Loading...
HomeMy WebLinkAbout2278DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.06 -2 -65 BOX 20 02278 - III I titi I r Tr rN Z� 6 `'. I'LL 1 ` 02278 O \� PUTNAM COUNTY DEPARTMENT OF HEALTH .: N_ -OF: E:NVIRO:NI MENTAL HEALTH -SERVICES-: _-_::..,: ..... CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # PV -9 -9' ZM4j" Located a f �2i � � •'�Y�'inil�- �� ��3 /c ��: Town or i/' Z Owner /Applicant Name 6L.4vf.) : MM 4� Tax Map H Block Lot -� Formerly f� �� .Subdivision Name � y r1471-" Subd. Lot # 0 Mailing Address 77 .1 cm IA14RY Tr ArfW 6A/1.44i1 G r,' Zip /0 Date Construction Permit Issued by PCHD Separate Sewerage System built by WAZE -PS Address Consisting of % A 'Q Gallon Septic Tank and S_7Y AF ,FIc °•C tar Other Requirements: Qi %i✓ Water Sunnly: Public Supply From or: X _ Private Supply Drilled by Address Address Buildiirg'Typet� c "f =�d✓v� G >�. " Has erosion control been completed?— Number of Bedrooms Has garbage grinder been installed? A10 I-dertify 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 t he utn County Department of Health. Date: i�`�- Certified by P.E. X' R.A. (Design Profess' nal) Address I g SC"Cor Rio t »rE iv )l /c � ` License # Q 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 revocatl' /�n�,�rnodification or change is necessary. B 6 � / 9 Title: Date: Y• White copy - HD FL; YU 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 O Y76 Well Location - Street Address: Tax.Grid # Map Block Lot(s) Well Owner: Name:' Address: Use of Well: 1- primary 2- secondary >e- ResidentO Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing ;K Open hole in bedrock Other Casing Details Total length / ft. Length below grade fy' " t. Diameter in. Weight per foot 1_lb /ft. Materials: eK Steel _ Plastic _ Other Joints: _ Welded _2!!� Threaded -Other Seal: 2 Cement grout _ Bentonite Other Drive shoe: X Yes _No Liner _ Yes -,4 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 b- gpm Depth Data Measure from land surface - static (specify ft) During yield test(ft) Depth of corn leted well in feet 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 or If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Typee gt lR-, 'xvyCapacity Depth '300 Model Voltage —W HP ! - Tank Type 5K Volume IM Date Well Compl ted j Putnam County Certification No. 117-11-'!�A Date of Report Well Driller (signature) n V iz: raeact location of well with aismnces to at least two permanept lanamarxs to be provtctea on a separate sneevplan. 1 Well Driller's Name j9lte4,, A' J&AC- Addres - . l Signature: Date: I y + � 0�7 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 ~ YML EN�I ICES ��� near����re���'' Yorktown (914) 245-2B0O Albert H. Padovani, Director LAB #: 32.200196 CLIENT #: 55055 NON STAT FR8C PAGE 1 MACQUIGNQN/NUTMEG HOME DATE/TIME TAKEN: 01/10/02 04:00P 97 SEMINARY ST DATE/TIME REC'D: 01/10/02 04:15P NEW CANAAN, CT 06840 REPORT DATE: 01/17/02 PHONE: (845)-528-0297 SAMPLING SITE: 21 ROARING BROOK RD SAMPLE tYPE..: POTABLE : KIT TAP PRESERVATIVES: NONE CQL'D BY: C. MACQUlGNON TEMPERATURE..: < 4C NOTES... � ^^� COLIFORM METH: MF 'ATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 01/10/02 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 01110102 LEAD (IMS) 1.6 ppb 0-15 ppb 9101 01/10/02 NITRATE NITRQG 8.25 MG/L 0 - 10 9139 01/10/02 NITRITE NITROG <0.01 MG/L N/A 9146 01/10/0p IRON (Fe) <0.060 MG/L 0-0.3 mg/1 2037 01/10/02 MANGANESE (Mn) _ 0.017 MG/L 0-0.3 mg/l 2037 01110102 SODIUM (Na) 3.67 MG/L N/A ' 01/10/02 pH 7.1 UNITS 6.5-8.5 9043 01/10/02 HARDNESS,T8TAL 90.0 MG/L N/A 01/10/02 ALKALINITY (AS 78.0 MG/L N/A . _01/10/02_ ,URBIDITY__�TUVR-_.�_- (1����TL['''',��-� _0-n5-RrU�'---��-'-`- _- ----- COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCQRDlN E NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. _ Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. ublic schools are set at 15 ppb. Rule for public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mm If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium is suggested. YML ENVIRONMENTAL SERVICES 321 Kear Street Heights. _._'__��~���~����~�^-��_ Albert H. Padovami, Director LAB #: 32.200196 CLIENT #: 55055 NON STAT PR8C PAGE 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ MACQUIGNON/NUTMEG HOME , DATE/TIME TAKEN: 01/10/02 04:00P 97 SEMINARY ST DATE/TIME REC'D: 01/10/02 04:15P NEW CANAAN, CT 0684O REPORT DATE: 01/17/02 PHONE: (845)-528-0297 SAMPLING SITE: 21 ROARING BROOK RD : KIT TAP COLQ BY: C. MACQUIGNON NOTES...: DATE FLAG PROCEDURE SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE..: < 4C C8LIFQRM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ RESULT NORMAL - RANGE METHOD PH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 T8 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L -� j MODKRATELYj HARP IWATE8y 70t14() MG/L- ' . -MG�L~�[LL-IGRAM�PER'LJTE� H*xu WATER: 140-300 MG/L (I grain/gallon = 17.2 MG/L) / SUBMITTED BY:* Albert H. Padovani, M.T.(ASCf?v, Director ELAPO 10323 YML EN��RONMEN�AL SERVICES �c�^ xear ��ree� (914) 245-2800 Albert H. Padovani, Director LAB #: 32.200196 CLIENT #: 55055 NON STAT PRDC PAGE 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ MACQUIGNON/NUTMEG HOME 97 SEMINARY ST NEW CANAAN, CT 06840 DATE/TIME TAKEN: 01/10/0X2 04:001'' DATE/TIME REC'D: 01/10/02 04:15P REPORT DATE: 01/17/02 PHONE: (845)-528-0297 SAMPLING SITE: 21 ROARING BROOK RD SAMPLE TYPE..: POTABLE : KIT TAP PRESERVATIVES: NONE COL'D BY: C. MACQUIGNON TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE RESULT NORMAL - RANGE PUTNAM CNTY PROFILE 01/10/02 MF T. COLIFQRM ABSENT /100 ML ABSENT 01/10/02 LEAD (IMS) 1.6 ppb 0-15 ppb 01/10/02 NITRATE NITROG 0.25 MG/L 0 - 10 01/10/02 NITRITE NITROG <0.01 MG/L N/A 01/10/02 IRON (Fe) <0,060 MG/L 0-0.3,mg/} 01/10/02 � MANGANESE (MM O.017 MG/L 0-0.3 mg/1 01/10/02 SODIUM (Na) 3.67 MG/L N/A 01/10/02 pH 7.1 UNITS 6.5-8.5 01/10/02 HARDNESS, TOTAL 90.0 MG/L N/A 01/10/02 ALKALINITY (AS 78.0 MG/L N/A TURBIDITY-(TUR ' - �-<� NTU � �' ' 0-5 NTU _`.. ~ ``- ^ COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATER WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDING-��7�HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. - Pb/Cu LEAD limits for p EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. tblic schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium is suggested. METHOD 1008 910{ 9139 9146 2037 2037 904-3 YML ENVIRONMENTAL SERVICES 321 Kear Street (914) 245-2800 Albert H. Padovani, Director LAB 0: 32.200196 CLIENT #g 55055 NON STAT PROC PAGE 2 MACQUIGNON/NUTMEG HOME DATE/TIME TAKEN: 01/10/02 04:00P 97 SEMINARY ST DATE/TIME REC'D: 01/10/02 04:151:-' NEW CANAAN, CT 06840 REPORT DATE: 01/17/02 PHONE: (845)-528-0297 SAMPLING SITE: 21 ROARING BROOK RD : KIT TAP COi-'D BY: C. MAC8UIGMON NOTES...: ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ SAMPLE TYPE..: POTABLE PRESERVATIVES: NONE TEMPERATURE-3 < 4C COLlFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. SOFT WATER: 0-70 MG/L VERY HARD WATER: ABOVE 300 MG/L '--�'--.--lMQDERAJlz.LY- HARD- WATER4 70-1/+0 'MG,/L^ !- ' �=/L­ -AALARAM, f,6R |=ITER HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) SUBMITTED BY:' Albert H. Padavani, M.T.(ASCPTA, Director ELAP# 10323 From: Chris Caralyus 845 - 628 -1905 To: Theresa Nemett tii V�r/4+�.U4iA�►� �lA.'V4Lile���i ilC+r 78 Secor Road, Suite 5 Mahopac N.Y. 10.541 Phone: (845) 621 -4756 Fax: (845) 628 -1905 To: Theresa Nemett Company: Putnam County Health Department Date: 21112002 Time: 8:02:36 AM Page 1 of 1 F TRANSMgI'i'AL :.:,.::., ,;. Fax Number: 278 -7921 Date: 2/l/2002 From: Chris Caralyus Fax Number: 845- 628 -1905 Company: Beyer & Associates Consulting Engineers Pages including cover page: 1 Subject: Roaring Brook Estates, Lot 1, Tm41.6 -2 -65 Comments: Theresa, Mr. Macquignon has paid his fee to us for his construction compliance permit, so you may release his permit to him directly whenever it is ready. If you have any questions or require further information please give me a call. Chris Caralyus Project Manager WinFax PRO Cover Page - -- ^ ^^ ^.'+^'� • t Il1Mr . r11 ITl Il1M !^I"H IL ITV AC'C/'1OTMCAIT flC O 7 DIVISION OF ENVIRONMENTAL A GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM �7 � ;4MC t 0 L,11 /VaN Owner or Purchaser of Building Building Constructed by L22 : W6_ Ate. }J;� Location - Street - Woo n 02,_,22L ,E o,136 Building Type V11 L Tax Map Block Lot y,4L C.'. chi` TownNillage Subdivision Name Subdivision Lot # I represent that I am wholly.and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or.assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly-is caused by_the.willful or.negligent.act of the occupant of the.bui.lding 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 fail re. of the system to operate was caused by the willful or negligent act of the occupant of the,bu ding utilizing the Corporation Name (if corporation) Si Title: Corporation Name (if corporation) Address: 3 / kr) =fi' i k= C4, kr&0 0 l C- Z %i(1 '� Address: State `�' Zip State Zip Form GS -97 r BRUCE'' R . EOLEY r.:.. .. ... ._ �.. , Public Health Director L- ORETTA MOLINARI R:N -,— M. S:N: Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH - 1 Geneva Road Brewster, New York 10509 Environmental Health (914).278 -.6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 ADDAREESS WRIFICATION EORM OWNERS NANIE: TAX NIAP NUMBER: E911 ADDRESS: TOWN: AUTHORIZED TOWN OF (Signature) DATE: CJ1 6 �-49iJ,CL. ,40D& The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERFRM) J January 24, 2002 Mr. Robert Morris Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: MacQuigrion Roaring Brook Road, Putnam Valley Tax Map 41.6 Block 2 Lot 65 Dear Mr Morris, Please find the enclosed materials for the As Built submittal for the above referenced property. This submission includes the following items: 1. Certificate of Construction Compliance 2. Three copies of Guarantee of Subsurface Sewage Treatment System 3. Well Completion Report 4. Water Analysis Report 5. Three (3) sets of As -Built Plans 6 Application fee of $200 7. E911 Address Verification Form I trust the above materials are adequate for your approval and completely satisfy your previous comments for the above project. However if you have any questions concerning this project, please do not hesitate to call me @ 621- 4756. Very trul ors, . YY j -Ti Chris Caralyus Project Manager PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONI MIN TAL HEALTH SERVICES FINAL SITE MPECTION Date: �s pec. c Z te kA wners _ AcC.l cat n O Ton .. Permit TM r Subdivision Lot #v 1. SeivaQ_e Svstetn Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lath. 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. Se«aQe System a. eptic tan_< size - 1,000 .......1,250. .t.©ther ................ b. Septic tank installed level ............... :................................ c. 10' minimum from foundation ........... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... ............................... f es � 1. -Le n� re q uired 51 Length 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%" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... - - -1 .: Pipe ends capped ........................ ............................... g. PumD or Dosed Svstems ize ot pump chamber ................ ............................... 2. Overflow tank ................ ............................ I............... 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ........................................ ;................ 6. Cycle witnessed by H.D.estimated flow /cycle........... 111-House/Building a. House located per approved plans ... ................................. 4 b, Number of bedrooms ....................... ............................... IN Nell dell located as per approved plans............. b. Distance from STS area measured 1 ft........... —00 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 watercour g. Footing drains discharge away from STS area ............:. t h. Surface water protection adequate.. . .. ............................. i. Erosion control provided ................................................. D e.. 4 M7 FILE No . 526 12/13 '01 0147 I D : BEYER &ASSOCIATES FAX : 8456281905 PAGE 1 PUTNAM COUN'T'Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION "AM 13 GENE For: Fill Alt information must be fully completed prior to any Trenches inspections being made. PCHD Construction Permit # Located: RoAkW(, g )i�e (V) , LUZyi; 'LL.0 Owner /Applicant Name: L t dU k TM' h & Bloch 2 Lot Formerly: Subdivision Dame: /Cr wu nJb_l &cr e!5nai G5 SubdivWon Lot # Is system fill completed ? Date: Is system complete ? Date: Is system constructed as per playas? d�5, Is well drilled? Date: Is well located as per plans? Are erosion control measures in place? Lt 15 I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans and .the ..- Standards, Rules and Regulations of the Putnam County Department of Date: t2 /4 to 1 Certi:led by: �----� PE " RA Design ]Professional Address: Lic. # Comments: Form Flit -99 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at I?Jr (f / m k rJomr, Town or Village Pv zlAM JALLEY R A N C, SPOOK Subdivision name cpLWrRyg r4 -rrS Subd. Lot # / Tax Map y/" Block �_ Lot 6S- Date Subdivision Approved I l /i S Y Renewal �/ Revision Owner /Applicant Name �C' L,�l/,p� M&QulLy 0& Date of Previous Approval Mailing Address 9'7 .SCA4y&jtr f'7" /VCW C4AZAi9V 67' Zip QMY0 Amount of Fee Enclosed 1-3.3o Building Type � Sl Lot Area a, 3A�. No. of Bedrooms 4 Design Flow GPDFnj) Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of /d-Q gallon septic tank and T-7 V L F Other Requirements: CU2?4,4Ai 4ezd iw /�.� OF /9A✓k ✓141i✓ FIZ- z To be constructed by CL,A,,,oE MAQui i) A/ Address Water Supply: Public Supply From Address or: _ Private Supply Drilled by ./A/ %'ULL Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatments stem 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 any repairs thereto. Signed: Address R.A. Date License # 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 t. App ed f d' ch a of domestic sanitary only. By Title: 1 Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Pro essi nal Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH . DIVISION OF ENVIRONMENTAL HEALTH SERVICES a APPLICATIONFOR APPROVAL OF PLANS FOR -;.. ;. :....:. .........._..:.:.:....::. A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: LC14UQr_ Al y�r_ v 2. Name of project: 3. Location TN: L'vT/am Vf&Lct' 4. Design Professional: i}Cc6L ,A/yo 5. Address: 36(_0 t2() , Su ITC 6. Drainage Basin: &/j2 �4/ L4Q P 7. Tvpe of Project: N2 _ Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status check one .... Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required ?� .................. 2— 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency 12. Is this..pr..oject_in- an.area under the control of local planning, zoning, or other_. _ ..- officials; ordinances?..._. .. ............................. ................... ............................... 13. If so, have plans been submitted to such authorities? ........ ............................... t�E� 14. Has preliminary approval been granted by such authorities? Date eanted: 15. Type of Sewage Treatment System Discharge ................. surface water X groundwater 16. If surface water discharge, what is the stream class designation? .................... �/1_ 17. Waters index number (surface) .......... ................... .................. ............. 18. Is project located near a public water supply system? ....... ............................... A f 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ A/0_ 21. Name of sewage system Distance to sewage system 22. Date test holes observed 23. Name of Health Inspector 24. Project design flow (gallons per day) ................................. ............................... ROD _ 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 1A/ Q 26. Has SPDES Application been submitted to local DEC office? ......................... 27. Is any portion of this project located within a designated Town or State wetland? . AA0 28. Wetlands ID Number ........................................................... ............................... 29. Is Wetlands Permit required? ........................:.................... ............................... A/0 Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? .. . ............................... A/ 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 //V.0 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? ...................... IV . ......... Yes/No DESCRIBE: �- - 33. Is there a local master plan on file with the Town 'or Village? ......................... S :: 34. Are community water and/or sewer facilities planned to be developed withiny 15. years in or adjacent to project site? .......... :.................................................... 35. Are any sewage treatment areas in excess of 15% slope? A- 36;- ' Tax Map ID Number ............................. ............................ Map Block Lot 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"tlie NYC Watershed-shall= be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the. application must be accompanied by a Letter of Authorization (Form LA -97). Failurelto 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 210145 of the Penal Law. SIGNATURES & OFFICIAL TITLES. Mailing Address: ............. 1- , Yo PA Al /0 -�`>�/ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIROMENTAL HEALTH SERVICES DESIGN DATA SHEET — SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Claued MacQuignon Address 97 Seminary St., New Canaan, CT. 06840 Located at (Street) Roaring Brook Drive Tax Map 41.6 Block 2 Lot 65 (indicate nearest cross street) Municipality Putnam Valley Drainage Basin Hudson River SOIL PERCOLATION TEST DATA Date of Pre - soaking 9/18/01 Date of Percolation Test 9/19/01 Hole No. Run No. Time Start — Sto Elapse Time (Min.) Depth to Water From Ground Surface (inches) Start Stop Water Level Drop in Inches Percolation Rate Min/Inch P -1 1 2:15 -2:35 20 21 24 3 6.7 2 2:36 -3:01 25 21 24 3 8.33 3 3:02 -3:32 30 21 24 3 10 4 3:33 -4:03 30 21 24 3 10 5 V -2 1 2:22 — 2:52 30 20 21.75 1.75 17 2' 2:54— 3:24 30 19 20.5 1.5 20 3 3:28 — 3:58 30 19 20.5 1.5 20 4 5 1 2 3 4 5 NOTS: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. ( i.e. 5 1 min for 1 -30 minhnch, <_ 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. 1 G.L. TRACE TOPSOIL LIGHT BROWN SILTY SANDY 0.5 LOAM, BOULDERS AND COBBLES 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' BEDROC Q 6.0' 6.5. NO GWT 7.0' 7.5' 8.0' 8.5' 9.5' 10.0' HOLE NO. 2 HOLE NO. 3 TRACE TOPSOIL TRACE TOPSOIL LIGHT BROWN SILTY SANDY LOAM, BOULDERS AND COBBLES LIGHT BROWN SILTY SANDY LOAM, BOULDERS AND COBBLES BEDROCK ® 5.5'. NO GWT Indicate level at which groundwater is encountered N/A Indicate level at which mottling is observed N/A Indicate level to which water level rises after being encountered N /A' Deep hole observations made by: Rob Roselli - BA Date 9/19/01 Design Professional Name: Beyer and Associates Address: 78 Secor Road, Bryant Pond Plaza, Suite 5. Signatu. Design Professional's Seal TEST PIT DATA EV All PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIROMENTAL HEALTH SERVICES 17ESIGN' DATA SHEET`- 'SUBSURFACE SEWAGE TREATMENT-SYSTEM Owner Claued MacQuignon Address 97 Seminary St., New Canaan, CT. 06840 Located at (Street) Roaring Brook Drive Tax Map 41.6 Block . 2 Lot 65 (indicate nearest cross street) Municipality Putnam Valley Drainage Basin Hudson River Date of Pre - soaking 9/18/01 SOIL PERCOLATION TEST DATA Date of Percolation Test 9/19/01 Hole No. Run No. Time Start— Stop Elapse Time gin.) Depth to Water From Ground Surface (inches) Start Stop Water Level Drop in Inches Percolation Rate Min/Inch P -1 1 2:15 -2:35 20 21. 24 3 6.7 2 2:36 -3:01 25 21 24 3 8.33 3 3:02 -3:32 30 21 24 3 10 4 3:33 -4:03 30 21 24 3 10 5 P -2 1 2:22 - 2:52 30 20 21.75 1.75 17 2 2:54— 3:24 30 19 20.5 1.5 20 3 3:28 — 3:58 30 19 20.5 1.5 20 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. ( i.e. _< 1 min for 1 -30 min/inch, <_ 2 min for 31 -60 min/inch ) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. 1 G.L. TRACE TOPSOIL 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0'. 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' LIGHT BROWN SILTY SANDY LOAM, BOULDERS AND COBBLES HOLE NO. 2 TRACE TOPSOIL LIGHT BROWN SILTY SANDY LOAM, BOULDERS AND COBBLES HOLE NO.-3— TRACE TOPSOIL LIGHT BROWN SILTY SANDY LOAM, BOULDERS AND COBBLES NO GWT NO GWT Indicate level at which groundwater is encountered N/A Indicate level at which mottling is observed N/A BEDROCK @ 5.5'. NO GWT Indicate level. to which water level rises after being encountered NIA 9 Deep hole observations made by: Rob Roselli - BA Date 9/19/01 Design Professional Name: Beyer and Associates Address: 78 Secor Road, Bryant Pond Plaza, Suite 5. Signatu Design Professional's Seal TEST PIT DATA k'1`a.. r , �u r C"a Indicate level. to which water level rises after being encountered NIA 9 Deep hole observations made by: Rob Roselli - BA Date 9/19/01 Design Professional Name: Beyer and Associates Address: 78 Secor Road, Bryant Pond Plaza, Suite 5. Signatu Design Professional's Seal TEST PIT DATA k'1`a.. r , �u r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIROMENTAL HEALTH. SERVICES &"SURFACE-SEWAGE,TREA T M EN T SYSTEM , Owner Claude Macquignon Address 97 Seminary St., New Canaan, CT. 06840 Located at (Street) Roaring Brook Drive Tax Map 74.16 Block 1 Lot 6 (indicate nearest cross street) Municipality Kent Drainage Basin Hudson River SOIL PERCOLATION TEST DATA Date of Pre - soaking 9/18/01 Date of Percolation Test 9/19/01 ( i.e. <_ 1 min for 1 -30 min/inch, 5 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 .ole. DEEP TESTS ONLY Depth to Water Water From Ground Level Percolation Run No. Time Elapse Time Surface (inches) Drop in Rate Hole No. Start — Stop (min •) Start Stop Inches Min/Inch ( i.e. <_ 1 min for 1 -30 min/inch, 5 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 .ole. DEEP TESTS ONLY 1 2 3 4 A.. 1 2 3 4 5 1 2 3 4 - 5 .. ' NOTES: 1. Tests to be reneated at same denth until annroximatelv eaual percolation rates are obtained at each nercolstinn test l ( i.e. <_ 1 min for 1 -30 min/inch, 5 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 .ole. 'DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 10.0' DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES " ` HOLE NO. 4 TRACE TOPSOIL LIGHT BROWN SILTY SANDY LOAM, BOULDERS AND COBBLES HOLENO. 5 HOLE NO. TRACE TOPSOIL LIGHT BROWN SILTY SANDY LOAM, BOULDERS AND COBBLES BEDROCK @ 6.5' NO GWT NO GWT Indicate level at which groundwater is encountered N/A Indicate level at which mottling is observed N/A Indicate level to which water level rises after being encountered N /A' Deep hole observations made by: Rob Roselli — BA Date .9/19/01 Design Professional Name: Beyer and Associates Address: 78 Secor Road, Bryant Pond Plaza, Suite S Signatu Design Professional's Seal R � s 1 ,yy� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIROMENTAL HEALTH SERVICES DESIGN'DATA SHEET `SUBSURFACE SEWAGE TREATMENT SYSTEM _rt .. � .. , - Owner Claude Macquignon Address 97 Seminary St., New Canaan, CT. 06840 Located at (Street) Roaring Brook Drive Tax Map 74.16 Block 1 Lot 6 (indicate nearest cross street) Municipality Kent Drainage Basin Hudson River Date of Pre - soaking 9/18/01 SOIL PERCOLATION TEST DATA Date of Percolation Test 9/19/01 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. min for 1 -30 min/inch, <_ 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 DEEP TESTS ONLY Depth to Water Water From Ground Level Percolation Time Ela se Time (Min•) Surface (inches) Drop in Rate Hole No. Run No. Start — Stop Start Stop Inches Min/Inch NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. min for 1 -30 min/inch, <_ 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 DEEP TESTS ONLY 1 2 3 4 1 " 2 3 4 5 1 - 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. min for 1 -30 min/inch, <_ 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES _.4,, G.L. TRACE TOPSOIL TRACE TOPSOIL LIGHT BROWN SILTY SANDY LIGHT BROWN SILTY SANDY 0.5 LOAM, BOULDERS AND LOAM, BOULDERS AND COBBLES COBBLES 1.0' 1:5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 10.0' BEDROCK ® 6.5' NO GWT NO GWT Indicate level at which groundwater is encountered NIA Indicate level at which mottling is observed N%A Indicate level to which water level rises after being encountered N /A' Deep hole observations made by: Rob Roselli — BA Date .9/19/01 Design Professional Name: Beyer and Associates Address: 78 Secor Road, Bryant fond Plaza, Suite 5 Signatu Design Professional's Seal 5� 4, t � ID" < 5. I& NGr 14.16 -4 f9AS1 —Tat 12 PROJECT I.D. NUMBER. $17.20 SEER - - Appendix State Environmental Ouallty Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME r7a ^e,cn tl._iJ1 /l r: i1_ A .-.. /' ! n,...- nn n. .f1.. i _ ,.... / r.�•r r 3. PROJECT LOCATION: Munlclpallty 1 IV ✓ P County (%r 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) fir!0 0 41zook tv/&,- CAUL fey{ . S. IS PROPOSED ACTION. LUNew U Espsnslon U ModIlI0a110n/allerallon 6. DESCRIBE PROJECT BRIEFLY: t 0,V PT PL/C &/) '7° /5CP✓Z00M /.Ag JS esi 7.- AMOUNT OF LAND AFFECTED: Initially acres >''.011ma1Ny acres A. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTF- IONS? MYea Q No It No, describe briefly B. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT) " V, Residential ❑ Industrial D Commercial ❑ Agriculture ❑ ParWorpl/Open -apace .. D Other. eNrrfZl Sv17..90L11V 11VG ��' � is S�r�/(z ,_ r�� ,yv✓ 6 10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING.- NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL. STATEEOR LOCAL)? M Yee D No .. If yea, list ageney(s) and pennlUsppro"Is j 11. I��w1D COES ANY ASPET.OF THE ACTION NAVE -A C11p111F&M WMAI rn- M:ouw- i►n_.n........ - -- - -- m Yea Pie v. 12. }AS A RESULT C 6J Yee t Applkanusponsw . � Slgnuure: i; PUTNAM COUNTY HEALTH DEPT. 022449 1. Geneva Road. (845) 278-6130 / l3rewaier „NY.10508 Date �' / 6 % Received of 0 Dollars $ The Sum Of J_ � For �4, y THANK YOU! r . *rcals.h. N Check El M.O. ❑ Credit Card By OVER I .\ PART It— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A DOES A-.110n EXCEED ANY TYPE I THRESMOLD IN 6 NYCRR. PAR1 617 i7 If yes, Coordinate trig revjew process anC use Ind FULL EAF Yes n NO L. 'WILL REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRp. PART 617.6' 11 No a negal.ve oeclaWto- ma, Oe wperseoec 01 enolne, involved agency' ° ...• _ Yes 1 NO ,. C COu:D ACTION RESuT 7 IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING 14, ,war$ may be hanowl ittsr•. if leg tole CI Existing ise Quality. surface Or groundwater Quality at quantity, noise tevet6 existing traffic patterns. solid waste 01006108or O' 403006a potentra' lot 9rosto• ohmage or flooding problems) Explain bliafly C? AesthetrC. agriculture'. 0►ChetOIDQ+cel. hrstarc, err effner 19elasol or Cultural resources, or Community or neighborhood Chat&Cte('► E zpte'r 1114011y C: vagetaltor or fauna. Osn, shellfish or wildlife 1peCa96. argntileanr A gortats, or threatened of endangered species? Explain briefly CA t romrnunity's axistrng planS or goals ss 0114etauy adopted. or a change in use of Intensity of use of lend or other nature' resources') Explain briefly Q Cs Gfowln, suoseouem development. or 19111109 activities likely to be Induced by the proposed action') Explain briefly. ". co - -. CE long term. short fora. cumulative or otnet 9rleels not identitroo in C1•08? Explain briefly. C7 Ding tmps:)S.Uncfudtr+6 changes in use of either Quantity or type of energy)' Explain briefly. s -w; D WILL THE PROJECT HAVE An IMPACT On THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA'l G Yes ❑ No E IS THERE. OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Y94 ❑ No If Yea, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether It Is substantial, large. Important or otherwise significant. Each effect should be assessed ):1 connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) Wavers Ibiliily: (e) geographic scope; and (f) magnitude: If necessary, add attachments or reference supporting materiels. Ensure that explanations contain sufficient detail to show that all relovant adverse Impacts have been ldentllied and adequately addressed. It question D of Part II was checked yes, the determination and significance must evaluate the potential impact of the proposed action Oh the environmental characteristics of the CE.A. ❑ Check this box if you have Identified one or more potentially large or significant adverse Impacts which MAY occur. Then proceed directly to the FULL EAF Dnd/or prepare a positive declaration. ❑ Check this box If you have dsttrmined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result In any significant adverse environmental impacts AND provide on attachments as.necessary, the reasons supporting this determination: saws of ea AaencY Point Or lioir Name Or lieboonsible Office, M Lead Agency Tab of Responsible Officer ha►ure of esponsr a 011ecte in Lead Asencv Ignalu►e of rWror (if a, Ileml from response e officer) L PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION Property of Located at IAJ({ ,/I 6 lc TN in I �c P' Tax Map # 6 Block a- Lot '6s-- Subdivision of 16o gizilvG /�r�,,,�. (,r� ✓,f/fdZ L �I;B S' Subdivision Lot # / _ Filed Map # )363,. Date Filed 111V91? Gentlemen: This letter is to authorize /5E(K -1,- Ibv o 4:f-ka a duly licensed Professional Engineer o 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 treatment and/or water supply systems _ inconformity with the proyisions_of. Article. 145.and/or 147 of the Education Law,--the Public Health Law, and the Putnam County Sanitary Code. Ve y ours, Countersigned,/ Si P.E., R.A., # D 7 VfZ (Owner of Property) Mailing Address Mailing Address: 1�� ! ,� T, State �� Zip State Zip Telephone: l'� / -- `� �6 Telephone: j —7 -7^ Form LA -97 Beyer and Associates Bryant Pond Plaza, Suite 5 Mahopac, New York '10541 Mr. Adam Stiebeling Assistant Public Health Engineer Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: MacQuignon Residence Roaring Brook Drive Putnam Valley TM41.6 -2 -65 Dear Mr. Stiebeling, �S`' " " " Tel. (845) 621-4756. . Fax. (845) 628 -1905 October 29, 2001 Please find the enclosed updated plan and forms for the above referenced property The plan and forms have been updated in accordance with your comments dated October 25, 2001: 1. Form CP -97 Construction Permit a. The date of the realty subdivision approval has been included. b. Curtain drain and fill requirements have been included on "other requirements'. 2. Form LA -97 Letter ofAuthorization a. The date of the realty subdivision filing has been filled out. b. The application has been signed. 3. Form PC -97 Application for Approval of Plans a. The application has been signed. Proposed Plan: 1. The effluent line can be installed approximately as shown. Any necessary adjustments to the path can be made during construction. .2. The curtain drain has been extended to the property line. 3. The standpipes and detail have been shown on the plan. 4. The 10 foot minimum line from Oe property line has been shown on the plan. 5. The junction box detail has been changed to indicate the required 2 feet of solid pipe. 6 The address has been changed to Roaring Brook Drive. Enclosed please find a copy of the fcflfowing items for your review and approval: • Construction Permit for Sewage Treatment System • Letter ofAuthorization o Application for Approval of Plansfor a Wastewater Treatment System. • Plan and firofile- Separate Sewage Treatment System (3 copies) �yy I trust the bo�e materials are adequate for your approval and complete the submission for the above project, However ij 'You have any questions concerning this project, please do not hesitate to call me @ 621 -4756 ` Ve y yours, ���% Chris Caralyus, Project Manager j 4' d BRUCE R. FOLEY �i LORETTA MOLINARI R.N., M.S.N. Public Health Director 41W I0� _ Associate Public Health Director October 25, 2001 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 FILE Preschool (845) 228 - 5912 " Fax (845) 228 - 61130 Beyer & Associates 73 Secor Road Bryant Pond Plaza Mahopac, New York 10541 Re: MacQuigan, Roaring Brook Drive (T) Putnam Valley, TM# 41.6 -2 -65 Dear Mr. Beyer: This office has received and reviewed the most recent sef of plans fQr. the above - mentioned project. We would like to offer the following comments for your�eview and consideration. Documents: 1. Application Form CP -97 - Construction Permit for a Separate'Sewage Treatment System. is incomplete it pis missing the-yellow copy........ a. Note the date the realty subdivision was approved (11 /18/88). b. Note the curtain drain and fill requirementsunder "other requirements." 2. Application LA -97 - Letter of Authorization. a. Note the date the realty subdivision was filed (11/18/88). b. Application must be signed by a design professional. 3. Application PC -97 - Application for a Wastewater Treatment System. a. Application must be signed. Plan: 1. Please verify that it is feasible based on exposed surface rock to install a 4 inch PVC effluent line as shown. 2. Curtain drain outlet to extend to property line (beyond proposed expansion area). 3. Curtain drain to contain two observation points (stand pipes). 5' -0" on either side. Please also provide detail. 4. Provide a note at the southeast property line stating "maintain-.minimum 10' -0" separation trench to property line. 5. Provide the following note along with the junction box detail, "Trench to begin T -0" from box, T -0. Separation shall be solid pipe backfilled with native soil or ROB fill." y , `6'.' Correct addiess of thelot shall read as "Roaring Brook Drive "; not Roaring Brook Road, Putnam Valley, New York. 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, . IL Adam B. Stiebeling Assistant Public Health Engineer ABS:cj enc. CP -97, LA -97, PC -97 J � BRUCE R. FOLHv October 25, 2001 4 # , IARBTFA MOL M RN., MS16. - ...4rarlatr rvMr llvarN Drnetar . Odtionii of Porrat Se+icw DEPARTMENT OF HEALTH I Geneva Road . Bmw'ste , New Yadt 10509 6arka.rmm nraw (NS)771.6ll0 FUO45)27 -MI N.Wa 5wke (M)273.6552 WIC "278-608 FM(669)271 -6025 _ 'Gary tvarreasa (Nn27a.60u 6ta0140172.6660 O reeeaoot Ms)na•ss)3 r.r(s5s)221 -6u5 ' '. Beyer & Associates 73 Sever Road Bryant Pond Plus Mahopac, New York 10541 Re: MacQuigan oaving Brook Drive (T) Putnam, Valley, TM# 41.6.2.65 Dear Mr. Beyer. This office has received and reviewed the most recent sat of plaps for the above mentioned project. We would like to offor the following comments i`or youtltefteW and consideration. 1?ocuments: .. 1. Application Form CP -97 - Construction Permit for a Separate Sawage Treatment System. The application is incomplete, it is missing the yellow copy.! a. Note the date the realty subdivision was approved b. Note the curtain drain and fill requiremcutatinder "other requimanants." 2. Application LA -97 - Letter of Authorization. a- Note the date the realty subdivision was filed (11/18/88). h. Application must be sigacd bye design pro%ssional- 3. Application PC-97 - Application for a Wastewater Treatment System. a. Application must be signed. Plan. I. Please verify that it is feasible based on exposed surface rock to install a 4 inch PVC effluent line ai shown. 2. Curtain drain outlet to extend to property lino (beyond proposed expansion area). 3. Curtain drain to contain two observation points (stand pipu6) 5' -0" on either aide. Please also provide detail. 4. Provide a note at the southeast property line staling "maintain.miniMuM 19 -0" separation trench to property fine. S. Provide the fbllowing note along with the junction box detail, <7aench to begin 2'-0" from box, 2' -0. Separation shall be solid pipe backftlled with native soil or ROB fill." • • *MJMKSN%nu arnow Mao" ,ao Hou sSma x0 : Ssrmsau R0a : Haow 29,00 : MgIZ aHSdTM TV:9T 9Z -100 : HWIS MIS E/E : MOW 906TSZ96 : HNOHd TZ6L- 8LZ -9t,8 7II11 HIUM 30 ZNHRIH VcMCI AJ non KVNSAd : SWN ZV:9T Ida TOOZ- 9Z -100 " HIVCI NOIZMN00 ONIMS and Associates 78 SecorRoad, Bryant Pond Plaza, Suite 5 Mahopac, New York 10541 Mr. Adam Stiebeling Assistant Public Health Engineer Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 Re: MacQuignon Residence Roaring Brook Drive Putnam Valley TM 41.6 -2 -65 Dear Mr. Stiebeling, Tel. (845) 621 -4756 - Fax. (845) 628 -1905 September 27, 2001 Our client, Claude MacQuignon, constructed a four bederoom, single-family residence at the above address to be serviced by an individual subsurface sewage treatment system and a private drilled well. The well has already been drilled. Enclosed please find a copy of the following items for your review and approval: - o Construction Permit for Sewage Treatment - System ^ - ® Letter of Authorization o Application for Approval of Plansfor a Wastewater Treatment System. e Design Data Sheet ® Short Environmental Assessment Form m Plan and Profile- Separate Sewage Treatment System (3 copies) a Fee — Certified Check in the amount of $300 I trust the above materials are adequate for your approval and complete the submission for the above project, However if you have any questions concerning this project, please do not hesitate to call me @ 621 -4756. r Very u yours, �6 7 .. Chris Caralyus Project Manager V. I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR S TMENT SYSTEM Located at —rCi ,16- Town or Village Az7-411 U,gGLEK Subdivision name A •r, E 6s -i47C Subd. Lot # —/— Tax Map y, 6 Block Lot _6 Date Subdivision Ap enewal Revision - - Owner /Applicant Name 66,4y t &Y 4C OU/ (,wo/✓ Date of Previous A oval Mailing Address y I (-nh e4zdf ' ST /yrz,z c.&I 677 Zip �J Amount of Fee Enclosed Building Type (� �Unp j:;r grj ALL4fLot Area ,�jj- No. of Bedrooms J—/ Design Flow GPD_g?o Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of /� f-rJ gallon septic tank and .S� 7 Other To be constructedku.. Address Water Supply: Public Supply From Address or: _ Private Supply Drilled by 4n/ %,LAZ e- Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will 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 any repairs thereto. Signed: P.E. R.A. Date Address Sanrl, lof! ,Z_ License #. 07 yS9 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 permit. Approved for discharge of domestic sanitary sewage only. I: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 ,z LETTER OF AUTHORIZATION RE: Property of Located at e.lAiL A&)_A � TN lovmlAm V V Tax Map # Block 3- Lot '6 Y_ Subdivision of ,+? ;„�( /��,, �,� �,,� ✓,t/ N T %S' Subdivision Lot # _ Filed Map # 2 36 Date ed Gentlemen: This letter is to authorize /3 E Vif �& �b k au4u Fr a duly licensed Professional Engineer >0 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 treatment 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'. 0 Mailing Address, `�,� SCc-prc, 1W J v iC '04 #W }- State ;/1 Zip Telephone: � /Z 16 :V (Owner of Property) s, Mailing Address: 17 S t2g 1 KrAtt- State Telephone: , O S_ q Z2 Yq -7..-% Form LA -97 Y U TNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR - A WASTEWATER TREATMENT. SYSTEM 1. Name and address of applicant: (-c.AVOc� A1y�rQu1fYuo&Z 5 7 5('m1n/4r,�l S T /vG-, ���V�i 1. C T-- nr., � �0 2. Name of project: Tf 3. Location TN: 4. Design Professional: I - V-6e,- , Iyp A s-! po:. 5. Address: 19 SEc oC (2f). , S� 176 � ` 6. Drainage Basin: cJ�iJT/ �2�y�i _ IAI yPP-CT Ni 105yl 7. Type of Project: �2 _ Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I — Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required?-7 . ...................... 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency 12. Is this project in an area under the control of local planning, zoning, or other officials ordinances? 13. If so have plans been submitted to such authorities. 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? .................... 4Z44 17. Waters index number (surface) ........................................... ................................ 18. Is project located near a public water supply system? ....... ............................... AID 19. If yes, name of water supply Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ 21. Name of sewage system Distance to sewage system 22. Date test holes observed 23. Name of Health Inspector 24. Project design flow (gallons per day) ................................. ............................... ROD 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required? ... 'cp �i 26. Has SPDES Application'been submitted to local DEC office? ......................... Form PC -97 2 ` 27. Is any portion of this project located within a designated Town or State wetland? . A10 28. Wetlands ID Number ........................................................... ............................... 29. Is Wetlands Permit required? .......................... ....... .............................................. /U0. Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? .. ............................... Al D 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 /� O 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 1V0 DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... S 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ..........:..................... . ............................... /V 35. Are any sewage treatment areas in excess of 15% slope? . ............................... 36. Tax Map ID Number .......................... ............................... Map Block - Lot IS 37. Approved plans are to be returned to ..... Applicant 1 _ 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 tq the.D P,.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 stormwaterplans 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 magg.�aar4puni&4ahkxs a Class A misdemeanor pursuant to Section r . o the Penal Law. SIGNATURES & OFFICIAL PE Mailing Address:. J .............................. M/h OTC f Al J BRUCE - 1L QL.0 _ ...,.......... _ Public Health Director March 30, 2000 -- IORETTA- MOLINARI kN., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 p Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 Claude Macquigon 97 Seminary St. New Canaan, Ct. 06804 Re: Macquigon, Roaring Brook Drive TM# 41.06 -2 -65, (T) Philipstown Dear Mr. Macquigon: As discussed, please find attached Application Form CP -97 "Construction Permit for Sewage Treatment System ", approved by this office on 10/6/99. This subject lot is approved to construct a SSTS, as stated for a duration of two years from the date signed. This office will.continue its review upon consideration of the above mentioned comments. Please -feel free-to- contact -me at ext.. 2157•ifany questions -arise: - - - - - - - ABS:cj Very truly yours, �44- Adam B. Stiebeling Assistant Public Health Engineer \�c TNAlVI PU COUNTY DEPARTMENT OF "HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERN11IT # Roaring Brook Drive �O-7-S Putnam Valley. Located at Town or Village, Roaring Brook Country Subdivision name. E s t e t e s Subd. Lot # 1 Tax Map 41 .0 6 Block 2 Lot 65 Date Subdivision Approved 11/ 18/88 Renewal x Revision Owner /Applicant Name r 1 a u [P ?'.g C r„; o° n n n Date of Previous Approval t �,� o 9 y Mailing Address 97 Seminary Street, Few Canaan, CT 06804 Zip Amount of Fee Enclosed $300.00 Building Type s i n a 1 e f a m i 1 Y Lot Area 2.12 Vo. of Bedrooms 4 Design Flow GPD SOO 1,7-5- Fill Section Only _ Depth Volume Approx. 350 PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1500 gallon septic tank and 520 l i n e a r feet of 24 inch wide trench Other Requirements: I 11g, C'.Pj�-T16i �2a'i i�•t To be constructed by Water Sunnly:,:...... - Public Supply From or: x Private Supply Drilled by Address Address.. . Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will 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 any repairs thereto. Signed: -P.E. o7-?77n R.A. Date 10/2/99 Address 2 Dale Avenue, Somers M89 License # 072770 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 ppro d for di g f d estic sanitary sew a only. By: Title: l Date: w p : 6 White copy - HD File; Yellow copy - Building Inspector; Pink cop - Owner; Orange copy - Design Pro essional Form CP -97 i f n , Ri)lrIAM CODriI'Y DEPADTNffiRT OF HEALTH to Pawido Pewit / \n, ` e[ zavkmu eml Had& savlo s eo. Caaei. N.Y.1NSU _ CES' KATE a PW=k f _ CONURUMON MAW POE SEWAGEMOM AL SYSTEM Roaring Brook Di?' "' r Putnam Valle m Lontod'at - VMW hRoaming Brook ;Ter: 41.06 aloelt 2 65 �tteoewat_ rY Itevl.lsn ❑ iA�laN..e Sun NLF Limited Partnership M" of Previolta Aplinvd 11 .� 18'� 88 Nabs Ad&— )tOn TJt/ S 5016 Date Subdivision- Al2broved Fee Enclosed ® Amn„nr $300.00 Single family rederice pmseeth>vody x >p _1 -0f w . 350 Nw"w d Bedrown Deaip Flow G P D 8 0 0 r PCHD Noltlintlm 4 Yegaired When POI V completed . Separate Some mas Syete- to conalat of l 0 Gallon Sep& Teak end -`: To be anetActed by AdlLes c :! water Supply; % Plmlle Sappb pros` Addreoe ' on Pewees Soppy Drilled by Mae Reguhemmts i. 1 represent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage di sal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards„�ules a regulations o. Mm County Department Of Hmkt% and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Corrimisslonerof HeaKhvirill be submitted to the Department, and a wriVen guarantee will be furnished the owns, his successor ;'MMsor assgnk.by the buckler, that said builder will y sewage disposal systsim duri the ( )years Immediately following tMdate of the issu- I,.,ri .Olaee in good operating condition an part of said sew ng. period of two 2 Once of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2).that the drilled well described ebb" Will be located as shown on the approwe0 plaryand that Yid well will be Installed in accordance with the standards. rules and regu iTTons of the Putnam y . County Department Of Health. - `` wee 912147 signed - P.E. ✓ ]EX►• — Dale .Avenue, Somer ,. N.Y. 10 ;0 fi Address License N. __g7 % 2 % % 0 ! APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless coamnict lon of the buckling .has been undertaken and is i. revocable for cause ioorrmaybe amended or modified when considered necessary by the Commissioner of Health. Any charge or alteration: of construction a requires a now , +t Approved for disposal of domestic sanitary sewage, a c- piivai yiatllr supply only..: 1 g� _ Title r rii - t I - PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Claude Macquignon Located at Roaring Brook Drive (T) Putnam Valley Section 1 Block 2 Lot 65. Subdivision of Roaring Brook Country Estates Subdv. Lot # 1 Filed Map # 41.06 Date 11/18/88 Gentlemen: This letter is to authorize Donald R. Knapp 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 �. _. _._ sysfem-or- sysTt-ems in-�- conformity with the provisions of Article 145 -or 147, Education Law, the Public Health Law, and the Putnam.County Sani- tary Code. 1 Very It-r,uiy yo rs, Signei J Owner of Pr -eper y Countersigned: P.E., R.A., # 072770 97 Seminary Street Address 2 Dale Avenue, Somers, New York 10589 Address (914) 248 -7726 FAX (914) 248 -7557 Telephone 81 New Canaan, CT 06804 Town 203 - 972 -0649 Telephone Pump Characteristics PUMP /Motor Unit Sebmwale Pump Modes S01SAi SP33A1 Horsepower 1/4 1/3 full load Amps &0 10.0 Motor Type . Shaded Polo (4 pole) R.P.M. 1550 Phase 0 1 voltage 113 Hertz 60 Operation Intermittent Tomperahre 110 °F AmMoot N MA`Desilla A insolaHon Ckss A ti'�{ o Sko Wieft 1 -1/1" NPT a /1q Unit Wiigbt 3101 Ins. Power Cord 18/3, SJTVIl,10, std. (10' optie■il) - Materials of Construction NO& Steel 1A denting Of Dkloctric on Muter Housing Cost Iron Pump Castag Cast Iron Shat Steel Mechankol Shah Sod Seal Faces: Carbon /Ceramic Seal Body: An &zW Stool Sp>Stobdess Steel Bellows: IN" holler Thertrm*stk Upper Bearing Bronze Sleeve Beairiag Lower haring Single Row Bo l Bearing Strainer /Bass Plastic avers Standess Steel Performance Data ■.■■■N■M■Er ■t ■r ■r,■r■r■■rril ■r1 ■t■ ■.r■■ ■t ■g= "N■■■■ ■r■l WM"■bo!r■■■rri - .rat: \it•►�r� ■rrrr.•■■ -rr� _ ■rr■ ■r.rrr�ta� A■r■■■■■■r■r■rrrrrrrrr ■ ®. CAPACITY -U.S. G.P.M. 45,- Total Hood (foot) 4 6 8 10 12 14 16 18 20 22 24 1/4 HP 44 41 36 33 _29 26 23 18. 12 6. 0 OPM 1/3 HP 47 45 43 40 37 34 30 26 22 16 10 Dimensional Data I. All dimensions in ladles 3.1 /2....... T (amponent dimensions moy _ . i i%2 /s usdr S. Not for construction purpose 1.1/2 NPT Unless certified 3.1/2 4. Dmsendons ond weights are appro>Umata S. On/Off level ooustobie 6. We reserve the right to 3 -112 make revisions to our I� products and their 4.112 swficotions without retire 11 -1/e 10 -1I8 7 -7/8 PUMP ON DISCHARGE HT 3 PUMP of:� AURORA /MYDROMMIC Pumps, Inc. 1840 Baney Road, Ashland, Ohio 44803 (419) 289.3044 1 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 Roaring Brook Drive, Putnam Valley, N.Y. Putnam Valley 41.06 65 (T) Section Block .2 Lot Subdivision of Roaring Brook Country Estates Subdv. Lot # 1 Gentlemen: Filed Map # 2363 A Date 11/18/88 This letter is to authorize Donald KpgW. P.E. a duly licensed professional engineer 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 "coiliiect or`i "wi "t — this' matt6r' and "to" 'supervise "tli "e "cons`truction" 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. Very truly yours, SUN L � St ership, a Delaware limited partnersb -) _Slg ephen E. Renneckar, V.P. - 4Afn et- -o- € -P4-o-13 er4ry Countersigned: SunChase Land Fund, Inc. Managing General Partner of � 072770 Sun Partners, General Partner P.E., K.A., # Addr.�s.,s. 6001 North 24th Street, Suite A 2 Dale Avenue Phoenix, Arizona 99016 Address Town Somers, New York 10589 602 - 468 -1090 (914) 248 -7726 Telephone Telephone \k� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at Roaring Brook Drive m Town orVillage Putnam Valley Roaring Brook Country Subdivision name F, s t e t e s Subd. Lot # Date Subdivision Approved 11/18/ 88 Tax Map 41.0 6 Block 2 Lot 65 Renewal x Revision Owner /Applicant Name C1 a I d y a c g u i g a n Date of Previous Approval 1 o/ 91 o, 7 Mailing Address 97 Seminary Street, Rew Canaan, CT 06804 Zip Amount of Fee Enclosed $300.00 Building Type s i n o 1 e f am i 1 v Lot Area 2.12 Wo. of Bedrooms 4 Design Flow GPD X300 117-5 If Fill Section Only Depth Volume A p r n x. 3 5 0 PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1500 gallon septic tank and 5 2 0 1 i n e a r feet of 24 inch wide trench Other Requirements: To be constructed by Is, Water Supply: Public Supply From br: x 'Privy 'Supply Drilled by "' Address Address j represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewagg 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 ttleereof 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 any repairs thereto. Address 2 Dale Avenue, Somers, )6*J16689 License # 072770 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 p ' Appro d for di g f d estic sanitary sew a only. _ _......._... Date: By: R Title: e White copy - HD File; Yellow copy - Building Inspector; Pink cop - Owner; Orange copy - Design Pro essional Form CP -97 PUTNAM COUNTY (DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # U ' Well Location: Street Address: Town/Village Tax Grid # Block Lots) Name: &:1.4zVop,,_r- Address: Well Owner: vr'a z%!1� ldG/, Us of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought - gpm # People Served _ t4___ Est. of Daily Usagegal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type U Drilled Driven Gravel Other Is well site subject to flooding? ........................... Yes No _ Is well located in a realty subdivision? ...................................... ............................... Yes No _ Name of subdivision of No. Water Well Contractor: T . l Address: Is Public Water Supply available, to site? ............................. ............................... Yes No Name of Public Water Supply: r Town/Village Distance to property from nearest water main: K Proposed well location & sources of contamination to be rovided on separate sheet/plan. Date: Applicant Signature: 4F PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue 10 � q `� Permit Issui g Official: Date of Expiration o S o Title: - J , Permit is Non-Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH - 1 Dlvld= d Bxdr u=mW Had& Savleala. CuuwL N.Y. M12 Bi&8or to Provlds Paaolt g rw m CERMCATE CONMUC1ION PERMIT FOR SEWAGE DISPOSAL SYSTEM Paa M v . Roaring "Brook Drive P -n -am Vallt Located at Two w V81060 N.ma Roar i na 'Brook. Lof r;. 1... Ter= Map 4l . 0 6 2 . 6 5. , _..,. Rawwd_ R Revielon p /A�YeoatNms Sun N.T.F Limi ted Partnership Date of Pr wim Approval 1 1 1 1 8 1 8 8 i Aft. -tivvI ir-- - -h SS tQ e t 1 D h n a n i u Aen zip Date Subdivision �A ;pn oved Fee Enclosed El Amn„nt $ 300 _00 Single family residence 1 4 800 PCHD NodSmt ea 4 Requited Wbeaweea m� Is — .� Nobae d BeArooan Dealt P1ow� G P D Sepaeaeo Sewmw Sys&m to oundst of r Gdba Septle Took and To be oaegaaeted by Atilben ? Waller Supply. X Ptmlic Sw* F$ Add e on 1tax.tw Supply DOW by octal. ea. a Otbee Re"hosee to 1 represent that I am wholly and completely responsible for the design and location of the proposed system($); 1) that the separate sewage divI stem above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a regu ns o Miami County Department of Health, and that on completion thereof a "Certificate of Construction Compliance' satisfactory to the Commissioner of Heaahwill be submitted to the Department, and a written guarantee will be furnished the owns, 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 Models of the I=. ante of the approval of the Certifkate 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 with the standards, rules and regu ons of the Putnam County Oepartnumt of Health. Date 912197 Si/ned P.E.'! I31►•- Add►eu.2 Dale Avenue, Somers, N.Y. 10 LicanseNo 072770 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless co r ion of the building Ms •been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction requires a neat Approved for disposal of domestic sanitary sewage, a i... ..: _.� ..ter supply only. 10/88 Date i �%/ By �-- - _._.__... Title r DEPARTMENT OF HEALTH 1 Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 '�1PPhICATION `fO "`CONST�TJOT A`WATER WELh _ PCHD PERMIT #� WELL LOCATION Street Address Town/Village/City Roarin-q Brook Drive, Putnam -Valle Tax Grid Number 41.06 -2 -65 WELL OWNER Name Mailing Address QPrivate O Public USE OF WELL 1 - primary 2- secondary (3 RESIDENTIAL OPUBLIC SUPPLY ❑AIR /COND /HEAT PUMP 0ABANDONED O BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify O INDUSTRIAL O INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT 10 gpm /# PEOPLE SERVED_ 4 EST. 13 REPLACE EXISTING SUPPLY O TEST /OBSERVATION ® NEW SUPPLY NEW DWELLING © DEEPEN EXISTING WELL OF DAILY USAGE_ Rnn gal Q ADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR DRILLING Npw rpAiaphcop public water supply not available WELL TYPE ®DRILLED ODRIVEN EIDUG C]GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Roaring Brook Country F r. t_to Lot No. 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:. LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED NA O ON SEPARATE SHEET (d A e) (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 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 any and all water or waste products from such well drilling operations be contained on this property and in such a man crr as not to degrade or otherwise contaminate surface or groundwater. / Date of Issue: 19 Date of Expiration 19 "-OC70 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller 1 PC -1 a PUT NAM COUNTY DEPARTMENT O F H EA ET H APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: Donald Knapp, P.E. 2 Dale Avenue Somers, N.Y. 10589 2. Name of Project, Roaring Brook Country Eatates3. Location T /V�C: Htitnam Valley 4. Project Engineer: Donald Knanr2 5. Address: 2 Dale Avenue Somers, N.Y. 10589 License Number: 072770 Phone: _(914)248-7726 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? ............. . No - 9. Has DEIS been completed and found acceptable by Lead Agency? NA 10. Name of Lead Agency NA is°th 1 -s�- project -�1 °n, an under the- cont ro _ l o�, ,.l.ocal 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: NA 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: 11118188 22. Name of Health Inspector: NA 23. Project design flow (gallons per day) ....... ............................... NA 11/93 0 e 2. 24. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. NO 25: Has;SPDES Application been submitted "fo'local DEC Office? ............... NA 26. Is any portion of this project located `within a.designated Town or State No wetland ? ............................ .. 27. Wetland ID Number....... ..... ...... ............................... N o 28. Is.Wetland Permit required? ............... ............................... No Has application been made to Town.or Local DEC Office? No 29. Does prbject.require a DEC-Stream Disturbance Permit? No •30. 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.or NO 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 pl.an or file with the Town or Village? No 33. Are community water, sewer facilities planned to be developed within 15 years? N o 34..- Are- :any . sewa.ge.- disposal areas in excess of 15X.-,slope? ...... NO 35. Tax Map.,ID ,Number .............:. 41:06 -2 -65 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 maybe 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. SIGNATURES & OFFICIAL TITLES: F /Do/nald Knapp, P. 2 Dale Avenue, Somers, N.y. 1058.9 MAILING ADDRESS: ` Date 1/87 Oate ~ ` YSIsm ii uildei Will the builder.,tha id 6 ate of fhe'i6i_ ascribed above. .'7 the Puinilm d RAN 414t jIn _,�ir'ViPriwlde rift Co PLIAN lot .7 .7 wuir/AbzdIeinCNii24` mme yjjjjl�t6eojjjjst of.:- 1250 500- IF, of, f igld� NY ` Date 1/87 Oate ~ ` YSIsm ii uildei Will the builder.,tha id 6 ate of fhe'i6i_ ascribed above. .'7 the Puinilm d RAN DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION Street Address off Pudding Street Town/Village/City Tax Grid Number Putnam Valley, NY Lot 1 WELL OWNER Name Mailing Address 6o�c N2--Ft w otin,Q%���(�0�Private Roaring Brook Country Partners RR#2 T<ain -La. -W NY 0 Public USE OF WELL 1 - primary 2 - secondary $$RESIDENTIAL ® BUSINESS ® INDUSTRIAL O PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify ❑ INSTITUTIONAL O STAND -BY AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED 5 /EST. OF DAILY USAGE 800 gal REASON FOR DRILLING NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION OREPLACE EXISTING SUPPLY ®DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING New Residence WELL TYPE 13DRILLED DRIVEN []DUG O 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. 1 WATER WELL CONTRACTOR: NamePF Beal & 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 1, []ON REAR OF THIS APPLICATION ' ®O�t,,ARAT HEET (date) J (/(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 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 provi a by th Putnam County Health Dep rtment. Date of Issue: 19 - Date of Expiration: 19ti�� mit Issuing Official Permit is Non- Transferrable White copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner 2/87 Orange copy: py: Well Driller r• o• 9 DI V41-,4 r 13, • ■ • z z • r r is v •1 31 DESIGN DATA SHEET- SUBSUFACE SEK%GE DISPOSAL SYSTEM FILE NO. OwnerRoar-Ing Brook Country Pattkied ddress RR# 2 , Box 42, Twin Farm La. Pound Ridg- V-1 11 NY Located at (Street) off Pudding Street Sec. ��' Block Lot -44-. (indicate nearest cross street) �; ,7 P1 v-1 flulJ Lot #1 Municipality Putnam Valley Watershed Date of Pre- Soaking 10/3/87 Date of Percolation Test 10/3/87 HOLE -- 11:41 -12:11 NUCER. CZ= TIME PERCOLATION PERCOLATION Run. Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start-Stop Mina Start Stop Drop In Min /In Drop Inches Inches Inches 1 11.06 - 11=36 30 24" _6�.-1E 2a" 13.3 211:36 -12:06 30 24" 2630" 23,411 13.3 3- 12:08 -12:38 30 24" _..26kCk 24" 13.3. 4 5 1 11:10- 11:40 30 - 241' _26" .. 2" 15:.. 2 11:41 -12:11 30 24" 26" 2" 15 ,3 12:11 -12:41 30 24" 2611 2" 15 4 5 11 15 min • 2 3 / prr 4 5 !TOTES: 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 from top of hole. TEST PIT DATA REQUIRED TO BE 'SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES .. DEPTH ..HOLE No.. . 1A G.L. 11 0 -8" topsoil 0 -8" topsoil 2' 8 -30" sandy loam 31 8 -42" bright brown sandy loam 41 30 -80" sand 42 -66" grey brown sand 5' 6' Rock 7' - Rock 8' 9' 10' 11° 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDK TER IS ENCOUNTERED NA INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING NA DEEP HOLE OBSERVATIONS MADE BY: Howard Kelly Dpi: 9/29/87 DESIGN Soil Rate Used 11 -15 yin /1" Drop: S.D. Usable Area Provided 6000 SF No. of Bedrooms 4 Septic Tank Capacity 1250 gals. Type Concrete Absorption Area Provided By 500 L.F. x 24" width tren �FESS /p Other 1.5 R0B /300 ;!cy fi 11 o Q o A. J-x Name Howard A. Kelly Signat m' Address 37 Fair Street SEAL sT 3x998 a� Carmel, NY 10512 �TF of "Evv -i° THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date • 0 PUTNAM COUNTY DEPARTMENT OF HEALTH D_IVI$ION , OF., ENVIRONMENTAL HEALTH SERVI.CES._..,.._. -.. _ :..._ ..:.c.. Date Re: Property of Roaring Brook Country Partners Located at . Off Pudding Street (T) Putnam Valley Section Block Lot -4*- Subdivision of Roaring Brook Country Estates Subdv. Lot # 1 Filed Map # Z�(n7j Date Z_; 6A Gentlemen: This letter is to authorize Howard A. Kelly a duly licensed professional engineer g 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 _._..:._- ._co- un.e.c.tioxi.. -with ._this, mat ter __an.d. _ta..._sup.;erxis.o_.tl e.. c.orik true ti.on...of system or systems in conformity with the provisions of Article i45 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, /� v� Signed. Owner of Property Countersigned: P.E. , R.A. , # .I n71' f Adjl�ress�� �{Z w,h �•1 � 37 Fair Street sH 38998 � � ® yhd 1(f 4,7 t (Of 7` Address Town --r- Carmel, New York 10512 C /y) Telephone 914 - 225 -7221 Telephone ? A ')'-cr 'a-'f"CL. dluose 4-0, :�,Jc. t%,.K %JI I jJ ow risu OU0. a 000 14 0, 7f4i A NoW. So, 9 %M (cmA 9xv) to 13 CL 10 I A I L L -qj 11%7 CQUXTYIEPAMMij OF HEALTH -7 -PtANS- APPROVED r0ij Roan 8 CPCIK c 01.fn 6 STA Ile s 4KY -00M QPUNT ONLY- ,�,I�Aeqo- Story F1 ED lAk, OODT.s 00rP4 7#1 2-'70, [ �L 'Fleet J3 Sy. Fi., C-ac _gnpLture itle . Ho's-flart 5r,012A. ILII IlLsIV-00.11. AIGROLA-14 (ap-CI• got) oit W4 u [ m �r $14 lmq,_ilm III il® W_ W X41 +5�> dirk mmim Va se- L.P,j*" FaR fvwm&!(* 4fl.d PUTNAM COUNTY DEPARTMENT OF HEALTH :ST , IL Alre s BEDBEDROOM COUNT ONLY; .,HOUSE PLANS APPROVED FOR t1r *-tory aorplatl •: EDROOMS 117-11. F11 167 40- aA FIcer) Q R. 13 s Ft . (C yi Sic, +urd..& Titi e Co. . Ho's-flart 5r,012A. ILII IlLsIV-00.11. AIGROLA-14 (ap-CI• got) oit W4 u [ m �r $14 lmq,_ilm III il® W_ W X41 +5�> dirk mmim Va se- L.P,j*" FaR fvwm&!(* 4fl.d PUTNAM COUNTY DEPARTMENT OF HEALTH :ST , IL Alre s BEDBEDROOM COUNT ONLY; .,HOUSE PLANS APPROVED FOR t1r *-tory aorplatl •: EDROOMS 117-11. F11 167 40- aA FIcer) Q R. 13 s Ft . (C yi Sic, +urd..& Titi e I MI •r APPENDIX B L &r ,* l PUM47km COUNTY DEPA.RII ETNT OF HEALTH - DIVISICN OF E'•NV'r_RONMTM HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SAGE DISPCEAL SYSTEMS REVIEW SHEET CONSTRUCTION P.....F'RMIT . REVI fIR a& vre, Y 6 -v, g 7-.! off ?,// IAI X-, , /e. . BY: (Name of Owner) (Street Locati6n) CC'S YESJ NO � I I I I I I. I vl L- trenca provided 5,690 recruired 60 ft. max. Parallel to contours 100% exp. I I� i I I I v SP5 i FILL SYSTEMS j claviarrier I 10 ft. fill notes nea spec. v' depth gauges AIM- 100 vr. flood elev 200 ft. reservoir, etc. 150 ft. trigall /gall. DOCr0,= Per-nit Application Corocrate� Resoluticn Plans - Three sets s/s Engineers Authorizaticn _ Design Data Sheet (DDS) SUEZ) - ZISICN Deep Hole Lcg ?arc -/ Consistent Perc Results (3) r^_11 Perc Hole Deoth cs House Plans - Two sets Well pe --,iu t; W-S C''Ze=er Variance Request Legal Subdi, vision Suhdivi sion Approval Ghec:ced E-A- acor^val SSDS A.d� . Lots Checked Wetland (Tcw-n /DEC Pe= ni t R & D) Data On DDS Plans & Permit Samoa REQUIRM D TT S. CN PLAN IS Swage System Plan - (norr -h arrca ) Swage System 'Hydraulic Profile - Gravity Flcw Fill Per file & D?me. ^_sicns - Volurne D or ,Trench/Gall ery; pump pit de3i is Septic - Size, Devil Well Detail, Service Line if over Construction Notes (grinder rate) Design _Bata: Derc. anal - -deep, xasul is _ _ ....._ •_ :. __.. Two -root Contours Existing & Proposer Drivefaav & Slooes Cat Footin�G,�tte_r,Curtain Drains (disc.harge OK) Perc & Deep Holes L.^cated Represantative of prim :y and expansion Expansion Azaa; show,; gravity flea, si: =. size If Punoed Pit & D Box Shown & Detailed House - No. of Bedroans. Wells & SSDS's Win 200 ft. of Proposes System Prcpe_rty Metes & Bounds House Setback Necessary (Tight lot) House Suer - 1 /4 " /f4L--..4 "0; Type pi^e No Bends; Max. Bends 45° w /cleanout SEPARATION DISTANCES SPECIFIED ON PIXN Fields 10' to P.L. , Driveway, Large Tree..s jop of fi? 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Strean, Watercourse, lake (inc. e_x ar 15' to Drains - curtain, Leader, Footing 351to catch ba.sin,stormdrain,piUrsi Ovate- rcours 10' to Water Line (pits -201) 50' inte-rmittent drainage course Septic Tanks 10' fran Foundation; 50' to well 15' Well to PL 9 Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. Very truly yours, I / , , , , P> PJ P� L \ �",GEND vx is'. Q v 50 �� PRIMARY ABSORPTION TRENCH 100% EXPANSION AREA BASED UPON OFFICIAL E -911 ADDRESS ED BY BUNNEY AS PER TOWN OF PUTNAM VALLEY 911 COORDINATOR,VERIFIED ON 12/5/01, FOR TM 41.6 -^ BL 2 — LOT 65, THE PLAN SCALE: 1" = 30' PUTNAM COUNTY THIS IS TO CE DEPARTMENT OF HEALTH SYSTEM WASDi THE SYSTEM V STANDARD RU DEPARTMENTi Putnam County Department Of adalta DEPARTMENT Hvieion of Environmental Health Service. PREPARED BY -b 200.36' SWING TIES TABLE (FT.) -0000 1250 GAL. 1250 GAL. SORPTION TRENCB 571 LF 574 LF PUMP CHAMBER N/A N/A DOSING TANK N/A N/A OVERFLOW TANK N/A N/A © • • • : • aw _ ®�® 0� © ®�N_ 0 •• �� _� N _ ®�� N I _M M ` ®�__ �M �� -' ®����� ON ®� © �I ®M m �I �01� 0�110- Moo w-momp-M-0 ©© ITEM REQUIRED PROVIDED SEPTIC TANK 1250 GAL. 1250 GAL. SORPTION TRENCB 571 LF 574 LF PUMP CHAMBER N/A N/A DOSING TANK N/A N/A OVERFLOW TANK N/A N/A DISTRIBUTION BOX N/A N/A 100% EXPANSION 571 LF 574 LF