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Home My WebLink About0609DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -2 -16 BOX 7 '� .irk IN is ,` T • 616 ` I. I C, ; I ; I� I ' 11.1• PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # 9 o O1 Located at _,o99 MC AdAtili s IZts or Vi Owner /Applicant Name IG/fi41 L 2L& ax Map Z.5 Block -2— Lot Formerly Mailing Address Subdivision Name Subd. Lot # Date Construction Permit Issued by PCHD T i Zip / 2-57o3 Sepa Tte Sewerage System built by'_/J :J TI(AZ44LL, Address -ice 164 Consisting of MO Gallon Septic Tank and O'i = _::1 e�K5 Other Requirements:. _._.. ,-_-/ 1 _. -- Water Supply: Public Supply From or: l/ Private Supply Drilled by 5/V0l � Address Address l!r _ 7,- GCNI g�L e VX Building Type 2 p, / e-oLo,4 jALHas erosion control been completed? Number of Bedrooms Has garbage grinder been installed? _ .J v 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 a onstruction Permit and approved plans and the standards, rules and r o e P ounty Departme f Health. Date: I " 9 --0 1 Certified by P.E. R.A. License # Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocat' , mo ' cW(K ge ne cessary. By: Title: Date: 1 p White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location _. Street Address: 5q mcManUS /Ul TownNillage:... .. Tax .Grid # M Block 2- Lot(s)' . WellOwner Name:` Address: rrl cJ el dzi �s/G' 1.23 Cccs� iran . VV /24 63 Use of Well: 1- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business ,Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing K Open hole in bedrock Other Casing Details Total length ZI ft. Length below grade ZD ft. Diameter (o in. Weight per foot l9 lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded _X Threaded _ Other Seal: _)�_ Cement grout X Bentonite Other Drive shoe: Yes No X. I Liner:— Yes )�__ No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test Bailed _Pump Compressed Air Hours Yield jo gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing . Well -Diameter(in) Formation Description ft. ft. Land Surface '9 ' a 4I F,t? 1 19/101) 6 OL 4.4m If yield was tested at different depths during drilling, list: Feet fflions Per Minute Pump /Storage Tank Information a, YA / Pump Type _&4_ Capacity Depth 386' Model La CMA Voltagee,3d ./1 HP / V2-V, Tank Type S2 - //9 Volume 8 `i 10j er ago / :310s— 3 Date Well Completed 3 -31-� Putnam County Certification No. a3 Date of Report i /h/oo Wfil Driller (signature) NOTE: Exact location of well with distances to at least two permanent landmarks to be proVO4 on a separaVsheet/plan. N Well Driller's Nam pr I ' we, 11 (20 --chc Address: 16V 2t 62 &1r�1 AJ y /�/Z Signature: Z�ClAo, ,, Date: White copyk-M File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller r Form WC -97: Ar PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM L) N?�, IDS Owner or Purchaser of Building k f� A i ilding Constructed by 59 Inc_ MA760c= `� S Location - Street Building Type Tax Map Block Lot (towaMllage AA g a - I Subdivision Name Subdivision Lot I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above- described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as. to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. D ed: Month Day Year Signature: Title: Cont/act�O\vner) - Signature Corporation Name (if corporation) Address:1�� C� PA State ► die Zip Izo--3 Corporation Name (if corporation) Address: State Zip Form GS -97 1. ^.. . - �'- - , . , , F- -- � . m ' - I --"-_.� -- - -.-, - " �'-� - - t - � - I � . I - ' �ta--:. I �' . %��; --*' NE CABS NORTHEAST LABORATORY OF DANBURY 39 MILL'PLAIN ROAD - DANBURY, CT , 06811 CT Cert: PH -0404 (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 REPORT TO: MR. MICHAEL BUDZINSKI 123 CUSHMAN ROAD PATTERSON, N.Y. 12563 cc:PUTNAM HEALTH DEPT. SAMPLE SITE: SAMPLE POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: • Total Coliform (Bacteria) PHYSICALS: LABORATORY REPORT DATE SAMPLE COLLECTED: TIME COLLECTED: COLLECTED BY: DATE RECEIVED @ LAB: TESTED BY: LAB LD.# REPORT DATE: 50 MdMANUS -RO7jU SO:, PAr FERSON; -N.Y. KITCHEN TAP WELL NONE RESULTS METHOD # 11/14/2000 11:30 A.M. M. BUDZINSKI 11/14/2000 LAB #11471 PHD1114 11/17/2000 MAXIMUM CONTAMINANT LEVEL (MCL) OR STANDARD per 100 ml S1vI 9222B - 0 per l00 m1 _.... • Color (Apparent) 0 - • Odor 2- CHLORINE - • pH EPA 2411 - • Turbidity 0.42_...__ Ims CHEMISTRY: 0.015 mg/L * ** • Nitrite Nitrogen <0.005 mg/L as N • Nitrate Nitrogen <0.20 mg/L as N • Alkalinity 182.0 mg/L • Hardness 218.0 mg/L • Iron <0.03 mg/L • Manganese 0.276 mg/L • Sodium 11.1 mg/L • Lead 0.001 mg/L EPA _1- 10.2,.,,. 15 _........,• _.._ . .... .:............. 3 Units _. . EPA 150.1 No. designated limits EPA 180.1 _ _. - -.._.. ...- S NTUs- EPA 354.1 1.0 mg/L SM 4500D 10 mg/L SM 2320B No defined limits - EPA 1 -30.2 No defined limits EPA 236.1 0.30 mg/L EPA 2411 0.50 mg/L Combined limit for Iron plus Manganese = 0.50mg/L EPA 273.1 - 20.0 mg/L** EPA 239.2 0.015 mg/L * ** ml= milliliter mg/L=milligrams per Liter ND =none detected MCL= Maximum Contaminant Level *Notification Level ** *Action Level COMMENTS: -All holding times (were) met. - Bacteria sample was not run due to presence of chlorine. RESULTS BASED ON SAMPLES SUBMITTED: 11 /14/2000 Labora 7..,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 - - -.-Lin ottcl'ILk:J FINN AL SITE T\SPECTIO\ S:_e.tLo n C. M41, �. Town{ T ki r 1. Sen•aae Svstem Area a. STS area located as per approved plans ........................... b. Fitt section - date of placement ,� 3:1 barrier Lgtn. Width Avg.Dp�n� C. NNatal�oit not stripped ................... ...........:................... d. Srone, brash,.etc., greater than 15' from STS area.......... e. 100' from water coursehvetiands ...... ............................... II. Sewase- System P- septic tan. size - 1,000.. I,250 ......other ............... eptic tank instalted level .............................................. ............ b. S c. 10'r-minimum from foundation ........ ...:........................... d. Distribtuion Box -1. Al out ets at same elevation -water tested ................ 2. Protected below frost ................. I............................. 3. Minimuza 2 fr.Original soil between box & t_each! Junction Box ropeKly set .:.... ....... . —r-1. Le:t;t. required v _Lengih installed 2. Dista1cl to watercourse measured Ft........ 3. Installed according to plan ................. :.................... l e 1116 -1132 "!foot ....S!ope of ten ..... 5. 10 ft. from property line - 20 A.- foundations. . 6. Depth of trench <30 inches from surface ............... Room altowed for expansion , 100 % ...... :. .............. . 8. Size of gravel "A - P /z" diameter clean ................ 9. Dep n of gravel in trench 12" ninimum ............... 10. Pipe ends capped ................... ............................. ... g. PumR or Dosed Systems . 'ize ot pump c ffam er........... .. .............................. 2. Over -flow tanlk ....................... ............................... 3. Alarm, visuallaudio ............. ............................... 4. Pump easily accessible, manhole to grade.......... 5. First box baffled ................... ..:............................ 6. Cycle witnessed by H.D.estimated florv/c} cle... III. Hous;/Buildinv • a. house located per approved plans ........................... b. Number of bedrooms ............... ............................... IV. Well delI located as per approved plans ....................... b. Distance from STS area measured( 00 ft... c. Casing 18" above grade ..................... I.................... 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. BaMill material contains stones <4" diameter.... e. Curtain drain & standpipes installed according tc f. G!r<ain drain outfall protected & dirto exist Viet g. Footing drains discharge away from STS area.... h. Surface water protection adequate ....................... i. Erosion control provided ...... ............................... P.!v.1197 Date: 3 ap - Inspected by: Owner Permit r Subdivision Lot '17 7 . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES P 7STRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at S own r Village 7�'*CDA Subdivision name M A-616% 10 Subd. Lot # _-L Tax Map 'Z-$ Block 'Z-Lot ILO Date Subdivision Approved ( L -1- 64 Renewal Revision Owner /Applicant Name i &eA� Mailing Address Amount of Fee Enclosed` Date of Previous Approval Building Type`=sbE4 -T iAt._ Lot Area 3e0 No. of Bedrooms-4—Design Flow GPD Zip Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of I ZS® gallon septic tank and Other Requirements:t l.L To be constructed by ` A--r :-n/&L t56 .L_ Address Water Supply: Public Supply From Address 3e 7C—ie— /t11,/ or: t// Private Supply Drilled by 1 ` FAL-- Address WgyJ�17 . AUy 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 theretf.— Signed: P E. VZ R.A. Date 7D q Address 02, 61.6 6444 &6- 6*2141%L Ali i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # Well Location: Street o illage Tax Grid # pA�ddress: Nl Iv I NUS 6J, EP,_1-bAJ Map 2.3 Block 'L Lot(s) 140 Well Owner: Name: M iC4+qr —L Address: /23 &L*0t4+J ZA Use of Well: Residential Public Supply Air /Con eat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage al. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen 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 M I C) ZF_& `l e D . :1 Lot No. —% Water Well Contractor: T 4:-, —6SA4_ Address: Abl Is Public Water Supply available to site? .................................. ............................... Yes Name of Public Water Supply: 01 k Town(Village Distance to property from nearest water main: Proposed well location & sources of contaminatio to be provided on separate sheet/plan. Date: — / ::T Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue Zrt c1q Permit IssumLy Official: Date of Expiration Lo 01 Title: dI{i Permit is Non-Transferrable White copy- HD file; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner [CF L--:::� ,b1:&/AJ5jr,l Address 123 C.IViMM F& iivesao m 'A y Located at (Street) C N1AWr� S , Tax Map 223 Block Z- Lot _ (indicate nearest oss street) Municipality _ � voz i*r'(w-so 0 Watershed 6FO-roj SOIL PERCOLATION TEST DATA Date of Pre - soaking G� ?.io ° � ' Date of Percolation Test 4— 27 — gq 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 2 �:ni� 1:2 2l 2 3 4 5 2 3 4 2dr Zj 3 8 4 5 1 2 3 4 NOTES: 1. Tests to. be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 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 HOLES HOLE NO. C HOLE NO. '2 HOLE NO. Indicate level at which groundwater is encountered -f-3) A Indicate level at which mottling is observed 61A- Indicate level to which water level rises after being encountered �l �►(_& Deep hole observations made by: )k. g.:;�fIF8ELAX-n Date��pI J Design Professional Name.ilj/vry -i �►�N�F�itX�ry Address: 6LAA)EriM AV Signature: ` Design Professional's Seal ftor N iIV �q�tdGHAEt , y 2 Si PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: 'M jt_ 7::� 123 [_O S�t M o 2. Name of project: 3. Locatioi&V: AVA5914 1 4. Design Professional -X— W&-r -H , - 5. Address: LM 6&nA/6/4-4v 7dwa Uzi_ Ci�MEt.. it�1 d61Z 6. TY12e o Pro'ect: Private/Residential Apartments Office Building Food Service . Institutional Realty Subidvision Commercial Mobile Home Park 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? ......................... A#4 9. Has DEIS been completed and found acceptable by Lead Agency? ............... 10. Name of Lead Agency ,y 11. If this project is an area under the control of. local- planning, zoning, or other officials, ordinances? ......................................................... ............................... A10 12. If so, have plans been submitted to such authorities? ........ ............................... 4A 13. Has preliminary approval been granted by such authorities? Date granted: N /4- 14. Type of Sewage Treatment System Discharge ................. surface water ' ✓/groundwater 15. If surface water discharge, what is the stream class designation? .................... 16. Waters index number (surface) ........................................... ............................... ' •r 17. Is project located near a public water supply system? ........................................ AID .. 18. If yes, name of water supply Distance to water supply 19. Is project site near a public sewage collection or treatment system? ................ Al Z) 20. Name of sewage system A1/ A- Distance to sewage system /J//+ 21. Date test holes observed 3 So Jqq 22. Name of Health Inspector A, S—riez Form PC -97 C 2 23. Project design flow (gallons per day) .............. 24. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 25. Has SPDES Application been submitted to local DEC office? ......................... 26. Is any portion of this project located within a designated Town or State wetland? 27. Wetlands ID Number ........................................................... ............................... 28. Is Wetlands Permit required? .......................................................... .................... l�e� Has application been made to Town of Local DEC office? ............................... 29. Does project require a DEC Stream Disturbance Permit? ................. : 0 30. 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? .......................I..... Yes/No 31. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, .salt stockpile, landfill, sludge disposal site or any �ee other potential known source of contamination? ... ............................... Yes/No N� DESCRIBE: 32. Is there a local master plan on file with the Town or Village? ......................... ES 33. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................. ............................. ... � 34. Are any sewage treatment areas in excess of 15% slope? . ............................... /J0 35. Tax Map ID Number .......................... ............................... Map 23 Block_ Lot d (P 36. Approved plans are to be returned to ..... f Applicant Design Professional If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES. Mailing Address: ................................... Vj C JS-W &I 14 -16-4 (2187) —Text 12 PROJECT I.D. NUMBER s1 7s1 -SEOR Appendlx C State Environmental Ouallty Revtew SHORT ENVIRONMENTAL ASSESSMENT FORM, For UNLISTED ACTIONS Onl PART 1- PROJECT INFORMATION (ro be completed by Applicant or Project sponsor) I . APPLICANT ISPONSOR 2. PROJECTTNNAMME 3. PROJECT LOCATION: Municipality A.J QF_ County U, rAJA 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) �OXI K�1 Pt7;�z� �2QX7 I ,Yl D274 6r- 6 I u. g'7 ALIE�:: pno . 5. IS PR POS_D ACTION: ew ❑ Exaansion ❑ Mcdification/alteration 6. DESCRIBE PROJECT BRIEFLY: - 7. AMOUNT 0= LAND AFFECTED: Initially 3 , O acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? as 0 No If No, describe briefly 9. WH T IS PRESENT LAND USE IN VICINITY OF PROJECT? emdentia! C) Industrial El Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑Other scribe: 1C. DOES'ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL STATE OR LOCAL)? jKes ❑ No It yes, list agency(s) and permit/approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes'; ❑ No- 'If yes, list agency name and, permll/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE - �1��F Applicantlsponscr name: —I Date:._ Signature:. rr= If the action Is In the Coastal Area, and you are a state agency, complete*the Coastal Assessment Form before proceeding with this4ssessment OVER PART II— ENVIRONMENTAL ASSESSMENT (To be completed by agency) A. DOES ACTION. EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another Involved agency:., ❑ Yes , ❑ Nb . C. COULD ACTION. RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If leglble) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, soild 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: 4 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. CS. Growth, subsequent development, or related activities likely to be lnduced.by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified In Cl-05? Explain briefly. C7. Othe'r impacts (including changes In use of either quantity or type of energy)? Explain briefly. b. 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 (.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. y ❑ 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'envirortmental impacts AND provide on attachments as necessary, the reasons supporting this ,,determination': Name of Lead Agency, Print or Type Name of Responsible Officer in lea Agency „ . it e o 'Respcnsi e Officer Signature o Responsible Officer in lea Agency , ignature o .reparer(I i erent rom responsible officer) Date .......... Im 70" r� - --, 3c" DINM -xtrr FAMILY ROOM - -- . . 2i Fincswr � -- of • x k, LMNG ROOM r x,rr (213oa6 O 3c46 BEDROOM 2 BEDROOM 2 BATH t7t: x c a er tali 117x irir ^''x•�'z nuscL0n MASTER BEDROOM SUITE tstr x tr r BAT H BATH 2432 3046 3046 .The Elmwood 27'6" K 44/30'. 2035 Square Feet m IP .y it as O ff ail i' O �z ' E+ �° ° (a C3 v (L) o � W l bo +" l 1 Ct•b�t.��+ � sl�i �� Lo-T*l loll fr) A • l 7M 23 -Z— tLP DEPARTMENT OF HEALTH Division of Environmental Health Services. . 4 Geneva Road _ - . .. :. . Brewster, New York .10509 Tel. (914) 278-6130 Fax (914) 278-7921 . BRUCE R. FOLEY Acting Public Health Director DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM Project: Let ,,I 1 lk Town: I 1 E Ito NOTICE OF COMPLETE APPLICATION: Delegated Joint Review io SUW�NlNoal DATE: • Z� 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 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 : 6014 Fax (914) 278 - 6648 Janine McColgan WIC (914) 278 - 6678 Fax (914) 278 - 6085 NYC Dept. of Environmental Protection 465 Columbus Avenue Suite 350 Valhalla, NY 10595 Re: Lot #7 Maggio Subdivision (T) Patterson East Branch Reservoir Basin: Dear Ms. McColgan: May 21, 1999 The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on May 14, 1999 is complete. The Department will notify you by June 3, 1999 of its determination. The Project has been delegated to the Putnam County Heath Department for review pursuant to the - - guidelines set forth in-the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Dept. of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Dept. of Environmental Protection regarding such activities to see if Dept. of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (914) 278 -6130 ext. 157. Respectfully Adam Stiebeling AS /jp Assistant Public Health Engineer tT s, x o. o Mm a t kes o s`° �'�� k �4 - '' �80.04z - t> - W FRAME HOUSE vinyl siding) garage J' 62.5' d`baxe i �, a ( I b b tT s, x o. o t k �4 - '' WOOD ECK., - $: s FRAME HOUSE vinyl siding) garage 62.5' ---y- i �, a ( I b o / / o rz C J4 2s0 00'0.91 m «60, PC.G f S rh ZN 53ffl�'c�`N?f AS -BUILT MEASUREMENTS (.IN FEET J 0 op + X01 / REVISIONS PUTNAM ENGINEERING, PLLC. N0. ENGINEERS - ARCHITECTS 4 OLD ROUTE 6, BREWSTER, NEW YORK 10509 (845) `279 =6789 FAX (845) 279 -6769 y G �+& .fY' 4 Y;t}WELL h /Y & C �f SSDS PREP, 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 l A. 0/ Job 111+ 113 115+ 105+ )12+ /So' + 1S2' iS9, �SSr �7 .71' 74 78 7Co' 7' " g 140 r2q+ 1Z1' ice' i2a' �� I�r' r�i+ i &9' 166, ice+ B7 8s' 8/, av+ ��' �7 / REVISIONS PUTNAM ENGINEERING, PLLC. N0. ENGINEERS - ARCHITECTS 4 OLD ROUTE 6, BREWSTER, NEW YORK 10509 (845) `279 =6789 FAX (845) 279 -6769 y G �+& .fY' 4 Y;t}WELL h /Y & C �f SSDS PREP, PUTNAM COUNTY DIAIT�RR OF �ALTH x DkfMs� sf i� � BieaNb Ses�lses. Ca.�al. PLY ]�Sl?. B misroopni lde'Pamlt so C121 AIR co `�, MlDVCAON PA Poll SBWAIM DlsPOSU STUM Leeabi at �r.!/�%9n4 r � D �b'�✓ /� �i� Sddk m Naaaa *hf'C -(d Zd 7 Sub& Ls t % Tu M,10 L eves as ; Block Owanr/ARB.n Wouse -}rdr &0' %-< Kam— F /P_Aff . VAAPif r Da(e of Ptwb" Appiovd /Wt 1011111111116 A W. 7 Uhf ^' /tide W f S /En `1 Town �� U.t/ ZIP Date Subdivision Approved Fee Enclosed [3 Amn„nt badbg Type GVo et9 � RsY►� ' ` Lo< A. Fm See(lee ody Depth �� Volaoe (22c+ u Number d Bednsaas �/..,, DWO Flow G P D PCSD NotlOedka h B� Whim PM b completed S"Wgb Sowing Sysh= b OEM" sf �GoBiw Sao. Tack ••a To be:aay4webd by Addmn widw Sapg¢: Pubic Supply Frame Address esi P, eeae Supply D.Sled by Addrave Miller boubenssags 1 represent '..that I am wholly and completely responsible for the design and .location of the proposed system(s). 1) that "a N rate saYr di sal s stem above described will be constructed as shown on the approved amendment there to and in accordance with the standard; rules a regu ns .1 na County Department of MMRh, and that on completion thereof a -- Certificate of Construction Compliance" satisfactory to the Commisftner,ot Mealthwill be submitted to the 0spartment- and a wIwitton guarantee_ will be furnished the owner, his successor; heirs or assigns by the builder that said builder will gaiiee in good operating condition any part or said sawige di.Spool system during the period of two (2) years immediately following the ate of the issu- "M of the approval of tM Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well 4" - able above wIM M Iontad,as,NOrrn on the approves glen and that tiiid well will M tall O in rWnce 8h tM erldards- rules and rpu�TaE soi—of lira Putnam County Dgmeoine M of Health. Data 0 Signed P.E. v n `RA. — Address eGrP #/0— License No APPROVED FOR CONSTRUCTION- This approval expires two yMrs\(EgA the date issued unless tonatruction of t M revocable for cause, of may be amended or modified when considered necessary by the Commissioner of Health. An re0uires a new permit. Approved for disposal of domestic sanitary sew ge, and /or private water supply only. Rev. Date - building 6 ?�, e- 7 % B¢- -�—" —� 10/88 building Ms been undertaken and is Y change or alteration of construction Title �� Julius i. Cesare, P.E. Blackberry Hill Brewster, New York 10509 914 - 279 -7115 February 16, 1994 Putnam County Health Department John Karell, Jr., P.E. 4 Genova Road Brewster, New York 10509 RE: Kunz /Saadat SSDS McManus Road Patterson Dear Mr. Karell, Enclosed are the required materials in connection with the renewal of Permit P 7686. Although this is a renewal, we have incorporated into the plan the following changes in line with the latest department policies. 1. The system is now shown on a maximum slope of 15 �. 2. The fill side slope is now shown as 1 on 3. 3. We have provided for 100 % expansion. Thank you for your cooperation in this matter. Very truly yours, yulius I. Cesare, P.E. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of $ry V(A Wz' Located at (� .DLc,t tl.��%� (T) Section Block Lot Subdivision of Subdv. Lot ; `7 Filed Map # Date %f Gentlemen: This letter is to authorize a duly licensed professional engineer t'� or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in- accordance wi -th the- standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law,.and the Putnam County Sani- tary Code. Very truly yours, Signed Countersi a P.E. , R.A. 12-0:? l Address Z"' � C A ZQ WW Telephone M ?=' U � ITT �_ � �: f � �.T l.�T'3�' �.T 3�! I� �? A �'F �� rte- T+a '�° d �� " I✓ � I-' . T APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: #,44 r F /RAH S o47 AlleGy S, fe, Nr 2. Name of Project: SSD-F fi7 /;94(�,G 5'9 3. Location T /V /C: 4. Project Engineer: %l4tJ / 64C-5ffF 5. Address: License Number: �to -c Phone: Z7 %-%/�� 6. Tv, —f Project: 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)? Tvoe Status (Check One.) Type I.. Exempt Type II. Unlisted !� 8. Is a Draft Environmental Impact Statement (DEIS) required? 9. Has DE?S been completed and found acceptable by Lead Agency? 10. Name of Lead Agency 11. Is this project in an area under the control of local planning, Zoning, or other officials, ordinances? ......... ............................... 12. If so, have plans been submitted to such authorities? .................. 13. Has preliminary approval been granted by such authorities? r Date Granted: — 14. Type of Sewage Disposal System Discharge...... Surface Water: Ground Waters 15. If surface water discharge, what is the stream class designation ?........ 16. Waters index number (surface) ........................................... 17. Is project located near a public water supply system? .................. �a 18. If yes, name of water supply Distance to water supply t 19. I-c project site ;fear a public sewage colleCtlor or disposal system: ?..... 20. Na:;:e o; sewage system 21. Date cb_erved: WS Distance to sewage system _ 23. Name e= Neclth Insoecto-. 24. Prcject design flow (gallons per day) ................................... I.. 6 2• 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required?..J 26. Has SPDES Application been submitted to local DEC Office? ............... 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? ........ Has application been made to Town or local DEC Office? .................. 0. Does project require a DEC Stream Disturbance Permit? ..............:.... 1. 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 or NO _ A/1) 2. 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 DESCRIBE: Is there a local master plan or file with the Town or Village? ........... /W- 34. Are community water, sewer facilities planned to be developed within 15 years? .35. Are any sewage disposal areas in excess of 15% slope? ........................ 36. Tax Map ID Number 37. Approved Plans are to be returned to: ................ Applicant Engineer J 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. Failure to comply with this )rovision 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. ;IGNATURES E OFFICIAL TI1 (AILING ADDRESS: t: 3. — - •- t- hr� -•- - - - -- --^r-= --- -s-a-r £ .� • TDEPARTENT OF HEALTH COUNT M 4 A Divielou of Envtrenmental Health`Servk�s.,,Cermel N Y 10511 ' En&00 (� to ProvidePe # on CERTIFICATE'OF C •Permit H f COPiSTR _ . ON PERM T FOR SEWAGE DISPOSAL SYSTEM SoB M T cManus Road .: to own nor v 'Pat Located at Maggio Subdivision 7 73 3 - 5 . Snhdlvlelon Name Subd. Lot to Tai A9ap Block Lot u/4'e� Re �e Dr.. Hans . W. Kunz Renewal melon o ownor/Appucadt Name 9/26%86 76 =86 Date'of Prevlode- APp'rovel Mpg ado 14 Smith Avenue " Mt Co, Kis To Butldlog Type COlonla l Lot nroa 3.020 AC . ' rFIWOSection ;Ody Depth Volume Nambar of Hedroome 4 Design Flow G P_ .D PCBD Notlfleatioti Is Reftulred When FIB le completed 1200... 444.LE of Tile .Fields Separate Sewe "rage Systemao consist of Gallon Septic Tank and_ To be codetipcted hY. to <be 'determined...Addreis Water Sa 1 %blle S •Alldrees PP) tlpply_ From x :. -,.. to be determin. ors Private Supply DiZed by Other Reoairemants 3 :5 feet fill Approx 700 c. y (.represent that. l am. wholly and completely responsiDle� for ttie design' and location of the proDOsad systeni(s) 1j that the; separate ;.. sewage - disposal 'system above described will be constructed as shown on th`e approved amendment there to and m`accoidance with the standards r6leiand regu s ions o a u nom be;womrtted ante bf tAo appro!al'of the Cert:f:cate, o''f Construction Complmnce of th wall be Iocated,,as shown -on the aDprovetl plan an will be ,instal County 0��+partm/e�nt of Health Signed T fessRa�l caw, n & Cor -n us P APPROVED FOR C. f -f UCTI,ON This approval expnes two years from the. revocable for"cause "or may be amendetl 'or`modified;when.cons�deretl necessary -1 re0uires a new p- mit. Approv/ /e�,d for - disposal of- tlomestic sendsry�se�arage .a 87 Date `� /� BY 11 ing the period, of two•(2).years Immediately following thedate of the issu linal_tystem or :any repairs thereto; 2)'Chat the drilled well described, above accordancwth e . tdalMend, regu ss if" the Putnam 6,; :Rte. ` :22, rews�t� :e No e issued unless con_ str uci ion of the building has, been 'Undertaken and is- ,-. 'the Commissioner'.oUHealth. Any change br alteration of construction Irdr �.j�vato a „�� tle y4 BALDWIN & CORNELIUS, P.C. CONSULTING ENGINEERS - LAND SURVEYORS RD 6 - ROUTE 22, BREWSTER, N.Y. 10509 (914) 279 -7115 September 21, 1987 Ms. Chris Johnson Putnam County Health Dept. Old Route 6 Carmel, New York 10512 Re: Permit # P -76 -86 Maggio Subdivision Lot 7 Dear Ms. Johnson: Enclosed please-find applications for a permit renewal for the above parcel. If you need any further information please do not hesi- tate to contact this office. Very truly yours, - S&C 6-42 6JPWnF. Eberle ject Engineer JFE /k enclosure PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date. 9/21/87 Re: Property of Dr. Hans W. Kunz Located at McManus Road (T) Patterson Section 73 Block 3 Lot 5 Subdivision of Maggio Subdv. Lot # 7 Filed Map # 2011 Date 12/5/84 Gentlemen: This letter is to authorize a duly licensed professional engineer /� s�`'� (Indicate to apply for a Construction Permit, for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of - the Putnam County Department of Health, and to sign all .necessary papers on my behalf in connection with this matter and to supervise the.construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned: P.E. ,, #� RD #6, RTE 22 BR.EWSTER,. N.Y. 30509 Telephone 09/,;f_ Z -7 9_ ��g Very truly yours, I Signed Owner of Property Address Town 06-1 7 H -15 � 6 Telephone s, x PUTNAM, COUNTY DEPARTMENT OF HEALTHtt Rev. 3�8 ✓ Division of Environmental Health Services: Carmel, N.Y. 1051? Engineer to Provide Permit N a on CERTIFICATE OF COMPLIANCE.. Permit • ..� �. !o � , _ CONSTRUCTION FOR SEWAGE DISPOSAL SYSTEM Patterson. Located at McManus Road Town or Village Subdivision Name M a g g 1 o S u.b d 1 V. Suhd. Lot A 7 TAX Map' 73 Block 3. Lot 5 Rene Owner /Applicant Name D e•r e k T T a fl Z 1110 watl_ ❑ Revision ❑ Date of Previous Approval Mailing Address 249 Danbury. Rd. Town Wilton, C T ZIP Building Type Colonial Lot . Area 3 . 0 2 0 Fill Section only X Depth 3 • 5 ' volume 7.0 0' C y . Number of Bedrooms 4 Design Flow G /P /D 8 0 0 G P D PCHD Notification is Required When Fill is completed Separate 1200 444 LF. of Tile Fields se p rage System to consist of Gallon Septic Tank and To be constructed by lo be d e t ermined Address Water SuPPU': Pdbllc Supply From Address or; X Private Supply Drilled by T o b e d e ter . Adaroee other Requirements 3.51 Fill A p:p r 0 X. 7.00 C. y 1 represent that I am wholly and completely responsible for the design and location of the proposed system(s);''1) that the separate sewage disposal, system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regulations o e Putnam County Department of Health,. anti that on completion.fheIreof a "Certificate . of Construction Compliance "satisfactory to the Corrimissioner,of Healthwill be submitted to the Department,, and a written guarantee will be furnished, the owner, his successors, r ovassigns by the builder, thaCsaid builder will place in good operating condition any p a r t of said -- sewage disposal system during the period of tw 2 ears im ediately following thedata of the issu- ance of the.app ► oval of the Certificate; oI, Construction Compliance' of the origt 1 system or a y s ther 2) that the drilled well, described above will be located as shown on the approved plan and that *said well will be installed ordance i e t rules and ►ego aTi o the Putnam County Department of Health: Date 7 / 18/86 Signed P.E. R.A. — Address RD 6 Rte 22 r ew st err AY 1050'/ License No 8 3 2 9 APPROVED FO CONSTRU TION: This,approval expires one year rom a ate.iss d .unless construdi of the building has been undertaken and is revocable for. se or may b a dell or modified when considers n e r by` -the misstonor .of ea h. Any change or alteration of constr ction requires a per it. ..A pr v for disposal of .domestic san' s e,' and'or w r ly on Date BY Title -a. w BALDWIN & CORNELIUS, P.C. CONSULTING ENGINEERS - LAND SURVEYORS RD 6 - ROUTE 22, BREWSTER, N.Y. 10509 (914) 279 -7115 September 22, 1986 John Karell, Jr., P. E. Director Environmental. Health Services Putnaml; ;County Health Dept. 2 County Center Carmel, NY 10512 Re: Maggio Realty Lot 7 SSDS Dear Mr. Karell: In response to your letter of September 17, 1986, we offer the following: 1. An additional design data sheet is.submitted for your records. 0 '�2. While our client does not have a set of house - plans, as yet, and in so far as he must allow lC/ the required fill to stabilize, we ask that he be given permission to place the fill on his property.'.. :Before construction of any house,we will submit the house plans for your approval. 3. All sheets of the SSDS design have been sealed . and signed. 4. Fill notes have been added to the plans. 5. Footing and gutter drains have been shown. 6. Deep hole locations are on the plans (1 " =20') scale drawing. We have added the deep hole location to the preliminary fill design plan. Sincerely,yours BALDWIN & CO�RRNNELIU�SS , P.C. hn F . Eber l e 6.J, roject Manager jc DAVID 0. BRUEN County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services September 17, 1986 Mr. William Hurley Baldwin & Cornelius, P.C. RD #6, Rte. 22 Brewster, New York 10505 Dear Mr. Hurley: JOHN SIMMONS, M.D. Deputy Commissioner Re: Proposed SSDS East Branch Woods - Lot 1 East Branch Woods - Lot 4 Maggio - Lot 7 (T) Patterson Review of plans and other supporting documents submitted at this time relative.to the above- captioned project has been completed. Comments are offered as.follow.s :.. East Branch Woods Lot 1 1. A design data sheet has not been provided 2. Two sets of-house plans have not been provided.- .3. Design data is not shown on the plan, i.e. perc rate soil type 4. All sheets are not signed and sealed 5. The.scale on the plan drawing is incorrect, 1:20,. not 1 :100 6. The sewage area and expansion area is shown within 100 feet of the wetland East Branch Woods - Lot 4 1. See # 1, 2, 3, 4 above 2. Construction notes have not been provided 3. The well has been relocated to the front of the lot. .Information as to the location of sewage systems across Doansburg Pond within 200 feet of the well must be provided. Maggio, L t 7 1. See e an d 4 t East Branch Lot 1. TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 _ 2 _ Mr. William Hurley September 17, 1986 4aggio, .Lot 7 (continued) - ( /d '2 Fill notes have not been provided '3./'Footing and gutter drain discharges are not shown Deep hole locations are not shown Extra plans for lots 4, 5 and 8 are returned. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. ou s ve PAI ul ohn Kar J., E. irector, JK:pt Environmental Health Services cc:JK File " BALDWIN & CORNELIUS, P.C. Engineers- Architects -Site Developers RD #6, Rte. 22 BREWSTER, NEW YORK 10509 (914) 279.7115 TO ,Me-, 'Ub r}� P-CLL wiz rt , s- Aill*," GUlJ,"-Y 17,' -bA C%t J L [EUTEQ OF UQQaZOMDUUL DATE r p 5i -z t-. v S JOB NO. .g ATTENTION RE: WE ARE SENDING YOU °Attached ❑ Under separate cover via the following items: • Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications • Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION 6 (7m r %i rr Tv ! .c: 14, 9>> THESE ARE TRANSMITTED as checked below: j<For approval ❑ Approved as submitted • For your use ❑ Approved as noted • As requested ❑ Returned for corrections ❑ For review and comment ❑ ❑ FOR BIDS DUE 19 REMARKS • Resubmit copies for approval • Submit copies for distribution • Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO3� ti SIGNED: � PROMU2142 �lac, &ft MM oIen If enclosures are not as noted, kindly notify at /once. I Ulll/lrl Cuul1`1' t�Li'nlll'1>Lii'1' Olr I i' '1'li L1V1S1U11 Cir LNV11iUill' m1'1'n I11rJ1L'1'll SLliV1CL5 UUUlar Ul"FlUr, 13U.IU M UA111,10%, 11. Y. 10512 , LLS1Ull 1)11TA SI I'1' -DEVA IV1'19 SMAU19 •ll1SPOS" SYST H 5/2/86 1 "1LL IIU. UNllet! Derek Tranzillo. Address Blackberry Hill Brewster, NY 10509 LUCUted Lift (Stj -eet j McManus Rd. 1300. 73 3 -• Diook _ Lot 5.7 liiill%r;Ce ti`eat�oeC :oi�oee � je`eGj' flwticlWllty. Patterson Watershed CLaton i3U1L 1'LIICUL TIUll TEST LATH. MQUllMil) '1'U 1l13, SU131,111T W1'1'll /11'1'Ll(,'11'1'1U113 llulu 1lumbrit' CLUCIC '1'11iL Iliiit Blbj;ee IIu. '1'1u1e Utai,t -Stop , 1.1111. 111311CUL1'1'lUll l�ejitle lici U�Ger Watet�'vel From Urowid' Sur1'aoe III la 4rsltes Start Uto � 111,01) itt lttaltee 1110 {tee luol�es I'L11CULATIU11 . Bull 1111t13 I.11u. /iu drug A 1 ; 9:54 .10:24 •30 21 24.0 3.0 10 2 10:25 10:55 '30 21 23,75 2.75, 10.9 - _ 3 10:55 . 1}.:25 30 ;21 24. - 3.0 10 I' B 1 . 9:54 10:24 30 -.21, 23.75 3.0 10 2 10:24 L0:54 30 •21 24.25 .3.25 9.23 10:54 11:24 30 21 24 3.0. 10 5 2 � ' J �°��c -��. • . f�.f�?m�z� . 6116166 flute 1) 'frrta to be repeated at n me �lepth uutll u >>ruxiiintely eclif �.l r M 11111811 Live obL-aitted qt eaolt peroglat. oat teat (tole. All data -to be su mlt�;e . •fut• rev eu. 2; Wptlt meaeuremetttat to be made from top of Wis. TEST PIT DATA IIEQUIRED TO BE -SU1'1• ITTED 11IT11 APPLICAT'I011 DESCRII' "011 OT' SOILS 17-3100UI'!T RED II.1 "L'ES`T' 110LE13 1 ll�P'1'11 HOLE, ]do:. 7 IioLi; IrO. IIOLr N0. G. L. 611• Topsoil 1211 1611 Silty 21111 Silty Loam 711 . J j611 ' 4211 . 4611 ROCK @ 44'' 1111 6011 66t1 7211 .1611 4411 I1IUICA'T'E LEVEL AT 1111IC11 GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO W1ITCII WATER LEVEL RISES AFTER BEING ENCOUN'T'ERED TES'T'S IME BY N/A Date N/A y�oiuir Soil Rate Used 10 p1 iVll'Drop: S.D. Usable Area Provided 2,500 s . f . 110. of U,edrooms 4 _ Septic Tatilc Capacity 1,200 Gala. 'Type i AVsorptiou AI-ea rov3c�ecT By 4 4L.I'.X2411 wl'p ,�ycltll � �- k y V,44 e 115me 111AALAW Q ,pp gttatiiii Address �✓ / /r/�Z /�%S /•C. Si ��A� z" p 1980 do Z fSSI THIS SPACE FOR USE BY 1 MT'11 DEPARTMENT ONLY: Soil Rate Approved Sq. T't /Cal. Checkod by Lbte_ •Submitted By: Baldwin & Cornelius', P.C. RD 6 - Route 22 Brewster, New York 10509 (914) 279 7115 DAVID D. BRUEN County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services September 17, 1986 Mr. William Hurley Baldwin & Cornelius, P.C. RD #6, Rte. 22 Brewster, New York 10509 Dear Mr. Hurley: f JOHN SIMMOW M.D. Deputy Commissioner Re: Proposed SSDS East Branch Woods -'Lot 1 East Branch Woods - Lot 4 Maggio - Lot 7 (T) Patterson Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows:. - East Branch Woods Lot 1 1. A design data sheet has not been provided 2. Two sets of house plans have not been provided .3. Design data is not shown on the plan, i.e. perc rate soil type. 4. All sheets are not signed and sealed 5. The scale on the plan drawing is incorrect, 1:20, not 1:100 6. The sewage area and expansion area is shown within 100 feet of the wetland East Branch Woods - Lot 4 1. See # 1, 2, 3, 4 above 2. Construction notes have not been provided 3. The well has been relocated to the front of the lot. Information as to the location of sewage systems across Doansburg Pond within 200 feet of the well must be provided. Maggio, Lot 7 1. See #1, 2 and 4 at East Branch Lot 1. TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 - 2 - Mr. William Hurley September 17, 1986 Maggio,.Lot 7 (continued)' 2. Fill.notes have not been provided 3. Footing and gutter drain discharges are not shown 4. Deep hole locations are not shown Extra plans for lots 4, 5 and 8 are returned. Upon receipt of a submission, revised to reflect the above . comments, this application will be considered further. ou s ve y.truly ohn Kar , Jr., .E. irector, JK:pt Environmental Health Services cc :JK File .Encl... PUTNAM COUNTY DEPARIMENr OF HEALTH - DIVISION OF ENVIRONMEM HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT �- DATE REVI ' BY: ( of er) (Street Location) COMMENTS YES NO DOCUMERrS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) j NJ Deep Hole Logy LI Consistent Perc Results (3) 30" Perc Hole 1 IT Other House Plans - Two sets PWS - Letter fiance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions.- Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail - erl Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area;shown;gravity flow,suff. size If Pumped Pit & D Box Shown & Detailed use - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 '0; Type pipe No Bends; Max. Bends 45° w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake Unc. expan) 15' to Drains -Crtain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fran Foundation 50' to Well 15' Well to PL GENERAI, Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same FU1HAN UUUU`1`Y ,L �`1'Illi'1'h i'1J'1' Ulr -1 �' 'ill L1V151U[l Cl+' LNV1JiUN61L[l'1'/1L 1 = 1211 SLIIVIULS UUUIITJ[ Uiriv1Ur 13Uimmu. UAIiMSL,- 11. Y. 10512 , 111;S1U11 I)/ TA Sl r U- SEVAIIAT1.9 SL'WAU11-lllS1'USAL MOTE 5/2/,86 F1LS IIU. UNllel' D rek Tranzillo, Address Blackberry Hill Brewster, NY_10509 W _ - Local ed a9: (Street: McManus Rd. Boo. 7-3— Block 3 — Lot_ 5.7 �liiili�aGe lie�l�vsG aT•oee a teeL•�' 1•iwllel pall ty Patterson Waterslled CLoton CUIL 1'1110111'1'lUll IEST DATA 1ILQU11iL1) TU 13H SU131•111T WITH AI'1'L1UA'1'1UI13 llcilo lluml101. MUCK lW." I - 1if,UL1111U11 I'L ICUlATIUI1 Iliul l�iNee l�ejiGli�v Wa�'er Watet�'vel Nu. Tlnro From Urowld, Sur1'aae i.11 1l riles SU1.1 IlaLa Stnit -Step 1.1111. Start Sto ) Drop a 11111. /lit drop Inches 1110110" 1ucl,es A 1 ; 9:54 10:24 - 30 21 24.0 3.0 10 2 10:25 10:55 30 21 23,75 2.75. 10.9 3--10,,55 11: 25 30 21 24 '3.0 10 B 1 . 9:54 10:24 30 :21 23.75 3.0 10 - 2 10:24 L0:54 30 '21 24.25 .3.25 9.23 3 10:54 11:24 30 21 ' 24` 3.0. 10 r: 2 • �G�iC'C ' /�s'i• /?��2�n�:z� , 6//5f c� is Voteis 1 j 'lint•" to be repeated at ee -mo Oept11 ulitil v > �roxlmately eq�i .l :, �11� 111 en nve obtained a eaotl peroplation set. Hole. Ali data to be eu mava' .-for rev eve 2� Wptll meaeurements to be made from top of Hole. TEST PIT DATA REQUIRED TO LIE -SU -V$' TTrM 111TH APPLICATION DESCRIP'1' T OIl Or SOILS E110,0UHTERED II: "s'EST TIME" . 1 DEI''I'lI HOLE, 1404. 7 . HOLE 110. HOLE 1.40. G.L. 611• Topsoil 1211 1811 silty 2411 Silty Loam J 3611 1211 4311 =WLRock @ 44'' 5411 6U 11 66" 7211 73i1 _ 84 11 IRDICATE LEVEL AT WHICII GROUND WATER IS ENCOUN'T'ERED INDICATE LEVEL TO WIIICII WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS IMDE BY N/A Date N/A Tact ac nar ciihiixricinn nlat Mnovin Raalty gi1hHiviGinn' 111AIAZL_ ' ULaILM Soil Rate Used 10 b11iVI "Drop: S. D. Usable Area Provided 2,500 s.f. Ila. of Bedrooms 4 Septic 'arik Capacity 1 200 Gals. 'Type Absorptioii Area rov ec By - 4 4L.F.x24" 7;2;1�611 ,�� " "'��+�,,dtll MAW _1X va me10 Address THIS SPACE FOR USE 13Y.1 'T'Ii DEPAR`T'P ENT ONLY: Soil Rate Approved Sq. Ft/Gal. Check-ad by, -Submitted By: SEAL 1930 83 Date Baldwin & Cornelius-, P.C. RD 6 - Route 22 Brewster, New York 10509 (914) 279 7115 4 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date July 18, 1986 Re: Property of Derek Tranzillo Located at McManus Road (T) Patterson Section 73 Block 3 Lot 5 Subdivision of Maggio Realty Subdivision Subdv. Lot # 7 Filed Map # Gentlemen: This letter is to authorize Don Crotty 2011 Date 12/5/84 a duly licensed professional engineer x or registered architect_ (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in .accordance with the standards, rules or regulations as promulagated by the Commissioner -of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly o rs i Signed Countersigned: 0 er of roperty # 2��?G� 249 Danbury Rd. P.E.,�., �J / Address Baldwin & Cornelius, P.C. Address RD 6, Rt. 22 Brewster, New York 10509 (914) 279 7115 Telephone Wilton, CT Town Telephone BALDWIN & CORNELIUS, P.C. Engineers - Architects -Site Developers .�, RD #6, Rte. 22 BREWSTER, NEW YORK 10509 (914) 279 -7115 TO �yl j� '� 6 "G L /Y- e -'? � � y S C111� P_In;6L , /V:'/; L [ETTEa of TURSEDUML DATE g �j ' !i �� JOB NO. 7 ATTENTION /.)I ... / 4-7 /^ 44' " .S RE: .� v� *7 /J�riGG 4747 P-L , G.7``� �r ✓��- ✓i �a �`�%/'v' i � '�"� �"�� C r�1ii WE ARE SENDING YOU J< Attached ❑ Under separate cover via the following items: • Shop drawings Prints ❑ Plans ❑ Samples ❑ Specifications • Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION .� /J�riGG 4747 P-L , G.7``� �r ✓��- ✓i �a �`�%/'v' i � '�"� �"�� C r�1ii '7/) 9 f G n�l�ur "� /c�V - ✓?ice "l Fvr� �c c ls�67r P- lv THESE ARE TRANSMITTED as checked below: For approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ ❑ FOR BIDS DUE 19 REMARKS • Resubmit copies for approval • Submit copies for distribution • Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO SIGNED: . . - 9� PROVM240 -2 Ar6es Ind Qvbk xm 01471. if enclosures are not as noted, kindly notify s a once. DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT #�t7 -'LF`6 WELL LOCATION Street Address � Town Village City Tax Grid N mbe k r Name �Ci� , Mailing Address ri ate WELL OWNER ks, .. • Gar - n, t► O Public USE OF WELL g R SIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED g - primary O BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify, 2- secondary 0 INDUSTRIAL O INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT , gpm /# PEOPLE SERVED /EST. OF DAILY USAGE_ gal E3 REPLACE EXISTING SUPPLY O TEST /OBSERVATION O ADDITIONAL SUPPLY REASON FOR DRILLING &NEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED ODRIVEN ODUG CIGRAVEL O OTHER IS WELL SITE SUBJECT TO FLOODING? YES IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: /Y h4-G -( c) Lot No. WATER WELL .;CONTRACTOR: Name feyyl- Address: IS PUBLIC.WATE' °SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION O ON SEPARATE SHEET (date) sizwature 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 thirty (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 any and all water or waste products from such well property and in such a manner as not to degrade or Date of Issue: / 7'_ 1 Z. 19 C Date of Expiration 19 shall take appropriate action to assure that drilling operations be contained on this otherwise contaminate surface or groundwater. l Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pi k copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller