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OX � PYJ'I'1VAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
CERTIFICATE OF CONSTRUCTION COMPLIANCE TREATMENT SYSTEM
PCHD CONSTRUCTION PERMIT # P � f — 0' i/ Q
Located at `t'� ,P2.S� � �'�'�' Town or Village f lc( ftw l= 070
Owner /Applicant Name D6Me-C.- F ,44% and � I�i'r ax Map r3 o Block Lot /Or
j j �I by i I'ol wv 7 -s-fot js
Formerl V y a "V� � l"� i;�fi �S �G1'frE�� Subdivision Name SC t
Subd. Lot #
Mailing Address GU4 r'"r , N Y Zip
Date Construction Permit Issued by PCHD
Separate Sewerage System built by Hdlln-J 661' �C PP Address G0ee-r, #64lew
mwst e/r, !k jr .
Consisting of ri Gallon Septic Tank and
Other Requirements:
Water Sup"I :
OF
Public Supply From TeYJ 1A t Address,
or: Private Supply Drilled by Address.
Building Type Fee-,, A Vti kit � Has erosion control been completed?
Number of Bedrooms " Has garbage grinder been installed? NS
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 e, utnam County Department of Health.
a
Date: ht C) Certified by P.E. R.A.
7 ` ^-� (Design Professiona )
Address 8� I `�( f � , �ti�r�fL°�' ; %* License # 6-�% 3cf54 .
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary
to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage
treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval
of the private water supply shall become null and void when a public water supply becomes available. Such
approvals are subject to modification or change when, in the judgment of the Public Health Director, such
revocatio , dificati r change is necessary.
By: � � Title: Date: /�' �� .,0 J
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CC -97
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P. W. SCOTT
Engineering & Architecture, P.C.
3871 Route 6
BREWSTER, NY 10509
E -Mad: pws @bestweb.net
(914) 278 -2110 FAX (914) 278 -2166
TO Putnam County Dept. of Health
4 Geneva Road
Brewster, New York 10509
OArE. / SOB NO.
/.. I6 0 a
A r-rENTIO
RE:Se tic As —Built
P
WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via '� �- C5 the following items:
❑ Shop drawings ❑ Prints ❑ Plans 7— Samples ❑ Specifications
❑ .Copy of letter ❑ Change order ❑
COPIES
DA T E
NO.
DESCRIPTION
1
1
Certificate of Construction Compliance
3
I 1
Guarantee of Subsurface Sewage Treatment System
3
1
As —Built Septic Plan
Fee : $200 y
THESE ARE TRANSMITTED as checked below:
For approval
For your use
❑ As requested
❑ For review and comment
�.' FOR BIDS DUE
REMARKS
19
COP`( TO
❑ Approved as submitted ❑ Resubmit
Approved as noted ❑ Submit _
❑ Returned for corrections 1! Return _
Ta i` &T -F-0R
_copies for approval
— copies for distribution
corrected prints
❑ PRINTS RETURNED AFTER LOAN TO US
TT I[AA6_ I1K "-S
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PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner or Purchaser of Building Tax Map Block Lot
Building Constructed by Town/Village
Location pp- Street Subdivision Name
Building Type Subdivision Lot #
I represent that I am wholly and completely responsible for the location, workmanship, material,
construction and drainage of the sewage treatment system serving the above - described property, and
that is has been constructed as shown on the approved .plan or approved amendment thereto, and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and
hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition
any part of said system constructed by me which fails to operate for a period of two years
immediately following the date of approval of the "Certificate of Construction Compliance" for the
sewage treatment system, or any repairs made by me to such system, except where the failure to
operate properly is caused by the willful or negligent act of the occupant of the building utilizing the
system.
The undersigned further agrees to accept as
conclusive the determination of the Public Health
Corporation Name (if corporation)
Address: (S- WeqL 1461(( KA , pm ,-5yft �
Corporation Name (if corporation)
Address:
(t�s�,
State Zip %3lu State
n
e
.Q1 w RC,( Zip
Form GS -97
12/12/00 15:00 PW SCOTT 4 19142787921 NO.021
18$
NORT11EAST LABORATORY of DANBURY
39 Miss. P LAIN ROAD - DANaURT, CT 06811 CT Cent: PH -0404
zLAA$ (3.)3) 748 -7903 - FAX 1203) 748.0652 NY Celt: 11471
LABORATORY REPORT
REPORT TO:
MR. ALLAN FINN DATE SAMPLE COLLECTED: 11/21/2000
15 WEST HOLLOW ROAD TM COLLECTED: 1 1.00 AM.
BREWSTER, N.Y. 10509 COLLECTED BY: A. FINN
DATE RECEIVED ® LAB: 1121/2000
TESTED BY: LAB#11471
LAB I.D. 0: N059
REPORT DATE: 11/22/2000
SAMPLE SITE: DORSET HOLLOW EST., LOT 011, PATTERSON, N.Y.
SAMPLING POINT: KITCHEN SINK
SOURCE: MUNIC&AL
TREATMENT: NONE
TEST PERFORMED RESULT. METHOD # MAXIMIUM CONTAMINAN
LEVEL (MCLI
BACTERIAL:
Total Coliform (Bacteria)
CHEMISTRY:
Chlorine Reside al
M1 = milliliter mg1L = mill igmins per Liter
0 per 100 ml SM 9222B . 0 per 100 ml
+ mg/L _ .._..
ND = none detected TNTC= Too Numerous To Count
COMMENTS:
- Holding Times (were) met.
-Sample collected in a sodium t:tiosulfate bottle
RESULTS BASED ON S�,MPLES SUBMTTTED:11121 /2000
SAMPLE, AS TESTED ABOVE: MOTABLE or FOINOT POTABLE.
(PER STATE OF NEW YORK DEP r. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER)
Laboratory Director
•NORTHEAST LABORAT CRY, 129 MILL STREET, BERLIN, CT 06037. (860)82$ -9787 - FAX (860)829 -1050
TOLL. TREE WITHIN CT: 800 -826 -0105 .OUTSIDE CT: 800 -654 -1230
12/12/00 15:00 PW SCOTT 4 19142787921
NO. 021 901
P.W. SCOTT email pws @be$Meb.net
ENGINEERING & I ARCHITECTURE, P.C.
3871 ROUTE 6 (845) 278.2110
BREWSTER, NY ' 0509 FAX (845} 278.2166
TO: 9VA4A R.
FAX: - P �79 -7ctZ (
PROJECT: l(nl/c�rt
TO:
FAX:
i ` , .1 I& ilik
T0:
FAX:
PROJECT:
TO:
Dws
PROJECT: PROJECT:
NO OF PAGES INCL. TRANSMITTAL
FROM. fWroy-k C
*-comments:
DATE:
re�r�.
Please call 845- 278.2110 if this transmission is illegible or unclear
PRODUCT 240
P. W. SCOTT
Engineering & Architecture, P.C.
3871 Route 6
BREWSTER, NY 10509
E -Mail: pws @bestweb.net
(91 j4) 278 -2110 FAX (914) 278 -2166
TO F'(,` ),hell(-• M',,)yV I`S
0
WY I
J
Q To Reader Cam 14*2 -WW
r
DATE / a
t �J
JOB NO.
ATTENTION
RE: "'3
C�
WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items:
• Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications
• Copy of letter ❑ Change order
COPIES
DATE
NO.
DESCRIPTION
THESE ARE TRANSMITTED as checked below:
For approval
For your use
❑ As requested
❑ For review and comment
❑ FOR BIDS DUE
REMARKS
• 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
,;
RE .
LABS
NORTHEAST LABORATORY of DANBURY
39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404
(203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471
SAMPLE SITE: DORSET HOLLOW EST., LOT #11, PATTERSON, N.Y.
SAMPLING POINT: KITCHEN SINK
SOURCE: MUNICIPAL
TREATMENT: NONE
TEST PERFORMED RESULT: METHOD # MAXIMIUM CONTAMINANT
LEVEL (MCL)
BACTERIAL:
Total Coliform (Bacteria)
CHEMISTRY:
Chlorine Residual
ml = milliliter mg/L = milligrams per Liter
0 per 100 ml SM 9222B 0 per 100 ml
* mg/L - - - - --
ND = none detected TNTC= Too Numerous To Count
COMMENTS:
- Holding Times (were) met.
- Sample collected in a sodium thiosulfate bottle.
RESULTS BASED ON SAMPLES SUBMITTED: 11/21/2000
SAMPLE, AS TESTED ABOVE: AM POTABLE or AMNOT POTABLE
(PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER)
fns'
Laboratory Director
*NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060370 (860)828 -9787 - FAX (860)829 -1050
TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230
LABORATORY REPORT
REPORT TO:
MR. ALLAN FINN
DATE SAMPLE COLLECTED:
11/21/2000
15 WEST HOLLOW ROAD
TIME COLLECTED:
11:00 A.M.
BREWSTER, N.Y. 10509
COLLECTED BY:
A. FINN
DATE RECEIVED @ LAB:
11/21/2000
TESTED BY:
LAB #11471
LAB I.D. #:
N059
REPORT DATE:
11/22/2000
SAMPLE SITE: DORSET HOLLOW EST., LOT #11, PATTERSON, N.Y.
SAMPLING POINT: KITCHEN SINK
SOURCE: MUNICIPAL
TREATMENT: NONE
TEST PERFORMED RESULT: METHOD # MAXIMIUM CONTAMINANT
LEVEL (MCL)
BACTERIAL:
Total Coliform (Bacteria)
CHEMISTRY:
Chlorine Residual
ml = milliliter mg/L = milligrams per Liter
0 per 100 ml SM 9222B 0 per 100 ml
* mg/L - - - - --
ND = none detected TNTC= Too Numerous To Count
COMMENTS:
- Holding Times (were) met.
- Sample collected in a sodium thiosulfate bottle.
RESULTS BASED ON SAMPLES SUBMITTED: 11/21/2000
SAMPLE, AS TESTED ABOVE: AM POTABLE or AMNOT POTABLE
(PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER)
fns'
Laboratory Director
*NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060370 (860)828 -9787 - FAX (860)829 -1050
TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230
PUTNAM COUNTY DEPARTMENT OF HEALTH
DMSION OF ENVIRONMENTAL HEALTH SERVICES
FINAL SITE INSPECTION
Date: l 7 0o
Inspecte y: ,:;�, 2,!F
Street Location Owner Do 2s ET
Town �,,4T >t 2s ®.�r Permit #P -- 3 g – o o
TM # / 3 , o a – / — / o s Subdivision Lot # _ //
1. Sewage System 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. SeN agre System
a. Septic tank size - 1,000 ,25 other ................
........ .........
b. Septic tank installed level ................ ...............................
c. 10' minimum from foundation .......... ...............................
d. Distribution Box
1. All outl at same elevation -water tested .................
2. Protected below frost .................. ...............................
3. Minimum 2 ft.Original soil between box & trenches
f. JJ rep i1' n Box - properly set ........... ...............................
I. Lehi required go o Length installed 4 v o
2. Distance to watercourse measured --- to 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. PumR or Dosed Systems
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/Building
a. House located per approved plans...
b. Number of bedrooms ...................�f .. �!:P........L.t/.o �r/..1 .
IV. Well ,¢5 I�pp�veQ'1
a. Well located as per approved plans . ...............................
b. Distance from STS area measured • 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 plan..
f. Curtain drain outfall protected & dir.to exist watercourse
g. Footing drains discharge away from STS area ...............
h. Surface water protection adequate ... ...............................
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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 (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
Date: ) /e O
To: SG ,,, i T
Ee; Z— or // /%2SFi /- laL4ml
ego
From: Gene D. Reed
Putnam County Department of Health
,
Fax #: X 7 97 — o21 i� 0/
No. Pages 21
(Including cover sheet) -
✓ For our information Please respond
y P
For your review Attached as requested
As discussed Please call
Notes/Messages G�NI�IFNT ;
1) , -5, S, r:5, At4 S CVO F1 /,4- / l 1-77 /5 ?�caviTtE1�)
In the event of transmission /reception difficulties, please contact this office at
(914) 278 -6130 ext. 2261.
11/13/00 13:29 PW SCOTT 4 19142787921 NO.023
t
PUI NAM COUNTY DEPARTMENT OF HEALTH
DMSF )N OF ENVIRONMENTAL HEALTH SERVICES
ATTENTION ADAM GENE
- REQUEST FOR FINAL INSPECTION For: Fill
All information must be F illy completed prior to any Trenches
inspections being made.
PCHD Construction Perrot # -3 - 00
Located: tN W-51 _ (T) (V) ytt i i I,t -i 1 w
Owner /Applicant Name: < Qtall �Ull -QMS TM 9 lock �_ Lot 1
Formerly: 'f�f Subdivision Name
Subdivision Lot #
Is system fill completed? Date: —
Is system complete? Date:
Is system constnicted as . )er plans r _ we
Is well drilled?
Is well located as per plats?
Are erosion control measures in place?
Date:
I certify that the system(s), as listed, at the above premises has been constructed and I have inspected
and verified their completion in accordance with the issued PCHD Construction Permit and
approved plans and the Standards, Rules and RegkDesignProfessiond ut '�nty Department of
Health.
Date: f Ilb Certified by. P� RA
r
Address: 1 Qweip ► Lic.
Comments:
Form FIR-99
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LOCATION
DESCRIPTION
FROM POINT
A
B
1
ST
47$ -0"
299-0"
2
ST
56' -411
19' -991
3
ST
50' -0"
28' -6" -
4
ST
57' -10"
23' -0"
5
DB
87' -0"
33' -0"
6
DB
811-911
32' -0"
7
DB
76, -7"
32, -4"
8
DB
71' -6"
33' -3"
9
DB
66' -8"
125 -6"
10
DB
62' -5"
38' -3"
11
PIPE ELBOW
58' -4"
41' -6"
12
TRENCH -P1
125' -10"
95' -0"
13
TRENCH -P2
124' -0"
95' -4"
14
TRENCH -P3
119' -6"
94' -6"
15
TRENCH -P4
117' -4"
96' -8"
16
TRENCH -P5
115 -0
97' -3"
17
TRENCH -P6
113' -6
98' -5"
18
TRENCH -P7
111' -6"
99' -2"
TEST PIT PROFILES
Hole # _ Lot
Hole # Lot #
Hole # Lot # _ �l
Depth to water _
Depth to water
Depth to water ----I
Depth to mottling
Depth to mottling
Depth to mottling
Depth to. rock/imp.
Depth to rock/imp.
Depth to rock/imp.
- G.L. �D 1 L
� � .
G.L. 1
G.L. _
0.5
0.5 Aj
0.5
1.0
1.0
1.0
2.0
2.0 .
2.0
r
3.0
3.0
3.0 G ✓�1- '
4.0
4.0
4.0
5.0
5.0
5.0
6.0
6.0
6.0
7.0
7.0
7.0
8.0
8.0
8.0
9.0
9.0
9.0
10.0
10�.0��
10.0
Hole # Lot #
Hole # Lot #
Hole # Lot #
Depth to water
Depth to water
i
Depth to water
Depth to mottling
Depth to mottling
Depth to mottling
Depth to rock/imp.
Depth to rock/imp.
Depth to rock/imp.
G.L.
G.L.
G.L.
0.5
0.5
0.5
1.0
1.0
1.0
2.0
2.0
2.0
3.0
3.0
3.0
4.0
4.0
i
4.0
5.0
5.0
5.0
6.0
6.0
6.0
7.0
7.0
7.0
8.0
8.0
8.0
9.0
9.0
9.0
10.0
10.0
10.0
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PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM n
PERMIT # 7" -39 0
Located at 41 West Street TownorVillage Patterson
Subdivision names o n s e t Hollow E s Subd. Lot # 11
Date Subdivision Approved
1998
Owner /Applicant Name Dorset Hollow Builders
Mailing Address
Tax Map 1 3 . 0 8 Block 1 Lot 1 0 5
Renewal Revision
Date of Previous Approval
15 West Hollow Road, Brewster, NY
Amount of Fee Enclosed $300.00
Building Type Residence
Zip 10509
Lot Area .92 No. of Bedrooms 4 Design Flow GPD 8 0 0
Fill Section Only Depth Volume
PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Separate Sewerage System to consist of 1250 gallon septic tank and i4o6 LF of
a`��%,� w;Je Ore jcAes .7 rows 8 Lf-) GL,., 1007e, reSNrye
Other Requirements:
To be constructed by Dorset Hollow Builders Address 15 West Hollow Road, Brewster,
Town of Patterson
Water Supply: x Public Supply From W a r i Address
or: Private Supply Drilled by Address
I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the
separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion
thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the
Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said
builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years
immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original
system or any repairs thereto.
Signed: �� P.E. X R.A. Date Ll -mot F Op
Address 3871 Route 6, Brewster, NY 10509 License# 059346
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 whpffjonsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires
a new pe pproved f ischarge of domestic sanitary sewage only.
By: Title: 09 ?0 ' Date:
White copy -,HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CP -97
NY
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 (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
June 6, 2000
P.W. Scott Engineering
3 871 Route 6
Brewster NY 10509
Re: Proposed SS.TS: Dorset Hollow Builders
West Street, Lot #11
(T) Patterson, TM# 13.08 -1 -105
Dear Mr. Scott:
Review of plans and other supporting documents submitted at this time relative to . the above -
regarded project has been completed. Comments are offered as follows:
1) The minimum of 1 foot of R.O.B. fill is required for the primary and reserve SSTS
area.
Upon receipt of a submission, revised to reflect the above comments, this application will be
considered further.
l l
12
VV e ly yours,
Robert Morris, P.E.
Senior Public Health Engineer
0
,A
BRUCE R. FOLEY
Public Health Director
P.W. Scott
3871 Route 6
Brewster NY
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 (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
10509
RE: Dorset Hollow Builder
41 West Street, Lot #11
(T) Patterson, TM# 13.08 -1 -105
Reservoir Basin
Dear Mr. Scott:
May 16, 2000
The Putnam County Department of Health (Department) has determined that the above referenced
application, including fee, and received by this Department on April 27, 2000 is complete. The
Department will notify you by June 5, 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 Dept. of Environmental
Protection review and approval of other aspects of a project, such as stormwater plans or the creation
y.:
Letter to: P.W. Scott - May 16, 2000
-2-
of impervious surfaces, and the project applicant should contact the Department of 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 (914) 278 -6130 ext. 2166.
v?)rely yo s,
Robert Morris, PE
RM:tn Senior Public Health Engineer
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 C Attached ❑ Under separate cover via
• Shop drawings ❑ Prints ❑ Plans
• Copy of letter ❑ Change order ❑
DATE
_91) _0Q
JOB NO.
99 -159
ATTENTION
DESCRIPTION
RE: Lot it
Dorset Hollow Estates —
(formally Van Cleef Estates)
Subsurface Sewage Treatment
System (SSTS)
1
1
Construction Permit for Sewage Treatment System (CP -97)
1
❑ Samples
the following items:
❑ Specifications
COPIES
DATE
NO.
DESCRIPTION
1
Application for Approval of Plans (PC -97)
1
1
Construction Permit for Sewage Treatment System (CP -97)
1
1
Letter of Authorization (LA -97)
1
2
Design Data Sheet (DD -97)
I
House Plans (2 sets)
2
1
Letter from G & E Development,LLC, Re: Public Water
1
1
Check #3g5-1l23-7!X) for the amount of $`300,06
1
1
Short Form EAF
THESE ARE TRANSMITTED as checked below:
• For approval
• For your use
• As requested
X1 For review and comment
❑ FOR BIDS 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
REMARKS
List Continued:
4 1 Septic Site Plan Drawings
1 I E911 Address Verification Form (E911 Verfrm)
COPY TO !�
i
SIGNED.
If enclosures are not as noted, kindly notify us at once.
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: Dorset Hollow Builders
Lot # 11
15 Wett Hollow Road
Brewster, New York 10509
orset Hollow Estates
)Q
2. Nameofproject: formally VanCleef Es0. LocationT/V: Patterson
4. Design Professional: Peder W. Scott, P.E., R.-';N• Address: 3871 Route 6
6. Drainage Basin: East Branch Reservoir Brewster, NY 10509
7. Type of Proiect:
X . 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 X
9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... No
10. Has DEIS been completed and found acceptable by Lead Agency? ...............
11. Name of Lead Agency Town of Patterson Planning. Board
N/A
12. Is this project in an area under the control of local planning, zoning, or other
officials, ordinances? .......................... ............................... .......................... Yes:
13.
If so, have plans been submitted to such authorities? ........ ...............................
Yes—Subdivision
14.
Has preliminary approval been granted by such authorities? Yes Date granted:
1998
15.
Type of Sewage Treatment System Discharge ................. surface water X
groundwater
16.
If surface water discharge, what is the stream class designation? ....................
N/A
17.
Waters index number (surface) ........................................... ...............................
. N/A
18.
Is project located near a public water supply system?
Yes
serViced
19.
If yes, name of water supply Town of Patterson Distance to water supplyby system
20.
Is project site near a public sewage collection or treatment system? ................
No
21.
Name of sewage system Individual Lots Distance to sewage
system
22.
Date test holes observed- 11 -1 y- q 6 23. Name of Health Inspector M.
B u d z i n s k i P. E.
24.
Project design flow (gallons per day) ................................. ...............................
800 cPD
25.
Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?...
No
26.
Has SPDES Application been submitted to local DEC office?
N/A
Form PC -97
2
27. Is any portion of this project located within a designated Town or State wetland? No
36. Tax Map ID Number ......................... Map I -3. o8 Block i Lot -05
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 I .,the application must
be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision
may be grounds for the rejection of any submission.
I hereby affirm, under penalty of perjury, that information provided on this form is true
to the best of my knowledge and belief. False statements made herein are punishable as
a Class A misdemeanor pursuant to Section 210.45 of the Penal Law.
SIGNATURES & OFFICIAL TITLES:
Peder W. Scott Agent for Applicant
Mailing Address' 3871 Route 6
Brewster, New York 10509
l
WetlandsID Number .............................................:............. ...............................
N/A
29.
Is Wetlands Permit required? Individual Lo.t
Has application been made to Town or Local DEC office? ...............................
N/A
30.
Does project require a DEC Stream Disturbance Permit? .. ...............................
No
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
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
No
.DESCRIBE:
33.
Is there a local master plan on file with the. Town or Village?
Yes
34.
Are community water and/or sewer facilities planned to be developed within
15 years in or adjacent to project site? ...
Water-'.Only
35.
Are any sewage treatment areas in excess of 15% slope? . ...............................
No
36. Tax Map ID Number ......................... Map I -3. o8 Block i Lot -05
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 I .,the application must
be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision
may be grounds for the rejection of any submission.
I hereby affirm, under penalty of perjury, that information provided on this form is true
to the best of my knowledge and belief. False statements made herein are punishable as
a Class A misdemeanor pursuant to Section 210.45 of the Penal Law.
SIGNATURES & OFFICIAL TITLES:
Peder W. Scott Agent for Applicant
Mailing Address' 3871 Route 6
Brewster, New York 10509
l
Cyr May 31, 2000
ew�rl�,
Department of Robert Morris, RE
Environmental Putnam Co. Health Dept.
Protection 4 Geneva Road
Brewster, NY 10509
465 Columbus Avenue
Valhalla, New York ,
105951336
Re: Dorset Hollow. Lot 11
West Street
Joel A. Miele Sr., P.E. Patterson, Putnam
Commissioner East Branch Reservoir
DEP Log # 10226 (Joint Review)
Dear Mr. Morris:
Bureau of Water Supply.
William N. Stasiuk, P.E., Ph.D. .• This letter is to inform you that the New York City Department of Environmental
Deputy'commissioner Protection (Department) has determined that the above - referenced application is
Tel (sid) 742 -2001 complete. In addition, the Department has no objection to the approval of the above -
Fax (91 a> 742 -2027, referenced regulated activity. This determination is based on the review of submitted
documents including the plan titled "Septic Site Plan Lot 11 prepared for Dorset
Hollow Estates ", dated 04/19/00.
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
V. CITY DEPARTMF
y� tir
FihR�A'MFNTAL PR�TE�`O�
wwi.d.nyc.ny.us/ ep
(718) DEP -HELP
465 Columbus Avenue, Valhalla, New York 10595 -1336
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
LETTER OF AUTHORIZATION
RE: Property of Dorset Hollow Builders
Located at 41 West Street
T/V Patterson
Tax Map #
13.08
Block 1 Lot 105
Subdivision of Dorset Hollow Estates (formally Van Cleef Estates)
Subdivision Lot #
Gentlemen:
Filed Map # 2 7 71
Date Filed 12/24/88
This letter is to authorize P e d e r W. s. c o t t, P. E . , R.A. ,
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 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.
Very
Countersigned: Signe
P.E., R.A., # 059346
Mailing Address 3 8 7 1 R o u t e 6
Brewster
State New York
Zip 10509
Telephone: (9 14) 278-2110
Mailing Address: Dorset Hollow Builders
15 West Hollow Road, Brewster
State New York
Telephone:
Zip 10509
(914) 279 -1339
Form LA -97
TEST PIT DATA RZ = TO BE Suai2= WITS APP-r: TIONN
L of DLS=, —TION �F SO=- EN�,'CUN7i'T�ED IN TEST UOL.: -S
141
INDICAIM LL'= AT TiMICH GRCiJNI ,1-L '� IS a'COWTL• M
INDICAM LEVEL, TO WrIIC.Y WA=, ZZvM RISES A= ELLNG :Z=GxIT —=
D=. Hou: OL'Sr..4VATIONS MADE BY: DA'T'z'
DESI&N
Soil Rate Used Z%% Min /1" Drop: S.D. Usable Area Provided
No See,• t • c k Capacity �%c� : wan gals. Type PT" —
Absorp -ion Area Provided By L.F. .. 24" Widta t: ends
Other
F
Name W rature
Address �Bi/ �o�' SF-u r: 1 o
4 -069
THIS SPA= FOR USE BY HEALTH DEP.AMYMM OMY: ::•., FESgl4 j'A
Soil Rate Approved sc:ft /gal. ' Lecked by Date
Dom-
HOLE M. 7 HMEP M.
3`
q
5'
6'
-
—
71 V
r
8'
9`
10'
:G
12'
141
INDICAIM LL'= AT TiMICH GRCiJNI ,1-L '� IS a'COWTL• M
INDICAM LEVEL, TO WrIIC.Y WA=, ZZvM RISES A= ELLNG :Z=GxIT —=
D=. Hou: OL'Sr..4VATIONS MADE BY: DA'T'z'
DESI&N
Soil Rate Used Z%% Min /1" Drop: S.D. Usable Area Provided
No See,• t • c k Capacity �%c� : wan gals. Type PT" —
Absorp -ion Area Provided By L.F. .. 24" Widta t: ends
Other
F
Name W rature
Address �Bi/ �o�' SF-u r: 1 o
4 -069
THIS SPA= FOR USE BY HEALTH DEP.AMYMM OMY: ::•., FESgl4 j'A
Soil Rate Approved sc:ft /gal. ' Lecked by Date
G &E DEVELOPMENT, LLC
Gregg Macaluso
914 - 878 -4355
March 17, 2000
Robert Morris P.E.
Putnam County Dept. of Health
4 Geneva Road
Brewster, NY 10509
Re: Dorset Hollow Estates Lot # 11
(formally Van Cleef Estates)
Edward Bloes
914- 234 -2281
This letter is to serve as a notice that I as the contractor for the Dorset Hollow
Water District, currently under construction, can provide adequate pressure to
serve the proposed lots. This water plant shall be inspected and approved by
PCDOH for use to meet the demand requirements for the subdivision.
PO BOX 352 BEDFORD, NY 10506
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 (914)278-6130 Fax (9.14) 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
E911 ADDRESS VERIFICATION FORM
OWNERS NAME: Dorset Hollow Builders Lot 11
TAX MAP NUMBER: 13.08 -1 -105
41 West Street
E911 ADDRESS:
Patterson
TOWN:
AUTHORIZED TOWN OFFICIAL: G'CN ✓ /'� ✓�"'�~�
(Signature)
DATE:
2 3 _ av
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.
(E911 VERFRM)
_........_ ... _ _... A ; ZENDD.i I
7 ^,^ y _iV�i N x.4/20 N %�i�! .d am; 1 .UN�Tr Ate; / VC its y
at (SL=aet; -�3I/ E` Corr v�../.4� tf /u -P� Se- i3. Blcc'c 7 :,-t i
71 Pj�T 'z� CSO/�/ llat�'�jie�. G•/2Q7��i/�/
4^ E: Cv-r;ACV 1=71= TO =m-- _" . wl M
I>-t-- of 2---- scak ...c Date of Pe- r=iat =c n Test lel
/-z
G07
COL"
-
� �.w ww►
lY
:.:n +.l.a_ Se
I:ept•1 �^
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L:'' :rave_:.
NO. Ty,-Op-
Ground
S=face
Mr.:L-:czes
so;--, Pate
SLi ?. 1.�.71AD .L:•
start
SI_:J l`�,
Drcc Tn
:".+:1 /r.n L co
z �7--
Indles
l':C:ies
inches
_
2
3
to be rem ter' at saw depth until k=prcxmte T y eq ,a? soil = tes
- are • cbtai nee at each nL;- =lat_cn test hole. • 'Al? cat-- to• be su.I•-;=4 t•'.
for revie-a.
• 2_ Depth maz =m ents to be irzc e Ica t--p of hale.
rev. 9/85 -
• _ _ . 4
.. ' . • .� .
- -•
_.
.. ....
.- ........ .._ ter.
s
z �7--
2
3
to be rem ter' at saw depth until k=prcxmte T y eq ,a? soil = tes
- are • cbtai nee at each nL;- =lat_cn test hole. • 'Al? cat-- to• be su.I•-;=4 t•'.
for revie-a.
• 2_ Depth maz =m ents to be irzc e Ica t--p of hale.
rev. 9/85 -
0
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 R6177of r,,_ C.a. DL,_(;F,— Gr �
WE ARE SENDING YOU 194Attached ❑ Under separate cover via
• Shop drawings / Prints ❑ Plans
• Copy of letter ❑ Change order f�
FUEUTRQ
i
DATE 9 �
JOB NO.
ATTENTION
LS
RE:
�`/ IDaYLF�t3'T�
n/O.
�`gN
CJ V
%�
�L�! L �F/
the following items:
❑ Samples ❑ Specifications
COPIES
DATE
DESCRIPTION
n/O.
�`gN
CJ V
%�
�L�! L �F/
ee
THESE ARE TRANSMITTED as checked below:
❑ For approval
• For your use
• As requested
1p For review and comment
❑ FORBIDS DUE
REMARKS
COPY TO
❑ 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
SIGNED:
if enclosures are not as noted, kindly notify us at once.
11 1
Vr
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 (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
June 6, 2000
P.W. Scott Engineering
3871 Route 6
Brewster NY 10509
Re: Proposed SSTS: Dorset Hollow Builders
West Street, Lot #11
(T) Patterson, TM# 13.08 -1 -105.
Dear Mr. Scott:
Review of plans and other supporting documents submitted at this time relative to the above -
regarded project has been completed. Comments are offered as follows:
1) The minimum of 1 foot of R.O.B. fill is required for the primary and reserve SSTS
area.
Upon receipt of a submission, revised to reflect the above comments, this application will be
considered further.
FROM
Ve ly yours,
Robert Morris, P.E.
Senior Public Health Engineer
14 -164 (2187) —Text 12
PROJECT I.D. NUMBER 617.21 'SEOR
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I— PROJECT INFORMATION (ro be completed by Applicant or Project sponsor)
1. APPLICANT /SPONSOR
2. PROJECT NAME
Dorset Hollow Builders
Dorset Hollow Estates
3. PROJECT LOCATION: (forma 1 1 Van C.1 e e f Estates)
Municipality Patterson County . Putnam
4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map)
Lot 1 ij - Dorset Hollow Estates (formally Van Cleef Estates)
4I Wei S +reed., ?catjr_rso ,j, N l
S. IS PROPOSED ACTION:
tJ New ❑ Expansion ❑ Modification /alteration
6. DESCRIBE PROJECT BRIEFLY:
Construction of subsurface sewage treatment system -'for single- family
resid'e.nce and connection to public water supply.
7. AMOUNT OF LAND AFFECTED:
/
Initially acres Ultimately acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
Yes [:]No . If No; describe briefly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
® Residential 1:1 Industrial ❑ Commercial ❑ Agriculture ❑ Park /Forest/Open space ❑Other
Describe:
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL,
STATE OR LOCAL)?
❑ Yes ® No If yes, list agency(s) and•permiUapprovals
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
® Yes ❑ No If yes, list agency name and permit /approval
Subdivision.approval from Town of Patterson Planning Board /PCDOH
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION?
❑ Yes ® No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant /sponsor name: P.W. Scott , P . E . , R.A. - Date: �'� 00
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 II— ENVIRONMENTAL ASSESSMENT (To be completed by agency)
A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF.
❑ Yes ❑ No
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration
may be superseded by another involved agency.
❑ Yes ❑ No
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible)
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, of other natural or cultural resources; or community or neighborhood character? Explain briefly:
C3. Vegetation of 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.
f
C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly.
C6. Long term, short term, cumulative, or other effects not identified In-Cl-05? Explain briefly.
C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly.
D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
❑ Yes ❑ No If Yes, explain briefly
PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant.
Each effect should be assessed in connection with its (aj setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d)
irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that
explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed.
❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY
occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration.
❑ Check. this box if you have determined, based on the information and analysis above and any supporting
documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts
AND provide on attachments as necessary, the reasons supporting this determination:
Print or Type Name of Responsible Officer in Lead Agency
Signature of Responsible Officer in Lead Agency
Name of Lead Agency
2
Title of Respon c
Signature of Preparer (if differ en a ns I'e, i2 all