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HomeMy WebLinkAbout4392DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -2 -60 BOX 33 04392 I,yti r Lit �, ' , jj♦ , L -� � 1 � L 16 - -L fT - I - ' L9 L - -. - - ` �'i 04392 PUTNAM COUNTY DEPARTMENT OF HEALTH Ai, -' DIVISIO GI PE ♦ d. \MENfA-L- - HE +AL—T.H'SLR'7 I CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # QV 34 - o 2 Located at (°i PHtS 9ly f R v I-A ROA D Town or =aggeLqWifr%, V, L LE U Owner /Applicant Name 3*) C26-raN 0,4n rZdA0 co1?Tax Map 534 Block 'Z Lot C0 Formerly Subdivision Name STQq W�'2 R V Kul 0, C Subd. Lot # 39 CPO—low DtI n-I Roioo Mailing Address OSS I O f +,.I 6 -. Zip Date Construction Permit Issued by PCHD 12 - 2 d - 'ZOO 2 3:2 cRo -ra/v oArti ilaFJ:. l Separate Sewerage System built by39 cRoio w pAn Pmo cogp. Address o ss I N I NG� r4 10. S6-2 Consisting of 12 S4 Gallon Septic Tank and SO0 t- F, -Pe'7LToari -r -o pV c p f c- I k 24 ` 6-RA V CL 'TR E K c H Other Requirements:_ Water Supply: Public Supply From Address 4 RIiNCIr� j vewue or: Private Supply Drilled by f F 11699 'f X0 r4-r IN c. Address 13Re W X TI &JI, /.� I� /o 5v Building Type �S1w G44xp FAr+rw v, .X- Has erosion control been completed? Number of Bedrooms ro u rL Has garbage grinder been installed? I certify that the system(s), as listed, serving the built plans (copies of which are attached), in plans and the standards, rules and regulati s y ` Date: ?4- O � Certified by Address 2 SoKrV Wi4L_fH rises weY ` ons cted essentially as shown on the as- -A q Construction Permit and approved in > Dep ent of Health. s UJ P.E. R.A. License # 0 6 2_ 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. Si By: ,�� Title: /�S l--E'r,1l-f-A Givw_4, -" Date: //'Y/Oy e copy - HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ,.. _. .�_, n,. _ ...� �....,., .._ .....__ ._ _ ,_.....:...,� ........,� ... WELIL COMPLETION REPORT, Well Location Str t ress: Town/Village: Putnam Valle Tax Grid # 84 -2 -60 Map Block Lot(s) Well Owner: Name: Address: VS Construction, 37 Croton Dam Road, Ossining, NY 10562 Use of Well: I- primary 2- seconrIlary 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 42 ft. Length below grade 41 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 5 gpm Depth Data Measure from land surface- static (specify ft) 5' During yield test(ft) 540' Depth of completed well in feet 6051 Well Log If more detailed information descriptions or � are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 27 Drilling in over den cla and boulders Hit rock at 27' , 27 . 4i� . ' .Drillin- " in'"r6ck -set casin.. - routed- _... _ .. 4 If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity _2= Depth 560' Model 7GS15412 Voltage 230 HP 1k Tank Type WX302 Volume 8L al e Date Well Completed 5/5/03 Putnam County Certification No. 001 Date of Report 6/26/03 IP Well D ' er i Lo NOTE: Exact location of well with distances to at least two ermanent landmarKs to be provtaern a separate sneevptan. Well Driller's Name P. F Address: 4 Pttd1e4tl Ave,, Bagmjx r, NY 1mm Signature: Date: 6/26/03 Perry Lo Bea White copy: ) D File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 BRUCE R. FOLEY Public Health Director �.�"'�CUitE"f"`iR ` °lvf(��ili'�AiT:i• �`R:Y�:;''fvl:�N:^: ��'�:�•�� �- Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914)278-6130 Fax (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: 3� Cl;a lc�� i�/aY'1 fZon cefL� TAX MAP NUMBER: 701.K '. 2— Lo T- : co xQT"'rA 9 E911 ADDRESS: ?HC0 S1qNT RyiJ RQ 41 D TOWN: �U i AUTHORIZED TOWN OFFICIAL: _ (Signature) DATE: r4 L LC- r ..s__.. ...'.,.' '� ;- -�.. .. ors -r• .. o... .. ,.-mot. - -. ... .'- �.�.. o. '.. gc. .e 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 VERFRM) PUTNAM COUNTY DEPARTMENT OF HEALTH . GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 3f] Cnb ?osJ 60Arl -go AD Co 12 P Owner or Purchaser of Building S4 02 too Tax Map Block Lot 39 c R o T6li PA m K0 ,,9_Q C-6 i2 P. VA L Building Constructed by TownNillage 'PHEA 5oQ�� F Pu Q ?o ti o Location - Street Building Type S i Rpj 0 lfE R,f21/ Ohl p L L Subdivision Name q 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 sen-ing 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 t�vo 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 .... . ope "rate properly is`caused'bi "the'willfdl or rievliQen "tact b1theboccupant ofth -t tiuildina utilizing -the system. The undersigned further agrees to accept as conclusive the determi Director of the Pu am unty Department of Health as to whether or to opera/ewa Gated b willful or negligent act of the occupant system. Dated`_Vl qth 'I i `Day Z Year Zoo 2 Signature: k ti Title: 1`12L-5'S1 ro General O fAc�r4Owner)j Signature of the Putt c Health ie to ure oVIe system bui ding utilizing the n i 1r I 39 CVO -row DAt-t tZ0A0 coa2P 3�1 C20 i o�j DAi''_ 12a?q0 0072? Corporation Name (if corporation) Corporation Name (if corporation) Address: 39 CRO Tv J OAM J�F0 A State O SS )n1 1/,3 6- 1V .% /, Zip / 0 S6 Z Address:.-'g2 CV6TaIJ 0A P-7 !20- State Zip 10 s6.2 Form GS-97 JMS ENVIRONMENTAL SERVICES, INC. i5oo SUMMER STREET T-AMED.RQ �-q.NNFGTIQUT._A69o5 NELA,C,,CT and NY State Certif4ed Environmental Laboratory. -4' '. 1• .� J... 7s ..,t- rnlr. y �•11f�.efa.., ei• T.✓v�•i. �. "♦w.. vwl.:'V.+i .. 4': Mailing Information: Name: PF Beal & Sons Address: 4 Putnam Ave City: Brewster State: NY Telephone: 845 - 279 -2460 Sample's Information: . ?Site.Lot�4` Preservative: Temperature: Client: VS Construction Zip: 10509 Fax: 845 - 279 -6613 Collector's Information: Name: Kevin Address of site: Strawberry Knolls City: State: Zip: Telephone: Date Collected: 6/26/03 Date Received: 6/27/03 HNO3 Time Collected: 13:45 Time Received: 15:00 <4C Lab No.: J034487 Date Analyzed Test Name 6/27/03 15:00 6/27/03 6/30/03 6/30/03 6/30/03 6/30/03 6/30/03 6/30/03 6/30/03 6/30/03 6/30/03 10:00 6/27/03 6/30/03 6/30/03 6/30/03 6/30/03 Total Coliform Chlorine Free Residual Color Odor Iron Manganese Sodium Chloride Hardness•°-•--• •- Nitrate . . Nitrite pH Sulfate Turbidity Alkalinity Lead Comments: * Below MCL Result MCL Method Absent Absent SMWW 9222B <0.1 mg /L N/A SMWW 4500CIG ND 15 Units SMWW 2120 B ND 3 TONs SMWW 2150 B <0.03 mg /L 0.3 mg /L SMWW 3111 B <0.01 mg /L 0.3 mg /L SMWW 3111 B 6.83 mg /L N/A SMWW 3111 B 23 mg /L 250 mg /L SMWW 4500 Cl C 82 mg /L N/A SMWW 2340 C .. 1.38 mg /L 10'mg /L '-' SMWW 4500 NO3E " <0.1 mg /L 1.0 mg /L SMWW 4500 NO3E * 5.96 S.U. 6.5 -8.5 S.U. SMWW 4500 H B 22.3 mg /L 250 mg /L SMWW 4500 SO4F 0.12 NTU 5 NTUs SMWW 2130 B 64 mg /L N/A SMWW 2320 B <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 M 11715 President Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com FEZ 'G 1-t Ck tit, LETTER OFTRM 11115 METTAL CRONIN ENGINEERING P.E., P.C. The Lindy Building; Suite 200 2 John Walsh Boulevard Peekskill, NY 10566 914 - 736 -3664 Fax 914 - 736 -3693 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 PERM #PV -3402 19 PHEASANT RUN ROAD TOWN OF PUTNAM VALLEY THESE ARE TRANSMITTED as checked below: July 8, 2003 ❑ FOR APPROVAL ❑ FOR YOUR USE ❑ AS REQUESTED ❑ FOR REVIEW AND COMMENT X PLEASE REPLY �:_ .� �_... =. �.�'ARE °SENDfl�iG'I'OU'a�tacQ�ed � � . 'w ._:..._ .:_ ._.. � , ... ry - .:, F:�._ - � . ,. .. ._ .. :.... `�: �'• . '_ . :. .... 1.) Three copies of as -built subsurface sewage treatment system plan 2.) Three certificate of the construction compliance. 3.) Three guaranties of SSTS 4.) Copy of survey showing - foundation location 5.) Well driller's completion report 6.) Water analysis 7.) E911 address verification form 8.) $200 certified check for application fee. 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, el %7& � _ Kenneth M. Murphy Design Engineer P. R®NIN ENGINEERING P.E. P.C. The Lindy Building, Suite 200,2 John Walsh Blvd., Peekskill, New York 10566 oatm.I'el'.a(W 7.£.,i3- 664'.. B "Fax:;(..1^4�:fi:�fivR_6 -.gc. :ter.: ...;n. �. ..•Fx�.a -..r. "dam= e•a'r`��. 'es.�, tF..0 ;. =���%: "' a�".` .;'- "': °:��':r- z.:.�:."a:'.-.;; ":r;;:re�.r .;..f.: �. December 10, 2002 Joseph Paravati, Jr. Assistant Public Health Engineer Putnam County Department of Health Division of Environmental Services 4 Geneva Road, Brewster, N.Y. 10509 n Re: SSTS Construction Permit Strawberry Knoll Subdivision — Lot 4, 14 Pheasant Run Road, Town of Putnam Valley Dear Mr. Paravati: Find enclosed three copies of the revised SSTS plan for -each of the above referenced subdivision lots. The plan has been revised as previously discussed including an additional junction box for lot #4 and the replacement of the 2" dia. high density polyethylene resin force line by a 1 t /2" dia. of the same specification. The revised headloss calculations and 'the new pump /. system curve are included. 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. cc: Val Santucci StrawbenyKno%Lots4rl,14r2,PCDK 12- 10 -02.doc Respectfully submitted, Luis Hernandez Project Engineer 07/07/2003 15:58 9147363693 CRONIN ENGINEERING 1 PAGE 01 .. .. .. .- -'(S O'.�,- _. wt v�v .'N r�P �. • -a�._ m , w. . -.. :. .. � -� - .. -6 tom.: . ��:.� ,•q �.:��. •�:�• -. , .,..,'.��. PUTNI AM COUNTY )DEPAR'IMMENT OF DMSION OF ENVIRONMENTAL HEALT e—�r ATTENTION' 0 GENE REQUEST FQF, FINAL INSPECTIM For: All information must be fully completed prior to any inspections being made. IEALTR SERVICES Fill Trenches PCHD Construction permit # Located: lot 'P 6AJ'l4ry u N 12009- (T ) V14LLC4 Owner /Applicant Name. C,2 oToq y a/,i RgAaa TyI g' Block Lott 6a Formerly: Subdivision Name: S712A 9WYLU lento L c_ Subdivision Lot n Is system fill completed? N�� __ Date: Is system complete? _ y�1 Date- . 7 do _ Is system constructed as per plans? VE.S Is well drilled? Date: Is well located as per plans? - - - Are erosion control measures in place? ye 1 I certify that the system(s), as listed, at the above premises has been and verified their completion in accordance with the issued 1 _approved: plans:== the Standards., Rules- and--Regulations of th, Health. onstructed and I have inspected "HD Construction Permit and Putnam County Department-of ........,- KLiJ r 1 viz I Date: 7 900 Certified by: c 9ZoM t �V G Design Prof si Address: JdMN KW t-r# �c01,b Comments; Form FIR -99 Lic. # PE - -- RA do 07/07/2003 15:58 9147363693 CRONIN ENGINEERING 1 PAGE 02 DD x p � n + -.c ^. = �== s.or'.. .. _ ark: °a'•, . -,;kk' . a .. -' a >. .. � - _ k "p m � a 7ilAFFd // r rr a iv . . (47)� ol Tt PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # P n M Located at Pheasant Run Road Town Bp*MW Putnam Valley Subdivision name Strawberry Knoll Subd. Lot # J_ Date Subdivision Approved May 15, 2002 Owner /Applicant Name 37 Croton Dam Road Corp. Tax Map 84 Block 2 Lot j:�o Renewal Revision Date of Previous Approval MIA Mailing Address 37 Croton Dam Road, Ossining, NY Zip 10562 Amount of Fee Enclosed $300.00 Building Type Residential Lot Area.`t.05 No. of Bedrooms 4 Design Flow GPD zon AC-. _ Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED - Separate Sewerage System to consist of 1250 of 4" PVC Perf. Pipe in 24" Gravel Trench _ Other Requirements: To be constructed by Water Supply gallon septic tank and �0 L. F. 37 Croton Dam Road Corp. Address 37 Croton Dam Road, Ossining, NY 10562 Public Supply From Address �' -``+= • - on ::. ` ::..�. ri��e- Supply Drilled -by- r t �Adclress 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- -Cii.�tiange" satisfactory to the Public Health Director will be submitted to the Department, and a written guaranteed ill -be 4juthisl ed the owner, his successors, heirs or assigns by the builder, that said builder will place in good oper" d'ition hfty",•Raq'b said sewage treatment system during the period of two (2) years immediately ow g the da of ` e issuanf tfiepp val of the Certificate of Construction Compliance of the original system or y rep rs theret a f Signed: ' P.E. 1 Date /0- /0 %\ X, Address Z2 John Walsh B1 �� — I,��r, "�ti?1,;'g, Peekskill,NY 1056(,icense # 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 modifiel when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new rmit. pprove r discharge of domestic sanitary sewa only. By: Title: u Date: 7 �. White copy - HD Fil ; Yel ow opy - Building Inspector; Pink copy - O er; Or e copy - Design Professional Form CP -97 RONIN ENGINEERING P.E. P.C. The Lindy Building, Suite 200, 2 John Walsh Blvd., Peekskill, New York 10566 T& (914) 73M664 o Fax. (914)736x3693: January 22, 2003 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 Strawberry Knoll Subdivision — Lot 4, 14 Pheasant Run Road Town of Putnam Valley Dear Mr. Paravati: Find enclosed the following information for the above referenced projects: 1. Three copies of the SSTS plans, latest revision December 10, 2002. 2. Copy of the Construction Permit for the Sewage Treatment with the original submittal. date. Copy oR he A00Tication to i oiistruct a Water Well with the "ongiiial u rriittal - " date. 4. One copy of the house plans. From the conversation with Theresa from your department, both Lots were approved on December 20, 2002. Since neither this office nor the contractor never received the permit to this date, we are re- submitting this documentation; no modification is done on the plans and / or applications. 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUETION PERMIT FOR SEWAGE TREATMENT-SYSTEM ­ PERMIT # PV- 3V 0;), Located at - .. _ Town or Vilia Putnam Valley Subdivision name Strawberry Knol l Subd. Lot # q- Tax Map 6)* Block 2 Lot rZ7 -- DateSubdivisionApproved t4AY /y, 2002- Renewal Revision Owner /Applicant Name 37 Croton Dam Road Corp. Date of Previous Approval N/A Mailing Address 37 Croton Dam Road „. Ossining, NY Zip 10562 Amount of Fee Enclosed $300.00 t' Building Type Residential Lot Area .2, 05 No. of Bedrooms 4 Design Flow GPD 800 (AC Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1250 of 4” PVC Perf. Pipe in 24" Gravel Trench Other Requirements: gallon septic tank and 500 L. F. To be constructed b Croton Dam Road Corp . Address37 Croton Dam Road; Ossining, NY 109 2 Water Supply: Public Supply From Address T T PUTNAM COUNTY HEALTH DEPT. 024340. 1 Geneva Road (845) 278 -6130 Brewster, NY I-O.W a ,Date , Received of 3 Dollars $ The Sum Of, For THANK Y U! Cash QC . heck A. O Credit Card By i II t 11•tl i,i^R T 1 1 1 1 1 1 1 iAt!Aueniii " ter, NY 10509 �stem(s) and that the iment thereto and in 1 that on completion be submitted to the he builder, that said iod of two (2) years lance of the original /Q -10— 0 z— 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 pe it. A proved fo ischarge of domestic sanitary se a only. By: � ��= Title: Date: f White copy - HD Fie; Y to copy - Building Inspector; Pink copy - ner; range copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DEVISRON OF IENWIEBONM EN TAL HEALTH SERVICES A - PILIgAT><�l�t TO �OIiSTRUCT A -WATER WELL _ please print or type PCHD Permit # y y ` - „l�''' Well Location: Street Address: To Putnam Tax Grid # Pheasant Run Road, Sublot# Valley Map8� Block X Lot(s) 40 Well Owner: Name: 37 Croton Dam Address: Road Corp. 37 Croton Dam Road, Ossining, NY 10562 Use of Well: X Residential Public Supply Air /Cond/Heat Pump Irrigation I- }primary Business Farm Test/1V4onitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5 gpm # People Served 4 Est. of Daily Usage 5o�gal. Reason for Replace Existing Supply Test/Observation Additional Supply IDafllift xx New Supply (new dwelling) Deepen Existing Well Detailed Reason Water supply for new residence. for Drilling Well Type x Drilled Driven Gravel Other Is well site subject to flooding? ................................................. .................... ............ Yes No X Is well located in a realty subdivision? ...................................... ............................... Yes X No Name of subdivision Strawberry Knoll Lot No. . Water Well Contractor: P. F. Beal & Sons, Inc. Addre sr tnam Ave . Brewster NY 10509 Is Public Water Supply available to site? .............................. °Y N y0.. .. Yes No x �,..... Name of Public Water Supply: N/A is "o`' e \ N/A + 60!, ,Pt o.. of ty) Distance to property from nearest water main: — Proposed well location & sources of contamination t e ` ided to s efe ,plan. ate:.-- {lc -ir.Z- ': -Applies SbnfurP jd .,;.. ti PERMIT TO CONSTRUCT A 1L This permit to construct one. water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED _FOR CONSTRUCTION: This approval expires two years from the date issued unless construction 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 'D Z, Permit Iss 'nk Official: Date of Expiration/ 2 — Title: Permit is Non-Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - wner; Orange copy - Well driller Fonn WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH C. 0� DIVISION OF ENVIRONMENTAL HEALTH ...._ .'. - . . INDIVl-DtWT-WATER SL?P °7,Y.? .SUJ F LRSi�FiLAtE T:ZEEAiiVidrlYi'SYS'fEMS .. _ - �--• - L : ° F" "'::: - REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: � h (�` � STREET LOCATION: Ph e asa,.11 1z".01.&A.d REVIEWED BY: RM, GR, `, SRDATE: 1921-0d-- TAX MAP#: (CONFIRMED) Y DOCUMENTS PERMIT APPLICATION U WELL PERMIT OR PWS LETTER C��PC -97 ( LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) (_L�CORPORATE RESOLUTION .//( )L )SHORT EAF )U PLANS -THREE SETS USE PLANS - TWO SETS C__)(OVAARIANCE REQUEST / SUBDIVISION (}✓ LEGAL SUBDIVISION gODIVISION APP�OV�L CHECKED CURT5 CTE DRAIN REQUIRED GENERAL. UULOCATED IN NYC w D U(_- )PLANS SUB TO DEP / /%� Y N (REQUIRED DETAILS ON PLANS CONT'DI (- C--j40USE SEWER - V/." FT 4 "0'; TYPE PIPE CAST IRON ff ��iiO BEND5: MAX'BENDS W /CI:EANOU.T - RENEWALS FILL SYST �` S (�( J10' H ONTAL; PAST CH SLOPES 3:1 T GRADE UCUZL SP CS/ OTES 1 -'S f. )L PEA & DE IENSIONS (UUFI EXPAN , ..,,�A -r..�. . CU(U CLAY 9AP.REER A i�LERVIOUS (•-J(�FILL CER ON NOTE UDEPTH G UVOL. O LAN FO O.B., UNCLASSIFIE C--)C_)SEP TION DISTANC M TOE OF SLOPE. TRENCH LF.TRENCH PROVIDED 60FT MAX. � ARALLEL -TO CONTOURS 100% EXPANSION PROVIDED (_}(�DELE D TO PCH U APPROVAL, IF U DETAIL/DUST FREE CRUSHED'STONE OR WASHED GRAVEL (�GEOTEXTILE COVER (DEEP TEST HOLES OBSERVED SEPARATION DISTANCES ON PLAN - FROM'SSTS (—ju- PE CS TO BE WITNESSED ( - �10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL (___) - APPROVAL SSDS ADJ, LOTS 20' TO FOUNDATION WALLS WETLANDS (TOWN/DEC PERIYIIT REQ'D ?) 100' TO WELL, 200' IN DLOD,150' TQ PITS (__)(DATA ON DDS PLANS &PERMIT SAME __ `` /)l ? }100' TO STREAM; WATERCOURSE, LAKE (inc. expan.). L" (CG 'Sb' t't�.C: `! °c'H- EA,STS:;- 35'S?ORTIWWXA N PIFEii�Vx Et a(,:-j200-/500'RFSERVOIR, 10' TO WATER LINE (pits - 20') YR. FLOOD ELEVATION W/I 200' ' 50' INTERNIITTENT DRAINAGE COURSE SOIL TESTING LOTS>10 YEARS OLD ETC. 150' GALLEY SYSTEMS REQUIRED DETAILS ON PLANS (; 10' MIN TO LEDGE OUTCROP SEWAGE SYSTEM PLAN-(NORTH ARROW) SEPTIC TANK SDS HYDRAULIC PROFILE U(__)10' FROM FOUNDATION; 50' TO WELL GRAVITY FLOW WELL CONSTRUCTION NOTES 1 -15 �(� DESIGN DATA: PERC DEEP RESULTS & 2' CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT cU FOOTING /GUTTER/CURTAIN DRAINS Ct4LJUSDA SOIL TYPE BOUNDARIES TT wNERS NAME ADDRESS IL�DIlVIENSIONS TO PROPERTY LINES L�ULOCATION OF SERVICE CONNECTION MIN 15' TO PROPERTY LINE / SLOPE Uv UC LOPE IN SSTS AREA % / (520 %) UUT. LE BLOCK, O UUREGRADED TO 15 %, IF REQUIRED ' Cs�TM#, PE/RA; NAME, ADDRESS, PHONE# DATE OF DRAWING/REVISION UC--)pUME� DATUM REFERENCE UUDOSE 75% LOCATION OF WATERCOURSES, PONDS (-- )UDETAIL FO' LAKES,WETLANDS WITHIN 200' OF P.L. L—)LJPIT AND DA TOI (PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS ,)WELLS & SSDS'S W/IN 200' OF SSTS C�CUSTANDPIPE 1�PROPERTY METES &BOUNDS UU1S' MIN to t �C_- - JEROSION CONTROL FOR HOUSE, WELL & U( -U20' MIN to SSTS, EROSION CONTROL NOTE 70 6L EVSHF.FTImini mn OLUME/DOSE VOLUME NOTED MAIN, (PIPE TYPE, ETC.) �I FVN & DETAILED . URT r f IDES, DETAIL /�/1 ,20'4%, 25' -3 %, 35'-1 %,100 % - <1% KJ%GE/100' with 182 cons day discharge FO PIPE s° t i A ? COUNTY i ;C it ti °t` �'i 6 , l J,� 1 i ! HEALTH ��c u Y �t�,F `v l,l ENVIRONMENTAL 1 �� 1 1 1 SERVICES, LETTER OF AUTHORIZATION RE: Property of 37 Croton Dam Road'Corporation Located at Mill Street (CR*23) / Lover's Lane) — f qe,4 A41.7- T/ Putnam Valley Tax Map # 9�4 Block -0 Lot (4-0 Subdivision of Strawberry Knoll Subdivision Lot # . `f , Filed Map # y "-9 ODA -k Date Filed./-/,q y Gentlemen: This letter is to authorize Timothy L. Cronin III a duly licensed Professional Engineer X or- R-egistered-Ar- hitect to apply for the required wastewater treatment and/or water supply permits) 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 Depa nSIR ;N ian all necessary papers on my ehalf a' connection with this matter and to sup �` e� t v of said wastewater tre en and/ ter supply systems i;co;tfor-ru wi -,. Novi • 1e:14S._and/or.147. lx' anon a _ the'ubic Tealt ty .. _ .. _ Law, and the P a �C0 it C de. �I ; c c� 0. Countersign. ed: �KUFESS% P.E., R.A., # _ �— - so Mailing Address 2 John Walsh Blvd., #200 Peekskill State N. Y. Zip Telephone. (914) 736 -3664 10566 Very Signed: (0 er of P Mailing Address: 37 Croton Dam Road Ossining State NY Zip 10562 0 Telephone: (914) 739 -7362 n It Ln , .. C- N C-3.� CD U) Form Lk,711 PUTNAM COUNTY DEPARTMENT OF HEALTH AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBNETTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: Construction of SSTS and Water Supply I Val Santucci represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: 37 Croton Dam Road Corp. Having offices at: 37 Croton Dam Road, Ossining, NY 10562 Whose Officers Are: President - Name: Val Santucci Address: (Same as Above) Vice President - Name: Same as President Address: (Same as Above) , Michelle Santucci Secretary -Name: Sri .. . a _ .¢ .. - �. .., .� - ..�..r .� .. -_ .... c. - ..... _...: .t> ci +•VG -� y` ... -._. ..r. .�. • � -.. ... .- ..._.. ._.d .... - Vi 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 Sinned Title: Sworn to 7(month) fore me this day of 6� (year) Notary Publiv KELLY M. LENT Notary Public, State of New York No. 01LE6026834 Corporate Seal Qualified in Westchester Cou�n� Commission Expires June 21,;3 Form CA -97 all J�ts Uf the Porporation with respect PUTNAM COUNTY DEPAR'T'MENT OF HEALTH DWISION OF ENVIRONMENTAL HEALTH SERVICES - APPLICATION FOR A-PPROVAL OF PLANS FOR _ - A WAgrEWATER TREAT ME-N`I''SYST9k 1. Name and address of applicant: 37 Croton Dam Road Corp. 37'Croton Dam Road Ossining, New York 10562 2. Name of project: Strawberry, Knoll 3. Location T/V: Putnam Valley 4. Desi Professional— ..Cronin TTI 5. Address: 2 John Walsh Blvd; 200 Lindy Bldg 6. Drainage Basin: Peekskill - Hollow Creek Peekskill,.:'New York 10566 7. Type of Project: X Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision 'Other (specify) 8. Is this project subject to State Environmental Quality. Review,(SEQR)? YP ( ) ............: _ Type Status check one ... .:.................:.. . ...... ...... ... Type I Exempt Type II Unlisted x 9. Is a Draft Environmental Impact Statement (DEIS) required? ................ ... No 10. Has DEIS been completed and found acceptable by Lead Agency? N/A 11. Name of Lead Agency 'town of Putnam .Valley Planning Board 12.. Is this project in an area under the control of local planning, zoning, or other _ efticlals, ordinar-ices. ..................... ...............:.:..............:.::....... .:.::...:..........- ..:....i'eS 13. If so, have plans been submitted to such authorities? 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 18. Is project located near a public water supply system? 19. If yes, name of water supply NSA , - . Distance to water supply N/A 20. Is project site near a public sewage collection or treatment system? ................ 9 NO 21. Name of sewage system N /A, Distance to sewage system N/A 22. Date test holes observed 'April$May :2000 23. Name of Health InspectorAdam stiebeling 24. Project design flow (gallons per day) .............. .................... ............................... 800 Gal /Day 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? ......................... No Form PC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner 37 Croton Dam Road Corp. Address 137 Croton Dam Road, Ossining, NY 10562 Located at (Street) PKCAZ5A01)' u!d QXA 9 Tax Map _ Block .2 Lot ,5e " (indicate nearest cross street) Municipality (L Putnam ya 1 eX Drainage Basin Peekskill Hollow Creek VDate SOIL PERCOLATION TEST DATA ofPre- soaking Of -,/0`00 Date of Percolation Test COQ` 00, Hole No. Run No. Time Start - Stop Elapse Time (pl-Iin.). Depth to Water Irom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch zz -2 et. -7 z 29 2 -`� �- /0`� 3rd ZZ -a�l.� Z.3 /3 3 ��Q - (0 .. 22 - 2-1f--3 4 5 .. 2G `' 2" 4 10 !=-_A I 1 ©. Zed - Z Z . 3 5 1 2 3 5. IN V I h-*j: 1. 1 ests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1 -30 min/inch, :5 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 07/14/2003 09:22 9147363693 CRONIN ENGINEERING 1 PAGE 02 1 bye -:1; ;r�..i�: �,.• 2 JOHN WALSHBOULEVARD THE LINDY BLDG; S IIT. 20 0 PEEKSKILL, N Y 10566 A'V I-ROM: Theresa Nemeth KenMuqhy COMPANY: DATH: IP.C.14D. JULY 14,2W3 FAX NUM03131t: TOTAL NO. OF PACES INCLUDING COVP..R: PHONE NUMBER: SENDER'S AEFFA13,14CE NUMBER: Phewmsit R M Road R>a: YOUR REFERENCE NUMBER 37 Cwton Dam load Cozp. P.C.)14. p amit #PV -34-02 ® URGENT 13 FOR REVIEW ® PLEASE COMMENT ©PLE SL+ REPLY 0 PLEASE RECYCLE Town of Putnam Valley SST's Cons=ctbon Compliance Sttawb=y Knoll, lot 4 MESSAGE / COMMF.N't5: 'This fag is tD infar- n you that .Val Sant"Ca will pmomally be 1D" co ?lisncc fir the above refeemmd �g g yau mquireaddidgn&Linfom3ajionor.have any one n1. Itespeci �ll e do t hesitate to call me. Kemeth M. 1 umhv 7 EL. (9114)736 =3664 10 FAX (91,6)736-3693 1L 164 We71 —Tact 12 PROJECT I.D. NUMBER 617.21 S EO R Appendix C .... - -.. ,.. - - - • ... ., , •: • 9taYrr=�rtvtrtitrmirit�l �Gtialltq :,RaVt��il►" �. - .... , . i -'• . ., , SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PRaJFM INFapYATION fTo be ccmoleted by Acolicant or Prolect soonsorl 1. APPLJCJINT /SPONSOR 2. PROJECT NAME 37 Croton Dam Road Corp., Strawberry.Knoll, Sublot # �f a. PROJECT LOCATION: Mi,,,k*Wty Town of Putnam Valley county Putnam County a. PRECISE LOCATION (Street addreu and road Intarseetlona. W=In nt WICIMarlts, atc. or provide rtup) Pheasant Run Road S. Is PROPOSED ACTION: ® New ❑ Expansion ❑ MoEltkatlonlalteratlon 6. DESCRIBE PROJECT BRIEFLY: 'Construction of Subsurface Treatment System and Well Water Supply to Serve a Single Family house. 7. AMOUNT OF LAND AFFECTED: (nlllally 2r Og 1 acres Ultimately .2 t 0 J~, acres e. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS7 tJYea ❑ NO It No, deecrtbe brlelly I. WHAT Js PRESENT LAND USE IN VICINITY Of PROJECT? . O Indwtrlal 0 commrarcial D Agriculture Cl PawForestropen span ❑ Otrw r .,,R�es�iO.entlal Surrounding Lands are zoned Single Family.Residential • rr 10. DOES ACTION INVOLVE A PERMIT APPROVAL OR FUNDING. NOW OR ULTIMATELY FRCM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL STATE OR LOCALI? ® Yes ❑ No It rs, list age ocy(s) and permltJappro.ds , Town of Putnam Valley Building Permit 11- "DOES ANY ASPECT OF THE AC71Cv HAVE A CURRENTLY VALID PERMIT OR APPROVAL7 BY" ❑ No tf red, t,at agency nan» and pow"nawmal Subdivision Plat Approval - "Strawberry Knoll Subdivision" 12. AS A RESULT OF PROPOSED ACTION WILL EXJSTINo PERmrr APPROVAL newRE woolncAn0N? ❑ Yee ® No I CERTIFY THAT THElNF.OFtAtAT)ON PROVIDED ABOVE 13 TRUE TO THE BEST OF MY KNOWLEDGE Agoir- tusom" tilvw Cronin En ' ne PE PC / Keith Staudohar oat.: /p — aci '0.4 SlpnaturL 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 1 PART IS—ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRIESM04-0 IN 0 NYCAR. PART 6i7,i27 it rod. coordinate Ilia f-im P=864 and usa i%— FULL EAF. 0 Yea NO 1 0. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 0 MYCAR, PART 617.67 It No, a n"allve aa!iarallan may b* suPw$4d&dbv anothorjInvOtwad JIQWCy , 7 0-7- 546d , C. COULD Acnom RESULT IN ANY ADVERBS EFFECTS AWOCIATED WrM THE FOLLOWINCI: (Anowera may ba nanawrtiten. It I"Ible) C1. ExIstitig.sli quality. suitace Of groundwater quality at quantity. nalse 104ala, 6112IIAO 00(fic Pfttsfna- solid waste production of disposal, polontlall1w. eraskm dralflage w flooding problems? Explain briefty: C2. AaaLlmlic, agricultural. &CU"1091CO. 1113tcdc, Of COW natural W cultural f00Gutc= CW community or neighborhood charactar? Explain bdattr. C3. Veectallon or fauna, flak aMlIfIsh of %vildlifo apocjw, significant habitats, or threatened of crAanwod spoclaia? Explain bdoilr. kd^Ie- C4. A community's existing plans or pals an officially adoptod, or a chango in uw or Intensity of uoo. of land or olhor natural resources? Explain brliiijh CS. Growth, subsequent devoloornant, or ralatod sclivitlea likely to be Inducad by tho proposed action? Explain briefly. Mo. n-4— CIL Long form. ~ term, cumulative, or other effects not Identified In CI-1-^37 Explain Wally. C7. Otrw impacts (Including cnangas In use of altriat quantity of typo of energy)? Explain Wally. 0 13 THERE. OA 18 THEAE LIKELY TO BE CONTROVERSY PIELATIM TO POTENTIAL ADVERSE E &VIRONNIV4TAL IMPACT117 n boot PART IIII—DETEAMINATION OF SIGNIFICANCE (To be completed by Agency) 1049MUCTM& For 9ecA advorm affect Identified above, deturnins vrhethor - It Is u0stantlal, Large, Important or ciUmirmise signif;r-arit. Ear-h otfact should be assessed In conr4ctlan with Its (a) setting (I.s. urban of turarl; (b) proamNlIty at a=, rrir#T (c) duration; (d) IffQvwWbiIIty;. (a) 9"raOic scope; and (1) magnitude. It necessary. add -attachments or miarwice supporting materials. Ensure that Qx0amillans C=Wn sufficient dotal to show that all Mirmt &dvWW Imp=z have bwa klentifted and adequately addressied'. ❑ Chach this box If you have Identified one of more potentially large or significant advwu Impacts wtilch MAY occur. Then proceed directly to the FULL EAF arsd4or prepare a posithv docimatimL ❑ Check this box If you have -determined, based on the Infommtlon rand ana".s,above and any suppoMng' documentation, that the priVallied ScUm WILL NOT result In any significant advem environirriental Impacts AND Provide an attachnwrift as , necessary, the raisons supporting thia daterminatim- Marne W Load Aaancy *r r Name of 410 ICRI in koad AgenCV "I'Aso of R- Oda Off slanmurq Of Vioniso I bcar M Lead AawKV Slrdluro as AWA,—w Ili aldfown J. raspanwO6a wteri 2, Data PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Street L_ ocation - •Toiv3i'� .. �1.�. TM # 1. SewaL-e 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 ............... ....................: H. 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 evation -water t sted ................. 2. Prot e ow frost .................. ............................... um 2 ft.Original soil between box & trenches e. Junction Box - properly set .......... ............................... 6. Trenches 1. Length required 5 bO Length installed S_b?) 2. Distance to watercourse measured Ft.......... U 3. Installed according to plan ......... ............ .I.................. 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 ............. .1 ........................ g: -Pump or-DosedpS s .tn _ . 1. Size of pump ch er ................ .. ... ... . . 2. Overflow t ......................... .. ......... 3. Alarm, aUaudio ........:........:.. .................:............. 4. P asily accessible, manhole to grade ................. 5. st box baffled .....:.................... ............................... Cycle witnessed by H.D.estimated flow /cycle........... III. House/Building a. House located per approved plans .............. b. Number of bedrooms......... • .............................� .......... IV. Well Well located as per approved plans ................ ................ b. Distance from STS area measured Im o - ft........... c. Casing 18" above grade ................ ............. ................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship . a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ............................... • .. d. Backfill material contains stones <4" diameter... • .......... e. Curtain drain & standpipes installed according`to plan .l( / f. Curtain drain outfall protected & dinto exist waterco g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ..... ...:........................... i. Erosion control provided ................. ............................... Rev. 12/02 Date: Inspected by: Permit # _. 1f v 9t -v a- Subdivision Lot # Ld»u � k%, �SI'IE P SPECTiO FDA`'lL PAID't,? 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: - Additional Comments: Reserved for Field Sketch if Applicable ti