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HomeMy WebLinkAbout0423DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13.3 -87 BOX 5 00232 64 f L+. 1 1 1 ■ , 00232 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM C PCHD CONSTRUCTION PERMIT # P- 13 01 11-rJ I.Z -i Located at - V,I5 to LA A ; T vn or Village rT - Owner /Applicant Name A stle v ,A ,scyc. ,q AYGS Tax Map 1-3 Block .3 Lot 8 •-I Formerly Subdivision Name AS *,Eo Subd. Lot # 1- Mailing Address 1�1 -14o Ov"N. A"v' ,C11A9'a . R660 P.Air K Aff Zip It 3'7 4 Date Construction Permit Issued by PCHD 3 - I'l Separate Sewerage System built by QCAyci1 CoPVsfgvc i'1ary ca4P Address 4-7,j; PCAe-SA1e1-0 MILL &RCwstk , xf iosoq Gallon Septic Tank d Si o o Consisting of 1,.Coy a, P a A 95:ep- i-"rj om 17R CM-9 9S Other Requirements:' I "-y> f, 0. 3- GRAv£Z FlL1, Water Supply: Public Supply From or: Private'Supply Drilled by ,m,,L-rom HyArr Address 1Jl s le-r-311 FAf*Efitxc)V NY Building Type 4r! s D � E ti T� �a Z Has erosion control been completed? 'fir Number of Bedrooms Has garbage grinder been installed? Al o I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: Certified by (De 'gn Profe io al) Address Z -,rtE Eaw�,v - �* v e Nip 3 GAICAefr N[ACC ARck 1rCc* v#'t6 P.E. R.A. License # (o % c� '. I �A en6 L. N';' l9 tie Any person &cupymg prerrus s served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals subject to modification or change when, in the judgment of the Public Health Director, such revocati odifica or change is necessary. / DaY . 4/111 By: Title White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 1. .. .y r NE NORTHEAST LABORATORY of DANBURY \��� kN ACCpAo4� 39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404 �o , Ice 203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 � i r LABS # www.NORTHEAST LABORATORIES. com < LABORATORY REPORT REPORT TO: HYATT PUMP SERVICE 299 SOUTH ROAD HOLMES, N.Y. 12531 SAMPLE SITE: SAMPLE POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: • Total Coliform (Bacteria) PHYSICALS: DATE SAMPLE COLLECTED: TIME COLLECTED: COLLECTED BY: DATE RECEIVED @ LAB: TESTED BY: LAB I.D. # REPORT DATE: PESCATOR?, LOT #1.7, LONGVIEW DRIVE, PATTERSON, N.Y. KITCHEN WELL NOT STATED RESULTS METHOD # 0 per 100 ml SM 9222B 2/21/2002 11:30 A.M. C. HYATT 2/21/2002 LAB #11471 & 11301 NY -019 3/4/2002 MAXIMUM CONTAMINANT LEVEL (MCL) OR STANDARD 0 per 100 ml • Color (Apparent) 0 - EPA 110.2 15 • Odor ND - - 3 Units • pH 7.36 - EPA 150.1 No designated limits • Turbidity 0.40 NTUs EPA 180.1 5 NTUs CHEMISTRY: • Nitrite Nitrogen <0.005 mg/L as N EPA 354.1 1.0 mg/L • Nitrate Nitrogen <0.10 mg/L as N SM 450ONO3D 10 mg/L • Alkalinity 182.0 mg/L SM 2320B No designated limits • Hardness 252.0 mg/L EPA 130.2 No designated limits • .: Iron 0.044 mg/L EPA 236.1 0.30 mg/L • Manganese 0.018 mg/L EPA 243.1 0.50 mg/L Combined limit for Iron plus Manganese = 0.50 mg/L • Sodium i 9.8 *.ng/L. EPA 273.1 20.0 mg.2 ** • Lead i 0.021 * ** mg/L EPA 239.2 0.015 mg/L * ** ml= milliliter mg/L=milligrams per Liter ND =none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count *Notification Level ** *Action Level COMMENTS: i -All holding times (were) met. - Nitrate tested by LAB#11301 SAMPLE, AS TESTED ABOVE: MOTABLE or DOTPOTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) RESULTS BASED ON SAMPLES SUBMITTED: 2/21/2002 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEAL'T'H SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT S'Y'STEM Owner or Purchaser of Building O cc/ ­'C-- Building Constructed by V c S T-A (� Location - Street t 3 3 , `87 Tax Map . Block Lot CAT (IFkt5o n% Town/Village Subdivision Name 5 ( o c:�ft Ate- 1 Building Type . Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of 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 10 Day (a, year o z General Contractor Owner) - Signature Ae'TaO kssow Corporation Name (if corporation) Address: .07— Peeof- rfccc, ,GorW State Kor..�(-I A y Zip t 7-5 I Title: Pg-*-,s - Ggyt_ c-L C+f C o-,-u 5 T-n-k." C-T7 a Corporation Name (if corporation) Address: 17-5- ttrt State /9 tu-a -�SZ-a, 'ujZip t oso� Form GS -97 i NE NORTHEAST LABORATORY OF DANBURY ID NIA ACC010 39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404 �o (203) .748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 f. LABS www.NORTHEAST LABORATORIES.com < _ r• LABORATORY, REPORT REPORT TO: HYATT PUMP SERVICE DATE SAMPLE COLLECTED: 09/10/2002 229 SOUTH ROAD TIME COLLECTED: 10:30 AM HOLMES, NY 12531 COLLECTED BY: M.H. DATE RECEIVED @ LAB: 09/10/2002 TESTED BY: LAB #11471 LAB I.D. # HYATT PUMP- NY1159 REPORT DATE: 09/17/2002 SAMPLE SITE: ASTRO REALTY, LOT # 17, ROUTE 311, PATTERSON, NY SAMPLE POINT: KITCHEN TAP SOURCE: WELL TREATMENT: NONE MAXIMUM CONTAMINANT TEST PERFORMED RESULTS METHOD # LEVEL (MCL) OR STANDARD CHEMISTRY: • Lead 0.006 mg/L EPA 239.2 0.015 mg/L * ** ml= milliliter mg/L--milligrams per Liter ND=none detected MCL--Maximum Contaminant Level TNTC =Too Numerous To Count <Q= Analyte detected below quantitation limits. Data deemed estimated. J =Qc recovery results outside control limits. Data deemed estimated. * ** = Action Level NOT MCL COMMENTS: - Sample, as received, complies with all State of New York regulatory guidelines. -All holding times (were) met. RESULTS BASED ON SAMPLES SUBMITTED: 09/10/2002 Quality Control Officer 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 I OCT -25 -02 09:33 AM TOWN OF PATTERSON OCT- E2 -ROV 14!36 FP.OM • INE I T53 ENGIVEERING 8452259717 BRIME R. FOLBY PWIC 1000 D/recry 9148782019 a rx � DEPARIMM' OF IMALTH 1 (kseva Road Bmwita, New York 10509 TO - 8796342 P.03 P :4,5 LQn1TA MOLNARI- U., USA Dir ew 01 Paw &ryws FiRIMOM9001 RNA (914) 178.6130 Pea e914) 211.7911 NoreSnR Settifam (9) X78.6338 WIC 01143278.6578 Ir e(911) 219.605 1 107 1300 OUN (9111 M. 5074 Pnac6e01 (P14) 2?kC92 Fa�c �91a; l9x • 5648 1191 yE ptrA i , ri Q. I OvMRS NAIME; , A;YKO -A, j.c i A Ire TAX 1VIAF NUMI3J�R: _ �- 3- •- �..-�t �3. � � " � �' E911 A.ADRE99: lot TOWN: A17',I'HORIZED TOWN OP)'it' AL: (Signature) DATE: The Putnam Cowaty Department of Health will not issue a Certificate of Construcdou Compliance unless the above form is completed, I.e., a legal E911 adds is assigned by an anthorUed torn official: This form is to be submitted with the application for a Certificate of Construction Compliance. 5 911 VE-1-t1 w e _z4ii INS/ 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 LETTER OF TRANSMITTAL Date: 12 -2 -02 Job No. 98105.317 Attn: Robert Morris, P.E. Re: SSTS for Astro Associates Lot 17 5 Vista Lane, Town of Patterson TM# 13 -3 -87 WE ARE SENDING YOU ® Enclosed ❑ Under separate cover via the following items: ❑ Shop Drawings N Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of Letter ❑ Change Order ❑ COPIES DATE NO. 5 11 -15 -02 AB -1 As -Built Drawing .............. ............_... ..........._....._..... ..__......- __._.._.........._.. ,.._...__..._...__._...._ ._.__........P........_.._..__. 1 ' 12 -2 -02 CC -97 Construction Compliance 3~ ~ _ r 10 -6 -02 GS -97 Guarantee ... ..... _. ..... _..............._ i......___.:_ ._...____._._- _ ...... ___....... 1 0-23-02 - - - - -- E911 Address Verification .... ._..__-- ._...................__ 1 i 3 -4- & 9 -17 -02 --- - - - - -- Water Test Results _ ........... .............. _._ .._. _..._..._......__._-._.-_.__... .__._...__..._ ...... ....._. -_ -_ __...._.........._..-......._.....__ ... _ ....- ......_.__....._...- ._.... 1 ; 5 -10 -01 WC -97 4 Well Completion Report ........ .___ ...._...__..._...:.....__a.._�� 1 8 -30 -02 64209 $200.00 Fee ~ 9444 .. ........ :..... ....... .. ............ .. _........................ _...._ ............. ... .._.......�.- - ----- __..._...__.._._.__.. _.._._.__.._._._.._.._..__..... _ _ THESE ARE TRANSMITTED as checked below: NFor approval []Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑Returned for corrections ❑ For review and comment ❑ REMARKS: ❑ Resubmit ❑ Submit ❑ Return DESCRIPTION copies for approval copies for distribution corrected prints COPY TO: SIGNEDdhn M. Watson, RE: Iot2002.dot PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ! 7 WELL COMPLETION REPORT Well Location Street Address: 5 V 'is�ftc L a &I e Town/Village: -�0 r Tax Grid # Map t3 Block 3 Lot(s) 87 Well Owner: Name: Address: A -6c 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 __X Compressed air percussion Other (specify) Well Type Screened Open end casing _X Open hole in bedrock Other Casing Details Total length K5 ft. Length below grade ft. Diameter in. Weight per foot % -7 lb/ft. Materials: Steel _ Plastic _ Other Joints: _ Welded _Y Threaded _ Other Seal: Cement grout _ Bentonite _ Other Drive shoe: Yes No Liner:, Yes 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 Yield _/ T gpm Depth Data Measure from land surface-static (specify ft) /9 fell During yield test(ft) �G . d h� Depth of completed well in feet 36's om 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 h C l U C ^+ tl, �);,� 1 If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type S&L Capacity J6 6 1 Depth Model cSL17 Voltageg HP Tank Type ' rc.1l Volume t�g ("'L1lan Date Well Completed r— Putnam County Certification No. D 0 Date of eport 101,6 �) % Well Driller (signature) f t �--i A�Z4-z imyi -E `t:xact location of/well Wan utssttances to at least two permanynt lanamarxs to ne provtnea on a separal/vsneeeeupian. Well Driller's Name �/ d h I7 �ti 1 Address: 1 At Signature: Date: S-116 6 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 276.82' n S 51-18'22' 1 `18'22 ° 2 1��QAG �r wi to 0 ;�rx • Cf { 74`.r3`sG O1 1� 00 e � 2 n ` ,5 D 2, Vl �00� '�"�GJ ne QEY .P L IPI, ��P Rs27 0° t 09s r. �{ 5.0d. 50 091 R'2�� �... _n AS-BUILT MEASUREMENTS NO. A CORNER OF' GARAGE & DECK B BACK CORNER OF DECK C PROPERTY LINE REBAR REMARKS 1 — 25' 50.5' 1,500 GALLON - SEPTIC TANK 2 — 29' 49' DROP BOX 3 — 35' 51' DROP BOX 4 — 41.5' 54' DROP BOX 5 48' 58' DROP BOX 6 — 54' 62' OROP BOX 7 — 60' 64.5' DROP BOX 8 — 39' 12' END OF TRENCH 9 44' 13' END OF TRENCH 10 — 49.5' 16.5' END OF TRENCH 1.1 55' 21. END OF TRENCH 92 dd; U��Arllxr h �\ fi r �.5'�'fa•SiC �ii`! w %c .'t 4t.i". Yi 3 'i'!k &iz' .P- L°`+�Y'+. ,Y' , °vy txS TREN H 1,3+' ,i ? 67,; s r €; a "»tx: �t END7RENCHfi' ; 14 22' — 85' END OF TRENCH 15 29' — 90.5' END OF TRENCH 16 36.5' — 95.5' END OF TRENCH 17 45' — 103' END OF TRENCN . 18 52' — 104' END OF TRENCH 19 58' — 111 ' END, OF TRENCH Putnam County Department of Heath Division of Environmental Health Services Approved as noted for conformance with apan4) le R es and Regulations of the am C y Health Department e Title D to e. NO. DATE" REVISION BY 3 Garrett Place N Sd) T E_ Carmel, NY 10512 ENGINEERING, SURVEYING & (845) 225 -9717 . (845) 225 -9717 fax LANDSCAPE ARCHI TEC TORE, P. C. www.insite—eng.com PROJEC T- SS TS FOR ASTRO ASSOCIA TES -LOT ,4917 5 VISTA LANE, TOWN OF PATTMSON, PUTNAM COUNTY, NEW YORK ORA KING: AS -BOIL T DRA WING a n . 17 1 PROJEC TJ M �, I ORA WING NO. SHEET •,R�n PUTNAbI COUNTY DEPARTMENT OF HEALTH �6 DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE MPECTION Date: O / Inspecte y: fix,G jqn Street Location--/4 Y, IZ4_ "3 1 Owner Town r�T y%GZ!J Permit # —13 — © i TM # / -3 -- - — .5-6 l 7 Subdivision Lot # 1 % 1. SeivaQe Svstem Area a. STS area located as per approved plans ..........:................ b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/ wetlands .......................... II. Se�tage System _ tank Septic tasize - 1,000 ......... 1,250 ......... oth �.�.. ®� 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 Box properly set ........... ....:.......................... f. ren'i ches Length required :52 Length installed Sao 2. Distance to watercourse measured -f t oa Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 -1/32 "/foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface ........ :......... 7. Room allowed for expansion, 100% ......................... 8. Size of gravel 3/4 - 1%" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ........................ ..........:.................... g. Pump or Dosed Systems Size of pump chamber ................ ............................... 2. Overflow tank ........ ................. ............................... 3. Alarm, visual/ audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ......................................... ;................ 6. Cycle witnessed by H.D.estirnated flow /cycle........... III. ouseBuildig a. House located per approved plans ................ b. Number of bedrooms .......................... �... ....... IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured I ft ........... c. Casing 18 ". above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. 'Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercours g. Footing drains discharge away from STS area ............... h. Surface water protection adequate... .. .:....................:....... 08/09/2001 09:39 845 - 278 -6392 1NSITE ENGINEERING PAGE 01 .16 PU'TNAM COUNTX DEpA M ENT OF HEAL'TE DMSION OF ENNUONMENTAL EF.A.LTH SERVICES ATTENTION ❑ ADAM GENE REQUEST FOR FINAL INS PECTION For: Fill All information must be fully completed prior to any Trenches iC inspections being made. PCHD Construction Permit # Located: r s t7i W (� (V) OwnerlAppRcant Name: As-roto A'5 So -cat' 13 Block Lot Sx. t7 Formerly: Subdivision Name: , AW" ASS Subdivision Lot t 17 Is system fill completed? Date: S °?J a/ ' Is system complete? Date. e" T_ ° Is system constructed as per plans? ZC5 Is well drilled? y Date: Is well located as per plans? Are erosion control measures in place? `� c I certify that the system(s), as listed, atthe above premises has been constructed and I have inspected and verified they 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: 0-1-01 Certified by.: PE K Rt-- -- Pro£ canal Address- Lie. # !o 1151 Insite Engineering, Surveying Comments: Landscape Architecture, PC. 1485 Moate 22 Brewster, New York 10549 Form FIR-99 i. InMC. 01 ITA VIM r(-11 IAITV IICDODTMCAIT r1C 0 T, BRUCE R. FOLEY Public Health Director L 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 August 10, 2001 Jeffrey Contelmo, PE Insite Engineering Route 22 Brewster, New York 10509 Re: Field.Inspection - Astro Associates NYS Route 311, (T) Patterson Lot # 17, TM# 13 -3 -55.17 Dear Mr. Contelmo: The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field: No comments. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Very truly yours, Gene D. Reed GDR:cj Environmental Health Engineering Aide �_!_!. ___ _______________________________ � ______w.* \a __ \\ , ! § � | ) | . ! e � ■, , ! | ! � i ■ � ■ e ■ � . , | ..... w- __-____w__m_______________ . � ., �I �! � \� PUT1o1AM COUNTY DEPAId'T1VIEIV'1' OF HEALTH DIVISION OF ENVIRONIVIENTAI, HEALTH SERVICES CONSTRUCTION PE 5 AGE TREATMENT SYSTEM PERMIT #- Located at Jy�'i Kd ug 31 I0 v z 5 rx' � ^' E or Arn. Subdivision namo �2 Q<;ScrjA i t� name Subd. Lot # Tax Map 13 Block 3 Lot I Date Subdivision Approved 0_y -00 Renewal Revision Owner /Applicant Name C/o t cwr s hE5CA't"cr e Date of Previous Approval Mailing Address QQ66QtS bouLC 8io P K Zip Y Amount of Fee Enclosed 4,1 co, v U Building Type OjAWIWL Lot Area, gc No. of Bedrooms 6✓ Design Flow GPD JOOO Fill Section Only Depth Volume PCHD NOTIFICATION IS,RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and ,j 001)r W06 Ark50 Other Requirements: ` j % -0=j 0, . 6PAV EL 6U, To be constructed by UAI rya W V Address Water Supply: Public Supply From Address or: _ Private Supply Drilled by ()/1> N!8wh% Address M/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 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 issuanc"f the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address P.E. •�-" Date I —ZZ —G � _= IPc# ) r;-:C 'E, PC. License # 01 1 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage trea hen t system has been completed and inspected. by the PCHD and is revocable for cause or may be amended or modified w onsidere necessary by the Public: Health'Dir'ector. Any revision or alteration of the approved plan requires a new pe Approv r discharge of domestic sanitary sewage only. By: Title: White copy- HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # Well Location: Street Address: viy-,A W o illage Tax Grid # NYS &Ouu '5:• SCE Map )'�2> Block 3 Lot(s) Well Owner: Name: SST& AS506,�fr5 Address: 60Vi i_VAW C/c Louis P155Cgt646 P RK � 1139 } Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought t5' gpm # People Served Est. of Daily Usage 30.3 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 — X Is well located in a realty subdivision? ...................................... ............................... Yes X No Name of subdivision _ A5fA0 6 S 1 _11: 5 Lot No. Water Well Contractor: j>nJK {Vpt 1 Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village )V/A Distance to property from nearest water main: P JA- Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: 1 -IT-1 Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. y revision or alteration of the approved plan requires a new permit. Well to be constructed by a wate, w 1 driller certified by Putnam County. i Date of Issue Permit Issui Official: Date of Expiration Title: Permit is Non -Trans a cable White copy- HD file; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WP -97 BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 February 26, 2001 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 Jeffrey Contelmo; PE Insite Engineering Route 22 1 Brewster, New York 10509 Re: Astro Associates, Lot # 17 (T) Patterson, TM# 13 -3 -55.17 Reservoir Basin - East Branch Dear Mr. Contelmo: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on February 15, 2001 is complete. The Department will notify you by March 18,' 2001 of its determination. ❑ The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ® Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department;fails to notify you within the above referenced time frame, you may notify the Department of its failure by Certified Mail, Return Receipt Requested. The notice would 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 New York City Department of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review, and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if DEP review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2166. Very truly yours, Gene D. Reed Environmental Health Engineering Aide GDR:cj BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (9,14)'278-7921 DATE 2/Z 61 0 T0: _Tnt51Te Eli, rcrt7y T- c v^cn7 t m o J S 7z0 �4S'St�ci/17�5 O T (T) ��1rr son/ T,-t. # 1-3 — 3 — 55 ,17 Reservoir Basin rw<1 sRAA/cH Dear The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on Z /S o is complete. Thepartment will notify you by 3 / t iB ')©/ of its etermination. e Project has been delegated to the Putnam County Health Department for rev w pursuant to.the guidelines set forth in the Watershed Agreement. J •nt review with the \7YCEP will commence pusuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you- within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects viithin the NYC Watershed may also require Dept. of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Dept. of Environmental. Protection regarding such activities to see if Dept. of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (914) 278 -6130 ext. 166. Very truly yours, RM:tn a nglne ws2 tNl�N hii�l �.4 L �IELrj Y /N PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: A-6 i 12a .4!56ochl -rO i STREET LOCATION: A40_ iZt 3l/ 111/STA L/4/VE e-/o 4,0015 PE5c/l roRe- REVIEWED BY: RM, GR AS, SRDATE: 2- /a. 3 /o j TAX MAP #: (CONFIRMED) 13 -- 3 - 5-S-, 17 , DOCUMENTS IT APPLICATION PERMIT OR PWS LETTER ( LETTER OF AUTHORIZATION ✓(,_)DESIGN DATA SHEET (DDS) . / CORPORATE RESOLUTION SHORT EAF PLANS -THREE SETS OUSE PLANS - TWO SETS ARIANCE REQUEST SUBDIVISION LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED lit/ PERC RATE I 7 )FILLREQUIRED DEPTH . .___) CURTAIN DRAIN REQUIRED GENERAL �} OCATED IN NYC WATERSHED (� ANS SUBMITTED TO DEP DELEGATED TO PCHD , �))DEP;APPROVAL, =IE_ -- Q!b7Rj:s.P g tre..ri EEP TEST HOLES OBSERVED ( ✓) PERCS TO BE WITNESSED APPROVAL SSDS ADJ, LOTS L�L)WETLANDS (TOWN/DEC PERMIT REQ'D ?) .. r(_) TA ON DDS PLANS & PERMIT SAME U(-WE 1969 NEIGHBOR NOTIFICATION L__ )(n TTER BI/ZBA, (� 00 YR. FLOOD ELEVATION •W/I200' U SOIL TESTING LOTS >10 YEARS OLD REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE GRAVITY FLOW CONSTRUCTION NOTES 1 -15 DESIGN DATA: PERC & DEEP RESULTS (� CONTOURS EXISTING & PROPOSED U�DRIVEWAY &' SLOPES, CUT FOOTING /GUTTER/CURTAIN DRAINS USDA SOIL TYPE BOUNDARIES L ) T1TLE BLOCK; OWNERS NAME ADDRESS �TM#, PEMA; NAME, ADDRESS, PHONE# U /// DATE OF DRAWING/REVISION LnODATUM REFERENCE L,JLOCATION OF WATERCOURSES, PONDS / LAKES,WETLANDS WITHIN-200' OF P.L.. (_-)UPROPOSED, FINISH FLOOR AND / BASEMENT ELEVATIONS (� WELLS & SSDS'S W/IN 200' OF SSTS HPROPERTY METES & BOUNDS . U-)ERO$IONxCONTIeQE'FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE ad add4,o ;sal !F114-Fetee Y "N (REQUIRED DETAILS ON PLANS CONT'Dl HOUSE SEWER- ' /a" FT. 4 "0'; TYPE PIPE CAST,'IRON' ~"•:.`' C.L)(_)NO BENDS; MAX BENDS 450 W /CLEANOUT RENEWALS . 9 r .GE) FILL SYSTEMS HO TAL; PAST TRENCH SLOPES 3:1 TO GRADE (__)(__)FILL SPECS / F NOTES 1 -5 (_)(_)FILL PROFILE & DI (_)( FI EE TA OA ILL G N E UU CLA RRIER (� )FILL CER I ]' ATION NO UUDEPTH GAUGES U(�VOL. ON FOR R.O.B., UNCLA ED,_& IMPERVIOUS C--)(--)S TION FOR FROM TOE OF SLOPE TRENCH )LF TRENCH PROVIDED 5-0 e LOFT MAX. 0U PARALLEL TO CONTOURS 100% EXPANSION PROVIDED DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS )10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS 100' TO WELL, 200' IN DLOD,150' TO PITS 100' TO STREAM, WATERCOURSE, LAKE (inc. ezpan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER . 10' TO WATER LINE (pits - 20') 50' INTERMITTENT DRAINAGE COURSE f.. Itz 1200'/500'RESERVOIR, ETC._ 150' GALLEY SYSTEMS 10' MIN TO LEDGE OUTCROP SEPTIC TANK (�(-J10' FROM FOUNDATION; 50'70 WELL WELL (_) DIEN NS TOPROPER (__)UMIN 15' TO PROPERTY LINE SLOPE SLOPE IN SSTS AREA (520 %) REGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS (__) OTES vUDOSE 75% VOME/DOS Y1 NOTED (__) )DETAIL F:7�OWNU E�TYPE, ETC.) (__)(SPIT AN H & DETAI AY STORAGE ABOVE ALARM CURTAIN DRAIN (� S 5' BOTH SIDES, DETAIL C__)C_)I5' MIN to CD S=> °0 25' -3% 3 '- 10 lrY00 %-<I% (x(__)20' MIN to CD DIS 1k6�`/tOil wi discharge o ON- PERFORATED PIPE claw 5.5,T,S. l �;�� /Ov r "T 6 ✓ {�e�' f i >t�; COMMENTS: itr�✓ er.�i� °�;nYlctl 5i` /f ,Feta�e l�C /oe,i �,`�:i 5, 7 reach de -fail he e,@-5 -tv re.-L.? 616-i¢ -flee erv,n na Stvric or G ev,12hed(:gravgf _ 74 ct/ell 4;.4era al,,,n 4-h e avant -e±•, /,'H f4,d e,t -1 / gS tT.• �iKlnru, (REVSIiEET)09 /01100 ! /NS /TE 7)?�7-ENGINEERING, SURVEYING & LANDSCA PEA RCHITECTURE, P.C. 1485 Route 22 (845) 278 -4990 Brewster, New York 10509 Fax: (845) 278 -6392 TO: Putnam Countv Health Department 1 Geneva Road Brewster, New York 10509 WE ARE SENDING YOU ❑ Shop Drawings ❑ Copy of Letter LETTER OF TRANSMITTAL Date: 2' If- 0l Job No. 98105.317 Attn: Robert Morris, P.E. Re: SSTS for Astro Associates - Lot 17 Longview Drive, Town of Patterson TM# 13 -3 -55.17 ® Enclosed ❑ Under separate cover via ® Prints ❑ Plans ❑ Change Order ❑ ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION 5 1 -22 -01 CD -1 Construction Drawing _ 1 1 -22 -01 CP -97 Construction Permit 1 1 -22 -01 WP -97 Well Permit 1 1� 1 I ---- ----------- - - - - -- 12 -27 -00 --------------- - - - - -- LA -97 CA -97 PC -97 Letter of Authorization Corporate Affadavit Application for Approval of Plans 1 ; 2 -12 -01 - - - - - -- Short EAF 1 12 -29 -98 DD -97 Design Data Sheet (previously submitted with subdivision application) 2 --------------- - - - - -- -- - - - - -- I Modular 5 Bedroom House Plans 1 _ ?,� oI 2�58� $300.00 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 ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ REMARKS: COPY TO: SIGNED: /y, �'—J4 �/Ohn M. Watson, P.E. IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE Iot2000.dot PUTNAM COUNTY DEPAR'T'MENT OF HEALTH DIVISION OF ENVIRONMEN'T'AL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: WK %j% v j12W 2. Name of project: SS j S o ccr Locati4 V: ITrRS� Insi.te Engineering, surveying & Landscape 4. Design Professional: Jeffrey J. Contelmo, P.E. 5. Address: prghitegturp, p.c. 6. Drainage Basin: Route 22 ����,Gt}t�; /.� i,✓�,;�('S(�t� 7. Type of Project: _ 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? ......................... wo 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... 13. If so, have plans been submitted to such authorities? ....... ............................... o 14. Has preliminary approval been granted by such authorities? , V0 Date granted: 15. Type of Sewage Treatment System Discharge.... ............. surface water -kgroundwater 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? ....... ............................... No 19. If yes, name of water supply % Distance to water supply i A 20. Is project site. near. a public sewage collection or treatment system? ................ ,'Jy 21. Name of stem s sewage g y �/� Distance to sewage system 22. Date test holes observed 23. Name of Health Inspector A��{ STf�CJNC 24. Project design flow (gallons per day) ............ 11600 ) 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... V0 26. Has SPDES Application been submitted to local DEC office? ......................... NIA Form PC -97 2 27. Is any portion of this project located within a designate i otitia r= wetland ?_ 28. Wetlands ID Number .......................................................... ............................... 29. Is Wetlands Permit required? ..... ..................... .....:....... ............................... Has application been made to Town or Local DEC office? ................................ 30. Does project require a DEC Stream Disturbance Permit? .............. I.................. o 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' U 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? ............................... YeSQ iUQ DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... 0AIL, lo,.vAl' 34. Are conununity water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................. ............................... U6 KAfowd 35. Are any sewage treatment areas in excess of 15% slope? . ............................... hl0 36. Tax Map ID Number .......................... .:............................. Map_ Block Logo 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 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 affrrm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: insiteFngineering, Surveying & Mailing Address: ...............:. .................. l andgrana i hitecti9 re,.R C 1485 Route 22 — —BFewster, New York - 6569 P TNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of LfRO AS ocIA re; Located at &V SW Tax Map # 1. 3 Block 3 Lot 5 Subdivision of AS -6RQ AsSooAfi5S $ 00 Subdivision Lot # /'r% Filed Map # Date Filed Gentlemen: This letter is to authorize Invite IIZgfneering, sazveying & Landscape Architecture, P.C. (Jeffrey J. Contelm a duly. licensed Professional Engineer. �_ ox==dxkrzbftodxxxxxto apply for the required wastewater treatment and/or water supply permits) to serve the above -noted property. in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary, Code.. `� Carr;` Very truly yours, Countersigned: I Mailing Address mite & Landscape vcture;'`P.C. Route 22 B-ei ,-Nw YbrAe 10509 State New York Zip 10509 Telephone: (914) 278 -4990 Signed: (Owner of Property) A510 ASS6C',RTES Mailing Address: C /oj ou j S PE5C6 b RE 92- 5r0 6UEE45 b0UL5VA90, GV AP RK State MEW `(OAK __Zip h3?q Telephone: I - -71 B - �79 °2640 Form LA -97 i;=;r � 17 iPUI'NAM COUNTY DEP.AR-TMENT OF HEALTH DIVISION Off' ENV R.ONMEN`'AL �I &A LTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owners��O /�SSFiG�r S �.lG Address AA---c ,��iR,c , �` Y / /3i Located at (Street) ,v Y-5 A7- 311 �'�y''4 Tax Map /3 Block 3 . Lot SS's i7 (indicate nearest cross street) Municipality i Drainage Basin cftsi 8xlwcl/ Date of Pre- soaking SOIL PERCOLATION TEST DATA Date of Percolation Test Hole No. Run No. Time Start - Stop Ela se Time (pMin.) De th to Water Prom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 17 A, l 10: � � -lu;.v c� 23 3 3 3 ` a �1 3 lo.`s - o. , 2 Z 3 "= 4 5 2 IV" 1'2 - h?: z Zy "- Z7'' � 3 3 !v; 3 d 2i4 27" 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 2 TEST PIT DATA ..."_::.._ DES.CRTI''I'ION : OF: S.OILS.1NCGUNTER.ED.IN,TDST.,�L DEPTH HOLE N0. i 7/. `HOLE NO. ,:Z 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' ;Locx. fzlezil Indicate level at which .groundwater is encountered Indicate level at which mottling is observed 1•,,� Indicate level to which water level rises after being encountered Deep hole observations made by: S „aN ;M. w�����, Date Design Professional Name: Jeffrey J.. Contelmo, P.E. Address: Incite Ehgi- ing, Surveying.& Landscape Architecwm, P. 1.-4875•.Route 22 Brewster, New York.10509 Signature: Design Professional's Seal C. o 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: krko A S SO C ► Q 115 1, Louj S f 5CA IbP`E. represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: ASS S OCI TES Having offices at: 92 - 50 Q UEr NS Bo yL E ✓A R0 � JF�o P Whose Officers Are: President - Name: LQU1 S PESCA 0P £ Address: SAM F T 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. Sworn to before me this day of month) l2— (year) Notary Public CARL M. CESAPANO Wary Public, SWP of New York N,.6001043 Qualified in Queens C""ly Commission Expires Dece'lloe, 22, J� Form CA -97 Signed: Title: _ Corporate Steal 14 -16-4 (2/87) —Text 12 ,.uPJECT I.D. NUMBER 617.21 SEOR Appendix C State Environmental Quality Review SHORT .ENVIRONMENTAL ASSESSMENT. FORM For UNLISTED ACTIONS Only' PART I— PROJECT INFORMATION (To be completed by Applicint,or Project sponsor) 1. APPLICANT !SPONSOR Sl a rfn 2. PROJECT NAME, SS''S Re A,5 go- L o r -i* 3. PROJECT LOCATION: &IAIA Municipality i r QlV County 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) ` Se't L©clipcosi tiAe dq if- ()AjS1fvGTIOjai'.. POW/ tf 5. IS PROPOSED ACTION: New, . ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: CoNsI I(cr od cic rjm AL - U5iO A166 , ft, V' WAY , sS 5, i'JCLL. AP4 APPyKTr."NANccS 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately '✓ +�7�� acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? d° es ❑ 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) ?, Mes ❑ No If yes, list agency(s) and permlVapprovals GeIVEL1 y fUmIr- I OVA/ of I (OrVsViv sstsL Wf-iL A'T1VAM' CCJ,V'r, 05101 A5 Pi. IL.OInaC 1f- '0 .1;: TE X, 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes `Nl It yes, list agency name and permitlapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes , I. CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: �L�f� �� vJA 13cd Pd. Date: 21— 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 Department of Environmental Protection 465 Columbus Avenue Valhalla, New York 10595 -1336 Jodi A. Miele Sr., P.E. Commissioner Bureau of Water Supply Michael A. Principe,.Ph.D. Acting Deputy Commissioner Tel (914) 742 -2001 Fax (914) 742 -2027 �hpokl rAi vvao /`/ l ,ww:nyc gov=dzp (718) DEP -HELP March 8, 2001 Robert Morris, RE Putnam Co. Health Dept. 4 Geneva Road Brewster, NY 10509. Re: Astro Associates Subd. Lot 17 NYS Route 311Nista Lane Patterson, Putnam East Branch Reservoir DEP Log # 10746 (Joint Review) Dear Mr. Morris: 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 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 "SSTS for Astro Associates Lot 17 ", dated 01/22/01. The applicant must contact Sissy De 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, ' t / � "DS9,9 Lloyd, P.E. Supervisor Engineering Design & Review xc:. James Covey, P.E., NYSDOH PROPOSED HAYBALE BERM INSTALL IMMEDIATELY BEHIND SILT FENCE J i 1�, s �' M .o 1' -0' Roe ti RCP (150 CYt) REQUIRED ' / y/ I 80X ('I EXPANSION ABSORP77ON TRANaiES (TYP.) cy �• TOWN R£GULA7ED WEILANO h �� • 1�, ' i PRIMARY ABSORP710N 0�'• ' 7RENCHES (TYP.) L- PROPOSED ROOF AND R® t l F0077NO DRAIN SILT 'O�Y9so Ash- ' () �' o yyE71,04D BUFFER 100' 2 i PROPOSED WA7ER I \ 80 68 ' SERNCE CONNEC77ON i �V 5' DIA. INLET M 5" DIA. OUTLET. J I NT w I DROP C 00 J* X88 o..., �_} PaFu� `�` ZA;l X tk