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HomeMy WebLinkAbout4399DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -2 -67 BOX 33 04399 PUTNAM COUNTY DEPARTMENT OF HEALTH �;•_..:�: _ ._ ._ ���: DI�I�IO1�T-. QF�����r ..c�w��:�:�:�- .���aTHs��;v C�E�:�.. � .��::��r .�1. -1 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # PV- la.- 03 Mom 9Located at 214 Pl-I��S�N 1 RWJ ROAD Town or Vi age VA LLC)y Owner /Applicant Name V S, C aN S TR V e-rl o A) Tax Map e4 Block 2 Lot 69 Formerly 3') C R O76 N r>!aM f o&o con Subdivision Name STR A W rf6 2 RV ICN v L L Subd. Lot # I Mailing Address 32 CROTOP DAM 2 oA0 o S.r /nf + N 6 . N e yJ YORK Zip I o 5-62 Date Construction Permit Issued by PCHD 39 CRo -rod 0,qm RQ Separate Sewerage System built by S9 cRoTaiJ OAM RoAp cag Address osxwjAJ 6 M V /oS4r2 Consisting of 12 5 0 Gallon Septic Tank and a D a l.. F - �f ` 'Pr 2 r 6 R A T;'.b FV C_ pipe sl�li 24l '` G'PAV& L -ryeTP c % Other Requirements: 3 0 Mid O F .-A�q.4J K tZ v fJ Water Sup&: Public Supply From Address g P rnJA RP —Or..—x Private Supply Drilled by P F. grA L S WOX //J c . Address e-R INas erbsion control- been coiriplcted? Number of Bedrooms R e 4 Has garbage A 01 I certify that the system(s), as listed, serving the ; built plans (copies of which are attached), in acct plans and the standards, rules and regulatio of Date: �— Z — -(J ) Certified by Address 2 - 704,0 pr e th i ,am1 (Design Pn K.r K IL ons c d essentially as shown on the as- PC onstruction Permit and approved 1p Y of Health. s. P.E. %� R-*. License # 0 6 V) rJ 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 revocati p, modification or change is necessary. By: 6L&Z t` , a-- Title: A-P Date: /(0/0 Why Copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT nu i h: rxact location or well wim aistances to at ie7 ro permanent lan(IMarkS to be provided a separate sheet/plan. Well Driller's Name P. 4_Ag4&4gR&Inc. Address: 4 pdmn Avenue, Brewsber, W Signature: Zo 0! � — /// _�" - Date: 8/18/03 �6- - - Perry L. a1 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC-97 Str r �Khoqllsf Lot #11 t Putnam Valle :9 Map 84 Block 2 Lot(s) 67 Well Owner: . , Name: Address: VS Construction, 37 Croton Dam Road, Qssinip2, 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 32 ft. Length below grade 31 ft. Diameter 6 in. Weight per foot __Lq__lb/ft. Materials: X Steel Plastic Other Joints: — Welded X. Threaded —Other Seal: _X_ Cement grout Bentonite Other Drive shoe: X Yes No ILiner: Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First — Yes—No Hours Second Well Yield Test Bailed X Pumped X Compressed Air Hours j gpm Depth Data Measure from land surface-static (specify ft) 301 During yield test(ft) 5401 Depth of completed well in feet 6051 Well Log If more detailed information descriptions or are available; please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 5 Drillinq in overburden clU and boulders Hit rock at 51 5: _32, -set --casipgj. 31 605 T Drillincfl in rock cfranite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump/Storage Tank Information Pump Type sub Capacity _5__qpm Depth 560!, Model 5GS15412 Voltage 230 HP 1k Tank Type WX302 Volume 86 lions Date Well Completed 5/28/03 Putnam County Certification No. 001 Date of Report 8/18/03 1 Well Dri r Sig nu i h: rxact location or well wim aistances to at ie7 ro permanent lan(IMarkS to be provided a separate sheet/plan. Well Driller's Name P. 4_Ag4&4gR&Inc. Address: 4 pdmn Avenue, Brewsber, W Signature: Zo 0! � — /// _�" - Date: 8/18/03 �6- - - Perry L. a1 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC-97 PUTNAM COUNTY DEPARTMENT OF HEALTH hDIVISION OF ENVIRONMENTAL HEALTH SERVICES ".. LL. ^!�. :.F A:' _•� �r°vl �� ..he rJ ...i .�`St j.�_•� '.! AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: Cow r' -r2g c -t-io N or S-r-r f yj/4 1-611 Ly T I, L stl,J C represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: V S. C c ,i --rRue'r I c) /j Having offices at: 3 '7 ClZv Top >9A ra R<j A,0 o s s I /.► 0 4 6 W V / o S C Z Whose Officers Are: President - Name: Vii L S✓ AJ Tv c 4�_ k Address: (lA"LlEr As Azovc Vice President - Name: t I Address: Secretary -Name: C14671-LC SP r1 1- v e c � �.... �: ..._. _ �.�. •Address: -�_ � lr: ��r -.' ,4. Treasurer = Name: Address: it i\ /r ) and that I am and will be individually responsible for any, to the approval requested and all subsequent acts relating ?IMUM L CRONIN Z Notary Public, State of New York No.4923313 Qualified in Westchester County Signed:. Corr, mi­ iort Expires March 14, '2, OU (o Title: Sworn to b e me this 2 ?w day of ont) o (year) Notary Public Corporate Seal Form CA -97 the corporation with respect I T LETTER OF TRANSMITTAL 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 I Geneva Road Brewster, N.Y. 10509 RE: V.S. CONSTRUCTION "STRAWBERRY KNOLL" LOT #11 TOWN OF PUTNAM VALLEY FORMERLY 37 CROTON DAM ROAD CORP. THESE ARE TRANSMITTED as checked below: August 25, 2003 ❑ FOR APPROVAL ❑ FOR YOUR USE ❑ AS REQUESTED ❑ FOR REVIEW AND COM1,1ENT X PLEASE REPLY WE AIRE SENDING YOU attached firee copies o ass -built su ace sewage treatment system plan 2.) Three certificate of the construction compliance. 3.) Three guaranties of SSTS 4.) Copy of survey showing foundation location 5.) E911 address verification form 6.) $200 certified check for application fee. 7.) Letter of Authorization 8.) Certificate of resolution for authorization 9.) Well completion report Since your department issued the permit a new owner V.S. Construction has purchased the lot from former owner 37 Croton Dam Road. The information enclosed is submitted for review only the water analysis will be submitted when it is obtained from the well driller. Respectfully submi !d, 07 1 7 Kenneth M. Murphy Design Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of V, S- C O /J ,s T fZ c.' G -r / o /A Located at 24 (�?��� .rA� T ` ZO J-) RO ram TN F� —iiipo, 11A Cc V Tax Map # g Block 2 Lot 6" Subdivision of S-r 2/3 Wr- YZ`Z V YN o L C_. Subdivision Lot # Filed Map # 29 °o Date Filed /'' jy /5 2002 Gentlemen: This letter is to authorize °'I�v►, o L, C R o f-4 N a duly licensed Professional Engineer k_ or egistered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the constru of said wastewater treatme and/or water supply systems in conformity with the provis' 0 of �'cre and/or 147 of th Ed ati n Law, the Public Health Law, and the Putnam Cou rya�.%t ry tru Countersigned: �; igned: # �,� 62980 j (O er f perry) KUF�S5�0 Mailing Address. Su l TLr Zoo Mailing Address: V S - C Q N J 7 R U CT-/ rA -L -:S7oK/J WALo4 KC, Vo State 're CK�SK(LL, i4yzip 1 W;'C6' Telephone: State OSSjNrN6. t Jy Zip IoS6'Z Telephone: Form LA -97 Rug 20 03 11:52a Donnelly Land Surveying 9149622209 P.8 .BRUCE R. - FOL.EY. ry Public Health Director :.LORETTA. MOLINARI, R.N., M,S.N-.. : Associate Public Health Director Director of Patient Services DEPARTMENT OF BEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914)279-6130 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 t OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS: TOWN: .�. C"o �V��RO i i G Se c -. Q 4 T0i- K '. 2 LoT:69 24 THCO S>gN'i Ro,'-J Ro A D PQi�jA AUTHORIZED TOWN OFFICIAL: (Signature) DATE: tq I-L6 NO SUT3 t-oT # I t 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 VERFRK PUTNAM COUNTY DEPARTMENT OF HEALTH GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 3`] CR6-roej OAS -90AD C012 P � 4 a Owner or Purchaser of Building Tax Map Block Lot 39 CROT0l1 D/Am IKOAD C6r2P, v-r-,�JA r`1 VA L t y Building Constructed by Town/Village �y PH6ASP,,J-T PuiJ Pot-ID s lRIQ0T06P.ZV kN04 -L Location - Street Subdivision Name Building Type Subdivision Lot. n I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate - properly is caused .by the willful onnegligenvact of the occupant, of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination ofpthe P is Health Director oft Pu nam County Department of Health as to whether or r�t t e ;blur ° f the system to op rak w ca by the willful or negligent act of the occupant b>! ldin� utilizing the system i ! TH Dat6d: th Day SO Year ZOO s er) - Signature 29 C2o •-7-0 ,�j OFgr -I Rotg o C 02-P Corporation Name (if corporation) Address: 37 CRO -rotJ OAM k�UFH_Q State 0 SS 1n1 //,3 6- Y-,1 f , Zip 10 S'6 Z f r Signature: Title: 'Y2(-_�`S) Dk:.0 3�) c20 10�j D�0-7 2090 CO2? Corporation Name (if corporation) Address:.�32 Cko-FD J DAPS 20- State 0SSI4It3 1�N% Zip 1056 2 Form GS -97 JMS ENVIRONMENTAL SERVICES, INC. 1500 SUMMER STREET STAMFORD, CONNECTICUT o6905 NELAC, CT and NY State Certified Environmental Laboratory Mailing Information: Collector's Information: Name: PF Beal & Sons Client: VS Construction Name: Kevin Bentson Address: 4 Putnam Ave Address of site: Lot 11 Strawberry Knolls City: Brewster City: Putnam Valley State: NY Zip: 10509 State: NY Zip: Telephone: 845-279-2460 Fax: 845-279-6613 Telephone: Sample's Information: Site: hose bib Date Collected: 9/4/03 Date Received: 9/5/03 Preservative: HNO3 Time Collected: 15:30 Time Received: 14:30 Temperature: <4C Lab No.: J036455 Date Analyzed Test Name Result MCL Method 9/5/03 15:00 Total Coliform Absent Absent SMWW 9222B 9/5/03 Chlorine Free Residual <0.1 mg /L N/A SMWW 4500CIG 9/8/03 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 MCL- Max. Contaminant Level mg /L- milligrams per Liter ug /L- micrograms per Liter Signature. State #: PH -0218 Michael Lapman ELAP M 11715 President Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com JMS ENVIRONMENTAL SERVICES, INC. 15oo SUMMER STREET .1 $ STAMFORD, CONNECTICUT o6905 NELAC, CT and NY State Certified Environmental CaborotorY Mailing Information: Collector's Information: Blame: PF Beal & Sons Client: VS Construction dame: C Beal Address: 4 Putnam Ave Address of site: Lot 11 Strawberry Knolls City: Brewster City: Putnam Valley State: NY Zip: 10509 State: NY Zip: Telephone: 845-279-2460 Fax: 845-279-6613 Telephone: Sample's Information: Site: Date Collected: 8/20/03 Date Received: 8/21/03 Preservative: HNO3 Time Collected: 14:00 Time Received: 13:20 Temperature: <4C Lab No.: J036089 Date Analyzed Test Blame Result MCL Method 812110315:00 8/22/03 15:00 8/21/03 8/21/03 8/21/03 8/22/03 8/22/03 8/22/03 8/22/03 ;:.13/,22/03 ... 8722/0.3._ _. 8/22/03 10:00 8/21/03 8/22/03 8/21/03 8/22/03 8/22/03 Total Coliform *PRESENT Absent E Coll 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 11.4 mg /L N/A Chloride 26 mg /L 250 mg /L Fja.r_dness. , ,,. _• . 64 mg /L N/A ~ ...Nitr Ce�_. _.. _ ..,_. - 1:65,i;6j/L ..; r:... 0 mg L. Nitrite <0.1 mg /L 1.0 mg /L pH 7.30 S.U. 6.5 -8.5 S.0 Sulfate 27.0 mg /L 250 mg /L Turbidity 0.38 NTU 5 NTUs Alkalinity 54 mg /L N/A Lead * 48.8 ug /L 15 ug /L Comments: * ABOVE ACTION LEVEL At the time of analysis the sample WAS NOT acceptable for total coliform N/A = Not Applicable S.U.= Standard Unit MCL- Max. Contaminant Level ug /L- micrograms per Liter SMWW 9222B SMWW 92228 SMWW 4500CIG SMWW 2120 B SMWW 2150 B SMWW 3111B SMWW 31118 SMWW 3111B SMWW 4500 Cl C SMWW 2340 C SMWW 4500 NO3E SMWW 4500 H B SMWW 4500 SO4F SMWW 2130 B SMWW 2320 B SMWW 3113 B r'.) ; G-3 t.:j cn r7l mg /L- milligrams per Liter RID- NoaS Detected NTU- Nephelometric Turbidity Unit TON- Threshold Odor Number to . 6 Signature: State #: PH -0218 Michael Lapman - ELAP M 11715 President Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com JMS ENVIRONMENTAL SERVICES, INC. 1500 SUMMER STREET STAMFORD, CONNECTICUT o6905 NELAC, CT and NY State Certified Environmental Laboratory Mailing Information: Collector's Information: Name: PF Beal & Sons Client: VS Construction Name: C Beal Address: 4 Putnam Ave Address of site: Lot 11 Strawberry Knolls City: Brewster City: Putnam Valley State: NY Zip: 10509 State: NY Zip: Telephone: 845-279-2460 Fax: 845-279-6613 Telephone: Sample's Information: Site: Date Collected: 8/20/03 Date Received: 8/21/03 Preservative: HNO3 Time Collected: 14:00 Time Received: 13:20 Temperature: <4C Lab No.: J036089 Date Analyzed Test Name Result MCL Method 8/21/0315:00 Total Coliform *PRESENT Absent SMWW 9222B 8/22/03 15:00 E Coli Absent Absent SMWW 9222B 8/21/03 Chlorine Free Residual <0.1 mg /L N/A SMWW 4500CIG 8/21/03 Color ND 15 Units SMWW 2120 B 8/21/03 Odor ND 3 TONs SMWW 2150 B 8/22/03 Iron <0.03 mg /L 0.3 mg /L SMWW 3111 B 8/22/03 Manganese 0.01 mg /L 0.3 mg /L SMWW 3111 B 8/22/03 Sodium 11.4 mg /L N/A SMWW 3111 B 8/22/03 Chloride 26 mg /L 250 mg /L SMWW 4500 Cl C 8/22/03 _ _.. _ : Hardness 64 mg /L N/A . ;.. _� _ .. _ SMWW 2340 C 8/22/03 Nitrate 1.65 mg /L 10 mg /L SMWW 4500 NO3E 8/22/03 10:00 Nitrite <0.1 mg /L 1.0 mg /L SMWW 4500 NO3E 8/21/03 pH 7.30 S.U. 6.5 -8.5 S.U. SMWW 4500 H B 8/22/03 Sulfate 27.0 mg /L 250 mg /L SMWW 4500 SO4F 8/21/03 Turbidity 0.38 NTU 5 NTUs SMWW 2130 B 8/22/03 Alkalinity 54 mg /L N/A SMWW 2320 B 8/22/03 Lead * 48.8 ug /L 15 ug /L SMWW 3113 B Comments: * ABOVE ACTION LEVEL At the time of analysis the sample WAS NOT acceptable for total coliform N/A = Not Applicable mg /L- milligrams per Liter ND- None Detected S.U.= Standard Unit NTU- Nephelometric Turbidity Unit MCL- Max. Contaminant Level TON- Threshold Odor Number ug /L- micrograms per Liter Signature: State #: PH -0218 Michael Lapman ELAP #: 11715 President Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com 09/09/2003 11:28 9147363693 09/09/09 '8118 11:12 F4$ CRONIN ENGINEERING 1 PAGE 01 X1002 d� L A& the t1ne a4 analysis the sample was sewptable tut total conform MIA = Not Applicable Mgt- milligrams per MCL -Affix. Canteminent Level ug/L gnlap qww pee' a 5lgellatao�: Michael Lapareoan Preelderd re' 203 961 9911 ; oN free 1 966 567 5097 Far 20 96: 9911 state M. PCB -0296 ELAP S. 11719 ImsEnvlrOnnentat,ca�n JMS ENVIRQNMENT4I� SERVICF,S. INC. - ` ?SGO SUi11A1 €R STREZI 4 -• STAWORC._CONNECTICUT 06905 _ tVkLA(. CT ar-d VY 510,e Certifed E- Vironmrrttil Li!bcromry Mailing Information: collect eg Informatlon: Nam e: PF Beal & Sons Clien6: VS Construction Dame: a�Vin Senteor� Addma: 4 Putnam Ave AddFes of site: 1.01 rry' 11 3tmwb® Knolls CltV: Brewarter City: P arts Valley StM: NY ZIP: 10608 BMW" Y Zip: TaOsphone: 845-2M2460 Fax: 845- x79-8613 Toleph no: Sample'a !nP ®rRnattle�: Sim: nose bib Daft Collected: 9(4103 Cate Ro colved; 9!5/03 Pmamflve: MN03 Time Collected: 15:30 Time R lred: 14 :30 Tompeoaturo: LW No.: J036455 Cate Analyzed Trig Name (Result h CL Method 13 /03 15:00 Toil Coftrffs AbsM At sent SUWW 92228 919/03 Chlotirm Frea R+esklual <0,1 mgt. P /A $Mi1JV 45000G 9/03 Lena 81WWW/ $113 B d� L A& the t1ne a4 analysis the sample was sewptable tut total conform MIA = Not Applicable Mgt- milligrams per MCL -Affix. Canteminent Level ug/L gnlap qww pee' a 5lgellatao�: Michael Lapareoan Preelderd re' 203 961 9911 ; oN free 1 966 567 5097 Far 20 96: 9911 state M. PCB -0296 ELAP S. 11719 ImsEnvlrOnnentat,ca�n 09/04/2003 15:59 9147363693 CRONIN ENGINEERING 1 JMS ENVIRONMENTAL SERVICES, INC. ' r oL/ t5oo SUMMER STREET �5TXMfOR ,B,= '•'aiVNEC7.lCUx.o69P.5 _�.- ..AIEfC, .Gind..A 10'T fialling Information: 4arne: PF Beal & Sons 4ddress: 4 Putnam Ave City: Brewster State: NY Telephone: 845- 279 -2460 Client: VS Construction Zip: 10509 Fax: 845279 -6613 Site: Date Collected: 8/20 /03 Preservative: HNO3 Time Collected: 14:00 Temperature: <4C 8121/0315:00 8122103 15:00 Test Total Coliform KOS PRESENT PAGE 01 Srate Cert ed.l nvjrsznmeh, {al tobomrory �a �L-v Information: Name: C eal Address site: Lot 11 Strawberry Knolls City: Pu m Valley State: N Zip: pate Re eived: 8/21/03 Time Re eived: 13:20 Lab No.: J036089 8/21103 Chlorine Free Residual X0.1 mg /L I 8121/03 Color ND 15 8/21/03 Odor ND 3' 8/22/03 Iron 40103 mg /L 0.3 8122103 Manganese 0.01 mg /L 0,3 8122/03 Sodium 11.4 mg1L I 8/22/03.. Chloride . 26 mg /L 25( _ ._ :........ _8/22103 t; Hardness-'' .. r.. N' .:. - .64 frig /L, - ": SMWW 2320 B 8/22103 Nitrate 1.65 mg/L 10 8/22103 10:00 Nitrite <01 mg/L 1.0 8121103 pH 7.30 S.U. 6.54 8122103 Sulfate 27.0 mg/L 25( 8121/03 Turbidity 0.38 NTU 51 8122103 Alkalinity __ 54 mg/L 8122/03 Lead " 48. u Comments: • ABOVE ACTION L EVEL At the time of analysis the sample WAS NOT acceptable for total collform N/A = Not Applicable mg/L- milligrams per I S.U. = Standard Unit NTU- Nephelometric 1 MCL- Max. Contaminant Level TON- Threshold Odor ug/L- micrograms per Liter _s Signature: Michael Lapman President ent SMWW 92228 ent SMWW 92228 A [ SMWW 4500CIG nits SMWW 2120 B NS SMWW 2150 B g/L SMWW 31118 g/L SMWW 31118 /A SMWW 31116 mg /L SMWW 4500 Cl C /A ' _.. ..._ --. '.SMWW 2340_C mg/L SMWW 4500 NO3E mg /L SMWW 4500 NO3E .5 S.U. SMWW 4500 H 8 mg/L SMWW 4500 SO4F iYUs SMWW 2130 B I/A SMWW 2320 B ugll- SMWW 3113 8 NO. None Detected Unit State #: PH -0218 FLAP M 11715 rel 203 961 9911 Toll free 1 866 567 S097 Fox 203 96119919 jmsenvironmemW.com SEP -4 -2003 THU 15:18 TEL:845- 278 -79 21 NAMG of 1TIMOM f C208/15/2003 08:38 9147363693 CRONIN ENGINEERING 1 PAGE 02 P'ITTi,A,NI COUNTY DEPARTMENT OF IDMSION OF ENVIRONMENTAL HEAILT AT1ClE1 ON It ® GENE M1t~' i OR FVi L il0iy For: All information must be fully completed prior to any inspections being made. PCkRD Construction Permit # Located: _ JEReiQWAjr (2VAJ 2010to (T) Owner/Applicant Name: 9;' MaT -10ar 'PAO) &62 Cq° -'I'�� _ Formerly: _ _ Subdivision Dame: Subdivision Lot*, Is system fill completed? .)Le 41 Date: Is system complete? _ Date: Is system constructed as per plans? YC r Is well drilled? W-f Date: Is well located as per plans? '4 10 Are erosion control measures in place? — rALTE SERVICES Pill 'trenches E224,40, VA ZL�X Block I Lot I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued P HD Construction Permit and approved plans and the Standards, Rules and Regulatioas of the Putnam County Department of Health. Date: ilo a u Li ZOO— Certified by: Address: Comments: TO PN Vim L�U Form FIR -99 1rCto-J :190Nia! e.06 trkM PE � &A_,_,r. Design Profe sional LL,—W Lic. # 08/18/2003 09:57 9147363693 CRONIN ENGINEERING 1 lei, M.- %j 14W 46 lb ib 9 AUG-18-2003 MON 09:23 TEL:845-276-7921 PAGE 02 Lj lz }4 IW 10 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 tZ Ll " .. . -. — . % "6i'-' 01/29/2003 10:14 9149626249 HL YORKTOWN PAGE ;,:N(t4G ROM 6.2 x la-I KITCHEN Lu bREAAFAST 13.2x12 - -11 LNING ROOM A fro-3 coo !�orfimb,!r irfi,matirm, P? . e(Ve exrtrick Houlihan!Laummce. Route 6. Box 6511 .1cacrion Vallcy, NY 10535 (91062.4900 51 .1 -�t-- - W UT I "- 0 ,(.8 LIy T 7--0 2 CAP. GARAGE~,, 23-o Y, 20-o FAMILY (ZOOM 17-1 X 14.71/9 Lou 5 ,�TSPA 1-va F!25T FLOOR The Kensin ton • 9 -!'Q o c ce.i I i i 1g-s on Fir; t f I o o c Hardwood floors on Firy EIuor Fi rqplace • Hydromic hear with Central air conditioning, • Tiled barlar,.),)m Eoors • Whirlpool cub with cite surround in jr.;i!;-cr b:Ltl,, • 1 2' x 24" deck _ IDII HSIIGN (DIE IENWRO NMIENTAIL HEALTH SIEI1 WCES CONSTRUCTION CTION PERMIT FOR SEWAGE TREATMENT SYSTEM N041,0-1 Located xt pHEiq SAN i RQ w Roffo own or Village Pu7NAM VA LL CY 1 . Subdivisi ®n name S•T r?AW6612Qj VPgi�Subd. Lot # f Date Subdivision Approved MAV ! S, 2002- Owner/Applicant Name 37 C20 ruht pAM X6/1[) GdRR Tax Map Sq- Block 2 Lot 6 Renewal Revision Date of Previous Approval Mailing Address 8� C90-F tQ DQi r Ro t; D ©S S i N I N G NC I Vl 40 R K Zip 10 56 2 ` n'Ountof Fee Enclosed Building Type StNGL6 ri9MrLi/ Lot Area,4.6 i1c. No. of Bedrooms 3 Design Flow GPD Goo 11 ESIpe1Jc &' MIR Section Only Depth 2.5 ' Vopume ±- P7OO C., Y-0 &Zate Seweir a System to consist of 12 SO gallon septic tank and 3r715' L, r, o ` q " �� t2��TZ►�-t'�e� j'�U c Iii �'� IN 24`' 62�V�r6 'l—rr� W el-1 Otheir 1e:quirements: To be omstructed by 39 CRa-n5y j DWI, RQj9p cofZ1''- Address S) CRa ; d Q nA M 120, O SS i N I t•16' NV 1 656.2 Public Supply From Address Private Supply Drilled by P.F '/� c SON -C IN C, Address I�� 'i'nl i� M �l irr 13f26 0 -f -re 2,-N y f 0:50q I represnt that I am wholly and completely responsible for the design and location of the proposed system(s) and that the s��otsegwe treatments sy tem described above will be constructed as shown on the approved amendment thereto and in ace10�irdace with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thez'4�toja "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the I3elh--rjjneat, and a written guarantee i the owner, his successors, heirs or assigns by the builder, that said bunnl,z:%elvill place in good operatin a`irt o , aid sewage treatment system during the period of two (2) years irJrATDM,3e�dtely following the o i once of a M 1 of the Certificate of Construction Compliance of the original 3'��mo ' s � any repairs er o. � - E. F Date l ? 3 `4-C1 6 2 -"o rJ Wq C--f' • � r L L IJ V 10, :g" License # C16 2f JV VL1 � U ''K(J F E71 �� IIU�lEIID FOR COI��'I RIl JrlrffO al expires two years from the date issued unless construction of the se:�� €treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or ` .iiO when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a ennit. Approved for discharge of domestic sanitary sewage only. 13 Title: 14P#C Date: I ( Xc, 3 WIM11- opy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pro essional Form CP -97 �. 08/08/2003 11:04 9147363693 CRONIN ENGINEERING 1 PAGE 02 PUTNAM COUNTY DEPARTMEN DI VISION OF ENVURONM'ENTAL HI DESIGN DATA SHEET - SUBSURFACE SENYAGE Owner 39 e.Ro- :)m DAwt comp. Address ar Located at (Street) Pj4aA rANT iz,.+ Ro fto Tax Maj (indicate nearest cross street) Municipality jeot +„ 1 ft _ Drainage Basin STRAW RRy KNOLL 4 ,. —; -. OF HEALTH L LTH3 SERVICES _ . REATMENT SYSTEM RoTof.f pArK tN�N ��-+A / lot V4 Block Z Lot 6 SI[ILL - 14dcCct W M(ZadK L o -r 44- SOIL, PERCOLATION TEST DtTA Date of Pre-soaking .11u6�,[- -- 7„� Zook Date ofPercilation Test t9ud -u,r', 8 o- NOTES: i. Tests to be repeated at same depth until approximately equ i percolation rates are omtatnea at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 rr in 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 ni Ir`_0_OrAM-2 CDT 4 M- Mra T97I - R4C.- ?7A -7QP1 wIpMC DI 17A1 ^" r rnnnTwe AIT nr n ^ De th to yater Water from ( round Level percolation Hole No. Run No. Time Start Stop Ela se Time �iViin.) Surface Start Inches) Stop Dropp In Inctes Rate Min/Inch - Ell is 1 g3Z 2 3 $« 2 N � 2 R46 %q-d 6 4 R 0 Its' 15- 5 )01 6 2 - - -- - - -- 5 ��� RpFESS� Pv 1 2 3 4 S NOTES: i. Tests to be repeated at same depth until approximately equ i percolation rates are omtatnea at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 rr in 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 ni Ir`_0_OrAM-2 CDT 4 M- Mra T97I - R4C.- ?7A -7QP1 wIpMC DI 17A1 ^" r rnnnTwe AIT nr n ^ ©8/08/2003 11:04 9147363693 CRONIN ENGINEERING 1 PAGE 03 ou CD r I } r ca f w kitr o I q r AUG -8 -2003 FRI 1AeAL__F- • — — ®8/08/2003 11:04 9147363693 CRONIN ENGINEERING 1 PAGE 01 CRONIN ENGINEERIN P.E.,P.C. ' 2? f OIiN WALSH, H OCl`'..`:EVA' RD' ` e THE LINDY BLDG; SUITE 200 PEEKSKILL, NY 1 566 �o Fkom: Joe Pa"Vati Jr. Ken Muq by. . COMPANY: DATE: P.0 -N D. AUGUS 8, 2003 FAX NUMOBA: TOTAL NO. OF PAGES INCLUDING CURER: 3 PHONE NUMBER: SENDER'S REFEYE 4CR NUMBER: Pheasant R un Road RE: YOUR REFPRPN NUMBER: 37 Croton Darn Road Corp. M PUtEW k Valley ❑ URGENT ❑ FOR REviEw ❑ PLEASE COMWNT ❑ P1.F SE REPLY ❑ PLEASE RECYCLE P.C.D.H. SSTS Constnution Trench Permit Stamimly Knoll, lot 1I Please find enclosed the sal tioa test data fpx the additioi Lai new. t e d in the gmtic nnad d Resnectf & Kenneth M. D TEL. (914)736 -3664 FAX (914)736-3693 13 FRI 10:00 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P -d ORONIe N ENGINEERING, P.E., P.C. 6 The Lindy Building, Suite 200, 2 John Walsh Blvd., Peekskill, New York 10566 Tel. (914) 736- 3664 o Fax. (914) 736- 3693 ,. July 17, 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. Strawberry Knoll, Lot 11 Pheasant Run Road Town of Putnam Valley Dear Mr. Paravati .. ,: - Plea.,e find - enclosed *.'" _ _ - ... 1.) Three copies of SSTS trench plan 2.) Construction permit application 3.) Soil data sheet 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 LORE'ITA-MOLINARI- P -M, Acting Public Health Director Director of Patient Services July 22, 2003 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 Ken Murphy Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, New York 10566 Dear Mr. Murphy: ROBERT 1. B6NDI County Executive Re: Field Inspection — 37 Croton Dam Road Corp. Pheasant Run Road, (T) Putnam Valley TM# 84 -2 -67, Lot # 11 A site inspection was made for the above referenced project on July 21, 2003. The following co ents must be corrected in the field. �>7 Silt fence was not installed. Silt fence must be installed by July 22, 2003 or a violation will � be issued. w5 �2 ✓. Fill pad length appears to be short. fir► S Bottom width at pad, (i.e. part of pad closest to the road) appears to be short. Impervious layer installed doesn't appear to be an impervious material (i.e. clay). Fill pad is not complete. It needs to be finished and graded off according to plan. 6: Re- inspection is required for the above comments. If you have any further questions, please contact me at (845) 278 -6130 ext. 2157. Sincerely, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj 08/01/2003 .' '0:9;:37 9147363693 CRONIN ENGINEERING 1 PAGE 01 PUT NAM COUNTY IDFPARt"LENT (OF ] HDmsioN CF E o ",EN'iAL HEA LT, AT'T'XNTION ®° g GENE BEMMST EQP For: All information must be fully completed prior to any inspections being made. PCID Construction Permit # - - Located: 'HEASM.411r fQ-P `Z64e) (T) der /applicant Name: ®, TIM. Formerly: Subdivision Name: Subdivision Lot # I Is system fill completed? %eel Date: Is system complete? — Date- Is system constructed as per plans? Is well drilled? Date: Is well located as per plans? Are erosion control measures in place? Y� I certify that the system(s), as listed, at the above premises has been and verified their completion in accordance with the issued I approved plans and the Standards, Rules and Regulations of the Health. Ke tr�4 ,a-r Date: 19U6041— Certified by: C96P al 6•%4 'P114 (01 l 14) 72 C-- �?64q Design ProfF Address, 2 SOHal L fk 7?4 Vo k fK(C L M /_ Comments: Form FIR -99 EALTH SERVICES Fill x Trenches VILLe., Y Block Lot ' "jL�g1r�Itt V rva t 4 Iq u 6U 2a 3 onstructed and I have inspected 'ID Construction Permit and Putnam County Department of ai � PE 19 Lic. # 07/17/2003 11:38 9147363693 CRONIN ENGINEERING 1 PAGE 01 PUTNAM COUNTY DEPART yff.NT OF IFALTH DMSION OF ENVIRONMENTAL HEAL SERVICES ATTENTION RADA 4I CJ GENE for- f Fill IV' AJI information must be fully completed prior to any inspections being made. PCHD Construction Permit # Located: FWAS4 9 :r FUN ROAD (T) Owner/Applicant Name, 37 cArddARrV 20Q COW TTM . Formerly: Subdivision Name: Subdivision Lot # Is system fill completed? V6 1 Date. Is system complete? Date: Is system constructed as per plans? Is well drilled? Date: Is well located as per plans? _ Are erosion control measures in place? Treoches I certify that the system(s), as listed, at the above premises has bees, 1 and verified their completion in accordance with the issued P l approved plans and the Standards, Rules and Regulations of the Date: l GOO Certified by: CIZ0141 Address: 2 � D AJ WOW Comments: Form FIR -99 Design Profeisi ,ISLtJx� rerex,rx, JUL -17 -2003 THU 10:36 TEL:845- 278 -7921 Fg 'rN A M VA LC Cat/ Block 2 Lot 67 7 26 tructed and I have inspected ) Construction Permit and nam Couaty Department of PE Kk Lic. # A NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DWESION OIF ENVIRONMENTAL HEALTH S ERWC ES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT EA'Il TENT SYSTEM PERMIT # Located at ?+ WAOrl ROO Town Subdivision name 9,rz 2y AMIL4 .Subd. Lot # Date Subdivision Approved 111A y is' z,<-X34 Owner /Applicant Name .3i CZZVZ t3 3>APg tDA D COMP. Tax Map Rqt- Block 2 Lot 9'7 Renewal Revision Date of Previous Approval NA . Mailing Address 3j C�p-tno ` jAr_t Pbo { C�ssii✓i�16 , Al, y. Zip 1,0.!5-6 e- Amount of Fee Enclosed Building Type En iP,-Iv riA L_ Lot Area Y , d ^9 No. of Bedrooms � Design Flow GPD 6'©a Acc_& Fill Section Only Depth 3� " Volume t`100 C. Y. PCH D NOTIFICATION IS REQUIRED WHEN ]FILL IS COMPLETED Separate Sewerage System to consist of /,2 5'D gallon septic tank and Other Requirements: �- 300 C.y, 00jSP ^CiFiE-D AAV 150 C .y, Im P.L.It t 0(411 ►iL To be constructed by 3`7 Ctta &j _gym Address 3-1 L6, , 01 s��i•JG, Af. y Water Sane pip, Public Supply From or: r---- Private Supply Drilled by Address Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations -oQthe Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance °''`sati"j&ctory to the Public Health Director will be submitted to the Department, and a written guarantee will.. be,;fdrnished tl} owri ,his successors, heirs or assigns by the builder, that said builder will place in good operating c�tnditoxi any^part`of sa -sage treatment system during the period of two (2) years immediately follow' a da of the,is�uLn a of tie approval f tli Certificate of Construction Compliance of the original system or an pairs ther o. E r c� ter Signed: 2:� Address .Z 0 • V. in-66' 4 License # Date 0-3 Dcs'.2-3 &D APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. Approved for discharge of domestic sanitary sewage only. By: Title:$ �e y Date: e copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 w- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL _ - V - pleme•p.iizt'or typt':,- :pCP1D Permit # r.0� .' 3:: Well Location: Street Address: Town/Putnam Tax Grid # - Pheasant Run Road, Sublot# Valley Map 8,�4 Block 2 Lot(s) 6�'7 Well Owner: Name: 37 Croton Dam Address: Road Corp. 37 Croton Dam Road, Ossining, NY 10562 Use of Well: X Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5 gpm # People Served 4 Est. of Daily Usage {oil gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling X New Supply (new dwelling) Deepen Existing Well Detailed Reason Water supply for new-'residence for Drilling Well Type X Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No X Is well located in a realty subdivision? ...................................... ............................... Yes X No' Name of subdivision Strawberry Knoll Lot No. Water Well Contractor: P.F. Beal & Sons, Inc. Address: 4 Putnam Ave.. Brewster. NY 1 n 5n9 Is Public Water Supply available to site? .................................. ............................... Yes No X Name of Public Water Supply: N/A Town/Village N/A Distance to property from nearest water main: + 6001 o' town & county) Proposed well location & sources of contamination to e pry ded on separate sheet/plan. Date: Applicant Signature: - - PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue 6_ a9 o -3 Permit Iss ing Official: / Date of Expiration Title: 1' �y I S S Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 "y RONIN ENGINEERING P.E. P.C. .`r The Lindy Buildin g, Suite 200 2 John Walsh Blvd., Peekskill, New York 10566 Tel,; (%L4)4736 -3664 °.>;ax. (914)73 &3693. - - April 29, 2003 Joseph Paravati, Jr. Assistant Public Health Engineer Putnam County Department of Health Division of Environmental Services �, a 4 Geneva Road, Brewster, N.Y. 10509 Re: SSTS Construction Permit Strawberry Knoll Subdivision — Lot 11 Pheasant Run Road, Town of Putnam Valley Dear Mr. Paravati: Find enclosed three sets of copies of the revised Fill Placement Plan and SSTS Plan for the above referenced project, revised date April 29, 2003. The plans have been revised in accordance with our previous phone conversation and the letter received from your office dated April 24, 2003 as follows: 1. The SSTS fill provides the 10' min. setback to the property line and driveway. 2. The impervious layer plan and sections provide a 3 horizontal : 1 vertical slope. 3. Cleanouts are labeled to be placed at a max. 50' separation. 4. PCDH construction notes are included on both plans. 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 Strawberry Knoll -lotl lRev1,04- 29 -03.doc : E0RETTA' ;Iv10L1NARI R.N:; "M:SN. Acting Public Health Director Director of Patient Services April 24, 2003 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 - ROBERT- J. '961NDI-' J :I County Executive 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 Luis Hernandez Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, New York 10566 Dear Mr. Hernandez: C� Re: Proposed SSTS - 37 Croton Dam Road Corp. Pheasant Run Road, (T) Putnam Valley TM# 84 -2 -67, R. S. Lot # 11 This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your review and consideration. 1-. 4 �C6nstrdcti6h notes 1 - 15 need to be *on both sheets (PCFID notes)... - 2. The well setbacks are off when measuring by scale. Please check all well'setback dimensions. 3. Impervious layer needs to be installed at 1:3, not 1:1. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Ve truly yours, �GriZ�' -t�Zv� 7oseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj PUTNAM# COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDTVMUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT. SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: ✓✓�lf f7a� lZi� Gf'r� STREET LOCATION:µ M, 97sp �p REVIEWED.BY: R GR, .M; -4/ SRDATE: o� 3 Z*7j­TAX MAP#: (CONRIRNMD) Y� !! N DOCUMENTS (/PERMIT APPLICATION j�(�WELL PERMIT OR PWS LETTER PC =97 � CV LETTER OF AUTHORIZATION UDESIGN DATA SHEET (DDS) CORPORATE RESOLUTION SHORT EAF ((___)PLANS -THREE SETS ( [/ (_) OU,SE PLANS - TWO SETS (� ✓ VARIANCE REQUEST SUBDIVISION ("LEGAL SUBDIVISION . SUBDIVISION APPROV CHECKED PE CRATE 1 UU L REQUL[REID a .� , DEPTLEi U CURTAIN DRAIN REQUIRED GENERAL U(✓) CATED.INNYC WATERSHED U�,s SUBMITTED To DEP LEGATED TO PC BD �DEP APPROVAL, IF REQ'D (y }(_PgEP TEST HOLES OBSERVED („}L__).P/ ERCS TO BE WITNESSED WEAPPROVAL SSDS ADJ, LOTS TLANDS (TOWN/DEC PERMIT REQ'D ?) UU ATA ON DDS PLANS & PERMIT SABRE UTTERAlVpA � 1969 NEIGHBOR NOTIFICATION ( f- iZ`>rtOOD ELEVATION'WlI200' ( )(SOIL TESTING LOTS >10 YEARS OLD REQUIRED DETAILS ON PLANS CZJC_JSEWAGE SYSTEM PLAN (NORTH ARROW) (_JSSDS HYDRAULIC PROFILE C of )ORAVITY FLOW IESIGN DATA: PERC & DEEP RESULTS 'CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT Q��FOOTING/GUTTER/CURTAIN DRAINS USDA SOIL TYPE BOUNDARIES UUTITLE BLOCK; OWNERS NAME ADDRESS / TM #, PEIM; NAM, ADDRESS, PHONE# )DATE OF DRAWINGIREVISION 3LLLOCATION DATUM REFERENCE OF WATERCOURSES, PONDS LAKESyWETLANDS WITHIN 200' OF P.L. �UPROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS WEL%u�`c:SSDS'S_W/LN 2 OF�S . �S PROPERTY METES & BOUNDS J( JEROSION CONTROL FOR HO WE SSTS, EROSION CONTROL NOTE MMENTS: W � :VS�:xrTln�mtimn YEN !REQUIRED DETAILS ON PLANS CONT'Dl ( �t� )HOUSE SEWER -'f." FT. 4 "0'; TYPE PIPE: CAST IRON U(r}NO BENDS; MAX BENDS 45' W /CLEANOUT UUSTTE O`C�ANGE) N :� .. FILL SYSTEMS (-✓ 10' HORIZONTAL; PAST TRENCH SLOPES N: I TO GRADEI----, SPECS / FILL MOTES 1 -5 n'a," =� �,•.yerN FILL PROFILE & DIMENSIONS (_) FELL IN EXPANSION AREA`C FILL GREATER THAN2 FEET 3.i /- CLAYyBARRIER . C )� CE CATION NOTE (_,DEPTH GAUGES VOL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS SEPARATION DISTANCE FROM•TOE OF SLOPE TRENCH* C- -JLJLF TRENCH PROVIDED% �60FT MAX. E -PARALLEL TO CONTOURS 100% EXPANSION PROVIDED UUDETPAL/DUST FREE CAUSHED•STONE OR WASHED GRAVEL C-JL )GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROIVI'SSTS 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL 4H C--W' TO FOUNDATION WALLS (x)100' TO STREAM, WATERCOURSE, LAKE (inc. ezpan), ( 50' TO CATCH BASIN, 35' STORMDRAIN PIPED WATER. U10' TO WATER LINE (pits - 20') ,- 50'- INTERMITTENT DRAINAGE COURSE ( /1L )200'!500' RESERVOM ETC. 150' GALLEY SYSTEMS U(_ JlO' MlN TO LEDGE OUTCROP SEPTIC TANLK C - -,)10' FROM FOUNDATION; 50' TO WELT, s WELL DIMENISIONS TO PROPERTY LINES (,�LOCATTION OF SERVICE CONNECTION (U(U 15' TOTROPERTY ALINE SLOPE (: :)�� „ )S 'OPE IN SETS AREA 20 %) U GRADED TO 15 %, IF REQUIRED DOS U`MP SYSTE ,� J UUPUMP NOTES UC_)DOSE 75% OF PIP UME/DOSE VOLUME NO D ( (___)DETAIL F RCE-.MAW, (PIPE TYPE, ETC.) UUP D -BOX SHOWN & DETAILED 'C-) DAY STORAGE ABOVE ALARM 5' ry MIN to CD o, 20'- 4 %,1.5' -3 %, 35'- l%,100 %-<I% MIN DISCHARGE/1001 with 182 cons day discharge MIR to NON-PERFORATED PIPE RONIN ENGINEERING P.E. P.C. The Lindy Building, Suite 200, 2 John Walsh Blvd., Peekskill, New York 10566 Tel. (914)736 -3664! Fax. (914) 736 -3693 March 6, 2003 Joseph Paravati, Jr. Assistant Public Health Engineer Putnam County Department of Health Division of Environmental Services 4 Geneva Road, Brewster, N.Y. 10509 Re: SSTS Fill Placement Permit / SSTS Construction Permit Strawberry Knoll Subdivision — Lot 11 Pheasant Run Road, Town of Putnam Valley Dear Mr. Paravati: The following information has been enclosed for your review, for the above referenced subdivision lot: 1. Three copies of the "Preliminary Design For Fill Placement Only Plan" dated March 5, 2003. 2. Two copies of the preliminary trench layout plan dated March 6, 2003. 3. Letter of authorization. 4. Affidavit Corporate Owner application. 5. Application for Approval of Plans for a Wastewater Treatment System. 6. Deign Data: Sheet — Subsurface, 'Sewage_Tred6iierit. 7. Construction Permit for Sewage Treatment System and Fill Placement Only. 8. Application to Construct a Water We 9. Short Environmental Assessment rm. 10. Application fee of $300.00. ; 11. Two copies of the house plans. The preliminary trench layout Plan is enclosed for your review in order to get the comments that may affect the construction of the SSTS Fill Pad. A copy of the final trench plan will be submitted by the time the fill pad has been placed, stabilized, and tested as required by your Department. 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 s bmitted, Luis He a dez Project Engineer cc: Val Santucci Strawbenyl{noll,Lotl 1,03- 06 -03.doc L F l,} t iM.0115 N i l o)) 1211@111W.111 . 3 5 ID.R�SIQIq OIF ENVRRONMENTAL HEALTH HI SERVRCES I _.';Y ..,?', :;:,-. r, �, ,. - ,. ,. Ott .- �. .. -r,.:. ._._ _.'.;� ..s; ?,.t3 ., ri^,:, �.�.... ....t• .. . CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at PHCA9AAIY 0VA1 ROA9 Town o� /fit, -rA)A,0 V,41-LeY Subdivision name _56Aiy&,rg 2 y 1w&LSubd. Lot # /l Tax Map 83� Block Z Lot 6'7 Date Subdivision Approved /'-IA y /s ?,042- Renewal Revision Owner /Applicant Name -7 (.2xomg )Al/ ZA9 6)2O. Date of Previous Approval 'v Mailing Address 31 en nW _,I)Ay AN9 . 05'So�/iN'(� 1✓ . y Zip 1456z_ Amount of Fee Enclosed 32�a Building Type �1epENTi.► L Lot Area Y, 59 No. of Bedrooms 3 Design Flow GPD Old Ac/r,e,1" Fill Section Only Depth 40 Volume 700 C . PCHD NOTIIFICAT12N IS REQUIRED WHEN ]FILL IS COMPLETED Separate Sewerage System to consist of gallon septic tank and 375- Z.F. of ?1 ,a rV1zATE_9 ?V6- 7t PE /A/ �f /l„ ► ��"L 7QE'NC�i . Other Requirements: i� 4 To be constructed by 37 CwTOn� M 5A � ( /� w- P Address 3.1 C'ey&J J14 43. G�ffi,Y/iN�� AY.. y. � z WateLSnn�ngIv:.... _ _= Public_Supply From o1r: V Private Supply Drilled by �?/7 AeA 4- $ S' ®A4r, 7AA0 . Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be ' d, mover, his successors, heirs or assigns by the builder, that said builder will place in good perating con diton,anrart,of said sewage treatment system during the period of two (2) years immediately follow' the to of th e issuance o tl�e appro`v 1b th&,Certificate of Construction Compliance of the original system or any airs th eto. Signed: P.Er z x D Date 031 0Or3 Address ,2 K.% cl .�� Al License # Gga"2.9BU APPROVED FOR CONSTRUCTION: This Appre res two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only. L Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of 37 Croton Dam Road Corporation Located at . (Mill Street (CR #23) / Lover's Lane ) —1�t�/JSA1vr ZUa/ lZc)AU, T/' Putnam Valley Tax Map # 04 Block Lot E 7 Subdivision of Strawberry Knoll Subdivision Lot # Gentlemen: Filed Map # 2-j0Q A -f Date Filed A/a y 14-i zdp z . This letter is to authorize Timothy L. Cronin III a duly licensed Professional Engineer X or 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 y ehalf i connection with this matter and to supervise ction of said wastewater ea a iand/o w ter supply systems in conformity with th ®v' NEW Y�$ cle 145 and/or 147 th . d gatlon is , the Public Health,__ the °Putri ut4ty So de.' Countersigned: P.E., R.A., Mailing Address 2 John Walsh Blvd. , #200 Peekskill State N.Y Zi P 10566 Telephone: ('914) 736 -3664 Very Signed: Mailing Address: State NY 37 Croton Dam Road Ossining Zip 10562 Telephone: (914) 739 -7362 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH lIDIIVIIS]ION OF IENVIRO ENTAIL._IHI A LTH SERVICES - -- _ ;, .. "cam � _.a.�.:.:;>" - .» . -. ;a .-, •._.. -, r. .- - a- <'�:m'- AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAitii COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: Construction of SSTS and Water Supply T 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: (Same as-Above) Treasurer - Name: Address: Same as Secretary (Same as Above) and that I am and will be individually responsible for any- an ':all to the approval requested and all subsequent acts relating erel Sworn to Vefore me this day of (month) do (year) Notary Publi KELLY M. LENT Notary Public, State of New York No. 01 LE6026834 Cualified in Westchester Coin Commission Expires June 21, Form CA -97 Col Signed: Title: e c j4poration with respect 0 08/27/2003 08:59 9147363693 CRONIN ENGINEERING 1 PAGE 02 CRONIN ENGINEERING P.E- ,P -.C. 2 JOHN WALS,H BOULEVARD THE LINDY BLDG; SUITE 200 PEEKSKILL, NY 1 566 TO: Tlcresa Neow& COMPANY: P.C.H.D. FAX NUMHFR: PHONE NUMBER: 37 Cmton Dana Road Corp. ,FROM: Ken DATE: AUGU4 27, 2003 TOTAL NO.OF PA ES INCLUDING COVER: Z _ .. SENDER'S ]RUERE NCE NUMBER; Pheasant R w Road YOUR RAFF.RENC NUMBER: P.C.M. I w33it # O URGENT 13 FOR REVIEW ❑ PLEASE COMMENT 13 PLEjSF., REPLY ❑ PLEASE RECYCLE Town of Putnam Valley SM Conwixtion Compliance Strawbety Knoll, lot 11 MESSA�( COMMErTIS: - Kenneth M. TEL. (914)736 -3664 a FAX (914)736 -3693 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AAA STET -. SUBSUREAC . SEWAGE:TREATMENT SYSTEM Sip CY?0-T0,Aj D19111 RO /7 o Owner G9 CRO i o,J Plq r4 716/9D Cog 'P Address 0 s ei N j N G- �y' I d 56-2 Located at (Street) PKEASRM 7- i2UN l2otW Tax Map SLI Block 2 Lot 6 7 (indicate nearest cr�;LtqDrainage street) Municipality �'v T- Ni4�"'► Basin �-���.rou fZt yc� SOIL PERCOLATION TEST DATA Date of Pre - soaking —5—ui-V 16, 2 oo 3 Date of Percolation Test--Tu Ly 19, zao 3 Hole No. Run No. Time Start - Stop Else Time De th to Water from Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 'PS 2C 1 641 WSJ s 2( 3 3 2 ca52 GI 4 5 1 3 4 5 1 2 3 4 5 NOTES: 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/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' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.5' 10.0' 2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED 1[N TEST HOLIES HOLE NO. HOLE NO. HOLE NO. Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Design Professional Name:— Fm,,,j-Hy L. c92o�(l� A Address: 2 So 'rM au-p . ?6- 6-Krff1 L ,lY MSDK' Signature Design Professional's Seal Date Cn V� LLJ ~Niyr .r yo' 62980 FU' 1e0FESS\��P� co Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Design Professional Name:— Fm,,,j-Hy L. c92o�(l� A Address: 2 So 'rM au-p . ?6- 6-Krff1 L ,lY MSDK' Signature Design Professional's Seal Date Cn V� LLJ ~Niyr .r yo' 62980 FU' 1e0FESS\��P� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: '.Kllila) Inspected by: Street Location PkgAscn� tzvk io"t Owner. ermit PV TM. # ILY" J-6-7 Subdivision Lot # ��l 1. Sewage System Area a, STS area located as per approved plans ........... * ................. b. . Fill section - date of placement 3:1 barrier Lgth. - Width Avg.Dpth_ c. Natural soil not stripped ........................................... - ....... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/wetlands .............. II. Sewage System a. Septic tank size - 1,000 .......... 1,250 ... other ................ b. 'Septic*tank installed level ................................................ :11, c. 10' minimum from foundation ... ................................. d. Distribution Box 1. - All outlets e elevation-water tested ...... t .......... 2, Pr elow frost ............................................... 2 ft. Original i9iisoil between box & trenches e. Junction Box - properly set ......................................... 6. Trenches - . i. Length required Length installed 00 2. Distance to watercourse measured Ft.......... �3 Installed "according to plan..... ............................... 4'.,;S'1d`ge of trench acceptable 1/16 - 1/32"/foot ............. 10--ft,k'from property fine - 20 ft.- foundations.......... 6. " �,Vt Depth 'd trench <30 inches from surfice .................. 7. Room allowed for expansion, 100% ......................... 8. Size of gravel 3/4 - 11/2" diameter clean ............... 9. Depth of gravel in trench 12" minimum..... ........... 10. Pipe ends capped ......................... ... ................. Pump--g -Dose vstems- I of pump chambe ............................................. 2.: tank . ..................... 3 Alarm, . m audio .................................................... Pu easily accessible, manhole to grade ................. first box baffled.... ..................................................... Cycle witnessed by H.D.estimated flow/cycle ........... ' . "AA. House located per approved plans ............................. .. 9�,.�Number of bedrooms ................................................... 'IV. Well Well ,located as per approved plans ................................. b. Distance from STS area measured -4 1 q 0 * - 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 ............... h. Surface water protection adequate ............... I..................... i. Erosion control ded ................................................ Rev. f2r1002vi M SIB INSPIEC- TION FOR FELL PAD Date: i /,P3S Inspected by: 6p Ala Fill pad located per the approved plan Fi§%b Re ed Len h 4- ° ¢ N 0 PadWi q g FiS� Required Width Fill Pad Depth Required Depth Run -of -Bank Fill Quality Slope from Top to Toe Layer Installed Sion Sieve Test Results (if applicable) I&A 54U (LOCI / 6 kv N -e C1 t ;ke c 14y . Additional Comments: I Ld kem MurAku c,,i 7/91 Reserved for Field Sketch if Applicable V PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES • '�-DEgIG-�•DA3'A-•SHEET =• SUBSURF'ACVSE`VA'GE`TREATMENT "SYSTEM Owner' 37 Croton Dam Road.Corp. Address 37 Croton Dam Road, Ossining, NY 10562 Located at (Street) %���- ''`?SH !� � . Tax Map R �c Block Z Lot E (indicate nearest cross street) Municipality _(T), P utnam Val lev Drainage Basin Peekskill Hollow Creek l� SOIL PERCOLATION TEST DATA _ _ Date of Pre-soaking �� - i.� -- ��o Date of Percolation Test 05-1,<-00'--. n V 1 r.J: 1. 1 ests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 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 De th to Water Water From Ground Level Percolation Hole No. Time Start Stop Ela se Time Surface (Inches) Start Stop Drop In Inches Rate Min/Inch No. Run - (p1lin.) 3 ���"_ ���i 21-23.-f- 4 5 , z z 3 1 /12 /Q 3' 7 Z 3 _3 .91 . .. 4 5 1 . 2 3 4 5 n V 1 r.J: 1. 1 ests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 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 2 TEST PIT DATA DESCRIPTION OF SOILS E C011�'.ERED IN TIES7I'.]E O LlE$ DEPTH HOLE NO. -2�j HOLE NO. may' HOLE NO. G.L. Al TCP so 0.5' io 1.0' 1.5'ro�o�r/ S'aN�Y �csA i'f 2.0' 2.5' f 3.0'' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 7-DP 5'c9 /L-- 70? Sri i L 0 N �r�y SANS e G�� file Indicate level at which groundwater is encountered N1,4 Indicate level at which mottling is observed Indicate level to which water level rises after being encountered �v/A Deep hole observations made by: Adam Stiebelingl Keith Staudohaur Date a ;2 7 --coo PCDH Cronin En ineer'n Design Professional Name: Timothy L. Cronin III Address: 2 John s Blvd. #200 P skil , NY 10566...: Signature: Design Professional's Seal PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .. � .: ..,, ....:. .., . • A_ PPsLICATION FOR APPROVAL OF PLANS FOR AT1ElT 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 ' Knol l 3. Location TN. Putnam Valley 4. Design Professional: Timothy L. Cronin III 5. "Address: 2 John "Walsh Blvd; 200 Lindy Bldg 6. Drainaae Basin: Peekskill Hollow Creek Peekskill, New York 10566 16. 7. Type of Project: 17. Waters index number (surface) X Private/Residential Food Service Commercial Is project located near a public water supply system? ....... ............................... Apartments Institutional Mobile Home Park If yes, name of water supply N/A Distance to water supply N/A Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review,(SEQR)? Name of sewage system N/A Distance to sewage system N/A 22. Type Status (check one) ........................ ............................... Type, I Exempt 24. Project design flow (gallons per day) 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 of cials,: ordinces? . 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 N/A Distance to water supply N/A 20. Is project site near a public sewage collection or treatment system? ................ No 21. Name of sewage system N/A Distance to sewage system N/A 22. Date test holes observed April &May 2000 23. Name of Health InspectorAdam Stiebeling 24. Project design flow (gallons per day) soo cal /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 , ..s 2 27. Is any portion of this project located within a designated Town or State wetland? /VO 28. Wetlands ID Number. . .. ..... ....... ...... N/A 29. Is Wetlands Permit required ............... .......... ............................... No Has application been made to Town or Local DEC office? No 30. 31. -Does project require a DEC Stream Disturbance Permit? .. ............................... . 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 NO 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination. Yes/No No DESCRIBE: _..._.._.... 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 2 Lot _.,ry 37. Approved plans are to be returned to ..... Applicant x Design Professional NQ- F: All applications• for reviewand .alZp v of anew S,ST :ta.be.located within the il�E V�Iatarshed-shall - --_ Tie 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 rRy also require DEP review and approval of other aspects of a project, such as stormwater plans or the creationof impervious surfaces, and the project applicant should obtain the appropriate forms for such activii s 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 pt•ovision . may be grounds for the rejection of any submission. - I hereby affirm, under penalty of perjury, that information ��ova,'d o�; i f ob is true . to the best of my knowledge and belief. False std m�ents .� a ',herein are p 's able as a Class A misdemeanor pursuant to Section ,21&45 oft ena1 q , S, I. x LU SIGNATURE'S & OFFICIAL TITLES. �v Timothy L. Cronin , 62980 _ FGSS��� Mailing Address: ..._... Cronin Engineering, t�C 2 John Walsh Blvd; 200 Lindy Bldg; Peekskill,NY 10566 PROJECT I.D. NUMBER 61721 Appendix C �lata< tivti�nme saEl- f1eial{tyYReQitdw�: SHORT ENVIRONMENTAL ASSESSMENT FORM For UNUSTED ACTIONS Only PART 1— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) SEAR 1. APPLICANT ISPONSOR 2. PROJECT NAME 37 Croton Dam Road Corp. Strawberry Knoll, Sublot 3. PROJECT LOCATION: tAunktpauty Town of Putnam Valley County Putnam County 4. PRECISE LOCATION (Street addnaa and road Intarsaetbns. prominent landmarks. etc.. or pra►Ide m&0) Pheasant Run Road S. 13 PROPOSED ACTION: M Navy D Expansion D ModlticatloNaltaratlan 6. DESCRIBE PROJECT BRIEFLY: 'Construction of Subsurface Treatment System and Well Water Supply to Serve a Single Family house. 7. AMOUNT OF LAND AFFECTED: Initlally acres Uttlmatety acres S. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LANO USE RESTRICTIONS? •C'.J Yes Cl No It No. de.crib. rxtalty III. WHAT is PRESENT LAND USE IN VICINITY OF PROJECT? U Residential D Industrfat D Commaelal D Agriculture D Psr%tF0rest1Opan apaca ❑ Ott. 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 LOCAL)? M Yes D No It yes, Ilst spanry(s) and permlVaoprovals Town of Putnam Valley Building Permit 11 • ANY ASPECT OF THE ACTICV HAVE A CURRENTLY VAUD PERMIT OR APPROVALt �DIM G . ta.s.Yes 01410 If yea, got agency name arnd parmMapwwal Subdivision Plat Approval - "Strawberry Knoll Subdivision" 12. AS A RESULT OF PROPOSED ACTION WILL E memo PERYRlAPPROVAL REWRE MODIFICATION? D Yes ® No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE 13 TRUE TO THE BEST OF MY KNOWLEDGE A0twusowsw namr Cronin Engine Keith Staudohar Date: Stgruturs; /. V 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 1 PAD? ASSESSIAENT ITO be completed by Agency) A. t?fO'E±S AGTtoo+ EJ9eEED ANY TYPE I THRESHOLD IN 6 NYCFIK PEAT tlt7.t7! It yea, coordinate the revkxt grococo and tress the FULL t:4F. t J Y. 4 No I B. WILL ACTION RECEIVE COORDINATED REVIEW AS•POOV10ED FOR UNLISTED ACTIONS IN A NYCAA. PART 617.87 If Mo. a nogative dectaratlon may ba supefseded Oy another Involvcd agony. _ ❑'vim; C. COULD ACTION RESULT IN ANY ADVERSE EFRE=$ ASSOCIATED WITH THE FOLLOWING: (Anawroro may bo handwritten, If Wglble) Ct. Existing air quality, surface W groundwW& quality or quantity, nolaa lovolo, 011011119 traffic patlmns, solid svasto production of disposal. pWcntlal for oroslot% dralnagd or flooding problems? Explain briefly. C2 Ac thotic, egricialtufel, archamiceiull. historic, or other natural of cultural rocsourcea; or community Or nolghbofho* ehara c.ter? Explain brtoftg: Aj O Y A— CD. Veeotatlon or fauna. fish. 0411flsh or wildllfo specloo, algnlflcant habitats, of throatoncd of erda"wed speciaa? Explain briofty. Ca. A community's oxlsling plans or gania as officially odoptcd, or a chango In use or Intonally of uoo of land or other natural roaaurcda? Explain brlofty, Nom C9. Growth. subsequent davolopmant, or rolstod activities 11haly to be Induced by tho proposed action? Explain briafty. (7) Ca. Long term,, short torm, cumulativo. or other ailecta not Identlflod In C1-C37 Explain Wally. rn C7. Otncr imp/accts %(Including changos In usa of althcr quantity as type of onorgy)7 Explain Drafty. 1 0. 113 rMERE, OR 18 E Utt>sLY TO ®E, COP TAOVaRSY RELATED TO POTENTIAL AMEASE ENVIRONMENTAL IMPACTU? If Yfjei 68pIaIn Isrlotty r'r PART Itt-- DETERMINATION OF SIGNIFICANCE (To b® completed by Agency) Piet 1.ICTM3. For awm adbww affect Identiflod above, destwmine whet" It la subm antial, larp. Important or otfwwla® Ognlf(eant. EbrJ1 affect should bo aaaaawd In connection with Its (a! tatting (I.o..urtwn of rursk (b) probability of ozcuftin (c) dundlon: (d) lrrysve wtwllty, (a) geographic scopo; and (n magnitude. If ncrcatesary, add dttochmonts or rofdsw= oupporting matartals. Ensure that oxplenattona contain cuff dent detail to show that dt mlovwt adverse Impecla havo boon ksntlfled and adsqIlately addroased. ❑ Chftk this box If you havQ IdentiflQd on® or more potentially largo or significant advww Impacts which MAY asaasur. T'hon procs*d directly to ft FULL EAF en>$lor prepare a poelttva doclaratlon. k this box If you have detellmined, based on the Information and anwywa WXrM and any Iulpporting documentation, that the proposes action WILL NOT result in any olgrllficant advww snvfronmental Impacts ARID provide on attachments a8 nscasawy, tho rwsona supporting IM8 d ®fuminatlon: • P -T� m ► —r'rz+ Nam, a–k Of ue10s++16o10 Osltcor m in Mama at Lead AVnCy ,tic of eloanstw Usticar ,anatum ar hepam (I r aMM Ito,. nalaanateea off Karl eta Z , -'I. t- r' 1 ®R . . . ........ . N S TRA WSERR Y KNOLL - L 0 T #11 AS-BUILT SEWAGE TREATMENT SYSTEM SCALE. • 1 130 FT. TANK DISTANCE ..... . ..... ......... ..... TANK I 18.5' I_ Z4' BOX DISTANCES FND or Isr• rREiVCH j 4T 60' 2U.5' ENID or JRD, 1711ENCH i 49' 94' 75' . . . ...... END OF 5 IN WNCH 56.5 ..... ..... ... . ................. . 160, ..... . ..... . ... .... XVC77ON 8OX 14 4D.;F 95' CND OF 71N. IRENCH j 64, 5' 90' . KjNCf.. END OF TRENCH i 74 ... . ............. .......... I ....... ,f;ArC,-Itw sox A7 1 .58 5' 118' Awcf"cov ent, o i(Vrr".w BOX ty 70, 80,e Oro 76,5 �z ..... ................ V • 'A ry i' r4 I st �•qAif, MFNC;0 S TRA WSERR Y KNOLL - L 0 T #11 AS-BUILT SEWAGE TREATMENT SYSTEM SCALE. • 1 130 FT. TANK DISTANCE ..... . ..... ......... ..... TANK I 18.5' I_ Z4' BOX DISTANCES FND or Isr• rREiVCH j 4T 60' 2U.5' ENID or JRD, 1711ENCH i 49' 94' 75' . . . ...... END OF 5 IN WNCH 56.5 ..... ..... ... . ................. . 160, ..... . ..... . ... .... XVC77ON 8OX 14 4D.;F 95' CND OF 71N. IRENCH j 64, 5' 90' . KjNCf.. END OF TRENCH i 74 ... . ............. .......... I ....... ,f;ArC,-Itw sox A7 1 .58 5' 118' Awcf"cov ent, o i(Vrr".w BOX ty 70, 80,e Oro 76,5 DISTANCES TO ENDS OF SS75 FND or Isr• rREiVCH j 4T 60' FND CV 2ND. fRCNCH i 4,6 ENID or JRD, 1711ENCH i 49' f",vD or 4 N. mrVCH 75' . . . ...... END OF 5 IN WNCH 56.5 ..... ..... ... . ................. . 160, ..... . ..... . ... .... END Or 6N WNCH 60,5' 95' CND OF 71N. IRENCH j 64, 5' 90' 69,5' 96' END OF TRENCH i 74 100 Em or ior,+ i 79. 3 16, 0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Loeatiqu:� -- _- : Street Strawberry Knolls, Lot #11 Putnam Valley Map 84 Block 2 Lot(s) 67 Well Owner: Name: Address: VS Construction, 37 Croton Dam Road Ossining, NY 10562 Use of Well: I- primary 2- secondary �_ 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 . ]Linen 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 Yield _5_ gpm Depth Data Measure from land surface- static (specify ft) 30' During yield test(ft) 540' Depth of completed well in feet 605' Well Log If more detailed information descriptions or sieve analyses Ut avarlai*,- 'v please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 5 Drilling in over urden clay and boulders Hit rock, at 51 5 -.- '.. - .. 32 605 Drilling _ in rock crranite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 5 •gpm Depth 560! Model 5GS15412 Voltage 230 HP 1k_ Tank Type WX302 Volume 86'aal Ions -,Y .}� 4 Date Well Completed 5/28/03 Putnam County Certification No. 001 Date of Report 8/18/03 Wei i sig P; . NOTE: Exact location of well with distances to at ley ,two permanent landmarks to be provides an a separate sheevplan. Well Driller's Name P. Address: 4 Flan. Ave e, Bteasber, NY 10609 Signature: Date: 8/18/03 Perry L. al White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97