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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 30.18 -1 -17 BOX 19 lirs .. t ol ? :: ' 4 so T i �i 4 T J •; . ' r i % I 02178 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES 2 ° D� I a � E 3 . a.a...2 • ......._- = �LE �; ��L. ,NO.- . . 3 . .HOLE #4 G.L. 0 -3'9' TOPSOIL TOPSOIL TOPSOIL. TOPSOIL : ' ®•5:. 3 -7 °010 MFnTitM BROODY MEDIUM BROWN MEDIUM BROWN MpDJUMBRO.WN 1.0' SANDY LOAM SANDY LOAM SANDY- :'LOAN SANDY LOAM 1.$' 3.0' 3.$' 4.0' , 4.5' 5.0' • 5.5' 6..0' 6.5' 7.0' 7.5' Indicate level at which groundwater is encountered NONE Indicate level at which mottling is observed NONE Indicate level to which water level rises after being encountered N/A Deep hole observations made by: ADAM STIEBELING Date 10/31/01 C0 AWN unroll 517/2002 Design Professional Name: JoEL GREENBERG Address: 2 gus OOT ROAD NORTH Signature 11 Vtg ARO ~ C p�v c A -4 $t �i A Of NF- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: ' 7 1g, 0 3 Inspected by: .3 r Street Location b; e S ore. 4 a ,� Ule0" Owner /tj q4 a- o �.- T ©wx1:_ . ... d- �►�;:, �If t , �...x..,.4..:... �.:. _...._-. Permit #° �.�.:_.�..,.�..:.. ___.... TM # 3 K + o — 1 — I '�7 Subdivision Lot 6 (X (p 17k id- 1. Sewage System Area a. STS area located as per approved plans.......... .. ................ b.. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped .................... ............................... d. Stone, brush, etc., greater than 15 from STS area.......... e. 100' from water course /wetlands ............... .................... II. Sewage System a. Septic tank size - 1,000 .... ..... 1, 250 ......... other ................ b. 'Septic tank installed level. c. 10' minimum from foundation...... d. Distribution Box 1. All outlets at elevation -water tested ..... �/ y. • r4 2. Prote elow frost ................... ..................`............. um 2 ft. Original soil between box & trenches e. unction Box - properly set .......... ............................... 6. Trenches, y 1. Length required ��q Length installed �� 1 2. Distance to watercourse measured Ft.......... 91 3. Installed according to plan .:....... ............................... 97 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface... ............... 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 11/2" diameter clean ...................: 9. Depth of gravel in trench 12" minimum .......:........... 10. Pipe ends capped ..:.................... ............................. g. Pump or Dosed Systems.: P_P_- ,. -- _........_ e'of um cham)e 2. Overflow tank. .. U 3..- Alarm, vis aut ......:............ ............................4. P sily accle, manhole to grade ................. 5 rst box baffled .....:.................... ............................... 6. Cyycle witnessed by H.D.estimated flow /cycle........... . House/Buildirig a. House located per. approved plans ... ....................:.......... b. Number of bedrooms .............................................. .q.... IV.. Well Well located as per approved plans. : .....:........................ b. Distance from STS area measured 4- 10 ' - 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 pl f. Curtain drain outfall protected & dir.to exist waterco s g. Footing drains discharge away from STS area ............... b. Surface water protection adequate ........ :........................... i. Erosion control provided ................. ............................... Rev. 12/02 v� V� C. Y� W1�. SPECTION Fill pad located per the approved plan Fill Pad Length Required Length Fill Pad Width Required Width Fill Pad Depth Run -of -Bank Fill Quality Slope from Top to Toe Impervious Layer Installed Erosion Control Installed Sieve Test Results (if applicable) Additional Comments: Reserved for Field Sketch if Applicable Required Depth Date: Inspected by: k r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR 3 .�:.:�: ::....... � . A- WASTEWATER TREATMENT- SYSi -EM .:.....:. - �.: _ .. <.:... . 1. Name and address of applicant: RICHARD PETRONE 344 LAKE; SHORE DRIVE PUTNAM VALLEY, NY 10579 2. Name of project: RICHARD PETRONE 3. Location TN: PUTNAM VALLEY 4. Design Professional: 0EL GREENBMG 5. Address: 2 MUSCOOT ROAD NORTH 6. Drainage Basin: HUDSON RIVER MAHOPAC, NY 10541 7. Type of Project _ 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)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... No 10. Has DEIS been completed and found acceptable by Lead Agency? ............... N/A 11. Name of Lead Agency N/A 12. Is this project in an area under the control of:local planning, zoning, or other officials,. ordinances? ............................................................ ............................... YES 13. If so, have plans been submitted to such authorities? ........ ............................... No 14. Has preliminary approval been granted by such authorities? N/A Date granted: N/A 15. Type of Sewage Treatment System Discharge................. surface water 4groundwater 16. If surface water discharge, what is the stream class designation? .................... N/A 17. Waters index number (surface) ........................................... ............................... N/A 18. Is project located near a public water supply system? ....... ............................... NO 19. If yes, name of water supply N/A Distance to water supply N/A 20. Is project site near a public sewage collection or treatment system? ............ :... NO 21. Name of sewage system N/A Distance to sewage system N/A 22. Date test holes observed 10/31 /00 23. Name of Health Inspector ADAM STIEBLING 24. Project design flow (gallons per day) .............................. 800 ... ............................... 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... NO 26. Has SPDES Application been submitted to local DEC office? ......................... N/A Form PC -97 8/99 2 27. Is any portion of this project located within a designated Town or State wetland? NO 28. Wetlands ID Number ......................... ... ..... .............................. ........:..................... . N/A 29. Is Wetlands Permit required? .......:...................................... ............................... NO Has application been made to Town or Local DEC office? ............................... N/A 30. Does project require a DEC Stream Disturbance Permit? .. ............................... No 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 No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? Yes/No NO rn DESCRIBE: t nn 33. Is there a local master plan on file with the Town or Village? P g ......................... 34. Are community water and/or sewer facilities planned to be developed within -- 15 years in or adjacent to project site? _ n 35. Are any sewage treatment areas in excess of 15% slope? . ............ .I.................. NO 36. Tax Map ID Number Map 30018 17 ........................... ..............................' Ma Block Lot 37. Approved plans are to be returned to ..... _ Applicant Design Professional -NOTE. All applications for.reuie-w -and approval. of a -new. S STS -to be- lo" within the NYC--- )Xlateished shall _ - be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this foray is true to the best of nay knowledge and belief. False statements wade herein are punishable as a Class A misdemeanor pursuant to Se ' as 210.45 the en Law. SIIGNATURES & OFFICIAL TITLES. Mailing Address: ................................... 344 LAKE SHORE DRIVE r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ . .. .r ..Yta .C_ .i v � n .! n .Y S .. t. �- ... a rot.. +._..[sa- i ..i .. .... ...._ _ .[•. . < .. •.. .J. ♦ .....an . - ..r �s Y � DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner RICHARD PETRONE Address 344 LAKE SHORE DRIVE EAST,PUTNAM VALLEY NY 10579 Located at (Street) LAKE SHORE DRIVE EAST Tax Map 30.18 Block 1 Lot 17 (indicate nearest cross street) Municipality TOWN OF PUTNAM VALLEY Watershed HUDSON RIVER. SOIL PERCOLATION TEST DATA Date of Pre - soaking 10/31 NOTES: Date of Percolation Test 11/1/00 -51M in for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be \;-submitted forleview./ 2. Depth iriea's'iiremeilts to be made from top of hole. Form DD -97 J VEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES ' DEPTH ` " .. HOLE N0. 1 HOLE NO. 2 HOLE NO. 3 G.L. 0 -31" TOPSOIL TOPSOIL TOPSOIL. 0.5' 3 - '7' 0" MEDTI JM 13ROWN MEDIUM BROWN MEDIUM BROWN 1.0' SANDY LOAM SANDY LOAM SANDY FOAM 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' rn 8.5' 10.0. tt7 t � Indicate level at which groundwater is encountered NONE Indicate level at which mottling is observed NONE Indicate level to which water level rises after being encountered N/A Deep hole observations made by: ADAM STtEBELINC Date 10/31 /00 Design Professional Name: JoEL GREENmG Address: 2 MUSCOOT ROAD NORTH _ MAHOPAC, NY 10541 Signature: Design Profes§ional's Seal w __ i • , /r/ .f it PUTNAM COUNTY DEPARTMENT OF HEALTH , , �- ._ ..E NVIRONMFN -TAL-- HEALT-H -SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. ,GENERAL INFORMATION Name of Projec 3I � J uyv) County V Site Location he c�� Building construction begun Extent Is pro Oily within NYC Watershed ? ................. ❑ Yes o SECTION B. TOPOGRAPHY (Please check all appropriate boxes) I. ❑ Hilly _❑ Rolling Steep slope .. . slope - - -❑ Flat -- 2. ❑Evidence of wetlands Low area subj ct to flooding ❑ Bodies of water D d't h k If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS - Appearance"of soil: Sand Gravel . Loam D Clay. Hardpan e 11. Observed from: Borings ❑ Bank cut ackhoe excavations 12. Soil borings /excavations observed by on 10 3 of 13. Depth to groundwater s� o L4 4k- on '( - 14. Depth to mottling V on B. Are test holes representative of primary & reserve areas ...... ............................... es ❑ No 16. Soil percolation tests made by on 17. Soil percolation tests witnessed by i�-� .,�-,� ✓�;� �� on SECTION D (on back) t( Form ST -1 ❑a ramge i c es oc outcrops 3. Property lines or corners evident ....................... ............................... ❑ Yes No - -- 4: Ao water courses exisf on or adjoin theproperty ............:......... ........ es .. ❑ No oss c 5. ,.Will these affect the design of the sewage system facilities ?............' es ❑ No -.6..: Do watershed regulations apply in this development ? .::.:::...::.:.:....... Yes No 7 Will extensive grading be necess ... _.. ❑ es No 8.' . � -�... � . _ •_ -...._ - �Will�exterisive fill be necessary for SSTS ? ........................ ................ ❑ Yes No .. - 9. Do filled areas exist within the SSTS area? ........ ............................... ❑ Yes ffN o If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS - Appearance"of soil: Sand Gravel . Loam D Clay. Hardpan e 11. Observed from: Borings ❑ Bank cut ackhoe excavations 12. Soil borings /excavations observed by on 10 3 of 13. Depth to groundwater s� o L4 4k- on '( - 14. Depth to mottling V on B. Are test holes representative of primary & reserve areas ...... ............................... es ❑ No 16. Soil percolation tests made by on 17. Soil percolation tests witnessed by i�-� .,�-,� ✓�;� �� on SECTION D (on back) t( Form ST -1 a SECTION D. DRAINAGE Q v 1 � f 1 ' 9 v 2 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? No 19. Will groundwater or surface drainage require special consideration? ..................... ❑ Yes o 20.. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... E] Yes 5klo SECTION E. REMARKS 21. • If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities? ................................ ............................... a Yes l l O I*6btion data 22. Do adjacent wells and/or sewage systems exist? ....:.......::::.:..: ...........:::::.:.......:...:: Yes EZrN0 23. Additional comments 24. Site observer /inspector and title ZD- f VN Its - 25. Dates) of observation(s)inspection(s) 1 O 3 TEST PI PROFILES Hole # Lot # # - Lot# _... - -Hole # . , : -_ -Lot Depth to water - Depth to water Depth to water Depth to mottling ' p.. g _ Delith'to ottling Depth to mottling Depth to rock/imp. ' t7 Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L. 0.5 o "31' -1'0 - 0.5 - - 0.5 1.0 2.0 '' hI - -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 6.0 7.0 7.0 7.0 8.0 �1��! �- - 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 is t6 121071 —TOst 12 L PROJECT 1.0. NUMBER 617.21 SEC Appendix C 1 State Environmental Ousllty nevier; SHORT ENVIRO_NM_ENTAI.,A_SSES MtNT.- F- ORM - ='-- :- -rte For UNLISTED ACTIONS Only PART'1" PROJECT INFORMATION (TO be completed by Applicant or. Project sponsor) ar, N h nctlon Is In the Coastal Aria, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 1. APPLICANT (SPONSOR 2. PROJECT NAME .RICHARD PETRONE RICHARD PETRONE J. PROJECT LOCATION: Municipality TOWN OF 'PUIT M VALLEY County PUTNAM 1. PRECISE LOCATION IStreet address and road intersections, prominent landmarks. etc.. or provide maps LAKESHORE DRIVE EAST S. IS POSED ACTION: Netr 0 Expansion 0 Modlllcaliorualterstion A. DESCRIBE PROJECT BRIEFLY: NEW HOUSE 7. AMOUNT OF LAND AFFECTED: Initially 0.863 acres Ultimately 0.863 acres S. Wt PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? jc�kyft ONO It No, describe "fly 9. WH is PRESENT LAN��D11 USE IN VICINITY OF PROJECT? e�Manllal L1 Igdtlttrlal 0 Comm*reial 0 Agriculture 0 Pork/F twos t/Open space 0 Other .__- a .�...� ., _.. ....._ ... � _ . _.� .. � .._,.- - .,. _ ..._ .. _... _.._..._... --.� ._.... ...........:.... � - -`- .. _..._......... ,.._ �.. 10, DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING, NOW' OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY IFEDERAL. ' STATE PR LOCAU'^^�� �7+( No 11 yes. list agor"el and oo mluavomysis u Yea ' PUTNAM VALLEY BUILDING DEPARTMENT it. DOES ANY a CT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? 13 yes Ne II yes. Itat aq*m notna and permlt/approo 1:. AS A RESULT OF ACTION WILL OUSTING PERMITIAPPROVAL REOUIRE MODIFICATION? 0 yes No I CERTIFY THAT THE INFORMATION VIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Apoueanwponaor RICHAJUI PETRONE Date: 6/30101 PRWECT ARCHITECT Signature: N h nctlon Is In the Coastal Aria, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART 10— ENVIRONAAENtAL ASSESSMENT I I o ue Curnpleteo oy •Agpti ' A. DOES ACTION EJCCEED'ANy TYPE f T►iREStiOlO IN 6 NYCRR, PART .617 12^ It ydu, char lnot`o.the f.—to- procooa and use the FULL EAF ❑ Yos7 J No G. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 HYCRR. PART 617.67 If No, a nogotivo doctaralion may b© supars"Od by anoiner Involved agon0y. ❑vos ❑Poi _ _ C. COULD ACTION AES1.10 IN AN7 ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Anoarora may bo hnrwarltten, If logible, Ci. Eulallno air quallly, Burfsco Of Groundwater quality or quantity, noroo Iorols. on1a11r1G traffic pattoma, @OIkI wagle production or disoosni. potential for on slon, drainage or flooding problems? Explain brlolly: Ca^.. Ao4thotle, Ogrt:utlural. arehaoologieal, historic, or otter natural or cultural rosourcoa; or eorri3rmnIfy of nolghbodioW chlarectorT Explain brlofly: C9. bo"atlon or fauna, fish, 91`1011116h or 01161110 apocloo, significant habliato, or throotoncd or Gnaengicnd opoc"? Explain bdoli ; C4. A CorrtnlunOty'o oulating piano or goalo ao officially odoptod, or o chango in uao or Intonoitq of uoo of k6IW of o" ntatur ®1 r000ufM? EAptain bnofty ca. (OMMIh, aueawurmf dovoloormni, or rolotod 0011141109 Iftly to bo induced by tiro pfop000d Dction9 60101n brlofly, D. 13 TyH.ERF- OR 18 TTHEAE LIKELY TO ®E, CONTROVERSY RELATED TO POTENTIAL ADVERSE ZNVt11 MENTAL IMPACTS? .0 bOfl ` ` 014d. - If Y(i®, PART 101 —DETER MINATOON OF SIGNIFICANCE (To be completed by Agency) INSTRUCTION& For each adverts® offset Identllled above, determino whether it to oubstantlasl, fares. Important or otflerwioe 919nllleanL Each afloct should be assstased in connection tenth Its (a) setting (i.e. urbap or rural); (b) probablllty of oceufvinp: (e) durstlon: (d) Ir►evs MIblllty: (e) geographic scope: and M monitude. It neesooary, add atI&chfmmta or mlarence suppoding mitertals. Ensuro that ouplanmtlons contain oulflelont d ®tell to show that all rmletvant adverse Impsoeto have been IdentIlled and ildequately'addroosed. ® Check this l=ox If you have Identified one or more potentially largo or significant adverse Impacts which MAv occur. Then prod directly to the FULL EAF and/or pimprar® in posltive declatr ition.. ® Check this bolt If you hate® determined. based on Ohm Information and analysis above and any supporting docurnentation, that the proposed action WILL NOT result In any significant, adverse environmental Impacts AN® provido on Iattachmonts as necessary, the rmosons Supporting this datertttindtion: Narm of AC(mcv r'CAt or YM Name O f 9"Pons'Re 0110cof on Load AQOnCy yotle of Naloongthle Off#cef 1eMINr0 V - 010on1 Q Officer en LQ Aa@n(y .onneum of Vrowref III diflef"I from mirionll e O Ice"I 01Q . 2 CO. Lattg form. 0h6n form, cumulativo, or ostler affects not Idontillod in CI CS? Explain Wtofty. 4 J :2— . C9. ONDOr Iftlpliet0 (including ehon"o In use of eithor quantity or typo of onargy)? Explofn bdoffy. G) D. 13 TyH.ERF- OR 18 TTHEAE LIKELY TO ®E, CONTROVERSY RELATED TO POTENTIAL ADVERSE ZNVt11 MENTAL IMPACTS? .0 bOfl ` ` 014d. - If Y(i®, PART 101 —DETER MINATOON OF SIGNIFICANCE (To be completed by Agency) INSTRUCTION& For each adverts® offset Identllled above, determino whether it to oubstantlasl, fares. Important or otflerwioe 919nllleanL Each afloct should be assstased in connection tenth Its (a) setting (i.e. urbap or rural); (b) probablllty of oceufvinp: (e) durstlon: (d) Ir►evs MIblllty: (e) geographic scope: and M monitude. It neesooary, add atI&chfmmta or mlarence suppoding mitertals. Ensuro that ouplanmtlons contain oulflelont d ®tell to show that all rmletvant adverse Impsoeto have been IdentIlled and ildequately'addroosed. ® Check this l=ox If you have Identified one or more potentially largo or significant adverse Impacts which MAv occur. Then prod directly to the FULL EAF and/or pimprar® in posltive declatr ition.. ® Check this bolt If you hate® determined. based on Ohm Information and analysis above and any supporting docurnentation, that the proposed action WILL NOT result In any significant, adverse environmental Impacts AN® provido on Iattachmonts as necessary, the rmosons Supporting this datertttindtion: Narm of AC(mcv r'CAt or YM Name O f 9"Pons'Re 0110cof on Load AQOnCy yotle of Naloongthle Off#cef 1eMINr0 V - 010on1 Q Officer en LQ Aa@n(y .onneum of Vrowref III diflef"I from mirionll e O Ice"I 01Q . 2 v PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISIO.I�T -OF FNVIROleiMENTAL HEALTH SETtVICESµ�" _. "..__._.,. CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # PV- 2 8 - 01 Located at 349 Lake- Shore, Drive Town or Village Putnam Valley Owner /Applicant Name Anthony R„uggi _Pro Tax Map 30.18 Block 1 Lot 17 Formerly Petranie Subdivision Name Roaring Brook Lake Subd. Lot # Mailing Address 2 wildflower Lane Putnam Valley, N.Y. Zip 10579 Date Construction Permit Issued by PCHD 6/21.402 Separate Sewerage System built by Jablonski & Son Address 128 Secor Road Consisting of 12 5 0 Gallon Septic Tank and 444 feet of fields Other Requirements:. Water Supply: Public Supply From Address, or: Private Supply Drilled by Boyd Artesian Well Address Route 52 Carmel_ Building-Type Residence' Has erosion control been completed? Yes Number of Bedrooms 4 Has garbage grinder been installed? No . I certify that the system(s), as listed, serving the aboJbith ises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordan the iss PCHD Construction Permit and approved plans and the standards, rules and regulatioywof the Cou* D artment of Health. Date: 8,! 6T0 Certified by Address Two Muscoot Road P.E. R.A.x License # 11056 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. By: � t Title: Date: l Wh copy - HID File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PIUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well 1Loc2tion Street Address: TownNillag /9 :.._� - -, Tax Grid # Map ..... Bloch" Well Owner: Name: A dress: Q C9 Aa Use of Well: I- primary 2_secondary Resi ntial Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling (Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing >( Open hole in bedrock Other Casing Details Total length ft. Length below grade 4/1 0 ft. Diameter in. Weight per foot lb /ft. Materials: xy. Steel _ Plastic _ Other Joints: _ Welded X Threaded — Other Seal: X, Cement grout _ Bentonite Other Drive shoe: Yes No Liner:~ Yes No Screen IlDetails Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes—No Hours Second Well Yield Vest _ Bailed _ Pumped Compressed Air Hours _,(,o Yield gpm Depth Data', Measure from land surface- static (specify ft) 3q During yield test(ft) Depth of completed well in feet /d Well Log ; . If more detailed information descriptions or sieve analyses " -... are available, please attach. Depth Frosts Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface - R -• If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information j Pump Type ,6A& Capacity Depth '�.fAh !2'6 Model Voltage 4�yp HP / Ap Tank Type %4 Voluri� /, ,../ �� "" i / _ Date Well Completed Putnam County Certification No. Date of Report Well Driller (ignature) NQ. l'E: Exact location of weu witn aistances to at Least two permanent ianamarxs to Ue provtue a sGpara►G� cuy►au. Well Driller's Name 1126V,01 Address: Signature; Date: White copy: HD Ftle; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 V� YML ENVIRONMENTAL SERVICES 321 Kear Street Albert H. Padovani, Director LAB on 32.305674 CLIENT #: 56026 NON STAT PROC PAGE RUGGIERO, AMATO T. DATE/TIME TAKEN: 07/17/03 11:45 2 WILDFLOWER LANE DATE/TIME REC'D: 07/17/03 12:50 PUTNAM VALLEY, NY 10579 REPORT DATE: 07/24/03 PHONE: (914)-879-4459 SAMPLING SITE: 349 LAKESHORE RD BLOER LOT #3018117 SAMPLE TYPE..: POTABLE : PUTNAM VALLEY, NY 10578 PRESERVATIVES: NONE COLT BY: AMATO RUGGIERO TEMPERATURE..: < 4C NOTES...: WATER THROUGH BIB COLIFORM METH: Ml:'-' ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 07/17/03 MF T. COLIFORM ABSENT 1100 ML ABSENT 1008 I:) 07/17/03 LEAD (IMS) <1 P 0-15 ppb 9101 07/17/03 NITRATE NITROG 1.53 MG/L 0 - 10 9139 07/17/03 NITRITE NITROG <0.01 MG/L N/A 9146 07/17/03 IRON (Fe) 0.189 MG/L 0-0.3 mg/l 2037 07/17/03 MANGANESE (Mn) <0.010 MG/L 0-0.3 md/l 2037 07/17/03 SODIUM (Na) ' 4.67 MG/L N/A O7/17/03 pH 7.2 UNITS 6.5 --- 8.5 9043 07/17/03 HARDNESS,TOTAL 60,0 MG/L N/A 07/17/03 ALKALINITY (AS 54.0 MG/L N/A . _/}7/17/03. —TURBIDITY (TUR _ 2.9 NTU _'_ �~0-5 NTU'''' ' .' , `�- -'-.-_.- ' ''_.-_' _-_..--~ COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDIN��[�-��E NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/CuLEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. ablic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have'a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive ' Fe/MnIf both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodi�m restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium is suggested. YML ENVIRONMENTAL SERVICES 321 Kear Street H N.Y. 10M— (914) 245-2800 Albert H. Padovani, Director LAB 0: 32.305674 CLIENT Q 56026 NON STtAT PROC PAGE 2 RUGGIERO, AMATO T. DATE/TIME TAKEN: 07/17/03 11:45 2 WILDFLOWER LANE DATE/TIME REC'D: 07117103 12:50 PUTNAM VALLEY, NY 10579 REPORT DATE: 07/24/03 PHONE: (914)-879-4459 SAMPLING SITE: 349 LAKESHORE RD BLOER LOT #3018117 SAMPLE TYPE..: POTABLE : PUTNAM VALLEY, NY 10578 PRESERVATIVES: NONE COL'D BY: AMATO RUGGIERO TEMPERATURE..: < 4C NOTES...: WATER THROUGH BIB COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION; BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM O TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L `MODE�R'TELY'-HARDjWATER:,�70-140MG/L ____ MG/L =�MlLLlGRAM_�ER-LIT�R- , ,-�'. , HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) SUB11]TTED BY: Albert,. n.`.`nSCr/ Dire zxcf � ELAP# 10323 r BRUCE R FOLEY _ „...: --Public Health Director:.'- . - LORETTA_ MOLINARI - RN., Associate' Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster,. New York 10509 Environmental Health (91 4)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 OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS: TOWN: A,462� L(YTI dA D WA r AUTHORIZED TOWN OFFICIAL::�O (Signature) � DATE: The Putnam County Department of Health will .not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be.submitted with the application fora Certificate of Construction Compliance. . (E911 VERFRM) DIVISION OF ENVIR®NME T' AL }HIEALTH -SE ��.�.�:8....r:�,. - ST........ �. r�.. Y:;v-w. ..>.�i. ..nA _.. .. ♦r .+v vr.. �.. ...r a.. uu. .r. ar r.... .. .� i x.._x�_.._vv a v.w .. .. v... •. r. GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Amato Ruggiero Owner or Purchaser of Building Owner Building Constructed by 3ctl . Lake Shore Drive East K- .. Location - Street . Residential Building Type 30.18 1 17 Tax Map Block I Lot Town of Putnam Valley TownNillage Roaring Brook Lake Subdivision Name 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 place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant- of-the- building utilizing the system. Dated: M D_ 1 Year Z o o R, Gene al Contractor w er) - Signature ow�'1l y– 5Diii Corporation Name (if corporation) Address:—/ '-9 0 5r1 :20 9 Il State 1414 06AI C– Zip Signature: Title: Owner Corporation Name (if corporation) Address: 2 Wi 1 cif 1 nw, LanP Putnam Valle State y New York Z1P 10579 Form GS -97 PUTNAM COUNTY DEPARTDIENT.OF HEALTTH- -- � DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION 11 ADAM El GENE x Joe Paravati REQUEST FOR FINAL INSPECTION For: Fill All information must be fully completed prior to any Trenches inspections being made. PCHD Construction Permit # PV-28-01 Located: Lake Shore Drive East (T) PUtnam Valley Owner /Applicant Name: Amato Ruggiero TNI 30.18 Block 1 Lot 17 Formerly: Petrone Subdivision Name: Roaring Brook Lake Subdivision Lot 9 Is system fill completed? N/A Date: _ Is system complete? Yes Date: 7/11/03 Is system constructed as per plans? Yes Is well drilled? Yes Date: 9/25/02 Is well located as per plans? Yes Are erosion control measures in place? I certify that the system(s), as listed, at the above premises has been constru and I have inspected and verified their completion in accordance with the issu d C Const ction Permit and approved plans and the Standards, Rules and Re lations f th Pu nam Coun Department of. Health Date: 7/ 1 5/ 2 0 0 3 Certified by: PE RA t D sign ro essional Address: Lic. # 11056 Comments: Form FIR-99 07/16/2003 10:43 8456282807 JOEL GREENBERG Y SlIEENBEVG & ASSOCIATES, PZ., RA. NCAR8 13SN 00-NST1 UCTION . - - -. ARCHrrEC7S - PLANNERS - 9UILDERS 2 MUSCOOT ROAD NORTH NPAHOPAC, NEW YORK 10541 T . (845) 6ZB.661 a F (H45) 6223.2807 I DATE.- TO: R E: A-TTENTI0N: FAX NUMBER: FRONT: COMMENTS' aq( M. PAGE 01 TOTAL. NUMBER OF PAGES INCLUDING `PHIS TRANSMITTAL SHEET: 2 IF VOID OON'T RECEIVE ALL PAGES OF TRANSMISSION, PLEASE CALL US AS SOON AS POSSI ®LE. hIAM{= � RI ITNAM f'f'tl If`ITY f1GPA17TMFf`IT ' f1F P � 0/16/2003 10:43 8456282B07 JOEL GREENBERG PAGE 02 t - FITTNANI C0iTN7CiY:'bEp'"TN NI' Ul D.EALT$ DIVISION OF ENMON11JENI'A.L HF.A►L7'H SERVICES ATTENTION D ADAM GENE x .roe Paravati " BEQUEUI FQj, FINAL INSP Qj= For: Fill All information must be fully -completed prior to any Trenches inspections being made. PCHD Construction Permit # PV -28 -01 Located: Lake Shore Drive East (T) Putnam Valley Owner /A,pplicantName: Amato Ruggiero TN1 30.18 Block 1 Lot 17 Fotj�erly: Petrone Subdivision Name: Rgarijng Brook Lake Subdivision Lot Is system fill completed? N /.,A, Date: Is system complete? Yes Date; 7L11 /03 Is system constructed as per plans? Is well drilled? Yes Data _-9/25J02 Is well located as per plans? Yes Are erosion control measures in place? I certify that the system(s), as listed, at the above premises has been constru and I have inspected and verified their completion in accordance with the issu C Coast ction permit and approved plans and the Standards, Rules and Re lations f th Pu am Coun bepartment of Health. Date: 7115/2003. Certified by: PE RA D ign ro e5510laa1 Address: 1 _ Lic. # 110 56 Comments: Form m 99 Tin _1r -pnm wFn 09:41 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 q P 11J ll NAM COUNTY 1V TY DEPA RTME T GIF HEALTH DIVISION OF ENWRONM ENTAL HEALTH SERVICES r CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM 1 PEIIBI�i[IIT # PV= 28 -01 r� � i Located at T,,ak-p- shere DFi a East own or Village Putnam 'Valley Subdivision name Bleyer Subd. Lot # F Tax Map 3 0.18 Block 1 Lot 17 Date Subdivision Approved 6/6/52 Renewal n/ a lion n a Owner /Applicant Name Amato Ruggiero Date of Previous Approval 10/29/2001 Mailing Address 2 Wildflower Lane, , Putnam Valley, New York Zip 10579 Amount of Fee Enclosed $3„n . n n Building Type Residence Lot Area n - g 6 No. of Bedrooms 4_ Design Flow GPD R n n FiRR Section Only Depth VoRume PcCH D NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerzge System to consist of 121;0 gallon septic tank and 4,44 i f of 1PAnhinq _t:rennches Other Requirements: FILL ,500, <5kkA b^1 NCg To be constructed by n -t selected Address Water Sum»Dy: Public Supply From Address ®1C: Private Supply Drilled by Address net seleete(3 6 I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the I crate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good opera king condition any part of said sewage treatment system during the period of two (2) years immediately th e date the issuance of e approval of the Certificate of Construction Compliance of the original system or aky repairs thereto. / 1 11 6.121.12nn2 Address Mu.-, M . 6 w • ► e 'r i1 APPROVED FOWCONS >UCTI(ORI: 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 hen considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires anew pe it. Approved r discharge of domestic sanitary se ge only By: �r �%— Title: Date: White copy - HD Fill; Yell w py - Building Inspector; Pink copy wn range copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PC11D Permit # PV— 2 8 — 01 Well Location: Street Address: TownNillage Tax Grid # LAKE SHORE DRIVE E PUTNAM MaIS O_.18 .Block 1 Lot(s) 17 Well Owner: Name: Address: AMATO RUGGIERO 2 WILDFLO Use of Well: x Residential. Public Supply Air /Con&Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought __5 gpm # People Served —4_ Est. of Daily Usage gala Reason for Replace Existing Supply Test/Observation Additional Supply Drilling _Ax_ New Supply (new dwelling) Deepen Existing Well Detailed Reason ew dwelling for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No x Is well located in a realty subdivision? ...................................... ............................... Yes x No Name of subdivision Ri eyer Lot No. Water Well Contractor: nnit aalnat:.es1 Address: Is Public Water Supply available to site? .................................. ............................... Yes No x - Name of Public Water Supply: Town/Village n a Distance to property from nearest water main: Proposed well location & sources of contam' ation be pro ' on sep to sheet/plan. Date:6 21 2 0 0 2.. - Applicant Signature: 0,4 - - PERMIT TO C NS RU A WATER WELL This permit to construct one water well as set abov ; is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5'of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a ester well driller certified by Putnam County. w 17 Date of Issue — _ a L Permit Date of Expiration Title: _ Permit is Non -Trans erra le White copy - HD file; Yellow copy - Building Inspector; Pink copy - 'Owner; Orange copy - Well driller Form WP -97 , 1 �t �1 PUTNAM COUNT Y DEPARTMENT OF HEALTH IIDMSION OF ENVffRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL _ pieiseprnt •Ertypr..;:..:...,.:..,, . PCHD Permit # / �/ n d� / Well Locatiom: Street Address: TownNillage LAKE SHORE DRIVE EAST PUTNAM VALL e Map30 < 18 Block 1 Lot(s) 17 Well Owner: Name: Address: MATO RUGGIERO 2 WILDFLOWER LANE, PUTNAM VALLEY, N.Yo105 Use of Well: X Residential Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5 gpm # People Served 4 Est. of Daily Usage _300 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling X New Supply (new dwelling) Deepen Existing Well Detailed Reasons NEW DWELLING for Drilling Well Type x Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No X Is well located in a realty subdivision? ........................................ I............................ Yes X No Name of subdivision BLEYER Lot No. Water Well Contractor: NOT SELECTED Address: N/A Is Public Water Supply available to site? ............................... ............................... Yes No X Name of Public Water Supply: N/A Town/Vil ge N A Distance to property from nearest water main: N/A Proposed well location & sources of contami i to be pro i d on se ate he t/plan. Date,: 7- / 9/ 2 0 0 2 Applicant Signature: PERMIT TO 64T R CT A WATER WUL This permit to construct one water well as set rth above, is granted under pro isions 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 providedby the Putnam County Health Department. During all well drilling operations, the applicant and/or well driler shall take appropriate action to assure that any and all water and waste products from such well driling operations be contained on this property and in such a manner as not to degrade or otherwise contamhate surface or groundwater. A?PROVE D. 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 amendd or modified when considered necessary by the Public Health Director. Any revision or alteration of the proved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam Count % n ,n Date ofIssue 3 --J '0 2- Permit Date dExpiration — Title: Permmi is Non- Transffeir ble WhiteDpy - HD file; Yellow copy - Building Inspector; Pink copy - OwVer; Orange copy - Well driller MOM Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of AMATO RUGGIERO Located at LAKE SHORE DRIVE EAST, PUTNAM VALLEY,N.Y. 10579. T/V PUTNAM VALLEY * Tax Map # 30.18 Block 1 Lot 17 Subdivision of BLEYER Subdivision Lot # F Gentlemen: Filed Map # Date Filed This letter is to authorize JOEL GREENBERG , R.A. a duly licensed Professional Engineer or Registered Architect x to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformi- with the provisions of icle 145 and/or, 147. of the. Education Law, the Public Health . .. tY P n. ' Lary 'ode,' Very truly yours Countersi d. is�'' � � - �,�,'! r� Signed: P.E., R. ., # (Owner of Property) �4\ CT' °'O� %fr °.' � 2 WILDFLOWER LANE Mailing ddress ;:Ma RD D. NO. . Mailing Address: MAHOPAC PUTNAM VALLEY State NEW YORK Zip 10541 State NEW YORK Zip 1 0 5 7 9 Telephone845 628 -6613 Telephone-845 526 -4715 Form LA -97 - .J t �r P - a- RE: AMATO RUGGIERO a - - - - -- l�w. 13 _ ' _ = ry 0 Imo' 1- 1'' P. N N S 17 PUTRTAIt'€ i?3 ,. ° A liiFt'iENT OF HEALTH ::. M&�SE PLAn':._... _ - DI � �... -_� - e� � COUNT O1�ff.SY s.. ❑ NLL'. SUE:..:; . THESE HOUSE S 1VZ JAI FOR APPRO A4 t .. its 61GXATUYI�� _Q2 DAM CS) W CD cn N CD CS) N W N I.- Lo A N Qn .A C H m m 0 RE: AMATO RUGGIERO I ENNSDAtE REAR ELEVA'I' I ON t C0 - W C0 om N CS) CS) N r W N r r tD r A U1 N Oi A J r Z7 1 C 7 H m 0 D f,7 m CS) N 03/06/2002 13:21 19145264717 RUGGIERO PAGE 03 zx • '14 0 00 6 �l x w z VX Ij 0 ii V it j zx • '14 0 00 6 �l x w z VX 0 zx • '14 0 00 6 �l x w z VX 03/06/2002 13:21 19145264717 RUGGIERO PAGE 04 j ..--•— tj I � E I1 �~ �z WC 1 , N �• I. I Cry LI r W W o 0 � O a ox a 1 co LI ul Q o -, CYY I 7. fi I I =1 Fx ;:r,u yi;,j?, sy •.' ,'.si:u sw �' S:� Gs I Ck • �„ I p I "J i I Ni COUNTY DEPARTMENT HEALTH DIVISION OF ENVIRONMENTAL HEALTH. SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner i Address Located at (Stree � -tee .S � '41f. Tax Map3b• 19 Block i Lot _ indicate nearest cross street) Municipality. Os=&4 - Watershed SOIL PERCOLATION TEST DATA Date of Pre- soaking Date of Percolation Test /7 1 1 5 I I I NOTES: 1. Tests to be repeated at same depth until approximate 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 JOEL. GRBMER13i Pr., RA, WAW AND ASSOCIATES ARcHmECTSMANINM « 2 NRECOW ROAD NORTHy .. II OWAC, NBNYORK 10541 (845) 6286613 FAX (845) 6W2W SMAIL• March 7, 2002 Shawn Rogan Putnam County Health Department Geneva Road Brewster, New York 10509 Re: Amato Ruggiero Lake Shore Drive East Putnam Valley, New York 10579 T.M. # 30.18 -1 -17 Dear Mr. Rogan, Enclosed please find application for renewal of permit The only change is that the property owner has been changed from Petrone to Ruggiero. Please call me when the approval is ready to be picked up. Very truly yours, I Gree erg, R.A. JLG:stw • a �\ PUTNAM COUNTY DEPARTMENT OF HEALTH DffV ISII (DN OIL' IENWRON1 ilEI TAIL IHIIEAIL'll'IHI SIERWC ES ®1 tii tittION PIERMIT FOR SEWAGE TREATMENT SYSTEM 1C IEMT # Located at LAKE SHORE DRIVE EAST own or Village PUTNAM VALLEY Subdivision name BLEYER Date Subdivision Approved 6/6/52 Subd. Lot # F Owner /Applicant Name RICHARD PETRONE Tax Map 30.18 Block 1 Lot 17 Renewal N/A Revision N/A Date of Previous Approval N/A Mailing Address 344 LAKE SHORE DRIVE EAST, PUTNAM VALLEY, NY 10579 Zip 1 n579 Amount of Fee Enclosed $300000 Building Type RESIDENCE Lot AreaO, 863 ANo. of Bedrooms 4 Design Flow GPD Bon ]Fill Section Only Depth Volume PCHI D NOTIFICATION IS RE U]IRlED WHEN FILL IS COMPLETED I d Selgairate Sewerage System to consist of 1250 gallon septic tank and r,F OF LEACHING $ TRENCHES Other Requirements: To be constructed by NOT SELECTED Address Witeir Supgllv: Public Supply From Address - �: * * * ** Private Supply.•Drilled by....Nr,� .. . ,Y Address _ I rcpresent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the seWate 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 theeof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said bulder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following th date of the is su of the approval of the Certificate of Construction Compliance of the original sysem or any repairs thlr to. R.A. Date License # 9 1 p56 APR FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the swage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or rn dified when considered necessary by the Public Health Director.. Any revision or alteration of the approved plan requires a iew i Appr ved r ischarge of domestic sanitary sew4-e nly. lBi: Title: l Date: lO lmld( Mite copy - HD File; Yellow copy - Building Inspector; Pink copy.- Owner; Orange copy - Design Prof ssio al Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .. .._ ..._.._... _... APPLICATION TO CONSTRUCT A WATER WE LL please prmf or type ,-ICI HD Permit Well Location: Street Address: Town/Village Tax Grid # LAKE SHORE DRIVE WEST PUTNAM VALLEY Map30.18 Block 1 Lot(s) 17 Well Owner: Name: Address: 344 LAKE SHORE DRIVE RICHARD PETRONE I PUTNAM VALLEY, N.Y. 10579 Use of Well: X Residential Public Supply Ait /Cond/Heat Pump Irrigation Primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5 gpm # People Served 4 Est. of Daily Usage 300 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling _X_ New Supply (new dwelling) Deepen Existing Well Detailed Reason NEW DWELLING for Drilling Well Type X Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No X . Is well located in a realty subdivision? ............. :....................................................... Yes X No Name of subdivision BLEYER Lot No. Water Well Contractor: NOT SELEC D Address: N/A Is Public Water Supply available to site? .................................. ............................... Yes No X Name of Public Water Supply: N/A Town/Village N/A Distance to property from nearest water main: — N/A Proposed well location & sources of contaminat' to be pro v d on separ to sheet/plan. Dated 6 /30/2001_ -- -- Applicant Signature: PERMIT TO O TI T A WATER WE6L This permit to construct one water well as set h above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well'Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water ell driller ce ified by Putnam County. Date of Issue olem 10/ 1 Permit Issu ng Official: Date of Expiration to e o- Title: Permit is Non - Transfer able White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WP -97 7'- 4— - ell 4 rfl c �- 4 � A � , x � . 4 O'er . OF eff U~ NZ it r L LIJ j IA tA 0 C) pO�!'r !T /Cpl �Q IZII GG'hlr✓ • FILL�p�p -rL1� 1 cv 2,;e® y£ I %j dU' s r1 s it TALLY X I O I � ! ceLaw.l !' 4fUNN 7 C A 3 _ V '1 L2(IO ' L ►!L� Cei.• i aS�' :<+.µY t °W�tN I lti,� I N Q ; 61 r_tr' rti iG (�JLx10 i � I Jn � Jlirl µ112Xq.p 5'jlz�, Jfp.rl ! _ 1 ... rY' I2� �; 16� IO'1 I � ' : � i_ �'d• - • -- v �g � 8' � I : � � — - i UP �7 a L.dJ tDli`IG� 1 �' -0 XT. f I H _ _ TV I' NT O OM GF O HiO.'NY3 L Y, - .. . -3 4 BEDROOb� ' t1LL SL S Qi EIti'T Pt�:`:'I$ illy � xLTEii <�TION$ ' � THESE HOUSE p-LAN iaiST -.BE SUBMIT TED TO TIDE PPODOH FOR APPROVAL 1 YNATURE $a T T DATE '4 I i 1 J �w " o-0.AS—GG —tdaa m t , a� Po . rod y A itRLnCF. R. gOQ LORtiY'�A AgOUNAW ILL:; D'aDlte A7eetaA a 4m dak Pao is Met& Dew 8)ime&- o f Pomwr J%n*66 DEPARTMENT bF HEALTH I Geneva. �,IoV j} Nrewrster. New 60309 vp /�, (�(¢��j A4T gCN-. rAADAAB SiTIESELING ! a GENE RI RD All Wormatlon blow Muse be !u-112 eompl and prior awp odied ding. 3AW-. 904GRNEZR OA VORM 1+0EL GRUNSERGe A+A. MUMS 0: R REED: 3144 LARZ SH092 DRIVE SQJl3®FMONI: � 4 0 PETRONE YES NO ® ( propWdUTS Within the drainage f ® pnposed Sm within $00 feet of a 0 kv!� Fropow SSTS within 200 feet of a ®. prop®sed SETS design Boa greater S9 firopr d SS S. for_® commerital.P of West SrmA or Bay& Corner R"ervolre. reir. nuivok stem er cow" ls:& eeml? ®p @}SEC Wet vW& IND ga_I6omldop ®P SPUS %FMBO ""mitt. It Is floe responsibility of dw desir professional to Ot*Wde the Above iafema "on prior to ad tes&g. Thb Deparumt woi➢I d0maiae the NYCDEP prWett status (Joltat or Ddepted) bagel on thu response. Of you smWered m to any of the questiiat, M'tCt;DEP mme arhese the soil treating. 71tis Department WW Coordinate a mutually suitable tin fe? Wd NABS with & PCDOH, the Deaign PedessionaR and NY DEP. I 21 a pnjeet has beets deterWned to be Ittc4ated bled on the Above a vwm "d then eui "0110 InforMadoa Indieataa NIYC6DEP t8 requlmd to vita Q tk troll testing, 01 will be the eok ,oadRrt " ®f rite de:iga proicsai ®pal to st;hc�luo8t rrrvrita�air� the 0 ®i6 tvaecrog moBOo N�fCD63�. 60R C®U"oHY Ott7E �Fllll i It Lrk- i It:. t� w- tilt TOTAL P.01 r t�r�1) 17ttrrt £y • a 4'2r� �7 sar ' IN ai ' 9Z Arr I/O y`1�4 / $ - ,• \ �~ E � � �, - -62T ►I CP vp Dora p M k _ / OZ Jtl SI•I 1�tri o f '': S ,?'• SI jai 91 NZ;1- 91 !. .. 00 an Jtl 002 { • I 02 4) . IZ i G • I � 8 8 �7r► / w ! d' I ' 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION O ENVIRONMENTAL HEALTH y e 1 RE: Property of LETTER OF AUTHORIZATION RICHARD PETRONE Located at LAKE SHORE ROAD WEST T/V PUTNAM VALLEY Subdivision of Subdivision Lot # Gentlemen: Tax Map # 30 °18 Block MAP OF PROPERTY OF EVELYN BLEYER F Filed Map # 655 1 Lot 17 Date Filed 6/6/52 This letter is to authorize JOEL GPJMMERG, R.A. a duly licensed Professional Engineer or Registered Architect x to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health-Director of the Putnam County Health Department,- and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with.the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Pt:tnam Gaur�ty Sanitary Code. _ .. ° _ ....._...._... F._._. ;.., ._ _ . Countersigned P.E., R.A., # _ Mailing Add e State NoY � 0 rv`�l N Zip 10541 Telephone: 845 628 -6613 Very tru Signed: Mailing Address: 344 LAKE SHORE DRIVE PUTNAM VALLEY State N.Y. Telephone: 845 528 -4712 Zip 10579 Form LA -97 JOEL GREENBERG, RA, NcARs 2 NRISCOOT ROAD NORTH MAHOPPA NEW YORK 10641 (845) 6286613 FAX(845) M8MW EMAIL- •Igaid d0beslwebjwt October 3, 2001 Adam Stiebeling Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: Richard Petrone 344 Lake Shore Drive Putnam Valley, New York 10579 T.M. # 30.18 -1 -17 Dear Mr. Stiebeling, Enclosed please fmd original certified mail receipts regarding the above. . ".Very truly yours,' eGreenbel, R.A. JLG:stw A PROJECT (Owners Name): STREET: SUBDIVISION LOT# MUNICIPALITY: TAX NUMBER: DESIGN PROFESSIONAL: DATE: v v ®, REQUESTED ADDITIONAL INFORMATION OTHER DTVLSION OF ENVIRO\,IE\TAL HEALTH L\DIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: � tiL STREET LOCATION: L .4lGg JHopel -. _.:•R -'ICE MDSY: R,�T,' AS sRD:+�rir: ' Zo i o._ .._ JAkht = Ci � b 4 1 DOCIINfE \TS /� ( REOUIRED DETAILS ON PLANS CONT'D) . P RMII' APPLICATION HOUSE SEWER -'W' FT. 4 "0'; TYPE PIPE CAST IRON WELL PERMIT OR PNS LETTER (� /UNO BENDS; NLkX BENDS 450 W /CLEANOUT P C -97 / RENEWALS LET ER OF AUTHORIZATION ()()SITE NOTE (NO CHANGE) D IGN DATA SHEET (DDS) FILL SYSTEMS . U ORPORATE RESOLUTION (� 10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE SHORT EAF () FILL SPECS' FILL NOTES 1 -5 YA S -THREE SETS U FILL PROFILE & DIMENSIONS E PLA \S • T�YO SETS FILL I EXPANSION AREA XNCE REQUEST EEL GREATER TR4M2 FEET SUBDMSION U CLXY BARRIER AL SUBDIVISION U( FILL CERTIFICATION NOTE (� SUBDIVISION APPROVAL (__) DEPTH GAUGES )(,,)PERC RATE 3 U VOL. O, i PLAN FORRO.B., UNCLASSIFIED & L IPERVIOUS L REQUIRED DEPTH PARATION DISTANCE FROM TOE OF SLOPE (__) .CURTALY DRAIN REQUIRED TRENCH GENERAL TRENCH PROVIDED 60FT MAX. 83 Lr- zjzz, L OCATED L\ NYC WATERSHED TO COi.TOURS Xc-'J'; LANS SUBMITTED TO DE P (0% EXP?,itiSION PROVIDED' ELEGATED TO PCHD L�(�DETAIL/DUST FREE CRUSHED STONE ORWASHED GRAVEL IE' P APPROVAL, IF REQ'D Lam( _JGEOTEXTILE COVER PEfP TEST HOLES OBSERVE SEPARATION DISTANCES ON PLAN - FROM SSTS U PERCS TO BE WITNESSED 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL (� - APPROVAI SSDS ADJ, LOTS 30' TO FOUNDATION WALLS ( ETLANDS (TOWN/DEC PERM REQ'D ?) ( 100' TO WELL, 200' IN DLOD,150'TO PITS Ta ON DDS PLANS & PERMIT SAME 100' TO STREAiNI, WATERCOURSE, LASE (inc. expan) 1969 NEIGHBOR NOTIFICATION 50' TO CATCH BASIN, 35' STORNIDRALN, PIPED WATER SETTER BIIZBA (� 110' TO WATER LINE (pits -20') 100 YR FLOOD ELEVATION W/I200' U/( :0' LNTERNMTENT DRAINkGE COURSE OIL TESTL\ G LOTS >10 YEARS OLD 00'I500' RESERVOIR, ETC. _ 150' GALLEY SYSTEINIS . . JGRAVITY ED ET O PLANS _... _ 10' �IL`iTO LEDGE. OUTCROP. ,..._�....._..,...... __. ; .,,.- •. -- _ . WAGE SYST 6I PLAN - (NORTH ARROW) _ .. _ . SE IC TADS HYDRAULIC PROFILE (�(___)10' FROM FOUNDATION; 50' TO WELL FLOW / WELL #J'ESIGN NSTRUCTION NOTES 1 -15 (_/ DIMENSIONS TO PROPERTY LINES DATA: PERC & DEEP RESULTS LOCATION OF SERVICE CONNECTION ONTOURS EXISTING & PROPOSED MID; IT TO PROPERTY LINE IVEWAY & SLOPES, CUT OTINGlGUTTER/CURTAIY DRATI`iS (�( _)SLOPE IN SSTS AREA (520 %) DA SOIL TYPE BOUNDARIES U( _)REGRADED TO 15 %, IF REQUIRED LE BLOCK, OWNERS NAME ADDRESS "ty, PE/RA; NAMB, ADDRESS, PHONE# QOSEIPiJrtP SYSTEMS TE OF DRAWING/REVISION, ;PU \I REFERENCE 1CATION. OF WATERCOURSES, PONDS KES,WETLAN`DS WITHIN 200' OF P.L. OPOSED FINISH FLOORAND �SEMENT ELEVATIONS ELLS & SSDS'S W/IN 200' OF SSTS LOPERTY METES & BOUNDS COMMEN"IS: 4 ,✓(nom J J �( (REVSHEET) PUMP NOTES (� DOSE 75% OF PIPE VOLUNIE/DOSE VOLUME NOTED DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) (__)( PIT AND D -BOX SHOWN & DETAILED Lam( 1 DAY STORAGE ABOVE ALARM CURTAIN DRAIN STANDPIPES, 5' BOTH SIDES, DETAIL C_j 15' MIN to CDS = >S %, 201-4%, 251-3%,351-1%, 100%-<I% C_j 20' `ILN to CD DISCHARGE /100' with 182 cons day discharge ( )(__j10' 61IN to NON- PERFORATED PIPE BRUCE R..: FOLEY Public Health Director October 16, 2001 LORETrA MOLINARI R:N., - M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509. Environmental health (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 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 U Joel Greenberg, RA 2 Muscoot North, RFD # 2 Mahopac, New York 10541 Dear Mr. Greenberg: Re: Petrone, Lake Shore Drive East TM# 30.18 -1 -17, (T) Putnam Valley This office has received and reviewed the recent set of plans for the above_ mentioned project. We would like to offer the following comments for your review and consideration. Plans: 1. Proposed lineal footage of "primary trench" equals 442.0 lineal feet. The required lineal feet of trench is 444.0. 2. Expansion trenches must be labeled (lineal footage). 3. Add additional note # 8, "well to be staked by a Licensed Land Surveyor prior to drilling ". 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. - ABS:cj Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer a 'a -- BRUCE .R.. . FOLEY Public Health Director October 16, 2001 LORETTA MOLINARI R.N., M:S.N. .. :. ..."." ;fiss6�iate':�bbif�•'.�leat�ir^� l�frectar, ...,.,,......� Director of Patient Services DEPARTMENT. OF HEALTH I 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 Preschool (845) 228 - 5912 Fax (845) 228 6113 Joel Greenberg, RA 2 Muscoot North, RFD # 2 Mahopac, New York 10541 Re: . Petrone, Lake Shore Drive East TM# 30.18- 1. -17, (T) Putnam Valley Dear Mr. Greenberg: This office has received and reviewed the recent set of plans for the above- mentioned project. We would like to offer the following comments for your review and consideration. Plans: 1. 2. �.. ,3 Proposed lineal footage of "primary trench" equals 442.0 lineal feet. The required lineal feet of trench is 444.0. Expansion trenches must be labeled (lineal footage). Add additiciral note # 8; ";�e11 01ic staked by- a- Licensed - Land. S.urvc.yo.t:.prioi_ta.: ° "- ...." -- "' drilling ". 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 N 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION ._REPORT.— _ . :.:...u._..:. Well Locktion' Well Owner: Street Address:" Town/Village: Tax Grid # Map304 Block / Lot(s) 1 Name: Address: Q '� u iti /�i dr% Ll , Ivy Use of Well: 1- primary 2- secondary Resid6ntial Public Supply Air cond/heat pump Irr gation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock Other Casing Details Total length ft. Length below grade _Vaft. Diameter _in. Weight per foot lb /ft. Materials: A Steel _ Plastic _ Other Joints: _ Welded Threaded — Other Seal: X Cement grout _ Bentonite Other Drive shoe: Yes No Liner: Yes YNo Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test Bailed _ Pumped Compressed Air Hours 01 Yield gpm Depth Data. Measure from land surface- static (specify ft) *3 During yield test(ft) Depth of completed well in feet Well Log Ci If more detailed information descriptions or sieve - analyses are available, please attach. De th From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface ` If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information I Aftl Pump Type Capacity Depth eSAh /26Model Voltage p HP Tank Type 0 %q VoluILAIf 'd , 3492 / M'n'bl / 1 . Date Well Comp eted Putnam County Certification No. Date of Report Well Driller ( ignature) NOTE: Exact location.ofwell with distances to at lepst two permanent landmarks to be provide a- sepatfat ssheetip an. 4 , ��� Well Driller's Name Address: Signature: ,' Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # PV -28 -01 SN .:,r 1 Located at LAKE SHORE DRIVE EAST - � Town or Village PUTNAM VALLEY Subdivision name BLEYER Subd. Lot # F Tax Map 3 0.18 Block 1 Lot 17 Date Subdivision Approved 6/6/52 RenewalN / A Revision N/A Owner /Applicant Namd�MATO RUGGIERO Date of Previous Approval 10 / 2 9 / 2 0 01 Mailing Address 2 WILDFLOWER LANE, PUTNAM VALLEY, N.Y. Zip 10 57 9 Amount of Fee Enclosed $300.00 Building Type RESIDENCE Lot Area 0.8 6 Rio. of Bedrooms 4 Design Flow GPD 8 0 0 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Se jarate Sewerage System to consist of 12 5 0 gallon septic tank and 4 4 4 LF OF LEACHING TRENCHES Other Requirements: To be constructed by NOT SELECTED Address Water Supply: Public Supply From Address or: - --_Pfivate Supply Drii16d by N0T--SELECtED - -- Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will furni ed the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating con tion any p of said sewage treatment system during the period of two (2) years immediately following the da f the iss ance of the proval of the Certificate of Construction Compliance of the original system or ;Py.`pairs theret . n Address2 MUS NORTFiMOPAC , N. Y. 10 5 41 License # 1 1 0 5 6 APPROVED FOR 6ONSTRUCTION: This ipproval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new rmit. Appro ed for discharge of domestic sanitary sewage only. By: r r Title: Date: 3'l� 2- White copy - HD File; Ye�low copy - Building Inspector; Pink copy - 16wner; !fie copy - Design Professional Form CP -97 I ° li, complete items 1 2 'and 3 Also�complete A #`Uw d by (P/ se,Prin Clearly) e. ' to of Deliver] a Item 4 if R' 'tted Delivery is deslretl: r �. (�'� � ■ Prior your name and `address on the •reverse i - - so we.can return tha card,to �rou " G Sigrati r.•. "` - `" " "` '. ■Attach this card to,fhe back rn of_the ailpfece ❑ Agent ' :� N or on the front if space permits X: Cl Addressee 1 Article Addressed�to h D s delivery address differentfrom item 1.? ❑ Yes, If YES enter deiiv rq address below No tS+ CtlYl m 4 Q ¢;¢ }. Z O PAC- E e Type s ❑ "'❑ ° L t�F j i ed Mall " .1 Express Mail gistered 'O Return Receipt for Merchandise 3` Insured Mail z o. C.O.Y. T m o T. r E p o 4 Restricted Delroery1 (Extra Fee) ' ❑Yes CL h icle Number (1 service' /ab / � v c ❑ ❑ o a� -�C� (.' - �I, stuff• .3,. Z Form 3811 :Jul 1999 s y / Domestic Return Receipt 102595.00= M•0952 $; - U rem COMPLETE THIS • ON V ; Complete ;items 1 2, and 3 lAlsocompiete 3 A Received by (Please Pnnt Clearly) ; .B ate oL0eljvq0 - m 4,if :6kricted Qelive i. desired „(x:'41 ite R ry „ o it your name and address on the r” "averse ; { is Signat 1 that we can return the'card o you s_ nt Attach this card tQ the back of the;mailpiece'; aL-. T d . m O'S: `� : o -N. - ° or on the front rf space permits N o o ` " p D YEIs delivery address di erent from item 1? d Yes �; E icle Atltlressed to _ If S enter delivery address below; ❑ No - T _"El _ ;tea d. Z. M a) "— 3 ce Type �m o�,� �� reified Mail.: ❑'Express Maif. Re ❑Return Receipt for Merchandise E ,E c • ° - a u - ❑Insured Mail C - - Restricted Del %eryT(Extra Fee) O Yes 2 Article Number §o fro m service labels t l MYN BPS For381 10259500-M Rtm4Rf 0952 Y � •; L 0 TON Ar 14 -�A 2 T A tV f , to _P W clot ' 5 sx V, A RAW US 0 SER irs TER J;� 7 '' 40 .......... iz ddre IF JOW�dre6 Za nbergiRA,'�N'CARB.";�-l�1 �'l�" 'Archit96t - .Planner A 2 musWot Road North A MMOPac NY 10541 y� f W NMI A W-V Q "ARIZ.—On" 01 OV too m. U� 7 . . . . . . . . . . . . . ....... ' T TIE bER - S � Kqw ai Its P S ermit ......... cl I P,16a'ge�pnn res a,�m S1 JS 0" WO, No W, Hyj_ low 1 S RIQ A - f Joel Greenberg, RA, NCARB Architect Planner 2h Auscoot Road North Y.1_05i A . 4 . - - - L hop(, N MUMS "J W INK nfemx"� swr�, now W- V�mg tp-- cW yvoo J T 0 -noon W�, ,Yzym noel A= 41 Whi 1`10 & e, °I 31 Haan us � 147 CENTER STREET, OLD TOWN, MAINE MOIL LR LIK I' 12 I. i REV 151 DNS S SPECIAL DISTRICT INFORMATION r r FOR ASSESSMENT PURPOSES ONLY R { ,arc uK cl" NOT TO BE USED FOR CONVEYANCES v v.m .. I I L'I � ,A11lD R Y AL FIFE M M LIR - -- W. SEWALL COMPANY � JAMES W as 3 AL ; a raa AL t f 16 O �o `. 1T * ;B . 15 1.08 AC. 'A } • 1.15 AC. r _ JoB r. .._:..... ..I, ... '; .._.... .. '... -. - _�._:. ._ _. ..' t4 1.02 � rub ' a • '�a r� q 50 516 I ,r 53 52 5 }: '8 . pr 8 \ pF�JE 2 y k $ a 54 m e. ,qa If I,..YI f / �'ka f y 9 10 ha m ror C aW / �0SR�p(F 1 � // q y1.09 � ya � � 9 f 55 � ,n 8 - A8 \ 1.76 AC. '_ 3 AC 56 . I Y A / 5 ow / \B •tW S 57 e 58 A ' a am'Vf 7 m t a as °' I rrt � e5°' 8 8 �a +8• • 66 } 60 �f '14a F' 67 la '6a A7 1 0' Taro 66 a 62 61 @� ' 0 8 gg raa ma U o 63 �a \ 4: j^ P/0 41.06-1.9 Haan us � 147 CENTER STREET, OLD TOWN, MAINE MOIL LR LIK I' 12 I. i REV 151 DNS S SPECIAL DISTRICT INFORMATION r r FOR ASSESSMENT PURPOSES ONLY R ,arc uK cl" NOT TO BE USED FOR CONVEYANCES v v.m .. I I L'I � ,A11lD R Y FIFE M M LIR - -- W. SEWALL COMPANY JAMES W I' 12 I. i 30 8 200 AC. AL `. rp a S 19 20 22 4 rsa i 23 / 50 24 Q / e rig .r 47 26 i •s q 45 a /, 44 42 $ $ 0-1 s„ 27 41 >nv . �•+ 40 90 �8 vzss v ar $ � 29 $ s,aO a 39 9 30 i $ sa �o snas � 8 .r ri 36 ya Jptl 12 " ui uaro 4ya' !r� a 34 . 8 Y 9tJO0 13 `E ° ° a ol smm� pals ............ ....moos uxr rm snsa L,_.i REL I M I NARY SMAE �� s a+riwn anrxwlr � xruorus gar oam r rob oar. am 000a.0 loam �a,s, 30. 17 1i TOWN OF PUTNAM VALLEY nKlx/rsmurt ,K sbmn ul[ —/ suwsoon,a 1luwrza aIR. t>• a. ul ' saxcga DIMICI LNE — risust owla 41.05 41.06 - 41.07 PUTNAM COUNTY, NEW YORK NR 4 oeia norssw+n__s•�o a WR v ov.._e•m Iltr 6 PN1m WDrAf Iamf1 M1@N R M frrR RII[ WamlYttl w Ftll) IM w 13 as "1 • k � ti` ti N � n %N 'OS C 4 °s= / / /// a oy° •r. `L� `�4 s gab �.. hLOT IF I �- I gee 1 1 re 3 \ D) \ mi \ ax N 2 / pOt L � I "e 1 h b I 'J 1 NOTE5 1)EIE,/ATIONS 340WN HERCOU ARE GENERALLY IN PIOfORDANCG W ITH FILED MAP NUMBER 2364. 2)ADD ITT ONK UNDEPGROUND EASEMENT3, VTI LI TIES OR STRUCTURES, ETC. OTNCA THAN THOSE SNDWN HEREON MAV BE ENCOUNTMED 3)TNE SUBSUR,Tim \NFDAM lam SHOWN HEREON,IF PHY, IS NOT GUARANTEED PS TO ACG1/RA01 OR COMPLETENESS AND S40lA2 BE VERIFIED BY T},E' CON'TRACM 8EFOR.E ANV EXCFWFI"ON. W V W F z o J � r• 4 i TOPOGRMOiC SURVE,,' OF PROPERTY PREPAREDeFOR ON N I E AND RICHARD PFT BEING LOT F A3 SHOWN ON A CEA.TA,N MAO ENTITLED,'MAP� PROPERTY OF EVE LYN DLEYM.EfC. -, 7AI10 MAP "'LFD IN THE P,JTwmm COVNTY CLCMWS OFFICE TUNE G, Iy SZ AS MAP NQ H$ER 6 55. AREP— 37, 607 5 F. OR 0063 ACRE5 5170ATE IN THE TOWN OF PU RAM VALLEY PUTNPM COUNTY, NE1J YORK SCALE! 1" •30'— rwtl, u.y.IrSN 5uQVCE ED '.TJEC E-e.EM 13, 2000 143xraIW \\ ANC MAPPREPAREODECEMBER 22,2037 •i1•MwAN'RiM.�w .� _.. ...i a COO-08Z LAKE SNo. j R� `•9 ace M s+ve/I.3 e...f-y C.III..Dw• 4r" FS T w "e 1 h b I 'J 1 NOTE5 1)EIE,/ATIONS 340WN HERCOU ARE GENERALLY IN PIOfORDANCG W ITH FILED MAP NUMBER 2364. 2)ADD ITT ONK UNDEPGROUND EASEMENT3, VTI LI TIES OR STRUCTURES, ETC. OTNCA THAN THOSE SNDWN HEREON MAV BE ENCOUNTMED 3)TNE SUBSUR,Tim \NFDAM lam SHOWN HEREON,IF PHY, IS NOT GUARANTEED PS TO ACG1/RA01 OR COMPLETENESS AND S40lA2 BE VERIFIED BY T},E' CON'TRACM 8EFOR.E ANV EXCFWFI"ON. W V W F z o J � r• 4 i TOPOGRMOiC SURVE,,' OF PROPERTY PREPAREDeFOR ON N I E AND RICHARD PFT BEING LOT F A3 SHOWN ON A CEA.TA,N MAO ENTITLED,'MAP� PROPERTY OF EVE LYN DLEYM.EfC. -, 7AI10 MAP "'LFD IN THE P,JTwmm COVNTY CLCMWS OFFICE TUNE G, Iy SZ AS MAP NQ H$ER 6 55. AREP— 37, 607 5 F. OR 0063 ACRE5 5170ATE IN THE TOWN OF PU RAM VALLEY PUTNPM COUNTY, NE1J YORK SCALE! 1" •30'— rwtl, u.y.IrSN 5uQVCE ED '.TJEC E-e.EM 13, 2000 143xraIW \\ ANC MAPPREPAREODECEMBER 22,2037 •i1•MwAN'RiM.�w .� _.. ...i a COO-08Z