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HomeMy WebLinkAbout3260DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73. -1 -55 BOX 26 1�m �'1 , rm o; , ;I � ��� ti•'T T 1 1 �� i, 1 19 1 I' 1 , 'OT - IqL 03260 PUTNAM COUNTY DEPARTMENT OF HEALTH D yISION_.OF FN-"- R 2N�NFl�T.4� .T,...HEAL,'�'H : E: CF. �. - - CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SE NT SYSTEM PCHD CONSTRUCTION PERMIT # lT-N e C—, e fn - Located at 'Z3Z < w r Village Owner /Applicant Name MM e- - ,' "1' �,.� Tax Map "'l3 Block _� Lot So= c4 . Formerly Lr ,cg, -r->y oQ t .} , t„,,, - Subdivision Name Subd. Lot # 'Z--. Mailing Address ��,, ,,,,, Zip LCX"'Co-2 Date Construction Permit Issued by PCHD Separate Sewerage System built by Address�„�;,,,,;�- Consisting of Gallon Septic Tank and t_� Other Requirements: Water Supply: Public Supply From Address or: X- Private Supply Drilled b -tom, "r,..1. 1 e Address �r�� ..., a Tvi1.�_, _�G.'Cisay��. 1- Has. Pl'nClra. n ii,+ n Number of Bedrooms '- 00— P900:% 45 Si5" Has garbage grinder been installed? I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: " 1 y-`� Certified by ,u•�.: -tom _ '�t„�,�,�.�: Address t� �-i.- P.E. K 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 revoca 'o mo ' icatio o Chang is necessary. By: Title: Date: Z Q White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH ` DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT .441VC4it- 2— to 'r 3 weii Lo�i®n * - - _Sir —e-t _ A _d.� d _ r. e�ss.: :— 0- IFIIV : Church Street o illage. Putnam Valley Tax Grid # Map 'TS Block I Lot(s) 55' Well Owner: Name: Address: V.S. Cor oration, 37 Croton.Dam Road, Ossining, NY 10562 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 42 ft. Length below grade 41 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 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'. est _ Bailed X Pumped X Compressed Air Hours 6 Yield 7 gpm Depth Data Measure from land surface- static specify ft) 10' During yield test(ft) 200' Depth of completed well in feet 265' Well Log If more detailed information descriptions or �s i :va-aralvse5 _ = a,- -.•..- ....... are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land surface 27 Drillinc in over urden clay nd boulders 27 Hit rocR at 27' - -a - �:� %s...,� t .`Lia�lii' i viAt;CU • =� _ 42 265 Dkillinc in rock granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 7gpm Depth 220' Model 7GS07412 Voltage 230 HP 3/4 Tank Type WX302 Volume 86 _gal. Date Well Completed 6/3/99 Putnam County Certification No. 002 Date of Report 7/14/99 Well Driller i ature) err ivv a m: exact iocauon of wen wan aistances to at mast two permanent ianamarxs to be provtaea -7am eparate sheet/plan. 4 Put Aven ue Well Drillees Name F. s Address: Brewster, NY 10509 Signature: Date: 7/14/99 White copy _ copy - Owner; Orange copy - Well driller Form WC -97 ";47 = NORTHEAST LABORATORY of DANBURY $J -a I&LL °pia I OAD 0Mfk1 RYA Jr' U 11 r ~ NY Cert:. 11471 y L (203) 748 -7903 - FAX (203) 748 -0652 LABORATORY REPORT - WATER SUPPLY TESTING REPORT TO: P.F. BEAL & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: Total Coliform (Bacteria) PHYSICALS: CHEMISTRY: Color Odor pH Turbidity RESULT: 0 0 ND 7.17 0.67 Nitrite N DATE SAMPLE COLLECTED: 7/6/99 Nitrate N TIME COLLECTED: 4:15 P.M. Alkalinity COLLECTED BY: PHIL BEAL - Hardness DATE RECEIVED @ LAB: 7/7/99 TESTED BY: LAB #11471 Manganese REPORT DATE: 7%13/99 Sodium 5.9 V.S. CONST., LOT CHURCH ST., PUTNAM VALLEY, N.Y. HOSE BIB ml = milliliter mg/L -= milligrams per Liter WELL mg/L NONE RESULT: 0 0 ND 7.17 0.67 Nitrite N <0.005 Nitrate N 0.51 Alkalinity 220.0 - Hardness 258..0 -;I:. 0.30 mg/L Manganese <0.01 Sodium 5.9 Lead 0.006 ml = milliliter mg/L -= milligrams per Liter * *Notification Level ** *Action Level MAXIMUM CONTAMINANT LEVEL per 100 ml 0 per 100 ml no designated limit NTUs 5 NTUs mg/L as N 1 mg/L as N mg/L as N 10 mg/L as N ' mg/L no designated limits no desirmat- limits 0.30 mg/L mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] mg/L 20 mg/L ** _ -- mg/L 0.015 * ** ND = none detected NTU =Units RESULTS BASED ON SAMPLES SUBMITTED: 7/7/99 SAMPLE, AS TESTED ABOVE: DOTABLE or AMNOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) w, c Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037- (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL ALTH - SERVIC'F GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 37 c ��- rc�+•t �r�a� -� � � ao co2p Owner or Purchaser of Building 37 GRr:rc)1,A Vh_tA �20A-a fa R'P. Building Constructed by Location - Street -7 ► 5-5 Tax Map Block Lot �illage L i nt c AR z Subdivision Name 3 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 eutilizing the., _ _.� Y The undersigned further ,agrees to accept as conclusive the determinatio = of y e P bli Health Director of the Putnam County Department of Health as to whether o4l, tit fai14 a oft e system to operate was caused by the willful or negligent act of the occupant of th -ibuil ing 6lizing the system. Dated: Month Day Year Signature: ¢,' ' ` n` \µa Al } Title: General Contractor (Owner) - Signature 3 7 �R o To ►s ® C o RP Corporation Name (if corporation) Corporation Name (if corporation) Address: 3-7 Address: State Tq Y Zip ' ens 4 2 State Zip Form GS -97 INSI TE IN— ING, SURVEYING& - -N - FR ; Z-A NGDSC APEARCHIrECTURE, PC. � LETTER OF TRANSMITTAL 1485 Route 22 (914) 278-4990 iV D'Lnr' N. 4V !Y --743, 7 DeLavergne Avenue (914) 297-1742 Wappingers Falls, New York 12590 d411P -4 cb- tc>cr,��C% WE ARE SENDING YOU ❑ Shop Drawings ❑ Copy of Letter Date:ci DATE Job No. Attn: 14 Re: .3:r KEnclosed ❑ Under separate cover via 5§ Prints ❑ Plans ❑ Samples ❑ Change Order. ❑ the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION 14 to-1 9 THESE ARE TRANSMITTED as checked below: Uloror approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return ❑ For review and comment ❑ REMARKS: COPY TO: Lot98.dot SIGNED: IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE corrected prints DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIIME TREATMENT SYSTEM PERMIT # / V` 6, "?9 Located at ��/���G%% ®/f or Village ®C'✓ti ,#-"l Subdivision name f Zinc, -A . ? Subd. Lot # _3_ Tax Map 3 Block / Lot 5�5 Date Subdivision Approved - - 211 8� ba n C-r �A" 04! � 9wfterfApplicant Name 77 C-A�f rev Ord''► amp® coe00, Mailing Address 3 7 c Kw 7o.cl .G' &,-t Amount of Fee Enclosed ¢' -7,69,!V, p e::, Renewal . Revision Date of Previous Approval Zip /as-6 2— Building Type 4+6 Lot Area qow -eo. of Bedrooms 41 Design Flow GPD 900 ���pya. p��.Lr'lr -�✓ Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of / ._ 2 �� gallon septic tank and Other Requirements: To be constructed by 31 CA®re v p/a-M A,0 Cye,0', Address 3? e e-,- i3 1-;o,4,P Water Sup"I Public Supply From Address 7 17 or: _ Private. Supply Drilled by �, F, �i -CGS ¢- �� ZG 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 treatmentsystem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address P.E. = Date 3 - -/'-'1 License # M -3 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 permit. Approved for discharge of domestic sanitary sewage only. By Title: Date: A,b qq White copy - HD File; Yellow copy - ilding Inspector; Pink copy - Owner; Orange copy - Design Pro essi nal Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL _ pieak printoitype - J A PCHD Permit Well Location: Street Address: o /Village Tax Grid # �Jfry � ' Map73,& Block / Lot(s) g .-S Well Owner: Name: 3 cr4ei.- 4-1 Address: 3 cA vTO4--, a 4-r-t- A,~ ,oi+, -% vAP• cv /- P oss��tszv� --J 0,/ / ©.Z`6 - Use of Well: _ Z Residential Public Supply Air /Cond/Heat Pump Irrigation 1 rimary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought _ gpm # People Served Est. of Daily Usage 3r cgal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling K New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type JDrilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision z.!vc -A 2 Lot No. -3 Water Well Contractor: F, l3�S �- s �vs, r2C; Address: Pviaj ,o, 4Fi~5T Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: /-",/A Town/Village 1(1-/// Distance to property from nearest water main: C;P -- / Proposed well location & sources of contamination to be provided on separate sheet/plan. Late: "I Applicant PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue 42 Permit Is uin g cial: , Date of Expiratio 3 .5 z ® Title: s I.- . 9h4(-,a Permit is Non - Transfer abl White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Fonn WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .. ,.o.__.,..s s ,w.. _ .rir••.n.. -, .:L'il�i%_iYV''i"��1Y il1I�' i� "V'1t�'i�l�`"v "�r`i'�:`il�t"° F.IL'1: i6:/.^ ,. ...... :">c�:,: �.:.. �. " ..::...::. .... .. A WASTEWATER TREATMENT SYSTEM 1. Name and address.of applicant: 3-7 c7g�-re-ld p 47-,L 2. Name of project: t5S-6 Fin- 37 CAmrarl pA-•-t go,3. Locatio &: ca", Insite engineering, Surveying & Landscape 4. Design Professional: Jeffrey J. Gmtelm, P.E. 5. Address: Architecture,_ P.C. Route 22 6. Drainage Basin: 0 V, 5&,J to c ✓irz moo; Y=k 10599 7. Tyne of Project: 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 x Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... " o 10. Has DEIS been completed and found acceptable by Lead Agency? ............... ^-' A-- 11. Name of Lead Agency aJ/ A-- 12. , I§ this prqject in an area trol _ .pja nirng ;. �. nag or other ea under the co of local oni. _ officials; ordiiiarices . .........� ..� .- ......� ..........._ -�.�. : .....:............... 13. If so, have plans been submitted to such authorities? ........ ............................... too 14. Has preliminary approval been granted by such authorities? granted: �� 15. Type of Sewage Treatment System Discharge ................. surface water X groundwater 16. If surface water discharge, what is the stream class designation? .................... 17. Waters index number (surface) ........................................... ............................... N 18. Is project located near a public water supply system? +J 19. If yes, name of water supply Distance to water supply �✓ 20. Is project site near a public sewage collection or treatment system? ................ ,yo 21. Name of sewage system / .I•— Distance to sewage system 22. Date test holes observed Z- 04-`l' °t 23. Name of Health Inspector A-yA-", fn 24. Project design flow (gallons per day) ................................. ............................... t3 L-no 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... Na 26. Has SPDES Application been submitted to local DEC office? ......................... �- Form PC -97 2 27. Is any portion of this project located within a designated Town or State wetland? 28. Wetlands ID Number .......................................... .... ° _.: _ . . _ w ... ................................................... Has application been made to Town or Local DEC office? ............................... v 30. Does project require a DEC Stream Disturbance Permit? .. ............................... A)O 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid orhazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No A-)0 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No N O 0 33. Is there a local master plan on file with the Town or Village? ......................... cc-'- Ae-10w71) 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... ccNw�I 35. Are any sewage treatment areas in excess of 15 % slope? Map .............. Map 73 Block l Lot .�� 36. Tax Ma ID Number ............ ............................... 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„ rAl iougir ie "pruj"ect ri y'rCquire l)EP "approval of the SSTS prior to final approval by the Department. Projects within the watershed may. also require DEP review and approval of other aspects of a project, such as stormwater,plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. 1 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: 1 Mailing Address: .................................... ' osc t% A-art-( zzc'�urz�, /,e- FEB- 23-1999 1009 :DMSXON FOR PERMIT API To: Public Health In the matter of at represent that I am an o Namo ofCorporation: _ Having offices at: 5 MIgse Officers Are: President - Name: V Address: S' Vice President - Name: Address: INSITE ENGINEERING 914 2 78 6392 P.09 COUNT'S DEPARTMENT OF HEALTH E ENVIRONMENTAL HEALTH SERVICIKS :Y Z.>nn s^C-. >_.y w i¢ J. :r ..... rJ. r. Y. a +l •>• _— .-]_ n/ AP KRZ DAVIT - CORPORATE OWNER APPLICATION [TON SUBMITTED TO PUTNAM COUNTY HEALTH DFPAR for: 5S 57 C" o^) OA-" tU A' :r or employee of the corporation and am authorized to act for: U ►'or✓ per, %'-o�p, ersstN /,jr,7, IV et e -r - -��- -- -T—' d i o ID q jv► Secretary -Name: Address- Treasurer - Name: Address: and that I am and Will be i to the approval requested Swom to before me this NOTARYP muc STATE OF NEW YORK QUALIFIED IN PUTNAM COUNTY NO.0IKL5065476 ' MY COMMISSION EXPIRES 9 -3 Z Form CA -97 0 idually responsible for any an4 �1 a ° s the 7rporation with t all subsequent acts relating a to. `. Signe aN Tide:'. day of (year) Corporate Seal IUIHL P.09 FEB-23-1999 10:,07 INSITE ENGINEERING 914 278 6392 P.02 PIS Y DEPARTMENT OF HEALT4 *M DMSION O.F ENVIRONMENTAL HEALTH SERVIU LETTER OF AUTHOR&ATION RE: Property of ':!77 C,40rbd PA-k,% F—Vit-p cpjgf. Located at (5)V IVYvmm Y�MW Tax Map# _73e .--Block Lot Subdivision of Subdivision L04 Filed Map # ZZ6-5,4 Date Filed cj�zct-% Gentlemen: This letter is to author xmite aBemsimr R_WMJW� & L=bma M9hkt_WW=, Px1_(4egf P. I M J. �j_ a d�y licensed Pwfesstl:al Engineer x (xPj%is&=ot*xb&=xxxxxto apply for the' requied wastewater treatment d'or water supply permit(s) to serve the above-noted property in adcordz nce with the standaids, rul or regulations as promulgatcd-by the Public Health Director of die Put County Health Departi ient, and to sign all necessary papers on my behalf in connection! with his mater and to su pervis( the construction of said wastewater treatment and/or water supplt systi ms in cionfonnity with the provisions of Article 145 and/or 147 of e ucar. aw, the Public He Lith Law, and the futna.m,'. Sanitary Code, 'Very trul 0 Countersigned: PE; KA, #.A Mailing Address LnW& 6 LM raft Stat; 'Telephone; Ardifteeb.Ue, P.C. Zip 10509 Signed: Mailing Address- '57 CAOTbO State A),'q. Telephone: -73 '1 - '7 G -Z- I FOrm PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH,_ SERVICES D E i 3 3 i'I" ­i --k) i ulCn le, S UR PACE SE' A6E Y RIc Ari'!vl'lE F a 'kJTkM 3 cmo- o� Ao# 0 c P2 'e, Address 3 cr�o,�.v �.�. -� m �� ©sTcvr• N y Located at Street ca-1,v Is .Tax Ma Block / . Lot S'3 (indicate nearest, cross street) Municipality PVTA.y4 V1 v 11 4-1,c j Drainage Basin NvONMV 110)-Tf/ ffA Date of P SOIL PERCOLATION TEST DATA Date of Percolation Test 2 2q Hole No. Run No. Time Start - Stop Ela se Time (pMin.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch P /-� 1 it o6 — .30 � 1 U- s C9 j it PA 3 4 5 l.� 1 11,0319 -1zrcc 30 24 .-.., . 'v� j i- ..` -M .. �_...:.+ IF ZV 4 Y 5 G 1 /l 0 3 o-no 30 2�y" 24 l/z" 2 I� G 2 IZ v °O ©s - IJ -`c3i 30 1Zfz 214 `/ZI' P G 3 j.7- 3,6 -' f `06 -30 2 Z11y" aqk 7. " �S 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. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 2 TEST PIT DATA . DESCRIPTION O. ,F.,801LS"ENCOUNTFRED-IN TEST HOLES DEPTH HOLE I. . 00 2-- HOLE NO. 3 HOLE NO. G.L. 03:, 1.01 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.51 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.01 8.51 9.51 10.01 Indicate level at which groundwater is encountered 0 O"F- Indicate level at which mottling is observed 0 de, Indicate level to which water level rises after being encountered Deep hole observations made by: G-roA6'-C Date Design Professional Name: Jeffrey J. Contelmo, P. E. Address: insite pyh-e,-xing, surveying & Lmxiscape Architecture, P. 1-5455--RoiAe 22 Brewster, New York 10509 Signature: Design Professional's Seal OF NEW >2_1 A 61 U164(? V) —Text 12 PROJECT I.D. NUMBER 617.21 SEOR Appendix C C: SHORT .ENVIRONMENTAL ASSESSMENT FORM - For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Appllcant.or Prolect sponsor) 1. APPLICANT /SPONSOR -7,%1517C 2. PROJECT NAME • °tj 5 s+✓� v� v ,,�� � L9Na�s��ty� � Ng�, 7vAC,P L ZnvGA>'c Z .moo ; 3. PROJECT LOCATION: Municipality PU I Ai/4p`+ a�iq County /oU! A ,6,-, 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) ��G C(JN 57rRtDGT2i�eti d/�, E}w -NCr G Aire MA to 5. IS PROP SED ACTION: New ❑ Expansion ❑ Modificationlalteration 6. DESCRIBE PROJECT BRIEFLY: GOR15TA VC, 7l0sv.OF dam/ /� LA.mTLY. g�::7[7�ivGrc %J Ad- I/C -t-- 7. AMOUNT OF LAND AFFECTED: Initially u t acres Ultimately o acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? W Yes ❑ No If No, describe briefly 8. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/ForesVOpen space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL) ?. ❑ Yes ❑ No If yes, list agency(s) and permit/approvals P Ck4 - ss 7-5 gr v- 64-t, n,eTA r )J a'u�a�,�.� uf►G,/� — Bv�Gt�J�G —.7T 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes dkv yes, list agency name and permit/approval 12. AS A RESULT ROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes ;7No I . CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE �NS.TT� Gc!! f- TNEF�' T�t/C rJ Sv�Cv���NG- 4- L •19NDSc.�'9,�El�/CCH?TE�Tr/R�� �G'i ApplicanUsponsor name: d NN /') wn/9TSd�✓ Date: 3 `1-1 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 (ro be completed by'Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative. declaration may b3 bUDefSerled br enother involvAd avancy D Yes ❑ No . C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) Ct. Existing air quality, surface or groundwater quality or quantity, noise levels, •existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or` related activities likely to be Induced,.0y the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not Identified In CI-05? Explain briefly. C7. Other Impacts (including changes In use of either quantity or type of energy)? Explain briefly. D. IS.THERE, -OR IS_THEP,E UKEL`! TO 6E, -CONTROVERSY 7E_LATED TO POTENTIAL ADVERSE ENVIRONMENTAL IM ACTS? `.. ❑ Yes IJ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (ro be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether It Is substantial, large, Important or otherwise significant. Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural);.(b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately addressed. ❑ Check this box if you have Identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a• positive declaration. ❑ Check this box If you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result In any significant adverse environmental Impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name o Responsi e Office! in Lead Agency Title of Responsible O icer Signature of Responsible Officer in Lead Agency Signature of Preparer (if different from responsible officer) Date E PERMIT WAIVER CHAPTER 144: Freshwater Wetlands, Watercourses and Waterbodies Ordinance of the Town of Putnam Valley, New York. The Town Wetlands Inspector, as Approval Authority, has determined that the proposed action will not have a significant environmental impact. Therefore, a PERMIT WAIVER is granted subject to the conditions noted below. DATE PERMIT ISSUED: March 25, 1999 DATE PERMIT EXPIRES: March 25, 2000 APPLICANT /SPONSOR: 37 Croton Dam Road Corp 37 Croton Dam Road Ossining, New York 10562 Insite Engineering, Surveying & Landscape Architecture, P.C. (agent) 1485 Route 22 Brewster, NY 10509 Attn: John M. Watson PROPERTY LOCATION: 232 Church Road, Lincar 2, Lot 3 TAX MAP #: 71-1 -55 SIZE OF PARCEL: 49 + acres ZONING: R -3 and R -1 PROPOSED ACTION: Construction of Single Family Residence, Driveway, SSDS, and Well within wetlands buffer to existing pond. Driveway access is within wetlands buffer to existing pond. MATERIALS REVIEWED: 1. Application Materials, file # WT -292, dated 2 -8 -99, referred 3- 17 -99. 2. Construction Drawing for Lincar 2, Lot 3, as prepared by Insite Engineering, dated 2- 24 -99. 3. Site Plan for driveway improvements, prepared by Insite Engineering, dated 3- 12 -99. DATE OF SITE INSPECTION: March 05, 1999 Page 1 oft lincar2lot3Pw a PERMIT WAIVER CHAPTER 144: Freshwater Wetlands, Watercourses and Waterbodies Ordinance of the Town of Putnam Valley, New York. The Town Wetlands Inspector, as Approval Authority, has determined that the proposed action will not have a significant environmental impact. Therefore, a PERMIT WAIVER is granted subject to the conditions noted below. DATE PERMIT ISSUED: March 25, 1999 DATE PERMIT EXPIRES: March 25, 2000 APPLICANT /SPONSOR: 37 Croton Dam Road Corp 37 Croton Dam Road Ossining, New York 10562 Insite Engineering, Surveying & Landscape Architecture, P.C. (agent) 1485 Route 22 Brewster, NY 10509 Attn: John M. Watson PROPERTY LOCATION: 232 Church Road, Lincar 2, Lot 3 TAX MAP #: 71-1 -55 SIZE OF PARCEL: 49 + acres ZONING: R -3 and R -1 PROPOSED ACTION: Construction of Single Family Residence, Driveway, SSDS, and Well within wetlands buffer to existing pond. Driveway access is within wetlands buffer to existing pond. MATERIALS REVIEWED: 1. Application Materials, file # WT -292, dated 2 -8 -99, referred 3- 17 -99. 2. Construction Drawing for Lincar 2, Lot 3, as prepared by Insite Engineering, dated 2- 24 -99. 3. Site Plan for driveway improvements, prepared by Insite Engineering, dated 3- 12 -99. DATE OF SITE INSPECTION: March 05, 1999 Page 1 oft lincar2lot3Pw U y `3 T C Q ~CDATF� OF PTP JF�IT� All work to be performed in accordance with the above referenced plans. 2. All erosion and sediment controls shall be in place prior to the initiation of construction/grading work. Erosion controls to be inspected by Building Inspector prior to commencement of construction activities. All erosion controls must be maintained properly throughout the construction process, and remain in place, until final site inspections for compliance with conditions of permit have been completed. 3. The Building Inspector shall be notified once erosion control measures are in place and at least 48 hours prior to the initiation of any site work. 4. The Planning Board, Wetlands Inspector, and/or Building Inspector, shall have the right to inspect the project from time to time. 5. The permit shall be prominently displayed at the project site during the undertaking of the activities authorized by the permit. 6. An additional escrow account in the amount of $ 300 must be established with the Town before this Permit Waiver can be considered validated. These additional escrow funds will be appropriated as required for construction monitoring purposes. Any portion of the account not used during the project monitoring period shall be returned to the applicant upon satisfactory completion of the project. Noncompliance with the conditions above will invalidate this Permit Waiver, and may result in a Notice of Violation and /or a Stop Work Order. Any questions regarding this Permit Waiver +,.9 +: 4. T "iT a9..« s T ..a.., i.,'i A: ^/4'1 '7�1Gq 1 � C+ i..�. -.9 ao' Laav i G VO' VV %A- U� u'TSYc vwa �. a�� %d— I a.v�, Gi Li1C 1Ct it tLi., �iuuCtu, Inspector (914) 526 -2377. Date Permit Waiver Prepared: March 25, 1999 Sit) 4',"t 0.6) Stephen W. Coleman Town Wetlands Inspector cc: Applicant/Agent Building Inspector Planning Board Environmental Commission Page 2 of 2 fficadlot3pw INSITE ENGINEERING, SUR VE YING & L L AXDSCAPEARCWECTURE, P.C. LETTER OF TRANSMITTAL VIQ Brewster, New York 10509 (914) 278-6392 7 DeLavergne Avenue (914) 297-1742 Wappingers Falls, New York 12590 TO: PCHD WE ARE SENDING YOU ❑ Shop Drawings Copy of Letter Date: 3-26-99 1 Job No. 92135.303 Attn: Adam Stiebeling Re: Lincar 2 - Lot 3 0 Attached ❑ Under separate cover via [:] Prints ❑ Plans ❑ Change Order ❑ the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION -1 3-25-99 Wetland Permit Waiver THESE ARE TRANSMITTED as chocked. below: El Foil approval -AE]Approve.dassubmitted Oesforapproval.;-- • For your use ❑ Approved as noted ❑ Submit copies for distribution • As requested ❑ Returned for corrections ❑ Return corrected prints [:1 For review and comment ❑ REMARKS: COPY TO: Lot98.dot SIGNED: V-" 11-7 C")Ay� John M. Watson IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE e P - 01NS /TE ,. ENGINEERING, SURVEYING & o %?!'tNrTFGTURF v C -_ 1485 Route 22 (914) 278 -4990 Brewster, New York 10509 (914) 278 -6392 7 DeLavergne Avenue (914) 297 -1742 Wappingers Falls, New York 12590 TO: P,G N, 4 Date: �, }� ot Job No. 3 3D Attn: ST..2 G- Re: 4, AI 2 WE ARE SENDING YOU Attached El Under separate cover via ❑ Shop Drawings Prints ❑ Plans ❑ Copy of Letter ❑ Change Order ❑ COPIES DATE NO. I P ............ ie �rZS —q� `.. -a 2 i L.-- GA -'13 �tJ s 7-A v r 7-AA -17 7—.- ❑ Samples DESCRIPTION 9 V TM9 ATE ._... __ ...... ....... ........ the following items: ❑ Specifications ecis d below- �.. fffFor approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ REMARKS: .NNMtMMM3Minl�iM7M'•R ^!- - - tMlMinn Mt�,U,..tMt�MM7Mt...' 0 :MN i ; rJ.NiM iMSf1N�� -�•. - .. • ' 4 COPY TO: _ J� __ Lot98.dot ESTCHESTER IW ODULAR HOMES, INC. v t.THE SCARSDALE 11 Second Floor , MASTFR BEDROOM 17' -2iz x 16'- 8" 48, First Floor KITCHEN ii BREAKFAST 12' -0" x 13'-O" I 8' -5' x I3' -O" : 27'8" X 48' • 2656 Sq. Ft. r— lip _ BEDROOM4 BEDROOM3 II' -O` x 91-7" T 101-01X 13' -0" DINING ROOM v 13'- 9" up 1 48' BERROOM 2 16' -4z2 x 13' -O" FAMILY ROOM 20' -0 "x 13' -O" LIVING ROOM 18'- 9" x 13' -0" '- 2%'8 STANDARD SCARSDALE 11 FEATURES • 4- Spacious Bedrooms • Framingham Pediment on Front Door • 2%2 Baths • Fireplace Options Available • Open Two -Story Entry Foyer • "Boxed -out" and "Angle Bay" Options • Formal Dining Room Available • Formal Living Room • 'Consult an Authorized Westchester Builder • Spacious Country Kitchen with Breakfast for a Complete List of Options Room and Pantry • Artist's renderings and Floor Plan Dimensions are • ' "COtta a -S e "" 3056 Lower Level Windows approximate. AlI specifications must be Written in the g Contract No oral conditions. with Architraves on Front ESTCHESTER MODULAR HOMES, INC. :I '16 Cal; (914) 832-9400 - (800) 832-3888 P 0. Box 900 e Dover 6 W0 �uw =. e r� � to 1. f- c- C: 278" STANDARD SCARSDALE 11 FEATURES • 4- Spacious Bedrooms • Framingham Pediment on Front Door • 2%2 Baths • Fireplace Options Available • Open Two -Story Entry Foyer • "Boxed -out" and "Angle Bay" Options • Formal Dining Room Available • Formal Living Room • 'Consult an Authorized Westchester Builder • Spacious Country Kitchen with Breakfast for a Complete List of Options Room and Pantry • Artist's renderings and Floor Plan Dimensions are • ' "COtta a -S e "" 3056 Lower Level Windows approximate. AlI specifications must be Written in the g Contract No oral conditions. with Architraves on Front ESTCHESTER MODULAR HOMES, INC. :I '16 Cal; (914) 832-9400 - (800) 832-3888 P 0. Box 900 e Dover 6 W0 Y. I: x1 �.y . ...... ...... ..__.. _ .. ; . � .. it ,� ..�. • . r y, ON57RUGTION NOTE: ,z4 GOPY OI= THE HOU5E FlI ,AN5 5UBM I TTED TO THE BU I L:D I NG I N5F'EGTOR ; 1NHEN FILING FOR .A BUILDING � RMIT , MUST B G SUBMITTED TO THE PUTN M UNTY HEALTH DEPARTMENT TO,'! 1�ER1IrY THE BEDROOM COUNT. 1. I DZ,1') .iL.l.1MENT 01' kakdAlITT. , BE '. it In �.� wa tip,. PUTNAM COUNTY DEPARTMENT OF HEALTH "IN — 77 DIVISION OF ENVIRONMENTAL HEALTH • INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR.CONSTRI 1( TION_Q1;RNIf . �r.-•: craY.-.,• -*+ �s.:- a..,- s�.tr•:- •;i.�:':i- �i.�.. �aiC� .+�'.M,.•..:,.L:"r.�..'IAa'r :... "..�z`_� = .:d��." ;gin: STREET LOCATION I� fLc�� NAirIE OF OWNER REVIEWED BY RNI, GR, AS MB, BH DATE TAX NIAP # Y DOCUMENTS Y PERMIT APPLICATION. ROSION CONTROL:HOUSE,WELL, SSDS C -1 PERC &DEEP HOLES LOCATED WELL PERMIT ✓ PWS LETTER PRESENTATIVE OF PRIMARY &EXPANSION ETTER OF AUTHORIZATION LOCATION MAP DESIGN DATA SHEET (DDS) EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE Pfz ORPORATE RESOLUTION F PUMPED, PIT & D BOX SHOWN & DETAILED HORT EAF OUSE -NO .OF BEDROOMS NS - THREE SETS WELLS & SSDS'S W/IN 200' OF PROPOSED SYS. %?i .�� 0 SE PLANS - TWO SETS PROPERTY METES & BOUNDS ARIANCE REQUEST HOUSE SETBACK NECESSARY (TIGHT LOT) S 7 FEE HOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE SUBDIVISION NO BENDS; MAX.BENDS 45° W /CLEANOUT kLEGAL SUBDIVISION FILL SYSTEMS IVISION APPROVAL CHECKED CLAY BARRIER RATE - FT. HORIZONT , LOPE 3:1 TO GRADE REQUIRED DEPTH FIL CS FILL NOTES AIN DRAIN REQUIRED FILL C " ATION NOTE DPIPES DE GAUGE GENERAL LL PROFILE & DIM IONS OC TED IN NYC WATERSHED VOLUME A S SUBMITTED TO DEP F IN EXPANSION AREA EGATED TO PCHD TRENCH EP APPROVAL, IF RE D TRENCH PROVIDED 60 FT MAX. D RCS TO BE WI HOLES OSSED�/1,�„ /� LLEL TO CONTOURS 100% EXPANSION PROVIDED .TA f IffAtni YR. FLOOD ELEVATIO�t OTHER REQ'D PERMIT(S) �v REQUIRED DETAILS ON PLANSDETAILS ON PLANS IfSWAGE SYSTEM PLAN - (NORTH ARROW) SDS HYDRAULIC PROFILE GRAVITY FLOW CONSTRUCTION NOTES DESIGN DATA: PERC & DEEP RESULTS 'CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT FOOTING /GUTTER/CURTAIN DRAINS SOIL TYPE BOUNDARIES TITLE BLOCK; OWNERS NAME,ADDRESS TM #,PE/RA; NAME,ADDRESS,PHONE# ATE OF DRAWING/REVISION DATUM REFERENCE . LOCATION OF WATERCOURSES, PONDS "LAKES AND WETLANDS WITHIN 200 FEET PROPOSED FINISH FLOOR AND BASEMENT EL. COMMENTS: ' ON PLAN - FROM SSTS. 10' TO P.L., DRIVEWAY, LARGE TUff .JpO OP.£�L,I,. 2n' •I''��F(,T:`Si�:IB�.;�ON= :'.rAL'.;5-= - -[:i rr c:A'i. `Cv ri.�� _, . ., e-.- ......,.. 100' TO WELL, 200' IN DLOD, 150' PITS 400' TO STREAM WATERCOURSE LAKE (inc. expan) 0'7`0 CATCH BASIN, 35' STORMDRAIN, PIPED WATER k0' TO WATER LINE (pits -20) 5�' INTERMITTENT DRAINAGE COURSE 200'/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS IS'MIN to CDS= >5 %,10'- 4 0/o,25'- 3 0/o,30'- 2 0/o,35' -1 %,100' - <I% 20'MIN to CD discharge /100'with 182 cons day discharge SEPTIC TANK 10' FROM FOUNDATION; 50' TO WELL WELL DIMENSIONS TO PROPERTY LINE LOCATION OF SERVICE CONNECTION