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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -2 -62 BOX 33 ,. �} i ' 116 1 of IN IN .IN IN III IN IN I IN ■ , 04394 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION'OVENVIRONMEI TAL'UEALTH "SERVICES "' . .. . . CERTIFICATE OF CONSTRUCTION COMPLIANCE F ATMENT SYSTEM PCHD CONSTRUCTION PERMIT # P V- 2 2 - 0 2 s; . �_� Located at 27 J1H EA SA N'T RU/J ROAD Town or Village PUT/JAM VA L L Owner /Applicant Name 3'7 C RO T6A) Wgm Voi4p Q12p Tax Map .941 Block 2 Lot. G 2 Formerly Subdivision Name SCI 01t W9ERR`,/ K y 6 L L Subd. Lot # w Mailing'Address Sr) C20 TON l P M ROp D' O S S► N I N 6 N -y Zip 10!9-6 2 Date Construction Permit Issued by PCHD J un1E `7.4 206 2_ 37 CR6Tolu o/9 r? Ram 0 Separate Sewerage System built by 39 CRo Ton► Pqm qtr co RR Address o s S i N) N 6 N Y / o rT6 2 Consisting of 12-50 Gallon Septic Tank and 6706 Z. F. OF 4'y PVC FE R F `P I C 53:'/13 24 " 6r2AVct- -rpe cH I/,j 12 " OF .�9/,JKRuN Other Requirements: Water Supply: Public Supply From Address 4 UTNAM E UE- of- Private Supply Drilled by P lgauL f Sam S I Aic . Address Irk PX1-, f1'. ill V 10 569 _.... -- Building Type S 1 N 6 L E� rAM I LY PC( Has erosion control been completed? y6 s f 11 Number of Bedrooms Fc-x) Z Has garbage groe�..be stalled? �� pF NEW YpR�k \�. r "?- y k-. urrp\ Iecer* that the system(s), as listed, serving the abov ,'pr "i es w,Q a c6 built plans (copies of which are attached), in acco ce Vii`' d l plans and the standards, rules and regulation e u am C Date: Certified by -C" t (Design Psi 62980 Address V is Nn) VVA LSK X1- VD PEkKSK I C a essentially as shown on the as- �nstruction Permit and approved of Health. P.E. # C) &<) 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. d &S. By:_ Title: F q (Ai I�e-e' Date: 7 / © 3 e copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 07/08/2003 15:02 9147363693 CRCNIN ENGINEERING 1�_ PAGE 02 3 .. C = 'O lCi�'8 11�� ��ey�`� G-1 1\I E El 1ti ! o $a o g1 o Ao o ..._._� - •- THE LINDY BLDG; SU172 200 PEEKSKILL, NY ®56,e TO. 'I bmm Nemeth FROM: Kea COMPANY. DATE: P.C.H.D. JULY 912003 FAX NUM Sk TOTAL NO, OF PAGES INCLUDING COVER 1 PHONE NUMBER! SENDERS REFTM WM NUld RR: 23 Ph== t R m Road YOUR REFEWN NUemER: 37 Croton Dania Road Corp. Valley ® URGENT ® POR REVIEW ® PLEASE COMMENT E3 PLEASE REPLY E3 PLEASE RECYCLE p.C.D.H. pmt #PV -33-02 . SSTs Cons=tioa Compbance Strawbeaty Knoll, lot 5 ARSSAM j���tfiilly A `.. _ Keith hi N TEL. (914)936 -3664 M FAX (9a�)756.3693 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT ell'�.ocahon ` - ^ Sfreet'Address: '� Mills Street Lot #6, Strawberry Knolls To "" i lager PutnamValley Tax G 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 32 ft. Length below grade 31 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' During yield test(ft) 500' Depth of completed well in feet 565' Well Log If more detailed information descriptions or ie4v anal�ises . :..... are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 17 D -rillina in arden clay and boulders I Hit rock at 171 17= - X32 I ri Tl . n ii ri c>c set - cas,fn 32 565 Drilling in rock aranite r If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity m Depth 520' Model 5GS10412 Voltage 230 HP 1 Tank Type WX302 Volume 86 gallons Date Well Completed 3/2/01 Putnam County Certification No. 001 Date of Report 6/4/03 Well Dn P ivvrr:: >✓xact location of well wittn aistances to at least Well Driller's Name P. F Signature: Perry L. permanent ianamarKs to oe pro on a separate sneetipian. Address: 4 Putn n ., l wAw, NY 10509 Date: 6/4/03 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 1000111 11 OF TRANSMITTAL CROMIN ENGINEERING ING S.E., P.C. The Lindy Building; Suite 200 2 John Walsh Boulevard Peekskill, NY 10566 914 -736 -3664 Pax 914 - 736 -3693 Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County Department of Health 1 Geneva Road Brewster, N.Y. 10509 IRE: 37 CROTON DAM ROAD CORP. PCDH PERMI #PV -22 -02 27 PHEASANT RUN ROAD TOWN OF PUTNAM VALLEY THESE ARE TRANSMITTED as checked below: _ _ _ June 9, 2003 ❑ FOR APPROVAL ❑ FOR YOUR USE ❑ AS REQUESTED ❑ FOR REVIEW AND COMMENT X PLEASE REPLY WE ARE ittached 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 64 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. Respectfully /jssuubamitt , Kenneth M. Murphy Design tngineer Public Health Director „:� �_ . , . _ d ,. ?- L- ORETTA- •MOL-iNAR:i; °R:N:;. M:��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 (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 E911 ADDRESS VERIFICATION FORM OWNERS NAME: 37 CW 016 to PAN R d AP C3 R P . TAX NIAP NUMBER: S�-�C E911 ADDRESS: .2..6 J TOWN: AUTHORIZED TOWN OFFICIAL: (Signature) DATE: - .. Z0, 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 VERFM PUTNAM COUNTY DEPARTMENT OIL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 37 CROT60J QAM -96AD C012 P, $4 (00 Owner or Purchaser of Building Tax Map Block Lot 39 CRO -Toll DA 9m C -612p, rt VA L I- y Building Constructed by TownNillage 29 PHCA cPdT Pu,,J ?o t:i D Location - Street Si,IQGLC 'r(Qr-11L�1 'RCslDe�JCC Building Type S ifZri WiTeRfZ)j KNpLL Subdivision Name q Subdivision Lot',, 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 two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system. or any .repairs made by me to. such .system, except.where :the failure- to:- _. _ operate properly is caused by the wfitfu `of"ne(li*Qent act of the occupant of the building utilizing the system. ly The undersigned further agrees to accept as conclusive the determin 'on f ','e. P '1' Health Director of th P nam R:,th Department of Health as to whether or of th' fai+ ure o. the system to operat .w ca! ,sed w illful or negligent act of the occupant of the .building tilizing the s stem.` Y �l N ; t; Dated; onth 6 Day Year Z00'2 General go6tracjoN0wneq - Signature 3 ? C20 -r-o /J DP 1`-t R019_0 CORP. Corporation Name (if corporation) Address: 37 C2O'TyJ O!- M 2UA_Q State o SS1n1 //,3 6' 3V \/, Zip / 0 G-6 Z Signature: Title: 32 c2o i o�,j DRS'' -t 120 ,q0 ca? Corporation Name (if corporation) Address:—'92 CVBTaN 0►1 %'1 2D. State OSJ yJ it3 NN/ Zip o 56 2 Form GS -97 Jun 04 03 13:4Ga Donnelltj Land Surveying 9149622209 p.l .. ♦ r. .ice• Yet. .Y. � � A4 't^.♦•'^I .:?.' ♦ ^•♦. .�.. ..,.. r....a. -a�._a to .. ..r��.:.'ti �.�i. .. i.�ry.v�: .....� � r .�� 1 •L.., Y. ♦ l •.. r. ..... .� .Q. �: ..���aw _rl�.•� �J a 0 V �r^ r 0 W Q Z 11 V l hxndatrvn � — 50.4' -- AO V � O 4 Ilk l p a o t .`4 i I ool I / � I f f O, a v Jun 04 03 10:46a Donnelly Land Surveying 8149622209 P. I cl cl < O �A) 42.7' Foundation Ilj -50.41 1A S- `W08/03 TUE 11:33 FAX f� Im001 P.F. BEAL & SONS, INC. 4 PUTNAM _AVENUE _ ... - ;-r .� , • B1Z WS fER; IEVV YaFC 16509"" WtiER TdFKS %AWV$IAN WELLS". _:c , .. WATER SYSTEMS COMMERCIAL WATER SYSTEMS JET PUMPS t' /06 %J'r6edlow - Over 12,7w &ell Ga„p!e %d HYDROFRACYURING SUBMgRSIBLE PUMPS TEL. 279 -2460 - 2461 WATER CONDITIONING EQUIPMENT FAX 279 -6613 COMPLETE INSTALLATION, REPLACEMENT AND REPAIR SERIVICE FAX TRANSMITTAL SHEET DATE: 7/$/03 TIME: 11:35AM TO: Joe P. 44MPANY: Putnam County Health Dept, FAX PHONE NO: 278 -7921 FROM: Peggy Mejias TELEPHONE NO: 279 -2460 JOB REFERENCE MESSAGE::: Water analysis fcr Strawbexry:Kol'ls Lot #6 NUMBER OF PAGES INCLUDING TRANSMITTAL: 2 ``07/08/03 14' 11:33 FAX la 002 IMS ENVIRONMENTAL SERVICES. INC. '�:�: � _..i5;n� SLI A/IME- l3-S:TREFp.T_..._R�i:.... .... ..,....._._ ,..�.._.�,.- ........ .�.�.........•- --- - -._.. .._ STAMFORD. CONNECTICUT 06905 NELAC, CT and NY Slate Certffi-ed Environmental Laboratory Mailing Information: Name: PF Beal & Sons Address. 4 Putnam Ave City. Brewster State: NY Telephone: 545- 279 -2460 Sample's Information: Site: ?got: #6 Preservative: HNO3 Temperature: <4C Client: VS Construction Zip: 10509 Fax: 845- 279 -6613 Collectors Information, Name: Kevin Address of site: Strawberry Knolls City: State: Zip: Telephone: Date Collected: 7/2103 Date Deceived: 7/3/03 Time Collected: 13:55 Time Received: 12:30 Lab No.: J034659 Date Analyzed Test Name Result MCL Method 713/03 15:00 Total Coliform Absent Absent SMWW 92228 713103 Chlorine Free Residual ec0.1 mgA. NIA SMWW 4500CIG 7171103 Color ND 15. Units SMWW 2120 B 717103 Odor ND 3 TONs SMWW 2150 B 7/7/03 Iron <0,03 mg/L 0.3 mg/L SMWW 3111B 717103 Manganese <0.01 mg/L 0.3 mg/L SMWW 3111 B 717103 Sodium 13.8 mg/L NIA SMWW3111B 717103 Chloride 21 mg/L 250 mg/L SMWW 4500 CI C 717,/03 ;:. _Ha[drts ::.. 40.rnglL.. .... NIA SMVA'V 2340 C 717/03 Nitrate 2.84 mg/L 10 mg1L SMWW 4500 NO3E 7/710310:00 Nitrite <0.1 mg/L 1.0 mg/L SMWW 4500 NO3E 713103 pH 6.74 S.U. 6.5 -8.5 S.U. SMWW 4500 H B 717103 Sulfate 16.2 mg/L 250 mg /L SMWW 4500 SO4F 7/7103 Turbidity 0.32 NTU 5 NTUs SMWW 2130 B 717103 Alkalinity 56 mg/L NIA SMWW 2320 B 717103 Lead <1.0 ug/L 15 ug1L SMWW 3113 B Ae the time of analysis the sample was acceptable for total coliform NIA = Not Applicable mg/L- milligrams per Liter MD. None Detected S.U,= Standard Unit NTU- Nephelometdc Turbidity Unit MCL- Max. Contaminant Level TON. Threshold Odor Number v91L- micrograms per Liter G' Signature; State : PH -0218 Michael Lapman ELAN #: 11715 President Tel 203 9619911 Toll free 1 866 567 5097 Fax 203 961 9919 Imsenvironmental.com JMS ENVIRONMENTAL SERVICES, INC. D i5oo SUMMER STREET _y 5j4M.E0.R.Q3.;CONNECTICUT o 6 9 0 5 NELAC,.CT and NY State rated v �iir�or ntal Laboratory s 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 Lot- Date Collected: 7/2/03 Date Received: 7/3/03 Preservative: HNO3 Time Collected: 13:55 Time Received: 12:30 Temperature: <4C Lab No.: J034659 Date Analyzed Test Name Result MCL Method 7/3/03 15:00 Total Coliform Absent Absent SMWW 92228 7/3/03 Chlorine Free Residual <0.1 mg/L. N/A SMWW 4500CIG 7/7/03 Color ND 15 Units SMWW 2120 B 7/7/03 Odor ND 3 TONs SMWW 2150 B 7/7/03 Iron <0.03 mg /L 0.3 mg/L SMWW 3111B 7/7/03 Manganese <0.01 mg /L 0.3 mg /L SMWW 3111 B 7/7/03 Sodium 13.8 mg /L N/A SMWW 31118 7/7/03 Chloride 21 mg /L 250 mg /L SMWW 4500 Cl C 7/7/03.. Hardness -- 40 mg /L N/A SMWW 2340 C 7/7/03 Niirate- "`-2.84 mg/L- -10-mg /L - - SMWW 4500•NO3E.:: 7/7/03 10:00 Nitrite <0.1 mg /L 1.0 mg /L SMWW 4500 NO3E 7/3/03 pH 6.74 S.U. 6.5 -8.5 S.U. SMWW 4500 H B 7/7/03 Sulfate 16.2 mg/L 250 mg /L SMWW 4500 SO4F 7/7/03 Turbidity 0.32 NTU 5 NTUs SMWW 2130 B 7/7/03 Alkalinity 56 mg /L N/A SMWW 2320 B 7/7/03 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 imsenvironmental.com i x y a ; R®NIN ENGINEERING P.E. P.C. The Lndy Building, Suite 200, 2 John Walsh Blvd., Peekskill, New York 10566 Tel.-(4-1'4) 736 -3664 o Fax. �(914)736.3693 1 n July 9, 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. H Permit #PV -22 -02 27 Pheasant Run Road Town of Putnam Valley Dear Mr. Paravati Please find enclosed as requested the original water analysis report from P.F. Beal & Sons 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, Kenneth M. Murphy Design Engineer 06/03/2003 15:00 9147363693 . CRONIN ENGINEERING 1 PAGE 01 pUTNANI COUNTY DEPARTMENT OF DIVISION OF ENMONWIENTAL HEALTI �I- ATTENTION 94a��R 11 GENE REQUEST FOR FINAL INSPECTION For: All information must be fiilly completed prior to any inspections being made. PCID Construction Permit # ,TV ^ Z 2 Located: ,?J4tAXAaT Ry,J RoPO (T) Owner /Applicant Name: -32 2601 N PAM— Qe A D TIM. Formerly: Subdivision Name: Subdivision Lot # _ Is system fill completed? . _ _ _ Date: Is system complete? .,)(F -r Date, Is system constructed as per plans? y� Is well drilled? l Date: Is well located as per plans ? - f Are erosion control measures in place? .�..� 3EALTH [SERVICES Fill Treaches D `UT.-JrQ -7 1%4 -Lgy '4 Block I- Lot '67- Trzwwgt YzTLy KWd LL. I certify that the system(s), as fisted, at the above premises has been c nstructed and I have inspected and verified their completion in accordance with the issued PC.HD Coastruetioa Peruoit W approved +'idfls ;au ` -fie ctaadasils; Rules - nd_P eq-t bons .of the Pvtnam Cou tty_ 13_epartment _of Health. Date: q'S-0;je -1 S002 Certified by: CMAMA 1 " t' PE Ra — Desien Profe ional Address: Z'SD1t,*1 WAL-M ILdp 6h K- I'Kme- N Lic. # Comments: Form FIR -99 nrrinnTMM rr nr_ 0 IFU7NAM COUN7 Y D EPAR7M EN7 OF H EAILM lDff V Sff (D N OF ENVIRONMENTAL H EALM SERVICES .,,....:eP. R'v ✓yj-i 'r: v.:..' . ' :�..::'.�, ji..:..prr .r ;..i4 . w .. ^:t.aT .^ter- .40 ="... . ..._ CONSTRUCTION CTItON PERMIT IF � `JAG E TREATMENT SYSTEM 0 PERMIT # V- ��. -� 2� � OI_, fl Located at � � � 5 (30 �ik4m 1Z� �. , Putnam Valley Town o� Subdivision name Strawberry Knoll Subd. Lot # _� Tax Map OW Block - Lot 2. Date Subdivision Approved NAY /,.T, 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 Amount of Fee Enclosed $300.00 Building Type Residential Lot Area ]Fin Section Onnfly Separate Sewerage System to consist of _ of 4" PVC Perf. Pipe in 24" Gravel Zip 10562 Z3 No. of Bedrooms .4 Design Flow GPD 800 C Depth /Z " VoRume ± 1�00 Y. 1250 Trench Other Requirements: 12 fi Or— B A�)K eVA) , F14L . gallon septic tank and 5,017 L. F. To be constructed by 37 Croton Dam Road Corp. Address 37 Croton Dam Road; Ossining, NY 1056 watenr Sup Aae Public Supply From Address on': �1 Private Supply Drilled by E Kt5T��9G .� - - `- �` ` Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the sparate 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 C " o; sfactory to the Public Health Director will be submitted to the Department, and a written guarantee Ok ner, his successors, heirs or assigns by the builder, that said builder will place ' ood perating orb ' 30 any pii sai ewage treatment system during the period of two (2) years immediately folio ing date of a is . once r ; 1=o the Certificate of Construction Compliance of the original system or any rep " ereto. LU Signed: Date 5—Z7-'-04 Address 2 John Walsh Blvd; 2(°�i,ie;?kskill,NY 10566 License # 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 of modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan require; a new ermit. Approv d for discharge of domestic sanitary sew ge only. r By: IQF Title: Date: White copy - HD ile; el w copy - Building Inspector; Pink copy - Oner; Age copy - Design Professional Form CP- G PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH r ,.... _ J2�T7?I3AJ;;:WATER.SUPI' ICY.&, S�UBSURFAC� :,�:.SE4VAGE•iRE�AT1� �i� ��p� r� _._:- - -11 .' REVIEW SHEET FO'it CONSTRUCTION P Wiry NAME OF OWNER: STREET LOCATION: REVIEWED BY: RM, GR, AS, ATE: G� �' °'L TAX'MAP#: (CONFIRMED) Y �Y DOCUMENTS ZPERMIT APPLICATION ER (, )( )PC -97 C,(JLETTER OF AUTHORIZATI N (.,,..J,L_)DESIGN DATA SHEET (DDS? C.e:J(JCORPORATE RESOLUTION 6C_JSHORT EAF C JPLANS -THREE SETS L,!:jL-)HOUSE PLANS - TWO SETS (_)('(VARIANCE REQUEST SUBDIVISION ((___)LEGAL SUBDIVISION (,:�f(—JSUBDIVISION APPROVAL CHECKED (=C- -)PERC RATE /.3 C:I--JUFILL REQUIRED I-A N DEPT LJC.,=)CURTAIN DRAIN REQUIRED GENERAL (_)ULOCATED IN NYC WATERSHED (___)(___)PLANS SUBMITT C_)C__)DEL 0 PCHD P APPROVAL, IF REQ'D DEEP TEST HOLES OBSERVED (==JC_,PERCS TO BE WITNESSED (off )EX- APPROVAL SSDS ADJ, LOTS (J(—,-�ETLANDS (TOWN/DEC PERMIT REQ'D ?) (�(_JDATA ON DDS PLANS & PERMIT SAME C-)C,:::jVRE 1969 NEIGHBOR NOTIFICATION U 00 YR. FLOOD ELEVATION W/I 200' L_)C,:=3 NESTING LOTS >10 YEARS OLD REQUIRED DETAILS ON PLANS C,:J�SEWAGE SYSTEM PLAN - (NORTH ARROW) (,e�)�SSDS HYDRAULIC PROFILE .Lo-jr )GRAVITY FLOW ; ONSTRUCTION NOTES 1 -15 ►ESIGN DATA: PERC & DEEP RESULTS 'CONTOURS EXISTING & PROPOSED AY & SLOPES, CUT .(2O(—jFOOTING /GUTTER/CURTAIN DRAINS USDA SOIL TYPE BOUNDARIES C )TITLE BLOCK; OWNERS NAME ADDRESS TM #, PE/RA; NAME, ADDRESS, PHONE# !'C_)DATE OF DRAWING/REVISION L,3(__)DATUM REFERENCE (,LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. C6UPROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS WELLS & SSDS'S W/IN 200' OF SSTS C�PROPERTY METES & BOUNDS C.ZJL__)EROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE COMMENTS: (REVSHEET)09 /01/00 Y N (REQUIRED DETAILS ON PLANS CONT'D) HOUSE SEWER - " FT. 4 "01; TYPE PIPE CAST IRON � %. NO BENDS; MAX BENDS 45' W /CLEANOUT RENEWALS (__)(—JSITE NOTE O CHANGE) FILL SYSTEMS /fU10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE (Ln'�FELL SPECS/ FILL NOTES 1 -5 C_-)(_)FELL PROFILE & DIMENSIONS (_ ffl LL IN EXPANSION AREA FILL GREATER THAN 2 FEET UU CLAY ARRM UC�FILL CE TIF TIO NOTE U( ___)DEPTH G GES C�(___)VOL. PL FOR O.B., UNCLASSIFIED & IMPERVIOUS _)SE RATION DI CE FROM TOE OF SLOPE )( TRENCH (ELF TRENCH PROVIDED 56?J 60FT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED DETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL -- CJGEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS (�10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS (•„100' TO WELL, 200' IN DLOD,150' TO PITS (=f:jC--)100' TO STREAM, WATERCOURSE, LAKE (inc. expan). __)50'_TO CATCH BASIN, 35'.STORMDRAIN, PIPED WATER, 3E�100: 5 INTERMITTENT DRAINAGE COURSE 0200'/500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS ✓X__J10' MIN TO LEDGE OUTCROP SEPTIC TANK (��10' FROM FOUNDATION; 50' TO WELL WELL /C_j�DIM(ENSIONS TO PROPERTY LINES C-ZC-JLOCATION OF SERVICE CONNECTION MIN 15' TO PROPERTY LINE SLOPE ( :J )SLOPE IN SSTS AREA v(S20 %) (___)C_,,JREGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS U(--JPUW NOES (�L )DOSE 75°/ O VOLUME/DOSE VOLUME NOTED C-J( AIL F FO CE• MAIN, (PIPE TYPE, ETC.) __)PIT AND - HOWN & DETAILED UUI DAY S ORAGE ABOVE ALARM CURTAIN DRAIN (—)(�STANDP , 5' TH SIDES, DETAIL C—)�)15' MIN D - 5 %, 20'-4%,!5'-3%,35'-1%, 100 % - <1% C�(_)20' MIN o CD DISCHARGE /100' with 182 cons day discharge UU10' MIN-o "NON - PERFORATED PIPE PIJTNAM COUNTY Y DEPARTMENT OF HEALTH :._...__ - -- . I?��E�'�'A�,= HEA'�'�: E��E���� - - .., AFFIDAVIT - CORPORATE OWNER APPLICATION . FOR PERMIT APPLICATION SUBMITTED TO PUTNAiM COUNTY 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: Same as President Address: (Same as Above) Michelle Santucci ecretan, -Name:- Address: - - - - . 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 byfore me this day of C (year) Notary Public KELa MAENT Diftry Public, State of New Vadi Rio. 01 LE6026834 Qualified in Westchester Cou Commission Expires June 21,M3 Form CA -97 Signed Title: Corporate Seal o the co oration with respect ...:1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIV�S_I.ON .Q. r�M RONMENTAL HEALTH _SERVICES .r ...j" -'ice - - .. . _ — a ea a . • - Y. I .. w .. l�Q�..rnn1•:'. a ... - . • ��Nr M - l `] �.. LETTER OF AUTHORIZATION RE: Property of 37 Croton Dam Road Corporation Located at Mill Street (CR #23) / Lover's Lane `PdEA5*,,JT R() ROP,0) T/'V Putnam valley Tax Map # y q Block Z Lot 62-. Subdivision of Strawberry Knoll Subdivision Lot # 6M; Filed Map # 2-1008 - E. Date Filed M A y 14-, 2002-. Gentlemen: This letter is to authorize Timothy L. Cronin III a duly licensed Professional E_ ngineer x to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the tion of said wastewater treatment d/or ya r supply systems i .coty- �vh- ie�4'? l,e 1.4;:arid/oT;147:of e: au ° ion.I; A uu .ic:H.ea'ltb : NEW L1' Law, and the Putna . � ani C 1 Countersigne P.E., R.A., # 0 OF FE5 Mailing Address. 2 John W 1 Blvd. , #200 Peekskill State N. Y. Zip 10566 Telephone: (914.). 736 -3664 Very trAnof Signed: op 4 )- Mailing Address: State NY 37 Croton Dam Road Ossining, Telephone: (914) 739 -7362 Zip 10562 Form LA -97 07/01/2003 09:47 9147363693 CRONIN ENGINEERING 1 PAGE 01 04 /86/02 FRI 14:98 KU V, .• �s VS CWStrUction -riz a[CO LAN 39 Mla ftaix Stour - VANWRT, CT . 069 ILI CT Cart: PH41104 � 203) 748.7903 - PAX (203) 748 -0652 NY CQA: 11471 ww w.NOkTHEAST LAUOKATORUSCOI Measurement of Turgeabie Organic Compot by-.Gas Chromotography -mass S SU vs. IIOLLS SAWLMG P00T WILL SOURCIt: AVILL (all results expmweO In fiash= -Now DE�TI:ID Totmene BDL RDL -E el owDet_ctionL imt - ViC1,- 5.Op8fL Results based ua ssmpk(6) submitted: 7CL_01 in Driuldog Water 7M(01 C.S. 71128(•01 LUV -io ®16 7'101: Oat b.mI 66, VALLEY, ii Y. 'later) uxffm D n C -tr ass PNORTM.k T LABORATORY, 129 MIL: STREET, BERLIN, CT 060 7o (860)823.9it.7 - FAX ($60'829 -1030 TOLL Fl1EZ Vkm -r..W CT: 800.426 -1105 c OUT: CT. SM- 634 -1:30 1 - -. IT. ^- /^ f IA IT4J nconOTMGA IT tiff o e P.a', DEAL I s S DATE SAMPLE COL. 4 Pd11IVAXAVIMB 1Y11ZB COLUCTED: '1STM MY 10309 COLLBCM B: YDATZ RTCEMD @ TESTO BY: UPORT EDA72; SU vs. IIOLLS SAWLMG P00T WILL SOURCIt: AVILL (all results expmweO In fiash= -Now DE�TI:ID Totmene BDL RDL -E el owDet_ctionL imt - ViC1,- 5.Op8fL Results based ua ssmpk(6) submitted: 7CL_01 in Driuldog Water 7M(01 C.S. 71128(•01 LUV -io ®16 7'101: Oat b.mI 66, VALLEY, ii Y. 'later) uxffm D n C -tr ass PNORTM.k T LABORATORY, 129 MIL: STREET, BERLIN, CT 060 7o (860)823.9it.7 - FAX ($60'829 -1030 TOLL Fl1EZ Vkm -r..W CT: 800.426 -1105 c OUT: CT. SM- 634 -1:30 1 - -. IT. ^- /^ f IA IT4J nconOTMGA IT tiff o e 07/01/2003 09:47 9147363693 04/20/02 FRI 14:O7 FAX CRONIN ENGINEERING 1 PAGE 02 1 VS C'4 ram NORTHEAST LABORATORY OF p NDURY ' LABS 39 MML PLAM ROAD - DAr UltY, CT 168 1 C" t Cert: F"404 203) y4e -7948 - PAX (208) 748.0652 Ny cert. 11471 LABORATORY !REPO T REPOR I NZAL t DATE SAvPLB LECTED: 7,'211(101 P.F. T O L THE C=: 2.30 Y.M . 4 PUTNAM AVENE BREWSTM N.Y. 10509 CALL (TED BY: C.S. DATE RECE @ LAB: 7.712001 $TED BY: LAB#11471 ' LD. w: Jt11.,Y -0 M91? AT DAM 7!6!2001 E, y` M11 _r.• T )E~ST PL�ORIVIF� BACTERIAL -. Total Coliform (Bac�erill) V.S. CO: -ST., STRAWBERRY RESULT- 0 per :00 MI SM LOT 09, PUI'NAM VALLEY, N.Y. UX]h I COtiTAWNANT LE3rFr. (�xQ.) 0 pil 100 ml ..,.:.- +_ .. �:.. �._ � sinry -. ._...p ..... -.. —�. �.__ -.... :.d �. .�.. .-.vow • r.. .... .... .....wr- ... -.. ... ..- Chlorine Residual DILL mg%L :• toll = milhiilcr MZ1. = mWigms per Lit<r NA - nonc detea:4 TNTC= Tao N:luerous To COUIT CO. TE: -HoUng Times (wercl met RESULTS BASED ON SAMMES SUEMITTED:7I2/2001 SAIMPLE, ASIESI&P ABOVE: DOTABLE (PER STATE OF NEW YORK MIT OF -rMALT14 SERVICES S :'R+h')AV- -5 Laboratory r 'OT POTABLE 0 ictar •NORTHEASTLABORATORY, 1Z9MIt.L STREET, BERLIN, CT M,*(S(,Q828. - ,r,- FaX; V/13/2001 09:54 9147363693 CRONIN ENGINEERING 1 OR°I H AS T° L &B®RA` ORY Old Dt11E Bully L LADS 39 WILL PLAID ROAD - DANMMY, CT 063121 . CT Cert: PH -o4o4 Q 203) 748 -7903 - FAX (203) 748.0652 14Y Cert: 11471 SAMPLE SITE: V.S. CONSIt STRAWBERRY XNOLLV. , OT-1'#!1 PUTNAM VALLEY. N.Y. SAMPLING POINT: WELL R iat SOURCE: WELL TREATMENT: NONE =S RJERFORMED RESULT:, LMZYHOD # MAXIMIUM CONTAMINANT LEVEL (MCI.) BACTER AL: Total Coliform (Bacteria) CHEMIST Y: Chlorine Residual , 0 per 100 ml SM 9222B 0 per 100 ml -I ND ms/L M1 = :milliliter mg(L = millig mms per Liter ND = none detected COMMENTS: -Rol" 13mes (were) met. RESULTS BASED ON SAMPLES SUBMITTED: 7/2/2001 TNTC= Too Numerous To Count SAMPLE, AS 'TESTED ABOVE: DOTABLE or DOT POTABLE (PER STATE OF NEW YORK DEPT. OF E1EA1TH SERVICES STANDARDS FOR POTABLE WATER) Laboratory Director 9NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060370 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WiTFIINI CT: RM -926 -0105 o OUTSIDE CT: 800 -654 -1230 LABORATORY REPORT REPOIR'I' TO: P.F. BEAL & SONS DATE SANIPLE COLLECTED: 7/2/2001 4 PUTNAM AVENUE TIME COLLECTED: 2:30 P.M. BREWSTER N.Y. 10309 COLLECTED BY: C.S. DATE RECEIVED @ LAB: 712/2001 TESTED BY: LA13# 11471 LAB I.D. #: JULY -08 REPOIR7 DATE: 7/6/2001 SAMPLE SITE: V.S. CONSIt STRAWBERRY XNOLLV. , OT-1'#!1 PUTNAM VALLEY. N.Y. SAMPLING POINT: WELL R iat SOURCE: WELL TREATMENT: NONE =S RJERFORMED RESULT:, LMZYHOD # MAXIMIUM CONTAMINANT LEVEL (MCI.) BACTER AL: Total Coliform (Bacteria) CHEMIST Y: Chlorine Residual , 0 per 100 ml SM 9222B 0 per 100 ml -I ND ms/L M1 = :milliliter mg(L = millig mms per Liter ND = none detected COMMENTS: -Rol" 13mes (were) met. RESULTS BASED ON SAMPLES SUBMITTED: 7/2/2001 TNTC= Too Numerous To Count SAMPLE, AS 'TESTED ABOVE: DOTABLE or DOT POTABLE (PER STATE OF NEW YORK DEPT. OF E1EA1TH SERVICES STANDARDS FOR POTABLE WATER) Laboratory Director 9NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060370 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WiTFIINI CT: RM -926 -0105 o OUTSIDE CT: 800 -654 -1230 07/30/2001 23:25 9147397156 PREMIER ATHLETIC CLU PAGE 02/02 tN ACCpq - _ ... - •e �•. .'.• -�� r:.- '.:... '. "e =.,., ...'"; :i: : y�= ;^a•,.F��.{.��-t'•: =..:�. ., "..: �!ie..`rg..: _..; :.'e.:..` .- w ,. ..`�Q oi;�C� -, +.1 :':.., �i: :��^;,�•,1 r. NORTHEAST LABORATORY of DANHURY TI A13 39 MILL PLAIN ROAD - DANBURY. CT 06811 CT Cart PH -0.104 "< 203) 748 -7903 - FAX (203) 748.0652 NY Cell: 11471 www.NORTHEAST LABORATORIESCOk1 REPORT TO: P.F. BEAL & SONS 4 P'[1TNAM AVENL7 BREWST.EP, N.Y 10509 SAMPLE SITE: SAMPLING POWT: SOURCE: COMPOUND Toluene LABORATORY REPORT . Measurement of kurgeable Organic Compounds in Drinking Water by .-Gas Chromotography -Mass Spectrometry DATE SAMPLE COLLECTED: 7/22001 '1'Z3 COLLTCTED: 2:30 P.M. COLLECTED BY: C•S• ID AU RXCTMl' (6 La.: 7/=001 TESTED BY- T.4B #10916 IMPORT pATE: 7/18/2001 V.S. CONSTRUCTION, STRABERRY KNOLLS SL'B3)7' PUTNaM VALI.FY, N.F. WELL WELL (cll results expressed in micrograms per liter) AMOUNT Lr 0 DETECTRD DETECTIO BDL 0.50 BDL =BeLow Detecdob Limit Results based on sample(s) mbmttted: 721001 MCL= Maxiu,v= Contar and Level • VJCL =5.0m L Laboratory Director *NORTHEAST LABORATORY, 129 MLL STREET, BERLIN, CT 06037• (860)828 -9787 -FAX 1%860)S29-1050 TOLL FREE WITHIN CT: 800 - 826 -0105.OUTSIDE CT: 800fi54 -1230 I 03,-12.01 MON 16:50 FAS PUTNAMI COUNTY DEPARTMENT OF 14 EALTH Di(VMSIION OF ENNIRONMENTAL HEALTH SERVICES 2005 Well ]Location Street Address: Mills Street Lot 6, Strawberry 'Knolls TownNillage: Tax Grad # Putnam Valley Map 8 <1 Block 2' Lot(s) 5 Well Owner: Name: Address: Vs Construction, 37 Croton Dam Road, Ossining, INTY 10562 Luse of Well: 1- prim2ry 2- secondary X Residential Public Supply Air cond/hew. pump i�Irriaation Business Farm Test /monitoring Ozhcr(specit) Industrial Institutional Standbv Drilling Equipment X Rotary Cable percussion _ X Compressed air percussion _ Other iap.cify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 32 ft. Length below grade 31 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 Drivc shoe: X Yes _ No Liner:; Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth t; Screen (ft) Developed? First — Ye' —`0 HDUa Second Well Yield Test _ Bailed X Pumped _2 Compressed Air ?-tours _ 6 Yield 8 gpm, Depth Datsa M:asu:c Km land surfacc- tic (spec iy H) 201 During yield tes.,(n) 1 525' Dcptb of wmpl_tcd WCH in feet 565' Well Log If more detailed information descriptions or sieve analyses please attach. Depth From Surface Rater _ Bearing Well niamerer(im Formation IDc *criptiou ft. ft. Land Surface 17 Drilling, in over den clay_ and boulders 17 Hit rcck at 17' 17 32 Drillin ir. rock set casing, routed r If yield was tested at different depths during; drilling, list: t4 rate well Cumnle:1purimit 3/2/01 Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth Model Voltage HP Tank Type Volume County Ce.- tication No. DWI: ofiiepan W.,11 prd '. ''' u ti 002 3/12/01 D 13ea ,VU i L: tXaet iocai:On of we ii Nlin atsiarim. to ut Icast IIvv Nei Illaitcuk fAII LI LAZ w i4Lw .., ..,• a .t ..... �••�� -r - i Well Driller's Name P. F. 1 s nc. Address: 4 Rkmt Ave., BrEwsber, NY 10509 Signature: _ Date: 3/12/01 Perry L. -� White copy: HD File; Yell copy - Building; inspector; Pink copy -Owner; Orange copy - We!l driller Farm WC -97 a RON N ENGINEERING P.E. P.C. The.Lindy Building, SuiteY200, 2 John Walsh Blvd., Peekskill, New York 10566... - s- TU.'19T f)73x3664 "• May 29, 2002 Michael Budzinski, P.E., Director of Engineering Putnam County Department of Health Division of Environmental Services 4 Geneva Road, Brewster, N.Y. 10509 Re: SSTS Construction Permit Strawberry Knoll Subdivision — Tax Map: 84 -2 -57 Subd. Lot I Tax Map: 84 -2 -62 Subd. Lot 6 Pheasant Run Road, Town of Putnam Valley Dear Mr. Budzinski: The following information has been enclosed for your review, for each of the above referenced subdivision lots: - 1. Application fee of $600.00 300/lot, 2. Construction Permit for Sewage Treatment System 3. Letter of authorization 4. Affidavit Corporate Owner Application - -° Ap plication for-Approval of for •a"Wastewater Treatment System _ ~ 6. Design Data Sheet — Subsurface Sewage Treatment 7. Well Completion Report and Water Analysis 8. Short Environmental Assessment Form: 9. Two sets of house plans 10. Three copies of the SSTS Plan 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 StrawbenyKnoll- L0T1,6,PCDH, 052902 07/08/2003 15:02 9147363693 CRONIN ENGINEERING 1 --PAGE 01 D!) 9c 0 E:N-Gl 2 JOHN WALSH ROURIEVARID THE LINDY BLDG; S11719 200 E PEKSKILL, NY 0566 TO, Thum Netne& FROM: Ken COMPANY! DATE: P•C•H•D• JULY 9, 3 FAX MGM TOTAL NO. OF PA i jES INCLUDING COVET: PHONE NUNDIM- SENDER'S REFS x+cx_NUwmEm Pheamt lqm Road RE. YOUR REF&RbNG4NUMWR:. 37 Crotm Do= Road Chip. g) PutU4 valky 13 URGENT 0 FOR REVIEW 13PLEASE COMMENT 0 PLE4SF REPLY 13 PLF,.AsE Rjacyap, RCIM. permit #FV-22V SM Coosawdon Comphmce Sftavbmy KaA lot 6 MM&GE I coboAgm T9 %4 TEL. (914)736-3664 0 FAX (910)736-3693 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: �� 3 Sxreet T,oc�tion..__ 9 ;� �:��. - Owner.:.: Inspected _ _... Town Permit # -v -L TM # �' _ o� - 2 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 ...... ............................... 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 /(% q fl �T 1. All outlet�at sa?e, ion -water teste ................. 2. Protected t .................. ............................... 3... m 2 ft. Original soil between box & trenches unction Box - properly set ........................... :............. 6. Trenches 1. Length required Length installed 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 PA" diameter clean .................... 9. Depth of gravel in trench 12" minimum ....... :........... 10. Pipe end ca ed.........., _ Puin or Dose stein . g 1. Size of pump c er ................ AXj 2. Overflow �. . . . 3. Ala , sual/ audio ........:........:.......... : ..................... . 4. p easily accessible, manhole to grade ................. First box baffled .................. :...................................... 6. Cycle witnessed by H.D.estimated flow /cycle........... DIL House/Buildhig a house located per approved plans ..................... . b. Number of bedrooms ............................. I ........... .......... IV. Well Welllocated as per approved plans .......:.......... 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. Backfill material contains stones <4" diameter ... . .......... e. Curtain drain & standpipes installed according to plan.. f Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area ............... 1. Surface water protection adequate .... ....:.......................... i Erosion control provided ................................................ Rev. 12/02 IMMUffa, w— P040- hft–f t–i- ff" 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) Additional Comments: Reserved for Field Sketch if Applicable Required Length_ Required Width Required Depth Date: Inspected by: 14-1" 047) —Taut 12 PROJECT I.D. NUMBER SEAR Appendlx C ' �' Sta3ii�Eii' rtrotitniiifaf •�iit�ff�_i�.^aa774w':-y. 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, SubIot,�# 3. PI10JECr LOCATION: Muakowty Town of Putnam Valley County Putnam County .4. PRECISE LOCATION (Street addrae and road kttesectlona, prominent landmarks, stc., or provkte map► Pheasant Run Road s. IS PROPOSED ACTION: ® New ' ❑ Expanslon ❑ ModlticalloNalteratlon 0. DESCRIBE PROJECT BRIEFLY: Construction of- Subsurface Treatment System to serve a Single Family House 7. AMOUNT OF LAND AFFECTED: IMllally .50 2 acre Ultimately 5, 3 acre t. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?' tJYes . ❑ No- 11 Na. daacrlIM trrielty E. WHAT 16 PRESENT LAND USE IN VICINITY OF PROJECT? A,,,gRaaldentlal O Industrial 0 Commercial ❑ Agriculture ❑ Park/FaeUOpen space ❑ Othei Daacrtee: _ Surrounding Lands are zoned Single Family Residential - 10. DOES ACTION INVOLVE A PERMIT APPROVAL OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL STATE OR LOCALI? ® Ye ❑ No It ye, list ager"s).and permitlapprovals .Town of Putnam Valley Building'Permit 11. ' DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAl7 Ely" YM ❑ NO h yes. Hot agency nmw ana permoiapproval Subdivision Plat Approval - "Strawberry Knoll Subdivision" 12. AS A RESULT OF PROPOSED ACTION WILL 'EXISTINO PERMRIAPPROVAL REOUIRE MODIFKATKM Ely" ® N. 1 CEFMFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE;TO THE BEST OF MY KNOWLEDGE AWkamrspmeor neem Cronin Engirt rin , PPE _ PC / Keith Staudohar Date: , 4 -9 7-02, Signature: If the action is In the Coastal Area, and you are a state agency, complete the Coastal Assessment Forth before proceeding with this assessment OVER .� jZra PART 18—ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION ED ANY TYPE I THRESHOLD IN 6 NYCRA- PART 017.127 If YGG- C0WdIn0I0 the t0vIQV WOW" OW I'm the FULL EV. 0 Y'3 Q. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 MYCAR, PART 6117.67 it No, a negative,Qoetatatloq m bo an thor Involved agency— ; 7 z , 9 may : au C. COULD AcnomkSULT IN Any ADVERSE EFF=8 ABSOCIATED. WITH THE FOLLOWINM- (Amtzioro My ftw4wfflten, It legiblel C1. FzlalMg sit quality, surface or groundwater quality Of quantity, 110100 I@vQI6- 021811ng If8flic 08110fris, solid W111010 production of disposal, pelonlial tat atosion, drainago at flooding probleaul Explain brioW. C3 Acelholle, agricultural, alcha"logic&l. historic, or other natural or cultural rocotircoo; or community or nalghborhood charscial Explain bdatjr. CD C& Vc9ofallon or fauna. flap, shiollflaft or wildillo spoclea,'olgrilficant habitalo, of threatened as Codangarod GpCCIW?'ExpjWn brk1jr. A/W C� C4. A community's qlstlng plans of pals as officially adopted, or a Change In uoo at Intansity of uoo of land or atra ntilurgi msourm? Explain briefly. CS. Growth, subsequent dovelopmani, or related activities likely to be Induced by the proposed action? Explain briefly, X A /W CIL Lang term, short term, cumutative, or other effects not IdentIflad In CI•CS? ExplaIn Welty. C7. Othv impacts anctuding changes In use of oitlw quantity or i* of onergyp F-tomin briefly. D. 13 THERE, OR 12 THERE LIKELY TO BIL CONTROVERSY RELATIO TO POTENTIAL ADVERSE ENVIF*MMWAL 11APACT27 oyco idth biw PART 111— DETERMINATION OF SIGNIFICANCE (To bs completed by Agency) IWWRUC?X*&' For SOCK adverse effect klentitiod above, determins whether it Io sumantial, lar", important or otherwise signific-mt. Each Offut Should be Qa$*eWW In connection with Its (a) Getting P.G. urban Of W&M (b) probability of *=rrin (C) duration; (d) Iffftw5lblift (0) geographic scope; and (9 magnitude. It necessary, add attachments or inference supporting materials. Eno ' urs that oxPUInallons contain sufficient detail to show that all relemll adverse Impula have bwa WmtlflW and adequately addres". ❑ Check this box If you have Identified one or more potentially large or olgraficant a0mrse impacts which MAY occur. Then proceed dimctty to the FULL EAF andkw prepam a positi" dodaratWL AZPwk this box If you have -detefirnined, based on the Infomatlon—and analysis above and any supporting' documentation, that the proposed actl6n WILL NOT result In any,signIfIcant advem environmental Impacts AND provide on attachments as racessaq, the masons supporting this detomination: 11111110 W L111112 AVIKY an* ?i Itinoc"SAIC OlfKer in Load Agency- Title at gespenstaia attKer ,or 4011:7 Officer in Lo® Aoencv sipatum Gi prepato (it differma from mocafflakile afficall Date 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) NogOy_4 _ 4�,q �720 -Tax Map Block Z Lot (0 2- (indicate nearest cross street) Municipality (T� PLtnam Valley Drainage Basin Peekskill Hollow Creek �, SOIL PERCOLATION TEST DATA Y. Date of Pre-soaking 0.5-1 - 48 Date of Percolation Test 05 - /6 - OD Hole No. Run No. Time Start - Stop Elapse Time (iblin.) Depth to Water )From Ground Surface (Inches) Start Stop Water Level Dro In Inches Percolation Rate Min/Inch 2 �/ �6 /� c6 �� 22 - 2 -. IF 4 5 yol 3r, 01 2 .. ,. // 38 _ /z og 2cJ- _ 26.3 3 1�c8 12- 4 5 1 2 3 4 -. N VIES: 1. Tests 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, s 2 min for 31 -60 min/irich)'All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 2 TEST PIT DATA ► ::: �,_ �DDESCRIPT- 10ICI °0E--SGI4,S- -E-N ;e DEPTH HOLE NO. / t HOLE NO. HOLE NO. G.L. OR sac.._ l oP Syi� 0.5' 1.0 9AA1_Qy J-0414 1.5 - :5i"oY 2.0' 2.5' 3.0" 3.5' Ge,4Y 5',g .a 0 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' cpC , 7.0' 7.5' _.. 8.0' 9.0' 9.5' 10.0' Indicate level at which groundwater is encountered /A Indicate level awhich mottling is observed Indicate level to which water level rises after being encountered` N% . Deep hole observations made by: Adam Stiebeling/ Keith Staudohaur Date 62�-27 - 00 - M ,} — Cronin Engineering Design Professional N Cronin III �. N Address: 2 John � a� a' �' IV* . i_ o Signature: Peeks ;f LY p �c7FESSO .40 Professional's Seal I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR _ •v• gWA -STENVAT-ER- TREATMENT-SYSTEM'.' 1. Name and address of applicant: 37 Croton: Dam Road Corp _..._.._ ........_. .. ._ .... 37 - Croton Dam Road t; Ossining, New York 10562 2. Name of project: Strawberry �Kno11 ~ Y Putnam Valley 3. Location TN: 4. Design Professional:.Timothy L..Cronin:, TIT `: 5. " Address: 2 ;John "Walsh Blvd; 200 Lindy Bldg 6. Drainage Basin: Peekskill' Hollow Creek , , .., Peekskill ;' New York" 10566 7. Tvpe of Proiect: X Private/Residential Food-Se'rvice '. ,=` 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 Type II = Unlisted x 9. Is a Draft Environmental Impact Statement (DEIS) required? .. No 10. Has DEIS been com leted and found acceptable b Lead AQenc P P Y 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 officials ordinances?'........:::. :.::. ...: ,.....�..:;::::::: .Yes '..... T�..._�. 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 j 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 N /A...• .- . Distance to water supply N/A 20. Is project sitemear a public sewage collection 'or treatment system? ....... :....... 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 2 27. Is any portion of this project located within a designated Town or State wetland? YES .;WetWd - Humbert r .� ::.ti a - .Lc�W. i ^.04sssVOfrIiA1 \1.'.Ti'•. =; - N /.A , .o . ��:.. �. = 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? .................................. 31. Is or was project site used for agricultural activityinvolving 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 No other potentially known source of contamination? o .:- Yes/N 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 ............... .............. .......... ......... 0 Ma W Block Lot 6. 37. Approved plans are to be returned to ..... - Applicant x Design Professional NOTE: All applications for review and approval of a new'SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval,_of the SSTS prior to final approval by the Department. Projectswithin 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 personother 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 submissio _ �� �F N E W Y pR`f. I hereby affirm, under penalty of perj Pt ah -x o Povided on this form is true to the best of my knowledge and be ,� rise � t ih a herein. are punishable as a Class A misdemeanor pursuant t S fion .7 of th nal Law. SIGNATURES & OFFICIAL TITTLES 280 fin, : PE Mailing Address: ................................... 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