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HomeMy WebLinkAbout0691DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23.11 -1 -69 4' imp] rm i T ■� L I IL 00691 Imo% PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES �UI�'e)I g m'mal' mgr WELL COMPLETION REPORT Well Location Street Address: TownNillage: Tax Map # •a ew MapV // Block Lot(s)6 Well Owner: Name: Address: Use of Well: _Resident' _Public Supply Air cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Institutional Standby Drilling Equipment _Rotary _Cable percussion Compressed air percussion Other(specify) Well Type Screened _Open end casing Open hole in bedrock:. Other Total Length _,� I ft. Materials:. Steel Plastic Other Joints: Welded Threaded Other Casing Details Length below gradeZft. Seal: Cement grout Bentonite Other Diameter min. E Weight per foot lb /ft Drive s hoe: Yes _ No Liner: _Yes . No Diameter in Slot Size Length ft Dept to Screen Developed? Screen Details First _Yes No Hours Second Well Yield Test _Bailed - -Pumped :NL Compressed Air- - Hours -- Yield"' gpm Depth Date measure from land su ace -stat c s ur ng yield test n 14,14- of completed well In Well Log D►e th From Surface W611 Diameter If more detailed ft. ft. Water Bearing in Formation Description information Land Surface descriptions or ..d� sieve analyses are available, please attach. If yield was tested Feet Gallons PerMinute ' Pump /Storage Tank I formation Pump Type Capacity, Depth Model at different depths during drilling list: Voltage . HP 4 Tank TvK= Volume Date.�W'II�Camplet2dl:� 1N;-1f Qnllet PC Cettific tey #, = *��IV�Y' °S tei ��I' << &�� � -� NI ,f ^Y �' 'f:R :r;;•� �rrr'� �(.Mri. r.�:l :� .. 3 L •�n :.:Irk..:. .,:.' 4 ktY .- '11 ilf. ! :: i � yh'�:f: �ll_P'Y }�'� I ll.:.�:.._ i•i. Iler'G' Vrt rl�ti :r�l ll'f.. ; J.rrtn If� 1 'r�:.::.. .,r, r•,:! 4 ... _.. -!, ._ PumpinSt Certificate# w.. :.nv .. _... A . ., ..: .... ... r ,. ... .... .:.. ..'.r. r.1 r_ 421L.�.J.:_ r .. ... _ .. •. a f!" W We � .r tiller N e „�: A�dress� !.:. i (: _it -.:: \..iJ; (•''i":....•. 1 l.' Y ..1. �4 ".1 ME� ^I �-!.A �r,4Ty�” r.h� Y:��I rryy r �.; ...r.'. tit. "1 - } e2 Q,�{{ !1� � Y � .-Jk ..� �rrl..n :f �r � 1. ,�Y:ik� �• �l {41� I d1. 1 ' ��{�', '� It �i �N I T;Y�.sF: �':l id I If IR���rr `8 � 1. F �.1�1 �1D �r� 1I rit l5.ii- i jam: <. it .Ir. is *'.....r:. ::: ti - _ +v. t % ' �a',�'K. tt •.�y{ n� � ��� 'i f..: _$. '....'<r..�..z :�C , �'. -�t J"�'.%'r :, L',�.i' r.: ! �:� -, 1 ,•1� � :i 1t� � VAi4�"4�•FG•4n 1:e: :, r,•, ..tr ;.y,!, r "sJfiiL�`li ; .. �� .. }d1 a' iti r{tlr .:i``.iK!. "�T' r. a. 1 r: M r9 �' i ia. n7 M �,,. 1. = "i1 �� fty - f ' ,i y �. �il t :•� „� 7?N `{�� r �'i p ^� S-'� 5, , � ve /L. I.i•r:rl.uri M. .H'i '.i. r.K:' 'Ib �ll�. � _ �. "kn"+� #`�'r ..R ,. +ESY.+ �E id.: f t ��� - .'Gi�:.i I .. o- I��i 'r.C� NOT E' jexact Location of well 11th distances to at least two permanent Undrhaft to • e p vided n sepa to shee - '/ or White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well drilier Form WC -97 Rev. 3/06 a' r PUTNAM COUNTY DEPARTMENT OF HEALTH 6 DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # a °1 Located at MOUt-N%ol N V lc=w PD Owner /Applicant Name 1-1 N Formerly Town or Village -y a Tax Map 13,11 Block Lot Subdivision Name Subd. Lot # Mailing Address 9 �A D U N TA t ,� VIM P AZ> P Al °rC��� °i Zip -7 Date Construction Permit Issued by PCHD S ' O q ' 1(7 Separate Sewerage System built by M IT'(PDA (l_ Address Consisting of 10 0 0 Gallon Septic Tank and ( 000 Cr AN- Co0Gr TG P V M P C14AMLSOt F0q'1C_C__ Mail cootpkTI t >IST, B0 375 4 STbe A&Rflots 10464S Other Requirements: Water Su Public Supply From or: Private Supply Drilled by KIrAV W� Address _F_ N Building Type ( FAM i Has erosion control been completed? Number of Bedrooms 'aF3M Has garbage grinder been installed? Address I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: Certified by DNS A • �A L-10 M P.E. 1" R.A. (Design Professional) Address ? MC/,MvP AJ,`AJK PAMA Nc; t q ,`LSbd License # t�4 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or Inge is necessary. !. White copy - HD Title: Building Inspector; Pink copy - Date: ' //—, 1120--11 copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Well PermitR #vi�f�� ,�1Y11�k����t'i�l��\ :4�i+��4Mi) WELL COMPLETION REPORT NOTE: ' ac Loctafion of well h distances to at lea §ftwo permanent I n ma ks to t e p ovided bn a separate Shea ppn. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 Town/Village: Tax Map # :GPS�;��k"'`° Well Location Street Address: .:.•.,�: !.:a r Map2?// Block Lots) Well Owner:. Name: Address: Use of Well: �Resider%tp _Public Supply Air cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Institutional Standby ' Drilling Equipment _Rotary _Cable percussion Compressed air percussion Other(specify) • ,w F. ..... ..- :�,,.., ., ...;j„.....n ..:- i;.. ;.,...5:�:i••,..,.,�.,.,...... y. �'..... .�, ... .7 .....;.. �,...f,::...,. .. ::... .. Well Type _Screened _Open end casing Open hole in' bedrock: Other Total Length I.A. Materials: Steel Plastic Other Casing Details Length below grade�ft. Joints: Welded Threaded Other Diameter °� in. Seal: Cement rout Bentonite Other Weight per foot ?Ib /ft Drive shoe: Yes _ No Liner: _Yes No Diameter in Slot Size Length ft Dept to Screen ft Develo ed? Screen Details First _Yes _No • Second •Hours Well Yieli� Test _Bailed _Pumped Compressed Air Hours-- - � Yield gpm Depth Date Measure from an surface-static (spelty ) ur ng yield test of completed well in Well Log Dre th From Surface ell ' iaine er If more detailed ft. ft. Water Bearing in Formation Description information Lana surface descriptions or sieve analyses are available, please attach. If yield was tested Feet ,. Gallons Per Minute Pump /Storage Tank Ir>formatitin" at different depths Pump Type Capacity I/� during drilling Depth Model � list: Voltage��/`) HP I; Tank T e . 1 Volume j� Date W II Complefeti ; Welf Driller PC Certificates# Pumlp�Installer,P�G Certificate '� We Driller Name & v Address ;Well > > ' E h>f" l :h� ! 'L }.. S. ✓A y' � � J [ 1 w h } t�� ,;, i s L :�§. % '{.4'vx . S'..: 1:'' t /`v: `4Y u \ i . :.. �a �: ,! Yi f �h �3"CI Lt Y TI 7 F�� .. i Sh I J M* h R.' � .'� i`d IV' "1. �• .I �t 1 ii�i`F F•� • +"M ". . I+e[. JS� �y'II�t,(� Naive :� �1� ...D xs , x t \ bi t. nR ,..� `y .',• � r� t,�x � 4"+. � / a .5� it is [ . f7n .� - 4 i �' 'J�x+' ; >•� ur )' � ,r;t�, F ldpJ2 #^#y t�71t1�1 {tY +`tiY,F ag�k -i. 4�1'�a.c'�q�k� :x'� 4y� c'� ✓ ' b°> t rn 4 sri gx.. i' 't O C ENGINEERING, RC 5W — o Z-IQ Mr. Michael Budzinski, P.E. November 16, 2011 Putnam County Department of Health 4 Geneva Road Brewster, N.Y. 10509 Re: King Residence SSTS 5 Mountain View Road Patterson, New York TM# 23.11 -1 -69 Dear Mike: I have reviewed your comment letter dated August 30, 2011 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 your original comments: 1. The SSTS reserve area is shown within 20 ft of an enclosed porch on piers at the rear of the building. Notation has been added to the plan to indicate that the rear extension -of the building is actually an -enclosed porch. - - 2. As per our office meeting, the reserve area has been redesigned to maintain the 200 ft separation distance to the downhill well. 3. The impervious barrier has been shown on the plan. A certification letter regarding the installation has been attached. 4. The Owner shall supply the well abandonment report directly to you. AI'he#W 5. The Owner shall supply the water quality analysis for the new well directly to you. *r*/e�7 6. The As -Built has been revised as per comment #2. It now shows the individual reserve laterals. any questions regarding this matter, feel free to call me at your in be reached at (845) 855 -2000. P.E. cc: Don King 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 S MEMORIAL AVE. SUITE 1 01 , PAWLING, NY 12564 PH: B,,46 -S55 -2000 • FX: 845 - 855 -2605 E: JKALIN@VERIZON.NET OC ENGINEERING, PC Mr. Michael Budzinski, P.E. Putnam County Department of Health 4 Geneva Road Brewster, N.Y. 10509 Re: King Residence SSTS 5 Mountain View Road Patterson, New York TM# 23.11 -1 -69 Dear Mike: This letter is offered to provide the certification of the clay barrier for the above referenced project. I hereby certify that I am a professional engineer licensed to operate in the State of New York and have performed a site visit for the above referenced project relative to the clay barrier for the subsurface sewage treatment system. Prior to the installation, I confirmed the location and installation requirements with the Owner. I found the clay barrier to be installed in the location staked out by the project surveyor. --I reviewed the tickets from -the-clay supplier to confirm the quantity of material required. It is with this understanding that to the best of my knowledge, information, and belief, the clay barrier was completed in general conformance with the design plans and specifications as approved by the Putnam County Health Department. Should you have any questions regarding this matter, feel free to call me at your gnFd e. I can be reached at (845) 855 -2000. CO n e 9 IN, P.E. ., _1 cc: Don King 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: 845- 655 -2000 • FX: 645- 855 -2605 E: JKALINQVERIZON.NET - „-.«s''�°N,` ".;• Page 1 of 1 ® �° Erivir�owtrenfal Services, litc, 41 Kenosia Avenue +1� mi WATEA. SOIL AND AIR ANALYSIS Ak Danbury. Connecticut 068i0 1 Telephone 203 -798 -2229 Hyatt Pump Service: Donald King Mailing Information: Collector's Information: JMS ID: 088085 Name: Hyatt Pump Service Name: Not Specified Address: 229 South Rd Address of site: Mt View Dr City: Holmes City: Patterson State: NY Zip: 12531 State: NY Zip: Phone: (845) 855 -5136 Fax: (845) 855 -5136 Phone: Sample's Information: Sample ID: 2 Site: upper well Preservative: N/A Temperature: Matrix: Water Date Analyzed Test Name 11/20/09 4:00 PM E. Coli 11/20/09 4:00 PM Total Coliform 12/01/09 Iron 12101/09 Manganese 12/01/09 Sodium 11/20/09 pH 11/20/09 Color 11/20/09 Turbidity 11/24/09 Hardness 11/20/09 Odor 11/21/09 Chloride 11/21/09 Nitrate 11/21/09 Nitrite 11/21/09 Sulfate Date Collected: 11/19/2009 Time Collected: Date Received: 11/20/2009 Time Received: 3:00:00 PM Lab No.: j0909025 Result MCL Method Absent Absent Colitag Absent Absent Colitag <0.05 mg/L 0.3 mg /L EPA 200.7 <0.05 mg /L 0.3 mg /L EPA 200.7 9.42 mg/L N/A - EPA 200.7 7.94 S.U. 6.5 -8.5 S.U. SM 4500 H B ND 15 Units SMWW 2120 B 0.92 NTU 5 NTU SMWW 2130 B 110 mg/L WA SMWW 2340 C ND WA SMWW 2340 C 10.8 mg/L 250 mg/L SMWW 4110 B 0.148 mg/L 10 mg/L SMWW 4110 B <0.05 mg/L 1 mg /L SMWW 4110 B 16.3 mg/L 250 mg/L SMWW 4110 B Comments: At the time of the analysis the sample was Acceptable for Total Conform At the time of the analysis the sample was Acceptable for E. Coll pH was received and analyzed after the EPA required 1 hour holding time. CFU = Colitonn Forming Units MCL = Maximum Contaminant Level mg/L = milligrams per Liter N/A = Not Applicable ND = None Detected NTU = Nephelopmetric Turbidity Unit S.U. = Standard Unit Units = Units Signature: Michael Lapman President � � r Reviewed By: — Sharon Houlahan, Director State #: PH -0218 ELAP #: 11715 CONPIECTICUT. NEW YORK A'ND NELAC CERTIFIED Toll Free 866- JMS -5097 I Corporate Fax 203-79B-2408 I I3b Fax 203 798 -2107 I www.jnsenvironn » rR3l.00m PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map Block Lot �b o�•� �.� Jet ti�� C�ra� ��ti ����n� . Building Constructed by Town/Village � Mdv�e�rc -, �i�w CLOAt� 'Location - Street Subdivision Name 5 I rJ Gr .lr f A M Building Type Subdivision Lot '# 1 represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above- described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and - hereby guarantee to the-owner; his` successors,-heirs or assigns; to place in good operating condition any part . of said system constructed by me : which fails to :operate for a period of two y ears 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: ont Day Year I/ eral Con (Owner) - Signature Corporation Name (if corpo ation) Corporation Name (if corporation) Address: 11 !� 141 l -ice p -b Mns l Address: Stater Zip ME(27 State Zip Form GS -97 HEALTH PUTNAM COUNTY DEPARTMENT OF DIVISION Of ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE.SEWAGE TREATMENT SYSTEM 7�0 tia t t2 Owner or Purchaser of Building. Building Constructed by Zj (� v y T A, r t-� I t C*j j -VAC) Location - Street Building Type Tax Map . Block Lot 0 TownNillage Subdivision Name Subdivision Lot # I. represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the, standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner; his successors,-heirs massigns, 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. r Dated: ont Day /t7 Year eral Cont r (Owner) - Signature K ,r��..S Corporation Name, (if corpo ation) Corporation Name (if corporation) Address: Address: State WVJ Zip f6l�1_01Y State Zip Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM otiA LZ> Owner or Purchaser of Building Tax Map Block Lot �botJA j'e/_'7 (J1 P_,A"TImt K) . Building Constructed by Town/Village D v i — l°,� r t-� T mAN (-o Ate Location - Street Subdivision Name S 10c,1:E fAM t �Y pis tD—:N CC Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has: been constructed as shown on the approved plan or I approved amendment: thereto, and in accordance with the. standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner,-his successors, heirs-or assigns; to place`in good operating condition any part of said system constructed by me, which fails to :operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance ". for .the sewage treatment system, or any repairs made by me to such system, except where the failure to operate.properly is caused by the willful or negligent act of the occupant of the building utilizing the system: - -- The undersigned further agrees to accept. as conclusive the :determination of :the Public Health Director of the Putnam.County Department of Health as to whether or not the failure of the, system to operate was caused by the willful or negligent act of the occupant of the building utilizing the .system.. Dated: ont Day l� Year eral Cont r (Owner) - Signature �N t� S Corporation Name (if corpo ation) : Address - :1:10 .. 11 Z 011 - . 17 -b. VPVA),- State Zip C� Corporation Name (if corporation) Address: . State Zip Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Building Constructed by Tax Map Block Lot Town/Village to c*ation - Street Subdivision Name SIPC,U& fAM I PTE�-NCC� Building Type Subdivision Lot I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system -serving the above described property, and that is has been constructed as shown on the'approved plan or approved amendment thereto, and in accordance with the. standards, rules and regulations of the Putnam County Department of Health, and ,-hereby guarantee to the-owner, his successors, heirs or assigns,- to-place in good operating- condition any part - Of said system. constructed by Me which fails to operate for a period of two year 5 immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs pairs 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 willtui or negligent act of the occupant of the building utilizing the system. Year / / (Owner) - Signature 'Corporation Name (if Address, 111!Z0 a/ 17-b ffl_ ( l .State zip llr/(n Corporation Name (if corporation) Address:. State Zip Form GS-97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL ABANDONMENT REPORT I, undersigned, - hereby certify that the abandoment of the above - referenced water well has been accomplished and completed in accordance with the methods described in Permit # A N* "04 to abandon said water well. Date: Signature: Print Name: .(oyN HLr tt� Address: Design Concantg ring6moorgaa min Memorial Ave. uite 301 Pawling, New YeFI' Form WAR -97 PCHD Well Abandonment Permit # please print or type Street Address: Town/Vi l lage Tax Grid # •fir: ::tier: 'iii p /vit A204.'s G_ i.:f:. /w, Map Block Lot ep rs':.:.-:, : Name: Address: •.� "•';i'irRI:4i�ia �i� tPli '.j;ili�,::J!'� r'•:4!Fii °iii...ii • Iti' ::'P ((/VV ._�. � • :. � ��Es;_d!.•�:F 'I I Iii} Drilled Driven Dug Gravel Other ;(,:y, .:_ ..\ •-' � '�` G+� fish ICe �q1. 'I':'...�Li\!.�}- ';i'- i`�::5• Iii ii� IL ..,._• : •�. r�ti 1:711_x.::- .ti•� \r.�:. h f ++{, Well Depth 7S'G ft Static Water Level ft Date Measured U •;' uf:;�. _i \:III ✓;i t. .:r LFi'i�: = 1 ;`' ' �;ih�j:ii +•i: ?:.! ;.. .:,;.. -: •:;; ( Exit t1A wl.L JP f, l a--s /�✓ E '�G QAeCA, .is:�.;; !don ,2 .:.,,.t I, 10 LD f ��,. AVW eJr(n•!Q dl....:.. •.I °' � `il 49/ Z45fle �I� W/04 �i�O r�0 / { /_ 10 �I s ` ''¢L'l�y <p GaiGC�� r" .. I, undersigned, - hereby certify that the abandoment of the above - referenced water well has been accomplished and completed in accordance with the methods described in Permit # A N* "04 to abandon said water well. Date: Signature: Print Name: .(oyN HLr tt� Address: Design Concantg ring6moorgaa min Memorial Ave. uite 301 Pawling, New YeFI' Form WAR -97 s PUTNAM, COUNTY DEPARTMENT OF HEALTH V DIVISION OF ENVIRONMENTAL HEALTH SERVICES j `UII ell Permit# WELL.COMPLETION REPORT Well Location Street Address: Town/Village: Tax, -Map # Maps ? j I Block Lot(s) Well Owner: Name: ' "" Adar" ss: v Use of Well: .. i . Residential' Public Supply : Air condlheat pump _Irrigation 1- Primary Business Farm.. Test/monitoring Other(specify) 2- Secondary Industrial Institutional Standby Drilling Equipment. _Rotary `Cable percussion VCompressed air percussion _Other(specify) Well Type, _Screened _O pen: 'end casing Operi''hole to bedrock Other y Total Length e-ft. Materials: ' /F Steele:. Plastic Other Casing Details Length Below grade�t. Diameter "r in. Joints: Welded o /Threaded Other Seal: Cement rout Bentonite Other ,. Weight per foot jIbift ,: Drive shoe: . '' Yes _ No Liner: ._Yes ;No Diameter, in Slot Size Length ft Dept to Screen' ft Develo ed? Screen Details First: .: ;:. Yes _No Second Hours Well Yield Test Bailed.' Pumped � Compressed Air Hours Yield:: : gpm Depth Date easure,.rom en 5.7 face. c spec L }.r F. �' u ngy,e test ,- /t' M. d east o_,compete we n . 1 Well Log 'Depth From Surfa°ce"'" Well "Dialnefer 'I `� If more detailed ­Water Bearing (in) Formation Description ft.` ft. Land Surface information descriptions or sieve analyses are available, �r please attach. If�yield was tested .'Feet �, ` Gallons Per Minute _. ,Pump /Storage Tank Information' p rn ..: ;,_ °® "Type'. :Capacity :. Pump Depth" , , :,� - Model Voltage . f; ` HP, at diffeeeint depths during drilling list: - pig .,,6,: �, ..- , ., -., Tank Type., Date weu completed ' ' ,f_, ,;, Well Driller PC Certificate # NY State #,, / y t '' tJy1 P °ump'Installer l?C Certificate # NY State # Date of Report" , Y 0 } ' W61 Dril)er'i"Name'&IAddress t y': ^A AN:; Well Duller (s natt�'r ) •� i v R r �+^` 1 0 J' P /�°,/ w' I n Pump�lhstaller Name &' . dress ' } " n � '� I i:. �. I �f �� a Itt 1 �i _.. � ti. a s L i d' �'�r ' f �w °':.r%, s , .X..;i.. 5;,, {? t!•� i i': -L�, . s :,' a' ...ai.!• Fc i° `, `T r.,.' .:Ji" L", G f PuWn lnstaller glbKidarre) � d•rr.. ' i �it�-t i �"' �i, c�..� NOTE: Exact�I ocation of well;with`distanre to at least two permanent landmarks to be provided on a separate sheet/plan. White copy: HD-File; Yellow copy = i3uildirig Inspector; Pink copy -Owner- Orange. copy -Well. driller Form WC -97 Rev:. 3106 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Well wc WELL COMPLETION REPORT ut, Well' Location Street Address: TdWn/VilIa'ge:' Tax.M,a 0 # GPS ockj Lot (s) M Bl (s) Well Ow. n . .. Naffid . .. A.4049e A. Use of Well: LL_RPsi.dentiaI Publi Supply Air cord/heat-. pump _Irrigation' .'Primar Business farm. Test/monitoring ..Other(specify) 27picbrd ir y Sta hdby: ndustHal Insti Lti6n11 ' air _Cable percussion VComprqssed ,.: percussion _Other(spocify) WeII Type: • T- c eh casing -Other Total Length je-f t. :Materials: '.:Plastic Other: ' eCasing Joints: Welde C i . Other----- Details Lenl#h'b6loW.grade jzjf , t. Diameter in. 'Britonite Other Seal: J—Aer'iierit grout ei Wei" ht�pe.:foiot -7 lblft ght�pe Drive shoe:' Yes: No Liner: Yet Ad Diameter in Slot Size Length (ft) Dept to Screen ft Developed? Screen Details.:. First Yes No. ec fid Sori Hours Well Yield Test Pum Opd,_y .Compressed Air Houirs--: Yidld,: - .. Date measure.from land sqrfaca-;tat[F (Spec iqr` . ..... Dpring yield last M7 . A A d ll I- 060t h. of complete we nA. W61116 detailed De pth'Fr6rh Suirfide— A. Water Be!H!21 W611- . DiAtnet e in Form rm . 'ation Description ft. ft. . U L�na S'��ce 'Iffriore irifothriation d escrip. ions or sieve analyses are available, f U please attach. If yield was tested -Feet:,'. Gallons Per Minute Pump /Storage Tank Information iat difteeent d6bth§,.: dbring drilling list: j "' pm Type p Q6pth­.,,, Model Volta.40 .�Y? r� 9-44A Tank Type 7 late 11 completed 64 IN. :% G6ftif i. c....a . . e f!Report t A Wbll(M,illbriNarnk,:'� ;-Wd d res V 11Y il" 7 :\1 "Hit. K, .,ump nitilld e g ' 1�1.1 "W" �,N i T t of 611 Al'i'distind6sto - -asttw to be provided ori'a s650*atdsfie !11 -'NpTE..�Bkaff. Location W W dt le.. o permanent Ian W h ite copy: HD File; Yellow copy' Building Inspector; Pink copy - OWner;. Orange. copy - Well driller FdtrhWC-97 :Rev;,3/06 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES : Permit Well , WELL COMPLETION REPORT Well Location Street Address: Town /Village: Tax Map # GPS Map,l " i ! Block Lot(s) 1f1 Well Owner: Name: `— Addr ss ". ' t Use of Well: r _ blic Supply Air coed /heat. pump _Irrigation P .. Residential Pu 1- Primary Business Farm Test /monitoring _Other(specify) 2- Secondary Industrial Institutional Standby Drilling Equipment _Rotary _Cable percussion UvCompressed. air percussion _Other(specify) WeII.,Type `Screened, Open end casing Open hole in bedrock _ Other . Total Length' I°ft. Materials;' Steel ; Plastic Other Joints: , Welded. ,Threaded Other. Casing Details Length below grade ijt. Diameter 7 in. Seal: ZCeiment grout Bentonite, Other Weight.perfoot lb /ft Drive shoe: Yes _ No Liner :. Yes . /No Diameter in Slot Size Length ft Dept to Screen" ft Developed?' Screen Details.. First.; .—Yes _No. Second Hours Well Yield Test _Bailed. pressed Air —Pumped. :COm Hours ;- X Yieltl: - _ gp m Date easure ,n su ce sta e s . eDepth urn yield Ai ro comp e e we n Well Log '. De th From SuHd e"" Well`rDiafneter " `" ' " If more detailed Water Bearing in Formation Description ft. ft. information { descriptions or sieve analyses are available, Land surface please attach. If. yield was tested : Feet : Gallons Per Minute :: Pump /Storage Tank'Information -•,, .� �:#> Pump Type :` Capacity , Depth' Model ` HP, Voltage �, _. . Tank Type , `'` =; ,1, ,:;•_.� , Vol'iume : ,,� . ti ✓` at different depths,.' Burin drillin ' list: Id .. Date Well Completed 1 UVell Driller PC Certificate # "y NYIState #,�� "� Date'of Report I ' C. ,ertificate # , . NY State ` #; %'g j�. _ Wqel Dril)er Name'& Atldress 1 ' Well Driller (snat fr�), a 1 r u.•' cl e' e 0 aJc..F Cr,. r y r Pump °Installer Name &4A re�ss . � h,. s�1; .i''%fi It , uf' !:v A„'.r.4,.m1 ;'Y.,�.rnr.. +i l.c „ .4y d�;%;..1_.r 7r �:^riv! 1 ir:E+ra iY"s7,;r.{:1.�tl: %C .�. r �I v r� Puinp,lnller (sig�iature) j „.M!'.,i�' .l`...r!ry r.� ' II ,.a.o': �..•:',.L NOTE; Sxacf "Location of well with `distances to at least, two permanent landmarks to be provided =ori a `separate sheetlplan White copy: HD File; Yellow copy = Building Inspector,-'Pink copy - OWner; .Orange. copy - Well: driller Form WC -97 Rev. 3106 PUTNAM COUNTY DEPARTMENT OF- HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Well Permit # WELL COMPLETION REPORT Well Location Street Address: ' .' . Town /Village: Tax Map # fj 1 Ict1,l k' Mapz ? / > Block: / Lot(s) 41 . .: • Well OWner: Name: AJ/1 Use`•& Well: ": l .Residential ! _Public Supply Air coed /heat,.pump _Irrigation: 1,Primary Business farm. Test /monitoring _Other(specify) 2 Secondary : industrial Institutional Standby Drilling Equipment. _Rotary _C able,.percussion l'Compressed air percussion _O ther(spec.ify) y r� WeILType _Screened.._Open end casing ;Open�h,ole, to bedrock _Other_ . Total Length *� e'ft. - . Materials: . Steel ; .: - Plastic Other Joints: Welded Threaded Other. Casing'Details Length below.grade-uift. Seal: f Cement grout' Bentonite. Other ' Diameter -7 in. o Drive shoe: Yes _ 'N6.' Liner::. Yes _No Wei ght-perfoot A lbyft '.: Diameter in Slot Size Length ft De t.to Screen` ft Develo ped? Screen Details : First. Yes No. _ _ Hours Second We*II Yield Test _Bailed_ Pumped, fit' ,Compressed Aire Hours ,C Depth Date Measure, from alni,pat ur,ng'y a est Apt ;o completed we n . � J � .. :.M""• ff. �v1 �In,v.• ��f'�. ' �/f �� h - ..0 )•I!' [ i s[ � . f:.. /. .•r'' � l /� l � Well Log: : -' De` th:From Suff ace. : detailed Water Bearing in :Forrriation Description Lana surface info&nation descriptions or , :, __ P I G4i rrte;. C.; (F c l,� \..'. ± _ . sieve analyses . . are available, please attach. If yield was tested; :' Feet ' 'Ga,Ilons.Per Minute:. PumpIStorage Tank-Information t'n :' ..�° I':p , `: .Pump Type Capacity :• ', at different depths durin drillin -777777771;', r Depth . . .Model Voltagea .. '. HP Tank Type. ...� >�:_.,: �> Volumer: A l t Well completed -. 4 d i l l -. I_ ,. I I t I� C I l (,rA4 .I Well Dnller'•<PC Certificate'# (((///��{]]] ;' ` �NY':State #"�. { }y�,1(� , ppI,' S h I i I t u 1 k Date'of Rernort', ryDate ^ ! ;h �, li s 1� •id III t 1 r Y '. Installer # :. 'INY State, #...'dJ r l`, , �,;'., .' /td...' , x M An .1 Pump PCIrCertlficate .... ....'• .... °.� : VPI f 11, 1 I , .I t I 1 t - i, I , 1 t r IFf ril)er,N•' amIe { ! , 1\ I !I WInl eC U D�•1 d{I lry(; e t s AIFldh 41 - '. I D1 ri iller 11 ( si 1 (J"� l W4(i�. e � II i '&, u �, I �.. Ii, i 11 I t is{ 1II 1 I, 4 I'.�I'�TIul�1�a:�,. l, 1 (i II111, ,I ! i I I .11 I11 i 'II i �•3��./?�ti6': I�,t}ac�' ��• t�.ti��S,�.,4Ju,•.���,.�!�I..r.� o'��j2�� M..,.Il,tt:l�' :: �FY/. 5t6,. t�" �1` T�/. �.' s' r". I�nin' e^Gr'kll �,.,1i1'I .. Pump!Ihstaller Name 8' A 'dress a u ` 1:� ' `4'"`'" I;1 ' 11 °t�, �, P ^umrpuln's alle,Y(srgiT tufe) I' sv I +:': 4 1 It1: `Ilut.�,' � 1 1 I 1 � ry.. , i �: t Jr ' �'r' ';`,."fit I A1. !, ' fl" I 1 ;l 1� •' {I�� 1 1 , l :' a tF'� Cr-��I I ^���!'; �..'(•. �Vt.r{ `'yC �a Ia ��ir�;I�';�wrS if 1 A "91 I� 'l. Ar..'. ,�,n�lyl.n, 1{:'i ,i m h���l. ✓'}r .�r.� ,1^'�'..'�:�.., .. P.�.v.a'.'.�^,. ,J'.t�.�;.,�...t.•.en:. .,ll .a.r ..;��...� r>T,�r:b2'��t. 1 MdIP+"�I..f!IiH1 NOTE: ` Efcact Location of well.wifh 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: 3106 Page 1 of I EfIvIrofiltiontal Services, file, 4­1 Ve-nooia Avenue -Lily. C0i1l-1'?C;fi(,Ut C26810 I Tok:-phonp_ 203 3-708-222'9 WATEA, SOIL AND AM ANALMS DWIIJ Hyaft Pump Service; Donald King Mailing Information: Collectors Information: JIMS ID: 088084 Name: Hyatt Pump Service Name: Not Specified Address: 229 South Rd Address of site: Mt View Dr City: Holmes Result City: Patterson State: NY Zip: 12531 State: My Zip: Phone: (845) 855 -5136 Fax: (845) 1356-:6136 Phon*e,' Absent Samplies Information: Sample ID: 1 Iron Sltd: New well @ old house Date Collected: 11/19/2009 Date Received. 11/2.0/2009 Preservative: N/A time Collected:. 0.3 mg/L Time Received: 3:00:00 PM Temperature: Sodium 22.8 rrlg IL Lab No.: j0909024 Matrix: Water 11/20/09 pH 7.1 S.U. Date Afialy'zied Test Name Result MCL Method 11/20/09 4:00 PM E. Coli Absent Absent Colitag 11/20/09 4:00 PM Total'Coliform Absent Absent Colitag 12/01/09 Iron 0,074 mg/L 6.3, mg/L EPA 200.7 12/01/09 Manganese <0.05 mg/L 0.3 mg/L EPA 200.7 12/01./09 Sodium 22.8 rrlg IL N/A_ EPA 200.7 11/20/09 pH 7.1 S.U. 6.5-8.5 S.U. SM 4500 H B 11/20/09 Color ND 15 Units SMWW 2120 B 1.1/20/09 Turbidity 1.01 NTU 5 NTU SMWW 2130 B 11/24/09 Hardness 146 mg/L NIA SMWW 2340 C 11/20/09 Odor ND N/A SMWW 2340 C 11/21109- Chloride 56.2 mg/L 250 mg/L SMWW 4110 B 1-1/21/09 Nitrate 0.858 mg/L 10 mg/L SMWW 4110 B 1'1/21/09 Nitrite <0.05 mg/L I mg/L SMWW 4110 B 11/21/09. Sulfate 20.3 mg/L 250 mg/L SMWW 4110 B Comments: At the time of the analysis the sample was Acceptable for Total Collf6rim At the time of the analysis the sample was Acceptable for E. Coll pH was received and analyzed after the EPA required I hour holding time. CFU = Coliform Forming Units MCL = Maximum Contaminant Level mg/L = milligrams per Liter N/A = Not App!lcable ND = None Detected NTU = Nephellopmetric Turbidity Unit S.U. = Standard Unit Units = Units Signat u.r:e: Michael Lapman President ti Reviewed By: Sharon Houlahan, Director State #: PH-0218 ELAP M 11715 30 r ' E INFCTICUT. MUN YORK AND 1,19LAC C WIRED Toll Free 866-JIVIS-509-r I Corporate Fax 203-798m2408 1 Lab Fax 203-798-2167 1 %v.%Av.jmsenvironn-ental.com ' - Page 1 of 1 Eli u/f0111n -90,11 Services, 111C.- 1`;- :1100 b AV- 2111-1a SOIL ANALYSIS Cl 1111j1.11y. C011 Lit 068io I Tcelei_d-ione 203- 796 -222P WATEA. AND AIR Hyatt Pump Service: Donald King Mailing Information: Collector's Information: JMS ID: 088084 Name: Hyatt Pump Service -Name: Not Specified Address: 229 South Rd Address. of site: Mt View Dr City: Holmes City: Patterson State: NY Zip: 12531. State:. NY Zip: Phone: (845) 855 -5136 Fax: (845) 855 =5136 Phone: Sample's Information: Sample ID: 1 , Site: New well @ old house Date Collected: 11/19/2009 Date Received: 11/20/2009 Preservative: N/A Time Collected:. Time Received: 3:00:00' PM Temperature: Lab.No.: j0909024 Matrix: Water Date Analyied Test Name Result MCL Method: 1.1/20/09 4:00 PM'E. Coll Absent Absent Colitag 11/20/09 4:00 PM Total Coliform Absent Absent Colitag 12/01/09. Iron 0.074 mg /L . 0.3 mg /L EPA 200.7 12/01/09 Manganese <0.05 mg /L 0.3 mg/L. EPA 200.7 12101/09 Sodium 22.8..mg /L N /A_ _. _ EPA 200.7 -. 11/20/09 pH 7.1 S.U: 6.5 -8.5 S.U. SM 4500 H B 11/20/09 Color ND 15.Units SMWW'2120 B 11/20/09 Turbidity 1.01 NTU 5 NTU SMWW 2130 B 11/24/09 Hardness 146 mg/L N/A SMWW 2340 C 11/20/09. Odor ND N/A SMWW 2340 C 11/21/09 Chloride _ 56.2 mg /L 250 mg /L SMWW 4110 B 11/21/09 Nitrate 0.858 mg/L 10 mg /L SMWW 4110 B 11/21/09 Nitrite <0.05,mg /L 1 mg /L SMWW 4110 B 11/21/09, Sulfate. 20.3 mg/l- 250 mg /L SMWW.4110 B Comments: At the time of the analysis the sample was Acceptable for Total Coliform. At the 'time of the analysis the sample was Acceptable for E. Coll pH was received and analyzed after -the EPA required• 1 hour holding time. CFO = Coliform Forming Units. MCL = Maximum Contaminant Level mg/l. = milligrams per Liter NIA = Not Applicable ND = None Detected NTU = Nephelopmetric Turbidity Unit S.U. =Standard Unit Units = Units r �!cG'�_ 77, �^ 1 Signature: Reviewed By Michael Lapman Sharon Houlahan, Director . President State #: PH -0218. ELAP #: 11715 CONNECTICUT, NFbV WON( AND NFLAC CERTIFIED Toll Flee 888 -JIv1S -8097 I Corporate Fax 203 -798 -2408 1 Lab Fax 203- 798 -2107 I wwvv.jmsenvironmantal.com o _ • f� /�I Page 1 of 1 k/fJfl/ �ttVitOttftl8tJt8t SCt "V /CBS, /ttC, ��� 41 � "=n����3i.n Av�l��ra �J(jrl f� L ATFA. SOIL A14D k!A ANALYSIS Dartbuiy. Conn,; +stir -ut oit :sio I TeIc-pi-i np. 203-7�-:8-222�, Date Analyzed Test Name l-lyati Pump Service: Donald King 4:00 PM E. Coli Mailing Information: 4:00 PM Total Coliform Collector's Information: JMS ID: 088084 Name: Hyatt Pump Service Manganese Name: Not Specified :Sodium Address: 229 South Rd pH Address of site: Mt View Dr Color City: Holmes Turbidity City: Patterson Hardness State: NY Zip: 12531 State: NY Zip: Chloride Phone: (845) 855 -5136 Fax: (845) 855 =5136 Phone: Nitrite Sample's Information: Sample ID: 1 Site: New well @ old.house Date Collected: 11/19/2009 Date Received: 11/20/2009 Preservative:. N/A Time Collected: Time Received: 3:00:00: PM Temperature: Lab No.: j0909024 Matriu: Water Date Analyzed Test Name 11/20/09 4:00 PM E. Coli 11/20/09 4:00 PM Total Coliform 12/01/09 Iron 12/01/09. Manganese 12/01/09 :Sodium 11/20/09 pH 11/20/09 Color 11/20%09 Turbidity 11/24/09 Hardness 11/20/09. Odor 11/21/09 Chloride 11/21/09 Nitrate 11/21/09 Nitrite 11/21/09 Sulfate Result Absent Absent 0,074 mg /L <0.05 mg /L 22.8 mg /L 7.1 S.U. ND 1.01 NTU 146 mg/L ND 56.2 mg /L 0.858 mg/L <0.05 mg /L 20.3 mg /L MCL Absent Absent 0.3 mg /L 0.3 mg /L N/A 6.5 -8.5 S. U. 15 Units 5 NTU N/A N/A 250 mg/L 10 mg /L 1 mg /L 250 mg /L Method Colitag Coiitag EPA 200.7 EPA 200.7 EPA-200.7 ... _ SM 4500 H B SMWW 2120 B SMWW 2130 B SMWW 2340 C SMWW 2340 C SMWW 4110 B SMWW 4110 B SMWW 4110 B SMWW 4.110 B Comments: At the time of the analysis the sample was Acceptable for Total Coliform At the time of the analysis the sample was Acceptable for E. Coll pH was received and analyzed after .the. EPA required ,1 hour holding time.. CFU = Coliform Forming Units MCL = Maximum Contaminant Level mg/L = milligrams per Liter N/A = Not _Applicable ND = None Detected NTU = Nephelopmetric Turbidity Unit S.U. = Standard Unit Units= Units Signature: Sae4e p _ Reviewed ay: Michael Lapman Sharon Houlahan, Director President State #: PH -0218 ELAP #: 11715 OPC EP tV C hd CRTIFIEL Toil Free 855 -J141S -5097 I Corporate Fax 203 -795 -2408 1 Lab Fax 203 - 798 -21o7 I tiv.vrv.jmsenvironmental.cam ' Page 1 of 1 (' Envit0111:lerrtat services, trn 1 #` no.-3i AvanLle WA TEA, ,,OfL A140 AIA ANALYSIS E-ard,uly. Connecticut Co-,810 I Telel_I�.t1? 2G3 -Ta8- 222! - Hyatt Pump Service; Donald King Mailing Information: Collector's Information: JMS ID: 088084 Name: Hyatt Pump Service Name: Not Specified Address: 229 South.Rd Address of site: Mt View Dr City: Holmes City: Patterson State: NY Zip: 12531 State: NY. Zip: Phone: (845) 855 -5136 Fax: (845) 855 =5136 Phone: Sample's information: Sample ID: 1 Site: New well Q old house Date:Collected: 11/19/2009 Date Received: 11/20/2009 Preservative: N/A Time Collected: Time Received: 3:00:00: PM Temperature: Lab No.: j09O9O24 Matrix: Water Date Analyzed Test Name Result MCL Method 11/20/0' 4:00 PM E. Coll Absent: Absent Colitag 11/20/09 4:00 PM Total Coliform Absent Absent Coiitag 12/01/09 Iron 0:074 mg /L 0.3 mg /L EPA 200.7 12/01/09 Manganese <0.05 mg /L 0.3 mg /L EPA 200.7 12/01109 Sodium _ 22.8mg/L N/A EPA200.7. 11/20/09 pH 7.1 S.U. 6.5 78.5 S.U. SM 4500 H B 11/20/,09 Color ND 15:1.1nits SMWW 2120 B .1.1/20/09 Turbidity 1.01 NTU 5 NTU SMWW 2130 B I: 11/24/09 Hardness 146 mg/L N/A SMWW 2340 C 11/20/09 Odor ND N/A SMWW 2340 C 11/211.09 Chloride: 56.2 mg /L 250 mg /L SMWW 4110 B 11/21/09 Nitrate 0.858 mg /L 10 mg /L SMWW 4110 B 11/21/09 Nitrite <0.05mg)L 1 mg /L SMWW 4110 B 1101/09 Sulfate 20.3 mg /L 250 mg /L SMWW 4110 B Comments: At the'time of the analysis the sample was Acceptable for Total Coliform At the time of the anal sis the sample was Acceptable for E. Coll . pH was received and analyzed after.the.EPA required 1 hour holding time. CFU = Colifom7 Forming Units MCL = Maximum Contaminant Level mg/L = milligrams,per Liter WA= Not Applicable ND = None Detected NTU = Nephelopmetric Turbidity Unit S.U. = Standard Unit Units = Units �i ��_ Signature: G Reviewed By: Michael Lapman Sharon Houlahan, Director President State #: PH -0218: ELAP #: 11715 CONNECTICUT, NE'N YORK AND NELk� CERTIFIED Toll Free eee- JMS -sog-( I Corporate Fax 203 -798 -2408 I Lab Fax 203-798-2107 I w•.viv.jmsenviromp-ntal.cam Sherlita Amler, MD, MS, FAAP Commissioner of Health Robert Morris, PE Director ogmkonmental Health DC Engineering John Kalin PE 3 Memorial Avenue Pawling, NY 12564 Dear Mr. Kalin: Department of Health 1 Geneva Road, Brewster, NY 10509 Office (845) 808 -1390 Fax (845) 278 -7921 or (845) 808 -1937 August 30, 2011 Re: . Construction Compliance for King at 5 Mountain View Road (T) Patterson, T.M. 23.11 -1 -69 Paul Eldridge County Executive This Department has received and reviewed the submitted application and plans for the above referenced project and the following. comments are offered for your consideration. C/ 1. The SSTS reserve area is shown less than 20 feet from the house foundation which is unacceptable ✓'Z. Portions, of the SSTS reserve area are shown less than 200 feet from the downhill well which is unacceptable. The impervious barrier between the house and uphill SSTS is not shown on the as =built plan. The impervious barrier is to-be located on the plan and a letter from the certifying engineer is to be submitted which states the impervious barrier was constructed in accordance with the approved plans. AIIA well abandonment completion report is to be provided for.the abandoned we on the parcel lot identified as TM 23.11 -1 -69. iii! A water quality analysis is to be provided for the new well on!the parcel lot identified as Al TM 23.11 -1 -69. . The as -built plan is to be revised to show the 100% SSTS reserve system absorption trenches. Upon completion of the above, this Department will continue its review. -Kindly advise us if there are any questions. . Michael J. Director of MJB:cw Donald King From: ' Donald King Sent: Friday, August 26, 2011 1:42 PM To: 'Gene Reed' Cc: 'joyce king' Subject: Donald & Joyce King -9 Mountainview Road, Patterson, NY 12563 Dear Mr. Reed: I was scanning back though older a -mails and found that I had missed the one you forwarded to me last Monday. As suggested, my wife will by dropping by your office with the following documentation as requested next week. She may be a little cranky as she has been after me to get all that needs to be done completed so she can move in. In any event, she will have the following: • Four copies of the SDS As- built, prepared by Mr. Kalin • Four copies of SDS guarantee by Mr. Kalin, the installer. • Multiple copies Certificate of Compliance. • Four copies of Water Analysis provided by well driller. • Well Abandonment Report. I checked my files on this item and found I had it, signed off by PCHD. • Multiple copies of Well completion Report. I also have a transmittal issued by Bibbo Associates, that indicated that it was forwarded previously. in any event, we have supplied four copies. If there is anything I may have missed, please let me know. Donald G. King Perkins Eastman 115 FIFTH AVENUE NEW YORK, NY 10003 T. 212.353.7285 F. 212.353.7454 E: dg.king ()perkinseastman.com WWW.PERKINSEASTMAN.COM From: Gene Reed [mailto:Gene.Reed @putnamcountyny.gov] Sent: Monday, August 22, 2011 10:53 AM To: Donald King Subject: FW: Dear Mr. King You only need to drop off the paperwork at the front desk as. I will not be doing the final review. After processing the paperwork, your submission will be passed on to the appropriate.'engineer for review. Thanks! N�3 OeT 7a 11. 7 11.-1': e_1 �., 1) I'D tJ 4"0 L Reason For CQT 6:7 k� GL P'1:.1" L 0-r a A 1-j C" . k-1 5�1,�`. 862'nd,onnient: , Description' Of Work To Be Performed: ., -'Va t 3 �ftj y G L_E� F -,4— -S "u "J A r tA t+(=:., NJ 'il \A Y L—t— N L 'C VJ C. C) "A NJ Applicant Signature: Vi V PERMIT''' permit, to abandon one: water:well as set forth, above, is granted.0 rid er provisions of Article :10 of the Putnam — �oufiy. Sanitary Code, . Subpart 5-2 of Part 5 of the New York State Sanitary Code and/or Part. 7 of 10 NYCRR 5 ?,4fid,provided that: 'Within 30 days of the completion of the abandonment of the water well, the applicant shall it to. the, *: Department a certified statemeni'thit the" informatio6 del ine' ated on the application for this pp c n been completed. 4 /IN. Date Permit'Issuin Title of Issue, Official White copy: HD file; Yellow copy Building: Inspector; Pink copy Owner; Orange copy -Well driller -97 Form V�A PUTNAM COUNTY DEPARTMENT. OF HEALTH DIVISION. OF ENVIRONMENTAL HEALTH ' SERVICES' APPLICATION TO ABANDON A WATER WELL P IeM e print or y . . ... . PCHD PERMIT # v:J 6 2%. frs Well Location: Street Address: Low h Village Tax Gfi&# .. .... ap�kjglock Lot (s (s) Well Owner . Name- Addr6ss: f-- %14 lj� A r-:k.\- r;�. 1;b� L L,i­­ , Well ' Type ` ' Driven :- .Dug . Gravel: Other� zR, De h atai Well Pep th' Static Wat Level.;' er Date Measured 'n Use of Well Re side nt ial .Public Supply Air/Co at Pump Abandoned . primary -Business' Fari Test/Observation-:_. Other. (speqify) 4epqn, ar Industrial 'Institutional Standby y Water Well Name: .... .. Address: Contractor:: N�3 OeT 7a 11. 7 11.-1': e_1 �., 1) I'D tJ 4"0 L Reason For CQT 6:7 k� GL P'1:.1" L 0-r a A 1-j C" . k-1 5�1,�`. 862'nd,onnient: , Description' Of Work To Be Performed: ., -'Va t 3 �ftj y G L_E� F -,4— -S "u "J A r tA t+(=:., NJ 'il \A Y L—t— N L 'C VJ C. C) "A NJ Applicant Signature: Vi V PERMIT''' permit, to abandon one: water:well as set forth, above, is granted.0 rid er provisions of Article :10 of the Putnam — �oufiy. Sanitary Code, . Subpart 5-2 of Part 5 of the New York State Sanitary Code and/or Part. 7 of 10 NYCRR 5 ?,4fid,provided that: 'Within 30 days of the completion of the abandonment of the water well, the applicant shall it to. the, *: Department a certified statemeni'thit the" informatio6 del ine' ated on the application for this pp c n been completed. 4 /IN. Date Permit'Issuin Title of Issue, Official White copy: HD file; Yellow copy Building: Inspector; Pink copy Owner; Orange copy -Well driller -97 Form V�A PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Street Location v A/n . Vie w 7Z4P,' Town 7�zArs,5"q TM # A- R. // / — -&l, Date: Ig xv ko Inspected by: Owner A,7% Ze Permit# Subdivision Lot # 1. Sewage Svstem Area YE NO COMMENTS a. STS area located as per approved plans .......... .. ................ h, Fill section --date of placement 3:1 barrier Lgth. Width­. Avg.Dptb, c. Natural soil not stripped...... .............. ............................... d. Stone, brush, etc., greater than 15' from STS area.......... —7Z e. 100' from water course/wetlands......... ............................ IL Sewaze Svstem a. Septic tank size ..... 1,250 ......... other ................. b. 'S eptic'.tank installed level .... ...................................... :­ c. 10' minimum from foundation .......................................... d. Distribution Box 7 7-,, 4e- 1. All outlets at same elevation-water.tested ............. 00 .... 2-. Protected below frost ................................ .............. 3. .. Mmirrium, 2 ft. Original soil between box & trenches oo, ne. Junction Box properly set ......................................... 6. Trenches 1. .Length required 3 7t Length installed _T 7 2. Distance to watercourse measured 3. Installed according to plan ........ . ........... 4. Slope oftrench acceptable 1116 -1/32" /foot ............. 5: 10 ft. from property line - 20 ft, foundations.......... 6. Depth of trench <30 inches from surfice ................. 7.,'-Room allowed for expansion, 100% ......................... Z/ 8 1 .. Size of gravel 3/4 - 11/2" diameter clean ................. I ... : 9. Depth of gravel in trench 12" minimum......::........... 10. Pipe ends ca d ppe . ....................................................... g. kuniD or. Dosed Systems -7 7e- 4e_ I Size of P ump chamber ............................................ ,2.. Overflow tank .......................... ............................... ..... 3. -Alarm, vi-suallaudio ...................... I .................... 4. PUMP easily accessible, manhole to grade ................. 5. Firk box, baffled ..................................................... 6. Cycle witnessed by H.P.estimated flow/cycle.. ILL HouseMuilding a. House located .per approved plans........ b. Number of bedrooms ............. ........... N. Well 5, /;,/V, �e- W4k_' Well located as per approved plans .... C, A, p, -fi A XX "1 44 4/le// 76 Ad-4, .b. Dikance from STS area rr c.. Casing. 18" above grade ............................................... d. Surface drainage around well acceptable ........................ Y.'Overan Worlananshin a. Boxes properly grouted ............... ............................. b. All pipes partially backfilled ......... c. All pipes flush with inside of box .................................. d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f Curtain drain outfall -protected & dir.to exist watercourse . g. Footing drains discharge away from STS area ................ h. Surface water protection adequate ............................. f ....... i. Erosion control provided ................................................ Rev. 12/02 F i Form Sherlita Amler, AM, MS, FAAP F` commissioner of Health V' Robert Morris, PE Director of Environmental Health December 28, 2010 John Kalin PE DC Engineering 3 Memorial Avenue Pawling, NY 12564 Dear Mr. Kalin: Department of wealth 1 Geneva Road, Brewster, NY 10509 Office (845) 808 -1390 Fax (845) 808 -1937 Robert J. Bondi County Executive Re: Field Inspection — 5 Mountain View Road (T) Patterson TM # 2111 -1 -69 The above referenced separate sewage treatment system can be backfilled. The following comment needs to be addressed: 1. A pump test needs to be witnessed by this Department once the electrical inspection has been completed and verification of such inspection has been submitted to this Department. 2. The original existing well needs to be abandoned and inspected by this Department upon completion. If you have any further questions, please contact me at (845) 808 -1390, ext. 43261. GDR:cw Sincerely, r Gene D. Reed Sr. Environmental Health Engineering Aide 5 mountain view road Sherlita Amler, MD, MS, FAAP Commissioner of Health Robert Morris, PE Director ofEnvironmental Health July 26, 2011 John Kalin PE DC Engineering 3 Memorial Avenue Pawling, NY 12564 Dear Mr. Kalin: Department ®f Health 1 Geneva Road, Brewster, NY 10509 Office (845) 808 -1390 Fax (845) 278 -7921 or (845) 808 -1937 Re: Field Inspection — 5 Mountain View Road (T) Patterson, TM 23.11 -1 -69 Paul Eldridge County Executive The above referenced separate sewage treatment system can be filled. There are no further 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, 12( �R , !� Gene D. Reed Sr. Environmental Health Engineering Aide GDR:cw /PUTNAM COUNTY DEPARTMENT OF HEALTI IVISION OF ENVIRONMENTAL HEALTH SERVI pK e7STRUCTION P RMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at IvinyN?An t 41's i 2fl �r Village 1�^ T6RSp!► Subdivision name N Subd. Lot # Tax Map 23.x\ Block i Lot �Cat Date Subdivision Approved Q I A Renewal ✓ Revision Owner /Applicant Name A•iA k,,cwy„n61r coq. Date of Previous Approval 4 ► S 1 o S Mailing Address Ey ov►.sTo %%v i J,e tto�,e �An£.e -so N Zip ►2Se--0 Amount of Fee Enclosed � Spc . a Building Type SF Lot Area 1.oS No. of Bedrooms 3 Design Flow GPD 00 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1000 gallon septic tank and A S 5 o C, A L- L CO I j 4- �. , �.. �' L�1A+�g�� , l oo o -P / L Lo,-IL. O V C 1 Flow -r•A -J K i .� 'i S LT Y L 4 ,v rw Other Requirements: 0 - Z R •c, .8 . F � � � Fo � G, �a�� �y 'P„ Q ?es � 5 O a �-ti' To be constructed by 7 6r,*s Address Water Supply: Public Supply From Address or: f Private Supply Drilled by `r 8i� 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 follo}king the date of the ksuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address ��s J R.A. Date V-� . 'Z j - 0 c9 License # +55� APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new rmit. Approve r discharge of domestic sanitary se age only. By: Title: Date: .3 — White copy - HD F' e; Ye ow opy - Building Inspector; Pink copy - Own rang py - Design Professional Form CP -97 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 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAIVER NAME: ADDRESS: SITE LOCATION:jc?Z�„J lG'lrc J DATE: ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health STAFF PRESENT: - M.D. Michael Budzinski P.E. Robert Morris P.E. Gene Reed Joe Paravati - baffy Womer SPECIFIC WAIVER REQUEST: DOES THE PROPOSED VARIANCE REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? YES ❑ NO I' WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? YES NO , ❑ DISCUSSION REOUEST APPROVAL OR DENIED APPROVED DENIED ❑ REASON FOR DENIAL DIftECTOR OF ENVIRONMENTAL HEALTH DATE ; Z� DATE 31V1 0 COMMISSIONER OF HEALTH Environmental Health (845) 278 -6130 Fax (845) 278 -7921 (SPECWAIVER) 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 COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLH SERVICES FIELD ACTIVITY REPORT ADDRESS: LlloanrY�,`u 1 /, kAL PIZ, ��� ��. Street Town State Zip PERSON IN CHARGE nR_TNTFRVTFWFI): T)atP. 7Z /.Z gj PUMP TEST [] DOSE TEST .2J — z1'' EL. START a a A STOP /0 Signature and Title RFPCIRT RFrF-TVF.T) BY: I acknowledge receipt of this report: SIGNATURE; 02/96 Pal? REQUIRED GALLONS /2 7 ,75 ai O oM.O O EL. START a a A STOP /0 Signature and Title RFPCIRT RFrF-TVF.T) BY: I acknowledge receipt of this report: SIGNATURE; 02/96 Pal? REQUIRED GALLONS /2 7 ,75 &W 1 &RK STATE /� SPECIFIC WAIVER APPLICATION DEPARTMENT OF HEALTH V�'� J Request for Approval of Noncompliance with ureau of Wate=A Supply, Protection the Standards of IONYCRR Appendix 75-A Wastewater Treatment Standards — Individual Household Systems GENERAL INFOILMATION (Applicant must oniplete) Name of Applicant io.ite Q.r�g�.tYE DE�EL�eA�,odT CoaP G o %N Address Street $ Mev�sta�w V aE..a ¢� Cityrrown PgrtE(7. 1 State N Y �P t 2 s% Contact Information phone: FAX: email: Site Location street.. tAbJW'CA%w4 V� 7-b Cityrrown 7&-r 1x&0" Caanty "P,�ttaA�l P l The following information is being submitted in support of my application fora specific waiver from compliance with one or more standards of IONYCRR Appendix 75-A, "Wastewater Treatment Standards — Individual Household Systems': 1. The wastewater treatment system cannot meet the following standards of 10NYCRR Appendix 75-A: at Separation distances cannot be achieved (75- A.4(b), Table 2, Separation Requirements) ❑ Excessive Slope (75- A.4(1), Soil and Site Appraisal) ❑ . Design is not addressed in Appendix 75-A ❑ Technology is not addressed in Appendix 75 -A ❑ Othi Explain: 2. The g design isproposed to mitigate non,fompliance with Appendix 75- A.(brief description): 3. Supporting information provided: Detailed Site Plan ❑ Detailed Design. ❑ Soil and Site Evaluation ❑ Neighboring conditions of concern (e.g., wells, waterbodies, wetlands, etc.) ❑ _ Other: Explain: I, (applicant) btN A1-1% ICit -JCS (type or print) acknowledge that this waiver request is necessary because it is not practical'for an onsite wastewater treatment system to a referenced standards of 1ONYCRR, Appendix 75-A on this property. / 1 Z og Signature Date I, (engineer) �pl3t./ $g,t. /SSEt2 rP 0. (type or print . knowle get at this waiver request is necessary. because it is not practical for an onsite wastewater treatment system to me t e refere ced tandards of IONYCRR Appendix 75-A on this, property. In my professional opinion, the proposed design des b in this p ication will provide a degree of protection equivalent to the onsite wastewater treatment standard(s) that ill met r this property and will not create an increased risk to public health or the environment. { �, _Av 155 5 PE License # *For Health Department use onli Based upon the information provided in this application to waive the referenced standards of Appendix 75-A and in accordance with IONYCRR §§ 75.3 and 75.6 (b), the waiver requested is hereby: XApproved as proposed. ❑ Approved, with following conditions: ❑ Not acted on, because additional information is required: ❑ Denied, because: Note: This waiver may be revoked should any conditions considered before approving this waiver change after approval, KA (w� I f/�t�� — o Health Department Representative Signature D e ® Instructions for Completing the Specific Waiver Application; Wastewater Treatment Standards — Individual Household Systems i ` Applicability: This SpQcific Waiver application form is intended for use by the applicant (property owner) or the applicant's representative (e.g., PE) to present information for consideration by the Health Department having jurisdiction to approve a new onsite wastewater treatment system (OWTS) on previously undeveloped property that does not comply with one or more standards of Appendix 75-A, "Wastewater Treatment Standards — Individual Household Systems ". A specific waiver shaft be obtained before construction of the onsite wastewater treatment system. Background: The responsible city, county, or district health office may grant a 10NYCRR Part 75 Specific Waiver from a provision(s) of IONYCRR Part 75, Appendix 75-A, only under the following circumstances: 1. Conditions at the particular site make it impractical to comply with these standards; 2. Appropriate protective measures to mitigate noncompliance are applied; 3. The design is not likely to pose a health hazard or create environmental contamination; and 4. Disapproval will result in a significant hardship. A Specific Waiver IS NOT intended as a device for routinely approving individual residential wastewater treatment systems that do not meet design standards. It is intended to provide administrative flexibility to resolve rare cases when hardships exist and /or other circumstances that make it impractical to meet Appendix 75-A standards The Specific Waiver application shall provide information and background about the site conditions and detail the proposal so that the Health Department is able to determine whether to approve or deny the application. The Health Department representative may ask for additional information to be submitted to make that determination. General Information Provide the applicant's current mailing address and contact information. Also provide the address of the property the specific waiver is being applied for, even if it is the same as the mailing address. Reasons for Noncompliance Check the applicable reason(s) for which the waiver is requested. If not already listed, include the spec_ ific standard(s) in the space provided and provide a brief explanation. More detailed information can be attached as needed or as appropriate. Proposed Mitigative Design Provide a brief description of the site characteristics and OWTS design in the space provided. Detailed information and plans can be attached to the application. Supporting Information Check any information provided. Any additional information can be listed after "other" in the space provided. Any or all of the information listed may be required by the Health Department representative depending on the complexity of the site conditions. To obtain a waiver, the applicant must demonstrate that the onsite wastewater treatment system design proposal is acceptable and is not likely to pose a health or environmental hazard. Detailed Site Plan contents may include some or all of the following: surveyed plat, accurate location of onsite and neighboring offsite (if applicable) drinking water sources or water courses, site topography, drainage features and any pertinent physical features. Appendix 75-A, Table 2, lists required separation distances. Detailed Design shall be submitted by a NYS licensed P.E. and will clearly identify the OWTS components and locations. Soil and Site Evaluation shall incorporate the characterization of the existing soils through, at a minimum: percolation tests and test pit evaluation, which identifies soil types and geologic limiting conditions (e.g., groundwater, rock or clay). Neighboring conditions of concern (if applicable) shall include at a minimum, onsite or nearby: drinking water sources, watercourses and wetlands. Other identified possible areas of concern that could be impacted by the OWTS shall also be identified. Acknowledgement of Risks The applicant (property owner) is required to sign the Specific Waiver application and acknowledge the risks that may be associated with the OWTS serving their property. A NYS Professional Engineer (P.E.) is required to provide his or her name and license number on the form and submit the supporting information and stamped design plans on behalf of the applicant. Health Department Representative Response The Health Department representative will approve; approve with conditions; not act and request additional supporting documentation; or deny the Specific Waiver application. The determination will be sent to the applicant and a copy of the determination and all information submitted with the application will be retained. P:\Sections\Residential Sanitation \OWTS \GUIDANCE\Specific WaiverOWTS- Legal.doc PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # Well Location: Street Address: Town/Village Tax Grid # 4 "W vls V_b 0 Map-Z-3.11 Block I Lot(s) (..,,q Well Owner: Name: Address: b1V0_gPA0AWY B�?m t &�(�1 V%60J Use of Well: X 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 I. Est. of Daily Usage 1TO gal., Reason for Replace Existing Supply Test/Observation Additional Supply Drilling _� New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type X Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No X Is well located in a realty subdivision? ...................................... ............................... Yes No X Name of subdivision Lot No. w A Water Well Contractor: Td� A�s.�+���� Addre s: Is Public Water Supply available to site? ................................... ....:.�........................ Yes No 9 Name of Public Water Supply: - - WI A Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination I D b provided n separate sheet/plan. Date: ®1 Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. A Date of Issue Date of Expiration 2) , rl Permit is Non - Transferrable Permit Title: White copy - HD file; Yellow copy - Building Inspector; _ Form WP -97 P�( C I AAA® 1.059 ACM5- I 4 I 110' 2' a�45- - - - - -z ' FM Ti 5�55-- - - - - -- 55' EP 7x55 - - -- 6 — — — — - -- - - -- - - - - - -- -513 I 10 915 5515 I sl 6 ---------- - - - - - -- OO _____==== �L�S�--- - - - - -� CL 45ION MAP OF A PORTION _ 4-- MOLWAIN VIEW PARK � TOMIEM, Nr' AB l.En MAP NO. 186 -A � `LEV 1211-71 1929 , LOW* / PATIO ENQ.'n POfiN 21 / V \ 30.95 \� /5TY FRAME 10c S 33.08' 1,0( 0$ PORCH / 4 "0 1 1 I , Roo, \• \ /v, I 1 lap W(TYP)\ Z N86-26-00 � 1 1 15.15' �I a$ o a "51NDIVI5ION MAP OF A PORTION '0 G OF MOWfAIN VIEW PARK, 3 ,c: TOMAP N Nr, FD.En MAP NO. 186 -A FILEn 1211-711929 iy � "too 4b 0 \ c^. EI.EC. METER '•. �\ . M. 497.18 �Fj L / �,p. Mv. our 495.be �a . 58222.49, "w` 22.49' NEW WELL LOCATION //,.4 j 509-40`8 „E 6 S5fn Y 2.51 �E'AVp( 517' 10 "E 4887' 5M'29 -27"E 48.64' MOUWAJN VIEW KOAn GENERAL NOTES I. OWNER: DONALD KING 2. TAX MAP ID #= 23.11 -1 -69 3. SSTS WAS INSTALLED BY JOHN KALIN AND TYNDALL SEPTIC SYSTEMS. 4. BASE MAP PROVIDED BY TERRY COLLINS, LS 5. THE SSTS WAS DESIGNED BY BIBBO ASSOCIATES, N SALEM, NY. POINT NUMBER DIST. FROM 99A91 99B19 PIC SEPTIC TANK 37.5' 24.3' PUMP CHAMBER 40.3' 29.6' DIST BOX 1 64.9' 63.0' LAT 1 2 67.2' 73.3' LAT END 3 84.4' 110.3' LAT 2 4 60.5' 61.1' LAT END 5 79.4' 107.3' LAT 3 6 54.7' 55.7' LAT, END 7 73.6' 103.0' LAT 4 8 48.7' 51.1' LAT END 9 68.8' 100.3' LAT 5 10. 60.7' 58.1' LAT END 11 87.3' 46.9' LAT 6 12 54.7' 53.6' LAT END 13 83.3 41.4' LAT 7 14 48.9' 49.4' LAT END 15 80.0' 36.2' MARK 'A' IS THE SOUTHWEST CORNER OF HOUSE. MARK "a' IS THE NORTHWEST CORNER OF HOUSE. MARK 'C' IS THE NORTHEAST CORNER OF HOUSE. PUMP 04AMSER NOTES I. PUMP: GOULDS PE41 2. THREE FLOAT SYSTEM (OFF, ON, ALARM) a nncc sin i imp. IA7 R r-ei PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # ,& N ru <� Y Located at H,,Qu t1Z-AZ y l/i.Ee,i Town or Village PAz2K . ?4/ Subdivision name IyA Subd. Lot # Tax Map 3, Block / Lot /_2_ Date Subdivision Approved AIA Renewal �_ Revision Owner /Applicant Name kvj, ggjALX F'. r ,,ey Date of Previous Approval Mailing Address ,n�;- �;� ,,, o &MMXJ2JV , A,< j Zip 1,2.5-10 Amount of Fee Enclosed Building Type .Slvs-cs ,,,,;; ✓ Lot Area /oS2 No. of Bedrooms 3_ Design Flow GPD oo Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of iota gallon septic tank and 4 5 -g n t;�.z- P.- [ r�yc' IOU -4 4,o ZOO 4,4z a- COAle c VAM5,tQtti :ro ve , Z-1-- x a S� ZZEA ra Other Requirements: rj - ��,� �=i�, ,� G,e,a�ir�.fs.,�.o�,rs o.v� y To be constructed by 7 —,91 -) Address Water Supply: Public Supply From Address or: ✓ Private Supply Drilled by T73n 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 Construction Compliance of the original system or any re airs thereto. 9 Signed: ' Date 3 2 I a 5 Address ense # 0 ZcsyQ' APPROVED FOR CONSTRUCTION: This approval expire ;Ol��b a date issued unless construction of the sewage treatment system has been completed and inspected by the P is revocable for cause or may be amended or modified en conside necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new p i ppro or discharge of domestic sanitary se a only. By: ✓ Title: )ate: Z White copy - HD File;.Yellow copy - Building Inspector; Pink copy - Owner; 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 type PCHD Permit # Well Location: Street Address: CZjijoVillage Tax Grid # Map./ / Block Lots) . Well Owner: lu Name: v6 A"Lo Address: o k v Ew Use of Well: V--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 _/50 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling ✓ New Supply (new dwelling) Deepen Existing Well Detailed Reason Co o ev for Drilling Well Type _Se!!fDrilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No 1,— Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision /VA Lot No. ,vs4 Water Well Contractor: 7-flX2 Address: TQ� Is Public Water. Supply _available to site2 . Yes No Name of Public Water Supply: iv.F Town/Village AIA Distance to property from nearest water main: ,vA Proposed well location & sources of contamination to be prov' ed on separ sheet/plan. 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 Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the, Public Health Director. y revision or alteration of the approved plan requires a new permit. Well to be constructed by a water ell ller ce ified by Putnam County. Date of Issue o Permit ss a j Offic ial: Date of Expiration 1 ® Title: Permit is Non- Transfe rable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 . v PUTNAM. COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL r please print or type PCHD PERMIT # Well Location: Street Address: own illage Tax Grid # 1,1 A0 N Maplaii Block 1 Lot(s) 4' Weil Owner: Name: Address: D o , Well Type: V" Drilled Driven Dug . Gravel Other Depth Data: Well Depth ft Static Water Level ft Date Measured Use of Well:. Residential Public Supply Air /Cond/Heat Pump Abandoned TFarm 1- primary Business . Test/Observation Other (specify) 2- secondary Industrial ' Institutional Standby Water Well Name: Address: Contractor: Reason For rHC wcLL dU;eRr-N'r kY SCRu/�,ES L[i'T a3.JJ - i/3. /N o,eDee IV dnmP4Y w /fH 10cfrD X44 -S,. A.vA As 644T- o.1 rwe Dc�vczu/�int a7- of Z07-69' , A/V F / 6vEc.t, Abandonment: wJL� Description of Work To Be Performed: /,�aaSCo 6'usrre wares IS ra 1W C4. vDE e).resneucTno v OC S /NG6C, JP7AM &.9 4ES /OG/lJl.6� %,R /r,�c�r A& ro S�xvrCb' Y /tES�TE/ G/Et� AA,.,O S�K/,�G� nJSP4s�4L S SirE�vl. A wE4, dS CvXReA1'7-C,y LcCATC4 0,V r//C PiPt>Aze7 :y SE.evrcivG T/f/.S WEc- /S cccA7z=.o Fc�2 .$�=���e'' ;17lSI�ctS'Rc. oti rft�s�TS' TyE,ee-.G�.eE �r'tc w�c�. is Z 6E` ABft/v,�.vE� ANro A Nc%:r✓ CuE��- i%.erct l-or� rHE SITE. AS PART t%� l%tE Dc�cJ�c Ur�'/>7csc.j ,Err��l� A i!/Gc.,J L�GsGU �arrta_ �E` !/I1�LGv'b 7o 56,eulc Tf/c N616.1lj0/21.v6 zcrr- A .SCFAAAATC ARPci e- Ar/GrC/ A44S Date: LZ 4 Applicant Signature: iL NAW, �I`WV PERMIT This permit, to abandon one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code, Subpart 5 -2 of Part 5 of the New York State Sanitary Code and/or Part 75 of 10 NYCRR and provided that: Within 30 days of the completion of the abandonment of the water well, the applicant shall submit to the Department a certified statement that the inf tion delineated on the application for this permit has been completed. Date of Issue Permit Issuing Official Title White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 WSZGt voolip] izves ON xu/xll 60:2T aam VOIRZILO Z14 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner P & 010/b Z),e Jy�rk telf Address _&jOloAl IWIAI Located at (Street) Tax Map Block Lot (indicate nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA Date of Pre - soaking VA Date of Percolation Test !V—Jold percolation test hole. (i.e. A I min for 1-30 min/inch, 12 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 fi, -W. ltbj'. V wo • T bie'. Rao, X 0., art." P-411 613 C�4 2 a 3� 1)-4 3 r 3 t1i /0- 1:12. - C14 4 /jo yj x#*0 CP 5 2 6L --Pr�n jQ AOFZ� A-A.1 T1.0. 3 -A , BA#g N-h\ C 6 4 n 4 6A /,s:sae -�,mgi 2 3 4 5 QnT1F.Q• 1 Testa to he rm6eated at Siarne death until . avoroximaiciv equal percolation rates are obtained at each percolation test hole. (i.e. A I min for 1-30 min/inch, 12 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 i001n [ZCRR ON XH /X,L] 60:5T QaM to /8Z /Lo ,, DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' p TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN 'TEST HOLES HOLE NO. D %f a•3 _ HOLE NO. ��' _ HOLE N4. - �5 [3/RI i �3A RR, iS E'2 Indicate level at whiclli groundwater is encountered Indicate level at which mottling is observed �- Indicate level to which water level rises after being encountered 14 4o,* Deep hole observations made by. aQ DALV -dA a "a' wee--.LA�" Date � Z Design Professional ame: AW, 644 PdO Address: --04.0 Signature: Deslga Professional's Seal PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of N Aga a, *u v,, ma c., Located at wt o,,,,,Ta v�E,� e.-t� T&V Tax Map # Subdivision of Subdivision Lot # - Gentlemen: Z3.\A Block A Lot 4 S Filed Map # - Date Filed This letter is to authorize 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 treatment and/or water supply systems in conformity wiifte provisiqns. of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Pu County anitary Code. Very truly yo , t e�5 ntersigned:. Signed: P.E. R/k, # 54-S' wner of Property) Mailing Address Mailing Address: Wi J .4W R oa'h AS Row 900 BAR /s jO State (914) 2 s�9 State Zip I Z 'SG 0 Or 1y; Telephone: Q Telephone:. <Z H S - 8' ­�g - q JFOp X5545 R�FESSIO�P�' Form LA -97 . ZOO[n- 1U89 ON XX/X11 60:21 QaA to/RZ/Lo PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM D Address Located at ( Street) ... -�e,4.j /e Tax Map a2 Block _/ Lot Municipality (indicate nearest cross street) Watershed �oedrl—e SOIL PERCOLATION TEST DATA Date of Pre-s'oaki 2— Date of Percolation Test 4-1cuh 7. kl*"w%A UL 00414G Ur. percolation test hole. (i.e. s I I submitted for review. 2. Depth measurements to be mac e 4b1`,, 0, -.9 k Me, Hole A;kv 5,1:. ime: TOM G ro Urtacw(l uchii , Qji -1 IL fro' RUA "t t „St Bit 7-040 71 2 -FIX 3 4 6 -Zb /6 3 2 e 1� z 3 0 3 4 Ila? 1167 5 A 0 Lc---,erz QQ OCI 4k& 3 A 4P- I A us J0 S 5 I T. kl*"w%A UL 00414G Ur. percolation test hole. (i.e. s I I submitted for review. 2. Depth measurements to be mac CIATES, L.L.P. eers - Planners March 21, 2005 Putnam County Department of Health 1 Geneva Road Brewster, NY 10589 ATTN: Robert Morris, P.E., Senior Public Health Engineer RE: Proposed SSTS — King Mountain View Road (T) Patterson, TM #23.11 -1 -69 Dear Mr. Morris: Joseph J. Buschynski, P.E. Timothy S. Allen, P.E. Sabri Barisser, P.E. John P. McNamara, P.E. Robert A. B. Howe, B.S., Phys. Please find attached 1 -copy PC -97, 1 -copy WA -97, 4- copies of the proposed septic plan, and 2- copies of the architectural drawings for your review and approval. In addition please find below responses toyouur letter _dated Fe b- rua 7, 2005.. 1. The construction permit has been submitted in quadruplicate as requested. 2. The well abandonment form has been included in this package. 3. Each of the design data sheets have been signed and sealed by a licensed design professional as requested. 4. All known SSTS and wells within 200' of the property have been indicated on the plan. ,5. A note has been added to the plans indicating the house, well and SSTS are to be staked by a licensed surveyor prior to construction. 6. The house plans have been revised to show three bedrooms. 7. Comment noted. 8. The SSTS profile shows the existing and proposed grades. Should you have any further questions or comments please do not hesitate to contact me. RDW/bs Enclosures Very truly yours, � V-411 Richard D. Williams, Jr. Planning . Site Design . Environmental Mill Pond Offices • 293 Route 100, Suite 203 • Somers. NY 10589 Phone: 914 - 277 -5805 • Fax: 914 - 277 -8210 • E -Mail: bibbo@optonline.net SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Bibbo Associates Mill Pond Offices 293 Route 100, Suite 203 Somers, NY 10589 Dear Sir or Madam: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 February 7, 2005 Re: Proposed SSTS: King Mountain View Road (T) Patterson, TM # 23.11 -1 -69 ROBERT J. BONDI County Executive Review of plans and other supporting documents submitted at this time relative to the above. regarded project has been completed. Comments are offered as follows: 1: Please submit the construction permit-in the quadruplicate form issued by this-Department. 2. Well Abandonment form is to be submitted. 3. Design Data Sheets are to be signed by a licensed design professional. 4. All SSTS and wells within 200 feet of the property lines are to be shown. 5. The house, well and SSTS are to be staked.by a licensed surveyor prior to construction. This note is to be added to the plan. 6. House plans are considered to have 4 potential bedrooms. 7. Project will be deemed as a joint review with the NYCDEP when the above revisions are addressed. 8. SSTS profile is to show existing and proposed grading. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:ky V ly yourSAA Robert Morris, P.E. Senior Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 14.16.4 (2/87) —Tent 12 PROJECT I.D. NUMBER 617.21 Appendix C State Environmental Ouality Review SHORT. ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) SEOR 1. APPLICANT /SPONSOR 2. PROJECT NAME. NALrO A�v,O �G � G 3. PROJECT LOCATION: Municipality County 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) T //e /�ieo T C%� t 1 T� 4S � cc E'3S�p 6�Y rViv- ieS7- it% i v. -r,,+y o V 6h•T C•K/ r!%T t/iCsW /et7 (SmT l//Ec✓ 72p•, ryjr- �/ /6t✓ /2.0 /NTL�ieSECi3' 6-A .1tW ef ASV iN I��rrE�esati ' 5., IS PROPO D ACTION: 94e. ❑ Expansion ❑ Modificationlalteration 6., DESCRIBE PROJECT BRIEFLY: ry,(E sI /S /J �e w`cLL LOGff7t'� Oiri /PZOT1i�E/2 /�i1RGEt• /r2 Kiti 70 /eu . C 47X-_ /f.,S c,,,� S�evia r� rff or.✓,u rP ?ate . 7. AMOUNT OF LAND AFFECTED: � Initially 7 J acres Ultimately yg _ acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? e's ❑ No If No, describe briefly 9. WHAT I PRESENT LAND USE IN VICINITY OF PROJECT? 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, STATEEE�0 CAL)? Eryes ❑ No II yes, list agency(s) and permlVapprovals 70W A-1 OF �/� 7rE2.0 Pn/. / L �iir/iC/ //vG �/�'rG Q -� f.✓ET�✓¢iv�0 f'rs 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes Q140 II yes, list agency name and permitiapproval 12. AS A RESULT OO ED F PRS ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes LNAo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE �, Ity 11V Applicant /sponsor n me: "' Date: Signature: t 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 r/T PA(T II— ENVIRONMENTAL ASSESSMENT (To be completed by 4ency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL.EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED 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 patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation oi'fauna 'lish shellfish or'wildlife species, slgnlflcant 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. ai C5. Growth, subsequent development, or related activities likely to be Induced by the proposed action? Explain briefly. cr) C6. Long term, short term, cumulative, or other effects not identified In Cl -05? Explain briefly. C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly. �• D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly ►1 PART III— DETERMINATION OF SIGNIFICANCE (ro be completed by Agency) 'INSTRUCTIONS: For each adverse effect Identified above; determine w' ietherit'is'substantial,'large, important or otherwise significant. Each effect should be assessed In connection_wlth..lts (a),setting (Le. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that. . explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately.addressed. " ❑ Check this box If you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a positive declaration. ❑ Check this box if you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: *:t0 i ,3 a ^ .,✓ "s" ,'twi.:. / t;. f... f`°Y, ""t;.ltr- _ t Name of Lead `Agency '` ► ,y! +0 Print or Type Name of Responsible Officer in lea Agency v -r Title of Responsi ' e O f ictr 1r Signature of Responsible Officer in Lead Agency Signature of Preparer (I rent from {espopsj., ;,,q_ e;r) \� . Date K, 4. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of _. /J�uac ,n .:;a Located at r/,,, �& p„- eieCa,-/ Tax Map # c.3, // Block i Lot <9 Subdivision of Subdivision Lot # Filed Map # -- Date Filed Gentlemen: This letter is to authorize 9,QW, ,ass oc.,a c�P 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 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 e. QP% BA+9;S�n . � CO .�� c , ; Very truly y Countersigned: �, ° f Signed: P.E., R.A., # (Own o rop ) Mailing Address ] WXuYVY1,V_►1­11 . , Mailing Address:,,- B1BBO AS80QA'rES LLP 293 Ratite I()() - Suite y3 ----- i& rram saaz� � r�- Somers, NY 10589 State (914) 27 ;EF80 State A mac Zip , 2s,6-o Telephone: Telephone: ieys !E :Z rr— gl 7 k Form LA -97 BIBBO ASSOCIATES LLP 293 ROUTE 100 —SUITE 203 SOMERS, NY 10589 (914)27.1-5805 (914) 277 -8210 FAX bibboCcDoptonIine.net TO WE ARE SENDING YOU ❑ Shop drawings ❑ Copy of letter ❑ Attached ❑ Under separate cover via ❑ Prints ❑ Plans ❑ Change order ❑ dI�4VC G3 OF 4 ° a0W 04UQL DATE ' a? o J0: OB N ATTENTI N RE: (% /' t^/ 64,16 AAAAof ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION t^/ 64,16 AAAAof 0 . A o j4A u 4L yelo THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ For your use ❑ As requested ❑ Approved as submitted ❑ Resubmit copies for approval • Approved as noted ❑ Submit copies for distribution • Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FOR BIDS DUE 19 0 PRINTS RETURNED AFTER LOAN T,0 US REMARKS l .e- .a 6,v Vle-c4g, /eo. 77 / i L ! / CoArT-AGr- 07e w OW A449 Q V ea770M.S Q2 C0,1W4 f0?V7J- COPY TO SIGNED: /f enclosures are not as noted, kindly notify us at once. ��.yAIZ/J ILLr, mx J;i r. �i BIBBO ASSOCIATES LLP T0: F�NAM Co�..►N TFi �E�. DATE: 2 3 zo►o Pt-tTnf ; �tKEC�JU�1NsK� (7•�, RE: tjo�A� -7 l�.�r.► SSAS � 'Q-£N �u� A I,-• WE ARE SENDING YOU (K) ATTACHED ( ) UNDER SEPARATE COVER THE FOLLOWING ITEMS VIA # COPIES DESCRIPTION L EJ{5 Sig AN THESE ARE TRANSMITTED AS CHECKED. BELOW: ( ) FOR YOUR APPROVAL AS REQUESTED ( ) FOR YOUR USE ( ) FOR REVIEW AND COMMENT REMARKS: : POS- BFEt�1 a- F�,b�a T+4E s- rq-'aAoA Of fS,%Trr— Lol�JTAL;r VS W rr/4 AIV'1' 0-jC-STtotJs O2 AD -o1r'o Jix\, t�Jro��wTto � 1S taE�b�� , COPY TO: SIGNED• 293 ROUTE 100 — SUITE 203 SOMERS, NY 10589 (914) 277 -5805 — (914) 277 -8210 FAX — bibbo @optonline.net IF ENCLOSURES ARE NOT AS NOTED, IQNDL Y NOTIFY US AT ONCE AT (914) 277 -5805 SOCIATES, L.L.P. r.rneers - manners kA January 15, 2010 Putnam County Department of Health 1 Geneva Road, Brewster New York, 10509 ATTN: Michael J. Budzinski, Director of Engineering RE: King Residence Mt. View Road Section: 23.11, Block: 1, Lots: 69 Patterson — (T) Dear Mr. Budzinski: Joseph). Buschynski, P.E. Timothy S. Allen, P.E. Sabri Barisser, P.E. John P. McNamara, P.E. Robert A. B. Howe, B.S., Phys. Please find attached the following in support of a renewal of the SSDS construction permit at the above referenced property: • 4 - copies of revised SSDS Plan Listed below are responses to your most recent comment letter: 1. The pump chamber detail has been revised to specify mechanical contact float switches. 2. The absorption trench detail has been revised as requested. 3. The note requiring the well on lot 43 to be drilled prior to the issuance of a construction compliance has been revised accordingly. 4. As discussed in a phone conversation between yourself and Matthew Gironda of our office, a specific waiver application has been previously submitted. Please feel free to contact us with any gVektions youlmay have. SB /mg Enclosures Ve,� trrly yo�rs, ,`tP.E. Planning o Site Design ® Environmental Mill Pond Offices 293 Route 100, Suite 203 • Somers, NY 10589 Phone: 914 - 277 -5805 Fax: 914- 277 -8210 • E -Mail: bibbo @optonline.net D sov*a I P New York City Department of Environmental Protection www.nyc.gov /dep 59-171unction Boulevard Flushing;-NY 11373 Steven W. Lawitts Acting Commissioner Tel. (718) 595-6565 Fax(718)595 -3557 Bureau of Water Supply Paul V. Rush, P.E. Deputy Commissioner 465 Columbus Avenue Valhalla, New York 10595 -1336 Tel (914) 742 -2001 Fax (914) 741 -0348 January 11, 2010 Michael Budzinski, P.E. Putnam County Department of Health 1 Geneva Road , Brewster, New York 10509 Re: King Residence- SSTS Mountain View Road, (T) Patterson TM # 23.11 -1 -69 East Branch Reservoir Drainage Basin DEP Log # 2002 -EB -0638- DJS.1 Dear Mr. Budzinski: `The New York City Department of Environmental Protection (DEP) has determined that the above - referenced application, received by the DEP on January 7, 2010, is complete. The DEP has no objection to the approval of the above- referenced regulated activity. This determination is based on the review of submitted documents including the plan titled "Subsurface Sewage Treatment System Plan for King Realty and Development Corporation, Mountain View Road, TM #23.11 -1 -69, Town of Patterson, Putnam County, New York ", prepared by Bibbo Associates, LLP, dated January 24, 2005, last revised. December 8, 2009. Please have the applicant contact David Alderisio at (914) 742 -2010 at least two days prior to start of construction of the SSTS so that the DEP may inspect and monitor the installation. Sincerely, Danny Shedlo, P.E. :' s , 7 c C_ Civil Engineer III Wastewater Design Review M " 1 >;�'y Via,: xc: Roger Sokol, PhD., NYSDOHa L 3r 1 P Q SHERLITA AMLER, iVID, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New,York 10509 ROBERT J. BOND[ County Executive ROBERT MORRIS, PE Director of Environmental Health January 12, 2009 Sabri Barisser, PE Bibbo Associates Mill Pond Offices - 293 Route 100, Suite 203 Somers, NY 10589 Re: Proposed SSTS for King at Mountain View Road (T) Patterson, TM # 23.11 -1 -69 Dear Mr. Barisser: This Department, ii'i conjunction with the NYCDEP, has received and reviewed the' submitted application and plans for.the above referenced project and the following comments are offered for your consideration. 1. The pump chamber detail specifies mercury float switches which are no longer acceptable. 2. The absorption trench detail is to be revised to specify the perforated pipe being installed level for a dosed system. 3. The note requiring the well on lot 43. to be. drilled prior to the' issuance of construction compliance is to be revised accordingly. 4. A specific waiver application is to be submitted for the absorption trenches being installed upgradient and less than 50 feet from the. house. .,Upon completion of the above, this Department will continue its review. Kindly advise us.if there are any questions. x sped gully, Michael JJBdzi ki, E Director oneering MJB:kly cc: D. Alderifiavftlwental 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 Nursing Home Care Fax (845)278 -6085 WIC (845) 278 -6678. Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 NEW YORK STATE SPECIFIC WAIVER APPLICATION PEPART1:')' , NT OF HEALTH Request for Approval of Noncompliance with Bureau of Water Supply Protection the Standards of IONYCRR Appendix 75 -A Wastewater Treatment. Standards— Inndividual Household Systems .,GENERAL INFORMATIONIApplicant Name of Applicant . t ur First . Mi Address street cityrroWn state Zip Contact Information phone: FAX: email Site Location street: Citvrrown County Zip The following information is being submitted in support of my application for a specific waiver from compliance with one or more standards of 1ONYCRR Appendix 75 -A, ",Wastewater. Treatment Standards Individual Household Systems'. 1. The wastewater treatment system cannot meet the following standards of 1ONYCRR Appendix 75 -A: ❑ Separation distances cannot be achieved (75- A.4(b), Table 2, Separation Requirements), ❑ Excessive Slope (75- A.4(1), Soil and Site Appraisal) ❑ Design is not addressed in Appendix 75 -A ❑ Technology is not addressed in Appendix 75 -A ❑ Other: Explain: 2. The following design is proposed to mitigate noncompliance with Appendix 75 -A (brief description): 3. Supporting information provided: ❑ Detailed Site Plan ❑ Detailed Design ❑ - Soil and Site Evaluation ❑ Neighboring conditions of concern (e.g., wells, waterbodies, wetlands, etc.) 0 Other:_ - Explain: I, (applicant) (type or print) acknowledge that this waiver request is necessary because it . is not practical-for an onsite wastewater treatment system to meet the referenced standards of 1ONYCRR, Appendix 75 -A on this property. Signature Date I, (engineer) (type or print) acknowledge that this waiver request is necessary because it is not practical for an onsite wastewater treatment system to meet the referenced standards of 1ONYCRR Appendix 75 -A on this property. In my professional opinion, the proposed design described in this application will provide'a degree 'of protection equivalent to the onsite wastewater treatment standard(s) that will not be met for this property and will not create an increased risk to public health or the environment. Signature PE License # *For Health Department use only Based upon the information provided in this application to waive the referenced standards of Appendix 75-A and in accordance with 1ONYCRR §§ 75:3 and 75.6.(b), the waiver requested is hereby: 0 Approved, as proposed. 0 Approved, with following conditions: ❑ Not acted on, because additional information is required: 0 Denied, because: Note: This waiver may be revoked should any conditions considered before approving this waiver change after approval Health Department Representative Signature Date Instructions for Lompleting the Specific Waiver Application; Wastewater Treatment Standards — Individual_ Household Svstems f Applicability: This Specific Waiver application form is intended for use by the applicant (property owner) or the applicant's representative (e.g.. PE) to present information for consideration by the Health Department having jurisdiction'to approve a new onsite wastewater treatment system (OWTS) on previously undeveloped property that does not comply with one or more standards of Appendix 75 -A, "Wastewater Treatment Standards — Individual Household Systems ". A specific waiver shall be obtained before construction of the onsite wastewater treatment system. Background: The responsible city, county, or district health office may. grant a IONYCRR Part 75 Specific Waiver from a provision(s) of 1ONYCRR Part 75, Appendix 75 -A, only under the following circumstances: 1. Conditions at the particular. site make it impractical to comply with these standards; 2. Appropriate protective measures to mitigate noncompliance are applied; 3. The design is not likely to pose a health hazard or create environmental contamination; and 4. Disapproval will result in a significant hardship. A Specific Waiver IS NOT intended as a device for routinely approving individual residential wastewater treatment systems that do not meet design standards. It is intended to provide administrative flexibility to resolve rare cases when hardships, exist and /or other circumstances that make it impractical to meet Appendix 75 -A standards The Specific Waiver application shall provide information and background about the site conditions and detail the proposal so that the Health Department is able to determine whether to approve or deny the application. The Health Department, representative may ask for additional information to be submitted to make that determination. General Information Provide the applicant's current mailing address and contact information, Also provide the address of the property the specific waiver is being applied for, even if it is the same as the mailing address. Reasons for Noncompliance , Check the: applicable reasons) for which the waiver is requested. If not already listed, include the specific standard(s) in the space provided and provide a brief explanation. Vlore detailed information can be attached as needed or as appropriate. Proposed Mitigative Design Provide a brief description of the site characteristics and OWTS design in the space provided. Detailed information and plans can be attached to the application. Supporting Information Check any information provided. Any additional information can be listed after "other" in the space provided. Any or all of the information listed may be required by the Health Department representative depending on the complexity of the site conditions. To obtain a waiver, the applicant must demonstrate that the onsite wastewater treatment system design proposal is acceptable, and is not likely to pose a health or environmental hazard. Detailed Site Plan contents may include some or all. of the following: surveyed plat, accurate location of onsite and neighboring offsite (if applicable) drinking water. sources or water courses, site topography, drainage features and any pertinent physical features. Appendix 75-A, Table 2, lists required separation :distances. Detailed Design shall be submitted by a NYS licensed P.E. and will clearly identify the OWTS components and locations. Soil and Site Evaluation shall incorporate the characterization of the existing soils through, at a minimum: percolation tests and test pit evaluation, which identifies soil types and geologic limiting conditions (e.g., groundwater, rock or clay). Neighboring conditions of concerti (if applicable) shall include at a minimum, onsite or nearby: drinking water sources, watercourses and wetlands. Other identified possible areas of concern that could be impacted by the OWTS shall also be identified. Acknowledgement of Risks The applicant (property owner) is required to sign the Specific Waiver application and acknowledge the risks that may be associated with the OWTS serving their property. A NYS Professional Engineer (P.E.) is required to provide his or her name and license number on the form and submit the supporting information and stamped design plans on behalf of the applicant. Health Department Representative Response The Health Department representative will approve; approve with conditions; not act and request additional supporting documentation; or deny the Specific Waiver application. The determination will be sent to the applicant and a copy of the determination and all information submitted with the application will be retained. PAVSectionAResidential Sanitation \OWTS \GUIDAYCE\Speciiic WaiverOWTS- Legal.doe BRUCE R. FOLEY LORETTA MOLINARI R.N., M.S.N. Public Health Director Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York -10509 Environmental Health (914)278-6.130 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 AL6 TO:- DEPARTMENT OF ENGINEERING AND DESIGN, REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATNEENT SYSTEM PROGR..Aivf JOINT REVIEW. PROJECT: AA-r OA PPOTPT4 TOWN' REVISION (JTREV2) SOCIATES, L.L.P. �s - Planners December 23, 2009 Putnam County Department of Health 1 Geneva Road, Brewster New York, 10509 ATTN: Michael J. Budzinski, Director of Engineering RE: King Residence Mt. View Road Section: 23.11, Block: 1, Lots: 69 Patterson – (T) IRTM. &1 —.95kF•11i 13i Joseph). Buschynski, P.E. Timothy S. Allen. P.E. Sabri Barisser, P.E. John P. McNamara, P.E. Robert A. B. Howe, B.S., Phys. Please find attached the following in support of a renewal of the SSDS construction permit at the above referenced property: • 4 - copies of revised SSDS Plan 4 - copies Lot 43 Well As -Built Plan • 1 - Well Completion Report for New Well on Lot 43 • 1 - Water Analysis for New Well on Lot 43 • 1- copy pump calculations & pump curve Listed below are responses to the comments made in the January 12, 2009 letters issued by your department, and the N.YC. D. E. P. : Putnam County Health Department Letter dated January 12, 2009 1. A well abandonment permit application for dug well #1 on Lot 43 was submitted to your department on January 28,2009, and the permit was issued on January 30, 2009. 2. The new well on Lot 43 has been drilled. Attached are copies of the Well As- Built Plan, as well as the Well Completion Report, and Water Analysis for the new well. 3. The depth of the proposed impervious barrier is now specified. on the plan. 4. Comment noted, the profile has been revised accordingly. Planning . Site Design . Environmental Mill Pond Offices 293 Route 100, Suite 203 • Somers. NY 10589 Phone: 914 - 277 -5805 Fax: 914- 277 -8210 • E -Mail: bibbo@optonline.net 5. The interior dimensions of the pump chamber are now shown on the SSDS plan 6. The dosing calculations have been added to the SSDS plans. 7. The absorption trench detail has been revised as requested. 8. Six inches of 3/4" crushed stone has been specified as the bedding material for the proposed pump chamber. 9. The proposed impervious barrier is now shown on the SSDS profile. N.Y.C.D.E.P. Letter dated January 12, 2009 1. Pump calculations including pump curve are included herewith. 2. The distribution box specified on the SSDS plan has a removable cover. 3. The distribution box detail has been revised to specify 12 inches of sand / pea gravel bedding. 4. A diversion swale is now shown on the SSDS plan on the uphill side of the fill section. 5. The septic tank detail has been revised to specify the required minimum baffle dimensions as requested. 6. See previous response. 7. The septic tank detail has been revised to show the minimum 20 inch diameter cover. Please feel free to contact us with any questions you may have.. 1 Very t P 1. I `I, 1 Sab' i SB /mg Enclosures ly yours, sser, Wit. Bibbo Associates, LLP. Project: KING Mill Pond Offices - 293 Route 100 - Suite 203 Designer: NT Somers, NY 10589 Checked: MG (914)- 277 -5805 Date: December 8, 2009 116 *1 OC�Zd_ 11614 W-1 % 1101 PER WCHD CODE: 0.5 GAU L.F.ABSORPTION TRENCH 0.5 gal. /If 375 If. OF ABSORPTION TRENCH PUMP CHAMBER PUMP CALCULATION DOSE REQUIRED (GAL.)= 187.5 INSIDE TANK DIMENSIONS: LENGTH (IN.): 96 WIDTH (IN): 52 DRAW (IN): 8.5 DOSE PROVIDED (CU. FT.) = 24.56 23.11 CU. FT. x 7.48 GAL.= 184 1 CU. FT. DOSE PROVIDED(gal.) = 184 CHECK: .DOSE- PROVIDED s -DOSE REQUIRED 184 5 2" PVC FORCEMAIN where Q =V x A V(FPS)= 3 A(FTZ)= 0.0218 Q(CFS)= 0.0654 Q(GPM)= 29.36 USE Q= 30 GPM LENGTH OF FORCE MAIN (ft.)= 120 ADDITIONAL EQUIVALENT LENGTH DUE TO FITTING LOSSES (ft.)= 24 L(ft.)= 144.0 FRICTION LOSSES -FL= 1.81 HF= L x FL/100 HF (ft.)= 2.61 H(ft.)= 13.25 TDH (ft.)= H +HF = 15.9 187.5 OK USE GOULDS MODEL PE41 SEE ATTACHED SHEET FOR PUMP CURVE O [qGOULDS PUMPS APPLICATIONS Specially designed for the following uses: • Mound Systems • Effluent/Dosing Systems • Low Pressure Pipe Systems • Basement Draining • Heavy Duty Sump/ Dewatering METERS FEET 40 35 'of30 D = 25 U_ 2 a 20 Z r 0 FQ 15 O 01 10 5 0 SPECIFICATIONS Pump — General: • Discharge: 1'/i" NPT • Temperature: 104 °F (40 °C) maximum, continuous when fully submerged. • Solids handling: 1/2" maximum sphere. • Automatic models include a float switch. • Manual models available. • Pumping range: see performance chart or curve. PE31 Pump: • Maximum capacity: 53 GPM • Maximum head: 25' TDH PE41 Pump: • Maximum capacity: 61 GPM • Maximum head: 29' TDH PE51 Pump: • Maximum capacity: 70 GPM • Maximum head: 37' TDH Submersible Effluent Pump PE MOTOR General: • Single phase • 60 Hertz • 115 and 230 volts • Built-in thermal overload pro- tection with automatic reset • Class B insulation. • Oil- filled design. • High strength carbon steel shaft. PE31 Motor: • .33 HP, 3000 RPM • 115 volts • Shaded pole design PE41 Motor: • .40 HP, 3400 RPM • 115 and 230 volts • PSC design PE51 Motor: • .50 HP, 3400 RPM • 115 and 230 volts • PSC design 0 5 10 15 m3 /h CAPACITY 0 2004 ITT Water Technology, Inc. Effective June, 2004 BPE31/41 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. AGENCY LISTINGS PUS � Tested to UL 778 and CSA 22.2108 Standards By Canadian Standards Association File #LR38549 Goulds Pumps is ISO 9001 Registered. Goulds Pumps ITT Industries HGOULDS PUMPS Submersible Effluent Pump PE PERFORMANCE RATINGS PE31 Total Head (feet of water) GPM 5 52 10 42 15 29 20 16 25 0 PF41 Total Head (feet of water) GPM 8 61 10 57 15 46 20 33 25 16 PUMP INFORMATION PE51 Total Head (feet of water) GPM 10 67' 15 59 20 50 25 39 30 26 35 8 DIMENSIONS (All dimensions are in inches. Do not use for construction purposes.) HARGE' Goulds Pumps is a brand of ITT Water Technology, Inc. — a subsidiary of ITT Industries, Inc. Goulds Pumps and the ITT Engineered Blocks Symbol are registered trademarks and tradenames of ITT Industries. PRINTED IN U.S.A. SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. www.goulds.com Goulds Pumps <& ITT Industries 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 /k PE31 M 0.33 115 12 20 1 Manual / No Switch 20' 1.5" 18" .5" 31 / 14.1 PE31 Pt Piggyback Float Switch PE41 M 0.4 10 Manual / No Switch PE41 P1 Piggyback Float Switch PE42M 230 5 15 Manual / No Switch PE42P1 Piggyback Float Switch PE51 M 0 5 115 13 20 Manual / No Switch PE51 Pt Piggyback Float Switch PE52M 230 6.5 15 Manual / No Switch PE52P1 Piggyback Float Switch Goulds Pumps is a brand of ITT Water Technology, Inc. — a subsidiary of ITT Industries, Inc. Goulds Pumps and the ITT Engineered Blocks Symbol are registered trademarks and tradenames of ITT Industries. PRINTED IN U.S.A. SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. www.goulds.com Goulds Pumps <& ITT Industries i i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Well WELL COMPLETION REPORT Well Location Street Address: Town/Village: Tax Map # a VJ�U) U A1'<Ajq Map�31/ Block I Lot(s) �3 Well Owner: Name: Addr ss: Use of Well: 1- Primary 2- Secondary j Residential _Public Supply Air cond /heat pump _Irrigation Business Farm Test/monitoring —Other(specify) Industrial Institutional Standby Drilling Equipment _Rotary _Cable percussion Compressed air percussion —Other(specify) Well Type _Screened _Open end casing Open hole in bedrock _Other Casing, Details., Total Length ft. Length below grade" t. Diameter 7 in. Weight per foot Ib /ft Materials: Steel lastic Other Joints: Welded Threaded Other Seal: Ceme t grout Bentonite Other Drive shoe: V Yes _ No Liner: _Yes No Screen Details Diameter (in) Slot Size Length (ft) Dept to Screen ft Develo ped? First _Yes _No Hours Second Well Yield Test Bailed Pumped _X Compressed Air Hours Yield gpm Depth Date easure from land surface-static spec ft ��i'" uri Dng yie test (ft) d Depth of completed well in ft. Well Log If more detailed Depth From Surface Water Bearinq Well Diameter (in) Formation Description ft. ft. information Land Surface descriptions or sieve analyses are available, please attach. If yield was tested Feet Gallons Per Minute Pump /Storage Tank Information at different depths L.. lcm Pump Type < -' Capacity during drilling Depth /�' J� Model/D�s��. list: Voltage HP Tank Tvae1&47/*,-"Volume %J N&E: Ehcact Location of well with distances to at least two permanent landmarks to be provided on a separate sheet/pian. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 Page 1 of 1 imsEavironmenfal Services, Inc. 41 Kenosi��Avenue tVATEA, Salt AND AIR ANALYSIS Danbury. Connecticut 013810 I TQIQphone 203 -798 -2220 Hyatt Pump Service: Donald King Mailing Information: Collector's Information: JMS ID: 088084 Name: Hyatt Pump Service Name: Not Specified Address: 229 South Rd Address of site: Mt View Dr City: Holmes City: Patterson State: NY Zip: 12531 State: NY Zip: Phone: (845) 855 -5136 Fax: (845) 855 -5136 Phone: Sample's Information: Sample ID: 1 Site: New well @ old house Date Collected: Preservative: N/A Time Collected: Temperature: Matrix: Water 11/19/2009 Date Received: 11/20/2009 Time Received: 3:00:00 PM Lab No.: j0909024 Date Analyzed Test Name Result MCL Method 11/20/09 4:00 PM E. Coli Absent Absent Colitag 11/20/09 4:00 PM Total Coliform Absent Absent Colitag 12/01/09 Iron 0.074 mg/L 0.3 mg/L EPA 200.7 12/01/09 Manganese <0.05 mg /L 0.3 mg /L EPA 200.7 12/01/09 Sodium 22.8 mg/L N/A EPA 200.7 11/20/09 pH 7.1 S.U. 6.5 -8.5 S. U. SM 4500 H B 11/20/09 Color ND 15 Units SMWW 2120 B 11/20/09 Turbidity 1.01 NTU 5 NTU SMWW 2130 B 11/24/09 Hardness 146 mg/L WA SMWW 2340 C 11/20/09 Odor ND N/A SMWW 2340 C 11/21/09 Chloride 56.2 mg/L 250 mg/L SMWW 4110 B 11/21/09 Nitrate 0.858 mg/L 10 mg/L SMWW 4110 B 11/21/09 Nitrite <0.05 mg/L 1 mg/L SMWW 4110 B 11/21/09 Sulfate 20.3 mg/L 250 mg/L SMWW 4110 B Comments: At the time of the analysis the sample was Acceptable for Total Coliform At the time of the analysis the sample was Acceptable for E. Coll pH was received and analyzed after the EPA required 1 hour holding time. CFU = Coliform Forming Units MCL = Maximum Contaminant Level mglL = milligrams per Liter NIA = Not Applicable ND = None Detected NTU = Nephelopmetric Turbidity Unit S.U. = Standard Unit Units = Units Signature: _M�40w�-- Michael Lapman President Reviewed By: Sharon Houlahan, Director State #: PH -0218 ELAP M 11715 CONNECTICUT. rlr=W YORK AND NEIAC CERTIFIED Toll Free 866 -JMS -5097 I Corporate Fax 203- 798 -2408 1 Lab Fax 203 - 798 -2107 I %v%vikv.jnnsenvironmental.com PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL PCHD Permit # u) - d d - D y please print or type Well Location: Street Address: Town/Village Tax Grid # S' Awwrs►.t u►elu ?A-Vre0 -S0c Map ;Z3.II Block 1 Lot(s) 43 Well Owner: Name: Address: er%%L1 ire -tie.. 5 Ae'v -ro"'a v ►E0'j 7-6006 Use of Well: X 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 3 Est. of Daily Usage 12� gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason ��► to 1SJ uL �� 1,� -r�� o r,� ,��,e�.r -c' wa �, t�,� �p„�,c,r��, t, Foy t?�a.oac�G� SSaS 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 N 1p, Lot No. Water Well Contractor: I,, i9e N%��- �Q�At��� Address: Is Public Water Supply available to site? .................................. ............................... Yes No _ Name of Public Water Supply: O l A � Town/Village Distance to property from nearest water main: rtJ I A Proposed well location & sources of contaminatio t be p`tovidd on separate sheet/plan. ?� S Date: 14 Z.' Applicant Signature: 1 - -- \ PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED_ FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. � � 1 Date of Issue 1"�b" O7 Permit Date of Expiration /-36-a Title: _ Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT # A w �-O'? Well Location: Street Address: o Nillage Tax Grid # T ►'a ¢ to 1?f'"V_V_C0bj, MapZ3.11131ock I Lot(s) Well Owner: Name: Address: Qc�•l 1L.�N T ��u.� �� a EtLSe,•�1 NY 1256o Well Type: \/Drilled Driven Dug Gravel Other Depth Data: Well Depth ft _f Static Water Level ft Date Measured Use of Well: 1 Residential Public Supply Air /Cond/Heat Pump Abandoned 1- primary Business Farm Test/Observation Other (specify) 2- secondary Industrial Institutional Standby Water Well Name: Address: Contractor: Reason For HE vJ ��� �., a..¢.�i1,-� --r s ra.,e._�. `cs �.. oT z� . �► - t - a ►t.1 0 �a..� �. � ro Go�►�t -Y vJIrA rf- ct�4S, pad us Ywt-f of TNT Oe,►�.�o E�tTor Abandonment: L-*r 6'1, A Waw we-t_L- '`�t`-� B�b+a�� -E� Fad- L-crr 41' , - A 6 eNVEMATE .,�.1 F L_Eb To t t.1_ Ar VJf-t_ L. o R-► L Description of Work To Be Performed: Qo&v, S -'o E Go �►St a..� GTto�.t CyF A S � �t u�E. �a.a��`i Q.ES�D�c�� �c�-w EwaY 'Fo sEri�«ETH E S%Tf,, V, Lt- evi A CA G. lt�%SPosAL sY-esrswA 0- L.Y Loc.ATO-L 0.-1 TK �Q pFE�Q.�( %`t►J4 TN►F q�To�.�1�+a4 LET, 'CNr1S "M. t.L S Leo Lac 0a ov- T1k�- 6t-Jt -Y Aa so% So irAa _F_ S4;- -rt1� tS TD $� �ABn�►3Doa���Ra� 1�. tS'rjoS�At- 6�-3•T�. 'fH .F ►roa -E VJELL- A t,t �2.ALL" fba. VV f- S•� . AS 'P0►aT of E. D�vE`oPn� �aNT Se_"%e_E a��►c+►a6orL►rso, LoT( t13� A 5e'PEQO►T� Ati'�PL —t c.aT ►oN AAs 8la6 t-4 vim% 16a.. TJ%E toeLL ovj to qS. 74�0 Date: Applicant Signature: PERMIT This permit, to abandon one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code, Subpart 5 -2 of Part 5 of the New York State Sanitary Code and/or Part 75 of 10 NYCRR and provided that: Within 30 days of the completion of the abandonment of the water well, the applicant shall submit to the Department a certified statement that the information delineated on the application for this permit has been completed. ,30-0? Date of Issue White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT # VV -Dc Well Location: Street Address: Town illage Tax Grid # o.-1 Map23.►1Block 1 Lot(s) y3 . Well Owner: Name: Address: �0 1'•1 1G. MT. �� a,a ►�.rTE�sci>J N� 12vr60 Well Type: Drilled Driven ✓. Dug Gravel Other Depth Data: Well Depth ft = Static Level ft JDate Measured Use of Well: Residential Public Supply Air /Cond/Heat Pump Abandoned I- primary Business Farm Test/Observation Other (specify) 2- secondary Industrial Institutional Standby Water Well Name: Address: Contractor: Reason For Abandonment: E t4crr v -4-£ Description of Work To Be Performed: p1Qj{}I.1Z%Dl �•�wYC� O`� ,�J (.� REV ?j,, 0,r.j 11► '�7�pA2+Et� BY S�o ASSOLtA•ES LAq:t t i i i Date: Applicant Signature: PERMIT This permit, to abandon one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code, Subpart 5 -2 of Part 5 of the New York State Sanitary Code and /or Part 75 of 10 NYCRR and provided that: Within 30 days of the completion of the abandonment of the water well, the applicant shall submit to the Department a certified statement that the information delineated on the application for this permit has been completed. /- � 0 Date of Issue White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT .# A Vl! - O Well Location: Street Address: o /Village Tax Grid # Wr, \)%SA,3 Qy MapZX\XBlock ! Lot(s) L z, Well Owner: Name: Address: boo k%1J4 Mme. \) "Is-vi Q' mv.0 Well Type: Drilled Driven ✓ Dug Gravel Other Depth Data: Well Depth ft Static Water Level ft Date Measured Use of Well: Residential Public Supply Air /Cond/Heat Pump Abandoned 1- primary Business Farm Test/Observation Other (specify) 2- secondary Industrial Institutional Standby Water Well Name: Address: Contractor: Reason For Abandonment: LL. . ►S OT MA L:e N v f . Description of Work To Be Performed: . UJCA \)jsL -t - 41- Z,, . O N 'F LA" E:1.�r"�r � ��LL �6QwI /L.E.� �A2�cb -04- 6r-1-1aT" t.ASr Q_FE-PE ,6 1 (lZylQa Date: Applicant Signature: I' 0 11 1 This permit, to abandon one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code, Subpart 5 -2 of Part 5 of the New York State Sanitary Code and/or Part 75 of 10 NYCRR and provided that: Within 30 days of the completion of the abandonment of the water well, the applicant shall submit to the Department a certified statement that the information delineated on the application for this permit has been completed. - 3o Da a of Issue White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller X Form WA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT # AW- Well Location: Street Address: TownNillage Tax Grid # Wr -'l I V vJ v,t' !��-t EAR -So�,� Map- Z&VIBlock 1 Lot(s) t--0 3 Well Owner: Name. Address. 10".3 k► N L w y � a Well Type: Drilled Driven -1/ Dug Gravel Other Depth Data: lWell Depth ft (Static Water Level ft jDate Measured Use of Well: Residential Public Supply Air /Cond/Heat Pump _Abandoned I- primary Business Farm Test/Observation Other (specify) 2- secondary Industrial Institutional Standby Water Well Name. Address: Contractor: teason For abandonment: )escription of Work To Be Performed: N06"1 11 �cQR��►�IPA'�wC Or` . 't \0.E 112-9)61 Applicant Signature: PERMIT This permit, to abandon one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code, Subpart 5 -2 of Part 5 of the New York State Sanitary Code and /or Part 75 of 10 NYCRR and provided that: Within 30 days of the completion of the abandonment of the water well, the applicant shall submit to the Department a certified statement that the information delineated on the application for this permit has been completed. G � G Date of Issue Permit Issui I? Official Tije A White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well Form WA -97 r BIBBO ASSOCIATES, LLP . TO: w!Awl► un �t�:'r DATE: �t7aa..-e 2 I�rfU : t,/� EKE SAD ►.r k RE' Da ►� JCS �.► ✓�E� ��•� -ry � WE ARE SENDING YOU ATTACHED ( ) UNDER SEPARATE COVER THE FOLLOWING ITEMS VIA # COPIES DESCRIPTION THESE ARE TRANSMITTED AS CHECKED BELOW: ( ) FOR YOUR APPROVAL (y(_) AS REQUESTED ( ) FOR YOUR USE ( ) FOR REVIEW AND COMMENT REMARKS: VA,�� I Arrcic�E.D IS A u�£•_t_ Y't3A,•iLbr.►M�• -+T �F"Tc- �[.l�.rto. '�tivG� �uEI.L"� p,. '1 t4E prf�o �E FEQ.E� -a-f�D 'P�vP E Q_1'4� , QL� AtS p'� ti'WLT_ MF' F 'I�oJ 1�1 E.Pc� PrN�'fN-INU '�cLsE . COPY TO: SIGNED: 4��ow' 293 ROUTE 100 - SUITE 203 SOMERS, NY 10589 (914) 277 -5805 - (914) X277 -8210 FAX - bibbo @optonline.net IF ENCLOSURES ARE NOT AS NOTED; -nNDL Y NOTIFY US AT ONCE AT (914) 277 -5805 a SHERLITA AMLER, MD, MS, FAAP Commissioner of Health ' LORETTA MOLINARI, RN; MSN Associate Commissioner of Health January 12, 2009 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J: BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Sabri Barisser; PE Bibbo Associates Mill Pond Offices 293 Route 100, Suite 203 Somers, NY 10589 Re: Proposed SSTS for King at Mountain View Road (T) Patterson, TM #23.11 -1 -69 Dear Mr. Barisser: . This Department, in conjunction with the.NYCDEP, has received and reviewed the submitted application and plans for the above referenced project and the following comments are offered for your consideration. t/1. Well abandonment.permits have been submitted for dug wells # 2 & 3 and lot 43, but no well abandonment permit was submitted for well # 1. Please clarify. A. Prior to approval of the construction permit, the new well for lot 43 is to be drilled. L2/'The depth of the impervious barrier is to be specified on the detail. L,,� It appears the pump chamber is incorrectly specified as 550 gallons on the SSTS profile. .A. The interior dimensions of the pump chamber are to be added to the detail. L. The dosing calculations are to be added to the plan. .X7. The absorption .trench detail is to be revised to specify the trench bottom and perforated pipe being installed level for a dosed system. The bedding material for the pump chamber is to be shown and specified on the detail. The impervious barrier is to be shown on the SSTS profile. 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 F 911- 773 -0313 J :3 r: 12 2 0.0 9 14 47 1'. 0' i Mi liael Bu unski, P.E. Jarxualy 1.2, 2009 r :; Put iam C;ou ty T)epartnzent of'Health l (� .i.evarR ad F3Te , terN w York 10509 • • _ >: ° .I is Re: Lional d King Res'de.uce — SSTS Renewal gsa ! MO lta•iin View .k oad, (T) Patterson East ranch. Resei7volr Drainage Basin U �'.Lov � 2002 -EB -038 ..:Ji ..: .. _. A,... g :_ • k,:' be r Mr. B dzMSkj.: Yr3rk City Departnient.ot 11.....xontzlen..,t11. F.rotectioil (DEP) bas.d�tei�llined .:::.. Tl1 New nZi�i tha >ahe a iaue- referenced renewal application received by the nE.l? on 7�?ece111l)eT Ar 201 is iracorrz�l tE�. Th.e fc�l1ow .ri.� iiIfc�riiiation is required before ,the OOP may cor � �.eraee i s .yeti -iely: � ,. r {. I II ' li. Provide all pui i calcu.latiot�s, .including a pump ciuve. Yacbr, d n Provllde a rei7iovable cover for the proposed distrilzutio►�. Provide 1 detail showing the required .l? lt�.cl�es of sancUpea gravel at the base o th disti'ibut?0. boy: ;. ; ,:. , . . •m�:C ° P.rov de di��erS10i1.d1tC11 on the uphill side of the fill material to prevent 7. e'K- - _ ^ ; rum i from entering the fill.. The inlet baffle. for the se 6c tank must extend b' 1l v thz la.qui.d level. a TWO n4ni {moil of 16 inches. , The ut.Iet baffle for,the septic tank must. extend below the `Iic�uicl level a nip�ipurn of IS inches. LI ,.. 7. The hover for the se �iic tazzk must have a mi nimuni top o enul6 of '� 0 inches. '. r lZ t7t tt C a t the Cie r d at 4 i• If ' cni have ' nyr questions e�rardin;, tl s a er. please onto c . n � rr ,(9 7 -2 10: , IS finer.;'= �>`!. ": •.. �'i:" _ ISR. � D d ,�.Isde ' sio Yt ay oc' F oject.Mal�a er. W ste ater ,Desia.l Review Roger Sokol, P.E., N.. S170H :r� � - - a -.; .«,., , .tP'; ```'2;:c: - ;:yam °,+...•,ai`u: :,. ,3. L;_ �� ,w r -.a: y.. ,,y4c:.i!S.i =:'� ,.. ' S.s:::C`•''t - � a ,y . —, �l.N:li �� ^:cry. •`' �r a, i -'''' _ .+r rte. l_.'i'' nc,:7t u'".:i•' •e9'.::,..< L::, � �.:nS'ii^�wc.r.�'7:.r,, ;..s - .tr {'":F�" ;y..,'�:. ��,_ie�,vk» tee. t.,»�•,•. .�:. r?�'ifi ;Si �':S!�Twu.;.,r� ?.;n d,,.� .._, a'g�7. —.. ..ia:._ .... -..,. - .,, ....w..r y...d.,u.,. - '�- ,c'a.� .r- 11'- ":�...a �',ra •a... _..v.vlK:«. �sc.,:�i.�, .. ,,..39�: �J,..., �`�'• .JI:> ,. 1 � � rotection 465 Columbus Avenue.. Valhalla, New York 10595 -1336 Stevon'W. Lawitts Acting. Commissioner Tel. (718) 595 -6565 Fax (718) 595 -3557 �yORK CttY DEPgRTM'_ `c' O *J ��02 Q�NMENTAL PRA ww:w. n +c.sav /dep (718) DEP - HELP.. Michael Budzinski, P.E. Putnam County Department of Health 1 Geneva Road Brewster, New York 10509 Re: Donald King Residence — SSTS Renewal Mountain View Road, (T) Patterson East Branch Reservoir Drainage Basin DEP Log # 2002 -EB -0638 Dear Mr. Budzinski: January 12, 2009 The New York City Department of Environmental Protection (DEP) has determined that the above - referenced renewal application received by the DEP on December 11, 2008 is incomplete. The following information is required before the DEP may commence its review: 1. Provide all pump calculations, including a pump curve. 2. Provide a removable cover for the proposed distribution box 3. Provide a detail showing the required 12 inches of sand/pea gravel at the base of the distribution box. 4. Provide a diversion ditch on the uphill side of the fill material to prevent runoff from entering the fill. 5. The inlet baffle for the septic tank must extend below the liquid level a minimum of 16 inches. 6. The outlet baffle for the septic tank must extend below the liquid level a minimum of 18 inches. 7. The cover for the septic tank must have a minimum top opening of 20 inches. If you have any questions regarding this matter, please contact the undersigned at (914) 742 -2010. Sincerely, t aa�� David Alderisio Associate Project Manager Wastewater Design Review xc: Roger Sokol, P.E., NYSDOH Fax:914- 773 -0343 Jan 12 2009 14:47 P.02 i I ael Bu inSki, P.E. 7anuar 12, 2009 Pu m Co ty Departmleat of Health ' '' 1 etaR ad - fEz Oster,, New York 10509 Re . Donald King Residence — SSTS Renewal Tdountain View Road, (T) Patterso East ranch Reservoir Dr,!inage Basin DP Log # 2002 -EB -0638 '. : Den Mr. u dzinski: rotecton as detemiew Y rk City Department of Eaviro�aental P ( D ed n�ihE he Ao ) -e-re1'eremced renewal application received by'the Mfon becembez .112 :20H is into plete. 'the ollowM9 iz oimation is required before tie �7E''mray rco ence i review: Prov de all pump calculations, izacludiztg a pump curve. Pro de a removable cover for the proposed distribution �oz� I. Przov de a detail showing the required 12 inches of •sand*a" gravel ai the base ` oithe, distribution box. . Pro de a diversion ditch on, the.uphill side -of the bill Waf&W to Prevent rLmo from entering the fill. Tie et baffle for the septic tack must extend below the liquid level a ` ' 12UM of 16 inches. I" : e utlet baffle for the septic tank must extend below tl%eicluid level a MPIPUM of 18 inches. I: y li j. The cover for the septic tank must have a minimum top opening oeN inches: �. . � �_ .. .. a � �� • � .. If c j have y questions regarding this matter, please contact the•umdeirsig ai d'at' (9 .74 -2010. _. S el D d eiisio ,AI, cute P of ect Manager W s ewatez Design Review xc Ro el Sokol, P.E., NX'SDOfi �� 6:.. it ". i.: .Y.' 'f'�..!r�...4f. "..'.a_... •.w.•...J.. rn. u.rM ... ... I._ f.. .... . .. _ I .i ltl \V n.y .. r.r�. .. \... _�1 .. \..i .._.I+. �- - .._ f42e �_ T "'" • � C� KY V�l� -- ✓YlX/ Tom'! � 1....�__..___. - - S �-o .���1►!h� �� � ��� -►-� - - -ten._ SHERLITA AMLER, MD, MS, FAAP Q W', ;� ROBERT J. BONDI Commissioner of Health * �F Count), Executive LORETTA MOLINARI, RN, MSN q�elw � ROBERT MORRIS, PE Associate Commissioner of Health. Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 S� TO: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM JOINT REVIEW 23: PROJECT: MOUA-4141 A) V 1 F - TOWN: Tq�ll Us c) SUB'D APP DATE. tJ NOTICE OF COMPLETE APPLICATION: DATE: 2 —� ❑ Within the drainage basins of West Branch, Boyds Comer.Re.servoirs.or. Croton Falls. ❑ Within 500 feet of a reservoir, reservoir steal or control lake. Within 200 feet of a watercourse, or a DEC wetland an.d appearing on a subdivision map approved after December 31, 1992. ❑ Design flow greater than 1000 gallons /day. ❑ Commercial SSTS. jtreview Environmental Health (845) 278 -6130 Fax (845) 278 - 7,921 . 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 OC TES, L.L.P. �ineers - Planners November 24, 2008 Putnam County Department of Health 1 Geneva Road, Brewster New York, 10509 ATTN: Michael J. Budzinski, Director of Engineering RE: King Residence Mt. View Road Section: 23.11, Block: 1, Lots: 69, 43 Patterson — (T) Dear Mr. Budzinski: Joseph J. Buschynski, P.E. Timothy S. Allen, P.E. Sabri Barisser, P.E. John P. McNamara, P.E. Robert A. B. Howe, B.S., Phys. Please find attached the following in support of a renewal of the SSDS and Well construction permits at the above referenced properties: • 1 — Specific Waiver Application (Lot 69) • 3 — Well Abandonment Applications (Lots 69 & 43) • 2 — Applications for Construction of a Water Well (Lots 69 & 43) 4 — Copies of Revised SSDS Plans (Lot #69) • 4 — Copies Well Plan (Lot #43) In response to your October 28, 2008 letter we offer the following: 1. An application to construct a water well on lot # 69 is included herewith. 2. An application to construct a water well on lot # 43 is included herewith. 3. The SSTS notes have been revised a s requested. 4. A note has been added to the plan stating that prior to the issuance of a certificate of construction compliance the well on lot 69 is to be abandoned, and the two proposed wells for lots 69 and 43 are to be drilled. 5. Comment noted. 6. The property owner of the adjacent lot is the same as the subject lot. Planning ® Site Design o Environmental Mill Pond Offices 293 Route 100, Suite 203 • Somers. NY 10589 Phone: 914 - 277 -5805 Fax: 914- 277 -8210 • E -Mail: bibbo@optonline.net 7. Comment noted, a separate well plan is included herewith. 8. A Specific Waiver Application is included herewith. 9. Comment noted. The plans have been revised as requested. Please feel free to contact us with any questions you may have.. I SB /mg Enclosures L JJL4-)k-- bl'�f A-CA c+ Awl- A—tis -�___� s BIBBO ASSOCIATES LLP TO: , DATE: 22 RE: WE ARE SENDING YOU ATTACHED ( ) UNDER SEPARATE COVER THE FOLLOWING ITEMS VIA # COPIES DESCRIPTION `A SSA S L A S Pue-wrrio.a THESE ARE TRANSMITTED AS CHECKED BELOW: () FOR YOUR APPROVAL ( ) AS REQUESTED ( ) FOR YOUR USE ( ) FOR REVIEW AND COMMENT REMARKS: j%v-AS'E- Co ►- �TALT vs w rp► R�� �� E� TtoaS ,�o� y,�,�� a qa E COPY TO: SIGNED: 293 ROUTE 100 - SUITE 203 SOMERS, NY 10589 (914) 277 -5805 - (914) 277 -8210 FAX - bibbo @optonline.net IF ENCLOSURES ARE NOT AS NOTED, KINOL Y NOTIFY US AT ONCE AT (914) 277 -5805 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Sabri Barisser, PE Bibbo Associates Mill Pond Offices 293 Route 100, Suite 203, Somers, NY 10589 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH December 9, 2008 1 Geneva Road, Brewster, New York 10509. RE: , King SSTS Mountain View Road (T) Patters6n, TM # 23.11 -1 -69 East Branch. Reservoir Basin Dear Ms. Barisser: The Putnam County Department of Health (Department) has determined that.the above referenced application, including fee, and revisions received by this Department on November 26, 2008 'is complete. The Department will notify you by December 29, 2008 of its determination. ❑ The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement'. z Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notifv, 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 lrotection 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. MJB:kly l' 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 io I- SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health October 23, 2008 Sabri Bari sser, PE Bibbo Associates Mill Pond Offices 293 Route 100, Suite 203 Somers, NY 10589 Dear Mr. Barisser: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Renewal for Application to Construct a Subsurface Sewage Treatment System for King Realty at Mountain View Road (T) Patterson, TM # 23.11 -1 -69 The _Putnam County. Department of Health (Department) has determined. that the above referenced application, received by the Department on October 27, 2008 is incomplete. Please be advised that the following information is required before the Department may commence; its review. A well permit application for the proposed on -site well is to be submitted. A well permit application for the proposed well to be constructed off -site is to be submitted. • The SSTS notes are to be revised in accordance with Putnam County Health Department Bulletin ST -19, revised July 2007. • Notes are to be provided on the plan relative to the abandonment and construction of all the water supplies affected by the development of the subject lot. -� The location map is to be made legible. • A letter from the adjacent property owner agreeing to the abandonment of the existing well and installation of a new well is to be provided. .r A plan showing the proposed location of the off -site well to be drilled is to be provided. A specific waiver application is to be submitted for the SSTS being uphill and less than 100 feet from the proposed dwelling. r' The SSTS design data (i.e., description of each deep test pit, percolation rate of each percolation test hole, minimum septic tank volume, minimum length of absorption trenches, etc.) is to be provided on the plan. 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 .Far (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 The 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, please contact me at (845) 278 -6130 ext. 2148. R spectfully, Michael J. B dz4ki, Director of ngi MJB:kly BIBBO ASSOCIATES LLP 293 ROUTE 100 - SUITE 203 SOMERS, NY 10589 (914)277 -5805 (914) 277 -8210 FAX ' bibbo aeoptonline.net TO > WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via • Shop drawings ❑ Prints ❑ Plans • Copy of letter ❑ Change order ❑ L 1 -91TU M @[P 4 c A LJV @U1:/ 0 i UZ%01 DATE _ (O — QS JOB NO. ATTENTIOfC ( � 1 /�' '�-/ ^ �.�� /X6 ie e �• � RE: the following items: ❑ Samples ❑ Specifications COPIES DATE NO. I DESCRIPTION e�a n.� u- cfio�. Pe rrn ct 4,0 o(k- c a.:h W THESE ARE TRANSMITTED as checked below: 4 or approval ❑ Approved as submitted • For your use ❑ Approved as noted • As requested ❑ Returned for corrections ❑ For review and comment ❑ ❑ FORBIDS DUE 19 REMARKS COPY TO • Resubmit copies for approval • Submit copies for distribution ❑ Return -corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: cS,t4 % AM COUNTY DEPARTMENT OF HEALT.I SION OF ENVIRONMENTAL HEALTH SERVI ..ONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # _f,�6�,�s, -,2- 91 Located at 1Vj0wy7-i4iN l/.6r. j le,0 Town r Village Subdivision name AAA. Subd. Lot # Tax Map a3. ii Block . / Lot_ 4'_ Date Subdivision Approved Al A. Renewal %,,�_ Revision.— Owner /Applicant Name /C,a,c /C�.a,r� Awwe QE,r Date of Previous Approval o Co Rp Mailing Address ///ay.vTai..� ��rr�,esoN .eJ°l Zip I�S6o Q+' Amount of Fee Enclosed veo . 00 Building Type ,Sm,,« Q,,,,y Lot Area / No. of Bedrooms 3 Design Flow GPD b Girl Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of /nn 0 gallon septic tank and A ��� en _ &A. L av c Qv6.2 <<� _ _�.v� -� .3. 7S 2,0-r it a7f � T�vc N Other Requirements: O - o? ' eo B A...- L-a� �i1RO�Q.� u�pdr�s o uc�y To be constructed by 7-d Q Address Water Supply: Public Supply From Address or: 1% Private Supply Drilled by I–, 0 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 s, sy tem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of C Compliance of the original system or any repairs theret C�Q'�p�� Signed: P.E. ✓ R. iA c S LLP = 5 Address i SS 45 �� APPROVED FOR CONS i Q§pproval expires two years fro ess construction of the sewage treatment system hl��nd inspected b the PCHD and is re se or may be amended or g Y P P Y Y modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only. a Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 .~ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # 1X6v.ousL y a - 91 Located at . Inu�urAiN (/sc.j ,0 Town r Village /A�rs.�row Subdivision name AAA Subd. Lot # Tax Map a3. // Block . / Lot jr,9 Date Subdivision Approved .v A. Renewal _�� Revision . f2�— Owner /Applicant Name _k,"r. )GAIL T*f Atup QED ,�,„ Date of Previous Approval Zo Co RP Mailing Address �aa.vr.�.,y l�iE�� oao %>>r�,esoN, A/y Zip /aS .90 Amount of Fee Enclosed x/00 - 00 Building Type 5,,�,�« r,,,,,y Lot Area %Y, No. of Bedrooms 3 Design Flow GPD �� Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of /oo 0 gallon septic tank and A s_sn G,4, g�&.o G.-� /dy finery C9,a� %J�L� Gnv� Qy&wirzewj ZZ" &, .2 7S Z,0-15' it 07Y ZwewcN Other Requirements: O - a * eo Z �aAo4e.c [/.QPzi'ES cwd- y To be constructed by 7–g n Address Water Supply Public Supply From Address or: 1/ Private Supply Drilled by 773 0 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 C Compliance of the original system or any repairs theret .�� OF NEB, C� Signed: P.E. R. fA SLIP Address 7;4w Q.,�, +,, 4^^ ._ _ i ,a 11ol S 5 APPROVED FOR CONS j %Approval expires two years fro V V�5 W411 ss construction of the sews a treatment s stem hand ins ected b the PCHD and is re r may be amended or g Y P P Y Y modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only. By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 ,f PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # f6�.nusLN a - 9! Located at (/•6w /� ?,0 Town r Village A - o Subdivision name AAA. Subd. Lot # Tax Map 23. ii Block . / Lot !r 9 Date Subdivision Approved Al A. Renewal v"' Revision _ Owner /Applicant Name %C „�,� �,Aj -rte A,o QE,,aagme r Date of Previous Approval 0 2 CoRP Mailing Address Oac,,c,rA,.✓ U, A,o 7rE,eso,v� .yy Zip la56o Amount of Fee Enclosed - /Do - co Building Type 5,,�,��E �,h,�y Lot Area fosy., No. of Bedrooms 3 Design Flow GPD �� Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of /oo 0 gallon septic tank and A Sso /1 ZL /f � 1--.71e- 1--.71e- c- 7,;,A=, .? 7S L ,,-r X e7/ TevcN Other Requirements: O - 2' ,eo B F << r,, o v4-y To be constructed by Td D Address Water Supply: Public Supply From Address or; ✓ Private Supply Drilled by T131D 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 C Compliance of the original system or any repair"UIDOU-Al .�f- �'� Signed: P.E. R. Address cS LLP - S SUffe 203 i gg a5 U� APPROVED FOR COIF 1 Q§�pproval expires two years fro ess construction of the sewage treatments stem ha��nd inspected b the PCHD and is rev se or may be amended or g Y P P Y Y modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only. Lo Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # s, y l a - 9/ Located at // /pCJ,yTA/ N (�sc..� x Town r Village Prr'a_ e roAv Subdivision name AAA Subd. Lot # Tax Map o23, ii Block . / Lot gir 7 Date Subdivision Approved Al A. Renewal _y"' Revision _ Owner /Applicant Name o CoRp � Mailing Address &A TA..y t/j- -g /C Li AO /�,arrE,eso,�, A y Zip /aS�o !I ,d' Amount of Fee Enclosed -/Oo . 00 Building Type ! ,A,,F F,,,,�,y Lot Area 2 No. of Bedrooms 3 Design Flow GPD �� Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of /oo 0 gallon-septic tank and A Ssn 6"A, /j � ��,uc 4 WagEg� roar .a,lJle- Love_ T.v .? 7S L A x,)Y Tsvc y Other Requirements: O - a ' eo rB F« Fart �R,com rr u ep=rE s o y4-cf To be constructed by Td Q Address Water Sup .Public Supply From Address or: 1/ Private Supply Drilled by T;!S Q 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 C Compliance of the original system or any repairs there �� O� �F�J Signed: P.E. R. IAT S LLP �, S Route 4 0o StJote 203 Address 27104Mnd i APPROVED FOR CO i Q� p P Y p royal expires two ears fro � ess construction of the sewage treatments stem ins ected b the PCHD and is rev se or may be amended or g Y P Y modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only. 0 Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Q Owner /<,//a G �,q .f,Q�il6t4Rl,►6,.7- Address . / iv-•aiirA 1/,rL:/ BCD 02 P Located at (Street)T Tax Map 2,3.1t Block �_ Lot (indicate nearest cross street) Municipality 16,T. -A rdvV Drainage Basin.. SOIL PERCOLATION TEST DATA Date of Pre - soaking cy/.? 2 /aa Date of Percolation Test. =T/_0 a Hole No. Run No. Time Start - Stop Ela se Time Min.) De�ppth to Water From.Ground. Surface (Inches) Start Stop Water Level Dropp In Inches Percolation Rate Min/Inch 1 2 3 4 5 2 3 4 5 2 3. 5 NOTES: 1. Tests to be epeated aksame depth until approximately equal percolation, rates are obtattied at each percolation .test hole` `(Le' . s 1 min for 1 -30 min /inch, s 2 ruin for 31- 60,rztfra/,}nch) All data to be submitted for revie 2. Depth cpeasui ements, tube made from top of hole. Form DD -97 vo;;' DEPTH G.L. 05 1.01 1.51. 2.0' 2.5' 3.0' 3.5' 4.0' 4.51 5.0' 5.5' .6.01 6.51. 7.0' .0 7.5' 8.0' 8.5' 9.01 9.51 10.01 2 -1 1 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. HOLE NO. V&e IT 'IV P If Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate le v*el to which water level rises after being encountered — Deep hole observations made by: Date Design Profession at Name:. Sh618 BIMAT%W F! I Address: 131BBO ASSOCIATES LLP 2.9.3- Route 100 z. 9 Ulte 203 'BA NY 10 01i @1104 - Signature: L� VVrA Ak, 0 .546 Design Professional's Seal S1 1�, b001n [ZC88 ON XX /XL] 60:5T (M WRVLO DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO, HOLE NO, �' HOLE NO. Indicate level at which groundwater is encountered _ � x _ Indicate level at which mottling is observed iy /- Indicate level to which water level rises after being encountered Deep hole observations made by: rQ �G�/1t,�j�ecj� 1�,'e•�61,� _ Dated Design Professional Na me: Ag 4 eAt -oiC Address • /J-c7 ,�� ��' �v� i t � ' •'� Af Signature; Deslp Professional's Seal 20018 19C89 ON Xd/XJl w2i aam to /8Z /LO PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAL i NTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address, v A) Located at (Street) Tax Map a,2 Block Lot (indicate nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA Date of Pre-soaking Date of Percolation Test d 2. RA v it 7C 'Y�. � :11, . . ;k - - I jl�...41J'Enl ......... ............ 0 r - M '�A- k V LAI %.7jv I Tim—e- Raw NOTES: 1, Te r su 2. Di C001E 19M ON xu /A,L1 60:51 (tam %0 /eZ /LO PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Dd /Yer'Q &1'er a Address /?OGN ?NIAI li/el4j R a Located at (Street) _ Tax Map �.. _ _ Block Lot (indicate nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA Date of Pre - soaking �L� L 6 T— Date of Percolation Test ::: >:.::::,• 1.,.;' <v:t:;.': ::...... .? li. in...:f J . .. + }.. ...:i:.:.: :''. i:Vi.,•. .. .... •...:,::.••.<:: ..: ... ;.. >� :. +.:.1•: ..:.:::.:..:.�,t: • „•l:, .V.11i.e.r ^.; •;r. :. !'� ' tw.•a: ntvl• n:.':: .�T•.:n.t: +•,tl.,,::1:4:pr•:)•; .. < }:<0 �: ::.:. "..: ;. ':':t'rtito n•, •,:' •. t.:;•'. IJt :.::: •: 1.;.:, .��.,.:.1:. >:-:....:..: >:::;:::: '.H1< : Il. ..li.: .. }:l .�, ... 4 .. ::FYI >. f�p.f;nt ....p:F:t�:':I : t•; t. x:. is�:: is <: <,.,.v:. >,:.y.....•..::,:.:•. 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'.:• i'r:y x0:d <;y,.,.,;,,,.,. ii .:1:•}.. t• Y.=1•I':k RI.:;!':,•:,'�IIIIfA�:p;: D �'�• tl•;i•.: .. :n:nv •• >::I .:IN >f:�:f %' iry�:l + :t':J�/�t ��" I,;i.l;.i,V a !■ — 6 nlyn �•n \: �Y�:1 ::. ...t.i:z)Pe�.ea� 1 •.P •� {�1.��!(� •,. }.0 . �; q11•�..: e: t: i•,: •:; � x t:i� ';.• .t:.l .: tt >. �` \•.) n}r. .e.,:•a ..::.::•.t:Iiu�sa�w;:. } >: :'.x0:1 �Y:�t >:t,��': "<i►�..4 �`'tt• ��..x.:t.. I: >:a;.:q.; � ;.,,:', .i}: art. ",`::•.:;Sto,' �� � t• t•io:i�l1l1 } .;}:•:l:,::,: t:::,: t:>:.,:.::: �n...,..}.... } >:,... >:t.::.:,..:.. >�•��.;;'::: }:,.,. >,:::,:�.::.:�I?<!•.,.,;� 1 Api o� 2 0�Y �- .3 b ° �oy� �� 3 Ca .� ` 4 �by� /�da /f� e�- �► 5 1 2 3 4 5 l 2 3 4 5 NOTES: 1, Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. 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 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: Cr,.us r PE/�rr�.Z- Foe sTS hiv/� wA r�/2 w�� represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: k/,yj�, &"4 r y AN,O D� �cz�P/I7ENT o.e.o Having offices at: `%%aqivro:�u Whose Officers Are: President -Name: Address: 122 vvr-.a.ni view �2r� Vice President - Name: Address: Secretary -Name: Address: Treasurer -.Name: Address: and that I am and will be individually responsible for any and all to the approval requested and all subsequent acts relating th.7,0 Signed Title: Sworn to before me this \,An- day of AQ month) x a):!&, (year) Notary Public MILDRED C. RAMOS Notary Public, RA M309uvY- Corporate Seal Qualified in Bronx County Commission Expires March 3, O b Form CA -97 the corporation. with respect U G11? PUTNAM COUNTY DEPARTMENY OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of /<i,v (e 2e"&!, Q4 AAAlyi Located at . ZyA TA /N �i6 w /60 (I V Tax Map # Q,?// Block / Lot Z? Subdivision of m Subdivision Lot # A/ /.I Filed Map # A/, Date Filed A1,4 Gentlemen: This letter is to authorize ZLAO Acroc1A17F -r [4/ 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 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. Countersigned: P.E., R.A., # 10 0-�ffl V 455A5 Mailing Address. BII360 ASSOCIATES l LO 293 Houte 100 - Suite god Somers, NY 105e� -5805 State • . Zip Telephone: 9 %4 20- � 9 x$545 9��ssio�a`� Very truly your, Signed: _ y �/ (Owner of Property) Mailing Address: 1,�9 ov , ,-A „A, v,t w PA ffERSBx1 State A/ y Zip 1aS68 Telephone: C , 117 Form LA -97 PUTNAM COUN'T'Y 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 )&Ae. y a 2. Name of project: 3. 4. Design Professional: &p5. 6. Drainage Basin: 7. Type of-Project: __1,f!,'Private/Residential Apartments Ofllce Buiiuiiig av: _ Address: ;Z A& •i 0 Food Service Institutional Real y Subdivision SbniE.e_S 1, lu !f 1'0.5A2 Commercial Mobile Home Park Other (specify) 8. Is this .project subject.- to-State'Environmental Quality Review (SEQR)? Type check one YP Status ( ) ........................ ..:............:............... Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... A16 10. Has DEIS been completed and found acceptable by Lead Agency? ............... AIA 11. Name of Lead Agency, VA 12. Is this project in an area under the .control of local planning, zoning, or other /AV41HS officials, ordinances? ......................................................... .......................... ...... �DG D�Pr 13. If so, have plans been submitted to such authorities? ........ ............................... 395 14. Has preliminary approval been granted by such authorities? Date granted: ,ti® 15. Type of Sewage Treatment System Discharge ................. surface'water groundwater 16. If surface water discharge, what is the stream class designation? .................... NA 17. Waters index number (surface) ..............:............................. ............................... �JA 18. Is project located near a public water supply system? ....................................... /Vy 19. If yes, name of water supply AIA Distance to water supply 20. Is project site near a public sewage collection or treatment system? ... .............. 100 ”- —'gib$, a4a *stem ;V ' ,, .,;; Distance to sewage system AIA 22. Date test holes observed `j -4_ a a 23. Name of Health Inspector 24. Project design flow (gallons per day)::::.:'`:.+.' ............. ............................... / 0 O 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... &0 26. Has SPDES Application been submittedtolocal DEC office? ......................... Form P(: -97 2 27. Is any portion of this project located within a designated Town or State wetland? ,y o 28. Wetlands ID Number ............................................... ............................... —.... AIA 29. Is Wetlands Permit required? . ............................... "a Has application b'een.made to Town or Local DEC office? .7 ............................... ova 30. Does project require a DEC Stream Disturbance Permit? ............................... AVO 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 abandoned landfill, hazardous 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 (Gw or Village? 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site ? .............................. ...:.......................... A-)v 35. Are any sewage treatment areas in excess of 15% slope? . ............................... ^ /UO 36. Tax Map ID Number ................................... :....... ............... Mapes Block_Z_ Lot 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 re uirPEP approval of the SSTS.prior to final approval by the Department. Projects within the watersh 4�- o require DEP review and approval of other aspects. of a project, such as stormwater�plans or the at o4fi impervious surfaces and the project applicant should obtain the appropriate forms for such actites o ' ? DEP and submit those forms to DEP for review and approval... a If the application is signed by a person other than the applicant shown in Item l .,the applicati D be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this pr isi+.. may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury; that information provided on this form is true lo-the best of my knowledge and belief. False statements made herein are punishable as a .Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICL4L TITLES: Mailing Address: .............. IBBO ASSOCIATES LL ....................LL q R Somers, NY 1 14) 277 -5$05 PROJECT ID NUMBER SEQR APP617.20 ENDIPENDI X C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1. APPLICANT I SPONSOR 2. PROJECT NAME I<IN 6 w . 3.PRQJECT. LOCATION: .1noa 17AIAl,. t✓� &� RA Municipality 10A 7.'6°Rsa County . 4. PRECISE Street Addess and Road Intersections, Prominent landmarks etc - or provide map pLOCATION: %NE ?ie0xWC7— '& (olArL-0 SO 01-0V OF ,S Ma ✓.tlritiiv liiEw I&IA2 //20 C'Alm/N VIA w 9,0 i vr&-oe .Saran wer-,f Rr- /G y iti /�,grT�*ieso v 5. IS PROPOSED ACTION : �lew El Expansion ❑ Modification / alteration 6. DESCRIBE PROJECT BRIEFLY: %iyf P,¢o�ccT /ti�cvOFt %^/iE ��- ts��Tiav oil' ,4 rN.4� .�JEO�oa7? StiGGE- �rn�...y /C�O�ivcE� �/,Q,�ec✓�fy, S�w.aG6" Os�as.Rc .SysTE/h� i4ti0 .4 �R /cc�D L✓BLG. 7. AMOUNT OF LAND AFFECTED: 'I'nitially _ Q - acres ' Ultimately ' • .> acres' - 8. WILL PROPOSED: ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? DI(e*s ❑ If describe briefly: No no, 9. W T IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) rFResidential ❑ Industrial ❑ Commercial ❑Agdcutture ❑ Park / Forest/ Open Space ❑ Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGE CY (Federal, State or Local) Yes . [:]No • If yes, list agency name and permit / approval: 11. DOES ANY ASP CT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes Vo • If yes, list agency name and permit I approval: 12. AS A RESUUT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? as 1340 1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor N e Da;V2- Sh Savl sue' / Y O Si nature Vv - - - . v. - - . -r"" , If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT (To be completed by Lead Aqencv) 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 E] 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. ANYADVEF2$E EFFECTS ASSOCIATED WITH THE .FOLLOWING: `(Arisw6rs maybe handwritten; if legit►fe)' C1.' Existing air quality; surface or groundwater quality or quantity; noise levels, existind .traffic pattern, solid Waste production or disposal, . po tential 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: F_ 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? Expl iri;bq 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? Explairi briefly: % C7. Other Impacts including changes in use of either quantity or typo 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 1 ff Xes, explain briefly: Yes E] No E. IS THERE, OR IS THERE LIKELY TO BE CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? if yes explain: Yes [:] No 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 identifed.and adequately addressed. If question d of part !I w'as checked yes, the determination of significance mustevaluate the potential impact of the proposed action on the environmental characteristics of tie 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 F 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 ac WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting, determination. Name of lead Agency Date o yp� met espouse oer ertCa . r "�, Titre ofJt Signature of esponsi a Officer in Lead Agency Signature of reparer asN95ibl9 Officer Brent froni responsible office . , . , -, . .. ,.. . UM wl r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT o TREATMENT SYSTEM PERMIT # D Located at , Odf e�i ®e� /Q To Village P *-i g CW Subdivision name . 0r Subd. Lot # Tax Map,?, // Block �_ Lot G '� Date Subdivision Approved A/ l;& Renewal Revision Owner /Applicant Name )e/ A) Date of Previous Approval Mailing Address 00 V m T: &m '/ `agg_ Zip Amount of Fee Enclosed Lf 2-�.o Building Typei vWl- Lot Area/4 � No. of Bedrooms 3 Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED `Separate Sewerage System to consist of 1666 gallon septic tank and Other Requirements: ooyoe t' 00/7 To be constructed by �'�a Address Water Supply: Public Supply From Address or: _leo—_ Private Supply Drilled by -TIR-P 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. n Signed: Address R.A. Date 'Z° License # thV-1 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe pproved f discharge of domestic sanitary sewage only. By: Title: c �d� Date: 2, White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; 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 type PCHD Permit # Well Location: Street Address: o illage Tax Grid # Ois x -'Av g ry p j►d/ Map.0 ff Block l Lot(s) 4 % Well Owner: Name: Address: Q 4 k /MC 6� ?N �' P o Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation �arimary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutions Standby Amount of Use Yield Sought _� gpm erve Est. of Daily Usage a i1'*gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling yNew Supply (new dwelling) Deepen Existing Well Detailed Reason fJ 6 W /Q Arl 4? 91 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 l/ Name of subdivision / Lot No. Water Well Contractor: D Address: Is Public Water Supply available to site9 ...... .......................... ............................... Yes No y ��� Name of Public Water Supply: Town/Village Distance to property from nearest water main: _ Mele Proposed well location & sources of contamination to be pr vided on separate sheet/plan. EDate: 1,111.4 Z Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water ell driller certified by Putnam County. Date of Issue l3 o Permit Iss ' fficial: Date of Expiration / G Title: Permit is Non - Transfer able White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL please print or type �1 PCHD PERMIT # &A -f/_ Well Location: Street Address: To illage Tax Grid # `e 0YW C a4) Map,,V$ lock Lot(s) G� Well Owner: Name: Address: A.1 lesfilic 400 A °WAV ✓A 0 /e A Well Type: lo*'ODrilled Driven Dug Gravel, Other Depth Data: Well Depth ,f ft Static Water Level ft Date Measured Use of Well: __y Residential , Public Supply Air /Cond/Heat Pump Abandoned 1- primary Business Farm Test/Observation Other (specify) 2- secondary Industrial Institutional Standby Water Well Name: Address: Contractor: n — Reason For Abandonment: Description of Work To Be Performed: % Fi`L ?� ® TV L G A# 1-/ G 1 C, ATj* 4 -f IS h /V,o ?h`AAA J IC/ GZ,,-0, . ltlGl��i�E . C Joe"A oe 2' Date: _ Applicant Signature: PERMIT This permit, to abandon one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code, Subpart 5 -2 of Part 5 of the New York State Sanitary Code and/or Part 75 of 10 NYCRR and provided that: Within 30 days of the completion of the abandonment of the water well, the applicant shall submit to the Department a certified statement that the inflation delineated on the application for this permit has been completed. G o2 Date o Issue Permit Issuing Official Title White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 I �� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM ONNMer D61,1of-k-D &-INd Address aN 77,#--'*' "W -I& Located at (Street) Hpo-AINN. A111PA-i fi? n� -Tax Map, Block Lot ,(indicate nearest cross street) Municipality P47700u,"am Watershed SOIL PERCOLATION TEST DATA r Date of Pre- 2. 2 . / - � S 3 3z) 9, .4 2... 3 4 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are oW percolation test bole. (i.e.,k 1 min for 1-30 rain/inch,s 2 min for 31-60 min/inch) All submitted for review. 2. Depth ateasurements to be made from top of hole. at each to be Wafer e Ground Le,yl D. J r Stop DC ofX77- 2 3 4 5 lb63 3i ga 2 . / - � S 3 3z) 9, .4 2... 3 4 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are oW percolation test bole. (i.e.,k 1 min for 1-30 rain/inch,s 2 min for 31-60 min/inch) All submitted for review. 2. Depth ateasurements to be made from top of hole. at each to be TEST PIT DATA 2- DESCRIPTION OF SOILS ENCOUNTERED IN TEST DOLES DEPTH BOLE NO. HOLE NO. HOLE NO. G.L. 1.0' r + 2.0 ' - 7.0' - .. _ 7.5' 8.0' 9.01 9.51 1 0.01 ..._ ..... 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: y&Mj 0,0 a .ri0,r.,� Address: faR 4 ,E Signature:. Design Professional's Seal pp04 GSS1 O:yq� w 4 �i lit 4: `s'T,yT No. aaA� yo 0 "1/1- PUTNAM COUNTY (DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA.SHIEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner _)t' N4cGp &11,a. Address 1 ,*PAj 7W 1A1 4i 10.41 R b Located at (Street) Tax Map Block 'Lot (indicate nearest cross street) Municipality Watershed 'SOIL PERCOLATION TEST DATA Date of Pre- soaking -¢ /2 th 9- Date of Percolation Test ofha/40 4fo g1EC� Ru1pt N0 . ase :Start - StOp Va e'Yime hEA) ' . De th to Water From Giv aud Surface (Inches) Start : St01QC7ies ater evel D�rop Iu Percoiat oA. to :: PAO- 2 Ca 3 3 a 4 a f 3 5. 1 2 3 4 5 1 , 2 . 3 NOTES: 1. Tests to be repeated at same depth until approxirriately equal percolation rates' are obtained at each percolation test hole. (i.e. s 1 min for 1 -3Q min/inch, ,.2 min for 31- 60'inin/inch) All data to be submitted forrevieµv. . _u 2. Depth measurements to be made from top of hole. Form DD -97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 0.51 1.01 2.01 2.51 3.0' 3.5' 4.01 4.5' 5 f .0 5.5 6.01 6.51 7.01 7.51 8.01 8.5' .5 9.01 9.51 10.01 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: 12 -Mlt 4 a1 #1 &V Address: beU NW00,0e*Aj JQ /,0 4 0 Signature: Design Professional's Seal V-S S I 0/-V a. Do kn LU 0. 41BA rF of Nt '2 PUTNAM COUNTY DEPARTMENT OF HE *LTH DIVISION OF ENVIRONMENTAL HEALTH �tRVICES y A DESIGN DATA SKEET - SUBSURFACE SEWAGE TREATME*T SYSTEM Owner 1)16,94 LQ k'4oye Address A/ V) ofP Located at (Street) ,&0&jV- , &oV 010A0 A*® Tax Map Blt (in �cate nearest cross street) Municipality Drainage Basin SOIL PERCOLATION TEST.DATA Date of-Pre-soaking Date of Percolation Test Lot_ Hole No. Run No.. Time Start • Stop Ela a Time i�iin.) De th to Water rom Ground Surface (Inches) Start Stop ater ve! D pp In U 8 Percolation Rate Nun/Inch 2 3 4 1 2 3 4 5 l 2 3 4 5 • •� a emu• , • . GU3 w DC repoarea al same aeptn untie approximately equal percolatiorl, rates are obtained at each Percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31.60tnin/inch) All data to be submitted for review, 2. Depth measurements to be made from top of hole. Form DD-97 DEPTH G.L:. 0.5' 1.0' 1.5' 2.0' 2.5 3.0' 3.5' 4.0' 4,5' 5.0, 5.5' 6.O' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9,50 10.0' TES. T PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOL4 NQ. DN �3 HOLE NO.��d'._ HOL9 NO. Indicate level at which' groundwater is encountered A6- —;.. -_ —..- Indicate level at which mottling is observed ---- -- Indicate level to which water level rises after being encountered Dee hole observations made by: e1 Design Professional Id me:_ �� Q F Address: / � ta4.6' '�� oa `�. ay�� -�v 9 Signature Design Professional's Semi LU ,a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION Property of Donald G, & Joyce E. King Located at Mountainview Road T/V Patterson, Tax Map# 23 Block 11 Lot 1 -69 Subdivision of N. A-. Subdivision Lot # N. A. Filed Map # N , A . Date Piled N. A. Gentlemen: This letter is to authorize Daniel J. Donahue, P. E. 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 Putnam County Sanitary Code. Countersign P.E., R.A., let Very truly yo Signed: (Owner of Propari) Mailing Address l01400�^ ie 0 04oO Mailing Address: 137 Route 164 L1ilill State Zip Telephone: L/ .2fl` State New York Patterson, Zip 12563 Telephone: , 845- 878 -9718 Form LA -97 DANIEL J. DONAHUE, P.E. July 30,2002 CONSULTING ENGINEERS 120 Breckenridge Road Putnam County Department of Hehopac, N.Y. 10541 Geneva Road 845- 628 -7576 Brewster N.Y. 10509 Att: Mr. Robert Morris, P.E. RE: Application for a Renewal of a permit SSTS and Well Property of Donald King Permit P -2 -91 Patterson Dear Mr. Morris: As per your request, please find new deep hole test data along with.three drawings which reflect the additional data. Your prompt attention would be appreciated. Sincerely, el J. Donahue, P.E. cc: D. King k 4M. Site - Sanitary • Environmental BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 June 25, 2002 Daniel Donahue, P.E. 120 Breckenridge Road Mahopac, NY 10541 RE: Application to Construct a Subsurface Sewage Treatment System King at Mountain View Road (T) Carmel, TM# 23.11 -1 -69 Dear Mr. Donahue: The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on June 13, 2002 is incomplete. Please be advised that the following information is required before the Department may commence its review. • Deep test holes must be witnessed by a representative of this Department. Soil ' testing is greater than 10 years old. The 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, please contact me at (845) 278 -6130 ext. 2166. RM:tn Ve 7,41y y yours, e A o 's, E. Senior Public Health Engineer PJ6DANIEL J. DONAHUE, P.E. CONSULTING ENGINEERS 120 Breckenridge Road Mahopac, N.Y. 10541 845- 628 -7576 June 14, 2002 Putnam County Department of Health Geneva Road Brewster N.Y. 10509 Att: Mr. Robert Morris, P.E. RE: Application for a Renewal of a permit SSTS and Well Property of Dbnald King Permit P -2 -91 Patterson Dear Mr. Morris: Enclosed herewith please find the following: 1. SSTS application 2. Letter of authorization 3. Fee in the amount of $300.00 4. Three copies of construction plans 5. Application for permit to abandoned a well 6. Plan for new well location By: 0' 1 J. 'Donahue, P.E. Site • Sanitary - Environmental PUTNAM COUNTY DEPARTMENT OF.-HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES(,,,�. DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM. Owner Address - Located at (Street) Tax Map a*3, 8 Block i Lot 42 (indicate nearest cross street) Municipality Watershed - ".G77'`'071 t4 SOIL PERCOLATION TEST DATA- Date of Pre-soaking ..a Date, of Percolation Test //z;z 310a Wip 3 4 5 NOTES: 1. Tests to be reneated at same death until ar)Droximately equal percolation rates are obtained at each percolation test hole. (i.e. :g I min for 1=30 min/inch, -.5 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" W gte.�:, 'G d ...,:From r un ey WCOJAPPA.:.: tt H 6 le', N 6*� Run No Tame ... Start Sto V Surfke�`Q Ch Start ... .... ... ... rp 14 - m: PC 2 10; 13 /4V 15- Zlt �;2. 7 3 116 2�7 -Iva 3 . 4 ,27 3 5 Ivs 6 27% 3. 2 0► 3 2 /0,, 3,Z 0;2 .2, Z—::;, __5 3 80t //,3 6 30 5 IA13 �r 4-3 2 'A>1 3 4 5 NOTES: 1. Tests to be reneated at same death until ar)Droximately equal percolation rates are obtained at each percolation test hole. (i.e. :g I min for 1=30 min/inch, -.5 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 DEPTH G.L. 0.5, 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' . 5.5' 6.0' 6.51. 7.0' 7.5' 8.0' '8.5' 9.0' 9.5' 10.0' W 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: DEED 4 M ,� Date _7z OR Design Professional Name: (. Address: V° N� . a ® well Signature:, Design Professional's Seal l dis 13 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION S U Fe r e s e "' 1, .. Name of Project rt��V),9�Tl?So�� County P u`it/ -z! Site Location /7vu�v; ��a,(J K592 d7 � Building construction begun AI Z9 Extent Is property within NYC Watershed ? ................. Yes No SECTION -B. TOPOGRAPHY (Please check all appropriate boxes) 1.. Hilly Rolling Steep slope Gentle slope E:] Flat 2. F7 Evidence of wetlands F Low area subject to flooding a Bodies of water - If yes, what is the condition of the fill? ��;,���,, /eat w, SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: F-1 Sand F-1 Gravel Loam F7 Clay D Hardpan F--] Mixture 11. Observed from: F--J Borings F-I Bank cut a Backhoe excavations 12. Soil borings /excavations observed by 13. Depth to groundwater 14. Depth to mottling on on on 15. Are test holes representative of primary & reserve areas ...... ............................... Yes D No 16. Soil percolation tests made by Z�� ✓/���a,�g on Y/: 3 Z��' 17. Soil percolation tests witnessed by 2t�F .Rd`s_ !� j�` on SECTION D (on back) Form ST -1 0 Drainage ditches F7 Rock outcrops r g p �©�e,( CVl CA�Vt �'i /�. uVe� (r,<Y 1 3. Property lines or corners evident ...................................................... 0 Yes �No 4. Do water courses exist on or adjoin the property? ............................ a Yes 2'7�No 5. Will these affect the design of the sewage system facilities ?............ Yes .✓ No 6. Do watershed regulations apply in this development ? ....................... r F� Yes F-� No 7 Will extensive grading be necessary? � ................. ............................:.. F—I Yes EE!r No 8. Will extensive fill be necessary for SSTS ? .................... %' 0 Yes F-1 No 9. Do filled areas exist within the SSTS area? ........ ............................... 77 Yes F--] No - If yes, what is the condition of the fill? ��;,���,, /eat w, SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: F-1 Sand F-1 Gravel Loam F7 Clay D Hardpan F--] Mixture 11. Observed from: F--J Borings F-I Bank cut a Backhoe excavations 12. Soil borings /excavations observed by 13. Depth to groundwater 14. Depth to mottling on on on 15. Are test holes representative of primary & reserve areas ...... ............................... Yes D No 16. Soil percolation tests made by Z�� ✓/���a,�g on Y/: 3 Z��' 17. Soil percolation tests witnessed by 2t�F .Rd`s_ !� j�` on SECTION D (on back) Form ST -1 0 .2 4 u SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? 0 Yes F-� No 19. Will groundwater or surface drainage require special consideration? ..................... F-] Yes a No 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? .......................... a Yes r7-J No . SECTION E. REMARKS 21. If a common water supply is proposed, has an inspection been made oft he existing or proposed source and facilities? .............................:.. ............................... 0 Yes a No Inspection data 22. Do adjacent wells and/or sewage systems exist ? ..............� s ¢41K9 .... :............. Yes... No d� e5 Wor eA-bA;1k0(10f 23. Additional comments 24. Site observer /inspector and title 25. Date(s) of observation(s)inspection(s) TEST PIT PROFILES Hole # Lot # Hole # 'Lot # Hole # Lot # Depth to water Depth to water Depth to water Depth to mottling Depth to mottling Depth to mottling Depth to rock/imp. Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L. a 0.5 .0.5 0.5 1.0 1.0 1.0 2.0 2.0 2.0 3.0 3.0 3.0 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 BRUCE R FOLEY Public Realth Dlrecw DEPARTMENT OF 1 Geneva Road t ` Brewster, New York . .l LOYtSM MOL1111AR1 -RN., M.S.N. Astocmte Public: Heal& Dlreaar Vredor of PO*nt Servk " BEALTH 10509 BEQiLEST D ATTENTION: STEBELIIIG ENE REED AA information below must be fully completed prior to any scheduling. �Z- R' ' ENGINEERORFIRM: �• !� D - PHONE M DEEPS: a PERCS:,Vf PUMP TEST: o ROADISTREET: TOWN: TAX MAPii: ' SUBDIVISION: LOW: • YES N o Proposed SM witbm the drainage basin of West Branch or Boyd$ Coror Reservoirs. C3 proposed SSTS within 500 feet of a reservoir, reservoir stem' or control Wix- a Proposed SSTS within 200 feet of a watercourse or a DEC wetland- 13 Proposed SSTS design flow greater than 1000 gallouslday or SPDES Petrmit required. a Pro nosed SSTS a Commerical Project. R. 1p It is the responsibility of the design professional to provide the above information prior. to soil testing. This Department wiili' determine the NYCDEP project status (Joint or Delegated), based an the response. If you answeredya to any of the questions, NYCDEP must witness the $ol testing: This - Department will coordinate a mutually suitable time for field testing with the PCDOA the Design Professional and NYCDEP. If a project has been determined to be Delegated based an the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re-witnessing of the soil testing with NYCDEP. FOR COLWY UM OMY -� DAM$: rl�11 041!u APR -4 -2002 THU 20:09 TEL:845 -278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 T • 'd. d0 1N3Wi8Ud30 AlNnoo WdNind:3WHN T26L- 8L2-Sb8 :131 LT : t0 3ni 2002-6 -inn BRUCE R. FOLEY Public Health Director 4;. DEPAR][WW OF Ja,A► M I Geneva Road Brewster, New ;York • 10509 LORETTA MOLD4M. R.N., M.S.1;. .tssociate AMC 864M Director Director qj Parent Service: ' FIELD TFS'Z' ATTENTION: ❑ ADAM STIEBEI,ING XGENE REED A11 information below must be f& completed prior to any scheduling. DAM ENGINEER OR FIRM: PHONE #: REASON: DEEPS '.O�_PERCS: o PUMP TEST: ❑ ROADISTREET: /�!/ �/ j/ re/ , TOWN: TAX MAP #: SUBDIVISION: LOT #: OWNER:. 0I' NX= - MA FO 0� 1NT VBM AND'MSSING Of SOIL UMINGG YES NO o �� roposed WS whWm the drainage basin of West Branch or Boyds Coiner Reservoirs. o Proposed SSTS within 500 feet of a reservoir, reservoir stem or control WW- 13 Proposed SSTS within 200 feet of a watercourse or a DEC wetland. o j� Proposed SSTS design flow greater d= 1000 galloolday or SPDES Permit required . 0 t5 Proposed SSTS for a Commerical Project. It is the respons% ty of the design professional to provide the above information prior td soil testing. This Department will determine the NYCDEP project statas (Joint or Delegated) based on the response. If yon ans4►j'ed KXI to any of the questions, NYCDFP must witness the sot testing. This - Department will coordinate a mutually suitable time for field testing with the KDOA, the DedP ' Professional and NYCVEP. If a project has been► determined to be.Delegated based on the above Mpouse and then subsequent information indicates NyCDEP is required to witness the oil testingit wM be the NYCDEP sole respousIility of the design professional to schedule re-witness u►g of the testing FOR COMY USZ O'LMy (30 TDM DA•LF� . i'.n '10ae A_ _ \\ "T J` // 99 '•YO on 42 i t , _ 9 - - - a/ 4N.09 AC.I Y y 40 q / � - � w^ - • � 1.01 X. - r``�i`:- B _�__ Bar _- _ ♦ / 8 5 {tt{ 25.9 p AL 3.72 AG 2.1 AG 7 Y �[ ,'' 8 •- - J tiro / >xn ro Inn n 4'' / � ,y�, � $,A q A. - - ` �' rr / n rr p3 94y 88 - �,r w Y •r �` 45 24 �h/ 42 �/ / ' 4p/ rop q ? \. i •w ' u a / / k'4 \� I 169 • I,P-c/ / pta \ rr / / •� 4t4 ,98 '`• x / ao• L \ I ! a °f r _ X Y /'• / u 4 -63 �x 4;y q* I' \\ 7 s / / / 4c � I 8 ;t�,g •1 rr ros '(, / iX \ 0 / /$ 0$ / / /r s t' / / / ?i�3 3 t't. mIn a= r- :.x... 1 a 1.3S AC. / •8' i � x / / k 43 12 , 9 a ' P r., n ��� a a 4• 4 / �, r i n 26 5'•,I CAL \. i 1 . n / � 9 � �4 o`t' i� A 'L f � �• 54 49 ?,5 R n 8 tl r - ...' S �Y .,s� 1.64 AG CAL ! �\ 18 � `� � � 8 �•D!A x ?,� //ro �- - - s $ x / h' 'Y I.OT.AG CAL. l n, 8 1.41 \AC. CAL !4 w ps .12 _ S S �° rgro4 ti ` ' a _ r' \ � •r4: idol'�t+ 4 21 �'♦ °g .PLO n7 �/i In.e -66 x'`/s3 8 Qro 19, '= r 21 8 g 4 '' +. , mit � \. � 1 y -pL' a ma ma 6,r e s }3 ` g 3ro s�/ 4a 4/ro ,' . ,''' /x Y ,, •, , 'r ,y '" ' \ \ \* Y \ � o < 6T 66 _ 6 „ a x 14t, 16 / � . 4,y �' � •'b I •z/(: n / 4 14 8,r / ro ,, aa�4r a �' / IC r •r •y, ' B t Y+ y �+ _'__-' _ -- H, 6 �4u • Iaa x P /// x 1/ s 1.30 AG 50� 4 1 1 VIEW AC. CAL. i A I I ° J t,..>• t r< A 1 8 t Y o wl imm - - •' I 1 r i 48 6.40 AC.i i 1 1 !V; ba �. /0:06 E, � —, a•% •' � v�. 2 i0,06 - /o; % °2 3 10,73.- 10,12- 0 7 :''2 ` - ; �2 7. 3 /0730 -10,1117 23— 24 5 oflnve .. 17 3 3TES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. i 2. Depth measurements to be made from top of hole. �l 3 1133 T ' 7 3Form DD -97 1 def X ._pdvaga Sapp &Mpd by Otllar , 1,r*Oev ntahat:I am wholly and cbrrib ly ►osponsiblafor the despn and location of th•.'propo»d ".system(s);'.1). that the saparat•,pwa a•.dis oral s stem aeovo datpib•d will M epnsttutted as shown'on tn• approved amendment there to and in accordance with the standards, rules and regulations of the am County •Oapntmeht 'of M«Ilth, and ;tl at on completion the►aof a'•.Cartificat• 'of Construction, Corriplianc• .., satisfactory to the Corrgniss W of, Health Will be supmntw .to• the Dopertnient and is wrltten muarenta will b• furnished the own•►, his succ•isors,' heirs ovasslp►s by the bulWir.lhat slid builder Will peace ilr +jood:operitin/ _condMioh' any'?.part' of;said sewn" dispoial itrstem eurirp; the period,ofawo'(2) years immediately following th•dateof the kau• Nrcm of the app►aral of tM ^CatNidti 'of Construction Ccmplsanc• of o► aoy r aks tho►ot0:2) that the drilled woll'defpibed adarb WiU bi located as non the eoi*6vaA.plin and`•thaf sew wNt wiltb• instian with Oards, rul and revu a ns . of the Putnam County per, math 1 Health. Pate, `3�� Q Sioned P.E. R.A. AddressilG/L� License APPROVED; FOR CONSTRUCTION Thk approval. expires two years from t. date assuad unNSS construction of the building has been undertaken and is "NoeaON for, cause or may b•'amah0a0 or mOCified WMh;considor net,n�he OMf of Mwtth: Any alt•►atbn of conttruetbn nmuires a'Mw p•►in pprovd for AitpOlil of dom•stk; sanitary r • w N su xw. l' lOtHH ate � �v • BY Title c } lQlriW Comm DlA�1�Tl OF HEALTH DhMali d wld aid& Saeiload. CU" N.Y :165U BaRldrer tp psra+ldo itiiat 1 M CSRIII+ICATS OF COPIPILINCB ., pdtta�te / `' a �� ` MUM. POR ALNf Iieatad ssrsi ar V ®fie . SdW. Let./ Tau Map "� — '- -Bloek lot o...ds��x... �L70/yA�� 11 �6LV 6 Rmoewd �evlal�a - p .. Date of pravloaaApporm"yd . � d / 'rT w . ,.... 11(ai11R Addadaa Town�!f At def X ._pdvaga Sapp &Mpd by Otllar , 1,r*Oev ntahat:I am wholly and cbrrib ly ►osponsiblafor the despn and location of th•.'propo»d ".system(s);'.1). that the saparat•,pwa a•.dis oral s stem aeovo datpib•d will M epnsttutted as shown'on tn• approved amendment there to and in accordance with the standards, rules and regulations of the am County •Oapntmeht 'of M«Ilth, and ;tl at on completion the►aof a'•.Cartificat• 'of Construction, Corriplianc• .., satisfactory to the Corrgniss W of, Health Will be supmntw .to• the Dopertnient and is wrltten muarenta will b• furnished the own•►, his succ•isors,' heirs ovasslp►s by the bulWir.lhat slid builder Will peace ilr +jood:operitin/ _condMioh' any'?.part' of;said sewn" dispoial itrstem eurirp; the period,ofawo'(2) years immediately following th•dateof the kau• Nrcm of the app►aral of tM ^CatNidti 'of Construction Ccmplsanc• of o► aoy r aks tho►ot0:2) that the drilled woll'defpibed adarb WiU bi located as non the eoi*6vaA.plin and`•thaf sew wNt wiltb• instian with Oards, rul and revu a ns . of the Putnam County per, math 1 Health. Pate, `3�� Q Sioned P.E. R.A. AddressilG/L� License APPROVED; FOR CONSTRUCTION Thk approval. expires two years from t. date assuad unNSS construction of the building has been undertaken and is "NoeaON for, cause or may b•'amah0a0 or mOCified WMh;considor net,n�he OMf of Mwtth: Any alt•►atbn of conttruetbn nmuires a'Mw p•►in pprovd for AitpOlil of dom•stk; sanitary r • w N su xw. l' lOtHH ate � �v • BY Title c } DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # �"°�- -�� WELL LOCATION Street Address Town/Village/City Tax Grid Number LAI& 1--404/ /ed 0rig A�77;6e:r 41y / ' � 'L - WELL OWNER Name Mailing Address P6 -77Ae rd / oTrivate O Public USE OF WELL i>- primary 2- secondary .9 RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION U INSTITUTIONAL O STAND -BY 0 ABANDONED O OTHER (specify, O AMOUNT OF USE YIELD SOUGHT -r gpm / #i aD /EST. OF DAILY USAGE �6 Sal ❑ REPLACE EXISTING SUPPLY O TEST /OBSERVATION M ADDITIONAL SUPPLY WNEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING X/r' w WELL TYPE ®DRILLED ODRIVEN ODUG O GRAVED 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES °,j/ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: W-//j LOCATION SKETCH H& SOURCES OF CONTAMINATION PROVIDED �vr SEPARATE SHEET (date) (si ature) PERMIT TO CONSTRUCT A WATER WELL This permit,to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department During all well drilling operations, the applicant shall take appropriate ;action to assure that any and all water or waste products from such well drilling operations be i:ontained on this property and in such a manner as not to degrade or otherwise costa surface or groundwater. Date of Issue : — � 19 Date of Expiration Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg;. Insp. Orange copy: Well Drille, DANIEL J. DONAHUE, P.E. - x CONSULTING ENGINEERS 120 Breckenridge Road Mahopac, N.Y 10541 914- 628-7576 September 6, 1995 Putnam County Department of Health 9 Geneva Road ` Brewster, N.Y. 10509 Att': Wm. Hedges RE: SDS - Renewal Property of Donald King Mountain Road Patterson Dear Mr. Hedges: As you may recall, upon filing for a permit renewal for the above captioned permit, you requested that the sewage disposal- system be. redesigned with trenches in order to comply with , present - st-anda- rds_;- - -' - Enclosed please find for copies of construction drawings revised to provide for absorption trenches as the primary sewage disposal system and galleys as the expansion system. I hope this meets with your approval. /I c e. 60 :S 1,11 Z' : 5 dpi `t V a Al 10 U Site • Sanitary • Environmental I DANIEL J. D.ONAHUE, P.E. CONSULTING ENGINEERS 120 Breckenridge Road Mahopac, MY 10541 914628 -7576 <1 151�' /1 G /Z,/'C c 154 /'AI /-, le;j-,O r f, w ,C !/" Site • Sanitary • Environmental P/88 one -77, Fete'. 2) that the dillilid Well dOMM" 4160VO i�� 'rims end. r4-UST097— of, the. PoAnim lCon I so 'No T of tile building haj lbeen u nd"ken and 'is Any Oiling@ ou ilt'41`86011 of, Construction T.Itill �-2 DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL �"'Z PCHD PERMIT # WELL LOCATION Street Address Toyn Village City . Tax Grid Number /�A' - 2�_ WELL OWNER Name d Mailing Address A/ /.IV c./ k/ A iD �� U � rivate Public USE OF WELL �- primary 2- secondary RESIDENTIAL D BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP 0 FARM 0 TEST /OBSERVATION M INSTITUTIONAL O STAND -BY O ABANDONED 0 OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVE EST. OF DAILY USAGE4�al 0 REPLACE EXISTING SUPPLY - O TEST /OBSERVATION Q ADDITIONAL SUPPLY NEW SUPPLY NEW DWELLING)- 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING vR/V WELL TYPE DRILLED [DRIVEN ODUG DGRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? -YES. _�NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot.No. WATER WELL CONTRACTOR: Nam-Pt' �F %TNP k2 <�S=F�� Address IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES __NO NAME.OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ®ON SEPARATE SHEET A1.141 f 3 (date) (sign X,( rte atu -'-�/ PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code; and provided that within thirt }� (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is.clear. . 2. Disinfect the well in.accordance with the Department attached to this permit.. 3. Submit a Well Completion Report on a form requirements of the Putnam County Health provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: Q 19 Date of Expi ion 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pi copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller DAQUINO and DONAHUE CONSULTING ENGINEERS ❑ John V. D'Aquino, P.E. Daniel J. Donahue, P.E. 314 Oscawana Lake Road 200 Breckenridge Road Putnam Valley, N.Y. 10579 Mahopac, N.Y. 10541 914 -526 -2039 914- 628 -7576 To DATE .. JOB NO. ATTEN I N RE: N / • w w l .4 .r 4c/h�z �G �� �r ,� ✓ TG WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans O Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION l .4 .r 4c/h�z �G �� �r ,� ✓ TG THESE ARE TRANSMITTED as checked below: Forte approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ — ❑ FOR BIDS DUE REMARKS 4� /t ID 19 4 L- fit/ A L- f /4 • Resubmit copies for approval • Submit copies for distribution ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US * NF4J/1P 4f Af r A/ A1 lv UL /0 FI-6T A IT Zr COPY TO SIGNED: RV G154 Gr / L C /V a T A .4 .r 4c/h�z 4f Af r A/ A1 lv UL /0 FI-6T A IT Zr COPY TO SIGNED: MAI�ost�sdMAMx.T 1t�S11 �/iaarbPtiwltLlWit/ m cmww►!E OPCompumm 00'MMUCUM Often' !G: UWG IPML slate[ P"4 ,v v/ ViEw WON • Nddbftoi NNW I - • Data of Pra... MWftAftm houfY?t.& d vision F e Enclosed ❑ fw .i 2/• -ca Aff t 9 L. Depth 3 M E =01 b . �or d riwr.,_ ,,�� �- ,— DMdp FIRS' G P D.. - _ afb" h --- . Wr FIR aid s.P.At. lo.al. Syw• to asomm 1- d Game SOP'& Tos „a 4 Q G, �' �� %�!G /�GG� Y .¢A[ 4L IN IND aa.Mebi yTlJ Water SIP* Ddii 4ft9_d��+ . 4. .;.. t.-T� that � an w1gMy ana t. --4 <LL • :'r�.t.�.w ..r�...: -s... „ .—• � ',}- -ti -_1�N�t� tai t11a '...v a +. . -.. +R • agora t♦gw�a t. WIN w oonitwetad as ttiow� an tM n ens toeagon aN _the Proposed sYrtMKO i) that the aoworw +nN"Inent tnwa to and to 'i county Domer"Ment aiMa ate t1 � aw that Ow`aomIP A we tua►aot a "CartNtnt� .ra..e ..�.._ np wRn the ffan0�1; ruNS a� (�//��. .,r ] 4 ..+--. y 4 "�)1 /'�• lit / 40,6 100* low. Lz- y ✓. '. DEPARTMENT OF 1-ALTH APPENDIX P • Division Of Environmental Health Services • TWO COUNTY CENTER – CARMEL, N.Y..10512 (914) 225 -3641 APPLICATION TO ABANDON A WATER WELL PLEASE PRINT OR TYPE .. '_." —�' —_- : • '. •. � ;�� r:� , 91Hccl AUUHU6. lu"N /VILLAIa'alY 1Ax GRIU NuiIiia, TELL LOCATION / %?o 1/00414 y /fw l?d Pq ji0s -JO'n - 4'/ - NAME.. AGURSS. • pg(VATE WELL OWNER Don Ring, 1n#v,4 &!j I c� �Pd ' p�t�`rddn %VA If PUBLIC WELL TYPE DRILLED DRIVEN' DGG G GR,�VEL � OTy = R DEPTH DATA 444 -AbQ 4 NVt16 — WELL DEPTH ft. STATIC WATER LEVEL - . ft.I DATE MEASURED — 1SE OF WELL O RESIDENTIAL O PUBLIC SUPPLY O AIR /CONO. /HEATPtIMP G ABANDONED 1 - primary O BUSINESS • O FARM O TEST /0115ERVooN O BOTHER (specify) 2 - secondary p INDUSTRIAL O INSTITUTIONAL _O _,TANWY LATER WELL Na.Ttt2: address : / ,I � :ON7TR_kCTOR: / /I ( ri 9i k 0Wa ;EASON FOR ^ 11 f G/G �� Ah ��I'G•L,I dh•t a�OG� j/ _BANDONMENy : e�04co !A� G T /it b �d )ESCRIPTION OF WORK ��(,� �'�i L 7 6 IQ .4'A'- " 'o 4 lV FO f• A . 20 BE PERFORMED: `p dOp Rf (��1e'�/'iC�eT.!' date) _ J (sig u e) - - -- - - -.. PERmiT This permit to abandon one water well as set forth above is granted under.provisions - of Subpart 5 -2 of'Part 5 of the New "York State Sanitary Code and provided that: Within 30 days of the completion of the abandonment-of the water well, the applicant shall submit to the Department a certified statement that the information delineated on the application for this permit has been completed.• Date of Issue: ; :Permit .Issuing O icy 23 �i D'AQUINO and DONAHUE CONSULTING ENGINEERS D John V. D'Aquino, P.E. , i Daniel J. Donahue, P.E. 314 Oscawana Lake Road 200 Breckenridge Road Putnam Valley, N.Y. 10579 Mahopac, N.Y. 10541 914 -526 -2039 914 -628 -7576 TO DATE w / � JOB NO. ATTE �N� - , ezeo G RE. rn iL° 2 d iL _ WE ARE .SENDING YOU ❑ Attached ❑ Under separate cover via the following items: • Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications • Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION iL° 2 d iL THESE ARE TRANSMITTED as checked below: 94—or approval ❑ Approved as submitted ❑ For your use O Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ ❑ FOR BIDS DUE • Resubmit copies for approval • Submit copies for distribution • Return corrected prints 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO r SIGNED: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date 5�� 4-13 Re: Property of �nAlk& d-D Located at *-V (T) /�d�/ef(�l� Section Block `� Lot Subdivision of Subdv. Lot # Gentlemen: Filed Map # Date This letter is to authorize p 1,��� �/-v ¢- J%G,j *` 4�4ti,l a duly licensed professional engineer — r registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by, the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems -in,conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned: P. E. , R. A. , # Address ±i2 1017z- Al�' Telephone Very truly yours, Signed Owner of Property Address Town Y-7ip --C'7 /b' Telephone "pUTNAM COUNTY DEPARTMENT OF HEALTH - ` Dlvbdoo of Envteonmentel Health Servkes.`Ceemel. N:Y 1051? Engineer to Provlde,Pecml on CERTIFICATE OF CO .:. • CONSTRU . N PERMPP FOR SEWAGE DISPOSAL SYSTEM. ®.. Iacslted (1 q G :e "Town or Village, ; Subdivision Name Sabd. Lot b Tax Map lock Lot c Renewal ❑ Revision ❑ Owner /Appllcant Nerve / Date of Previons Approval Malft Addie 1! e' (jYA T"la *1 etc+' /[ o j Town-& f�Cr� U �j Zip Sallding Type L�[ild ft ! G Lot A !, D QGr.� Fm Section OuIY Depth Vointne. Number of Bedrootns Design Flow G P D V FCOM Notilicadon is Required When Fill is completed 6,1 ��CC'' Separate Sewerage Syetetn to consist of Ol)!V Gallon Sepik Teak aad �_/'/ It J G t t1 t To be' contracted by - 71715 d Q R f�e ']�e/ h'i i n 'L Address Water SnPPI': Public Supply From ,Address ort Privaie Sumly DrNed by!&k a / 6AK/44 ',tG ddim Otholr Rendkemente I represent - that -1 am wholly and.completely responsible for thedesign.and location of the proposed system(s); 1) that the separate,sawaie disposal Sr; above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regulations o � e u County Departrent of .Health;' and that on completion tliereof:a "Certificate of con struction' Compliance "'satisfactory to the Commissioner of Healthwill , be submitted to the Department, and a written guarantee' will be furnished the owner, his successors, heirs of assigns by the builder, that said builder v4i11• Place in gootl opeiatinq condition any part ob said, sewage disposai system duri the period of two (2) years Immediately following the date of the`•issu• " once of the approvai-of the Certificate of Construction compliance of the orl 1 system or any _ rep irs'thereto; 2) that the drilled well described above' ivtll be located as shown on the approved plan and that said well will be installed ` ccordAnce th andaids, rules d regu a .ons> of . the ,' Putnam County Department f Health. Date Address G/C en License No ° /IV• APPROVED -FOR CONSTRUCTION: This approval expires A'. the Aate issued n ass construction of the building his'been .undertaken and is revocable for rouse or may be amended or modNied when onary y the isiioner of Health. Any change or alterot on of construction requiresra'n w'per t, proved for disposal of dom slit ge and /or or 'supply only. Rev. / /tq/�� 1/87 Date By Title ` M3 1 DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX .CENTER, CARMEL, N.Y. 10512 (914) .225 -0310 APPLICATION TO CONSTRUCT A WATER WELL Q/ y PCHD PERMIT # / WELL LOCATION Street Address Town/Village/City Tax Grid Number t� h Q i a tau -er d r0 — J_ WELL OWNER Name Mailing Address a 49 AUVA441.1 ew er ' APrivate O Public USE OF WELL primary - secondary WRESIDENTIAL O PUBLIC SUPPLY O BUSINESS O FARM O INDUSTRIAL U INSTITUTIONAL Q AIR /COND /HEAT PUMP O TEST /OBSERVATION O STAND -BY O ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT _gpm /# PEOPLE SERVED 7M. OF DAILY USAGE Q gal O REPLACE EXISTING SUPPLY O TEST/ OBSERVATION GIADDITIONAL SUPPLY WNEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING W LL REASON FOR DRILLING DETAILED REASON FOR DRILLING yr r 4; 4 Ic Fr S u -7 r i,, WELL . TYPE DRILLED ❑ DRIVEN []DUG. C] GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES _ X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME.OF SUBDIVISION: Ill® Lot No. WATER WELL CONTRACTOR: Name rz JP Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES Y—NO NAME OF PUBLIC WATER. SUPPLY: TOWN. /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: /t 41 LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED 0000 ,ION .SEPARATE SHEET d U ( ate) (signat e) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well d 'ling perations be contained on this property and in such a manner as not to/�de rade or ther contam a e surface or groundwater. Date of Issue: 19 vC Date of Expiration 19 it Issuing Official Permit is Non - Transferr ble White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller PUrNAM CCUM Y DEPARTMENT OF HEALTH ' DIVISION OF ENVIRCMMM HEALTH SERVICES APPENDIX I DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTR4 FILE NO. owner D c h a/ Address 6U#1441." V/ B au Rd Located at (Street) ¢ / Sec. Block Lot (indicate nearest cross street) Municipality Fa T4,erc o rl Watershed N, e(::, SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBmI= WITH APPLICATIONS Date of Pre - Soaking L26166 Date of Percolation Test w/341f 0 ?,3 3 3 4 / /� /�. °a �0 �� 3 EOLE 5 NUMBER CLOCK TIME PERCO=CN PERCOLATION Run Elapse . Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min/In Drop Inches Inches Inches 1 a3 3 3 2f / 4' 14 V- '" sz 3// // f� �o ?,3 3 3 4 / /� /�. °a �0 �� 3 5 2// 03 3 /oZ 1 2 3 use Min %in 4 5 - N=: 1. Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to* be submitted for review. 2. Depth measurements to be made fran top of hole. rev. 9/85 TEST PIT DATA OF • ENCOUNTERED IN TEST HOLES DEP'T'H HOLE NO. HOLE NO. Horz N0. a G.L. 1' .. 21 3' 0 4' ,! s ►l 1 5' 6' 7' 8' 9' 10' 11' 12' 1 14' INDICATE LEVEL AT WHICH GRWNDXNTER IS ENCOUNTERED' N b Al INDICATE LEVEL` :M WHICH WATER LEVEL RISES AFTER BEING ENCOUN'T'ERED p �.- n ,t .3 d q p DEEP HOLE OBSERVATIONS MADE BY:,, OlFA d , Da- 4 � �, DATE: I� DESIGN Soil Rate Used $' /y Min /1" Drop: S.D. Usable Area Provided No. of Bedrooms 3 Septic Tank Capacity Z66 U gals. Type Absorption Area Provided By L.F. x 24'' width tren �OFsSIOy;�� Other iv t l G Name /,y� / (� b� �. Signature Address 0200rtc�'�a SEAL ?� �. V OF r4 THIS SPACE FOR USE BY HEALTH DEPAR24ENr ONLY: Soil Rate Approved sq.ft /gal. Checked by Date &6,DDAQUINO and DONAHUE NSULTING ENGINEERS John V. D'Aquino, P.E. Daniel J. Donahue, P.E. 314 Oscawana Lake Road 200 Breckenridge Road Putnam Valley, N.Y. 10579 Mahopac, N.Y. 10541 914 -526 -2039 914- 628 -7576 WE ARE SENDING YOU Attached ❑ Under separate cover via_ ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ L[EMEI3 OF UMMMOMODUM DATE ^ JOB ND. ATTEN TI G lje✓ /�'Z�lri �" �•, RE. p x ' .JDs✓ �� •. �r�l�i the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION Gv -e � 17 THESE ARE TRANSMITTED as checked below: !ty For approval El Approved as submitted �J ❑C For your use ❑ Approved as noted • As requested ❑ Returned for corrections ❑ For review and comment ❑ _ ❑ FOR BIDS DUE 19 • Resubmit copies for approval • Submit copies for distribution • Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US f%S okc d r,& Iq L. () 14/1 � .0'" 4 i t Jt /o f-1 COPY TO SIGNED: Ati` If enclosures are not as noted, kindly notify us at once. or - --------- -- 7' Av- A- - - - ------- e4-4 11,A.-k - --------- no DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 Daniel Donahue 200 Breckenridge Road Mahopac, New York 10541 Dear Mr. Donahue: JOHN KARELL Jr., P.E., M.S. Public Health Director January 25, 1991 RE: Proposed SSDS King Mountain View Road (T) Patterson TM #1404022 A field inspection was conducted by the writer on January 23, 1991. Comments are offered as follows: 1. The stream on the adjacent property appears to be .. within 100 feet of proposed SSDS. This stream is to be shown on plan. 2. The adjacent existing well appears to be indirect line of drainage to the proposed.SSDS. 3. All existing and proposed wells within 200 feet of the proposed SSDS are to be shown on the plan. Upon receipt of submission revised to reflect the above comments,.this application will be considered further. V truly yours, Robert Morris Assistant Public Health Engineer RM:mk t'. . DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 January 16, 1991 Mr. Dan Donahue Breckenridge Road Mahopac, New York 10541 Re: Proposed SSDS: King Mountain View Road (T) Patterson TM #14 -4 -22 Dear Mr. Donahue: JOHN KARELL Jr„ RE, M.S. Public Health Director Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: An adjacent property owner, Ronald Braun, stated his well and a stream is not shown on the plans submitted. Please contact this office at your convenience, to address the above comments. RM/ j p I)A' 0 T e Ver ruly yours, xh'd/ lt� Robert Morris Assistant Public Health Engineer eAL,(- F_ 0 W IC, 0 aq- `S(UAr" Lt-.l t S .10 A 0 D STA t �occ L - 1 pd� 'knit) p I pED yr Vie. .D P D'AQUINO and DONAHUE CONSULTING ENGINEERS ❑ John V. D`Aquino, P.E. 4 Daniel 3. Donahue, P.E. 314 Oscawana Lake Road 200 Breckenridge Road Putnam Valley, N.Y. 10579 Mahopac, N.Y. 10541 9174 -526 -2039 914 - 628 -7576 TO I°a % Vv A;., Car» �j die _, WE ARE SENDING YOU V Attached ❑ Under separate cover via ❑ *Shop drawings 0 Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ DATE / %/ JOB NO. ATTENT O e �.r E. 'D As requested For review and comment ❑ . the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION THESE ARE TRANSMITTED as checked below: REMARKS COPY TO • For approval • For your use �0 As requested For review and comment ❑ . FOR BIDS DUE 294 6 /d I'Le d JC r C_ r • Approved as submitted • Approved as noted ❑ Returned for corrections ❑ _ • Resubmit copies for approval • Submit copies for distribution • Return corrected prints 19 ❑ PRINTS RETURNED AFTER LOAN TO US 4 °7/ !//h¢Gr/'X, d,b — - /I►✓✓ �'' /r7,Yl Y7'Y�v �r/d//l ,F 5—f 41'r�67�� 4-D SIGNED: If enclosures are not as noted, kindly notify us at once. 2 December 19, 1990 Mr. & Mrs. Rudolph Muck Mt. View Road Patterson, NY 12563 Re: Department of Health Review of Proposed Sewage Disposal for Property Name: Donald King Address: Mt. View Road Town: Patterson Tax Map: 14 -4 -22 Dear Mr. & Mrs. Muck: Please be advised that an application for a Construction Permit relative to the construction of a sewage system and well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call Mr. Hedges or Mr. Morris of the Health Department at 225 -0310. ry ul y yours, Donald G. King RECEIVED BY: Address:,;,? lq-/- U, Ow U aeon AIVIA5z 3 Tax Map: 14 -4 -4 December 19, 1990 Mr. & Mrs. Charles Krasinski Mt. View Road, Box 265 Patterson, NY 12563 Re: Department of Health Review of Proposed Sewage Disposal for Property Name: Donald King Address: Mt. View Road Town: Patterson' Tax Map: 14 -4 -22 Dear Mr. & Mrs. Krasinski Please be advised that an application for a Construction_.Permit relative to the construction of a sewage system and well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. I If you have any questions, concerns or information which may bear on the Health Department's review of this applicaton, you may call Mr. Hedges or Mr. Morris of the Health Department at 225 -0310. Ve my yours, Donald G. King RECEIVED BY: Address: &j Tax Map: 14 -2 -5 0 December 19, 1990 Mr. Enrico Capari & Ms. Megen McCormick Mt. View Road, Box 266 Patterson, NY 12563 Re: Department of Health Review of Proposed Sewage Disposal for Property Name: Donald King Address: Mt. View Road Town: Patterson Tax Map: 14 -4 -22 Dear Mr. Capari & Ms. McCormick: Please be advised that an application for a Construction Permit relative to the construction of a sewage system and well proposed for the captioned property has been made to the Putnam County Department of Health.. Attached please find a copy of the latest site pl.an. If you have any questions, concerns or information which may bear on the Health Department's review of this applicaton, you may call Mr. Hedges or Mr. Morris of the Health Department at 225 -0310. Very ly Donald.G. King ". I A December 19, 1990 Ms. Kathleen H. Blaun Box 275 Somers, NY 10589 Re: Department of Health Review of Proposed Sewage Disposal for Property Name: Donald King Address: Mt. View Road Town: Patterson Tax Map: 14 -4 -22 Dear Ms. Blaun: Please be advised that an application for a Construction Permit relative to the construction of a sewage system and well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any questions, concerns or information which may bear on the Health Department's review of this applicaton, you may call Mr. Hedges or Mr. Morris of the Health Department at 225 - 0310. V y my yours, Donald G. King �SENDER ..Complete r. erris 1 and 2 .when additional services are - desired, .and complete items: z . 3 and`4. Rut yoyr address in the RETJRN TO °Space en "the rever sa side: do.this yy�ll p4e ant this card from being Yetumed- to.you. The returri r if e rovitl e nam 1e kJ rs eliVfSped>te'snd : } the date of deliver For, ad rtiona ee o, o rrxQt t erutc�sRe2 ar a nFt postn5asis es and o,ec,k boxles) for additional sere sb reytyre�ted r Q ice' °* C7 °`Show to whom delivered, d e ass `s a8i3res 2.R�strcted�F?elivery jFxtra c $ P1. fEzria ehor & 3. Article Addressed to ��`' yPe uf'sewrce.. D= Registered F] Insured (�Certrfigd COD Return Recei "t (, /(7� Q, Express Mari . ,Q for.Merchao Ise o;s'o:4 /L S Nor, f T �' Alu_yays obtain signature of addressee or. agent and DATE•DELfVERED. ( ign r �— AOdR ss ee 8 : Addressees Address ( Y r j iC, regyesied and fee paid) . . f .Signature —. Agent j 7- 'Date of Delivery" L)tt'HK 1 MtN 1 Ut- K- ALTH APPENDIX P < • Division Of Environmental Health Services +.' TWO COUNTY CENTER - CAPJAII, N.Y.. 10512 (914) 225 -3641 • APPLICATION TO ABANDON A WATER WELL - PLEASE PRINT QA TYPE •• .' - -- , � - -_ •. •. SINiii AMUS. WELL LOCATION / 14oivt41,1vltwr?d NAME. WELL OWNER D on � WELL TYPE � DRILLED DEPTH DATA I WELL DEPTH A IU1�N /IiI�L�1li'uUIY PA fl organ - . AGOR s. nj tol A0 a 1/1 ljv AN D R I J =N J Dix 11:.1 GRID Numikil -r A4 ;r/ 40- Vdh y - PSIVATE IJ IUBL1C !; k4lena �,! h 4 Nt .16 ft. I STATIC WATER LEVEL • ft.I DATE MEASURED USE OF WELL 0 RESIDENTIAL'` ". 04 PUBLIC O AIR /COND.l Pi1MP G ABANDONED 1 - primary 0 BUSINESS r; O•-,7FARM D TEST /ORgRvATIoN r 3 BOTHER (specify) 2 - secondary Q INDUSTRIAL'~ ~`:`'' f Ia Z (NS.IITUTIONAL -O STAND/BY 1 WATER WELL CONTR�ICTOR : Name : � / .h �Addres s : REASON FOR ^ �eI EGG tO%9 p f W-� �� ®n �ki'G C .I aht 4 AD C_& r1.3ANDONMEN� DESCRIPTION OF >i:ORK toe/ ELL 7 iv DD F10 p Fi? . !y y. f Q r0 BE PERFORMED: S!;11/tT1ti�`! cave R' �rJ�it'EM7.0 ( at ")" - _ (sin tune PERMIT This permit to abandon one water well as set forth above is granted under. provisions- of Subpart 5 -2 of'Part.5 of the New'York State Sanitary Code and provided that: Within 30 days of the completion of the abandonment-Of the water well, the applicant shall submit to the Department a certified statement that the information delineated on the application for this permit has been completed...... ' Date of Issue:- - Y:Permit .Issuing official 23 libCONSULTING ENGINEERS John V. D'Aquino.�E. 3l4Cwom*unu Lake Road Putnam Valley, }JI 10579 014'k6'2080 December 6, 1990' Robert Morris Assistant Engineer ' Putnam County Department of Health 110 Old Route 6 Carmel N.Y. ' RE: Proposed SSDS Property of King Mountain View Rd. Patterson (T) ` Dear Mr. Morris". Daniel l Donahue, �E. 20N Breckenridge Road Mubopuo N.Y.lO541 014'628'7576 The following response to your comments is in the same order as they were presented: ' 1. Neighbor notification will be completed upon acceptance of our plan. 2. A letter from the building department is enclosed. 3. As per your request, the house plans have been revised accord ingly.(��^'u - . // 4. The 4 x 4 note has been removed. «°aw���/ 5. Application to abandoned well enclosed. 6. One foot of fill now shown in the area of the ssds. 7. Deep test hole data noted on the plan. 8. There is a note on the plan making reference to the location of adjacent ssds and wells. 9. The dosing volume has been adjusted. 10.The pump pit details are now shown on the plan as well as the alarm location. 11.The pressure line has been relocated. The above responds to all the comments listed in your November 19, 1990 letter. I have enclosed four copies of the revised plan and would appreciated a response as to their acceptability in order that we may commence public notification. ;9:%14 Daniel J. Donahue, P.E. Site 0 Sanitary 0 Environmental JOHN N. CALBO Building Inspector TOWN OF PATTERSON PUTNAM COUNTY PATTERSON. NEW YORK 12563 November 30, 1990 To Whom It May Concern; Property owned by Donald & Joyce King, Mountainview Road, ris in a' 1 .(.one). acre zone. Mrc`,K.ing "Ka4,'1.060 acres which meets the Town of Paf•terson zoning. 4 •• =` Yours truly, JNC /cs if Ir i. 4 1 '4 f� � � ; - John N. Calbo Building Inspector ol 1 b�bNllVlld 878 -6319 PETER C. ALEXANDERSON County Executive Mr. Dan Donahue Breckenridge Road Mahopac, New York 10541 Dear Mr. Donahue: DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225-0310 November 19, 1990 Re: Proposed SSDS: King Mountain View Road (T) Patterson TM #14 -4-22 0 JOHN KARELL Jr., P.E., M.S. Public Health Director Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: �1 Neighbor notification is required (guidelines enclosed) ✓2. A 1 tter from the building Department of Patterson is required stating the above lot is a 1 building lot. �` ew York State Sanitary Code requires that studies, dens, etc. be considered as potential bedrooms. Therefore, the SSDS should be based on a four bedroom design. 4. Remove 4 x 4 noted before tri- galley on plan view. t 2 Application to abandon a -water well has not been submitted. V °• Deep test holes should be a minimum of eight feet in depth if fill is not proposed. Design data sheet shows deep test holes are seven foot deep. This would require one foot / of ROB fill. ��/ Deep test holes results not noted on plan. . All existing and proposed wells within 200 feet of proposed SSDS and all existing and proposed SSDS within 200 feet of proposed well are to be shown on plan or a note stating // none exists. __/9, Dosing volume of pump pit is 64 gallons. Utilizing tri- galleys, the dosing volume should / be 100 gallons or greater. Revise accordingly. r 10. Pump pit details not noted on plans: Audio - visual alarm required and overflow capacity, i.e., one day storage capacity above the alarm level is to be provided. ✓11. Pressure line is shown running through proposed SSDS. Revise showing line circumventing SSDS. Upon Receipt of a submission, revised to reflect the above comments, this application will be considered further. Ve�ay) truly yours, `Robert Morris Assistant Public Health Engineer RM /jp PETER C. ALEXANDERSON County Executive Mr. Dan Donahue Breckenridge Road Mahopac, New York 10541 Dear Mr. Donahue: DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225-0310 November 19, 1990 Re: Proposed SSDS: King Mountain View Road (T) Patterson TM #14 -4 -22 JOHN KARELL Jr., P.E., M.S. Public Health Director Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: 1. Neighbor notification is required (guidelines enclosed) 2. A letter from the building Department of Patterson is required stating the above lot is a legal building lot. 3. New York State Sanitary Code requires that studies, dens, etc. be considered as potential bedrooms. Therefore, the SSDS should be based on a four bedroom design. 4. Remove 4 x 4 noted before tri- galley on plan view. 5. Application to abandon a water well has not been submitted. 6. Deep test holes should be a minimum of eight feet in depth if fill is not proposed. Design data sheet shows deep test holes are seven foot deep. This would require one foot of ROB fill. 7. Deep test holes results not noted on plan. 8. All existing and proposed wells within 200 feet of proposed SSDS and all existing and proposed SSDS within 200 feet of proposed well are to be shown on plan or a note stating none exists. 9. Dosing volume of pump pit is 64 gallons. Utilizing tri- galleys, the dosing volume should be 100 gallons or greater. Revise accordingly.. 10. Pump pit details not noted on plans: Audio - visual alarm required and overflow capacity, i.e., one day storage capacity above the alarm level is to be provided. 11. Pressure line is shown running through proposed SSDS. Revise showing line circumventing SSDS. Upon Receipt of a submission, revised to reflect the above comments, this application will be considered further., Very- truly yours, "Robert Morris Assistant Public Health Engineer RM /jP APP- rNDIJY 3 y P;71_- A-I CGUNLY C "I' CF F=,LTa - D.IVISICN CF E-haUT-H S =-T 1 L -L its SUPPLY & Sm-gU 1- AC✓ SEA C D,_SrCL-1 r, S'-117S7EMS cz C,. er) (:t=G Lo.:`tzon) CUIMEN S { Y _S NO DCi D- S :' .- 'S I I Pe--mit Arml i cat ion Corporate Resolution I Plans -.Three Sots I V1.1 F -ng;.1 ers Authcr-iZ. t?C:1 AIA I I Design Data Sheet - ) Deep Nola Lx, S/s Cons =s z t Parc R=su l- (� ) Pero tole Ceot_h S ICN c House Plans - Two. sets jt'e_i 1 p- -^ -I-t; Legal Sncc> =_S on Suba vision Azo_oval Chacz_3 Fx- acprcval SSDS Ad. . Lots Checked -Ketla d (T--,.,-, /D=C Pe:;mit R & D) rata On DDS Plans & -t e--mi-i t Same R= QliIlRED D=-A-1 1 ON P, .�N-S Sewage System Plan - (nort -1 a=ro ) Serwa is Sys-, Cj Ul iC � =J.?1e F` 1 P_of i le & D_. =n. S_c,-, s - Vo1L, e D or J Box;Trencn /C-al' e= y; pit I Saptic Tai < - S-ze, 1P_ail,, -v_ce Ti la over Corst_=-2cticn Notes (g= -er rate) Design Catty,.: _rrc lee; r =s': =s T•iYti -i oJL Con LJL:- s -... -� & Pr opcC a Driveway & Sloc -s Cat ro0i 1°7_%Ci tter,0,2-rtai n Drains (disc .= -=- l){) P=-,-t-c: & Deep .soles Low =.e3 Representative of pr?iT J a--id i E` �c'lsi on Area; s- o;4-z; gr_v ty flos, S .. size If PL---,--d Pit & D Sox Shown & Det= i .;.•.:. House - No. of Be rooms tti'e_�1S & SSDS'S '.J /11 2�� ice. O- t�rc_JC - -- =jam °iS Property 'Mzetas & Bounds F:O -'Se 5 = ✓ =C:{ ecessary (Tighe. lot) House SErher - 1/4 � L. e "O; 1 r �e pi_ No Be^.�is; i•; Bends -^_5° w /cle�-lout S`aaap -TION DIS="_ -=- - SP `?=1-ON PLAN Fields . 10' to P.L., Driver�a�-, L=-ge Tree`,'.-- -f fill 20' to Foan,—'aticn c•;a11s 100' to Well; 200' in D.L.O.D, 1500' _S 100' to Str =am, Ttia te- co,?-se, -J--a (_ 10' to r�-- LL -i 15'LC C.LCiI -- I I Pre--1969 I I Nei bor noti icat I I I I LF trench provided =e:'L?1_"e3 60 %t. max. a_el1 _1 to '100% exo. I I I I I I /( I ✓C I I ' I I FILE, SvS -IDS I cla�-� arri r I 10 it. /71 I rill note I I P_°iJ SY'. deoth cauges I I I 100 vr. flood elev. I ' I I' 200 ic. reservoir, etc. ' _ 150 rz. c_? ,�- =?1. I i _ I I 10 to Eater Line (pits -20') 50' ir_LLe_-4r,i ttent c__ir =ca course S =)tic Tanks 10' frar, Foc-�cation; 50' �o we_1 1S' Well to ?r o i ` 0 Re: Property of Rev,,,. d L Located' at Rev, /.7 14 Crk. (T) 104 iel-r& Section Block Lot Subdivision of�.�} Subdv. Lot # Filed Map # Date Gentlemen: This letter is to authorize a duly licensed professional engineer or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my.. behalf in connection with this matter and to supervise,the'construction of said system or systems in conformity with the provisions of Article 145 or. 147-, Education Law, the Public Health.Law, and the Putnam County Sani- tary Code. Very truly yours, r Signed Countersigned: Owner of Property ff - U, , R P.E. , R.A.., # �.��� Address - 2 e f' -Ci f'9��r Address Town Telephone` Telephone f PETER C. ALEXANOERSON County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225-0310 October 31, 1990 Mr.. Daniel Donahue, P.E. -200 Breckenridge Road Mahopac, New York 10541 JOHN KARELL Jr., P.E. Director Re: Application: King Street: Mt. View Road- Town: Patterson Fee Due: Additional $25.00 CERTIFIED CHECK/ MONEY ORDER Dear Mr. Donahue: This department is in receipt of the above referenced project. A review of your application will not be made until this. office receives the required fee. V y trr ly yours, John Karell Jr., P.E. Public Health Director / X41 By: Christine o n Intermediate lerk JK:CJ Receipt is acknowledged of $125.00. The fee is $150.00. ,r DAQUINO and DONAHUE CONSULTING ENGINEERS ❑ John V. D'Aquino, P.E. Daniel J. Donahue, P.E. 314 Oscawana Lake Road 200 Breckenridge Road Putnam Valley, N.Y. 10579 Mahopac, N.Y. 10541 914 -526 -20339^9 >> 914 - 628xr7576 � �� TOu'� C.� ✓n Tom/ �� T cr�� _ WE' ARE SENDING YOU ❑ Attached ❑ Under separate cover via [LIETTIEM O1F 'TRUS010cTUaL, DATE � � J09 NO. ATTEN TI pd L L RE. ' Tr /�c4� 1j1r spy � L j-G e._ • dR . Pa Lrci" . ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Copy of letter ❑ Change order ❑ the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION LL__ e0ltS Gam` � `r' /dfJ ('C e• -L- f tom' J. THESE ARE TRANSMITTED as checked below: xFor approval ❑ Approved as submitted • For your use ❑ Approved as noted • As requested ❑ Returned for corrections ❑ For review and comment ❑ _ • Resubmit copies for approval • Submit copies for distribution • Return corrected prints ❑ FOR BIDS DUE // 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS ))"r- d ✓ "r1i` r d �i"� s J I l •4 f! :1' 1) ! l'l m fir✓'& G ry t a -L� __ COPY SIGNED: If enclosures are not as noted, kindly notify us at once. c 04 m Z, m > 0 z T I Tl.N, . . . . . . . . . . . . . . . . j (01 al 04 m Z, m > 0 z T I Tl.N, . . . . . . . . . . . . . . . . j 04 m Z, m > 0 z T I Tl.N, .' 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