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HomeMy WebLinkAbout0741DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 24. -1 -18 BOX 8 ir ., ` , 16 1 If i� IL L 14 ir 0074 BRUCE R. ''F&EY Public Health Director Mr. & Mrs. Romano 32 Country Hill Rd. Brewster, NY 10509 Dear Mr. & Mrs. Romano: LORETTA Ni OLINARi R.N., M.S.N.'. Associate Public Health Director Director . of Patient. Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental . Health '(914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914).278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 March 17, 1999 Re: Addition- Romano- Country Hill Rd.. No Increases in Number of Bedrooms (T) Patterson Tax # 24 -1 -18 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 17, 1999 The addition is approved with the following conditions. 1. The total number of bedrooms must remain at Three without prior, approval by this. department. 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. Any other permits or. variances required are the,responsibility.of the applicant and the jurisdiction of the Town of Patterson, If you have any questions, please contact me at your convenience. Very truly Y - William Hedges WH:kg Senior Public Health Sanitarian BRUCE R. FOLEY, R.S. Acting Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) '278 -6130 ADDITION APPLICATION = ,RESIDENTIAL ON Y STREET- TOWN TX MAP # CJJ� NAME. PHONE /`�8 ?�� PCHD PERMIT # l��J MAILING ADDRESS ��2. CguY-Ay-� 14'l Description of Addition V<Xm A (2OOrh D Number of existing.bedrooms Proposed number of bedrooms 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. Please submit this form and the following to PUTNAM COUNTY HEALTH DEPARTMENT, 4'GENEVA ROAD, BREWSTER, NY 10509, Phone 278 -6130 with the following information. 1. a ck.for $100.00. 2. o _ _ oor plan syi including basement, if any) Non- professional drawing is accep,a e. , 3. Sketch of floor plan. Non profe na awing is acceptable. 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Include all wells and septic systems within 200 feet of property line. Any questions please contact this office. OFFICE USE Comments and /or conditions application August 1995 . ,. -. PUTNA COUNTY. DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL ADDITION % REPAIR. FORM SECTION A. "GENERAL INFORMATION Name o t 3'L Co w �%4� 4 � ��,,._... f Projec 96V' TM# Year of Construction Size of Parcel SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. 'lly molling CIS,teep, slope entle slope O 2. OEvidence of wetlands OLow areas subject to flooding . Chodies of 'water 06;; n age ditches Mock outcro "s \ , ns. 3. Property lines evident? ..._- .... O 4. Water courses exist-on, or adjacent to parcel? ❑ '200f'of the exin "8STS5. Existing individual wells wiu stig SECTION C. , EXISTING SUBSURFACE SEWAGE TREATMENT.SYSTEM (SSTs) ..., ; 1. Physical character of existing SSTS area. .r pe 17st6ep slope A. OLevel. L`Gentle Isla B. OWell.drained L`iMod well drained OSome what poorly drained OPoorly drained C. Area available for SSTS. (Primary & Reserve) CIE xtremely limited Somewhat limited Ild'equate (1) Indicate . location of SSTS A Size and typ6o; f septic tank gallons Metal OConcrete oplastie, B. Type of absorption area 1:'Fields : `ft. 2. Pits 3. Gallies ft. (2) Indicate setbacks, front street, backyard, and side yard dimensions (3) Shom location of well (4) Show location of driveway (5) Note physical features (steep slopes, rock outcrops, - streams /wetlands) SECTION E. EXISTING WATER SUPPLY OPWS COMMENTS: IjShared well L irhdividual well Ruled OD'ug— 6Casmgcabovegroimd e a �Aht C pG * * BRUCE R. FOLEY, R.S. Acting Public Health Director DEPARTMENT OF HEALTH . Division Of Environmental Health .Services " 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 Putnam County Dept of Health . 4 Geneva Road Brewster, NY 10509 Re: Residence Tax Map o2 Town Gentlemen: According to records maintained by the Tnm, the above noted dwelling IS IS NOT in compliance with Town code and the total number of bedrooms on record is This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER Building Inspector _moo -7C--) IVIOC 'n Z5 C: C'n CD m rM 2•--v CD qp� r r - v' O�L48� MOT co I T- W-4 Vr Al +1 ..l. Or SA Ift 14 !Lilu 1� LmalLu ow 1P�I I I RC flo t A! . P. I I C. G to 267 —94 '� �6--s� 12'9 . l 51 M M I 7 20'5 32 'k 275 I 267 _I 0 b 4 coL,,-4n ll (7)C' ,j O NRM SITE 10 =ON MAILING ADCRESS FiTVAL ,� :�� PROPOSAL FOR SEA DISPOSAL SYSTM REPAIR ,x..33,-... PERSON INT RVIEwED � PM Complaint Name & Relationship (.e, owner, tenant, etc.) DATE TYPE FACILITY PF4POS,ED Il6TAIJ3t l /3 PHONE REGISTRATION # pr 1 (include sketch locating all adjacent wells): Non: Repair must be in same location and of same type as .original sewage disposal system. 'Di'fferent location may require submittal of proposal from licensed professional engineer or registered architect. AF r i a d♦ O o e zz,,es Proposal approved -- Proposal Disapproved Insaector's Signature & Title Date r000eal approved with the following conditions: 1. Procurement of any Town permit,. cable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's. name. b. Site Street Name, Town and Tax Map number. c. Iodation of installed.components tied to two fixed points (e.g.,house corners). d. System description (e.g.,.1250 gal. concrete septic tank, three precast 6' diem. x 6' deep drywalls surrounded by one foot + gravel) . e. Installer's =6-and number. 3 System repair to be performed in accordance with the above proposal and conditions. I, as owner, or reported a of owner agree to the above conditions. SIGNATURE TITLE lPgS: V&te MD); Ye] law Crown ffi); Pink (kptiomnt) N L- �wT1a..1 A -i= Irr `l S T= A_5.7 a., S', say eY n wlAL-WYT +445 t - 41954 A,wuST ,o, vqq' g Mae 9—f--ad Ar: V-q . Peait�j .Corp. �zs P 15 -G-7 -a So3 WIT # G 1'Z!,L z� 34s'.001 9 ol�i li oe�� S 4° Io Ir �` 62 - e6.0 ,�V1�✓ SSos �s 3UELZ( ,KG OwN ck �n-ii �25CtJ ----- V �.�., u. �'Y� ^�-Y• /oivision Mtic Putnam County Department oY Health o,°, Environmental Health Servioee � T/Jp_ t f' a �Approve� as ..oto3 .o_ confo!aance with ,�c1.�� /- Z4-3 5 s app11aa51c FL cs and P.agulations of the gcPe$SIon ?� Putnam county Eealt Lepartment. Signs u Dat e (7 2aC�aia� 1Li�.Ctv.1 1i A:t,- ^�E� %• r�ee+r'- Cau't` \dam a% ��•fA/SN S1[�r.t -t= +1.?%, 1'ccvi.��� c�¢]IFY4L fI,EStwnas L7tSA�S�ItJ',C:aLt u1.o� �uc'1->zucr•t I� Q� L r� a�.:*�s~� ry u ltia �c P��a ..t '-AA'4- -Tff-Sat7=r.M4 l..i�4STtivL>ccT�i7 Y Of ' �Dastau'zvAnvt P�i�rin.s I i v.1:.cL �E2c�aD OuEiZ. Q�cglnAuc� "ICJ �ua�T,:LY�c;J I. Tror \ in I �1.� 130 Jd� t1�,4sa M � Y / L oUC. Co o Ir �` 62 - e6.0 ,�V1�✓ SSos �s 3UELZ( ,KG OwN ck �n-ii �25CtJ ----- V �.�., u. �'Y� ^�-Y• /oivision Mtic Putnam County Department oY Health o,°, Environmental Health Servioee � T/Jp_ t f' a �Approve� as ..oto3 .o_ confo!aance with ,�c1.�� /- Z4-3 5 s app11aa51c FL cs and P.agulations of the gcPe$SIon ?� Putnam county Eealt Lepartment. Signs u Dat e (7 2aC�aia� 1Li�.Ctv.1 1i A:t,- ^�E� %• r�ee+r'- Cau't` \dam a% ��•fA/SN S1[�r.t -t= +1.?%, 1'ccvi.��� c�¢]IFY4L fI,EStwnas L7tSA�S�ItJ',C:aLt u1.o� �uc'1->zucr•t I� Q� L r� a�.:*�s~� ry u ltia �c P��a ..t '-AA'4- -Tff-Sat7=r.M4 l..i�4STtivL>ccT�i7 Y Of ' �Dastau'zvAnvt P�i�rin.s I i v.1:.cL �E2c�aD OuEiZ. Q�cglnAuc� "ICJ �ua�T,:LY�c;J • J•ti � � ral• J I:r� DIVISION OP ENVIRONMC m Hawn smicEs PROPO6AL FOIL SERB bwposAL SYS'ZSrI REPAIR r . 3— RIOZ lcp-e7 4& PHONE PQID Complaint # N=e &.Relationship (i.—el owner tenant, etc.) DATE TYPE FACILITY PRfJP06ED INSTALLER 7' / _ PHONE ,REGISTRATION # wal (include Wwtch locating all adjacent wells): NOTE: Repair must be fn 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. —:�� r � -xp ezo Z a ' -54•e,.��s /.a ✓c--- `"� ��`� 's Signature & Proposal Disapproved Cate showing: a. Owner's name. • b. Site Street Name, Town and Tax Map number. c. Location of installed owponents tied to two fixed points (e.g. ,house corners). d. System description (e.g.,.1250 gal. concrete septic tank, three precast 6' diam. x 6' deep drywells surrounded by one foot + gravel). e. Installer's new and mmiber. 3. System repair to be perfonmed in accordance with the above proposal and conditions. Date I. as owner, or reported of owner agree to the above conditions. SIGNATURE Z1111 TIME white (BAD); YelI Clean ffi)t Pink LVAlout) I Vd . 4 �44 I'A T t, OW AS 4t I rj Kitt— "r � A 14 U) CQ is J 14 di �qy I rj Kitt— "r � A 14 U) CQ is J LABORATORY REPORT TYPE: P W LAB ID NUMBER: 95 -4656 CLIENT: Key Realty Corp 93 Gleneida Ave Carmel NY 10512 SAMPLING LOCATION: Kitchen tap :.. Lot 6, Country Hill Rd,. Patterson NY 'COLLECTED BY:. R. MciSWson DATE COLLECTED: 08/14/95 TIME COLLECTED: 3:30 PM DATE RECEIVED: .08/14/95.- DATE OF REPORT: 08/17/95 ANALYTE RESULT UNITS METHOD ANALYZED Total Coliform Absent Colilert 08/14/95 E. Coli .....Absent _.......:. Colilert - 71_.7.___-- 08/14/95 This sample, as submitted to the laboratory, and. as compared to the New York State limits for drinking water quality for the tests. performed, 'was: ACCEPTABLE. NOT ACCEPTABLE. Laboratory Director NYSDOH ELAP #11218 ' CT Lab Approval #PH -0171 . 1 618 Clock Tower Commons, Rte 22, Brewster, NY 10.509 1 914.278.7600 I Fax 914. 297 =0536 0 i WELL COMPLETION REPORT Off ice Use only DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH.0 STREET ADDRESS: WELL LOCATION TAi 61110 NUMBER: . i WELL OWNER NA nuunwa. , �d �,�II �. PZPBIVATE PUBLIC E OF WELL SIOENTIAL PUBLIC SUPPLY -❑ AIR /COND./ EAT PUMP 0 ABANDONED 1 primary BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) - Secondary p INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /NO. PEOPLE SERVED _/ EST. OF DAILY USAGES gal. REASON FOR NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION DRILLING REPLACE EXISTING SUPPLY.• .. ❑ DEEPEN EXISTING LL DEPTH DATA . WELL DEPTH J ft. STATIC WATER LEVEL . ft. DATE MEASURED ORILLING ❑ ROTARY 9CA COMPRESSED AIR PERCUSSION ❑ DUG WELLDRIU#MREWS WELLDRILLINO IN ADDRESS Clapp Hill Road sic>. LaGrangeville, N.Y. 125 EQUIPMENT ❑WELL POINT B LE PERCUSSION 0 OTHER (specify): WELL TYPE .1 0 SCREENED. .: ❑ OPEN END CASING. VOPEN' HOLE IN BEDROCK O OTHER. TOTAL LENGTH - - - -Q fL MATERIALS: IV STEEL O PLASTIC O OTHER CASING LENGTH :BELOW GRADE it. JOINTS: ELDEO ' O THREADED O OTHER DETAILS p1AMETER S in SEAL: MENT GROUT O BENTONITE OOTHER WEIGHT PER FOOT Ib. /.ft. DRIVE SHOE ES O NO UNEA: OYES 'ONO' SCREEN DIAMETER (in) 'SLOT SIZE LENGTH (Iq DEPTH 70 SCREEN'(,!) . DEVELOPED? FIRST DETAILS o YES ONO SECON _�. __ ..:...._ .. ; _.. _. _ _ _ _.___ .. _ - HOURS GRAVEL PACK YES GRAVEL 'DIAMETER. Top sorroM ❑ NO SIZE OF PACK In.- DEPTH tl DEPTH It. WELL LO If more detailed. formation descriptions or'sie4e analyses. WELL YIELD EST It detailed pumping YSf are available, piease.attach' M 00: O PUMPED i tests were done is in- DE MPRESSED AIR ;formation at 'h d7 s V 1 0 .❑ OTHER ;OYES NO It. WELL DEPTH DURATION ORAWOOWN YIELD SUM IL hr, min. It, 9Dm- - n WATER ❑ CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? .O YES O NO PUMP INFORMATION TYPE CAPACITY MAK R DEPTH MODEL ,.,... VOLTAGE HP P9�AI RK I V Well Dia- FORMATION DESCRIFnON COOS. s., 4 STORAGE TANK. T YP E CAPACITY , GAL.,..:,., WELLDRIU#MREWS WELLDRILLINO IN ADDRESS Clapp Hill Road sic>. LaGrangeville, N.Y. 125 OAT q s., 4 —,� . _ .. ,. n -.1 _ 11, i✓ DIVISION OF ENVIRONI MEWAL HEALTH SERVICES ..__ _ Owner or Purchaser of mca -13P --- Building Type Section Block Lot U Subdivi ssiion V / Subdivision Lot # GUARANM OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the 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_" . f.or...the sewage disposal system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of - Environmental Health Services 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 ing utilizing the system. Dated this day of 19 Signa General Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk Ti r Y ................ . . . . . . . . NE. N 6d I V 'N& 7W 72 �Z �v I I l �ZT4�m S1fcd&!ow- 4 � Z: TIM IN - t gpi, , -4 4e Z.i V Y�,sq - a_tp . Title.- !yam N � i5111. Aw will 11 "i- hKt., W'iAoim MI' NIA if , Out"afn u,,.... DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509. (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT 0. WELL LOCATION Street Ad less T ge City �.. i2d N Tax Grid-Number' Z -- 7 WELL OWNER Nam. Ma' lin Address 3- Private O Public USE OF WELL 1 - primary 2- secondary e% ESIDENTIAL O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O ABANDONED O BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify, 0 INDUSTRIAL O INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT _gpm /# PEOPLE SERVED 1p E] REPLACE EXISTING. SUPPLY 0 TEST/ OBSERVATION SUPPLY NEW DWELLING) L} DEEPEN EXISTING /EST. OF DAILY USAGE1pO_�gal GI ADDITIONAL SUPPLY LL _ REASON FOR DRILLING DETAILED REASON FOR DRILLING G WELL TYPE DRILLED DRIVEN ODUG O GRAVEL. O OTHER IS WELL SITE SUBJECT TO FLOODING? YES ><-' NO IF WELL IS LOCATED IN A_,LEALTY SUBDIVISION, NAME OF SUBDIVISION: elc ,t* 7 rlw At t ___Rsa 4T� Lot No. '7 WATER WELL CONTRACTOR: Name #AObP•tW-5 Address: kj46*jRAW4&d /!1E IJ IS PUBLIC WATER SUPPLY'AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY __...DISTANCE..TO_.PROPERTY FROM NEAREST WATER MAIN: RAEUZ % y� LOCATION SKETCH RCES OF CONTAMINATION PROVIDED TON SEPARATE SHEET V� C-1 - (date) Lfihtnature) 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 su h a manner as not to degrade or otherwise contaminate'surface,or groundwater. Date of Issue: 19� Date of Ex ation 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 J • PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property.of_ Date 6 —,7— 95` 1, v Located at �'pV L=:e. A (T) OU Section Z Block f Lot Subdivision of Subdv. Lot # Filed Map #. Z/d Date � 466 Gentlemen • T. MICHAEL DALT, P.E. CON ULTING ENGINEER' Nft This letter is to authorize P`0 OXIM a duly licensed professional engineer or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly your S 014�Countersigne R.A. , # Address CONSULTING ENGINEER p 9. BOX 243 Telephone :l OVAer of Pr6pert}' 9_*_S (9,kLL71 AA 4_.F- Address G4-ew•t_-L_ Town 011l ` ?_2_b 1 6-2� Telephone It•1A1� t r�`�� � S'L ,+. 4". 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'+ .o.S.r„ r 7 .cS ;�N.d.�!: 1.s� � s�`�k'��*.�yk+��imr. �S�+i (c53'xt5'2.d"+4 ipon{Ibl•fatM d•{gi,�a,W location ottM 4pr000{w r{Yst•ml{j: 1)tn•t�tM fa N ■t• t•{w■ •°tdh o{at { {tNn ..a.,,u, U♦c ., A •. `� 4yr♦ .xo- -a:� r. b i+s� tt t . v �� i?th• ipprw•w0 en•ntath xi anO in ateo►danp,wlth :th ottandar0{, iUMS an r•ou On{ 0 r ompNtton to "N•o • ,C•yRiffC t•f ol,ConRrudion Compl4ne� h 5�et tO tMYcommk"it #1 4"Ithwlll gai nntt" wHl, fur hlNd tMCowmr ,hi{ •uca{■N{,aMN{a auipsby h� buil�di►�thitt�wldFbuild�r will �t•IO �'n rtiit�r■IO w+`���� �_,•?sd��_�'.��,tsu Iara�i •x0r••{ two Y ■►�, n0_ m? MM aat• ssu�Ot�unN{f eanfttYetlon, OfrtM OYildiny h■{ b••n unONtakan and Is all III bytM lCOmmisslOMr �orWMNltll, Any chiieq• Or an «atan o1 oor,itruetlon ! ir"rR I a.�TN:.32G 'r1L�F^�.c,E:ssSk -s -sS �4.�.,srrt. 1, kw Lor t Nl +ofraOmatk {anN ■ry {�w• , t• w■tor supply Only ea`ani4p. ti2C� •�'r rF+ tee.. -- ti.s _ '' . t 4 r eY * • 1 TitM a DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # P -AR -PA WELL LOCATION Street Address Town Village City C O 0 N MILL. ROAD PATTEASOAl Tax Grid 'Number 2-4-1-19 WELL OWNER Name Mailing Address 5Z- PLAZACFALTY ®Private O Public SE OF WELL - primary 2 - secondary ® RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED 0 BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify 0 INDUSTRIAL 13 INSTITUTIONAL O STAND -BY p AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED S. /EST. OF DAILY USAGE 6D6 sal O REPLACE EXISTING SUPPLY O TEST/ OBSERVATION 1+3 ADDITIONAL SUPPLY 12 NEW SUPPLY NEW DWELLING) 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON .FOR DRILLING F S WELL TYPE DRILLED DRIVEN QDUG GRAVEL O OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: CDUNTRV NILL ESTATi5 Lot No. S WATER WELL CONTRACTOR: Name T, 8• D . Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY - `DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: -- --- - - -- LOCATI N S ETCH 6 SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET ir (d ) Widhatur PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirt -y (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 su h a manner as not to degrade or otherwis a to s face or undwater. Date of Issue: /� / / % 19 r _► 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 ti n: DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New.York 10509 (914):278 -6130 APPLICATION TO CONSTRUCT A' :WATER WELL PCHD PERMIT # I' VDUro WELL .LOCATION Street ress �., u , To Village- City .- Tax Grid Number —141$ ^. . WELL, OWNER Name- - . Mailing Address box 41 o (private a 13 Public USE OF" WELL 1'- primary - secondary 1{ -#SIDENTIAL .Q BUSINESS. .0 INDUSTRIAL, D PUBLIC SUPPLY, " 0 AIR /COND /HEAT PUMP .0 ABANDONED O.FARM:.. O TEST /OBSERVATION O OTHER (specify 0 INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT 57 gpm/ PEOPLE SERVED a /EST. OF DAILY USAGE,�gal O REPLACE EXISTING SUPPLY O TEST /OBSERVATION C4 ADDITIONAL SUPPLY 04EW SUP LY (NEW'DWELLINGI 11 DEEPEN EXISTING LL .REASON FOR DRILLING DETAILED REASON FOR DRILLING 1.1� : IAD cj 9:b all WELL TYPE. ELLED .. DRIVEN DUG aGRAVEL. OTHER IS WELL SITE SUBJECT TO FLOODING? YES' '---�'JNO IF WELL IS LOCATED IN A REALTY SUBDIVISION, 'NAME OF SUBDIVISION: Lot No. WATER- -WELL CONTRACTOR:-_ Name___' �- Cz +_7_ ._.... -: - -_ _ - -. _. Address: IS•PUBLIC WATER SUPPLY AVAILABLE,TO SITE:. YES 'NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY .DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED 9_N SEPARATE SHEET - 2C� (date) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant 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 otherwiap- contaminate surface or groundwater. Date of Issue:. Date of Expiration 1 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Located at C.ounlnz( (T) Section Block Lot Subdivision of �'��w'�►��iJ Subdv. Lot # Filed Map # Date T. MICHAEL UAL -yvP.E. . Gentlemen : CONSULTING ENGINEER P.O. BOX 243 This letter is to authorize SHENOROCK, N.Y. 10587: a.duly licensed professional engineer or.r+�.gistered architect .(Indicate. to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with.the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or '147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned. C2 P.E. , R.A. , 1 M6b T. MICHA Address CONSULTING ENGINEER P. 0. BOX 243 SHENOROCK. N. Y: 1027 Telephone Very truly yours, 0 Signed . Own r UX ffroorty Address Town Telephone. DEPARTMENT OF HEALTH Division of Environmental.Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION Street Address UvAIr'P� w Town/Village/City Tax Grid Number P-P TT�2� r,w Z4- - 18 0 LO 1.6 - 4 - zl WELL OWNER Name Mailing Address rivate 62- AZT Qom, -per, -C Pw ur -rmex- d L. 2b 2 1LpTo,�rl Public USE OF WELL (D - primary 2- secondary RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify O INSTITUTIONAL O STAND -BY Q AMOUNT OF USE YIELD SOUGHT �J' gpm /# PEOPLE SERVED S /EST. OF DAILY USAGE 60o Bal O REPLACE EXISTING SUPPLY O TEST /OBSERVATION 12-ADDITIONAL SUPPLY SREW SUPPLY NEW DWELLING) 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING QSVI� WELL TYPE 1PRILLED DRIVEN aDUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES _ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Coyy)1I(` 141kA.i 15-64 -re5 Lot No. Co WATER WELL CONTRACTOR: Name __T Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _ C NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETqH &40URCES OF CONTAMINATION' PROVIDED FAN SEPARATE SHEET (date) (signature) PERMI.T 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 dril operations be contained on this property and in suc a manner as not to/�degrade or of er i e, cont inate surface or groundwater. Date of Issue: 19 "l 1 Ax Date of Expiration' 2�? 19q_ P krfit Issuing 76f ficia1 Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller y '6. PUTNAM COUNTY DEPARTMENT OF.HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of �ji �r1 --TIC Located at I N.fm ol,V is -y -21 (T) �Pyjti.1 Se on Block Lot Subdivision of- E�tJ11t.(� Subdv. Lot Filed Map #, Gentlemen: Date T. MICHAEL DALY, P.E. CONSULTING ENGINEER P. 0. BOX 243 SHENOROCK, N. Y. 10587 This letter is to authorize / a duly licensed professional engineer L// registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam-County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article -i 5 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, Signed l Countersigned Owner f ropert P.E., R.A., # Address) Addr e s s 1. MICHAEL DALY, P.E `''n . T ° CONSULTING ENGINEER P. BOY. SHENOROCK, N. Y. 10557 Telephone C/1 -7 *2 - S3 2 Telephone . ,cif - - - - - - -- - - - - -- -- 1 represent inert 1 am'wAOUy and completely .tafponfipa for the design and location of the proposed system(y; 1) that the Ypa►ate Ywaoa difpOYl system above dapitled will, tw Constructed a ehown on the approved amendment there to and in accordance with the standards. rules and regule[wrrs M ' [lie wsnam 'County Oeperti li -,of . OlMltty rind that on eomPlatbn;thanOf i .�C ifieate of 'Construction Compliance" satisfactory to the Commissioner of Mosit will be. 'uibmittad .te tIM, Oepa"mod, and a written yuarintei will.a furnished the owner, his succeYors, heirs or assigns by the bulkier, that old buildar will 011 IN " ..pod o0e►i1tNg eabntoh,alig part, of YW aaraN• ditposal, system durbg the period of two (p) years immediately fO1lowNg.tUe,date Of the issee- anp of the approve l "of ten Cartilkate of Construction carnwlence of, tni orginal syetein o► any rap.MS then )that ten dNINd .well. aeaerM" above WIN be Mated aB nhd1Y11 On ilea approvid plan and that Yid well will be installed in accordance h the st r rrlpu aeons Xof It Putnam County rtno" of tieanh ' �// date Signed P.�E.�_�/ R.A. Addre lieanse No APPROVED OR CONSTRUCTION -This oval impirestwo years from the date issued unions struction of the building .has been undertaken and Is revocable for Ceuta or may be anMKW or modified when considered necessary by the Commissioner of Health. Any charge or alteration of Construction . refluMGK7z MR.. Approved for disposal of domedIc' Ynnary towe". and r priv a water supply only. Rev. y - j- �, � 8 �— Title �" .1\ DEPARTMENT OF HEALTH Division.of Environmental Health. Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT WELL LOCATION Str et Address Cv ► To V llage City Tax s Grid Number - - WELL OWNER Name �? Mailin Address h . i- ' . l OPfivate Public USE OF WELL 1 - primary. 2- secondary . © -IESIDENTIAL 0 BUSINESS. 0 INDUSTRIAL' ❑ UBLIC SUPPLY O FARM O INSTITUTIONAL. ❑ AIR /COND /HEAT PUMP O TEST /OBSERVATION O STAND -BY ABANDONED 0 OTHER (.specify, O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED 8 /EST. OF DAILY USAGE 6,00 gal REASON FOR DRILLING 99iW SUPPLY ❑PROVIDE ADDITIONAL SUPPLY -OREPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL ❑TEST OBSERVATION DETAILED REASON FOR DRILLING 4 WELL TYPE LnDRILLED DRIVEN DDUG O GRAVEL 13 OTHER IS WELL SITE SUBJECT TO FLOODING? YES _L::�'NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES !i NO NAME OF PUBLIC WATER.SUPPLY: TOWN /VIL /CITY. DjSTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED o ON REAR OF THIS APPLICATION 0 E S ET CNI- (d te) (s gnature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of'Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is.clear. 2. Disinfect the well in accordance with the requirements of the Putnam. County Health Department attached to this permit. 3.. Submit a Well Completion Report on a form provided by the Putnam County Health Department. �- Date of Issue: A 1 19 7% Date of Expiration: 19 ::7/ Mite e� i issuing f ici Permit is Non- Transferrable copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner 2/87 Orancre copy: Well Driller �� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Z/ 18 55 Re: Property of Located at (T)�� }��{`�� Section 5 Block Lot Subdivision of % 1 Subdv. Lot # Ll� Filed Map # �� %Cp'� Date j Z2 6,6 T- MICHAEL DALY, P.E. Gentlemen: CONSULTING ENGINEER P. 0. BOX 243 This letter is to authorize SHENOR a duly licensed professional engineer or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, "'7C e Si ned �7e�a0era.� Countersigned:' ? Owner operty P.E. , R.A. , Address T. MICHAEL DALY P IE Address CONSULTING ENGINEER P. 0. BOX 243 SI'rN0: -'.'o" x' r'' y TOSST �zs 7 Telephone ec Town 04 6'� >� -s-00 Telephone CON ON PANUT:1 Located u ' Sabdivision Nam Owner /ApP,licant N MaWng Addres BniwloL°�C.Ai aa` Tqt Area _ 4n. Fill. sectbo duly papfb volume Number of Bedrooms _ Design Flow G P D D DD . ' PCHD NodBcoil is Regalred.Wtiea Fill Is completed .. Separete so w. ewersge System to.00nglst otGaiOa Septic Tack an d To be eaastracted by.7 -J Addeeea Water SupPiT: Ptibllc,Sapply,From „ Address or: Pdvste Supply Ddlled by Addwss Other Requirements 1 represent that I am . wholly and, completely. responsible foi the design and location of the proposed system(s); 1) that the. separate sewage disposal a stem above describso will be:;constructed -as shownlon the 'approved amendment thereto and 'in aceordance,with 'the standards, rules an regu a :ons O e' U nam County Department of Health, no that,oncompletion thereof a. "Certificate of Construction Compliance', satisfactory.to the Commissioner of_Healthwill be submitted to 'the .Departmant6 andLa written;guarantee. will De furnished4he owner ',:his successors, helrsor assigns by.the pullder, that said builttir'w1h place' in .good operating conI I— - ,any part of se id sewage tlifposal system, during" the'. period bf'two.(2) year medlately following thedats of thi itsu- ance of the :approval :of the, Certificate of. Construction 'Complunce of -t" original_ system or any repair h e o; 2) that the: drilled•.well describad�,above will be louteu'as shown on ttie approved plan and that said well will be installed i " Wccrd a wit the rtl , ru sand regu aT4Tes: of t /DS Putnam County C Department of; Healthl(� QT Date V�tJ ''� , 1�"lC� Swn� _ P. E. VVV_ R.A. Address ' t License No .. S N k nilbcc� �(�.tJ APPROVED FOR CONSTRUCTION: This approval:expu'es'two years from 'the date issued unless construtRlon 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 requires�ayn�e�w 'pe mit. Approved for disposal of domestic sanitary sews ge,,A o.r a water' supply only. �J ' Rev. Date /, / �•' t3y � , tie �­7 L/G/ 1/87 . �C 1. VV'- PU iAM COUNTY DEPA MMU OF HEALTH - II SION OF HEAL FSEW3a INDIVIDUAL WNTER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT c DATE REVI &/ J BY: Q_ ( of Owner) (Street Location) COMMENTS YES NO DOCUMENTS Permit Application q3 Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole Other House Plans - Two sets -If PWS - Letter r'. = ariance Request �0 REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow � Fill Profile & Dimensions. - Volume l / D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over 76 Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area;shown;gravity flow,suff. size If Pumped Pit & D Box Shown & Detailed House - No. of Bedrooms Wells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Setback Necessary (Tight lot) House Sewer - 1 /4 " /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 151 to Drains- Curtain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' fran Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) Data On DDS Plans & Permit Same PUTNAM COUNTY DEPARTMENT OF HEALTH Rev. 318.6 Division of EnAronmeutsl Health Services - Carmel N.Y. 10511 Englneer to Provide Permlt # . on CERT�ICATE OF COMPLIANCE 4011 N PERMIT F R UCTIO 0 SEWAGE. DISPOSAL SYSTEM. Located at u LL- _ ED aD Town or Village' Subdivision Name �Subd. Lot 0 Tax Map -Block A= Let T3-u Gt,e -k oG,11A h4 10 �Q� Repewal ❑ Revision ❑ . Owner /Applh;anf Name • , 2' —1 Date of Previous Approval ' MaWng Address Town lay-t3W�T'r =.� - zip Building Type, l�►.iT� t�l— Let .Area ` w t /X L. _ Fill Section Only Depth Volamo Number of Bedrooms 4 Design Flow G /P/D 8 O O PCHD Notification Is Required When FIR le completed Separate Sewerage, System ,to consist of _ % ?�yGallon Septic Tank and �J -7( o � 2 �ZQr t� �T"L�►JC bl To be constructed by Address Water Supply: 'Public Supply From Address or: ✓. Prlvate:Supply Drilled by ^� �a�' Address Other Requirements 1 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 and regulations of e Putnam County Department of Health, 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 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 thedate'of the Issu- ance of the approval of the Certificate of Construction Compliance of: the orfginbl` system or any repairs the et") that a drilled well described above will be located as stiown'on the approved plan and that said will will be Installed,' accord ce Wit he Stan ► les a r u au a iTfions of the Putnam County Department of Health, Date , I ZiC`� S Signed . P.E. R.A. .� _.ed-13 8 APPROVED, FOR CONSTRUCTION: This approval expires one y: from'the date i ued unless con revocable for taus LL'or ma tie mended or modified when consider' nets by a ommissioner requires a new e n p yeti for disposal of Aomestic sa age,` an to t Date � (/ BY ' - icense No of the building has been undertaken and is Any change or alteration of constr ction o _ Title I Division Of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y.. 10512 (914). 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL f-, a - V � IS WELL SITE SUBJECT TO FLOODING? _ YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:Cd�,,�, LOT NO.: c_ WATER WELL CONTRACTOR: Name o 13: Address: IIS PUBLIC WATER SUPPLY AVAILABLE TO SITE: — YES ✓ NO INAME OF PUBLIC•WATE"R SUPPLY: DISTANCE TO PROPERTY. FROM NEAREST WATER-MAIN- T0W -N /V /C LOCATION SKETCH & SOURCES OF CONTAMINATION.— 6 (date) (s.ignature) - -- PERM 1T 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 W 11 Co pletion Report on fo m p ovided by the Putnam C n y Health Departmen . Date of Issue: C 1�- P it Issuing Of al Permit is Non - Transferrable STRUI AUORESS. WWNIViLLAGEIC11Y IAx Vii NUMbEA. YELL LOCATION �,�� ����� Po,;;, - l�r�c�5O►� _ - NAME. • ADDRESS: 11QrPSIVATL WELL OWNER L � —, Z � PUUC ❑ oV3 USE OF WELL 2 RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /CONO. /HEAT PUMP ❑ ABANDONED 1 - primary ❑ BUSINESS ❑FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) 2 - secondary ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY O MOUNT OF USE YIELD SOUGHT 5 gpm. /NO. PEOPLE SERVED 8 / EST. OF DAILY USAGE -CoQQ gal. REASON FOR GYNEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ORILLING ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL WELL TYPE DRILLED DRIVEN DUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? _ YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:Cd�,,�, LOT NO.: c_ WATER WELL CONTRACTOR: Name o 13: Address: IIS PUBLIC WATER SUPPLY AVAILABLE TO SITE: — YES ✓ NO INAME OF PUBLIC•WATE"R SUPPLY: DISTANCE TO PROPERTY. FROM NEAREST WATER-MAIN- T0W -N /V /C LOCATION SKETCH & SOURCES OF CONTAMINATION.— 6 (date) (s.ignature) - -- PERM 1T 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 W 11 Co pletion Report on fo m p ovided by the Putnam C n y Health Departmen . Date of Issue: C 1�- P it Issuing Of al Permit is Non - Transferrable PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner 'R)L � o� 4��z-P Address 'C2,TzZ, f ox Located at (Street Cr��� ��.� 1� Block 4 Lot'o -� n lca e nearest cross street) Municipality Watershed T- �_e�._��K -Cigig-'m � •2 SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME ,< . PERCOLATION X­-*. PERCOLATION Run Elapse Depth to Water Water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches t 10- 30 �- 2 O- �; n c7 t Zo l� 5 Notes: 1) Teets to be repeated at same depth until approximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. G.L.a���('�I 6►r tr 12 1t tJoJ�t�.)fl� 18" ' 24" C 3011 , 36rf tr 42" 48" cr 5411 \� 60" ` 66" `! 11 �2 , 78ri . f 8411 rr HOLE NO. INDICATE LEVEL AT WHICH_ GROUND WATER IS ENCOUNTERED �o INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date 8 DESIGN Soil Rate Used Mir�/1 "Drop: S.D. Usable Area Provided p.t5`n00� No. of Bedrooms Septic Tank Capacity �'� Gals: Absorption Area Provided By ,a 'j (v L. F. x24" 3b" C_ Address ox 7�Gt 3 �c ure SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal. Checked by �,eO -Date Putnam County Department of Flealth Division of Environmental Sanitation AFFIDAVIT - CORPORUITE CUNER APPLICATION . FOR PERMIT APPLICATION '.SUBMITTED TO � PUMM COUNTY HEALTH DEPARTMENT � TO: Commissioner of Health - In the matter* of application for rgnstruction ,permit for seLarate sewage system I6 Jerry Weissman _V. Pres.— — — _ — — — — — — — — represent that I am an officer or employee of the corporation'. and .am authorized to act for _ _ _ _= �—�•_1 _ _ _ (name o .corporation) 'having offices at — Rt. 22, P.O..Box 377 Brewster, N.Y. 10509' Whose officers are - President _ Robert Fregosi -' (hame— sand Addre —ss —)— — Jerry Weissman Vice- President . (game and Address] Secretary — — — — — — — — — _— — (Name and Address) Treasurer --- - (Name and Address) _ ..and that ..1 am and will be individually responsible any or.all'acts' of the corporation with respect _to the appX%ov ted a a1.1 sub - cequent acts relating thereto. Shorn to before me this 4 day S' ed of 1/1 19 J'b Title Notary lic ri�h�r� • s. BARR Notary .Public, State of Neer 10k Resil;r.^ ir. Fo:.•.! "" Ctizrr „xi • :`orrLtnis':inn �.xL'••Ue 'Corporate Seal I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Buckingham Development Corp. Located at Rt. 164, Patterson Section Maa 15 Block 4 / Lot °(O Gentlemen: This letter is to authorize a duly licensed professional engineer �' or registered architect (Indicate) to apply for a Construction Permit for a separate sewage system; to serve the above noted property in accordance with.the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in with the provisions of Article 145 or 1475 Education Law, the Public Health Law, and the Putnam County-Sani- tary Code. Very t Signed a Countersign P.E. R.A. #_ CJ (914) 279 -9400 ;3,c) � Telephone Rt. 22, P.O. Box 377, Brewwter, N.Y. 10509 Address Address Telephone �o \0 N L6CATIa.L K--EY H T= S7 1: A`I = 24-b 6-1= P,- z= Z-9 'I-C B A-3 = 35 -6" B A 4 41' -0" o-¢- LI -0' S ., Or-Y HY 1445 \­ 41554. A,xOST In, Noce. Ert.4{ . o is or v�umn (.g 6-6.4 IQ any. not - )I.....• Mae p�ai+ti od �'or: V-3 lZeai . Corp. 4?3 P15 =G7 -9508 CDT # 6 �yiSL(, 345, 00' �I • 1 ! b 7 'Y SSbs e� Lo,- LL_TF1T Q G t �, /� Ply MI 4 �S� lIGNia Putnam Cogpty Department of Health OV SIG o ,Divis.ion of Lfivironmental Health Services IApproved as noted for conformance with „gyp, 214-3 S `� applicablc Pules and Regulations of the q _ .� V Putnam C unty Realth partment. 6� Signature'& Title Daste �Z- gzQluf eZCD — 42-q L, i� a��.lCrrhLi.�h -• �i�^- .]�tz�l._t^�� "r1 r'+V_�t.�+Y- �L'�"'�������- M S Ian kf t •. Lcg"A i Q;' I H1IS IS �a c><¢?IW ��IIa: •thE SElv.+a� �ISA�AL J1-?v ,�74.f } �l AG t�/JGt3l]LS't` n QL l U �.Ln�'•�•17 M wl T41 ,C i�l_fa ,.1 Wi ilf- S I.&- rMIrz , k,Jas _r L,ke 91 y i2-.- ��L� R�ca1.n A,vS \IjI r1'1 o uc FRgIVE ' 1 ' IDo �,tPVnlTi0f1 / / I ROaFG��6•(I� /j� /`Y\ / - J1eAlh1. w R= �S•u�' �p CO `K- / MCF-j— -�.3dr 209 "o—: _0 L - \ghlgJ (� ems G N O - 7 'Y SSbs e� Lo,- LL_TF1T Q G t �, /� Ply MI 4 �S� lIGNia Putnam Cogpty Department of Health OV SIG o ,Divis.ion of Lfivironmental Health Services IApproved as noted for conformance with „gyp, 214-3 S `� applicablc Pules and Regulations of the q _ .� V Putnam C unty Realth partment. 6� Signature'& Title Daste �Z- gzQluf eZCD — 42-q L, i� a��.lCrrhLi.�h -• �i�^- .]�tz�l._t^�� "r1 r'+V_�t.�+Y- �L'�"'�������- M S Ian kf t •. Lcg"A i Q;' I H1IS IS �a c><¢?IW ��IIa: •thE SElv.+a� �ISA�AL J1-?v ,�74.f } �l AG t�/JGt3l]LS't` n QL l U �.Ln�'•�•17 M wl T41 ,C i�l_fa ,.1 Wi ilf- S I.&- rMIrz , k,Jas _r L,ke 91 y i2-.- ��L� R�ca1.n A,vS \IjI r1'1 o uc