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HomeMy WebLinkAbout4460DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.15 -1 -15.3 BOX 34 n\ul ` PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENV IRONNMENTA.L:HEALTH SERVICES.._._- •„ '..::���. =,�` ... , .CERTIFICATE OF CONSTRUCTION COMPLIANCE F REATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Pl( 50--60 /41- J Located at S°I MILL S T245-E J— Town or Wfte ?u �fi AJ iq M Vii LtC �i Owner /Applicant Name 39 CRo i ors n,4r&L R OA O Tax Map 94 19- Block % Lot 15". 3 Formerly Subdivision Name IJE[.So��l -t�IJI J' CS 1 A -r6:: ' Subd. Lot # -X Mailing Address ,5-61 MILL S-rR EG-T- u i-,Q A r-i V14 LU i` v N , y. Zip / o !S 7 1 Date Construction Permit Issued, by PCHD 11,1114 0 0 i --T9 CR6 To Dq r", � o 4 Separate Sewera e System built b 37 cgo -rol DAr+ ROiD c� Address oSSinI1�J G" o), a Z4 2 Consisting of SO Gallon Septic Tank and Z . T - of * "�, & a r- o 2 o T e p PVC lhl `Z4 /' GROVEL TutNch Other Requirements: Water Supply: Public Supply From Address 4 ru-iN i9 wt or: ✓ Private Supply Drilled by `t - 0� A t- I SofJ s .TN C • Address 779 t''W -4 - 't nO N Y r o S o ol .Ruild'i g. Typ-S:i' Ct - r~�'!.�� ..- 2t .J Has erosion.control.beets cotiiplete ? ._ Y Number of Bedrooms -d y yL Has garbage tars I certify that the system(s), as listed, serving the built plans (copies of which are attached), Via plans and the standards, rules and regulati Date: /1, —/ 3 --o% Certified by (Design Address t-5-6 HO W41-SH ELVjO- stalled? 4 ' -- mis, ct�d essentially as shown on the as- PCH Construction Permit and approved party S'' of Health. J A P.E. t✓ R.A. License #© 6 2 9 8 0 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocati mo ' catio o ch ge is necessary. By: Title: VL l Date: i e 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 WELL COMPLETION REPORT veil "Lciea' ` Stieetdclre�s: +lls Street, Lot #3 h TowitNilla e• Putnam Valley Tax Grid # J` MapS*.(SBlock f Lot(t.) 15.3 Well Owner: Name: Address: S Construction Corp., 37 Croton Dam Road, Ossining, NY 10562 Use of Well: 1- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 84 ft. Length below grade 8-' ft. Diameter 6 in. Weight per foot 19 Ib /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 =ld 50+ gpm Depth Data Measure from land surface- static (specify ft) 30' During yield test(ft) 80' Depth of completed well in feet 145' 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 60 Drillinc in over urden clay and boulders 60 Hit roc at 60' -r�0. :H4. ..,�ri llii�:Lririr6� 84 145 Drillinc in rock granite t If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity jQWm Depth 100' Model 10GS07412 Voltage 230 HP 3/4 Tank Type RTX302 Vol 1. Date Well Completed 7/9/01 Putnam County Certification No. 002 Date of Report 9/6/01 Well Dr' a si e al I UTE: rxact location or well with dista s to ate tw ermanent lanamarxs to oe prov7 on a separate sneeupian. Well Driller's Name P. F. & In . Address: 4Putrlam Awe., Brewster, NY 10509 Signature: Date: 9/6/01 Perry L. Be 1 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 i $itUCE A R.- FOLFY_ Public Health Director f LORETTA. MOL INARi.. ILN.; MS. ' .^ Associate Public Health Director Director of Patient Services DEPARTNMNT _ 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: -917 CRo-i oN agm RoA o Cogl°- TAX MAP NUMBER: Sc'c. . 844, /S SG f(- 1 L o 7 = / S5 3. SUM. -O i E911 ADDRESS: MILL STREET' TOWN: pj -'-� 14 rx A L LC Y AUTHORIZED TOWN OFFICIAL: (Signature) DATE: -712 6 Zoo 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 VERFRIvI) --mow.. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL, HEALTH SERVICES �; = -. ._ z' -�== �b. _.- _. .. - ._....., . ;,- : -. «:., �: ,,.- s..• � .�.% 7;: �- GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM T % ��a�� vi n► jZaA d co fL P. ��, � S I 15.3 Owner or Purchaser of Building Tax flap Block Lot 37 C_Ro,r6^J VAt4 R(54b CORE:` o?UTYJA^ VALL '1 Building Constructed by Towne MILL r T IZe E r— NEC.J��J C� 1.�►J � J-r�� . ►Jrr lQ- Location - Street Subdivision Name Building Type 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 sho«-n on the approved plan or approved amendment thereto, and in accordance with the standards. rules and regulations of the Putnam C ounty Department of Health, and hereby 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 ot)erate 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 agrees to accept as conclusive the determin ti Va th Public ealth Director of the Put Department of Health as to vyhether or of til e of e stem to operate �ps caurd jounty the willful or negligent act of the occspan f th i ing ut il' ing the Th It i 1;g X, DL 1,7 Year 200 Simature:11 Owner) - Signature Title: FRCf0 bE:L-N !?,7 �7 eZ c Tom t�l� fZO�ob Ca fi"01 C , Corporation Name (if corporation) Corporation Name (if corporation) Address: 37 C R u 7 c),�J PA JZ0Alkn, Address: T 2 CRcrToN .oWb fL-17 State 6- rr1,,J1aC ,� y Zip /aC (--L State 0 -Cr1N /,W N - V. Zip IOS_� Form GS -97 $ ( ,14.31 A F ; d } i`•kr P i 4#i 'X i`a # V 1' ` r Cy ' �TTU°X'�yr• i+f _, 1 f 4 .0. ' - � � - � - - - _ __ _ _ _ _._.� .'y'._ } _ par Sj t s tom; ,rte: p�- 3,, Sir �� •. Y .. �` M „��� M� ��: - NR Ar NORTHEAST LABORATORY OF DANBURY `wo�N ACco,O a,' •�,,- ��_ -:�.�.. MIL�P, L 2..,0.:. ...ILP4A8 N.0R YT2 I t� . � CA :°r•_- ®��inn�. ' N�Y T :CCeerrtt: : P111T4;0741 203) _L 748 -7903 - -PAX .6 04_• _, .�o. . ��+...r . �� \ LABS www.NORTHEAST LABORATORIES.com REPORT TO: P.F. BEAL & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLE POINT: SOURCE: TREATMENT: DATE SAMPLE COLLECTED: T11viE COLLECTED: COLLECTED BY: DATE RECEIVED @ LAB: TESTED BY: LAB I.D. # REPORT DATE: 8/21/2001 2:00 P.M. KEVIN B. 8/21/2001 LAB #11471 & 11715 PFB -89 8/29/2001 V.S. CONSTRUCTION CORP., LOT -43, "O . "; NM LS ST., PTJT *TAm VALLEY, N.Y. HOSE BIB @ TANK WELL -NEW NONE ml= milliliter mg/L--milligrams 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: JWVOTABLE or OT POTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) RESULTS BASED ON SAMPLES SUBMITTED: 8/21/2001 - Laboratory Director oNORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800- 826 -0105 o OUTSIDE CT: 800 - 654 -1230 MAXIMUM CONTAMINANT TEST PERF'ORMIED RESULTS METHOD # LEVEL (MCL) OR STANDARD BACTERIAL: • Total Coliform (Bacteria) 0 per 100 ml SM 9222B 0 per 100m.1 . PHYSICALS: o Color (Apparent) 0 - EPA 110.2 15 • Odor ND = - 3 Units • pH 6.62 - EPA 150.1 No designated limits o Turbidity. 0.40 NTUs EPA.180.1 5 NTUs CHEMISTRY: e�`N =. ..g .� y _ . �.:. ng/L�3s3 _ •. EPA :,54.1' •. Nits en:: `� ,x0.105 i z'. p ... '::� 'qp:m ' -:. ^ ,• N; .b " g/L • Nitrate Nitrogen <0.1 mg/L as N EPA 353.3 10 mg/L • Alkalinity 16.0 mg/L SM 2320B No defined limits, • Hardness 26.0 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 Tron plus Manganese = 0.50 mg/L. o Sodium <1.0 mg/L EPA 273.1 20.0 mg/L ** o Lead <0.001 mg/L EPA 239.2 0.015 mg/L * ** ml= milliliter mg/L--milligrams 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: JWVOTABLE or OT POTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) RESULTS BASED ON SAMPLES SUBMITTED: 8/21/2001 - Laboratory Director oNORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800- 826 -0105 o OUTSIDE CT: 800 - 654 -1230 �,ETTER OF TRANSMITTAL ._. � .. , - -.- .'� .. s. �4. rr n Irr. .. _. � .. r � ...1 ' .V .. � • +.an .!' , ! ! .. t.ir� r. L. ....J.. • � 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" 59 MILL STREET P.C.D.H. PERMIT #PV -56-00 THESE ARE TRANSMITTED as checked below: December 14, 2001 ❑ FOR APPROVAL ❑ FOR YOUR USE ❑ AS REQUESTED ❑ FOR REVIEW AND COMMENT X PLEASE REPLY WE ARE SENDING YOU attached snbsu`riace sewage treafinent system plan 2.) Three certificate of the construction compliance. 3.) Three guaranties of SSTS 4.) Copy of survey showing foundation location 5.) Well completion report 6.) Water analysis 7.) E911 address verification form 8.) $200 certified check for application fee. l 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, .A Kenneth M. Murphy Project Designer M _.r PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Street Loc 'o�i Town ' TM# , — 1. Sewage Svstein Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier :Lgth. Width Avg.Dpth o c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from grater course / wetlands .............................. II. Sewage Svstem T Septic tank, size - 1,000 ........1 250 .....other ................ b. Septic tank installed level ............... 6 AN Owner Permit Subdivision Lot # " _a 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 Box - properly set ........... ..........:...........:........ f. Trenches T Iegth required _ Length installed —fiff+ 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.......... v . 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 .................. .................:...... . o... g. PUmD or Dosed Systems 0 1. Size ot pump chamber ........... ................... 2. Overflow tank .............. ............................... ��. 0. 3. _Alarm, visual / audio ................... ............................... . 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ............... ............................................. .. 6.- Cycle witnessed by H.D.estirnated flow /cycle........... I. House/Buildin a. house located per approved plans ............... ................ b. Number of bedrooms ................. .......................:.....4' .. . IV. Well a. —Well located as per approved plans............. b. Distance from STS area measured �o© 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.. L Curtain drain outfall protected & dir.to exist watercours g. Footing drains discharge away from STS area ............:.. h. Surface water protection adequate... .. ......................:....... i Frncinn rnntrnl nrAUMPri � c 12/12/2001 11:01 9147363693 Aso wl� l 48. !' X 1517NG BFDRM 001 A CRONIN 48.0. 49.6, a ti 0 ti 10' 0' a o INSTALL 70' R£LOW rt• .r�E.v�.:�Es Nnr 60X cp P f monumen A?4'520'�� ---- -- • ��..�.� • ?h9itte�titOtty w /mss 1 L"8. 0 (61 mQ $,3Z M /LL board fiance Mr- ^ 4 'M -'MMA4 1.lcn 1 p! A-R TFI : A4..i -278 -7921 40 33 "W 83.58' pde wu ite t0 'W 89.30' NG 1 PAGE 01 1> CA114, b� A LU r 'V IC L4 'p D 1 -SCu.� off. C � I?kk IN Q-001) t 135heo exist. well >< 3 n n � o T N b • 18 "n�c� I mopJe existing, NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 m �fZ -- REMOVE 70' ACROSS *E-' L i 2r 1NFLUENGLc' LINE � 1 _0 CUT PIPE I-HFRE r 2S $ AND GAP a ti 0 ti 10' 0' a o INSTALL 70' R£LOW rt• .r�E.v�.:�Es Nnr 60X cp P f monumen A?4'520'�� ---- -- • ��..�.� • ?h9itte�titOtty w /mss 1 L"8. 0 (61 mQ $,3Z M /LL board fiance Mr- ^ 4 'M -'MMA4 1.lcn 1 p! A-R TFI : A4..i -278 -7921 40 33 "W 83.58' pde wu ite t0 'W 89.30' NG 1 PAGE 01 1> CA114, b� A LU r 'V IC L4 'p D 1 -SCu.� off. C � I?kk IN Q-001) t 135heo exist. well >< 3 n n � o T N b • 18 "n�c� I mopJe existing, NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 m BRUCE R. FOLEY Hcaltli Director ` DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 L ORETTA : MOLINARI R.N.; hi S �r Ii'ociate 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 December 13, 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: Croton Dam Corp., Lot # 3 Mill Street, (T) Putnam Valley. TM# 84.15 -1 -15.3 Dear Mr. Cronin: E0611, This office has reviewed your fax of 12/12/01 regarding the separate sewage treatment system "trench" installation locations. As -built location of trenches were inspected on 12/11/01 by the Putnam County Health Department. It was noted that trenches appeared to be within 200 feet direct line of drainage keyhole of existing well on the adjacent lot # 84.15 -1 -16 to t..lbe.nortll.„ .�...._..,:,...a_... �..._.,_...._ Your a`Wt layout ,on the Submitted fax confirms this. Separate ' age-treatment system modification shall occur as shown on the modified plan. 9 The as- built drawing submitted for the compliance shall show representative of required 100% expansion. 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 BRUCE IL FOLEY LORMA MOLMARI ILN., M&N A..d.0 Pkkk Hbdth Oa. OW H.4h Db-w 0 O� am" f Pok.1 Sher DEPARTMENT OF HEALTH I Geneva Road Brewster, Now York 10509 t.lb- - Hfth (040271-6130 FM(143)273-ML HnWa 6M6M(245)276 -65$8 WIC(145)270-W6 Fo(949)27$-6065 Idy hidempfi.. (645)"8-6014 Vu(10)272.66" December 13.2001 Pradod(145)226-5912 9=(04 $)236.611) Titnothy Cronin, PE Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, New York 10566 Re: Croton Dam Corp., Lot * 3 Mil Street, M Putnam Valley TM# 94.15-1-15.3 Dear W. Cronin: This office has reviewed your fax of 12/12/01 regarding the separate sewage treaurent system "trench" Installation locations. As-buift location of trenches were inspected on 12/11/01 by the Putnam Cowry Health Department. It was noted that trenches appeared to be within 200 Im direct line of drainage keyhole of existing well on the adjacent lot# 84.15-1-16 to the north. Your as-built layout on the submitted fax confirms this. ' —7— 7' w age troatin ent system niodifkittian 9W;'occ& as akown on thomodiflod ylan. The as-built drawing submitted for the compliance shall show representative of required 100% expansion. 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. Stlebeling Assi*twt Public Health Engineer ABS:cJ XO : KOH : MOK J'E'00 : Min CMSdM ME T trT-ORG : Mai 11MIS T/T : SHOVC1 E69E9ELVT6T6 : ZM0HC1 TZ6L-8LZ-Gf78 : 72.1 MUM aO IMIMIM AME100 KVNIncl : HWVN VZ:ET IIM TOOZ-VT-OHO : MVa 7 MOHMN03 DNIMS 12/10/2001 13:16 9147363693 CRONIN ENGINEERING 1 PAGE 01� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION ADAM d GENE UQ1E ST 'FOR FINAT. INSPECTION' For: Fifl All information must be fully completed prior to any Trenches inspections being made. PCID Construction Permit # ?yr 50 - 0 Located.- —T-9 M t LL S •r" R:j"" 5'T_ ('� {�i �c� i`O� A r'*t V� L �. � Y Owner /Applicant Name: JTQ -CRaTcwJ OW4 I-0 X4.0 T 14.1 $^$lock Lot E—T Formerly: _ Subdivision #EL so NJ % c. u 1.r g r Subdivision Lot # - Is system fill completed? Is system complete? Is system constWcted as per plans? -r Is well drilled? Ygf Is weU located as per plans? Are erosion control measures in place? * -J _ Date: Date: D€�k1— Q4rTL 1 2W 1 Date: I certify ttiat the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulations.,of._the Putnam County,- Department-of: Date: PAPq 't+I WL, 0 ;—W i Certified by: c-14410 6061 PE RA ' Design professional Address: VtCKrKj LL j. JO S7E5 Lic. # ro20180 Comments: _ Form FM -99 PUTNAM COUNTY DEPARTMENT OF HEALTH U� DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM - ERNHT # V— 0 -O D i . ° Located at /tI%/LL �. To r Village UTPOAtg VALL.F_X Subdivision name /V zs0n/ /Zew-4 Subd. Lot # 3 Tax Map PC/-. i Block / Lot Date Subdivision Approve OE �6-g 5/ Renewal Revision Owner /Applicant Name 31 Pp-m/,) -D,4m 1D . NTZ-F- , Date of Previous Approval A1 Mailing Address 31 eIrl %-roo I,ti �© �55 a ao 1.10 G , Al Y. Zip Amount of Fee Enclosed Building Type (�-E5� ��ivT�A L Lot Area Zoo. of Bedrooms __�( Design Flow GPD 860 C Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of /,257D gallon septic tank and 15�qV L-.t. DF `� rl a i7:`E2'ZO i�. ' lPl 0- t- i P s A) _Z V G r2 A U6L_ Other Requirements: ---- n To be constructed by 3'i ern -tor) J:>A ;�i 2D Gfij ,Address �`( C_rmro ]b. -.,d `2c> , ) 4 C, .cif. Water Supply: Public Supply From Address • �/ ate pp y._Drilled.hy� 5p Address-- _ yg or.. Pray Su 1 ?.� JBAAt� fi. �s C 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 C,ompIWO e satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee w ld�be„furnisQ' ?thesowner, his successors, heirs or assigns by the builder, that said builder will place in good operating en ,'o any park o�sa�i sewage treatment system during the period of two (2) years immediately following the date of e i fiance th"P'roval the Certificate of Construction Compliance of the original system or any r ai thereto. Signed: \ c , Address % J j LA &�ti d1 I'l c R.A. Date // u/c /0 License # V -0 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 consi red riecessaryft the Public Health Director. Any revision or alteration of the approved plan requires a new e i Appr �\#ha` d of domestic sanitary sewa a only. _1 By: Title: Date: 1 Z White copy - HD File; Yellow copy - Building Inspector; Pink co - Owner; Orange copy - Design ProfeLsiol orm CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A. WATER WELLL ,Pease pftt dr`type �.:, r - -PCHD Mrmrt -# Well Location: Street Address: Tax Grid # ze-L Sr �Town/Village T C` M [416y Maps . /r Block I- Lot(s)/!3.3 Well Owner: Name: Address: 1 3 � N � �� . 3 Y rft -0,2 �sSQn� 8.,1� A) �` Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify). 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5 gpm # People Served Z_ Est. of Daily Usage gal. Reason for_ Replace Existing Supply Test/Obseirvation Additional Supply Drilling ✓ New Supply (new dwelling) Deepen Existing Well IDetailed Reason � Alse e-6- for Drilling Well Type 7 Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes q/ No Name of subdivision Meao)V cS1 Ai-e- I WsiT- Lot No. 3 Water Well Contractor: r Sys MQc , Address: � gTA)A Ave-, �z.c ' A) J Is Public Water Supply available to site? .................................. ............................... Yes No F/ Name of Public Water Supply: A 4 Town/Village /t! Distance to property from nearest water main: Proposed well location & sources of contamination t rovided on separate sheet/plan. Date: Zd v 00 Applicant. Signature. �- . . PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED .FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alter on of the approved plan requires a new permit. Well to be constructed by a water well dril r ce if by utnam County. Date of Issue j Permit Issu g Official: JL� Date of Expiration 0 Title: Permit is Non- Transferrabl White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 )s�z DSCkj 09/07/2001 14:26 9147363693 02!22/2681 21 :01 5147397156 CRONIN ENGINEERING 1 PAGE 04 PREMIER ATFLETIC CLU PAGE 02/02 .P.F. BEAL. & SONS, INC. ��•. .,—:'. MIl�Wig" T -• � �b y •�x 4 �•-��� — �O�GR��FR�• �� � VR� � F 'v. • l T i. .0v� �l��i'�9{��P' � : �.. nr� i .s� •. , . E>y1ffiWVj L WATM6Yi7M � ,�.� s c".�ad%%,,�.+a/i��i - ��c•vr i�.: ��% IdM/l G'w�o/ +k� MYwwnuCn►�wo WiMU w6LE FWAPS Tat„ i "ai 2764"0 - t warts odmWowe try FAX (E48) 2?9 -861 a CoMPLIRE INlTALL IMN, ORKPLACRU NT AND REPAIR S MVMM August 21, 2001 VS corporation Attn: Val Santucci 37 Croton Dam Road Ossining, New York 10562 Dear Mx. Santucci: sgard rg L'ot 3 �M1 'ia txeet, pl.ease be advised that -he yell •aaa .cr:a.11- sd`— fox- the—new - r ®:siae ice on uuly 9, 2001. The well was drilled to a depth of 145' and a flow of 53 gpm. We have instA.1ed a 3d HP Submersible p:unp at a depth of 100' and this pump will be able to be removed for service in tae Future by hand. ;be fact that the well is on a trill is not important d -e to the depth,, of this well. Servicing wil__ not r)e a problem. FtB /nm Very truly yours, P. F. a, pnc. SEP -7 -2001 FRI 14:20 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 4 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF EN_ VIRONMENTAJL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Propertyof 'ejn0oJ AAaq 'E�OAI7 Cor_�-. Located at /V1jt-,- -r���i Cc wN �y t".1"D Z -3_ T V f in-so ta,m,k 1/ t_t€ v Tax Map # R V. / Block / Lot / . 3 Subdivision of "'A(E LS0W f L,�C 011-5 E5_f_r,4_T7E_C VV FJT Subdivision Lot # 3 Filed Map # ,25 /l Date Filed o FR - o ± - 5/ Gentlemen: This letter is to authorize 71,H 6-7 ti y L . C''Iao v 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 or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on m ! be alf in connection with this matter and to supervise the construction of said wastewater treatm nt d/or water supply systems in conformity with the provisii t 'r icle 1.45.. ancV. 147 f tit. uc Lax the.P.ubl'ic- Health- _ i aw, arid- e'Putwm'n C, s�ai °. de: - Very o 1 LU �� Cou tersigned: �� ,� Signed: (�eEJi�ENr) JVV P.E., # _ 6�9 `` (owner of ,ro rry) Mailing Address .2 joy 1 7n)A t c N 51VV Mailing Address: 3 -1 PROTNO PAfK '?QA D 'r no ? F V'c & L State �Zip 10-576-4-f State At. y , Zip f 0 5r 2-. Telephone: _ �g ) 7�6�6 G� Telephone: (9_ , 3.-j - 75 6 Z- . Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES JIOATIfDN ' 012 = .PPItO�l- - L- OFT-L. NSTOg ._ A WASTEWATER TREATMENT SYSTEM . 1. Name and address of applicant: 31 C" -TOnJ D>4M � `I �ea-r -cdy �fl wt � -ewe , •. (�SS � n1 � nl G � • � /O S � � 2. Name of project: ss~rs v)/ATE ' SW'p� 3. Locatior(Dv: 4. Design Professional: 74M o-r.A y L. ��,� ;� j��5. Address: Z TO4A) W41 -rr{ OL_vo 6. Drainage Basin: fdnL nuv � 43 F--a D,), 7. Type of Project: Private/Residential Apartments Office Building Food Service Institutional Realty Subdivision Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted . .1./ 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... JV0 , 10. Has DEIS been completed and found acceptable by Lead Agency? ............... A11A 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other n r d ic. . _-Qr-d nances? ......:...:.....:::............... .:::..................:........ ............... Y _...w.....;r:;.. 13. If so, have plans been submitted to such authorities? ... M //k 14. Has preliminary approval been granted by such authorities? Date granted: N/A' 15.mT Type wage Treatment System Discharge ............ surface water ✓groundwater 16. If surface water discharge, what is the stream class designation? .................... N /-A 17. Waters index number (surface) ..........................................: ............................... %k 18. Is project located near a public water supply system? ....... ............................... �J L 19. If yes, name of water supply NIk Distance to water supply -,LL/A- . 20. Is project site near a public sewage collection or treatment system? ................ '?l0 21. Name of sewage system Distance to sewage system 22. Date test holes observed g t, w : 23. Name of Health Inspector M eer� ��G 24. - ProJ ect design flow (g allons per. day) .... . . .......:....... ............................... RW GA 1-I Day ° 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... JyO 26._t Has -SPDES Application been submitted to local DEC office? ......................... /V d Form PC 97 }' 8/99 2 27. Is any portion of this project located within a designated Town or State wetland ?C7 n�a!W =,rwr - ..vc1e� .4 .. -, •.. r .. � "M1.n ..u.� .�a�.iK�i. n �9._!'v�N'w4'� +. � w��y��f++.'r ..:i.�.��.Iii . 'Hti r `�L P t.. ..�K 7..`r . ':•�s.w r� �� �. v.Ei M'wly r.. 29. Is Wetlands Permit required? ...... A/ y - Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ............................... 6 , 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landf lling, 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 r/D , DESCRIBE: 33: Is there a local master plan on file with the Town,or Village? ...... ..................... E' 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? . ............................... AID 36. Tax Map ID Number .......................... ............................... Map 8 .►f Block / Lot 15.3 , 37. Approved plans are..to be returned to . ..... Applicant ✓ Design Professional .........NJTEaAllap licati&.s fir -r view.'ansi a pfoval of anew SSTS "to b6r Within'i6d, C"Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the proj ect may require DEP approval of the ASSTS 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 DER for review and approval. If the application is signed by a person"otherthan'the'appl'icant shown•in Item` !.,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision maybe grounds for the rejection of any submission. I hereby:gffirm, under penalty of perjury, that information pro �kr orm is true to the best of my knowledge and belief. . False teenents. deg herein Mfr r�r�tshable as a Class A misdemeanor pursuant to Sect n f1O. 45 ot, ,P lrl. SIGNATURES & OFFICIAL TITLES: Mailing Address :........................ czo ►� sa, , c 3� l LLJ d r t PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES "- - DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner _3 i l Qo`Mn) Address 31 0A EVAA (� t�yrAG, N. y Located at (Street) lVfj ( I .Qr _ Tax Map 9-Y-4r Block / Lot (indicate nearest cross street) Municipality LT)'i,rr-OAM OLc�,e ,o Drainage Basin 691 i4kLL Ao�_Lo „q C,,� SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test Hole No. Run No. Time Start - Stop Ela se Time iI in.) De th to Water rom Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 1 ,s �'Cz- s ►v►sYa �4 � 2 3 4 5 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. (Le. 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 . _.. .�.... .. ... �r..: lr � - . - r - �/pi•.'. �.iy �.p(y•y..�.y : sO RSfC. ti ..a• . _ � 4 - c DEPTH HOLE NO. A HOLE NO. 3 3 HOLE NO. G.L. 4 // T0'P20 IL G" TO7>5b ► - t-0P�50 1 L-- 05 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' coox SL, si►N 7> fBzAY sApi ] .5L /G r /TL y QM PWTJJ 9 Indicate level at which groundwater is encountered Ii%n, 6 Indicate level at which mottling is observed %✓oN g Indicate level to which water level rises after being encountered IVI Deep hole observations made by: 9N, t�S (-COO A11/0 eWC ), A .S , CP. t,.A )%Date 6 e . 09 zed Design Professional Name: I g M 0 tf / te do ro - Address: Signature Design Professional's Seal 6,2980 . t4tea We7}::T�at 12 _ . S1t.?1 :. 'RWECTLaNUMaER - .. SEAR ,_ - • -Slat*' E V1001nihentil CUellty Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS 6114 PART 1— PROJECT INFORMATION (To bs completed by Applicant or Project sponsorl 1. A PLJ/C�ANT APONWRy (� 2. PROJECT NAME yam. �j!� /� .1 I 1 'r_.rr-r % 1 \Aw1 Tf1�i1 1 " r v_v. .i O 1� A IPA �P;:/_V �i� -a -y DAl i. `PA0JECT LOCA110N: IZi�, c0i2P, umftoeft T C*Wtr 1?_ LUT 4. PRECISE LOCATION JOIN& addrau and road IntwoacWft OW wtt landmarks. stc„ of provlda ff") W ILL 5-17. �CAK'��-y TD. 2.3) —A P �_,oX. 1 500 ' 50 ��FS"1"O rM A —DA M S 11:1$ P�RO/POSED ACTM t_7Naw O ExWWO O MadUkattanMaltamtlon e. DESCRIBE PROJECT BRIEFLY: LA/V�'P2uc-T1a.to o, MAT&`n _�Su 6'T_>Ly�.�>21 7. AMOUNT Of LANG AFFECTED: InmallY <2J O 25 sera Ultlmatab -2, 0.e S . &CM I. WI�ILLJL PROPOSED ACTION COMPLY WITH EtlSTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? L1?Ya O No It N0. Oaarft ttrlatly e. vft T PRt vfr LAND USE IN VIC3NRY Of PROJECT? - tl.E ❑ h+eustifai Cornrrt.rclal AWkYlt un O PanlForaUOp.n tpiea otNar IN So/V(:; L� FPM /L}/ 'C— �SaAEN ?��9L 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY WEDEAAL, ,...STATE LOCALi1 ..�.. L ?YU ❑ No If bra, ilat ap�+eyl =) and o!�wappra�ral= , 1 owns o� .'Pu�j�M ANY ASPECT Of THE ACTiCY NAVE A CURRENTLY VAUO Pf.AMR OR APPROVAL? 6yft CI No n YSa, no agwwj iwnw and o«nwtapwwal Sut3��vrsoN � R*bv,� 1� LSo!�1v��yvrs_ ..t744T�S = yl1ElT�► .Srn(3DiUos16A) 12. AS A RESiJLT P�tOf00ED A0" * LL'WQS7M PE1tIgTJAfPROVAI REOWIE YOOIfIGT10N? I CD°ATiF1f THAT THE INFORMATION PROVIDED ABOVE IB TRUE TO THE BEST Of MY KNOWLEDGE AoWEeanvapanw nanw: O ._ IA) :5 Y ! Z Dais: ze .i .......,.,... ..- r- ,.•...� -. L� a`s ro..'t�:a� '& s4ifi34+'CgIF ..C" . . It the action Is in thO.Coastal Ana, and you 011,8: state a9snayr eomOste the Coastal- AssessrrNnt Form baton proeaHdfnq m"'this - assessment- PART It— ENVIRONMENTAL ASSESSMENT (To be Completed by Agency) A. GOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN a NYCA$% PART $17.127 It yes, coordinate the review O'eca lend we IM FULL EAF. CJ Yee ❑ No B. WILL ACTION RECEIVE COORDINATED AEVIEW AS PAOVIDED FOR UNLISTED ACTIONS IN a NYCAA. PART 417.x7 If No, a nogattve dectaratlon may be Out ad by another Involved ageney _ ayme ° `�' ❑ rte G ccuLD ACTION RESULT IN ANY ADVENE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be hwwr M en, IP legible$ C11. Existing al'- quality, to" or Oroundiaatar quality Of `quil(1ilty, noise levels, existing traffic patterns, aotid waste production Of disposal, Potential for erosion. drainage or flooding problanta: Explain litany: Cx. A'olhetlr . agrkuitural, arcflseolopiEal, Mstorle, or otlta. natural or cultures rssauema: a eomtnunity ar nslghperptood ciWoef'o t xplalrl bd®ny. C& Vegetation or fauna, II^ 8he1111sh or wildlife speCloa, algrdllCant habltala, of threatened or endangered opeeleaT Explain briefly. Cd. A Community's existing plans of goals as officially adopted, or a chance In use or Intensity of use of land at other natural reooureeal Explain CS. Growth, Subsequent development, or related activities likely to bca Induced by the proposed action? Explain brielly. Ca. Long term, 311an term, cumulative, or other atlects not Identtflod In C1457 Explain brlolty. C7. Other impacts pnctudlng Chan gas In use of either quantity or typo of anorgy)7 Explain bnotly. D. IS THEM Olt ie THEII1E LIKELY TO e! CONTROVIFIBY RELATIID TO POTENTIAL ADVEIgE ENVIRONMENTAL IMPACTET , > .... ❑ Yea .: ❑ No i8 Yon. •aatplabl FART W DETERAUNATIAN OF 3NNIFiCANCE (rd be empleted by Agency) INSTRUCTXM& Fgf earM edalerse effect Identlflsd above. sirr9lno wMthor n la tlubetantlaJ, WrOe. bnport lit ar ottldr+atle®i1gNf east. 'eainection Each of eW shmid bar assessed In with its (a) to aing p.e. urban of (emit: (O p abstIlllty of oeatirdn (s) dtuatloe; (d) I fsiE9llittr. (•) f8aropraphk sedge. and M n"nittrde. if neceeaary, add ettaebmai'tb of .—fail prppgy�p afatsiifal0. 6nlrro that uDlanatlons c9ritsin suH delat detail to show that all reie nt adverse Itepaota Dave, best Idsntiflsod iiid' t ey ;y ❑ Chock this box It �l , _Y x g> t sdv you Rave identfiled one Or it1OPQ potentlall lay Ot si hlticant Impalas which MAY occur. Then pfoceed dirictly to the FULL EAF andkr prepare a positive dscloratlon. 0 Check A le box It .yw hm- -Miser nlned, based an the inlortnatlonn and ns documentation, that ;♦h0 ' PnDpo!!d rnCtlOn MILL N nsuit In ItA�allOnMiebnt Adiefte 4rMronn,iih ®,•- TM provide On sttachnien s t "as 'Y tiesuppOrtlhg thitl d® �" Name Ct Load Aae/KY V" P"K or Vol Name 40 It efpatlr . Key at Lead Alf"CV Kai ire _. . O 0 ex E,:y v^.,$ .. C.!}. Si TT .As ,..d� .;.y.i v�a�'�.��- 1•I�S £�l,' Xc .:ar �+dKl w: Depth to water Depth to mott ling 1 VIC Depth to,rock/iznp. - . . -7 G.L. Depth to water Depth to mottling _ Depth.to rock/imp: G:L. 0.5 D r_ 12) Depth to water Depth to mottling .. r Deptli-to rock%imp. 7 G.L. 1.0 1.0 1.0 2.0 �tr 3� k S r� 2.0 rr-6 2.0 �' 83 3.0 e -o CvN�rc.4 3.0 n- �-jkb 3.0 �-' 4.0 4.0 4.0 5.0 5.0 �(� ( 7 5.0 ( `- �� r IRX_ 6.0 ?j c� `� .6.0 6.0 jam- t'1 7.0 51ci 8.0 _.... 9.0 10.0 I ' C VI 7.0„ ¢-� 7.0 8.0 rc 1 fi}/ 8.0 9.0 X09 C 9.0 10.0 10.0 Hole r Lot # Hole # Lot # Hole # Lot # Depth to water _.Depth to water Depth to water Depth to mottling Depth to mottling Depth to mottling Depth to rock/imp. : _.Depth to rock/atri: ___ ...x _ F I}epth:toock/iinp. G.L. G.L. G.L. 0.5 -- 0.5 0.5 1.0 1.0 1.0 2.0 2.0 . - 2.0 _. 3.0 3.0 3.0 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6.0 9 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 a• t V.S CDNSTRU( T 1 >; SN- /PD93209 /NY ---Ir- Or . 1&& .. 8.1. 29•$ ire - i twT Na it•1 1 —E MULL CA art IutCKS y A: ' s» M%W 1 s NICK• Idea I ' : IT' NN kP ,f IvO�• i9 •Y Tt' Mi N► i 1 ------- --- -- --- - - - - - -J ' tAa am N 1 IT N WAT ca. dAm . • N!+ IAR tia. Am MAT • q[ el QC J tMMi so = .. •%Will •• Immallmorpdoz i •� cw Name P KIEL Ift NK v le'-L 716' , • i <'� wr vnra *so 1^' •� 'QD1 S im.4 "s I vw 6 rRATN U ` Wcu Te dom � T ON -SITE STEEL R#/1j1ER reTrtTt I e SIGNER, PROVIDED 6 INSTALLED >, •. ,i`n )� u -r .. ON -SITE BY QIIILDER er1 11 • I e L I / .. WN M II , so 1 R R1wTCAt Sili' TYlC 't' g' :�O' SW OR GNMK C T •O•f ( .� I t . t7[ bNi wt p+el 1 1 � • �° fig ..K °• . 1; ----- 1 -------------- �Tte�Tl•1 -I Yr�•Y•'a� 'q 6� _-- _- _-- _ -aYO- 1/ I I�ef 1 1 �i�aN�. a�tRR 1 91-4 Ur IY -a Vr . 11 11 11 t• OVER Gear[. RASE IATER S✓e TLP[ 'a' cTV aTPlOID w DICIn , MISM TO CLS AS12. ATTACH WA IN' IWC 'S• 8Y XKUS AT M OL rAa LAIN Wr •C ME GTP MIIER AT RRRIIT ANGLES M ClG JMIS. ATTACH d 1 1.40- IIK 'S' dM KKWZ . Am Ir SOL SET RAC[ lCKW% r AT 00 JORITS Alb &TAG= ,RINK r-9• EACH I/RER ) /16• 1. Le s OLR OWI AtlTf IOU01 dO0 MARLi eKi6011 ) L CEILNIE RRYVALL WILL RE DNTTTER I'M ALL ON -SITE ILIIQM CONEY M M "M ALL S ]Pe• - eOTN WERIM 6 C=RASR 4cwx T UIR'-TTT Iwo IC' 9.. -Y 6'-7 1J2' 6• -] 1/r M ME LOCATMW MAWWO VALLEY k4 MJINMI EDWT% 30 PS► 90V LOU ! . Q` f 4>lTG E7<trN1e;LT1 rit, K• OCRa< MM VALLS r r 3'm�! eiORREis a es at. 3 58 SPECIAL Tip STORY a *NV vnnoNsa;:, aR aarsaa P� r U120 x1l GARAGE &[2'x7 BUMPOUT G� �I1 Oil[N RET- tl�jliifplpt M K• ?-1 Lra4 V<•.q' -t• NL. uR Ee4 PA 11W6 ea16tATp�'SIr•a,STR - EST STORY 1 ''} s r + r;ei/►;.@ MSTEELCOW-SIK -NeRR. VALUIv[R YM STUOR ND. A[�SIM�• fiT►r[al WAIL) Q: TA' OE. ATRAOH' Who LCHENT COeTCR NAILS ! Y eK orw2soil � •k �. irTr tat -�» SMI /M�tTl0/ lit ••T-r REMtORsi16' WTKi2',4VP A!/LX0 VERT]LALLT a EMC SIK OVER a :e $IVu �S6e6• < n, AeTAp �✓6A;CC1F/rl; CRUEa tAK2 4 -)/B' L01G rA/t• 14l «U01 F 7. OC. tnm056) Rad.e7�SADYlSLbY Plf�t07 Jew rM 1- It ! -,ti L " CXT %0 s2 too on IL Ow V94mv snu ■9■ 01 lik■$ it 1 0 W §CJI-4 NOW VOLLS am imsis e w SL TO K R• Ot qKM Nftq. Im me, ti W.M 3t4•ftsr-.r Bit- N MLL.WK, t-# IIEIW41.W-r 14L 4WR Vlt.lo K, MSw".W-ir SV►■e TSTI" 3s- lKsomofm CCILPCG K" LORD ■Ly 4dC#A CGUI"W60 S4■L K I=TPLILCN tit tW CC Xpeca" 63 talofr ir. W-0 sm -34le top, MO. Ms 41 tvmn 0, r sm"Am" fly wal "r"I Im- 0 4 I CLO \Jlq Im is air W W 3 PA C,: W/20 x AAVWPOM OMM eKCGI ►,,) "d-sms few WO-Mr IIE WAW-MW#Imwt&cvv J r. z 4N. 5EP -07 -2000 15:56 P.0Bi11 1= S r- - - - - -- - - --------------------------- -- -J C. - - - --� 1 ---- 1 G I 1 Z 1 a I I i t I � ■�� •r Q- 1 i � % i kid. 1 1 1 iYr1E('� i �1l I ( � j � 1 1 [ � 0���� • Qy ix��a>r low i 0011 i �s. at 04 :d a $ i t , I L---------- i I V1 I ! ` I 1 I I 11 1 1 1 1 I 1 i i I i I J C j I 1 1 I i sell 111.71 g %c Ig 1 •�� 1 I I 1 1 I .1. 1 1 1 1 oil 9 the I 1 1 1 I - I i� - -- - - -- 1' loan =2 MT 711 jrA X-M 1 1 r 1 1 • I 1' �� 'f 1 1 L - - -__ -- -- -------------------- ------ ---- - - - - -- FL ` f �T tT r. �• PUTNAM COUNTY DEPARTMENT OF HEALTH DIVI,S -QN._ F JFNN'VIR.ONMENTA:L-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: L:oAj s-rj?_-u c'rr 6A) of 55TS Aro I, -- VA t- JA.nl -ra ' cc represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: 31 er C TON I)AtA . e be :- . Having offices at: 31 N 2a-r e 10 DAM ko A, Q .15; Y N G ) Whose Officers Are: President - Name: VA L SAN7 u M Address: (_-;,Arvt6 AS Awn u F_ ) Vice President - Name: 5 t-tE. AS i��ESI ��iyT Address: (SA vu E. A S A r3 o u 6 Secretary -Name ' Jct}aJ -ru Ca � i � t-F � i, � E _ . Address: 71A cA Ni .... A! E) Treasurer - Name: 5Ar te- S c t rz. Address: 3 o Y .F- i and that I am and will be individually responsible for any an all ct f ie corporation with respect to the approval requested and all subsequent acts relating treio. f Signed:. Title: Sworn to before me this Zv day of (�th) vo (year) NOt 1�4 Y L. CRONIN tary 6�'(ic, state of New York No.4923313 Qualified in Westchester COW* commission Expires March 14, Zoo Z. Corporate Seal Form CA -97 rm Lot 2 CAST #FON M FT MW EASE100' 70 —. 1250 GALLON "ClIfIE 11P77C 7W COVN7Y OF PUMAM FOR SLOPES ±16[.11 -4'e PILL' SVO?J8 PIPE ro PEFFPVC N too' 0 7REAV� (ENDS ARE CAP P- -0) 1009 EXPANSION APEA LOT 3 Areo=2 02.�3 Aces 4W$w?w,, Oat* A. Pad 99 o FOOTING DRAWS AjVb Roa, LEADERS ld-)Vd 10114CRI Y RIA AS 10RAICRI Y MAIIS RBWN Knip zxls-,,.Vc oFa trir .h- :4 M FT MW EASE100' 70 —. 6 *2, 7W COVN7Y OF PUMAM FOR SLOPES AND MAfiVrAMW swNr LRas FOR ALL s7RffT ro too' 0 -e 9-Y rvr T. EET FOOTING DRAWS AjVb Roa, LEADERS ld-)Vd 10114CRI Y RIA AS 10RAICRI Y MAIIS RBWN Knip zxls-,,.Vc oFa trir .h- :4 m fig aS ii -77 7LI; fflolii IL X 'I y W t SUVSURFACE`6EWA6f` MEAlMENr- SYSMI'M (SSW 1S.-DESIOVED 1 93.5' SOUTH MD OF 2ND.- TRENCH 61.5' ON A SOIL PE"tlt&A 76N - kA"jr �6r 8. TO TO "Imuts qD OF WIVCH. 65.5' 10.6, INCH- DROP ($ SOIL DAM,SHEET - 53.5' 10A 5 Sovm END OF 57H, TRENCH 2. 4Nv'11VEE??'W,45 'PR/0R TO - STARnNG ot*Kl AND O'77RED m.5' U 81.5' PR /0R, , 110 BACKFILbING T74£NCHES. SOU �H END OF 77H. TRENCH 68' z 3. ' Ai --A ADD /WOWS UN AUMORIZED ALMRA77�.& D0177 7`0 iklS,,D��A LNG: /S 5FC770N 7209:(2) OF THE NEW' YbRK,'.SrA�7E 93. 5' 124.5' DUD OF 97,V_ TFE�.'Cq A VFOL*776N:0 128' 0 F'i C4 D EDUCATION LAW. 4. PROPERTY SHOW HEREON APPEARS `ON A., f7LED MAP _�&§DIWSION W W (A Z 0 0 p) PLAT PRMA RE-,() q-OR NELSON. ;/ jews K�tr­ A06PAAM BY ISADEY _��,ED z w 0 w j SURWnNG A tN6*tfR1lV6 PC, IN THE AND, wA rsow N PU77VAM .6-- CLL_RK5 OFIICA AS MAP No. 2511 ON, AUG. -5; 1991. I IL _J S. HOUSE L OCA 776W W TH RESPECT 70 -0 �R OPCi4Ty UNES WAS SURVEYED HOUSE. _. z w lep,;- I.. AND PREPARED IS Y' DONALD J DOMMELL Y P. &. V) 5 1w, W o 2 Q HELL 'LOCA nON' NCR END, OF �u. IL X 'I y W 1 77' 1 93.5' SSrS rANK LOCA n01V NCR END, OF �u. A B srpnc TANK 1 17' 1 53' 51STANCES ro 'SOUTH ENDS OF ssrs NCR END, OF �u. A B soum Eivv OF isr rRovcH 57.5' .99.5, SOUTH MD OF 2ND.- TRENCH 61.5' 101.5' qD OF WIVCH. 65.5' 10.6, ✓UNC7701V BOX f4 53.5' 10A 5 Sovm END OF 57H, TRENCH 76.5' m.5' SOUTH END OF 6TH. TRENCH 81.5' 115' SOU �H END OF 77H. TRENCH 68' 120' §00H END OF 87H. TRENCH 93. 5' 124.5' DUD OF 97,V_ TFE�.'Cq 99' 128' D45TANCES TO SS TS -BOXES NCR END, OF �u. A B. JUNCTION. SOX f 34.5, LJJ ,IUN& nolv Box A2 41.-5' 69' JUNC 7701V BOX fJ 4-7' 73' ✓UNC7701V BOX f4 53.5' 76.5' ✓ UNCn0N BOX 0 60' &,' 5' - JUNC770,v Boxffi6 .66' 85.5' A#yC77CW BOX f7 ',72.5' JUNC7701V BOX *0 `--j 79' T.. 935' t N chow SOX ,o9 1. 85' 98.51 DISrANCES W NOR7H ENDS OF SSrS i. A I NCR END, OF �u. 5 > M: NORTH END OF 15r TRENCH 34.5, LJJ ix - .)�. w 0 0 to 0.4 rE. .12114101 50' Ld w z Mcc z 53' 7 5 !3,0 r NORTH END OF 6 TH. 7A9VCH 54.5' �6 Z w _j z < X; z z 0 'W LLJ 0 F'i C4 W W z w 0 w .6-- DISrANCES W NOR7H ENDS OF SSrS i. A I NCR END, OF �u. SEC 77ON 84.15 NORTH END OF 15r TRENCH 34.5, 47' NOR 17'/ DV9 OF. 2ND. TfCNOY 0.4 rE. .12114101 50' TRENCH NORTH END OF 5r�q� TRENCH 53' Y. r NORTH END OF 6 TH. 7A9VCH 54.5' �6 DISrANCES W NOR7H ENDS OF SSrS i. A I NCR END, OF �u. SEC 77ON 84.15 BLOCK. l LOT 15.3 SUSL 0 T j ORAMV: IfUld I CHECKED: TcJ 0.4 rE. .12114101 NORTH END OF 5r�q� TRENCH r NORTH END OF 6 TH. 7A9VCH 54.5' �6 RE NSIU.N TAX MAP At SEC 77ON 84.15 BLOCK. l LOT 15.3 SUSL 0 T j ORAMV: IfUld I CHECKED: TcJ 0.4 rE. .12114101 1 k Formerly AVA77. Now : or,;- hrirerly'ItA1COWE�Z N09"35'20" E 94.51' - -- ' _ Stone Wall 0enerdly 0n Line o0a .d 4e l' l 4 Coffin y RoL� 2� a A A 11 �O zv W t.3 a h y t k*, S o 4$p. !S' � �a