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HomeMy WebLinkAbout4338DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -1 -49 BOX 33 Xr 4 i ' I. rim UL-' 04338 �,- vo\v . k 0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR S TMENT SYSTEM PCHD CONSTRUCTION PERMIT # .pV Z3 ° 00 hTn Z'O Located at SAs.s i A? n 9_0 i1 �' own r Village A L_L Owner /Applicant Name,3 7 eMT00 P Tax Map p �L— Block �_ Lot 43 Formerly Subdivision Name _?L0 .JAM eH A S C Subd. Lot # Mailing Address 3'e (e OMjl >1A A Z�OA 0 . 0--,671A)IA16 . A) / Zip 1,0.5 Z Date Construction Permit Issued by PCHD P -- I Q -- 00 Separate Sewerage System built by ,31 l"gorptj AA zAp 0R P Address 37 6bTDN AM , 12y� �s ►��►� o� A/' y 0 Consisting of 12. Gallon Septic Tank and 4348 L.F- Pile mow+ C... b�7TZL1�.6 u+ ..:..... .. .- ..:....P.::.. `�. -.... ..„, ..... .. .. .w_... ... .a..._... mac... ,... ._..... -. _ ._. ._.— .. -.... ,... � .. _ .. .. . ... ... .a.... .. rr..i Other Requirements: Water Supply: Public Supply From Address or: y1 Private Supply Drilled by f. F, 5EAL 1l seNS c- , Address q f ��-r� AM A u E . 3'rP_ wSre- e , y. to5o9 Building Type A FAm t" 1Zut DFAMA L. Has. erosion control been completed? XU Number of Bedrooms Has g!rbhai finder been installed? A/0 . NFw "y- I certify that the system(s), as listed, serving Aie� a pre a constructed essentially as shown on the as- built plans (copies of which are attached), iri�ac , rd cwh'the'rs ue PCHD Construction Permit and approved plans and the standards, rules and regulatio Itriam:?oun partment of Health. Date: 01 0,9 k Certified by `� ,` y } P.E. V Address .2 Z. 14 11l% 4 L B 1 v J. f � t ;' ?� `` License # D 62 0 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 su 'ect to odifiication or change when, in the judgment of the Public Health Director, such revocatio , odi c do r an s necessary. .'i.: G`': +.` ..s_� �'e- _ c as 1 _ �•• - 4C'::: lam- a. � =L. ..'�• By: Title: Date: Z �I- 0 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 )PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WFI .lf , tt''nlbi P f .lE'1f'lf ON REPORT Well Location Street Address: Kr amers Pond Rd, Put -Chase S Town/Village: Putnam Valley Tax Grid # lob �}5 Map Block ®. Lot(s) 5. Well Owner: Name: Address: S 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 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 will st =. � �°` $�a°`"fecT� X np� -�'X��P essed; X7- rd .m )(Depth Data Measure from land surface- static (specify ft) 301 During yield test(ft) 540' Depth of completed well in feet 605' Well Log If more detailed information descriptions or sieve analyses are available, please attach. ][Depth From Surface Water Bearing Well Diameter(in) )Formation )(Description fft. ft. Land Surface 25 Drillin in over urden elag and boulder 25 Hit roc at 25' 25 52 Drillinc in rock set casina, arouted 52 605 in rock crranite _—Dri-11inc If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type_ Capacity Depth 560' Model 5GS10412 Voltage 230 HP 1 Tank Type WX302 Volume 86 Date Well Completed 9/1 8/00 Putnam County Certification No. 002 Date of Report 1/19/01 WeeD, a . eal NUT E: Exact location of well with aistances .WtU Drille ~ Signature: White copy least two permanent ianumarxs w uG Jiuviy W un a wYazaw �uvvvY =w= Date: 1/19/01 Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 NORTHEAST LABORATORY of DANSURY 39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0464 (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 REPORT TO: P.F. BEAL & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLE POINT: SOURCE: TREATMENT: TEST PERFORMED LABORATORY REPORT DATE SAMPLE COLLECTED: TIME COLLECTED: COLLECTED BY. DATE RECEIVED @ LAB: TESTED BY: LAB I.D.# REPORT DATE: 1/10/2001 10:30 A.M. KEVIN BENTSON 1/10/2001 LAB #11471 PFB -002 1/15/2001 V.S. CONSTRUCTION, LOT 45, PLT174AM CHASE SLED., PUT14AM VALLEY, N.Y. HOSE BIB WELL NONE- MAXIMUM CONTAMINANT RESULTS METHOD # LEVEL (MCL) OR STANDARD BACTERIAL: <0.005 mg/L as N EPA 354.1 • Total Coliform (Bacteria) 0 per 100 ml SM 9222B 0 per 100 ml _.-...... -, PHYSICALS: 6.0 mg/L SM 2320B • Color (Apparent) 0 - EPA 110.2 15 • Odor ND - - 3 Units • pH 6.50 - EPA 150.1 No designated limits • Turbidity 0.26 NTUs EPA 180.1 5 NTUs CHEMISTRY: • Nitrite Nitrogen <0.005 mg/L as N EPA 354.1 • Nitrate Nitrogen 0.22 . mg/L as N SM 4500D • AflWinity 6.0 mg/L SM 2320B • Hardness 22.0 M91L EPA 130.2 • Iron <0.03 mg/L EPA 236.1 • Manganese <0.01 mg/L EPA 243.1 • Sodium • Lead <1.0 mg/L EPA 273.1 <0.001 mg/L. EPA 239.2 1.0 mg/L 10 mg/L No defined limits No defined limits " 0.30 mg/L 0.50 mg/L Combined limit for Iron plus Manganese = 0.50mg/L 20.0 mg/L ** 0.015 mg/L * ** ml= inilliliter mg/L--milligrams per�L' ter ND=none detected ' MCIJ= M Contaminant Level * *Notification Level ** *Action Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: Xn OTABLE or OT POTABLE RESULTS BASED ON SAMPLES SUBMITTED: 1 /10/2001 Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 a31 L'20ToO DAM ROAD NP-P. Building Constructed by 5A WOOD YFI Location - Street Building Type ow illage ( UTA)A M l.: H`15F. Subdivision Name 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 ia- has- beerrc ^�s�ugwLas shown on the. approved -p1, gr-��prove-d a m.endrnent thPreLO,,andin - -- 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. A n The undersi ed further agrees to accept as conclusive the dete 'nat bn th u lic Health Directo oft e Putn County Department of Health as to whether no h f ilu a the system to per caus b the willful or negligent act of the occup t of e ild' utilizing the S m. D t 0/ Day Year DOr Signa m Title: r Gen a Co tr c or (0 er) - Signature Corporation Name (if corporation) Corporation Name (if corporation) Address: 3-i et -oro�v M �� tJSS►A)oA)G . Address: 31 eOT(I A) DAM koA�) O_i�is State A/ . Zip 0� State Zip /�5`�� l .... ?�. _g .. ..-' r.�., �, .i.�dasr. .. Juror 't,- - �. _.-.� ��`._ -.. _. � ..t',•. ... e.4 "' _. dti- +Cis: d. ..s..._ _.. J.trrs.. ,. .- .... _.r-.� - Form GS -97 BRUCE R. FOLEY Public Health Director LORETTA MOLINARI -R.N., M.S.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 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 .OWIVERS.NAME: 31 CeUMA) DAq 'P,�A> TAX MAP NUMBER: JP _. 5u S- E911 ADDRESS: �► O 'TOWN: -_ ... �...... - . , 7 AUTHORIZED TOWN OFFICIAL: (Signature) DATE: Vti. The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERFRIvn. 7P 7�1 q I RONIN ENGINEERING P.E. P.C. The Lindy Building, Suite 200, 2 John Walsh Blvd., Peekskill, New York 10566 a�N Tel. (914) 736 -3664 o Fax. (914) 736.3693 January 25, 2001 Adam Stiebeling, Public Health Engineer Putnam County Department of Health Division of Environmental Services 4 Geneva Road, Brewster, N.Y. 10509 Re: SSTS Construction Compliance Putnam Chase Subdivision — Lots 2, 5, 14 Sassinoro Drive, Town of Putnam Valley j LI 2 EN I(4- Dear Mr. Stiebeling: In response to your letter dated 1/22/01, regarding additional informatlon for the above _ referenced subdivision lots, please find the following information enclosed: 1. Lot 2: Form WC -97 dated 1/24/01, including Pump /Storage Tank Information. 2. Lot 5: Form WC -97 dated 1/19/01, including Pump /Storage Tank Information. Water Quality Laboratory Report dated 1/15/01. 3. Lot 14: Form WC -97 dated 1/24/01, including Pump /Storage Tank Information. Water Quality Laboratory report dated 1/18/01. 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 matter. Respectfully submitted, Luis � ernandez Project Engineer I 'I`d GE'# r 1 PutChABLots2514,01- 25-01. I s. BRUCE R. FOLEY Public Health Director January 22, 2001 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Timothy Cronin, PE The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 Re: Application of Certificate of Construction Compliance: Putnam Chase, Sassinoro Drive Lots # 2 �5� and 14, Town of Putnam Valley Dear Mr. Cronin: a This office has determined that the above referenced Certificate of Construction Compliance applications, received by the Department on January 10, 2001 are incomplete. Please be advised that the following information is required before the Department may commence its review. Lot #2 1. Form WC -97 - Well Completion Report (original attached). a. Pump /storage tank information needs to be completed b. Tax map number is required. Lot #5 1. Form WC -97 well completion report required. 2. H2O quality analysis required. Lot # 14 1. Pump /storage tank information required. Please submit completed copy. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact us if any questions arise. ABS:cj Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer PUTNAIiI COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION ' D, In: a A 5S' Kf a C p4.1 Street Loc Town Permit # TM 9_ — I Subdivision Lot # _ 1. Sewage System Area a..STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ........... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/ wetlands ...... ............................... II. Sewage System a. Septic tank size -1,000 ..... ......other ................ b. Septic tank installed level ............:. .. ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box T All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box -properly set ........... ............................... .rends required Lengtlrinstalled' " Vince to watercourse measured Ft.......... all ac�rding to plan ......... ............................... of trpA acceptable 1 /16 -1/32" /foot ............. 5. t m property line - 20 ft: foundations.......... 6. of tr ench <30 inches from surface .................. oom allowed for expansion, 100% ......................... 8. Size of gravel 3/4 -1 ` /z" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped .................................. :.................... g. PumR or Dosed Systems Size ot pump chamber ................ ............................... 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 '1 Z 06 ft........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ............. I......... 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. . Curtaiin drain &standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 6/97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION MeADAM All information must be fully completed prior to any inspections being made. . 11 GENE PCHD Construction Permit # RV -,:20 - 0 0 Located. '>a_cs'kx)zxA Owner/Applicant Name- -':3 rA Formerly: Subdivision Subdivision L, Is system fill completed? . Is system complete? An Is system constructed as per plans t Date:--., 'is well located as per plans? Are erosion control measures in place? For: Fill Trenches I certify that the syst*s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCBD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. Date: - /2-44/40D Certified by: nn DesiAofessional Address: ,9 _Tw," Lic. # oe z _g60 Comments: Form FIR-99 PUTNAM COUNTY D EPARTM ENT ®IF H EALT H IDRVffSffCN +N7R® lE1ll AL HEALTH H SILRVICES CONSTRU CUON PIE W— AGIE TREATMENT SYSTEM PIERM[]IT # Located at Sassinoro Drive /Kramers Pond Road Town gc Mjap Putnam Valley Subdivision name Putnam Chase Subd. Lot # Tax Map 84 Block 1 Lot Sub Lot At Date Subdivision Approved 0-7— ZS--00 Renewal Revision Owner /Applicant Name 37 Croton Dam Road Corp. Date of Previous Approval N/A Mailing Address 37 Croton Dam Road, Ossining, W Zip lo (;2 Amount of Fee Enclosed $300.00 Building Type Residential Lot Area 3, 00 No. of Bedrooms 4 Design Flow GPD 800 AC. Fill Section Only Depth Volume IP'CIPIfHD NOTIFICATION IS REQUIRED WHEN JFffLL IS COMPLETED_ Separate Sewerage System to consist of of 4" PVC Perf. Other Requirements: To be constructed by Water SUPPRY, 1250 ipe in 24" Rravel trench. gallon septic tank and �/ ' L. F 37 Croton Dam Road Corp. Address 37 Croton Dam Road, Ossining, NY 10505 Public Supply From Address or: X Private Supply Drilled by P.F. Beal & Sons, Inc. Address 4 Putnam Ave. Brewster, NY 10504 I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage- treatments sy tem 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 ConstrruEtiew, . pliance" satisfactory to the Public Health Director will be submitted to the Department, and a written 90ite" ished the owner, his successors, heirs or assigns by the builder, that said builder will place in goo er ag-e a art of said sewage treatment system during the period of two (2) years immediately following of the is uanbe f approval of the Certificate of Construction Compliance of the original .��W'r' :.,.. � system or any reps' to o s ;' Signed: Address 2 John Wal iLP.E. R.A. Date .- 1 —uc3 NY 10566 License # 062980 nJFE'55-% : - so" APPIROVE D FOR CORISTRN�1C s 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 a it. �PIi ved isc, ;ge of domestic sanitary sewge only. By Title: Date: 40.-// White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pr fess oval Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL ,p please print or type PCHD Permit # Well Location: Street Address: Town/Vdbp Tax Grid # 1 " Sassinoro Drive, Lot . 6 Putnam Valley Map 84 Block Loi(s) Well Owner: Name: Address: 37 Croton Dam Road Colp., 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 _—A— 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? ............................................................... ....... Yes No iP Name: f-sttbdivision _ - ?cam, �'��;c �= u. _emu. `�oi'No:`. Water Well Contractor: P.F. Beal $ Sons, Inc. 4 Putnam Ave., Brewster NY 105 Is Public Water Supply available to site? ' -- PP Y .................�.,:..,:.:. ��..,,...c,.� ...� .......... Yes No X t � Name of Public Water Supply: N/A To N/a Distance to property from nearest water main: ' Proposed well location & sources of contaminatio to p „ sep sheet/plan. wt' Date: 04/24/00 Applicant Signature: PERMIT TO CONSTRUCT 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 certified by Putnam County. Date of Issue 01(0[001 Permit Issuing icial: . Date of Expiration O © Title: Pe'rmit'is Non- Tran'sYeirr ble r: 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 O_F PLANS. FOR_..:, _ A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: 37. Croton Dam Road Corp. 37 Croton Dam Road Ossining,-.NY 1,0562 2.. Name of project: Putnam Chase Lot # 3. Location TN: Putnam Val ley 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 (SEAR)? Type Status (check one) ....................... ............................... Type I Type II — 9. Is a Draft Environmental Impact. Statement (DEIS) required? .............. 10. Has DEIS been completed and found acceptable by Lead Agency? ................ Exempt Unlisted X NO N/A 1 I.-' 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,,ordukances . 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. 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) .... .................................. ............................... 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 03/29/99 23. Name of Health Inspector Adam Stiebeling 24. Project design flow. (gallons per day) ............................... 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 z 27. Is arty. portrort.of.this Rroject..Jocated within a designated Town or.State wetland? No _ 28. Wetlands 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? .. ............................... N0 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? ......................... YES 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ...................I............ _ No 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 $STS 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 � v 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 I .,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. JF N °;�" . p hereby dorm, sander penalty of perjury, tha ion prov is form is true to the best of my knowledge and belief. False ent 'laer are punishable as a Class A misdemeanor pursuant to Sectio 5 of I La SIGN A TURE I L TITLES: �. � I�A ° AM QO V, l 62960 "K. S0 Mai S�;���ai ;l.0 1j�w'v1�i�V3 Cronin Engineering, P.E.,P.C. Mailing Address `�. 1. .... 3 �, l� �: �.� d..... John Walsh Blvd, Peekskill, NY 10566 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: 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 .....�4,dd as a boye) Treasurer - Name: Same as Secretary ^ A w 1 Address: (Same as above) and that I am and will be individually responsible for any to the approval requested and all subsequent acts relating Signed: Title: Sworn to bef re me this day of onth) 20q0 (year) . Notary Public KELLY M. LENT Notary Public, State of New York Corporate Seal No. 01 LE6026834 ouallfied in Westchester Count Commission Expires June 21, 2M/ Form CA -97 prporation with respect t p COUNTY DEPARTMENT HEALTH � HEALTH s 3 �} .., q 4,7 + Y 6 ti ? '' SERVICES t S LETTER OF Aa.JTH®1l 12ATION RE: Property of 37 Croton Dam Road Corp. Located at Sassinoro Drive /Kramers Pond Road Ty Putnam Valley Tax .Map # 84 Subdivision of "Putnam Chase Subdivision" Block 1 Lot ��+9 Subdivision Lot # _� Filed Map # 2 Date Filed 0? —? 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 RE W t ' and to sign all necessary papers on my behalf in connection with this `�. matter and P1 t struction of said wastewater treatme an or water supply systems in confo � ,' io �o €Article 145 and/or. 147 -o he d ati -arwY the:Public ;Health - r........�Law an . �'th _ . - - t� ,� tarp;- Code......... �� �.�.... : r ; A Very truly our Counters i \ L`'Qr;. 62980 Signed: Pres . 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 Telephone: (914) 739 -7362 Zip 10562 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 'DESTGIV`DATASHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner' 37 Ggo7z)lu (>qNi gkAp oo-LP Address 37 UZoTON L>m aD 0551Nru4 N y. Located at (Street) /Zq�at �7t� J v� Rofro _Tax Map 2_1 Block _I ' Lot -Z 7 (indicate nearest cross street) Municipality(?') &EmAM V,q uEtl Drainage Basin jgXS i u t. k)u-o L j r g4gr . f�l�So�u 2l uc7Z . SOIL PERCOLATION TEST DATA Date of Pre = soaking o4 -06 X19 A Date of Percolation Test 04 -09-99 " j, .: 1YpTES: 1. Tests to be repeated at same depth until approximateiy'equal percolation rates are obtainea at caret percolation test hole. (i.e. s 1 min for 1 -30 min/mch, s 2 min for 31 -60 min/mch) -.All data to be , submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 De th to Water From Ground Water Level Percolation Hole No. Run Stop ElapsLme Surface (Inches) In gins No. Start Mi�Inch 1 wl -- (44 2 ►8 -Z i 3 � 2. (144"1y13 Z-7 q 4 5 3 �Ztr -( 4f 30 21 -Z4 3.. i a 4 5 ... .. '• 3 w �� 4 5 j, .: 1YpTES: 1. Tests to be repeated at same depth until approximateiy'equal percolation rates are obtainea at caret percolation test hole. (i.e. s 1 min for 1 -30 min/mch, s 2 min for 31 -60 min/mch) -.All data to be , submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 9 TEST PIT DATA i DESCRIPTION OF SOILS ENCOUNTERE HOLES DEPTH HOLE NO. HOLE NO. I* HOLE NO. tl G.L. 4a I L -7b p 11— so �. . 0.5' 1.0' 1.5 91VWAJ -4&A , Loh I" ,u SOU LOAM 2.0' 2.5' N Indicate level at which ground`vater is encountered Indicate level at which. mottling is observed Afif&E 0A Indicate level to which water level rises after being encountered r' Deep hole observations made by: �4ffi AJ(-1 ,40& �i"• t�Date —L —tj q Design Professional Name: :p!M at4g �. �� ��� Address: � mj ,—PAA6 aa,�� #A/6 R e ro A C— ��� R41� Signature Design Prof'essional°s Seal x r � `o• . 62980 u"KOr'ES������ .617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM T_ 4 -: On 7'-. �,- 7. � . ........ 1,..For.UNU- S­T ED-ACTIOW I"L: y Part I - PROJECT INFORMATION (To be completed by'Applicant or Project sponsor) SEAR 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 ISassinom Drive 5..PROPOSED ACTION IS: §New ❑Expansion 0modification/afteration 6. DESCRIBE PROJECT BRIEFLY: constriction of subsurface sewage treatment system and individual we# water supply 7. AMOUNT OF LAND AFFECTED: Initially 3, 00 acres Uftimately--21D acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?. I[Yes ONd If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ■esidential ElIndustrial ❑Commercial OAgricuftural OPark/Forest/Open space 00the'r Describe: T'-Sumonding lands ajo i6n 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? @Yes ONo If yes, list agency(s) name and pqrmillapprovals Town of Putnam Valley -Budding Permit 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR -APPROVAL? MYes ONo If yes, list agency(s) name and permittapproval Subdivision Plat Approval - 'Putnam Chase Subdivision' 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? OYes Wo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/Sponsor name: Cron" date: 0419-00 0''ggPIE-g-P-G-�l-Keith- Signature:_ A, LW-A 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? dyes, coordinate the review process use the FULL EAF ❑Yes []No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a ne9a�.deplaretlr?g `naylrf?eFSgded;ty:aFlCtjie nvcthd-dgerj'cy:_ - ._ _ :�i;,:. ::. i; . a: -x�: .,. a P �, -gin: ❑Yes ❑No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: Answers may be handwritten, if legible. C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly: CD rn C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: 0� C6. Long term, short term, cumulative, or other effects not identified in C1 -05? Explain briefly: A N�'y C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly: n -- 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: Pad Ill DETlERPAINATION -OF SIGNIFICANCE (To be completed�by / kgency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference.supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part II was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the anvirnnmantal nharnntaricfim of fha rGa ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: 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 Public Health Director May 17, 2000 LORETTA MOLINARI R.N., M.S.N. . Associate Public.-Health Director - T " '� `� "'� .z° • `-' Director" o Patient `Services ' j;. DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Ak 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 Dear Mr. Cronin: Re: Putnam Chase Town of Putnam Valley 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. At such time as Map is filed, construction applications submitted will have to be completed i.e. ' Date S'ubdiuis or. A p eVed:" This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact meat ext. 2157 if any questions arise.. Very truly yours, aL,� Adam B. Stiebeling Assistant Public Health Engineer ABS:cj a if +.4 rr Ii ELF i. :r*(34 c32r..SIVIFFIN (S PC; IL 0 ts f p Ch- - /aMIDID/sly 31' 5! $44")L I ON 159)0 ADDINON 1;.! V A I PA & P. vv&'0 . 'no , 0 , C--. ll-� Vs CONSIRMIlon cow./s%FrN is in) fl- I I I ¢ REAR SN- xw pr I alkill mom L J'111 Lim, UNUIlli HAKIL TUN 1 Vr'4 Ka 15 PC' fi IM CM M r- CM Q EM czi E m rMs—KMA41L VP*it Q16mv CAP, I iri it tT , MT I= (1,441M Or ArMp. M.1, "Mt. WN ► Knl% 0Y-11 It 11- wh tea R A 02 OM ILA3 InTill-ow, P. 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