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HomeMy WebLinkAbout0429DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -3 -101 BOX 6 00238 - ;; to.� Tim r i' , , L, ., i� �* � �. ; - T rr 00238 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # 10-30-0/ Located at( IY0J0)ALL } ILL 90A7�AfkT Ofi� w r ag on A-rrgKS0K-[ Subdivision nameCOVWALL } Il 1, IrSYAfES Subd. Lot # 44 Tax Map 13 Block 3 Lot , D Date Subdivision Approved Renewal Revision - Owner /Applicant Name AM MD D i L LCI Date of Previous Approval Mailing Address 7 TALACER QQA0 ., 139EWSAM ; My, AM& Zip /060!7 Amount of Fee Enclosed $ 3cy,0 0 Building Type t6i dcrilfiAL Lot Area 012Ae.. ,No. of Bedrooms ] Design Flow GPD 6'00 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and Q 2 ` WIVE AbWf iriGlj -17ENMCS Other Requirements: PUMP Pir- & $ WA`! 011-49115V-710A/ 800 To be constructed by 'AN, PiE 0451h�kmhy,649 Address _ y /� Water Supply: Public Supply From Address or: _ Private Supply Drilled by 'TD AC A9fE9 ^JVr- 0 Address IVA I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto Iand 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. Y R.A. Date s %'P 1 f rJ ap-r -1I , S- 4VL yiN( -, L�1rOSCA ARcrfirFc �,�,� Address t License # 6 �� APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage trea nit system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w en onsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe pprov &sch,�rge of domestic sanitary sewage o ly. By: fJ Title: Date: b U White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 MIM Il UI"I AAIMIAAI AAIM IMIM. IMIM IM IMaL MM SMI flMAAMAIA£IMIMIMIMIMIM1MI"IMIMIM IM I" I AWkO-41" !"I M A I"MA- MIMiMIMIMI"IQAIM Mal y y S � Y (f/11 1111 111 /1/�:if011yy1il11IHY3Hli1 NII/ Fiil y[ WY1/ 1/ IYH I�IIyIHyTHVC1/MIY/111YVt1%11i1/ 11111 Y11il yrlY/ li lyl'1IN11IefVfIN11lG11W!i!1%11l Vii /1/11/1YIil11:it11G1H11/NTl / liiWilfl'17H1111111IW 1111i71f11I11Y1N1i1) } PUTNAM COUNTY DEPARTMENT-OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FI\i'AL SITE INSPECTION Date: Inspecte y: q, e Street Location A/�vAjG �G /_ 2-� Owner t ; ZL Town ,¢> ��jZS art/ Permit 4 �^ o TM #' 13 -- 3 — 3 Oaf Subdivision Lot # 11, .Sewage System Area YE NO COMMENTS a: STS area located as per approved plans ........................... Q[c 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 �L a. 6eptic tank siz - ,000.......1,250 .........other ................ b. Septic tank ins evel ................ ............................... Y� c. 10' minimum from foundation .......... ............................... d. Distribution Box. f/a s 5, le /e r5 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 ........... ............................... f. r_e_5ce_s 1. Length required 375 Length installed 3 7 9' 2. Distance to watercourse measured.-- 10 0 Ft.......... 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:Roo m,al'lowed for, expansion,�LOQ% .� -l� 8. Size of gravel 314 -1 `` /2" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... k--- 10. Pipe ends capped .................................. :.................... g. PumD or Dosed Svstems 1. ize ot pump c am er ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual / audio ..................... ............................... _....... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ........................................ :.................... 6. Cycle witnessed by H.D.estimated flow /cycle........... IV III.House/Building a. House located per approved plans ... ............................... b. Number of bedrooms ....................... ............................... IV. Well a Well located as per approved plans ...... ..........................as --0 �- b.,�Di,stance from- STS_area measured c. Casing 18" above rade .................. d. Surface drainage around well acceptable ....................... - V. 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 ........... : ........................ ............. 05/21/2002 16:38 ATTENTION 845 - 225 -9717 Z, 7.0 ` -7 -t Z-1 1NSITE ENGINEERING PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ADAM WGENE TEST FOR FINAL M PECTION All information must be fully completed prior to auy inspections being made. PCHD Construction Permit # _ P-3o ~d_i For: pill Trenches PAGE 01 Located: _ 1'73 SoMftr6i,- DRrte (P (V) &TIreermv - Owner /Applicant Name: - SMAD .11 C TM 13 Block Lot 101 Formerly: A11A Subdivision Name; C> W i &i. Subdivision Lot till _ Is system fill completed? /�A Date: Is system complete? c Date: V-2-O az Is system constructed as per plans? Ygs' Is well drilled? v _ Date: As Or-C-7 d -o -2 Is well located as per plans? Y� Are erosion control measures in place? y465' I certify that the system(s), as listed, at the above premises has 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 of the Putnam County Department of Health. -21 -oz Date: Certified by: p_ D Profs onat Address: Lic. Con3ments: Form FIR-99 MAY -21 -2002 TUE 03:40 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 BRUCE R. FOLEY Public Health Director May 28, 2002 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 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Jeffrey Contelmo, PE Insite Engineering 3 Garrett Place Carmel, New York 10512 Re: Field Inspection - BNW, LLC Cornwall Hill Road/Somerset Drive, Lot #4 (T) Patterson, TM# 13 -3 -34.04 Dear Mr. Contelmo: The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. 1. Revised plans must be submitted to this Department for review showing the alternate system installed. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Sincerely, Gene D. Reed GDR:cj Environmental Health Engineering Aide e J SENDING CONFIRMATION DATE : MAY -28 -2002 TUE 20:55 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 92786392 PAGES : 0/1 START TIME : MAY -28 20:54 ELAPSED TIME : 00,001, MODE : ECM RESULTS : NO ANSWER FIRST PAGE OF RECENT DOCUMENT FAILED TO SEND FULLY... Tef$eey Contchno, PE Incite Engineering 3 Barrett Place Catmcl, New York 10512 Re: Field inspection - HMMP, LLC , Cornwell Hill Road/Som6raet Drive, Lot #4 (T) Patterson, TM# 13 -3 -34.04 Dear Mr. Comclmo: Tho above referenced separate sewage treatment system can be baektilled. Me following comments must be cmcctod in the field. 1. Revisal plane must be submitted to this Department for review showing the alternate system installed. If you have any fiatl= questions, please contact me at (845) 279.6130 ext. 2261. Sincerely, 7 Gene D. Recd GDRej Environmental Health Engineering Aide I i BRUCE R. FOLEY * w LORMA MO[ D"M RN, M.S.N. Nwc Heam Dn.W A..elar Fl,0lk R ft O%w, Abwow qr Panty SbW= ' DEPARTMENT OF HEALTH . 1 Genova Road Browser, Now York 10509 ZMmm l Huaa (US)3'A-6(30 Fa(W5)271.7931 MWAN SIMM (94S)3n -6532 WIC (615)271.6611 ►ag"272.6045 s.nr Lroa aen (MS)f71.6014 !44(145)270-6612 9nadmd 4S)224.3912 4f4(K5)= -6113 May 28, 2002 Tef$eey Contchno, PE Incite Engineering 3 Barrett Place Catmcl, New York 10512 Re: Field inspection - HMMP, LLC , Cornwell Hill Road/Som6raet Drive, Lot #4 (T) Patterson, TM# 13 -3 -34.04 Dear Mr. Comclmo: Tho above referenced separate sewage treatment system can be baektilled. Me following comments must be cmcctod in the field. 1. Revisal plane must be submitted to this Department for review showing the alternate system installed. If you have any fiatl= questions, please contact me at (845) 279.6130 ext. 2261. Sincerely, 7 Gene D. Recd GDRej Environmental Health Engineering Aide I i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: STREET LOCATION: REVIEWED BY: RM, GP, AS, SRDATE: DOCUMENTS (� PERMIT APPLICATION )WELL PERMIT OR PWS LETTER (�Z(_)PC -97 C ���� LETTER OF AUTHORIZATION (�)rJDESIGN DATA SHEET (DDS) CORPORATE RESOLUTION SHORT EAT PLANS -THREE SETS U(__)HOUSE PLANS -TWO SETS (_)VARIANCE REQUEST SUBDIVISION U LEGAL SUBDIVISION (SUBDIVISION APPROVAL CHECKED C _,t CRATE 117 DEPTH CURTAIN DRADWEQUIRED- � GENERAL ( d(/ )LOCATED IN NYC WATERSHED kNS SUBMITTED TO DEP LEGATED TO PCHD P APPROVAL, IF REQ'D EP TEST HOLES OBSERVED RCS TO BE WITNESSED - APPROVAL SSDS ADJ, LOTS TLANDS (TOWN/DEC PERMIT REQ'D?) TA ON DDS PLANS & PERMIT SAME E 1969 NEIGHBOR NOTIFICATION 'TER BUZBA YR. FLOOD ELEVATION W/I200' L TESTING LOTS>10 YEARS OLD REOUTRED DETAILS ON PLANS �(�SEWAGE SYSTEM PLAN - (NORTH ARROW) �USSDS HYDRAULIC PROFILE CT� �GRAVITY FLOW . C.`C._)CONSTRUCTION NOTES 1 -15 C /dUDESIGN DATA: PERC & DEEP RESULTS WLJ2' CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT __)FOOTING /GUTTER/CURTAL I DRAINS (�UUSDA SOIL TYPE BOUNDARIES LJ(_)T1TLE BLOCK; OWNERS NAME ADDRESS Z TM#, PE/RA; NAME, ADDRESS, PHONE# DATE OF DRAWING/REVISION (__��DATUM REFERENCE � L LOCATION OF WATERCOURSES, PONDS LAKES WETLANDS WITHIN 200' OF P.L. ( _6 �PROPOSEDFINISHFLOORAND BASEMENT ELEVATIONS 4ZC�ERO WELLS & SSDSSWAN 200' OF SSTS ROPERTY METES & BOUNDS SION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE CONINIENTS: (REVSHEET)09 /01 /00 TAX ALAP =: (CONFIR`4ED) N (REQUIRED DETAILS ON PLANS CONVD) �HOUSE SEWER -'/4" FT. -t "0'; TYPE PIPE CAST IRON NO BENDS; AIA-\ BENDS 45° W/CLEANOUT RENEWALS (_ -)SITE NOTE (NO CHANGE) FILL SYSTEMS J10. HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE FILL SPECS' FILL NOTES 1 -5 U)FILL PROFILE & DI`IENSIONS UFILL IN EXPANSION AREA FILL GREATER THAN2 FE T (� JCLAYBA.RRIER (� FILL CERTIFICATION NOTE (� DEPTH GAUGES U VOL. ON PLAIT FOR R.O.B., UNCLASSIFIED & IMPERVIOUS, U SEPARATION DISTANCE FROM TOE OF SLOPE / TRENCH _-)LF TRENCH PROVIDED LOFT MAX. �L_ VUPARAI LEL TO CONTOURS ( JLJ100% EXPANSION PROVIDED U DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS (_ 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL ( 20' TO FOUNDATION WALLS 0100' TO WELL, 200' LN DLOD,150' TO PITS 100'TO 0 STREAM, WATERCOURSE, LAKE (inc. espan) ( )50' TO CATCH BASIN, 35' STORNID)tALN, PIPED WATER .2210' TO WATER LINE (pits - 20') 50' LNTERtiITITENT DRAINAGE COURSE (_ 1KJ200'1500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS L_�)LJ10' MIN TO LEDGE OUTCROP SEPTIC TANK (_4LJ10' FROM FOUNDATION; 50' TO WELL . / WELL ( IENSIONS TO PROPERTY LINES (�}ULOCATION OF SERVICE CONNECTION // tillN 15' TO PROPERTY LINE SLOPE C-4--)SLOPE IN SSTS AREA (520 %) b (_,K,_)REGRADED TO 15 %, IF REQUIRED % DOSE/PUMP SYSTEMS )PUA1P NOTES L-__)( —'DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED ( LJDETAIL FOR FORCE MAIN, (PIPE TYPX, ETC.) ( J(�PIT AND D -BOX SHOWN & DETAILED (�7 7U1 DAY STORAGE ABOVE ALARM CURTAIN DRAIN (;(_)STANDPIPES, 5' BOTH SIDES, DETAIL to CDS= >5 %,20'4 %,25'- 3 %,35' -1 %,100 % -<I% ( _J( j20' NIIN to CD DISCHARGE /100' tivith 182 cons day discharge (___)( JI0' DIIN to NON - PERFORATED PIPE BRUCE R. FOLEY Public Health Director Im PROJECT: DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of . Patient Services Environmental Health (914)278-6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914),278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 DEPARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM � h0 DELEGATED TOWN: C SF&K PV DATE SUB'D APPROVAL: NOTICE OF COMPLETE APPLICATION DATE: (� I IN S / T E 71"SCAPEARCHITECTURE, INEERING, SURVEYING & P.C. Pump Pit Design for SSTS for Cornwall Hill Estates —Lot 4 Design Flow = 600 gallons per day Use Peak hourly flow 10 times average daily flow Q Peak = 600 10 = 4.2 GPM (24)(60) Static Head = 8 feet C = 130 d= 2„ L = 60± feet GPM = 53 GPM V = 6.6 ft/sec Equivalent L (Bend and Valve Losses) = 50t feet Total L = 110 feet HI = 10.44(Total L)(GPM)(1.85) = 7 feet C(1.as)d(4.s7) Total Dynamic Head (8 feet + 7 feet) = 15 feet Use Goulds Pump Model #3885 Series WE03L (or approved equal) This pump will pump 53 GPM with a total dynamic head of 15 feet rt, l,Ll+`M� �L�1j TSB t : � 7- ; ssts99147.doc /NS/ TE ??�7­ENGINEERING, SURVEYING & LANDSCAFEARCHITECTURE, P.C. 1485 Route 22 (845) 278 -4990 Brewster, New York 10509 Fax: (845) 278 -6392 TO: Putnam County Health Department 1 Geneva Road Brewster, New York 10509 WE ARE SENDING YOU ❑ Shop Drawings ❑ Copy of Letter ✓I LETTER OF TRANSMITTAL Date: 7 -26 -01 Job No. 99147.304 Attn: Robert Morris, P.E. Re: SSTS for Cornwall Hill Estates - Lot 4 Somerset Drive, Town of Patterson TM# 13 -3 -34.04 ® Enclosed ❑ Under separate cover via ® Prints ❑ Plans ❑ Change Order ❑ the following items: ❑ Samples ❑ Specifications COPIES I DATE NO. DESCRIPTION 5 5 -7 -01 CD -1 Construction Drawing 1� 5 -7 -01 CP -97 Construction Permit 5 -7 -01 WP -97 Well Permit 1 ----=---------- - - - - -- LA -97 Letter of Authorization 1 15 -1 -01 1 --------------- - - - - -- CA -97 PC -97 Corporate Affadavit Application for Approval of Plans 1 5 -7 -01 -- - - - - -- Short EAF 6 -21 -00 DD -97 Design Data Sheets (previously submitted with subdivision application) 2 I --------------- - - - - -- -- ----- 3 Bedroom Floor Plans 1 15 -1 -01 -- - - - - -- $300.00 Fee 1 5 -7 -01 -- - - - - -- Pump Pit Design Calculation & Specifications i THESE ARE TRANSMITTED as checked below: ® For approval ❑ Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑ Returned for corrections ❑ For review and comment ❑ REMARKS: b COPY TO: ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints ' SIGNED: Ile, hn M. Watson, P.E. IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE lot2000.dot PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of BMMD LLC Located at Cornwall Hill Road T/V Town of Patterson Tax Map # 13 Block 3 Lot 34 4 Subdivision of Cornwall Hill Estates Subdivision Lot # q Filed Map # 2856 Date Filed 04 -04 -2001 Gentlemen: This letter is to authorize Insite Engineering, Surve iigg & Landscape Architecture, P.C. Jeffrey J. Contelmo, a duly licensed Professional Engineer. X or Registered Architect_ to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Very truly yours, Countersigned: 4., .. Signe P.E., # 61931 ;z '• >- (Owner of Property) Mailing Address En ,gin ring, Surveying Mailing Address: 2 Tanager Road I aridscaneArchitecture, P.C. Brewster 1485 R6ufe22; Brewster State New York Zip 10509 State New York Zip 10509 Telephone: (845) 278 -4990 Telephone: (845) 279 -3613 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: Cornwall Hill Estates Lot # 41 I, Bruce Major represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: BMMD LLC Having offices at: 2 Tanager Road, Brewster, NY 10509 Whose Members Are: John Boyle Bruce Major Bruce Major John Dale and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating th to Signed: Title: _Manager Sworn to before me this / s� day of (month) /v% (year) 9.4 0 1 Notary Public FAISM ='40tM Pubk- -State of NGwY0&t Corporate Seal IL's. O1 PA4492 "' Form CA 97,: =:;,,: IV U `. NAM COUNTY DEPA.RTAIIEN T OF HEALTH DMS101N OF ENVIRONMENTAL HEAL T H SERVICE APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMIENT SYSTEM 1. Name and address of applicant: Z 2. Name of project: iltiL n -oAit7 L ocatlC3I— i t1� =YLy 11?S1yG' i� • llt- ^9iiTiG� �iL Vc°� liiy S L L is Cape . Design PI "oi�sslonal; Jeffrey J. Con�elm�, P_b__ 5. Address: F 9fe _ , R. Q. _ 6. Drainag Basin: �}��� �r n%� �U`e, 22 e 7. T -pe of Proiect: _ Private/Residential Food Service Commercial ApaiLments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......:.................. FG:t5 10. Has-DEI-S been completed and found acceptable by Lead Agency? ..... 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ....' ..................................................... ............................... 13. If so, have plans been submitted to such authorities? K 14. I-fas prelifraiyapproval been granted by such authorities? qC5 Date granted. 15. Type of Sewage Treatment System Discharge................. surface water X groundwater 16. If surface water discharge, what the stream class designation? .................... ti 1,4, 17 Waters index number (surface) ............................. ............................... I t l ted I'll* t 1 t 1) .......... "i I.4- s FL 11 oca near a pu is wa er supp y sys em ......... ............................... �c 19. If yes, name of water supply N � A- Distance to water supply ,0 % A" 20. Is project site near a public sewage collection or treatment system? ................ y�o, 21. Name of sewage system A- Distance to sewage system 22. Date test holes observed ��,u� _ i.� zc�00 X23. Name of Health Inspector �D . 5 � 1c% -L. -� 'c' ``z r � 24. Project design flow (gallons er da ...... .... ........................... 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... /JO 26. Has SPDES Application been submitted to local DEC office? ......................... ✓��� Form PC -97 27. Is any portion of this project located within a designated Totivri or 5ialf,, wetland? IV� 28. Wetlands ID Number .................................... ............................... ................... 29. Is Wetlands Permit required? ..... .............:.............:....... ...I........................... Ai Has application been made to Town or Local DEC office?. ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ............................... /�J 31. Is or was project site used for agricultural activity involving application of pesticides to 01cl-jards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ /o 32. is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ........I ...................... DESCRIBE; 33. Is there a local master plan on file with the Town or Village? ......................... "�� 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... 35. Are any sewage treatment areas in excess of 15% slope? . ............................... /J0 f i Block Lot © Taa Ma �. 36. p ID Dumber ............. ............................... ..I.......... Ma p 37. Approved plans are to be returned to ..... Applicant Design Professional NOTE: All applications for review and approval of a new S STS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater,plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval.. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 o W i Penal Law. SIGNATURES & OFFICIAL TITLES: Mailing Address : ............... .................... X prti%s OSO 14 -16.4 (2/87) —Text 12 PROJECT I.D. NUMBER 617.21 SEAR �t Appendix C State Environmental Quality Review SHORT .ENVIRONMENTAL ASSESSMENT FORM - For UNLISTED ACTIONS Only PART,I— PROJECT INFORMATION (To be completed by Appilcant.or Project sponsor) 1. APPLICANT /SPONSOR B' L L5 2. PROJECT NAME. i f�� Cc ��NwAI'� i jet 5' )✓ S Lo7 3. PROJECT LOCATION: PAM ✓/ti Municipality Sokf, County I, 4. PRECISE LOCATION (S reet address and road intersections, prominent landmarks, etc., or provide map) ScE Locl�f)o&F Me Q�j ('cnls;l2VG�IGa P(c'��'i��fc� 5. IS PROPOSED ACTION: VNew ❑ Expansion ❑ Modificationlalteration 6. DESCRIBE PROJECT BRIEFLY: CaI�SiFilLr )CAS �► � OAIG �alilL`� RtS i gi Ik( r_'). DANe� - i , 5515, Vr LL AW A PPS "2 i EPA IVGr :�.. 7. AMOUNT 0 ND AFFECTED: O C- °° Initially d acres Ultimately ACt acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 5zes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ❑ IFResidential Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: 10.. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)?. .Yes ❑ No If yes, list agency(s) and perrnlVapprovals P4jV9w;t'l FE) �►iT- 7 �+�v" cr F�ittE>v5cs�/ .556-WELL o P.CAD, D(010fi l4: 644" r -10WA) of (ATT660d 11. DOES'ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes . I& If yes, list agency name and permitlapproval 12. AS A RESULT PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? rO�FI ❑ Yes (&o 1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ;S)SSI I �Elv`GIAiCEIQII�''C y.S6'�i��'� /Ji%rr Bnc Applicant/sponsor name: J N M, VJAnCN V. G� Date: 0—& Signature: —v If the action is in the Coastal Area, and you are a state agency, complete'the Coastal Assessment Form before proceeding with this assessment OVER 1 PART 11— ENi/IRQNMENTAL ASSESSMENT (fo be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another Involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly.' C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explain C5. Growth, subsequent development, or'related activities likely to be Induced-by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified in Ci-05? Explain briefly. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural);. (b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a'positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on "attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Date N Title of Responsible Officer Signature of Preparer (If different from responsible o ficer) r PTJTNAM COUNTY DEPARTMENT OF HEALTH D SION Off` ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUIBSiSREA.CE SEWAGE TREATMENT SY'STEN Owner p 9?i D :, L-6-4,- Address Located at (Street) Oox , ,� :z- He V_. 1-J> �o,�.�c�� r2_'axMap• Block Lot (indicate nearest cross stveet) 1\4unicipalit}, FATrQe 5 E,r� Drainage Basin ' re-,4 C-01 ' L-0,7— ze Date of P SOTL'PERCOLATZON TEST DATA Date of Percolation Test Bole No. Run No. Time Start - Stop Ela se Time Min.) De th to Water Trom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation . Rate Min/lacb z 2 o 3 5 q 2 �r �o;a-►�o a >o. o 4 5. 1 2 3 •4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 mWinch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 DEPTH G.L. 0.5' 1.0' 2.0' -2.5' 3:0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST MT. DATA DESCRIPTION; OF SOILS ENC0UNTERED IN TEST HOLES A HOLE NO ' HOLE N0, HOLE NO. 9 Indicate level at which groundwater is encountered N0,0E Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Jo N0 v114 - C JA'Cso iJ Date 2 - ( &- o0 Design Professional Name :Jeffrey J. Contelmo , . P.R. Address: Incite suzveyam & Landscape Architecture, P. Brewster, WeWr,York`'I0509 4 t Signature: Design Professional's Seal PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL aa please print or type PCHD Permit Well Location: Street Address: o Tax Grid # C0 &iWALL )4XL AOAP Eag -r ig t &,N) Map Block 3 Lot(s) -3q O Well Owner: Name: Address: P11M0 ac 2 7AAM -!R PWAA W w rr: A1Y Jo�cn Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation . 1- rima Business Farm Test/Monitoring Other (specify) Industrial Institutional Standby Amount of Use Yield Sought _,5_ gpm # People Served Est. of Daily Usage 30 y gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling 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 Name of subdivision (%o &uA(,L No Em es Lot No. Water Well Contractor:Tq r- Oic7�I�ftui ' Address: N�l� Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: -01 Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department, 3) Submit a Well Completion Report on a form �. provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration `�f the approved plan re uires a new permit. Well to be constructed by a water 11 driller ce d by Putnam ounty. `e of Issue U Permit Issuin i ial: of Expiration Title: tit is Non -Trans a ra opy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 [qGOULDS PUMPS APPLICATIONS Specifically designed for the following uses: • Homes • Farms • Trailer courts • Motels • Schools • Hospitals • Industry • Effluent systems SPECIFICATIONS Pump • Solids handling capabilities: 3/4' maximum. • Discharge size: 2" NPT. • Capacities: up to 140 GPM. • Total heads: up to 128 feet TDH. • Temperature: 104 °F (40 °C) continuous 140 °F (60 °C) intermittent. • See order numbers on reverse side for specific HP, voltage, phase and RPM's available. FEATURES ■ Impeller: Cast iron, semi - open, non -clog with pump - out vanes for mechanical seal protection. Balanced for smooth operation. Silicon bronze impeller available as an option. ■ Casing: Cast iron volute type for maximum efficiency. 2" NPT discharge. ■ Mechanical Seal: SILICON CARBIDE VS. SILICON CARBIDE sealing faces. Stainless steel metal parts, BUNA -N elastomers. © 2000 Goulds Pumps Effective February, 2000 83885 ■ Shaft: Corrosion - resistant, stainless steel. Threaded design. Locknut on three phase models to guard against component damage on accidental reverse rotation. ■ Fasteners: 300 series stainless steel. ■ Capable of running dry without damage to components. ■ Designed for continuous operation when fully submerged. MOTORS ■ Fully submerged in high - grade turbine oil for lubrica- tion and efficient heat transfer. ■ Class B insulation. METERS FEET 40 130 ------ 35 i ..'.._ 110 - __ 30 100; pQ 90 .WE45F+�-_- - - -'_._ 0 601 — F 15 50 i -- °- -- 40 for Submersible Effluent Pump II 3885 PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. Single phase: • Built -in overload with automatic reset. • All single phase models feature capacitor start motors for maximum starting torque. • '/3 and' /2 HP —16/3 SJTOW with 115, 208 and 230 Volt three prong plug. • 3/ -2 HP —14/3 STOW with bare leads. Three phase: • Overload protection must be provided in starter unit. • '/2 -2 HP —14/4. STOW with bare leads. ■ Designed for Continuous Operation: Pump ratings are within the motor manufacturer's recommended working limits, can be operated continuously without damage when fully submerged. .— — -�- —0-5 GPM ......, ..:. s FT i ■ Bearings: Upper and lower heavy duty ball bearing construction. ■ Power Cable: Severe duty rated, oil and water resistant. Epoxy seal on motor end provides secondary moisture barrier in case of outer jacket damage and to prevent oil wicking. 20 foot standard with optional lengths available. ■ 0 -ring: Assures positive sealing against contaminants and oil leakage. AGENCY LISTINGS cipTested to UL 778 and ® CSA 22.2108 Standards By Canadian Standards Association us File #LR38549 Goulds Pumps is ISO 9001 Registered. SERIES: 3885 I SIZE: ' /•'SOLIDS IRPM: 3500 & 1750 201 120 10 r.__.___.,_.._ — -- _ — - - - - _ 0 00 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160GPM L L I I I I I I I I I I I I I 0 5 10 15 20 25 30 35 m3/h CAPACITY Goulds Pumps ITT Industries W C;tij ' f 7 Rpm ✓+r 7,a�k J �i li'3•'� } {. t t I ly,� �l �m d k ' " "�rq r atK''• �'`'a:a!/ r 1 f �'�P;' / .,ts .it�,t�9C'AVF - �" I 3 f I ` 9 ��RZ+,H � ' agti � �`hr 4„Y•� ,,,� =tinr F'0. - }O7 �y�ea.,� w�,'? —_ ar"'},',j * (r�`;1'�,+t_ t' � :t• � 11j a ,� �,ta � !�- .r,L';t L it low ts AA K.14 . V EArT LATE ts 4n. 4 f T UP OP �;v,, T' V*l L 4 Tli 'C VK. Cl U . --w- -CO) tM A'- b CRC); ,AA 19A� 6E 11-1 �6 AT �r� le 1-3 Zi IJFPL--'- WZU e q, f- fll-7 L.� j, 37 &, oA - I .1w. RQF fb `��►�.�c,af .� , Y 1 �f3�ix .l1`��1�,r.W�•N AM�JRirl�l �1li � - � ( -r• ` IS L to." t` 'Lso•AIn tot i �Q •a rT O` �YJl a , ,fit; •� :�i° ^ •i �' �•? x i A A i rsv ! c L} .,Nl. o ......... _ .`� 't! etcF-Rr /. 12 * t 1 r�r jO l_JU ^ -i - L sh e; F7 . KY f✓o ._ v It I t, ro fit ' , jL'- fp"�.0 ` ... _._. __... � I?';�,., ;�,. I r / rt '��� �•e`• .. _ tj is' p' _ ....... i 6;, ,- 7. s- - - �-v tip ! � ....,� � �• � � ',ii L_ ..._ ... __.. -._�...._..._ ._— b 9y..R` r '. A u Pl r 1 C 2 r • TT. r Q C LU r' < 7 1` • eo 1p x. I — t ' BM1VID L.L.C. 2 Tanager Road Brewster, NY 10509 Tel- 845- 279 -3613 Fax- 845- 2791771 Date: Aug 17, 2001 From: Bruce Major To: . Robert Morris, PCBOH Subject: House Plans for Cornwall Hill Estates Lot 4 Rob, We are currently selecting house plans for our sub - division, Cornwall Hill Estates, and request your review of the attached proposed plans for lot 4. This lot is approved for a 3 bedroom system. If we plan to use this plan on more then one lot within this sub - division are we required to re- submit? Thanks i advance, Attached : Two copies of plans 540, -- 530 520 510 PLAN SCALE.- 1" = 30' i h; h PROPOSED i N N; 3 BEDROOM N' ,N! IQ �; DWELLING h Ih 2 . 8 WAY PRIMARY A TRENCH T OlSTR1BURON Box 2 ? i EL. 525.0 PUMP PIT �CRAC F.F. = � � INV.. OUT= 523. — n i Q .Q Q Q _. .- - ----- Q 4 "0 CIP 0 114; MIN. SLOPE Putnam County Department of Health Division of Environmental Health Services A ,egoN as noted for conformance With JILJ — 2 "0 SDR 21 FORCE MAIN LL 4 "0 PVC SDR 35 ® 1 18%FL EXPANS MIN. SLOPE TRENCH 1000 GALLON SEPTIC TANK SSTS PROFILE SCALE.- HORZ.• I" = 30' VERT: I"= 10' URN N ,� 5 540, -- 530 520 510 PLAN SCALE.- 1" = 30' i h; h PROPOSED i N N; 3 BEDROOM N' ,N! IQ �; DWELLING h Ih 2 . 8 WAY PRIMARY A TRENCH T OlSTR1BURON Box 2 ? i EL. 525.0 PUMP PIT �CRAC F.F. = � � INV.. OUT= 523. — n i Q .Q Q Q _. .- - ----- Q 4 "0 CIP 0 114; MIN. SLOPE Putnam County Department of Health Division of Environmental Health Services A ,egoN as noted for conformance With JILJ — 2 "0 SDR 21 FORCE MAIN LL 4 "0 PVC SDR 35 ® 1 18%FL EXPANS MIN. SLOPE TRENCH 1000 GALLON SEPTIC TANK SSTS PROFILE SCALE.- HORZ.• I" = 30' VERT: I"= 10' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SE TREATMENT SYSTEM 4 PCHD CONSTRUCTION PERMIT # P-30--u& Located at !"73 somik'.5o 'r' 5"p-s "E 1�bown or Village % <IVA y Owner /Applicant Name IQ mA9 la LL C Tax Map J 3 Block -S Lot / o f Formerly Subdivision Name Coxypu w. Njz,t a-�f s Subd. Lot # Mailing Address Z >A -'JAG F-R R a A D i&g ni c rL2 NY Zip 1 o C-0 9 Date Construction Permit Issued by PCHD 0—C-01 Separate Sewerage System built by ovt70� cy-�c Pt Address i ho M��Ds c:eoZ 2oAp .; 0 PUTNAM COUNTY DEPARTMENT OF HEALTH _DpIVISJION OF ENVIRONMENTAL HEALTH SERVICES 4fri � i, WELL COMPLETION REPORT Well Location Street Address: I' Som2ri 7,ve r• rh jr ; +a�e Town/Village: Tax Grid # Map 13 Block 3 Lot(s) 101 Well Owner: Name: % Address: 1-73 s� Rs6 �E > / D2 6 MD �Ac �'gTTI��SU n1 nl ✓ Use of Well: 1- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock _ Other Casing Details Total length _ 1 ft. Length below grade c94 ft. Diameter '7 in. Weight per foot �lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded _ Threaded _ Other Seal: _ Cement grout _ Bentonite Other Drive shoe: Yes No Liner _ Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test Bailed Pumped _X Compressed Air Hours Yield M gpm Depth Data Measure from land surface- static (specify ft) Feet During yield test(ft) Rom Depth of completed well in feet o 4�.15 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 ` ' If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type j 0111 Capacity \5 (a{'M Depth Z--1-0� Model IS47 axV -S' Voltage Ind HP '17 Tank Type 0%tkN4 Volume R 6ML Date Well Completed H/9,9101 Putnam County Certification No. 007 Date of Report fi k6 c)l Well Driller (signature) I A&0_11 MOO NOTF/. Exagt location of well with distances to at least two permanetA landrfiarks to be provided on a separate et/plan. .! Well Driller's Name ff#iii 111j,1t Address: a Signature: Date: 0 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 C4�O6 LCO@ LCO2 9116 6CT6 8O07 -I/ow g^0 peezxe qou ITeqs peulqmo::) enIex Ieloq Alaqq 'quasaJd We eseueBuem pue uojT qqoq 11 uW/e�] axTsoJJoM sJeqem eqJ aznpaJ oq ueNeqaepun AMm asla ^7M S^T 10 enTV« 8]66O3 ajom go anIex Ml e exeq squlod uoTqnqljqsTp ejom ou qeqq saiTnbai smaqsAS nlIqn6 jog eIn8 -qdd gy le 4as aie sIooqzs zTIq� ^IeIquelod aq qsnm quemqeaj4 e pue qdd gT ueqq JTe44 40 %0T ueqq jeddoJ T peel V6� ld jot sqTmTl OW31 n3/A' ^NOI1331103 AO 3WIl 3% lW WlSM S5313M8UJ 3Hl 8OA 'Sa8WONt/lS 831VM SNINNI8O lV83O3A tH3 ONt/ MWlS X8OA M3N ]Hl IOUO33t/ AlmuOO AUVlINVS AU013VASIMS V JO (lON SVM)^ UMUM ]H1 WHl 31VJIONI SmOSM 3S3Hl lJW( :SlN3NNO3 -�-- 111 91-0 OlN ^C kv/N WSW 881 V/ Al l/ 8W 922 �^8-9^9 SllNO sm U/N WSW W1 I/5w C^0-O l/8N 0TO^0> I/Bm C^0-0 l/8W 2M0 ko/N l/BN 1040 0T - 0 l/SN 80^T qdd SoT-0 qdd 2^C lN3S8W lW 00T/ lN3S8W DOHl]N D3Nt/8 - IVNUON aOS]U ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4W :HlDN NUOSIlOJ ^ ]NON :S]AIlh08�S�8J �N NOS8Ill 318V1O6 ;^^A6Al 3lJNVS TLL7-MB 01 XW=l :SlN3WNO3 UOl) AlIOI88Ol 20/62/TT SW) AlINIIUXIV 20/62/TT lVl0PSS3NO8WH 20/62/TT Hd 20/62/TT (eN) WOIOOS 90/62M (uW) 3S3NUBNVW 20/62/TT (SY NOW 20/62/TT 0081IN WIUlIN 20/62/TT 8O8lIN 3W8lIN B0/62/TT (SNI) QV31 20/62/TT WUOAI103 ^l AW 20/62/TT MAO86 AlN3 WuNlO6 mOOmOHd sum ]lMI ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ wJOvi 3Su8 :^^^SmON ' - UOfvW wOHR :A8 OnO3- d ^S]lVlS] MIH MUMNUOJ : W8O 13S83NOS S 107 :31IS SNIMMS | '| HLY-M-WI8) :3NOHJ 20/90/2T :]lUO l8OW8 60901 AN '83lSMM8 0C:0T 20/62/TT :O.33U ]NIl/]lUO O8 438VNt/1 �2 01:60 20/62/TT :N3XWl 3NI1/31M 371 ONWR ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ l 3Bu6 3O8J lAlS NON CLT9G :# lN3I13 668S02^S6 :# 8M jolzaQD :Tuexoped ^H qJeqIt,) 0082-GhE (M6) 86901 ^A^N MOTeH uwMM/\ WaM Wa) MS S33IAWS W1N]NNOUIAN3 WA /NS/ T —JT�7—ENGINEERING, SURVEYING & LANDSCAPEARCHITECTURE, P.C. 3 Garrett Place (845) 225 -9690 Carmel, New York 10512 Fax: (845) 225 -9717 TO: Putnam County Health Department 1 Geneva Road Brewster, NY 10509 WE ARE SENDING YOU ❑ Shop Drawings ❑ Copy of Letter LETTER OF TRANSMITTAL Date: 12 -12 -02 Job No. 99147.304 Attn: Robert Morris, P.E. Re: SSTS for Cornwall Hill Estates Lot 4 173 Somerset Drive, Town of Patterson TM# 13 -3 -101 ® Enclosed ❑ Under separate cover via ® Prints ❑ Plans ❑ Change Order ❑ the following items: ❑ Samples ❑ Specifications THESE ARE TRANSMITTED as checked below: ®For approval ❑Approved as submitted ❑ For your use ❑ Approved as noted ❑ As requested ❑Returned for corrections ❑ For review and comment ❑ ` Gr rcr r •�/t7E i�E �V,In� ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints REMARKS: COPY TO: lot2002.dot SIGNED: dt'L. et-j-A -- dn Jo M. Watson, P.E. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES �L461t }.it: 11L, WELL COMPLETION REPORT Well Location Street Address: 17 3 Sanely I fv� _ fn� ��� �u }e Town/Village: n Tax Grid # Map 1.3 Block 3 Lot(s) 101 Well Owner: Name: /+ j Address: 1-7 3 s o. 6,e s 6,r -> Z I V 6 Use of Well: 1- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock _ Other Casing Details Total length I ft. Length below grade oP0 ft. Diameter in. Weight per foot alb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded _ Threaded _ Other Seal: _ Cement grout _ Bentonite Other Drive shoe: Yes No _ Liner Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield Test _ Bailed _ Pumped i Compressed Air Hours Yield M gpm Depth Data Measure from land surface- static (specify ft) �(.(_ During yield test(ft) a Depth of completed well in feet L) r 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 S If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity \15 "'I Depth Z---°" Model 7.94117,FV -5' Voltage I10Y HP ?16, Tank Type C a p tk k4 Volume 1% � lr Date Well Completed //&/61 Putnam County Certification No. 007 Date of Report , 111d 6 /1) Well Driller (signature) A�X NOT F/. Exagh location of well with distances to at least two permane land arks to be provided on a separate et/plan. J ZL Well Driller's Name Address: �1' '• `j/� /7!,�d h Signature: Date: 11 h C)) C d White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISJJION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: 173, Sa,nEri ?,v,2 rnwrdl I -; iu }es 3 r Town/Village: � Tax Grid # Map 1.3 Block .3 Lot(s) 101 Well Owner: Name:: Address: 143 s o M U &s D2 t v j-� RIVID [I C Use of Well: 1- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock _ Other Casing Details Total length ft. Length below grade ft. Diameter ? in. Weight per footlb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded _ Threaded _ Other Seal: —Cement grout _ Bentonite Other Drive shoe: Yes No Liner: _ Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test Bailed _Pumped Compressed Air Hours Yield M gpm Depth Data Measure from land surface- static (speci ft) e "- During yield test(ft) , Depth of completed well in feet 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 ` If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type J Capacity 15 ',M Depth Z-7-°/ Model TS41 I7,FV-5' Voltage I'W V 1P 11 Tank Type C1 t KI'd�a Volume Date Well Completed Putnam County Certification No. 007 Date of Report / //, � A) Well Driller (signature) A4 NOT . ExaA location of well with distances to at least two perm in–eIA land arks to be provided on a separate etlplan. Well Driller's Name ffkm Address: �/� t'� /- C p AIP� Signature: Date: 1 C') White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNA.M COUN'T'Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAG)E TREATMENT SYSTEM eMM7 LLC 13 31 lol Owner or Purchaser of Building Tax Map Block Lot Building Constructed by TownNillage ► ?; so,MERsEf 7�'iY£ n�0„pIy.A2L Hii-. 6S,-,aIr-5S 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: Month / Day !6 Year goo 'k— General Contractor (Owner) - $ignq6e >r -T) LL L Corporation Name (if corporation) Address: a rANAGO, AQA-0 State 9Ac,,j; -rcm , ay Zip ja; &i Signature: Title: Corporation Name (if corporation) Address: State Zip Form GS -97 DEC -11 -02 07:51 AM PATTERSON TOWN HALL 9148786343 P.03 090 -10 -200 14:59 FROM:INGIT£ ENGINEERING 8452259717 T0:8458Te6343 ap,t�cg R. FQLEY I ORMA MOLT Ait) LN,1 M,9,N. Pjad Malrh Dhotor .assertam lglphe llepllb Dtrtetw DurMor 4 MON SEPWIVA r DUARTIMNT OF HEALTH 1 Own Road Efewitsr, New York I= • 1<avlromecnlp! R[UQI �914)2;t•61a0 Pmch(4)�ie•79 IYur!!Ag �enlen (914) 118 -1!!1 WIC 1914) 278.6678 Pbc (914) 271.618 Sally lntmmoa4an (914)171.6014 jheMaol (914)271,W81 prx(9 4)171 -6649 MUM NAME: TAX MA.P NtIMBER: 13 - E911 ADDRESS: 1.13 r Tow$-- [A'IrU AMECORIZED TOWN OMCIA,L: (SIgnaturc) DA'I7u: LLC Co u, A i WAIF 1.0. ly The Putnam County Department of Health will nc Construction Cox.pbance unless the above form is con address is 1>%dgne4 by an authorized town official: Thi with the application for a Certificate of Construction ( a91) %4 issue a Certificated ileted, Lc., a legal E911 form is to be submitted J' �H k i r� ;k m • 1 t YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 93.203899 CLIENT #: 56173 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ NON STAT PROC PAGE 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ BMMD LLC DATE/TIME TAKEN: 11/29/02 09:4� 2 TANAGER RD DATE/TIME REC'D: 11/29/02 10:30 BREWSTER, NY 10509 REPORT DATE: 12/06/02 PHONE; (845)-279-1771 SAMPLING SITE: LOT 4, SOMERSET DRIVE SAMPLE TYPE..i 'POT'BLE : CORNWALL HILL ESTATES, PATTERSON, NY PRESERVATIVES: NONE COL'D BY: BRUCE MAJOR ' TEMPERATURE..: < 4C NOTES ... a ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ BASE FAUCET ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ COLlFORM METH: Ml-:' DATE FLAG PROCEDURE- Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium is suggested. pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY, WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATIOW, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MOIL. THE HARDNESS MAY RANGE FROMO TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED,, SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L MODERATELY HARD WATER: 7%140 MG/L MG/L = MILLIGRAM PER LITER HARD WATER: 140-300 MG/L 11 grain/gallon = 17.2 MG/L) SUBMITTED BY: Dif ="Dwi -/ ELAP# 10323 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 32.209308 CLIENT #: 56173 STAT PROC PAGE BMMD LLC DATE/TIME TAKEN: 12/11/02 09:00A 2 TANAGER RD DATE/TIME REC'D: 12/11/02 10:56A BREWSTER, NY 10509 REPORT-DATE: 12/12/02 PHONE: (845)-279-1771 SAMPLING SITE: LOT 4 - CORNWALL HILL ESTATES SAMPLE TYPE..: POTABLE : SOMERSET DR., PATTERSON, NY PRESERVATIVES: NONE COL'D BY: BRUCE M.' TEMPERATURE..: NOTES...: BASEMENT FAUCET COLIFORM METH: N/A ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~=~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 12/11/02 IRON (Fe) <0.060 MG/L 0-0.3 mg/1 2037 12/11/02 HARDNESS,TOTAL 4.0 MG/L N/A COMMENTS: Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED, SOFT WATER: 0-70 MG/L VERY HARD WATER:,ABOVE 300 MG/L MODERATELY HARD WATER: 70-140 MG/L MG/L = MILLIGRAM PER LITER HARD WATER: 140-300 MG/L 0 grain/gallon = 17.2 M6/L> SUBMITTED BY: Director ELAP# 10323 � HILL ROAD s 05 °52'00 " E 183.69 R- 25.00', L -41.12 z =` �= 94 °14'45." < N4 S O cV CL �*....- .:: LAJ � N w w h L6 00 �0N 00 CO D� Notes: `l. THIS IS TO CERTIFY THAT THE SEWAGE TREATMENT SYSTEM WAS CONSiRUCa AS INDICA7ED ON THIS PLAN AND THAT THE SYSTEM WAS OBSERVED SY INsITE ENGINEERING, SURVEYING, & LANDSCAPE ARCHITECTURE, P.C. BLFORE IT WAS COVERED OVER. THE SYSTEM WAS CONSTRUCTED IN GENERAL ACCORDANCE WITH ALL STANDARD RULES AND REGULATIONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND THE NEW YORK STATE DEPAR TMEN T. OF HEAL TH. " '2. ALL FACIL177ES EXISTING, UNLESS NOTED OTHERWISE. J. HOUSE LOCA77ON INFORMATION SHOWN HEREON /S BASED ON FIELD SURVEY BY livsuE ENGINEERING, SURVEYING, AND LANDSCAPE ARCHITECTURE, P.C. COMPLETED OCTOBER { 21, 2002. AS --BUIL T MEASUREMEN TS NO. A SOUTH CORNER OF DWELLING B NORTH CORNER OF GARAGE C U77LITY POLE REMARKS 1 14' 54' 66' 1,006 GALLON SEPTIC TANK 2 18' 44' 63' 8 -WAY DISTRIBUTION BOX 3 38 29 67' END OF TRENCH 4 30' 46' 53' END OF TRENCH 5 38.5' 70' 43' END OF TRENCH 6 .72' 77' 26' END OF TRENCH 7 75' 64' 53' END OF TRENCH 8 84' 60' 73' END OF TRENCH Putnam County Department of Health Division of Environmental Health Service@ Approved as noted for coni'ormanoe with appl, a le rul s and regulatlong of tho t am Co stealth Departmen . �2 ignature & Title a$e 0 NO. I DATE l REVISION I BY �IVG NEERING, SURVEYING & 3 Garrett Place Carmel, NY 10512 (845) 225 -9690 (845) 225 -9717 fax