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631- 589 -8100
84. -1 -55
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SHERLITA AMLER, MD, MS, FAAP
CorRrn�ss.orfer of Hc�altl�" ...
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
Mr. and Mrs. Ponarski
28 Sassinoro Drive
Putnam Valley, NY 10579
Dear Mr. and Mrs. Ponarski:
,......., ......_...._... ROBERT J. BONDI
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Re
Addition — Approval - Ponarski
No Increase in Number of Bedrooms
28 Sassinoro Drive
(T) Putnam Valley, T.M. 84 -1 -55
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 November 9, 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-
0
All:. lumbing fixtures rnust- b,e:�dated, with -water-.s�avin &-,devices. f i e knew low - lush. r: --
toilets, restrictors for shower heads and faucets etc.).
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.
Very truly yours,
Michael Luke
Public Health Sanitarian
ML:cw
cc: Building Inspector, Town of 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
o`.
SHERLITA AMLER, MID, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
ROBERT J. BONIDI
County Executive
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ADDITION APPLICATION RESIDENTIAL ONLY
STREET SAYC� �1'I \i�, T ®Vb'lY e Ax MAP# 94 f "
NAME PHONE - IPCHN A
MAILING
ADDRESS
(DESCRIPTION OF
ADDITION
Gl e. C_ k a..
NUMBER OF EXISTING BEDROOM PROPOSED# OF BEDROOMS 40
(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- 6.1.30..
1. Certified check or money order for $100.00.
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 and tax map #)
*Non- professional sketches are acceptable
4. Copy of survey showing well and 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.
OFFICE USE
COMMENTS
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085
Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
. �' L�ORETT;k�MOL,INARI,-RN-,:MSN--
Associate Commissioner of Health
ROBERT IBONDI
County Executive
DEPARTMENT OF HEALTH
I Geneva Road, Brewster, New York 10509
PUTNAM COUNTY DEPT. OF HEALTH
1 GENEVA ROAD '
BREWSTER, NY 10509
Re: 28 Sassinoro D-r-ky-e
Residence
TAX "# 84--1 -55
To Whom It May Concern:
According to records maintained by the Town, the above noted dwelling,
IS - xxx IN COMPLIANCE WIDI TOWN CODE.
IS NOT IN COMPLIANCE WITH TOWN CODE
LEGAL BEDROOM COUNT IS
This information has been obtained from:
4
CERTIFICATE OF OCCUPANCY: see attached rn#2000-294
OTHER:
Assist . Building Inspector John W. Allen
8/4/05
Date
CERTIFICATE OF OCCUPANCY Water Supply Section (845) 225-5186 Fax (845) 225-5418
lm Environmental Health (845) 278-6130 Fax (845) 278-7921
Nursing Services (845) 278-6558 WIC (845) 278-6678 Fax (845) 278-6085
Early Intervention/Preschool (845) 278-6014 Fax (845) 278-6648
SKERLITA AMLER,.MD, NIS, FAAP.....
ne-ri freealth
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
November 3, 2005
Mr. and Mrs. Ponarski
28 Sassinoro Drive
Putnam Valley, NY 10579
Dear Mr. and Mrs. Ponarski:
DEPARTMENT OF HEALTH
I Geneva Road, Brewster, New York 10509
Re: Addition - Ponarski
28 Sassmoro Drive
(T) Putnam Valley T.M. 84-1-55
ROBERT J.BONDI
County Eiicutive
Based on the information submitted, the'above mentioned addition cannot be approved for the
following reason:
:.7;.....- . .. .. . ..:. .- i. I-
Alo,,�.r-i)Jan�-fo:r.tl�-e-wbole.house.have.' not tieca"-,-
submitted with the application.
If you have questions, please contact me at your convenience.
ML:cw
Very truly yours,
Michael Luke
Public Health Sanitarian
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
03/01/2005 21:15 8455283949 MAREK PONARSKI PAGE 04
SHERMA AML1F:)Ii, MAD, MS, FAAP
Commissioner of Health
LORE7TA MOi.IhNAft RN, MSN
Associdte Commissioner of Health
. ... Jo s � W� ^y0+0.�_ •',i J � rt • -1'•• 14a.1 .r • r4
ROBERT i SONDI
DEPARTMENT OF HEALTH
I Geneva Road, Brewster, New York 10509
November 3,'2005
Mr. and Mrs: Ponarski
28 Sassinoro Drive
Putnam Valley, NY 10579
Re Addition - Ponarski
28 Sassinoro Drive
(T) Putnam Valley T.M. 84 -1 -55
Dear Mr. and Ms.. Ponarski:
Based ou the in.fomiation submitted, the above mentioned addition cannot be approved for the
Following reason:
: ' dp flppla3 for hewlous; have iaot been:Sketches. ofcxikliji pc n ' °
submitted with the application.
If you have questions, please contact me at your convenience.
ML:cw
JAN -17 -2000 MON 20:56
Very truly yours,
Michael Luke
Public Health Sanitarian
1®
ffj
V Y%1( it
Eavironm0tal Health (845) 278-6130 fax(845)278-7921
Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WJC (845)278.6678
Nursing Home Care Fax (845)278-608S
early Interkation(Preschool (845) 278-6014 Fax (845) 278 -6648
TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P
03/01/2005 21:15 8455283949 MAREK PONARSKI PAGE 01
FACSIMILE TRANSMITTAL SHXJET
To:
'FRom:
Michael Luke
Marek Ponarski
COMPANY:
[)AT}{
Dcpwment of H.caB
11/7/2005
FAX NURMER:
TOTAL NO. OP PAGITS INCLUnwc, c:ovpR:
845-278-7921
3
1'((()Nr, NUMMER:
17
,,F,Nl)[-*,R'S RKFF 'RPNCR NUOUR:
84-5-278-6130
Addition — Ponas, 1!q (I) Putnam VJq
T.M. 844-55
YOUR YwrTIRENCT, NUMBRR,
Sun Ro'otn
Vinyl Tech Sun room addition (4 Season)
t', C' 1:1 1i0T1 Rl;,NFIT-,W
❑ I'LRA'S•. COWNUN-r ❑ Pu;AST7 RhIlLy ❑ P).h.A.sr,- Rxm,cm,
Dear Michael Tj;uk
Y,
or )th iffic, first and second floor.. If therc is anything case you requix. d, please Cd me direcgy
at mv coil phone 914-527-9002.
Thank you m* advance
Sincerciv
Ponarski.
7
(CLICK )FERF ANI) TY1,115 RV.TURN ADDRESs]
TPL:845-279-7921 NAME:PUTNAM COUNTY DEPARTMENT OF P 1��
\� PUTN+M COUNTY DEPARTMENT OF HEALTH
DIVISION OF. ENVIRONMENTAL HEALTH SERVICES
w.' o �r^c 'c =•Y.: l...a .. _ i-�.. '� r _y!: 7
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM
PCHD CONSTRUCTION PERMIT # t?V 19 - 0 0
Located at .J A giS I A) til?_Pa 'D6 V own Vil age I uT )A M 11A L LE y
Owner /Applicant Name 37 Gmmta yAM Pix OmP, Tax Map 84 Block / Lot -5-5_
Formerly Subdivision Name / uTVA14 PN A .s f,.;:::
Subd. Lot #
Mailing Address ,31 � �-nN _DAn.t �n . 0551iJ,N G . � � Zip
Date Construction Permit Issued by PCHD 81 g%Od .
Separate Sewerage System built by ,31 Orcorm Aet eil. , Coe ? Address 31 Ozo-roA) 4N,,4
Consisting of Gallon Septic Tank and 2/40 Z-1. n1
I
y r RI PF /A) � f � G2�I ►�� (. 7 %e�.r�ct/ .
Other Requirements:'
Water Supply: Publi upp y. From . Address
r: Private Supply Drilled by., ?.r . YA K � .55�; e /A/0',Address �f ��ri��9�t� Q��. , �e�+ �s —,E e
N• Y
Building Type t /t // y' ,�FS�yr�n /C' ', Has erosion control been- completed?.
Number of Bedrooms.. Has garbage grind r ' •bee6aista- it/O .
i c uF� 0 \
I certify that the system(s), as listed, serving the above
built plans (copies of which are attached), i rdanc
plans and the standards, rules and re i. f the Pi
Date: 1-7 u y Certified by
Address
,ras shown on the as-
Permit and approved
P.E. R.A.
7T
# 06 Pq to
Any person occupying mg P remi_e, "eved 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 modification or. change when, in the judgment of the Public Health Director, such
revocatioll - mo cati o h e ecessary. -
t
By: - Title: Date:
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CC -97
F-M
CEARTIFICATE 0"i'Mr-PLIANCEHOCCU PAN CY
CERTIFICATE NO.: 2000- 294 PERMIT NO.: 2000- 425
TNW: 84.4-55 i,C)I- # j.i DATE: December 06, 2000.
LOCATION: 28 SASSINORO DRIVE
ISSUED TO: 37 CROTON DAM ROAD CORP.
This c;ertificate covers tl-ie con3truction •-.Df:
Mew 'Dnefamily Residence W/G!
I
P;=x
Year Round Four bedroom
The applicant having naretc-fore MLLE an application a buiialing
I
permit pursuant to the Towm Code, Sanitary Code, the Uni-form
B u i I d i F1 re- C c, di e .5. n c! t'h e T, a w s in effect i rL t h -:-; To w n of Pitt n a i-0.
V.-':-Iley, Piull-na-ain, �_'o•.,.ntv, NY, having paid tLe fe- Lherefcr
and, the u1ndersigned hay.tnq cy
..n3peczlon that
the applicant lh.as suYsequeritly proceeded %,;_-';th t.-he ::2.t-ection or
UL'e 1E the
.I.Mprovel -lit Of th�-� ',DrC)jD1_)eJ Stll!Ct.
requirements of the lawn a:tl aforementioned,
and that thc- Preii-lises have no,.,i,teen co.re.pleted and, are read.;
for occupancy pursutant to the provi31ons of law. i4ow, therefore,
thiLs certificats of conin-liance/occupancy 11'ierebv i.3.,ued tinder tie''
seal Of the Town of Putnaryi Valley.
TOWN OF PUrNAM VALLEY, N, Y.
6dzr_' 10,
4_11�4
By:
CODF. ENFORCMCNT OFFICEP
a
Owners Name onars I one
Address 28 Sassinoro Drive, Putnam Valley, NY Setbacks f50 1r50 1940
Submitted By Jos grey, Agent TM# 84 -1.56
Vinyl Tech, Inc. - 668 Dutchess Turnpike, Poughkeepsie, NY 12603
Phone: (845)464 -0037 Fax: (845)473.1627
Rear Lot
I An `desk 3 i
Side Lot Lett Side =_� Right Side Side Lot
310' Setback£` ;� w:s Setback
I Front Lot ,
Sassinoro Drive
143' "'xx �' 269.8'
_� ..
�., ,`r . .. ... • - .. Hl . s .. y. nos. .. �- - ..__..... • ka•�- v •.. t_ .._. ..
Front Setback
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Sassinoro Drive
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SURVEY 0.A
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VEYORS CER TIFI CA TIO/ d
r4 gnnn nnNArn .r;lnONNELLYLAND SURVEYOR, P. C., ALL RIGHTS RESERVED {
As shown on a rnav filed in the
Records on Jul
i
/
L =J69.26'
'— Drainage & Utility
"
Easement
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Lot NO. >P
Area= 3.2568 Acres
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SURVEYORS CER TIFICA TION
COPYRIGHT Q 2000 DONALD J. DONNELL Y LAND SURVEYOR,.' P. C., ALL RIGHTS RESERVED '.
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CERTIFICATIONS INDICATED HEREON SIGNIFY THIS
SURVEY WAS PREPARED IN ACCORDANCE WITH THE
EXISTING CODE OF PRACTICE FOR LAND SURVEYS
ADOPTED BY THE N. YS. ASSOC. OF PROFESSIONAL
LAND SURVEYORS.
CERTIFICATIONS L - p'OfVL`Y:��O THE PERSON 10
.
FOR WHOM THl Se 1Y WA�t�+ZEP� ED AND ON HIS
BEHALF TO TH Tl ND •ND , G INSTITUTION
LISTED
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CERTIFICATION A NVIC SF RABLE TO
ADDITIONAL IN Ow 49 f SU ENT OWNERS. i
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UNAUTHORIZED ALTERATION OR ADDITION TO THIS
SURVEY IS A VIOLATION OF N.Y.S. EDUC. LAW
SECTION NO. 7209.
UNDERGROUND STRUCTURES, IF ANY, NOT SHOWN.
ALL CERTIFICATIONS ARE VALID FOR THIS MAP
AND COPIES THEREOF ONLY IF SAID MAP OR COPIES
BEAR THE RED INKED SEAL OF THE SURVEYOR WHOSE
SIGNATURE APPEARS HEREON.
DONALD J. DONNELL Y
LAND SURVEYOR, P, C.
1929 COMMERCE STREET
YORKTOWN HEIGHTS, NY 10598
PHONE: (914) 962 -2215
>-a Y. (914) 962 -2209
I
�a CertifiE
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As shown on a map filed in the'IPutnazn County Clerk's Office, Division of Land
Records on Jul y 95, 9000 as map no. 2832.
Situate in the
TO )FN OF ...PUTNAAf VALLEY
COUXTYPF PUTNAKP
Scale: .$,# =50 ;P May 96, 1999Date of Field Survey
July 97, 2000 Date of This Map
Nov. 6, 9000 Dwelling & ffrell Location
Nov. 30, 2000 Drive & Hralk Located & Cert
1:
marski & Xenli Huang
)rtgage Corporation (USA)
;essors and /or Assigns
National Title Insurance Company (RjVF-5124)
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FOR A 94=9C LIU EKPRStfm IA 004M of TI[ LU or T14= PLANS.
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7.
e-
ii
s1
Note, A New 6'x6' PT WDti
Post on 12' 0 Cone, Pier
on 16.0 Cone, Footing a;
12'-2'
Note, B New 61x6' PT WD
Post on 12' 0 Cone, Pier
on 22'0 Cone, Footing
PUTNAM COUNTY DEPAMMENT OF HEALTH
HOUSE PLANS APPMVED FOR
BEDROOM COUNT ONLY,
�! BEDROOMS
Signature & Tttte a "
SUNROCM PLAN I
for
MR. and MRS. PONARSKI
r V I llrlrl V r%6616 I I Iw 1.
a•
RICHARD J. IUELE,= P.E.
��ysFO a
05S `` QUEEN WAPPI GERS ALLS, . 12590
i
T'
I
Exlsting House
A
Living Room
lKltched
Dinning Room
Window
Window
SG Door
New Open Deck
SUNROOM by TEMO
Floor LL . t00 PSF
E
1/8' TO PHywd under
71-61
2118' P.T. Jolsts is, OC
IA
�+
'
surlrooN
Declare Material
•ga
'
Exist, Deck
cis per Omer
Floor LL 50 PSr
x�
-
arrow Load . 50 PSF
I x�
3- 2'x10' Girder H B
a
; •.
2'x8• P,T, Joists I41 aC M -
jIl
Exist, 2- 2'40' Girder, Posts and Foo l to Remain
Hot Tub to be Located on
Deck as per Owner Max.
-61
Allowable Hot Tub Load 100 PSF
MewA7,
fA—
B
Ewe
j'
6, 5' -9j'
A 2- 2'x10' Girder
B
1/
Roll
1' 1'
7' 7,
i
16'
24'
v PLAN
SCALE 1/4' 1' -0'
P-MX C VMP9 OR N= THAT I PLANS ARE DIVALID
A, O ALTEASD
L IF NOr STAIPCD VY A. MY8 4E@STLRS9 DODm1 M ARDMi[CT-
L ALL VCRK SMALL COMPLY VRM THE R=DtDCNTS W M Nm TR, NNYOM AnowmlL wuwo coca APK MU L
APPO MM K=MQAPPVl=H,PATD00VlR&
I M CWRACTM SMALL MAIa NO DEVIIITMN rim M DRAVIPDS al owtirmum UNLESS MDDR = IN VRITOC Sr THE D/O mm
DOLL MM ATTO ��TNNAL[LDLIdIPQ� R WOIE COKNCDIC 4 %K M=P[CT[E DAY 1' CD�Ttd L DRAVDPCS AIm OtCAlCAT<DD. TO !HL
MT'Lf tM TK DNAVDCI >trzpN1�®VDD vHETHER mt HCT Mr PRE a TUQS[
a M ISI MMM M ALSPali16t PM M SAre" Or M STR=UK MAUL CMW"TIDL
• ALL STM=UTAL LUDM MM .DOTS AND V® EP
MSS TO Is rSR OR SETTER AND HAVE A ML AomeM STRESS OF 870 M
ANO A M®LLLS Dr DAS=TY . TO L40LM PSL
7, ALL CMCRM WORK DINT CW MI TO ACI KUM AND EPLCIILCAMM CDCRM YIAU IS A MDIDLM W 1000 PD IN STRDCM
L = OLY LUM WIT% WT MMU STFUTOq SIRIMTW PAM=", AND APPEARN ii RM M a VI= USL
R STAIRS To MIRE A xem m TRGD or Ur vnm A HOSD03 Nor LCIS THAN LY M ID MW TWA L-L/4 -. M MAMMtM RISM DULL
SE 8-V4. Inc STAIRS TD , MmVID D VM RML!M"' SETWUN SA•-W MM VtTM U• CLSARNCE rbl SPDdSCi KOI OUARD RAM.
To cos Alm MAVE A MDOM{M M A "w *w
U. M CUSYM POCK VTTN M l=U=AT0d SHOW ON TMS PLAN MST M R 0fiNCKlTS Q M NTS RLSMDVIAL lKM=C COOL
IL M DfDeRR ASSUCS No REOD60MZrY /OR Cm6TRLCTMI MEANS. NM= TLDMla=. JCaVC S DI POMEMM, DR FOR
SAFETT• PRECADTtWn AIM PRwRAMS d CO*CCTMR WITN M Wosx THME AIM NO VAXX W tCl, NOR AMR MKXWWAaLITY W FLTNSai
FOR A 94=9C LIU EKPRStfm IA 004M of TI[ LU or T14= PLANS.
• ,i
7.
e-
ii
s1
Note, A New 6'x6' PT WDti
Post on 12' 0 Cone, Pier
on 16.0 Cone, Footing a;
12'-2'
Note, B New 61x6' PT WD
Post on 12' 0 Cone, Pier
on 22'0 Cone, Footing
PUTNAM COUNTY DEPAMMENT OF HEALTH
HOUSE PLANS APPMVED FOR
BEDROOM COUNT ONLY,
�! BEDROOMS
Signature & Tttte a "
SUNROCM PLAN I
for
MR. and MRS. PONARSKI
r V I llrlrl V r%6616 I I Iw 1.
a•
RICHARD J. IUELE,= P.E.
��ysFO a
05S `` QUEEN WAPPI GERS ALLS, . 12590
i
T'
I
T
w
i.
New 2'X10' Ledger
Secure to 'Rim Joist
1/2'0 Lags 16' OC
1:I
J
iA
3- 6'X10'
Order
pout
12' 0 Conc, Pier on
2210 Conc. Footing
Snow Load o 60 PSF
Floor LL 100 PSF
e rclor
P
7' 61x81
peat
SECTION A -A
SCALE 1/4' ■ 1' -0'
1' -4'
Approx,
Exist.
Grade
12' 0 Conc. Pier on
16.0 Conc. Footing
DUILDINO MSPLCTDR NOTC THAT "M PLANS ARC INVALID
A. 11" ALTLRID
D. IF ,NOT ITANPO DT A NYS RCOISTCKD OIDIMSER DR ARROTCOT.
L ALL WORK SMALL COIWLY VITN THE RCMIREMENTE W THE Nn.Mk IONYOARRESID INnUBUILONOOODSMPUGSw
ANN101OR0 NOW ONOAPPMNON M.PATI000VERS.
L THE �t�NTRACiDR SMALL PWR No OCVIATwN PRm THC DRAwms OR CPCCCiricEARyaw wun AUTwRI3D IN VRITINO DT THE CNOMCER.
ATILNTDD7� ®µTF3 RyWtmL tRaOQKCIIG AHnT rLD cERIARET� TNEtt �ITMM CIPICATidll. TD THE
No [L _MAD MW THE SMALL t. C0� " ST9n� WSW NLIITt RLOMIDIlEt m VIQMR �1 NOT T14Y ARE SMC1ttCD IN TMCu
& THE CONTRACTOR 13 RWMIBLC FOR THE SAFETY W THS STRUCTUX DURING CRNSTIUCTI04
IL A BY=TtRAL LLASN (FLOOR JOISTS AND VMD ��I TO 0L EP/RR M BETTER AND HAVE A NM XMBINO STRESS DF 979 PCL
7. ALL COMON TE VORK SMALL CRPDAM TO ACI BUM AND SPECPICATIONS. CONCRETE DOLL BE A KIM" OF 30M PSI IN STASNO M
0. USE IDLY LIMBER VITM OUT MFC CTS EFFECTING 97RMTK DURABILITY, AND APPEARANCES RM THE INTSMUST USG
IL !TANS TO HAVE A NI D(UM TREAD OF IV WITH A NOSING NOT LESS TWA 3/4• MIT No MORE THAN 1 -1/4'. THE MAxDRM RISER SMALL
TO MIST. � AND V6 ABE EIPRMID0WI AR.WW, DETVLLN 34' -00' MM VRN I& CLLARA/CL FICH SPDNgtL D= OINRD RAIL
la TK.`pRSTINO DECK WITH THE MODWMATION3 00101 ON THIS PLAN MEET THE RESIMMINTS Or THE WS KRIMMIAL &II W O ISDL
u. TNZ EtNDIZER ASSUIES !m IIII90I8IDILITY FOR CONSTRICTION MEANS, METHS, TgCMNZM S i6 LV=S M PROCEDURES OR ►03
SAFETY PRECAUTIONS AM PROORANS IN COMECTM WITH THE WORK THERE AMC MO VARRANTISS, NOR ANY NERMANTABRITY Or FITNESS
FOR A SPECIFIC USE [%PRESSED OR INKMI) IN THE USE CV THESE PLANS.
. n
iAi
�8
. Y
3- 1.78'x9,25' LVL Design By TEMO
V
f�.
Sunroom Walls By Tema
Aa.
8•
12' -2'
-
7/4• T60 Plyad
under owrooN
n
I fr
Add S 81x6' Jolato Under
Sldowall of Sunrcon
".
2'X8' Joists 16' OC
Now
2- 2140' Glydor
:'
.:
slPpnon Joist
hanger 33/86
S.
Grdo endxPa
81X10' Lodger Wrdor and ata
�!^
Socurod to RNA
Now
6'x6' post
'
Walt w/ I /e• Lnga
ApprOX.
at 161 an add Lags
Exist,
1
a0 Needed
Grade
! V
Floor LL w 30 PSF
Snow Load a SO PSF Ft &ie'
^.
:�::^
{';;.
'�
New 12' 0 Conc, Pier on
42,
, PA
2210 Conc, Footing
i,
111
New 12' 0 Conc, Pier
on 16'0 Conc, Footing
r:Y
SECTION B -B
/4' ■ 1' -0'
•1
6f
SUNROOM PLAN
for
MR. and MRS. PONARSKI
28 SASSINORO DRIVE
PUTNAM VALLEY, NY.
ff
RICHARD J. 1UELE, P.E.
45 QUEEN ANN LANE
WAPPINGERS FALLS, NY. 12590
12'
INSTALLERS LAYOUT -SKETCH
VERIFY ALL FILL MEASUREMENTS BEFORE CUTTING
NOTICE:
THIS JOB HAS NOT BEEN CONFIRMED.
PLEASE FAX AN APPROVAL WHEN READY TO ORDER.
2 ;+ 2
,i 2
t
24' -0"
z
NOT TO SCALE
RECOMMENDED BEAM (SUPPLIED BY DEALER):
3PLY x 9 1/4 LVL
BASED ON A SNOW LOAD OF 55 P.S.F. 05W10850 08/29/05 VINYLTEC
DETAILED BY. MIRHET MELKIC
'r
00
Lo
�W O
.2"
UL 58SL
ICC LEGACY REPORT PFC -5176
ICC LEGACY REPORT ER 5262 -P
ICC LEGACY REPORT NER -567
FLORIDA PRODUCT APPROVAL M
ELE�/ATI ON S
i
tS
4;
'Y
ii
,S
.1�
1`
+!i
+f
�1.
m
SHOWN WITH FACTORY GLASS TRANSOMS
L
MINIMUM DESIGN LOADS
DEAD LOADS:
1) ROOF: 2PSF
2) WALLS: 5PSF
3) F 00R: 5PSF
LIVE LOADS:
1) ROOF: 55PSF
2) WALLS: 9OMPH
3) FLOOR: 40PSF
"FLEC110N LIMITS:
1) ROOF: L /180
2) WALLS: L/175
3) FLOOR: L/240
SHOWN WITH CUSTOM GLASS TRANSOMS
'•ti
TOTAL WEIGHT OF TEMO PRODUCT: 1982:,00 lbs.
W
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W co
Z O
(�
i-na
ALL TEMO SUNROOMS ARE
DESIGNED IN ACCORDANCE
WITH THE NEW YORK STATE
BUILDING CODE.
NOTE: ALL OPERATING GLAZING
PRODUCTS SUPPLIED BY TEMO
SUNROOMS INCLUDE TEMPERED
HPG -2000 GLASS THAT CONFORMS
WITH CHAPTER 24 OF THE CODE
0o
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a 00 N
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MINIMUM DESIGN LOADS
DEAD LOADS:
1) ROOF: 2PSF
2) WALLS: 5PSF
3) F 00R: 5PSF
LIVE LOADS:
1) ROOF: 55PSF
2) WALLS: 9OMPH
3) FLOOR: 40PSF
"FLEC110N LIMITS:
1) ROOF: L /180
2) WALLS: L/175
3) FLOOR: L/240
SHOWN WITH CUSTOM GLASS TRANSOMS
'•ti
TOTAL WEIGHT OF TEMO PRODUCT: 1982:,00 lbs.
W
U)
W co
Z O
(�
i-na
ALL TEMO SUNROOMS ARE
DESIGNED IN ACCORDANCE
WITH THE NEW YORK STATE
BUILDING CODE.
NOTE: ALL OPERATING GLAZING
PRODUCTS SUPPLIED BY TEMO
SUNROOMS INCLUDE TEMPERED
HPG -2000 GLASS THAT CONFORMS
WITH CHAPTER 24 OF THE CODE
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LEGEND:
$ LIGHT!SWITCH
® LIGHT!,
RECEPTACLE
FAN
EXISTING HOME
I -1
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THE SIDE WALL ATTACHMENT
N
TO HOUSE IS A NON -LOAD
z
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BEARING CONNECTION.
Q
PROPERLY CAULK BOTH SIDES
ZO
OF ALUMINUM EXTRUSION
AT THIS CONNECTION.
is
0
cr
0
36" WINDOW 44.5" WINDOW
44.5" WINDOW
44.5° WINDOW 44;5" WINDOW 36" WINDOW
ti.
24' -0"
k
�R
2
.a
RECOMMENDED BEAM (SUPPLIED
BY DEALER):
3PLY x 9 1/4 LVL
BASED ON,(,A SNOW LOAD
OF 55
P.S.F.
:'?
FRAME COLOR: WHITE
;
FACIA/,TRIM: WHITE
NOTE:
ENCLOSURE NOT TO BE USED
INTERIOR KP: WHITE
AS A PERMANENT LIVING
AREA
EXTERIOR, KP: WHITE
SKIN TYPE:TEMKOR
FLOOR
PLAN':c
0
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a
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NOTE:
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N
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z
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BEARING CONNECTION.
Q
PROPERLY CAULK BOTH SIDES
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OF ALUMINUM EXTRUSION
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s
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GALVANIZED FASTENERS INTO ACQ LUMBER
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c EXISTING WALL ° � o Z
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INTO EACH WALL STUD J
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GALVANIZED FASTENERS INTO ACQ';.'LUMBER Q zo
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0 0
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM
PCIHIIID CONSTRUCTION PIERMIIT # ?V 19 - 0 D
Locatedat S -ASSJA7D%_P'f1. /bVF_ o e t TOAM VAL(.GV
Owner /Applicant Name 31 C _mjo INA RD.,, RzP. Tax Map 64 Block _� Lot s
Formerly
Subdivision Name Pu7 -A)AIW POA-SE
Subd. Lot # //
Mailing Address 31 N-.-Cmbn1 -DA(A 'L�>b , ®sSIMA)G. A/Y Zip /y.59'c
Date Construction Permit Issued by PCHD
Separate Sewerage System built by ,31 OZaTM AA �!D- , Ooe R Address 31 er-orolo Am Z . &.5m:w6 #1
Consisting of 1.2�5 r0 Gallon Septic Tank and ��0 L. 01` �f �� ?2f0,CA72Q
Other Requirements:
Watem Sa y_p_1_y_:
Public Supply From Address
or: ✓ Private Supply Drilled by i? t= . 1-96A L_ %yC . Address 41 /�c/inW�s ,�,As, , �eewlTe je
Buildin g Tape t' - 1/L li. = � yy� t%C4' : Ha erosicri:c`Qntrol;been: completed` - ...:
Number of Bedrooms Has garbage grinder been installed? i1/D
I certify that the system(s), as listed, serving the above pre s e cons t d entially as shown on the as-
built plans (copies of which are attached), ' cordance `i ction Permit and approved
plans and the standards, rules and regu ions f the P; ent tealth.
s:
UJ
Date: j 1-1-00 Certified by - P.E. Y_ R.A.
(De ' n Prof ss�\' a� . 6� - 0
Address �. .� �n = ' - �' ' se # &
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 modification or change when, in the judgment of the Public Health Director, such
revocati mo cati o h ge necessary.
By: _ Title: Date:
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CC -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
ENVIRONMENTAL HEALTH. S RV_IC-U _
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM
.37
0-MA) �'->AM 120Pb eoe P. Sic . 8 31A
Owner or Purchaser of Building Tax Map Block Lot
( QC� -ion �A,�1 �eA!) lae P • I uUOVI oT V'-"- t�+4M �A L L F�
Building.Constructed by TownNillage
Location - Street
Building Type
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 capsed by the willful or negligent acY._of the . occupant of the. building- utilizing:the ... .
The undersigned further agrees to accept as conclusive the determi ati n j the ujlic Health
Direct r of a utnam County Department of Health as to whether or o ilur of the system
to ope ate ' 's aused by the willful or negligent act of the occupan bf , e ildi g utilizing the
// Day / 7' Year ody Signature:
Title:
(Owner) - Signature
'O�`� 1 QoTON DAM �o{� l �eP 'b -3j eTIIQa NM �0AD
Corporation Name (if corporation) Corporation Name (if corporation)
Address: 3 &oTaa -D ^M L>,--AD
State . Zip
Address: 3 � etzot-ano T� PoAD
State Zip 1osG t
Form GS -97
a� r " } •
7 `
}p�a� u �7'��/�p7 (� A'�f�pT� }{�y.►yL7���'p`y�{�{��yT 7�rygry @�7{�'7yp�ry /�g}��
.'. Ji,T�6i1SVli ` a. i�IVLW�����JS�C1111Y��1�,LJ1V�" ®1�' 11iL�LJ��2i11
e D V tt��.1�1�9 OP E �O l�l 111 I E til1U 21 l� ER VICES
GUARANTEE. Off' SUBSURFACE t ilCE SE WAOIE TR EATIVUILNTS H STEIN
l:szo ni �A� 124) 0o�P. Sec. 8 5141
Owner or Purchaser of Building Tax Map Block Lot
31 000TOn) �AA9 ROAD P-0P-P. /ALLE
Building Constructed by ow illage
5Ass1Wo;eD i�eiyFE. , i uTNAM CdAfF_
Location - Street Subdivision Name
GL.E'i9iLy
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 F_ :.
The undersigned further agrees to accept as conclusive the determination of Pie Pu lic Health
Director of the Putnam County Department of Health as to whether or not f ure o system
to operat w ca ed by the willful or negligent act of the occupant of th b Win til' g the
SyI
D I/ Day / r Year 200D Signature:. �
Title:
ene al on a or (0 ner) - Signature
c'.
3-� ORTA) DA PA 00 ego- ,) & ) 00P,� .
Corporation Name (if corporation) Corporation Name (if corporation)
Address: 3I ee-oTc�N AM Roo, i�ss►�vnsG . Address: ,31 eem4 -DAM 20A%], 0WWjA,-
State %V . Zip Dom_ State ��• y Zipl::: /�.$��
Form GS -97:
W
Cronin Engineering
PUTNAM COUNTY DEPARTMENT.OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL .COMPLETION. REPORT
_
eRi ocitio'n -' `
beet Address: kramers Pond Rd
tnam Chase Subd., Lot #11
Town/Village:
1 Putnam Valle
Tax Grid #
Map Block Lot(s) 11
Well Owner:
Name: Address:
VS 0sainirmi NY IQ967
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 __3 L_ft.
Diameter 6 n:
Weight per foot 19 lb/ft.
Materials: X Steep Plastic Other
Joints: _ Welded X Threaded _ Other
Seal: X Cement grout _ Bentonite Other
Drive shoe: X Yes _ No
Lincr:—Yes X No
$cr"n 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 Yield 300 gpm
Depth Data
Measure from Ian s ace,stat�e specs
245,
During yield test(ft)
180,
Depth of completed well in feet
245'
Well Log
If more detailed
information
descriptions or
sieve analyses
are available,
please attach...._......__.`_.
Depth From
Surfaee
Water
Bearing
Well
biameter(in)
Formation
Description
ft.
ft.
Land Surface
10
Drilling
in over
de_ n clay and boulders
10
slit rock
at 10,
10
32
Drilling
in rock
set cas routed
32
245
Drilling
in rock
cawif& .
If yield was tested
at different depths
during drilling,
list:
_
Feet
Gallons Per Minute
Pump /Storage Tank Information
Pump Type ,sub Capacity lama
Depth 200, Model 7GS05412
Voltage 230 HP
Tank Type WX302 V 86
Date Well Completed
8/25/00
Putnam County Certification o.
002
Date ofRepo Wo
11 /I,0 /00 ,
l.v! &; zxu" tocauon of wen wun Qtsmrtces to at
Well Drillers Name
Signature:.
two permanent landtnar to be on a se pame blieftlan.
c. Address: 4 BAM Ave.. fir, tnFLxi
Date: 11 /10 /00
White eopy: HD FA; Yellow copy - Building Inspector, Pink copy - Owner, Orange copy - Well driller
Form WC47
I
PUTNAM COUNTY DEPARTMENT OF HEALTH
IDIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT
Well Location
Street Address: Kramers Pond Rd
tnam Chase Subde, Lot #11
TownNillage:
Putnam Valley
Tax Grid #
Map Block Lot(s) 11
Well Owner:
Name:
WIR
X Residential
Business
Industrial
Address:
. Public Supply Air cond /heat pump Irrigation
Farm Test/monitoring Other(specify)
Institutional Standby
Use of Well:
1- primary
2- secondary
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 IIDetails
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 30 gpm
Depth Data
Measure from land surface- static (specify ft)
245'
During yield test(ft)
180'
Depth of completed well in feet
245'
Well Log
If more detailed
information
descriptions or
:sieve anaC ses- - ' -=
are available,
please attach.
Depth From
Surface
Water
Bearing
Well
Diameter(in)
]Formation
Description
ft.
ft.
Land Surface
10
Drill in
in over
urden clay-and boulders
10
Hit rock
at 10'
10
32 -"
' i;iillin
in "rock
'set cash , routed
32
245
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 Tin
Depth 200' Model 7GS05412
ovoltage 230 HP_
Tank Type WX302 V 86 .1
Date Well Completed
8/25/00
Putnam County Certification No.
002
Datt of Report
11/10/00 IP
Well Dril
Y
NOTE: Exact location of well with distances to at
Well Driller's Name
Signature:
two permanent landmarks to be 7 o a separate /sheet/pian.
C. Address: 4 IRAmEm w., Brwster, NY 1
Date: 11 /10 /00
White copy: HD F Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC -97
N
NORTHEAST LABORAT01
�`9�I1�ILL PLAIN' LOAD - DANBURY,
C
IAM (203) 748-7903 - PAX (203) 748-0652
JL
CT Cert: PH-0404
NY Cert: 11471
--milli milligrams p 'er Liter ND=none detected MCL-Maximum Contaminant Level
*Notification Level ***Action Level
COMMENTS:
-All holding times (were) met
SAMPLE, AS TESTED ABOVE: OTABLE or OT POTABLE
RESULTS BASED ON SAMPLES SUBMITTED: 11/2/2000
LM
LABORATORY REPORT
s.
REPORT TO:
P.F. BEAL & SONS
DATE SAMPLE COLLECTED:
11/2/2000
4 PUTNAM AVENUE
-NORT1EAST-LABORAT6RYA19 MILL STREEt,' 9787
'B9klN CT 060j1--(960)829- JAX ($60)829-1050
TIME COLLECTED:
10:00 A.M.
WITHIN :800.1 105 !0 3
TOLL :FREE 7, CT 2 0
ifi8lbi&.1100-6544
BREWSTER, N.Y. 10509
COLLECTED BY-
KEVIN
DATE RECEIVED @ LAB:
11/2/2000
DATES) TESTED:
11/2/200 * 0 - 11/7/2000
TESTED BY:
LAB# 11471
REPORT ORT
P DATE:
11/8/2000
SAMPLE SITE:
V.S. CONSTRUCTION, LOT #11, PUTNAM CHASE SUB., PUTNAM VALLEY, N.Y.
SAMPLE POINT:
HOSE BIB
SOURCE:
WELL-NEW
,TREATMENT!
NONE
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
is
• Odor
ND
-
3 Units
• pH
6.51
EPA 150.1
No designated limits
• Turbidity
0.14
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
Alkalin4--
_ju �!SM2AZQB-�-
91 A4=
• 1.1Hardness .,.:
mg/L EPA-130.2
No defined limits
,
<0.03
mgI4,_ -EPA 236.1
0.30 mg/L
Manganese
.4.01
...ing/L EPA 243.1
0.50 mg/L
Combined limit for Iron plus Manganese = 0.50mg/L
• Sodillm'
<1.0'
mg/L EPA 273.1
20.0 mg/L**
• ::-:'Lead
<0.001
mg/L EPA 239.2
0.015 mg/L***
--milli milligrams p 'er Liter ND=none detected MCL-Maximum Contaminant Level
*Notification Level ***Action Level
COMMENTS:
-All holding times (were) met
SAMPLE, AS TESTED ABOVE: OTABLE or OT POTABLE
RESULTS BASED ON SAMPLES SUBMITTED: 11/2/2000
LM
Laboratory Director ...
s.
w
-NORT1EAST-LABORAT6RYA19 MILL STREEt,' 9787
'B9klN CT 060j1--(960)829- JAX ($60)829-1050
WITHIN :800.1 105 !0 3
TOLL :FREE 7, CT 2 0
ifi8lbi&.1100-6544
Public Health Director
" • ` '"L- �ORETTA MOL INARI 1LI4.1' M.8 .''_:>
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (9i4)278-6130 Fax (9.14) 278.7921
Nursing Services (914)278-6559 WIC (914)278-6678 Fax (914) 278-6085
Early Intervention (914)278-6014 Preschool (914) 278 -6082 Fax(914)278-6648
OWkRS NAN1EE:
TAX VI AP NTJNIBER:
E911 ADDRESS:
TOWN:
AUTHORIZED TOWN OE:
(Signature) /
- "180411
37 C12o-j-�vJ Aiqrh )?6 60
974 1"r : / p o i -oume d I r
�
����" .
00
The Putnam County Department of Health will not issue a Certificate of
Construction Compliance unless the above form is completed, i.e., a legal E911
address is assigned by an authorized town official. This form is to be submitted
with the application for a Certificate of Construction Compliance.
(E911 VERM1)
t4
11/13/po MON 14:26 FAX
_ NO
.REPORT TO:
P.F. BEAL & SONS
4 PU'TNAMAVENUE
BRLWSI1R, N.Y. 10509
SIMPLE S(Ty:
SAMPLE POINT:
SOURCE,
TREATMENT:
TEST PERFORMED
BACTERIAL
HEAT. �.ABORA�TORYYOIE
PLAIN ROAD DBNBZTRY, CT 06811
(203) 748 -7903 - FAX (203) 748 -0652
LABORATORY REPORT
DATE SAMPLE COLLECTED:
TNE COLLECTED:
COI.T..FCTFD BY:
DATE RECEIVED @a LAW
DATE(S) TESTED:
TESTED BY:
REPORT )DATE:
CT Curt: PH -0404
NY Cert: 11471
11/2/2000
1 Q00 A.NL
11/2/2000
11/2/2000 •- i 1n12000
LAWI 1471
1118/2000
V,S, CONSTRUCTION, LOT #11, P'UTNAM CHASE SUB,, PUIM, Vf VALLEY, N.Y.
HOSE BIB
WELL -NEW
NONE
MA.fi af0f CONTAI►97NANT
AE9Cl'I,TS METHOD # LEnj IMCL) OR STANDARD
• Total ColifcwL (B8Lte3±,f) 0 per 100 inl SM 922213 0 ptr 100 ml
PHYSICALS:
0003
•
Color (Appamut)
0
-
EPA 110.2
15
•
Odor
ND
-
3 Units
•
pH
6.51
-
EPA 150.1
No designated limits
•
Turbidity
0.14
N1Us
EPA 180.1
5 NIUs
CHSMCSTRY:
•
Nitrite Nitrogen.
<0.005
mg& as N
EPA 354,1
1.0 mg/L
•
Nitrate Nitrogen
<0.20
mg/L as N
SM 4500D
10 mg&
•
A1kdiniiy
I6,0
mg/L
SM 2320B
No_ defined limits
•
:
Hrudac -s .
_.. 24.0.
..!
'Ina
4YFPA236.1
:, -:. __..,
.. .__ ...._......._..
.�
.403,
0.30.mg/L
•
Mangan
<0.01
ing/L
EPA 243.1
0.50 mg11.
Combined litait for iron plus Mango iso
•
Sodium
<1.0
mg/I.
EPA 273.1
20.0 mg/L **
•
Lead
<0.001
mgIL
EPA239.2
0.015 mg/L * *w
ml--milliliter mgapmillig aw pa Litcr Nl om- one detected MCL = Nbidmum Conwmixwn Level.
A "NotiAcati0ji Level *'"Aelfon Level
COMMENTS:
All holding times (were) met.
SAKPM AS '.rMZD ABOVE: ® OTARVE or F[DIOT POTA.$LE
RESULTS BASED ON SAMPLES SUBMITTED: 1.1=ow) "I
_
• mom✓"`.
Laboratory Director
•NORTHEAST LABORATORY. 129 MILL S "CRUST, BERLIN, CT 06037. (860)828 -9787 - FAX (860)829 -1050
TOLL FM WITHIN CT: 800-826 -0105.OUTSIDE CT: 800•,654 -1230
11/13;.00 MoN 14:25 FAX Q 002
P TI NAM COUNTY DEPARTMENT OF HEALTH
IIDMSION OIL IENV IRONN EENTAIL IR ALTI7H[ S}ER VU CIES
.. _,`2./-:°Y+a�.+i'.usis 'J4atl :/CYSV''s.a vw _.rY..I�. —e••Lr Y. w �:' -ice. y\+:�AZ"_Y -z
Well Location
Street Address: yZ s pond �
tnam Chase Subd., Lot 011
Town /Village: Tax Grid #
I'Dutnam Valle Map Block Lot(s) 11
Well Owner:
Name: Address:
VS
X Residential Public Supply . Air cond/heat pump Lrigation
Business Farm Test/monitoring Other(specify)
Industrial Insritutional Standby
bJse of WeRI:
1- prhmarry
2- secondary
Drilling Equipment
X lotwy Cable percussion X Compressed air percussion w1er (Vtcify)
Well Tyre
Screened Open end casing X Open hole in bedrock Other
Casing Details
Total length 32'- ft.
Length below grade 31 ft.
Diameter _ i in.
Weight per foot 19 lb/ft.
Materials: X Steel Plastic Odder
Joints: Welded X Tkreaded Other
Seal: X Cement grout_ Bentonite Other
Drive shoe: X Yes No
Liner: Yes __,% No
Setreenn Details
Diameter (in)
Slot. Size
Length(ft) Depth to Screen (ft)
Developed?
First
_ Ycs_No
Hours
Second
Well Yield Test
Bailed x Pumped x Compressed Air Hours 6
Yield 30 gpm
Depth Data
Measure from land surfacevtattc (specify )
245'
Dmins yic. test(ft) Depth of comp etcd well in feet
180' 245'
Well Log
if more detailed
information
descriptions or
Isieve analyses
at'e'azailal3le, -:
please attach.
Depth From
Surface
Water
Bearing
Well
Diamcter0a)
Tormation
flDescoiptaon
ft.
fft.
Land Surface
10
Drillinq
in overburden
cl.a and tzad—e.Es
10
Hit rock
at 101
_ 1Q ._ ..
32.
--Drilling
in rock
set casing, routed-
- 32
245
Dril t
in rock
goalte
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Trump /Storage Tank Information
Pump Type sub Capacity 7t
Depth 2001 Model 7GS05412
Voltage 230 IMP }
Tank Type TAM 02' V 86 ,
art ell Completed
8/25/00
Fumam CoNty rtification No.
002
are of Veport
11/10/00
Well Drill'.
P
iNu ix: Lxaci tocattoti oz wen wtut aistances yo at t two petznanenz ranama" w oc 7"Q on a sepacatefsneCVp►an-
Well DrilleVs Name P. e, Address: 44 _�_n Aup -, BMMELM, NY 1M
Signature: Dam: 11/10/00
a 1
White copy: RD F' , Yellow copy - Building Inspector; Pink copy - Owner, Orange copy - Well driller
Form WC -97
BRUCE R. FOLEY.
Public Health Director
i; .
..1
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (845) 278 - 6130 Fax (845) 278 - 79 21
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845
iprly Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax
FAX COVER SHEET
Date:
To:
t
From: —
Adam B.Stiebeling
Asst. Public Health Engineer
LORETTA MOLINARI R.N.; M.S.N.
Associate Public Health Director
Director of Patient Services
A1.
1�
z
�i-
) 278 - 6085
845) 278 - 6648 )�
�4
t.
i.
.�j'i
.1�
-iw
.1
;1
oft 1
. 1.
1,.
1
espond;
d as requested
all
Fax #: -7 3�7 3, b 1
No. Pages
(Including cover sheet)
For your information _. —__ __ Please r
For your 'review Attache
::��As discussed Please c
Notes/Messages�►�—
I
T
!f
III lig
11DEVISION 61F ENVERONMENTAL HEALTH. SERVICES,
_ _. __ ._�'_— ..t s +--. .+. �.. a}O:f,:�...��y':"+ ^^`- �4!':_ -:. N.. iry.,cw.�•.�T. '{.- Y�'�Vs..c•...�.. w
� .. � ... .. ;7; r. r. Fes--^: -.� :- .:'..�:_ 'a,.. a,.;,_ 30=• - � i. -'._. . n .. -.. _ _ ..
CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM
i� IPERMffT # - 0 �
I
Located at Sassinoro Drive/ d Town oixViMW Putnam Valley
Subdivision name Putnam Chase Subd. Lot # // Tax Map 84 Block 1 Lot Sub Lot zwl
Date Subdivision Approved
Renewal Revision
Owner /Applicant Name
37
Croton
Dam
Road
Corp.
Date of Previous Approval
n/a
Mailing Address
37
Croton
Dam
Road,
Ossining,
NY
Zip 10562
Amount of Fee Enclosed $300.00
Building Type gesidential Lot Area 3,26 No. of Bedrooms 4 Design Flow GPD Qnn
qQ
Fill Section Ou9y Depth Volume
P CH>1D NOTIFICATION IS RE llJl(REI<D WHEN FILL IS COMPLETED
Segpairate SeweraFe System to consist of
1250
of 4" PVC Perf. pipe in 24" gravel trench.
Other Requirements:
gallon septic tank and q00 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,
®n�i x� Private Supply Drilled`tiy' "p.F. Beal I Sons, Inc Address 4 P „rnam Ave,
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 desc bW4b ve will be constructed as shown on the approved amendment thereto and in
accordance with the standards, n06g4 , of the Putnam County Department of Health, and that on completion
thereof a "Certificate of Con Co ce tisfactory to the Public Health Director will be submitted to the
Department, and a written e��rwill be fi
builder will place in good o era tag c
immediately following the w f the i
system or any rep s th ret
62980
Signed:
Address 2 John Walsh Blvd, \
H dH a owner, his successors, heirs or assigns by the builder, that said
Y o said sewage treatment system during the period of two (2) years
the r val of the Certificate of Construction Compliance of the original
U
zr
w ,
P.E. R.A. Date
, NY 10566 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
anew permit Ap ov r dis harge of domestic sanitary sewag only.
By: Title: Date:
White copy - HD File; Yellow copy - Building Inspector; Pink copy Owner; Orange copy - Design Pr fess onal
Form CP -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
FINAL SITE Il\'SPECTION
Date: t i -7 c:v
- Inspecte ;..
- Street Lo n -- Owner
Town ' Permit # ?\I 1 q —0c)
TM # 18 1 —,59 Subdivision Lot # 11
1. Sewage System Area
a. STS area located as per approved plans ...........................
b. Fill section - date of placement
3:1 barrier Lgth. Width Avg.Dpth
c. Natural soil not stripped ................... ...............................
d. Stone, brush, etc., greater than 15' from STS area..........
e. 100' from water course / wetlands ...... ...............................
II. Seytage System
a. Septic tank size - 1,000 ........1,25 ........other ................
b. Septic tank installed level ................ ...............................
c. 10' minimum from foundation .......... ...............................
d. istributi n Box �
. All outlets at same elevation -water teste .......
2. Protected below frost ..................... ................
3. Minimum 2 ft,Original soil be en ox & trenc es
e. Junction Box - properly set .................... M ..................
f. renl ches r
en require _ Length installed
Dist a to x atercourse measured Ft..........
3. Insalle acc�r&ng to an .................. ��....................
4. Slope of encth acceble 1 /16 2 /foot .............
10 fro rop ine - 20 ft.- foundations..........
t
6. Dep, of tre <30 inches from surface........ ,
7. Roo allowe for expansion, 100 % ............ . ...
8. Siz of gravel 3/4 - ' 'diameter clean...,
9. De th of gravel m trendX12" All —
:1 e-ends ca' e.
...::: �` ..:: " ......... .
.... ..... ... .. ....
g. Pump or Dosed S steps
ize o pump c am qer .. ........ ...............................
2. Overflow tank .............
.......... .................. .........
3. Alarm, visual / audio ............... ..................................
4. Pump easily accessible, manhole to grade ................
5. First box baffled ........................................ :.................. ..
_....._ 6. Cycle witnessed by H.D.estimated flow /cycle...........
III. Houseffluil&ng
a. House located per approved plans .. ....................:..........
b. Number of bedrooms .......:.............. ............................... C
IV. Well
a. Well located as per approved plans ..............................
b. Distance from STS area measured 0— 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 ................. ...............................
Rev. 6/97
10 COMMENTS
�T
Aoa i
U
c,ronin Engineering
1r R/ LLVI'1 M COU ll H DEPARTMENT OF HE ALTIE
DWISION OF ENVMON'N IENTAL HEALTH SERVICES
�� I ; f � I I +�; ^� �1! •t lu � � 1
AI! information must be fully completed prior to any
inspections being made.
For: Fill _41
Trenches &11_�
PCHD Co coon Permit # ��/
Located: tdancu F�a� A� (T) ( fv raA°r Vi
Owner /mil Name: 37 CR e`�� AgIV 20 TM 8!4 Block -._ Lot
Formerly. Subdivision Name: ty r4,gr P c NAde:
Subdivision Lot # B/
Is system fill completed? a JA Date:
Is system complete? Yf Date: x0 v, r .2400
Is system constructed as per plans?
Is well drilled? YEd' Date:
Is well located as per plans? t
Are erosion control measures in place? e-(
la 002
I certify that the system(s), as listed, at the above premises has been constructed and I have inspected
and verified their completion in accordance with the issued PCHD Construction Permit and
approved plans and the Standards, Rules and Re_o-uiations of the Putnam County Department of
Health.
l3atc: nI U� _ 1...1 , " C .' -Ufied by .41figimy,
Design Professional
3RE c rN® Y fSVr c 01A)C XVITV -I80
~so Itl.4i wA t q 90 v L vJqR0
Address: 3'eUKXditU.r,._eJ• Y. 105W-C Lic. go /
l JP,7 3 %�� C°rAComments: "A t m rP � [ lA t
Form FIR 99
4;
i.
it
V.S.g
'f
r
Mar
i
!J PUTNIAM C
HOUSE PLAM
CCIUNT ONLY9,
B
'ALL
ON:3 TO THESE HOUSE
IRP WST 'CIE
PCDOH FOR APPROVAL
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PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT
Well. Location•,
. <. 4
�trget,At�ldrps� - 7 "`
C., 'Rd
tnam Chase Subd. , Lot #11
w Ni a e: . j..
To n 1! g
Putnam Valley
Tax Grid'# •:. �:: � �- ° �:~ :�:
Map Block Lot(s) 11
Well Owner:
Name: Address:
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 ._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
I 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 30 gpm
Depth Data ;
Measure from land surface - static (specify ft)
245'
During yield test(ft)
180'
Depth of completed well in feet
245'
Well Log
If more detailed
information
descriptions or
sieve analyses
are 'a4aiW le,
please attach.
Depth From
Surface
Water
Bearing
Well
Diameter(in)
Formation
Description
ft.
ft.
Land Surface
10
Drilling
in over
urden clay and boulders
10
Hit rock
at 10'
10.
32,.
Drilling
in. rock
set_ casing,_, routed ..:. ,
"' 32�
245
Drillin
in rock
ranite
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump /Storage Tank Information
Pump Type sub Capacity 7m
Depth 200' Model 7GS05412
Voltage 230 HP 1
Tank Type WX302 V 86 1.
Date Well Completed
8/25/00
Putnam County Certification No.
002
Date of Report Well Dril
11/10/00 IP y .
NOTE: Exact location of well with distances to at 1 st two permanent landmarks to be on a separate fsneevp Ian.
Well Driller's Name P- Inc. Address: 4 /putg n Ave., Ba3m+p , NY 1_0509
Signature: Date: 11 /10 /00
White copy: HD FA," Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC -97
RTE
NORTHEAST LABORATORY OF DANBURY
'*—"39.W1tL-PLAM,.R0AD --m'DANBURY' --C - ----06811'. T
9 T;- - 'C -Cert!
LABS (203) 748-7903 - PAX (203) 748-0652 NY Cert: 11471
LABORATORY REPORT
REPORT TO:
P.F. BEAL & SONS DATE SAMPLE COLLECTED: 11/2/2000
4 PUTNAM AVENUE TIME COLLECTED: 10:00 A.M.
BREWSTER, N.Y. 10509 COLLECTED BY. KEVIN
DATE RECEIVED @ LAB: 11/2/2000
DATE(S) TESTED: 11/2/2000 — 11/7/2000
TESTED BY: LAB# 11471
REPORT DATE: 11/8/2000
SAMPLE SITE: V.S. CONSTRUCTION, LOT #11, PUTNAM CHASE SUB., PUTNAM VALLEY, N.Y.
SAMPLE POINT: HOSE BIB
SOURCE: WELL-NEW
TREATMENT-.. NONE
MAXIMUM CONTAMINANT
TEST PERFORMED RESULTS METHOD# LEVEL (MCL) OR STANDARD
BACTERIAL:
0 Total Coliform. (Bacteria)
0
per 100 nil
SM 9222B
0 per 100 nil
PHYSICALS:
• Color (Apparent)
0
-
EPA 110.2
15
• Odor
ND
-
3 Units
0. pH
6.51
EPA 150.1
No designated limits
0 Turbidity
0.14
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
16.0
m
23 20B
.....No defined limits
..7,4'0
..AM
'
No -defuii!d1imits
• iron
<0.03
1119/1,
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 = 0.50mgtL
• Sodium.
<1.0
mg/L
EPA 273.1
20.0 mg/L**
• Lead
<0.001
mg/L
EPA 239.2
0.015 mg/L***
ml=milliliter mg/L--milligrams per Liter ND=none detected MCL--Maximum Contaminant Level
* *Notification Level "Action Level
COMMENTS:
-All holding times (were) met.
SAMPLE, AS TESTED ABOVE: OTABLE orFE]INOT POTABLE
RESULTS BASED ON SAMPLES SUBMITTED: 11/2/2000
Laboratory Director
oNORTHEAST 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
/ ` F
1
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION TO CONSTRUCT.A WATER WiELL
ease- rinC'o type _ PCHD' Permit # V -/ " 00;.:
Well Location:
Street Address: Town/Vll+age Tax Grid #
Sub
Sassinoro Drive/ Putnam ValleyMap 84 Block 1 Lot(s)
Well Owner:
Name:
Address:
37 Croton Dam Rd. Cor
37 Croton Dam Road, Ossining, NY 10562
Use of Well:
X Residential Public Supply Air /Cond/Heat Pump Irrigation
1- primary
Business Farm Test/Monitoring Other (specify)
2- secondary
Industrial Institutional Standby
Amount of Use
Yield Sought 5 gpm # People Served Est. of Daily Usage 5 00 gal,
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
X New Supply (new dwelling) Deepen Existing Well
Detailed Reason
Water supply for new residence.
for Drilling
Well Type
X Drilled Driven Gravel Other
Is well site subject to flooding? ................................................. ............................... Yes No X
Is well located in a realty subdivision? ...................................... ............................... Yes No
Name of subdivision G WE Lot No.
_
Water Well Contractor: P.F. Beal & Sons Inc... tnam Ave—Brews ter my 10509
0
Is Public Water Supply available to site? ........... ...... ..:.....��...,�......... Yes No X
Name of Public Water Supply: N/A N/A
Distance to property from nearest water main: A" ~:��,•��
! ibc
Proposed well location & sources of contaminatio pr . se p , t sheet/plan.
Date: r - l.�l Applicant Signature, F 298
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 a new permit. Well to be constructed by a water well drill c 'feed by Putnam
County.
Date of Issue 01 Permit Issuing Official: (0,7
Date of Expiratio Title:
Permit is Non - Transfer a le
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
. DMSION.OF.ENVIRONMENTAL HEALTH.:SERVICES
LETTER OF AUTHORIZATION
RE: Property of 37 Croton Dam Road Corp.
Located at Sassinoro Drive /Kramers Pond Road
T/ Putnam valley Tax Map # 84 Block 1 Lot, Sub Lot.* 36
Subdivision of "Putnam Chase Subdivision"
Subdivision Lot # 1 A Filed Map # 2932- 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 D rigen, t ;r o sign all necessary papers on my.be alf in connection with this
matter and to ' a tion of said wastewater treat nt d/or ater supply Y 1 systems
conforn�i tt Vie. ions ic1e-145:�.polQr.1;47,0 e:: u on, ;,the Pul;lic:Health: "� - =a'
Law, and Tth Sani Code. 1
Nk
X980.
Countersigned: 'J40 - ri UFES$\��P� /
06 2 -
Mailing Address 2 John Walsh Blvd. #200
Peekskill
State NY
Zip 10566
Very
Signed:
Pres.
Mailing Address: 37 Croton Dam Road Corp.
37 Croton Dam Road, Ossining
State NY Zip 11162
Telephone: (914) 736 -3664 Telephone: (914) 739 -7362
Form LA -97
� � I
PUTNAM COUNTY DEPARTMENT OF HEALTH
DPaSIO N OF ENVIRONMENTAL HEALTH SERVICES
AFFIDAVIT - CORPORATE OWNER APPLICATION
FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT
To: Public Health Director
In the matter of application for: Construction of SSTS and Water Supply
Val Santucci
represent that I am an officer or employee of the corporation and am authorized to act for:
Name of Corporation: _
Having offices at:
Whose Officers Are:
President - Name:
Address:
Vice President - Name:
Address:
Secretary -Name:
37 Croton Dam Road Corp.
37 Croton Dam Road, Ossining, INY 10562
Val Santucci
(Same as above)
Same as President
(Same as above)
Michelle Santucci
-dress (Same as above j
m
Treasurer - Name:
Address:
Same as Secretary
(Same as above)
and that I am and will be individually responsible for any
to the approval requested and all subsequent acts relating
Signed:
Title:
Sworn to e ore me this day of
L month) 2 60 (year)
Notary Public
KELLY M. LENT
Notary No c li LEtate of N4 w York Corporate Seal
Qualified in Westchester Count
Commission Expires June 21, 24
Form CA -97
i
ion with respect
I
PUTN.AM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATJON EO.R.APP.RO.VAL.OF PLANS FQIt:.
A WASTEWATER TREATMEW SYSTEM
1. Name and address of applicant: 37 Croton Dam Road Corp .
37 Croton Dam Road
Ossining, NY 10,562
2. Name of project: Putnam Chase - Lot # /f . 3. Location TN: 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
Apartments Institutional
Office Building Realty Subdivision
Commercial
Mobile Home Park
Other (specify)
8. Is this project subject to State Environmental Quality Review (SEQR)?
TyT. P (check one), ....................... .. Type I - Exempt
e Status .......:..........:........
Tv
pe 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, ordinances? - _........ ...............:.:.:�....:;.,:, ..�. .YES
13. If so, have plans been. submitted to such authorities? YES
14. Has preliminary approval been granted by such authorities? YES Date g>'anted: 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) .... .............................................. ............................
18. Is project located near a public water supply system? ........................................
N/A
NO
19. If yes, name of water supply N/A I . Distance to water supply N/A
20. Is project site near a public sewage collection or treatment system? ................ No
21. Name of sewage system N/A Distance to sewage system N/A
22. Date test holes observed 03/29/99 23. Name of Health Inspector Adam stiebeling
24. Project design flow. (gallons per day) ................................ ............................... 800 GAL %DAY
25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... NO
26. Has SPDES Application been submitted to local DEC office? ......................... NO
Form PC -97
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? ............................... 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? ............................ Yes/No NO
32. Is project located within 1,000 feet of existing or abandoned landfill,
hazardous waste site, salt stockpile, landfill, sludge disposal site or any
other potentially known source of contamination? ... Yes/No YES.
DESCRIBE: Property adjacent to the west was the former Orlando Landfill.
33. Is there a local master plan on file with the Town or Village? ......................... YES
34. Are community water and/or sewer facilities planned to be developed within
15 years in or adjacent to project site? ................................ ............................... No
35. Are any sewage treatment areas in excess of 15% slope? NO
36. Tax Map ID Number ..... :................................................... Map g:t Block 1 Lot ,59
37. Approved plans are to be returned to ..... Applicant X Design Professional
" "fiT0"TE:-AIi appCcaTions foi ieview aiid�approial of a new SETS to 6e located wit ul°"n t'e%1Y� VVatec`s�ied shalt'
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 stonnwater,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
b accompanied by a Letter- of Authorization (Form LA -97). Failure to comply with this provision
may be groun4s for the rejection of any submission.
6aerreb, rna, wader penalty of perjury, thainformation provided on this form Is true
?d
the bit of nay knowledge and belied False naents made herein are punishable as
.a ca,,e7ass7i misdemeanor pursuant to Sect' 210 9S of the Pe IL
c, C'I
SI�'l fffl 'f1 5 OFFICIAL TITTLES.
Mailing Address: .................................... Cronin Engineering, P . E . , P . C .
John Walsh Blvd, Peekskill, NY 10566
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
' bk9rGN"DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner 3-7 GgoTa" * j> 1M Solt p Gx);W Address _ -> C9g7z)N Q^M IZD I OSSImiv , Aj
Located at (Street) &/Lmjt�126 t�!Aj ] jw" Tax Map 8 Block � Lot 7,0 Z-q
(indicate nearest cross street)
MunicipalityLl j BgwAM I/Az- gag Drainage Basin i -KS�I t.t Lt.v aJ Ct2E>= i�
W jXoAJ 21 licit.
SOIL PERCOLATION TEST DATA
Date of Pre-soaking D/ f —o7 —9q Date of Percolation Test } -.oe -9a
Hole No.
Run No.
Time
Start - Stop
Ela se Time
iVlin.)
Depth to Water
Irom Ground
Surface (Inches)
Start Stop
Water
Level
Drop n
Inches
Percolation
Rate
Min/Inch
ILI - ZZ
3
q
ZZ-
-3
3
323_335
lZ
lg -2.Z
3
ct
4
5
2
►. _ 335
3
—
2t z�
6
3
3" -3r'
4
5
2.
3.
4
5
NOTES: 1. Tests to be repeated at same depth until approximately equal percolation gates are obtaimd 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.
Form DD -97
/�DmPTI-41- TEST PIT IlDATA
DESCRIP'T'ION OP 'SOILS ENCOUNTERED IN ` EST HO LIES
HOLE NO. 37 A HOLE NO. HOLE NO.
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'
9.50
10.0'
S tL
1�IZ�t.va� �,v� Coq
33"
tvp SOIL.
Cf of
two oq 104-1
7-3 " .
Indicate level at which groundwater is encountered
ae
accav�.�9
Indicate level at which mottling is observed
fuv
vb5C7tv��
Indicate.level to which water level rises after being encountered
64A
Deep hole observations made by: AD4nn �e-.89UVC-� B go -M
0i�
,eDate o3 Lq - ,7q
PC-®IJ
4��&
Design:-ProJ�e.,3sional Marne: -nm ozyV f- CAOa,oN
ro
Address' IAJ ZJAI41 � � = P G.
� � � � C N �
r,j
Sdgrt- ture::7
6280
Design Professional's Seal
° 617.20. SEAR
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only: - -
Part 1 - PROJECT INFORMATION ITn he rmmnlatatt by Annlirant nr Prniart ennnenrl
1. APPLICANT /SPONSOR:
2. PROJECT NAME:
37 Croton Dam Road Corp.
Putnam Chase Subdivision, Lot #
3. PROJECT LOCATION:
Municipality Town of Putnam Valley County Putnam County
4. PRECISE LOCATION: (Street address and road intersections, prominent landmarks, etc., or provide map)
Kramers Pond Road / Sassinoro Drive
5. PROPOSED ACTION IS:
ENew ❑Expansion ❑Modification /afteration
6. DESCRIBE PROJECT BRIEFLY:
construction of subsurface sewage treatment system and individual well water supply
7. AMOUNT OF LAND AFFECTED:
Initialty 26 acres Ultimately. 3, 2 6. acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
®lies ❑No If No, describe briefly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
Wesidential ❑Industrial ❑Commercial ❑Agricultural ❑Park/Forest/Open space ❑Other
Describe:
Surrounding lands are zoned single.. a*. regiglen6al
eµ`
. 1. ,... r•.a..r �p yo-. Otis M, �.. • ..., x. - ti ur s.y,_r .p.�,.='y.... ,w ..,. -.... w. rr .e`r.....F...... �. u... �9 PMi!.��.A. �.� ......•...., 4- M
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW, OR ULTIMATELY FROM ANY OTHER - GOVERNMENTAL
AGENCY (FEDERAL; STATE OR LOCAL)?
®lies ❑No 'If yes, list agency(s) name and permit/approvals
Town of Putnam Valley — Building Permit
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
®lies ❑No If yes, list agency(s) name and permil/approval
Subdivision Plat Approval — `Putnam Chase Subdivision"
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION?
❑Yes WO
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant/Sponsor name: C ith Staudohar date: 04 -19 -00
Sgnature:
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
[]Yes ❑No
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a
negative declaration maybe superseded by another involved agency. _ '
J.0
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: Answers may be handwritten, if legible.
C 1. 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 tern, 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 TH&ESTABLISHMENT
OF A CRITICAL ENVIRONMENTAL AREA (CEA)? ❑Yes ❑No If Yes, explain briefly:
E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
❑Yes []No If Yes, explain briefly:
_ IPart III -,DETERMINATION OF SIGNIFICANCE (To be completed by Agency). __..._. � , _.....
-- ---- INSTiZUCTIONg:` orencch adverse-eftettidentified-above,, determine whetherit1s- 9;; bstar1tial,- large,,�impu7taritOrotherW;*se'"signi4cant
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
Signa�ureJof Res nnsble Officer in Lead Agency
= Q
.fD ,
Name of Lead Agency
date
Title of Responsible Officer
Signature of Preparer (If different from responsible officer)