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HomeMy WebLinkAbout0434DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13.3 -107 BOX 6 00243 em in . Icy% I is { �{ '? me IN IN IL 0 �. IN L r : or Nem 00243 \ V` PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # ' y- �3 y -�`'�' _:� to Located at 11 (-OSKI KE Ce,)&T J I own r Village od Owner /Applicant Name 90MM�, LL(- Tax Map 13 Formerly Block 3 Lot I o7 Subdivision Name gMtAo LU, GORnIWAO- 'HILL ESTATES Subd. Lot # 11 Mailing Address 4-JhGa RdA9 'iawsf6k , 01 Zip 105,01 Date Construction Permit Issued by PCHD 5-403 Separate Sewerage System built by O6 "TP" — ' Address X� G� 55 AAA STaIt- �viuc.�- L -c Consisting of 1)50%) Gallon Septic Tank and 5Go Lf of a' W& AbS-f- PT1o,-J Tc&twGs Water analysis result fcr Eodiura tE',s j ;s: _ .... __ ._. _ nndlL Water eontaininr r nrm i.hnn ?0 rn. -ii, r! n,,;,,: a :'Y.z„T-'I ,;112 Lhe used fay - ti drinking n b on severely risY ist i gin r t Water eontaining pep Other Requirements: q&fJAgg 3 of aoctiuni shaaE?ci nr t g; u,c- 3 by a:,ca to on moderately restricted sodium diets. P U NAr.'- C.O.-Ul"'TY EDEN. OF HEALTH Water SUDDIV: Public Supply From. or: X Private Supply Drilled by Address_ Address Building Type R(s %0E4T JAL Has erosion control been completed? Number of Bedrooms 5 Has garbage grinder been installed? /JO /do 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: `5 W 1(-'09- Address sm►s r E 3 CGAKRETT QL4Q Certified by „j G I S„R4Ey,N %n�► r�� License # i ^R r QPJA6L dy, 10512 P.E. R-.A (01 11 3) 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 Ki'eati t to odification or change when, in the judgment of the Public Health Director, such revocation, o change i necessary. By: �� Title: Date: d White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 0*// WELL COMPLETION REPORT Well Location Street Address: 1/ Town/Village: Pee rS-6 kj Tax Grid # Map 13 Block __5 Lot(s) 10% Well Owner: Name: Address: n M !i c" , Lwsi6 / l kY. Use of Well: 1- primary 2- secondary Residential Public Supra 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 _K_ Open hole in bedrock Other Casing Details Total length cY5 ft. Length below grade _ZV-ft. Diameter -7 in. Weight per foot 1 lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded Threaded _ Other Seal: —Cement grout Bentonite Other Drive shoe: Yes No _ Liner Yes _K No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped X Compressed Air Hours 6 Yield _ gpm Depth Data Measure from land surface - static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 6 f K - (587 QS If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type , I Capacity Depth 2.) 0 Model _-X,�o I. VV �q Voltage 2-.36 HP j Tank Type A3,A*rV:, Volume Date 7�367d� omPutnam County Certification No. 067 Dat7fR;ort,,,, Well Driller (signature) NOTY: Exgct location of well with distances to at least two permanedt langmarks to be provided on a sepape sheet/plan. Well Driller's Nam t - Address: Aff hy. 9�/ G�561� /yT J Signature: L,7 Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Mar 17 .04 -10: 57a BRUCE R. FOLEY Public Health Director TOWN OF PHTTERSO 845 - 878 -2019 p.2 LORETTA MOLINARI Ri.N., M.S.N. Associate Public health Director Director of Patfent services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Eorlrocmeutal Hcalth (9!4)218 -6130 Fax(%4) 378.7921 Nurtlq 3arvlces (914)218 -6559 WIC (914)278 -6678 Fax(914) 278 -6085 Early latcrvention (914)278 -6014 Prctchoal (914) = 78.6082 Far(914)278 -6648 OWNERS NAME: �7_r -r-0 L-C, -� TAX AU NUMBER 13 - I- t o 1 E911 ADDRESS: << CAEsHvic( Co�t1 TOWN: Qr�TS'Ea S�� AUTHORIZED TOWN OFFIC]fA1,: j (Signature) DATE: 7//71e The Putnam County Depalrtmextt of Health will not )issue a Cerdficate of Construction Compliance unless the above forlm is completed, i.e., a legal E911 address is assigned by an authorized town offlciaL This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VF.RFYtIvA 2.2:d 6 e2BL8:01 LiL6S22Sb8 E)NI833NI9N3 31ISNI:W02l3 62:£0 K02 -91 -NNW PITTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM %miq LLC 13 3 107 Owner or Purchaser of Building Building Constructed by 11 CNESg kE CcauRT Location - Street R,�S%DE.N; IAc Tax Map Block Lot QATT6 &so,J ow illage j>mj,,0 cLc. , (-0R jWALQ Alt( EsrArCS Subdivision Name Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above- described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the buildin utilizing the system. Dated: Month H rr4 Day 12 Year Zooz_ Signature: General Contractor (Owner)- Signature Corporation Name (if corporation) Address: State Zip Title: b "p . LL Q Corporation Name (if corporation) Address: a "IraI O (rE2 Z00 � b(te jsl c 2 State 0 y Zip 1,0509 Form GS -97 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown He`ghts, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 32.401492 CLIENT #g 56173 NON STATPROC PAGE: 1 BMMD LLC DATE/TIME TAKEN: 03/02/04 08:30A 2 TANAGER RD DATE/TIME REC'D: 03/02/04 11:11A BREWSTER, NY 10509 REPORT DATE: 03/10/04 PHONE: (845)-279-1771 SAMPLING SITE: LOT 11 CORNWALL HILLS ESTATE SAMPLE TYPE..: POTABLE : 11 CHESTNUT CT PATTERSON NY PRESERVATIVES: NONE COL/Q BY: BRUCE MAJOR TEMPERATURE..: < 4C NOTES...: BASE FAUCET COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~° ~~~~~~~~~~~~~"~~~~~~~=~°"~"~~~~~°~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 03/02/04 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 03/02/04 LEAD (IMS) <1 ppb 0-15 ppb 9101 03/02/04 NITRATE N%TROG 0.23 MG/L 0 - 10 9139 03/02/04 NITRITE NITROG <0.01 MG/L N/A 9146 03/02/04 IRON (Fe) {0.060 MG/L 0-0.3 mg/l 2037 03/02/04 MANGANESE (Mn) <0.010 MG/L 0-0.3 mg/1 2037 03/02/04 SODIUM (Na) 97.1 MG/L N/A 03/02/04 pH 6.6 UNITS 6.5-8.5 9043 03/02/04 HARDNESS,TOTAL <2 MG/L N/A 03/02/04 ALKALINITY (AS 172 MG/[ N/A 03/02/04 TURBIDITY (TUR <1 NTU 0-5 NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER ,(WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDIN THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTEDv AT THE 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 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. 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 i suggested.. s I NSI TE E ENGINEERING, SURVEYING & LANDSCAPEARCHITECTURE, P.C. 3 Garrett Place (845) 225 -9690 Carmel, New York 10512 Fax: (845) 225 -9717 TO: Putnam Countv Health DeDartment 1 Geneva Road Brewster, NY 10509 LETTER OF TRANSMITTAL Date: 3 -16 -04 Job No. 99147.311 Attn: Robert Morris, P.E. Re: SSTS for Cornwall Hill Estates Lot 11 11 Cheshire Court, Town of Patterson TM# 13 -3 -107 WE ARE SENDING YOU ® Enclosed ❑ Under separate cover via ❑ Shop Drawings ® Prints ❑ Plans ❑ Samples ❑ Copy of Letter ❑ Change Order ❑ the following items: ❑ Specifications COPIES !DATE ' NO. I DESCRIPTION 5 -- 3 -310 -04 AB-1 As -Built Drawing 1 �— ^- 3_16 -04 _ j CC -97 Construction Compliance 3 j 3 -12 -04 I GS -97 I Guarantee 1 E911 Address Verification 1_ —�_- 3 -10 -04 Water Test Results 1 1 v 16 -2 -03 + 3 -10 -04 WC -97 i 06269 ompletion Report $300.00 Fee 26858 .. fj 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: SIGNED: /V, Joh M. Watson, P.E. IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE Iot2002.dot YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albert H. Padovani, Director LAB #: 32.401492 CLIENT #: 56173 NON STAT PROC PAGE: 2 --------------------------------------- M M N M N N- IV M N M N N AI N N M M N M N N N N N N N N N- N N N N N N N-- BMMD LLC DATE /TIME TAKEN: 03/02/04 08:30A 2 TANAGER RD DATE /TIME RECD: 03/02/04 11:11A BREWSTER, NY 10509 REPORT DATE: 03/10/04 PHONE: (845)- 279 -1771 SAMPLING SITE: LOT 11 CORNWALL HILLS ESTATE SAMPLE TYPE..: POTABLE : 11 CHESTNUT CT PATTERSON NY PRESERVATIVES: NONE COL'D BY: BRUCE MAJOR TEMPERATURE..: < 4C NOTES...: BASE FAUCET COLIFORM METH: MF --------------------------------------- M N N N N N N N N N N N N ------ mm N N N - N N N N N N N - N N N N N N DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 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 3007 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: IV Alber. • . Padovani, M.T. (ASCP) Director ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION l Date: Inspected by: 4, Kg-ap Street Location iY Gy�s�rLrr� G�-o Owner ��� L `� Town ?,#rr -gxsav Permit # TM # Z,3-,3-W7 Subdivision Lot # e� 1. Sewage System Area YES O COMMENTS a. STS area located as per approved plans ..........:................ F7 0.'0,00 p, 0,1<- b.. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... H. Sewage System -- a. Septic tank size - 1,000 .......... 1,250 ......... other/ .da_r b. 'S epfic' tank installed level ...................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ..............:. 2. Protected below'frost .................. ............................... 3... Minimum 2 ft. Original soil between box & trenches e. Junction Box - properly set .......... .......................... ...... 6. Tcenc es- . 1. Length required Length installed �6 a 2. Distance to watercourse measured + i oo Ft.......... 3. Installed according to plan .......................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property he - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - l lh" diameter clean .................... 9. Depth of gravel in trench 12" minimum ....... :............ 10. Pipe ends ca pped ........................ ............................... g. Pump or DosedpSystems 1. Size of 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. HouseMuddiiig ra Ouse- located persapproved plans - . b ° Nuinber,�of bedrooms 1 L, :_ 7 IV Well located as per approved plans .............. Distance from STS area measured 1.0 o ' 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" diameterY, - -. - e Curtain drain &standpipes installed accordug t --� G ;, f� Curtaui drain outfall protected-& diF,; ekust w' terco -► f „ " g: Footing drains discharge -away: from ;STS area --� _ _.__ I . Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 12/02 „T ,T, . _; T 'd d0 1N3WIdUd30 h1Nnoo WdNindc3WdN T26Z- 82-2-SOB:131 SS :80 nH1 cow- e2 -9nu r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION ❑ ADAM GENE RIBQI XST FO FINAT, =PEC For: Fill All information must be fully completed prior to any Trenches _ inspections being made. PCHD Construction Permit # Q - 4 -,b 3 Located: h Qytf,a.e Lo—y f A t -T-)0 ) Owner /Applicant Name: RµM-d u- C- �W TM Bloch 3 Lot Formerly: Subdivision Name: Subdivisinn Lnt t I I Is system fill completed? Is system complete? 6fo Is system, constructed as per plans? yE�, Is well drilled? V fs Is well located as per plans? J_ Are erosion control measures in place? Date: --' Date: _ d - z `t - ° Date: %- J't I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCIjD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. • Date: -V� -0 Certified by: �T PE ?t- R.A. Ir*lte Engineering, Surveying bes' Profes i Landscape Architecture, RC. Address: 8 Garrett Place Lic. # R Comments: Carmel, New York 10512 Comments: �'iI -J- ( Ar+J e t p4&A-VV% v'r" r.*J5 rein P +S� G.4GU drn/ot�' c If ✓e'gKA,�+9 - o Kn1 Form-FIR-99 T/T:d T26Z8LZ :01 1UGS22Sb8 9NIN33NISN3 31ISNI :WOdJ E0 :60 cow- e2 -9nu LORETTA MOLINARI R.N., M.S.N. Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845)278-6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 September 2, 2003 Jeffrey Contelmo Insite Engineering 3 Garrett Place Carmel, New York 10512 Dear Mr. Contelmo: ROBERT J. BONDI County Executive .,5 Re: Field Inspection — BMMD, LLC 11 Cheshier Court, (T) Patterson Lot # 11, TM# 11-3 -107 The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. 1. The curtain drain and stand pipes need to be installed and inspected by this department prior to backfilling. 2. A bedroom count needs to be performed by this department upon further completion of construction. 3. The cast iron pipe needs to be installed from house to septic tank. 4. Footing drain outlet was not found upon inspection. If you.have any further questions, please contact me at 845- 278 -6130, ext. 2261. Sincerely, 4w- �9.' Gene D. Reed Environmental Health Engineering Aide GDR: cj �i 4: SENDING CONFIRMATION DATE : SEP -3 -2003 WED 12:08 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 92259717 PAGES : 1/1 START TIME : SEP -03 12:07 ELAPSED TIME : 00'22" MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... a LORNITA 34OLIKARI R.N., M.B.N. ROBPRT 1. BONDI PuNk Hrdfh Dftd. cony F—dt. DEPARTMENT OF HEALTH 1 (3enen Rued, Brewster, Now Ymk 10509 tlnrt�mmnal NesW (94S)278.61t0 P. (949)278.7921 N.M.1 8-1— (845) 278.6338 WIC(W)272-6678 Fa(245)279-6015 z" r.tmvanle (945)278-6014 P. (84'3) 278.6618 September 2, 2003 Jeffrey Comelmo Insite Engineering 3 Garrett Place Carmel, New York 10512 rte; Field Inspection - BMMD, LLC 11 Cbeah(cr Court, M Patterson Lot 011, TM'O 13:3 -107 Dear Mr. Contelmo: The above referenced separate sewage treatment system can be backlilled. The following comments must be corrected in the field. 1. The curtain drain and stand pipes need to be installed and iospacted by this depattmcm prior to backfilling. 2. A bedroom count needs to be performed by this department upon Iluthef completion ofconstnrction. 3. The can iron pipe needs to be installed from house to septic tank. 4. Footing drain outlet was not found upon inspection. If you have any further questions, please contact me at 845 -27" 130, erg 2261. Sincerely,, Gene D. Reed Envmmmental 11ealth Engineonq Aide GDP-:cj 0 LORETTA MOLINARI R.N., M.S.N. Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 September 29, 2003 Jeffrey Contelmo Insite Engineering 3 Garrett Place Carmel, New York 10512 ROBERT J. BONDI County Executive Re: Field Inspection — BMMD, LLC 11 Cheshier Court, (T) Patterson Lot # 11, TM# 11-3 -107 Dear Mr. Contelmo: A re- inspection for the above referenced property has been completed. There are no further comments to be addressed. If you have any further questions, please contact me at 845- 278 -6130, ext. 2261. Sincerely, Gene D. Reed Environmental Health Engineering Aide GDR: cj fieldins SENDING CONFIRMATION DATE : SEP -29 -2003 MON 1124 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE 92259717 PAGES 1/1 START TIME SEP -29 11:23 ELAPSED TIME : 00'20" MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED.. a < LORMA ).(OLINARI AAI., M.S.N. AOBffitT 1. BOND1 DEPARTMENT OF HEALTH I Caneve Road, Brewster, New York 10509 NMMeMOtal 8ea101 (US)279.6130 FS.(845)273.7921 Nnn(e8 BervA (815)271.6551 WIC (615)271.6670 P..(MS)271 -6085 6a1ly fahr7ead0w? e118.e1 (MS) 278.6011 gar (815) 271.6611 September 29, 2003 Jcf&ey Contelmo Inshe Engineering ' 3 Garnett Plan j. Cannel, New York 10512 Re: Fleld Inspection — BMMD, LLC I I Chahicr Coin (T) Patterson Lot # 11, TM# 13..3.107 Dear Mr, Contelmo: A re- inspection for the above referonced property has been completed. There are no Anther comments to be addressed. If you have any further questions, please contact roe at 845- 278 -6130, =t 2261. Sincerely, I Gene D. Reed Environmemal Health Engineering Aidc GDR:cj fieldins BM1VID L.L.C. 2 Tanager Road Brewster, NY 10509 Tel- 845- 279 -3613 Fax - 845- 2791771 Date: April 24, 2003 From: Bruce Major To: Robert Morns, PCBOH Subject: Change House Plans for Cornwall Hill Estates Lot 11 11 Cheshire Ct. Re: Permit 4 P -4 -03 Tax Map 13 Block 3 Lot 107 Rob, We are currently selecting house plans for our sub - division, Cornwall Hill Estates, and request your review of the attached proposed plans for lot 14. This lot is approved for a 5 bedroom system. 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Block 3 Lot 101 Date Subdivision Approved 4 - 4 -o 1 Owner /Applicant Name Smm-p Lit Renewal Revision — Date of Previous Approval Mailing Address 2 TAmAgER RoAp i 6gfWsf6A I%Y Zip 10so9 Amount of Fee Enclosed Building Type 9 esi a eN flA L Lot Area 3• �t No. of Bedrooms Design Flow GPD /Doo' AcR 6f Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of [,.;-DD gallon septic tank and SC0 4 OF 'L, LjIPF AgroR PnoN TREA/cHES Other Requirements: -7 1 -D to C u R -rA r N To be constructed by '16 gE p6rgemIlle> Address a Water Supply: Public Supply From Address or: - ><' Private Supply Drilled by r 46 D61-ge MiN61 Address AJA 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: Address P.E. Al R.A. l [A,vbscA PE �e1{r 7�R � P. c, Al loc/z License # Date (' I a 31 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treat ystem has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when c sidere ecessary by the Public Health Director. Any revision or alteration of the approved plan requires a new perm' . pprov r discharge of domestic sanitary sewa a only. l ag � 2 G By: /�M' Title: Date. . White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy. - Design Professional Form CP -97 m ou� • 465 Columbus Avenue Valhalla, New York 10596 -1336 Christopher O. Ward 'Commissioner Bureau of Water Supply Michael A. Principe; Ph.D. Deputy Commissioner Tel (914) 742-2001 Fax (914) 773.0343 March 21, 2003 Robert Morris, P.E Putnam Co. Health Dept. 4 Geneva Road Brewster, NY 10509 Re: Cornwall Hill Estates. Lot 1l/BMMD, LLC. 11 Cheshire Court Patterson, Putnam East Branch Reservoir DEP Log # 12850 (Joint Review) Dear Mr. Morris: This letter is to inform you that the New York City Department of Environmental Protection (Department) has determined that the above - referenced application is complete. In addition, the Department has no objection to the approval of the above - referenced regulated activity. This determination is based on the review of submitted documents including the plan titled "Proposed SSTS for BMMD, LLC./ Cornwall Subd. Lot 11 ", dated 02/18/03. The applicant must contact Sissy De La Ossa of my staff at (914) 773 -4416 at least 2 days prior to the start of construction of the SSTS so that a Department representative may inspect and monitor the installation. Sincerely, D._� J32--, Danny Shedlo, P.E. Project Manager Engineering Design & Review xc: ' James Covey, P.E., NYSDOH „ UTY DEPAR NOM t °T RO�'MENTAL PR www.ny c.gov /dep. (718) DEP -HELP �' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # f C 0 3 Well Location: Street Address: own/Village Tax Grid # C R E -S I KE CvJ2-r I p A-qC k -SO Ai Map IS Block 3 Lot(s) I �% Well Owner: Name: Address: 6 M ml) L L C 1 2 TAMAGC-R POA> Q,e cvJsr5,z A/Y 1/0s-01 Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation - rima Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served -15'- Est. of Daily Usage 3 o&;' 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 >--:f-No Name of subdivision Co t n/ WA c, L fit i L - ES KA !'E,s Lot No. - -I — Water Well Contractor: To 9 6 'Pie Z5 �/O /N6 D Address: A1 1A Is Public Water Supply available to site? ............................... Yes No X' .................................. Name of Public Water Supply: lz Town/Village Ai /A _a Distance to property from nearest water main: A1_14 Proposed well location & sources of contamination to be provided on separate sheet/plan. , Date: �y' Applicant Signature: PERMIT TO CONST CT 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 , el driller c rtified by Putnam County. Date of Issue Z ,j r� °' .� 15erriiit �ssIng Official: /!'L✓ Date of Expiration a Title: Permit is Non - Transfer ab e White copy - HD file; Yellow copy - wilding Inspector; fink copy - Owner; Orange copy -Well driller Form WP -97 LORETTA MOLINARI R.N., M.S.N. Acting -Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Insite Engineering& Survey 3 Garrett Place Carmel, NY 10512 RE: BMMD, LLC 11 Cheshire Court, Lot # 11 (T) Patterson, TM #.13 -3 -107 Reservoir Basin Dear Sir: ROBERT J. BONDI County Executive March 14, 2003 The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on February 24, 2003 is complete. The Department will notify you by April 2, 2003 of its determination. ❑ The Project has been delegated to the Putnam County Health Department for. review pursuant to the guidelines set forth in the Watershed Agreement. ® Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is. sought. in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a prof ect, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Letter to: Insite Engineering & Survey - March 14, 2003 -2 Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2166. 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L6-Oa V10 \Ya"101 \ cSh SQ \3S \'YIQ 'SQU3a 2i31.i3Z SA1d uo .LIIlk2i3d 1Z3,i1( 7 1:02;I LSYO 3dId 3d i1 .O..t- 'L3 ,�' /� • 2I3.t13S 3SAOHC�C� '• ,•. 1`OI.LYOI'Ipy iIIkwu A S 3 14,1 00 t (Q33 \�2II31\OJ) -d�1 ?C'di 3if Q2IS `SY ',do 'M Ag a3.413IA32i .. :1`011Y00113MUS : daMT 10 30 3IAIYId I1I1213d \0113121 LS \00 21031.33I-iS A13IAald SIN31.S:1S L \3IQ.LYU139YAM 30Y33RSgfIS'Y A'IddAS 213-LYM ZYIIaLA_IQrI H11Y3H 1Y1\3I£\02iL1N3 AO KOISIAIQ H11Y3H 30 L \3IC1`1Yd3Q A.L:1f100i IQY2 ina /NS/ T ENGINEERING, SURVEYING & L4NDSCAPEARCHITECTVRE, P.C. 3 Garrett Place (845) 225 -9690 Carmel, New York 10512 Fax: (845) 225 -9717 TO: Putnam Countv Health nenartment 1 Geneva Road Brewster, NY 10509 WE ARE SENDING YOU ❑ Shop Drawings ❑ Copy of Letter LETTER OF TRANSMITTAL Date: 2 -18 -03 Job No. 99147.311 Attn: Robert Moms, P.E. Re: SSTS for Cornwall Hill Estates Lot 11 11 Cheshire Court, Town of Patterson TM# 13 -3 -107 ® Enclosed ❑ Under separate cover via ® Prints ❑ Plans ❑ Change Order ❑ the following items: ❑ Samples ❑ Specifications COPIES -_ - DATE I NO. DESCRIPTION 5�� 2 -18 -03 1 CD -1 ( Construction Drawing 1 22 -18 03 i CP -97 Construction Permit -1 CA -97 ; Corporate Affadavit—._ v— ��---- �_.,_..._ _...____._- _____.__.._..._._.__ 1 LA -97 , Letter of Authorization PC -97 Application for Approval of Plans 1 2 -18 -03 i Short EAF ; 1 1 i i 2 -18-03 2 -16-02 � WP -97 . Well Permit r DD -97 Design Data Sheets (previously submitted with subdivision approval) 1 12 -14 -03 86436 $300.00 Fee 2 I ! 5 Bedroom Floor Plans THESE ARE TRANSMITTED as checked below: ®For approval ❑Approved as submitted ❑ Resubmit ❑ For your use ❑ Approved as noted ❑ Submit ❑ As requested ❑Returned for corrections ❑ Return ❑ For review and comment ❑ REMARKS: copies for approval copies for distribution corrected prints COPY TO: SIGNED: c - Jo M. Watson, P.E. IF ENCLOSURES ARE'NOT AS`AIOTED, KINDLY NOTIFY US AT ONCE I0t2002.dot `'?;} PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of BMMD LLC Located at Cornwall Hill Road T/V Town of Patterson Tax Map # 13 Block 3 Lot ID7 Subdivision of Cornwall Hill Estates Subdivision Lot # Filed Map # 2856 Date Filed 04 -04 -2001 Gentlemen: This letter is to authorize Insite Engineering, Su� & Landscape Architecture, P.C. Jeffrey J. Contelmo, a duly licensed Professional Engineer X or Registered Architect— to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Very truly yours, Countersigned- Signed.,, `04 .'_ - P.E., # 61931 (owner of Property) Mailing Address nI'sife En ing eeliiig, Surveying Mailing Address: 2 Tanager Road & Landscape-Architecture, P.C. Brewster State New York Zip 105 1 Z State New York Zip 10509 Telephone: (845) It o Telephone: (845) 279 -3613 Form LA -97 i•7�r w,V .� Z PUTNAM COUNTY NTY DEPARTMENT OF DEALT DIVISION OF ENVIRONAENTAL HEALTH SERVICES DESIGN DATAA. SIMET - SUBSURYACE SEWAGE TREATMENT SYSTEM Owner Ni ,fit D I— 6-(f— Address Located at (Street) ryc r_. n.2�'ax Map Block �. Lot (indicate nearest cross st -eet) hfurlicipality r-AT g's.",'YJ Drainage Basin SOIL PERCOLATION TEST DATA Date of Pre - soaking i 9j4o Date of Percolation Test (0 1aCnL0 c-) Bole No. Run No. Time Start - Stop Ela se Time (win.) De�ppth to Water k'rom .Ground Surface (Inches) Start Stop 'Suter Level Drop In Ihc�hes Percolation Rate Min/Inch iJ 9:5 r -- 10: r& a 5 a A y 3 �: 3 st-O 2 �� 10 �� a( awl 3 7. 3 ao 7-s 4 5 'q:6'�A-10,17 2 1 oto a3 Lss�� 2 /p: tg— lo:�f3 ate. as a3 3 mod. 3 g 3 10:gef JI :69 4 Y 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. (Le. 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 PUTNAM COUNTY. DEPARTMENT OF HUALITI DIVISION OF ENVIRONMLNTAAL .HEALTHI SLRVICLS APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: Mir L I-C ?. -(A Al AGC 2 6o A-> 2. Name of project: �&WAJJ_ ILA PfAf�� fV4 j1y1511)# 3. Location t/V: TA164s Do Insite Engineering, surveying & landscape 4. Design Professional: Jeffrey J. contehm, P.E. 5. Address: Architecture, P.c, Route 6. Drainage Basin: LAsr gQANCH 22 g �, Ugw Yorke 050 7. Type of Project: Private/Resi dent 1 al 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) ....................... ............................... Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... Y(S 10. Has DEIS been completed and found acceptable by Lead Agency? .... r- ..... v�CEi►►J3�>t' i �� 11. Name of Lead Agency 7W N m -ff6 k -Co A! ?LAA; AJ i r 1r, &0A & D 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? ........ ............................... 14. Has preliminary approval been granted by such authorities? V Date granted: 4 z000 15, Type of Sewage Treatment System Discharge ................. surface water k groundwater 16. If surface water discharge, what is the stream class designation? .................... N 1A 17. Waters index number (surface) ........................................... .......................:....... 18. Is project located near a public water supply system? ....... ............................... _ 4 f2 19. If yes, name -of water supply IVIA Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ N0 21. Name of sewage system . AIIA Distance to sewage system N 22. Date test holes observed ?gA cc jol,,o 23. Name of Health Inspector AbAm, SrIPAr UA16 no � B1310o 24. Project desi flow (gallons per day 0Do g??.. ................................. ..........:.................... 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... A10 26. Has SPDES Application been submitted to local DEC office? .............................. Form PC -97 2 27 28 Is any portion of this project located within .a designated Town or State wetland? Wetlands TD Number ....... ......:.....:::................................... .................... Alga U ..........rz . yc-,5 b�' -ZZ 29. Is Wetlands Permit required? ..... : .................... ......:....... ............................... NO Has application been made to Town or Local DEC office? .............. .................. /J 1 A- 30. Does project require a DEC Stream Disturbance Permit? .. ............................... rye 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? ............................ Yes/No /yo 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No Y65 DESCRIBE: k CSSNnA Nv [Am-p [i t_L �FASrs r�E or coRN gat 4U R 1 SALT STOCK PILL (PAIi6RSo,/ 01PHWA.Y ,CPL Alo.grH slrr) 33. Is there a local master plan on file with the Town or Village? ......................... 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? V AIDW.w 35. Are any sewage treatment areas in excess of 15% slope? . ............................... ,Jo 36. Tax Map ID Number .......................... .::............................ Map 13 Block 3 Lot i0i' 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 to the Department, and need not be sent in d' uplicate 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 affrrm, under penalty of perj ' that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.4�the Penal Law. . SIGNATURES & OFFICIAL TITLES: Mailing Address: ................................... C:.4 -- r-Zr l o!5 2 'd d0 1N3WiNUd30 :t1Nnoo WdN1nd:3WdN T26L- BL2- Sb8:-131 OiA rapt •5Y! b; •{,' ZO 'd March 21, 2003 Robert Morris, PX Putnam Co. Health Dept - 4 (}eneva Road Brewster, NY 10509 Re: Cornwall Hill Estates. Lot 1I/BMMD, LLC- 11 Cheshire Court Patterson, Putnam East Branch Reservoir DEP Log # 12850 (Joint Review) Tear Mr. Morris: b2:60 Nns 2002- 22 -dbW •i: This letter is to inform you that the New York City Department of Environmental Protection (Department) has determined that the above - referenced application is complete. In addition, the Department has no objection to the approval of the above- referenced regulated activity. This determination is based on the review of submitted documents including the plan titled "Proposed SSTS for BNIMD, LLC./ Cornwall Subd..Lot 11 ", dated 02/18/03, The applicant must contact Sissy De La Ossa of my staff at (914) 773 -4416 at least 2 days prior to the start of construction of the SSTS so that a Department representative may inspect and monitor the installation. 'Sincerely, Danny Shedlo, P.E. Project Manager Engineering Design & Review James Covey, P.B., NYSDO14 S17: OT io, iz Jpw •'.:. J. _ _ ... . .......... .....�.. .. .. .. . —. —_. .... ... .� 9NId33NI9N3 d3Q DAN Z 'd d0 1N3WiMUd30 J.l1Nnoo WdNlfld : 3WdN T262L- a2 -Sb8 : -l31 b2:60 Nns c002- z2-6yw O',I- HIM N _ 'e Il ' •'r•. ':,P.`+ • ' of • ,-,+`+1� "/� INC NYC DET/B "Free � i�.:' • '•- �. ;�j •,' : Operation and Engineering Division FAX #: 914-773-0343 Fax-- Cover Sheet Date: as - -ji�o Phone: qlQ-- If 1,6MMT), LLC. !, r a Number of saes: (Including Co��er Sheet)- . 'If there are any problems with this transmission, pleasc calt: ifeltl:l'�:..., .. ... .. .� , .'r, .?• •,. .. `_! v7jj1,. 1 .r.,4',n >. jail. •. M. s +... t`>'�''i - . TO "d Sb:OT 0, TZ JPW MO— �ZZ -VW xP3 9NIJ33NI9N3 d3Q DAN TH S E Rs If PUTNAM COUNTY DEPARTMENT OF HEALTH PLANS APPROVED FOIRL COUNT ONLY, E E D TO THE SE ROUSE ST R tai 'Tll TLE ID4TE -Vva I e A '0 h gtMw At Q., PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM .COUNT ONLY, WO pd� BEDROC,11`79) :.TIONS TO THESE HOUSE ;r7l, ALL S QU " 1 " PCDOH FOR APPROVAL PL SV�E S*�`-:-,Z W-03 J)ATB SIGNATURE &TITLE Shown with optorel two—ar 9-rage pdage and d, rJe top window oar front door. 4,44; 62 .4 El UNP-STCHMSTER 00, ULAR OFNES. INC. V-m 48' t First Floor 48' 1 . 5- Spacious Bedrooms ® 2%2 Baths • Open Two-Story Entry Foyer • Formal Dining Room • Formal Living Poor, • Spacious Country Mtchen vAth BreakP -SL Room and Pantry • "Cottage -S!yle" 3056 Lover Level Windows With Architraves on Front 27,8° • Framingham Pediment on Front moor • Fireplace Options Available • "Boxed -out" and "Angle I'?ay' Options Available • Consult an Authorized Westchester Builder for a Complete List of Options ® Artist's renderings and Floor Piz, Dimensions are approximate. All specifications must t be Wriluen in the Contract No oral conditions. P. O. Box 940 o Dover Plains, NY 12522 (914) 832 -9400 o (800) 832 -3888 14 -164 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 SEAR ;i Appendix C State Environmental Quality Review SHORT .ENVIRONMENTAL ASSESSMENT FORM _ For UHLISTED.ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Appllcant.or Project sponsor) 1. APPLICANT /SPONSOR ivi L 2. PROJECT NAME, i Cc t S LCT4�- SSS F w 3. PROJECT LOCATION: Municipality SG�'V County 4. PRECISE LOCATION (S reet address and road Intersections, prominent landmarks, etc., or provide, map) SEE L0C/V)GiQ_ MAf ©IJ P�Awfdcr 5. IS PROPOSED ACTION: ew ❑ Expansion ❑ Modificationialteration 6. DESCRIBE PROJECT BRIEFLY: Cas- IrwGrlal or ON'c rAMiL` KESig, iNcG�.P�ifvE '�i SSiS� �tLL AW A PPS /2 EVA IVC�1s `: 7. AMOUNT QF LAND AFFECTED: 3 1661 Initially _ acres Ultimately :5� acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? tkas ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? kResidential ❑ Industrial ❑ Commercial Agriculture ❑ Park/Forestiopen space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL) ?. _ ❑ No It list .Yes yes, agency(s) and permltlapprovals ptm wly fravr• To-.4N C 55TS•T W ELL - P.CAS Dvile;vc• 6A114)T__10WAJ V( (ATWkk 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes I& If yes, list agency name and permitlapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes C&NO i CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE S1vSri-�Ea'ElN'EE�r'>VACf SII�U�;r��11 1/�l�su{PE q�;tffrEc�u ^C,PC: n& Applicantisponsor name: JJ04 M, WATSW V. G, 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 PA,T 11-,,7.ENVIRONMENTAL ASSESSMENT (To be completed by 4gency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.120. 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) Ct. 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 brie C5. Growth, subsequent development, or'related activities likely to be induced..by+ the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified In Cl-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: 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) r 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 #J I 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 / day of (month) A& (year) 200 / Notary Public cam Form Title: _Manager P Corporate Seal A24492 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES *11 WELL COMPLETION REPORT Well Location Street Address: l��SKtr?Ei� s i Town/Village: P e� Tax Grid # Map I�7 Block Lot(s) "t�7 Well Owner: Name: Address: Use of Well: 1- primary 2- secondary Residential Public Sup& Air cond /heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion _,X Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length X3 ft. Length below grade �ft. Diameter -7 in. Weight per foot / lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded Threaded _ Other Sear Cement grout X 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 6 Yield 50 gpm Depth Data Measure from land surface - static (specify ft) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 6 ' f _ & 6 lt/ea' y If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type`r ,,r t Capacity Depth 2.10 Model __j$ ,o 1. SV ,,Q tS Voltage 2.30 HP Tank Type C,�o>- Volume _ Date.Well Comple ed Putnam County Certification No. 06' Date of Re ort ©;s Well Driller (signature) fty- &01)-- Ae/41 NOTIZ: Exgct location of well with distances to at least two permanerft landmarks to be provided on a sepapre sheet/plan. �, J Well Driller's Nam t SM6 Address: `d /9' Signature: i%utn Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PLAN SCALE. 7' = 30' ERA TION OF THIS DOCUMENT, UNLESS UNDER THE DIRECTION A LICENSED PROFESSIONAL ENGINEER, IS A KOLA 77ON OF '770N 7209 OF AR77CLE 145 OF THE EDUCA77ON LAW. �P P� �0 0 0 Site Data & Location: TOTAL ACREA GE. • 3.50 AC.f TAX MAP NUMBER: 13 -3 -107 11 CHESHIRE COURT TOWN OF PATTERSON PUTNAM COUNTY, NEW YORK Notes: &Qlican tlPecord Owner BMMD, LL 2 TANAGER ROAD BREWSTER, NY 10509 1. THIS IS TO CERTIFY THAT THE SEWAGE TREATMENT SYSTEM WAS CONSTRUCTED AS INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS OBSERVED BY INSI7E ENGINEERING, SURVEYING, & LANDSCAPE ARCHITECTURE, P.C. BEFORE IT WAS COVERED OVER. THE SYSTEM WAS CONSTRUC7ED IN GENERAL ACCORDANCE WITH ALL STANDARD RULES AND REGULATIONS OF THE PU7NAM COUNTY DEPARTMENT OF HEALTH AND THE NEW YORK STATE DEPARTMENT OF HEALTH. 2. ALL FACIL177ES EXISTING, UNLESS NOTED OTHERWISE. 3. PROPERTY LINE, HOUSE AND WELL IS BASED ON FIELD SURVEY BY INSITE ENGINEERING, SURVEYING, AND LANDSCAPE ARCHITECTURE, P.C. COMPLETED MARCH 5, 2004. IN- D AS a7 f P j \ ZL�er N- -03 M06 �1 -mil a + 'CHESHIR V , COUR T, AS —BUIL T MEASUREMEN TS N0. coax CF HOUSE came of HOUSE ! REMARKS 1 28' 70' 1,5W cAuav sgnnc MW 2 32' 79' aEm our 3 39' 83' ORW pox 4 45' 86' DRW Box 5 51' 89' ORW SOX 6 57' 92.5' ww ewr 7 63' 96' DROP = 8 79' 64.5' 00 OF nENaH 9 62' 41' 00 OF MUCH 10 76' 137' aw Cr nwwc" 11 91' 145' 00 o' MUCH 12 68' 21 arRrAW DRAW aFAN OUT 1131 170' 217' anrrAw M4w aw1ARGE Water es SlYsis result for sodium Via) is _ _ t mg/L We-tor coptaining more than 20 mg/L of so diva4 :;i13uF3 not be used for drdnking by people on severely ros,,rieto s sdl m-n dieC,. Ifluter eonu dndng Mare. than 270 nig/L of sodium shOu' n..:' L e Us3.d bad people on moderately restricted sodium diets. FU .: jffi r_'i Ct- *;i:1 " 'T DEPT. OF HEliLTffII