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HomeMy WebLinkAbout0527DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 15. -1 -50.3 BOX 6 I ro T �� ,6 „ xi , - III ' Is �i me ' ', I� I is ir mom Is 00527 ,,, 'r . ,� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: 301 Quaker Lane Town/Village: Patterson Tax Grid # Map Block Lot(s) Well Owner: Name: Address: Beno Construction P.O. Box 404 Patterson, NY Use of Well: 1- primary XXX 2- secondary X Residential Public Supply Air cond /heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 41 ft. Length below grade 39 ft. Diameter 6 in. Weight per foot 17 lb/ft. Materials: X Steel —Plastic _ Other Joints: Welded X Threaded _ Other Seal: _ Cement grout X 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 _Pumped X Compressed Air Hours 6 Yield 7 gpm Depth Data Measure from land surface- static (specify ft) 40 During yield test(ft) 7 Depth of completed well in feet 545 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 20 Sandy Loam with gravel 20 160 Hard Granite Black s ldhite 160 420 Granite with Pink Feldspar 420 545 7 Iack & Irhite Granite w sof t soots If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 160 1/2 Pump-Type sub Capacity 5 Depth. 400 Model GOULDS Voltage 2' )0 Hp 1 Tank Type diav Volume 62 365 2 545 7 Date Well Completed 10/19/04 Putnam County Certification No. 02 Date of Report 11/2/04 Wglt -p 1 NOTE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. Well Drillers e 1 in nc. Address: 75 Putnam Ave. Brewster, NY Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 '-n 'N JmsEnvironmental Services, /nc l� WATER, SOIL AND AIR ANALYSIS Mailing Information: Name: Mill Drilling Co. Address: 75 Putnam Ave City: Brewster State: NY Telephone: Sample's Information: Client: Nick Beno Zip: 10509 Fax: 845 - 279 -5075 41 Kenosia Avenue I Danbury, Connecticut 06810 1 Telephone 203 - 798 -2229 Collector's Information: Name: Rob Address of site: 301 Quaker Lane City: Patterson State: NY Zip: Telephone: Site: Tank Hose Bibb Date Collected: -1/12/05 Date Received: 1113/05 Preservative: HNO3 Time Collected: 4:00pm Time Received: 2:00pm Temperature: <4C Lab No.: J0500243 Date Analyzed Test Name.. Result MCL Method 1/13/05 16:00 Total Coliform Absent ....Absent .: SMWW 9222B 1/13/05 Chlorine Free Residual <0.1 mg /L ;SMW.W 4500CIG 1/13/05 Color ND 1 5 Units ' SMWW 2120 B 1/13/05 Odor ND 3 TONs SMWW 2,150 B 1/14/05 Iron 0.15 mg /L 0.3 mg /L SMWW 3111B 1/14/05 Manganese <0.050 mg /L 0.3 mg /L SMWW 3111B 1/14/05 Sodium 7.2 mg /L N/A SMWW 3111B 1/14/05 Chloride 3 mg /L 250 mg /L SMWW 4500 Cl C 1/14/05 Hardness 98 mg /L N/A SMWW 2340 C 1/14/05 Nitrate <0.1 mg /L 10 mg /L SMWW 4500 NO3E 1/14/05 10:00 Nitrite. <0.1 mg /L 1.0 mg /L SMWW 4500 NO3E 1/13/05 pH 7.22 S. U. 6.5 -8.5 S.U. SMWW 4500 H B 1/14/05 Sulfate 11.67 mg /L 250 mg /L SMWW 4500 SO4F 1/13/05 Turbidity 1.07 NTU 5 NTUs SMWW 2130 B 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 S.U.= Standard Unit MCL- Max. Contaminant Level ug /L- micrograms per Liter mg /L- milligrams per Liter ND- None Detected NTU- Nephelometric Turbidity Unit TON- Threshold Odor Number `Reviewed by Sharon_ Houlahan, Director CONNECTICUT, NEW YORK AND NELAC CERTIFIED State #: PH -0218 ELAP #: 11715 Toll Free 866 -JMS -5097 I Corporate Fax 203 - 798 -2408 1 Lab Fax 203 - 798 -2107 1 www.jmsenvironmental.com 'e PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: 301 valcer Lane Town/Village: Patterson Tax Grid # Map Block i Lot( §)SUS 3 Well Owner: Name: Address: Be= Cunat:ruc:t:ion P.,0. Lox !a()[,., Patterson,: Use of Well: 1- primary �ti.;�t. 2- secondary <: Residential Public Supply Air cond /heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing h . Open hole in bedrock Other Casing Details Total length 41 ft. Length below grade a. ft. Diameter '6 in. Weight per foot 17 lb /ft. Materials: x Steel Plastic Other Joints: Welded A Threaded Other Seal: _ Cement grout X Bentonite Other Drive shoe: X Yes No Liner: Yes fC No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped `( .Compressed Air Hours 6 Yield 7 gpm Depth Data Measure from land surface - static (specify ft) 40 During yield test(ft) Depth of completed well in feet 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 F 0 Sazuav ?Joan, wil. -h gravel 20 160 t `, Hard. Gran.fta Black, u Finite 160 420 Granite v3'itl. Piult Fe:l.dspar 4217 545 _ i Fia.clt. t' ' =itt: tc� : rani. t e DTI $L=i t: rPi? i If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 161) 1/2 Pump Type sub Capacity 5 Depth 400 Model GitJLD'S Voltage 230 HP I Tank Type dif.m) Volume (}?. 365 _ 545 Date Well Completed 1V /Al /�Jf Putnam County Certification No. 02 Date of Report 11/2;/04 Well•Dtiller (signature), -•. f r: ::it f` /„. ii fr ��1: .r�•rr %j�r NOTE: Exact location of well with distances to at leasttwo permanent landmarks to be provided on a separate sheet/plan. rr � Well Driller's Name ru1.V 1'1. •7 -`' Putnar: Brea s es r ress: ,rl�aP�• !r � Jr, Yg`ft Signature: �' G , rr ' /, Date: i i ' `- f � White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICE, CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # .) --S -0c) Located at 301 Q UAtER LAN6' Cfi�r Village P(�iT*ER -oN Owner /Applicant NameR&No CoNVsTRvc7oN C�caRP Tax Map 15 Block / Lot So• 3 FormerlyAtoiK Je'A1A5-iV0C 00, C;OAf, Subdivision Name _ALON61: Subd. Lot # 3 Mailing Address PO- 82:�k 409- P197 -MYSoN /Vy Zip J2563 Date Construction Permit Issued by PCHD 4 % /oJoZ Separate Sewerage System built by ! r"Q CONS i COP -f, Address '°a 000 f� -Rq,5AA) Consisting of _/ 5o Gallon Septic Tank and S7 / Z -4w7 o z' Vvi o6 AR—SORT70LI 2:KF ) c. HNES Other Requirements: Atnm G Water Supply: Public Supply From Address 7S DvTNAN�.�l6; or: Private Supply Drilled by MILL DRl j.uN6 Go . Address NY /o so9 Building Type RESJ0GNT1 A.L.. Has erosion control been completed? Y45.3 Number of Bedrooms Has garbage grinder been installed? K) c� 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:, OCp Certified by P.E. R.A. ' Profess al) Address�r�sirz� cni r�in�EE2lJjG d sy2yayrM o - [ANme-4,oK AwAim=E icense # 6) 9 31 3 GARRErTi- P[AL . cARMcL- P )OS) -L Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are 'ect to modification or change when, in the judgment of the Public Health Director, such revocation, di cation o ange is n ssary. / By:. � Title: 11)r / '� Date: �l� a 4 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 Dec 16 05 04:38p BRUCE R. FOLEY Public Health Director TOWN OF PRTTERSO 845 -878 -2019 p.2 C y y LORMA MOLINARI. RN.. M.S.N. Ammiale Public Hdabb Dirertor Director of Patiem Sewicei DEPARTMENT OF HEALTH X Geneva Road Brewster, New York 10509 Eovboumeatal Hculth (914)278 -6139 FSA(R14) 271.9921 NursInr 6crrloa (914) 27V - 6358 WIC(914)218-6678 Fa4 (914) 176.6095 Eady laterreatim (914)279.6014 PreuhW (914)218 -d082 Fox(914)279.6648 Oyynm NAM: BEN(> Cc:,htsTgVe- -PCN Ca)?P. TAX MAP NUMUM E911 ADDRESS: 3a 1 QUAtek ZANE TOWN: Aq TT,6gsioN AUTHORIUD TOWN OFFICIAL: '(Signature) DATE: �� 6 Ile Putnam County Department 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 town official: This form is to be submitted with the application for a Certificate of Construction Compliance. P[lvrIUWV0 Z.,Z:d 6T028L8:01 LTL6S22Si78 9NI833NI9N3 31Isw :wobu 00 :9T 5002- 9T-030 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: 01 'Quaker Lane Town/Village: Patterson Tax Grid # Map /j'_ Block Lot(s) Well Owner: Name: Address: Betio Construe -ton P.,0o Box 4.04 Prtt.te o-.a, .-i Use of Well: 1- primary e ;'. 2- secondary �i Residential Public Supply Air cond /heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion ' h Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock- Other Casing Details Total length 41 ft. Length below grade 39 ft. Diameter 6 in. Weight per foot I. 7 lb /ft. Materials: X Steel Plastic Other Joints: Welded 1 Threaded Other Seal: —Cement grout 1 Bentonite Other Drive shoe: X Yes No Liner: Yes )C No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes—No Hours Second Well Yield Test _ Bailed _ Pumped ?( Compressed Air Hours 6 Yield 7 gpm Depth Data Measure from land surface- static (specify ft) 40 During yield test(ft) ; Depth of completed well in feet .54:5 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 20 Sailci Loa,, with mrayei 210 160 t.j., f?ard Granite Blab' . ,YY} :tte 1601 ei20 �, Granj.ze- with h Pitt%.. Fe:.i.E spar 4` :3/ � d. :i a i :.. White, �F ,rana t— If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 160 1/2 Pump Type sub Capacity a Depth 400 Model G`DU1.YjS Voltage 230 HP I Tank Type di".a:r. Volume € ' . 3 »5 X, . 545 7 Date Well Completed Putnam County Certification No. Date of Report Well -Duller (signatyie.) ,. 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 ,;� • . ja I im ,�;1L . Signature: ,,;., .�,f /F'�rr';fF` ri Address: '': Pstnau', lre, Brewster, x :4 . Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 /NS /TE IMI�7ENGINEERING, 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: 01 -V -06 Job No. 04127.200 Attn: Robert Morris, P.E. Re: SSTS for Beno Construction Corp. Lot 3 301 Quaker, Town of Patterson, TM# 15 -1 -50.3 WE ARE SENDING YOU ® Enclosed ❑ Under separate cover via the following items: ❑ Shop Drawings ® Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of Letter ❑ Change Order ❑ 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: �'�^ 114, n M. Watson, P.E. dh ect En gineer, Associate IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE lot2002.dot iffs Environmental Services, Inc. IFU WATER, SOIL AND AIR ANALYSIS Mailing Information: Name: Mill Drilling Co. Address: 75 Putnam Ave City: Brewster State: NY Telephone: Sample's Information: Client: Nick Beno Zip: 10509 Fax: 845 - 279 -5075 41 Kenosia Avenue I Danbury, Connecticut 06810 1 Telephone 203 - 798 -2229 Collector's Information: Name: Rob Address of site: 301 Quaker Lane City: Patterson State: NY Zip: Telephone: Site: Tank Hose Bibb Date Collected: 1/12/05 Date Received: 1/13/05 Preservative: HNO3 Time Collected: 4 :00pm Time Received: 2:00pm Temperature: <4C Lab No.: J0500243 Date Analyzed Test Name Result MCL Method 1/13/05 16:00 Total Coliform Absent Absent SMWW 9222B 1/13/05 Chlorine Free Residual <0.1 mg /L 1. N/A SMWW 4500CIG 1/13/05 Color ND 15 Units SMWW 2120 B 1/13/05 Odor ND 3 TONs SMWW 2150 B 1/14/05 Iron 0.15 mg /L 0.3 mg /L SMWW 3111B 1/14/05 Manganese <0.050 mg /L 0.3 mg /L SMWW 3111B 1/14/05 Sodium 7.2 mg /L N/A SMWW 3111 B 1/14/05 Chloride 3 mg /L 250 mg /L SMWW 4500 Cl C 1/14/05 Hardness 98 mg /L N/A SMWW 2340 C 1/14105. Nitrate <0.1 mg /L 10 mg /L SMWW 4500 NO3E 1/14/05 10:00 Nitrite <0.1 mg /L 1.0 mg /L SMWW 4500 NO3E 1/13/05 pH 7.22 S. U. 6.5 -8.5 S.U. SMWW 4500 H B 1/14/05 Sulfate 11.67 mg /L 250 mg /L SMWW 4500 SO4F 1/13/05 Turbidity 1.07 NTU 5 NTUs SMWW 2130 B 1/14/05 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 Reviewed by: Sharon Houlahan, Director Signature: State #: PH -0218 Michael Lapman ELAP #: 11715 President CONNECTICUT, NEW YORK AND NELAC CERTIFIED Toll Free 866 -JMS -5097 I Corporate Fax 203 - 798 -2408 1 Lab Fax 203 - 798 -2107 1 www.jmsenvironmental.com JMSEnvironmental Services, Inc. WATER, SOIL AND AIR ANALYSIS Mailing Information: Name: Mill Drilling Co. Address: 75 Putnam Ave City: Brewster State: NY Telephone: Sample's Information: Site: Tank Hose Bibb Preservative: HNO3 Temperature: <4C Client: Nick Beno 41 Kenosia Avenue I Danbury, Connecticut 06810 1 Telephone 203 - 798 -2229 Zip: 10509 Fax: 845 - 279 -5075 Collector's Information: Name: Rob Address of site: 301 Quaker Lane City: Patterson State: NY Zip: Telephone: Date Collected: 1/12/05 Date Received: 1/13/05 Time Collected: 4:00pm Time Received: 2:OOpm Lab No.: J0500243 Date Analyzed Test Name Result MCL Method 1/13/05 16:00 Total Coliform Absent Absent SMWW 9222B 1/13/05 Chlorine Free Residual <0.1 mg /L N/A ... ...SMWW 4500CIG 1/13/05 Color ND 15 Units "" SMWW 2120 B 1/13/05 Odor ND 3"TONs SMWW 2150 B 1/14/05 Iron 0.15 mg /L 0.3 mg /L SMWW 3111B 1/14/05 Manganese <0.050 mg /L 0.3 mg /L SMWW 3111B 1/14/05 Sodium 7.2 mg /L N/A SMWW 3111B 1/14/05 Chloride 3 mg /L 250 mg /L SMWW 4500 Cl C 1/14/05 Hardness 98 mg /L N/A SMWW 2340 C 1/14/05 Nitrate <0.1 mg /L 10 mg /L SMWW 4500 NO3E 1/14/05 10:00 Nitrite <0.1 mg /L 1.0 mg /L SMWW 4500 NO3E 1/13/05 pH 7.22 S. U. 6.5 -8.5 S.U. SMWW 4500 H B 1/14/05 Sulfate 11.67 mg /L 250 mg /L SMWW 4500 SO4F 1/13/05 Turbidity 1.07 NTU 5 NTUs SMWW 2130 B 1/14/05 Lead. <1.0 ug /L 15 ug /L SMWW 3113 B \t the time of analysis the sample was acceptable for total coliform I/A = Not Applicable mg /L- milligrams per Liter ND- None Detected i.U.= Standard Unit NTU- Nephelometric Turbidity Unit ,ACL- Max. Contaminant Level TON- Threshold Odor Number jg /L- micrograms per Liter Reviewed by:J Sharon Houlahan, Director Signature: State #: PH -0218 Michael Lapman ELAP #: 11715 President CONNECTICUT, NEW YORK AND NELAC CERTIFIED Toll Free 866 -JMS -5097 I Corporate Fax 203 - 798 -2408 1 Lab Fax 203 - 798 -2107 1 www.jmsenvironmental.com PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM ,B& NO Co N s 7RULT /o „l f o RP. Owner or Purchaser of Building I3C✓A0 Co h� S71?vC/7oN Gc 2p. Building Constructed by - P0 Sox. PTrc Z S o N_Ny /2S63 Location - Street RC- -sl D&1\1TrAL Building Type JS. — Tax Map / — _11: �0 - 3 Block Lot PA TTcRso N TownNillage ALoNGL -5080- 1wsloN Subdivision Name 3 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 tae 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 ✓4 vl/ . Day ? 1 Year `lu 0 C Signature: _ lf`�a t AtC'3 ,�S 'a Title: rest,, "I b eAA 7' General Contractor (Owner) - Signature 13- F,(%) C o cz Corporation Name (if corporation) Address: �'� �t���C 4�y �'l,��zj��,sc �,► �' Corporation Name (if corporation) Address: State P � -f Zip 2 State Zip Form GS -97 tAh'ANJIUN AU,)UMI-'IIUN TRENCH (TYP.) DRAINAGE INLET (62) FL EC TRANS. (0) _ F M c- TER - - --® LcC (78 ) 82' \ �2) �3) PRIMARY ABSORP77ON — TRENCH (TYP.) \ L4) \ 54 7 54' 19 \ 13 3' 6 53' 18 12 52' 17 11 49, 4 49' 16 1 3 41' 15 9 42' 37' 2 36 14 8 / DROP BOX (TYP.) / 1250 GALLON SEP77C TANK °sF 0 \ ALTERA77ON OF THIS DOCUMENT, UNLESS UNDER THE DIRECTION OF A LICENSED PROFESSIONAL ENGINEER, IS A VIOLA 77ON OF SECTION 7209 OF ARTICLE 145 OF THE EDUCA77ON LAW. G� �0 D - 0 PSG �P �0 C ® WELL 20 ENLARGED PLAN SCALE.- 1" = 30' Z 2< 0 U U tiN U Q W �Q o v� A7D NO. CORNER OF DNELLING DER OF DNELLING Cam OF DNELLM CORNER of DNELUNG REMARKS 1 26' 68' — — 1250 GALLON SEPnC TANK 2 60' 94' — — DROP BOX 3 64' 96' — — DROP Box 4 69' 97' — — DROP Box 5 73' 99' — — DROP Box 6 77' 101' — — DROP BOX 7 83' 104' — — DROP Box 8 95' 134' — — END OF TRENCH 9 103' 140' — — E)VD OF TRENCH 10 ill' 148' — — END OF TRENCH 11 ..116_' 151 '...,...,, . -. -. END OF TRENCH 12 121' 155' — — END OF TRENCH 13 125' 158' — — END of TRENCH 14 40' 57' — — END OF TRENCH 15 46' 54' — — END OF TRENCH 16 52' 50' — — END OF TRENCH 17 58' 50' — — END OF MENCH 18 65' 55' — — END OF TRENCH 19 71' 59' — — END OF TRENCH [20 — — 39' 84' HELL NO. I DATE I REVISION i BY 3 Garrett Place Carmel, NY 10512 `4 ENGINEERING, SURVEYING & (845) 225 -9 . (845) 225 -97717 17 fax ;j OA NDSCAPEARCHITECTURE, P.C. www.insite— eng.com PROJECT.- SS TS FOR BENO CONS TRUC TION CORP. �P�� ° ; C o yo (QLONGE LOT Co 301 QUAKER LANE, WIN OF PATTERSON, PUTNAM COUNTY, NEW YORK r Q O W DRAWING: � �' . r AS —BOIL T DRAWING 2� 6'9U' �° �� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: © a z-.-1 Inspected by:� Street Location Owner 8rlw,sce Lev_ c�rla, Town P6,-#",,A . Permit # P- 6 -o O TM # /.S - / SD, 3 Subdivision Lot # 3 1. NO I COMMENTS 3:1 barrier Lgth. Width . Avg.Dpth z,c:Natural soi °not stnppecl� �d `"Stone, brush,�etc ;greater than 15 from TKS area e 100'=from water course / wetlands ..... ............................... 11 Sewage System ; ; o .- 2 �e- 'V -13 x 11 - -�--... 1 1 ;. i. Erosion control provided ........... ............................... • .. • .. Rev. 12/02 4. T *d JO 1N3W1NUd30 AlNnoo W0Nif_13 :3k1tjh T 26,L - 8)_2 - St78 : _131 2t7:TT NOW t7OO2-S2-100 PUTNAM COUNTY DEPARTMENT OF HEALTH DnqSION OF E NVMONMENTAL HEALTH SERVICES ATTENTION 0 ADAM REQ1,TF,9T FOR. FINAL INSPECTION fqr: I Fill All information must be fully completed prior i o al-ly Trenches ,%� inspections being made. PCHD Construction Permit # Located- 591 Owner/Applicant Name: %e�-5'woJ( "Q4LJ-'E CORD• Block I Lot 60. S Formerly, Subdivision Name: 1,E S11WIMSion Lot "b". Is systeal fill completed? "'r" Date: Is system complete? YC Date: Is system constructed as per plans? Is well drilled? fie 5 Is well located as per plans? — Ic Are erosion control measures in place? ----- -- Date: I certify that the system(s), as listed, at the above premises has been constructed and I have inspected in issued PCHD Construction Permit and and verified their completion J accordance with the iss 0 approved plans and the Standards, Rules and Regulmions of the Putnam County Department of Health. Date: Certified b PE KA Des a ProfeksiApl Address, Insite EnalneeriLla, Su �.P_y!WA Landscape Architecture, P.C. Comments: 3 Garrett Place Garin-el, Now orft -MM" Form FfR-99 Lic. 9 � I q � k T/T:d T 26,La2: 01 _'V2 -43 311SNI:WOdJ lF:TT t,002-52-100 r_)NId33NIS1 i. 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 November 2, 2004 Jeffrey Contelmo Insite Engineering & Survey 3 Garrett Place Carmel, NY 10512 Dear Mr. Contelmo: ROBERT J. BONDI County Executive Re: Field Inspection — Brimstone Dev. Corp. Quaker Lane, Lot # 3 (T) Patterson, TM # 15. -1 -50.3 The following comments must be corrected in the field: 1. It appears the SSTS is not installed per the approved plan. 2. Any part of the SSTS must maintain 10 feet minimum off the retaining wall. 3. The footing drain discharge was not found upon inspection. 4. All erosion control measures must be properly installed in the ground prior to the start of any construction. 5. Field measurements indicate the well may have moved from the approved location. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. GDR:km Sincerely, Gene D. Reed SR. Environmental Health Engineering Aide 1. SENDING CONFIRRATION DATE : NOV-5-2004 FRI 10:21 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845-278--7921 PHONE : 92259717 PAGES : 1/1 START TIME : NOV-05 10:20 ELAPSED TIME : 00'22" MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT witErl'A mOLINATII Tt0Rf7T J TIMM L%pAJ.t'(rvfF—N-T 0;- I Geneva kcd. 1054"' HursinVS—Ar" (1451279-65-51r. Early Insilc Engineering & Survey 3 Garett Place Carmel. NY 111512 TM U I 1.-1 Dear Mr. Contclmo: Tbot IWInwille• comments must he corrected in the Jrp 1. it appears the SSTS is pot installed per the appiovrd ulon. Atly part of ibe 9STS mill ' t maintlini 0 *ot minimum ofi: r'- retaining wall. 3. Tltt,. rnnting drain discharge wa7, rm tbund uilu;: 4. All erosion control measure; rrwt b,: il-lbe p,,-nd prior to 1110,51AII of any construction: 5. Field nicasuremMts indirafe 0u; %c cil f lhe ppr-'—,-d locaticut. If yvii hAve ally fin-flier qucqtions, plenRc ccln!,10 ,w N 1 226 1, I Z. 6DR:kTI) &, 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 September 27, 2004 Jeffrey Contelmo Insite Engineering & Survey 3 Garrett Place' Carmel, NY 10512 Dear Mr. Contelmo: ROBERT J. BONDI County Executive Re: Field Inspection — Brimstone Dev. Corp. Quaker Lane, Lot # 3 (T) Patterson, TM # 15.4-50.3 The following items are in violation of Article III, Section 2C of the Putnam County Sanitary Code. 1. Erosion control measures not properly installed in the ground. This violation may lead to an enforcement hearing and subsequent fines. The violation is to be immediately corrected to minimize the number of days you are out of compliance. Please note that fines may be issued for every day the violation is not corrected. 3 1 Very truly yours, ret' Y Gene D. Reed SR. Environmental Health Engineering Aide SENDING CONFIRMATION DATE : NOV-5-2004 FRI 10:24 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845-278--7921 PHONE : 92259717 PAGES : 1/1 START TIME : NOV-05 10:24 ELAPSED TIME : 00'21" MODE : ECM RESULTS 1* OK FIRST PAGE OF RECENT DOCUMENT T-R,-,4NS11TTTED.•- Dear Mi. Contchilo: The follovriTig items are in violamw,, Am( h. :1 2! dw Nolool County Sanilwv Cndc. 1. c-rosion contml mea.-.urn.1 not 1"' i�. This violation mny lead to an cnff,. ":!I 111M. 'llic violation in to be immediately mirrecled to minimize the WA71IN:1 1 V(.;j "('-'alt of compliant.. noic that firic., moy be issued fol tv':r., 11 li!a I t h P T, gii,etrill v Ai d, UORAm LOHEVTA MOLTNAM Plumy j. irimmif WNlic H,.t,h LhM!_ J)FpAR.TMFN1 OF HFAIJIH I 0c.— R-cl, 4:•:1 ':1 'ol', ,6509 .NnrrinR.9trvltn(OAS1719. Wl -,,< (94') Or 0:, ."LTACIllbCT 27, 2004 Jcf&vy Coutcltno trwile EngincefiDg, & Survcy 3 (;t�' 101 Place Carl 3cl, NY 10512 Dear Mi. Contchilo: The follovriTig items are in violamw,, Am( h. :1 2! dw Nolool County Sanilwv Cndc. 1. c-rosion contml mea.-.urn.1 not 1"' i�. This violation mny lead to an cnff,. ":!I 111M. 'llic violation in to be immediately mirrecled to minimize the WA71IN:1 1 V(.;j "('-'alt of compliant.. noic that firic., moy be issued fol tv':r., 11 li!a I t h P T, gii,etrill v Ai d, UORAm SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Jeffrey Contelmo Insite Engineering & Survey 3 Garrett Place Carmel, NY 10512 Dear Mr. Contelmo: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 March 1, 2006 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Field Inspection — Brimstone Dev. Corp. Quaker Lane Lot #3 (T) Patterson, TM #15. -1 -50.3 A re- inspection at the above referenced lot has been completed. There are no further comments to be addressed at this time. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Sincerely, re .'Cl' GDR:lm Gene D. Reed SR. Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 r, SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 February 15, 2006 Jeffrey Contelmo Insite Engineering & Surveying 3 Garrett Place Carmel, New York 10512 Re: Dear Mr. Contelmo: ROBERT J. BONDI County Executive Filed Inspection — Brimstone Dev. Corp. Quaker Lane, Lot # 3, (T) Patterson TM# 15. -1 -50.3 In reference to the above noted lot, this Department is in receipt of your submission for a Certificate of construction Compliance. At this time, we cannot review your submission for the reasons noted below. 1. Open comments from a field inspection performed on October 29, 2004 have not been addressed. (See attached comment letter dated November 2, 2004). It appears the Putnam County Department of Health construction permit # P -5 -00 has �e expired. A permit renewal needs to be submitted to this Department along with the required fee of $500.00. If you have any further questions, please contact me at (845) 278 -6130, ext. 2261. GDR:cj Sincerely, Gene D. Reed Senior Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 -4 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 November 2, 2004 Jeffrey Contelmo Insite Engineering & Survey 3 Garrett Place Carmel, NY 10512 Dear Mr. Contelmo: ROBERT J. BONDI County Executive Re: Field Inspection — Brimstone Dev. Corp. Quaker Lane, Lot # 3 (T) Patterson, TM # 15. -1 -50.3 The following comments must be corrected in the field: 1. It appears the SSTS is not installed per the approved plan. 2. Any part of the SSTS must maintain 10 feet minimum off the retaining wall. 3. The footing drain discharge was not found upon inspection. 4. All erosion control measures must be properly installed in the ground prior to the start of any construction. 5. Field measurements indicate the well may have moved from the approved location. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. GDR:km Sincerely, Gene D. Reed SR. Environmental Health Engineering Aide PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # 5— 00 Located at Qv A ic6,2 L AN t town or Village P A r1' 6.es c.-j Subdivision name A Lo. -j(;E Subd. Lot # 3 Tax Map I ;; Block 1 Lot .5'o. a Date Subdivision Approved 6 - 3 0 - Cf g Renewal Revision �Z Owner /Applicant Name P. C "P i5v rL o P M 6.j l'� Date of Previous Approval 4 lo- u n Mailing Address IV FA2 HILLU015 !'LfAJM1)7VhLL15 NY Zip Amount of Fee Enclosed -2 l . f7-r'° Building Type g gs, -o &v tt A t Lot Area 1."0' No. of Bedrooms 4 Design Flow GPD S'oo gcQEf Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of !, 2 ;'° gallon septic tank and of V 01PC AAeygPrra -,j -rXcAvck61 Other Requirements: To be constructed by ya;c Al O uI4 Address A.1 1A Water Supply: Public Supply From Address or: Private Supply Drilled by VNK-1V OWN Address _ T/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: P.E. ,/ R-4. Date s 11 ro AWN niCfRJ G, - AVEY1V6, 4iA�v�fC4PE ARCH /fE47OP -0 P.C. Address A9PC- r PL License # 6 936 CA,effl IVY J v�� 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 onsiderAd necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new p it. Appro or discharge of domestic sanitary a only. By; Title( Date: o 2- White copy - HD File; Yellow copy - Building Inspector; Pink copy - er Orange co - Design Professional /Form CP-97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT ,g, TREATMENT SYSTEM PERMIT # r -s 00 - Located at I01 Q U A k CR L A,J L (9own or Village �/4 ���s a �✓ Subdivision name AL oAjC jr Subd. Lot # _"ice,- Tax Map l rr Block I Lot fib•3 Date Subdivision Approved C - ' qq Renewal ?`� Revision RIMS /off t�� v. C oR r, Owner /Applicant Name } fer. d E N 1' LJWDA A 4 Any Gic Date of Previous Approval Z - I I - oy Mailing Address 9-15C W 0 o,D> X 72 a r- M A N o PAC .nl Y Zip 1 aryl Amount of Fee Enclosed -' 36b "0 Building Type 26.1 D 6101 AL Lot Area 2-3015No. of Bedrooms Design Flow GPD 81�'b cA6 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 17-xo gallon septic tank and -�__7 1 t r o _� 2` w 1 U G A Qs U,,P_ P -f r o 4 Other Requirements: To be constructed by j"o R i 1> 6-1'E R M 1 N 6 P Address 1A Water Su 1 : Public Supply From Address or: Private Supply Drilled by 'r0 3 6 -D 611;;2 wa 6 Address NIA 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: P.E. RA. Date /- / a Z Nsi E lky& IN G, J VRVf'%1Al6r, LA_ A1A,-rA °C A£eNO f11.02L6. A0 Address ±624AAAyr PLa CAein 6L N ash License # ' r) Is / 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 modifi ed when sidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permi.. roved discharge of domestic sanitary sewag/e� only. By: Title: / Date: W 0 a Z White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 i T T T T PUTNAN9 C®UNT_Y HEI�LTH DEPY 0 23 15`5 1 Geneva Road . (845j 278 6130" Brewster; NY 10509 Date } PUTNAM COUNTY DEPARTMENT OF HEALTH \ DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FRiUSEW AGEj TREATMENT SYSTEM PERMIT # Located at 452CA 4:e,r- Town or Village Subdivision name /d.1•, Subd. Lot # Tax Map (cE�, Block i Lotc:;o.-.*.. Date Subdivision Approved (ems =_-,o ---i!t C Owner /Applicant Name����I,�,,,� Renewal Revision Date of Previous Approval Mailing Address 9se c t (.,.A 5- -.- - Zip (C>c�.,A i_ Amount of Fee Enclosed , e>e Building Type�ntidjs-;., Lot Area'Z.:�t- No. of Bedrooms Wit— Design Flow GPD� Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of lZs6 gallon septic tank and S'-1 i L;!F' Other Requirements: To be constructed by Address ,Water Supply:. Public Supply From Address Private Supply Drilled by Address represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the ienarate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in �ccordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion hereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the ►epartment, and a written guarantee will be furnished the owner, his successors, heirs or. assigns by the builder, that said iilder will place in good operating condition any part of said sewage treatment system during the period of two (2) years imediateiy following the date of the issuance of the approval of the Certificate of Construction Compliance of the original :.,stem or any repairs thereto. Signed: Address P.E. Y.- Date 4E5 -zcD -n`N `Liicense # 213 i APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified whe nsidered ne ssary by the Public Health Director. Any revision or alteration of the approved plan requires a new perms proved ischarge of domestic sanitary se ag only. By: Title: �l Date: 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 pCONSTRUCTION PERMIT F EWAGE TREATMENT SYSTEM PERMIT # �' /��� Located at Town or Village Subdivision name Subd. Lot # -:s_ Tax Map _(1:-, Block Date Subdivision.Approved (c> - Renewal Revision Owner /Applicant Name. :- Date of Previous Approval Mailing Address Zip lcx;."4 t Amount of Fee Enclosed . c:>c) Building Lot Areal :moo t.. No. of Bedrooms 4 Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and S-1 i 1✓N -'[' <r�•.a.. ? Other Requirements: To be constructed by Address Water Supply: 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 separate sewage treatment 5y stem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: P.E. Date F -x_-) ­5A l7 +e. i.�a�e -1 ��'7. �N x� f.��....dt'.c �"r- t..�•1'c err. Address t�k �..+� 2. _: --��- i.1�r" ion -��y 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 whe nsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires anew permit/ proved isclharge of domestic sanitary se ag onlly�. By: j B '��J Title: % /J��l `✓�'' Date: /1 t9t7 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 Rd PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # / -.t' OO Well Location: Street Address: Town/Village Tax Grid # 4aA—V..r- . Map lc-, Block l Lot(s)Sc>, Well Owner: Name: S90A MC OW. c -W. Address: Use of Well: Cr Residential Public Supply Air /Cond/Heat Pump Irrigation �Whmary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served __q_ Est. of Daily Usage7! � al. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling 7L New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type 14. Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Y. Is well located in a realty subdivision? ...................................... ............................... Yes ic, No Name of subdivision At5yn4a... Lot No. "z, Water Well Contractor: Awe, Address: ';'J - Is Public Water Supply available to site? .................................. ............................... Yes No -A.. Name of Public Water Supply: Town/Village r%tea. Distance to property from nearest water main: 16- Le-Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: y> - w -St 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 1 driller certified by Putnam County. Date of Issue Permit Iss ' g c'al: Date of Expirat on Title: /l Permit is Non- Transfe>< abre White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 /NS/ T 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, New York 10509 LETTER OF TRANSMITTAL Date: 3 -11 -03 Job No. 02188.100 Attn: Robert Moms, P.E: Re: SSTS for P.C. Development Alonge Subdivision Lot #2 Quaker Lane, Town of Patterson TM# 15.-l- 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 5 1 1 DATE last rev. 3 -11-03 ©-�, f NO. C -1 �I �C" P -97 ? LA 97 I_ ^ DESCRIPTION Construction Drawing Construction Permit Letter of Authorization $150.00 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: Rob, This application is submitted to revise the name and owner of a currently approved septic permit. There are no design alterations. If you have any questions, please contact me. John COPY TO: I0t2002.dot SIGNED: CJoh 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 LETTER OF AUTHORIZATION RE: Property of P. C, -P ey Zee'° -ice ( Located at _ 6?v4u6e L-AA115 @N QA- ff6R Tax Map # I Block I Lot Subdivision of Q e vC 90-2 Subdivision Lot # Filed Map # -L-7 4 2 Date Filed 6 -3v 4q Gentlemen: This letter is to authorize Insite En nig eering Surveying & Landscale Architecture P.C. (Jeffrey J. Contelmo, P.E. ) a duly licensed Professional Engineer 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 sigh 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 Educational Law, the Public Health Law, and the Putnam County Sanitary Code. Countersigned: P.E. # Mailing Address: State New York Telephone: Insite ENH eerg rSurveyinj Landscape Architecture, P.C. 3 Garrett Place Carmel Zip 10512 Very Truly Yours, . . Momm reft., Mailing Address: State I© FAC . -iLjo LANP , Zip (845) 225 -9690 Telephone: `l I `f- " 7 &0 _ & 0 3 2-- pcdoh.dot Form LA -97 I NSI TE ENGINEERING, SURVEYING & LANDSCAFEARCHITECTl1RE, P.C. 3 Garrett Place (845) 225 -9690 Carmel, New York 10512 Fax: (845) 225 -9717 TO: Putnam County Health Department 1 Geneva Road Brewster, New York 10509 LETTER OF TRANSMITTAL Date: 3 -11 -03 Job No. 02188.100 Attn: Robert Moms, P.E. Re: SSTS for P.C. Development Alonge Subdivision Lot #3 Quaker Lane, Town of Patterson TM# 15. -1- 50.3 WE ARE SENDING YOU ® Enclosed ❑ Under separate cover via ❑ Shop Drawings ® Prints ❑ Plans ❑ Copy of Letter ❑ Change Order ❑ the following items: ❑ Samples ❑ Specifications COPIES 5 DATE last rev. 3-11 -03 f NO. C -1 DESCRIPTION Construction Drawing 1 f S- ( -U 3 , CP -97 Construction Permit �1 _ LA -97 , Letter of Authorization 1 �� i $150.00 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: Rob, This application is submitted to revise the name and owner of a currently approved septic permit. . There are no design alterations. If you have any questions, please contact me. John COPY TO: I0t2002.dot SIGNED: ( ohn M. Watson, P.E. IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE i r ! k k NL'4iFy PUTNA' M COUNTY D] DIVISION OF ENVIROM LETTER OF AUTHORIZATION RE: Property of 19, < < yeyewm(,my j Located at QvAKdf- t APJ E (P/V u-rfEr.roN Tax Map # Block I Lot . So.3 Subdivision of a L,.,16: -0 Subdivision Lot # 3 Filed Map # -L-7 g 2 Date Filed 6 - 3 v - " Gentlemen: This letter is to authorize Insite Engineering Surveying & Landscape Architecture, P.C. (Jeffrey J. Contelmo, P_E.) a duly licensed Professional Engineer 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 Educational Law, the Public Health Law, and the Putnam County Sanitary Code. Countersigned: P.E. # 61 Mailing Address: State New York Telephone: OF AlEw ;C"-k; Landscap A6e&e, P.C. 3 Garrett Place Carmel Zip 10512 Very Truly Yours, . .,Signed: ro (Owner of Property) & Mailing Address: )Q FM N', W )-A r-e, PlQCCSr,Au i IIQ, N y 105 '70 State (845) 225 -9690 Telephone: Zip °r 4- -z pcdoh.dot . Form LA -97 BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road . Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 March 25, 2002 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 John Watson, PE Insite Engineering 3 Garrett Place Carmel, New York 10512 Re: Proposed SSTS - Alonge Quaker Lane, Lot # 4 (T) Patterson, TM# 15 -1 -50.3 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: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. Please add construction notes # 9 and 15. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very tlady yours, wi /&IX7 Robert Morris, PE Senior Public Health Engineer RM:cj 4 /NS /TE ENG /NEER /NG, SURVEY /NG & LANOSCAPEARCHITECTURE, P.C. 3 Garrett Place (845) 225 -9690 Carmel, New York 10512 Fax: (845) 225 -9717 TO: Putnam County Health Department 1 Geneva Road Brewster, New York 10509 WE ARE SENDING YOU ❑ Shop Drawings ❑ Copy of Letter LETTER OF TRANSMITTAL Date: 3 -18 -02 Tjob No. 96134.303 Attn: Robert Morris, P.E. Re: SSTS for Brimstone Development Corp. Alonge Subdivision Lot #3 301 Quaker Lane, Town of Patterson TM# 15. -1- 50.3 ® Enclosed ❑ Under separate cover via ® Prints ❑ Plans ❑ Change Order ❑ ❑ Samples the following items: ❑ Specifications COPIES j DATE ❑ Submit NO DESCRIPTION 5 1 ! last rev. 3 -16 -02 1 -15 -02 CD -1 CP -97 Construction Drawing Construction Permit 1 1 -15 -02 WP -97 I Well Permit 1 ---- - - - - -- LA-97 I Letter of Authorization 1 2 -28 -02 -------- $300.00 i ........_.....---.__ ._'_____.___ ?_...__.._.��.__..� i I THESE ARE TRANSMITTED as checked below: ® For approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ REMARKS: COPY TO: lot2002.dot ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints SIGNED: eifiv. J n M. Watson, P.E. IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE 01/15/2-902 07:27 545- 276 -6392 114SITE ENGINEERING PAGE 04 3C UTlr AM COUNTY DEP RTMEN Jl OF HEALTH H DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of j>15 V15L0P1465A1i• 6; k,DVAI-10,Q Located a�t�7 �l uq k 9 j/v F� ! ~ ,- r4f�L� T87� 1�3 Y n, 19, 131c. ck � Lot S'0 SubdMsion of 4 L 6,lv G 6 5ubd vision Lot # -3 Fled Map # S"7 4'y Date Piled o 3 0~ Gentlemen: This letter is to auf'rrrize Insite Engineering. St n gMnjz &c %an.dsoane Architecivxe P C (Jeffrey J Contelmo. ZZI a duly licensed Professional Engineex to apply for the required wastewater treatment and/or water supply pem-ii,.0) t6 ser c the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of ;fhe Putnaft County HealthDpipar• ment,.and to •sigh all necessary papers on m . behalf in connection with this matter and to supenise the construction of said wastewater imatment add/Ox orate; supply systems in conformity with the gm:+xsions of Article 146 and/or 147 of the EducaLonal' Law, the Public Health Law, and The,Punam County SaniWity Code, OF NE V-.ry Tiviy Yours, Countersigned: { i Signed: P'E. # 6193 (1 of Prop Malkin "address: Tr. 1 r ,� ,,,� g ��,girieGrin�;.;Stzrev1ng & Mailing Address: '� ll!_`ST(�� �c U • Landscape Aschit®cturE, F.C. 3 Ciatxett Place Cannel S� b (,� aa� %CoAD . r"h4ppRG stateTew York zip log 12 stag_ zip 1 vs Telephone: 84: 2259690 Telephone: pedoh.dot 4' . { !Foam LA -97 C PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL a5 please print or type PCHD Permit # �Z Well Location: Street Address: Town/Village Tax Grid # d Q UA,(i` LAN & PA<6kSvnJ Map j Block ) Lot(s) S0.3 Well Owner: Name: A LO.-►O r Address: sqe. Lj oo D STR rr�A 6A114f -04� 'DO. OOP ^ AMoPAC QY /off ) Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1 rimary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served __ff_ Est. of Daily Usage 00 gal. Reason for Replace Existing Supply ' Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type _,,V Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yeses No Name of subdivision A LVA!C Lot No. - Water Well Contractor: -110 6 9fE2A 1466) Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: A Town/Village N Distance to property from nearest water main: d A 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. Anv revision or alteration of the approved plan requires a new permit. Well to be constructed by a water ai: by Putnam County. Date of Issue `C �, U Permit Issuin O a • Date of Expiration Title: g,� Permit is Non-Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # 10` d Well Location: Street Address: TownNillage Tax Grid # UA 6,X 1,M 1 Map 5 Block I Lot(s) 5 �. Well Owner: Name: Address: C�6 k 1.A C Q. c(-b it I Ly P v M, '03'0 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 gpm # People Served ==I Est. of Daily Usage gal. 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 ✓ No Nameof subdivision ALo,,G,,4. 5,.,bikit9i-5 ro-j Lot No. 3 Water Well Contractor: Address: 0. ns6IV Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: "'^ 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: CrWW21r- PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED_FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. revision or alteration of the approved plan requires a new permit. Well to be constructed by a water ell ller certified by Putnam County. Date of Issue ! 4-3 Permit Iss ' >cial: Date of Expiration 41 o Title: Permit is Non -Trans blfi White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 1 /NS/ TE ENGINEERING, SURVEYING & LIANDSCAFEARCHITECTURE, P.C. 3 Garrett Place (845) 225 -9690 Carmel, New York 10512 Fax: (845) 225 -9717 TO: Putnam County Health Department 1 Geneva Road Brewster, New York 10509 LETTER OF TRANSMITTAL Date: 4 -2 -02 Job No. 96134.303 Attn: Robert Morris, P.E. Re: SSTS for Brimstone Development Corp. Alonge Subdivision Lot #3 301 Quaker Lane, Town of Patterson TM# 15. -1- 50.3 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 NO. DESCRIPTION 5— last rev. 4 -2 -02 CD -1 Construction Drawing j 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: Rob, The proposed drawings have been revised per your 3 -25 -02 comment letter. If you have any questions, please contact me. John COPY TO: Iot2002.dot SIGNED: jhn - -� o 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 APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant:.a..,, 2. Name of project: ai,,,, 4�,,,.6d tv �� 3. LocationdV: . Lnsite &gineerin4. Surveying & Iandscape 4. Design Professional: Jeffrey J: Cmtelmo, P.E. 5. Address: Architecture, P.C. 6. Drainage Basin:i.k. •�,,,� ate 22 &&A Now ,erk 19599 7. Type of Project: V�. Private/Residential Food Service Apartments Institutional' Office Building Realty Subdivision Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted _y.- 9. Is a Draft Environmental Impact Statement (DEIS) required? .................... 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency V% I e.. 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 ?--�� 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) .............................:............. ............................... vl� 18. Is project located near a public water supply system? ....... ............................... 19. If yes, name of water supply ,r•I Distance to water supply�� 20. Is project site near a public sewage collection or treatment system? ................ w4,21 21. Name of sewage system ;..I ea- Distance to sewage system 22. Date test holes observed S < t _ 41-1 23. Name of Health Inspector. 24. Project design flow (gallons per day) ................................. ............................... � 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... ;mss 26. 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? 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 v~� 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 ^z. 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? . ............................... 36. Tax Map ID Number .......................... ............................... Mapr� Block_ Lot d-2> 37. Approved plans are to be returned to ..... Applicant eL 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 :.... ............................... Id-4 e--X:�, Yna =, � Z.2_ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of $3e- ;.�..ti -�-� '(ytia�••��.�� �� Located at Tax Map # (r,' Block I Lot . Subdivision of f�t� Subdivision Lot # _46 Filed Map # -1�z.. Date Filed Gentlemen: This letter 1S t0 authorize Incite EhcTirrinq, Surveying & Landscape Architecture, P.C. (Jeffrey J. Oontelmo, a duly licensed Professional Engineer x — cxRegKUmdftKW=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., D(.j(., # 6193, Mailing Address mite Ehgineeri_nq, surveying & Landscape Architecture, P.c. Route 22 Bmeter, New *eL-Ae 10509 State Now York Zip '10509 Telephone: ( 914) 278 -4990 Very truly yours, Signed: /%��I��% (Owr�e�,4� Property) Mailing Address: State ty` f Zip tCa+s'4 t Telephone: (,..ZA -• +tom ©M6 Form LA -97 P.E I /NS/ T 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: /-/7-00 Job No. 96134.303 Attn: Robert Morris, P.E. Re: SSTS for Alonge —Lot 3 Quaker Lane, Town of Patterson TM # 15 -1 -50.3 WE ARE SENDING YOU ® Attached ❑ Under separate cover via ❑ Shop Drawings ® Prints ❑ Plans ❑ Samples ❑ Copy of Letter ❑ Change Order ❑ the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION 4 C -1 Construction Drawing 1 08/20/99 CP -97 Construction Permit 1 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 08/20/99 -- Short EAF 1 $x`99 --- $300.00 Fee -,ir- ' '60`7 &0 Co S-? 2 ++ -- -°9 Modular 4- Bedroom House Plans 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_3.doc SIGNED: ZnO���' Je J. Contel , P.E. IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE .-.,,. /NS/ T E ? ENGINEERING, SURVEYING & L P.C. LETTER OF TRANSMITTAL Route 22 (914) 278 -4990 Brewster, New York 10509 (914) 278 -6392 7 DeLavergne Avenue (914) 297 -1742 Wappingers Falls, New York 12590 TO: PCHD Date: 2 -10 -00 Job No. 96134.303 Attn: Shawn Rogan Re: SSTS for Quaker Lane, Lot 3 Town of Patterson, TM# 15.1 -50.3 WE ARE SENDING YOU ® Attached ❑ Under separate cover via the following items: ❑ Shop Drawings ® Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of Letter ❑ Change Order ❑ COPIES DATE NO. DESCRIPTION 4 last rev 2 -9 -00 C -1 Fill Drawing 1 DD -97 Design Data Sheet 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: Shawn - The length of trenches on the enclosed plans have been revised according to your 1 -21 -00 comment letter. The enclosed design data sheets also contain original stamp and signature. Please call if you have any other questions. COPY TO: _ SIGNED: John M. Watson IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE LoM.dot 'Pr TrrhT..A n om . e;F r +s: FCC v . i�(� y.., rr. T •T ►.JOROJ'•` JlJ r i{ - �����` 4Y ' �7 J1 rry it rr r'' ^� ... �. `r"` i 3 ca ' x _ r r p Kv frt DESZGI�I IJATA SHEET' SU23SU 2FACE�i SEWAGE :T.REATNENT_.SYSTEMy kt , Owner STL: P HI / /1 Address .woo/ S T tiroP..AG N� /O.Stf Srf� Located at (Street) Tax Map /5, Block. ( Lot "S D o3 F (indicate nearest cross street) <; } 'Municipality P,47_765Q -;5 c/ ' =° Drainage Basin ST 8VU�`/z,� - SOIL 1 RCOLATIO'N TEST DATA Date ofPre- soaking L "T Date of Percolation Test Hole No. Run No. Time Stara - Stop Elapse Time Min.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate; Min/Inch PEA . 1: E;0- ?,� 4 P36 1 °�z -3:Z2' 30 2 3:Z3 -3:53 3 �12- L� 4 5 1 2 3 4 5 I i 11%ji ; t: tests Lo oe repeatea at same aepw until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 m_ in for 1 -30 minrnch, s 2 min for 31 -60 min/inch) 'All data to,be submitted for review. i. 2. Depth' measurements to be made froth top of hole. ' Form DD -97 8 s t �•a it 7t � ,y! 1 .' - , DEPTH,, HOLE N0. lY y 0 5' Z tti 4 y 6 5.0' 6.0' .. , X7:0'...._. �8.0' 9.0' 9.5' 10.0' 4t ' yy tTry� C A /{ H�'{ V�"'il JIWa'! 4tf 4("k- tail.. OF;SOZLS ENCOiJ�TTEREDiXN TEST HOLES:: �y."�Vl NiT n„ - 1, Ds N0: Fc V OF Nr- Indicate level at which groundwater is encountered 'V s� Indicate level at which mottling is observed 61,931 — NJ�'' �j �. p�17>r r �l1'i.• J' Indicate IeveI to which water level rises after being encountered IVI,4 Deep hole observations made by: 2'> Hn/ G�/'Sor✓ Date S t'� 47 Design Professional Name: Jeffrev J Conteimo P E `' Address:Insite Engineering & Surveying', P.C. A, OF NEIV ro ' E Rallte 22 `• ��FS�`I J. COF�r�, t Brewster, New York 10509 ' Z Signature v Desiga Pr0fessionaVsS6W BRUCE R. FOLEY Public Health Director January 21, 2000 DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETfA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278 - 1921 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 #3 (T) Patterson, TM# 15. -1 -50.3 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 BRUCE R FOLEY Public Health Director LORETTA MOLINARI- R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT' OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 fax (914) 278 - 7921 Nursing Services (9 14)278-6558 Fax(914)278-6085 Early Intervention (914)278-6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 TO: Re: Dear: Date: Proposed SSTS: �UA� /wy..e /-I - 3 (T) xg4 � Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: The construction of.this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department.. AAA., I s4,-,c Ir-K ON" t ,,.._o i 'P1 L016 eve ev o-4'e Upon receipt of a iubmission, revs d to reflect the above comments, this application will be considered further. SR:tn sstsproposed Very truly yours, Shawn Rogan Public Health Technician r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATbIE \-T SYSTEMS REVIEW SHEET FOR CONSTRUCTION PEP'vllT-- 17, STREET LOC ATION / 11.E NAME OF OWNER F-WED BY R.Ni, GR, AS, NIB, BHS /etc. O b TAX NI.4P # / �• cS �' DOCUI81E \TS Y N 7F— lPER�IIT APPLICATION PC -1 WELL PERMIT PWS LETTER LETTER OF.A6q ATION D IGN TS) DATA S CORPORATE RESOLUTION ._ SHORT EAF PLANS - THREE SETS HOUSE PLANS - TWO SETS VARIANCE REQUEST FEE SUBDIVISION j LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED PERC RATE /(- ),Z FILL R TAEQUIRED DEPTH N DRAI'N REQUIRED TA \PIPES GE'NERkL LOCATED N NYC WATERSHED EROSION CONTROL:HOUSE,WELL, SSDS PERC 8c DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY & EXPANSION LOCATION INLAP EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE iE pUMPED, PIT & D BOX SHOWN & DETAILED HOUSE -NO.OF BEDROOMS WELLS & SSDS'S WAN 200' OF PROPOSED SYS. PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE NO BENDS; bLAX.BENDS 45° W /CLEANOUT FILL SYSTEMS CL BARRIER 10. . HORIZONITAL;SLOPE 3:1 TO GRADE FI SPECS NOTES FIL CERTI ATION NOTE TtiL.,PE/RA; NALME,ADDRESS,PHON E- DATE OF DRAWING/REVISION Ld�JDATUIM REFERENCE LOCATION( OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET ,PROPOSED FINISH FLOOR AND BASEMENT EL. COMME-NTS: PLANS SUBMITTED TO DEP FILL IN EXPANSION AREA DELEGATED TO PCHD TRENCH „_— DEP APPROVAL, IF REQ'D LF TRENCH PROVIDED ) 60 FT MAX. DEEP TEST HOLES OBSERVED PPECS TO BE WITNESSED T PARALLEL TO CONTOURS 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 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL PRE 1969 NEIGHBOR NOTIFICATION 20' TO FOUNDATION WALLS _'WELL TO PL / LETTER BI/ZBA 100' TO WELL, 200' N DLOD, 150' PITS / 100 YR. FLOOD ELEVATION 100' TO STREAM WATERCOURSE LAKE (inc. expan) / OTHER REQ'D PERINUT(S) 50' TO CATCH BASIN, 35' STORMDRAN, PIPED WATER REOLiRED DETAILS ON PLANTS 10' TO WATER LINE (pits -20') SEWAGE SYSTEM PLAN-(NORTH ARROW) 50' INTERMITTENT DRAINAGE COURSE SSDS HYDRAULIC PROFILE 2007500' RESERVOIR, ETC. GALLEY SYSTEMS GRAVITY FLOW _150' 00` CONSTRUCTION NOTES , IN to CDS= >5 %,6'-4 %,25'- 3 ° /q30'- 2%,35' -1 %,100' - <l% DESIGN DATA: PERC & DEEP RESULTS 20'MN to CD discharge /100'with 182 cons day discharge 2' CONITOURS EXISTING & PROPOSED - SEPTIC TANK DRIVEWAY & SLOPES, CUT 10' FROM FOUNDATION;.50' TO WELL PO MTITLE FOOTING /GUTTER/CURTA DRAINS N WELL SOIL TYPE BOUNDARIES DIMENSIONS TO PROPERTY LINE BLOCK; OWNERS NAME,ADDRESS � LOCATION OF SERVICE CONNECTION TtiL.,PE/RA; NALME,ADDRESS,PHON E- DATE OF DRAWING/REVISION Ld�JDATUIM REFERENCE LOCATION( OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET ,PROPOSED FINISH FLOOR AND BASEMENT EL. COMME-NTS: PUTNAM C� &-- NTY DEPARTMENT HEALTH ]DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner S72:-5PK�/ /aLoti6 -zs Address !wool-) ST in,410AU- SrT� Located at (Street) Tax Map, /5, Block ( Lot S (indicate nearest cross street) Municipality - 0,47TCaz-�5oAl Drainage Basin id 8%e4 � r' SOIL PERCOLATION TEST DATA /3 IVVC�WP Date of Pre - soaking S (3 LT-f Date of Percolation Test S/1 f q I Hole Igo. Run No. Time Start - Stop Ela se Time Min.) De th to Water rom Ground Surface (Inches) Start Stop Water Level Drop IA Inches Percolation Rate Min/Inch 2 :o�i-- BSI`f IS 23 % Z6% 3"/,f 3 ':c -3:3�- IS 4 5 2 3o zz- 2�s1it- za 3 s:�- �`Yz�- 3C� �� 2,3.'/2. (/Z �O 4 -1 2 3 4 .. 5 - -- -��• . •• •��w 19 -aicu aL aaniG dupin unni approximately equal percotatton 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 froin top of hole. Form DD -97 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA 1 DESCRIPTION OF SOILS ENCOTJNTERED IN TEST HOLES HOLE NO. 1)3A' HOLE N0. Q 6 HOLE N0. Indicate level at which groundwater is encountered N� Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: ,1oHA/ rw/V,'gvr✓ Date Design Professional Name: Jeffrey J. Contelmo, P.E. Address:lnsite Engineering & Surveying, P.C. RautP 22 ' Brewster, New York 10509 ` Signature: Design Professional's Seal ��OF rlccyY� V G� - FESSIC;t`lF�"� ''Kt • W BRUCE R. FOLEY Public Health Director. TO: PROJECT: LORETTA MOLINARI ILK, M.S.N. Associate Public Health Director Director a Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New . York 10509 Environmental Health (914) 278.6130 Fax (914) 278 -7921 Nursing Services (914) 278 - 6558 wTC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278.6082 Fax (914) 278 - 6648 DEPARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATIO \T STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM DELEGATED rte; ,e..J. J6 TOWN: C SErj K PV DATE SUB'D APPROVAL: 6-30-99 NOTICE OF COMPLETE APPLICATION DATE: T0: f ? N Dear Date:. RE: (�u„�cer �L 43,F -.3 (T) A�-Uc, ; /5 ; —/— 5-D, 3 Reservoir Basing . j 8yz- The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and rece'ved by this Department on C72,, / 0-Q is complete. The Department will notify you by OD 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 SR:tn Public Health Technician ws2 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: (PI L'W(Ic tOr Gj��(.tG� �fivr�G —ZG represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: Qr- IrAST -Ori i �%L)�c -oP -� -OJT Co PE'• -P Having offices •at: SiSb uoaciz�' rc_t>Ab , M fl 145PAC. I PL 16 s1+1 Whose Officers Are: . President -Name: r P N IU A L-o NfsL Address: ; b t.�Joe)'D %eonb , MAiL-bPl9 -_ A3 I Vice'President -Name: 7-Ad,- o: - fi" ,J&L ct-r - XNbPRc N� y. IBS � Address: S13 0USF_to�L 'b,P . Sx, 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: , t s r n n)_r Sworn to before me this a ) day of Ocr on (year) Notary Public ..... ._THOMAS I JACOSELLIS Notary Public, State of New York No.02JA6003334 Corporate Seal Oualified in Putnam County C9.4 Commission Expires March 2.20_ _ • Form CA -97 BRUCE R. FOLEY Public Health Director DEPARTMENT 1 Geneva Brewster, New OF HEALTH Road York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services January 21, 2000 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 Dear Mr. Contelmo: Re: Proposed SSTS- Quaker Lane, Lot #3 Brimstone Development Corp. (T) Patterson, TM# 15. -1 -50.3 Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: The construction of this sewage disposal system maybe subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department of Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. Please submit design data sheets with an original PE stamp and signature, photocopies are not allowed. The last expansion trench incorrectly states the length as 2 @ 51'. The total length is 67 If. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Very truly yours, Shawn Rogan Public Health Technician SR:cj i. 14 -164 (2187) -Text 12 PROJECT I.D. NUMBER 617.21 SEni R Appendix C State Environmental Quality Review SHO_ RT .ENVIRONMENTAL ASSESSMENT FORM. For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant.or Prolect sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME. �s...rd �� 'Jt I�c•..�.d�x.'�c_ I�.t�.1u► • °tti+��'�•C� (era � • 3. PROJECT LOCA OWN::• Municipality `�'��v�°'�a+'� County 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) ��� �K� L ems• �'G:W �N.� s�G�`t �' cr•� 1 5. IS PROPOSED ACTION: %New • ❑ Expansion ❑ Modlf[cationlalteration 6. DESCRIBE PROJECT BRIEFLY: ��r,.nryc..�♦ c� i• _ 1 V 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? HYes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? IN 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)?. and rmitiapprovals 94es ❑ No If yes list agency(s) pe -arm ;���'���+� �„�;•�. � -+� • —'� ��„Jl {`L!•�.�A1 �h..LN 'lt°11s17V\ kkA� ^.%t•+ �� 11. DOES'ANY ASPECT OF THE ACTION RAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ 1% Yes No If yes, list agency name and permitiapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑ Yes o I. CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE �uw:�s_ ���v�t `r:v:q � G✓a..�dv.`i•�r.� �` (��..�.cl�s�x, ��'�tz.�„+�„���. Applicant/sponsor name: --�� 1 E '�� Dale: g" ?� Signature: If the action is in the Coastal Area, and you are a state agency, complete' the Coastal Assessment Form before; proceeding with this assessment OVER PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE 1 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? If No, a negative declaration may be superseded by another Involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE' FOLLOWING: (Answers may be handwritten, If legible) 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 C5. Growth, subsequent development, or-'related activities Illiely to be induced- by the proposed action? Explain briefly. C6. Long term; short term, cumulative, or other effects not identlfled 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 o� more potentially large or significant adverse Impacts which MAY occur. Then proceed directly to the FULL EA.F and/or prepare a*positive declaration. E3 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 differe-nt-from responsible o icer) Date �q j a 590•` C \ � 100' WETLAND SETBACK TO \ N�C-DEC WETLAND #8R -4 41 A Al 0.0 - � / \\ /.DAa %E� S:AR[1z EO CGNftRv4�q!J GNi'RAR<E. SSTS� i / \ C/C \ PERCOLAA77ON TEST HO(E (T1P.) \ TESTHOLE (7YR)\ \ TTS 600 \1 DJA Pis IN / L't DROP BOX (TYP.) �4 "0 PVC fDR 35 ® Y l 1/8° /FT. MIN. SLOP / 1250 GALLON \ \\ ? L L • SEP77CI TANK \ 0 r y+ 0: t' _ t i 1 LOT 4 T �. Mr SLOPE A. \ \ \ EXPANSION ABSORPTION TRENCH 2'. WIDE PRIMARY f• 610 \ i 1,ABSORP770N TRENCHh'(TYP.) \. ROPO•SED \ �`F 73'f~ SCHARGE TO INFIL NO 720 \ .0 \ so, LJ FOODN67DRAIN J l — — — DISCHARGE J 6�0 y WATER SERVICE\ Is I CONNEC77ON PROPOSED WELL — �CBD i}4t N y1 () ; 23054 ACRES,.* E 08 1Y1 (104424"sf. t) �= // !/ �,A i