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HomeMy WebLinkAbout0435DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -3 -108 BOX 6 ■ .T :661 me 21 9 91 Ir r. KJ. r; , I I , I,I � I 1 116 ■ 1 L.: - �I' :' 4 : Ir 6.21 r . '. 00244 AM COUNTY DEPARTMENT OF HEALTH O SION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREAT ' ,1T,SY TEM PCHD CONSTRUCTION PERMIT # `60_ Located at I-.?- Cf SdT:&_c or Village Pf�?T��erSo�l Owner /Applicant Name SrOM0 Ll.. G Tax Map /3 Block 3 Lot /C 8 Formerly tj I /� Subdivision Name gAimo tcc, C_0CVW4,LL t4ru 92his Subd. Lot # 2 Mailing Address Z JANA&eC rZoAQ _ R ev1sf/L.. nl `�� Zip nSU Date Construction Permit Issued by PCHD .7-3-05 Separate Sewerage System built by Oyfy -- G0'0'c-L-` T'5 Address St 6A-0 -ate KouVJ f'CP, �"'��" Consisting of '2a 000 Gallon Septic Tank and 600 LF oo 7—' rwrps R-6S02P r-r'Q 6 fXAC^ f_3 Other Requirements: N 6 N l Water Supply: Public Supply From Address /oil iCr3�l, O�ias�n/, or: C Private Supply Drilled by A_66z�r M. 4YArr -t- .Sow 5 Address NY �7- s7,3 Building Type &5r =Q 6Jr L Has erosion control been completed? O Number of Bedrooms (0 Has garbage grinder been installed? /y D 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: q- 00'0(0 Certified by P.E. R.A. T,4 syr�L F rNE al et, 3. ,ev Prof ssi nal) Address u"%*er, & a xm c� , e- c . License # C,19 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 are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modificatioh or change is necessary::" _ ;­ "I I )qq /<:�6 By: 6 Title:``' Date: �© b White copy - HD F' e; Ye copy -Building Inspector; Pink copy - Owne Or a copy -Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES r WELL COMPLETION REPORT Well Location Street Address: (? Ca ,. WA f TownNillage: Tax Grid # Map « Block 3 Lot(s) Lob Well Owner: Name: Ma Address: AC Z T t-jAl c - /Gwtt t etc -z✓5 Tat 1 N� <v �� I 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 Open hole in bedrock Other Casing Details Total length ft. Length below grade ft. Diameter 7 in. Weight per foot �lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded , Threaded _ Other Seal: _ Cement grout Bentonite Other Drive shoe: " Yes No Liner _ Yes Y No Screen Details Diameter (in) Slot Size Length(ft) I Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test Bailed Pumped Compressed Air Hours -6 Yield CA gpm Depth Data Measure from land surface- static (specify ft) lK I�-9. During yield test(ft) ddb Depth of completed well in feet 1 *10 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 77 ✓ ` �, If yield was tested at different depths during drilling, list: Feet Gallon's Per Minute Pump /Storage Tank Information Pump Type �l Capacity L Depth JL2A Model nwoq,1714 Voltage _2 �47 H P Tank Type vjWolume jWd Date Well Completed 4 01 a Putnam County Certification No. Date port Well Driller (signature) NO' C: Vkact location of well with distances to at least two permanenf landmarks to be provided on a sep'ar sheel/plan. Well Drillers Name 7 - t Address: Ml Gf� AOL- AlY. s Signature: ' ;:;: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Aug 20 03 07:28a 13RUCE R FOLLY Public Health Dih-clor TOWN OF PATTERSO 845 - 878 -2019 P -2 LORETTA MOLINARI. RN,, M.S.N. .laaGCI&W Public NCOM Director DfMcfor of Palient Servku$ DEPARTMENT OF HEALTH 1 Geneva Road Brewster, Now York 10509 Eovfrwmcalal Health (914)27! -6130 Fox(9,14)2M -7921 NerskvS Servlcu (914)27d -6i58 WIC (914)278.6673 Fm(914)219-6095 Lrady laterveialod (914)278 -6614 Prescbod (914)2786082 fttVI4)218.6"B E911 ADDRESS YFRTFYCA'fTdN FORM O'WNERSNAME: IhMMID LL(- CbRNwt+tL PILL atsTATES LJ 1a TAX ?NEAP NUlY1'BER: 13.3 -1 o t E911 ADDRESS: TOWN: 4 A- r4ti�bo •i AUTHORIZED TOWN OFFICIAL: (Signature) � / ' DATE: :0-d /D The Putnam County Department of Health will not )issue a Certificate of Construction Compliance sunless the above form is completed, i.e., a legal E911 address is assumed by an authorized town official. This farm is to be submitted with the application for a Certificate of Construction Compliance. (E9I 1 VERPM y/2:d 6102BL8:01 LU6S22Sb8 ON1833NION3 31ISNI:WMA L2 *T 872 -61-OM PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH[ SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM ✓/ Ill Z�) L L c Owner or Purchaser of Building Building Constructed by q Cov-1-T, Location - Street rq 6v l C-,yVQ it2/ 0v Tax Map Block . Lot F A f rc---r- sod TownyVrHage- CB a,;jvwku. N ('St_195 Subdivision Name Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month Day L? Year q-A:� G* General Contractor (Owner) - Signatu L-Z- C Corporation Name (if corporation) Address: ��� �L%/ylP /s�e� �✓ State .•s o..> Y Zip 2 5, Signature: Title: Corporation Name (if corporation) Address: State Zip Form GS -97 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 1.603586 CLIENT #: 56173 NON STAT PROC PAGE: 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ BMMD LLC 166 SOMERSET DRIVE PATTERSON, NY 12563 SAMPLING SITE: 17 CHESHIRE CT (LOT 12) : PATTERSON .OL-D BY: BRUCE MAJOR NOTES...: BASE TAP DATE FLAG PROCEDURE DATE/TIME TAKEN: 06/17/06 11:0O DATE/TIME REC'D: 06/19/06 1052 REPORT DATE: 06/26/06 PHONE: (845)-590-9734 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE - TEMPERATURE..: < 4C .. � COLJFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE � 06/19/06 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 06/22/06 LEAD (INS) 1.0 ppb 0-15 ppb 9003 06/23/06 NITRATE NlTROG 0.54 MG/L 0 - 10 9052 06/21/06 NITRITE NITROG <0.01 MG/L N/A 9162 06/23/06 IRON (Fe) <0.060 MG/L 0-0.3 mg/] 9002 06/21/06 MANGANESE (Mn) <0.010 MG/L 0-0.3 mg/l 9002 ' 06/21/06 SODIUM (Na) 96.0 MG/L N/A 9002 06/19/06 pH 7.4 UNITS 6.5-8 .5 9043 � 06/20/06 HARDNESS,TOTAL <2 MG/L N/A 06/20/06 ALKALINITY (AS 188 MG/L N/A 9001 06/23/06 TURBIDITY (TUR <1 NTU 0-5 NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE (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. Pb/Cu LEAD limits for p EPA Lead & Cop/er 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. 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,mqximum`of mg/L of Sodium YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 1.603586 CLIENT #: 56173 NON STAT PROC PAGE: 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ BMMD LLC 166 SOMERSET DRIVE PATTERSON, NY 12563 SAMPLING SITE: 17 CHESHIRE CT (LOT 12) : PATTERSON COL'D BY: BRUCE MAJOR NDTES...: BASE TAP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE is suggested. DATE/TIME TAKEN: 06/17/06 11:O0 DATE/TIME REC'D: 06/19/06 11:52 REPORT DATE: 06/26/06 PHONE: (845)-590-9734 SAMPLE TYPE..: POTA8LE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLlFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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 WHlCH 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: Albert/H. Padovani, M°J�A<SCP)+ ' Director ^ ' 4 %f /NS/TE "' EN LANDSCAPEARCHITECTURE, PC. SURVEYING & 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: 07 -06 -06 Job No. 99147.312 Attn: Michael Budzinski, P.E. Re: SSTS for BMMD, LLC (Lot #12) 17 Cheshire Court TM# 13 -3 -108 ® Enclosed ❑ Under separate cover via ® Prints ❑ Change Order ❑ Plans ❑ -- ❑ Samples COPIES DATE I DESCRIPTION j. .... ................ .... . _. ..............,...........:.... 5 ......... ............,.. ....................:..................,................. 07 -06 -06 .............. AB -1 ............... ........ .._ ....... .......... ................. ..._„_.....-..............._............._,...,...,...................._...._...............,,....... ............................... i As -Built Drawing 1 _ ..... _ ......... . ...... ......,.... 07 -06 -06 __. ..................._....... CC -97 ...._......................._.. ............__.._.._.... _....___.. _.._.__............_._....._.._.... ......__.._._......._.._...._�. I Construction Compliance ,............. ; _ ................ 3 ... ......._..... a 06 -26 -06 ...: ........ GS -97 ........ ... ....._........ ..... _...... ..... _.. ........ . . .r....... ...................... Guarantee 1 8 -20 -03 --- - - - - -- E911 Address Verification 1 6 -26 -06 --- - - - - -- ... ........ ... ........... ... .... ... ..... .............. ........... ........... ............ ..._._................ ............... ..... ...... ...... ........_._ Water Test Results 1 04-12-06 WC -97 Well Completion Re 1 6 -27 -06 .......................... . . . ... ............... .............. ........... ................................. _..... ! 141 2374 216 ' $300.00 Fee _ ......:_ ......................................._.._ .................. ....... ...... . . . . . . ... ..... .................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . ................ . . . . . . . . . . . . . . . . . . . . . . . .................. . . . . . . ........... .... ....._................__.........._.._..._..._._...__.__._.-- ........... ...... .....__._ ....... _.__.._... __.__..._....._.__...___...... THESE ARE TRANSMITTED as checked below: the following Items: ❑ Specifications ®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: e'ct son, P.E. eer, Associate IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE lot2002.dot SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Jeffrey Contelmo Insite Engineering & Survey 3 Garrett Place Carmel, NY 10512 Dear Mr Contelmo DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health The above referenced separate sewage treatment system can- be- backfilled. There are no open comments to be addressed at this time. If you have any further questions, please contact me at ($45),'2-78-6130 ext. 2261. Very truly yours, GDR:kly Gene D. Reed' Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax(845)278-7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 DIVISION OF MMONAMxT2-.,L.HEALTH'SER'VTCES 'Il�Ik ,ST'Y' ]1TSPE�COIV: Ins. petted by StreetZ<ocation �1 wmer3i►�I vi l 'i w .3' 7L �..3 - /D� . S ubdivision`Lot # / dz `sewage S kfii Area '. `S 0: iC0 f.' .4 N' S a i'STS area roved locatedas er�pplans p p b Fill4secf�on ,datenf placement , 3 1 °barner Lgth_ . Width Avg Dpth 1 c l�atural soil not stepped d tone,'brush, greater than 31 ' from�ST`S area 4 . ... 1 v e 1'00'�froin water course %vetlanls.: ;.. :. IL SewageSvstem Septictank lother 2 d,Q.� ` a , size�.k•696- 0 b aseptic *tanlcinstalled:level a 10' ni mum_from- foundation r ; a D�stril.utRion:Box 1 All §4 fsame4elevation water tested 2 Protected beYow f'es Muiimum;2 ft Ongmal:soil between box &trenches , e Junction.Boz prr perlyset 6: ° venc es 1 `Length required Length Installed 2 IDistance to watercourse measure` /O o F #: d✓f" 3'; Installed taccorduig to „glen .. `Slope�oftrenchac cep: able�l /1,61 /32 "foot {� fr6rn property line 20`$ foundations a; 6. Depth of trench <30 inches from surface:.;. ...:. 7.. Room allowed for.:expansiot,,,100 %: ,.. ,............ w ; gar ►� 8. Slze:of gravel 3%4 II diameter :clean .......... ...... :..: 9. Dep., of;gravel. n trench,l2" Minimum., 10: Pipe endi,za ed �..< ....:..... .....:.:.......:.:,::.: :..... pppp { g..Pump,or.`Doi r ystems . .......... sual/aucho 4 Pump easily accessible; - .manh6le to:grade.................. 'it 6kb -6-- C�yycle witnessed :by H D estimated flow /cycle...:.:..... IIL., Ho.us e7B uildmg .. . a Iouselocated per approved plena .:...:...:.... b Number of bedrooms ...........:....... IV. :ell .. Well located as per approved, plans . ......:.......:................ b distance from STS .area :measured , . _ ? ft.:........ c. Casing.18” above grade............: d ;Surface .drainage;aroundwell., acceptable ......:................. V. ,Over-all Worltanshiu a oxes,;properly grouted:' .................. b All pipes partially: backfilled ......... :. ............................... C." All p pes lush wWl 'Inside :of :box. ...................... dackfill:material,.contains stones4 ". diazneter ....:......... e :Curtain drasi & standpip:es installed:according to plan.. f :Curtain drain`:6utf4u protected 8i dir to exist watercourse g. ':Foote g drains :discharge:away`from STS;area ............... h. Surface :water pr..otection . adequate .... ....:...............:.......... i. Erosion control provided .................................................. Rev. 12/02 El ®® VA Mi MA '1 A+ me-,,5vre e cove, ?Le, 60 \ se i � .��• / ' /� � 0140__ --� �� \��� \, \� � � \ • 1 \d 6 / I LOT 1{ SSTS PELT 'FILED i f I MAp I ��PROPOSED 2000 / \ GALLON SEPF)C TANK ! y OQ 111 I MOD Oposm / 0 VEWAY @F EQ71.Q, }y�639 J 77 LOT 11 WELL PER FILED MAP 12856 � - - - - CHESHIRE COUR'T,. .\ I,'. PERMIT # 'NAM COUNTY DEPARTMENT OF HEAL ON OF ENVIRONMENTAL HEALTH SER CONSTRUCTION PERMIT FOR SEWAGE TREATMENT .SYS'I P- J-03 Located at /7 GNG- -SHIRE Go4--2T ColLNv"AL,L- Subdivision name W)LL ES?AMS Subd. Lot # /Z Town or Village PATTZ&ON Tax Map 13 Block 3 Lot /o% Date Subdivision Approved f71-ED 4-4- -01 Renewal — Revision Owner /Applicant Name 13Mnnp, LLC. Date of Previous Approval 12 -)7 -o2 Mailing Address Z 77aNAGEx ROAD BKE NsrE& _ NY Zip o SO Amount of Fee Enclosedle(Do . oo Building Type PEsi pc. Nrlt;L Lot Area 9•og gc, No. of Bedrooms (o Design Flow GPD /,Z.P d Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of Z, o oo gallon septic tank and Other Requirements: Note G To be constructed by To GE DETEIZM /N% Address /1t /A Water Suuuly: Public Supply From Address or: X Private Supply Drilled by To aE nE- rERnnNEp Address /Y /,4 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: _ 1 P.E. x R.A. Date 10/all / TEE (.1NCqr )y , SulNC�viNV,sc�w►�s4+v� ARcHjT�a.� P/-. Address 3 G License # 61431 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 w n c nsiderej necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe pro r 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # >'s it!K6 121 wn or Located at J'� ct{ i�vr�Y � Village Nf . >t!�so.-J Subdivision name 14,L t fsfAfis Subd. Lot # 1't' Tax Map 1 Block Lot I o , Date Subdivision Approved F t L CV 4-ti-01 Renewal Revision Owner /Applicant Name RMA- , LL C Date of Previous Approval Mailing Address -L 1'A.-vA&6A- fkO.g-> 62EAl>P -JQ ,ply Zip lino Ir Amount of Fee Enclosed *300,00 Building Type Ral :Z" f!AL. Lot Area 1.0" � No. of Bedrooms S Design Flow GPD 1000 Gr D AC . Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of gm 1, Soo gallon septic tank and 300 L'S oc Zr W06 A8So" R.110AI 'rR6,VCAE,< Other Requirements: Vy...t; To be constructed by fO 6k 1-36 f k M 1>✓C- D Address a/A Water Supply: Public Supply From Address or: Private Supply Drilled by -rfl gE Address dO 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 buiwer,..that said builder will place in good operating condition any part of said sewage treatment system during the period ( wo=(2) years 'immediately following the date of the issuance of the approval of the Certificate of Construction CompliancOf the:origi al i system or any repairs thereto. rj CD Signed: P.E. -R-7t- Date >1 !al l r Y09 f/ S'[Af'E �V1lf£� fv,R6 r Pt . •• :t Address 3 G pr,n L- License # 6; 1171 — v CARMf,� n/y f')SI u� APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction c�the sewage trea ystem has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w en c sidered essary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe pproved o ischarge of domestic sanitary sewage only. By: Title: Date: vJ? White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 y I APR -21 -200.6 1c:. -4 FP..OII:INSITE ENGINEERING 8452259717 TO:2787921 P:1/1 PLT'NAM COUNTY DEPARTMMT OF HEALTH )IMSION OF ENMONIKENTAL HEALTH SERVICES ATTENTION 11 JOSRP14i At "s. ge "Mag A GBNE All information must be hilly completed prior to any inspeckions being made. For: Fill. Trenches X PCHD Construction Permit Loeatcd: I _C.f� r C oYy� (V) Owner /Applicant Name-, W4 5_ Block -3 Lot /013 Formerly: _ _.- Subdivision Name: jwle-s Subdivision Lot 0 /2 Is system fill completed? Date: Ai 1A Is system complete? Date: Y17-1 10(o Is system consuwai as Par law? is well' dri l led? Is well' located as per plans? Y� Are erosi on control measures in place? ,� . Ice rtify that the system(s), as lasted, at the above premiums has bmn constructed and X have inspected and vezxlYed their compbeticffi in accordance with. the issuad PCHD Constrt>�on Porn t and approved plans and the Standards, Rules and Ragulatianc of the Putnam County Daput ent of Health. l7atc ` Zt Cedi6od by: PE RA acs o �r•1'�,�1E. E.at� �..1�'iXiC"! � �„e•,�^C'pv[K � �j �C� - Address; e• �...�• ,� a Comments: Form FIR -99 BMMD LLC 166 Somerset Drive Patterson, NY 12563 Date: November 18, 2005 From: Bruce Major To: Robert Morris, PCBOH Subject: Modification to House Plans for Cornwall Hill Estates Lot 12 Re: Permit# P -1 -03 Tax Map: 13 Block 3 Lot 108 Address: 17 Cheshire Ct This is the final change including a fifth bedroom over the garage as we spoke about. Lot 12 within our sub - division, Cornwall Hills Estates, and request your review of the attached proposed plans for approval. The modification is to place the fifth bedroom above the garages. This lot is approved for a 6 bedroom system. Thanks in nce, Attached: Three copies of plans & return envelop ENG /VEER /NG, SURVEY /NG & LANDSCAPEARCH /TECTURE, P.C. 3 Garrett Place (845) 225 -9690 Carmel, New York 10512 Fax: (845) 225 -9717 TO: Putnam Countv Health Department 1 Geneva Road Brewster, NY 10509 LETTER OF TRANSMITTAL Date: 11 -1 -05 Job No. 99147.312 Attn: Robert Morris, P.E. Re: SSTS for BMMD, LLC (Lot 12) Cornwall Hill Estates TM# 11-1 -108 WE ARE SENDING YOU ® Enclosed ❑ Under separate cover via the following items: ❑ Shop Drawings ® Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of Letter ❑ Change Order ❑ COPIES I DATE NO. j DESCRIPTION ...... _.__.._._.._ ............. .....__........_..._.....,..__......___......_._..----- .._. 5 LastRev10 --- _...._._.._......_.. _..__...._...__.._� _. __ _._._.. . ......... __._...._...__......_...._._ -31 -05 CD -1 E Construction Drawing ..... ._....__......____.._...__._..._.._..._......_...._.._. ... _ .... ._........_._.. ....__.........._.._ _..._ ........ ... ........ . ....... . ... .._ ............. . ._ .................. ........ _.._ 1 11 -1 -05 CP -97 I Construction Permit .......... .._. ..._,_.. ...... ............ _...._ ..... _._.. ....._......... .......... __._.._ ._ - - ...._._...._._._._.._..._.. 1 j 10 -28 -05 ........._.....__............_........__ ..,_._.._..._...,_.__._..._.... r..................................................... _..... __..... __._. _ L_..____ _ _ .._._-..._..__..._...__......_.._.__............._............_...__.........._.._._..............__........... 141 5110 364 1 $200.00 Fee _ _ _..__..__ . 1_ _ _. ,_ _ _._........____....._..__.._.._ ............. ................I.............. .... ........... ..... .. ... .............. .............. ...... ............................... ...._... ............._........_ .... ._......_......._..__.......__......_..._...__...._.._._.._ ..............._-... _........................_..... ...... ..... ............... ..._................................................................................... ....................... ..... ........_.. ............. - i i i ...... _... ...... ............ ........._................_`....................._........ .. . ........ _ ...... ...... ................ .............. _....._......_........._.................. ... ... .... _ ............... ..... ...... ....... .......... ....... ....._.. ...... _ ... .......... .... .._ ......... ............. ..._.. ..... ............ ... ... .... .._... ...... ... 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 El Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ REMARKS: Rob- The enclosed plans have been revised to show a 6 bedroom SSTS design. COPY TO: Lot022205.dot SIGNED: �Cit1 fi( c Jo n M. Watson, P. E. IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE 1 r r 1 r � � BMMD LLC 166 Somerset Drive Patterson, NY 12563 Date: October 25, 2005 From: Bruce Major To: Robert Morris, PCBOH Subject: Modification to House Plans for Cornwall Hill Estates Lot 12 Re: Permit# P -1 -03 Tax Map: 13 Block 3 Lot 108 Address: 17 Cheshire Ct Rob, We are modifing the approved house plan for Lot 12 within our sub- division, Cornwall Hills Estates, and request your review of the attached proposed plans for approval: The modification is to place the fifth bedroom above the garages. This lot is approved for a 5 bedroom system. Thanks in advance, Attached: Three copies of plans & return envelop 131 1�f. (,/// -CONT. RIDGr Vrf4T A5PHALT 5MINGLE5 A5FMALT Q 5HINZ5 r J -4 . . . ........ . . .... -4 L J. i A5FHAL7 5HINGLM r . . . . . . . ... Iii 5TUCCO PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY, BEDIIOOTAS ALL S E�NT TO THESE HOUSE PLAN TI�E PCDOH FOR APPROVAL Z�r 11U111v A- / o 4/j, r M- a 9) 0) 3052 3052 { .. rues I I.:.:.! tij 1 i ,J I Y .Aft I I UNCKCt,AVA' - i re:ra - = —,- -,,.I I{ tl�.g "i..I. amr ragvA-c�.a � Itl+ � Tf - 1:1 .. . tii _II. �aoauuwemACewa�w e I I or . p�erp a I; ;_ I I I rl i ; 1 u io- aaira0.wm I I , ''! I I I - - – -,J Jill" ' . . - ,� - . -.. ... � � 24••O '..- .. _.: T °J'- - � 9`4 1 ' 3'6• - , g!�6' _ /. 3',6'...,,. 9'-6' �G _ _.... - 16.9' / -- ._._ .., ... .. .._ _ . -.� ' ig4 66 BA5EMEtJJ FOUNDATION PLAN scsutY,- 1•o' PUTNAM COUNTY DEPARTMENT OF HEALTH DTI SIONT OF ENVIRONNIENT'A.L HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR, 'A WASTEWATER TREATMENT SYSTEM L Name and address of applicant: PMlvi-a ccc zTA: ✓A�� /toa'� 15,REWr `r5- �* Alf 1050y 3 P�5/zSt�nJ 2. i \Tame of proleCt: . Locatioldrv: Tr Trite &ngirnaa ing, surveying & Landscare 4. Design Professional: Jeffrey J. contehm, P.E. 5. Address: LutitggL m P c_ 6. Drainage Basin: Easr 4RAAIcH 7. Tyne of Project: Private/Residential Food Service Apartments Institutional Office Building _mil Realty Subdivision 3 Garrett Place Carmel, New York 10512 Commercial Mobile Home Park Other (specify) 8. Is this project subject, to State Environmental Quality Review (SEQR)? Type Status (check one)............ ............ ............................... Type I Exempt Type II Unlisted .Y 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... y6s 10:. Has been completed and found` acceptable by Lead Agency? ne gx rvv3 11. Name of Lead Agency r„wN n.r RA-rf6RS#A1 C1 AeJA1.1.N6! 9PARb 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... yes 13. If so, have plans been submitted to such authorities? .......... : ............................ y 0el.J7 tINAL. 14. Has*;cUmiaaLy approval been granted by such authorities? yr;� Date granted: 15. Type of Sewage Treatment System Discharge.* ................ surface water _u _groundwater 16. If surface water discharge, what is the stream class designation? ..................... 6444 17. Waters Index number (surface) . ..N A 18. Is project located near a public water supply 1 system? ....... ............................... No 19. If yes, name of water. supply ;�; Distance to water supply A//_ 20. Is project site near a public sewage collection or treatment system? .................. Ala 21. Name of sewage system A114 Distance to sewage system -IA -P Opt — -7- 1 1 22. Date test holes observed Pews - E120p,u 23. Name of Health Inspector ADA,, -of, --g & 24. Project design flow (gallons per day) ...... ............... ............................... 000 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... 4/0 26. Has SPDES Application been submitted to local DEC office? ......................... ,,/ /,� —T 27. Is any portion ofthis.project located within a designated Town or State wetland? y65 28. Wetlan ds"ID Number .......:................... ,' NK50� be-Z"Z 29. Is Wetlands Permit required ?. ... ....:.......................... Has application been made to Town or Local DEC office? ............................... ............. 30. 'Does project require a DEC Stream Disturbance Permit? .. ............................... Al-7 3 i. Is or,,vas 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? ............................ 1TeslNo Vu 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? .......I ....................... Yes/No yes DESCRIK: kcsiS.mAm i.A,N➢ FILL 46A.Pr rl'(5 ' OF CO.OeA; /AL(, Mlt LI Ro.A o AN' sni.r Wp'ckr!L6 rp4T"s,,A, iit&m.Ay PC,- -r - .,,aero 9F SItE) 33. Is there 'a Local master plan on file with the Town or Village? ......................... yr4l 34: Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... U.vk Vll,..v 35. Are any sewage treatment areas in excess of 15% slope? . ............................... 36:. Tax Map ID Number .......................... ............................... Map Block :3 Lot v9, 37. Approved Mans are to be returned to ..... Applicant Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSSTS prior to final approval by the Department. Projects within the watershed may also - equire DEP review and approval of other aspects of a project, such as stormwater�plans or the creation of .mpervious surfaces, and the project applicant should obtain the appropriate forms for such activities from CEP and submit those forms to DEP for review and approval. f the application is signed by a person other than the applicant shown in Item /.,the application must )e accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision nay be grounds -for the rejection of any submission. .................. Iliereby of lim, utider penalty of perjury, that information provided on this form is true to the bestof, my knowledge acrd belief. False statements grade herein are pujiishable as a Class 7nisdemeanor pursuant to.Section 210.45 of the Penal Law. IGNATU� OFFIIC4L TITLES: 14.16 -4 (11195) —Text 12 PROJECT I.D. NUMBER 617.20 SEAR Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME gtVAl'A L Lt, Ss7i rue c oO_A)WA4 t_ Ia.LV 651_A7_6S it"r -O 12 3. PROJECT LOCATION: Municipality fA-rr 6lz5,, County 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) 166 Lvc.R'Tiv.v MAP VA/ Ca•�511?vc'%IOJ .DR/��l/I�� 5. IS PROPOSED ACTION: C'9 New ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: 'f/2 VC 0F 0 —h5 C&Aj y R6.0 7C.VCE pRJ ✓fiwa�J S'STS,, U166t, AA!•D f AP.°VR rENANcE6', 7. AMOUNT OF L ND AFFECTED: 'l Initially. If'L7� acres Ultimately acres 6. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ,Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF-PROJECT? 0 Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest /Open space u Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? Yes ❑ No If yes, list agency(s) and permit /approvals •,�QIVEWAy iF1'M/f ,� TOwN J.F .PA ?'/E2io.'V gSTri � NN.�C1c'P L'cn ♦wg" – Pct4D V I LD W C m j'r 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes Q'No If yes, list agency name and permit /approval 12. AS A RESULT QF 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 :L00V;';T6 g alNj;jS41m. , SvRJE 14jr6, a IAMT>i L APF APcH I r&rrV9 f, P, C, J`rff.- t � �y 17,117 L& r t � t Date: L_ Applicant /sponsor name: Signature:L 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) 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. If question D of Part II was checked yes,.the determination and significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis. above .and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency. Signature of Preparer (if different from responsible officer) Date 1 A. DOES ACTION EXCEED ANY TYPE I THRESHOLD JN 6 NYCRR PART 617.4? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No S. 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 by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified in CI-05? Explain briefly. C7. Other Impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. WILL THE PROJECT HAVE AN.IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF•A CEA? ❑ Yes ❑ No E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑Yes No If Yes, explain briefly PART III— DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it Is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability. of occurring; (c)' duration; (d)' irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part II was checked yes,.the determination and significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis. above .and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency. Signature of Preparer (if different from responsible officer) Date 1 /NS/ TE ENGINEERING, SURVEYING $ LANDSCA PEA RCHITECTURE, P.C. 3 Garrett Place (845) 225 -9690 Carmel, New York 10512 Fax: (845) 225 -9717 TO: Putnam Countv Health Deoartment 1 Geneva Road Brewster, NY 10509 WE ARE SENDING YOU ❑ Shop Drawings ❑ Copy of Letter LETTER OF TRANSMITTAL Date: 12 -19 -02 Job No. 99147.312 Attn: Robert Morris, P.E. Re: SSTS for Cornwall Hill Estates Lot 12 17Cheshire Court, Town of Patterson TM# 13 -3 -108 ® Enclosed ❑ Under separate cover via ® Prints ❑' Plans ❑ Change Order ❑ the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION 5 12 -13 -02 ...... ............. CD -1 Construction Drawing �^ _......_..._ ._......_......._._...._..._... 1 _..- _..._. ._.._._.........._ 12 -17 -02 _ .. CP -97 _...._._.. -- - _....__.._ _..._- ___....._. — - ._.._ ...... _ .... - ...... ........ _-_..._...._.._...._..__....._......_._..._.__.............._ .......... ........ ._........-. .............. ..... _............... Construction Permit 1 � ^5 -1 -01 CA -97 � Corporate Affadavit ... ............._. ..... . ............ .. .... ._ ............... _... 1 ...... .__.... ... .._ .........................._.. -- ..._ --- - - - - -- _...._...._....__....— --------- ....._..._.._.......__..__ ....... __..__.._ ... .............. -......._......-.-.__.._ _......__..__..._._.._........- .... _ ................ __. ... .......... --._ ....... _ ... ..... - ........ _ ........ .......... " Letter of Authorization 1 j --- - - - - -- PC 97 Application for Approval of Plans .... _ .................._....... ....._......- .._._.._........._ 1 ..........._......._.. __....__.....___..._......_..__ ( 12-17-02- _...__..._._._- .__...___ --- - - - - -- _ __.___.._.._.__..___..._---_._._._..___..._.__._.._. ..._.__._._...__-- _..._... -___. —_..._.......... _ .... _.._._.......-_-.._.._-....-. ._....__.._....._._..._._...... Short EAF Y�1 _.�..._._..�. 12 -17 -02 WP -97 Well Permit � ._--- ..._..__.._.._._.._......_ ......... ....-_ ..... _..._..____......___. -..__....._ 1 6 -21 -00 DD -97 Design Data Sheets (previously submitted with subdivision approval) 1 112 -3 -02 34800 $300.00 Fee - 2 --- - - - - -- 97731 --- - - - - -- 5 Bedroom Floor Plans 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: «- !l G/ COPY TO: SIGNED: � ohn M. Watson, P.E. Iot2002.dot PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of BMMD LLC Located at 11 c lil5gH /4E rc .2-r T/V Town of Patterson Tax Map # 13 . Block 3 Lot Subdivision of Cornwall Hill Estates Subdivision Lot # Gentlemen: >2 Filed Map # 2856 Date Filed 04 -04 -2001 This letter is to authorize Insite En ing eering 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 L r 'c.Health Law, and the Putnam County Sanitary Code. Very truly yours, n Countersigned: Signed �- P.E., # 61931 h (Owner of Property) Mailing Address & La'MCa eW'fftecture State New York G�1Zip Telephone: (845) 2 22'5.q<;-7o jg Mailing Address: 2 Tanager Road 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 # 17- 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 t to Signed. Title: -Manaizer Sworn to before me this / S-t day of (month) (year) Zoo Notary Public . 4MMIrM rAKKJM Corporate Seal 1v�3�yPuti9c= 5tQtaofNaarYba� ;: to Puh�n -, ' ��.1 w=-27vt ;,f t•r;t/; PUTNAM COUNTY DEPART NT OF HEALTH DIVISION OF EN ONlI NT E.A LT4 SERVICES DESIGN DATA SHEET - SUSURFACE SEWAGE TREATMENT SYSTOT Owner � 5 PPM D , 1 6z:- Address CA^'.' Located at (Street) Hi rc- ,, - a ,-T (indicate nearest cross st et) Municipality (', zi 5 -v-J Drainage Basin g i— `ice /f A10 � SOIL PERCOLATION TEST' DATA. Date of Pre - soaking 62 l 9 �')o Date of Percolation Test Hole No. Run No. Time Start - Stop Ela se Time Min.) Depth to Water krom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch C� 5 2 l0:06- Ib z�s as i9 a� 7.3 i 3 1 iJ P-9 0 ) •9 a.a J 7� 3 4 5 .2 "ol0A 1 3 3 X0:32,- 10�5�1 %9l cCo!,� 4 5. 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately, equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 I DEPTH G.L. 0.51 1.01 1.51 2.01 2.51 3.0' 3.5' 4.01, 4.51 5.0 5.5' 6.0' 6.5' 7.0' 8.5' 9.01 9.51 10.01 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES . I 'HOLE No. HOLE NO.I�E .- HOLE NO. 2 Indicate level at which groundwater is encountered 'ri oti 6' Indicate level at which mottling is observed luoJa- Indicate level to which water level rises after being encountered tj IA- Deep hole observations made by: -�vye) M, OA--rWa Date 1.&7 00 Design Professional Name: Jeffrey J. Contelmo, . P. E. Address: insite &qh-x=ing, surveying & Landscape Architedmre, P.C. 154 -Roiate 22 Brewster, New York 10509 Signature: Design Professional's Seal PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # P / -0-3 Well Location: Street Address: Clown/Village. Tax Grid # 17 , gj5 E K 1 P 6 Coo!,-I' P.4'rr-CRso v Map 11 Block 13 Lot(s)/z,16 Well Owner: Name: Address: ISM p Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation - Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought i gpm # People Served S 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 "X Is well located in a realty subdivision? ...................................... ............................... Yeses_ No Name of subdivision Cv.,t „i w A L L m l l. i. 6 t rA7 f5 5 Lot No. I IL Water Well Contractor: r0 R e a Kri�,e At N'5 y Address: •vi® Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: ni f,A Town/Village .0 Distance to property from nearest water main: N 1A Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: 12� 0�° °� 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 applirt 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 oth1rwise :.:1 contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued uthss construction of the well has been completed and inspected by the PCHD and is revocable for cause--or maybe amended or modified when considered necessary by the Public Health Director. y revision or aiferaioriP of the approved plan requires anew permit. Well to be constructed by a water ell ller c rtifiey 1'iltrim County.. Date of Issue 74 &J- Permit IssuinZWicial. Date of Expiration Z Title: Permit is Non-Transferiahk White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Insite Engineering & Survey 3 Garrett Place Carmel, NY 10512 RE: BMMD, LLC 17 Cheshire Court, Lot #12 (T) Patterson, TM# 13 -3 -108 Reservoir Basin Dear Sir: January 14, 2003 The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on December 23, 2002 is complete. The Department will notify you by February 6, 2003 of its determination. 1] 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 aproject, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the. Department of Letter to: Insite Engineering - January. 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. Ve truly y urs, , Robert Morris, PE RM:tn Senior Public Health Engineer 'd d0 1N3WI8Ud30 AiNnoo WUNind:3WUN T26Z- 8Z2- Sb8:131 llliiiti _ I�r V S� t• O 'd January 29, 2003 Robert Morris, PE Putnam Co. Health Dept. 4 Geneva Road Brewster, NY 10509 Re: Comwall Hill Estates. Lot 12/BMMD, LL.C. 17 Cheshire Court Patterson, Putnam East Branch Reservoir DEP'Log # 12781 (Joint Review) Dear Mr. Morris: bS:Zt IdJ 2002- Z£ -Ndf 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 plait titled "Proposed SSTS for BMMD, LLC./ Cornwall Subd, Lot 12 ", dated 12/13/02. 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 Depaltment representative may inspect and monitor the installation. Sincerely, �Lr� Danny Shedlo, P.B. Project Manager Engineering Design & Review James Covey, P.E., NYSDOH bi:6l �0, 6Z upt S�bM- iLZ- bT6:XPd 9NId33NI9N3 d3Q DAN TI-mg- EV SSil RUL PUTNAM COUNTY DEPARTMENT 01' 1-1,1AIII'll. HOUP �.�LANS APPROVED FOR BEDROOM COUNT ONLY, BEDR0,051." ALL SUBSE mo •TIFIESE HOUSE pl,-,4dNs U FICDOH FORA ROV SIG A► RE & TITI, 4D,.TE Shomi with optional tmo—.rgsr.gepackage end dicte top window over to, it door. m=22mmmm*lllffl - -OR fful;ir-mum, W O UL A- Al N.1 1.1 _ s", _ A_ _ _ Wiz. DA_ 1 Second Floor � pr First Floor [rsr I STANDARD SCARSDALE If FEATURES 0 5- Spacious Bedrooms 0 2%2 Baths' a Open Two -Story Entry. Foyer ® Formal Dining Room o i=orrnal living Room e Spacious Country l0tchen with Breal,�s_ Room and Pantry e "CotIage-Style" 3056 Lower level Windows with Architraves on Front 2TV 27rB °. ® Framingham Pediment on Front Door ® Fireplace Options Available ® `Boxed -out" and "Angle Bay Options Available ® Consult an Authorized Westchester Builder for a Complete List of Options • ® Artist's renderings and Floor Plan Dimensions are approximate. All spednt dons must be Wlren in the Contram No oral conditions. P. O. Box 900 o Dover Plains, NY 12522 (914) 832- 94 -00 0 (800) 832 -3888 010 �--- K)TCHIFI °z i ; BREKFAST "' FAMILY' g00M t 12 -0 Ir . 6= z I� -0 20' -0 z 19-0" Gf�R�6E� O DINING ROOM LIVING ROOM up I I i [rsr I STANDARD SCARSDALE If FEATURES 0 5- Spacious Bedrooms 0 2%2 Baths' a Open Two -Story Entry. Foyer ® Formal Dining Room o i=orrnal living Room e Spacious Country l0tchen with Breal,�s_ Room and Pantry e "CotIage-Style" 3056 Lower level Windows with Architraves on Front 2TV 27rB °. ® Framingham Pediment on Front Door ® Fireplace Options Available ® `Boxed -out" and "Angle Bay Options Available ® Consult an Authorized Westchester Builder for a Complete List of Options • ® Artist's renderings and Floor Plan Dimensions are approximate. All spednt dons must be Wlren in the Contram No oral conditions. P. O. Box 900 o Dover Plains, NY 12522 (914) 832- 94 -00 0 (800) 832 -3888 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES arr:u,011 )4 II �5� J,, f Iol WELL COMPLETION REPORT Well Location Street Address: l? CK6(a wti-T-- Town/Villag` Tax Grid # Map Block 3 Lot(s) W8 Well Owner: Name: Address: - kC Z T,�, ,� �-�✓5i �� <� s 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 —A Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length JoXft. Length below grade /0 / ft. Diameter _ -in. Weight per foot / 7 lb /ft. Materials: X Steel _ Plastic _ Other Joints: _ Welded Threaded Other Seal: _ Cement grout Bentonite Other Drive shoe: Yes No Liner _ Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped X Compressed Air Hours _ Yield S gpm Depth Data Measure from land surface- static (specify+ ft) l� T �t During yield test(ft) i►i�1 Depth of completed well in feet /I�fJ 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 - - 77 ✓ ` E, ' ='.�` If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity e_ Depth 1,10 Model =0g4t7l1. Voltage HP Tank Type ! v, '- Volume 1"I Date Well Completed Putnam County Certification No. Date of port Well Driller (signature) NOTE: lfxact location of well witti distances to at least two permanem ianQtnarxs to De proviaea on a separrc snu.Wpnw. Well Driller's Name A 1&rf, 9. &OT t, Signature: Address: / Qf S2iv1 l 1 =3 Date: White cop VM551w copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 / LOT 11 SSTS PER PCHD PERMI T ,h' -4 -03 1 l °' S 12 1 6 O.C. 4 13 14 15 16 (3s) / .o�� A i r r LOT 11 WELL PER PCHD PERMIT P -4 -03 t + t 1 rff� fti 4 i 25 24 23 22\ 20 \ 18 DECK x. 6 9EDRQOti! t D WELL NG•-.:. loo �i 7) WELL q 1t ..•t 1 ~t t' �1 CHESHIRE COURT , r• �? 114A MAP NUMacn: r J-J- / Utt 2 TANAGER ROAD 17 CHESHIRE COURT BREWSTER, NY 10509 TOWN OF PATTERSON . PUTNAM COUNTY, NEW YORK Notes: 1. THIS IS TO CERTIFY THAT THE SEWAGE TREATMENT SYSTEM WAS CONSTRUCTED AS INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS OBSERVED :BY INS /7E' ENGINEERING SURVEYING, do LANDSCAPE ARCHITECTURE, P.C. BEFORE IT WAS COVERED OVER THE SYSTEM WAS CONSTRUCTED IN GENERAL ACCORDANCE WITH ALL STANDARD RULES AND .REGULAnONS OF THE PUTNAM COUNTY DEPARTMENT OF HEALTH AND THE NEW YORK STATE DEPARTMENT OF HEALTH. 2. ALL FACIL177ES EXISTING UNLESS NOTED OTHERWISE. J. PROPERTY LINE, HOUSE AND WELL IS BASED ON FIELD SURVEY BY INSITE ENGINEERING, SURVEYING, AND LANDSCAPE ARCHITECTURE, P.C. COMPLETED MARCH 5, 2004. AS —BUILT MEASUREMENTS N0. cojam or ►rain Comm? aF H&AW REMARKS 1 22' 63' 4000 av-uw S&W TAW 2 71' 110' DROP BOX 3 77' 114' DROP WX 4 84' 119' old. Box 5 90' 124' DROP BOX 6 96' 129' AM' &X 7 102' 134' DRW BOX 8 109' 139' DROP WX 9 115' 144' OROP BOX 10 112' 160' iwD OF 1 mcm 11 •106' 155' iND OF WENCf 12 101' 152' END OF TRENCH 13 96' 149' .END OF MOXH 14 90' 145' Do OF _>R YCH 15 85' 141' END Or 1RENCH 16: 80' 137', EkO of ME? CH 17 74' 134' END O'MENa+ 18 69' 76' END OF MtNGH 19 75' 81' END OF MENCH 20 81' 87' END OF TREKH 21 86' 92' 00 OF 1RENCH 22 91' 98' BO OF 7Mp+ 23 97' 104' ao OF rReNCH 24 103' 110' END OF tea+ 25 109' 116' 00 OF RRENCH