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00581
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM
PERMIT #
Located at t J ` o 4 eX S b"'� Town or Village PA-11
Subdivision name6b14J V*t, Ahly C Subd. Lot # 3 � Tax Map �7— 3 Block Lot
Date Subdivision Approved
Owner /Applicant Name) l y &e' ,
Mailing Address k/
Renewal Revision
Date of Previous Approval
Zip /7-J r►-3
Amount of Fee Enclosed Q n 1 6 IL-
aAMl �?�
Building Type Lot Area XIS No. of Bedrooms3 *'Design Flow GPD 1300
Fill Section Only Depth Volume
PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Separate Sewerage System to consist of gallon septic tank and
1h 0
Other Requirements: —{—n
To be constructed by
Water Supply: Public Supply From
Address CA-?W4-1 -- --
Address
or: Private Supply Drilled by /V C Address
I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the
separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion
thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the
Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said
builder will place in good operating 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. i
Signed:
Address
R.A. Date -7 / f MOO
License # 5-33Z7 -1
APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the
sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or
modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires
a new permit. Approved for discharge of domestic sanitary sewage only.
B Title: �/ �� Date:
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design rofessional
Form CP -97
t
BRUCE R, FOLEY
Public Health Director
LORETTA MOLINARI RN-M.S.N.
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
'Brewster, New York 10509
Nil'
REQUEST FOR FIELD TEST N G.
ATTENTION: ❑ JOSEPH PARAVATI GENE RFED
All information below must be fuX completed prior to any scheduling. DATE:
R.Nr,INV..R.R nR FIRM- PFi(INT. f!• ti 7.f 7"q
q
REASON: 7
DEEPS: PERCS: ❑ PUMP TEST: ❑
ROAD /STREET:
TOWN: TAX MAP #: 2-3 C T `
SUBDIVISION: CO�,�L�� �G� SL�� _ LOT #: 3 ;�'—
OWNER: r--i L--A- 06 It
NYCDEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING
YES NO
❑ a""– Proposed SSTS within the drainage basin of West Branch or Boyds Corner Reservoirs.
❑ ,l""7 Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake.
❑ 0 Proposed SSTS within 200 feet of a watercourse or a DEC wetland.
❑ Af Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required.
❑ ,r Proposed SSTS for a Commercial 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. If you answered Yes to any of the questions, NYCDEP must witness the soil tests. This
Department will coordinate a mutually suitable time for field testing with the Design Professional and
NYCDEP.
If a project has been determined to be Delegated based on the above response and then subsequent
information indicates NYCDEP is required to witness the soil tests, it will be the sole responsibility of
the design professional to schedule re- witnessing of the soil testing with NYCDEP.
FOR COUNTY USE ONLY
DATE: 744 QQ TIME:
COMMENTS:
(FIELDTEST)
V
4�;j0
y.•Yq
vTN,q
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHEET — SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner: '614 4N 6' GRl
Located at (street): �9�
M c z_-
Municipality: jP97 —,&—n 00
Addres w: J_0"
`Vv-%r-
TM # Section;?19 Block 1 Lot
Watershed: 04 VC-V
SOIL PERCOLATION TEST DATA
Witnessed by: G "--'o Date of Pre - soaking:_ �i Z Date of Percolation Test:
Hole No.
Run No.
Time
Start —
Stop
Elapse
Time
(min.)
Depth to
Water from
ground
surface
(inches)
Start - Stop
Water
level drop
in inches
Percolation
Rate
min /inch
2
q `a v 110.1 it
z
4
y -'rZ
23
r- Z2 r
J
6.
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
Notes:
1. Tests to be repeated at same depth until approximately equal percolation rates are
obtained at each percolation test hole. (i.e., < 1 min for 1 -30 min /inch, < 2 min for 31 -60 min /inch).
All data to be submitted for review.
2. Depth measurements to be made from top of hole.
BRUCE k FOLEY
Public Xaltk Dirsator
L*►Y
A 11 LORETTA MOLINARI �i..IN., M.S.N.
V Associate Public Health Director
Derector of Patient Se vices
DEPARTMENT OF HEALTH
1 Geneva Road - .'' b
'Brewster, Now York 10509 �l
REQUEST FOR D I�87' �g .
ATTENTION: 0 JOSEPH PARA`{TATI :k GENE FIE1Fri
All information below must be fidly completed prior to any schedtding. DATE: Z4�y
ENGINEER OR FIRX ,� -
REASON:
ROAD /STREET:
TOWN:
SUBDIVISION:
PHONE #: 7'14 ��
Q7-% X,:
DEEPS: n - PERCS: JL PL'1 W TEST; a
SE
LOT #:
NYMP CR9MI A FOR J RIT REVIEW AND WITNESSXN'G OF SOM TESTING
YES NO
* Proposed SSTS within the drainage ba9in of'West Branch orlBoyds Corner Reservoirs.
o Ae ' Proposed SSTS within 500 feet of a reservoir, reservoir stein or control take.
4 W Proposed SSTS within 200 feet of a watercourse or a DEC wetland,
❑ Af Proposed SSTS design flow greater thin 1000 gallons/day or SPDES Permit required.
o ,K proposed SSTS fora Commercial Project.
It is the responsibility of the design professional to provide the above information prior to soil testing.
This Departrr Rt will determine the NYCDEP project status (Joint or Delegated) based on the
response, If you aaswemil ym to any of the questions, NYCDEP must witness the soil tests, This
]Department will Coordinate a mutually suitable dyne for field testing with the Design Professional and
NYCDEP. 12 Tk;r
If a project has been determined to be Delegated based on the above response and then subsequent
information indicates NYCDEP is required to witness the soil tests, It will be the sole responsibility' of
the design professional to schedule re- witnessing of the soil testing with NYCDEP.
FOR COUNTY USE ONLY
DATE: G TME:
Comm
(FIELDTEST)
a
QJ T� ~q�►
4 yt
Ou N •[
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner: J 4' 'a 1 Address: �J01114 £ 2J' E 71,
Located at (street): 1j_ "_ J PA1 C <t J_ S T_ TM # Section: ' Block C Lot �Y'J'o
Municipality: / 4 71rcAj D 1) Watershed: C-144'1- �Qrl X_ ty
SOIL PERCOLATION TEST DATA
Witnessed by: �' 14l�
Date of Pre - soaking: .9_" 61 Ll 4p" Date of Percolation Test: : y '
Hole No.
Run No.
Time
Start —
Stop
Elapse
Time
(min.)
Depth to
Water from
ground
surface
(inches)
Start - Stop
water
level drop
in inches
Percolation
Rate
min /inch
9 (� r
/ P�/ e V
i
Q► �}
I. W -��.i
3 ®-
—
2
-- �&
Co
' •j "'2 9,1,r'
42,r
f
4
5
2z T a
X. Y
5
1
2
3
4
5
1
2
3
4
5
Notes:
1. Tests to be repeated at same depth until approximately equal percolation rates are
obtained at each percolation test hole. (i.e., < 1 min for 1 -30 min /inch, < 2 min for 31 -60 min /inch).
All data to be submitted for review.
2. Death measurements to be made from ton of hole.
4 -.4—
AJ 6. TEST PIT DATA
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH
HOLE NO_
G.L.
0.5'
1.0'
2.0'
2.5'
3.0'
C
3.5'
!
4.0'
_
5.0'
5.5'
6.0'
6.5'
7.0'
8.0'
8.5'
9.0'
9.5'
10.0'
HOLE NO oZ.
HOLE NO HOLE NO HOLE NO
Indicate level at which groundwater is encountered /(k7/",t
Indicate level at which mottling is observed A}', -Vc,) x
Indicate level to which water level rises after being encountered
Deep hole observations made by: ._[/ �?� i� Date 111%5?1
Design Professional Name:
Address:
Signature:
Design Professional = Seal
JUL -17 -2008 02:21PM FROM- ENVIRONMENTAL HEALTH 8452787921 T -131 P.002/004 F -216
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION FOR APPROVAL OF PLANS FOR
A WASTE4 WATER TREATMENT SYSTEM
1..
Name and address of applicant: C /�'"�� /-I L to
d' W-
Soiv-'e.
--
P A
P �-i "
2.
Name of Project: k f -� 3. Location: TN. P ( *)
4.
Design Professional: C. Vt11 5. Address:.I
6.
Drainage Basin: ti'
7.
nma ofProiect.
> Private /Residential Food. Service
Commercial
Apartments Institutional
Mobile Home Park
Wfice Building Realty Subdivision
Other (specify)
A10—
81
Is this project subje ct to State Environmental Quality Review (SEQR)
? .............. Yes/No
Type Status (checIc one) ... ............................... ............. ......
Type I .Exempt
Type H _ Unlisted
9.
Is a Draft Environmental Impact Statement (DEIS) required ? ....................
Yes/No A/
10.
Has DEIS been completed and found acceptable by Lead Agency ? ............. Yes/No
11.
Name of Lead Agency
12. Is this project in an area under the control of local planning, zoning, or other officials,
ordinances? ...... ....................................................... ............................... Yes/No Al 0
13. If so, have plans been submitted. to such authorities? .. ............................... Yes/.No
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? ..........; ...... Yes/No
19. If yes, name of water supply Distance to water supply
20. Isprojcct site: near a public Se Wapc; collection or treatment system? .......... Ye:sfNo
v
21. Name of sewage system Distance to sewage system
22. Daic test holes observed % 23. Name of Health Inspector
24. Project design flow (gallons per day)
25. Is State Pollutant Discharge Elimination system (SPI)ES) Permit required?... Yes/No
26, Has SPDES Application been submitted to local DEC office? ......................... Yes/No
Rev. 11t02 Form PC -97
Pg. 1 of 2
C: s
JUL -17 -2008 02:22PM FROM - ENVIRONMENTAL HEALTH 8452787921 T -131 P- 003/004 F -216
27. is any portion of this project located within a designated Town or State wetland ?... Yes /No U
28. Wetlands ED number .................................................................. :..............................
29. Is Wetlands Permit required? ...................................... ..........................:.... Yes/No .a
Has application been made to Town or Local DEC ........................... Yes/No
30. Does project require a DEC Stream Disturbance Permit? .... .........................Yes/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
32.
33.
34.
a�.
36.
37.
application or industrial activity? .......................................... ........................ "Yes/No
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? ................................... .................I.............. Yes/No
DESCRIBE
Al d
tvd
Is there a local master plan on file with the Town or Village? .........................Yes/No
Are community water and /or sewer facilities planned to be developed within
15 years in or adjacent to project site? ............................ .........................Yes/No
Are any sewage treatment areas in excess of 15% slope? ......................... ...... Yes/No 'r d
Tai. Map ID Number .............. ............................... Map 2-3 Block � Lot
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 storm-water 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 1, 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 penalo) 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 misdenseanur
pursuant to Section 210.45 of the Penal :Law.
SIGI\TATURES d OFFICIAL TrTZE
Mailina Address: I ..........................
Form PC -97
JUL -17 -2008 02:21PM FROM - ENVIRONMENTAL HEALTH 8452787021 T -131 P.001 /004 F -216
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
LETTER OF.AUTHORZZATION
RE. Property of
,
Located at
TN A 1,
(� Tax Map # Z 3 Block �� Lot
Subdivision of- tf�/�/.
00' Subdivision Lot # Filed Map # Date Filed
Gentlemen:
This letter is to authorize
a duly licensed Professional Engineer � or R ere€1-r4del� eel:- to apply for the required
wastewater treatment and/or water supply-permit(s) to serve the above -noted property in accordance
with the standards, rules or regulations as promulgated by the Public Health Director of the.Putnam
County Health Department, and to sign all necessary papers on my behalf in connection with this
matter and to supervise the construction of said wastewater 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 de.
oG,y4"'�
P.E., R.A.,
Mailing Address / L( &m,+ 17
State Zip
Telephone:
Very truly yours,
Signed..
(Owner 'of Property)
Mailing Address: �'I - 1" k—
State Zip
ele hone: r —1 ! _ J
Form LA -97
'"14.16' -0M87) —Text 12
PROJECT I.D. NUMBER 617.21 'SEQR
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART 1— PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
1. APPLIC T /SPONSOR --�y
2. PROJEC NAME `,/ A.
3. PROJECT LOCATION:
Municipality 4A.1 County
4. PRECISE LOCATION (Street address and road Intersections, prominent I dmarks, elc., w provide map)
. 1
5. IS PROPOSED ACTION;.
❑ New %xpanslon ❑ Modlflcatlonlalteratlon
6. DESCRIBE PROJECT.BRIEFLY:
he-f
vsdvoe)')�'
,
7. AMOUNT OF ND AFFECTED.
Initially 4- L 10 - acres Ultimately acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
my, No If No, describe briefly
9. W,� IS PRESENT LAND USE IN VICINITY OF PROJECT?
l�J`Qesldentlal ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open apace ❑ Other
escr be:
d r •
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL.
STATE _PR LOCAL)?
es ❑ No If yes, tla agency(s) and permlVipproval9
�� f 4 4'oe-
it. DOES ANY OF THE ACTION HAVE A CURRENTLY V LID PERMIT OR APPROVAL?
❑ Yes o If yes, list agency name and permlUapproval
12. AS A RESULT P OPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION?
❑ Yes
1 CERTIFY THAT THE INFO ATION PROVIDED 'ABOVE IS TRUE TO THE BEST 0 MY KNOWLEDGE
Dale:
Applicantlsponsor name:
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
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
July 15, 2008
John Karell Jr., P.E.
121 Cushman Road
Patterson, NY 12563
Dear Mr. Karell:
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Re: Addition - Filapger, A- 006 -08
81 Somerset
(T) Patterson, TM # 23.4-45
ROBERT J. BONDI
County Executive
ROBERT MORRIS, PE
Director of Environmental Health
This office has received and reviewed the most recent set of plans for the above - mentioned
project. We would like to offer the following comments for your review and consideration
Construction permit application not submitted.+'
�
(' PC -97 not submitted..
V 1 Letter of Authorization not submitted. ✓
4. Sho t EAF not submitted.
r � esign dat per.a�d.d�.ep�tlts,.r�.plan.
:� Footrn gutter drain not shown on plans.
SSTS hydraulic profile not shown on plans.
House sewer — ?ia per foot cast 3rn_n_ pipe nt!t Shown on plane
This office will continue its review upon consideration of the above - mentioned comments.
Please feel free to contact me at est. 2163 if any 'questions arise.
Very truly yours,
Lawrence C. Werper
Public Health Engineer
LCW /kly Environmental Health (845) 278 -6130 Fax (845) 278 -7021
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648
.q. X:
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS
REVIEW SHEET FOR CONSTRUCTION PERMIT
NAME OF OWNER: ' f'`� �•1 G � Q STREET LOCATION: (3 Z y % U �� L-at j e-r,,
REVIEWED BY: M GR, AS, SRDATE: I TAX MAP #: (CONFIRMED)_ •� y
Y N DOCUMENTS
C_)(,j< ERM1_T AP,- LICATION
L)()WELL PERMIT OR PWS LETTER
�LDETTE R OF:ALITHORIZATIQNSIGN DATA SHEET (DDS)
V lORPORATE RESOLUTION
HORA=F LANS -THREE SETS
L� OUSE PLANS -TWO SETS
C)(�VARIANCE REQUEST
/ SUBDIVISION
(;)/ LEGAL SUBDIVISION
SUBDIVISION APPROVAL HECKED
(_ )(_)PERC RATE
_
()( ILL REQUIRED DEPTH
UCZd URTAIN DRAIN REQUIRED
GENERAL
CCU OCATED IN NYC WATERSHED
�)( LANS SUBMITTED TO DEP CY l9r l7rl ✓4
C4, TO PCHD
C_,(�EP APPROVAL, IF REQ'D
DEEP TEST HOLES OBSERVED
� TO BE WITNESSED
U EX- APPROVAL SSDS ADJ, LOTS
(_)( ETLANDS(TOWN/DECPERMTT tE.Q� '?
F {
DA -TAVON "DDS PLANS18c P_ERIVITT�5AIVIE--
rC�P�t E NEIGHBOR NOTIFICATION
U ETTER BUZBA
100 YR. FLOOD. ELEVATION W/I200'
SOIL TESTING LOTS>10 YEARS OLD
REQUIRED DETAILS ON PLANS
C�fj')SEWAGE SYSTEM PLAN (NORTH ARROW)
CJC &- SD�S HYI)RAU:LIC PROFILE
(✓ UGRAk xu` —FLOW -c�
))CONSTRUCTION NOTES 119'/
U DESIGNaDATA: PERC &DEEP= RE5ULTSJ
T CONTOURS EXISTING & PROPOSED £d
))DRIVEWAY & SLOPES CUT
✓ G IGT UOSD O TINYTPTE E R/C[ NRDTAAR IN E DR A+ INS
C�)TITIOWNERS NAME ADD
ESS
TM #, PE/RA; NAME, ADDRESS, PHONE#
DATE OF DRAWING /REVISION
(DATUM REFERENCE
LOCATION OF WATERCOURSES, PONDS
A
AKES,WETLANDS WITHIN 200' OF P.L.
C)(_)PROPO5ED F NISH FUO-0_ -A-N.
BASEMENT ELEVATIONS
J (_)WELLS & SSDS'S WAN 200' OF SSTS
(__)(_)PROPERTY METES & BOUNDS
()EROSION CONTROL FOR HOUSE, WELL &
SSTS, EROSION CONTROL NOTE
COMMENTS:
(itrvstIgr .JowoI/m
'Y I N� (REQUIRED-DETAILS ON.P -LANS CONT'D)
HOUSE - SEWER`' /` lff TYPE PIPE GASTyIRON
NO BENDS; MAX BENDS 450 W /CLEANOUT
RENEWALS
C))SITE NOTE (NO C
FILL SYSTEMS
C)(_)10' HORIZONT A �� ; A ST T ENCH SLOPES 3:VO GRADE
())FILL SPECS/ FIL ES 1 -5
UCUFILL PRO W& DIMENSIONS
)FIL XPANSION AREA
FILL GREATER THAN2 fEET
UU CLAY BARRIER
())FILL CERTIFICATIO E
C_JL PTH GAUG
)L )VOL. ON FOR R.O.B., UNCLASSIFIED & IMPERVIOUS
UUUSEP ION DISTANCE FROM TOE OF SLOPE
IMLF TRENCH PROVIDED��' 60FT MAX. �`r /'� ! ' y
PARALLEL TO CONTOURS
100% EXPANSION PROVIDED
DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL
LJGEOTEXTILE COVER
SEPARATION DISTANCES ON PLAN - FROM SSTS
(� 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL
)20' TO FOUNDATION WALLS
WELL, 200' IN DLOD,150' TO PITS
i:JJIOO'TO
STREAM, WATERCOURSE, LAKE, (inc. expan)
50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER
10' TO WATER LINE (pits - 20')
))50' INTERMITTENT DRAINAGE COURSE
(� 200' /500' RESERVOIR, ETC. 150' GALLEY SYSTEMS
))10' MIN TO LEDGE OUTCROP
SEPTIC TANK
(�)10 FROM FOUNDATION; 50' TO WELL
())DIMENSIONS T OPERTY LINES t� L
()) LOCATIO SERVICE CONNECTION /� ' C'-L -�
CUUMIN 0 PROPERTY LINE
SLOP
))SLOPE IN SSTS AREA 520 %)
(__))REGRADED TO 15 %, IF REQUIRED
DOSE/PUMP SYSTEMS
UUPUMP NOTES
())DOSE 75% OF PIPE VOLU OSE VOLUME NOTED
)DETAIL FOR FOR IN, (PIPE TYPE, ETC.)
UUPIT AND D- SHOWN & DETAILED
C))1 ORAGE ABOVE ALARM
CURTAIN DRAIN
(_)C_JSTANDPIPES, 5' BOTH SIDES, DETAIL
( __))15' MIN to CD5 = >5 %, 2 ' o, 5' -3 %, 35' -1 %, 100%-<1%
(,))20' MIN to CD ARGE /100' with 182 cons day discharge
(� ON- PERFORATED PIPE
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHEET SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner 1 C� C- -r2- -1 Address
Located at (Street) 6M V Tax Map ;7-3 Block Lot h
(indicate nearest cross street)
Municipality P p (%) Watershed
SOEL PERCOLATION TEST DATA
S 1 v s-/-7
Date of Pre - soaking fo 2.,3 0 j Date of Percolation Test jz woo P L
No ole
Run No.
Time
Start- Stop
Elapse Time
(Min.)
Depth to Water
From Ground
Surface (Inches)
Start J Stop
Water .
Level
Drop In
Inches
Percolation
Rate
Min /Inch
�S
2
Ivti�° lt°°
3Y
Z-(o
/
3
oS 1!?'
30
1q.
4
1 vN .Lot
30
7-LI -Z-(o
7-
/s�
5
L
1
Q ou i
!
�2 2v
-7
2
Z f qQ
Al-
o z-, z z,
7
3
4
5
1
2
3
4
5
NOTES: 1. Tests to be repeated at same depth until approximately equal percolation
rates are obtained at each percolation test hole. (i.e. _< 1 min for 1 -30
minhnch, <_ 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
Pg. 1 of 2
d
DEPTH
G.L.
0.5'
1.0'
1.5'
2.0'
2.5'
3.0'
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'
LAlklq G-A-
TEST PIT DATA
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
HOLE NO. t HOLE NO. HOLE NO.
rty e 56l L
.r
v�d� b rvi,.J ti
s a ►� �Q
�IrtM1V`
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: I Date
Design Professional Name:
/�1Ls� ii
r
C 0_ Address:
Design Professional =s Seal
JK JOHN KARELL, JR., P.E.
7 T 845-8,118-1-1894
1.�1 �C�;5MMA1� ROAD
PATTERSON, NEW FORK, 12363
June 30, 2008
40.,0/
Larry, . l
Attached plan and engineering report for FilAngeri. Fee was.paid previously.
Fi k aeec l
jk
'AL 'vA L+nsL.�Jutn .000
4- SERIAL NUMBER YEAR, MONTH, DAY ."POST OFFICE \ U 5 DOLCARS�AN D:CENTS
7:;17 5 0 8 42 ID 7 J
ROBERT J. BOND]
:DNE HUNDRED : DOLLARS & -;c ##ic County Executive
:AMOUNT:
.Y TD - -
NEGOTIABL,00NEY'4 FT'HE`�ll "5: v9ND.rPOSSESSIONS.
`SEE4?tVtRSV,, ARNING
)DRESS ..
.FROM
. CLERK
• u�:?
-ADD ESS
QED FOR
will result in an increase in living area.
ROBERT MORRIS, PE
o
D ec
JAN .2 9 2007.
ITOWN OF PKFTERSON
A) Any addition which is considered a potential bedroom requires a formal
approval _of plans (Construction Permit) by the Department and plans are to be
prepared by a Professional Engineer or Registered Architect in accordance
with applicable sections of the Putnam County Sanitary Code, unless system is
presently designed for proposed number of bedrooms, Plans will provide for
the installation of additional and /or new sewage disposal area meeting rp esent
code requirements.
B) The determination of whether a proposed. room addition to a house is
considered a bedroom will be made by Department staff based upon:
- location of the room in the house
- size of the room
l." Accessory rooms such as dens, libraries, studies, computer rooms,
offices, sewing rooms, etc. may be considered potential bedrooms.
2. Large bedrooms, which may easily be divided by a partition wall,
may be considered two potential bedrooms.
3.. Storage areas or unfinished portions of the addition may also be
considered potential living. area.
C) Any addition which is not a bedroom will require the submission of a plan
prepared by the property owner (to scale) showing the entire house floor plan
existing and proposed. The determination of what constitutes a potential
bedroom will be made by Department staff (i.e., an office 8' x 10' may be
considered a potential bedroom). Once the review has been completed the
plans will be, stamped noting the number of bedrooms, including potential
bedrooms. If the number of bedrooms remains the same as existing, no further
expansion of the sewage" disposal system will be required. If however, it is
determined that any increase in potential bedrooms is proposed then refer to
"A" above. A letter from the Department will be issued indicating total
number of existing bedrooms and no expansion of sewage disposal area will be
required and any other permits or variances required are the jurisdiction of the
Town.
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278-6026, WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -085
Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
Re:
Tax Map #:
Address: e
Town:
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York.] 0509
TownLeaal Bedroom Count
A
Year Built: z94
ROBERT J. BONDI
County Executive
(Owner's Name)
According to records maintained by the Town, the above noted dwelling,
is in compliance with Town Code.
is not in compliance with Town Code.
The Legal Bedroom Count is:
This information has been obtained from:
Certificate of Occupancy:
Other:
Building Vpecto /
a� —
Date
Environmental Health (845) 278 -6130 . Fax (845) 278 -7921
Nursing Services.(845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648
SHERLITA AMLER, MD, MS, FAAP
. Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
DEPARTMENT OF HEALTH
Geneva Road, Brewster, New York 10509
ROBERT J. BONDI
County Executive
ROBERT MORRIS, PE
Director of Environmental Health
ADDITION APPLICATION RESIDENTIAL ONLY
n � �L�
STREET �f ��� l�Io,C` .TOWN TAX MAP# �; ..� � s
NAME PCHD#
MAILING
ADDRESS
DESCRIPTION OF
ADDITION 6�d� 161511 f 1014f t I .ae—D kook j
NUMBER OF EXISTING BEDROOMS PROPOSED # OF BEDROOMS _
(FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR)
* *Any addition which is considered a bedroom requires formal approval of plans (Construction permit) L
prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the /
Putnam County Sanitary Code.
.Please submit this form and the following to Putnam County Health-Dept., 1 Geneva Rd,
Brewster, NY 10509, Phone: (845) 278- 61.30.
1. Certified check or money order for $100.00.
2. Sketches of existing floor plan (drawn to scale, all living area including basement)
3. Two sets of proposed floor plan (drawn to scale— with name, street and tax map #)
*Non- professional sketches are acceptable
4. Copy of survey showing well and septic locations to the best of your knowledge.
Include date of installation if known. Label all wells and septic systems within 200 feet
of the property line. Contact this office with any questions.
5. Copy of Certificate of Occupancy from Town or Certification from Building
Dept. with legal bedroom count of dwelling.
OFFICE USE
COMMENTS
Environmental Health (845) 278 -6130 Fax (845) 218 -7921
Water Supply Section (845).225-5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early InterventioniPreschool (845) 278 -6014 Fax (845) 278 -6648
JK 1 JOHN A, ELL, JR., P.E.
121 CUSHMANROAD 845 - 878 -7894
PATTERSON AE FORK, 12363
June 30, 2008
ENGINEERING REPORT
FWGERI, HOUSE ADDITION
SOMERSET DRIVE, PATTERSON (T)
Proposed House Modifications
It is proposed to add one additional bedroom to the Filingeri house as shown
on the attached plans. Included in the addition is a new garage location in
the basement, a library off the living room on the first floor and a 0
bedroom on the second floor.
Existing Conditions
The existing SSTS is designed and approved for a 3 bedroom house. The
original soil percolation rate was 11 -15 minutes per inch. 375 linear feet of
trench were installed along with a 1000 gallon concrete septic tank.
Proposed SSTS Modifications
The writer reviewed and plotted the "as- built" SSTS location based upon the
plan submitted by Laurent Engineering dated 12/28/93. Based upon the plot
of the ties, which included only the trench ends it is this engineer's opinion
that three of the ties # 5, 7 and 8 are inaccurate. In. light of the foregoing,
when deep -test holes were excavated the first j box was located, excavated,
inspected and it's exact location measured off the house.
Inspection of this j box indicated that the trenches in the box were installed
perpendicular to the house which is generally parallel to the contours on the
north side of the box. Based upon this location of the first j box, using only
the correct tie information the "as- built" location of the SSTS was plotted on
the plan. The proposed SSTS was then added to the plan.
Deep test holes were excavated on May 7, 2008 and inspected by the writer
and the Putnam County Department of Health. Soils encountered were
sandy loam with no water or rock to 7 feet. Soil percolation tests were
conducted on May 6 and 7, 2008. Test hole # 1 perc'ed slowly as the soils
beginning at 18 inches in this area were very compacted. Test hole # 2
exhibited a 15 minute percolation rate which was consistent with the original
subdivision approval.
In order to identify the area of compacted soil the area above the existing
SSTS was probed from the location of perc test hole # 1 toward test hole # 2.
Once the probes indicated a non compacted soil a perc test hole was
excavated. Testing of this hole was performed on June 24, 2008. The
testing was witnessed by the PCHD and indicated a 7 minute per inch perc.
Based upon the soil percolation test a portion of the area above the existing
SSTS was eliminated from the design and the proposal for the house
addition was reduced from two bedrooms to one bedroom.
125 linear feet of additional primary trench will be added to the existing
SSTS. 500 linear feet of expansion area is shown. The existing 1000 gallon
concrete septic tank will be replaced with a 1250 gallon concrete septic tank.
N
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a
120POS 0 TWO BEDROOM ADDITION
ADD 2 200 LF OF TRENCH '
ADD 2 JUNCTION BOXES FILANGERI SOMERSET DRIVL�
REPLACE 1000 GALLON SEPTIC TANK �
WITH A 1500 GALLON SEPTIC TANK. PATTERSON (T)
OA-
_ APPROVED SSDS
AS -BUILT SSDS PER LAURENT f
PROPOSED ADDITIONAL TRENCHES
FOR 2 BEDROOM ADDITION °Tf
' 2 9
1
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EXISTING 3 BEDROOM HOUSE
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.... � ._..... .,_... ....... „_ . fir,. ,`
- ,•.•,� � BEDROOM ADDITION - -
. _ _ ...... , ' PREPARED BY
JOHN KARELL, JR.
SHMAN ROAD
PATTERSON, NEW YO RK
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ASSOCIATES, P.1
MILLBROOKE OFFICE CEM
Route 22 & Mibtown Road
Brewster, New York 10509
(914)278 -61OB - (FAX) 278 -26:
CONSULTING SITE ENGIf
'DRAWING TITLE
AS-BUILT PLAN
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DATE
DRAWN BY Y-V^r
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ASSOCIATES, P.1
MILLBROOKE OFFICE CEM
Route 22 & Mibtown Road
Brewster, New York 10509
(914)278 -61OB - (FAX) 278 -26:
CONSULTING SITE ENGIf
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SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
John Karell Jr., P.E.
121 Cushman Road
Patterson, NY 12563
Dear Mr. Karell:
DEPARTMENT OF HEALTH
I Geneva Road, Brewster, New York 10509
ROBERT J. BONDI
County Executive
ROBERT MORRIS, PE
Director of Environmental Health
January 15, 2008
Re: Addition — Application Incomplete
81 Somerset Drive, (T) Patterson
TM # 21-1 -45
Review of plans and other supporting documents submitted at this time relative to the above
regarded project has been completed. The following was not submitted with your application:
1. Sketches of existing floor plan (drawn to scale, all living area including basement).
2. Two set of proposed floor plan (drawn to scale, with name, street and tax map #). Non-
professional sketches are acceptable.
3. A formal proposed SSTS plan needs to be submitted to the Department for review, along
with all applicable forms required for new construction.
4. The fee for review is $500.00. Please submit an additions $400.00 in the form of a
certified check or money order.
Upon a receipt of a submission, revised to reflect the above comments, this application will be
considered further.
GDR:kly
Sincerely,
-4 � '. * 11Z24_
Gene D. Reed
Sr. Environmental Engineering Aide
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ADDITION APPLICATION
ROBERT J. BONDI
County Executive
ROBERT MORRIS, PE
Director of Environmental Health
RESIDENTIAL ONL
STREET -� TOWN `TAX MAP#
NAME _�' PHO PCHD# 0 wQ
MAILING
ADDRESS
DESCRIPTION OF
ADDITION
NUMBER OF EXISTING BEDROOMS 3 PROPOSED '# OF BEDROOMS
(FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR)
"Any addition which is considered a bedroom requires formal approval of plans (Construction permit) G �
prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the U
Putnam County Sanitary Code.
Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd,
Brewster, NY 10509, Phone: (845) 278 - 61.30.
1. Certified check or money order for $100.00.
2. Sketches of existing floor plan (drawn to scale, all.living area including. basement) ; r
3. Two sets of proposed floor plan (drawn to scale — with name, street and tax map #)
*Non - professional sketches are acceptable
4. Copy of survey showing well and septic locations to the best of your knowledge.
Include date of installation if known. Label all wells and septic systems within 200 feet
of the property line. Contact this office with any questions.
5. Copy of Certificate of Occupancy from Town or Certification from Building
Dept. with legal bedroom count of dwelling.
OFFICE USE
COMMENTS
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648
.X
e o'
SHERLITA AMLEM MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Town Legal Bedroom Count
/A
ROBERT J. BONDI
County Executive
Re: (Owner's Name)
� I
Tax Map #:
Address: d'
Town:
Year Built: /?%3
According to records maintained by the Town, the above noted dwelling,
is in compliance with Town Code.
is not in compliance with Town Code.
The Legal Bedroom Count is:
This information has been obtained from:
Certificate of Occupancy:
Other:
Building pecto` Date
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Nursing Services.(845) 278 -6558 Fax (845) 278 -6026 WI.0 (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
Chris Filangeri
81 Somerset Drive
Patterson, NY 12563
Dear Mr. Filangeri:
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ROBERT J. BONDI
County Executive
ROBERT MORRIS, PE
Director of Environmental Health
July 21, 2008
Re: Addition — Filangeri, A- 006 -08
81 Somerset Drive
(T) Patterson, T.M. # 21-1 -45
I have received and reviewed the plans for the proposed addition to the above mentioned
residence. Based on the information submitted, the above mentioned addition cannot be
approved for the following reason:
1. The legal bedroom count for the dwelling is four. The potential bedroom count of your
proposed addition is five. (see attached)
Please revise the proposed floor plan to reflect no more than four potential bedrooms.
If you have any questions, please contact me at your convenience.
Sincerely,
Lawrence C. Werper
Public Health Engineer
LCW:kly
cc: J. Karell, PE
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648
Dear Mr. Werper,
Enclosed is information from Jack Karell regarding an addition to 81 Somerset Dr. in
Patterson. Jack has informed me that it is most likely possible that only one bedroom
could be added instead of the two I have "designed ".
I expressed the need for the two bedrooms because of my growing family. I have four
sons, (triplet boys who are now seven years old and a one - year -old baby.) Currently, the
triplets share one bedroom with the baby in the other, bedroom. As you can imagine it is
quite crowded in the triplets' room and the need for them to have a larger room is
paramount. Ideally, my wife and I would prefer for them to each have their own room,
but as Jack mentioned, that seems to be improbable. They are "on top of each other"
now; I can't image them as teenagers.
I have enclosed three separate rough designs. Design #1 is for the "improbable" two
added rooms (labled bedroom #4 and #5). Design #2 is for one added bedroom along the
south side of the house. Design #3 is for one added bedroom along the east side of the
house. I understand it is most likely that they will have-to share the "big" bedroom, but at
least they will have more space than they have now.
The 1 S` floor is an added library. I am a teacher and my children's education is very
important. Again, sharing a bedroom leaves little space for the boys to do homework,
research, etc. The library will contain the seemingly thousands of books we have as well
as computers and "quiet space" for them to work. The bottom floor includes a new
garage. The current garage will become a play area for the kids.
Please take a look at the three designs and let me know which one we can move forward
on. You can reach me at home 845- 878 -3938 or cell 914 -224 4519 or e -mail
filan eg ri2@aol.com I greatly appreciate your understanding in this matter and I look
forward to hearing from you soon.
Very Sincerely,
2977 C
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�
1,K)Rk'111 AMERICAN
VAUK.')RIAVORIFS, INC..
ANALYSIS DATA SHEET
TYPE:
PW
LOCATION:
Lot 35, Somerset Dr., Patterson, NY:
REPORT TO:
Cornwall Homebuilder.'
ADDRESS:
155 E. Main St.
CITY, STATE, ZIP:
Brewster, NY 10509
DATE COLLECTED:
12-20-93
TIME COLLECTED:
3:35
COLLECTED BY:.
S.
REPORT, JOATE.-'
12-Peco.ra
7-22 =93
.Lan
93 '8103
SAMPLE SOURCE:
Kitchen faucet
DATE
ANALYSIS
RESULT UNITS METHOD... 'ANALYZED,,'.�,
Total coliforni
Absent COLILERT 12-21=931-.'::."
THIS SAMPLE' AS RECEIVED AT THIS LABORATORY MET
q
THE REQUIREMENTS
OF NEW YORK STATE DRINKINGwATER STANDARDS.
Laboratory Director
NEW YORK STATE ELAP CERTIFICATION NUMBER: 1121
j
j-
.75
-1 (VATR (.'(.)1\,fi\!0NS, RTE 2'-2, BREWS'I"ER, NY 1,0509 914-278- AX 91 +2 7 4
7600"/F" 7&*
WELL GUMYLET1UN MEXUMI
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
/Y
WELL LOCATION
STREET ADURESS: TOWN/vItc(cricily TAX GRID NUMBER:
Cornwall Hill Patterson, NY Lot #35
WELL OWNER
NAME: ADDRESS:
Cornwall Home Bldrs 155 E. Main St., Brewster, NY
❑ PBIVATE
❑ PUBLIC
USE OF WELL
1 - primary
2 - secondary
ja RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP D ABANDONED
❑ BUSINESS D FARM O TEST/ OBSERVATION D OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
[-]REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION []ADDITIONAL SUPPLY
®NEW SUPPLY (NEW DWELLING) ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH 475 ft.
STATIC WATER LEVEL ft.
DATE MEASURED 10/14/93
DRILLING
EQUIPMENT
t] ROTARY ® COMPRESSED AIR PERCUSSION D DUG
❑ WELL POINT ❑ CABLE PERCUSSION D OTHER (specify):
WELL TYPE
O SCREENED ❑ OPEN END CASING 91 OPEN HOLE IN BEDROCK O OTHER
CASING
TOTAL LENGTH 31
MATERIALS: ® STEEL O PLASTIC ❑ OTHER
LENGTH BELOW GRADE 0 ft.
JOINTS: ❑ WELDED 13 THREADED ❑ OTHER
DETAILS
DIAMETER 6' in.
SEAL: ® CEMENT GROUT ❑ BENTONITE ❑OTHER
WEIGHT
_
PER FOOT 19 1b./ft.
DRIVE SHOE ®YES ONO LINER: ❑ YES $] NO
SCREEN
DETAILS
DIAMETER (in)
'SLOT SIZE
LENGTH (It)
DEPTH TO SCREEN (1t)
DEVELOPED?
FIRST
O YES ❑ NO
HOURS
SECOND
GRAVEL PACK
❑ YES
❑ NO
GRAVEL
SIZE:
DIAMETER
OF PACK in.
TOP
DEPTH it.
BOTTOM
DEPTH It.
WELL YIELD TEST If detailed pumping
METHOD: ❑ PUMPED I tests were done is in- �
JCOMPRESSED AIR , ! ormation attached?
❑ BAILED O OTHER ; ❑ YES . ❑ NO
1�1ELL LOG it more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
Waler
g4ef-
ing
weft
Die-
Deter
FORMATION DESCRIPTION
WOE
ft.
It.
WELL DEPTH
It.
DURATION
hr. min.
DRAWOOWN
ft,
YIELD
gFm.
sumac,
12
D
ill
' ng in overburden clay & boul
er
2
illin
in rock set casing, rou
ed
475
4
455
118
31
475
DrillLng
in rock granite.
WATER O CLEAR TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? O YES ONO
ANALYSIS ATTACHED? O YES O NO
STORAGE TANK: TYPE
CAPACITY GAIT.
PUMP INFORMATION
TYPE
MAKER
MODEL
CAPACITY
DEPTH
VOLTAGE HP
WELL DRILLER NAME P . F . Beal & ons , nc . DAt / /93
ADDRESS 4 Putnam Ave. SIGNATURE
Brewster, NY 10509
PUINAM COUNIY DEPARn-MIT OF REALM
DIVISION OF ENV7RON*flaITAL REALTH SERVICES
Owner or Purchaser of Building
Building Constructed by
Location — Street
Municipality
Building Type
Section Block Lot
Subdivision Narre
-3 S�
Subdivision Lot #
GUARANi'EE OF SUBSURFACE SERE DISPOSAL SYSTF4
I represent that I am wholly and completely responsible for the location,
workmanship, material, construction and drainage of the sewage disposal 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; : ru les a n d regulations of ;the Putnam County Department. ' of Health, and' .•'.
hereby guarantee to the owned 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 disposal 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 cccupant.of the building utilizing
the system.
The undersigned further agrees to accept as conclusive the detennination of
the Director of the Division of Environirental Health Services 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 utiIi.zing
the system. r.._-.A. _. -/ �f
Dated this Z 01� day
d
19 Y3
Pis,
ture
Corporation flame (if Corp.)'
l5" A n cL% Al 105'01
Address
rev. 9/8S
Mk
Signature
Title
A"t In
corporation Na�; s (it Carp.)
i s
ft"m TM i�1TiAl� W Am. 1.118 Ae t.
set�all otay ohm
N®ber e[ H Delon Flow G @ D IOOd PCHD Not0cmdals b Fm IS "Mimed
00
A WzDa4o
�epmeulq SowtxeDe Syaleer ib b�aa4t d �C•oBea SeglAlc Teo ��� ' .
To bs. i' Yae/sd, Ammea
Wsi/Ba S"*: BaOlI. Slips Fao® Addieos
ta.e..e. i" DeSled by
Olbte "
I represant;thata am wholly and completely responsible for the dgtgn'and location of the proposed systerii(s); 1) that .tfie separ�t0 fww di sal s stem
above dewibod will;W const►uctod es shown on the'approved amendment thereto and in accordance with tM standards, ►ides a rpu ns,0 . nam
County Department, of 'Mmilth, and lMt on completion thereof a "Certifkits of Construction Compliance^ mUsfaetory'4o_ the Commissioner of Health will
be aabmltte0 to the Departnklnt, and.'a writtai guarantee will- ba.Yu►nisne0 the owner, his successors. hei►s.or assigns by the builder, that.seld.bYllder will
plea
in ;000 00eratMlg, eun0ltbn:.any pert of. iaq fgwa4e disposal systanl' during the period of two (2) Years inlniodletely following tMdatst.of the isMr•
ame of the'epprovsilTOf tM ;COrtillcate ;o1,Construdiori ComplNnca of _the origlhal ystern;or,any.rripei ► s thereto; 2) that the drilled well described above
Willi M IOCataO ea ahawn on the approdsd.plan and that sef0 well will pi: 1 _ in accordance with the . sta s. r ls[ d r¢qu a ons , of ;the putnam
t:ouMY Department of Health:
Date
Signed P.E. RA.
AOdrog .. . license N_
APPROVED FOR CONSTRUCTION: This approval expMaf twOyearf. from the date iswed unless construction of the building has peen undertaken and is
revocable for cause or may be anmvi®d.or modified when mmid0ed necessary b the Cominissioner of Health. Any charge or alteration of'corlstruction
requires . new permit. Approved for dispoial of domestic saMtary sewage, a � p'rivat ar supply only.
Rev. Date BY
10/88 7—r-r— --3--
-c
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
APPLICATION TO CONSTRUCT A WATER WELL F_1�13 PCHD PERMIT #
WELL LOCATION
Street Address
Gw r- v
To Village Cit Tax Grid Number
o _ I
WELL OWNER
Name Mailing
Address M(Private
R6VM nlzjVE; 4MbVje44 a.Oftblic
USE OF WELL
10- primary
2- secondary
® RESIDENTIAL O PUBLIC SUPPLY ❑AIR /COND /HEAT PUMP O ABANDONED
0 BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify
0 INDUSTRIAL b INSTITUTIONAL O STAND -BY O
AMOUNT OF USE
YIELD SOUGHT gpm /# PEOPLE SERVED J57 /EST. OF DAILY USAGE 6&d gal
E3 REPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION 13. ADDITIONAL SUPPLY
NEW SUPPLY NEW DWELLING 0 DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
groundwater.
0 6,
Issue:
19
Date of
Expiration
WELL TYPE
DRILLED
is Non - Transferrable
DRIVEN
copy: HD File Pink copy: Owner
DUG
GRAVEL 0
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Z,'O
Lot N
WATER WELL CONTRACTOR: Name Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _�_NO
NAME OF PUBLIC WATER SUPPLY: 044 TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:,
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
30N SEPARATE SHEET
(date) gnature) /
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the provisions
of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within
thirt7 (30) days of the completion of water well construction, the applicant 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 attached to this permit.
3. Submit a Well Completion Report on a form provided by the Putnam County Health Department.
During
all well drilling operations, the applicant
shall take appropriate action to
assure that
any and
all water or waste
products from such well
drilling operations be contained
on this
property and in such a man
as not to degrade or
otherwise contaminate surface or
groundwater.
Date of
Issue:
19
Date of
Expiration
1972 Permit Issuing Official
Permit
is Non - Transferrable
White
copy: HD File Pink copy: Owner
3/89
Yellow
copy: Bldg. Insp. Orange copy:
Well Driller
0
LAURENT ENGINEERING
ASSOCIATES, PC.
73 FAIRFIELD DRIVE
PATTERSON. NEW YORK 12563
914.278.6108
CONSULTING SITE ENGINEERS
Date: 6 -17 -93
To: Putnam County Health Dept.
4 Geneva Road
Brewster, NY 10509
Attention:
Mr. William Hedges
Gentlemen: We enclose ( 4 ) copies of:
Job No.: 93011 -35
Project: Proposed SSDS - Lot 35
Cornwall Ridge
Patterson, N.Y.
CX B/W Prints O Reproducibles O Reports O Tracings
O Specifications O Memorandum O Copy of Letter. O
Description: Revision /Date No.
Drawing SS -35 'Proposed SSDS" Rev. 6 -17 -93
Corrected copy of "Design Data Sheet"
Per your comments.
Sent Via:
O Our Messenger O Blueprinter O First Class Mail
O Your Messenger IHand Delivery O
Copy to:
O Special Delivery
Mr. S. LoParco Very truly yours.
LAURENT ENGINEERING ASSOCIATES, P.C.
Per:
Harry W. Nic ols, Jr., P.E.
L a -T --q- 3r
DESIGN DATA Sdj�oT- SUBSUFACE SFWP.GE DISPOSAL SYSTEM FILE NO.
Address
Located at (Street) V Sec. - Block ( Lot
indices nearest c oss street)
m1micipality �el Watershed
SOIL PEpWLATICN TEST DATA PSQ=ED TO BE SU&%a T D WITH APPLICATICNS
Date of Pre- Soaking r Date of Percolation Test
HOLE
NL'� CLOG' TIME PERCOLATIGN PERCOLATION
Run Elapse Depth to Water Fran Water Level
No. Time Ground Surface In inches Soil Rate
Start -Stoo Min. Start Stop Drop In Min /In Drop
1
�,� 2-
vvf-
A: 20
Inches Inches Inches
2�5
4
5
1 o
2 2 : :
4
5
NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates
are obtained at each percolation test hole. All data to* be subrittod
for review.
2. Depth measurements to be made Iran top of hole.
rev. 9/85
2
3
4
5
NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates
are obtained at each percolation test hole. All data to* be subrittod
for review.
2. Depth measurements to be made Iran top of hole.
rev. 9/85
DEPTH
G.L_
1'
2'
3'
4'
5'
6'
7'
8'
9'
10'
11'
12'
131
.14'
INDICkTE LEVEL AT WMCH (MOUN MUM IS ENCOUNTERED o,
INDICATE LEVEL, TO WHIGS SEATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP ROLE OBSERVATIONS MADE BY:Aj�(p DATE:.
DESIGI
Soil Rate Used _ Min/1" Drop: S.D. Usable Area Provided � 00D 5. ..
No. of Bedroans !�7 Septic Tank Capacity .1 d t) gals.' Type
Absorption Area Provided By --�- -� ! - L.F. x 24" width trench
Other
Name , TI'S (_1, ,k) K)1 +A 0 L Signature..
Address: :22 4!F— . , SEAL
7,6__at�� K) US L06 6,)2
Soil Rate Approved
sq.ft /gal. Checked by
Date
I
0
PU TNAM COUNTY D E PARTMEN T O F' H EAL TH
APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM
1. Name and Address of Applicant:
CIT. CIF'
2. Name of Project: 4422L:7 3.._, Locatiort1 V /C: �
4. Project Engineer: `( W. IJ 64412 ` 5. Address: Jfq r"6,ITEll IF_1_•P pr-,
• • - . .i + ; ..-� -fin 1�l .�(:
License Number: t2- Phone: E tQ t> e
6. TyDe of Pro ect: ; ,•.,, is -..
Private /Residential Food .Service - ....Commercial ,
Apartments Institutional Mobile Home Park
Office Building ..Realty Subdivision Other (specify)
7. Is this project subject:to State Environmental Quality Review (SEQR)?
Type Status (Check One) Type I.. Exempt /
Type II. Unlisted
8. Is a Draft Environmental Impact Statement - (DEIS) required? ............. ADD
9. Has DEIS been completed and found acceptable by Lead Agency? ...........
10. Name of Lead Agency iJ %Pc
11. Is this project in an area under the control of -local planning, zoning,
or other officials, ordinances? ......... ............................... 9J e
12. If so, have plans been..submitted to such: author .s tie s ?_ ...................
13. Has preliminary approval•been* granted by such authorities? Date Granted:
14. Type of Sewage Disposal; System Discharge...... A Surface Water !� Ground Waters
15. If surface water discharge, what is the stream class designation ?........ _ )JA
:6. Waters index number (surface) ............................................ N
17. Is project located near a public water supply system? .................. j�14
:8. If yes, name of water supply Distance to water supply _
9. Is project site near a public sewage collection or disposal system ?.....
.O. Name of sewage system Distance to sewage system
:1. Date observed: i� 23. Name of Health Inspector: ME. O_�Z7 U��1�h�j
4. Project design flow (gallons per day)., .... ............................... _62oo
2.
25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. N D
26. Has SPDES Application been submitted to local DEC Office? K1
27. Is any portion of this project located within a designated Town or State /
wetland ? ....................... ......... ............................... o
28. Wetland ID Number .........................................................
29. •Is Wetland Permit- required? .............. ............................... (Na
Has application been made to Town or Local DEC Office? .................. NZA
30. Does project require a DEC Stream Disturbance Permit? ................... D
31. Is or was •project site used for agricultural activity involving application
of pesticide$ to orchards or other crops, solid or hazardous waste disposal;`'
landfilling,'sludge application or- industrial activity? ........ YES or NO 4
32. Is project located within 1;000•feet of existence of abandoned landfill,
hazardous waste site, salt stockpile, landfill, sludge disposal site or
any other potential known-.source of contamination? ..............YES or NO ice-
DESCRIBE:
33. Is there a local master plan or file with the Town or Village ?�
34. Are community water, sewer facilities planned to be developed within 15 years? 1�NNa�l
35. Are any sewage disposal areas in excess of 15% slope? .............a.......:..; 4J
36. Tax Map ID Number .........................................................
37. Approved Plans are to'be returned to: ................ Applicant Engineer
If the application is signed by a person other than the applicant shown in Item.1, the.
application must be accompanied by y-a Letter of Authorization. Failure to comply with this
provision may be grounds for the rejection of any submission.
I hereby affirm, under penalty of perjury,- that information provided on this
form is true to the best of my knowledge and belief. False statements made
herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of
the Penal Law.
SIGNATURES & OFFICIAL TITLES:
4AILING ADDRESS:
292 "
63 F
` U
J
non (j em
g ( ¢SUGAR ,,'� OU !CH
Vest 2 RD
311
.e ! � i J _
O V. 3 Little Re `E POiersDR
M ^`
\ U 2 8
N
r •� i ,
��iy+O� MICL\ P L 9 syi LEQUARHY i
CY. \ \\ 9
g 1 t ES
9
S, 5
3.�
� The
g A O
asp'''
4 1L ,
s
t,���12 S��Y�'k�°� 'dS z�,. ` t5+'k'y�q, •gtgv •, C)
r , �, �3 N = Great
ps j =
64 Z.
43
11
18
0
_• 0p
I
311
Pp Arl
9p
62
S1
1.25
,1 Pond
BRUCE R FOLEY
Public Xvalth Dir6ator
LORETTA MOMWARI 1-N., M.S.N.
Associate Public XealA Director
Dtretlar of PaaYrnt Services
DEPARTMENT OF HEALTH
1 Geneva Road
•Browster, Now York 10509
R1[T UELD ESM
ATTENTION. a JOSEPH PARAVATX )CGENE REM
All information below most be h& completed prior to aoy scheduling. DATE:
ENGINEER OR FI M:
REASON:
]DEEPS: ❑ PERCS:� PUMP TEST: ❑
ROAD /STREET: oA4 &. b Iz i ✓ F
TOWN: �� T --}� d i1 J C TAX NIAP #. 2:5 7—
SUBDIMION: �. pl�lu4tl,4[ -�- 0�1 LOU., 3 5�
N'YCDEP CRITERIA EM .YQINX REVIEW AND 3MMELSING OF SOIL - LISTING
YES NO
p Proposed SSTS within the drainage basin of West Branch or$oyds Corner Reservoirs.
Proposed SSTS within 500 feet of a reservoir, reservoir stein or control lake.
❑ Proposed SSTS within 200 feet of a watercourse or a DEC wetland.
O Proposed SSTS design flow greater than 1000 gallons/day or SPDES Permit required.
❑ Proposed SSTs for a Commercial Project.
It is the responsibility of the design professional to provide the above information prior to soil testing.
This Department will determine the NYCDEP project status (Joint or Delegated) based on the
response. If you answered yes to any of the questions, NYCDEP most wvituess the soil tests. '".:is
Department will coordinate a mutually suitable time for field testing with the Design )Professional and
NYCDEP.
If a project has been determined to be Delegated based on the above response and turn subscyuent
information indicates NYCDEP is required to witness the soil tests, it will be the sole responsibility of
the design professional to schedule re- witnessing of the soil testing with NYCDEP.
p FOR COUNTY USE ONLY
DATE: ` ® TnME:
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(FIR UTEST)
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ALL SUBSEQUENT REVISION,VALTERATIONS TO THESE H USE
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=utnam County He-a t Department.