Loading...
HomeMy WebLinkAbout0431DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -3 -103 BOX 6 ' , , ' so I T P, r kP 00240 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Cornwcdl A;11 k-f. �,o_f WELL COMPLETION REPORT Well Location Street Address: d Town/Village: 0 Tax Grid # Map j' Block 3 Lot(s) Jv Well Owner: . Name: Ammh 11 Address: kc ,7 ' Use of Well: 1- primary 2- secondary Residential Business Industrial Public Supply Air cond/heat pump Irrigation Farm Test/monitoring Other(specify) Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length -,Mft. Length below grade �ft. Diameter _in. Weight per foot 17 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 Compressed Air Hours Yield _10 gpm Depth Data Measure from land surface- static (specify ft) �� �C During yield test(ft) 80 - 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 a u T/1 sa,464 �a If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type yTAe&tt2/ Capacity //2 Depth 21tO Model 2$O ply 915 Voltage 13 O HP Tank Type K1), *CVolume KPH Date Well Completed 1 / 1 � 6 �– Putnam County Certification No. 1 007 Date of Report' . Well Driller (signature) I a& hwt NOTE: Enact location of well with distances to at least two permanenylanCInarxs to ne provided on a sepa�rre sneevpian. Well Driller's Name e- A &44S6K.5 _TA C_ Address: i g Iffib Sil lyaAers4in 'AlY r Signature: Date: White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 ® PUTNAM COUNTY DEPARTMENT OF HEALTH DJ--VISION _ CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # P{ 30 -dZ OF ENVIRONMENTAL HEALTH SERVIC Located at /0? $046CS67" ID9ZVt �o¢NiJ4L.C. Subdivision name f&cLS 1� Subd. Lot # % Date Subdivision Approved Er., `i" 41"01 Owner /Applicant Name 9144!D , L.LL.. own r Village ?A 71a-'Q( Tax Map /S. Block 3 Lot / 4 Renewal tle evision yeS Date of Previous Approval ('0 01 Mailing Address Z j AAJA &z e�r, KDAUD [ f -w<2LZ Ill' l Zip O �Sp Amount of Fee Enclosed C)b�,(jU Building Type &5gM ir4L Lot Area /J / No. of Bedrooms q Design Flow GPD �y0 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage - System to consist of /, Z gallon septic tank and 5—U) L.F of � w�DG /�6Sc�TiGV•1 ��C.i�S Other Requirements: -- 0,� D6-6EP GJ aI pt4v� , Z 6 C-7PAv6L r:r — To be constructed by 'IV 13e Address Water Supply:, Public Supply From Address or: _ Private Supply Drilled by Tb 13a � � 1� Address Al 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 and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: P.E. R.A. Date 5 7 Address 3 t^,&t?agrr nr �_ �jy i os-i 2 License # Ca 1931 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 when con 'tiered n cessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. F ppr ved ischarge domestic sanitary sewage only. By: � Title: Date: `2.,1 /o White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pr fessional Form CP -97 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: �illage Tax Grid # /C1 01 6&56r O.C. Map 13. Block 3 Lot(s) 10-S Well Owner: Name: Address: LLc- Z, -M�J - -,tee. /ZUA! NY / osvq Use of Well: 'C Residential Public Supply Air /Cond/Heat Pump Irrigation -primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought __'S- gpm # People Served S" Est. of Daily Usage oc> gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling X 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 X_ Is well located in a realty subdivision? ...................................... ............................... Yes X No Name of subdivision C,0zxa iALt_ d-r1 h -,�..� Lot No. Cv Water Well Contractor: Tz� 0� Address: PJ A Is Public Water Supply available to site? ................................. ............................... Yes No V Name of Public Water Supply:} Town/Village A; A Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: 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 of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue Date of Expiration Permit is Non - Transferrable Permit Issuing Official: Title: White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 /NS/ T 7�ENGINEERING, SURVEYING & L4NDSCAPEARCHITECTURE, 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: 05 -20 -05 Job No. 99147.306 Attn: Robert Morris, P.E. Re: SSTS for Cornwall Hill Estates Lot 6 107 Somerset Drive, Town of Patterson TM# 13 -3 -103 ® Enclosed ❑ Under separate cover via ® Prints ❑ Plans ❑ Change Order ❑ the following items: ❑ Samples ❑ Specifications COPIES I DATE NO. DESCRIPTION 5 4 -29 -05 CD -1 Construction Drawing 1 5 -20 -05 CP -97 Construction Permit 1 5 -20 -05 WP -97 Well Permit 1 ! 4 -25 -05 141 - 4838 -158 $200.00 Fee REMARKS: This revision is based on the proposed lot line revision with Lot 5. There has been no increase in bedroom count. ._ ....... i COPY TO: SIGNED: J hn M. Watson, P.E. t. 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: This revision is based on the proposed lot line revision with Lot 5. There has been no increase in bedroom count. COPY TO: SIGNED: J hn M. Watson, P.E. t. IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE ?ot022205.dot PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PE IT WAGE TREATMENT SYSTEM PERMIT # L.- Located at 107 -Co M CR S S'f 'DR ! yC (Lbwn or Village eq T1 eA s 0AI r CCUR v wA Lt Subdivision name HI y, csrAfcS Subd. Lot # Tax Map 17, Block 3 Lot f o3 Date Subdivision Approved F i i E P 1-4-01 Renewal -- Revision Owner /Applicant Name 151AM 7> L t c Date of Previous Approval Mailing Address Z Tq .v4 ,G 6& je o A > -'2 cwsfe)e Al Y Zip Amount of Fee Enclosed -1 :? CO D -7 Building Type ACS'l �Ie JVAL� Lot Area 1, 4;! xNo. of Bedrooms i-I . Design Flow GPD_&op Aek'Cc, Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1 ., -a so gallon septic tank and x-00 Z. F. o e '2- W)Pe 4VsoRPrjt)1V TR6,yc:HC-t Other Requirements: � r_ v" 'r,, 6o cue rA /ij -DR Anti Z`-o� (Z, ©��• CaAAveL F(w To be constructed by ro e C n Cno1!, ymCj� Address Water Supply: Public Supply From Address or: X Private Supply Drilled by j-0 56- a E-T E!i /A/ N €32_ Address /,q 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 and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion .thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: P.E. ice, Date S-18-0-1. S! evc-1 E . /-vG, SvRv y /niG, Lq v�scq�` QRcJ/I �?iR� .P Address rr �+ "67 C q R M C` NY 1'11� S/z License elm 3 ! 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 whe nsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new perm't proved 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 _ , T -UTN M c ®u r wE ray DEPT 0 2 4 2 5 4 • 1.Geneva Road :,(845) 278 6130.:: Brewster, NY 10509 :Date Im BRUCE R. FOLEY Public Health Director TO: PROJECT: LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (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 ID TOWN: C SE PV DATE SUB'D APPROVAL: NOTICE OF COMPLETE APPLICATION DATE: oh lo L 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/Village Tax Grid # 101 0Rtv9 17A TTleR5DAf Map I.-S. Block 3 Lot(s) lo3 Well Owner: Name: Address: eMI"7>/ LLB Z lr4VAGep, ROAD 0REwS1EA Al-, loroq Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1 -prima Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5 gpm # People Served 5- Est. of Daily Usage lco 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 X Is well located in a realty subdivision? ...................................... ............................... Yes >e No Name of subdivision COQAI wA IL L 9 7 t L EsrAt,61 Lot No. C Water Well Contractor: Tp 13e Address: Is Public Water Supply available to site? .................................. ............................... Yes No . �,,e Name of Public Water Supply: :n/-4-4 Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: 8 -18 - 0,7. Applicant Signature: iLmmmz�q r1-M7 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 anal is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water w ller certified by Putnam County. / Date of Issue 1C b 4 Permit Issu' g ffici Date of Expiration I a l a Title: Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 4�1 SEXUAL HARASSMENT PREVENTION: -WHAT ALL EMPLOYEES NEED TO KNOW The Putnam County Personnel Department is sponsoring a Sexual Harassment Prevention Training Seminar for all employees. The program is designed to engage participants in realistic, practical dialogue about what needs to be done and what approaches and techniques can be used to prevent sexual harassment in the workplace. Mr. Larry Ritter, . of the NYS Office for Temporary and Disability Assistance, will present the training. PARTICIPATION IS MANDATORY FOR ALL COUNTY EMPLOYEES WHO HAVE NOT ATTENDED SEXUAL HARASSMENT PREVENTION TRAINING IN THE LAST TWO YEARS. Location: Lakeview Monday October 28, 2002 Monday October 28, 2002 Tuesday October' 29, 2002 Tuesday October 29, 2002 , Lake T 9:00 am -12:30 pm 1:00 pm- 4:30 pm 9:00 am- 12:30 pm 1:00 pm- 4:30 pm to: Understand the definition and terminology associated with sexual harassment. Recognize those actions that could be considered sexual harassment. Apply the skills necessary to prevent and stop sexual harassment. Using the scenarios depicted in Subtle Sexual Harassment Training Scenes, determine what situations are or could develop into a sexual harassment problem. Understand the agency's policy, complaint procedure and disciplinary process with regards to sexual harassment. Please register for this training by completing and returning the form below to the Personnel Department by October 11, 2002. We will send confirmation of the date for which you are registered and directions. If you have any questions,. please contact Charlessa C. Thatcher in the Personnel Department at 225 -0860 Ext. 1119. Name (print): Department: First choice session date and time: .Second choice session date and time: Supervisor's signature of approval: Department Head's signature of approval: -^ 0" ENGINEERING, SURVEYING& 3 Garrett Place (845) 225-9690 Carmel, New York 1D512 Fax (845) 225-9717 TO: Putnam County Health Department 1 Geneva Road Brewster, N}~1O50B WE ARE SENDING YOU [� Shop Drawings U Copy of Letter U��������� ��U� LETTER " ~~"� ��" TRANSMITTAL " "AL Date: 9-9-02 1 Job No. 99147.306 Attn: Robert Morris, P.E. Re: SSTS for Cornwall Hill Estates Lot 6 107 Somerset Drive, Town of Patterson TM# 13-3-103 ZEno|nmed [l Under separate cover via Z Prints [] Plans Fl Change Order Fl [l Samples COPIES DATE NO. DESCRIPTION Construction Drawing 8-28-02 1 CP-97 Construction Permit 5-1 -01 CA-97 Corporate Affaclavit --------- PC-97 Application for Approval of Plans 8-28-02 WP-97 Well Permit the following items [I Specifications 6-21-00 i DD-97 Design Data Sheets (p iously submitted with subdivision approval) 5-28-02 1 14094 $300.00Fee THESE ARE TRANSMITTED ma checked below: ZForoppmvu( ElApproved as submitted []Roaubmd FlFnryourume Fl Approved oonoted []Submit As requested FlRatumad for corrections El Return [lFor review and comment [l COPYTO: W2002.cot copies for approval copies for distribution corrected prints SIGNED: � jio n M. Watson I , P.E. /F ENCLOSURES ARE NOT43 NOTED, KINDLY NOTIFY USA7ONCE 14 -16-.4 (2/87) —Text 12 PROJECT I.D. NUMBER 617.21 SEAR Appendix C State Environmental Quality Review SHO_ RT .ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant.or. Project sponsor) 1. AP,PLICANT /SPONSOR 2. PROJECT NAME. II /` M LLr- r0& Co:4' WALL' 14-Is - st T S 3. PROJECT LOCATION: D n Municipality ( '(`f�Rso^� County IPVTA/,gM 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) JC E LOCA-ffoN MAP Onl CovS4RvC1o,v. D1eftw /N G, 5. IS PROPOSED ACTION: -TrNew, ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: �or►SS!�JCTIanI or o ,ji;.. C,R.MrLY (ZEsrpENCCy DRrvEwAv .qn/D APPvrtfr;vAvcEf, 7. AMOUNT OF LAND AFFECTED: Initially b I t� acres Ultimately ' 61 " acres S. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 19yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space 0 Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)?. ( ryes ❑ No If yes, list agency(s) and permlVapprovals 72tvEuAv Pkmrr - To..,v of P4T. 62So1✓ r9f; t -ELL •- PCHD . aV1 Lp /NG /'g:,q � wr - rOW ✓ 11. DOES'ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes 9No If yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes No I. CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE SNt1t6 E1V G/A/6EQ? 11V G SORV6YitiG, LAN'DscgPt 9,ec9 1r6 crv. ?6 Applicant/sponsor name: J094 /n. LJA'ri v n/ /'. Date: Signature: 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— ENVIRONMENTAL ASSESSMENT (To 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 briefly C5. Growth, subsequent development, or'related activities likely to be induced..4y the proposed action? Explain briefly. O C6. Long term, short term, cumulative, or other effects not Identified in C1-05? Explain briefly. COO <r— to "``" r• (`;• . — C7. Other Impacts (Including changes in use of either quantity or type of energy)? Explain briefly. y W CP C.T c,ty D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? AV ❑ 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 of 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 orl attachments as necessary, the reasons supporting this determination: Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Name of Lead Agency Date K Title of Responsible Off icer Signature of Preparer (If different from responsible officer) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISIO N OF ENN4RONT./IEN 'AL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANTS FOR A WASTEWATER TREATMENT SYSTEM L Name and address of applicant: 8r+r�D, ZLC 2 'fA,vA6t5A ROAD /3 R 6;- Is`rcv & NY w5'uq 2. Name of project: S5i's F°rL ��"�"�o, Lf-C 3 &;ZNWAw K w . &—A-A I;FS cvT �p 4. Design Professional: Jeffrey J. Contehro -'P.E. 5 6. Drainage Basin: �Astr3RgHC� LocationCV/V: PA Insite Engineering, Surveying & Landscape Address: Architecture p_c-_ 3 Garrett Place Carmel, New York 10512 7. Type of Project: � Private/Res i dent ial Food Service Commercial Apartments 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) .................................... I ............. I..... Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......I ........:......... No 10. Has DEIS been completed and found acceptable by Lead Agency? ............... A1,M 11. Name of Lead Agency N A 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ........ ............................... .............. ............................... ,vo 13. If so, have plans been submitted to such authorities? ............ N /A 14. Has preliminary approval been granted by such authorities? ,v& Date granted: N 15. Type of Sewage Treatment System Discharge .. ................ surface water � groundwater 16. If surface water discharge, what is the stream class designation? ....................... .LAI 17. Waters index number (surface) ........................................... ............................... -via 18. Is project located near a public water supply system? ................ 19. If yes, name of water. supply N fA Distance to water supply &A 20. Is project site near a public sewage collection or treatment system? ................. 21. Name of sewage system ,v /A Distance to sewage system y 22. Date test holes observed .,z, C -oe ¢g..3- ,;:23'. "-Name of Health Inspector AvA.-� - 4'-n9R6LWrr PEaer € -ZO-vo 6= 2► -ov) 8f3�oa' 24. Project design flow. (gallons per day) ......:...:.:::: ............... ............................... 8 00 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... ,-do 26. Has SPDES Application been submitted to local DEC office? ......................... ti /,a Form Pr; -97 L 27. Is any portion of this project located within a designated Toxin or State wetland? No 28. Wetlands ID Number .......................................................... ............................... tiLa _ 29. Is Wetlands Permit required?. ...... ......................................................................... Nn Has application been made to Town or Local DEC office? ..............:................ �V_m 30. 'Does project require a DEC Stream Disturbance Permit? . .. ............................... NO 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landflling, sludge application or industrial activity? ..........................:. Yes/No A/o 32. Is project located within 1,000 feet of existing or abandoned Iandfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially knoiyn source of contamination? ............................... Yes/No, Y ,5s DESCRIBE: ICCS'sMArJ LAND F-) L LP-APr , r-De Vr COANWALL 141Gi PoADl AA)n sA,.r srotxpleC 1/047 roti N +cHway �EPr. -��R�� o� s�rE) 33. Is there a local master plan on file with the Town or Village? ...... :................... acs 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? .. .............................:. VVX, 91JA1 35. Are any sewage treatment areas in excess of 15% slope? . ............................... 36.. Tax Map ID Number..... ................... Map / 3� Block 3 i� .... Lot 3 37. Approved plans are to be returned to ..... Applicant Design Professional NOTE: All applications for review and approval of anew SSTS to be located within the NYC Watershed shall be sent tathe 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 I= ..M. DEP and submit those forms to DEP for review and approval. n.� M. If the application is signed by a person other than the applicant shown in Item 1. the application Est be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provispan' r may be grounds for the rejection of any submission. CD r� t I hereby affirm, under penalty of perjury, that information provided on this form is. true r� .< to flee best Dn,, my knowledge and belief. False statements trade herein are pccnishable as a Class A msdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES 4 OFFIC:tAL TITLES. E gin d , Surveying & 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 1 o 3 Subdivision of Cornwall Hill Estates Subdivision Lot # Filed Map # 2856 Date Filed 04 -04 -2001 Gentlemen: This letter is to authorize Insite Engineering Surveying & 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 3 GA State New York Telephone: (845) 278'x#994 225 • is '7G Zip i Very truly yours, Signed F jor (Owner of Property)py�. ryeyma Mailing Address: 2 Tanager Road tune, P.C. Brewster State New York Zip 10509 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 # C 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 thereto Signed: Title: --Manager Sworn to before me this J— day of (month) (year)01-00 1. Notary Public _ '�V �t FAiL90f _ � ft 0fNew Corporate Seal fao.o1 Form CA.97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSMACE SEWAGE TREATMENT SYSTEM' Owner IF R irk D * LAG Address Located at (Street) Gor✓fle—, 't-le v- /u, nzTax Map. 1 Block >. Lot ld3 (indicate nearest-cross st et) Municipality rA•C`c:i'say3 Drainage Basin' 6A f 'tar 41060 : Date of Pre - soaking tO .. SOIL PtRCOLATION TEST DATA 0 Date of Percolation Test M Hole No. Run No.. Time Start - Stop EIa se Time gin.) De th to.Water iprom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Minanch 9:37 - iQ: 67 6 a3 a S A a i 13. 2 36 3 10 -.39 -18;09 . 4 5 1 9;(J -0 6 2 0: 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 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' 1.0' 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' , 2 ,. TEST PTT iDA.TA DESCRIPTION OF SOILS tNCOUNTER.ED LET TEST HOLES s HOLE NO. Q "HOLE N0. to HOLE NO. C '(0 p501l, V SAKV Indicate level at which groundwater is encountered q'Z Cold � �v Ag Indicate level at which mottling-is observed /Noah Indicate level to which water level rises after being encountered 4 (_(0 �g Deep hole observations made by: Date Z -W o0 Design Professional Name: Jeffrey J. Contelmo, .P.E. Address: Incite Fngireeriny, Stiucveying & Larxisea Architecture, P.C. 1-4-M. Route 22 Brewster, New York 10509:: >� /�< 4i• ,rt: Signature: Des 's Seal i, , :>: Apr.• .,. �, i��� o � PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVIC CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT PCHD CONSTRUCTION PERMIT # c- Located at l a--] {��`p own , r Village 2a-A&Q rs o n Owner /Applicant Name ►I _LC Tax Map ��, , Block a Lot c� 3 Formerly N1k Subdivision Name BAA D 1CV0JWALL Hlt�l% rPrT�f . r Subd. Lot # (U Mailing Address ';t -1-a r\ a A a nk `i2a f -A-g-r, iv Zip Date Construction Permit Issued by PCHD 5l Zt oT Separate Sewerage . System built by i' ui(i,nc t oyi Address N Consisting of 1,, Gallon Septic Tank and c,uc---, L.�� �� ` ►A� '=. �. R-2,011111 Other Requirements: 'I �- G `' C\e 4A cLL( k-cLl n art.: n 1`- d" R_ t1 F , r l► vel Fl 11 Water Supply: Public Supply From. Address or: _ Private Supply Drilled by AA\ A- N\ j± t &j) si,i, . Address to%% goule Apt ] aL&A r-,m, N y Building Type �Q � r� e.r► t ► c,Q Has erosion control been completed? Je 5 Number of Bedrooms Lt Has garbage grinder been installed? mo 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: :Z [2olo5 Certified by P.E. -)r-- R.A. D sign Pro ional) Address e� ; k LAI re,e(License # 603 3Eia►r�{.l'- luC� C.c,rmei, y IDSl�' Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are ubject to modification or change when, in the judgment of the Public Health Director, such revocation o ficationdar change is yqcessary. By:/ Title: {� Date: ! White copy - HD File; Yellow copy -Building Inspector; Pink copy -Owner; Orange copy -Design Professional Form CC -97 Jul 21 05 09:11a TOWN OF PRTTERSO 845 - 878 -2019 P.1 . JUL-20 -2005 13:19 FROM INSITE ENGINEERING 8452259717 70:8782019 P:2/2 BRUCE R. FOLEY Pubfie Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LOREM MOLINARI.ILN, M.S.N. drsoelare Peblie Health Director Director of Patlant Sevleez Eevlronmadnl lhdtb (914) 278.6130 Faz (914) 278 - 7921 Nursing Services (914) 278.6558 WIC (914) 278.6671 Fax(914)278-601S Early Ineervtmlan 1914)219-6014 ?mcboo) (914) 278.1082 F&x (914) 278.6648 OWNERS NAME: B►nmb LLC, TAX MAP NUMBER: 11.3-103 E911 ADDRESS: 101 -ALMA-41' nR►vE TOWN: PA'rticuoN AUTHOREZED TOWN OFFICIAL: (Signature) DATE: �� 6 The Putnam County Department of Health wiill not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized towns, offi,ciaL This form, is to be submitted with the application for a Certificate of Construction Compliance. (b911`T,1LFRM) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES (f orhW A All FZ /,Of # � WELL COMPLETION REPORT Well Location Street Address: (j Town/Village: hArSOK Tax Grid # Map j Block 3 Lot(s) )v Well Owner: Name: Ammh ii Address: hc > on 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 X Open hole in bedrock _ Other Casing Details Total length ft. Length below grade /60 ft. Diameter in. Weight per foot Jlb /ft. Materials: Steel Plastic Other Joints: _ Welded V 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 A0– gpm Depth Data Measure from land surface-static (specify ft) /O Ta T During yield test(ft) Aeot 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 sTAC Z2/ Capacity 112. Depth 110 Model 1-90 OW Voltage 110 HP� Tank Type �p,yCVoIume /0 4 P/1 Date Well Completed 111161'* 1 Putnam County Certification No. 00-7 Date of Report 1111,L6 Well Driller (signature) mmn�j_ zwt INU IC: hiact location of well with distances to at least two permanenylanparks to be provided on a sepaote sheet/plan. Well Driller's Name AMe, A -I�C• Address:1tl e Rib 6 `a Ars ,� r � Signature: Date: White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 /NS/ TAE L ENO /NEER /NG, SURVEY ING & LANDSCAPEARCH/TECTURE, 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 LETTER OF TRANSMITTAL Date: 7 -22 -05 Job No. 99147.306 Attn: Robert Morris, P.E. Re: SSTS for Cornwall Hill Estates Lot 6 107 Somerset Drive, Town of Patterson TM# 13 -3-103 WE ARE SENDING YOU ® Enclosed ❑ Under separate cover via ❑ Shop Drawings ® Prints ❑ Plans ❑ Copy of Letter ❑ Change Order ❑ ❑ Samples the following items: ❑ Specifications COPIES DATE j NO. DESCRIPTION 5 7 -22 -05 i A13-1 As- Built Drawing —_ 1 7 -20-05 CC -97 Construction Compliance 3 1 i 7 -20 -05 j 7 -19 -05 GS-97 Guarantee f Water Test Results 1 - --' 1 —7. -19-05 7 -21 -05 _ 1 141 8853 653 $300.00 Fee E -911 Address Certification 1 111 -11 -04 WC-97 Well Completion Report 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: Iot2002.dot SIGNED: b° dfJWatson, P.E. Project Engineer, Associate IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovani, Director LAB ##: 1.504745 CLIENT #: $6173 NON STAT PROC PA P~: 1 NN- N---------- -- yNNwwwww w- N------ - ----- -------- -- -N- --N ­ ---- .-- ------------ BMMD.LLC 166 SOMERSET DRIVE PATTERSON, NY 12563 DATE /TIME TAKEN: 07/].2/05 08:45 DATE /TIME RECD: 07/12/05 10:00 REPORT DATE: 07/19/05 PHONE: (845) - 590 -974 SAMPLING SITE: LOT 6 - 107 SOMERSET DRIVE, PATTERSON SAMPLE TYPE;..: POTABLE BASE FAUCET PRESERVATIVES: NONE COLD BY; BRUCE MAJOR TEMPERATURE!..: NOTES...: COLIFORM ,METH: N/A NwNNN.. NNMNwN1 /NMww------------ --------- MN wIF- NwN..N-- Nw- N- N- - -N ------ -- - - -N DATE FLAG PROCEDURE RESULT NORMAL - RANGE- PUTNAM CNTY PROFILE 07/12/05 MF T. COLIFORM ABSENT /100 ML 07/14/05 LEAD (IMS) 2.5 ppb 07/15/05 NITRATE NITROG 2.52 MG /L 07/13/05 NITRITE NITROG <0.01 MG /L 07/15/05 IRON (Fe) 0:454 MG /L 07/13/05 MANGANESE (Mn) <0.010 MG /L 07/15/05 SODIUM (Na) 128 MG /L 07/12/05 pH 7.2 UNITS 07/15/05 HARDNESS,TCTAL <2 MG /L 07/15/05 ALKALINITY (AS 212 MG /L 07/15/05 TURBIDITY (TUR 2.1 NTU COMMENTS: FAX TO 845.878 -7999 ABSENT 0 -15 ppb 0 - 10 N/A 0 -0.3 mg /1: 0 -0.3 mgJ1: NIA 6,5 -8.5 N/A N/A 0 -5 NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER (WA. ,(WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDIN 0 THE NEW YORK STATE; AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THR TIME OF COLLECTION. Pb /Cu LEAD limits for p EPA Lead & Copper than 10# of their than 15 ppb and a treatment must be potential. iblic schools are set at 15 ppb. Rule for Public Systems requires that no.moze distribution points have a LEAD value of more COPPER value of 1.3 mg /L, else water undertaken to reduce the waters corrosive Fe /Mn if both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. METHOD 1008 9003 9052. 9162 9002 9002 9002 9043 9001 € 20yd : M Wa R : R 111 so -6 t -znr YML ENVIRONMENTAL SERIVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 2452800 Albert H. Padovani, Dixector LAB #: 1.504745 CLIENT #: 56173 NON STAT PROC PAIGE: 2 - - - - - - - M - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - -.- - - - - - - - - - - - BMMD LLC 166 SOMERSET DRIVE PA.TTERSON, NY 12563 DATE /TIME TAKEN: - 07/12/05 08:45 DATA; /TIME RECD: 07`/12/05 10:00. REPORT DATE: 07 /19/05 PHONE: (845)-590-97-'3 4 SAMPLING SITE: LOT 6 - 107 SOM8RSST DRIVE, PATTERSON SAMPLE TYPE,.; POTABLE BASE FAUCET FRE9ERVATIN/33S: NONE COLD BY: BRUCE MAJOR TEMPERATURE;..: NOTES—.: COLIFORM -METH: N/A - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ------ N - --------- - - - - --------- - - - - - - - - - DATE FLAG PROCEDURE RESULT NORMAL - RANGE! METHOD 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. phi pH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF p1l IS ONE" OF THE IMPORTANT ANA 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 CONCEN'T'RATION, BOTH EXPRESSED AS .CALCIUM CARBONATE, IN 1,114 /L.. t'HE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG /L, DEPENDS ON TIC$ SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED., SOFT WATER: 0 -70 MG /L VERY HARD WATER: ABOVE 300 Mr /L MODERATELY HARD WATER: 70 -140 MG /I, MG /L = MILLIGRAM PER LITER HARD WATER: 140 -300 MG /L (1 grain /gallon - 17.2 MG /L)� SUBMITTED BY- Albert . Padovani, M. T. ASCP) Director � Hodd :Xv3 BLAP# 10323 Wd H : rto 9L S0- 61 -zar . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 'BM MVIIt_C_ 13. 3— 10 Owner or Purchaser of Building Tax Map Block Lot LA4-cLQ fV P niu P a2� Building Constructed by l07 Location - Street S l dewft j Building Type TownNillage Bla't� LA�i✓J4� �f'cu- �'i7"�4�� Subdivision Name 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 ,2o Year e2oo5 General Contractor (Owner) - Si lure I) nn rn fl ,i 1 -C— Corporation Name (if corporation) "41T. wlff,41 i iL a...I W O TA Signature: Title: Corporation Name (if corporation) Address: State t,�� -try Zip State Zip Form GS -97 YML ENVIRONMBVTAL SERV]CES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 1.504745 CLIENT #: 56173 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ BMMD LLC 166 SOMERSET DRIVE PATTERSON, NY 12563 NON STAT PROC PAGE: I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ` DATE/TIME TAKEN: 07/12/05 08:45 DATE/TIME REC'D: 07/12/05 10:00 REPORT DATE: 07/19/05 PHONE: (845)-590-9734 SAMPLING SITE: LOT 6 - 107 SOMERSET DRIVE, PATTERSON SAMPLE TYPE..: POTABLE : BASE FAUCET PRESERVATIVES: NONE COL'D BY: BRUCE MAJOR TEMPERATURE..: NOTES...:, COLIFORM METH: N/A ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAB PROCEDURE PUTNAM CNTY PROFILE 07/12/05 MF T. COLIFORM 07/14/05 LEAD (INS) 07/15/05 NITRATE NITROG 07/13/05 NITRITE NITROG 07/15/05 IRON (Fe) 07/13/05 MANGANESE (Nn) 07/15/05 SODIUM (Na) 07/12/05 pH ' 07/15/05 HARDNESS,TOTAL 07/15/05 ALKALINITY (AS 07/15/05 TURBIDITY (TUR COMMENTS: FAX TO 845-878-7999 RESULT NORMAL - RANGE METHOD ABSENT /100 ML ABSENT 1008 2.5 ppb 0-15 ppb 9003 2.52 MG/L 0 - 10 9052 <0.01 MG/L N/A 9162 0.454 MG/L 0-0.3 mg/l 9002 <0.010 MG/L 0-0.3 mg/l 9002 128 MG/L N/A 9002 7.2 UNITS 6.5-8.5 9043 <2 MG/L N/A 212 MG/L N/A 9001 2.1 NTU 0-5 NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD��� =�{��HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. 11"b /CU LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. ublic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director- LAB #: 1.504745 CLIENT #: 56173 NON STAT PROC PAGE: 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ BMMD LLC 166 SOMERSET DRIVE PATTERSON, NY 12563 DATE/TIME TAKEN: 07/12/05 08:45 DATE/TIME REC'D: 07/12/05 10:00 REPORT DATE: 07/19/05 PHONE: (845)-590-9734 SAMPLING SITE: LOT 6 - 107 SOMERSET DRIVE, PATTERSON SAMPLE TYPE..: POTABLE : BASE FAUCET PRESERVATIVES: NONE COL'D BY: BRUCE MAJOR TEMPERATURE..: NOTES...: COLIFORM METH: N/A ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAB PROCEDURE RESULT NORMAL - RANGE METHOD Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should qontain 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 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 (1 grain/gallon = 17.2 MG/L) SUBMITTED BY: Director ELAP# 10323 ^ ' YML ENVIRONMENTAL SERVICE.'.')' 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director / BMMD LLC DATE/TIME TAKEN: 07/20/05 12:30 166 SOMERSET DRIVE DATE/TIME REC'D: 07/20/05 01:37 PATTERSON, NY 12563 REPORT DATE: 07/25/05 PHONE: (845)-590-9734 SAMPLING SITE: 107 SOMERSET DRIVE SAMPLE TYPE..: POTABLE : PRESERVATIVES: NONE COL'D DY: BRUCE MOTOR TEMPERATURE..: NOTES...: COLIFORM METH: N/A DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 07/21/05 IRON We) <0.060 MOIL 0-0.3 mg/1 9002 COMMENTS: VAX TO 845-878-7999 COMMENTS: Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. SUBMITTED BY: Director ELAP# 10323 JUL -14 -2005 07:39 FROM:INSITE ENGINEERING 8452259717 TO:27e7921 P:1/1 PUTNAM COUNTY DEPAXt'1 URNT OF HEALTH DIVISION OF ENVMONMMAL EMALTH SERVICES ATTENTION � JOSEPH YC-FJqE REQUEST-FOR—FINAL INSPECTION For: kill All information must be fully oompl&W prior to Amy Tmnchas imcpections being made. PCHD Construction Permit 0 P Located: J. (v) . y g -so- V, Owner /Applicant Name: rn ru h. u . Block — Lot l g Formerly: A - — Subdivisibon Natne: .nja H1,11 F:,51 g kS Subdivision Lot — is system fill oompleted7 . ye g Date: a Is system complete? Ye I Date: r- Is system constructed as per plans? _yes Is well drilled? _ ��5 Date: -7 • a Is well located as peer plans? _ VLJ Arc erosion control measares in place? S I certify that the syswn(s), as w4 at the above p = iw bus bw n constwted aad I havo inspected and verified their completion in wcotda= with the issued PCHD Construction. ,permit and approved pleas and she Standards, Rules and Rogulaiions of the Putnam County Deparhmt of Health. bate: Certified by: Ffi ,.� RA besi Pro nal Address: ,.3 Fi arr�r -f-f•• �a �c., . a �1, n� os ,t Comments: Form M. -99 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: Inspected by:.' Street Location Saw; �r s e r., Owner Town dot 9fe( -,;& . Permit # 'p •- 3<9 -- o g TM # 1.31 -- , — i o 3 Subdivision Lot # 1. Sewage System Area a. STS area located as per approved plans .......... .. ................ b.. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 1 00' from water course /wetlands ..... .............................. IL Sewage System " a. Septic tank size - 1,000 ........1,25 .........other ................ b. 'S eptic*tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3... Nfinimum 2 ft. Original soil between box & trenches e. Junction Box properly set .......... ............................... 6. Trenches 1. Length required Of' Length installed 500 2. Distance to watercourse measured 4- 10+ © Ft........., 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ....................:.... 8' Size of gravel 3/4 -1' /z" diameter clean ...................: 9. Depth of gravel in trench 12" minimum ....... :........... 10. Pipe ends capped ........................ ............................... g. Pump or Doseif Systems 1. Size of pump chamber ................. ............................... 2. Overflow tank ....................... ..............' * " ", * " "...... " "I 3. Alarm, visual / audio ........:........... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First boy, baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III: House/Buildidg a. house located per approved plans........ b. Number of becrrooms .... ............................... .. IV. Well Well located as per approved plans ....... : ................... ..... b. Distance from STS area measured -'" %o 6O 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 .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain g. Footing drains dish protected watercourse discharge away from STS area h. Surface water protection adequate .... ....:.......................... i. Erosion control provided ................. ............................... Rev. 12/02 MAE MrAMMMA WOME FOAM 0 WIM WGIM v. C" OW ANN KNIM MIRE am -- EWA MAPON WE, County ueyur�wef- ui ,3 Environmental Health Services O Subdivision Mo 8 O as noted for conformance with P of Section Two 7 'e idea and Regulations of the t °b�rztr°'�us�nwa / //� /d9e• m qty Health Departme t, re & ,itle ate. OVERALL PLAN SCALE.• 1' = 60' wEtt ' 29 EXPANSION ABSORP77ON TRENCH (TYP.) (f00X EXPANSION PROVIDED 1,250 GALLON SEP77C TANK - J8. Msy C. 0. Y5 11 _ 2 PRIMARY ABSORP7701V _ 24 7RENCH (7YP.) 10 23— �t1 p 12 l nT F 27 14 16 M ULIE 145 OF 1HE EWCA77ON LAW. SCALE: 1 — ZP DRAIN PE NO. DATE PROJECT.• (CORN 107 SCUMSE7 DRAWING: PRAECT NO. DA 7E SCALE 29 h J. PROPERTY LINE AND BUILDING INFORMATION IS BASED ON FIELD SURVEY BY INS1 TE ENGINEERING, SURVEYING & LANDSCAPE ARCHITECTURE, P.C. COMPLETED 7/20/2005. AS -BOIL T MEASUREMENTS NO. A CORNER OF DWELLING .B CORNER OF DWELLING REMARKS . 1 40' 57' 1,250 GALLON SEPTIC TANK 2 50' 64' CLEAN OUT 3 107' 116' CLEAN OUT 4 158' 169' DROP BOX 5 160' 174' DROP BOX 6 159' 176 DROP BOX 7 155' 174' DROP BOX 8 151' 172' DROP BOX 9 148' 172' DROP BOX 10 145' 171' DROP BOX 11 142' 171' DROP' BOX 121 181' 208' END OF TRENCH 13 182' 207' END OF TRENCH 14 184' 207' END OF TRENCH 15 187' 208' END OF TRENCH 16 190' .209' END OF TRENCH 1.7 193' 210' END OF TRENCH 18 190' 205' END OF TRENCH 19 192' 205' END OF TRENCH 20 130' 143' END OF TRENCH 21 126' 142' END OF TRENCH 22 120' 139.' END OF TRENCH 23 115' 137' END OF TRENCH 24 111'. 136' END OF TRENCH 25 108' 136' END. OF TRENCH 26 104' 136' END OF TRENCH 27 90' 90' BEGIN OF PERFORATED CURTAIN DRAIN 28 214' 222' BEGIN OF SOLID CURTAIN DRAIN 29 208' 258' DISCHARGE OF CURTAIN DRAIN NO. I DATE I REVISION I BY PROJECT 3.Garrett Place INSIT E Carmel, NY 10512 ENGINEERING, SURVEYING & (845)-225-9690 (845) 225 -97717 17 fax LANDSCAPE ARCHITECTURE, P.C. www.insite— eng.com