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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 72. -1 -37.52 BOX 26 1A%. �p. " J a IF I '- :'Lr;' �r 03187 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Addr,,-ss:.-. ....Tix.,Qrid:#- 'D 46 Cimarron Road rl-utnam. Valley I-Map Block Lot(s) Well Owner: Name: Address: Santucci Construction Corp., 15 Travis Lane, Montrose, NY 10548 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 31 — ft. Length below grade 30 ft. Diameter 6 in. Weight per foot 19 lb/ft. Materials: X Steel Plastic Other Joints: Welded X Threaded Other Seal: X. Cement grout Bentonite Other Drive shoe: X Yes No ILiner: 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 __L Compressed Air Hours 6 Yield 40 gpm Depth Data Measure from land surface-static (specify ft) lot During yield test(ft) 320' Depth of completed well in feet 390' Well Log If more detailed information descriptions or sieve analyses please attach. Depth From Surface Water Bearing, Well Diameter(in) Formation Description ft. ft. Land Surface 8 Drilling in overiurden clay and boulders Hit rock at 8' 8 31 Driling in rock ..set _casing. SjoUted in j, If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump/Storage Tank InTo"" ation, 0D Pump Type sub Capacity Depth 340' Model 100-S154-12 ea Voltage 230 HP 1.5 Tank Type W X 30,' ) Volume lLla T1 Date Well Completed 10/26/05 Putnam County Certification No. 004 1 7 ate of Report 2/10/06 r we (signs) ' 1.4a Beal NOTE: Exact location of well with distances to at I o permanent landmarks to be provided on a separate sheet/plan. Well Driller's Name. P. Fj keal & -So ad.; 7hc . Address: 4 Putnam Ave., Brewster, NY 10509 Signature: Adw ,2!r ) - §±K Date: 2/10/06 4aX/L' ' Beal White copy: HD File; Yellow copy- Building Inspector; Pinkcopy - Owner; Orange copy- Well driller Form WC-97 J) PUTNAM COUNTY DEPARTMENT OF HEALTH .,...o a IFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # 'N -1 t - 04 Located at 4& C1 4,e "o'J kwp,, g Town or Village I -I POT- " 6. K 1&kLC- Owner /Applicant NamdSr- O g CO%& s, Coe-P., Tax Map I L Block 0 J_ Lot 2- a:sr;�h�'c9h Formerly Subdivision Name �A�rcggstrv- go oi%s4 Ca Ioic, IPA, eCj'--L�IM Subd. Lot # ;- Mailing Address _� S re —Aa s �.e.�� �.o:►�c 20 ��� 1Ps Zip 1® � Date Construction Permit Issued by PCHD Z- 'Z. 13 3 C�' Separate Sewerage System built by A,al,T'0-_,c.t �'na%La "; Address Hoed st Q_ 1 O ff $ Consisting of O Gallon Septic Tank'and `��i �-•� • o 1F Zq �a g mp Other Requirements: (a .� ® R o " ®�,�,� Water Supply: Public Supply From Address or: X Private Supply Drilled by P Z S Address aC*WW'ele- ( w�cjq �ia ,:� C Number of Bedrooms 4 Has garbage grinder been installed? 0 Cs 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 toe Pypam �qgnty,pepartment of Health. Date: i 3(a Certified by Address R &r�W t t A / &rs a&1 P.E. X R.A. License # 0(p2 -sCA" 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 revocati n, modification or change is necessary. B .a Title: Date: Y• it copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 BRUCE R. FOLEY a a * .e * LORETTA MOLIN -ARI RX-: M:S.N. - ' " ' c• �0�•�0. � � ` '� • ' ' �- r'issociae Yubiic iieaitn lli "rector 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 E911 ADDRESS VERIFICATION FORM OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS: I to] IKIM AUTHORIZED TOWN OFFICIAL: DATE: Dominick Santucci 72: 01 -37.52 lJ Cimarron Road TOWN OF PUTNAM VALLEY (Signature) 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. (E911verfrm) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT We! I.Lp_- tech-.- . .:.'S 0 : - "_ :' ?5 =. _. T:,S= R: ':'slab:: - ]Map 146 Cimarron Road Putnam Valley Tai::;;;.: . Block Lot(s) Well Owner: Name: Address: Santucci Construction Corp., 15 Travis Lane, Montrose, NY 10548 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 31 ft. Length below grade 30 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: X Steel —Plastic _Other Joints: _ Welded X Threaded _ Other Seal: Y 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 40 gpm Depth Data Measure from land surface - static (specify ft) 10' During yield test(ft) 320' Depth of completed well in feet 390' Well Log If more detailed information descriptions or sieve analyses are avatlable;'..__.- please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 8 Drilling in over burden clay and boulders Hit rock at 8' 8 31 Drilin '.n. rock . ,et g ... - -. ._31 390 Dri g If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity hl gDm Depth 340' Model IOGS15412 Voltage 230 HP 1.5 Tank Type i Volume $ Date Well Competed 10/26/05 Putnam County Certification No. 004 Date of Report 2/10/06 Well i r (signa e) Dicta .Beal NOTE: Exact location of well with distances to at l7nc. o permanent landmarks to be provided on a separate sheet/plan. Well Driller's Name P. F eal & S o Address: 4 Putnam Ave., Brewster, NY 10509 Signature: Date: 2/10/06 a Beal White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 APR -20 -2005 15;20 BADEY & WATSON, PC PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - ¢� GUA A�ITEE OF SUBSURFACE SEWAGE. TREATMENT SYSTEM Dominick Santucci Owner or Purchaser of Building Santucci Construction Corp. Building Constructed by Cimarron Road Location- Street P. 02/02 72. 01 37.5.2 Tax Map Block _. Lot ..._.........(T) Putnam Valley_ Town/Village Westchester Holding Co., Inc. Parcel III Subdivision Name -� Residential 5 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 accorditnee 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. „ .FL :.: z. -._ A: _..;; . s. -_ r i. +,'. tT_ r. _, _. .. .. .. �" 1 3`00 IC 51 %, t, j, ui[: CUliilativu 6 11tC i ubli Ht lth 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. I Dated: Month _ l' / ? ay YearI4?2 Signature: Zvi, 15�', Title: _ General Con a or (i�wner) - Signature Santucci Construction, Corp. Corporation Name (if corporation) Address: 15 Travis lane, Montrose State New York Zip 10548 Corporation Name Address: State tion) Zip Form GS -97 TaTRL P.02 -Inc. Page 1 of 2 Environmental Services, c. 41 Kenosia Avenue Danbury. WATER, Soft AND AAA ANALYSIS Connecticut 06810 1 Telephone 203-798-2229 Z- P F Beal and Sons Inc Mailing Information: Collector's Information: JMS ID: 013638 Name: P F Beal and Sons Inc Name: Phil Beal Address: 4 Putnam Avenue Address of site: Santucci Construction 46 Cimarron Road City: Brewster City: Putnam Valley State: NY Zip: 10509 State: NY Zip: Phone: (845) 279-2460 Fax- (845) 279-6613 Phone: Sample's Information: Site: Kitchen Tap Date Collected: 4/24/2006 Date Received: 4/25/2006 Preservative; HNO' Time Collected: 11:00:00 AM Time Received: 12:00:00 PM Temperature: <4 Lab No.: J0603805-4168 Matrix: Water Date Analyzed Test Name Result MCL Method 04/26/06 Alkalinity 64 mg/L N/A SMWW 2320 B 04/26/06 Lead (flush) <1 ug/L 15 ug/L SMWW 3113 B 05/04/06 3:00 PM E. Coli Absent Absent SMWW 9223 B 04/26/06 Manganese 0.073 mg/L 0.3 mg/L SM 3111 B 04/26/06 Sodium <1 mg/L N/A SM 3111 B 04/25/06 pH 6.9 S.U. 6.5-8.5 S.U. SM 4500 H B 04/25/06 Color ND 15 Units SMWW 2120 B 04/25/06 Turbidity 2.18 ntu 5 ntu SMWW 2130 B 04/26/06 Hardness 178 mg1L N/A SMWW 2340 C 04/25/06 -171, ND. -_N/A-, -SKAMAQ-340 C. 04/26/06 Chloride 3.31 mg/L 250 mg/L SMWW 4110 B 04/26/06 Nitrate <0.1 mg/L 10 mg/L SMWW 4110 B 04/26/06 Nitrite <0.1 mg/L 1 mg/L SMWW 4110 B 04/26/06 Sulfate 11.4 mg/L 250 mg/L SMWW 4110 B 04/25/06 Chlorine Free Residual <0.1 mg/L N/A SMWW 4500CIG 05/04/06 3:00 PM Total Coliform Absent Absent SMWW 9223 B Comments: At the time of the analysis the sample was Acceptable for Total Coliform At the time of the analysis the sample was Acceptable for E. Coll Total Coliform Resampled 513/06. Received @ Lab 5/4/06 CFU = Coliform Forming Units MCL = Maximum Contaminant Level mg/L = milligrams per Liter N/A = Not Applicable ND = None Detected ntu = Nephelopmetric Turbidity Unit ppm = parts per million S.U. = Standard Unit ug/L = micrograms per liter Units = Units CONNECTICUT. NEW YORK AND NELAC CERTIFIED Toll Free 866- JMS -5097 1 Corporate Fax 203 -796 -2408 1 Lab FaX 203 - 798 -2107 I wwwjrnsenvironmental. cam Page 2 of 2 Environmental Services, Inc. 41 Kenosia Avenue IVATEA, SOIL AND AIA ANALYSIS Danbury. Connecticut 06810 I Telephone 203- 798 -2229 and "Sons fnc Mailing Information: Collectors Information: JMS ID: 013638 Name: P F Beal and Sons Inc Name: Phil Beal Address: 4 Putnam Avenue Address of site: Santucci Construction 46 Cimarron Road City: Brewster City: Putnam Valley State: NY Zip: 10509 State: NY Zip: Phone: (845) 279-2460 Fax: (845) 279-6613 Phone: Sample's Information: Site: Kitchen Tap Date Collected: 4/24/2006 Date Received: 4/25/2006 Preservative: HNO3 Time Collected: 11:00:00 AM Time Received: 12:00:00 PM Temperature: <4 Lab No.: J0603805-4168 Matrix: Water Signature: =40ee4 Reviewed By: Michael Lapman Sharon Houlahan, Director President - State #: PH-0218 ELAP #: 11715 CONNECTICUT. NEW YORK ANO NELAC CGRTMIED Toll Free 866-JMS-5097 I Corporate Fax 203-798-2408 1 Lab Fax 203-798-2107 I wwwjmsenvironn-entd. cam SEAL. & SONS, HNC. 4 PUTNAM AVENUE ARTESIAN WELLS BREWSTER, NEW YORK 9 OW9 WATER TANKS - WC,T�si SYt� _ . — ... . i _ . _:.g.t� - /•.r. _��'... -_ °. � ... ' �.. ' _ _. G_ .. .,_. . ..,,: ".. r,.. _ ".. ".- `,�,'i,= ,'rR?e�e;r;A %: FJ�.-rr.4 ?�o �!'.4' :. .� . :IEiriiade%�� ui�iTUl'rr«e'v �o�i7 %'iJiiei fFJ'iLeUs �ioiri�o%eted" HYDROFRACTURING SUBMERSIBLE PUMPS TEL. (645) 279 -2460 - 2469 WATER CONDITIONING EQUIPMENT FAX (8455) 279 -6613 COMPLETE INSTALLATION, REPLACEMENT AND REPAIR SERIVICE July 7, 2006 Santucci Construction Corp. Attn: Donna 15 Travis Lane Montrose, NY 10548 Re: 46 Cimarron Road Putnam Vallev, NY Dear Donna: Please note that in December 2005 we installed at the above - referenced property a Well Xtrol WX302 captive air tank guaranteed for a period of five years. This tank has a sealed diaphragm which prevents the tank from becoming waterlogged. It has an 86- gallon capacity and a 25.4 - gallon drawdown at 40/60 pounds pressure. _.,:_- _..... _.., ,. Pteas _?.- cont;-:%ct_...me,_at.youu,r_ earl iest- co.- ATen;,en P.::if Very truly yours, P. F. Beal & Sons Inc. /�- Adam L. Beal ALB /mm BADEY & WATSON LETTER of TRANSMITTAL 3063 Route 9, Cold Spring, New York 10516 Date: 17 Jul 2006 File No. 98 -105 W. O. # 16903 RE: Certificate of Construction Compliance TO: Horton Hollow Road Mr. Joseph S. Paravati Jr. Sub. Lot 5 Westchester Holding P Subd. Lot No. 2 Putnam County Department of Health Tax Map 72.1 -37.52 1 Geneva Road Permit/Title/PO # RGP 16623 Brewster, NY 10509 Sent via: US MAIL ❑ UPS -NIGHT ❑ MESSENGER ❑ UPS -2 DAY El PICK -UP El UPS -3 DAY R FAX El UPS -GRND 0 We are sending: UPS -COD copies date description of document ❑1 17- Jul -06 lCertificate of Construction Compliance for Sewer Treatment System 1 127-Apr-06 E911 Address Verification Form ❑ 3 120-Apr-06 Guarantee of Subsurface Sewage Treatment System ❑ F-11 I 10- Feb -06 lWell Completion Report Fl 07- Jul -06 Letter from well driller ❑1 24- Apr -06 I Well Water Test Results U ` °- M- Buiff' `S 0`903- RO i ❑1 20- Jun -06 — n Fee ❑ I ❑ 1 --71 REMARKS: Dear Mr. Paravati, please find the above documentation for your review. If you have any questions please feel free to contact us. Copies to: File Yours truly: Neal A. Seidl Jr. Engineer Tel: (845) 265 -9217 ext 25 Fax: (845) 265 -4428 Email: nseidl @badey- watson.com Santucci Pro=des, LL.0 40 40-05 500113 626157 30334 SHERLITA AMLER, MD, MS, FAAP Commissioner of..Health _ >,�. �..w.,�,:� ~:. tom:=_ - �:•x °- -��,:: ._ . - ��.:.; ti LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Neal Seidl Badey & Watson 3063 Route 9 Cold Spring, NY 10516 Dear Mr. Seidl: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI Co Unty.Executive- ROBERT MORRIS, PE Director of Environmental Health April 24, 2006 Re: Field Inspection Santucci Cimarron Road, (T) Putnam Valley, TM # 72. -1 -37.52 A site inspection by Mike Luke of this Department was made for the above referenced project on April 19, 2006. The following comments must be corrected in the field: 1. The SSTS was not constructed according to the approved plan, specifically, the junction boxes were relocated to one side instead of going down the middle. Since, this is the only change and the total length of fields required has been provided, a revised plan will ........_ -� i .. -. - •- �nl'i�lT�� Yi� � �Y /�L �ii'1' L' aa� iil _ ��wl���....,y. .. w.. r _s. -.�. �- .... -_ y. r - .. i i ... -� _+f .vim ...v.. r-. w1 .� v..r -� -.. r.•.r -� ��,�.,a.�,,. -�Y -ar -. �. - 2. Large stones need to be removed before backfilling. Please re- inspect and confirm. A re- inspection by this Department will not be necessary. 3. Although a large third floor attic has been provided, and was not shown on the approved plans, this Department does not consider 3rd floors as habitable space unless a fire escape or sprinkler system is provided. If you have any further questions, please contact me at (845) 278 -6130 ext. 2157. JSP:kly Sincerely, Joseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax(845)278-7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 PUTNAM COUNTY. DEPARTMENT OF HEALTH DIVISIONOF ENVIRONNEENTAL HEALTH'SERVICES FINAL'SITE'INSPECT GN Date: / ?/a Street Location > .r a r 1-o Inspected by: ,zrz owner lown .. ,.. ..ernmit # -- . .. ..... _ . . TM # 2 I- 3 7, s Y `Subdivision Lot.# .1. :Sewaae`:System Area YES O: CoNa! ANTS a. ;:STS -area located as per approye4 plans ............................ b :Fill section date of:placement 3 . l ,bamer Lgth. Width . AvgDpth c. Natural ;soil snot stripped... .... .............. ..................... d. Stone, brush,;etc.,, great' lhan 15' from.STS area... ......... - e. 1:00' from-water course/ wetlands ....... ..................... IL Sewaae':System. - a: 'Septic -tank size 1;000 ...:. 1,2 :.::....:other ............ b. ':Septic-:tank installed Level . ............... .c. .10' n inimuni from. foundation- ............................ I Distribution;Box 1. All :outlets at:s'ame elevation- vaater tested :. :...::... 2.: P rot ected `below.frost..................... 3::Ivfinimum 2 40liginal.soil between;box & trenches. e. Junction -Box pro..perly et .......... ............................... y 6, Trenches 1. Le #gth.required -�Yg Length installed 5�8 2 Distance to_watercourse_measuted Ft .... ,,i.0 p f- "3 . `Installed :according to :.plan \ ..... ,�c> v: s�o •�� -S ope oftrenc `ac �ptatr'm :1/32" /foot .............. 5. a0-ft. :f .omproperty line - 20 `ft:- :foundations.......... ` - 6. Depth of trench <30 inches from:surface......_........... 7. Room allowed for expansion, 1;00% o .......................... L S. :Size of gravel 3A 1I /V diameter .clean ...............'....: R. Depth of gravel in: "trench 12" minimum ......... ........... ✓ 10. Pipe ends ca ed . .....................:......... 1. Size.of pump chamber ..............1.. "j.. .. 2. :Overtlowtank .............. .......... 33 Alarm,suaVaudi .........:...... ............................... 4. Pump easily a ssible, manhole .to.:grade ................. 5. First 'box' ed .......................... ............................... 6. C�gqcle witnessed:by H.D estimated flow /.cycle........... M.-House/Bundina a. House'Jo"cated"per approved plans ................ ...... ✓ - _ -- b. Number of bedroom:s ..... .............. ............................... r r w 1 IV Well , Well located as per approved plans ....:............. 1 (01, b.: Distance:from STS. .ar. ea measured c. Casing..18" above grade ................ ............................... d. Surface drainage around well acceptable ....................... V. _Overall Worlmanshb) , a.. Boxes: properly.; grouted ........................ ✓ b.. All .pipes partiaUy backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4 ".diameter ............... „A- / e. Curtain drain &standpipes installed:according to plan.. V. I f. Curtain drain outfal protected : & :dinto exist. watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate .... ....:.......................... i. Erosion control provided .................. ............................... Rev. 12/02 APR-18-2000. BADEY & WATSON, PC PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION 1-1 JOSEPH (I GENE REQUEST FOR FINAL -INSPECTION Date: 4/1812006 PCHD Construction Permit # PV-11-04 X -Mike Luke For: Fill Trenches Located: Cimarron Road (T) (V) ('r) Putnam Valley Owner/Applicant Name: Santucci Construction Corp. TM 72 Block _1 Lot 37-52 formerly. - WA . Subdivision Name: . wastcheater bolding Co., Inc. Pan;w III Subdivision Lot # . .......... 2 Is system fill completed? yes Date: 202006 Is system complete'? Yes Date: 411812006 Is system, constructed as per plans? Generally ... .... Is well drilled? Yes Date: . ..... 12/28/2005___._... Is well:located as per plans? Generally Are erosion control measures in place? yes I cenify 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; 4/10/20M Certified by: PE X RA_ Design Professional Address-.. 1$adey & Watson, P.C. 3063 Route 9, Cold Spring, NY Lic. # Comments:; Dwr Mr- Luke, the trenches are In and ready for i2!p!5ion. Form .F,!R-99 062505 TnT01 PAM OPP_1.Q_P91Mr_ TI 1P IPI-M7 TPI - 44c-P74 -7qP1 ..W0MP-P11TW0M.rni1bdTV nPP0PTMPMT nr P 4 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES u - - �. -� ~ - -_ .._ -. .. • C(UNST1tUC`TION YEIt1VIl'i' FO�t S�WAC�1�:'fit>�A�TIV><Ei�i�i' SY S�i'1✓'lvi - PERMIT # PV Located at (2 i M omo a i 11 �a Ac, Co,�T�..FC. Subdivision nameS�r�ow�s�fl.� Loc S Subd. Lot # 2— Date Subdivision Approved �� %-y 8, ZooA Owner /Applicant Name A +-►, r� cc eo�sc. �� P. Town or Village U-*� R- -T-T "ta-t Via Tax Map -4 Z Block i Lot 3 . Renewal Revision Date of Previous Approval -t 04 Mailing Address 15 TZI o vli Lou S 0Y. 10 5,A6 Zip _ Amount of Fee Enclosed 0 1 A Building Type Kotsto Lot Area 2-0.8W -No. of Bedrooms 4 Design Flow GPD 5300 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of I t2so gallon septic tank and `tAg Q- F• d Z g" W t atc A a so tz-PTy., a I �E1.lc�l �J Ptaczp QT Other Requirements: 3 =�" at., tu '0 t: fx►A 20 c3 5 a--,k e C P dv t` To be constructed by �J P.,srou -% Cos-4c GQ P-A. Address Water Supply: Public Supply From Address `+ .. r= •`.r^s �� \: ?� of "t! i .�'s_11F �tiir. ice' 1� �, c . Z. �y....�c ►.l.C.. fjlddm,;ti_ [�i��Y4! �Ty � (k( I�����. 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 thb 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:'' �lX� -' P.E. R.A. Date Zr L3 a 6 Address �E � �Af-SA u�t SJ��l6'F1 • �` E c1� w �, . P C License # ©!p Z So S. 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 when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. Approovved/ for discharge of domestic sanitary sewage only. By: Title: 1" Date: O� copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: O3 zv -F£zc aj l Inspected by: ;73 P ^1 7 �'.7:,�.ia` ``'`''' „jai. •,.,' e...v -t..: i!±.ry.� 'C.p^� — . _.i T� - <^ - �a..e� _ _ ,.. _ ..... a. �n Town VA tIZA, Permit # l- t j- e 4% � TM # 3-7 5'2— Subdivision /k L�!s Ca eat, 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. 1 00' from water course / wetlands ...... ............................... II. Sewage System a. Septic tank size - 1,000 .:........ 1, 250 ......... other..*., .............. b: ' Septic'tank installed level .......................................... C. 10' minimum from foundation ...................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. .. Minimum 2 ft. Original soil between box & trenches e. Junction Box - properly set .......... ............................... 6. renc es 1. Length required Length installed 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32” /foot ............. 5. 10 ft. from property he - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 11/2" diameter clean ..............., ...: 9. Depth of gravel in trench 12" minimum .......:........... ends caueii. . -.. ...: _ ..... ....:..............:.......:... g. Pump or Dosed.Systems 1. Size of pump chamber ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual/audio ........:........:.. ..............................: 4. Pump easily accessible, manhole to grade ................. 5. First box baffled :......................... ............................... 6. Cycle witnessed by H.D.esiimated flow /cycle........... IIL House/Buildirig a. House located per approved plans ... ....................:.......... b. Number of bedrooms ................ ........................ I............. IV. Well Well located as per approved plans . ......:........................ b. Distance from STS area measuredlGty' . 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 ............................. I.... 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 .... ............................... i. Erosion control provided ................. ............................... Rev. 12/02 SITE INSPECTION FOR FILL PAD Date: °Z 3 C� �' . 1 Inspected A4 Fill pad located per the approved plan -Fill Pad Length Required Length_ Fill Pad Width (I'D Required Width q4;, ok Fill Pad Depth Required Depth -iun-of-Bank Fill Quality) Slope from Top to Toe Impervious Layer Installed, trosion Control Installed Sieve Test Results (if applicable) Reserved for Field Sketch if Applicable PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .a -- DESIGN DATA 'SHEET' 9UB9VRFAC Owner Santucci Construction Corp. Address 15 Travis Lane Located at (Street) Cimarron Road Tax Map 72. Block 0' Lot 37.52 (indicate nearest cross street) Municipality Putnam VaHey Drainage Basin SOIL PERCOLATION TEST DATA Hudson River Date of Pre - soaking 12127/05 Date of Percolation Test 12/28/05 Hole No. Run No. Time Start - Stop Elapse Time (Min.) Depth to Water From Ground Surface (Inches) Start - Stop Water Level Drop In Inches Percolation Rate Min/Inch I 1 12:59 1:25 26 19" - 22" 3" 9 I 2 1:25 - 1:55 30 19" - 22" 3" 10 I 3 1:55 2:25 30 19" - 22" 3" 10 4 - - 5 - - J 1 1:03 - 1:33 30 19" - 22" 3" 10 •. VJ 31Y "4lJ 22 J 3 2:03 2:33 30 19" 22" 3" 10 4 - - 5 - - K 1 1:33 2:00 27 19" - 22" 3" 9 K 2 2:00 - 2:30 30 19" - 22" 3" 10 K 3 2:30 - 3:00 30 19" - 22" 3" 10 4 - - 5 - - NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. < 1 min for 1 -30 min/inch, < for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of Form DD -97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST BOLES::_; 'R ,=,-) G == f�TU. �vI1uL�h1M. G.L. 06 FEB 24 'AN 11: 17 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 10.0' Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered N/A N/A N/A Deep hole observations made by: N/A Date N/A Design Professional Name: John P. Delano, P.E. Address: Badey & Watson, Surveying and Engineering, P.C. 3063 Route 9, Cold Spring, NY 10516 Signature: ° Design Professional's Seal Form DD -97 (Pg. 2 of 2) 0 5 k'kk1 LU �. i a `�'625��' ARaPE S%00'*. BADEY & WATSON LETTER of TRANSMITTAL 3063 Route 9, Cold Spring, New York 10516 Date: 23 Feb 2006 File No. 98 -105 W. 0. # 16903 RE: Proposed SSTS TO: Horton Hollow Road Mr. Joseph S. Paravati Jr. Sub. Lot 5 Westchester Holding P Subd. Lot No. 2 Putnam County Department of Health Tax Map 72.1 -37.52 1 Geneva Road Permit/Title/P0 # RGP 16623 Brewster, NY 10509 Sent via: US MAIL El UPS -NIGHT f_1 MESSENGER El UPS -2 DAY El PICK -UP El UPS -3 DAY El FAX El UPS -GRND 0 We are sending: UPS -COD copies date description of document ❑1 23- Feb -05 lConstruction Permit for Sewage Treatment System ❑1 28- Dec -05 —1 IDesign Data Sheet ® 28- Dec -05 Se arate Sewage Treatment System Sheet 1 of 1 SD15509 R03 REMARKS: Dear Mr. Paravati, please find the above documentation for your review. Copies to: File Yours truly: Neal A. Seidl Jr. Engineer Tel: (845) 265 -9217 ext 25 Fax: (845) 265 -4428 Email: nseidl @badey - watson.com Santucci Pro=bes LLC 40 40 -05 500113 626157 29065 FEB-09-2006 17:04 BADEY & WATSON, PC P.01/01 . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION JOSEPH GENE. REQUEST FOR FINAL -INSPECTION Date:, 2/02006 For: fill Trenches PCHD Construction Permit # PV -11.04 Located: Cimarron Road (T) (V) M Putnam Valley Owner/Applicant Name: Santucci Construction _Corgi TMj?Block 1,,_ Lot -IT- Formerly: WA Subdivision Name- Westchester Hording CO., Inc. PareW 19 Subdivision Lot# 2 Is system . fill completed? yes Date: 2/9/2006 Is system complete? WA Date: WA — Is system constructed as per plans? W . A Is well drilled? Yes Date: 12J2812006 Is well located as per plans? Gonerally. Are erosion control measures in place? yes I certify that the, system(s), as listed, at the above premises has been constructed and J 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. ti Date,, Y: Design Professional Address: .,Batley & Watson, P.C. 3063 Route 0, $ping, NY Lie. # 062505 Comments:: Joe, the f1H Is in place and.ready for t!P!e!fl-- Form. FIR-99. TOTAL P.01 FEB-9-2006 JHU 16:43 TEL:e45-27e-7921. -NAME:PUTNAM COUNTY nPPAPTMPHT nr P 1 NAM COUNTY DEPARTMENT OF HEALTH D p SION OF ENVIRONMENTAL HEALTH SERVICES CONST1R1UCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # ` 1 — (Dq Located at CIMAZZOKL aZOAD Subdivision name 5X' �N i--1-4 5 Subd. Lot # Date Subdivision Approved xx.� ,j ;; ° ZC>,- , Owner /Applicant Name `WTJCJC i Ca-6 � _ czX2 . 7 Town or Village `Au -jF--4 Tax Map 1Zr Block i Lot a5Z Renewal Revision Date of Previous Approval Mailing Address (5 ` X15 L WE- 4 MWT�ria , �j"( 105LO Zip Amount of Fee Enclosed CUE� 0 Building Type iQ214TIAL Lot Area 23 2.44No. of Bedrooms 4 Design Flow GPD ID Fill Section Only Depth Volume Separate Sewerage System to consist of gallon septic tank and 4400 LjF cwiz —4-4, iii As MZfAQ4 QAcgo Air &i cc- Other Requirements: y" � S itl D w-,%q WZ vvjO Aai) C0U\rV-L r=ile- - To be constructed by ik c b L-4 '' 5W6 Address CZLO -a , Mq P Water Supply: Public Supply From Address �...... rr3Jaw .su�piy'1Jr-.i.cd vy _, ai: ° °�` °A s-W.3' - S:ixW- 0 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. % R.A. Address ` ' '. s.� ; � ��I,..� :a.:e7 SM ,94 1 C6dC9 License # Date 04 0C.2 -505 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 10 considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. Appro for discharge of domestic sanitary sewa a only. By: Title: Date: o White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pr fessional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO °"'ONSTI$.1: CT A please print or type PCHD Permit #� Well Location: Street Address: Tax Grid # /Town/Village 6 UL1 '41. * ��`n Lj � aSTU" \I&JX-q Map 4Z Block Lot(s) 3-?g'5 Well Owner: Name: JAddress: c bST, tx>Q. I 15 %ms's c0rr-, Use of Well: _ 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 rj gpm # People Served & Est. of Daily Usage � " gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason S } p for Drilling Well Type C Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes_ UL No Name of subdivision5Y_0 -A! *r U'S L c Lea )�-i( DA<IL Lot No. 2 Water Well Contractor: �D /b. Q_gc�LC Address: ,ti`s Iii Is Public Water Supply available to site? .................................. .........................:..... Yes No �C Name of Public Water Supply: IN 1A Town/Village AJ A Distance to property from nearest water main: 71." ", Proposed well location & sources of contamination to be provided o eparate sheet/plan. ;.Date' j f. ; . ' 0 ,- '! �!�, . -_ + : _ __ V 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. revision or alteration of the approved plan requires a new permit. Well to be constructed by a water, e IAM ller certified by Putnam County. Date of Issue Permit Iss ng- fficial:/�✓ Date of Expiration Title: Permit is Non-TranifirkaVe White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Santucci Construction Corp. Located at Cimarron Road T/V (T) Putnam ValleY Tax Map # 72• Block 1 Lot 37.52 Subdivision of Subdivision Lot 5 Westchester Holding Co., Inc. Parcel III Subdivision Lot # 2 Filed Map # 2824B Date Filed 7/812004 Gentlemen: This letter is to authorize John P. Delano, P.E. a duly licensed Professional Engineer n/ or Registered Architect _ to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Very truly yours, Countersigned,° . Sipe � P.E., M # 062505 (owner of Property) Mailing Address Barley &Watson, P.C. Mailing Address: 15 Travis Lane State 3063 Route 9 Cold Spring New York Zip 10516 Telephone: 845- 265 -9217 Montrose State NY Zip Telephone: (914) 736 -0293 10548 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ AffMAVIT- CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: SSTS Construction Permit 1, Dominick Santucci represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: Santucci Construction Corp. Having offices at: 15 Travis Lane, Montrose, NY 10545 Whose Officers Are: President - Name: . f nin l k)16 k 1,30-n t u e-c"I Address: 15 row I s Vice President - Name: e-Lrc- -,San 4"Ce_; Address: 1,S__ 1 �'a.0 is Lae— Secretary -Name: Address: Treasurer - Name: Address: and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Sipe t Title: Sworn o before me this day of O 1, 2,er- -(month) v o y (year) Notary Public SANDRA L, FALLOON No. 01FAS083212 Corporate Seal Notary Public — New York State Quaffled in Putnam County My Commission Expires Aug. 11, 20-2_�; Form CA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES A�YII.Yt,E�ll�l...r _ V O DUAL tj►i' iri�:AliiS l"�►R A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: Santucci Construction Corp. 15 Travis Lane Montrose, NY 10548 2. Name of project: "Santucci" 3. Location: TN: M Putnam Valley 4. Design Professional: John P. Delano, P.E. 5. Address: Badey & Watson, P.C. 6. Drainage Basin: Hudson River 7. Tvne of Proiect: 3063 Route 9, Cold Spring, NY- 10516 �L 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)? ------------ Yes/No No Type Status (check one)_ ---------------------- - - - - -- Type I _ Exempt _ Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? Yes/No No 10. Has DEIS been completed and found acceptable by Lead Agency? Yes/No n/a 11. Name of Lead Agency Putnam County Department of Health this project in an area under. the control. of local .nla.nning, coning, or other ._._.�. _ .,. ofricals; ordinancea`1__ - _. _ -_ _..__.. _... ..._...r..,�. .. .. __..._ - ... Yes/No � Yes_. --------------------------------------------------- 13. If so, have plans been submitted to such authorities? Yes/No Yes ------------------------ 14. Has preliminary approval been granted by such authorities? Yes Date granted: 15. Type of Sewage Treatment System Discharge _ surface water 16. If surface water discharge, what is the stream class designation? 1/5/2004 groundwater n/a ---------------- - - - - -- — 17. Waters index number (surface) --------------------------------------------- - - - - -- — 18. Is project located near a public water supply system? Yes/No ----------------- - - - - -- — 19. If yes, name of water supply „/a Distance to water supply 20. Is project site near a public sewage collection or treatment system? Yes/No n/a No n/a No 21. Name of sewage system n/a Distance to sewage system n/a 22. Date test holes observed !., o /10/2002 23. Name of Health Inspector J. Paravati 24. Project design flow'(gallons per day) y 1 800 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required? Yes/No No 26. Has SPDES Application been submitted to local DEC office? Yes/No n/a Form PC -97 Page 1 of 2 27. Is any portion of this project located within a designated Town or State wetland ?_ _ _ _ Yes/No No 28. Wetlands ID Number n/a 7;'� Tn 11T- A....Ad fin.�.±-'� . :. LJ t; .. ....- . .S -.G M21i __ 1R._':5 �. :,p.- .. ... .. ':r:._ ..F. •. Vu:i�lI ------------------------------------------- i \l� Has application been made to Town or Local DEC office? Yes/No n/a 30. Does project require a DEC Stream Disturbance Permit? Yes/No 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/No Yes 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? Yes/No No 35. Are any sewage treatment areas in excess of 15% slope? Yes/No No 36. Tax Map ID Number ----- Map 72. Block 1 Lot 37.52 37. Approved plans are to be returned to ------------------ _ Applicant v/ Design Professional '- � v : viii d iiilCa �ii�" t� `re °1iC�V i7fiu a l ioVa u -d`t1Cw SJ S u"be iucat d wiiIll7a -ihe i- fC'`1Na elsifed- shai1!' 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 1., 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: .fr�� 1 o ! ' Engineer for Applicant Mailing Address:..................... Badey & Watson, Surveying & Engineering, P.C. 3063 Route 9, Cold Spring, NY 10516 Form PC -97 Page 2 of 2 PROJECT ID NUMBER 61 SEAR APPENNDIDI X C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only -PA 1 T= FRUj C "iNFCjRMA i IN (`1 "a ee compie ed °tiy applicant or Nrojec't Sponsor) - .. < ... -. 1.APPLICANT /SPONSOR 2. PROJECT NAME Santucci Construction Corp. 11S8ntucci" 3. PROJECT LOCATION: Municipality (T) Putnam Valley County Putnam 4. PRECISE LOCATION: Street Address and Road Intersections, Prominent landmarks etc -or provide map Cimarron Road (see map provided) 5. IS PROPOSED ACTION ® New 1:1 Expansion Modification / alteration 6. DESCRIBE PROJECT BRIEFLY: Separate sewage treatment facility to service new single- family dwelling with private water supply. 7. AMOUNT OF LAND AFFECTED: Initially c 2 acres Ultimately < 2 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ® Yes El No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ® Residential Fl Industrial 1-1 Commercial ❑Agdcufture 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 FI No If yes, list agency name and permit / approval: Town of Putnam Valley. - Building & Driveway Permit 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 plat has been filed. 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 N e dohnP. Delano, P.E. Date: 1015/2004 Signature If the action is a Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT (To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? Yes 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. E] Yes 0 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 pattern, 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 -05? Explain briefly: C7. Other impacts (including changes in use of either quantity or type of energy? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? (If yes, explain briefly: - n Yes Nc i f E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes a lain: ❑ Yes El No PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine Whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility, - (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been Identified and adequately addressed. If question d of part ii was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. Check this box if you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action F-1 WILL NOT result In any significant adverse environmental Impacts AND provide, on attachments as necessary, the reasons supporting this determination. Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of reparer different from responsible officer) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES �.: ;-;s: r. <.:::.:: -_. .. ., _.... �.c��': ^„•�..5.��� -a..:: TF" ,- .. -E' ^a �. ".: 'r."Fy' 1' 1., -p-a :, �t^�� v �c't, r.�a -�a jicS TEN ,� �$ '*i �� , "►71lTlr'Lri— ifY1iL� Su�SRs►�..`�'E'�'"i'iry Owner Santucci Construction Corp. Address , 15 Travis Lane, Montrose, NY 10548 Located at (Street) Cimarron Road Tax Map 72- Block 1 Lot 37.52 (indicate nearest cross street) Municipality (T) Putnam valley Drainage Basin Hudson River Date of Pre- soaking SOIL PERCOLATION TEST DATA 08/09/00 Date of Percolation Test 08/10/00 Hole No. Run No. Time Start - Stop Elapse Time (Min.) Depth to Water From Ground Surface (Inches) Start - Stop Water Level Drop In Inches Percolation Rate Min/Inch A 1 9:31 — 9:36 5 19 — 22 3 2 A 2 9:37 — 9:44 7 19 — 22 3 2 A 3 9:45 — 9:54 9 19 — 22 3 3 A 4 9:56 10:06 10 19 — 22 3 3 5 — — B 1 10:07 — 10:14 7 19 — 22 3 2 B 3 10:26 10:36 10 19 — 22 3 3 4 5 — — 1 — — 2 3 — — 4 — — 5 — NOTES: 1. Tests to be repeated at same depth until appro Percolation test hole. (i.e. < 1 min for 1 -30 m submitted for review. 2. Depth measurements to be made from top ,of t y' `,.Pdre61, tion rates are obtained at each '1=60 min/inch) All data to be IT gas; ji." Form DD -97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST BOLES . . ,. r m..sc ♦. - ..r� 1: a "� - -ti , ".- oa._. >.a'..> - ,.ti.�:... K �Z G.L. Topsoil Topsoil 0.5' Sandy Loam Silty Loam 1.0' 2.0' 2.5' I V 3.0' V Clay Loam 3.5' Clay Loam I 4.0' 4.5' I 5.0' 5.5' 6.0' 6.5' V I 7.0' V 7.5' 8.0' 8.5' 9.0' ..._•-�'- -- ve.- -� �y: _•�..- �.c.or a ..�. >e .+...o -.._.- .. .,, . _.._.r ....- °-- ....- ......v.-- _ ....t.. - .. -.. �.a. -- era- sas.+..voaa rte... > .r. -� �... -.. ,., .. -..:ID •�- ...%o:_ ..er - �n a ..-r 10.0' Indicate level at which groundwater is encountered n/a Indicate level at which mottling is observed None Observed Indicate level to which water level rises after being encountered 4' -3" in Hole 1, 2' -7" in Hole 2 Deep hole observations made by: A. StiebeHng - PCDH; JPD - B &W Date 1116/2000 Design Professional Name: John P. Delano, P.E. Address: Badev & Watson. SaNIlEneineerine. P.C. Signature Form DD -97 (Pg. 2 of 2) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Owner Santucci Construction Corp. —Address 15 Travis Lane, Montrose, NY 10548 Located at (Street) Cimarron Road Tax Map 72- Block 1 Lot— 37.52 (indicate nearest cross street) Municipality (T) Putnam Valley Drainage Basin Date of Pre-soaking SOIL PERCOLATION TEST DATA 10/16/02 Hudson River Date of Percolation Test 10/17/02 Hole No. Run No. Time Start - Stop Elapse Time (Mn.) Depth to Water From Ground Surface (Inches) Start - Stop Water Level Drop In Inches Percolation Rate Min/Inch F 1 1:16 1:38 22 19 — 22 3 7 F 2 1:40 2:03 23 19 — 22 3 8 F 3 2:05 2:31 26 19 — 22 3 9 F 4 2:33 3:00 27 19 — 22 3 9 F 5 3:01 3:29 28 19 — 22 3 9 H 1 1:52 2:14 22 19 — 22 3 7 H_ 2 H 3 2:40 3:06 26 19 — 22 3 9 H 4 3:07 3:36 29 19 — 22 3 10 H 5 3:37 4:06 29 19 — 22 3 10 2 3 4 NOTES: 1. Tests to be repeated at same depth until approxim rc ,, Iwi'on rates are obtained at each percolation test hole. (i.e. < 1 min for 1-30 min/' 0 min/inch) All data to be submitted for review. A' ' L 2. Depth measurements to be made from top,-OA ho f j -;� Form DD-97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST BOLES l�lt/ [{ v -.t -' .. yy✓�. i�aa a. Tit /�L 1�r .�. .- .11�L1J 1 \Vi' ... �w ... -.. .LLrl�/.. .. n. z, G.L. Topsoil Topsoil 0.5' V V 1.0' Silty Loam Light Brown Silty Loans 1.5' V V 2.0' Light Brown Silty Dark Brown Silty 2.5' Sandy Loam Sandy Loam 3.0' V 3.5' Dark Brown Silty I 4.0' Sandy Loam _V 4.5' V 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 10.0' Indicate level at which groundwater is encountered Not Encountered Indicate level at which mottling is observed 3' -0" in Hole 3, 3' -0" in Hole 4 Indicate level to which water level rises after being encountered n/a Deep hole observations made by: J. Paraaati - PCDH, RAV - B &W Date 10/10/2002 Design Professional Name: John P. Delano, P.E. Address: Signature Form DD -97 (Pg. 2 of 2) LORETTA MOLINARI Public Health Director Y � ' . 'Yf�aCa'!�`rna.+.ti�aw. :.'MVT.'."..4 >L a-r.. S- ry_.9. '��R ..-��, ^ •^w K ":a_ '�La.s� DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 . Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 ROBERT J. BONDI County Executive CERTIFICATE OF APPROVAL OF REALTY SUBDIVISION PLANS TO: Westchester Holding Co. Inc. 33 Chester Court Cortlandt Manor, New York 10567 This certificate is issued under the provisions of the Public Health Law in connection with the approval of plans on February 6, 2004 for your realty subdivision known as Subdivision Lot 5. Westchester Holding Co. Inc. Parcel III The following data was furnished in connection with the submission of the plans: Location: Cimarron Road Acres ( approx.) 32.9 No. of lots 2 Size (approx.) 12.1 & 20.8 acres Owner intends. to. Sell lots only Topography Moderate to steep slopes Depth to groundwater 6.5 feet When October 2002 Soil Generally silty sandy loam to 4 feet Grading (cut or fill) N/A Drainage Natural overland flow Water Supply Individual drilled well Sewage treatment Individual subsurface sewage treatment system APPROVAL OF THIS SUBDIVISION IS GRANTED ON CONDITION 1. That the proposed facilities for water supply and sewage disposal are installed in conformity with said plans. 2. That no lot or remaining land (if applicable) shall be subdivided without plans for such resubdivision being submitted to and approved by the Putnam County Health Department. APPROVAL OF THIS SUBDIVISION IS GRANTED ON CONDITION (continued) That the developer shall furnish each purchaser of a lot on which water supply and/or sewage treatment facilities were installed with a reproduction of the approved plans and an accurate as -built plan depicting all installed sanitary facilities. 4. That the developer shall furnish each purchaser of a lot on which there was no water supply and /or sewage treatment facilities installed with a reproduction of the approved subdivision and/or construction permit plans and shall notify the purchaser of the necessity of installing such facilities in accordance with approved construction permit plans. That the sanitary facilities on these lots shall be inspected for compliance with the approved plans at the time of construction by a P.E., R. A., or exempt L.L.S. and a certificate of construction compliance is to be submitted to the Putnam County Health Department for approval prior to occupancy. 6. That individual wells and sewage treatment systems shall no longer be constructed or used for household domestic purposes when public facilities become available. Connection to the public sewerage system is required within one year of the system(s) becoming available. 7. That plan approval is limited to 5 years and expires on February 6, 2009 8. That the approved plans •must be filed with the Putnam County Clerk prior to offering lo;.:'fo �aie and wl4alil 9l7 uay.; of Erie, 0 e i j,�.r, �nnrnyai. B y. MichaelI Bu ski, Director of Etneeri MJB /JP cc: I Delano, PE File BADEY & WATSON LETTER of TRANSMITTAL 3063 Route 9, Cold Spring, New York. 10516 Date: 07 Oct 2004 File No. 98-105 W. O. # 16903 RE: Proposed SSTS Santucci TO: Horton Hollow Road Joseph S. Paravati, Jr. Sub. Lot 5 Westchester Holding P Subd. Lot No. 2 Assistant Public Health Engineer Tax Map 72.4-37.52 Putnam County Department of Health Permitrritle/PO # RGP 16623 1 Geneva Road Sent via: Brewster, NY 10509 US MAIL El UPS-NIGHT El MESSENGER El UPS-2 DAY El PICK-UP El UPS-3 DAY El FAX UPS-GRND W We are sending: UPS-COD copies date description of document 0 106-Oct-04 1 jApplication fee 4400.00 F 41 105-Oct-04 lConstruction Permit for Sewage Treatment System Eli I ILetter of Authorization- F�l 106-Oct-04 lAffidavit - Corporate Owner Application FT I - FApplication for Approval of Plans for a Wastewater Treatment System 51 105-Oct-04 1 IShort Environmental Assessment Form v 711 106-Feb-04 lCertificate of Approval of Realty Subdivision Plans, two (2) pages F2] 1 —7 [Floor Plans - 4 Bedroom, three (3) sheets 74 105-Oct-04 —1 Se crate Sewage Treatment System Fill Plan Sheet 1 of 2 F-11 105-Oct-04 7 ISeparate Se;Wage Treatment System Sheet 2 of 2 REMARKS: For your review Copies to: File Yours truly: Jason R. Snyder, Assistant Engineer Tel: (845) 265-9217 ext 13 Fax: (845) 265-4428 Email: jsnyder@badey-watson.com Santucci Properties. LL.0 40 40-05 500113 626157 25279 I N r\ 00 rn It U 2 a a 0 w 0 N r; I 0 1 N N V) z 1B 28.0' SEPTIC TANK 2A 50.5' SEPTIC TANK 2B 36.1' SEPTIC TANK 3A 46.0' DROP BOX fiUX 4A 51.6' DROP BOX 48 50.8' DROP BOX 5A 58.0 DROP BOX 58 51.4' DROP BOX 6A 64.6' DROP BOX 6B 53.0' DROP BOX 7A 71.2' DROP BOX 7B 55.4' DROP BOX 8A 77.6' DROP BOX 8B 58.7' DROP BOX 9A 121.8' END LATERAL 9B 58.9' END LATERAL 10A 116.1 END LATERAL 106 51.5' END LATERAL 11A 112.2' END LATERAL 116 45.2' END LATERAL 12A 109.5' END LATERAL 128 40.3' END LATERAL 13A 105.8' END LATERAL 13B 34.3' END LATERAL 14A 102..2' END LATERAL 14B ' iSA' 28.4 29.0'Y._ END LATERAL ENDLATERAL✓ 15B 74.5' END LATERAL 16A 36.9' END LATERAL 16B 71.1' END LATERAL 17A 44.8' END LATERAL 17B 68.7' END LATERAL 18A 53.8' END LATERAL 18B 66.9' END LATERAL 19A 62.6' END LATERAL 19B 66.2' END LATERAL 20A 69.4' END LATERAL 20B 68.3' END LATERAL WB 176.0' WELL WC 143.3' WELL F cD O Z m