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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.07 -1 -8 BOX 20 r No :: t �We Af 02282 = PUTNAM COUNTY DEPARTMENT OF HEALTH Z , @DIVISION': OF 'KNVHRONMENTAL-HEALTH --SERVICES CERTIFICATE OF CONSTRUCTI COMPLIANCE FtRS ATMENT SYSTEM PCHD CONSTRUCTION PERMIT $t �l" (3 Located at \./o 14 �.c�D BZI Town or h d Owner /Applicant Name tl A d ri 9,l &Tlf Tax Map I - Block J Lot fro —A i * Formerly �5 j j4 L j= P er5 � + J Subdivision Name 12,oA z t n � &cx)k; )5 ,may Subd. Lot # Z_ Mailing Address Date Construction Permit Issued by PCHD Zip J a�" J . Separate Sewerage System built by j ,j Address 1" v" Consisting of LDW Gallon Septic Tank and W i DF.-:i 2'ge, Water Supply: Public Supply From Address or: v'-' Private Supply Drilled by P Yl Address e4- �Lc �xAe Building Type — Has erosion control been completed? Number of Bedrooms Has garbage grinder been installed? I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations c" PutpaoC)unty DApartment of Health. Date: & Address Certified by Any person occupying premises served by the above P.E. &`<A. License # shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or chartge is necessary. By: aL lk Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PITT NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WRI.i. rOMPT,1;:'1ION REPORT Well Location Streel Addreess: To /Village: Tax Grid # Ma ,, Block 1 Lot(s)e Well Owner: Fe Address: Use of Well: 1-primary 2- secondary Residential Business Industrial Public Supply Air cond/heat pump Irrigation Farm Test/monitoring Other(specify) Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing >< Open hole in bedrock _ Other Casing Details Total length V"rin. ft. Length below grade Diameter Weight per foot �/_lb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded 7cThreaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: Yes — No Liner:_ Yes _ o Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes No Hours Second Well Yield 'rest _ Bailed _Pumped �Compressed Air Hours YieldoP�e gpm Depth Data Measure from land surface- static (specify ft) During yield test(ft) Depth of completed well in feet r 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 " D .. - r ... t . ....... ,.. .. _ .., . p . . If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth Model Voltage HP Tank Type Volume Date Well Completed Putnam County Certification No. Date of Report W I Driller (signature) NOTE: Exact location Orwell WIM lllSiant:eS LV 21t 10a5t I W V pw u14UMUL tauu 11CU Aa w VV F-1— 1— .,.. » ��y-» »•� �••- -- r — Well Driller's Name / Address%S Y �. i Signature: -77 Z2 "t Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM - 14 n -24 . Owner or Purchaser of Auilding n 1-) ki -Z/ .4 liq Building Constructed by Location - Street -L Building Type 41.1 f - 6 Tax MAp Block Lot 4 Town/Village Subdivisioli-Name 2i Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month_ Day j Year General Contractor (Owner) - Signature Corporation Name (if corporation) Address: State Zip o� Signature: Title: Corporation Name (if corporation) Address: 4-o z j,, State Zip )wc 9 Form GS -97 N8 NORTHEAST LABORATORY OF DANBURY :. -- _..... _...... �_._ �._.......z: CT Cert: `PA= 0404__..._...._ LABS 39 -3 MILL PLAIN ROAD - DANBURY, CT 06811 NY Cert: 11471 (203) 748 -7903 - FAX (203) 748 -0652 LABORATORY REPORT - WATER SUPPLY TESTING REPORT TO: MR. RICHARD ANNUNZIATA DATE SAMPLE COLLECTED: 7 /7/99 443 AUSTIN ROAD TIME COLLECTED: 12:00 P.M. MAHOPAC, N.Y. 10541 COLLECTED BY: BOB DATE RECEIVED @ LAB: 7/7199 TESTED BY: LAB #11471 REPORT DATE: 7 /14/99 SAMPLE SITE: 2, LYONS COURT, PUTNAM VALLEY, N.Y. SAMPLING POINT: KITCHEN SOURCE: WELL -NEW TREATMENT: NONE TEST PERFORMED RESULT: MAXIMUM CONTAMINANT LEVEL BACTERIAL: Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml PHYSICALS: Color 0 Odor. ND - pH 6:51 no designated limit Turbidity 0.27 NTUs 5 NTUs CHEMISTRY: Nitrite N <0.005 mg/L as N 1 mg/L as N Nitrate N <0.50 mg/L as N 10 mg/L as N Alkalinity.,.",. 18.0 mg/L - -- no designated limits - Hardness 24.0 mg/L no designated limits Iron 0.038 mg/L 0.30 mg/L Manganese 0.020 mglL, 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium. 4.1 mg/L 20 mg/L ** Lead <0.001 mg/L 0.015 * ** ml = milliliter mg/L = milligrams per Liter ND = none detected NTU =Units * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED:7 /7/99 SAMPLE, AS TESTED ABOVE: MPOTABLE or AMNOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Laboratory Director •NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037© (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 o OUTSIDE CT: 800 - 654 -1230 Aug -06 -99 14:3T From -US ALLIANCE CARP August 6,1999 Z0386TT581 T -664 P.01 /01 F -681 Lawrence & Patricia Garfield. One Duniull Drive Somers, New York 10589 TO. Adam Steibeling RE: Lot #2 - Roaring gook Estates 8 Lyon Court, Putnam Valley New York 10579 Dear Mr. Steibeling, We understand that there may be some trees within 10 feet of the septic area at the above referenced property. We would like to keep these trees as is and understand that they may cause some future damage to the septic area. If you have any questions or need any additional information, please call me at 203 -967 -7520 weekdays between 9 am - 5 pm, or leave a message at 914 -24 &6084 (home) and we will return your call. Thank you for all your assistance in this matter. Si ly, , Patricia Garfield Aug-06-99 WIT From-US ALLIANCE CORP 20306TTSBI T-864 P.01/01 F-681 Lawrence & Patricia Garfield Somers, New York 10589 August 6,1999 TO: Adam Steibeling RE: Lot #2 - Roaring Brook Estates 8 Lyon Court, Putnam Valley New York 10579 Dear Mr. Steibeling, We understand that there may be some trees within 10 fect of the septic area at the above referenced property. We would like to keep these trees as is and understand that they may cause some future damage to the septic am_ if you have any questions or need any additional information, please call me at 203-967-7520 weekdays between 9 am - 5 pm, or leave a message at 914-248-6084 (home) and we will return your call. Thank you for all your assistance in this matter. S. , ly 'y' Patricia Garfield Sy PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # V y air M If Located at e C�ZiVf Town or Village �( �T�'1 /�i►� � %� Subdivision name ilhiZm E%We, Subd. Lot # Z. Tax Map Block ,� Lot Date Subdivision Approved ) /%/ Renewal Revision A Owner /Applicant Name Mailing Address Date of Previous Approval Zip / 0 Amount of Fee Enclosed /C� Building Type i L Lot Area 2.(o o. of Bedrooms Design Flow GPD &00 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of I 000 gallon septic tank and, 3X Other Requirements: To be constructed by E4 - 2 F,7- fZ06 r / Address eiS'1 h� 1 / 14 C Water Sunnlv:.. Public Supply From Address or: Private Supply Drilled by - `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.I ` c.,"-" R.A. Date d h Address PGA �+� �9, S� yl/%�' //yY�L /oL• Y 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 p it pprov for dis arge of domestic sanitary sewage only. By: Title: _ Date: 1 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Located at �yol�S CA L7 2 f T/V P,4.,jTP)ft //P Tax Map # 44 /. Block —L— Lot Subdivision of r2/rl Subdivision Lot # Z•- Filed Map # Date Filed 110 Gentlemen: This letter is to authorize -91>./ a duly licensed Professional Engineer _l� or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions-of-Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Countersigned: P.E., R.A., # Mailing Address Very truly yours, Signed: (Owner of Property) Mailing Address: kspn gAe State Zip _ f � State Zip jpXI Telephone: -D 3 Telephone: dos —o7�0 Form LA -97 001 Wu I'll/ ,o1 ZSi StZ =17 '31Z 6.- , " a PUTNAM COUNTY DEPARTMENT OF HEALTH D11VISION OF ENVIRONMENTAL IIEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at 49 L �/ o (,0U IZI Town or Village RA �7) otm \/,4 Owner /Applicant Name l Tax Map Block Lot e Formerly S'y LF Pyt4erS i, J Subdivision Name P-60,4 2 ( n � Subd. Lot # Z— Mailing Address Date Construction Permit Issued by PCHD Zip )OS-4j. Separate Sewerage System built by vi /1 J Address kSTIL-J A!t�3 yayc Consisting of 1000 Gallon Septic Tank and -3,8 D r—TQ f 2, Pf Other Requirements: ater Su Public Supply From Address_ vim. Prv_ate Su _ -1 _Drilled by PP�'9Y1 Address or: pP- y _ Building Type b — L Has erosion control been completed. Number of Bedrooms 3 Has garbage grinder been installed? �uAV � eS I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations " Putpao' unty DApartment of Health. Date: & Address Certified by P.E. &`<A. License # y� Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 Cpl' �a Sheet of- or' .4 PUTNAM COUNTY DEPARTMENT OF HEAL - 3u - j_ DiVxSi ®t�T OT ENVIRONIMEP� TALHEATLgI SERVICES . FIELD ACTIVITY REPORT v. 21,716- Sheet Town - State Zip PERSON IN :CHARGE � -7 -3® 9 Name and Title P TYPE OF FACILITY_ v. FINDINGS; 9 - X r ' , o. 'c _- -.. Pw - 2? Tithe = Si nature end g �l ® RFPCIRT gF.CFTv.n - I ow receipt ofthia report SIGNATURE., . 02/96 Title, e Public Health Director July 21, 1999 To: Mr. Roy Fredrickson PO Box 950 Mahopac, NY 10541 Dear Mr. Fredrickson, Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Re: Lyons Ct. Lot 92 TM# 41.7 -1 -8 Town: Putnam Valley A final inspection was conducted on Tuesday, July 20, 1999 for the above referenced lot. = =�- This- lett6f s.toaiMs"e you.- and -all parties - involved - that -thE. aiitary Sewage= Treatment System -. -_ and Well were not constructed in accordance with the approved plans prepared by Donald R. Knapp, PE, approved by this office October 8, 1997; permit # PV -8 -89. A. Insufficient linear footage of trench: 380 linear foot vs. 517 required. B. Insufficient septic tank size: 1000 gallon vs. 1500 gallon required. C. Insufficient pump chamber size: 750 gallons vs. 1000 gallons required. D. Insufficient pump dose. E. Insufficient pump size. F. Insufficient expansion area provided. G. Height of well head less than 18" above grade. H. Erosion control measures inadequate and/or insufficient (installed poorly). I. Distribution box installed out of level. Revised plans are required to be submitted for a design change. -oa ra. �- ... -.•..v � _'r...:- v:a::u'R+n +"iNi. •..9.oH+-e_s`.:'.aw. .a » -.. �.rr zYSiv. >.s. ..i'v�aa..�avT'. � .t .. r..•r'+sr _.. a.• ✓��.. S ...'�r5.s_.T..aG'.Ma. X<....isc.. M1'a +� /.t.n _. ..n...aire.b.s.. r_a.N, _.. Plans and Applications include: 1. Revised SSTS, Well and Site plans. 2. House Plans. 3. Permit Application (CP -97) 4. Letter of Authorization. 5. Revised pump design spec's and criteria. 6. Revision fee of $150, certified check. T following Items require attention and correction: Provide speed levels in or at Distribution Box to level and equalize flow. Level Distribution Box. Fix/repair "leak" at Distribution Box inlet. Properly grade and backfill area of Distribution Box. Provide risers to grade for Pump Chamber. Pump power and alarm system to be wired directly to elect Control Panel. * Both pump and alarm to have "separate," dedicated electrical circuits, as required. 7. 100% expansion area to be laidout and proved in the field by staking. * 100% expansion to also be shown on As- Built. Extend well. head, min 18" above finished grade. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, (� Adam B. Stiebeling Assistant Public Health Engineer ABS:mcb CC: PV Building Insp. P a ke, Tonco _77 f _ _ a a i a Sheet of 7,- AM, COUNTY- DEPARTMENT OF IIE.ALTII- -7 i�-0i,'-ENVIR-ONMENT-AL'*rl.EATLII-'S'ERVICES—'--�-: -----------'---'-- FIELD ACTIVITY REPORT NTAN/rp- 1CJ'q Tel: ADDRESS: 1�0'r -2 L -y 1/. 7 -/ -6 V',l Street PERSON IN CHARGE nR TNTF-RVTF. n -. Town State r nq t t- 7A Zip c;, /n Name and Title TYPE OF FACILITY: j FINDINGS:— TIT �0`t z�ti i O C)" lJ N ao'l 1i I-z- G-0 r z S -y 5 (0010 9X10 A'I L �Oql 0 �Ca- Z -?,o -, (0 (2 Signature and Title 77t Sol cl RFP0-RT'RF-CFTVFT) BY.' I acknowledge receipt of this report: SIGNATURE:_ 02/96 Title:— ° r Sheet Z, of Z--- PUTNAM COUNTY DEPARTMENT OF HEALTII '�I`V'�SfON OIL' ENVIRONIVIENTAI ;`��ATL�`�I+;R�IC�'S""�' " " FIELD ACTIVITY REPORT jyAMF• TPI: Z m 02>7:6 AnnRRs .s• �-r Z �Yo C-T✓ 41.7-1-6 Street Town State Zip PERSON IN CHARGE r ¢�uo�tccLSo,:y F - 30 9 Name and Title TYPE OF FACILITY: FINDINGS: I,- f? tA2.1-c- �-X-I-S"JAAOC�6 - () I/_ I � s �,r1r -,�,.fl �ccun �� �.� -►_� - trcJ _ � �t�Lr- .. � -U Vl o ��2 � s �iz. � fz �rt iz. . L1\I1'qPF= nK, �X ,c�.w D H TFT ! ?? f; r (0/3D Signature and Title T1TT\l1T1T T TTf'T"TT rr7TI TINTS I acknowledge receipt of this report: SIGNATURE: n,) /4A Title: V BRUCE R. FOLEY Public Health Director July 21, 1999 To: Mr. Roy Fredrickson PO Box 950 Mahopac, NY 10541 Dear Mr. Fredrickson, LORETTA MOLINARI RN., 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 Fax(914)278-6085 Early Intervention (914)278-6014 Fax(914)278-6648 WIC (914)278-6678 Fax (914) 278-6085 Re: Lyons Ct. Lot #2 TM-r 41.7 -1 -8 Town: Putnam Valley inspection w4sacon4ucte4- on,Tuesday;..7uly 20,1999 for the above - referei ced-lot - This letter is to advise you and all parties involved that the Sanitary Sewage Treatment System and Well were not constructed in accordance with the approved plans prepared by Donald R. Knapp, PE, approved by this office October 8, 1997; permit # PV -8 -89. A. Insufficient linear footage of trench: 380 linear foot vs. 517 required. B. Insufficient septic tank size: 1000 gallon vs. 1500 gallon required. C. Insufficient pump chamber size: 750 gallons vs. 1000 gallons required. D. Insufficient pump dose. E. Insufficient pump size. F. Insufficient expansion area provided. G. Height of well head less than 18" above grade. H. Erosion control measures inadequate and/or insufficient (installed poorly). I. Distribution box installed out of level. Revised plans are required to be submitted for a design change. Plans and Applications include: 1. Revised SSTS, Well and Site plans. 2. House Plans. 3. Permit Application (CP -97) 4. Letter of Authorization. 5. Revised pump design spec's and criteria. 6. Revision fee of $150, certified check. The following Items require attention and correction: 1. Provide speed levels in or at Distribution Box to level and equalize flow. 2. Level Distribution Box. 3. / Fixhepair "leak" at Distribution Box inlet. Properly grade and backfill area of Distribution Box. 5. Provide risers to grade for Pump Chamber. Pump power and alarm system to be wired directly to elect Control Panel. * Both pump and alarm to have "separate," dedicated electrical circuits, as required. 7. 100% expansion area to be laidout and proved in the field by staking. * 100% expansion to also be shown on As- Built. Extend well head, min 18" above finished grade. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any_ questions arise. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:mcb CC: PV Building Insp. 2 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 _- ..a,.• APPLIC- ATION' TG - CONSTRUCT A WATER WELL- :- _ - PCHD PERMIT WELL LOCATION Street Address Lyon Court. Putnam Valle Town/Village/City Tax Grid Number 41.7-1-8. WELL OWNER Name Mailing Address VPrivate D Public USE OF WELL 1 - primary 2- secondary ® RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL ® PUBLIC SUPPLY Q AIR /COND /HEAT PUMP 0 ABANDONED 0 FARM O TEST /OBSERVATION E3 OTHER (specify U INSTITUTIONAL 0 STAND -BY 0 AMOUNT OF USE YIELD SOUGHT 10 gpm /# PEOPLE SERVED 4 /EST. OF DAILY USAGE 800 gal REASON FOR DRILLING 0 REPLACE EXISTING SUPPLY ® NEW SUPPLY NEW DWELLING ® TEST /OBSERVATION 12 ADDITIONAL SUPPLY D DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE ®DRILLED ®DRIVEN ®DUG ®GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Roaring Brook Country 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: _... NA LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ®ON SEPARATE SHEET NA (date) (signatu 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 manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue:, 19�G Date of Expiration 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller 2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date 9 -2 -97 Re: Property of SUN NLF Limited Partnership, a Delaware limited partnership Located at Lyon Court, Putnam Valley, N.Y. (T) Putnam Valley Section 41.7 Block 1 Lot 8 Subdivision of Roaring Brook Country Estates Subdv. Lot ## 2 Filed Map # 2363 A Date 11/18/88 . Gentlemen: This letter is to authorize Donald Knapp, P.E. a duly licensed professional engineer X or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with,this matter and to supervise the construction of said system or systems in conformity with the provisions of XHicl"e` 14 "5 " "of 147, Education Law, the Public Health -Law, and the Putnam County Sani- tary Code. Very truly yours, SUN invite Partnarship, a Delaware limited partnership By : -- gne* Stpp h� An E_ Rannarkar, V_p_ Ehxrer- -o+- Px-Oj!)-erty- Countersi ned: SunChase Land Fund, Inc. Managing General Partner of P.E. , )RW. , }# 072770 Sun Partners, General Partner 6001 North 24th Street, Suite A 2 Dale Avenue Phoenix, Arizona 85016 Address Town Somers, New York 10589 (914) 248 -7726 Telephone 602 - 468 -1090 Telephone a DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225-3641 APPLICATION TO CONSTRUCT A WATER WELL ��UU PCHD PERMIT #1 ul WELL LOCATION off SPueddkngdStreet Putnam a�Ieyge ity TaxLOE Number WELL OWNER Name Mailing Address Roaring Brook Countr .Partners RF02 ��X yZ oilv�c( fln(,�XX3Private Twin La. PX NY O Public USE OF WELL 1 - primary 2 - secondary RESIDENTIAL O PUBLIC SUPPLY ® BUSINESS O FARM ® INDUSTRIAL C]INSTITUTIONAL O AIR /COND /HEAT PUMP O ABANDONED O TEST /OBSERVATION O.OTHER (specify O STAND -BY AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED 5 /EST. OF DAILY USAGE 800 gal REASON FOR DRILLING jk4EW SUPPLY O PROVIDE ADDITIONAL SUPPLY ® TEST /OBSERVATION O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING New Residence WELL TYPE ®DRILLED ODRIVEN ®DUG OGRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:Roaring.Brook Country Estates Lot No. 2 WATER WELL CONTRACTOR: Name PF 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 ® ON REAR OF THIS APPLICATION ((late) PROVIDED []ON SE�SH (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above''is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant s.hall:- �. 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 prov' d t Putnam Coun Health Depart nt. Date of Issue: 73 24 19 ermit Date of Expiration: 2 19 suing Official Mite copy: H.D.-File Permit is Non - Transferrable Yellow copy: Building Inspector 2/87 Pink Copy: Owner Orange copy: Well Driller PL'i!1M COUNTY DEPARU,= OF HEALTH - DIVISICN OF ENVIRONMENTAL HEALTH SERTvI= INDIVIDUAI, WATER SUPPLY & SUBSURFACE Sr' QA.GE DISPCSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PEERMIT - J JAO . � /eU� r` �`s � �� /Gr1�17 //ii� �S �. �U. ... -.. DATE REVDvim: �/ ��c�i (Name of Owner) (Street Location) CC1PS YES NO I I I i ( I` I — S c'D IVIA- d . i I - LF u=a. ch pro 0 reguired ^d 60 ft. max. Parzllei to contours 100% exo. I i I I I SDS I li I' I �r- FILL SYSTEMS I , clavbarrier I 10 ft. fill notes new soec. deotn gauges 100 vr. flood elev. I 200 ft. reservoir, etc. Lj 150 ft. trigall /gall. A/ DWUMI M Permit Application Coroorate Resolution Plans - .Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Pe_rc Hole Depth s/s SUBDI<TISICN _ (3) rF., C-; HOLS2 P111 an - T6vio sets Wei 1 / pe_rau t; Ph letter Variance Realest G-s Legal Subdivision Sabdi r_sion A -c roval C!ecs d Ex-acorn-val SSDS Ad!. Lots Chec'.c Wet'-and (Town /DEC Permit R & D) -Data On DDS Plans & Permit Sai-ra REQUIRED DETA.TTS ON PLANS Sawage System Plan - ( north arrow) Sewage System Hydraulic PrO.Eile - Gravity F1cw Fill Profile & Dimensions - Volume D ate- ox Trencn /Gallery; Pump pit ca a i is Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes (grinder rate) ...Design Data: perc and deep resuls, Twirroot Contours Existing & Propcs -J Driveway & Slopes Cut Footin�Gstter,Curtsin Drains (disc:Large Oi{) Pero & Deep Holes Located Representative of primary and e- ..ansion Expansion Area; shown; gravity flora, suit . size If Pumped Pit & D Box Shawn & De. 4-- U, ed House - No. of Bedroans Wells & SSDS's w /in 200 ft. of Proposed System Property motes & Bounds House Setback Necessary (Tight lot) House Suer - 1 /4 "/ft. 4 "0; Type pine No Bends; Max. Bends 450 w /cleanout SEP_ARk"TION DISTANCES SPECIFIED ON PT IND Fields 10' to P.L., Driveway, Large Trees,Top of fil .,-Foundation Walls 00' to Wei 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. exxr. 15' to Drains- Curtain, Leader, Footing 351to catch basin, stormdrain,Pinei Watercours 10' to Water Line (pits -201) 50' inte- rm_ittent drainage course Septic Tanks 10' fran Foundation; 50' to well 15' Well to PL 9 PUTNAM COUNTY DEPARTMENT OF HEALTH :7, ;r; ..:.: _. �:_ DIVIS.IONm -OF" - ENVIRONMENTAL- ,.-HEALTH- SERVICES•- Date Re • Property of Roaring Brook Country Partners Located at off Pudding Street (T) Putnam Valley Section 15 Block Lot Subdivision of Roaring Brook Country Estates Subdv. Lot # 2 Filed Map # Z3US z 3&3 d, Gentlemen: This letter is to authorize Howard A. Kelly Date a duly licensed professional engineer g or registered architect_ (Indicate to apply for a Construction Permit fora separate sewage system, to serve the above noted.property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in c.onnect3-on- with -- this•- ma- t -t -er. and. - to-- s-upervise-the construction~off ~s -ai-d- °--- system or systems in conformity-with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned P.E. , R.A. , h 37 Fair Str��I Address Carmel, New York 10512 914 - 225 -7221 Telephone Very truy yours Signed caner of Property f ' 2 ✓'OX 4/2_ Address U� A)y IOT7� Town C�/Y) ?6 Telephone r . f `I. 1 9' -d' a- P�►JE� sunEe ��s �� �J 4�ROER1 3'w►I�i�� NL;'4� 1'�IGtOt.1�1� L�J1►Jc, RooN1 d roc 0,o! koor4 I 0 RN�u.kr w sl ew - �c�IER ao, 4wo-wP ,.. PUINAM- COUNTY DEPARTMENT OF I HEA 1. f•.:::.. ..! ._...ROarin ��' ©ok �ovnf'fY �:StatCS xa k'ANS APPROVED F'OR &DRO'OM'e.OtiNT _ONLYj OFF�vv� /y6Sf:V ->7ROar�ts %�X/Y�; s toy Flaor�un SUS. LoT X02 Si. (c4c4 Flocr) Signatu 're- $�i•�•�c�--- :•... -... ,__ tQ �- K1tc.o iC4 3/o 049 it y . .. r: �.:;, +.dam:. ••Y:;'` 1 r . f `I. 1 9' -d' a- P�►JE� sunEe ��s �� �J 4�ROER1 3'w►I�i�� NL;'4� 1'�IGtOt.1�1� L�J1►Jc, RooN1 d roc 0,o! koor4 I 0 RN�u.kr w sl ew - �c�IER ao, 4wo-wP ,.. PUINAM- COUNTY DEPARTMENT OF I HEA 1. f•.:::.. ..! ._...ROarin ��' ©ok �ovnf'fY �:StatCS xa k'ANS APPROVED F'OR &DRO'OM'e.OtiNT _ONLYj OFF�vv� /y6Sf:V ->7ROar�ts %�X/Y�; s toy Flaor�un SUS. LoT X02 Si. (c4c4 Flocr) Signatu 're- $�i•�•�c�--- :•... -... ,__ tQ �- K1tc.o iC4 3/o 049 . .. r: �.:;, +.dam:. ••Y:;'` 1 p.Mltu.lt, 04 - 01411+1 1200pi • Um I YT •: �Elm 8 .u- T 2 ii Z u�tce•Paao���:ltn oF'rug ARas Ply 6��• 1 • IS is jow- A. b � ta�': "� J A1u►J4 Rd 6u0=• LS' _ �1�..18 ¢S2 kl�caot,AV1 , u jmj k oPaN TO b s 6 X% FLOM • -X it Oft ,r1 o Z C y, PUTNAM`COUNTY DEPARTMENT 0p HMTE Q _.__..ROarinc .8#-vvK C41.nti'y E alres HOUSE PLANS.APPROVED POR 664,el /G / ' • 'BEDROOM COUNT ONLY I' BEDROO Story MS :IWX &W �— l- /7•// . / 119orplar) 7- :5(ld CdT a i. nature & Title: - -- ; w.irt ;s r • 4 ?mot e `,i r: �I',.M r —� L_J .DRK PONSULTING ENGINEERS Civil and Environmental Engineers 2 DALE AVENUE, ,SOMERS, N.Y. 10589 LETTER .OP.TRANS T.TAL. TO: BILL hEDGES. P.E. PUTNAM COUNTY HEALTH DEPARTMENT F-A■11►A DATE: 9/4/97 JOB NO. RE: ROARING BROOK COUNTRY ESTATES We are sending: ❑ attached ❑ under separate cover ❑ FAX X plans ❑ approval of subcontractor ❑ photograph • specifications ❑ order on contract ❑ copy of letter • shop drawing ❑ samples X FORM ❑ reports ❑ ❑ 1 9/2/97 CHECK # 883289724 IN THE AMOUNT OF $1200. 1 9/2/97 LETTER OF AUTHORIZATION - LOT # I 1 9/2/97 CONSTRUCTION PERMIT 1 9/2/97 APPLICATION TO CONSTRUCT A WELL 1 9/2/97 APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 2 912197 HOUSE PLANS 3 9/2197 SSDS DESIGN PLANS 1 912/97 LETTER OF AUTHORIZATION - LOT # 9/2/97 'CONSTRUCTION :PERMIT.:, 1 9/2/97 APPLICATION TO CONSTRUCT A WELL 1 9/2/97 APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 2 9/2197 HOUSE PLANS 3 1 9/2/97 SSDS DESIGN PLANS ❑ continued on the attached sheet THESE ARE TRANSMITTED AS NOTED BELOW: X for approval ❑ for information ❑ for action ❑ as requested REMAR ❑ no exceptions taken ❑ note comments • for correction • for review and comment ❑ resubmit copies for approval ❑ resubmit copies for distribution 11 return corrected print BY:—DONALD KNAPP RE COPIES TO: TEL: (914) 248 - 7557 L_ BILL hEDGES. P.E. PUTNAM COUNTY HEALTH DEPARTMENT ATTN: We are sending: ❑ attached X plans ❑ specifications ❑ shop drawing ❑ reports DATE: 9/4/97 JOB NO. RE: ROARING BROOK COUNTRY ESTATES • under separate cover ❑ FAX • approval of subcontractor • order on contract ❑ samples ❑ photograph ❑ copy of letter X FORM o• o e o 1 9/2/97 LETTER OF AUTHORIZATION - LOT # 4 1 9/2197 CONSTRUCTION PERMIT 1 912197 APPLICATION TO CONSTRUCT A WELL 1 9/2197 APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 2 9/2197 HOUSE PLANS 3 912/97 SSDS DESIGN PLANS ,1 _....__. _r_..... _ _9/2197 LETTER` OF'AUTHORIZATION -'LOT # "6= 1 9/2/97 CONSTRUCTION PERMIT 1 912197 APPLICATION TO CONSTRUCT A WELL 1 912197 APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 2 9/2/97 HOUSE PLANS 3 9/2/97 SSDS DESIGN PLANS d he a sheet ❑ continue on t attached THESE ARE TRANSMITTED AS NOTED BELOW: X for approval ❑ no exceptions taken ❑ resubmit copies for approval ❑ for information ❑ note comments ❑ resubmit copies for distribution ❑ for action ❑ for correction ❑ return corrected print ❑ as requested ❑ for review and comment ❑ REMARKS: BY DONALD KNAPP. P.E. COPIES TO: TEL: (914) 248 - 7557 PUTS NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Inspected by: `lLcw 5 r Owner Towm Permit # — 8 -- TM # �{ 1 7 �� Subdivision Lot # 1.. Sewage System 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. Sewage Syste a. Septic t t m si e - Weey�el ..... 1,250 ......... other ................ b. Septic tank in ........ ........ ............................... c. 10' minimum from foundation .......... ............................... d. Distribtuion Box . All outiets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches Junction Box - properly set ........... ............................... enat required 3T, Len,h installed PBX:? 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 %z" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... .I.e Pipe ends capped ........... ::::...... :.................................... g. Pump or Dosed Systems Size of pump chamber ................ ............................... 'i 2. Overflow tank ............................. ............................... Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. HouseBuildin a. house located per approved plans ... ............................... b. Number of bedrooms ....................... ............................... IV. Well a. Well located as per approved plans...,........ c ................... b. Distance from STS area measured.,O ft.:......... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. BackfiIl materilfcontains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rov 1/07 ti COMTMENTS w 0 ��ti�ly v ; .► 1.. IMF {mmm��i {M/.% == IBM 100 A C' ���1riC�►�� ti r PUINAM.COUNTY DEPARIMENT. OF HEALTH DIVISION OF ENVIRCNMENM HEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Roaring Brook Countrb Partners' Address RR#2, Ttdn Farm Lane, Pound Ridge, NY 0011 Located at (Street) off Pudding Street" Sec. Block Lot -4.5— ►r7, 9 (indicate nearest cross street) �V-t3V>jv15ick)Lot 2 Municipality Putnam Valley Watershed Date of Pre- Soaking 10/3/87 Date of Percolation Test 10/3/87 HOLE NUMBER CI,OC:R TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 1 10:55 -11:25 30 24.5" 30" 5.5" 5.5 2 '11:25 -11:55 30 24.5" 30" 5.5" 5.5 3 11:57 -12:27 30 24.5" 30" 5.5" 5.5 5 1 10:57 -11:27 30 23" 25" 2" 15 - .—I .. 2 11:28 = 11:58.....30. __ _.._.2�it :: _ -' _ _25:". _ .._ s. �__. w ..._ . .Q - -15- 2'! 3 12:00 -12:30 30 23" 25" 2" 15 4 11 -15 5 1 2 3 4 5 NOTES: 1. Tests to be repeated: at same depth until approadmately 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. rev. 9/85 TEST 0 IN TEST HOLES . 6' Rock 7' 8' 9' 10' 11' 12' 13' 14' ......INDICATE :LEVEL. AT. WHICH .GROUNDWATER -IS ENCOUNTERED -.: -- _ . INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED NA DEEP HOLE OBSERVATIONS MADE BY: Howard Kelly DATE: 9/29/87 DESIGN Soil Rate Used 11 -15 Min/l" Drop: S.D. Usable Area Provided 6000 S.F. .No. of Bedrooms 4 Septic Tank Capacity 1250 gals. Type Concrete Absorption Area Provided By 500 L.F. x 24" width trench' Other y.. �Q o,��� }l 1.5 ROB /300 :. f .11 Name Howard Kelly Signature Address 37 Fair Street SEAL 'r Carmel, NY 10512 Sf� 3b) 01 98 lE OP NFVJ �U THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /galo Checked by Date PC -1 2 PUT NAM COUNTY D E PARTM E NT OF H EA LT H "`'APPLICATION`FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: Sun NLF Limited Partnership 6001 North 24th Street, SumtL A Phoenix, AZ 85016 2. Name of Project: Roaring Brook Country Estates 3. Location T /lam Putnam Valley Y 4. Project Engineer: Donald Knapp, P.E. 5. Address: 2 Dale Avenue Somers, N.Y. 10589 License Number: 702770 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 (SEQR)? 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 11-: Is-this-project in an area under the control of local planning, zoning, or other officials, ordinances? ........................................ .Ye s 12. If so, have plans been submitted to such authorities? .................. Mn 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: 111181 8 22. Name of Health Inspector: NA 23. Project design flow (gallons per day) ....... ............................... 80 11/93 2. 24. Is State Pollutant Discharge Elimination System (SPDES) Permit :required ?.. NA. 25. Has SPDES Application been submitted torlocal DEC Office ?¢ �" NA' 26. Is any portion of this project located within a designated Town or State wetland ?....... ..... ........ ......., ... No N 27. Wetland ID Number .......................................................... No 28. Is Wetland Permit required? .... ......................... ..... Has application been made to Town or Local DEC Office? No 29. Does project 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, No landfilling, sludge application or industrial activity? ........ YES or NO 31. Is project located within.1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or NO No DESCRIBE: 32. Is there a local master plan or file with the Town or Village? ........... No 33. Are community water, sewer facilities planned to be developed within 15 years? No 34. Are any sewage disposal areas in excess of 15% slope? ........................ No 35. Tax Map ID Number ......................... ............................... 41.7-1-8 36. Approved Plans are to be returned to: ................ Applicant �_ If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A.Misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: Donald Knapp 2 D&Ae Avenue, 'S m s, N.Y. 10589 MAILING ADDRESS: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH~ SERVICES FINAL SITE INSPECTION 7 �� Date: Inspected by F 4 Owner Permit # g— I Subdivision Lot # L Sewage System Area a. STS area located as.per.approved plans ...................... ...... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped .................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/ wetlands ...... ............................... II. Sewage System a. Septic ta s e - 1,000 1,250 ......... other ................ b. Septic tank ins a evel .........:...... ............................... c. 10' minimum from foundation .......... ............................... d. Distribtuion Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches Junction Box - roperly 1 set ........... . ............................... . . engt? required � 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' /2" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... —1.0. _Pipe. ends .capped:..... ......................................... .... g. Pudio or Dose d'Sysfem 1. Size o pump chamber . ........... ............................... C��I 2. Overflow tank ............................................................ 3. Alarm; visual/ audio .................... ............................... 4. Pump easily accessible; manhole to grade ................. 5. First box baffled ....:..................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. HouseBuildin� arouse located per approved plans ... ............................... b. Number of bedrooms ....................... ............................... IV. Well a. Well located as per approved plans............ r ................... b. Distance from STS area measured Ino ft.:......... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ..............................I d. Backfill materiafcontains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 1/97 .. _ f 1 PUTNAM COUNTY DEPARTMENT OF HEALTH \ Division of Environments! Health Services. Carmel, N.Y. 10512 Engineer to Provide Permit # on CERTIFICATE OF IJ/1NCE CON UCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Permit # L Putnam_ off Pudding Street aTovmyor Village Subdivision Name Roaring Brook: Saud. Lot # 2 Ter: Map Block T Loth 1 V N Country Estates Owner /Applicant Name Roaring Brook Country Partners Renewal—O' Revision ❑ Date of Previous Approval MaWng Address gkg9 s Tin Farm T.anP Town Pound Ridge.. NY ZIP Building Type 2 Story Frame. Lot Area Flfi Section Only Lj Depth Volume Number of Bedrooms 4 Design Flow G P D 800 GPD pCHD Notification Is Required When FIB is completed Separate Sewerage System to consist of 19 5 0_Gallon Septic Tank and 500 L.F of fields To be constructed by K. Fiortino Adds Putnam Valley, NY Water Supply; Public Supply From Address M X Private Supply Drllled_y Beal _Address Brewster, NY Other I represent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regu a ions o e Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Health 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 disposal system during the period of tw (2) years immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of t original syste or (+pairs thereto; 2) that the drilled well described above will be located s shown on the approved plan and that said well will be install in actor c w standards, rules and regu aas Tons oof" the Putnam ' County OeDa m 'nt Of Health. e 12 Date Signed / P.E. X R.A. 37 Fair Street, Care , New or Address - License No APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when consider metes y Dy t Commissioner of Mealth. Any change or alteration of construction requires a riw permit. Appr ad for disposal of domestic sun' yag0, an r 'vat w p ly. _ 1%81 Date 13v Title ��w� %' i (� -= (� PUTNAM COUNTY DEPARTAGM OF )�ALTH 2 \ Dtwwon of W HeaN6 Sacvlces. Carmel. N.Y. 10512 F. is Awide Peesk I CO a CEIC1fFICATB O ii' - � Pon* f CO N P)! F0� SBWAGB. DASIOSALYSII. - . Put_ham lral_t y" Loomed at L Y n (� n„ r f 'OWN or Vlfiage SWkVvlm@a Name 8nar i ng Brook C,.[uSt181C lLt N 2 Tax Map 41 7 Bbek l lot R Estates Renewat_11 Revlabn OaraedAppYaat Non s�S u n N T. P T. i m i t e d Partnership Due of Previous ApprovalI 11118 18 8 MrmAddress 6001 North 24th Street, PhoeniXt" tip q 1 / Date Subdivision Annroved Fee Enclosed 0 Amnunt $300.00 ! B Single family residence Ar 2 Onb Depth — Vdame Naatber of Bedrooms_ 4 Design Flow G P D A () Q PCHD Noditsdm b Regabred When FIR b comph*od Sepssate Sewerage System to cmdd of 150C. Gallon Septle Tank dad To be eandirs tad by Address Water S"*. Pamlk Sopaly From Address on 15 0 0 Private Shy Drilled by Address otber Ret{ahemeoa 1 represent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the apa►ate swage disposal system above described will be constructed as shown On the approved amendment there to and in accordance with the standards, rules a regu ns O nam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" atisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heir 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 thedste of the issu- ance 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 rpu a7%ns of the - Putnam County Department of Health. <��;? Date 912197 speed �� �-- P.E. X . R.A. _ Addrss 2 Dale Avenue Somers N.Y. (1 58/9 License No- 072770 r APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless constr ' on of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of earth. Any change or alteration of construction "Quiress'a now permit. Approved for disposal of domestic sanitary sewage, and/w--private _wa r�wpply only. \' 1088 Oate �^ � Title � /�' L P LA r�, 4rI T-AN je_ 14 3e. I- & . --- 26, 2 34 -5 3:Z1 36 615, 36 6 j, 36, 49 71 :54' 75' 56 40 ' 3,6 14 61' 38 725T,11 i.lslot, or Environmental Bulth sorwic" .ROY' A. Ff, EDRIKSEN P. W 3S:,B -r 1-^ks 100-s V'Aab, ►pproved as noted for @onformwg •itA 4^HO NEW YORK '1054 1 ipplicable Ikles andI ti w of 6 Z 8 0 3 7 di Eft JOB i DORN sy. abp*c. 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