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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -1 -61 BOX 33 I !�`l . ■ , 'T ,, I I in I I 04349 r. -...... _,%-A-o PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL - - CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR S MENT SYSTEM PCHD CONSTRUCTION PERMIT # PV' 146-00 Located at 31 KRAMeRr Porn 1?0AA ^ Town or V&ge VALL45"i — Owner /Applicant Name 37 cRoTaN OR/%7 RoAl2 CORP. Tax Map � �f Block I _ Lot 61 Formerly Subdivision Name Fu i tJ ov M CN14 SE' Subd. Lot # I 1 Mailing Address .20 -21 Winn mo ?,r Po d P RD_ 1?u T'h► r4 M l✓A. L L t i Zip I 0'T'7 °1 -.r Date Construction Permit Issued by PCHD i0 a v+ 2 I 2060 39 cRQTaN 1019M Ropy Separate Sewerage System built by 39 CRMiJ Aft l 17600 CCO.. Address Os S1 d Jnic, /0-y- 106wz Consisting of 12 So Gallon Septic Tank and �0- 12EiZ FO Rp Te:,0 PAC ?I P6 I/J 24" GRAVCL Other. Requirements: Water Sup lv: Public Supply From Address f Pu —1d n aV6�i L� Private Supply Drilled by f f gCAL Soy-! -f irk C - Address rRe Ws'T612, N Y. W-61 1304ing.Type SU-)CLC - FAMI L Lf . HRs erosion cnntro! been cQ iplefed? :_�/'�S. .....z n Number of Bedrooms ro v Has gar g��g ti&I installed? ly J I certify that the system(s), as listed, serving the o re 5;+ere ns cted essentially as shown on the as- built plans (copies of which are attached), in r; trued C Construction Permit and approved plans and the standards, rules and regulatio o utn "`ity D ent of Health. Date: 6 Certified by P.E. R.A. Address 7 J JA �\ v: y License # 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 revocatio modifi tion r an e i ecessary. By: Title: Date: 2 S o White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 c a s .- ' PUTNAM COUNTY )[DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 91 VklgM Ea.r Piiii b WELL COMPLETION REPORT 'Lri�tiioie- t�'��Put- CYiase 3ubde Kramers Pond Road, .Lot 17 own ill ag. Putnam Valley ax Gricl # 84e -1 -61 Map Block Lot(s) Well Owner: Name: Address: VS Construction, 37 Croton Dam Road, Ossining, NY 10562 Use of Well: 1- primary 2-secondary Residential Public Supply Air cond /heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment _ x Rotary Cable percussion -g Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing ](Details Total length 42 ft. Length below grade 41 ft. Diameter 6 in. :. Weight.per foot 19 lb /ft. Materials: X Steel Plastic Other ^Welded Joints: _ 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 Field 'Pest _ Bailed X Pumped X Compressed Air Hours 6 Yield 6 gpm ][Depth Data Measure from land surface- static (specify ft) 30' During yield test(ft) 440' Depth of completed well in feet 505' 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 20 Drilling in ove urden clay boulders 2 Hi t rock at 201 -� : 20� ° - - - - -42_ ", : Dri'l1 i' .ih-- rdak :yet =cas fad 42 505 Drilling 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 Depth 460' Model 5G810412 Voltage 230 HP 1 Tank Type WX30 V u 8,gal . Date Well Completed 11/17/00 Putnam County Cert ification No. 002 Date of Report 6/1/01 Well r s e) Beal NOTE: Exact location of well with dts anc o a east two permanent lancimarKs to ne 7aea on a separate sneevplan. Well Driller's Name P. Address: 4 Rftomm Ave -, Bnjoter, W 1f'M Signature: Date: 6/1/01 Perry Beal White copy: HD File; ellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 NORTHEAST LABORATORY of DANBURY \N ACco',, 19 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404 0` 'o •; �:. �2€ 13�:' �" 8�4tf2 '.;'l�s�f•(i�U3�.7�+s= oFi�2'�. _;,;;� .., -; 1Y' �i -;eif:= �1147.1:.'.p:.�::;:, -�• �.:.�.- U a = LABORATORY REPORT REPORT TO: P.F. BEAL & SONS DATE SAMPLE COLLECTED: 6/1/2001 4 PUTNAM AVENUE TIME COLLECTED: 1:00 P.M. BREWSTER, N.Y. 10509 COLLECTED BY: C. BEAL DATE RECEIVED @ LAB: 6/1/2001 TESTED BY: LAB #11471 LAB I.D. # PFB -65 REPORT DATE: 6/7/2001 SAMPLE SITE: V.S. CONSTRUCTION, LOT #17, PUTNAM CHASE SUB. DIV., PUTNAM VALLEY, N.Y. SAMPLE POINT: HOSE BIB @ TANK SOURCE: WELL 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 15 • Odor 1 -MUSTY - - 3 Units • pH 7.00 - EPA 150.1 No designated limits • Turbidity 0.25 NTUs EPA 180.1 5 NTUs CHEMISTRY: • Nitrite Nitrogen _ .._._......._.._<0`.005._ __mg/L.as:N _V..NitratENiliog en 0.25`.�:�asN -__ SM4500D mg/L° • Alkalinity 6.0 mg/L SM 2320B No defined limits • Hardness 58.0 mg/L EPA 130.2 No defined limits • Iron <0.03 mg/L EPA 236.1 0.30 mg/L • Manganese <0.01 mg/L EPA 243.1 0.50 mg/L Combined limit for Iron plus Manganese = 0.50 mg/L • 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 TNTC =Too Numerous To Count * *Notification Level * "Action Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: MIPOTABLE or ONOTPOTABLE RESULTS BASED ON SAMPLES SUBMITTED: 6/1/2001 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 BOTH` � , . _� �R�1� IQ1 ~1✓1 �+. 1`�F� t': :,` '. : °t' ,=„� i ,. ... June 4, 2001 The Lindy Building; Suite 200 2 John Walsh Boulevard Peekskill, NY 10566, 914- 936 -3664 Fax 914 -736 -3693 Adam B. Stiebeling, Assistant Public Health Engineer Putnam County (Department of Health 1 Geneva Road, Brewster, N.Y. 10509 IRE: 37 CROTON DAM RAID CORP. " IPITi'NAM CHASE SIBIDWISION" KRAMERS POND RAID, LOT 17 P.C.D.H. PERMIT #PV46 -00 THESE ARE TRANSMITTED as checked below: ❑ FOR APPROVAL ❑ FOR YOUR USE ❑ AS REQUESTED ❑ FOR REVIEW AND COMMENT X PLEASE REPLY WE AM SENDWG YOU attached 1.) Three copies of as -built subsurface sewage.tre4tmen .sys!em.p➢zn..� 3.) Three guaranties of SSTS 4.) Copy of survey showing foundation location 5.) E911 address verification form 6.) $200 certified check for application fee. 7.) Soil data sheet ei= Should you have any questions or require additional information regarding this matter, please contact me at the above phone number. Thank you for your time and assistance in this matte. i pe ctffu ➢ ➢y submi ted, neth M. ur y Project Designer J zJ 0 InThe Lindy Building, Suite 200, 2john Walsh Blvd., Peekskill, New York 10566 Tel. (914) 736-3664 • Fax. (914) 736-3693 94- June 21, 2001 Adam B. Stiebeling, Assistant Public Health Engineer -,5 Putnam County Department of Health Division of Environmental Services I Geneva-Road. Brewster, N.Y. 10509 Re: SM Construction Compliance 37 Croton Dam Road Corp. P.C.D.HPermit #PV-46-00 "Putnam Chase Subd " Lot 17 Town of Putnam Valley Dear Mr. Stiebeling: -U Enclosed is the folloyy* information-necessary- -for finalAppioval fqr.the.- abo ed:-'.--.. ve;Tef=e-nc I Laboratory Report 2.) Well Completion Report The.original construction Compliance package was submitted and received by your office on June t' for review only. Kindly review the documents enclosed. Should you have any questions or require additional information please contact me at the above number. Thank you for your time and assistance m this matter. N, Respec full sub d, M. Murp y Kenneth:9 Project Designer BRUCE. Public Health Director -MOUNARY-R.N., Associate Public Health Director Director of Patient Services DEPARTMENT OF BEALTH I Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278.6678 - Fax (914) 279 - 6095 Early Intervention (914) 278 - 6014 Preschool (914) 278.6082 Fax (914) 278 - 6648 OWftRS NAME: TAX MAP NUMBER: 5e( E911 ADDRESS: TOWN: AUTHORIZED TOWN OF . (Signature) DATE: '51 'E=TO4 . &A-0 . &ef. t A The Putnam, County Department of Health, will not issue a Certifiate 'of Construction Compliance unless the above form is completed, ioeo9 a legal E911 address is assigned by an authorized town official This form is to be subiaittid wrath the application for a Certificate of Construction CompUance. (E91 I VERMNO v, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES E7E- �SUBSUREACE .SEWAGE,TREATMENT-SYST,E -M :- 32 C 120 T o iJ D;9/'h R.6 A/' Owner -1,9 cPoTow 0&9 RoAn colZP Address a r r i,,j a N. y. i o S-6— -L Located at (Street) _1i Kar inert -r ' I90 db fLoA0' Tax Map 81t Block I Lot 6 (_ (indicate nearest cross street) ' S v 3L °'r : 17 Municipality? w;j or- Po -jArs l%pice� Drainage Basin PtFeK,[d i Lc., No L c U w g_)Zao K SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test Hole No. Run No. Time Start - Stop Elapse Time t1VIin.) Depth to Water F rom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Mitanch 1 2 3 4 5 1 3 4 5 1 2 3 4 5. . NOTES:; ' .1. Tests to be repeated at same depth until approximately equal percolation rates are ootainea 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. S Form DD -97 a; 2 " TEST PIT DATA flDESCPJPTION OF SOILS ENCOUNTERED E'4 TEST HOLES -Z� ^: - : '%�`-M'+�:.o -P. .. '. _' '�:.`i- :...::.K}i•.�y,c r�-�C��: yam: -,. y�.n�•, .:j -;•. t .... DEPTH ^ ` HOLE NO. HOLE NO. HOLE NO. G.L. W) I'm TRIOcef uaL 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' A. 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 datJ6 &Jcdu,-J-TetzLrn Indicate level at which mottling is observed ,JoNdl` ar rerw4cro Indicate level to which water level rises after being encountered tj /4t Deep hole observations made by: Ttmo-rni L ctZ.bijW Date J 2-7 v 1 Design Professional Name: Ti mo Tm f L. c fR o,,j + iJ s, " of Address: t,1jiia i t) '',_ s u o 1-6— 2 y o Signatur .cc f Design Professional's Seal x Uj FG - nVOFESS%O P�. iz NOO.24'43 "E 136.61' Guy 1-24'43")r 77�1.4f' IN S70058'01*'E 106.24' * S68043'49•E 31.98' -R—M5.00, L-70.92' 0 f U.1 located at As "-v _,777 ---- -- - - --------------- - ---------------------- - - 7S:7h� 0 �wn on a map filed in the %tnam County Clerk's Office, Division of Land Records on July 25, 2000 as map no. 2832. Situate in the Scale: Afa y 96, 1999 Date of Field Sum Arow 28, 2000 Date of This Map March 15, 2001 Foundation Location Well Guy 1-24'43")r 77�1.4f' IN S70058'01*'E 106.24' * S68043'49•E 31.98' -R—M5.00, L-70.92' 0 f U.1 located at As "-v _,777 ---- -- - - --------------- - ---------------------- - - 7S:7h� 0 �wn on a map filed in the %tnam County Clerk's Office, Division of Land Records on July 25, 2000 as map no. 2832. Situate in the Scale: Afa y 96, 1999 Date of Field Sum Arow 28, 2000 Date of This Map March 15, 2001 Foundation Location "� l� � w � 3r t i Lyi �,r i, d`�` .� j. �, ,v ♦ � �, y i �i �4 r . Y' f � � ✓ dppi x i r•i�v��^ tt -.�i ku �y ��Yt� 9 f z 1yq � S i PUT. NAM CQUNTY DEPT �ARTMENT OF DIVISIONDY ENVI R ONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purcliaser`of Building ;P 37 2OAD a2P. Building.Constructed by 3+ > (IAMCIL C 106 � l2a�n Location - Street 56VT: gel 614 Zv : G t Tax Map Block Lot f„ l 7i.ciNAM I%LLf � illage dAM 1.14ASE- Subdivision Name. Building Type Subdivision Lot # . a, 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. cThe undersigned further agrees to accept as conclusive the determination of a Public Health. Director of the Fqtnam, County Department of Health as to whether n t fa a of the system to op rat a aus d by the willful or negligent act of the occup t o bu g utilizing the `i DaY Z Year b 6 Title: . 7 (Owner) - Signature CiLOT&O IMAM ?.:QA 0 00 R. P. 3 etr � �>Am 2oAl) C. oe... Corporation Name (if corporation) Corporation Name (if corporation) Address: 3 0 -r 4 DAM EoAJ). 0_550WWO State 7J. y Zip /a5 z Address: 51 C6-6,0 PAg -2Lk, �. ©_-,5,,A)11vG State /�/ y Zip 1256 e, Form GS -97 DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL ITE1\SPECTION. Date: Street Locaj \ Owner 3� �!pectedl � y. Town Subdivision Lot (# 1. Sewage Svstetli Area YES ® COl ElV'I'S 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 grater course / wetlands ...... ............................... II. SeAge System a. Septic tank size -1,000 ......... ,2" ........other................ b. Septic tank installed level .................... :.......................... c. 10' minimum from foundation...._ ...... ............................... d. Distribution Box . All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction B�ox. - properly set ......... ............................... f. a "1" ches J. Length required Leng & installed 2. Distance to water a asured F 3. Installed acco g to plan .. ........ I ...................... 4. Slope of tre acceptable 1 16 - 3211/ ot... ....... .. 5. 10 ft. fro property line - ft: f un do 6. Depth o ench <30 inches" om s e ................ 7. Room 1 wed for expanse n, 100 ................. 8. Size f avel 3/4 -1 %:" ameter ...... ......... 9. Dep o gravel in trenc 1211 mi um ................... 10. Pipe nd capped......... g. RumR or d Systems -. . Size otp ch r ........ ............... . ........... 2. Overflow t ........... 3. Alarm, visual/aud• ........ ... ........................ 4. Pump easily a ible anh to grade ................. 5. First box ba ed ........................ ............................... 6. Cycle witnessed by ..estimated flow /cycle......... III. ouse[Buildin a. House located per approved plans... ................... .. b. Number of bedrooms ................... ............................... IV. We] I a: Well located as per approved plans.... .�,..... ........ b. Distance from STS area measured ft........... c. Casing 18" above grade ................................................. , d. Surface drainage around well acceptable ....................... M. 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 & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................................................ n_.. tines - AM C®UN'I'1''DEP1R1'MEN'C F HEATH' DMSION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION XADAM All information must be My completed prior to any inspections being made. Q GENE For: Fill Trenches '---' I MVL Wl PCHI) Construction Permit # PV-4C-00 Located: K(kaMj[rt4 Po jo ROAD (T) (u) rL VW Lc.e' K Owaer /AppkW Name: X7 GRa-ro•,► M^ Rc Ao SRI° TM 8� Block + Lot 61 Formerly: Subdivision Name: Pu TN A P-% CMp ,tom' J Subdivision Lot # 11 Is system 811 completed? � 12 Is system complete? Vie; f Is system constructed as per plans? Y6 X Is well drilled? xcr Is well located as per plans? Yt -r Are erosion control measures in place? e-r Date: Date: 19JMI L Z 10 `.r?.00 Date: I certify that the system(s), as listed, at the above premises bas been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations of the Putnam County Department of Health. Date: %gPRIL Z? 2^ 00 I _ Certified by:Tirg2mY C. CFa'.+r PE tRA DesignFProfessional ..' _ r ...... _�.....�__ Address: Z 'SoHN W LSH Wlyo PEEKSK�L rJy. I pS66 Lic. # a� L 86 Comments. 6X'1 R+9 J06C IO i 6'J r )4O Le WA,f psN tr 11*1) F'XPA0,+ -r1 6 N d 99,4 .e- -c q we- O F Re- Ci Ap i .c! G ?tcpsc: :zNJ,pe cT. Form FIR-99 - f O iLPIL V AOIBLViN ®r MIN \Y JilnUIMMIN R 1_1�&Ld IMMAULd i[ im k�)Ilm V A�.jtjn iC6NSTRtC`I ON PEI I PERMIT # _...:. Located at r /Kramers Pond Road TownixXV4hip Putnam Valley Subdivision name Putnam Chase Subd. Lot # 17 Tax Map 84 Block 1 'Lot 61 Date Subdivision Approved 01 _25— 00 Renewal Revision Owner /Applicant Name 37 Croton Dam Road Corp. Mailing Address 37 Croton Dam Road; Ossining, NY Amount of Fee Enclosed $300.00 Date of Previous Approval N/A Zip 10562 Building Type Residential Lot Area 3.22 No. of Bedrooms 4 Design Flow GPD 800 Fill Section Only Depth Volume PcCHD 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 444 L.F. To be constructed by 37 Croton Dam Road Corp. Address 37 Croton Dam Road, Ossining, NY 10562 Water SuDiDly: Public Supply From Address or: - ;X Priy tc:Stipply�rlled li :':P:Ib....Beal &; :Sons, -Inc. - .. Address 4: Putiram ,eve _ A 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 described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regplations of the Putnam County Department of Health, and that on completion thereof a "Certificate of ConstrucionCem�pTlii<e�' satisfactory to the Public Health Director will be submitted to the Department, and a written guarar►�eel'�be Mshe . e owner, his successors, heirs or assigns by the builder, that said builder will lace in good o e � t condition . _. said sewage treatments stem during the period of two (2) years immediately follo3wft the dale of is th pr al of the Certificate of Construction Compliance of the original �:.. system or any pair theret Signed: Address 2 J r �u J P.E. _ R.A. 10566 Date - 9— v)—cu 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 necess by Public Health Director. Any revision or alteration of the approved plan requires a new pTte estic sanitary sewn a only. By: Title: Date: I Zti White copy - HD File; Yellow copy - Building nspector; Pink cop' Owner; Orange copy - Design Pro ssiona Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL _ PCH� ••. :re.. .. •o •.e 3r.r.. A•:.•• —,�., .rte ..' —•r• •pleate-pn66r't5je D Pe11111t # •,.. Well Location: S eet : . Town/Idiliage Tax Grid # / Su4 Kramers Pond Rd. LOT 17 Putnam ValleyMap 84 Block 1 Lots) 41 Well Owner: Name: Address: 37 Croton Dam Rd Corp 37 Croton Dam Road, Ossining; NY 10562 Use of Well: X Residential Public Supply Air /Cond/Heat Pump Irrigation 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 _ New Supply (new dwelling) Deepen Existing Well Detailed Reason Water supply for new residence. for.Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ........................... .I... Yes No Is well located in a realty subdivision? ...................................... ............................... Yeses(_ No Name of subdivision o r\ M ' N A S • Lot No. 1'T Water Well Contractor: P.F. Beal $ Sons, Inc. S�4 Ave., Brewster NY 10509 Is Public Water Supply available to site? ........................... Sit � ,�..1:.�c��; ...... Yes No X Name of Public Water Supply: N/A �° To . N A Distance to property from nearest water main: :�•?.•s i, Proposed well location & sources of contamination 'pr vided,p`' ate s e plan. Date: — Z `i -CO Applicant, Signature:. . .pl? .� 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 driller certified by Putnam County. Date of Issue Permit Issui Official: Date of Expiration t S + Off,. Title. Permit is Non-Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH ' DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR, °A WAS7t'Eii�-ATE� `I'It]�A•1��'i''S�SiiF1VT .... �.,.:: ... _ ..:, ';�:•::. _..:;_� :.:.�: 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 # jZ 3: Location T V: ' Putnam Val ley 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 Off ce Building Realty. Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type P (check one) ..................................... ..... Tvpe I _ Exempt v e Status ........ Type II Unlisted X 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... No 10. Has DEIS been completed and found acceptable by Lead Agency? ............ ..... N/A 11. Name of Lead Agency Town of Putnam Valley Planning Board 12. Is this project in an area under the control of local planning, zonmg, 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 granted: 08/02/99 15. Tvpe of Sewage Treatment System Discharge ........::....... surface water X groundwater 16. If surface water discharge, what is the stream class designation? .................... N/A 17. Waters index number (surface) .................. N/A 18. Is project located near a public water supply system? ....................... 19. If yes, name of water supply N/A Distance to water supply N/A 20. Is project.site near a public sewage collection or treatment system? ................ NO 21. Name of sewage system N/A Distance to sewage system .N /A 22. Date test holes observed 03/29/99 23. Name of Health Inspector Adam stiebeling r 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 29. Is Wetlands Permit required? .................. 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 84 Block 1 Lot 01. 37. Approved plans are to be returned to..... Applicant X Design Professional OTP.,- All -applicaf ors -fo reView dfid'Approval of a- new °SSTS to'be-located-wiftfl- the-4Y Watershed d 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 stonmwater.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. ,Uer& affirm, sender penalty of perjury, that information provided on this form is true t/a'3est of my knowledge and belief. Falsest enis trade herein are punishable as r lads A misdemeanor pursuant to .Sectio 210 5 of the Penal Law. C:) Mailing Address:..... ...... ......................... Cronin Engineering, P . E . , P . C . .._; John Walsh Blvd, Peekskill, NY 10566 27. Is any portion of this project located within a designated Town or State wetland? NO I rids ID Numlier. N/A 29. Is Wetlands Permit required? .................. 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 84 Block 1 Lot 01. 37. Approved plans are to be returned to..... Applicant X Design Professional OTP.,- All -applicaf ors -fo reView dfid'Approval of a- new °SSTS to'be-located-wiftfl- the-4Y Watershed d 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 stonmwater.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. ,Uer& affirm, sender penalty of perjury, that information provided on this form is true t/a'3est of my knowledge and belief. Falsest enis trade herein are punishable as r lads A misdemeanor pursuant to .Sectio 210 5 of the Penal Law. C:) Mailing Address:..... ...... ......................... Cronin Engineering, P . E . , P . C . .._; John Walsh Blvd, Peekskill, NY 10566 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner - -87 CA-0-MN Q,4 M &A p GuXP Address M Cao'MAJ L)?, -2t nmj IZ D OS -jAjjV4 Aj Located. at (Street) cnS 'e.Kib rzp4v Tax Map Pj_ Block 'I Lot Z,6 4T (indicate, nearest cross street) Municipality(?' t-toll Drainage Basin PLAMIAM tbuotj cg�mg SOIEL PERCOLATION TEST DATA Date o € Pre - soaking o-q--o-i —9`i Date of Percolation Test Hole No. Run No. Time Start - Stop ]Elapse Time (Min-) Dvth to Water from Ground Surface (Inches) Start Stop Water Level ro D In Inches Percolation Rate Minftch 34 1 wo'— 10:"L 10 —2,3 3 9 2 to3 Z.- 1671 3 3* 3 _9 4 ..5 '1&'7— IpSl.. 3 3 3 4 5 .4 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min fbi 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitW for review. .2. Depth measurements..-to be made from top of hole. Form DD•97 2 TEST PIT DATA D RI-T G1LS -ENC0 NTE " T HOLES DEPTH HOLE NO. G.L. �, LEN ®. .5 HOLE N®. �o l� 5,p! L- 0.5 ' :. 50 IL 1.5' 9c 2.5' uWA; 3.0' 4.0' ._.. 4.5° 5.0' 7,4J 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5° .�. ... ... ��.'_ •. ti.. _ r .� ... ._ .. -r s.. =r..F ' n. _..... .. ...y y.ar � - .�.- 1-•. �.av -+erg ^4.. ..; .. t.c�. 9.5' Indicate level at which groundwater is encountered Indicate level at which mottling is observed .K...- Indicate level to which rii$ter level crises after being encountered�j 5 Y R Deep hole' made by:- , � G® � D ate:` I�esi ®sional IVaane. ._ ....., ..: : . signpLE4: '25 62 09,81 , ~Ki►F E 3Sti0NP 'a SEAR Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL' 'ASSESSMENT FORM For UNLISTED ACTIONS Only Az Part 1 - PROJECT INFORMATION (To be comoleted 'bv ADDlicant or Proiect soonsor) 1. APPLICANT /SPONSOR: 2. PROJECT NAME: 37 Croton Dam Road'Corp. Putnam Chase Subdivision, Lot # 17 3. PROJECT LOCATION: Municipality Town of Putnam Valley County Putnam County 4. PRECISE LOCATION: (Street address and road intersections, prominent landmarks, etc., or provide map) Kramers Pond Road / Sassinoro Drive 5. PROPOSED ACTION IS:. Wew ❑Expansion OModification /afteration 6. DESCRIBE PROJECT BRIEFLY: construction of subsurface sewage treatment system and individual well water supply 7. AMOUNT OF LAND AFFECTED: Initially, . ° acres Ultimately :, - t. � acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ®Yes . .ONo . If No, describe briefly. 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? . •Wesidential 01ndustrial OCommercial OAgricultural OPark/Forest/Open space 00ther Describe: Surrounding lands are 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)? ®Yes ONo 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? vYes . ONo If yes, list agency(s) name and perrnillapproval Subdivision Plat Approval — `Putnam Chase Subdivision" 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? OYes BVo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/Sponso ron► P.C. Keffi Staudohar date: 0419 -00 Signature: U If the action is in a Coastal Area, and you am a state agency, complete a Coastal Assessment Form before proceeding with this assessment OVER 1 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 ❑No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a �negative declaration pmt ay be superseded by another involved agency. , ;�La.G e$ i' -ra :.c _.I�4V�ii� ',:. �.' —... o- -•..: y y.. r+ %✓ .o . ". �r s . , aK=id - ^..t�r..... .,.. =.rrr. ,,s` -' : s— C" Yoz,.:• =a m_:.:'o' a_.'iuu"v' . i+ •`" <t' +.. t�ii' C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: Answers may be handwritten, if legible. C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: . C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly: C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. Long term, short tern, cumulative, or other effects not identified in C1 -05? Explain briefly: C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? ❑Yes ❑No If Yes, explain briefly: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? Yes ❑No If Yes, explain briefly: Part III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) - l ISI$ � � �Eor:e ch adverse f6eci"sdentifLd ove; determine whether-.it4s substant!alF large, important orot henuise- srcJnificart. r _ 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 envnronmentai ❑ 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 tfl11LL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency date Title of Responsible Officer Signature of Preparer (If different from responsible officer) Print or T uameDf Responsible Officer in Lead Agency Uj C:D Sq f Retponsible Officer in Lead Agency C C Name of Lead Agency date Title of Responsible Officer Signature of Preparer (If different from responsible officer) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .... :.: - Ar h' D�i'6IT - C ®RPORA�' 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 I. Val Santucci represent'that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: 37 Croton Dam Road Corp.. Having offices at: 37 Croton Dam Road, Ossining, NY 10562 Whose Officers Are: President - Name: Val Santucci Address: (Same as above) Vice President - Name: same as President Address: (Same as above) Secretary -Name: Address: Treasurer - Name: Address: Michelle Santucci (Same as above) 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 befo e me this(Ot-k- day of �(aonth) 2 oo o 7 (ygar) Notary Public KELLY M. LENT Notary Public, State of New York Corporate Seal. No. 01 LE6026834 Qualified in Westchester Count Commission Expires June 21, Form CA -97 t e 44tporation with respect PUTNAM COUNTY DEPARTMENT ` OF .`, DMSION OF ENVIRONMENTAL HELTH SERVICES LETTER OF AUTHORIZATION Property of 37 Croton Dam Road Corp. Located at Sassinoro Drive /Kramers Pond Road T/ Putnam valley Tax Map # 84 Subdivision of "Putnam Chase Subdivision" Block ? Lot 61 Subdivision Lot # 17 Filed Map # 28 3,2 Date Filed 67—X560. Gentlemen: This letter is to authorize Timothy L. Cronin III a duly licensed Professional Engineer X to apply for the required wastewater treatment and/or water supply .permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department _ o sign all necessary papers on my behalf in connection with this matter and to super is of said wastewater treatme t an water supply systems in conformi with e P �a�i6d 'c 145. and/or 147 of th cati aw, the Public Health z7W .:; — .. and the dliitai�'. i3 _ Very trul 'our, Counte ed: CFO. e2�so ���, Signed: Q Pres . P.E., # 0629 NKUFESS0 ( erof r erty) Mailing Address 2 John Walsh Blvd. #200 wiling Address: 37 Croton Dam Road Corp Peekskill State NY Zip 10566 Telephone: (914) 736 -3664 37 Croton Dam Road, Ossining State NY Telephone: (914) 739 -7362 Zip 10562 Form LA -97 L�3ZP.;sk1trr?A C5 PC: tG ,i I i� I 'ra f, �3 ZO 7/ -A' / -7 9 PUTNAJ COUNTY DEPARTMENT OF HEALTH HOUSE .PLA.NS APPROVED FOR ELDPj,00Pfi COUNT ONLY, ALL SUL-51-IENT sYE I51C)NIA,LTEPATIOr4S TO THESE HOUSE-, 1'6 oli FOR APPROV SIGATiTRE TITLE O -- sh - 102 "1 M / / i_ l��l!ff i ! 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