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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -2 -68 BOX 33 4. ... IN 4 1 1 1, IN `r IN . ; . L Is IN .L_ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR lage-i TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # P V- 9- 02 Locatedat 22 fee -AX19N T 12QN `Zd (4D Town r r N /q M VFl t IL C Y Owner /Applicant Name :?9 CT?o -ro;s Agn BROAD cO Tax Map S4 Block 2 Lot 6 g Formerly. Subdivision Name STR� h1��fLjZ1/ Kr► o L C Subd. Lot # I IL Mailing Address S9 C iR o TOJ Piln f2a -1 D O SS i ,J / iJ � � hl �/ Zip 10 S 6 2 Date Construction Permit Issued by PCHD /IPR 1 L 11, tab 9 3� C2 oTON DA/� 1ZO�n Separate Sewerage System built by 39 c-faf d PAA PonD ct-W, Address 0 CSiN INC. !J V7 10562 Consisting of 12,0 Gallon Septic Tank and .56 0 1-..F o F P V C_ 1z Fam 'TC�o fi ?6 I>J 24G G121JVC_ TTZCNCkf Other Requirements: Water Supply: Public Supply From Address 14 foTN19 M AVLSrJVzr or: Private Supply Drilled by P F JT60L so1J-r -TN Iz• Address MVCW-t'Tell, qy 1 �sd'i Building. Type. Q i P 61.1f M i_ 128r s. Has erosion.control been completed? . Number of Bedrooms 1--c 0 R Has garbage grinder been installed? I certify that the system(s), as listed, serving the qabe re W ci�d essentially as shown on the as- built plans (copies of which are attached), in ac nstruc tion Permit and approved plans and the standards, rules and regulat' s o artmpntsOf Health. Date: Z 3 ''U Certified by � % = P.E. (Design P to al)Address 2 5o N 1nJ�9 �� c/!,' ; ' s Eo .. _ . � cense # 0 b Z�� Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. By: Title: APL4E Date: /O LO to 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 I{I[]EALTIHI SERVICES WELL COMPLETION REPORT Welll Locatiop_.. t Address: _ _ _ _ Strawberry Knolls, Lot #12 TowtrlVilla Putnam Valley Map Block Lot(s) Well Owner: Name: Address: VS Construction, 37 Croton Dam Road, Ossining, NY 10562 1Use 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 __2L_ 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 12 Yield 8 gpm )(Depth Data Measure from land surface- static (specify ft) 18' During yield test(ft) 150' Depth of completed well in feet 665' Well ]Log If more detailed information descriptions or sieve analyses are avarlable,. _. , .., please attach. )lDe th From Surface Water Bearing Well Diameter(in) Formation )[Description ft. ft. Land Surface 15 D ' Hit rock 15 32 Drillin Pat15 set casing, routed - If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity _5_0m Depth 620' Model 5GS15412 Voltage 230 BP A Tank Type M02 olu 8 al. Date Well Completed 2/13/01 Putnam County Certification No. 001 Date of Report 6/26/03 Well I Per eleai� iNu i t: t;xact location of wen with a�spitices to least two permanent ianamarxs to be prove a on a separate sneevptan. 1 s d Well Driller's Name Pa F Signature: Perry L e/ White copy: HD File; Yelp Address: 4 Putrm Ave., Erewster, NY 10509 Date: 6/26/03 copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 BRUCE R. FOLEY LORETTA MOLMARI R.N., M.S.N. 'Associate- Public ,-Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 OWNERS NAME: TAX NIAP NUMBER: E911 ADDRESS: TOWN: 39 UQ iot-1 i W&N fZoAn ee119 SEG •. �� Q�K'. 2 La T-: �o$ Sv���T�(2 ?(4r SAtJ -r R0iJ Re) AD i?ct IAM AUTHORIZED TOWN OFFI (Signature) DATE: The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERFRM) MONSOON@�T�I��AI�INYTd�L� CRONIN ENGINEERING P.E., P.C. The Lindy Building; Suite 200 2 John Walsh Boulevard Peekskill, NY 10566 914- 736 -3664 Fax 914 -736 -3693 Joseph S. Paravati, Jr. Assistant Public Health Engineer Putnam County (Department of Health I Geneva Road Brewster, N.Y. 10509 RE: 37 CR ®TON (DAM ROAD CORP. PCADH PERIM #]PV -7 -03 22 PHEASANT RUN ROAD TOWN OF PgT NAM VALLEY THESE ARE TRANSMITTED as checked below: September 23, 2003 ❑ FOR APPROVAL ❑ FOR YOUR USE ❑ AS REQUESTED ❑ FOR REVIEW AND COMMENT X PLEASE REPLY WE ARE SENDING YOU attached 1.) Three copies of as -built subsurface sewage treatment system plan 2.) Three certificate of the construction compliance. 3.) Three guaranties of SSTS 4.) Copy of survey showing foundation location 5.) Well driller's completion report 6.) Water analysis 7.) E911 address verification form 8.) $200 certified check for application fee. Should you have any questions or require additional information regarding this matter, please contact me at the above phone number. Thank you for your time and assistance in this matte. Respectfully submitted, Kenne rphy Design Engineer JMS ENVIRONMENTAL SERVICES, INC. 1500 SUMMER STREET M S STAMFORD, CONNECTICUT o6905 NELAC, CT and NY State Certified Environmental Laboratory Mailing Information: Name: PF Beal & Sons Address: 4 Putnam Ave City: Brewster State: NY Telephone: 845 - 279 -2460 Sample's Information: "Site.: =Lot 123 Preservative: HNO3 Temperature: <4C Client: VS Construction Zip: 10509 Fax: 845 - 279 -6613 Collector's Information: Name: Kevin Address of site: Strawberry Knolls City: State: Zip: Telephone: Date Collected: 6/26/03 Date Received: 6/27/03 Time Collected: 13:45 Time Received: 15:00 Lab No.: J034485 Date Analyzed Test Name Result MCL Method 6/27/03 15:00 Total Coliform Absent Absent SMWW 9222B 6/27/03 Chlorine Free Residual <0.1 mg /L N/A SMWW 4500CIG 6/30/03 Color ND 15 Units SMWW 2120 B 6/30/03 Odor ND 3 TONs SMWW 2150 B 6/30/03 Iron <0.03 mg /L 0.3 mg /L SMWW 3111 B 6/30/03 Manganese <0.01 mg /L 0.3 mg /L SMWW 31116 6/30/03 Sodium 8.99 mg /L N/A SMWW 3111 B 6/30/03 Chloride 22 mg /L 250 mg /L SMWW 4500 Cl C 6/30/03 Hardness 102 mg /L N/A SMWW 2340 C 6/30/03 Nitrate 1.34 rrlgfL _ 1,0 mg /L SMWV1( 450 NO3E... '..� r- 6/30/03•10.00 Nitrite- -._ ...o...<0 'I'rm3iL; ._1:0 m� %L ._ - ___ -- • SNinCIIW"45 NO3E_.. :. -- 6127/03 pH * 6.00 S.U. 6.5 -8.5 S.U. SMWW 4500 H B 6/30/03 Sulfate 21.1 mg /L 250 mg /L SMWW 4500 SO4F 6/30/03 Turbidity 0.1 NTU 5 NTUs SMWW 2130 B 6/30/03 Alkalinity 48 mg /L N/A SMWW 2320 B 6/30/03 Lead <1.0 ug /L 15 ug /L SMWW 3113 B Comments: * Below MCL 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 Lapmah ELAP #: 11715 President Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEAIL'I['IHI SERVICES: . GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 07 Ctgo- otj DAM RoA D CoRP. % � 2 6-9 Owner or Purchaser of Building Tax Map Block Lot -s") CRo -t-ON DAM PoAD C.ofZ�. �vTN1jn1 VA t_L6 � Building Constructed by TownNillage 22 P14eAS�NT .Ry�.► Rolq_b Location - Street Building Type ST�d�1,�1��rzRY �iJot_L Subdivision Name Subdivision Lot 12, 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 rivo 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 o erate ro erly i caused by the willful or neQli.eent ,act.ofthe occupant.o.f.the building utilizing the _ .., P .; ate..P...P ..., _ s...... _ .:... system. .._. ... ... _ _ . .. _.. The undersigned further agrees to accept as conclusive the determin tin f the Public Health Director of the Putnam County Department of Health as to whether r n t e ure of the system to ope4�te�s caused by the willful or negligent act of the occup t o ding utilizing the th �_ Day Year 20o Signature (Owner) - Signature 3% C120TaeJ -00- M d20AP cofZ�. Corporation Name (if corporation) Address: ? % C12pT"yel -Pti -1 o(d .O State 0 SS I N I i� 67, hljl Zip 10S6Z Title: "rfZ CID 4-5N 32 CRo T W DAr-i f?oAb CafLP Corporation Name (if corporation) Address:.'% CRoa/4 O2_ 72 - State 0 sS /N /AJ Zip 10 S-6 2 T Form GS -97 SURVEY OF PROPERTY BEING LOT 12 Located In 'M i I 11g; I & M�A As Shown on a Afap Filed in the Putnam County Clerk's Office on May 15, 2002 as map no. 2900 Situate in the TO Jr jV OF IDUITIVAff VAZ[J,[,F, K LO Lot M ,_----_--. r. r_�� �: .. .. ..- .. .t� ... . � . ... . �.� .. _ ...:b� . �i I ;f ............. . . . . . . . . . . . . . . . . . . . . u. , 1p 4z p A W"t I {; 09/30/2003 09:55 9147363693 CRONIN ENGINEERING 1 PAGE 01 4 1N EP�IK m 1 PA(SC 01 09/Zd/2� ®3 13s6a 9147363693 Are ejdj-r)rY ZA fa SEP 24 1$3 A 029 Fe DaL OPP*< Fw$qw'ft- -ra e' A= rer., ro r`l��r_ add !md t 1 o v nn � m «moo i. 41h ® ! lk Ist� it lb e� I ! pile } gob + I 1 4 Pv d Me 47Q ...... �r "A �, r�_ 9sa 1 I.L] «� : P�1 1 c'P4 NTY WmATMENT Cr P , 1 Y .Y :.� ^s's, GC.I drTr '= :r l -36L - Btu - =t-� 1 `d� 7 ..' dlC� :1�II••_.ld:�.C'3� =-C �00e- ? -c35 SEP -30 -2003 TUE 09:33 TEL: 845- 278 -7921 NAME' PUTNA COI INTV 11EMM- Ema."T -- X9/18/2003 15:50 9147363693 CRONIN ENGINEERING 1 PAGE 01 PUTNAM COUNTY DEPARTMENT Of HEALTH DIVISION OF ENVIItONNIENTAL HFALT 11 SERVICES Baer ATTENTION ❑ MM M 13 GENE QUEST FOR FINAL INSPECTION For: All information must be fully completed prior to any inspections being made. PCHD Construction Permit # P V` ? - O 3 Located: -t-l- fH6/4sjRnNT_..'RUN V u I o Ovvner /Applicant Name: 39 Cna 7-01" ,a M fzoasP c Formerly: Subdivision Nan Subdivision Lot # Is system fill completed? r Is system complete? �� Is system constructed as per plans? �� J Is well drilled? Is well located as per plans? Are erosion control measures in place?^ Fill Trenches 1m m AGCe-✓ if . _ Block ? Lo -f $ -O? I certify that the system(s), as li,,sted, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued ICHD Construction Permit and approved plans and the Standards, Rules and Regulations of tbb Putnam Couoty Department of _ .. .- :- Health: ...,.._ � _ ..- - - _��-., - ..5 , :. - _ ?: -�•.- ., Date: I 1$1 200 Cenified by: � oNrr� �N �i��� li- PE — RA Design Pro ssicl Address: 2 To Comments: Form FIR-99 SEP -18 -2003 THU 15:44 TEL:845- 278 -7921 ✓Ka-C INZI Lic. # is F NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 09/19/2003 09:52 91 -Y= CZ1. ti t3 SEP-19-2003 FRI-09.-43 - TEL:845-278-7921' CRONIN.ENGINEERING 1 Illl NAME: PI ITWOM rni IkJTV PAGE 01 twl �lllll l Wz 111 III Illl NAME: PI ITWOM rni IkJTV PAGE 01 twl PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES : CONSTRUCTION PERMIT FOR SEWAGE ;TgEA PERMIT # Located at Pheasant Run Road Town Putnam Valley Subdivision name Strawberry Knoll Subd. Lot # Tax Map 84 Block 2 Lot Date Subdivision Approved May 15, 2002 Renewal Revision Owner /Applicant Name 37 Croton Dam Road Corp Date of Previous Approval -- N/A Mailing Address 37 Croton Dam Road, Ossining, NY Zip 10562 Amount of Fee Enclosed $300.00 Building Type Residential Lot Area 9.12 No. of Bedrooms 4 Design Flow GPD 800 Fill Section Only Depth Separate Sewerage System to consist of 1250 of 411 PVC Perf. Pipe in 2411 Gravel Trench Other Requirements: Volume gallon septic tank and 60y L. F. To be constructed by 37 Croton Dam Road Corp. Address 37 Croton Dam Road, Ossining, NY 10562 Water Supply: Public Supply From Address or: X Private Supply Drilled by / f-x1 ;; �rh / j/ Address T ......,. _.. ,..... _ _ 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 udationg of the Putnam County Department of Health, and that on completion thereof a "Certificate of Constructi . : 06m nYWir`s isfactory to the Public Health Director will be submitted to the yDepartment, and a written guara. �Wv' d fiffsisli the .9wner, his successors, heirs or assigns by the builder, that said builder will place in good op rat 'g nil do past sa y sewage treatment system during the period of two (2) years immediately followi�g,tlfpate th tissua oe'Q the appr valpf the Certificate of Construction Compliance of the original system or any. Signed: // Address 2 John Walsh Blvd; 2 aso JE. �C B Date z-3--o3 ekskill,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 or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new Approved for discharge of domestic sanitary sewage only. By: Title: - f, . Date: Wh' copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 p ± RONIN ENGINEERING P.E. P.C. ' ' The Lindy Building, Suite 200, 2 John Walsh Blvd., Peekskill, New York 10566 k` Tel. (914)736 -3664 Fax. (914)736 -3693 - _ April 1, 2003 Joseph Paravati, Jr. 3 Assistant Public Health Engineer Putnam County Department of Health ' Division of Environmental Services 4 Geneva Road, Brewster, N.Y. 10509 Re: SSTS Construction Permit ` Strawberry Knoll Subdivision — Lot 7, 8, 9, 10, 12 Pheasant Run Road, Town of Putnam Valley Dear Mr. Paravati: Find enclosed three sets of copies of the revised SSTS Plan, dated March 27, 2003 for { each of the above referenced lots. The plans have been revised in accordance with our previous phone conversation and the letters received from your office dated February 27, -M4rch -1.7,2001 . -:Tb, .e SSTS -flan and-profitgfgS IQ—t #12 ha i eeri i iadi ed- - ;Y provicCe a 1:5 °7o slope instead the previously .proposed 1.0% slope from the septic tank to the first junction box. Additional information for lot #7 and lot #9 is enclosed as follows: r Lot #7: 1. Copy of the design data sheet for the deep hole #14a submitted during the Subdivision approval.. The rock depth is 5' or 60" as shown on the SSTS plan. The total depth is 5' 4" instead 54" which is a typo on the Subdivision Plan. -` 2. Copy of the percolation test #14b is enclosed and incorporated on the SSTS plan. 3. Two copies of the proposed residence plan are enclosed showing no doors ' and 6' ft. opening at the conservatory and study room. r, V' 1 Lot #9: 1. Copy of the design data sheet for the deep hole #18b submitted during the Subdivision approval. The rock and total depth is 5.5' or 66" as shown on the SSTS plan. Kindly review at.your earliest convenience. 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, !rr Luis Hernandez Project Engineer Strawberry Knoll - lot 7,8,9,10,12R1,PCDH,03- 31- 03.doc zvor PUTNAM COUNTY DEPARTMENT OF HEALTH N 3 DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS . REVIEW SHEET FOR CONSTRUCTION PER1vfIT NAME OF OWNER: 7 Cr Aof) Q,,A (Zj- 6,e STREET LOCATION: � �SGL✓� 1 �t1 11 I W �` �` . .. REVIEWED.BY: RM, GR, At, SRDATE: 13 /o -3) 1 :(FIIt y / N DOCUMENTS (-yPERMIT APPLICATION ,(�%% WELL PERMIT OR PWS LETTER We-1I e i'-'s UPC -97 , c�:�pf -e hors LETTER OF AUTHORIZATION. - �e v' ¢Prrov IC __)DESIGN SHEET (DDS) J2 -v CORPORATE RESOLUTION �r� b d SHORT RAF" k ( )1 )PLAN S -TDREE SET'S (� )HOUSE PLANS - TWO SETS C- JZVARIANCE REQUEST SUBDIVISION A�LEGAL SUBDIVISION ' SUBD'IVISION APPROVAL CRECKED (_ }PE RC RATE I �vr1! H j ! KG. 6► 7,L REQUIRED]! DEPT$ (�(_)CURTAIIV DRAIN RE UIRED ////// G]ENE]RAL U�OCATED IN NYC WATERSHED (�(�PLANS SUBMITTED TO DEP ( t /}/ DELEGATED TO PCHD L L/ APPROVAL, IF REQ'D (L/J( -DEEP TEST HOLES OBSERVED (—J ,/ EROS TO BE WITNESSED (J - APPROVAL SSDS ADJ, LOTS (� WETLANDS (TOWNIDEC PERMIT REQ'D ?) CV U�ATA ON DDS PLANS & PERMIT SAME (_JCZ)rRE 1969 NEIGHBOR NOTIFICATION (_„)( LETTER. t$UZBA L,,- ) .0Y1@ FLOOD'ELEV�4TIOR:VS.A. i0b -`-..� ( (�9PIL-'IKSTING LOTS'>10 YEARS OLD REQUIRED •DETAILS ON PLANS (,/k—, )SEWAGE SYSTEM PLAN- (NORTH ARROW) SSDS HYDRAULIC PROFILE NCTION NOTES I -15 DATA.: PERC & DEEP RESULTS (�!?�DRIVEWAY' & SLOPES, CUT l opo f �✓;1 LJFOOTRq(; /GUTTER/CURTAIN DK,kl * (,� )UUSDA, SOIL TYPE BOUNDARIES '` (!:�)(-JTI;'TLE BLOCK; OWNERS NAME ADDRESS t" TM#, PE/RA; NAME, ADDRESS, PHONE# (j::�)- DATE OF DRAWING/REVISION (DATUM REFERENCE . (U( ]LOCATION OF WATERCOURSES, PONDS LAXES,WETLANDS WITHIN 200' OF P.L. ✓)PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS (-)WELLS & SSDS'S W/IN 200' OF SSTS �L- )PROPERTY METES & BOUNDS �(�JEROSION CONTROL FOR.HOUSE, WELL & SSTS, EROSION CONTROL NOTE MWENTS: Y / N (REQUIRED DETAILS ON PLANS CONT'D� HOUSE SEWER - 1/:' FT. 4 "0'; TYPE PIPE. CAST IRON �} (_}UNO BENDS; MAX BENDS 45' W /CLEANOUT OTE (NO z; CHANGE) FILL SYSTEMS U(�10' HORLZONTAL; PAST v ES 3:1 TO GRADE -FILL SPECS/ �S 1 -5 c U)U FILE & DIMENSIONS L IN EXPANSION AREA FILL GREATER T '(UU CLAY BARRIER ( )LdjF LL'CERTIFIC NOTE UUDEPTH G S (�(�V N PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS SEPARATION DISTANCE FROMTOE OF SLOPE TRENCH* (� _ _ )LF TRENCH PROVIDED 60FT MAX. 510 (.F ( 1 )� PARALLEL TO CONTOURS (� `100°/° EXPANSION PROVIDED (�UDETkKL/DUST FREE CRUSHED'STONE OR WASHED GRAVEL (.�J(_JGEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM"SSTS Z 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL (�C___)20' TO FOUNDATION WALLS (lQL_)100' TO WELL, 200' IN DLOD,150' T0, PITS U(0100' TO STREAM, WATERCOURSE, LAKE (inc. expan), (Z(_-,)50' TO CATCH BASIN, y35' _ST0RMDRAlXrPj 'ED`WATER.:,p ✓�U�Oy'$tgWATEILINI� (pifs'..20)•- ...:.:.,., _.. , _ .• -. _ • .. --. L4cLj5o,. INTERMITTENT DRAINAGE COURSE 200' /500' RESERVOIR, ETC. 150' GALLEY SYSTEMS 0010' MIN TO LEDGE OUTCROP SEPTIC TANx ZC- ;)10' FROM FOUNDATION; 50' TO WELL WELL (�Vl DIMENSIONS TO PROPERTY LINES ( LOCA TION OF SERVICE CONNECTION }('__)( MIN 15' TO PROPERTY LINE SLOPE LOP!. IN SSTS AREA 1'7�` (S20 %) UUREGRADED TO 15 %, IF REQUIRED • • DOS UMP SYS UUPUMP NOTES )(r)DOSE 95 °/o OF P UMEIDOSE VOLUME NOTED ()C-_)DETAIIL ORCE-.MAIN, (PIPE TYPE, ETC.) U( )P D -BOX SHOWN & DETAILED 1 DAY STORAGE ABOVE ALARM CURTAIN D I V (—)USTANDPIPEES BO , DETAIL (x(__-)15' MIN to C o, 20' -4 %, 15' -3 °l0, 35' -lb /o, 100 °l0 - <1% (- _,)t___)20' CHARGE /100' with 182 cons day discharge (U to NON- PERFORATED PIPE 25; �-�•- �.�,r�z., i i�•� �V,�c.�ic.� ,�r-ea �� w�dz -�.lt It 6e 001A6 ;07�- �; � A,^d V 49 v:" T-no s V" 6a A see-: to ka 4 Pc .' C 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 Joseph Paravati, Jr. Assistant Public Health Engineer Putnam County Department of Health Division of Environmental Services 4 Geneva Road, Brewster, N.Y. 10509 February 5, 2003 Re: SSTS Construction Permit Strawberry Knoll Subdivision —Lots 7, 2 Pheasant Run Road, Town of Putnam Valley Dear Mr. Paravati: LOT (r The following information has been enclosed for each of the above referenced. subdivision lots for your review: 1. Three copies of the SSTS Plan prepared by this office and dated January 30, 2003. 2. Letter of authorization. 3. Affidavit Corporate Owner application. 4. Application for Approval of Plans for a Wastewater Treatment System. 5. Design Data Sheet — Subsurface Sewage Treatment. 6. Construction Permit for Sewage Treatment System. 7. Well Completion Report for lot # 12. 8. = Applieati�i to Constn:ct a Water Well for lot #7: 9. Short Environmental Assessment Form. 10. Application fee of $600.00 ($300/lot). 11. Pump / System Curve for the proposed pump to serve lot #7. 12. Two copies of the house 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 ubmitte , uis H andez Project Engineer cc: Val Santucci StmwbeayKnol tL4&7,12,PCDH,02 -03-03.doc 0 :k7# �� � � �� CO IL]E'i'fER OF AYJ'd'gIORtZAi'IORI RE: Property of 37 Croton Dam Road Corporation Located at Mill Street (CR #23) / Lover's Lane) — oiv F0,4_-0, T/T Putnam valley Tax Map# 1494 Block X Lot 6°,9 Subdivision of Strawberry Knoll Subdivision Lot # Filed Map # 2960 p - jf Date Filed 1 (A X 14-,,206L Gentlemen: This letter is to authorize Timothy L. Cronin III a duly licensed Professional Engineer x or h4M 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 Dep to sign all necessary papers on my behal 'n connection with this matter and to sups '�'� N c Y0 ion of said wastewater tre e an r wa oth upply systems in conformity t`Provisioi% ` icle 145 and/or 147 of Ed atio Law Public Health -Law, and -the i t anrt ot-._.- .. r i z Very truly uFs 1, ` Countersigned: . ,ru ~KUF sS�o�P- Signed: M P.E., R.A., rr _ 8 0 (0 f Prope ) ` Mailing Address 2 John Walsh Blvd. , #20o Mailing Address: 7 Croton Dam Road Peekskill Ossining State N.Y. Zip Telephone: (914) 736 -3664 10566 State NY Telephone: (914) 739 -7362 Zip 10562 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: Construction of SSTS and Water Supply 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: Addire�s"- Treasurer - Name: Address: Michelle Santucci (Same,.: as -aAbcve 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 relatil Sworn to before me this day of month) �!�. , (year) Notary Public KELLY M. LENT Notary Public, State of New York No. 01 LE6026834 Qualified In Westchester Coun Commission Expires June 21, 2&'. Form CA-97 Sine Title: Corporate Seal on with respect PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Welitoeafion - Street Address: Mills Street, Lot 12, Strawberry Knolls Town/Village: Putnam Valley Tax Grid # Map 84 Block 2 Lot(s) 5 Well Owner: Name: Address: VS Construction, 37 Croton Dam Road, Ossining, NY 10562 Use of Well: 1- primary 2- secondary X Residential Business Industrial Public Supply Air cond /heat pump Irrigation Farm Test/monitoring Other(specify) 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 6 gpm Depth Data Measure from land surface- static (specify ft) 20' During yield test(ft) 625' Depth of completed well in feet 665' Well Log If more detailed information descriptions or sieve analyse.----.- � are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation )(Description ft. ft. Land Surface i 15 Hit roc at 15' _.- _....15 . _ ... :. _ 32. -• :Dr ll n n °rock set casiri , routed• - 32 665 Drillinc in rock Q ranite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type, Capacity Depth Model Voltage HP Tank Type Volulne Date Well Completed 2/13/01 Putnam County Certification No. 002 Date of Report 3/12/01 Well Drill si D NOTE: Exact location of well with distances to at least tw etTrtanent landmarks to be provide a separate sheeVplan. Well Driller's Name P. F. Be s' c. Addres Ave., Bois s , NY 10509 Signature: Date: 3/12/01 Perry L. Beal White copy: HD File; Yellow opy - Building Inspector; Pink copy - Owner; Orange copy - Well driller PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL.HEALTH SERVICES DESIGN DADA -SHEET —SUBSURFACESE`VAGE TREATMENTS STEM' Owner 37 Croton Dam Road Corp. Address 37 Croton Dam Road, Ossining, NY 10562 Located at (Street) 109A,' ITax Map_ 8 Block Lot �6'8_ (indicate nearest cross street) Municipality (T) Putnam Valley Drainage Basin Peekskill Hollow Creek 1 SOIL PERCOLATION TEST DATA Date of Pre - soaking (per ^ /G -OD Date of Percolation Test Q f — i7—D O , Hole No. Run No. Time Start - Stop Elapse Time (pl-Iin.) De th to Water from Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 27 2 9 2 -1 q 2 %4 5-1�- �� i3 4 21- 2 3, 7 217 /I 3 �� -� _ I1�3 a-0 4 5 .21._-.�2 31.�... :.�..7...... . ��.._ 3 2 31 5— 29, -a 12 4 5 1 2 3 4 5 fNOTES: 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 .IN TEST HOLES HOLE NO. z.I A HOLE NO. • .2 41-.6 . HOLE NO. 0 ve V1. vez, w vry .....• ..c. .. Indicate level at which groundwater is encountered AfA Indicate level at which mottling is observed Af/A Indicate level to which water level rises after being encountered A11A Deep hole observations made by: Adam Stiebelingl Keith Staudohaur Date D�Z -27 -OV PCDH Cronin Engineerin' i7w Design Professional Name: Timothy L. Cronin III A. Address: 2 John Walsh Blvd. #200 Signature Design Professional's Seal I LU \'v'YUFt -\0\s Y 11NA1V1 kV UIN 1 Y l)LYAKIIV1L1N 1 UV' JULAL11i DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 'i•.a v —.. .:..... Jtye.. -�. .�.._w.a _.�.� ri. n. .+F.'. __. .. . .:ti .r —...: re`s iC' "..�.r • ".:. -. �Yji.y �- +:.:.�w___...y.. _i:.p'.:iP.'+*C... •�' .. YY ,^ii= I. Name and address of applicant: 37 Croton Dam Road Corp. 37 Croton Dam Road Ossining, New York 10562 2. Name of project: Strawberry Knoll Sub tot. 4. Design Professional: Timothy L. Cronin III 6. Drainage Basin: Peekskill .Hollow Creek 7. Type of Project: X Private/Residential Apartments Office Building 3 Location TN: Putnam Valley 5. Address: 2 John Walsh Blvd; 200 Lindy Bldg Food Service Institutional Realty Subdivision Peekskill, New York 10566 Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review,(SEQR)? Type Status (check one) ........................ ............................... Type I Type II 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency. Town of Putnam .Valley Planning Board Exempt Unlisted x NO N/A 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... Yes 13. If so, have plans been submitted to such authorities? ...... ............................... Yes 14. Has preliminary approval been granted by such authorities? Yes Date granted: Jan 2001 15. Type of Sewage Treatment System Discharge ................. surface water x groundwater 16. If surface water discharge, what is the stream class designation? .................... N/A 17. Waters index number (surface) ........................................... ............................... N/A 18. Is project located near a public water supply system? No 19. If yes, name of water supply 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) ............................... 800 Gal /Day 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? ......................... NO NO Form PC -97 27. Is any portion of this project located within a designated Town or State wetland? �V® 'J 28. Wetlands ID Number ............... ............................... .................. .......................... N/A 29. Is Wetlands Permit required? No Has application been made to Town or Local DEC office? . ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ................... ............. 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No 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 DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ........................... NO NO NO NO YE S 2 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 37. Approved plans are to be returned to ..... Applicant x Design Professional NOTE: All applications for review.and.anproyal of a new SSTS to be located within the NYC Watershed_-shall - be sent to the eparunent; and need not be sent in�duplica"te.to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require.DEP review and approval of other aspects of a project, such as stormwater.plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item I .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information proifked on tfr%s, r � is true to the best of my knowledge and belief. False sta emen s ma e- purr h' le as a Class A misdemeanor pursuant to Section 10. S o the ena 44, , - -, r ) w SIGNATU ES & OFFICIAL TITTLES: /J�cO 629$o Timothy L. Cronin Nk��r�aoN Mailing Address: ................................... Cronin Engineering, PE PC' 2 John Walsh Blvd; 200 Lindy Bldg; Peekskill,NY 10566 PROJECT I.D. NUMBER 6t7� SEAR Appendix C State Environmental Quality Review �SHORT ENVW6N* N': TACASSESSMENT _FORM For UNLISTED ACTIONS'Only PART t— PROJECT INFORMATION (To be completed by Applicant or Project sponsor] v It 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 I - APPLICANT ISPONSOR 2. PROJECT NAME 37 Croton Dam Road Corp. Strawberry Knoll, Sublot # / • S. PROJECT LOCATION: Munklpagq Town of Putnam Valley county Putnam County a. PRECISE LOCATION (Strsat address and rob Intersections, prominent landmarks, st—, or provide map) Pheasant Run Road S. 13 PROPOSED ACTION: ® New ❑ E:pansW ❑ ModlfleallWalteratlon I. DESCRIBE PROJECT BRIEFLY: Construction of"Subsurface Treatment System to serve a Single Family House 7. AMOUNT OF LAND AFFECTED Initially 3. I Z suss Ultimately 3, I Z acres B. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yea ❑ No If No, dsecrlbe brlelty 1. WHAT IS PRESENT LAND USE IN VICINITY Of PROJECT? Q R 61CIN tlal ❑ Induatrtal ❑ Commarclal ❑ Agriculture ❑ PutlForestlOpen span ❑ Otrw Deeeribe: •_:Surrounding Lands are zoned Single Family Residential • r 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY'OTHER GOVERNMENTAL AGENCY (FEDERAL STATE OR LOCAL)? ® Yes [IN, If Ices. [let agency(,) and permlUapprovels , Town of'Putnam Valley Building Permit 11. DOES ANY ASPECT of THE ACTICV HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? uYM ❑ No If yw ust ag, name and pem mappm., Subdivision Plat Approval - "Strawberry Knoll Subdivision" 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REOUIRE MODIFICATION?• ❑ Yea ® No 1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE 13 TRUE TO THE BEST OF MY KNOWLEDGE AppIkar,ttopma" Mme, Cronin Engine r' h Staudohar Dale: Slgnalura: v It 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 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES Acnom EXC ED ANY TYPE I THRESHOLD 194 0 NYCAR, PART 017.129 It yea, coordinato tha rovtov P opo and up© ute FULL EAF. 0 Yco S. WILL ACT10N RECEIVE COORDINATED REVIEW As PROVIDED FOR UNUSTED ACTIONS IN A NYCAR, PART 017.07 It No. a nogativo doclaratlon may be aup®reedod by anolhor Involved agony. Cl Yp 0 "cause Q Olti 6Cafw iw AA1V AovdkiE&Fadr8 ASSOCIATED WITH THE FOLLOWING: IAnovoro may bo ftw4 rttten, It bglbEOl Ct. Exloling air quality, ourfaco W grouoderotor quality or quantity, noloo lavolo, existing ?(affix paticnla, ootld vraoto production or dlopoaal, polontlal lot croslon, dralnago or Heading problomo? Explain brtotty: CS Acalhatic, agricultural, arehacaloglcal, hlalorte, or olhor natural or cultural rosourcoo; or eammunity or nelghbarnoad character? Explain bdofty: NO O i/7 �- C3. Vcgotallorl at fauna, flan, aNillloh or rrildllfa opccloo, algnlflcant habltato, or threatened or cndaneorcd spazloo? Explain brlolly: IvIgne— Ca. A caminunity's existing plans or gooia as officially odoplod, or a chango In use of Intonslty of uao of land or olhar natural resoumm? Explain Wally A/v 4 J CS. Grown. subsoquont dovolopmont. or rolatod aetivitloo likely to bo Induced by the proposed action? Explain brtolty. Cab. Long term, short torm, eumulatlw, or other affects not identified In C1-Q7 Explain Wally. C7. 01" impacts Qncluding changes in use of outlet Quantity or type of onorgy)? Expialn brioliy. V 4 YIA-'-' D. 10 THEAF- OA Is THERE LIKELY TO @a. CO94TA4V9RSY RELATED TO POTENTIAL ADVERSE ERVIRO9lM&STAL IMPACT27 ❑ Yoe It Yea, onptaln bi,*fly - - - (DART IID ®®(ETE.RABINAT)®M OF 380NIFI CE (To ba completed by Agency) 104S1T UC'Y'tt & For o®an ®f7vct kWollitl®d ?above, dattarmine erhwha It to subatrintial, ttas , Impwtont or other alam Wgnlf;erutt. E=A off= should bo asamosed In connection with Its (a) Betting p.©. urWn or rural); (1b) probability of ot:currin (e) dunWon; (d) Iff0viarnibdift. (a) gwgruphic €at:w; and (I') magnitude. It risc a amy, edd attachmonta or rcifertmw ouppo ting matertab. Enaum that ®x8lrrauatlorts• contain cuff slant &ttdl to shmv abet all rtaievwt adverm Impacts have b=n Idcniffled and QdeWteily addressed. ❑ Check this bolt If you haw Identified one or more potentially large or aigrdficant advc=Q Impacts which WAY occur. Than proceed directly to the FULL EAF ancyor preparo a pooittve doclam mL bK—Chack this bolt If you how detwi mined, based on the Information and ww4Wa abcrm mW any supporting documentation, that ft pnopoaW action WILL NOT r® u(t In any significant advimmi onnironmental Impacts AND provide on attrachmonts as necesawy, IM reawns supporting thio detcarmination: 4�—'Q t QQ VIM PoartIQ Or A0356-10MtKof In LoM AGency Title espans or j613n4tum or ROSPOAS101<1 Ullicer in Laos AawKy iQnatura at Pr"Mir v (If diffamm Iram M90=U6660 or iced • Date 2 r u tiNA.M COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION ���..� Date: Ins ected by: Street Location �t S� t� /L rC. ��� Owner oy Z7 ,. TM # - Subdivision Lot # 51 ,; 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 ............... ....................... H. Sewage System a. Septic tank size - 1,000 .... ..... 1, 250 ..... .... other ................ b. 'Septic'tank installed level ..... ................................. :.....:... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevatio - aver- teste3 ... - �..f'. 2. Protected be .................. ............................... 3. - _M, ' 2 ft.Original soil between box & trenches e. Function Box - properly set ..... ...................................... 6. 1 renc es 1. Length required y 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 -1 1/2' diameter clean ...................: 9. Depth of gravel in trench 12" minimum .......:........... 10. Pipe ends capped ............................. ... .......... ,g. Pump or Dosed, ystems . - 1: - Size -of pump- chamber: � '"......... ,A /. .....:: 2. Overflow ta�a-u �io.*.*. ............... ........... 3. Alarm, vis :........:.. .... ........................... 4. P asily accessible, manhole to grade ................. _5,-First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Building a. house located per approved plans ............................... b. Number of bedrooms ................... ............................... . IV. Well Well located as per approved plans ................................. b. Distance from STS area measured ( (9 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 watercour g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ........ :........................... i. Erosion control pprovided ................. ............................... Rev, f2/02 r i/ rte= owl { III � r SUE NSFE.C.TIONX.OPLELLY 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: Al, am WELL LOCATION c.%` CV D,� AS' qW 10e. 5'1 AM W tXISMG jiWER,6441M X7*. 4Lr -41, V "0 V Lot 12 Z v" tt L?_ L ib t tf CEA AAIO 4. 1. • ND Z OF T�S X. A W 111' I A ND Z OF T�S A NOB1H ,EWVF'l . S TRDVCN'. 49, 70. SOUT�;,'E-ND 1OF - 76r':.'- '.%4&5`�- SOUTH END QF:'.47H. TRENCH 5 52.5' BOX A. 2D7 :2025 SOUTH-'-END.Oo.:, J5g., 1.62 xF DISTANCES TQ; �-&M ND Z OF T�S NOB1H ,EWVF'l . S TRDVCN'. 49, 70. SOUT�;,'E-ND 1OF - 76r':.'- '.%4&5`�- SOUTH END QF:'.47H. TRENCH 5 52.5' ?f-,,57?� TRENCH SOUM,END't 60'., 53, DISTANCES TO' -N0R7P-';EN0-.0FSS;7� NOB1H ,EWVF'l . S TRDVCN'. ij. '51.- 70. NOP97 I END 11 --OF' M,V." M061,1. - 76r':.'- '.%4&5`�- NLW. itfi E OF '.47H. ND, .79.5' 52.5' '84.5'. 53, 1 SUBSURFACE SEWAGE TR£A7AlENT SYSTEM (SS75J 15 QESIGNED., to ON A SQJL- PERCOLAi7DN RA1F Jf`.'TO f5 AdINUTES PER U 2 INCH DROP (SEE S01L DATA SHE�7) .�. .� 300 .. s a 2. ,ENG!lJEER 'WAS NQIIFIED PRi[)R T0,= 5TAR7YNG WORK AND �rE✓JS!J/ E PRIOR TO`BACXFILUNG TRENLH£5. (_ sot (5OJ '. -- �� J ',\ z 5 S N 3.' UNAU7FiOR/ZED AL'7FRAj7lxVS:OR ADD070VVS TQ 7H 0R,40 YS 0. N Zp W&AifON OF.SE&ON•7209 (2) OP' 1HE W W XDRK S'TATE••• _ J ° _ ` £ EDUCA77ON LAW AA.7E:' "03 22 7001 LLi .V 4 'HOUSL� AND- SELL LOCA ilOrV H? M RES??ECl TO 7?ROPER7 LINES .14AS a LL Z Sl/Ri�YED AND PREPARfIi BY.. DONNELLY LANpiSUJt'li£)�lJJG,.P.0 .', - 9 - z 5. PROPER 2 C7!TY,N 'IffRY KNOL AS ,. -. t -.' :/ � p / Z ShOWN' ON A AIAP FILED 1N,.7iYE PlJTIYAk - C011iVTY CLERKS OFt7CE 7 ey ON. A#A'Y, 1'S; , A5 sMAP, iVo 2900. _ - V - f �laj' `/ / , f ;! . •'µ v � 0� NEW yOR� (I J JtV\y •` v�. 1 �. .�. .� 300 .. s �_._.— ���;�," ��� �rE✓JS!J/ (_ sot (5OJ '. -- �� J ',\ z 5 ion 6B ' 0. — _ J _ ` AA.7E:' "03 22 7001 `'• ,. tWr �'AN9OV AREA . - 9 - ,. -. t -.' :/ � p / I! - - �-3'a& PENF.P,YC 7N 4" GRRVF! M-1MJY ,'' 7 '� � � "Tav� - (Eh'35 ARE Cr•PPEOP ' :l - - f �laj' `/ / , f ;! . •'µ v � 0� NEW yOR� (I J JtV\y •` v�. 1 .�. .� 300 .. s �_._.— ���;�," ��� �rE✓JS!J/ (_ sot (5OJ '. -- �� J ',\ z 5 ion 6B ' 0. — _ J _ ` AA.7E:' "03 22 7001 ,. tWr �'AN9OV AREA . - 9 - v � 0� NEW yOR� _•' ti. 0 h� J JtV\y •` Y 'y 7F. ••. 1 W 4L )MY, 7N�A . ZHE' SEN/AGE:DtSPOSAC SYSTEM WAS /2 /� ED AS /ND /GATED. QN THIS PLAN AND THAT 'THE SYSTEM etgao �`• ^1ED BY ttME BEFORE 'I T WAS. V& ED OttR. ':THE SY$ M "STANDARD ol RUC7ED IN ACCDRDANCE WTJHCALL RULES .. -THE — O .A770NS OF PU77VAM C0dNTY D£f?AR7%IENT Of HEAL 1H •'= rrW YORK ;STATE DEPAR? AU NT OF K£AL7N ° LL X:•' } ` SEWAGE @EAVUENT sMEh pe v DEP.r of REAL rH- R c . A 1250, GALLON CM0.9 1E- SEPTIC TANK AND 500E F. 11,AliC PIPE IN 2d" GRAVEL TRENCH PUTNAM COUNTY.DEPARTMENT OF HEALTH > ;::.DIVISION ff ENVI ON NTIP LTH.SkRACES •--fd " �° >AIN' ROAD 'CORD 37 CROTOr?! DAAI';ROAD qP(P APPROVED AS NOTED FOR CONFORMANCE WITH ! >AM..ROAD .. V CR01G1Y DAM ROAD _ APPLICABLE RULES AND REGULATIONS OF THE 10562 QSS/N1NG „ -iV Y t05S2 P COUNTY HEALTH DEPARTMENT: GNA � V t :• BY PEEKSK /LL' .HOLLOW .BR00K .• r• a , UREI I ,SON$., /NC' . 1 :. GTY OF PE£KSK2L ,f4WT- DYSHE9 '' •. '.. ENUE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location ye6evim Street Address: Strawberry Knolls, Lot #12 Town/Village: Putnam Valley _ - Tax Grid # 84 -2 -68 Map Block Lot(s) Well Owner: Name: Address: VS Construction', 37 Croton Dam Road, Ossining, NY 10562 Use of Well: 1- 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 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 12 Yield 8 gpm Depth Data Measure from land surface- static (specify ft) 18' During yield test(ft) 150' Depth of completed well in feet 665' Well Log If more detailed information descriptions or sieve analyses .. ..... are available, please attach. Depth From Surface 'Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 15 Drilling Hit rock at 15' -, -1 -5 32 Drilling in-rock,'-set cash, , .; "routed 32 665 nrillina in rock --anitp 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 620' Model 5GS15412 Voltage 230 HP 1� Tank Type M02 olu 8 al. 1, Date Well Completed 2/13/01 Putnam County -Certification No. 001 Date of Report 6/26/03 WelWr. PeBeal l rvi r;: txact location of well with Well Driller's Name P. Signature: Perry L. White copy: HD File; Ye to at least two permanent landmarks to be provt�d on a separate sheet/plan. p' Address: 4 Putman Ave., Brewster, NY 10509 Date: 6/26/03 copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97