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HomeMy WebLinkAbout0655DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23.09 -1 -13 1 rm .. i . m " 1 ljj� y 00655 ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E., MPH Director of Environmental Health December 3, 2014 . DC Engineering John Kalin, P.E. 3 Memorial Avenue Pawling, NY 12564 Dear Mr. Kalin: DEPARTMENT OF HEALTH , 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 MARYELLEN ODELL County Executive Re: Field Inspection — Guardian Home Builders Bear Hill Road. (T) Patterson, TM 23.09 -1 -13 An inspection at the above referenced lot'has been completed.. There are no open comments to be addressed at this time in reference to this Department's open work inspection. If you have any further questions, please contact me at (845) 808 -1390 ext. 43261. Sincerely, ' U Gene D. Reed Principal Environmental Health Engineering Aide GDR:cml PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL EMALTH ' SERVICES FINAL SM INSPECTION Street Location BeAr_9 11 T11, Town 7RIMAzrson TM# 4:3,09 —/ —/3 1. Sewage System Area . a. STS area located as per approved plans .......... :................ b. Fill section; - date of placement 3:1 bani wi Lgth. Width Avg.Dptb c. Natural soil not stripped . ..........:.. ............................... d. Stone, brush, etc., greater than 15' from STS area...:...... e. 100' from, water courselwe# lands ...... ............................... li Sewn a stem ,� ae =jc size, 1,000 ... ........ :other ......:.........: b. 'Squetaalc installed level ....... I.................................... c. 10' hwi m m-from. foundation ....................... . d. D' tiasion Boz 1. o at same on- water.tested ....:............ 2-. Protected below frost ..............:.: ..............:.:.::.:.: :....._ . 3. 1&6iin 2 ft.Osigiasl soil between box & trenches e. Ju B properly set .......... ............................... 6. r Fl required a 3C Len installed 2. Distance to watercourse measured - Ira Ft.....:.... 3. Installed according to plan ...:... ..................I............. 4. Slope of trench acceptable 1116 - '1132 "/foot ............. 5. 10 ft. from .property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface ................:. 7. t Room allowed for expansion, 100% ......... : .......... ..... B.. Size of gravel 3/4 - l'An diameter clean. ............... I ... 9. Depth of gravel intrench 12" minimum......:,........... 10. Pipe ends.ca4 ed ..................... ..................:............ g, per ore stems 1. .2. Over$ow teak .............. :.............................. 3. i�larm„ visuaUauclio .......:......:. ............................... 4. Pump >easity access�le, manhole to grade....... 5. First bona baled .................... ...............:.............. 6. de witnessed by H.D.esrimated flow/cycle........... IIL House il a House orated per approved plans ....... V ..................... b. Nudber of bedrooms ..................... WenTocated as per approved plans . ......:....................... b. Dikance from STS area measured 4 - /4c ' ' ft ........... C. Casing 18" above grade ......................... ` d. Surface drainage around well acceptable .....:....... ........... V. ' Overall WorlrmaQShio . a. b. All �� �b .......... ............................... c. All pipes $ush whhwhh inside of box ......... ..................... d. Backfill material contains stones <4" diameter.. .... e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outf dl protected & dir.to exist watercourse g. Footing drains discharge away from STS area ....:.......... h. Surface water protection adequate.....-L, ......................... i. Erosion control provided ................. ............................... Rev. 12102 Date: II Inspected by: Ownerd�rdia�w Permit # 0 7 Subdivision Lot # PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM, PERMIT # : Located at Ei Town or Village-CfiYr��l Subdivision name LU Eaw Subd. Lot # _aL_ Tax MapZ Block Lot 15 Date Subdivision Approved _ - Iq - Owner /Applicant Name (=1X1M2ZNtQ4J +"*-T�LA Mailing Address Amount of Fee Enclosed -� Renewal' Revision Date of Previous Approval I - L% 3 Zip 106do Building Type / /-At-t Res Lot Area No. of Bedrooms 4- Design Flow GPD (PfJ-C Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1260 gallon septic tank and �. C.> Other Requirements: Ae&og;>nc�,j - To be constructed by Ow k* L, Address e46zit . Water Sunaly: Public Supply From or: ./ Private Supply Drilled by Address Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment 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 Director /Commissioner will be submitted to the Department, nd a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will pl d-perating condition any part of said sewage treatment system during the period of two (2) years immediatelfdll urge ¢ate of the issuance of the approval of the Certificate of Construction Compliance of the original system o loll— rq. a s OP Signed: P.E. / R.A. Date Address � ^ - ' � ,� v� 196414 License # .079004 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 considere necessary by the Dinector /Commissioner. Any revision or alteration of the approved plan requires a new p rmit. Approve for discha(ge of domestic sanitary sewa only. By: L Title: Date: 1—Z, White copy - HD F Yel c py - ilding Inspector; Pink copy - Owner; ng o y - Design Professional ' ; Form CP -97 FEB -5 -2004 05:36P FROM:DC ENGINEERING 845- 8552605 TO:27e7921 ATTENTION PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 13 JOSEPH REDUEST,FORF.TNAL INSPECTION All information musvbe fully completed prior to any inspections being made. ENE For PCHD Construction ermit # �' . y (.0 —' U�l Located:. 2 3 Owner /Applicant Name: Ati M; Formerly: Subdivision Name: Subdivision Lot # _ Is system fill completed? _ !r Date Is system complete? Date:1 Is system constructed as per plans? Is well drilled? V . Date Is well located as per plan ? Are erosion control measures in place? I certify that the system(s), as listed, at the above premises has been and verified their completion in accordance with the issued I approved plans and the Standards, Rules and Regulatiogs-tf' lie Health. Date: ertificd by: P.1/1 Lot constructed and I hAve inspected CHD Construction Permit and Tutnikm County Department of PE RA d �zgn rrore�sionaa - Address: ()04- Comments: T Form FIR -99 OC ENGINEERING, PC LETTER OF TRANSMITTAL To: Putnam Co. Dept. of Health 4 Geneva Rd. Brewster, NY 10509 Date: Nov 19, 2014 Job No: 033110 Attention: Mike Budzinski, P.E. RE: Bear Hill Estates — Lot No. 3- Rt. 311 (t) Patterson We are sending you: X Attached 0 Under separate cover via _ 0 Shop Drawings 0 Prints X Plans 0 Samples 0 Copy of Letter 0 Change Order 0 The following items: 0 Specifications Copies Date No. Description 3 11/17/14 Bear Hill Estates — Lot No. 3, Septic Trench Plan (sht 2 of 2) 1 11/15/14 Design Data Sheet — Fill Pad Perc Test These are transmitted as checked below: X For approval 0 As requested X For your use 0 For review and comment Re Sig cc: DESIGN CONCEPTS ENGINEERING, PC 3 MEMORIAL AVE. SUITE 301, PAWLING, NY 12564 PH: B45- 1355-2000 • FX: B45 -1355 -2605 E: JKAUN (PVERIZON.NET �.(f.'1.�xr tea• wT PUTNAM COUNTY DEPARTNIENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner: Located at (street): ftA 41 Lt- GOAD Municipality: ( -T) PA "TTf-PS'DN Address: 10 M"(4fX—,L TT- 14ATONA14 TIM # Secti.on:q?,OiBlock ( Lot 13 Watershed: GFTot`l SOIL PERCOLAETION TEST DATA ( f I L L PAC) 1 Witnessed by: ✓ Date of Pre - soaking: t i' `I' I y Date of Percolation Test: It • is, I �{ ( 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 3E� I Zoa- 273" 2 't:01- zqr 3'' I ptL't -Poko 3 Z:t$ - 2:21 its I 3.0 -h ih 4 I i 3 I 2c as — Z:t lg "— ZI ' I 3„ Z " 2 Pitiv Pap 3 2: qt 9 41 -5 4 I 5 I I I. 2 4 j i � .,I• f I 2 I 3 4 I I. Notes: !. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e., < t min for 1 -30 min/inch. < 2 Rtin for 31 -60 miniinch). AR data to be submitted for review. 3. Depth measurements to be made from top ofhole. Form DD -97, F°- f or'- JAN -29 -2004 01:44P FROM:DC ENGINEERING 845- 8552605 TO:2787921 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION JOSEPH ENE REQUEST FOR FINAL INSPECTION For 2i All information must be fully completed prior to any Trenches inspections being made. PCHD Construction Permit # C) ( — 0-1 Located: ` sdN Owner /Applicant Name: _C6L%W_;Dt AA Mlzi. Bl ek Lot Formerly: Subdivision Name: Subdivision Lot # Is system fill completed? _. Date: ,22' " A Is system complete? =- - - -- - - - - -- Is system constructed as per plans? Is well drilled? \! Is well located as per Are erosion control n I certify that the system(s and verified their comp approved plans and the Health. Date: / ' %- Address: .5FR Comments: Form FIR -99 in place ?( -_ _-. _ - Date:. Date: P. 1/1 listed, at the above premises has been constructed and I have inspected in in accordance with the issued PCHD Construction Permit and dards, Rules and Regulalio ). e -Ntnam County Department of f Certified by: PE RA rofession .,1%# A Lt I i Or ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E., MPH Director ofEnvironmental Health DC Engineering John Kalin, P.E. 3 Memorial Avenue Pawling, NY 12564 Dear Mr. Kalin: MARYELLEN ODELL County Fxecutive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 November 13, 2014 Re: Field Inspection — Guardian Homebuilders Bear Hill Road (T) Patterson, ,TM.3 -2 -35 An inspection of the fill pad at the above referenced project has been completed and found to be in compliance with the approved plans. Trench permit and plans must be submitted to this Department for final approval of construction prior to the installation of the separate sewage treatment system. Please note that field measurements by this Department in no way suggest the exact size, depth and location of the fill pad. It is the responsibility of the Design Professional to ensure the construction at the above referenced project is in with the approved plans.. If you have any further questions, please contact me at (845) 808 -1390 ext. 43261. Sincerely, Gene D. Reed Principal Environmental Health Engineering Aide GDR:cml Ld PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVI ES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERNUT # - O-C.. O 1 Located at A&, ' u 9 "9�PAQ Subdivision name � F-Rj L1L 1�-Sr, Subd. Lot # Date Subdivision Approved Q� Owner /Applicant Name G VAV,- t "K� 44tyg y l t.D�S b Town or Village PAITEP:�p 1� Tax Map 1i3. 01 Block Lot Renewal " Revision Date of Previous Approval Mailing Address `p W V*ty li S LA VtDNA 14 NY Zip Amount of Fee Enclosed Building Type t FAW ' W Lot Area 7J Fill Sect>d Only of Bedrooms A-- Design Flow GPD_W Depth J1�5 Volume Separate Sewerage System to consist of l 25-0 gallon septic tank and Other Requirements: At3 0 P 'T 1®t-� T W S To be constructed by b UvNit V Address A&V Water Supply: Public Supply From Address or: Private Supply Drilled by 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�oper itmg condition any part of said sewage treatment system during the period of two (2) years immediately follow,ing.the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any rep, its,ther Signed:\ P.E. 1/ Address ;�'� ' M� oli v qVC da N I'lSb R.A. Date 9• �• % 3 License # APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires anew peimit. Approved fA discharge of domestic sanitary sewadonly. -Date: L4 ::�_ FIL�W10, • 9 Is Title: Inspector; F - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH CONSTRUCTION PERMIT FOR SEWAGE TREATMENT r PERMIT # _07 Located at BeAF- 41 1-V l oAt) Town or Village FAITS- F-SOt,) Subdivision name �EAE:t4jLt, MTAT�S Subd. Lot # 3 TaxMapl-S-01 Block Lot Date Subdivision Approved I o% l l( O 7 Renewal Revision Owner /Applicant Name WINO/144W Am4 el5 too, . Date of Previous Approval - I-, ZS Dg7 Mailing Address 7do 's u mmt* ST s u i TS I - I- s 7AAffioR-49, c- T Zip O(.V O Amount of Fee Enclosed S a o Building Type I FAN l trj M t p . Lot Area 4t 3 No. of Bedrooms 3 Design Flow GPD OO Fill Section Only �_ Depth 3 S Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1666 Other Requirements: 3,�, F- . 0, g, F i L- L,- gallon septic tank and 100 G q L- p✓M P c4AM$ef- To be constructed by J-a D Address Water Suuuly: Public Supply From Address or: v"" Private Supply Drilled by T. E. . D 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 ache issuance of the approval of the Certificate of Construction Compliance of the original system or any r lSai )rs there.. o. ' 019 Signed: I P.E. R.A. Date Addy 1 � [,►ice` �?� ?( G, SMCMOe-i t�AlfE PA ev 0 6 MY License# 07gD0� ��� �`�•c,, r' % � 2564 APPROVED FORAeUINST" T'ION: 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 rmit. Approve or discharge of domestic sanitary s age only. By: - Title: Date: White copy - HDile;�`Yellov� copy -Building Inspector; Pink copy Own r; range copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL _ please print or type (PCHDP Rlli� n: Well Location Street Address: Town/Village: Tax Map # �µIL-� F-OAC) t>A1TG� -Sort MapZ3•13 Block I Lot(s) ?• Well Owner: Name: Address: Phone #: W I NOwAR•0 J+0L.0j►vfns I?a v S s-r s u l Tr,, i -i� I'*3 1761-79-ss C4 po " 't tar> STAA4Fo¢!=� L 06 j o f . Use of Well: ✓ Residential Public Supply Air /cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring, —Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield Sought S gpm #People Served Est. of Daily usage (o 0 C� gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drilling P,*New Supply (new dwelling) Deepen Existing Well Detailed Reason t4ew wC —L.t~ ro p o 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 BEAR 41 L-t, eSTATES Lot No. 3 Water Well Contractor: 7-g4r-> Address: -� Is Public Water Supply available on site? ....................................... ............................... Yes No _ Name of Public Water Supply: N ^ — �, Town/Village ►''f A Distance to property from nearest water main: N , �- --�'�v I Proposed well location & sources of contaminatio (to bp.s'r v i 8 ro� parate sheet/plan. Date: I`[ I Applicant Signatu 4,11. l� (1 `J� PERMIT TO COI%kTRIJCTcA'WATER WELL This permit to construct one water well as set forth above, is grartted'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. 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 Commissioner of Health. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam 9'ounty. 7 Daze of Issue Permit Iss Ing Official: Date of Expiration — r/2 Title: Permit is Non- Transferable White copy - HD file; Yellow copy - Building Inspector; Pink copy - All e copy - Well driller Form WP -97 Rev. 3/06 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type Well Location Street Address:. Town/Village: Tax Map # f' F+B L4, F0-AaaD C1 PATTY SON Map 13,07 Block I Lot(s) 13 Well Owner: Name: Address: Phone #: GVAF�ObA ils *ME UI 10 ST, �-A- toNAt4i NY I®S3/o Use of Well: Residential _Public Supply Air /cond /heat pump _Irrigation 1- Primary Business Farm Testimonitoring —Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield Sought____,5_gpm # People Served Est. of Daily usage Soo gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drillin New Supply (new dwelling) Deepen Existing Well Detailed Reason Su o for Drilling Well Type V Drilled Driven Gravel Other Is well site subject to flooding ? ........ ............................................. ............................... Yes No No Is well located in a realty subdivision? ........................................... ............................... Yes Name of subdivision gg6& 411 gEsTATIE.-S Lot No.�_ Water Well Contractor: 1*0 Address: Is Public Water Supply available on site? ....................................... ............................... Yes _ No Name of Public Water Supply: tj o�` Town/Village Distance to property from nearest water main:_ N ®L Proposed well location & sources of contamination to be provided on separates et/plan. Date: 7 3 1, 9 2_> 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 Departmei 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 Commissioner of Health. Any revision or alteration of th approved plan re es a new permit. Well to be constructed by a water well driller certified bly Putnam County. B I Date of Issue �'3 Permit Date of Expiratio � :ww�/s Title:_ Permit is Non - Transferable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owrofr; Orange copy - Well driller Form WP -97 Rev. 3106 OC ENGINEERING, PC September 4, 2013 Mr. Michael Budzinski, P.E. Putnam County Department of Health 4 Geneva Road Brewster, N.Y. 10509 Re: Bear Hill Estates Subdivision — Lot #3 SSTS Renewal (T) Patterson, TM 23.09 -1 -13 Dear Mike: I have reviewed your comment letter regarding the above referenced project. As requested, I have modified and/ or provided additional information on the attached plans and in this letter. To facilitate your review, I have keyed the following responses to the original comments from each department: 1. The floor plans have been revised to include the basement. Two copies of the plan are attached. 2. See above. 3. See above. 4. The construction permit has been revised and is attached. If you have any questions regarding the revisions made, please feel free to call me at your e. 1 can be reached at (845) 855 -2000. in, P. E. DESIGN CONCEPTS ENGINEERING, PC 3 MEMORIAL AVE. SU FE 101, PAWLING, NY 12564 PH: 845 - 655 -2000 • FX: B45- 655 -2605 E: JKAUN ©VERIZON.NET ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E., MPH Director of Environmental Health August 20, 2013 John Kalin P.E. DC Engineering 3 Memorial Avenue Pawling, NY 12564 Dear Mr. Kalin: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 MARYELLEN ODELL County Executive Re: Proposed SSTS for Lot # 3 — Bear Hill Estates (T) Patterson, TM # 23.09 -1 -13 This Department has received and reviewed the revised plans for the above referenced project and the following comment is offered for your consideration. The submitted house floor plans did not include the basement floor plan. Please submit 2 / copies of the basement plan. V-2 . The submitted house floor plans do not include overall length and width dimensions for the house. The house footprint shown on the. site plan does not coincide with the submitted floor plans. d4• The submitted construction permit application specifies 378 LF of absorption trenches whereas the site plan shows 336 LF of absorption trenches. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. Respectfully, Michael J. Bu4iins ', m P. . Director of Eigineer MJB:cw ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E. Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 . MARYELLEN ODELL County Executive TO: NYCDEP DEg.ARTMENT OF ENGINEERING AND DESIGN REVIEW Ate: p�q� ALbC--2jS)-o FROM: DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM DELEGATED New Application ❑ Renewal ft PROJECT: LOCATION: ` �2FAC 2�D (.c.. 4--4N TOWN: DATE SUB'D APPROVAL 10 -l9 -07 TM NOTICE OF COMPLETE APPLICATION DATE: 9 —8 -13 DELEGATED ENGINEERING REPORT PROPOSED SEWAGE TREATMENT SYSTEM PROPOSED RESIDENCE Bear Hill Road TOWN OF PATTERSON, PUTNAM COUNTY, NEW YORK JUNE 2013; Rev'd 8/2/13 WARNING: IT IS A VIOLATION OF SECTION 7209, SUBDIVISION 2, OF THE NEW YORK STATE EDUCATION LAW FOR ANY PERSON, UNLESS ACTING UNDER THE DIRECTION OF A LICENSED PROFESSIONAL ENGINEER OR LAND SURVEYOR TO ALTER IN ANY WAY, ANY PLANS, SPECIFICATIONS, PLATS OR REPORTS TO WHICH THE SEAL OF A PROFESSIONAL ENGINEER OR LAND SURVEYOR HAS BEEN APPLIED. COPYRIGHT 2013 JOHN A. KALIN, P.E. Prepared by: Design Concepts Engineering, P.C. John A. Kalin, P.E. 3 Memorial Avenue Pawling, NY 12564 N Submitted herewith is a report containing the engineering design data relative to the proposed Subsurface Sewage Treatment System (SSTS) to serve a private residence. within the Town of Patterson, Putnam County, New York. PROJECT DESCRIPTION: The parcel to be serviced by the proposed SSTS is located on Bear Hill Road. The parcel is identified on the Town Tax Maps as Grid # 23.09 -1 -13. It was formerly known as Lot #3 within the Bear Hill Estates subdivision. The project is currently vacant land with an expired Health Department approval. The proposed residence will consist of a four (4) bedroom, single - family dwelling to be constructed on an existing lot. The proposed dwelling will most likely be two stories high with a full height basement. The irregularly shaped property slopes up from its frontage on Bear Hill Road. The entire parcel is wooded and the property remains in the same condition as when it was originally approved under PCHD Permit P -06 -07 on April 28, 2008. GENERAL DESCRIPTION OF SSTS: Attached please find the proposed plans for the layout of the sewage disposal system and the detailed design calculations. The new SSTS design shall replace the previous design. The disposal system is proposed to generally consist of the following components: • 3.5 ft R.O.B. Fill Pad • 1,250 Gallon Precast Concrete Septic Tank • Precast Concrete Distribution Box • 333 L. F. of Absorption Trenches with 100% reserve area Deep test holes were excavated and witnessed by representatives of the Putnam County Health Department (refer to location on plan) with the prior design engineer, Putnam Engineering. We have reviewed the soil testing results and accept them. Our office performed percolation testing at the request of the Health Department. The system was sized as per the results of the testing and subsequent conversations with the Health Department. The previous design has been revised to reflect changes in the Health Department ST -19 Bulletin. The bedroom count has been raised to four (4). The pump chamber has also been removed from the design. Attached please find the proposed plans for the layout of the sewage treatment system. The Design Flow utilized to design the SDS is 150 GPD /Bedroom, or 600 GPD (based upon a 4- bedroom design) Noting the soil percolation rate of 8 -10 minutes per inch, and DESIGN CONCEPTS ENGINEERING, PC 3 MEMORIAL AVE. SUITE 101, PAWLING, NY 12564 PH: B45- 655 -2000 • FX: B45- 855 -2605 E: JKAUNOVERIZON.NEr N . . 't SSTS Engineering Report - Bear Hill Estates Lot #3 M Patterson June 18, 2013; Rev'd 8/2/13 associated application rate of 0.9 GPD /SF, the required length for standard 2' -wide absorption trenches is 333 L.F. For this design, the system shall be arranged using six (6) rows of trenches @ 56 L.F. for a total absorption trench length of 336 L.F. A 100% expansion area has been tested and reserved on the parcel. WATER SUPPLY: Water will be provided through anew well and submersible pump. Refer to the plan for its' location and associated details. It has been located with the appropriate separation distances to the property lines, existing adjacent and proposed septics. Prior to use, the well shall be disinfected and tested in accordance with Health Department Standards. DESIGN CONCEPTS ENGINEERING, PC 3 MEMORIAL AVE. SUITE 101, PAWLING, NY 125B4 PH: 645 -555 -2000 s FX: B45 -B55 -2605 E: JKAUN@VERIZON.NET PUTNAM: COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET — SUBSURFACE SEWAGE TREATMENT SYSTEM' Owner: C+ V AF-t>IAN 4oACC V L -66Q -S Address: IO MCKetV Sr, K A"?o NAO h r Located at (street): Municipality: PA't-rVF-sot-a TM # Section 1 4, 131ock j_.Lot 13 Watershed: SOIL PERCOLATION TEST DATA Witnessed by: 4, Date of Pre - soaking: 7.1 S ( 3 Date of Percolation Test: i . I t Hole No. Run No. Time Start — Stop Elapse Time (min:). Depth to water from ground surface (inches) Start.- Stop Water level drop in inches Pe latiotii Rate min /inch 2 1 t I 3 q,. Z ;4j, IZ 4w, ih 4 5 9;06- 9,J7 10 - zqw 3" 304 2 ;( 3 4 5 P3 C_ 1 q:o8 -q;18 Iv 4821" 3`' y 1 2 q•. Ig : 31 I3 3 4 5 3 1 1b 6 z " 2 q. T7 II 3 q: ti - • J5, 11 .7 0 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. Form DD -97, pg 1 of 2 LETTER OF AUTHORIZATION RE: Property of G VAV-A I qo,4 4Q1ge8V (yM1,r, Located at ' VA'o TN t7A1jWS01-) Tax Map Block Lot Subdivision of IRC-W- i -V C;9SY^1T,5_'S Subdivision Lot # 3 Filed Map # Date Filed 10/11/07 Gentlemen: This letter is to authorize JOHN A KALIN, PE A duly licensed Professional Engineer X or Registered Ar-s#hect -- 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 Commissioner of Health of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and /or water supply systems in conformity with the provisions of Article 145 and /or 147 of the Education Law, the Publi -Heal aw, and the Putnam County Sanitary Code. C c/) Z Countersigned: P.E., R.A., Mailing 3 MEMORIAL AVE, PAWLING State: PAWLING Zip: 12564 Telephone: (845) 855 -2000 Signed: (Owner of r (*rty) Mailing Address: 0041esUtL•DO —S State: 1`'Y Zip: 10-C 3 Telephone: 11Y V10 3L97 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: G VA, 7-a>l AN OyMS43-v i TG(/ I, L A V-- Ga-Y T AMP7,I N I represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: G V A?-p AN. +6tSV i t.1> 5 Having offices at: (d M z; r_e-e�:v sT , 1 NI 10 S 3 b Whose Officers Are: President - Name: Address: Vice President - N Address: Secretary -Name: Address: Treasurer - Name: Address: and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Signed: Title: V Sworn to before me this a I day of. (mo h) A 0 ear) Notary Public THERESA A. TYCHOSTUP Notary Public, State of New York R1 No. Y6170160 Corporate Seal Qualified In Putnam County My Commisslon Expires 07.02- Form CA -97 8 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: G VAV (Atli E�M 01 Vt260-L r�Or -),A r► y J VS3b 2. Name of Project: ' 55AILW LA, OST - DoT 3 3. Location:d V: Pxi `(tep -sPrJ 4. Design Professional: 5. A68 6. Drainage Basin: i r4SI BRA"tA 944 Tmem Ave• Suite 30, Pawling, New York 12564 7. Type o ro ect: Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR) ? .............. Yekv Type Status (check one) ...................................... ............................... Type I Exempt V Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required ? .................... Yes/No NO 10. Has DEIS been completed and found acceptable by Lead Agency ? ............. Yes/No N/A 11. Name of Lead Agency N 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ............................................................. ............................... Ye /No 13. If so, have plans been submitted to such authorities? .. ............................... Yes 14. Has preliminary approval been granted by such authorities? N Date granted: N A 15. Type of sewage treatment system discharge ........................ surface water ✓ groundwater 16. If surface water discharge, what is the stream class designation? .......................... N 16 17. Waters index number (surface) ............................................. ............................... N 1A 18. Is project located near a public water supply system? . ............................... Yes 19. If yes, name of water supply — Distance to water supply j t 20. Is project site near a public sewage collection or treatment system? .......... Yes/No NO 21. Name of sewage system Distance to sewage system N A 22. Date test holes observed 25 03 23. Name of Health Inspector � 0C- PA BVA"T 24. Project design flow (gallons per day) ............................. ............................... 4/00 6TD 25. Is State Pollutant Discharge Elimination system (SPDES) Permit required? ... Yes/No t� o 26. Has SPDES Application been submitted to local DEC office? ......................... Yes/No N 0 Rev. 11/02 Form PC -97 Pg. 1 of 2 a 27. Is any portion of this project located within a designated Town or State wetland ?... Yes/No ftQ 28. Wetlands ID number .................................................................. ............................... 29. 30. 31. 32. Is Wetlands Permit required? ...........:.......................... ............................... Yes/No NO Has application been made to Town or Local DEC ........................... Yes/No ND Does project require a DEC Stream Disturbance Permit? .... .........................Yes/No NO Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? .......................................... .........................Yes/No Is project located within 1,000 feet of existing or abandoned landfill, hazardous NO waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ................................... ............................... Yes/No No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? .........................Yes/No 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? .................................. .........................Yes/No NO 35. Are any sewage treatment areas in excess of 15% slope? .............................. Yes/No Ny 36. Tax Map ID Number .............. ............................... Map,23,91 Block I Lot 13 37. Approved plans are to be returned to ................ Applicant _Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item 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 penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are pun is . lass A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: Mailing Address: ........................... UM1 11 k V1 R,C LJ G 1 II ICC E I Memorial Ave. Suite Pawling, New York 125 4 \ Form PC -97 DC ENGINEERING, PC August 2, 2013 Mr. Michael Budzinski, P.E. Putnam County Department of Health 4 Geneva Road Brewster, N.Y. 10509 Re: Bear Hill Estates Subdivision — Lot #3 SSTS Renewal (T) Patterson, TM 23.09 -1 -13 4 Dear Mike: I have reviewed your comment letter regarding the above referenced project. As requested, I have modified and/ or provided additional information on the attached plans and in this letter. To facilitate your review, I have keyed the following responses to the original comments from each department: 1. The multi -part carbon copy well permit application has been completed and attached. 2. Attached please find two sets of preliminary proposed house plans. 3. The percolation tests were retested as requested. The design rate of the system was changed to 8 -10 min /in. A copy of the design data sheet is attached. If you have any questions regarding the revisions made, please feel free to call me at your can be reached at (845) 855 -2000. .E. D E S I G N CID N C E P T S E N G1 N E E R I N G, PC 3 MEMORIAL AVE. SUITE 101, PAWIJNG, NY 12564 PH: 845- 855 -2000 • FX:645- 855 -2605 E: JKALIN @VERIZON.NET ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E., MPH Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 June 26, 2013 Fax # (845) 278 -7921 John Kalin P.E. DC Engineering 3 Memorial Avenue Pawling, NY 12564 Dear Mr..Zapp: MARYELLEN ODELL County Executive Re: Incomplete SSTS Application Determination for Bear Hill Estates — Lot #3 (T) Patterson, TM 23.09 -1 -13 The Putnam County Department of Health (Department) has determined that the above referenced project, which was received by the Department on June 21, 2013 is incomplete. Please be advised that the following information is required to be submitted before the Department can determine the application complete and commence its review: v The well permit application is to be submitted on a PCHD 4 co carbon form. P pP copy Two (2) sets of house plans are to be submitted. The percolation test results for P -1 and P -2 are in excess of ten (10) years old and are required to be redone and witnessed by this Department. Review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information as to the completeness of your application. Please be advised that failure to submit information to the Department or to follow procedures is sufficient grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed Regulations and Putnam County Department of Health Regulations. Should you have any questions or care to discuss this matter further, please contact me at (845) 808 -1390, ext. 43148. Q Michael J. =uerlin k�'.E. Director of MJB:cw 6 14 -16- 4(9/95) -Text 12 617.20 PROJECT I.D. NUMBER Appendix CSEQR State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only DADT 1 DDf%TCrT TAT17(1DA4ATT!\TKT /T.. k }.v A-li -t -P-i -t q­­') n�nv If the action is in the Costal Area, and you are a state agency, complete the Costal Assessment form before proceeding with this assessment 1. APPLIeANT/SPONSOR JOHN A. KALIN, P.E. 2. PRoJECT NAME BEAR HILL ESTATES —LOT 3 3. PROJECT LOCATION: Municipality Town of PATERSON county PUTNAM 4. PRECISE LOCATION (Street address and road intersection, prominent landmarks, etc., or provide map) BEAR HILL ROAD 5. IS PROPOSED ACTION: ® New ❑ Expansion ❑ Modification/Alteration 6. DESCRIBE PROJECT BRIEFLY: Construction of a new three bedroom single family residence. 7. AMOUNT OF LAND AFFECTED: Initially 0.95 acres Ultimately 0.95 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ® Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? 0 Residential ❑ Industrial ❑ Commercial ❑ Agriculture ® Park/Forest/Open Space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? 0 Yes ❑ No If yes, list agency(s) and permit/approvals Building permit - Town of Patterson; Driveway and Erosion Permit — Town of Patterson 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes ® No If yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT ' POVAL - REQUIRE MODIFICATION? ❑ Yes ® No This is a new action on an exi Ceti CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS IQ I DGE / fu Apptiumt/Sponsor Name: John A. Kalin P.E. Date: Signature: n�nv If the action is in the Costal Area, and you are a state agency, complete the Costal Assessment form before proceeding with this assessment PART II - ENVIRONMFNTAL ASSESSMENT rTo be comoleted by Aeencv) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 If yes, coordinate the review process and use the FULL EAF. ❑ Yes ® No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTION IN 6 NYCR, PART 617.6? If No, a negative declaration maybe superseded by another involved agency. ❑ Yes ® No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers maybe handwritten, if legible) Cl. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waster production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: No C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: No C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: No 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: No C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: No C6. Long term, short term, cumulative, or other effects not identified in C1 -05? Explain briefly: None C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly: None D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA? ❑ Yes ® No E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ®No If Yes, explain briefly: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural): (b) probability or 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. If question D of Part II was checked yes, the determination and significance must evaluate the potential impact. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Office in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (if different from responsible officer) ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E., MPH Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 August 8, 2013 Phone # (845) 808 -1390 Fax # (845) 278 -7921 John Kalin, P.E. DC Engineering 3 Memorial Avenue Pawling, NY 12564 Dear Mr. Kalin: MARYELLEN ODELL County Executive Re: Application to Construct a Subsurface Sewage Treatment System for Bear-Hill Estates, Lot #3 (T) Patterson, TM 23.09 -1 -13 East Branch Reservoir Basin The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and revisions received by this Department on August 5, 2013 is complete. The Department will notify you by August 28, 2013 of its determination. O The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ❑ . Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed approved, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects. within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 808 -1390 ext. 43148. Re pectful , Uo ichael J. Budz'i ski, Director of Eng' ee g MJB:cw JUL -12 -2013 01:52P FROM:DC ENGINEERING 845 - 8552605 TO:2787921 P.1/1 .x BRUCE R. FOLEY Public Health Director LOR.ET'i'A MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 REQUEST FOR FIELD TESTING ATTENTION: ❑ JOSEPH PARAVATI d/ GENE REED All information below must be A& completed prior to any scheduling. DATE: 7. ENGINEER OR FIRM: d 0 g p KA V t N p PHONE #: 6. a, Too D REASON: DEEPS: D PERCS: ® PUMP TEST: D ROAD /STREET: I?IJA P N I( L ge- O TOWN: P'A—t c MD L� TAX MAP #: 2 3, 13 J 7, Z , Z3 • 01 SUBDI MION: 9 E L 7 , LOT #; , l -13 OWNER: NYCDE, P CRITERIA, FOR JOINT REVIEW AND MMSSING OF SQIL TESTING, � YES NO ❑ a Proposed SSTS within the drainage basin of West Branch or Boyds Corner Reservoirs. ❑ 2!r Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. CI C�< Proposed SSTS within 200 feet of a watercourse or a DEC wetland. 0 Proposed SSTS design flow greater than' 1000 gallons /day or SPDES Permit required. 0 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 ,des 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: TEME• CONDIMENTS: ?JT� gt PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of W f NQ �Loyv&S (Wr Located at &V;g' r�,p . -J__b W 'J 'NA �Z'f : ' 3 'i` ?7EP�SorJ Tax Map #)3,o9 Block I Lot 1 Subdivision of��('�lti Subdivision Lot # J Filed Map #77)074r Date Filed 10119 Gentlemen: This letter is to authorize JOHN A KALIN PE A duly licensed Professional Engineer X or Registered A&ehiteet 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 Commissioner of Health of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and /or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. 1' v\ Countersigned. 'D/ � P.E., R.A., # II I Mailing Addr%81��` 3 MEMORIAL AVE _.PAW' LB State: PAWLING Zip: 12564 Telephone: (845) 855 -2000 Signed: (Owner o roperty) Mailing Address: 760 6X_ ST- l k State: &_0_11ti� TZip: d 6 1 o / Telephone: vP,,z 3 — 9 � g{— 19 --?x3 Form LA -97 g ,f A` F. L ■ ✓- ., r A5 z G'. 1 Fit Pm r I collas mr O O J�['t Fit Pm r I collas mr O O PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: 6A4cA represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: �� ='�^' ° W4(;Z6 Having offices at: 10 b 9W'1*74Q< & 6'' 0'6/7D/ Whose Officers Are: President - Name: ��'wl &W(A Address: Vice President - Name: b ��7) Address: 'Secretary -Name: r_7_2" 81017J C_&* Address: 'lug S�r�- �l�►�e- S� ( C.:P Qe; irk Treasurer - Name: Address: and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Signed: Title: worn to before me this �� day of "t. {month) o (year) n /1 Alf / is , . 1)&-Al EZ, 1 Notdry Public Lorraine D. Pellegrino Corporate Seal Notary Ahlic My Commission Expires April 30, 2013 Form CA -97 Sherlita Amler, MD, MS, FAAP Commissioner of Health Robert Morris, PE Director of Environmental Health. John Kalin, PE DC Engineering 3 Memorial Ave. Pawling, NY 12564 Dear Mr. Kalin: Department ®i Health 1 Geneva Road, Brewster, NY 10509 Office (845) 808 -1390 Fax (845) 808 -1937 Robert J. Bondi County Executive August 27, 2010 Re: Application to Construct a Subsurface Sewage Treatment System for Bear Hill Estates, Lot # 3 (T) Patterson, TM # 23.09 -1 -13 East Branch Reservoir Basin The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on August 26, 2010 is complete. The Department will notify you by September 16, 2010 of its determination. N The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ❑ Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice "should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed approved, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 808 -1390 ext. 43148. Michael J.1 Director of MJB:kly BRUCE R- FOLEY Public Health Director TO: PROJECT: DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York. 10509 LORETTA MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 AAX ALA Etas /cam DEPARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM -F DELEGA TED l� re-6 — '�JIAMAM 4b'd/kk's 640 TOWN: C SE& K PV DATE SUB'D APPROVAL: (D "-tg - NOTICE OF COMPLETE APPLICATION DATE: A06--'? 27)� ��� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address-loo .5;;e,rt - 5, , _ sL,,� t Te ! - K- GvTP�s'►Ft�l� Located at (Street) VkL,,.._ Pz.,o,,o Tax Map 23,49 Block I Lot' 13 (indicate nearest cross street) Municipality rt' -S Drainage Basin mss; or'J. SOIL PERCOLATION TEST DATA Date of Pre - soaking -d 3 Date of Percolation Test C 7/Z/44:3 Hole No. Run No. Time Start - Stop Ela se Time Min.) Depth to Water rrom Ground Surface (Inches) Start: Stop Water Level Drop In „ Inches Percolation Rate Min/Inch 2 1,I ,, 24 - Z -1 3 i I: 32 - I '4-L 4 1i.. +s- W55 A 5 4 5 2 3 4 5 NOTES: l . Tests to be repeated at same depth anti! approximately equal percolation rates are obtained at eacn percolation test. hole. 0.d. = 1 min for lm30 min/ineh, <_ 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made. from top of hole. I C W114 PUTNAM -COUNTYDE-PARTAI-ENT OF HEALTH DIVISION Of ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address j3"1z_ 141 L I- 7eo'# p Located At (Street) Tax'Map _ Block — Lot (indicate nearest cross street) Municipality -;Pfz gf, ," Watershed td.sr cA. jC_VA, SOIL PERCOLATION TEST DATA Date -ofPre-soaking CJ eP -Date -of-Percolation Test 2. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole: (i.e. s I min for 1-30 min/inch, s 2 min for 31 =60 min/inch) All data to be submitted for review. Depth measurements to be made from top,of hole. Form DD-97 0 DEPTH G.L. 0.5' 1.0' 1.5' 2.G' 2.5' 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' 1G.0' DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. , _ HOLE NO. HOLE NO. � j Ff Eb T- LQ icL' •- Indicate level at which groundwater is encountered 1A Indicate level at:which mottli-t?p. is observed Indicate level to which water level rises after being encountered r AA P- Obel-T C kr C P/PP Deep hole observations made by:QC-,A iS & f3 .bscfl FAMOTIC&A -2) Date( Design Professional Name: PU-r- V n o� Address:c.,�� S ignature Design Professional's Seal CIL a DEPTH G.L. 0..5' 1.0' 2.0' 2.5' 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' DESCRIPTION OF SOILS ENCOUtV"1E"JJ u. i��l - -�------ HOLE NO. HOLENO. L6 HOLEN0. Co Indicate level at which groundwater is encountered r`1nr�E — indicate level at which.mettling is observed Indicate level to which waterlevel rises after being encountered tit / Deep hole observations made by: Date �= f=�' Design Professional Name:— Hof NEw�' Address: n �Q'��`pHA Co jxr Signature: 0674A Design Professional's Seal v ;'I I ENGINEERING REPORT PROPOSED SEWAGE TREATMENT SYSTEM PROPOSED RESIDENCE Bear Hill Road TOWN OF PATTERSON, PUTNAM COUNTY, NEW YORK JULY 2010 WARNING: IT IS, A VIOLATION OF SECTION 7209, SUBDIVISION 2, OF THE NEW YORK STATE EDUCATION LAW FOR ANY PERSON, UNLESS ACTING UNDER THE DIRECTION OF A LICENSED PROFESSIONAL ENGINEER OR LAND SURVEYOR TO ALTER IN ANY WAY, ANY PLANS, SPECIFICATIONS, PLATS OR REPORTS TO WHICH THE SEAL OF A PROFESSIONAL ENGINEER OR LAND SURVEYOR HAS BEEN APPLIED. COPYRIGHT 2010 JOHN A. KALIN, P.E. Prepared by: Design Concepts Engineering, P.C. John A. Kalin, P.E. 3 Memorial Avenue 0 0 SSTS Engineering Report - Bear Hill Estates Lot #3 M Patterson July 28, 2010 Submitted herewith is a report containing the engineering design data relative to the proposed Subsurface Sewage Treatment System (SSTS) to, serve a private residence within the Town of Patterson, Putnam County, New York. PROJECT DESCRIPTION: The parcel to be serviced by the proposed SSTS is located on Bear Hill Road. The parcel is identified on the Town Tax Maps as Grid # 23.09 -1 -13. It was formerly known as Lot #3 within the Bear Hill Estates subdivision. The project is currently vacant land with an expired Health Department approval. The proposed residence will consist of a three (3) bedroom, single - family dwelling to be constructed on an existing lot. The proposed dwelling will most likely be two stories high with a full height basement. The irregularly shaped property slopes up from its frontage on Bear Hill Road. The entire parcel is wooded and the property remains in the same condition as when it was originally approved under PCHD Permit P -06 -07 on April 28, 2008. GENERAL DESCRIPTION OF SSTS: Attached please find the proposed plans for the layout of the sewage disposal system and the detailed design calculations. The new SSTS design shall replace the previous design. The disposal system is proposed to generally consist of the following components: • 3.5 ft R.O.B. Fill Pad • 1,000 Gallon Precast Concrete Septic Tank • 1,000 Gallon Precast Concrete Pump Chamber (tank only) • Precast Concrete Distribution Box • 378 L. F. of Absorption Trenches with 100% reserve area Due to the topography, a pump chamber will be necessary for the future replacement system. To facilitate future construction, the pump chamber tank will be installed as part of the initial construction. The pump and appurtenances will be installed when needed. Test holes were excavated and witnessed by representatives of the Putnam County Health Department (refer to location on plan) with the prior design engineer, Putnam Engineering. We have reviewed the soil testing results and accept them. WATER SUPPLY: Water will be provided through a new well and submersible pump. Refer to the plan for its' location and associated details. SSTS Design Calculations Project: Lot #3 Residence - Bear Hill Estates S/D Location: Bear Hill Road Patterson, New York 1. DESIGN CONSIDERATIONS 3 Bedroom Single Family Dwelling Installation of a new residence with a three bedroom SSTS. Note: Garbage Grinders Shall Not Be Used 2. DESIGN FLOW (Per PCHD Design Standards) 3 bedrooms x 200 gal /bed -day = 600 gal /day Use: 600 GPD 3. SEPTIC TANK SIZE Provide 1,000 gallon septic tank. Install inlet baffle and Zabel A -300 effluent filter. 4. TREATMENT FIELDS .Perc Rate: 15 min /inch (primary and reserve) Design Flow: 600 GPD (3 bedroom) Method of Treatment: Standard Trenches Primary Fields Req'd: As per PCHD Appendix H, provide 375 LF of fields 375 LF / 7 rows = 53.6 LF /row Use: 7 rows of 54 LF standard absorption trenches Reserve Fields Req'd: As per PCHD Appendix H, provide 375 LF of fields Provide 375 LF of laterals arranged around site constraints D E S I G N C O N C E P T S E N G I N E E R I N G P C 3 MEMORIAL AVE. SUITE 1 01 , PAWLING, NY 12564 PH: 645 -B55 -2000 • FX: B45 -655 -2605 E: JKALINQVERIZON.NET Lot #3 Bear Hill Estates SSTS Calculations Page 2 July 30, 2010 5. PUMP CHAMBER: PUMP DESIGN - For Reserve area Pump calculations: Daily design flow: 600 gpd Dose volume: .65 gal /ft x 375 LF x 75% = 182.8 Use: 150 gallons Friction Head: Pipe type /size: 2" polyethylene Length: 30 LF H -W coefficient: 120 . Assumed flow rate: 40 gpm Loss ( @30GPM): 3.11/100' (per Goulds) Equivalent Lengths: Straight Length 90 LF Fitting loss (use 2" dia) 90° elbow (3): 5.5 x 3 45° elbow (4): 2.5 x 4 Quick disconnect (1): 5.0 x 1 Discharge (1): 1.5 x 1 Gate Valve (1): 1.2 x 1 Total length: 63.4 LF =Use: 64 LF Friction Head: Friction head = Equivalent length x Head Loss /100 ft of pipe 64LF x3.11FT 2.0 ft 100FT Static Head: Static head = Elev at High Point - Elev. at Pump 805 -797.5 = 7.5ft Total Dynamic Head: Total dynamic head = static head + friction head 2.0 +7.5= 9.5 FT Use: 10 ft D E S I G N C O N C E P T S E N G I N E E R I N G P C 3 MEMORIAL AVE. SUITE 1 01 , PAW.LING, NY 12564 PH: 845 -855 -2000 • FX: B45 -855 -2605 E: JKALINOVERIZON.NET Lot #3 Bear Hill Estates SSTS Calculations Page 3 July 30, 2010 Pump specifications: Using the total dynamic head of 21 ft, a Goulds Effluent Pump Model PE31, .33HP, 115V, has been selected. This pump can deliver approximately 42 gal /min against 10 ft of total head. Refer to attached sheets for pumps specifications and chart. Drawdown / Float Switches: Tank capacity: 24.7 gal /in (1,000 gallon tank) Total Dose = dose volume + drain back Force main drain back = length of force main x 0.16 gal /ft 30 LF x 0.16 gal /ft = —5 gal Total Dose = 150 gal + 5 gal = —155 gal Draw down = Total DoseNol per Depth of tank 155 gal / 24.7 gal /in = 6.27 inches or 6 1/4" Per draw down calculation, set float switch for 6.25" draw down. The float switches should be set at 3" (offl and 9.25" on above the floor of the 1,000 gallon pump chamber. The alarm switch should be set at 12.0" above the tank floor. Emergency storage volume capacity is about 815 gallons. Cycle time: Dose = 155 GAUCYCLE Pump rate = 42 GPM 155 gal /cycle / 42 gal /min = 3.69 min Q min 42 sec) Water Supply Water will be provided through a new well and submersible pump. Refer to the plan for its' location and associated details. It has been located with the appropriate separation distances to the property lines, existing adjacent and proposed septics. Prior to use, the well shall be disinfected and tested in accordance with Health Department Standards. D E S I G N C O N C E P T S E N G I N E E R I' N G P C 3 MEMORIAL AVE. SUITE 1 01 , PAWLING, NY 12564 PH: 645 -655 -2000 • FX: 845 -B55 -2605 E: JKALIN @VERIZON.NET 0 n4v ITT Goulds Pumps PESubmersible Effluent Pump �RGOULDS PUMPS Goulds Pumps is a brand of ITT Water Technology, Inc. - a subsidiary of ITT Industries, Inc. www.goulds.com Engineered for life Residential Water Systems FEATURES • Corrosion resistant construction. • Cast iron body. • Thermoplastic impeller and cover. • Upper sleeve and lower heavy duty ball bearing construction. ■ Motor is permanently lubricated for extended service life. ■ Powered for continuous operation. ■ All ratings are within the working limits of the motor. ■ Quick disconnect power cord, 20' standard length, heavy duty 16/3 SJTW with 115 or 230 volt grounding plug. ■ Complete unit is heavy duty, portable and compact. ■ Mechanical seal is carbon, ceramic, BUNA and stainless steel. ■ Stainless steel fasteners. PERFORMANCE RATINGS v--> PE31 Total Head (feet of water) GPM 5 • 52 10 42 15 29 20 16 25 0 *k41 To Head (feet o ater) GPM 8 61 10 57 15 46 20 39 25 16 PUMP INFORMATION 451 T al Head (feet X water) GPM 10 67 15 59 20 50 25 39 30 26 35 HP GOULDS PUMPS Residential Water Systems DIMENSIONS (All dimensions are in inches. Do not use for construction purposes.) 11 KHARGE Minimum Float Switch Cord Discharge Minimum Maximum Shipping Order No. HP Volts Amps Circuit Phase Style length Connection Basin Solids weight Breaker Diameter Size Ibs/kg PE31 M 0.33 0 115 12 20 1 Manual / No Switch 20' 1.5" 18" .5" 31/14.1 PE31 P1 iggyback Float Switc \FE41NV 5 15 nual / No Swi 41 Piggy ck Floay1witch P M X73/0 3.7 10 Manua Switch PE 1 Piggyba at Switch P 51 N 9 5 Ma al / No witch 51P Pi back Float itch PE52M MO /4.7 10 anual / NASwit 7PE52P1 iggyback Flo I T'T GOULDS PUMPS Residential Water Systems APPLICATIONS Specially designed for the following uses: • Mound Systems • Effluent/Dosing Systems • Low Pressure Pipe Systems • Basement Draining • Heavy Duty Sump/ Dewatering SPECIFICATIONS MOTOR General: • Single phase • 60 Hertz • 115 and 230 volts • Built -in thermal overload protection with automatic reset. • Class B insulation. • Oil -filled design. • High strength carbon steel shaft. PE31 Motor: Pump — General: • .33 HP 3000 RPM • Discharge: 1 Yz" NPT • 115 volts • Temperature: *104 °F (40 °C) maximum, continuous when • Shaded pole design fully submerged: 41 Motor: • Solids handling: Ik" maximum sphere. • . HP 3400 RPM • Automatic models include a float switch. • 115 d 230 volts • Manual models available. • PSC des • Pumping range: see performance chart or curve. 1 Motor: PE31 Pump: • . P 3400 RPM • Maximum capacity: 53 GPM • 115 230 volts • Maximum head: 25' TDH • PSC desl IE41 Purm • im capacity: 61 GPM AGENCY LISTINGS • Maxi m head: 29' TDH . ump: aximum cap ty: 70 GPM • aximum head: ' TDH cip us Tested to UL 778 and CSA 22.2 108 Standards By Canadian Standards Association METERS FEET File AR38549 0 a W x V z 0 0 0 101 0L `f'GGPM 0 5 10 15 m3/h CAPACITY Goulds Pumps is ISO 9001 Registered. 0 J � DC ENGINEERING, RC LETTER OF TRANSMITTAL To: Putnam County Health Department 4 Geneva Road Brewster, NY 10509 Date: August 20, 2010 Job No: 072810 Attention: Mike Budzinski, PE RE: Bear Hill Estates Lot #3 SSTS Submission We are sending you: ✓ Attached ❑ Under separate cover via _ • Shop Drawings ❑ Prints ✓ Plans ❑ Samples • Copy of Letter ❑ Change Order ❑ The following items: ❑ Specifications Copies Date No. Description 2 7/28/10 Fill Plan 2 7/28/10 Trench Plan 2 7/10 Engineering Report 2 7/10 Design Calculations 2 - Applications These are transmitted as checked below: ✓ For approval ✓ For your use Remarks: Signed: cc: File ❑ As requested ❑ For review and comment D E S I G N C O N C E P T S E N G I N E E R I N G P C 3 MEMORIAL AVE. SUITE 1 01 , PAWLING, NY 12584 PH: 845 -855 -2000 a FX: 845- 855 -2605 E: JKALINOVERIZON.NET o� 010 PUTNAM COUNTY DEPARTMENT OF HEALTH /ay DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # -'' 06 ©--7 Located at eek z Rt Lt,, t -ak- r) Town or Village F-1-M► --SLWJ Subdivision name d ;i,. P-&-1 A,TP _ Date Subdivision Approved /0 �9 AD Tax Mawr IM Block d Lot 13 Renewal Revision Owner /Applicant Name A,'SSc9e.jfkiF ,'S Date of Previous Approval Mailing Address'7CO _ . >� 7" d - �° � �Fvf -'ate I_ "' = Zip Amount of Fee Enclosed ; �a�.JC. -e:a✓ d�pc��fie. y Building Type'k4,%r.,ic6 Lot Area4�,No. of Bedrooms ',5_ Design Flow GPD &V Fill Section Only _)<' Depth `�i i 2. Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of Other Requirements: gallon septic tank and To be constructed by-JE ,& Dan lz,,- Address Water Supply: Public Supply From Address or: _X Private Supply Drilled bye & - 'Da-T -c--?4-i; e j sF3 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. Signed: Address P.E. R.A. Date ti IV License # 0x'7 ±''�(o 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 4cessary by the Public Health Dire tor. Any revision or alteration of the approved plan requires a new p it. Approv discharge ofd estic sanitary s wage only. ` ,j -2 By: Title: Date:�f � White copy - HD F e; Yel opy - Building Inspector; Pink copy n r; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or typeGIiQPe 171ti Well Location Street Address: Town/Village: Tax Map # 1�1L.." "- C> Map'O'S )Block i Lot(s) (3 Well Owner: Name: C3�L R"-'- Address: '700 1��r% P -X ?— /-5,i.1-T-5 1 - ice- Phone #: 1.03 i1%$ S 0 C i AC e5 � a P�r-� iz} �� t'r• 06.g0o 4&4 - 1833 Use of Well: Residential _Public Supply Air /cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield Sought�gpm # People Served Est. of Daily usage gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drill in New Supply (new dwelling) Deepen Existing Well Detailed Reason b5vtzion for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ............................................................... :...................... Yes _ No Is well located in a realty subdivision? ........................................... ............................... Yes L No Name of subdivision Eek'4- i+e "'�­ ES i Pr c S Lot No. Water Well Contractor: 'T7 NE `L7= �� �� � ►� Address: Is Public Water Supply available on site?.......... .............................. ............................... Yes _ No Name of Public Water Supply: / Town/Village 1J� Distance to property from nearest water main: 619 � a 7-4A,4 ; k—v rn ttj Proposed well location & sources of contamination to be provided on se ;an. 1. Date: 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 Departmei 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 Commissioner of Health. Any revision or al eration of the appr ed plan requires a new permit. Well to be constructed by a water well driller certifi d by Putnam ounty. -�� Date of Issue Permit Is ing O jcial: Date of Expiration '? Title: 1 Permit is Non- Transferable 11-N A White copy - HD file; Yellow copy - Building Inspector; Pink copy - OVr dl:L,9fange dopy - Well driller V Form WP -97 Rev. 3/06 gA TNAM G NEERI ' PLLC. ng/neers and Arch/tects April 21, 2008 Mr. Michael Budzinski, P.E. Director of Engineering Putnam County Health Department 1 Geneva Road Brewster, NY 10509 RE: Bear Hill Estates — Lot 3 Town of Patterson TM #23.09 -1 -13 Dear Mr. Budzinski, This office is in receipt of your letter dated March 6, 2008, and has addressed your comments as follows: A pump pit /overflow tank has been added to the design for future use of the expansion area. Details and pump calculations have been added to the plan with a note indicating that the pumps and controls are to be installed at a later date. 2. The proposed house has been changed to an approvable three (3) bedroom design and footprint revised accordingly. Two copies of the new floor plans are attached for your approval. Enclosed are five (5) sets of the revised fill plans and two (2) copies of the revised trench plan for your approval. Please contact me at this office if you should have any questions. Sincerely, PUTNAM ENGINEERING, PLLC ,rn/ ' / RJZ /ea Enclosures 4 OLD ROUTE 6, BREWSTER, NEW YoRK 10509 • (845) 279 -6789 • Fnx (845) 279 -6769 • Emwa.: info@putnameng.com SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health March 6, 2008 Rick Zapp Putnam Engineering 4 Old Route 6 Brewster, NY 10509 Dear Mr. Zapp: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Proposed SSTS for Lot # 3 — Bear Hill Estates (T) Patterson, TM # 23.09 -1 -13 This Department has received and reviewed the revised plans for the above - mentioned project and the following comments are offered for your consideration. 1. The submitted trench plan is not approvable since the raw sewer and septic tank locations and elevations will not provide gravity flow to the 100% reserve system area. The submitted house floor plan is not approvable as a three- bedroom dwelling for the following reasons: a. the walk -in- closet is large enough to be considered a potential bedroom. b. bedroom # 2 is considered large enough to be divided into two (2) smaller bedrooms. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. MJB:kly Respectful kJ Michael J. Director of Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool(845)278 -6014 Fax(845)278 -6648 PUTNAM rULNEINEERINEPLLE. Engineers and Architects March 4, 2008 Mr. Michael Budzinski, P.E. Director of Engineering Putnam County Health Department 1 Geneva Road Brewster, NY 10509 RE: Bear Hill Estates — Lot #3 Town of Patterson TM #23.09 -1 -13 Dear Mr. Budzinski, In response to your letter dated December 10, 2007 regarding the above referenced project, please note the following: • Additional field- testing was performed and witnessed by Gene Reed on 1/10/08 and by Joe Digit on 2/26/08. Attached is the Associated Design Data Sheet.showing results of the same. • Based on the above referenced results the SSTS Plan has been revised to utilize the usable area for the primary and expansion systems and the bedroom count has been reduced to three (3) bedrooms. We have addressed your comments as follows: 1. The labeling of the percolation and deep test holes have been corrected and the additional test hole locations added as noted above. 2. The redesigned plan incorporates percolation and deep test holes in both the primary and expansion areas. 3. By reducing the bedroom count to three (3) the length of absorption trenches has been reduced to 378 L.F. and therefore will not require dosing. 4. General Note #4 has been revised as per Bulletin ST -19 as directed. 5. The Distribution Box Detail has been revised to specify a minimum of 2 feet , of solid pipe out of the box prior to the start of perforated pipe for each trench. (1,0832) 4 Oro RouTE 6, BREwsTER, NEw YoRK 10509 • (845) 279 -6789 • FAx (845) 279 -6769 • EMAIL: info@putnameng.com Enclosed for your review and approval is the following: I. Revised Fill Plan and Details (5 sets) 2. Revised Trench Plan (2 copies) 3. New Design Data Sheet for additional testing performed 4. Revised "Construction Permit" for new three (3) bedroom design 5. New three (3) bedroom floor plans (2 sets) Please contact me at this office if you have any questions. Sincerely, PUTNAM ENGINEERING, PLLC r Richard J. Z Jr. RJZ /ea Enclosure (L0832) PUTNAM ENGINEERING. PLLC. Englneers and Architects 4 Oro RouTE 6, BREwsTER, NEw YORK 10509 ® (845) 279 -6789 o Fax (845) 279 -6769 o EMAIL: info@putnameng.com SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Rick Zapp Putnam Engineering 4 Old Route 6 Brewster, NY 10509 Dear Mr. Zapp: DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health December 10, 2007 Re: Proposed SSTS for Lot # 3 — Bear Hill Estates (T) Patterson, TM # 23.09 -1 -13 This Department has received and reviewed the submitted application and plans for the above - mentioned project and the following comments are offered for your consideration. �1. The plan incorrectly shows three (3) deep test holes labeled "D -1" and two (2) percolation holes labeled "P -1 ". ,--'2-. The submitted design does not provide for any percolation test holes in the reserve area l which is unacceptable. Since the SSTS design contains greater than 500 LF of trenches, dosing is required per Bulletin ST -19, revised July 2007. 4. General note # 4 is to be revised per Bulletin ST -19, revised July 2007. 5. The distribution box detail is to be revised to specify a minimum of 2 feet of solid pipe out of the box prior to the perforated pipe. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. Respectfullv. Michael. Director MJB:kly 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 December 4, 2007 Rick Zapp . Putnam Engineering 4 Old Route 6 Brewster, NY 10509 Dear Mr. Zapp: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Proposed SSTS for Bear Hill Associates Bear Hill Road (Lot # 3 — Bear Hill Estates) (T) Patterson, TM # 23.09 -1 -13 East Branch Reservoir Basin The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and revisions received by this Department on November 30, 2007 is complete. The Department will notify you by December 24, 2007 of its determination. O The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ❑ Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed approved, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2148. Michael J. Bu zins , P Director of gineer MJB:kIy Environmental Health (845) 278 -6130 Fax 845).278 -7921 Water Supply Section (845) 225 -5186 Fax 45) 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 BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 TO: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW PROJECT: TOWN DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM DELEGATED -714 Z,3 , Dq _ 1-/3 b j� t �.t_ /G •9 7s a� C SE6 K PV DATE SUB'D APPROVAL: NOTICE OF COMPLETE APPLICATION DATE: T- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION.OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: ' Property of , (4 1 L-.— , 5 _l ATcS I- -C— . Located at Se��g_. T/V A- r--agsg,.3 Tax Map # :23. c)9 Block j Lot Subdivision. of � ►},�� ES S Subdivision Lot # Filed Map # 3069 Date Filed 10 19/0-1 Gentlemen: R This letter is to authorize FL-L_G- a duly licensed Professional Engineer or Registered Architect 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 Putnam4Couiq, itary Code. r 0 W 0 ,ii /� - Countersigned`,,N9% P.E R.A. # Q4 °.:,ti... .7 EN Mailing Address oLp..1cx.; 6 i .iZ_SLJ 6- i e, %z_ State Zip %SQL Telephone: Very tr,4 you Signed.-r-'-,,.� (Owner of Property) Mailin g AddressV��y .. State' � ZiP t = -2,3 Telephone, j,y ,5 g ` - f FJ7 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES a AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: ftArt +jII L. IF 57AlF5 LO'� 3 Lt /"-,) 9404 6/4 represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation. Having offices at-. 10D at- (r- S)D` �� 6-r7 O f Whose Officers Are:: - President - Name- I —,, &4,j �a Address: 1 z) D Leho, at- S;- ! r.- G-- U6 f' -b Vice President - Name: Address: Secretary -Name: Address: Treasurer - Name: Address: and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating to. Signed: Title: to before this 0 day of. mo _ &: (year) Public NOTARYPUBLIC My COMMISSION EXPIRES JAN, 31, 20 Corporate Seal Form CA -97 TO: DATE: PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: lEeAcL N i us- ES i / E S -- Lo �3 -r fnI, -Z-,3, o9 ( -- l3 ENCLOSED, PLEASE FIND: COPIES OF THE SSDS PLAN 69 Li- ? "Ov > ?y O P 'T R G 55-L-t�, i ►Z: n1G1� ?L,A JJ 2_ COPIES OF THE HOUSE PLANS l� CONSTRUCTION PERMIT APPLICATION WELL PERMIT APPLICATION HEALTH DEPARTMENT FEE ($500.00) SHORT EAF @ DESIGN DATA FORM I� LETTER OF AUTHORIZATION APPLICATION FOR WASTEWATER TREATMENT (PC -97) ® LETTER OF EXPLANATION C:+uE" COPIES TO: (SepSubFomi•2001) SIGNED: Z\cK-- 4 OLD RouTE 6, BREWSTER, NEW YORK 10509 • (845) 279 -6789 0 Fax (845) 279 -6769 0 EMAIL: info@putnameng.com December 13, 2007 Michael Budzinski, P.E. Director of Engineering Putnam County Health Department 1 Geneva Road Brewster, NY 10509 RE: Bear Hill Estates Proposed SSTS for Lot #3 & Lot #4 TM #23.09 -1 -13 (Lot #3) & TM #23.13 -1 -7.2 (Lot #4) Dear Mr. Budzinski, I am enclosing a request for field testing for the above reference properties. As you are aware previous field testing was performed on these lots in 2003 and Design Data Sheets submitted to your office with our previous submissions. At this time, we are requesting additional testing in order to satisfy the Putnam County Health Department testing requirements for the submitted layouts. Please call me if you have any questions. Sincerely, PUTNAM ENGINEERING, PLLC RJZ /ea Enclosure (L07292) 4 OLD RouTE 6, BREWSTER, NEW YoRK 10509 o (845) 279 -6789 o Fax (845) 279 -6769 o EMAIL: info@putnameng.com 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 REQUEST FOR FIELD TESTING ROBERT J. BONDI County Executive All information below must be fully completed prior to any scheduling. DATE: i ENGINEERING FIRM: �b r tj&t ► PHONE PERSON TO CONTACT: I2iC1 =-F�' KNEW CONSTRUCTION ❑ REPAIR PROGRAM ❑ ADDITION PROGRAM REASON: ROAD /STREET: DEEPS: K PERCS: VL PUMP TEST: ❑ cIL- Z'3.. < TOWN: E TAX MAP #: -Z3 SUBDIVISION: ?�) AIL-k-- ES; F i i:j LOT #: OWNER: `BrA,�?— R i L- ir A SSo,--.IA`T F-�- Lea - I 13 Lt�T4T:e NYCDEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING YES NO ❑ Proposed SSTS within the drainage basin of West Branch or Boyds Corner & Croton Falls Reservoirs. ❑ ,� Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. ❑f Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. ❑ Proposed SSTS for a Commercial Project. It is the responsibility of the design professional to provide the above information prior to soil testing. The Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered, Les 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 NYDCEP. 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: / 1:/ 9 & ' o p COMMENTS: TIME: 4 10 dV Li .i 0 REQ. Me FIELD TESTING:KLY 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 (843) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 Town -lit CT IF 84 p0 7 311 ti g. 5, 0 19 V4 5 60 A Pond FM Camp I'l Brad y(1.-'?--,-\) Pond 311 16 02/14/2008 THU 11:04 FAX 449 PCHD SIiERLITA AMLE& MD, MS, FAAP Commissioner of Realth , LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 REQUEST FOR FIELD TESTING ROBERT J. BONDI County &ecullve 2002/002 All information below crust be fully completed prior to any scheduling, DATE: o- o- ENGINEERING FIRM: 'EbTrV-N"1_ E4sl '= ,j l ; ?r+� PHONE #: PERSON TO CONTACT: ?-IC. — Ia.PF' g X 12 NEW CONSTRUCTION 0 REPAIR PROGRAM ❑ ADDITION PROGRAM REASON: DEEPS; O PERCS:Ig PUMP TEST: ❑ ROAD /STREET: 1�F 1�..�.._ 90LID TOWN: ; TAX MAP SUBDIVISION: �t�� =�,-(Z 4� w �_5��*r ► E LOT #: OWNER; tKP'E?--- 2il. -L- A- So c- NYCDEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING YES NO C1 �6 Proposed SSTS within the drainage basin of 'West Branch or Boyds Corner & Croton Falls Reservoirs. ❑ Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. ❑ p( Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ �L Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. U K Proposed SSTS for a Commercial Project. It is the responsibility of the design professional to provide the above information prior to soil testing. The Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you 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 NYX)C'PP. ,';, 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: oL 3: ckS1 TI 4L a1- Cam i O COMMENTS: 0.5Q. FOR FIELD 'CE51TNG.KLY 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 r..rfu Tw#orvnntlnn/Procrhnn1 (R451279 -6014 Fax (845) 278.6648 02/14/2008 THii 11:04 FAX 444 PCHD p eEngineersanciArchicE,c,-s TNAM llrl� l�'1NE, PLLC�. 1 DATE; - - �l i4 TO., _L��� � i7 FAX NO: ' " 19Z PAGES: lG-- _ , including this Cover sheet. X001/002 From the desk of... RICHARD I ,ZAPP JR, SR. PROJECT ENGINEER FO ))0/00, From the desk of... RICHARD I ,ZAPP JR, SR. PROJECT ENGINEER Redrm 17 6 x 21- 0- L 0 3 wvteo 0 L PUTNAM COUNTY DEPARTMENT OF HE kLTH HOUSE PLANS APPROVED FOR EED"11.00,Dd "",CUNT OINLY, -3 IBEDROOIIS Y 'E ALL SUBSEQUE"T 'r .�VT /A ISION _L!J.IF I.TIONS TO THESE 11011TS ,R A T,U6 MUST DE SA-UITTED. TO THE PCD01-1 FOR APPIIOV,iL DATP4 p N 8A T v 41t E 4 � qnT PROJECT BEAR HILL E5TATE5 51MVIV1510N LOT #5 46 BEAR HILL ROAD ToM OF PATTER-WN, NEW YORK I TAX MAP No. 23.04, BLOGK 1, LOT 0 ti 1-044 Dining Rm Master Bed 16-:8 13-4 Livin., g 6r, 17-4 x 13-4 m 2 Clar Garage 21,31-8 x 23-4 1PROJECT BEAR HILL E5TATE5 SUBDIVISION LOT #3 46 BEAR HILL ROAD TOWN OF PATTER-SON, NSW YORK TAX MAP No. 25.0cl, BLOCK 1, LOT 13 �7 I 41 -O Vr-lFf#-AIS4L.�/ -II W-5 -I PROJECT BEAR BILL E5TATE5 50DIV15ION LOT #5 46 SEAR HILL ROAD TOWN OF PATTERSON, NEW YORK TAX MAP No. 23.0q, BLOCK I, LOT 0 PUTNAM COUNTY DEPARTMENT OF HEALTH. DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE -TREATMENT SYSTEM owner: Address: EeA-IZ A& -I— Located at (street): _ TM # Section: Block Lot Municipality: TA77%a6ay Watershed: dA-6 -r SOIL PERCOLATION TEST DATA Witnessed by: Date of Pre - soaking: Date of Percolation Test: "7 /X6 / 3 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 3 2, IJ 223 6 4 1 0 , _ 1 ,' - a-1 - 2 3 2 -2 ly 3 4 jig i 2 3 3 T;3 - /3 2-1 - 4 5 1 - 9"j 6 9 - a- 1 - Z2 - .9,2- - -zz 3 4 - 5 Notes: I. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e., 4 I rain for 1 -30 min/inch, < Z min for '71-60 chin/ inch). All data to be submitted for review. 3. Depth measurements to be made from top of hole. Form DD -97• pg I of -2 TESL' .PTT.D,ATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE # HOLE # HOLE# G.L. 0.5' 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' Indicate level at which groundwater is encountered Indicate level at which mottling is .observed Indicate level to which water level rises after being encountered Deep hole observations made by: Date Design Professional Name: Address: Signature: Design Professional = Seal 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: W I rCW�KFC> l a (-D l N&e2 W-f'O -AT100 180'1rymmfr- ST. sy (Te I—k STA M"P-0 CT 06go f 2. Name of Project: DW 4l IL1 S'1AT1r,S- coo-3 3. Location: T/x: RJ 0►J 4. Design Professional: Jatt� A• �rN� PE Ue eering PC 5. Address: Memorial Ave. Suite 301 6. Drainage Basin: 4FAS't M"" MS"Ip- awing, New VoRM564 7. T e o roiect: Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review(SEQR) ? .............. Yes/No Type Status (check one) .............. ............................... ..........................Type I Exempt Type II Unlisted . k-' 9.. Is a Draft Environmental Impact Statement (DEIS) required ? .......:............ Yes/No Nf�l 10. Has DEIS been completed and found acceptable by Lead Agency ? ............. Yes/No 11. Name of Lead Agency N� 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ............................................................. ............................... Yes%No YES 13. If so, have plans been submitted to such authorities? .. ............................... Yes/No No 14. Has preliminary approval been granted by such authorities? Date granted: N A 15. Type of sewage treatment system discharge ......:........I........ ✓ surface.water groundwater 16. If surface water discharge, what is the stream class designation? .......................... N /A L 17. Waters index number (surface) N�A 18. Is project located near a public water supply system? . ............................... Yes/No NO 19. If yes, name of water supply N�i� Distance to water supply _ 122_ 20. Is project site near a public sewage collection or.treatment system? ...........Yes N6 No 21. Name of sewage system Distance.to�sewage system 22. Date test holes observed 6/Ls o-3 23. Name of Health Inspector Jq' pAP -AVATI 24. Project design (g P y�...... 4 , ........ ............................... go o flow a�iors er da O 25. Is State Pollutant Discharge Elimination system (SPDES) Permit required? ....Yes/No NO 26. Has SPDES Application been submitted to local DEC office? ......1 .................. Yes/No N /� Rev. 11/02 Form PC -97 Pg. 1 of 2 27. Is any portion of this project located within a designatpd Town or State wetland ?... Yes/No_ ffio_ 28. Wetlands ID number :................................................................. ............................... 29. Is Wetlands Permit required? ..............:. .................Yes/No N Has application been made to Town or Local DEC ............................ Yes/No N 30. Does project require a DEC Stream Disturbance Permit? ............ ►UD ................. 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 application or industrial :activity? ............................................... . .........Yes/No . No 32. 'Is project located within 1,000 feet of existing or abandoned1andf ll, hazardous waste site, salt stockpile, landfill, sludge disposal site or airy other potentially known source of contamination? ......................... ............................... ..... Yes/No No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? .........................Yes/No Ye's 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? .................................. ................. .........Yes/No 35. Are any sewage treatment areas in excess of 15% slope? .............................. Yes/No i�lo ............ ............................... Ma 23.9 Block I Lot l3 36. .Tax Map ID Number Map p-01 0 37. Approved plans are to be returned to ................ �Applicant Y Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department: Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item 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 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. . Mailing TITLES.. DesiM Concepts Ed0n� eerng PC lmemorial vie.. uite 301 Form K-97 it DEPTH G.L. 0.51 1.01 1.51 10' 2.51 3.01 3.5' Off 4.51 5,ff. . 5;5-f 6ff 6.51 7.0' 7.51 8W01 8.51 9'.0' 9.5' 16.01 TEST PIT DATA, DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. t> HOLE NO. HOLE NO. v Indicate level at which groundwater is encountered Indicate level at which mottling is observed. Indicate level to which water level rises after being encountered Deep hole observations made by: Date. Design Professional Name: Address: Signature: Design Professionalls SeM 2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner zl— d-j Address gdjr- 14 j L Lox p Located at (Street)' Tax Map Block Lot (indicate nearest cross street) Municipality �2Egs&4 Watershed 6A-->r 37m Jck-\ SOIL PERCOLATION TEST DATA Date of Pre-soaking Date of Percolation Test percolation test hole, (i.e. s I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top.of hole. Form DD-97 ........ ... F�omGFOUnd xeye erco-la. 6, `B ... . ........ .. . .St xi i S, T q surfa ce c.: (inches) :Siam -A Drop In. Rate - 6 . ..... ...... 2 3 4 5 2 3 4 5 I 2 3 4 5 NnT'P.Q• 1 TF-,zt(z tn hp. rpnp.itnrl at same denth until approximately equal Percolation rates are obtained at each percolation test hole, (i.e. s I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top.of hole. Form DD-97 1 .1 z/ " PUTNAM COUNTY ;DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address ,Eg,z 141 /-j- _6A-m 1 L I I-eoq p Located at (Street)' Tax Map Block Lot (indicate nearest cross street) Municipality Watershed �Sr 3_7z_',AtJC_kA SOIL PERCOLATION TEST DATA Date of Pre= soaking j IQ -7 Date of Percolation Test j/1,0 07 .... ....... . er - - -_r- .. ........ 1)e p F.4t)UU ...... 'N ...... u r a6o (Ifi, S s, .... . ........ N f .... ...... 3 3 3 :3 7 4 -3 16-- 3,U7 5 2 3:17— 31 V7 3o 17 3 3;,t8 q,'j b .0 7' 1 4 5 1 2 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole, (i.e. s I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top.of hole. Form DD-97 DEPTH G.L. 0.51 1.01 1.5' 101 2.5' 3.0' 3.5' 4.01 4.51 5.5' 6.0' 6.51 7.0' 7.51 8wOl 8.51 9-.0, 9.51 16.01 TEST PIT DATA DESCRIPTION OF SOILS ENCO'a-;—JL EKED IN T ELI-31-1 HOLES HOLE NO. J9 3 HOLE NO- 2 u HOLE NO. —C> Indicate level at which groundwater �is encountered �' Indicate level at which mottling is observed �3( Indicate level lo which water level rises after being encountered Dee p ry hole obseations . made by - eo e Date Design Professional Name: Address: Signature: Design Professional's Se2d 2 r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES �l DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Located at (Street) ' Tax Map Block Lot '(indicate nearest cross street) Municipality ' s Watershed s 137z A jC A SOIL PERCOLATION TEST DATA l Date -of Pre = soaking - 7�7,��d Date -of Percolation Test 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 i TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST MOLES DEPTH HOLE NO. HOLE NO.. HOLE NO. G.L. 0.5' 1.0' 1.5' 2:0' 2.5' 3.0' 3.5' 4.5' 5:0' . 5.5' 6:0' 6.5' 7.0' 7.5' 8:0' 9:0' 9.5' 10.0' Indicate level , at which groundwater,is%zencountered Indicate. level at which mottling is observed Indicate level :to which water level rises after being encountered Deep hole observations' made by: Date Design Professional Name: Address: Signature: Design Professional's Seal I — 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I - PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME Bear Hill Associates Bear Hill Estates - Lot #3 3. PROJECT LOCATION: Municipality Patterson County Putnam 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) Bear Hill Road TM# 23.09 -1 -13 5. PROPOSED ACTION IS: ✓D New E] Expansion Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: Construction of a 4 bedroom residence with site improvements including driveway, sewage disposal system and drilled well. 7. AMOUNT OF LAND AFFECTED: Initially 4.93 acres Ultimately 4.93 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Z Residential 1:1 Industrial Commercial. Agriculture Park/Forest/Open Space Other Describe: R -4 Zone 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? Yes a No If Yes, list agency(s) name and permittapprovals: 11. 'DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? E] Yes 0 No If Yes, list agency(s) name and perrnittapprovals: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes Z No I CERT THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ' Applicant/sponsor na R hard J app Jr / P 'ect ineer Date: 11/14/07 Signature: a L-- FL- 1 I 4- If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 DADT 11 _ 1RADAPT ACCCCCMGAIT /Tn ha rmmnlatad by I and AnP_nrvl . A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? 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 [:] No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern; solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly: C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. Long term, short term, cumulative, or other effects not identified in C1 -05? Explain briefly: C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? Yes n No If Yes, explain briefly: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? El Yes F� No if Yes, explain briefly: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part II was checked ves, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the EAF and /or prepare a positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting this determin Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency 11/14/07 Date Title of Responsible Officer �Jl HS el f 3 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: e&-Z- N ASS6c -iA-TIF S �Ti�Fz,e� _ �T• �Co�1'CO1 2. Name of project: 5oAIL j}Lu l e5rPqf-S-LoTO'� 3. Location TN: 4. Design.Professional: F,rA&ja 5. Address: 4 6L, 0 9w G 6. Drainage Basin: mss, &L, gzsig2 La . /056° 7. Type of Project: Private/Residential Food Service T Commercial Apartments, Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review -(SEQR)? Type Status (check one) ....................... .......................... ...... Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 1 r1-6 10.. Has DEIS been completed and found acceptable by Lead'Agency? .. .............. ,� 11. Name of Lead Agency _ A 12. Is this project -in. an area under the control of local planning, zoning,-or other. officials, ordinances? ........:.................................:.............. ............................... 13. If so, have plans been submitted-to such authorities? ... :............... :................. t 14. Has preliminary approval been granted by such authorities? Date granted: //IN 15. Type of Sewage Treatment System Discharge ................. surface water groundwater 16. If surface water discharge; what is the stream class designation? ....................�_ 17. 'Waters index number (surface) ......... .......... :..:.................:.. ..:............................... 18. Is project located near a public water supply system? 19. If yes, name .of water supply L, ,� �� Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ 21. Name of sewage system \-Ve Distance.to sewage system 22. Date test holes observed 3 23.. Name of Health Inspector 24. Project design flow (gallons per day) . .. ............................ eo�p 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? ......................... 4 Form PC =97 -27. Is any portion of this project located within a designated Town or State wetland? tiO 28. Wetlands ID Number ................................................... ........................................ 29. Is Wetlands Permit required? .............................................. ..............................: . Has application been made to Town.or Local DEC office? ............................... A� 30. Does project require a DEC Stream Disturbance Permit? .. ............................... . lSO 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling; sludge application or industrial activity? ............................ Yes/No ' (jO 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No 0 'DESCRIBE: 33. Is there a local master plan on file with the Town or Village.? ......................... °vS 34. Are community water and/or sewer facilities planned to be developed within rJ 15 years in or adjacent to project site? ................................ ............................... fl 35. Are any sewage treatment areas in excess of 15 % slope? ....... .- ........................ . 36. Tax Map ID Number p� .......................... ............................... Ma L3 : Block.___ Lot l 3 37. Approved plans are to be returned to ..... Applicant_ Design'Professional NOTE: -All applicationsfor review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other.aspects of'a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item 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 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 SIGNATURES & OFFICIAL TITLES. Mailing Address: .... .........:..................... (�q P UTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Y DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner s N-t �- X�SS�c rte . Address-loo Located at (Street) Tax Map g3 Block I Lot' (indicate nearest cross street) Municipality F xr;� SC03 Drainage Basin mss; '8f.�t 12-�Sr ►2.�0 �z_. SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test 61"ICd3 Hole No. Run No. Time Start - Stop Elarise Time Min.) De ?�th to Water . rom- Ground Surface (Inches) Start, Stop Water Level Drop In „ Inches Percolation Rate Min/Inch 4 it °¢3- W-S5 la '2.1 24 b 3,�3 5 2 � '2.0 w ZZ 3 I'2-', 19 —f2_41 3Q 2-L Z ! S, o 4 5 2 3 4 5 NOTES: I _ Tests to he repeated at same depth anti! aaaroximately enual nermlation rates are obtained at each percolation test hole. i.e. _ i min for 1 -30 min/inch, <_ 2 min for 31 -60 min/inch) All data to be submitted for review. ?. Depth measurements to be made from top of hole. DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. ' �Z—: HOLE NO. G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.J; 4.0' 4.5' 5.0. 5.5' . 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' iG.J' mac._ MW Wt"-0,_ Indicate level at which groundwater is encountered /A Indicate level at which mottlin¢ is observed A Indicate level to which water level rises after bein Pn- uuntered ,-SIA C�A�f�a� Deep hole observations made by:aeais vATjQ>c.%*n) Date Z c3 Design Professional Name: J2,)M�, Address: .� Z m tI G1 s. So Signature: `� r �:l i10 , Design Professional's Seal OF NEB s;t y PIUTNAM COUNTY DEPARTAIENT OF HEALTH DWISION OF ENVIRONMENTAL HEALTH SERVICES M DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner ' - i,,, 6a i - �-� Address', ij-4 G,z Located at (Street) wiz 141L L- Tax MapZ3, 0111 Block _Jrw _ Lot _ (indicate nearest cross street) Municipality Drainage Basin �T tZ- SOIL PERCOLATION TEST DATA Date of Pre - soaking Hole No. Run No. Time Start - Stop Ela se Time Min.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Dropp In Inches Percolation Rate N in/Inch 3 ;yc� --3 t� Ira- jaA z A 12,0 4 5 1 14v -- Z ',: d 30 lb- /9 i o, d 3 2!41 3 2) 4 .5 4 5 NOTES: I . Tests to be repeated at same depth :anti! approximately equal percolation rates are obtained at eacn percolation test hole. (i:e. <_ i 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. I — - .. DEPTH G.L. 01.51 1.01 .2-01 25 .3.01 3.5' 4.01 4.5' 5.01 5.51 61.0' 6.51 7.01 7.51 8'.01 8.51 9.01 9.51 10.01 DESCRIPTION OF SOILS ENCOUNTE"J"'q j"a'" HOLE NO. - J5 HOLE NO. 6:2 HOLE No. L I if e Z:-4�0 Indicate level at which groundwater is encountered F,10 Indic ate 'level at which mottling is observed le . el rises after being encountered rJ Indicate level to which water Date I "? I ---� tions made by: egtj E- Deep hole observations Design Professional Name: Address: 0 Signature: Design Professional's Seal A Z. 0 JdT: 03 4 4 ALL SUBSEQUENT REVISION/ALTERATIONS TO THESE HOUSE PLANS MUVT BE SUBMITTED TMTHE PCDOH FOR APPROVAL �SI6 TUBE 8 TRLl: _ A � DATE R GUAFOXAN HOMMU,LDM.LLC. _ IC OtM -- ox, MTt! � i i FAT - i raxi a nnnn xr. r---- ------- - - - - -ti .en mm naac nn/e ---- --- -- --- ----- ---- ---- --- -- -- - -� FRONT ELEVATION _11 TI v I ' / v v P:\PROJECTS\CIVIL\7782 Bear Hill su ylnv 909 10T3).c o P6o�- J- 4S- It 57) N 40. 0., %l; /,' / t' �;� ' --FRONT YARC•, M 01 46 8 Z /"Y\ N) LO I- V\ T= n�-vvGQI 47' 713 71 0'(7? CA 0 J `)NUGIX� NOUV�)07. rV t c:l S 11/pIl // P -4 1 tiii PUTNAM COUNTY DEPARTMENT OF HEALTH 4 3 DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT# —61 I I Located at • �� L1 I Town or Village ' k-r rf- /v Owner/Applicant Name&A2oi4N, a i.ALWASTax Map 23_69) Block / Lot 15 Formerly Subdivision Name 15e42 '--4(( ,s- -_2S rl Subd. Lot# 3 Mailing Address IO frl4kJ JJ4rZ41 Ati , A.)y Zip IC S Date Construction Permit Issued by PCHD //-25-14 I2 sa-�a1�� b.,�C;- Separate Sewerage System built by .D-D i�c,e. 4. I AAddress -1-10 1 M-Q S) /014 /2s 31 Consisting of / Gallon Septic Tank and (p Lf= br- STV 1y4,2i ZA to ID ' i i sot t-tc -1-1e--et 6cae-5 Other Requirements: Water Supply: Public Supply From Address `4T AM • v or: /* Private Supply Drilled by' 1j L.l--i loS Address ak,u -r-�,i L((vSvoj Building Type SI i&k. F4M P1 S Has erosion control been completed? Vi- Number of Bedrooms 4 Has garbage grinder been installed? kJ 0 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- the issued PCHD Construction Permit and approved plans and the standards,rules and regulations of the'uutn• • Cooun`ty,Department of Health. (71-(' A ' 1Date: /(�.24./L. Certified by ; =I ,-�-II P.E. R.A. ` n ` �d, o ssion ) : 71/zS(p� ' ! set . I Address 3 M> M0ZI Jul( ULU1 a l ' 'C / License# c 7q 004 Any person occupying premises served by the above sy'stem(s)shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. 1'� ___ _I__/_k %%s✓,,,_A' '��-Title: /J L Date: L . a j opy- HD File; Yellow copy- Building Inspector; Pink copy-Owner; Orange copy- Design Professional Form CC-97 l • PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Well Permit# p_AD 40-C)--) . WELL COMPLETION REPORT Well Location Street Address: TownNillage: Tax Map# GPS: 46 Bear Hill Rd, Lot 23.9-1-13 41°28'36"N #3, Bear Hill Estates Patterson Map Block Lot(s) 73°38'24N Well Owner: Name: Address: Guardian Home Builders, LLC, 10 Mekeel Street, Katonah, NY 10536 Use of Well: X Residential _Public Supply Air cond/heat pump _Irrigation 1 1-Primary Business Farm Test/monitoring _Other(specify) 2-Secondary Industrial Institutional Standby 1 Drilling Equipment X Rotary_Cable percussion XCompressed air percussion_Other(specify) ., Well Type _Screened_Open end casing X Open hole in bedrock_Other Total Length 21 ft. Materials: X Steel Plastic Other Casing Details Length below grade 19i1 Joints: Welded X Threaded Other Diameter 6 'in. Seal: X Cement grout Bentonite Other . Weight per foot 19 lb/ft Drive shoe: x Yes _ No Liner: Yes XNo Diameter(in) Slot Size Length (ft) Dept to Screen (ft) Developed? Screen Details First _Yes_No 1 Second Hours. Well Yield Test Bailed __Pumped x Compressed Air Hours 6 Yield 12 gpm Measure from land surface-static(specify ft) During yield test(ft) Depth of completed well in ft. Depth Date 50' 320' 360' Well Log Depth From Surface Well Diameter If more detailed ft. ft. Water Bearing (in) Formation Description information Land Surface 6 Drilling in overburden, clay and boulders . descriptions or Hit rock at 6' sieve analyses 6 21 Drilling in rock, set casing, grouted are available, 21 360 Drilling in rock granite please attach. • If yield was tested Feet Gallons Per Minute Pump/Storage Tank Information at different depths _ Pump Type 3j., Capacity_ during drilling Depth 3Yd Model�`jr�i,,/d list: Voltage yid HP'/y Tank Type OAR, um Vole ,G'L Date Well Completed Well Driller PC Certificate# 019 • NY State#NYRD10105 Date of Report 9/19/14 Pump Installer PC Certificate# 0 1 R NY State# 10 57.50 11/15/16 Well Driller Name&Address: Well si ture) P. F. Beal & Sons, Inc., 4 Putnam Ave., Brewster, NY 10509 1 C'hristo�her Beal Pu p Installer Name/)&Address: /../i1'�c�� �..,Rump Ins Iter(s' natur' ) / atI/4 .1` (. . ('Ij/' r°' /S.5— (.�;C/? %//%' �'/J 2Z ,e� . r NOTE: Exact Location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. White copy: HD File; Yellow copy -Building Inspector; Pink copy-Owner; Orange copy -Well driller Form WC-97 Rev. 3/06 1 • DC ENGINEERING , PC LETTER OF TRANSMITTAL To: Putnam Co. Dept. of Health Date:Oct.25,2016 Job No: 033110 4 Geneva Rd. Attention:Mike Budzinski,P.E. Brewster, NY 10509 RE:Bear Hill Estates—Lot No.3-Rt.311 (t)Patterson We are sending you: X Attached o Under separate cover via The following items: o Shop Drawings o Prints X Plans o Samples 0 Specifications o Copy of Letter o Change Order o • Copies Date No. Description 5 10/11/16 Bear Hill Estates—Lot 3-As-Built Plan(1 of 1) 1 10/24/16 Certificate of Construction Compliance for SSTS 1 10/16 Guarantee of SSTS These are transmitted as checked below: i I X For approval 0 As requested X For your use o For review and comment Remarks: •et a 4 c-3Q1 l 5 f w A.►1/44d1)P i o SoO fi Signed: John A.Kalin,P.E. cc: File DESIGN CONCEPTS ENGINEERING , PC 3 MEMORIAL AVE. SUITE 301,PAWUNG,NY 12564 PH:845-855-2000 • FX:845-855-2605 E:JKAUN.00@COMCAST.NET Diameter(in) Slot Size Length (ft) Dept to Screen (ft) Developed? Screen Details First _Yes_No 1 Second Hours. Well Yield Test Bailed __Pumped x Compressed Air Hours 6 Yield 12 gpm Measure from land surface-static(specify ft) During yield test(ft) Depth of completed well in ft. Depth Date 50' 320' 360' Well Log Depth From Surface Well Diameter If more detailed ft. ft. Water Bearing (in) Formation Description information Land Surface 6 Drilling in overburden, clay and boulders . descriptions or Hit rock at 6' sieve analyses 6 21 Drilling in rock, set casing, grouted are available, 21 360 Drilling in rock granite please attach. • If yield was tested Feet Gallons Per Minute Pump/Storage Tank Information at different depths _ Pump Type 3j., Capacity_ during drilling Depth 3Yd Model�`jr�i,,/d list: Voltage yid HP'/y Tank Type OAR, um Vole ,G'L Date Well Completed Well Driller PC Certificate# 019 • NY State#NYRD10105 Date of Report 9/19/14 Pump Installer PC Certificate# 0 1 R NY State# 10 57.50 11/15/16 Well Driller Name&Address: Well si ture) P. F. Beal & Sons, Inc., 4 Putnam Ave., Brewster, NY 10509 1 C'hristo�her Beal Pu p Installer Name/)&Address: /../i1'�c�� �..,Rump Ins Iter(s' natur' ) / atI/4 .1` (. . ('Ij/' r°' /S.5— (.�;C/? %//%' �'/J 2Z ,e� . r NOTE: Exact Location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. White copy: HD File; Yellow copy -Building Inspector; Pink copy-Owner; Orange copy -Well driller Form WC-97 Rev. 3/06 1 � JT11/q ALLEN BEALS,M.D. MARYELLEN ODELL Commissioner of Health — County Executive ROBERT MORRIS,P.E. d4 N1 Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808-1390 E911 ADDRESS VERIFICATION FORM OWNER'S NAME: G)-(A.D, tk In TAX MAP NUMBER: p 3. CJ q — E911 ADDRESS: 4(0 �e(3`,12. ) 1 ,- )) TOWN: 0. �2 S 017 AUTHORIZED TOWN OFFICIAL: (/v � -`t'•. ( ignature DATE: I l t )'/ 1 The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, ie., a legal E911 address is assigned by an authorized Town official. This form is to be submitted with the application for a Certificate of Construction Compliance. KLY 7/13 c-3Q1 l 5 f w A.►1/44d1)P i o SoO fi Signed: John A.Kalin,P.E. cc: File DESIGN CONCEPTS ENGINEERING , PC 3 MEMORIAL AVE. SUITE 301,PAWUNG,NY 12564 PH:845-855-2000 • FX:845-855-2605 E:JKAUN.00@COMCAST.NET Diameter(in) Slot Size Length (ft) Dept to Screen (ft) Developed? Screen Details First _Yes_No 1 Second Hours. Well Yield Test Bailed __Pumped x Compressed Air Hours 6 Yield 12 gpm Measure from land surface-static(specify ft) During yield test(ft) Depth of completed well in ft. Depth Date 50' 320' 360' Well Log Depth From Surface Well Diameter If more detailed ft. ft. Water Bearing (in) Formation Description information Land Surface 6 Drilling in overburden, clay and boulders . descriptions or Hit rock at 6' sieve analyses 6 21 Drilling in rock, set casing, grouted are available, 21 360 Drilling in rock granite please attach. • If yield was tested Feet Gallons Per Minute Pump/Storage Tank Information at different depths _ Pump Type 3j., Capacity_ during drilling Depth 3Yd Model�`jr�i,,/d list: Voltage yid HP'/y Tank Type OAR, um Vole ,G'L Date Well Completed Well Driller PC Certificate# 019 • NY State#NYRD10105 Date of Report 9/19/14 Pump Installer PC Certificate# 0 1 R NY State# 10 57.50 11/15/16 Well Driller Name&Address: Well si ture) P. F. Beal & Sons, Inc., 4 Putnam Ave., Brewster, NY 10509 1 C'hristo�her Beal Pu p Installer Name/)&Address: /../i1'�c�� �..,Rump Ins Iter(s' natur' ) / atI/4 .1` (. . ('Ij/' r°' /S.5— (.�;C/? %//%' �'/J 2Z ,e� . r NOTE: Exact Location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. White copy: HD File; Yellow copy -Building Inspector; Pink copy-Owner; Orange copy -Well driller Form WC-97 Rev. 3/06 1 1 1 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director ** TEST REPORT ** LAB #: 9.600636 CLIENT #: 65409 NON STAT PROC PAGE: 1 of 1 GUARDIAN HOMEBUILDERS DATE/TIME TAKEN: 10/10/16 11 :OOA 10 MEKEEL ST DATE/TIME REC'D: 10/10/16 11 :22A KATONAH, NY 10536 REPORT DATE: 10/12/16 PHONE: (914) -643-8071 SAMPLING SITE: LOT 3 BEAR HILL RD, PATTERSON NY SAMPLE TYPE. . : POTABLE : KITCHEN TAP PRESERVATIVES: NONE COL'D BY: JERRY FARINELLA TEMP RECEIVED: .4C ON ICE • -NOTES... .. .. ... . _.-- . ___.. _._ _..�... ._. COLIFORM.METH.: ME _ START DATE/TIME END DATE/TIME FLAG PROCEDURE RESULT NORMAL - RANGE METHOD I I 10/10/16 0430 10/11/16 0330 MF T. COLIFOR ABSENT /100 ML ABSENT SM 18-20 9222B COMMENTS: MFTCTom Coliform = This result indicates that the water ® (was not) of a satisfactory sanitary quality according to t e New York State and EPA federal drinking water standard for this parameter. This comment applies to the Total Coliform test only. i I THE ABOVE TEST ' :!CED TES MEET ALL REQUIREMENTS OF NELAC, AND RELATEO� / O TH" LES RECEIVED BY THE LAB SUBMITTED BY: Albe Pa•• 'ani, M.T. (ASCP) Director ELAP# 10323 I . mpleted well in ft. Depth Date 50' 320' 360' Well Log Depth From Surface Well Diameter If more detailed ft. ft. Water Bearing (in) Formation Description information Land Surface 6 Drilling in overburden, clay and boulders . descriptions or Hit rock at 6' sieve analyses 6 21 Drilling in rock, set casing, grouted are available, 21 360 Drilling in rock granite please attach. • If yield was tested Feet Gallons Per Minute Pump/Storage Tank Information at different depths _ Pump Type 3j., Capacity_ during drilling Depth 3Yd Model�`jr�i,,/d list: Voltage yid HP'/y Tank Type OAR, um Vole ,G'L Date Well Completed Well Driller PC Certificate# 019 • NY State#NYRD10105 Date of Report 9/19/14 Pump Installer PC Certificate# 0 1 R NY State# 10 57.50 11/15/16 Well Driller Name&Address: Well si ture) P. F. Beal & Sons, Inc., 4 Putnam Ave., Brewster, NY 10509 1 C'hristo�her Beal Pu p Installer Name/)&Address: /../i1'�c�� �..,Rump Ins Iter(s' natur' ) / atI/4 .1` (. . ('Ij/' r°' /S.5— (.�;C/? %//%' �'/J 2Z ,e� . r NOTE: Exact Location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. White copy: HD File; Yellow copy -Building Inspector; Pink copy-Owner; Orange copy -Well driller Form WC-97 Rev. 3/06 1 0.3:44AM -- PO2 • PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM ' .3 , o - 1 -J3 Owner or Purchas of Building Tax Map lock Lot tAmoci rx0110 . Ict,e/r&cLL-C •. Building Constructed by Town/Village /I geetZ ROI -02_.(01 9 A"L4(1 i_ --;°,foc14- Location • Street Ata- - Subdivision Name 1-•-O -d-43 Building Type bdi iniSu iv' i . .. on Lot# I represent that I am whollyand completely p letel y responsibly for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above-described property and that is,has been constructed as shown on the-approved plan or approved amendment thereto, and in . accordance with the standards,rules and regulations ofthe Putnam County Department ofHealth,and hereby guarantee to the owner,his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the"Certificate of Construction Compliance"for.the sewage treatment system, or any repairs made by me to such system, except where the failure`to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the. system. • The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the.Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month C-7-1-- Day Year ) A � Signature: •.L1 , . A ice.at_AII Or Title: Jl24-- General Contractor(Owner) - Signature • Corporation Name (if corporation)� t'p ) Corporation Name (if corpor.•tion) �y'lfG Address: Address: : �s 9 A _ /P � i 6-- State Zip State I V ' Zip / 3 J Form GS-97 l 1 I 0105 Date of Report 9/19/14 Pump Installer PC Certificate# 0 1 R NY State# 10 57.50 11/15/16 Well Driller Name&Address: Well si ture) P. F. Beal & Sons, Inc., 4 Putnam Ave., Brewster, NY 10509 1 C'hristo�her Beal Pu p Installer Name/)&Address: /../i1'�c�� �..,Rump Ins Iter(s' natur' ) / atI/4 .1` (. . ('Ij/' r°' /S.5— (.�;C/? %//%' �'/J 2Z ,e� . r NOTE: Exact Location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. White copy: HD File; Yellow copy -Building Inspector; Pink copy-Owner; Orange copy -Well driller Form WC-97 Rev. 3/06 1 YML ENVIRONMENTAL SERVICES • 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director ** TEST REPORT ** LAB #: 1 .603311 CLIENT #: 65409 NON STAT PROC PAGE: 1 of 2 GUARDIAN HOMEBUILDERS DATE/TIME TAKEN: 11/15/16 02:30P 10 MEKEEL ST DATE/TIME REC'D: 11/15/16 03:30P KATONAH, NY 10536 REPORT DATE: 11/23/16 PHONE: (914) -643-8071 • SAMPLING SITE: LOT 3 BEAR HILL RD PATTER-SON NY SAMPLE TYPE. . : POTABLE : KITCHEN TAP - PRESERVATIVES: HNO3 COL'D BY: JERRY FARINELLA TEMP RECEIVED: 5C ON ICE NOTES. . . : COLIFORM METH: MF START DATE/TIME END DATE/TIME FLAG PROCEDURE RESULT NORMAL - RANGE METHOD • PUTNAM CNTY PROFILE W/"0 TC 11 /18/16 LEAD 2.4 ppb 0-15ppb SM 18-19 3113B 11/16/16 0215 11/16/16 0315 NITRATE NITRO <0.23 MG/L 0 - 10 HACH 10206 I 11/16/16 0245 11/16/16 0345 NITRITE NITRO <0.01 MG/L 1 .0 MG/L SM18-204500NO2 ' 11/18/16 IRON (Fe) 0.21 MG/L 0-0.3 mg/1 SM 18-20 3111B 11/21 /16 MANGANESE (Mn <0.01 MG/L 0-0.3 mg/1 SM 18-20 3111B 11/21 /16 SODIUM (Na) 20.87 MG/L N/A SM 18-20 3111B 11/1)8/16 0420 11/18/16 0423 * pH 7.1 UNITS 6.5-8.5 SM18-20 4500HB 11/18/16 HARDNESS,TOTA 92 MG/L N/A SM 18-20 2340C 11/22/16 ALKALINITY (A 80 MG/L N/A SM 18-20 2320B 11/16/16 0400 11 /16/16 0403 TURBIDITY (TU <1 NTU 0-5 NTU SM )8 (2130B) COMMENTS: • Pb/Cu LEAD limits for public schools are set at 15 ppb. EPA Lead & Copper Rule for Public Systems requires that no more than 10% of their distribution points have a LEAD value of more • than 15 ppb and a COPPER value of 1 .3 mg/L, else water treatment must be undertaken to reduce the waters corrosive potential. Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. IMS = IMMEDIATE METAL SAMPLE. (INTERPRETATION: WATER SAMPLED AFTER SITTING UNDISTURBED. A MINIMUM OF 6 HOURS OR OVERNIGHT) NMS = NORMAL METAL SAMPLE. (INTERPRETATION: WATER SAMPLED AFTER RUNNING FOR 10-15 MINUTES MINIMUM) Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium is suggested. • • r°' /S.5— (.�;C/? %//%' �'/J 2Z ,e� . r NOTE: Exact Location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. White copy: HD File; Yellow copy -Building Inspector; Pink copy-Owner; Orange copy -Well driller Form WC-97 Rev. 3/06 1