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BOX 19
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Rev. C8 PUTNAM COUNTY DEPARTMENT OF HF'ALTH
Division of Environmental Health Services, Carmel, N.Y. 10512
Engineer Must Provide PV 22-85
P.C,H.D, Permit #
1
CITE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM. PUT: LJ Aa�eFY;_: .. _..._
LAKE SHORE ROAD EAST Town or Village
Located at Tact Map 8 Block 2 Lot 3 • 1 & 3.2
RONALD FIORENTINO ROAR G BROOK
Owner/applicant Name Formerly -- --- Subdivision Name Subdv. Lot # 410.& 41
Melling Address LAKE SHORE ROAD WEST Zip 10579. Date Permit Issued..- 12/1/86
PUTNAM VALLEY, NEW YORK
Separate Sewerage System built by R. F I:ORENTINO Address SAME
Consisting of 1250 Gallon Septic Tank and - -140LF OF TRI— GALLERIES 12' —0 " o .
Water Supply: Public Supply From Address
ors XXX.X Private Supply Drilled by N. Anderson Address BAR ER ATRERTn PITT VAT ►]gy
Building Type ONE FAM, RESIDENCE Has Erosion Control Been Completed? YES
Number of Bedrooms 3 Has Garbage Grinder Been Installed? N
Other Requirements
I certify that the system(s) as listed serving the above premises we e c structed easent al as shown on the ans of the completed work ( copies
of which are attached), and in accordance with the standards, rules a d r ulations, in ac co danc with the fil plan, and the permit issued by the
Putnam County Department Of Health. /
FEB. 13 1987
Date r Certified D P,E. R,q,XX
Addres,MUSC00T NOR D#2JBX 48,9'-MAHOPAC,NEW YO 10541 055 7 � 6
use No
- --
Any person occupying premises served by the above systems) shall pro ptly t ke we ction as may be necessary to secure t e correction of any unsanitary
conditions resulting from such usage. Approval of the separate sews go. stem all become null and void as soon as a pub(;: sanitary sewer becomes
available and the approval of the private water supply shall become null void an a public water supply becomes available. Such approvals are
subject to modification or change when, In the judgment of the Commissions Heal h revocation, modification or change is necessary.
Date 2°`' / By _ Title 1e�
/ �
b� Rev. • 3186
` 'i � CONS'I'RLJCTIUN
PUTNAM COUNTY DEPARTMENT OF HEALTH .
Division of Environmental Health Services. Carmel, N.Y. 10512 Engineer to Provide Permit #
SEWAGE DISPOSAL SYSTEM
at LAKE SHORE RAOD EAST
_ on CERTIFICATE OF COMPLIANCE
PUTNAM VALLEY
Town or Village
Name ROARING BROOK LAB &d, jet #410 & 411 Ta: Map 8 Block 2 Let 3.1 & 3.2
I R. FIORENTINO Renewal _❑ Revision Y
Owner /Applicant Name
Mailing Address LAKE SHORE .ROAD
Date of Previous Approval
Town PUT. VAL . , NY ZIP 10579
Building Type .ONE FAM, RES . • Lot Area 53, 712SF Fill Section only Depth Volume
Number of Bedrooms 3 Design Flow G /P /D
600 PCHD Notification Is Required When Fill is completed
Separate Sewerage System to conslat of 10 0 0 capon Septic Teak and 13 6 LF OF TRI GALLERIES
To be constructed by R. F.I ORENT INO Add. K . SH . RD. WEST ,PUT . VAL . , tY 10579
Water Sapplys_Pdbllc Supply From Address
XX
ors Private Supply Drilled by N N. ANDERSON Address BARGER ST , PUTNAM VALLEY, NY 10579
Other Requirements
represent that sm wholly and completely responsible for the design and location of the propose system(s); 1) that the separate sewage disposal system
above described will be constructed as shown on the approved amendment there to and in accords a with the standards, rules and regulations of e Putnam
County Department of Health, and that on completion theieof a " to of Construction o pliance" satisfactory to the Commissioner of Healtnwill
be submitted to the Department, and a written guarantee will b flumni-S d the owner, his cce rs, heirs or assigns by the builder, that said builder will
place in good operating condition any part of said sewage disp sal syste during the per d two (2) years Imm dlately following thedate of the issu-
ance of the approval of the Certificate of Construction Complia a of th original system r ny , pairs thereto; that the drilled well described above
will be located as shown on the approved plan and that said well will be stall accordance st ards, r as and regu a�laTons of the Putnam
County Department of Health.
Date 10/17/86 Signed r P.E._ R.A.
MUSCOOT NO,RF 2, 488, MAHOPAC, N 0'i l4�nse No 11056
Address
APPROVED FOR CONSTRUCTION: This approval expires one y r from t e date ' ued unless construction of he building has been undertaken and is
revocable for cause or may be amended or modified when considers eces y by t e Commissioner of Health. ny change or alteration of construction
requires a new permit. Approved for disposal of domestic sanitary ... ate► supply only.
I
I
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISIO4 OF ENVIRONMERIAL .HEALTH SERVICES
RONALD FI0RENTIN0 8 2 3.1 p& 3.2
Owner or Purchaser of Building Section Block Lot
RONALD FIORENTINO
Building Constructed by
LAKE SHORE ROAD.EAST ROARING BROOK'LAKE
Location - Street Subdivision'Name ....
PUTNAM.VALLEY 410 &'411
Municipality Subdivision Lot t
ONE:FAMILY RESIDENCE
Building Type
GUARANIM OF SUBSURFACE SEWAGE DISPOSAL SYSTEM
I represent that I am wholly and completely.responsible for the location,
workmanship,' material, construction and. drainage of the sewage disposal system
serving the above described property, and that it has•been constructed as shown on
the approved plan or approved amendment thereto, and'''in accordance with the
standard's, 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 disposal ''System' or any
repairs made , by. me 'to . such system, except where the failure to operate properly is
- - - eaused ,by- the -wi11•ful 7or -Yieg'1-igent- act of- the,occupant of "the bu Bing utilizing"
the system.
= The undersigned further agrees to`. accept.. as -conclusive the determination
the Director of the Division of Environinental Health. Services of the Putnam Coun
Department of Health as to whether or not the failure of the system to operate wa:
caused by the willful or negligent act of the. occupant of the building utilizin•:,
the system.
Dated this 13 day of FEB. 19 87
General Contractor (Owner) - Signature
Corporation Name (if Corp.)
Address
rev. 9/85
mk
Signature.
Title CONTRACTOR
Corporation Name' (if Corp.)
AcY&ess
a
ti
BREWSTER ILAB®RATOM ES
_
B0u 224 - BREWS4EiR,
(994) 225 -2072
SAMPLE NO. 6393
SOURCE: Kenny Fiorentino hose bibb - well
Lakeshore Drive East
Putnam Valley, NY
COLLECTED: November 20, 1986
BY: P.F.Beal & Sons, Inc.
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method 0 per 100 ml.
Hardness 2gpg
Iron 0.02 mg /1
PH 6.
This result indicates the source of the sample was
of satisfactory sanitary quality when the sample was collected.
November 25, 1986 % � 6
Roy Bickwit P.E.
Director
Office Use Only
DEPARTMENT OF HEALTH.
Division Of Environmental Health Services
COUNTY -DEPARTMENT OF HE ALTH
—STREET
WELL'LOCAT'ION
AOURESS: WNW I I TAX GRIO NUMBEit'*
Lakeshore Dr. , E. Roaring Brook Lake, Putnam Valley, NY
WELL OWNER
NAME. ADDRESS:
Kenn y.Fiorentino, T,akPs'hn-rR Ap R BaAX_in_ZBrook Lk. P. V.
❑ PRIVATE
0 PUBLIC
USE OF' WELL
Iff RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR/60NO./HEAT PUMP ❑ ABANDONED
1- primary
2 - secondary
❑ BUSINESS 0 FARM 0 TEST /OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL 0 STAND-By 0-
AMOUNT OF USE
YIELD SOUGHT 22 5 gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE gal.
-REASON FOR
NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION
BS C ON
DRILLING
Z -REPLACE.EXISTIN.G;-SUPPLY -• C]:DEEPE-N-EXISTING--WELL,~,--,
DEPTH DATA
WELL DEPTH 2.255 t ft.
STATIC WATER LEVEL 30 ft.
MEASURED 11/11/86
DRILLING
)b�ROTARY IN COMPRESSED AIR PERCUSSION 0 DUG
EQUIPMENT
0 WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
0 SCREENED ❑ OPEN END CASING. XX.OPEN HOLE IN BEDROCK 0 OTHER
TOTAL LENGTH 21 tL
MATERIALS: USTEEL 0 PLASTIC 0 OTHER
LENGTH.BELOW GRADE' 20 ft.
JOINTS:. 0 WELDED., , JaTHREAD ED 0 OTHER
CASING
DETAILS
DIAMETER .6 1h.
SEAL:. CMEMENT GROUT ❑ 8ENTONITE 0 OTHER
WEIGHT
PER FOOT 19 1b./ft.
DRIVE SHOEMES '0 NO
LINER: 0 YES ZMO
SCREEN
DIAMETER (in ) (in)
,.)
'SLOT SIZE
LENGTH GTH (111)�
DEPTH TO SCREEN (ft)
DEVELOPED?
DETAILS
FIRST
0 YES 'O NO
SECOND
HOURS
GRAVEL PACK
ONO ...J
GRAVEL '
SIZE: .
DIAMETER
OF PACK I 9-
TOP.
DEPTH —ft.
BOTTOM
DEPTH — It.
WELL YIELD TEST If dei�iled pumping
MErH*OO: INPUMPEO tests were done is in-
:.,foe ' ?,�,
O-COMPRESSED'AIR, --: mAtion;attadhed'?,�,'
0 8AILED 0 OTHER 'DYES -ONO
11 more detailed 1&ittiflion descriptions or sieve analyses
WELL LOG - are available. pleaie... attach.
DEPTH FROM,
- - SURFACE
I
Water
pese_�
lng
Weil
v " I
meter
In
- " '' '. __.
FORMATION DESCRIPTION
ODE •
it.
I (L
WELL DEPTH
It.
DURATION
hr. min.
DRAWOOWN
It.
YIELD
9pM.
Surface.
6.
Drilling
in overburden clay and bLdr�
-Tjf-Trnrjc
at 10 feet
225'
6
205.
20
6,7
21
)riiiijag
in rock,set casing,grouted.1
21
22 1;
n-r-niij,
in rock
-aranite,
WATER ❑ CLEAR
TEMP.
QUALITY 0 CLOUDY
HARDNESS
0 COLORED
ANALYZED? 0 YES ONO
ANALYSIS ATTACHED? 0 YES ONO
STORAGE TANK: TYPE
CAPACITY GAL.
PUMP INFORMATION
TYPE
MAKER
MODEL
CAPACITY
DEPTH
VOLTAGE — HP
WELL DRILLER NAME P.F. Beal & So–ns, -Lnc. DATE
/
ADDRESS PO Box B Brewster,NY 1058 11 11/ 6
PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY SUBSURFACE SEMM DISPOSAL SYSTEMS
-% 2 - 321 1 \1.3 . � � l/ - FIELD .XNSRE ON REPORT
DATE:---.—
INSP . BY.
(Name of Owner) (Street Location)
INITIAL SITE INSPECTION YES NO OAS
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
cut, house location, separation distances,etc...
Adjacent wells/ septics ............................
D.H. - Deep Hole
G.W.- Groundwater
D.H. 1 Lot D.H. 2 Lot D.H. 3 Lot
Depth to G.W. Depth to G.W. Depth to G.W.
Depth to rock Depth to rock Depth to rock
Soil Descri tion
0 ft. 0 ft
3 ft. 3 ft
6 ft. 6 ft
9 ft. 9 ft
12 ft. 12 ft
Soli Descr
0
ft.
3
ft.
6
ft.
9
ft.
12 ft.
Soil Descri
DATE:
FINAL SITE INSPECTION INSP.BY-.
YES
NO
CAS
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........... ..... o ........
10 ft. maintained from property line and
20 ft. from house.— . ........................
Distance well to SSDS (ft.) ......................
Numberof bedrooms checks ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. from nearest trench.. ............
15 fto of peripheral soil horizontally
from trench ..... .............................. .
�
Boxes properly set.. .... . ...................
Could surface runofffram driveway, roads,
ground surface, etc., channel near SDS area....
Does lot drainage appear OK in area of SDS......,
FINAL GRADNG OF SITE ACCEPTABLE..
PUTNAM COUNTY DEPARTMENP OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS
��- j1-,.4-3.1-,,.
( Name of Owner)
REVIEW SHEET - CONSTRUCTION PERMIT
DAI'E REVI o�-
(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 & Expansion Area
E>cpansion Area; shown; gravity flow suFf . _see_.:.. :•= --
Ifi -'Pit &`D *Box Shown & Detailed
House - No. of Bedroans
Wells & SSDS's w /in 200 ft. of Property Located
Property Metes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4 " /ft. 4 110; 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,Storm,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
btleuxvllx ��
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES:
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN,DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner R. Fiorentino Address Lake Shore RD West,Put. Val.,NY 10579
Located at . ( Street Lake Shore Rd EasS:ec . 8 Block 2 Lot 3.1 & 3.2
ica a nearest cross•s ree
Municipality Town of Putnam Valley -Watershed Hudson River.
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
Run Elapse. Depth to a er a er ve
No. Time _ From:Ground'Surface in Inches Soil Rate
Start -Stop Min. Start Stop Drop in Min. /in drop
Inches Inches Inches
PTH##1 ' 1 9`$30r, 10 :00 . 30 '36, 39.5 3.5 30/3 0 5 =8, 5
210-:01 10:31 30 36 39.5 305 30/3.5 =8,5
310 32 11.62 in r 3a _ s _ 5 30- 13.5_8 5_
411:03 11:33 30 36 3905 3.5 30/305 =805
-PTH#2 19:35 10:05 30 36 3905 3,5 30/3,3 =9.0
210:06 10:05 30 36 39.5 3013 36/3o3 =900
411:08 11:38 30 36 39.5 3.3 30/ 3 a'3 =9 0 0
5
1
2
- r
1 �
jJ .�
f,
Notes: 1) Tests I to be repeated at same depth until a roximately equal soil
rates are obtained at each percolation test hole. All data to be submitted �'
for review.
2) Depth measurements to be made from top of hole.
DAVID D. 'BRUEN
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
JOHN SIMMONS. M.D.
Deputy Commissioner
November 12, 1986
Joel Greenberg, R.A.
RR #8, Muscoot North
Baldwin Place Road
Mahopac, New York 10541
RE: Proposed SSDS
Fiorentino
Lake Shore Road (T) Putnam Valley
8 -2 -3.1 & 3.2 P. V.
Roaring Brook Lake
Dear Mr. Greenberg:
Review of plans and other supporting documents submitted at this
time relative to the above captioned project has beeri:completed.-
Comment are offered as follows:
submit 2 copies of house plans
submit'.3 copies of well permit'application
show horizontal and vertical scale and finish floor
elevation on sewage profile
provide 10' separation of galleries.to driveway
show leader, gutter and footing drains
Upon receipt of a submission, revised to reflect the above
comments, this application will be considered further.
Very truly ours,
Anne tner
AB :pt Asst. Public Health Engineer
.cc:AB
JK
.File
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
,.
APPLICATION. TO•:CON�STRUCT *;WATER 'WELD
?? PCHD PERMIT
WELL LOCATION
Street Address
LAKE SHORE ROAD
Town/Village/City Tax
EAST PUTNAM VALLEY, NEW YORK
Grid Number
8 =2 -3.1 & 3.2
WELL OWNER
Name Address MPrivate
KENNETH FIORENTINO LAKE SHORE ROAD W. PUT, VAL,NY ❑Public
USE OF WELL
1 - primary
2 - secondary
12 RESIDENTIAL ❑ PUBLIC SUPPLY ❑AIR /COND /HEAT PUMP
❑ BUSINESS O FARM O TEST /OBSERVATION
❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY
17ABANDONED
❑ OTHER (specify
AMOUNT OF USE
YIELD SOUGHT 5 gpm /# PEOPLE SERVED 4 /EST. OF DAILY USAGE300 gal
REASON FOR
DRILLING
®NEW SUPPLY
❑REPLACE EXISTING
❑PROVIDE ADDITIONAL SUPPLY
SUPPLY ®DEEPEN EXISTING WELL
DTEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
DOMESTIC WATER SUPPLY FOR NEW HOUSE.
WELL TYPE
DRILLED
❑DRIVEN
ODUG
®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. 410 & 411
WATER WELL CONTRACTOR: Name NORMAN ANDERSON _ Address: BARGER ST,P9UT. VALo ,NY
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES XXXX NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE.- TO- PROPERTY:- -FROM- NRAREST..._WATER..MAIN• r
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
®ON REAR OF THIS APPLICATION ®0 RAT
11/14/86
(date) - _____T_(4Tgnatu
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 Department.
Date of Issue: 19��G
Date of Expiration: 19 ap ermit Is 'ng Office"
Permit is Non - Transferrable
8/86
PUTNAM COUN'T'Y DEPART OF HEALTH - DIVISION OF ENVIRONMENTAL
FIELD INSPECTION REPORT
INSP. BY
( of Owner) treet Location)
INITIAL SITE INSPECTION YES NO COMMENTS
Wetlands on/or proximate�to property y.. ...........
Property lines or corners found ...................
Can estimate house location... .................. G
Will driveway need cut ............................
Must trees be removed - note these ................ J�
Deep holes representative of entire SDS area......
Additional deep holes needed..... .... ....
Sufficient SDS area available considering driveway
cut, house location, separation distances,etc...
Adjacent wells /septics............................
D.H. - Deep Hole
G.W.- Groundwater
D.H. 1 Lot D.H. 2 Lot D.H. 3 Lot
Depth to G.W. G-r. ?' Depth to G.W. Depth to G.W.
Depth to rock Depth to rock Depth to rock
Soil Description Soil Descri tion it- estr' ion
0 ft. ( 0 ft. 0 ft.
3 ft. ""'"` 3 _ -.3 f 3 ft.p�
6 ft. �J 6 ft. 6 ft.
9 ft. 9 ft. DS 9 ft.
l
Uk&
12 ft. 12 ft.'� vI2 ft. M
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.........
Room 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. from house... .... ..................
Di-stance well to SSDS (ft.). ......................
Numberof bedrooms checks ........................
St_o►es, brush, stumps, rubble, etc., greater
than 15 ft. fran nearest trench ................
15 ft. of peripheral soil horizontally
Fran trench ................................
Boxes properly set ...............................
Coatld surface runoff fran driveway, roads,
grand surface, etc., channel near SDS area....
j
Do--slot drainage appear OK in area of SDS.......
FINAL GRADNG OF SITE ACCEPTABLE..... ..........
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date 5/1/85
Re: Property of Ronald Fiorentino
Located at Lake Shore Road East.
(T) 8 Section - - - -- -Block 2 Lot 3.1 &302
Subdivision of Roaring Brook Lake
Subdvo Lot * 410 & 411. 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 accordance wiih the standards, rules
or regulations as promulagated by the Commissioner of the Putnam County
Department of Health, and to sign all necessary papers on my behalf in
connection with this matter and to supervise the construction of said-.-~=
system or systems in conformity with".,1ttie .pravisitons of Article 145 or
�: - -14 7, £citxco ion Law,
E0 q
tary . Code. G\ ��RENCE c
�wv
a
M° 0 56
is Health Law, and the Putnam County Sani-
untersig ed> �op NEB �o
11056
oot No,RFD #2.Bx 488
9s
,C,NY 10541
,3
'e
��lr Very
Signe
Lake Shore Road'West
Address
Putnam Valley,NY 10579
Town
528 -2373
Telephone
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APPENDIX C
FINAL SITE INSPECTION Date j2, /
OWNER I pected by
)0,/
$. ()P1 Si-TRT)TX7T.qTrW Tryp 4
YM
Nd
CCMM&9TS
SEWAGE DISPOSAL AREA
a. SDS area located as per approved plans
b. Fill section - Date of placement
2:1 barrier.. IGTH WIDTH AVG.DPTH
c. Natural soil not stripped.
d. . Stone, brush, etc., rester than 151 from SDS area.
A
e. 100 ft. fram watercourse /wetlands.
SEWAGE DISPOSAL SYSTEM
a. Septic tank size - 1,000 1,250 )
b. Septic tank installed level
c. 101 minimum from foundation
d. No 900 bends, cleanout within 10 ft. of 450 bend
e. DISTRIBUTION BOX
1. All outlets at same elevation - water tested
2. Protected below frost
3. Minimum 2 ft. original soil between box and trenches
f.. JUNCTION BOX -,properly set
g. TRENCHES
1.. Len required - 1 A Length installed
.2. Distance to watercourse measured*. ft.
3. Installed according to -plan
4. Distance center to center p
—A-
k:
5. S.12r,�2 of trench acceptable 1/16 - 1/32 " /foot.
i
6. 10 feet from property line - 20 feet - foundations
7. Depth of trench <-30 inches from surface
8. Roan allowed for expansion, 50%
9. Size of gravel 3/4 - 11" diameter
1 10. Depth of gravel in trench 12" minimum
11. Pipe ends
hb PI-W- -OR. -DOSE.- SYSTEMS
1. Size of pump chamber,
2. Overflow tank
3. Alarm, visual audio
4. Pump easily accessible manhole to -grade
5. First box baffled
6. Cycle witnessed by Health Department
estimated flow per cycle
HOUSE
a. House located per approved plans.
b. Number of bedrocins
WELL
a. Well located as per approved plans
b. Distance from SDS area measured ft.
c. Zgs�ing 18" above grade.
d. Surface drainage around well acceptable.
OVERALL WORKMASHIP
a. Boxes properly grouted
b. All pipes partiallybackfilled
c. All pi flush with inside of box
d. Backfill material contains stones < 4" in diameter
e. Curtain drain installed according to plan
f. Curtain drain outfall protected & dir.t6 exist.waterCOUrSE
g. Footing drains discharge away frcm SDS area
h. Surface water protection adequate
i. M'-r—osion control provided on slopes greatex than 15%.
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