The URL can be used to link to this page

Home My WebLink About4343DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -1 -54 BOX 33 1 ru ' ' - T J 1@6 or 1 Ir T. kP 04343 PUTNAM COUNTY DEPARTMENT OF HEALTH f v —DIVISION. OF EhTVI ONMEN-_AL. I .c � SE VAC] C� v •a.:.r r • .. ,pan -.. f..'.-. .. ':a •e....:r CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # PV- I S - U U ,3 h Located at S/3 9S-1 rs o il4 OR 105' Town o age ?U - N�qf --i Vii L LC Y Owner /Appkeant Name 17 CT?dTdr! Allm go/4o Tax Map 9 V- Formerly Block _�_ Lot .-4 Subdivision Name Fu -rPJAM GH #qX6 Subd. Lot # 10 Mailing Address 3 7 CJ20 —1 6tJ a,4M Ro i9 o O S S I rl l nl 61 A `r 10S 6-2_ Zip Date Construction Permit Issued by PCHD 19 U CU l ± .94 2666 37 CRoToA Mm Pa 0 Separate Sewerage System built by37 Cl?a-Md OR//'? ROAD coRf,, Address osxj d i N G N, y 16S6' 2 Consisting of Gallon Septic Tank and �� L, Q V "'g P�FO IZA TEO PVC .PIPE tr►' 24" G1zPV1EL i RE,) c H Other Water Supply: Public Supply From or: X Private Supply Drilled by P F M5.0 t If Soaf' r iu c J C11+0 r 1 Mott- I A-#,. 1g1Ca; 0K' . Address If I- — V 1PUT-Nr9 m tq vcm u — Address 7':REku'TE2 . /�1, Sr! /0's-01 Jbitding _'hype SiN 6`ce• A/�?!C.v!: E .. "_Has erosion_cone.Yo .been ceihpleted?.. --: CFA` Number of Bedrooms Has garbage grinder been installed? nl0 ,�-� � Gw '•h. I certify that the system(s), as listed, serving the V rises a 64structed essentially as shown on the as- built plans (copies of which are attached), ' accowiY'sue Construction Permit and approved P lans and the standards rules and reg ions " . ent of Health. Date: I•— 2- `J -01 Certified by Address Z P.E. X R.A. License # O 6 Z,O) eO 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 publ' - ter supply becomes available. Such approvals are subject to mo ' ication or change when rig, eU 'g1 nt of the Public Health Director, such revocati , mod' is r ch ge is necessary. c�c„ By: Title:.. ,, Date: ate: 7i G _ 1 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 , PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT well Put— Chase �YSulid . Kramers Pond Road, Lot #10 TowriNillage: Putnam Valley Tax Grid •# �,o _X y Map p4 Block / 5,'Lot(s) 10 Well Owner: Name: Address: VS Constructione 37 Croton Dam Rd Ossinipq, 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 32 ft. Length below grade 31 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: X Steel _ Plastic _ Other Joints: _ Welded X Threaded _ Other Seal: X Cement grout , Bentonite Other Drive shoe: X. Yes No Liner _ Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed X Pumped X Compressed Air Hours 6 Yield 60+ gpm Depth Data Measure from land surface- static (specify ft) 30' During yield test(ft) 380' Depth of completed well in feet 480' Well Log If more detailed information descriptions or sieve anal ses Y are available, please attach. )(Depth From Surface Water Bearing Well Diameter(in) Formation )(Description ft. ft. Land Surface 2 Drillin4 in ove burden clay and boulders 2 Hit.xodc at 2' : 2 : -- . "• ._ 32 ..: Dr ll . ,• -.� roc .. _. .. ,._set casiri i =r- owed:. 32 480 Drilli a in roc ranite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 2c t Depth 400' Model 7GS10412 Voltage 230 HP 1 Tank Type WX302 Volume 86 Al. Date Well Completed 8/29/00 Putnam County Certification No. 002 Date of Report 1/15/01 WeVie NOTE: Exact location of-well with distances at least two permanent landmarks to be proyr¢tsd on a separate sheet/plan. Well Driller's Name /Sons, Inc. Address: �4 Putm Aw„ Elowaber, NY 10509 Signature: Date: J /15 /Ol Per a Beal White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 2�,... _NORTHEAST LABORATORY OF DANBURY ' $' ILL'PL �iPf ROAD " - "DAISBURY; "rC Y '" rO6$'1 �' `y • CT C&E. PH- 0404 (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 REPORT TO: P.F. BEAL & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLE POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: • Total Coliform (Bacteria) PHYSICALS: LABORATORY REPORT DATE SAMPLE COLLECTED: 12/5/2000 TIME COLLECTED: 10:30 A.M. COLLECTED BY: KEVIN B. DATE RECEIVED @ LAB: 12/5/2000 TESTED BY: LAB #11471 LAB LD.# BEAL137 REPORT DATE: 12/12/2000 V.S. CONST. CORP., LOT #10, PUTNAM CHAE SUB., PUTNAM VALLEY, N.Y. HOSE BIB WELL NONE RESULTS METHOD # 0 per 100 ml SM 9222B MAXIMUM CONTAMINANT LEVEL (MCL) OR STANDARD 0 per 100 ml • Color (Apparent) 0 - EPA 110.2 15 • Odor ND - - 3 Units • pH 7.21 - EPA 150.1 No designated limits • Turbidity 0.50 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 • Alkalinity. -. _ ...... _ ., 8.0_ _. , ._ _ mg/L _ S1YI 220$_ . _ .,No.. deftned.limlt& '. . ,. ., • .� Hardness— ` ',- -.. „ _ ...28.0. ...._,1i . . ,.:: ._ -... — EPA -I30.2 "'" • „".. _ .. NYdei-rired lirrii ° .. • Iron 0.035 mg/L EPA 236.1 0.30 mg/L • Manganese <0.01 mg/L EPA 243.1 0.50 mg/L Combined limit for Iron plus Manganese = 0.50mg/L • Sodium 1.3 mg/L EPA 273.1 20.0 mg/L ** • Lead <0.001 mg/L EPA 239.2 0.015 mg/L * ** ml= milliliter mg/I--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 DOT POTABLE RESULTS BASED ON SAMPLES SUBMITTED: 12 /5/2000 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 Owner or Purchaser of Building Tax Map Block Lot 3� NOT00 uAAR ROAD FA MA M IALLC Building Constructed by o� illage (uTA) AM l: HA-5C- Location - Street Subdivision Name 110 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 determination `of t14 Puf "ealth Direct of e Putnam County Department of Health as to whether or t th ail a of e,�ystem to ope to s c se y the willful or negligent act of the occupan the uil g u i mg the sytem. 1 A b . t�o:o jWo4h CSI Day ZI Year Zdd5l Signatu re: J- C6p ctor (Owner) - Signature Title: 31 P-0-M/0 -DAM _R , 00 E . 3y Ceom/ Ji w pow ooe l:t, . Corporation Name (if corporation) Corporation Name (if corporation) Address: 31 cizoj,)m AM 2+0, 0ss)ndP10G State %V . y Zip Address: 3 0—M DAM koAi�, 0_-60j0xx; State Zip Form GS -97 I V BRUCE•; I;L::-'YOL-EY Public Health Director -LORF,17-A; NOLINARI-R.N.; X&N., Associate Public Health Director Director of Patient Service: DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 Environmental Health (914) 279 - 6130 Fax (9-14) 278 - MI Nursing Services (914) 278 - 6558 WIC (914) 279 - 6678 - Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278.6082 Fax (914) 279 - 6648 E911 AD-DRESS VERIFICATION FORM OWNERS NAME: &A!) Nef. TAX MAP NUMBER: /0 E911 ADDRESS: 3 6 J /V O R jo D)12 TOWN: I AUTHORIZED TOWN OF . (Signature) DATE: !, The Putnam, County Department of Health will not issue a Certificate of 'P Construction Compliance unless the above form is co mpleto, 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. (E91 I VERFRK 14 16 IRWIN 11! IN Mi 111AN w CR®NIN ENGINEERING P.E., P.C. .January 24, 2001 The Lindy Building; Suite 200 2 John Walsh Boulevard Peekskill, NY 10566 914- 736 -3664 Fax 914- 736 -3693 Adam. B. Stiebeling, Assistant Public Health Engineer Putnam County (Department of ]health 1 Geneva Road, Brewster, N.Y. 10509 RE: 37CROT®NDAM ROAD CORP. " LLll V YM CHASE S W BDI MIO N9 SASSINORA DRIVE, LOT 10 P.C.➢D.It PERMIT #]PV -18 -00 THESE ARE TRANSMITTED as checked below: ❑ FOR APPROVAL ❑ FOR YOUR USE ❑ AS REQUESTED ❑ FOR REVIEW AND COINBIENT X PLEASE REPLY . SENDING YOU attached) _..... 1.) Three copies of as -built subsurface sewage treatment system plan 2.) Three certificate of the construction compliance. 3.) Three guaranties of SSTS 4.) Well completion report 5.) Water analysis report 6.) Copy of survey showing foundation location 7.) E911 address verification form 8.) $200 certified check for application fee. Should you have any questions or require additional information regarding this matter, please contact me at the above phone number. Thank you for your time and assistance in this matte. Respectfully submitted, enneth M. Murphy Project Designer PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: 3 O 1 Inspepte :y Street L.o n _ S ixx :� . Owns r ; a ...` V) Town Permit # TM # Subdivision Lot # l 1. Sewage System Area a. STS area lobated 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. §eptic tank size - 1,000 ....... ......other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. Ail outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box properly set ........... ............................... ' f. renc e 1. Length required Length installed 2. Distance to watercourse measured Ft.......... 3. c O 4. Slope Installed of trench acceptable 1/16 -1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- fo�n 'ons.......... 6. Depth off%- trench <30 inches from si�rfa 7. Roo llowed expsion,100 % ..... ..... ...... .. 8. Si of ave13 - 1 Viz" diameter clean ................... 9. D th of ravel n nch -2- 'minimum ................... :10.-Pi "e.ends ' Pe _ .�:_ _ ...,._.. - ._ .. g. �Pum 1• r Dose S stems' 1. iz1 ftmp c am e , :... ............................... 2. Overflow tank........... .............: 3. Alarm, visual /audio ... ............... ...... a►`iole @6d ..... 4. Pum easil accessible 5. First box baffled ...................... ............................... .. n 6. Cycle witnessed by H.D.es� mated flow/ cIe ..... .... III. ouseBuildin a. House locited per approved plans..ift ....... b. Number of bedrooms .................... ............ . IV. Well a. Well located as per approved plans............. b. Distance from STS area measured ........... 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 ................. ............................... Rev. 6/97 form 31-3 iU �s inn IBM :a s� 10 form 31-3 Vo t'z-r- 14:32 9147363693 CRONIN ENGINEERING 1 PAGE. 01 PUTNAM COUNTY DEPARTMLNT OF HEALTZ DIVISION OIF ENVIRONMENTAL HEALTH SERVICES AMMON ADAM GENE MQ E FOR F 2MUMM For- Fill All information must be My completed prior to any inspections being made. Trenches -�- PCHD Construction Pennit # ?V 19- 0 43 Located: S,0:EXwJ0P8 A10r L/ALtgr4 —er policant Name::Kr7Z c R Tii-L—Block Formerly: Subdivision Name: Subdivision Lot 0 10 Is system fill completed? JL4. Is system complete? Y-6--X. Is system constructed as per plans.? Is well drilled? Yt '.r Is well located as per plans? W.7 Are erosion control measures in place? Date: Date: Date: I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plaw and the Standards, Rules and Regulations of the Putnam County Department of Health. !RA Design Professional Address: 2 'ZW4 PQ (t 04 Lic. # 0 6 1 Comments, Form Fitt 99 C, PUTNAM COUNTY DEPARTMENT OF HEALTH Try DIVISION OF ENVIRONMENTAL HEALTH SERVICES -.�� ' -�`� ✓- �''.. .. �: '. `• �' .�' =~` :.~mil✓ _ �.•Y. ^ -JP•_ {.•a .�...'�...%:" "f.' !f i•V\'i��.: �y. ��•. ..6i CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Il c Q Z, Located at Sassinoro Drive /Kramers Pond Road Subdivision name Putnam Chase - Subd. Lot # /D Date Subdivision Approved Town ffrXMffff Putnam Valley Tax Map 84 Block' 1 Lot Stib Lot a1�9 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 1 OS62 Amount of Fee Enclosed $3o0 -no Building Type Residential Lot Area 3, 1 Z No. of Bedrooms 4 Design Flow GPD 800 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1250 of 4" PVC Perf. pipe in 24" gravel trench. Other Requirements: gallon septic tank and Z/ 1/ 31 L. F. To be constructed by 37 Croton Dam Road Corp. Address 37 Croton Dam Road, Ossining, NY 10562 Water Supply: Public Supply From Address - . y ; .... .�_.Plltllaili° AVA Brewster, NY 10509 I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system de a will be constructed as shown on the approved amendment thereto and in accordance with the standards, ens Ew County p p " �c� uK� of the Putnam Coun Department of Health, and that on completion thereof a "Certificate of Co t3ri Colt ce' atisfactory to the Public Health Director will be submitted to the Department, and a written ar ' wil furiff dd a owner, his successors, heirs or assigns by the builder, that said builder will place in good V frig c M any said sewage treatment system during the period of two (2) years r '�f the val of the Certificate of Construction Compliance of the original immediately following the ate f the , �q��, Rp, p system or any r77s there.'. Signed: Address 2 John Walsh Blvd., 4; P.E. _ 11, NY 10566 R.A. Date License # 062980 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. Ap ve fo dis rge of domestic sanitary sewag only. By: Title: Date: CYO White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design 4ofelsional Form CP -97 I UTNAM COUNTY DEPARTMENT OF HEALTH IIDII\gSffCN OF IEN VffROIMIENTAL IHIIEAIL'll'IHI SERVICES APPLICATION TO CONSTRUCT A.WA\TI)JllB WELL i ,�_ .r, &s s_ '• c- ,e8�e id�t3r "tY4i - F.'.. . - :�_.r. ,�:; .: "5�= :' ND'Perm 1�� /r �'lliY—i?li Well Location: Street Address: Town/ViN1§6 Tax Grid # Sassinoro Drive/ Sub Kramers Pond Rd LOT Putnam Valley Map 84 Block 1 Lot(s) 4W 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 -primary Business Farm Test/Monitoring Other (specify) 2-secondary Industrial Institutional Standby Amount of Use Yield Sought 5 gpm # People Served Est. of Daily Usage 500. gal, Reason for Replace Existing Supply Test/Observation Additional Supply Drilling __X_ New Supply (new dwelling) Deepen Existing Well Detailed Reason u 1 for new residence. Water supply' 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 17 No I'M Name of subdivision v- N4M C Lot No. 10 Water Well Contractor: P.F. Beal & Sons In '.r4� utnam Ave . , Brews ter, NY 1050S Is Public Water Supply available to site? ...............:�................... �... a No Ys X Name of Public Water Supply: N/A 4P. b N/A Distance to property from nearest water main: LU Proposed well location & sources of contaminate ;i - qn s e sheet/plan. Date:. Applicant Signature:. <<� so 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 (3 0) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue dio Permit Issuin Official: "�- Date of Expiratio 1 c7, Title: Permit is Non- Tn•annsfferi 0 White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIDAVIT -' CORPORATE OWNER APPLICATION , FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: construction of SSTS and Water Supply Val Santucci- I represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: 37 Croton Dam Road Corp. Having offices at: 37 Croton Dam Road, Ossining, NY 10562 Whose Officers Are: President - Name: Val Santucci Address: (Same As above) Vice . President - Name: Same as President Address: (Same as. above) Secretary -Name: Michelle Santucci Address: (Same as above) Treasurer - Name: Same as :Secretary 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 befi re 'me this ,;/�day of j(,Znth) 2000[)— (year) j - Notary Public KELLY M. LENT . Corporate Seal Notary Public, State of New York No. 01LE6026834 Qualified in Westchester Countv, Commission Expires June 21, 204 Form CA-97 of Ye coiyoration with respect 0 Ir"UTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ � • .... v }:. _ •r'Y:- ,.. s .-, c.. :,� -h.°^: �_'-� a�.4 . '..i��: tt v:.F :.. .-`y .y,';c' r ::/.:.� :. T ,vV j.'_: � .., u ti . ... _c � e . ., -:!'- +�:v _ a �r . 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 , Cp, Subdivision of "Putnam Chase Subdivision" Subdivision Lot # 1 Filed Map # Z952 Date Filed a-? -Z.S" —00 Gentlemen: This letter is to authorize Timothy L. Cronin III a duly licensed Professional Engineer x to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Departm sign all necessary papers on my behalf in connection with this i�� E matter and to superv' �tri W of said wastewater trea en d/or water supply systems in conformity wi d ision;a° e.145:and/or.,147. o e_ d do ,_ e, Tublic Health - the Pu ^ 6' �it (o e: :.. . >> Lu Very tru your 2: Countersign 62980 P��' Signed: Pros. N�UFESSI� P.E., # 0629 ( er of ) Mailing Address 2 John Walsh Blvd. #200 Mailin g Address: 37 Croton Dam Road Corp. Peekskill 37 Croton Dam Road, Ossining State NY Zip 10166 State NY Telephone: (914) 736 -3664 Telephone: (914) 739 -7362 Zip 10162 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FORAPPROVAL OF.PLANS_FOR- 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 # /Q 3. Location TN; Putnam Valley 4. Design Professional: Timothy L. Cronin. I1I 5. Address: 2 John Walsh Blvd. 6. Drainage Basin: Peekskill Hollow Brook Peekskill, NY 10566 7. ' Type of Project: X Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................................................... Ty pe I _ Exempt Tvpe.II — Unlisted X 9. Is a Draft Environmental Impact Statement (DEIS) required? .......................... No 10. Has DEIS been completed and. found acceptable by Lead Agency? ............... 11. Name of Lead Agency Town of Putnam Valley Planning Board N/A 12. Is this project in an area under the control of local planning, zoning, or other ..:_. -,-officialsi ordinances? ........ .. . ............ - :......... ...::... .YES o: 13. If so, have plans been submitted to such authorities? ........ ............................... YES 14. Has preliminary approval been granted by such authorities? YES Date gzranted: 08/02/99 15. Tvpe 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 NIA. 20. Is project site near a public sewage collection or treatment system? ................ No 21. Name of sewage system N/A Distance to sewage system N/A 22. Date test holes observed 03/29/99 - 23.. Name of Health Inspector Adam Stiebeling 24. Project design flow. (gallons per day) .................................. ............................... 800 GAUDAY 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 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? ............................... NU 30. Does project require a DEC Stream Disturbance Permit? .. ............................... NO 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? .............................. Yes/No NO 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ................. I .............. Yes/No YES DESCRIBE: Property adjacent to the west was the former Orlando Landfill. 31 Is there a local master plan on file with the Town or Village? ......... :............... YES 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ........ ............................... 35. Are any sewage treatment areas in excess of 15% slope? NO ............. Ma s4 Block 1 Lot 36. Tax Map ID Number .................... p 37. Approved plans are to be returned to ..... Applicant X Design Professional NOTE: All` applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater.plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. 1 herreby affirm, sander penalty of perjury, that information provided on this form is trace to tlae best of my knowledge and belief. Eals enis made herein are punishable as a�3 misdemeanor pursuant to see 'ors 2 .95 of the Pppal Law. - 6~ SIG A TAUkES & OFFICIAL T'ITT'LES. Mat1t4g: Address :.... ............................... Cronin Engineering, P . E , P . C . 0 i`M ? .John Walsh Blvd, Peekskill. NY 10566 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL, HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner 37 CAOTL)IV D,,4 M &A D Gu?P Address 37 U 67V AJ DIM RQ O551N1 N4 AJ y, Located at (Street) k!i -)2s l +v0: jLDA=O Tax Map 8j� Block _Lot (indicate nearest cross street) Municipality?') M/L Drainge Bair 54-1 u tkPao "i GIZze-K M)A) Ow 2lucM �Q SOIL PERCOLATION TEST DATA V Date of Pre- soaking odt -oa -19. Date of Percolation Test o4 =09 79 9 Hole No. Run No. Start -Stop ElapsL Time De th to Water rom Ground Surface (Inches) Water Level IncLeess Percolation MinInch l 1 w-1 g 2 X39- l0 °� 30 so -1 3 10 3 D°� — to 1, 10 zo -2 3 3 to 4 5 2A 2 a 3q - lop' Zq t e; L/ 3 6 3 .10 °' ' tOZ� Zq l 8 -Z 1 3 0 . 4 Is : 5 . 4 . 5 NOTES: 1. Tests to he reheated at same denth until anoroximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/mchl All data to be submitted for review. 2. Depth measurements to be made from.top of hole. Form DD-97 / DEPTH G.L. 0.5' 1.0' 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' 8.5' 9.5' 10.0' r TEST PIT DATA DIESCWP'1{'ll®1\ -G F S0.1LS IENCOU iT. ER Eg–IN— T'IES74, IGIL-IES . _ w HOLE NO. Z.6 Z2 P So L T W4 -M. a bZ.'0 L �O HOLE NO. HOLE NO. 3 � P SocL Soil. 5-t-0 W LOAM Indicate level at which groundwater is encountered A �A gal vMA� Indicate level at which mottling is observed oA6Mu99?P Indicate level to which water level rises after being encountered Deep hole observations made by: A04M ,cznt a -b 1g,0& Date L —1q 9 DeSig�:P�rOfOsional Name: T//P'1gn4y &. cao/t106� Ad Signa , e° QD 62980 Design professionall's Seal 617.20 SEQR Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT .FORM - -For UNLISTED ACTIONS.Only- - "; Part 1 - PROJECT INFORMATION (To be completed by Applicant or. Project sponsor) 1. APPLICANT /SPONSOR: 2. PROJECT NAME: 37 Croton Dam Road Corp. Putnam Chase Subdivision, Lot # 16, 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/ Sassinoro 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 / acres Ultimately 3 1-2- acres, 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? MYes ONo If,No, describe briefly 9. =WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? "@Residential 13Industrial OCommercial OAgricultural OPark/Forest/Open space 00ther . 'Describe: Surrvunding lands_are.zoned single family, residential :... .. -- ; - ,. w _ .. _ „ _ •., . . __ • ,.... . a.� nom.. ..- �_ ... ...... .. �. - ...... _ ..:r z - .... _._.._..d .�...wo -..�; .. .. _ ' . ... .. . ...-.. _.�.. ... .. .. - ^`d -. .. .+�.., -. 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ®Yes ONo If yes, list agency(s) name and permit/approvals Town of Putnam Valley — Building Permit 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ®Yes ONo If yes, list agency(s) name and permit/approval Subdivision Plat Approval — `Putnam Chase Subdivision' 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? OYes Flo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/Sponsor name: C it h Stau ohar date: 0419-00 Signature: N 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 ONo B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a n- 7e�DaLtive declaration maybe superseded . by another• invo-Ived agency. ;„ Yinr9at •. ,. .. I�No •.. ,•p,�• ..-.. f_ _ M ti v 'w '''ax �.l •c- .3.- .J.�r •a . .��• ..r .�-.. • .. •l.a -. C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: Answers may be handwrdten, 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 beefy: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? DYes ONo If Yes, explain briefly: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? DYes ONo If Yes, explain briefly: Part Illy DETERMINATION OF SIGNIFICANCE (To be completed by A.gerrcy).:, "INSTRUCTIONS: For each' adverse effect identified above, defeimirid'Whetffer it is "substantial, large, important of olheiwise 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 0 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. 0 Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action 1ftfll_t_ NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Signature,of Responsible Officer in Lead Agency date vD C, _a .— Title of Responsible Officer Signature of Preparer (If different from responsible officer) r7",-- _l - � Y1 I - -.- 9 • 6✓O vb vb Vb 4'-O n-4 v2 F AHD 4. '"' -57 s e> vb ;0� 3.1 MAS E ` F Ilk PUTNAM COUNTY DEP TM HOUSE PLANS APPROVED FOR BEDROOM COUNT opm To BEDROOMS ALL SUBSEQUENT REVISIONIALTERATI TO T] , 1 n y0 PLANS bIU T UIIMITTEll TO THE H FO: & TITLE =fir, 10'-b T-0 Ld$ OF SLID" SeLOM _ WWI 5ME1.yEfo TO s� i '1: Lo t NQ 9 ig N16-24% 454L F. -4 70 pert p vc: - in n 24' grovel trench It (ends are capped.' t is lOOX expansion CO 86, 95- exist. well existing water service O 7 47LF-410 sdrJ8 pvry pipe / \°'�\ \N tree NJ C, NJ �_-roof leaders and footing drains (1yp) �N N$ 4 1 01,4 4 22L - F. -4 cost Iron pipe 1250 gatfon cant septic tank 95- exist. well existing water service O 7 47LF-410 sdrJ8 pvry pipe / \°'�\ \N tree NJ C, NJ �_-roof leaders and footing drains (1yp) �N N$ 4 1 01,4 4 *ELL LOCA MW 'Y Y WELL 43' 43' SS IS DIS, rA A CES A B, SEPTIC TANK 27" 62' JUNCTION BOX 790 89, JUNCTION BOX JUNC PON BOX ,43 XW770N BOX P 1001 107$ SCA L E.- I SUBSURFA CE SE WA GE 7R EA TM EN T S YS 7 E Mv CONSISTS OF A 1250 GALLON CONCRETE SEP77C TANK, 454 L.F OF 4 "o PERFORA TED PVC PIPE IN 24" GRA VEL TRENCH. 37 CRO TON DAM ROAD CORP. 37 CRO TON DAM ROAD OSSINING, N. Y 10562 PRI VA TE - WELL B Y- P.F BtAL & SONS INC 4 PUI TNA M A VENUE BREWSTER, N. Y 10509 37 CROTON DAM ROAD CORP. 37 CRO7*0N DAM ROAD OSSINING, N. Y 10562 PEEKSKILL HOLLOW BROOK