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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -1 -71 BOX 33 04358 PUTNAM COUNTY DEPARTMENT OF HEALTH ��IO1;.Q..VIltnl�T1VIL�T:' HEALTH SERVICES CERTIFICATE OF CONSTRUCTION_ COMPLIANCE FOR SEWAGE THE - N SYSTE M PCHD CONSTRUCTION PERMIT # 1`� ` au_���( J D Located at 96 M KSP I H I W 12.D r Village �V A NA % - d F Owner /Applicant Name V S, &.i s- TA"*,v GAP, Tax Map O Block Lot _ Formerly Sf e Subdivision Name f994D 9 10GF. Subd. Lot # I Mailing Address 34 C 2,t aav -b*1 ikD i d ,5S # At m/ ivy Zip /OSb Z Date Construction Permit Issued by PCHD 31} CQATo,J p*sl Ao Separate Sewerage System built by V S. (001 &TlLVt rrioN Coa,Pr Address 0 b S i N lK. N`/ 1052 L Consisting of Jr' 0n Gallon Septic Tank and q4'? (,, F� 0 Y,� PeaFio-YYi" _FUC rK 2,q" 4ieevf4 'rkgro sS . Other Requirements: . No N E Water Supply: Public Supply From Address 15'1- Smog. 5'! .or: X Private Supply Drilled by N0Rrn4w AwDwod /NC., Address PuTwem Vfq,! ,, 1 tj 445fi Btiildin' -Type .51041, +�ira,u fit.�.(,� Has erosion ooritiol been completed? °Y Number of Bedrooms Ll Has gar I certify that the system(s), as listed, serving the a o built plans (copies of which are attached), in c d plans and the standards, rules and regulati f the Date: - l . 1 Certified by ov `Design Address 39.LO (.�IrvE tea:— M9 alled? tq 0 its ,vii eon ct. d essentially as shown on the as- h PC onstruction Permit and approved epart W of Health. 62: so P.E. X R.A. 4 "15444- License # bG 2990 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 revocation, modification or change is.necessary . , _�M itle: Date: WHitecopy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 tl .�• � .. .b .a. � n rill �V "G ::+F{^'.._.._ - .. � .. -. BRUCE R. FOLEY Public Health Director DEPARTNIENT OF HEALTH[ 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 (845) 278 - 6558 WIC (845) 278.6678 Fax (845) 278.6085 Early Intervention/Preschool (845) 278.6014 Fax (845) 278 - 6648 E911 ADDRESS VERIFICATION FORM `: 5 �PNS -T 11.uLZ"rvN cop'? OWNERS NAME: '' , TAX MAP NUMBER: `b E911 ADDRESS: 96 RoAo TOWN: VU-TN AUTHORIZED TOWN OFFICIAL: .(Signature) DATE: 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 Certificate of Construction Compliance. (E911 verfnn) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION. OF ENVIRONMENTAL HEALTH SERVICES. GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM cvjwmwrio�j GK-P, Owner or Purchaser of Building Tax Map. Block Lot V S, Co�•,�rt'2y(� -T+•�✓ Coup, vTA04M V Building Constructed by Town/Village 96 4 9,2 I k1c c. 20,90 /I., E Location - Street Subdivision Name SING r t FMrrw, 4;) 0P✓4C— It 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 .... ..m_ . .... ..._.. .......,... _..w - ..o -.vv: sisr.. .,r .,... �.. ... .....,..._..... -w. .... �r ..r.• •.. .. ... ............. ..�a +.�.. .,.,e 'ep.• .. .,r ... .. •. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the Day l Year ?A" Signature: - - Z_Zj Z9 Title: L rc sco &#,-rx ovr&n.. Gert%1Vt tra1tor (Owner) - Signature ^ . V S. CST /tG4G'tr1 #41 a Corporation Name (if corporation) Corporation Name (if corporation) Address: 3 CUT0-/ _PA% %�i�o . as Srwrtiy Address: State ^/ Lj Zip Z- . - State _L 5oPh.F ZiP Form GS -97 YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 10598 (914) 245- 2A0.0• - �'�= Al5efe %i.' Fadovahi:, Director ** TEST REPORT * *. LAB #: 1.102630 CLIENT #: 2500 NON STAT PROC PAGE: 1 of 2 ANDERSON WELL DRILLING DATE /TIME TAKEN: 06/27/11 12:15 152 BARGER ST DATE /TIME RECD: 06/27/11 12:50 ATTN: NORMAN, SARAH REPORT DATE: 07/06/11 PUTNAM VALLEY, NY 10579 PHONE: (845)- 528 -1491 SAMPLING SITE: 96 MARSH HILL, LOT 11 SAMPLE TYPE..: POTABLE OUTSIDE TAP PRESERVATIVES: HNO3 COLD BY: VAL SANTUCCI TEMPERATURE..: <20 >40C NOTES...: COLIFORM METH: MF DATE .FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 06/28/11 MF T. COLIFORM ABSENT /100 ML ABSENT SM 18 -20 9222B 06/29/11 LEAD (IMS) 1.1 ppb 0 -15 ppb SM 18 -19 3113B 06/28/11 NITRATE NITROG 0.85 MG /L 0 - 10 SM18- 20450ONO3 06/29/11 NITRITE NITROG <0.01 MG /L 1.0 MG /L SM18- 20450ONO2 06/28/11 IRON (Fe) <0.060 MG /L 0 -0.3 mg /l SM 18 -20 3111B 06/30/11•'*-' MANGANESE (Mn) <0.010 MG /L 0 -0.3 mg /l SM 18 -20 3111B 07/01/11 SODIUM (Na) 11.9 MG /L N/A SM 18 -20 3111B 06/27/11 pH 6.7 UNITS 6.5 -8.5 SM18 -20 4500HB 06/28/11 HARDNESS,TOTAL 146 MG /L N/A SM 18 -20 2340C 06/27/11 ALKALINITY (AS 86.0 MG /L N/A SM 18 -20 2320B 06/27/11 TURBIDITY (TUR 0.8 NTU 0 -5 NTU SM 18 (2130B) COMMENTS: MFTC ota Coliform = This result indicates that the water Q��(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. Pb /Cu LEAD limits for p EPA Lead & Copper than 100 of their than 15 ppb and a treatment must be potential. ablic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg /L, else water undertaken to reduce the waters corrosive Fe /Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg /L. IMS = IMMEDIATE METAL SAMPLE.(INTERPRETATION: WATER SAMPLED AFTER SITTING UNDISTURBED A MINIMUM OF 6 HOURS OR OVERNIGHT) NMS = NORMAL METAL SAMPLE. (INTERPRETATION: WATER SAMPLED AFTER RUNNING FOR 10 -15 MINUTES MINIMUM)•,': - -? YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y..10598 (914) 245 -2800 Albert.-H. •Padovan '- D_i =tr: _ ** TEST REPORT ** LAB #: 1.102630 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: 06/27/11 12:15 DATE /TIME RECD: 06/27/11 12:50 REPORT DATE: 07/06/11 PHONE: (845)- 528 -1491 SAMPLING SITE: 96 MARSH HILL, LOT 11 SAMPLE TYPE..: POTABLE OUTSIDE TAP PRESERVATIVES: HNO3 COLD BY: VAL SANTUCCI TEMPERATURE..: <20 >40C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 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. pH IS A FIELD MEASUREMENT AND IS REPORTED FOR REFERENCE ONLY. Ht _ ' TQTP; iA NESS':_Z;i FINED,,- IBS- HE_ SUM. ,OF THE�'.CALGIUM :,& 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) ALK (ALKALINITY REPORTED AT pH 4.5) THE ABOVE TEST PROCEDURES MEET ALL REQUIREMENTS OF NELAC, AND RELATE LY TO T ESE nSAMPLES RECEIVED BY THE LAB SUBMITTED BY:— LfV e Albert H. Pado ani, M.T.(ASCP) Director ELAP# 10323 t •- �'i� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES , WFI I COMPLETION REPORT Well Location Street Address: Town/Village: -P'1 Tax Map # Map Block Lot(s) GPSI:I:,,:;, •,;,u Well Owner: Name: Address: t/G Use of Well: 1- PriMary 2- Secondary - `� _Residential _Public Supply Air cond /heat pump _Irrigation Business Farm Testimonitoring _Other(specify) 'Industrial ` Institutional Standby Drilling Equipment Rttry ". Cable percussion Compressed air percussion _Other(specify) Well Type te'''a _Screened . Open end casing Open hole in bedrock _Other Casing Details Total Length 12-15—f t. Length below gradea3ft. Diameter 6o in. Weight per foot Ib /ft Materials: Steel Plastic Other Joints: Welded Threaded Other Seal: Cement grout Bentonite Other Drive shoe: X Yes _ No Liner: _Yes V No Screen Details Diameter (in) Slot Size Length (ft) Dept to Screen (ft) Develo ed? First _Yes No Hours Second Well Yield Test _Bailed _Pumped Compressed Air Hours . (v f Yield S gpm Depth Date Measure from land surface-static (specify ft) During yield test (ft) Depth of compete wel , n ft. Well Log "' If more detailed ' 't Information... .. _; dbscriptions'or °' sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter (in) _ Formation Description ;.... ^,;" ft. ft. Land.surface l : ct� -lL/r t.�- _ f 3 - 6, If yield was tested at different depths during drilling list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type,v, Capacity Depth 2 Model W1 X b a- Voltage '2,-;D HP �� Tank Type u1 ' 4 Volume y Date (Nell Completed .. �• �r UVBII DrLller "PC CertIflCBte # NY State #! -- �, Pump Installer PC..Certlfcate ate of Report Well Driller ,.Name &Address W611 Mr, er;(signatuZW4��. Pum Installer Name 8 Address k kk.z p. r Z S�. �..i �i'>.�'d' .:Y,. dpi Pd Installer (sign ur ) n° . `. -. .. �r aMt'�'.'• ". ii4: I NOTE: Exact Location of well with distances to at least two permanent landmarks to be provided on a separate sheet/pian. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 Sherlata Viler, MD, MS, FAAP Commissioner of Health Robert Morris, PE Director of Environmental Health me"artment of Health I Geneva Road, Brewster, NY 10509 Office (845) 808 -1390 Fax (845) 278 -7921 or (845) 808 -1937 Cronin Engineering Mr. Tim Cronin 39 Arlo Lane Cortlandt Manor, NY 10567 Dear Mr. Cronin: Paul Eldridge County Executive July 21, 2011 Re: Field Inspection — VS Construction Corp Marsh Hill Road (T) Putnam Valley, TM 84.4-71 Subdivision Lot 11 The above referenced separate sewage treatment system can be backfilled. There are no open comments to be addressed at this time in reference to this Department's open work inspection. If you have any further questions, please contact me at (845) 808 -1390 ext. 43261. .4 ;r a ...a ..-. ��.. .�_su. _. .... -.r. ..r. � .. _r. -.�.. s..- u � ...... .� -- syr '.vGS. sG^tiLiic. p✓ o. .n .-• .. _. .w.qw K... ia.• °.7 r. �-?' .-. ... e. .!'.... .o... -.T, � +�0 .w� Sincerely, Q Gene D. Reed Environmental Health Engineering Aide GDR:cw PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: 711'1111 ii Inspected by: - StFe?t Owner U S, Town ���� R% / /�,� P.erniit # %mod/— /f O TM # Sz/, 7,l Subdivision Lot # 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 - 1,000 .... ..... 1,250 ......... other ... b. "Septic�tank installed level ........... . .. .............. ................ .. .... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1.. All outlets at same elevation -water tested....' ............. 2. Protected below frost .............. :... ............................... 3. ".1Vfinimum 2 ft. Original soil between box & trenches e. Junction Bog properly set .......... ............................... 6. Irenches 1..Leogth required �_ Length installed 2. Distance to- watercourse.measured--�- i o o Ft....... .... ` 3. 'Install ed according to plan ............................... 4. Slope of trench acceptable 1/16 -1/32" /foot ............. 5. 10 ft. from .property he - 20 ft.- foundations.......... 6. Depth of trench <.30 inches from surface .................. 7. Room allowed for expansion, 10.0 % ......... : .......... ..... 8: Size of gravel 3/4 - I lk" .diameter clean ...................; 9. Depth of gravel in trench 12" minimum ................... 10,. "Pipe-ends za pped .; PuMb,6 �DosedpSgstems 1. Size of pump chamber ................. ...........:......... ".....:... 2. Overflow tank ............................. ..................... ........... 3. Alarm, visual/audio..:.....:... ......... ............................... 4. Pump easily accessible, manhole to grade ......::......... 5. First box ba$ Ied .:........................ ............................. ... 6.. Cy � cle witnessed by H.D.estimated flow /cycle........... M House/Building a. house located per approved plans " ........:.....: b'.. Number of bedrooms .................I ......... IV. Well Well located as per approved plans .......:...................... b. Distance from STS area measured 1o0 ft ........... C., Casing-18" above grade ................ ........:...................... d. Surface drainage around well acceptable ....................... V. Overall Worlananshin . a.. Boxes properly grouted ................ ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ............................... d. Backfill material contains stones <4" diameter ....:......... e. - Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ........ :............................ i. Erosioa control provided ................. .............. .......... ......... Rev. 12/02 COMMENTS orm 11 -07-08 13:25 FROM- T -053 P0001/0001 F -504 PUTNAM COUNTY DEPARTMENT OF HEALTE[ DMSION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION ❑ ADAM REQUEST FOR FINAL 1NSPR ,TION All information, must be fully completed prior to any inspections being made. El GENE A Jof For- Fill Tremches �.�,...� PCI-ID Construction Permit # 4)v 16-049 Located: ASK [-1 u.c., R M .PU *J*-' - Owner /Applicant Name: _-., CoWeatmy,,oN CORP, TM Block. - -- Lot Formerly: Subdivision Name: ► A � � � Subdivision Lot # 1 � Is system, fill completed? Date: Is system complete? Date: Is system constructed as der plans? Is well drilled? `Y_S Date: Is well located as per plans? Are erosion control measures in pla e? NEW I ceitify that the system(s), as listed, at the above premises has,1 on I have inspected and verified their com P letioa in accordance with the stie > � -on Permit and a roved , lens and the Standards Rules and Re lati `�e Cho a artment of +p ..,.w.- . -•— .__ -... �"IGalth.... - , n ..- > - . -.. - ..- -. — I_. h�y -'Lry `\ y� ... _ �, . r .- ...... �. � _ _ l _ F 1.. Certified b emu. Uj ku Date- '" � ... -..� ....�... z� Des i P ssb ° p�at-rss�o�°� Address: Comments: z Form FIR -99 UZ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES r� .. r �. ..'_..�. -_. � �.. _ �:Lt -._... .-. �. - - .�.lt r-i 1 .. ;1 ... - r - .. ..T'. � _: •J .4t.:' -�r� �• iy� CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYS o - u 11 PERMIT # PV- 16 -:,s Located at 96 . .harsh :.il Road Town or Village PtItnam Va.1'ley Subdivision name E n e r a. l u It i d g e Subd. Lot # 11 Tax Map 8 4. Block t Lot 71 Date Subdivision Approved 4 o v e mb e r' 19, 2; 0 7 Renewal x Revision Owner /Applicant Name V. S C n n c t r i i r t i 0 n Corp Date of Previous Approval 7/ 21 / 0 8 37 Croton Dar-i Road, I0562 Mailing Address 6 s s i n I N a York. Zip Amount of Fee Enclosed $ 5 0 0 Single =am ly 8.272 4 00 Building Type ;;e s de;, t d Lot Area No. of Bedrooms Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1 ,5#Yo gallon septic tank and 448 L F. of 4" dia . pCrfora {ea pvc pipe in 10 (ravel tr:;nches Other Requirements: no n To be constructed by t . b, d . Address - - Water Supply: h a Public Supply From n 1 a Address. n/ a - -or:, :... Private Supply Urilled by - t b. d :.. Addr 'ess: - - - - 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, sY tem described above will be constructed as shown on the approved,amendment thereto and in accordance with the standards, rules _#nd°tb"— atiegs of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction�C o�l'y ' ' tisfactory to the Public Health Director will be submitted to the Department, and a written guar W 411 be flf ll ' ed�e owner, his successors, heirs or assigns by the builder, that said builder will place in good operhtin ndjitigR, pa o aid sewage treatment system during the period of two (2) years immediately follow' da .9f iss anc6?of the a ro` al of the Certificate of Construction Compliance of the original system or any r airs ereto. Signed: ; 6 91S 1 - -` P.E. X R.A. Date ~`��� ' t Hanor, NY 1056 Address 39 A rlo Lane ,� ! ? License # 0 6 2 9 8 4 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 a new permit. Approved for discharge of domestic sanitary sewage only. Title: Date: copy - HD File; Yellow copy - B ilding Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type �. F ; ,r,. PCHPermi# 00 :N EI -5 Well Location Street Address: Town/Village: Tax Map # 96 t4ar5h Hill Rd Puthum ValleyMap 84 Block 1 Lot(s) 71 Well Owner: Name: Address: 37 C ro t o1 Dam Road Phone #: V. &.. ConsLruction OZsiAing NY i05;32 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 gpm #People Served 4 Est. of Daily usage 8 0 gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drillin x New Supply (new dwelling) Deepen Existing Well Detailed Reason 1Iew Po.twbla Water su 1 'co new dwellin. for Drilling Well Type 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 emerald Ridge Lot No. 11 Water Well Contractor: .t • b • d • Address: - - - - Is Public Water Supply available on site ? .......:............ ................... ............................... Yes No x Name of Public Water Supply: n/ a Town/Village n/ a Distance to property from nearest water main: well location & sources of contamination to be pro de on separate sheet/plan. ,Proposed Date: l Applicant,Slgnature: 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. 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 Commissioner of Health. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam CN, nty. i i �! officim Date Date of of • • Title: - -Z' Permit is Non -Trans White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Rev. 3/06 PUTNAM COUN TY DEPARTMENT OIL HEALTH DIVISION OF ]ENVIRONMENTAL HEALTH SERVICES_ AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTNENT To: Public Health Director In the matter of application for: 56 TS 6iyoawl oo NA I-r Cav (117yM On - I, V 1O. 5qvqyC4,i represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: V. Having offices at: �� i)N D� RD ,e QS5►iv iivl,. Al!tj I o �Z.. Whose Officers Are: President-Name: V& L K10 5 UC,�,► Address: �6 a, Svc Vice President - Name: Address: Secretary -Name: Treasurer - Name: Address: and that I am and will be individually responsible for any and 11 is � f th oforation with respect to the approval requested and all subsequent acts relating th t � _ o Sinned: Title: Sworn to before me this day of J� Nota u r Notary Puib Public, StAate of new VW " No. 40872 Corporate S WHO in Dutchess Loft Commission Expires December 16, lei Form CA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of y: c7 • 6tjSllt�7toni a_ Located at TN Tax Map # Block Lot Subdivision of7�i22D -f #� Subdivision Lot # 11 Filed Map # z,,a&-;/4 Z Date Filed I �9 Gentlemen: Thic lPttar is to niithnri7a Y.lr Or I r 1`YI0-#m 6, v&'V1JV Jy a duly licensed Professional Engineer ?c 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 re lations as promulgated by the Public Health Director of the Putnam County Health Depa atrv��dr6',.; all necessary papers on my behalf in connection with this matter and to supe z tio of said wastewater treatment and/or eater supply systems in conformity ovii is 145 and/or 147 of the Educ tion Law, the Public Health Law, and the ' �out�Itary Mailing Address CCiNl+iu Aiw/vpwry Very trulivda. _ I ;l IRS Signed: (Owner Mailing Address: V-51 CrSTrr.T�ow Gzi!/w M9r.►a.. C4TWIJ Offm 20� Os6 I AJjAAj State N � Zip /d Telephone: 9N �16 - 14(oy State A/� Zip 10%'L._ Telephone: / Iq �qj y6p Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DYS.IGN �IATA,S_ ET. SUBSURFACE SEWAGE TR,- ,FATMENT SYSTEM Owner 5 `CoNS�ffZvUly� cofz•P• Address 37 GP.r:r1-DN D,4!y► ftoPtD a Located at (Street) lq\AV 54 thU- V- AD Tax Map 64, . Block 1 Lot S (indicate nearest cross street) Pr?+"taNf .,.of . 8�i:- 1. -: 1D.1 l0•2� 10.3 'cipality Drainage Basin `Pc'�'VKit:i:: N�l,t;bw t�CtmK SOIL PERCOLATION TEST DATA Date of Pre - soaking o-? -i t -04 Date of Percolation Test 0-7 - t3 • o a' Hole No.... -�Run=No. Time Start - Stop Elapse Time (NI in.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate MinAnch . 3 �2 - 3 4 le I 5 2 p3 , 4 IN u rh,'): 1;1 A!ests to be..repeated at same depth: until approximately equal percolation rates are obtained at each peecolatiori 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's: Depth measurements to be made from top of hole. . Form DD -97 , r i TEST PIT DATA v 1 (DESCRIPTION OF SOILS ENCOUNTERED IN TEST MOLES �.... _.DEPTH 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0', 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 10.0' K HOLE NO. p2-1 . Lf Err 600w,0' f Wa "AmD, . Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered N[A Deep hole observations made by: G920�� LIM �a �G, Date .s : ° we �v Design Professional Name: NEW Address: Yoga"` Signature: v F` ESS ��P�,� Design Pro nays Seal r88r��y(yyt �jNl.�.j11C�irt� Ir ` z \, "SF 62980�/ a^'UFES51oN�� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DT ESIGN DATA SHEET SUB SURFACE SEWAGEjREATMENT SYSTEM Owner 44, 40jWXno) j C 01- F Address t4 MM IZD 05510106 flog-r.L Tax Map Block I Lot ► i Located at (Str6et) lhllu 1 (indicate nearest cross street) Municipality tr) -rVTN A^.% - V� Watershed F ,g-*4Y-tu- +JoUow 51Q-V. 'n SOIL PERCOLATION TEST DATA 7,- Date of Pre - soaking 0,A-10!.lo,5,---Datq.of;Perqolation,Test 04 W, 06 I NOTES: r - I ` I Tests to be repeated at same depth until approximgteilty�'e4ual percoldtibfi rates are obtained at each percolation test hole. (i.e. I min for 1-30 min/inch, :!�-2 min for 31-60 min/inch). All data to be submitted for review. 2. Depth measurements to be made from top of hole. J Fomi DD-97 P2. 1 01•2 Depth to Water From Ground Water Level Percolation Time Elapse Time Surface (Inches)' Drop In Rate Hole No. Run No. Start - Stop (Min.) Start Stop Inches Min/inch 2 3 4 5 3 4 5 F IV Q A_ Z2- 7 611 2 3 A0 $4. 4 gs3 Q 0jr 41 5. j I NOTES: r - I ` I Tests to be repeated at same depth until approximgteilty�'e4ual percoldtibfi rates are obtained at each percolation test hole. (i.e. I min for 1-30 min/inch, :!�-2 min for 31-60 min/inch). All data to be submitted for review. 2. Depth measurements to be made from top of hole. J Fomi DD-97 P2. 1 01•2 Design Professional =s Seal 62380 �'�OfESSeO TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. VJ HOLE NO. Vvi AA HOLE NO. 2 G.L. d� '�P d� _ L 1.0' "W A4 !AN4 LoAm mu o 154b&N L&4Ao 1.5' 2.5' 3.0' o• 4.0' 4.5' 5.0' ww ® ctl- 5.5' 6.0' .6.5' 7.0' 7.5' " 8.0' Po tzaC . WAIM 9.0' 9.5' Indicate level at which groundwater is encountered Indicate level at which mottling is observed 96we Indicate level to which water level rises after being encountered... �A Deep hole observations made by: c9owiF1 lmla P14 Date ®* • 10 . �g JIM T u 20-44-it I Design Professional Name: -n mm , e,tiojow 11�; Address:., Design Professional =s Seal 62380 �'�OfESSeO , I -A , PUTNAM COUNTY DEPARTMENT OF HEALTH IVISION OF ENVIRONMENTAL HEALTH SERVIC] PERMIT' FOR'SEWAGE-_TRE-ATMENT SYSTEM - PERMIT # Located at MARSH H I L L ROAD Town or Village &)W M VALL -EV Subdivision name "ERALP RINE Subd. Lot.# 11 Tax Map Block 1 Lot �1 Date Subdivision Approved NOVEM BER 19, Z ;Renewal Revision Owner /Applicant Name V.S. CONSTRyeTI614 CORP. Date of Previous Approval Mailing Address 3MROTynI DAM Ra4D, O I / 6 MEW 'I/URK Zip 05(02 Amount of Fee Enclosed 11500000 Building Type -91 y6 E !L) Lot Area $•22 No. of Bedrooms Design Flow GPD 800 Fill Section Only Depth Volume Separate Sewerage System to consist of 1,500 '.._ gallon septic tank and 1iy�3�L�F� of g114P PERF06ATE42 rve PIPE Ill 2y" Gr,,RA.VGL TJCR&H Other Requirements: A/oNE To be constructed by T. J3. D. Address Water Sunnly: Public Supply From Address ::. -- or::. Y Private Supply,Pl . lled 12y.. • n. _ — Address .. 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 Construc ' ce" satisfactory to the Public Health Director will be submitted to the Department, and a written guar $0 0. the owner, his successors, heirs or assigns by the builder, that said builder will place in good op h ► F04-&iti0C9 f said sewage treatment system during the period of two (2) years immediately followin e e o e is f val of the Certificate of Construction Compliance of the original system or any re irs t re Signed: P.E. V R.A. Date 65-62-260%, Qz Address 22 J otW WAL % _ _ EKM ILL, A/ 1056& License # 0(o.Z980 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 a new permit. Approved for discharge of domestic sanitary sewage only. 10 By Title: � Date: al C ®8 Ataiopy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 e PUTNAM COUNTY DEPARTMENT OF HEALTH DIVIKON OF ENVI[RONMENTAL HEALTH SERVICES APPLICATION-TO , r . : �T WELL,. a , _ COI���'l[3�J A- �Y�TEIB Ole print or type PCHD Permit # t'6 —0 Well Location: Street Address: ff - � illage Tax Grid # NAPSH ILL tom® D02M &4t E Map 9tJ Block J Lot(s) '�l Well Owner: Name: Address: ff Cm -WiW UP, 31-CtaToOAm R 0Sai4t04 A!1LW oltK 2 Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation I- primairy Business Farm Test/Monitoring Other (specify) 2- seconda Industrial Institutional Standby Amount of se Yield Sought J gpm # People Served Ll Est. of Daily Usage 0 gal. Replace Existing Supply Test/Observation Additional Supply Rumn for gDnnllinn New Supply (new dwelling) Deepen Existing Well etaifleafl Reasoan Alp �0 L cvuPP A1 vaIFLL, N for IDirilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes —�a� No Is well located in a realty subdivision? ...................................... ............................... Yes—/- No Name of subdivision �MR@60 RiP&F- I Lot No. 1g Water Well Contractor: to 86p, Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: AI IA Town/Village ! �IA Distance to property from nearest water main: �4 Proposed well location & sources of contamination to bSqoided on separate sheet/plan. Date: , 05 -OZ -Zoog . Applicant Signature: �. ... ...., ,. .. PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue Jaflbs Permit Issuing Offici Date of Expiration; Title: 2 Permit is Non- Trannsffen• abfl White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 V.S. CONSTRUCTION 4t 9_9 'r 2 K� 39' -9 I /1' i PLwa 33' -l1 5/8• (i � tl Ir_ UV 2" 13' -7 7//' F PLUn VENN 31 60 JEFFERSON ,r 1ST FLOOR pUT AM COUNTY DF.YARThIF,NT OF REALTII 03/14/2007 1 /1' =1'-0' r E 4'LAN APPROVED FO 01220 II BEDROOM COUNT ONLY, pv, c� -o 8 BEllRO0A1S I, ALI. SUBSEQUENT RE1'ISION�ALTER TIO \S TO T- ESE HOUSE PLA�'SMU�STQBE SU13.11I17'EU 7'O TH9 SN- /DN- 4220/NY 60'-0• 12.3 12' 11-4 1/2' 0' -8 1 /1' dfidY] = ❑e MKf V1 LtTAle NLW '��ALxv Le Pe[ -qAL Mtb MDE v wz L•.z a> zuz xuz LO•c •L 12-ll 1/2' Yhd P(2 � 77 19-fI /2' c TIl]Jx DDT c-TOPH / SIDP FAMILY ROOM v dAOf nT. lbP ;< zazze1pL�mrt eco-D ? V ^ ` I.m LaiT�aov M y eua urs vv r UAD vicei eEaD (u 12 c m vEN:,rrcaD KITCHEN Y. >0 uw PRN➢ 1 alaD LID(f IQOVD EIUR EVL 9 O 7w0 VCNi ROV'D LL9 VENT PQDV2 DINS ID 11 mM •� _■ LIX (Ab _ I f r 1lAG L-I f- MExrDAT@ flf[RKE �rDCK1NG L -- = 40 L[(EN1MT PIAV% N00E1 SM)CaS � ' f(ie VD,T TWf L.N iz I r ° d = •.; "v' T 1� ( sss1 awt fL•♦ ' 11'-11 1/2' 6 ' ttre ar Erv. ' L 2• 'De • w 1? Ai(' 3 /0' Y J77( iu a 1 _ J 1 LA 0 r M vt � .`. UTILIS`L N = r 4 HATS Nfi (� �j �©I'+ fa ITPAE1ef 1•SLIDR fEYp [: V NurtL1 Ta Vdi IS C 3' -B 112' ry`' C KO LDS ADn IfELY s m. L(GNT Pte; ' K c� ■p Q - ADVL'uDRIV[YT vzaw --- -Y rvL rocs a • -. CEMENT , �}*( ENLn16 zr �DLDCE $S 1 •- 1'3/8' a vae .vPUCALLE fOKf - LIVING ROOI so17Y 3,1 2' -7 3/e' ° © zP -aa• xumeAa NcT I 11 U 7 Fr In .) LY•t UDfT RED'D 2 -3 - n vENr ffvD ^R�� 3J': 1 S /8' i)ID LNWT PlDVN �• PLDfA Rfx TD AxM S < INSTALL LL60 VTM PROV•D eAlsE 3 4. LAILDc am TrPC x mP. GNIAGE aP iTp'. 1 •e sv iRDO1 a FOYER 1 nm' 1 CI ¢E NOTE t10 311 V[NT fE9H ©� yl I� I— LIDR PP.CV'n GG Len I=1 ON -SITE STEEL HEADER 6 1' I� �>.' -B /e' 31' -0' 1 12' -5 1/2' �• �'D DESIGNED, PROVIDED 6 INSTALLED a ° ON_SITE BY IULlLDElj 1 - _- _- _ -____- _ - - -_- 1 -hi f 1 ' STEEL BEAN ON-SITE BY HUILOER „pp.L Y paL,( pzdx y I FC6X I � 1u7 FCLTttc ' -10 3/8 a J 1 d44 •_B' 7,_4', 3,_g, 6,-0, /z-ir sL6•_D• 3,_6• 6,_1• J•-6• 12'-0' ID' -4 T /2-TVO STORY 1 5 2D �I a 1 Ca LD.Ir PANELIZED WALLS ` 19' -1' ff (DS VIL' VN1 IR) H NOTES f0' -D' �20.aLA 57 -0. 1.2x6 E%T WALLS B 16. O.C✓2x1 MARR WALLS Z 9 - -0' CLG HT. 3.2x10 SPF82 FLUB JOISTS 2 'We. / JOIST HANGERS I.MV BRICK MOULD DBL HUNG VINDOVS (TVHDW 91 =21210M B2= 2812M, M3N= 3016M, N1= 2D52M, 811- 2856EN3 S.CLG GIRDER OVER LIV /DR/KIT /FOYER TO HE' 1 -1 1 /2•x11 1/1•x1Y-1' /31'-1' ML 7.12 6, CEILING ORYVALL WILL BE OMITTED FOR ALL ON -SITE PLUMBING CONNECTIONS 7. BLDR INSTALLED HEATING SYSTEM TO COVER A 86,000 BTU LOSS SAM R -19 flit TNSVLATI04 REQUIRED PER NYSE.C.G. 9.SITE LOCATION, MONTROSE. NYN VESTCHESTER COUNTY, 45 PSF SNOV LOAD 30.2x10 SPPi2 CEILING JOISTS OVER GARAGE. BASE LAYER 5 /1D• TYPE • %' GYP APPLIED AT RIGHT ANGLES TO CL'G JOISTS. ATTACH /1 1 /1• TYPE S• DV SCR WS AT 21' G.C. FACE LAYER 5 /B' TYPE k• GYP gPPLI'c ➢. AT RIGHT ANGLES TO CLG JOISTS. ATTACH / l 7/e' TYPE 'S' DV SCREWS AT 72. O.C. SET HACK SLREVS'2' AT END HINTS AND STAGGER JOINTS 2' -0• EACH DYER. 7/36• DSB OVER JOISTS PERPEN r /Btl NAILS (RC260U x Y .J. a Q Z ❑ F- u la 0 a Z Q� cwi l zi Q J 3 o. O E w a oM O W A Q� f 8 rn Z 4 W E N aS Q R � S >•. ��' rRP0 BOY 87 !JI =37004 PA 7701 -- HOfVIES (7 r7) 114_JBBs PAX (T 17) 44I -7677 FROM THE INSIDE OUT "w- ZXCsts0uss.coi iPl:DOH FOR APPROVAL Y' �I. f. = _x �T 7a 4 O - z o0 8 � o O` nw i>r •q � y zt a at ( rA C 4 ti a a�" T'' u F;1 E• w L G 9!/ R � S >•. ��' rRP0 BOY 87 !JI =37004 PA 7701 -- HOfVIES (7 r7) 114_JBBs PAX (T 17) 44I -7677 FROM THE INSIDE OUT "w- ZXCsts0uss.coi iPl:DOH FOR APPROVAL Y' �I. f. = _x •i^ sa p V.S. C; NSTRUCTION CORP./ 1� W q FW p O t3 F Qx' '3 • is F F q O w ;d :s n� m� i� I� � a c m i. i.. Ila If li c' :.y Ip - --------------- .IA .;r NOTES, - I. 2.6 t9T_WALLS B 16' QCJ2.4 MARR WALLS B'v0' Ir -b' ru rma B % -D' " 4a emr urtrss `!; J' J6' -2 7/4• Jr 1�tp• ^, 28 -10 3/4 t2 ?' -6' L '• it n,wT B. TRUSS ROOF SYSTEM IS DESIGNED FOR CEILING DEAD LOAD ONLY AND NO MECHANICAL EOUIPMENT SMALL BE INSTALLED IN THE' CEILING SN— /QN- 4220/NYI J W a a LJ z F- a o_ a z�w z x �x J a� f 0 � w ca C3 U y ix 0 2 4 w� a f D Qy N B p O O W q FW p O t3 F Qx' F F q O w n� m� � a c m 1 IV.S. CONSTRUCTION CORP./ 1`. Ir r •• 1 SN- /ON- 4220 /7 r I 8 S MTC _ I•r______ ______ ___ 1 1 _____________________________________ ____ ______ ___________________ __ I 1 /Y n1A VT AICIOt fRTS 1 I WCIOR f1RN1 lCLnC! rlft tli I I I I I 1 I - -J I COLUKN SPACING BASED ON I -1 1/2'.9 1/1' ILL. 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R Ii SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 James Teed Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 Dear Mr. Teed: ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health June 17, 2008 Re: Proposed SSTS — V.S. Construction Corp. Marsh Hill Road (T) Putnam Valley, TM # 84 -1 -71 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. The following forms have not been completed: a. Application to construct a water well c. Form PC -97 2. Please provide floor plans without previous Health Department Stamps. 3. Please provide two dimensions from the well to the property line. 4. Please provide a cleanout detail. Please contact us if any further questions arise. JSP/kly Very truly yours, Joseph 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 RQNff \Y ENGINEERING, PE, PC ,The Lindy- Building, Suite 20 0 2 , John Wal_sh.Boulevard, Peekskill. -,NeW York 10566_ Tel.:'914- 736 -3664 G Fax: 914 - 736 -3693 May 2, 2008 Mr. Joseph Paravati Assistant Public Health Engineer Putnam County Health Department 1 Geneva Road Brewster, New York 10509 Re: VS. ConsfrucOon Corp.- Emerald Ridge SSTS Construction Permit Marsh Mill Roam Lot 99 Town of PuMarn Valley, New York Secdon: 84:00, Block: 9, Loh 71 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 authorizng 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. ._' • Fouf (4) Su"' surface SewageTreatment Stystem - pg tali n Pe.0i PI0Ds;,fprothe,..'abb. eW .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. Respectfully Submitted, James W. Teed, Jr. Project Engineer cc: Owner- Val Santucci (V.S. Construction Corp.) File- Paravati-PCDH- Santucci - Emerald -Lot 11 -Trans jt- 20080502.doc PUTNAM COUNTY DEPARTMENT OF HEALTH ,DWISION -OF -ENVIR � Y ENTAL,HEAL'TH SERVICES LETTER OF AUTHORIZATION RE: Property of 1.5. Construction Corp. Located at Marsh Hill Road ITjV Putnam Valley Tax Map # Subdivision of Emerald Ridge 84 Block Subdivision Lot #� Filed Map Gentlemen: rj o 3 A A Id, 1 Lot 71 y' I do" "K 19, Zo,'? This letter is to authorize Timothy L. Cronin III, P.E. a duly licensed Professional Engineer I ✓ I 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 Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the c ; i� 'd wastewater tretment and /or water supply systems in conformity with the prov' . ' 1 4 nd /or 147 of the Ed cation Law, the Public Health :Caul!, a;id the Puti?anrC rl S`anita -Cone * `� ery trul y u Countersigned: ` `<< P.E., R.A., # 062980 F� 1QACL / Mailing Address Cronin Engineering P.E., P.C. Mailing Address: V.S. Construction Corp. 2 John Walsh Boulevard, Peekskill 37 Croton Dam Road, Ossining State New York Telephone: (914) 736 -3664 Zip 10566 State New York Zip 10562 Telephone: (914) 447 -4647 Form LA -97 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: Subsurface Sewage Treatment System Construction Permit (TM # :8q- 1--17L )' I. 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: Address: Treasurer - Name: Address: n and that I am and will be individually responsible for any Jan to the approval requested and all subsequent acts relatinTIMOTHY L. CRONIN Z Notary Public, state of New York Signed No. 4923313 Ouatified in Westchester County Title: Cor mission Expires March 14, 2,01 O Sworn to before this day of ti '&)0A- (year) Notary Public Corporate Steal Form CA -97 corporation with respect 0 ! PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SE, ZV�CFS .. - ... _...h. -..�`� -t. .r+. .-•_ _ r. ... y...vey .4...1GYl 4•J.P . ..'2 .� '�.• APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: V.S. Construction Corporation 37 Croton Dam Road Ossining, New York 10562 2. Name of Project: Emerald Ridge- Lot 11 3. Location: TN: Putnam Valley 4. Design Professional: Timothy L. Cronin III 5. Address: 2 John Walsh Boulevard 6. Drainage Basin: Peekskill Hollow Brook Peekskill, New York 10566 7. Type ofProiect: ✓ 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) ? .............. Yes/No No Type Status (check one) ...................................... ............................... Type I Exempt Typei-1Z Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? .................... Yes/No No 10. Has DEIS been completed and found acceptable by Lead Agency ? ............. Yes/No N/A 11. 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/Nq Yes -If so, have plans b�en'submitted'to such�aiithorities? ............. ............ 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? .......................... N/A 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 N/A P AN 0 1P Date test holes observed e 23. Name of Health Inspector old 24. Project design flow (gallons per day) ............................... 800 GPD 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 n Y 27. Is any portion of this project located within'a designated Town or State wetland ?... Yes/No No 28. Wetlands ID number ..........................................................:....... ............................... N/A 29. 30. 31. 32. Is Wetlands Permit required? ...................................... ............................... Yes/No No Has application been made to Town or Local DEC ........................... Yes/No N/A 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 117�Y771��i 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? .............................. Yes/No No 36. Tax Map ID Number .............. ............................... Map 84.00 Block I Lot 71 37. Approved plans are to be returned to ................ Applicant Design Professional -M 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 -97). Failure to _ this provision may be grounds for the rejection of any submission. P`� "qF W YoR c^'o I hereby affirm, under penalty of perjury, that Afor do rovi n *t' . is true to the best of my knowledge and belief. False statements ma et i re p ea- l sA misdemeanor pursuant to Section 210.45 of the Penal L SIGNATUIPES a& OFFICIAL TITLES: Tiffiothv L. Croni tk . s298o V Mailing Address: ........................... Cronin Enginee 2 John Walsh B Form PC -97 617.20 Appendix C State Environmental Quality Review :. SH ART- E NVIROIVMENTAL- ASS8SSME,NT "FORM 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, 2650 ft. north of intersection of Marsh Hill Road and Peekskill Hollow Road 5. PROPOSED ACTION IS: R] New E] 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 8.227 acres Ultimately 8.227 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 0 Yes No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ✓0 Residential [:] Industrial Commercial Agriculture 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 permittapprovals: Town of Putnam Valley- Building Permit 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? 0 Yes E] No If Yes, list agency(s) name and permit/approvals: Town of Putnam Valley- Site Development Approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? Yes Z No I CERTIFY TH ORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: C m Enginee ng, P.E., P.C./ James W. Teed, Jr. Date: OS—OZ -ZOo(? Signature: If the acudKis in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 i, .f } co Y W Ww00) U U L N C L U U ` O C N w 4_- N m O C cc U N m 1� .� co X d «� d O ` N O C m oN CO U ca C v C o E r W c oQ.` vi o E c m c U N N N p) U m N N ° m EvL- �:,C m o - T C C 2 pz.- .� m Q m U m So O. 7 m �0Noa (D c/l D U O C a O. 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Parcel TWx Map IdendWatian Niimbcr: 114.06444 -_ - -• Property Location: Marsh B I Road (Loth), Putnam Valley, New York Design Engineer: Cronin Engineering P.E., P.C. 2 John Walsh Boulevard, Peekskill, New York 10566 r 0 Z A V F 11, I I' t .O �s W Z 1 A Z to W z z fo E O 0 in O a. m PUTNAM GOUNTY_PEPARTMEN , T OF HEALTH yousE PLANS AppsuffF6t Bs'n'dbm'Colih,r ONLY. ��e- BEDROOMS iLL SUBSEQUENT RElASj%WALTERATiv-3NS TO l'b"ESE tHM '@LANS MUST BE SUBMrITED TO TfiE PC[)O;i FOR APPROVAL ex lIGNATURE 9 TITLE DATE (L V.S. CONSTRUCTION CORP. /GEORGE SN— /QN- 5034L/N' 4.r 98' -0• 6'- D'04AXi ' a 1 I Ir - - -- - -- ---------- - - - - -- ------------------- ----------------- - -- - -- - - - - - - - - - - - - - - - vs• ou m• Ar[]q ARn pifgML YDAZiplf oR miML Qm A b9 - - - - - - - -- I I 1 I I DlrOlpt fTAMf ISLDIOiD im w OL vIF]I 1AO60.L OVaT Y.Y' r 1610rt ME I. m[ ®[ Aimoo:rY rd Lsa Amloc�dia a i . � 1 I h I � I I 1 I I I COLUMN SPACING BASED ON 1 i 4 -9 1/4' M.L. 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O f' O U 3o� ?= LL PUTNAM GOUNTY j1PERAT °AENT OF HEAL-114. a HOUSE PLANS APPROVED�FOR BED1OOar t;06NfONLY. BEDROOMS t.. ALL SUBSEQUENT R- 10SION/ALTERAATIONS TO THESE HOUSE N PLANS MUST BE SUBMITTED TO THE PCOOH r)R APPROVAL cu CD SIGNATURE ATLE PATE 0- 41 (s � t, f • �I ?2 PUfNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES t WELL COMPLETION REPORT Well Location Street Address: Town/Village: 11 Tax Map # Map Block Lot(s) GAPS y Well Owner: Name: Address: VC, C,,p UY, Pat 0.55g, r,3 Use of Well: i- Prirrjary 2-Secondary )< Residential Public Supply Air cond/heat pump ,Irrigation Business Farm Test/monitoring __�Other(specify) Industrial Institutional Standby Drilling'EEquipment '.Rc�tory': Cable percussion Y-4Compressed air percussion _Other(specify) ' Well Type Screened Open end casing A Open hole in bedrock Other Casing EYqtails Total Length ft. Length below grade k, ft. Diameter (,q in. Weight per foot 11_1b/ft Materials: :)I- Steel Plastic Other Joints: Welded ;r- Threaded Other Seal: ' Cement grout Bent6n'ite Other Drive shoe: X Yes No Liner: —Yes V No Screen Details Diameter (in) Slot Size Length (ft) Dept to Screen (ft) Developed?: First Yes No Hours Second Well Yield Test —Bailed —Pumped _2�,Compressed Air Hours Ca -f Yield 15 gpM Depth Date Measure from an surfacestatic (specify ft) During yield test (ft) Depth of completed well.in ft. SO 0 Well Log If more detail6d information.'' . descriptions *017' i3ieve','a1181ys ,es are available, please attach. Depth From Surface Water Bearing Well Diameter (in) Formation Descrip ft. ft. Land Surface If yield was tested at different depths during drilling list: Feet Gallons Per Minute Pump/Storage Tank Information Pump Type Qv, 4S. Capacity Depth 2-YC' ? Model W X Voltage 2,3z> HP_11= rk4� Tank Type _� Volume T bate W 6iFUni�'16(a AP 611'-D"' 11I&�PSCc'Cdftif1b'btlJ#;. -.-:'7NYS "f'R rt.�-4. P6;:np-'InstaIIetPC.-.- -bttificat(�4 Ni� -N fa :0 7, Gi nj1:14 jq!:Aj" ... ..... . . js Pqmp:,.ffttaIIe -&- -Ad ;4 �'ql ll ta Z Z.. NOTE: Exact Location of well with distances to at least two permanent landmarks to be provided on a separate sheet1pian. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC-97- Rev. 3/06 i o n i b ' LOT » I Aga =358, 384 Sq. Ft. = 8.2274 Acros E a s e m e n 9 O/ 110:tOrld! m QOI�100/aO J Approximate Location- Of .uric, Fire Tanks / 1 t! s1 t•i '�O e yJ 1' 1 b� r= f•� ,i 7 ce�L47. R-30. 00 >2 ' "02'25"#' 30.00' e2R=ff0.00' L= 235.73' %0- `p M Monument �KK r3 0 1 � AS -BUILT S.S.T.S. LOCATION DISTANCES DESCRIPTION A B SEPTIC TANK CENTER 4110' 18.5' JUNCTION BOX 1 (1) 61.5' 44.0' JUNCTION BOX 2 (2) ``� 67:5' 1 48.5' JUNCTION BOX 3 (3) 73.5 53.5' JUNCTION BOX 4 (4) 79.5' ,I 58.5' JUNCTION 'BOX 5 (5) 85.51 �` 64.d JUNCTION BOX 6 (6) 91.5' ��. 69.5' JUNCTION BOX 7 (7) 97.5' 75.1Y JUNCTION BOX 8 (8) 16.0 80.5' TRENCH 1 END (9) g3,g !, . 91.5' TRENCH 2 END (10) 875'' 93.0' TRENCH 3END (1 1) g2.d �� 95.5' TRENCH 4 END (12) 96.5' 88.d TRENCH 5 END (13) 101.0' I. 101.( TRENCH 6 END (14) 106.0'j. 104.5' TRENCH 7 END (15) 11,1.0'. 108.0' TRENCH 8 END (16) 118.0' -:" 111.0' AS -BUILT WELL LOCATION DISTANCE DESCRIPTION 7C D WELL 23.4' -0; I di l �j 1 <� 1 �i s bi O' l' c, '