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HomeMy WebLinkAbout4341DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -1 -52 BOX 33 04 341 V1 1 Fir I L r :L ru 04 341 i0� d X4 - � PUTNAM COUNTY DEPARTMENT OF HEALTH �1 C �j%� �j C 'JIC:O]� 1 -i0 ' iul1:� V IRONi iHFN "H3f1�'�i J "i:YERF� '21 C.�1J1J!:� y CERTIFICATE OF CONSTRUCTION COMPLIANCE F ��,. -GE: ATMENT SYSTEM PC COppNSTRUCTION PERMIT # �V �.22 00 �� l � U Locate a© e" A9�51NDtO -�- �� �l own rVMW lei TOA-M VA LLE Y Owner /Applicant Name 37 CzoT(4 JAM. Z)Ai) Onge-Tax Map E_ Z Block / Lot 5-?s Formerly Subdivision Name 'Rm )A M C H A-S Subd. Lot # c4 , Mailing Address 37 Ce-QW 0 JDAM ebAO , 0.-s Pn9 , •,� r , /� i% Zip 105 62 Date Construction Permit Issued by PCHD 8 La- Separate 00 Sewerage System built by 37 l E TOO) J>AM 2)A &address .37 NCB TOA) DA ;g rz� 0�sw�ab, Consisting of 1,25 Gallon Septic Tank and- o. �f(� i �e Per-F ��'IPE �vj .2c�" 62AV81_ TtZ,c^ICH , A102 1 CAST r>isi ZPJB0T16t0 Other Requirements: Water Supply: Public Supply From Address or: ✓ Private Supply Drilled by `t: F. 364 _ SoA)S, 7A_/0. Address /-/ i 4Tx-AIq A ve. . VY., ro5CZ9 J. _-" B�tiidirig'Tylre °JiiuC' fa Mii: /�-F.r rpEiHas erosion control been completed? Number of Bedrooms Has garbage grinder been installed? /Vo . I certify that the system(s), as listed, serving the above premises wgfe' .tp�`s as shown on the as- built plans (copies of which are attached), ' or ance with the i'su CH13;Egns� "or termit and approved plans and the standards, rules and regul ions of a Putnam p en> Health. '4 Date: // —Z2-00 Certified by w • " ` yP E. (Design Professional) X.V �\ 2 '0 le I ' ri Address 22 Z "A'\) WALt 4 3UvO • , 1E,= sacf LL . Al, lcens��- ' 06 ?q AO 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' modificA'onr hange when, in the judgment of the Public Health Director, such revocatio , odific ion gsary. By: �'' ` Title: Date: 7i Z tin White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 r ' _.;- V� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH [ S ERVIIC ES WELL COMPLETION REPORT We' Lo��tnoun�` Street Address: Put -Chase Sub. Kramers Pond Road Town /Village: Putnam Valley Tax Grid # W Map Block Lot(s) 8 Well Owner: Name: Address: VS Construction, 37 Croton Dam Road, Ossining, NY 10562 Use of Well: 1- primary 2-secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby [Drilling Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 52 ft. Length below grade 51 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: X Steel _ Plastic _ Other Joints: Welded X Threaded Other 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 12 gpm Depth Data Measure from land surface- static (specify ft) 30' During yield test(ft) 140' Depth of completed well in feet 205' Well Log If more detailed information descriptions or "eve adaLyses_Q are available, please attach. Depth From Surface Water Bearing Well Diameter(in) ]Formation Description fft. fft. Land Surface 32 Drillind in over urden clay and boulders 32 Hit rock at 32, X32:.::. 52 -' = Dr3= '_ >lin in= Lock set; -casri -- roxted� :° 52 205 Drillind in rock crranite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 10gplri Depth 160, Model 10GS10412 Voltage 230 HP 1 Tank Type lIX302 Volume &6 al. Date Well Completed 11/13/00 Putnam County Certification No. 002 Date of Report 12/8/00 Well n r to Bea h1UrT E: Exact location of well with distances to at l )st two permanent landmarks to be prov on a separate sheet/plan. Well Drillees Name Pe F Signature: Perry Le Be White copy: HD File; YA Address: 4 R t m Avem7a, Brewster, NY 101509 Date: 12/8/00 ki copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 FNZ - NORTHEAST LABORATORY_ OF DANBURY _ ., -_ - �. ... .. 'i- %�S•r " ":�.: .. ; , ~ - .. • -PH =0404 . �..2 c�^ � ..1.:`�: :. .'�39VIILL PLAIN ROAD DANBURY; CT' ' 06813 LASS (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 •�.r LABORATORY REPORT REPORT TO: P.F. BEAL & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLE POINT: SOURCE' TREATMENT: DATE SAMPLE COLLECTED: TIME COLLECTED: COLLECTED BY: DATE RECEIVED @ LAB: TESTED BY: LAB I.D.# REPORT DATE: 11/21/2000 10:00 A.M. WAYNE MAYES 11/21/2000 LAB #11471 BEAL133 11/28/2000 V.S. CONSTRUCTION, LOT #8, PUTNAM CHASE SUB., KRAMERS POND RD., PUT VALLEY, N.Y. HOSE BIB @ TOP OF WELL WELL -NEW NONE 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: MOTABLE or aOT POTABLE RESULTS BASED ON SAMPLES SUBMITTED: 11 /21/2000 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 MAXIMUM CONTAMINANT TEST PERFORMED RESULTS METHOD # LEVEL (MCL) OR STANDARD BACTERIAL: • 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 6.66 - EPA 150.1. No designated limits • Turbidity 0.33 NTUs EPA 180.1 5 NTUs CHEMISTRY: • Nitrite Nitrogen <0.005 mg/L as N EPA 354.1 1.0 mg/L • Nitrate Nitrogen <0.20 mg/L as N SM 4500D 10 mg/L - �' - �: _. - .. - . ,.. ,.� �.• _ t mg/L r � .SM 2320B N fin x 11IilltS d •o e ed. . . . • Hardness ...... 16.0 . mg�L" EPA 130.2 No'd'efnW hinit's • Iron <0.03 mg/L EPA 236.1 0.30 mg/L • Manganese <0.01 mg/L EPA 243.1 0.50 mg/L Combined limit for Iron plus Manganese = 0.50mg/L • Sodium <L0 mg/L EPA 273.1 20.0 mg/L ** • Lead <0.001 mg/L EPA 239.2 0.015 mg/L * ** ml= milliliter mg/L--milligrams per Liter ND =none detected MCL= Maximum Contaminant Level * *Notification Level ** *Action Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: MOTABLE or aOT POTABLE RESULTS BASED ON SAMPLES SUBMITTED: 11 /21/2000 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 k PUTNAM COUNTY DEPARTME EALT'H DWISION OF EN O NTAL-- HEALT E SERVICES. GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM I=QQlw' /,4M IZoAt) 1:0i rP- Owner or Purchaser of Building Tax Map Block Lot Building Constructed by �illage Location - Street Subdivision Name Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or, approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. .... The undersigned further agrees to accept as conclusive the dete at' n th blic Health Direct r of e Pu County Department of Health as to whether no he a lur f the system t� ope to s ca e by the willful or negligent act of the occup of e u d' utilizing the A Day , Z Year 2" Title: ((wner) - Signature V J)AM ��� �� - 3 7 06TOa � 1 �La 00 3i �;2 oTV� Corporation Name (if corporation) Corporation Name (if corporation) Address: 31 ceo c),-j P0h G�SS►n)cn3G . Address: 31 PF—�OT)c AJ DAM !!ND, State State / / . % Zip Ol � Wz _ State /\/"V- Zip Form GS -97 i -BRUCE Public Health Director .LORETTA .; ,M 4.Td: -}r �} Associate Public Health Director Director of Patient Services 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 911 ADDRESS VER OWNERS NAME: oTi)�i TAX MAP NUMBER: SSG• ' cl� �4 : LOT.' �i E911 ADDRESS:�7 TOWN: hUtT 0 k 1A, LL €" AUTHORIZED TOWN OFFICIAL: (Signature) ✓ DATE: ( D D D 10 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 fora Certificate of Construction Compliance. (E911 VERFRM) 11/17/00 FRI 10:11 FAX 914 736 3693 Cronin Engineering 19001 PUTINAM COUM DEMnIENT OF EFEAT DIVISION OF ENVIROnIENTAL ZZALTH SERVICES ATTENTION 0"ADAM GENIE RMIMMEOR For: FM All information must be My completed prior to any Trenches inspections being made. PCHD Construction Permit Located: SA5,yania-b Owner/Applicant Name: -21 ForReliT. '? e-r4AM VALV-Y �— Block I Lot —,j&L - Subdivision Name: j7tmjOAM U-bfAre Subdivision Lot # S. Is system fill completed? AW Date Is system complete? ' yg4 Date: -0 /6 —80 system constructed as per plans? Is well drilled? -- y6j Date: Is well located as per plans? Are erosion control measures in place? 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 Replations of the Putnam County Department of Health. Dater —IG ZY Certified by: Design Professional Address: Comments: Nn - :rp--w F1, tae hmd'- � q PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at Sassinoro Drive /Kramers Pond Road Subdivision name Putnam Chase Subd. Lot # Date Subdivision Approved- "j�2SZ7O Town oxW Putnam Valley Tax Map 84 Block 1 Lot Sub Lot Renewal Revision Owner /Applicant Name 37 Croton Dam Road Corp. Date of Previous Approval N/A Mailing Address 37 Crotnn Dnm Road, Ossining, NY 10562 Zip 19562 Amount of Fee Enclosed $300.00 Building Type Residential Lot Area 3,95" No. of Bedrooms _4 Design Flow GPD_8.0.(L AC. Fill Section Only Depth Separate Sewerage System to consist of 1250 Volume gallon septic tank and 4 � !Z 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 Water Supply: Public Supply From ° �or• 'x Private Supply Drilled by P -•F•. - -Bea1 °14 +Sbn "-,- 'nc-: Address Address Putnam Ave -- - - -J Brewster, NY 10509 I represent that I am wholl om f4Y a rYgli \or the design and location of the proposed system(s) and that the separate sewage treatment FnYi ?g e C structed as shown on the approved amendment thereto and in accordance with the standards, ru . sl ;Yegulations df 6 tnam County Department of Health, and that on completion thereof a "Certificate of Cons c `rCo " sa'Ci fac ry to the Public Health Director will be submitted to the Department, and a written guar tte will b d the er, his successors, heirs or assigns by the builder, that said .�, w; builder will place in good operat ' g onditi i`, art of tS sewage treatment system during the period of two (2) years immediately following the date o PC suan ie app \,a& f the Certificate of Construction Compliance of the original system or ep irs thereto. 980 . ESS\�� Signed: P.E. R.A. Date 'x--14 BUG Address 2 John Walsh Blvd . , P ..kski 11 NY 1 OS66 License # _06.2.9.5.0 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 con idered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe App ve r ' ch a of domestic sanitary sews a only. By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink cop - Owner; Orange copy - Design Pr fes Tonal Form CP -97 PUTNAM COUNTY DEPARTMENT OIF HEALTH DI[ RSEON OF IENVRRONM ENTAIL HEALTH S ERWCIES APIEDILIICA-T>( ®1`Y �',0 C®NST)18�JCT �. -'t •: �. , -.�.•" .... r+.�.:- ..s � �, �Y-'�ri .� . ... =:^ .. >`.. .• � .. to .a � ....q. —;,e, �'Kt.y.. ty.., s_ :. ;�2: ♦. please print or type PCHD Permit # ` Well Location: Street Address: TownNiXxga Tax Grid # Sassinoro Drive/ Sub " Z Kramers Pond. Road LOT 8 Putnam Valley Map 84 Block 1 Lot(s) Well Owner: Name: Address: 37 Croton Dam Rd Corp 37 Croton Dam Road, Ossining, NY 10562 Use of Well: X Residential Public Supply Air /Cond/Heat Pump Irrigation I- prinmry Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5 gpm # People Served Est. of Daily Usage 500 gal. Reason for Replace Existing Supply Test/Observation Additional Supply IlDrifling X New Supply (new dwelling) Deepen Existing Well Detailed Reason Water supply for new residence. for Drilling Well Type X Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No X Is well located in a realty subdivision? ...................................... ............................... Yes 1% No Name of subdivision a2 &1 Lot No. Water Well Contractor: P.F. Beal $ Sons, Inc. �� y4.. tnam Ave., Brewster, NY 105 Is Public Water Supply available to site? .......................� ?� ��.! r. t. ... ..... Yes No Name of Public Water Supply: N/A �� A Distance to property from nearest water main: rX Proposed well location & sources of contaminatio be rovi epara ee Ian. _;`s;i: Date; Apnlicant.Signature a PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires,, new permit. Well to be constructed by a water well chiller iednby Putnam .f, County. �1 � \\ i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICE_ S LETTER OF AUTHORIZATION RE: .Property of 37 Croton Dam Road Corp. Located at Sassinoro Drive /Kramers Pond Road T/ Putnam valley Tax Map # 84 Block 1 Lot Sub Lot $jj, SZ. Subdivision of "Putnam Chase Subdivision" Subdivision Lot # Filed Map ## 3 Z Date Filed Gentlemen: , This letter is to authorize Timothy L. Cronin III a duly licensed Professional Engineer X to apply for the required wastewater treatment and/or water supply .permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department _ - - o sign all necessary papers on my behalf in connection with this matter and to supervi ctt`Q of said wastewater trea Idn,, t d/or water, supply systems in conformity with ey 5. and/or 147 of ca Law, the Public .Health .0 sr 4 14W; and'die -with m 'un o e. °..a ... Very o ry, y .c Countersign ` , •�� 62980 �� Signed. Pres . P.E., # 0629 v "KOFESSko / erc P erty) Mailing Address 2 John Walsh Blvd. #200 Peekskill State NY Zip 10566 Mailing Address: 37 Croton Dam Road Corp. 37 Croton Dam Road, Ossining State . NY Zip 10562 Telephone: (914) 736 -3664 Telephone: (914) 739 -7362 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVHSHO i 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 1. Val Santucci represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: 37 Croton Dam Road Corp. Having offices at: 37 Croton Dam Road, Ossining, NY 10562 Whose Officers Are: President - Name: Val Santucci Address: (Same as above) Vice President -Name: Same as President Address: (Same as above) Secretary -Name: Michelle Santucci Address' (Same as ab Treasurer - Name: Same as Secretary n 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) 2 0 (year) Notary Public KELLY M. LENT Corporate Seal Notary Public, State of New York No. 01 LE6026834 Qualified in Westchester Count Commission Expires June 21, 2Uil� Form CA -97 acts with respect 0 PUTNAM COUNTY DEPARTMENT OF HEALTH ' DIVISION OF ENVIRONMENTAL HEALTH SERVICES { APPLICATION FOR APPROVAL-OF..I'LANS FOIE.. _ A WASTEWATER TREATMENT SYSTEM 1- Name and address of applicant: 37 Croton Dam Road Corp. 37. Croton Dam Road Ossining, NY `10562 2. Name of project: Putnam Chase - Lot # 8 . 3. Location TN.: Putnam Valley 4. Design Professional: Timothy L. Cronin III 5. Address: 2 .John Waish' Blvd. 6. Drainage Basin: Peekskill Hollow Brook 7. Type of Project: X Private/Residential Food Service Apartments Institutional Office Building Realty Subdivision Peekskill, NY 10566 Commercial Mobile Home Park 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 -.-officials, .orditian4e� ?. _.s. _. _ _ Es ,. .. .....................:.:.: ............................... Y _ , .... ...........� 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: (g allons per da y ) ................................. ............................... 800 GAL /DAY 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? ......................... NO Form PC -97 27. Is any portiort.of this project located 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? .. ............................... 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, landfrlling, 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 vears in or adjacent to project site ? ............:. 35. Are any sewage treatment areas in excess of 15% slope? NO 36. Tax Map ID Number .......................... ............................... Map 84 Block 1 Lot L 37. Approved plans are to be returned to ...:. Applicant Design Professional &OTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP .review and approval of other aspects of a project, such as stormwater.plans or the creation of . impervious. surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby aff Baas, under penalty of perjury, that reformation provided on this form is true to the best of my knowledge and belief. tatemeaats grade herein are unishable as a Class`A misdemeanor pursuane to S tion 10 of Pena & OFFICIAL TITLES. CC) M 'Address: ................................... Cronin Engineering, P . E . , P . C . T" 2 John Walsh Blvd, Peekskill, NY 10566 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner al c_p,0j?)Aj 1?4 M &Ap co,-LP Address M'CP_o7z)Aj L-. m aD, 0551AIlAi4 Aj Located at (Street) Kg6nje-7Z6 A*jb A0 ,Block Lot e Tax Map Affj zq (indicate nearest cross street) municipanty(y PjrA,1*yi. Vo CSI Drainage Basin _trt�U-0 Aj -C-94M9 ffi3O-<0AJ /Ziur-M S011, PERCOLATION TEST DATA Date of Pre - soaking -0& -ill Date of Percolation Test _o4 ­pj --I q Hole No. Run No. Time Start - Stop EaNe Time 11, ii.) D?th to Water rom� Ground Surface (Inches) - Start Stop Water Level Dro Ingin es . on Percolation Rate Min/Inch 3,1 _q sT Z11 Z7- - Vs 3 '7 2 QsS- 1v +9 Z�fi 22 -25 S . 3 lot It io 43 24 -3 .4 5 0. U 2 At st l To- 2, 25 3 3 3 4 .5 2 3 4 5 A Uftb: 1. Tesps, to be' repeated at same depth until approximately equal percolation ram are oomeo-a carm percolation test hole. (i.e. s I min for 130 minfinch, s 2 min for 31-60 min/inch) All data to be submitted for review. .2. Depth me'asu'rements to. be made from top of hole. Form DD-97 / DEPTH G.L. 0.5': fl .0' 1.5 ° 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5. 8.0' . P IlD1ESCIUMON OF SOMS ENCOUNTERED ffN TEST HOLES HOLE INTO. o�L ee �' HOLE NO. Z3 HOLE ICI®.. 2A- _ :MP SoiL sotL do°' (bit 2 9.0' 9.5' _.. _.. -.._� 10.0' Indicate level at which groundwater is encountered 71. indicate level at which mottling is observed ®tee: 00S vA0 Indicate level to which water level rises after bcin encountered Deep made by: A hA It- lAko-& �T� Date ,: n -q-q- Design Professional Name: nem owy g— egoaow . . NEW Addrepp _ /Q ss.} �V6. s �. Jr YO •A' L y •K'a Q A Sign aNre: rtrt� w H�esign Professional's Seal � ` si98o 0 617.20 SEQR Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM Fo r,U NLISTEDiACTIONS,Only ....: ,... _ . Part 1 - PROJECT INFORMATION (To he'comnleted by Annlirant or Proiect snnnsnr) 1. APPLICANT /SPONSOR: 2. PROJECT NAME: 37 Croton Dam Road Corp. Putnam Chase Subdivision, Lot # 8 3. PROJECT LOCATION: Municipality Town of Putnam Valley . County Putnam County 4. PRECISE LOCATION: (Street address and road intersections, prominent landmarks, etc., or provide map) Kramers Pond Road/ Sassinorb Drive 5. PROPOSED ACTION IS: Wew ❑Expansion ❑Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: construction of subsurface sewage treatment system and individual well water supply 7. AMOUNT OF LAND AFFECTED: Initially--.3-96 acres Ultimately 3 96- acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ®Yes ❑No If No, describe briefly Yl 9; WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? i ffitesidential ❑Industrial ❑Commercial ❑Agricultural ❑Pari /Forest/Open space ❑Other Describe: Surmunding lands are zaned7single.famityresldential . ;. .. .._ :' ,• . 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL) ?. . ■BYes ' ❑No if yes, list agency(s) name and pennitlapprovals Town of Putnam Valley— Building Permit 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID,PERMIT OR APPROVAL? Wes ON' If yes, list agency(s) name and permillapproval Subdivision Plat Approval — `Putnam Chase Subdivision' 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑Yes ®No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/Sponsorrame: 2$n in rin P. eith Staudohar date: 04 -19 -00 Sgnature: N the action is in a Coastal Area, and you are a state agency, complete a Coastal Assessment Forth before proceeding with this assessment OVER 1 A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR, PART 617.4? if yes, coordinate the review process use the FULL EAF ❑Yes ❑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. syperseded. by _another_.involved,agency.;.:_. ❑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: C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. Long term, short term, cumulative, or other effects not identified in C1 -05? Explain briefly: C7. Other impacts (including changes.in use of either quantity or type of energy)? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? ❑Yes ❑No If Yes, explain briefly: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? []Yes ONo If Yes, explain briefly: . IP8gt lfl,- DETI<RMINATION—OF StC;NIFICANCE (To be completed by,Agency) - _ ,.. , _. ,_ . .:..:.::: .... :.... _. •%t�9fiAUCT'.GNS... For each-adve se effect identified above; -creterfn"ihe Whbther if is 6015sfar tVi - large; impor3anfo othii&ise 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 of the L; A. ❑ 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 Na iii of Responsible Officer in Lead Agency $igitature of Responsible Officer in Lead Agency __. N Name of Lead Agency date Title of Responsible Officer Signature of Preparer (if different,from responsible officer) /ctTi�d/n a,!5e ShN' ✓is:D.�. 101-5 vz Oze ✓e s� a . � r F (f vb Le . ����y�Lt�L� O/f�/a l .. fir_ EIi�Df��V�a'-- s3 t: of TO EE ,6T 5--0 1, R� Ik� eSz la 1: rr-5 V2 - s vi ro i r4 z -2 i ' a•.v 1 Imo. Ep26kW r a r-6 v vb, Vb vb dzs � 4/b r * -S 114 4/b T Q :2t0 tVR1 twr-cr -r OASTOM Woe of C7KJ{05 WOW AEONS i 4V'0 Y:. 1 I l' R /ctTi�d/n a,!5e ShN' ✓is:D.�. 101-5 vz Oze ✓e s� a . � r F (f vb Le . ����y�Lt�L� O/f�/a l .. fir_ EIi�Df��V�a'-- s3 t: of TO EE ,6T 5--0 1, R� Ik� eSz la 1: 7 70' AM. F iI G L.F-4'# PEW PVC AV Q?A $a 7RDVM tS ARE CAPPED) 8 CMEM) A- -OMM z L.F. 8 ca7w MaL .kilo For --- D We" w PVC 12W atuav D Cowc- SDIW z '01 w e" TAW *14 '# CAST OWN ME 151' Ld 5F 7REA 77WEN T SYSTEM 'CRETE SEP77C TANK, 454 L.F. OF GRAVEL TRENCH. 00M7 to. MAIM. 37 CROTOM DAY ROAD CORP 37 CROMN DAY ROAD OSSINING, N. Y. 10562 MM? AM PEEKSKILL HOLLOW BROOK �Flwffl Lot MO. DISTANCES z A 8 c (D --- D xx 19' z oismounav Box E 151' Ld 1jj.j, END OF Isr. REACH F z TAX MAP SMAT CMAO? END OF 1ST. TRENCH z xx Lot MO. DISTANCES I x A 8 c SEPTIC TANK --- D xx 19' jj. J, oismounav Box E 151' xx 1jj.j, END OF Isr. REACH F 170.9 TAX MAP xx END OF 1ST. TRENCH sWCROA xx 119-6' BLOCK.- END OF LAST TRENCH H iDRAYN: Lh Lot MO. DISTANCES I x A 8 c SEPTIC TANK --- D xx 19' jj. J, oismounav Box E 151' xx 1jj.j, END OF Isr. REACH F 170.9 169.1 xx END OF 1ST. TRENCH G xx 119-6' 108.8' END OF LAST TRENCH H '18ag,, 18j,,5,, xx BVD OF LAST TRENCH l I XX 1 140.6.1 12J.9, MU LOCH 77ON I x I Y W 1 89.8'1 91-5- DEPT, OF HEALTH rucnam Gounvy Depar'Ument or K--Xu jivision of Environmental Health BerViGet Ipproved as noted'-for,conformafio6 with applicable Rules. and Reaulations oY the PU Co@p De out "9,'Tit LL ilia