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PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR EAOE TREATMENT SYSTEM
PCHD CONSTRUCTION PERMIT # 1W 3 - 01 1 ff
Located at ,4b'L c:u" tjau.. N L4__ Town or Village PA:r �''&4
Owner /Applicant Name `/,,Vj 6'Lee L.LC, Tax Map 13. 1 Block I Lot '7o
Formerly
Subdivision Name
Subd. Lot # 3 (o
Mailing Address ATr A40, W lfi rE' PL`-7N 5 . zip
Date Construction Permit Issued by PCHD l a d O 1 SADDLE- C7C
Separate Sewerage System built by �j c�ct. t e_ fZ'► Address Ku LfY\ E;S , J ) y l 2�31
Consisting of 1 a-.5Z) Gallon Septic Tank and 5 bo LF of 2 y " poi uG p( t
A;-tJ Q I UU `)u
Other Requirements:
Water Supply: Public Supply From Address
H PurNAM 4VE
or: Private Supply Drilled by P F BF-Al- Address tJ5T!EX_ P YjQsoli
Building Type fZ e 51 h r-,XX E Has erosion control been completed? ye 5
Number of Bedrooms 3 Has garbage grinder been installed? &l 0
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 ounty Department of Health.
Date: qJ15101 Certified by P.E. R.A.
(Design Professional)
Address 19 ? 1 go-Lt u- Q i `I 10 S-0!2 License # 0'
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 ubject to modification or change when, in the judgment of the Public Health Director, such
revocation, o ificatio or change is necessary. /
By: Title: 5 � Date:
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CC -97
0
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT
Well Location
Street Address:
Cornwall Hill Road Lot 36
TownNillage:
Patterson
Tax Grid #
I Map Block Lot(s)
Well Owner:
Name: Address:
Saddle Ridge Homes, Inc., 12 Saddle Ridge Court, Holmes, NY 12531
Use of Well:
1- primary
2- secondary
X Residential Public Supply Air cond /heat pump Irrigation
Business Farm Test/monitoring Other(specify)
Industrial Institutional Standby
Drilling Equipment
X 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 72 ft.
Length below grade 71 ft.
Diameter 6 in.
Weight per foot 19 lb /ft.
Materials: X Steel _ Plastic Other
Joints: I Welded X Threaded _ Other
Seal: X Cement grout _ Bentonite Other
Drive shoe: X Yes No
Liner _ Yes X No
Screen Details
Diameter (in)
Slot Size
Length(ft)
Depth to Screen (ft)
Developed?
First
Yes No
Hours
Second
Well Yield Test
Bailed X Pumped x Compressed Air
Hours 6
Yield _ 7 gpm
Depth Data
Measure from land surface- static (specify ft)
50'
During yield test(ft)
300'
Depth of completed well in feet
365'
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
45
Drillint
in ove
burden clay and boulders
45
Hit roc
at 45'
45
72
Drillin
in ro
set ca '
72
365
Drillinc,
in rocR
aranite .
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump /Storage Tank Information
Pump Type sub Capacity 5g=
Depth 320' Model 5GS07412
Voltage 230 HP 3/4
Tank Type WX250 Volume 44 _gal.
Date Well Completed
7/18/01
Putnam County Certification No.
002
Date of Report
9/19/01
W iller gnatur
lcolm Be 17r.
NOTE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plKh.
Well Driller's Name P. F. Bea & Sons. 2nc. Address: 4 Putnam Ave., Brewster, NY
Signature: Date: 9/19/01
Malcolm T. Beal, r.
White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC -97
10509'
li
.-:y-:� ���:44Al4 P02
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner or Purchaser of Building
R»ilAiner rnnctnintpA by
Location - Street
'Lu
Building Type
3, �
Tax Map Block Lot
TownNiIlage
Subdivision Name
Subdivision Lot #
I represent that I am wholly and completely responsiblq 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 ofthe Putnam County Department ofHealth, 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
General
Year Signati
Title:
:�E_AJC �Zul IN a 4
Corporation Name (if corporation) Corporation Name (if corporation) '0
Address: . . MAL5_8,iXL C1 k Address: Pi o m es
State Zip -State fkI Zip _ .3
1
Form GS -97
BRLCE R. FOLEY
Pubhc tfealth Dtrecxr
DEFARTNM'NT OF HEALTH
i Geneva Road
Brewster, New York 10509
LORETTA MOLINARI RN., M.B.N.
Associate Public Health Director
Airecror of Partanr servicrs
lamoumeatai Health (914) 278 - 6130 Fmt(914) 278 -7921
.NurAnt; Snafus (9141 273 - 655E WIC (914; 273 -667E Fat (914) 278 -608:
Early Inter veattan (914) 2 "8 - 6014 Prachoal (914) 278 -6082 Fax (914) 278-- 6648
W-11 MWIVIRI O 1 0
OWNERS NAME:
TAX MAPNLMBER:
E911 ADDRESS:
TOWN:
AUTHORIUD TOWN OFFICIAL:
(Signature)
DATE:
The Putnam County Department of Health will not issue a Certificate of
Construction Compliance unless the above form is completed, i.e., a legal E911
address is assigned by an authorized town official. This form is to be submitted
with the application for a Certificate of Construction Compliance.
(7-91 I VERPR •1)
NE
NORTHEAST LABORATORY of DANBURY �NACC0,004
39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404
203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 q,
LABS www.NORTHEAST LABORATORIES.com a
LABORATORY REPORT
REPORT TO:
P.F. BEAL & SONS DATE SAMPLE COLLECTED: 9/9/2001
4 PUTNAM AVENUE TIME COLLECTED: 6:00 P.M.
BREWSTER, N.Y. 10509 COLLECTED BY: RICK DeVALL
DATE RECEIVED @ LAB: 9/10/2001
TESTED BY: LAB #11471
LAB LD. # PFB -95
REPORT DATE: 9/13/2001
SAMPLE SITE: SADDLE RIDGE HOMES, LOT #36, CORNWALL HILL RD., PATTERSON, N.Y.
SAMPLE POINT: TANK HOSE BIB
SOURCE: WELL
TREATMENT: NONE
MAXIMUM CONTAMINANT
TEST PERFORMED RESULTS METHOD # LEVEL (MCL) OR STANDARD
BACTERIAL:
• Total Coliform (Bacteria) 0 per 100 ml SM 9222B 0 per 100 ml
PHYSICALS:
• Color (Apparent) 5 - EPA 110.2 15
• Odor ND - - 3 Units
• pH 7.22 - EPA 150.1 No designated limits
• Turbidity 1.7 NTUs EPA 180.1 5 NTUs
CHEMISTRY:
• Nitrite Nitrogen <0.005 mg/L as N EPA 354.1 1.0 mg/L
• Nitrate Nitrogen <0.05 mg/L as N EPA 353.3 10 mg/L
• Alkalinity 166.0 mg/L SM 2320B No defined limits
• Hardness 224.0 mg/L EPA 130.2 No defined limits
• Iron 0.229 mg/L EPA 236.1 0.30 mg/L
• Manganese <0.01 mg/L EPA 243.1 0.50 mg/L
Combined limit for Iron plus Manganese = 0.50 mg/L.
• Sodium 8.3 mg/L EPA 273.1 20.0 mg/L **
• Lead 0.002 mg/L EPA 239.2 0.015 mg/L * **
ml= milliliter mg/Irmilhgrams per Liter ND =none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count
**Notification Level ** *Action Level
COMMENTS:
-All holding times (were) met.
SAMPLE, AS TESTED ABOVE: OPOTABLE or UOTPOTABLE
(PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER)
n
RESULTS BASED ON SAMPLES SUBMITTED: 9/10/2001
L -oratory Director
•NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050
TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230
0
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM
PERMIT #
Located at rorhyvali Ali I P,&-i01, "Town r Village Pectt ers"0-v,
Subdivision name Vom Ot4 �ubd. Lot # Tax Map Block l Lot 7b
Date Subdivision Approved Renewal Revision 1�
Owner /Applicant Name yam aetf L LC Date of Previous Approval /
Mailing Address /V GvmoL y-c rA e a. /'�/ °�-� ifP P /OL��NS. /� Y, Zip
Amount of Fee Enclosed 4.�00 • On
Building Type 1-y Lot Area 1< >.- IICNo. of Bedrooms Design Flow GPIh
Fill Section Only Depth Volume
PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED
Separate Sewerage System to consist of
1 zto
gallon septic tank and 3 v L:F-
is E) X
Other Requirements
Wr w
To be constructed by —M (% Address
Water Supply:.. Public Supply From
Address
or: X Private Supply Drilled by —r& �> 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 s sy tem 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 repai er to.
Signed: P.E. R.A. . Date q( o a
Address 8871 Ka "TIE 6 , ere wcfer. NY. l° SQ % License # Ot' ( 3 M
APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the
sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or
modified whe o idered ne sary by the Public Health Director. Any revision or alteration of the approved plan requires
a new permit, roved f charge of domestic sanitary sewage only. e�Zl2d 11� a/
By: ✓ Title: Date:
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CP -97
P. W. SCOTT
Engineering & Architecture, P.C.
3871 Route 6
BREWSTER, NY 10509
E -Mail: pws @bestweb.net
(914) 278.2110 FAX (914) 278 -2166
TO Z, beA� PC P fl 14
dC VIT[E 3 @1P 4 ° ° K @W04VQ0,
DATE
JOB NO.
ATTENTION
L
RE: v C/44 / 4r
WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items:
• Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications
• Copy of letter ❑ Change order ] C` elf Y�CC ( aM pert an � i c, f
COPIES
DATE
NO.
DESCRIPTION
4`�� S °
1f �i0
THESE ARE TRANSMITTED as checked below:
AFor approval
KFor your use
❑ As requested
❑ For review and comment
❑ FORBIDS DUE
❑ Approved as submitted
❑ Approved as noted
❑ Returned for corrections
• Resubmit copies for approval
• Submit copies for distribution
• Return corrected prints
❑ PRINTS RETURNED AFTER LOAN TO US
P. W. SCOT
Engineering & Architecture, P.C.
3871 Route 6
BREWSTER, NY 10509
E -Mail: pws @bestweb.net
(914) 278 -2110 FAX (914) 278 -2166
TO Putnam County Dept. of Health
4 Geneva Road
Brewster, New York 10509
WE ARE SENDING YOU Attached
_17- l L= U u +L '� L U L1L'� K LET L S
OArE I JOB NO.
A rTEN FoN
RE. Septic AS —Built
❑ Under separate cover via the following items:
❑ Shop drawings ❑ Prints ❑ Plans = Samples ❑ Specifications
❑ Copy of letter ❑ Change order .❑
COPIES
DATE
NO.
I DESCRIPTION
1
❑ Approved as submitted
I
Certificate of Construction Compliance
1
I
I 1
Well Completion Report
3
❑ Returned for corrections
1
1 Guarantee of Subsurface Sewage Treatment System
3
r
1
As —Built Septic Plan
FOR BIDS DUE
WIL
6_7
Fee: $200
�
g ► l;�l
>
THESE ARE TRANSMITTED as checked below:
❑
For approval
❑ Approved as submitted
❑ Resubmit copies for approval
l
For your use
G Approved as noted
r_ Submit copies for distribution
❑
As requested
❑ Returned for corrections
, Return corrected prints
C
For review and comment
r
❑
FOR BIDS DUE
❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS
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COPY TO
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PUTNARI COUNTY DEPARTMENT OF HEALTH
DMSION OF ENVIRON)tiiENUAL HEALTH SERVICES
FINAL SITE MPECTION
Date:
Inspecte y:
Street Location _C°o gzi„ �� z ��L 2 Owner VA 14 CZE,F L G G
Torn _ 1�/�TTF2Son/ Permit #
TM r_ 13 , 7 -- Z 7 t Subdivision Lot # 3 j
1. SeWaae System Area
a. STS area located as per approved plans ...........................
b. Fill section - date of placement
3:1 barrier Lgth. Width Avg.Dpth_Zj!�:'
c. Natural soil not stripped ................... ...............................
d. Stone, brush, etc., greater than 15' from STS area..........
e. 100' from water course / wetlands ...... ................. ...............
II. SewaQe System
a, eptic tan. • size - 1,000 ........1,25 .....other ................
b. Septic tank installed level ................ ...............................
c. 10' minimum from foundation :......... ...............................
d. Distribution Bo
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 ........... ...............................
f. renc es
T—Zength required 7 7 Length installed 3 7 �3
2. Distance to watercourse measured -t / c9 v 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. PumD or Dosed Systems
ize 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. ouse/Buildin
a. House ocated per approved plans........... ........
b. Number of bedrooms ........................3..... D.7........,
IV. Well
a. Well located as per approved plans ..............................
b. Distance from STS area measured -f-1,9 ° ft........
c. Casing 18" above grade ................ ...............................
d. Surface drainage around well acceptable ....................
V. Overall Workmanship
a. Boxes properly grouted ................ ...............................
b. All pipes partially backfilled ........ ...............................
c. All pipes flush with inside of box ...............................
d. Backfill material contains stones <4" diameter..........
e. 'Curtain drain & standpipes installed according to ple
f. Curtain drain outfall protected & dinto exist watercc
g. Footing drains discharge away from STS area...........
h. Surface water protection adequate ... : ... .........................
09/07/01 12:38 PW SCOTT 4 845 - 278 -7921 NO.153 P02
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
ATTENTION 13 AbAM XftEN)E
MUEST R FINAL SSPEC7I01'd V--� For: Fill
All information must be fu ly completed prior to any Trenches
inspections being made.
PCHD Construction Perm., t ego oh
Located: a (T)
Oamer /Appli Na _ t le !1'r TM J-3.: Block Lot
Formerly: l W Subdivision Name: +�
Subdivision Lot #
Is system fill completed? . k Date:
Is system complete? i'''ce Date:
Is system constructed as 1. er plans? $101 l"*flf`4� '
Is well drilled? 6:i: Date:
Is well located as per plans?
Are erosion control mean Tres in place?
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: Q Certified by: PEY�-,.. RA ,
F' W. 5co . ViGt � � r P C. 'Design Professional
Address: Pak 1� A ZO"IAZ7 A-44- Lie. # _
Comments:
Form FIR 99
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 - 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
September 12, 2001
Peder Scott, PE
PW Scott Engineering
3871 Route 6
Brewster, New York 10509
Re: Field Inspection - Van Cleef, LLC
Cornwall Hill Road, (T) Patterson
Lot # 36, TM# 13.7 -1 -70
Dear Mr. Scott:
The above referenced separate sewage treatment system can be backfilled. The following
comments must be corrected in the field:
No comments.
If you have any further questions, please contact me at (845) 278 -6130 ext. 2261.
Very truly yours,
Gene D. Reed
GDR:cj Environmental Health Engineering Aide
SENDING CONFIRMATION
DATE : SEP -12 -2001 WED 09:48
NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH
TEL 845 - 278 -7921
PHONE
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FIRST PAGE OF RECENT DOCUMENT TRANSMITTED...
a
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BRUCE R. FOLEY LOREM MOLMRt RX M.5 N.
P.M. Neaaa Dusuw A>aur/y4 PMW Aedra D03•uw
D1 etw of Parku S. .r
DEPARTMENT OF HEALTH
1 Goneva Road
Browstm, New York 10509
ar,.a.imnul pwna (145) 27/ -613 0 Ha(145) 278 -7931
".,as &—I— ("5)378.6501 WIC (945)278 -6578 9ia(945)278.608r
l:rrb ftry lrn(84)378 -074 P5)"274 -664
BvOni (N5)7L.59R FWA45)3n -1117
September 12, 2001
Peder Scott, PE
PW Scott Engineering
3871 Route 6
Brcwstcr, Now York 10509
Re: Field Inspection - Van Cleef, LLC
Cornwall Hill Road, (T) Pattcnon
Lot q 36, TM413.7 -1 -70
Dear Mr. Scott:
The above referenced separate sewage treatment system can be backfilled. The following
comments must be corrected in the field:
No comments.
If you have any &ruler questions, please contact me at (845) 278 -6130 ext. 2261.
Very truly yours,
V Aele
Gcno D. Reed
GDR:cj Envimmnental Health En&eerinv, Aide
AGREEMENT FOR PERMANENT DRAINAGE EASEMENT
THIS INDENTURE, made the day of , 2001, between:
VAN CLEEF, L.L.C., a New York State Corporation,
with a place of business at:
c/o Silverman Realty Group
237. Mamaroneck Avenue
White Plains, NY 10605
Hereinafter GRANTOR, and the
COUNTY OF PUTNAM, a New York Municipal Corporation
With its principal place of business at:
40 Gleneida Avenue
Carmel, NY 10512
Hereinafter. GRANTEE.
WITNESSETH:
WHEREAS, GRANTORS are the owners of a certain parcel of land in the Town of
Patterson, County of Putnam, State of New York, more particularly described in the
"Schedule A" attached hereto and made a part hereof, and w
WHEREAS, the GRANTEE has requested a permanent drainage easement, under and
along the above referenced parcel for the purpose of re- designing, improving and
upgrading a-portion of the drainage along a section of County Route 64, CORNWALL
HILL ROAD, in the Town of Patterson, County of Putnam, State of New York, and
WHEREAS, the GRANTORS desire to create such a permanent drainage easement in,
under and along said portion of the GRANTOR'S property for the benefit of the
GRANTEE;
NOW THEREFORE, the GRANTORS for and in consideration of the sum of ONE
DOLLAR, lawful money of the United States and other good and valuable consideration
paid by the GRANTEE, the receipt of which is hereby acknowledged, DO HEREBY
GRANT, TRANSFER AND CONVEY. to the GRANTEE, its successors and or assigns,
a permanent easement and right -of -way, in, under and along the premises hereinafter
described in `Schedule A', attached hereto and made a part hereof, for the purposes of re-
designing, building, constructing, maintaining, using, operating, repairing and
reconstructing drainage system, making the required excavations thereupon, over and
across the land, and inspecting the area from time to time, together with the right of the
GRANTEE, its officers, employees, agents, servants or contractors, of ingress and egress
to enter upon and along the below described parcel of land for the full and complete use,
occupation and enjoyment of the easement hereby granted, and all rights and privileges
incident thereto, including, but not limited to, any of the purposes hereinbefore specified.
To have and to hold the easement and right -of -way by the County of Putnam and its
successors and assigns forever.
PROVIDED, however that:
1. The GRANTEE, its successors, assigns and or transferees shall hold harmless,
defend and indemnify the GRANTORS for any and all acts, actions, commissions
or omissions performed by GRANTEE, its successors, assigns, transferees, agents
and or employees in connection with the utilization of the easement granted
hereunder.
2. GRANTOR covenants with the GRANTEE that GRANTOR is lawfully seized
and possessed of the real property described in `Schedule A' herein, that
GRANTOR has good and lawful right to convey it and any part thereof, including
the rights covered by this instrument, and.that it will forever warrant and defend
the title thereto against claims of any persons.
IN WITNESS WHEREOF, the parties have caused this Agreement to be duly executed as
of the day and year first above written.
GRANTOR:
VAN CLEEF, L.L.C.
LI-A
LEON SILVERMAN, MANAGING PARTNER
GRANTEE,
COUNTY OF PUTNAM:
Lin
ROBERT J. BONDI,
COUNTY EXECUTIVE
Acknowledgements:
STATE OF NEW YORK)
COUNTY OF
On this day of , 2001 before me personally came
LEON SILVERMAN, to me known, who being by me duly sworn, did depose and say
that he resides at
: that
he is the Managing Partner of Van Cleef, L.L.C., the Corporation described in and which
executed the foregoing instrument, that he knows the seal of said corporation; that the
seal affixed to said instrument is such corporate seal; and that he signed his name thereto
in the regular course of business of said Corporation.
Notary Public
STATE OF NEW YORK)
COUNTY OF PUTNAM )
On this day of , 2001 before me personally came
ROBERT J. BONDI to me known, who being by me duly sworn, did depose and say that
he resides at Mahopac, New York; that he is the County Executive of Putnam County,
the municipal corporation described in and which executed the foregoing instrument; that
he knows the seal of said corporation; that the seal affixed to.said instrument is such
corporate seal; and the same was affixed to said instrument under authority of the Putnam
County Charter and that he signed his name thereto under the same authority,
Notary Public
■ TERRY BERGENDORFF COLLINS ■
Professional Land Surveyor
N.Y.S. Lic. No. 49691
52 Starr Ridge Road - Brewster, New York 10509
Telephone: (845) 279 -4261 T Fax: (845) 279 -6838
Successor to Robert H. BergendorQ James C. Edgett, William Alexander
Van Cleef Estates - Lot 36
Proposed Drainage Easement - NW Corner
March 2, 2001
Revised March 8, 2001
Job No. PA 1 -5 -3
c:\deeds \vanclf.drain36r
All that certain plot, piece or parcel of land situate, lying and being in the Town of
Patterson, County of Putnam and State of New York being part of Lot No. 36 as shown on a filed
map entitled "Final Subdivision Plat of Van Cleef Estates" filed in the Putnam County Clerk's
Office December 24,1998 as filed map no. 2771 and being more particularly described as follows:
Beginning at a point on the southerly line of lands now or formerly Williams at the
northwesterly corner of Lot No. 36 as shown on the aforementioned filed map no. and which
point is S 87 -15 -43 E 9.00 from a point on the easterly side of Cornwall Hill Road where the
same is intersected by the southerly line of lands now or formerly Williams; thence from said point
of beginning along the southerly line of lands now or formerly Williams and the northerly line of
Lot No. 36 S 87 -15 -43 E 158.91 to a point; thence through.lands of Lot No. 36 S 77 -01 -13 W
57.88, S 82 -30 -12 W 62.02 and S 83 -44 -54 W 36.06 to the westerly line of Lot W 36; thence
along the westerly line of Lot No. 36 N 8 -41 -04 W 32.99 to the point and place of beginning.
Containing within said bounds 2887 square feet, 0.066 acres more or less.
F. W. bluu I I
Engineering & Architecture, P.C.
3871 Route 6 !
BREWSTER, NY 10509
E-Mail: pws@bestweb.net
(914) 278-2110 FAX (914) 278-2166
TO RR,*
Vic— -Do t�
WE ARE SENDING YOU 0 Attached 0 der separate cover via –
0 Shop drawings 0 Prints 0 Plans
0 Copy of letter 0 Change order 0—
11_�CTU[212 @IF VDUH@N0U1TZ%1L
DATE -s- 1(?-C)
I 1�-
ATTENTION
RE:
K eMSEL:F
0 Samples
COPIES DATE NO. DESCRIPTION
THESE ARE TRANSMITTED as checked below:
El For approval
0 For your use
0 As requested
El For review and comment
0 FORBIDS DUE
REMARKS
COPY TO
• Approved as submitted
• Approved as noted
• Returned for corrections
0
the following items:
0 Specifications
• Resubmit —copies for approval
• Submit — copies for distribution
• Return —corrected prints
0 PRINTS RETURNED AFTER LOAN TO US
SIGNED:
if enclosures are not as noted, kindly notify us at once.
BRUCE R. FOLEY
Public Health Director
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
LORETTA MOLINARI R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085'
Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648
Peder Scott, P.E.
PW Scott Engineering
3871 Route 6
Brewster NY 10509
RE: Van Cleef LLC
Cornwall Hill Road, Lot #36
(T) Patterson, TM# 13.7 -1 -70
Reservoir Basin
Dear Mr. Peder:
October 19, 2000
The Putnam County Department of Health (Department) has determined that the above referenced
application, including fee, and received by this Department on October 3, 2000 is complete. The
Department will notify you by November 9, 2000 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
r
Letter to: Peder Scott, P.E. - October 19, 2000
IN
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.
PIPU1
Very ly yours,
Robert Morris, PE
Senior Public Health Engineer
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PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS
REVIEW SHEET FOR CONSTRUCTION PERMIT
NAME OF OWNER: STREET LOCATION:
REVIEWED BY: RM, GR, AS, SRDATE:
TAX MAP #: (CONFIRIAED)
DOCUMENTS Y (REQUIRED DETAILS ON PLANS CONT'D)
IT APPLICATION - HOUSE SEWER -'/<" FT. 4 "0'; TYPE PIPE CAST IRON
PERMIT OR PWS LETTER NO BENDS; MAX BENDS 450 W /CLEANOUT
C -97
ETTER OF AUTHORIZATION
ESIGN DATA SHEET (DDS)
'ORPORATE RESOLUTION
HORT EAF
LANS -THREE SETS
[OUSE PLANS - TWO SETS
ARIANCE REQUEST
SUBDIVISION
EGAL SUBDIVISION
(_j!�)C_)SUBDIVISION APPROV CKED
�)LJPERC RATE
(__)(__)FILL REQUIRED _ n7c= DEPTH
(_)(_JCURTALN DRAIN REQUIRED
GENERAL
LOCATED IN NYC WATERSHED
PLANS SUBMITTED TO DEP
DELEGATED TO PCHD
(_fmj( PEP APPROVAL, IF REQ'D
DEEP TEST HOLES OBSERVED
PERCS TO BE WITNESSED
EX- APPROVAL SSDS ADJ, LOTS
WETLANDS (TOWN/DEC PERMIT REQ'D ?)
DATA ON DDS PLANS & PERMIT SAME
)(_,)PRE 1969 NEIGHBOR NOTIFICATION
LETTER BI/ZBA
100 YR, FLOOD ELEVATION W/I200'
0 TESTING LOTS >10 YEARS OLD
SEWAGE SYSTEM PLAN - (NORTH ARROW)
SSDS HYDRAULIC PROFILE
GRAVITY FLOW
CONSTRUCTIO TES 1 -15
DESIGN DAT ER SULTS
2' CONTOURS & PROPOSED
AY & SLOPES, CUT
(FOOTING /GUTTER/CURTAIN DRAINS
USDA SOIL TYPE BOUNDARIES
TITLE BLOCK; OWNERS NAME ADDRESS
TM #, PE/RA; NAME, ADDRESS, PHONE#
(DATE OF DRAWING/REVISION
)DATUM REFERENCE
(LOCATION OF WATERCOURSES, PONDS
LAKES,WETLANDS WITHIN 200' OF P.L.
')ED FINISH FLOOR AND
ENT ELEVATIONS
& SSDS'S W/IN 200' OF SSTS
tTY METES & BOUNDS
N- CONTROL FOR HOUSE, WELL &
SSTS, EROSION CONTROL NOTE
COMMENTS:
(REVSHEET)09 /01/00
Ulu a L,11•LoA
(- ==SITE NOTE (NO CHANGE)
FILL SYSTEMS
z_c__)l0'HORIZOr4TAL; PAST TRENCH SLOPES 3:1 TO GRADE
(_)L_)FILL SPECS/ FILL NOTES 1 -5
U(_)FILL PROFILE & DIMENSIONS
(_J(_)FILL IN EXPANSION AREA
FILL GREATER THAN2 FEET
(��)G CLAY BARRIER
(FILL CERTIFICATION NOTE
(�DEPTH GAUGES
VOL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIIOUS
L)C_)SEPARATION DISTANCE FROM TOE OF SLOPE
TRENCH
( fj�(::' )LF TRENCH PROVIDED 60FT MAX.
7( _ e )� PARALLEL TO CONTOURS
J( u/ )T 100% EXPANSION PROVIDED
7((Z)DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL
(� GEOTEXTILE COVER
SEPARATION DISTANCES ON PLAN - FROM SSTS
U - 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL
20' TO FOUNDATION WALLS
100' TO WELL, 200' IN DLOD, 150' TO PITS
100' TO STREAM, WATERCOURSE, LAKE (inc. expan)
50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER
10' TO WATER LINE (pits - 20')
(50' INTERMITTENT DRAINAGE COURSE
200'/500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS
(_)10' MIN TO LEDGE OUTCROP
SEPTIC TANK
(� 10' FROM FOUNDATION; 50' TO WELL
WELL
(DIMENSIONS TO PROPERTY LINES
LOCATION OF SERVICE CONNECTION
MIN 15' TO PROPERTY LINE
SLOPE '
SLOP IN SSTS AREA (920 %)
(__)(__)REGRADED TO 15 %, IF REQUIRED
"u6airutv►r aY b ► e;tvia
YPUMPNOTES OSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED
ETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.)
IT AND D -BOX SHOWN & DETAILED
DAY STORAGE ABOVE ALARM
CURTAIN DRAIN
%20'MIN TANDPIPES, 5' BOTH SIDES, DETAIL
5' MIN to CDS = >5 %, 20' -4 %, 25' -3 %, 35' -1 %, 100 % - <I%
to CD DISCHARGE /100' with 182 cons day discharge
0' MIN to NON - PERFORATED PIPE
P.W. Scott email: pws @bestweb.net
Engineering & Architecture, P.C.
3871 Route 6 (845) 278 -2110
Brewster, NY 10509 FAX (845) 278 -2166
November 22, 2000
RESPONSE LETTER
Robert Morris, P.E.
Putnam County Health Dept.
4 Geneva Road
Brewster, NY 10509
RE: Van Cleef Estates
Lot 36
1) Address corrected & included with this response.
2) Note added to plan.
3) Notes added regards to NYSDEC Wetlands.
4) House and retaining wall moved away from septic area.
5) Fill moved from NYSDEC Wetland Buffer.
6) Fill Note #1 removed regards to fill settlement.
7) Design Data Sheets coordinated.
8) The 10 foot fill extension noted on plans.
9) Well erosion control silt fence added to plan.
Please review and call with any questions.
With regards,
Peder , P. E., R.A.
President
A R C H I T E C T U R E* E N G I N E E R I N G S I T E P L A N N I N G
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\� PUTNAM COUNTY DEPARTMENT OF HEALTH
t� DIVISION OF ENVIRONMENTAL HEALTH SERVICES
CONSTRUCTION PERMIT SEW' E TREATMENT SYSTEM
PERMIT It e'3 — D '
Located at Town or Village Pctttm
Subdivision name jlcv�, %SLR Subd. Lot # Tax Map l3c Block _L_ Lot
Date Subdivision Approved
( q
q 0
Renewal Revision
Owner /Applicant Name
pp �.
Vale&
C(-e-e i'
U C Date of Previous Approval
Mailing Address > -7 l�%iDdW r() Vt EC, / ' Ott° C (A i t4_S _ �� Zip
Amount of Fee Enclosed 4 :�00 , 00
Building Type e *iJPM.fi Lot Area ILA No. of Bedrooms T Design Flow GPD
Fill Section Only Depth Volume
PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Separate Sewerage System to consist of ® gallon septic tank and t-0 0 L
W t (e Pr 1 ykCW , 1cam x, gesene
Other Requirements:
I :) be constructed by —MD Address
Wgter Supply: Public Supply From
Address
or: - )�_ Private Supply Drilled by (t D 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 Ustem 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
R.A.
Date 1. 17,,4(2:)
License #
D,03 � t
APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the
sewage treatme ystem has been completed and inspected by the PCHD and is revocable for cause or may be amended or
modified wh9d co sidered nec ssary by the Public Health Director. Any revision or alteration of the approved plan requires
anew pe , i prove or harge of domestic sanitary sewa only.
z;-
By: ' Title: � Date: r�
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CP -97
t
� -- ��-- +.. - -.r r -. �. _'_ �K-„': "FN:TRr_��,J1^z."Pt. ^'.'. . :..�- ..'.;r•k,.,,a..:cs�. -.�,., w• �...,.. .r.,,,w.aa......�- .o::...w.:..< a 4xr�x�;^.�" i:'"s... z,. �n...u.- .,.......,-- �..e�:. -.,r ���:- ...'n.��:... r..
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION TO CONSTRUCT A WATER WELL J
please print or type PCHD Permit # f I
Well Location:
Street Address: Town/Village Tax Grid #
PGromwil Map ,3 J Block I Lot(s)
Well Owner:
Name:
dress:
Uam a� L L C T
A, te . vse . WA;te
Use of Well:
_ZC Residential Public Supply Air /Cond/Heat Pump Irrigation
1- primary
Business Farm Test/Monitoring Other (specify)
2- secondary
Industrial Institutional Standby
Amount of Use
Yield Sought_ gpm # People Served Est. of Daily Usage al.
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
New Supply (new dwelling) Deepen Existing Well
Detailed Reason
vo V -\A G-f , lr 1'i- ` -•P?
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 VOVI& 0,eJ S•CGi S Lot No. �
Water Well Contractor: 'T Address:
Is Public Water Supply available to site? .................................. ............................... Yes No
Name of Public Water Supply: / Town/Village
Distance to property from nearest water main: ,V/
ra te sheet/plan.
Proposed well location & sources of contaminatio;qz
Date: (J �- �'� 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 wat ll dril r certified by Putnam
County. /' ;
Date of Issue f b
Date of Expiration /
Permit is Non- Transf rra 1
Permit
Title:
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
'4tt
14-16.4 (2187) —Text 12
PROJECT I.D. NUMBER 617.21 SEQR
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 , 1 1. 2.,PPOJECT NAME
3. PROJECT LOCATION: p G <
Municipality l 'f-t vm -- County 't
4. PRECISE LOCATION (Street address and road Intersections prominent landmarks, etc., or provide map)
. ��* � 6 — &A 6 eJ 'fs -rcffe5
Pck -t-t,e (MA , N Y. . . -
5. IS PROPOSED ACTION:
P&New ❑ Expansion ❑ Modificationlalteration
6. DESCRIBE PROJECT BRIEFLY:
7. AMOUNT OF LAND AFFECTED:
Initially `�� acres Ultimately fit". acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
KYes ❑ No It No, describe briefly
S. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other
scribe:
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 permlUapprovals
11. 90ES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
lKyes ❑ No If yes, list agency nam,% and. permlU ` proval
kv�-,W, vl w4- j ��wyi
4 It
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?
❑ Yes M No
Applicant1sponsor
Signature:
1. CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
p� Z
Z Date:
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
H.
PART II— ENVIRONMENTAL ASSESSMENT (fo be completed by 4gency) .
A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF.
❑ Yes ❑ No
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration
may be superseded by another Involved agency.
❑ Yes ❑ No
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible)
C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production 'or disposal,
potential for erosion, drainage or flooding problems? Explain briefly.
C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood-character? Explain briefly:
C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly:
C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly
C5. Growth, subsequent development, or related activities likely to be.induced by the proposed action? Explain briefly.
C6. Long term, short term, cumulative, or other effects not identified in C1.C5? Explaln briefly.
C7. Other impacts (including changes In use of either quantity or type of energy)? Explain briefly.
D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
❑ Yes ❑ No if. Yes, explain briefly
PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS: For each adverse effect Identified above, determine whether it is substantial, large, important or otherwise significant.
Each effect should be assessed in connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d)
irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that
explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed.
❑ Check this box if you have Identified one or more potentially large or significant adverse impacts which MAY
occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration.
C&k this box if you have determined, based on the information and analysis above and any supporting
�> d mentation, that the proposed action WILL NOT result in any significant adverse environmental impacts
11� AA provide on•attachments as necessary, the reasons supporting this determination:
o-
Name of Lea Agency
rint� ype Name o Responsi e Officer in Lea Agency Title o Responsible Officer
W O
Signature of Responsible Officer in Lead Agency Signature of Preparet (if different from responsible officer)
Date
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
RE: Property of
Located at
LETTER OF AUTHORIZATION
nw
LC
+ (_ t-
C�tA1
(3V PA -MSON Tax Map # Block Lot
Subdivision of V ,0� N C S' ` e
Subdivision Lot #
Gentlemen:
114
Filed Map #
7 7l Date Filed
9,77/4
L-171
L�
This letter is to authorize � • V J CAD 74 C-1 I I N Q&V f A
a duly licensed Professional Engineer or Registered Architect to apply for the required
wastewater treatment and/or water supp y 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 tretment and/or water supply systems in
conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health
Law, and the Putnam County Sanitary Code.
Countersigned:
P.E., R.A., #
Mailing Address .
State �j Zip
Telephone: f
Very truly yours,
V,A a / L
Signed: h vL
(Owner f operty) QA1,� S/ P
Mailing Address: e��7 s (e Ar„A,
State
Telephone:
Form LA -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION FOR APPROVAL OF PLANS FOR
A WASTEWATER TREATMENT SYSTEM
1. Name and address of applicant: -um C (�-t L L C
1`27 rx mea rip Y5e. G� A-vif .
2. Name of project: UCivA � S-Cotf 3. Location TN: ktT -irgni
4. Design Professional: gj�r , bV 5. Address:! J'aure
6. Drainage Basin: T-&s -C Prq-pa,6, Fp�etyp )r,
7. Type of Project:
-- Private/Residential Food Service Commercial
Apartments Institutional Mobile Home Park
Office Building Realty Subdivision Other (specify)
8. Is this project subject to State Environmental Quality Review (SEQR)?
Type Status (check one) ....................... ............................... Type I Exempt
Type II Unlisted
9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... /Vm
10. Has DEIS been completed and found acceptable by Lead Agency? ................ &1A
11. Name,-of Lead Agency -r vv'vx 4 Pg t t'Prp, Q {�t,►.1h vt r�_ _&-na rte(
12. Is this project in an area under the control of local planning, zoning, or`6ther
officials, ordinances? ......................................................... ...............................
13. If so, have plans been submitted to such authorities? ........ ...............................
14. Has preliminary approval been granted by such authorities? f\-S Date granted: 9f,—
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)
18. Is project located near a public water supply system? ....... ............................... *
19. If yes, name of water supply ± Distance to water supply
20. Is project site near a public sewage. collection or treatment system? ................ /'Y'D
21. Name of sewage system -Tnd►'y,4tut I / Lr,S Distance to sewage system
22. Date test holes observed ((- (� -16 23. Name of Health Inspector iO. A( 42!? k'A(' P E
24. Project design flow (gallons per day) ................................. ...............................
25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?...
26. Has SPDES Application been submitted to local DEC office? ......................... ,
Form PC -97
2
27. Is any portion of this project located within a designated Town or State wetland? /;V0
28. Wetlands ID Number ........................................................... ............................... %}
29. Is Wetlands Permit required? ............................................... ..............................A
Has application been made to Town or Local DEC office? ...............................
30. Does project require a DEC Stream Disturbance Permit? .. ...............................
31. Is or was project site used for agricultural activity involving application of
pesticides to orchards or other crops, solid or hazardous waste disposal,
landfilling, sludge application or industrial activity? ............................*. Yes/No �
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 IKtl
DESCRIBE:
33. Is there a local master plan on file with the Town or Village? ......................... Yel�
34. Are community water and/or sewer facilities planned to be developed within
15 years in or adjacent to project site? tk4l er tb ,
35. Are any sewage treatment areas in excess of 15% slope? . ............................... /Y11)
36. Tax Map ID Number .......................... ............................... Map /3, 7 Block Lot ?0
37. Approved plans are to be returned to ..... Applicant _X Design Professional
NOTE:.All applications for review and approval of a new SSTS to be located within the NYC Watershed shall
be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP
approval of the SSTS prior to final approval by the Department. Projects within the watershed may also
require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of
impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from
DEP and submit those forms to DEP for review and approval.
If the application is signed by a person other than the applicant shown in Item l .,the application must
be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision
may be grounds for the rejection of any submission.
I hereby affirm, under penalty of perjury, that information provided on this form is true
to the JKst of my knowledge and belief. False statements made herein are punishable as
vglasVA misdemeanor pursuan,
M
SIU &S & OFFICIAL TITLE
r-
�,s�w
Maffi do ss :.... ...............................
'3cF71 Rour- 6
r CGcuf— .
Elie
CI f January 23, 2001
21 ew r
k
Department of � .
Robert Morris, P.E
Environmental
Protection Putnam Co. Health Dept.
4 Geneva Road
465 Columbus Avenue Brewster, NY 10509
Valhalla, New York
10595 -1336
Re: Van Cleef Est. Lot 36
Joel A. Miele Sr., O.E. Cornwall Hill Road
Commissioner, Patterson, Putnam
East Branch Reservoir
DEP Log # 10527 (Joint Review)
Dear Mr. Morris:
Bureau of Water Supply
Michael A. Principe, Ph.D.
Acting Deputy Commissioner :
Tel (914) 742 -2001
Fax(914)742 -2027
/.�C1TY DEPq
t a •
\NENTAI PRQ.%
Cww W. n c-- 'gov %dep
(718) UEP-HELP
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 "Septic Site Plan Lot 36 prepared for Van Cleef
Estates ", dated 09/28/00 and last revised 01/23/01.
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,
Margaret Lloyd, P.E.
Supervisor
Engineering Design & Review
xc: James Covey, P.E., NYSDOH
BRUCE R. FOLEY
Public Health Director
V
LORETTA MOLINARI R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921
Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085
Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648
FAX COVER SHEET
Date: 11 Idol
From: Robert Morris, P.E.
Senior Public Health Engineer
Hazmat Coordinator
.or your information
.s
For your review
As discussed
No. Pages 2'
(Including cover sheet)
lease respond
Attached as requested
Please call
Notes/Messages XP a �A A
In the event of transmission /reception difficulties, please contact this office at
(914) 278 -6130 ext. 2166.
January 11, 2001,
e O"Orst Of
Robert Morris, P.E
ec bo . n:
Putnam Co. Health Dept.
4 Geneva Road
Brewster, NY 10509
Re: Van Cleef Est. Lot 36
W-&-Niele Sr., P.E.
Cornwall Hill Road
;arnmissjonor.
Patterson, Putnam
East Branch Reservoir
DEP Log # 10527 (Joint Review)
Dear Mr. Morris:
Bureau of Wat" supply
Please note the following comment regarding the system design above referenced.
WcMd A. P*WIM Pld�. .
This comment was provided by Margaret Lloyd of our Department through a
c&mfts'Ow
'telephone conversation with Michael Budzinski, was not addressed by the applicant
j -$1- 742- 2001
e!. .4)
in the latest submission.
'-.F 4) 742*027
• The depth of proposed fill of 2 feet should be reduced to the required 1.5 feet.
Such that the trench may be keyed six inches into insitu soil.
If you have any questions regarding this matter, you may contact me at (914) 773-
4416.
Sincerely,
�_ ::
,
ssy
Sissy De La Ossa
Assistant Civil Engineer
Engineering Design & Review
xc-. James Covey, P.E., NYSDOH
!7131 Gi•4rEl�
re...
ivew1'or&
Department of
Environmental
Protection
465 Columbus Avenue • .
Valhalla, New York
10595 -1336
Joel A. Miele Sr., RE: .
Commissioner
Bureau of Water Supply
Michael A. Principe, Ph.D._
Acting Deputy Commissioner'
Tel (914) 742 72001
Fax(914)742-2027.,
/YORK CITY DEPARTM,
TAL?VL f
www.nyc.gov /dep
7 18) DEI? - HELP
December 20, 2000
Robert Morris, P.E
Putnam Co. Health Dept.
4 Geneva Road
Brewster, NY 10509
Re: Van Cleef Est. Lot 36
Cornwall Hill Road
Patterson, Putnam
East Branch Reservoir
DEP Log # 10527 (Joint Review)
Dear Mr. Morris:
Please note the following comment regarding the system design above referenced.
This comment which was provided in our letter dated November 2, 2000, was not
addressed by the applicant in the latest submission.
• . A distance.of 20' must be kept between the toe of the fill and the house. This
distance should be also kept between the fill and the property line.
If you have any questions regarding this matter, you may contact me at (914) 773-
4416.
Sincerely,
0 ", / c Diu
Sissy De La Ossa
Assistant Civil Engineer
Engineering Design & Review
xc: James Covey, P.E., NYSDOH
.:a ::Nis;' . �. � • .
December 20, 2000
Robert Morris, RE
Putnam Co. Health Dept.
4 Geneva Road
Brewster, NY 10509
Re: Van Cleef Est. Lot 36
Cornwall Hill Road
Patterson, Putnam
East Branch Reservoir
DEP Log # 10527 (Joint Review)
Dear Mr. Morris:
Please note the following comment regarding the system design above referenced.
This comment which was provided in our letter dated November 2, 2000, was not
addressed by the applicant in the latest submission.
e A distance of 20' must be kept between the toe of the fill and the house. This
distance should be also kept between the fill and the property line.
If you have any questions regarding this matter, you may contact me at (914) 773-
4416.
Sincerely,
�;.' Y C- r�"Ju Gsk'
Sissy De La Ossa
.Assistant Civil Engineer
Engineering Design & Review
xc: James Covey, P.E -, NYSDOH
New York City
Mw : T)Pnnrtment of
R Li- Environmental Protection
OPERA7'JO.NIS c. L.NGINEERING �
465 COL UAISLIS A VENUE Cover
SUITE' ,�
P A L HA L [A, NEW
�YOAX yOSV S
FAX '77S- 0343 Shoot
Transmit to FAX# 3 9 z )
Number of pages: 2 Date: I - X20 -oy
(Including Cover Sheet)
Deliver `Co:
From: ISS 4 Ile CCk OS s a Phone:
Subject: " \lot ri r, J.P.t,t A. 4 f Leaf 3 6 `�
BRUCE R. FOLEY
Public Health Director
ti
`tORETTA 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 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648
Peder Scott, P.E.
PW Scott Engineering
3 871 Route 6
Brewster NY 10509
Re: Proposed SSTS: Van Cleef, LLC
Cornwall Hill Road, Lot 936
(T) Patterson; T1�19 13.7 -1 -70
Dear Mr. Scott:
November. 17, 2000
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:
The construction of this sewage disposal system may be subject to local wetlands regulations. You
should contact local wetlands officials in this regard.
1) Incorrect address is noted on the Construction Permit Application.
2) House, SSTS and well is to be staked by a licensed surveyor prior to the start of any
construction. This is to be noted on the plan.
3) Plan notes that there are no New York State Department of Environmental
Conservation wetlands within 200 feet of the SSTS. Revise accordingly.
4) A retaining wall is not permissible to hold back SSTS fill inside the theoretical toe
of slope.
5) Fill is being proposed inside the New York State Department of Environmental
Conservation wetland buffer. The subdivision plat notes that a New York State
Department of Environmental Conservation wetland permits is required. Please.
submit the New York State Department of Environmental Conservation wetland
approval.
6) Fill note #1 is not applicable for fill sections 2 feet or less.
7) Design Data Sheet does not note groundwater, however, the SSTS design.data on the
plan and profile notes no ledge and groundwater. Revise accordingly.
Letter to: Peder Scott, P.E. - November 17, 2000 -2-
8) The minimum of two feet of fill is required horizontally 10 feet from the edge of any
trench. This has not been provided on the current plans.
9) Erosion control methods for the proposed well have not been shown.
Upon receipt of a submission, revised to reflect the above comments, this application will be
considered further.
RM:tn
Very truly yours,
V/kkz� /� 64'� (,-�)
Robert Morris, P.E.
Senior Public Health Engineer
P. W. SCOTT
Engineering & Architecture, P.C.
3871 Route, 6 ;
BREWSTER, NY_16509J
E -Mail: pws @bestweb.net
(914) 278 -2110 FAX (914) 278 -2166
WE ARE SENDING YOU Attached r via
❑ Shop drawings ❑ Prints ❑ Plans
❑ Copy of letter ❑ Change order ❑
❑ Samples ❑ Specifications
COPT S DATE NO. DESCRIPTION
iv
THESE ARE TRANSMITTED as checked below:
• For approval
• For your use
❑ As requested
• For review and comment
• FORBIDS DUE
REMARKS
• Approved as submitted ❑ Resubmit copies for approval
• Approved as noted ❑ Submit copies for distribution
• Returned for corrections ❑ Return corrected prints
❑ PRINTS RETURNED.AFTER LOAN TO US
COPY TO 02, ..- Oq G b
SIGNED:
P. W. SCOTT
Engineering & Architecture, P.C.
3871 Route 6
BREWSTER, NY 10509
E -Mail: pws @bestweb.net
(914) 278 -2110 FAX (914) 278 -2166
TO Putnam County Dept. of Health
4 Geneva Road
Brewster, NY 10509
WE ARE SENDING YOU 0XAttached ❑ Under separate cover via
❑ Shop drawings ❑ Prints ❑ Plans
❑ Copy of letter ❑ Change order ❑
LCCTITEEQ @ F� ° UV @W0CTCT511
OATE
JOB NO.
ATTENTION
RE: L0 t 36 Vol , , . 'F .
DESCRIPTION
Subsurface Sewage Treatment
System (SSTS)
Application for Approval of Plans (PC -97)
❑ Samples
the following items:
❑ Specifications
COPIES
DATE
NO.
DESCRIPTION
Application for Approval of Plans (PC -97)
I
Construction Permit for Sewage Treatment System (CP -97)
1
1.0
1
Letter of Authorization (LA -97)
1
2
Design Data Sheet (DD -97)
1
House Plans (2 sets)
wall ("18c-ran � 1�`Cccft�'n �✓ P -g 7
1
1' 0
1
Check # llg for the amount. of $ a00,,00
1
(O 2 0o
1
Short Form EAF
THESE ARE TRANSMITTED as checked below:
j For approval
• For your use
• As requested
Si For review and comment
C FOR BIDS DUE
❑ Approved as submitted
❑ Approved as noted
❑ Returned for corrections
❑
REMARKS
List Continued:
4 1 Septic Site Plan Drawings
COPY TO
• Resubmit copies for approval
• Submit copies for distribution
❑ Return corrected prints
❑ PRINTS RETURNED AFTER LOAN TO US
SIGNED. C % VI/
If enclosures are not as noted. kindly notify us at once.
TEST PIT DATA R s � TO BE SuPMITTED Wic APPI'rATION
/.07 ' '� DES�'"2 10:. jr SOILS* =UN
D=11.1 IN TEST HC S
D=11.1 HOZZ rte.
G.L.
�dP�a /G Tv�oir. '
2'
3'
3'3„
4'
8'
9'
10'
12'
la� - -
14'
INDICT 7M AT TaEI= GRCUNLS�2 IS ENCOUNT�.ID
ILMICATE Lc '* TO mucti, wA=., !Z-VM RISES AF= BEING MCOL -x=M
DET.- HOLE. OBS=,%VATIONS MADE By:— - DATE:
DESI&N
Soil Rate Used /l -lS Min/1" Drop: S.D.'Usable Area Provided
EO=- M. 2
H012 NO.
Na. of udro s Septic Tank Capacity 17,5e gals. Tyre 6 G ^sic.
Absorption Area Provided By L.F. :: 24" widthe:ZC�a
Other
\
Nacre �Wo7T �yGiiu���P /N��,1�c�riTs �iR�gratt:rc °a
Address SM
THIS SPACE, FOR USE BY EMUTH DE2A=N71 CNLY:
Soil Rate approved - sq.ft /gal. ' C±.ecke d by Date
`7 e?iLL
Department of
Environmental
Protection
465 Columbus Avenue
Valhalla, New York
10595 -1336
November 2, 2000
Robert Morris, P.E
Putnam Co. Health Dept.
4 Geneva Road
Brewster, NY 10509
Re: Van Cleef Est. Lot 36
Joel A. Miele Sr., P.E. Cornwall Hill Road
Commissioner Patterson, Putnam
East Branch Reservoir
DEP Log # 10527 (Joint Review)
Dear Mr. Morris:
Bureau of Water Supply Please note the following comments regarding the system design above referenced:
Michael A. Principe, Ph.D. 1. The note on the plan that says "There are not NYSDEC wetland within 200 feet
Acting Deputy Commissioner p Y
of the subsurface sewage treatment system (SSTS) ", should be deleted;
Tel (914)
Fax (914)742 2027 2. A distance of 20' must be kept between the toe of the fill and the house;
3. The point C on the attached copy shows a confusing regrading shape at the toe of
the fill. An explanation to this detail should be submitted.
If you have any questions regarding this matter, you may contact me at (914) 773-
4416.
Sincerely,
Sissy De La Ossa
Assistant Civil Engineer
Engineering Design & Review
xc: James Covey, P.E., NYSDOH
0
ti..,.�f.r„,:my.u>�dep.l
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