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HomeMy WebLinkAbout4350DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -1 -62 BOX 33 04350 !7%. 'IN JI Is ?IIIre I egos I III �� �. r .� :.�� , Y , ,. -� ; 04350 PUTNAM COUNTY DEPARTMENT OF HEALTH DiV IOl' OF-E VIRONMEN SAL HVXLTWS RV fCE9 CERTIFICATE OF CONSTRUCTION CO PLIANCF FOR SEWAG SYSTEM PCHD CONSTRUCTION PERMIT # Located at 29 klogm 2,r' ion 00,gn Town or Hage i'�T�irq M L% L LC � Owner /Applicant Name 39 c Ro Twi P4 in i?sAb c42P, Tax Map Ste_ Block 1, Lot - 6 Z Formerly Subdivision Name PJ 7NAfn c N#gXLr Subd. Lot # ►� Mailing Address S9 I(fL,� NI�'R x 100 i+, V-640 PU T�JA M LIA L I-C l /J . j/._ Zip I 0 S" 7 `3 Date Construction Permit Issued by PCHD NO ", Zo Zy d v 39 eRoTda .0,41� ROAP Separate Sewerage System built by 37 cR�Ta;� D�3r� 1Z0 cQ2P. Address ossJ� i� c N,y. / o S 2 Consisting of )250 Gallon Septic Tank and q'Y- e-,'F' OF ` �� Pc'RrofZQT6P Pyc PI X li 24{ y 61ZA VC-C -r, (-sN C-1 Other Requirements: 0 TO i B `' o F. eigN KR 0 iJ Water Supply: Public Supply From Address or: ✓, Private Supply Drilled by'PF V'5AL � Sad-r 1ti c . Address MZe-'JX -r6R /Ogg 7 Building Type T,­yLti gcr Has erosion control been completed? }��S Number of Bedrooms Ru P- Has I certify that the system(s), as listed, serving built plans (copies of which are attached),� plans and the standards, rules and. regul #dior. Date: 6— s / Certified by Address W614 A een installed? NEW Yn C3, y L. tirtU� %Vemi e§ wer'e- Ut ted essentially as shown on the as- Construction Permit and approved nt of Health. P.E. K R.A. License # 0 6'V) 80 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 sub 'ecI to modifi ti on or change when, in the judgment of the Public Health Director, such c g revoca modifi ti is necessary: / r P White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pro F. L.- I r • PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ WELL COMPLETION REPORT'..: Well Location - Street Addre s• v I Kramers Pond Rd Put –Chase Subd., Lot #18 Town/Village: ,, Putnam Va..�e Tax Grid # 84. -1 -62 Ma Block Lot (s) P () WeQ1Owner: -- Name: Address: VS Construction, 37 Croton Dam Road, Ossining, NY 10562 ,use off Well: ) =.pAmary 2= secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Willing ]Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) :Well Type Screened Open end casing X Open hole in bedrock _ Other dieing Details Total length 34 ft. Length below grade 33 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: X Steel _ Plastic _ Other Joints: _ Welded X Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: X Yes _ No Liner:_ Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second ,Nell Yield Test _ Bailed X Pumped X Compressed Air Hours 6 Yield 7 gpm Depth Data Measure from land surface- static (specify ft) 30 During yield test(ft) 260' Depth of completed well in feet 325' Welll 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 ' � in ave b=den clay and boulders 15 Hit ro _ at._151, _. . - set casing, 15 34 Dril-lini in roc 34 325 Drillinj in ro granite If yield was tested at different depths :during drilling, ,list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity _IqW Depth 280' Model 7=7412 Voltage 230 HP 3/4 Tank Type WX302 Vo ume 6 l . Date Well Completed ,:12/29/00 Putnam County Certification No.. 002 Date of Report 4/26/01 We roo a1 r1VG:➢'ll E: Exact location or well with Well Driller's Name P Signature: Perry L.,Aeall teas[ [wo permaneuL 1iu1u11i U&b w U viu,,u v„ a a�jj ."­ �.,.. �Y...... Address: 4 n Ave., Baaff terx NY 1009 Date: 4/26/01 ;,.White copy: HD File; ellow copy -Building Inspector; Pink copy - Owner; Orange copy Well driller Form WC -97 NE NORTHEAST. LABORATORY .OF DANBURY _ _ � X39 MILL PLAIN ROAD - DANBURY, CT' 06811 w CT Cert -PH -0404 < LABS (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 CHEMISTRY: • Nitrite Nitrogen • Nitrate Nitrogen • Alkalinity • Hardness • Iron • Manganese • Sodium • Lead <0.005 LABORATORY REPORT <0.20 REPORT TO: :.. ".` 3.0 mg/L . P.F. BEAL & SONS DATE SAMPLE COLLECTED: 2/8/2001 4 PUTNAM AVENUE TIME COLLECTED: 10:30 A.M. BREWSTER, N.Y. 10509 COLLECTED BY: BOB MAYES DATE RECEIVED @ LAB: 2/8/2001 TESTED BY: LAB #11471 LAB I.D.# PFB -22 REPORT DATE: 29 Krta►vtU 0"o n✓� 2/16/2001 SAMPLE SITE: V.S. CONSTRUCTION, LOT #18, PUTNAM CHASE SUBDIVISION, PUTNAM VALLEY, N.Y. SAMPLE POINT: HOSE BIB — TOP OF WELL 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 15 • Odor ND - - 3 Units • pH 6.46 - EPA 150.1 No designated limits • Turbidity 0.15 NTUs EPA 180.1 5 NTUs CHEMISTRY: • Nitrite Nitrogen • Nitrate Nitrogen • Alkalinity • Hardness • Iron • Manganese • Sodium • Lead <0.005 mg/L as N <0.20 mg/L as N :.. ".` 3.0 mg/L . 24.0 mg/L 0.043 mg/L <0.01 mg/L 1.2 mg/L <0.001 mg/L EPA 354.1 SM 4500D 'SM 2320B' EPA 130.2 EPA 236.1 EPA 243.1 EPA 273.1 EPA 239.2 1.0 mg/L 10 mg/L 'No—defined—limits—L.. No defined limits 0.30 mg/L 0.50 mg/L Combined limit for Iron plus Manganese - 0.50mg1L 20.0 mg/L ** 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: UOTABLE or ONOTPOTABLE RESULTS BASED ON SAMPLES SUBMITTED:2 /8/2001 Laboratory Director 1 h - ,,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 x c: `r ��:, � ":� � °k � 1 �A', i �,r � I,I •, .1L � � ' i �F, Y I,� s 3 � 3 i'; e v r I�l ? � a 5,0,E �7 .�� 6 1 "� +� � �•. "�,' �, ° '� ° L`1 �l � I � 3 '� � � � � � 6' ��} 1 e ``•; GUARANTEE OF SUBSU,RFAC1E SWAGE TREATMEla T SYSTEM �1,>Ir+9 124). e.: 8f� .r3 /�': / 6 z Owner or Purchaser of Building Tax Map Block Lot 3i L20T0� � UTm M /ABLE Building Constructed by o� illage . Z7 IIRA��� Pa,� 26 4"> f uTA)A M 0 HA-5E- Location - Street Subdivision Name ace Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent: act of the..occupant of the. building utilizing the _ system. " The undersigned further agrees to accept as conclusive the dete at n blic Health Direc r the tnam County Department of Health as to whether r no the of the system V o opat as us d by the willful or negligent act of the occup t of a ild' utilising the t th P'1v9`i Day IrnYear `266 i Signa e: Jul p Title:' Gen ral ctor ( wner) - Si afore Corporation Name (if corporation) Corporation Name (if corporation) Address: eemm AM Poo, yss n ►yP,,,o . Address: 3i l "A) J)A+ koA%), State %V . Zip D/ �.Z State I��• y Zip Form GS -97- BRUCE R. FOLEY Public Health Director LORETrA MOLINARI - R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 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) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278.6082 Fax (914) 278 - 6648 OWNERS NAME: TAX MAP NUMBER .5( E911 ADDRESS: TOWN: AUTHORIZED TOWN Of (Signature) &A-0 The Putnam -County Department of Health will not issue ''a Certificgfte 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. (E911VERFRK SS "AN .F__V i'. •:p• m _. '.�. ". 777 L=89.39' R=2.93.00', 4n'.Ai. � .M0. 18 located at a As shoum on a map filed in the Putnam County Clerk's Office, Division of Land Records on July 25, , 2000 as nwp no. 2832. Situate in the F PUTJVAJV VALLE. C, -OF ~ Scale: 1 " =50' .fay 26, 1999 ate of Field l�ov. 28, 2000.Date of This Magi LETTER OF TRANSMITTAL _.... _ v.�r..:. ..... .... .s.io =• r a'�i»`%.... -�'... ......�'8.° ..�. ,... ..L..�',;' _ ..- _.., :�..c._�.'.............: � .��:b= .:..��a.;.�m"R;.:.i'..... ... -,3.- •.+"'..... � °.mil' CRONIN ENGINEERING P.E., P.C. The Lindy Building; Suite 200 2 John Walsh Boulevard Peekskill, "NY 10566 914 - 736 -3664 Fax 914 - 736 -3693 Adam B. Stiebeling, Assistant Public Health Engineer Putnam County Department of Health 1 Geneva Road, Brewster, N.Y. 10509 RE: 37 CROTON DAM ROAD CORP. "PUTNAM CHASE SUBDIVISION" KRAMERS POND ROAD, LOT 18 P.C.D.H. PERMIT #PV -42 -00 THESE ARE TRANSMITTED as checked below: June 5, 2001 ❑ FOR APPROVAL ❑ FOR YOUR USE ❑ AS REQUESTED ❑ FOR REVIEW AND COMMENT X PLEASE REPLY WE ARE SENDING YOU attached ...�. K• _ . .. .-.- ... .. . «.. �. .i ...r. +.. _ r ..a ._ .. _.� �� I. .._. -,- ... -�.- C .... -. -. ,.J .....- .w.y... ♦ _ �r..�� Tyr._ . 1.) Three copies of as -built subsurface sewage treatment system plan 2.) Three certificate of the construction compliance. 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.) Well completion report 8.) Laboratory report 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. Respec fully submitted, /,'Kenneth M. Murphy Project Designer PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRO'NMEN -IAL HEALTH SERVICES f\ FINAL SITE PiSPECTION . Street To:_ wn TM # owlie'V - . Permit # Subdivision Lot 1. Sew ale Svstetb_Area YES 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. SeNAhge System a. Septic tank size - 1,000.....1,25 .........other ................ b. Septic tank installed leve .. ....... ............................... c. 10' minimum from foundation .......... ................. ............... d. Pistribution Box . All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.0riginal soil between box & trenches e. Junction Box -properly set ........... ............................... f. Trenches 1. engt required L led 2. Distance to watercou se ed Ft........ 3: Installed according t an ..... ............................... 4. Slope of trench ac ptable 1/16 - 1 /32 "/f t ..... ...... 5. 10 ft. from prop line - 20 ft: found ions........ 6. Depth of trenc 0 inches from surfa 7. Room allow for expansion, 100 /0. ....... ... 8. Size of grav 3/4-11/2" diameter an ................ 9. Depth of g vel in trench 12" m' mum ............... _._.. . Pipe`ertd Plre + T g. FuM or Dos d S stems 1. VtLb Vl r! 111/ V11411aVN1 •• .............•....•.•. :� ..... 2 ank :........ ............................. .......... 3. Alarm, 'is o .................... ........:...................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ............................. . ............................ .. 6. Cycle witnessed by H.D.estimated flow /cycle........... III. ouse/Buildin a. House located per approved plans............. ............ •. . b. Number of bedrooms .................... ............................... IV. Well 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 ....................... 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 ................. ............................... Date: tq - > ` 6/ CON11MMENTS .. Qi E 05/01/2001 10:12 9147363693 CRONIN ENGINEERING I PAGE 02 1 ; PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION ADAM 0 GENE REQJJFST FOIL FZiAL INSMCTION For: Fill Al information must be fully completed prior to any Trenches inspections being made. PCHD Constructio-11 Permit # ?V—`f z - a J Located: KP.*MrL9a ro"10 &240 (T) M FV770LJAr4 VALI-6;--( 0"er/ApphQ" Nam:37 go-rd-J 4wn Roga c-Gfe TM 94f Block t Lot _!EL Formerly: Subdivision Name: Pu1eJAf'4-Cnjg.-C Subdivision Lot # to Is system fill completed? „!2 Is system complete? ye -C Date: &eRf L 'Z-'70w— 7' .66 1 Is system constructed as per pLw3? Is well drilled? yf-r Date: Is well located as per plans? Yet Are erosion control measures in place? I certify that the system(s), as Wed, 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 PutnAm. County Depanmen I t of Health. Wri� Certiti by: PE RA Design Professional Address: I -T000 AM "H ZEK 0 _Fff KS K t L L. 0 SW L ic. # es t q 86 Comments: Form FIR -99 PUTNAM COUNTY DEPARTMENT 07 HEALTH SRON -07: ENWRONMEN �' 3 _SE RV [C.'u - � ±1► ti � E !" I , I I ��► ` i" I !': '�, I I I �Ii !" .� I �` � : i � a'd ,i :� °i'1 � 1 11 � I � i � I E � � Located at JMwkvfaWAh1Rt0yKramers Pond. Road Town 6F7AI6 Putnam Valley Subdivision name Putnam Chase Subd. Lot # l_ Tax Map Date Subdivision Approved 0 7 :�'�' -li© Renewal Owner /Applicant Name 37 Croton Dam Road Corp. 84 Block 1 Lot Revision Date of Previous Approval N/A Mailing Address 37 Croton Dam Road, Ossining, NY Zip 1056.2 Amount of Fee Enclosed $300.00 Building Type Residential Lot Area No. of Bedrooms 4 Design Flow GPD 8o0 Fill Section Only Depth Volume PCHD NOTIFICATION IS ltd, iJIR EgD WHEN 1FffLL IS COMPLETED Separate Sewerage System to consist of 1250 gallon septic tank and L. F. of 4" PVC Perf. pipe in 24" gravel trench. Other Requirements: To be constructed by 37 Croton Dam Road Corp. Address 37 Croton Dam Road, Ossining, NY 10562 W ater SWinK ': Puhliic:SuppLy__Fro_m —� _� _ _ Address,. or; X Private Supply Drilled by P.F. Beal & Sons, Inc. 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 treatment s,, stem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules.. ations of the Putnam County Department of Health, and that on completion thereof a "Certificate of ConstIrt'Ftjot (t satisfactory to the Public Health Director will be submitted to the Department, and a written g il4. N61 �sh the owner, his successors, heirs or assigns by the builder, that said builder will place in good o era condi ion f said sewage treatment system during the period of two (2) years immediately foll i g the ate the ' of ap , oval of the Certificate of Construction Compliance of the original system or any epa'. s the �o. Signed: ,�. s !! `' P.E. R.A. Date Address 2 John Walsh B N�UFF-ea P�1`1, 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 conside d necale Public Health Director. Any revision or alteration of the approved p an requires a new it. A ove domestic sanitary sewa a only. By: Title: Date: C g White copy - HD File•, Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pro ssi nal Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO =CONS I'RUCT A WATLR�WELL- 43 7:. r please print or type PCHD Permit # 1 �� 100 Well Location: Street Address: Town/ViNage Tax Grid # Kramers Pond Road, LOT (8 Putnam Valley Map 84 Block 1 Lot(s) 6Z Well Owner: Name: Address: 37 Croton Dam Rd Corp 37 Croton Dam Road,.Ussining, 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 50o 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 Is well located in a realty subdivision? ...................................... ............................... Yeses(_ No Name of subdivision huTNA M e s � Lot No. Water Well Contractor: P.F. Beal $ Sons, Inc. A New Ave. I Brewster NY 105 `esg Is Public Water Supply available to site? ............... ............ ..:.��P.J��,�..! :.�::u1,..2 ... Yes No X Name of Public Water Supply: n/a Tod. na Distance to property from nearest water main: n/a / Proposed well location & sources of contamination t e ro ided sirpa ate sl*etfplan. Date: Applicant'SQnatui-e.�- J 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 c ' ed Putnam County. Date of Issue ( r'10,01 Permit Issuing Official. Date of Expiratio 1111 2,. Title: Permit is Non- Transferra 1 White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Forrn WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH $EJRNUCES, 71 DESIGN DATA SHEET - SUBSURFACE, SEWAGE TREATMENT SYSTEM Owner -37 c8o72»Aj pqm f2vA p ex),TP Address 3-? C90-TOAJ L>m aD o5simAj6 Ai Located at (Street) r=,t�c7ZS tUA - ao" Tax Map 81 Block - I Lot .10 ?e' (indicate nearest cross street) Municipality?' I A.JrAJAM Drainage Basin ffl-Z-�Xju tk.)uo&j r12Z15-k. htJD.�OAJ /ZjVcM SOIL PERCOLATION TEST DATA . Lo Date of Date of Percolation Test Hole No. Run No.* Time Start -Stop Ela&se Time i in.) D?th to Water rom Ground Surface (hches) Start Stop Water Level Dro Ingin es Percolation Rate Min/Inch U lo" IZ 2-0-13 3 -4- 2 loft_ 100 10-7-3 3 /0 3 to 30 10-kif iY 2v -Z-3 3 4 5 Ts 2 io*- t6l" V7 3. 3 4 5 2' 3 4 5 NVA-Lb: t. Tests to be repeated at same depth until approximately equal percolation rates are obtamea alic.aca percolati o-in test hole.,'(i.e. s I min for 1-30 minthich, s 2 min for 31-60 min/inch) All data to be submitted for review, Z. Depth'me'asurements: to be made from top of hole. Form DD-97 2 Ts EST PIT D.' AT.: A X ..DESCR1,PT10NQF SOILS-ENCOUNTERED �/DEPT�H HOLE NO. HOLE NO. HOLE NO. 5- 7 G.L. 0.5' 1.0 2.o &Z 2.5 3.5 4.0 4.5 6ft 544vO tea.. A, 54413 Y.. 4LIttiez 5.0 5.51 6.0' 6.51 e 7.00 7.51 e r e -7 4J 8.01 1-7 I—Lo A 8.51 9.5 10.01 o Indicate level at which groundwater is encountered Indicate level at which mottling is observed ;Mw 'Indicate. level to which water level rises after being encountered 6 0 Deep l<gle observations made by: 'ArAm SntM6gdA,1-C, 0A467?k 5i Date 3 eq-t79 Signft&..- Name: Miignju j- eayy,A) deALAS 4AJ tM?- MA6 P. e. A C Design Professional's Beal pt, VC 62980 "ROFEW 0 617.20 . Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM _ For UNLISTED ACTIONS.OnIy- Part 1 - PROJECT INFORMATION (To be comaleted by Awlicant or Proiect sponsor) SEQR 1. APPLICANT /SPONSOR: 2. PROJECT NAME: 37 Croton Dam Road Corp. Putnam Chase Subdivision, Lot #fig 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: flew OExpansion ❑Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: construction of subsurface sewage treatment system and individual well water supply 7. AMOUNT OF LAND AFFECTED: Initially .._.. p! acres Ultimately c O JZ acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ®Yes ONo If No, describe briefly. Q;-.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Wesidential Dlndustrial OCommercial OAgricultural ❑Park/Forest/Open space 00ther Describe: Surrounding lands are zoned single family residential -- __ . - ...,. ._�..... . 7,- .. ,. - .... .... _ ...... .....- ro ..r .-m 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ®Yes ❑No If yes, list agency(s) name and permiUapprovais 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 permillapproval Subdivision Plat Approval — "Putnam Chase Subdivision" 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? OYes 540 I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ApplicanUSponsorna P.C. /Keith Staudohar date: 04-19 -00 Signature: - If 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 = rt ,pit vErleclaratigrt may," superseded. by another invglyed agency - 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 traffx patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly: C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. Long term, short term, cumulative, or other effects not identified in C1 -05? Explain briefly: C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? ❑Yes ONo If Yes, explain briefly: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? DYes ONo If Yes, explain briefly. Part III - DETERMINATION OF SIGNIFICA- NCE (To be completed. by.Agepcy) IRfS�'ffiUC f�f S: Foy each adverseerect ideiftr�ed *&bovE, deiamjirieA,yhether k is subsi antiai, - Iarge, i6ipo;iant or othervviso ss nificsrt. 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 dl was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. O 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 WILT_ 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 Tyl a @me Mesponsible Officer in Lead Agency r•— � Gf7 SC Sigrj,Ajtk*jA�f Regbonsible Officer in Lead Agency date w . Title of Responsible Officer Signature of Preparer (If different from responsible officer) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of 37 Croton Dam Road. Corp . . Located at Sassinoro Drive /Kramers Pond Road Tj Putnam Valley Tax Map # 84 Block 1 Lot 6-Z ice: Subdivision of "Putnam Chase Subdivision" Subdivision Lot # /c5'' Filed Map # X GA9 Date Filed 0 7 02 f — 0�) 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 iri accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Departure tic4+'�` 11 necessary papers on my behalf in connection with this matter and to supervis :eke AMC o aid wastewater trea en d/ water supply systems in- conformity,,. ith th�pr .uisio _ Ar'� e�� 5..and/or -147 of the f d _ io w,.the Public Health _ Y Law; and �th�%PIu rtam £ untY ' Co e. �. �. - LU ,_ Very tru ur , c' . \G . s '• 6.2980 Coun rsigned: NNJFESS \ON Signed: Pres . P.E., # 062980 �_. ( tFwrty) Mailing Address 2 John Walsh Blvd. #200 Mailing Address: 37 Croton Dam Road Corp. Peekskill 37 Croton Dam Road, Ossining State NY Zip 10566 State NY Zip 10562 Telephone: (914) 736 -3664 Telephone: (914) 739 -7362 Form LA -97 ICI. TNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIDAVIT - CORPORATE OWNER APPLICATION. FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: Construction of SSTS and Water Supply T 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) - Same as President Vice President - Name: Address: (Same as above) Secretary -Name: Michelle Santucci (Same as- abo e) - a v Treasurer -Name. Same as Secretary Address: (Same as above) A and that I am and will be individually responsible for any to the approval requested and all subsequent acts relatin Signed: Title: Sworn to bef re me this ' day of A�� ;_(Month) 20 (year) Notary Publi KELLY M. LENT Corporate Seal Notary Public, State of New York No. 01 LE6026834 Qualified in Westchester Count Commission Expires June 21, 2 Form CA -97 si f thk f orporation with respect 11 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 'APPLICATION FOR APPROVAL OF PLANS FOR - A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: 37 Croton Dam Road Corp. 37 Croton Dam Road Ossining, NY 10562 2. Name ofproject: Putnam Chase - Lot # . 3. Location o'V: Putnam Valley 4. Design Professional: Timothy L. Cronin I11 5. Address: 2 John Walsh Blvd. 6. Drainage Basin: Peekskill Hollow Brook Peekskill, NY 10566 7. Type of Project X Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one ) ....................................................... 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? ............... 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 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 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 84 Block 1 Lot , r 37. Approved plans are to be returned to ..... Applicant x Design Professional iVOTE:A11 applicd1ibns'for review and�approval ofa new SSTS to 6e located`vtntlun the 1YC Watershed 5h-a}i 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. I hereby affirm, under penalty of perjury,. that i, to the best of any knowledge and belie, f Pals a arWS2 misdemeanor pursuant to Sect' n 2 r-> SIqq'*J#J & OTF'ICIAL TITLES.- �s ,n provided on. this form is true made herein are punishable as of the Penal Law.. Ma Cronin Engineering, P.E.,P.C. 2 John Walsh Blvd, Peekskill, NY 10566 it.I ... Q. -;12A C7;lc. ,C407-/ � �g I �- i 19 56 I•E Vt.,& -ILI J 1, - T, ter � — MEN vot was was ■assn was -RC% PUTNAM COUNTY DEPARTMENT OF TH HOUSE PLANS APPI.IOVED FOR BEDROOM COUNT ONLY,, BEDR00AITS ALL UBSEQUEINT P S IUST B SULjBk'N—`TfEID —0 THE PCDOH FOR APPROVAL' -tx�l . 0 A R GA I'A UE DkT G-NX.CUIRE 0 UT 'Z o (-Iol ,,.. -. .,,,.� ,� ;err iR,T �€F.•+�.^�a'. ... i. I r . 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