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HomeMy WebLinkAbout4393DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -2 -61 BOX 33 -is Me Ir 4 ti T h I 1 Is :6 1� I LA .1 l Ir 04393 PUTNAM COUNTY DEPARTMENT OF HEALTH .ENY.RON- ,MENTAL, - HE .,4�.:T . . R�CF S.:.. CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # P V- 3 3- O 2 m-m Located at 2 3 'Bg6g SPt J 7- RU IJ f?OA b Town or Vi VtgLLC'X Owner /Applicant Name 3') cQ6 d N DA() ROOD CoRpTax Map 49 4 Block Z Lot G 1 Formerly Subdivision Name STRA vJ fat RRU KN 6 C Subd. Lot # S Mailing Address S? Cno T o N -DA/yi ROM) O SS) N IN 6 /J j/ Zip / 8S6Z Date Construction Permit Issued by PCHD J 2 5"- 20 0 2 S9 cQoTON .0tgr ? k'0r9 -0 Separate Sewerage System built by 37 cRo ra N aq/r! �'o� coRP Address o Ssr N N (, N V 10067- Consisting of %2 50 Gallon Septic Tank and Soo L, F. OF PVC 'Re '2FOQ►9 TED PIPE //J 24-" CArgVi l- - TRC1g04 Other Requirements: Water Supply: Public Supply From. 1 OTN N t"" t9 V (�- .'J or Private Supply Drilled by?,,�F. REAL f X(N4X !NC , Address ���'WS t'� !y /oSa`1 �/+r''?lcrV Has erosion control beerr-completed?' feted. Bwlcfiing Type � ►.i� . L �.: � - Number of Bedrooms "' Fc) y 2 Has garbagegq, stalled? Address I certify that the system(s), as listed, serving the abonise co * ` ed essentially as shown on the as- built plans (copies of which are attached), in ac with PC onstruction Permit and approved plans and the standards, rules and regulatio of lou am ;" ep Ye t of Health. Date: ' Z6 Certified by �' A �� P.E.X R.A. (Design Pr Address 3d KN W r9L S �L V_b P � s' , f L License # 06 Z `7 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. By: vL t '� Title: 0&44h 6LI Date: G 0 3 Whit copy - HD File; Yellow copy - Buil mg Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 BRUCE R.* EY s Public Health Director LORE TfA MOMNIAR: - %N M' S:11'. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 . Fax (9.14) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 OWNERS NAME: E911 ADDRESS VERIFICATION FORM 39 CRaTot•1 iiDA("x fZaAn ce2P. TAX WIAP NUMBER: 70L E911 ADDRESS: ?HC0 SfgNT 'Ryj,3 Ro A D TOWN: �� i �jAr��V1q I-L6 y AUTHORIZED TOWN OFFICIAL: (Signature) I DATE. JYJ 14 (00-3 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 forge is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERMNO PUTNAM COUNTY DEPARTMENT OF HEALTH � :.��YISION:..OF .ENN7- IR,O.N,, ! . ]� AL. HFr�:LTWSERVVT E:S .� GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 32 C66Toj 96t-q -gaAD coR P, S�' c1q- (0A_ Owner or Purchaser of Building Tax Map Block Lot 39 C RO -ro li fM m V*oA.D C-672p, I�� T�J ti r-( VP L C t Buildina Constructed by TownNillage 'PHCq S'giJ'T RUtit Po t�i D Location - Street S l tit G..0 I:A M I L �/ J`. C T 1 P 6FA J CC Building Type S'f?l-114"if6RfZV eNO L L Subdivision Name Subdivision Lot I I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate-properly:is causes. -by the willful or negligent act of the occupant-of the building utilizing:the. system. The undersigned further agrees to accept as conclusive the determinate n f th blic Health Director of the P tnam County Department of Health as to whether or the ailur the system to oper e w a6bedth willful or negligent act of the occupant e uildi a utilizing the system + y j! 4 Date : Mon ay 2 S_ Year 20o s Signature: 1 lI i I l t It Title: `�2LT� L� ) - Signature 3� C11%T0..#j DANI Rot9D Co2p Corporation Name (if corporation) Address: 37 CROT6,0 OAM '12UA-0 State 0 SS 1nl J/,3 6' IQ -Y, Zip 10 S6 Z 3? C120 70+J DA11 Vdi4O C012? Corporation Name (if corporation) Address:.-'92 U167-aN DA/2-7 20- State 0 SJW iIJ 6°, Zip 10 56'Z Form GS -97 JMS ENVIRONMENTAL SERVICES, INC. 1500 SUMMER STREET 5 NELAF �T,a� N 5 tot e, Ce rtifie _Enyironmeatal •STAMFORD., CONNE CT I C U T �laboraxor �/ - Mailing Information: Collector's Information: Name: PF Beal & Sons Client: VS Construction Name: Kevin Address: 4 Putnam Ave Address of site: Strawberry Knolls City: Brewster City: State: NY Zip: 10509 State: Zip: Telephone: 845-279-2460 Fax: 845-279-6613 Telephone: Sample's Information: Site xLof5 Preservative: HNO3 Temperature: <4C Date Collected: 6/26/03 Date Received:. 6/27/03 Time Collected: 14:40 Time Received: 15:00 Lab No.: J034482 Date Analyzed Test Name Result MCL Method 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 6/3.0/03 --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 Absent Absent Chlorine Free Residual <0.1 mg /L N/A Color ND 15 Units Odor ND 3 TONs Iron <0.03 mg /L 0.3 mg /L Manganese <0.01 mg /L 0.3 mg /L Sodium 11.3 mg /L N/A Chloride 22 mg /L 250 mg /L Hardness ... .. ;. 76 mg /L N/A _........ Nitrate ._: ....._ ._: 1.50-- mg /c....._:- 10'mg/C _... Nitrite <0.1 mg /L 1.0 mg /L pH 6.61 S.U. 6.5 -8.5 S.U. Sulfate 16.8 mg /L 250 mg /L Turbidity 0.07 NTU 5 NTUs Alkalinity 26 mg /L N/A Lead <1.0 ug /L 15 ug /L At the time of analysis the sample was acceptable for total coliform SMWW 9222B SMWW 4500CIG SMWW 2120 B -SMWW 2150 B SMWW 3111B SMWW 3111B SMWW 3111B SMWW 4500 Cl C SMW N 2340 C SMWW�4500 NO3E ' SMWW 4500 NO3E SMWW 4500 H B SMWW 4500 SO4F SMWW 2130 B SMWW 2320 B SMWW 3113 B 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 FLAP #:.11715 President Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com 07/02/2009 13:46 9147363693 CRONIN ENGINEERING 1 PAGE 01 JMS ENVIRONMENTAL SERVICES, INC. ....�..:.a: �..� �s. �, � �5pa:. ?UMPAfR;S�R�EE.T.. >, .. _ ' �� .,. ". - , =.a ~•_ .._. $TAMFORD, CONNECTICUTGo6go5 NELAC, Cr and ..F ot�l � Mailing Information: Collectc Name: PF Beal & Sons Client: VS Construction Name: I, Address: 4 Putnam Ave Aware City: Brewster City: State: W Zip: 10509 State: Telephone: 845.279 -2460 Fax: 846-279-6613 Telepl rmation: Site, Lot 5 Preservative: HNO3 Temperature: {4C Date Collected: 6126103 Time Collected: 14:40 Date Analyzed Test Name J a� VY State Certified Environmental Laboratory 7ZAwjr6-x-(Zy j0Q6L(,-. ''s information: vin f)jefAjPW't' rZuI"J ?2At;0 of site: Strawberry Knolls T L C Zip: Date Re eived: 6127103 Time R eivad: 15:00 Lab No.: 6/27103 15:00 Total Coliform Absent Ab 6/27/03 Chlorine Free Residual X0.1 mg/L h 6/30103 Color ND 15 6 /30 /03 Odor ND 3r 6/30/03 Iron <0.03 mg/L 0.3 6130/03 Manganese <0.01 mg/L 0.3 6130103 Sodium 11.3 mg/L f� 6130/03 Chloride 22 mg/L 250 ".76. _ r . _ _ P 6/30103 Nitrate 1.50 mg /L 10 6/30/03 10:00 Nitrite <0.1 mg/L 1.0 6/27/03 pH 6.61 S.U. 6.5-8 6/30/03 Sulfate 16.6 mg /L 250 6130/03 Turbidity 0.07 NTU 5 6130/03 Alkalinity 26 mg/L 6/30/03 Lead 0.0 ug/L 15 At the time of analysis the sample was acceptable for total coliform WA = Not Applicable mg/L- milligrams per S.U.m Standard Unit NTU- Nephelometric T MCL- Max. Contaminant Level TON- Threshold Odor ug/L- micrograms per Liter Signature. Michael Lapman President Te! -103 961 9911 Toll Free 1 $06 567 $09" F:;.\ ',.)'t 9a1 901 Till - ? -P0717 wpn 11 : SA TFI : R45- 278 -7921 J034482 nt SMWW 92228 SMWW 4500CIG its SMWW 2120 B Vs SMWW 2150 B I/L SMWW 31118 1/L SMWW 31118 SMWW 3111E g/L SMWW 4500 Cl C WL SMWW 4500 NO3E Y gL SMWW 4500 NO3E S.U. SMWW 4500 H 13 g/L SMWW 4500 SO4F Js SMWW 2130 B SMWW 2320 8 I/L SMWW 3113 B ND- None Detected Unit State #: PH -0218 ELAN #: 11715 jm$environmentai,com NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 I: 9,90, LETTER OF TRANSMITTAL 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 PERMI #PV 33-02 23 PHEASANT RUN ROAD TOWN OF PUTNAM VALLEY June 30, 2003 THESE ARE TRANSMITTED as checked below: ❑ FOR APPROVAL ❑ FOR YOUR USE ❑ AS REQUESTED ❑ FOR REVIEW AND COMMENT X PLEASE REPLY °�� AI3E'SENDINC�k ®�:J at#�Cl�ed; ter:. -'s- -- 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.) Updated well completion report 6.) E911 address verification form 7.) $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. Respe5dfully submitted, Kenneth M. Murph Design Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT VY�llI Loan® efiidres`s� "' ":. "` `` Mills Street, Lot 5 Strawber Knolls own/ViIlage: Putnam Valle Ma Block Lot s p 84 2 ( Well Owner: Name: Address: VS Construction 37 Croton Dam Road Ossinigg, 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 eft. Length below grade 41 ft. Diameter =min. Weight-per foot 19 lb /ft. Materials: X Steel Plastic Other Joints: Welded X Threaded _ Other Seal: g Cement grout _ Bentonite Other Dfive 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 6 gpm )(Depth Data Measure from an surface - static (specify ft) 60' During yield test(ft) 640' Depth of completed well in feet 705' Well Log If more detailed information descriptions or siev _analyses. are available, please attach. Depth From Surface Water Bearing Well Diameteron) Formation Description I ft. ft. Land Surface Hit rock at 20' :: _� 20:: .: :42 :Drilhiri iii' -rock .:scat: aaszfid# arouted 42 705 Drillina in rock aranite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity Depth 660' Model 5GS15412 Voltage 230 HP 1 Tank Type WX302 V u al. Date well Completed 2/28/01 Putnam County Certification No. 001 Date of Report 6/24/03 Well r' Nu'r &:: txact location or wet► pin ats ,ja / at Least iwo permanent tanamarxs w oe pruVISYGLL UII it JGpiU'4LG J11GGUP1411. Well Driller's Name 1'ff L i.tr,1-?II be., Brewghpr, 11 I Signature: „% Date: Perry V Beal White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 7k ' r'�x`�,w1.t,�. ,�+ y �.i "•mss ��. r�,�,;'R..rt -5" ;;� � r� ."... � d�. xiF ♦�`f'•T, •c�•�G.� 't��iiip' �c #' �a:y�i�- "' ., `.� ' '.'tl4 �•.',��'i ba,, 1 Fyn + ''t• A- : a' ,.(�x7 � }a X14 � i =7�' 7' ^�.P�A _F +•4� �,; • �� -�° �"Jy��� . ON .e ` R. -tins b,��a"�• "ti _'.'[���i � .1 i �+..,' %L�� l- i,,� -y�j w j F tip- Y�� kt• y ~ t,> d tom, a• ,# Vi � � �r�� '`�5.z �, 1'cY , � �i �,. �Y •�:U -�i t r _ �• ( v'k��• � a + Nom. r £' �..��� � ti.��: �'+ iwj, y Y emu.. f1 ,•�¢ a ,y � -.F+ w s • w 4 ow IN I Y ._'k''.:_'. _ �..'���� i �Y ��� •rA. -t, ,'� y C P �� k Tip ,� " �3k«•t�' G _ � ^I° � ' X �, i' ?� �a� z... r � }�3- .y 3u e S �. °7v i`'+'W� .-2•. m.99'' •y � . � - J ,u, f _ - car: �' y�. €�� ea -�,� '' ,r'{'o �' r'�5�� w„ � ^� �, �•.��'�� �, �� P k'. �� r� MN ��5 SO ' 3: ir a✓.�/1 M � I �� 4� N .r5� .� 3 � t fy 5� t}� { �t '{�[ � � s � M FfA. r d�ik ..c J,',,J,4'' kq'i ;r n�S'Z,. .n- •`c ;; n `j `f'^'�n�Y'4;,.e,s -�4 � 1r t� ! �•'�, l i.. •(s *a t xs 5s ,> � �: r a� . ow kk l f yyyEii M %,.,SKY '•' n 1 a` t �i �i ,: �. ��P :¢ s �� h � � a . ''°yea r�,� ;�,��` ^t � ,� �..�,•: 5p �, .. RIP v ? T r*,�' 'h^,��"�'t9`•�";� '§'��r°s w 1':�y'..�� � q'��,��^�.k �$7""4".�''�,�^ e g >E'- ,. F,R•� ^ �N�' *�p� 3' � . *"1 R�?t�"' �_. a tint ��°•. -b x q� � r;� *'_F ''`� ems. VL` � _e'h♦ u`.4 `k� e t 7} !.' _„ i''"W.�.�s +'� 4",aJ ..t, "'�aMy .° ,�. � O. Ca!k �i 0• 5 t• M � �� ^�4 r � y.as _ ion fir.!' 'q ♦ � �� - � W - •. -'' - ,- � ' ,+ Vii. J I RONIN ENGINEERING, P.E. P.C. CAF The Lindy Building, Suite 200, 2john Walsh Blvd., Peekskill, New York 10566 Tel. (914) 736-3664 o Fax, (914) 736 -3693 Joseph S. ParavatL Jr. Assistant Public Health Engineer Putnam County Department of Health. Division of Environmental Services I Geneva Road. Brewster, N.Y. 10509 Re: SSTS Construction Compliance 37 Croton Dam Road Corp. P.C.D.HPermit #PV-33-02 23 Pheasant Run Road Town of Putnam Valley Dear Mr. Paravati July 7, 2003 please enclos&d-thawateranalysis-ri has been completed to show the required PCDH profiles. Please review at your earliest convenience. If there are any questions or if additional information is required please do not hesitate contacting me at the above number. Thank you for your assistance in this matter. Respectfully submitted, Kenneth M. Murphy Design Engineer 06/23/2003 16:17 9147363693 CRONIN ENGINEERING I PAGE 01 PUTNAM COUNTY DEPARTMENT OF DIVISION.OF ENVIRONMENTAL HEAL T1 __3-�Se f, ATTENTION ArWM , OGENE REQUEST FOR EINAT. INSPECTION For: All information must be fully completed prior to any inspections being made, PCHD Construction Permit #'EV - 3� - 0 z Located: -P-46A PVJT V0.1-2 VOAQ (T Owner/Applicant Name: 39 RO A-0 — TM Formerly: Subdivision Name: Subdivision Lot f"r Is system fill completed? r' JA y Date: Is system complete? e y Date: Is system constructed as per plans? Is well drilled? Date: Is well located ,as per plans? YE _r Are erosion control measures in place? I I certify that e sy!je4), as fisted, at the above premises has been and verified ir..,co4pletion in accor$bV with the issued P approved.. VIIV and Reg W-a-tions _okbe dard Health. iz- Date: Opr Certified by, Cfzo" 10 fiFtL(' Design Profe Address: A L -(If Wrt (),6 P( I Comments: 1_41V5 Form FIR -99 T11W-P7-PRP7 mnw 14:Rq TIZI ! R4r-%-P7R-79 P1 1EALTH JCA SERVI 1C ES � Fill Trenches K. M-rA►Ar%, VALLCY E_ Block t Lot _ � L ,AyJTe'fZVV KNal-L "TWILr 23T 206:r instructed and I have inspected 'HD Construction Permit and umam. q u !p arqqe n t. of:: Eelzi4c' PE - P-,k anal Lic. 9 lAo± I . NAME:PUTNAM COUNTY DEPARTMENT OF P. I 0 I "I I \ •ti�I ((�)I \ I l II)I I "•dl'l I III \ I (1 >I III •�I I I! IDI1 yj I�I(01013) 1 I MUM Iil •\I III �I I'�� I( I iCONSTRUCTIIO- N ARN'>IT FOR SEWAGE- "`lt` AT*ENT SYSTEM " Located at ifF 015*,T w/U Town of -Village Putnam Valley Subdivision name Strawberry Knoll Subd. Lot # V., Tax Map �Y Block Z Lot 6 '0 Date Subdivision Approved /1A y is- 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 $300.00 Building Type Residential Lot Area 2, 67 No. of Bedrooms 4 Design Flow GPD RDD_ (A C. Fill Section Only Depth Volume PCH D NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1250 gallon septic tank and SZ)D L. F. of 4" PVC Perf. . Pipe in 24" Gravel Trench Other Requirements: To be constructed by 37 Croton Dam Road Corp _ Address 37 Croton Dam Road; Ossining, NY 10562 Wzjgr S-U-P 1 - Public Supply From Address AddresJ I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Com liance" satisfactory to the Public Health Director will be submitted to the Department, and a written guaraneil shed the owner, his successors, heirs or assigns by the builder, that said builder will place in good oper �c r i i@j p4kof said sewage treatment system during the period of two (2) years immediately foll g e dat of assuance oi$t aRp oval of the Certificate of Construction Compliance of the original system or repair theret°"'� Signed: v� =% P.E. X Date `Uf /V' Address John Walsh Bl �J LoBLdg�;Peekskill,NY 10566 License# 062980 NKOFESS \0 A / APPROVED FOR CONSTRUCT " proval 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 modifief when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires anew it. pprove or discharge of domestic sanitary sew ge only. By: Title: / Date: White copy - HD FA; Ye 1 copy - Building Inspector; Pink copy - O , ner; O 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 vI'. 10 ' ),XX6 $664 *.Fax. -(914' 7 5 -5693 November 18, 2002 Joseph Paravati, Jr.,'}` Assistant Public Health Engineer fi 00-0Z Putnam County Department of Health Division of Environmental Services 4 Geneva Road, Brewster, N.Y. 10509 Re: SSTS Construction Permit for 37 Croton Dam Road Corp. Strawberry Knoll Subdivision — Lot S TM # 84 -2 -61 .Pheasant Run Road, Town of Putnam Valley Dear Mr. Paravati: Find enclosed three copies of the revised SSTS plan for the above referenced project, dated November 18, 2002. The plan and sewer profile grading and 50' maximum cleanout separation have been revised in accordance to your comments. Should . you have any questions or require additional information regarding this matter, please contact me at the above phone number. Thank you for your time and assistance in this matter. cc: Val Santucci StrawberryKnoll,LotsM 1,PCDH,11 -04- 02.doc Respectfully submitted, Luis Hernandez Project Engineer SENDING CONFIRMATION .+ .. • M..�fAo L... .-�. �..«, a� rr '. F'• .e<•- � '- r '; 'n� ..+ ry, P'. t.: . t ' .. .� . .. -+An 4.... ........ .. .r - '. 4'`' .4' r ... r -r. . f o-' � DATE : NOV -4 -2002 MON 1747 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 k PHONE : 919147363693 PAGES : 2/2 START TIME : NOV -04 17446 ELAPSED TIME : 00'55" MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... Ls f e 7m O[T9-ekz ($") 78 63W0 ilgt i qmm amald'P°Itln7V" n09d2aaJ/001l9FWl f4 JO MAS aqa aj . 80�69W�J90jnf� p"san60t w pa%pvuv — nmdat anoS god — poodwi aesala — n0pamdo�nl an0[ aog� (7aa9i �aew 9mpopn� Lp p0?°d 'olti -c b n ^ VT--TIT _ 7 •Nnd r[71 -Hdo jwmyoda(j AnnoC) m0aWa w 1777 7✓ :ny p —gy f IT ralBQ / „J ” tt�- eu(tNl+wt ao�+litrrp ro.v>dd oras-urtsru wa•*.ww h0Y ' laws iiG9'.LLLffMnd ow -utf m om tso- ut(Cot) -w" fts—N rt6C-tGi(f�7V Ct19•Ui Uf0) WN9•I�m9.u7 60901 VoA ANN 'impmma. F" 0eaa20 I HlTm d0 I NSY )lVdSQ ""-S NOW Ja XW -mw wi-m A74'Id ^m -w X10 Mlo'N -WNW 'N'S•Iq ''N'1f IHVM70W tlJ.la1[O'I Ae'[Od 't2 HOIlgH 7 BRUCE R. FOLEY T, :ibli ; H alth : Director. - =< DEPARTNENT OF HEALTH 1 Geneva Road -Brewster, New York 10509 LORETTA MOLINARI-.R-N;,, :M S:N, Associate Public Health` Director Director of Patient Services Environmental -Health (845) 278.6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax(945)278 6085 . Early Intervention (845) 278 - 6014 Preschool (845).278-6082 Fax (845) 278 - 6648 Date: ni n -ee.n J From: :7`©seph Putnam County Department of Health Fax #: �- 9/y-736 363 No. Pages (Including cover sheet) 'oryour�infa�.x>tiolx : �_ : PEt;ase i`esc�c�lid For your review Attached as requested As discussed. Notes/Messages , Please call In the event of transmission /reception difficulties, please contact this office at (845) 278 -6130 ext. of 15 7 I" a BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.M. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 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 October 31, 2002 Luis Hernandez Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, New York 10566 Dear Mr. Hernandez: Re: Proposed SSTS - 37 Croton Dam Road Corp. Pheasant Run Road, (T) Putnam Valley TM# 84 -2 -61, RS Lot # 5 This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your review and consideration. 2. b- -- - 'Cleanout spacing needs to be at 50 feet on center, not 75 feet as shown on the plan. There appears to be inconsistencies in the plan view regrading and the profile regrading, specifically the 496 and 498 foot contours. Please clarify. This office will continue its review upon consideration ofthe above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. JSP: cj Very'Aruly yours, Joseph S. Paravati, Jr. Assistant Public Health Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAC;E - -.. - - .are- =' = '=�^'- ~-• `° WS�E'T'FOR CONSTRUCTION PERMIT ..._ . ._._ :... � .,.....::..�.�,,: 3.1 "Grn +on Dn-Yn R� Corp, �" NAME OF OWNER: STREET LOCATION: ,PHea5"� Run 2oa� REVIEWED BY: RM, GR, Ae, SRDATE: l 3 o , o TAX MAP #: (CONFIRMED) o� " Y , N DOCUMENTS Y N (REQUIRED DETAILS ON PLANS CONT'D) (J[) PERMIT APPLICATION I HOUSE SEWER - " FT. 4 "0'; TYPE PIPE CAST IRON WELL PERMIT OR PWS LETTERS A 5 V4 NO BENDS; MAX BENDS 45' W /CLEANOU JPC -97 W�' RENEWALS LETTER OF AUTHORIZATION DESIG DATA (� N DA SHEET (DDS) ) CORPORATE RESOLUTION SHORT EAF PLANS -THREE SETS USE PLANS - TWO SETS U( f ARIANCE REQUEST SUBDIVISION LEGAL SUBDIVISION rUBD IVISION PROVAL CC RATE ►+ %REUIRED DEPTH TAIN DRAIN REQU RED GENERAL (_JL&!�LOCATED IN NYC SHED UCUPLANS S TO DEP U(_.:_)D TED TO PCHD EP APPROVAL, IF REQ'D EEP TEST HOLES OBSERVED PERCS TO BE WITNESSED (-_) APPROVAL SSDS ADJ, LOTS -J-WETLANDS (TOWN/DEC PERMIT REQ'D ?) (j ATA ON DDS PLANS & PERMIT SAME % =_= EfBe R,-, =(_} -YR-. FIJOOli ELEVATONN W/I 200' (__)Ur/ SOIL TESTING LOTS >10 YEARS OLD REQUIRED DETAILS ON PLANS (SEWAGE SYSTEM PLAN - (NORTH ARROW) (-_JSSDS HYDRAULIC PROFILE (� GRAVITY FLOW �J CONSTRUCTION NOTES 1 -15 DESIGN DATA: PERC & DEEP RESULTS (_•_)2' CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT L Li!!�)L�FOOTING /GUTTER/CURTAIN DRAINS d USDA SOIL TYPE BOUNDARIES ��TITLE BLOCK; OWNERS NAME ADDRESS TM#, PE/RA; NAME; ADDRESS, PHONE# ,(iDATE OF DRAWING/REVISION U — DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. CtO )PROPOSED FINISH FLOOR AND, ASEMENT ELEVATIONS C WELLS & SSDS.'S WIIN 200' OF SSTS PROPERTY METES & BOUNDS ,(��EROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE UU10' HORIZO ; P � (UFILL SPECS/ (UUFILL PRO & DI n [TENCH SLOPES'3.I TO GRADE 1 -5 rm Z�� ' (U(U CLAY BARRY (-_)(__)FILL CERTIFICA NOTE U )DEPTH GAU (___)( )VOL. O AN FOR. R.O.B., . CLASSIFIED & IMPERVIOUS (�(_,SEP TION DISTANCE FROM TOE OF SLOPE TRENCH ✓( _)LF TRENCH PROVIDED Co a 60FT MAX. CL 'TO CONOURS 100% EXPANSION PROVIDED _• )DETAIIJDUST FREE CRUSHED STONE OR WASHED GRAVEL U(—JGEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM -SSTS 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO. FOUNDATION WALLS 0100' TO WELL, 200' IN DLOD,150' TO PITS U , 100' TO STREAM, WATERCOURSE, LAKE (inc, expan). $0! O CAT' C!H BASIN, 3T STORAW46,1 1�,; PII'ED W ►:T ,R. =: O`iVATER r. (pits-201) Y 50' INTERNIITTENT DRAINAGE COURSE 200' /500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS 10' MIN TO LEDGE OUTCROP SEPTIC TANK U /(-J10' FROM FOUNDATION; 50' TO WELL WELL DIMENSIONS TO PROPERTY LINES LOCATION OF SERVICE CONNECTION (__)(,JMIN 15' TO PROPERTY LINE MLP (/( LOPE IN SSTS AREA 0 (� REGRADED TO 15 %, IF REQUIRED UC_JDOSE 75% OF P OL OSE VOLUME NOTED (UUDETAIL FOR FOR IPE TYPE, ETC.) /(� /� U )PIT AND D- HOWN & DE ! ° / U(�1 DAY RAGE ABOVE ALARM C-JC-JSTANDPEW,S, T BOTH SID . (!)(--)15' MIN to C 100 % - <1% (�(�20 MIN t IS E /100 with 182 cons day discharge NON - PERFORA ' �� :OMAIENTS: C' .&m ain't IEVSHEET)09 101/00 (t � a PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH SE.R.VICES LETTER OF AUTHORIZATION . RE: Property of 37 Croton Dam Road'Corporation Located at Mill Street (CR*23) / Lover I s Lane) T/ Putnam Valley Tax Map # 8 �4 Block z Lot G/ Subdivision of Strawberry Knoll Subdivision Lot # Filed Map # ,.9QQA- Date Filed IA4✓ Gentlemen: This letter is to authorize Timothy L. Cronin ' I II a duly licensed Professional Engineer X or- Registered Arc4-kite-ct to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my be if in Vonn, ection with this matter and to sup . struction of said wastewater atm nt d/or supply systems conformity_ °'�fi. f- Article 1.45 and/or- 147 e he,: �� ors -L- e Public T�e�.l:rli Law, and th din Count Code. Countersign %. 629$0 � P.E., R.A., # s�° �k 0 Mailing Address .2 John Walsh Blvd. , #200 Peekskill N.Y. State Zip Telephone: (914) 736 -3664 10566 Very trul Signed: of C Mailing Address: 37 Croton Dam Road Ossining State NY Zip 10562 Telephone: (914) 739 -7362 6 �� - Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES.. AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBNHTTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: Construction of SSTS and Water Supply L 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: Address: Val Santucci (Same as Above) . Vice President - Name: Same as President Address: (Same as Above) Secretary - Name: Michelle Santucci _ 'Address: ` ....., .( ame as- -i-bov��) ....... _ -.._ _. _._ . .. Treasurer - Name: Address: Same as Secretary (Same as Above) and that I am and will be individually responsible for any aNd all to the approval requested and all subsequent acts relating � ��i Sinned: Title: Sworn to b fore me this ~- day of (month) cP (year) Notary Publi r KkLY M. LENT Notary No i01 State of Corporate Seal Qualified in Westchester Courtt�� Commission Expires June 21, 23 Form CA-97 f the i �rporation with respect f PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL well Location Street Address: Mills Street Lot 5, Strawberry Knolls Town/Village: Putnam Valley Tax Grid # Map 84 Block 2 Lot(s) 5 Well Owner: Name: Address: VS Construction, 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 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 I 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 6 gpm Depth Data Measure from land surface- static (specify ft) 60' During yield test(ft) 665' Depth of completed well in feet 705' 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 20 in --Drilling 20 Hit rock at 20'., 20 42" ' -Di i111a in r'6c ag, grouted 42 705 Dril-linq in rock crranite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth Model Voltage HP Tank Type Volume Date Well Completed 2/28/ 01 Putnam County Certification No. 002 Date of Report 3/12/01 yDril 1 NOTE: Exact location of well with distances to at Well Driller's Name P< Signature: Perry L. two permanent lanumarlcs to be prov7 on a separate sneevptan. Address: 4 IRYmam Ave., BrewA r, NY 10509 Date: 3/12/01 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 14-16.4 047} —Tait 12 Qit 2� SE�R PF10ECT I J D NUMBER . . - Appettdlz C _ . • '8tatti Efivtrorim�nflGulillty R�rl�w SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (1'o be completed by Appllcant or Protect aponeorj 1. APPLICANT 13PON30A 37 Croton Dam Road Corp. 2. PROJECT NAME Strawberry.Knoll, Sublot # 3. PROJECT LOCATION: Munktptift Town of Putnam Valley County Putnam County .4. PRECISE LOCATION (Strast addrssa and road Intaraeetlona. Pmmittwt WWmartca. etc., or provide =P) Pheasant Run Road S. 13 PROPOSED ACTION: EI Nw ❑ Expansion ❑ ModlfkatlotValteratlon B. DESCRIBE PROJECT BRIEFLY: Construction of- Subsurface Treatment System to serve a Single Family House 7. AMOUNT OF LAND AFFECTED: -f �i 6 % Initially 2, 6 wr" Ultimately acres B. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? U Yp ' ❑ No If No oescdbe OMlly •. WHAT 18 PRESENT LAND USE IN VICINITY OF PROJECT? JU Raaidentlal C1 InduaUW ❑ Commercial C3 nn Agriculture l.: PanvForestl'Open space ❑ Omer SS - A____e�_. '... . N .. . .. .. ... _ � .— .� ... -._ � '; --_ — ...�.. .....p, ..j ! .en w u•JY•n ..n .... ..— ... •..,... .. ... �.,. ...... • —.fl 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 LOCAL)? ; ® Yes ❑ No II yes, 11st agenty(a) and permlUapprovals Town of Putnam Valley Building Permit 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? Ely" ❑ No If yes. Rat agency name and Pwmn/approval Subdivision Plat Approval - "Strawberry Knoll Subdivision" 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PmrT/APPROVAL REQUIRE MODIFICATION? ❑ Yaa No I CERTIFY THAT THE INFORuATION PROVIDED ABOVE 13 TRUE TO THE BEST 'OF MY KNOWLEDGE . Cronin Engineej i PE PC / Keith Staudohar Date: A.Wkm�ew nay slgrytur< -. .. 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 If—ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EX 0 ANY TYPIZ I THRESMOW IN 0 NYCAA PART 417.127 It yoo. 0owdInOtO tha 1`003w po*ca" OM we trw, FULL EAF. 0 Va. B. WILL ACTION RECEIVE COOAOINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 MYCAR, PART a I?.$? it NO, a d"allve declaratlon, may 00 suPenleded b In Yea t9-wo L C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Anatvato may be ft&nd*M1@n, It Wgibwl C1. EX18114'alt quality, ourface or groundwater quality ,WqUsnlltlf, 110160 l0vOIC, 0391011ng If0flic Pelta`fnk Wid w3616 production of disposal, pmentlel for eroalm, drains" at flooding problem? ExPlaln briefly: C1 Aaalfwtir, agricultural. grchaWlailkal, historic, or other natural of cultural roacurcan; of community at noIg . fiftilood 0-re tftj Explain briefly No /a C3. Vogetallon of fauna. flak 041111118h of VAIdlife sped ". significant habitats, or throaloned or endangered spacles? Explain briefir. No /%-e- C4. A Cornmunity'l axislIng plans of goals as officially adopted, or a change In u30 of InlonsitY of U00 of land of alhw nstutal.resoum"I, Explain C3. GrarAh, subsequent dovelopmant, or related activities likely to be Induced by tho proposed action? Explain brialty. None OIL Long term, short term, cumulat*o, or other affects not identlflcd in Ci-a? Explain brialty. Ate ki t W. Other impacts prictuding changos In use of ollfw quantity of type of onorgy)? Exotain tidally. 0- 13 THERE, OR 18 THERE LIKELY TO OF, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IIAPACTP7 M I FAAT 111 — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) W9'E' LWn0N&- For each adIvem effect Identified above, determine whatM It Is submantial, WrW. important or othemse slonifteant. EaWi effeW should be &&%*"ad In connection with Its (a) setting P.a. urban of rurat (b) ptobablilty of ocx:urr1m (c) duration; (d) '"wferalbil"r. (e) 9"raphk scopes; vW M magnitude. If necessary, add attachnients or rgiferance 0uppo4ing materiab. Ensure that exPlarieficins contain sufficient dotall to show that all relevant adverse Impacts hive boan Identified and adaquat* iddressed. ❑ Ch=it this box If you have Identified one or more potentially 1*40' or signIftant adverse lmp'wft which MAY occur. Then proceed directly to the FULL EAF andkw propare. a pocitt". declaratlam' ❑ Cheep this box If you have -detwimined, based on the InfoartalloP and -analysts &:,bove and any supporting documentation, that the proposed Mien WILL NOT result In any - significant advenite'environniumlal Impacts AND provide on attachments as necessary, the reasons supporting this determination':' Manw,at 1.644d Agency )4 &r— Pmt or ype P44aw "Ampo.no ClIbco► in. LQ;a Agency .Title of Rejacnisbia Qlficat slanatwe "e—Irw %Car t" Lead Ationcy SIPMUM 0 PMPUM (If diffeMn IrWn M . %P0M&f)k .0kal zz Sato PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR SYSTEM, : - 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 TN: Putnam Valley Lot. It ��- 4. Design Professional: Timothy L. Cronin ITT 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)? Type check one YP Status ( ) ........:............... ..........................:.... 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 offcials, ordinances.- - . _ . _ _ ...... Yes._ - 13. If so, have plans been submitted to such authorities? Yes 14. Has preliminary approval been granted by such authorities? Yes Date granted: 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? ...:... ............................... No 19. If yes, name of water supply. NSA Distance to water supply', N/A 20. Is project site near a public sewage c6llection or treatment system? ................. NO 21. Name of sewage system s N/A Distance to sewage system N/A . 22. y Date test holes observed Apr -i1 &May" 2000 23. Name of Health InspectorAdam Stiebeling 24. Project design flow (gallon's per day) .... ............................... (g p' y) ....::...: 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 2 27. Is any portion of this project located within a designated Town or State wetland? YES 28. Wetlands.ID Number. - 29. Is Wetlands Permit required? ..... ............................... NO Has application been made to Town or Local DEC office? . ............................... NO 30. Does project require a DEC Stream Disturbance Permit? .. ............................... NO 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ..:.........:.:. ....... Yes/No NO 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially knov�m.source of contamination? .......................... ...... Yes/No No DESCRIBE: YES 33- Is there a local master plan on file with the Town or Village? ......................... 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ............................... No 35. Are any sewage treatment areas in excess of 15% slope? . ...................... .......... NO 36- Tax Map ID Number .........:...............: ............................... Mapes Block z Lot 61, 37. -Approved plans are to be returned to ...:: Applicant. x Design Professional ggIicatiof s ffl. review and ag rcrvai'6f a iiev� SSTS*'to be locatea witnin fhe NYC' tershed shall - be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater.plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item 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. �tyy`" ., O/�� I hereby affrrrn, under penalty_ of perjury, that information. rev' �It`oh t`hi� »t ' true to the best of my knowledge and belief. False s e nts ad here ° u a e as. �.. a 'lass A misdemeanor pursuant to Secl1 2 .4 o th al L kk SIGNAT°UItES & ®FFIC'LAL T'IT'LES: PF. 62980/ . Timothy L. Cronin P � �P Cronin Engineering, PE Mailing Address: ................................... . 2 John Walsh Blvd; 200 Lindy Bldg; Peekskill,NY 10566 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ _ - - •.a ii.. ,-zz..r., ;:�:.!..`t.,..r.,. DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner. 37 Croton Dam Road Corp. Address 37 Croton Dam Road, Ossining, NY 10562 Located at (Street) ,80Ai Tax Map Block Z Lot (indicate nearest cross street) Municipality . CT) Putnam Valley Drainage Basin Peekskill Hollow Creek w� SOIL PERCOLATION TEST DATA Date of Pre - soaking 0:5 - /-,5--0 0 Date of Percolation Test DS -/6 - dy . Hole No. Run No. Time Start - Stop Elapse Time tilvlin.) De th to Water krom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 25S 951 - D 23 — Z5,7.. 01.1. 3 �02� -la 4 _5 3 %DSO — / % °° 3� 4 5 1 2 3 5 IN u 1 t6: 4. ' 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 submitted for review. 2. `Depth measurements to' be made from top of hole. Form DD -97 DEPTH G.L. 0.5' 1.0' 2.0' 2.5' 3.0." 3.5' 4.0' 4.5' 5.0. 1 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 'PEST PTT DATA 10ESCtIPT'g ®N','S ®ILS EICIi-d']E1lCD?1[1 HOLE NO. ro P 5011- HOLE NO. /0 J -O A AA HOLE NO. 2 M 9.5' 10.0' Indicate level at which groundwater is encountered 7- A Indicate level at which mottling is observed /V /A Indicate level to which water level rises after being encountered Deep hole observations made by: Adam Stiebel, ing/ Keith Staudohaur Date PCDH Cronin Engineering Design Professional Name: Timothy L. Cronin ' III N P W R r , Address: 2 John Walsh Blvd. #200 Peeks ,,y 10.566 Signature: Y,FO 62980�� UFESS%() '. Design Professional's Seal �-- -- I