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Home My WebLink About4339DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -1 -50 BOX 33 m ., - A ., ; LL, ii is •, ;r`im, ME �;; �■i i ■ 1 , 1 L �r f Lt ' '- in m 04339 SHERLITA AMLER, MD, MS, FAAP 'Commissioner of Health : ,:-- ' �' LORF,' I'�A�fo'IOLIi+iARf;;1�A1;-tY��" m ".:-, ::.�•:;:'. Associate Commissioner of Health ROBERT J. BONDI County Executive Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 ' ADDITION APPLICATION RESIDENTIAL ONLY. STREET . S TOWN Plf TAX 6# v NAME _ ' PHONEFY - iV 3 — PCHM C ar: % MAILIN( ADDRES DESCRIPTIONS OF ADDITION 1 NUMBER OF EXISTING BEDROOMS, y _PROPOSED # OF BEDROOMS (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) *• *Any addition. which is considered a bedroom requires formal approval of plans .(Construction permit): prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam .County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd; Brewster, NY 10509, Phone: (845) 278 -6130. Certified check or money order for $100.00. V '2. Sketches of existing floor plan (drawn to scale, all living area including basement, to be - i-i- sl?dwn. and di a isione�i.a;a -rise of each roc specified) (See'`Seotion 3.c of Bulletin HA -1) . 3. Two sets of proposed floor plans (drawn to scale — with name, street and tax' map #) __rV1o__n_-p`ro essional 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 o your ge. nclride date of installation known. Contact this office with any questions. 5. Copy of Certificate of.0ccupancy from the Town or Certification from the Building . Department with legal bedroom count of dwelling... 4 Environmental. Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225=1580 0 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN; MSN Associate Commissioner of Health July 14,2009 Mrs. Woodruff 346 Depew Street Peekskill, NY 10566 DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 ROBERT J. BOND[ County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Addition - A- 093 -09 No Increase in Number of Bedrooms .30. Sassinoro Drive (T) Putnam Valley, T.M. # 84.4-50 Dear Ms. Woodruff: 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 July 14, 2009. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at four without prior approval by this Department. 2. The area of the existing sewage disposal system and its expansion area must be maintained. 3. All ylumbing.fixtures- must be updated with. water' sayii _devices,' i d.; newAb_.-flush-_t'' toilets, restrictors for shower heads and faucets etc. 4. 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) 278 -6130, ext. 43261. Sincerely, Gene D. Reed Senior Engineering Aide GDR:kly cc: BI, (T) Putnam Valley Environmental Health (845) 278 -6130 Fax (845) 27.8 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 Y' 4* SHERLITA-A-MLER, MD9 MS, FAA.P Commissioner. of Health ROBERT J. BONDI County Executive ROBERT MORRIS, PE Associate Commissioner qj Health Director uj b tronmental r7eutin DEPARTMENT OF HEALTH..", I Geneva Road. Brewster, New York. 10509 Town Legal Bedroom Count & Proposed Addition Status Re: RICKETY (Owner's Name) Tax Map # 84. 1750 Address: Town: Putnam Valley Year Built:. 2000 According to records maintained by the Town, the a.bove.noted dwelling, ks in compliance with Town Code. Is not in compliance with Town Code. The Legal Bedroom Couht is: 4 This information has been obtained from:. Certificate of '.Occupancy: c0#2060-293 & .2006-53 Other: The plans for the proposed addition are considered: New Construction xx ion to existing house only own and/or re -build allowed under Town Regulations 6/29/09 I �ssjst-. Bqildi.n,g1nspe,,pl;qr W.,,,,,Aj1en .Date .6. Environmental Health (845) 278-6130 Fax (845) 278-7921 Water Supply Section (845) 225-5186 Pax (845) 125-5418 Nqrsing.Services (845) 278-6558 Fax (845) 278-6026 'Nursing Home Care Fax (845) 278-6085 WIC (845) 278-6678 Early. Intervention/ Preschool (845) 228-2847 Fax (845) 225-1580 7\�? 'x N `t X x I X:? 'V< m 0� — ------ All I 6 "xX&,ly 'x C\l to; < < u to (Y) <) tr>'w X "Cl; OR �X. (0! 1v a C) C`4 1� iw, V < to 4-10. 'OD M m rD;; -Z V C\l 1 Ci O)o LO 20 OD tl L X 0 Cl) < 04 US Co Z� co X C) 04 cli -v x Y, x X� .. ... U) X >� Nx x IN < A co Cl)i < < IN ":76 Sheet ( of PUTNAM COUNTY .DEPARTMENT OF HEALTH IVISION.OF ENVIRONMENTAL HE FI,.- SERYIGFS - I ' +•. �',... A IELD ACTIVITY REPORT N M-E: 1z1CiCrriT TPI: AT)T)RFS4: 30 5,4551A-)b W -DTI -, Ruril/.w i /.4/ar-, lJ,y Street Town State Zip PERSON IN CHARGE QR TNTFRVTFWFT): T)atP 7�1a g Name and Title TYPE OF FACfiLITY : ,Q� A �A, ' % `f,�,� ,,,,A 'FINDINGS: CJC >.,J= .. . -.. by �w c.e ..4 .��I.q .r .p..�.e e-.. ..sue:. ... yet} •vG'Y'; C.�.•] b•u �ws.. .f....YP.`�. lr. l 1 1 ��J1LSnfPW. i Signature and Title BFP_C)RT RFC'FTVRT) RV: I acknowledge receipt.of this report: SIGNATURE: 02/96 Title: R a�� . SN— /PD932 s PUTNAM COUNTY DEPARTMENT OF HEALTH ,y I o :i x TJnTTQr T)T AATc -- - = -�. Mr J r q �L P ly y��Fi N Ef1 1 }� by offing I' �l all -I ; .L r y i � ■ ■; ■, ■I fir MEN; ■■��■,�, ; 'fff. aff 81 an ■fa ■ � ti 1 1- s. 1- �1G 4 t; +e 4 h •' try d .t �C. 1� �Z at. a s«• . Vr,,c 1 1 1 1 r vtteir r OL�Kt 1 1 1 1 1 1 1 r.r 1 MOtCL L l-A C[T WALLS a w 0C/l.• rrtq WALLS t. r-1• CLS $I. 2 lde S•Ael rLml ATSIf 1 10. 0C. • w vweO,4 5 11001 STSKM To K ¢r of L rt! Girm LtfSit WIC. is K• t-t vr-v 7. CLG KM OYI! HALL TO K: t-1 1 ?•r •'�I 110 W Ke tpcmq WlC 10 K- t. lk= SYSTEM IS QSWAKS rot cull AMC rN ■CCMMfK111 col"I o SIMI K M PA- W I - Td :.- :.mss..:•} ".Fn,+r.- - :. :1: ; > } SN- /PD9: -•ff s•w -- - - - - -. 'it• 7 r r e• n' r . (D; t cto p _ Lr•r L +p0r+ •7 Kwm+ t• PUMNnAL OQg ® OM «oMta� vY Batt IT y Tr-r McLi 1 1 r af° 1 ' � ♦t.. srr I+rgl1 1 ^w 1 toe• •rtf .. t•c. rw L. —J li.ltJ 'i 7T N• -= /t' r V vr K n , NO, 7 flfl KelOOt Of OMR mom," Lr-r r Ir -r ow TO i .r t tr r. r•• rr tMM1/TO+ t,/ MtlI4 w K. H W. IM•�+w — f! t e7 K Yf . l -- !!! 1fVYi !!)dam - - - -- "- - lum. vmILS —�r V� ur tor. PUTNAM COUNTY DEPARTMENT OF HEALTH r -r ' HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY �" sf — o93 —oq f BEDROOMS � A L�S �• _ � _ So O O•• ALL SUBSEOUENT REVISION/ALTERATIONS TO THESE HOUSE r -1r PLANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL 1i K _r S NATURE & TITLE WE - ;4 +:6 3C 56 SPECIAL TWO STD AAjZ por m w120 xit GARAGE L12' K7 & ulsAromr. 4M 77"46 2ND STORY .• (r)r) "d am .r v iu f►7r1 «• -M riltntat .t7�le+ 1pp-m-p Li a s«• . Vr,,c 1 1 1 1 r vtteir r OL�Kt 1 1 1 1 1 1 1 r.r 1 MOtCL L l-A C[T WALLS a w 0C/l.• rrtq WALLS t. r-1• CLS $I. 2 lde S•Ael rLml ATSIf 1 10. 0C. • w vweO,4 5 11001 STSKM To K ¢r of L rt! Girm LtfSit WIC. is K• t-t vr-v 7. CLG KM OYI! HALL TO K: t-1 1 ?•r •'�I 110 W Ke tpcmq WlC 10 K- t. lk= SYSTEM IS QSWAKS rot cull AMC rN ■CCMMfK111 col"I o SIMI K M PA- W I - Td :.- :.mss..:•} ".Fn,+r.- - :. :1: ; > } SN- /PD9: -•ff s•w -- - - - - -. 'it• 7 r r e• n' r . (D; t cto p _ Lr•r L +p0r+ •7 Kwm+ t• PUMNnAL OQg ® OM «oMta� vY Batt IT y Tr-r McLi 1 1 r af° 1 ' � ♦t.. srr I+rgl1 1 ^w 1 toe• •rtf .. t•c. rw L. —J li.ltJ 'i 7T N• -= /t' r V vr K n , NO, 7 flfl KelOOt Of OMR mom," Lr-r r Ir -r ow TO i .r t tr r. r•• rr tMM1/TO+ t,/ MtlI4 w K. H W. IM•�+w — f! t e7 K Yf . l -- !!! 1fVYi !!)dam - - - -- "- - lum. vmILS —�r V� ur tor. PUTNAM COUNTY DEPARTMENT OF HEALTH r -r ' HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY �" sf — o93 —oq f BEDROOMS � A L�S �• _ � _ So O O•• ALL SUBSEOUENT REVISION/ALTERATIONS TO THESE HOUSE r -1r PLANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL 1i K _r S NATURE & TITLE WE - ;4 +:6 3C 56 SPECIAL TWO STD AAjZ por m w120 xit GARAGE L12' K7 & ulsAromr. 4M 77"46 2ND STORY .• (r)r) "d am .r v iu f►7r1 «• -M riltntat .t7�le+ P V �Y�11 yam$ �•§ A a ? w gEPA Moji ° ;T !t% Rz o �e rl took— --0 -� a • • >{••- for q I II = I I I IZ 9 a4 � I o $ I I A W I • I 1 ". I d it .a h g � 7Sta up$ap1l i � ni HN I NQ P �� q Y 141 » ® %io 1 I ja 9 S all �g PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY � A— oR3 —e9 BEDROOMS ALL SUBSEQUENT REVISION/ALTERATIONS TO THESE HOUSE PLANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL TT /SO'd SIGNATURE & TITLE DA1ff III III 8 III � Ilioa4 72 &b 8 r •SSaST OOOZ- LO -d3S z I V I Ig e I i� I[ 7Sta up$ap1l i � ni HN I NQ P �� q Y 141 » ® %io 1 I ja 9 S all �g PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY � A— oR3 —e9 BEDROOMS ALL SUBSEQUENT REVISION/ALTERATIONS TO THESE HOUSE PLANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL TT /SO'd SIGNATURE & TITLE DA1ff III III 8 III � Ilioa4 72 &b 8 r •SSaST OOOZ- LO -d3S z I V 2' -Y 2-?X8 LEDGER (T TO EASTNG STR W /5/8'DA Bar. (STACK) FU (TYPICAU. 58' -C i i 2820 B pmlf f M DOW- to' THICK POLREI AM8 WTH W111 Nr M— ;WFjt3:.OF.. v Fot- *MATION WAI i .. j V DOW ABOVE NiFJ r i 7 I — — — — .20'x10' DEEP CONTIN10US PO4RED — — — — — CONCRETE FOOTING - TYPICAL —1 i ( I 7 -5' A I o' D �T -s• I� HOLD DIAEtSION AW � � I I � I TANK �SLS� I. - (�(,(T�DLTEO N I —I L J L —J L— L— h I 4' STEM FIFE COL NN ON T-W x 9-0' x T-0' DEEP 1 POI RED COND;M FOOTING ryp1CAL UNLESS OTHRWSE NOTED LOCATE MERbR FOIIDATIDN WALLS AS i I REflLM BY MODIL,AA ^n MAWACTLRER i SO 0 lip _ I _ �- , .... �. ., i - .. .I• -6... .I -, 9 ..a , . v f } .... • - .N.r. -.. .. r✓ • J .. ..s I "y, ..L. ' . .��a.'�— -..w . rr . .. . r';w . • . f ♦ a 1 - - WlUW W/ US MLER i POMET — — — — 5! I XCAUATED 4' POVED WITH I M8 4' CiL E0 AND 4 ML VAPOR BARRIER 0POP FOUWAT10N AT QAR M DOOR — — Ole" C OORDNAIE W/ I — — MOUL.AA MANIIFACPJFO 0 N PLAN 2'-2- 16'-2' 2'_2• , 12' -7* 20 -6• . CONDITIONS: I P \ i rci, i au i Pei/FOOT9JGS (TYPICAL 1. )' QC. 5 -0' F9:TE m PICAL 2820 msww W6WN �� ►sNE® 8!-3, 4' POURED CONCRETE SLAB NTH WWL4xWl4 WWF OVER 4'' CRUSHID STONE/GRAVEL BED NC 4 WL VAPOR BARRER 33' -10' .HOLD OPi Y DeJ -2' 4'-4' Y -6 �OC STA L _ J ,NFL 1� I) COOF04ATE LOCATION OF I W/ MOWI AR MAWFACTLIRER 4DDIT04AL STRUCTURAL WO VY DIA. x 18' ANCIHOA BOLTS I to �n Ave _4• I ( A 1 I I W670ii W/2ldi NAL$i I `Q BEAM POCKET I . nWICAL) 7 a a I I ' �o ;,�.. -.•.rte _ , I ( � I I � 9.4 ' 154' .may_ - ".- ... .� .... _..-. ....- s. ». - __"-_ .. _: _.. ..___. _•___.._ s__ _� ..... .... w�v ..__. -. ..... ._.�. ^ de. _ _ ... .. 4' DEEP BRICK S%H F - I I TYPICAL TYPICAL AT FRONT OF PUTNAM COUNTY DEPARTMENT OF RfW SEc-noN HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY —J I BEDROOMS BEVISIOWALTERATIONS T H SE HOUSE — — PLANS MUST BE SUBMITTED TO THE PCOOH FOR APPROVAL SIGNATURE & TITLE Y D TE `t PC 9.4 ' 154' .may_ - ".- ... .� .... _..-. ....- s. ». - __"-_ .. _: _.. ..___. _•___.._ s__ _� ..... .... w�v ..__. -. ..... ._.�. ^ de. _ _ ... .. SHERLITA AMLER, MD, MS, FAAP Commissioner of ffedttlt � �' ` LORETTA MOLINARI, RN,.MSN Associate Commissioner of Health August 24, 2005 Matthew Rickett 30 Sassinoro Drive Putnam Valley, NY 10579 Dear Mr. Rickett: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: ROBERT J. BONDI _ County Executive • ' _ •` Addition - Approval - Rickett No Increase in Number of Bedrooms 30 Sassinoro Drive (T) Putnam Valley, T.M. 84. -1 -50 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 the Department dated August 24, 2005. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at four without prior approval by this Department. 2. The area of the existing sewage disposal system and its expansion area must be . - maintained: 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. 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 your convenience. Ve truly yours, ,Q oseph S. Paravati Jr. Assistant Public Health Engineer. JSP:cw cc: Building Inspector, (T) Putnam Valley Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool(845)278 -6014 Fax(845)278 -6648 . $ e 08/11/2005 16:03 FAX 9145929110 SUBURBAN SUNROOK la 02 Remideme- AAW _ .. 3 0 S inore W, -Ptttmm w8118y ,.. _ _ - '`��eut°��"�b•9�1��I��n�.= . _.,,. 03 E. UBin St (rt 119) EIMSfOfd. W 10523 PUTNAM COUNTY DEPARTMENT OF HEALTH 914 892 -7455 fax- 914 592 -9110 D.1cam 9 WC - 8152 -H97 ROVED FOR BEDROOM COUNT ONLY, q. BEDROOMS ALL SUBSEQUENT R.EVISIONfAL ERAAf0 THESE HOUSE A��' 54 PLANS MUST BE SUBMITTED T THE PcbiW7 9� All �� 3 :.;' ei g 0 GNATURE & TITLE DA.T.. mow 4°�� e � a>,r r� 10•'6' w � 6 Ir Ell WW • ag 11 1 01 61 11 Malmo aw MOP aw AWT r is aLOb sI mowl - Ir�sm M we WE pmw AI pG mW t -W 2T gilt Isla p Ol Jr, ►rF �+K uq a low n C � cammm ira tar � v4r a• R ` wppl��O� �6 e6kw'09 * L w Mir a n.r As I I" vale ryW eotlla o ii' 9R A 1 Ita a el / aao+ etp as clabpwl VA nea 311 S U7. Simi ° cll GYb1(eL T KpPOUI �{ T fie. 6 1 M�1�Gg@1p0y9� �([•Y� Ww ri t o � eab7 (y Isi Sl T Ilk, lV uM iM� wi 1 T p6 III 1I OvO p�pyfiRid s�sy AUG-11 -2005 THU 16:04 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 08//1111/20051 :03 FAX 9145929110 SUBURBAN.SUNROOM 003 �+ +�P .:5 '� ..+ .O ..,.. A ,- ":rte ....... , r-. _ . .. -. `�•> .. .,- ;��i.y;r.r:.,., c,.... �'i.y �µv� � ..ti .. .y .'f.'.; y.. .v. .. .. M. N:. .. .. " .v�•..rV ��!•\ 66 Zm- ip.q Y N r A 'not 1 9w f .. i ■ p �o i ' � 5 I � ■ � S h � r� aft + • ► r I - --- ... - -- © IM • I C • `a�i��tlY i y 9 a Md$ g t � ypr Vi 1 1 16 PC AUG -11 -2005 THU 16:04 TEL:845- 278 -7921 NAME:.PUTNAM COUNTY DEPARTMIENT OF P. 3 In 1 1 1 ;1 1 1 ; 1 . 1 / 1 I 1 1 1 •t 1 1 1 1 I 1 I 1 1, 1 1 08/11/2005 16:09 FAX 9145929110 SUBLU -4N SUNROOR -e -- - -- - . -1 Q04 wgj�,i. g 1 - - 1 1 ilq m�v I 1 n'"'1` t r t 1 1 1 I I b 1 t ■■ m. 1 1 1 °T I `1 ; • aa316 'o I L 3C 1 , 1 1 yyyy�� ggtt '6 -J..J I 1 6 ( 1 1 i { h 1 MOO 4 I I I 1 1 .a �s 1 t 1 I I 1 1 1 I 1 1 1 1 1 / 1 1 1 1 . 1 1 1 (f.-- _ ------- oa_ol 7_71 rc 131 AUG-11 -2005 THU 16:04 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 4 t 1 . 1 1 , ir 1 1 1 I - - - - -- -- - -- - - -_ - -� i 1 1 t 1 1 1 1 6-¢ -.1 1 � ■D 1 1 1 1 � 1 I 1 1 • � 1 t 1 mJ 1 6.._ mom. - -_ee �s- ._- _e- re- mm- • -e --.. - oso + f p__ ----------------------- RP_m - -m- ... ------ - 1 A•.a la•..o •► .. AUG-11 -2005 THU 16:04 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 4 JUL -8 -2005 11:30 FROM:PUTNAM COUNTY DEPARTt845- 278 -7921 TO:919145929110 P:3/4 SKERLITA AMLER, Mil, MS, FAAP (46 ROBERT J. BONDI 't�nfltlRRtOrtCT,Qf Health. _ & County F- aCECUlfva LORET TA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH n 1 Geneva Road, Brewster, New York 10509 ADDS ION APPLICATION AMEN TIA L, Q= STREET _6 s i � c► E✓ TOWN a TAX MAP# ,at • w..W AA., .� M.,� UYI Al i 1_ i (Pr. L,,: ) l tiun gUr1 X 14 _ 1 ) I rl vrt P\/ v n n r A MMtLING ADDRESS- 30 _ 51n r^0 hC_". e' DESCRIPTION OF MJMER OF E)aSTWG BEIDROOMS ^PROPOSED # OF BEDROOMS _._q (FROM cERT.. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR.) **Any addition which is considered a bedroom requires formal approval of plans (Construction permit} prepared by a Professional Engineer or Registered ArchiWet in accordence with applicable sections of the Putnam County Sardtary Code. Please submit this form and the following to Putnam County Health Dept.,1 Geneva Rd, Brewster, NY 1.0509, Phone: (845) 278 -6130. Ceiiified'cliecic or 2. Sketches of existing floor plan (drawn to scale, all living area including basement) 3. Two sets of proposed floor plan (drawn to scale — with name, street s.nd tax map #) *Non-professional sketches are acceptable 4. Copy of survey showing well =4 septic locations to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 .feet of the property line: Contact this office with any questions. 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFF CE USE COMM IM Etivirantnental.ReaM (845)278.6130 Fax(845)278-7921 Naretng Services (845) 278.6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervendonfteschool (845) 278 -6014 Fax (845) 278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH �.n.., DIVISION OF ENVIRONMENTAL HEALTH SERWCES .. r'.i.. 'd .r^ "a•o .: l =•. =:� •. '+r"""+ -�a+ .'d. .'s.. n `vo . � `� ;-.yam . CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHID CONSTRUCTION PERMIT # Located at ,�A�S��o2o �z-tUE 31 own r Village t L,0 tJA M l/A L L- Y Owner /Applicant Name -f f 06TOj SAM -J�p•,, ! n r r'. Tax Map 8!� Block / Lot Formerly Subdivision Name Subd. Lot # 9- . Mailing Address 31 CP-07M DAM ^'kva� f 015.51,01 V Zip 1056 z- Date Construction Permit Issued by PCHD 9/9 00 Separate Sewerage System built by,37' C'eoToQ .3),Am �L�;,�Ri�Address '...37 (Iea`roA) )„-l+ Consisting of /Z5"0 Gallon Septic Tank and :QO �. �` . 'nr %''.,�i' pel? F 0 � A � F i 1� C t � r,F ok) .2 � 2 �! �i E L E�iC�i' 1 Other Requirements: — Water Supply: Public Supply,.From Address or: V"' Private Supply Drilled ?2L, w 1 Tf � Al./. m5d9/ guild g Type =,�J yid p e--� ntro be omp t dr• - y lias erc�sion.co 1 erz c lee 7 f r. Number of Bedrooms Has garbage grinder been installed? NO. I certify that the system(s), as listed, serving the above pre 'lse o ttx - S-A il� to ssentially as shown on the as- built plans (copies of which are attached), i rdance th issue I truction Permit and approved plans. and the standards, rules and regula 'ons o the,Pu o a;leatmen o ealth. Date: - 17 - c-t) Certified by _ Address -2 J,t � ,n W,.f .s P.E. R. A. # p6zIeu 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 modi, cation or change when, in the judgment of the; Public Health Director, such revocatio modific4on orrc n a is necessary. � Title: By: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 SHERLITA AMLER, MD, MS,,FAAP Commissionercif7dlth=�^ LORETTA MOLINARI, RN, MSN Associate Commissioner of Health August 12, 2005 Matthew Rickett 30 Sassinoro Drive Putnam Valley, NY 10579 Dear Mr. and Mrs. Rickett: DEPARTMENT OF HEALTH 1. Geneva Road, Brewster, New. York 10509 Re: Addition — Rickett ROBERT J. BONDI •:Cduiily °Executive 30 Sassinoro Drive (T) Putnam Valley, T.M. 84. -1 -50 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. The heated sunroom is a potential bedroom. 2. The legal bedroom count for the dwelling is four. The potential bedroom count of your �- :•.,_proposed -addition .is five. v _ _.._.... x3.p The additioWof a pot iiifa fbedroom(s) requiresµtbis Departments approval of a revised° - septic system plan from a professional engineer. Please revise the proposed floor plan to reflect no more than four potential 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 your convenience. Si erely, (:seph S. Paravati Jr. Assistant Public Health Engineer JP:cw Cc: Building Inspector, Putnam Valley Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 08/11;2005 16:03 FAX 9145929110 SUBURBAN SUNROON lI 01 . r..._ �= ' %'�`' -. ,. - .... .... .. .. � . h�c .- :laic'.. ✓'� �.. .. '1 .. ... C A0 �.A6`d �L ►Ys ' !. e' A 0 I- , 3UA - -�.- r(D jVfl v Q AUG -11 -2005 THU 16:03 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 I� 08/11,12005 16:03 FAX 9145929110 SUBURB.4N Q05 �`a- a 5.. T..' anedox... SERIES "23.0 CO.h ! ewgianci -D* -fkA% cues ft6..&wcit k d S easo'-de� . gn�d �d-�qg li..h-: -7, rvo. an d -p- lerg, %,-efficient aluminum. A slim LW it high h aluminum LP '%ts this pefiiig Llemg-.IS. 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R•..�i► ..�w�4.r�.i�.f�.. �1/a.'J'•.. .7.•�at aii \- . ?~jt. CERTIFICATE OF COMPLI.ANCEHOCCUPANCY CERTIFICATE NO.: 2000- 293 PERNUT NO.: 2000 - 422 TM#: 84. -1 -50 _ i,;;1 :, DATE. December 06, 2000 LOCATION: 30 S4SSINORO DRIVE ISSUED TO: 37 C'ROTON DAM ROAD CORP. Thi_ :-,ertir;_. :at- �.overs the ,:3r,structiorl of. New 0 ie -fame i F;r::,idPr,t:.e Ii :r,.:� ;;'. :':.•c; .. i:.._l� .... l Fairi 1`.r Year - AcLind Four badr::Crr. The app..- 'Li-:uiit. ita[`ing L .J.1'ed all apglicatl- -•rl for a bui.ldi: -,q to tNe. Tc:>wry Cade, 7`•anitary C: t }ie Uri -- BuriLling & -Fire '-ndez ai?d the Laws ir. effect in the ` nO--'!! of Put.riam Val ._e*; , Putr:i�in, Fount; ICY, i.aving paW the fee therefc-L- and r;. _ iried ha i ,:, 1 pe- scinsl inspe t .:r, ascertained ttt'YC t:rie •9ppii :'.:•ant i',::12+•.. ,:vlbse us-- nf.1.y pCC,:.°FerilF;d wits -. iiQ�+t:ilrtCiBr, = J?' the prop , ad true :t ur: in . =illf %hall .2 writh. the .:`..t `. Le laws as ul.�rCT11E?C:ti"'il di . [:c.t_4ttfi2 Fil.~I ':d!�L'►: dfiel. ttcd*:?r1csJ. Rlf?t n_ .r. ._. � -T.... S... ,. .. ..ee c' a.a _ a i .a .w.. �.o.,.. .�-c[. ...5 p .wG._ .'M•tlGD:�!+•- .-wro .._. r.. .m, w.�FS^ «q.�c•. ..,..e.e'��j' c..� .ae �-•..- w ..a...... ...wc. n p an!i that t:-te L1-e►1)i e:-5 t►aV-. 1-10w beers ful].v_ CJP.LUJ.er. d a:-.�-? -.re raady .foi � pursuant to the provJ SitiP_s L law. Nr,lW, �.�li� :Erf ],.i :'a•_e +�f 'C�Ct'tN�.i.Zi'itie�•i +J�CU��rl� iS ,,. _•=k� i:i51.2(7 ,J.IIdF?L t h Seal. of them T:Dwn of '�'ut-nam, Va!'Le.r. '110VWW OF rLrrryAm VALLEY, M. T. By: CODE BWORCE ENT OLuP'iCER I 1, Pill CER'rIFI•ATE NO.: 2000- 293 PERTNUT NO.: 2000- 422 t 1 - December 06, 2000 TM#: 84.-1-50 DATE. LOCATION: 30 SASSINORO DRIVE ISSITED TO: 37 CROTON MW ROAD CORP. Th.-i � t i f_`Lcate cove!-- C-Ofist Lr' -u Ct _J(Dn, (-.)f : New r0ne-fami.ly I Famiilv Year _Rcund Fcu�f bedl-O"c"ITI, k.A having heref.ofore file an f, r hu I t- I-, r, i ji-I 4� i I S 1 •a 1-1 t t (1,, -.!-:e 'Icwn. Code, San_-'Lafy C,d- "DrIl" d aL-J the Laws Jmil eFfe-cr- in thie ToS,,ti of Plit-nal"i r ar- U U rl , I I a v A r c, paid kp J c e d fr - -: - n e e ry pers- -ia J c, ri a s c e r ed 2 J.* a I'l 't e, S j la r,s- u n t 1. y t h Le r c t r o D -1 ,c r., T_ S of .. L`PD J_C14_9 a3 t a C,f i oned; Lj. u -i hav--1 n.ow L,i�er! comc_i.c�ted and arp- n ad-,v anc-i -at t.'l-- orernise., I Or rtrT'_M"-1 VALLEY, ff. T. Ell BY: CODE ENFORCEMENT OFFICER pursi-uint rc 1-1h provis-L-oris law. Now, rheref:-re, of of Pu._riazu Vall:°'Le-• /,. Or rtrT'_M"-1 VALLEY, ff. T. Ell BY: CODE ENFORCEMENT OFFICER -� yt 400 �_ ^ 26 Ch C -A UPC LOT 6 �n—� AREA-3.02 AC. ,. 214' 9 7 Frt r V /P� SACK �\ / r• S id 0 MW. 000 • sap i "� an( Q. ACW 6pX nYRJ � '.••� GE7AAVV i 0 v ChB l / \ Ch �i .0 .0 0AR �r �V' • O 420 PROWDE 6' . COVER -WR J8 � MW OW? SEPAL TANK —Mozo ell? & Z�� olz-4,V 'R,'h'-4 00 ORZ-4,V .00 INS S Meon 93 33 I NIO - wall . N10. Lot No. 6 Area= 3.0184 Acres Ho 90.87. r WO/I (,r,4 * I 107.j, wy ati 90.87. r WO/I (,r,4 * I PUTNAM COUNTY DEPARTMENT OF HEALTH CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # ?V "_Luk-�,i\OAM Located at `BAs- soAfoP -p D�o�r� (�o�v r Vi ge ALL-1 Owner /Applicant Name-3 f OrM4 /:1M �D• , rz j>. Tax Map —f-- Block / Lot Formerly Subdivision Name e+,&5.- Subd. Lot # 6-. Mailing Address 31 er -riTm J)AM (!OA,JI) 06,51 .4i.jG /O•Y. Zip 10946 z- Date Construction Permit Issued by PCHD S OD Separate Sewerage System built by ,3i CeoTaa DAM �, , �oR+? Address 3 1 Cea -M,0 D,a�t �1, Q -151VJ W6 ,V, Consisting of /,Z5"0 Gallon Septic Tank and :5l)D 4-/7 DF V "af f eR tD P-A-re D NQ. e_ J1'1nF iYO -2V- " CR A vEL. 7�& "C-W Other Requirements: Water Supply: Public Supply From Address, or: ✓I Private Supply Drilled by N BF-AL Y .�45- /ire. Address 4 74TA)AV 4ye. , 3�W -rrez _... _ p �. y 10510-9 ix�g ape ' f. fib Y :Has erosidn control - en Corr? oted7 Number of Bedrooms Has garbage grinder been installed? NO NF-V C D � I certify that the system(s), as listed, serving the above pr. se 4ere cons . te4. ssentially as shown on the as- built plans (copies of which are attached), i c rdance 611e issu4 'EHY� o truction Permit and approved w..:. laps and the standards rules and re la 'ons o the Put o ` - :,,JJ e t. Health. P 'drhn 9, Date: - ( -] -r.0 Certified by �- z - ' `! i' P.E. X R.A. r (D gn Prgfe � �, Address �- .1 .� S �_1' �5' k ��(%f~ ;`I;icense # 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 4oe on or change when, in the judgment of the Public Health Director, such revocatio modific is necessary. .1L By:`� Title: Date: L71 F� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 IPUTNAM COUNTY DEPARTMENT OF HEALTH VIRQ VI GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM E204 Sic 8_ 31M : / Owner or Purchaser of Building Tax Map - Block Lot �czC7 TOT7 �+�M lr oA� 0aZP. — j —aus.� o�- { tT�AM l%A L_�Y_ Building Constructed by TownNillage t, rA) A AAsE 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 operat. prQpedy is.caused:by.,the.willful or negligent act -of the occupant of ihe.building utilizing :the..:..,:. i - system. .. a ... .. - s . _ _ ..� .�. . . The undersigned further agrees to accept as conclusive the dete --1 at on fa the u-blic Health Director f the tnam County Department of Health as to whether o no th ilur ' of the system to,opat w c used by the willful or negligent act of the occupant of fheild' g utilizing the X, // Day ri Year ,ZV00 Signature: (Owner) - Signature -ems l U E- 0-M N YAM DC_.08 r Corporation Name (if corporation) Address: �37 &- a-rand -DAM . SAD State A/ y Zip D/ 56 L Title: '. :51 eeoTofJ DAM 'aAD eP-P- Corporation Name (if corporation) Address: 3 � erI_CrC-aN j�4A I�) . State )V. . Zip /o z Form GS -97 r� Public Health Director .... -��_. , �; isORETFA ;�MOI;�I�►RI•= RN�:M,S:N:, • t° : �. 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 _ 1 1 ' � - *---1 - 1TNOV OWNERS NAME : TAX MAP NUMBER: E911 ADDRESS: TOWN: AUTHORIZED TOWN OF (Signature) DATE: 3.7 C R 016 0 -09 Rd t90 SAC ' G 41 'r4 K: / C off- : E-o Su13Corr•. 6 Pu � r)prh lI�ILC� � 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. (E511 VERFRM) t N n BRUCE R. FOLEY Public Health Director t LORETTA MOLINARI RN., M.S.N. . Associate Public Health Director Director of Patient Services',, DEPARTMENT OF BEALTH 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 " FAX COVER SH E:IE'i' Date: f To: t,4 . ]From: Adam B. S.tiebeling Asst. ]Public ]health Engineer For your information For your review A discussed 4 . Notes/Messages L (' JTK I. i„ Fax #: _ a� (0 'T > hio: Pages (Including cover sheet) �i - -- -- Please respond i1 Attached as requested — Please call ®(�(_ ('O 1 %-L �- -. xi ,: t PUTNA 1 COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE MSPECTION Date: - Street Loc; on ,rl Ss c c01z0 �� MOwner Town \l Permit '# ff � TM # e2q —1 Subdivision Lot # 1. SeNvage 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 ..... 2" .....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 soil between box & trenche. e. Junction Box - properly set ........................... ...... f, renc es e req 're Length instal ed 2. �' ce to qrcour.. e rrfeasured Ft.....a ... 3 , nstalled acg to �l .................................... � I,� Slope of trench a cep able 1/16 - /32 /foot ............. 5. 10 ft. from prope ` ne - - foundations.......... Depth of trelich ches from surface .................. Room alloded for ansion ,100 % ......................... 8 Size of gravel 3/4 -1 %z" diameter clean .................... ... - 9::Depth of �avel I�: treraeh. k2°.',: rriini ;niufri:...:M��:,:;�::�:�:�.::" 10. 'pe ends/ Capped.... .... ...... ............................... g. rumwor Uosea 6ysiems 1. Size -61 pump chamber ..... ............................... 2. Overflow tank ...................... ............... . . ........ 3. Alarm, visual / audio ........... ............................... 4. Pump easily accessible, mash o grde ................. 5. First box baffled ........................ ..... ..... ::........::..... 6. Cycle witnessed by H.D.estimate ow /cycle........... III. House/Buildin a. F fo—us—eTocated 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 ... ............................... i. Erosion control provided ................................ I ........ ....... YES IM I COMMENTS 2XIMM, v K. o i 11/01/00 WED 12:36 FAX 914 736 3693 Cronin Engineering 9001 INW-V brand tax transmittal memo 7671 1 #of pages I- TO From Q l+ 63 Trtwi, & -#- MOM # 6- Pex , Fax l- PARTMENT OF HEALTH DIVISION OF ENVIRONNII]EINTAL HEALTH SERVICES ATTENTION KADAIM All information must be fully completed prior to any inspections being made. 0 GENIE For. Fiu,-.e k Trenches ✓- PCHD Co ct. Permit # Located: jqmgmt Popo lZbA.P (T) (f fu-r,-JAfq Al We Owner/14 4VRmtName::ECR47-c)OJPA/I 1204D _TM 8Y Block I Lot 50 Formerly: Subdivision Name: aAM COA-fe: Subdivision Lot 9 1, - Is system fill completed? P M - Is system complete? YE -r KEY Is system constructed as per plans? Is well drilled? YCJ' Is well located as per plans? Are erosion control measures in place? Date: Date: Nov. L 2d00 Date: I cm* 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. MI. Date: y: PE• 1AJ0 Y . fSUI (-0.1A)C XVIM zooDesi ini Professional Z -Td jjj,J WAVq jr0UL&iqRo Address: F'e6KXW1L(,., iJ-y 1656C —Lic.# 6'Z 96U Comments: Form FIR-99 7 PUTNAM COUNTY DEPARTMENT ®IF HEALTH IIDEVIIS>IQN...4. F— ENVffR(DNMEN7AIL IH EAIL7H- 5.IERV1CIE5 .._p_ _ ..._ �:.�' �:!'OS ^i�•�.: i-. .e ...r �'!,.� - •. ..:� .k �.. •.r � �). il.:.�r . ^�:�. ,. —!'i"t'�?�: •. ..� - i�i�.. r... _ ..F .... — • o v� Located at Sassinoo Drive/ r Town Putnam Valley Subdivision name Putnam Chase Subd. Lot # 6 Tax Map g4 Block 1_ Lot Date Subdivision Approved ® ?—L 5--00 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 F%Ericlosed $300.00 Building Type Residential Lot Areal,02* No. of Bedrooms 4 Design Flow GPD_gon Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1250 gallon septic tank and 561) L.F. of 4" PVC Perf pipe in 24" gravel trench Other Requirements: To be constructed by 37 Croton Dam Road Corp. Address 37 Croton Dam Road, Ossining, NY 10562 _ a WateT Su Il .:._. _. Public_Supply_ From..... - ,F - ro+- r na_ _.rte ...V P '•F_ ,_.Try.T .. n . ... � ... ♦ a ^<':. .... .. � yC M c^ ti- w'+.. u... c-.. s� ..� l% rye l.J. w._ o1r: Private Supply Drilled by Address 4 Putnam A,rP _ _ ___ Brewster, NY 10509 I represent that I am wholly and completely responsible for the designVd 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 Cons cl ioadEG; ance" satisfactory to the Public Health Director will be submitted to the .�"� � Via.. Department, and a written aidn hed the owner, his successors, heirs or assigns by the builder, that said builder will place in good�pdr �n condit c ` y,' \ of said sewage treatment system during the period of two (2) years immediately followda e °bf thitfi�ce a approval of the Certificate of Construction Compliance of the original system or any Kairs Bret Uj tu Signed: P.E. R.A. Date Address 2 John Walsh ck` k� NY 10566 License # 06nso 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 rXcessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe 't. A rov f dis arge of domestic sanitary se age only. By: MI.., Title: wt- Date: 6?[Q f White copy - HD File; Yellow copy - Building Inspector; Pink jy - Owner; Orange copy - Design 404sional Form CP -97 ' PUTNAM COUNTY DEPARTMENT OF HEALTH ' `DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION. FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM I. Name. and address of applicant: 37 Croton Dam Road Corp. 37 Croton Dam Road Ossining, NY 10562 2. Name of project: Putnam Chase - Lot # 6 3. Location T.N: 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)......: ................ ............................... Type I _ Exempt . Type II — Unlisted X 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... NO 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 ,. :..: of(ieials; ordinances? ...•. ..:....• .....:....::....:.....� :.. ;:,.....:......_..::...:.. :..:............... YES - -... 13. If so, have plans beer' 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 des' flow. (gallons per day) ................. ............................... � (g P 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 •2 27. Is any portion of this project located within a designated Tow.n.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? 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? ............ NO ................ Yes/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? .............. I .................. 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 ? . ............................ ............................... _ NO 35. Are any sewage treatment areas in excess of 15% slope? . ............................... NO 36. Tax Map ID Number .......................... ............................... Map 44 Block .1 Lot Z-0 37. Approved plans are to be returned to ..... Applicant_ Design Professional - NOTE: All applications for review and approval of a new SS 'S 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. 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. x d hereby affirm, under penalty of perjury, that l f�� pra e this fora is true to The best of my knowledge and belief. False Pat t %8�e lia ` re punishable as a Class A misdemeanor pursuant to Section ® aI UJ UJ SI GJY.q O CdAL TITLES.- :�• ? lrl A &`V 629$0 MailingAddNsia` � ;:......:. Cronin. En�gine� e E.,P.C. John Walsh Blvd, Peekskill. NY 10566 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF EN_ VIRONME_NTAL_ H_ EALTH SERVICES _. -:.a Dr ^.l.�t .{"�'^E}1' %•a° s�•1a �}F'• ri �� >- :rr•ii .w.v -t nw ..+ •�. .. -Ny�i v.. -.�1yW .�.��[ �.'. f'.��1�:. ►� '. �.m. M:: N' .��.s- :.:l.v •I�. �+Y� ry�w'. .-._ -.. �.Yy� LETTER OF AUTHORIZATION. RE: Property of 37 Croton Dam Road Corp. Located at Sassinoro Drive /Kramers Pond Road T/ Putnam valley Tax Map # 84 Subdivision of "Putnam Chase Subdivision" Block 1 Lot Sub Lot &,SZ) Subdivision Lot # Filed Map # 1 Z Date Filed O 1 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 DeparC d to sign all necessary papers on my behalf in connection with this matter and to supe °`ifs ction of said wastewater treatme t an or water supply systems _. in- conformity.. ''tl a proviso icle:.'145.and/or 14.7 the cat' Law, the Public. Health.. _ Law, and th ,•P' am Sit Code. Countersigned: P.E., ' . # o z ' Very to 62980 �FESS�a Signed: Mailing Address 2 John Walsh Blvd. #200 Peekskill State NY Zip 10566 It of Pres. Mailing Address: 37 Croton Dam Road Corp. 37 Croton Dam Road, Ossining State NY Telephone: (914) 736 -3664 Telephone: (914) 739 -7362 Zip 10562 Form LA -97 ` - PUTNAM COUNTY DEPARTMENT OF HEALTH r ,II0)IIvfS1ON OF ENVIRONMENTAL HEALTH SERVICES WELL CObP .1�'�IIGIq ][BEP�flB'��, Nell➢ ILom4non $treet:Address: Leo TowmNillage: Tai Grid #. >cg 1°arid �d� %,ot::46 :. Ptati�an Valley Map Block : L&W 6`; _ r well e>r Maine Address _ F YmS4 �'or�sat�tal a 37 Cx�oto>at. De>n Road,a Oesi441!< Il0562 B: ±�4 �yA We 0f e9l X Residential Public Supply Air - d/lreat pump Irrigation i :` *' Il P�ai»esv Business "Farm ' Test/monitonng' Other(specifs} . -s conafl>arry :..Indiasirial Institutional Standby'- ; r polliq �alaiipnieii :I Rotary . Cable percussion % Compressed air percussion Other (specify) aJ6!efll T Screened Open.tnd casing ' . Open hole in bedrock Other y Total length 72 ft ° Materials: % Steel Plastic . _Other Ca�on Detaals Length below grade ' :. 71 ft Joints: Melded X Threaded _ Other i eat- .treat -gr® t_ ='olitte _`:eF Vheight per foof I9 lb /ft. Drive shoe: %Yes _ No t. Liner:. Yes X N6. _ Diameter.(in) Slot Size Length(ft) Depth fo Screen (ft) Developed? scaeeaa flDetadls :. First ' — Yes No a 'Second Hours i We9I Yiew Test . Bailed % Pumped X Compressed Air Hours 6 ' Yield 8 gpm Dep$Ba IlBSits Measure. m :and surface - static (specify ft) : During yield test(ft) Depth of completed well in feet _ 6�° 85O t : eII IIh�" tfi lei' ®na qua ace 'Water : '. : ell: .: ]F ®i'iriaatiota .;:.. . If more detailed - fft,.: ' �g �eanng ` ®iaineter(inj IIDess p8no on a a } { information Land S'urace 57 Da'i1 i>E CIa aY -&ds's descriptions or. 57 � 'w r �� 570. ( ., � f -.::yam sieve aiia;<lgs .: - 57. S.._ -'72 _ v w»u.w.5.. +._. +. - ••- - -"+._ ---1 -... .. aaa a� and available, 72 505 mill " in .>i' rardte . please attach t; 5. r If yield was tested, Feet Gallons Per Minute Pump /Storage Tank Informatton; " at dif ei6i depths �..,. .' Pump specify during dri Piing, Depth Model . v hst . Volfsge � Tank 'Type /olume . r _ Date, a Comp Putnam unty erq cation No Dete o Report ": 6Vell KOTE. Exact ocaiion ofwelt vvetRi d cesto at least permanent landmarks tt) be j on a sep sheerlplan • i 'n - d7 t. 4 M' x i - -L4 r f Stgtsaturiy ... Date Pe:. ... r pp e 810..; .. i �Ihite cmpy I� 1~ ale, loviy copy Buildeaig Inspector, Pink coPY Orange qopY Well duller s �. Foriii V�'1r�Y7 ^t Y e. F-12rdikR NORTHEAST LABORATORY OF DANBURY 777-77 WE; Ylk4f46i�:"s LABS 39-3 MILL PLAIN ROAD - DMBURY, CT 06811 NY Cert: 11471 (203) 748-7903 - FAX (203) 748-0652 LABORATORY REPORT WATER SUPPLY TESTING IMPORT TO: P.F. BEAL & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 SAMPLE SITE: . SAMPLING POINT: SOURCE: TREATMENT: DATE SAMPLE COLLECTED: THvIE COLLECTED: COLLECTED BY: DATE RECEIVED @ LAB: DATE(S) TESTED: TESTED BY: REPORT DATE: 1/15/99 3:30 P.M. C. BEAL 7/16/99 7/16/99 LAB# 11471 7/29/99 V.S. CONSTRUCTION, LOT #6, PUTNAM CHASE SUBD., KRAMER POND RD, PUTNAM VALLEY, N.Y. HOSE BIB WELL-NEW, NONE : . RECOMMENDED L-BUT- BACTERUL: Total Goliform (Bacteria) 0. per 100 ml .0 per 100 ml CHEMISTRY: Chlorine Residual ND mg/L ml = milliliter mg/L = milligrams per Liter ND = none detected RESULTS BASED ON SAMPLES SUBMITTED:7/16/99 SAMPLE, AS TESTED ABOVE: OPOTABLE or DOT POTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Laboratory Director •ORTHEAST LABORATORY, 129 MILL STREET, BERLIN,CT' 060374 (860)828-9787 - FAX (860)829-1050 TOLL FREE WITHIN - .. CT . : 860-826-065i OUTSIDE &:' 800,-654-1,230, Y:' 1, 1 flit/ i, P.F. REAL & SONS DATE SA v2LE COLLECTED: 4 /15/990 4 PU1NAM AVENUE TIDE COLLECTED- 3:15 P.M. BREWSTER, I4.Y. 10509 COLLECTED BY: MM McGRM DATE RECETVM @ LAB: 4/19/990 MTED BY: LAB#11471 11301 MORT DATE: 4/23/99 Do 1 ` 1 Yti FAIMI Manganese 00 0 ND 7.61 0.41 <0,005 0.29 62.0 90.0 0.038 <0.01 per 100 nil NTUs nng/L as N mg/L, as N mg/L =S/L mg/L mp)L sodium 3.9 mg/L Lead 0.004 inglL 0 per 100 ml no designated limit 5 NTUs 1 mg/L as N 10 mg%L as N no designated limits no designated buts 0.30 mg/L 0.30 mg1L [Note: Combined Limit for Iron plus ese:= :0:50 i a� -j 20 rag/Loo 0.015000 tn1— >B militer mom. = milllgmms per Liter AID = none detected RP -Units — NotaScadon level �OaAcHlott Lcvel IZ017S BASED ON SA LES SIB -4/1 *RESUILTS OF SA YES ANALYZED BEYOND 30 HOTS COIF BE INJ'ALM SAbOLF, AS TIESTED ABOVE: 101POTABU oir,avr iparau (PER NEW YORK STATE DEPT OF MALTH SERVICES STANDARDS FOR POTABLE WAM) Laboratory Director .NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037o (860)8284787 - FAX (860)839 -1050 TOLL FREE WI TEW CT: 8004264105 o OUTSIDE CT: 800 - 654 -1230 NORTHEAST LABORATORY of DANBURY CT. Cert:. PH -0.404. _ = I�I$.L'P%AIN RDAYS ' 'iiAN DURiC�:.C` �:$:i:i„ :.. ,s .. _.. �-`N 4 �ert:`"11471 (203) 748 -7903 - FAX (203) 748 -0652 EPA METHOD 524.2 Measurement of Purgeable Organic Compounds in Drinking Water by: Gas Chromotography -Mass Spectrometry REPORT TO: � :.. P.F. BEAL & SONS DATE SAMPLE COLLECTED: 7/15/99 4 PUTNAM AVENUE TIME COLLECTED: 3:30 P.M. BREWSTER, N.Y. 10509 COLLECTED BY: W. MAYES DATE RECEIVED (a3 LAB: 7/16/99 TESTED BY: LAB# 10916 REPORT DATE: 7129199 SAMPLE STM: V.S. CONSTRUCTION, LOT #6, PUTNAM CHASE SUBDIVISION, KRAMER POND RD., PUTNAM VALLEY, N.Y. SAMPLING POINT: HOSE BIB SOURCE: WELL -NEW (all results expressed in micrograms per liter) : COMPOUND AMOUNT LIMIT OF COMPOUND AMOUNT LIMTr OF DETECTED DETECTION DETECTED DETECTION 1,1,1,2- Tetrachloroethane ND 0.5 romoform ND 0.5 1, 1, 1,-Trichloroethane ND 0.5 is- 1,2- Dichloroethene ND 0.5 1,1,2,2- Tetrachloroethane ND 0.5 is- 1,3- Dichloropropene ND 0.5 1,1,2- Trichloroethane ND 0.5 arbon tetrachloride ND 0.5 1,1- Dichloroethane . ND 0.5 oroform ND 0.5 1,1- Dichloroethene ND 0.5 orobenzene ND 0.5 1,1- Dichloropr6pene ND 0.5 oroethane ND 0.5 1,2,3- Trichlorobenzene ND 0.5 loromethane ND 0.5 1,2,3- Trichioropropane ND 0.5 thy1 Benzene ND 0.5 1,2,4- Trichlorobeazene ND 0.5 richlorotrifluorethatte ND 0.5 1,2,4- Trimethyl Benzene ND 0.5 exachlorobutadiene ND 0.5 1,2- Dichlorobenzene ND 0.5 Prof Benzene ND 0.5 - - fi - i 1n:1;3Dichlaroetfiaae .0.5.= ....:.d .;,... 1,2- Dichloropropane ND 0.5 - Butanone (MEK) ND 0.5 1,3,5- Trimethyl,Benzene ND 0.5 aphthalone ND 0.5 1,3- Dichlorobenzene ND 0.5 -Butyl Benzene ND 0.5 :;, 1,3- Dichloropropane ND 0.5 - Propyl Benzene ND 0.5 14- Dichlorobeniene ND 0.5 Xylene ND 0.5 2,2- Dichloropropane ND 0.5 Isopropyltoluene ND 0.5 Dibromochloromethane ND 0.5 cc-Butyl Benzene ND 0.5 Dibromomethane ND 0.5 tyrene ND 0.5 Dichlorodifluoromethane ND 0.5 rans- 1,2- Dichloroethene ND 0.5 2- Chlorotoluene ND 0.5 tans= 1,3- Dichloropropene ND 0.5 Trichlorofluoromethane ND 0.5 ert -Butyl Benzene ND 0.5 4- Chlorotoluene ND 0.5 etrachloroethylene ND 0.5 Benzene ND 0.5 oluene ND 0:5 Bromo Dichloromethane . ND 0.5 richloroethylene ND 0.5 Bromo Benzene ND 0.5 *1 Chloride ND 0.5 Bromochloromethane ND 0.5 p- Xylene ND 0.5 Bromomethane ND 0.5 ethyl.tert -Butyl Ether ND 5.0 ND.- None Detected Results based on sample(s) submitted:7116199 Laboratory Director . •NORTHEAST LABORATORY 129 MILL STREET, -BERLIN,.CT 06037• (860)828 -9787 - FAX ($600,294.050,.... TOLL FREE WITHIN CT: 800- 826-0105.OUTSIDE CT. 800 -654 -1230 .RFC NORTHEAST LABORATORY w DAmBuRy VI °COOW188/W I.S NL�i61Ya � ®{:18{' l��iSla�VRYy ��l/LS ®�� •�• Ys3.' • '^t�tt.Y.T�T ��f- �.Y�- Vy.Cj��:.4 y�is. i. >D^'.'.P ..� b NY Cert: 11471 (203) 748 -7903 - FAX (203) 748 -0652 HgORGANI[EC cC I�H CALS (AND =ER LM TS) REPORT TO: o P.F. BEAL & SONS DATE SAMPLE COLLECTED: 7/15/99 4 PUTNAM AVENUE TINE COLLECTED: 3:30 P.M. BREWSTER, N.Y. 10509 COLLECTED BY: W. MAYES DATE RECEIVED @ LAB: 7/16/99 DATE(S) TESTED: 7/16/99 - 8/2/99 TESTED BY: LAB #11471 & 11301 REPORT DATE: SAMPLE DESCREMON: WELL WATER 8/2/99 SAMPLE LOCATION: VS CONSTRUCTION, LOT #6 PUTNAM CHASE SUBDIVSION, KRAMER POND RD., PUTNAM VALLEY, N.Y. SAMPLE POINT: HOSE BIB PARAMETER: o ANTIMONY o ARSENIC a BARIUM o BERYLLIUM 0 CADMIUM 0 CHROMIUM 0 CYANIDE 0 FLUORIDE .o MERCURY 0.014 200.7 1�NICKEL �y� }1� /}}��y♦ • NITRITE NITROGEN • NITRATE NITROGEN .005 plus NITRITE NITROGEN • SELENIUM • SILVER • SULFATE o CHLORIDE • THALLIUM • LEAD • COPPER o SODIUM NLkXQMUM CONTAMINANT EPA TESTED BY LEVEL (MCL) OR STANDARD RESULT (m¢/L METHOD # Lab ID# .006 <0.003 204.2 11301 .05 <0.005 206.2 " 2.0 0.014 200.7 " .004 <0.001 200.7 " .005 <0.005 213.2 " 0.1 <0.01 218.2 " 0.2 <0.01 335.2 4.0 <0.10 340.2 11471 002 <0.0002 245.2 11301 .1 <0.02 249.1 11471 - 10:0 a� a _4:1D,•..:.:.._ .: _...:33:x;, r_.. 1.0 (as N) _ <0.005 354.1 " <0.50 10.0 (as N) 353.2 .05 <0.002 270.2 11301 0.05 <0.01 272.1 11471 as 33.3 375.3 " 250.0 <5 325.3 " 0.002 <0.001 279.2 I.1301 aao 0.005 239.2 .11471 aaa <0.02 220.1 NOTIFICATION LEVEL (mg/L) 28.0 5.8 273.1 11471 * MCL HAS NOT BEEN ESTABLISHED FOR TMS CHEMICAL. MCL (RE: LEAD & COPPER): SEE LEAD & COPPER RULING, SECTION 19- 13 -B102 (i) (6) mg/L--milligrams per Liter Laboratory Director i -NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037° (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826-0105 o OUTSIDE CT: 800 -654 -1230 NORTHEAST LABORATORY of DANBURY nil I ..,,.o� .. ".�: �.... r - ...- 1+•.�:F�i.. ..1:. r .�! �- e- .qtr -`i?a :. %d++: .. ...'. -,r :: l:' �.'ii -y.:� C .. i1 -0404... 39 -3 MILL PLAIN ROAD - DANDURYO CT 06811 NY Cert. 114711 (203) 748 -7903 - FAX (203) 748 -0652 CERIFICATE OF ASBESTOS ANALYSIS (METHOD:. TRANSMISSION ELECTRON MICROSCOPY -- T.E.M.) REPORT TO: P.F. BEAL & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 Date Sample(s) Collected: 7/15/99 Collected By: 3:30 P.M. Date.Sample(s) Received @ Lab: 7/16/99 Tested By: SCI LAB Report Date: 7/29/99 SAMPLE DESCRIPTION: WELL WATER SAMPLING LOCATION: V.S. CONSTRUCTION, LOT #6, PUTNAM CHASE SUBD. KRAMER POND ROAD PUTNAM VALLEY, N.Y. DESCRIPTION: DRINKING WATER WATER FILTERED (liters). 0.025 STRUCTURES DETECTED(total): NSD STRUCTURES DETECTED* NOM) NSD ANALYTICAL. SENSITIVITY(N1F'/L): 0.14 ASBESTOS CONC. (total) MFL) <014 ASBESTOS CONC. 0010µ�(IVIFL) 'ASBESTOS 'TYPE *Fiber criteria > =0.5 microns, 5 :1 aspect ratio: NAD/NSD = no asbestos detected, NA=not analyzed, MF/L- -nullion fibers per liter. NOTE:Drinking water analysis by EPA - 600/443 -043 (100.1). Analytical sensitivity calculated as though 1 fiber had be detected on the TEM GRID area analyzed: Samples are refrigerated upon receipt and filtered within 4 hours. . Samples Analyzed .by: The SCILAB Group of Laboratories > = GREATER THAN < = LESS THAN Results are based upon samples submitted: 7/22/99 J) WYI.Utc *a Laboratory Director ,NORTHEAST LABORA TORY, 129MILL STREET, BERLIN, CT 06037•.:(860)828 - 97$7 - FAX (860)829 -1050 'POLL FREE *ffi �1 CT: 800- 826 -0105 i OtJTSIDE CT: 800 = 6541230 7 n 4 75 i�0�0 � E � r�e�A r, 3:•:� C� � •� 1 k , �4.7y �, ��t'y � t. �`v i '� W. TS�l'AW �� ® RA""" dS�iY ®�° `D��1 �F ti ^ ^r e.�.0.''i. �••.+ ...�.`• � �.ry a r „ �. .z a r��p. --em7�uu t r 4i uyr act t �r 1K e r : 1 I 3 5' fZ �� NdIIY.H. F$. 748-1903 FAX (203)'71 $ 4 652 i OrL ftic ' (all results reported 3p mic ro gr��s Dd�Y �® X u �F r S s d a a �ivf.,'� .�f `�'i '` si��v �• X71 s 3� >:� j� x °d' y '� � + tVl w A�Si�1�LECOLLECTED ��"T ` r,� - , ��'fW' ` :- TIME COLLECTED � ':•. '�- fl 3 30 P M rc,� , `. �;'' `'. VSTER, Id Y 10509 � + ��" ' +- `' � CO�,LECTED BY: `� �i � �, s rW MAYES� � � •; r .,..�. .... r .. .... , mss.- .... `".� ar .. { {;S ®411V�E � ; JI ®&'J �Y VV TJIUIL! C 4. Y' K:A �� ' {3G � t .''c •t 2 ' �R A T.j p g p1V,Il�pL�1, pAy VIlG pCpE T 4 pp p T RE UL OVU ..`. (*G, ANOPHOSPHORUS PESTIlC ®ES s PEST IlCIIDES/PCB's Aldan ND 0.05 r Alachlor ` ND 0.44 Endrin .. -, ND 0.1 Atrazine ND -0.22 Dieldrin . ND 0.1 Bi tachloi' ND 0.1 Heptachlor ND .0 .1 Ivietolachlor ND 0.1... Heptachlor Epoxide ND 0.05 Metnbuzui ND 015 Lindane ND 065 Simazme Propachlor ND 0 5 e Toxaphene ND ' 10 ]HERBIlCIIIlDES Oi. UA�(1]1. ': y .', ND' ., , 0:5 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _.. . _.. _ � .'� .,. - a i=-i : m _ , , , i .:< . �7 �e ... •i%s» "c:'�ee. � "ai •V'•� , . ra— ,. SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner ?7 Go07aA1 1?� M flo/t O GUS Address 3? G►ZpTt�Ay �tM %I y OSS�N ►�6 �lJ y. Located at (Street) . 46!j l dnS t:b 6 I2© Tax Map j61 Block �_ Lot (indicate nearest cross street) Municipality?') Ptx-itlAm 1/ Drainage Basin ft-g4 5-1 L(- hbuL oW GIZ K W q.<,,0AJ 2 t vc-1Z XVD2a=tce SOIL PERCOLATION TEST DATA of Pre - soaking 04 -oe 21-9 Date of Percolation Test = pq - oc-ctq Hole No. Run No. Time Start - Stop Elanse Time iVlin.) De th to Water rom Ground Surface (Inches) . Start Stop Water Level Drop In Inc7�es Percolation Rate Min/Inch 3 to31 a 4 5 ti 1 q.s� J0Z'1 'l ,s I L-.... 27' 2� zt_loS� 30 —'L 'q Z.S t7- 3 lOS'-�lzl 3o ii -Z�t Z,S �Z 4 _.. 5 1 2 3 3 4 5 MUTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtamea at eacn percolation test hole. (i.e. s 1 min for 1 -30 min/'inch, 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. i Form DD-97 TEST PIT DATA ]F- -JON -;;S0j-�S ,. 0F /DEPTH HOLE NO. 1 -1 HOLE NO. k A HOLE NO.- G.L. MP So t 0.5 1.01 1.5 IZOVOAW 54ON L04M 2.01 2.51 3.0' 3.5' 4.0' 4.5' 5.01 M1 6.0' 6.5' 7.0' 7.51 8.01 8.51 9.5 MO WA M 10.0 :5 jJ pj Indicate level at Which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: &D4M 5zM,--BauAF(-) ZA467IN Date q, Design Professional Name: TjmQ134V L. CrzyAjjAj Address: Signature Design Professional's Seal KON V. Eli tu 62980 617.20 SEAR Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM T LIST.- A�P NS — �Q 10, Only;� 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# 6 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) Kfamers Pond Road/ Sassinoro Drive 5. PROPOSED ACTION IS: View ❑Expansion ❑Modification/afteration 6. DESCRIBE PROJECT BRIEFLY: construction of subsurface . sewage treatment system and individual well water supply 7. AMOUNT OF LAND AFFECTED: Initially 2A-,E_acres Ultimately 3, 05 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? MYes ❑No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Wesidential ❑ndustrial ❑ommercial ❑Agricultural ❑Park/Forest/Open space ❑0ther Describe° Sunounding-lands are zoned ,sing-le f2mily.,residenfial 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? @Yes ❑No If yes, list ag6ncy(s) name and permitlapprovals Town of Putnam Valley- Building Permit 11. DOES ANY ASPECT. OF THE ACTION HAVE A CURRENTLY VALID PERMIT. OR APPROVAL? JjYes ❑No If yes, list agency(s) name and p6rmillappmval 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 nam m nna ohar date: 0419-00 Signatuire'. �.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 Dyes ❑No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a - negative.declaration may be-superseded-by anotber.involve 2gsnr �SYes.� nR:- a ❑ND C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: Answers may be handwritten, if legible. C11. 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: ©v- 1 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 ES%LI I E OF A CRITICAL ENVIRONMENTAL AREA (CEA)? . ❑Yes ❑No If Yes, explain briefly: --� per. t' . °�• E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑Yes ❑No If Yes, explain briefly Part III - DETERMINATION OF SIGNIFICANCE.(To.be_completed by Agency). _ °, - BfdST63ifCT9Oic�S: reach-adverse effect identified-above, detefmrne **ether iris dbstantiar,'lar —g iritpbnant or otherWise'signifioairt. 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 ❑ 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) PUTNAM COUNTY DEPARTMENT OF HEALTH " DIVISION OF ENVIRONMENTAL HEALTH SERVICES Ian ^.r - y`°'.i:, i, .w. ..4 .i.Gr �.:., � "- ^�Cc,.i -c.' _u:1r- .°i".'i� +i.:a ...: JGio'Z-,�a? +'�T t ^� �� ] - °.�.•.. .r. ,. .t .,.. 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: Secretary -Name (Same as. above) Michelle Santucci Address:., .._r .._�_. .:..: (Same,.as..a�ove) Treasurer - Name: Same as Secretary w n .n Address: (Same as above) and that I am and will be individually responsible for any and all a s o the c oration with respect to the approval requested and all subsequent acts relatin reto. w fj 61 Notary Signed: Title: day of z (year) KELLY M. LENT Notary Public, State of New York Corporate Seal No..01 LE6026834 P Qualified in Westchester Count Commission Expires June 29, 2 6 Form CA -97 i I _ BRUCE R. FOLEY - r j +Public Wealth- -D to May 17, 2000 LORETTA MOLINARI RN., M.S.N. - • -...- .� . _ •:,.'. = :Assoclat� •- f'tibltc'�`I�'sfth= _Dire€tor�_ ��: - -. - .-- Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (9.14) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 if 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 z 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. - t_s>:ch-4 me• as ,Mall -is- filed�zonstruction applications- submitted_wilLhavW- be. complete 1 -i.e, "Date Subdivision Approved." 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 PUTNAM COUNTY DEPARTMENT OF HEALTH D S O�Y- z! DI LENVIRONMENTAL- .HEAIj.'I�.,S.ERYICES� _... r s!.a.• --•,.o �., - °.y,v -s, Y, w -ta a. ^v ...:?s.. • r i r.. .....ow;r.re.•.. -mow:.: *s :ray- e-..4. _a<•rr.,.m -�o .. ....��.+.� GUARANTEE OF.SUBSURFACE SEWAGE TREATMENT SYSTEM 31 Cp -o-rom J"'AM. 1204b Sic . 8�4 3%A -, / -I-DZ : —'5�0 Owner or Purchaser of Building Tax Map Block Lot N_'C7'TOT7 1%6M 1?0Al) ��QP Taus. o* ` `CZ SAM t A LLE�/ Building Constructed by TownNillage 5A551,2,o a�v Location - Street �IA) 6 Z-E E411114- y 2!f512 --1I1 C6— Building Type Irr/J A M e kA 5 E 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 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 bytthe willful or negligent act of the occupant of the building, utiliing_the, ..... - system. ��'- • .....- ....,..._ 4 .. {.-. The unjFrsigned further agrees to accept as conclusive the determinate the rtblic Health Dir to � f t utnam County Department of Health as to whether or of a ilur of the system tR o era vv aused by the willful or negligent act of the occupa f t ildi g utilizing the ated ont // Day / Year 200 Signature: Title:, .a, NMI A 123n a . ntra for (Owner) - Signature �Am P0 b l z P. �O �� oTO n1 � M � D e P- P. Corporation Name (if corporation) Corporation Name (if corporation) Address: 31 eQOTaa 1�AM -A!) State A1 y Zip D/ S6 Z Address: 3 � eleara,0 3�w POAD . State Ass ., ;e ^4,X Zip loS� z Form GS -97 RR PUTNAM COUNTY DEPARTMENT 01F HEALTH DMSION OF ENVIRONMENTAL HEALTH i ', i I i I SERVffCES WELL C059 WeR Lmtion Street. Address: putnam Chase, 106iziir lid Rd, Town/Village: Tax Grid U. putaw Vagley Map Block Lot(s) 6 Address: . _ _ _• . Casig iktails. . - 7. ....... _ .... �i Cgs l t psis Yoko : t:$o Road-'$ o "Ailf 10561---_-., :.:: yora Joints: — Welded X. Threaded Other �Tse ff. so. :;° :.Residential Public'SuppI Air cond/heat pump . Irrigation,. Liner: Yes X No ScHeemI Deftfls Farm Test/moniio n 'ng Other(specifyuress .. )... Diameter (in) Slot Size Incliastrial Institutional Standby . t Drilling Equipment - -- _ X'.. Rotary Cable percussion' X Coinpressed air percussion Other (specify) /e9� Mgr X n hole in bedrock Other ned Open casing Open _ Yes—No Hogs Second Wen Y1elel Test . _ _ _• . Casig iktails. . - 7. Total length - . is ft.. Length Wow grade 91 ft. In Weight per foot i9 lb /fL Materials: X Steel _Plastic . _Other Joints: — Welded X. Threaded Other rent- grot�t -i4 ft te-_` er . Drive shoe: X Yes —No Liner: Yes X No ScHeemI Deftfls Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hogs Second Wen Y1elel Test _ Bailed X Pumped X Compressed Air Hours 6 Yield 8 gpm Depth ]ate Me�ane m land surface- static (specify) 60.0. During yield test(ft) 859' Depth of completed well in feet 505' Wen ]LOS If ritore<detailed fo»tioi w':�; - _ siescrapteons or :. aae avai➢ablei . _ .., : ply attach. - 7. -; De th Fmin Surface .: -Water 3B�anng :: WeR ®ia ®eter{ia) lForimition ; ]lDescH9iota ` .:.`' - ft. Latia.5urface 5�- :$I: :.i� and`.: ddri • - _. .72 505 Drill1i iai gEigto - If yield tested Feet gallons Per Minute Ptmmp/Siv�ge, ��nk'.ii�fformatroa__ .; -':, a• depths`;'.• l - '. ; -� . .. 1'u�p'•ypeapacitY F model . -_ _ old - :- Tad Type If .... A -T its E NE LABS W LRI&!A ST:- LABO_RATORY,..OFIDANBUBx -- CT Cert: PH4MU 39 -3 MILL PLAIN ROAD - DANBVRy, CT 06811 NY Cert: 11471 (203) 748 -7903 - FAX (203) 748 -0652 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: P.F. BEAL 8t SONS DATE SAMPLE COLLECTED: 7/15/99 4 PUTNAM AVENUE TIME COLLECTED: 3:30 P.M. BREWSTER, N.Y. 10509 COLLECTED BY: C. BEAL DATE RECEIVED @ LAB: 7/16/99 DATE(S) TESTED: 7/16/99 TESTED BY: LAB# 11471 REPORT DATE: 729/99 SAMPLE SITE: V.S. CONSTRUCTION, LOT #6, PUTNAM CHASE SUBD., KRAMER POND RD, PUTNAM VALLEY, N.Y. SAMPLING POINT: HOSE BIB SOURCE: WELD -NEW TREATMENT: NONE TEST PERFOkN1f6- BACTERIAL: Total Goliform (Bacteria) CHEMISTRY: Chlorine Residual ml = milliliter mg/L = milligrams per Liter ND = none detected 0 per 100 ml 0 per 100 ml ND mg/L --- RESULTS BASED ON SAMPLES SUBMMM:7/16/99 SAMPLE, AS TESTED ABOVE: MOTABLE or FEJ 1OT POTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) •NORTHEAST LABORATORY, 129 M 1 STREET, BERLIN, CT' 06037• (MOWS-9787 - FAX (860 )M1050 7 :w 7,' -3 JEML ?L&W BMW - DAENW, C? 016912 (203) 748-7903 • FAX (20G) 748-0652 P.F. IDEAL & SONS 4PMAMAVENUE BF"STwtl N..y. 10509 w qor— Y, cir cwt PH.4m" NY Cam 114,yo DATE SAWLE COLLECTED. 4115/99- T2& COLLECTED- 3:15 FbL COLLECTED BY: Mm mcGkM DATE RECED/W @LAB: 4/19/99o. * 77SM 13Y-. LAB#1 1471 &. 11301 MORT ]DATE: &=99 0 ND 7.61 w deli Emit 0.41 Nws 5 NTUs -fill- KI go" Nitrite N <0.005 mglL as N I mg/L as N 11301-Nia%WN 0-29 mglL as N 10mglasN A&aliaiW 62.0 mglL no desipmd limits Heldam 90.0 mg/L no desipazed limirs bron 0.03: MWL 030 UOL mmlown <0.01 MVL 030 Ma [Now. cmbbed urnit for kon phn in SO&M 3-9 L"d 0.004 =1 - wim1w MgVL - Mims== pw Lbw o,3Wcdficwfo&Lsvd 000Ac" Lavd wx 20 o MI)a 0.0150-�* ND - nn d"wd Nru-uw2s MULTS BASED ON SAWIM SUDbffr=:4/19M *RESULTS OF SAWLES ANALYZED BLFYOND 30 110M COMM BE INVALIDD P---" SABOM AS TESTED ABOVE.- ILX"TAXE or. aOT POTAK2 M NEW YMX STATE WT OF HEALTH SEtVM STANDAM FOR POTABLE WAM) T-ItM®Rva. m LAomry Disww oNORTHEAST LABORATORY, 129 N3LL ST W, BERLIN, CT 060310 0823 -9787 - FAX (860 1050 TOLL FREE VITHN CT. 800426-0105 o OMIDE CT- 800434-1230 NORTHEAST LABORATORY of DANBURY LABS - MII.L'LYN ~1YOAD = �AOI�'�'96�I''°' -::Q •NY'"er ^;1l'd71':....�, '..::;:s ;°:V. (203) 748 -7903 - FAX (203) 748 -0652 EPA METHOD 524.2 Measurement of Purgeable Organic Compounds in Drinking Water by: Gas Cbromotography -Mass Spectrometry REPORT TO: COMPOUND AMOUNT P.F. BEAT. & SONS DATE SAMPLE COLLECTED: 7/15/99 j 4 PUTNAM AVENUE JUE COLLECTED: 3:30 P.M. BREWSTER, N.Y. 10509 COLLECTED BY: W. MAYES 0.5 DATE RECEIVED ® LAB: 7/16199 0.5 TESTED BY: LAB# 10916 ND REPORT DATE: 7129/99 SAMPLE SITE: V.S. CONSTRUCTION, LOT f16, PUINAM CHASE SUBDIVISION, KRAMER POND RD., r 0.5 PUTNAM VALLEY, N.Y. oroform SAMPLING POINT: HOSE BIB 0.5 SOURCE: WEI.IrNEW 0.5 COMPOUND 1,1,1,2- TeawMo 1,1,1,- Trichlomethane 1,1,2,2- TetracWo 1,1,2- Trichloroethane 1, l- Dichloroethane 1,1- Dichloroethene 1, 1 -Dichloropropene 1,2.3 T'richlorobenzeae 1,2,3- TricWoropropane 1,2,4- Trichloroben=e 1,2,4- Trimethyl Benzene ,2 pichlorobc a e 1,2- Dichlompropene 1,3,5- Trimgth l Ben=e 1,3- Dichlorobenzme 1,3- Dichlompropane 1,4- Dichloroben= 2,2- Dicbla"wpane Dibromochlbrotnethane DtbromomNhane Dicblorodiliuoromethan 2- Cblorotoluene Trichlorofluaromedwe 4- Chlorotoluene Broma Didrloromelhaae Bromo Benzene Bromochlommedme Bromomethme AMOUNT DETECTED roethane ND ND methane ND ND ND ND ND ND ND ND ND _ - ;,ate.., ND ND ND ND ND ND ND ND e ND ND ND ND ND ND ND ND ND Results based on sample(s) submitted:7116199 (aU results vWressed to mkwgran a per lfta) LIMIT OF COMPOUND AMOUNT LIMIT OF DETECTION DETECTED DETECTION 0.5 romoform ND 0.5 0.5 is-1,2- Dichloroethene ND 0.5 0.5 is- 1,3- Dichloropmpene ND 0.5 0.5 arbon tetrachloride ND 0.5 0.5 oroform ND 0.5 0.5 oroben=e ND 0.5 0.5 oroethane ND 0.5 0.5 oaomethaae ND 0.5 0.5 Benzene ND 0.5 0.5 ifluorethane ND 0.5 0.3 orobutadiene ND 0.3 0.5 , Bcn=c ND 0.5 .0.3 ~ 0.5' - Butanone (MEK) ND 0.5 0.5 me ND 0.5 0.5 Butyl Benzene ND 0.5 0.5 Bm=c ND 0.5 0.3 Xylme ND 0.3 0.5 Lsopropyltohrme ND 0.3 0.5 utyl Benzene ND 03 0.5 tyrme ND 0.5 2. 0.5 1,2- Dichlomethene ND 0.5 0.5 tans- 1,3- DhcWompropene ND 0.5 0.5 ert -Butyl Benzme ND 0.5 0.5 etrsicWorodbylene ND 03 0.5 ohrme ND 03 OS rirblaroethylme ND 03 0.5 myl Chloride ND 0.5 0.5 Xylene ND 03 0.5 tat Butyl Ether ND 5.0 ND - None Detected atow Laboratmy Ditecoor oNORTHEAST LABORATORY; 129 MILL STREi'rT, BMW, CT 060379 (860)28-9787 - FAX (860 )M1050 TOLL FREE WITHIN CT: 800426-0105.OVPSIDE CT: SM54 -1230 .;1' REPORT DATE: SAMPLE DESCRIPTION: WELL WATER SAMPLE LOCATION: VS CONSTRUCTION, LOT #6 PUTNAM CHASE SUBDMSION, KRAMER POND RD., PUTNAM VALLEY, N.Y. SAMPLE POINT: HOSE BIB MAICDWM CONTAMINANT CT Cert: PH 4404 LABS 39 -3 MU PLAIN ROAD - DAIIIIBURY9 CT 06811 NY Cert: 11471 PARAMETER: (203) 748 -7903 - FAX (203) 748 -0652 RESULT (mXj) INORGANE . CHEAUCALS LAM THEER L991SI REPORT TO: P.F. BEAL & SONS DATE SAMPLE COLLECTED: 7/15/99 4 PUINAM AVENUE TIME COLLECTED: 3:30 P.M. BREWSTER, N.Y. 10509 COLLECTED BY: W. MAYES <0.003 DATE RECEIVED aQ LAB: 7/16199 11301 DATE(S) TESTED: 7/16/99- 0/99 ARSEMC TESTED BY: LAB#11471 & 11301 REPORT DATE: SAMPLE DESCRIPTION: WELL WATER SAMPLE LOCATION: VS CONSTRUCTION, LOT #6 PUTNAM CHASE SUBDMSION, KRAMER POND RD., PUTNAM VALLEY, N.Y. SAMPLE POINT: HOSE BIB 0° NCL HAS NOT BEEN ESTABLIMI) FOR TMS CHEbUCAL MCL (RE: LEAD & COPPER): SEE LEAD & COPPER RULING, SECTION 19- 13 -BI02 (l) (6) m&/L=milftmms per Liter ONORT1MAST LABORATORY, 129 MILL STREET, BERM, CT 05037® (860)828-9787 - FAX ( 1050 MAICDWM CONTAMINANT EPA TESTED BY PARAMETER: LEVEL (MCL) OR STANDARD RESULT (mXj) METHOD # Lab ID# • ANTIMONY .006 <0.003 204.2 11301 • ARSEMC .05 <0.005 206.2 • BARIUM 2.0 0.014 200.7 • BERYLLIUM .004 <0.001 200.7 " • CADMIUM .005 <0.005 213.2 • CHROMIUM 0.1 . <0.01 218.2 " • CYANIDE 0.2 <0.01 335.2 • FLUORIDE 4.0 <0.10 340.2 11471 • MERCURY......_ .. - - - .002 .. <0.0.002-- _ _245.2 _ ... . , , 41301-- . . ,.. • V _ 0.0 , 2491 1. 4. 171 • NITRATE NITROGEN 10.0 (as N) <0.50 353.2 11301 • NITRITE NITROGEN 1.0 (as N) <0.005 354.1 " • NITRATE NITROGEN <0.50 plus NITRITE NITROGEN 10.0 (as N) 353.2 " • SELENIUM .05 <0.002 270.2 11301 • SILVER 0.05 <0.01 272.1 11471 • SULFA'T'E 00 33.3 375.3 " • CHLORIDE 250.0 <5 325.3 " • THALLIUM 0.002 <0.001 279.2 11301 • LEAD 000 0.005 239.2 11471 • COPPER 000 <0.02 220.1 • SODIUM $IOTIF&00N LEVEL (ma/L) 28.0 5.8 273.1 11471 0° NCL HAS NOT BEEN ESTABLIMI) FOR TMS CHEbUCAL MCL (RE: LEAD & COPPER): SEE LEAD & COPPER RULING, SECTION 19- 13 -BI02 (l) (6) m&/L=milftmms per Liter ONORT1MAST LABORATORY, 129 MILL STREET, BERM, CT 05037® (860)828-9787 - FAX ( 1050 NE NORTHEAST LABORATORY of DANBVRY s i GT C ert: 4.944 l/isf�yw� N »egg 39 -3 Mu t PLAIN ROAD - DANBURY, CT 06811 NY Cert. 11471 (203) 748 -7903 FAX (203) 748 -0652 CERMCATE OF ASBESTOS ANALYSIS (1VlETHOD: TRANSMISSION ELECTRON AUCROSCOPY — T.E.M.) REPORT TO: P.F. BEAU & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 Date Sample(s) Collected: 7/15/99 Collected By: 3:30 P.M. Date Sample(s) Received a@ Lab: 7/16/99 Tested By: SCI LAB Report Date: 7/29/99 SAMPLE DESCRIPTION: WELL WATER SAMPLING LOCATION: V.S. CONSTRUCTION, LOT #6, PUTNAM CHASE SUBD. KRAMER POND ROAD PUTNAM VALLEY, N.Y. DESCRIPTION: DRINKING WATER WATER FILTERED (liters): 0.025 STRUCTURES DETECTED(total): NSD STRUCTURES DETECTED* ( >10um) NSD ANALYTICAL. SENSITIVITY Wll 0.14 ASBESTOS CONC. (total) (MEL) <0.14 _ ... . ,.... ....,ASBESTOS .G N.14 ...... ASBESTOS TYPE — *Fiber criteria >=0.5 microns, 5:1 aspect ratio: NAD/NSD = no asbestos detected, NA=not analyzed, MF/L--million fibers per liter. NOTE:Drinking water analysis by EPA -600 /4-83 -043 (100.1). Analytical sensitivity calculated as though 1 fiber had be detected on the TEM GRID area analyzed. Samples are refrigerated upon receipt and filtered _ within 4 hours. Samples Analyzed by: The SCILAB Group of Laboratories > = GREATER THAN < = LESS THAN Results are based upon samples submitted: 7/22/99 -Cl �iPl.�ta Laboratory Director •NORTHEAST LABORATORY, 129 MILL STREET. BERLIN, Cr 06037• (8b0)28. V - FAX (860 )M1050 g"i T wD= unTm M. 20OM64105 * OUTSIDE CT: S'1- 230 •r i k,- W* CT Cert: PH-0404 w: 39 B&Z, PLAW ROAD DA'kWRY` CT 06811 NY Cert: 11411 (203) 748-7903 - FAX (203) 748-0652 ajR Irejifts reported in iiif6ogm6ibei liter hag ojL T TO: .4� -.7115/99 DATE SWLE COLLECFED: P.F. BEAL & SONS _IImE PM _4 Am AV -W. T.Y... .105 9 -COLLECTED BY. ZREWSIM 0 7 bXlijkE LAB 4 V16/99 .,�,,4Z 11301 & 10781. REPORT DATE: .sk�&U srrE: LQT PUtNAM CHASE SnDMSTOK.kg�"POND RD.. PUTNAM VALLEY sy. ag A I P "'i �L'b i V. %Z*.�,._ �e. NEW WELL.. ANALYTE NAME RESULT NML ANALYTE NAME RESULTS MDL PESTICEDES/PCB's ORGANOPHOSPHORUS PESTICIDES Aldrin ND 0.05 Alachlor ND 0.44 Endrin ND 0.1 Au-&nc ND 0.22 Dieldrin ND 0.1 But ND 0.1 Heptachlor ND 0.1 Metolachlor ND 0.1 Heptachlor Epoxide ND 0.05 Metribuzin ND 2.0 Lindane ND 0.05 Similzine ND 0.15 P 0.5 ND I oxaphene ND, 1.0 HIERBICMES 2 ND ,-.PCB-1 W.�-,`. ND 0.5...... - A-D 1.0 u Deb- -on p i.' I;d.-11232 Di IWO 0.5'�.i:. Dindse 248 Peiifai:blo,ro*,pha D &4 X0..7: TESHPLIG TRucrlo,L Y HexachlOrobenaene . ..... R DBCF-��z _FF e AND 0muyu u Ia0cmam . . . . . . all v.S- >_ �z I• 101 nax. v1v07v Nv¢LS KIVU" K7 s 2vo rlC13l VIW/S Olr-S(Tr By KW" A'. 1 d tl •{ Ifdi SE PLANS A O• �. -- SN- /P093209/14Y 1 PUTNAM COUNTY -DEPA i T 10ENT OF IfEALTm t: Ifdi SE PLANS A OVER 110R 13ED:ROOAI COUNT ONty, ' BEDROOMS ALL' SUBSE, 'ENT REVISION /ALTERATIONS TO THESE HOUSE PLAI`:dS 14I BE SUBAUTTED TO THE PCDOIi FOR APPROVAL SIG FATURE &TITLE DATE a r vwniS FRONT ELEVATION 31i 50 SPECIAL 1 0 STORY aRiz mw ew W/2 x It GARAGE 6122 x 7 BUNPOU T t ., SIVZOMM M 82W5 ELEVATIONS F" (717) 4u -7577 Ism 71[ wift an w-w-9x ZLfAU 3 COX mw, /•�e A v m i m i CS) m A -0 m I . . . . . . . . . . . ........... Sw— /PD93M/N.Yl m Vl ILL Rib 3 EM 3 3 3 E= ti 3 M 'U 3C 50 SPECIAL Tr. SURY C1120 At GARAM M 7 I 1 EL EVATIONS Mod W- 41 sm aaa2j&— V.S. CONSTRUCTION SN- /PD93209 /NY" If �w 9 ' i.. Y u ' T1V r! 3 r RIGHT GABLE M an 3C 58 SPECIAL Tv0 STORY /2 r 0 01 GARAGE t12' O BUIIPQUT vmr"-+M 1"a ELEVATIONS ,. [sn) •r. -uae .,� riY(7�s)sa -sist � Lw peRar�orD vs'•ri' N M lLn • ;v :m i + r N Q1 m O1 r a 1 1 I 1 an 40 t340Ra 1 .�> .szw ' e i 8' �l 1 f L ---------------------- aTR gate or 1 If R ZZO 3f°i02 CALM jMM OWED GAGAM. CASE LATER S/IT TT."'2i 'a• GYP APPLteD 02 QwA" BN -SITE STEEL HEADER ' DESIGWE I. PROVIDED & INSTALLED o �u BY /PD93209/Nr ON—SITE BUILDER — lo AS W QL SET DAM DOW-4 S AT EM JOMTS tats STAMM =WS L-0' EACH L=Q llt6• , la • �� ie s 2-LATL1)S 3/O• TTCE •tr o 1 1 . s: F VW G7 GMMEC CLG OW` r -" SEE C= CC 1 T eca In IA ___--- ------ --- ---- ----- 1 --- _- ____- �__�__�--- .__ -__ --. I t a aem 17/4. P-TBtt F w fl V1 �L 11 of IST STQRr a 11 VwAsmri (vrv) � � o f a•a1LL� ttGwt¢ 1 1 to eons vela a 1 srT eae .xa rsv 929 2 of 70R6+1 f.! BI 01 I1 01 ;t ` 'S !If .i i� ., T�y a n0ia .i pt. "m a0 a RI I.=, s• " ED Tad aQ OT - W lO�ft1 ua al• cm rm a• -r I. — E WIN w cca.T Ra retype � staDT 1.206 EST VA[-LS a 16' 0 ;72-4 INAR WALLS Z 9•-• CLb Of. a 2019 SPra2 rLOOO jmsTS a i6. OC. 4.1Nr v0dev3 9 CtS fdalER OWED al-t1 e(OOTER 10 9E- 2-1 W-dl IV4'.W-4' M. 6.1 %MM SIB' 1TPE •r• STP. 00011 SIDES DOME SIDE -MM. VALU BVER 2-4 STUDS OVD. SCEAnew. GTv. -cv. Valli a 16. at. AtaAEN -160 1'maT untEO aa1LS Q r Ix -025v% j li T.1 91 LAMA S+6• TTPE . 61P. APPLIED VERTKAILLT OBI UK SUE OVER h.4 STUDS e tS, OG. A1tAL11 -160 CEIFO/ C§&KD 00OLS 0 -716• LOM WI /4• D" *EAU) Q T' OE. 4-IOS6) . !.r J i i 11 11 I/ R ZZO 3f°i02 CALM jMM OWED GAGAM. CASE LATER S/IT TT."'2i 'a• GYP APPLteD 02 QwA" 'i :i A/1•,LSS ED OL16 AWS. ATr*M WO I" TUBE 'r SW $=WS At 24' OC FADE LATEG SILT SN- /PD93209/Nr AS W QL SET DAM DOW-4 S AT EM JOMTS tats STAMM =WS L-0' EACH L=Q llt6• • �� . O O O 10: RAISE ALL I I aro• - mm OTTEew a rJL1LRf6R 4raCEPI IL SM =ATM* Rfle= VALUT, t1V PUICIM EMIATT) 20 doff ZCDV LOW . s: F m )Z V { ° 14. -6. 6' 3C 58 SPECIAL TX0 STORY V1 46%02 Bw f109 %3/20 nil GARAGE &12'x7 9WOUT USE PA fWS IST STQRr a "" VwAsmri (vrv) SAN 128/EBaT •<T-0' 01 EV4 OVD.63. npb 70R6+1 f.! ;t ` 'S !If g.e pro 1 L 4= t"T CK c=m" /s aa1tT:E w aoaaa lQetSA aCIIK £'I r. afARO l O :1 IL'a 4'L'G agru" d8 IA ; LIvIN6 am 1} r-,6• 4•-0• Ls• -a v2' R ZZO 3f°i02 CALM jMM OWED GAGAM. CASE LATER S/IT TT."'2i 'a• GYP APPLteD 02 QwA" '.. A/1•,LSS ED OL16 AWS. ATr*M WO I" TUBE 'r SW $=WS At 24' OC FADE LATEG SILT 1tIDE 'O' GL'a' APitIEB Al lilffif Cw3tk'E to ELG JOTS. aTTAEN a/ 0 ) /(J' TTPE 12, I:t/ SCREWS AS W QL SET DAM DOW-4 S AT EM JOMTS tats STAMM =WS L-0' EACH L=Q llt6• 050 O ;M Ann Pa L WOO M14LS e1 ew$ S. 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(jl t -D 19 W r ..-NdRTHEAST LABORATORY op, IDAmBuRy 39 MILL PLAIN ROAD. - DANBURY, CT 06811 CT Cert: PH -0404 1a� f (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 REPORT TO: P.F. BEAL & SONS DATE SAMPLE COLLECTED: 11/13/2000 4 PUTNAM AVENUE TIME COLLECTED: 11:00 A.M. BREWSTER, N.Y. 10509 COLLECTED BY: WAYNE O Hardness DATE RECEIVED @ LAB: 11/13/2000 O Iron TESTED BY: LAB# 11471 o Manganese LAB I. D.# BEAL127 REPORT DATE: 11/20/2000 SAMPLE SITE: V.S. CONSTRUCTION CORP., LOT #6, PUTNAM CHASE SUB., KRAMERS POND RD., PUTNAM VALLEY, N.Y. SAMPLE POINT: HOSE BIB SOURCE: WELL -NEW TREATIPYIElvi: NOINT-1 . MAXIMUM CONTAMINANT TEST PERFORMED RESULTS METHOD # LEVEL (MCQ 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 6.70 - EPA 150.1 No designated limits • Turbidity 0.31 NTUs EPA 180.1 5 NTUs CHEMISTRY: o Nitrite Nitrogen <0.005 mg/L as N o Nitrate Nitrogen <0.20 as N e:.. Alkalinity-. g , c -- 12.0 _ ., ffig/L . O Hardness 20.0 mg/L O Iron <0.003 mg/L o Manganese <0.01 mg/L • Sodium • Lead 1.4 mg/L <0.001 mg/L EPA 354.1 SM 4500D r .> Siv12'20B-"". EPA 130.2 EPA 236.1 EPA 243.1 EPA 273.1 EPA 239.2 1.0 mg/L 10 mg/L No. defined linut`s 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= milliliter mg/L-- milligrams per Liter ND =none detected MCL= Maximum Contaminant Level . * *Notification Level ** *Action Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: OPOTABLE or OINOTPOTABLE RESULTS BASED ON SAMPLES SUBMITTED: 11 /13/2000 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT, _.....__..._ .::_ We 'Ecatlon treet Ad dress: Putnam— Chase, Kramers Pond Road, Lot #6 Town/Village: Putnam Valley Tax Grid # Map Block Lot(s) 6 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 72 ft. Length below grade 71 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 6 Yield 40 gpm Depth Data Measure from land surface- static (specify ft) 60' During yield test(ft) 380' Depth of completed well in feet 505' 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 57 Drilling in over urden clay and boulders 57 Hit rock at 57! __....57..._ : 72 dn- -rock , grouted,. W :. ........., _... 72 505 Drilling in rock ciranite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 7gprn Depth 400' Model 7GS10412 Voltage 230 HP 1 Tank Type WX302 Volume 86 gal. Date Well Completed 3/29/99 Putnam County Certification No. 002 Date of Report 11/13/00 Well it i y r Nu 1'E: txact location or well Wltn aistances to at [east im Well Driller's Name P. Signature: Perry L. White copy: HD File; l� permanent tanomarxs to oe prov►ugSr vn a separaLc MnccvNiai. '/// Address: 4 Putrm Ave., Brewster, NY 10509 Date: 11/13/00 low copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 O 21/6 or rl�-?n -.27, 6-;"., IA161 Meor enlerlioe 0? Stoll 41011 SOr voy 5q lop" C- r 5 cy Area= 3.0184 Acres 70- ""SAW NEU 500 L F. - 4 10 PEIRF PVC /A- E R 20* G YAVE MENCOY WA r (ENDS CAPPED) IUWCE _f60 LF. 4'0 OR AWCPON Box (rip) -7 PW PIPE 387 Ar WET SLCP77C TANK PIPE fOOX EAPAN-VaV---j 4REA . p C) .A� ,PL S