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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -1 -69 BOX 33 1110 1 :N) 4 04356 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT IN41 199i ai "" .. ; -Street- Address:, . , . - ....� S Me,-e&k Ar Me,-e M (%a #e 4 Map Sy Block I Lot(s) (0 Well Owner: Name: ' c� 1 ,O Address: un•( / '5 '/ k c c i '3' E i-') �h 0104 fit s d 1 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 �-Iotary Cable percussion Compressed air percussion Other (specify) Well Type Screened ✓Open end casing Open hole in bedrock Other Casing Details Total length tom- -6•S ft. Length below grade 'tb ft. Diameter _min. Weight per foot /7 lb/ft, Materials: Steel Plastic Other Joints: _ Welded v Threaded _ Other Seal: dement grout _ Bentonite Other Drive shoe: Yes '--No Liner _ Yes --'No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield Test _ Bailed _ Pumped Compressed Air Hours-7/- Yield S- gpm Depth Data Measure from land surface- static (specify ft) 36 During yield test(ft) Depth of completed well in feet G 00 WellLog If mkire detailed information desciptions or sievtanalyses.. -.. -... aretvailable,'..... plg,F attach.,ti ; 4« Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface a o Ua-,/ b w d& r✓ X00 f"s f _ ".._ � -:.. -. - -::•_ - _, .. _ . _. ___ ..._....__..._ ., .:�.. ..„ ,..... w. ._.- „,,.:.;__..._...- .,..p_.._ ...�. W I=f;yild was tested at :deferent depths a- dun g drillitg; list: Feet Gallons Per Minute Pump /Storage Tank Information Pump TypeT4 '�`” '` if-apacity � Depth s' Model t,/ - a� Voltage a3b HP __L4,5-144 Tank Type W k 30.1, Volume T0./ DeweVellll Completed o Putnam County Certification No. 0 Q JIr/D 77//1) Well Driller (signature) A J _inn d.N a4141 t NQE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate sneevpian. WdDrilleesName 11 adman iA d erjdxl S i gature: �� A,,( -m 912 a� II I /,Am Address: lr-� wti a,PK ill �y Date: 7 ! !G " Q Ny VVIe copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 PTIK CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT PCH D CONSTRUCTION PERMIT # EV -18 -08 Located at 95 MARSH H J {L RoA D Tao or Village 'J:'UrivA04 V4LLF_)t . Owner /Applicant Name Vo5® C 4STRvc-11W &P.P. Tax Map 8q Block 1 Lot (09 Formerly At A Subdivision Name F H E R4L,P I,104 r- Subd. Lot # 9 Mailing Address 3 r� CRoi bpj —NM 'ROAD. 0 4S W "A 4 AJ V Zip 145) 2 Date Construction Permit Issued by PCHD Jb/i12o0$ CPL4-r+oN ';>,*Aq ROAD Separate Seva erage System built by V.S . CbNSTR,vcY oAl CoR.P. Address 05c3 ! NIA ,4y 102 Consisting of 1500) Gallon Septic Tank and ft Lor of Y`V P &rfae4'TF'P PV C Other Requirements: 1250 &ArUPN Fuin P IWABARL Watea• Supply: Public Supply From Address 151 13MZA64k SIMFIFIT or. Private Supply Drilled by A&MMI Ai4DrJ(280fs/ Address P07N" V,*401 ,P1 U_599 _._.. - B6ti g Type 64C iW P a) F --Has erosiorrcontroh n coriiplefed? _ : _'V Number of Bedrooms Has I certify that the system(s), as listed, serving the a E built plans (copies of which are attached), in or `i plans and the standards, rules and regulatio s o e Date: 07 2'. ZU0 Certified by (Design Address 2 J)W4 WMN BLVD ,? 9k<1U -,ni_N aq led? #o P L. C "o Anis `wee con ct d essentially as shown on the as- rith PC onstruction Permit and approved am of Health. 62980 j� . P.E. s R.A. • ~ License # 6629 4?6 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 revocatipn, modification or change is necessary. N P�Wff_W/ Title: 6�v 61 Date: copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT WgllV ©c�sgdn :.. s yVi a r k A r Town/Willage: -; �" : :�. / L/4 ,. 4 `haRCis il •# _ -..._ _ <,.::,:, -. , Map 84 Block 1 Lot(s) (p Well Owner: Name: Address: ( 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 otary Cable percussion Compressed air percussion Other (specify) Well Type Screened 6-"'O'pen end casing Open hole in bedrock Other Casing Details Total length jt.s'ft. Length below grade 'i•i> ft. Diameter _in. Weight per foot �'� lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded I-- Threaded _ Other Seal: _t-Cement grout _ Bentonite Other Drive shoe: Yes &--No Liner _ Yes --No Screen Details Diameter Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield Test Bailed _ Pumped Compressed Air HoursZ Yield �E gpm Depth Data Measure from land surface- static (specify ft) 36 During yield test(ft) Depth of completed well in feet G vu Well Log If more detailed information descriptions or sieve analyses please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface a o v a,/ b w do ry If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type 6"t 4 "" rCapacity S' Depth 5-o Model Voltage a34 HP Tank Type W Volume Date Well Completed Putnam County Certification No. 00 F,—/v Date of Report -7 Ile, 1A) Well Driller (signature) le NOTE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. Well Drillees Name Ah al er gd rl/ Signature: 4 A-4 /i1" rj&l Lh lAk-M . Address: /S-�, �4 % uw► ��py Date: 7Z& & / 0 Ny White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 BRUCE R. FOLEY Public Health Director DEPARTMENT OF BEALTH 1 Geneva Road, Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (843) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278.6085 Early Intervention /Preschool (845) 278.6014 Fax (845) 278 - 6648 OWNERS NAME: ]E911 ADDRESS VERIFICATION FORM Ve S. !ION COP-91 E911 ADDRESS: TOWN: 'FU (n) " VA AUTHORIZED TOWN OFFICIAL: DATE: HAK&� N i tc. 20,4D �v ..(Signature). The Putnam County Department of Health will not issue a Certificate of construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certifcatc of Construction Compliance. (E911 verfrm) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH_ SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM U. 51 o C4&sTQ- LU � ,.� Cote, Sq 1 Cog v Owner or Purchaser of Building Tax Map Block Lot VS, CONSZey&-rtonl (20)ef, uTto" Building Constructed by ow illage T� 9S moost pit, 9 Location - Street 11 T— Subdivision Name tAlh br, Fft i,T �a o �� 9 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 determination o the Health Director of the Putnam County Department of Health as to whether o not he it 7lic he system to operatj was Kused by the willfiil or negligent act of the occupar of le ildi ilizing the G 07 Day 2.0 Year 2A1 Signature: ) - Signature �2&s i ff o v Title: V,9. C 1V6—t Lvc or1 Core. —V,9. S. a/V&r1ZVv-r,.rV CORP. Corporation Name (if corporation) Corporation Name (if corporation) Address: -:61 Crto-rori 'Dr*r► RP, , 0 64, 1NINk Address: -L State N Zip 2059 Z State Zip Form GS -97 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245- 28.0.0. ,,.. '.Hr..:.•c.%w�. �vr Yns -.s's� - vc+ �..! - - - Aiberi H'. - Padovahr, D� recto`s LAB #: 1.002899 CLIENT #: 2500 NON STAT PROC PAGE: 1 of 2 ANDERSON WELL DRILLING DATE /TIME TAKEN: 07/14/10 12:15 152 BARGER ST DATE /TIME RECD: 07/14/10 01:00 ATTN: NORMAN, SARAH REPORT DATE: 07/21/10 PUTNAM VALLEY, NY 10579 PHONE: (845)- 528 -1491 SAMPLING SITE: 95 MARSH HILL, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : TAP PRESERVATIVES: NONE COLD BY: SANTUCCI TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 07/14/10 MF T. COLIFORM ABSENT /100 ML ABSENT SM 18 -20 9222B 07/20/10 LEAD (IMS) <1 ppb 0 -15 ppb SM 18 -19 3113B 07/15/10 NITRATE NITROG 1.42 MG /L 0 - 10 SM18- 20450ONO3 07/14/10 NITRITE NITROG <0.01 MG /L 1.0 MG /L SM18- 20450ONO2 07/15/10 IRON (Fe) <0.060 MG /L 0 -0.3 mg /l SM 18 -20 3111B 07/16/10 MANGANESE (Mn) <0.010 MG /L 0 -0.3 mg /l SM 18 -20 3111B 07/16/10 SODIUM (Na) 12.6 MG /L N/A SM 18 -20 3111B 07/14/10 pH 6.7 UNITS 6.5 -8.5 SM18 -20 4500HB 07/16/10 HARDNESS,TOTAL 162 MG /L N/A SM 18 -20 2340C 07/16/10 ALKALINITY (AS 86.0 MG /L N/A SM 18 -20 2320B 07/15/10 _ TURBIDITY (TUR 0.6 NTU 0 -5 NTU SM 18 (2130B) COMMENTS: MFTC X6"t'al Coliform = This result indicates that the water _(was) (was not) of a satisfactory sanitary quality according to ew York State and EPA federal drinking water standard for this parameter. This comment applies to the Total Coliform test only. Fe /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg /L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg /L of Sodium is suggested. pH pH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. 4 0 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245 -2800 �� _ ._ - .. ....._ °Albert• H.-- <Pa'dovan-; Director. LAB #: 1.002899 CLIENT #: 2500 NON STAT PROC PAGE: 2 of 2 ANDERSON WELL DRILLING 152 BARGER ST ATTN: NORMAN, SARAH PUTNAM VALLEY, NY 10579 DATE /TIME TAKEN: 07/14/10 12:15 DATE /TIME RECD: 07/14/10 01:00 REPORT DATE: 07/21/10 PHONE: (845)- 528 -1491 SAMPLING SITE: 95 MARSH HILL, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : TAP PRESERVATIVES: NONE COLD BY: SANTUCCI TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG /L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG /L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0 -70 MG /L VERY HARD WATER: ABOVE 300 MG /L MODERATELY HARD WATER: 70 -140 MG /L MG /L = MILLIGRAM PER LITER HARD WATER: 140 -300 MG /L (1 grain /gallon = 17.2 MG /L) THE ABOVE TEST PROCEDURES MEET ALL REQUIREMENTS OF NELAC, AND RELATE ONL 0 THESE SAMPLES RECEIVED BY THE LAB SUBMITTED BY: Alber H. Padovani, .T.(ASCP) Director ELAP# 10323 r.... f BY THIS CERTIFICATE OF COMPLIANCE THE cam_ :.,_ .:.T o+ . . R .•. T R1 . ,. t ...-- VICE 6.-. 150 White Plains Road, Suite 104, Tarrytown, NY 10591 CERTIFIES THAT Upon the application of: Velardo Electric - Claudio Velardo 203 Barnes Street Ossining, NY 10562 Located at: 95 Marsh Hill, Putnam Valley, NY 10579 Application Number: /0083571 Section: Block: Lot: Upon premises owned by: V.S. Construction - 37 Croton Dam Road Croton, MY Certificate Number: 10083571 BDC: 106 Permit Number: 655 -10 A visual inspection of the electrical system at this premise described as a Residential occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located inlon the premises at: 95 Marsh Hill, Putnam Valley, NY 10579 Basement, Outside was inspected in accordance with the NYS and NFPA 70 -99 and the detail of the installation, as set forth below, was founded to be in compliance therewith on the 09 Day of July 2010. Name Date Quantity Rating Circuit Type Receptacle 2 Convenience - Sviitch.., .. :. , .: :. :. -e 7 A/C - P -RES Fixtures 6 Incandescent Service disconnect 1 Meterpan: single- Single phase 1 P -RES Service 1 0 -299 P -RES Septic Pump & Septic Alarm I P -RES Air Handler 2 120/240V P -RES Disconnects 2 Single Phase 60 amps to 100 a Panel 1 200 AMP 33 Single Phase Panel 1 60 AMP 8 Single Phase Receptacle 1 GFCI This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. This certificate is valid for work preformed before date of inspection only. jeannie 16 Wednesday, July 14, 2010 Pagel of 2 a� Officer: Nick Morabito This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location Indicated. This certificate is valid for work preformed before date of inspection only. jeannie 16 , July 14, 2010 Page 2 of 2 CRONIN ENGINEERING PeEa9 P.C. July 26, 2010 The Lindy Building; Suite 200 2 John Walsh Boulevard Peekskill, NY 10566 914- 736 -3664 Fax 994 -736 -3693 Joseph Paravad, Public Health Engineer Putnam County Department of Health 4 Geneva Roast Brewster, MY 90509 RE: Emerald Ridge SETS As -Built 95 Marsh Hill Road Town of Putnam Valley Section: 84, Block: 1, Lot: 69 Subdivision Lot 9 THESE ARE TRANSMITTED as checked below; M FOR APPROV:U. © FOR YOUR USL (M AS R1,QUKSTVID ❑ 1'OR Rli \'lli \`V : \NO CO \IDf IiN't' ❑ PLIi:1SR. RI:PJ.Y REMARKS Per your request please find below the results of the pump test conducted by this office for,the above- referenced property: Pump Chamber interior dimensions: 9.2'x 4.4'= 40.5 sq. ft. Dose required = 26.2 cu. ft. (195.8 gal.) = 0.64 ft. = 7.7" Pump start elevation: 17" from bottom Pump stop elevation: 9.5" from bottom Total drawdown witnessed: 7.5" This information supplements and completes the application package previously submitted to your office. As we have discussed, time is of the essence. Kindly review at your earliest convenience. Should you have any questions or require additional information, please contact me at the above number. Thank you for your time and consideration in this matter Copy to: Val Santucci via fax 914.739.7156 S' aye .James W. Teed, Jr. Cronin Engineering, P.E., P.C. RONIN ENGINEERING, PE, PC The Lindy Building, Suite 200, 2 John Walsh Boulevard, Peekskill, New York 10566 Tel.: 914 - 736 -3664 G Fax: 914 - 736 -3693 July 21, 2010 Mr. Joseph Paravati Assistant Public Health Engineer Putnam County Health Department 1 Geneva Road Brewster, New York 10509 Re: V.S. Construction Corp. Certificate of Construction Compliance 4 Bedroom Residence 95 Marsh Hill Road Town of Putnam Valley, New York 10579 Section: 84, Block: 1, Lot: 69 Subdivision Lot 9 of "Emerald Ridge" Dear Mr. Paravati, Enclosed for your review and approval please find the following items regarding the application for a Certificate of Construction Compliance at the above referenced project: 1. One (1) Certified Check in the amount of $300 made payable to the Putnam County Health Department. 2. One (1) Electrical Underwriter's Certificate for the. SSTS Pump. `:. , F4ur_.(4):�nies'of a &6 (2) year guarantee signd by the Owner•& thb;InGtaliar- -- 4. Four (4) Well Completion Reports signed by Norman Anderson (The Well Driller) 5. One (1) Copy of Satisfactory Results of a Water Analysis by a Yorktown Medical Laboratories, a NYSDOH Approved Laboratory. 6. One (1) E911 Address Verification Form verified by the Town of Putnam Valley. 7. Four (4) Certificates of Construction Compliance 8. Four (4) Sets of "As- Built" Plans signed and sealed by Timothy L. Cronin III, the Design Professional. 9. One (1) Copy of As -Built Foundation Survey by Donnelley Land Surveying. Please review the above items at your earliest convenience and should you have any questions or require additional information, please do not hesitate in contacting me at the number above. R mitted, c^ James W. Teed Project Engineer cc: Val Santucci - Owner File- Paravati-PCDH- Santucci -Marsh Hill Road -Lot 9-SSTS As- Built- Trans- JT- 20100721.doc Sherhta Amler, MID, MS, FAAP Commissioner of Health Director of Environmental Health July 22, 2010 Timothy Cronin, PE The Lindy Building, Ste 200 2 John Walsh Blvd. Peekskill, NY 10566 .;:Dear Mr. Cronin:. Robert J. ]Bondi County Executive Department ®f I'lea.lth 1 Geneva Road, Brewster, NY 10509 Re: Field Inspection — V.S. Construction Corp Marsh Hill Road (T) Putnam Valley, TM # 84. -1 -69, Lot 9 The above referenced separation sewage treatment system can be backfilled. Please provide pump test results along with your final compliance submission. If you have any further questions, please contact me at (845) 808 -1390, ext. 43261. GDR:kly Sincerely, Gene D. Reed Sr. Environmental Health Engineering Aide ]Environmental Health .(845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845.).225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing / Home Care Agency (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / preschool (845) 228 -2847 Fax (845) 225 -1580 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: : o io Inspected by: .Street Locatign - I V` Owner ti, S t C o.cs so-. Town ?orA;*r Permit# P — 147 oR TM # 4 41. 1 }- G 9 Subdivision Lot # g 1. Sewage System Area a. STS area located as per approved plans ........................... b.. Fill section date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped..:... ..........:.. ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands...... .... : .......................... II. Sewage System a. Septic tank size.- 1,OD0 .......... 1,250 ......... other ... b. 'Septic'tank iiistalled level ............ ............................... c. 10' minimum from foundation .......... .................:............. d. Distribution Box 1. All outlets at same elevation- water.tested ................. 2. Protected below frost ................... ............................... 3... Minimum 2 ft .Original soil between box & trenches e. Junction Box properly set ......... ............................. ... 6. Trenches 1..Length required qv o* Length installed vvo 2. Distance to watercourse measured t (do Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1116 - 1/32"/foot .............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6.. Depth of trench <30 inches from surface .................. 7.,: :,Room allowed for expansion, 100%0 ......... :............... 8. Size of gravel 3/4 - 1I /V diameter clean ...................: 9. Depth of gravel in trench 12 minimum ......::........... 1. ends.c g. 7P. ump or Dosed Svstems 1. Size of pump chamber ................. ................. 2. Overflow tank .......................... ............................... 3. Alarm, visual/ audio ...:................ ..............................: 4. Pump easily accessible, manhole to grade........ :........ 5. First box baffied...: ...................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... IQ. House(Buildi i2 a. douse locatedper approved plans• ....................... b. Number of bedrooms .................................. 11_5k. ........ IV. Well Well located as per approved plans . ......:........................ b. Distance from STS area measured 't't Do - ft ........... c. Casing. 18" above grade ................ ............. ................... d. Surface drainage around well acceptable .....:................. V. Overall Worlamanshin , a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........................................... c. All pipes flush with inside of box .............. I................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area... ............. h. Surface water protection adequate.................................... i. Erosion control provided ................. ............................... Rev. ,12/02 nest,# '10 -07 -14 15:51 FROM- T -818 P0001/0001 F -689 .m FUTNAIyI COUNTY IDRPARTMIENT OF HEALTH[ gD STON OF EN O"IENTAL HEALTH SERVICES ATTENTI ON RFOiJEST FOR FTN L 1N,SPECTION All information must be fully completed prior to any inspections being made. For: Fill Trenches _ PCHD Construction Permit # 1PV_ 0 Located: ..OA " K-M - 'PU1" 'Voi V Owner /Applicant Name: V! . &AVLU T''dw 00M, TM 84 Black .�._ Lot _ Formerly: - Subdivision Name: Subdivision Lot## a—� Is system fill completed? Date: Is system complete? _ � S — Date: t� Is system constructed as per plans? Is well drilled? �ss Is well located as per plans? Are erosion control measures in place ?� I certify that the system(s), as listed, at the above premises and verified their completion in accordance with the :apprond plans and the Staudards, Rules and Regulatic Date: i��'/ t'� ° Certified by :�. Design Date: lW U to NEW ,e inspected Permit -and 3ariment of RA Address: 7- -10RAI WILM 8W9. , P W.,90 !tom It A/ Lic. (D Z.1 9—P Comments: Form FIR -99 Jul 09 10 03:41p Dan Ciarcia (914) 245 -5670 p.2 . - � ..- � ... fi..... ...� = .:;y'.; : i.. - • -w. n r . Y• r �J r _ �_.. .. .- , . � -.. ..I...: .: � .... �. _?j:: � ..-... r7 • 'Y' PUTNAII�I COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION ❑ JOSEPH REQUEST FOR FTNAL INSPECTION All information must be fWly completed prior to any inspections being made. PCHD Construction Permit 4 PV -18 -08 Located; Marsh Hill Road Owner /Applicant Name: V.S. Construction Corp. Formerly- 0 GENE For: Fill Trenches Z (T) (V) Town (T) TM 84 Block 1 Lot 69 Subdivision Name: Emerald Ridge Subdivision Lot f, 9 Is system fill completed? NA Date: Is system complete? Yes Date: 7010 Is system constructed as per plans? Yes Is well drilled? Yes Date: 7-8 -10 Is well located as per plans? Yes Are erosion control measures in place? Yes I certify that the system(s), as lasted, at the above premis and verified their completion in accordance with approved'plans ajd.tt; Standards;. Rules- and- Reuglat' Date. 7/9/10 Certified by: Address: 2451 Mohansic Avenue Yorktown Heights, NY 10593 Comments: Form FIR -99 F tiEyy Y ted and I have inspected .6 P , Construction Permit and PE 0 RA ❑ Lic. 4 61664 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM:•_ _ _.Owner+ ��j5:.(or <-ffzU 7i -M 6PIZP. Address 3? GP.o1'A j DAM ;.Rom, oiNlpi N:� ►oS Located at.(S.treet) MAVt q tflU- Romp Tax Map 04 Block 1 Lot S (indicate nearest cross street) PD01,104 of $4= 1 — lo.1 110.; 10.3 "icipality ft) FUPJAm JAtil.E4 Drainage Basin ?&-e�6 •L .Hvubw %tLcoiG SOIL PERCOLATION TEST DATA Date of Pre - soaking 0-) - li - Date of Percolation Test 6'7 -.13 • a 4 Bole No... Run No. Time Start - Stop Ela se Time (Rin.) Depth to Water From Ground Surface (Inches)..... "Start ' Stop Water Level Drop In, Inches, Percolation Rate mimgnch e2,& Y 2 3 4 1110 -1153 lZ 12n -23 If �5 1 - . 3 �t3.,ilZs ,t7- 4 2s_ 37 I1 (1 tt- Ig -21 5 2 4 , NOTES: 1., Tests to be repeated at same depth until approximately equal pe ?colatioin rates are obtained at each percolation test hole:. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review.: ' 2'.: Depth measurements.to be made from top of hole. Form DD -97 2 �� TEST PIT DATA V9 OF SOILS ENCOUNTERED IN TEST HOLES ..r. 'DEPTH -:; HOLEAFO:' 7 i HOLE`NG. 2 HOLE'N0: per' SotL Tb 0.5 4" 1.0' 1.5 B C.aK�fOw�N� ; ,9.� � 2.0' 2.5' 3.0' err 3.5' gb vN �. G� �RAvb QtAveL 4.0' �j Comes � 4.5' 4�a,» URjtv�t L4 co Mes, 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 10.0' Indicate level at which groundwater is encountered SNCOuWA:;-;Aab Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Nv A • �� Deep hole observations made by: G�vWW LIwEnI[, PEe,PG, �Gp1t Date .e . o 0 Design Professional Name: T1MO?ttV L, 6r2opw s Address: ►�I�N 1.� Obtf) NE b4 ` Signature Design Professional's Sea.1 PUTNAM COUNTY DEPARTMENT OF HEALTH ON OF ENVIRONMENTAL HEALT] �' 0NSTRUCTION'PEkMIT FOR SEWAGE- TMME PERMIT # Pq — R-6�0 Located at MAR60 HILL RpAP To or Village Subdivision name FMFg&p RIDGF– Subd. Lot # 9 Tax Map 84 Block 2 Lot 69 Date Subdivision Approved IV OI► _- 19ab0e+ ' Owner /Applicant Name Y ^J. &4ST1z9 W Cogg' , Mailing Address 21 Amount of Fee Enclosed -4500,00 Building Type S gg Lot Area2.92 Fill Section Only Renewal Revision Date of Previous Approval zip :k597- �t 800 No. of Bedrooms . 7 Design Flow GPD 46W Depth Volume Separate Sewerage System to consist of -1, 660. gallon septic tank and 7�0 /-.1 F, OF 1Y PggFow}zE2 YVe fwt on 2q" G mm Two , Other Requirements: rump IISMM To be constructed by 7: PS Address Water Supply: Public Supply From Address �ar'c .�►- - Priv ite.Supply DYi11Ld: iy: T..b,l%. I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatmentsystem described above will be constructed as shown on the approved amendment thereto and in accordance with the std les and regulations of the Putnam County Department of Health, � and that on completion thereof a "Certif e�f ^h Compliance" satisfactory to the Public Health Director will be submitted to the Department, en -gQ e ' 1 be furnished the owner, his successors, heirs or assigns by the builder, that said builder will plvice ' - goo o e -ati/ dh 'tion any part of said sewage treatment system during the period of two (2) years immediately follq f this su ce of the approval of the Certificate of Construction Compliance of the original system or an a ` w w z Signe > , �� P.E. y R.A. Date Address 2 j R, P6QWku4,AtV :205 License # 66Z98o APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires anew pe it. Approved for charge of domestic sanitary sewage only. r)-4� Title: �'t� h- Date: l 0 1 O copy - HD File; Yellow copy - Build 6g Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 EUTNAM COUNTY DEPARTMENT OF HEALTH IIDRVIKON OF ENWI ONMENTAL HEALTH SERWCES 7' A WA,'I[')ER W...IE]LJ[.,. please print or type PCHD Permit # Well Location: Street Address: To illage Tax Grid # 69 MMSH NHL, Rom> FbrvAm Aug Map 84 Block :J Lot(s) So Well Owner: Name: Address: Use of Well: Residential Public Supply Air/ ond/Heat Pump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2-secondary Industrial Institutional Standby Amount of Use Yield Sought _ gpm # People Served Y Est. of Daily Usage &O gal. Reason for Replace Existing Supply Test/Observation Additional Supply IlD>rn9lnnng V' New Supply (new dwelling) Deepen Existing Well Detailed Reason Aw Poraft (a# uP ?o AlE i Ea 6 for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes- No Name of subdivision EMECALP RiP4E Lot No. _ 9 Water Well Contractor: Address: - — Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: _ GPI Town/Village P!/A Distance to property from nearest water main: A/ Proposed well location & sources of contamination rovided on separate sheet/plan. •Date:° ���' 7i `� °cJ�Applicant Signatur _:. ., ...� ...:.. � r .._ :.. _: "� .;�:. :::.� ;.�:. � �. _ .�. PERMIT TO CONSTRUCT CT 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 C®1� STRUCTI ON: 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 0 ( Permit Issuing Offic'al Date of Expiration Title: If-L_ :�/ Permit is Non- Tlransffe>rr lle White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 RONIN ENGINEERING, PE, PC The Lindy Building, Suite 200, 2 John Walsh Boulevard, Peekskill, New York 10566 • 914-736-3693 August 28, 2008 Mr. Joseph Paravati Assistant Public Health Engineer Putnam County Health Department I Geneva Road Brewster, New York 10509 Re: V.S. Construction Corp.- Emerald Ridge SSTS Construction Permit Marsh Hill Road Lot 11 Town of Putnam Valley, New York Section: 84.00, Block. 1, Lot. 71 Dear Mr. Paravati, Per your comment letter dated August 28, 2008, Please find enclosed the following regarding an application for a Subsurface Sewage Treatment Construction Permit at the above referenced lot: 1. Four (4) Revised Subsurface Sewage Treatment System Construction Permit Plans for the above referenced lot. Should you have any questions or require additional information, please do not hesitate in contacting me at the number above. • es =WTeed, Jr. Project -Engineer cc: Owner- Val Santucci (V.S. Construction Corp.) File- Paravati-PCDH-Santucci-Emeraid-Lot 9-Trans-#-20080828.doc SHERLITA AMLER, MD, MS, )F'AA)P Commissioner of Health LORE'TTA MOLINARI, RN,16ISN Associate Commissioner of Health R®BER'T ./. B ®NDI I :. _ County: Executir- , _ _ - DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 James W. Teed Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 Dear Mr. Teed: ROBERT MORRIS, PE Director of Environmental Health August 8, 2008 Re: Proposed SSTS — VS Construction Marsh Hill Road, (T) Putnam Valley TM # 84 -1 -69 This office has received and reviewed the most recent set of plans for the above - mentioned project. We would like to offer the following comments for your review and consideration. 1. Based on the subdivision plat, run -of -bank fill was required for grading purposes over the . SSTS area. Please provide the fill contours and the required Putnam County Department of Health fill notes. 2. The subdivision lot number was not provided in the Putnam Valley tax id box. 3... , ..The distribution box detail is to note -the bedding material-and .the: minimujp /maximum :earth• cover. 4. The absorption trench detail is to note `dust free' in addition to washed stone or gravel. 5. The dose level of 7.3" is not shown correctly in the detail. The difference in the pump on /off elevation is shown as 6 inches. This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at est. 2157 if any questions arise. JSP /ens V y truly your oseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 P/2 RONIN ENGINEERING, PE, PC The Lindy Building, Suite 200, 2 John Walsh Boulevard,- Peekskill, New:Ynrk JQ566,. 1el,: 914 -736 -3664 C Fax: 914 - 736 -3693 June 24, 2008 Mr. Joseph Paravati Assistant Public Health Engineer Putnam County Health Department 1 Geneva Road Brewster, New York 10509 Re: V.S. Construction Corp: Emerald Ridge SSTS Construction Permit Marsh Hill Roads Lot 9 Town of Putnam Valley, New York Section: 8400, Block: 1, Lot: 69 Dear Mr. Paravati, Please find enclosed the following regarding an application for a Subsurface Sewage Treatment Construction Permit Renewal at the above referenced lot: 1. One (1) Affidavit of Corporate Ownership authorizing Val Santucci to represent V.S. Construction Corporation. 2. One (1) Letter of Authorization authorizing Cronin Engineering P.E., P.C. to apply for a construction permit at the above referenced lot. 3. One (1) Certified check for $500 made payable to the Putnam County Health Department on behalf of the above referenced application - -.. 4. Four (4) Subsurface Sewage Treatment System Construction Permit -Plans for-the above referenced lot. 5. Four (4) Subsurface Sewage Treatment System Construction Permit Applications for the above referenced lot. 6. One (1) Application for Approval of Plans for a Wastewater Treatment System 7. One (1) NYSDEC SEQR Short Environmental Assessment Form. 8. One (1) Design Data Sheet 9. Three (3) Sets of proposed House plans at the above referenced lot. Should you have any questions or require additional information, please do not hesitate in contacting me at the number above. 7 Res bmitted, Teed, Jr. Project Engineer cc: Owner- Val Santuod (V.S. Construction Corp.) File- Paravati PCDH- Santucci Emerald -Lot 9-Trans- ft- 20080624.doc ARts k ®i Y'u ilk ,r AF'IFI DAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: Subsurface Sewage Treatment System Construction Permit (TM #:8y -i -&9 ) Val Santucci represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: v S. Construction Corp. Having offices at: 37 Croton Dam Road, Ossining, New York 10562 Whose Officers Are: President - Name: Val Santucci Address: 37 Croton Dam Road, Ossining, New York 10562 Vice President - Name: Address: Secretary -Name: Treasurer - Name: Address: and that I am and will be individually responsible for any a d 1 of the corporation with respect to the approval requested and all subsequent acts relating e�j l Signed: Title: Sworn to before me t ' ,?,, day of J."V_ - {m 4yar) U c, state Notary rublid2luailified in Westchester County ' Om- ission Fxniras March 14 ZO t o Corporate Seal Form CA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH I♦.5.1 :,�1.��.% • • W.`iI' .•�V • ®f \ V -Ei . ♦' Z�� M�N i �L HEALT-Hf SERVIC JJ ..... -v... ..-. .. I LETTER OF AUTHORIZATION RE: Property of V.S. Construction Corp. Located at Marsh Hill Road TV Putnam Valley Tax Map # 84 Block 1 Lot 69 Subdivision of Emerald Ridge 3d63 Subdivision Lot # 9 Filed Map # 3Ko3 4 J Date Filed Ndyfo ie 14 Zoa!E Gentlemen: This letter is to authorize Timothy L. Cronin III, P.E. a duly licensed Professional Engineer ✓ or Registered Architect 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 Depw tme ri 11 necessary papers on my behalf in connection with this matter and to supervis .�o id wastewater tretment and /or water supply systems in conformity with the o�v/1sins of i'4 14 and/or 147 of the Education Law, the Public Health _,. .. ..> :X aw arld the Putria C4iunty'Alk ksrY e.'; �_,`^..... .. . , E II Countersigned: P.E., R.A., # _062980, Mailing Address Cronin Engineering P.E., P.C. 2 John Walsh Boulevard, Peekskill State New York Zip Telephone: (914) 736 -3664 10566 / Very trul r Iy II (I III l aw.. Signed: Mailing Address: V.S. Construction Corp. 37 Croton Dam Road, Ossining State New York Telephone: (914) 447 -4647 Zip 10562 Form LA -97 PUTINAM COUNTY DEPARTMENT OF HEALTH _- - T-L HIEALT1[;S-]E-RVW!2_IE$•y:�. 2. 4. 6. 7. 8. 9. 10. 11. APPLICATION FOR APPROVAL OF PLAINS FOR A WASTEWATER TREATMENT SYSTEM[ Name and address of applicant: V.S. Construction Corporation 37 Croton Dam Road Ossining, New York 10562 Name of Project: Emerald Ridge- Lot 9 3. Location: T/V: Putnam Valley Des; n Professional• Timothy L. Cronin III 5 Address- 2 John Walsh Boulevard g Drainage Basin: Peekskill Hollow Brook Type of Project: V Private/Residential Food Service Apartments Institutional Office Building Realty Subdivision Peekskill, New York 10566 Commercial Mobile Home Park Other (specify) Is this project subject to State Environmental Quality Review (SEQR) ? .............. Yes/No No Type Status (check one) ...................................... ............................... Type Ixempt Type II Unlisted Is a Draft Environmental Impact Statement (DEIS) required ? .................... Yes/No No Has DEIS been completed and found acceptable by Lead Agency ? ............. Yes/No N/A Name of Lead Agency Not Applicable 12. Is this project in an area under the control of local planning, zoning, or other officials, .. ....... . . ..ordinances ?........ ..... Yes/No Yes 13. If so, have plans been submitted to such authorities? .. ............................... Yes/No Yes 14. Has preliminary approval been granted by such authorities? N/A Date granted. N/A 15. Type of sewage treatment system discharge ........................ surface water ✓ groundwater 16. If surface water discharge, what is the stream class designation? .......................... NIA 17. Waters index number (surface) N/A 18. Is project located near a public water supply system? Yes/No None 19. If yes, name of water supply Not Applicable Distance to water supply N/A 20. Is project site near a public sewage collection or treatment system? .......... Yes/No None 21. Name of sewage system Not Applicable Distance to sewage system NIA 6 Z o5 22. Date test holes observed q1�,Loy,1J1ytqq 23. Name of Health Inspector Job 19i► 24. Project design flow (gallons per day) ............. 800 CPD 25. Is State Pollutant Discharge Elimination system ( SPDES) Permit required? ... Yes/No No 26. Has SPDES Application been submitted to local DEC office? ......................... Yes/No N/A Rev. 11/02 Form PC -97 Pg. 1 of 2 27. Is any portion of this project located within a designated Town or State wetland ?... Yes/No No yy.. - •'.is oaf a:�v�, o.. =:�..r . ��.•.P' •' "M:- 's`ri.:.«a:o:- .:p a•:eiw'ii, -.x« w. -..... ...+,r.; �;.= ��.'.::.r V: � +a�..'i.:a.'�- Jl.:r:�..w.; Y',��a•..ey^�r.r��ip ► ti.e 'vw 1 28. Wetlands ID number ................................................................. ............................... NIA 29. Is Wetlands Permit required? ...................................... ............................... Yes/No No Has application been made to Town or Local DEC ........................... Yes/No NIA 30. 31. 32. Does project require a DEC Stream Disturbance Permit? .... .........................Yes/No No 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 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 No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ........ ..........Yes/No Yes 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? .................................. .........................Yes/No No 35. Are any sewage treatment areas in excess of 15% slope? ............................ 36. Tax Map ID Number .............. ............................... Map 84.00 Block I Yes/No No Lot 69 37. Approved plans are to be returned to ................ Applicant 'k Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater 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 1, the application must be accompanied by a Letter of Authorization (Form LA -97with th is provision may be grounds for the rejection of any submission. ry e• `u/ I hereby affirm, under penalty of perjury, th in ma ' id n is form is true to the best of my knowledge and belief. False statements isha is a Class A misdemeanor Jh pursuant to Section 210.45 of the Penal La w SIGNATURES & OFFICIAL TITLES. Timothy L. Mailing Address Cronin Engine 2 John Walsh Boulevard. Peekskill. NY Form PC -97 617.20 Appendix C State, Environmental Quality-Review..,. For UNLISTED ACTIONS Only PART I - PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME V.S. Construction Corporation Construction of Single Family Residence. 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) West side of Marsh Hill Road, 2670 ft. north of intersection of Marsh Hill Road and Peekskill Hollow Road 5. PROPOSED ACTION IS: 0 New El Expansion Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: Construction of a new single family residence, SSTS and Private Well Supply. 7. AMOUNT OF LAND AFFECTED: Initially 2.921 acres Ultimately 2.921 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ,R] Yes F] No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? 0 Residential n Industrial Commercial Agriculture El Park/Forest/Open Space Other Describe: Surrounding lands are zoned R -2 (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 No If Yes, list agency(s) name and permitlapprovals: Town of Putnam Valley- Building Permit 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? 0 Yes No If Yes, list agency(s) name and permittapprovals: Town of Putnam Valley- Site Development Approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? Yes ❑✓ No I CERTIFY THAT THE INFO MATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Croni gmeering, P. ., .C./ James W. Teed, Jr. Date: 4/3 Z& Signature: If the action is in the Coastal Area, and you area state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 L"_. _.__ PART u _ IMPACT ARRFSSMFNT ITn be completed by Lead Aaencv) A DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAR Yes []No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another involved agency. ❑ Yes [] No 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 pattern, 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)? E] Yes E] No If Yes, explain briefly: E.---IS Tt_IERE, Gk,IS:T!4ERE.LIKELY. TO BE, GONTROVER�Y RELATERTO POTENTIAL ADVERSF,ENVIRQNMENTALIMPACTS? n Yes F-] No If Yes, explain briefly: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) 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 environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and /or prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting this determination Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Date Title of Responsible Officer Signature of Preparer (If different from responsible officer) J�y J Vp_ or ALL TRENCH ENDS ARE CAPPED PRIMARY AREA 'A (400 L.F. TOTAL) P. Found J ABSORPTION TRENCH I 1(4p=1p.T.1OTAL INSTALLATION) N On Line AS -BUILT k DISTRIBUTION BOX (TYPICAL INSTALLATION) C) P. Found On Line A. 0T 1 ff 100% EX DB cz,) Ices P. Found 0.3 S. W. Cz ¢ AS-BUILT :k 198 L.F. OF 'POLYETHYLENE �,AS BUILT PUMP C B CONCRETE] FORCE LINE 12 L.F. OF 4-0,SDR-35,PVC PIPE APPROXIMATE WELL TANK WELLXTROL MODEL WX302 PRO SE-rBA 125 PSI ST 4b AS BUILT SEPTIC TANK (1500 GALLON 311 L.F. OF 4*0 C � As—Bull t WG// rons- 0<\ ri L 0 Ido. J_ cz 0 0 0 10 TO 7 MINUTES PER INCH AND SURVEYING ST 8; 2008 WITH IBDIVISION AND SITE ,M COUNTY CLERKS v mmmmmm 00� R-=110. 00 ' L= 55.95' AS -BUILT S.S.T.S. LOCATION DISTANCES DESCRIPTION A B . DISTRIBUTION BOX CENTER 201.1 189.0 TRENCH 1 BEGIN 195.2' 182.7' TRENCH 2 BEGIN 194.0' 180.0' TRENCH 3 BEGIN 193.0' 177.5' TRENCH 4 BEGIN 192.3' 175.2' TRENCH 5 BEGIN 205.0' 191.5' TRENCH 6 BEGIN 202.8' 189.0' TRENCH 7 BEGIN 200.6' 184.5' TRENCH 8 BEGIN 199.2' 181.7' TRENCH 1 END 149.0' 143.0' TRENCH 2 END 147.0' 139.1' TRENCH 3 END 145.4' ` " 1 '355' TRENCH 4 END 144.0' 132.1' TRENCH 5 END r 253.0' 236.0' TRENCH 6 END 251.2' 233.1' TRENCH 7 END 249.4' 230.2' TRENCH 8 END 248.3' 228.1' r e� �t o� A S-BUIL T CONS AS -BUILT WELL LOCATION DISTANCES DESCRIPTION C D WELL 46,3' 19.01 AS -BUILT S.S.T.S. LOCATION DISTANCE - -.... DESCRIPTION B C SEPTIC TANK CENTER PUMP CHAMBER CENTER 14.4' 65.