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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13.07-1-32 BOX 6 ,r { 1. r .�� em - 00263 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health October 30, 2009 William O'Brien 906 Route 311 Patterson, NY 12563 Dear Mr. O'Brien: DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Addition- Approval — O'Brien No Increase in Number of Bedrooms 906 Route 311 (T) Patterson, T.M. # 13.7 -1 -32 I have received and reviewed the plans for the proposed addition to the above mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from the Department dated October 28, 2009. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at four without prior approval by this Department. 2. The wasteline for the detached garage must be connected to the existing 1250 gallon septic tank. This requires a separate permit from the Putnam County Health Department and the installation must be done by a licensed Putnam County Septic System Installer. 3. The new media room (former garage) is to remain unfinished and unheated. 4. An inspection of the repair and the new addition (including the existing house) must be made by a representative of this Department. 5. The area of the existing sewage disposal system, and its expansion area, must be maintained. 6. All plumbing fixtures must be updated with water saving devices, i.e., new-low flush toilets, restrictors for shower heads and faucets, etc. 7. The approval is for the proposed changes only. This approval does not validate any construction shown as existing that has not obtained proper approvals. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Patterson. If you have any questions, please contact me at your convenience. K spectiuny, Joseph S. Paravati, Jr., PE Assistant Public Health Engineer JSP:kly cc: J. Bonelli, RA BI, (T) Patterscnvironmental 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 Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 a SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH o a 1 Geneva Road. Brewster, New York 10509 ADDITION APPLICATION RESIDENTIAL ONLY CJ STREET IVD�9 ®;311 TOWNLWZ ✓ TAX MAP # d� — "3 NAME /� /,�,`� (L��3 PHONE BLt S_-6 ?0" Z ZC19 PCHD# MAILING ADDRESS `? h /O C3,// A_) V /oZsGo�3_ DESCRIPTION OF ADDITION Pao rm Or> ST© DAME t>CJ1A C N ED, &Al 0Y_-, F LoPr NUMBER OF EXISTING BEDROOMS 3 �P OPOSED # F BEDROOMS (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) * *Any addition which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, Brewster, NY 10509, Phone: (845) 278 -6130. 1. Certified check or-money order for $100:00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement, to be shown and dimensioned and use of each room specified). (See Section 3.c of Bulletin HA -1) 3. Two sets of proposed floor plans (drawn to scale — with name, street and tax map #) * Non- professional sketches are acceptable and preferred. (See Section 3.d of Bulletin HA -1) 4.. Copy of survey showing all well and septic locations on the subject property to the best of your knowledge. Include date of installation known. Contact this office with any questions.. 5. Copy of Certificate of Occupancy from the Town or Certification from the Building Department with legal bedroom count of dwelling. OFFICE USE COMMENTS 5. 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 Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 a 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. BOND[ County Executive ROBERT MORRIS, PE Director of Environmental Health Town Legal Bedroom Count & Proposed Addition Status. Re: &14l " 0 t -°�✓ (Owner's Name) Tax Map.# Address: Town: Year Built:lj�j According to records maintained by the Town, the above noted dwelling, is in. compliance with Town Code. Is not in compliance with Town Code. The Legal Bedroom Count is: '' a� This information has been obtained from: Certificate of Occupancy: Z Other: & The plans for the proposed addition are considered: . New Construction Addition to existing house only Teardown and /or re -build allowed under Town Regulations Building spect % , ate 6. 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 Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 JOHNA. BONELLI ARCHITECT 93 Cortland Road Mahopac, New York 10541 October 1, 2009 Department of Health 1 Geneva Road Brewster, N.Y. 10509 Re: Owner: William O'Brien 906 Route 311 (T) Patterson, T.M.# 13.7 -1 -32 Phone 845 - 621 -8786 Email jab5368 @yahoo.com Please see the enclosed application and all required supporting documentation regarding the above - mentioned project. Please feel free to call me with any questions regarding this project. I can be reached at (914) 356 -5340 at any time. Thank you, John A. Bonelli R.A. s . ':i i�•.�S�c'i'tR CERTIFICATE OF OCCUPANCY AND COMPLIANCE 'Tv�jn of 'pattmon., Ntfu Rark N °_ 1119 M 2.002 DATE ISSUED October 21, THIS IS TO CERTIFY TH Inc. 0 ON THE-PROPERTY OF Same LOCATED ON 906 Route 311 HAS BEEN SUBSTANTIALLY CONSTRUCTED. TO THE REQUIREMENTS OF THE BUILDING CODE, ZONING ORDINANCE AND LOCAL LAWS OF THE TOWN OF PATTERSON, NEW YORK AND MAY BE OCCUPIED AND USED AS- Sincite Famitti Three Bedroom DwettinQ w/Finizhed Bement Two-CaA Garage Linden and 12 x 16 ReoA Deck Building Permit Dated Permit No. ...334.9... Application No. ....3279 .................. SECTION ......... jM BLOCK .........I .............. LOT...... . 32 .............. FEE $ 25.00 BUILDINh""INSPECTOR PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # ' - v Located at tT wn or Village Owner /Applicant Name 7AZ10C, lAdD t/: "1 'ax Map 1. ,49� Block/ Lot Z? Formerly Subdivision Name Subd. Lot # Mailing Address 1 � 46 IA16t Z Zip leo Date Construction Permit Issued by PCHD G,4 Separate Sewerage System built by 7 coAN /mlp i)A/pvj_,:�vlAddress 71 d`- •T,�'1A/�i� t�,�'. A414tk' t6,�J, Consisting of 18.60 Gallon Septic Tank and 4 L.,- !'f 'W/x;k ,d " p -riakt -IA-'t�New Other Requirements: A�✓a e;rd 44r, -,J A ,�,!/✓ J 2 c : 41klf3Aiie ' °° ° ' Water Sup&: Public Supply From. Address or: Private Supply Drilled by Address Building Type Z.-0/1 4- Has erosion control been completed? Dumber of Bedrooms 15' Has garbage grinder been installed? _ A�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 standar s; rules and regulations-of -&d`Pu - ®unty: I)eparCment of Health. Date: 1.i �'� Certified by .Ff P.E. vl R.A. -.� ;— ,� (Design Professional) Address ?,117 -AI44 ! ' 4.I- � Ai-!079 651 License # e6 l" 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- 10ject to odificationr or change ,when, in the judgment of the Public Health Director, such revocation/in di icatimr} b) change is necessary. By: i' Title: / - Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 irl � i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # P- 6-04. Located at PPS ..� /l To r Vill SOS Owner /Applicant Name IMCOn/!C ZAVD J) aELDpA&Wrax Map / 0,0'7' Block / Lot Formerly Subdivision Name Subd. Lot # Mailing Address 7? S°7F, A16iZ %/Ob,4G 4 Zip /Os Date Construction Permit Issued by PCHD 3, /8- W Separate Sewerage System built by 7 1.44 P0gQPAdWAddress L9 DR. A4949p4L9ti%i Consisting of 1,W50 Gallon Septic Tank and 4+wL.r oE �VV <p�' A p-rzadZ�2Eic/G1% If Other Requirements: /o% 0 0.4,440AI Pi/M� C/,lgMf3e�2 Water Supply: Public Supply From or: ✓ Private Supply Drilled by Address Address Building Type 51AJ&4, eA*74 Has erosion control been completed? V/E5 Number of Bedrooms Has garbage grinder been installed? AJO 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 standar s, rules and regul Pa ent of Health. Date: t. 0 IS 11'�-Certified by P.E. ✓ R.A. DD (Design Professional) Address /t/?�c/gnrl ,cl�r/ ,��,�/ - t �� E License # �1 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 ar s ject to odification or change when, in the judgment of the Public Health Director, such revocation, m di icatio change i necessary. By: Title: J I,i L Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location eet Address: 31'v T wnNillage: _ LL=l Tax Grid # Map 13,d7Block / Lot(s) 3a Well Owner: I Name: Address: T460AJ1G I-AAlD '��UGLO A11E1,I�. ZResidential Use of Well: I- primary 2- secondary C Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing ]?� Open hole in bedrock _ Other Casing Details Total length O ft. Length below grade 39 ✓ft. Diameter in. Weight per foot _lb/ft. Materials: _--/- Steel _ Plastic _ Other Joints: _ Welded ?�' Threaded — Other Seal: . Cement grout _ Bentonite _ Other Drive shoe: -_' Yes _ No Liner:_ Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes No Hours Second Well Yield Test _ Bailed _ Pumped -74 Compressed Air HouWf Yield L gpm Depth Data Measure from land surface - static (specify ft) o l During yield test(ft) Depth of completed well in feet 3 ocs 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 G /' If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type 14 Capacity Depth W Model Voltage V HP Tank TypeWWIV Volume 60 Date W II Completed 77 o Putnam County Certification No. 9 Date of Report Ph 1-d 71 ell Driller (signature) NO E. /Exact location of well with distances to at least two pertnrntAanamarxs to tie provided on a separate sl►ccuN►a,1. Well Driller's Name Address�S Signature: Date: /d ZV'' White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Lt�- Form WC -97 �.y.l OCT -07 -02 12:52 PM TOWN OF PATTERSON - • - • «, u r r.AA 1146 2798760 PUTNAM ENGINEERING BRUCE IL FOLEY Publie Fhal►A DIrraor 9148782019 DEPARTMENT OF HEALTH 1 Genova Road Brewster, New York 10309 P.01 ® 0021002 LORErrA MOLINARI AN., M.S.N, Anoclale Ablie HfidA Drreeror Dfreator of Padlenf Servrte9 EmAronmtnsol Htilth (914) 278.6130 Fix (914) 276 - 7921 Nursing Services (914)219-6559 WIC (914) a7S • 6678 Fox (914) 278.6035 Early totermoon (914)178.6014 Preschool (914) 278.6082 fix(914)278-664S E911 ADDR 4, LURY I� CA11Q T ORD� ONV&ERS NAME: C :-71G TAX MAP NUMBER,. 1/ . 0 - / -- 3-7, E911 ADDRESS: ��Ol U?IT�" W T %ir3'�S'7�'fiYi OWN: f�l AUTHORIZED T08VIX OFFICIAL: (Signature) &A� BATE: � The Putnam County Department of Health will not Issue a Certificate of Construction Compliance unless the above form is completed, i.e., a Iegal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (Eg 11 VEfiMN%) PUTNAM COUN'T'Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map Block Lot Building Constructed by Town/Village X G / ! �i� /Spit, N I'✓ Location - Street Subdivision Name Am 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 ofthe 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 thebuilding utilizing the system. Dated: Month JQ Day __�_ Year Z002,,, General Contractor (Owner) - Signature Corporation Name (if corporation) Address: State Zip Signat Title: _, Corporation Name (if corporation) Address: / '!!� P Z-e--""e �Z State/ Zip aj % L- Form GS -97 `� 0 � YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 93.203024 CLIENT #: 55952 NON STAT PROC PAGE .1 TACONIC DEVELOPMENT IN .`` DATE/TIME TAKEN: 09/19/02 11:00A 42 KAITLIN DRIVE -~ DATE/TIME REC`D: 09/19/02 12:35P MAHOPAC, NY 10541 REPORT DATE: 09/30/02 PHONE: (914)-490-4493 SAMPLING SITE: 906 RTE 311, PATTERSON, NY SAMPLE TYPE..: POTABLE : PRESERVATIVES: NONE COL'D BY: ROBERT J. PANNY TEMPERATURE..: < 4C NOTES...: WATER TANK COLlFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 09/19/02 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 09/19/02 LEAD (IMS) <1 ppb 0-15 ppb 9101 09/19/02 NITRATE NITROG <0.2 MG/L 0 - 10 9139 09/19/02 NITRITE NITROG <0.01 MG/L N/A 9146 09/19/02 IRON (Fe) <0.060 MG/L 0-0.3 mg/l 2037 09/19/02 MANGANESE (Mn) <0.010 MG/L 0-0.3 mg/1 2037 09/19/02 SODIUM (Na) 3.94 MG/L N/A 09/19/02 pH 7.0 UNITS 6.5-8.5 9043 09/19/02 HARDNESS,TOTAL 40.0 MG/L N/A 09/19/02 ALKALINITY (AS 42.0 MG/L N/A 09/19/02 TURBIDITY (TUR <1 NTU 0-5 NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WAT WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD E NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential., ublic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium that for people on a contain no more than moderately restricte' is suggested. are proscribed. Suggested guidelines state sodium restricted diet,the water should 20 mg/L of Sodium. For those on a diet, a maximum of 270-mg/L of Sodium � YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-280O Albert H. Padovani, Director TACONIC DEVELOPMENT IN DATE/TIME TAKEN: 09/19/02 11:0OA 42 KAITLIN DRIVE DATE/ TIME REC'D: 09/19/02 12:35P MAHOPAC, NY 10541 REPORT DATE: 09/3O/02 PHONE: (914)-490-4493 SAMPLING SITE: 906 RTE 311, PATTERSON, : COL'D BY: ROBERT J. PANNY NOTES...: WATER TANK DATE FLAG PROCEDURE NY SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLlFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ PH. pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5., Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT' TO WHICH THE WATER HAS BEEN SUBJECTED" SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L MODERATELY HARD WATER: 70-140 MG/L MG/L = MILLIGRAM PER LlTER HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L> SUBMITTED BY: Director ELAP# 10323 �00� �EPal��fii.pN %f 3 Cl G d � 2 z i i IN �1 cl� yam' E ....... ... IREVISIONS WELL 0 1 (1. 0 1 '11 WNE.. 5 q 10 11 12 15 14 15 16 17 AP77�7r�;� cr 1, .6 NV 91 130 Z6, N_ 04 SOMIS HOV31-1 3 138 133 12$ 143 ill 115 E3. 136, 41 13f I2r7.cj 120 IQ?, 97 13.3 117 Ill 105 100 94 66 IREVISIONS WELL 0 1 (1. 0 1 '11 WNE.. HITE-CTS AP77�7r�;� cr 1, .6 NV 91 130 Z6, N_ 04 SOMIS HOV31-1 3 Ilk F;A_ ACCESS EASEMENT AS PER F.M. 2385 __ _ _ r ..• ••vc• .,y .- VGVLLVG '�ti. O[JG(.11Gl,, JL'G. ( Llber 1525, Page 430 ) concrete S 32 °45'00 " E X11- 101, found ar s, found w. �o ^ hon pin found N 32°45'00" W i J t h ° poet fame 252.28' 282.57' km Poe tot now or formerly HILLIAM R. & GARNET MAE DALEY ( Luber 575, Page 411 ) roted and limited below, only to. EVELOPERS & BUILDERS, INC. .E SERVICES L 7D. ( IWO No. T7P -14516 ) INSURANCE COMPANY AREA = 1.0 >48 ACRES seal, signature and any certification aooearino htorann Y QQ ;I^A C"" r-r t o� a a v !V a o� a a, I Concrete o,-b Structure pde 4 O C y O a � 0 `W .al, o ;, 9 n SURVEY OF PROF PREPARED FOR TACONIC D F, VF I.� PUTNAM COUN7Y DEPARTMENT-OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE MPECTION Date: v 2 Inspected/by: FEj2_ Street Location `��-, % / Owner L AN D -7Q9 v. Town ;� 7- 7- E7Z Sc>n/ Permit # ice— €s —'o �? TM € 1 c9 7 — / — 3 2 Subdivision Lot # 1. Seivage Svstetn Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil-not stripped .................................................. d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. Sewage System a. Septic tank size -1,000 ..:..::1,250 .......other.......:........ 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. Trenches Length required Length installed 5vG,o 2. Distance to watercourse measured.+ r ovFt.......... 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 X30 inches from surface .................. 7. Room allowed for expansion, 100%... ...................... 8. Size of gravel 3/4 -1%2" diameter clean .................... 9. Depih of gravel in trench 12" minimum ................... 10. Pipe ends capped ........................ ......:...:.................... g. Pump or Dosed Systems 1. Size ot pump chamber ................ ............................... 2. Overflow tank ......:..................... ............................... 3. Alarm, visual/ audio .................... ............................... 4. Pump easily accessible, manhole to grade ................ 5. First box baffled ........................................ : .......... .... . 6.- Cycle witnessed by H.D.estimated flow /cycle......... III. ouse/Buildin a. house locate d per approved plans .. ............................... b. Number of bedrooms ..................... ............................... IV. Well aa. Well located as per approved plans .............................. b. Distance from STS area measured-.,-/ '73 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 plat f. Curtain drain outfall protected & dinto exist watercoi g. Footing drains discharge away from STS area............ h. Surface water protection adequate ................. ....... ...:.:.. i. Erosion control provided ........... :................................. Alt 2796769 PUTNAM ENGINEERING PUT CO HEALTH PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL ELEALTH SERVICES ATTENTION 13 ADAIM. �4 GENE All information must be fully completed prior to any inspections being made. For: Fill Trenches PCHD Construction Permit # T) (V) A-Z. Located: a_ Owner/ApplicantName: 12-r-7 Block.--:/— Lot Formerly: Subdivision Name: Subdivision Lot Is system fill completed ? Date: Date: 7' Is system complete? Wo Is system constructed as per plans? dnr Is well drilled? r Date, 7A 11)4, Is well located as per plans! Are erosion control measures in place? [a 001/001 I certify that the system(s), as listed, at the above premises has been constructed and I ha,,,,e 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, 7 _X ...... .. ... ..... I` c Certified - ' . .:;d 7 PE Date., %,,ertified by. RA Design Professional Address: ,7- # Comments- 6"! S' d, Form FIR-99 JUL-9-2002 MON 23:35 TEL:845-278-7921 NAME:PUTNAM COUNTY DEPARTMENT OF P BRUCE R. FOLEY Public Health Director July 12, 2002 DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 . Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Paul Lynch Putnam Engineering 4 Old Route Six Brewster, New York 10509 Re: Field Inspection - Taconic Land Development Route 311, (T) Patterson TM## 13.07 -1 -32 Dear Mr. Lynch: The SSTS trenches only on the above referenced property can be backfilled. The following comments must be corrected in the field. 1. It appears the pump tank is higher in elevation than the septic tank. The slope of the pipe from tank to pit need to be verified. 2. A pump test needs to be witnessed by this Department once the electrical inspection has been completed and notification of such has been submitted to this Department. 3. A bedroom count needs to be performed by this Department upon further completion of the dwelling. 4. Speed levelers may be needed injunction boxes to insure a more equal distribution. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. GDR: cj Sincerely, / ---I/ Gene D. Reed Environmental Health Engineering Aide e SENDING CONFIRMATION DATE : JUL -15 -2002 MON 08:11 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 92796769 PAGES : 1/1 START TIME : JUL-15 08:10 ELAPSED TIME : 00'23" MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... Paw Lynch Putnam Broneedas 4 Old Route Six Brewster, New York 10509 Re: Field Inspection - Taconic Lend Development Route 311, (T) Patterson Tai# 13,07 -1 -32 Dear Mr. Lynch: The SSTS trenches only on the above referenced property can be backffikd. 17he following comments must be corrected in the field I . It appears the pump tank is higher in elevation than the septic tank The slope of the pipe from tank to pit teed to be verified 2, A pump teat needs to be witnessed by this Department once the electrical inspection has been completed and notification of such bes been submitted to this Dcpsrunent 3. A bedroom count needs to be performed by this Department upon fiuthor completion of the dwelling. 4. Speed lavdcre may be needed injunction boxes to insuro a more equal distribution if you have any finther questions, please contact me at (845) 278 -6130 ext. 2261. Sincerely, Gene D. Reed GDR:cj Environmental Health Egkmriag Aide • BRUCE R. FOLSY 0. 1GWffA MOUNAR2 R.N., M.S.N. P.6ne Rma6 D6ubr A—Mft P.Mra H-0 D1,wW Jkw• b, Qr Pati•N .A�.r:e•. DEPARTMENT OF HEALTH I Geneva Road Browner, New Yoder 10509 ¢eMn.neM.l 9.+b6 (1979176.6136 Pu(695)271 -7921 3"Wi (945)271 -6591 WW (9479271.6676 106(195)278•603 • ¢.r1Y lea7n.n.a (94s)X76 -e019 iu(648276.6668 fradwd (945)228-5912 Vm"223.6112 July 12, 2002 Paw Lynch Putnam Broneedas 4 Old Route Six Brewster, New York 10509 Re: Field Inspection - Taconic Lend Development Route 311, (T) Patterson Tai# 13,07 -1 -32 Dear Mr. Lynch: The SSTS trenches only on the above referenced property can be backffikd. 17he following comments must be corrected in the field I . It appears the pump tank is higher in elevation than the septic tank The slope of the pipe from tank to pit teed to be verified 2, A pump teat needs to be witnessed by this Department once the electrical inspection has been completed and notification of such bes been submitted to this Dcpsrunent 3. A bedroom count needs to be performed by this Department upon fiuthor completion of the dwelling. 4. Speed lavdcre may be needed injunction boxes to insuro a more equal distribution if you have any finther questions, please contact me at (845) 278 -6130 ext. 2261. Sincerely, Gene D. Reed GDR:cj Environmental Health Egkmriag Aide 09/18/2002 15:10 FAX 845 2796769 BRUCE R. FOLEY Public Health Director PUTNAM ENGINEERING PUT CO HEALTH IM002 /002 ..... ...... ... . DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI• RN., M.S.N. Associate ,Public Health Director Director of Patient Services ATTENTION: ❑ ADAM STIEBELING i ;GENE REED All information below must be f dll completed prior to any scheduling. DATE: ENGINEER OR FIRM: �' ~} r, . PHONE #: REASON: DEEPS: a PERCS: o PUMP TEST:;Q ROADISTREET: TOWN: -�:. ; a TAX TvIAP #: 13-07-1-37 SUBDIVISION: = LOT #: i OWNER:sn n .n ►: YES NO o :zr' Proposed SSTS within the drainage basin of West Branch or Boyds Corner Reservoirs. o tf Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. Q A' Proposed SSTS within 200 feet of a watercourse or a DEC wetland. o cr, Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. 0 Proposed SSTS for a Commerical Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered)= to any of the questions, NYCDEP must witness the soil testing. This Department will coordinate a mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. FOR COUNTY USE ONLY DATE: TIME: v �� ih Lir!TS% % . / ©© (FI LDTEST) TCI •Mdg- a7A -74PI NAME:PUTNAM COUNTY DEPARTMENT OF P. '2 �►�il r 1 PUTNAM E NGINEERING, PLLc Engineers and Architects P SEPTIC SUBMISSION FORM TO: A,�,e7 /� ®/�, %J��• DATE: PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: ZAC006 /-d/, 0/ PTT4iCSolj ENCLOSED, PLEASE FIND: Ld COPIES OF THE SSDS "AS- BUILT" PLAN o,• jjebV1st7 S57"S; Ef CONSTRUCTION COMPLIANCE CERTIFICATE EY WELL LOG a HEALTH DEPARTMENT FEE ($200.00) WATER ANALYSIS 0 GUARANTEE FORMS - 3 ORIGINALS a E 911 ADDRESS FORM 0 REMARKS: COPIES TO: LETTER OF EXPLANATION ' SIGNED: 4 OLD ROUTE 6, BREWSTER, NEW YORK 10509 • (845) 279 -6789 • FAx (845) 279 -6769 • EMAIL: puteng @bestweb.net , Separate Sewer gg System'to consist of 1c?5o. gallon septic tank and:��- • ' o Other Requirements: ' To be constructed by. ;Tb Ae :�! ,Vi`,t1 D.: ...Address, - Water StAiDM . Public. Supply From . , Address Private Supply Drxlled.by. ?O t�E ,G7E +9 /�tl Address I representthat I am wholly and.*eoriipleiely responsible for the design.and location of the proposed sys* (s):and that the sgparat�ge treatment system described; above will be constructed as 'shown on the approved amendment thereto and in accordance With the standards; rules and regulations of he Putnam Cotinty.Deparunent of Health, and that on completion jfli eof a. "Certificate of Construction Compliance" satisfactory,to the.Public Health Director will be submitted to the . t. Department, and A. written guarantee will be furnished the owner; his successors, heirs or assigns:by the:builde.r, that said .builder Will place in good.operating condition any partof said sewage treatrnent system during the period of 60.(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 therI t' Signed.. P E R.A D ate %.ao?•aAZ Address lc�7�11:. J -- !tl� to License. #. APPROVED FOR CONSTRUCTION: This approval "expires two years from the'date issue,.d unless construction of the sewage treatnie stem has been completed and inspected by the PCHD: amid is revocable for cause or may be.amerided or modified wh. co idered n ssary bythe kbiic Heal&. Director. Any revision or alteration of the. plan requires s- anew permi A roved f ischarge of domestic sanitary sewage only. By: Title. '� Date,,,. White copy = HD. File; Yellow copy - Building Inspector; Pink copy. - Owner; Orange copy - Design rofessional Form CP -97 i 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PE R SEW MTor L ENT SYSTEM PERMIT # Located at 1-:2e&725- T� e /�,�T4- S?Ne J Subdivision name /v Subd. Lot # Tax Map 13,07 Block % Lot Date Subdivision Approved Renewal Revision Owner /Applicant Name 7,4C©M6 1-/JaiP t Date of Previous Approval Mailing Address 79 Y7-4 15 W, , 0,4,0p,46, �JVi Zip /0-'eW ov Amount of Fee Enclosedltupd A4 C. Building Type i T�- Lot Area 1,olle No. of Bedrooms _� Design Flow GPD &V Fill Section Only Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist �of� 1,;?50 gallon septic tank and OnG•F n�— Other Requirements: To be constructed by Z-7 06 , )E ie!?M` AD Address Water Suunly: Public Supply From or: Private Supply Drilled by 70 &- Address Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the ;separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs theret_ o Signed: Address P.E. R.A. Date A Va dtVa f{ya tPc & License # Ob74141& 0FZW5r, Al Y, /o t' i� APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatmeritewstern has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified whe con idered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permi A roved f ischarge of domestic sanitary sewage only. y By: Title: dkk--- Date: la 2— White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design frofessional Form CP -97 77 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type /-1 PCHD Permit # F - Lo o Well Location: Street Address: o illage Tax Grid # A772�0,.% Map / -4,,07 Block / Lot(s) 3,.2 Well Owner: Name: r "AjiG Lam Address: p&-y—okv "Exir I `l `? 67-0,o�46W it - M /V* AC9 �c1. X05 Use of Well: a/' Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought �' gpm # People Served 6 Est. of Daily Usage OAP gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason 61je1z, &,211 for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...... Yes No ✓ Name of subdivision Lot.No. Water Well Contractor: 7 43E Z)Z7APM1A1 D Address: Is Public Water Supply available to site? .................................. ............................... Yes No e/ Name of Public Water Supply: Town/Village Distance to property from nearest water main: /, ,r1,;z,E It Proposed well location &sources of contamination tolquovid d et/plan. Date: 1,,Pa • -VV4 � Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water a driller certified by Putnam County. A Date of Issue Permit Issuing Date of Expiratio Title: Permit is Non - Transfer abl White copy - HD file; Yellow copy - Building Inspector;..: Pink copy - Owner; Orange copy - Well driller Form WP -97 SEPTIC SUBMISSION FORM TO: �e)6�T DATE: jaa I o Z PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: 13 WELL PERMIT APPLICATION 0' HEALTH DEPARTMENT FEE ($300.00) lad SHORT EAF DESIGN DATA FORM Lkr LETTER OF AUTHORIZATION ❑ APPLICATIONTOR WASTEWATER TREATMENT (PC -97) ❑ LETTER,OF EXPLANATION REMARKS: COPIES TO: 4 OLD ROUTE 6, BREWSTER, SIGNED: • (845) 279 -6789 • FAx (845) 279 -6769 • EMAIL: et ENCLOSED, PLEASE FIND: l COPIES OF THE SSDS PLAN COPIES OF THE HOUSE PLANS tJ CONSTRUCTION PERMIT APPLICATION 13 WELL PERMIT APPLICATION 0' HEALTH DEPARTMENT FEE ($300.00) lad SHORT EAF DESIGN DATA FORM Lkr LETTER OF AUTHORIZATION ❑ APPLICATIONTOR WASTEWATER TREATMENT (PC -97) ❑ LETTER,OF EXPLANATION REMARKS: COPIES TO: 4 OLD ROUTE 6, BREWSTER, SIGNED: • (845) 279 -6789 • FAx (845) 279 -6769 • EMAIL: et nr 1. Name and address of applicant: _� �2/ Lug . � � - -- --- ,.:mss•.. -T- iWW ilir i� !1. .4i �� ! _ 2. Name-of project: pN� t��a, � M 3. Load 4. Design Professional: �+ 5. Adclrss:' ` i W. o ' 6. Drainage Basin :.�iGrS / � �,�'t�I` a r 00. 7• PrivatefR identia! &Service Commercial Apattments . ,._,,,,,,,�,,;�fi�.onal ........ �)4iob_ .• I3q;e ar ile Office Buildingidioa ,.,.,.± :DjsA! a 8. Is this project subjecttmg.. a ent Quail a'R view , (SEQR)? . ....Type. Status (check one)..•.....»a. ..:.... .:.................:....... :::. Type I Pmt:; °` Type II Unlisted 9. Is a D 019 o rafl•Environmental °I f �e t ) a ted? ........... 10. t Has DIMS "been completed acceptable by Lead Agency? ......... 11. Name of Lead "A enc F g. Y 12. Is tlys:proje�t ,�n an area; % l of localpung, Mn g, pr�hsr, . - of�cialsi,ordinances?,,, y`�� i �t� • N���r••' �a• H• NMH. .'�Yi•iii.N1�.YN1•wN••f•�•'.�•i �♦ f ICi'�• .'�P ., »ti .� 13. if so, have plank beef Qr1�N }•••N1iiN!•i•.••Ny �IR•a••• .. .. >..4 t! ... 5 .. ,.. ...... 14. Has preliminary approval M te 45 15. Type -of Sewage Tittlarge.:...L,.,4 ,.. surf�ce.water, g0,10 �v Ater 16...If surface water +dis .. s clas dtgitation? ... ,: .... 17• Waters Er i9 rs index number (s i r 18. Is project }ldcate ' p1y'�s .:::::..::..:.:...::..... 19. If. yes, name •of water Iista}op;tQr spy; --�-�- " o 20.. Is project site near a p; M` collection or treatment.system? ........ ......... 21. Name of sewage •" g' } .. , ;rz ,. ;. Distance to sewage system AUW 22. Date test •hole's d ��' � t c 23. Na e'of Health Inspector G 24. Project design flo " ... Fa ! t 25. Is State Pollutant. " r " ttTOn System f 9FDES) Permit required ?... Q 26. Has SPDES . Aooliest•'t emitted to local DEC office? .....................:... 27 " Is.any port of this p j�ct l c i h�crithitt aldesi ated-Town or State wetlands 28. Wotl er *, 0, ¢ Y..►YYHeiY �YeYYY..�41.ei ►Y.J YAYeYHe{ YYYYee. e.e O. Ye. eYiYieJHYHNe Y..HHIH....- ...- ..- ... 29. Is Wetlands Permit'.rgp(]J�(; 6{r� y I, ii liyiiYe:Y Via. Y1y�►NY "yet YY Y�' � ►YfN..ereeY eY. eeY eee .................. Has application been r uffice? ....... .. .................... .... /JP 30. Does project require a DEC Stream Disturb ce.Permit? ................................... ,/0 31. Is or was project site used for..agdouttnral activity: involving application of pesticides to orchards or other Crops, solidi hazardous waste disposal, landf lling, sludge applicati� dust al activity? ............................ Yes/No.. 0 ., .. 32. Is project located within 1,Q00;, (f,existipg or abandoned landfill, hazardous waste site, salt si+ kiC andfill,`` §ludge`disposal site or any other potentially known sit 6"6' :af contamii htiori P1fJ'i'NAM COTJi�T ' ` N' ,. Q . *ALTH DIVISION 0` ff' 5 AL ALTS SERVICES . DESIGN DATA SHEET - S BIOR' R ''ACE SEWAGE TREATMENT SYSTEM Owner r _ 24 ga-6 a,��v >G l,� Addr .ss , 31, PA Tt,W soy% Located at (Street) 2 G' ��, �- Tak Mdp Z Block 1 Lot )-I (indicate nearest crossatreet) Municipality P,aTij2sor Drainage Basin. 69d—K&�i� kv SOIL AtOLATION TEST DATA Date of Pre - soaking Date of Percolation Teat De th to Witter Water From Ground Level Percolation Bole No. Run No. Starrt{ :„ 11a ` In !me Surface (Inches) drop In Rate Start Stop inches Nn/Inch 2, 3 . UfaucN.ne�lhia �!?4 i ra_ 4 r In 7 { NOTES: 1. Tests to be`N depth until approxitriately equal percolation rates are obthined at each: percolation ta't <IY'.` >s `l min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) A�Id,ta.tQ be submitted fo .r• t 2. Depth measure :i:,i�@i.mlde from top of hole. 5 to ;:•. , ��! �7 3 S 33 . 3 _ 3 .33. q 7 3 3 • -:,..: 3 33 3 . UfaucN.ne�lhia �!?4 i ra_ 4 r In 7 { NOTES: 1. Tests to be`N depth until approxitriately equal percolation rates are obthined at each: percolation ta't <IY'.` >s `l min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) A�Id,ta.tQ be submitted fo .r• t 2. Depth measure :i:,i�@i.mlde from top of hole. DEPTH G.L. 0.5' 1.0' 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' E,� 0 HOLE 2 HOLE NO. ENO , „1,^ HOI No. H Indicate level at whiqb Indicate level at- whje�j° Indicate .level to whidh Deep hole observations Design Pro Address: \ V f . i Q Sipature: -/0" Vii:: {',._: iY. _.. •< m :being«encountered u ! .` 11' W u Professidbul's Seal CD f ' encountered 1,leo�'- :being«encountered u ! .` 11' W u Professidbul's Seal CD M, co M y � L M PA ..O Postage r'.t7 Certified Fee ru Postage Postage $ O T. . O Restricted Delivery Fee p (Endorsement Required) qb. nj Certified Fee M P,ps_arl O Return Receipt Fee Total Postage & Fees William e. �^ b(Endorsement Required) or P 902 Roi O Clty, $ �"'I . Patterso or Peter Riebold c o crry 911 Route 311 `` S� p Restricted Delivery Fee • - - C1e T 920 Route 311 (Endorsement Required) c:j `` Patterson, NY 12563 O Total Postage & Fees $ 03/07/02 to rn SE - o Joseph Plaskett Jr. ... 0; Route 311 0 o c. Patterson, NY 12563 1 0 =PF- ". � M Postage ..O Postage r'.t7 Certified Fee ru Postage Ln ru Return Receipt Fee (Endorsement Required) O LJI O Restricted Delivery Fee p (Endorsement Required) G Total Postage & Fees fu M Sent.T— . O 0 Total Postage & Fees William ,� sire or P 902 Roi O Clty, $ �"'I . Patterso or Peter Riebold �; Ur tr- MPAI ". � off" , M Postage $ ..t7 M Postage Ln ru Certified Fee V9 ru LJI Return Receipt Fee (Endorsement Required) rrk O Return Receipt Fee (Endorsement Required) G O Restricted Delivery Fee p (Endorsement Required) iC] 0 Total Postage & Fees $ rLi (Endorsement Required) m Sent To 0 $ �"'I . or Peter Riebold c o crry 911 Route 311 `` ,.Patterson NY tr- mn o (t" M Postage $ 1,57 ARMCO V9 ru Certified Certified Fee rrk Ln Return Receipt Fee (Endorsement Required) G '' e �D C3 �a. iC] Restricted Delivery Fee C� p (Endorsement Required) foil Total Postage & Fees $ �"'I . M O Sent To - George Bueschel Sr. ° 920 Route 311 c:j `` Patterson, NY 12563 PUTNAM CO 'AR NT OF HEALTH DI'ION OF L1AL S'EALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Located at 1'2,pv)�r_ 9//. (�� T`r�llSo c/ T :Map # 1/31 07 Block I _ Lot _.1A, Subdivision of Subdivision Lot # Filed Map # Date Filed Gentlemen: This letter is to authorize a duly licensed Profession wastewater went and with the standards, rules a County Health Departma matter and to supervise tt inconformity with the pre Law, and the Pum= Countersigned: P.E., R.A:, # Mailing Address State Telephone: or Registwed Architect ` to apply for the required �mit(s) to serve the above -noted property in accordance omulgated by the public Health Director of the- Pumam necessary papers on my behalf in connection with this said wastewater treament and/or water supply systems 145 and/or 147 of the Education Law, the Public Health Very tAr Signed __ ) VCINEERINE, PLLE. Englneers and Archltects SEPTIC SUBMISSION FORM TO: A wr goyl -?Rm aE. DATE: 24�'� PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: r46 0,&116 /-Ag) r) AT7A-W-SCX) 2gy7E .311 ENCLOSED, PLEASE FIND: 9 4 COPIES OF THE SSDS PLAN ❑ COPIES OF THE HOUSE PLANS 3 CONSTRUCTION PERMIT APPLICATION La WELL PERMIT APPLICATION ❑ HEALTH DEPARTMENT FEE ($300.00 ) Of SHORT EAF 0 DESIGN DATA FORM ❑ LETTER OF AUTHORIZATION APPLICATION FOR WASTEWATER TREATMENT (PC -97) ❑ LETTER OF EXPLANATION REMARKS: COPIES TO: On 'NIA, f "-I i 4 OLD ROUTE 6, BREWSTER', NEw"YoRc`10509 - (845) 279 -6789 - FAX (845) 279 -6769 - EMAIL: puteng @bestweb.net 7) —Tefd 12 "t ix�n �try. o ECT I.D. NUMBER SECIR ' Appemb C 8t±e EaMlefliilelttal thlauty Review Si 4 T: C v-000HUNTAL ASSESSMENT FORM 'For`.t(NI.ISTEd ACTtON8 Only PART 1- PROJECT-INFORMATION ITo be comoliiQ -h- rAedUcant orProlect sponsor) APPLICANT fSPONSOR 2. NAME. :1: TAcoA#6 ..z�4� 17C-i�MGM )PROJECT L Z'\1C�t -A: 1'P 3. PROJ LOCATION. Municipality C=* 4. PRECISE LOCATION (Street address and road 104600160m prominent.;,. dmuks, etc., or provide map) �?�be � ,GocpTov MWP 0A1 SSTs 104A 5. IS PROPOSED ACTION: ONew ❑ Expansion [] MpE(iiptl Itorallm 6. DESCRIBE PROJE BRIEFLY: / fiWllL� f�'�/� -ti 7. AMOUNT OF LAND AFFECTED: v/�P Initially ae►es h aces _ S. WILL OPOSED ACTION COMPLY WITH _ �NING'OR OTHER EXISTING LAND USE RESTRICTIONS? es ❑ No It No, describe brMlly, 9. WHA ES PRESENT LAND USE IN VICINITY 2Residential ❑ Industrial Q Agriculture U ParldFomV/Open space ❑ Other t'•V.. Describe: 10. DOES ACTION INVOLVE A PERMIT All bING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL. STATE OR LOCAL)? y ❑ Yes No It ya, Ilat a 77n0 mwapprovals - J,, G r 11. DOES ANY A�/SSP/ECT OF THE ACTIONS Y VALID PERMIT'OR AP *ROYAL? ❑ Yes No It yes, list's i9jit p ►1hlHitpptoval a 12. AS A RESULT O�FyP,ROP08ED ACTIQ�f IplrItTUPPROVAI REQUIRE MODIFICATION? ❑ Yes No Ln I CERTIFY TH# PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE �F h APplica t/sponsor n Date: fib' Signature: If the solo) I Are x, and you of a stag agency, complete the Cosata �� ' before proceeding with this assessment OVER Lim PUTNAM COUNTY AEPARTMENT OF HEALTH DIVISION OF ENVIRI,O� , NTAL HEALTH SERVICES RE: Property of LETTER OF AUTHORIZATION Located at 0-, V qr7-,oeYo1J Tax Map # /3, 07 Block i Lot ,9A Subdivision of Subdivision Lot # Filed Map # . Date Filed Gentlemen: This letter is to authorize a duly licensed Professional Engineer, ,/ or Registered Architect to apply for the required wastewater treatment and/or watar-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 p @, We 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam iW e. Very tA(tOw"ner Countersigned: ` sF 4 a6 ��� Signed P.E., R.A., # (�(� �i �'°RQ P�� ri•) Maili ng Address 4";• y �?cWi Y 6 Mailing Address: /7 -eawy. State A/ Z Zip 054 Telephone: State Zip /o Telephone: Ors -7a a 14-164 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 SEOR v 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) 1. APPLICANT /SPONSOR 2. PROJECT NAME. (5, —aNEx- - 1_L&P e7y kE' � ?k1E 3. PROJECT LOCATION: Municipality S�p� 1� County 4. PRECISE LOCATION (Street address and road intersections, prominent I�ndmarks, etc., or provide map) �'S`1'S Pj'P.J✓ 7u 147&yrON IVIN0 O, J PLlJdJ 5. IS PROPOSED ACTION: New ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: _ 7. AMOUNT OF LAND AFFECTED: 'f "4'e Ia U�7 Initially acres Ultimately acres 8. WrIL ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? -�L /PROPOSED LKYes ❑ No If No, describe briefly i 8. WHA IS PRESENT LAND USE IN VICINITY OF PROJECT? ,T Residentlal ❑ Industrial ❑ Commercial ❑ Agriculture ❑ ParidForest/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)? ?.--,,�� C1 Yes EX0 If yes, list agency(s) and perrniVapprovais 11. DOES ANY ASPECT OF THE ACTION HAVE A�CURRENTLY VALID PERMIT OR APPROVAL? Cl Yes No If yes, list agency name and permll/approval 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 /lid/ �""' Applicant/sponsor n e: Date: t Signature: If the action Is in the Coastal Are , and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 P1f1'TNAM COUNTY DEPAR, MENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Loeo2 Ge R� u ecN,' L �Prrnn ✓�_ Address Located at (Street) g c 3) N Tax Map Z Block I Lot 1- I (indicate nearest cross street) Municipality P10T1Lekso -% Drainage Basin Lf X�2 SOIL PERCOLATION TEST DATA Date of Pre - soaking i r - r -o , Date of Percolation Test 11-'14-01 Hole No. Run No. Time' Start - Stop Ela se Time (Min.) Depth to Water From Ground Surface (Inches) Start Stop Water Level ]Drop In Inches Percolation Rate Ndin/Inch . 1 s 2 101(, ia a 3 )o aZ IW" 3 5 4 5 1 10 02 P. 27 3 3 G 2 r07,4 1021 7 a4 - 47 .3 P 33 3 a .. I 7 3 5.33 4 1038 io57 19 7 3 - 3 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 I min for 1 -30 min/inch, <_ 2 min for 31 -60 min/inch) All data to be submitted for review. 2. <. Depth measurements to be made from top of hole. -Abbl ril JJ&1A DESCRIPTION OF SODS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. G.L. 0.51 1.01 1.51 2.0' 15' 3.5' 4.01 4.5' 5.01 5.51 6.01 6.51 7.0' 7.5' 8.01 8.5' 9.01 9.5' 10.01 HOLE* NO. Indicate level at which groundwater is encountered 1,1a Indicate level at which mottling is observed — XIId, Indicate level to which water level rises after- being encountered 1111W� Deep hole observations made by . e15'6W6 � Date Design Professional Name: Ahhym Address: 671011, , &&— 6 . Signature: `.J Design Professional's Seal - -05 5 N N Q @JL�,�CHAE(� 674 6 10/24/2001 15:40 FAX 845 2796769 A BRUCE R. FOLEY Public Health Director PUTNAM ENGINEERING PUT CO HEALTH Q001/001 DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI- -R.N., M.S.N. Astoclate Publk Health Director Director of Patient &rvkw. REQUEST FOR FIELD TESTING ATTENTION: o ADAM STIEBELING X/GENE REED All information below must be f ab complet^ted.prior to any scheduling. DATE: 2D D ENGINEER OR FIRM: lal?WM 6 f &fit LiC ' PHONE #: � —' b)S 5 REA$ON: DEEPS: PERCS: o PUMP TEST: 13 ROAD/STREET: TOWN: SUBDIVISION: OWNER: clie / - z TAX MAP#: LOT #: 3y YES NQ n Proposed SSTS within the drainage basin of West Branch or Boyds Corner Reservoirs. C3 Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. E3 Proposed SSTS within 200 feet of a watercourse or a DEC wetland. C3 Proposed SSTS design flow greater than 1000 galloadday or SPDES Permit required. E3 Proposed SSTS for a Commerical Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered ya to any of the questions, NYCDEP must witness the soil testing. This Department will coordinate a mutually suitable time for field testing with the.PCDOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. FOR COUNW USE OnY DATE:/_O Q 1 ®r 2 Q TM: nrT- a4 -PRS1 wFn 1F+:77 TFI:R45- ?7R -79 ?1 NAMF:PUTNAM COUNTY DEPARTMENT OF P. 1 o.ar v a 13 13 � I.00 AC. CAI. \aT-es �r 8 9 P zotsl ti N 'G yet � /0 ti s 10 ``off 6 's rJJ /JJ �• .d \CAL CAL�� rr 1.04 AC. 1.18 AC. CAL. \L. FA' .1 il, \il / q / / 13 � I.00 AC. CAI. \aT-es �r 8 9 P zotsl ti N 'G yet � /0 ti s 10 ``off 6 's rJJ /JJ �• .d \CAL CAL�� rr 1.04 AC. 1.18 AC. CAL. \L. FA' {rJ 5 1.99 AC. CAL. 13 J' ,J OJ 61 1.19 AC. / I l I 1 I i r I 1 .1 / / / / / / oe {rJ 5 1.99 AC. CAL. 13 J' ,J OJ 61 1.19 AC. / I l I 1 I i r I 1 .1 11/06/2001 14:23 FAX 845 2796769 BRUCE R FOLEY Public Health Director PUTNAM ENGINEERING 4 PUT CO HEALTH Q001/001 DEPARTNENT OF HEALTH I Geneva Road Brewster,- New York 1 0509 LORETTA MOLINARI.-R.N., M.S.N. Associate Public Health Director Dlractor of Patient Stmicst ATTENTION: o ADAM STIEBELINTG GENE REED All information below must be filly completed prior to any scheduling. DATE: / ENGINEER OR FIRM: >� fvR.�► filef;w ���LL I' PHONE #• '79 G 7R REASON: DEEPS: a PERCS: X . PUMP TEST: o ROAD/STREET: t2G" 31L TOWN: �� 7" TAX MAP#• SUBDIVISION: 641A LOT #: 3Z_ OWNER: a fn 9-r. e Aae_ l F,&gamr ��� NYCDEP CRITERIA FOR JOINT HEYMN,AND WITNESS NU OF SOIL. TESTIN • YES NO o p! Proposed SSTS within the drainage basin of West Branch or Boyds Corner Reservoirs. E3 ;S Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. o p Proposed SSTS within 200 feet of a watercourse or a DEC wetland E3 qft Proposed SSTS design flow greater than 1000 gallons/day or SPDES Permit required. 0 9t Proposed SSTS for a Commerical Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP • project status (Joint or Delegated) based on the response. If you answered yet to any of the questions, NYCDEP must witness the soil testing. This Department will coordinate a mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. FOR COUNTY USE ONLY DATE: / 3 3 O TIM; Q (FIELDTEST) NOV -6 -2001 TUE 15:19 - TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 February 21, 2002 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Gary Tretsch Putnam Engineering 4 Old Route 6 Brewster, New York 10509 Re: Proposed SSTS - Burchel - Panny Route 311, (T) Patterson TM# 13.07 -1 -32 Dear Mr. Tretsch: Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: The construction of this sewage disposal system maybe subject to local wetlands regulations. You should contact local wetlands officials in this regard. 1. Neighbor notification is required. at � q 2. A clay barrier two feet wide and at a depth below the footing drains must be shown between the SSTS and house foundation. 3. The type of protection under the driveway for the footing/ tter drain is to be noted. 4. Erosion control measures for the house are to be shown. 5. The well location is to be dimensioned from two prope e� 6. Service connection from the well to the house is to be shown. 7. The permit application notes the owner as Buechel - Panny, the plans notes the owner 'as Taconic Lane Development. The owners name on the plan and permit must be the s pW. 8. If the parcel is not in a realty subdivision remove "Lot # 32" from the title block. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very y yours, /wV Robert Morris, PE Senior Public Health Engineer RM:cj PUTNA.M..COUNT DEPARTMENT"OF,, jMALT , DIVISION OF ENVIRONMENTAL HEALTH SERVICES V APPLICATION FOR APPROVAL OF PLANS TOR A WASTEWATER TREATMENT 'SYSTEM 1. Name and address of applicant: Pa-k`)AJ 2. 4. 6. Name of project: JkON►C_ LA-TO -ve gc a a4f 3. Design Professional: 0Z r( 4A,17 ,c vW,4 W145. Drainage Basin: E45? �3 , e�w ��s 2i!cyie Acatio6T�: 164r,� Address: 0124- W.''r� /%.. 7. ct: Private/Residential Food Service Commercial Apattments 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 AJO Type II: Unlisted 9. Is a Drafft Environmental Impact,'Staterent (DEIS) required? .............:..... ...... �✓0 10. Has'DEIS been completed and found acceptable by Lead Agency? ............... �+ 11. Name of Lead Agency 12. Is this.project in an area underahe control of local planning, zoning, -or�other officials, ordinances? ... ,......:.. ................................... ...................:........... rs 13. 'If so, have plans bee: n submitted to such_ authorities?. .:..:......:....:.....:........ ........ 14. Has preliminary approval been granted by such authorities? ' Date granted: AJ® 15. Type of Sewage Treatment :System,, Discharge .....:..::....... surface water ,/groundwater 16. If surface 'water discharge, what,lithe stream class designation? .............. ....... 17. Waters index number (surface) .............. . ............................... ............................ AA 18. Is project located near a `Aiblic'water supply s stern? n!Q 19. If. yes, name of water supply....:...:... :. Distance to water supply 20:. Is project site near a public sewage collection or treatment system? ................ a 21. Name of sewage system .::: Distance to sewage systemitx"�" 22. Date test holes observed" io•3vw/ 23. Name of Health Inspector Oe4L k��D 24. Project design flow (gallons per day) .................................... ............................'DD 25. Is State Pollutant Discharge,-,Elimination System ( SPDES) Permit required ?... E10 26. Has SPDES Application been submitted to local DEC office? ......................... 27. Is.any portion of this project located within a designated Town or State wetland? : o . 28. Wetlands ID Number :............ :............6..........:...... .. ............ ............................... 29: Is Wetlands Permit required ?� ......................... a..........:;..::....: :.::.:::::..................... Has application been made to Town or Local DEC office? ................................ A/a 30. Does project require a DEC Stream Disiurbance'Permit? ............................... 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No . ....... io 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile; landfill, sludge disposal site or any other potentially known source of contamination? Yes/No o DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... 34. Are community water and/or sewer facilities planned to be developed within' 15 years in or adjacent to project site? ................................ ............................... C.:... . <...: 35. Are any sewage treatment areas in excess of 15% slope? 36. Tax Map ID Number ................:......... ............................... Map 3, u7 Block 1 ,Aot' ,: 37. Approved plans are to be returned to ..... Applicant Design Aio' fesg`ional 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 mayrequire 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 aprson other than the applicant shown in Item l.,the application must be accompanied by a Letter of Aythorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I /iereby affirm, under penalty of perjury, tlI at tnforttatign provided on tlris form is true to the best of my knowledge and belief. False statements made Herein are punishable as a Class A ;misdemeanor papsuant tc SIGNATURE'S & OFFICIAL 11TLE'S: Mailing Address: ............. ............ 0 .L� �% i { j NOW OR FORMERLY GEORGE A BUECHEL, 5 cv Au ac Qj 1 _ Yal "L 074 (r04) Pl.V4 N;A0 i o ' 'To ,gpvrE o i * - - iJIPAIAI. c 1 uw o p \� I N 32 t5'r10: 1N 0 w T .PUTNAM COUNT-Y-.-DEPARTMENT-OF--HE.AL.TH.---- DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner -R, Located at (Street) z-,*. Tax Map 15, o Block Lot 3;2 (indicate nearest cross street) Municipality Watershed E/457- -j3j?AWG,q SOIL PERCOLATION TEST DATA Date of Pre-soaking L_�6 Date of Percolation Test /,j I X5 ". 30" ... . ... . .. ................ .... . ..... . .. .... . .. .. . ... . .......... . .. D - W l from ground A . Level " . Hole .......... ........ . ....... . .. . .. ..... . .. Ue I. Ala Time .L Surface : 0 : : ....... ... . . . . ... . . . . . . . . . . . . . . . . . /01100 —/0"/50 2 ........ .. 3 6?,,,3Z /0, V7 4 10;09 -ia/13 27 . 2 3 4 /0130 '/0;57 7 5 7- 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. :5 1 min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. - 2. Depth measurements to be made from top of hole. ... Form DD-97. .. .. .. .. - — TEST PIT DATA 2 -DESCRIPTION OF SOILS ENCOUNTERED N TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO.. <—' GJ,. 0.51 - =16 1.0 isc'-%'e v 1.5 A 114�x 2.01 2.51 3.01 .3.51 4.01 Se M1, CO-M i iz f 0' 4'ra V e_ I Ak� Fhie s511A 4.5 5.0 r Ve 61(a 6.0' - --- ------ _eq 7.5 -7 8.0 ------ -- -- ....... .9.0 9.5 10.0 - -------- -- ----------- Indicate level at Which groundwater is encountered.--... Indicate. - level at which. mottling is- observed.....: Indicate level to Which water level rises after being encountered Deep hole observations made by: 7) H Date _Za 3el Design Professional Name: Address: .. ..... ........ ..... Signature:. Design Professional's Seal - FUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH. SERVICES INITIAL INDIVIDUAL /COMMERCUL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project 1 PA N NX tT �i� T'r TZ S�iJ County PU 1i✓AI_l Site Location /2d : 311 L d i ' 3 a r, �J, 04 1-3 o -7 — / — 3 Building construction begun NO Extent Is property within NYC Watershed ? ................. dyes 'E] No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. FI Hilly F-1 Rolling ti. 2. F_� Evidence of wetlands. Steep slope Gentle slope Flat aLow area subject to flooding Bodies of water Drainage ditches 0 Rock outcrops 3. Property lines or comers evident ....................... ............................... 4. Do water courses exist on or adjoin the property? .........................:.. 5. Will these affect the design of the sewage system facilities ?........ 6. Do watershed regulations apply in this development ? ....................... 7 Will extensive grading be necessary? .................................................. 8. Will extensive fill be necessary for SSTS? ......... ............................... 9. Do filled areas exist within the SSTS area? ........ ............................... If yes, what is the condition of the fill? Yes No Yes ' No ;Yes No dyes 1 No Yes 'Yes No No 0:Yes EfNo SECTION G SOIL OBSE VATION 10, Appearance of soil: Sand Gravel � Loam Clay � Hardpan � Mixture 11. Observed from: Q Borings F_� Bank cut Backhoe excavations 12. Soil borings /excavations observed by cy, Rte, R e—, on 3 13. Depth to groundwater ,y o /J I r5i on 14. Depth to mottling n/OIVA� on' 15. Are test holes representative of primary & reserve areas ...... ............................... Yes No 16. Soil percolation tests made by o on 1 //6�T_ 17. Soil percolation tests witnessed by / ,,a n F' c T,> , H: on SECTION D (on back) Form ST -1 2 SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? ❑ Yes �o 19. Will groundivater or surface drainage require. special consideration? ..................... 0 Yes No 20. Will gullies, ditches, etc., be filled and watercourses be relocated ?......... ................ Yes o ,SECTION E. REMARKS 21. If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities? ................................ ............................... a Yes No Inspection data 22. Do adjacent dells and/or sewage systems exist ?........�c1�i . ?!!R °�l /.. sicp s Yes ,F No �.... 23. Additional comments 24. Site observer /inspector and title 4�Ne D, zo en 25. Date(s) of observation(s)inspection(s) _ / p/ F I Al 41 lie { 4 TEST PIT PROFILES Hole # Lot # Hole # Lot r Hole # Lot # Depth to water Depth to water Depth to. water Depth to mottling Depth to mottling pepth to mottling Depth to rock/imp. Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L.. 0.5 0.5 0.5 1.0 1.0 1.0 2.0 2.0. 2.0 3.0 3.0 3.0 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 I acknowledge receipt, of this report - SIGNATURE; Red �orxw� Ro,7c 1'•nO�luM W1��„��J, �l Y• ZG' RerCfwnd� TA, x MAP- 2 '1 $LOCV- — 1 oi4,\cres ti �� L r C �) v o rc bar (',J) bur rIGA ?" T�!T - (tv • Concre