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PUTNAM COUNTY DEPARTMENT OF HEALTH
a
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE YSTEM
PCHD CONSTRUCTION PERMIT # 7�qLC6"f
SI
Located at BASSI n10Ro qZI VC Town or V*6ge �i17��i/'`'
Owner /Appkemt Name T7 02onrl OAIy 1 DAy Tax Map i3 q Block I Lot �6
Formerly S f— Subdivision Name Il' ?NKI r l C ion -d e-
Subd. Lot # 12
Mailing Address S1. S1q S S 1 N oR o CE l t/6- Puri J A rh VA 1. C Z-Y , /y Y. Zip I &T 1 i
Date Construction Permit Issued by PCHD 2 'r- 2 60 0
ro 37 C2dT0r•l.0V9rii ROA-0
Separate Sewerage System built by 37 C l2O T oi, A41'4 AA.#a C61110- Address &S-ClM y JG, 0Y. / o <K2Z
and r
?I PE 1/J ct
Other Requirements:
Water Suooly: Public Supply From Address
or: w,'� Private Supply Drilled by? 'F lrog C.19 SOa.J" l ,-J C Address prw fTmn_ N, y / OS'75
Building Type Slg(c e r /'iii `i 2k�'-( Has erosion control been completed? VeT
Number of Bedrooms FO y i L- Has garbage grin_ b
-ni NEW
��P, �y L. C,Y
I certify that the system(s), as listed, serving the ab e p i%ises we
built plans (copies of which are attached), in acc c �'
plans and the standards, rules and regulatio of e P tnamm
Date: LI- 3 0 f Certified by
Address
installed?
ted essentially as shown on the as-
Construction Permit and approved
�nt of Health.
W�
•U
P.E. R.A.
/License # Q 6 2- 0) 0
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary
to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage
treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval
of the private water supply shall become null and void when a public water supply becomes available. Such
approvals are subject to modification or change when, in the judgment of the Public Health Director, such
reoti ,.na�9 dift cati n:_ ar ch ge isaucessac.1::
By: Title: Date: J0 r)
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CC -97
PUTNAM COUNTY DEPARTMENT ENT OIF HEALTH
DIVISION OF (ENVIRONMENTAL HEALTH SERVICES
91 Sn SS j/J is ? a of. W ELL COMPLETION REPORT
Well Location
Street Address: Dut_Chase Subde
xra °rte D^aa -mod, Lot #12
Town/Village:
Putnam Vallee
Tax Grid # 84. -1 -56
Map Block Lot(s)
Well Owner:
Name: Address:
VS Construction, 37 Croton Dam Road, Ossining, NY 10562
Use of Well:
1- primary
2- secondary
X Residential Public Supply Air cond/heat pump Irrigation
Business Farm Test/monitoring Other(specify)
Industrial Institutional Standby
Drilling ]Equipment
X Rotary Cable percussion X Compressed air percussion Other (specify)
Well Type
Screened Open end casing X Open hole in bedrock Other
Casing Details
Total length 32 ft.
Length below grade 31 ft.
Diameter 6 in.
Weight per foot 19 lb /ft.
Materials: X Steel _ Plastic _ Other
Joints: _ Welded _XThreaded _ Other
Seal: X Cement grout _ Bentonite Other
Drive shoe: X Yes . No
Liner _ Yes X No
IScreen Details
Diameter (in)
Slot Size
Length(ft)
Depth to Screen (ft)
Developed?
First
Yes No
Hours
Second
Fell` Yiel'aff Vest
_Bailed X Pumped' y'-X Compressed Air "° ' ' `" ` '
�Iours 6'
Niel gpm
Depth Data
Measure from land. surface- static (specify ft)
30'
During yield test(ft)
340'
Depth of completed well in feet
425'
Well Log
If more detailed
information
descriptions or
sieve analyses
are available,
please attach.
Depth From
Surface
Water
]bearing
Well
Diameter(in)
]Formation
Description
ft.
ft.
Land Surface
14
Drillin
- in ove
burden cla and boulders
14
Hit rock
at 14'
14
32
Drillina
in roc
, set casingr cfrouted
32
425
Drillin
. in rock
granite
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump /Storage Tank Information
Pump Type sub Capacity 5cfpm
Depth 360, Model 5GS07412
Voltage 230 HP 3/4
Tank Type WX302 Volume 86 gal.
Date Well Completed
8/30/00
Putnam County Certification No.
002
Date of Report
3/28/01
WZDri
a-
iNui t: rxact location of well with distances
Signature:
L.
least two permanent landmarks to be pr6vid�d b'h a separate sheet/plan.
��Z1�LGa�
Date: 3/28/01
White copy: JJ-D File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM
,37 CizoTooJ %>A•y /ZAD 5VT . gl 0W. i /v Z : S�
Owner or Purchaser of Building Tax Map Block Lot
37 PoTow 1iA �c�Ail �2 ?. RalJAM 1 ALLF_
Building Constructed by �illage
,31 y21 ye�
Location - Street
1-�i-f o�.y T2�5.s e oS.yc&
Building Type
uTAAM CHA5&
Subdivision Name
1-2.,
Subdivision Lot #
I represent that I am wholly and completely responsible for the location, workmanship, material.
...��w....,c-Dngtructioa-and ainage-_of the sewaae.treatment.s�•stem sere T.tl�aboVe -desc
drag rbad open: mod:
" (fiat 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. h A_
The undersigned further agrees to accept as .conclusive the det na n th �iblic Health
Direct o of e Putn roby County Department of Health as to �vheth r no the ilur of the system
to oper�e caus the willful or negligent act of the occu t of e ildin utilizing the
Day 325 Year 26o i Si
Title:
37 vI�o-ro -,A I Jj2bA0 00 ZP 3-f SAM 2o.A) aei.::b
Corporation Name (if corporation) Corporation Name (if corporation)
Address: 3-f or,00 _DAwA RoAD , (assv.01A16 Address: 31 D-atoj PAM RoA-i) 055tillv6.
Zip:..�.,
Form GS -97
BRUCE R. FOLEY
Public Health Director
LORETTA MOLINARI R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF BEALTT I
1 Geneva Road
Brewster, New York 10509
Environmental health (914) 278 - 6130 Fax (9.14) 278 - 7921
Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085
Early Intervention (914) 278 - 6014 Preschool (914) 278-6082 Fax (914) 278.6648
®R.S NAM: .37 ecr oYOa ��>� EDA9 . jel>.
TAX MAP NUMBER: ?ec. ' 8� ��� l L-07— : �G' �3L (Q-T : 12
AUTHORIZED TOWN OFFICIAL:
a,
(Signature)
RARE
The Putnam County Department Of Health.wffi Health. mot issue a Cea°tnficate ®f
Construction Compliance unless the above form is completed, Le q a lejal E91g
address is assigned by an authorized town official. This form nis' to be submitted
w th the application for a Certgf cats of Construction COmmPH21 e.
(E911 VERFM
aaccxx
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NE
NORTHEAST LABORATORY OF DANBURY
39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404
LABS (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471
LABORATORY REPORT
REPORT TO:
P.F. BEAL & SONS DATE SAMPLE COLLECTED: 1/24/2001
4 PUTNAM AVENUE TI& E COLLECTED: 10:30 A.M.
BREWSTER, N.Y. 10509 COLLECTED BY: KEVIN B.
DATE RECEIVED @ LAB: 1/24/2001
TESTED BY: LAB# 11471
LAB I.D.# PFBO14
REPORT DATE: 1/30/2001
SAMPLE SITE: V.S. CONSTRUCTION CON., LOT #12, 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
PHYSICALS-
• Color (Apparent) 0 - EPA 110.2
• Odor ND - -
• pH 6.88 - EPA 150.1
• Turbidity 0.24 NTUs EPA.180.4
CHEMISTRY:
• Nitrite Nitrogen
<0.005
mg/L as N
EPA 354.1
• Nitrate Nitrogen
0.32
mg/L as N
SM 4500D
• Alkalinity
6.0
mg/L
SM 2320B
• Hardness
24.0
mg/L
EPA 130.2
• Iron
<0.03
mg/L
EPA 236.1
• Manganese
<0.01
mg/L
EPA 243.1
• Sodium
• Lead
<1.0 mg/L EPA 273.1
<0.001 mg/L EPA 239.2
0 per 100 ml..
15
3 Units
No designated limits
5 NTUs
1.0 mg/L
10 mg/L
No defined limits
No defined limits
0.30 mg/L
0.50 mg/L
Combined Ihh for Iron plus Manganese = 0.50mg/L
20.0 mg/L **
0.015 mg/L * **
ml= milliliter mg /L= milligrams per Liter XD =none detected. MCL=Maximum Contaminant Level TNTC =Too Numerous To Count
* *Notification Level ** *Action Level
COMMENTS:
-All holding times (were) met.
SAMPLE, AS TESTED ABOVE: MOTABLE or DOT POTABLE
RESULTS BASED ON SAMPLES SUBMITTED:1 /24 /2001
- Laboratory, Director
•NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050
TOLL FREE WITHIN CT: 800 - 826- 0105.OUTSIDE CT: 800 - 654 -1230
(✓n der Cons t r,,c t i on)
250.00' L--f 47.02 '
ebb
A,,406gp
I
RONIN ENGINEERING, P.E. P.C.
The Lindy Building, Suite 200, 2 John Walsh Blvd., Peekskill, New York 10566
Tel. (914) 736-3664 • Fax. (914) 736-369.3
April 4, 2001
Adam B. Stiebeling,
Assistant Public Health Engineer
Putnam County Department of Health
Division of Environmental Services
I Geneva Road. Brewster, N.Y. 10509
Re: Certificate of Construvtion Compliance
"Putnam Chase Subdivision
Lot 20
21 Kramers Pond Road
Town* of Putnam Valley
Dear Mr. Stiebeling:
Please find enclosed the revised information requested in your letter dated Apil 2 d.
Please review at your earliest convenience. If there are any questions or if additional
information is required please ' do not hesitate contacting me at the above number. Thank
you for your, assistance in this matter.
Respectfully submitted,
74,
Kenneth M. Murphy
Project Designer
S
0
PUTNAM COUNTY DEPARTMENT OF HEAL'T'H
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
F AL SITE INSPECTION
Date:
Inspecte y:
Street Location 4551 t-AQ9Z Owner (S V4>TV M
Town Permit # PV
TM Subdivision Lot # `Z'
1. Sewage Svstetb 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. Sevhg System
...25 ......other...........
a. Septic tank size - s - -1,000 ... .. 1,25
b. Septic tank installed level ........... ...............................
C. 10' minimum from foundation ..... ...............................
d. Pistribution Box
. All outlets at same elevation -water tested............
2. Protected below frost .............................................
3. Minimum 2 ft.Original soil between box & trenc
e. Junction Box - properly set ....... ...............................
f.. _renc a .. _ :,n...e
�
03/27/2001 16:40.
914.7363693
CRONIN ENGINEERING 1
PAGE 04
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
ATTENTION 4AM 0 GENF,
REQUEST FOR FINAL INSPECTION For: Fill
All information must be My completed prior to any Trenches
inspections being made.
PCHD Construction Permit # V_ 31- 6 0
Located: -S&S-cl-IJOV-0- uAlvtr (T) oo ffien^ V4444L_ce
qwner/Apoimt Name: T7 cgo ro,#j awe 44ow coin TM Block L_ Lot -a
-
Formerly: Subdivision Name: OWN.,gru cdtA�v
Subdivision Lot #
Is system fill completed? 144 Date":
Is system complete? Date: PlAnc" 'Z:L 2 69
Is system constructed as per plans?
Is Well located as per Plans? AL
Are erdsion control measures in place?
I certify that the system(s), as fisted, at the above premises has been constructed and I have inspected
and verified their completion in accordance with the issued PCHD Construction Permit and
approved plans and the Standards, Rules and Regulations of the Putnaba County Department of
Health.
Date. tkgcm 2 100 1 . Certified by- CIZO,-Jvj 4Rj4*1AJLr4rt'('j�PE RA
Design Profeskonal.
OWOJ W
Address: Kt L-t- Nj Y. 10.0cir Lic. #
Comments.-'
co
+brm FIR-99
CD
PUTNAM COUNTY DEPARTMENT 07 HEALTH
DIVESHON GIF IENWRONMENTAC, HEALTH S ERVEC ES
CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM
PERMIT # f V-31-0 0
Located at Sassinoro Drive d
Subdivision name Putnam Chase Subd. Lot # /,Z
Date Subdivision Approved is 7 —ZS-0o
Owner /Applicant Name 37 Croton Dam Road Corp.
Mailing Address
Amount of Fee Enclosed
Town orcYiNap Putnam Valley
Tax Map 84 Block 1 Lot. sni* .
Renewal Revision
Date of Previous Approval
37 Croton Dam Road, Ossining, NY
$300.00
Building Type Residential
N/A
Zip 10562
Lot Area G, // No. of Bedrooms 4 Design Flow GPD Boo
]Fill Section Only Depth Volume
CHD 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 �4d d L. F.
To be constructed by 37 Croton Dam Road Corp. Address 37 Croton Dam Road, Ossining, NY 10562
Wager SunspI - Public Supply From
or: X Private Supply Drilled by P. F. Beat & Sons, Inc.
Address
Address 4 Putnam 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 treatments sy tem described above will be constructed as shown on the approved amendment thereto and in
accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion
thereof a "Certificate of Constructio nce" satisfactory to the Public Health Director will be submitted to the
Department, and a written guar . Afill 'fi�i 1 d the owner, his successors, heirs or assigns by the builder, that said
builder will place in good ope�dtin& adition a, p of said sewage treatment system during the period of two (2) years
immediately followin a dale of fhe'issu,4 o th alp oval of the Certificate of Construction Compliance of the original
system or any rep 'rs h�eret . `�`"``�
Signed: c `'
Address 2 John Walsh
r
W
, L P.E. R.A.
��� 10566 License #
Date l y v v
062980
APPROVED FOR CONS'II RUC I 1
EIID s approval expires two years from the date issued unless construction of the
sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or
modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires
. - �..,..w.; i`;11 -
-anew p rt: "A' ov d -r d 'charge o�dmestic- sanitary sewa only:-4• ' u
By: Title: Date: �0 co
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional om CP -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION TO CONSTRUCT A WATER WELL �/
please print or type PCHD Permit # 10 ►" - 3 / - o -D
Well Location:
Street Address: Town/VKIWe Tax Grid # f S�
Sassbioro Drive/
OT 12 Putnam Valley Map 84 Block 1 Lot(s)
Well Owner:
Name:
Address:
7 Croton Dam Rd Corp.
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 500 gal.
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
__)L_ 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 40
Na�i�:of,subdi�ision.....: _.:::_:.:�== �-:. -� �- t.�y"� -'`:. ._ .. •- � .., -..Lot -- - __ ......
Water Well Contractor: P.F. Beal 4 Sons, Inc. Ad -Putnam Ave., Brews ter NY 1050
....................� ....
Is Public Water Supply available to site? •' �` "� `" YoN Yes No
�...
G
Name of Public Water Supply: N A To' A
Distance to property from nearest water main:
Proposed well location & sources of contamination rovid rparat shy et/plan.
w
I
Z r
Date: 7' Z =wy Applicant Signature:
PERMIT TO CONSTRUCT ELL
This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the
Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided
that within thirty (30) days of the completion of water well construction, the applicant or their designated
representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the
requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form
provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or
well driller shall take appropriate action to assure that any and all water and waste products from such
well drilling operations be contained on this property and in such a manner as not to degrade or otherwise
contaminate surface or groundwater.
APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless
construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be
amended or modified when considered necessary by the Public Health Director. Any revision or alteration
of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam
County.
Date of Issue Permit Issuing Official:
Date of Expiration 8 L Title: Z
Permit is N.on- Transfe;rrabl _: r . — ---_- =
White copy - HD file; Yellow copy -Building Inspector; Pink copy- Owner; Orange copy- Well driller
Form WP -97
.. M -,=*. 1
• PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
- - _APPLICATION FOR APPROy. —h- , =.PLA , §:.I'4
c r A WASTEWATER TREATMENT SYSTEM
1. Name and address of applicant: 37 Croton Dam Road Corp.
37 Croton Dam Road.
Ossining, NY 10562
2.
Name of project: Putnam Chase
- Lot #
/,Z
3.
Location TN: ` Putnam Valley.
4.
Design Professional: Timothy L.
Cronin
111
5.
Address: 2 John Walsh Blvd.
6. Drainage Basin: Peekskill Hollow Brook. Peekskill, NY 10566
7. Tvpe of Project:
X Private/Residential Food Service. Commercial .
Apartments Institutional Mobile Home Park
Office Building Realty Subdivision Other (specify)
8. Is this project subject to State Environmental Quality Review (SEQR)?
Type Status (check one) ..................:.... ............................... Type I Exempt
Type II — Unlisted X
9. Is a Draft Environmental Impact Statement (DEIS) required? .............
10. Has DEIS been completed and found acceptable by Lead Agency? ...............
11. Name of Lead Agency Town of Putnam Valley Planning Board,
NO
N/A
12. ,Is this project in an area under the control of local planning, zoning,.or other
officials;, ordinances? ............................... ....:.......................
...............::: ::.
13.' If so, have plans been submitted to such authorities? YES
14. Has preliminary approval been granted by such authorities? YES Date granted: 08/02/99
15. Type of Sewage Treatment System Discharge ..........:...... surface water x groundwater
16. If surface water discharge, what is the stream class designation? .................... N/A
17. Waters index number ( surface) ........:.................................. ...............................
N/A
18.. Is project located near a public water supply system? ...... ............................... No.
19. If yes, name of water supply N/A Distance to water supply N/A
20. Is project site lnear.-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 "0'3 2 9/ 0*9 23. Name of Health Inspector Adam Stiebeling
24. Project design flow (g allons p er 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
4 e
2
27.. Is any porttQ ..pf this project located within a designated Town_gr Stale.;,t�retland ?:_ _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? .. ............................... Nn
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' s4 Block 1 Lot . Sr..
37._ Approved:plaps are to_.bc mturtied to_;.,,. Atmlicant.. -- - - -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 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
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. Ntvv- ._ yo
•I hereby affirm, sander penalty of perjury, that inform 'io � r�veded` is rm is true
to the best of my knowledge and belief., False atejn nts ..ad ark u °skiable as
a Class A misdemeanor pursuant to Sec ' n d 0.450 e P
SIGN A TURES & OFFICIAL T'IT'LES:
629W
Mailing Address: ................................... Cronin Engineering, P . . , P . C .
".John Walsh Blvd, Peekskill, NY 10566
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENYI_RONMENTAL HEALT$. SERVICES _ ._
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner Z7 Ggoialu f �'1 vA D cos-LP Address J-7 GCZvT�N 13M IZD 0551MAJ4 � y,
Located at (Street) K ,6414 ,i )-b,v6 fwA-O Tax Map 8q Block _ Lot Z$ Zcj
(indicate nearest cross street)
Municipality(?') &EA/AM VAt ijal Drainaae Basin
%wl)Sow 2
'/DaateofPre-soaking__,c>,q-o'7-qLI SOIL PERCOLATION TEST DATA
Date of Percolation Test
Hole No.
Run'No.
Time
Start - Stop
Ela a Time
N11 n.)
De th to Water
from Ground
Surface (Inches)
Start Stop
Water
Level
D In
Inro ches
Percolation
Rate
Mindnch
��
1
)zzl3�
1S.
IS ZI
3
2-41
2.
137_ ji-S
3
�
3
1 rr _ z)3
l�3
21
.3
6
4
5
l i� 36
Ipi 21
3
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PlUTEb: 1. Tests to be repeated at same depth until approximareq equal percoiauon razes are oommea aE caul
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
e � 4
2
`v
TEST, PIT DATA
DESCRI{IP7I'IlON OF -SOI LS,EN REW-K- TIES - - iiii101LE& - r
DEPTH HOLE N0. l HOLE NO. ' Z HOLE NO. 33
G.L. I-V JO gat L -t7-)P <o t z- i
0.5'
1.0' ccia [,vv.4,o� 1�•,
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'
Indicate level at which groundwater is encountered nja &c' aVICV met.»
Indicate level at which mottling is observed A. AAA 0050 VO6
Indicate level to which water level rises after being encountered
Deep. hole observations grade by: AQ�qm /A 40- 72t eDate C)3 Zq_g9
Design Professional Name: T1-.*",an4V 1— cgm nEw
�
Address: C P. fv
2 J G A''�
'
L
Signature:
62980
FES51oNP
Design Professional's Seal o "KU
617.20 SEAR
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
-, -
For UNLISTEDYAG TIONS, Only,,
Part I - PROJECT INFORMATION (To be completed by Arwlica'nt or'Proiect sponsor) -
1. APPLICANT/SPONSOR:
2. PROJECT NAME.
37 Croton Dam Road Corp.
Putnam Chase Subdivision, Lot # 12.
3. PROJECT LOCATION:
Municipality Town of Putnam Valley County 'Putnam County
4. PRECISE LOCATION: (Street address and mad intersections, prominent landmarks, etc., or provide map)
Kfamers Pond Road Sassinom Drive
5. PROPOSED ACTION IS:
NNew OExpansion ❑Modification/alteration
6. DESCRIBE PROJECT BRIEFLY:
construction of subsurface sewage treatment system and individual well water supply
7. AMOUNT OF LAND AFFECTED:
Initially _C, 2 _acres Ultimately acres.
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
I[Yes ONo If No, describe briefly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
Wesidential 01ndustrial OComniercial OAgnicuftural' OPark/Forest/Open space 00ther
Describe:
Sufmunding.lands.am.zoned.single family. residential
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (FEDERAL, STATE OR LOCAL)?
RYes 13No If yes, fist 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?
WYes qNo 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?
13Yes WO
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant/Sponsor name: Cronin Engineering j?F C. lKeilh Slaudohar date: 0419-00
Signature:
41 LI-1
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
OYes ONo
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a
negative :deplaration_may. be. superseded
Ayes ONO
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 term, short term, cumulative, or other effects not identified in C1 -05? Explain briefly:
C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly:
D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT
OF A CRITICAL ENVIRONMENTAL AREA (CEA)? DYes ONo If Yes, explain briefly:
E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
bYes ONo If Yes, explain briefly
Part Ill.- DETERMINATION OF SIGNIFICANCE (Tote completed by Agency) - -
" `fNS7Rt &nONS: For each adverse effect id6iff ed above,'deteirriine wfiefhef fi Ws 615stantial; large, important or otheivuise signific ant.- ':;
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
OT
D 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.
O 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:
Name of Lead Agency
Print or Type Name of Responsible Officer in Lead Agency
Title of Responsible Officer
Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer)
date
RE: Properly of 37 Croton Dam Road Corp.
Located at Sassinoro Drive /Kramers Pond Road
T/ Putnam Valley Tax Map # 84 Block 1 Lot
Subdivision of "Putnam Chase Subdivision"
Subdivision Lot # / Z Filed Map # 2#3"L Date Filed
Gentlemen: .
This letter is to authorize Timothy L. Cronin III
a duly licensed Professional Engineer x to apply for the required
wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance
with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam ..
County Health Department, and to sign all necessary papers on my behalf in connection with this
matter and to supervise the construction of said wastewater treatmerl an pwater supply systems
in conformity wi - - le 145. and/or 147 the tdt a ti awt the Public Health --
'th �o�usmo - Artic
_,...... _.._ 1 _
the. - � . ....._ _ .. ... ..
w; and
P.E.,
Mailing Address 2 JM r-� Blvd . #200
Peekskill
State NY
Zip 10566
Telephone: (914) 736 -3664
Very trUA Yob 1 % It. - ('I
- IIS�II��IIsl.l�ll� ►.�
Mailing Address: 37 Croton Dam Road Corp
.37 Croton Dam Road, Ossining
State NY
Telephone: (914) 739 -7362
Zip 10562
Form LA -97
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
A 'r WAVIT - C®I'Lr012ATE OWI�IEn APPLIOATIONN
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
j Val Santucci
represent that I am an officer or employee of the corporation and am authorized to act for:
Name of Corporation: 37 Croton Dam Road Corp.
Having offices at: 37 Croton Dam Road, Ossining, NY 10562
Whose Officers Are:
President - Name: Val Santucci
Address: (Same as above)
Vice President - Name:
Address:
Secretary -Name:
Same.as President
(Same as above)
Michelle Santucci.
Address: ame as above)
e)
. ... .:..:.: -
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 befo a me this ` � day of
jl (x ;nth) 200 year)
Notary Public
KELLY M. LENT ®� Ol'a$e Seal
Notary Public, State of New York
No. 01 LE6026834
Qualified in Westchester Coun
Commission Expires June 21, 2
Form CA -97
V ®�
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