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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 73.18 -1 -29 BOX 28 03460 .1 g I 11 1 ' foul T. ' % T I'� 03460 PDTNAM CODNif ZPA'JTMl!NT OF NMaTH Dwww dnovbewaiaw Hesitis Seevloee. Ca" N.Y. 10512 N P112bQT FOR SBWAOB DEPOSAL SYSTEM to Paavlde PeamN � a CER11s+ICATE OF COMPLIANCE 2Z Town or VabSe ,E`(i��"t N . Lot H Z3 Tax Mop `7 �i 1 � � � W Z9 Owe /A�ila�t alms I _ i fUGtlfZ O E i!. ©_ „ t h1 C Renewal_ RovWen • Dated Pmvloae Approval Wefts Add w lar L -02CLry Sit_ Tow, L11Tf_r- FF.i?zzY zip it CAZ. Date, Subdivision Annzoved F %a ��1 Fee Enclosed 11 Amrnmt Type FC -�C 7AV l"A'ST 1 f }C� Lot Area 1 • 1!5rl AIC FM Seotloa O* LJ Depth Volatile- Number of Bodwome : Dealp Flow G P D CJ PCHD Notmtytloe Is Regahed Wben Fill b completed Se W'" Se..RP Syates to Comm of GaOon Sq* Tank •n -_---!57)S LF. 62C V (!f006 To be aentraoted by vNW eO QN Afte.._ UL1WCIC cl{VA Water Sol*: PdAt Supply From Address M %4 Ptfi Sup* DOW byi2Wt nV1311-1 Awe vu"-) ) \k)0 other Reubemmb I represent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sew die sal s stem above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a rag u ns o e u n m County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissionw of Hsaithwdll be submitted to the Department. and a written guarantee will be furnished the owner, his successors, heirs or assigns by the bulkier, that said builder will place In good operating condition any part of said $swage disposal system during the period of two (2) years Immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above WHO be located as shown on the approved plan and that aid well will be Installed in accordance with the standards, rubs and rpu T13ni of the Putnam County Department of Health. Oats Signed P.E..�_'R.A. _ f Address 1 I License No � 01 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change or alteration of construction nttulrea a new �:� p proved for dispoal of domestic sanitary sew or p only. A �// )/88 Dial By Title � � X :n... r.p.. Dlvlale� d W Ha11h to CER'TIIIftCATE OF COMPLIANCE Poll dt / I Y — 'ZZ _l �CONSTROC110N P!lRNNT FOR SSWAGE DISPOSAL SYSTEM A U c a Fv� m V Y Lasted at �' °- -Jlt i. I\ `y4D �oyTll own or Whige Nome %1/I�G�fj'1 _ saw W# Z TosMap ?3s ma >a�� Raw I y Revbloo O /AppfYsat N.ee t-ljV44R DCV. CO,_ 14r. - r 4- _ 9 3 Date d Prevbns Approval_ Town 1 -1771E- FmjzV . A) n. -7 6 * p t 57 Bi l_�t �� Fee Enclosed[] Amrntnt Type (S e5 f pcw TtitL Let Area 1' 3o 5t -Lgev Fm section one Vobrme Nmdm d Beaman DealRn Flow G P D ' PCH�D7NelMatba b Refprleed Whoa FS b completed Separate SewvnW Syetprn a oamibt d ! 000 soon Septic Teak aba .3'7 0 1_r a Z- NwC j4 (35©RC'"r1va - rREA)CNC'T To be comat Bled by ---y rv, ,'Oo[Jrj per, U 10&A) 019J.-) Water Sappb: Pd ft Supply Free Addrem on —mvate Sap* MOW by N fV kr OE,) IV Awe 61 it! Otter e I �.Q� F_j L 1 repressor that 1 am wholly and completely responsible for the design and location of the p►opoad system(s); 1) that the separate sewage disposal system above described will be constructed a$ shown on the approved amendment thereto and in accordance with the standards, rules a�repu ns o nom County Department of Hhith, and that on completion thereof a ••Certificate of Construction Compliance*, satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the bulkier, that aid budder will place in good operating condition any part of said $swags disposal system during the period of two (2) years Immediately following the "to of the issu. once of the approval of the Certificate of Construction Compliance of the original system Or any repairs thereto; 2) that the drilled well defpiMd above will be located as shown on the approved plan and that said well will be installed in accordan ith the standards, rules and rpu ions of the Putnam County O"Ift of Health. Date 2 �• 3jct! Signed P.E. RA. - F z m �t'% j Address- T� �N4 i�r� p� r' License No I .__ .. _ _ �....�. ....�... ......,.n..� of the buikdino has been undertaken and is , W MUWAGR BOPM" SMW CW ell TWE Qff Voko SS m, SWIPIL Lit 0--L3 at D-E=4 Co. PAC X9_0 Q Deb of plpeva= Arpmad Nomm Ad&= Imm ZIP !:3C)D T Date Subdivision AD ed 9 /89-T ' Fee Enclosed .9 Ammint jl.' Beaft Iryp— W-Am f.o9 DVAI—Vebma Wmbw ed. Sedmimsisa Deep raw G P D DO PM Noffitaillim b Reqdmd When FM III cemplabd 1COO Sipumb Uwanp SyMm to Gomm of WOO Sam Smpdr To* mad lfb be emsbadWAy— —Addmm I.J WtdW Sam* rem Addrem SW* DAW by --Add,=. Odw Z 0 represent that 1�"Sm wholly a" iorn*aaay* iqslionswie foi the design arid location of tho proposed witom(s) 1 1) tiwt the t allfte described will be constructed as shown on thit oppr" t here to and In accordance with the standards. rules EL&AR, County DqWtWAnt.„44 t Walth Vast . afidihit�pncbfn 10".111MOpta, Certi!icata of -Construction Compliermf* StIsfactory,to tho COMMIalonar of HwIthmilS M submaw to and a written guai"tee, wail be furnished the OWnW, his tamcallmorg. Maria of assigns by the buildeir, that wait WNW will alimm In flood operating cotialkiiiinany'" . " if held systein during the Period of two (2) ymrs knonatilately folloWiN thedilte Of the ISMO- amice Go the a�l,of tiii. Certificate of, Construction - Coinpilen,ce oflfti original system or any reinirs thereto; 2) that the drifted Well de=QM a(1)M R pi� the I appro . vod*m .40id ad rogU5FMrS__OQ the Putnarn that said weltwill," Installed In accordance waft the etanSOMQ6 Fula a cowl" Departw" if Heatift, 449 /193 4? Addross.—I"'i lJ L O 6 Z -Limm No. '6 APPROV(ED Grioga CONSTOtUCTIOm This approval mmpares maid, aid isbodAniess construction of the building has been Undertaken and Is Vemabla f oneq of Mcalth. Any charma. oralte7ation of. construction APWGVW ftr- diepml 64 Oomiialc G. jii7: Watm–MA"Ov only.- Rev. TI 10/88 M Public Health Director w •• .'.ML�IVL iA 1 aJLillYtlltl'�.i�l ., 1h7.�i.1V. -• ♦'. Associate Public Health Director Director of Patient 'Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914)278-6136 Fax (9 14) 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 - 6.648 March 24, 2000 Al &Linda Roskosky 28 Briar Hill Rd. Putnam Valley NY Re: Addition- Roskosky - 28 Briar Hill Rd. No Increases in Number of Bedrooms (T) Putnam Valley Tax # 73.18 -1 -29 Dear Mr. & Mrs. Roskosky: I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp form this Department dated March 23, 2000 The addition is approved with the following conditions: �. The total-number of bedrooms must remM_:1 at Four without prior apnroval b _ "this7depaftittent. . 2. The area of the existing sewage disposal system, and its expansion area, must be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. 4. The septic system must be consturcted as shown on the attached plan R- 49 -00. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley If you have any questions, please contact me at your convenience. Very truly yours, William H es WH:kg Senior Public Health Sanitarian cc: BI DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel- (914) 278 - 6130 F =. (914) 218 - 7921 BRUCE R- FOLEY fSir'ector ' PROPOSED ADDITION APPLICATION (RESIDENTIAL 0�'LY) STREET �XINIAP �� NAME PHO*E PCHD r -7-6 0 q l F a b -0.1-9-1 n r 1 P��- MAILINGADDRESS a� /J,/Lc -�yt, /��L c_2.� /��w ✓-�T V,� DESCRIPTION OF ADDITIONJc- .� -�c�± NUMBER OF EXISTING BEDROOl1S --3 PROPOSED r OF BEDR0011S_2' (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING D;SPECTOR) *Any addition which is considered a bedroom requires formal approval of plans (Construction Permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Yiese su'timit tills form ana'th followiri'to I'u'tnzm Count} Health Dept., 4 Geneva. Rd., Brewster, NY 1009, Phone 278 -6130. Certified check or money order for $100.00 Sketches of existing floor plan (drawn to scale, all Ih-inD area including basement) * Non- professional sketches are acceptable Dwo sets of proposed floor plan (drawn to scale, with name, street, and tax map I) * Non- professional sketches are acceptable )r—Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 44'X Copy of Cert. of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE Comments Fcb 98 PUTNAM COUNTY HEALTH DEPARTMENT j F1TVT I A' 11F;��TE�?F p T?f T FQY: -A T-T 'WIT !T G! _ :.� PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR OFFICIAL USE ONLY SITE LOCATION /7'I Y 1i` 04 fif-fA ,6,16V TM# OWNER'S NAME PHONE MAILING ADDRESS 2/`n�`C' PERSON INTERVIEWED PCHD Complaint # Name& Relationship (i.e., owner, tenant, etc. DATE TYPE FACILITY PROPOSED INSTAL1kER / PHONE ADDRESS REGISTRATION# Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system .Different location may require submittal of proposal from licensed professional engineer or registered architect. I, as owner, or reported agent of owner agree t e c Itions stated on this form. SIGNATURE " �r GI d� �/ �S� // TITLE DATE Proposal approved with the following_ conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name' b. Site Street Name, Town and Tax.Map number. C. Location of installed components tied to two fixed points (e.g.,house comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Proposal aDDroved Inspector's Signature & Title COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99NE ry)A%XN F-0 Ooo 0\ y fvy- f . 7to� PUTNAM COUNTY DEPARTMENT OF HE-A014 HOUSE PLANS All"'PROVIED. FOR BEELN"'OUCUl COUNT 0..i,,]!Y; _B E D FRO 0 M Sigrialkii-a & Title II tAl OU v ic �sn ru nd 1,4 1h0, la aid 17 li. ........ i I ' I l-' LMI is 1 tAl OU v ic �sn ru nd li. ........ i I ' I l-' LMI is 1 P3JTN_AM COUNTY DEIPAR'I'1V,��N'II' OF HEAI'T ,, .. 'jii.j��tf:y.n'i. ..�w•'an lb "r ^r a%- K{w•t«P ^� o.�•mr..� +�.Yn.tm DI SION OF ]ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # 7V.- Z 2- - °t 3 Located at (FbR mgm,LY .GipcN 4,cL kV 5) r Village a u 'qtr kK ✓ u� i57w Owner /Applicant Name 4.5 :f ON 5TR L) c fi'ia^J cozy Tax Map 7 -3, 1 e Block J Lot 2 `j Formerly Subdivision Name hit ck 1z 3 Subd. Lot # 23 Mailing Address 3 7 o oa,J y il.- M R p 0.S S t w 1V U X1.1 Y Zip 1 O S& 2 Date Construction Permit Issued by PCHD /O - 2 i - 9 Separate Sewerage System built by ys. c_,wsrrz uc+.00 c.ogp Address 5 A%�A ; Consisting of 12.50 Gallon Septic Tank and L101' L F 2' w 17E 7-R6 W c 1� E Other Requirements: Water Supply: Public Supply From Address ®n... K... Private. Supply. Drilled -by 4- u Building Type r( F r,,Er4tiAL- Has erosion control been wed? Number of Bedrooms 3WyRcow\, M5 &Q Has garbage grinder been installed? NO I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: .7- Z 2 _ 9 ! Certified by , P.E. o� R.A. t Address ZAI5tTE f; w6,tr4 Mil t,u�. , 5 QU�� -�,�u�scA.- F License # I q-51 �Rc -r ct�Rc ;?C, I1(l� 9'r 2 2, 'QZEw 5 T-S R, NY 1 dam9 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 revoc ion, modification or change is necessary. By: 1 Title: Date: White copy - HD 'le; ello copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional .v. ... r. Y�•r —. a y � „ •. :�. �.,1.. .. .. - �.. ....�T.R LCt'1�.�:�iY4.`ti'17111` =:.� ra � .. . •.'t.:•'- .. - a .. _- �.a. 28 Briar Hill Drive Putnam Valley, New York 10579 March 20, 2000 Mr. Bill Hedges Department of Health Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Dear Bill: Re: Map. 73.18 In accordance with our telephone conversation of last Thursday, March 16, 2000, attached please find application and check in the amount of $100.00 representing the application fee for the changes we would like to make to our basement at 28 Briar Hill Drive, Putnam Valley, New York. You indicated that you would secure a copy of the survey and C.O from the Records Department. If you Have a problem securing them, please let me know and I will send you a copy of my originals. Please call me at my office if you have any questions or need additional information. My number is 914 -964 -5200 ext 269. 1/c4 �, 9 Thank you for your kindness and help. .... Sincerel '- ,. LINDA B. ROSKOSKY ii acaL 4, fr 7�v4l 4.0 7 %4,A Id -7 k4-,.,,4o . I A!" 1 t� 41 a � . { h ' it - VI-,dG I I t I � • j { j � i i i t I � � � 1 March 14, �-000- T HE j- Putnam County Department of Health MiTF(k)RD 1 Geneva Road Brewster, NY 10509 Re: Freedom of Information Law request Site: DeLuca Farms, Agor Lane, Putnam County, New York Dear Madam or Sir: Please send me a copy of Putnam County's file(s) forlthe DeLuca Farms site, NY site code number 340018. The site is located at Agor Lane, Mahopac, Town of Carmel, Putnam County, New York. If Putnam County is unable to copy, please advise whether I may send in a copy service to review and copy the County's file(s). Please call me at 856-596-2544 ext. 405 with any comments, or questions. Thank,ypu fpr,your attention to this request. Ar; yours, D. Spear Atlantic Coast Environmental Claim Office 303 Lippincott Centre Suite 121 Post Office Box 428 Marlton, NJ 08053 Telephone 856 596 2544 Facsimile 856 988 3754 �Pf t i � I z ' 1 i �� f I I ... .... . I .... .... I . .... .... I I .... h E v7 if i ; i � i 1 I 1- PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES OFFICIAL USE ONLY U _ely,.0 SITE LOCATION XI e ll`jl *16 AO51 y�-- /K Y T M # 7/ �, g ' -7.-Z . OWNER'S NAME PHONE'S MAILING ADDRESS 2 ,, f�• %/ �, PERSON INTERVIEWED PCHD Complaint # Name & Relationship (i.e., owner, tenant, etc. DATE TYPE FACILITY PROPOSED INSI�TYTi.I~ R PHONE ADDRESS REGISTRATION# Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system .Different location may require submittal of proposal from licensed professional engineer or registered architect. Y; as owner, of reported "A&iit or'owner agree iy a c"` iuons siaiea un—dds fuiiil. SIGNATURE U `�/ �= // / J� TITLE e,�) -e --1 Prol2osal approved with the following, conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: DATE-,,3 a 3 st,� a. Owner's name b. Site Street Name, Town and Tax Map number. C. Location of installed components tied to two fixed points (e.g.,house comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Proposal approved " Inspector's Signature & Title COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML c� CERTR FIICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # mod-- 2 Z -- 013 ag a1ZiA,%z14 i1rLRD Located at (FbR mgmt,'r Gig c-&i q L- L R.£1 5� T 2y a -ter Village rout nt ✓�� 45•y' Owner /Applicant Name �. 5. �a�+ 5-rR c1 c -ho N Cow Tax Map 73, l g Block 1 Lot 2 9 Formerly Subdivision Name 4*1c -kV' 3 Subd. Lot # 2 3 Mailing Address 3 o► OO.J y p--M R 0 ©S S f w tV cm . W'( Zip 1 0 5 6 2 Date Construction Permit Issued by PCHD !O - 2 ( - '17 Separate Sewerage Svsteip built by �s. Coc�SrR �c +,oti z,ti? Address Consisting of IZ,So Gallon Septic Tank and kb t ' LF 2' W iVE -T"R6NcItC5 Other Requirements: Water Supply: Public Supply From Address DC Private Supply Drilled b � 3EAL- i- a P � a� ���� ®r: PP Y Y , . Sr��i S r �a.tc , Address Building Type Has erosion control been cold? Number of Bedrooms 3ibRcow\, 'Des , &:J 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 of the Putnam County Department of Health. Date: ;7-22- le Certified by P.E. o,/ R.A. �'DkegnPr a zonal) License # 1 '7 Address iTE i 31 Alr2� � -mac NR� �`r7c. IL( 85 fRr :221 M;:w 5 rR 1z' N'/ I ose'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 revoc ion, modification or change is necessary. W B \mil � Title: n � Date: Y• White copy - HD le; (el lo copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Well Location Street Address: Woodland.Estates Krarm R-nd Town/ViIlage: Putnam Valle Tax Grid # Svop'vtis 1,-rJ torn IS Map 75,t i Lot(s) z Well Owner: Name: Address: V. S. Co ration, 37 Croton Dam Road, Ossining, NY 10562 Use of Well: 1- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment _X__ Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 33 ft. Length below grade 32 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: X Steel Plastic Other Joints: _ Welded X. Threaded _ Other Seal: X Cement grout — Bentonite Other Drive shoe: X Yes No Liner` Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed x Pumped --)L Compressed Air Hours 6 Yield 5 gpm Depth Data Measure from land su ace.static specify ft) 100' During yield test(ft) 540' Depth of completed well in feet 605' Well Log If more detailed information descriptions or �av a ►alYScs are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 6 Drillinq in over urden clay and boulders 6 Hit rock t...61 4. ' S 33� Drillin in rock set casing,grouted � 33 605 Drillina in rock hcj'w. 12- Z°1 q If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity _%Wm Depth 560' Model 5GS10412 Voltage 230 HP 1 Tank Type WX302 Volume 86 Date Well Completed 12/28/98 Putnam County Certification No. 002 Date of Report 1 1/19/99 Well Dr' a ign ip ry .Elea I w't: exact location of well with atstances 7toa ast two permanent lanamarxs to tie provtaea off a separate sneevpian. 4 Putnam Avenue Well Drillees Name & Address: Brewster, NY 10509 Signature: Date: 1/19/99 er White copy: HD e; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller NORTHEAST LABORATORY OF DANBURY —01 Ce rf: '1 H� 4CV A 39 -3 : c • MILL PLAIN RoAID - DANBURY, OT 06811 b NY Cert: 11471 LAW (203) 748 -7903 - FAX (203) 748 -0652 LABORATORY REPORT -- WATER SUPPLY LY TESTING REPORT TO: P.F. BEAL & SONS DATE SAMPLE COLLECTED: 1/6/99 4 PUTNAM AVENUE TIME COLLECTED: 3:30 P.M. BREWSTER, N.Y. 10509 COLLECTED BY: W. MAYES DATE RECEIVED @ LAB: 1/7/99 TESTED BY: LAB# 11471 REPORT DATE: 1/11/99 SAMPLE SITE: V.S. CONSTRUCTION, LOT #23, WOODLAND ]EST., PUTNAM VALLEY, N.Y. SAMPLING POINT: HOSE BIB SOURCE: WELL TREATMENT: NONE TESL' PERFORMED RESULT: MAXIMUM CONTAMINANT LEVEL BACTERIAL: Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml PHYSICALS: Color 0 Odor ND pH 7.20 no designated limit Turbidity . 0.34 NTUs 5 NTUs CHEMISTRY: Nitrite N <0.005 mg/L as N 1 mg/L as N ____ .., .....: 11301 - Nitrate N . 1.9. mg/L as N _ 10 m.g/I, as N. Alkalinity ` ' '"230.0 mg/L " rio`de "sgrlated`iimits -- �' _ Hardness 256.0 mg/L no designated limits Iron 0.030 mg/L 0.30 mg/L Manganese 0.012 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium 3.0 mg/L 20 mg/L ** Lead <0.001 mg/L 0.015*** m1= milliliter mg/L = milligrams per Liter ND = none detected NTU =Units * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED: 1/7/99 SAMPLE, AS TESTED ABOVE: MOTABLE . or MkOT 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 TnT.1- FRF.F. WITHIN CT: 800-826-0105 ® OUTSIDE CT: 800 - 654 -1230 PUTNAM COUNTY DEPARTMENT OF HEALTH DIIO KTVTR.ONM1Eil I� ,?[�A;l�'I':crlP,-::1r GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM V15. Cor SfiizUC.T(v,\ eo,D_P. 73 tg ( Z9 Owner or Purchaser of Building Tax Map Block Lot 3?. 4fiZ0I_0N 7AMiZOA.0 COR? ` LI NA.Nl VALGEy Building Constructed by Town/Village ` 3i � my, I�1 LL 92aQ0 �FRevo-Y 15mr -(i UaL 1zo _5011t k) L I NC_ A. R 2ZT Location - Street Subdivision Name 'P-Z5, 1p ENr1NL 23 Building Type 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 W llful_Q negligent..a�.t of the.occ i4pant::ottk_e.buiIcli - E>,t�i1. Ir �the, — - _- The undersigned further agrees to accept as conclusive the determina on o the �ubli s alth Director oft Put am County Department of Health as to whether or n the, ailur, of th �s stem to opera w, 4 ca �, e by the willful or negligent act of the occupant Q, the ti ildi3r", g utili ing the sYLem Day 5 Year Signature: at t LI Title: ) - Signature V.5 CC)TZ? Corporation Name (if corporation) Corporation Name (if corporation) '-'/0 3-7 e ra o - o r%► D' �- t"i ;z, 0A. r> Address: _3 -;� 'ri?,T-n r j �.,. r� 2,&.p Address: State o SS : iv c N G Zip Z State Zip Form GS -97 .i .. Y PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE IN SPI�C'TI . =.�- . ,._ ....� Date: Street Location L Inspected by: Town Tivir. 3� ►�, -1 -Z� 0i ner t -- Permit 4 iii} - 22 Subdivision Lot 4 1.. Sewage S3 stem 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 tank size -1,000 .......: ,25 .........other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribtuion Box T—All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches Junction Box - ,properly set ..................... ............................... lengt required , >79 Length installed 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ......... .......... ...................... 4. Slope of trench acceptable 1116 -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 %" :diam..eter clean ........ ...::.: o: g av &t n ifencri 2. ":mi ffi mum:::.............. 10. Pipe ends capped ........................ ............................... g. Pump or Dosed Systems Size ot pump. chamber ................ ............................... 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. Houuse/B�uildin� a. ousH a located per approved plans ............................ b. Number of bedrooms .................. ............................... IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured ft........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... : d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to-exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... r7: I DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New.York 10509 (914) _27 -61,30 . %f �i i.es �..��.•x� �-v "S. -1 ,wr r wY -'�:v a:� ..:.F^. �a+-Y �s�CJ.:i�vti :il . o.. i� a...a. .. .�' •tyr .�,. ..:=i i.:; ia-.:r ^�c�ti: APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT #PV 22-13 WELL LOCATION Street Address r Lt- . Town/Village/City Tax 76 .16 Grid Number -- 2 WELL OWNER Name " Mailing Address . y Wrivate _-? O Public USE OF WELL primary secondary ?RESIDENTIAL D BUSINESS 11 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify p AMOUNT OF USE YIELD SOUGHT C-> gpm /# PEOPLE SERVED _ /EST. OF DAILY USAGE 4t7 gal O REPLACE EXISTING SUPPLY O TEST /OBSERVATION Q ADDITIONAL SUPPLY -NEW SUPPLY NEW DWELLING D DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN ODUG GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Z JINC./912 Lot No. 23 WATER WELL CONTRACTOR: Name U 4uow" Address: ()JJVK16WO IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: W LA TOWN /VIL /CITY f� D1:•S ANCe TO °PkO'r'r;rfx FROM- W-r;AR S `Wk'fZR -MAIN: :�- LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED VPN SEPARATE SHEET (date) s gnat r eh 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 contamina a surface or groundwater. Date of Issue: „� ---- -- Date of Expiration 19 e2!�� Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller e va ROad, Br Sterl Health Servic APpLICAT (914) 27g_6130eW York 105095 zpN Street Address TO COjjSTRUCT A WATER ��a�a , t . , s WELL U STAND -By ""11uN OYJEO ® (SPO' TEST V '� /EST. DE /OBSERVATION OF DAILY USA(s� EPEN EIS '2' ADDITIONAL SUPPLY TING WELL. °RILLED IS WELL SITE SUBJECT T DRIVEN 0 FLOODING? YF ALL YS LOCATED IN ®DUG �ATE'R �� S�DIVISION YES ®GRAVEL ®�� 1-11 IS ALL CONTRACTpR. N� 9 NA SUBDIVISIO NO N P�LYC VATER SUPPLY AV e -f LO t No OF P�LIC AISLE TO SITES Addr WATrrn DISTAAYr� - SOURCES OF CO -ten SEPARATE SHE �'EIMINATION ess: S Permit t0 s1gnat ) 'ubPart . constru pE�IT on t), (30) days o f t t s of the ter well a0 set A WA �-- W pu he cOm New Yo et fOrt ELL D mP the well Pletion of k State Sa h above is Depart ect the ell l the water . water well cons y Code, and rated under the a ubmit ma Well ached to thlS dae ce with the ruct1On9 the appl c rat Within cons a 1 Well r�illing Operation Report 011.a fo requirements of the Putnam shall: Y and in such waste Product ns, the app 1 ' rm Provided by the team County HeaIt:1h Essue: net as not ftO degrade such ell d ill take apPz-o Putnam County Health DeVa� , xP1ratiOn 1g or O ling operat:. Priate action` -` 3 � rwise coat 1Ons be cons to assume � Mon-Tr ans 19__ ate surf aired on tjs ferrable Penn ace or grourx dw,;� Whit, it Issujng Qf �-;a • - PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of. UNCAP- MYF_-LCPMSNt GO. 1W, Located at BIRCH HILL 91). falt (T), PU:IhW )JALLE, Y Section_IL& Block Lot Subdivision of LINCAP- JIL 5-UMMUN Subdv. Lot # Filed Map #2q5aA. Date qblM Gentlemen: This letter is to authorize Nblirl ENGINEE-EAW-5 Mb L 515N PC a duly licensed professional engineer o 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 ..p:onnectio. 'with..-. hj�L. matter and to supervise the construction of said ,syste,m.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 Signed Countersigned • P.E. lFf:M Address t M.Otl+ CD -CAK M_ E I N-`(: 10512 E68 -.Telephone 8 Address •IttLE FED( 1 K-d • rl(P43 Town 2b1 -44U -400 .,Telephone . - /.. P'UTNAM COUNTY DEPARTMENT OF HEALTH Division of Envrironmental Health Services ... ~Aa: FIDA�Ii� 4.l1dYVcu tB' VWNZ' b^ " 40ar FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health in the matter of application for: represent ghaIt g am an officer or employee of the corporation and am authorized to act for �� � CO• b.N�. ame of Corporat having offices at 261 _tf Whose officers are: President: Donald Nuckel 281. Liberty Street Little Ferry, NJ 07643 (Name and Address) Vice- President: (Name and Address) (Name and Address) Treasare_: (Name and Address) and that I am and will be individually responsible for any 'and all acts of the corporation with respect to the approval requested and all subse nt acts �eI thereto. S;bora to before me this day 19 9`_3 _rota . Public. . ARLENE FAUSTINI NOTARY PUBLIC OF NEW JERSEY MY COmm fission Expires June 24, 19% E.�s- Signed: Tit1e: Cnrnnrate Sea j DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914),278-61.30 _. APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT WELL LOCATION Street Address Town/Village/City Tax Grid Number BiQ::A4 "IL,L V-D sok_AH 90-t1 i4m N/p1.1 t'-j 29 WELL OWNER Name i.iNC¢1? DE�1..Cja Mailing Address a� i.�,ik,Private IaC Zbl t.1F,EX" yr• k-'*L FC�I, OPublic USE OF WELL d) - primary 2- secondary tO RESIDENTIAL O BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY 0 AIR /COND /HEAT PUMP O ABANDONED 0 FARM 0 TEST /OBSERVATION 0 OTHER (specify O INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT S gpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE 300rgal O REPLACE EXISTING SUPPLY 0 TEST /OBSERVATION GI ADDITIONAL SUPPLY MNEW SUPPLY NEW DWELLING) 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE Uzi DRILLED DRIVEN DUG 13GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: t_.IF -iC-6. re— Lot No. 2�S WATER WELL CONTRACTOR: Name L I► AK*X:)V 111 Address: Ui-AY4,10W 14 IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: Jim TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN__: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED SON SEPARATE SHEET (date) ig ture) 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 thirt3• (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 drillin operations be contained on this property and in such manner as not to degrade or othe i conta inate surface or groundwater. Date of Issue: 19 13V Date of Expiration 19 If Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller 71 24'X 40'e %0 Sq. Ft 40'-- Zzo- rri .0 PI,ZDJkRTMENTT OF PEAT, d C_ HOUSE 7,T,p.�j�D APHT'r- FOR BEDHOWI! C 0L'!: 71, 0., 1 LY M C, < -LETI") Q 00) N, S f' C cn Sig=nature uTitle Date A STANDARD WESTFORD FEATURES o 3-Spacious Bedrooms o Consult an Authorized Westchester Builder o Country-Style Eat-in Kitchen for a Complete List of Options o Fireplace Options Available ® Artist's renderings and Floor Plan Dimensions are approximate. All specifications must be Written in the contract. No oral conditions. ESTCHESTER MoDuLARIHFOM-ES, INC, 1A.f P.O. Box 900 Dover Plains, W 12522 (914)832 -9400 ® (800) 832-3888 ENGINEERING; SURVEYING & Route 22 (914) 278-4990 Brewster, New York'1050 9 (914) 278-6392 7 Del-avergne Avenue (914) 297-1742 Wappingers Falls, New York 12590 TP: T.E.R.OF-T. AM TTA Date: lt- 9 1 DESCRIPTION 1 Job No. 1)( 114-7.3 Z-3 Attn: 9A v,, !;-r i e- a 6 L Re: trr - Ga - WE ARE SENDING YOU Attached ❑ Under separate cover via the following items: ❑ Shop Drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of Letter ❑ Change Order ❑ COPIES DATE I NO. ........... 7 DESCRIPTION Z- - f (-901 c c- cl -7 'Zoo IV -er ............... ..................... ............................. ..... . ....... . ............. ........... ---------- - ---- ------ -- ------ - - ------- - ------- ----- - ------- --------------------- ............ --------------- - -- - ------ ------------ -- �-..--.-...THESE.AR,E-TRANSMITTEDasc,hepkqctj;t��lqv�7_ tz-ro-ri�pr-ova-r -5�16URbitfid—n-W,�ubmit- El For your use ❑ Approved as noted ❑ Submit ❑ As requested ❑ Returned for corrections ❑ Return ❑ For review and comment ❑ REMARKS: COPY TO: Lot98.dot copies for distribution corrected prints IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE "'NEER" LETTER OF TRANSOTTAL P� .C. --��s` E NG INSITE uR0,0 4, ' Route 22 "r Brewster, New York 10509 Fax.- 914 278-6392 7 Del-avergne Avenue (914) 297-1742 Wappingers Fallsi, New York 12590 TO: P<— t1j) DATE A checked below: ATTENTION rho 15 1-no ez -e- 1-5 RE: &C77- Z. For approval Approved as .7 WE ARE SENDING YOU Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans. ❑ Samples ❑ Specifications ❑ Copy of Letter ❑ Change order ❑ -:7- THESE ARE TRANSMITTED as checked below: For approval Approved as submitted ❑ Resubmit copies for approval ❑ For y6ur,use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ a ❑ FOR BIDS DUE 19- ❑ PRINTS RETURNED AFTER LOAN, O US REMARKS: Insite Engineering & Design, P.C. 1849, Rt. 6 Carmel, NY 10512 TO 91 C. H. P. > WE ARE SENDING YOU OAttached ❑ Under separate cover via- • Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ (LETTEM OF cMUSEDUML the following items: ❑ Samples ❑ Specifications COPIES DATE •!B N FAT-T E Nr i RE: G%29 /1 C44--i,_St V, PE vZM tl .,SPP L, A /I ttEP A \ bt4 the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION G%29 /1 C44--i,_St V, PE vZM tl .,SPP L, A /I ttEP A \ bt4 b129 A3, b1241 R3 THESE ARE TRANSMITTED as checked below: zz L-]� For approval ❑ Approved as submitted ❑ Resubmit copies for applaval ❑ For your use ❑ Approved as noted ❑ Submit copies for distri ttfj on > ❑ As requested ❑ Returned for corrections ❑ Return —corrected prints i . C r ❑ For review and comment 0 -;–� ❑ FOR BIDS DUE 0 PRINTS RETURNED AFTER LOAN TOSS 19 S REMARKS— C-) COPY TO SIGNED: 0 PUTNAM, COUNTY DEPARTMEW OF HEALTH _JDIVISION OF ENVIRONMENTAL HEALTH_ SERVICES_ _ N t" .; x,.r.*..:,o,v:. r�v`-i^i.�it ?veQie+- :.w.:+i.,....iu.. �t c.�",.�T.... dCK ;�•on= .r- ..,'t•- ✓' Date �? Re: Property of LINCA9 DEV�LO�NtEo`I'r' Go; INC. Located at 13 KC A HIL-L- P-OAD S aTH (T) FurWA, A VALLEY Section 73. 16 Block' Lot Subdivision of LIkC-A,?: 5UBDIVI!E-_>1,n1A Subdve Lot # L Filed Map .3,&, Date Gentlemen: This letter is to authorize Insite Engineering & Surveying, P.-C. a duly licensed professional engineer x 9ccx cf "x&4?x �cSc xix 2Sc (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 ' O:c ..6._c.l..d_ - ... _ • ilia i"i cI .. `•• system or systems in conformity with the provisions of Article 145 or 1.47, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned. Jeffrey J. Contel P. E. , fix, # 61931 Insite,Engineering & Surveying, P.C. Address Route 22, Brewster, NY 10509: 278 -4990 Telephone Very t Signed z-✓,,W,er o2 'Property Lt�c�.� pEV�c.pPP�tetvT cro.� �t�. Address L► ': L F5KR ` 4 IJ _� . 17 o 43 Town V1 - 44o - 4 -7oo Telephone G DPTISICN OF ENVU492,01M HEALTH Sa MS FI_TS. `n. . 2b1 L1gE�( sz�,tsc Omer Us4CAIZ MWELOO-It T' CO,jI Address LuTTLt r- *MZ.YstvJ VIto43 ` Located . at . (Street) 51MOH 1-11 �-L ROAD . 5o u'�1 -1 Soc.. 713• Vb Block 1 Lot 29 (indicate' nearest cross street).: tKunicipalitySrsA ye.�,LEY- - -. Watershed SOIL• PERCOLATION TEST DATA RRXLRM TO BE SUBMITM WrM APPLICATIONS Date of Pre- Soaking N %A, Date of Percolation Test V-4. A HOLE. NU14BM CI= TIME PMM ATICN PERCOLATION Run Elapse Depth to Water From Water Level No.' Time Ground Surface In Inches Soil Rate ...Start-Stop Min. Start Stop . Drop In MWIa Drop Inches Inches Inches I • 2 A btiS1UN FE RC,OLAT10N 7,&Tf of I i-l5 M,M�,N 1C TAXEM FV.C" -TV4S Fit_ZD .MJ�P`.a Z 3 F%, GD q S/bq, 3 4 5 ..�, M 1 NO z M. 3 .. . 4' 5 cn 1 � � • 'ra 3 4 5 t'MES: 1. Tests to be repeated at same depth until appraximately equal soil rates are obtained.at each percolation test hole. All data to* be subnitted for review. 2. Depth measurements to be made from top of hole. rev. 9/85 77 CZSCRIMON OF SO= RjCCQ'11-r—E M hOLF-S DEPTH HOLE U0. ROLE NO. 20 30 ...... . IFE 40 5' it 60 70 J7.m.l. 80 Cj -7 -O' ecc'y- G?. ' -7 go 106 12' 131 nmMkTE!j 'COUNTERM _qRpq�� IS, &N INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEffd-ERttm DEEP HOLE OBSERVATIONS MADE BY: NiS-tr-> U1% �4 4 GCO�SU"Xs C- • DATE: 1) A-7 DESIGN Soil Rate Used Min/1t° Drop*. S.D. Usable Area Provided Noo Of Bedroans- Septic Tank Capacity gals. Type Absorption Area Provided By 3-76 L.F. x 24" width trench Other V-0 R.n. 6 - � 70�NE �J,,o __ Ze Name i1-4s-tY5. 4 1>S5(QJj C-Signature Address 1&41 VtouvTE ep SEAL fi� mg? 6193A THIS SPACE FOR USE BY HEALTH DEPAFMTM ONLY: Soil Rate Approved sq.ft/gal. Checked by Date .LLL LC 5T Z 1 PUTNAM. COUNTY DEPARTMENT . OF HEALTH , v^ e•,r, ► n•i r w ;fix = "f ; a , :�"s. Rr T.f.. ? �: tc.�<ra �" �°RS:4 �is �a,. ..-r ar f � -F�±'1 4 �r •a'�'�i= .. ra -:r� : - . %. , - . I- 7. ? y�a:f,°:. . ->. e• .r� =. -tom I.. Name and Address: of ,Applicant: L INCA? DEVELoF MEt#- CO., WC 2E1 Ub" tt WtLE M9izY N• _ !. Name of Project: 95D5 FOR LINCAR. MELOPMENt 3. Location .I /V /C: R.1fiNAM VALLEY. ,., °•: � ao• , INC Project Engineer: IN°Si1E ENCalNEMWI AND DE.SIC-aAl(n5. Address: V9 ft (p . CARMEL., rl.Y. Io512_ - . License Number: CP19?Sl Phone: q14 -225 "l�l� • T Of Pro ec e t: Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) • Is this project subject to State Environmental Quality Review (SEQR) ?. .` Type Status (Check One) Type I.. Exempt Type II. Unlisted - • Is a Draft Environmental Impact Statement (DEIS) required? ...:......... Pb • Has DEIS been completed and found acceptable by Lead Agency? ........... NAA . Name of Lead Agency NiA Is this project in an area under the control of local planning, zoning, ELM CePF• W ._or,...other-kff.iclals. ordinances ?. If so, have plans.been submitted to such authorities? .................. No i:; -; �-n Has preliminary approval been granted by such authorities? WA Date Granted: i±� =� M Type of Sewage Disposal System Discharge...... Surface Water . X Ground Wate;rg r `; _11�A- If surface water discharge, what is the stream class designation ?........ -< Watersindex number ( surface) .......................................... NfA Is project located near a public water supply system? ...... ............. No If yes, name of water supply N/A Distance to water supply N A Is project site near•'a public sewage. collection or.disposal system ?..... NO Name of sewage system Nr'id► Distance to sewage system N�,... Date observed: UNKNOWN 23. Name ,of Health Inspector: LINMc51NA Project design flow (gallons per day)......... ............. a ...........:.. v 00 2. 4 : .. . . .. I . 25. Is. State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. X10 j 26. Has SPDES Application been submitted to local DEC Office? <°o . ............. N4 27. Is any portion of this project located within a designated Town or State wetland?.... ............................... ............................... Nb 28. Wetland ID Plumber .................... ........o...... 29. Is Wetland Permit required? .......... aaaaoo0Daaee >.. Has application been made to Town or, Local DEC Office? >..y ............. MIA 30. Does project require a DEC Stream Disturbance Permit? ................... NO 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 or NO NO 32. 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: 33. Is there a local master plan or file with the Town or Village? ........... Yr;�5 34. Are Community water, sewer facilities planned to be developed within 15 years? NO 35. Are any sewage disposal areas in excess of 15% slope? ........................ ND 36. Tax Map ID Number . ..... ... . ..... . 37. Approved Plans are to be returned to: ................. Applicant Engineer If the application 1s 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 fora 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 MAILING ADDRESS: . . -..::: ...,, :' _ . _RE�:2Rft•1�W1YFp�.r .L..C" Gam, r�f � r, nC+;;� PC. t4 -~. ezC�Y�'S..V P >Gls". •.mac •��,•.dY��'. -•.. Alf `b�9'�,f 10 ^nF' '�i(e• i}'•.- .r Q4 E_�'.�. � .�....W•�.•y v2f b,- 1iv.Ci �• IvN.. •. _ J7 CROTON DAM ROAD OSSINING, NEW YORK 10562 T 22 AS —BUILT AIL45UMENTS i I 42' 20' i 1250 GALLON SEP PC TANK 2 110' 87' CLEANOU r 3 151' 129' 6 WAY DISRIBUAON BOX 4 97 8C END OF TRENCH 5 i02' - 86' END OF TRENCH E 104' 90' END OF TRENCH 7 215' '9!' END OF TRENCH 8 2,5' 193' END OF TRENCH 9 217' 194' END OF TRENCH �10 218' 196' END OF TRENCH SITE LOCATION: TOWN OF PUTNAM VALLEY PUTNAM COUNTY, NEW YORK TAX MAP NO. 73.18 -7 -29 DOTES: 1. THIS IS TO CERTIFY THAT THE SEWAGE TREATMENT SYSTEM NAS CONSTRUCTED AS INDICATED ON THIS PLAN AND THAT THE SYSTEM WAS OBSERVED BY INSITE ENGINEERING, SURVEYING AND LANDSCAPE ARCHITECTURE, P.C. BEFORE IT WAS COVERED OVER. THE SYSTEM WAS CONSTRUCTED IN GENERAL ACCORDANCE KIRH ALL STANDARD RULES AND REGLILA77ONS OF TFI£ PUTNAM COUNTY DEPARTMENT OF HEALTH AND THE.NEW 'YORK STATE DEPARTMENT OF HEAL TK 2. ALL: FACILITIES EXISTING,' UNLESS'NOTED OTHER895E: J. -PROPERTY L!NE,..HOU5E LOCATION, .AND•W£LG 'LOCAT.LON TAKEN FROM FIELDWORK PREPARED BY INSIT£ ENGINEERING, SURVEYING & LANDSCAPE ARCHI TECTLOE, ,P C.,. COMPLETED. 4- 28 -99. l'a%09a County Department or meaLu Jivlalon as tal Health 8ervioe+ Approved as noted for oonfor me with applicable Holes and Eeplaticros at, the, Pu Cotmty tb Departaenti.f. - '� ��ITofitre � ,41 iM�� NO. I DATE RENSION I t r ® T 1485 Route 22 IV S ® Brewste.; NY 10509 ` `°' ENGINEERING, SURVEYING & (914) 278 -6392 for L r/ LANDSCAPE ARCHITECTURE, P.C. www.irsile- eng.com PROJECT•. SS TS FOR of NEW r V. S. CONSTRUC77ON CORP. `O"r LINCAR 3 SUBDAISION, LOT 23, PUTNAM VALLEY, NEW YORK t DRA. WING. AS —BOIL T `trig W DRAWING R B PROJECT N0. 81147323 PROJECT . JJC MANAGER AW1NG NC. AR- SHEf 1 / DATE 2 -3 -99 8Y MAP x, �ti ... w,n •c� WELL " .A-- AL7ERA770N OF THIS DOCUMENT, UNLESS UNDER 777E DIRECTION OF A LICENSED PROFESSIONAL EN&MEER, IS A WOLA770N OF SEC770N 7209 OF ARTICLE 145 OF 7HE EOUCA77ON LAW