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HomeMy WebLinkAbout0438DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -3 -111 BOX 6 X86 , T koi , - y , ilp r �. 161 ir V 00247 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # P -21 o­z Located at 1:7.1-. S� �2s, =_� 'p/2t ✓t 'own or Village PAffEQS o.n/ Owner /Applicant Name b iM m D t. L C- Tax Map 1 Block Lot Formerly Subdivision Name CoRdy&L 14iu rS -rA -1_65 Subd. Lot # 15- Mailing Address Z 'fAdAcmR 40AZ? SA6051'K NY Zip __10,4_04 Date Construction Permit Issued by PCHD 10 I Separate Sewerage System built by s u fp oaR eonl ae-'C Address 157o 1n 6A d s e_4 aSs° R o A� S�b�trnv,tiE�,�y �zs�a Consisting of 7_9­0 } i . ©F �.w C SoR fain/ fin! • < l YMoir 00htaining more than 20 sn g11L of sodium sho Uwe ttao e v r�zs�:3'lrt,� .5041hun d a 7+£ a fats. s nipai pp �t n 29® , FA 0 Other Requirements: Dr'pT. OF HEALTH Water Supply: ' Public Supply From, or: Private Supply Drilled by mlL- o,J NVAfy", Address /o/$ ,FT. 311 PATi ! ;04/ „/y Address Building Type R 6�0&1 r/'AL Has erosion control been completed? /v y Number of Bedrooms I Has garbage grinder been installed? /V 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 P.E. X -%.A. (Des gn Profe s' nal) Address Twp f(i - LAWcA P' License # (v' 1931 Aacu►rE- cr(/Rfi, P C. a boAocyre n YP erson cu PY in g premises served by 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 ater supply shall become null and void when a public water supply becomes available. Such approvals e s ject t modification or change when, in the judgment of the Public Heal Dire tor, such revocation o ficati r change is necessary. 0�/,% j By: Title. U Date: CIE White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION .OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map Block Lot �r»M'D LLC. SA ?'f�iRScN Building Constructed by TownNillage . 1 ?Z sn:0EASEs DRa ✓G IOP WALL HILL ICfkrjes Location - Street 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 14 Year2oo '- General Contractor (Owner) - ature 8M��, LLc Corporation Name (if corporation) Signature: Title: Corporation Name (if corporation) Address: z 'fiANA(;E1%1 QoQa Address: � a;'� State g�Ews,cR ,el( Zip /JbCo State, Zip -97 Form GS YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Pacovani, Director LAB #: 32.300742 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ CLIENT #: 56173 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ NON STAT PROC PAGE 1 BMMD LLC DATE/TIME TAKEN: 01/30/03 1O:00 2 TANAGER RD DATE/TIME REC'D: 01/30/03 11:5J. BREWSTER, NY 10509 REPORT DATE: 02/07/03 PHONE: (845)-279-1771 SAMPLING SITE: 172 SOMERSET DR, PATTERSON, NY SAMPLE TYPE..i POTA8L£ : BATH FAUCET PRESERVATIVES: NONE COL'D BY: BRUCE MAJOR TEMPERATURE..: < 4C NOTES...: ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ COLIFDRM METH: Ml::' DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 01/30/03 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 01/30/03 LEAD (IMS) 1. ' ppb 0-15 ppb 9101 01/30/03 NITRATE NITROG 2.47 MG/L O - 10 9139 01/30/03 NITRITE NITROG <0101 MG/L N/A 9146 01/30/03 IRON (Fe) 0042MG/L 0-00 mg/1 2037 01/30/03 MANGANESE (Mn) <0.010460L 0-0.3 mg/l 2037 01130/03 SODIUM (Na) 320 MG/L N/A 01/30/03 pH 6.9 UNITS 6.5-8.5 9043 01/30/03 HARDNESS,TOTAL 28.0 MG/L N/A 01/30/03 ALKALINITY (AS 402 MG/L N/A 01/30/03 TURBIDITY (TOR 5.6 NTU 0-5 NTU COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER (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 public schools are set at 15 ppb. EPA Lead & Copper Rule for Public Systems requires that no more than 10% of their distribution points have a LEAD value of more than 15 ppb and a COPPER value of 1.3 mg/L, else water treatment must be undertaken to reduce the waters corrosive potential. 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 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert H. Padovani, Director LAB #: 32.300742 CLIENT #: 56173 NON STAT PROC PAGE 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ BMMD LLC 2 TANAGER RD BREWSTER, NY 10509 DATE/TIME TAKEN: 01/30/03 1000 DATE/TIME REC'D: 01/30/03 11:51 REPORT DATE: 02/07/03 "HONE: (845)-279-1771 SAMPLING SITE: 172 SOMERSET DR, PATTERSON, NY SAMPLE TYPE..: POTABLE : BATH FAUCET PRESERVATIVES: NONE COL'D BY, BRUCE MAJOR TENPERATURE..: < 4C NOTES...: ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ COLIKORM METH: Ml::' DATE ' FLAG PROCEDURE RESULT NORMAL - RANGE ` \ METHOD is suggested. pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY,, WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE.NORMAL RANGE OF pH IS 1.5 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: Albert H: Padovani, M.T.(ASCP) ELAP# l0323 YML ENVIRONMENTAL ICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245-2800 Albert R. Padovaani, Director LAB #: 3E.301074 CLIENT #: 56173 NON STAT PROC PAGE I BMMD LLC DATE/TIME TAKE14: 02/10/03 10:00 2 TANAGER RD DATE/TIME REC'D:'02/10/03 12:00 BREWSTER, NY 10509 REPORT DATE: 02/13/03 PHONE:. (845)-279-1771 SAMPLING SITE: 172 SOMERSET DRIVE , , PATTERSON NY SAMPLE TYPE..: POTABLE : BATH TAP 'PRESERVATIVES: NONE C0L'D BY: BRUCE MAJOR TEMPERATURE..: pJOTES...: COLIFORM METH: N/A DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 02/10/08 IRON (Fe) <0.060 MG/L 0-0.3 mg/1 2037 02/10/03 TURBIDITY (TUR <1 NTU 0-5 NT8 COMMENTS: Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. SUBMITTED BY: ao/ Director ELAP# 10323 . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # F - Z 1 02 �- L r Located at 4-1z svm,. -R 5c7 r rvg j0 awn or Village r.4 -rreA yo;J E ,9,RN'VAt.L HUL Subdivision name Es -fAfCs Subd. Lot # ! 5 Tax Map 13.. Block 3 Lot 111, Date Subdivision Approved Owner /Applicant Name B^c) f [ c Renewal -- Revision -° Date of Previous Approval Mailing Address S -re, a4 06 ; & Geis ri'm NY Zip .� s Amount of Fee Enclosed n%tc Building Type Pf: 4 i7zN nvAL Lot Area 5 0''V*' No. of Bedrooms Design Flow GPD .3oa Ac- Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of !., z3-o gallon septic tank and y w -4 L. F. ,F Z' ,Jf�g Aftr,;R�+froa TRE,vcNES Other Requirements: 3 - b A:.- Q - o 61 ANf FG PI L A i8 Aj,1 *PJ N rix l s f/N fir' 1�1c'61 To be constructed by Tk, g j; p ETen,"I.V 2 Address ,y /a Water Sunnly: Public Supply From Address or: �_ Private Supply Drilled by P rfeR AWL-p Address N/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: P.E. lk� Address T. c eAX m.ct Nv i 0s' I z - Date 10 —t —O' License # crg a1 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 en onsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe p discharge f domestic sanitary sewage only. By: - Title: SI A— Date: /� IWO 2-- White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 ol v e "3W 7� 01 "O'ol 0 oo� LVI 10 M", PER PLED MAP JVS56 NO PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # 2- t d Well Location: Street Address: own/Village Tax Grid # ! �a So/t�lERs6� D2t PAr1& s0,✓ Map 13. Block Lot(s) Jf i Well Owner: Name: 1A M L L C Address: IA' AIA G A R qA -P okew)"6, 74 V Use of Well: _Residential Public Supply Air /Cond/Heat Pump Irrigation 1 -prima Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm #People Served i;- Est. of Daily Usage Sap gal. Reason for Existing Supply Test/Observation Additional Supply Drilling �eplace 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 '?sue No Name of subdivision CgAAIW,ALL NiLL ES1'/�'j'�S Lot No. .� Water Well Contractor: T'o 8 j5 -y6?E9M1N E-P Address: /A Is Public Water Supply available to site? . ................................. ............................... Yes No Name of Public Water Supply: Town[Village Distance to property from nearest water main: N Proposed well location & sources of contamination to be provided on separate sheet/plan. Da'e: +.q, O t- Applicant Signature: x->< PERMIT TO CONSTRUCT A WATER WELL TB 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 tha within thirty (30) days of the completion of water well construction, the applicant or their designated reltesentative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the re( tirements 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 wd driller shall take appropriate action to assure that any and all water and waste products from such wd drilling operations be contained on this property and in such a manner as not to degrade or otherwise coUrninate surface or groundwater. AIPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless colstruction of the well has been completed and inspected by the PCHD and is revocable for cause or may be arlended or modified when considered necessary by the Public Health Director. Any revision or alteration ofhe approved plan requires a new permit. Well to be constructed by a water a driller certified by Putnam Cunty. Die of Issue Z Permit Iss ' Official: Die of Expiratio l/ Title: Prmit is Non - Transfers le V6ite copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT # Well Location: Street Address: TownNillage Tax Grid # Map 13, Block Lot(s) (I 1 Well Owner: Name: Address: Well Type: X Drilled Driven Dug Gravel Other Depth Data: 5-7-1j Well Depth7 7 Static Water Level�0777 ft Date Measured Use of Well: ,Residential Public Supply Air /Cond/Heat Pump Abandoned Tprimary Business Farm X Test/Observation Other (specify) 2- secondary Industrial Institutional Standby Water Well Name: Address: Contractor: 7° Reason For n�oT iv�xar� —. TKq y'ex,-, `✓4y PI'v,° ''$"f 0-4 6&I A P 2 «•c. Abandonment: Description of Work To Be Performed: CvT CR�Si^+4 /ticT &AA -,oC- �,��' 1°v"ripJ p, pt�✓4 i4 � W FC C', . W CT C- OWC-�TV� Date: Applicant Signature: PERMIT This permit, to abandon one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code, Subpart 5 -2 of Part 5 of the New York State Sanitary Code and/or Part 75 of 10 NYCRR and provided that: Within 30 days of the completion of the abandonment of the water well, the applicant shall submit to the Department a certified statement that the infiorination delineated on the application for this permit has been completed. L o L- Dat of Issue Permit Issuing Official Title White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -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 # 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 ther to Signed: Title: -Manager Sworn to before me this / sT day of (month) (year) ' Notary Public Newt Corporate Seal Oum%dInPuln, ., n.. Form CA.97 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 44- 111 Subdivision of Cornwall Hill Estates Subdivision Lot # Filed Map # 2856 Date Filed 04 -04 -2001 Gentlemen: This letter is to authorize Insite Engineering, Surveying & Landscape Architecture, P.C. Jeffrey J. Contelmo, a duly licensed Professional Engineer X or Registered Architect— to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law't��ealth Law, and the Putnam County Sanitary Code. Countersign( P.E., # 61931 Mailing Add r State New York Zip IQ CAA Telephone: (845) 278 -4990 Very truly yours, Signed (Owner ofProperty) 0.1 ! %9�✓� - Mailing Address: 2 Tanager Road C. Brewster State New York Zip 10509 Telephone: (845) 279 -3613 Form LA -97 NS /TE LnENGINEERING, SURVEYING B A=SCAPEARCH/TECTVRE, P.C. 1485 Route 22 (845) 278 -4990 Brewster, New York 10509 Fax: (845) 278 -6392 TO: Putnam County Health Department 1 Geneva Road Brewster, New York 10509 WE ARE SENDING YOU ❑ Shop Drawings ❑ Copy of Letter LETTER OF TRANSMITTAL Date: 4 -9 -02 Job No. 99147.315 Attn: Robert Moms, P.E. Re: SSTS for Cornwall Hill Estates - Lot 15 Somerset Drive, Town of Patterson TM# 13 -3 -111 ® Enclosed ❑ Under separate cover via ® Prints ❑ Plans ❑ Change Order ❑ the following items: ❑ Samples ❑ Specifications COPIES --DATE ^T^ ' NO. + _ -�- DESCRIPTION 5 4 -2 -02 CD -1R Fill Drawing yig► ���� 4 -2 -02 CD -2 Construction Drawing LA -97 Letter of Authorization �__... 511 01_ CA -97- CorporateAffadavit_ _ 4-9-02 WA-97 Application to Abandon a Water Well ^ — T 1 � 4 -9 -02 C(- 1-01 I WP-97 __ Well Permit ! ./ $3 00.00 Fee 1 4 -9 -02 CP -97 Construction Permit 4 -9-02_ ^._ I Short EAF_. 6_20 -00 DD -97 Design Data Sheets (previously submitted with subdivision approval)___ 2 i 4 Bedroom Floor Plans THESE ARE TRANSMITTED as checked below: ® For approval ❑ Approved as submitted ❑ Resubmit ❑ For your use ❑ Approved as noted ❑ Submit ❑ As requested ❑ Returned for corrections ❑ Return ❑ For review and comment ❑ REMARKS: COPY TO: copies for approval copies for distribution corrected prints SIGNED: '4t n� Cohn M. Watson, P.E. lF F/,PLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE Iot200o.dot DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' 2 TEST PIT DATA DESCMTION OF' SOILS ENCOUNTERED IN TEST HOLES W : � �7Sm ICG _ t,J i�v 5%9 A'S iloJ tV ruo;5 1�5 I6 Ci HOLE N0. HOLE Noj. HOLE N0. r DPSa 11, �aTSolG 62. shly I..oM I LOAM Indicate level at which groundwater is encountered ^.) o-' Indicate level at which mottling is observed Noah Indicate level to which water level rises after being encountered A- Deep hole observations made by: -boy J ik Date 2 -lG o0 Design Professional Name: Jeffrey J. Contelmo, P.E. Address: Insits Engir�eering, surveying & �Lafidscape�� Archi.tecbme, P. , New York Signature: Design Professional's Seal .,A BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 16509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 May 14, 2002 Insite Engineering & Survey Route 22 Brewster, NY 10509 RE: BMMD, LLC 172 Somerset Drive, Lot #15 (T) Patterson, TM# 13 -3 -111 Reservoir Basin East Branch Dear Sir: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on April 16, 2002 is complete. The Department will notify you by June 30, 2002 of its determination. ❑ The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ® Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of If Letter to: Insite Engineering & Survey - May 14, 2002 -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. Ven truly yo s, Robert Morris, PE RM:tn Senior Public Health Engineer NYC DEP ENGINEERING Fax :914- 773 -0343 Jul 22 '02 16:28 N. U1 -7-0 —�—Z2 �.,� '2�E] .raeaj E'%E0 5'65'06 X4f0.4 M5,61 'Y77YH7V,,f 3l7N311 V S179J"Y17700 "P : 0Af1 933N1'JN.7 ,' SNOLL iV3dO Y • jo j C a'EOrp'� [fig ( - r I -to }.. t• ,::.'. :t'.t• t . i'.`., tl: .'. �: :. •' .. '::y�1 �ti�tiB.�S� .9111 !it.i.+:t:.R3u.W.it'Ctl:'.. :1 •• i'. nr :_..•...._. .. .. .. '.. , ..• _ .. aHtw Tau — as —PP02 MON 16:12 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 Z 'd d0 1N3Wi6Ud38 J,1Nn00 WdNlnd :3WUN Robert Morris, P.E Putnam Co- Health Dept. 4 Geneva Road Brewster, N°Y 10509 T26L- 8L2- 9V8 :-131 ZT :9Z NOW Re: Cornwall Hill Estates. Lot 15 172 Somerset Drive Patterson, Putnam East Branch Reservoir DEP Log # 12456 (Joint Review) Dear W. Morris: 20ea- 22-inr This letter is to inform you that the New York City Department of Environmental Protection (Department) has detenmined 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 15 ", dated 04/02/02. The applicant mast 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. Danny Shedlo, P.B. Project Manager Engineering Design & Review xc: James Covey, P.E., NYSDOH 7n'A - R7:9Z — ZO, ZL 1nf y 5X0— iZZ— bI6:xP3- 9NM33NION3 d39 3AN 14.1&4 (2/87) —Text 12 PROJECT I.D. NUMBER 81%.21 SEAR 4 Appendix C State Environmental Quality Review SHO_ RT .ENVIRONMENTAL ASSESSMENT FORM_ _. For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant'.or Project sponsor) 1. APPLICANT /SPONSOR 6Iy1mb LC F2_ PROJECT NAME , sr Fc, . CoR,vwAU RILL, 6SI2' 11GJ # l 3. PROJECT LOCATI n ' I /i Awl Municipality ! . -/2sON County r"VI 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) S6E bocATfOA/ NtaP by co�vS'9'�E've,7 c >V DA0 -AI,) /NC 5. IS PROP PSED ACTION: New ❑ Ekpansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: :. Co.1JSTRvCTj ©n% �)- LNG FAmr�y .. R Es nFat/c.ti, �2� vE�,✓AY� ss��% (-J FC.I, AN 7> A PPvA -rt;AvA.,vcEs 7. AMOUNT OF LAND AFFECTED: S'� `)'f s' $ }� Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ;RYes ❑ No It No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? 5iVesidential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other ascribe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL) ?, Ryes ❑ No If yes, list agency(s) and permlUapprovals VRWEway Pt =RrnlT — Tv✓N. �F PA�'t,�eron/ dtC�l'N4 Pc+�.arT — w�v aF PA7Tl�2ron! 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes -N:�o If yes, list agency name and permitlapproval 12. AS A RESULT OPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑ Yes FNo I CERTIFY THAT THE INFORMATION PROVIDED ABgVE IS TRUE TO THE BEST OF MY KNOWLEDGE 1C/✓9/fFi LNG /Ni�,2 /NG�J'�RvEY/NG, �'LA.VAsc,�bPLLARCi[Ifti�%vR� p C. OT Applicant/sponsor name: °NN rl • wgT.COA1 P15; Date: a 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 (ro 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, It 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..gy the proposed action? Explain briefly. .f • I� dam:. C6. Long term, short term, cumulative, or other effects not Identified in C1-05? Explain briefly. —a . , C C7. Other Impacts (including changes In use of either quantity or type of energy)? Explain briefly. > P ( 8 9 q Y YP 9Y ry < D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether It Is substantial, large, important or otherwise significant. 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 detall to show that all relevant adverse Impacts have been Identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a* positive declaration. ❑ Check this box If you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result In any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Print or Type Name of Responsible Officer in Lead Agency . Signature of Responsible Officer in Lead Agency Name of Lead Agency Date PIA Title of Responsible Officer Signature of Preparer (if different from responsible officer) - P'UTNA.M COUNTY DEPARTMENT OF HEALTH DIVISIONT OE ENW RON- MENTA, L HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM I., Name and address of applicant: Qm m � , L LC 21'AAiA G6k ROA*P _ 626W1:Tr ,, r►Y ►�S aq 2. Name of project: CocdwAiL MILL C' M1E> sysvr1404 3. Locatio&f: PAT ;5-.& s o y Insi.te i ngine;azing, surveying & Landscape 4. Design Professional: Jeffrey J. Contelm, P.E. 5. Address: Architecture, P_c_ 6. Drainage Basin: Ea cf aR A, j CH 7. Type of Project: Private/Residential' Food Service 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 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... Y6S 110. Has G£ -i -&been completed and found accept-able by L. ead Agency? b(CKM Ore M3 11. Name of Lead Agency 'fo,,j,j of PA?r62sojv . PLAuNlN& ROA! -D 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... 13. If so, have'plans been submitted to such authorities? ................ y�S ���pfr!�•vAL FIVAL 14. Has approval been granted by such authorities ?YU Date granted: t(- 6' -1600 15. Type of Sewage Treatment System Discharge...............:. surface water � groundwater 16. If surface water discharge, what is the stream class designation? ..:................. A/ 17. Waters index number (surface) ............................................. ...................... .......... ^i f_- 18. Is project located near a public water supply system? ................. Na 19. If es , name of water. supply _ .w /Q � � � � Distance to water supply N q_ 20. Is project site near a public sewage collection or treatment system? ................. /a 21. Name of sewage system Al A Distance to sewage system vcvs 22. Date test holes observed Wes — ct -'.4 . 23. Name of Health Inspector /1'D.AM .�'fr�e Fi►�►� 24. Project design flow (gallons per day) $ 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... Na 26. Has SPDES Application been submitted to local DEC office? ............... ........... _ +AIIp Form PC -97 27.. Is any portion of this.project located within a designated Town or State wetland? 4 . YSD yP zz 28. Wetlands ID . : Number .........:.................................. ................:.............. N .......... - 29. Is Wetlands Permit required ....: ............. ... ... Has application been made to Town or Local DEC office? . .............:................A :- 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, landflling, sludge application or industrial activity? ............................ YeSiNTO WD 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 `9tS DESCRIBE: 14CA -10A.d LAOD -01,L (i(-AS'f t1i>6 or CORAIWALL ulu Mt>,) .T wAV APT— N60,7U vF 33. Is there a local master plan on file with the Town or Village? ..................... E�. 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ .............. .I................ VNKMvw.ly 35. Are any sewage treatment areas in excess of 15% slope? . ............................... No 36. Tax Map ID Number ................... ........................:...... Map J 3 Block 3 Lot 37. Approved plans are to be returned to ..... Applicant .S� Design Professional NOTE: Alf 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 SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project; such as stormwater,plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from. DEP and submit those forms to DEP for review and approval. W rn If the application is signed by a person other than the applicant shown in Item l .,the applicationast<-- be accompanied by a Letter of Authorization (Form LA-97). Failure to comply with this proviH on,.m:�? may be grounds.f'or the rejection of any submission. o > = , I hereby affirm, under penalty of perjury, that information provided on this form is tru to the best ofmy knowledge and belief. False statements made herein are punishable a4,,, c a Class A misdetneanor pursuant to Section 210.45 of the Penal Law. CO 2`' SIGNATURES 4 OFFICUL TITLES: Insite Engineering. Surveying & Landscape Architecture, P.C. = ' Cannel, New York 10512 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Cor -Awall 14.v, r <I LJ-* X WELL COMPLETION REPORT Well Location Street Address: 1'-7-Z- Town/Village: A tC (-S d;,� I Tax Grid # Map 1 3 Block 3 Lot(s) !I I Well Owner: Name: + Address: o A4 t >, LL C_ y AC h c� � �--w s�•� N r G �`a 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 __X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length ft. Length below grade Diameter -i in. Weight per foot _Zlb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded _X Threaded _ Other Seal: _ Cement grout . Bentonite Other Drive shoe: Yes No Liner: Yes No Screen Details Diameter (in) Slot Size r Length(ft) Depth to Screen (ft) Developed? First Yes—No Hours Second Well Yield Test _ Bailed _Pumped Compressed Air Hours Z Yield &0 gpm Depth Data Measure from land surface- static (specify ft) '.3 ? T � During yield test(ft) ' ,44, hn Depth of completed well in feet d 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 3A6 3 n <, d 330 If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type AC '. 7. 1 Capacity (I S GPm Depth 1101 Model 1S I -Lfq 3`Z Voltage 17-oY HP 3/4 Tank Type ivH�jj Volume (,AL. Date Well Compl ted Putnam County Certification No. Date of of eport Well Driller (signature) ivy*tjE: coact location of weir wrtn arstances,-toai,leasi two permanwnt ianpmarxs to ve proviucu un a separatuonvoupiaii. Well Driller's Name !70 Address:./d/9 /j Y + Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 10 (-N W Imi f P'TTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL EALTH SERVICES DESIGN DATA SHEET - SVBSUPFACE SEWAGFE TREATMENT S'li''STEl l Owner1 Address c'N mac.. p�. i�l 13 ,�-e. s Located at (Street) / &> Ah 7ax Map Block Lot'' I (indicate nearest Cross st et) Municipality �A'i`cn5'x3 Drainage Bashi. Cfe� k `tom? ,"��o' LD•7— l . Date of Pre - soaking SOIL PERCOLATION TEST DATA Date of Percolation Test Hole No. Run No. Time Start.- Stop Ela se Time Min,) De�pth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate MiaAnch 3 —30. al��t/•.. © "�,d 4 5 S-0 7.3 2 -�53.*O 3 16,6 3 jo,';b '7, 4 r 5 • 1 . 2 3 4 5' 71 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 site TOTAL A TAX MAP 172 SOMI e�°`�,R.) Toter OF c PUTNAM .15 If If m 8MMD. Lb 7- If 2 TA NA GE BREWS TEA If If m If > lro / If 7/ A �.l A I I& %_, s ploE 10 _AS -_ I i, , -�4 5 12 1 irn n should scat flee' alth services 3 with of the L 1-u- Ite. DATE PROJECT- .. 4 t ,F s i° A *y-.? %1 :< a k .F t) t AS —BU1L T MEASUREi�9ElV REVISION n i e �f k { 1 T 3 rmel, Place - � Carmel, NY 10512 'ENGINEERING, SURVEYING & (845). 225 -9 (845) 225 -9717 717 fax LANDSCAPE ARCHITECTURE, P.C. www.insite-eng.com SSTS FOR BMMDa LLC CORNWALL HILL ESTATES LOT , 95) 172 SalERXT DMVE TOM OF PATTERSW PUN" MWTY, WW YORK 'tt OF NEW 9�p� C y3. Al I 1 C l,l oar'A" as UMITY REMARKS 1 82' 3..9 . I.= Q4d(N W tC TAM J. 2 74 47' smzn arse OUT 3 78'_ 66' r 5 87' 70' 6 93' 75' AW �ar 7 99' 81' 8 105' 86' ear 9 111'. 92' GW 10 117' 980 l 56' 82' Caro ax rrtMN 12 94' 105" . dr FAM0+ 13 106' 56' 00 OF naNCH 14 137' - 95' OW or >,mhoi 15 136" 1 99' am or mugN REVISION n i e �f k { 1 T 3 rmel, Place - � Carmel, NY 10512 'ENGINEERING, SURVEYING & (845). 225 -9 (845) 225 -9717 717 fax LANDSCAPE ARCHITECTURE, P.C. www.insite-eng.com SSTS FOR BMMDa LLC CORNWALL HILL ESTATES LOT , 95) 172 SalERXT DMVE TOM OF PATTERSW PUN" MWTY, WW YORK 'tt OF NEW 9�p� C y3. Al I 1 C l,l PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE PCHD CONSTRUCTION PERMIT # P -z 1 02 FOR WAGS -T . , TMENT SYSTEM `d � d_3 j ,J Located at 111- So1ni5R s9 f 674n or Village !'ATt6R S *,J Owner /Applicant Name tzc Tax Map is Block - _-:? Lot J// Formerly -- Subdivision Name COtTW A L L H i L L 5.9 rZ IEs Subd. Lot # Mailing Address `x rAfjA & E2 R U a r'N AC dwsn',t .0 Al y Zip i o-4r--D q Date Construction Permit Issued by PCHD Separate Sewerage System built by ovt P0o:2 C.AyiceP -r-y Address 15'a m gkmf G .ROsf AuAl> . is A�sun�fian/ �RE�✓Ck;� Consisting ofr f Gallon Septic Tank IM4 t��aF Z' be used for Other Requidm'oer tPa, +. __�Qx1rEi� `'� ztx uy Water Supply: Public Supply From Address or: Private Supply Drilled by —4T4%bV gVArt Address iol a fit, z�� PAfT�,esav, , ✓y Building Type (c 6Ss'E, tiTiAL Has erosion control been completed? N0 Number of Bedrooms la Has garbage grinder been installed? No I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- 'built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: 1 �' In Certified by P.E. > -R-A- Address SNx.,re Fnl igg—egiye. s✓ !v,g ,,�, �' �dNa;r.4PX� /�Ft °N /f�e�r�Qi_License # .VG_A.eRSr, OZ4r.0 c4RAIi% -1y ior!% Any person occup�mg 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 chars Q�wi en,:irl th J_4gment of the Public Health Director, such revocati 'difilcat' or change is necessary. By: / �f�✓ � Title: Ah Date: 212 J White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 T PUTNAM COUNTY HEAL TH DEPT 1 Geneva Road (845) 27 &6130 i j 0 2 4 5 0 1 Brewster NY 10509 3. Feceived a The Sum Of �.�,_;� Q-�- �°z�,-; Dollars $CY o� For � r Cas Check. ❑ Credit Card g _> Y � ! 1 l l 1 1 1 1 1 1 1 1 1 1 1 1 A } /NS /TE ENGINEERING, SURVEYING & L4NDSCAPEARCHITECTURE, P.C. 3 Garrett Place (845) 225 -9690 Carmel, New York 10512 Fax: (845) 225 -9717 TO: Putnam County Health Department 1 Geneva Road Brewster, NY 10509 WE ARE SENDING YOU ❑ Shop Drawings ❑ Copy of Letter LETTER OF TRANSMITTAL Date: 2 -18 -03 Job No. 99147.315 Attn: Robert Moms, P.E. Re: SSTS for Cornwall Hill Estates Lot 15 172 Somerset Drive, Town of Patterson TM# 13 -3 -111 ® Enclosed ❑ Under separate cover via ® Prints ❑ Plans ❑ Change Order ❑ the following items: ❑ Samples ❑ Specifications COPIES DATE NO. 1 DESCRIPTION 5 2 -18 -03 A13-1 As -Built Drawing 1 2 -18-03 CC -97 Construction Compliance 3 �~ 12 -10-02 GS -97 Guarantee 1 _1_____.�._.�._.. 12 -10-02 -- - - -•�i 2 -7 & 2 -13 -02 ! E911 Address Verification Water Test Results ��M��-- _..._.._._..__._..____._... __._....._.._�..._._._... 8-15 -02 ! WC-97 Well Completion Report . 12 -3 -02 ; 34800 $200.00 Fee 97729 1 2 -14 -03 j Well Abandonment Certification r THESE ARE TRANSMITTED as checked below: ®For approval ❑Approved as submitted ❑ Resubmit ❑ For your use ❑ Approved as noted ❑ Submit ❑ As requested ❑Returned for corrections ❑ Return ❑ For review and comment ❑ REMARKS: copies for approval copies for distribution corrected prints COPY TO: J� Jo n M. Watson, P.E. I01:2002.dot DEC -11 -02 07:50 AM PATTERSON TOWN HALL 9148786343 Dk-10 -200 14:59 FROM:INSITE ENGINEERING 94522597' .7 TC:8458796243 i P.02 P:3 "; BRUCE A. FOLLY * # UM MOLMAN. RN., I1r -SK Pub* lfeatlA Director ,taroctate AoWle x oM D&tCW Dfreetor 4r PQtknt Seriku DEPARTMENT OF HgAL,'TH 1 (3o R d jiuva oa Armter, Nevi► York 10509 • EaMroaaeaeAt Hca19e (9I4)�TS •61?Q Pe =p14) Ttl- 1"iardaa 6enleq (91h if1.6SS9 W1C (p14)171 -641a Fqt (Qt4) 7A .6DB5 Udy Iatervadoa ('814) 111.6014 PMU11401 (014) 916440/3 Fu (0 ) 271.048 OWURS NAM: TALC MAP NUM EX 1 K911- ADDRESS. } TOWN; � LL A,V'TRORM TOWN d$?ICW,: (Signata>ra) . DATE: 1211 a 4 The , F utioaitn County Department of Redlth wM not Construction Compliuce azdess the above farm is tong address is assigned by an authorized town ofiiciRL Thb with: the application for a Certificate of Contraction 0 L er issue a Certificate of ietedt i.e., a legal B911 brm is to be submitted ;3 • 'ld •F BMMD.L.L.0 2 Tanager Road Brewster, NY 10509 Tel 845-279-3613 Fax 845- 279 -1771 Date: Feb 14, 2003 From: BMMD LLC To: . Putnam County Department of Health Subject: Abandon Well All work as described under permit # P-21-02 has been completed. Bruce Major, Manager I Sworn to before me this day of (month) Vt)uAnru (year) acct o C), Notary Public TINA MARIE OMEARA NOWY Public, State of New York No. 01OM6056696 � Oualifle* d In Putnam County Term Expires March 26,20" PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: Inspected by: E� Street Location Som�9ZS T t�TI, Owner �� f L/- G Town &7-74W5,�2i✓ Permit # o ff TM # 13-7s—/// Subdivision Lot # 15- 1. Sewaee Svstem Area a. STS area located as per approved plans .................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth_ c. Natural soil, not stripped .:.......... ............................... d. Stone, brush, etc., greater than 15' from STS area... e. 100' from water course / wetlands .............................. II. Sewa ' e System a. Septic tank size - 1,000 ....... ,250. ......other........ b. Septic tank installed level ........ ............................... c. 10' minimum from foundation .......................... :...... d. Distribtuion Box 1. All outlets at same elevation -water tested......... 2. Protected below frost .......... ..................:............ 3. Minimum 2 ft.Original soil.between box &. trer Junction B x - properly set ................ ............................... ength required..// _ Length installed 9 2. Distance to watercourse measured - - 100 Ft... 3. Installed according to plan .. ............................... 4. •Slope of trench acceptable .1/16 - 1/32" /foot...... 5. 10 ft. from property line - 20 ft.- foundations... 6. Depth of trench <30 inches from surface........... 7. Room allowed for expansion, 100 % .... :............. 8. Size of gravel 3/4 - 1' /z" diameter clean ............. 9. Depth of gravel in trench 12" minimum............ 10. Pipe ends capped .......... ............................... g. Pump or Dosed Systems 1.Size ot pump chamber ........ ............................... 2. Overflow tank ..................... ............................... 3. Alarm, visual / audio .............................. . ............ , 4. Pump easily accessible, manhole to grade........, 5. First box baffled .................. ............................... 6. Cycle witnessed by H.D.estimated flow /cycle.. III. House/Build' a. ouse ocated per approved plans .............. b. Number of bedrooms ............................e .. ... IV. Well a. Well located as per approved plans ........................ b. Distance from STS area measured -- I oo. ft... c. Casing 18" above grade ........... ............................... d. Surface drainage around well acceptable ................ V. Overall Workmanship a. Boxes properly grout 'ed ............ ..... .............:............, b. All pipes partially baci ed ... ...........................M... c. All pipes flush with inside of box .... ...... ............ ..... d. Backfll material contains stones <4" diameter...... e. Curtain drain & standpipes installed according to l f. Curtain drain outfall protected & dinto exist water g. Footing drains discharge away from STS area....... h. Surface water protection adequate .......................... i. Erosion control provided ......... ..........:..........:......... Rev. 1/97 orm NOV -7 -2002 10:12 FROM:INSITE ENGINEERING.8452259717 TO:2787921 PUTNAM COUNTY DEPARTMENT OF HEALTH DXVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION d ADAM GENE F4j,B3ST FOR FINALMsp -EcnoN For: Fill All Wormation must be fully completed prior to any Trenches inspections being made. PCHD Constructioa Permit # f, 21' ° 7- Located: I1z. loAoxer !mlv(r -LA f7'�r 'C a"4 Owner /Applicant Name: 4MOPI ct, C TM 1% Block - 3 Lot Y1- Formerly: Subdivision Name; f tlQMw_Act MILL MKf F Subdivision Lot"" / 5 Is system fill completed? Es Date: `t • zei- . O z . Is system complete? 16f Date: t t Is system constructed as per plane? _ Is well drilled? Date: t l Is well located as per plans? 3(s Are erosion control measures in place? W5 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, Mules and Regulations of the Putnam County Department of Health. Date: l (� a -z' Certified by: PE RA, Inalte Engineering, Surveying Des' Profess o Landscape Architecture, P.C. Address; :9 Garrett Place Lic. Carmel, New York 10512 Comments: Form FIR. -99 NOU -7 -2002 THU 10:13 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P P: 1/1 id "Title - 3 report: - SIGNATURE; Title, SEP -25 -2002 15:07 FROM:INSITE ENGINEERING 8452259717 TO:2787921 P:1/1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVURONMENTA1 HEALTH SERVICES ATTENTION Q ADAM tTGENE All information must be fully completed prior to any Trenches inspections being made. PCHD Construction Permit # f- -L I r 0 Located' 1-71, S aa6,o_ fg r r2a,wx _ (% (V) P4 ,ri6Axa v Owner/Applicant Name: ammb . 44C TM "_ Block x Lot P Formerly: „ N/A Subdivision Name: c >*: �re- Subdivision Lot # _ Is system fill completed? I t$ .Date: 4 -2 4 -p z Is system complete? Nn Date: 4 -'Z -1 -01 Is system constructed as per plans? N�- Is well drilled? n%o Date: _ Y _,z 4- c12 Is well located as per plans? /V _ Are erosion control measures in. place? C4!5_� 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 Perbnit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Ilealth. Date: �t �� Certified by: PE idk- Insite Engineering, Surveying A �qigrofesslo& Landscape Architecture, PC. Address: 3 Garrett Place Lic. # C/ I s t Carrnel, Now York 10612 Comments: Form FIR -99 SSP -25 -2002 WED 15:06 TEL:845- 278 -7921 BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6.130 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 November 14; 2002 Jeffrey Contelmo, PE Insite Engineering 3 Garrett Place Carmel, New York 10512 Re: Field Inspection - BMMD, LLC 172 Somerset Drive, (T) Patterson Lot # 15, TM# 13. -1 -111 Dear Mr. Contelmo: The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field. 1. Connection from the house to the septic tank needs to be completed. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Sincerely, '4� Gene D. Reed GDR: cj Environmental Health Engineering Aide SENDING CONFIRMATION DATE : NOV -15 -2002 FRI 11:54 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845- 278 -7921 PHONE : 92259717 PAGES : 1/1 START TIME : NOV -15 11:54 ELAPSED TIME : 0012111 MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... BRUCE R FOLEY rY LORETCA MOLINARI RN., M.E.N. M11e fl fth Dt- A Wi k Pw6ea Hinrra Phrrw Olin w qr Pmtar &,vier, DEPARTMENT OF HEALTH I Geneva Rood, Brewster, New York 10509 tierlramn4.1 Et"aa (//3)771 -6130 Fa(14S)71/ -7921 Nanlnl lerrka (645)273.65S1 WIC (1/5)271 -6671 FU(143)779.609S Firy IalmentlenlPrn�6aol (N!)17t -601/ F x(W)271.6601 November 14, 2002 Jeffrey Cootclmo, PP IDsite Engineering 3 Garrott Place Carmel, New York 10512 Re: Field Inspection - BMbiD, UX 172 Somerset Drive, M Patterson Lot # 15, TM# 13. -1 -111 Dear Mr. Contelmo: The above re&renced separate sewage treatment system can be back011ed. The following comments must be cor=ed in the Held. 1. Connection from the house to the septic tank needs to be completed. If you have any further questions, please contact me at (945) 27M130 ext. 2261. Sincerely, Gene D. Reed GDR:q Environmental Health Engineering Aide PUTNAM COUNTY DEPARTMENT DE HEALTH ' DIVISION OF ENVIRONMENTAL HEALTH SERVICES ti DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner (3mm> t t.c Address Z TAy �;r; R0 6r, Rk6WSr5 �y ri'oi IF Located at (Street) i'% SarnE@fEr pRw& Tax Map /?. Block, (indicate nearest cross street) Municipality PA•r'!Ens*�.� Drainage Basin EAdf eW AN -N SOIL PERCOLATION TEST DATA 3 Lot m Date of Pre-soaking N�A FI«'PAV ogRCf Date of Percolation Test H -14 o% Hole No. _ Run No. Time Start - Stop Elapse Time I(Min.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch P! 1 3:0o _ z :ob !$ 19" 2z" 3 6.0 2 7:1q - 3:y0 2� iqa 't L" '3 -7.0 LA 0'z- 4 5 P2 2 3,'3 ' 3 4 s 5 ,1 2' . w. 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtamea at eacn ,. percolation test hole. (i.e, s 1 min for 1 -30 min inch, s 2 min for 3'1 =60 min/inch) All data to be submitted for review. t' 2. Depth measurements to be made from top of hole. Form DD -97 G.Cs, 0.5, 1.01 1.5' 2.0' 2.5' M, 3.5' 4.01 4.5' .5 5.0' 5.5' 6.0' 6.51 7 .0' ..0 7.5'. 8.01 8.5' 9.01 9.5' 10.01 2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. HOLE NO Indicate leve t which groundwater is encountered Indicate ndicate I el at which mottling is observed Indic -level t( -level to which ter 16Vel rises* after -being encountered p 0 s D hole observations made by: Date Design Professional Name: Jeffrey J. 'Contelmo, P.E. Insite Engineering, Surveying & Address: Landscape Architecture, P.C. 3.Garrett Place, Carmel, New York 10512 Signature: Design Professional's Seal ICE /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 Department 1 Geneva Road Brewster, NY 10509 WE ARE SENDING YOU ❑ Shop Drawings ❑ Copy of Letter LETTER OF TRANSMITTAL Date: 10-3-02 Job No. 99147.315 Attn:- Robert Morris, P.E. Re: SSTS for Cornwall Hill Estates Lot 15 107 Somerset Drive, Town of Patterson TM# 13 -3 -111 N Enclosed ❑ Under separate cover via N Prints ❑ Plans ❑ Change Order ❑ the following items: ❑ 'Samples ❑ Specifications COPIES DATE NO. DESCRIPTION 5 10 -1 -02 CD -1 Construction Drawing 1 8 -28 -02 a CP -97 Construction Permit 1 --- - - - - -- DD -97 Design Data Sheets .c� THESE ARE TRANSMITTED as checked below: NFor 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 ❑ 4 REMARKS: Rob- The ROB fill pad has been installed and inspected by your department. Enclosed are revised construction drawings and the design data sheets for the fill pad percolation tests. Please call if you have any questions. - John COPY TO: SIGNED: ectr 130 ZO ns ohn M. Watson, P.E. IF ENCLOSt S ARE N7 A$�N!.TED, KINDLY NOTIFY US AT ONCE Iot2002.dot /NS /TE ENGINEERING, SURVEYING & LANDSCAPEARCHITECTURE, 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 WE ARE SENDING YOU ❑ Shop Drawings ❑ Copy of Letter LETTER OF TRANSMITTAL Date: 10., Job No. 99147.315 Attn:'- Robert Morris, P.E. Re: SSTS for Cornwall Hill Estates Lot 15 107 Somerset Drive, Town of Patterson TM# 13 -3 -111 ® Enclosed ❑ Under separate cover via ® Prints ❑ Plans ❑ Change Order ❑ ❑ "Samples the following items: ❑ Specifications COPIES ( DATE NO. 4 DESCRIPTION 5 l 10 -1 -02 CD -11 Construction Drawing 1 8 -28 -02 ,> CP -97 I Construction Permit 1 --------- DD -97 Design Data Sheets I - V ; 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: Rob- The ROB fill pad has been installed and inspected by your department. Enclosed are revised construction drawings and the design data sheets for the fill pad percolation tests. Please call if you have any questions. - John COPY TO: SIGNED: ZO ohn M. Watson, P.E. IF ,5SAREN ARE 1015.7�ED; KINDLY NOTIFY US AT ONCE Iot2002.dot