/, ft. Materials: ✓Steel Plastic Other Joints: Welded --Threaded - Other Casing Details Length below gradepft. Seal: �.e ent grout Bentonite Other Diam'eter in. Weight per foot lb/ft Drive shoe: Yes %--l�o Liner: —Yes L--No Diameter in Slot Size Length (ft ) Dept to Screen (ft ) IDeveloped?] Screen Details First' A I —Yes —No Second I --dHours Well Yield Test Bailed Pumped '-,"Compressed Air Hours 7 Yield gpM lofl Depth Date Tea—sure from land surface -static (specify ft) 3 During yield test ft) Depth . compete well In ft. Well Log Depth From Surface Well Diameter ft. ft. If more detailed Water Bearing (in) Formation Description information Land Sufface b O G o v c,/ 16 4 r e 4.- descriptions or _0 300 7,0 A W sieve analyses are available, please attach. If yield was tested Feet Gallons Per Minute Pump/Storage Tank Information Pump Type.�ct nt,fv b/,r— Capacity S at different depths during drilling Depths Model list: Voltage X30 HP Tank Type L.) y 3 6 � volume -s ��, ,�� ��,, ��✓ >. :, Driller Pump =Ins�aller >PC E rtlficate � t� � NRMM:i 1`1 r 11* i;! k T: TV. lit DnllerxNam fi$c ss.. '41� W 4TA V MG LA i ' -" N p t an Address" a ,� NOTE: - Exact Location of well with distances.to at least two permanent Iandma�s to bWprovided on a separate sheet/pian. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC-97 Rev. 3/06 �P �P CP h0 WELL 0 k5`- CONC. ELEC. PAD DOSING TANK 1,500 GALLON SEPTIC TANK 4VI 2 4110 PVC , S OR35 S S82O / / 5 6. e 24 7 / 9 / 1 , 12 / 8 13 1415 / ,do-M,/ gZ C lop 22 2 3. 24 151 :t kcN /1 19/ `, a") 0,L 0W . 216.N �'4 ce i AREA = 1 410 SOLID PVC 4"0 PVC SDR 35 GF•ANTY UNE FROM DOSING DANK { J. PROPERTY LINE AND BUILDING INFORMA-fi ''SHOWN` HEREON IS BASEL) UN zvn •c . OF PROPERTY PREPARED BY TERRY BERCENOORFF COLLINS BROUGHT TO DATE ON JULY 5, 2011. 4. A DOSE TEST PERFORMED BY THE CONTRACTOR AND WITNESSED BY THE PCDOH AS WELL AS INSITE ENGINEERING, SURVEYING, . AND LANDSCAPE ARCHITECTURE, P.C. YIELDED A DRAW OF 18" EQUATING TO A DOSE VOLUME OF 398 GALLONS PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES. APPROVED AS NOTED FOR CONFORMANCE WITH APPLICABLE RULES AND REGULATInhis nF TNT: I/ i ISSORP77ON TYP.) I NO. I DATE AS —BUIL T MEASUREMENTS A B C NO. CORNER OF I CORNER OF CORNER OF REMARKS BUILDING BUILDING BUILDING 1 59' 25' 1; 000. GALLOA SEPTIC TANK 2 68' 20' DOSING TANI( 3 32' 73' DISTRIBUTION BOX 4 91' 60' END OF TRENCH 5 96' 62' END OF TRENCH 6 102' 65' END OF TRENCH 7 10T 68' END OF TRENCH 8 113' 71' END OF TRENCH 9 118' 75' END OF TRENCH 10 90' 29 77' END OF TRENCH 11 96' 35' 81' END OF TRENCH 12 102' 41' 85' TR NCH 13 108' 47' 89' END OF TRF�!rH 14 114' 53' 93' END OF TRENCH 15 120' 59' 98' END OF TRENCH 16 32' 67' TRENCH 17 38' 74' END OF TRENCH 18 45' 80' END OF TRENCH 19 51' 86' END OF TRENCH 20 58' 93' END OF TRENCH 21 64' 99, END OF TRENCH 22 73' 25' END OF TRENCH 23 73' 32' END OF TRENCH 24 73' 39' END OF TRENCH 25 74' 46' END OF TRENCH 26 76' 53' END OF TRENCH 27 78' 60' END of TRENCH REVISION `1 / T = 3 'A I Place BY