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Home My WebLink About1557DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -4 -63 BOX 14 9 1 oil a U16. M 01557 a� PUTNAM COUNTY DEPARTMENT OF HEALTH • � r DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # J)cV 4i it /V'a. Located at Town or Village Owner /Applicant Name lk-IA( As f. 6c2,c L-21 Tax Map 3 Block ` Lot 3 Formerly 61 Mailing Address Subdivision Name , Gals Subd. Lot # d-D C_A�rc�' C�a .icgo. Date Construction Permit Issued by PCHD /Z�`9 Zip O6 a Separate Sewerage System built by ,�f�t %, Address (o ACe--- '44 / c.tzb/-v Ct o 1�77e� Consisting of vo o Gallon Septic Tank and 2- rePdic� C Fwd #S-) Other Requirements: Water Supply: Public Supply From Address or: Private Supply Drilled by _7 Address Building Type 16L9 Has erosion control been completed? y Number of Bedrooms _7:T Has garbage grinder been installed? 9114 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 P4tnam County Department of Health. Date: z• Certified by P.E. R.A. (Design Professional) Address G� = License # %/? aCplr; -d AP- cX_�/ e,2 X/K 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 revocati n, modificat' nor change is necessary. By: Title: _ Date: White copy - HD ale; Y&Jow copy - Building Inspector; Pink copy { Clwne ,r' Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location StreetAddre.ss: Victorian Heights, Lot #7 Town/Village: Southeast TaxGrid # Pa Block Lot(s) Well Owner: Name: Address: 1!fK Associates, 12 Old Forge Road, Greenwich, Cr 06830 Use of Well: 1-primary 2-secondary X Residential Public Supply Air cond/heat pump ___jrrigation Business Farm Testtmonitoring 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 31 ft. Length below grade _3D ft. Diameter 6 in. Weight per foot 19 lb/ft. Materials: X Steel Plastic Other Joints: Welded _L_ Threaded Other Seal: X Cementgrout Bentonite — Other Drive shoe: _1_ Yes No ILiner: Yes y. No Screen Details Diameter (in) Slat Size Length(ft) Depth to Screen (ft) Developedd? First Yes _ No Hours Second Well Yield Test Bailed X Pumped X Compressed Air --6-1 Yield 5 gpm Depth Data Measure from land surface-static (specify ft) 80, During yield test(ft) 560' Depth of completed well in feet 600' WeD Log If more detailed information descriptions or sieve analyses are available, please attach. "t th From Surface Water flearing Well Diameteron) Formation Description & ft. Land Surface 3 D-7-illing in overburden clay and boulders Fit rock lat 31 3 31 Drilling in rock- set rasing. arcintpd 31- 6-00 -Drilling ift*r6ck, grallite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump/Storage Tank Information Pump Type Capacity Depth Model Voltage -BP Tank Type Volume, .77 jul Date Well Completed 9/6/05 Putnam County Certification Ro. 004 Date ofRqmrt 11/11/05 NOTE: Exact location of well with distances to at least in ent 'sn dmarb to be provided on a separate sheettplan. Well Driller's Name P F T-4-1 Inc Address: 4 Pubw Av--., Braister, NY 10509 Signature: Date: 11/11/05 Katthe'w L. Beal White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller 1117*� n-7 PUTNAM[ COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Victorian Heights,`Lot P7 Town/Village: Southeast Tax Grid # Map' Block Lot(s) Well Owner: Name: Address: HYH Associates, 12 Old Forge Road, Greenwich,-CT 06830 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 31 ft. Length below IQ__ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: X Steel _ Plastic _ Other Joints: Welded Threaded _Other Seal: X Cement grout Other Drive shoe: ,g Yes _ No Liner: Yes y 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 Yield J5 gpm Depth Data Measure from land surface -static (specify ft) 80' During yield test(ft) 560' Depth of completed well in feet 600' Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing well Diameter(in) Formation Description ft. ft. Land Surface 3 Drilling in overturden clay and boulders !!it rock at 3' 3 31 Drilling lli ar s 31 600 Drillinp- in rock gganite- If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth Model Voltage HP Tank Type Volume. Date Well Completed 9/6/05 Putnam ounty Certification No 004 o Report 11/11/05 Well J)riller sign liviatthe . • L ..,Beal NOTE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate stteevplan. Well Driller's Name P F Beal Inc. Address: 4 Pint Ave., 3raster, NY 10509 Signature: Date: 11/11/05 ivia.tthew L. Beal White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner, Orange copy - Well driller r..- 1117!+ A-7 BRUCE R. FOLEY _Public. Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 ..) :,-t- LORETTA MOLMARI R.N., M.S.N. A sociate Public Hea'1!R Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 E911 ADDRESS VERIFICATION FORM OWNERS NAME: H Y4 H�5 S o c 1 G "tee S. L L C TAX PYLAP NUMBER: 34.-4 6 5 E911 ADDRESS: 4Z 6 o n h I a L. 4 h t°. TOWN: AUTHORIZED TOWN OFFICIAL: (Signature) DATE: i ;l a-p- 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 assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. CE911 VERFRM) Julius I Cesare, P.E. 4601 Treadstone Ct. ..._ Raleigh, NC 27616 Oct. 9, 2006 Putnam County Health Department Att: Michael Budzinski, P.E. 1 Geneva Road Brewster, New York 10509 RE: Chestnut Knolls Subdivision aka Victorian Heights Lot 7 Construction Compliance Town of Patterson Dear Mr. Budzinski, Herewith tvansmitted are the required documents for the above noted filing. These documents are as follows: 1. A Certificate of Construction Compliance 2. E -911 Address Verification Form signed by the Town of Patterson Planner �- — - — -- 3. Three -copies of the Contractors Guarante® 4. Well Completion Report 5. Water Quality Report 6. Check to cover required fees. 7. Three Prints of as -built drawing. Very truly yours, O� Julius 1. Cvsarc, P.E_ GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Building Constructed by Location -;Stre t /Ybyrl rtII'_I/'I V11 -e— Building Type Tax MapJJ Block Lot TownNillage �12 Subdivision Name 59 /el . 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: Month I Day 06 Year 0-4_ General Contractor (Owner) - Si re ol Signature: Title: Corporation Name (if corporation) Corporation Name (if corporation) � Address: 12- O W r k % • GrTeAU,14Ls: State CT a Zip 06730 State Zip Form GS -97 —=r Page 1 of.1 JMSEnvironmental So lees, Inc. 41 Kenosia Avenue VIATEA, SOIL AND AlA ANALYSIS Danbury. Connecticut 06810 1 Telephone 203- 798 -2229 Mailing Information: Name: H2O Services Address: 13 Caldwell Road City: Patterson State: NY Zip: 12563 Phone: (845) 279 -4420 Fax: H2O Services Collector's Information: JMS ID: 018269 Name: H2O Serivices Address of site: Lot #7 Victorian Heights City: Brewster State: NY Zip: 10509 Phone: Sample's Information: Site: Other Date Collected: 9/5/2006. Date Received: 9/5/2006 Preservative: HNO' Time Collected:. 9:45:00 AM Time Received: 11:15:00 AM Temperature: <4 Lab No.: J0608397 Matrix: Water Date Analyzed Test Name Result MCL Method 09/06/06 Manganese <0.05 ppm 0.3 ppm SM 3111 B 09/06/06 Sodium 118 ppm N/A SM 3111 B 09/05/06 pH 6.56 S.U. 6.5 -8.5 S.U. SM 4500 H B 09/05/06 Color ND 15 Units SMWW 2120 B 09/05/06 Turbidity 0.3 ntu 5 ntu SMWW 2130 B 09/06/06 Hardness 190 mg /L N/A SMWW 2340 C 09/05/06 Odor ND N/A SMWW 2340 C 09/06/06 Iron <0.05 ppm 0.3 ppm SMWW 3111 B 09/08/06 Chloride 200 mg/L 250 mg /L SMWW 4110 B 09/08/06 Nitrate 2.27 mg /L 10 mg /L SMWW 4110 B 09/08/06 Nitrite <0.05 mg /L 1 mg /L SMWW 4110 B �_.... .._.., • - .--- 09/381U6- -- —Sulfate-- ._ ......_.. . _...._ -. ..... 26:9- mg /L•- - 250-mg/L- --SMWW-41.10,B_ ...�._ -... �_....._ .. -. - ...._. 09/05/06 Chlorine Free Residual <0.1 mg /L N/A SMWW 4500CIG 09/05/06 4:00 PM E. Coli Absent Absent SMWW 9223 B 09/05/06 4:00 PM Total Coliform Absent Absent SMWW 9223 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. Coli CFU = Coliform Forming Units MCL = Maximum Contaminant Level mg /L = milligrams per Liter N/A = Not Applicable ND = None Detected ntu = Nephelopmetric Turbidity Unit ppm = parts per million S.U. = Standard Unit Units = Units Signature: �'K�- . _ Reviewed By: Michael Lapman Sharon Houlahan, Director President State #: PH -0218 ELAP #: 11715 CONNECTICUT, NEW YORK AND NELAC CERTIFIED Toll Free 866- JMS -5097 I Corporate Fax 203 - 796 -2408 1 Lab Fax 203- 798 -2107 1 www.jmsenvironmerdal.com Iron Pin sat 03 0 Common Area Goss Cut ' Sophi4 Lane \ _ —Nee Edge of Bit. Pwnf. S 25-03-00- Wr 17.95' I sY �N Common Area Q 2006 Inslte En91neerfnm Surveying & Landscape Al hltecture, P. C. All Rights Reserved i 1 I { r Survey of Property Prepwod for 1 Victorian Heights, LL C r... - O altuate In �. 2 Town of Patterson County of Putnam State of New York scale r - 30' ,ea3 L •'. a R p P Putnam County Department of Health � Division of Environmental Health Services 'Approved as noted for conformance with o °? applicable Rules a:d Populations of the P nam Count Health Department. he n° glMture it Date g rn P E RSFuNbldFlH O RRnfFd '.1 /m ne nMaeAd E7M MARCH 4. 2003 ald Plot kon s Ch-t t Kr ffw" nEwWOW CONPL m mop nos 2785 a N and L f3ELo#M UPDA=. APRs 2+ aW5 OOl Subject Lob 7 Totd Pored A- eav- lj',e� s,g t'Vfp4V7r—xo wa S) MAP PRLPARtD: MARCH 24, 200.5 Sophia Lone os shown harem b c 3W right of ray hrmeNy NAP RE14SE0: MAY 4, 2008 known w Chestnut Grim No 776 Report r Abstract of TRIe has bran proWded Undwground structure , If ony .1-t, not Mown harem, Ihb map may not a used h cronnectkn WN o SLrvey except as noted The boutlon of unc6gsaund hgwowments A78daNt" ore . db--t, t.f —.t r me Aonlsm or encroo h—ts are not dwoys known and oNon must be to obtoh t)Ue hsurance for my subsequent r futon sethwted If any, underground kW.—.t. r --hmonb grantees me not crormred by fhb c.Vftets Unauthorized dtarotlan or ado3lbn to Nla survey la o CarUflcotions hdkwtsd hereon ap-Ky Nat fbb —y rw HdoNon of Section 7209 subdM 12 of the New York State Ed —tion Low. prepared h oeeardaoes with the nIsth9 Cods of Preetics for LarM Svneye adopted by Ns New York State Ave - lotion The dterotlun of survey maps by riyme other Nan the of Prolssdond Land Surw)on; Inc Sold —tiff tlans shop rlghd preprr b mbloodhg, c Ai klg and -t b the run only to the pram for wham Nla survey ras prepa'ed general wolf— and benefit of the pvbUC Lice, Land and on hl behdf to the fide Moor`yq 9owmmontd agency suneyre Mdl not offer --y mops survey Plana r and /r landhg haUtutkxr Ibt d herew2 and to the osalg"ees �yy p/pb prepared by others of the londhq Institution. 11 aly copies boon Ne orlglnd o1 thb surroy mrkad sit, tiro Carti6cotkns are not honalraEls to addlt/md Imdhq sw.wyar's ambrused ad era ganuha true and cmect coplas hatltutkhs r eubeawaat ownsa of the w yrz orl9hd work and'ophlan. NE T L PC . 3 canett Ploce • Cormsl, New York 10512 NICHOLAS c. C PIS, S Phone (843) 225 -9690 • Fax (843) 228 -9717 New York State L/cen a No. 049330 www /nape— eng.crn