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HomeMy WebLinkAbout0430DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -3 -102 BOX 6 00239 �I it sit T _ ; i I ` 00239 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FO �' ATMENT SYSTEM s A � D PCHD CONSTRUCTION PERMIT # �� �� Located at 11-; iar4 gp sf-i' p R 1 v i (5wn or Village P.AT1 fk,:oA/ Owner /Applicant Name A M MV . L t C Tax Map 1'3 Block 3 Lot 102. Formerly Subdivision Name C#911WA I.L HILL Cf T AV.S Subd. Lot # Mailing Address 1, 7A.N A r 64 Ri o q,p g � Evisr" //Y Zip /0 !9,0 el Date Construction Permit Issued by PCHD 6'.-12- v Separate Sewerage System built by ycrr -mig coNc6PrS Address 150m A *DS G2os f RaA7 �,, z Consisting of J ._ s oo Gallon Septic Tank and S-0q y F ' � I a 4 A _'s o e n r, o o%J Other Requirements: Zi �U,Q • C r. �w�� F� �-� c- WT-At a k-> a Water Supply: Public Supply From Address or: i' Private Supply Drilled by /411.roAj HYA-rT Address /gig gr. 311 PATiFR_VdA)A/- J Building Type A 6VP V N rJA L Has erosion control been completed? Yk f Number of Bedrooms `I Has garbage grinder been installed? NO I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: l o I ZIl v2 Certified by P. E. ' 4 �nIS�TE cn16lr/61;RJ'NG, CVAV6 G J (D= n Professi nal Address L AMP S-c Apr A Q C, License # c/ y. 51 C 4 P,A ft , A/Y 1007- Any person occupfmg premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modificatio or c ange is ecessary. By: Title: L Date: OZ- White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 ENGINEERING, SURVEYING & LA NDSCA PEA RCHITECTURE, 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: 10 -29 -02 Job No. 99147.305 Attn: Robert Morris, P.E. Re: SSTS for Cornwall Hill Estates Lot 5 119 Somerset Drive, Town of Patterson TM# 13 -3 -102 ® Enclosed ❑ Under separate cover via ® Prints ❑ Plans ❑ Change Order ❑ the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION 5 10 -28 -02 AB -1 As -Built Drawing _._.._._. ....____..._..__.....__- ..___._ 1 __..._.__. 10 -29 -02 CC -97 Construction Compliance 3 10 -3 -02 GS -97 Guarantee ........ -... _.._...._....____ ........ _...... 1 - - - - - -- - ._...._._ ..... . ...... _._. I --- - - - - -- __._...__.._________._—__._....___..__...___......_.._._.._..__._____._...-...__........__........___..__.__....._..--.--.---_-.---..._.-........__..._-- E911 Address Verification 1 10 -16 -02 -- --- - - - - -- . __.- _....__._._...._. Water Test Results ___.___.._....._..._ _ _..___..___._.- _..__..__ __..._._._--........._..._...... ...__.___....._...__..___.._... ._._.__ ............ .... ..._._..._......__. -_.. .......... .._ ................ ........... ..... __....___ 4 ...___.....__..... ..--- ._._...... __._.._......_ 11 -22 -01 WC -97 . Well Completion Repo 1 ..._..........._..._._.._.._.._....._..........._...._.___.(..--.... 10 -3 -02 ...._.- ___.._...._..__..____._- 26547 .___-- .- -_.___ $200.00 Fee _..._.....-------- __.._ —_. _ _.__...__—_______.._...__.___.._.__.____.____.__._..._-.__. �_ ........ ....._.._......._._- _.._- -.__.. _....... _. ....... _ ....... ...... _.... 1.___._.__......____.......__...... ....._.___._...._._._.__._._.._ . .._._.__..---- __.._........_... __._..____ ..... ______.-_.._..__......._.._..__._._........_.......___..-......... _.__..____.._.._..-..__.. _....____..__..__...__._....__. 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 ❑ As requested ❑Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ REMARKS: COPY TO: lot2002.dot SIGNED: / v"` e, - J hn M. Watson, P.E. IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: O f q � a.�►>r�? sET -pe1 vE Town/Village: E - Tax Grid # Map 17, Block 3 Lot(s) l o j. Well Owner: Name: //_,, Address: jo 41't Q &Xe Use of Well: 1- primary 2- secondary Residential U 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 Tin. Weight per foot lb/ft. Materials: Steel _ Plastic _ Other Joints: _ Welded Threaded _ Other Seal: _ Cement grout Bentonite Other Drive shoe: X 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 gpm Depth Data Measure from land surface- static (specify ft) A c-, During yield test(ft) 86 to 141 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 C54w4 6 1) 1 q� (� 6 If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type JACVp:l Capacity 15 �Pa"► Depth -353" Model Aqgc Voltage 2Z0 HP IS Tank Type CaAo.pj0 Volume o C-AL, Date Well Completed J/41 do Putnam County Certification No. a6 I Date of Report ) Well Driller (signature) NOTE` Exatt location of well with distances to at least two permanent landtharks to be provided on a separapheet/plan. Well Driller's Name Rjiu ga&-ff Address: A/W f '-so NY Signature: Date: White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 NORTHEAST LABORATORY OF DAasURY M"4+ %N ACCO934 M MIL PLMN ROAD - iaMBURTy CT 0" 1� 1 CI' Cert: PH -0404 (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 LABS www.NORTHEAST. LABORATORIES.com i LABORATORY REPORT REPORT TO: JOHN BOYLE, LLC DATE SAMPLE COLLECTED: 10/03/2002 119 SOMERSET DRIVE T ffi COLLECTED: 12:15 PM PATTERSON, NY 12563 COLLECTED BY: JOHN BOYLE DATE RECEIVED @ LAB: 10/03/2002 TESTED BY: LAB #11471 &11301 DATE TESTED: 10/03 - 10/11/2002 LAB I.D. # BOYLE-NY1217 REPORT DATE: 10/16/2002 SAMPLE SITE: 119 SOMERSET DRIVE, PATTERSON, NY SAMPLE POINT: KITCHEN SINK SOURCE: WELL TREATMENT: SOFTENER MAXIMUM CONTAMINANT TEST PERFORMED. RESULTS METHOD #' LEVEL fMCL) OR STANDARD BACTERIAL: • Total Coliform (Bacteria) PHYSICALS: • Color (Apparent) • Odor ., • pH • Turbidity CHEMISTRY: • Nitrite Nitrogen • Nitrate Nitrogen • AUadinity • Hardness • Iron • Manganese 0 per 100 ml SM 9222B 5 - EPA 110.2 ND - 7.77 - ASTM- D1293 -99 0.10 NTUs EPA 180.1 <0.005 mg/L as N EPA 354.1 3.0 mg/L as N EPA 353.3 210 mg/L' :. SM 2320B <5 mg/L..: EPA 130.2 <0.03 mg/L EPA 236.1 <0.01 mg/L EPA 243.1 0 per 100 ml 15 units 3 Units No designated limits 5 NTUs 1.0 mglL - 10 mg/L No designated limits No designated limits 0.30 2 mg/L 0.30.2 mg/L 2 Combined limit for Iron plus Manganese = 0.50 mg/L • Sodium 175 mg/L EPA 273.1 No designated limits 3 • Lead <0.001 mg/L EPA 239.2 0.015 mg/L * ** • Chlorine Residual <0.05 • mg/L - ml--milliliter mg/L--milligrams per Liter NI) none detected MCL =Maximum Contaminant Level TNTC =Too Numerous To Count "•Notification Level ** *Action Level 3=Water containing more than 20 mg/L of sodium should not be used for drinking by people on severely restricted sodium diets. Water containing more than 270 mg/L of sodium should not be used for drinking by people on moderately restricted sodium diets. COMMENTS: - Sample, as received, complies with all State of New York regulatory guidelines. -All holding times (were) met. SAMPLE, AS TESTED ABOVE: OTABLE or OT POTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Quality Control Officer Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060374 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 OCT -25 -02 09:33 AM TOWN OF PATTERSON 9148782019 P.02 OCT-22-Me 14136 FF'tOM:INSITE: ENGINEERING 9452RSgt4 7 TQ 8786343 P'S'S C BRUCE & FOLEY � IAOTTA MOLiNARI kN., MAX Phbl�a health DQ afa► drroclare PIM19 NeaM Dfmrm. 1kmfOr Of ratfrer &PKCK DEPARIMNT OF HEALTH i Geneva Road Brewster, New York 10509 - ICmlroome+�rn1 Iialtl (914j2?1•5131 Fi�x(�!4) R7t.ttpt iE XMIrf aenIt's (914) 271.6391 w!c (914)278-608 Pat 1914) 378-doss 3 B211 AQIjRES&=Ej!CATI0Nk0M �nrly Joterrentiaa (91�►31; � 60t4 1h'�s�oel p14) 37011 Efts (414) 271 -8648 , . F ii V WN F+/ S NAM., .� S m A tp 0 L r- ('C -F A-A0 "LL N L k, ChrA JFi,� s� TAX " N1UMEI E911 ADDRESS: TOWN; . AUTHORIUD TOWN Ula'FiCJhL: ..�..� .. (819RAtnre) UA,TV .. .._ .w..,.... s The Putnam County Department of Health wM not issue a Certificate of Construction Compliance sunless the above Form is completed, i.e., it legal E911 address is assiped by am authod zed town of£iciaL. This form is to be submitted with the appltcation for a Certificate of Construction Compliance. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEAL'T'H SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM �rhMn c« Owner or Purchaser of Building 3mmDtUc Building Constructed by II�J S�wiE2 Sa:'( VR.IvE Location - Street 9ESIrE;d r IAL. Building Type 13, 3 lv2 Tax Map Block Lot f,A-r're R s o rJ TownNillage 4�o.2Nt,JALL MILL UfAICS Subdivision Name 5 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 on jb"� Day Year ton Gee 1 ontrac or (Owner) - Signature f�mrhi� � lLC Corporation Name (if corporation) Address: 2 -rAAGiA Rogp State U EW S -rER , N v Zip I as a oq Signature: Title: Corporation Name (if corporation) Address: State Zip Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 17 FMAL SITE DiSPECTION 1 0 k Z A!� Date: I 7Z'-V-V"V1.'C A116 e- 72eo" Inspected ify: 4; Street Location Owner 731w Town ' PC.g 7-7—,--:L- r2 5 c,,o-a Permit # TM 9. Subdivision Lot # 1. Sewage S Systein Area - g - Y a. STS area located as per approved plans ........................... b. Fill section - date of placement .):I 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. SeN!as!e Svstem---. a. L Septic,tan size .,;- 1,000 ...... .... .. b. SepticE ffi—siailled level ............................................... c. 10' minimum from foundation .......................................... d. Distribution Box 1. All out lets at same elevation-water tested ................. 2. Protected below frost ................................................. 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box -properly set .......................................... f. Trenches I. Length required _5-0e9 Length installed 5-,q5) 2. Distance to watercourse measured-i i .......... 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 -1 Y2" diameter clean..... .. .............. 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped .................................. ; .................... g. PumR or Dosed Systems 1. bize ot pump chamber ................ ............................... 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 ........... III. House/Build1ing a. house located per approved plans .................................. b. Number of bedrooms .......................... . IV. Well a. Well located as per approved plans ........................... b. Distance from STS area measured * ft........... c. Casing 18" above grade ................................................. 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 .............. 'pesjfisfflled-iccotdingt6 f.'C—ur-tiln drain outfall protected & dirlo a Mu� irs g. Footing drains discharge away from STS area............ .... h. Surface water protection adequate .................................... i. Erosion control provided ........... : .................... — !COMMENTS K / 4e 9 -,,> - C9, (- v� 12/11/2001 09:51 845 - 278 -6392 1NSITE ENGINEERING PAGE 01 a 1- . r I PUTNAM COUNTY DEPARTMENT OF HEALTH DrVrMON OP ENVMONMENTAL HEALTH SERVICES AxTENTION ADAM ® GENE RMLIFST FOR FINAL MISP . ION For_ Fill All information must be fully completed prior to any Trenches X inspections berg made. PCHD Construction permit * � Z t-t " ° I Located:— _ C0Ri%1 1A <_L, HILL ROAD %4o -rte 9f' V_Ag-j� T� (V) PA-frtkS0A1 Owner /Applicant Name: Smm .. LL c - TM � 5 Block 3 Lot 1 o Z Formerly: Subdivision Name: C oRa WA 1.L HILL. 6,S raTEs Subdivision Lot r r Is system fill completed? YC 5 Date.' n - t o - or Is system complete? YES' Date: _ 11-to—of Is system constructed as per plans? Is well drilled? yEf Date:, Is well located as per playas? X� Are erosion control measures in place? , , -- I certify that the systems), as Jisted, 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. Date, __ 41 - t o -0( Certified by: PE X -RA,- P fessio (nsite E019 w►� Surveyino & # q Address: Sea %, . . [� 5k;;;iteg%w P- 1485 Route 22 Comments. BrewstPP. r�fgw Yffirk 10509 1. u ' 1' • • l/' I d -, BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 December 12, 2001 Jeffrey Contelmo, PE Insite Engineering Route 22 Brewster, New York 10509 Re: Field Inspection - BMMD, LLC _ Cornwall Hill Road/Somerset Drive (T) Patterson, TM# 13- 3- 34.05, Lot #5 Dear Mr. Contelmo: The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field: 1. The septic tank needs cast iron pipe connection. 2. Curtain drain stand pipes must be properly installed as per the approved plan. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Very truly yours, 4-01e. 0. ta� Gene D. Reed GDR:cj Environmental Health Engineering Aide 0 1� SENDING CONFIRMATION DATE : DEC -12 -2001 WED 16:56 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 92786392 PAGES : 1/1 START TIME : DEC -12 16:56 ELAPSED TIME : 00'21" MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... Dear Mr. Contelmo: The above refctcnced separate sewage treatment system can be backfilled. The following comments trust be corrected in the field: 1. The septic tank needs cast iron pipe connection. 2. Curtain drain Brand pipes must be properly installed as per the approved plan. If you have any further questions, please contact mc, at (845) 27"130 ext. 2261.' Very truly your. Oahe D. Recd GDR:cj Environmental Health Engineering Aide BRUCE R. FOLBY LOREWA MOLINARI R.N., M.S.N. Fvb(e Health Db de A-1.* F*b&- 11 ebh Dbww O mw 9' AWtat &rvLe DEPARTMENT OF HEALTH 1 Geneva R010 Bra Ver New York 10509 [aeboeaaaW two,(16A)11 -6130 Fe.(w)Z71-M1 ' tt.n4l en.tw tat))rn•13st a'1C116A211 -6611 Fa04A)71.6613 nrb lawrnaaea p45)371. ""' F."145)371-644S (uA221.912 Fn(11))Ztl -6113 December 12, 2001 Jcffmy Contelmo, PE Incite Engineering, Route 22 Brewsw, New York 10509 U: Field Inspection - EMMD, LLC Cornwall Full Road/Somenet Drive (T) Psurson, TM# 13 -3- 34.05, Lot U5 Dear Mr. Contelmo: The above refctcnced separate sewage treatment system can be backfilled. The following comments trust be corrected in the field: 1. The septic tank needs cast iron pipe connection. 2. Curtain drain Brand pipes must be properly installed as per the approved plan. If you have any further questions, please contact mc, at (845) 27"130 ext. 2261.' Very truly your. Oahe D. Recd GDR:cj Environmental Health Engineering Aide BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 December 27, 2001 Jeffrey Contelmo, P.E. Insite Engineering & Survey Route 22 Brewster, NY 10509 Re: Field Inspection: BMMD, LLC Cornwall Hill Road/Somerset Drive, Lot #5 (T) Patterson, TM# 13 -3 -34.05 Dear Mr. Contelmo: The above reference separate sewage treatment system can be backfilled. The following comments must be corrected in the field: No further comments. If you have any questions, please contact me at (845) 278 -6130 ext. 2261. Very truly yours, r Gene D. Reed Environmental Health Engineering Aide GDR:tn PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at Li7&waLL IWI A6A01S0)11Vr&,6rf V Town or IARegefrEP.�O Subdivision name CoRr4wALL 0 ja )'% tES Subd. Lot # Date Subdivision Approved q_q - 01 Owner /Applicant Name A M10 2 LLL Tax Map 13 Block,_ Lot Renewal Revision Date of Previous Approval Mailing Address 2— ''rAh Q RcwSfEQ , Ab V. Zip �C Amount of Fee Enclosed 3.2'1 t Building Type AES)P,6)V it L Lot Area No. of Bedrooms-4—Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 120 gallon septic tank and ,SDD LF 'A"106 AASO 3' (-1^ ree"`oED Other Requirements: L OF NX r5. G -PAVeL To be constructed by ' 14 61' 015f,64 1 W,�',D Water Sunny: Public Supply From 50 iii) � 7 `6V &rkW DtC+lJ Address Address oa:,: Private Supply Drilled by TO 66 oozawN 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 issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address P.E. _ rn��, & [}4,vOScAOE AQc �j,rEt R.A. > Date c -) I -Q 1 License # 61731 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified a considered necessary by the Public Health.Director. Any revision or alteration of the approved plan requires a new peftitj Appr for discharge of domestic sanitary sewage only. By: Title: Date: White'copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 } � ®. ,r +��, r� � � :. ��w�uvrwrw7wrov �wt�ww� i 4 �i t I i e /NS/ T ENGINEERING, SURVEYING & LANDSCAPEARCHITECTURE, 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 LETTER OF TRANSMITTAL Date: 6 -5 -01 Job No. 99147.305 Attn: Robert Morris, P.E. Re: SSTS for Cornwall Hill Estates - Lot 5 Somerset Drive, Town of Patterson TM# 13 -3 -34.05 ® Enclosed ❑ Under separate cover via ® Prints ❑ Plans ❑ Change Order ❑ ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION 5 5 -7 -01 CD -1 Construction Drawing 5 -21 -01 CP -97 Construction Permit 1�� ~^ 5 -21 -01 WP -97 Well Permit 1 -------------- - - - - -- LA -97 Letter of Authorization 1 5 -1 -01 CA -97 Corporate Affadavit 1 -------------- - - - - -- PC -97 Application for Approval of Plans 5 -21 -01 -- - - - - -- Short EAF DD -97 Design Data Sheets (previously submitted with subdivision application) 2 -------------- - - - - -- -- - - - - -- 4 Bedroom Floor Plans 1 5 -1 -01 -------- $300.00 Fee 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 ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ REMARKS: COPY TO: Iot2000.dot SIGNED: w� ��-/ John M. Watson, P.E. IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of BMMD LLC Located at Cornwall Hill Road TN Town of Patterson Tax Map # 13 Block 3 Lot 34.06' Subdivision of Subdivision Lot # Gentlemen: Cornwall Hill Estates r J Filed Map # 2856 Date Filed 04 -04 -2001 This letter is to authorize Insite Engineering, Sjp ve & 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. Countersigned: P.E., # 61931_ Mailing Address State New York Zip 10509 Telephone: (845) 278 -4990 Very truly yours, Signed, (Owner of Property)1�,0�,,,� Ig Mailing Address: 2 Tanager Road P.C. Brewster State New York Zip 10509 Telephone: (845) 279 -3613 Form LA -97 Garlinghouse: Plan Number92219(Copyright 2000 Garlinghouse, Inc.) Grandeur With Columns And Brick Plan No: 92219 Stories: 2 TLA: 3335 Main: 2432 Upper: 903 Beds: 4 Baths: 3.25 As you enter this gracious home, the turned staircase and 21' high ceiling make quite an impression. The formal dining room and the living room /parlor both contain beautiful, brick fireplaces and the parlor also boasts a bar. The expansive family room features a built -in entertainment center, cathedral ceilings, and the largest fireplace of the home. The spacious, island kitchen has room for several counter stools, as well as a large breakfast room. Off the utility room is a entry, which leads to the workshop and golf cart storage area. The master suite exceeds all expectations and spans the entire width of the home. It boasts a vaulted 12' ceiling, two walk -in closets (one of which is a room sized L- shape), and a plethora of bathroom amenities. The upper floor claims three large bedrooms, a balcony, and two full baths in a creative shared arrangement. PUTNAM COUNTY DEPARTMENT OF .HEALTH °# ,HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLYg TL? _ 1 aNS TO THESE HOUSE I� S UST B", PCDOH FOR APPROVAL �Ii NATURE & TITLE DATE Da able for Plan 92219 Stories 2 Units 1 Total Living Area 3335 sq. ft. Total Bedrooms 4 Porch Y Main Living Area 2432 sq. ft. Total Baths 3.25 Deck Y Upper Living Area 903 sq. ft. Full Baths 2 1 st Floor Master Y Lower Living Area 0 sq. ft. 3/4 Baths 1 2nd Floor Laundry N Bonus 0 sq. ft. Half Baths 1 Garage Garage Type attached Exterior Wall Size 4" Exterior Insulation R4 Garage Bays 3 PUTNAM COUNTY DEPARTMENT OF .HEALTH °# ,HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLYg TL? _ 1 aNS TO THESE HOUSE I� S UST B", PCDOH FOR APPROVAL �Ii NATURE & TITLE DATE Garlinghouse: Plan Number92219(Copyright 2000 Garlinghouse, Inc. e Level 1 Floorplan rm G ,C's" P iuo : • "' ar e,....o i me"40, t�i1S " tlC411 _ or. t8>r20 !U1e. tiViUnl1 �� I.ww WakBiap 13x;5 4m 1 Main'FWf 8ed#4 13XTI s Balcony Bod *3 13x14 - +.�, Bed�►2 Ent Bow t5><i t Upper Floor PUTNAM COUNTY DEPARTMENT OF HEALTH <5 DMSION OF ENVIRONMENTAL HEALTH „ INDMDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: STREET LOCATION: REVIEWED BY: GR, AS, SRDATE: l r TAX MAP-: (CONFIRMED) Y� DOCUiy NTS PERMIT APPLICATION )WELL PERMIT OR PWS LETTER (PC -97 LETTER OF AUTHORIZATION ( t_)DESIGN DATA SHEET (DDS) (_;,�(_)CORPOR4TE RESOLUTION (SHORT EAF (__)UPLANS -THREE SETS (_JUHOUSE PLANS - TWO SETS (_j )VARIANCE REQUEST T SUBDMSION LEGAL SUBDMSION (��SUBDMSION APPROVAL CHECKED (__)PERC RATE (FILL REQUIRED DEPTH U CURTAIN DRAIN REQUIRED GENERAL LOCATED IN NYC WATERSHED PLANS SUBMITTED TO DEP ( X }DELEGATED TO PCHD APPROVAL, IF REQ'D P TEST HOLES OBSERVED CS TO BE WITNESSED APPROVAL SSDS ADJ, LOTS i LANDS (TOWN/DEC PERMIT REQ'D?) 'A ON DDS PLANS & PERMIT SAME 1969 NEIGHBOR NOTIFICATION TER BUZBA 00 YR. FLOOD ELEVATION WA 200' ;OIL TESTING LOTS >10 YEARS OLD AGE SYSTEM PLAN - (NORTH ARROW) i HYDRAULIC PROFILE .VTTY FLOW (CONSTRUCTION NOTES 1 -15 ►DESIGN DATA: PERC & DEEP RESULTS 12' CONTOURS EXISTING & PROPOSED `DRIVEWAY & SLOPES, CUT ' POTING /GUTTER/CURTAIN DRAINS S SDA SOIL TYPE BOUNDARIES ):14TLE BLOCK; OWNERS NAME ADDRESS TM #, PE/RA; NAME, ADDRESS, PHONE# TE OF DRAWING/REVLSION TUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. ( PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS &_)(,� YELLS & SSDS'S W/IN 200' OF SSTS PROPERTY METES & BOUNDS __)EROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE COMMENTS: (REQUIRED DETAILS ON PLANS CON'T'D) HOUSE SEWER -' '/" FT. 4 "0'; TYPE PIPE CAST IRON C,�L_JN O BENDS; b1.4X BENDS 45- W /CLEANOUT RENEWALS UL—)SITE NOTE (NO CHANGE) FILL SYSTEMS C�10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE (FILL SPECS/ FILL NOTES 1 -5 L—) jFILL PROFILE & DIivIENSIONS FILL Lei EXPANSION AREA FILL GREATER 7HAN2 FEET CLAY BARRIER FILL CERTIFICATION NOTE DEPTH GAUGES VOL. ON 1 PLAN FOR RO.B., UNCLASSIFIED & IMPERVIOUS (___) SEPARATION DISTANCE FROM TOE OF SLOPE EN LF TRENCH PROVIDED 60FT MAX. WPAPLkLLEL.TO CONTOURS 100% EXPANSION PROVIDED DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL U GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS (4�-) P.L. DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS )100' TO WELL, 200' IN DLOD,150' TO PITS (� 100' TO STREAM, WATERCOURSE,-LAKE (inc. expaQ) )(�50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (pits = 20') 50' LNTERivITTTENT DRAINAGE COURSE 200'/500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS 10' bILN TO LEDGE OUTCROP SEPTIC TANK (J10' FROM FOUNDATION; 50' TO WELL WELL DIMENSIONS TO PROPERTY LINES LOCATION OF SERVICE CONNECTION (_J-ILN 15' TO PROPERTY LINE / SLOPE (J )( SLOPE IN SSTS AREA (520 %) REGRADED TO 15 %, IF REQUIRED �� DOSE/PUIy1P SYSTEMS ( /)PUbfP NOTES T 75% OF PIPE VOLUMEMOSE VOLUME NOTED 'AIL FOR FORCE MAIN, (PIPE TYPX, ETC.) AND D -BOX SHOWN & DETAILED DAY STORAGE ABOVE ALARM CURTAIN DRAIN ((__)STANDPIPES, 5' BOTH SIDES, DETAIL (_--)C_J15' MTiV to CDS = >5 %, 20' -4 %, 25' -3 %, 35' -1 %,100 % -<1% (_JL__)20' 1vIIP 1 to CD DISCHARGE /100' with 182 cons day discharge L,(_J10' MIN to NON- PERFORATED PIPE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # Well Location: Street Address: Town/*tlge' Tax Grid # CA2u�✓ I�lbr: Q p So�i aSEf /il ;= 'a Map Block Lot(s) ,p, Well Owner: Name: Address: (YIAD; LLC 12- -VA WA 6Ef, ROAD, 6ge"f1E4 5�09 Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation - rimary Business Farm Test/Monitoring Other (specify) Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage 3Q N 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 CoWwALL RILL EMU Lot No. � Water Well Contractor I c IS6 Os; frig iNrD Address: A►/4 Is Public Water Supply available to site? .................................. .. .............................. Yes No X Name of Public Water Supply: 1�1 Town/Village A Distance to property from nearest water main: Proposed well location & sources of contamination to e provided on separate sheet/plan. Date: 3 2i -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. y revision or alteration of the approved plan requires a new permit. Well to be constructed by a water/we l driller certified by Putnam County. Date of Issue l 0 i I Permit Issuing ill: Date of Expiration I Title: Permit is Non -Trans a rable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 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 # S 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: ' Sworn to before me this / J day of (month) H% (year) 2.0 o / Notary Lhc W7PaW0!* .01 PA6M4M d 9t Puft Form ww e Corporate Title: _Manager Seal UrNAM COUNTY DEPARTMENT 01R HEALTH DIVISION OF ENVIRONMENTAL 1HEAL T 1� SERVE ES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: P L Z %t•ti i� �ti�� j/_��7�j 5575 Rn-. l� 5 2. Flame of project: ilici t ^. Design Professional: Jeffrey J. Confelmo, P_�`__ j 6. Drainage Basin V 7. Type of Project: Private/Residential Apal Lments Office Building L ocatioAT: �S1Site D,- jLneeririy, Suu`v,- y:b,.q & Landscape Address: 7":2: ; e, c _ Rowe 22 -BY--,179 ter,-. r-Y^ - 1 -0-509 Food Service Institutional Realty Subdivision Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type I1 Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... Fits �, 10. Has•D 4-S been completed and found acceptable by Lead Agency? ..... 11. Name of Lead Agency -%e rd cs Pfi >� ^ ✓� -� �� 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 t--5 ...................... 14. Has approval been granted by such authorities? q65 Date granted: 4 -(o- 15. Type of Sewage Treatment System Discharge ................. surface water .X groundwater 16. If surface water discharge, what is the stream class designation? .................... ti 1,4, 17. Waters index number (surface) ........................................... ............................... 18. Is project located near a public water supply system? ....... ............................... N C 19. If yes, name of water supply N Distance to water supply 0) 1,A- 20. Is project site near a public sewage collection or treatment system? ................ ,ej o 21. Name of sewage system � 1 � g y Distance to sewage system 22. Date test holes observed,pvc, &/ -ZC joo 23. Name of Health Inspector 24. Project design flow (gallons per day ............................................................. 25. Is State. Pollutant Discharge Elimination System (SPDES) Permit required ?... /Jc> 26. Has SPDES Application been submitted to local DEC office? ......................... A) �A-- 27. Is -any portion of this project located within a designated'Totiti,-n or Stake 'vvetland? 28. Wetlands ID Number. ..................................................... ............................... /V 29. Is Wetlands Permit required? ..... .................... .....:....... ......I...... ................... Has application been made to Town or Local DEC office?.....: .......................... 30. Does project require a DEC Stream Disturbance Permit? ............................... N 0 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity��`� 32. is project located Nvithin 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile; landfill, sludge disposal site or any other potentially Imown source of contamination? ............................... U� DESCRIBE: '� SST S; ��i�pr�E'�,t°�ns� l� r�,r�z��y bar— N -:�•�x c�= s r';�� 33. Is there a local master plan on file with the Town or Village? ......................... �'�� 34. Are community water and/or setiver 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 36. Tax Map ID Number ........................................... I.............. Map 1 Block Lot �05- 37. Approved plans are to be returned to ..... Applicant Design Professional NOTE: All applications for review and approval of a ne%v SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may 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 misdemeanor pursuant to Section 210.45 o �4 t Penal Law. SIGNATURES & OFFICIAL TITLES. Mailing Address: .................................... --7— Ar ✓.d r.e o.�� v 14.16.4 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 SEAR Appendix C State Environmental Quality Review SNORT .ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Appllcant*or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME • 3. PROJECT LOCATION: Municipality RM.Solki County FLIONAM 4. PRECISE LOCATION (S reet address and road Intersections, prominent landmarks, etc., or provide map) SEE LC)ci)lr,o;NJ" .MAf ©rJ Cc1V51'r -VCNN( Pe4wlid r 5. IS PROPOSED ACTION: tR ew ❑ Expansion ❑ Modificationlalteration 6. DESCRIBE PROJECT BRIEFLY: Caj-Sieux/h Ij o O�JG �AI`9i�� RtSiiCtiG�� Xvc' iii 5S' 5, WrLL 7. AMOUNT OF LAND AFFECTED: 1 Initially 3'27Aa , r/ Ultimately Z kLJ— acres .3 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 5.y-es ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? kBesidential ❑ 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 permit/approvals Df iVL14 0 �E � �GwA� c;� ifij TrC%SCf1% 5S75•r\�EL . ° P.CAD. bvilPide - h, `4)'r- 10WV Oi' f'/tTt�Q �1i 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes If yes, list agency name and permitlapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑ Yes C�No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: 10 lsl L WATUN A L Date: �- 2[ O/ Signature: M 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 Il— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE 1 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 briefly C5. Growth, subsequent development, or'related activities likely to be Induced-0 the proposed action? Explain briefly. ••i C6. Long term, short term, cumulative, or other effects not identified in C1-05? 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. Eacheffect 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: , i ; Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Name of Lead Agency Date 2 Title of Responsible Officer Signature of Preparer (If different from responsible officer) t Y UTNAM COUNTY DEPARTMENT RTMENT Off' HEALTH D SION OF ENVIRONMENT AL MALTH. SERVICES DESIGN DATA SIEET - SUBS ACE SEWAGE TREATMENT SYS T EIS Owner F M H D, C+.6-� Address Located at (Street) Ov-1ila-JAv lVe v 1&> ;o,� L��� nm7ax Map l Block >. Lot (indicate nearest cross st Ieet) Municipality Drainage Basin Eft � i '5X ^36-x'1 L©� SOIL P RCOLA.TION TEST' DATA Date of Pr' CSC Date of Percolation Test Hole No. Run No. Time Start - Stop Ela se Time [PiVlin.) De' fh tb `Water rom Ground Surface (Inches) Start . Stop Water Level Dro In Iriftes Percolation Rate Min/Inch 2 �o: �16; 3 �a' --�r�. i 30 ' a a3 15,0 4 5 1 2 3 4 y 5 2 3 4 -5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 DEPTH G.L. 0.5' 1.01 1.51 2.01 2.51 3.01 3.51. .4.01 4.5' 5.0' 5.5' 6.01 6.51 7.01 7.51 8.01 8.5' 9.0' .9.5 10.01 TEST PIT DATA bESCRIPTION OF SOIB'ENCOUNTERED' IN TEST HOLES "HOLENb. '6k- HOLE N0. HOLE N0. W IV Indicate level at which groundwater is encountered Indicate level at which mottling is observed n3oaE Indicate level to which water level rises after being encountered Deep hole . observations, made by: lowJ #4k - OA-C->op Date Design Professional Name: Jeffrey J. ConteLmo,.P.E. Address: insite ngine�sinq, stwy%ung & -Lm&qape Architecture, P. T.-4,W, Route 2 2 Brewster, New York 10509 Signature: Design Professional's Seal -,I.- "'A" I FINE Indicate level at which groundwater is encountered Indicate level at which mottling is observed n3oaE Indicate level to which water level rises after being encountered Deep hole . observations, made by: lowJ #4k - OA-C->op Date Design Professional Name: Jeffrey J. ConteLmo,.P.E. Address: insite ngine�sinq, stwy%ung & -Lm&qape Architecture, P. T.-4,W, Route 2 2 Brewster, New York 10509 Signature: Design Professional's Seal -,I.- "'A" I • APPaDDC J -P yl %lAM C OURrY DEPARUP OF �7.TH DIVISION OF ENVIRONMTAL HEALTH SF- tVIC RS DESIGN DATA SHL,'�- SL`BSUFACE SEiWPGE DISPOSAL SYSTEM FILE W. owner •N tE� CA�.� i �- PZ&es s'il4e En s , `� 310 H;Eon'K IlJCd tea at (SLI'!2'C) G -L- 1ot (indicate nearest cross street)^/ ' Wa-tershed • 1" c- SOIL PERCOLATION TEST DATA REQU= TO HE SU�M.iTTED WITH APPLICATIONS Date of Pre - Soaking ( Date of Percolation Test 5 HOLE NCTKM Ci::OC.K TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water ravel No. Time Ground Surface In Indies' Soil Rate Start Stop Mina Start Stop Drop In Min /In Drop Inches Inches Inches 1 �.... I041 ua M t 6 Y4, Wiz,' /�,� A 4 h nl ��` 2 1� low o IA 8u Z5 M,N (�►" c 3" t ri jk dtOA3 2 (�� Ii3 ► ac�►� ls %f 4[ ,., lqM 3Y4 6-m La <<� 5 4-J °-1; �� � -7 rA � `� u � � - Oyu 13� " (V� wi t,� l.5" 2.2©A 69 `° r0 L;� 5'.z It 21 z 3 o IA law 105 Z5 M,N (�►" c 3" 4" jk dtOA3 2 (�� Ii3 ► ac�►� ls %f 254 )�b _ 3X 11th i13= r`'1t�? (�3/ ° v��4" �}• 13� " (V� wi t,� l.5" 2.2©A 69 `° r0 L;� 5'.z wo — i11= 21 Note: ._ This witnessed testing was not performed by Insite Engineering. See attached supplementat testing by Insite Engineering. (Originally tested as Lot # 11 Proposed as Lot # Eby Insite Engineering). as ror review. 2. Depth m.`.asureents to be mde frcmn too o- hole, • TEST PIT DATA REIQUME DESCRIPTION OF S ,EF�TrI HOLE NO. I �yeL. �r ° 3r TO BE SUBMITDED WITH EtaC0iJA22E M 324 TXS f�Ho .-otj, J� OLE NO. APPLICATION AOtIE W. 0 ° Note: This witnessed testing was not performed by Insite Engineering. See attached supplemental testing • ° by Insite Engineering. (Originally tested as Lot #15. Proposed as Lot # ,5by Insite Engineering). r • j•. DICATE L> IM AT WHIM CRMMMER IS MXUJNTERED DICATE LEVF..L TO NMCH WATEcR LEVEL, RISES • AFM BEING ENOQUNTEM rJ o t'e� :.° HOLE 4BSERVArIm =E BY: Vjs�s flor-, vese DATE: S DESIGN 'tl Rate -Used "7' Min11" Drop: ' . S.D.* 'Usabld Area Provided of Bedrocnis . Septic Tank , Capacity' gals . Type Sorption Area Provided By L.P. x 24" width trench . a t e _ t ' Q �'�' i • i :'" + , lg9' ' P45 • - S ignature cress '%b M ,'� ST: .. SFAL G': 064%0 :S SPACE FOR USE BY UEALTii DEPAIMff= CNLY; `.1 Rate Approved sq.£t /gal, Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner__ R tI N. O , L L C, Address 2 l umpu-� rw Located at (StreeQPjVwALi 1j ILL go./ c;�� Tax Map 13 Block 3 Lot" (indicate nearest cross street) Municipality .......,1" j' ^ Drainage l3asin�,5, ���l►�C�( LO 1 ,j SOIL PERCOLATION TEST DATA Date of Pre - soaking — l.p Date of Percolation Test Hole No. Run No.. Time Start = Stop Ela se Time Min.) De�ppth to Water k'rom Ground Surface (Inches) Start Stop Water Level Dropp In Inches Percolation Rate MinAnch 2 :5-0 ._ 11 :22 29 3 /"2— 1[1116 Zy - 4 5 1 ' Note: This supplemental testing was performed by Insite Engineering and not witnessed by the PCHD. See attached previously witnessed testing performed by others. 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 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. t t 2. Depth measurements to be made from top of hole. Form DD -97 2 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. -5 �---- HOLE NO. ' 5C HOLE NO. Note: This supplemental testing was performed by Insite Engineering and not witnessed by the PCHA . See attached previously witnessed testing performed by others. Indicate level at which groundwater is encountered Indicate level at which mottling is observed N obi E-i Indicate level to which water level rises after being encountered 7' '0 `' (S.fl) Deep hole observations made by: TO A0 +°'l. WA-r I Q t', Date 8-2-00 Design rofessional Name: ` $� •_Jeffrey J.:.Contelmo. Address: Insite Engineering & Sum Rnuj -p 22 Brewster, New York 10509 Signature: `'•''',f` �lT kS I Design Professi ,r (�C, Se!� al APPROXIMA 7E L OCA TION ROOF /FOOTING DRAW A PPROXIMA 7E L OCA 77ON CURTAIN DRAIN (SOLID PIPE) ,e.05 6�4 NN, 16 NN, N--, \ NN, 15 14 N", 13 12 1011 89 7 a a 2 4 22 C.O. 26 20 19 CURTAIN DRAIN (PERFORATED PIPE) sa 17 Cb 28 °G0. 0. 27 c 0 ---p24 29.' CO. LOT 6 SST S PER FILED MAP #2856 PLAN SCALE.- 1 il = 30 l