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HomeMy WebLinkAbout0528DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 15. -1 -50.4 BOX 6 00528 till J T I r IN 00528 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # % 0 U l� 0 Located at '3r) S � a (LQi Lane, Yitlag�- r s� Owner /Applicant Name RrPS -hQp Lfz fne-s 11 Tax Map 15,-_ Block _�_ Lot h Formerly Alorw - It-l"onSkne- WLt. rc„c_ Subdivision Name Subd. Lot # Mailing Address ` , 0. tB6X q y'7 -Rre 08+e r, nl X Zip /ham Date Construction Permit Issued by PCHD IQ y Separate Sewerage System built by Tr ? ; �-�� Address ; , (� (Sr,r �It;� fR�;�� l+?t;Iy�i It)$c1 Consisting of 12,,TV _ Gallon Septic Tank and 41,0P L F- e F 2 wide �-- �-en�he 5 Other Requirements: Water Supply: Public Supply From Address or: Private Supply Drilled by Mill Df i ��i � �V£ . Address -15 Puh3am - La „e_, �o,aslor, N'y Building Type l e5i m+i & ( Has erosion control been completed? Ye .5 Number of Bedrooms I Has garbage grinder been installed? NQ i I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: -f Certified by �/�''`� P.E. ,�' R.A. Address License # & /9 / 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 approva a subject to modification or change when, in the judgment of the Public Health Director, such revocation', lodific or change is necessary. By: Title: Date: b White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy = Design Professional Form CC -97 i 1' T R 7RTTf1 RT RT R 1'RTR TRTR7 R TR7 F_7A_7R_7 R_TY_T3f T_lf_iRTJL PUTNAM COUNTY H.OAI TWDEPT. 1 Geneva Road (846) 27"130 Brewster, NY 10509 15 5J Received of TT4 Sum Of o 0 Dollars $ 0.00 ~Y THA4 YOU! El Cash. El Check wo. ❑ Credit Card By Nov 03 03 10:41a TOWN OF PRTTERSO 945- 878 -2019 P•3 BRUCE R FOLEY Public health Director LORETTA MOL1NAlti• RN., M.S.N. A00clate Public Neallh Direa r Director eJ Parkin! Services DEPARTUEN T OF HEALTH I Geneva Road Brewster, New York 1 05a9 1Sartroaroentel klcslgi (914)218.6110 Fex(9.14) Zia -7921 Nu"Ihl; Strvlca (910278.6550 WIC (914) 278 - 6675 Pax (914) 218 - 6085 E20y Interventtoa (914)27a -6014 Pieu6od (914)273 -MS2 Fax( 04)178 -6618 E,,9 AnDBF.� W.,RlELCAIT N FORiM,, • OW -A-ERS NAME: P,S- t1t/ F�7?rr�ds 1� TAX MAP NVM FI.L- E911 ADDRESS; 3bS L',jQ'6 r Lss�; TOWN: _ Qr He rs AUTIiOR ` D TOWN OF'''YCiAx.: (Signature) DA.T IE: The Putnam' Department of Health wffl not .issue a. Certfcate of Construction Compliance uWess the above form is completed, i.e., a legal E911 . address is assigned by an authorized town official This form is to be sub=litted with the application fora Certificate of Construction Compliance. (E91 I VEROW ell 6ti028L8-01 LTL Z83 6S2ZSbS SNIa33NISN3 31ISNI *WO 6S�0i £602- >: -ftON PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Quaker Road Town/Village: Patterson Tax Grid # Map � Block Lots .A4 Well Owner: Name: Address: Prestige Homes'.P:O, Box 407 Brewster, NY 10509 Use of Well: 1- primary XXXX 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 1. 7 lb /ft. Materials: X Steel Plastic Other Joints: _ Welded L Threaded _ Other Seal: _ Cement grout _ Bentonite Other Drive shoe: X Yes No Liner: Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped X Compressed Air Hours 6 Yield 30 gpm Depth Data Measure from land surface - static (specify ft) .40 During yield test(ft) 380 Depth of completed well in feet 405 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 1 Sand Clay 1 .405 Granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type :LLB Capacity 71 (:. jthjA, Depth3� odel'�� o SLctl Voltage ) HP *4 Tank Type WX b i Volume (, a 380 30 Date Well Completed 8/29/03 Putnam County Certification No. 02. 790/'3 Report j03 Well Drill s•g ature) NOTE: Exact location of well with distances to at least two permanent landmarks to be A vided on a separate sheet/plan. We1lDriller'sN :i. grilling, Lnc, Address: 75 Putnam Avenue - Brewster, NY Signature: Date: I if" l0 3 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 mov 03 03 10:41a BRUCE R FOLEY Public Health Director TOWN OF PRTTERSO 845 - 878 -2019 p.3 LOle.M7A MOLINARI• R.M. M.S.N. rtasoetate Public Health Director Director of Patient servlers DEPARTMENT OF FMALTH I Geneva Road Brewster, New York 10509 iariroamcntal ikalth (914)278.6130 Fn(914) x78 -7911 Nurslaa Servlcp (914)278 - 6319 WIC (914) 278 - 667! Fax (914) Z78-6085 Early laterveWon (914)272-6014 Ctesaboal (914)2796092 Fax (9t4) 278 -6618 OWAXRS NAME: RP,54144 Unews 1 f TAX MAP NUMBER. E911 ADDRESS: .365- (�Jakor Lena- TOWN: AUTHORIZED TOWN OF 1CM: ;✓1� •At ✓r`.'��:�'' �t�� - ���....._ —, (Signature) DATE: The ]Putnam County Department of Health wM not issue a Certificate of Construction Comphauce uWess 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. (E911 VERE MJ b�£-d 6Tt328L8 :01 LTL6C-2Mt7B SNId33JI5N3 31ISNI :WONA 65 :0T £002-2 -MN /NS/ TE { ENGINEERING, SURVEYING 8, LANDSCA PEA RCHITECTURE, 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, NY 10509 WE ARE SENDING YOU ❑ Shop Drawings ❑ Copy of Letter LETTER OF TRANSMITTAL Date: 12 -30 -03 Job No. 03136.100 Attn: Robert Morris, P.E. Re: SSTS for Prestige Homes II 305 Quaker Lane, Town of Patterson TM# 15 -1 -50.4 ® Enclosed ❑ Under separate cover via ® Prints ❑ Plans ❑ Change Order ❑ the following items: ❑ Samples ❑ Specifications COPIES DATE ❑ Submit E NO. DESCRIPTION 5 1 12 -12 -03 i AB -1 As- Built Drawing 1 12 -30 -03 CC -97 Construction Compliance 1 11 -17 -03 GS -97 Guarantee -- —� 1 11 -8 -03 - - - - -- Water Test Result 1 i 11 -14 -03 5127155 _ _ , $200.00 Fee 1 11 -3 -03 ------ i E -911 Address Certification 1.... 11 -11-03 WC 97 i Well Completion Report - _..._. - ^- - 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: Iot2002.dot ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints SIGNED: hn M. Watson, P.E. IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE NOV-5 -2003 10:17 FROM:INSITE ENGINEERINGa 8452259717 TO:2782199 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL REALTH SERVICES GUARANTEE OF SUBSURFACE SWAGE TREATMENT SYSTEM / S- / 5o, y Owner or Pur aser of Building Tax Map Block Lot Building C stmacd by To illage Location - Street Subdivision Rarne SesidthilaJ !Y Building Type Subdivision Lot # P:3/3 t/ 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 furtber agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated.- Mouth ouch � Yea � Signature: � �.^ y ,� General Cdntractor (Owner) -JK-ts� 16t Corporation.Nam,e (if corporation) Address: sou f kf State g mj S� & ! �, - Zip [0.5 D Corporation Name (if corporation) Address: State _ _ Zip Forn GS -97 JMS ENVIRONMENTAL SERVICES, INC. 15oo SUMMER STREET STAMFORD, CONNECTICUT o6905 Mailing Information: Name: Mill Drilling Co. Address: 75 Putnam Ave City: Brewster State: NY Telephone: Sample's Information: Client: Prestige Homes Zip: 10509 Fax: 845 - 279 -5075 NELAC, CT and NY State Certified Environmental Laboratory Collector's Information: Name: Bob Mill Address of site: Lot 4 Quaker Rd City: Patterson State: NY Zip: Telephone: Site: outside hose bib Date Collected: 11/8/03 Date Received: 11/8/03 Preservative: HNO3 Time Collected: 7:10 Time Received: 11:00 Temperature: <4C Lab No.: J038312 Date Analyzed Test Name Result MCL Method 11/8/03 15:00 Total Coliform Absent Absent SMWW 9222B 11/8/03 Chlorine Free Residual <0.1 mg /L N/A SMWW 4500CIG 11/8/03 Color ND 15 Units SMWW 2120 B 11/8/03 Odor ND 3 TONs SMWW 2150 B 11/10/03 Iron <0.050 mg /L 0.3 mg /L SMWW 3111B 11/10/03 Manganese <0.050 mg /L 0.3 mg /L SMWW 3111B 11/10/03 Sodium 17.4 mg /L N/A SMWW 3111B 11/10/03 Chloride 28.0 mg /L 250 mg /L SMWW 4500 CI C 11/10/03 Hardness 200 mg /L N/A SMWW 2340 C 11/10/03 Nitrate 1.56 mg /L 10 mg /L SMWW 4500 NO3E 11/10/03 10:00 Nitrite <0.1 mg /L 1.0 mg /L SMWW 4500 NO3E 11/8/03 pH 6.53 S.U. 6.5 -8.5 S.U. SMWW 4500 H B 11/10/03 Sulfate 27.4 mg /L 250 mg /L SMWW 4500 SO4F 11/8/03 Turbidity 0.19 NTU 5 NTUs SMWW 2130 B 11/10/03 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES • FINAL SITE INSPECTION Date: 2 S� Inspected by: G, ggga? Street Location 30,6 QVAk Ert 1.4,,&; Owner p yL, m sr©,u6 C%/. co Town RA r rg7tsnn/ Permit # 2- )7-00 TM # / 6, - l - 50, !V Subdivision Lot # 4 1. Sewage System Area YES O COMMENTS 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 ...... ............................... H. Sewage System a. Septic tank size - 1,000 ...:.... ,25 .........other ................ b. ' Septic'tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1 All outlets at same tesfe. d [ 2. Protected below frost ............................................... 3. .. Minimum 2 ft. Original soil between box & trenches e. Junction Box -properly set .......... ............................... 6. T renc ies 1. Length required q00 Length installed #0 2. Distance to watercourse measured -- I o 0 Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft, from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... d 8. Size of gravel 3/4 - 11/2' diameter clean .................... 9. Depth of gravel in trench 12" minimum ....... : ....... .... 10. Pipe ends capped ........................ ............................... g. Puma 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 .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. HouseMuilding " 6Z a. house located per. approved plans, 'if `Number of bedrooms � ; _ w..: 4 Well located as per approved plans ...... ........ ... b. Distance from STS area measured ft........... C. Casing. 18" above grade ............................. :................. d. Surface drainage around well acceptable ....................... V. Overall ' Workmanship . a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ....... ............................... c_. % All_plpes.flush with inside of-box -� d lbackfill.niatenal coritams _stones e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from. STS area...... h.,-- Suiface•:water- protection adequate w - - a►� i_Erosion-control piovided......... ... Rev. 12/02 Form ST- •SEP -24 -2003 12:13 FROM:INSITE ENGINEERING 8452259717 TO:2787921 P:1/1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HlIrALTH SERVICES ATTEN'T'ION Q AT)AM M GENE We ♦: h: h. �► For: Fill All information must be fully completed prior to any Wrenches ): inspections being made. PCHD Construction Permit # P 1 -7 -- (3 u Located: �D�. ©uaker Owner /A,pplieaat Name: E e . i) lzaA M.w„a� TM, IS, _ Block �� Lot ,,,$b, y Formerly: 'Rw{� feu, gyp, Subdivision Name: Subdivision Lot,", Is system fill completed? &/R Is system complete? — . *_5 Is system constructed as per plans? Ve 5 Is well drilled? Is well located as per plans? Are erosions control measures in place? YP S Date: Date: —912q&:3 Date; 9 /2H /b 1 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 PCFID Construction Penaait and approved plans and the Standards, Rules and Regulations of the Putbam County Department of Health. Date: z q/v 3 Certified by: pg RA Insite Engineering, Surveying & esign rof "ona1 Landscape Archtwure, P.C. Address. a Gait Plaw Lie. # J Carme , Now a Comments: Form FIR -99 WED 12:06 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 s ' o 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 September 29, 2003 ROBERT J. BONDI County Executive Jeffrey Contelmo Insite Engineering 3 Garrett Place Carmel, New York 10512 Re: Field Inspection — Brimstone Development Corp., Formerly P.C. Development 305 Quaker Lane, (T) Patterson Lot # 4, TM# 15. -1 -50.4 Dear Mr. Contelmo: The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. 1. Clean silt out of distribution box and junction boxes. 2. Trim back pipes in cleanout boxes. 3. Grading needs to be completed around the well which must maintain 18" above grade. 4. Fix up existing silt fence and install additional silt fence below the well and rear yard construction area. 5. The additional room on the main floor is considered a potential bedroom giving the house a bedroom count of (5). If you have any further questions, please contact me at 845- 278 -6130, ext. 2261: GDR: cj Sincerely, Gene D. Reed Environmental Health Engineering Aide D 4 0 SENDING CONFIRMATION DATE : SEP -29 -2003 MON 11:23 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 92259717 PAGES : 1/1 START TIME : SEP-29 11:22 ELAPSED TIME : 00'23" MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED.. A". L0RETIA MOLINARI R.N., M.S.N. ROBERT 1. BONDI PDWIe Neehh Dlraew CDUnry E—dl. DEPARTMENT OF HEALTH ! 1 Geneva Road, Brtwsar, New York 10509 RWronw"tal Belts (8{5)271.6130 Fa(845)278 -7921 Nan111 semus (845) 278.6558 WIC (845);t78.6675 F.(845)278-6085 14rty aMnftndwftWb el (845)278.6614 Fa(845)271.6648 September 29, 2003 Jeffrey Contclmo Insitc Engineering 3 Garrett Place Carmel, New York 10512 Re: FieldImpxtian — Brimstone Development Corp., Formerly P.C. Development 305 Quaker Laos, (T) Patterson Lot 4 4, TM415. -1 -50.4 Dear W. Contelmo: The above referenced separate sewago treatment system can be baddiilled. The following comments must be corrected in the field. 1. Clean sift out of distribution box and junction boxes. 2. Trim back pipes in cleanout boxes. 3. Grading needs to be completed around the well which must maintain IS" above grade, 4, Fix up existing silt fence and install additional silt fence below the well and rear yard construction area. 5. The additional room on the main floor is considered a potential bedroom giving the house a bedroom count of (5). If you have any further questions, please contact me at $45- 278 -6130, ext. 2261. Sincerely, ' ✓. / /aw Gene D. Reed Environmental Haahh Engineering Aide GDR:cj 1*. '..' LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Envir6nmental 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 December 19, 2003 Jeffrey Contelmo Insite Engineering 3 Garrett Place Carmel, NY, 10512 Dear Mr. Contelmo: ROBERT J. BONDI County Executive Re: Field Inspection — Brimstone Development Corp. Formerly P.C. Development 305 Quaker Lane, (T) Patterson Lot #4, TM# 15 -1 -50.4 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.jc fieldins Sincerely, Gene D. Reed Environmental Health Engineering Aide n PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # f-11-00 ° Located at 30Y VA L ,q N e awn or Village PA <6;,`y 6 A,) Subdivision name R LOn/�6 Subd. Lot # �_ Tax Map J Block 1 Lot -�—O. '/ Date Subdivision Approved C — ? 0 q q Renewal Revision 13kI M S- 10A16� "MV, CORP, Owner /Applicant Name -sf6tq rI 4 LIA/PA ALONGE Date of Previous Approval Mailing Address C k W k'D sl y-A 66111' Zip 00 Amount of Fee Enclosed 30o Building Type AOrvsNl SAL Lot Area 2 ,qI .'No. of Bedrooms J- Design Flow GPD &6o A 6 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System tem to consist of '2So gallon septic tank and yDD L o Other Requirements: To be constructed by AD Ae �G 7�P�11N t; 32 Address nA Water Supply: Public Supply From Address or: V Private Supply Drilled by 12 C9 7>6,S6 2r111V6 Z Address .11A 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. *>� Date $ ETC F✓Gi R /NG; svAv y 6? elAAF CHI?'�cTu�eE Address 3 c G CAA^l Et- N o i z License # ,/f :r/ APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w en nside necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new perm' . ppro for discharge of domestic sanitary sewa only. By: Title: Date: z 2 �- White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH �d DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SE GE TREATMENT SYSTEM rnPERMIT # � ' 00 Located at � .a„6 &2c! Town or Village Subdivision name ^A a-^9,c. Subd. Lot # -_ Tax Map jr. , Block I— Lot =,c>. +.�. Date Subdivision Approved Renewal Revision Owner /Applicant Name �� a„i,s�,,� .Liz -A.- A1dov-dad ate of Previous Approval Mailing Address Zip Amount of Fee Enclosed Building Type; fit.,. -mil Lot Area No. of Bedrooms 4_ Design Flow GPD �c�4> Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of J-z-cr-'en), gallon septic tank and 4®-.> Other Requirements: To be constructed by ",,16.kA6921.20, Address Water Supply: Public Supply From Address or: _)4, Private Supply Drilled by -L4,.,. 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 treatmentsystem 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 i }t . ►�.u•d cod�c a� r L+4vic.e+na.s.�e T # . v• �t �t Address o y� -1 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 w n considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. Approve r discharge of domestic sanitary sewage only. By: % Title:i� I�Z1 Date: •�f' o-� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PRO PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL {� please print or type PCHD Permit # 1 Well Location: Street Address: Town/Village Tax Grid # C.��- �-•.:- �s.�...� ���-4�.1�r�r -��.�. Map lS Block t Lot(s)cGc--., ' Well Owner: Name: Address: 4q--2RA-C6 10,,�.A -S+,--4r - LCMei•P� Use of Well: be—Residential Public Supply Air /Cond/Heat Pump Irrigation 1- imary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought — gpm # People Served.. _ Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling Y. New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type -ve, Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes X.. No Name of subdivision A.l r Lot No. 4 Water Well Contractor: �,�,� �,.� A dress: Is Public Water Supply available to site? .................................. ............................... Yes No SU,_ Name of Public Water Supply: Town/Village Distance to property from nearest water main: .,..,� o.. Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: -Z.-.:o -4t Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED _FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director y revision or alteration of the approved plan requires a new permit. Well to be constructed by a wa4we- dri ller c rtified by Putnam County. Date of Issue 116 J Permit Issinng qficiA4 Date of Expiration Z Title: l C Permit is Non -Trans a rab e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 1 DEPT)THE CITY OF NEW YORK DEPARTMENT OF ENVIRONMENTAL PROTECTION. JOEL A. NUELE, 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 # 4 Quaker Lane (T) Patterson; © Putnam East Branch Reservoir Basin DEP Log # 9976 (Joint Review) Dear Mr. Morris: William N. Stasiuk, P.E., Ph. D. Deputy Commissioner Bureau of Water Supply, Quality and Protection April 7, 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, Alonge Subdivision - Lot 4," dated 9/30/99 and revised on 2/14/00, 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, I UPUIVIbul Engineering Design Review xc: James Covey, P.E., NYSDOH 465 Columbus Avenue, Valhalla, New York 10595 -1336 BRUCE R FOLEY Public Health , Director 4 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 (914) 278 - 6558 WIC (914) 278 - 6678 . Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278- 6648 John Watson Insite Engineering & Survey Route 22 Brewster NY 10509 Re: Proposed SSTS: Alonge Quaker Lane, Lot #4 (T) Patterson, TM# 15 -1 -50.4 Dear Mr. Watson: March 28, 2000 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. 1) Provide specs for the previous pavement to be utilized in driveway. 2) It is advised that the roofing/footing drain infiltrators not be proposed above the SSTS. It appears that it is possible to propose the infiltrators to the other side of the property. Upon receipt of a submission, revised to reflect the above comments, this application will be consider further. RM:tn Ve ly yours, ✓� b Robert Morris, P.E. Senior Public Health Engineer 1i LOT 3 0 V Dc1 1 tK 16a 17\ o�O O 0— N Z L N 22'12'50" E, 129.1.7 6� R Bit. Pair t. II I! 126.11 Stone Wall L = ' (o_0ss3'js )R= 1227.00' T6. rn, 501 60 N p 14 PROPOSED UTILITY EASEMEt 13 12 EXPANSION ABSORPTION 11 TRENCH (TYP.) 0 10 (1009 EXPANSION PROVIDED) 7 5 \--DROP BOX (TYP.) 4 8 -WAY DISTRIBUTION BOX DROP BOX (TYP.) 3 2 PRIMARY ABSORPTION TRENCH (TYP.) 1 WELL S o n S 22'14'39" W, 32.31 ' e S 27J426" W, 11.75' S 25'50'10" W, 20.87' S 7926'39" W LOT 8 37.13' MJ OF THIS DOCUMENT, UNLESS UNDER THE DIRECTION -LASED PROFESSIONAL ENGINEER, IS A W LLA RON OF 7209 OF ARTICLE 145 OF 7HE EDUCATION LAW. 1,250 GALLON SEP T7C TANK Dwelling PLAN SCALE.• 1' = 30' WIN �11 S 1 21 22, �° �� 23— O y� 24—= O �O o�O O 0— N Z L N 22'12'50" E, 129.1.7 6� R Bit. Pair t. II I! 126.11 Stone Wall L = ' (o_0ss3'js )R= 1227.00' T6. rn, 501 60 N p 14 PROPOSED UTILITY EASEMEt 13 12 EXPANSION ABSORPTION 11 TRENCH (TYP.) 0 10 (1009 EXPANSION PROVIDED) 7 5 \--DROP BOX (TYP.) 4 8 -WAY DISTRIBUTION BOX DROP BOX (TYP.) 3 2 PRIMARY ABSORPTION TRENCH (TYP.) 1 WELL S o n S 22'14'39" W, 32.31 ' e S 27J426" W, 11.75' S 25'50'10" W, 20.87' S 7926'39" W LOT 8 37.13' MJ OF THIS DOCUMENT, UNLESS UNDER THE DIRECTION -LASED PROFESSIONAL ENGINEER, IS A W LLA RON OF 7209 OF ARTICLE 145 OF 7HE EDUCATION LAW. 1,250 GALLON SEP T7C TANK Dwelling PLAN SCALE.• 1' = 30' WIN �11 S 1 PT 5 ince with ns of the melt . J6 ate WELL AS -BUIL T MEASUREMENTS NO. A CORNER OF DWELLING B CORNER OF DWELLING REMARKS 1 30' 61' 1,250 GALLON SEP 17C TANK 2 1 45 110' DROP BOX 3 80' 155' DROP BOX 4 117' 178' 8 WAY DISTRIBUTION BOX 5 121' 181 ' DROP BOX 6 126 182' DROP BOX 7 128' 181' DROP BOX 8 132' 183' DROP BOX 9 136' 184' DROP BOX 10 136 180' DROP BOX 11 135' 175' DROP BOX 1.2 136 - •. .- _ 171'. _ DROP, BOX 13 144 175' DROP BOX 14 149' 178' DROP BOX 15 178' 217' END OF TRENCH 16 .177' 220' END OF TRENCH 17 175' 222' END OF TRENCH 18 173' 222' END OF TRENCH 19 171' 223' END OF TRENCH 20 169' 223' END OF TRENCH 21 163' 221' END OF TRENCH 22 157' 218' END OF TRENCH 23 155' 219' END OF TRENCH 24 151' 217' END OF TRENCH I NO. I DATE I REWSION I BY .,- INSITE u!ll4'Vti!;.:' ENGINEERING, SURVEYING & Rl- ANDSCAPE ARCHITECTURE, P. C. PROJECT SS TS FOR PRESTIGE HOMES ll (ALONGE SUBDIVISION-LOT 4) 305 4UAKER LANE, TOM OF PATIERSON, PUINAM COUNTY, NEW YORK DRA WING: A.S -R/ 1/I T nRA wwr. 3 Gorrett Place Carmel, NY 10512 (845) 225 -9690 (845) 225 -9717 fox www.insite—eng.com OF NEIV � Q� '4K Qy J. OO,yTF�0� uj 2 Lp���. 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: TownNillage Tax Grid # 30 �) ✓AY,6A WJ6 PAlf C25o J Map Block f Lot(s) Well Owner: Name: A LvA/Cg Address: ;-g` vjoo? �1nnS/v�+ �I:�• Copp. MA HoPAi: Ni Idryi 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 _q___ Est. of Daily Usage 3 PO gal. Reason for Drilling Replace Existing Supply Test/Observation Additional Supply 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? ...................................... ............................... Yeses No Name of subdivision A Lo J a6 Lot No. 4 Water Well Contractor: 90 g6 -p 6rg-R,4 jNr I_ Address: A Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: — //A TownNillage n/ /A Distance to property from nearest water main: ,/ /A • Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: Applicant Signature: W 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 driller certified by Putnam County. Date of Issue 4 A14 L Permit Issu' fficial: Date of Expiratio o Title: Permit is Non - Transfers le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 'sureau of Water Supply 'Michael A. Principe, PhA _Deputy Commissioner ' -Tel (914).742 -2001 Fax (914) 741 -0348 June 13, 2002 Robert Morris, P.E. Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: Alonge Subdivision - Lot # 4 Quaker Lane (T) Patterson; C Putnam East Branch Reservoir Basin DEP Log # 9976 (Joint Review) Dear Mr. Morris: This letter is to inform you that the New York City Department of Environmental Protection (Department) has determined that the above - referenced 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, Alonge Subdivision - Lot 4," dated 9/30/99 and last revised on 6/3/02, 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, Margaret Ll d, P. Supervisor Engineering Design Review xc: James Covey, P.E., NYSDOH 4 ' e 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 305 Quaker Lane, Lot #4 (T) Patterson, TM# 15.4-50.4 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. Ve my yours, kL) 1&k)*10 Robert Morris, P.E. Senior Public Health Engineer RM:tn enc. —..NYC DEP ENGINEERING Fax:914- 773 -0343 .. -------- - - - - -_ - ..._._ May 14 _'02 14:59 P.03 t .1 '•+era - Mr. Robert Morris, P-E, Putnam County Department of Health C}e'partitten oaf'" , . 4 Geneva Road nu3ionmenta� Brewster, New York 10509' Re: Alonge Subdivision - Lot # 4 �o®s'r'�►+ Quaker Larne •:' •vat, wewYeax . • ••: M Patterson; 0 Putman East Branch Reservoir Basin DEP Project # 9976 ( joint Review) `:5'Comtni sivner' ' 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) and offers the following: - • Provide design detail for the S way baffled distribution box. Provide 100 feet separation distance from the infiltrators to the SSTS. X PrIne ipe, Pn.t). flepi�g► comn►tasio�!�er' If you have any questions regardiig this matter, please call me at (914) 773 -446- 1. Tal:(914)742 -2001 'Fax • .14).741.0346 Sincerely., Lucie Lops Associate Project Manager Engineering Design Review xc: James Covey, P.E., NYSDQH : i•t 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 26, 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, 305 Quaker Lane, Lot # 4 (T) Patterson, TM# 15 -1 -50.4 Reservoir Basin Dear Mr. Watson: The Putnam County Department ofHealth (Department) has determined that the above referenced application, including fee, and received by this Department on March 21, 2002 is complete. The Department will notify.you by April 18, 2002 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 . l�y yours, 1 Robert Morris, PE Public Health Engineer RM:cj TO Dear DEPARTMENT' OF HEALTH Division of Environmental. Health Services 4 Geneva Road Brewster, New. York 10509. _ /Tel. (914 ) 278-6130 Fax (914) 278-7921 DATE BRUCE R. FOLEY Public Health Director (T) 3DF �UkzeL.) G� 1 Reservoir Basin, The.Putnam County Department of Health (Department) has determin d tha the above referenced application, including fee; and received this Department on'- D Z— is complete. The Department will notify you by 6 2– of its d termination. 0 The Project has been delegated to the Putnam County Health Department for h 'd 1' - f . h , .. h._W ........_h 'd A........ review pursuant to t e gui a Ines set ort to t e aters a greement. Joint review.with:the. NYCEP will commence- pusuant to the guidelines set forth in - the Watershed Agreement: If the Departmen-t_fails to.notify:youu within the above referenced time frame, you. may notify _the, Department. of its failure.by certified mail,.returri receipt requested. �. The - notice should be sent forty ` 4 attention -at the above 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) -(fi) -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 sformwater plans or the creation: - of impervious surfaces; .and the .project applicant: should contact the Dept., of Environmental` - Protection regarding such activities to see if Dept. of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (914) 278 -6130 ext. 166. Very truly yours, Robert Morris, PE RM:tn Public Health Engineer ws2 a /NS/ TE ENGINEERING, SURVEYING & LANDSCAPEARCHITECTURE, P.C. 3 Garrett Place (845) 225 -9690 LETTER OF TRANSMITTAL Carmel, New York 10512 Fax: (845) 225 -9717 TO: Putnam Countv Health Department 1 Geneva Road Brewster, New York 10509 Date: 3 -18 -02 Job No. 96134.304 Attn: Robert Morris, P.E. Re: SSTS for Brimstone Development Corp. Alonge Subdivision Lot #4 305 Quaker Lane, Town of Patterson TM# 15. -1- 50.4 WE ARE SENDING YOU ® Enclosed ❑ Under separate cover via the following items: ❑ Shop Drawings ® Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of Letter ❑ Change Order ❑ COPIES ❑ Approved as submitted ! DATE copies for approval NO. DESCRIPTION 5 copies for distribution last rev. ❑ Returned for corrections CD -1 Construction Drawing 3 -16 -02 —_1 -5 --0 1 71 2 CP -97 Construction Permit 1 1 -15 -02 WP -97 Well Permit LA -97 Letter of Authorization 1 ---- - - - - -- 1 2 -28 -02 -------- $300.00 _.._.- .._....... .. ..... . -- - - - - _ �-- __ - --- - -- - - - -- -- - - - - -- - - -- -- - -- - - - -- - 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: COPY TO: IM2002.dot SIGNED: �'o c 'j.L, jion M. Watson, P.E. IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE 01/15/2002 07:27 845 -278 -6332 1NSITE ENGINEERING PAGE 05 PUTN AM COU NIY DEPARTMENT (aFyp���J[ +'.ALY.�TH Dl"' ISI N OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATI ®N m: Property of AiMSI'OWt pgyt5LVP1"9''Af'r CORAORA -7 i0A) .Located at 0'' 04K C- r2 1,A06' ry PA11"r,L)' cry Tax Map Black 1 Lot SubdiAsion of A L orJG C Subdivisior Lot # _ �( Filed Map # G 71 ? bate Filed Gentlemen; This letter is to authorize insite Enaineeri.ng, Suiy'eyir_g & Landscape Axchiteoture, P.C. +''Jeffrey J. Contelmo.. a duly licensed Professional B4neer to apply for the required wastewater treatment and/or water supply permit(s) .o serve the above-noted property in accorda:rce with the standards; rules or regulations as promulgated by 'the Public, Health- Director of the Putnam County Health Departtt=t,,.ald to sign all necessary papers on thy behalf in comnection with this matter and to supenise the construction of Raid wastewater treatment a6d /oar v<<ater supply systems it conforrrtit�y. Ivit11 tl-e prmisions of article 145 and/or 147 of the Educational Lave, the Public Realth Law, and the Putnan County Sanitary Code. y� o OF NE . 1N L ery y Yours, Countersigned: 'Signed: P.E. # 61931" ; (Own/of h9POEY) P /g Mailing Address: Insite En St1ry .. A4ailitig Address: Landscape 3 Garrett place Carmel YKA N-n t 4 C, State -New York Z.p m12 State _/� -7_ Zip (a Telephone: 1845) 225 -9694 Telephone: (WD ( oZ a pxioh.dot Form LA -97 D po"oftwo P T) THE CITY OF NEW YORK DEPARTMENT OF ENVIRONMENTAL PROTECTION JOEL A. MIELE, SR., P.E. Commissioner Phone (914) 742 - 2001 Fax (914) 742 - 2027 Mr. Robert Morris, P.E. Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re:. Alonge Subdivision - Lot # 4 Quaker Lane (T) Patterson; © Putnam East Branch Reservoir Basin DEP Project # 9976 ( joint Review) Dear Mr. Moms: William N. Stasiuk, P.E., Ph. D. Deputy Commissioner Bureau of Water Supply, Quality and Protection March 22, 2000 The New York City Department of Environmental Protection (NYCDEP) has determined that the above Subsurface Sewage Treatment System (SSTS) application is complete. However, the following items must be satisfactorily addressed before NYCDEP can issue an approval: Provide specification for the pervious pavement (turfstone) to be utilized in the driveway. Please be advised for this material to be considered pervious, it must have at least 50% void area. 2. The infiltrators must be kept at least 100 feet away from the absorption field. The review of the SSTS project will not start until NYCDEP receives the required information. Should you have any question, please, do not hesitate to call me at 773 -4461. Sincere , Lucie Lops Associate Project Manager Engineering Design Review xc: James Covey, P.E., NYSDOH 465 Columbus Avenue, Valhalla, New York 10595 -1336 NYC DEP ENGINEERING Fax:914- 773 -0343 Mar 23 '00 8:23 P. 03 THE CITY OF NEW YORK DEPARTMENT OF ENVIRONMENTAL PROTECTION JOEL A. MIELE, SR, P.E. Commissioner - Phone (914) 742 - 2001 Fax (914) 742 - 2027 Mr. Robert Morris, P.E. Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: Alonge Subdivision - Lot # 4 Quaker Lane (T) Patterson; 0 Putnam East Branch Reservoir Basin DEP Project # 9976 ( joint Review) Dear Mr. Morris: March 22, 2000 The New York City Department of Environmental Protection (NYCDEP) has determined that the above Subsurface Sewage Treatment System (SSTS) application is complete. However, the following items must be satisfactorily addressed before NYCDEP can issue an approval: 1. Provide specification for the pervious pavement (turfstone) to be utilized in the driveway. Please be advised for this material to be considered pervious, it must have at least 50% void area. 2. The infiltrators must be kept at least 100 feet away from the absorption field. The review of the SSTS project will not start until NYCDEP receives the required information. Should you have any question, please, do not hesitate to call me at 773 -4461. Sincere , Lucie Lops Associate Project Manager Engineering Design Review xc: James Covey, P-E., NYSDOH 465 Columbus Avenue, Valhalla, New York 10595 -1336 /NS/ TE ENGINEERING, SURVEYING & ILA NDSCAPEARCHITECTURE, P.C. 1485 Route 22 (914) 278 -4990 Brewster, New York 10509 Fax: (914) 278 -6392 TO: Putnam County Health Department LETTER OF TRANSMITTAL Date: 2 -29 -00 Job No. 96134.304 Attn: Rob Morris, P.E. Re: SSTS for Alonge - Lot 4 Quaker Lane, Town of Patterson TM # 15 -1 -50.4 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 4 last rev. 2 -14 -00 C -1 Construction Drawing 0 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 enclosed plans have been revised according to the NYCDEP comment regarding the portion of proposed driveway within the 100' NYSDEC buffer. Pervious pavement has been shown on the enclosed plans (as shown on the approved subdivison plans) for this situation. Also, a baffled distribution box has been provided before the first trench and drop boxes have been provided every 50' along the effluent line according to PCHD comments. Please call if you have any other questions - John COPY TO: Lot2000.dot SIGNED: ze John M. Watson IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT STREET LOCATION' C 1Ii'�"y1 b NAME OF OWNER �r /MS1 U`V�Q REVTENVED BY Rai, GR, AS, NIB, BH( DATE TAX NIAP #_A y N DOCUMENTS Y N PER:�IIT APPLICATION PC -1 WELL PER` IT _ PWS LETTER LETTER N�c-�C 'clo `I DE (15 DATA SHEE CORPORATE RESOLUTION SHORT EAF PLANS - THREE SETS HOUSE PLANS - TWO SETS I VARIANCE REQUEST FEE SUBDIVISION LEGAL. SUBDIVISION SUBDIVISION APPROVAL CHECKED PERC RATE I �� •'' FILL REQUIRED DEPTH CURTAIN DRAIN REQUIRED STANDPIPES GENERAL m / LOCATED N NYC WATERSHED PLANS SUBMITTED TO DEP DELEGATED TO PCHD DEP APPROVAL, IF REQ'D DEEP TEST HOLES OBSERVED PERCS TO BE WITNESSED EX- APPROVAL SSDS ADJ. LOTS WETLANDS (TOWN/DEC PERMIT REQ'D ?) DATA ON DDS PLANS & PERMIT SAME PRE 1969 NEIGHBOR NOTIFICATION LETTER BUZBA 100 YR. FLOOD ELEVATION OTHER REQ'D PERINIIT(S) REOLTRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE GRAVITY FLOW CONSTRUCTION NOTES DESIGN DATA: PERC & DEEP RESULTS 2' COiTOURS. EXISTNG & PROPOSED CONTROL:HOUSE,WELL, SSDS PERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY & EXPANSION LOCATION MAP EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE PIT & D BOX SHOWN & DETAILED - NO.OF BEDROOMS WELLS & SSDS'S WANT 200' OF PROPOSED SYS. PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER -1/4" FT. 4 "0; TYPE.FIPE,:x.,,,. NO BENDS; MAX.BEND .�V�6 Cffj NOUT` .. CLAN BARRIER 10- HORIZONTAL;SLOPE 3:1 TO GRADE FILL tRTliRATION, ECS ,,-s NOTES FILL NOTE UME , N EXPANSION AREA TRENCH LF TRENCH PROVIDED ` 60 FT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED ON PLAN - FROM SSTS 10' TO P.L., DRIVEWAY, LARGE�TRE __gS, TOP OF FILL 20' TO FOUNDATION WALLS `-15'WELL TO PL 100' TO WELL, 200' RN DLOD, 150' PITS 100' TO STREAM WATERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAN, PIPED WATER I O' TO WATER LINE (pits -20') 50' INTERIMITTENT DRAINAGE COURSE ,'RESERVOIR, ETC. _150' GALLEY SYSTEMS 006 to CDS = >5 %,9 4 %,25'- 3 %,30'- 2 %,35' -1 %,100' - <I% to CD discharge /100'with 182 cons day discharge SEPTIC TANK DRIVEWAY & SLOPES, CUT F/_T_� 10' FROM FOUNDATION; 50' TO WELL FOOTING /GUTTER/CURTAN DRAMS wvvu SOIL TYPE BOUNDARIES v-r7 TITLE BLOCK; OWNERS NAME,ADDRESS TSI;- ,PE/RA; NA.IE,ADDRESS,PHONE# DATE OF DRAWNG/REVISION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET PROPOSED FNISH FLOOR AND BASEMENT EL. CONINI ENT S: DIMENSIONS TO PROPERTY LINE LOCATION OF SERVICE CONNECTION D �) � THE CITY OF NEW YORK DEPARTMENT OF ENVIRONMENTAL PROTECTION / o JOEL A. MIELE, SR., P.E. Commissioner Phone (914) 742 - 2001 Fax (914) 742 - 2027 Mr. Robert Morris, P.E. Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: Alonge Subdivision - Lot # 4 Quaker Lane (T) Patterson; © Putnam East Branch Reservoir Basin DEP Project # 9976 ( joint Review) Dear Mr. Morris: William N. Stasiuk, P.E., Ph. D. Deputy Commissioner Bureau of Water Supply, Quality and Protection January 31, 2000 The New York City Department of Environmental Protection ( NYCDEP) has determined that the above Subsurface Sewage Treatment System (SSTS) application is complete. However, the following items must be satisfactorily addressed before NYCDEP can provide a determination: 1. Verify that the proposed driveway's impervious surface will not be within the 100 feet of wetland buffer. 2. Due to an excessive slope to the first drop box, baffles are required. The review of the SSTS project will not start until NYCDEP receives the required information. Should you have any question, please, do not hesitate to call me at 773 -4461. Sincerel Lucie Lo s Associate Project Manager Engineering Design Review xc: James Covey, P.E., NYSDOH 465 Columbus Avenue, Valhalla, New York 10595 -1336 14 -16.4 (2187) -4ext 12 PROJECT I.D. NUMBER 61741 SEAR Appendix C State Environmental Quality Review SHORT .ENVIRONMENTAL ASSESSMENT FORM. For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION Go be completed by Applicant.or Project sponsor) 1. APPLICANT /SPONSOR E:v.ali.tite s :u►r1 2. PROJECT NAME. mss. -�r'J �H � t�wr►.���c.- t.° ��r..�: - $u,r��,� 3. PROJECT PROJECT LOCA ON: Municipality County 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) 1 5. IS PROPOSED ACTION: %New ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: �.,�s�ry�i�'t< rr� �� ,a�t_ �e}..�: �y �e.�+ � �cr�.� i �t• � dt�a�y 7. AMOUNT OF LAND AFFECTED: Initially 7- "1::t acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 9yes ❑ 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)? • ®•Iles ❑ No If yes, list agency(s) and permit/approvals ,• i7c:Jc�oc...r�t' crw: -t- o "'`vw,� a.Q `���<.�-�.•.� 11. DOES•ANY ASPECT OF THE ACTION PAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes No If yes, list agency name and permil/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL.REQUIRE MODIFICATION? ❑ Yes Daflo I. CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: --- ���-+� • '�"� Date: ea ° ° M Signature: If the action is in the Coastal Area, and you are a state agency, complete'the Coastal Assessment Form before; proceeding with this assessment OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by 4gency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 6170 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) 61. 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 likely to be Induced.0y the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified In C1-05? Explain briefly. C7. Other Impacts (including changes In use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (ro 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 detall to show that all relevant adverse Impacts have been identified and adequately addressed. ❑ Check this box if you have Identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a' positive declaration. ❑ Check this box if you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental Impacts AND provide on4ttachments 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: yT�Y�lcc � �G STS Foe g(Z�.,vSsr�..�� Ped . Co2P - Wr represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: 6P i m sTo PJ Having offices at: 5_96 &Jaea:D loo ,4�jb LnANoPRc., M..\/. 1 a Whose Officers Are: President-Name: 'SrrE PN g, 0 -AL 0j-_)&f, Address:. Sg6 r)eo-z> Jec�AD� Vice President -Name: TNern -14s AI-n N) �-g Address: Secretary -Name: Address: Treasurer -Name: Address: and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. to before me this 7 day of ,&_(pontl) 1'9 q (year) , sJt- KC0eEUss �ry Putt. State of NM rods No. 02JA6003334 `Wed in Putnam '4atExpi=March2. �� Corporate Seal BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M&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 TO: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW PROJECT: r'ZiT=0 DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM NOTICE OF COMPLETE APPLICATION: �. SUB'D APP DATE: DATE: t/ 1':k16V ❑ Within the drainage basin of West Branch or Boyds Corner Reservoirs. ❑ Within 500 feet of a reservoir, resery ' ntrol lake. WWithin 200 feet of a watercou or a DE ' wetland a d appearing on a subdivision map approved after December 31, ❑ Design flow greater than 1000 gallons /day. (MEV) — m PUTNAM C(CJN` Y DEPARTMENT, (F HEALTH ��k m : is • ` DIVISION OF EN,VI[RONA/F —ENTAL HEALTH SERVICES f. DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner STLsPKEs.,i�/ ALoi✓6 -� Address wooer ST inAfOAV -' N1 X05 � SrTE R0�.0 A .0 Located at (Street) -�n kv�D Tax Map /.5. Block ( Lot S0.4 (indicate nearest cross street) Municipality Drainage Basin L�i4ST A_V2AM644 SOIL PERCOLATION TEST DATA Date of Pre - soaking —� f q'7 Date of Percolation Test 5 (� qI Hole No. Run No. Time Start - Stop Ela se Time Min.) De. tli to Water t,rom Ground Surface (Inclies) Start Stop Water Level Drop In Inches Percolation Rate MinAnch 2 3 3f59 - Ve, 3/� 4 5 �5 3 p ( GZ t /2 Z-7 /Z_ s 2 rd 7-7 `1 S3.� 3 �:� - �:3 ©. �� 27 142- S. 4 ;. 5 1 2 3 , 4 5 - ---�• • • • W 11vv a cu aL wine uepum unto 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 s submitted for review. ' 2. Depth- measurements to. be made from top of hole. Form DD -97 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 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 �` r DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE N0. I3 HOLE NO. Indicate level at which groundwater is encountered` Indicate level at which mottling is observed _ 1A Indicate level to which water level rises after being encountered Deep hole observations made by: BtjAJ w svnl —V Date S Ifs qr 7 Design Professional Name: Jeffrey J. Contelmo, P.E. Address:Insite Engineering & Surveying, P.C. I Brewster, New York 10509 .Signature: ' Design Professional's Seal OF NE;V �0 O 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 (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 John Watson Insite Engineering & Survey Roufe 22 Brewster NY 10509 Re: Proposed SSTS: Alonge Quaker Lane, Lot 94 (T)Patterson, TM# 15.-1 -50.4 Dear Mr. Watson: February 7, 2000 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. 1) Verify or show that the proposed driveways impervious surface-will not be within 100 feet of the wetland buffer (NYCDEP). 2) Drop boxes are to be proposed in the effluent line every 50 feet. Furthermore, a baffled drop box is to be proposed before the first SSTS J -box. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ve ly yoZ tlw vo Robert Morris, P.E. RM:tn Senior Public Health Engineer 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 (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 January 21, 2000 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, Alonge R.S. (T) Patterson, Lot #4 Reservoir Basin - East Branch Dear: 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, /lug `Shawn Rogan Public Health Technician SR:cj PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM $ +2c ..... yrc+� ' D �w ms's- a�- r•-rc�i Gv�t�� 1. Name and address of applicant: B,2a.ST�� a �EGdP^•«�T Gore!' 2. Name of project: •ic -x.�,c S�bd t,,,g � 3. LocatioreVV: !?�.o -�. r• -,,�, Laf 4' Incite &q neesing, Surveying & Landscape 4. Design Professional: Jeffrey J. Cmtehm, P.E. 5. Address: prchi_er cum, P.C. 6. Drainage Basin: IiL ,-k Route 22 . "1 .,,, e, 22 7. Tyne 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 _iig_ 9. Is a Draft Environmental Impact Statement (DEIS) required? .......................... ^411 10. Has DEIS been completed and found acceptable by Lead Agency? ............... r•(a 11. Name of Lead Agency jam, 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? .............................................:........... ............................... Nvle= 13. If so, have plans been submitted to such authorities? ........ ............................... 14. Has preliminary approval been granted by such authorities ?-n,� Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water L, groundwater 16. If surface water discharge, what is the stream class designation? .................... 17. Waters index number (surface) .......................................... ............................... vim 18. Is project located near a public water supply, system? ....... ............................... 19. If yes, name of water supply ,.�1�.. Distance to water supply�� 20. 'Is project site near a public sewage collection or treatment system? ................ ^CDO 21. Name of sewage system Distance to sewage system 22. Date test holes observed 4G._ i,4 23. Name of Health Inspector 24. Project design flow (gallons per day) ................................. ............................... Qd0 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? ......................... Form PC -97 27. Is any portion of this project located within a designated Town or State wetland? f 28. Wetlands ID Number ........................................................... ..........:.................... r. 29. Is Wetlands Permit required? ........................................ :...................................... 2. 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 DESCRIBE: ^0 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 .......................... ............................... Map -A e, Block_ Lot x&-C>.+ 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 thisform 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 14 3e=' � 22_ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of- ;,,�� -� Located at 4 ��ry L-11--p- e! l` ' --fit w,-, Tax Map # Block t Lot . 4 Subdivision of At5 Subdivision Lot # 4 Filed Map # Date Filed !v - Gentlemen: This letter is to authorize Incite a gineering, awyeying & landscape Architecture, P.C. (Jeffrey J. gontelmo, a duly licensed Professional Engineer x oxAeC==dxAxxbAx1xxxxxto 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. Very truly yours, Countersigned: Signed: P.E., X_A., # 6 19 3 (ow of Property) Mailing Address Incite Engineering, surveying & landscape Architecture, P.C. Rate 22 Preat_-ry New Yerk 19509 State New York Telephone: Zip 10509 (914) 278 -4990 Mailing Address: =,S State Zip too'-4l Telephone: CO22_( _ quo sa Form LA -97 P.E I e /NS /TE LANDSCA PEA RCNITECTREPC.& LETTER OF TRANSMITTAL 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 WE ARE SENDING YOU ❑ Shop Drawings ❑ Copy of Letter Date: I -1? -®0 Job No. 96134.304 Attn: Robert Morris, P.E. Re: SSTS for Alonge —Lot 44 ?""4'�"�° •- Quaker Lane, Town of Patterson TM # 15 -1 -50.4 ® Attached ❑ Under separate cover via ® Prints ❑ Plans ❑ Samples ❑ Change Order ❑ the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION 4� C -1 Construction Drawing 1 W 08/20/99 CP -97 Construction Permit_ 1 � i°�- 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 1 08/20/99 Short EAF 1 9-30-19 — $300.00 Fee 1� `T�o`tGo�o54- �2 „..._. — 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 ❑ As requested ❑ Returned for corrections ❑ Return ❑ For review and comment ❑ REMARKS: COPY T0: It96134_4.doc I copies for distribution corrected prints SIGNED: 2L2� JeIrply J. ntelm , 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 Well Location Street Address: Quaker Road Town/Village: Patterson Tax Grid # Map Block Lot(sP4 Well Owner: Name: Address: Prestige Homes:P:Q: Box 407 Brewster, NY 10509 Use of Well: 1- primary XXXX 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 � Bentonite Other Drive shoe: X Yes No Liner: Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped X Compressed Air Hours 6 Yield 30 gpm Depth Data Measure from land surface- static specify ft) 4Q During yield test(ft) 380 Depth of completed well in feet 405 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 1 Sand Cl a 1 .405. Granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type M 2 rapacity :7 a4 Depths odeljj� _o4SLoLl Voltage 230 UP .3jq ._........._...__.... . Tank Type W125 i Volume CZ c 380 30 . Date Well Completed .8/29/03 Putnam County Certification No. 02. Date of Report .9/.3/03 Well Drill s' ature) NOTE: Exact location of well with distances to at least two permanent landmarks to be» vided on a separate sheet/plan. Well Driller'sN +i. l7rijling, Ltic, Address: 75 Putnam Avenue - Brewster, NY Signature: '� Date: ���► �D 3 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97