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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 22.12 -1 -9 BOX 7 oil gr is +� ti In YAW, I so I ir h 1 00534 TNAM COUNTY DEPARTMENT OF HEALTH ION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located a l y 1� ' fa�✓�f !� /�/�-� Town r Village Owner /Applicant Name )!5 % t-L /h 64,15 Tax Map 122, Formerly Mailing Address 12 AIA mJ Ll Date Construction Permit Issued by PCHD _,; -- /, Subdivision Name Subd. Lot # Block % Lot 1 Zip �o7 Separate Sewerage S, sy tem built by r Address C S A " Consisting of IX50 Gallon Septic Tank and 10!6_0 644-L-onJ Other Requirements: Z A- .- d Water Supply: Public Supply From" or: ✓ Private Supply Drilled by Address Address ✓-� �c/ -ems- il/. �,! Building Type / _)1 e�� G-f Has erosion control been completed? -e S Number of Bedrooms Has garbage grinder been installed? 41.0 I certify that the system(s), as listed, serving the above premises were ()f NEW ly as shown on the as- built plans (copies of which are attached), in accordance with the iss s �` Permit and approved plans and the standards, rules and regulations of the Putnam Coun a i He ffi. m �� Date: f✓ Certified by d a G E. / R.A. (Design Prgfessional) bo 0591 3 Address -7/ �`Z.v�/t"� ✓- ��5'Te,�.� �' V,AA' %O 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 subject to modification or change when, in the judgment of the Public Health Director, such M. White copy - HD or change is necessary. Title: copy - Building Inspector; F n Date: copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: 48 LWingtonville Road Town/Village: Patterson Tax Grid # Map Block Lot(s) Well Owner: Name: WiLLiam Hillis Address: 39 Lime Ri e Road – EWjguag, NY Use of Well: 1- primary XXX 2- secondary X Residential Business Industrial Public Supply Air cond/heat pump Irrigation Farm Test/monitoring Other(specify) 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 ft. Length below grade 60 ft. Diameter 6 in. Weight per foot 17 lb /ft. Materials: _X_ Steel _ Plastic _ Other Joints: _ Welded X Threaded _ Other Seal: _ Cement grout y 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 _fj Yield s_ gpm Depth Data Measure from land surface- static (specify ft) 3 During yield test(ft) 700 Depth of completed well in feet 945 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 sand cobbles 20 25 weathered ledge 25 945 gneiss w uartz seams If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type 81j=siblL apacity s Depth 400 Model 5GS10412 Voltage 230 HP 1 Tank Type by others Volume Date Well Completed 3/2W06 1 Putnam County Certification No. 02 Date of Report 5 806 Well Dri r (signature) NOTE: Exact location of well with distances to at least two permanent landmarks to be prob eTon a separate sheet/plan. Well Driller's Name PKll DrilLing, Inc. Address: 75 Putnam Ave.. Brewster, NY Signature: Date: May 8, 2006 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 SAUCE R FOLEY A Ntc fika h Df vaw .- wW. i 0-4�e rue i oo t-. eiti et LORET'Y'A MOLiNA U R N., MSN. Amdate PuWk HeaM Diraw r D6VUw 4V Pditff saws s DEPARTMENT OF HEALTH I Clown Road . 18Mw5w, Now Yott 10509 Eavbmmld He dM 0914)M-6130 IFU (4.14) 278-Ml Sim vim k914) 2I$ - 6SSi WIC DIs? 27i - 667= Fog (9N) 273 -6066 X" latar+wdit (014)278-6014 • (414)27x4= fa(914)272- O'C NXRS NAME: TAX MAP NUMBER E911 ADDRESS: TOWN-. iffril�sd� AUTHORIM TOWN 0MCAL: is wn) DATE. The Putnam County Departmeut of Health will not issue a Certificate of Construction Compliance unless the above form is completed, %e., a legal E911 address is assiped by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (fi4I IVMMJVQ TOTAL P.02 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES G NTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM l Owner or Pur baser of Building Tax p Block Lot l Building Constructed by Location - Street Building Type TownNillage Subdivisions /Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where. the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month `� D wear 2 Signature: C� Title: C) r ysv t2 General Contractoy Owner) - Signature Corporation Name (if corporation) Address: Corporation Name (if corporation) Address: State Zip State Zip Form GS -97 Page 1 of 1 %MS Environmental Services, Inc. ��k 41 Kenosia Avenue V V A7FA. SOii AND .4!A ANALYS.IS Danbury. ConnectirutO6810 I Telophone 203 -798 -2229 Mailing Information: Name: Hillis Address: 48 Ludingtonville City: Patterson State: NY Phone: (914) 490 -8005 Sample's Information: Site: Bathroom Tap Preservative: HNO3 Temperature: <4 Matrix: Water Zip: 12563 Fax: (845) 227 -2360 Hillis Collector's Information: JMS ID: 007381 Name: William Hillis Address of site: 48 Ludingtonville Road City: Patterson State: NY Phone: Date Collected: 10/30/2006 Time Collected: 12:00:00 PM After Filter Zip: 12563 Date Received: 10/30/2006 Time Received: 3:10:00 PM Lab No.: J0610317 Date Analyzed Test Name' Result MCL Method 10131/06 Iron <0.05 ppm N/A SM 3111 B 10r30106 Color ND 15 Units SMWW 2120 B 10/30/06 Turbidity 0.5 ntu 5 ntu SMW W 2130 B MCL = Madmum Contaminant level NIA = Not Applicable ND = None Detected ntu = Napbelopmetric Tutrbkifty Unit ppm = parts per million Units m Units Signature: - Reviewed By:+t%� Michael Lapman Sharon Houlahan, Director President State #: PH -0218 ELAP M. 11715 1. litJ6_ TI.: lli .FdEt`;'i }1= :F'f.r!Ji!!eL.`.= :F�'TIFIV1, Toll Free 866 -JMS -5097 I Corporate Fax 203- 796 -2408 1 tab Fax 203- 798 -2107 1 www.jIMenvQOnniental.aorn Page 1 of 1 %MS Environmental Services, Inc. Ilk 41 KenosiaAvenue 46 IVA7FA. Ori AND AM ANALMS Danbury. Connecticut 05£10 1 Telephone 203 -798 -2229 Mailing Information: Name: Hillis Address: 48 Ludingtonville City: Patterson State: NY Phone: (914) 490 -8005 Sample's Information: Site: Other Preservative: HNO3 Temperature: <4 Matrbr- Water Zip: 12563 Fax: (845) 227 -2360 Hillis Collector's Information: JMS ID: 007236 Name: William Hillis Address of site: 48 Ludingtonville Road City: Patterson State: NY Phone: Date Collected: 10/26/2006 Time Collected: 10:00:00 AM After Fi ter Zip: 12563 Date Received: 10/26/2006 Time Received: 11:40:00 AM Lab No.: J0610120 Date Analyzed Test Name Result MCL Method 1027106 Manganese <0.05 ppm 0.3 ppm SM 3111 B 1027106 Sodium 33 ppm N/A SM 3111 B 1026106 pH 6.89 S.U. 6.5 -8.5 S.U. SM 4500 H B 10126/06 Color *29 Units 15 Units SMWW 2120 B 1026106 Turbidity 4.8 ntu 5 ntu SMWW 2130 B 1026106 Odor NO 3 TON SMWW 2150 B 1027106 Hardness NO N/A SMWW 2340 C 10127106 Iron *0.4 ppm 0.3 ppm SMWW 3111B 1027106 Chloride 3.63 mg /L 250 mg/L SMWW 4110 B 1027/06 Nitrate <0.1 mg/L 10 mg/L SMWW 4110 B 1027/06 Nitrite <0.05 mg /L 1 mg /L SMWW 4110 B 1027106 Sulfate 19.3 mg/L 250 mg /L SMWW 4110 B Comments: *ABOVE MCL MCL = Maximum Contaminant Level mg/L = milligrams per Liter N/A - Not Applicable ND = None Detected ntu = Nephelopmetric Turbidity Unit ppm = parts per mllllon S.U. - Standard Unit TON = Threshold Odor Number Units = Units I n f signature: �� _ Reviewed By: ' `•�- i'•. {�:�,`•. Michael Lapman Sharon Houlahan, Director President State #: PH -0218 ELAP M 11715 :tlll6i'Tl,U!,1,I6'.`I'.'FM: •!IlihiE! :42� "!IIGD Toll Free 866 -WS -5047 I Corporate Fax 203 -798 -2408 1 Lab Fax 203 -798 -2107 I www.jrnsen*onrrent3Lccrn U •-mil �i�i� Page 1 of 1 ° JMSEnwronaaataJ fenlees, loe. AL 4, KorwsiaAvenLw WATER, SOIL AND AIA ANALYSIS Danbury. Connecticut Oeato I Tek Lone 203 - 708 -2229 Mailing Information: Name: Mill Drilling Co Address: 75 Putnam Avenue City: Brewster State: NY Phone: (845) 279 -5041 Sample's Information: Site: Tank Hose bib Preservative: HNO' Temperature: <4 Matrix: Water Mill Drilling Co Collectors Information: JMS ID: 013757 Name: Bob Mill Address of site: 48 Ludingtonville Road William Hillis City: Zip: 10509 State: Fax: (845) 279 -5075 Phone: Date Collected: 4272006 Time Collected: 3:00:00 PM Patterson NY Zip: Date Received: 4/272006 Time Received: 4:10:00 PM Lab No.: J0603899 Date Analyzed Test Name Result MCL Method 05/01/06 Alkalinity 60 mg/L N/A SMWW 2320 B 0428/06 Lead (first draw) <1 ug /L 15 ug/L SMWW 3113 B 0428/06 Manganese 0.129 mg/L 0.3 mg/L SM 3111 B 04/28/06 Sodium <1 mg /L N/A SM 3111 B 0427/06 pH 6.69 S.U. 6.5 -8.5 S.U. SM 4500 H B 0427/06 Color 10 Units 15 Units SMWW 2120 B 0427/06 Turbidity 3.58 ntu 5 ntu SMWW 2130 B 0428/06 Hardness 68 mg /L N/A SMWW 2340 C 0427/06 Odor ND N/A SMWW 2340 C 04128/06 Iron '0.341 ppm 0.3 ppm SMWW 3111B 0428/06 Chloride 3.85 mg/L 250 mg/L SMWW 4110 B 0428/06 Nitrate 0.167 mg /L 10 mg/L SMWW 4110 B 0428/06 Nitrite <0.1 mg/L 1 mg/L SMWW 4110 B 0428/06 Sulfate 21 mg /L 250 mg/L SMWW 4110 B 0427/06 Chlorine Free Residual <01 mg /L N/A SMWW 4500CIG 04/27/06 4:30 PM Total Coliform Absent Absent SMWW 9223 B Comments: *ABOVE MCL At the time of the analysis the sample was Acceptable for Total Coliform CFU = Coliform Forming Units MCL = Maximum Contaminant Level mg/L = milligrams per Liter N/A = Not Applicable ND = None Detected ntu = Nephelopmetric Turbidity Unit ppm = parts per million S.U. = Standard Unit ug/L = micrograms per liter Units = Units Signature: Aize4 Reviewed By: AAAA� i Michael Lapman Sharon Houlahan, Director President State #: PH -0218 ELAP M 11715 CONNECTICUT. NEW YORK AND NELAC CERTIFIED TW Fmo Dee -AG -500 1 Commets Fax 203 - 796 -24M 1 Lab Fax 203- 790-2107 1 www.jr�er�rirormrtaLoorn P.W. SCOTT ENGINEERING & ARCHITECTURE, P.C. 3871 Route 6 Brewster, NY 10509 E -Mail: �ewsc®tt @Pcn.com (845) 278 -211 FAX (845) 278 -2166 TO LLIEUTEn OLI M%L1VMO LJ uIr DATE Dv / JOB NO. ATTENTION gy RE: WE ARE SENDING YOU /Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints Plans ❑ Samples ❑ Specifications .21-1copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION Y 16e- 4 -e �. zl ! ' Lam. ..- Co THESE ARE TRANSMITTED as checked below: For approval ❑ For your use ❑ As requested REMARKS COPY TO LW. ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ For review and comment ❑ ❑ FOR BIDS DUE • Resubmit copies for approval • Submit copies for distribution ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: /f enclosures are not as noted, kindly notify us at once. BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET — NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by ROBERT O'MALLEY 104 RT 292 HOLMES, NY 12531, Located at 48 LUDINGTONVILLE RD. PATTERSON, NY 12563 Application Number: 3007193 Section: 22 Block: 9 Lot: 1 WILLIAM HILLIS 48 LUDINGTONVILLE RD. PATTERSON, NY 12563 Certificate Number: Building Permit: 4121 3007193 BDC: W104 Described as a occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in /on the premises at: Basement, Outside, A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed herein, was conducted in accordance with the requirements of the applicable code and /or standard promulgated by the State of New York, Department of State Code Enforcement and Administration, or other authority having jurisdiction, and found to be in compliance therewith on the 12th Day of September, 2006. Name OTY Rate Rating Circuit Type Miscellaneous 1237-06 Alarm,, nd Emergency Equipment Panel Board 1 0 SEPTIC Alarm Appliances and Accessories Pump Motor 1 0 SEPTIC F.H.P. Wiring and Devices Receptacle 1 0 20 A Special An as built inspection, of the delineated electrical installation, determined that an obvious hazard is not present and the installation is believed to be in comformance with the applicable reference standard for the estimated period of construction of the premises wiring system. s":;a/ 1 of 1 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health September 14, 2006 P.W. Scott Engineering 3871 Route 6 Brewster, NY 10509 Dear Mr. Scott: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Field Inspection — Hillis 50 Ludingtonville Rd. (T) Patterson, TM # 22.12 -1 -9 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health 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. 2251 JD:kly Sincerely, i r Joseph Digit 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Street Location Town EW Tr TM # % — 1. Sewage Svstem Area a. STS area located as per approved plans .......... .. ................ b.. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped ................. d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... H. Sewage System a. Septic tank size - 1,000 ...:.....1, 250 ........other ................ b. 'S eptic' tank installed level ............................................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ...............: . 2. Protected below frost .................. ............................... 3... Minimum 2 ft. Original soil between box & trenches e. Junction Bog - properly set .......... ............................... 6. T renc es� 1. Length required Length installed 2. Distance to watercourse measured+ i oo Ft.... .. 3. Installed according to plan ...................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 IT foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 11/2" diameter clean ...................: 9. Depth of gravel in trench 12" minimum................... 10. Pipe ends capped ........................ ............................... g. Puma or Dosed Systems jZo Get 1. Size of pump chamber ..................... .. ................ 2. Overflow t ........................... ............................... 3. Alarm, visu audio .......:........:.. ............................... 4. Pump easily a entMe, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Buildin a. House located per approved plans ............. . ...:.......... b. Number of bedrooms .................... ............................... IV.. Well Well located as per approved plans .......:................, .... b. Distance from STS area measured v�"O ft........... c. Casing 18" above grade ................ ............. ................... d. Surface drainage around well . acceptable ....................... V. Overall Workmanshia . a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto exist watercour g. Footing drains discharge away from STS area ............. h. Surface water protection adequate ........................... ... i. Erosion control provided ...... ............................... .. Rev. 12/02 Date: / / --// Inspected by: Owner &11111-4-1Y Permit # F-0/— O Subdivision Lot # I3 -0 4W A.� A mum WAM %M WOM MMI =M E%= WE IMAM e =� I3 -0 4W SITE INSPECTION FOR FILL PAD Date: Inspected by: Fill pad located per the approved plan Fill Pad Length Fill Pad Width . Required Length Required Width Fill Pad Depth Required Depth Run -of -Bank Fill Quality /�°�'R�s 04 Slope from Top to Toe Impervious Layer Installed >115S Erosion Control Installed YES Sieve Test Results (if applicable) Additional Comments: Reserved for Field Sketch if Applicable s PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION Or! ENVIRONMENTAL I1EATLH SERVICES FIELD ACTIVITY REPORT A�r�s�: _. �. U•D1��r /C�.�l t/�L� = � f�I 7"7'�l�.Sa�d _Street Town State Zip PERSON IN CHARGE QR INTETzymWFT): TlatP: PUMP TEST 0. DOSE TEST Ins ' ?`APJ L iv �D REQUIRED GALLONS L� 9, 3� I acknowledge receipt of this report: SIGNATURE: 02/96 Title; 00 0 �.om I T� • J 9, 3� I acknowledge receipt of this report: SIGNATURE: 02/96 Title; JUL -26 -2006 22:07 P.W. SCOTT 8452782166 P.01i01 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENIRONVIENTAL HEALTH SERVICES ,cu 12 $QUEST FOKEINAL INSPECTION For: Fill_ Trenches 4� - PCHD Construction permit Located OVA0 S 7'4(J V1",'4,-' APA V (1) (V) /'A j f eASoAi Owner /Applicant Name Ct/�i u- /�4 -f "1 / L�-ryCS ' TN[ Block _/Lo ; Formerly Subdivision Name .--- -� Subdivision Lot Is system fill completed? Date Is system complete ?- $ - Date o Is system constructed gec ris? as p�a , Is well drilled? - - yam Date o Is well located as per plans , -. Are erosion control =measures,in:piace ?' „ I certify that the systems), as listed, at the above, premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. Date: Z5 , Gert fied'by: PE VRA Design Professional S 21 Ad dress_ _ i e� � �/ Lie. # Comments: A Ae-e e) %/7�� % 11-7 H1.? - 77"C FOR: ❑ ADAM GENE Form FIR -99 _ TEL: X345 -27 '- 7921'" NAME :PUTNAM COUNTY DEPARTMENT OF P. 1 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health PW Scott Engineering 3871 Route 6 Brewster, NY 10509 Dear Mr. Scott: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Field Inspection — Hillis Ludingtonville Rd. (T) Patterson, T.M. # 22.12 -1 -9 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health July 28, 2006 The above referenced separate sewage treatment system can be backfilled. The following comments need to be addressed. 1. A pump test needs to be witnessed by this Department once the electrical inspection has been completed and notification of such has been submitted to this Department. 2. The swale above the SSTS needs to be completed per the approved plans. 3. Erosion control measures need to be fixed up and maintained. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. GDR:kly Sincerely, a4� 6 Gene D. Reed Senior Environmental 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 InterventiontPreschool(845)278 -6014 Fax(845)278 -6648 I acknowledge receipt.of this report r SIGNATURE; 02%96 Title;_ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address Zoj>)"7-o1jyzz_z_,g Rqxr.) Located at (Street) Tax Map 22,jOlock Lot (indicate nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA Date of Pre-soaking s 2 46 Date of Percolation Test 6 Hate No Run 0 ":j Tea x 40: .. . . ..... . se T-: Time xx ui X: rt' Stogy 3. 7 lei /V 3,3 3 z03— a:16 4 11 3 6, 5 a 6, 7 1 V22 -3 7 la, 3 2 ;L 91 - -30 /7-/ 3 :x'3:30 4 30 ;2./ 2. yy 5 2 3 4 5. NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 91,// // 2. Depth measurements to be made from top of hole. Form DD-97 TEST. PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO: HOLE NO. HOLE NO. G.L. 0.5' 1.0' 2.0' 2.5' 3.0' 3.5 S 4.0' w. 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5'0 r 8.0' 9.0' 9.5' 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Date Design Professional Name: Address: Signature:. . Design Professional's Seal MACS- 29- 2006 at F. W. SCOTT 8452782166 P. 06106 SHEkITA AMLER, MID, MS, FAAP o.. ROBERT J. BONDI Commissioner Of Health County Executive LORETTA MOLINARI, RN, MSN W Associate Commissioner of Health DEPARTMENT OF HEALTH I Geneva Road, Brewstar, Now York 10509 REQUEST FOR ULD TESTING All information below must be ful completed prior to any scheduling. DATE: ENGINEERING FIRM: ul ��Of PHONE PERSON TO CONTACT: ,KNEE' CONSTRUCTION U REPAIR PROGRAM O ADDITION PROGRAM REASON: DEEPS: PERCS:1 PUMP TEST: 0 ROAD /STREET'': _... �i� U c�,► , ti V i LA,L TOWN: �_:�f�"�2 ✓�0►�/ TAX MAP #: ��- • j� � / SUBDIVISION: LOT. #: OWNER: :' GL, t Li.• f NYCDEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING. YES NO ❑ !Proposed SSTS within the drainage basin of West Branch or Royds Corner & Croton palls Reservoirs. ❑ Proposed SSTS within 500, feet of a reservoir, reservoir stem or control lake. ❑ 0" Proposed SSTS within 200 feet of a watercourse or a DEC wetland. 11 6 Proposed SSTS design flow greater than 1000 gallons/day or SPDES Permit required. ❑ Proposed SSTS for a Commercial Project. It is the responsibility of the design professional to provide the above information prior to soil testing. The Department will determine the NYCDEP project status (Joint or Delegated) based on the response: If you 'answeredyes to any of the questions, NYCDEP must'witness the soil tests. This Department will coordinate a mutually suitable time for field testing with the Design Professional and NY'IDCEP. If a project has been determined to be Delegated based on the above response and then subsequent Information indicates NYCDEP is required to witness the soil tests, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. FOR DAT F': q CoDgM S.. >ay. poi a>e> a resr . Kr Y Euvlrpnmeutal Health (845) 278134 Fax(845)279-792t.' ax (845) 278 -7921; Water Supply Section (845) 225 -Sins Fax (845) 22S -5418 Nursing Servlces (845) 27&6558 Fax(943)278-6026 WIC(845)27W78 Nursing Home Care Fax (84S) 278 -6085 Early.intecveatidn /Preschool (845).278.6014 Fa(845) 2784648 TnT01 D Mr MA2 -�� -21 i1:!1 • i. 1 : l t• -I TEL : 845 -278 -7921 MAMF : PI ITW0M ��I II KITY r1rPn0TMChJT M7 0 a o ........... X. ` sy �� 292 T S (� x'SoLakeon ' eat -- - -- - i A i 190 z - - .� o,-N0p Brbwns Pond W p i QP N Lake A 2531 . .. . . . ......... i o 311. �. S. ES -JAY i� •,` 1 +i 9p W FS ® O L z j C @R7 i 52 84 SurTeaN IN r Yn1EPS �� `,,� ao 0 h N. LUCI fi KNOLLCRE3T� RD f O% 0 0 0 ,ncHl a; AM �1 /..r PaMpNK D �rn 43 t j 3 HURS SCH e 3D Qe` z, z RE RE ` p = EPGq pY 0 �° p .,.Qv'✓"F t� ,O O ON 0 cc S Town CT z Rill ti X .# "qo p NRREn o s .A Cifi�, ° Q1f FsL. a e Carmel i WAY ; i O 5MftP3 AXIkit711 —i Pik SDR40- / ' � .= "f •ice '- _ -- -• - 1 1/24 PVC SDR40 ID n, 3y..__...... - , OR 4 FE iLep ru i a ._ 0 nj ,-R6 r1 _ a�ecwor ee�e 770 D D _ �,, _.._. Al OW GEC: PUMP z0 0 0 s IC TANK - 0 0 0 °m 1.2'/ FT(1 /4'/PT. MIN.). --- - _ u GARAGE — °- --- — �`-—T ID 3 Eft E1Fl_ x --_ - - .7e4.50 co —i' ry m PROPOSED RESIDENCE � BEDROOM - _ N o FF= 7.0 -- 6'0 BF =75858.8 MAR-29-2006 4�1 P. W. SCOTT F.W. Scott � IN Brewster, NY 10509 P.C. 8452782166 P.01/06 email: pwscott(gsuscom.net TELEPHONE! ,($45 .)278-2110 FAX: (845) 278-2166 Fax Transmittal PROJECT: To: j F-;,(jdZ/A)-SA—/ To: Fax: 7 Fax-, To: 170. atx: Fax: NO OF PAGES 1N CL. TRANSMITTAL FROM: COMMENTS. ME ge 7 c6ZTI�� DATE: -3- . 1p�A I S. Z 4S A OfC, Ali G 11 1 T F , C T U R E E N G I N E E R I N G - S I T E P L A N N I N G "7GRETARYtApjAC;3'4.-,!n Dato\MiCroset\Teiiipl,.)tes!LE'TTr:;PI--IEA.D FAX.dot --� -70114 KIC)ME7 • P1 ITKIC)111 rni IWTv n1=PAPTMFNT OF P. I MAR-29-2006 P.W. SCOTT 8452782166 P.03/06 PUTNI A14 COUNTY DEPARTIVIENT OF HEALTH Dl-VTSYON OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner �:. -$' �,.��: -Address _ 7 L S' �.� �-� �' -17�Uyo Located at (Street) i i .�7�t; ��i ti� ��,� �(.. �/_� Tax Map? Block _Lot -- {{ (indicate nearest cross street) Municipality C i . � �- L� Drainage Basin _ _ `� PERCOLATION TEST DATA Date of.Pre- soaking _ (•��y��a (r ����� _ Date of Percolation Test NOTES. 1. Tests to be repeated at same deptn until approximately equal percolation rates are ootainee at each percolation test hole. (i.e. s 1 min for 1 -30 miniinch, s ' min for 31 -60 min/inch) All data to be submirtcd for review. Depth measurements to be made from top of hole. Form 00 -97 - - - - -rte, .-. .r r.�n - >n ^,.t {, lf1MC. GI ITAIl11A i�rl IAIT'.l 1'tCpFOTMChIT I'7C LJ � De th to Water Water > rom Ground Level- - Percolation No. Time Elappse Time Surface (Inches) Start Stop, Drvp In Ypches .Rate v1in7inch Hole Run No. Start - Stop (I�1:in.) S 2 la:�j if ;� ` �c� (�j '�� •1 -�� j<`t`� �! � r ! + . 1 t i` • .., NOTES. 1. Tests to be repeated at same deptn until approximately equal percolation rates are ootainee at each percolation test hole. (i.e. s 1 min for 1 -30 miniinch, s ' min for 31 -60 min/inch) All data to be submirtcd for review. Depth measurements to be made from top of hole. Form 00 -97 - - - - -rte, .-. .r r.�n - >n ^,.t {, lf1MC. GI ITAIl11A i�rl IAIT'.l 1'tCpFOTMChIT I'7C LJ � MAR -29- 2006 i i DEPTH r� G.L. J` P.W. SCOTT 8452782166 P.02 /06 DESCRIPTION OF SOILS ENCOUNTERED IN TEST MOLES 0.5' 1.0'. 2,0'. 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' ED 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' HOLE NO. 2 A HOLE NO.;�, I OXA-jap- &4c&,W HOLE NO. , 2C 0 --64 jopfo(L It u y Indicate level at which groundwater is encountered" Indicate level at which mottling is observed 5tr c- Indicate level to which water level rises after being encountered Deep hole observations made by: Al� S (wc� o mate � Design Professional Name: Address, Signature W� Design professional's Seal tiq 11 MAR -29 -=-306 r F.W. SCOTT 8452782166 P.05/06 11L' rax it IVIEN T OF HEALTH DIVISION OF ENVIRONMEN'T'AL HEALTH SERVICES DESIGN DATA SHEET � SUBSURFACE SEWAGE. TREATMENT SYSTFM Owner ! 1-t > t.'Z' 1 . —Address– L Ld 1 r WVJ" Kd A Located at (Street) MA{IJ '1", �(I tr' I 2- Tax Map V. Block �(� Lot (indicate nearest cross street) Municipality f y-� Drainage Basin t�"AS'r 14- . XgL/ �SOIL PERCOLATION TEST DATA Date of Presoaking ° 496. Date of Percolation Test °j9" Depth to Water ]From Ground Water Level Percolation Time Hole No. Run No. Start - Stop Ela se Time Surface (Inches) Min.} Start Stop Drop In Inches Rate Minanch 22 ,557 32 y3 Z5 /?l ' y - -- 4 o .30 13 i �5' /4- 1 l r 4 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1. min for I -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review, 2. . Depth measurements to be made from top of hole. Form DD -97 — .-AC NAME:PUTNAM COUNTY DEPARTMENT OF P. 5 MAR -29 -2006 a P. W. SCOTT 8452782166 P.04/06 it.)i r L t i AIA DESCRIPTION OF SOILS ENCOUNTERED tai TEST HOLES DEPTH G.L. 1.0' 2.0' 2.51 3.0' 4.0' 4.5' 5.0' 53 6.0' 6.5' 7.0' 7.5' 8.01 8.51 9.0' 9.5' 10.0' HOLE NO. J CL- -ZK -e ,y A- tA,4,e c i s HOLE NO: f��• 0y& HOU NO. Indicate level at which groundwater is encountered indicate level at which mottling is observed Indicate level to which water, level rises after being encountered /- Jo "1 _ Deep hole observations made bv: ,cif`~ / /�Li is Date 3 04, Design Professional Na Address: ----r- Si¢ nature; .- -- -4dl -- Design Professionals Seal .vi IkITII MrOnOTMCKIT nI R 4 . � __ JL4 ZIP NO T. III T 101 j PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES STRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # -`0 Located at 4dl-linJ TZ)aJ J; LSE P-Ae - To r Village PA-M--C& Subdivision name Subd. Lot # Tax Map ?. 1Z Block Lot _ Date Subdivision Approved Renewal Revision Owner /Applicant Name WiLA -i fMn 44 i c.V1s Date of Previous Approval Mailing Address l;L motm M° 57)ee 7 -, Sq q % (3 n.f -'rte: /�Y Zip /05-10 C7 Amount of Fee Enclosed f Soo, ov Building Type Lot Areal No. of Bedrooms -L Design Flow GPD goo Fill Section Only Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of ) 5z gallon septic tank and 1,;t5'0 � pti n�p �cf �'r� c"lZ ) �5�0 t? -c,t h! v�,t., --Xllc e� �I J,6- Other Requirements: J9 ©r- 1Ci LL To be constructed by M-6 Ip Address Water Supply: Public Supply From Address or: —Yj Private Supply Drilled by %,1� 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 treatments sY tem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately followwi late of the issuance of the approval of the Certificate of Construction Compliance of the original system or any rep irs a to. Signed: Address vim- CP 49, P.E. R.A. Date /Z '.,� 3 -0-3 AJj /D�b� License # O _73& 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 onsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe t. proved ischarge of omestic sanitary sewage only. B • Title• (- PA— Date: l D White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP4 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: o illage Tax Grid # LUDJJV&TbaJ✓ILLW- P_!) FZ e-4SoN Map22.12 Block I Lot(s) 9 Well Owner: Name: t31L-1- 1t (bL15 Address: .Z H�,a� �►; sue, l-� 13L, 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 Est. of Daily Usage _gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason 4V C[✓ for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision 6[(lll.Cyl? -, WT" 'I LFl Lot No. Water Well Contractor: 'zzp Address: Is Public Water Supply available to site? .................................. ............................... Yes No JO Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination t pro ' on separate sheet/plan. Date: zz 'O-f 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 wate ll driller certified by Putnam County. , Date of Issue /0-L/ Permit Iss ' Official: PAZ 4 414, Date of Expiration 3 8 Title: Permit is Non -Trans aria e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health PW Scott Engineering 3871 Route 6 Brewster, NY 10509 Dear Mr. Scott: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 June 14, 2005 Re: Proposed SSTS: Hillis Ludingtonville Road (T.) Patterson, TM # 22.12 -1 -9 ROBERT J. BONDI County Executive 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. A clay barrier two feet wide and at a depth one foot below the footing drain is to be proposed between the SSTS and the house. The clay barrier is to be shown in the plan and profile views. 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 test must be witnessed by a representative of this Department. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:kly Ve ly yours Robert Morris, P.E. Senior Public Health Engineer Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 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 00 P.W. SCOTT ENGINEERING & ARCHITECTURE, P.C. 3871 Route 6 Brewster, NY 10509 E -Mail: pwscoit @rcn-com (845) 278 -2110 FAX (845) 278 -2166 TO a WE ARE SENDING YOU x Attached ❑ Under separate cover via _ • Shop drawings ❑ Prints ❑ Plans • Copy of letter ❑ Change order ❑ �L DATE �.r e •tr JOB NO. ATTENTION RE: / lS IL the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION THESE ARE TRANSMITTED as checked below: ❑ For approval • For your use • As requested • For review and comment • FORBIDS DUE REMARKS COPY TO IJ • Approved as submitted • Approved as noted ❑ Returned for corrections • Resubmit copies for approval • Submit copies for distribution • Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: if enclosures are not as noted, kindly notify us at once. P.W. SCOTT ENGINEERING & ARCHITECTURE, P.C. 3871 Route 6 Brewster, NY 10509 E -Mail: pwscott@rcn.com (845) 278 -2110 FAX (845) 278 -2166 TO WE ARE SENDING YOU )I Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ ILC44IEn O1P ❑ Samples COPIES DATE NO. DESCRIPTION THESE ARE TRANSMITTED as checked below: • For approval • For your use ❑ As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS COPY TO • Approved as submitted • Approved as noted ❑ Returned for corrections the following items: ❑ Specifications • Resubmit copies for approval • Submit copies for distribution • Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US d fed sE� —�-0 '��—= i � � SIGNED: If enclosures are not as noted, kindly notify us at once. r i MAY -26 -2005 02:32 P.W. SCOTT 8452782166 P.01iO3 r Pow. Scott email: pwscottAsuscom.ne t 'Engineering & Architecture, P.C. 3871 Route 6 - -- TELEPHONE: 5845) 278 -2110 Drewster, NY 10509 FAX: 84S 278.2166 Fix Tra.m. PROJECT: _ �S NO OF PAGES ZINC TRANSMITTAL FROM: l.c' COMMENTS; DATE: I i r%f PMWA p Am. ARC HIT .E.CT.UR'E"ENGI NEE RiNG*'S :ITE PLANNING .-.� .ter. -ar T r _ r .n -rr� . r� nr n-�n -�nne �. inner . ni ITA II�M r^r�l Ik ITV I'1cOf1DTMCLIT flC D 1 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health PW. Scott Engineering 3871 Route 6 Brewster, NY 10509 Dear Mr. Scott: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 May 26, 2005 Re: Proposed SSTS: Hillis Ludingtonville Road (T) Patterson, TM # 22.12 -1 -9 ROBERT J. BONDI County Executive 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: NYS Department of Health Guidelines state that house footing drains must be a minimum of 100 feet from an SSTS if the SSTS is proposed upgrade and the seasonal high groundwater is above the footing drains. Deep test holes data indicated that groundwater is at 50 inches, therefore, all drains for the foundation must be proposed at an elevation less than 50 inches below the natural grade. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:kly V ly yo , /tom Robert Morris, P.E. Senior Public Health Engineer Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 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 P.W. SCOTT ENGINEERING & ARCHITECTURE, P.C. 3871 Route 6 Brewster, NY 10509 E- iVlail: pwscott @rcn.com (845) 278 -211® 1=AX (845) 278 -2166 TO WE ARE SENDING YOU A Attached ❑ Under separate cover via _ ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ DATE 6 . / � �s e JOB NO. ATTENTION c>/-S e_`/ ® � RE: f u. 'S / A?_ the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION A?_ - 4- THESE ARE TRANSMITTED as checked below: /1 ` For approval ❑For your use ❑ As requested ❑ For review and comment ❑ FOR BIDS DUE REMARKS COPY TO • Approved as submitted • Approved as noted • Returned for corrections • Resubmit copies for approval • Submit copies for distribution • Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: If enclosures are not as noted, kindly notify us at once. P.lfbl. SCOTT . ENGINEERING .& ARCHITECTURE, P.C. 3871 Route 6 Brewster, NY 10509 E -Mail: pv4scott@rcn.com (845) 278 -2110 FAX (845) 278 -2166 TO WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ dCE44IFEQ OIL 4 ° a�G�]A 044Qd DATE JOB NO. ATTENTION RE: �^ f 1 ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION f 1 9 ��.OAJ S7` -cuc 1 a A-f /,Z-, 6' J`71- 74 ate. se y `.THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ For your use ❑ As requested ❑ For review and comment . ❑ FORBIDS DUE y REMARKS ' • Approve&as- submitted ❑ Resubmit • Approved as noted ❑ Submit _ • Returned for corrections ❑ Return _ _copies for approval copies for distribution corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO SIGNED: ff enclosures are not as noted, kindly notify us at once. r_ P.W. Scott email: pwscott@suscom.net r Engineering & Architecture, P.C. 3871 Route 6 (845) 278 -2110 Brewster, NY 10509 FAX (845) 278 -2166 March 30, 2005 f Mike- $udzinski Putnam County Health Department 4 Geneva Road Brewster, NY. 10509 Re: Hillis Septic System Septic Revisions Dear Mike: Please find enclosed the attached SSTS for review with an update to address the following revisions. A. Driveway and house footprint reflect memo changes. B. All tanks relocated to south -east corner of residence with lower inverts. C. Profile on SP -1 pump calcs on SP -2 revised to reflect revised tank locations, elevations and pump line lengths. Please accept these drawings. If an amended SST application and fee is required, please call to discuss. With gar, Peder . S ott, P.E., R.A. Presid t Attachments CC: Bill Hillis A R C H I T E C T U R E• E N G I N E E R I N G °SITE PLAN NI N G S: \Open Projects \HILLIS RESI DEN C E\Lettars\BudzinskiSeptic.doc P.W. SCOTT ENGINEERING & ARCHITECTURE, P.C. 3871 Route 6 Brewster, NY 10509 E -Mail: pwscott@rcn.com (845) 278 -2110 FAX (845) 278 -2166 TO �.�,� l aL_� 9 � S V l [LIEVVIEn @1P DATE X = �+ JOB NO. ATTEN N RE: + _c LA 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 _c LA THESE ARE T ANSMITTED as checked below: For approval ❑ For your use ❑ As requested ❑ For review and comment ❑ FOR BIDS DUE REMARKS COPY TO ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections • Resubmit copies for approval • Submit copies for distribution • Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: N enclosures are not as noted, kindly notify us at once. ITTNAM COUNTY DEPARTMENT GE HEALTE r SION DE ENVIRONMENTAL HEALTH SERVII C ®NS'I'ISiJC'I'I ®1`t PERIVIIT FOR SEWAGE TREATMENT SYSTEM PERMIT # P` Pl_ o* Located at 4 U D/,(J G -TC>j ✓/ wi5 #0A4-,> Subdivision name 4&fa Subd. Lot # Date Subdivision Approved Owner /Applicant Name W / t- L / A-,L1 Town or Village Tax Mapq2_12L Block Lot Renewal Revision_ Date of Previous Approval /1,0h-- Mailing Address 0' jL4A i'J 5 TR,66''I' 5c/j �D� Zip Amount of Fee Enclosed ` oo gc j,(Sj Building Type 1z Lot Area No. of Bedrooms Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of / ,�I- 5' gallon septic tank and %)50 6AL_OAJ � ✓M� G/�,�- r- lP>�{1 �• %'Z�d E���� �2��2��� av�2Fc�cxc> •T.��/L Other Requirements: 8 `F Z 1 " at/ /J'-)f 4t,S , 7—xe�kjG1 To be constructed by , ' % fi �P Address Water Supply: Public Supply From or: V' Private Supply Drilled by Address Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment s, sY tem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Co actory to the Public Health Director will be submitted to the Department, and a written guarantee wil er, his successors, heirs or assigns by the builder, that said builder will place in good operating co, -sewage treatment system during the period of two (2) years immediately following the date of the is u c o rov c e Certificate of Construction Compliance of the original ,. system or any re th to. Signe 059 .�':' R.A. Date D Address ✓ (� -. 1�(\,�(� In %'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 when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. pprov or discharge of domestic sanitary se We only. By: / Title: Date: 6 hrl-F White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # Z Well Location: Street Address: T wn/Village Tax Grid # /r-� Map2,2, /2111ock l Lot(s) Well Owner: Name: Address: Use of Well: Residenti 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 Est. of Daily Usage al. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existi g Well Detailed Reason W /� , s, for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ........:........................................ ............................... Yes No Is well located in a realty subdivision? ...................................... ............ .................... Yes No Name of subdivision Lot No. Water Well Contractor: Address: Is Public Water Supply available to site? .. .............................................................. Yes No _ Name of Public Water Supply: G Town/Village Distance to property from nearest water main: ProposeVwel oc ion & sources of contamination to-be pro d on se ate e�t/pl Date: ��j Applicant Signature: PERMIT TO CONSTRUCT IWATER 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 wa er well driller certified by Putnam County. Date of Issue L Permit IsAuing icial: ! Date of Expiration 11,2 1 Q Title: Permit is Non- Transfe rib e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 �-- /•- //— - - - - -- WOOa03A'� / - - -�-- — — — — — — — — 30 301S3a C13SOd0ad — �\ \ -- - -- — L NIA \ \ 30rare N \ Wvl oad3S IV nd \\ — AON°3"�a3w3 \\ \ 00 z vt — Vlid v3ad��saax��ao� — £a 'rte -- - - -- �'sa —' — _�•' —� la ga d.11 ,49 0 SNf1a 4L -- :f742) e3dwwo3B0l�al� ed — _/_ YID614 , yS — — 099---- - - - - \. NOLLnBRliS10 3D SON3 — _ —.._— - -- P.W. SCOTT ENGINEERING & ARCHITECTURE, P.C. 3871 Route 6 Brewster, NY 10509 E -Mail: pwscott @rcn.com (845) 278 -2110 FAX (845) 278 -2166 TO WE ARE SENDING YOU x Attached ❑ Under separate cover via • Shop drawings ❑ Prints ❑ Plans • Copy of letter ❑ Change order ❑ LETTER OF TRANSMITT/aL DATE 7- JOB NO. ATTENTION RE: [11 lie 1 1 the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION aZ A2 o ,�.� THESE ARE TRANSMITTED as checked below: f For approval / ❑` For your use • As requested • For review and comment ❑ FORBIDS DUE REMARKS ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections • Resubmit copies for approval • Submit copies for distribution • Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO SIGNED: H enclosures are not as noted, kindly notify us at once. P.W. SCOTT ENGINEERING & ARCHIT'ECT'URE, P.C. 3871 Route 6 Brewster, NY 10509 E -Mail: pwscott @PCn.com (845) 278 -2110 FAX (845) 278 -2166 TO dIE4VIn @[F U ° ° H @W04VQ1 DATE JOB NO. ( /Es7 O ATTENTION RE: 164LAS C_ 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 �v THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ For your use ❑ As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS • Approved as submitted • Approved as noted ❑ Returned for corrections • Resubmit copies for approval • Submit copies for distribution ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO a- 01 / c�_/_ 11, SIGNED: If enclosures are not as noted, kindly notify us at once. NIFAllm P.W. Scott email: pwscott@suscom.net Engineering & Architecture, P.C. 3871 Route 6 845) 278 -2110 NOWIFAW Brewster, NY 10509 FAX (845) 278 -2166 July 7, 2006 To: Mike Budzinski Fax: (845) 278 -7921 Re: Hillis SSTS The following letter is a response to the memo dated June 29, 2006. 1. The curtain drain has been proposed as one level of prevention to eliminate a seep, which appeared during the excavation of the force main for the SSTS. The inclusion of this structure was a form of mitigation if the seep was not mitigated with a surface swale proposed. Accordingly, the inclusion of the curtain drain is not to be construed as a required construction element on the septic plan since in the area of the SSTS based upon extensive field testing, there is no need to lower the water table with the fill proposed. The details of the curtain drain have therefore been eliminated from the plan. 2. The surface swale outlet protection is depicted on the eastern swale extending down the hillside. The western end is connected to a yard basin and pipe extending down the hillside to the driveway drainage. 3. The curtain drain has been eliminated as noted. Please review the submission. Should you have any questions or comments, please feel free to contact this office at your earliest convenience. Wi Regards, jjI Pecter . Scott, P.E., R.A. President CC: Bill Hillis 845- 227 -2360 A R C H I T E C T U R E * E N G I N E E R I N G * S I T E P L A N N I N G ^: : .t ' �i) )p j �,Itt.IS RES R" >Ajc -.f vet r�(w i E P.W. SCOTT ENGINEERING & ARCHITECTURE, P.C. 3871 Route 6 Brewster, NY 10509 E -Mail: pwscott @rcn.com (845) 278 -2110 FAX (845) 278 -2166 TO �y2zh 'JJ WE ARE SENDING YOU Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ FUEVV1E12 OF O o A L1VMOU191L DA[T �fM V f✓L JOB NO. ATTENTION l� RE: is ❑ Samples COPIES DATE NO. DESCRIPTION J THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ For your use ❑ As requested ❑ For review and comment ❑ FORBIDS DUE ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections the following items: ❑ Specifications ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO SIGNED: If enclosures are not as noted, kindly notify us at once. SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Mr. Peder Scott, PE PW Scott Engineering 3871 Route 6 Brewster, New York 10509 Dear Mr. Scott: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 June 29, 2006 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health c-'/ Re: Revised SSTS - Hillis Ludingtonville Road, (T) Patterson TM# 22.12 -1 =9 This Department has received and reviewed the revised plans for the above referenced project and the following comments are offered for your consideration. i�. The curtain drain detail shown on the plans is inadequate. The detail must include sufficient information such as trench width, size of gravel, size and type of pipe etc. A. The locations of the outlet protection for the surface swales are not shown and indicated � on the plan. '�3. Curtain drain monitoring pipes upgradient and downgradient of the curtain drain are to be provided and a detail provided. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. MJB:cj Respectful f-L&A Michael J. Director of 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 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Peder Scott, PE PW Scott Engineering 3 871 Route 6 Brewster, NY 10509 Dear Mr. Scott: DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health June 16, 2006 Re: Revised SSTS: Hillis Ludingtonville Road (T) Patterson, TM # 22.12 -1 -9 This Department has received and reviewed the submitted application and plans for the above referenced project and the following comments are offered for your consideration. ;r(1) The site plan shows the pump chamber and overflow tanks as being 1250 gallons although the SSTS profile specifies the tanks as being 1500 gallons. Erosion control measures are to be shown for the well and SSTS. *(3) A curtain drain detail is to be provided on the plan. , t-('4) A _detail of the surface swale is to be provided on the plan. ,Fc{5) Outlet protection is to be provided at the swale discharge ends. )tZt -lS Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. MJB:kly Very truly Michael J. l Director of 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 .PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - 4 .. • DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner' lw 11,1.1 S Address Located at (Street) 12 �U-K 132 Tax Map 2,7. I Z Block L Lot _ (indicate nearest cross street) Municipality Z ✓SoJ Drainage Basin ✓z"1 el-1-1- SOIL PERCOLATION TEST DATA Date of Pre- soaking 0tlz > Date of Percolation Test. Hole No. Run No. Time Start - Stop Ela se Time �NiiB.) Dip th to Water rom Ground Surface (Inches) . Start Stop Water Level Dro In Inc�es Percolation Rate Min/Inch 2 3 ",k) �,�►� v ►� 3 3 4 2 2 ?� MJ tit 3 6. 5 7,41 a' 7v �ttr� 2 I_ 2,+- -2; ZZ 2 3 3 dD 3.30 2]v M i 1, I" �' 114- y 4 x'33 ` P3 �30 .itj 2 ►� Viz ` �% � 1' z� 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtamea at eacn percolation test hole. (i.e. s 1 min for r -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole: Form DD -97 DEPTH G.L. 0.5' 1.0''. 2.0' 2.5'. 3.0' 3.5' 4.0' 4.5' 5.5' 6.0' 6.5' 7:0' 7.5' 8.0' 8:5' 9.0' 9.5' 10.0' 2 .TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. Z I 'HOLE NO. HOLE NO. I . T Indicate level at which. groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: �£'"� Date S ZS- of, Design Professional Name: (oAX to ME-. Address: 'U �... �'�0- : f r'� w PU : AM COUNTY DEPARTMENT OF HEALTH.. ?.r ` DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE .SEWAGE TREATMENT SYSTEM Owner` s• .t,; ti. Address '"w 0 o LCs N TgC4,ui)S Located at (Street) ( -i J�( c; C (� ti��l L ((� %; Tax Map C` Block Lot - (indicate nearest cross sweet) Municipality Drainage Basin r: Ct1 OIL PERCOLATION TEST DATA PTA- j Date of Pre - soaking PT Date of Percolation Test �-��z6 ' ! P i 1 iVUIES: 1. -1 ests to be repeated at same deptn untie approximately equal percolation rates are ootainee at each percolation test hole: (i.e. s I min for 1 -3.0 minlinch, s 2 min for.) m in/inch) All data to be submitted for review.. 2. Depth measurements to be made from top othole.. For,.i DD -9 "r Depth to Water Water Time Ela se Time �14lin.) rom Ground Surface (Inches) Levey - Drop In Percolation Rate Hole No. Run No. Start - Stop . Start Stop. Inches MinlInch mac,=. 2 r:�, -1:ti� `��; ��- ��,� �,i� -� N -t cI • 5 I i j •'4 1 0 46 �•, .. �. I iVUIES: 1. -1 ests to be repeated at same deptn untie approximately equal percolation rates are ootainee at each percolation test hole: (i.e. s I min for 1 -3.0 minlinch, s 2 min for.) m in/inch) All data to be submitted for review.. 2. Depth measurements to be made from top othole.. For,.i DD -9 "r P TNAM COUNTY DEPARTMENT OF HEALTH IVISION OF ENVIRONMENTAL HEALTH SERVICEil=)Q, CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM y PERMIT # Located at �, 111�c16 7'O,� V/6-C- / 0A Town or Village J�RS Subdivision name + Subd. Lot # Tax Ma62a. /9� Block Lot` fG�? Date Subdivision Approved Renewal Revision Owner /Applicant Name W L L / M/ LL. /S Date of Previous Approval /�%ah -e . Mailing Address T/ZlT' : -Sy, t,e /3a� ... Zip Amount of Fee Enclosed Building Type / Lot Area i_ No. of Bedrooms Design Flow GPD p ,Cam f..�/C.� . . Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED I represent that I `am' wholly and completely responsible for the °design and "location of the proposed system(s) and that the ... serrate "sew -age treatment sv is em described above will be cfonstructed as shown on the approved amendment thereto and in accordance with the standards; rules and, regulations of.the Pufiam County Department of Health, And h at completion there ffa " Certificate of.eonstruction Compliance" `satisfactory to the Public Health Director will be submitted to the Deparrtment, an d a written guarantee will be _furnished the owner, his successors, heirs or assigns by the builder, that said builder ill pface in good operating condition any part of said sewage treatment system during the period of two (2)'years . a W. t. uninediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any re th to. j ;Sign P.E. R.A. Date O �n Addressdc /l . License # d S / q F 7 3 ;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 causeYor may be amended or _ :modified when considered-necessary by the Public Health Director. Any revision or= a�terathon of the approved plan requires a new perm i . ppro or discharge of domestic sanitary se a only. B �.."- y:. Title: bate. White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 ,. 7 P.W. Scott Engineering & Archie 3871 Route 6 Brewster, NY 10509 May 30, 2006 Gene Reed PCDOH 4 Geneva Road Brewster, NY. 10509 Re: Hillis Residence Ludingtonville Road Town of Patterson Permit #P -01 -04 P.C. email: (845) 278 -2110 FAX (845) 278 -2166 Please find enclosed a revised SSTS reserve system for the above subject septic. The SSTS reserve area has a recorded percolation rate of 24 min/inch. This application rate has been incorporated into the new design for the reserve only. The plans have been revised to show a single pump as requested by the homeowner. 24- hour storage capacity is provided in the tanks. Please accept this plan for amended SSTS approval. Should you have any questions or comments, please feel free to contact this office at your earliest convenience. 4 er g s, W. Scott, P.E., R.A. President CC: Bill Hillis (845) 227 -2360 A R C H I T E C T U R E * E N G I N E E R I N G * S I T E P L A N N I N G TO P.W. SCOTT ENGINEERING & ARCHITECTURE, P.C. 3871 Route 6 Brewster, NY 10509 E -Mail: pwscott@rcn.com (845) 278 -2110 FAX (845) 278.2166 WE ARE SENDING YOU Attached ❑ Under separate cover via _ • Shop drawings ❑ Prints ❑ Plans • Copy of letter ❑ Change order ❑ �19`l� l� Ign @1P V ° ° H @W0V1VQM DATE JOB NO. ATTENTION RE: .3 3 the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION .3 3 z� sAe -zo •30 -o 4 THESE ARE TRANSMITTED as checked below: For approval /❑ For your use ❑ As requested ❑ For review and comment ❑ FOR BIDS DUE REMARKS COPY TO ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: if enclosures are not as noted, kindly notify us at once. SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health PW Scott Engineering 3871 Route 6 Brewster, NY 10509 Dear Mr. Scott: ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 June 8, 2006 Re: Revision for Hillis (P- 01 -04) (T) Patterson, T.M.# 22.12 -1 -9 This Department has received the submitted plans for the above referenced project. Prior to review of the plans, a construction permit and application fee of $250.00 are to be submitted. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. MJB:mcb Respectfully, A Michael J. udzi�, PE Director o 7nlrineennl; 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 e SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Mr. Peder Scott, PE PW Scott Engineering 3871 Route 6 Brewster, New York 10509 Dear Mr. Scott: DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 March 29, 2006 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Hillis SSTS Ludingtonville Road, (T) Patterson This office is in receipt of your letter dated March 17, 2006 and accompanying sketch plan for the above referenced project. In order to revise the system, a construction permit revision application and package is to be sent to this Department. An additional percolation test will be required in the area of the relocated reserve system trenches. It appears the clay barrier can be removed if the additional percolation test confirms the original design data. The revised plan is to show accurate topographic contours and the system is to be placed on slopes less than or equal to 15 percent. Please be advised this Department will not issue a waiver on the placement of the SSTS reserve system fill. Kindly advise us if there are any questions. Respectfully, Michael J. B � �zin Director of Ftgineering MJB:cj 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 MAR -17 - '." "10�• I:J : 40 P. W. SCOTT P.W. Scott Engineering & Archi 3871 Route 6 Brewster, NY 10509 7 21006 'vikc Budzinski P(. `DOH (8451 278 -7921 Re.,:'. 41,111s Septic i .udingtonville Road Dattersori. NY P -C. 8452782166 P.01i02 (845) 278 -2110 FAX (845) 278 -2I66 TAI( -,ase fired enclosed a feasibility map for septic system revision. Based upon site cor+diti ns. the client has request the following: l . Re sc primary system to move one row to east side and split one row into 2 - 32' i cic rements. too t• e reserve to eastern side of residence. Our office has utilized a transit and field o oordinated a 15% existing slope confirmation. The topography by our surveyor not correspond to this finding., 1: x I minate 100' long x 2' wide clay barrier. our sketch plan and determine that with this relocation are any additional dc,r I:r :i::id percolation tests required. Resen /e deep and pere test #2B is located within tll i` i ::, :: , .0 -ea. The client would also request•a waiver on the installition ofthe requity pro -•. ido „u:- office with the procedure for said waiver an call to discuss re �': z;i cztl5. P.F.. R.A. Ct: l3iil Hillis fill. r S� ! d. ! � T ! C T U R E ' ' E N G I N E E R I N G " S I T E P L A N N I N G :.•. c , c•': TCI - 0417- �:57M -7UP1 NAMF- PI ITNGM rnl INTV nFPAPTMFNT nF P, 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICE CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM /fir o�.5 �- �/ • ®� PERMIT #• Located at U� /l//f,L� o•� Subdivision name 6=)ubd. Lot # Date Subdivision Approved Owner /Applicant Name Town or Village j'�-IOA75 Tax Mapg, l Block / Lot Renewal Revision Date of Previous Approva6 Mailing Address /,D, 14AZA) S 5y/ /3 a- Zip /as Amount of Fee Enclosed Building Type l Lo/ Lot Area. No. of Bedrooms Design Flow GPD 6� Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of Z2 �5v gallon septic tank and Other Requirements: w To be constructed by / 1 Address Water Supply: Public Supply From Address or: _ Private Supply Drilled by rL--2 Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating co . ' ' any part of said sewage treatment system during the period of two (2) years immediately following the date of i "MIEW approval of the Certificate of Construction Compliance of the original system or any r ai t e �Q'� o.Fa W. sc Cr pwtoft Signed: "' P.E. R.A. Date Addressi% License # 05`7,34� ..� ° 059 -��°` �. APPROVED FOR CONSTRU jz val expires two years from the date issued unless construction of the sewage treatment system has been com -an 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 ermit. Approve or discharge of domestic sanitary se age only. �/ c Date: By; +, Title: White copy - HD F e; Ye copy copy - BBuilding Inspector; Pink copy - �vner; O0ange copy - Design Professional Form CP -97 '' � � z' P. W. Scott email: pwscoft@rcn.com Engineering & Architecture, P.C. 1. 3871 Route 6 845 278 -2110 Brewster. NY 10509 FAX (845) 278 -2166 February 23, 2004 Robert Morris Putnam County Department of Health 4 Geneva Road Brewster, NY 10509 RE: Dear Robert, Ludingtonville Road Proposed SSTS: Hillis I have had made following changes to our submission of proposed SSTS on TM #22.12 -1 -9: 1. The house plans indicate 4 bedrooms, the loft area could not be used as a bedroom as there would be no access to Bedroom #4 and the loft is open to below. The den entrance has been modified to an open hallway. 2. Bedroom count has been indicated on the plan view of the house on the septic plan. 3. The well is blocked by the residence from dirrect flow from the SSTS. To move the well up hill is very difficult due to the site grades. 4 &5.The SSTS has been revised to 22" of fill minimum and permit requirements are noted on the plan. 6. Dose Volume is noted on the plans, see SP -1 (pump detail) & SP -2. 7. Well location is dimensioned from adjacent property lines. If you have any questions, please do not hesitate to call. Feder W. Scott, P. E., R.A. President A R C H I T E C T U R E * E N G I N E E R I N G * S I T E P L A N N I N G I I �S:W)P r: F Robert Morris 2,23.04.doc P. W. SCOTT Engineering & Architecture, P.C. 3871 Route 6 BREWSTER, NY 10509 E -Mail: pwscott @rcn.com (845) 278.2110 FAX (845) 278 -2166 TO WE ARE SENDING YOU Attached ❑ Under separate cover via • Shop drawings VPrints ❑ Plans • Copy of letter ((❑ Change order ❑ LETTER Oz TRANSMITTAL DATE JOB NO. ATTENTIVq RE: For your use • As requested / For review and comment ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION For your use • As requested / For review and comment ❑ FORBIDS DUE 2 I/G oct THESE ARE TRANSMITTED as checked below: For approval • For your use • As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS • Approved as submitted • Approved as noted ❑ Returned for corrections ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO SIGNED: If enclosures are not as noted, kindly notify us at once. LORETT.A MOLINARI Public Health Director DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 Environmental Health (845)278-6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 February 18, 2004 Peder Scott, P.E. PW Scott Engineering 3871 Route 6 Brewster, NY 10509 Re: Proposed SSTS: Hillis Ludingtonville Road (T)Patterson, TM #22.12 -1 -9 Dear Mr. Scott: ROBERT 1. BOtiDI County Executive 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. House plans are considered to have six (6) potential bedrooms. 2. Bedroom count of house is to be labeled in the plan view. 3. It is strongly advised that the well be located at an elevation higher than the SSTS. 4. SSTS requires 22 inches of fill, revise plans and noted permit requirements. 5. The minimum of 22 inches (approximately 2 feet) of fill is required for the entire SSTS. 6. Dose volume is to be noted on the plan. 7. Well location is to be dimensioned from two fixed points. 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. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:lm i obely y s, rt Moms, RE Senior Public Health Engineer LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 February 18, 2004 Peder Scott, P.E. PW Scott Engineering 3 871 Route 6 Brewster, NY 10509 Re: Proposed SSTS: Hillis Ludingtonville Road (T)Patterson, TM #22.12 -1 -9 Dear Mr. Scott: ROBERT J. BONDI County Executive 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. House plans are considered to have six (6) potential bedrooms. 2. Bedroom count of house is to be labeled in the plan view. 3. It is strongly advised that the well be located at an elevation higher than the SSTS. 4. SSTS requires 22 inches of fill, revise plans and noted permit requirements. 5. The minimum of 22 inches (approximately 2 feet) of fill is required for the entire SSTS. 6. Dose volume is to be noted on the plan. 7. Well location is to be dimensioned from two fixed points. 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. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. f7uarm V ly y s, obert Moms, P.E Senior Public Health Engineer TO P. W. SCOTT Engineering & Architecture, P.C. 3871 Route 6 BREWSTER, NY 10509 WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ LETTER OF TRANSMITTAL ❑ Samples ❑ Specifications 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 ❑ ❑ FOR BIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO SIGNED: If enclosures are not as noted, kindly notify us at once. LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 February 2, 2004 Peder Scott, P.E. PW Scott Engineering 3871 Route 6 Brewster, NY 10509 Re: Proposed SSTS: Hillis Ludingtonville Road (T) Patterson, TM# 22.12 -1 -9 Dear Mr. Scott: ROBERT J. BONDI County Executive 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 note the "New York State Department of Health. Individual Residential Wastewater Treatment System Design Handbook" comments that have been highlighted. In particular the separation distance can be no less that 50 feet from a footing drain downgrade. Revise accordingly. 2. Lot area on permit notes 4.4 acres. SSTS plans note 18.4 acres. Revised accordingly. 3. The project review will continue after comment #1 is addressed. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ve y yours A(/./ Robert Morris, P.E. Senior Public Health Engineer RM:tn V gg�� FROM : PRUDENT I AL , 12/24/2000 12:07 ,II 1� �d FAX NO. :19142320626 Dec. 24 2003 12 :40PM P1 3407769902 ARMOUR ENTERr ni= r'ACC 01/01 yiuis ARMOUR ENTERPRISES REAL ESTATE INVESTORS & DEVELOPERS December 24, 2003 Putnam County Dept of Health Dlvlslon of Envlronmental Health Services Putnam County, New York RE: Ludingtonville Road Patterson, NY 22:12 -1 -9 Gentlemen: This letter shall authorize Mr. Blll Hillis, of 39 Lime Ridge Road, Poughquag, NY, as contract vendee, to apply to Putnam County Department of Health for a single family residence septic and well permit for the above- captioned property. Yours very truly, a as S. Armour JSA/el COMOWO PIOCO e Rcycd Done Mall a 8T. IHOMA,S o U.3. SIN 18I.ANDS OM 0 (34CD 774-M v FAX (340) 776-4082 rU 11NAM 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: (j J�UVt AA MAW 6�&zZ z 2. Name of project: RLUS CE 3. ,A L0 J2 u 4. Design Professional: r 99N 5. 6. Drainage Basin: ;'I' ARCH . HIlLIS S"C T Svi �'C__ 192. �_' v Location TN: gnmo''j Address: ot"zy .N 4 1,050 TV De of Project: PrivatelResidential 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 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 10. Has DEIS been completed and found acceptable by Lead Agency? .....:......... �d 11. Name of Lead Agency 12. Is this-project in an area under the control of local planning, zoning, or other officials, ordinances? ............................... ..... NO 1 Ia 13. If so, have plans been submitted to such authorities? ti 14. Has preliminary approval been granted by such authorities? Date granted: 1' 15. Type of Sewage Treatment System Discharge ................. surface waterroundwater 16. If surface water discharge, what is the stream class designation? .................... MA 17. Waters index number (surfaced ................ M 14 18. Is project located near a public water supply system? ....... ............................... NO 19. If yes, name of water supply V 1(, ,Uo '�� Distance to water supply 3+ tLt� 5 20. Is project site near a public sewage collection or treatment system? ................ J .,.._.. .r_ ��n _ ..u,,., ,,. sewage system 1, �,�,, cRaL , Distance to sewage system 3L, Uo ??. Date test holes observed 23. Name of Health lilspc;cwr nr,, /H 5-tCl 24. Project design flow (gallons per day) ................. e .. 2.... ............................... 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?...�'� 26. Has SPDES Application been submitted to local DEC office? .........................! , Form PC -97 2 Is am- portion of this project locat d witlllr ^ designated Town or State n etl;:..,'. &n —=u3 Tn T� 1 1v1� _, '� :n ber. 29. Is Wetlands Permit required? ............... ............................... l'0 Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ............................... 31. Is or was project site used for agricultural activity" involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile. landfill. sludge disnnsal site or any other potentially known source of contamination? ............... Yes/No DESCRIBE: 33. Is there a local master plan on file with the To«-n 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 22 [ 2-Block Lot 37. Approved plans are to be returned to ..... Applicant ��Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater.plans or the creation of impervious surfaces,. and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for revievN• and approval. If the application is signed by a person other than the applicant shown in Item I .,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, underpenalty 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 misdemeanor pursuant to Secti "P.45 of the Penal Law. e SIGNATURES & .OFFICIAL TITLES: Mailing Address: ................................... sZ (C) S-07 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of (� i (. (l�l� 1(,uS Located at Lupw G -ra�\ft ,i 6 Tax Map # 22. (Z Block Lot Subdivision of P2 6u' (DtJI "4N",/L S Subdivision Lot # Filed Map # Gentlemen: This letter is to authorize PQPL Date Filed a duly licensed Professional Engineer or Registered Architect Xto 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 tretment 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 tru Countersigned: Signed: P.E., R.A., # Ob 34<0 Mailing Address 3k7 f State Zip ED 5_0 Telephone: ZW 2 (CO Mailing State Telephone: Z VS — 2_2_7 -- Z 3 6 d Form LA -97 gg FROM :PRUDENTIAL, 12/24/2003 12:37 15'x, FAX NO. :19142320626 3407769902 ARMOUR ENTERRRI.SC ; Is ARMOUR ENTERPRISES io Iji REAL ESTATE INVESTORS & DEVELOPERS I it �I I. .illll I: i �I t1la III • I I �. I I (I II December 24, 2003 Putnam County Dept of Health Division of Envlronmental Health Services Putnam County, New York RE: Ludingtonville Road Patterson, NY 22:12 -1 -9 Gentlemen: Dec. 24 2003 12:40PM P1 r~ /'ACC 01/01 This letter shall authorize Mr. Bill Hillis, of 39 Lime Ridge Road, Poughquag, NY, as contract vendee, to apply to Putnam County Department of Health for a single family residence septic and well permit for the above - captioned property. Yours very truly, a as S. Armour JSA /el R Co"'m w*t* Plvom - Roya► Dwe Mall • Sr. %iOMAS • u.8. vMQiN &" 00802 c (34C)7744M a FAX (JW) 776-M2 14.164 (2/87) —Text 12 PROJECT I.D. NUMBER 617'.21 Appendix C State Environmental Ouality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME P -miri2 LA _ S f _n 1� 1 � 141 LI—I S Sr-P it r _ 13. PROJECT LOCATION: P _ Municipality County P� � J fq w/ 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) L VIiING %lu vcau:' AL?) t1,96) r'fET" �aRfH FRo►�t /li �r t . CR57- Sf0e- eF 579a'1_. 5. IS PRO OSED ACTION: ( ew 0 Expansion 0 Modificationlalteration 6. DESCRIBE PROJECT BRIEFLY: cc 7. AMOUNT OF LAND AFFECTED: Initially Z d acres Ultimately 2 • y acres 8. WIL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? es 0 No It No, describe briefly 9. WHA IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ ParklForestl0pen space 0 Other Describe: SEOR - • 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ❑ Yes I✓ N o If yes, list agency(s) and permlUapprovals 11. DOES ANY ASP T OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? 0 Yes V4 o If yes, list agency name and permlUapproval 12. AS A RESULT OF OPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? 0 Yes o I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ApplicanUsponsor name: Signature: Date: 01,405 I If the action Is In the Coastal Area, and you are a state agency, complete the I Coastal Assessment Form before proceeding with this assessment OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by agency) A. DOES ACTION E,,XXgf ED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. 11 Z 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 I 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 briefly C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified in C1-05? Explain briefly. C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether it Is substantial, large, important or otherwise significant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a. positive declaration. ❑ Check this box if you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result In any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Name of Lead Agency Date 2 Title of Responsible Officer Signature of Preparer (if different from responsible officer) Y PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES. DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM &&rner Address <;-c (�(.Evubb Located at (Street) .( 1)�c; C. �L �(t�r �,� ; �!� Tax Map � i Block Lot .5-- (indicate nearest cross street) Municipality �� , ;� � ' ��, Drainage Basin R(lnA.,r OIL PERCOLATION TEST DATA Date of Pre - soaking PT %-0 Date of Percolation Test iNUIES: 1. rests to ne repeated at same deptn unto approxtmatety equal percolation rates are omainea at eac;i percolation test hole. (i.e. -< 1 min for 1 -30 miniinch, :5 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Fonm DD -9" Depth to Water Water From Ground Level— - Percolation Hole No. Run No. Time Start Stop Ela se Time Sin.) Surface (Inches) Start Stop Drop n Inches Rate N in7lnch - 1 ( :"IG I (f�11 r�, } 4 5 I I r 1 P. 4 F __7 4 L__L_5 iNUIES: 1. rests to ne repeated at same deptn unto approxtmatety equal percolation rates are omainea at eac;i percolation test hole. (i.e. -< 1 min for 1 -30 miniinch, :5 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Fonm DD -9" 21L l8i Z� 0 TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES 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' g¢u 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' HOLE NO. 2A (- -- -6-�1L HOLE NO.. n� C->-6 ,f -IpP,�o(L k ?-4 §F� �.�� � �.' % Vii. HOLE NO. 2 �. `gro(L 4 VAA 1 9,T c, a-) )k Indicate level at which groundwater is encountered Mout- Indicate level at which mottling is observed see AP,.,ocJc- Indicate level to which water level rises after being encountered Deep hole observations made by: (Wr/ IAMO �/d'L�QSSo Date 4 Design Professional Name: S- Address: Signature Design Professional's Seal ti t ,r' ��- •.�('� � ,.. = :_ :fit '1 • • ii. pt Y r . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address Ovu-V nu T-�IwoS Located at (Street) J �,V� ) G 7r�IUti(JQ i'i Tax Map2e t'Z Block Lot .�- (indicate ne�afest cross street) �,� � Municipality � (C,�1 Drainage Basin t �-r i94AJ-Ct1 OIL PERCOLATION TEST DATA / /ZV,> (,( �e Date of Pre - soaking ���z��� �z zf� Date of Percolation Test (° 1� o I PTZ INU1h6: 1. -tests to be repeated at same depth until approximately equal percolation races are oomineu at each percolation test hole. (i.e. <_ 1 min for 1 -30 min/inch, <_ 2 min for 31 -60 minfinch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 Depth to Water Water rom Ground Level— Percolation Hole No. Run No. Time Start - Stop Fla se Time Min.) Surface (Inches) Start Stop Drop In Inches Rate Min7lnch - 2 1-5 3 17 ���,� ��,25 4 • 5 ( } i rr 76 3 (2: 01- F (n °Z (7 0 4 -- 5 I + E� p 1 i 7, AN 2 • C` (� 1 5 INU1h6: 1. -tests to be repeated at same depth until approximately equal percolation races are oomineu at each percolation test hole. (i.e. <_ 1 min for 1 -30 min/inch, <_ 2 min for 31 -60 minfinch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 W(U Si Z90 0 TEST PIT DATA 2 ' DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES 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' HOLE NO. 2A HOLE NO.. a k -e4 OIZA..,►G2 /��� 4� tj k N P <1 r (,(a7U lj,P/ �G HOLE NO. C u 52 4 1 '2 c Pin" Indicate level at which groundwater is encountered 596 Moo k Indicate level at which mottling is observed See Ap"'aic- Indicate level to which water level rises after being encountered Deep hole observations made by: Date Design Professional Name:, �2 Address: Signature; Design Prof'essional's Seal / PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: 48 bxUngtcnville Road Town/Village: Patterson Tax Grid # Map Block Lot(s) Well Owner: Name: William Hillis Address: 39 Line RLdRe Road - Poupftuag, NY Use of Well: 1- primary XXX 2- secondary X Residential Business Industrial Public Supply Air cond/heat pump Irrigation Farm Test/monitoring Other(specify) 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 ___62_ft. Length below grade 60 ft. Diameter 6 in. Weight per foot 17 lb /ft. Materials: 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 _L_ Yield _5- gpm Depth Data Measure from land surface- static (specify ft) 3 During yield test(ft) 700 Depth of completed well in feet 945 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 sand cobbles 20 25 weathered ledge 25 945 w uartz seams .4a If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Infofmatiot -* -� -.. =: Pump Type slmrsibli a aci ty.: 5-� — Depth 400 Model 5(510412' Voltage .230 HP 1 Tank Type by ohs Volume — Date Well Completed 3/20LO6 Putnam County Certification No. 02 Date of Report 5/8/06 Well Dri r (signature) NOTE: Exact location of well with distances to at least two permanent landmarks to be proy K on a separate sheet/plan. Well Driller's Name Mill priLLipg, Inc. Address: 75 Putnam Ave.. Brewster, NY Signature: Date: May 8, 2006 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 from.. �� _���r-ts 2 31�, , I°IA 7YI. G bl551rPT R s o Gl1�F j'mi�� MAlrl 14 KrPr+5,9 P4 bMH / 12Cro 6A11� � INT _ ` 100• WELL SETBACK ` ;,q, f oI + NT 13," - •. � 2 STORY FRAME A.C. ire RESIDENCE ❑ UNITS Pills" PATS FRAME STEPS � - ELECTRI TRANSFOR .F AME "PORCH so. \ \ Rol O \ O 0� s A' PORTION OF A L. 1663, c.p. 239 ���SAS\ \ TAX LOT 22.12 -1 -9 \ ^ \ OVERHEAD WIRES TYPICAL ST 4 n- am 5T 14 V- exoA u � s WA / \. IfIA ` I bl SSI roTolL 32' I O ' Mali o4' 2 II 4 .}.p Z &4' 64 ry P 14 64! (o4 N4�A�irvilT -PF rILL.,, Ft►�t�j�f�NGY , � / ( - ` rN M p CMAr�I f3Eit 1ZOb his L Lot OD --TBACK 1 r4 � I 2 STORY FRAME A.C. RESIDENCE p, d / FRAME STEPS c cnTnn � / I 0 4" CIP 1 iU) T 42ff"5i' T CSIME�l5 /a�5 PEDER W. SCOTT, F "This is to certify that the sewage treatm( on this plan and that I inspected this sysi system constructed in accordance with r A h m rn► Inty rlpnartmpnt of Hpalth x rbi�lT,4 AVIV O , 5 U r.MvK z ENIEK= 'v�cF�av y ' � .074 Q - Bic' /�/ • 1� 2 srl4a - /00' /57' ENO 07#aA H P'°IA /33' ENO 17644/ P3 I //' 147' ,No rl�ENcf/ r4 /aye-. 142 P-OD ?'jkPA:*'°5 /�o' 137' eNr_' tnOW,# r6 df¢, 131' ENn rPWAf:7.4 P7 "I /if* ENv Tie�nCN r'a 1 q3 ' /wr ,P,40 1' AC# p9 109' 15f FAV END /82.1 EN p T)ONC4Y P/2 179' 13Y# 00TXE/vt✓M P13 /74' /3¢ 340 MEIW P14 / 70' PEDER W. SCOTT, F "This is to certify that the sewage treatm( on this plan and that I inspected this sysi system constructed in accordance with r A h m rn► Inty rlpnartmpnt of Hpalth x