Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0526
DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 15. -1 -50.2 BOX 6 00526 -f all l6wo Imm IN �• ,�� IN 1 JA 00526 I PUN AM COUNTY T DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SE 7err-,-e�' ENT SYSTEM PCHD CONSTRUCTION PERMIT # D v Located at 9Q11n Ier Lane (� or Village Owner /Applicant Name... P (, �e1�w li nn rriP Tax Map /S. Block _�_ Lot S70. Formerly ' 3,,�_"[)e y, (- o l Subdivision Name X41 cax� Flo Subd. Lot # at Mailing Address %c, r th (/ L-4 ,na— bletmn4y, I k- t tj y Zip za 7o Date Construction Permit Issued by PCHD 7 U Separate Sewerage System built by 'De a I"p- o( d- Address )c fi,) r AI I 1 Let ne, A 6 (,•n y1 Ile, N D S. ") i Consisting of 1,2 SM Gallon Septic Tank and , L ' L., i �P A&Sc►rn-frck, �r�nG�}PS Other Requirements: Water Supply: Public Supply From Address or: ( Private Supply Drilled by P r lbg j 4 Sly C Address y 'PLij ,iM A&- ; P i sJ �: N y cgs Building Type Aesidfb H&O Has erosion control been completed? yei Number of Bedrooms q Has garbage grinder been installed? No I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: (- z b— 0+ Certified by _ -zo6 i Fe 81�17e eril, Svry Address '�, I r. o-i- 4- ti r p P.E. R.A. L&a5tz -W Ate,,,, - {ee4re, License # W 9:3 / 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 approval are bject to modification or change when, in the judgment of the Public Health Director, such revocation m ific 1 or change i n essary. By: Title: dA Date:li White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 Nov 03 03 10:41a BRUCE R, FOLEY Public Health blractar TOWN OF PRTTERSO 845 - 878 -2019 p.2 LORETTA MOLINARI• RN., M,s.N. Attociatc Public Health Director Director of AvIdAr Services DEPARTM MT OF HEALTH 1 G+ ays Road Brewster, New York 10509 irovlronmental Health (914) 278 - 6130 Fea(9,14) 278.7921 Nursing 5crricca (914) 278 - 6558 WIC (914) 278 - 6678 Fug (914) 278.6085 !Early iaterven6an (914)271-0014 Preuhool (914) 2M M2 Fax(914)273-6(A0 OWNERS lti AIVIM- TAX KAP NUMER: E911 ADDRESS: 5229 Qun lrvr-pQr TOWN; _�d.- Fr5or1 /4'✓�r, f:,��, ,„mot . /, /iir '--� AUTSO1t M TOWN OFFICIAL. - (Signature) DATE: The Putnam County Department of Health will not Issue a Certificate of Construction Compliance unless the above form is comlplet4 Le., a legal E911 address is assigned by an authorized towla official: This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERMK 17/17 -d ZTZ6S22SbB SNI833NISN3 31ISNI:W(383 69:0T £002 -2-rCN 0 BRUCE R, FOLEY LORETTA MOLINAM. RN., M.S.N. Public Health bireeror ��C►W ��$� drtooiatc Public Xeallb Director Dlreclor of patimr Srrvlccr• DEPARTTvENT OF F ALTS 1 Guaeva Road Brewster, Naw York 10509 Eorlronmental Health (914)278.6130 Pea (9,14) 178.7921 Nursing Scr ku (914)278 -6558 VYiC (914)278 -6678. Fug(914) 278.6085 Karly laterven{ion (914)276 -6014 PrcSe11001 (914)210.6081 Fax(914)278 -664" I O Yl'ftRS rl A.17JX: TAX MAP NI M.B)ER: E911 ADDRESS: 1t,ng TOWN-. � , �--" AUTRO1t1Z�ED TOWN OFFICIAL: �''' "" "`� �� � (Signature) DATE: The Putnam County Departraeat of Health will not 'issue a Certificate of Construction Compliance unless the above form is completed i.e., a legal E911 address is assigned by an authorized to*% official: This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERMK b�b:d 6T029L8:01 ZTL6S22SbG 9NI833NI9N3 31ISNI =W083 WOT VW2 -E-rG4 Nov 03 03 10:41a BRUCE R, FOLEY public ifealth Dlreeror TOWM OF PATTERSO d , 845 - 878 -2019 p.2 LOIiETrA MOLINARI• RN., M.S.N. Associate Public Health Dlrectcrr D10-ecwr of Patiein sovleee DEPAMENT OF HEALTI� 1 Gdaeva Road $ranter, New York 10509 tailroameatal ffealth (914)278.6130 Fsx(9,14) 278.792! Nurrlea Sen►icai (914) 278.6338 WIC (914)278 -6678 Fax(914) 278.•6085 )Early InkwenHOn (914)276.6014 PrcuhoW (914)219.6082 Fax(914)278 -6648 E91.1 AD RF V' R AMON OVMR5 KAW- TAX MAP NUMBER: E911 ADDIMS: 4&ae., TOWN-. /,/4 ---, AUT19ORIZED TOWN' OFFICIAL: r'` � (Signature) r Q DATE: The Putnam County Deparb rent of Health will not (issue a Certificate of Construction Compliance unless the above form is comlplet4- i e:, a legal E911 address is assidnled by an anthorized town official: Tb&s form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERI =RK . .......... b.b :d 6702818/-01 )-TZ6S22St9 9NI833NISN3.31ISNI =WO11d 6S :6T £002 -2-rCN PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT gtc�c -tE tur-z- Well Location Street Address: 299 Quaker Lane Town/Village: Patterson Tax Grid # Map 15.. Block ( Lot(s) ,50, • Well Owner: Name: Address: Pamela Crecco, 10 Farhill Lane, Pleasantville NY 10570 Use of Well: 1- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X. Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total•length 32 ft. Length below grade 31 ft. Diameter 6 . in. Weight per foot 19 lb /ft. Materials: X Steel Plastic Other Joints: Welded X Threaded Other Seal: X Cement grout _ Bentonite Other Drive shoe: X 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 X Pumped X Compressed Air Hours X Yield _Q gpm Depth Data Measure from land surface- static (specify ft) 30' During yield test(ft) 180' Depth of completed well in feet 245' Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameteron) Formation Description ft. ft. Land Surface 17 Drilling in overliurden Hit ' rock at 17' 17 32 Drilling in rock set casing, 32 245 Drillina in rock aranite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 7gpm Depth 200' Model 7GS07412 Voltage 230 HP 3/4 Tank Type WX250 Volume 44 gallons Date Well Completed 5/15/03 Putnam County Certification No. 001 Date of Report 9/5/03 Well iller signature) Christopher Beal NOTE: Exact location of well with distances to at least two permanent_ landmarks to be provided on a separate sheet/plan. Well Driller's Name P. F. Beal & Sons, Inc. Address: 4 Patrw Ave., pr,_NY 10509 Signature: Date: 9/5/03 Christopher Beal White copy: HD File; Yellow copy- Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAMf COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # - _ o O Well Location: Street Address: TownNillage Tax Grid # Map It 5 Block Lot(s) c,,.z, Well Owner: Name:0CJA -; r� tJ%5 V- Address: C;.v5c=. "c.,_,a -t— Use of Well: _b4� Residential Public Supply Air /Cond/Heat Pump Irrigation 1-Amary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought G. gpm # People Served _� Est. of Daily Usages al. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling 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 *PC, No Name of subdivision At ft., n p Lot No. Z Water Well Contractor: S_� Address: %— Is Public Water Supply available to site? .................................. ............................... Yes No K. Name of Public Water Supply: ...1 Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: 8 -w -!ic Applicant Signature: d 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 11 ller certified by Putnam County. r Date of Issue f Permit Iss ' g >c' Date of Expiratio 0 7-- Title: % Permit is Non -Trans rr ble White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 D� 1 1 THE CITY OF NEW YORK DEPARTMENT OF ENVIRONMENTAL PROTECTION J) JOEL A. MIELE, SR., P.E. Commissioner Phone (914) 742 - 2001 Fax (914) 742 - 2027 Robert Morris, P.E. Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: Alonge Subdivision - Lot # 2 Quaker Lane (T) Patterson; © Putnam East Branch Reservoir Basin DEP Log # 9975 (Joint Review) Dear Mr. Morris: William N. Stasiuk, P.E., Ph. D. Deputy Commissioner Bureau of Water Supply, Quality and Protection February 1, 2000 This letter is to inform you that the New York City Department of Environmental Protection (Department) has determined that the above - referenced Subsurface Sewage Treatment System (SSTS) application is complete. In addition, the Department has no objection to the approval of the above - referenced regulated activity. This determination is based on the review of submitted documents including the plan titled "SSTS prepared for Brimstone Development Corporation," dated 9/17/99, prepared by Insite Engineering, Surveying and Landscaping Architecture, P.C. The applicant must contact Lucie Lops of my staff at (914) 773 -4461 at least 2 days prior to the start of construction of the SSTS so that the Department may inspect and monitor the installation. Sincerely, a Margaret Lloy, , P. E. Supervisor Engineering Design Review xc: James Covey, P.E., NYSDOH 465 Columbus Avenue, Valhalla, New York 10595 -1336 BRUCE . R. FOLEY Public Health Director January 21, 2000 DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 Jeffrey Contelmo, PE Insite Engineering Route 22 Brewster, New York 10509 RE: Quaker Lane, Lot # 2 (T) Patterson, TM# 15:4-50.2 Reservoir Basin - East Branch Dear Mr. Contelmo: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on January 18, 2000 is complete. The Department will notify you by February 7, 2000 of its determination. ❑ The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ® Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice 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 Department of Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (914) 278 -6130 ext. 2159. Very truly yours, Shawn Rogan Public Health Technician SR:cj PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION' OF ENVIRONMENTAL HEALTH IN-DIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMMIT STREET LOCATION' NAME OF OWNER �/ � � mac! • ��� ' REVIE«'ED BY RNI, GR, AS, ;•IB, BH� � �o `�' TAX I✓[.AP # IS, �� �• -� Y N DOCUMENTS PER`tIT APPLICATION PC -1 WELL PERMIT _ PWS LETTER LETTE 0RlZATION` SIGN DATA SHEET ) P" TE RE UTION SHORT EAF f PLANS - THREE SETS HOUSE PLANS - TWO SETS VARIANCE REQUEST FEE SUBDIVISION LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED PERC RATE FILL REQUIRED DEPTH LUICURTAN DRAIN' REQUIRED STA \PIPES GENERAL I OCATED N NYC WATERSHED LANS SUBMITTED TO DEP ELEGATED TO PCHD EP APPROVAL, IF REQ'D EEP TEST HOLES OBSERVED ERCS TO BE WITNESSED X- APPROVAL SSDS ADJ. LOTS WETLANDS (TOWN/DEC PERMIT REQ'D ?) ATA ON DDS PLANS& PERMIT SAME RE 1969 NEIGHBOR NOTIFICATION ETTER BU ZBA 00 YR FLOOD ELEVATION OTHER REQ'D PERViIT(S) REUTIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN-(NORTH ARROW) SSDS HYDRAULIC PROFILE / GRAVITY FLOW 1' N I SION CONTROL:HOUSEWELL, SSDS C & DEEP HOLES LOCATED RESENTATIVE OF PRIMARY & EXPANSION ATION MAP . AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE U�1PED, PIT & D BOX SHOWN & DETAILED USE - NO.OF BEDROOMS LLS & SSDS'S W/N 200' OF PROPOSED SYS. OPERTY METES & BOUNDS USE SETBACK NECESSARY (TIGHT LOT) USE SEWER -1/4" FT. 4 "0; TYPE PIPE BENDS; bL4X.BENDS 45° W /CLEANOUT FILL SYSTEMS CLAY BARRIER 10kFT. HORIZONTAL;SLOPE 3:I TO GRADE FILQSPECS ---""1 FILLNOTES TION NOTE PROFILE & DIMENSIONS FILL N EXPANSION AREA TRENCH PrF�LF TRENCH PROVIDED S 16 60 FT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED SEPARATION' DISTANCES SPECIFIED ON PLAN-'- FROM SSTS 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS _I TWELL TO PL 1 00' TO WELL, 200' IN, DLOD, 150' PITS 100' TO STREAM WATERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAN, PIPED WATER 10' TO WATER LINE (pits -20') 50' INTERMITTENT DRANAGE COURSE /500' RESERVOIR, ETC. —150' GALLEY SYSTEMS 00• CONSTRUCTION NOTES MIN to CDS=> 5%, 0'- 4%, 25'- 3 °/q30'- 2 %,35'- 1 ° /g100' - <1% DESIGN DATA: PERC & DEEP RESULTS 20'MN to CD discharge /100'with 182 cons day discharge T 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 m LOCATION OF SERVICE CONNECTION TM- ,PE/RA; NA:ViE,ADDRESS,PHONER DATE OF DRAW NGIREVISION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET FT—]PROPOSED FNISH FLOOR AND BASEMENT EL. CO.NIIIE \ ?S: BRUCE R FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI RX, M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278.7921 Nursing Services (914) 218 .6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914)278-6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 TO: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW • DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM JOINT REVIEW PROTECT: TOWN: NOTICE OF COMPLETE APPLICATION: 1-1-ala"s 1 &1— All- - 1Z SUB'D APP DATE: 6 _3�Q7 DATE: ❑ Within the drainage basin of West Branch or Boyds Corner Reservoirs. Cl Within 500 feet of a reservoir, rese �wetl l lake. Within 200 feet of a watercou se or a Dd appearing on a subdivision map approved after December 31, 199 . ❑ Design flow greater than 1000 gallons /day. ( =V) Date: • 7 - 4 1 RE :�- Reservoir Basin Dear The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on �� T c)-O is complete. The Department will notify you by P-h I, C10 of its determination. ❑ The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice 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 Department of Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding. this matter, please call meat (914) 278 -6130 ext. 2159. Very truly yours, Shawn Rogan SR:tn Public Health Technician ws2 PUTNA.M alliJNTY DEPARTMENT rF HE, A.LTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN RATA SHEET - SUBSURFACE SEWAGE TREATMENT SXSTEM sOwner STSPKam/ AL OAIkE Address S7 Srl 1.3�.~tSTO��� R.os�O MiD Located at (Street) Tax Map Block Lot SD�Z (indicate nearest cross street) Municipality Drainage Basini�?�T �✓'�°�`'� SOIL PERCOLATION TEST DATA ',v ; r ✓�SG� fi i` n/'� C.C.S Date of Pre - soaking S (3�q' i Date of Percolation Test S if q % Hole No. Run No. Time Stara - Stop Ela se Time Min.) D to Water De Ground Surface (Inches) Start Stop watcr Level Drop In Inches Percolation Rate MinAnch 3 3:�5 - f:15 3CO 23 �� f 54 i 7 .4 5 ?47- '2 q 331q- z6'/ 3 �� 2 S t7- 3;, % 3O z 5311- ?_6 1,2 3 ?f 3- i �O Z6 a3 /� 4 5 1 2 3 4 LT/1TTl ;5 ••%J• 1. Lrbu w ve repeatea at same aeptn 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. t ' 2. Depth- measurements to be made from top of hole. Form DD -97 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' ' TEST PIT DATA' @kw DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE N0. Q ?-A HOLE N0. * n F (3 HOLE N0. Indicate level at which groundwater is encountered Indicate level at which mottling is observed !!�/Jf1 Indicate level to which water level rises after being encountered �t/A Deep hole observations made by: 12>w Date S (4 �7 Design Professional Name: Jeffrey J. Contelmo, P.E. Address:Insite Engineering & Surveying, P.C. Brewster, New York 10509 ` Signature: Z ` Design Professional's Seal �E OF NE W rU COh ?� �1. �i,`cF IP��N "193 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: 2. Name of project: Pq i 3. Locatior> V: Incite &gineering, surveying & Iar�c3scape 4. Design Professional: Jeffrey J. Cmtelm, P.E. 5. Address: Ar. , P.C. 6. Drainage Basin: jig, { °� ,,,,t rite 22 V a . Drew ��r 199. 7. Type of Project: _ Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ........................ ............................... Type I Exempt Type II Unlisted jo4— 9. Is a Draft Environmental Impact Statement (DEIS) required? ........................: ,erg 10. Has DEIS been completed and found acceptable by Lead Agency? ............... ^(g- 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 ?.!qd .Date granted: e.- 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) ........................................... ............................... vd� 18. Is project located near a public water supply system? ....... ............................... 19. If yes, name of water supply y,1 G.. Distance to water supply�� 20. Is project site near a public sewage collection or treatment system? ................ CIS. 21. Name of sewage system Distance to sewage system 22. Date test holes observed k -4-1 -123. Name of Health Inspector m;j,5. I3...d�,.,,.�,�.; •per. 24. Project design flow (gallons per day) ................................. ............................... Ire> Ca0 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 'V% 4W 2.6. Has SPDES Application been submitted to local DEC office? Form PC -97 2 27. Is any portion of this project located within a designated Town or State wetland? :,U4=1 28. Wetlands ID Number ........................................................... ............................... �— 29. Is Wetlands Permit required? ......................................:....... ............................... Has application been made to Town or Local DEC office? ............................... ��.. 30. Does project require a DEC Stream Disturbance Permit? .. ............................... 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 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 Inc, 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? ................................ ............................... 35. Are any sewage treatment areas in excess of 15% slope? . ............................... v.® 36. Tax Map ID Number .......................... ............................... Map Ar, Block _L Lot evz>, 2, 37. Approved plans are to be returned to ..... Applicant _y_ Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater,plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm,. under penalty 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 pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES. Mailing Address: .................................. r ,� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of tnmi%& * Located at F Tax Map # t.c;, Block i Lot c;e>. z- Subdivision of AiT..R4 Subdivision Lot # °Z Filed Map # a,-lgZ Date Filed Gentlemen: This letter is to authorize Incite Ehgi.neering, Surveying & Architecture, P. C. (Jeffrey J: Cbntelmo, P.E a duly licensed Professional Engineer x_ csrAeVs1amd ;0ff0d=xxxxxto apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Countersigned: P.E.,1K.A., # Mailing Address Incite axrh eerinq, surveying & Lmxhcape Architecture, P.C. Route 22 State New York Zip 10509 Telephone: (914) 278 -4990 Ver trul ours, • . er of Property) Mailing Address: c,jae, - State tJY Zip Telephone: Gnu - ot5d:)-f3 Form LA -97 r /NS/TE ENGINEERING, SURVEYING & LANDSCA PEA RCHITECTURE, P.C. 1485 Route 22 (914) 278 -4990 Brewster, New York 10509 Fax: (914) 278 -6392 7 DeLavergne Avenue (914) 297 -1742 Wappingers Falls, New York 12590 TO: Putnam County Health Department 1 Geneva Road Brewster, New York 10509 LETTER OF TRANSMITTAL Date: /- 17- oo Job No. 96134.302 Attn: Robert Morris, P.E. Re: SSTS for Alonge —Lot 261-4� Quaker Lane, Town of Patterson TM # 15 -1 -50.2 WE ARE SENDING YOU ® Attached ❑ Under separate cover via ❑ Shop Drawings ® Prints ❑ Plans ❑ Copy of Letter ❑ Change Order ❑ ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION 4 cj- )'7-99 C -1 Construction Drawing 1 08/20/99 CP -97 Construction Permit LA -97 Letter of Authorization 1 --- PC -97 Application for Approval of Plans for a Wastewater Treatment System 1 08/20/99 WP -97 Well Permit 1 05/14/97 DD -97 Previously Submitted Design Data Sheet 1 i 08/20/99 --- Short EAF 1 116-30- 94? — $300.00 Fee ,f 96a4&o6SZ 2 — — Modular 4- Bedroom House Plans � /U • z -• '!-. l���'�.�.eV i•j' r�ir c.esa- Prny,.{,q,., �.x ,wt...c.�. •i® THESE ARE TRANSMITTED as checked below: ® For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ REMARKS: COPY TO: It96134_2.doc SIGNED: J. ontel P.E. IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE 14.16.4 (7J87)--4ext 12 PROJECT I.D. NUMBER 617.21 SEOR Appendix C :.: State Environmental Quality Review SHO_ RT .ENVIRONMENTAL ASSESSMENT FORM. For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Appllcant.or Project sponsor) 1. APPLICANT /SPONSOR jWz,:—tc_ �vw�i.lG�e-� 2. PROJECT NAME, 'S'� =ra,r .g 3. PROJECT LOCA ON: Municipallty �'E'°�'o�°'� County l 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) Jr S. IS PROPOSED ACTION: New ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: ,�.,.n�ra�c�t a� -sA� •,a�L �e�.rK� +y met-. i, �e..�c� L �t•. J��+�y 7. AMOUNT OF LAND AFFECTED: Initially �•` y acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 2EYes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL) ?. Rves ❑ No If yes, list agency(s) and. permlUapprovals •ate ;��..�,,.y •PQ- „�.•�. e `��t,�,.�... - . ��� o �.�,,; -�.r .�,�,.. •tom �..�•�,,.��^� ..►� `d � .race: e'�„a,.� � cr1 11. DOES•ANY ASPECT OF THE ACTION VE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes 1% No If yes, list agency name and permll/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑ Yes ONO I. CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ,W+i -�c� �l�i•�c%1 � (,..••.. u�c�aiG 1ri�`"�t��.L.t��vasla jut- .�:.•4X,��`�td^t•�aY�,���+• 1 Applicant/sponsor name: --��4 `� '� Date: 25�0 ” If> °415 Signature: a If the action Is In the Coastal Area, and you are a state agency, complete' the Coastal Assessment Form before; proceeding with this assessment OVER PART II— ENVIRONMENTAL ASSESSMENT (ro 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. 1 ❑ Yes ❑ No __ I B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative"declaratlon v may be superseded by another Inolved agency. ) ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WiTH THE FOLLOWING: (Answers may be handwritten, If legible) C1. 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 brtetly. C5. Growth, subsequent development, or'related activities likely to be Induced..gy the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified In C1-CS? 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 o� more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare appositive declaration. ❑ Check this box If you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental Impacts AND provide on'attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) Date 2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES . AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: Se'-T5 Fort- 1A4" � . co tL P - ( At,-4-"' C-° represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: OR -1 9 t-n pmS +iT' 0_4e ° ' Having offices at: (-66 jA)a!:;`b P tiA b, l'MARoPR Whose Officers Are: President-Name: s�- Pti E Low! Er Address: S8b iOMI) 12.oAD I Iq�IQ��G, N • bS�{- Vice President -Name: Address: Sl3 dUS ieLx=6k4 D,_ 5664. -rN� Mo946PAC,, N'� idS"�'% Secretary -Name: Address: Treasurer -Name: Address: and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Signed: Title:. A ss 1 T Sworn to before me this cR % day of o--0 (month (year) Notary ubli THOMAS J. JACOBEL08 Notary Public, State of New York Corporate Seal No.02JA6003334 Qualified in Putnam County Commission Expires March 2,710' Form CA -97 NOV -5 -2003 10:18 FROM:INSITE ENGINEERING 8452259717 TO:19147479415 PUTNAM COUNTY DEPART'MEN'T OF HEALTH DIVISI ®N OF ENVIR®NMIENT'AL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM u /� -- -� Owner or Purchaser f Building Tax Map Block Lot Building Constructe by Tow . illage _a99 i�►)[l �P r L Ate, . Location - Street Subdivision gire Building Type Subdivision Lot # P: 3/3 Z represent that Z 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. // D y Years Signature: Title: Contractor (Om6er) - Signature Corporation Name (if corporation) Corporation Name (if corporation) Address: /10 AYC- t1(C4- tLl � rGisAS W Address: T— State Aj Zip / e 5' 7c, State Zip ` Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION d' Date: /o/9 03 Inspected by: Street Location Owner P e, 'D F vEtonyEAZZ . Town Permit # P — - o p TM # / S - / -- 5--of OIL Subdivision Lot # :2, 1. Sewage System Area a. STS area.located as per approved plans .......... .. ................ b.. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped ................. .. ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. Sewage 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 .......... ............................... 6, Tr —en c h es 1. Length required 6- 74_ Length installed 5-;76 2. Distance to watercourse measured -/- /0oFt.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 11/2" diameter clean ...................: 9. Depth of gravel in trench 12" minimum .......:........... 10. Pipe ends capped ........................ ............................... g. Pump or Dosed Systems 1. Size of pump chamber ................. ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual/ audio ........:........... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ............ . .................................... I....... 6. Cycle witnessed by H.D.estimated flow /cycle......... M. House/Building a. house located per approved plans b. Number of bedrooms..... --- "�' IV. Well Well located as era roved lans� P PP P �} :... . b. Distance from STS area measured / a-p ft........... c. Casing- 18" above grade ................ .............:................. d. Surface drainage around well acceptable ....................... V. Overall Workmanshh3 . 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 & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate .' ..... .............................. i. Erosion control pprovided ................. ............................... Rev. ?2/02 COMMENTS OCT -6 -2003 15:12 FROM:INSITE ENGINEERING 8452259717 T0: 2787921 P:2/2 P'CJTNA M COUNTY DEPARTMENT OF REt LTH DIVISION OF k.NMONMENTAL HEALTH SERVICES ATTENTION a ADAM *ENE t�E(�L1P'ST FOR FIN_ A�.11SP_ECTION For: Fill , All information must be fully completed prior to any ',Trenches inspections being made. PCHD Coustructioa. Permit # p y-9 --loo .Located: C�U0.kw, arw, - Owner. /Applicant Name: t- C. TM I_ Block Formerly: Subdivision Name: 61-n Subdivision Lot', 9- Is system fill completed? _L✓1A Date- Is system complete? ye! S Date. o Is system constructed as per plans? YEA Is well drilled? YES Date: Mt. Is well located as per plans? Very. Are erosion control measures in place? --- ice_ I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. Date: 1016103 _ Certified by: Insite Engineering, Surveying & e9 Prof ' nal Landscape Architecture, P.C. Address: 3 Garrett Place arms , ew York Comments: Form FM-99 f If T- G -agGj� MfIAI q S •fits TCI • Qd�_77!]_7g71 IJOMC • PI ITKIOM rni IKITV nPPOOTMPWT fly' P P LORETTA MOLINARI R.N., M.S.N. Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 October. 14, 2003 Jeffrey Contelmo Insite Engineering 3 Garrett Place Carmel,, New York 10512 Dear Mr. Contelmo: ROBERT J. BONDI County Executive Re: Field Inspection - P.C. Development Quaker Lane, (T) Patterson TM# 15. -1 =50.2 The above referenced separate sewage treatment system can be.backfilled. The following comments must be addressed. • Upon inspection of the house at the above referenced lot, the extra room downstairs with doors is considered a potential bedroom giving it a count of (5) bedrooms. Approval by this Department is for (4) bedrooms. If you have any further questions, please contact me at 845-278-6130, ext. 2261. Sincerely, 'eg0) 'y " - 9// "�W Gene D. Reed Environmental Health Engineering Aide GDR: cj 9 4 SENDING CONFIRMATION DATE OCT -14 -2003 TUE 13:56 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE PAGES START TIME ELAPSED TIME MODE RESULTS 92259717 1/1 OCT -14 13:56 00'22" ECM OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED.. W I.ORETTA MOI.INARr ILK. M.S.N. ROBERT r. BONDI Public R dsh Dhauor Cowry l .Wtw DEPARTMENT OF WALTH 1 fleneva Road, Brewster, New York 10509 EN"roemmGl BneY (645)278.6150 Fu(845)278.7921 Nmme Sn•ks (645) 271.6558 WIC (1145) 278 , 6678 Pmt (845) 278.6015 RAY 10e 130NPr lux1 (145)278.6014 Pa(645)278. 6648 October 14, 2003 Jeffrey Contelmo Incite Engineering 3 Garrett Place Carmel, New York 10512 Re: Fieldlospeetion- P.C.Development Quaker Lane, (T) Patterson TMq 15.-1-50.2 Dear Mr. Contelmo: The above referenced separate eewage treatment system can be beckfllled. The following comments must be addressed. • Upon inspection of the house at the above referenced lot, the extra room downstairs with doors is considered a potential bedroom giving it a count of (5) bedrooms. Approval by this Department is for (4) bedrooms. If you have any further questions, please contact me at 845 - 278-6130, ext 2261. Sincerely, �) GC -e�e� Gene D. Rood Environmental Hoalth Engineering Aide GDR:cj LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 February 10, 2004 ROBERT J. BONDI County Executive Jeffrey Contelmo Insite Engineering 3 Garrett Place Carmel, New York 10512 Re: Field Inspection — P. C. Development Quaker Lane, (T) Patterson Tax Map # 15. -1 -50.2 Dear Mr. Contelmo: A re- inspection at the above referenced lot has been completed. There are no further comments to be addressed. If you have any further questions, please contact me at 845- 278 -6130, ext. 2261. GDR: cj Sincerely, WL 0, .Gene D. Reed Environmental Health Engineering Aide LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845)278-6130 Fax(845)278-7921 Nursing Services (845)278-6558 WIC (845)278-6678 Fax(845)278-6085 Early Intervention/Preschool (845)278-6014 Fax (845) 278 - 6648 February.2, .2004 Insite Engineering 3 Garrett Place Carmel, New York 10512 Dear Sir: ROBERT J. BONDI County Executive Re: Proposed SSTS — Compliance PC Development, Lot # 2 Town of Patterson, TM# 15 -1 -50.2 Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: 1. The SSTS was approved for a four (4) bedroom house only. The house constructed is considered to have five (5) potential bedrooms. 2. SSTS guarantee has not been fully completed. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Vea truly yours, / 1940 Robert Morris, PE Senior Public Health Engineer me 01/15`2702 0 7:27 845 -278 -6332 1NSITE ENGINEERING PAGE '02 PUTNAM COUNTY DEPARTMENT OF HEALTH DnISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION M: 1'ropertyof S �� 1S7&V6 7'EVCLoe,19 �7 ' ('Ok eon AT'1on1 Located at �-Muq J; V E4 frK;9 50A1 Tax Map l�; Block Lot 90.2 Subdivision of Lom0 r. - - -- Subdivision Lot 2 Filed Mi p 0 1-7q -L Date Filed - 30 - q 9 Gentlemen: This lert:r is to authorize Imte Enzineerinz Sarvevina & Landseave Architecture. P.C. (Jeftztv J. Contzlmo PEE) a duly licensed Professional Engineer to apply for the required wastewater treatment and/or Arater supply permit(s) to serve tt e above -noted propem. Ln accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Pulnarn County Health-Depanment, and to sign all necessary papers,on my bchalC in 'comeolion with trig niaaei ar.d to supervise the construction of said wastewater treatment and/or water supply, systerns in conformity with &e pro.)d,�iors o* Article 145 and/or 147 of the lydueational Law, the public Health La;,,,, and the Putnam Counts;.Si u i�v�G doe R Countersigned: P.E. # Very Truly Yours, Signed: ERIC. Mailing Add_+-ess: Insite Engineering. S'u:veyinq & Mailing Address. �%� (A- ST_DOtI)t -L). Landscape Architecture, P.C. 3 Garrett Place carinel �� b V 6-> 0?,-, . 1 SPA C State New York Zip _ 10512 State � _ Zip 05 Telcrohone: (845) ?� ; -9690 Teiephone: w0 )t -08,6 9 pcdch.dot Form L_k -97 PUT14AM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # Well Location: Street Address: Town/Village Tax Grid # -n4 QVAK 6_ LAf ®_'16i<Rj9 0% Map i r. Block i Lot(s) _50,1 Well Owner: Name: (�L0At6-6' Address: OC 000�() pff4SANe �gv, C�,QO, �IA�la�4c i i0-0i1 Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation rimary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought S gpm # People Served Est. of Daily Usage Apo gal. Reason for Existing Supply Test/Observation Additional Supply Drilling ,,,Replace 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 i� No Name of subdivision A LOA) Lot No. -2- Water Well Contractor: 'f-0 Re- D &r6& !x'4517 Address: Is Public Water Supply available to site? .................................. ............................... Yes No x Name of Public Water Supply: A Town/Village Distance to property from nearest water main: !� Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: 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 well driller certified by Putnam County. I Date of Issue--/—%/ ssue --/— Date of Expiration; ; Permit is Non - Transferrable r Permit Title: _ White copy - HD file; Yellow copy - Building Inspector; Pink copy - Orange copy - WA Form WP -97 2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # f -'t-00 Located at?" ' O J A k 6k- L Ati v own or Village PA < 2sc -g/ Subdivision name A L O1u & E Subd. Lot # `I- Tax Map I �_,. Block I Lot 9'0- Z Date Subdivision Approved C - 3 0 - q q Renewal _'Revision 13 /t 1/A5 -MA % -b t;d. C'" P, 2 - -7— b U Owner /Applicant Name f c p,/g- v $ i rmA/a AL ov bp e) Date of Previous Approval Mailing Address S"8 C W o op s ri4c01�Y' A,4Ro P,4 C . n/ Zip oS" Amount of Fee Enclosed `* 3 00 019 Building Type /Z155/p r,v I-jA L Lot Area a y ± No. of Bedrooms � Design Flow GPD $ 00 Ac es Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1 -1:. 57-O gallon septic tank and !�'7 e L F o 41 Z, w i C> E A .R- .S o k P'yn/' 1"R CW C-K'6 S Other Requirements: To be constructed by ' 6 6' T,) i; Al 1 N 6D Address AJIA Water Supply: Public Supply From Address or: ><O" Private Supply Drilled by 'rO B6 . e1'j5R,1mtA1 E Address _�/f ,_ 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 ihereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: P.E. -"<' R.A. Date i - �s^` 0 2 ? .4/pjred^r N �S'vQv�y/NG �IAN►7ScQ(�� M-1- EeT(leE, P.�, Address L/� C Am K N.Y sa License # I 'S APPROVED FOR CONSTRUCTION: This `appr'oval 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 p emit. Approved r dischargelof domestic;:sanitary� sew e only. By: `° '� Title: c Date: 74 '-0 Z White copy - HD ile; llo copy - Building Inspector; Pink copy - Own ,Oran opy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # 4 " O O Located at 01JAKL4 i.AdI (gwn or Village PA' f6K -5eA1 Subdivision name A t o AjGE Subd. Lot # `►— Tax Map i' S Block 1 Lot 5,o.3. Date Subdivision Approved 6" 30 - q q Renewal _d, Revision / Owner /Applicant Name P. C, -D 6 v FL o r M L 'J'r Date of Previous Approval -7 - 5 - oa Mailing Address 10 FaP, 911-L LAA16 s°LCACArJ,rvi.ccF AA/ Zip ias'�v Amount of Fee Enclosed Building Type ? ESii>e j f/AI- Lot Area 1, g 4+, No. of Bedrooms :4 Design Flow GPD ?yo AC,96; Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 11.i� 0 gallon septic tank and gi G -i- -F. aF 1*96,yc14 iFS Other Requirements: To be constructed by il1VxA101V4 Address ry, /A Water Supply: Public Supply From Address or: Private Supply Drilled by vm y a w Address V /,a I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed Address _ P.E. AQc,N / fEe lvre,- Date -11 -03 License # G q 3 0 taaMeL.AW Io,rrZ. 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 w considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe rt. pprove r discharge of domestic sanitary s 7it By: Title: Date: 2— White copy - HD; File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form P -97 GA fir, 31 o3 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL „ please print or type PCHD Permit # Well Location: Street Address: Town/Village Tax Grid # I S °-1– SO 2 %uAkEC kAJ PcgtC-XSaAJ Map 15 Block / Lot(s) Well Owner: Name: --JAddress: tea tr,_a /0 FAA HILL 4N, Pleasgwrul 16, k /057C) Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought ___5_ gpm # People Served Est. of Daily Usage 3 00 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason CAV COn.�s --9. Cl– In for Drilling Well Type _� Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ........0. AAQ6. ... JA(NR . .............................. Yes � No Name of subdivision BRIMS r-orJe bf- Ue- kOPMAT -f. , A t-onju Lot No. 2� Water Well Contractor: A-= Address: Phnfasty U14 Is Public Water Supply available to site? .................................. ............................... fes No V Name of Public Water Supply: — Town/Village Distance to property from nearest water main: ^� Proposed well location & sources of contamination to rovided on separate sheet/plan. r Date: 03 lo- 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 wat7lill driller certified by Putnam County. ' /, / 4,4 Date of Issue 3 1 do 3 Permit Issuing O. Date of Expiration D Title: Permit is Non- T��raansfe ra 'le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 JMS ENVIRONMENTAL SERVICES, INC. 1500 SUMMER STREET STAMFORD, CONNECTICUT o6905 Mailing Information: Name: PF Beal & Sons Address: 4 Putnam Ave City: Brewster State: NY Telephone: 845 - 279 -2460 Sample's Information: Site: Kitchen Tap. Preservative: HNO3 Temperature: <4C Client: Grecco Zip: 10509 Fax: 845 - 279 -6613 Date Collected: Time Collected: NELAC, CT and NY State Certified Environmental Laboratory Collector's Information: Name: Mike Forschner Address of site: Quaker Ln City: Patterson State: NY Zip: Telephone: Date Received: 12/3/03 Time Received: 14:30 Lab No.: J038965 Date Analyzed Test Name Result MCL Method 12/3/03 15:00 ''Total Coliform Absent Absent SMWW 92228 12/3/03 Chlorine Free Residual <0.1 mg /L N/A SMWW 4500CIG 12/3/03 Color ND 15 Units SMWW 2120 B 12/3/03 Odor ND 3 TONs SMWW 2150 B 12/4/03 Iron 0.146 mg /L 0.3 mg /L SMWW 3111B 12/4/03 Manganese <0.050 mg /L 0.3 mg /L SMWW 3111 B 12/4/03 Sodium 6.88 mg /L N/A SMWW 3111B 12/4/03 Chloride 32 mg /L 250 mg /L SMWW 4500 Cl C 12/4/03 Hardness 132 mg /L N/A SMWW 2340 C 12/4/03 Nitrate 0.635 mg /L 10 mg /L SMWW 4500 NO3E 12/4/03 10:00 Nitrite <0.1 mg /L 1.0 mg /L SMWW 4500 NO3E 12/3/03 pH 6.75 S.U. 6.5 -8.5 S.U. SMWW 4500 H B 12/4/03 Sulfate 39.3 mg /L 250 mg /L SMWW 4500 SO4F 12/4/03 Turbidity 1.21 NTU 5 NTUs SMWW 2130 B 12/4/03 Alkalinity 80 mg /L N/A SMWW 2320 B 12/4/03 Lead <1.0 ug /L 15 ug /L SMWW 3113 B At the time of analysis the sample was acceptable for total coliform N/A = Not Applicable mg /L- milligrams per Liter ND- None Detected S.U.= Standard Unit NTU- Nephelometric Turbidity Unit MCL- Max. Contaminant Level TON- Threshold Odor Number ug /L- micrograms per Liter Signature: State #: PH -0218 Michael Lapman ELAP #: 11715 President Tel 203 961 9911 Toll Free 1 866 567 5097 fax 203 961 9919 imsenvironmental.com /NS/TE ENGINEERING, SURVEYING & LANDSCAPEARCHITECTURE, P.C. 3 Garrett Place (845) 225 -9690 Carmel, New York 10512 Fax: (845) 225 -9717 TO: Putnam County Health Department 1 Geneva Road Brewster, NY 10509 LETTER OF TRANSMITTAL Date: 1 -26 -04 Job No. 03136.100 Attn: Robert Morris, P.E. Re: SSTS for P.C. Development 299 Quaker Lane, Town of Patterson TM# 15 -1 -50.2 WE ARE SENDING YOU ® Enclosed ❑ Under separate cover via ❑ Shop Drawings ® Prints ❑ Plans ❑ Copy of Letter ❑ Change Order ❑ ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION 5 ! 12 -15 -03 ; A13-1 As- Built Drawing 1 { 1 -26 -04 ; CC -97 Construction Compliance 1 11 -18 -03 GS -97 Guarantee 1 ' 12 -3 -03 - - - - -- Water Test Results 1 11 -25 -03 & 1 -21 -04 —1 1391 & 1409 $300.00 Fee % zod-100 ,f. (c ,cc) 11 -3 -03 - - - - -- E -911 Address Certification 9 -5 -03 WC -97 Well Completion Report I THESE ARE TRANSMITTED as checked below: ®For approval ❑Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested []Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ REMARKS: COPY TO: lot2002.dot SIGNED: j n M. Watson, P.E. IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT AIot czr jv(3D v.ScrJ G;;rZ_ Well Location Street Address: 299 Quaker Lane Town/Village: Patterson Tax Grid # Map ? Block t Lot(s) Well Owner: Name: Address: Pamela Crecco, 10 Farhill Lane, Pleasantville NY 10570 Use of Well: 1- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Well Type X Rotary Cable percussion X Compressed air percussion Other (specify) Screened Open end casing X Open hole in bedrock _ Other Casing Details Total length 32 ft. Length below grade 31 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: X Steel _ Plastic _ Other Joints: _ Welded X Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: X Yes No Liner _ Yes _XNo Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First No Hours Second --Yes- Well Yield Test Depth Data Bailed X Pumped X Compressed Air Measure from land surface- static (specify ft) During yield test(ft) 30, 180, =Hours Yield _0 gpm Depth of completed well in feet 245' 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 17 Drillina in overliurde clay Hit rock at 17' 17 32 IDrilling in rockJ set casincr, cirouted 32 245 Drillincr If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 7gpm Depth 200, Model 7GS07412 Voltage 230 HP 3/4 Tank Type WX250 Volume 44gc allons Date Well Completed 5/15/03 Putnam County Certification No. 001 Date of Report 9/5/03 Well Driller signature) Christo her Beal NOTE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. Well Driller's Name P. F. Beal & Sons, Inc. Address: 4 Putrl mt Ave., Breiaster, NY 1n9m Signature: - Date: 9/5/03 Christopher Beal White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 i i Y i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT,i�,�czC 5v(3b, 5ccni:rZ Well Location Street Address: Town/Village: Tax Grid # 299 Quaker Lane Patterson Map Block Lot(s) Well Owner: Name: Address: Pamela Crecco, 10 Farhill Lane, Pleasantville, NY 10570 Use of Well: X Residential Public Supply Air cond/heat pump Irrigation 1- primary Business Farm Test/monitoring Other(specify) 2- secondary Industrial Institutional Standby Drilling Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Total length 32 ft. Materials: X Steel _ Plastic _ Other Casing Details Length below grade 31 ft. Joints: Welded X Threaded Other Diameter 6 in. Seal: X Cement grout _ Bentonite Other Weight per foot 19 lb /ft. Drive shoe: X Yes No Liner _ Yes X No Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes No Screen Details Hours Second Well Yield Test Bailed X Pumped X Compressed Air Hours =yield Yield _0 gpm Depth Data Measure from land surface - static (specify ft) During yield test(ft) Depth of completed well in feet 30' 180' 245' - Well Log Depth From Surface Water Well Formation If more detailed ft. ft. Bearing Diameter(in) Description Land Surface 17 Drilling in over urden clay information Hit rock at 17' descriptions or 17 32 Drillinq in rock set casing, routed sieve analyses 32 245 _ Dril ' n in are available, please attach. If yield was tested Feet Gallons Per Minute Pump /Storage Tank Information at different depths Pump Type sub Capacity 7cjpm during drilling, Depth 200' Model 7GS07412 list: Voltage 230 HP 3/4 Tank Type WX250 Volume 44_C' alloris Date Well Completed Putnam County Certification No. Date of Report Well riller (signature) 5/15/03 001 9/5/03 Christo her Beal NOTE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. Well Driller's Name P. F. Beal & Sons, Inc. Address: 4 Putz m Ave., Bn3oter, NY 1115fXa Signature: - Date: 9/5/03 Christopher Beal White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 a 1 5 June 13, 2002 Mr. Robert Morris, P.E. Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: Alonge Subdivision - Lot # 2 Quaker Lane (T) Patterson; © Putnam East Branch Reservoir Basin DEP Project # 9975 (Joint Review) Dear Mr. Morris: The New York City Department of Environmental Protection (NYCDEP) has reviewed the recent submission of the above Subsurface Sewage Treatment System (SSTS) project, dated 6 -3 -02, and offers the following:_ �eLa7 • As the total trench length exceeds 500 feet a mechanical dosing unit capable of holding at least 1 day's flow is required for system. See Appendix -75A.7 (3)(b)(3). The SSTS review cannot proceed until the necessary information is received. If you have any questions regarding this matter, please call me at (914) 773 -4461. Sincerely,.;, r . `' Lucie Lops Associate Project Manager Engineering Design Review xc: James Covey, P.E., NYSDOH zo 0. k BRUCE R. YOLEY y LORBTfA MOLINARI R.N., M.S.N. PO4. Nsdtli gcne�w As,x6Y, PW O N dth D&%Wv Obcam 41 Pa11ra, ,rw,iep DEPARTMENT OF HEALTH 1 Qweve Road Brslvsrer. New York 10509 rmbmueehl t(a1u CW)371.6L70 ft(945)175 -7931 !•anlq ev,;r p15)7ri -63f9 wIC(45)218.6678 Fe 045)X78 -6083 r nr 1sar+aam (M5)27a -6011 1u(615)278 -649 11-1 1 4n99 -5912 10(915)229.6117 FAX CA`iT'.lt BAEET Date; t a Z- To: In the event of trawmissiodreception difficulties, please contact this office at (845) 2784130 cit. 2166. • • MZZIwSNVUI ZNMnooa IMOM 3o a!)Vd ZsM 3 x0 : No. Pages J w0a : (Including cover aheet) From: Robert Morris, P$, HwiI QNSdwm Senior Public Health Engineer Mai IHVIS Emergency Response Coordinator SHOVa _ For your information `please respond For your review Attached as requested _ As discussed Please cull NoteLlMessages In the event of trawmissiodreception difficulties, please contact this office at (845) 2784130 cit. 2166. • • MZZIwSNVUI ZNMnooa IMOM 3o a!)Vd ZsM 3 x0 : Sirmssd w0a : Snow 118£,TO : HwiI QNSdwm V£ :00 LT -Atiw : Mai IHVIS 5/5 SHOVa LTL65ZZ6 HNOHd TZ6L -8LZ -568 rMI HZ'MH 30 JAMIUVdHQ XINII00 KVNZQd : MNN 9£:00 IHa ZOOZ- LT -XVW : H1V(1 NOIRMHOO ONIMS BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 May 14, 2002 John Watson, P.E. Insite Engineering & Survey Route 22 Brewster, NY 10509 Re: Proposed SSTS: Brimstone Development Corp. /Alonge 299 Quaker Lane, Lot #2 (T) Patterson, TM# 15.4-50.2 Dear Mr. Watson: Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: 1. Please see New York City Department of Environmental Protection comments enclosed and revise accordingly. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very-truly yours, Robert Morris, P.E. Senior Public Health Engineer RM:tn enc. NYC DE.P..E.N.GINEERING Fax:914-773-0343 May 14 '02 15:00 P.04 f3epa.:-tcnent' ronTenta - .Protection'.'*- PZ 0115S ne -Ti1'M4)7424W1 -0348 April 17, 2002 Mr. Robert Morris, P.E. Putnam County Department of Health 4 Geneva Rdad Brewster, New York 10509 Re: Aloncge: Subdivision - Lot # 2 Quaker Lane - (T) Patterson; C Putnam Ewt Branch Reservoir Basin DEP Project # 9975 (joint Review) Dear Mr. Morris: ".J I . - The New York City Department or Environmental Protection (Nyul)bil)teas reviewed the recent submission of the above Subsurface Sewage Treatment System (SSTS) project and offers the following: • Provide 100 feet separation distance from the infiltrators to the SSTS and at -least 10 feet to the property line. If you have any questions regarding this matter, please call me at (914) 773-4461.. Sincere -,,/'Uucie Lops Associate Project Manager Engineering Design Review X01 James Covey, P.E., NYSDO14 11-N Mv, ; UM A A KInMC - DI ITKIOm rni WTY n;=PQPTmFrWT nF P 4 BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278.7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 March 25, 2002 Early Intervention (845) 278 - 6014 Fax (845) 278 -'6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 John Watson, PE Insite Engineering 3 Garrett Place Carmel, New York 10512 Re: Alonge - 299 Quaker Lane, Lot # 2 (T) Patterson, TM# 15 -1 -50.2 Reservoir Basin - East Branch Dear Mr. Watson: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on 3/21/02 is complete. The Department will notify you by 4/20/02 of its determination. ❑ The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ® Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by Certified Mail, Return Receipt Requested. The notice would be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with Section 18 -23 (d) (6) of the New York City Department of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if DEP review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2166. Ve ly yours lole s, PE Public Health Engineer RM:cj I® /NS/ TE F ENGINEERING, SURVEYING & LANDSCAPEARCH/TECTURE, P.C. 3 Garrett Place (845) 225 -9690 Carmel, New York 10512 Fax: (845) 225 -9717 TO: Putnam Countv Health Department 1 Geneva Road Brewster, New York 10509 LETTER OF TRANSMITTAL Date: 3 -18 -02 Job No. 96134.302 Attn: Robert Morris, P.E. Re: SSTS for Brimstone Development Corp. Alonge Subdivision Lot #2 299 Quaker Lane, Town of Patterson TM# 15. -1- 50.2 WE ARE SENDING YOU ® Enclosed ❑ Under separate cover via the following items: ❑ Shop Drawings ® Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of Letter ❑ Change Order ❑ COPIES DATE ❑ Resubmit NO. DESCRIPTION 5 last rev. 3 -16 -02 CD -1 Construction Drawing 1 1 -15 -02 corrected prints CP -97 s Construction Permit 1 -15 -02 Well Permit 1 — - — - - -- -- +WP-97 j LA -97 Letter of Authorization 1 12 -28 -02 -- - - - - -- i $300.00 I THESE ARE TRANSMITTED as checked below: ® For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ REMARKS: COPY TO: SIGNED: 14 hn M. Watson, P.E. Iot2002.dot IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PE IT FORS WAGE TREATMENT SYSTEM PERMIT # P- V- OD ,� - ! -DD Located at e_-Z;j,,k4,c l_a,•c- ��.-• -� •�.��- Subdivision name Subd. Lot # 2� Tax Map tS Block I Lot m5pc�. 7� Date Subdivision Approved $Zj,"5r WC n EN av pmi:Wr ion Owner /Applicant Name(! - ,, SIL L .I Jr.- Alt Renewal Revision Date of Previous Approval Mailing Address �r�cv \�.lo� q=-14 rA& * Zip t ®C;Al Amount of Fee Enclosed n,4--- Building Type Lot Area i "-t No. of Bedrooms 4— Design Flow GPD ca,!n, Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and x"16 LV- Other Requirements: To be constructed by Address Water Suonl4: Public Supply From Address Private Supply Drilled by Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the ,,Qarate sewage treatment s sY,tem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion - thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address P.E. � Date e6 - Zz> - cA'cj t,jY License 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 a considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires anew p( it. Approv or discharge of domestic sanitary sewage only. By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 �� i �l PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT AL�cTE SAD 1sm� - tu-rZ Well Location Street Address: 299 Quaker Lane Town/Village: Patterson Tax Grid # Map ] S Block ( Lot(s) 5 a. Well Owner: Name: Address: Pamela Crecco, 10 Farhill Lane, Pleasantville NY 10570 Use of Well: 1- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock _ Other Casing Details Total length 32 ft. Length below grade 31 ft. Diameter 6 . in. Weight per foot 19 lb /ft. Materials: X Steel _ Plastic _ Other Joints: _ Welded X Threaded — Other Seal: X Cement grout _ Bentonite _ Other . Drive shoe: X Yes _ No Liner:_ Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Pump Type sub Capacity 7gpm Depth 200' Model 7GS07412 Voltage 230 BP -3/4 Tank Type WX250 Volume 44 gallons _ Yes No Hours Second Date Well Completed 5/15/03 Well Yield Test Bailed X Pumped X Compressed Air Hours X Yield _Q. gpm please attach. 30' 180' 245' Well Log Depth From Surface [f more detailed ft. ft. information Land surface 17 descriptions or sieve analyses 17 32 Water Bearing Well Diameteron) Formation Description Drillin in overliurden clay and boulder Hit rock at 17' Drilling in rock set casing, please attach. If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 7gpm Depth 200' Model 7GS07412 Voltage 230 BP -3/4 Tank Type WX250 Volume 44 gallons Date Well Completed 5/15/03 Putnam County Certification No. 001 Date of Report 9/5/03 Well' rifler si nature Christo her Beal 14u b: t xacl location oI well wim QlstanGes Cu at ludbi. twu Fuliva►icun icuiuuuuaw w w yay.auvu vaa w „Wr,.a...........--r - -•- Well Driller's Name P. F. Beal & Sons Inc. Address: 4 Pub= Ave BomBj r,_NK 10" Signature: Date: 9/5/03 Christopher Beal White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 L=49.20' R= 1227.00' (p= 0277'51') —'curve total E, 104.66' 0� 1 '50" E N C3� N OT I Q L N� EXPANSION ABSORPTION TRENCH (TYP.) (1009 EXPANSION PROI/IDED) / 13 14® 15® 16' 17 1( PRIMARY ABSORPTION —I 1 TRENCH (TYP.) 1,250 GALLON SEPTIC TANK '1 D t5v000 s �o �O. 12 Ill ..10 DROP BOX (TYP.) / n i J lNSITE ENGINEERING SURVEYING & LANDSCAPE ARCHITEC7URE, P.C. 1211512003. AS -BUIL T MEASUREMEN TS NO A CORNER OF DWELLING B CORNER OF DWELLING REMARKS 1 46' 36' 1,250 GALLON SEPTIC TANK 2 87' 51' DROP BOX 3 91' 57' DROP BOX 4 96' 62' DROP BOX 5 100' 68' DROP BOX 6 105' 74' DROP BOX 7 110' 80' DROP BOX 8 132' 67' END OF TRENCH 9 133 70' END OF TRENCH 10 136' 75' END OF TRENCH 11 140' 80' END OF TRENCH . 12 143' 85' END OF TRENCH 13 89 97' END OF TRENCH''" 14 82' 99' END OF TRENCH 15 77' 96' END OF TRENCH 16 70 92 END OF TRENCH r18 7 .65' 88' END OF TRENCH 59' 1 85' 1 END OF TRENCH Putnam County Department of Health Division of Environmental Health Ser;riceL� Appr v d as noted for conformance with appl le Ru and Regulations of the �41 , j — n C Health Departure t. /") Signature & Title. Date 1 NO.- I DATE I REVISION I BY ® v 3 Carmel, Garrett 105 Camel, NY 10512 (845) 225 -9690 (845) 225 -9717 fox $* :, ENGINEERING, SURVEYING & LANDSCAPE ARCHITECTURE, P.C. www.insite— eng.com PROJECT. SS TS FOR 4, ��� , 20.78' P. C. DEVEL OPMEN T �` ����. °4:A" (ALONGE SUBDIVISION —LOT 2) 0 ?4 199 QUAKER LANE; 70M OF PATIERSON, PUTNAM COUNTY. NEW Yow Cr w 2.5 W �n;4 w1w �O 61Q 1 �,o.. 3 ��� p6poseo Dtoo., Tpwer / PfvPoS ED YioR✓{NAIEa � 1;. / / TiJFi SRat+OU SYStEN � / N\ ,%% •:' / / ' / / / , / F aC / / / / /�,-- - -- • 610 A 'AK O 10 1 i PERC011A AO 7ES j OLE _(T dd j / / w y DE / TFST HOLE TV=) FXPANS?ON%ABSORPTIOFI / / l TRF�CH (TYP.) rza / / /' /`e$ LOT 3 (/ = � �-� / / • % !;•;. � / / / / �'~-- -Loo• NOTi422 \ .. \ PROPOSED WELL SQL KFENCE,{TYP.) RO p" P OX (T}P.) \ 1 by / / / / -,` /_`ii•ppYr / / 4'0 VC JSBR 35 ® 118 /F . IN OPE / o / 12 GALLON 7IC TANK - Io WIDE PRIMARY ABSOR ON 1. ? `NCH (TYP) / z / 4'0,CIP ® 114 .. M ?N.. LOPE t 00o Iy .— — — —' — `- - \ PROPOSED WELL ' LOT 1 / �'i / "s= ooPOS6 62, o FOOTING ORAI r� f E 612• DISCHARG/ // ws PROPOSED WELL �. / i / / ,o +* 2:•s / ✓ i9A7ER SERVICE CONNEC7/ON LOT 2 i R09F"/DRAIN DISCJ-IARG£ i f 8365 ACRES f \ \ / TO INFILTRATORS• .t /� Y�`-' Imo^ / r \ ,r (BO,000 ac/ t). * 3 ., , . �. s.,. �. �r'a..r..u- ....sz t: :. - < - ". `1-- ��-''... r....""'•: :rT`