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HomeMy WebLinkAbout3910DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.16 -1 -58 BOX 30 I FINE I'll virl J .. 4R----�96N. � T *�� I .` , #. , NN 03910 PUTNAM COUNTY DEPARTMENT OF HEAL _DIVISION -OF ENVIRONMENTAL HEALTH .SER CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # - �� ®,n Located at 9.1 MAR&i H i .L 'ReA or Village iTihli4M i A"!l y Owner /Applicant Name V, S, - NS d RvCi+0N aP p. Tax Map _33. i �6 Block I- LOW .58 Formerly Mailing Address 3 C ROTON "DAM ROAD p 0 Subdivision Name F HP- f?ell,n iliAAF Subd. Lot # Zip la-scz Date Construction Permit Issued by PCHD 2d zf 37 Cft TDty ;SAM Rap Separate Sewerage System built by V'S . CD' N$-t1zVC -riLW Cagg Address fi Ss In iI44 --Ivy Consisting of -1 00 Gallon Septic Tank and 'PVC PIPE IN 74' 67PAyEL -DAENC Other Requirements: NONE Water Supply: Public Supply From or: Private Supply Drilled by _� *P. N- `%1-A105"QN Address RGSR SET Address Flo rnl4M YALLF-v I niT!f 9 Building Type 15iO4d,E Aftlo RiKIPW55, Has erosion control been completed? Number of Bedrooms Has garbage grinder been installed? /Vo I certify that the system(s), as listed, serving the built plans (copies of which are attached), in acc plans and the standards, rules and regulationglo� Date: — cy--' 10 Certified Address r� L. Crt ,r . rah�ises 6� one cted essentially as shown on the as- r th. ue&. Construction Permit and approved itnam;t. W" Dep ent of Health. Y 4! �J P.E. X R.A. License # ©{,29 20 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 revocat' n, modification or change is necessary. B itle: Date: t Whi a 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 Well ocatlon e� dress: hl ars h Y l xv Town/Village: 114 -A Q'11 1AAe r4 Tax Map # Map Block Lot(s) GPS_,kTMLL, Well Owner: Nam e: Address: /� 6�6�� �ti�(ti-i �Iw"► Qat 1fe� DSO %,t i Use of Well: esidential _Public Supply Air cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Institutional Standby Drilling Equipment _Rotary _Cable percussion Compressed air percussion Other(specify) Well Type Screened pen end casing _ Open hole in bedrock _Other Total Length I ft. Materials: -&- Steel Plastic Other Casing Details Length below grade ft. Joints: Welded _1,1-Threaded Other Diameter in. Seal: ment grout Bentonite Other Weight per foot %Ib /ft Drive shoe: Yes "o Liner: _Yes _No; Diameter in Slot Size Length ft Dept to Screen ft Develo ped? Screen Details First I I _Yes No Hours Second I I Well Yield Test _Bailed _Pumped ompressed Air Hours Yield gpm Depth Date Measure from land su ace -static (specify ft) -36 During yield test (ft) Depth of completed well in ft. Well Log Depth From Surface Well Diameter If more detailed Water Bearing in Formation Description ft. ft. information Land Surface -_ ----- descriptions.or -. sieve analyses are available, please attach. If yield was tested Feet Gallons Per Minute Pump /Storage Tank Information at different depths during drilling list: Pump Type '%capacity Depth YKO Model Z, Voltage 1216 HP�o Tank Type Volume $' G C� Date Well Completed' 'Well Duller PC Certlfrcate# 'pp .a 9 3 ;'�NY�State # cs/ 5'....,, :c,,�„ `'*. PumpInstaller PC Certificate # a l Date ofReport Well Driller Name'& A`tldress >� , F ti F ; n Y ° a M , n" -4 � Jv' S a WeII Drtller st nature g ) Y Pum Installer Name &Atldress ;,g x 3 z, f. _<,. ?a .Z < iz>, u '�. v ., .'Ex ... , a .atLewa' s Ax x_. as v ks:mu: r.5 . �..5'4 +,s». x^w>. \�'..eY3` >.. _M, :y'.� � , ,.<'iu�� Pump Installer(si` nature) � t , ?5'v.F }'; ,,,,.'.» » ✓iai?'3Y .�. :s].Y:o �'vx NOTE: Exact Location of well with distances to at least tw permanent landmarks to be ovided on a separate sheet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 BRUCE R. FOLEY Publk :Health D1r�ict�r DEPART.NMNT OF HEALTH 1 Geneva Road, Brewster, New York 10509 LORETTA MOLINARI RAT., - M.S.N. Associate Public Health Director Dwector of Pah'ent Services Environmental Health (845) 278 - 6130 Pax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278.6678 Fax (845) 278 - 6085 Early Interventiow7reschool (845) 278 - 6014 Fa: (845) 2711- 6648 E911 ADDRESS VERIFICATION FORM OWNERS NAME: VS CONSTRUCTIOW CORP- TAX MAP NUMBER: 83.16-1-58 E911 ADDRESS: 71 Marsh Hill Road TOWN: Putnam Valley AUTHORIZED TOWN OFFICIAL 1 -.0 17 /..1 -0 -- - __... _.. _._.. _ The Putnam County. Department of Health will not issue a Certificate of construction Compliance unless the above form is completed, i.e., a legal E91 I address is assigned by an authorized town official. This form is to be submitted with the application for a Certificatc of Construction Compliance. (E911 ver&m) FUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION ENVIRONMENTALREALTH SERVICES. GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM V, 3, cows ata,-, (or Owner or Purchaser of B V15. CON5 1,9WIleT Building Constructed by .72 Nnysr, Pitt _ Location - Street jcz � -T, 88.1 I 5S uilding Tax Map Block Lot J Cc pup, VP tWFN Town/Village � M � 2 -PIED R k D(A Subdivision Name 5 [N t, t v+ ► t,4 - Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination qf the Lublic Health Director of the Putnam County Department of Health as to whether or o he ri ilur the system to operiteavas used by the willful or negligent act of the occupantf e tilizing the I I —Day 3 Year 20 !d (Owner) - Signature Va - Co N S1R,tAc� A ON C-of q Corporation Name (if corporation) Address: Z�{ CU_Q7N D Am, ROA9 , D55, qN G State Nj vw � vpm Zip Corporation Name (if corporation) Address: State Zip Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVIC 15'FRUCTION ERM ' FOR SEWAGE TREATMENTSYS'Y 9M PERNIIT # ' Located at MAJ61- HlU- ROAD Town o Village yr � t Subdivision name J ,J&At b P4D41 Subd. Lot # ^7 Tax Map 61-14 Block I Lot _ $ Date Subdivision Approved 11- 141 -0'7 Renewal ✓ Revision Owner /Applicant Name \1!5 tplu6MwG &A 1p&p Date of Previous Approval 02.2o.ce Mailing Address 3i QLA11 bM D+^nn 710A A bSSINIr.ILt hN Zip p� 5 6 IF Amount of Fee Enclosed Sb0 Building Type 6 1&,LC- �tWtW Lot Areal. • No. of Bedrooms Design Flow GPD Da w � i �. - -- . Fill Section Only - Depth Volume Separate Sewerage System to consist of _ ��p gallon septic tank and Other Requirements: ✓_ To be constructed by q4 6M4rWGjjo,J &0 Address Water Sup"I : Public Supply From or:.... P -nvate Su ply Drilled �b. _ ,r, . pi? -- . . y �SD1�D Address I represent that. I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatmentsystem described -_ yAwill be constructed as shown on the approved amendment thereto and in accordance with the standards, rules . reI2fti4mthe Putnam County Department of Health, and that on completion thereof a "Certificate of Constru ®M'`' mp ' '� sa�'isfactory to the Public Health Director will be submitted to the Department, and a written guar tee ^,i�'1 be fuurnis 6 *'owner, his successors, heirs or assigns by the builder, that said builder will place in good oper 'nindi �?part o said sewage treatment system during the period of two (2) years immediately following the date a issu 66` t °e appcoyal of the Certificate of Construction Compliance of the original P system or any repairs ther _, f 2 V Signed: �tb jo �^ P.E. R.A. Date I -10- D Address Sq Af1L a L License # p(, ZRgo N` 1oS67 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 p ,pqnit. Approved for discharge of domestic sanitary sewage only. gWhit Title: y F Date: c� py - HD File; Yellow copy - Buil 'ng Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type �1 PCHD1? @(tilt`# w? Well Location Street Address: ow illage: Tax Map # PVTAlA'n 0%AJJ Map03.14 Block I Lot(s) Well Owner: Name: Address: Phone #: \15 C®1u qty A-v N (AL®• 1-7 4ZvTDN P4^\ R o& l) O S5t N 1 rt4, 1�►� !'� �F7 Igin 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---Ir gpm # People Served Est. of Daily usage 080 gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drilling VNew Supply (new dwelling) Deepen Existing Well Detailed Reason l t= WC1E for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes _ No Is well located in a realty subdivision? ........................................... ............................... Yes V/ No Name of subdivision k-WU,® IL-104C Lot No. Water Well Contractor: P ORANAiy ®.A1MI 140) Address: Is Public Water Supply available on site? ....................................... ............................... Yes No _ Name of Public Water Supply: & T n/Village , Distance to property from nearest water main: Proposed well location & sources of contamination to be on separate sheet/plan. .�Iicant,.Signatur - - Date:.... pp 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. 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 Commissioner of Health. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putn unty.',ef) n Date of Issue / O �� Permit Issuing Offi ial: / ` �OZ X Date of Expiration I n Title: Aunz Permit is Non- Transferable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Rev. 3106 r YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 _ _..._.. _....._ . Pa t} yy� - .. .. _. ..� . yt ... a. ...>- ....na�: ...v.. �.: ",:_. �,. 0."•. .., s,. ..,. ... .,. . � .. .. dn..,�7,y�t`.I:'y.,. _���, �y C.wo.?.�n �F.. s: -t .. .. -i..ry �..�. .. ..-. _.. ..,.. . .. .. A_. ex:t.:H .. .,..N_..: LAB #: 1.003914 CLIENT #: 2500 NON STAT PROC PAGE: 1 of 2 ANDERSON WELL DRILLING DATE /TIME TAKEN: 09/14/10 10:00 152 BARGER ST DATE /TIME REC'D: 09/14/10 10:35 ATTN: NORMAN, SARAH REPORT DATE: 09/21/10 PUTNAM VALLEY, NY 10579 PHONE: (845)- 528 -1491 SAMPLING SITE: LOT 7 SAMPLE TYPE..: POTABLE : MARSH HILL, PUTNAM VALLEY, NY PRESERVATIVES: NONE COLD BY: NORMAN ANDERSON TEMPERATURE..: < 4C NOTES...: WELL COLIFORM METH: MF ------------------- - - - - -- ---- ~-- ~-------- ~ ---------- DATE FLAG PROCEDURE RESULT NORMAL - RANGE PUTNAM CNTY PROFILE 09/14/10 MF T. COLIFORM ABSENT /100 ML 09/17/10 LEAD (IMS) 1.0 ppb 09/17/10 NITRATE NITROG 1.45 MG /L 09/15/10 NITRITE NITROG <0.01 MG /L 09/16/10 IRON (Fe) <0.060 MG /L 09116110 MANGANESE (Mn) 0.012 MG /L 09/21/10 SODIUM (Na) 12.4 MG /L 09/14/10 pH 6.4 UNITS 09/16/10 HARDNESS,TOTAL 196 MG /L 09/16/10 ALKALINITY (AS 88.0 MG /L 09/15/10 TURBIDITY (TUR <0.3 NTU _ COMMENTS .. _ - MFTC a Coliform = This result indicates that (was) (was not) of a satisfactory sanitary ew York State and EPA federal drinking this parameter. This comment applies to the only. ABSENT 0 -15 ppb 0 - 10 1.0 MG /L 0 -0.3 mg /l 0 -0.3 mg /l N/A 6.5 -8.5 N/A N/A 0 -5 NTU METHOD SM 18 -20 9222B SM 18 -19 3113B SM18- 20450ONO3 SM18- 20450ONO2 SM 18 -20 3111B SM 18 -20 3111B SM 18 -20 3111B SM18 -20 4500HB SM 18 -20 2340C SM 18 -20 2320B SM 18 (2130B) the water quality according to water standard for Total Coliform test 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. Fp YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 Albeit ii Padovan DireecQr LAB #: 1.003914 CLIENT #: 2500 NON STAT PROC PAGE: 2 of 2 ANDERSON WELL DRILLING DATE /TIME TAKEN: 09/14/10 10:00 152 BARGER ST DATE /TIME RECD: 09/14/10 10:35 ATTN: NORMAN, SARAH REPORT DATE: 09/21/10 PUTNAM VALLEY, NY 10579 PHONE: (845)- 528 -1491 SAMPLING SITE: LOT 7 SAMPLE TYPE..: POTABLE : MARSH HILL, PUTNAM VALLEY, NY PRESERVATIVES: NONE COLD BY: NORMAN ANDERSON TEMPERATURE..: < 4C NOTES...: WELL COLIFORM METH: MF ------------- ~ ------ ���� DATE FLAG PROCEDURE 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) SUBMITTED THE ABOVE TEST PROCEDURES MEET ALL REQUIREMENTS OF NELAC, AND RELATE ONLY TO HESESAMPLES RECEIVED BY THE LAB BY: EMW % lam Albert H. Padovani, M.T.(A CP) Director ELAP# 10323 .... • ;39 Arlo Lane ENGINEERING P:E , P.C.. Cortlandt Mano,r,NY.19567 Professional Enaineerina &Consultind T•(O!A) 71A -lAAa G:rn;ni 7 -jti -:ienn PUT'NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVI�ES LET Y t � " A�J�ili���A� TOiv:, RE: Property of Q 4 i (�AJ�1tiLyL?lD� C® Located at N 4(2,5H- I-it.Lt- UAD (?V P�i'-/ti Tax Map # Block e t Lot s� Subdivision of eA4eA C1_0 0-061 Subdivision Lot # Filed Map # 3 Date-Filed 11- lq - 0"7 Gentlemen: This letter is to authorize "?V/j►w a duly licensed Professional Engineer k., oz_Rzg4= 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 proms- �:j@ - -o ',le 145 and/or 147 of the u tion , the Public Health Law, and.the Putnam . 1 "o Very truly rs ^y: i'E4i W 1 W n Countersigned: �, ,�,- z r Signed: G ,c� P.E.,' c• .; # � i (own r o r ' e ,) Mailing Address Pc Mailing Address: \1!� cc,4.P _51 AN-0 LPOJE , 60pr"Nff- ^NOII sn G ewfij DAM NIPS. State P�l Zip iD56 7 Telephone:_ a14j 736 •3661+ State Zip ►.CfGc- Telephone: 41 cet 4t kl 464"7 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBNIITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: \J-"i Lafy 4TAy4,yg,0 e-ya A -7 L'tfMeat.V►cJ� �p 1, 4AMY64A represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: y-5 CGS iT4,X.VPP 664e Having offices at: '3'7 GRv e DAM RaAP F�SSI,uING lam - I o5'b2 Whose Officers Are: President - Name: \tPN `54444LI Address: 31 Lt gnm 04M APA-D 0SStoJINI1 MA 1 O'TL Z Vice President - Name: Address: Secretary -Name: . . � - �Addr" "ass: .- - .. .. _.. .. .. .. _ -- ..,.... �... _ . _. _ .. Treasurer - Name: Address: and that I am and will be individually responsible for any an all is -thf moration %yith respect to the approval requested and all subsequent acts relating t .ei Sworn to before me this _ I p day of (month 20 I v (year) Notary P lic .,.WEY DICOLA Notary Public, State of New York No. 011316199087 Qualified in Westchester County Term Expires January, 6,2013. Form CA -97 Corporate Seal ���1 ���►��l!�,�.!1,11�,� �t 0II Sherfita Amler, AM, MS, FAA-P Commissioner of Health Robert Morris, PE WC DireqoVfF7iro n mentalHealth Ra"F artm-ent of "wealth 1-- 1 Geneva Road, Brewster, NY 10509 Office (845) 808-1390 Fax (845) 908-1937 November 9, 2010 Timothy Cronin Cronin Engineering, P.E., P.C. 39 Arlo Lane Cortlandt Manor, NY 10567 Re: Field Inspection — V.S. Construction Marsh Hill Road (T) Putnam Valley, TM # 83.16-1-58 Dear Mr. Cronin: %I Robert J. Bondi County Executive The above referenced separate sewage treatment system can be backfilled. There are no open .-comments to-be,addressed,at this time in-referenced to this—Departments--open-work inspection.:..:. If you have any further questions, please contact me at (845) 808-1390. ext. 43261. Sincerely, Gene D. Reed Sr. Environmental H6alth Engineering Aide GDR:kly PUTNAM COUNTY DEPARTMENT OF REALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date:o . - Inspected by: Ca Street Location.. Owner -_Vi ..Town Permit # PV TM # q 3, I e — l 5-6 Subdivision Lot # 1. Sewage System Area a. STS area located as per.approved plans .......... ................. b.. Fill section - .date of placement 3:1 barrier Lgth. Width . Avg.Dpth C. Natural soil not . stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/ wetlands ...... ............................... II. _Sewage: System a. Septictank size - 1,000 .... ......1,250 ......... other ... 00,0_ b. - Septic.tank installed level . c. 10' minimum from foundation .......... ............................... A Distribution Boa . 1: All' outlets at .same elevation -water tested...::::.. 2. Protected below frost .......................... x ..................... 3. .. Nfinimuin 2 ft.Original .soil between box & trenches e. Junction Box properly set .......... ............................... 6. "Trenc ems - 1. Length.required #,0 ® Length installed -,f0® 2. Distance to watercourse measured _t. jq::,, Ft.......... 3. 'Installed according to plan....... .............. 4. 'Slope!of trench acceptable '1/1'6 _ 1/32" /foot ............. 5. ;1O ft. from .property he - 20 ft .T foundations.......... 6. Depth of trench <3 0 inches :from surface .................. 7. Room allowed for expansion, 100 % .........:............... 8. Size of gravel 3/4 1'A diameter clean ...................: 9. Depth of gravel .in-trench 12" minimum ................... 10. Pipe ends ,c a ed.......:... .... .. .............................. g. PuFp or Dose pvstems 1.. Size of pump chamber ................ ............................... 2. Overflow tank ..: ....................... ............................... 3. Alarm, wisua] audio .......... . ....................:.:........ ..:........ 4. Pump easily accessible, manhole to grade ................. 5. First''box baffled ......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... IIL.House/BuRding .a. Huse located er approved plans ......:....... b. Number of bedpooms ..... ...........................��:! ......... IV. Well Well located as per approved plans ................................. b... Distance from STS area measured -71"/9o- ft........... c. Casing 18" above grade ................ ............. ................... d. Surface drainage around well . acceptable ....................... V. Overall Workmanshin . a.. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ....................... . ................... c. All-pipes flush with inside of box ... ............................... d.. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f Curtain drain outfall protected & dir.to exist watercourse g. .Footing drains discharge away from STS area............... h. Surface water protection adequate .... ....:.......................... i. Erosion control provided ................. ............................... Rev. 12/02 `10 -11 -01 16:10 FROM- T -908 P0001/0001 F -995 _ :.PUTNAM COiJN'> Y- DEPA,RTMENT OF HEA.i TH' DIVISION OF. ENVIRONTYIENTAL HEALTH SERVICES ATTENTION C1 ADAM REQUEST FOR FIN AY, INSPECTION All information must be fully completed prior to any inspections being made. 0 GENE For: Fill Trenches PCHD Construction Permit # PV— 06 ~ 0 8 Located: 71 MA 14 M Ue ROAD V, Ovs�ner /Applicant Name: •Corr `tt'�v Div �, $ �� Block,��,..� Eot ,_ Formerly: Subdivision Name:�M k' D4 Subdivision Lot # _ Is system fill completed? VIA Date: Is system complete? YES Date: go 1,9 Is system constructed as per s? Is well drilled? ..,. Tan. Date: %12e 4 ?0 to Is well located as per plans? 6� Are erosion control measures in place? I certify that the systems), as listed, at the above and verified their completion in accordance approved plans and the — :,Health_ .... Standards, Rules and Date: l ZUI Certified by: Address: h/.j aLs 1�I�10�A/yl Comments: Form FIR -99 and I have inspected truction Permit and runty Department of r, /mil g iJ A l rlA1VA k. 'l u iN A x jjr-j 'f-,n 1 YktjiN I Ut ti -LA-U I ti DB ISI ®N OF ENVIRONMENTAL HEALTH SERVICES J DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM :¢ O`VI1�- �-O�S'ff2uC.iiv,V Cola ddress 37 - G2o -fDN RA�v1 RortDr d 'N:yG :�5� Located at (Street) MAN tHU, R-6AD Tax Nlap 831(1 Block 1 Lot 58 (indicate nearest cross street) nicipality a) PupjAm \1aI4� ej Drainage Basin..��'���: �}oi,t,D.w gam(_ Vp SOIL PERCOLATION TEST DATA Date of Pre - soaking o-7 - os - o4 Date of Percolation Test �,� .oq • o - Hole No. Run `No. Time Start - Stop Ela 'se Time I n.) Depth to Water:. I,rom Ground Surface (Inches) Start Stop Water Level Dro In IncUs Percolation Rate Min/Inch Yh 2 1036 iooff I (� -? 3 3 to*F -[05`+ q t$ -Zl 3 4 5 loi --LZ '� 3 25 2 _3 psi^ l (oo 4 5 2 3 5 NOTES: ' I.: ` Tests to he reneaterl nt same denth until annrnximitely Pmial na'rrnla:tinn rntac are nhtainpr nt aarh percolation test hole:_ (i.e. e I min for 1 -30 rr in/inch, _< Z min for 31 -60 min/inch) All data to be submitt ed tot review; Ti. , '.1)epth measurements :to. be made from top of hole. Form DD -97 0\ TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE. NO. -2-5 A te,.. H.0 Q , NO VA&A, EDLE 05 1.01 1.5 llvlN 99A.VP f7N� :'5AND U60r (38a_-2 '2.0t eA7AveL U-/ COMes k, ra%sj a- Z-4 Zvi a le- 5 2.5' 3.0( 3.5' 4.01 "N AAJ6 4NJf) 6Vftt avul JFL-.�JD 4,o_� QlAtkL 4.5' UJI C061(bW5 5.0 5.51 in. 6.0' 6.5 3 7.0' 84J 7.5' 1.1 in 8.51 9.01 Indicate level at which groundwater is encountered 44 6)a ewcouji-AEUT) Indicate level at which mottling is observed Hr". ois,5 1.ve�> Indicate level to which water level rises after being, encountered NJA Deep hole observations made by: C&MIQ Pte.. Date �.-7.00* Design Professional Name: Address: LL Signature: Design Professional's Seal or NEW 629-80 - PUTNAM COUNTY DEPARTMENT OF HEALTH VISION OF ENVIRONMENTAL HEALTH SERVICES COINISTRUC-TION PERM C-7t r OR SEWAGE TREATMENT SYSTEM PERMIT # �470(0-01�- Located at tjARS H HILL. ROAD) Town or Village NNAM VALLEY 6 6$ Subdivision namep RID�,E Subd. Lot # 7 Tax Map -� Block 1 Lot 44= Date Subdivision Approved NOVEMBE R 190 200 Renewal Revision Owner /Applicant Name V,5. CoAS=0r -lu&/ Cogp, Date of Previous Approval Mailing Address 37 CRoTnN PAM RO,Qn oftiy/NG, , NEW VORK Zip 105b2 Amount of Fee Enclosed $500.00 Building Type &4& LE FAMIty Lot Area 2.1156 No. of Bedrooms _q Design Flow GPD 800 Fill Section Only Depth Volume Separate Sewerage System to consist of 11500 gallon septic tank and 400L.F. OF 4` 91 PER FogaTleP PVC PIPE /N 2y "60PAVEL. 7imww Other Requirements: NONE To be constructed by T,QQ Address Water Supply: Public Supply From T orb , e/ _ Private' Supply Drilled by . T Address Address — `r- I represent that I am who and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment ay stern 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 C0m071rk(* - -,sgtisfactory to the Public Health Director will be submitted to the Department, and a written guar 6; wik e_fur�ij lied tR owner, his. successors, heirs or assigns by the builder, that said builder will place in rth;ttetit ra ing.oqu�dition any 4 of id sewage treatment system during the period of two (2) years 031 immediately folio 'tl'e i ssuance;. fthe ap ov q of the Certificate of Construction Compliance of the original system or any �p irs ere Signed: P.E. R.A. Date of 31 -2008 Address 2JONr4 WALS9 Bou ll' P Klu. , IVY 10566 License # 062:980 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: 'P" / ts,— Date: 2 4 White 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 APPLICATION TO CONSTRUCT A WA'I'TER W1±,LL P ase prin f type P _... e..._ CH let o D Permit # Well Location: Street Address: I To illage Tax ' # MA LL Puwm 1/ Map Block 1 Lot(s) Well Owner: Name: Address: ff V,S• Cr onl P. 3 CRonw DAM ROAP, 055INit4cl AlEwyalyc 105 2 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 5 gpm # People Served _ Est. of Daily Usage dOO gal. Reason for Replace 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 Name of subdivision 5#4FgALD Rip4F Lot No. q Water Well Contractor: TAL? Address: °-- Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: AIIA Town/Village YA Distance to property from nearest water main: Proposed well location & sources of contamination to pr ded eparate sheet/plan. �y 01!,31-2006.. 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. e ®� Date of Issue Z a Q D Permit Issuing Official: Date of Expiration o 6 Title: Permit is Non- Transfe able 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 INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS • .. .SH •hn s -'•C „e •..� . . .. :.. T.:6 CY:hw- .wrt....v`r .. •t .a .- ..e,...r --,I: a:- •ty '•I9 ..... .. • v c.r .v :n ... :4 .. � � 0.'. Ham. -vy. � ..rr i1 _ • n- tr.v .• • t0 :C.;ONSTRUC�'ICjN:$EI�1VI. NAME OF OWNER: V Gel, i STREET LOCATION: REVIEWED BY: RM, GR, A GSRDATE: 2 6 ,t Ok TAXMAPn: (CONFIRMED) 2E' z6 (Y DOCUMENTS Y N (REQUIRED DETAILS ON PLANS CONT'D) PERMIT APELICATION L.—,,)C—)WELL PERMIT OR PWS LETTER ,/ (_)PC -97 ( OLETTER OF AUTHORIZATION (DESIGN DATA SHEET (DDS) (CORPORATE RESOLUTION SHORT EAF (��PLANS -THREE SETS (_HOUSE PLANS -TWO SETS (__)(_t ! VARIANCE REQUEST SUBDIVISION LEGAL SUBDMSION SUBDIVISION APPR VAL CHECKED C��y ERC RATE (_J( I:JFILL REQUIRED DEPTH (�( CURTAIN DRAIN REQUIRED GENERAL Ec—ic2z;,OCATED INNYC WATERSHED LANS SUBMITTED TO DEP )DELEGATED TO PCHD (�( DEP APPROVAL, IF REQ'D � EEP TEST HOLES OBSERVED J (__)(yERCS TO BE WITNESSED (_ C__ X- APPROVAL SSDS ADJ, LOTS (_)(&WETLANDS (TOWN/DEC PERMIT REQ'D ?) (_am}/ ()DATA ON DDS PLANS & PERMIT SAME (_J( JPRE 1969 NEIGHBOR NOTIFICATION (__J(g6LETTER BI/ZBA ( J(40100 YR. FLOOD. ELEVATION WA200.. - - - ((,SOIL TESTING LOTS >10 YEARS OLD / REQUIRED DETAILS ON PLANS (_)s )SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE GRAVITY FLOW CONSTRUCTION NOTES 1 -15 DESIGN DATA: PERC & DEEP RESULTS . ( T CONTOURS EXISTING & PROPOSED ( DRIVEWAY & SLOPES, CUT (t�UFOOTING /GUTTER/CURTAIN DRAINS (f� USDA SOIL TYPE BOUNDARIES TITLE BLOCK; OWNERS NAME ADDRESS TM #, PE/RA; NAME, ADDRESS, PHONE# (_)DATE OF DRAWING/REVISION (DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS CALLAKES,WETLANDS WITHIN 200' OF P.L. –)PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS ��WELLS & SSDS'S W /IN 200' OF SSTS PROPERTY METES & BOUNDS )EROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE COMMENTS (IiEVSIIEET)09/0I /0U �NO HOUSE SEWER -' /," FT. 4 "0'; TYPE PIPE CAST IRON BENDS; MAX BENDS 450 W /CLEANOUT B Fo-P�E GPATLS C_)(__)SITE NOTE �NGE) FILL SYSTEMS U(_)10' HORIZONTAL; PAST TRFAICIT SLOPES 3:IJO GRADE (_)L)FILL SPECS/ I ES 1 -5 (_)(_)FILL PR E &DIMENSIONS (___)UFI EXPANSION AREA .U(__) CLAY BARRIER )(_)FILL CERTIFIC ON NOTE (_)L�DEPTH G j ES (--)(_)VOL�. PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS (—)(_)SEPARATION DISTANCE FROM TOE OF SLOPE TRENCH C- D(_)LF TRENCH PROVIDED ' '& p LOFT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED DETAILMUST FREE CRUSHED STONE OR WASHED GRAVEL' (__)GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS ��L 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS Cm 41 100' TO WELL, 200' IN DLOD,150' TO PITS 100' TO STREAM, WATERCOURSE, LAKE. (ine. eapan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATERLINE its 20' O'INTF.P-- t!LITTENT- DP AINAGE- COURSE -- .–. • �__... 6HIO'*MIN 200'/500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS TO LEDGE OUTCROP SEPTIC TANK ( (�10, FROM FOUNDATION; 50' TO WELL WELL (DIMENSIONS TO PROPERTY LINES LOCATION OF SERVICE CONNECTION 15' TO PROPERTY LINE SL, OPE (___)(_)SLOPE IN SSTS AREA 1)-- (_)(+ EGRADED TO 15 %, IF REQUIRED UUPUMP NOTES (_)(DOSE 75% OF PIP ' UME/DOSE VOLUME NOTED U(_JDETAIL FOR CE MAIN, (PIPE TYPE, ETC.) �.: (_))PIT AN - OX SHOWN &DETAILED CL) )1 STORAGE ABOVE ALARM CURTAIN DRAIN )(•_)STANDPIPES, 5' BOTH SIDES, (_)( _J15' MIN to CDS = >5 %, 2 ' o, 25' -3 %, 35'-1 %, 100 % -<1% L,L)20' MIN to CD ARGE /100' with 182 cons day discharge C—)Lj10' M ON- PERFORATED PIPE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONM.ENTAL_HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: V.S. Construction Corporation 2. 4. 6. 7. 8. 9. 10. 11. 37 Croton Dam Road Ossining, New York 10562 Name of Project: Emerald Ridge- Lot 7 3. Location: TN: Putnam Valley Design Professional: Timothy L. Cronin III Drainage Basin: Peekskill Hollow Brook Type of Project: ✓ Private/Residential, Food Service Apartments Institutional Office Building Realty Subdivision 5. Address: 2 John Walsh Boulevard Peekskill, New York 10566 Commercial Mobile Home Park Other (specify) _ Is this project subject to State Environmental Quality Review (SEQR) ? .............. Yes/No No Type Status (check one) ...................................... ............................... Type I Exempt Type II Unlisted ✓ Is a Draft Environmental Impact Statement (DEIS) required ? .................... Yes/No No ....... Yes/No N/A Has DEIS been completed and found acceptable by Lead Agency? Name of Lead Agency Not Applicable 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ............................................................. ............................... Yes/No Yes —. _ . _,... : _ r_. . 13. If so, have plans been submitted to such authorities? .. Yes/No Yea 14. Has preliminary approval been granted by such authorities? N/A Date granted: N/A 15. Type of sewage treatment system discharge ........................ surface water ✓ groundwater 16. If surface water discharge, what is the stream class designation? .......................... N/A 17. Waters index number (surface) N/A 18. 19. 20. 21. Is project located near a public water supply system? Yes/No None If yes, name of water supply Not Applicable Distance to water supply N/A Is project site near a public sewage collection or treatment system? .......... Yes/No None Name of sewage system Not Applicable Distance to sewage system N/A 22. Date test holes observed 24 25 23. Name of Health Inspector Project design flow (gallons per day) 800 GPD 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 Rev. 11/02 Form PC -97 Pg. 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' 29. 30. 31. 32. Is Wetlands Permit required? ...................................... ............................... Yes/No No Has application been made to Town or Local DEC ........................... Yes/No N/A Does project require a DEC Stream Disturbance Permit? .... .........................Yes/No No 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 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 83.16 Block 1 Lot 58 37. Approved plans are to be returned to ................ Applicant ''� Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review'and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Itexn.,1,,,Q4e application must be accompanied by a Letter of Authorization (Form LA -97). Failure to coti ply-, i'th ?th s' , ovision may be grounds for the rejection of any submission. L x y ff m, penalty fperjury, �' ry, I hereby a it under enal o that a r at on ��v is fir i true to the best of my knowledge and belief. False statements d ere A pun ag[,e'; assa Cl misdemeanor ,.: w pursuant to Section 210.45 of the Penal L _ �\a SIGNATURES & OFFICIAL TITLES: Timothy L. Cronin III Mailing Address ............................ Cronin Enqineerinq 2 John Walsh Boulevard, Peekskill, NY Form PC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH L- i . -r '�' .- .. r = _0 �` -ER�� HEAL H� SPE_ A LETTER OF AUTHORIZATION Property of V.S. Construction Corp. Located at Marsh Hill Road JTTV Putnam Valley Tax Map # 046 Block d. ' Lot 58 Subdivision of Emerald Ridge Subdivision Lot # Gentlemen: 0 3003 V .// Filed Map # 3045 J Date Filed �O BEi° s9. �ZwF This letter is to authorize Timothy L. Cronin 111, 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 pgrvise the;co sc of said wastewater tretment and /or water supply systems in conformi with the prp ic 145 and /or 147 of the d cation Law, the Public Health e7 c�.v P.E. R.A # 062980 \ ,ill 62980 " ,. w� Mailing Address Cronin Engineering P.E., P.C. 2 John Walsh Boulevard, Peekskill State New York Zip 10566 Very Signe Mailing Address: V.S. Construction Corp. 37 Croton Dam Road, Ossining State New York Telephone: (914) 736 -3664 Telephone: (914) 447 -4647 Zip 10562 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 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 (TW 83.160 1 -5g) 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: Address: Treasurer - Name: Address: and that I am and will be individually responsible for any a a. Is [of the corporation with respect to the approval requested and all subsequent acts relating t r o. Signed: Title: Sworn to before me this 3l day of JAlw Notary U iC KEITH STAUDOHAR otary Public, State of New York No. 4988872 Qualified inTutchess Courty t:omrni�sion Expires Decsmber 1G. Corporate Seal Gmo) Form CA -97 617.20 Appendix C State Environmental Quality_Revew _ SHORT ENVIRO N E � FORM" For UNLISTED ACTIONS Only PART I - PROJECT INFORMATION To be completed by A plicant or Project Sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME V.S. 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, 2650 ft. north of intersection of Marsh Hill Road and Peekskill Hollow Road 5. PROPOSED ACTION IS: New E1 Expansion El Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: Construction of a new single family residence, SSTS and Private Well Supply. 7. AMOUNT OF LAND AFFECTED: Initially 2.456 acres Ultimately.. 2.456 acres . . 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? n Yes F1 No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential Industrial Commercial Agriculture Park/Forest/Open Space Other Describe: Surrounding lands are zoned R -2 (Single Family Residential) 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) name and permit/approvals: Town of Putnam Valley- Building Permit 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? F,/]Yes No If Yes, list agency(s) name and permit/approvals: Town of Putnam Valley- Site Development Approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? Yes Z No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: ineering, P.E., P.C./ James W. Teed, Jr. Date: Signature: I . e action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 `tit PART II - IMPACT ASSESSMENT (To be comDleted by Lead Aaencvl A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. ❑ Yes qo - .•^WIll-ACTION RECEIVE:COORDINATED REVIEW A: PROVIDED` OR`if LISTED'ACTIONS IN 6 NYCRR; PART 617:6 ?` If No, a negative °" declaration may be perseded by another involved agency. 0 Yes 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: /+N 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: N G C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: oV b C6. Long term,, short term, cumulative, or other effects not identified in C1 -05? Explain briefly: N � C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly: Al D D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTA AREA (CEA)? nYes No If Yes, explain briefly: E. IS THERE OR IS T RE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE - ENVIRONMENTAL IMPACTS? _. . 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 E 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 NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting this determir t�c�� ►� Name of ad Agency L /� a.f y COrry.P��1 Print or Type Name of Responsible Officer in Lead Agency 4 _. Signature of Responsible Officer in Lead Agency �a °o ate Title of Responsible Officer Signature of Preparer (If different from responsible officer) ONIN ENGIN E]�RING, PE, PC a .`a The Lindy Building, Suite 200, 2 John Walsh Boulevard, Peekskill, New York 10566 i -y14- 736-3664 -- ay::.91A- 736 -3633 January 31, 2008 Mr. Joseph Paravati Assistant Public Health Engineer Putnam County Health Department 1 Geneva Road Brewster, New York 10509 Re: VS. Consftcdon Corp - Emerald Rldge SETS Construction Permit Marsh Hill Road- Lot 7 Town of Putnam Valley, New York Section: 83.16, Block. 1, Lot 58 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. Construction Corporation. 2. One (1) Letter of Authorization auth zing Cronin Engineering P.E., P.C. to apply for a construction permit at the above r erenced lot. 3. One (1) Certified check for $50 ade payable to the Putnam County Health Department on behalf of the above referenced application 4: Four- (4) Subsurface Sewage Treatment System Construction Permit -Plans forthe above referenced iot. 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) Application for Approval of Plans for a Wastewater Treatment System 8. One (1) NYSDEC SEQR Short Environmental Assessment Form. 9. One (1) Design Data Sheet 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. Respectfully Submitted, Z:Jr. mes W. Te / Project Engineer cc: Owner- Val Santucci (V.S. Construction Corp.) File- Paravati-PCDH- Santucci - Emerald -Lot 7- Trans- ft- 20080131.doc 1 \SO � V7 i LOT 7 y� Area=106, 998 . Sq. Ft. =2.4563 Acres i IOLA W, o% Well 9 i cr \\ OJ r \ I � I LOT 6 ( t off/ � 1 I: a \ i 1 LOT 8 (1500 GALLON CONCRETE) t21 L.F- OF 4'0 CAST IRON PIPE w/ 22' BEND �399 L.F. OF 4"0 SDR -35 PVC PIPE ' FLEXED (NO BENDSI PRIMARY AREP (400 L, F. TOTAL AS -F JUNCTION (TYPICAL INSTALLA" ,s y \\ '\ c,0 -' `\ S 1� t (No o- 6� 1 �.i.7 o• � G '- CO cc 7 r+ Y TRENCH 7 END (15) I° TRENCH B END (16) SAS -BUILT WELL LOCAT DESCRIPTION �., WELL a f i' �00- '0A I � ��: ., i `['t, * �, .1 t ... -. .�C- r .. '+� � .� -. .. .. - { -._ .s..•..1F .v.. �. • :4� .I "Yha•� � :.S t^.'1 ..y � sr \ AS -BUILT S.S.T.S. LOCATION DISTANCES I DESCRIPTION A.! B SEPTIC TANK CENTER 463 � 25.1' JUNCTION BOX 1 (1) 13821 111.1' JUNCTION BOX 2 (2) 141.9': 1143 JUNCTION BOX 3 (3) 146.0'., 117.8' JUNCTION BOX 4 (4) 150.2', 121.6' JUNCTION BOX 5 (5) 154.5': 125.5' JUNCTION BOX 6 (6) 158.9; 129.5' JUNCTION BOX 7 (7) 163.4'' 133.7' JUNCTION BOX 8 (8) 168.0 138.1' TRENCH 1 END (9) 181.7' 158.1' TRENCH 2 END (10) 184.7;- 160.5' TRENCH 3 END (11) 187.9' 163.0' TRENCH 4 END (12) 191.1' 165.7' TRENCH 5 END (13) 194.5' 168.6' TRENCH 6 END (14) 198.11 171.6' Ti2ENGM 7.1 ;., ,- _ 2,1;1.7.: 201-T ;1.74,8' TRENCH 8 END (16) 205.5' 178.2' AS -BUILT WELL LOCATION DISTANCE DESCRIPTION A C WELL 60.1' 27.8' LOCATION M OWNER V.S. CONS1 . (VALER