Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
2179
DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 30.18 -1 -23 BOX 19 'I oil 02179 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FORS 1-,7e TMENT SYSTEM PCHD CONSTRUCTION PERMIT # /may 0 Located at z vJ�e .7 4 e r e !fir �' eef Town or Village Owner /Applicant Name h1.e 1A §-vr,3 et / e Tax Map 3el •) d Block % Lot t-- Formerly 15'a-n /! � a r '- % 0 /71%0 Subdivision Name -11;� e� /9'-a C°,0 Py _ Subd. Lot # 9` Mailing Address '� A, /"•/��U�7 A' I Zip Date Construction Permit Issued by PCHD � �3 °'c 2 Separate Sewerage System built by Ao ,e-" ev Address A/7 Al J/"" /'�`W- 4>Al le-;( ivy Consisting of /24,x'!1 Gallon Septic Tank and S °C� '1(401-:r �/- '"" ' d r. ZZ2 Other Requirements: Water Supply: Public Supply From. Address or: k1 Private Supply Drilled by 1-'5ef/ 91,9 s • Address151-eh,�jIyy'" /1 )"' Building _T _ e.... _ -r Has erosion control been completed? T Number of Bedrooms 4 Has garbage grinder been installed? //G' I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam Count a artment of Health. ' Date: &L7--� C' � Certified by ,i ,� (Design Profes y, C-9 -- ' Address 112-1 ��G %�z�. /P'�"� r- e nse # G a ose'wer Any pe on occup y g premises served by the ab a system( a such action as may be necessary to secure the correction of any unsanitary conditions resulting Approval of the separate sewage treatment system shall become null and void as soon as a public sacomes 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 , modification or change is necessary. By:. Title: ��T T�— Date: atlq A>-3 -3 Wh 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 RE1PORT Wifll-Lo6tion;--:- Str-det-Addreg�i-.:;;,�-,�,---.--!: 367 Lake Shore Rd (Roaripg BrMk. Road ) Valle y Map No-Ql Block I' of Well Owner: -Putnam Name: Address: Work gg U=sg 441 ILALrigp ar 0 A5=et "_qgjjx NX IQ528 Use of Well: I-primary 2-secondary x Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify):., Industrial Institutional Standby Drilling Equipment X Rotary _ Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 52 ft. Length below grade 51 ft. Diameter 6 in. Weight per foot 19 lb/ft. Materials: X Steel. — Plastic — Other. Joints: Welded _X_ Threaded Other Seal: X Cement grout Bentonite Other Drive shoe: X Yes No 'ILiner: Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test Bailed X Pumped X Compressed Air Hours 6 Yield 5 gpm Depth Data Measure from land surface-static (specify ft) (sp FFft 301 During yield test(ft) 5401 Depth of completed well in feet 6051 Well Log If more detailed information descriptions or sieve I analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. , ft. Land Surface 15 Drillinct in over urden clay and boulders Hit rock at 151 15 1 -,r,9. -nri 11 j,.nCl- i n - rnak� pei-. ra-pi ing, g�nut 52 605 brillina in rock aranite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump/Storage Tank Information Pump Type sub Capacity _qgM Depth 560' Model -59510412 Voltage 230 HP 1 Tank Type NX251 Volume 62 allons Date Well Completed I ! 1/28/03,i 11 Putnam County Certification No. 001 Date o Report 5/15/03 1 Wei er signature) 7Z*/ lPhill Of. Beal NPT16: Exact location of well witli distances to at least two permanent ianamarKs to t)e proviaea on a separate sneevpian. Well Driller's Name P. p, iBeal Anm , Inc. Address: 4 Putnm Ave., BtEwsber, NY 10509 Signature: Date: 5/15/03 Phifip 4. Beal White copy: HD File; Yellow copy- Building Inspector; Pinkcopy - Owner; Orange copy- Well driller Form WC-97 J1. ':.1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION-FOR APPROV,AtL:OF,PL- ANS.FOR.__ _ 9 ,��:_..... -. A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: 2. Name of project: JS� 4. Design Professional: 6. Drainage Basin: a�rJ 3. Location T/V: ?.7 ne 7. Type of P o ect: 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)? /'A® Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ..............ec°t.... 10. Has DEIS been completed and found acceptable by Lead Agency? .....-:..... 11. Name of Lead Agency i 12. Is this project in an area under the control of local planning, zoning, or other = officials; ordiriances? :::.:::::.: '. G� ......... ............................... ............................... 13. If so, have plans been submitted to such authorities? ... :................................... j 14. Has preliminary approval been granted by such authorities? Date granted: 15. Type of Sewage Treatment System Discharge ................. surface water groundwater 16. If surface water discharge, what is the stream class designation? ..:.......:......... /vf� 17. Waters index number ( surface) ................................................... :...................... N 18. Is project located near a public water supply system? ....... ............................... e% . 19. If yes, name of water supply Distance to water supply�l" 20. Is project site near a public sewage collection or treatment system? ................ 21. Name of sewage system Distance to sewage system e_, 22. Date test holes observed 23. Name of Health Inspector W 24. Project design flow (gallons per day) ................................. ........:.......... ............. Foe- 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.:; ,:.. !✓y 26. Has SPDES Application been submitted to local DEC office? ......................... Form PG97 I 27. Is any portion of this project located within a designated sown or State wetland? Ale 29. Wetlands ID Number .......................................................... ............................... 29. Is Wetlands Permit. required? ...... ............................. . .............................. Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ............................... 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No /ly 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 IV-a DESCRIBE: 33. Is there a local master plan on file with the Town or Tillage? ......................... &o 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site ? ................ Ale 35. Are any sewage treatment areas in excess of TS% slope? . ............................... �y c. Jam' 36. Tax Map ID Number .......................... ......:...................:.... Maps Block p Lot z-2 -�-� 37. Approved plans are to be returned to ..... Applicant Design Professional NOTE:.All applications for review and approval of a new SSTS to be located .within the NYC Watershed shall --be sent to the Department,.and need not be sent in duplicate t6the 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 form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNA.TU,RES & OFFICIAL TITLES. S �i rJ-7 PI '1 Mailing A dsf�... /..... ��% e� Al ��fy, PUTNAM COUNTY DEPARTMENT`OF.HEALTH AM ;... . - DNISION OF ENVIRONMENTAL -HEALTH SERVICES ka. COUNTY - OFFICE. BUILDING CARMEL ,N.. Y...,-. 10512 _R'cT. -. TT vim. —... xar. r_ . •,} 1� � , w i DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. .P1 " ", "•l R. Fiotentino I VF �� Owner Address Lake Shore Rd. West; Putnam Valtt�x 10579 Located at (Stree(Indicate North Road Sec. _g _Block 2 Lot_ neares cross. s Flee ) Municipality Town of Putnam Valley Watershed .Hudson River SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Elapse Depth to -a er Water Uvel No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches PTH #11 9:45 10:15 30. 16 19.33 3.33 30/3.33 =9. 2 1019 10.49 30 16 19.33 - 3.33 30/ 3.3 3 =9 3 10.53 11.23 30 16 19.33 3.33 3013. 43 =9 5 PTH #2 1 • 9:50 10:20 30 16 19 3.00 30/3 10 2 10 •..2,1..... .1.0... 5.1....... 3.0..._ 16 3 10:5 2 11:22. 30 16 19 3.00 30J3 10 1 2 4 5 oten: 1) Tests to be repeated at same depth until apppproximately equal soil rates are obtained at each percolation test hole. All data.to be submitted for r.--view. 2) Depth measurements to be made from top of hole. IPiDICATE I✓ ^L AT WHICH GRObIlD WATER IS E:1COTNT RED NONE INDICATE Llmr.Tj TO WiICH WATER L.EIM RISES ArTE.� PEIFdG Ei;COU►tTER.G'D NONE T;S "'S i:LD E BY Joel L. Greenberg rate* 4/19/85 11r.Jl�;Ll Soi? Rate Used 8 -lo P -aJ' ops a: -. _ _ : - --S D Ea - Usiwhe- Ares.• Provided 5. 000SF - ° 10100 og Eedreom. 3 • Septic Tank Capacity 1000 C-also Type Precast Conc. Abon&-ptica Area Pr�ov �ed By . 136I„F „x24” idth tray cna PRECAST CONCRETE TRI- GALLERIES CO ilr Joel L. Greenberg :3 Ur$ � F Addr_33 Muscuot No,RFD#2,BX 488 O Mahopac,NY 10541 t- , +:'. C FCR CBE 13Y HSALTH DEPARLi.1''.N• Ci;bY: �,,�Ofr ot1�.1 R3 *..Q..ypprc�:ed Sqo FtjCsl e Chc NEB 0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: 1191 /v:3 Street Location L4& -ik°— cSApi ' Owner e.►h:w _ Permit #4 . TM # . Y 30, If - !, aad'J Subdivision Lot # 1. Sewage System Area 7 a. STS area located as per approved plans .......... .. ................ b.. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped ................ d. Stone, brush, etc., greater than 15' from STS area......:... e. 100' from water course / wetlands .. ............................... H. Sewage System a. Septic tank size - 1,000 ...:.....1',250.. .....other ................ b. • Septic*tank installed level ................ ............................... c. 10' minimum from foundation ...................................... 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.....T-5, C........ 6. Trenches 1. Length required ' �ength installed 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 - 1 �/2" diameter clean ...................: 9. Depth of gravel in trench 12" minimum ....... :............ 10. Pipe ends capped ........................... g. Puma or Dosed Svstems. Size of pump chamber' - ...... ............................... 2. Overflow tank.. ............ ............................... ....... 3. Alarm, vis audio....:...:. ...............Jade. .. ...... ....... 4. Pum ily accessible, manhole to ............... 5. . st box baffled .......................... ............................... Cycle witnessed by H.D.estimated flow /cycle........... M. Ouse/Building a. house located per approved plans ... ....................:.......... b. Number of bedrooms ....................... ............................... IV.. Well Well located as per approved plans . ......:........................ b. Distance from STS area measured D 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.. yy f. Curtain drain outfall protected & dinto exist watercou s 'v g. Footing drains discharge away from STS area ............... h. Surface water protection adequate.... .... : ....:..................... i. Erosion control provided ................. ............................... Rev. 12/02 YAM W� r� J _... _ 5rr - IZdSPECT.I«1 FO XFMt P 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 trosion Control Installed Sieve Test Results (if applicable) Additional Comments: Reserved for Field Sketch if Applicable Required Depth Date: Inspected by: o PUTNAM COUNTY DEPARTMENT OF HEAL'T'H DIVISION OF ENVIRONMENTAL HEALTH SERVICES E OF SUBSURFACE SEWAGE TREATMENT SYSTEM or Purchaser of Building 1110" wof_&�k* a�)� Building Constructed by -36 .-� z cv% e - a� w Location - Street Building Type Tax Map Block Lot Town/Village rd 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, f 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 _ .... system.... 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: Mo th F Day :?e Year z�,5; V eneral Contractor (Owner) - Signature Corporation Name. (if corporation) Address: q tom' 4 State Zip Signature: Title: l } ra Corporation Name (if corporation) s Address: / State ,, ► Zip o 5 Form GS -97•. JMS ENVIRONMENTAL SERVICES,..INC. 1500 SUMMER STREET S STAMFORD, CONNECTICUT o69o5 Mailing Information: Name: PF Beal & Sons Client: Work Horse Homes Address: 4 Putnam Ave City: Brewster State: NY Zip: 10509 Telephone: 845-279-2460 Fax: 845-279-6613 Sample's Information: Site: Hose Bib Preservative: HNO3 Temperature: <4C Date Analyzed 7/25/03 16:00 7/25/03 7/25/03 7/25/03 7/26/03 7/26/03 7/26/03 7/26/03 7/26/03 ..... 7126/03- 7/256/03 11:00 7/25/03 7/26/03 7/26/03 7/26/03 7/26/03 NELAC, CT and NY State Certified Environmental Laboratory Collector's Information: Name: B. Mates Address of site: 367 Lakkeshore Rd City: Putnam Valley _9d , 13 State: NY Zip: Telephone: Date Collected: 7/24/03 Date Received: 7/25/03 Time Collected: 11 :30 Time Received: 16:00 Lab No.: J035359 Test Name Total Coliform Chlorine Free Residual Color Odor Iron Manganese Sodium Chloride Hardness Nitrite pH Sulfate Turbidity Alkalinity Lead Result MCL Absent Absent <0.1 mg /L N/A 5 Units 15 Units ND 3 TONs 0.136 mg /L 0.3 mg /L 0.103 mg /L 0.3 mg /L 10.2 mg /L N/A 23 mg /L 250 mg /L 76 mg /L N/A ..1..59 mg /1- .::. . 10: MO /.L . <0.1 mg /L 1.0 mg /L 7.17 S.U. 6.5 -8.5 S.0 19.0 mg /L 250 mg /L 2.33 NTU 5 NTUs 60 mg /L N/A <1.0 ug /L 15 ug /L At the time of analysis the sample was acceptable for total coliform Method SMWW 9222B SMWW 4500CIG SMWW 2120 B SMWW 2150 B SMWW 31118 SMWW 3111B SMWW 31116 SMWW 4500 Cl C SMWW 2340 C SMWW 4500 NO3E SMWW 4500 NO3E SMWW 4500 H B SMWW 4500 SO4F SMWW 2130 B SMWW 2320 B SMWW 3113 B N/A = Not Applicable mg /L- milligrams per Liter ND- None Detected S.U.= Standard Unit NTU- Nephelometric Turbidity Unit MCL- Max. Contaminant Level TON- Threshold Odor Number ug/L- micrograms per Liter 6 1 Signature: State #: PH -02 8 Michael Lapman FLAP M 11715 President Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com t DEPARTMENT OF HEALTH Division of Environmental Health Services TWOCOUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICAm?ON T.O.CONSTRUCT A.WATER WELL- 1 PCHD PERMIT # J WELL LOCATION Street Address NORTH ROAD Town/Village/City Tax Grid Number PUTNAM VALLEY NY 8 =2 -1 WELL OWNER Name Address WEST ImPrivate RONALD FIORENTINO LAKE SHORE ROAD PUT. VAL NY10579 13 Public USE OF WELL 1 - primary 2 - secondary 13 RESIDENTIAL 0 PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP 0 ABANDONED 0 BUSINESS 0 FARM 0 TEST /OBSERVATION 0 OTHER (specify ❑ INDUSTRIAL O INSTITUTIONAL 0 STAND -BY 0 AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED 4 /EST. OF DAILY USAGE 300 gal REASON FOR DRILLING ®NEW SUPPLY O REPLACE EXISTING OPROVIDE ADDITIONAL SUPPLY ❑TEST /OBSERVATION SUPPLY ® DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING DOMESTIC WATER SUPPLY FOR NEW HOUSE WELL TYPE DRILLED DRIVEN ®DUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES XXX _NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, ,NAME OF SUBDIVISION: ROARING BROOK LAKE Lot No. 409 WATER WELL CONTRACTOR: Name NORMAN ANDERSON Address: BARGER ST. ,PUT,. VAT. Ny IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES xxxx NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO-PROPERTY-FROM NEAREST GIATEF. MAIN:. LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED []ON REAR OF THIS APPLICATION N A 11/14/86 (date) 7 Wignat PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of 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 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 attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Departmen . Date of Issue: / 19 Date of Expiration: .�— 19 Permit Issuing Permit is Non- Transferrable M. BRUCE R. )"'OLEY LORETTA MOLINARI R.N., NI.S.N. J�irnl K., Director of Patient S'ervices DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 Enviroamental Health (9M)279-600 Fax (914) 278 - 7921 Nursing Services (914)278-6558 MC (914)278-6678 Fax (91 1) 278 - 6085 Early Intervention (91,0278-6014 Preschool (914) 278-6082 Fax (914)'-178 - 6648 L911 ADDRESS VERIFICATION FORM 0 VV N 11" RS NA NI E: TAX IVI AP IN U NIB E R: E91 t ADDRESS: 'I"OWN: C TIIC PLIA11,111.1 COLItIty Department of Ifeafth wit( uot issue a Certiticace of COWSO-LIC41011 Complian.ce -unless the. above form is co►nplieted, i.e., a E911 address is assigne(I by an authorized town official. This form is to be: ubujli t ted with the aj..)Pficatloll for a el-tificate of Coils tru C I"i oil Compliance. 0-9 1 V 11 -'! Tl \-, NI) . •LORETTA'-= MGLIN-ARI R.N. -M.*8. i:-- --1 a_. —. Acting Public Health Director Director of Patient Services August 1, 2003 :........... .. :— '- 'R0BERT" T.� -BONllI I County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York 10598 Re Dear Mr. Sullivan: Field Inspection — Fiorentino Lake Shore Road East, (T) Putnam Valley TM# 30.18 -1 -22 & 23, Permit # PV -23 -85 A site inspection was made for the above referenced project on July 31, 2002. The following too ents must be corrected in the field. Gravel appears to be dirty and a decision will be made as o Nether the gravel should be _ removed - ` :�L� i`hy �-krn w� �' flop 04o-"Ys v � -11 c :3: �2 ~ The two 90° elbows just before the septic tank need to be removed. The 90° elbow on the PVC line needs to be replaced with 45° elbows and a cleanout. ps iJ If you have any further questions, please contact me at (845) 278 -6130 ext. 2157. �( ►, "go eruty ;� JSP: cj Sincerely, Joseph S. Paravati, Jr. Assistant Public Health Engineer 07/28/2003 07:35 9149624248 JOSEPH SULLIVAN PUTNAM COUNTY D EPAMIENT OF $E 4LT DIVISION OF ENVIRONMENTAL EMALTIE1 SERVICES A'1 TENTION 04AWor GENE 4d - Rai TF ��' lFmlt FIl�IAI, l[N All Wforwafioa must be fully completed prior tm any inspections being made. For: Fill Wrenches PAGE 01 PCHD Construction Permit 9 ✓P ki 3 '° C ' `r��51 Y5 Located: - -- Omer /Applicant Name: Ar rre)w 41 TM _SezrBlock Lot Formerly: Subdivision Name: 4� 4a% nom -•4' Subdivision Lot # Is system fall completed? "' _ Date:,, /p Is system complete? Date: Is system constructed as per plans. Is well drilled? vo-x Date: Is Drell located as per plans? �/le -- - Are erosion control measures in place? I certify that the system(s), as listed, at the above premises has been commeted acid 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 Putr County Department of .. health. - .... , ... ... _ . _ Date: 3 Certified by: � Z� :'q Design Professional Address: uc.0 Comments: d Form FIR-99 JUL -28 -2003 MON 08:01 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 �51 . . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ._ _...... -g CONSTRiTCTION PERMIT FO ATMENT "S'YSTEM." ' PERMIT # Located at ),1,4 1���� �od Town or Village Subdivision name Adarijg Awo/' Subd. Lot #� Date Subdivision Approved Owner /Applicant Name /�� '0�a/l /- �'o r ,�j -VI C, Mailing Address Tax Map 30 / Block ! Lot Renewal Revision Date of Previous Approval, / Amount of Fee Enclosed -3 Oe� V Building Types Lot Are' /�G� No. of Bedrooms Design Flow GPDFdU Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of ,� 2 fD gallon septic tank and �-5�-0 d i PLC Are-'vc,"'k-o Other Requirements: To be constructed by 61 W'r,7e- Address Address ydm e PUTNAM COUNTY HEALTH DEPT. 023290 1 Geneva Road (845) 278 -6130 Brewster, NY 10509 Date 1310 Re eived of Th Sum Of� Dollars $'0i' o d . For V THANK YOU! O Cash 0 Check ❑ M.O. ❑ Credit Card By stem(s) and that the lment thereto and in I that.on.completion be submitted to the lie- builder, that said -iod of two (2) years:: iance of the original Address 2 F7 Z License # a r x'93 APPROVES FOR CONSTRUCTION: s o years from the date issued unless construction of the sewage treatment system has been completed ► CHD and is revocable for cause or may be amended or modified when considered necessary by the Pub or. Any revision or alteration of the approved plan requires anew p it. Approved f discharge of domestic ni sews only. By: Title: Date: White copy - HD Fil , Yel w c py - Building Inspector; Pink copy - er; ge copy - Design Professional Form CP -97 PU NAM COUNTY DEPARTMENT OF HEALTH IlDWIMON OF IENWRONMIEN'ITAL HEALTH S ERW(CES APPLICATION TO CONSTRUCT A WATER WELL Y please print or type PCHD Permlt.# _ b'.� Well Location: Street Address: Town/Village Tax Grid # oIAp %1/06,v Mapco J9- Block J Lot(s)e-'2-43 Well O®vv ner: Name: % Address: Use of Well: 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 gpm # People Served . Est. of Daily Usage `gal. Reason for Replace Existing Supply Test/Observation Additional Supply IDrfilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No d' Is well located in a realty subdivision? ...................................... ............................... Yes ei' No Name of subdivision 1—d `iyi '0 //r Lot No. _ Water Well Contractor: M . ,¢,? do -y Address: f'q AvGA'J eolln- Lo" Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village �. Distance to property from nearest water main: ^/ /gam Proposed well location & sources of contamination to be provided on separate' sheet/plan. Dale:_ W3d a Applicant Signature: -i/ . �i:� -' �ap,� �,y�`/ _ ... �- . z ... -- _ -_ . -- .._.. . _... .. , 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 _I OR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. A Date of Issue -,5--Z,.-3 d'Z-- Permi Date of Expiration —Z y2 -f Title: Permit is Non -Tra nsfferr bRe White copy - HD file; Yellow copy - Building Inspector; Pink copy'- Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES r� FIELD INSPECTION REPORT INSP. BY: (Name of Owner) (Street Location) INITIAL SITE INSPECTION YES NO C'S Wetlands on /or proximate to property .............. Property lines or corners found... ................. Can estimate house location ....................... Willdriveway need cut ............................ Must trees be removed - note these ................ , Deep holes representative of entire SDS area..... Additional deep holes needed..... ... .... Sufficient SDS area available considering driveway "(A cut, house location, separation distances,etc... ��`°" A-' "`' CU� Adjacent wells/ septics ............................ D.H. 1 Lot Depth to G.W. Depth to rock 0 ft. Soil Descri tior 3 3 ft. 6 ft. House SSDS located per approved plan ............. 9 6 ft. 12 9 ft. Width of trench average -� 12 ft. D.H. - Deep Hole G.W.- Groundwater D.H. 2 Lot D.H. 3 Lot Depth to G.W. Depth to G. W. Depth to rock Depth to rock Soil Descr 0 ft. 3 ft. YES 6 ft. House SSDS located per approved plan ............. 9 ft. 12 ft. 0 ft. 3 ft. 6 ft. 9 ft. 12 ft Soil Descri tion ®I DATE: FINAL SITE INSPECTION INSP.BY: YES NO COMMENTS House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable......... Roan allowed for expansion trenches....... ..... Over 100 ft. from watercourse .................... Natural soil not stripped or SDS area unnecessarly graded...... ... ............... 10 ft. maintained from property line and 20 ft. fran house... ........................ Distance well to SSDS (ft.) ...................... Number of bedrooms checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. from nearest trench ................ 15 ft. of peripheral soil horizontally frantrench ..... ............................... Boxes properly set .. . ...... ..................... Could surface runoff fran driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE ................. r —+ DIVISION O ENVIRONMENTAL 4 \ f SERVICES LETTER OF AUTHORIZATION RE: Property of A4 Located at Tax Map # 3� i Block / Lot ::�a 0�� Subdivision of Subdivision Lot # 4�d Filed Map # 30 .7C Date Filed �/ 6 Gentlemen: This letter is to authorize d�as w ���� ✓A°% a duly licensed Professional Engineer or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the 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 Putnam County Sanitary -Code. - a _ ......... . Very truly your Countersigned: Signed: Gv -� P.E., R.A., # .2 (Owner of Property) Mailing Addres W G N O ��Lzz! State �r. Telephone: y ,4,1 9' Mailing Address: 4c, 49^ �A ,tc 40 States «- _Zip_Z.o f 7 4 Telephone: 6 S- S Z6 — Z 3 7,3 Form LA -97 P1J'TN-,kM, COUNTY DEPARTMENT OF HEALTH DIVISION OFEN"RONMENTAL. HEALTH EET SUBSEU SE' 1A SEAGE TREAXIMtNT SYSTEM, u Owner </ Address 6 4'/� ��Drii �/Z��l1G'l/�/ Located at (Street) Map Block Lot (hidiQato nearest cross street) Municipality _ W atershed,/Cfe/0 SOJI, PERCOLATION TEST DATA Date o.f.'Pre-soaking '2 - Date of Percolation T .1 gists to 00 repeated at same depth until approximately equal percolation rates are 00talnea at car.,, percolation test hole. -(i.e. s I min for 1-30 mirdinch, s 2 min for 31-60 min/inch) All data to be s u brn itted for review. • Dept► measurements to be made •om top of hole. Form DD-97 Depth towati v: "W Time, Isla W 111we From GruWW'....'; Surface (164`6�) 'Start "Wol C-Nq Rji4 loo. t V P. N. 2 3 3 2— 1' 4 5 7 2 '2 'v 3 4 5 2 3 4. 5 _._i..__ .1 gists to 00 repeated at same depth until approximately equal percolation rates are 00talnea at car.,, percolation test hole. -(i.e. s I min for 1-30 mirdinch, s 2 min for 31-60 min/inch) All data to be s u brn itted for review. • Dept► measurements to be made •om top of hole. Form DD-97 T.U"ISTPITDATA DESCI.UPTION OF SOILS ENCOUNTERED IN TEST HOLES OLE 7-y 0.5' 1.01 2,0' 2.5 43 r 5,01 -- --------- 5.5; .6.5' 7.5' a- 8. 5" 10.0 2 indl.c.aic, level. at which groundwater is encountered _ %VQ�� at which mottling is obsciv el e ICV(,! to which waiter ICVCI rises aller being encounlered Dcc,.p 1.1011 C) bservation . s inacle by: Date —u IT sional Name: - Addrcs:.-s- Zq 7 2— qzz: Design Professional's Sea.1 ' 87 of IvEtv NN C1 ?489b t-ssl ,/, ce, mf AH - ?' -00 SAT .x:19 AEI HNAM CTY ENV HEALTH FAX MO, 19142737921 ?. l BRUCE R. FO1.EY Public Health Director ��� b Associate Publle Health Director Director of Patient Services DEPARTMENT OF MALTH 1 Geneva Road Brewster, Now York 10509 FIELD TESTING A'I " "iEbMO',N: O G 9 GENE RE-ED All1>atorrnation below must be f& completed / prior to any scheduling. DATE. 0 Z' ENGINEER OR RRM: d ` w l < 1� ✓�+� . T.. PHONL 0: REASON: 'ROADISTREE : TOWN. SUDDIV DEEPS: )< PERCS, o PUMP TEST: o OWNER: von TAX M,APi#. _ - 1LO7'#:�__ YES NO o Proposed SSTS within the drainage basin of West Branch or Boyds Corner Reservoil-S. C� Proposed SSTS within 500 feet of a reservoir, reservoir'stem or control lake. n Proposed SSTS within 200 feet of a watercourse or a DEC wetland. greater than 1000 gallons/day or• SPDES Permit required. 0 � Proposed SSTS for a Commerical Pruject. _ - _ _ _._ . ,......._. L. It is the .responsibility of the design professional to provide the above information prior to sail testing". This Department will determine the N-YCDEP project status (Joint or Delegated) based on the response. If you answered lE to any of the questions, NYCDEP must witness the soil testing. This .department will coordinate a mutually suitable time for field testing with the PCD01I, the Resign Professional and 1N•YCDEP: If a project has been determined to be Delegated based on the above response and then subsequent information indicates NVCDEP iS required to witness the soil testing, it will be the sole responsibility of the design profemional to schedule re- witnessing of the soil testing with NYCDEP. FOR COUNTY USE ONLY f (FIELDTESr) 14-16-4 (2f87)—Ttoxf 1Z PROJECT Ijb. NUMBER 017.21 SEOR SHORT ENVIRONMENTAL ASSESSMENT FORM Aw UNLISTED ACTIONS Only PART I—PROJECT INFORMATION (ro be vornploted by Appkant or Project aponeor) 1 - APPLICAN7 )SPONSOR 2 PROJECT NAME 3 PR J CT LOC�- TION .1 Munlc'Ipallty 4 PRECISE LOCATION (SLIfni address and r 0nlerueetwng, prominwit londmarkti. Mc., of proVIdd map) 6. is PRO YOSED ACTION New 0 Expenoion ❑ 1, Iodificationi.1tots lion 6. DESCRIBE PROJECT BRIEFLY- 7. AMOUNT OF LAND . �JFICTM a. WALL PROPOSED CTION COMPLY WITH EXISTING Z0Ni"A.--�0-R 01HER EXISTING LAND USE PIESTA)CTIONS? Kea Ej No It No, dwrib, W-101y 9. WHET IS PFIESENT LAND USE IN VICINIT'r OF PROJECT? . �1'6 F l'iderWall 11dUatlial Gornrylarclal Agricuilure Park/Folostjopen IsPico Oths, rfbfa 10. DOES AC71ON INVOLVE A PENMIT APPROVAL, 08 FUN04NG, NOW 08 ULTIMATELY F90X ANY OYHJR OOYERNMENTAL AGENCY (FE.012RAL. STATE PR LOCAQ? XY06 14c, It yen, list aWscy(z) artd pa4iTtIVappfoy&l!6 11. DOES ANY ASPEC7 OF THE ACTION HAVE A CURSPINTLY VALID Pf- Wf'r 08 APPAL)VA' ogyols 0 No it yas, i1al agenay name and pormildapproval fly 3 I? AS AAESULT04: PPOPOSE-0 A(MON WILL -EXISTING PERMIT)APPROVAL RE'QU)RE MODIRCKTION') Ya, No Ile_ jl/ V CERTIFY THAT THE INFORMAT16N PROVIDED ABOVE 1S 'RUE TO IME MV OF W A"QMME Applicant'sponsoi nerno: Signuture� H the action Is In the C032tal Area, and you are Q OtMe 69000Y4 COMPIOW that CouRtal Assessmeni Form Wore proceeding. with this 988488mcnt' IVER PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS .. _... REVIEW SHEET FOR CONSTRUCTION PERMIT ,... r r... •. -: .m�.v..tn "::..:..'... .. e. .k a.. . ... •st'♦ -:. ..v_:Y ..Y t.e_ .. .. •.. .. •a... . .t..•. K.... .r., NAME OF OWNER: 'cN' AYD STREET LOCATION: REVIEWED BY: RM, GR, AS, 6Z--AkE: �'1 TAX MAP #: (CONFIRMED) �• '— / , °21 JU N DOCUMENTS PERMIT APPLICATION WELL PERMIT OR PWS LETTER (e UPC -97 (/)(__)LETTER OF AUTHORIZATION ( 6UDESIGN DATA SHEET (DDS) C-�)(. CORPORATE RESOLUTION (_/jUSHORT EAF PLANS -THREE SETS HOUSE PLANS - TWO SETS U( VARIANCE REQUEST SUBDIVISION ( f )LEGAL SUBDIVISION (6(_)SUBDIVISION APPROVAL CHECKED (__)(,:::jfERC RATE L_)(_rT1 LL REQUIRED DEPTH (�(_URTAIlV DRAIN REQUIRED GENERAL (_J(- -)LOCATED IN ERSHED UUP TTED TO DEP U LEGATED TO PCHD C P APPROVAL, IF REQ'D , L, )(DEEP TEST HOLES OBSERVED FJ�� (,fj ) PERCS TO BE WITNESSED U(,,::�EX- APPROVAL SSDS ADJ, LOTS C_)(_2WETLANDS (TOWNIDEC PERMIT REQ'D ?) /5LJDATA ON DDS PLANS & PERMIT SAME UL,�JfRE 1969 NEIGHBOR NOTIFICATION UL,0TTER BUZBA L ( i100 ; FLOOD ELEVATION W/J 200' UC,:::�SOIL TESTING LOTS >10 YEARS OLD. REQUIRED DETAILS ON PLANS (SEWAGE SYSTEM PLAN - (NORTH ARROW) (::�)(,)SSDS HYDRAULIC PROFILE (� _ GRAVITY FLOW CONSTRUCTION NOTES 1 -15 DESIGN DATA: PERC & DEEP RESULTS T CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT (= �(__)FOOTING /GUTTER/CURTAIN DRAINS : f �USDA SOIL TYPE BOUNDARIES (C__)TITLE BLOCK; OWNERS NAME ADDRESS TM #, PE/RA; NAME , ADDRESS, PHONE# (_,)DATE OF DRAWING/REVISION (DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. (,O�PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS U�(�WELLS & SSDS'S WAN 200' OF SSTS ( ,!!I( )PROPERTY METES & BOUNDS EROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION CONTROL NOTE COIVII LINTS: (REVSHEET)09 /01/00 Y N (REQUIRED DETAR&ON PLANS CONT'D ((__)HOUSE SEWS E/, :' '0'; TYPE PIPE CAST IRON ( .�f( )NO BENDS; Y S 45'W /CLEANOUT RENEWALS Ti FILL SYSTEMS UC_)10' HORIZO AL; PAST TRENCH SLOPES 3:1 TO GRADE ()(FILL SPECS / ILL ES i -5 (_)UFILL PRO DIMENSIONS __)FILL AN ON AREA FILL GREATER THAN 2 FEET UU CLAY B R UUFILL CERT AT OTE LJ(_JDEPTH GAU UUVOL. O AN FO O.B., UNCLASSIFIED & IMPERVIOUS U(�SEP TION DISTA E FROM TOE OF SLOPE TRENCH (LF TRENCH PROVIDED Sy 60FT MAX. CONTOURS ( 100% EXPANSION PROVIDED DETAIL/DUST FREE CRUSHED'STONE OR WASHED GRAVEL i ( )GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM'SSTS (_ rc 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS (,f:1C )100' TO WELL, 200' IN DLOD,150' TO PITS (, ff )100' TO STREAM, WATERCOURSE, LAKE (inc. ezpan). 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (pits: 201) -: 50' INTERMdTTENT °DRAINAGE COURSE - 200' /500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS (�U10' MIN TO LEDGE OUTCROP SEPTIC TANK (�( J10' FROM FOUNDATION; 50' TO WELL WELL ((_JDIMENSIONS TO PROPERTY LINES (,fy —)LOCATION OF SERVICE CONNECTION (MIN 15' TO PROPERTY LINE SLOPE )SLOPE IN SSTS AREA !?( 20%) UL,�REGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS UUPUMP OTES C_)( SE 7 o P1P VOLUME/DOSE VOLUME NOTED (__)(JDETAIL FOR KMAIN, (PIPE TYPE, ETC.) U(_JPIT AND -B OWN & DETAILED (__)C__)1 DAY ORAGE ABOVE ALARM CURTAIN DRAIN (�USTAND IP S, 5' OTH SIDES, DETAIL C--)C-J151 MIN DS- 5%,20'-4%,15'-3%,35'-l-/6, 100%-<l% (x(_)20' MIN ISCHARGE /100' with 182 cons day discharge (__)C_)10' MIN o NON - PERFORATED PIPE Public Health Director May 6, 2002 DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 1;ORETTA N10L�i+lEiiri :N: iVi:S.14 J. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York 10598 Dear Mr. Sullivan: Re: Proposed SSTS - Fiorentino North Road, (T) Putnam Valley TM# 30.18-1-22,23 Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: 4" cast iron pipe to note 2% slope. is- re u.Lred or_ the plans statinb g that resent - site, cnditious. arecm arable - Axe ieual Hate o op to those at the time of the original approval with respect to the well and septic area. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Sincerely, Shawn Rogan Public Health Technician SR:cj 1 BRUCE R::,FOLEY..:. Public Health Director May 6, 2002 -LORETTA - MOLINARL R.N.,.FM.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 Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York 10598 Dear Mr. Sullivan: Re: Proposed SSTS - Fiorentino North Road, (T) Putnam.Valley TM# 30.18 -1 -22, 23 Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: 1. 4" cast iron pipe to note 2% slope. =tA renewal note-is re_ quired on the plans stating that present site conditions.-are comparable _ ^ to those at the time of the original approval with respect to the well and septic area. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. SR:cj Sincerel , Shawn Rogan Public Health Technician PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Res Property of Ronald Fiorentino Located at North Road (T) 8 Section - - - - -- Block 2 Lot 1 Subdivision of Roaring.Brook Lake. Subdva Lot 409 Filed map # Date Gentlemen: This letter is to 'authorize Joel L,. Greenberg a duly licensed professional engineer or registered architect xxx (Indicate to apply for a Construction Permit for a separate sewage system, to 'serve the above noted property in accordanc6-with the standards9 rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to aign.all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems: in -conformity with; the: provisions of 'Article ;145_�or 1479 Education Law. lic Health Lawq and the Putnam County Sani -- µED q tart' Code. o\r���RtiNCE I AA � Very truly* 59 Countersigned CAF °FONE�� PoEog RoAoq 11056 Muscoot NO,RFD #2,Bx 488 Address Mahopac,NY.10541 628 -6613 Telephone gned ek—bf Property Lake Shore Road West Address Putnam Valley,NY 10579 Torn 528 -2373 Telephone A, AY 2^ 19 r®ijlV S� # y �kT-tj PEnNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS - DATE REVIEWED: BY: (Name of Owner) (Street Location) —� DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage_&-.,Z�p Aion..Area; .: Expo -ision Area; shown; gravity flow; cuff : -8ize If Pumped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS °s w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains- Curtain,Stom,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fran Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same , S7S� Otf - So b Ly�a.0 t woe I IL OO ° p� Q% 00 •10 Ip 'Y f t ` k r p � `gip t ��1 y •� 'H ''� " W il,,r o � � tsr "6�C "a;�' Va c � �r I •'"af J- O ,.. � � ♦FTG CRS e � �_ � .. O,. ., a ,,, A.. - � p °: �' � •vR• °o ,yam 4. p 'eL v n i•` F ,`,,� a z a,•t3•� T :i L f� 'n S � �s.� ,. - � O `rSi {�4 ��a � � , `• t t ,h � vd d•,��F l4' ," oM1�1 4 q4��r .� �� �::f a r . i t� t , i•�p�I �.v � is � D� � -b °ti (�t) � it Y, �►�'�n\ orr �j o � B a. �� !1 � ' ' 1 rOt?'OCI i t1 � 1 wf ,ir '•t ! �� [�' r��t ' p. tt'e�'' k� f x i •, Z �• S °�e/ � � n" "'`'" t � t,�. apt �? `c r� � � !;,. � ` Nq �EPT G '`' ry .. I , D"r a w 1 ".9 1t10 , o. Pr0l�at's \ 1 a, 'J �GIC.s'f4,bF It- o.. _. /1So o / /on �xPar7slrp Ar34e,ne- I Co d DacK II V A,X, i' 4 "PVC, 0®hF 3s' �1 ?� 7r v, ca / ;;�,.. ,O 3 1�C` 0 P.L }� . ...J�.s('Ci7'r CO n1�tTj OT i2.� G' a / /tea Sc� A,-c. on w 4e 1/' s o eJy e_s '5v '-v a y 0' ale /10- /a'- d 54 ef-J' 2g Po i9ox /A OF NEW). "TUd to to oertify. that the Damage die posal system W6© gee Sias oonotrueted as indioated on this plan and that the oyotem * ° waa lnepooted by no before it me covered over. The oyntem crag conotrwoted in aonordanoo with all standard 9y ruldo and rogulationa of the Putnar. County Department of Health and the ffm York State D�opartmant of Health." PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF RO MENTAL ALTH SE ES. As - ?4 r� /� -a3 -X5 APPROVED AS NOTED FOR CONFORMANCE WITH APPLICABLE RULES AND REGULATIONS OF THE F%TNAM COUNTY HEALTH DEPARTMENT. LaXc. �/to.�c �a pd 0la /i h� 4-06"P C`T� was �r �» YQf• y .r8 . - >.� (k r2! /'w/,n en"u�y -- - 60.. 71 ra 6Y gz P.L }� . ...J�.s('Ci7'r CO n1�tTj OT i2.� G' a / /tea Sc� A,-c. on w 4e 1/' s o eJy e_s '5v '-v a y 0' ale /10- /a'- d 54 ef-J' 2g Po i9ox /A OF NEW). "TUd to to oertify. that the Damage die posal system W6© gee Sias oonotrueted as indioated on this plan and that the oyotem * ° waa lnepooted by no before it me covered over. The oyntem crag conotrwoted in aonordanoo with all standard 9y ruldo and rogulationa of the Putnar. County Department of Health and the ffm York State D�opartmant of Health." PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF RO MENTAL ALTH SE ES. As - ?4 r� /� -a3 -X5 APPROVED AS NOTED FOR CONFORMANCE WITH APPLICABLE RULES AND REGULATIONS OF THE F%TNAM COUNTY HEALTH DEPARTMENT. LaXc. �/to.�c �a pd 0la /i h� 4-06"P C`T� was �r �» YQf• y .r8 . - >.� (k r2! /'w/,n en"u�y i 'JV PUTNAM COUNTY DEPARTMENT OF HEALTH Engineer to Provide, Permit Rev. 3186. DIAslon of Environmental Health Services. Carmel, N.Y. 10512 E°� 1 on CERTIFICATE OF COMLIANI:E� / /'�� ONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Permit q PUTNAM VALLEY ted at NORTH ROAD Town or village - .ROARING =`BROOK LA: 409 ' �,.....K.. d.A t.. ubdlvielon Name a . Lot q Tsa Map 8.. Block .2 Lot Renewal_ p Revision X Owner /Applicant Name R F IORENT INO Date of Previous Approval MaWngAddross LAKE SHORE ROAD WEST, Town PUTNAM VAL,NY Zip 10579 Bullding Type ONE FAM. RES. yet Area 29, 210SF Flfisection Onb' Lj Depth th Volume Number of Bedrooms 3 Design Flow G /P /D 600 PCHD Notification Is Required When Fill Is completed Separate Sewerage System to consist of 10 0 0 Gallon Septic Tank and 13 6 LF OF TR I GALLERIES To be constructed by R o 'PT0 RENTINA AddrossT.AKF SHORE R . W_ F.STT PITT - XIAT..- x'10579 Water Supply: Public Supply From Address or: XXX Private Supply Drilled by N;.* ANnR.R SnN Address B8RrPR qTR F.F.'j,t PTTrP _ 17AT. - I my 1 n ci 79 Other Requirements represent that I am wholly and completely responsible for the design and location of the proposed sy a (s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance w h t standards, rules an regulations o e Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Com ian " satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his succes rs, {rs or ssigns by the builder, that said builder will place in good operating condition any part of said sewage disposal sy Ing the period of o ) r mmediately f owing the date of the issu- ance of the approval of the Certificate of Construction Compliance o he or{g al system or any a her o; 2) that th rilled well described above will be located as shown on the approved plan and that said well will be Install rdance with the s ndar s, and u a ons of the Putnam County Department of Health. Date 10/17/86 Signed c• P.E._ R.A. XXX Address is nse No 11A56 APPROVED FOR CONSTRUCTION: This approval expires one year fr m the da issued less construction of the buildi g has been undertaken and is revocable for cause or may be amended or modified when consider etl n sa►y b the Co Is inner of Health. Any change or alteration of construction requires a new permit. Approved for disposal of domestic sanitary s wage 6t at ply Drum, Date 1-094. j��J y -- PUTNAM COUNTY DEPARTMENT OF HEALTH Permit - ~ tal Health Services, Carmel, :N. Y.40512- -' -' ..,. _ Division of Environmen .. M _...._... .._......... _... _ _ ..... . -- CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Putnam Valley own or i lage North Road Tax Map 8 Block 2 Lot 1 Located at Subdivision Roarinq Brook Lake subd. Lot a 409 Renewal _❑ Revision _❑ Owner /Address K. Fiorentino, L-K. Sh. Rd. W. , Put. Val, gate of Previous Approval One Fam.Res. 29 201SF Building Type Lot Area ► Pill section Only ❑ Number of Bedrooms 3 Design Flow G /P /D 600 P.C. H. D. Notification Required Separate Sewerage System to consist of 1 ()()n — ,Gal. Septic Tank and 40OLF of Leaching Fields To be constructed by R. Fiorentino Address Lk. Sh. Rd. W. Put. Val.NY Water Supply: Public Supply From XX Private Supply to be drilled by N. Anderson j Barger St.,Putnam Valley,NY 10579 fl Address Other Requirements 1 represent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regu a ions o e u nam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill 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 operating condition any part of said sewage disposal system during the period of two (2) years Immediately following thedate of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above will be located as shown on the approved plan and that said well will be installed in accordance /,a/�th the standards,,/, rules and regulations of the Putnam County Department of Health. 1. A I/-4 �� Date 5,�1,L85 Signed P.E. R.A.XXXI Address Muscoot NO RD##2 B 88 M o aC NY 10541 Icense No. 11056 r' X, APPROVED FOR CONSTRUCTION: This approval expires one year fro a date is ed unless construction of the b Iding has been undertaken and Is .evocable for cause or may be amended or modified when-considered necessary by the ommissioner of Health. Any change or alteration of construction ;uires a ney perms. Apr for disposal of dome sa 'Lary se age, and /or ivat �ater••supply only. By IFfn/ It1- +j- �11�[` Title