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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.06 -2 -63 BOX 20 fV0 oil co . �,` hL 02276 0 a PUTNAM COUNTY DEPARTMENT OF HEALTH p :._- ...,..,,..- ,,,..-,._:,--,,,DIVLSIOl1 - OF.EN_VIRO– NMENTAL..HEALTH— SERVICE .S_-.,__ "._..�.-_.,_...:.: CERTIFICATE OF CONSTRUCTION COMPL: PCHD CONSTRUCTION PERMIT # Located at 4 Ly,4 s � (' d Owner /Applicant Name &r)LJn214Td., Formerly Ztm,i �e 1'P/hens4, � Mailing Address GE TREATMENT SYSTEM 8 -y_q? Town or Village "trm- a.4 V At `�` Tax Map , fo Block 2- Lot Subdivision Name aApunj &WjC Subd. Lot # �- Zip / Qs-!- / Date Construction Permit Issued by PCHD I 0 Separate Sewerage System built by hn of o Z���� Address 4JST"l 120, i 14/�0,W 11 Consisting of 000 Gallon Septic Tank and c�� �C1f ZFi l c>`pp Other Requirements: 70 0 . V-4 U $4 P nk f�� ,1 Water Supply: Public Supply From Address or: t/ Private Supply Drilled by &)Dlrl-,1260 Address j?;)01g,9a-z Sr , -�c% j , * /ky -- BuildingType � l � �� � Has erosion control been-corripleted? - e4 Number of Bedrooms Has garbage grinder been installed? 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 o e PAn�n County Department of Health. Date: v' /3/ 9 �' Certified by Address P.E. l/ R.A. License # 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. a .hi By: 6��S� Title: Date: i9f.'F White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location S eet Address: Town/Village: Tax Grid # Map Block Lot(s) Well Owner: Na : �- Address: Use of Well: 1- primary 2- secondary � Residential Business Industrial Public'Supply Air con eat pump Irrigation Farm Test/monitoring Other(specify) 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 .,:)- 3 ft. Length below grade 2-,"5-ft. Diameter G ` in. Weight per foot lb /ft. Materials: Steel _ Plastic . Other Joints: _ Welded '—Threaded _ Other Seal: Z,, Cement grout _ Bentonite _ Other Drive shoe: --),--Yes No Liner: Yes No 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 Yield T gpm Depth Data Measure from land surface- static (sify ft) 2O During yield test(ft) Depth of completed well in feet .9/-/10 Well Log If more detailed information descriptions or sieve. analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface J/ If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity . Depth Model Voltage HP - Tank Type Volume '. Date Well Co pleted Putnam Countyrtification No. Date of Report '71 Well Driller (signature) NUI'h: hXact location of well with distances to at least two permanept landmarks to be provided on a separate sneet/plan. Well Driller's Name s Address:/�(Y Signature: Date: ZZ / y 14 �� 9 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 l v"Alz NORTHEAST LABORATORY OF DANBURY CT Cert: PH-0404 =L"S 39 -3 MILL PLAIN ROAD - DANBURY, CT 06811 NY Cert: 11471 (203) 748 -7903 - FAX (203) 748 -0652 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: MR. RICHARD ANNUNZIATA 443 AUSTIN ROAD MAHOPAC, N.Y. 10541 DATE SAMPLE COLLECTED: 7 /7/99 TIME COLLECTED: 2:00 P.M. COLLECTED BY: BOB DATE RECEIVED @ LAB: 7/7/99 TESTED BY: LAB# 11471 REPORT DATE: 7 /14/99 SAMPLE SITE: 4, LYONS COURT, PUTNAM VALLEY, N.Y. SAMPLING POINT: KITCHEN, SOURCE: WELL -NEW TREATMENT: NONE TEST PERFORMED RESULT: MAXIMUM CONTAMINANT LEVEL BACTERIAL: Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml PHYSICALS: Color 0 Odor ND _pH_ 6.50. _ no designated limit Turbidity 0.53 NTUs 5 NTUs CHEMISTRY: Nitrite N <0.005 Nitrate N <0.50 Alkalinity 18.0 ...Hardness- , .22:9 Iron 0.049 Manganese 0.016 Sodium , 4.5 Lead <0.001 b� mg/L as N 1 mg/L as N mg/L as N 10 mg/L as N mg/L no designated limits mg/L na designated-limits ............ _ ....._ ...... _ mg/L 0.30 mg/L mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] mg/L, 20 mg/L ** mg/L 0.015 * ** ml = milliliter mg/L = milligrams per Liter * *Notification Level ** *Action Level ND = none detected NTU =Units RESULTS BASED ON SAMPLES SUBMITTED:7 /7/99 SAMPLE, AS TESTED ABOVE: MOTABLE or CINOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) .7 Lin, Std. Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105. OUTSIDE CT: 800 - 654 -1230 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM El� o An htJ n gil� Owner or Purchaser of Building Building Constructed by /_ o Cu Loc ion -'Street ai - 4,�4- Building Type 4/. & 2 63 Tax Map Block Lot Town/Village P442 vl r Subdivision ame 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 ..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: Month Day Year General Contractor (Owner) - Signature Signature: Title: �(-G4}i20 & II ),o 5-1t18(� 12'C 34/Zo i'I17 LM _2/ ? , Corporation Name (if corporation) Corporation Name (if corporation) Address: � SjJ 11-1 12,2,t1Z> State jT fW003C_ Zip 1054 / Address: 4 I n *2. State Zip /cis / Form GS -97 APPENDLK B PUINPM CCUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIROMMU HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SAGE DISPOSAL SYSTEMS - - PERMIT .. r :,. - :R.zVIEW �Si•B;ET: CONSTRLTCiIO '�- -� RE<Th V-LD ,03 y . rL� S DATE -,%2lyl �Oy/Itkr% sr / t, A V, BY: H,A , (Name of Caner) (Street Location) CAS YES -1 NO I I i• I ft 4 I I I R L- tench provided ,So 0 requires 5-00 60 ft. max. SO Parallel to contours 100% exp. I I i i Lo -- I FILL SYSTEMS clavbarrier V, 10 ft. / fill notes new spec. depth gauges Leo' L-00r AIM I 100 yr. flood elev. 200 ft. reservoir, etc. 150 ft. trigall /gall. Al AW DCCUMFNTS Permit Application Corpora to Resolution Plans - Three sets s/s Engineers Authorization _ Design Data Sheet (DDS) SUBDIVISION Deep Hole Log Perc // —/S Consistent Perc Results (3) Fill Perc Hole Depth cd House Plans - Two sets Well pe_r ni t; PWS Variance Request C�'RP1, Legal Subdivision Subdivision Approval Checked Ex-approval SSDS Ad!. Lots Checked Wet-land (Town/DEC Pe---nit R & D) Data On DDS Plans & Permit Same REQUIRED DFTA TT Z ON PLANS . Sewage System Plan - ( nor t-h arrow) Swage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or (��';Trench /Gailery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes (grinder rate) Design Data : -pert and deep resul=s Tw-o -Foot Contours Existing & Proposed Driveway & Slopes Cat Footin /Gatter,Curtain Drains (discharge OK) Perc &Deep Holes Located Representative of primary and ec..,ansion Expansion Area; shown; gravity flow, saff . size If Pmm_:)ed Pit & D Box Shoran & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Proposed System Property Metes & Bounds House Setback Necessary (Tight lot) House Seger - 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 Tre s,Top of fii 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expar. 15' to Drains - certain, Leader, Footing 35'to catch basin,stormdrain,pived watercours 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks ,10' fran Foundation;. 50' to well 15' Well to PL 9 p two�(. years immediately tl,,o Construction C ;t igi thereto; 2i that the;drill6d%well Mad, #1 '9%�a 2! stirs no rtm ni! C 8 �rilM-Heih'h. Coti Date APPROVED FOR CONSTRUCTION: -this a �prova . ),!expires two-y"Fs from th Xiate"isiued unless 'eonstruction 'of the buildir�j has-t)oen undertaken and is �ended or revocati,li foi cause oi:mi�jlia abiriended or modified-whiiin cii�iideiriid ne�essa !�Y, the om.missioner of-,Health. Any Change or alteration of construction Rev. . 395E�M By PU1'im COUNTY DEPARTMENT., OF HEALTH v DIVISION OF - HEALTH SERVICES , DESIGN-DATA SHEET SUBSUFACE_SFWAGE DISPOSAL SYSTEM :.: -- FILE NO. Owner Roaring Brook Countrv.Partners AddresSRR #2, Twin Farm Lane, Pound Ridge, NY ' Located'at (Street) 6ff-Pudding St. Sec. Block ( 17 Lot _�r t� (indicate nearest cross street) v13h1d51o7� Lot 4' Municipality Putnam Valley Watershed SOIL PERCOLATION TEST DATA RDOUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking 10/7/87 Date of Percolation Test 10/7/87 HOLE NUMBER CLrOCK TIME PERCOLATION PERCOLATION Run Elapse No. Time Start -Stop Min. Depth to Water From Ground Surface Start Stop Inches Inches mater Level- In Inches Soil Rate Drop In Min /In Drop, Inches 1 1:20 -1:50 30 .2411 27" 311 10 2 1:52 =2:22 30 24t1 27" 311 10 3 2:25 -2:55 30 2411 27" 311 10 4 5 1 1:22 -1:52 30 2411 26" 21' .15 2 1:53 -2:23 30 24t1 26" _.2" 15� 3 2:26 -2:56 30 2411 26" 211 15 4 11 -15 5 1 2 3 4 5 NOTES: 1.. Tests to be repeated'at same. depth until approximately equal soil rates are obtained at each percolation test-hole. All data to'be submitted for review. 2. Depth measurements.to be made fran top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE. SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH. HOLE N0. 4A HOLE NO. 4B HOLE NO. GeL. _ 1° 0 -8" topsoil 0 -8" topsoil 2' 8 -42" bright brown 8 -42" bright.brown sandy loam 3° 41 42 =65" !'grey brown sand san y oam 42 -72" grey sand Rock 14' ... NA- ' iiVDIC'ATE "LEVEL "AT Tn1HIC;H'GROONDRATER''IS' ENCOUNTERED "-'- ' INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED NA DEEP HOLE OBSERVATIONS MADE BY: Howard Kelly DATE: 9/29/87 DESIGN Soil Rate Used 11415 Min /1" Drop: S.D. Usable Area Provided 60.00 S.F. No. of Bedrooms 4 Septic Tank Capacity 1250 gals. Type Concrete Absorption.Area Provided By 500 L.F. x 24" width tree VESS Q 4V A. ESC �< Other .1.5 315 _ cy fill UName Howard Kelly Signature ' l ` 10 m, Address 37 Fair Street SEAL 3899 s 4( ,. Carmel, NY 10512 �rF OF NEW+ THIS SPACE FOR'USE BY HEALTH DEPAR7MENP ONLY: Soil Rate Approved sq.ft /gal. Checked by Date :aL 4 J, ALL(rrdti x toy_ C / 1011�41�80'/i �L• o• 81�• <.11 Q.O. t 1:3�d18" SC• o. — - O , .x r r SM1\TG►1 FoQ d E2�a iPOTQ. :f x� W'It1 qs[S• O.So R I d t ,_ 914,1 %A4 w.J 4 It-R.I.S ,: pJ p 3 ?i r F'4«�1\�,Y SZ�1 .1 gZt4KfsST v 1( \TCt1En� D. .o; w,lAtA1Jt (J N I '+ eaq..n.•K tt:Yt�i.b� 1 I 1� °r 0 .3. • I r� 1 f � 1 I ; L/'♦ aliApti( Dt 3i 1r am 11•ST. .t ' � w gtSK� L[4S ♦ ♦ I . 1 31t R+IoJt �T. RQ31.i4 W'�W4 +10� t. ©O j+ x: twvty WA V -V- C 'W-41 On IPA u ' FOYER �I.414 • `'_ \ d , ;_ "� ,1. �iq � 211 -4��i -. . Sw1/tt.1 FOR ' E+\T. • ST L14►1T� 1 .� 5 w " �. .t : q 1I Z —•S�o X0044 WI �otagl.c S1psl.lt,r+tt 9•- ' -11 P'UT NAM COUNTY DEPARTMENT OF MnTff = - -- ±, oar 1 * 1 Brook C ov�I j-r �Csi'cii'e s HOUSE PLANS APPROVED POR /ebmme- -�,ey al = " BEDROOM COUNT ONLY; a D oMS sad.107W f y n X .51 t /S6 J'$. Fr. (La LA Fvor' .._ ... , griatY & Title te . s 3 t, •'j,; t ti , .x r :f x� -on t '� tYyYi { too- O 10 t SAraWfs O 10 (�1 10 b+l ulsc Ft S�►Tuti11'f r � � j ! s • 'Accts I. �g L>,T►•I �G° I ►- Lot • S � I -� ir EBB Im i 0 r IL In> ©i • ' Q®.161 M �0 . 1 910 1 O L�1 STS 1 S3A s I W W I j -ry 39 $ vQ Nt �► 2 lam' Z'- ' '�z" 10'• •1N 19'• yi �• O Q. ®. O '• M q'• q" .0. 1. ' -A" ` 1�.1 =.4" 101'•9" (o °•'It" 1 `, • '1 etOvaeed ioUS FANS APPROVED FOR qUAll-,ey sf _ OUNT ONLY for F1C o tlo BEDROOMS �a a. F o C r) f :l F Y- �� 4 T I PUTNAM COUNTY DEPARTMENT OF HEALTH ,w... �. �,.:...... >.., _,�...,.�. >..._.,.... DIVISION OF. ENVIRONMENTAL -IEALTH.,SERUICES... Date Re: Property of Roaring Brook Country Partners Located at off Pudding St. (T) Putnam Valley Section Block ( Lot Subdivision of Roaring Brook Country Estates Subdv. Lot # 4 Filed Map # 23 Date Z7 �3 Gentlemen: This letter is , to authorize Howard A. Kelly a duly licensed professional engineer X or registered architect_ (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with 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 c.onnectijo.n. with -thi matter and. t.o - -s zp`ervi•se..,t ie..constructicizi. af ai,cl_� =_: __'....: system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned: P.E., R.A., # LIJ U � Z J8.,0 Very truly /f yours / C��G4N�C' f Iva" l n j Signed �Y N (-f :rtx /oj C/'fGJI Owner ot Pr erty n Address Howard 21y, P.E. /1R2 IJ4-,y L(Z 7W/" f qWh 37 Fair Street Address Carmel, NY 10512 914 - 225 -7221 Telephone Town Oyn ! .IC I1%t (nr76/ rft) 76Y-J-9-7Z 'telephone 7 DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL �/` l Q PCHD PERMIT # l V IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN .A REALTY SUBDIVISION, NAME.OF SUBDIVISION: Roaring Brook Country Estates Lot No. Lot 4 WATER WELL CONTRACTOR: Name PF Real ,& Sons Address:Brewster, nY IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER.MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ❑ ON REAR OF THIS APPLICATION []ON ,SEPARATE EET / (date) (signature) 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 s.hall: 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 t Putnam County Health Department. �—Z Date o f Issue: 19 � �._ Permit Issuing Official Date of Expiration: 3 -2 19 9 � Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner 2/87 Orange copy: Well Driller Street Address Town/Village./City Tax Grid Number WELL LOCATION off Pudding Street Putnam Valley, NY Lot 4 WELL OWNER Name Mailing Address rdxyZ &,M 6whd 1 y ,LN3Private Roaring Brook Country Partners RR #2 Twin La., 1, NY O Public USE OF WELL CkRESIDEN.TIAL ® PUBLIC SUPPLY 0 AIR /COND /HEAT PUMP O ABANDONED 1 - primary ® BUSINESS O. FARM O TEST /OBSERVATION O OTHER (specify, 2 - secondary ® INDUSTRIAL b INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED 5 /EST. OF DAILY USAGE 800 gal REASON FOR QJEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY (3 TEST/ OBSERVATION DRILLING ❑REPLACE EXISTING SUPPLY ®DEEPEN EXISTING WELL DETAILED New Residence .REASON.FOR DRILLING WELL TYPE DRILLED DRIVEN ®DUG ®GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN .A REALTY SUBDIVISION, NAME.OF SUBDIVISION: Roaring Brook Country Estates Lot No. Lot 4 WATER WELL CONTRACTOR: Name PF Real ,& Sons Address:Brewster, nY IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER.MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ❑ ON REAR OF THIS APPLICATION []ON ,SEPARATE EET / (date) (signature) 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 s.hall: 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 t Putnam County Health Department. �—Z Date o f Issue: 19 � �._ Permit Issuing Official Date of Expiration: 3 -2 19 9 � Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner 2/87 Orange copy: Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE PERMIT # \� ` k-- ° '' Located at 0 S C, ')U Subdivision name Subd. Lot # 4 Date Subdivision App o e� Ce 7 Owner /Applicant Name 1 00 , ;a Mailing Address Amount of Fee Enclosed T T Renewal Revision Date of Previous Approval !!� Lz�6?1— Zip J,0 ¢ Building Type —1- Lot Area /5-& No. of Bedrooms —13 Design Flow GPD 60 0- Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1(700 , gallon septic tank and 3%SFr- n Fr Other Requirements: 7 F-1— i2a L, To be constructed by 0-3, cacv GAL 7-j" K:— Address Water Su 1 : Public Supply From Address ,..._ ors........ - Private Supply Drilled by....._. r._.� Address Gee .._ _. tth 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 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 treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or an y rep 'rs there o. Signed P.E. ✓� R.A. Date � nn / Address Po 133 x �'c� {'� %f-a �� License # 0 S. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new = ved f sc rg f domestic sanitary sewage only. By: Title: ! Date: S !t White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 ` PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENNIRONNIE\TAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SELVAGE TREATINIE \-T SYSTEMS r w =.�REY(EL�'SIdEEi FOR CONSTRC4G a I @N PERSITT - - - STREET LOCATION o.l 7 NAME OF OWNER - vl�t Z i b�'t�► REVIEWED BY' RNi, GR, AS, IB, BH TAX MAP # Y N DOCUMENTS Y N PERMIT APPLICATION PC -1 WELL PERMIT _ P WS LETTER LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) CORPORATE RESOLUTION SHORT EAF 4 PLANS - THREE SETS HOUSE PLANS - TWO SETS VARIANCE REQUEST FflFEE SUBDIVISION LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED PERC RATE FILL REQUIRED DEPTH CURTAIN DRAIN REQUIRED STANDPIPES GENERAL ATED IN NYC WATERSHED VS SUBMITTED TO DEP EGATED TO PCHD APPROVAL, IF REQ'D P TEST HOLES OBSERVED wS TO BE WITNESSED LPPROVAL SSDS ADJ. LOTS tiAiDS (TOWN/DEC PERMIT REQ'D ?) �E 1969 NEIGHBOR NOTIFICATION TER BI/ZBA KR. FLOOD ELEVATION FHER REQ'D PERIMIT(S) REQUIRED DETAILS ON PLANS ROW) 3 L -tY J .TION II.� --z - (0 � OF PRIMARY & EXPANSION SUFF JSE SETBACK NECESSARY (TIGHT LOT) JSE SEWER -1/4" FT. 4 "0; TYPE PIPE BENDS; MAX.BENDS 45° W /CLEANOUT FILL SYSTEMS 3:1 FILL CERTIFICATION NOTE DEPTH GAUGES F1IAxPaOFILE & DIMENSIONS ANSION AREA flLF TRENCH PROVIDED 60 FT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED ON PLAN - FROM SSTS - 10' T- O.P.L., DRIVEWAY, LARGE TREES; TOP.OF FILL - = -- 20' TO FOUNDATION WALLS _15VELL TO PL 100' TO WELL, 200' IN DLOD, 150' PITS 100' TO STREAM WATERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATERLINE (pits -20) 50' INTERMITTENT DRAINAGE COURSE 200' /500' RESERVOIR, ETC. _150' GALLEY SYSTEMS 15'MIN to CDS= >5 %,10'- 4 %,25'- 3 %30'- 2°/N35' -1 %,100' - <1% 20 'MIN to CD discharge /100'with 182 cons day discharge SEPTIC TANK m 10' FROM FOUNDATION; 50' TO WELL WELL DIMENSIONS TO PROPERTY LINE DRESS ® LOCATION OF SERVICE CONNECTION TM"�,PE/RA; NAME,ADDRESS,PHONEr, D OF RAWING/REVISION OCT IOl OF GV-i TERCOURSES, PONDS O ET ROPOSED FINISH FLOOR AND BASEMEN COMMENTS: STEM PLAN- (NORTH AR HYDRAULIC R I VIlY 0 CONSTRUCTION NOI[ES- ERC & DEEP RJS11i 'CONTOURS EXISTING & PRO .00 VEWAY &SLOPES, CUT F---- -. TYPE B0 DA TITLEBCO ERS NAM ROW) 3 L -tY J .TION II.� --z - (0 � OF PRIMARY & EXPANSION SUFF JSE SETBACK NECESSARY (TIGHT LOT) JSE SEWER -1/4" FT. 4 "0; TYPE PIPE BENDS; MAX.BENDS 45° W /CLEANOUT FILL SYSTEMS 3:1 FILL CERTIFICATION NOTE DEPTH GAUGES F1IAxPaOFILE & DIMENSIONS ANSION AREA flLF TRENCH PROVIDED 60 FT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED ON PLAN - FROM SSTS - 10' T- O.P.L., DRIVEWAY, LARGE TREES; TOP.OF FILL - = -- 20' TO FOUNDATION WALLS _15VELL TO PL 100' TO WELL, 200' IN DLOD, 150' PITS 100' TO STREAM WATERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATERLINE (pits -20) 50' INTERMITTENT DRAINAGE COURSE 200' /500' RESERVOIR, ETC. _150' GALLEY SYSTEMS 15'MIN to CDS= >5 %,10'- 4 %,25'- 3 %30'- 2°/N35' -1 %,100' - <1% 20 'MIN to CD discharge /100'with 182 cons day discharge SEPTIC TANK m 10' FROM FOUNDATION; 50' TO WELL WELL DIMENSIONS TO PROPERTY LINE DRESS ® LOCATION OF SERVICE CONNECTION TM"�,PE/RA; NAME,ADDRESS,PHONEr, D OF RAWING/REVISION OCT IOl OF GV-i TERCOURSES, PONDS O ET ROPOSED FINISH FLOOR AND BASEMEN COMMENTS: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ..... .-. .... e- .— :...- - -. -tr1 ..�.�.... ....: - .r• .....vRU.a-.c .. ee .•. » � •_. .� .e -. .. .as —.r.. ....�..n¢ a - �r :.. .. . �+,•.x u -.. -..v .•s �•vr. +.. h•r:.. :.�., . ..e RE: Property of LETTER OF AUTHORIZATION I-I,-Q �J 2 /4T ,4. Located at (fou&dE' TN-R91fim dWeVTax Map # 41. 6o Block Z Lot Subdivision of p2ir�- ,if'K. F�•�'%� -S Subdivision Lot # _ Filed Map # Z36 3 Date Filed I 1,5 Gentlemen:. This letter is to authorize _ _ K y 4 • a duly licensed Professional Engineer C /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: . Countersigned: P.E., R.A., # State Telephone: Very truly yours, Signed: (Owner of Property) - — `- / Ms1n5M i11/! @IINVlUN- Mfn�,M?M;M;M +M;fN'nnI, M M;yl @MYM11.U`M?LV!fONM!M 0 E�1J19. PU I raw�tl• .4 -We' J of `:'The Su For `J U4T.Y HEA9.TH DEPT 19 Road (9]4) 278 6130 Date ayuster, NY.:10509 ,z r v • ® - • - liN`w -x'11 ® ® Yy6J17iiNE1lN3WiVtilill'�E. - . -..,. ,..,.fu111 VIYH'HHSNyl Wl W 1i/112i111:vlltiiy,'!V` Form LA -97 8 Public Health Director -: ,._.� <.._:.: -_._.. LORE' FTA =- 1VIOt; IN. 4it�- •R:N:;. :M:S:N.,:, ;_�_.,:_-_s; Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Mr. Roy Fredrickson, P. PO Box 950 Mahopac, NY 10541 Re: Annunziata #4 Lyons Court TM #: 41.6 -2 -63 Town: Putnam Valley Dear Mr. Fredrickson: August 6, 1999 This office has received and reviewed the most recent set of revised plans for the above mentioned project. We -would like to offer the following comments for your consideration. All comments pursuant to Putnam County Health Department Bulletin ST -19. Plans submitted are illegible and therefore unacceptable. 1. Plan shall make reference, by note, of the survey source. A aiatum reference is•to-be- provided :` 3. House location with proposed finished floor and basement elevations specified. 4. Plan and profile of the SSTS, to include 100 percent reserve area, construction details of absorption system and components including septic tank, distribution of junction boxes, pump pit, dosing siphon, etc. 5. Two -foot contours of the property. If ground is to be cut or filled, both existing and proposed contours must be shown. 6. Location of all existing wells and SSTS within 200 feet of proposed SSTS and wells, or a note stating that none exist within 200 feet. 7. Location and discharge points for gutter, footing, storm and curtain drains. 8. Design criteria on plans to include number of bedrooms, soil percolation rate and deep test hole soil information, and sizes of SSTS components. 9. Construction notes pursuant to Appendix C. 10. Illegible 11. Location map minimum scale of 1" = 2,000') 12. Erosion control measures for house, well and SSTS. Y 13. :":-- -.-The pump -pit design/detail• shall:include, as a.minimum, the follow2ng; Make and model of pump to be used and operational characteristics. One -day's storage past the high -level alarm within the`pump chamber. Check valve. Unions Operating and alarm levels for pump. Means for pump removal for maintenance. Pump curve should be supplied with the engineering report. The pump operating range should be indicated on the pump curve. Pump dose volume to be equal to 75 percent of the volume available in the SSTS pipe network. Minimum velocity of 2 feet per second to be provided in force main. Baffled distribution box is to be utilized for SSTS. Trench detail for force main, specify pipe type and rating, bedding and cover. Note stating, "All electrical work and material for pump installation shall comply with the National Electrical Code. " Note stating, "All pump power and control wiring shall be made directly to the control panel without any outside splices. " Note stating, "The pump control panel, disconnects and alarms shall be located inside the house. 14. Delineation of United States Department of Agriculture Soil Conservation Service soil type boundaries. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS/jp BRUCE . R. FO�;EY Public Health Director LORETTA; L..MOLINARI' R.N:;- M.S.N: >n. Associate Public Health Director Director of Patient Services DEPART MNT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 August 6, 1999 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Mr. Roy Fredrickson i PO Box 950 Mahopac, NY 10541 Re: Annunziata '� �'� `'``' S C-r TM #: 41.6 -2 -63 Town: Putnam Valley Dear Mr. Fredrickson: This office has received and reviewed the most recent set of revised plans for the above mentioned project. We wo(u�l+�d.like to offer thollowmg comments for your consideration. i �°...'°�' 1. Plan shall make reference, by note, of the survey source. 2. A datum reference is to be provided. 3. house location with proposed finished floor and basement elevations specified. 4. Plan and profile of the SSTS, to include 100 percent reserve area, construction details of absorption system and components including septic tank, distribution of junction boxes, . pump pit., dosing siphon, etc. 5. Two -foot contours of the property. If ground is to be cut or filled, both existing and proposed contours must be shown. 6. Location of all existing wells and SSTS within 200 feet of proposed SSTS and wells, or a note stating that none exist within 200 feet. 7. Location and discharge points for gutter, footing, storm and curtain drains. 8. Design criteria on plans to include number of bedrooms, soil percolation rate and deep test hole soil information, and sizes of SSTS components. 9. _Xogible Construction notes pursuant to Appendix C. 11. Location map minimum scale of V = 2,000) 12. Erosion control measures for house, well and SSTS. 13. When-a-ptrmp�t- lraposed -due to- insufaQent-elevation-for gravity -flow or for - dosing ----y purpuses, the pump pit design/detail shall include, as a minimum, the following: - Make and model of pump to be used and operational characteristics. - One -day's storage past the high -level alarm within the pump chamber. - Check valve. - Unions i _ .. _ ,,.Operating and alarm levels for. pump.. Means for pump removal for maintenance. Pump curve should be supplied with the engineering report. The pump operating range should be indicated on the pump curve. Pump dose volume to be equal to 75 percent of the volume available in the SSTS pipe network Minimum velocity of 2 feet per second to be provided in force main. Baffled distribution box is to be utilized for SSTS. Trench detail for force main, specify pipe type and rating, bedding and cover. Note stating, "All electrical work and material for pump installation shall comply with the National Electrical Code. " Note stating, "All pump power and control wiring shall be made directly to the control panel without any outside splices. " Note stating, "The pump control panel, disconnects and alarms shall be located inside the house. 14. Delineation of United States Department of Agriculture Soil Conservation Service soil type boundaries. p ca ion, i requue ppen ix 16 Fee Soo `t`�- rr ° --� This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS/jp Z�� q l `O si- Flo 1 37,s r x 3,14 x �-z)z 7,48 -16- l&3 64L. 17,46/ -� ®� A I \ P r N S,IfliL ( 11 � .z Fl r FN v-' . 500 GALLON PUMP TANK 500 GREASE TRAP 2 TON 7.,5 -K 3,-5- Notes; 1) Reinforced with 6x6x10 guage wire mesh 2) Joints sealed with asphalt cement or equal 3) Concrete strength 3500 PSI. @ 28 days `2J Fr 7� .% r MID HUDSON CONCRETE PRODUCTS, INCORPORATED Route 9 • Cold Spring, New York 10516 914- 265 -3265 BRUCE_ R-. FOLEY_....- _- --- • -.._ -- -- -- . aPublic' Health '-Director - ��� ��. � -•� ~-* W �� -��• yY -� -- - Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services ' (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 ' July 14, 1999 Roy Fredriksen PO Box 950 Mahopac, New York 10541 Re: Lyons Court, Lot 4 TM# 41.6 -2 -63, (T) PV Dear Mr. Fredriksen: This office has conducted a second "final inspection" for the Sanitary Sewer Treatment System on the above referenced lot. I offer the following comments: • Submit revised plan(s) and applications. • Submit house plans. — - - - An additional- inspection-will- be-required prior to-issuance-of a Certificate o:fConstruct dh - -" -'- Compliance. To inspect: • Removal of "switch" on pump control panel at pump chamber. 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, Q. Adam B. Stiebeling Assistant Public Health Engineer ABS:cj BRUCE R. FOLEY LORETTA MOLINARI R.N., M.S.N. Public Health Director - �M 04 Associate Public Health Director Director of Potient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914)278-6130 Fax (914) 278-7921 Nursing Services (914)278-6558 Fax(914)278-6085 July 2 ' 1999 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648® WIC (914) 278 - 6678 Fax (914) 278 - 6085 Roy Fredriksen PO Box 950 Mahopac, New York 10541 Re: Lyons Court, Lot '4 TMT 41.6 -2 -63, (T) Putnam Valley Dear Mr. Fredriksen: This office has conducted a "final site inspection" on Wednesday, June 30, 1999. I offer the following comments for your attention and consideration. 1. Please submit "copy" of approved plan -Mth Putnam County Health Department approval stamp. 2. Submit a set of house plans for the PCHD file. C�! sG, rzuwC 74 lf(� 9 3. Specifications and design criteria for pump required. An additional inspection will be required to witness the following: `1. Connection from house to septic tank; pipe. - 2 ,2/ Cleanliness of "concrete spillage" in/at baffles inside septic tank. Connection of septic tank to pump chamber. O� Installation of pump and related appendices. Pump cycle to be witnessed by PCHD. 6. Re- installation of silt fence in disrepair. This office will continue its review upon consideration of the above mentioned comments. P ease ee free to contact me at ext. 2157 if any questions arise. Very truly yours, &L-t 1. Adam B. Stiebeling Assistant Public Health Engineer ABS:cj BRUCE R. FOLEY Public Health Director_. _ LORETTA MOLINARI R.N., M.S.N. Associate Public„ Health , Director Dir°e6or7 of 13YM&e - Servfees Y ' DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 2781- 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 July 2, 1999 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Roy Fredriksen PO Box 950 Mahopac, New York 10541 Re: Lyons Court, Lot #4 TM# 41.6 -2 -63, (T) Putnam Valley Dear Mr. Fredriksen: This office has conducted a "final site inspection" on Wednesday, June 30, 1999. I offer the folio ng comments for your attention and consideration. Please submit "copy" of approved plan with Putnam County Health Department a roval stamp. 2. Submit a set of house plans for the PCHD file. n Specifications and design criteria for pump required. An a itional inspection will be required to witness the following: C ............ -. ..�. ..... •.. . .r.. -,. "_ .. ..� .. r.. .. G,. �. .�. ".. .. • f s ._a. .. .s *. .�.. C Connection from from house to septic tank; pipe. w 2 leanliness of "concrete spillage" in/at baffles inside septic tank. Connection of septic tank to pump chamber. VRe-installation stallation of pump and related appendices. ump cycle to be witnessed by PCHD. of silt fence in disrepair. r' / 711%�i9 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, &L.t �Aw- Adam B. Stiebeling Assistant Public Health Engineer ABS:cj I acknowledge r - e of this report Sl PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH; SERVICES FINAL SITE INSPECTION Date: Inspected by: Street Lo on _ LY ,Vb.LS t' Torn TM 4- 41. to, Z-6-3 Owner Permit # 7,4— Subdivision Lot # 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 Sy tem a. Septic t c si �eeye�l .....1,250 ... ...... other ................ b. Septic tank inst............ .... ...................... .I........ . c. 10' minimum from foundation ............ .......... .... .......:....... d. istribtuion Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches Junction Box - properly set .... ............................... cF ILength required Lena h 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 % ..........:.............. maize of gravel 3/4 - 1 %" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................:.. Pipe ends capped:::....:.:::::::. :::.:.. : .:..:...:.:::.....:: :.. '...: g. Pump or Dosed Systems 1. Size ot pump chamber ................ ............................... 2.17 Overflow tank ............................. ............................... 3. Alarm, visual/ audio .................... ............................... ii 01II. 4: Pump easily accessible,, manhole to grade ................. 5. First box baffled..............: .................... ............ I. ...... 6. Cycle witnessed by H.D.estimated flow /cycle........... House/Buildin a. House located per approved plans....... b. Number of bedrooms ........................ ........... IV. Well a: Well located as per approved plans.......... b. Distance from STS area measured (00*_ 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.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev- 1/97 G PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date 912197 Re: Property of SUN NLF Limited Partnership. a Delaware limited partnership Located at Lyon Court, Putnam . Valley, N.Y. (T) Putnam Valley. Section 41.6 Block 2 Lot 63 Subdivision of Roaring Brook Cuntry Estates Subdv. Lot # 4 Gentlemen: Filed Map # 2363 A Date 11/18/88. This letter is to authorize Donald Knapp, P.E. a duly licensed professional engineer X or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with,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 the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned: P. E. , �M . , # 072770 2 Dale Avenue 0 { Very truly your , SUN NLF unit _ Par ship, a aware limited pa?'-ners�?i By: _Sz-gnett- tephen E. Renneckar, V.P. Own e r- of- -Pr ogertY- SunChase Land Fund, Inc. Managing General Partner of Stn Partners, General Partner - Ad4i -es s- 6001 North 24th Street, Suite A Phoenix, Arizona. 85016 Address Town Saners, New York 10589 (Q14) 242 -7726 Telephone 602 - 468 -1090 Telephone :.:; °' s:?,.*3'+v-- T.,-'a'».- -* >A•'.+�+rr- .e..s.�v aTs^'a'_.',.- f. ':,.: -r e"'_ -Y -err+ s p 5 7: s..': _ / to POTPiAA�OOIINITD�A>;iMEMOF�ALTH r� 4 `bo P�ovtds Pet�adt . DleYla� d BnRMmetadl Hedl>t Setwlot�. Ceneel. N.Y IOSU � f - •� "MIXTOCATROF CO- N PEW= FOR SBWAGE WROS" SYSTEM r . n Court - : .. yo ' Pu nam Valz Ito Pr "rook cttea.rar 4' Tub 41 6 .? R .63 Countr "y. Estates Renewal AD ..O„K /Apo,mN,�,Sun_.NLF Limited Partnership Dane of PMVkM Ap rGQ A 6001 North 24th Street,Phoenix, AZT.T° Date. Subdivision Approved .11118197 Fee. Enclosed .Type S le Family Re iCe- FmSectlon -V' �7 Depth vohtme NU,Wh i Of Hedbooma 4 Deai�t Flow G P, D ADO PCSD Nomad un in Retla4ed VVhl M Fm b aomiYle1ed Soiiaw siWeirma 11W 0111110151 d T500 G im Sapd Tmh ma .. To be onefteeted by Ad&*= Wafer SmIlift • PgIft .Stlpp�g Ftos Addee•a orl X Pdvae. Sail * Deed by A.la ma OdW Ret#irelmeap 1 np►eserlt,tMt l am wholly and eompNtaly responsible tp the design and location of the proposed system(s); 1) that the %operate sewalN disposal stem above described will be constructed as shown on the approyed smendment there to and in accordance with the standards. rules ano regu wns o • nam county, Oepartmant of MeeKh. and that on completion thereof 0 "Cortificato, of Construction Compliance- ,satisfactory to this Commis a. of Hoailhwill . be submitted to the: Oopart"t. and a written guarantee will 0a furnishal the owner. his .suc9essork heirs or'assiins by the bulkier.1 hat so Ml bulkim will place ill 4iod ipMatinp condition ,ony -part of said sewage tlisposal system during „the period of two (2) yeas immediately following the"to of the issu- •nie' of the approval -of, IM CertlfislN of Construction Conloilance of the oryinel system or,any repels tMi to; 2) that the drilled well described above will be located bas shown on the pprodelt plan and that said well swill be installed in accordance with the standards. rules, and regu ns of the Putnam county oepertm.nt of Heath. 072770 F Date..: .� 7 A 7 SiYneo .. - _ P.E. APPROVED FOR CONSTRUCT ON•This.approvaI akpirest o Years from the date issued unNss�Onstru '11 n the OuiWirlg has tleori undertaken and is revocable for cause or may be amended or modified when considered necessary_ by the. Co missioner of Has Any change or operation of construction "requi►is a new mit. AOproved for disposal of domestic sanitary ' r p ly only. I.V. Date �C/� �/ % Title V88 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York-10509 (914) 278 -6130 APPLICATION TO'_CONSTROCT _ A _ WATER WELL PCHD PERMIT # 4. WELL LOCATION Street Address Town/Village/City Putnam Valle Tax Grid Number 41.6 -2 -63 WELL OWNER Name Mailing Address gPrivate O Public USE OF WELL 1 - primary 2 - secondary ® RESIDENTIAL ® PUBLIC SUPPLY ® BUSINESS O FARM ® INDUSTRIAL O INSTITUTIONAL O AIR /COND /HEAT PUMP D ABANDONED O TEST /OBSERVATION O OTHER (specify O STAND -BY AMOUNT OF USE YIELD SOUGHT 10 gpm /# PEOPLE SERVED_ /EST. ® REPLACE EXISTING SUPPLY O TEST /OBSERVATION V NEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL OF DAILY USAGE 800 gal M ADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR DRILLING . aw -asi diance pub] J c water supply not available - f WELL TYPE DRILLED ®DRIVEN ®DUG OGRAVEL ®OTHER IS WELL SITE SUBJECT TO FLOODING? YES x NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Roaring Brook Country RAtatPA Lot No. 4 WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES x NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE, .TO. .PROPERTY_;FROM.._NEAREST - WATER MAIN:, .N -A.... _ .. _.,.._. �.:.....,..._,.._r_.....: __..,.___ _... .h:.... LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED NA []ON SEPARATE SHEET (date) G 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 thirt, (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. During all well drilling operations, the applicant shall take appropriate action to assure that 1:any and all water or waste products from such well drilling operations be contained on this ;property and in such.a manner as not to degrade or otherwise minate face groundwater. , _coat of Issue: 2 Z 19 Date of Expiration °ermit is Non - Transferrable 1/89 19 0Y Permit Issuing Official White copy: HD File Pink copy: Owner Yellow copy: Bldg. Insp. Orange copy: Well Driller !] PC -1 PUT NAM COUNTY D E PART M E NT . O F H EA LT H APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: Sun Nlf Limited Partnership Phoenix, Az 85016 2. Name of Project, Roaring Rr��L n�»n�r., �R�_.�.es3. Location T /V�' : Putnam Valley 4. Project Engineer: a onald Knapp 5. Address: 2 nai P Au, -nm- Somers, N.Y. 10589 License Number: 702770 Phone: (914) 48 -7726 6. Type of Project: x Private /Residential Food Service Apartments Institutional Office Building Realty Subdivision Commercial Mobile Home Park Other (specify) , 7. Is this project subject to State Environmental Quality Review (SEAR)? Type Status (Check One) Type I.. Exempt x Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? eo 9. Has DEIS been completed and found acceptable by Lead Agency? NA 10. Name of Lead Agency NA - 11.- Is- thi-s•-project- -'fn' an area- under--the control of local planning, - zoning; yes - or other officials, ordinances? .......... ............................... 12. If so, have plans been submitted to such authorities? .................. No 13. Has preliminary approval been granted by such authorities? Date Granted:_ 14. Type of Sewage Disposal System Discharge...... Surface Water x Ground Waters 15. If surface water discharge, what is the stream class designation ?........ 16. Waters index number (surface) ........... ............................... 17. Is project located near a public water supply system? .................. No 18. If yes, name of water supply Distance to water supply 19. Is project site near a public sewage collection or disposal system ?..... No 20. Name of sewage system Distance to sewage system 21. Date test holes observed: 111 lb. 88 22, Name of Health Inspector: NA 23. Project design flow (gallons per day) .............................. ....... ann 11/93 06 2. 24. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. N o 25. Has SPDES Application:been.submitted to local DEC Office? NA 26. Is any portion of this project located within a designated Town or State` No wetland ?............ ......... ...................... ................. 27. Wetland ID Number ......................... .............................., 28. Is Wetland Permit required? .............. ............................... Has application been made to Town or Local DEC Office? .................. No No 29. Does project require a DEC Stream Disturbance Permit? No 310. Is or was project site used for agricultural activity involving application of pesticides to or or other crops, solid or hazardous waste disposal, No landfilling, sludge application or industrial activity? ........ YES or NO 31. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or No any other potential known source of contamination? ..............YES or NO DESCRIBE: 32. Is there a local master plan or file with the Town or Village? No 33. Are community water, sewer facilities planned to be developed within 15 years? No 34. Are any sewage disposal- areas-in excess of 15% slope? ..... .. .. No _- 35. Tax Map ID Number ......................................................... 41.6-2-63 36. Approved Plans are to be returned to: Applicant x Engineer If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. 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. � / 6 SIGNATURES & OFFICIAL TITLES: Dona Knapp, P . E . 6 MAILING ADDRESS: �Lq S 0 1 r . } l r Yqi` 046 4 ' d J S • f gFFLw TY R, NP ON °1� d t f'1� / 0L s i �Lq S 0 1 S_ AYOOT }� .-- 76 1766 a�i E�hD eo Q�,rc a � 11v .�! 1�� -� •�� 1 1� _1�s�• _ ��t �� 144 4a A. a + is