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BOX 34
04459
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04459
PUTNAM COUNTY#EPTMENT OF HEALTH
I: O,-I r_ O - _ N,V .ate , ;.. " '
A -
CERTIFICATE OF CONSTRUCTION COMPL.I`ANCE FO VV T ATMENT SYSTEM
PCHD CONSTRUCTION PERMIT # RV,
Located at S -1 M 1 + XT fR 66'f T . V or Villag i �A rh
Owner/Applicant Name 39 cgorod OAM 120A(2 & Tax:M /5" Block
Formerly Subdivision Name NMLSo:.i
Snbd. Lot # 2
Mailing Address S -7 r► 1 i s- --r 12.6E 1'. � a , ?1�? ,%►.; t� �L4' `f . N. y Zip 7 04-'7
Date Construction Permit Issued by PCHD 1 'Z ..1: U
�'i Cf2oT0�i D!-}r►+ y2. b(#.�
SeFarate Sewerage S, sv tem built by �� cr�o� ��. t9 r4. 1?0AP col- Address sass a ii 4 Aj C Ail./,_ / o 5-c"2
Consisting of 12 57 Gallon Septic Tank l= - %'� iZ 1 o ii fa i'Ld P��
Other Requirements:
Water Sunoly: Public Supply From Address
Private Supply Drilled by`PF Address zCw—rr Lk OZ- 5
_^-s 4gftft vrosic'h= control been comp e 3K
Number of Bedrooms "Fa u -L Has garbage ender been installed?
I certify that the system(s), as listed, serving a �`mise « nstructed essentially as- shown on the as-
built plans (copies of which are attached) A#&e is CHD Construction Permit and approved
plans and the standards, rules and reg ation o e ; , e ent of Health.
W
w
Date: - 3C1 -0 Certified by `* P.E. i�A ----
Address 2.w k.� L i, 34)7, License # .C,! 6 Z- °j c ' .
Any person occupying premises served by the above, sym( "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 asi, 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
revocatio , modifi lion r h e 's ecessary. :
By: Tide :: l Date: j 0 l7 O
White 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
57 WELL COMPLETION REPORT
S i Location '+
treet ,address" Mills Street,
Lot #2, )
Town/Village:
Putnam Valley
LTax Grid #
apes{ /SBlock Lot() i,c—,z
Well Owner:
Use of Well:
1- primary
2- secondary
Drilling Equipment:
Name: Address:
VS Construction .Cor ., 37 Croton Dam Road, Ossinin , NY-10562
X Residential Public Supply Air cond /heat pump Irrigation
Business Farm Test/monitoring Other(specify)
Industrial Institutional Standby
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 92 ft.
Length below grade 91 ft.
Diameter 6 in.
Weight per foot 19 lb /ft.
Materials: X Steel _ Plastic _ Other
Joints: _ Welded X Threaded _ Other
Seal: X Cement grout _ Bentonite Other
Drive shoe: X Yes No
Liner _ Yes X No
Screen Details
Diameter (in)
Slot Size
Length(ft)
Depth to Screen (ft)
Developed?
First
_ Yes—No
Hours
Second
Well Yield Test
Bailed X Pumped X Compressed Air
Hours 6
Yield 8 gpm
Depth Data
Measure from land surface- static (specify ft)
30'
During yield test(ft)
300'
Depth of completed well in feet
365'
Well Log
If more detailed
information
descriptions or
�cveanaec
are available,
please attach.
Depth From
Surface
Water
Bearing
Well
Diameter(in)
Formation
Description
ft.
ft.
Land Surface
55
Drillind
in overburden
clay and boulders
55
Hit roclk
at 55,
y5
g2�•...r.;
. Dri l,iri:
-in= rec;'
�;.: `set -caSiii' Yrout=ea _ - .. .
92
365
Drillind
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 7gTpm
Depth 320' Model 7GS10412
Voltage 230 HP 1
Tank Type WX302 m8 al .
Date Well Completed
7/9/01
Putnam County Certification No.
002
Date of Report
9/6/01
Well Dr' r
P Be 1
1`4%11 r.: DXdl:l IMULIUn Ut wen whit
Well Driller
Signature:
White copy
Least two nermanent ianamarlcs to oe p ea on a separate stteeVnian.
Address: 4 Putnatrt Ave., master, NY 10509
Date: 9/6/01
copy - Owner; Orange copy - Well driller
Form WC -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
�:.v•.:i`i.,y: °-+'. .:e -"..V, - a';�'= ^•.°._ .<a '.�•� _-a r :.�..�.'�•~r'i�rs"Y�'cy� c. .'"-.'`"'. t^".-x.� _ :; :� ' e;'3..r.'= 's� :.�t.!`er,"°.�e`•c
GUARANTEE OF SLBSURFACE SEWAGE TREATMENT SYSTEM
ZdAo cofZP. $4.
Owner or Purchaser of Building Tax .'iap Block Lot
3 7 cRo rdrJ VA/'4 Ra /qn Co U- r"J'�on, Vn LAG (I
Building Constructed-by Townie
MILL S TIZe e- r—
Location - Street
CL e-
Building Type
C J-rja ,r wej ✓q -
Subdivision Name
2
Subdivision Lot
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 piace in good operating condition
any part of said system 'constructed by me which fails to ope:ate 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 or negligent act of the occupant of the building utilizing the
�++ tvsyJ��.n� :.,U, ... _ ,s -. '_,_ .' __. _. ._ c.� -- v ., _, .. ..a,. -.. -- r...._ �.� .. .ca °ua, -•y a' .. y .�. ..—. ...�. .- ..... -._ �.. - ..-...
The undersigned further ;agrees to accept as conclusive the determination of the PVe Health
Dire ter o tZutng County Department of Health as to whether or n t the it e o system
to o erat .w au by, th e willful or negligent act of the occupant the i Dina zina the
T Hay 21 Year 200 (
) - Signature
Corporation Name (if corporation)
Address: 37 cRo 7 bf-J PA6 j2dA'-`
State 6 d'.IJ-IJ iw C �� .y Zip
Signature:
Title: OVAJ7 1
3? CTZ n 0AJ 4:�GA /2o rob co lzr,
Corporation Name (if corporation)
Address: X 7 CRq- ,�J 'M IZP
State &-UI AJ /AJ E,.n! -LZip 10 96'7�–
Form GS -97
NE
NORTHEAST LABORATORY oF• DANBURY �0 kN ACCobo -
,. _ ' 9-Ir4404=
.
203) 748 -7903 -'FAX (203) 748 -0652 NY Cert: 11471
LABSSS a R www.NORTHEAST LABORATORIES.com <
• ' O ;i' .
REPORT TO:
P.F. REAL & SONS
DATE SAMPLE COLLECTED: 8/21/2001
4 PUTNAM AVENUE
TIME COLLECTED:
1:15 P.M.
BREWSTER, N.Y. 10509
COLLECTED BY:
KEVIN B.
ND
DATE RECEIVED @ LAB:
8/21/2001
•
TESTED BY:
LAB #11471 & 11715
6.78
LAB I.D. #
PFB -88
No designated limits
REPORT DATE:
8/29/2001
0.20
L . x ragEF T
EPA 180.1
SAMPLE SITE:
V. S. CONSTRUCTION CCiRP., LOT #2, `: &9WXftdCftW,
MILLS J ., ?iii`T�:�1 VAULEY, r: :Y
SAMPLE POINT:
HOSE BIB @ TANK
SOURCE:
WELL -NEW
<0.005
TREATMENT:
NONE
:0. mgiL . '
•
Nitrate Nitrogen
MAXII UM CONTAMINANT
TEST PERFORMED
RESULTS METHOD #
LEVEL (MCL) OR STANDARD
BACTERIAL:
• Total Coliform (Bacteria) 0 . per 100 ml SM 9222B 0 per 100 ml
PHYSICALS:
•
Color (Apparent)
0
-
EPA 110.2
15
•
Odor
ND
-
-
3 Units
•
pH
6.78
-
EPA 150.1
No designated limits
•
Turbidity
0.20
NTUs
EPA 180.1
5 NTUs
•CHEMISTRY:
•
Nitrite Nitrogen
<0.005
L as N
'EPA 'sS4.1 "
:0. mgiL . '
•
Nitrate Nitrogen
0.192
mg/L as N
EPA 353.3
10 mg/L
•
Alkalinity
8.0
mg/L
SM 2320B
No defined limits
•
Hardness
24.0
mg/L
EPA 130.2
No defined limits
•
Iron
<0.03
mg/L
EPA 236.1
0.30 mg/L
•
Manganese
<0.01
mg/L
EPA 243.1
0.50 mg/L
Combined limit for Lon plus ivianganese = 0.50 mg/L
•
Sodium
<1.0
mg/L
EPA 273.1
20.0 mg/L **
•
Lead
<0.001
mg/L
EPA 239.2
0.015 mg/L * **
ml= milliliter mg/Irmilhgrams per Liter ND =none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count
* "Notification Level *' *Action Level
COMMENTS:
-All holding times (were) met.
SAMPLE, AS TESTED ABOVE: MOTABLE or ONOT POTABLE
(PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER)
RESULTS BASED ON SAMPLES SUBWHTTED: 8/21/2001
Laboratory Director
•NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037° (860)828 -9787 - FAX (860)829 -1050
TOLL FREE WITHIN CT: 800 - 826 -0105 c OUTSIDE CT: 800 - 654 -1230
Public Health Director
.: Y..r. - . J. :,:- 'f..��AlL i��'R aMi�ViXi��,•ZV{, �� �r�Y�Ir.'. .. .'��
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (914)278-6130 Fax (9.14) 278-7921
Nursing Services (914) 278 - 6558 .WIC (914) 278 - 6678 Fax (914) 278 - 6085
Early Intervention (914) 278 - 6014 Preschool (914) 278-6082 Fax (914) 278 - 6648
E911 ADDRESS VERIFICATION FORM
OWNERS NAME: _107 CRo i oN DA/n RoA0 CORP
TAX MAP NUMBER: $C . S . /� Fs�G 1{: l L o?' = / 97 '� Sv IrCxo T = `L
E911 ADDRESS: MILL STR E ?'
TOWN: pu T A r-h VA L La Y
AUTHORIZED TOWN 'OFFICIAL:
(Signature)
DATE: -7/2 6 h o0 1
.. ..-.- r . — �.- ..•.� - . w .. ... .w .. N - .q vti -y.. - .yey,.,..•ti. _� .... a. ...- - .ra- a r -- �.. were. -r -.... ... .r. .-..r. as' ,v a.-vs i..y.. ... y
The Putnam County Department of Health will not issue a Certificate of
Construction Compliance unless the above form is completed, ie., 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 VERFRIvI)
M 7R[2 W W n
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
Adam B. Stiebeling,
Assistant Public Health Engineer
Putnam County Department of Health
1 Geneva Road, Brewster, N.Y. 10509
RE: 37 CROTON DAM ROAD CORP.
"NELSON / LEWIS ESTATES WEST SUBDIVISION"
MOLL STREET, LOT 2
P.C.D.H. PERMIT #PV-51-00
August 30, 2001
THESE ARE TRANSMITTED as checked below:
❑ 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.) E911 address verification form
6.) $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,
Kenneth M. Mu y
Project Designer
WO
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
,i:' � .�'o :C �4:y�- ...wki• -. ..- ti�o-... . _....,b a.-.. .-r. ....�. r. .•�.'.. � .• r...�,�,'n iy: � 1 R+'...i •- - � o- .._ . _. w..6: i•.T�.: .. .ww. �•i� •... . -^
GUARANTEE,OF SUBSLRFACE SEWAGE TREATMENT SYSTEM
37 ZoAi:2 cofZIf
Owner or Purchaser of Building
3� C_Ro_ Olj �bilb GOR%�
Buildina Constructed by
MILL s T'R.e e r—
Location - Street
(I�+CLG �I�l� � �.. y IBC f (���!✓ C�r
Building Type
aj- IS (
Tax -lap Block Lot
UT;,J "Or, 'VA Li G y
TownNtfazae
Subdivision Name
Name
2
Subdivision Lot T
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
herebv guarantee to the owner, his successors, heirs or assigns. to oiace 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 or negligent act of the occupant of the building utilizing the
The undersigned further aarees to accept as conclusive the determina 'on o'
Director pf tjh e Putn m County Department of Health as to whether or the f
to operate vets c ed v the willful or negligent act of the occupant th
9" 6Uf T Year
Title: FRETi
(Owner) - Signature
th
iAg the
7 C�Zs 0Z a i �� 4-4^ )ZO IOb Ce A',
Corporation Name (if corporation) Corporation Name (if corporation)
Address: 37 CRe i dA. LW6 /Z dA`P
State 6 r.rj-J 4< Y Zip I oS'r--L
Address: T2 CRa7 6-4j
State O- U/A/ /,w �fv-Y. Zip lOS6"�
Form GS -97
RONIN ENGINEERING P.E. P.C.
The Lindy Building, Suite 200, 2 John Walsh Blvd., Peekskill New York 10566
Tel:( 91436�6�,�1g.�aar.(914).36.3603
September 11, 2001
Adam B. Stiebeling,
Assistant Public Health Engineer
Putnam County Department of Health
Division of Environmental Services
1 Geneva Road. Brewster, N.Y. 10509
Re: ")STS Construction Compliance
37 Croton Dam Road Corp.
P.C.D.HPermit #PV -51 -00
]hill Street, Lot 2
Town of Putnam Valley
Dear Mr. Stiebeling:
rEnclosed Hs the•-following information necessarytor °fujl approval for`the abov referenced
project: .
1.) Laboratory Report
2.) Well Completion Report
The original construction Compliance package was submitted and received by your office
on August 31" for review only.
Kindly review the documents enclosed. Should you have any questions or require additional
information please contact me at the above number. Thank you for your time and assistance
in this matter.
Respectfully submi ed,
enneth M. Murphy
Project Designer
10/17/2001 15:59 9147363693 CIIN ENGINEERING 1 PAGE 01
- l T
Li
he ndy Building, Suite 200, 2 John Walsh Blvd,, Peekskill, New York 10566
el, (914)78&9669 • Fax. (914) 7M.3693
OCTOBER 17, 2001
ADAM S. STIESELING
PUBLIC HEALTH ENGINEER
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL SERVICES
I GENEVA ROAD BREWSTER, N.Y. 10509
RE. • SSTS CONSTRUCTION COMPLIANCE
37 CROTON DAM ROAD CORP.
P. C. D. H. PERmIT #PV-51 -00 .
57 MILL STREET
TOWN OF PUTNAM VALLEY
DEAR MR. STIESELING:
THIS LETTER IS TO INFORM YOU THAT VAL SANTUCCI WILL PERSONALLY BE PICKING UP THE
CONSTRUCTION COPLIANCE WHEN THE PUTNAM COUNTY HEALTH DEPARTMENT HAS ISSUED FINAL
-- APPROVAL FOR: THE ABOVE REFERENCED PROJECT.
PLEASE CONTACT ME AT THE ABOVE NUMBER WHEN FINAL APPROVAL HAS SEEN ISSUED SO I CAN
INFORM MR. SANTUCCI. IF YOU REQUIRE ADDITIONAL INFORMATION OR HAVE QUESTIONS
PLEASE DO NOT HESITATE TO CALL ME.
RESPECTFULLY SUBMITTED,
Kenneth M. Murphy
Project Desipff
--- ' • • -- • - - . - ' -1 ..-.'+ -A !^f11 IAITV mff'm^OTMCLIT Me, m 4
R
BRUCE R. FOLEY
Public Health Director
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
LORETTA MOLINARI R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
October 9, 2001 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648
Preschool (845) 228 - 5912 Fax (845) 228 - 6113
Timothy Cronin, PE
Cronin Engineering
The Lindy Building, Suite 200
2 John Walsh Blvd.
Peekskill, New York 10566
Re: 37 Croton Dam Corp., 57 Mill Street
Nelson/Lewis Estates, Lot #2
(T) Putnam Valley, TM# 84.15 -1 -15.2
Dear Mr. Cronin:
This Department has considered your verbal request of how to proceed as resulted form the
separate sewage treatment system final inspection and documented in this Department's letter of
9/14/01.
A. Removal of 1250 gallon septic tank. Installation of required 1500 gallon septic tank and
. additional 44 l:i of absorption-trencn,.
B. Installation of 1000 gallon septic tank in series with existing 1250 gallon septic tank and
installation of additional 441.f. of absorption trench.
* Both alternatives will be adequate for the septic sewage treatment system design as
�� ttire� or a S.0 bedroom house.
C. Removal /opening of "doorway" to a dimension 72" or larger. rar s �% b °I
Prior to constriction, approval of revisions must be secured by this Department: 0 9f)o r
a. Application Form CP -97
b. Three (3) copies of the revised plan. 6 — S
c. Certified check in the amount of $150.00 (revision fee). o �t
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.
Very truly yours 4-
Adam B. Stiebeling
Assistant Public Health Engineer
ABS:cj
I0,109/2001 09:45 914730693 CRONIN ENGINEERING 1
A �1
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BRUCE It FOLBY LORETTA MOLMARI RN., M.S.N.
/.Ntn HwAp Obraw Aaa6W Pabrm Akakh Dha
Dk.— of PaGw &"k.
DEPARTMENT OF HEALTH
f Geneva Road
lewab6r
B, New York 10509
xwb9a.nul Nraah (84S)178 -61]9 r'a(MS1771-MI
Nu,aler 9errim (x45)171.6531 WIC(645)278.6618 1.01,19178.608S
October 9, 2001 Zarb' War -89s t1MS)271 -6014 9.r(SU)278.6648
nudlod (145)228.5911 Nr(NS)221 -611]
Timothy Cronin, PE
Cronin Engineering
'I'he I,indy Building, Suilu 200
2 John Walsh Blvd.
Peekskill, New York 10566
Re: 37 Croton Dam Corp., 57 Mill Street
Nelson/I.ewis Estates, Lot 02
(T) Putnam Valley, TMit 84.15 -1 -15.2
Dear Mr. Cronin:
This Department has considered your verbal request of how to proceed as resulted form the
separate Suwavo treatment system final inspection and documented in this Department's letter of
9/14/01.
A. Removal of 1250 gallon septic tank. Installation of required 1500 gallon septic tank- and
additional 44 l.f of absorption trench,
8. Installation of 1000 gallon septic rank in series with existing 1250 gallon septic tank and
installation of addi tional 44 I. f. of absorption trench.
* Both alternatives will be adequate for the septic sewage treatment system design as
required for a 5.0 bedroom house.
C. Removaliopetting of "doorway' to a dimension 72" or larger.
Prior to construction. approval of revisions must be secured by this Department
a. Application Form CP -97
b. Three (3) copies or the revised plan.
a. Certified check in the amount of Sl$0.00 (revision fee).
This office will continua its icviow upon consideration ofthe above mentioned comments.
Please fact free to contact me at ext. 2157 if any questions arise.
Very truly yours
Adam B. Sliebeling
Assistant Public Health Engineer
.._ fiSS:cj.
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NOINER00 ONICES
BRUCE R. FOLEY,
-PubU6 Fiealih , Director
LORETTA AbLINARI _R.N., M.S.N.
Associate..Puel c. is,caah - D'
14' I
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648
September 14, 2001 preschool (845) 228 - 5912 Fax (845) 228 - 6113
Timothy Cronin, PE
Cronin Engineering
The Lindy Building, Suite 200
2 John Walsh Blvd.
Peekskill, New York 10566
Dear Mr. Cronin:
�r e
Re: 37 Croton Dam Corp., 57 Mill Street
Nelson/Lewis Estates, Lot #2
(T) Putnam Valley, TM# 84.15 -1 -15.2
This office has received and reviewed the application for Certification of Construction
Compliance for the above mentioned project. We would like to offer the following comments for
your review and consideration.
As noted at the time of the final SSTS inspection:
t re l s ;n:-a 5: >bed�ooni t nt- design- requirPif ert::.:ScTc sigi e axi�i.- ...:.'
installed is for 4.0 bedrooms. A Certificate of Construction Compliance cannot be issued
at this time. Modifications to the SSTS require previous approval.
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.---
Very truly yours, .
Adam B. Stiebeling
Assistant Public Health Engineer
ABS:cj
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DATE : AUG-21 -2001 TUE 11:59
NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH
TEL 845 - 278 -7921
PHONE : 919147363693
PAGES : 1/1
START TIME AUG-21 11:58
ELAPSED TIME : 0015511
MODE : ECM
RESULTS : OK
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PUTNAM COUNTYDEPARTDIENT OF HEALTH
DIVISION OF ENVIRONMEN rAL HEALTH SERVICES
FINAL SITE INSPECTION
Inspec
C-
:';x ,
Street Location ' t Owner C�
Town Permit # �( — .�f rc!E)
TM # 15 — —I 2 Subdivision Lot #
1. Seiyage Svstet'n 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. SeAge System
a. Septic t •size -1,000 ........ ,25 ,........other ...............:
b. Septic tank installed level ................ ...............................
c. 10' minimum from foundation . .........................................
d. Distribution Box
1. All outlets at same elevation -water tested .................
2. Protected below frost .................. ...............................
3. Minimum 2 ft.Original soil between box & trenches
e. Junction - properly set ........... ...............................
f. ren "1 ches
1. engt required Length installed � a6
---- - - - - --
2. ' Distance to watercourse measured Ft..........
3. Installed according to plan... .......................................
4: Slope of trench acceptable 1/1.6 -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%" diameter clean.......,...,.... _..�.
10. Pipe ends capped .................................. :....................
g. Pump or Dosed S ste s
1 Size of pump chamber ................ ................:..............
2. Oveiflovr tarik::..::.::..:.:::::...............................................
3. Alarm, visual / audio .:.................. ........:......................
4'. Pump easily accessible, manhole to grade ................
5. First box baffled ........................................ :...............
6. Cycle witnessed by H.D.estimated flow /cycle..........
III. HouseBuildin
a. house located per approved plans .. ................::.............
b. Number of bedrooms ...................... ...............................
IV. Well
a. Well located as per approved plans... .........................
b. Distance from STS area measure ft..........
c. Casing 18" above grade .................. ..............................I
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 plar
f. Curtain drain outfall protected & dir.to exist watercot
g. Fooling drains discharge away from STS area............
h. Surface water protection adequate ...............................
i. Erosion control nrovided .......................... :--------
t 09/14/2001 11:26 9147363693
dRONIN ENGINEERING I PAGE 01
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
ATTENTION ADAM ❑ GENIE
REOUST F NSP TION For: Fin
All information must be fully -completed prior to any Trenches
inspections being made.
PCHD Construction Permit #. P V- S-1- 6 0
Located: 5'"? -T-rRiFGT- ful-NAP-q V19 LLC'l
Owner/A"kew Name: 37 CEMOP 0,111 8640 `fM..8J_ /rBlock-.`/ Lot Z4-:
Formerly. cr7-A7'er
Subdivision Lot 9 S
Is system 0 completed? -PLA Date:
Is system complete? Vex Date: A0G. I-T.0 'L66 I
Is system constructed as per plow? _YOLr
Is well drilled? Date:
Is well located as per plans ?
Are erosion control measures in place?
'4
1 certify that the system
(s), p fisted, at the above premises has been constructed and I have inspected
and `verified their complption in accordance with the issued PCHD Construction Permit and
approved plus and the Standards, Rules and Regulations of the Putnam County Pepgtment of
Date: ftt-)G Certified by:-fl g9f V., G CRO JIWI—q-E _ PLA
Design Professional
Address- Z . ToffiU WA 4 &6-ff-f A"14 C X/#X(Lic, G 'Zq
,AJ
Comments:
Form FIR 99
-1 —, A . -- — — � .. -n� Tel -rIAC- DI ITKIOM rni IKITY nPP0PTMPKJT nF P - I
t
i
\ PIT NAM COUNTY DEPARTMENT OF HEALTH
i
DIVISION OF ENVIRONMENTAL HEALTH SERVICES '�-
.. �.. ♦ :h .1. ♦, – rY 1.. i•. ..Jt.q r ... .. ...• /•-. — / - s .r 1.t w : .•"'4..r r
CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM
n
PERMIT #
,, //
Located at me-L ST. �r Village PyTvJA/q l/ }liLeY
Subdivision name NELS ly / L�'W15 Subd. Lot # � Tax Map �; � / TBlock J Lot /5. �
Date Subdivision Approved OB /O 51-9 Renewal Revision
Owner /Applicant Name 31 eVn-mo -T>Ajti PcA D �� . Date of Previous Approval v
Mailing Address _ 31 �VaN�) , V� ;moo Zip 1()56?—
Amount of Fee Enclosed 3 C) -n oO
Building Type' Lot Area 2 253 No. of Bedrooms --�— Design Flow GPD--Sn-o
Ac
Fill Section Only Depth Volume
PcCH D NOTIFICATION IS RE UIREID WHEN FILL. IS COMPLETED
Separate Sewerage System to consist of /X: 5Z) gallon septic tank and Z/00 Z-. f. OF
�� (ls pF"e-Fo eA-r6 PVe r Qi PP /A/ 9� G;ZA V F'L i R6A1CW
Other Requirements: --- n
To be constructed by m eQ,-. o �m 2 �, ��?kAddress 31 �YO J�Nvu r�
Water Supply: _ Public Supply From
Address
Privke sup^ 1 �Di4k Address tiri-a - tip
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 Corn,pl' r rOWper, ctory to the Public Health Director will be submitted to the
Department, and a written guarantee will'- <slce his successors, heirs or assigns by the builder, that said
builder will place in good operating c�tti rat' 4 1n 1 pa�t� rd sewage treatment system during the period of two (2) years
immediately follo)Oq the date of the f s'su 'e of, of The Certificate of Construction Compliance' of the original
�...:..:•4.
system or any
Signed:L
Address Z 4 v kA
thereto.'
R.A. Date
License # 06 Z'�I *'o
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 vAen consyi ary ublic Health Director. Any revision or alteration of the approved pl requires
a new i App h o do estic sanitary sewa only.
By: Title: Date: �' 1 I D
White copy - HD File; Yellow copy - Buildl g Inspector; Pink copy - Owner; Orange copy - Design Profession 1
orm CP -97
1`
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES r
- APP- LICA'TION TO CONSTRUCT A WAFER
WE -
:.: 1. ..
_- please print or type PCHD Permit # h — 61.
% — �. V
Well Location:
Street Address: Town/Village Tax Grid #
//
/FILL ST, CT F' ttWAA t VA LL& Map ) 4-131ock / Lot(s) !S Z
Well Owner:
Name:
I Address:
e2o
31 N-_ nl iv �sl <�o
Use of Well:
✓ Residential Public Supply Air /Cond/Heat Purdp irrigation
1- primary
Business Farm Test/Monitoring Other (specify)
2- secondary
Industrial Institutional Standby
Amount of Use
Yield Sought :5 gpm # People Served Est. of Daily Usage pv al.
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
✓ New Supply (new dwelling) Deepen Existing Well
Detailed Reason
Wp-re�_ Su -P– (=0c -- J-4ky l�
for Drilling
Well Type
Drilled Driven Gravel Other
Is well site subject to flooding? ................................................. ............................... Yes No
Is well located in a realty subdivision? ...................................... ............................... Yes ✓ No
Name of subdivision Xl��ie;� t Intl S's�T� c VA/F _ S T Lot No. 2 .
Water Well Contractor: f?T:. BEA _ Soma Tiyc, Address:
Is Public Water Supply available to site? .. ............................ ............................... Yes No ✓
Name of Public Water Supply. NIA Town/Village V /A
Distance to property from nearest water main:
Proposed well location & sources of contaminatio o e provided n separate sheet/plan.
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 thapproved plan r fquir s a new permit. Well to be constructed by a water well drill e certi f V by Pntn�n
�. (\ 11
Date of Issue tZ 1 001 Permit
Date of Expiration Z i o 7. Title: _
Permit is Non -'. ansferr ble
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Forrn WP -97
r6 I?–,
�050-
0
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
> C7.- n.'•''t`•. --.i ... -e:: \•.,yi. T.'.• --. G aAkPtICATION NjRAPPROVA :OF'AA 9'1f
A WASTEWATER TREATMENT SYSTEM
1. Name and address of applicant: ,3'f Rn.ft0rJ DAo J�0'-A.o
2. Name of project: SS (S "Y WAT6_z!_ _5VP)-e_Lj 3. Location(Dv: 11AZ-_i6,y
iJcGYSOsiI G.�vt %/J c6,iT�9�` -�
4. Design Professional: Ti, �+� y L . e �vy,A) /f1 5. Address: _,O V/ /f(fH
6. a Drain age Basin: - _
g �',LrIx ILL OGGld1nI' �'�I�c?� � �E�y`�fiC�, -r,J• y. � 1�.5�'6'
7. Type of Project: _
v,/ Private/Residential Food Service Commercial
Apartments Institutional Mobile Home Park
__ Office Building Realty Subdivision Other (specify)
8. Is this project subject to State Environmental Quality Review (SEQR)?
TypeStatus (check one) ....................... ............................... Type I Exempt
Type I1 Unlisted ✓
9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... /v0
10. Has DEIS been completed and found acceptable by Lead Agency? ............... N�
11. Name of Lead Agency :_
..1.2. Is this prMe un an axes under the eortrol of local planting, zoning, or_ _other
._ __. .... ..... ...
.officials, ordinances? ...... ................ .. ..... E�
F
13. If so, have plans been submitted to such authorities? ....:....:......... ,tt
14. Has prelimin approval been anted b such authorities? Date .y anted. �I
azy Pp Y
15. Type of Sewage Treatment System Discharge.; surface water V",O� groundwater
16. If surface water discharge, what is the stream.class designation? iv /,¢
17. Waters index number (surface) - . :,:..
18. Is project located near a public water supply system? .... ..0
19. If yes, name of water supply N��4 `= Distance to Vater supply
20. Is project site near a public sewage collection or treatment system? .................. N .
21. Name of sewage system NIA Distance to sewage system t1A
22.
Date ./Q WA) _ " 23. ' -Name Health
test holes observed JQ / of Inspector -A�,o,4
t;5n e
24.
Project design flow (gallons per day) ..............::::..... ............................... .
_AW y
25.
Is State Pollutant Discharge Elimination System (SPDES) Permit requued?:.
/C1D
26.
........ .
-Has SPDES Application been submitted to local DEC office? .........
ND..:.
}
Form PC -97
:" 4
2
27. Is any portion of this project located within a designated Town or State Wetland? ' k/D
W. A; 7 7.
..................... MIA
lands 11D-Nurnber.7�.....,.� ............................................... . .. . ............
29. Is Wetlands Permit required? ..............................................................................
Has application been made to Town or Local DEC office? ................................ NO
30. Does project require a DEC Stream Disturbance Permit? ................................. ND
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,
haz&d66s "wa*"s't"e'-s--it*e--,'-s''a'lt-st-ockpile, landfill, . sludge e - disposal site or . any
other potentially known source of contamination? ............................... Yes/No k/0', -
DESCRIBE:
33. Is'there a local master plan on file with the Town or Village? ......................... YEJ
34. Are community water and/or sewer facilities planned to be developed within
15 years in or adjacent to project site? ............................................................... 'AID
35. Are any sewage treatment areas in excess. of 15% slope? ................................. IVD
36. Tax Map ID Number ......................................................... Map zt, i
il3lock J Lot
37. Approved " P Ian's are to be returned to ..... Applicant v-' Design Professional
!1i6TE-.AI14
be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP
approval of the S final approval by the Departinehf.'," Pr9J*e`c`t9 hifi the watershed may also
_STS prior to f
require DEP review and approval of other aspects of a project, such as s,torniwateqlans or the creation of
impervious surfaces,'and the project applicant should obtain the app rop rat6 four il& such'activities from
DEP and. submit those forms to DEP for review and approval.
If the application is signed by a per's'66`76their than the applicant " ihd in Item I.,the application must
0 VC -?I, with'thisp-toy'Ision
be accompanied by 4 Letter of Authorization (Form LA 97). VaiW6_V(
may be 'grounds', for the rejection of any submission C,
C41-N
I hereby affirm, under penalty of perjury, that infiforiin"a p ila u rm, true
n
to the best of my knowle4ge and befief. a en ma laerei'are :imashable as
a Class A misdemeanor pursuant to e on 10.4,
SIGNA TOMS 4 OFFICIAL
Q. -1.k
Mailing Address: .... ....................... !.-.
7-777-
{
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
,' b� ., i ).,',:,.^ ."<= t- r w' ".,.e•. .°..... .. %'. .'`v r -%e` _ n -•vi _ •_• -.: " o.
LETTER OF AUTHORIZATION
RE: Property of 37 TCQ-tQ/3 DAM AD Cor- T-'_
Located at eou ") -F EoA -0 2 3 .
W7 .+t A)AR ��u� Y Tax Map # 9 4, 15 Block i Lot 15. Z
Subdivision of ' �► cLt od J t- C Al rS E5-rA-t-qc5 VV f-5-T
Subdivision Lot # , 2
Gentlemen:
Filed Map # 2�5 i/ Date Filed () g - y 5 - 91
This letter is to authorize T t't o -r H y L - zoa ix) (!
a duly licensed Professional Engineer v-' 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 orregulations as promulgated by the Public Health Director of the Putnam
County Health Department, and to sign all necessary papers on my, beh if in connection with this
matter and to supervise the copstruction of said wastewater tre im -t dlor water supply systems
m conformity wi a pr "Article 145 and/or 147 of E ca n'I�aw, the'ublic..Health._._... _
- LaW, and drip -P utnam) o Aty: Sam Ccide:. - - - m
Very t r
Countersigned: `` `� J 62980 Signed: �.' oev i
/P., .
P.E., IN, # c�ON (Owner of r erty)
Mailing Address 2 got A i INALs 9 3�vI>.� Mailing Address: 3i �� o-t o� SAM, KeA�
5u. re 0C7o 9& KILL
State . , \I . Y . Zip i U g'6'6'
Telephone: (y I �E)_( 3 G 3 G C. 44
05.5) ^)?NG
State )\) - y . Zip 0 -6"/- ?_-
Telephone: CJ" 14)
Form LA -97
PUTNAM COUNTY DEPARTMENT OF HEALTH
_-D-1 � JjR,0N 1�' 'AL; HEALIMSERWCE
AFFIDAVIT - CORPORATE OWNER APPLICATION
FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT
To: Public Health Director
In the matter of application for: of 55T-5 AA)Z> WA-M- P- 5jT-i -Ly
S,, N -r N cc i
represent that I am an officer or employee of the corporation and am authorized to act for:
Name of Corporation: 3`1
ereo -meo
P-A.0
1?0A0 Qcn-P
Having offices at: 01
Ct? o-t o /o
-�>A v"
ZCAD 05 S j A)1N C , IV.
Whose Officers Are:
President - Name: l/Ai_ �5^NTU c( i
Address: ( -(AllC AS A01)V -,2
Vice President - Name: 5Am e- Ai rzle r y r1>Cty/vT .
Address: (SAME R -BD if i)
Secretary -Name: M ��,�Irtti cC/
Ic+-�rGP L
^ Address: (cAm E As -Ar30V,4 )
Treasurer - Name:
Address:
5-,�-C2 €T A -i!.-
0
and that I am and will be individually responsible for any and
to the approval requested and all subsequent acts relating th(
Signed:
Title:
Sworn to bef e me this ?,0 day of
4 tj em 4( onth) Z o J (year)
Notary bl l7THY L. CRONIN X
Notary Public, State of New York
Rio. 4923313
GLIalified in Westchester County Corporate Seal
Form CA -97
corporation with respect
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner 01 Prf _o 7-fmf Z -K;14 1- *t & - . Address .3J A,- "o ki D4k M �'>oAb . Uls es0 c,)6 Al
Located at (Street) 4'rREg Tax Mapge�. it Block / Lot T Z
(indicate nearest cross street)
Municipality (T, I �n-rry�4w� �P'u b Drainage Basin
SOIL PERCOLATION TEST DATA
Date of Pre - soaking Date of Percolation Test
Hole No.
Run No.
Time
Start - Stop
Else Time
�i11in.)
De th to Water
rom Ground
Surface (Inches)
Start Stop
Water
Level
Dro In
Inc�es
Percolation
Rate
1VIin/Inch
2
3
4
5
2
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
2
TEST PIT DATA
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. 2�
G.L.f
0.5' . 5AA) b w ,4-L
1.0' CR--A VF-C._
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'
19.5'
10.0'
HOLE N0.
Z !-I
G' /-ro
s L
HOLE NO. 2 L-
Indicate level at which groundwater is encountered 66 Al E
Indicate level at which mottling is observed
Indicate level to which water level rises after being encountered P /A .
Deep hole observations made by: fq, WJ CiQo€JtAWc1Jy6 i' ; A S. (Pe. o.r�,Date t5 %�aDti
Design Professional Name:
Address:
Signature
Design Professional's Seal
62980 /
,��UFESS.��.
1. APPLICANT RIPONWR
2. PROJECT NAME
s. PROJECT Lou►Tlolr:
�eb.ah► T C40ty LOT Z
.4. PRECISE LOCATION (SV6d MOMS Bed toad IRIWSWOOM OWInWt Nndtw1wk ate., of POWN X01
(A�in�1 -)! �D, 23) — A Fi'p-c7 1 600
vv
SoES't- Tz%—.o m
.S. "Is P�Rp/POSEp ACTH
LYN•�r ❑ EEO $ft❑ MlodltfeatloNalt•;atlen
S. DESCRIBE PROJECT BRIEFLY:
l _ ON3T2u1 C� ...O r' U Cis U 2�Q�c� JENlA C
7. AMOUNT OF LAND AFFECTS? �' Zy 3
IM11aly acne UfllmatNlr
ACTION COMPLY WRM OUSTING ZONING OR OTHER EXISTING :AND USE RESTRICTIONS?
S. 1MI,LL
-,)PROPOSED
E Ya ❑ No It ft, OrNty
• WHATA N1UMT LAND USE IN VICINITY OF PROJt:GT7
R�OMItl•1 O dwtrW ' O ComrtNrelal Aprkultun " O Psrl4ForprlOp•n spa" ❑ Ciro;
(rJ .'
- Su2�DUNID >ai GAL- A�V1�S SONGLE F.jM/Ly �SaDEN?/�9L
ZON ON C J�>95
10. DOES ACTION INVOLVE A PERM!! APPACVAL DA FUNDING. NOW OR ULTIMATELY fAOM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL
W
�oul» ;
Win ❑ No M rm IUt 411dw l �d ASOMmItla�P►�raia . , �<
14 t
�OWA IA ALlE Y _
11 09p ANY ASPECT OF THE ACTIC.v NAVE A CURAENTIY vAUO PERMrr OR APPROVAL?
®/
YM .. - , � No .° tl �. Wt 40•rwy +wnn M• O�nrMtfAppa►v
7.
BI j StpN aVl._ �- I',11i�1Sb!+1 �LEK/ /S!'j�41'€S '`1IllE1']`.�t �uC3D1i/o5ldnl
.._:,
Ac"ON AL IIEOUIRE YOQW"?10NT
12 ABA WILL OOSTINti PERMTT/AlM10V 1z A
IIES1ULT OF
yes
1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE 13 TIME TO THE BEST OF MY %NOMeLEDGE
amm 1, iA) GN h , iV Z Date
it the action is in tta. Coastal Are& and ,j
coastal- Assesmint Form b�tors p
,..t .
rs statf`.agncr,. complsts the
e01p
{
PART U— ENVIRONMENTAL ASSESSMENT (To be completed by Agency)
I A. 06E5 ACTION EttnCEED ANY TYPE 1 TMRESMOLD IN fl NYCRA, PART a' r"27 11 ya ®, ooaelslete the review Process and Yee Via FULL UP.
0Yee Olio
B. WILL ACTION RECEIVE COOROINATED REVIEW AS PROVIDED FOR UNUSTEO ACTIONS IN It NYCAR, PART ®17.x7 11 No, a negathe declaration
may be superseded try a 400 Invotrod tpaney
O W6 _ -
C. COULD ACTION RESULT 1N ANY ADVMIE IFFI TS ASSOCIAT 30 WMI THE FOLLOWING (Answers may be handwritten. It Iegiblel
Ct. Entallfq ur quality. _ su we or gi undwalsr. qualltli `or quentity notes` W%*'L sxlsting traffic patlsme, solid waste p►oduetloo or deposal.
potential far erosion. disMoga or nooding PtOO"2 Explain Melly.
CZ AesUWtle, agllCYltY/al, alcllseological.,hletorlc, Or Other natural ol, Culture
l. TdourP. or get"unity or neighborhood eharscteR._Esplsln baofly:
CO. vegetaIf" or fauna flag. "Iflah or wildlife SWISS. slgnlf1=11t habitats. Or thlsataned of endangered opeclaa? Explain briefly: .
C-& A comitunity'st existing plans or goals as officially adopted, or o change In use or intensity of use of land or other natural re"wreee? E otain
Cam, Csrowlh, subsequent dowlopment. or related activities likely to bid Induced by the oroposed action? Explain briefly,
CIL Long term, short tern, cumulative, or other effects not Identified In C1-05? Explain broth.
C7. OUw impacts Ilnctuding changes In use of either quantity or type of energy)? Esotasn briefly.
0. 18 T>'IOM OR to TNIERE LIKELY To eE: CONTROVtRaY RELATO TO POTENTIAL ADVERB✓$ OMMOMMEdTAL' IMPACTa?
❑ Yee! _ 3 No It Yes, 0<9"n brlsiny
PART tU�= DFTERjIIIINATION OF SIGNIFICANCiE (To be completed by Agency)
}..f.:
dnttstbve. d lnhPNito INSiUCTM* For 0=11 adws sftso tuiD W11, el
lerpe. Inlgortent Or otMeltrlw *N "t.
Each oHsw should be In conneotlon with Its (a) sWin®p • urban or
ninit (b1. pnobablilfy o/ oeeurHna (e► duration. 4
In"01111 llIt% (0) p"MOhie wW. and M IllagrMude. It . edd attachments or l+itele➢reee" llpportbto ItlattlMYle. Ensure that
"tllanatlone contain sutiklalt eaten to'~ tttat all fel"M adxefae Impacts haw been Idantltitod and addsssfod. 7 7
Q C>!tecfc this box If you haw identlfled Otte or r1Wr® potentially large or algNfleartt Impacts Mfitkh MAL
occur. Then proceed directly to the FULL EAF andlbr prepare a,poeltlw Idecieratbn.
® Checit thle. box if . you (taw deteliMIned. blaeed on thi' informatbn rend attaiyais aboMe illd
' doeume�tatloet, .that_ age propo®sd aCtlott wIL� N ®T treWt in Itnyitlp � irfv�rotw,rrtttaE hnpacta
Akb provide on attachments rile Akiiizijr Eh® moons supporting Ihle &WMMkjo& >
NWO of toad AgarKY
PftK OF TY92 Nl1rk4 ;; AMPORM Officer a L= Agency - e
, asllr4 r Kar at Lead Agency a
xx\jb jaiLfi _ -its SASi' . � �'�•' 3't�",ta` :;. bird `'' ' *
,,. e a. a, c: -d A. .�3R�?" S�I^�; �: :.�' 7� . S"%���r i...�•. sx •t* ra.�;}
ggx
17--
Hole # Lot # Hole P, Lot Hole 9, C Lot A
Depth to water Depth to water Depth to water �\C
Depth to mottling Depth to mottling, Depth to mottling
'-""I J
&eWio r f Depth to rock/imp.
e tff t ckfiffi oc r]
p " :0
G.L.
0.5 (2
1.0
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3.0
4.0 f- L.-
5.0
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7.0 (f o?7?:;,L&
8.0
9.0
G.L.
0.5 0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0 C zel=
9.0
G.L.
0.5
1.0
2.0
1.0
4.0
5.0
6.0
7.0
8.0
9.0
10.0 10.0 10.0
7-5 7,
t
R
Ho
Id
Depth to -water Depth to water Depth to water
Depth to mottling Depth to mottling Depth ,to mottling
I D ep 0 --'^D�epitlitoroc'klimp.
tfif i --fbc unp Depth to rock/imp.
G.L. G.L. G.L.
Ir f"
1.0 1.0
2.0 - 1b,
3.0
4 . .0 S(e'_ 6
.5.0
2.0
0.5
1.0
2.0
5.0
0 60 1 60
5.0
6.0
7.0 7.0 7.0
8.0 8.0 8.0--4-
9.0 9.0 9.0
10.0 10.0 10.0
3.0
3.0
4.0
4.0
5.0
0 60 1 60
5.0
6.0
7.0 7.0 7.0
8.0 8.0 8.0--4-
9.0 9.0 9.0
10.0 10.0 10.0
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--------------------- -- --------------------------------- Tl-----
------------------------------ ------------ ----- --- ----- ----- ---- --- ---
- it
----------- 011
-- A W. &� — +.1.101 A
-- - ---------
—!G-11C LUZ= ;IlHim" &IOX4
110—ft US 1.
0.1 .01 =l+ �" I L I-I. —
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----------------------- ------------------------------- ------------------- ------- - -j
--------------------------------------- ----------------------------------------------
91
Julixt X�flj Nni 11. nx --trinj -TA I
01
P011
,p6
Ilio"
'. .1
x x —0
Sight Cl8em-7t --------
P.,. Wire
no, ou Mon F'
L 98.74
p r"
County Route 23
O
O
O
57.9'
O
Ilio"
'. .1
x x —0
Sight Cl8em-7t --------
P.,. Wire
no, ou Mon F'
L 98.74
p r"
County Route 23
IPI
LOT 2.
TRE-A=2 293 ACRES
X
A-
ROOFLEAOERS DRAINS ( AND
E,ISMV,G KEU
– EvSqw
WAM? -ZMfC-'
CAST 0?0 PA-C
1250 C4LL aV
CONCRETE SEPTIC TANK
PW SORM
P I .
DISMOV71W 6L1' W/ DAME
. . AWCWN WX (1YP)
..... . . . . .
s
' rRrMCH
20 GRA In
IVT—t
30 Fr NW EASDgNT TO I
MA(NrAMW SLOPES AND 5
<0
100X E)PANSION AR-IA
v.
0.
AS-f
. . .............
SCA
5.
..........
X
12
M/L L
T
SWEET
a
WELL LOCH AON
X
B
W
17'
72.5'
SS7V TANK LOCA AON
A
B
SEP77C TANK
17'
59'
CLEANOUT
1 104.,5'
103.5'
DIsTANCEs TO wEST ENDS OF SSTs
C
D
WEST £ND OF 1ST. TRENCH
72'
16'
WEST END bF' 2ND. TRENCH
76'
21'
WEST END Of' 3RD. TRENCH
81,
28'
WEST END OF 4M. 7RENCH
86'
34'
KEST END Of' 5TH. TRENCH
90.5'
1 41'
NOMS
1. SUBSURFACE SEWAGE 7REATMENT SYSTEM (SS IS) IS DESIGNED
ON A SOIL P£RCOLA7701V RA IF OF 1 TO 7 MINUTES PER
INCH DROP (SEE SOIL DA TA SHEET).
2. ENGINEER WAS.NORRED PRIOR TO STARTING WORK AND
PRIOR TO SACKRUING TRENCHES
3. UNAUTHORIZED ALTFRA7701VS OR ADDITIONS TO THIS DRAWNG IS
A KOLA 77ON O•)' S£C77ON 7209 (2) OF THE NEW YORK STA 7E
EDUCA77ON LAW.
4. PROPERTY SHOWN HEREON APPEARS ON A FILED MAP EN777LE0 SUBDIVISION
PLAT PREPARED FOR NELSON / LEWS ESTATE'S WEST'.' PREPARED BY BADEY
AND WA TSON,'SURVEYING AND ENGINEERING P.C., FILED /N THE PUTNAM
CO. CLERKS OFPCA AS MAP No. 2511 ON AUG. 5, 1991-
5. HOUSE LOCA77011 w RESPECT TO PROPERTY LINES WAS SURVEYED
AND PREPARED :BY.- DONALD J. DONNELLY, P.C.
D ISTANCES TO SS TS BOXES
C
D
D.B. W/ SAME /1
31,
32'
WNCROWBOx 02
37'
it. 5,
MVC710Y Box fJ
43'
32'
,A'INC770N BOX /4
49'
33.5'
,R/NCnot, aOx /5
56'
37.5'
D /STANCES TO EAST ENDS OF SS TS
C
D
EAST END OF IST. 7RENCH
21'
74'
EAST END OF 2.N0. TRENCH
24.5
72
EAST END OF 3RD. TRENCH
29'
71'
EAST END OF 4YH.. TRENCH
33.5'
69
EAST END OF 57N TRENCH
I 38.5'
69'
ri
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w
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a
R.,4S' av D.AIc
RF'AS -CIN
MAP
70N.- 84.15 BLOG:Y.• 1'
LOT.- 15.2 SUBLOT.• 2