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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www. s ca n y o u rd o cs . c o m 631- 589 -8100 22.16 -1 -6 BOX 7 Fd ., C rill, oil I �,- 1 �; FINN. , las IN m ' IN 0 �,r I. , PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD C! STRUCTION PERMIT # Located at L-y 01 N � j) N V 'i Lk,6, ED :*10 Owner /Applican ie Y Q C-Alz—)ed Lt" Formerly. Town or Village P #I TEgS61Y" (7-) Tax Map )-I' 1(0 Block Subdivision Name Subd. Lot # Lot L Mailing Address 1 5 ti E^ C'+ e- 12-emlo hoT j s Zip Date Construction Permit Issued by PCHD i — 0 `/ "-Separate Sewerage System built by �61�rf� d � Address V a+rs 1i tN t_ Consisting of 100 Gallon Septic Tank and Other Requirements: Water Supply: Public Supply From (� Address /,, or: Private Supply Drilled by /� Address Ere AJ- 5k�,'/ Building Type 1,000P tom►> �i Has erosion control been completed? Number of Bedrooms Has garbage grinder been installed? IJ I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, a and re ations of the utnam Co a artment of Health. p g P 1t 17101 Date: ( ® Certified by ! P.E. X R.A. (Design Professio al Address Z.� �- 12, Y License # . -7 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 revocation, modification change is necessary. t L�,t, 6 By: Title: kgepy ate: 1 I White copy - HD File Yellow (4y - Bui ding Inspector; Pink copy - Owner; Or De sign Professional Form CC -97 Nov 24 04 01:01p TOWN OF PRTTERSO 845 - 878 -2019 BM CB R FOLEY LORETTA MOUN,4RI- RN., NUN. Puntu ffewth D:re cr Agioaiate Prt51k Health Dtrauer Dtraerar of Pae vu AMC" DEPARTi�I'NT OF HEALTH I Cleneva Road Brewster, New York 10509 Earicoaneahl Health (9 L4) 278. 6170 Fa: (9 L4) 278 - 7921 ![stcstnq S�rlep (91a12T8 •6558 WIC (910273 •5678 Fax(9V4) 298.604: Earty iacerraactoc (?14)278 -69:4 Preschool (914)1.78-6082 Fax(914)218,6W OWNERS NAME: E911 ADDRESS: TOWN: AUTHORIZED TOWN OFFICIAL: `-- (Signature) DATE: The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless fhe above form is completed, i.e., a legal. Egli address is assigned by an authorised town official. This form is to be submitted with the application for a Certificate of Construction Compliance. c II'V7eZrn4t; p.2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: 50 Ludingtonville Road Town/Village: Kent Tax Grid # Map Block Lot(s) Well Owner: Name: Address: Marquise Construction Corp., 20 Bosywell Rd, Putnam Valley, NY 10579 Use of Well: 1- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock _ Other Casing Details Total length 52 ft. Length below grade 51 ft. Diameter 6 in. Weight per foot _1lb /ft. a Materials: X Steel _ Plastic _ Other Joints: _ Welded X Threaded _ Other Seal:. X Cement grout _ Bentonite Other Drive shoe: X Yes No Liner _ _ Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes No Hours Second Well Yield Test _ Bailed X Pumped X Compressed Air Hours 6 Yield 7-21_ gpm Depth Data Measure from land surface- static (specify ft) 30' During yield test(ft) 540' Depth of completed well in feet 605' 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 Drilling in overb rden clay and boulders Hit rock at 20' 20 52 Drilling in rock, set casing, grouted 52 605 Drilling in rock yranite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 5gpm Depth 560' Model 5GS15412 Voltage 230 Hp 12 Tank Type WM20B Volume 60 gallons Date Well Completed 10/8/04 Putnam County Certification No. 006 Date of Report 1/10/05 WellQr'Ner (signature) hr --_r Beal NOTE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. Well Driller's Name P. F. Beal & Sons, Inc. Address: 4 Putnam Ave., Brewster, NY 10509 Signature: Date: 1/10/05 Christopher Beal White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Page 1 of 1 MINSEnvironmental Services, Inc. �� 41 Kenosia Avenue LlATEA, SOIL AND A/A ANALYSIS Danbury. Connecticut 06810 I Telephone 203 -798 -2229 P F Beal and Sons Inc Mailing Information: Collector's Information: JMS ID: 006324 Name: P F Beal and Sons Inc Name: Chris Beal Address: 4 Putnam Avenue Address of site: Marquise Const. 50 Ludingtonville Road City: Brewster City: Kent State: NY Zip: 10509 State: NY Zip: Phone: (845) 279 -2460 Fax: (845) 279 -6613 Phone: Sample's Information: Site: Not Specified Date Collected: 9/21 /2005 Date Received: 9/22/2005 Preservative: HNO3 Time Collected: 2:30:00 PM Time Received: 1:30:00 PM Temperature: <4 Lab No.: J0509992 Matrix: Water Date Analyzed Test Name Result MCL Method 09/23/05 Alkalinity 72 mg /L N/A SMWW 2320 B 09/23/05 Lead (flush) <1 ug /L 15 ug /L SMWW 3113 B 09/22/05 Color ND 15 Units SMWW 2120 B 09/22/05 Turbidity 0.4 ntu 5 ntu SMWW 2130 B 09/22/05 Hardness 56 mg /L N/A SMWW 2340 C 09/23/05 Odor ND N/A SMWW 2340 C 09/23/05 Manganese <0.05 mg /L 0.3 mg /L SMWW 3111 B (NY) 09/23/05 Sodium 14.6 mg /L N/A SMWW 3111 B (NY) 09/23/05 Iron <0.05 ppm 0.3 ppm SMWW 31118 09/23/05 Chloride 1.19 mg /L 250 mg /L SMWW 4500 Cl C 09/22/05 pH 7.5 S.U. 6.5 -8.5 S.U. SMWW 4500 H B -NY 09/23/05 Nitrate <0.1 mg /L 10 mg /L SMWW 4500 NO3E 09/23105 Nitrite <0.1 mg /L 1 mg /L SMWW 4500 NO3E 09/23/05 Sulfate 14.3 mg /L 250 mg /L SMWW 4500 SO4F 09/22/05 Chlorine Free Residual <0.1 mg /L N/A SMWW 4500CIG 09/22/05 4:00 PM Total Coliform Absent Absent SMWW 9222B Comments: 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: azedo' _ Reviewed By: Michael Lapman Sharon Houlahan, Director President State #: PH -0218 ELAP M 11715 CONNECTICUT. NEW YORK AND NELA: CERTIFIED Toll Free 866 - JMS -5097 1 Corporate Fax 203- 798 -2408 1 Lab Fax 203- 798 -2107 1 mm.jrnsenvironment3l.cam Page 1 of 1 JASEnvironmental Services, Inc. I Al 41 Kenosia Avenue FIATEA, SOIL AND AIA ANALYSIS Danbury. Connecticut 08810 I Telephone 203 -798 -2229 P F Beal and Sons Inc Mailing Information: Collector's Information: JMS ID: 006147 Name: P F Beal and Sons Inc Name: Chris Beal Address: 4 Putnam Avenue Address of site: Marquis 50 Ludingtonville Rd City: Brewster City: Kent State: NY Zip: 10509 State: NY Zip: Phone: (845) 279 -2460 Fax: (845) 279 -6613 Phone: Sample's Information: Site: Not Specified Date Collected: 9/15/2005 Date Received: 9/16/2005 Preservative: N/A Time Collected: 3:00:00 PM Time Received: 1:00:00 PM Temperature: <4 Lab No.: J0509795 Matrix: Water Date Analyzed Test Name Result MCL Method 09/16/05 Chlorine Free Residual <0.1 mg /L N/A SMWW 4500CIG 09/16/05 4:00 PM Total Coliform Absent Absent SMWW 9222B Comments: 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 Signature: _ Reviewed By: Michael Lapman Sharon Houlahan, Director President State #: PH -0218 ELAP #: 11715 CONNECTICUT. WIN YORK AND NELAQ CERTIFIED Toll Free 866- JMS -so97 I Corporate Fax 203 - 796 -2408 1 Lab Fax 203 - 798 -2107 1 www irnsenvironrnental.cam JPUTNAM COUNTY DEP'AR'TMENT OF HEALTH DMSiON OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGk TREATMENT SYSTEM ' ry /'-A � �i�- - '2,2-, 12 , { - 6 Owner or Purchaser of Building • Tax Map Block Lot Building Constructed by Town/Village Location - Street Subdivision Name S L L.iv Building Type Subdivision Lot # 1 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 ofthe Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to. place in good operating condition any paint 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 trade 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 L Day 8 Year Signature: � (Se Q Title: General tonttactor (Owner) - Signature Corporation Name (if corporation) Address: State Zfp Corporation, Name of corporation) . Address: State Zip Form GS -97 —O v The People of the State of New York s- i * '47 is W Ya� !e •T�' r }i i;sy nom' g-, r a a 17 j c' •4 THIS is i r3 i� r• f A a i1 a t tik E.T(n'k`1aij,'( ' �N��C i�+il'$. WAS STAN '. Z30iCilyi,a �Yy ;y HEAL r r \a .�0 \ �Qr' j - t T t'r'• _1 Yti 14 vo vo r,, A t77' .ERTIFY THAT THE SEWAGE DISPOSAL SYSTEM WAS CONSTRUCTED AS IT ON THIS PLAN AND THAT THE SYSTEM WAS IN ACCORDANCE W WITH ALL ZED OVER. THE SYSTEM WAS CONSTRUCTED, S, RULES AND REGULATIONS OF THE PUTNAM COUNTY DEPARTMENT OF iD THE NEW YORK STATE DEPARTMENT OF HEALTH. •AS-BUILT MEASUREMENTS(• No. A $ REMARKS E?,l 3 V91 5 q5 3o 'L- E 10 7- � tZ 7-- 15 -15- r� j(o G i q, - � w f L'L' S �i• 3g5' YUTNAM COUNTY DEYARTAUNT OF HEALTH „_ DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL STI'E INSPECTION Date:lp ILI 7 e Inspected by: Street Location Z v4i n f) -1v.1 y111 z Town 4eebors TM #�: 1. Sewane 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. 1 00' from water course / wetlands ...... ............................... 11 Sewage System a. Septic tank size - 1,000e ./....1, 250 ......... other ................ b. 'Septic tank inst vl. ............ ............................. c. 10' minimum from foundation .......... ............................... d. Distribution Bog 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3... Minimum 2 ft. Original soil between box & trenches e. Junction Box properly set .......... ............................... 6. Trenches 1. Length required Length installed 2. Distance to watercourse measured j- j ! Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32” /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................`. 7. Room allowed for expansion, 1000 8. Size of gravel 3/4 -1'/2" diamet._ cle s 9. Depth of gravel in trench 12" minimum..:..... ...... 10. Pipe ends capped ........................ ............................... g. Pump or Dosed Svstems 1. Size of pump chamber ................. ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual/ audio ........:........... ..............0................ 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Building a. house located per approved plans .............. IV. Well located as per approved plans . ......:........................ b. Distance from STS area measured, f:2-`_ ft... - c---- Casing--1 -8 "above= grader `} s d . " . Surface_dramage =mound well: t4k167. Overall Workmanship a.. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............: e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ........ :........................... i. Erosion control provided ................. ............................... Rev. E02 V. Owner C.arroi I Permit # p— 17— 03 Subdivision Lot # • - COM 4ENTS fsr 82:8T C13M t7 O2-2T-1:)0 1UM-16-00 SAT 9:07 AM PUNAM CTY ENV RALTE PAX NO, 1914'11787921 r. PUTN" COMM DEPARTMENT OF EZ"TH DMUON OF ENVMONMZNTA3L RMTH SUMCES kITETMON 12 ADAM Ozm*z,- REQ=1 FOB ZMAL ]NOMION: For. IR AU Jafomation must be fishy completed prior to any Trenches inspections Wing made. PCHD Construction Pftvvilt is 01) Located: AO)fjj Cr) (v). Omer/Applicant Name- PVJL-(-1 d2l L4rdZe -TM ;2-g -14 Black I - Lot .M- -Ila Subdivision Name' . Sitb"on Lot # is system fa completed? Date is system complaq? Date. y e--s 13 system constructed as per plain? Is well drilled? Date- Is WCU looted w per plan!? Are erosion control measures in place? I cc* that the system(s), as listed, at the above prep 'ues buss been commaed mad I We haycvted and verified their compWon in accordance with the Imod PCW Coss mcdoa Permit and approved plans and the StwWards, Rants and RegWallow of the Put= County Dqwftont of Health. . Certified by: -7pE r A RA Date- '14 ju,0AA -2 -77 COMM", Form M-99 058cl !V1d80 :/- t'0-64-400 :Aq }uaS a 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 October 20, 2004 John Karell, Jr., PE 121 Cushman Road Patterson, New York 12563 Dear Mr. Karell: ROBERT J. BONDI County Executive Re: Field Inspection — Carroll Ludingtonville Road, (T) Patterson TM# 22.16 -1 -6 The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. 1. The stone used in the SSTS trenches has a significant amount of fines and is considered marginal. Only clean crushed stone or washed gravel can be used in SSTS trenches. 2. A bedroom count must be performed by this Department upon further completion of construction. 3. The well casing must be 18" above grade at a minimum. Furthermore, grading must be completed to ensure proper drainage away from the well. If you have any further questions, please contact me at 845- 278 -6130, ext. 2261. Sincerely, '4� -0, --64 Gene D. Reed Sr. Environmental Health Engineering Aide GDR: cj PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL, HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # P-14-03 Located at L-u b I W 61 To d V I t—i—lz-- A D Town or Village Subdivision name iPATFe-92sON0 - -) Subd. Lot # Tax Map ;-2. ( t Block i Lot Date Subdivision Approved Renewal Revision A, �r11 t.�.l C i� Owner /Applicant Name .54 - ate of Previous Approval l _ -I I 0 -� Mailing Address l S 0 G C fF 6 0 t l4E 0-6 A-0 MI-K-156-0 NY Zip ) v Amount of Fee Enclosed Building Type W00.0 J�6 Lot Area 12A- No. of Bedrooms 3 Design Flow GPD & cro Fill Section Only Depth Volume Separate Sewerage System to consist of k OO d gallon septic tank and I s- LF �-4.T M�j C t+- Other ;Requirements: To be constructed by �J Address chfl -lt Water Supply: Public Supply From Address or: _ & Private Supply Drilled by 6,/i'_ Address 43 "5jP 2. � ? 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 following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date 3l 1® License # —573 Z-7 l L.73 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatm system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w en co Is idere ecessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe proveAAr discharge of domestic sanitary sew e nly. c� sy: 3 Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 0 PUTNAM, COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # F—/9-0,3 Located at W 0/ l0 C `d 1 J V I LX451/ U iD Subdivision name Subd. Lot # Date Subdivision Approved Owner /Applicant Name9� 1 ? /,�j/ Cri w���i Mailing Address J Sj cC G,.4 uya A 4, s hL Town or Village r +%� e /V r/ Tax Map ?;7—'i6ock I Lot 4 Renewal Revision Date of Previous Approval ICd IV OSY4 Zip Amount of Fee Enclosed o Building T yp e Lot Area ,Jz *-e o. of Bedrooms Design Flow GPD &00 . Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1000 gallon septic tank and Other Requirements: To be constructed bye p P-, t xe Address _6"n-.44 Water Sunaly: Public Supply From Address or: k Private Supply Drilled by &GQ 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 following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. P.E. %` R.A. Date /1 v Address%, !� d�AJ 1�% ij�� License # X77 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w onsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires anew perm proved ischarge of domestic sanitary sewage only. B y: Title: Date: V White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 LORETTA MOLINARI R.N., M.S.N. Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845)278-6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278,- 6014 Fax (845) 278 - 6648 November 4, 2003 John Karell, Jr., P.E. 121 Cushman Road Patterson, NY 12563 Re: Proposed SSTS: Carroll Ludingtonville Road (T) Patterson, TM# 22.16 -1 -6 Dear Mr. Karell: 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 have not been submitted. 2. If the proposed barn is to have footing drains, the barn must be proposed a minimum of 50 feet from the SSTS, it downgrade. 3. Neighbor Notification has not been completed. 4. SSTS hydraulic profile is not legible. 5. House footing /gutter drain discharge has not been shown. 6. USDA soil typ and soil boundaries, if existing, have not been provided. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. 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 ruly yours, A 4'�o Robert Morris, P.E. Senior Public Health Engineer .,U LORETTA MOLINARI R.N., M.S.N Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845)278-6130 Fax(845)278-7921 Nursing Services (845)278-6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 John Karell, Jr., P.E. 121 Cushman Road Patterson, NY 12563 RE: Carroll Ludingtonville Road (T) Patterson, TM# 22.16 -1 -6 Reservoir Basin Dear Mr. Karell: ROBERT J. BONDI County Executive October 15, 2003 The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on October 6, 2003 is complete. The Department will notify you by November 6, 2003 of its determination. The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ® Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of r Letter to: John Karell, Jr., P.E. - October 15, 2003 -2- Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2166. Ve truly your Robert Morris, PE RM:tn Senior Public Health Engineer Ce � _ l o W '1625- October 22, 2003 �Ilerw�rlC, Department of Environmental Protection Robert Morris, P.E Putnam Co. Health Dept. 465 Columbus Avenue 4 Geneva Road Valhalla, Now York 1059s-1336 Brewster, NY 10509 Christopher 0. Ward Re: William and Theresa Carroll Residence -SSTS Cartirraissiaraer Ludingtonville Road Patterson, Putnam East Branch Reservoir Tax Map # 22.12 -1 -6 DEP Log # 14126 (Joint Review) Dear Mr. Morris: C) CIO U_, Bureau of Water supply This letter is to inform you that the New York City Department of Environmental Michael A. Principe, Ph.D. Protection (Department) has determined that the above - referenced application is Deputy commissioner complete. In addition, the Department has no objection to the approval of the To (9i d) 742 -2oot ' above- referenced regulated activity. This determination is based on the review of Fax (sta)na o343 submitted documents including the plan titled "SSTS for William and Theresa Carroll ", dated 09/10/03. The applicant must contact Sissy De La Ossa of my staff at (914) 773 -4416 at least 2 days prior to the start of construction of the SSTS so that a Department representative may inspect and monitor the installation. Sincerely, c Danny Shedlo, P.E. Project Manager Project Review Group ORKCITY DEPARTME� O� xc: John M. Dunn, P.E., NYSDOH RM O ��'RONMENTALPROt��` www.nyc.gov /dep (718)'DEP -HELP Sent By: LLL; 1234567 ; �&KWAN Rpia $u!10) 148 Oslo ztgsss taryct;tstcodsaa aloe aq; a4 eras ;l'�ugsai ros alp ssanquA of laanbasgns naql pm asQOdsa aAOq>a aqi no PaNq paid u2mx alp flIoQjd gig Tia ftq. m pPg jai marl aIquiF .39 ssaulpL mm dgowsaaRmh aq 3 pfd. "?p ;Pa[o td ja(r •2uqpl ltos of iogd uoq. uuo jm. aaogs sq; aputpad of peuo,, vanoba c 3�maad szoas o 6t♦plsaouss coot uagp RPM4 •Puepaes 3(l V.10 asmoa t 4vAL s ;o i1 I lo4uoa .to w;s qoAnsat'xroAtasai s 30 121 •2110AI29011 -DWOD sphg xo 43= 18 40J& JO u!nq OSUMI : #arm xtia ® USUM t$ 0 :SD*d f --� v soma 0 1 � � =3Li'�'Q •�u3npagas L� of Loud Aug -19 -03 10:21AM; Page 1/1 - tLS31t1'1�9 . J ff f 24 A�� alnpagas ei isuolssa3oad uS;sap oqi ;a aimbaa q dgaJM saas»puc aogv=0jsq T'aq of paupu alap uaaq aq pafud vjj 'd MAK Pm Faolssa ;old c [mtn}nya a a4"V. loo, jM ivauq"da( ;o [tts 01 W pa WA M R04L jj `asaodsa c LN aqi ausmraloP MUL auamusdaq sqZ . . sa;atd Amp aip jo [lgtgcsuodrai aql sr i� ntroz) is poi sus pasoda'a idl n aog U21saP SZSS posodoad .,)d o 00Z uW. SjSS gasodaaa o OOS u! "4 SxSS Pasadoad -�{ o P aqi mlqjA SM pasodoad o ON m r111� Wolswafflis A WA01 5-07144 lQ �n� g 6 0 Sol. ®A �?x . Pte' tu►atrar� f i . .. • AJIILL.'4 7 M.Li 3® J.hi ' AIJG -19 -2003 TUE 10:05 TEL:845 -278 -7921 Vg aq dsnm A+o @q uopBaugpq Ur Lsi' ayo WOUN31.• y 01- JmWa VIM '1 rw .> mo3 id Sonia n NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 "W v d lm aot9.ju lts n `' "'ra m low Y.WSHV 4 AIJG -19 -2003 TUE 10:05 TEL:845 -278 -7921 Vg aq dsnm A+o @q uopBaugpq Ur Lsi' ayo WOUN31.• y 01- JmWa VIM '1 rw .> mo3 id Sonia n NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 d. 5. C. e Carmel WA.— LW 12531 / 311 I 1 1 i o { 4 �.. 84 unER ��✓ � T WNE1 A 9 1 RO LUCIL SO DLLCREST.. RD ✓ ay Q I ) RI I FM 6U Zf i Z C f I F1 I 1 rners 84 ,a AY'�P . LONGVIEW. -AAh _ _ ■ IOT rr r .c TO - .a.., O'Q6' I / i. `1y 4S q1,,a 22 6 e 12.26 AC. CAL. N I I 4 � 751.61 1 2.45 AC. LIJ Z Y 6, , A o I•/ y' N� I� 1 1.01 Aye eti 65.97 I 9, `�• 7 9 2t a 1.22 AC. CAL. 18,41 AC. I w 4L ti`1 9r I 8 •�' e L26 AC. V\ lF B 3.1 1 1.34 AG 6� 2 2.44 AC. 1 �r BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Date: 6 AL 7 L I To: f Dd,�-, ,21NzWt5 i- 7Z-e! PII Dee-lg--.- From: Gene D. Reed Putnam County Department of Health ZFor your Information For your review As discussed Notes/Messages P Fax #: 77 3 © 3 S5 No. Pages (Including cover sheet) —/Please respond Attached as requested Please call i CL n �5 In the event of transmission /reception difficulties, please contact this office at (845) 278 -6130 ext. 2261. 0 SENDING CONFIRMATION DATE AUG -27 -2003 WED 11:01 NAME PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 919147730355 PAGES : 4/4 START TIME : AUG-27 10:58 ELAPSED TIME : 0214011 MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... BR17C8 R POLBY [.ORFITA MOLINAaI R.N., M9.N. P.b& Areah Dtrearar Analarr PYWM 1l-M DDVWW Dbeeen q( Patlarr Serrber DEPARTMENT OF HEALTH 1 Gown Road &.water, New York 10509 saNrmmM R ae t,s3(us)>•r3.2124 P"(845)779-7921 x1 HMPa dm (947)x73.6153 Wn: (94S)273.3673 Pa(945)211.605 duly/mu do (945)273.6014 Prmawat "r 27160R2 Fu(545)271.6941 �R C� V •R� BHFL P . Date - To: Nf&k Z 1A&W'6 f[ I Fax b: 77 3 0 3 S No. Pages T (Including cover shut) Fram• Gene n ji�ral Putnam County Department of Health _ZFor your information __Z/ Please respond _ For your review Attached as requested As discussed Fleas. tall Notes/Metsagee P 4 D o 4/ 6 14 Q e> ,ob ZJ -'d m l tRLg& on A,g 1prwen o-6 7Z1'7 l / "I e., Oj„� �., [tP /n 1 nn /JQ,N t•5 I n4G In the event of transmLeMn /reeaption diffieultiesr please contact this oDlu at (e" 278 -6130 ext. 2261. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner A2RDGG Address Ly7prn/67 -dN i/G16 VfeAn Located at (Street) 7Lt, 31/ Tax Map a.2. )2Block _� Lot (indicate nearest cross street) Municipality, _ .4�rf,,-_g!-50A/ Watershed -,6,f5 'jzA11G1-1 SOIL PERCOLATION TEST DATA Date of Pre-soaking f / 5 %03 Date of Percolation Test 9 J16 &O� NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be sufamitted for review- 2.' Depth measurements to be made from top of hole. Form DD -97 :« :::> :;.:::; t ............. e......:......:::. titer.:.::::::. <.::::; :::.::..::...:..:..:.... ..:::::::.:..::::::..;.. N :.. ..... ;:<:. .:...:.::::.: ;:.:��::: > "' .. a ` ::T' e : se::..�,::.:::: :::.. G .o.und ......:::::::: >::: n:r ace; ::.. ::.;:.:;::. �..,f ..:: .. niches .:;::..::.fro Level.;.:;:.:. . :J<n .: .::::::::::...Mate..:,:: p >:;:Perc o anon. . >::.:.. : >:< ::: tat: > -::StQ :.................. >:<: »:<::<:.. » En.....:.......::> : >:<5tart;:::::<:;: »::eta J 1 10'07-V37 -,7,0 of -2.7 3 10 3 Iola- 1/1 fl 3r ?—v — A7 3 O 4 5 2 1 0,'0 As /-3,-3 2 /0 3_0 2-y— 6 X 2-144 13 i3 4 5 2 /0: 1q r kg 30 2 3 //',4q 3co 24 - 1- 6 2 15-- 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be sufamitted for review- 2.' Depth measurements to be made from top of hole. Form DD -97 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' T 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST FIT JDATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. ) HOLE NO. HOLE NO. 3 Indicate level at which groundwater is encountered Alo&E Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: R 2�,�0 % a 7�� Z, eggge, Date I o P. G.D -W. D.9, P. Design Professional Name: Address: Signature: . � a Pr -2 4�N�l Design Professional's Seal l 10 PITTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project 0472 DL I_ �' ) l`�% �2 /11ounty 1D g LIV,- Site Building construction begun Extent Is property within NYC Watershed ? ................. Yes F-� No SECTIONS. TOPOGRAPHY (Please check all appr7entle.slope ' to boxes) 1. � Hilly- 0 Rolling Steep slope F7 Flat $eloA✓ 4;04are'L 2. 0 Evidence of wetlands 0 Low area subject to flooding F7 Bodies of water 0 Drainage ditches F7 Rock outcrops 3. Property lines or comers evident ....................... ............................:.. 4. Do water courses exist on or adjoin the property? ............................ 5. Will these affect the design of the sewage system facilities ?............ 6. Do watershed regulations apply in this development ? ....................... 7 Will extensive grading be necessary? ................. ............................ .... 8. Will extensive fill be necessary for SSTS? ......... ............................... 9. Do filled areas exist within the SSTS area? ....... .......:....................... If yes, what is the condition of the fill? 0 'des ENo Yes No Yes a No H Yes Q No Yes Fzr, 0 F7 Yes No' aYes No SECTION C. SOIL OBSE VATIONS 10. Appearance of soil: Sand F7 Gravel � /Loan Z—Clay � Hardpan F7 Mixture 11. Observed from: a Borings 0 Bank cut Backhoe excavations 12. Soil borings /excavations observed by Ga 'gZ,6Ep ? G.P 1=t , on 13. Depth to groundwater Alt?A)6—� on 14. Depth to mottling NO;c1 on 15. Are test holes representative of primary & reserve areas ...... ................:.............. 16. Soil percolation tests made by .05�y,ti AA72 61- L P on 17. Soil percolation tests witnessed by Z n '? c, ]z i::A� on . SECTION D (on back) N Form ST -1 2 SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? 0 Yes dNo 19. Will groundwater or surface drainage require special consideration? ...................... F-]-Yes o 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ....................:.... 0 Yes No SECTION E. REMARKS 21. If a common water supply is proposed; has an inspection been made of the existing or proposed source and facilities? ................................ .....................:......... F� Yes J`No Inspection data 22. Do adjacent wells and/or sewage systems exist? .... N.s :..41s .I 9 A .... t ..`......... Yes ffF-1 No 23. Additional comments 24. Site observer /inspector and title �� 706912 e9. G. V. 1-t , 25. Date(s)- of observation(s)inspection(s) , /d TEST PIT PROFILES Hole # Lot # Hole # Lot # Hole # Lot # Depth to water Depth to water Depth to water Depth to mottling Depth to mottling Depth to.mottling Depth to rockhmp. Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L. 0.5 .0.5 0.5 1.0 1.0 1.0 2.0 2.0 2.0 3.0' 3.4 3.0' 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 ADJACENT PARCELS CARROLL PROPERTY TM # 22.12 -1 -6 Owner: Patrick Walsh 141 Gage Road Brewster, New York, 10509 Patterson 22.12 -1 -4 K & K Brothers, LLC, 49 Mt. Torn Road, Pawling, New York, 12564. 22.12 -1 -5 Angelo Senno, 240 Drewville Road, `Carmel, New York, 10512. 22.12 -1 -7 Louis DiSalvo, 80 Ludingtonville Road, Holmes, New York, 12531 22.12 -1 -9 James Armour, Royal Dane Mall, St. Thomas Virgin Islands,00802.. Kent 0 22. -2-44 New York State 22. -246 K & K Brothers, LLC, 49 Mt. Tom Road Pawling, New York, 12564. f November 10, 2003 RE: Department of Health Review of Proposed Sewage Treatment System for Property Carroll ( Walsh ) Ludingtonville Road Patterson (T) TM # 22.12 -1 -6 Dear Neighbor: Please be advised that an application for a Construction Permit relative to the construction of a sewage system and /or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any questions, concerns or information which may bear on the Health Department's review of this application you may call the Health Department at 278 -6130. Very truly yours, 0 Title: Received By: Address: Tax Map #: Ir Q ru�4 D r B a - O• • • - • ro - o O Agent X ressee so that,live can retilm,`the card to you CERtI IEIED ,11lIr RECEIRT; ® :Complete dems'1 2 and3 Also complete , Agent (Dornestrc Marl y��tN,o��,l�nstiranceMCovera In Pro�v� dad) � 1� AFC Pnnt -your name .and address 6mthe reverse ^e *� 7 ❑:Addressee so that:we can return the card to you by (Pnnted;Name) -0 0 Postage $ 0.37 UNIT ID: 17910 or on the front,if'space permits. <, ❑Insured Mail o: CAD. 2.30 C3 Certified Fee . 1. Article Addressed to. - D Is delivery address different from it if YES, enter delroery'address'below r r r 1 ° 75 Postinwk Clerk.: KQf�C re 11/12/03 Holms, New York 12531 O. s. seN Type I! - Certified Mail 0, Express 'Mail Sent To ' ❑'Registered ❑' Return •Receipt•for,Merchandise': i Street Apt. Alo.; f 4. Restricted DeliveryZ 65rtra'Fee) a or PO Box No. I 2 Article Number (fransferfro m service label)' e �.1PS.Forrri 3811 'A. u' 2001 i t 1 z'; Domestic Return Receipt - i 0- r orm 3800 April 2002- See f,1e_�erse f_or Instructions Ir Q ru�4 D r B a - O• • • - • ro - o O Agent X ressee so that,live can retilm,`the card to you ivied by ( nnf 1Vame). ,' . ® :Complete dems'1 2 and3 Also complete , 7§i Agent In FA P!G Y A 1� AFC Pnnt -your name .and address 6mthe reverse r *� 7 ❑:Addressee so that:we can return the card to you by (Pnnted;Name) -0 0 Postage $ 0.37 UNIT ID: 17910 or on the front,if'space permits. <, ❑Insured Mail o: CAD. 2.30 C3 Certified Fee . 1. Article Addressed to. - D Is delivery address different from it if YES, enter delroery'address'below Cl -p rO 0 ru Retum Receipt Fee (Endorsement Required) Restrlofed Delivery Fee (Endorsement Required) Total Postage S Fees 1 ° 75 Postinwk Clerk.: KQf�C re 11/12/03 Holms, New York 12531 O. s. seN Type I! - Certified Mail 0, Express 'Mail Sent To ' ❑'Registered ❑' Return •Receipt•for,Merchandise': i Street Apt. Alo.; f 4. Restricted DeliveryZ 65rtra'Fee) a or PO Box No. I 2 Article Number (fransferfro m service label)' e �.1PS.Forrri 3811 'A. u' 2001 i t 1 z'; Domestic Return Receipt 102595 02- M71035 i 0- . — --T k' A Signa ¢ item 4 if'Restricfed Delivery . Is desired j rint your name and address `on the reverse ' O Agent X ressee so that,live can retilm,`the card to you ivied by ( nnf 1Vame). ,' . ® :Complete dems'1 2 and3 Also complete , 7§i Agent okon the front if spacwpermits:' ' D Is delivery,add' different from item 1 �: If YES, enter delivery.. add ress below.. , No. 1 Article, Addressed 10: 1 Pnnt -your name .and address 6mthe reverse K81K Brothers, LLC *� 7 ❑:Addressee so that:we can return the card to you by (Pnnted;Name) C.:-D, a of D ery., i ® Attach this card to the back +of ffie mallpiece Certified Mail ❑;Express Mail i\ - ❑ Registered ❑ Return Receipt foe. Merchandise, or on the front,if'space permits. <, ❑Insured Mail o: CAD. 4 Re005ted.Delivery4 „(Ex(ra Fee) ,,[:].yes /O . 1. Article Addressed to. - D Is delivery address different from it if YES, enter delroery'address'below ✓ ❑ No' j Louis DiSalvo 1 80 Luddington Road Holms, New York 12531 s. seN Type I! - Certified Mail 0, Express 'Mail ' ❑'Registered ❑' Return •Receipt•for,Merchandise': i ❑ insured. Mail,',• O -CO.D. f 4. Restricted DeliveryZ 65rtra'Fee) a ❑Yes I 2 Article Number (fransferfro m service label)' �.1PS.Forrri 3811 'A. u' 2001 i t 1 z'; Domestic Return Receipt 102595 02- M71035 i C6r iplefe Items' 1 2, and"3 Also complete: A Signa ¢ item 4 if'Restricfed Delivery . Is desired j rint your name and address `on the reverse ' O Agent X ressee so that,live can retilm,`the card to you ivied by ( nnf 1Vame). ,' . C: Data Deliye ® 'Attach this card to the;back of the mallpiece 1 okon the front if spacwpermits:' ' D Is delivery,add' different from item 1 �: If YES, enter delivery.. add ress below.. , No. 1 Article, Addressed 10: 1 K81K Brothers, LLC *� 7 49 Mt. Tom Road Pawling, NY 12564 s se ype. Certified Mail ❑;Express Mail i\ - ❑ Registered ❑ Return Receipt foe. Merchandise, - -T - — _ ❑Insured Mail o: CAD. 4 Re005ted.Delivery4 „(Ex(ra Fee) ,,[:].yes 2 Article Number r� from ransfar seance label PS form 38'11 August 2001•`' d ? Dorr1eS11C Retiim Receipt 102595 -02- W1035' 1� I U.S. ., Postal Service CERTIFIED MAIL RECEIPT (Domestic mail Only; No Insurance Coverage Providec C3 U.S. Postal Service C3 Ln ST 0 � rfko-6. II I rood A 7 T f, L U ru, (Domestic Mail Only; No Insurance Coverage Provided) Postage $ 0.37 UNIT T IN 0910 C3 OCA&AW 1059 1 A L U S E. r'n C3 C3 Certified Fee 2•30 Postage C3 _a Return Receipt Fee (Endorsement Required) UNIT IN 0910 1.75 Postmark Here cc 0 C3 Clerk: KQRCDD C3 RestrIcted Del_" Fee (Endorsement Requireo C3 Return Receipt Fee fu 7bW Postage & Fees $ 4.42 (Endorsement Required) 0 Here Clerk: KGRCDD C3 r%- sent or PO Box No. CRY, State, 27P+ 4 or PO Box No. ------------------------ - --------- - ----- :�: Complete items 1,-2 and ,&.', Alsocomplete A. ignature.. 'gent ❑ Restricted Delivery is desired, item 4, if est Adressee ■ Print your name and:address on the reverse b so that we can,rettim' the -card 'to.yoU.. led Nam C. Date of Delivery Aftachthis,card to the back%of,the mailpiec or on the4front if space permits' it ern Is delivery address 1? ❑ Yes 1. Article Addressed to: IfYES,'e4rd lvery.addres't -0 -No s be ow. ;1verv, lqm�r�- U l Angelo Senno 240 Drewillp 4; Carmel, Ne-1ji*,,"fK z J. pie- , 3:� Ic a T y Ceitifidd Mail ❑ Express Mail ❑ o6l., 40,Retum Receipt for Merchandise C.O.D. 3),IA135 Ins ail [I -7:777-7777-=7 .4 C dt D i (Extra'Feq) ❑ Y6,s 2. Article ftNumber, , f 002 MY -?500 244? N (rranv�r - SL PS, rorrn -881'1: August 9001 Domestic R6 t urn Rec.,i , 10259602-M-1035 U.S. Postal Service CERTIFWb MAICRECEIPT ru, (Domestic Mail Only; No Insurance Coverage Provided) r-3 0 I OCA&AW 1059 1 A L U S E. r'n -a Postage $ 0.37 UNIT IN 0910 0 0 C3 Certified Fee 2.30 C3 Return Receipt Fee 1.75 Postmark -a (Endorsement Required) Here Clerk: KGRCDD cO O Restricted Deffirery Fee (Endorsement Required) rU Total Postage & Fees $ 4.42 11/12/03 C3 F_777_79 ............ . .. ......... or PO Box No. ------------------------ - --------- - ----- :�: Complete items 1,-2 and ,&.', Alsocomplete A. ignature.. 'gent ❑ Restricted Delivery is desired, item 4, if est Adressee ■ Print your name and:address on the reverse b so that we can,rettim' the -card 'to.yoU.. led Nam C. Date of Delivery Aftachthis,card to the back%of,the mailpiec or on the4front if space permits' it ern Is delivery address 1? ❑ Yes 1. Article Addressed to: IfYES,'e4rd lvery.addres't -0 -No s be ow. ;1verv, lqm�r�- U l Angelo Senno 240 Drewillp 4; Carmel, Ne-1ji*,,"fK z J. pie- , 3:� Ic a T y Ceitifidd Mail ❑ Express Mail ❑ o6l., 40,Retum Receipt for Merchandise C.O.D. 3),IA135 Ins ail [I -7:777-7777-=7 .4 C dt D i (Extra'Feq) ❑ Y6,s 2. Article ftNumber, , f 002 MY -?500 244? N (rranv�r - SL PS, rorrn -881'1: August 9001 Domestic R6 t urn Rec.,i , 10259602-M-1035 PS�Form 38'0_Q�, April 20C Conp1 ete:item's 'nd'3. .Also.cbmp ' l t W item 4-,if�R4siriqto, Delivery ,,is desired .' I e, Agent - r:I n `❑ , Addressee h so we can return t e card to .you iM, Attach this card to f I -thO;Oack,,o:the mai piece B 7 (frintZZ e)' C. b e,of E'Llivery ed b -.'or on� the front if space permits. ru �1� TIT, C3 A C3 -n 0 ST �ff C2954 A L U S E Ij 17� Mr. Ken Lutters . 1 0. 13 UNIT ID: 0910 -0 Postage $ PO Sox 308 Staatsburg, NY 12580 3.-.Service Type C3 Mail '0 Ekpres s Mail C3 2.30 C3 Certified Fee 2.: Articl Number qkansfer. from service labeO 1. 1FJ Postmark 102595-02-M-1035 C3 Return ReOW Fee Hem ,n OMorsement Reciulred) erk: OR CDD 43 ResWcW Delivery. Fee C3 (Endorsement Required) 4.42 11/12/03 ni Toted Postage & Fees C3 C3 Sen I To No.; or PO Box No. PS�Form 38'0_Q�, April 20C Conp1 ete:item's 'nd'3. .Also.cbmp ' l t W item 4-,if�R4siriqto, Delivery ,,is desired .' I e, Agent - 1, Print� the - reverse` - -C -your name and address on the `❑ , Addressee h so we can return t e card to .you iM, Attach this card to f I -thO;Oack,,o:the mai piece B 7 (frintZZ e)' C. b e,of E'Llivery ed b -.'or on� the front if space permits. D.- Is delivery address different'frorn item I?' t! Yeg 1. Article Addressed to: If YES, enterdelivery address below: ❑ No Mr. Ken Lutters C/O New York State Parks - Taconic Region PO Sox 308 Staatsburg, NY 12580 3.-.Service Type Mail '0 Ekpres s Mail V.Certified Registered ❑ Return,Receipt for Merchandise ❑ insured Mail ❑-C.O.D. Restricted Pelivery? (Extra Fee) ❑ Yes 2.: Articl Number qkansfer. from service labeO P9 IFOH d Au4u :. ' "Vt Obl D"t] C ReturmReceip! 102595-02-M-1035 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: I LL i L' S zCA-8vNJG lu KIS�� Jos 2. Name of project: CA240 "i-4.- 1=67" 3. Location TN: 4. Design Professional:Tp dlJ �� ,t i_ „ 5. Address: _1 Z( CUB f' 6. Drainage Basin: M j Opig wn- f P47t X -45elk) A) Lr / Z„5 6 j 7. Type of Project: Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted X 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... A/0 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? .........................Nr/v.. - ..!'...................... $ 13. If so, have plans been submitted to such authorities? ........ ............................... �$ 14. Has preliminary approval been granted by such authorities? Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water X groundwater . 16. If surface water discharge, what is the stream class designation? .................... 17. Waters index number (surface) ........................................... ............................... 18. Is project located near a public water supply system? ....... ............................... AlO 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ 21. Name of sewage system Distance to sewage system 22. Date test holes observed i 23. Name of Health Inspector-4a -e 4ee el 24. Project design flow (gallons per day) ................................. ............................... l(lo 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... AJ 26. Has SPDES Application been submitted to local DEC office? ......................... Form PC -97 Q /00 27. Is any portion of this project located within a designated Town or State wetland? 1N+ 0 28. Wetlands ID Number ... :...................................................................................... 29. Is Wetlands Permit required? .............................................. ............................... Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ............................... 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No a 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No d DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... 35. Are any sewage treatment areas in excess of 15% slope? . ............................... _Lo Nd 2 NO 36. Tax Map ID Number .......................... ............................... Map ?• D Block____ Lot b 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 review and approval. If the application is signed by a person other than the applicant shown in Item l.,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to SIGNATU ES & OFFICIAL TITLES. Mailing Address: ................................... 14.164 (9195) Text 12 PROJECT I.D. NUMBER 617.20 SEOR Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only. PART i— PROJECT INFORMATION (To be completed by Applicant or'Project sponsor} 1. APPLICANT /SPONSOR Wi W 'x. 544 - 4:�4iefz& toC� 2. PROJECT NAME � t� L/1L- . 3. PROJECT LOCATION: �a Al �) "� nleipality / x✓ County 0° �✓/ f `� °/ 1 4. PRECISE, LOCATION (Street address and road Intersectlona, prominent IandmaA 3. etc, or provide map) 718 A/ if i LL 0— 4-0� /v �' J t� b✓ �r 5. IS PROPOSED ACTION: Klew ❑ EXpanslon ❑ Modiflcatlonfalteration 6. DESCRIBE PROJECT BRIEFLY. C ®,W7AUcnaA) O,' ff SIAJO L& 1'4Mt(_i 0#0V:s_.1 13.1toW W z_•e_ W i'779- dR141L-`Vr*r PV24 LIV O/ Aell� 1�7N Vr 4_& lze 7. AMOUNT OF LAND AFFECTED: _L_ Initially acres Ultimately acres 6. WILL PROPOSED ACTION COMPLY WITH, EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? IYes %Vo No. ,/It describeWelly " �f , �,, ® �J 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ORe3ldential ❑ Industrial ❑ Commercial ❑Agriculture ❑ ParWForestlOpen spats ❑ other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL. STATE OR LOCAL)? ❑Yes *0 It yes. list agency(s) and pennitlapprovals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? ❑ Yes WO It Itst yes. agency name and permltlapproval 12. AS A RESULT OF ROPOSED ACTION WALL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yea o 1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE /0'j k Appilcantlsponsor name' Date. Signature: It the action Is In the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR, PART 617.47 If yes. coordinate the review process and use the FULL EAF. Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? It No, a negative declaration may be superseded by another involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) Cl. Existing air quality, surface or groundwater quality or quantity.-noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage a flooding problems? Explain briefly: C2. Aesthetic, agricultural. archaeological, historic, or.other natural or cultural resources; or community.or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change In use or intensity of use of land or other natural resources? Explain C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not Identified In CI-05? Explain briefly. C7. Other Impacts (Including changes in use of either quantity or type of energy)? Explain briefly. 0. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA? ❑ Yes ❑ NO E. IS THERE, OR IS THERE LIKELY TO BE. CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No It 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) Irreversibillty; (e) geographic scope; and (Q magnitude. it 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. If question D of Part 11 was checked yes, the determination and significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CFA ❑ 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 andfor 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: Name of Lead Agency Print or TVpe Name —of esponsi a Officer in Lead Agency Title of esponsi ricer ignature of Responsible Oilicer in Lead Agency Siriature of reparer III dilltrent Itom respomi e o 1X-11 Date 7 f 1 1 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address t u L-c j& Located at (Street) vd 2zli (04_44" Tax Map 16ock Lot (ndic!,2*est cross street) s-r Municipality Watershed Watershed G? SOIL PERCOLATION TEST DATA q ((,i- 10,3 - '3 /N /0 3 Date of Pre-soaking Date of Percolation Test . . . . . . . . . . . . . . . . . . t -:D e I ro r LU,'G a 'T kSWA w Ei jx. Met v' 105, 3o 2 7 3 to )1-40 4 5 47) 1011 051 30 2 3 113 1143 4 5 qq %q 3 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. :5 1 min for 1-30 mirLfinch, :s 2 min for 31-60 rnirLlinch) All data to be submitted for review. U0 hole. 4. Deoth measurements to be made from+ no- a TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. G.L. 1 0.5' 1.0' 2.0' 25 3.0' 3.5' 4.0' 4.5' _ -- 5.0' 5.5' 6.0' - 6.5' 7.5' , 8.0' 8.5' 9.0' 9.5' 10.0' ; HOLE N0. 1- HOLE NO. 3 661 .... .. . .. ....bd(5..: L 2 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: , �" . tLt UL6 sSgr„ DFP .JJCDate % 0 Design Professional Nam Address: k 71 / Signature:. fit/Y I Design Professional's Seal EW u.1 w w,� z 53 Fp PROFES`'`O y Sn� r/ S PUTNAM COUNTY DEPARTM[ENT OF HEALTH DIVISION OF ENVIRONWNTAL HEALTH SERVICES RE: Property of Located at TN Subdivision of .- LETTER OF AUTHORIZATION Tax Map # 22-• Block _ Lot Subdivision tot # Filed Map # Date Filed Gentlemen: This letter is to authorize a duly licensed Professional Engineer /---or R t to apply for the required wastewater treatment and/or water supply permits) 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. NEW Y 'Countersigned: P.E., R. &, # . /Ax S��L7 ic�2 532�p�P. Mailing Address SFO p o� 1 h4 Very truly yours Signed: (Owner O P OM) Mailing Address: G P4- 4) c State Zip State U hi-2 Zp Telephone: _ _ Telephone: 01 / Farm LA -97