HomeMy WebLinkAbout4334DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
84. -1 -45
BOX 33
I
r r-
'f
■
IN
I `�
I,
IN NO
04334
REBECCA WrrMBERG. RN, BSN
Public Xeolth Diredw
ROFAW WITIS .ET
March 9, 2012
MARYEMEN ODELL
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Phone At (845) 808 -1390
Fax # (846) 27 8-7921
Revised To Reflect Correct Tax Map Number
Joe & Maria Bellino
6 Sassinoro Road
Putnam Valley, NY 10,579
Re: Addition- A- 017 -12
No Increase in Number of Bedrooms
6 Sassinoro Road
(T) Putnam Valley, T.M. 84. -1 -45
Dear Mr. & Mrs. Bellino:
I have received and reviewed the plans for the proposed addition to the above - mentioned residence.
The proposal for the addition has been approved as per plans bearing the approval stamp from this
Department dated February 29, 2012. The addition is approved with the following conditions:
_.1.... The, to number, of bedrooms .must remain at four without prior approval by this Department.
2 -"'The Vda' f&d'existing sewage <iispasal-sgste' ' ariurrtsyexTansiaft area muss )e
3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, .
restrictors for shower heads and faucets etc.
4. This Department recommends you contact your local Building Department to ensure setbacks
and other current codes can be met.
5. The approval is for the proposed changes only. This approval does not validate any
construction shown as existing that has not obtained proper approvals
Any other permits or variances required are the responsibility of the applicant and the jurisdiction of
the Town of Putnam Valley.
If you have any questions, please contact me at (845) 808 -1390, ext. 43261.
GDR:cw
cc: BI, (T) Putnam Valley
Sincerely,
ene D. Reed
Senior Engineering Aide
AvWcHed1hD&mW
OfZWrmwewd 1ev�
DEPARTMENT OF �TH
R Geneva Road, Brewster, Now York 10509
Phone # (845) 808-1390
Fag # ($4S) 27& fl
00a tr4,1111,11910VII.,
NARY ODELL
O �
TOWN 'M t: 1 TAX NM # P4 .—'I ® 4S
NAM PHONE 09#4—S:S1--0;3 PCHD#
( ) u t (CND ✓/
MARLING
ADDRESS_ %._a And", a
DESCREMON OF
ADDITION
X
t o S 7 1
*MMMER OF EXISTING BEDROOMS , NUMBER OF PROPOSED NEW BEDROOMS
* OMOM CERT. OF OCCUPANCY OR CERTMCAUON FROM BU"ING INSPECTOR)
**Any addition.wWcb is considered a be&mm regnit+es formal approval of plans (Construction peewit) prepared by
a Professional Engineer or Regiored A dgteet in accordance with applicable sections of the Putnam County
Sanitary Code.
_
Please submit this fora_ ► and the following to Putmw County ide a ]Dept., l Geneva Rd,
Esewstd, i 10,'1: (8'� Si?u2:° -
.1. tCertifged check or money order for $100.00.
B. Sketches of existing floor plan (drawn to scale, afl giving am including basement, to be
shown and dimensioned and use of each room specified). (See Section 3.c of Bulletin
HA-i)
3. Two sets of proposed floor plans (drawn to scale -- with name, street and tax map•#)
* Non professional sketches are acceptable and preferred. (See Section 3.d of Bulletin
HA-1)
4. Copy of survey showing all well and septic locations on the subject property to the best
of ' ' knowledge. Include date of won known. Contact this office with any
questions.
5. Coy of Certificate of Occupancy from the Town or Certaffication from the Building
D
tVarknot wida legal bedrdom count of d
Q CE ITSE
CoheAH TTS
4.
AECCA WM RNBERG, RN, RM
Public Health Diredor
Director ofEnvironmewd Health
MARYELLENODELL
County Bw=dw
DEPARTMENT OF HEALTH
1 Geneva Road, Biewster, New York 10509
Phone # (845) 808-1390
.- Fax # (845) 278-7921
Town Legal Bedroom Count & Proposed Addition Status
Re.: BELLINO (Owner's Name)
Tax Map# 84.
---- - -7-1-45 -- -
Address: 6 Sassinoro DrIATP .
Town:- Putnam Valley
Year Built: 2001
According to records maintained by the Town, the above noted dwelling,
is xx in compliance with Town Code.
ln.eM� ith Town Code. d
-:
The Legal Bedroom Count is: 4
This information has been obtained from:
Certificate of Occupancy: CO#2001-177
Other:
The plans for the proposed addition are considered:
xx * Addition to existing house only
Teardown and/or re-build allowed under Town Regulations
B&I ding Inip'e-cor` Office Date
Doreen C. Pia'cente
5.
Public Health Director
,� ,- ct -�i.. a �.•+YE' YodCf` r�L.rin O.::A. -R� �.N�I•r .r • .�..
YAVector of Erviromnental Health
February 17, 2012
DEPARTMENT OF
I Geneva Road, Brewster, New York 10509
Phone # (845) 80&1390
Fax # (845) 278 -7921
Joe & Maria Bellino
12 Hanimac Road
Putnam Valley, NY 10579
Dear Mr. and Mrs. Bellino:
MAR i L' 1VieE ®JaELL
Coway Rucuft
Re: Addition- A -017 -12
6 Sassinoro Road
(T) Putnam Valley, T.M. 84. -1 -45
I have received and reviewed the plans for the proposed addition to the above mentioned residence.
Based on the information submitted, the above mentioned addition cannot be approved for the
following reasons.
1.
2
The 12' X 15' room between the proposed finished basement and the utility room is considered
a potential bedroom.
The legal bedroom count for the dwelling is fouir. The potential bedroom count of your
proposed addition is five.
-The.-addition ,of a_- potential bedroom-re this TJepax nent's_at�prav_al of a._rev_is0_sgpt
-
system plan from a professional engineer.
Please revise the proposed floor plan to reflect no more than four Uotential bedrooms, or have a
professional engineer or registered architect design a sub - surface sewage treatment system meeting
present code requirements.
If you have any questions, please contact me at (845) 808 -1390, ext. 43261.
Sincerely,
Gene D. Reed
Senior Engineering Aide
GDR:cw
cc: BI, (T) Putnam Valley
> j
0 vi
ol r6
ii
30
SlAp
CA
byy
Ir
k
-7 `a"
0
LA cotl
CP
ip
PUTNAM COUNTY DEPARTMENT OF HEALTH
HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY
BEDROOAAS' A - 0/ 7
If,,- / -
ALL SUBSEQUENT REVISIONIALTERATIONS TO THESE HOUSE
PLANS MUST BE Sl IBMITTED TO THE PCDOH FOR APPROVAL
C & TITLE 19ATE
1/4'*40
xtrsa
at
-roe
(A
5
-T;le
C.
los-11
00
C4
CP
ip
PUTNAM COUNTY DEPARTMENT OF HEALTH
HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY
BEDROOAAS' A - 0/ 7
If,,- / -
ALL SUBSEQUENT REVISIONIALTERATIONS TO THESE HOUSE
PLANS MUST BE Sl IBMITTED TO THE PCDOH FOR APPROVAL
C & TITLE 19ATE
NOGCY
L—W-4 7/8'
SN- /ON- 2010216/NY
0) o o
(D (D
FAMILY ROOM
rL"T CcLba
0 0NXKT,
ml rcw .am fc.0l,'"
"Lom m.
V, m
pro l 0� wl O
Ir Cc"
Mm= MW -\.-A Avtc m 26'
;T17Tc
b ur SAAM it 2
J
E L T N=MMIZED WALLS Z
A02.9 "3/,• WALL
—
5• Is I/?-
7
II
TWO LAYERS (IF 51W TYPE •r GYP� ON CLG. BASE LAYER APPLIED AT
STCDY Rtw ANGLES TO JOISTS-,WITH 1 1/4' TYPE 'S' DRYWALL SCREWS e
6 If= 24' Of- FACE LAYER APPLIED;AVRIGHT ANGLES TO JOISTS THROUGH
Z
•� t!_ BASE LAYER WITH I 71W'TYPE,, -,DRTWALL SCREWS Ir aC. AT JDINT51
AND INTERMEDIATE JOISTS: FAWLAYE)R-JOINTS OFFSET 2•• FROM BAsEb
LATER JOINTS. 11/2' TYPE -e'.DRYWALL SCRENTS PLACED Z• BACK ON
EITHER sioc or FACE LAYmompimume w a-c
ONFZITMSTEM :AIIER Pir
-8 7/8• 6 DESIGNEIV� PROVIDEZW Val
TIP 0 W lff
°_ -__ - -- - - -- P- ------ ---- -- --
•� :w _ -- STEEL BEAM,
M r 2Ar q
VM 2'1;
14q-8'
c
V,j
4
ti
>z <316616 JEFFERSON
IN � .:.' 1ST STORY
cm off!
4 ogle= •.1• v
0
Fil
Ali
oi:
.3
1P
is -
it
qqtt
APT.
AT f . Aj
A
ilk
CT
!i
Tf
CTIaN CORP./SPEC QPC)
a
To
an TV
� f. T,
l•m Lw.
_T
Iw KITCHEN
Md.
/47• -Il•
spror
P
mm,
Z
Ir-5 I lr
�j
m.. Wr
:tulm
7 4
ilel/ 4-WKe-ur
-Ll m
IS
i.fLG
az
4
1/• -
lc,'
CLc
FOYER
3
4.
4
.a -5
MANGERS
"-L. 2-2.12.15••
SPF.2
PLUMBING CONWCTIO.5
Q
NOGCY
L—W-4 7/8'
SN- /ON- 2010216/NY
0) o o
(D (D
FAMILY ROOM
rL"T CcLba
0 0NXKT,
ml rcw .am fc.0l,'"
"Lom m.
V, m
pro l 0� wl O
Ir Cc"
Mm= MW -\.-A Avtc m 26'
;T17Tc
b ur SAAM it 2
J
E L T N=MMIZED WALLS Z
A02.9 "3/,• WALL
—
5• Is I/?-
7
II
TWO LAYERS (IF 51W TYPE •r GYP� ON CLG. BASE LAYER APPLIED AT
STCDY Rtw ANGLES TO JOISTS-,WITH 1 1/4' TYPE 'S' DRYWALL SCREWS e
6 If= 24' Of- FACE LAYER APPLIED;AVRIGHT ANGLES TO JOISTS THROUGH
Z
•� t!_ BASE LAYER WITH I 71W'TYPE,, -,DRTWALL SCREWS Ir aC. AT JDINT51
AND INTERMEDIATE JOISTS: FAWLAYE)R-JOINTS OFFSET 2•• FROM BAsEb
LATER JOINTS. 11/2' TYPE -e'.DRYWALL SCRENTS PLACED Z• BACK ON
EITHER sioc or FACE LAYmompimume w a-c
ONFZITMSTEM :AIIER Pir
-8 7/8• 6 DESIGNEIV� PROVIDEZW Val
TIP 0 W lff
°_ -__ - -- - - -- P- ------ ---- -- --
•� :w _ -- STEEL BEAM,
M r 2Ar q
VM 2'1;
14q-8'
c
V,j
4
ti
>z <316616 JEFFERSON
IN � .:.' 1ST STORY
cm off!
4 ogle= •.1• v
0
Fil
Ali
oi:
.3
1P
is -
it
qqtt
APT.
AT f . Aj
A
ilk
CT
!i
Tf
A.
Li
Al
F-POT7ENTfl�-AL
BEDROOM
0 (D
@ IV O.C./2.4 KARR WALLS
L-Nw
7-
-----------------
IR JOISTS e 16• QC.
BE 24. ar.(16 OT- GARAGE /FR ROOF)
- 24210. 02-2842 03-3046. 04=2852 011=2856)
:R BATH 01 T13 BE, 2-1 I/2•x9 1/4's4D'-D•/4?--D• K.L./2-Z.10.15-4' SYPII2
BRII/64ALL/RATH03 TO BE: 2-1 1 /2'.14'.40' -0' NL
TEN IS DESIGNED FOR CEILING DEAD LOAD ONLY
AL EDUIPMENT SHALL RE INSTALLED IN THE CEILING
NTRAL VAC OUTLET
vvw'ami %4
as BEDROOM at
POTENTIAL
Sao
BEDROOM
iii
ob
3• -3'
HALL
Al
F-POT7ENTfl�-AL
BEDROOM
0 (D
@ IV O.C./2.4 KARR WALLS
L-Nw
7-
-----------------
IR JOISTS e 16• QC.
BE 24. ar.(16 OT- GARAGE /FR ROOF)
- 24210. 02-2842 03-3046. 04=2852 011=2856)
:R BATH 01 T13 BE, 2-1 I/2•x9 1/4's4D'-D•/4?--D• K.L./2-Z.10.15-4' SYPII2
BRII/64ALL/RATH03 TO BE: 2-1 1 /2'.14'.40' -0' NL
TEN IS DESIGNED FOR CEILING DEAD LOAD ONLY
AL EDUIPMENT SHALL RE INSTALLED IN THE CEILING
NTRAL VAC OUTLET
vvw'ami %4
iii
3• -3'
BATH 02
lv�
co"IT
M TIC MCDA
13S.I.
I, Cwwa
M., To •,TIC
wa
2 W3
W3
mV
BEDROOM 01
POTENTIAL
BEDROOM
I-
F
Rom 7K
o 74,0 pl-slj
-PT
iii
o 74,0 pl-slj
-PT
A B i2M 6AL'PWP M
id-41 cdc crOr lir 1ST. mmcH 175' 165, fiVSW PkZWW. 4t-6'.1
END r: 77?EJVCH
START OF.MDC 7RENCH
169'
158'
STARr,C;-.JRO. 7RENCH
151'
START OF 4M. 7RDVC.Al
-156.51
144.5'
ST�RT. OF 57H. 7RENCH
150'
U8',
'SUR,
START OF 77H. 7RDvcH
IJ8'
124'
START OF 87H. 7RENCH
I32'
117.5'
START OF 97H. TRENCH
126.5'
111'
START OF 107H. TRENCH
2�0 ,
-,04,
START OF 11TH. 7RENCH
175,
1 97'
A B i2M 6AL'PWP M
id-41 cdc crOr lir 1ST. mmcH 175' 165, fiVSW PkZWW. 4t-6'.1
w. 4.
Lot No. I
tM75MIG WA MR SZROCr
. . . . . . . . . .
r4
T
I-CADERS AND -
If; DUNS (tip)
22Lr.-410 CA57 FaV W 1250 CAUCW PUMP Ch,WRE1
1.750 CAUOV awcpflr SPN W N HWROWA.7C .9-60 PYJAIF
ALDO AND WSUAL AZARM
Vx CArFANqjaV A 9F
e 1 R5 L 1� - 2 5 Z w FU X Pm frillr U.,
601c.r. - 4,0 PDW. Pic 4.
24. MAW1 M004
PUTNAM CHASE LOT #1
-A S- BUIL T SE WA GE TREA TMEN T S YS TEM
SCALE. 1 30 FT
.ilia rrrra.
NIS /S.;
CONSM
WAS W-9
WAS • CCA
AND REC,
AND W
SuBsul
COWTS75 0
RIMP CHAM
Pvc PIPE, 1A.
MPAM IF 5
37 CROMT
37 CROMN
0S9NWQ )V.
WA M? Rff
PR / VA T hn
P.F. BEA t
4 PUTNAAd A
END r: 77?EJVCH
END OF 2ND. 7RENCH
7-iJ-75'.
143'
END. OF 3RD.:,7RDVCH
END OF 4N. :0E*0Y-
;118!
'129-
END OF 57H. 7RENCH
109.5'
122'
END OF 77H. TRENCH
96'
110,
END OF 87m. wA(rH
89,5.'
104
END OF 9TH.' TRENCH
83'
98.5'
END OF 107H. '.TRENCH
76
gj'
00 OF IIM. TRENCH
70'
.875'
w. 4.
Lot No. I
tM75MIG WA MR SZROCr
. . . . . . . . . .
r4
T
I-CADERS AND -
If; DUNS (tip)
22Lr.-410 CA57 FaV W 1250 CAUCW PUMP Ch,WRE1
1.750 CAUOV awcpflr SPN W N HWROWA.7C .9-60 PYJAIF
ALDO AND WSUAL AZARM
Vx CArFANqjaV A 9F
e 1 R5 L 1� - 2 5 Z w FU X Pm frillr U.,
601c.r. - 4,0 PDW. Pic 4.
24. MAW1 M004
PUTNAM CHASE LOT #1
-A S- BUIL T SE WA GE TREA TMEN T S YS TEM
SCALE. 1 30 FT
.ilia rrrra.
NIS /S.;
CONSM
WAS W-9
WAS • CCA
AND REC,
AND W
SuBsul
COWTS75 0
RIMP CHAM
Pvc PIPE, 1A.
MPAM IF 5
37 CROMT
37 CROMN
0S9NWQ )V.
WA M? Rff
PR / VA T hn
P.F. BEA t
4 PUTNAAd A
I CORP./SPEC (IPC)
ON-SITE
GABLE VENTS
(—' 3a _)
P'll
if
IMR
FRONT ELEVATION
11
1'i
t u
4..
2L
Tj
IfY
.Ot'r
f a:
\.
•tl.: �T
y e kO�r. ^k
a t Y
Si77ZWril " • 1 ,
DR
q ovy - m
Cl cr
m DD 3
ID
Z.
ON
Rio
AS PLAN
e
.i
FOR PROFESSIQNA4., "Jqj, ;p F MNQr CONSULTANTS
CHASE: LOT#1
PUTNAM
At
L OCA 770N.
ILAODU AND
11 1 u .
swr OF isr TRENCH
175'
165'
V OF 1ST.' 7RDVCH,.
144
149.5,
V OF M. TRENCH
I375'
143'
V OF 3RD. MDVCH
128
135 .5'
V OF 4N. OENOi-
150'
.129'
D OF 57H. ZkOVO4'
109.5'
122'
V OF 679 .- 7RM04
103`
116'
ID OF 7TH. TRENCH
96
110,
V OF 87H. TRENCH
69.5'
104'
ID OF YTH.'MDVCH
120'
98.5'
ID OF 10TH. .7RENCH
76
93,
ID OF 11 TH. 7RENCH
70'
675'
ILAODU AND
11 1 u .
swr OF isr TRENCH
175'
165'
START oF,ma . 7RDvcH
169'
158,
START OF MO. 7RDVCH
162.5'
151'
START OF 47H. TRENCH
'156.5'
144.5'
START OF 51H. rROYCH
150'
I38'-
START or 0m. rRDvcH
144'
fil,
START OF 77H. mavcH
178,
124'
START OF 67H. TRENCH
1,12'
117.5'
START OF 97H. mDvcp
126.5'
ill'
START OF Yow. 77?EAcy
120'
104'
SrAPT OF IfN WNCY
WAS C&
AND RE
Lot No. I
D1,571110 IVA 11N _1rq1117
N.
N.
4.
I&W UPA. PUMF
7MON.• 4'-6" -. . I
I FVAJP MF- Sfp
I Pt4P.* NMROVA VC " PUL' I
.- •'l V rA".;7nl .*Y,
/*
N627r2OV
22Lr.-410 C45r #?0V PAP[- Mr. PW p
UW CAUXW 01JVF 0, ',' Pcx 24' tV?A Ift WNW
1730 " ON CDVCRE IT SEP 17C rAW (-ft ov cq*W)
ALOCI A•.Vr WU.4'. ALARM
cm
CONSTRI
WAS INS
PUTNAY'
CHASE
LOT #1
WAS C&
AND RE
AS—BUILT
SEWAGE
TREA TMEN T S YS TEM
AND 774;
SCALE: 1
30
F-r
suast
awwrs (
PUMP 0MA
r #_, P/!:T
SIPAM IF'
37.,CR070k=,
37 C-907M
OSSYMING, I
WA M? SEO
PRI VA T M,
P. F. BEA t
4 PUnVAM
FRONT ELEVATION
® Qa W-AW-M Alb, S ll f-
>Ir
YSG
{iS
ti
[!`liill!ili 1 Ir q
CERTIFICATE NO.: 2001-177 PERMIT NO.: 2001- 2
TI%4#: 84.-1-45 DATE: October 1, 2001
LOCATION: 6 SASSINORO DRIVE
ISS'LT1D TO: 37 CROTON DAA1 ROAD. CORP.
4
This
one.family residence w/rear deck (12, x 241);
two -car garage; fireplace; four bedrooms;
unfinished basement.
f: -, r :z
_j h,, -1 4 -Ig
The applicant hav-ing heretofore filed an applic- a t- i ri I _1ji, �A-L I
- -' -) i�,' +-
LD U a n; t
r tie Town Code, Sari-itar-,., rM
Bi-tilding & F-Jrc, C(--,de ar---i the Lak,4,7, J-n 1-_ffeCt- in r,-je
Valle-, ri an, t- i-i r
ha v i na r) a i d the r e q
and 't-1-1 e 1-LGIv-41-rig by personal inspe,:;t-Lc-)i1. a& =-r+Ca-ined
the proceeded Or
-h t he
-iEe in I J -=in, J t
-i nt P. r o,.7 g- rc!. 1� t h i-= LD-E-OpOsed
. . I a err e -1e
r-,J he- a.�; for i n�-tol f.J
7-,.7
-il-icJ mal--eria s rvet everv, rei
13
and
that t(-l=- ) remds----
have
now been fi.illy
and :.,re
for
oc-c-i-tplant:-.1,
to
the t-,rovisions
of
this
peal
of the
V
of Pl-ttnam Valley.
P t he
TOWN OF PUTM-W VALLEY, N. Y.
By:
D e
.1 .
� PUTNAM COUNTY DEPARTMENT OF HEALTH
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM
PCHD CONSTRUCTION PERMIT # 9V - 2°1- o Located at G SASS i nl D L 0 01? i VZ� Town or Im A L LiL
Owner /Applicant Name 39 c fla -tort Z)Ar4 ROAO cup,* Tax Map 941 Block Lot
Formerly Subdivision Name )'Q 'r -"1qA L kAX6
Subd. Lot # I
Mailing Address 6 SASSliJO)10 MILK 190-riJtlr AL(.Cy. *J..>/. Zip 10 S -7�j
Date Construction Permit Issued by PCHD f 10 6. Z
39 CR07o %J pNA I2n.
Separate Sewerage System built by 39 CnoTo.�1�-�, �?c,�vF, Ce,2 P Address os, r �,� i %j c,
Consisting of 1 S® Gallon Septic Tank and 6 O I L, F=• - q- �;,� PO YR E. • P U C
?J PL' I� 4" QZAI/EL- -- R2eluc/ -(
Other Requirements: '?U M r2
Water Supply: Public Supply From Address
If ,J y ^
or: Private Supply Drilled b Y i F Qt A:fiAddress 9126 -w.f /6-001
r
�.�.. .:: ". ldi g:.T, ape ';- 56J6'L L' -l' l � ' a irf ias-ero'siori om letecl?
Number of Bedrooms If Has garbage grinderbgen installed?
Jr Nt4 yv.
I certify that the system(s), as listed, serving the abode raises wire co ted essentially as shown on the as-
built plans (copies of which are attached), in c 'Vvithed Construction Permit and approved
plans and the standards, rules and regula ' ns P tnam "'',(�Dep nt of Health.
Date: �` '�/ Certified by c '�� P.E.
R.A.
(Design �af�,s - X80 4�
Address 2- S oH.0 PJA �'K rt do License #
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary
to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage
treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval
of the private water supply shall become null and void when a public water supply becomes available. Such
approvals are subject to modification or change when, in the judgment of the Public Health Director, such
revocatio modi icati r ch ge is necessary.
By: - Title: 19_ Date: 1Z1_T')C1
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CC -97
PUTNAM COUNTY DEPARTMENT NT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
W1ELL.COMPLLTIION R]EPORT--
Well 1Location
Ti�:� ree t Address: Rramers Pond Rd.
ut —Chase Subde, Lot #1
Town/Village:
Putnam Valley
Tax Grid # 84. -1 -45
Map Block Lot(s)
Well Owner:
Name: Address:
VS Construction, 37 Croton Dam Road, Ossinin , XTY 10562
Use of Well:
1- primary
2- secondary
X Residential Public Supply Air cond /heat pump Irrigation
Business Farm Test/monitoring Other(specify)
Industrial Institutional Standby
Drilling Equipment
X Rotary Cable percussion X Compressed air percussion Other (specify)
Well Type
Screened Open end casing X Open hole in bedrock Other
Casing Details
Total length 32' ft.
Length below grade 31' -- ft.
Diameter 6 in.
Weight per foot 19 lb/ft.
Materials: X Steel Plastic _ Other
Joints: Welded X Threaded Other
Seal: X Cement grout _ Bentonite Other
Drive shoe: X Yes No
Liner Yes X No
Screen Details
Diameter (in)
Slot Size
Length(ft)
Depth to Screen (ft)
Developed?
First
Yes No
Hours
Second
Well Yield Test
Bailed X Pumped X Compressed
Air
Hours _E_
Yield 25 gpm
Depth Data
Measure from land surface - static (specify ft)
30'
During yield test(ft)
240'
Depth of completed well in feet
325'
Well ]Log
If more detailed
information
descriptions or
1
sieve'analyses .
are available,
please attach.
Depth From
Surface
Water
Bearing
Well
Diameter(in)
]Formation
Description
ft.
ft.
Land Surface
10
Drillin
in overburden
clay and boulders
10
Hit rock
at 10'
- lv
32
ii -rock
set cas �" `' -
32
325
Drillin
in rock
granite
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump /Storage Tank Information
Pump Type sub Capacity 7tqpm
Depth 260' Model 7GS07412
Voltage 230 HP 3/4
Tank Type WX302 V al o
Date Well Completed
9/13/00
Putnam County Certification No.
002
Date of Report
9/19/01
Well Dr' e
. Bea
NOTE: Exact location of well with distances to at least two permanent landmarks to be provi on a separate sheet/plan.
Well Driller's Name P, Address: _ 4 Putnam levee, B 3oter, ICY jM
Signature: Date: 9/19/01
Perry L eal
White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC -97
r
NB
NORTHEAST LABORATORY OF DANBURY �'�o,N ACC0,010
39.. MILL PLAIN ROAD,. DANBIIRY� CT 06811 CT Cert: PH -0404 o`
•: =:moc vi.:�' _ °�, ...:cn;; ... .. � - .,�. ... ..... _... 'e: :�+s is ,�'�•- y,".�v ... r �` ,.1r "s Rat a�. 4=''
`E�(�Os3) 748 0652 yCerl� 1471 c, 4
LABS y www.NORTHEAST LABORATORIES. co
REPORT TO:
P.F. BEAL & SONS
4 PUTNAM AVENUE
BREWSTER, N.Y. 10509
SAMPLE SITE:
SAMPLE POINT:
SOURCE:
TREATMENT:
TEST PERFORMED
BACTERIAL:
e Total Coliform (Bacteria)
PHYSICALS:
LABORATORY REPORT
DATE SAMPLE COLLECTED:
9/19/2001
TIME COLLECTED:
10:00 A.M.
COLLECTED BY:
KEVIN B.
DATE RECEIVED @.LAB:
9/19/2001
TESTED BY:
LAB #11471
LAB I.D. #
PFB -99
REPORT DATE:
9/21/2001
V.S. CONSTRUCTION, PU'1NAM CHASE SUB., LOT #1, PUTNAM VALLEY, N.Y.
HOSE BIB
<0.03
WELL
• Manganese
NONE
mg/L
RESULTS METHOD #
ABSENT per 100 ml SM 9223
MAXIMUM CONTAMINANT
LEVEL (MCL) OR STANDARD
ABSENT
• Color (Apparent) 0 - EPA 110.2 15
• Odor ND - - 3 Units
• pH 7.04 - EPA 150.1 No designated limits
• Turbidity 0.12 NTUs EPA 180.1 5 NTUs
CHEMISTRY:
1.0 mg/L
-EPA 353.,3:!,:-
• Nitrite Nitrogen
<0.005
mg/L as N
e .,)`lit *ate Nitrogen, •
- .1,36 ; ..
mg/L as N -
._...._ : .. < <� _ •`A1k�Tuiity ,.. _
0.50 mg/L
• Hardness
32.0
mg/L
• Iron
<0.03
mg/L
• Manganese
<0.01
mg/L
• Sodium
• Lead
<1.0 mg/L
<0.001 mg/L
EPA 354.1
1.0 mg/L
-EPA 353.,3:!,:-
_ 10 mg/L.
-!"'; `. ...` _ "No defined' li'm`its`'.°;; ° ,.:"' "`..' -'"•` w
EPA 130.2
No defined limits
EPA 236.1
0.30 mg/L
EPA 243.1
0.50 mg/L
Combined limit for Iron plus Manganese = 0,50 mg/L
EPA 273.1
20.0 mg/L **
EPA 239.2
0.015 mg/L * **
ml= milliliter mg/L--milligrams per Liter ND =none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count
. "Notification Level ** *Action Level
COMMENTS:
-All holding times (were) met.
SAMPLE, AS TESTED ABOVE: -1 OTABLE or FE-1-kOT POTABLE
(PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER)
RESULTS BASED ON SAMPLES SUBMITTED: 9/19/2001
Laboratory Director
-NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060379 (860)828 -9787 - FAX (860)829 -1050
TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230
09/25/2001 11:48 9147363693 ' CRONIN ENGINEERING 1 PAGE 01
s s.•:r =-. :.v..±.
a r"i���1ia!'<� �V1r_y.�„w�.�-
��^.'o° pp...a. m . �r .;p-- des =v*.: <_ _ �i T�'��.— ...ex, —y.r� �� r
09-21-2W2
83, NRWI FMM KIRTMErST LAs e- Lv { u 1 r 1.1 r."4
s
X0Sjj2A8T LAPQ
Smi ka
I"N
7 T9e+.12 - %ax pom 740.0"a NY Q:c!kre i14`i b e m
s.fi� i Eab�B ago
+
no ax
'
:.
i alum
Pit.. Bill.
}0AU SAUM W==: 91I9fg00i
4 Ara"
Took COLLEcfib
�1
`, �0 +°M3.BivfEJ91a�Y:;
f
DATE �G % m- 9e i l + ,
fl 4WI1471
V.P. OMMUMUM. PUMAM C57A�1h+ VO,a Y.OS' C8.. IA. +'as4Dq ®A.6XY. X - � {
0
OA
® Tel
) iCr: tVd AB6 mv i
o t go
OW ) o e W-A 110'2 19,
o t
9 a
Wits, Sol, W� d'sigow EmiQ
SPA I
11! o 0112 XTUS EPA emi
I Mal i$
m
o
1.
..-:..n:.....
1.96 EPA 35813 ; 10 matt
10.0 Ate, St 332Ca NO &Ifiud ROOM
no ,rim. EPA 130h 1Na 9�ad wuita' .
SPA236I1 0.502 i
4.01 VA1 1
b'dav&
41,9 BWZ VA 25'3 ' 241'3 MIOL40
VA239 0.015 mm 1
r�t�+ ,e+illiliG� Y 0 48 cvwQzbftt I..&%d TkTo. eu
N T��oa�e
gnoe aaa�va.a r- +vw..+ls�snawn�m� Pfa 4�dIda61 Gd1LG�+Ir Cid {�9q�%a �$_°/„�""I �8�' °riY+L•Im (�'W'J�A°��.
log a OUTS= CT. "U- 654b1330
i1
TOTAL P. W
�v^.FJ I r.1� A4 1 ��1 I1= �I ^^I.I I 1 , .n.we� n1 1Tl 1/Y.w + •;• � -
._.._—
1
r Jr.' v l lr i'ilvl 1. V U 1r:1 I LL',rtXJN l lrlr.l� i yr r1i:.t�
DIVISION OF ENVIRO NTA HEALTH SERVICES
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT. SYSTEM
3�1 AM i?4 iP. 8f 1 s No � 5
Owner or Purchaser of Building Tax Map Block Lot
37 01ZoTOa DAM 1&D OPeP. ���� lAu-E
Building Constructed by <ow illage
SAssi�lo� �� /vim 1 uTNAM l: HRSF`
T
Location - Street Subdivision Name
Building Type Subdivision Lot #
I represent that I am wholly and completely responsible for the location, workmanship, material,
'construction and drainage of the sewage treatment system serving the above - described property, and
that is has been constructed as shown on the approved plan or approved amendment thereto, and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and
hereby `guarantee to the owner, his successors, heirs or assigns, to place in good operating condition
any part of said system constructed by me which fails to operate for a period of two years
immediately following the date of approval of the "Certificate of Construction Compliance" for the
sewage treatment system, or any repairs made by me to such system, except where the -failure to
operate properly is caused by the willful or negligent act of the occupant of the building utilizing the
system.
_ .. .
The undersigned further agrees to accept as conclusive the dete in 'on the iblic Health
Direct the County Department of Health as to whether o� n th ilur f the system
op t as usbd by the willful or negligent act of the occup t °:.o a ildi utilizing the
D#- 1 Year tOo Si
Title:
(Ovvner) - Signature
3.Y. ep-o�i /0 J)AM _aao 009f. .3 Y eP-oTO� �M �aE� �oti4 .
Corporation Name (if corporation) Corporation Name (if corporation)
Address: 31 C�oTc�NiM+�, �ss►n�o�G
State %V . y Zip
Address: 31 0e0TOa _E)AM ?C A�, Nziliix)�'
State Zip
Form GS -97.
3,
T
1
r Jr.' v l lr i'ilvl 1. V U 1r:1 I LL',rtXJN l lrlr.l� i yr r1i:.t�
DIVISION OF ENVIRO NTA HEALTH SERVICES
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT. SYSTEM
3�1 AM i?4 iP. 8f 1 s No � 5
Owner or Purchaser of Building Tax Map Block Lot
37 01ZoTOa DAM 1&D OPeP. ���� lAu-E
Building Constructed by <ow illage
SAssi�lo� �� /vim 1 uTNAM l: HRSF`
T
Location - Street Subdivision Name
Building Type Subdivision Lot #
I represent that I am wholly and completely responsible for the location, workmanship, material,
'construction and drainage of the sewage treatment system serving the above - described property, and
that is has been constructed as shown on the approved plan or approved amendment thereto, and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and
hereby `guarantee to the owner, his successors, heirs or assigns, to place in good operating condition
any part of said system constructed by me which fails to operate for a period of two years
immediately following the date of approval of the "Certificate of Construction Compliance" for the
sewage treatment system, or any repairs made by me to such system, except where the -failure to
operate properly is caused by the willful or negligent act of the occupant of the building utilizing the
system.
_ .. .
The undersigned further agrees to accept as conclusive the dete in 'on the iblic Health
Direct the County Department of Health as to whether o� n th ilur f the system
op t as usbd by the willful or negligent act of the occup t °:.o a ildi utilizing the
D#- 1 Year tOo Si
Title:
(Ovvner) - Signature
3.Y. ep-o�i /0 J)AM _aao 009f. .3 Y eP-oTO� �M �aE� �oti4 .
Corporation Name (if corporation) Corporation Name (if corporation)
Address: 31 C�oTc�NiM+�, �ss►n�o�G
State %V . y Zip
Address: 31 0e0TOa _E)AM ?C A�, Nziliix)�'
State Zip
Form GS -97.
BRUCE R FOLEY
Public Health Director
_mil: •r.E rT C-qe ec- 7�'x.;rj.t - '�•.PR ^:cam =• �.a..Ta i %•i..��
LORETTA MOLINARI R.N., M.S1.N.
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road .
Brewster, New York 10509
Environmental Health (914) 278 - 6130 Fax (9.14) 278 - 7921
Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6083
Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648
® NAME:
3 e OTOa SAM EDAM
TAX MAP NUMBER:
E911 A1DIDRIESS:
AUTHORIZED TOWN Of
0
(Signature)
DATE:
The Putnam County Department of Health wffi not issue a Cerfificate of
Construction Compliance unless the above form is completed, Leo, a lejal. E911
address is assigned by an authored town officiaL M form is to be submitted
with the application for a (Certificate of C®nstmcdon (Compllanc&
CE911 VERFRM)
�C
1�A
>'r
r
ti (,
C
4 { !3
M
Q
0
tO
;r <`d , i:' ._ ,..;� r.,. - ,•t... y; :.r. sr ,n'ao'�ri= E;;'�'�C - f. c - ..:7-y.:. ;p' . tee-.. �j��: -.•..... •i...x':�1r 6':-i :v.� 1C , >,
U6'
16.6'
a
0
° r
w
a V �
^
IV
es
t 5 Asp
l� 6
110 �
E./
N �5 38
Drainage & Utility
Easement
S27 °22'47" Or 282.55'
SASSIMORO RRIVE
(Under Construction)
Guy Wire
Guy
R= 30.00=
L--37.75'
0�
v
v
Qo
3
O /
�4i _tf 'n�V1 a2: 42 C14 ?3 7156
P -PEMIE ATHLETIC' 1_UU
SEP -16- 20181 91:67 PM JIM Gk'.AY 914 592 053 r.v<
_James l3.. Gray
640 CenMW Paris Avenue, #416
Searsdiie, ICY 10593
September 17, 2001
Putnam County Health Department
1 Gcn @va. Road
Brewster, A1Y 10509
To Whom It May Concern.
This letter is in reference to the pmperty located at 6 Sassirlore Thrive, Putnam Valley,
NY 10579. It is my sole intention to use the morn located on the amain Hoar (to the right
of the front en rance) as an office. As my parent comparYy is located in Oakland, CA it is
necessary that I work from my home and require a room dedicated for this purpose.
Should you treed any further information or justification, please do trot hesitate W cetttaet
me at the above address.
'hank: ypu,in advance for your cooperation.
Sincerely,
J es It. Gray
Q D
CRONIN ENGINEERING P.E., P.C.
The Lindy Building; Suite 200
2 John Walsh Boulevard
Peekskill, NY 10566
914 - 736 -3664 Fax 914- 736 -3693
Adam B. Stiebeling,
Assistant Public Health Engineer
Putnam County Department of Health
1 Geneva Road, Brewster, N.Y. 10509
RE: 37 CROTON DAM ROAD CORP.
"PUTNAM CHASE SUBDIVISION"
SASSINORA DRIVE, LOT 1
P.C.D.H. PERMTT'#PV -29 -00
LETTER OF TRANSMITTAL
THESE ARE TRANSMITTED as checked below:
September 19, 2001
❑ FOR APPROVAL ❑ FOR YOUR USE ❑ AS REQUESTED ❑ FOR REVIEW AND COMMENT X PLEASE REPLY
WE ARE SENDING YOU attached
•' ' '' I:)° i1i'ree copies ofas= liailf sulisur�'ace sewage treatment system plan
2.) Three certificate of the construction compliance.
3.) Three guaranties of SSTS
4.) Copy of survey showing foundation location
5.) E911 address verification form
6.) $200 certified check for application fee.
Should you have any questions or require additional information regarding this matter,
please contact me at the above phone number. Thank you for your time and assistance in this
matte.
Respectfully submitted,
Kenneth M. Murphy
Project Designer
e-
,n
BRUCE R. FOLEY
�- ``Public Beak.-
LORETTA MOLINARI R.N., M.S.N.
1SSOCiate•':L'b -liC I�ealf {. 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 (845) 278 - 6014 Fax (845) 278 - 6648
Preschool (845) 228 - 5912 Fax (845) 228 - 6113
FAX COVED SHEET
Date:
To: fZo ti( t4v .
]From:
Adam B. Stiebeling
Asst. Public health Engineer
�. - -For your iiiforniaton
For your review
As discussed
Notes/Messages
Fax #: %�,& —
No. Pages I
(Including cover sheet)
Please respond
Attached as requested
Please call
-* I �� LIOmlr-
GC- �Gl
f: c - 7-7 t41.0 4,tktt-vl�w r"
In the event of transmission /reception difficulties, please contact this a at
(845) 878 -6130 ext. 2157.
0
09/25/2001 15:21 9147363693 CRONIN ENGINEERING 1 PAGE 02
RQNIN ENGINES NC. P E P.C. .
The Lindy Building, Suite 200, 2 john Walsh Blvd., PeelAiil o�k'1056G
Tel. (914)786.3664 0 Fax. (914)736,3693
SEPTEMBER 25, 2001
ADAM B. STIEBELING
PUBLIC HEALTH ENGINEER
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL SERVICES
4 GENEVA ROAD BREWSTER, N.Y. 10509
RE. • SSTS CONSTRUCTION COMPLIANCE
37 CROTON DAM ROAD CORP.
P. C.D.H. PERMtr #PV -29 -00
6 SASSINORO DRWE
TOWN OF PUTNAM VALLEY
DEAR MR. STIESELING:
THIS LETTER IS TO INFORM YOU THAT MANDY SANTUCCI WILL PERSONALLY BE PICKING UP
THE CONSTRUCTION COPLIANCE WHEN THE PUTNAM COUNTY HEALTH DEPARTMENT HAS ISSUED
FINAL APPROVAL FOR THE ABOVE REFERENCED PROJECT.
PLEASE CONTACT ME AT THE ABOVE NUMBER WHEN FINAL APPROVAL HAS BEEN ISSUED SO I CAN
INFORM MR. SANTUCCI. IF YOU REQUIRE ADDITIONAL INFORMATION OR HAVE QUESTIONS
PLEASE DO NOT HESITATE TO CALL ME,
RESPECTFULLY SUBMITTED,
Kemeth M. urphy
Project Designer
PUTNAM COUNTY-DEPARTitIENT OF HEALTH
t DIVISION OF ENVIRONMENTAL HEALTH SERVICES
i FINAL SITE RiSPECTION
� y Date:
wtreet'I
CaWL 5Stne o 40 Owner (. 2.t,,k
ToNvn _ Permit #(- 7R_00
TM r 13 4 -1— Subdivision Lot # j
1. S eY,�$e Svstem Area 1 L., + - C-rM 1 Vr_
a. SiS area located as per approved plans .. : ........................
b. ED section - date of placement
k I barrier Lgth. Width Avg.Dpth
c. Mural soil not stripped ................... ...............................
d. Stone, brush, etc., greater than 15' from STS area..........
e. h0' from water course / wetlands ...... ...............................
II. S evv s!e System
a. fphc t size -1,000 ....... , 5 :::other ................
b. S!ptic tank installed level ................
c. lei' minimum from foundation ....... ............,,................. ~_
d. Dstribution Box
. All out le is at s vati - ter t� est
..... ........
2 Protected bel frost ................ ...............................
. 3. Minimum 2 Origin soil between box & tren hes
e. J•lncti Bo - properly set ....... ...............................
f.
_re
nc .,l c
2.
3. Install d acmging to plan ........................ %...........
4,
5.
6.
8.
9.
g. um') or D sed Systems 2
ize o mp c am er .. ....... ...........................J...
2. Overflow ......... ................. ...............................
3. Alarm, visua a io ...........:........ ...............................
4. Pump easily accessible, manhole to grade .................
5. First box baffled .......................... ....................... :.......
6. Cycle witnessed by H.D.estimated flow/ cle....... .
M. House/Building -
a. house located per approved plans....... .. .
b. Number of bedrooms ... ............................... ....@
IV. We]1
a. Well located as per approved plans........ ..
b. Distance from STS area measured ft........
c. Casing 18" above grade ...........................
d. Surface drainage around well acceptable ..............
V. Overall Workmanship
a. Boxes properly grouted....: .. ............................... ,
b. All pipes partially backfilled ......... :.................. ...:..
c. All pipes flush with inside of box ...........................
d. Backfill material contains stones <4" di
e. 'Curtain drain & standpipes installed a or ding 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. Erc►sion control provided ................. ........................... .....
RF
�quired ��1�Q Length installed
to watt course measured l7
Slope of trenc � acceptable 1/16 - 1 /32 "/f ot.....:.......
10 ft. from prgperty line - 20 ft. -four tions..........
Dep of trench <30 inches from surf e ..................
Roo allowed for expansion ,100 ° / .........................
Size ' f gravel 3/4 -1 Y2" diameter ean ....................
IJep of gravel. irrtrench_1.2 ". ..morns
P.ipe a ds capped ............... . ...............................
R
COMMENTS
U v,
coo
- _PUTNAM COUNTY DEPARTMENT OF HEALTII -
DIVISION OF ENVIRONNIENTAL IIEATLII SERVICES
'yo . ... - , ; FIELD ACTIVITY - t .PQR
ADD Fqq,
Street Town State Zip
PERSON IN CHARGE
9
f1R TmTFRvmWPn: k, ;:" t v
TEST . [] DOSE TEST
L - -- _ _._ --._
t7 i� 5 ( c.,h6 -
REQUIRED GALLONS
It
/
7.10
_.
EL.:START--:-- _ -.. ".
a
. A
�'If ID L
Signature and Title
EL. STOP
111
I acknowledge receipt of this report: SIGNATURE:
02/96 •Title;
Rev.
1
i
1
3W07/1001 14:26 9147363693
c Qq ji 6 / 2001 22:39 9147357156
CRONIN ENGINEERING 1
FWMIER AT►LETIC CLU
The
New York board of Fire Undex%YritRt3
Buteau of Electricity
is n•: the PtuCess Of issuing o cert;fica[ 4:
compliance fur tl•a eiechi:at ;r�si�ila[ip:
as provided kC:r i:•t the :tppi:catio❑ fot
aupeciior,
New York Board of Firre Underwribers Y
;bureau of U,ectricity adivi'v
pursuapt :u .'\FP:iC,tiUtl
ha$ peen completed -md czat;ficate of
compliance seWng forth aw detai; of tlx
elettric system :s being peeaarec{I
hu Pe ctor Date
PAGE 02
PACE 02i@2
kle%MC • OI iTAinm rni WTv n1=PA9TMFNT nr7 P. ?
• 09/07/2,001 14:26 9147363693
BRUCE R FOGEY
Pnblk McWth Director
CRONIN ENGINEERING 1
PAGE 03
DEPARTMENT of HEALTH
I Geneva Road
Brewster, Now York 10509
P ev 10,014,
LORETTA MOLINARI RN., M.S.N.
Aramum Publk Meald Dim mar
Director of Paom Savka
REQUEST FOR FIELD'�'EST iG
ATTENTION: XADAII STIEBELING ❑ GENIE REED
All information below must be W i: completed prior to any scheduling. DATE:
,ENGINEERORFIRM: cRo�ia! �it3(,'1�cIC' tzi�C PHONEM (714 ) 7SOC-3C'C4�
REASON:
DEEPS: ❑ PERCS: ❑ PUMP TEST
ROAD/STREET:
TOWN: ler-NA L e T.txxe-,-:
SUBDIVISION: ,_ ,d LOT #• ,
OWNETU 37 GR670 ! RAA 9'0140 CdRP_
M F.P CMnMA FOR _iOi1V'T IZVIEW AND WIrNESSM- OF SOIL TE51IN
YES N:5�
Q Proposed SSTS within the drainage basin of West Branch or Boyds Corner Reservoirs.
D fS Proposed SSTS within $00 feet of a reservoir, reservoir stem or control lake.
❑ Proposed SSTS within 200 feet of a watercourse or a DEC wetland.
o a� Proposed SSTS desYgY► flow greater than 1000 gallousiday or SPDES Permit required.
0 t/ Proposed SSTS for a Commerical Project.
It is the responsibility of the design professional to provide the above information prior to soil testing.
This Department will determine the NYCDEP project status (Joint or Delegated) based on the p•
response. If you answered y-a to any of the questions. NYCDEP must witness the soil testing. This
Department: will coordinate a mutually suitable time for field testing with the PCDOH, the Design
Professional and NYCDEP.
If a project has been'determined to be Delegated based on the above response and then subsequent
information indicates NYC'I)EP is required to witness die soil testing, it will be the sole responsibility
of the design professional to schedule re- witnessing of the soil testing with IYYCDEP.
FOR COUN -r USE Oa ILY
DATE: TME:
— — — - -- - � • � - • � T,-.. onr_o�o_�0�4 MOMP! P1 ITNOM rni INTY DFPARTMENT OF P. 3
PUTNAM COUNTY DEPARTMENT OIF HEALTH
IIDI��II I T I�'- IET��I RONM ENTAIL IHIIEAILTIH .-S ERWC ES. _
CONSTRUCTION O V PERMIT FOR SEWAGE TREATMENT EA7CIViI1El YT SYSTEM
D
lC IEPMUT # o
af' o
Located at Sassinoro Drive /Kramers Pond Road Town cvt*kJa . Putnam Valley
Subdivision name Putnam Chase Subd. Lot # Tax Map 84 Block 1 Lot
Date Subdivision Approved 7 ` 4,5 - w Renewal Revision
Owner /Applicant Name
Mailing Address
37 Croton Dam Road Corp.
37 Croton Dam Road. Ossini
Amount of Fee Enclosed $300.00
Date of Previous Approval
M
N/A
Zip 10562
Building Type Residential Lot Area S, Z-6 No. of Bedrooms 4 Design Flow GPD S00
AC-
Fill Section Only Depth Volume
PCHD NOTIFICATION RS IEEE UIREI<D WHEN FILL IS COMPLETED
Separate Sewerage System to consist of 1250 gallon septic tank and ra 0L) L. F.
of 4" PVC Perf. pipe in 24" gravel trench.
Other Requirements: 1250 Gal. concrete pump chamber w /liydromatic SP40 pump or equal.
To be constructed by 37 Croton Dam Road Corp. Address 37 Croton Dam Road, Ossining, NY 10562
,W aea Suma�ly: - Public-Sup
ply_From__ Address
or: x Private Supply Drilled by P • F. Beal •& Sons. Inc. J Address 4 Putnam Ave
Brewster, NY 10509
I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the
separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion
thereof a "Certificate of Construction C _" satisfactory to the Public Health Director will be submitted to the
Department, and a written guarantee
W. owner, his successors, heirs or assigns by the builder, that said
builder will place in good operati c it -a of id sewage treatment system during the period of two (2) years
immediately following the date o . e ' ance of the Certificate of Construction Compliance of the original
system or anyrrdp4rs thereto. A.
Signed: �, �' �""7 c; E. R.A. Date
61 Address 2 John Walsh Blvd` . �e\�. 10566 License # 062980
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 App ved d' charge of domestic sanitary sewag only.
By: "- Title:_....... Date: e/z43
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pro essio 1
Form CP -97
• PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
r:. •...: : - ::: :�� = „�.r'. .,. APPLICATION TO CONS'T'RUCT A W- AX-.E-R` -WELLP
please print or type PCHD Permit # J3
Well Location:
Street Address: TownflWRW Tax Grid #
Sassinoro Drive/ Putnam Valle
I Y Map 84 Block 1 Lot(s) Q-S
Well Owner:
Name: 37 Croton
Address:
Dam Road Corp.
37 Croton Dam Road, Ossining, NY 10562
Use of Well:
X 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 5'O gal.
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
y New Supply (new dwelling) Deepen Existing Well
Detailed Reason
Water su 1 for new residence.
for Drilling
Well Type
x Drilled Driven Gravel Other
Is well site subject to flooding? ................................................. ............................... Yes No X
Is well located in a realty subdivision? ...................................... ............................... Yes .ac No 0
Name of subdivision PLIrA/A.-o e 1445 Lot No. l
Water Well Contractor: P.F. Beal & Sons Inc. 4 Putnam Ave., Brewster NY 10509
Is Public Water Supply available to site? . \��� . 1 e, R�, Yes No X
Name of Public Water Supply: N /A N/A
Distance to property from nearest water main: A
Proposed well location & sources of contamina ' be o s } to sheet/plan.
Applicant-Signature:
PERMIT TO CONSTRU - _ ATER 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 Z1a U' Permit Issuinj Official:
Date of Expiration $ / Title: t W'
Permit is Non- Transferrabl
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
• : - ' ' PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
{
APPLICATION FOR APPROVAL OF PLANS FOR_-
:,e.. 'F„'- .,ems.: ,.-. . .;.r-- ;.:F'y•. ,, - -,. +t � .,
A WASZ EWATER' TREATMENT SYSTEM - a.
1.
Name and address of applicant:
37 Croton Dam Road Corp.
37 Croton Dam Road
Ossining, NY 10562
2.
Name of project: Putnam Chase
- Lot # / 3. Location TN:' Putnam Valley
4.
Design Professional: Timothy L.
Cronin III 5. Address:
2 John Walsh Blvd.
6.
Drainage Basin: Peekskill Hollow Brook,—
Peekskill, NY 10566
7.
Type of Project:
X Private/Residential
Food Service
Commercial
Apartments
Institutional
Mobile Home Park
Office Building
Realty Subdivision
Other (specify)
8. Is this project subject to State Environmental Quality Review (SEQR)?
Type Status (check one ) ..... ............................... ...... .... Ty Exempt
Type II _ Unlisted X
9. Is a Draft Environmental Impact Statement (DEIS) required? ............:
10. Has DEIS been completed and found acceptable by Lead Agency? ............... N/A
11. Name of Lead Agency Town of Putnam Valley Planning Board
12. Is this project in an area under the control of local planning, zoning, or other
officials' ordinances . -
13. If so, have plans been submitted to such authorities? .......................................... YES
14. Has preliminary approval been granted by such authorities? YES Date glinted: 08/02/99
15. Type of Sewage Treatment System Discharge ................. surface water X groundwater
16. If surface water discharge, what is the stream class designation? .................... N/A
17. Waters index number (surface) ........................................... ...............................
18. Is project located near a public water supply system? ....... ...............................
N/A ,
NO
19. If yes, name of water supply N/A Distance to water supply N/A
20. Is project site near a public sewage collection or treatment system? ................ No
21. Name of sewage system N/A Distance to sewage system N/A
22. mate test holes observed 03/29/99 23. Name of Health Inspector Adam Stiebeling
24 t:_Proje ct.-:design flow. (gallons per day) ................................. ............................... 800 GAL /DAY
25' 1=1s' State Pollutant Discharge Elimination System (SPDES) Permit required ?... No
-• r . c\J
'is SP DES Application been submitted to local DEC office? ......................... NO
"` Form PC -97
2
27.. Is any portion of this project located within a designated Town or State wetland? NO
Vetlands�ID Number ................. ...................................... ............................... N/A
29. Is Wetlands Permit required? .............................................. ............................... NO
Has application been made to Town or Local DEC office? ............................... NO
30. Does project require a DEC Stream Disturbance Permit? .. ............................... NO
31. Is or was project site used for agricultural activity involving application of
pesticides to orchards or other crops, solid or hazardous waste disposal,
landfilling, sludge application or industrial activity? ............................ Yes/No NO
32. Is project located within 1,000 feet of existing or abandoned landfill,
hazardous waste site, salt stockpile, landfill, sludge disposal site or any
other potentially known source of contamination? ........... Yes/No YES
DESCRIBE: Property adjacent to the west was the former Orlando Landfill.
33. Is there a local master plan on file with the Town or Village? .................I........ YES
34. Are community water and/or sewer facilities planned to be developed within
15 years in or adjacent to project site? ................................ ........... ..................... NO
35. Are any sewage treatment areas in excess of 15% slope? . ............................... NO
36. Tax Map ID Number .......................... ............................... Map 84 Block 1 Lot 4-67
37. Approved plans are to be returned to ..... Applicant X_ Design Professional
NOTE; All applications for review and -approval'of a new- SSTS�-to belocated- widiifi*�lfe NS�C VVa'terslied 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. I
If the application is signed by a person other than the applicant shown in Item l .,the application must
be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision
may be grounds for the rejection of any submission.
I hereby affirm, under penalty of perjury, that information provided on this form is trace
to the best of easy knowledge and belief. Fill tements made herein are punishable as
a Mass A misdemeanor pursuant to ,fie on 10 45 the P 1
SIGNATURE'S OFFICIAL TITLES.
Mailing Address: ................................... Cronin Engineering, P . E . , P . C .
2 John Walsh Blvd, Peekskill, NY 10566
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
.... ., _r APF-II)XVI'li - CORPORATE -OWNEIC APPLICATION
FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT
To: Public Health Director
In the matter of application for: ' Construction of SSTS and Water Supply
T Val Santucci
represent that I am an officer or employee of the corporation and am authorized to act for:
Name of Corporation:
37
Croton
Dam
Road
Corp.
Having offices at:
37
. Croton
Dam
Road,
Ossining, NY 10562
Whose Officers Are:
President - Name: Val Santucci
Address: (Same as above)
Vice President -Name: Same as President
Address: (Same as above)
Secretary - Name: Michelle Santucci
Address: (Same as above)
... • •...... -�..V ....... .. •..::. :.. ..•r.r. to .. � � _ � r t=I Y !!I . _. r. --. • —. � • —�r�. • > ...r... •....r r. •- .�••..
Treasurer - Name: Same as Secretary JELL (i f.r
Address: (Same as above)
and that I am and will be individually responsible for any
to the approval requested and all subsequent acts relatin;
Simed:
Title:
Sw rn to bef re me this 'day of
1 onth) 2O (year)
Notary Public
KELLY M. LENT
Notary Public, State of New York . Corporate.Seal .
No. 01 LE6026834
Qualified in Westchester Count
Commission Expires June 21, 2
Form CA -97
all Wtsjpf the f orporation with respect
esi
j
PUTNAM COUNTY DEPARTMENT OF HEALTH
DMSIO T OF E_ RONMENTAIL HEALTH SERVICE
:'T •. .f Wit' w..IP.v.rr r r'T. !`: -C`�- "....R= --r �.�v.�. ..._.. ., .. -4 Y .. .1 �T. w�IP. �' u r �e.�
LETTER OF AUTHORIZATION
RE: Property of 37 Croton Dam Road Corp.
Located at Sassinoro Drive /Kramers Pond Road
T/ Putnam valley Tax Map # 84 Block 1 Lot 4S
Subdivision of "Putnam Chase Subdivision"
Subdivision Lot # I Filed Map # '1032- Date Filed
Gentlemen:
This letter is to authorize Timothy L. Cronin III
a duly licensed Professional Engineer X 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 , i said wastewater treatmerf an4or water supply systems
inconformity with the p W e S and/or 147 o the ati w;tie Public Health ,.-
Lavd tie Putiiarn` - <.�,an''
Countersi
P.E.,
Mailing Address 2 John Walsh Blvd. #200
State NY
Peekskill
Zip
' E
Signed:
Pres.
Mailing Address: 37 Croton Dam Road Corp
37 Croton Dam Road, Ossining
10566 State NY
Telephone: (914) 736 -3664 Telephone: (914) 739 -7362
Zip 10562
Form LA -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
SU�SIJRFAC'SE WAGE TREATMENT SYSTEM
Owner 37 GgoTdiv 1,-y4 M L- ogA p col-P Address y? G►zgyAj l go 05S1MAJ , Ny.
Located at (Street) j /1 t7TZ6 tb"0 A-D Tax Map 8�_ Block �_ Lot Z $ _Zcj
(indicate nearest cross street)
Municipality(' ). aLT-Al VjIA. oil Drainage Basin
f;<tJ�Sow 2 ! uc?L
SOIL PERCOLATION TEST DATA
v� _
V Date of Pre - soaking o 4 -08 -a g Date of Percolation Test ate( —oq --9 ci
Hole No.
Run No.
Start -Stop
ElapsL Time
Dep th`to Water
1�"rom Ground
SStarte Sop)
Water
Level
Inches
Percolation
NnAnch
2_4
21- Z4
.3.
S
2
e4lf _ 9
Z_7
3
Cl 39;
3
5
Z3. s3
3�
Z3_U
3
�a
l
�s3 "9z3
,30
_. 23-26
-..
4
..
5
1
2
3
4
5
NOTES: 1. Tests to be repeated at same-depth. until approximately equal percolation rates are obtained at eacn
percolation test hole. (i.e. s 1 min for 1 -30 minrnch, s 2 min for 31 -60 min/inch) All data to be
submitted for review.
2. Depth measurements to be made from top of hole.
Form DD -97
I�
• 2
TEST PIS' DATA
!�... _ HDES �D1FI
'!.
4'
DEPTH HOLE NO. A HOLE NO. HOLE NO.
G.L.
0.5'
1.0'
1.51 aBi
way tV4-M
2.0'
2.5'
3.0'
3.5' � 9 we a C,
4.0'
4.5'
5.0'
5.5'
6.0'
6.5'
7•S,
g:0'
10.0' -
Indicate level at which groundwater is encountered�a�
Indicate level at which mottling is observed 085 7zL
Indicate level . to which water level rises after being- encountered -
Deep hole observations,made:by.: A s�-a�-l3 t � A4 0-& �—.ta� Date e--q9
_J AEW
Dpsign-Professional Narne" M1mowV A.. - mmi
Address: NC
—�
s z , v.
•
Cn
CAJ
-• =-; Design Frofessional's Seal 629.80 �.
L:! a
Hr e
617.210 SEAR
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
.1'. --- .k.g r -AC T IONS - - . ... 1
Part I'- PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
1. APPLICANT/SPONSOR:
2. PROJECT NAME:
37 Croton Dam Road Corp.
Putnam Chase Subdivision, Lot #
3. PROJECT LOCATION:
Municipality Town of Putnam Valley County Putnam County
4. PRECISE LOCATION: (Street address and mad intersections, prominent landmarks, etc., or provide map)
Kramers Pond Road Sassinoto Drive
5. PROPOSED ACTION IS:
§New ❑Expansion ❑Modification/alteration
6. DESCRIBE PROJECT BRIEFLY.
construction of subsurface sewage treatment system and individual well water supply
7. AMOUNT OF LAND AFFECTED:
Initially-6.9-6—acres Ultimately 8 2 6 acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
,ffYes ❑No If No, describe. briefly
rz
9..'-,WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
Wesid.ential ❑1ndustrial ❑Commercial ❑Agricultural ❑Park/Forest(Open space ❑0ther
'Des*cnbe:
Spmounding lands are d.sing zone ,�pfqMilyresidendai---.-.--..,,-
10. DOES ACTION INVOLVE PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (FEDERAL, STATE OR LOCAL)?
I[Yes ❑No -'if yes, list ije'6'c'y(t) name and permit/approvals
Town of Putnam Valley - Building Permit
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLYVALID PERMIT OR APPROVAL?.
BYes ❑No If yes, list agency(s) name and permit/approval
Subdivision Plat Approval - 'Putnam Chase Subdivision'
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL'REQUIRE MODIFICATION?
❑yes 940
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant/Sponsor /Keith Staudohar date: .04-19-00
Signature: 7 e7c
77
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
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 ONo
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•:f.4'„b Ni) - .. ..L.• RL n d...- .., ". P .w .!, •9,w l .tee a. .M : P.4 fr'• ♦ e I.R: h4 e. .q•t../ .i ..
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: Answers may be handwritten, if legible.
. C 1. 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:
D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT
OF A CRITICAL ENVIRONMENTAL AREA (CEA)? ❑Yes ❑No If Yes, explain briefly:
E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
❑Yes ❑No If Yes, explain briefly:
Y�
Pav611I - DETERMINATION. OF SIGNIFICANCE (To be completed by Agency) :.. .:........ <.. --
. - II &TftUCT10141 .- F-a.- -wh•adverse et`ectridentifsed abl vE; d'eterniine-whefFier it is subs!antial; large; important or otherwise significant. -
Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d)
irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that
explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question
D of Part II was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the
environmental characteristics of the CEA.
❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then
proceed directly to the FULL EAF and /or prepare a. positive declaration.
❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that
the proposed action WILL NOT result in any sign'if'icant adverse environmental impacts AND provide on attachments as
necessary, the reasons supporting this determination:
Name of Lead Agency
Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer
Signature of Responsible Officer in Lead Agency.
Cv
date
Signature of Preparer (If different from responsible officer)