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Home My WebLink About0564DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -1 -28 BOX 7 rum 111. Is 1111 1 1 oil I �I . k.1 ob- � 00564 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE F,�R SEWAGE TREATMENT SYSTEM kr o PCHD CONSTRUCTION PERMIT # P 3 D i Located at 'L5 SomiCA:er 7Riy€ Town or Village PA T1 -CRSoAI Owner /Applicant Name R C I LLY c ant r reyeT1 o.N Tax Map 2 3 Block Lot Z8 Formerly A hkAgi S- ft-vta Subdivision Name 60k,/VW ALt_ k 11) G E, Subd. Lot # z $ Mailing Address f ; S M A 1.4 stR f- 9T SQEwsTbR r1Y Zip 10 -' 5 Date Construction Permit Issued by PCHD '. - L( -to -Z Separate Sewerage System built by RgiLLy coe►s-rjevc7-1oA1 Address 15y MAN sreesr g2EwsrE��,� 10.90q Consisting of , ovo _ Gallon Septic Tank and 300 i. F F --L' w ry 6 A BsoeP 'ri on/ Other Requirements: 2` Mid. R,0.0- 6-CA v C L frh- L Cq s o "f Water Supply: Public Supply From, or: Private Supply Drilled by /11 14'M Tr Address !oip .Rl. 311 OA.rreexoo ✓,, JV Y Address Building Type R ESI-pE,vf1A L Has erosion control been completed? yic: Number of Bedrooms 3 Has garbage grinder been installed? NJ I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: ! o --,I q —0.1. Certified by elf _ P.E. ;'c -ft.*- Address SNS1TiC CNa,,,j"AJ*A1ts, ;4f,&G GANAsCAR0 A:CCN f rEc7VA0 ' f License # C/ q 3 / CA.e/A6, IAIY I °T/b Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction ofany 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 a subject to modification or change when, in the judgment of the Public Health Director, such revocati, n, difica change is necessary. By: r6GV Titl�� Date: d'l i3'< 6 Z" White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 i r ❑Cash ❑Check M O. O Credit Card 1 ! 1 A 1 A 1 1 l 1 I /NS/TE ENGINEERING, SURVEYING & LANDSCAPEARCHITECTURE, P.C. e 3 Garrett Place (845) 225 -9690 Carmel, New York 10512 Fax: (845) 225 -9717 TO: Putnam County Health Department 1 Geneva Road Brewster, NY 10509 WE ARE SENDING YOU ❑ Shop Drawings ❑ Copy of Letter LETTER OF TRANSMITTAL Date: 10 -29 -02 Job No. 00219.300 Attn: Robert Morris, P.E. Re: SSTS for Reilly Construction 28 Somerset Drive, Town of Patterson TM# 23 -1 -28 ® Enclosed ❑ Under separate cover via ® Prints ❑ Plans ❑ Change Order ❑ the following items: ❑ 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 ❑ REMARKS: COPY TO: M2002.dot SIGNED: a/k G'o , 6,A'�� Jo n M. Watson, P.E. IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE OCT -25 -02 10:02 AM TOWN OF PATTERSON 9148782019 OCT- 22-2302 14:35 FROM - INSVE ENGINEER"i 845?259717 2XVC1 R POLr;Y PrDiic 1104kb &PW10P. ABPAR,'TM NT OF aALTH I C3enen Road Brow"mr. New York 10309 Tc:e7SC343 P.02 P:2.5 LORETTA MOLIN ARI M M.S.N. Aseociwr Prbiid fkaUb Dtrtetar DL-Roror of P9l1ext &ryica Z'nrro =anrp Ha dik 0)14)$78.4130 Pa 0,14) 271.7.11 Nrridflo 38nlcq (014)178.6533 WX (D +4)771 -6670 F®c(014) 219 -BATS FA11Y Itlte AdOn (P14)271 +6014 Prm%#W (014)2714012 Fsx(914)411 -fi&9 TORN NTI i s own'RS)iAm. W L+ko%s e� NI ca '4srR,0-r1e041 OOROW" f��e�E -"Ir -TAX NUMUR; - - r r r �� • ~/~ V� - TOWN: DAM /,0/,? Y/O z .��✓��1 (Si�natRre) I7ze Putnam County Department of Health will not fssue a Certifcate of Constraetion Compliance Wess the above form is completed, i.e., a legal E911 addren is assigned by an $utho)rized toviia official: '1'bb form is to be submitted with the appReatfon for a Certificate of Construction Complime, MUMBAR RM 193 NORTHEAST LABORATORY of DANBURY S�0 to ACCO,?a 39 MILL PLAIN Roan - DANBIIRY, CT 06811 Cr Cert: PH -0404 203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 v LABS www.NORTHEASTLABORATORIES.com LABORATORY REPORT REPORT TO: REILLY CONSTRUCTION 155 MAIN STREET BREWSTER, NY 10509 FAX #(845)278 -0931 SAMPLE SITE: SAMPLE POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: • Total Coliform (Bacteria) PHYSICALS: • Color (Apparent) • Odor pH • Turbidity CHEMISTRY: • Chlorine Residual • Nitrite Nitrogen • Nitrate Nitrogen • Alkalinity • Hardness • Iron • Manganese DATE SAMPLE COLLECTED: TIME COLLECTED: COLLECTED BY: DATE RECEIVED @ LAB: TESTED BY: LAB I.D. # REPORT DATE: 28 SOMERSET, PATTERSON, NY WATER TANK WELL NONE RESULTS METHOD # 10/14/2002 12:00 PM TOM BIGLIN 10/14/2002 LAB #11471 & 11301 REILLY CONSTRUCTION- NY1238 10/25/2002 MAXIMUM CONTAMINANT LEVEL (MCL) OR STANDARD 0 per 100 ml SM 9222B 0 per 100 ml 5 - EPA 110.2 15 ND - - 3 Units 6.19 - EPA 150.1 No designated limits 0.06 NTUs EPA 180.1 5 NTUs <0.05 mg/L - - - -- <0.005 mg/L as N EPA 354.1 1.0 mg/L 0.74 mg/L as N EPA 353.3 10 mg/L 12 mg/L SM 2320B No defined limits 48 mg/L EPA 130.2 No defined limits <0.03 mg/L EPA 236.1 0.30 mg/L <0.01 mg/L EPA 243.1 0.50 mg/L Combined limit for Iron plus Manganese = 0.50 mg/L • Sodium 6.8 mg/L EPA 273.1 20.0 mg/L ** • Lead <0.001 mg/L EPA 239.2 0.015 mg/L * ** ml--milliliter mg/L- milligrams per Liter ND =none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count "Notification Level ** *Action Level COMMENTS: -All holding times (were) met. - Sample, as received, complies with all State of New York regulatory guidelines. SAMPLE, AS TESTED ABOVE: UOTABLE or aOT POTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Quality Control Officer Laboratory Director .NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 . OUTSIDE CT: 800 - 654 -1230 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Reilly Construction 23 1 28 Owner or Purchaser of Building Tax Map Block Lot Reilly Construction Building Constructed by 155 E. Main Street, Brewster, NY 10509 Location — Street Residential Building Type Southeast TownNillage Cornwall Ridge Subdivision Name 28 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 it 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 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 10 Dgyl4 Year 2002 Signature: C . xd� Title: President neral Ifontractor (Own — Signature Corporation Name (if corporation) Address: 155 E Main Street, Brewster State: New York Zip 10509 Burdick Contracting Corporation Name (if corporation) Address: PO Box 532, Brewster, State NY Zip 10509 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES L. FINAL SITE INSPECTION. Date: /,9// 0a -P- Inspected by: f TZ9ED Street Location Owner FyWcw Town Permit # TM #. 3 , s 2 -- ;2_0 Subdivision Lot # 2 6 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 ...... ............................... II. Sewa a stem a. Septic a c size 1,00 ........1, 250 ......... other ................ b. Septic tank installe level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distr"btui n Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches Junction Box - roperly set ....................... ............................... 1. ength required 1� od Length installed 3p® 2. Distance to watercourse measured _- 100 Ft.......... 3. Installed according to plan ......... ............................... 4. •Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. '10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 1' /z" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ........................ ............................... g. Pump or Dosed Systems Size of pump chamber ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ................................... :..................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Buildm a. oouseeooTcated per approved plans ......................... b. Number of bedrooms ............................ - 3....F7Z......... IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured /�® ft........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ..........:.................... b. All pipes partially backfilled ........... ............................... c. All 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 & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 1/97 orm 7 M- OCT -10 -2002 17:41 FROM:INSITE ENGINEERING 8452259717 TO:27e7921 P:2/2 PUTNTAM COUNTY DEPARTMENT OF HTALTH DTViSm OF ENVIRONMENTAL HEALTH SERVICES ATTENTION ADAM 9 GENIE PROM .: • : 1 FIX I R3 ' 151; All information must be fully completed prior to any Trenches inspections being, made. PCHD Construction Permit # P- 3 Located: So�+c2 rE7' ggjv E f l • J PA'f cesQ�� _ Owner /Applicant Name: ^ jA.•+E & TM S31. Block z- Lot ze Formerly: Subdivision Name: !�oR.yw&L4. Pu a0e Subdivision Lot n I. t Is. system. fill completed? Yes Date: Is system complete? yE a Date: Is system constructed as per plans? 4Cs Is well drilled? yrs Date: v • 3 Is well located as per plans? Y Ef Are erosion control measures in place? la Ux hv'c� I certify that the system(s), as listed, at the above premises has been constructed and 14mve 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: , td Certified by: PE k" DA-- Insite Engineering, in 8a �ez rofes al n9► Surveying . Landscape Architecture, PC. Address: 3 Garnett Piave Lie, # C rL �' �.L,._. -.� arme , ew a 10512 Commeots: _ Form FIR -99 - -- .- - ^M- TUf1 + ,7•a+ Ta1 - A4q- P7R -79P1 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 IF BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1. Geneva Road, Brewster, New York 10509 Environmental Health (84 5) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschooi (845) 278 - 6014 Fax (845) 278 - 6648 October 11, 2002 Jeffrey Contelmo,' PE Insite Engineering 3 Garrett Place Carmel, New York 10512 Re: Field Inspection - Byron Somerset Drive, (T) Patterson Lot # 28, TM# 23. -2 -28 Dear Mr. Contelmo: The above referenced separate sewage treatment system can be backfilled. No comments. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. GDR: cj Sincerely, Gene D. Reed Environmental Health Engineering Aide PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: yy�� 26 6 4J� V Tow illage: 6 Tax Grid # Map 13 Block I Lot(s) 20 Well Owner: Name: Address: �.'� S 1�►�, �5S N1ai>1 Sheet iretjJer ply /0104 Use of Well: 1- primary 2- secondary Resi a tial Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details: Total length ft. Length below grade 77 ft. Diameter —7in. Weight per foot _ lb /ft. Materials: Steel _ Plastic _ Other. Joints: _ Welded X Threaded _ Other Seal: X= Cement grout _ Bentonite _ Other Drive shoe: Yes No Liner: Yes XNo 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 Ho=_6 Yield � gpm Dephi Data Measure from land surface` - static (specify ft) During yield test(ft) Depth of completed [rw' well in feet We11Log If mcfe detailed infomation desciptions or sieveanalyses are a!ailable, pleas attach. Depth From Surface I Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface - h 7<_ F ob it f/ , " ' If yild was tested at diferent depths durig drilling, list: Date X11 Completed - a/ ' F// -1 Feet Gallons Per Minute Pump /Storage Tank Information Pump TypeZ Capacity -EaM Depth d't y Model Z,66So 7 Voltage „2.3 HP 3/�(- Tank Type Volume _oZ Putnam Putnam C''ojjunty Certification No. Date o Report Well Well Driller (signature) r•.l u NCkV Exi[dt location of well with distances to at least two permanpht landmarks to be provided on a separate sheeyplan. q WeDrillees Name / i; , -�'�r — Address:! S>Egture: ., Date: f XA7h copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 N, IL L= 104.46' R= 375.00 LLJ Q 0) W EXPANSION ABSORPTION TRENCH (TIP.) / S 85'03'00" E (100 % EXPANSION PROVIDED) 12 13 14 15 16-1,-PRIMARY ABS0RP770N I I I (I I l i 11 TRENCH (TYP.) E 544.81• 0 011 1,000 GALLON SEPTIC TANK- DROP BOX (TYP.) A _.. DWELLING CAI SSTS PER FILED MAP A2117A (TYP ) WELL APPROXIMA 7E L OCA 77ON EXIS77NG DR/ VEWA Y 7 544.81• 0 011 1,000 GALLON SEPTIC TANK- DROP BOX (TYP.) A _.. DWELLING CAI SSTS PER FILED MAP A2117A (TYP ) WELL APPROXIMA 7E L OCA 77ON EXIS77NG DR/ VEWA Y IV r A K. - PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM r, PERMIT # I -3 0&- Located at So m CkS£T 'b Q i V E Town or Village PA ITCk J,6 4 Subdivision name &P,#VALL 91UGC Subd. Lot # 28 Date Subdivision Approved Owner /Applicant Name 4��s QJQ d Tax Map _ f,3 Block Z Lot '18 Renewal Revision Date of Previous Approval Mailing Address 26-9-7 ROV76 Z2 PArrIe,SO�I ./�y Zip IT S, Amount of Fee Enclosed � 3�o� Building Type 9CSIb Lot Area I - Y1 No. of Bedrooms 3 Design Flow GPD 000 Fill Section Only Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of in gallon septic tank and :W L F V w tD E, A B o ep P Ti d „f Other Requirements: To be constructed by '(0 QC _D 6'! ERat IA/ 63i Credit c a d C MTN -AATHTR-AIM I BRUCE R FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 John Watson, P.E. Insite Engineering & Survey Route 22 Brewster, NY 10509 Re: Proposed SSTS: Bryon Somerset Drive, Lot #28 (T) Patterson, TM# 23 -2 -28 Dear Mr. Watson: January 3, 2002 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) Deep test hole results indicates that a minimum of 2 feet of fill is to be provided for the entire SSTS. Fill is nofadequate for the top trenches. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. R;i1 Very trul yours, Robert Morris, P.E. Senior Public Health Engineer /NS/ T ENGINEERING, SURVEYING & LANDSCAPEARCHITECTURE, P.C. 1485 Route 22 (845) 278 -4990 Brewster, New York 10509 Fax: (845) 278 -6392 TO: Putnam County Health Department 1 Geneva Road Brewster, New York 10509 WE ARE SENDING YOU ❑ Shop Drawings ❑ Copy of Letter LETTER OF TRANSMITTAL Date: 1 -22 -02 Job No. 00219.300 Attn: Robert Morris, P.E. Re: SSTS for Byron /Cornwall Ridge Lot 28 Somerset Drive, Town Of Patterson TM# 23 -2 -28 ® Enclosed ❑ Under separate cover via ® Prints ❑ Plans ❑ Change Order ❑ the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION 5 Last Revision: 1 -21 -02 CD -1 Construction Drawing i THESE ARE TRANSMITTED as checked below: ® For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ REMARKS: Rob - Revisions were made to provide a 2' minimum of fill over the entire septic area. If you have any questions, please contact me. Thank you - John COPY TO: SIGNED: C/Ohn M. Watson, P.E. IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE lot2000.dot BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 John Watson, P.E. Insite Engineering & Survey Route 22 Brewster, NY 10509 Re: Proposed SSTS: Bryon Somerset Drive, Lot #28 (T) Patterson, TM# 23 -2 -28 Dear Mr. Watson: January 3, 2002 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) Deep test hole results indicates that a minimum of 2 feet of fill is to be provided for the entire SSTS. Fill is noladequate for the top trenches. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very trul yours, Robert Morris, P.E. Senior Public Health Engineer INSITE ENGINEERING, SURVEYING & 1ANDSCAPEARCHITECTURE, PC.- 1485 Route 22 (845) 278 -4990 Brewster, New York 10509 Fax: (845) 278 -6392 TO: Putnam County Health Department 1 Geneva Road Brewster, New York 10509 LETTER OF TRANSMITTAL Date: 12 -20 -01 Job No. 00219.300 Attn: Robert Morris, P.E. Re: SSTS for Byron /Comwall Ridge Lot 28 Somerset Drive, Town Of Patterson TM# 23 -2 -28 WE ARE SENDING YOU ® Enclosed ❑ Under separate cover via ❑ Shop Drawings ® Prints ❑ Plans ❑ Samples ❑ Copy of Letter ❑ Change Order ❑ the following items: ❑ Specifications COPIES _ DATE NO. D 5 Last Revision: CD -1 Construction Drawing 12 -20-01 f r__ THESE ARE TRANSMITTED as checked below: ® For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected,prints ❑ For review and comment ❑ REMARKS: Rob - Revisions were made to provide a 2' minimum of fill over the entire septic area. If you have any questions, please contact me. Thank you - John COPY TO: I0t2000.dot SIGNED: "a� iu l�J (�hn M. Watson, P.E. IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATi<IEiNT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: STREET LOCATION: REVIEWED BY: RM, GR, AS, SRDATE: 1' N DOCUMENTS �PERi•I1T APPLICATION ��. )�ti ELL PERMIT OR PWS LETTER (LUPC -97 11 ILJLETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) CORPORATE RESOLUTION SHORT EAF (T PLANS -THREE SETS HOUSE PLANS - TWO SETS UUVARLkNCE REQUEST SUBDMSION ( )LEGAL SUBDIVISION 7( X )� SUBDMSION APPROVAL CHECKED TC A )—PERCRATE Ct FILL REQUIRED E v C CURTAIN DRAIN REQUIRED / �� GENERAL ( rY )LOCATED IN NYC WATERSHED IiS SUBMITTED TO DEP EGATED TO PCHD APPROVAL, IF REQ'D P TEST HOLES OBSERVED CS TO BE WITNESSED vEX APPROVAL SSDS ADJ, LOTS (3vWETLANDS (TOWN/DEC PERMIT REQ'D ?) DATA ON DDS PLANS & PERMIT SAME (PRE 1969 NEIGHBOR NOTIFICATION V(�LETTER BUZBA 0100 YR. FLOOD ELEVATION W/I200' (_�_)(_JSOIL TESTING LOTS >10 YEARS OLD / REQUIRED DETAILS ON PLANS ( /_ IK )SEWAGE SYSTEM PLAN - (NORTH ARROW) (_ — SSDS HYDRAULIC PROFILE GRAVITY FLOW CONSTRUCTION NOTES 1 -15 DESIGN DATA: PERC & DEEP RESULTS 2' CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT ' FOOTING /GUTTER/CURTAIN DRAINS USDA SOIL TYPE BOUNDARIES TITLE BLOCK; OWNERS NAME ADDRESS TNI4, PE/RA; NAME, ADDRESS, PHONES ►DATE OF DRAWINGIREVISION )DATUM REFERENCE )LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. )PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS BLS & SSDS'S WAN 200' OF SSTS PERTY METES & BOUNDS UUEROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE COMMENTS: (ttEVS if E ET) 09 /01100 TAX MAP =: (CONFIRINIED) 1 (REQUIRED DETAILS ON PLANS CONT'Dl HOUSE SEWER -/4" FT. 4 "0'; TYPE PIPE CAST IRO, I NO BENDS; i IA-X BENDS 450 W /CLEANOUT / RENEWALS ")SITE NOTE (NO CH_aNGE) FILL SYSTEMS HORIZONTAL; PAST TRENCH SLOPES 3 TO GRADE 'ILL SPECS! FILL NOTES 1 -5 'ILL PROFILE & DINIENSIONS 'ILL LN EXPANSION AREA FILL GREATER TITANS FEET CLAY BARRIER :II.L CERTIFICATION NOTE. 3EPTH GAUGES VOL. ON PLAN FOR RO.B., UNCLASSIFIED & IMPERVIOUS SEPARATION DISTANCE FROM TOE OF SLOPE TRENCH LF TRENCH PROVIDED PARALLEL TO CONTOURS 100% EXPANSION PROVIDED LOFT MAX. AIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL OTEXTILE COVER � / SEPARATION DISTANCES ON PLAN =FROM SSTS t_ J( 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS 100' TO WELL, 200' IN DLOD,150' TO PITS (_) 100' TO STREAM, WATERCOURSE, LAKE (Inc. espaa) 50' TO CATCH BASIN, 35' STOPUN RAIN, PIPED WATER 1O' TO WATERLINE (pits -20') 50' IXTERti11TTENT DRAINAGE COURSE 0200'/500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS (J(_)10' i`II`i TO LEDGE OUTCROP SEPTIC TANK UU10' FROM FOUNDATION; 50' TO WELL / WELL (`(�DIi`1ENSIONS TO PROPERTY LINES C. LOCATIONI OF SERVICE CONNECTION CLJNIIN 15' TO PROPERTY LINE // SLOPE U( '' SLOPE IN SSTS AREA (5 20 %) t . (_)( (_)REGRADED TO 15 %, IF REQUIRED DOSE/PUNlP SYSTEMS PUbIP NOTES DOSE 75% OF PIPE VOLUMEMOSE VOLUME NOTED DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) PIT AND D -BOX SHOWN & DETAILED 1 DAY STORAGE ABOVE ALARM CURTAIN DRAIN ((e I- __�WSTANDPIPES, 5' BOTH SIDES, DETAIL ( 15' AIIN to CDS = >S% ,20'-4 %,25'- 3 %,35' -1 %,100 % -<I% ( 20' bIIi I to ( CD DISCHARGE /100' ivith 182 cons day discharge �10' hIL`I to NON - PERFORATED PIPE /NSI TE ENGINEERING, SURVEY /NG & LANDSCAPEARCXrECTURE, PC, 1485 Route 22 (845) 278 -4990 Brewster, New York 10509 Fax: (845) 278 -6392 TO: Putnam County Health Department 1 Geneva Road Brewster, New York 10509 Y ` LETTER OF TRANSMITTAL Date: 11 -07 -01 Job No. 00219.300 Ann: Robert Morris, P.E. Re: SSTS for Byron /Comwall Ridge Lot 28 Somerset Drive, Town of Patterson TM# 23 -2 -28 WE ARE SENDING YOU ® Enclosed ❑ Under separate cover via the following items: ❑ Shop Drawings ® Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of Letter ❑ Change Order ❑ COPIES 5 _ 1 1 DATE 11 - "1 11 -6-01 11-6 -01 NO. CD -1 CP -97 WP -97 Construction Drawing Construction Permit f Well Permit LA -97 Letter of Authorization 2 1� —~ �- � PC-97 3 Bedroom modular Floor Plans Application for Approval of Short EAF 1 10 -9 -01 DD -97 Design Data Sheets (2 pages) $300.00 Fee ^ -t� i THESE ARE TRANSMITTED as checked below: ® For approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Retumed for corrections ❑ For review and comment ❑ REMARKS: COPY TO: I0t2000.dot ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints SIGNED: / ('/�hn M. Watson, P.E. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # f s— 0 �—' Well Location: Street Address: Town/Village Tax Grid # .SOM(SO7 h?1116 PA- OkS0/v Map -& 3 Block 2 Lot(s) 2B Well Owner: Name: Address: JAKI2 5 Q A0N I S! "I .ROXr6 71 iArE2SOV IVY 1 z sC3 Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1-prima Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought _ gpm # People Served __5 Est. of Daily Usage 3PZ gal. Reason for eplace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes_- No Name of subdivision CoANWA L 1, k IbG 15 Lot No. 12$ Water Well Contractor: 1a 6v >6TC mfg6-D Address: /V /A Is Public Water Supply available to site? .................................. ............................... Yes No X Name of Public Water Supply: /V Town/Village N Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: l�a Applicant Signature: MA 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 evision or alteration of the approved plan requires a new permit. Well to be constructed by a water well 1 er certifie by Putnam County. Date of Issue Permit Issui Date of Expiratio 0 "Y" Title: Permit is Non- Transferra le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 C 10/12/2001 15:05 845- 278 -6392 1NSITE ENGINEERING PAGE 02 ]PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of 6'A T-o a Located at t'hYrnso Tax Map # 2-3 Block 'Z- Lot C'a Subdivision of Subdivision Lot # Filed Map # . z < <7 A Gentlemen: Date Filed Sc- This letter is to authorize iwi—te eer t Surveying a landscape Arctvtectxe, P.C. (Jeffzey J. ca teuro,f a duly licensed Professional Engineer 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 treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam C-o-unty tary Code. Countersigned:. P.E., ]K A., # sz Mailing Address Of -NEW State Mw Xork Zip 10509 Telephone: (914) 278 -4990 P.C. Very truly yours, Signed: ' /-- 'er of Property) Mailing Address: a`� Rola-t _ Q cA State �� Zip oiSiP Telephone: "J(A (k o� ) Form LA -97 PUT NAM 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 A M CS 16YRoAl �S foz : PA -7r,R So N .v Y 1 i-S_C _? 2. Name of project: UokO WALL 21D G LKZ83. Locatio 1rI. PA7rERS0 �1i Incite Engineering, Surveying & Lardscape 4. Design Professional: Jeffrey J. Contelmo, P.E. S. Address: Architecture, P.c. Route 6. _ Drainage Basin: 6a s T 9RAN Rou te 22 cm 7. Type of Project: Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building t 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 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... N A- 10. Has DEIS been completed and found acceptable by Lead Agency? ............... d A 11. Name of Lead Agency r) � a 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... S 13. If so, have plans been submitted to such authorities? ........ ............................... YES 14. Has preliminary approval been granted by such authorities? r' !k Date granted: ri Jk 15. Type of Sewage Treatment System Discharge ................. surface water groundwater 16. If surface water discharge, what is the stream class designation? .................... - 17. Waters index number (surface) ........................................... ............................... NIA 18. Is project located near a public water supply system? ....... ............................... No 19. If yes, name of water supply Distance to water supply 01pC 20. Is project site near a public sewage collection or treatment system? ................ NO. 21. Name of sewage system Distance to sewage system . y 22. Date test holes observed P cs j�?� ;! 23, Name of Health Inspector 24. Project design flow (gall' ns'per day) :..: :: ::.. Co 0 ... ............................... 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? ......................... A :., : Form PC -97 27. Is any pgir ion of this` project located within a'designated Town or State wetland? No 28. Wetlantls40 Number ...:......::........ .............. ............................... N 29. Is Wetlands Permit required? ..... . ...................................................................... N 6 Has application been made to Town or Local DEC office? .............. .................. 30. Does project require a DEC Stream Disturbance Permit? ................................. NO 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 /ID 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any rq other potentially known source of contamination? ............................... Yes/No � DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... ACS 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ..........................:..... ............................... ()NKA1ow n/ 35. Are any sewage treatment areas in excess of 15% slope? . ............................... /V 0 36. Tax Map ID Number ...................................... :.................. Map'-7-3 Block 2, Lot 2.9 37. Approved plans are to be returned to ..... Applicant Design Professional NOTE: A1f - 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. - - -- c� 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 prQvision , may be grounds for the rejection of any submission. - - I hereby affirm, under penalty of perjury, that information provided on this form is true: ; to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES A OFFICIAL TITLES. Mailing , Address .... ............................... s2 :j OMNU=—� =® Insite Engineering, Surveying 1485 Route.22 - PPVU3 er.- 14 -16-4 (2/87) —Text 12 PROJECT I.D. NUMBER 617.21 SEAR x Appendix C State Environmental Quality Review SHO_ RT .ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART 1— PROJECT INFORMATION (O be completed by Applicant.or Project sponsor) 1. APPLICANT /SPONSOR )Ih s eYROA1 2. PROJECT NAME. SS rS rOA ORA)W LL 9 ED 1✓ Lo-r Z 8 3. PROJECT LOCATION: p PUI-/.)a/n Mynicipality f aITIEA.S'W County 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) SEE L�Cgrlo;v av con4.:r2vr;T1oA/ . i*>,eAw1Nv 5. IS PROPOSED ACTION: ,ffNew ❑ Expansion ❑ Modificationlalteration 6. DESCRIBE PROJECT BRIEFLY: �oNStRvcTr�!v tiF aAva: rAm14 -DA IVe6wAil Ssrl, w F_ LL /{N" AFPVR'r6NI'NC -6S 7. AMOUNT OF LAND AFFECTED: �� g 9 07 Initially acres Ultimately e acres B. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Is-kyes ❑ No It No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/ForesVOpen space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL) ?. KYes ❑ No It yes, list agency(s) and permit/approvals A) V EwA y P6-f2in i t - -row n/. o f /OATrcfk xov .40LWAld -1 PE,e,r, T Towr✓ -f" ORTft;,�ro -N 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes XNo If yes, list agency name and permitiapproval 12. AS A RESULT F ROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes Nc I. CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ::rWS I -ri CIVC-fNGrgef'NG) rURvF_Y /,VG,` 1AffVSCAPE 4RCNITEt1Vg9 PC. Applicant/sponsor name: J o IAM M, W ATSoAI 0.15. Date: (� v Signature: If the action Is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (ro be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED kTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another Involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten; If legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels,. existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or` related activities likely to be induced.V the proposed action? Explain briefly. CD __...- cz. 00 _. 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: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (if different from responsible officer) Date 2 09/20/2001. 09:38 845 - 278 -6392 1NSITE ENGINEERING PAGE 01 BRUCE R. FOLEY 'ublic Health Director LORBTTA MOLINARI.. R.N., M.S.N. Auociate Public Health Director Director of Patient Services DEPARTMENT OF BEALTH 1 Geneva Road Brewster, New York 10509 R QUEST FOR FIELD USMG ATTENTION: ❑ ADAM STIEIELING tdlGE ME All information below must be u1 completed prior to any scheduling. DATE: ENGINEER OR FIRM: ref` s'71' 6yJ6' E�s+�Zj PHONE 9: 4-79-4910 REASON: DEIEPS: PERCS: d" pY.fiZP TEST: a ROAMT'REET: TOWN: TAX MAP#: VF---L-7-0 SUBDIVISION: Cep y -t a > LOW: "715 OWNER: J-4 6 H Ad 1� 7 ❑ Proposed SSTS within the drainage basin of West Branch or Doyds Corner Reservoirs. o Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. 0 ,W Proposed SSTS witWn 200 feet of a watercourse or a DEC wetland. ❑ W Proposed SSTS design flow greater than 1000 gallonslday or SPDES Permit required. ❑ K Proposed SSTS for a Commerical Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. Xf -you answered yes, to any of the questions, NYCDEP must witness the soil testing. This Department 'will coordinate a- mutually suitable time for field testing with the PCDOR, the Design Professional and NYCDEP.: If a project has been determined to be Delegated based on the above response and theta subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. FOR COUNTY USE ONLY l �''OMMF.NTS- (FMLDTEST) cc0- PM -PSR1 THII 09:39 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 -PIF TT T3-8 - - - - - - - - - p .54 AC A I . 2 1. or Ac 57 —31.05 AC. 40 1.56 AC.. 31 Z iN 39 3.77 AC. V 76.11 AAG CAL A, •3 70 36 3 S.40 1.36 `,,,a � 1. 23 16 46.12 AC ob" 23.07 15 1 I,55 A :Fj z ROUTE 23. 11 23.1 7 (.7 • -17.59 A, 1.4 n a6 4.1 45 A 67 40 10.41 AC. %; CAL 62 9.21 AC. 6 9 711p VA. 8.33 AC. CAL. f 32.98 AC, T•tO 37 27 r47 y 10447 AC. CAL .93 AC CAL 4 1 6 ai 9 SCH 1198 AC. C AL. 250 AC. CAL z r A, go 57 n9 ra ),-49 48 /3."4* 1 'At 31 26.0; AC. CAL. AL 56 75.96 kc, 4v 50 42.0 AC. fAL I&IG AC. CAL.) 32 ti" 3, 50 3C CAL A i A, . I 32.113 At 41' 54 4.17� A C. 53 rr; t P/0 3�.3-63 .4 34- 4L5- _P �_ _ 21 1 a A CAL • mmnmlW -2 -5-23 P/O 34.-5-28 3 6 3 LEGEND MAP I 400' PRELIM MARY SCALE 22 24 4 TOWN OF PATTERSON 33 34 35 6 PUTNAM COUNTY. NEW YORK PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACK SEWAGE TREATMENT SYSTEM Owner � AX, CS, % Address '7_R7 2oyT�'L4 IATI'k�ml Nil hrG3 Located at (Street)r f oyAEAg6 <t>Alvi�lCognlWALL SILL b Tax Map '1 3 Block Z Lot 2 13 (indicate nearest cross street) Municipality PA-tf6 K S o ti Drainage Basin e A -97- 16A A N C H LoT-�f-2.8 SOIL PERCOLATION TEST DATA Date of Pre- soaking 10100-L61 Date of Percolation Test /0Iq /01 Hole No. Run No. Time Start - Stop Ela se NIi Time �n.) De th to Water rom Ground Surface (Inches) Start - Stop Water Level Drop In Inches Percolation . Rate Min/Inch 4 1 I�S'I °- Z':o3 ��► 23�r 2,6'��- 3 Lit 5 10 3.3 2 Z; 67. — 2 : 18 4� 2d I'C 3 �. 3 5 1 2 3 4 5 1VOTES: 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 submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5'. 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' ..6.5 1 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. 1. HOLE NO. ' ' HOLE NO. a Indicate level at which groundwater is encountered NO A16 Indicate level at which mottling is observed /VoNG Indicate level to which water level rises after being encountered �►/�/.i Deep hole observations made by: JO MN M . W:A-T:ro Ay, fA Date Design Professional Name: � r_fFKtiy 3 c ti-rc , M o Address: �iifs��C ENGINE &kiNG Sv2�EylNG �TG�N�ScAv� `''p ROUTE 2'j ARCNliECTvR� - r kewsieR [NY fooq Signature: Design Professional's Seal 5 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner 7r,, S Y ( s� Located at (Street) )0MC2S6r, R)VC Co2NWALL Mitt RD _Tax Map 23 Block 2 Lot 2 8 (indicate nearest cross street) Municipality ,eSoN Drainage Basin �sT 9/ R4. M SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test Hole No. Run No. Time Start -Stop Ela se Time Min.) De th to Water From Ground Surface (Inches) Start Stop Water Level Dropp In Inches Percol ion to n/Inch 1 2 3 4 5 2 3 4 s 5 1 2 Z3 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 submitted for review. , 2. Depth measurements to be made from top of hole. Form DD -97 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0, 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8 0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST DOLES HOLE NO. HOLE NO. * HOLE NO. I 2 Indicate level at which groundwater is encountered N6N� Indicate level at which mottling is observed AZOA1 Indicate level to which water level rises after being encountered Deep hole observations made by: JOHN M. WAT-So N, Date Design Professional Name: Jr.FG2ry J, CamrKLMD , P_ 6 Address: 1 /)S I T L' CW G INcERiNG 3upVz5YMC, 1 CAN7Tl -6 Rourc 22 ARCr� tC -cfUR� ��eC�rrc Al y rosoq Signature: Design. Professional's Seal I 1 I ".PUTNAM COUNTY- DEPARTMENT OF' HEALTH - .-- -- DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner X/7ZDiJ Address Located at (Street): Dt---.IIF—AJ P.-fe Tax Map 0-3 Block Lot 'a (indicate nearest cross street) Municipality P,*7-7-�7Z5c�1 Watershed j3z"cj+— SOIL PERCOLATION TEST DATA PPercolation aLlu V Lv-av X f Ll I nn+ V 0 1 f.-I ................ ... se. .............. I .............. . . . . . . . . . . . . . . . . . . . . . . ..... . . . . . . . . ... ... . ........ ...... ............ ............. . ........ . . . . ....... ....... .. Emu= .... .... ... . . . . . . . . . . ...... . . .. . . . . . . . ...... Water ...... X 61 N ....... ............ ....... ...... . ...... .. .. . .... .... T66 . ...... ..I ..... "" Start -.' Z.... . ... . .... , Time : From Ground ... e t Level . J Inc Ties P e "b o n. . o k hnne c.. . . .... ..... .. .. ........... ... . . . .......... . .... ........ . ... .. . . .. . ... ..... . .r.. 2 L�-7- 3 4 —3103 3 5 6-0 2 3 38 2 4 /2 5 W. 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. :5 1 min for 1-30 min/inch, -< 2 min for 31-60 min/inch) All data to bc submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 TEST PIT DATA • 2 _.. - DESCRIPTION OF SOILS ENCOUNTERED IN TEST BOLES a DEPTH HOLE NO. HOLE N0. HOLE NO. G.L. 0.5' 5, 1.0' 1.5'. 2.0'. 2.5 Ve Me c.,/ 3.0' r e ow Z3r, 3.5' r Sa K Z 4.0' dJo tzar s✓ ' e a.5' �C - -IQ -:;.f 7o�r�s 5.0 el kS 6.0' 7.5' 7 • o ,, 8.5' . s.0' 10.0' _ { Indicate level at which groundwater-is encountered i j Indicate level at which.mottling is_observed. - - . t 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 i s s } E , �. AM' Cpl _ a�� !Ga Slicet ~of 11 ,- .� _� PUTNAM COUNTY- DEPARTMENT -OF HEALTH .: . Y - DIVISION OF EN VIRONiVIENTAL IiEATLII SERVICES �Wr �Oq�► ` ` I+IELD`ACTIYTY AEP30AT= .. -. -- F' _ r.- ('j Y24/ `F Tel` 1A,NF AnTIRF. q:..5 ,i,"ms, i �� i�T% �TLSC?Jy %y, ,` Street }Town __ _ State Zip 11 f. t: _ __ f PERSON IN CHARGE ,_ _ 11 !lR TNTFR VTF IF17 :=� /�`�r %� 1- -1 1I � ' X nA 1 d ' -:8 ld� Name and Title �- . : �: - . ' : . E Yw , . . .TYPO "I 1_: , � " 11- _ FINDIt �► - 1. } - , _ '' - - __� . a , } n - � r. . _ : _ 3 x_ $ - -P , ' p I`� F. .-% 2 . 5 _. 3 . "� ' { 17-- - t S -- : a. y _. r 1 - - . _, . - ' `• . . Signature and Title . _ Y - , � " - - - , - - - 4� �M--, �. 9,�� . 2 ° � � , � I , 5 __� , % - - , �� f : ,, - ^ �� I- h. - 3 . ' { S ' `• . . Signature and Title . :� -. I acknowledge'receipt of this report: . SIGNATURE: _; ` / N - . - , � , I . - 7 A ,� - ) � I . — 9 'm � il L 02/96 ; 'Title -1 9 ,_ I .. I - 9� 1 I t " . � - 1 '_ , . . . % i JY� b r.- ,- " . 1. Rev - I I I I I I i i I I I I I I I I I I I I I II I I I I I 1 I I I I I i 1 I I I I b F I f I I I / e I f I e / W j I / � � I I / co I \ I � 1 I 1 I I 1 \ 1\ \\ 1 1\ 1 I 1 1 I 1 1 \ 1 1 1 ( I 1 1 I 1 \ 1 1 1 \ 1 1 \ \ 1 \ 1 \ \ \ 1 1 \ 1 \ \ \ \\ \ 1 1 1 1 1 \ 1\ \ 1\ \ 1\ 1 \ 1 I 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project two, ky) A�� County 1`,Jgf M Site Location SoMM,�5 TZS T GZj�� r 13 r # a — a Building construction begun r� Extent Is property within NYC Watershed ? ................. Yes No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. a Hilly F-� Rolling a Steep slope. ZGentle slope F] Plat 2. F--J Evidence of wetlands, o Low area subject to flooding F--J Bodies of water F-J,Draina6 ditches 0 Rock outcrops 3. Property lines or corners 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 ? ............ - .E7 9. Do filled areas exist within the SSTS area? ........ ............................... If yes, what is the condition of the fill? SECTION C. SOIL OIBSE-3y9flONS 10. 11. 12 Yes Yes 0 .Y s Yes 0 Yes N; No No a No a No Q Yes a N Fl Yes No Appearance of soil: Sand Gravel 0 Loam Clay F--J Hardpan F---] Mixture Observed from: a Borings a Bank cut EyBackhoe excavations Soil borings /excavations observed by on 13. Depth to groundwater /t/aa ✓4 on 14. Depth to mottling Al b fq1--- on 15. Are test holes representative of primary & reserve areas ...:.. ............................... 16. Soil percolation tests made by on 17. Soil percolation tests witnessed by i �i_ f�'�, or SECTION D (on back) on Form ST -1 2 SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? 0 Yes N 19. Will groundwater or surface drainage require. special consideration? ..................... 0 Yes N 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... a 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? ................................ ............................... Yes /No Inspection data 22. Do adjacent wells and/or sewage systems exist ?. - ` ` .......... ..........�t.�:ti.!��...:...... Yes ,� No 23. Additional comments 24. Site observerlinspector and title 25. Date(s) of observation(s)inspection(s) . �/67 1,7 /a / 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 rock/imp. Depth to rocklimp. 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 3.0 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 BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845)278-6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Insite Engineering & Survey Route 22 Brewster, NY 10509 Re: Proposed SSTS: Bryon Somerset Drive, Lot #28 (T) Patterson, TM# 23 -2 -28 Dear Sir: November 26, 2001 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: Deep test holes must be witnessed by a representative of this Department. Fill is to extend 10 feet horizontally past the edge of any trench and then slope 3:1 V ` to grade. 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. Vepit: urs, Robert Morris, P.E. Senior Public Health Engineer RM:tn of Somr*su DRIVE