Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
3907
DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.16 -1 -55 BOX 30 !'y~ �lj T 1 I 03907 PUTNAM COUNTY DEPARTMENT OF HEA DIVISION OF ENVIRONMENTAL HEALTH. SE_R. • t, [) � ♦ _ t. . _ � w v^' :- Y.a._ ca ... , r - -w. ♦ .♦ r ..'it' .M a ..� a+• ...y.. •�. Y. ^. { •<.�� v. . � a o - %S. CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATME PCHD CONSTRUCTION PERMIT # _ ?V -05 -a8 Located at 5,5 MARSH RILL ROAD To or Village FUTN4H VALLFW Owner /Applicant Name V. � , corISMUCTio d C09p, Tax Map 83-16 Block :1 Lot 55 Formerly t4A Subdivision Name EA4 E RALP R' 04 E Subd. Lot # q Mailing Address 37 C4 TW -P q»1 ADV , d S S l N /NG A N zip 20592 Date Construction Permit Issued by PCHD 5119L2 00$ Separate Sewerage System built by V, S, C04 STfZyC -T1c / 6DRP Address '�� C O ScN�D 4"y l 997- Consisting of 1500 Gallon Septic Tank and LIL19 L•F OF t{'(5( PF4Fo9+9'r" PVC 11pr- iN 2y`' (.awe. TrR,rzwr -t+ Other Requirements: N 0 N F Water Supply: Public Supply From. Address . / I SL RA06,L ST"56T N or: X Private Supply Drilled by 0KMW AWpERFron1 Address Py , A*i .Building.Type ��l��e._i��� Has erosion control been completed ?._ 5 Number of Bedrooms Has garbage I certify tlat the system(s), as listed, serving the above built plans (copies of which are attached), in accor c plans and the standards, rules and regulation a Pi Date: Z _ ��ertified by i Address 4 J0104 ? A/o 1 h wes , ed ssentially as shown on the as- the iHD o ` truction Permit and approved Health. P.E. X R.A. # 661290 Any persm occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure ie 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 pri+ate water supply shall become null and void when a public water supply becomes available. Such \pprovalsare subject to modification or change when, in the judgment of the Public Health Director, such evoca�ipA modification or change is necessary. /V41101-11-1-b /¢ Title: 5 Date: ?ZO4 A cops - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 I Public Health Director -- LOREM A� � MOL;NAM R.:., V.S.K. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278.6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 E911 ADDRESS VERIFICATION FORM OWNERS NAME:. o C0/VGTq-QC-rL0W TAX MAP NUMBER: /C E911 ADDRESS: 5�.3 HAKOoH H 1(-(, RoA D TOWN: Vu t N /k AUTHORIZED TOWN OFFICIAL: s' (Signature) tX4 0 DATE: It 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 Certificatc of Construction Compliance. (E911 verfrm) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location -: .., Street. Address: � -3 M ._ (�. ... 11I Town/Village - =[, y _ -� r; ' Tax.Gtid # MaP �.06B10Ck Lots) S5 Well Owner: Name: Address: V 'I scr.fkc -cr '>^die k oD 4,PK /f 'W' 0 Use of Well: 1- primary 2- secondary VResidential Public Supply Air cond/heat pump Irrigation Business Farm , Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened ✓Open end casing Open hole in bedrock Other Casing Details Total length ajLS- ft. Length below grade a o ft. Diameter in. Weight per foot ! lb /ft. Materials: steel _ Plastic _ Other Joints: —Welded _✓ Threaded _ Other Seal: '- <ement grout _ Bentonite Other l Drive shoe: Yes v. o Liner _ Yes L_-No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield Test _ Bailed _Pumped teompressed Air Hours t Yield 4, gpm Depth Data Measure from land surface- static (specify ft) 30 During yield test(ft) Depth of completed well in feet 6, D0 Well Log If more detailed information descriptions or sieve analyses are-available; please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface v ve-y c f pit/ If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type,t w 6m-,3i u-Capacity Depth 41M Model t510 --a 1— Voltage A3_0_ HP 1 09) lie Tank Type 3o a Volume a O, Date Well Completed 4//,3//,) Putnam County Certification No. 6 of— /0 Date of Report '7 //, //" Well Driller (signature 'In. culkeL. - Nu'i'E: rxact location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. Well Driller's Name �11m inaA Ay"'e-sejl Address: IS—D, drt _a�l r 4h Q # ' I �� Signature: �I u� Date: 4 i3 �� OV � White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .-y ,i .... r.. �..�...,.�... ..t }~,- ,<••r•:•.T . -._ � .- -......� ..o•_ p.. —J S....� -. 'a. - l u-�_ 1. Y• ��. .. • GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM YO 8 • Coti6x a marl CAP-e. Owner or Purchaser of Building 89.0 IL S5 Tax Map Block Lot V A CSI S (aVC.-ri orJ CDiQ.P. RiTnre V� Building Constructed by TownNillage Rg tAM-60 H I LA, ROAD Location - Street 61A1G,L,F +n t!,�3 Rfu i ur7�cr-_ Building Type 0;1A WW P >4 % Subdivision Name 41 Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination th ublic Health no Director of the Putnam County Department of Health as to whether or no rail ail f the system to operate w s ca d by the willful or negligent act of the occup of a ild g utilizing the system. A A , Daj4; V4dth,� a� Day ZL Year U10 Signature: Title: GeATE f offtractor jOwnery - Signature Corporation Name (if corporation) Corporation Name (if corporation) Address: MCu'row D" P-*40� 6WAItAfh Address: State Ail Zip 1-059 Z. State Zip Form GS -97 °.. YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 A- ber-.t, H:.. Padovarai, .Dir..ec.t.ar�:: LAB #: 1.002946 CLIENT #: 2500 NON STAT PROC PAGE: 1 of 2 ANDERSON WELL DRILLING DATE /TIME TAKEN: 07/15/10 12:45 152 BARGER ST DATE /TIME RECD: 07/15/10 01 :25 ATTN: NORMAN, SARAH REPORT DATE: 07/22/10 PUTNAM VALLEY, NY 10579 PHONE: (845)- 528 -1491 SAMPLING SITE: 53 MARSH HILL RD, PUTNAM : KITCHEN TAP COLD BY: VAL SANTUCCI NOTES...: LOT 4 DATE FLAG PROCEDURE VALLEY, NY SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE. . : . < 4 C COLIFORM METH: MF RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 07/15/10 MF T. COLIFORM ABSENT /100 ML ABSENT SM 18 -20 9222B 07/20/10 LEAD (IMS) <1 ppb 0 -15 ppb SM 18 -19 3113B 07/21/10 NITRATE NITROG 0.84 MG /L 0 - 10 SM18- 20450ONO3 07/16/10 NITRITE NITROG <0.01 MG /L 1.0 MG /L SM18- 20450ONO2 07/21/10 IRON (Fe) <0.060 MG /L 0 -0.3 mg /l SM 18 -20 3111B 07/16/10 MANGANESE (Mn) <0.010 MG /L 0 -0.3 mg /l SM 18 -20 3111B 07/16/10 SODIUM (Na) 12.8 MG /L N/A SM 18 -20 3111B 07/15/10 pH 6.6 UNITS 6.5 -8.5 SM18 -20 4500HB 07/16/10 HARDNESS,TOTAL 176 MG /L N/A SM 18 -20 2340C 07/16/10 ALKALINITY (AS 90.0 MG /L N/A SM 18 -20 2320B 07/15/10 TURBIDITY (TUR <0.3 NTU 0 -5 NTU SM 18 (2130B) - COMMENTS.. MFTC a Coliform = This result indicates that the water (=!�ew (was not) of a satisfactory sanitary quality according to York State and EPA federal drinking water standard for this parameter. This comment applies. to the Total Col if.orm test only. Fe /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg /L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg /L of Sodium is suggested. pH pH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 -- - - Albert:: LAB #: 1.002946 CLIENT #: 2500 NON STAT PROC PAGE: 2 of 2 ANDERSON WELL DRILLING 152 BARGER ST ATTN: NORMAN, SARAH PUTNAM VALLEY, NY 10579 SAMPLING SITE: 53 MARSH HILL RD, PUTNAM : KITCHEN TAP COL'D BY: VAL SANTUCCI NOTES...: LOT 4 DATE FLAG PROCEDURE DATE /TIME TAKEN: 07/15/10 12:45 DATE /TIME RECD: 07/15/10 01:25 REPORT DATE.: 07/22/10 PHONE: (845)- 528 -1491 VALLEY, NY SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4'C COLIFORM METH: MF RESULT NORMAL - RANGE METHOD Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG /L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG /L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0 -70 MG /L VERY HARD WATER: ABOVE 300 MG /L MODERATELY HARD WATER: 70 -140 MG /L MG /L = MILLIGRAM PER LITER HARD WATER: 140 -300 MG /L (1 grain /gallon = 17.2 MG /L) THE ABOVE TEST PROCEDURES MEET ALL REQUIREMENTS OF NELAC, AND RELATE ONLY TO TH SE SAMPLES RECEIVED BY THE LAB SUBMITTED BY: Albert H. Padovani, M.T.(ASCP) Director ELAP# 10323 RONIN ENGINEERING, PE, PC The Lindy Building, Suite 200, 2 John Walsh Boulevard, Peekskill, New York 10566 Tel.: 914- 736 -3664 Fax: 914 - 736 -3693 - . _. -.._.. ..,.. . v ..•r..., _. ....r -.. p... > o• -.... ... yam. 1... �, ... -.. ..' - July 26, 2010 Mr. Joseph Paravati Assistant Public Health Engineer Putnam County Health Department 1 Geneva Road Brewster, New York 10509 Re: V.S. Construction Corp. Certificate of Construction Compliance 4 Bedroom Residence 53 Marsh Hill Road Town of Putnam Valley, New York 10579 Section: 83.16, Block. 1, Lot: 55 Subdivision Lot 4 of "Emerald Ridge" Dear Mr. Paravati, Enclosed for your review and approval please find the following items regarding the application for a Certificate of Construction Compliance at the above referenced project: 1. One (1) Certified Check in the amount of $300 made payable to the Putnam County Health Department. 2. Four (4) Copies of a two (2) year guarantee signed by the Owner & the Installer 3.- - Four (4)-Well Completion. Reports signed by Norman Anderson (The Well Driller) 4. One (1) Copy of Satisfactory Results of a Water Analysis by a Yorktown Medical Laboratories, a NYSDOH Approved Laboratory. 5. One (1) E911 Address Verification Form verified by the Town of Putnam Valley. 6. Four (4) Certificates of Construction Compliance 7. Four (4) Sets of "As- Built' Plans signed and sealed by Timothy L. Cronin III, the Design Professional. 8. One (1) Copy of As -Built Foundation Survey by Donnelley Land Surveying. Please review the above items at your earliest convenience and should you have any questions or require additional information, please do not hesitate in contacting me at the number above. cc: Val Santucci - owner bmitted, Project Engineer File- Paravati-PCDH- Santucci -Marsh Hill Road -Lot 4-SSTS As- Built -Trans JT- 20100726.doc Sherlita Amler, MD, MS, FAAP Commissioner of Health Robert-Morris, :PE Director of EnvironmentalHealth July 22, 2010 Timothy Cronin, PE The Lindy Building, Ste 200 2 John Walsh Blvd. Peekskill, NY 10566 Dear Mr. Cronin: Robert J. Bondi County Executive Department of Health 1 Geneva Road, Brewster, NY 10509 Re: Field Inspection — V.S. Construction Corp Marsh Hill Road (T) Putnam Valley, TM # 84.4-69, Lot 4 "he above w ynt.sysem.c_an be � c ; t�ac 11 d Ii7lelCe: P_�o comments to be addressed at this time in reference to this Departments open work inspections. If you have any further questions, please contact me at (845) 808 -1390, ext. 43261. GDR:kly Sincerely, Gene D. Reed Sr. Environmental Health Engineering Aide . 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 Nursing / Home Care Agency (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date. 7zz- Inspected Street Location --Owner- __2 I'lalle-y-- Permit# F> V 0 q TM 9 Subdivision Lot # 41 1. Sewage System Area a, STS area located as per approved plans .......... ...... :........... h. Fill section - date of placement 3:1 barrier Lgth. " Width_. Avg.Dpth c. Natural soil not stripped ................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/wetlands ........................................ IL Sewaze Svstem a Septic tank size.- 1,000 .......... 1,250 ......... other ... .. ..... ... b S eptic*tank installed level ..... ....................................... :- c. 10' minimum from foundation .......................................... d. Distribution Box 1. A outlets at same elevation -water tested ............ 2. Protected below frost .................. 3 ... Nfinimuni 2 ft. Original soil between box & trenches' e. Junction Box properly set ............................... ...... 6. Tenc hes 1. .Length required g�,z Length installed tlelq 2. Distance to watercourse measured 4- / e o Ft.......... 3. Installed according to plan ........................... I ............. 4. Slope of trench acceptable 1116 - 1/32"/foot .............. 5. 10 ft. from property line - 20 ft." foundations.......... 6. 1, Depth of trench <30 inches from surfice .................. 7.:' `Size allowed for expansion, 100% ......... ............... 8. Size of gravel 3/4 - 1' /z" diameter clean .................... 9. Depth of gravel in trench 12" minimum ..... . 10: Pipe.ends,.pap ........... Tumv.-or-DoYed Systems T Size of pump chamber.... .............. ..... .......................... ,2. Overflow tank .......................... : ............... I .................... 3. Alarm, visual/audio .................................................... 4. Pump easily'accessible, manhole to grade .................. 5. Firk box, baffled ............................... I ......................... 6. Cycle witnessed by H.P.estimated flow/cycle ........... M Home/Buildiii a. House locate per approved plans . ... .. ... . ..... b. Number of located ............................. ............ well ell Well located as per approved plans ............. 66 ............. b. Distance from STS area measured y,,,06 - ft........... c.. Casing. 18" above grade ............................. ; ................. d. Surface drainage around well acceptable...... . 6 ................ V. Overall Workmanship a. Boxes properly grouted .................................................. b. All pipes partially backfilled .......................................... c. All pipes ' flush with inside of box ................................... d. Backfill material contains stones <4" diameter .............. . e. Curtain drain & p standpi es installed according to plan.. f Curtain draiii outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate.... .... : .......................... i. Erosion control provided ............................................... Rev. 12/02 '10 -07 -19 11:43 FROM- T-819 P0001/0001 F -694 DIVISION OF ENVIRONWIENTAL HE LTH SERVICES ATTENTION 11 ADAM RF,QT MT FOR FINAL TNSPECTION All information must be fully completed prior to any inspections being made. ^ GENE For: Fill Trenches. X., PCHD ConstrVcoon Permit # —0 Located: MAF-Sh ROL, o PU71VPm'. Owner /Applicant Name: Y. 5, CO SIevOT(ON Cosa, TM - - -21. -Block I Lot _ ,.. Forzaerly: Subdivision Name: Subdivision Lot # Is system fill completed? FJJA Date: Is system complete? - C(I & D.J bt4LA v Date: Jq cM 16 1, w 10 Is system constructed as per plans? 6& Is well drilled? A Date: Is well located as per plans? N0 Are erosion control measures in: place? �s I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued_ PCHD Construction Permit and approved plans and the Standards, Rules and Regulation °6 he Putnam County Department of . _. health. - _ ^ Date: 19 /Z,° 10 Certified by: PE RA Design Professional Address: 7— JokAt WAN 40.T i9XWJkL AL4- 096 Lie. # 06 7,g Comments: Form FIR -99 Jul 09 10 03:41p Dan Ciarcia (914) 245 -5670 p.3 s >-. �• a -r. o r - -La :.v. -....: ..i '.3 .- +. � .- � .- 'r --•. �•it � •sr. . -.. i :,- . -•� s - c..a a..., ..: r - i r- v .. -cr >. - •.- _•e_., PUTNA.M COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION 13 JOSEPH REQUEST FOR FINAL INSPECTION All information must be fully completed prior to any inspections being made. PCHD Construction Permit # PV-05-D8 Located: Marsh Hill Road Owner /Applicant Name: V.S. Construction Corp. Formerly: © GENE For: kill ❑ Trenches R) -- (T) (v) Town (T) TM 84 Block 1 Lot 68 Subdivision Name: Emerald Ridge Subdivision Lot # 4 Is system fill completed? NA Date: Is system complete? Yes Date: 7/13/10 Is system constructed as per plans? Yes Is well drilled? Yes Date: 7/13/10 Is well located as per plans? Yes Are erosion control measures in place? Yes I certify that the system(s), as listed, at the above prer and verified their completion in accordance vAth _. ._appraved plans Arid the Standards, Rules and Date: 7/9/10 Certified strueted and I have inspected Vonstruction Permit and a1 ..County Departunent_.of- - - �.... r... :..... PE ✓❑ RA ❑ Address: 2451 Mohansic Avenue Yorktewn Heights, NY 10598 j ic. 61684 Comments: All work should be complete early next week. Form FIR -99 ins Y 4. z 3— IF I X _ PELT # Located at , rte 1,411 6cae Subdivision name [yKe r- « g,cl y e Subd. Lot # 14 Date Subdivision Approved 1 \I6 s nA % o o" Owner /Applicant Name Town or Village 'Po -Fyi, o i 1e.:./ Tax Map !W4, Block �_ Lot Renewal Revision Date of Previous Approval Mailing Address L 'T C re f" b A wt 6 a ()SS r 0 1 r S 1 y Zip I o,; 6Z Amount of Fee Enclosed S GrV Building Type S �, ^ ern . Lot Area 2. 4' No. of Bedrooms __L-L_ Design Flow GPD 9 L)oC pd t S a vrnC Q_ GIC . Fill Section Only Depth Volume Separate Sewerage System to consist of j , �' • gallon septic tank and I?" r Ty-r" . --zd bo I i.. (AA, a dg if Cf rc, ve i -t re ii c:h . Other Requirements: To be constructed by --T6D Address Water Supply: Public Supply From Address off:.: Prv, plyDrlled.by- . _ : . _ . _ - ..Address .. ; I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the stppdards;.ru es and regulations of the Putnam County Department of Health, and that on completion thereof a "Certifiag dfonYS�tiitibn Compliance satisfactory to the Public Health Director will be submitted to the Department, atm e be furnished the owner, his successors, heirs or assigns by the builder, that said builder will pl# ; ^good peFgtirig cor3di ion any part of said sewage treatment system during the period of two (2) years immediately f}l o�+vrng tdate of the'issuar' ce of the approval of the Certificate of Construction Compliance of the original system or Signed: Addressa M 't. �• �• 4ti P.E. R.A. w ./1 J . jo%b License # —Date- 1 y 6 0?glpv 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 perm it. Approved jdiscnarge>of/domestic sanitary sewage only. oitopy�- Title: _--� Date: Is HD File; Yellow copy - Buil rng Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner VS C, v s4yuc..-ku -v1 :N Address 3 n, +v-0 Do k4 Rd. Pi) i Located at (Street) Tax Map W4 Block t Lot -68 o r6Z (indicate nearest cross street) Municipality (:f) ITV 4 h k W1 y! y Watershed A e V SU 1 � k l o w Tr k SOIL PERCOLATION TEST DATA Date of Pre - soaking 07/410Y- Date of Percolation Test 07 10? 1 64� No ole 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 i2l A 1 X032 _ 10S-b 1 18 -2 1 3 � 2 lose – 11 08 -- 1 3 ,OF 32 2-4 1 3 4 1(3 2- - il5-6 24 i _ Z 5 1 5-' (57 �� _Zo 5- ��. 2 3 4 5 1 2 3 4 5 AU ES: 1. 'bests 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, _< 2 min for 31 -60 min/inch). All data to be submitted for review. 2. Depth measurements to be made from top of hole. Pomi DD -9r Pa. I o1'? DEPTH G.L. 0.5' 1.01 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' 9.01 9.5' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE No. HOLE NO. D 5- HOLE NO. I 3evw4 ell Liz Lou t V\ Indicate level at which groundwater is encountered e? V\ C- &-%j V" 41-11C Indicate level at which mottling is observed /"D-. - Indicate level to which water level rises after being encountered. U 2-1 1 D 5 Deep hole observations n,�,y;,. Gran ,n PC _D %4 _Date -.7- . I Oq Design Professional Na — 2 -1-0 � --, L,. , s- R4 c-- *k -, k- i S. lgl;t�jre: '2, < 629,S0 rofessiwa'I=s Seal 0 ss: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL - 3,= 'Please print or type Well Location: Street Address: Town/Village Tax Grid # - -j jt aQd' tVv ?�% rn V, /4, Map 9 Ll Block Lot(s) (, Well Owner: e: Address:�7 Nair + j V 7 cM S Ti° ✓ � 174 VI / ,3 T (�" L" pi Do o f ,- d . Agg "i 4 Use of Well: VResidential Public Supply Air /Cond/Heat Pump Irrigation /05-" 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5-- gpm # People Served Est. of Daily Usage 1�00 gal. Reason foreplace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ........................ ............................... ......................... Yes No Is well located in a realty subdivision? ..... ...... .......................... ............................... _ Yes No e ^ r, t R td 5 e Name of subdivision C� a Lot No. Water Well Contractor: -f-f2 D Address: _ Is Public Water Supply available to site? ............................... .............................. Yes No Name of Public Water Supply: —' _ Town/Village —' Distance to property from nearest water main: Proposed well location &sources of contaminat' e�!e p�s�e t/pla n. Date -Cl ::Applicant - Signature PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue ,f k 7 Permit Issuing Offici Date of Expiration Title: Permit is Non-Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 ba RONIN ENGINEERING, PE, PC The_Lindy Building, Suite 200, .2 John. Walsh Boulevard_, Peekskill, New York 10566.. 1el.: 914 - 736 -3664 C Fax- 914 =736 -3693 May 5, 2008 Mr. Joseph Paravati Assistant Public Health Engineer Putnam County Health Department 1 Geneva Road Brewster, New York 10509 Re: V.S. Construction Corp.- Emerald Rime SSTS Construction Permit Marsh Hill Road- Lot 4 Town of Putnam Valley, New York Section: 83. 16, Block: 1, Lot 55. Dear Mr. Paravati, In reference to your comment letter dated March 12, 2008, please find enclosed the following regarding an application for a Subsurface Sewage Treatment Construction Permit at the above referenced lot: 1. Four (4) Revised Subsurface Sewage Treatment System Construction Permit Plans for the above referenced lot. Should you have any questions or require additional information, please do not hesitate in contacting me at the number above. Respectfully Submitted, W. Teed, Jr. roject Engineer cc: Owner- Val Santucci (V.S. Construction Corp.) File- Paravati PCDH -Santucci- Emerald -Lot 4Transit- 20080505.doc SHERLITA AMLER, MD, MS, FAAP Commissioner of Health .. 'LORE'TTA.MO.LINA3 .RN,..MSN_, , Associate Commissioner of Health March 12, 2008 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 James W. Teed Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 Dear Mr. Teed: ROBERT J. BONDI County Executive ROBERT MORRIS,'PE" Director of Environmental Health Re: Proposed SSTS — VS Construction, Inc. Marsh Hill Road (T) Putnam Valley, TM# 84.4-68 This office has received and reviewed the most recent set of plans for the above - mentioned project. We would like to offer the following, comments for - your, review.. and. consideration.. 1. The trench detail is to note "clean dust free crushed stone or washed gravel ". 2. SDR -35 pipe needs to be noted as opposed to SDR -38. Please note this on all required areas of the overall plan. This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at est. 2157 if any questions arise. JSP /kly Very truly yours, G9.( 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 A ml PUTNAk COUNTY DEPARTMENT OF HEALTH . DIVISION OF ENVIRONiVIENT,AL.HEALTH .> , ....... _ .. INDIVID.i A-L WATER SUPPLY SLT—c -- AE SEWAGE TRP:ATIYIENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT Ng1vlEOFOWNER: VS O'on1�'iXDGTIVA) TREETLOCATION: NI��SU �/��� %Zoe ®, Py;ny,&, REVM ED.BY: RM, Jar', SRDATE: /a- �4Z5 TAX NEAP #: (CONFIRMED) $ 41 -- DOCUMENTS )PERMIT APPLICATION )WELL PERMIT OR PWS LETTER )PC.-97 a rLETTER OF AUTHORIZATION )DESIGN DATA SHEET (DDS) )CORPORATE RESOLUTION )SHORT RAF )PLANS -THREE SETS OUSE PLANS - TWO SETS )VARIANCE REQUEST SUBDIVISION )LEGAL SUBDIVISION ' )SUBDIVISION APPROVAL CHECKED ?ERC RATE !r 10 �f]LL REQUIRED DEPTH 7RTAIN DRAIN REQUIRED GENERAL j6CATED.IN NYC WATERSHED )S SUBMITTED TO DEP )DELEGATED TO PCHD )D P APPROVAL, IF REQ'D )'BEEP TEST HOLES OBSERVED ) PERCS TO BE WITNESSED R�X AXPROVAL SSDS ADJ, LOTS )WETLANDS (TOWN/DEC PERMIT REQ'D7) TA ON DDS-PLANS & PERMIT SAME J� j`��.tE ].9G9 NEIGHBCIR N,C?:T?�'FCATION . TTER. BUZBA j3'00 YR. FLOOD ELEVATION WlI 200'' )SOI - TESTING LOTS>10 YEARS OLD R.QUIRED •DETAILS ON PLANS I R'YDRAULIC PROFILE A►n*.. eorr ec f VTTY FLOW • (CONSTRUCTION NOTES 1-lei 7 DESIGN DATA: PERC & DEEP RESULTS 2' CONTOURS EXISTING & PROPOSED 0 IVEWAY & SLOPES, CUT iF0QTING /GUTTER/CUR.TAIN DRAINS iUMA SOIL TYPE BOUNDARIES i TICLE BLOCK; OWNERS NAME ADDRESS T1w, PE/RA; NAME, ADDRESS, PHONE# IDITE OF DRAWING/REVISION IDATUM RF.FERF,NCE . ILOCATION OF WATERCOURSES, PONDS L ias,WETLANDS WITHIN 200' OF P.L. IPROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS IWKLLS & SSDS'S W/M 200' OF SSTS OROPERTY METES & BOUNDS •. )MMSION CONTROL FOR_HOUSE, WELL & SSTs, EROSION CONTROL NOTE (REQUIRED DETAILS ON PLANS CONT'Dl )HOUSE SEWER-%" FT. 4 "0'; TYPE PIPE. CAST IRON UUNO BENDS; MAX BENDS 45 W /CLEANOUT RENEWALS SITE NOTE (NO CHANGE) FILL SYSTEMS 10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE ( FILL SPECS / FILL NOTES 1 -5 FILL PROFILE & DIMENSIONS (� LL IN EXPANSION AREA FILL GREATER THAN Z FEET CLAY BARRIEIR FILL CERTIb'ICATION NOTE U DEPTH GAUGES VOL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS (SEPARATION DISTANCE FROM'TOE OF SLOPE TRENCH L!x _JLF TRENCHPROVIDEDw 60FT MAX.. - PARALLEL to CONTOURS (___)L )100% EXPANSION PROVIDED U,aUDET'UST =FREE ORUSHED'STONE`OR��4'ASHED1GRAVE L_J(__)GEOTEXTILE COVER. SEPARATION DISTANCES ON PLAN - FROM'SSTS ( r/ U10' TO Y.L. DRIVEWAY, LARGE TREES, TOP OF FILL. . 20S.T.O'ROL.- SNDA:TTON= �!"AifiS� .�crr� e: -S}.oc,� • 100' TO WELL, 200' IN DLOD,150' T0, PITS 1.00' TO STREAM, WATERCOURSE, LAKE (inc. ezpaci) .. ( 0' TO CATCHBASIN,35'.STORMDRAIN,PIPED WATER L 10' TO WATER LINE (pits - 20') LJ� X50' INTPSvIITTENT DRAINAGE COURSE, 9E200'1500' RESERVOIR, ETC. 150' GALLEY SYSTEMS 1O' MW TO LEDGE OUTCROP SEPTIC TANK ULJIO' FROM FOUNDA. TION; 50' TO WELL WELL (! 1F_1DIMEPiSIONS TO PROPERTY LINES L�OCATION OF SERVICE CONNECTION MIN 15' TO'PROPERTY LINE SLOPE L- /t_- -) OPE IN SSTs AREA ` ° _,am) DEGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS PUMP NOTES . DOSE 75% OF PIPE VOLUMEMOSE VOLUME NOTED (� ETAIL FORFORCE:MAIN, (PIPE TYPE, ETC.) PIT AND D -BOX SHOWN & DETAILED 1 DAY STORAGE ABOVE ALARM CURTAIN DRAIN STANDPIPES, T BOTH SIDES, DETAIL 15' MIN to CDS= -•>5 %, ZO' -4 %, 25' -3 %, 35'-1 6/6,100 % - <1% ,' ' O' MIN to CD DISCHARGE/100' with 182 cons day discharge 10' MIN to NON - PERFORATED PIPE e r. 1�,Ld! PUTNAM COUNTY DEPARTMENT OF HEALTH D V SIO: .�T TV, �ONMEl�d'I'AL�.H L'I'H -SER -' CCE LETTER OF AUTHORIZATION RE: Property of V.S. Construction Corp. Located at Marsh Hill Road ITIV Putnam valley Tax Map # 84 Block 1 Lot , 68 Subdivision of Emerald Ridge ' Subdivision Lot # 14 Filed Map # 3 G f Date Filed do v,. 1 { Z o c -1- 3oQ(A 1j Gentlemen: This letter is to authorize Timothy L. Cronin III, P.E. a duly licensed Professional Engineer I ✓ I or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the piovisi nso� icle 145 and/or 147 of th E an Law, the Public Health and the Putnam r a Sai�fl o e. w , Very trul y s, Countersigned: Signed: 062980 P.E., R.A., ner r0p ) Mailing Address Cronin Eggineenrg P:1': Mailing Address: V.S. Construction Corp. 2 John Walsh Boulevard, Peekskill 37 Croton Dam Road, Ossining State New York Zip 10566 State New York Zip 10562 Telephone: (914) 736 -3664 Telephone: (914) 447 -4647 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION..OF .ENVIRONMENTAL HEALTH SERVICES .l+I� . .: Y. .. ,. Y - . l ., a • �a .s rt ..♦ �. :W.•. .. L .. t t ..Y' •f ✓ il/ .- ♦.. ..• ..t .• .. AFFIDAVIT -CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: Subsurface Sewage Treatment System Construction Permit (TM #: k4 — - 6y ) Val Santucci represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: V. S. Construction Corp. Having offices at: 37 Croton Dam Road, Ossining, New York 10562 Whose Officers Are: President - Name: Val Santucci Address: 37 Croton Dam Road, Ossining, New York 10562 Vice President - Name: Address: Secretary -Name: ddf Treasurer - Name: Address: and that I am and will be individually responsible for any < to the approval requested and all subsequent acts relating Sworn to before me this t 5 day of Qualified iri :1i i9sS Coui rorrmis-sIwr, Expir -; N" ,emUvr 1 Form CA -97 Signed: Title: orate Seal the corporation with respect PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - APPLI 'A IOl -FOR APP-ROVA.L. OF PLANS EOR._ A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: VS Cry S�� E crr�P 3--a- C ro Vv" l' V►n `Z Old , // (�sSryAc' S 1VY 1oS' -62 2. Name of project: �vU'0St(/I 60�O 41 3. Locatior('V: _?v VK 4. Design Professional: ,Hno41,ti t. Cr.1ivi IfC-5. Address: Z -77—o kn W vel• 6. Drainage Basin: f fro 1 (ow -3 r-0 o 12.0 0 S 6 7. Tvne of Proiect: 1/ Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ........................ ............................... Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... Ni3 10. Has DEIS been completed and found acceptable by Lead Agency? ............... `— 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or. other - =. _._officials; or inarrces? .:.................. ... ......... ............................ ... .................... ........_. 13. If so, have plans been submitted to such authorities? ........ ............................... a' 14. Has preliminary approval been granted by such authorities? Date 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) ........................................... ............................... 18. Is project located near a public water supply system? ....... ............................... &1#0 19. If yes, name of water supply Distance to water supply — 20. Is project site near a public sewage collection or treatment system? ................ 140 21. Name of sewage system F P Distance to sewage system — 6 2 � 22. Date test holes observed 23. Name of Health Inspector J0 V- 17' (A,014 24. Project design flow (gallons per day) ................................. ............................... 56V 5pd 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... evo 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? My 'J 28. Wetlands ID.Number . ,.......... sr. 29. Is Wetlands Permit required? .............................................. ............................... Has application been made to Town or Local DEC office? 30. Does project require a DEC Stream Disturbance Permit? .. ............................ .... AA 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 49 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? ............................... Ye56D DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... e,S _ 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ....... :....................................................... 35. Are any sewage treatment areas in excess of 15% slope? . ............................... A/a 36. Tax Map ID Number .......................... ............................... Map Block Lot 6 37. Approved plans are to be returned to ..... Applicant I" Design Professional NQ_TE: All applications for review-and approyai o f anew t.S �S n .bc:.IoLated.withiiilhd.NY —C Watershed sha•11 =- be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater.plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms.for;such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA- y�.).: Failure to comply with this provision may be grounds for the rejection of any submission. I hereby,affirm, under penalty of perjury, that to the best of my knowledge and belief. False, a Class A misdemeanor pursuant to Sectio� SIGN4,TURES & OFFICIAL TITLES: y of NEW form is true at�ka,Z' & nishable as W. 4 x r 27 -TO �_ �-J1.1Sl„_ 19 IvJ 19 ksk--all NY l os-66 J• r .............................. of NEW form is true at�ka,Z' & nishable as W. 4 x r 27 -TO �_ �-J1.1Sl„_ 19 IvJ 19 ksk--all NY l os-66 617.20 SEAR • Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only Part 1 - PROJECT INFORMATION (To be completed by Aonlicant or PrniPr:t snnnsnrl 1. APPLICANT /SPONSOR: 2. PROJECT NAME: VS Construction Corporation Construction of Single Family Residence 3. PROJECT LOCATION: Municipality: Town of Putnam Valley County: Putnam County 4. PRECISE LOCATION: (Street address and road intersections, prominent landmarks, etc., or provide map) West side of Marsh Hill Road, 2200 ft. north of intersection of Marsh Hill Road and Peekskill Hollow Road 5. PROPOSED ACTION IS: ONew ❑Expansion ❑Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: Construction of a new single family residence, ssts and private water supply. 7. AMOUNT OF LAND AFFECTED: Initially 2.946 acres Ultimately 2.946 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? N■Yes ❑No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ❑Residential ❑Industrial ❑Commercial ❑Agricultural ❑Park/Forest/Open space ❑Other Describe: Surrounding lands are zoned R -2 (Single Family Residential) 40:-DGES /`;GTfGNL INVOLVE- A- PERM,:F-APF-RE)V ;L -OR FUNDiNG;1NOW 'OR ULTD1ATcLY FROM- 'ANY`0THER GOVERNMEN'TAC' AGENCY (FEDERAL, STATE OR LOCAL)? Eyes ❑No If yes, list agency(s) name and permit/approvals Town of Putnam Valley — Building Permit 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑■ Yes ❑No If yes, list agency(s) name and permit/approval Town of Putnam Valley -Site Development Approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑Yes 0■ No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/Spons name: Cronin Engineering P.E•• P.C. /Patrick Bell Date: January 25, 2008 ' Signature: If the action is in a Coastal Area, and you are a state agency, complete a Coastal Assessment Form before proceeding with this assessment OVER 1 PART II- ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR, PART 617.4? if yes, coordinate the review process use the FULL EAF ❑Yes ❑No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another involved agency. C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: Answers may be handwritten, if legible. C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly: C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. Long term, short term, cumulative, or other effects not identified in C1 -05? Explain briefly: C7. Other impacts (including changes in use of either quantity or type,of energy)? Explain briefly: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑Yes ❑No If Yes, explain briefly: Part III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS For, each-adverse effect. identified above, determine whether. it.is_,substaritial, large, important:or.otherwise_ ._ F — -- 1 sigdi€cad� -1=aeh Of et -sho j[ be assessed -iri connectiori4ith its,(aj setting'(i:e :•urb 'ar oT- coral); (�) probabifity-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 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 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 Signature of Preparer (if different from responsible officer) Title of Responsible Officer Signature of Responsible Officer in Lead Agency date RONIN ENGINEERING, PE, PC The Lindy Building, Suite 200, 2 John Walsh Boulevard, Peekskill, New York 16566 Tel..: 914-7361 664-p Fax: 916- 736.3693 January 25, 2008 Mr. Joseph Paravati . Assistant Public Health Engineer Putnam County Health Department 1 Geneva Road Brewster, New York 10509 Re: VS. Construction Corp.- Emerald Ridge SSTS Construction Pennit Marsh Hill Road- Lot 4 Town of Putnam Valley, New York Section: 84.00, Block. 1, Lot: 68 Dear Mr. Paravati, Please find enclosed the following regarding an application for a Subsurface Sewage Treatment Construction Permit Renewal at the above referenced lot: 1. One (1) Affidavit of Corporate Ownership authorizing Val Santucci to represent V.S Should you have any questions or require additional information, please do not hesitate in contacting me at the number above. 7Res Submitte d, eed, Jr. Project Engineer cc: Owner- Val Santucci (V.S. Construction Corp.) File- Paravati-PCDHSantucci- Emerald -Lot 4Trans- #- 20080125.doc Construction Corp. 2. One (1) Letter of Authorization authorizing Cronin Engineering P.E., P.C. to apply for a construction permit at the above referenced lot. 3. One (1) Certified check for $500 made payable to the Putnam County Health Department on behalf of the above referenced application _ 4, _ Four (4) Pgbsurface Sewage Treatment System. Construction. Permit Plans for the above _ .. : y..:.... 5. Four (4) Subsurface Sewage Treatment System Construction Permit Applications for the above referenced lot. 6. Four (4) Applications to Construct a Water Well at the above referenced lot. 7. One (1) Short Environmental Assessment Form (SEAR 617.20) 8. One (1) Application for Approval of Plans for a Wastewater Treatment System. 9. One (1) Design Data Sheet for Soil Testing at the above referenced lot. 10. Three (3) Sets of proposed House Plans at the above referenced lot. Should you have any questions or require additional information, please do not hesitate in contacting me at the number above. 7Res Submitte d, eed, Jr. Project Engineer cc: Owner- Val Santucci (V.S. Construction Corp.) File- Paravati-PCDHSantucci- Emerald -Lot 4Trans- #- 20080125.doc PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: 1 Town/Village: 1 ax. Grid_# Map 85.14Block w .. Lot(s) 55. Well Owner: Name: Address: Vzj spa ccer 3'% erd-6koo a,t,, !f 41 0 Use of Well: 1- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened ✓Open end casing Open hole in bedrock Other Casing Details Total length s' ft. Length below grade a o ft. Diameter 6 in. Weight per foot 1 f1 lb /ft. Materials: steel _ Plastic _ Other Joints: _Welded _✓ Threaded _ Other Seal: 'dement grout _ Bentonite Other Drive shoe: Yes 1.,t o Liner _ Yes L_-No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped ttio-mpressed Air Hours'? i Yield 4 gpm Depth Data Measure from land surface- static (specify ft) 30 During yield test(ft) Depth of completed well in feet �d4 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 G V Ue y t1 Pn/ Q b L_ [ti fi i` ' {rte" 1 �.✓r If yield:was tested at diffe .refit depths dui ingdrilling,a"' list'". Feet Gallons Per Minute Pump /Storage Tank Information Pump Typey+,,6mAr3-;b/ ,Capacity _ Depth LP Model i- a�a'J_ Voltage v HP Tank Type 3o 3, Volume O, Date Well Completed 11,3 / v Putnam County Certification No. of— /o Date of Report ?/ %d 110 Well Driller (signatures '1'�+ l.� % Atlly C/ttiC&4001 NOTE: Exact location of ,well with distances to at least two permanent landmarks to be provided on a separate sneettplan. Well Drillees Name �%V�l -L it1c rey Sd ii Address: 1,5—D, au .a, Signature: - ?ir Date: 6 a 1M v White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Qj LOT 0c° Qp �R °d s 0 et 5 0 • ; . St ,� ALL TRENCH END$ � t °f(.,' °r ro ARE CAPPEL• ner i�, � �. 332 L.F. OF 4.0 SDR -35 PVC PIPE 1_ w122• BEND 1 �� ��� \O� 'jl� AS BUILT SEPTIC TANK 310 L.F. OF 4'0 CAST IRON PIPE ' vi �• ' ` t� Q c S BUILT f G�' J. nONBOx X0.0 o (TYPICAL IN ALLATION) G` 4 100% EXPANSION AREA .0, - S�c�, 7 SOLID FNC PIPE ;`t� ���-- .—--- - - -- -� Q �e9 1 4 11 '11 1' 1' 1 M - i� 11,1 111 1111 1 ,11 8' \` - ----- ----- -- - ----•.- -.. -.- 4'0 PVC ROOF LEADER 8 ` 4'S HDPE FOOTING DRAIN y, L077 DISCHARGE AWAY FROM SSTS � tr �C�oss .— st Cif Set i ' Area-128,306 / ^nt ^�e Setback L.17 2.9955 t , 3�6 �?j'• vQrWOy 1 100.0' SETBACK A s—Bu#t a 1 Well • Center /ine 1 er0 //v o y: 4. 4TE OF 8 TO 10 MINUTES PER NNELLY LAND SURVEYING =D AUGUST 8, 2008 WITH 1IDGE SUBDIVISION AND SITE N PUTNAM COUNTY CLERKS AS -BUILT S.S.T.S. LOCATION DISTANCES I DESCRIPTION A B SEPTIC TANK CENTER 55.1' 14.3' JUNCTION BOX 1 53.4'. 49.0' JUNCTION BOX 2 56.3' 55.0' JUNCTION BOX 3 59.3' 61.0' JUNCTION BOX 4 63.2' 66.9' TRENCH 1 END NORTH 109.1' 72.3' TRENCH 2 END NORTH 110.7' 76.7' TRENCH 3 END NORTH 112.1' 80.9' TRENCH 4 END NORTH 114.5' 85.8' TRENCH 1 END SOUTH 23.7' 79.7' TRENCH 2 END SOUTH 29.2' 83.4' TRENCH 3 END SOUTH 35.0' 87.6' TRENCH 4 END SOUTH 40.7' 91.6' AS -BUILT WELL LOCATION DISTANCE DESCRIPTION C D WELL :188.0' 163.0' o rrr deed A S-BUIL T S.