Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0724
DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23.13 -1 -6 BOX 8 00724 {�` .. .� 00724 PUTNAM COUNTY DEPARTMENT OF HEALTH J TIJ DIVISIO N OF ENVIRONMENTAL HEALTH SERVICEICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM P14,111) CONSTRUCTION PERMIT # JI Located at 9,corF_ 311 (OLoyaxAr Village Owner /Applicant Name Euc4j O &LJMJP,S Tax Map 23,13 Block I Lot & Formerly Subdivision Name Subd. Lot # Mailing Address 19 DIES i a?_ L: l L,46�,Ac i wo g.,J ucx) c> -4' ( Zip I vSr Date Construction Permit Issued by PCHD ii /a qlo q .ip.r�ES &A.0 iA��c> 3-i C�hr�ES Pto��Pt R te. Separate Sewerage Sxstem built by s;� Qv�Ttva c.�r►rnr -- ��� Address 3`(r, Consisting of love? Gallon Septic Tank and 4,3?_ F. or 2' wicg_� A-5So1,)-Pr),aA TRE yh Pomp C'A* ftlz (2i 2 GAS PP5c> � � (L-, ,a t 3 i=i ��-� "I ° cu ,2i74r, ..� D �-A► ►,J Other Requirements: Water Sup"I : Public Supply From Address + P,.rn,►arn MEL. or: Private Supply Drilled by Pr, BBL * 60115 _ ,,..1 c.. Address b7_e3 -,m z_ , rtY iosoc Building Type Has erosion control been completed?. V r= S Number of Bedrooms ' Has garbage grinder been installed? rJp 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 iswed CHD Construction Permit and approved plans and the standards, rules and reg e P epartment of Health. Date: Certified by P.E. X R.A. P' T' JkM FA- -,'# ►i5�R-l� FLI-e- (Design Professional) Address T ®uv Iz. om 6 _ B�tc►- SSrr�c a�(. 1asa�t License # oa 1446 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 subject to modification or change when, in the judgment of the Public Health Director, such revocatio .m dificati r change is necessary. B y. G' Title: !'— Date: i , r �Gf.� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 �i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Bear Hill Road Town/Village: Patterson Tax Grid # Map Block Lot(s) Well Owner: Name: Address: Euclid Antunes, 19 Westerly Lane, Thornwood, NY 10594 Use of Well: 1- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock _ Other Casing Details Total length 32 ft. Length below grade 31 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: X Steel _ Plastic _ Other Joints:. _ Welded X - Threaded Other Seal: X Cement grout _ Bentonite Other Drive shoe: X Yes No Liner _ Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield Test Bailed X Pumped X Compressed Air Hours 6 Yield 8 gpm Depth Data Measure from land surface - static (specify ft) 30' During yield test(ft) 140' Depth of completed well in feet 205' Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameteron) Formation Description ft. ft. Land Surface 5 Drilling in overburden clay and boulders Hit rock at 5' 5 32 Drilling in rock, set casing, grouted 32 205 Drillink in rock granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 7gpm Depth 160' Model 7GS05412 Voltage 230 HP 1/2 Tank Type WX251 Volume 62 gallons Date Well Completed 8/4/04 Putnam County Certification No. 006 Date of Report 10/5/04 Well D ' si nature) risto her Beal NOTE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. Well Driller's N F . Beal & Sons Inc. Address: 4 Putnam Ave., Brewster, NY 10509 ame Signature: - Date: 10/5/04 uiristopher White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 02/08/2005 TUE 17:19 FAR BRUCE & FOLEY Public Health Director Q1002/002 LORETTA MOLINARI R.N.. M.S.N. Amadlats Public Health Director D"cror of Patient Skm*es DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 ft0mammal Hesi1L (914) 274 - 6130 fox (914) 279.7921 Honing Sw#*es (914) 279 - 6S58 WIC (914) 299.6679 Fax (914) 278 - 6095 Early leler+eapea. (014) 279.6014 rnsel,00l (914) 279-6092 Fix (9 M) 276 - 6649 OWNERS NAME.- 41,44 TAX MAP NUMBER off- 3.13 `°- E911 ADDRESS: 3/1 kou-fx-- 3 1/ TOWN:�13 AUTHORIZED TOWN OFFiCMAL; (Signature) yam' DATE: The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assiped by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. . (691 I VERRIA) T .d sloe- 6G8 -Stla 0S8311Ud 30 Hnol ebZ c T T SO Go qad UT AM NGINEE�ING, PLLE. Eng/neers and Architects September 8, 2005 Robert Morris, P.E. Putnam County Health Department 1 Geneva Road Brewster, NY 10509 Dear Mr. Morris: I am enclosing for your review and approval 4 copies of this As -Built SSTS Plan, Drawing #AB -1, revised to include measurements from two corners of the dwelling to all trench ends in accordance with your February 22, 2005 comment letter. Please contact me at this office if you should require any additional information. Sincerely, PUTNAM ENGINEERING, PLLC Richard J. Z p RJZ /ea Enclosure (L05335) 4 Oro ROUTE 6, BREwsrER, New YORK 10509 0 (845) 279 -6789 • FAx (845) 279 -6769 o EMAIL: putnamengineeting @suscom.net 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 February 22, 2005 ii Insi Engirace urvey 3 Garr C Re: Proposed Compliance: Antunes Route 311 (T) Patterson, TM # 23.13 -1 -6 ROBERT J. BONDI County Executive N 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. Current code requires that the ends of all trenches are located and the dimensions from two points are provided on the plan. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:ky Ve l�y yours Robert Robert Morns, 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner. or Purchaser of Building ,%�►'rzx I�� Building Constructed by 31 l [Et zs _r- 3 1 l C. Tax Map Block Lot TownNillage Location - Street Subdivision Name 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 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: Z Day 1y Year 0'-f Signature: Title: Na=ZWtrKctor,(Owner) - Signature Corporation Name. (if corporation) Corporation Name (if corporation t_ - Address: t q LJT&5111s L/.(- )j Ls- Address: P 6jAW(9- 5;r —/VC4( YZt /s -T -4v PL, tjLcur7 I '2411-WL.i L-�C, State NY Zip State �j .r Zip Z Fomi GS -97 JMSEnvironmental Services, Inc: WATER, SOIL AND AIRAN LYSIS _J 41 Kenosia Avenue I Danbury, Connecticut 06810 1 Telephone 203- 798 -2229 Mailing Information: Collector's Information: Name: PF Beal & Sons Client: Euclid Antunes Name: Bob M. Address: 4 Putnam Ave Address of site: Barrett Hill Road City: Brewster City: Patterson State: NY Zip: 10509 State: N.Y. Zip: Telephone: 845 -279 -2460 Fax: 845-279-6613 Telephone: Sample's Information: Site: Date Collected: 12/14/04 Date Received: 12/15/04 Preservative: N/A Time Collected: 3:30pm Time Received: 2:00pm Temperature: <4C Filter: Lab No.: .10412374 Date Analyzed Test Name Result MCL Method 12/15/2004 16:00 Total Coliform Absent Absent SMWW 9222B 12/15/2004 Chlorine Free Residual <0.1 mg /L N/A SMWW 4500CIG 12/15/2004 Color ND 15 Units SMWW 2120 B 12/15/2004 Odor ND 3 TONs SMWW 2150 B 12/17/04 Iron <0.050 mg /L 0.3 mg /L SMWW 3111B 12/17/04 Manganese <0.050 mg /L 0.3 mg /L SMWW 3111B 12/17/04 Sodium 42.8 mg /L N/A SMWW 3111B 12/17/04 Chloride 143 mg /L 250 mg /L SMWW 4500 Cl C 12/17/04 Hardness 108 mg /L N/A SMWW 2340 C 12/17/04 Nitrate 1.48 mg /L 10 mg /L SMWW 4500 NO3E 12/17/04 10:00 Nitrite <0.1 mg /L 1.0 mg /L SMWW 4500 NO3E 12/1.5/04. - pH 7.02 S.U. 6.5 -8.5 S.U. SMWW 4500 H B 12/17/04 Sulfate 27.5 mg /L 250 mg /L SMWW 4500 SO4F 12/15/04 Turbidity 0.41 NTU 5 NTUs SMWW 2130 B 12/17/04 Lead 6.71 ug /L 15 ug /L SMWW 3113 B 12/17/04 Alkalinity 84 mg /L N/A SMWW 2320 B At the time of analysis the sample was acceptable for total coliform Signature: G ";,; ;,;/": State #: PH -0218 Michael Lapman ELAP #: 11715 President CONNECTICUT, NEW YORK AND NELAC CERTIFIED Toll Free 866 -JMS -5097 I Corporate Fax 203 - 798 -2408 1 Lab Fax 203 - 798 -2107 1 www.jmsenvironmental.com e 1 f LITNAM 1 E!tT T, PLLC. E and Architects SEPTIC SUBMISSION FORM TO: DATE:?/ PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: C> A r-, TV,.J E�S — PE ►2 r� ► P- i S - 9 Co 1-1Y6 9cliTy. 311 E - Tec�Sc)..S Tpl0 2.3. 13 -- I —(::o ENCLOSED, PLEASE FIND: COPIES OF THE SSDS "AS- BUILT" PLAN CONSTRUCTION COMPLIANCE CERTIFICATE WELL LOG l� HEALTH DEPARTMENT FEE ($300.00) WATER ANALYSIS GUARANTEE FORMS - 3 ORIGINALS E 911 ADDRESS FORM ❑ LETTER OF EXPLANATION REMARKS: COPIES TO: (SepSobForm•2004) SIGNED: F=t Cy__ 7Z_Ac f7> 4 Oro RouTE 6, BREWSTER, NEW YORK 10509 - (845) 279 -6789 - Fax (845) 279 -6769 - EmAtu putnamengineering @rcn.com PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION / l Street Location —6l Y S TZ-/-d 3 1( � Town - _PtiA00 TM # 2V_25, 13 1. Sewage System Area a. STS area located as per approved plans .......... :................ b.. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped ................: .. ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. Sewage System a. Septic tank 1,00 ...: ..... 1)250 ......... other ................ b. ' Septic tank inst a ............... ............................... c. 10' minimum from foundation ......... ............................... d. Distribution Box 1. All' outlets at same elevation -water tested....... 2. Protected below frost .................. ............................... 3. .. Minimum 2 ft. Original soil between box & trenches e. Junction Box properly set .......... ............................... 6. renc es 1. Length required /f 12- Length installed /f 3 2 2. Distance to watercourse measured - - /ac, Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 1lk" diameter clean ...................: 9. Depth of gravel in trench 12" minimum ....... :........... 10. Pipe ends ca pped.....: g. Puma or DosedpSystems 3. Alarm, visuaUaudio ........:........... ..........................:...: 4. Pump easily accessible, manhole to grade.... ............. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Building_ - -- IV. We IV I located as per approved plans . ......:........................ b. Distance from STS area measured -t- /y0 ft........... c. Casing-18" above grade ................ .............:................. d. Surface drainage around well acceptable ...:................... Overall Workmanship . a.. Boxes properly grouted ................. .. ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ........ :........................... i. Erosion control provided ............................. . ................... Rev. 12/02 Date; �o : Impede& y Owner Permit G Subdivision Lot # NO I COMMENTS 10/181/2004 MO N 11:29 FAX PCHD t PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENT-A&HE.AJUR SERVICES ATTENTION LJ josuii GENE REQUEST FOR FINAL INSPECT-I For: Fill All information must be fully completed prior to any Trenches 1"MS inspections being made. PCHD Construction Permit 4 Locatcd:- tj,'(S. Owner/Applicant Name: Aj, .T--►rz- TM Z3, IS -Block 1 Lot (0 rA19IFY —Subd-vision Formerly; P'AC Name: Subdivisi ou Lot# Is -system fill completed? Date: Is system Complete",, — Date: Is system constructed as per plans? Is well drilled? O� Date: Ts well located as per plans? Are owsion control measures in place? [a 001/001 I certify that the system(s), as listed, at the above preriii.yc,s iii been constructed and I have ansptcted and verified their completion in accordance iNdtb the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the P team Co'Unty Department of Health: Date: Certified by: P RA Design Professional 0 LI;7 Address: Lie.#, Comments: (rZ8tvn FR Form FIR-99 Avf 6 OCT-1e-2004 MOH 1 1:7p TEL :R49-R-7H--?qj:)j 1, 4-411: - F11 FITh:1m i"ni ]KITY r)1=Pi21DTMC7K1T nE:- 0 y LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH . 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (84.5) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648' October 29, 2004 Paul Lynch Putnam Engineering_ 4 Old Route 6 Brewster, New York 10509 Dear Mr. Lynch: ROBERT J. BONDI County Executive Re: Field Inspection — Antunes . NYS Route 311, (T) Patterson TM# 23:13 -1 -6 The following comment must be corrected in the field: • It appears the SSTS was not installed according to the approved plan. . _ ..... _If.you-have any further questions, please contact me at (845) 278 -6130, ext. 2261. Very truly yours, Gene D. Reed Sr. Environmental Health Engineering Aide GDR: cj 12/103/2004 FRI 12 :52 FAX 44-+ PCHD 0001/001 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTE SERVICES ATTENTION. 0 JOSE, PH GENE REQUEST FOR FINAL INSPECTION For: Fill All information must be fully completed prior to any Trenches inspections being made. PCHD Construction Permit # Located: Ll •`�, S, fZotJT� � 6 4-- f��rTOwner /Applicant Name: " ,u ' Tu��.3. i3 Block 1 Lot�� Formerly: Subdivision Name: Subdiviion Lot # Is system fill completed ? Date: Is system complete? — ____ _ __ Date: Is system constructed as per plans ?� Is well drilled ?. `Z rl Date: Is well located as per plans? Are erosion control measures in place? 'n--eS I certify that the system(s), as listed, at the above premises leas been constructed and I have'inspected and verified 'their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards; Rules and Regulations ofith o ty Department of 1:Iealth. ��— Tate: Unified by. RA, Design Pro sional Form FIR-99 DEC -3 -2004 LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 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 December 16, 2004 ROBERT J. BONDI County Executive Paul Lynch Putnam Engineering 4 Old Route 6 Brewster, New York 10509 Re: Field Inspection — Antunes NYS Route 311, (T) Patterson TM# 23.13 -1 -6 Dear Mr. Lynch: The above referenced separate sewage treatment system can be backfilled. The following comment must be addressed. • A bedroom count must be.performed by this Department. . _...._.......... If you have any further questions, please contact me at 845- 278 -6130, ext. 2261. Sincerely, Gene D. Reed Sr. Environmental Health Engineering Aide GDR: cj 0 SENDING CONFIRMATION DATE : DEC -17 -2004 FRI 10:18 NAME PUTNAM COUNTY. DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 92796769 PAGES START TIME : DEC -17 10:17 ELAPSED TIME : 00'20" MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... i i a , LORETTA. MOLINARI ROBERT J. BOND[ Nbfte Heaa6 Dt—w r—ay. r—odlw DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, Nrw Yoer 10509 Eavlmn td Bntlth (845)276 -606 rax(845)278 -7921 )Vanlna 8rrriees (845)278.6550. WIC (8451258 -6678 Nx(845)278 -6085 Batty tnter•entinnWtaxeaal (H45 )276 -(,014 Fox(845)27A -6648 I December 16, 2004 Paul Lynch Putnam Engineering 4 Old Route 6 Brewster, New York 10509 i Rc }leld Inspection Amunes NYS Route 311. (T) Patterson Dear Mr. Lynch: .. The Bbovc referenced separate sewage trcalwc:-. wslem can b.. backfilled. The following comment mu4t be addressed. • A bedroom count must bcperfortm •all,: thic )ep ^rtmenl.. Ifyou have ony further questions, please consac ,n,� rt 345-27i -6130, ext. 2261. SinCtrCl!. Cie" , D. Recd Sr. Rnviri— .wntal Health Engineering Aide i ODR:cj I BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET — NEW YORK, NY 10038 CERTIFIES THAT Upon the application of WILLIAM PICARELLA PO BOX 158 BREWSTER, NY 10509, Located at RT. 311 PATTERSON, NY 12563 Application Number: 2014608 Section: 2313 Block: 1 upon premises owned by EUCLIO ANTUNES RT. 311 PATTERSON, NY 12563 Certificate Number: 2014608 Lot: 6 Building Permit: BDC: W104 Described as a occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in /on the premises at: Basement, Outside, A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed herein, was conducted in accordance with the requirements of the applicable code and /or standard promulgated by the State of New York, Department of State Code Enforcement and Administration, or other authority having jurisdiction, and found to be in compliance therewith on the 6th Day of December, 2004. Name - ,• QTY Rate Ratin Circuits Twe - Miscellaneous SEPTIC PUMP AND ALARM Alarm and Emergency Equipment Sensor 1 0 110 Smoke Appliances and Accessories Furnace 1 0 Oil Access Control 1 0 36000 BTU Air Conditioner 1 0 48000 BTU Pump Motor 1 0 1 H.P. Motors 2 1 Panels 1 200 30 Wiring and Devices Outlet 20 0 Fixture 8 0 110 Incandescent Receptacle 4 0 110 General Purpose seal Receptacle 2 0 110 GFCI Continued on Next Page 1 of 2 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. eA TNAM N �ERING, PLLE ngineers and Architects February 7, 2005 Gene Reed Putnam, Count,, Health Department 1 Geneva Road Brewster, NY 10509 RE: Antunes Route 311 Town of Patterson Dear Gene: Enclosed please find a copy of the electrical compliance certificate for the above referenced project. Please contact.Paul Lynch at this office to schedule a pump test for the property. If you have any questions please do not hesitate to call. - -- Very truly yours, PUTNAM ENGINEERING, PLLC Claire Pierson (L0563) 4 0w RouTE 6, BREwsTER, NEw YoRK 10509 • (845) 279 -6789 • FAx (845) 279 -6769 • EMAIL: putnamengineering@rcn.com PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL IIEATLH SERVICES FIELD ACTIVITY REPORT NAME: r►l ill ��� .. 'z ' 311 /V Y , Street Town State Zip PERSON IN CHARGE PW u L G %C H OR TNTFRVTFWFTI: V7�11�4M �� T�ata PUMP TEST DOSE TEST :22 _ i REQUIRED GALLONS 2 / z r; I_. h I M I Signature and Title f RFPnRT RFrFTVFT) RY: I acknowledge receipt of this report: SIGNATURE; 02/96 Rev. Title; SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health February 15, 2004 Putnam Engineering Mr. Paul Lynch 4 Old Route 6 Brewster, NY 10509 Dear Mr. Lynch: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Field Inspection — Atunes NYS Route 311 (T) Patterson, T.M. #23.13 -1 -6 ROBERT J. BONDI County Executive The above referenced separate sewage treatment system can be backfilled. The following comment must be addressed. • A re- inspection at the above referenced lot has been completed. There are no further- comments to be addressed at this-time -.- If you have any further questions, please contact me at (845) 278 -6130, ext. 2261. GDR: cw Sincerely, -.,$z �.- . �)- A�4 Gene D. Reed Sr. Environmental Health Engineering Aide 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 O % \PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVI( CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # P— 1 (16 P,34"TTr�ZS Located at 1JYs Ruvn- � 1 i Town r Village , Subdivision name Subd. Lot # Tax Map X3.13 Block Lot _ Date Subdivision Approved Renewal Revision Owner /Applicant Name r--t9GL1 O AV,TL).ri_, Date of Previous Approval S1810-3 Mailing Address 1`j L J S S M et%4' LAt-JS; Zip %oS Amount of Fee Enclosed Building Type' i ' L-6 Lot Area •1 L No. of Bedrooms -5 Design Flow GPD &eO Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of i yry C9 gallon septic tank and i�3Z.. L vl ; o lP Z . Q1 PIS, ,J IM ortf act. - a 'TarTs -rA Other Requirements: Ft U-.. To be constructed by'IAkes 6IACjUk4.vQ J�j� yApLgkddress 3i 17-5(.;(( Water Supply: Public Supply From Address or: Private -Supply Drilled by v % >V L 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 treatmentsystem 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 issuan approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address .E. �A R.A. Date it Lai Lo5� 4,Y, I of f5 License # 069 44la APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatme system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w c sidere necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe prov or disc ge of domestic sanitary sewan only. By: Title: Date: % 12,9 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM ENGINEERING, PLLC 4 Old Route 6 Brewster, New York 10509 Phone: 845 -279 -6789 Fax: 845- 279 -6769 e -mail: putnamengineering @rcn.com • r� We are sending you ✓ U.S. Mail, _ Originals Prints Colored Prints LETTER OF TRANSMITTAL Date: P/E Job: attached under separate cover, the following items via Overnight, Hand Delivery, Pick Up: Reports Plans Photographic Exhibit Specifications Other: Copies Date Dwg. No. Description 1) to o� �, _. �% DS 0 pf'Ima These are transmitted: _ For approval — Approved as submitted _. For your use _. Approved as noted _. As requested , Returned for corrections For review /comment — Resubmit copies for approval Submit — copies for distribution REMARKS: v a_ Copies to: SIGNED: l_� s noted, kindly notify this office. PUTNAM ENGINEERING, PLLC 4 Old Route 6 Brewster, New York 10509 Phone: 845 -279 -6789 Fax: 845 -279 -6769 e -mail: putnamengineering @rcn.com LETTER OF TRANSMITTAL Date: Nov /0 1,� RE: FUC4tO hP "VAAC-5- . P/E Job: TO: eome-r �i S no 11 We are sending you attached under separate cover, the following items via U. S. Mail, _ Originals A"_ Prints Colored Prints Overnight, ft_ Hand Delivery, Reports Photographic Exhibit Other: Pick Up: Plans Specifications Copies Date Dwg. No. Descri tion S� WA U These are transmitted: For approval ___- Approved as submitted For your use ^ Approved as noted _ As requested ^ Returned for corrections — For review /comment — Resubmit copies for approval Submit _ copies for distribution REMARKS: Copies to: SIGNED:' If ires are not as noted, kindly notify this office. i. -� - ��� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # P-1 54b b Located at i J, 4, S P00,15 31/ own r Village P -rT�yOd Subdivision name Subd. Lot # Tax Map r'VJ3 Block. / Lot 10 Date Subdivision Approved Renewal ✓ Revision Owner /Applicant Name /D 4/;QJA/95 Date of Previous Approval /a, ! 1, /9 q6 Mailing Address / dt/ &STEf�l� L,t/. noeA/vJW iD, /J, Zip 1 D Amount of Fee Enclosed 000 t Building Type aix.&.a A01 Lot Area o. of Bedrooms 3 Design Flow GPD x000 Fill Section Only Depth Volume Separate Sewerage -System to consist of /DAB gallon septic tank and �3a G' oz a' Other Requirements: c f�08 /�i� %5 C /� %��� Cc1/2 �d kl To be constructed by To 13E DA7232NJ/,ti&-b Address Water Supply: Public Supply From Address or: ✓ Private Supply Drilled by TO Be 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 treatments stem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: P.E. ✓ R.A. Date I U u Z Address %1,40 OUD RU17V (c. License # 00!646 A-'A' /C;-Z!V2 Al /0629 APPRO D FOR CONSfRU TION: 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 iOnconsidered necessary by the Public Health Director. Any revision or alteration of the approved pla requires a new p it. Appr for discharge of domestic sanitary sewage only. `• -lea-1162 By; Title: (, j Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPAR'T'MENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL CC please print or type /1 ' PCHD Permit # Well Location:' Street Address: To illage Tax Grid # /;q 1jE /% ,4?Yt�ZSDA/ Map,,�-1/3 Block 1 Lot(s) (o Well Owner: Name: A/d%�dr9e's's::t / / /A. MI'' /. -C �+UCL7 /- �N /G/NGt7 I /7, / �y� J �-�1 L 7 YVGdI C 6- �� �i�/� vLf/ AJ I / 0�7 Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought __5_ gpm # People Served _ Est. of Daily Usage (goo gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling -Y/ New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ..:.............................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No wl Name of subdivision Lot No. Water Well Contractor: Tn $E DEr6C M/&/c-7;D Address: Is Public Water Supply available to site? .................................. ............................... Yes No 4/ Name of Public Water Supply: Town/Village Distance to property from nearest water main: I W11-E Proposed well location & sources of contamination to be pro ' eet/plan. Date: la 151 1 Vim-- Applicant Signature: Pp g 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. ny revision or alteration of the approved plan requires anew pepnit. Wel constructed by a wate el filler ce ified by Putnam County. / Date of Issue (� Permit Issuin c'al: Date of Expiratio 't;;-/ J Title: Permit is Non- Transf rra le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 9 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/Preschool (845)278-6014 Fax (845) 278 - 6648 Putnam Engineering 4 Old Route 6 Brewster, NY 10509 RE: Antunes /formerly Casey NYS Route 311 (T) Patterson, TM# 23.13 -1 -6 Reservoir Basin Dear Sir: April 8, 2003 The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on November 7, 2002 is complete. The Department will notify you by April 30, 2003 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. ® Joint review with the NYCDEP will commence pursuant to the. guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions. as set forth in the regulations. Please be advised that projects within the NYC Watershed may also. require 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 Letter to: Putnam Engineering - April 8, 2003 -2- Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 eat. 2166. RM:tn V ly yours, kobert Morris, PE Senior Public Health Engineer LORETTA MOLINARI R.N., M. S.N. Acting Public Health Director Director of Patient Services DEPARTMENT OF ]HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC(845)278-6678 Fax(845)278-6085 Early Intervention/Prescho6l (845) 278 -6014 Fax (845) 278 -6648 April 8, 2003 Putnam Engineering 4 Old Route 6 Brewster, NY 10509 Re: Proposed SSTS: Antunes /formerly Casey NYS Route 311 (T) Patterson, TM# 23.13 -1 -6 Dear Sir: 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 review the enclosed change of Status Memo to New York City-Department of Environmental Protection. 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:tn Ve y yours, 11•� Robert Morris, P.E. Senior Public Health Engineer i BRUCE R. FOLEY Public Health Director TO: PROJECT: LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (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 Preschool (845) 278 -6082 Fax (845) 278 - 6648 DEPARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM CHANGE OF STATUS TOWN: C SE K PV STATUS HAS BEEN REVISED TO: DEP LOG#: ❑ D EGATED JOINT . REASON: fifl0 i W 5Wn O 0-) 4_1 �' t O 3 91 Please contact Robert Morris, P.E., Senior Public Health Engineer, as soon as possible if there are any questions about this change of status. (DELSTATUS) , LORETTA MOLINARI R.N., M.S.N. Acting Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 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 Putnam Engineering 4 Old Route 6 Brewster, NY 10509 Re: Proposed SSTS: Antunes NYS Route 311 (T) Patterson, TM# 23.13 -1 -6 Dear Sir: ROBERT J. BONDI County Executive March 19, 2003 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. Mr. Gene Reed, Environmental Health Services, noted that there is a stream within 200 feet of the proposed. SSTS. All waterbodies, wetland and watercourse within 200 feet of the property lines are to be shown. 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. Ve my yours Robert Morris, P.E. Senior Public Health Engineer RM:tn g TNAM NEERINC, PLLC. ngineers and Architects SEPTIC SUBMISSION FORM TO: (2666gq- 1--fde'aS � DATE: ftW- Z <,�63 PUTNAM COUNTY HEALT DEPARTMENT PROJECT: r'✓.(,IGf.I r} ��/TUr� %?iUi�r 3 i , "r PA -R3ct� Z3, o - I ENCLOSED, PLEASE FIND: CO PIES OF THE SSDS PLAN C(W �'� Ll Ll Ll Ll Ll REMARKS COPIES TO: COPIES OF THE HOUSE PLANS CONSTRUCTION PERMIT APPLICATION WELL PERMIT APPLICATION HEALTH DEPARTMENT FEE ($300.00) SHORT EAF DESIGN DATA FORM LETTER OF AUTHORIZATION E APPLICATION FOR WASTEWATER TREATMENT (PC -97) LETTER OF EXPLANATION Cd yu-(� �- off (ze 4 vtl i SIGNED: ( l 4 OLD ROUTE 6, BREWSTER, NEW YORK 10509 - (645) 279=6769 • FAX (645) 279 -6769 • EMAIL: puteng @bestweb.net ROWS DESIGN DATA S=-.�LTBSUF CE SEWAGE DISPOSAL SYSTR4 FILE NO. Caner Address -7 7 (f tJ Lccat_-A at (Street) NY2 FPPTC-- 31 Se--. 13.13 Blcr--k Lot (indicate nearest -cross street) min icipality 3 Watershed SOIL P MA=CN TEST DAM RE,-,U= TO BE SUBM1=1 WITH APPLICATIONS Date of Pr . e-Scaking. Date of Pezc6ia#ic6 T,est,_7�2AIOL� HOLE t NM3M CL= TIME PERCOLAMON P—MCOLATIMN Run 'Elanse Deoth'to Water F*rcm Water Level No, Time Ground Surface In Indies Soil Rate Start-Stca Min. Staft, stop Drop In Min/In Drop Inches Inches Inches 112' X2:4 31:2 25 134 17 2 17- -j?- 24,1(z 3 -LOCI)' 5 5 2 :j Te-its to be repeated: at same depth until approximately equal soil rates are obtained at each percolation test hole. All•data, to* be suhnitti?d. for review. 2. Depth xeas=ements to be made fran too of hole. -Z 2 1:14 3 4 t l'4 17 5 2 :j Te-its to be repeated: at same depth until approximately equal soil rates are obtained at each percolation test hole. All•data, to* be suhnitti?d. for review. 2. Depth xeas=ements to be made fran too of hole. TEST PIT Y• ' 7• t' :It To BE t / Y:1• W= APPLICATION DESCRIPTION OF • t X• Y:1' M IN E HOLES DEM HOLE NO. ECLE NO. HOLE NO. G.L. 2' 3' a1 5' 6' 7' 8' 9' 10' 12' . •TeP ' ���1 C.� C JW Sd N �y Lam► Nt Tap Sco l L.. SQ N LgA M VJ1 TVA,:LE SAND . AW LAI 13' 14" INNDIC= LEVEL AT WHICH GROUNDk -A= IS ENCOC7N'.I' ED 42 fiCs`f .:ifa- i O hf L .�l� INDICATE LEVEL TO W'F-. C(i WATER LEVEL RISES AFTER EELNG =UNT= DEEP HOLE OBSERVATIONS MADE BY DATE: :-114 DESIGN ' Soil Rate Used Min/1" Drop: S.D. Usable Area Provided S d"!:>G7 No. of Bedrooms Septic Tank Capacity gals. Type CIONC Absorption Area Provided By L.F. x 24" width trench Other Name k55s 'iOAT G f''C Signature' —' Address GjU � G� �LV�f� SEAL .�► 0-76,75, 5, `rF�p 06744 THIS SPACE FOR USE BY HEALTH DEPARMIEM ONLY: Soil Rate Approved sq. f t /gal . -Checked by Date 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/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 V Den ber 31, Putnam Engineering 4 Old Route 6 .' Brewster, NY 10509 Re: Proposed SSTS: Antunes NYS Route 311 (T) Patterson, TM# 23.13 -1 -6 Dear Sirs: 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. There is no record iri this Department of a representative witnessing percolation tests on this lot. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection on 'this lot, percolation tests must be'witnessed by a representative of this Department. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very y yours, Robert Morris, P.E. Senior Public Health Engineer O1J14/2003 10:38 'FA %.845 2796769 PUTVAM.`ENGINEERING: "PUT -C I�j001 /001 1 BRUCE R. - FOLEY ' public Health Ulreetor� . O4� LORETTA MOLINARI''R Assoclate Public' Health ' Vreclor of Patient Servicei —DEPART HEALTH ` 1 ` Genava ; Rpad Hrcwstar, New : "York 10509 m III FIEll) T MINC ATTENTION 0 ADAM.STIEBELING NE REED' All information below must be f,�y, completed prior to any scheduling, DATE ��' °i ENGINEEROIZIr'IRM€ .' .�yt ��- �r�c'Cf1t._ ' X'HONE #,7�i REA$ON. DEEPS: a PERC : PUMP TI'ST a. ROADISTREF'1':1. TOWN: TAX MAP #t SUBDIVISION ...:. IOT #:r x OWNER'' YES ' , NO o Proposed SSTS wn the drainage basin of iNest Branch or Boyds Corner Re_ servoirs. c7 Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake:: Proposed SSTS within 200.feet of a watercourse or :a DEC wetland Proposed "SSTS design flow greater than 1000 gallons /day ox_SPDES'Peamit r.equired. o Proposed SSTS fora Commerical Project. , It is the responsibility of the design'pi ofe.Wdnal to provide the above information prior to,soil _testing. This Department will determine the NYCDEP -project status (Joint: or Delegated) based on the response.. If you answered ye,£t'Q aiiy of the duestions,:NYCDEI'raust•witness the soil testing. This Department will .coordinate.-ifinutuxlly suitable tine for field testing with the ,PCDOH,,the: Design. Professional And NYCDEP. ; If.a proieckhas been determ iced to be Delegated based'on'the above aesponse'und then siubsequent, information indica`tes"NYCDO is required to witness the nil, ,.it will :lie the sole iresponsibility of the design professional to schedule re- witnessing of the soil testing with NXCDEP. " . ; r VGINEERINU PLLG Englneers and Architects SEPTIC SUBMISSION FORM TO: 4�j 4i'Kir . /&- DATE: 0 3 PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: Z 44 c Iiel 4n )Gt/I eS � f✓TCJ 7. 6e -fon -7YLi Z 3. ENCLOSED, PLEASE FIND: COPIES OF THE SSDS ❑ CONSTRUCTION COMPLIANCE CERTIFICATE ❑ WELL LOG ❑ HEALTH DEPARTMENT FEE ($200.00) ❑ WATER ANALYSIS - ❑ GUARANTEE FORMS - 3 ORIGINALS ❑ E 911 ADDRESS FORM END ❑ LETTER OF EXPLANATION REMARKS: COPIES TO: �1 ``' . ~ s' a r h-eeA ed �c-f. . SIGNED: 4 Oro ROUTE 6, BREWSTER, NEW YORK 10509 - (845) 279 -6789 - FAX (845) 279 -6769 - EMAIL: puteng@bestweb.net gUrrN . QD TY NT:.taF ALTH DTVTSION OF E ONM -NTTAL aALT'li SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner G.'vG t7 f��tJ ! rJ Address I Lls EP O T .31) Located at (Street). y l_r Air &tl Tax Map 23.13 Block I Lot (indicate nearest cross street) Municipality P�q j � 50),F Drainage Basin s .i ✓�� ��: I. 2�J . SOIL PERCOLATION TEST DATA Date of Pre - soaking Z rl Q N 44 5 �3 Date of Percolation Test ,_� ;7JA004'12' NOTES: 1. Tests to be repeated at.. same depth until approximately equal percolation rates are Mainea ai ead, percolation test hole. (Le. 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. Hol:No- Run No. Time Start - Stop Ela se Time �Nlin.) De th -to Water - . from Ground Surface (Inches) Start Stop Water Level ]Dropp In Ync6es Percolation Rate Nu/Iach .3 3 a-, 34 -31-v3 Z9 2, 2.`, -' ?-5" 9.7 4 31,03 - 333 30 P_;, As 3 la 5 3 .M - 'f .d3 ,30 a — et !s 3 ► 0 1 t :37 -1:57 2! do 20 - 23" 3 6.7 2 t:t 7 -Z:13 14 P,o 3" 3 SS 3 3 2 t 3 ,2: SS 22, �o,r �'� 3 r%. 3 4 2,:53 5 V.4q - 30"17 Z3 P-0 P1.3 ,3.. f 7. . 6 3:10— 3'. 4z Zd ZOCr Z3" 3 7 3'qz - fob Z `I zo ' 2 3,. 3:,� 0 _L NOTES: 1. Tests to be repeated at.. same depth until approximately equal percolation rates are Mainea ai ead, percolation test hole. (Le. 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. 1 I 1 OF"S 9- t MOMM. VtEST HOLES DEPTH HOLE NO. HOLE N0. HOLE NO. G.L. 0.5 1.01 1.51 2.0' 2.51 3.01 13.51 4.51 5.5' 6..0 631 8.01 8.51 9.01 9.5' - 10.0. Indicate level at which gr0undwaiter is encountered Indicate level at which M*oftling,is -observed Indicate .level to which w' level rises after-be i*ng encountered enc Ater I Date sawa%, 0 31 obs6vations made by: Design Professional NAtne,'. Address: atic( 1e41Ak Signature: i, 'r, A 'PUTNAM COUNT'S DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project t�/�/ O 115/ � ^1v�CV) �,¢T1��YZ County P(ZLNAd:Z Site Location lZ, Building construction begun NJ 0 Extent Is property within NYC Watershed ? ................. Yes F_� No SECTION B. TOPOGRAPHY (Plea 'check all appropriate boxes) 1. 0 Hilly .7 Rolling Steep slope � Gentles ope F7 Flat 2. Evidence of wetlands Low area subject to flooding a� Bodies of water Drainage ditches F__J Rock putcrops 3. Property lines or corners evident ....................... ............................... 0 Yes No 4. 'Do watercourses exist on or adjoin the Yes No . facilities? �'go dccrN h1 /� b, 510 � 5. Will these affect the design of the sewage system ............ Yes No 6. Do watershed regulations apply in this development ? ....................... E21.Yes No 7 Will extensive grading be necessary? ................. ............................... a Yes ��No 8. Will extensive fill be necessary-for SSTTS ?............................................... " ? Yes 9. Do filled areas exig within the SSTS area? ........ ........................ ...:.... a Yes F3eNo If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: F_� Sand E] Gravel a Loam F_� Clay F7 Hardpan F7 Mixture 11. Observed from: a Borings Bank cut. a Backhoe excavations 12. Soil borings /excavations observed by on 13. Depth to groundwater on 14. Depth to mottling on 15. Are test holes representative of primary & reserve areas ...... ............................... 0 Yes a No 16. Soil percolation tests made by �1�`� u �N" 1q -0N�N9_�7�1N6 on - 1 / :3 0 Z& 3 17. Soil percolation tests witnessed by e:�', K g,,5_�17 on SECTION D (on back) Form ST -1 0 . 1. SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? Yes cz No' 19. Will groundwater or surface drainage require special consideration? ..................... Fl Yes 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... a Yes No SECTION E. REMARKS 21. If a common water supply is proposed; has an inspection been made of the existing or proposed source and facilities? .............. ........................................ :......... Yes No Inspection data a 22. Do adjacent wells and/or sewage systems exist ?..Aawg ... A!/.T"ff/. -ov .. .�1% ................. Yes No 23. Additional comments 24. Site observer /inspector and title 4f�L -9r,-6.v . e-: /¢, 25. Date(s)-of observation(s)inspection(s) &JZG, 'r0-5L WA 0n/ 1 / �50 lrte 3 TEST PIT PROFILES Hole # Lot # Hole # 'Lot # Hole # Lot # Depth to water Depth to water Depth to mottling Depth to rock/imp. G.L. Depth to mottling Depth to rock/imp. G.L. Depth to water Depth -to mottling - ---- Depth to rock/imp. G.L. a.s . 0.5 0.5 1.0 1.0 1.0 2.0 _ 2.0 2.0 3.0- 3.0 4.0 4.0 Fie] 6.0 7.0 8.0 9.0 10.0 5.0 6.0 7.0 8.0 9.0 10.0 3.0 4.0 W, 6.0 7.0 8.0 9.0 10.0 PUTNAM COUNTY DEPARTMENT OF. HEALTH ° DIVISION OF ENVIRONMENTAL HEALTH SERVICES �° T DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address 2¢` :3Z4 Located at (Street) Tax Map ' 3d3B1ock Lot (indicate nearest cross street) Municipality p,� Watershed 57- BE" SOIL PERCOLATION TEST DATA Date of Pre - soaking / y / p Date of Percolation Test ; / ; F iF' 3 2 t'// - :2; a-3 2- �2- :9- T7 Form DD -97 5 - �O 2 4 �2 0 -- '2 3 j �• O 3 ;J 3,' ,z z- 3. 1103 3 NOTES: 1. Tests to be repeated at. same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s l min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 I acknowledge receipt of this report SIGNATURE; / 02'/96 Title: Pm 17 'E-t-- tM!�!M T, PLLC. cts SEPTIC SUBMISSION FORM TO:,By�T MO/1�� P. DATE: !v� " �� ' c�0� PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: ENCLOSED, PLEASE FIND: COPIES OF THE SSDS PLAN ❑ COPIES OF THE HOUSE PLANS ❑ CONSTRUCTION PERMIT APPLICATION ❑ WELL PERMIT APPLICATION . ❑ HEALTH DEPARTMENT FEE ($300.00) ❑ SHORT EAF ❑ DESIGN DATA FORM ❑ LETTER OF AUTHORIZATION E�T�D ❑ APPLICATION FOR WASTEWATER TREATMENT (PC -97) ❑ LETTER OF EXPLANATION , COPIES TO: SIGNED: W z VA Wt,O%A"f-Ol4�, 4 Oro ROUTE 6, BREWSTER, NEW YORK 10509 - (845) 279 -6789 - FAX (845) 279 -6769 - EMAIL: Cam') • %.�� ��_. I net J FA 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/Preschool (845)278-6014' Fax(845)278-6648 Putnam Engineering 4 Old Route 6 Brewster, NY 10509 RE: Antunes NYS Route 311 (T)Patterson, TM# 23.13 -1 -6 Reservoir Basin Dear Sir: December 3, 2002 The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on November 7, 2002 is complete. The Department will notify you by December 25, 2002 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. ❑ Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental. Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a prof ect, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of B I Letter to: Putnam Engineering - December 3, 2002 -22 Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2166. RM:tn Very truly yours, Robert Morris, PE Senior Public Health Engineer 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/Preschool (845)278-6014 Fax (845) 278 - 6648 Putnam Engineering 4 Old Route 6 Brewster, NY 10509 Re: Proposed SSTS: Antunes NYS Route 311 (T) Patterson, TM# 23.13 -1 -6 Dear Sir: December 3, 2002 Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: 1)..._ _Construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this. regard. 2) If percolation tests were not witnessed by a representative of the New York City Department Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. 3) It appears that a depression is being filled in with fill in an attempt to provide the required two feet of fill for the SSTS. However, it also appears that the elevation in this SSTS area is approximately 764. If the elevation in the SSTS area is not 762 or less, how is it assured that the minimum of two feet of fill will be provided? Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. V ly yo Robert Morris, P.E. Senior Public Health Engineer RM:tn LORETTA MOLINARI R.N., M.S.N. Acting Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New. York 10509 Environmental Health (845) 278 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 -{085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Putnam Engineering 4 Old Route 6 Brewster, NY 10509 Re: Proposed SSTS: Antunes NYS Route 311 (T) Patterson, TM# 23.13 -1 -6 Dear Sir: ROBERT J. BONDI County Executive May 2, 2003 Review of plans and other supporting documents submitted at this time relative to the above - regarded project been completed. Comments are offered a follows: 1. Additio STS plans are required for approval of the permit. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, Robert Morris, P.E. . Senior Public Health Engineer I L ITNAM E I NEERINC, PLLC. Engineers and Architects SEPTIC SUBMISSION FORM TO: ,0,9,5FT z0 DATE: /O, 311 vG5)A PUTNAM COUNTY HEALTH DEPARTMENT -- PROJECT: 47-d 45S A�AV4J Y 08&-RT L24-5E� ;P7-,.3// ENCLOSED, PLEASE FIND: COPIES OF THE SSDS PLAN I� COPIES OF THE HOUSE PLANS CONSTRUCTION PERMIT APPLICATION ❑ WELL PERMIT APPLICATION Ed HEALTH DEPARTMENT FEE ($300.00) ❑ SHORT EAF ❑ DESIGN DATA FORM Z LETTER OF AUTHORIZATION 2 APPLICATION FOR WASTEWATER TREATMENT (PC -97) ❑ LETTER OF EXPLANATION REMARKS: COPIES TO: PCWD &121'IrT ,t1 /5= 9& SIGNED: 4 OLD ROUTE 6, BREWSTER, NEW YORK 10509 - (845) 279 -6789 - Fax (845) 279 -6769 - E ��: uteng @bestweb.net £ "d JO 1N3W1atid30 A1Nf100 WUNind : 3WUN tZ6L- 8LZ -Sb8 "131 £0:80 Iad 2002- S2-8du April 25, 2003 Robert Morris, P.E Putman Co. Health Dept. 4 Geneva Road Brewster, NY 10509 Re: Buclid Antunes. SSDS Route 311 Patterson, Putnam Middle Branch F eservoir DEP Log 4 12897 (Joint Review) Dear Mr. Morris: This letter is to inform you that the 'New York City Department of Enviromnental Protection (Department} has determined that the above - referenced application is complete. In addition, time Departtmcnt 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 "SSDS prepared for Euclid Antunes ", dated June 1996, and last revised March 24, 2003. Time applicant must contact Sissy 'De La Ossa of my staff at (914) 773 -4416 at least 2 days prior to the start of construction of the SSTS so.that a Department representative may inspect and monitor the installation. Margaret O'Conno�C, ]�.E. Supervisor �' Engineering Design & Review James Covey, F.E., NYSDOH 20 .d ZO:OT j0,� Sz�.id - ..._ d ib!i�b 0- �ZZ- VT6:X-e.J 9NId33NI9N3 d3Q 3M 10/22/2002 10:54 FAX 845 2796769 PUTNAM ENGINEERING 0002/002 PUTNAM COUNTY DEPARTMENT OF HEALTH ]DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Z7c1GLr10 Ai ru"/'=5 Located at Cry ArranolJ, u,\e. T/V Po'-ffes o YI Tax Map # 2 3e) 3 Subdivision of Block J- Lot 6 Subdivision Lot # Filed Map # Date Filed _ Gentlemen: 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 Puciam 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 Code. Countersigned: P.E., R.A., # , Mailing Address 01-1) PAI/TE (v &RaAJs rWZ State Zip Telephone: Very truly yours Signed: (Owner of Fropem•) Mailing Address: fwl& State 'I4 p4c- Zip 104,7 Telephone: 9lq - 76Lo - 6 73,9y PDTNAM COURrY DSPAD111 M OF REAM Dhbka d Hed& Set to Provide Peaslt l I a CERIVICATS 0 CO N PERMQr FOR SWAGS D>SlOBAL SYSgBM .. t e e d d a t 2 O u T G 5 t 1 Tee, or rye Sdmmvmm Noelte , c.ha- cat 0 Ter: Map . l i' 3 Block_ loot c Items —❑ 0tr.er /ApPIMM Nano tzT GAS , e a -7 Date d Prevba ; Appmvd � Ad&e•e l -7 Cfj 6-E.j L/Sf,�tr. Town STD(KIMV L U-*--' — zh, natc Subdivision_ -AZgroved Fee Enclosed Amn„nt zo 3c:le ^ Typed d 6t l ,r%tMn IM AM-6-7756, A c Fm Sew 0* Li Depth —Vdmn- Numehur d Bedieomo 3. Dedp Ftow G P D - _69 D 0 1 PCHD Nodfles o Is Required When Pm Is oamplated Sepaearo Saucier a System to asedet d ��� .GaOon septle Tank and 43-Z LE 2-' w t %t . A916oi2P T10 4 7ge.0 c4 4 Te W,Owsk eted by nb � 'RyKht lIJ E'>7 Afl&.0 Water Sap*r Pd & Supply Foam Addteaa on Supply DdUled I'D --Udmn P-0 ' lx (1. 0tber Reoahemeaa 21 rs P 1 ropes nUthat 1 am wholly and completely responsible for the design and location of the proposed system(s); l) that the separate sew di W stem above described will be constructed as shown -on the approved amendment there to and in accordance with the standards, rules a regulations o • nom County Department of M••Ith, ,and that on completion thereof a ^Certificate of Construction Compliance" Satisfactory to the Commissioner of H•althwill be submitted to `the OpMrlrrient, and i written guarantee will be furnished the owner, his fucassm heirs or assigns by the builder, that sold builder will piece in good operatMg condition any part of Yld sssva0• disposal system during the period o we (2) rs Immediately following the date of the {SaU- afla of the approval of the Certificate of Construction Compliance of the original a ny repairs t eto; 2) that the drilled well deaalOeA above will lxs located as shoavn on thaepp►wsd plan and that. Yld well will M 1 wi h the sY ds, rules and rpu a� o�T ns of the Putnam County Dap tm•nt f Health. Date Signed P.IP� R.A. Aid ssCASKIW a�50<•IA Mee- 551 CA BLVD 44e190u.1EF LAU -: 0167fiicense No cro- l -F-7Uo APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the building Ms been undertaken and is revocable for cause or may be amended or modified when considered ne*uR -u loner of Health. Any change or alteration of construction r•puiress ate— /ow permit. 907 for di�i I of domestic sanitary s gg or rl�ate wa er supply only. Rev. 1Of 88 "ate � �� By �— Title i �F / %`�� _ DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL Q PCHD PERMIT JP/6--f. WELL LOCATION Street Address 3L.� Town/Village/City Tax Grid Number 74 Z3•t3- (--to WELL OWNER Name Mailing I?� G� 606 Address - 0 4T RM�VtLLE (f � 2527- O Public USE OF WELL RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP 13' O ABANDONED 1 - primary BUSINESS O FARM O TEST /OBSERVATION p OTHER (specify 2- secondary 0 INDUSTRIAL U INSTITUTIONAL O STAND -BY p AMOUNT OF USE YIELD SOUGHT _gpm /# CI REPLACE EXISTING SUPPLY PEOPLE SERVED�� /EST. OF DAILY USAGE Good gal ❑ TEST /OBSERVATION 13 ADDITIONAL SUPPLY REASON FOR DRILLING OUNEW SUPPLY NEW DWELLING ❑ DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN ODUG C]GRAVEL 0OTHER IS WELL SITE SUBJECT TO FLOODING? YES y_NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name -rD 5s -,r=)eT-Ef Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES �NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY - DISTANCE TO PROPERTY FROM NEAREST WATER rIAIN__600,M -)z j A41L E LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED N SEPARATE SHEET (date) (signatu 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 requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise co rface or groundwater. Date of Issue: ��� / Date of Expiration 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller PUTNAM ENGINEERING, 102 Gleneida Avenue Carmel, New York 10512 914 = 225.3060 Fax: 914225 -2955 7'0: bi c t--, WE SENDING V0111 the following items: — Shop drawings _ Copy of letter nttached V ['Tints _ flans _ Change order Letter of Transmit Date: Attention: -t Dl A- RE: v �,S _ t hider separate cover via __ Samples _ Specifications Co ies Date No. Description # 4 THESE ARE TRANSMITTED as checked below: _ For approval _ Approved as submitted _ Resubmit _ copies for approval _ For your use _ Approved as noted _ Submit _ copies for distribution X As requested A Returned fir corrections _ Return _ corrected prints For review and comment Other REMARKS: �-es bS w1z"C. Q tai j Z � Gyl COPY TO SI(►NID: If enclosures are not as noted, kin y notify u at once. i ATTORNEY AT LAW --_� 14oel /t;l November 12, 1996 Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 ATTN.: MR. HEDGES Re: Cashin Associates, P.C. letter of October 31, 1.996 Dear Mr. Hedges: 32 COURT STREET, SUITE 707 BROOKLYN, N.Y. 11201 (718) 858 -2033 PUTNAM COUNTY OFFICE (914) 878 -4733 We enclose copy of letter from Cashin Associates, P.C. As your records may indicated there is a proposed sub - division filed with the Patterson Planning Board concerning subdivision of property on Bear Hill. In fact the Department of Health has been there to inspect "deep holes ". Please advise.if the proposed construction permit of Robert Casey will affect development of our property.�If'so, we would object. Very truly yours, h1tZA i Kt2 i PH HAUSMAN ,7H /yr enc. cc.: Cashin Associates, P.C. 50 Tice Boulevard Woodcliff Lake, NJ 07675 Cashin Associates, P.C. Engineers and Architects Hauppauge, NY e Woodcliff Lake, NJ - Miami, FL NEIGHBOR NOTIFICATION CONSTRUCTION PERWr October 31, 1996 R & J Associates c/o Joseph Hausman 700 Columbus Avenue New York, NY 10025 TO WHOM IT MAY CONCERN: Re: Department of Health , Review of Proposed Sewage Disposal System for property Name: Robert Casey Address: Route 311 Town: Patterson Tax Map: 23.13 -1 -6 Please be advised that an application for a_Construction Permit relative to the construction of a sewage and /or 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, of the Health. Department, at 278 -6130, Ext. 168. Very truly yours, By: �a^M� J pct Title: Project Engineer RECEIVED BY: Address: . Tax Map: 23.13 -1 -7 Upon receipt, please sign above and return in the enclosed return address envelope. JK/sc 961065 50 Tice Boulevard - Woodcliff Lake, NJ 07675 (2'01) 930-1600 - FAX (201) 930 -0544 4 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date J Re: Property of Located atoU'r' (T) I A-r-F Section 13 Block ( Lot Subdivision of Subdv. Lot # Filed Map # Date Gentlemen: /I 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 Countersi P.E. , R.� Address Telephone Very truly yours, Signed 'Owner of roperty Town' / V� Telephone lR PC -i PUT NAM C O UN TY D E PART M E N T. O F H EA L TH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: T� ` L- GV Z 7 Gl��%Y?j L� r� r✓ 12 5 82 2. Name of Project: 3. Location T /V /C: 4. Project Engineer: r A "5 41� S X'�l�"r10C, 5. Address: *o Fr LA(c 5 91 076 License Number: Phone: ZTS' 2S'� 6. Type of Project: Private /Residential Food Service Commercial Apartments' Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEAR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted X_ 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. NO 9. Has DEIS been completed and, found acceptable by Lead Agency? ........... 10. Name of Lead Agency 11., Is this 'p�dject in"An area under the control, of local pl-anning, zoning, or other officials, ordinances? ......... ............................... 2. If so, have plans been submitted to such authorities? ................ 3. Has preliminary approval been granted by such authorities? Date Granted: N /A 4. Type of Sewage Disposal System Discharge....... Surface Water' Ground Waters 5. If surface water discharge, what is the stream class designation ?........ NI-4 N/A 6. Waters index number (surface) ..... .... ............................... T. Is project located near a public water supply system? S. If yes, name of water supply NO ' • � Gy1�Ea -tEa2 T1-1.4 �l Distance to water supply I MILS 9. Is project site near a public sewage collection or disposal system ?..... O .. &eXIM 'PiA rJ 0. Name of.sewage system Distance to sewage system I " --e 1. Date observed: 23. Name of Health Inspector: 4. Project design flow (gallons per day)...... .. ............................. �D C?a 2. 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. !y 26. Has SPDES Application been submitted to local DEC Office? ............... A 27. Is any portion of this project located within a designated Town or State wetland? ................................... ............................... NO . ............. ............................... 28. Wetland IO Number ........ 29. Is Wetland Permit required? .. ........... ............................... Has application been made tc Town or Local DEC Office? .................. NIA 30. Does project require a DEC Stream Disturbance Permit? .........:.......... M o 31. Is or was project site used'for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, ,,1 landfilling, sludge application or industrial activity? ........ YES or NO 'v O 32. Is project located within 1,000 feet of existence of abandoned landfill, ' hazardous waste site, salt stockpile, landfill, sludge disposal' site or l any other potential known source of contamination? ..............YES or NO V DESCRIBE: 33. Is there a local master plan or file with.the Town or Village? rJ O 34. Are community water, sewer facilities planned to be developed within 15 years? NO 35. Are any sewage disposal areas in excess of 15% slope? 36. Tax Map ID Number ................... ......................r�.�..... 37. Approved Plans are to be returned to: Applicant Engineer If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter-of Authorization. ;Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Clash A Htsdemeanor pursdant to Section 210.45 of the Penal Law. "'�i SIGNATURES & OFFICIAL TITLES: 50(J *,JeC,� / - MAILING ADDRESS: Cashin Associates, P.C. Engineers and Architects 50 Tice Boulevard Woodcliff Lake, NJ 07675 (201) 930 -1600 • Fax (201) 930 -0544 a — _ WE ARE SENDING YOU ( I�Attached O Shop drawings O Copy of letter O•T[ � �� JOO NO •TT[NTwN qlA l `r �Q & 7/z&/,9 ` -1 �W [-7 k/ O Under separate cover via •the following items: O Prints O Plans O Samples O Specifications O Change order ❑ 1 COPIES DAATE NO., DESCRIPTION qlA l `r �Q & 7/z&/,9 ` -1 �W [-7 k/ i 1 9 l� [`MCP Cam. CF G oM NCB Vim= —1 Fin 1 THESE ARE TRANSMITTED as checked For approval !Y❑ For your use . ❑ As requested ❑ For review and comment below: • Approved as submitted ❑ Resubmit copies for approval • Approved as noted O Submit copies for distribution • Returned for corrections ❑ Return corrected prints O O FOR /BIDS DUE 19 O PRINTS RETURNED AFTER LOAN TO US REMARKS '3I l L GO.'7018 91 M.95 SOAUS H -1 )VIj ANI COPY TO SIGNED: it onele[uro[ are wet so owed. kindly notify r[ of once. Cashin Associates, P.C. / Engineers and Architects 50 Tice Boulevard Woodcliff Lake, NJ 07675 l` �p 01 l 930-1600 • Fax (201 ) 930 -0544 TO W i (.L'j" 14(5-txe-c. f ulwa 1 Gov N-i2:�j 0"c-ra - 4 61+ tJWA IZ-v-PrO WE ARE SENDING YOU Attached ❑ Under separate cover via 0 Shop drawings Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ L IEVI EM (01F MUSUDUMU p.Tft 0 Cr 30. cZ. q as no •TT[MT1ON - 3U A- sbrJ :the following items: 0 Samples ❑ Specifications . G THESE ARE TRANSMITTED as checked below: REMARKS Phi LL AITP G IA-t-0 t��A1 S(D PL-A-1-j-3 >0t: a -1 QUiG', l �1J� P2tl�irt ,a In / a Lp Pi L.`s ar— - -� A- 01_w-t_-v1T" PieuYh -a_TL, COPY 0 SIGNED: 6Altl A if •11tlosuro• art net 1/ OW04. kindly notify Ys Of once. XFor approval ❑ Approved as submitted 0 Resubmit copies for approval • For your use ❑ Approved as noted 0 Submit copies for distribution • As requested 0 Returned for corrections 0 Return corrected prints • For review and comment O ❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS Phi LL AITP G IA-t-0 t��A1 S(D PL-A-1-j-3 >0t: a -1 QUiG', l �1J� P2tl�irt ,a In / a Lp Pi L.`s ar— - -� A- 01_w-t_-v1T" PieuYh -a_TL, COPY 0 SIGNED: 6Altl A if •11tlosuro• art net 1/ OW04. kindly notify Ys Of once. I M A5 -51JILT MEA50REMENT5 ( IN FEET) . Y. S- RourrE GRAPHIC SCALE 30 Bo ( IN F %T T ) I inch = 30 M UTN.4M N6 /NEER /TUG, FUE E - ARG4ITEGT5 4 OLD ROUTE 6, BRBNSTEK NEH YORK 1050q (845) 2'Tq -61bq FAX (648) 2'fq -616q 0 PUTHAH a1611Mffit NS PUX 2004 PURSUANT TO NEW YORK STATE EDUCATION LAW, REVISIONS ARTICLE 145, SECTION 7209 SUBDIVISION 2, 'IT IS NO. A VIOLATION OF THIS LAW FOR ANY PERSON I UNLESS HE IS ACTING UNDER THE DIRECTION OF A LICENSED PROFESSIONAL ENGINEER, TO ALTER AN ITEM IN ANY WAY. IF AN ITEM BEARING THE SEAL OF AN ENGINEER IS ALTERED, THE ALTERING ENGINEER SHALL AFFIX TO THE ITEM HIS SEAL AND THE NOTATION 'ALTERED QY' FOLLOWED BY HIS SIGNATURE AND THE DATE OF SUCH ALTERATION, AND.A SPECIFIC DESCRIPTION OF THE ALTERATION.- q/8/05 I ADDED AS -BUILT MEAVAM-ENTS AS PER HD. ����iL• �® ��51• F31iE�flQ= fli�iF�i�Z7FL�F�7F3: IF�F3: fF�Gi��©€] F���] �� ®6•�1F�fii�Gl� © ©�t��l<f]��QiO o��i•000�60 © ©F���! 1Q51Q�F3]!F3[] Fri• �F�F�F�S163- SiIF�fF�7 iF�=] F�L7F��F��i3SlFT= flt►3fiF��Fx�F�fmF3f,�� o�oo�0000000000000000000000000000 UTN.4M N6 /NEER /TUG, FUE E - ARG4ITEGT5 4 OLD ROUTE 6, BRBNSTEK NEH YORK 1050q (845) 2'Tq -61bq FAX (648) 2'fq -616q 0 PUTHAH a1611Mffit NS PUX 2004 PURSUANT TO NEW YORK STATE EDUCATION LAW, REVISIONS ARTICLE 145, SECTION 7209 SUBDIVISION 2, 'IT IS NO. A VIOLATION OF THIS LAW FOR ANY PERSON I UNLESS HE IS ACTING UNDER THE DIRECTION OF A LICENSED PROFESSIONAL ENGINEER, TO ALTER AN ITEM IN ANY WAY. IF AN ITEM BEARING THE SEAL OF AN ENGINEER IS ALTERED, THE ALTERING ENGINEER SHALL AFFIX TO THE ITEM HIS SEAL AND THE NOTATION 'ALTERED QY' FOLLOWED BY HIS SIGNATURE AND THE DATE OF SUCH ALTERATION, AND.A SPECIFIC DESCRIPTION OF THE ALTERATION.- q/8/05 I ADDED AS -BUILT MEAVAM-ENTS AS PER HD.