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HomeMy WebLinkAbout4351DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -1 -63 BOX 33 04351 17-- ' 'J' •'� r 1; g, or ■ 6 , I I 04351 01 PUTNAM COUNTY DEPARTMENT _ RTMENT OF HEALTH ....DIVISION OF ENVIRONMENTAL HEALTH SERVICES .T ia: 'r. �:n .. v. -,e ':�,; :. , J, i� r. -:,: .. ... c••:.a n. ..: ,,,M.. ..A ........ � :m- �..... . ... _ _ r �..�__ .. �' T , � _ . . CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # PV- 4.57 6 d Located at 25- )<1ZAMC fl1 6*10 ro1q,0 Town or V*iage Pu ; n)AM u'6 Y Owner /Akeant Name _T7 Cnaro,,J A9ryr Rog» c:ot2(�' Tax Map Block �_ Lot 6 3 Formerly Subdivision Name Po rM.4r+ `I-NSe - Subd. Lot # ) °1 Mailing Address PoNw 'PoAO : (UT-.,,JAM VAur Y, N', )/ Zip Date Construction Permit Issued by PCHD / Oy' 2.1, 2606 ' 37 G ?oToia 019 P7 KaAv Separate Sewerage S, sy tem built by 3 7 CiPo7ci� QP3!'� �o�db eQi�P Address OSS �� i� G , Consisting of J250 Gallon Septic Tank and 0l/,'/ L•�� - PF12F6 i q Ter. #01/c- 191(C 14 2q", 6F19V '4_ _ 12trijc_k( Other Requirements: Water Supply: Public Supply From Address 41 40TAJAM 4 t/6AJL'e or: V"" Private Supply Drilled by P, F. 0241- �SoJS ter., Address 25Re7VS7-&7Z; N,Y' /OSa 5 e'I�,oc`.NC�Ii3s erosion control been.cempleted? . x __C . r... _.ap .. p.. T 'i�v_. tis ..r I .... e.. _.+.�. V • .-•P. .r :. -tea... n.. .. w. .a ,...•Y- �� -�-. .- - '► -�w�_. 1.-. .�� Number of Bedrooms Fou lL Has garbage grinder been installed? I certify that the system(s), as listed, serving the built plans (copies of which are attached), in al plans and the standards, rules and regulatio s o� Date: L/—/5-0/ Address '- Certified by r1's�s SVe ns , cted essentially as shown on the as- th_ ec Construction Permit and approved n en nt of Health. d� P. E. ' -';� f License # IQ6 Z� $`D 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 t modificati^ or change when, in the judgment of the Public Health Director, such revocation, odifi do h e i n cessary. By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF lH[IEAL')<'IH[ DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT —Well ]Locati6ior °' Stre&Addr� �' D k Kramers . and Rd Put -Chase Subd. , Lot #19 TownNilldge: - Putnam Valle Tax Grid # 84. =1 -63 Map Block Lot(s) Well Owner: Name: Address: VS Construction Corp., 37 Croton Dam Rd, 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 IDrilling Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock _ Other Casing Details Total length 32 ft. Length below grade 31 ft. Diameter 6 in. Weight per foot 19 lb/ft. Materials: X Steel _ Plastic _ Other Joints: _ Welded X Threaded _ Other Seal: X Cement grout _ Bentonite Other Drive shoe: X Yes _ No Liner:_ Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield Test _ Bailed X Pumped X Compressed Air Hours 6 Yield 10 gpm )[Depth Data Measure from land surface- static (specify ft) 30' During yield test(ft) 380' Depth of completed well in feet 485' Well Log If more detailed information descriptions or sieve anases:. are available, please attach. De th From Surface Water ]Bearing Well Diameter(in) ]Formation Description ft. ft. Land Surface 12 Drilling in ove r urden clay and boulders 12 Hit rock at 12' _ 1 _ ' in rack st _ -g4outed 32 485 in rock aranite __Dri-lling If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type suh Capacity 1_.gpm Depth 400' Model 7GS10412 Voltage230 HP 1 Tank Type WX302 Volume 8 al . 06f C' A414A 77 Date Well Completed 12/19/00 Putnam County Certification No. 002 Date of Report 4/30/01 We ) Be NUT E: Exact location or wen wim aisiances Lo Ieas< <wU No, uia►icuR tauu,uama L., vv 171.11V4 �•• �. r.+. ,.. -� r - b , Well Driller's Name P. s Inc. Address: 4 t Ave , Bmusber, NY 10509 Signature: Date: 4/30/01 91 a Perr L�el cal White copy: HD File; lo w copy - Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 NE NORTHEAST LABORATORY OF DANBURY LABS (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 BACTERIAL: • Total Coliform (Bacteria) 0 per 100 ml SM 9222B PHYSICALS: 0 per 100 ml • LABORATORY REPORT 0 REPORT TO: EPA 110.2 15 P.F. BEAL & SONS DATE SAMPLE COLLECTED: 4/17/2001 4 PUTNAM AVENUE TIME COLLECTED: 10:45 A.M. BREWSTER, N.Y. 10509 COLLECTED BY: WAYNE MAYES - DATE RECEIVED @ LAB: 4/17/2001 • TESTED BY: LAB 411471 NTUs LAB I.D.# PFB-47 CHEMISTRY: REPORT DATE: 4/23/2001 SAMPLE SITE: V. S. CORP., LOT #19, PUTNAM CHASE SUBD., PUTNAM VALLEY, N.Y. SAMPLE POINT: HOSE BIB <0.005 SOURCE: WELL -NEW 1.0 mg/L TREATMENT: NONE <0.20 mg/L as N SM 4500D MAXIMUM CONTAMINANT TEStPERFORMED RESULTS METHOD # LEVEL (MCL) OR STANDARD BACTERIAL: • Total Coliform (Bacteria) 0 per 100 ml SM 9222B PHYSICALS: 0 per 100 ml • Color (Apparent) 0 - EPA 110.2 15 • Odor ND - - 3 Units • pH 7.11 - EPA 150.1 No designated limits • Turbidity 0.31 NTUs EPA 180.1 5 NTUs CHEMISTRY: • Nitrite Nitrogen <0.005 mg/L as N EPA 354.1 1.0 mg/L • Nitrate Nitrogen <0.20 mg/L as N SM 4500D 10 mg/L •.. `.. Alkalinity 6.0 mg/L SM 2320B No defined limits _: Y': -'" _.•:_ -I1araryss - .- 20A '� ` �nig/L . .� ._ EEA.30:2__ .T.. _ _ . �' ,� .� :1tti tlefr_ned lu�uts; , • : ,' • 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 = 0.50mg/L • Sodium <I.0 mg/L EPA 273.1 20.0 mg/L ** • Lead <0.001 M9/`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: OPOTABLE or UOT POTABLE RESULTS BASED ON SAMPLES SUBMITTED:4 /17/2001 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 i RONIN ENGINEERING P.E. P.C. The Lindy Building, Suite 200, 2 John Walsh Blvd., Peekskill. New York 10566 Iel. (014)73&366`4;vRv •(3 ;i36-3693— �, .� *, r _ -• ....i• .: -�a. , . , ;.�:'r. :_ . June 4, 2001 Adam B. Stiebeling, Assistant Public Health Engineer Putnam County Department of Health Division of Environmental Services 1 Geneva Road. Brewster, N.Y. 10509 Re: SSTS Construction Compliance 37 Croton Dam Road Corp. P.C.D.HPermit #PV -45 -00 "Putnam Chase Subd. " Lot 19 Town of Putnam Valley Dear Mr. Stiebeling: _,._� .........._ �'ETrcl�sed is fihe- 'iawtrt irnfrniatia�iiecss-y 1 apprcrvai for-the-aboVe ref6renced project: 1.) Laboratory Report 2.) Well Completion Report The original construction Compliance package was submitted and received by your office on April 23`d 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 in this matter. X tfully submitted, h M. Murphy Project Designer j.- •a.�r��'e. �DR�CL'i��it�r iOLEIr -tn •t =•e., e. (- .,. ,....:1.. «r e. Public Health Director ... .. 'LO�tE;ffx � MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 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 I . I1 TAX MAP NUMBER: -Se( E911 ADDRESS: TOWN: AUTHORIZED TOWN OF (Signature) DATE: W W3 0133111.61-01 j 7 e(wTo &A!) of. . R1 °-The ' Putnam 1 County Department of :Health will not issue a Certificate of Construction Compliance'unless the above form is completed, i.e., a legal E911i address is assigned by an authorized town official. This form is to be submitted ;a with the application for a Certificate of Construction Compliance. (E91 i VERFRK a A �P1�Jy�Tj{ NAIT MCOUNT /Y/��� DEPARTMENT //�� O' F HEALTH ., ._ •_. ...� Jf.I..� e.J^�.sY.E.�L- ,�6�`�•��"•• •. �1!<+v ••���n���L.�6t[�6,XdL�ti���'� �iV��j`b �•.� �:i 1t �i .. r..0 •. GUARANTEE OF SUBSURFACE BSURFACE SE L GE TREATMENT SYSTEM 31 CnaC, JPA g ZA I Owner or Purchaser of Building 37 l-2oTw bz, 4 izoAD Building Constructed by ZS �2�Y''1��Lf Paa� Location - Street Tax Map Block Lot 21?. 'RCTNAM IA LLC ow illage t?6A 0 Tc TAM M OtMs& Subdivision Name —54,06 LF 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.buiy4m�-g uti�ilin system. The undersigned further agrees to accept as conclusive the detaftin do of ublic Health Dire; or f the Putn County Department of Health as to whet r o t t fail e f the system tope at was c sed by the willful or negligent act of the oc; pan o the uil i g utilizing the t, Day n Year Z6-1 Si Title: Cc�kktor (OVAner) - Si 37 ('�2crro.1 I)A.A (Zo,�� �o�P 3-f C► �� ���t 2oa�� C flei�. Corporation Name (if corporation) Corporation Name (if corporation) Address: 31 a�oapa DAM EoAD• 0s5 v y•NG State �J. X Zip /05 2 Address: 31 C�-oroj PAq -2oAI) �ss�- ��•�G. State /A/ y Zip x'056 e . Form GS -97 -.. s �.v � - .GYYr�— ...v.. ..^.4 ' -F �, {....� �.,:�.r. -�M ....V. 1 r.. � r. I���}. � .JV . =A..;. .. ,rte ,.ff ��:.����y'e:fr1.. W+'.. •.... •V. p� O 3 �s.e• uoi }opunoj Lot 19 O twin 19" kickory BOx�s p ook 16" o°k, p LETTER OF TR,ANS .fie -:y, •. ...t ..d.,.�,a- --s �.. ...� "v...,►• °..o aa�,.�... w°"':,:= d�.�..'.• ... "n`r�� "i.= ie..'3e- ivy ^ -,. .. .• °s. �S ......�, ..,.� �q" ac."�'..r....:"%'..:-0:f�.:'o '.N .� ;•�a.. CR®1VI LJ1vW1ll1V11:/3GJ1@LLNG 1C.E., P.C. The Lindy Building; Suite 200 2 John Walsh Boulevard Peekskill, NY 10566 914- 936 -3664 Fax 914- 936 -3693 Adam B. Stiebeping, Assistant Public Health Engineer Putnam County Department of Health I Geneva Road, Brewster, N.Y. 10509 RE: 37 CROTON DAN ROAD CORP. llKtVRWJCYN N®tD L®T 19 P.C.D.H. PERMIT AY W 45-00 THESE ARE TRANSMITTED as checked below. April 19, 2001 ❑ FOR APPROVAL ❑ FOR YOUR USE ❑ AS REQUESTED ❑ FOR REVIEW AND COMMENT X PLEASE REPLY WE t111lOJC. SJ1`i1Vlt/i1LLV`lY .. .aft t . - _ r -. ., . � ........ , .. .L ..:..e ti> ..._ ".._. �..... ... •-.. -.._ -, .�.. ... .. _- . -.. .. ..- ... `_. _ elked .•y_ rr ✓sue .� .._ ..... ......... s :�..J � .�-,�• .- .Y.cs, •�. 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 S.) E911 address verification form 6.) $200 certiffDed check for application fee. Should your have any questions or require additional information regarding this matter, please contact me at the above phone number. Thank you for your time and assistance in this matte. Respectfully submitted, 41, Kenneth M. Murphy Project Designer v{ . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PE o AGE TREATMENT SYSTEM PERMIT # Located at /Kramers Pond Road TownmxWtW Putnam Valley Subdivision name Putnam Chase Subd. Lot # 1:1 Tax Map 84 Block 1 Lot Date Subdivision Approved t) 00•. Owner /Applicant Name 37 Croton Dam Road Corp. Mailing Address 37 Croton Dam Road; Ossining, NY Amount of Fee Enclosed $300.00 Building Type Residential Renewal Revision Date of Previous Approval N/A Zip 10562 Lot Area No. of Bedrooms 4 Design Flow GPD 800 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 12so gallon septic tank and S� 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 _Water SUDn1V: Public Supply From _.Address 'or: X Private Supply Drilled by P.F. Bead & 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 system 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 Constructjpn� e" satisfactory to the Public Health Director will be submitted to the Department, and a written guarani" Bh the owner, his successors, heirs or assigns by the builder, that said builder will place in good ope;atixl dridifioni art' f said sewage treatment system during the period of two (2) years immediately fol g the date of iss f t�ie, p val of the Certificate of Construction Compliance of the original system or an rep `rs theretci Signed: -�� P.E. R.A. Date Address 2 John Walsh B1 s ;, F N.,_.- ^nN� kskill,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 consiflere necess y the Public Health Director. Any revision or alteration of the approved plan requires anew pelpkit. Appr ved sch a of domestic sanitary sew a only. By: �" Title: Date: ll Kk White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professiona Form CP -97 t PUTNAM COUNTY DEPARTMENT ®IF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A�rWAT.ER WEI[.ILL, _ }ft'inf�r type' ' PCHD Permit # J Well ]Location: h9 ddieas=,w SUB Town/WR#ga Tax Grid # Kramers Pond Road LOT 16 Putnam-Valley Map 84 Block 1 Lot(s) Well Owner: Name: Address: 37 Croton Dam Rd Corp 37 Croton Dam Road, Ossining, NY 10562 Use of Well: X Residential Public Supply Air /Cond/Heat Pump Irrigation I- Primary Business Farm Test/Monitoring Other (specify) 2-secondary Industrial Institutional Standby Amount of Use Yield Sought __5_ gpm # People Served �_ Est. of Daily Usage SOS gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling X New Supply (new dwelling) Deepen Existing Well Detailed Reason Water supply for new residence. for Drilling Well Type X Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No X Is well located in a realty subdivision? ...................................... ............................... Yes x No Name of subdivision Putnam Chase Lot No. /,9 Water Well Contractor: P. F. Beal & Sons, Inc. Address:- 4-.,RR nam Ave. Brewster, NY 10509 . Is Public Water Supply available to site? . :. <` V Y° Yes No X Name of Public Water Supply: N/A "Fb N/A Distance to property from nearest water main: N/A Proposed well location & sources of contaminatio e ' ided . ; to sh e Ian. 4 . w Date: 29 _UU Applicant Signature:.. ..._ _. a" PERMIT TO CONSTRUCT A 1L 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 o the well has bedif 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 ler c rtified y Putnam County. Date of Issue W/001 Permit Issuing/Official: Date of Expiration t I 07 Title: i IT Permit is Non -Tn ansffer°r°a Ile 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 ©uL:_0T• -.PLANS ;: APPLIEATION FOR APPtA 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 # 1.3 3. Locatioil@: Putnam Valley ' 4. Design Professional: Timothy L. Cronin III 5. Address:. 2 John Walsh Blvd. 6.. Drainage Basin: Peekskill Hollow Brook Peekskill, NY 10566 7. Type of Project: X Private/Residential Food Service 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? ................:........ NO 10. Has DEIS been completed and found acceptable by Lead Agency? ............... N/A 11. Name of Lead Agency Town of Putnam Valiey 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. Tv pe 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 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 stiebeli.ng 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 7 _27 Is,any portion Qf -this prqjeet 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 .................... .:............................. p ...... Ma sa Block 1 Lot 63 . 37. 'A roved , plans are t Applicant.. X..- _._:....Design Professional - PP P_. -..., ..-- ..- ,o.be.Letu�rned_to .... NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater.plans or the the 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. d hereby affirm, under penalty of perjury, that information provided on this form is true to 'bet L., , my knowledge and belief. Fals to esreents grade herein are punishable as a s isdemeanor pursuang to Sect' h 2 .4s of th Penal /Law. UJ �. . Ila SI A OFFICIAL T'IT'LES. <r Maili qd . SS :.... ............................... Cronin Engineering, P . E . , P . C . CD John Walsh Blvd, Peekskill, NY 10566 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: Construction of SSTS and Water Supply 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) Vice President - Name: Same as President Address: (Same as above) Secretary -Name: Michelle Santucci Address; - - , (S.ame._as above) Treasurer - Name: Same as Secretary Address: (Same as above) and that I am and will be individually responsible for any to the approval requested and all subsequent acts relating Signed: Title: a to efore me this day of (month) 2 0 4 (year) Notary Public KELLY M. LENT Corporate Seal Notary Public, State of New York P No. O1 LE6026834 Ouatified in Westchester Count Commission Expires June 21, 2.� Form CA -97 co oration with respect MAD & 1 NAM COUNTY A Y ' P R a \ { OF D ° ,y 1/ e R fi,N i , ` 1 9 1 ti j r 1 LETTER OF AUTHORIZATffON RE: Property of 37 Croton Dam Road Corp. Located at Sassinoro Drive /Kramers Pond Road Ty Putnam Valley Tax Map # 84 Subdivision of "Putnam Chase Subdivision" Block 1 Lot C3. Subdivision Lot # 13 Filed Map # .2$32 Date Filed O 1-2 �5 - 0o, Gentlemen: This letter is to authorize Timothy L. Cronin III a duly licensed Professional Engineer x 0dwadak=hkmct 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 co tion of said wastewater treatme and/ r water supply systems in cortfarrnit with thergr vision kf . 'cle.l45.and/or 147 of:tll� d . Ado aw 'the'Public-Health Law, and a utna. ,Coin an de. 4 p Uj Very truly urs i C- t Co tersigned: 62980 Signed: Pres . P.E., # 0 OFESS���= (0 r of Pr Mailing Address. 2 John Walsh Blvd. #200 Peekskill State NY Zip 10566 Telephone: (914) 736 -3664 Mailing Address: 37 Croton Dam Road Corp 37 Croton Dam Road, Ossining State NY Telephone: '(914) 739 -7362 Zip 10562 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner -37 cjgonw r,*4,v? &A 0 wjl4> Address 32 C90TOAJ D" aD I 0551mW4 Aj Located at (Street) Kg6o, _AP Tax Map Affj Block _.!l Z�T?S t;b"6 tW Lot (indicate nearest cross street) Municipality Drainage Basin ftg�%j LC: j## e i#j e FrAjAm VAt- D' htvD:Wj -A I VcM SOIL PERCOLATION TEST DATA Date of Pre-sp,Wd- ...-DateofPercolatiohTeit Hole No. Run No. Time'* Start - Stop Elapse Time (Nilin.) Depth to Water From Ground Surface (4ches) Start Stop Waiir Level Drop In Inches Percolation Rate Minduch 3� 1 3-101.1 le zo - Z13 5 6 UP 2 it— Z_ 10 le 2.4 . 2,0-2-1 4 .3 9 7 2 2,1 -211 3 9 3 it 8 -Z i 3 4 5 2 3. 4 5 NU 11;5: I Tests to be'repeated at tame depth - uhtil approximately equ#i percolation -rates are obtained attach fbr' f-30 minlinch, 2 min for 31-60 m in�h) MI * Percolation test hole. (i.e. s I min inrl data to be subm'iftd Abi review. 2. Depth, measurements to be made from top of hole. j, Fom DD-97 TEST PIT DATA 41 SOILS ENCOM'ftkj 'a DEPTH HOLE NO. G.L . HOLE NO-��, HOLE NO. 0.5 1.01 61 AJ .1.5 54,Vh L04M 2.0 0, L =A0 2.5 .3 .0 33 4.0 4.5 5.0 5.5 6.0# 6.51 7.0' 7.5' 8.0 8.51 9.5 10.01 Indicate level at which groundwater is encountered Indicate level it which mottling is observed ............... ................................. Indicate level to which mater rises after being encountered Deep hole observations ma Date Design Professional Addres&10 _V25mm.... x :C siguqg CL CD 44 C) LU EU Mtn AroTesslonal's Segg A 40 62980 UF '% 617.20 SEAR Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM Part I - PROJECT INFORMATION (To be completed by Applicant or Proiect sponsor) 1. APPLICANT/SPONSOR: 2. PROJECT NAME: 37 Croton Dam Road Corp. Putnam Chase Subdivision,'Lot # 3. PROJECT LOCATION: Municipality Town of Putnam Valley County Putnam County 4. PRECISE LOCATION: (Street address and mad intersections, prominent landmarks, etc., or provide map) Kramefs Pond Road 'I Sassinoro Drive 5. PROPOSED ACTION IS:' lNew ❑Expansion ❑Modificationlakeration 6. DESCRIBE PROJECT BRIEFLY: construction of subsurface sewage treatment system and individual well water supply 7. AMOUNT OF LAND AFFECTED: lnitialL=,3 acres Ultimately 3,6(7 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? EYes. ❑NP If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? @Residential ❑lndustrtl ❑ornmercial ❑Agricultural ❑13ark/Forest/Open space ❑0ther Describe: SurMunqing`J#pq4,q% c(sin ftaltly. residenMat, ....... -zq.!2q- '71 Ile I 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? IlYes ❑No If yes, fist agency(s) name and permillapprovals Town of Putnam Valley — Building Permit 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Wes ❑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? ❑Yes Wo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE —;Q1h Staudohar Applicant/Sponsor narn natneeting P. date: 04-19-00 Signature: Zwt��� 9 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 ,i, A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR, PART 617.4? if yes, coordinate the review process use the FULL EAF 0Yes ONo B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? Nq, a yv� L laratior..ma : e"s - :yam - e��aa. '-deF �. upersede: ..by,anr►iher.irivolvedagency.= -' .-.. - .._�::�. ones ONo 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 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)? OYes ONo If Yes, explain briefly: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? 0Yes ONo If Yes, explain briefly: a ... 13-ETERMINATIO N . F, , IGINlFICANCE -(T6be comnldted;bV Agenncy) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part II was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the of the GEA. 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. 0 Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Print or Tpp amesaf Responsible Officer in Lead Agency Cl) WC -3— Skj�WK6,f Regonsible Officer in Lead Agency CD v t1 Name of Lead Agency date Title of Responsible Officer Signature of Preparer (If different from responsible officer) e. m Q [I 4 ALL PUTNAM COUNTY DEPA.RTMEP3T OF HEALTH PLAN'S APPROVED FOR BEDROOM COUNT ONLY, BEDROOMS 3 E IJENT 1-VIU �a: ALTE "I'LOP,'a T(3� -i'E41-IR HOUSE UST BE, WD i.TND NOT v , PCDO %t I A VAI. c—.v »~sue 0 ■ ■ ■■..� ■■■s L = �■ Imo; � !% ;`_' - '����_ = ■rr i =: - - - - � WI l E �, w RIG-4T GABLE as D- 5PA 5 i7r Ic tt Xy is r yew CL --RP /-LL•ZZA 1'r a —41 ARE- ff"SAC IN SiTt ST k**3 SEE rl0TC q10 1. 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