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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13.-3-109 BOX 6 00245 �'y ~, ' 1 �� I� � ■ � ■ Ir I Jr' 00245 f PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FO SEWA'r ATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at 16b SoMtRStii DR`'JE 40s;�Ior Village ATiERS orgy Owner /Applicant Name Formerly i Mailing Address a 11 bMfAa , LLC. Tax Map 13 Block Lot I Oq Subdivision Name CO(UV ALL 41 LL CS-rA•r 6S Subd. Lot # 13 9,00,9 , 69'E%4SfR' 0 Date Construction Permit Issued by PCHD Separate Sewerage System built by Zip 10509 Address Consisting of 1)d5 o Gallon Septic Tank and boo Lf ©F aJ W,Dt AZ)SDRQ-r InrJ T94N 85; - O'' Df6q Curti r� Other Requirements: � � n1 0 R A� Water analysis resu ¢ ®� so iva'.- � � _...._ - Water Supply: Public Supply Fr $Qr °es ntWning more than 20 '�iY�di���° Pe BPmssn'2 70 mg/L of sodium sr .,., ° ` :...: '. neDple oncmoderesely or: X Private Supply Drilled by Address Building Type RtS%Ott4 r 4L Number of Bedrooms 4 Has erosion control been completed? Has garbage grinder been installed? 0 ,fib 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: �^ Certified by 21, Design Address ::046 6 1 Er�Gin�gbtw SvK�Ey,N , wy sc P.E. X R.A. LTQat• V-(-. License # 61 q 3 1 3 GARttEt'f PLKt C.A(tNiL) my (05lk 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 a subject to modification or change when, in the judgment of the Public Health Director, such revocat' odifica ' or change ecessary. By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 i 0 PUTNAM COUNTY DEPARTMENT OF HEALTH. DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM r /;I D� L_ c 1 3 (o �1 Owner or Purchaser of Building . Tax Map Block Lot g enfL- J�l�1i�Yt i o r✓ Building Constructed by TownNillaae 66 5 D me-Ai E-r b 2 i ✓ (. Gp •Z�wtYw ,'(i w �� f � Location - Street Subdivision Name 63 (G1 w ry V Al—, ?j 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 Year Signa i i��s► —� Title: e wzl General Contractor (Owner) - Si Corporation Name (if corporation) Address: L C. C Corporation Name (if corporation) Address: Z State Zip State . Zip t V 1 Form GS -97 Aug 20 03 07:28a 13RU'CE R. FOLEY Pauie Aea(lh Dlrectcr TOWN OF PATTERSO 845 - 878 -2019 DEPARTMENT OF BEALTH 1 Geneva Road Brewster, New York 10509 P.3 LORETrA MOLMAIC. RN., M.S.N. Araoeiate PUNIC Meallh Director Director qj Patimi Survlaea 1E:avlMwcaa4 Ilealt6 (914)778 -6130 FA(914) 278.7921 N"rq Sorvkej (914) 378 -6558 WW(914)279-6679 Pea (914) 279.6085 Earl) Inkrveadoo (914) 2711.6014 Prodool (914) 378 -6082 fa(914)278.6649 OWNERS NAME: L L. C to 1kM W A(.L N 1 aL JSTA-r Es , Lo T %3 TAX MAP NUMBER E oq 19911 ADDRESS: I G SOA('R s6-f PA. #V6 TOWN: 1A'r I C9 so.y ACTTHORMID TOWN OFFYCUL: '(Signature) DATE: The Putnam County Department of Health will not issue a Certificate of Construction Compliance u less the above form is completed, i.e., a legal E911 address is assigned by an authorized towta official. This form is to be submitted with the application for a Certificate of Constraction Complliauce. (691 Iv>:.RF IK b�£ d 6T028L8:O1 4TL6S229178 9NId33NISN3 31ISNI:14083 L2:bT £002-67-" t j PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street A ress: 1 /1W oK -ertV Pr Town/Village: Q (Z6' 6h IMap/3, Tax Grid # Block -� Lot(s) Well Owner: Name: Address: Q ,y U LCGe /'/ /� z o o2 � 6 Act & -oidS - - , . Use of Well: 1- primary 2- secondary �_ Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length ft. Length below grade Oft. Diameter 7 in. Weight per foot 1Zlb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded Z Threaded _ Other Seal: _ Cement grout Bentonite Other Drive shoe: jL 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 I Yield C)G� 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 If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump TypAAcu,z,2i Capacity — Depth U If Model 15 4711T v'SZ Voltage 1.30 HP J_ Tank Type Q4.j.,0;, Volume Date Well C mplet 5c-7`/ /o 3 Putnam County Certification No. 06 7 Date of Report d a3 Well Driller (signature) I A NOTE: Exatt location of well witn aistances to at least two permanent iananiams to oe proviueu un a separfc sucvupiaii. Well Driller's Name 141X e, Ct rh ...'Address: , / h Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 91z21o3 - e?(� FINAL SITE INSPECTION Date: 2 d Y Inspected by: GI k EE1� Street Location 5or9��sT �TL, Owner Town Permit #� TM # n.— -.3-/09 Subdivision Lot # / 3 1. Sewage System Area i YES O COMMENTS a. STS area located as per approved plans .......... : ................ i'���grs o �. b.. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped .................................................. d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... = II. Sewage System �. _� -. - -� - - _ - a.'Septic tanksize,'1,000 .......1;250....... .other ... b. Septic 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. Trenches . 1. Length required 5-0o Length installed 5- ®'c3 2. Distance to watercourse measured 4- Ido Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft. foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... ' 8. Size of gravel 3/4 - 11/2" diameter clean ...................: 9. Depth of gravel in trench 12" minimum .......:........... 10. Pipe ends ca pped ........................ ............................... g. Puma 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. House/Building a. House located per approved plans b` Number of;bedrooms- i h -- -, IV Well- - _ Well$located as per approvedplans� b Di to from STS area measured ft �C!l`--•� c. Casing. 18" above grade ................ .............:................. ;. d. Surface drainage around well acceptable ....................... ; V. Overall Workmanship . a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter............ e. Curtain drain & standpipes installed according -t fain drain outfall protected & d r:.to'exist.w ' �" "� ate o r g. ' Footiig dig_ discharge away from STS area ............... h. Surface water protection adequate ........ :........................... i. Erosion control provided ................. ............................... Rev. p2/02 Form -3 MAY -19 -2003 08:01 FROM:INSITE ENGINEERING 8452259717 TO:2787921 P:1/1 PUTNAM COUl, W DEPARTMENT OF WALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AT 2G "'TENTION a ADAM ENE ME 101FINAL INSPECTION For: Fill All information must be frilly completed prior to any 'Trenches inspections being made. PCHD Construction Permit # t -Z- y'7_ Located: )GG f-a'"15R sET' () (V) 1A7T6R Ca-/ Owner /Applicant Name: Utz c TM � 3 Block I Lot 10 4 Formerly- olA Subdivision Name: '. &_w_ tc Hirt Qc rAza. Subdivision Lot TM Is system fill completed? �fA Is system complete? DIES (rltwc4ai Is system constructed as per plans? ye f_. _ Is well drilled? N C7 Is well located as per plans? Are erosion control measures in place? Date: Dater Date: I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam. County Department of Health. Date: 5 i Cerkificd by: p X RA Inane Engirwring, Surveying 8� esi Professi n Landscape Architecture, P.C. Address: 3 Garrett Piece Lie. # i9 19 ;1 Carmdl, New York 10512. Comments: 7Y6_ 5 c-O rt c- rlb-It is S v c K f;T" e - 7e- (.v 5 ce:'C-7— r f 17ge "' G H !--5 Form FIR -99 7 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 May 23,.2003 Jeffrey Contelmo, PE Insite Engineering 3 Garrett Place Carmel, New York 10512 Dear Mr. Contelmo: ROBERT J. BONDI County Executive Re: BMND, LLC Somerset Drive, (T) Patterson Lot # 13, TM# 13 -3 -109 The above referenced separate sewage treatment system can be backfilled. There are no further comments to be addressed. 1. Stand pipes for the curtain drain need to be installed. 2. The well and septic tank need to be inspected upon completion of construction. 3. A bedroom count must be performed by this department upon further completion of construction. 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 SENDING CONFIRMATION DATE : MAY -27 -2003 TUE 09:10 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 92259717 PAGES : 1/1 START TIME : MAY -27 09:10 ELAPSED TIME : 00'22" MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... A a � x LORMA MOLINARI R.N., M.S.N. ROBERT J. BONDI A,aag Ada, H hA Dorm- Caaaly 6r a. Dk.da o/ POW., &IA1 r DEPARTMENT OF HEALTH 1 Go w" Road, Brewster, New York IOS09 Eadrmdmrllal llata (843)278 -6130 Fm(845)218 -7921 nanla8 SoMm (NS) 278 -6538 WIC(945)278-6678 F"(845)276-6083 early Inmt d.Nh�aaol (945)278 -6014 V=(943)279 -6618 May 23, 2003 lefavy Contelmo. PE Insite. Engineering 3 Garrett Place Carmel, New York 10512 Re: MM, LLC Somerset Drive, M Patterson Lot # 13, TM# 13 -3 -109 Dear W. Comdmo: The above referenced separate acwage uratmtun aystcm can be backfilicd, There are no further commoots to be addressed. 1, Stand pipes for the curtain drain need to be installed. 2• The well and septic tank need to be inspected upon completion of construction. 3. A bedroom count must be performed by this department upon further completion of construction. If you have any further questions, please contact me at 845 -279 -6130, eat. 2261. Sincerely, /f Gene D. Rccd f Environmental Health Engineering Aide GDR-cj 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 22, 2003 Jeffrey Contelmo, PE Insite Engineering 3 Garrett Place Carmel,,New York 10512 Re: BM1VID, LLC Somerset Drive, (T) Patterson Lot # 13, TM# 13 -3 -109 Dear Mr. Contelmo: ROBERT J. BONDI County Executive The above referenced separate sewage treatment system can be backfilled. There are no further comments to be addressed. If you have any further questions, please contact me at 845- 278 -6130, ext. 2261. Sincerely, ..Ao �/✓, Gene D. Reed Environmental Health Engineering Aide GDR: cj SENDING CONFIRMATION DATE : SEP -22 -2003 MON 11:42 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 92259717 PAGES : 1/1 START TIME : SEP-22 11:41 ELAPSED TIME 00' 20" MODE : ECM RESULTS : OK 1 FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... 4c LORETTA MOLINARI R. M.S.N. ROBERT J. BONDI POW Ndd D(ro Cony E—,iw DEPARTMENT OF HEALTH I Owen Road, Brewster, New York 10509 Parhonmeml Bath (445)176 -6130 FUMM272.l"I NmYa1 944tH— (445)271.6551 WrC (2{5)2/8.6671 Pa(845)27e -6065 EItbO�terrasdaVPraelnl (613)276.6611 Paa(145)278.6641 September 22, 2003 JefBey Coatelmo, PE insite Engiaeeriag 3 Garrett Place Carmel„New Yoxk 10512 Re: BM M, LLC 9omereet Drive, (7) Patterson Lot # 13, TM# 13 -3 -109 Dear W. COmelmo: The shove re£erencod separate sewage treatment system can be balled. There are no further commenta to be addressed. U you have any further questions, please contact me at 545- 279.6130, M. 2261. Sincerely, � Om D. Reed Environmental Health Engineering Aide GDRcj PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ,1od * 12 WELL COMPLETION REPORT Well Location Street Address: M4 SOl�f- erst.,l Pr Town/Village: /D� e f_Y6 ki Tax Grid # Map 13, Block, � Lot(s)j C7 Well Owner: Name: Address: A &- °o C 6r N- , Use of Well: 1- primary 2- secondary �_ Residential Public Supply 61 Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion / Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length eft. Length below gradeft. Diameter % in. Weight per foot 1Zlb /ft. Materials: Steel _ Plastic _ Other . Joints: _Welded Threaded _Other Seal: _ Cement grout 11 Bentoniie _ Other Drive shoe: -4 Yes No Liner: Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test ..._.._.._.. `Bailed ,Pumped Compressed Air Hours . _. Yield gpm Depth Data Measure from land surface- static (specify ft) 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 Y- d _ I/ If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump TypAAcurxZiCapacity 00k,_ Depth 16 q Model 1 $ Lilly d' Voltage 1.30 HP _ Tank Type, Volume —'-v Date Well C mplet Putnam County' Certification No. Date of Report ;' .. Well- Driller .(signature) YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 93.302165 CLIENT #: 56817 NON STAT PROC PAGE 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ' MAJOR, BRUCE DATE/TIME TAKEN: 08/08/03 03:30P 166 SOMERSET DRIVE DATE/TIME REC'D: 08/09/03 09:00A PATTERSON, NY 10563 REPORT DATE: 08/18/03 PHONE (845)-590-9734 *Av4��n /Cw4�1*m^�� ��Iw' CSr»vTW� /&T- ��� : SAMPLING SITE: 166 SOMERSET DRIVE : PATTERSON,NY COL'D BY: BRUCE MAJOR NOTES...: LAUNDRY ROOM FRONT ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COLIFORM METH: Ml::' ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 08/09/03 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 08/09/03 LEAD (INS) 4.0 ppb 0-15 ppb 9101 08/09/03 NITRATE NITROG 0.78 MG/L 0 - 10 9139 08/09/03 NITRITE NITROG <0.01 MG/L N/A 9146 08/09/03 IRON (Fe) <0.060 MG/L 0-0.3 mg/1 2037 08/09/03 MANGANESE (Mn) <0.010 MG/L 0-0.3 Mg/1 2037 08/09/03 SODIUM (Na) 97.6 MG/L N/A 08/09/03 pH 6.8 UNITS 6.5-8.5 9043 08/09/03 HARDNESS,TOTAL <2 MG/L N/A 08/09/03 ALKALINITY (AS 168 MG/L N/A 08/09/03 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 & Copper than 10% of their than 15 ppb and a treatment must be potential. ublic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/Ln 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 is suggested. '. YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 93.302165 CLIENT #: 56817 NON STAT PROC PAGE 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ MAJOR, BRUCE 166 SOMERSET DRIVE PATTERSON, NY 10563 SAMPLING SITE: 166 SOMERSET DRIVE : PATTERSON,NY COL'D BY: BRUCE MAJOR NOTES...: LAUNDRY ROOM FRONT ~~~~~~=~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE DATE/TIME TAKEN: DATE/TIME REC'D: REPORT DATE: PHONE: (845)-59{ 08/08/0303:30P 08/09/03 09:00A 08/18/03 -9734 SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C COL FORM 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 WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L MODERATELY HARD WATER: 70-140 MG/L MG/L = MILLIGRAM PER LITER HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) SUBMITTED BY: r)JW - ` ELAP# 10323 /NS/ T 11��LANDSCAPEARCHITECTURE, ENG /VEER /NG, SURVEY /NG & P.C. 3 Garrett Place Carmel, New York 10512 (845) 225 -9690 Fax: (845) 225 -9717 TO: Putnam Countv Health nPnartmPnt 1 Geneva Road Brewster, NY 10509 WE ARE SENDING YOU ❑ Shop Drawings ❑ Copy of Letter LETTER OF TRANSMITTAL Date: 9 -8 -03 Job No. 99147.313 Attn: Robert Morris, P.E. Re: SSTS for Cornwall Hill Estates Lot 13 166 Somerset Drive, Town of Patterson TM# 13 -3 -109 ® Enclosed ❑ Under separate cover via ® Prints ❑ Plans ❑ Change Order ❑ the following items: ❑ Samples ❑ Specifications COPIES j DATE 5 9 -8 -03 NO. I DESCRIPTION As- Built Drawing I AB -1 1 19 -8 -03 CC -97 , Construction Compliance 9 -8 -03 � GS -97 i Guarantee v8_ -18 -03 - - - - -- Water Test Results 8 -8 -03 46863 - -�— $200.00 Fee 88253 —___— 1 8 -20 -03 - - - - -- ICE -911 Address Certification _,............. .......... .... _.. I � i THESE ARE TRANSMITTED tis 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: COPY TO: copies for approval copies for distribution corrected prints SIGNED: I✓l OJ nM.Wetson,P.E. IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE Iot2002.dot 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 Insite Engineering & Survey 3 Garrett Place Carmel, NY 10512 Re: Proposed SSTS: BMMD, LLC 166 Somerset Drive, Lot #13 (T) Patterson, TM# 11-3 -109 Dear Sir: ROBERT J. BONDI County Executive October 1, 2003 Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: 1. E -911 form has not been submitted. 2. Original well log has not been submitted. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. V truly yo s, Robert Morris, P.E. Senior Public Health Engineer T= o p%43 PC I Olf co .A7 JC ii� 4 ~ x- x. r -S - f! w y r�< Am f T i } X is t3 �',r ' t 3 +;• x -_ t., s � a thy. + t 1 + M r .�. ✓ r e.•eh` rya . r. not ( ' f ' i V 'r R 1 i yr�rly - mi L.- +. AM A�... ' OAK?? + + i yr�rly - q T (S + 7f /VjLW IV7[!'f I z a� x 1� s rc . t T l h > L ` 1 ;a r N .. - f - 1f q T 2", 9 �" GYli� J C'iF ��? 9��1i�' � �� -i �s rid �...�#.t� =•,�4 , � . . h > L ` 1 ;a r N .. - f - 1f PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # � - oZ a• - � � . a - 3y-'?3 Located at )cc Sommstt DARE T or Village �.�?tE���•U COAAWALL HALL Subdivision name Es-fA-rg:; Subd. Lot # 13 Tax Map V3, Block T Lot i o q Date Subdivision Approved f L g b y- j -o i Renewal Revision -X/- Owner /Applicant Name 13 r mp . L LC Date of Previous Approval Mailing Address 2 -TAaA[,E2 AvY Zip v� Amount of Fee Enclosed -14 A 0 Building Type r (Sr ;, >;N rya Lot Area 7.7+/-No. of Bedrooms 4_ Design Flow GPD TOO Ac. Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1,_24-0 gallon septic tank and roo 4F or 2 khw5 A95PA P TfoM rRENcA6S Other Requirements: -7'- 0" r C 1Jara rN D.e A I a To be constructed by ro sr "o E Address _ ,din Water Supply: Public Supply From Address or: K Private Supply Drilled by 7'o 845 Address M/A 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: tNS; Ew 1 SEklw 5f4 VC V' val ,f- LA Address 3 GAA Or-e--& A ca eAQr!EL '), P.E. Date -41 IT 03 N 1 FGCT ✓2 E.� /'. i . License # 019.31 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 (arid is rev(Ec4blgf COtuse or may be amended or modified w considered necessary by the Public Health Director. Any revision or Pa ation of a approved plan quir s anew pe t. pprove r discharge of domestic sanitary sews a only,:: ; : ' - iq1 / By: Title: rDate: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 ❑Cash ❑ :O ❑Credit Carc1. gy `/ Gheck dvQit'xC. l l L 1 1 1 1 L 1 1 1 1 1 1 1 1 1 1 1 1 1 1 LUA A 1 LVA 1 1-4 1 1 7 1 54 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # JQ a 07 Well Location: Street Address: Town/Village Tax Grid # Iw'G S-ffiERS&r ;xwg Pn.rfLacom Map 13 Block "3 Lot(s) ioq Well Owner: Name: Address: i+MMD ►1lC t 'fnN/aGER Au1� .�,'QGri37�i2,NY 1oiJ� Use of Well: k Residential Public Supply Air /Cond/Heat Pump Irrigation - primary Business Farm Test/Monitoring Other (specify) - ary Industrial Institutional Standby Amount of Use Yield Sought 5 gpm # People Served V, Est. of Daily Usage 3 oo gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling X New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type ( Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ..............:................ Yes No e Is well located in a realty subdivision? ...................................... ............................... Yes �e No Name of subdivision S-ORN ✓AC.i HILL &W z s Lot No. 13 Water Well Contractor: fv rE Address: Is Public Water Supply available to site? .................................. ............................... Yes No 2< Name of Public Water Supply: VIA Town/Village Distance to property from nearest water main: ^/ /A Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: t4- O3 Applicant Signature: Icy- PERMIT TO CONS N'i�UCT 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 11 driller certified by Putnam County. f= Date of Issue 2.03 Permit Issui cial: Date of Expiratio rf :V/7_1 0 Title'. Permit is Non - Transfer able i White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 .,� l A A t 1 1 1 1 1 t l 1 1 t 1- t 1 1.. 1. 1 t t . •�.; �. 7 PUTNAM COUNTY DEPARTMENT OF HEALTH �X DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # 10- ola - O goo, Located at C� S ogr-'� ��J1/� Village PATrj5Amy CoprjwALL AiLt, Subdivision name 16C fA-rv,s Subd. Lot # 13 Tax Map 13, Block 3 Lot l ti9 Date Subdivision Approved f 1 LE P -f-j-01 Renewal -- Revision Owner /Applicant Name S/X/d'i , , LL( Date of Previous Approval i Mailing Address 1- 1'A�MA r�6e ROAD r t3RWs16R AI)l Zip /DSOq Amount of Fee Enclosed Building Type B&sm fw f1AL Lot Area 7.1 % No. of Bedrooms 4 Design Flow GPDA G o Ac. Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of / 9 Z -�_10 gallon septic tank and 5'00 L F o� Z-I W I*DC A8soR ffioAN TRCvckCS Other Requirements: 7 r- o" 26E1P Cu-c a 'DR f11nl To be constructed by To 86 1>£11ERM iNEp Address s✓,q Water Su I : Public Supply From Address _ or: Private Supply Drilled by Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage 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. X' "K 0.. Date 5'' v c ,z- °E Aq u i recfvR P.C. aS-f a, ) License # C/93[ 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 nsidered ecessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe i . =arge of domestic sanitary sewage only. By: Title: 42-- Date: 2—f C / ° 2-- White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 BMNM L.L.C. 2 Tanager Road Brewster, NY 10509 Tel- 845- 279 -3613 Fax - 845- 2791771 Date: Sept 18, 2002 From: Bruce Major To: Robert Morris, PCBOH Subject: Change House Plans for Cornwall Hill Estates Lot 13 Re: Permit # Tax Map 13 Block 3 Lot 109 Rob, We are currently under contract to build. the attached house plans for our sub- division, Cornwall Hill Estates, and request your review of the attached proposed plans for lot 13. This Lot has been approved for a 4 bedroom system by your office. Thanks in advance, Attached: Three copies of plans & return envelop. 60 ga 61 a3s ZO Department of Environmental Protection i65 Columbus Avenue Valhalla, New York 10595 -1338 (7h.risto Ward '�':nii�a�aASaet�ltc�• July 24, 2002 Robert Morris, RE Putnam Co. Health Dept. 4 Geneva Road Brewster, NY 10509 Re: BNND LLC /Cornwall Hill Estates. Lot 13 166 Somerset Drive Patterson, Putnam East Branch Reservoir DEP Log # 12522 (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, Lot 13 ", dated 05/31/02. 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 Department representative may inspect and monitor the installation. Sincerely, Danny S e o, P.E. Project Manager Engineering Design & Review xc: James Covey, P.E., NYSDOH y.CIIY DEPAR, MF p� a n,IS E�3 . iRp'VMENiAL PBO�'G� at, I Vii. www. nyc. gov /dep (7 1 &1 0EP -HELP /NS/ TE ENGINEERING, SURVEYING & L4NDSCAPEARCH/TECTURE, P.C. 3 Garrett Place (845) 225 -9690, Carmel, New York 10512 Fax: (845) 225 -9717 TO: Putnam County Health Department 1 Geneva Road Brewster, NY 10509 WE ARE SENDING YOU ❑ Shop Drawings ❑ Copy of Letter LETTER OF TRANSMITTAL Date: 5 -31 -02 Job No. 99147.313 Attn: Robert Morris, P.E. Re: SSTS for Cornwall Hill Estates Lot 13 166 Somerset Drive, Town of Patterson TM# 13. -3 -109 ® Enclosed ❑ Under separate cover via ® Prints ❑ Plans ❑ Change Order ❑ ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION 5 ^ —_' 5 -31 -02 CD -1 Construction Drawing ❑ As requested 5 -31 -02 CP -97 Construction Permit 5 -15 -01 CA -97 Corporate Affadavit 1 --------------- - - - - -- LA -97 Letter of Authorization 1 -------------- - - - - -- PC -97 , Application for Approval of Plans 1 5 -31 -02 --- - - - - -- Short EAF 1 ` 5 -31 -02 WP-97 Well Permit - _ 6-20-00 DD -97 Design Data Sheets (previously submitted with subdivision approval) 1 - -- -------------- - -- --- - - - - -- $300.00 Fee 2 --------------- - - - - -- --- - - - - -- 4 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: COPY TO: W2002.dot SIGNED: J n M. Watson, P.E. IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # a a O Well Location: Street Address: &wnNillage Tax Grid # ICG PA`?1t�02SVAI Map j''3 . Block 3 Lot(s) / o Well Owner: Name: Address: 6MmD1 LLc I -L TAMAG6A P.OAP S, ?CvS151'ee, tiY IoS-)l Use of Well: )Z Residential Public Supply Air /Cond/Heat Pump Irrigation 1 -prima 6 Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought i!� gpm # People Served 1�1 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 X No Name of subdivision CoRn/wALL RrLL 69TAfCS Lot No. 13 Water Well Contractor: Address: A11A Is Public Water Supply available to site? ................................. ............................... Yes No k Name of Public Water Supply: ,/V A Town[Village N t1 Distance to property from nearest water main: VIA Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: 3 ' 1' d�— Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED_FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a wat711 11 driller certified by Putnam County. . AA Date of Issue Z Permit Issuin al: Date of Expiration 2 � Title: tv Permit is Non- Transferr White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Fonn WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH.. DIVISION OIL, .ENWRON7MENTAL EALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A '"IASTEWATER TREATMENT SYSTEM L Name and address of applicant: 6MM) L LC Z "�ANACg�Q RaA� _ tt t'S .Fo,Q PvRN ✓/l i.t- MILL 60'4 2. Name of proj ect: svgnPvlsfony . oT 13 4. Design Professional: Jeffrey J. Contelim, P.E. 6. Drainage Basin: 1✓gsf 64A,,JeH 7. Tvpe of Project: Private/Residential Food Service 0 t 3. Location \T: PA-rT_6P_soN invite Engineering, Surveying & landscape -5. Address:�,;e, Apartments Institutional Office Building 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 x 9. Is a Draft Environmental Impact Statement (DEIS) required? ...................... yes 10. Has Ply been completed and found acceptable by Lead A enc Y.....S , Cc Cinl3 ER J11 3 11. Name of Lead Agency TVV o F e..47TEQs'o.V joLANNJNG k9r,1 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? �s Conl17ltl0NAC 14. Has r;@4 approval been granted by such authorities? YES Date granted: 15. Type of Sewage Treatment System Discharge .................. surface water X groundwater . 16. If surface water discharge, what is the stream class designation? .. .. .:............... 17. Waters index number (surface) ..................................:....:... ............:.................. all 18. Is project located near a public water supply system? ........................ N� 19. If yes, name of water supply �/� . Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ n/a 21.. Name of sewage system A/ Distance to sewage system Qapc . `t, 1.16 -Z j 9 19 0o ., 22. Date test holes observed .06- cs_: 61-kvioo . Name of Health Inspector A *DA rK , sr a6u A►G- 2!ldo.,: 24. Project design flow (gallons per dl a ' ............. ............................... 66p G P 17 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? .............:........... N ` Form PG92- 2 27. Is any portion of this project located within a designated Town or State wetland? y�S' 28. Weil ands'ID Number ........................................................ ............................... jnLy c n fC 29. Is Wetlands Permit required ?........:.... .. V0 Has application been made to Town or Local DEC office? ..............:................ 30. Does project require a DEC Stream Disturbance Permit? /V 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, land1311ing, sludge application or industrial activity? ............................ Yes/.No '0 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 DESCRiI3E: lCGSSrcAN LANp/---11L Z/E-�4s'. :)D5 ov coAyw -jaNi Lri -b�Ab) r dtib SALT krxfeP /r_,l . rA.4-rrFP -&'m RMWIVAY ilCPT — AVoRTU nF s►TZ—�- ) 33. Is. there a Focal master plan on file with the Town or Village? ......................... yE,r 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site ? ................... U�v�Grvow.r/ 35. Are any sewage treatment areas in excess of 15% slope? . ............................... 36, Tax Map ID Number ..... .................. ............................... Map Block 3 Lot 167 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 duplicate to the DEP, although the project may require DEP approval of the S:STS prior to final approval by the Department. Projects within the watershed may also require DEP re- 4ewand approval of other aspects of a project; such as stormwater`pla.ns or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review.and approval. If the application is signed by a person other than the applicant shown in Item L,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge acid belief. False stateineas made herein 'are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES 4 OFFICXAL TITLES: A 0- 14 PUT'NAM COUNTY DEPART NT OF HEALTH DIVISION OF ENVIRONMENTAL -EALT.H SERVICES DESIGN DATA SHEET SUBSURFACE SEWAGE TREATMENT NT SYSTEIYI Owner Ni, D Address c••�•'�'n- r�rr �, i3 r�� sr Located at (Street) Garu�r✓,f�w t'c u lz� f vru��s7�7- t�z 'ax Map l Block . Lot .I 0 (indicate nearest cross st�e et) Municipality PAT c:? Drainage Basin C-A i 14.164 (1/87) —Text 12 PROJECT I.D. NUMBER 617.21 SEAR J 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 9wip • ac 2. PROJECT NAME, SS J S Q Cc WALL 1 )LL SJ t S LQ 3. PROJECT LOCATION: Municipality S0 &f County 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) SEE LOCAF,i wd MAP cent (,ws-1C -van6d W4wildc- 5. IS PROPOSED ACTION: 99Lsew ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: �QNSiFi1C(I0N' Lqr ON'G TAMIL, K.rSIVc1VG� �. PAIv vAyJ 5515, WELL AW A PPV2 EMA fVCk 5 *.: :.. 7. AMOUNT OF LAND AFFECTED: —7,7 +/— 7� +� Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? W-es ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL) ?. .Yes ❑ No If yes, list agency(s) and permit/approvals Pf )vcW:k1, f6 tr- Tc�,,JV c M- Trrgs�'f�/ .5srs,* W ELL - P.C:04 bw1oid4 - #4),r -7Cw;V OF 11ATf6k5Ck( 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes It yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑ Yes GNO I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ;SJ351 i � ENC►rJ� E�'1w�C a Sf.'�f iif'�Ili�t! & L/�NG�SC!{P� �'�I.' fjI f ECiJ ^C, P C: �.t. Applicant/sponsor name: J��� M- 1IVATUN � Gl Date: —� z-- Signature: If the action is In the Coastal Area, and you are a state agency, complete' the Coastal Assessment Form before proceeding with this assessment OVER 1 PART 11— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? if yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another Involved agency. ❑ Yes ❑ No - C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) Cl. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain C5. Growth, subsequent development, or'related activities likely to be induced..by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified in C1-05? Explain briefly. C7. Other Impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? 11 Yes C1 No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (ro 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 o� more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on "attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Date K Title of Responsible Officer Signature of reparer (If different from responsible officer) i i 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 # ) 3 I, Bruce Major represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: BMMD LLC Having offices at: 2 Tanager Road, Brewster, NY 10509 Whose Members Are: John Boyle Bruce Major Bruce Major John Dale and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto Signed: Title: Mana er Sworn to before me this ��day of (month) H-4 (year) 140 / Notary Public N`ary Sto} y� Corporate Seal _No. of 6M"92 Form PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of BMMD LLC Located at Cornwall Hill Road TN Town of Patterson Tax Map # 13 Block 3 Lot log Subdivision of Cornwall Hill Estates Subdivision Lot # 1'3 Gentlemen: Filed Map # 2856 Date Filed 04 -04 -2001 This letter is to authorize Insite Engineering, urvveyipg & 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 Lawjheftblic . Health Law, and the Putnam County Sanitary Code. ,ter' Fr � F Ne!� 7 �. . .G,D".� ✓j"ea . i Countersigned: P.E., # 61931 Mailing Address & Landscape,(A_ bhitecture 1485 Route a Brewster State New York Zip 10509 Telephone: (845) 278 -4990 Very truly yours, Signed (Owner of Property) ig Mailing Address: 2 Tanager Road P.C. Brewster State New York Zip 10509 Telephone: (845) 279 -3613 Form LA -97