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01558
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PUTNAM COUNTY DEPARTMENT OF HEALTH
= = DIYISIN OF� I(
ENVIRONMENTAL HEALTH SERV
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM
PCHD CONSTRUCTION PERMIT # ,P -vE-s P
pe�"%off. ✓Y y —0,7-5--g
Located at Owner/Applicant Name
Formerly
Mailing Address4l
Town or Village PAqScw
Tax Map Block —SG Lot r
Subdivision Name Qkojy k�c
Subd. Lot #
OLP
/ 1c
Date Construction Permit Issued by PCHD 1 Sa/9F
Separate Sewerage System built by 6441 Address f /�C'- �2 of y
NE,. H4,/ d 6 7% -,t�
Consisting of b-o o Gallon Septic Tank and �D a f -7 K-e =xc/�P
., CA(�h ��)
Other Requirements:
Water Supply:
Public Supply From
Address
or: Private Supply Drilled by I E-A L Address
Building Type a 'k� Has erosion control been completed? y
Number of Bedrooms
3 Has garbage grinder been installed? #�5
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 regul#tions of the Putnam County Department of Health.
Date: 49 /'( to Certified by P.E. P__� R.A.
/ (Design Professional)
Address G� j D's C�— License # l/
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
revoc tion, modif. ion or change is necessary.
By: Title: Date: 7%
r
White copy - ile; Uw copy - Building Inspector; Pink copy 4wndOOrange copy - Design Professional
Form CC -97
Survey of Property
Prepared for
Sophia Lone Victorian Heights, LLC
u WHO
SUHO Situate 17
Town of Patterson County of ;Putnam
C7 X70.00' N State of New York
N 25173'00' E 3 ;
17.95' scale P' - 30' i
ti u I
µ w Os
i•
W° m + Dopariment of Healcn
stiona,o Conn ..'J
i�
Lot 9 + �
Division of Envircnmel:tal Health Derv. cee 1.
noted for co ^� ^Lf^ance with
R nna of the
Cov'd. Deck
app ='af'' `:'les and Red Sf
Lot % st Health Dep�'�W -I t.
�ultna--:i CDar S:
Two Start' 5'
Frame Dwelling & t a /• Dat .,
. gignatur
C-'d. Oak F7lFn MAa RFFrRCMrr• JV� F7aDWW COWPLE7ED: MARCH
4! Arnwrdad Fhd SLbd1AO- pat known as Ch-brut K a.1 FMD* WX UPDATED. APl6L 2S 52pOG
I raeerded October 4. 2000 as map nos. 2785 a H and L
O %b*f Lot 8
A 1 O� Q 7otd Pored Area 15%104 sf.. t (0..467 A— t)
co ` y MAP PREPARED: MARCH 26 2005
0 i SophM Lane m shown ha— b o 50' dobt of way f—ady MAP RENgD: MAY f, 20M ,
known as Orestnut Orlw, MAP REKSED.• SEPTEMBER 1{, 2008
Z SSwritar W No 7706 Report a, Abefraet of 7106 has been proNded
Line i
wa Underground sbuctu. I If any f— Trot drown hersm. A map may r# be used h aOrin.c -t , o Suety
paanour (typ)ti eseepr w noted. Ihs /oof d ar undm wd often msrb to obttY er . b doaath, statemerrt t a, (W bet
° ar k of d It an y, - not dwoys know+ orM or en mart m to obtoh Ube harmcs /ar mfltiuDSequmt er Iutun
estknoted l/ any, uMeryound hrprorwnenta er envoaahments grantsst ry r
a s net corored by this V&-te. Unau& —kad dteratkrn er oddltlori to this as y Is o
135.57' sMR ` Ndatkn of SeaHn 7209 subdh6k. 2 of the New York
-N 8737 00` W o o Cert»ROatkna kWkated h— apn7ry U at mb aa—y woe
5UH prgaared h accordance with the esbthg Cod. of Proctkv State Ed—twr Law.
far Lwrd 51rrw)s adapted by the New Yank State Assoc/ofka The dterat/on of erslsy maps by—,—. other than the
Common Area of Prof -d-al Land S—om M. Sold — tiff —dons MW artghur preperer he m/d-04 cerlfushg oad not h the
run wily to Uw person far when fhb srrnay was prrPw'd generd edhn and bene6f of tie puNk> Lkvnaed Lmd
and on hle behdf to the flue eanpmx gowmmentd Wt' y SLr Vey shag net after e—eY OfiPat eurwy PIMA or
andln lendhg haUtutkn 17sted hereon, and to the —i rees survey plate prepaed by o&,-5',
of the /sndhg kratltutA-
pay oopin fhm the wgghd of this survey mwked with Me
Certecotlwrs we not b— felobte to oddlflmd /mdhg aurwycre smbassad sail Ors garwha frus an0 cwract cropNa
hatltutk- er aubmquanf a— of the aurwyer's aNghd ersk and aphi-
00/NS/ TE 'r
ENG /NEER/NG, SURVEYING & _ AA
,WDSCAPEARCH1TEC7Z1,9E, P.C.
S Garrott Place a C-1. New York 10512 NICHOLAS G. CHAP /S .5. _:
Ph— (845) 228 -9690 e F (845) 228 -8717 Nsw York State Cleanse Nay 049530
.— Inalte- anv.awn
® 2006 Inshe Englneering, Surveying Q[ Landscape Archltecture, P.0 All Rights Reserved. 92138.208
". ckd d. dw
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r. Julius I Cesare;'P:E::- ___
4601 Treadstone Ct.
Raleigh, NC 27616
Oct. 9, 2006
Putnam County Health Department
Att: Michael Budzinsk_ i, P.E.
1 Geneva Road
Brewster, New York 10509
RE: Chestnut Knolls Subdivision aka Victorian Heights
Lot 8
Construction Compliance
Town of Patterson
Dear Mr. Budzinski,
Herewith transmitted 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 Guarantee.
4. Well Completion Report
5. Water Quality Report
6. Check to cover required fees.
7. Three Prints of as-built drawing.
Very truly yours,
D4�
Julius I. Cesare, P.E.
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
Building Constructed by Town/Village
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.1irther 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 t \ Day . Year
.
General Contractor (Owner) - Sign e
Signature:
Title:
\64 A:55cc,, ((-c Corporation Name (if corporation) Corporation Name (if corporation)
Address: (e2 d V ���� Address:
Y- 4
State G� Zip (� , C7 State _
Zip
Form GS -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT
Well Location
Street Address: Chestnut Knolls
Subd. , Lot #8
Town/Village:
Patterson
Tax Grid #
Map Block Lot(s) 8
Well Owner:
Name: Chestnut Knolls Address: 12 Old Forge Road
Attn: Shahram Gangei Greenwich, CT 06830
Use of Well:
1- primary
2- secondary
X Residential Public Supply Air cond/heat pump Irrigation
Business Farm X 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. 5 gpm
Depth Data
Measure from land surface- static specify ft)
60'
During yield test(ft)
380'
Depth of completed well in feet
605'
Well Log
If more detailed
information .
descriptions or
sieve analyses
are available,
please attach.
De th From
Surface
Water
Bearing
Well
Diametetfio)
Formation
Description ..
ft.
ft.
Land surface
10
Drilling
in over
den cla ..and boulders .
10
Hit rock
at 10'
10
32
Drillin
in rock
set casinct, ctrouted
32
605
Drilling
in rock
granite
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 lume
Date Well Completed
10/19/99
Putnam County Certification No.
002
Date of Report
10/29/99
yV je,s e)
1, Jr.
NOTE: Exact location of well tth tics ces to at Least two permanent lanamarKS to oe provlueu on a Sepivaw 5ncovpla 1.
Well Driller's N e P. Be 1 &Sons Inc. Address: 4 Putrran Averm, Brewster, NY 10609
Signature: Date: 10/29/99
1 al, r.
ildine Inspector: Pink copv - Owner; Orange copy - Well driller
BRUCE , R:.:_ FOL(;Y_ :.:.: v: _.: .. :...,....
Public Health Director
DEPARTMENT OF
1 Geneva Road
Brewster, New York
HEALTH
10509
LORETTA. MOLFNARI R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
Environmental Health (914)278-6130 Fax (914) 278 - 7921
Nursing Services (914)278-6558 WIC (914) 278 - 6678 Fax (914) 278-6085
Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648
E911 ADDRESS VERIFICATION FORM
OWNERS NAME: t-1 p H '550C SoG l G �e S
LL
C.
1
TAX 1NL4,P NUMBER: -34-.
-.
E911 ADDRESS: #41 L-Q n e-
TOWN: J!:�A 47"e e-S c h N?
.
AUTHORIZED TOWN OFFICIAL:
(Signature)
DATE:
/ A I
tFr
® �
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.
(E911 VERFRM)
3 Page 1 of 1
imsErrviroamentai Services, me. � di KenosiaAvenue
tVATEA. SOIL AN'J AtA ANALYSIS Danbury. ConneCtiCUt 06810 1 Telephon? 203 - 799 -2229
H2O Services
Mailing Information: Collector's Information: JMS ID: 019254
Name: H2O Services Name: H2O Sedvices
Address: 13 Caldwell Road Address of site: Lot #8
Victorian Heights
City: Patterson City: Brewster
State: NY Zip: 12563 State: NY Zip:
Phone: (845) 279 -4420 Fax: Phone:
Sample's Information:
Site: Other Date Collected: 9/13/2006 Date Received: 9/13/2006
Preservative: N/A Time Collected: 4:00:00 AM Time Received: 4:25:00 AM
Temperature: <4 Lab No.: J0608724 -2
Matrix: Water
Date Analyzed Test Name
Result
MCL
Method
09/13/06 Chlorine Free Residual
<0.1 mg /L
N/A
SMWW 4500CIG
09/13/06 4:30.PM E. Coli
Absent
Absent
SMWW 9223 B
09/13/06 4:30 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 Appl Icable
- Signature: /�l�G/1rrt�G �7�_ Reviewed By:
Michael Lapman Sharon Houlahan, Director
President State #: PH -0218 ELAP #: 11715
01.1N[CTI ?1J I', NEW YORK, APID NEIAC CPPTIF Ef
Toll Free 866 -JMS -5097 I Corporate Fax 203 -798 -2408 I Lab Fax 203 - 798 -2107 I -,vww.jmsenvironn-ent3l.CCm
A F- `^
- •--- �~°��' - ::: Page 1 of 1
VL1U�En viroamenfai Services, Inc. %� 41 I<enosis Avenue
C�J t?ATEft. SOIL AND AAA ANALYST � CIL=J� Danbury., popnecticut 06810 I., c4ephono 203�798 -2229 - -
Mailing Information:
Name: H2O Services
Address: 13 Caldwell Road
City: Patterson
State: NY Zip: 12563
Phone: (845) 279 -4420 Fax:
Sample's Information:
Site: Not Specified
Preservative: N/A
Temperature: <4
Matrix: Water
H20 Services
Collector's Information:
Name: H2O Serivices
Address of site: Victorian Heights
Lot #8
City: ,
State: NY Zip:
Phone:
Date Collected: 9/27/2006
Time Collected: 9:30:00 AM
JMS ID: 019158
Date Received: 9/27/2006
Time Received: 10:45:00 AM
Lab No.: J0609103
Date Analyzed
Test Name
Result
MCL
Method
09/28106
Manganese
<0.05 ppm
0.3 ppm
SM 3111 B
09/28/06
Sodium
8.97 ppm
N/A
SM 3111 B
09/27/06
pH
6.76 S.U.
6.5 -8.5 S.U.
SM 4500 H B
09/27/06
Color
7 Units
15 Units
SMWW 2120 B
09/27/06
Turbidity
2 ntu
5 ntu
SMWW 2130 B
09/27/06
Odor
ND
3 TON
SMWW 2150 B
09/28/06
Hardness
130 mg/L
N/A
SMWW 2340 C
09/28/06
Iron
0.11 ppm
0.3 ppm
SMWW, 3111B
09/28/06
Chloride
12.5 mg/L
250 mg /L
SMWW 4110 B
09/28/06
Nitrate;
0.63 mg/L
10 mg /L
SMWW 4110 B
09/28/06
Nitrite
<0.05 mg/L
1. mg/L
SMWW 4110 B
09/28/06
Sulfate
54.1 mg/L
250 mg /L
SMWW 4110 B
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 TON = Threshold Odor Number Units = Units
Signature: � _ Reviewed By:1�._�;:..¢.•
Michael Lapman Sharon Houlahan, Director
President State #: PH -0218 ELAP M 11715
CO NNEC TICLIT, NPW YCDAK .U'117 MULA^ I.ERI'If tEG
Toll Free 966- JMS -5o97 I Corporate Fax 203 - 796 -24o9 I Lab Fax 203 -799 -2107 I www.irnsemAronrnent3l.cam