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HomeMy WebLinkAbout0464DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13.07 -1 -60 BOX 6 00273 6j -91TA 61 . -. X0 r-1 Td 00273 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION. OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE .,FOR SEWAGE TREATMENT SYSTEM .74 PCHD CONSTRUCTION PERMIT. # Located -at _ C-OR -PWALL- 01w, F-OAD hi s �1j1.1 Town or Village H Owner /Applicant Name �bu4�lt�g ��'�F -tF Ft N Tax Map Block Lot Formerly Subdivision Name Subd. Lot # Mailing Address BA)C N+ N� ^ ' Zip lu �y jj Date Construction Permit Issued by PCHD 1 ®�, Separate Sewerage System built by STD Address' Consisting of Q6� Gallon Septic Tank and C�. Other Requirements:: Water SU Dnly: Public Supply From Address on - Private Supply Drilled by Address Building. Type"­ 10a -HG-f- Has erosion control been completed ?:. Number of Bedrooms Has garbage grinder been installed? i 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 b Clit�7r+- ` / • �— Y -�"�� Ld/! / P:E.. )( R.A. (Des' n Professional) J Address ' . 8 jLA-T# WH f—PA G� �� -��'� � ti7` t"70 License # An person 'occupying remises served b the above system s shall promptly take such action as ma 'be necessary YP PY gP Y ,, Y () P P Y Y azY to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate •sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject'to modification or change Aen, in the judgment of the Public Health Director, 'such revocation, dificatio or change;is necessary. By: Title: U Date: Z. L8 /11, 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 Street Address: Curt wd l A'// U, Town/Village: lPalts, rs o n Tax Grid # Map Block Lot(s) Well Owner: Name: Address: aS` A 1 ij h 141 I t f 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 Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock .Other Casing Details Total length 2 i ft. Length below grade eft. Diameter Tin. Weight per foot _LZlb /ft. Materials: Steel _ Plastic _ Other Joints: Welded _ Threaded _ Other Seal: _ Cement grout V.Bentonite Other Drive shoe: _.X Yes No I Liner Yes X No Screen Details Diameter (in) Slot Size l.ength(ft) Depth to Screen (ft) Developed? First Yes—No Hours Second Well Yield Test _ Bailed _ Pumped Compressed Air Hours j6_ Yield _L�T gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) ,Bd tFC� Depth of completed well in feet a�S 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 /0 r C-C e iimp c., If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth Model Voltage HP Tank Type Volume Date Well C omple d j �Ilgrlq Putnam County Certification No. OCR Date of Re rt Er Well Driller (signature) � NOTE: Exkt location of well with distances to at least two permanenylandm rks to be provided on a separ2p sheet/plan. /�� , �� Well Driller's Name 1)j)'1f&1 t� Address: 311 - 6 /era k ) Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH �J I" DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCT PERMIT FOR SEWAGE TREATMENT SYSTEM PE Located at U94 J �� ► ! -d Town or Village e2, ier_cn. Subdivision name Subd. Lot # Tax Map 0,01 Block [ Lot 66 Date Subdivision Approved Renewal Revision Owner /Applicant Mailing Address Date of Previous Approval Zip r) Amount of Fee Enclosed 4-500,00 Building Type g Si Lot Area No. of Bedrooms Design Flow GPD i Old 0 Fill Section Only Depth Volume Separate Sewerage System to consist of 606 gallon septic tank and Other Requirements: To be constructed by 713 Address ti rn Water Suuoly: Public Supply From Address Private Supply Drilled by -TOP ' Address 5, I represent that I am wholly and completely responsible for the design and location of the proposed system(s) an&tha ° seFarate sewage treatment system described above will be constructed as shown on the approved amendment the& aig � accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on cnmpl&%n thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to: the . Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Addres r APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and 'is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. Approved r discharge of domestic sanitary sew eo9nly. By: Title: !cc Date: G4 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 # U -' Well Location: Street Address: TownNillage Tax Grid # w � Mapt� , o7 Block i Lot(s) app Well Owner: Name: -th ftV M + Address: Use of Well: _&._ esidential Public Supply Air Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought _ tj_ gpm # People Served 4 - Est. of Daily Usage O gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling C New Supply (new dwelling) Deepen Existing Well Detailed Reason 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 X Name of subdivision Lot No. Water Well Contractor: T15 0 Address: Is Public Water Supply available to site? Yes No X Name of Public Water Supply: �& Town/Village Distance to property from nearest water main: Proposed well location & sources of contaminatio to be provided on separate she plan. Date: - Applicant Signature: .. I J- d' I 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 wat well driller certified by Putnam County. , Date of Issue 3 l0 Permit Offi . � Ameo Date of Expiratio 10 Title: t C Permit is Non-Transf6rrafile White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 LIr HARR NICHOLS JR., P.E. March 6, 1998 Robert Morris, P.E. . Putnam County Health Department . 4 Geneva Road Brewster, NY 10509 RE: Proposed SSDS - Griffin Cornwall Hill Road (T) Patterson, NY Dear Mr. Morris: / LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road j \ \ Brewster, New York 10509 (914)278 -6108 - (FAX) 278 -2658 CONSULTING SITE ENGINEERS In response to your review letter dated February 24, 1998 we offer the following: 1. Percolation tests were witnessed by Jannine McColgan of NYCDEP on 12- 23 -97. The test results were submitted to your office on February 5, 1998. 2. Return receipts for the neighbor notifications are enclosed herewith. J ' Kindly issue a Permit for this project at your earliest conveneince. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. chols, Jr., P.E. HWN: T . d 97049 3 9113 q JTo uoxs� no3 amulna If of 6 8 L C r vie LL- 0 K1 icy `� SOL /p Pvc SDZ_ 36 1250 &a L. Z S P SEPTIC TANK 12 .q °� goyip.PlGSDS- . 3 9 13 a 10 � lS 10 o i J. Ct�P.) ! 1� t 1 3 t } '7 1 1 �I J I _ Putnam County Departm k' Division of Environmental' Approved as noted for c appli le Rules and Re Co Health F Signature Title f I _ (DN89 °o0'5O'W - 93.44' Q IJ 8b° 03' 00' W - 187, 41' Q N 56 37' 30' W - 199: I t' ® N 56 0-7'00' W - 437.77' (D N 88' 48' 30' w - 120. 19' ©N 87' 3D 20" VV - 62.48 !� N 17' 10'50" W - 14.30' eQ NO-')* 37'40' W - 7.55' Q N 21° 20'20'E - 141 .'60' +o N 2V 23' 40" F - 82.47' +1 N 19' 57'7-0'F- - 1.4 .53' IZ N 43'30' 50,E - t7 .25' N 45'55'00'e- - 42.47' ® 4J 49' 00 2d p- - 21.99 +5 N 49° 29 3d F- - 139.99' leno. ll-, 1 PARCEL PLAN JCALE. : 1" = 2ool SITE - LO C. 1 M SCA : PROPERTY SHOWN ON TAX MAP: 13. 0-7 ••�.� 837.77' --� •�� 16 �� t'1°J'4ri'Op ® N 49' 43' 30" E - 200.00 ' 19 'S 4d Ko' 30 F - 100.00', ® N 49' 43' -3 E - 201 .00 21 f G - 267'14199.51 L dtR. - so. oo' � - a62• 0'39.5" L - 80.94, (R 2gt = 57o.00' A.4'5z�or" L e 48.42 N 49' 45' 30' E — 239.44' ® 5 17' 30'4d E - 49.84' 2v 5 V 13' 10" E — 117 , Ob' @ 5 15° 40 l0' E - 155.21' ® S 43° 37'00' E - 134• • ZI' 29 $ 8° 54'- 50" E - 17-5.(,,7' leno. ll-, 1 PARCEL PLAN JCALE. : 1" = 2ool SITE - LO C. 1 M SCA : PROPERTY SHOWN ON TAX MAP: 13. 0-7 ••�.� 837.77' --� •�� PUTNAM COUNTY. DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM THOMAS 4 (,e9-y N. CAPF-PIN 19),0_1 l (00 Owner or Purchaser of Building PLO 65 AL-PH 60 1 L17 Building Constructed by C-op M- WNL -L, laruw _ PND Location - Street P-t �b%D a 4,1- Tax Map Block Lot Town/Village Subdivision Name Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department .of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs'made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month ( Day -;4 Year Signature: Title: General dritractor (Owner) - ignature Corporation Name (if core ation) Corporation Name (if co oration) Address: K 0, /3,, 5-�e� State /(J Y Zip / 6 Sd Address: ?d-1&,�, s3A,re�fle� State P p,,,, ;4o, k Zip /ox Form GS -97 ?- ?– PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY 8, SUBSURFACE SEWAGE TREATMENT Sl'STENIS REVIEW SHEET FOR CONSTRUCTION PER N(IT STREET LOCATION CpPR/W.<lL4 H ILL NAME OF OWNER /4I. 4t CORY A, Gglpr–m REVIEWED Bl' RM, GR AS, MB, BII TAX MAP #13,07-1- Y DOCUMENTS Y N PERMIT APPLICATION PC -1 WELL PERMIT_ PWS LETTER LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) TE RESOLUTION SHORT EAF PLANS.-. THREE SETS HOUSE PLANS - TWO SETS VAR4ANCEREQUEST FEE SUBDIVISION LEGAL SUBDIVISION SUBDIVISION AP AL CHECKED FILL DEPTH TAIN DRAIN R ED STANDPIPES EROSION CONTROL:HOUSE,WELL, SSDS PERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY & EXPANSION LOCATION MAP EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE IF— A4PED, PIT & D BOX SHOWN & DETAILED HOUSE - NO.OF BEDROOMS WELLS & SSDS'S WIN 200' OF PROPOSED SYS. 'PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE NO BENDS; MAX.BENDS 45° W /CLEANOUT FILL SYSTEMS CLAY BARRIER 1 - HORIZONTAL;SLOPE 3:1 TO G FILL SP OTES DEPTH GENERAL FILL PR & DIMENSIONS LOCATED IN NYC WATERSHED ME \ PLANS SUBMITTED TO DEP FILL IN EXPANSION AREA DELEGATED TO PCHD TRENCH / DEP APPROVAL, IF REQ'D LF TRENCH PROVIDED J 60 FT MAX. DEEP TEST HOLES OBSERVED -8y MLB, 'Fg PARALLEL TO CONTOURS PERCS TO BE WITNESSED 12-la-3117 100% EXPANSION PROVIDED EX- APPROVAL SSDS ADJ. LOTS SEPARATION DISTANCES SPECIFIED WETLANDS (TOWN/DEC PERMIT REQ'D ?) ON PLAN - FROM SSTS DATA ON DDS PLANS & PERMIT SAME 4f 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL PRE 1969 NEIGHBOR NOTIFICATION 20' TO FOUNDATION WALLS _15'WELL TO PL t•EM.R Bl/ZBA 100' TO WELL, 200' IN DLOD, 150' PITS +96-YR. FLOOD ELEVATION 100' TO STREAM WATERCOURSE LAKE (inc. cxpan) 04+IER REQ'D PERMIT(S) 50' TO CATCI I BASIN, 35' STORMDRAIN, PIPED WATER REQUIRED DETAILS ON PLANS 10' TO WATER LINE (pits -20') SEWAGE SYSTEM PLAN- (NORTI I ARROW) ,. 50' INTERMITTENT DitAINAGI,- COURSE SSDS I IYDRAULIC PROFILE 2007500' RESERVOIR, ETC. _150' GALLEY SYSTEMS GRAVITY FLOW CONSTRUCTION NOTES to CDS= >5 %,101- 4 %,25'- 3 %,30'- 2 %,35' -1 %, 100' - <I % DESIGN DATA: PERC & DEEP RESULTS to CD discharge /I00'with 182 cons day discharge CONTOURS EXISTING & PROPOSED SEPTIC TANK DRIVEWAY & SLOPES, CUT 10' FROM FOUNDATION 50' TO WELL - FOOTING/GUTTER/CURTAIN DRAINS WELL SOIL TYPE BOUNDARIES DIMENSIONS TO PROPERTY LINE TITLE BLOCK; OWNERS NAME,ADDRESS LOCATION OF SERVICE CONNECTION -NN PE /RA; NAME,ADDRESS,PHONE# DATE OF DRAWING /REVISION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET PROPOSED FINISH FLOOR AND BASEMENT EL. COMMENTS: mm LAURENT ENGINEERING ' // ASSOCIATES, P.C.. MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road 1., \ Brewster, New York 10509 b (914)278 -6108 - (FAX) 278 -2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS , February 5, 1998 Robert Morris, P.E. Putnam County Health Department' 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Thomas & Cory Griffin Cornwall Hill Rd. Patterson, NY 12563 Dear Robert: Enclosed are the following: 1. Four (4) prints of SS -1 "Proposed SSDS ", dated 1- 22 -98. 2.. "Short Environmental Assessment Form ", dated 1- 22 -98. 3. "Application For Approval of Plans For a Wastewater Disposal System ". 4. "Construction Permit for Sewage Disposal System ", dated 1- 22 -98. 5. "Application to Construct a Water Well ", dated 1- 22 -98. 6," "Design Data Sheet ". 7. "Letter of Authorization ", dated 1- 22 -98. M 8, Two (2) copies of Residence Floor Plan(s), for 'Bedroom Count Only ". CIO C=) M. 9. Bank check in the amount of $300.00, review fee. M cnC Neighbor Nortification letters have been mailed. Receipts will be submitted to your Department when they are returned. w _ __ <° , r February 5, 1998 Page 2 97049 We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very, truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. N hols, Jr., P.E. HWN:RTL:bd 97049 cc: T. & C. Griffin w /enc. 13.07 -1 -59.1 l 13.07 -1 -59.2 Lorraine & Robert Guzzo Rt. 2 Box 202 Cornwall Road Patterson, NY 12563 Francis & Cassandra Schepperle Cornwall Hill Road Patterson, NY 12563 John & Jane Dobbins Shirley Drive Patterson, NY 12563 Robert & Margaret Barry. . Shirley Drive Patterson, NY 12563 Patricia Semo Shirley Drive Patterson, NY 12563 Michael & Anne Montesano Shirley Drive Patterson, NY 12563 Rosemarie DiVito Route 311 Patterson, NY 12563 Anthony & Jean Cloidt. 182B Route 311 Patterson, NY 12563 13.07 -1 -62 13.07 -1 -63 11 13.07 -1 -64 I . 13.07 -1 -65 13.07 -1 -66 13.07 -1 -67 l(e� Lorraine & Robert Guzzo Rt. 2 Box 202 Cornwall Road Patterson, NY 12563 Francis & Cassandra Schepperle Cornwall Hill Road Patterson, NY 12563 John & Jane Dobbins Shirley Drive Patterson, NY 12563 Robert & Margaret Barry. . Shirley Drive Patterson, NY 12563 Patricia Semo Shirley Drive Patterson, NY 12563 Michael & Anne Montesano Shirley Drive Patterson, NY 12563 Rosemarie DiVito Route 311 Patterson, NY 12563 Anthony & Jean Cloidt. 182B Route 311 Patterson, NY 12563 14-16-4 (2187)—Text 12 7, 'PROJECT I.D. NUMBER 617.21 SEOR -Appendix; C Sta t a Environmental Ouallty Rivisiv SHORT. ENVIRONMENTAL .ASSESSMENT, FORM �For UNLISTED ACTIONS Only' PART I—PROJECT INFORMATION (To be completed by Applicant .& Project sponsor) P 1. APPLICANT /SPONSOR O&S, A C 0 -r G,4 r 2. PROJECT NAME, ssos 3. PROJECT LOCATION: Municipality County 01 YVN 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map). Corv-suic:-l1 14,M 1R(=1. T>cxAAe_-csC>v-% 1?-563 5. IS PROPOSED ACTION: New ❑xpansion [)Modificationlaiterati6n 6. DESCRIBE PROJECT BRIEFLY: .2 :5+o7r S W / 1,5 w\r -500 -PAA0vN 064cA. M��ey 7. AMOUNT OF LAND AFFECTED: Initially —4:1.49 acres Ultimatel y acres il. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN V:CINITY OF PROJECT? Residential ❑ Industrial Ehommercial ❑Agriculture ❑ Park/Forest/Open space ElOther Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FED11L,'-'__ STATE OR LOCAL)? ❑ Yes RNo If yes, list agency(s) and pormlVap"provals C:) tr 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes No .'If yes, -list agency name'an. d perml . Vapproval . C 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? 'DYes.' No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY'Kk6WLEDGE Applicant./sponsor - name: M-k WA5 tA -65,IZIF�rl_N Date: - 1 2 2 6 Signature: Z/ If the action-.Is In* the Coastal Area, and you are a state agency, complete the Coastal Assessment. Form before proceeding with this assessment 1 C: IBC PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. -❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS-PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? It. No, a negative declaration may be superseded by another Involved agency.':` ❑ Yes ❑ N8 C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) Ct. Existing air quality, surface or °groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or'related7activities liWy to be induced , by -the proposed action? Explain briefly: C6. Long term, short term, cumulative, or other effects not identified in C1-05? Explain briefly. C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III— DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should . be assessed in connection with Its.(a).setting (i.e. urban or.rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or'significant adverse impacts which MAY °occur. Then proceed directly. to the FULL EAF and /or prepare, a positive declaration. ❑ Check this box if you have determined, based on' the information and analysis above and .any supporting documentation, that the proposed action WILL NOT-result ,in any significant- adverse environmental impacts AND provide on attachments as necessary,,the reasons supporting this °determination: Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency. Name of Lead. Agency 2 Title of Responsible Officer Signature of Preparer (if different from responsible officer) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: 117K' M 6. `, : �' Y y C- -'► `? �� `3a x ��- 7 2. Name of project: -pro 120 SS'OS 3..- Location T/V: 4. Design Professional: 0,Yr„ W t4;c�o6 )r. 5. Address: Cocnwc kk kN, \` IRvA 6. Drainage Basin: C rc +n 7. Type of Project: _ x Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this.�prcject subject to State Environmental Quality Review (SEAR)? Type Status (check one) ...................... ............................... Type I Exempt _X Type II Unlisted ­,X 9. Is a Draft Environmental Impact Statement (DEIS) required? ............. N 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? ........ ............................... 14. Has preliminary approval been granted by such authorities? 1 Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water groundwater 16. If surface water discharge, what is the stream class designation? .....:.............. 17. Waters index number (surface) .................................:.......... ............:.................. NAN 18. Is project located near a public water supply system? ....... ......:........................ N �, 19. - If yes, name of water supply N Distance to water supply =-rte 20. Is project site near a public sewage collection or treatment system? .............:... 21. Name of sewage system WA Distance to sewage system N#6, 22. Date test holes observed i Z-23 - q Z 23.: Name of Health Inspector 24: Project design flow (gallons per day) ................................. ............................... l 06 p 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... Nh _ 26. Has SPDES Application been submitted to local DEC office? ......................... A Form PC -97 2 27. Is any portion of this project, located within a designated Town or State wetland ?___ .28. Wetlands,ID Number ........................... :................................................... ............. WA 29. Is Wetlands Permit required? .............. .............................. .............................. Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? .................� 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops; solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ........................... Yes/No y 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, N 0 DESCRIBE: 33. Is there a local master plan on file with the Town or Village ?. ......................... �a 34. Are community water and/or sewer facilities planned to be,developed within 15 years in or adjacent to project site? ... ............................... 0 35. Are any sewage treatment areas in excess of 15% slope? . ............................... 36. Tax Map ID Number .......................... ............................... Map 13,C77Block Lot 37. Apprgved 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 1.,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuantao SectiIn 210.45 of ihe.1'enal Lv. SIGNYATURES & OFFICIAL TITLES: Mailing Address: ................................... 0� U f-e-9+ VNGi . SSJ'nC- �C- .�: S�oc�e Ce_n4mt 'R4- 22 4 M 1 � +owe -P.1, Qe-uj York . ID5"09 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Located at . C.O. '. \A' A Rc5c.. TN y-,<,nV1 Tax Map # � U7 Block I Lot O Subdivision of Subdivision Lot # Filed Map # Date Filed Gentlemen: This letter is to authorize k ac' r y W- J -r • 1P- E - a duly licensed Professional Engineer X_ or . to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam Coyry Code.. Countersigned: P.E., ., # `� or ivcW. 10 NICHOC 'rQ ` p W Mailing Address �.avre- F a k PM'- ! 1 broc- k O i cL� Very truly yours, Signed: vner of Property) f— Mailing Address: P O Box 23 4:2 R+ -22 11-%wA Rd po'4e_ -ec:�^ -- State —Zip 105a) 9 Telephone: "y /4 Z79- r202 State &)&LA.-� " k Zip I Z 5 ("_'s Telephone: Form LA -97 1.29 AC. x � � s►ae — ` 40 35 /r - ri 2.94 AC. w. ta. / 13.07- P /0% 1 .O7 13 / 161 P/0 3.20- ` ��B 61� n/ �6 3.20 O�c 2 '37 } 36 // / F F: at /P, / ,$ \ isz19 1.33 AC. 9, A . CA lee : 17.03 AC. �y s 1.25 AC. � ZT169 �Lq >r i 56 _ 1.43 AC. CAL. 57 Tac LOCATION MAC' FWPJ�!RTI I;S CONTIGUOUS To TNOMA5 1 0091 GKIFFIN 55 COR)4kAL . R1LL 120AP pATT� IZSON , Me!W Yol2K. 8.78 AC. CAL.;: TM 0 t3 •C7 -1 - �O i LAURENT ENGINEERING j/ \\ ASSOCIATES, P.C.! MILLBROOKE OFFICE CENTRE j Route 22 & Milltown Road Brewster, New York / \ (914)278 -6108 - (FAX) 278-2 278 -2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS LIST OF CONTIGUOUS PROPERTIES FOR NEIGHBOR NOTIFICATION Thomas & Cory Griffin Cornwall Hill Road Patterson, NY TM #13.07 -1 -60 3:19 -1 -36 t 3.20 -2 -20 13.08 -1 -1 13.07 -1 -33 13.07 -1 -34 13.07 -1 -35 13.07 -1 -36 C. 13.07 -1 -39 13.07 -1-40 John J. & Mary Bodor . RD 2 Patterson, NY 12563 Patterson Associates c/o Hartz Group Inc. . P.O. Box 1411 400 Plaza Drive Secaucus, NJ 07094 George A. & Frederick Buechel RD 2 Box 182 - Rt. 311 Patterson, NY 12563 Patt Ross Bodine Rte. 311 Patterson, NY 12563 . Joseph Plaskett, Jr. as trustee c/o Joseph & Bernice Plaskett P.O. Box 188 Patterson, NY 12563 Anthony & Anna Vigna Route 311 Patterson, NY 12563 . Adolph & Alvina Williams Cornwall Hill Road Patterson, NY 12563 Zoltan & Antoinette Handrix " Cornwall Hill Road. Patterson, NY 12563 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH-SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner -11-1D PrUL& ry C r y� '% n Address ?�0� . Bc>A 34-7,. a "in Located at (Street) �„�,�t, ;�� �-�; 0.a Tax Map i3:b7 Block ( Lot 60 (indicate nearest cross street) Municipality}- -SAY., Drainage Basin C ra�o�1 SOIL PERCOLATION TEST DATA Date of Pre - soaking 12 - 22 - 9 7 Date of Percolation Test . 12 - G 3 -. 9 7 Hole. No. Run No.. Time Start - Stop Ela se Time an.) De�ppth to Water From Ground' Surface (Inches) Start f--.-* Stop Water 'Level , . Drop In Inches Percolation Rate AIin/Inch 1 . .. i 1°0-6 -11:20 14 25 %,..._28 % 5 2 11: 21 -11, 3 5 14 24'/z - 07'12 .5 S 3 i 4 24 277 3 15 4 5 2 1 11:00-1111 11 25 - 28 3 2 1i :12- 11,29 17 243 1,q°'273/4 3 3 11.31 -1147 16 24 -- 2 7 3 4 -07 6 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 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.5' 5.0' l.�!• 5.5' 6.5' 7.0' .5' 8.0' 8.5' 9.0' 9.5' 10.0' 2 TEST PIT,DATA , DESCRIPTION OF SOILS ENCOUN'T'ERED IN TEST HOLES HOLE NO. HOLE NO. HOLE NO. i 1 o„ G` I 11 6p Indicate level at which groundwater is encountered o in Indicate level at which mottling is observed c,v, Indicate level to which water level rises after being encountered 1A Deep hole observations made by: M , p L)OZ I t4 SV- 1 Date Design Professional Name: j- I�,�ry jay- M;JA,I's F. Lav r ar, st C�- Address: Signature: Design Professional's Seal NEW YO nicr�o�� fi Q r ' n No. 56124 p O'90FESSIO'k -- DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 27877921 February 24, 1998 Harry Nichols Laurent Associates Millbrook Office Centre Route 22 & Milltown Road Brewster NY 10509 RE: Griffin, Cornwall Hill Road (T) Patterson, TM# 13.07 -1 -60 Reservoir Basin Croton Dear Mr. \?ichols: BRUCE R. FOLEY Public Health Director The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on February 24, 1998 is complete. The Department will notify you by March 16, 1998 of its determination. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject .to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Dept. of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Dept. of Environmental Protection regarding such activities to see if Dept. of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (914) 278 -6130 ext. 166. Very truly yours, ,4)6&v Mow Robert Morris, PE RM:tn Public Health Engineer �. DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 February 24, 1998 Harry Nichols Laurent :associates Millbrook Office Centre Route 22 & Milltown Road Brewster NY 10509 Re: Proposed SSTS: Griffen Cornwall Hill Road (T) Patterson TM# 13.07 -1 -60 Dear Mr. Nichols: BRUCE R. FOLEY Public Health Director Review of plans and other supporting documents submitted at this time relative to the above captioned project has been completed. Comments are offered as follows: "The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard." 1) Percolation Tests must be witnessed by a representative of this department. Please contact this office to arrange a mutually suitable time. 2) Return receipts for the neighbor notification must be submitted. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Very truly yours, aw� M &yl*o Robert Morris, PE Public Health Engineer RM :tn ., ,:;� 3.19 -1 -36 3:20 -2 -20 13.08-1 -1 LAURENT ENGINEERING j� MILLLI L9ROO E OFFICE CENTRE \• Route 22 8 Milltown Road Brewster, New York 10509 (914)278 -6108 - (FAX) 278 -2658 HARRY W. NICHOLS JR., P.E. + ` CONSULTING SITE ENGINEERS LIST OF CONTIGUOUS PROPERTIES FOR NEIGHBOR NOTIFICATION Thomas .& Cory Griffin Cornwall Hill Road' Patterson, NY - TM #13.07 -1 -60 John J. & Mary Bodor RD 2 Patterson, NY 12563 Patterson Associates w c/o Hartz Group Inc. P.O. Box 1411 400 Plaza Drive Secaucus, NJ 07094 13.07 -1 -33 George A. & Frederick Buechel RD2 Box 182- Rt. 311 Patterson, NY 12563 13.07 -1 -34 Patt Ross Bodine .. Rte. 311 Patterson, NY 12563 . 13.07 -1 -35 Joseph Plaskett, Jr. as trustee c/o Joseph & Bernice Plaskett P.O. Box 188 Patterson NY 12563 ¢ 13 07.1_ -4• 0� i Anthony & Anna Vigna . Route 311 Patterson, NY 12563 Adolph & Alvina Williams Cornwall Hill Road Patterson, NY 12563 0 Zoltan & Antoinette Handrix Cornwall Hill Road Patterson, NY 12563 13.07 -1 -59.1 Lorraine & Robert Guzzo 7 Rt. 2 Box 202 Cornwall Road Patterson, NY 12563 13.07 -1 -59.2 Francis & Cassandra Schepperle (� Cornwall Hill Road Patterson, NY 12563 13.07 -1 -62 John & Jane Dobbins Shirley Drive Patterson, NY 12563 13.07 -1 -63 Robert & Margaret Barry Shirley Drive Patterson, NY 12563 13.07 -1 -64 Patricia Semo Shirley Drive Patterson, NY 12563 13.07 -1 -65 Michael & Anne Montesano Shirley Drive Patterson, NY 12563 13.07 -1 -66 Rosemarie DiVito Route 311 . / Patterson, NY 12563 �p 13.07 -1 -67 Anthony & Jean Cloidt , 182B Route 311 Patterson, NY 12563 97049 2/98 ' j \ L-AURENT ENGINEERING ..ASSOCIATES, P.C.° MILLBROOKE OFFICE CENTRE j j\ \ Route 22 Milltown Road N Brewster, New York 10509 (914)27$, -6108 - (FAQ 278 -2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS RE: Department of Health Review of Proposed SewageTreatment System for Property Name: 1-40MA5 M. �' GoI.Y A G}21r- FIN Address,: 09NWALL I—i ILL 90AV Town: PA-T —YZ-cx�:'N N`f Tax Map #: 13.07 - 1 -lo0 Dear Please be advised that an application for a Construction. Permit relative to the construction of a sewage system and/or well proposed for•the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan., If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at 278 -6130. Very truly yours, . By: Title: A6,0NI Di2 �.LiC4N`r Received By: Address: Tax Map #: 7 ;'August 199 i HARRY W. NICHOLS JR., P.E. VCS LAURENT ENGINEERING ..ASSOCIATES, P.C, MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road Brewster, New York 10509 (914)270 :6108 -(FAX ) 278 -2658 CONSULTING SITE ENGINEERS 709/ i S saC,'G(o s RE: Department�of Health Review of Proposed SewageTreatment System for Property Name: 'iOMA5 M. Gowf A.G91�`IN lop �p/ V�2 Address: CORNWALL I-4 11 -1... R0A0 Slec�U W z AAT a70?4 Town: rA"C1r—�12_64�2N , Hi Tax Map #: 13.07 - I - loo Dear Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for.the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan., If you have any questions, concerns or information which may bear on the.-Health Department's review of this application, you may call the Health Department at 278 -6130. Very truly yours, By: Title: JAG N� 02 A VE 1 GANG" Received By: Address: Tax Map rr: 3. August 199'1 LAURENT ENGINEERING - ASSOCIATES, P.C.' / MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road Brewster, New York 10509 j \ (914)27$, -6108 - (FAX) 278.2658 HARRY W. NICHOLS JR., RE' SITE ENGINEERS &ea A, d i p /'• e�Z f�LGPC� o� RE: Department of Health Review of Proposed SewageTreatment System for Property �� �� Ili Io�S�� Name:'IJF4�t�tAS M. COR-f 'A. (991r- 'F►N Address: CORNwAU, I4 ILL )t2OA Town: PA-CTr—,R-,R , Wi Tax Map #: 13.07 I - boo Dear Mr. :i5L0cw ; Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for.the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan., If you have any questions, concerns or information which may bear on the 'Health Department's review of this application, you may call the.Health Department.at 278 - 6130. Received By: Address: Tax Map 4: /0. D 2 - / - 5 �5 LAURENT ENGINEERING j IN ..ASSOCIATES, P.C:' MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road j j \ Brewster, New York 10509 (914)270, -6108 - (FAX) 278 -2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS %/ ss ,80G>✓i`7� t� RE: Department of Health Review of Proposed SewageTreatment System for Property Pa *.A ) IV ),R Slo _--3 Name: -Mo W , M A cog-(. t Address:Cogt4wALL 14 ILL'9oab Town: PA -T1t5-11R_6!5;1N W1. Tax Mdp #: 13.07 - 1-& 0 Dear Please be advised that an application for a Construction Permit relative to the.construction of a sewage system and/or well proposed for-the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan., If you have any questions, concerns or information which may bear on .the Health Department's review of this application, you may call the Health Department at 278 -6130. Very truly yours, By: dva_�L'-_ Title: G15N -[' 152YL AP U-64NT Received By: Address: r Tax Map r: �? . o % • �` 3�} 'A itst 19".. %j j� \ LAURENT ENGINEERING MILBROO EIOFF CE CENTRE j\ j \ \ Route 22 d Milltown Road (914)270.6108 e (FAX) 278 -2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS Jr , RE: Department of Health Review of Proposed 19 7- %v64U SewageTreatment System for Property Name: 1"4o MA5 M. eot2Y A . Gt2 I r- F I N Address: CORNWALL N ILL .12o.4Y> Town: I:WT-T r-1RG�2N N `i Tax Map g: 0-01- 1-&0- Dear 2X P&4skt Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for.the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan., If you have any q>.iestions, concerns or information which may bear. on :the Health Department's.review of this application, you may call the Health Department at 278 -6130. Very truly yours" Received By: Address: Tax Map #=: ^/ 25.0 7 - / - �S �� / LAURENT ENGINEERING ASSOCIATES, P.C: MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road j \ Brewster, New York 10509 j(914)270;6108 - (FAX) 278 -2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS Dear RE: Department of Health Review of Proposed Sew ageTreatment System for Property Name: 'li40MAS M. �' CORI ,rs,,- 6121r- 'FIN Address: C011NW,4U. �4 ILL ROAb Town: PA11r --REON , N`f Tax Map #: 13.07- 1- loo . Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for.the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan., If you have. any questions, concerns or information which may bear on the' Health Department's review of this application, you may call the Health Department at 278 -6130. Very truly yours, By' Title: Aee- MY t :MZ -A?IP U-C: WT Received By: Address: Tax Map # , '.:August 199- i HARRY W. NICHOLS JR., P.E. C�I)Aoall /Ud / P" d Dear 101 1�11' LAURENT ENGINEERING •-ASSOCIATES, P.C.' MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road Brewster. New York 10509 (914)270,•6108 - (FA)) 278.2658 CONSULTING SITE ENGINEERS RE: Department of Health Review of Proposed Sew ageTreatment System for Property Name:`i40MAG M. GOlRI'A- G121r-FIN Address: CORNWALL. 4ILL }20.417 Town: PA-rT r,-12-4:0N , N1 Tax Mdo #: 0.07- 1 -Co0 - Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for-the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan., If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at 278 -6130. Very truly yours, By: 14' 4Q Title: C_ Received By: Address: Tax Map r: 10.,o 7 August \ LAURENT ENGINEERING \ MIL I - BROOKEOFF CE CENTRE 1 j \ Route 22 & Milltown Road Brewster, New York 10509 j(91 4)278, -6108 - (FAX) 278 -2658 ' HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS L.,( iIj,� ono RE: Department of Health Review of Proposed X 011)wall /7/;// SewageTreatrrient System for Property Narne:'1" 0MAS M. 5i 0091 A. GiLIr-FIN Address: CORNwAIA, 1-1•,I LL . Rq,,40 Town: PA-T -TO ZEN N`( Tax Map #: 13.07 - 1-&0.. Please be advised that an application for a construction Permit relative to the'construction of a sewage system.and/or well proposed for.the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan., If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at 278 -6130. Very truly yours, :. By: Title:. j�( NZ 152y A L. 16-'A " Received By: Address: Tax Map r: /23.02 sAugust 19, Lbrrce i new �obe� uz zc� a Box coot Cbr-nu)rxh Pa. -H-e rson Q Dear RE: Department of Health Rev' iew.'of Proposed- SewageTreatment System'for Property Name: 'i -4owis M, �' G091 "A - 09 1PFIi Address: CORM vALL- ILL. ROAD Town: PA7 -UMEVN °Nei Tax Map #: 13.07 - I -boo Please be advised that an application for a Construction Permit relative to the'construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site.plan. , If you have any questions, concerns or information which may bear on:-,the Health Department's review of this application, you may call the Health Department at_278 -6130. Received By: Address: Tax -Map T'71: , -V -5 1— - S9 ; Very truly yours, By: Title: A/c_-�55kY ' \ j% \ \ LAURENT ENGINEERING —ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road Brewster, New York 10509 (914)270, -6108 - (FAX) 278 -2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS 0arg RE: Department of Health Review. of Proposed SewageTreatment System for Property Name: fitbMAS M. 4 COP-1 A. 0?,1r✓5IN Address:09NW,4I..I- e411 —L } OAV Town: Tax Map #: 13.07 - 1-&0 Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for.the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan., If you have any questions, concerns or information which may bear on. ' the Health Department's review of this application, you may call the Health Department at 278 -6130. Received By: Address: Tax Map T',": t \ \ LAURENT ENGINEERING MILALB OO EI . OFFICE CE CEN RE ' j j HARRY W. NICHOLS JR., P.E. \ \ \ Route 22 d Milltown Road Brewster. New York 10509 (914)270, -6108 - (FAX) 278 -2658 CONSULTING SITE ENGINEERS EMO MA RE: Department of Health Review of Proposed SewageTreatment System for Property Name: '1 -40MAS M. 4 CoWf A'.091r- 5IN Address: CORWwALL WLL:'RoAV Town: PA -T- 'r-12-Sr;N Tax Mdp #: 13.07 - I - &0 Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for.the captioned property has been rriade.to the Putnam County Department of Health. Attached please find a copy of the latest site plan., If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at 278 =6130. Received By: Address: Tax Map ;=: /3. D 7 _ f -- (v - .r Very truly yours, By: ' LAURENT ENGINEERING Sell j j -ASSOCIATES, P.C..: MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road \ Brewster, New York 10509 j (914)27$, -6108 - (FAX) 278 -2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS . ww RE: Department of Health Review of Proposed SewageTreatment System for Property 5Z Name: ' -AvMA5 MA C091-A..G121Fti%IN Address: C09NWAL ,14 ILL. RoAV Town: , N`f Tax Map '&: 13.07 - 1 -&o Dear � ??�o 7`1�4z Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for.the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan., If you have any questions, concerns or information which may bear on the . Health Department's review of this application, you may call the Health Department at 278 -6130. Veiy truly yours, By: Title: ANN-(' 152k A ffo 6ANI Received By: Address: Tax Map IT /� a:7 / - (v - - -- August 19? r . ?D�� r� Gi Gl 52mo .. • • 5�1 r 1e br RE: Department of Health Review of Proposed SewageTreatment System for Property Name: "1-40 MAS M. 4 COR-f A . 0911 =r I Address: CORNWALL �4 ILL .,ROAt0 Town: pA-C- 'r12-59N N`( r n Tax Map #: 13 .07 - 1 �o Dear N 1S • cS e MD Please be advised that an application for a Construction Permit relative to. the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the. latest site -plan. , If you have any questions, concerns or infonnation which may bear on the Health Department's review of this application, you may call the Health Department at 278 -6130. Very truly yours, By: Title: ,%S,G�NTD121�L1L:4t�IT Received By:. Address: Tax Map D1- `,<August 1 �)9-. i i HARRY W. NICHOLS JR., P.E. j� LAURENT ENGINEERING .-ASSOCIATES, P.C: MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road Brewster, New York 10509 (914)27!}:61108- (FAX) 278 -2658 CONSULTING SITE ENGINEERS RE: Department of Health Review of Proposed SewageTreatment System for Property Name: 14o MN,- M. £i CORI A ':0?,1PFIN Address: CORNw,4LL- I41I_ _ RoAt? Town: 151A7T�YZ_N Tax Mdp #: 13.01 - I - loo Dear cdl. Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for.the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan., If you have any questions, concerns or information which may bear on.. the' Heal th Department's review of this application, you may call the Health Department at 278= 6130. Vcry.truly yours, By: Title: &t! W: " 15212 A?? i'C 4f; Received By: Address: "fax Map 9 /3 0') �Au�ust 19�) ' LAURENT ENGINEERING j \ —ASSOCIATES, P.C..: MILLBROOKE OFFICE CENTRE j \ Route 22 d Milltown Road j \ Brewster, New York 10509 (914)27¢, -6108 - (FAX) 278 -2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS RE: Department of Health Review of Proposed SewageTreatment System for Property Name:'140MAS MA eoP, f A'. G1tZ 11✓FIN Address:09NWALl- HILL ROAV Town: PA-t -Tr,-IR-e,1N Ni Tax Mdp #: 13.07- 1 - &0 ' Dear %%�, . %�• Vi�D '. Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for.the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan., If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at 278 -6130. Received By: Address: Tax Map #: _ 10,07---L (o(, 'Ab* -ust 1997 '+ LAURENT ENGINEERING j k -ASSOCIATES, P.C:' + j j MILLBROOKE OFFICE CENTRE Route 22 & Milltown Road j \ Brewster, New York 10509 j \ (914)278:6108- (FAX) 278 -2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS raA RE: Department of Health Review of Proposed SewageTreatment System for Property /I;t Name: 1- 40MAS M. 51 COW( Al- :091t✓FIN Address: CORNWALL 41 LL ROA Town: rA.TT r, 12�N N `i Tax 1\�l�p tl: 13.07- I - loo Dear%% , l�%7 -r.� . �Oi� ; • Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for.the captioned property has been made.to the Putnam County Department of Health. Attached please find a copy of the latest site plan. . If you have any g0estions, concerns or information which may bear on the:,;Health Department's review of this application, you may call the Health Department at 278 =6130. EX HARRY W. N:CHOIS JR., P.E. February 3, 1999 Robert Morris, P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Compliance Thomas & Cory Griffin Cornwall Hill Road Town of Patterson Dear Mr. Morris: Enclosed are the following: LAUR ENT ENGINEER ;NS ASSOCIATES, P.C. M;USAOCKE OFF ;CE CENT?.: RzO4 22 6 M ;It'z —n Ra+C @rr�nur,lY�wYart 1C'1.9 (IIg27a- IC-3 • ( ;:AX) 273.71IM CONSULTING SITE E`4GI-I_ ?RS 1. Five (5) prints ofDrawing S -1, "As -Built Plan," dated 12/31/99. 2. "Certificate of Construction Compliance for Sewage Disposal System," dated 1/28/99. 3. "Guarantee of Subsurface Sewage Disposal System," dated 1/28/99. 4. Well Completion Report, dated 9/21/98. 5. ' Laboratory Report, dated 2/1/99. 6. Application Fee in the amount of $200.00 payable to Putnam County Health Department. If there are any questions concerning; the enclosed, please call. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. Nichols, Jr., P.E. HWN:JM:his 97049 yr a.,r v -- --1 11 `"RV11 fU 92787921 P.01 To: ci i? From: jFf F m Re: C1.P Kir LO -AVOW Aw" , Job No. 17M t Date — Personal —Phone Call 1JYT fair 11ASItumo I (A OA REPORT TO: NORTHEAST LABORATORY of DANBURY 39 -3 MILL PLAIN ROAD - DANBURY, CT 06811 (203) 748 -7903 - FAX (203) 748 -0652 LABORATORY REPORT -- WATER SUPPLY TESTING CT Cert: PH -0404 NY Cert: 11471 ROSS ALAN DATE-SAMPLE COLLECTED: 1/11/99 & 1/28/99 25 BYRAM LAKE ROAD TIME COLLECTED: 12:00 P.M. & 8:50 A.M. ARMONK, N.Y. 10504 COLLECTED BY: R. ALAN DATE RECEIVED @ LAB: 1/11/99 & 1/28/99 TESTED BY:LAB #11471 & 11301 REPORT DATE: 2/1/99 SAMPLE SITE: GRIFFIN LOT, CORNWALL HILL RD., PATTERSON, N.Y. SAMPLING POINT: POWDER ROOM SINK SOURCE: WELL TREATMENT: NONE TEST PERFORMED RESULT: MAXIMUM CONTAMINANT LEVEL BACTERIAL: 1/28 -Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml PHYSICALS: Color 0 Odor 4- METALIC pH 7.46 no designated limit Turbidity 1.5 NTUs 5 NTUs CHEMISTRY: Nitrite N 0.052 mg/L as N 1 mg/L as N 11301 -Nitrate N 0.64 mg/L as N 10 mg/L as N Alkalinity 206.0 mg/L no designated limits Hardness 296.0 mg/L no designated limits Iron 0.094 mg/L 0.30 mg/L Manganese 0.035 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium 5.0 mg/L 20 mg/L ** Lead 0.001 mg/L 0.015*** ml = milliliter mg/L = milligrams per Liter ND = none detected NTU =Units * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED: 1/11/99 & 1/28/99 SAMPLE, AS TESTED ABOVE: ❑ or IMNOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) 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 DEPARTi\IENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: p 1 9,0 Inspected by:_ �, 7?� �� Street Location �� � ,`� /�: *4 Owner _ aZ t F• F4 N Town i7.A 7-r woe/ Permit 4 — J Ti•i f t 3,C9.2 — — o Subdivision Lot 4 1. Sewaze Svstem Area a. STS area located as per approved plans ............................ b. Fill section - date of placement 3:1 barrier Lath.'. Width Avg.Dpth c. Natural soil. not stripped . ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water coursehvetlands ...... ............................... II. Sev�-age System a. Septic tank size - 1,000 .......... 1, 250 ......... other .............:.. b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribtuion Bgx 1. oft same elevation - water tested ................. 2. Protected below frost .................. ............................... 3. Ziinimum 2 ft.Original soil between box & trenches Junction BOX roperly set ............... ..... F.-T-e-nag required �'oo Length installed Soo 2. Distance to watercourse measured -f- ZOcaFt.......... 3. Installed according to p� ........................... -'.. Slofre acceptable , l / - /32" /foot ............. 5. 10 roperty line X20 ft.- � foundations ...:...... 6. Depth tren <ies n� , 601' ce . .............. i. Room r ....................... 8. Size • 3/4 - 1 %Z "diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ........................ ............................... CF. P ump or Dosed Svstems Size of pump c am er ................ ............................... 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. ouseBuildinQ a. House located per approved plans ....... i.il ........... 6 Nrrt6.. ..P.egr....... IV. Wel Number of bedrooms.�Q � r5 fo ,dot �;-c a. Well located as per approved plans . ............................... b. Distance from STS area measured oo ft ........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Worlcmanshin 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 ... ............................... i. Erosion control provided ................. ............................... Rev. 1/97 orm I.,( K17— G7 -177tf 114 %41ml t-Kul TO 92757921 P.02 TOTAL P.02 l to itL_ r.. °_.: �.....r_.......«.— .._...d° 1 � 80c1 Wd ° t-1.8QT] pfd � ,�v ap tB•I�BOiI 91d m\ pp i 1 1 1 I C V rr r n it 1 TOTAL P.02