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HomeMy WebLinkAbout4391DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -2 -59 BOX 33 �L u rrm . NN 1 ' - T r 61 �., .4 me if IN ,.l . , k LAIN. 04391 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES UL OAPLETION REPORT r . Well Location Street Address: Strawberry Knolls, Lot #3 Town/Village: Putnam Valley Tax Grid # Map 84 Block 2 Lot(s) 59 Well Owner: Name: Address: VS Construction Corp., 37 Croton Dam Road, Ossining,, NY 10562 Use of Well: 1- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 82 ft. Length below grade 81 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: X Steel Plastic Other Joints: Welded X Threaded Other Seal: X Cement grout _ Bentonite Other Drive shoe: X Yes No _ Liner Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed X Pumped X Compressed Air Hours 6 Yield 8 gpm Depth Data Measure from land surface- static (specify ft) 20.2' During yield test(ft) 149.2' Depth of completed well in feet 665' Well Log If more detailed information sieve analyses are available, please attach. t Depth From Surface Water Bearing Well Diameter:(in) Formation Description ft. ft. Land Surface 65 Dri 11 i nci i n ove 1dPra- 65 82 Dr' 82 665 Drillina in rockhranite , If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 5nm Depth 620' Mode15015412 Voltage 230 HP 1 Tank Type WX302 Volu allons Date Well Completed 11/8/01 Putnam County Certification No. 001 Date of Report 9/11/03 Well ri s' re al Nu'i'h: txact location of well win atstanses.to Well Drillees Name Signature: Perry L. permanent lanamarxs to ne pr ea on a sepgrate sneevpian. D. / White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller PUTNAM COUNTY DEPARTMENT OF HEALTH DAL`" SWN ,- ENV1RQW- NTT EALTITISERVI CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # P V- 31- O L 10 Located at 0i ifNi't4s (4N T Puns Ro/*D Town or Vil age rurtlAm Owner /Applicant Name 37 cfloroiJ DAM Ylono coizp Tax Map i?q Block 2 Lot s 41 Formerly Subdivision Name S ffztl W Ts t R I2 Y KNOLL Subd. Lot # 3 Mailing Address 3 7 C fZ o T o N -0,9M R 0 AD 0 S S I t.1 ! N 6, Mi W yoR K Zip 10562- Date Construction Permit Issued by PCHD DEC - _S- Soo 2 30 C 07-0.0 DAM ROAo Separate Sewerage System built by 30 cQo-ro;J pt9m f1oAy C- al"'PAddress o r rl, iN tAV to S6"2 Consisting of 129'0 Gallon Septic Tank and Sd b Z • F. - 6f "0- Fes, R r a RA Teta ?V c,:. .F 19C /-J s4" G'�LRV� L -r2�:� C� Other Requirements: Water Supply: Public Supply From Address 4 u rNAr� O VeAJUC or: X Private Supply Drilled by'? r ACA L I SON -" I N c • Address 7Z)Q9 W X Tr 2,-0 , W y ) o Sag Bw�lwng'I3'Pe:: : r 1}A! �L-V figs Has e:c on coiit;el bsen- soxngleted ?-4 .... VJC: -5.....- . Number of Bedrooms loo y 11- Has I certify that the system(s), as listed, serving the built plans (copies of which are attached), in arx plans and the standards, rules and regula ' ns o: Date: 3­0 0 3' Certified by C (Design P1 Address 2 SOKtJ inIA L.CK - L VV Pe i K -• K L. ted essentially as shown on the as- 1 PqH4 Construction Permit and approved ieD � ent of Health. -_--- . 6.2980 P.E. �oyP - S6 License # G`i 6 'rl 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. :teTitle: �,ty'r Date: o '3 copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH IDIVISION OF ENVIRONMENTAL HEALTH SERVICES - WELL COMPLETION REPORT Well Location Street Address: Strawberry Knolls, Lot #3 Town/Village: [Putnam Valley Tax Grid # Map 84 Block 2 Lot(s) 59 Well Owner: Name: Address: VS Construction Corp., 37 Croton Dam Road, Ossining, NY 10562 Use of Well: I- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm _ Test/monitoring Other(specify) Industrial Institutional Standby ]Drilling ]Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 82 ft. Length below grade 81 ft. Diameter 6 in. Weight per foot 19 lb/ft. Materials: X Steel Plastic Other Joints: Welded X Threaded Other Seal: k Cement grout — Bentonite Other Drive shoe: X Yes No Liner: Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed X Pumped X Compressed Air Hours 6 Yield 8 gpm ](Depth Data Measure from land surface- static (specify MY 20.2' During yield tesgft) 149°2' Depth of completed well in feet 665' Well Log If more detailed information descriptions or sieve'analyses— __ - are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation. Description ft. ft. Land Surface Hit roc!k nf 61; 65- .. _ 82- . — -Is--ca _ .... ..._ 82 665 Drilling in rock If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity _ Depth 620, Mode15GS15412 Voltage 230 HP 1% Tank Type WX302 Volu allons Date Well Completed 11/8/01 Putnam County Certification No. 001 Date of Report 9/11/03 Well ri s' re al Null t: hxact location or well wim aista as, io Well Driller's Name Signature: Perry L. permanent MUMUKS tU DC p CU U11 d JCpgtlaLO 511GGVplilll. D. White copy: HD File; Yellow copy - Buildirig Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 BRUCE R. FOLEY Public Health Director •�:.:,.': -,. "`�'I.`'CIItE°�"1� ' A%!' ii�INr '1'RT''1t.'I�%;."I�I:�:N". :.'�� � .. .. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914)279-6130 Fax (914) 278.7921 Nursing Services (914)278-6558 WIC (914)278-6678 Fax (914) 278-6085 Early Intervention (914)278-6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 E911 ADDRESS VERIFICATION FORM OWNERS NAME: S9 U Q 16 t--1 DArlx fL o w n c e 2 P TAX MAP NUMBER: Vi-K 2 Lo-r: S C� S J7L,3,r E911 ADDRESS: TH ,/ S N T R V kJ R 0� D TOWN: Q i r-� V iq L.LL AUTHORIZED TOWN OFFICIAL: l/a (Signature) ^ / i. DATE: Y v 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 VERMA) PU A NAM COUNTY DEPARTMENT OF HEALTH DIVISION �ff GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM S.°7 CQ o -ro a1 ])AM ROAD Co R . %-`-f I- 59 Owner or Purchaser of Building Tax Map Block Lot ,S9 CRo-t'oN D/ar'✓l ROAD CCoRP. t��sTr.1An -t VA L L C Building Constructed by Town/Village 'P14E 9 S q N-r R y1-J R o,9-b Location - Street SIN 6 L t Building Type S-rrRr1w13R!6nRY klkUoLL Subdivision Name 2 Subdivision Lot r 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 propgz•, and that is has been constructed as shown on the approved plan or approved amendment theret and in accordance with the standards. rules and regulations of the Putnam County Department of Heal, and hereby guarantee to the owner, his successors; heirs or•assigns. to place in good operating coition 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" T-6r the sewage treatment system; or any repairs made by me to such system, except where the fait e to - �ci�SEra e�lc�p�rtir i�` au edtiy t`h�ill %1 or negli�errt act 6f the occt7pant Nf e b4lditta �iliz P-- the- �- - system. The undersigned further agrees to accept as conclusive the deter Director f the Putnam County Department of Health as to whether to opera t waused by the willful or negligent act of the occupy Year 1-0 (Owner) - Signature 352 0720 Tv®J .'nom ►2oAP COP41 Corporation Name (if corporation) Address: 29 C2o- c)tj PAM 26( .D State OSSINll,�6� 1Jy Zip 10562 Signature: atr V Title: 'rQ C-D-0" �-f N the blic Health �t ilur . f the system ildi 'g utilizing the 32 CRoT6/•1 OAS 720116 CORP. Corporation Name (if corporation) Address: 32 CRo -Fa/N eA1 2 - State p SS /Nh1J �� /_Zip 10 56 2 Form GS-97 JMS ENVIRONMENTAL SERVICES, INC. 1500 SUMMER STREET x1� - ;.�.,� -� ��TAQ4FOi�D CA NN. EC T.ICUT.o6.9.0.5 NE1AC, .CT.•and7NY 5tate.,,Cer if4q...F. ir(y�na7en.ta(.Lab.or -star! ., , �•kF� gyp.. w,ew.l. <• ..Y^ ✓.�]- e�W`n.., .ten__. ...�+•,;•�JI.e .••f Y+.ba. .. v'•1.•f -441 C'• ^. . '--� • ray.. Mailing Information: Collector's Information: Name: PF Beal & Sons Client: VS Construction Name: Wayne M Address: 4 Putnam Ave Address of site: Lot #3 Strawberry Knolls City: Brewster City: Putnam Valley State: NY Zip: 10509 State: NY Zip: Telephone: 845-279-2460 Fax: 845-279-6613 Telephone: Sample's Information: Site: hose bib Date Collected: 9/8/03 Date Received: 9/9/03 Preservative: HNO3 Time Collected: 16:15 Time Received: 13:30 Temperature: <4C Lab No.: J036533 Date Analyzed Test Name Result MCL Method 9/9/03 15:00 Total Coliform Absent Absent SMWW 9222B 9/9/03 Chlorine Free Residual <0.1 mg /L N/A SMWW 4500CIG 9/9/03 Color ND 15 Units SMWW 2120 B 9/9/03 Odor ND 3 TONs SMWW 2150 B 9/10/03 Iron <0.03 mg /L 0.3 mg /L SMWW 3111B 9/10/03 Manganese <0.01 mg /L 0.3 mg /L SMWW 3111 B 9/10/03 Sodium 13.5 mg /L N/A SMWW 3111 B 9/10/03 Chloride 45 mg /L 250 mg /L SMWW 4500 Cl C 9/10/03 Hardness - -, ... 120 mg /L . N/A SMWW 2340 C .. Nitrate '1.33 mg /L" 10-m'g /L SMWW 4500*NO3E 9/10/03 10:00 Nitrite <0.1 mg /L 1.0 mg /L SMWW 4500 NO3E 9/9/03 pH 7.01 S.U. 6.5 -8.5 S.U. SMWW 4500 H B 9/10/03 Sulfate 23.7 mg /L 250 mg /L SMWW 4500 SO4F 9/9/03 Turbidity 0.11 NTU 5 NTUs SMWW 2130 B 9/10/03 Alkalinity 42 mg /L N/A SMWW 2320 B 9/10/03 Lead <1.0 ug /L 15 ug /L SMWW 3113 B At the time of analysis the sample was acceptable for total coliform N/A = Not Applicable mg /L- milligrams per Liter . ND- None Detected S.U.= Standard Unit NTU- Nephelometric Turbidity Unit MCL- Max. Contaminant Level TON- Threshold Odor Number ug /L- micrograms per Liter Signature. ' '�`''� State #: PH -0218 Michael Lapman ELAP #: 11715 President Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com R®NIN ENGINEERING, P ., P.C. -. %t 1Jii��zy tJ11., a� a i 209AJ`Oz taia`a"Iz1 f" ,Tel. (914)736 -3664 o Fax. (914) 736 -3693 September 16, 2003 Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County Department of Health Division of Environmental Services 1 Geneva Road. Brewster, N.Y. 10509 Re: SSTS Construction Compliance 37 Croton Dam Road Corp. P.C.D.HPermit #PV -32 -02 "Strawberry Knoll" Lot #3 Town of.P.utnam Valley Dear Mr. Paravati ... .ei .�,M.sv 4VV ^.. .y.i.... ....•... r... .a. era.+�.+s ....a.- �..w.n .... -y r:.v........vw. .-..s. .. .... ... ..i .� � .y.� -. - A r s r ... +m �. d... � Y.7p. - n .-- -. •'c. mow• . -�.- .. � . a Please find enclosed the original well completion report and water analysis for the above referenced project. The report has been completed to show the required PCDH profiles. Please review at your earliest convenience. If there are any questions or if additional - - information -is- required- please -do -not- hesitate- contacting- me -at- the - above- number: -- - Thank you for your assistance in this matter. Respectfully submitted, Kex7 Kenneth M. Murphy Design Engineer RONIN ENGINEERING, P.E. P.C. - The Lindy Building, Suite 200, 2 John Walsh Blvd., Peekskill, New York 10566 A 693,z. Te 1: -, (914 .3 September 8, 2003 Joseph S. ParavatL Jr. Assistant Public Health Engineer Putnam County Department of Health Division of Environmental Services I Geneva Road. Brewster, N.Y. 10509 re ,--Re: SSTS Construction Compliance 37 Croton Dam Road Corp. P.C.D.HPermit #PV-32-02 9 Pheasant Run Road Town of Putfiam Valley Dear Mr. Paravati --Peasd find'enclosed-the signed guarante& forms in revised -SS' TS- as- built plan: Please review at your earliest convenience. If there are any questions or if additional information is required please do not hesitate contacting me at the above number. Thank you for your assistance in this matter. Respectfully submitted, 0 evo Oaaf � Kenneth M. Murphy Design Engineer M A J� zio h � Ol CO oti�s C13 co rb LN . c� �C, . •off � �.N���,�� ..-y �_�._. �_ �� .: ~_. �ti. ��'c!, � __.s���_'j y�: �_ '��`°'I� -. .�.�y_G._M_._ e.�.i.°'., s•t'•�":`,'�s'°•` >tA. `.: '' .., .';"`"?°""�.. «..: 'a. °i?1°�^.. .. my`w� ,�•�ia • Qs e o o �m h � Q . w � N7851'14'E 130.41 b Rt _ _ 3 OrO /' A3 Temporary Grading Easement o `� �. in favor of Lot No.2 o p 146.75' �1 h � Ol CO oti�s C13 co rb LN . c� �C, . •off � �.N���,�� ..-y �_�._. �_ �� .: ~_. �ti. ��'c!, � __.s���_'j y�: �_ '��`°'I� -. .�.�y_G._M_._ e.�.i.°'., s•t'•�":`,'�s'°•` >tA. `.: '' .., .';"`"?°""�.. «..: 'a. °i?1°�^.. .. my`w� ,�•�ia NE LASS 39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404 �o`� 'fl N 203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 www.NORTHEAST,LA.BORATORIES.com < LABORATORY REPORT INORGANIC CHEMICALS (AND THEIR LIMITS) REPORT TO: P.F. BEAL & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 SAMPLE DESCRIPTION: WELL WATER DATE SAMPLE COLLECTED: TIME COLLECTED: COLLECTED BY: DATE RECEIVED @ LAB: DATE(S) TESTED: TESTED BY: REPORT DATE: 12/6/2001 4:00 P.M. BEAL 12/7/2001 i2/7/2001-12/17/2001 LAB #11471 & 11301 12/28/2001 SAMPLE LOCATION: V.S. CONSTRUCTIN CORP., LOT #3, STRAWBERRY KNOLLS SUBD., PUTNAM VALLEY, N.Y. SAMPLE POINT: TOP OF WELL MAXIMUM CONTAMINANT . ' EPA TESTED BY PARAMETER: LEVEL (MCL) OR STANDARD RESULT (me/L) METHOD # (Lab ID# • ANTIMONY .006 <0.010 200.9 11301 • ARSENIC .05 <0.004 200.9 " • BARIUM 2.0 0.056 200.7 " • BERYLLIUM .004 <0.001 200.7 " • CADMIiJM .005 <0.001 200.7 " • CHROMIUM 0.1 <0.001 200.7 " • CYANIDE 0.2 <0.01 335.4 " • FLUORIDE 2.2 0.71 340.2 11471 • MERCURY .002 <0.0002 245.1 11301 • NICKEL .1 <0.01 249.1 11471 NITRATE- NHROGEN <0.20 SM 450QNOsD. � ` NITRITE NITROGEN -. -,.. ... _ ... 1.6 :(as .., -- '<0�005. ' ...... _. a .. .. t- 354:"1.. _._. • NITRATE NITROGEN plus NITRITE NITROGEN 10.0 (as N) <0.20 353.2 " • SELENIUM .05 <0.010 200.9 11301 • SILVER .01 0.001 200.7 " • SULFATE 250.0 <10.0 375.3 .11471 • CHLORIDE 250.0 <5.0 325.3 " • THALLIUM 0.002 <0.002 200.9 11301 • LEAD 0.015 0.005 239.2 11471 • COPPER 1.3 <0.02 220.1 " • IRON 0.30 1.02 236.1 " • MANGANESE 0.30 0.109 243.1 " • ZINC 5.0 <0.01 289.1 " NOTIFICATION LEVEL (m¢/L) • SODIUM 20.0 8.0 273.1 11471 mg/L=milligrams per Liter At 440wolf-um"ni - V Laboratory Director •NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800- 826 -0105 •OUTSIDE CT: 800 - 654 -1230 n ®RTHEAST LABORATORY OF DANBURY �N ACCO gyp., � .ii - -39` I�YLY; `ff�LA%A! ' �OPiD "'`= ' �NNBURY ,��T `' 'Q➢���]1�f' `"CT Cerf' P'H -0404 ` � �" y �c�{ yc�' 203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 n www.NORTHEAST LABORATORIES.com REPORT TO: P.F. BEAL & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 1050.9 SAMPLE SITE: SAMPLE POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: O Total Coliform (Bacteria) PHYSICALS: • Color (Apparent) • Odor • pH • Turbidity CHEMISTRY: o Alkalinity * Hardness Al . ' : '� • .. DATE SAMPLE COLLECTED: 12/6/2001 TIME COLLECTED: 4:00 P.M. COLLECTED BY: PFB DATE RECEIVED @ LAB: 12/7/2001 TESTED BY: LAB# 11471 LAB ID. # PFB -134 REPORT DATE: 12/14/2001 V.S. CONSTRUCTION CORP., LOT #3, STRAWBERRY KNOLLS SUBDIV., PUTNAM VALLEY, N.Y. TOP OF WELL 4.5 WELL -NEW EPA 180.1 NONE 126.0 RESULTS METHOD # MAXEAUM CONTAMINANT LEVEL (MCL) OR STANDARD 0 per 100 ml SM 9222B 0 per 100 ml 12 - EPA 110.2 15 ND - - 3 Units 7.70 - EPA 150.1 No designated limits 4.5 NTUs EPA 180.1 5 NTUs 126.0 mg/L SM 2320B No designated limits 110.0 mg/L EPA 130.2 No designated limits ml= milliliter mg/L--milligrams per Liter ND =none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count * *Notification Level ** *Action Level COMMENTS: -All holding times (were) met SAMPLE, AS TESTED ABOVE: OTABLE or OT POTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) RESULTS BASED ON SAMPLES SUBMITTED: 12/7/2001 r -7 Laboratory Director °NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037° (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 o OUTSIDE CT: 800 - 654 -1230 NN NORTHEAST LABORATORY of DANBURY o �" ACC090. ttOA .. i -D wp.v. - -BURY. CT ' _.068 Q4' 1 c_T c' �,.♦} p 1 -q,4 :. •`� 1k ° � = :r� - = �� - w.:.N. ""i 'P� t n. - .••r.•.M.�.., -. A. 1�'.... .- -'pY:r . •: ... 4ic;. ..P^ Q' w...,e�i• 203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 LABS www.NORTFIEAST LABORATORIES.com LABORATORY REPORT EPA METHOD 524.2 Measurement of Purgeable Organic Compounds in Drinking Water REPORT TO: by:Gas Chromotography -Mass Spectrometry P.F. BEAL & SONS DATE SAMPLE COLLECTED: 12/6/2001 4 PUTNAM AVENUE TIME COLLECTED: 4:00 P.M. BREWSTER, N.Y. 10509 COLLECTED BY: PFB. DATE RECEIVED Q LAB: 12/7/2001 TESTED BY: LAB #10916 REPORT DATE: 12/20/2001 SAMPLE. SITE: V.S. CONSTRUCTION CORP., LOT #3, STRAWBERRY KNOLLS SUB., PUTNAM VALLEY, N.Y. SAMPLING POINT: TOP OF WELL SOURCE: WELL (all results expressed in micrograms per liter) COMPOUND Dichlorodifluoromethane Chloro methane Vinyl chloride Bromomethane Chloroethane Trichlorofluoromethane - 1,1- Dichloroethene Methylene Chloride Trans -1,2- Dichloroethene 1,1- Dichloroethene Cis -1,2- Dichloroethene 2,2- Dichloropropane Bromochloromethane 1,1,1,- Trichloroethane 1,1- Dichloropropene 1,2- Dichloroethene Carbon Tetrachloride Benzene Trichloroethene 1,2- Dichloropropane Dibromomethane Bromo Dichloromethane Cis- 1,3- Dichl'oropropene Toluene Trans- 1,3- Dichloropropene 1,1,2- Trichloroethane 1,3- Dichloropropane Dibromochloromethane Tetrachloroethylene AMOUNT DETECTED BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL 7.8" LIMIT OF DETECTION 0.50 0.50 0.50 0.50 0.50 0.50 0.50 0.50 0.50. 0.50 0.50 0.50. :.. 0.50 0.50 0.50 0.50 0.50 0.50 0.50 0.50 0.50 0.50 0.50 0.50 0.50 BDL 0.50 BDL 0.50 BDL 0.50 BDL 0.50 BDL 0.50 BDL =Below Detection Limit Results based on sample(s) submitted: 12/3/2001 COMPOUND 1,1,2- Tetrachloroethane thyl Benzene 1,2,2 - Tetrachloroethane opropyl Benzene' 2, 3 -Tri chlo rop rop ane romo Benzene Propyl Benzene Chlorotolueue Trimethyl Benzene Butyl Benzene Trimethyl Benzene ;utyl Benzene . AMOUNT LIMIT OF DETECTED DETECTION BDL 0.50 BDL 0.50 BDL 0.50 BDL 0.50 BDL 0.50 BDL 0.50 BDL. 0.50 BDL 0.50 BDL 0.50 BDL 0.50 BDL. 0.50 BDL 0.50 _ . BDL, _' - 0.50... ; BDL 0.50 BDL 0.50 BDL- 0.50 BDL 0.50 BDL 0.50 BDL 0.50 1= Dichlorobenzene BDL 0.50 Isopropyltoluene BDL 0.50 Z- Dichlorobenzene BDL 0.50 Butyl Benzene BDL 0.50 2,4- Trichlorobenzene BDL 0.50 iphthalene BDL 0.50 machlorobutadiene BDL 0.50 Z,3- Trichlorobenzene BDL 0.50 ethyl -tert- butyl -ether (MTBE) BDL 0.50 MCL= Maximum Contaminant Le�eL .._...- - • -. - -• -.- "MCL- S.Oµg/L c 1. Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037- (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WI'T'HIN CT: 800 - 826 =0105 - OUTSIDE CT: 800 - 654 -1230 NE ..sL _;: .NGRT _._ir±AST;a 'RATOR 11. .. 39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: ]PH -0404 • ~ �o� ���� 203) 748 -7903 - FAX (263) 748 -0652 NY Cert: 11471 I DADS www.NORTTi[EASTLABORATORIEES.com t LABORATORY REPORT (METHOD: TRANSMISSION ELECTRON MICROSCOPY -- T.E.M.) REPORT TO: P.F. BEAL &. SONS 4 PUTNAM AVENUE BRFWSTER, N.Y. 10509 Date Sample(s) Collected: Collected By: Date Sample(s) Received @ Lab Tested By: Report Date: 12/6/2001 4:00 P.M. 12/7/2001 SCI LAB 12/20/2001 SAMPLE DESCRIPTION: WELL WATER SAMPLING LOCATION: V.S. CONSTRUCTION CORP LOT #3, STRAWBERRY KNOLLS SUBDIV. PUTNAM VALLEY, N.Y. WATER FILTERED (liters 0.05 STRUCTURES DETECTED(total): NSID STRUCTURES DETECTED* ( >l0um) NSD ANALYTICAL. SENSITIVITY(NIF/L): 0,04 -ASBESTOS CONC: ZtgW) M—L-1 ASBESTOS CONC. ( >10M) OaQ <0.04 ASBESTOS TYPE - - - -- *Fiber criteria > =0.5 microns, 5:1 aspect ratio: NAD/NSD = no asbestos detected, NA =not analyzed, MF/L= million fibers per liter. . NOTE:Drinking water analysis by EPA - 600/4 -83 -043 (100.1). Analytical sensitivity calculated as though 1 fiber had be detected on the TEM GRID area analyzed. Samples are refrigerated upon receipt and filtered within 4 hours. Samples Analyzed by: The SCILAB Group of Laboratories < = LESS THAN >. = GREATER THAN Results are based upon samples submitted; 12/7/2001 Laboratory - Director °NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037° (860)828 -9787 - FAX (860)829 -1050 } _ 1 X�-w A-'�dz: Xc 1H nq 39 MILL PLAIN ROAD - DANBURYt CT 06811 CT Cert: PH -0404 �a 1N AccoAO' 203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 www.NORTBIEAST,LABORATORIES.com LARSa'i a x Synthetic Organic Chemicals REPORT TO: 6.0 11g2 EPA 547 <0.4 0.4 P.F. BEAL & SONS EPA 549 DATE SAMPLE COLLECTED: 0.09 12/6/2001 EPA 548 4 PUTNAM AVENUE 0.02 TINE COLLECTED: 504.1 4:00 P.M. 0.02 BREWSTER, N.Y. 10509 504.1 COLLECTED BY: BEAL DATE RECEIVED @ LAB: 12/7/2001. . TESTED BY: LAB #11301;11398 REPORT DATE: 1/9/2002 SAMPLE SITE: V.S CONSTRUCTION LOT #3 STRAWBERRY KNOLLS SUBDIVISION PUTNAM VALLEY N.Y. SAMPLING POINT: TOP OF WELL SOURCE: NEW WELL (all results reported in micrograms per liter (pg/L) PARAMETER RESULT RL UNITS REFERENCE DIOXIN TO FOLLOW 1.0'. pg/L 1613B SYNTHETIC ORGANIC COMPOUNDS Alachlor (Lasso) <0.1 0.1 µg2 EPA525 Aldrin <0.1 0.1 µg2 EPA252 Atraznie <0.1 0.1 µg2 EPA252 Benzo(a)pyrene <0.02 0.02 µ91L ' EPA525 Butachlor <0.1 0.1 µg2 EPA525' Dieldrin <0.04 0.04 µg2• EPA252 Di42- ethylhexyl)adipate <0.6 0.6 µg2 -.EPA525 Endrin <0.01 0.01 µg2 EPA525 Heptachlor <0.04 0.04 µ9/L EPA525 Heptachlor epoxide <0.02 0.02 µg2 EPA525 -- Hexachlorobenzene �0.1 µg/L, . EPA252, Hexachlorocyclopentadiene <0.1 r µ91L -� - _ EFEPU52' Lindane (gamma -BHC) 4.02 0.02 99/L EPA525 Methoxychlor <0.1 0.1 µg2 EPA525 Metolachlor (Dual) <0.1 0.1 µg2 EPA525 . Metribuzin (Senor) <0.1 0.1 µg2 EPA252 Propachlor <0.1 0.1 µg2 EPA252 Simazine <0.007 0.007 µg2 EPA525 Di- (2- ethylhexyl)phthalate <0.6 0.6 µg2 EPA252 CARBAMATES HPLC Aldicarb <0.5 0.5 µg2 EPA 531 Aldicarb Sulfone <0.4 0.4 µg2 EPA 531 Aldicarb Sulfoxide <0.5 0.5 µg2' EPA 531 Carbaryl <1.0 1.0 µ91L EPA531 3- Hydroxycarbofuran <I.0 1.0 µg2 EPA 531 Methomyl <0.5 0.5 µg2 EPA 531 Oxamyl (Vydate) <1.0 1.0 µg2 EPA 531 Carbofuran <0.9 0.9 1A92 EPA 531 HERBICIDES Glyphosate Diquat ENDOTHALL Endothall EDB and DBCP ANALYSIS 1,2- Dibromo -3- Chloropropane 1,2- Dibromoethane (EDB) <6.0 6.0 11g2 EPA 547 <0.4 0.4 µg2 EPA 549 <0.09 0.09 1192 EPA 548 ND 0.02 1192 504.1 ND 0.02 1192 504.1 µg/Lr --micrograms per Liter ND = None Detected RL - Reporting Limit <--Less Than pg/Itpico grams per Liter 2 accv ...- �:.-.�. 4"� �5�'T1��i�i:1�3[liT "IkcO'I>� �' = �i���it'$'; "L°I<" ' � �� ; •�1°��i'i. P� -94�i4 ��,n coq ., • _ 203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 www.NORTHEAST LABORATORIES.com LABS o _ a x y. Synthetic Organic ChemicaRs REPORT TO: P.F. BEAL & SONS DATE SAMPLE COLLECTED: 12/6/2001 4 PUTNAM AVENUE TIME COLLECTED: 4:00 P.M. BREWSTER, N.Y. 10509 COLLECTED BY: BEAL DATE RECEIVED @ LAB: 12/7/2001 TESTED BY: • LAB# 11301;1139.8 REPORT DATE: 1/9/2002 SAMPLE SITE: V.S CONSTRUCTION LOT #3 STRAWBERRY KNOLLS SUBDIVISION PUTNAM VALLEY N.Y. SAMPLING POINT: TOP OF WELL SOURCE: NEW WELL (all results reported in micrograms per liter (µg/L) PARAMETER RESULT RL UNITS REFERENCE ORGANOPHOSPHORUS PESTICIDES Alachlor ND 0.44 µg/L E507 Atrazine ND 0.22 µg/L E507 Butachlor ND 0.1 µg/L E507 Metholachlor ND 0.1 µg/L E507 Metribuzin ND 2.00 µ91L E507 Simazine ND 0.15 99/1, E507 PESTICIDES/PCB's Aldrin ND 0.05 µg/L EPA 508 Endrin ND 0.1 µg/L EPA 508 Dieldrin ND 0.1 µ9/L EPA 508 Heptachlor ND 0.1 4911, EPA 508 Heptachlor Epoxide ND 0.05 µg/L EPA 508 Lindane ND 0.05 491L EPA 508 P.rcpachlor:Kr.� y :. , _ ... IvD ��,' .'- 0.5 1?g%Y EPA-508 Toxaphene ND 1.0 119/L EPA 508 PCB -1016 ND. 0.5 µ9/L EPA 508 PCB -1221 ND 0.5 µg/L EPA 508 PCB -1232 ND 0.5 µg/L EPA 508 PCB -1242 ND 0.5 µ9/L EPA 508 PCB -1248 ND 0.5 µ9/L EPA 508 PCB -1254 ND 0.5 99/L EPA 508 PCB -1260 ND 0.5 µ9/I, EPA 508 Chlordane ND 0.5 99/L EPA 508 Methoxychlor ND 0.5 491L EPA 508 HERBICIDES 2,4 -D ND 1.0 µ9/L EPA 515.1 Dalapon ND 5.0 µg/L EPA 515.1 Dicamba ND 0.5 µ9/L EPA 515.1 Dinoseb ND 0.5 µg/L EPA 515.1 Pentachlorophenol ND 0.2 µ9/L EPA 515.1 Picloram ND 0.5 µg/l, EPA 515.1 2,4,5 -T ND 0.2 µ9/L EPA 515.1 2,4,5 -TP ND .0.2 µg/L EPA 515.1 µg/L--micrograms per Liter ND = None Detected RL--Reporting Limit < =Less g/Irpico /grams r Liter Results based on sample(s) submitted: 12/7/2001 Laboratory Director ! ' oNORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060370 (860)828 -9787 -. FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 o OUTSIDE CT: 800 - 654 -1230 NORTH; 1111 l TRANSMITTAL CRONIN ENGINEERING P.E., P.C. September 3, 2003 The Lindy Building; Suite 200 2 John Walsh Boulevard Peekskill, NY 10566 914- 736 -3664 Fax 914 - 736 -3693 Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County Department of Health 1 Geneva Road Brewster, N.Y. 10509 RE: 37 CROTON DAM ROAD CORP. , PCDH PERMI #PV 32 -02 9 PHEASANT RUN ROAD TOWN OF PUTNAM VALLEY THESE ARE TRANSMITTED as checked below: ❑ FOR APPROVAL ❑ FOR YOUR USE ❑ AS REQUESTED ❑ FOR REVIEW AND COMMENT X PLEASE REPLY WE ARE SENDWG YOU •atia&ed,; 1.) Three copies of as -built subsurface sewage treatment system plan 2.) Three certificate of the construction compliance. 3.) , <—t b 'UL' SUS 6/1Te ?t 4.) Copy of survey showing foundation location 5.) Well driller's completion report 6.) Water analysis 7.) E911 address verification form 8.) $200 certified check for application fee. NO • w r• w� Should you have any questions or require additional information regarding this matter, please contact me at the above phone number. Thank you for your time and assistance in this matte. Respectfully submitted, r1KZe M. Murphy Design Engineer I; 'oy'+�:F "' �. w. J:nv� .: -s a .,.. nv��r . =. = '1i..,.�: � ?.a'e•'•yi . LORETTA MOLINARI R.N., M.S.N. Public Health Director August 29, 2003 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster,. New Y6rk 10509 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 ROBERT J. BONDI County Executive Ken Murphy Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, New York 10566. Re: Field Inspection — 37 Croton Dam Road Corp. Pheasant Run Road, (T) Putnam Valley TM# 84 -2 -59, R.S. Lot # 3 Dear Mr. Murphy: A site inspection was made for the above referenced project on August 28, 2003. The following comments :rust be Corrected in the field.., 1. Cast iron pipe is not installed and needs to be inspected by this department before backfilling. 2. It is not clear as to where the footing/roof leader drains are discharging. Location of discharge needs to be verified before compliance is issued. 3. The system can be backfilled. If you have any further questions, please contact me at (845) 278 -6130 ext. 2157. Sincerely, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP: cj 08/25/2003 15:17 9147363693 CRONIN ENGINEERING 1 PAGE 01 . t •• _ _ . x.04 .- r - ul.. �. ,•i•.. �•+YY•�••Cf.: •. � -5�. _ a... _ ... .> • � v ra,F.t,:.., . - "" PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVMONMENTAL H-EALTh SERVICES "To (' ATTEN'T'ION 11 kv&w 13 GENE RF ,LtF�ST FOR ENAL INSPECTION For: All information, trust be fully completed prior to any inspections being made. PCHD Construction Permit # cv_ -3 fL r 01 Located: 04 0 Sn N rt RoA Tz o t�9 t) {T; Owner /Applicant Name: 39 CR 0 r6A. ei gn- 2oAO cd? TM Formerly: Subdivision Name: Subdivision Lot # = Is system fill completed? Date: Is system complete? ye-s- Date: Is system constructed as per plans? YE -C ... . Is well drilled? S Date: Is well located as per plans? L% Are erosion control measures in place? I certify that the systew (s), as listed, at the above premises has been c and verified their completion in accordance with the issued P ­:'a proved— lans . and, the: Standards, Rules. d . Regulations cf -the 6 KC-A-3 Date: -z o a3 Certified by: r-14 v 10 V xtJ Design Profe Address: I 'SbKP WALtK MU Comments: Form FIR 99 AUG -25 -2003 MON 15:16 TEL:845 -278 -7921 Fill Trenches Block Z Lot T STRA w reRl21/ KA14 1.L [ AV G • 25; '2662 structed and I have inspected D Construction Permit and rnarn_Co�,�nt�r -.Dgg4p eqt.- ±�f. _ :_ _.. " - :,1. PE RA Lic. # NAME:PUTNAM COUNTY DEPARTMEN) i i IIDIIVffSIIGN GIF IENWRONM ENTAL HEALTH SERVICES �.ticyx- 9ktMN, ftkm l 1 -E n,� / _ . ...; ...._.. :fir... � PlERMffT # T" Y 3 A--- oa, Located at Pµ A t �� 96.4 Town �� Putnam Valley Subdivision name Strawberry Knoll Subd. Lot # 5. Date Subdivision Approved 14 AY D5r. `00 Owner /Aoplicant Name 37 Croton Dam Road Corp. Mailing Address 37 Croton Dam Road; Ossining, NY Amount of Fee Enclosed $300.00 Building Type Residential Tax Map 63 5� Block Z Lot -5.9 Renewal Revision Date of Previous Approval N/A Zip 10562 Lot Area -42J No. of Bedrooms 4 Design Flow GPD 800 TA C . l - Fill Seem ®nn Only Depth Separate Sewerage ftstem to consist of 1250 of 4" PVC Perf. Pipe in 24" Gravel Trench Other Requirements: Volume gallon septic tank and 500 L. F. To be constructed by 37 Croton Dam Road Corp. Address 37 Croton Dam Road; Ossining, NY 10562 wakL&Rpw Public Supply From Address 1� aloe <_. keSS Pryate.S:ttpply:.DiiJled by- _ ` 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 Construction Com(rl mu.,satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee.Will -be. i tx owner, his successors, heirs or assigns by the builder, that said builder will place in good operating g f s 'd sewage treatment system during the period of two (2) years immediately follo 9" date ofAhe ' an c g ap , va , f the Certificate of Construction Compliance of the original system or any pairs ereto.,� Signed: Address 2 John Walsh Blvd; X. Uj . w, z, ? E. X R.A. skil 1, NY 10566 License # Date % 4 —0 2- 062980 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modifleo when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new rmit. Appr ed for discharge of domestic sanitary se a only. By: Title: Date: White, copy - Fil Y low copy - Building Inspector; Pink copy - O er; O e copy - Design Professional Form CP -97 RONIN ENGINEERING P.E. P.C. The Lindy Building, Suite 200, 2 John Walsh Blvd., Pe_ ekskill, New York 10566 66 4I;a;- 24�iRaafi9d November 18,• 2002 b Joseph Paravati, Jr. Assistant Public Health Engineer Putnam County Department of Health Division of Environmental Services 4 Geneva Road, Brewster, N.Y. 10509 Re: SSTS Construction Permit for 37 Croton Dam Road Corp. Strawberry Knoll Subdivision — Lot 3 TM # 84 -2 -59 Pheasant Run Road, Town of Putnam Valley Dear Mr. Paravati: Find enclosed three copies of the SSTS plan for the above referenced project, latest revision dated November 4, 2002. The absorption trench detail on sheet S -2/2 has been modified in accordance • to your comments. The revised house plan showing a 6' wide opsniYng at the s{u � �,a .previously'siili .it#e uaider setiar to craife ,.:.. ':w - . Should you have any questions or require additional information regarding this matter, please contact me at the above phone number. Thank you for your time and assistance in this matter. Respectfully submitted, Luis Hernandez Project Engineer cc: Val Santucci StrawberryKnoll ,Lots3R1,PCDH,11- 04- 02.doc PUTNAk COUNTY DEPARTMENT OF HEALTH Jl`tIF D IVIS ION OF ENVIItONN1EN�AL FIE, AITH TVA•LEdc SFkLY ��1713SU�C$JI l a �� 9YAGE TREATM ENT - MENT �. SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT, NAME OF OWNER: STREET LOCATION: 'TS P REVIEWED BY: RM, GR, Ad, SRDATE: TAX MAP#: (CONFIRMED) Y IN DOCUMENTS C.OL—)PERMT APPLICATION UC SWELL FERMTT OR PWS LETTER R:f�bLJLETTER C_JPC -97 0 OF AUTHORIZATION UDESIGN DATA SHEET (DDS) i rrrr��Trr )LJCORPORA,TE RESOLUTION (✓ Y _)SHORT EAF U VARIANCE REQUEST �' SUBDIVISION C ))LEGAL SUBDIVISION L�f/ SUBDIVISION APPROVAL CHECKED ERC RATE C-) L REQUIRED DEPTH C_J TAIN DRAIN REQUIRED GENERAL UOCATED IN NYC WATERSHED C� PLANS SUBMITTED TO DEP CZ)C= ]DELEGATED TO PCHD (�B/ EP APPROVAL, IF REQ'D DEEP TEST HOLES OBSERVED C )(y�PERCS TO BE WITNESSED Cam( JEX- APPROVAL SSDS ADJ, LOTS (� WETLANDS (TOWN/DEC PERMIT REQ'D ?) DATA ON DDS PLANS & PERMIT SAME (� PRE 1969. NEIGW . R ,NQTMCA.T ON ..- i-U - Ai _CZ100 YR. FLOOD ELEVATION W/I 200' Cj(�SOIL TESTING LOTS >10 YEARS OLD REQUIRED DETAILS ON PLANS USEWAGE SYSTEM PLAN - (NORTH ARROW) CV SDS HYDRAULIC PROFILE ( l( )GRAVITY FLOW CONSTRUCTION NOTES 1 -15 DESIGN DATA: PERC & DEEP RESULTS 2' CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT FOOTING /GUTTER/CURTAIN DRAINS USDA SOIL TYPE BOUNDARIES TITLE BLOCK; OWNERS NAME ADDRESS TM#, PEI RA; NAME, ADDRESS, PHONE# (DATE OF DRAWING/REVISION ►DATUM REFERENCE (LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. IPROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS (WELLS & SSDS'S WAN 200' OF SSTS (PROPERTY METES & BOUNDS (EROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE �o��t�w,5 ►mot � � �d�`�w1 �Ti �7Q�L 7PT \nn /n1 /nn Y, N (REQUIRED DETAILS ON PLANS CONT'D) ( �MOUSE SEWER - V," FT. 4 "0'; TYPE PIPE CAST IRON C.!�)(--)NO BENDS; MAX BENDS 45' W/CLEANOTJT (J(_10' HORIZONTA • P) C _)UFO SPECS / FIL (J(_JFILL PRt�� D U(�FILL - ON C -:_)C__j CLAY BARRIER RtN CH SLOPES 3: ) TO GRADE 1 -5 [ONS Alla Cam( )VOL. ON PLAN . ., CLASSIFIED & IMPERVIOUS C�C•_)SEPARATIO ISTANCE FROM TOE OF SLOPE TREN LF . CH PROVIDED 300 60FT MAX. PARALLEL TO CONTOURS (J�/ )100% EXPANSION PROVIDED SEPARATION DISTANCES ON PLAN - FROM'SSTS rl(__LO' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL N20' TO FOUNDATION WALLS 100' TO WELL, 200' IN DLOD,150' TQ PITS )A00'TO STREAM, -- �59'-T0'CeaTC'H BASM, 35' S'TORMDRAIN, PIPED WATER (,Z}C_)10' TO WATER LINE (pits - 20') (�50' INTERNIITTENT DRAINAGE COURSE ✓ ✓200'/500' RESERVOIR, ETC. 150' GALLEY SYSTEMS (�10' MIN TO LEDGE OUTCROP SEPTIC TANK Cam(__, )10' FROM FOUNDATION; 50' TO WELL WELL C -j(—)DiM NSIONS TO PROPERTY LINES we'll e-kA St' C_J(_)LOCATION OF SERVICE CONNECTION UUMIN 15' TO PROPERTY LINE SLOPE CzC__)SLOPE IN SSTS AREA �(S20 %) CCZRE� GRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS A C_JUPUMP NOTES U(_JDOSE OF E VOLUME/DOSE VOLUME NOTED C__)C�DETAM F CE.MAIN, (PIPE TYPE, ETC.) (—J(- )PIT D -Box &DETAILED 1 STORAGE ABO ARM DRAIN UC_JSTANDPIPE 5' B SIDES, DETAIL (�C�15' MYN to CD %, 2014%,251-3 %, 35' -1b /o, 100% 1% C__)(�20' MIN to GE /100' with 182 cons day discharge UU10' MIN t ON -PE TED PIPE ��s�` Free, -`' ne�L1s •k ha, %>7c�ier�a o,+ ��1,� �-J2:1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .. :q." (i •.n . °�.% .'„ i ... � .as va -.`s" . .. w=+r:� ...� � C ,.. -• a ,. "-.e ...', .. �. -�,mi ��:.w,� � ... . "�{i i' LETTER OF AUTHORIZATION RE: Property of 37 Croton Dam Road ,Corporation Located at ( Mill Street (CR #23) / Lover l. s Lane .- ?'116- 115AAIT /zUA 1 2DA0. T/T Putnam valley Tax Map # 81¢ Block ,2 Lot ..9 Subdivision of Strawberry Knoll Subdivision Lot # 33. Filed Map # z 5)Oa A- jF- Date Filed A a,f it , 200 2. Gentlemen: This letter is to authorize Timothy L. Cronin III a duly licensed Professional Engineer X or- Registered Ar-clliw 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 Departmen _ all necessary papers on my Whalf in connection with this matter and to supervis c 'y said wastewater trea a and/o ater supply systems _ :?n.conformity with th ; r %ns of_ i. le 5 and/or .147 .th d ation a the Public.l-Jealth Law, and the�Putnar. y GLO e. w er�"t 2 -62980 Countersigned: Z-" P.E., R.A., # Mailing Address 2 John Walsh Blvd. , #200 Peekskill State N. Y. Zip Telephone. (914) 736 -3664 10566 ' Very Signed: Mailing Address: State NY Telephone: _ KY) k 37 Croton Dam Road Ossining (914) 739 -7362 Zip 10562 Form LA -97 PUT NAM COUNTY DEPARTMENT OF HEALTH _ _ AFFIDAVIT - CORPORATE OWNER APPLICA'T'ION FOR PERMIT APPLICATION SUBNHTTED TO PUTNANI COUN'T'Y HEALTH DEPARTMENT To: Public Health Director In the matter of application for: Val Santucci Construction of SSTS and Water Supply represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: 37 Croton Dam Road Corp . Having offices at: 37 Croton Dam .Road, Ossining, NY 10562 Whose Officers Are: President - Name: Address :. Val Santucci (Same as Above) Vice President - Name: Address: Same *as President (Same as Above) Secretary -Name: Michelle Santucci Address: .;.- .�,.�(Same ::as Above) � _ .. . .� ..... �,..��'. - ._.._......�:.:�` �.,,...� . >� ......_ -•_ Treasurer - Name: Address: Same as Secretary (Same as Above) and that I am and will be individually responsible for any to the approval requested and all subsequent acts relatin; Sworn to b fore me this off" day of (month) o2Do (year) Notary Publi iKEL 1P M. LENT Notary Public, State of Now York No. 01 LE6026834 Qualified in Westchester Cou'p,� , Commission Expires June 21, ��L Form CA -97 Si-ned: Title: Corporate Seal o f the corporation with respect D I PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Welt.L Lot #3, Strawberry Knolls' Putnam -Valley T ax Grid # Map Block Lot(s) Well Owner: Name: Address: VS Construction Corp.; 37 Croton Dam Road, Ossining, NY 10562 Use of Well: I-primary 2-secondary x Residential Public Supply _ Air con /heat pump —Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional — Standby Drilling Equipment X Rotary _ Cable percussion X Compressed air percussion Other (specify) Well Type Screened — Open end casing X Open hole in bedrock Other Casing Details Total length 82 ft. Length below grade 81 ft. Diameter 6 in. Weight per foot 19 lb/ft. Materials: Steel Plastic Other Joints: Welded X Threaded— Other Seal: X Cement grout Bentonite Other Driveshoe: X Yes No ILiner: Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes—No Hours Second Well Yield Test Bailed X Pumped X Compressed Air Hours 6 Yield 8_ gpm Depth Data Measure from land surface-static (specify ft) . 20.21 During yield test(ft) 149.21 Depth of completed well in feet 6651 Well Log If more detailed information descriptions or sieve analyses..- are available, please* attach. Depth From Surface Water Bearing Well - . Diameter(in) Formation Description ft. ft. Land Surface 65 Drillina in overlurden clay and ]Muldprs 65 Hit rock at 65, 65.-, _ .B2 _. .DrilliAq p k set casip route "rocI iiid afil e If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump/Storage Tank Information Pump Type sub Capacity _5c Zm Depth 620' Model 5GS15412 Voltage 230 HP , V,- Tank Type V I Date Well Completed 11/8/01. Putnam County Certification No. 002 Date of Report 1/7/02 Well le s al NOTE: Exact location of well with distances to at east two permanent landmarks to be provyea on a separate sneevpian. Well Drillees'Name P14-- �&SO2, Inc Address: 4 Putnam Ave., BmAster, NY 10509 Signature: Z� Date: 1/7/02 Perry L. eal White copy: HI) File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC-97 02/01/02 FRI 16:38 FAX 02-81-2002 03:36PM FROM NM-fHf--RST LHB OF L*VBLJRY TO 19452796613 P.01 L. 'c S 0 TV t REPORT -T0: P.F'Bcd"& Sow 4 N=m Avenue Blvv,*Ar, N.Y. 10509 SAWLE gM, LAMP U,P-2=- SOURCE: !�INLVVXRONMENTAL SERVICE, -11S,Q 0-LD-WATUBURY. ROAD- ---..UNIT 1.2 3URY, CT 06488 267-653 WATER "ALYSIS DATE SAMPLE COLLIECT)ED, 1/2912002 THE COLLECTS D: 4:00 p.m COUACTED BY: Wayne Mayes DATE RECKNED: 113012002 TESM BY: ELAN 11715 FILE LD, 0 CW-061 REPORT DA'C'E: 2j1/2002 V.S. CamsWielon Corp., Lot 43, Stm =y Xncll.% Put= Valley, N.Y. Tcmp Pump in Well w4l None DATE RWSULTS TESTED NIET90D CON AMAM LEVEL f o Inm. + <03 mg/L 2/1/02 EPA 236.1 0.30 M(-ryL ToD-il=- <015 pg/L 2/1/02 EPA 524.2 }Lg&=mimg=s per Liter NT Nephdomietic Turbidity Unit niglm-miUigram pet Liter -All h a I Ong tunes es (*ef e) raet- f 0 7671 coloept. hone FaX # RcsW& CWfficd by JARS Lal�orawry -PH-0219 - ELAN 11715 r i N9 NORTHEAST LABORATORY of DANBURY o �N A C Coq - ��• - - - l�r,•- L:�:a':.� �Tz�, �L- ,��'a'Dl,}�_�.- ;BiJ,�B:�.�� =_. Q�l��-� :.�T.�ert:.:�.��0404� - o�41� 203) 748 -7903 - FAX (203) 748 -0652 I.AB3 www.NORTBEASTLABORATOREES.com < CHENUSTRY: • Alkalinity 126.0 mg/L SM 2320B No designated limits • Hardness 110.0 mg/L EPA 130.2 No designated limits ml= milliliter mg/L= milligrams per Liter ND =none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count -- Notification Level * "Action Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: 0 OTABLE or OT POTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) RESULTS BASED ON SAMPLES SUBMITTED: 12/7/2001 cru Z-4461-- .Laboratory Director , •NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 LABORATORY REPORT REPORT TO: P.F. BEAL & SONS DATE SAMPLE COLLECTED: 12/6/2001 4 PUTNAM AVENUE TIME COLLECTED: 4:00 P.M. BREWSTER, N.Y. 1050.9 COLLECTED BY: PFB DATE RECEIVED @ LAB: 12/7/2001 TESTED BY: LAB #11471 LAB LD. # PFB -134 REPORT DATE: 12/14/2001 SAMPLE SITE: V.S. CONSTRUCTION CORP., LOT #3, STRAWBERRY KNOLLS SUBDIV., PUTNAM VALLEY, N.Y. SAMPLE POINT: TOP OF WELL SOURCE: WELL -NEW TREATMENT: NONE M(AXD4UM CONTAMINANT TEST PERFORMED RESULTS METHOD # LEVEL (MCL) OR STANDARD BACTERLAL: • Total Coliform (Bacteria) 0 per 100 ml SM 9222B 0 per 100 ml PHYSICALS: { • Color (Apparent) 12 - EPA 110.2 15 • Odor ND - - 3 Units • pH 7.70 - EPA 150.1 No designated limits • Turbidity 4.5 NTUs EPA 180.1 5 NTUs CHENUSTRY: • Alkalinity 126.0 mg/L SM 2320B No designated limits • Hardness 110.0 mg/L EPA 130.2 No designated limits ml= milliliter mg/L= milligrams per Liter ND =none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count -- Notification Level * "Action Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: 0 OTABLE or OT POTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) RESULTS BASED ON SAMPLES SUBMITTED: 12/7/2001 cru Z-4461-- .Laboratory Director , •NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 NE NORTHEAST LABORATORY ®IF DANEUP.Y Sao 1N AcCp9O 4N��. CT Cert: ., PH- 0404.. 4 . lr 203) 748 -7903 FAX (203) 748 -0652 NY Cert 11471 LABS n " - l www.NORTHEAST LABORATORIES.com LABORATORY REPORT EPA METHOD 52402 Measurement of Purgeable Organic Compounds in Drinking Water REPORT TO: by :Gas Chromotography -Mass Spectrometry P.F. BEAL & SONS DATE SAMPLE COLLECTED: 12/6/2001 4 PUTNAM AVENUE TIME COLLECTED: 4:00 P.M. BREWSTER, N.Y. 10509 COLLECTED BY: PFB. DATE RECEIVED @ LAB: 12/7/2001 TESTED BY: LAB#10916 REPORT DATE: 12/20 /2001 SAMPLE. SITE: V.S. CONSTRUCTION CORP., LOT #3, STRAWBERRY KNOLLS SUB., PUTNAM VALLEY, N.Y. SAMPLING POINT: TOP OF WELL SOURCE: WELL (all results expressed in micrograms per liter) COMPOUND AMOUNT LIMIT OF COMPOUND AMOUNT LIMIT OF DETECTED DETECTION DETECTED DETECTION Dichlorodifluoromethane BDL 0.50 ; ii : Chlorobenzene BDL 0.50 Chloromethane BDL 0.50 ` ,':':1,1,1,2- Tetrachloroethane. BDL 0.50 Vinyl chloride BDL 0.50 > : thyl Benzene BDL 0.50 Bromomethane BDL 0.50 <' in, p- Xylene BDL 0.50 Chloroethane BDL 0.50 `<' >< Styrene BDL 0.50 Trichlorofluoromethane BDL 0.50 %> Xylene BDL 0.50 1,1- Dichloroethene BDL 0.50 Bromoform BDL 0.50 Methylene Chloride BDL 0.50 1,1,2,2- Tetrachloroethane BDL 0.50 Trans -1,2- Dichloroethene BDL 0,50. : Isopropyl Benzene BDL 0.50 1,1- Dichloroethane BDL 0.50 � > >�1,2,3- Trichloropropane BDL 0.50 Cis -1,2- Dichloroethene BDL 0.50 Bromo Benzene BDL 0.50 2,2- Dichloropropane BDL 0.50 `` - Propyl Benzene BDL 0.50 1?12,..:., Bromochloromethane BDL 0.50 ' < > <' - Chlorotoluene BDL 0.50 1,1,1,- Trichloroethane BDL 0.50 ><1,3,5- Trimethyl Benzene BDL 0.50 1,1- Dichloropropene BDL 0.50 ert-Butyl Benzene BDL 0.50 1,2- Dichloroethane BDL 0.50 ' >: ?,1,2,4- Trimethyl Benzene BDL 0.50 Carbon Tetrachloride BDL 0.50 ? ec -Butyl Benzene BDL 0.50 Benzene BDL 0.50 `:> 1,3- Dichlorobenzene BDL 0.50 Trichloroethene BDL 0.50 i` >`. `1,4- Dichlorobenzene BDL 0.50 1,2- Dichloropropane BDL 0.50 - Isopropyltoluene BDL 0.50 Dibromomethane BDL 0.50 `` >`,1,2- Dichlorobenzene BDL 0.50 Bromo Dichloromethane BDL 0.50 :' -Butyl Benzene BDL 0.50 Cis -1,3- Dichloropropene BDL 0.50 ' "`:1,2,4- Trichlorobenzene BDL 0.50 Toluene 7.8* 0.50 aphthalene BDL 0.50 Trans -1,3- Dichloropropene BDL 0.50 ' <: ezachlorobutadiene BDL 0.50 1,1,2- Trichloroethane BDL 0.50 < ?:1,2,3- Trichlorobenzene BDL 0.50 1,3- Dichloropropene BDL 0.50 ethyl -tert- butyl -ether (MTBE) BDL 0.50 Dibromochloromethane BDL 0.50 Tetrachloroethylene BDL 0.50 BDL =Below Detection Limit MCL= Maxim_ um Contaminant Lec$L_.._...__. -- .. _.._ -__- . Results based on sample(s) submitted: 12/3/2001 4 *MCL - 5.0µg2 /�.. .5 w ° Laboratory Director oNORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037o (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 o OUTSIDE CT: 800 - 654 -1230 NR < AMf 39 MILL PLAIN ROAD - DANBURY, CT 06811 ACT Cert: PH -0404 203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 LABS www.NORTHEAST LABORATORIES. com LABORATORY REPORT INORGANIC CHEMICALS (AND THEIR LIMITS) REPORT TO: P.F. BEAL & SONS DATE SAMPLE COLLECTED: 12/6/2001 4 PUTNAM AVENUE TIME COLLECTED: 4:00 P.M. BREWSTER, N.Y. 10509 COLLECTED BY: BEAL DATE RECEIVED Qa LAB: 12/712001 DATE(S) TESTED: 12/7/2001 - 12/17/2001 TESTED BY: LAB #11471 & 11301 REPORT DATE: 12/28/2001 SAMPLE DESCRIPTION: WELL WATER SAMPLE LOCATION: V.S. CONSTRUCTIN CORP., LOT #3, STRAWBERRY KNOLLS SUBD., PUTNAM VALLEY, N.Y. SAMPLE POINT: TOP OF WELL MAXIMUM CONTAMINANT EPA TESTED BY PARAMETER: LEVEL (MCL) OR STANDARD RESULT (mg/L) METHOD # (Lab ID# • ANTIMONY .006 <0.010 200.9 11301 • ARSENIC .05 <0.004 200.9 " • BARIUM 2.0 0.056 200.7 • BERYLLIUM .004 <0.001 200.7 " • CADMIUM .005 <0.001 200.7 " • CHROMIUM 0.1 <0.001 200.7 • CYANIDE 0.2 <0.01 335.4 " • FLUORIDE 2.2 0.71 340.2 11471 • MERCURY .002 <0.0002 245.1 11301 • NICKEL .1 <0.01 249.1 11471 • NITRATE NITROGEN 10.0 (as N) - <0.20 SM 4500NO3D NITF.II'E NTI120GEN: F .. :` .::: }.0 (as N) ' <O.00S - _. 354- v _.: ...�.«:..._ • NITRATE NITROGEN plus NITRITE NITROGEN 10.0 (as N) <0.20 353.2 " • SELENIUM .05 <0.010 200.9 11301 • SILVER .01 0.001 200.7 • SULFATE 250.0 <10.0 375.3 11471 • CHLORIDE 250.0 <5.0 325.3 " • THALLIUM 0.002 <0.002 200.9 11301 • LEAD 0.015 0.005 239.2 11471 • COPPER 1.3 <0.02 220.1 " • IRON 0.30 1.02 236'.1 " • MANGANESE 0.30 0.109 243.1 " • ZINC 5.0 <0.01 289.1 " NOTIFICATION LEVEL (me/L) • SODIUM 20.0 8.0 273.1 11471 mg/L--milligrams per Liter Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 M NE o NORTHEAST LABORATORY. OE. DAMBURY p %N "°°ORO' r .39 1VdIL PLAI "AO D - DANBURY, b T.- b '� `CT Cent ` lP]ET -0404w � _ 203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 - C, LARS www.NORTHEASTLABORATORIES.com LABORATORY (METHOD: TRANSMISSION ELECTRON MICROSCOPY -- T.E.M.) REPORT TO: P.F.' BEAL & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 Date Sample(s) Collected: Collected By: Date Sample(s) Received @ Lab Tested By: Report Date: 12/6/2001 4:00 P.M. 12/7/2001 SCI LAB 12/20/2001 SAMPLE DESCRIPTION: WELL WATER SAMPLING LOCATION: V.S. CONSTRUCTION CORP LOT #3, STRAWBERRY KNOLLS SUBDIV. PUTNAM VALLEY, N.Y. WATER FILTERED (liters 0.05 . STRUCTURES DETECTED(totall NSD STRUCTURES DETECTED* ( >10gm) NSD ANALYTICAL. SENSITIVITY(MF/L) 0,04 -A -.BESTO S ;O: - .. ASBESTOS CONC. ( >10gLn) ML) <0.041 ASBESTOS TYPE - - - -- *Fiber criteria > =0.5 microns, 5:1 aspect ratio: NAD/NSD = no asbestos detected, NA =not analyzed, MF/L= million fibers per liter. NOTE:Drinking water analysis by EPA - 600/4 -83 -043 (100.1). Analytical sensitivity calculated as though I. fiber had be detected on the TEM GRID area analyzed. Samples are refrigerated upon receipt and filtered within 4 hours. Samples Analyzed by: The SC- LAB Group of Laboratories < = LESS THAN > =GREATER THAN ]Results are based upon samples submitted: 12/7/200 �- _ 4 o ]Laboratory - Director °NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037° (860)828 -9787 - FAX (860)829 -1050 I NE LABS REPORT TO: P.F. BEAL & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLING POINT: SOURCE: ORTHEAST LABORATORY of DANBURY �iiY:� PISII,IN "'�tiAY; = "I?1�Tr1"Bl7Ff'Y'; �`"'� `"�6s�'�' "CT'�er`�•`�t� 203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 www.NORTBEAST,LABORATORrES.com Synthetic Organic Chemicals �N.FiGC�o. v°�� eti e � v �: v DATE SAMPLE COLLECTED: 12/6/2001 TIME COLLECTED: 4:00 P.M. COLLECTED BY: 1 I NE LABS REPORT TO: P.F. BEAL & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLING POINT: SOURCE: ORTHEAST LABORATORY of DANBURY �iiY:� PISII,IN "'�tiAY; = "I?1�Tr1"Bl7Ff'Y'; �`"'� `"�6s�'�' "CT'�er`�•`�t� 203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 www.NORTBEAST,LABORATORrES.com Synthetic Organic Chemicals �N.FiGC�o. v°�� eti e � v �: v DATE SAMPLE COLLECTED: 12/6/2001 TIME COLLECTED: 4:00 P.M. COLLECTED BY: BEAL DATE RECEIVED @ LAB: 12/7/2001. . TESTED BY: LAB #11301;11398 REPORT DATE: 1/9/2002 V.S CONSTRUCTION LOT #3, STRAWBERRY KNOLLS SUBDIVISION, PUTNAM VALLEY. N.Y. TOP OF WELL NEW WELL PARAMETER DIOXIN SYNTHETIC ORGANIC COMPOUNDS (all results reported in micrograms per liter (pg/L.) RESULT RL UNITS REFERENCE TO FOLLOW 1.0. pg/L 1613B Alachlor (Lasso) <0.1 0.1 µ9/L EPA525 Aldrin <0.1 0.1 µ9/L EPA252 Atrazine <0.1 0.1 µg/L EPA252 Benzo(a)pyrene <0.02 0.02 µg/[. ' EPA525 Butachlor <0.1 0.1 µg/L. EPA525 Dieldrin <0.04 0.04 µg/l, EPA252 Di {2- ethylhexyl)adipate <0.6 0.6 99/L EPA525 Endrin <0.01 0.01 µg/L EPA525 Heptachlor <0.04 0.04 µg/L EPA525 Heptachlor epoxide <0.02 0.02 µg/L EPA525 Hexachlorobenzene <0.1 0.1 991L EPA252 EP�1252 Lindane (gamma -BHC) <0.02 0.02 µg/L EPA525 Methoxychlor <0.1 0.1. µg/L EPA525 Metolachlor (Dual) <0.1 0.1 µg/L EPA525 Metribuzin (Senor) <0.1 0.1 µg/L EPA252 Propachlor <0.1 0.1 µ9/L EPA252 Simazine <0.007 0.007 µ9/L EPA525 Di- (2- ethylhexyl)phthalate <0.6 0.6 µ9/L EPA252 CARBAMATES HPLC Aldicarb <0.5 0.5 µ9/L EPA 531 Aldicarb Sulfone <0.4 0.4 µ9/L EPA 531 Aldicarb Sulfoxide <0.5 0.5 µg/L EPA 531 Carbaryl <1.0 1.0 µg/L EPA 531 3- Hydroxycarbofuran <1.0 1.0 µ9/L EPA 531 Methomyl <0.5 0.5 µg/L EPA 531 Oxamyl (Vydate) <1.0 1.0 991I, EPA 531 Carbofuran <0.9 0.9 µg/L EPA 531 HERBICIDES Glyphosate <6.0 6.0 µg/L EPA 547 Diquat <0.4 0.4 µg/L EPA 549 ENDOTHALL Endothall <0.09 0.09 µg/L EPA 548 EDB and DBCP ANALYSIS 1,2- Dibromo- 3- Chloropropane ND 0.02 µg/L 504.1 1,2- Dibromoethane (EDB) ND 0.02 µ9/L 504.1 jig/L--micrograms per Liter ND =None Detected RL= Reporting Limit <--Less Than pg/Irpico grams per Liter 1. 'E NORTHEAST LABORATORY OF DANB RY -�,,,• - ._391 1fLP=VROAD _" �1��,��';, ''I�t2��$V- 14�a'r Cert W147464#-- q� . �,. 203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 www.NORTHEAST LABORATORIES. com ' 4 fJOt4i,fq� d 3'.. S Synthetic Organic ChemicaRs REPORT TO: P.F. BEAL & SONS DATE SAMPLE COLLECTED: 12/6/2001 4 PUTNAM AVENUE TIME COLLECTED: 4:00 P.M. BREWSTER; N.Y. 10509 COLLECTED BY. BEAL 0.22 DATE RECEIVED @ LAB: 12/7/2001 ND. TESTED BY: • LAB# 11301;1139.8 E507 REPORT DATE: 1/9/2002 SAMPLE SITE: V.S CONSTRUCTION, LOT #3, STRAWBERRY KNOLLS SUBDIVISION, PUTNAM VALLEY, N.Y. SAMPLING POINT: TOP OF WELL µg/1- SOURCE: NEW WELL 0.15 PARAIi TER ORGANOPHOSPHORUS PESTICIDES Alachlor Atrazine Butachlor Metholachlor Metribuzin Simazine PESTICIDES/PCB's Aldrin Endrin Dieldrin Heptachlor Heptachlor Epoxide Lindane (all results reported in micrograms per liter (pg/L) RESULT RL UNITS REFERENCE ND 0.44 µ9/L E507 ND 0.22 PA E507 ND. 0.1 µg/L E507 ND 0.1 µg/L E507 ND 2.00 µg/1- E507 ND 0.15 1191L E507 :`Prof ash Toxaphene PCB -1016 PCB -1221 PCB - 1232. PCB -1242 PCB -1248 PCB -1254 PCB -1260 Chlordane Methoxychlor HERBICIDES 2,4 -D Dalapon Dicamba Dinoseb Pentachlorophenol Picloram 2,4,5 -T 2,4,5 -TP jig/L--micrograms per Liter ND = None Detected Results based on sample(s) submitted: 12/712001 ND 0.05 µ9/L EPA 508 ND 0.1 µg/L EPA 508 ND 0.1 µg/L EPA 508 ND 0.1 9911, EPA 508 ND 0.05 µg/L, EPA 508 ND 0.05 991 EPA 508 i T3 0;5 T `µ9/l .EPA 508 ` ND 1.0 T µ9/L vEPA 508 ND 0.5 µg/L EPA 508 ND 0.5 µ9/L EPA 508 ND 0.5 Eig/L EPA 508 ND 0.5 991L EPA 508 ND 0.5 µg/L EPA 508 ND 0.5. 1191L EPA 508 ND 0.5 µg/L EPA 508 ND 0.5 µg/L EPA 508 ND 0.5 µ9/L EPA 508 ND 1.0 µg/L EPA 515.1 ND 5.0 991 EPA 515.1 ND 0.5 µ91 EPA 515.1 ND 0.5 µ9/L EPA 515.1 ND 0.2 µg/L EPA 515.1 ND 0.5 991L EPA 515.1 ND 0.2 µ9/L EPA 515.1 ND .0.2 µ9/L EPA 515.1 RL= Reportin Li it <--Less Dun g/L =pico /grams p&r Liter Laboratory Director 1 °NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037° (860)828 -9787 FAX (860)829 -1050 TOLL FREE WITHIN CT: 800- 826 -0105 o OUTSIDE CT: 800 - 654 -1230 N� LABS' NQ.RTHEAST ,L.AB_ORATORY of DANBURY rg M1111 LAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404 203) 748 -7903 - FAX (203) 748 -0662 NY Cert: 11471 www.NORTHEAST LABORATORIES.com. . REPORT TO: P.F. BEAL & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLING POINT: SOURCE: Synthetic Organic Chemicals R DATE SAMPLE COLLECTED: 12/6/2001 TRAE COLLECTED: 4:00 P.M. COLLECTED BY BEAL DATE RECEIVED @ LAB: 12/7/2001 TESTED BY: LAB #11301;11398 REPORT DATE: 1/14/2002 V.S CONSTRUCTION, LOT #3, STRAWBERRY ]KNOLLS SUBDIVISION, PUTNAM VALLEY N.Y. TOP OF WELL µg/1, NEW WELL <0.1 PARAMETER DIOICIN SYNTHETIC ORGANIC COMPOUNDS Alachlor (Lasso) Aldrin Atrazine Benzo(a)pyrene Butachlor Dieldrin Di- (2- ethylhexyl)adipate Endrin Heptachlor . Heptachlor epoxide Hexachlorobenzene (all results reported in micrograms per liter (pg/L) RESULT RL UNITS REFERENCE ND 1.0 pg/L 1613B Hexachaorosyclopertadiene- -- Lindane (gamma -BHC) Methoxychlor Metolachlor (Dual) Metribuzin (Senor) Propachlor Simazine Di42- ethylhexyl)phthalate CARBAMATES HPLC Aldicarb Aldicarb Sulfone Aldicarb Sulfoxide Carbaryl 3- Hydroxycarbofuran Methomyl Oxamyl (Vydate) Carbofuran HERBICIDES Glyphosate Diquat ENDOTHALL Endothall EDB and DBCP ANALYSIS 1,2- Dibromo- 3- Chloropropane 1,2- Dibromoethane (EDB) 11g/I--micrograms per Liter ND = None Detected <0.1 0.1 µ9/L EPA525 <0.1 0.1 µ9/L EPA252 <0.1 0.1 119/L EPA252 <0.02 0.02 µg/1, EPA525 <0.1 0.1 11g/L EPA525 <0.04 0.04 µ9/L EPA252 <0.6 0.6 119/1, EPA525 <0.01 0.01 11g/L EPA525 <0.04 0.04 9g/1, EPA525 <0.02 0.02 µ9/L EPA525 <01 0.1 _ F,PA252. :0.1 . _....... 01 .. _ . _µms,. _. _ ._._ . _ EPA257 <0.02 0.02' 991L EPA525 <0.1 0.1 µ9/L . EPA525 <0.1 0.1 µg/L EPA525 <0.1 0.1 µg/L EPA252 <0.1 0.1 µ9/L EPA252 <0.007 0.007 µg/L EPA525 <0.6 0.6 µg/1, EPA252 <0.5 0.5 99/L EPA 531 <0.4 0.4 µg/L EPA 531 <0.5 0.5 119/L EPA 531 <1.0 1.0 99/L EPA 531 <1.0 1.0 µg/L EPA 531 <0.5 0.5 99/L EPA 531 <1.0 1.0 991 EPA 531 <0.9 0.9 µg/L EPA 531 <6.0 6.0 11g/L EPA 547 <0.4 0.4 µ9/L EPA 549 <0.09 0.09 µg/L EPA 548 ND 0.02 µg/L 504.1 ND 0.02 µ9/L 504.1 RI,- Reporting Limit < =Less Than pg/L =pico grams per Liter 1 AILA 2 NORTHEAST LABORATORY OF D REPORT TO: P.F. BEAL & SONS 4 PL TNAM AVENUE BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLING PONT: SOURCE: 203) 748 -7903 - FAX (203) 748 -0652 1 NY Cert: 11471 www.NORTHEAST LABORATORIES.com Synthetic Organic ChemgcaRs C 4 a x DATE SAMPLE COLLECTED: 12/6/2001 TIME COLLECTED: 4:00 P.M. COLLECTED BY: BEAL DATE RECEIVED @ LAB: 12/7/2001 TESTED BY: LAB #11301;11398 REPORT DATE: 1/9/2002 V.S CONSTRUCTION, LOT #3, STRAWBERRY KNOLLS SUBDIVISION, PUTNAM VALLEY, N.Y. TOP OF WELL NEW WELL PARAMETER ORGANOPHOSPHORUS PESTICIDES Alachlor Atrazine Butachlor Metholachlor Metribuzin Simazine PESTICIDES/PCB's Aldrin Endrin Dieldrin Heptachlor Heptachlor Epoxide Lindane v a SO' parh6- . :.._ _... . Toxaphene PCB -1016 PCB -1221 PCB -1232 PCB -1242 PCB -1248 PCB -1254 PCB -1260 Chlordane Methoxychlor HERBICIDES 2,4 -D Dalapon Dicamba Dinoseb Pentachlorophenol Picloram 2,4,5 -T 2,4,5 -TP (all results reported in micrograms per liter (µg/L) RESULT RL UNITS REFERENCE ND 0.44 µg/L E507 ND 0.22 µg/L E507 ND 0.1 µg/L E507 ND 0.1 µg2 E507 ND 2.00 µg/L E507 ND 0.15 99/L E507 jig/L--micrograms per Liter ND = None Detected Results based on sample(s) submitted: 12/7/2001 ND 0.05 µ,/L EPA 508 ND 0.1 µl9 EPA 508 ND, 0.1 µg/L EPA 508 ND 0.1 µg/l- EPA 508 ND 0.05 µg/L EPA 508 ND 0.05 µg2 EPA 508 ND - 1.0 V µg/L EPA 508 ND 0.5 µg/L EPA 508 ND 0.5 µg/L EPA 508 ND 0.5 µg/L EPA 508 ND 0.5 99/L EPA 508 ND 0.5 µg2 EPA 508 ND 0.5 9911, EPA 508 ND 0.5 µg/L EPA 508 ND 0.5 µ9/L EPA 508 ND 0.5 µ9/L EPA 508 ND 1.0 µ9/L EPA 515.1 ND 5.0 µg/L EPA 515.1 ND 0.5 µ9/L EPA 515.1 ND 0.5 µ9/I, EPA 515.1 ND 0.2 µg/L EPA 515.1 ND 0.5 99/L EPA 515.1 ND 0.2 1191 EPA 515.1 ND. 0.2 µg/l, EPA 515.1 RL =Repo Li it r Less Than pg/L =pico /grams per Liter dffik O i Laboratory Director oNORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060370 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800- 826 -0105 o OUTSIDE CT: 800 - 654 -1230 09/10/2003 11:23 9147363693 CRONIN ENGINEERING 1 PAGE X05 CRO -NIN .EN._G_ IN,,E.�.EWIN. P .. .i y:: ..;1a °.iv to y`.:��I�F.• ^.f�.. w�Ya"_ �n -� w •,•c .�h a� yu.• at '.`:1 • ...�..:. .. .,' Grp 2 JOHN WALSH, B0V] THE LINDY BLDG;• SL PEEKSSILL, NY. i 70: FROM: Theresa Neweth D S COMPANY: DATE: E • ASR D^ P.C.H.D. SETOF FR 10, 2003 PAR NUMBER: TOTAL NOA XTE 200 1 )566 SUNDER'S RPPVRP. NCE NUMBER: Pheasant R , YOUR REFRREK NUMBER: 37 Croton Dam Road Corp.. 70: FROM: Theresa Neweth Ken M by COMPANY: DATE: P.C.H.D. SETOF FR 10, 2003 PAR NUMBER: TOTAL NOA FS �NU .t10iNG (OVF,R 1 P14ONEi NUMBER: SUNDER'S RPPVRP. NCE NUMBER: Pheasant R m Road YOUR REFRREK NUMBER: 37 Croton Dam Road Corp.. P.CDH.: e i 't ##PV -32 -02 © URGENT O FOR REVIEW ❑ PLEASE COMMF. N T 0 PLE�SE REPLY U PLEASE RECYCLE Tows of Putnam Valley SM Co11smxtlon Compliance Stwvberry Knoll, lot 3 MFSSAQE I COI •11� • i 1 Y� W •1 t. �.d i.. �.141>_..�� I.i� SEP -10 -2003 WED 11:22 De*M En a - v i , I 1 ,r TEL. (914)736 -3664 FAX (94)736 -3693 E TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P 5 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION / . Date: Inspected by: _Ii!l,.LdJ» %2u�i 0,?T �.a, � Town ..__ ..3• ,�- �-e:.r �+- ^".-.,_ - �% ti,,,.., �/,� l Permit # 81 1�2 U a TM # Subdivision Lot # 1. Sewage Svstem 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 , vation -water tested..../0,1 . 2. Prot elow frost .................. ............................... um 2 ft.Original soil between box & trenches e. Junction Box - properly set .......... ............................... 6, Irenches 1. Length required '5 00 Length installed S-0 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ......... .......:....................... 4. Slope of trench acceptable 1/16 - 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 % ......................... 8. Size of gravel 3/4 - 11/2" diameter clean ...................: 9. Depth of gravel in trench 12" minimum....... ; ........... _10. Pipe ends ca ped. „. ............._., -g: Piinip ©r IrosedPSystems. 1. Size of pump chamber.......... .......... 2. Overflow tank........ ........................ ........... 3. Alarm, visu io ........................ 4. Pum y accessible, manhole to grade ................. 5 'rst box baffled .......................... ............................... 6. C�yycle witnessed by H.D.estimated flow /cycle........... III. House/Buildhig a. House located per approved plans ......................... b. Number of bedrooms ....................... .....................`7z....... IV. Well Well located as per approved plans .......:................V :.... b. Distance from STS area measured ft........... c. Casing 18” above grade ................ ............. ................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship . a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backf l material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall brotected & _.dinto-.exist watercourse Surface =rotection adequate .... ....:.......................... Erosion provided ................. ............................... Rev. 12/02 S :'f- '." "'x NS x `ab h �+a.TILUMFORT Date: Fill pad located per the approved plan Fill Pad Length Fill Pad Width . Fill Pad Depth Run -of -Bank Fill Quality Slope from Top to Toe Impervious Layer Installed Erosion Control Installed Sieve Test Results (if applicable) Required Length Required Width Required Depth Inspected by: 14.1" wart—Text a 61 T21 PROJECT I.D. NUMBER S EQ R Appendix C - _-._� . ..:�•K..:�:�� ---- - _ _�s•. � . � - �-:__..: 3ta3ir"- E�viror ,�ss�tai-:0��lliy'-����Gw.:... _ _.. ,.... :x� ..; . r�:�.ti SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME 37 Croton Dam Road Corp. Strawberry Knoll, Sublot # :3. 3. PROJECT LOCATION: Mu ice, Town of Putnam Valley County Putnam County 4. PRECISE LOCATION (StrM addraaa and rob IntersectW11. prominent landmarks, etc., (W Prowl" map) Pheasant Run Road S. IS PROPOSED ACTION: ® N..I ❑ Expansion ❑ ModlfleatloNalteration 1. DESCRIBE PROJECT BRIEFLY: Construction of- Subsurface Treatment System to serve a Single Family House T. AMOUNT OF LAND AFFECTED. Initially Z.23 acres Ultimately �, �5 acres B. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ZlYes ❑ No If N. describe brlally I. WHAT le PRESENT LAND USE IN VICINITY OF PROJECT? A.YResidenHal ❑ Industrial ❑ Commercial ❑ Agrkulture ❑ Put/FwssUOpsn span ❑ Otnu Surrounding Lands are zoned Single Family Residential • r 10. DOES ACTION INVOLVE A PERMIT APPROVAL OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL STATE OR LOCAUJ? ® yes ❑ No If yea, list agency(s),and permwapprovale. , Town of Putnam Valley Building Permit 11. lay" ANY ASPECT OF THE ACTICV HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? lay" ❑ No M r.. Wt agency earne and parmmapproval Subdivision Plat Approval- "Strawberry Knoll Subdivision" 12. AS A RESULT OF PROPOSED ACTION WILL:E=1 90 PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yea ®No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE 13 TRUE TO THE BEST OF MY KNOWLEDGE AoWleanuaws r tip, Cronin Engine ing, PE PC / Keith Staudohar Date: 4 -9 -02 Signature: '-- If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER PART II— ENVIRONMENTAL ASSESSMENT (TO be completed by Agency) A- DOES ACTION EXCEED ANY TYPE I THRESHOLD IN A NYCAR. PART 8t7.tZ7 If yoo, eomdlnato tho rove= proaaaa and us a 9% PULL EAF. ❑ Yoo bo 1 a. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 8 NYCRR, PART 817.87 If No, a A"alive declaration may bco OuPwaadod by mother Involved agency -... -�:a = - •Li`iaW� a n REV"` "' . eo - -,_ - .» .. - .'" -� vim' *• C. COULD ACTION RESULT IN ANY ADVERSE EFF=8 AASOCtATED WITH THE FOLLOWING: (Anodoro may W handwmiaen. If leglbh) CT. Eslating air qu ©Illy, eudsco or ®roun"at®a quality or quantity, nolao lavols, bulating traffic pettGans, eoild 08810 production or disposal, pmontial for eroslon, drainage jjoy flooding probietros? Explain briofly.. AID C3 A8011tatie, agricultural, areehasologleal. 11181orie, or other natural of cultural roaoureoo; of community of nolghborflood eharsaW Explain briefly: AJ C1. Vwtatlon or fauna, fish. ahoilfloh err mifdlifo Species. algnlflcant habitats, or th(antonGd of endanlgorod opocles? Explain bftil r. - Al V Ca. A community's ouisling plans or goals as officially odoptod, or a ch'ange In upo or Intonsity of uoo of land or otha natural ressourcos? Explain CS. Grovnh, oubsequont devolopmont, or rolatod aetivelloG ilkoly to ba induced by the propoSad action? Explain bdofly. C& Long torm, short torm, cumulativo, or other offecta not Idontlfled In Cl-CZ? Explain brlalty. A /b C7. Othar. impacts Qnciuding crhangost In uue of oitfw quantity or type of onorgy)? Explain brially. IV � 0. 18 THERE, OR IS THERE LIKELY TO 62. CONTROVIZASY RELATED TO POTENTIAL ADVERSE ENVIROMMENTAL 11APACT87 ❑ Yea_ rr FART III— DETERAMNATION OF SIGNIFICANCE (To be completed by Agency) I96MUC7'XM&- For each adverso effect Identified above, determine wfttha It to aubaitauttial, law. Important ce otherwtse Ilignlfic ant. Each affect ,should be aaasesed In connection with Its (a) setting P.a. urban of rural); (b) .probability of ocwrring; (c) duration; (d) IrrvvwWbillty, (e) g®ograaphic scope; and (n magnitude. If n4csasary, add stlanchmmils or rollwence supporting materials. Ensum that ®xplanatlarttl contain suffklent detail to shots that all relevant Adverw Impects fufttb Dwo untitled and ads"ntafy addmassd. ❑ Check this bon If you harp identified one or ease potentlally lorg® or significant advww Impacts which MAY aacur. Then proceed directly to the FULL EAF 8ndlor prepare a poeithe "aratkxL ❑ Check this box If you have -determined, based on the Information turd ar- alyals above and any supponing docurnenttatlon, that the proposed actin WILL NOT result In any .aignificant advem onv(ronmerital Impacts AND provide on attaichnillInts as racessary, the reasons supporting thla determination: tlA Manse of Load AGargY m ►— DeT ro oe44fpo014 K�{tBV in Lead AgeCney I 'Eja at gesponsdAa FIKer Si or S ryry nn Kerr m Load Aeency Sipasum er Pmparm (if difforon: irorn msocou&bW or ieeeri • n -, ,.' , • r. .. ago a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner 37 Croton Dam Road Corp- ' .. Address 37 Croton Dam Road, Ossining, NY 10562 Located at (Street) fl,* ,?c1tj_�1_' '_ -Tax Map b4 Block Lot (indicate nearest cross street) Municipality (T) Putnam Valley- Drainage Basin Peekskill Hollow Creek SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test 5.9 Hole No. Run No. Time Start - Stop Elapse Time tll Iin.) De th to Water from Ground Surface (Inches) Start Stop Water Level Dropp In Incles Percolation Rate NlinAnch 1µr -g ° -� z7• "2'y 3 3rd a . 2 9 3g �� . ' Z - % 3 • /(:1 4 5 2 _9 44 33 .22 4 5 2 3 5 tv v 1 r.3: t.. ; 1 ests. to be repeated at'same depth until approximately equal percolation rates are obtained at each `.percolation test hole. (i.e. s 1 min for 1 -30 min/inch, <_ 2 min for 31 -60 min/inch) All data to be u `submitted for review. - 2. '`'Depth measurements -to be made from top of hole. Form DD -97 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0'' VEST PIT DATA HOLE NO. `%)P SAM • � rPA Y A0 AND 3.5' HOLE NO..' HOLE N0. G`1 ,Ado 6w—A V E i_ . 2 Indicate level at which groundwater is encountered # A Indicate level at which mottling is observed N/4 Indicate level to which water level rises after being encountered �f 1A Deep hole observations made by: Adam Stiebeling/ Keith Staudohaur wYRk PCDH Cronin Enineerrng,r o Design Professional Name: Timothy L. Cronin III Address: 2 John Walsh Blvd. #200 Peekski , 10566 Signature: Design Professional's Seal .lj 62980 1- WOFES'5\0 - / PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FORT APPROVAL OF PLANS FOR VV EIN , i:� 1: Name and address of applicant: 37 'Croton. Dam Road Corp. 37 Croton Dam Road " 0 sining, New Yorkl 10562 2. Name of project: Strawberry 'Knoll M 3. Location TIV: Putnam Valley IOU too t. 4. Design Professional: Timothy. L. -Cronin 'T11 ' .5. -Address: 2 Johfi Walsh' -Blvd; 200 Lindy Bldg 6. Drainage Basin: Peekskill Hollow Creek. Peekskill,' New York" 10566 7. Type of Protect: X, Private/Residential . Food Service Commercial Apartments Institutional Mobile Home Park - Office Building Realty Subdivision -Other (specify) 8. Is this project subject to State Environmental Quality Review,(SEQR) ?. ,.Type Status check one . Type I Exempt YP ( ) ..... ............................... .............. Type II Unlisted x 9. Is a Draft Environmental Impact Statement (DEIS) required? - .' .................. NO 10. Has DEIS been completed and found acceptable by Lead Agency? ................ 11: Name of Lead Agency Town ..of Putnam .Valley Planning Board 12. Is this project in an area under the control of local planning' zoning, or other off vial 13. If so, have plan* s been submitted to such authorities? ........ .... .I I .......................... Yes 14: Has preliminary: approval been granted by. such authorities? Yes ' Date granted: Jan 2001 15. Type of Sewage Treatment System Discharge ................. surface water x groundwater 16. If surface water discharge, what is the stream class designation? .................... N/A 17. Waters index number (surface) ............•........ N/ A NO 18. Is project located near a public water supply system? ......... :............................ 19. If yes, name of water supply . N/A Distance to water supply N/A 20. Is project site near a public sewage collection or treatment system? ............... NO 21. Name of sewage- system N/A Distance to sewage system N/A 22. Date test holes observed Aprilvay. .2000 23. Name of Health InspectorAdam stiebeling 24. Project design flow (gallons per day) soo Gal /Day 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? ......................... No Form PC -97 27. Is any portion of this project located within a designated Town or State wetland? YES 28. Wetlands ID Number. N/A �.a.• _�.. :.�.. �. .., u a;1 � r _:i �s����%`. "'..�.��.iy 0•• - �-'i• 29. Is Wetlands Permit required? .. No - Has application been made to Town or Lbcal DEC office ...............: NO 30. --Does project require a DEC Streambisturbance'Permit? ................................... NU 31. Is or was project site used for agricultural activity' involving application of pesticides .to orchards or other crops, solid or hazardous waste *disposal, NO landfilling, sludge application or industrial activity? .... Yes/No 32. Is project located within .1.;000 feet of existing.or abandoned landfill, . hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No No DESCRIBE: ..: .... . 33. Is there a local master plan on file with the Town or Village? YES 34.-' "Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to.project site ?_ .. . .............. .. ... .... ::.................. _ NO 35. Are any sewage treatment-areas in excess of 15% slope? .................:.. :. N 36. Tax Map ID Number ........................... ...................... ....:...:. Map g�f Block -4 Lot 49 37. Approved plans are to be.returned to ..... Applicant x Design Professional NL?TE AiI' pplieat cns: fora -yi—w annd appruwd of a n_ -6 'S SZS:t wh alo�X�in +W i-:- be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP.review and approval of other aspects of a project, such as 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 thari the: applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure 'to comply with this provision may be grounds for the rejection of any submission. „ ... I hereby affirm, wader pe 'alty of perjury,1hat irrjorrraation provided on than f orrt� is true to the best of my knowledge and belief false stateara s ade herein are punishable as a Class A misdemeanor pursuant to Section 21 . the Penal Law. SIGNATU ES & OFFICIAL TITLES. Timothy L. Cronin PE- Mailing Address: Cronin Engineering, PE PC 2 John Walsh Blvd; 200 Lindy Bldg; Peekskill,NY 10566