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84. -1 -48
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04337
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT
iiu. f
3t a ,�
j3S WIUAANt S .SUZt 6T_ IMap
r�tf# �,,r -'.� _- ♦._♦ _
gf Block Lot(s) g
Well Owner:
NA 22]"ddress-
7"
Use of Well:
1- primary
2- secondary
Residential Public Supply Air cond/heat pump Irrigation
Business Farm Test/monitoring Other(specify)
Industrial Institutional Standby
Drilling Equipment
Rotary Cable percussion Compressed air percussion Other (specify)
Well Type
Screened Open end casing 2<0pen hole in bedrock Other
Casing Details
Total length ' ft.
Length below grade
Diameter in.
Weight per foot lb /ft.
Materials: ' Steel Plastic Other
Joints: _ Welded Threaded _ Other
Seal. _ Cement grout _ Bentonite Other
Drive shoe: es No
Liner _ Yes ,--Io
Screen Details
Diameter (in)
Slot Size
Length(ft)
Depth to Screen (ft)
Developed?
First
�" : a
--�
Yes—No
Hours
Second
Well Yield Test
_ Bailed _ Pumped Xcompressed Air
Hours
Yield gpm
Depth Data
Measure from land surface- static (specify ft)
3)
During yield test(ft)
Depth of completed w
well in feet
G V0.
Well Log
If more detailed
information
descriptions or
sieve analyses
are available,
please attach.
.
Depth From
Surface
Water
Bearing
Well
Diameter(in)
Formation
Description
ft.
ft.
Land Surface
I
P
AfdZgaz - .—
r, _
-r
i` � "
O
VA
dE
00
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump /Storage Tank Information
Pump TypeKa�jz Capacity
Depth Mode t c
Voltage _2,:�50 HP
Tank TypeF� kW15e.30-),Volume 2�_ 0
Date Wel Comp ted
M10
Putnam County Certification No.
Date of Re ort
WeljDri r (signature)
NO E: act location of well with distances to at least two pe anent an arks to be provided on a separate sheet/plan.
Well Driller's Name / (/C Addrew-
Signature: Date:
White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner Orange copy -
Well driller Form WC -97
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IPA( ��w ���� (1�3i '�r€ b �Iy�:�'��`�.�'�����:���� (�)� ��� •��.���
O]ERTIDFN CATE OF CONSTRUCTION COMPLIANCE FOR SIEWAGE TREATMENT SYSTEM
PCHD CONSTRUCTION CTION PIE]fBMIT # PV 32 d 0
0� 1 /
Locatedat SASS INOR0 PE1VC Town r� V,4tZE `r
Owner /A"Keant Name 51 C R o T &4 DI9M ROAO cot?. Tax Map Block Lot
Formerly
Subdivision Name N T rJ arm CIP9 X r:
Subd. Lot #
Mailing Address /6 SRSXit biZ o d iZ I %1E PU N A Ax. Vig L lE N1 Zip 10 SdA
Date Construction Permit Issued by PCHD 19U 6 - 27 2606
r.
37 CRo i o,J Dfir"I j2019-0
Separate SeweragLftstem built by37 G12oT6tJ Pi9A i 6AD CORP. .Address. oSSllJ ioJ Go /J• V. 10S-6z,
Consisting of 12 SO Gallon Septic Tank and PE R 1--o 2 47.9
PIT
PVC PIPE 1,P➢ 2q" G124VCL rRoJcd
Other Requirements: 1.71 S —r R 1 Mu 0 10 -IJ -s Te ri
Water° Snnne ®flw: Public Supply From Address
f �UT�i9V� AVE u
one Private Supply Drilled by P f 5951 L 1 SO t�3 S J t J C Address OR W dC-r R, /Q - K.
Building Type'Sik&a 'r, MILY Rf✓-f- 'Hits erosion control been completed? jl T ~
Number of Bedrooms — Has garb ge' riin tal d,
I certify that the system(s), as listed, serving the 've , e ted essentially as shown on the as-
built plans (copies of which are attached), in a wi °' fit~ i s d P Construction Permit and approved
plans and the standards, Hiles and regulaiio o P tnamoit Dep W nt of Health.
Date: (— y / Certified by 2930 P.E. V R.A.
Address 2 TO)rd W AL.id� *K4 (! ,0- (nest 1 m�� - s�
%��r pC�' ptILC, , � License # 6 2-0)
Any person occupying premises served by the above system(s) shall pro 'mptly 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.plablie water supply becomes available. Such
approvals are subject to modification or change when, in the judgment of the Public Health Director, such
revocation odifica on c g. 's necessary.
0 By: Title: Date: :S !2_
White copy - HD File; Mellow copy - Building Inspector; Piny copy - Owner; Orange copy - Design Professional
Form CC -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT
S'um.�.i .�.,
etl` ocationiree"ddress:
�t -Chase Subd.
Kramers Pond Road, Lot #4
own/�i age:
Putnam Valley
Tax Grid # '
Map 84 Block 1 Lot(s) 48
Well Owner:
Name: Address:
VS Construction, 37 Croton Dam Road, Ossining, NY 10562
Use of Well:
1- primary
2- secondary
X Residential Public Supply Air cond/heat pump Irrigation
Business Farm Test/monitoring Other(specify)
Industrial Institutional Standby
Drilling Equipment
X Rotary Cable percussion X Compressed air percussion Other (specify)
Well Type
Screened Open end casing X Open hole in bedrock Other
Casing Details
Total length 52 ft.
Length below grade 51 ft.
Diameter 6 in.
Weight per foot 19 lb /ft.
Materials: X Steel Plastic _ Other
Joints: Welded X Threaded —Other
Sea]: 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 6
Yield 25 gpm
Depth Data
Measure from land surface- static (specify ft)
30'
During yield test(ft)
220'
Depth of completed well in feet
285'
Well Log
If more detailed
information
descriptions or
are available,
please attach.
Depth From
Surface
Water
Bearing
Well
Diameter(in)
Formation
Description
ft.
ft.
Land Surface
25
Dr ill in
in overburden
clay and boulders
25
Hit rock
at *25'
?5
:. 52'::
i?:.lin
iri rock
set casino routed
-52
285
Drillin
in rock
aranite
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump /Storage Tank Information
Pump Type sub Capacity 7wm
Depth 240' Model 7GS07412
Voltage 230 HP 3/4
Tank Type WX302 Vol 86
Date Well Completed
9/19/00
Putnam County Certification No.
002
Date of Report
2/26/01
We ril eaalr.
o e
NOTE: Exact location of well with distances to at least two permanent landmarks to be provided on a s6parate sheet/plan.
Well Driller's Nam P. ` Bea/ & ons Inc. Address: 4 Putnam Avenue, Brewster. NY
Signature: Date: 2/26/01
b corm T. Beal r.
White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC -97
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..^'- '`'.W��i'�w \., ?• iii''° �Ly.+ V-- P..— In'"in�c—wer....r.. -.Y'° •r. w �A . . �-•ti q. � •rA e . \ ,�/•. \ew
39 MILL PLAIN ROAD - DANBURY, CT 068111 CT Cert: PH -0404
LASS (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471
REPORT TO:
P.F. BEAL & SONS
DATE SAMPLE COLLECTED:
1/24/2001
4 PUTNAM AVENUE
TIME COLLECTED:
9:30 A.M.
BREWSTER, N.Y. 10509
COLLECTED BY:
KEVIN B.
DATE RECEIVED @ LAB:
1/24/2001
TESTED BY:
LAB #11471
LAB LID.#
PFB -016
REPORT DATE:
1/30/2001
SAMPLE SITE:
V.S. CONSTRUCTION CO., LOT #4, PUTNAM CHASE
SUBD., PUTNAM VALLEY, N.Y.
SAMPLE POINT:
TOP OF WELL
SOURCE:
WELL
TREATMENT:
NONE
MAXEVR M CONTAMINANT
TEST PERFORMED
RESULTS METHOD #
LEVEL (MCL) OR STANDARD
BACTERIAL:
o Total Coliform (Bacteria)
0
per 100 ml SM 9222B
0 per 100 ml
PHYSICALS:
• Color (Apparent)
0
- EPA 110.2
15
• Odor
ND
- -
3 Units
• pH
6.50
- EPA 150.1
No designated limits
• Turbidity
0.24
NTUs EPA 180.1
5 NTUs
CHEMISTRY:
o Nitrite Nitrogen
<0.005
mg/L as N EPA 354.1
1.0 mg/L
o Nitrate Nitrogen
0.27
mg/L as N SM 4500D
10 mg/L
z.... •o t�lkalinity -- _ . ...... - .
, .... , 4 ..._
v
r►g/L. .SNP 2•�10B _ .
_._ —No defirred-limits
• Hardness .
30.0
mg/L EPA 130.2
No defined limits
• Iron
<0.03
mg/L EPA 236.1
0.30 mg/L
• Manganese
<0.01
mg/L EPA 243.1
0.50 mg/L
Combined limit for Iron plus Manganese = 0.50mg/L
• Sodium
<1.0
mg/L EPA 273.1
20.0 mg/L **
• Lead
<0.001
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: MIPOTABLE or OINOTPOTABLE
RESULTS BASED ON SAMPLES SUBMITTED: 1/24/2001
Laboratory Director
°NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060370 (860)828 -9787 - FAX (860)829 -1050
TOLL FREE WITHIN CT: 800 - 826 -0105 o OUTSIDE CT: 800 - 654 -1230
1INTME-00RINF TRANSMITTAL
" ", . � °- + --=�= , -•- • '-�. o "'%:rr v %tr' „ : �'�'.'s . �'.�„':'°. � " +i.:.r�-�"' - _ �4+..:'- :o`-.' • ,,. 'ti^ � o •::i c.:.�, :;w�.°'w "•' .
CRONIN ENGINEERING P.E., P.C. March 2, 2001
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 4
P.C.D.H. PERMIT #PV -32 -00
THESE ARE TRANSMITTED as checked below:
❑ FOR APPROVAL ❑ FOR YOUR USE ❑ AS REQUESTED ❑ FOR REVIEW AND COMMENT X PLEASE REPLY
WE ARK SENDING YOU. attached
1.) Three copies of as -built subsurface sewage treatment system plan
2.) Three certificate of the construction compliance.
3.) Three guaranties of SSTS
4.) Well completion report
5.) Water analysis report
6.) Copy of survey showing foundation location
7.) E911 address verification form
8.) $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 subipitted,
aV
' `J Kenneth M. Murphy
;r; Project Designer
BRUCE R. FOLEY
Public Health Director
LORETTA MOLINARI R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
DEPARTIJENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (914) 278.6130 Fax (914) 278 - 7921
Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085
Early Intervention (914) 278 - 6014 Preschool (914) 278082 Fax (914) 278 - 6648
® NAME: 3Y ettOTO4 DAM EDA9 (r
. ef .
TAX MAP NUMBER: .5ec.:
E911 ADDRESS: 4 r5 A5 s / nl a Rio 72 P
TOWN: _?d-W APt VA i_�-6 Y
AUT'H®RIEZ)EItD TOWN OF FI[CU L: 4 d
fl
(Signature)
DATE:
Tae Putnam County Department ®f Health will not issue a Cerfificate of
(Construction Compliance unless the above form is completed, :Le, a legal E9111.
address is assigned by an authorized town Official. This form is to be submitted
wAth the application for a Certificate Of COnstracctg®rm Compliance.
(E911VERFRhO
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ft r,+ I .s f t o -� n tc. f y a 4 r. S . t ;* v a�, 1• t {� - f �"
P.UTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL - HEALTH SERVICES
' .. � .._ o• . ..e- •e. .. -.. ••'�"_•rar- .vim° - ... .'-" ':.;r`. .�, _, �. ..
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM
CZO-TW DAM , 004P-'. .
0
Owner or Purchaser of Building Tax Map Block Lot
LRM0 DAM 1 M D Coe�. u-�AM jALLE
Building Constructed by ow illage
(uTA)AM HRSF
Location - Street Subdivision Name
SNGc .� /LV S��E�1
/CIF 1
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 determinaf'on
4: Direct o the P tnam County Department of Health as to whether o no the
to ope ate as c" by the willful or negligent act of the occup I�Ii of e
sAste _ I
Day -2 P Year Loci 1 Signatte: _
Title:
) : Signature
theLPublic Health
it ' o the system
ildi utilizing the
3Y ea o-ratj -DAM _RZAD 009f. 31 OP-OTOA) PW PG4D ooe i�
Corporation Name (if corporation) Corporation Name (if corporation)
Address: .31 &OTON AM 2+0, 055►nJv10G
State /V . % Zip o.�5 6.Z
Address: 31 CeoTO.4 -DAM koAO, 056i0jsxt
State Zip /45We
Form GS -97.
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
FINAL SPI'E INSPECTION
_:.':::'€.^...,e.n.-- -.._.. .';;'.'"� ,'. v..:r „ «,� -�:i = :,3?..Y,' - r�. -r ......:s. �.= .&i.:. --s.r .. �'�•.'iv'€�y:.: .1JG� :°`T� ..CT'�^ "'1-°r:�a
�c '>f M� Inspected y:
Street Location J iz Owner jWre I-*
Town Permit
TM # - - Subdivision Lot #
1. Sewage Syste 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. Seifte System
a. Septic tank size -1,000 ........1,25 ......other ................
b. Septic tank installed level ................ ...............................
c. 10' minimum from foundation .......... ...............................
d. Distribution Box
1. All outlets at same elevation -water tested ................
2. Protected below frost ................ ...............................
3. Minimum 2 ft.Original= sailt4etween box trenches
e. Junction Box - proo erly set......... .. ...............................
f. Trenches
T. Length re R t ed Len instal( ed
2. Distanc . o watercourse measure, Ft..
3. Install according to plan ............................. ........
4. Slope f trench accepta/1/16, 1/32 /folot.......... .
5. 10 ft.' from property lifoundatio `�•�
P P Y t
6. Dep 'of trench <30 in surface.: t
7. Roo 1 allowed for ex 0 %. 8. Size of�ravel 3/4 l.P r�an. 9. Dep of�gravel in tre ch 12 minimum ...................
10. Pipe nds capped....... ................ ..........:....................
g. Pum or Zed S ms
.. r --• - -r ..._ ... ., ..................................................
2. Overflow tank ............................. ..............................
3. Alarm, visual / audio .................... ...............................
4. Pump easily accessible, manhole to grade .................
5. First box baffled ............................ ............::.................
6. Cycle witnessed by H.D.estimated flow /cycle...........
III. House/Buildin
a.. House located per approved plans ... ...:...........................
b. Number of bedrooms ....................... ............................... .
IV. Well
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" 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 ... ...............................
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02/27/2001 15:55
9147
CRONIN ENGINEERING 1
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
ATTENTION 4ADAM
RM I'EST FORMAL INSPECTION
All information. must be fully completed prior to any
inspections being made.
O GENE
For: Fill
Trenches 'fir
PAGE
PCHD Construction Permit #
Located: - SR- sSiaoRo 021114r (T) 00*--" .fu T+ Il 'h_ VII c c tr Y
Owner /Ap*wt Name: 33 P. MW jo-W-N RQAp C?J _ TM e q Block / Lot 4
Formerly Subdivision Name: , r°U T,—J6 + C04,04-
• Subdivision Lot #
Is system fill completed? �� Date:.:.
Is system complete? Y�j Date: F6 Z' 27. 200
Is system constructed as per plans?
Is well drilled? x Date:
Is well located as per plans ?,L -r
Are erosion control measures in place?
I certify that the system(s), as listed, at the above premises has been constructed and I have inspected
and verified their completion in accordance with the issued PCHD Construction Permit and
approved plans and the Standards, Rules and Regulations of the Putnam County Department of
Health. .
-.. - _.� Certified: by: , jr-pp
_
RA ..:. � .
Design Professional
Address: ? 7410J A),41,4H A% Lic. it
s
Comments:
Form FIR 99
Ei
PUTNAM COUNTY DEPARTMENT OF HEALTH
\ . DRWRON 07 IENWRONM EN.7AL HEALTH S ERW(CES
CONSTRUCTION PERMIT SEWAGE TREA'g'MEI T STEM
PERIyiI T #
j �y,))
� a.� U
r
Located at Sassinoro Drive/ _ TowriMxRMW Putnam Valley
Y
Subdivision name Putnam Chase Subd. Lot #_ Tax Map 84 Block 1 Lot
Date Subdivision Approved Opt Renewal Revision
Owner /Applicant Name 37 Croton Dam Road Corp. Date of Previous Approval N/A
Mailing Address 37 Croton Dam Road, Ossining, NY Zip 10562
Amount of Fee Enclosed $300.00
Building Type Resi denti a 1 Lot Area 3, de) No. of Bedrooms �r _ Design Flow GPD Ran
Fill Section Only Depth Volume
PCIEHID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Separate Sewerage System to consist of
1250 .
.of 4" PVC Perf. pipe in 24" gravel trench.
Other Requirements:
gallon septic tank and zf S/ V L. F.
To be constructed by 37 Croton Dam Road Corp. Address 37 Croton Dam Road, Ossining, NY 10505
Wzj@i :.Su®nllv: Public Supply From Address
~ X - i P . F . Beal -. Sons, Inc. Address 4 Putnamf Ave.
®u�: Private Supply Drilled by �
Brewster, NY 1050.11
I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the
separate sewage treatmentsystem described above will be constructed as shown on the approved amendment thereto and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion
thereof a "Certificate of Cons truiY ance" satisfactory to the Public Health Director will be submitted to the
Department, and a written gu ed the owner, his successors, heirs or assigns by the builder, that said
builder will place in good c ji rai, 66`nd Yi`ohy p of said sewage treatment system during the period of two (2) years
immediately following ate €the *R�Me o `a roval of the Certificate of Construction Compliance of the original
system or any repa' th eta.kf'
Uj
IU
Signed :• <� P.E. R.A. Date .5
Address 2 John Walsh NY 10566 License # 062980
APPROVED FOR CO1qSTRIUCT10K: This approval expires two years from the date issued unless construction of the
sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or
modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires
a new pe t. App ved Adcha&e of domestic sanitary sew ge only.
By: Title: Date: Z °
White copy - HD File; Yellow copy - Building Inspector; Pink co y - Owner; Orange copy - Design Pro ession 1
Form CP -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION -TO CONSTRUCT,A. WATER-WELL
please print or type
PCHD Permit # iff1l- 3,g - -00
Well Location:
Street Address: Town/We Tax Grid # 1
Sassinoro Drive, Lot 4 Putnam Valley Map 84 Block a Lots) �{£3
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 4 Est. of Daily Usage 500 gal.
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
x New Supply (new dwelling) Deepen Existing Well
Detailed Reason
Water supply for new residence
for Drilling
Well Type
�_ Drilled Driven Gravel Other
Is well site subject to flooding? ................................................. ............................... Yes No X_
Is well located in a realty subdivision? ...................................... ............................... Yeses No 4W
Name of subdivision LzAvAM 6,-#45E Lot No. `{-
Water Well Contractor: P.E. Beal & Sons, Tnc - `� - ', p
o
Is Public Water Supply available to site? ............. —� ... Yes No x
�"I°O
Name of Public Water Supply: N/A �`�
Distance to property from nearest water main:
Proposed well location & sources of contaminat • n b v c it 'fin se ar a sheet/plan.
V w
ate;04 / 24 i 0 Q AI3p11cmiLSgL-u'r —
� � �`•. 62980
PERMIT TO CONSTRUi&;A— ER 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 certif d b utnam
County.
Date of Issue lb Permit Issu' g Official:
Date of Expiration ¢} `213 p,� Title:
Permit is Non - Transferr le
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
. _ . _� _ _ -�_ _ APPLI�AT'IQN.:FOR.APPRO�Ah OF PL�NS_F4R .. -_.. _ ._ . ___...._ .s ;;_• :_: r:.- ...-:.:: .
A WASTEWATER TREATMENT SYSTEM
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 # zf 3..Location TN-6 Putnam Valley
4.
Design Professional: -Timothy L.
Cronin 111. 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)?
Tvpe Status (check one) ....................... .................:............. Tvpe I _ 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
........................ ..:.
13. If so, have plans been submitted to such authorities? YES
14. Has preliminary approval been granted by such authorities? YES Date granted: 08/02/99
15. Tv*
e 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) ........................................... ............................... N/A
18. Is project located near a public water supply system? ....................................... 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. Date test holes observed ' o3%29/99 23'. Name of Health Inspector Adam, Stiebeling
24. Project design flow (gallons P "er da Y) ...............................
800 GAL /DAY
25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?...
NO
26. Has SPDES Application been submitted to local DEC office? ......................... NO
Form PC -97
6 .
IA
27.
28.
..Is,any.portion.of this project located within a. designated. Town. or State wetland? . NO_
Wetlands ID Number ............................
Is Wetlands Permit required? ................
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? ty? ............................ 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? ......................... YES
34. Are community water and/or sewer facilities planned to be developed within
15 years in or adjacent to project site ?....... .......
35. Are any sewage treatment areas in excess of 15% slope? ............................... NO
36. Tax Map ID Number .......................... ............................... Map 84 Block 1 Lot
37. Approved plans are to be returned to Applicant x_ Design Professional
NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall
be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP
approval of the SSTS prior to final approval by the Department. Projects within the watershed may also
require DEP review and approval of other aspects of a project, such as stormwater.plans or the creation of
impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from
DEP and submit those forms to DEP for review and approval.
If the application is signed by a person other than the applicant shown in Item l .,the application must
be accompanied by a Letter of Authorization (Form L o comply with this provision
may be grounds for the rejection of an submission ��
Y J Y Al I...
I hereby affirm, u nder penally of perjury, thIht i
to tine best of my knoWedge and belief. p'al' ate
a Class .A misdemeanor pursuant to ,sect ° .45
y
rov d this form is true
iJe h ' ; re punishable as
:Kunal
r�.iP-�rIQJ i- 1'il.ifId
Mailing Address: ............ ,.,...... Cronin Engineering, P . E . , P . C .
,John Walsh Blvd, Peekskill, NY 10566
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
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 Lo ltg
Subdivision of "Putnam Chase Subdivision"
Subdivision Lot # ' Filed Map # Zf' 5 Z Date Filed D°7-2-5--00
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 D t; and to sign all necessary papers on my behalf in connection with this
matter and to s' NEWt struction of said wastewater tr eatment And/or water supply systems
inrconf0 r ity; _ - �t ec.i� _ of Article- _145_and/or: 147 of e_. du tion - v�,.the_Public- Health
Law, and ..they 't A ; ty 'tary Code. _ _ 1 f.
Uj Very truly1yoursi
? Af I 1
�Z�so
fit
Signed: Pres . -MIX"
P.E., #
Mailing Address. 2 John Walsh Blvd. #200
Peekskill
State NY Zip 10566
Telephone: (914) 736 -3664
Mailing Address: 37 Croton Dam Road Corp.
37 Croton Dam Road; Ossining
State NY Zip 10562
Telephone: (914) 739 -7362
Form LA -97
PUTT AM 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: Construction of SSTS and Water Supply
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
Vice President - Name:
Address:
(Same as above)
Same as President
(Same as above)
Secretary -Name: Michelle Santucci
Treasurer - Name:
Address:
Sa e_as,_-,above)__._-___-
Same as Secretary
(Same as above)
and that I am and will be individually responsible for any
to the approval requested and all subsequent acts relatin,
Signed
Title:
Sworn to before me this CVM__ day of
Sworn
200 (year)
Notary Public
KELLY M. LENT Corporate Seal
Notary Public, State of New York
No, 01 LE6026834
Qualified In Westchester Coun&j
Commission Expires June 21, 2
Form CA-97
tion with respect
ID
PUTNAM COUNTY DEPARTMENT Of HEALTH
DIVISION OF ENVIRONMENTAL HEALTH S
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner S7 CgolVJ De4 M &AQ wiTP Address, 32 C,1Za7zw j>m aD OSSIAIINv4 tj y.
Located at (Street) KAM!21tmS 1;&y6 I2oA-0 Tax Map jff� Block _I Lot 7.0 zq
(indicate nearest cross street)
Municipality(l) PurmAm VA"OLI Drainage Basin & gs4ju tbU.411 CgZrg
D( SOIL PERCOLATION TEST DATA
Date Oq ve -�q -4 Date of Percolation Test'
ate of Pre-soaking --012 -q 9
HoleNo.
Run No.
Tinie
Start - Stop
El Time
2�1 Nei
DVth to Water
rom Ground
Surface (Inches)
Start Stop
Water
Level
Drop in
Inches
Percolation
Rate
NwInch
34—
Z- I- 7. 4
3
2
30
3
3
LZ:Le 17 0
300
4
1 34, 115"
a
-ts
2
3
3
4
5
2
3
4
5
NOTES: I Tests to het—aneated at same death until azwroximatelv
eaual nercolatio''n Wefare obtained at each
percolation test hole. (i.e. s I min for 1-30 minlinch, s 2 min for 31-60.miarmch) All _data to be
submitted for review..
2. Depth measurements to be made from top of hole.
Form DD-97
- XDEPTH ` `HDESCAIMON OE SOILS ENCOUNTIER EHD IN TEST HHOLES
HOLE NO. to HOLE NO. ' 11 HOLE NO.
O.L. a [ [_ — o c
0.5'
1.5 to � bra• ®; ta4l a J7LU&A0 4 ��
2.0'
2.5'
3.0' o O &4j6jMqj, 34"
4.0'
4.5'
5.0'
5.5'
6.0'
6.5' ° -v
y �
7.5'
9.5'
10.0'
Indicate level at which groundwater is encountered pAJco &Pt -reel
Indicate level at which Mottling is observed Ajeef o®S&VU,4
Indicate level 't® which water level rises after being encountered
Deep hole observations trade by: A zge?& °ST t Date 0 31LI —1d
Design Professional Name: Tt,,w aniq &_. <"&i&)
Address: -
Signature
'f
I
Design Professional's Seal
'v:.tv r0
A tiA�..
d�,!arT,' � w
r ' _
�•,F•
62980 �.?
.. 617.20 SEQR
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For- UNLISTEd..ACTIONS.Only�. •:
Part 1 - PROJECT INFORMATION (To be completed by Annlicant or Prniect snnncnrl
1.. APPLICANT /SPONSOR:
2. PROJECT NAME:
37 Craton Dam Road Corp.
Putnam Chase Subdivision, Lot #
3. PROJECT LOCATION:
Municipality of Putnam Valley County Putnam County
4. PRECISE LOCATION: (Street address and road intersections, prominent landmarks, etc., or provide map)
Kramers Pond Road / Sassinoro Drive
5. PROPOSED ACTION IS:
§Yew ❑Expansion ❑Modification /alteration
6. DESCRIBE PROJECT BRIEFLY:
construction of subsurface sewage treatment system and individual well water supply
7. AMOUNT OF LAND AFFECTED:
Initially acres Ultimately 3, 00 acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
®Yes ❑No If No, describe briefly
9. WHAT IS PRESENT LAND.USE IN VICINITY OF PROJECT?
Wesidential ' - ❑Industrial ❑Commercial ❑Agricultural ❑ParklForest/Open space ❑Other
Describer
Surrounding /ands--are zone dsirngle -fatuity
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (FEDERAL, STATE OR LOCAL)?
JjYes ❑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?
®lies ONo If yes, list agency(s) name and permillapproval
Subdivision Plat Approval — "Putnam Chase Subdivision"
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION?
❑Yes Wo
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant/Sponsor 111111 j ill'ill - har date: 04-19 -00
Sgnature:
T
ff the action is in a Coastal Area, and you am 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
DYes ❑No
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a
riegatne leclaratior. may ",SypeEseded by
[]No
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: Answers may be handwritten, if legible.
C 1. Existing air qualty, 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:
1_
D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE EST6BLIS'�ft�tT
OF A CRITICAL ENVIRONMENTAL AREA (CEA)? DYes ONo If Yes, explain briefly: =y cn L- -cam
E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONM. ENTA4PA1 TS?
DYes DNo If Yes, explain briefly.
,.
Pal 1I9 - DETR�9tP l7,TIOtb.OF"S[vfdtF9LAPdCE (To be complei�:d b., A enc T—:
.......... ...
WSTRUCTIONS: " For each adverse-effeci 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.
D 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.
D Check this box if you have determined, based on the information and analysis above and any supporting documentation, that
the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as
necessary, the reasons supporting this determination:
Print or Type Name of Responsible Officer in Lead Agency
Signature of Responsible Officer in Lead Agency
Name of Lead Agency
date
Title of Responsible Officer
Signature of Preparer (If different from responsible officer)
BRUCE 'R. FOLEY
May 17, 2000
LORETT_ A MOLINARI R.N., M.S.N.
Director of Patient Services
DEPARTMENT OF 'HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (914) 278 - 6130 . Fax (914) 278 - 7921
Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085
Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 . Fax (914) 278 - 6648
Timothy Cronin, PE
Cronin Engineering
The Lindy Building, Suite 200
2 John Walsh Blvd.
Peekskill, New York 10566
Re: Putnam Chase
Town of Putnam Valley
Dear Mr. Cronin:
This office is in receipt of individual sanitary sewage treatment system and well construction
plans and applications subject to the above referenced Realty Subdivision, lot #'s 2,3,4,5,6.
Prior to further review of such applications, please provide this office certified proof of filing or
the Realty Subdivision map.
_ such -time •as -Map is.:filed,.c.,onstwo4gp -_applications- submitted�will -have to-.be.-co
"Date Subdivision Approved." r w
This office will continue its review upon consideration of the above mentioned comments.
Please feel free to contact me at ext. 2157 if any questions arise.
Very truly yours,
Adam B. Stiebeling
Assistant Public Health Engineer
ABS:cj
g
1.
o
OZ
IT
�,. � :per g � ' � r
o ' � ti
4 ' .Q, y�
jr
�' + fiO I
-Z—
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•6ld,
100
Rig
I
root n AVQ U op
S !S TO CER
IVSTRUCTEO A
5 INSPECTED
s CONS17?UC
ilS DACES TO, T 'E -IVDS OF SS TS- ,
l�E51` EN0 4F 1ST TRENCH 104' 48'
S1 ENfl' OF 3RD TRENOH 172 61 "
l�1ES7' END 'OF -47h!
%S%l�iE %� E•i�5% E'f5'. OF'
sntc ravx .
t:7"
73.5'
D/S.. 77ov. 80X'
63'
64'
ilS DACES TO, T 'E -IVDS OF SS TS- ,
l�E51` EN0 4F 1ST TRENCH 104' 48'
S1 ENfl' OF 3RD TRENOH 172 61 "
l�1ES7' END 'OF -47h!
%S%l�iE %� E•i�5% E'f5'. OF'
EASE END DF 1ST TRE$CH ,
'62.'
113.5'
END ;OF "2/ilD,, 1REiCM
=,
6B 5'
116'
EAST EtVQ OF .3RD 7RENGH .
15'„
20
EAS 7` EkD. OF 4--7H,;.. lRENV -
81.5'
12J'
qf
� C�
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