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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 24. -1 -19 BOX 8 gim ., F+ . ., I,yL JL♦ 1i I' ■r i T .I ,T ,�`1., -A . '1 1% .4 ` 1 T l� �L' I J Am 66 a. '. 00742 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Paul Wren 35 Country Hill Road Brewster, New York 10509 Dear Mr. Wren: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 August 25, 2006 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Addition — Wren, A- 261 -06 No Increase in Number of Bedrooms 35 Country Hill Road (T) Patterson, TM# 24.4-19 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 from this Department dated August 24, 2006. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at four 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. 4. This Department recommends you contact your local Building Department to ensure setbacks and other current codes can be met. 5. This approval is for the proposed changes only. This approval does not validate any construction shown as existing that has not obtained proper approvals. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Southeast. If you have any questions, please contact me at (845) 278 -6130, ext. 2261. Sincerely, V9. r�_Uk Gene D. Reed Senior Engineering Aide GDR:cj cc: Building Inspector, (T) Southeast Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678• Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845).278 -6648 SHERLITA AMLER, MD, MS, FA-AP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Paul Wren 35 Country Hill Road Brewster, New York 10509 Dear Mr. Wren: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive February 3, 2006 Re: Proposed Addition lan . This Department is in receipt of your letter dated January 31, 2006. At this time, no file has been found for 35. Country Hill Road. Furthermore the permit number. _you (provided (4196) is inconsistent with this Department's issuance of permit. numbers. Kindly re- submit any additional information in reference to the above referenced project to enable us to help you with your request. If you have any further questions, please contact me at 845- 278 - 6130, ext. 2261. GDR:cj Sincerely, Gene D. Reed Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225-5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool(845)278 -6014 Fax(845)278 -6648 16 -light window H =5'0' W =5'6' 25'8' Room entrance, from garage W = 3'0" L =3'0' 12 -light window H =4'0' W = 3' 0' PUTNAM GOUNTY G €PAHTMENT OP HEALTH HOW PLANS aPPWO FOA 99WOM COUNT ONLY 4 -E SUBSE61AW NEWS ON/A0t9AUN9 fO NUF HOUSE PLAM MNSI k .9MM199 TO THtt P949i1 FOR AWROVAL XAL 35 Country Hill Rd Bonus Room Interior Floor Plan (Interior Patterson, NY 12563 Dimensions Shown) Section 24, Block 1, Lot 19 Scale: 5/16' = 1' 23'8' �T G a_ E- 00 L- L 'Xl ri M 0 IL EE O ca.Ner - 0-ft W924 WWI. 0%4 C1A.tio 2' , (op We 2'Wxa: W c.t sVv.0 2'), 6 070sv.X0-lrru H 14, YMI K-J to boa%, ARTIVIENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY BEDROOMS ALL SUBSEQUENT REVISION/ALTERATIONS TO THESE HOUSE PLANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL 2-4f I NATURE & TITLE /DATE Proposed Bonus Room & 2nd Floor Detail M 1 26' V r---------------------------------------- i 40 U co Bonus room entrance LWOW from garage Bath 1 Office Bath Bed 2 N U7 i rA i m CV C C C Hallway TER9!IIAL. ; POTO�afl. Erb ® ®�._._.. j N •. Open - - - - - -- ------------------------- - - - - -- Bed 1 Entryway Bed 3 C = Closet Z_ QQ Ic PUTNAM COUNTY DEPARTMENT OF HEALTH L HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY BEDROOMS 3 0 ' ALL SUBSEQUENT REVISION /ALTERATIONS TO THESE HOWf ri PLANS MUST BE SUBMITTED TO THE PCDOH FOR 0 "W'1t IGN � �m.�2. � • ISO ATURE & i ITLE DATE CO N Second Floor ,w First Floor Kitchen Breakfast Bath Dining Open Room Entryway C PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY C Closet BEDROOMS o A Attic opening ALL SUBSEQUENT REVISION /ALTERATIONS TO THESE HOUSE PLANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL r V SIG ATURE & TI LE fDATE Living Room Exercise /Va C�A,VE�S iilv6as�, Y Finished Basement Completed / Inspected, as of 5/1/2006 Existing frame /drywall Existing 250 amp Electrical Panel (on plywood): W = 37 ", H = 70" Existing door to stairs, external Bilco doors: W = 36 ", H = 78" f- Existing Window: W = 32 ", H = 13" .................. X.................................................... X.......................... Chlorinator Water Oil ------� Softener Tank O S Proposed closet Basement wall width (Interior) = 26' Proposed frame Width = 38" Length- 20' 11" Depth = 12" Boiler S Door: 28" width x T e x Proposed frame A '• 4— Length = 9'.10" O I O O R i S Waste exit to septic S Proposed frame / Proposed frame Length = 24' x / Length = 13' x: Door: 36" width Washer '• `• Dryer x Proposed frame O O Length = 9' O 0 Proposed frame Proposed Frame €x Length = 21' Length = 8' Well Supply j x' (. Existing door to stairs, external Bilco doors: W = 36 ", H = 78" f- Existing Window: W = 32 ", H = 13" PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY Basement wall gth = 38'5" _ BEDROOMS 5 `� l) Nv e-w*,v eS ALL SUBSEQUENT REVISION /ALTERATIONS TO THESE HOUSE PLANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL SIGNATURE & TLE DATE- - Legend x = proposed electrical outlet O = existing light fixture S = existing smoke detector Basement wall width (Interior) = 26' PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY Basement wall gth = 38'5" _ BEDROOMS 5 `� l) Nv e-w*,v eS ALL SUBSEQUENT REVISION /ALTERATIONS TO THESE HOUSE PLANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL SIGNATURE & TLE DATE- - 88° qrg' 50" W C_,-T-O N E ' � Y 1 R ' Z d HE a� o y, Ae Division of Environmental Health ServI066 Approved as noted for conformance with appll7 blbl Rules and Regulations of th8 n...K,dG..- r......b1v�Ann l +h_nanartment• / 31&ature A Title �PW - 0 5q, o W OW- .tnat the system was•inspected by me betore it was covered over. Tne system was cons ttucteii in accordance with all standard rules and regulations of the putnam' County. Department of Health and the York State 1oartmenk of Health." N 8'3 °'0 3' 4-0" Ljo t 84:22' r. GeNtRp� -�Y bpi Y ' " 005 2lao��a v O IV O QO O n or ��3 3 •' i�i't a A wzrr Y. tojt�IGy. �3 S7M #��f -1 -(q S10 TEFST- 11�t�Q�j ► ''rr `` nn I No A $ REMARKS r, - \ a^ 2 I T ' �,1P SI 464 3 3G 2-D L �ot�Il �3 s9ox ' 2 3 1 o v o o: U C'* . a. a� o y, Ae Division of Environmental Health ServI066 Approved as noted for conformance with appll7 blbl Rules and Regulations of th8 n...K,dG..- r......b1v�Ann l +h_nanartment• / 31&ature A Title �PW - 0 5q, o W OW- .tnat the system was•inspected by me betore it was covered over. Tne system was cons ttucteii in accordance with all standard rules and regulations of the putnam' County. Department of Health and the York State 1oartmenk of Health." N 8'3 °'0 3' 4-0" Ljo t 84:22' r. GeNtRp� -�Y bpi Y ' " 005 2lao��a v O IV O QO O n or ��3 3 •' i�i't a A wzrr Y. tojt�IGy. �3 S7M #��f -1 -(q S10 TEFST- 11�t�Q�j ► ''rr `` nn I No A $ REMARKS I _ � 2 lzso .Ce G F. , 5 P L 2 I l ' �,1P SI 464 3 3G 2-D L �ot�Il �3 s9ox 5 3 7 3' �13 8 10 ro 31 n t -7o a g-i sv G.N 115 Iz 14 Is g8" 5�O Ra . (0o 1 L (05 b i. qq ? 67 L{y % 7-71 0 7 ZS'I.62 - • Pie -song, l�-u -y . V4--T ,eso CT) • OAiCP •, JOLUV KAREIL J9 P.E. 9fSCfhr7• 90AP -AM n ,l wJV 10563 LI e�s I 1 9 Paul Wren 35 Country Hill Road Brewster, NY 10509 August 14, 2006 Gene Reed Department of Health 1 Geneva Road Brewster, NY 10509 Dear Mr. Reed: Please find enclosed my proposed plans to build a "bonus room" as part of my on -going construction to create a two -car garage. This is a revision to my original plans to build a single -story garage, which were already reviewed and approved by the Patterson building inspector (did not require Department of Health review). This request is for review by the Health Department of the proposed bonus room atop the garage. Relevant data points concerning the revised proposal include the following: • Proposed bonus room will only be accessible from the interior portion of the garage. • No changes will be committed to any rooms of the existing house. • Bonus room will be heated and cooled as a separate zone, by separate equipment, from the main house • Bonus room will not be partitioned. • Bonus room will be used as an exercise area. • Garage will abut but not be attached to the existing house • A town of Patterson building permit currently exists for the two -car garage (# 4253). • Completed construction to date includes poured and inspected footings and sidewalls. The legal property address is the following: • 35 Country Hill Road Patterson, NY 12563 • Section 24, Block 1, Lot 19 The mailing address, to which correspondence may be addressed, is the following: • 35 Country Hill Road Brewster, NY 10509 Enclosed materials include a DOH application, fee, complete floor plans of the three levels of the main house (to which no changes are proposed), a survey indicating the well, septic and new addition locations, a certified legal bedroom count, and two (2) sets of architectural and floor plan drawings for the garage and bonus room. Thank you for your time and consideration. Sincerely, Paul Wren Enclosure (12) Aug 10 06 10:30a Paul Wren 845 - 319 -3088 p.3 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, Rh'. MSN Associate Commissioner ofifealth DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Ececwive a �---� O ADDITION APPLICATION RESIDENTIAL ONLY OaAw o ff j STREET f1/• to TOWN T ,f s�►Al TAX MAP# l.0 r it tf NAME ,,ist PIIONE If �E"3ft-e PiHD# MAELING ADDRESS,.;' DESCRIPTION OF ADDITION . .4 -04 -40 Ir NUMBER OF EXISTING BEDROOMSPROPOSED # OF BEDROOMS (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUII,DING INSPECTOR) **AjW 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 Dept., I Geneva Rd, Brewster, NTY 10509, Phone: (845) 278- 6.130. 1. Certified cbeck or money order for S 100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) 3. Two sets of proposed floor plan (drawn to scale — with name, street and tax map #} *Non- professional sketches are acceptable 4. Copy of survey showing well and septic locations 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. 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS Environmental Health (845) 278 -6130 Fax (845) 278 - ?921 Nursing Services (845) -175 -6558 WIC(845)279-6678 Fax (845) 278 -6085 Earh- latervention/Preschool (845.) 278-6014 Fax (845) 278 -6649 AUG 10 '06 11 28 Aug 10 06 10:56a Paul Wren 845 - 319 -3088 p.l SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County arecutive Town Legal .Bedroom Count Re' AU L (Owner'-, Name) Tax Map #: Agr PAI AY f or Address: 3f Y• IY1d� Ad Town:rTq.SD Year Built: 1,4f,4 According to records maintained by the Town, the above noted dwelling, is e—n in compliance witli Town Code. is not in compliance with Town Code. The Legal Bedroom Count is: This information has been obtained fro►n: Certificate of Occupancy: �/ Other: / � 6" / , " � 11 Build I ingidspecia, Date AUG 10 106 11:53 Environmental health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 845 319 3088 PAGE. 01 Paul Wren 35 Country Hill Rd Brewster, NYI0509 January 31, 2006 Mr. Gene Reed Department of Health 1 Geneva Rd Brewster, NY 10509 Dear Mr. Reed: Please find enclosed a revised copy of my proposed plans to finish my basement, as an update to those originally approved under permit #4196. You will note my proposal to include a small storage room, adjacent to the larger room already approved. Per our discussion, I have modified the dimensions to provide less than eighty (80) squared feet of total enclosed area. I appreciate any help to expedite my review. Sincerely, Paul Wren Existing frame/ drywall .................... X ............................................. ................................ Chlorinator Water Oil 1 Softener Tank O S I Proposed closet Proposed frame Width = 38" Length= 20' 11" Depth = 12" Boiler S Door: 28" width T x Proposed frame A Length= 9' 10" 'aro P � O I O O CUy1rNiS�e�� Rw..2 �®mwt S Waste exit to septic S Proposed frame / Proposed frame Length = 24' Ex / Length = 13' Door: 36" width Washer ..................: Dryer �� x Proposed frame A r-i O Length = 9' '�oovh O 72 S-6 Proposed frame Proposed Frame x Length = 21' Length= 8' Well Supply 1 X.. ..X. Existing door to stairs, external Bilco doors: W = 36 ", H = 78" Basement wall length = 38' 5" ❑E Existing 250 amp Electrical Panel (on plywood): W = 37 ", H = 70" 4- Existing Window: W = 32 ", H = 13" x: X:; Legend x = proposed electrical outlet O = existing light fixture S = existing smoke detector Basement wall width (Interior) = 26' xE Fact Sheet Proposal To finish a portion of an existing, un- finished basement Owner Paul & Katherine Wren Property Tax Address 35 Country Hill Rd Patterson, NY 12563 Section 24 Block 1 Lot 19 Phone Day: (914) 642 -4660 Evening: (845) 319 -3088 Current Structure Properties (Basement) Poured concrete slab, 11" thick Walls are sealed with two coats, Dri -Lock latex sealer. Space is dry. Two 110v electrical switches are active, powering 4 lights & outlets. Height from slab floor to 1st floor joists is T7 1/2". Proposed Construction & Materials Vapor Barrier 6 mil, affixed to all basement walls and flooring Framing 2" x 4" framing, spaced 16" on center Sole plate as pressure- treated lumber, studs / top plate as utility grade Sole plate affixed to slab floor by lag bolts. Top plate affixed to 1st floor joists by 3" round head framing nails Studs affixed to sole & top plates with 3" round head framing nails (toenailed) Electrical bores consistent with code (< 60" stud area, set aback 5/8" from outer rim) Outside and inside corner framing consistent with code Insulation Unlaced R -10 fiberglass batts inserted between wall studs Walls 5/8" Sheetrock gypsum affixed using 1 1/4" GripRite coarse thread drywall screws Flooring Tile or floating engineered wood Ceiling 5/8" Sheetrock gypsum affixed using 1 1/4" GripRite coarse thread drywall screws Heating Oil hot -water baseboard Electric Work to be performed by Amp Electric (pending) or other local contractor ;. rPUTNAfV! COUNTY HEALT61 DEPT 1 y- rt k 4 Geneva Road r (914) 278-6130' r e ` . Brewster NY 10509 } r i ( Received of 2 Y x f T The Surn Of �-° I � Y2 � Dollar $M - 1 t� T AE .. x'�l+. HA I..tl T /! r ❑Cash �sCheck �%) MO ❑ Credit Card By _ y PUTNAM COUNTY DEPARTMENT OF HEALTH � DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTIONN COMPLIANCE FO ATMENT SYSTEM PCHD CONSTRUCTION PERMIT # F-C 7 ` L s P MP-5 0 Located at � N �� � Town or Village �� 1. Owner /Applicant Name_Kl�� P�1 Tax Map v2 `7 Block ® Lot Formerly C Z 0 A) C7 Subdivision Name ff Subd. Lot # Mailing Address Date Construction Permit Issued by PCHD -7 Separate Sewerage System built by NOQiI Address 2A 10 %L %` L 1— � - S dd i ZS'�, Consisting of l Z Q Gallon Septic Tank and Y� 7`_ IVY -3 x,1 C�,L Other Requirements: Water Supply: Public Supply From, Address or: XC Private Supply Drilled by L�iTL -- Address 9P4-U,5A_-%'7C y Building Type dQUaK. Has erosion control been completed? Y& =J Number of Bedrooms I Has garbage grinder been installed? WO I. certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- �uilt plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulatio s of a Pu am County Department of Health. Date: /0 Certified by P.E.X R.A. Address License # '9 3 Z-7 Any person occupying premises served by the above systems) 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 bec a null and void as soon as a public sanitary sewer becomes available and the approval of the private water su . ly ihall become null and void when a public water supply becomes available. Such approvals are ubjectrito odification o'r change when, in the judgment of the Public Health irect.r, such revocation, dificat'o r change ' necessary. :5r Abilit, � ��A Gl By Title: 4350* Date: AAMfte White co - F e co B g Inspector; Pink y caner; ang py - Design Prof ssiona Slr �l ,iC�v /�� C -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Country Hill Road Town/Village: Patterson Tax Grid # Map Block Lot(s) Well Owner: Name: Address: Westchester Modular Homes Inc., 2910 Rte 22 Patterson 1VY 12563 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 72 ft. Length below grade 71 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 X Compressed Air Hours 6 Yield 20 gpm Depth Data Measure from land surface- static (specify ft) 30, During yield test(ft) 180' Depth of completed well in feet 245' Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 57 D 57 Hit roc t, 57, . 57. : -_ - 72 Drillin q in roc set casin:, ou e 72 245 Drillin d in roc granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type-_u Capacity7g� Depth 200' Model 7GS 5412 Voltage 230 HP �- Tank Type WX302 Volume 8 al. Date Well Completed 9/13/99 Putnam County Certification No. 002 Date of Report 11/4/99 =�2v iNVrr:: rxact location of well Well Driller's Name P. F Signature: Perry ] White copy: HD File; Yell, to atleast tyvfi permanent lanamartcs to be prov a on a separate sheettptan. Address: Date: 11/4/99 copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Putnam County Department of Health the s_daca disposal syst° was constructed as indicated•on this plan and - Division of gnvironmental Health-services .that the - system was me before it- was - covered over. The oe vritls system has constructed in accordance with all standard rules and Uproved as noted Yor °onYorman regulations of the putnam °County Department of Health and the ft York oe le Rules and Regulations of the State �o "tt of Health." _ ap Yu Cc ReNaly lDepa74 ll0 7A /!L ,2 411 184 .22' r at. 7► N 83e; 03'40 ".w zignature do Title Z3c G Gq• 7-0 W GaNtRAL-Ly ( O►J \p4.4Z' S J 6F`R�F�Y Db510 G,04dN S B�eQg, 5 oil ua �O � r Q C 0 3 0 � c � 3 � 2 Ui v o 0 UC d2 �w d e VN D6S1tJG� TcST t1��1Q9 ixf � /Q p o ` 0 MEASUREMEN 10 REMARKS 5l. 1 Colo" 23 . -. /1z1i4 i oo t 40 •' /� °` oa 1. %dam,, -y! fol Lid x O n O t D X12 � " l 1 jr o o �xrcS x 4 L 4aQrN IZOAV lot P m WMgi S rNJ04 -1 -1 y OW-C-1 C- 7 uv rbUlb'f °95bto N- D �1t 0� DAfCD;- JOffiV KAREIL JR P.E. I.�rcrsco PASh7e AiV ANYto563 aw- ►��sorJ NY 01 55 \. \• 9 too-It," GI IZ , 13 g�6 i oo t 40 •' /� °` oa 1. %dam,, -y! fol Lid x O n O t D X12 � " l 1 jr o o �xrcS x 4 L 4aQrN IZOAV lot P m WMgi S rNJ04 -1 -1 y OW-C-1 C- 7 uv rbUlb'f °95bto N- D �1t 0� DAfCD;- JOffiV KAREIL JR P.E. I.�rcrsco PASh7e AiV ANYto563 aw- ►��sorJ NY NE NORTHEAST LABORATORY OF DANBURY CT Cert: PH -0404 LABS 39 MILL PLAIN ROAD - DANBURY, CT 06811 NY Cert: 11471 (203) 748 -7903 - FAX (203) 748 -0652 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: P.F. BEAL & SONS 4 PUTNAM AVENUE BREWSTER,'N.Y. 10509 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: Total Coliform (Bacteria) PHYSICALS: 11/15/99 -Color 11/15/99 -Odor pH 11/15/99-Turbidity CHEMISTRY: DATE SAMPLE COLLECTED: 10 /27/99 & 11/15/99 TIME COLLECTED: 1:30 P.M. & 2:30 P.M. COLLECTED BY: MTB DATE RECEIVED @ LAB: 10/27/99 & 11/15/99 TESTED BY: LAB# 11471 REPORT DATE: 11 /17/99 WESTCHESTER MODULAR, COUNTRY HILL, PATTERSON, N.Y. NOT STATED WELL NONE RESULT: MAXIMUM CONTAMINANT LEVEL 0 per 100 ml 0 per 100 ml 0 15 ND 3 Units 7.56 no designated limit 0.55 NTUs 5 NTUs Nitrite N <0.005 mg/L as N 1 mg/L as N Nitrate N 0.29 mg/L as N 10 mg/L as N Alkalinity 75.0 mg/L no designated limits Hardness 154.0 mg/L _ no designated. limits _ 11/15/99 -Iron 0.107 mg/L 0.30 mg/L Manganese 0.031 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium 6.0 mg/L 20 mg/L ** Lead 0.002 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: 10/27/99 & 11/15/99 SAMPLE, AS TESTED ABOVE: MOTABLE or aOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Y1 A 4i'711 d 1 Laboratory Director •NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826- 0105.OUTSIDE CT: 800 - 654 -1230 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM It 1l Peer-solu ;4 ( 1 I Owner ck Purchaser of Building Tax Map Block Lot AlmpCC Building Constructed by Location - Street Building Type 17-a-w N nF P UsOP-_J, Town/Village Subdivision Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. -.. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was aused by the willful or negligent act of the occupant of the building utilizing the system. �\ / —Day. Year % Signature: I/ct✓����/ C� � Title: (00 �) - Signature X4 C- Corporation Name (if corporation) Address: ja State Zip / �'i3 Corporation Name (if corporation) Address: 62? State /tl y Zip /a5Z9 3� Form GS -97 �- 1 7 w;. i PUTNAM COUNTY DEPARTMENT OF HEALTII DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street-Address: Town/Village: Tax Orid # County Hill Road Patterson Map Block Lot(s) Well Owner: Name: Address: Westchester Modular Homes, Inc., 291 t:e 22 Patter Use of Well; Residential Public Supply Air coed /heat pump Irrigation I- primary Business — Farm Test/monitoring Other(specify) 2- secondary 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 Total length 72 ft. Materials: _X_ Steel _ PIastic _ Other Casing Details Length below grade 71 ft. Joints: _ Welded _X Threaded _ Other Diameter 6 in. Seal: .X Cement grout Bentonite Other Weight per foot 1Llblft. Drive shoe: X 'Yes No Liner: Yes ,g No Diameter (in) Slot Size Longth(ft) Depth to Screen (1t) Developed? Screen Details First Yes No Second Hours Well Yield Test _ Bailed X Pumped _X_ Compressed Air Hours _E Yield –2Q gpm Depth Data easare froin land surface-static (specify R During yield tes ) Depth ot'completed well et 1 WeR Log 30, Depth From Surface Water 180' Well 245' Formation ft. ft. If inore detailed Bearing t>'lameter(ia) Description information Land Surface �7 n in 57 Hit rod at descriptions or 57 72 sieve analyses - i in r oil 72 245 in in r an are available, please attach. If yield was tested Feet Gallons Per Minute Pump /Storage Tank Information at different depths Pump Type glib CapacitY7 _ during drilling, Depth 200' Model X5412 list: Voltage 230 HP_ Tank Type M02 Volume al. Date Well Completed Putnm Coun; Maricatio. Dato of Report W611 c al 9/13/99 002 11/4/99 nvi r:: rxact locailon of well Well Drille Signature: White copy pernnanent lanamarKS to De proYl tl on a separate meeupfan. Address: 4 iaj= Date: _ 111419„9 _ copy - Owner; Orange copy - Well driller Form WC -97 ' 4• PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION DEPORT Well Location Street Address: Town/Village: Tax 0. id # Coantr dill Road Patterson Map Block Lot(s) Well Owner., Name: Address: Westchester Modular Haanes► Inc. I 2910.. te 22 Fatterjon, NY 1203 Use of Well; X Residential Public Supply Air cond/heat pump Irr7igation 1- primary Business Farm Test/monitoring Other(specify) 2- secondary Industrial Institutional Standby Drilling Equipment X Rotary Cable percussion _X_ Compressed air percussion Other (spccify) Well Type Screened Open end casing X Open hole in bedrock Other Total length 72 ft. Materials: Steel , Plastic _ Other Casing Details Length below grade 71 ft. Joints: _ Welded ,X Threaded _ Other Diameter G in. Seal: ,X Cement grout _ ]3entonite Other Weight per foot jLlb /ft. Drive shoe: x Yes No Liner: Yes No Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? Screen Details First Yes No Second Flours Well Yield Test _ Bailed X Pumped _X_ Compressed Air Hours.- Yield 20 gpm Depth Data Meaurc from land surfac"tatio specs During yield test(ft) 57c of oompleted wolf in feet 30, 180' 245' Well Log Depth From Surface Water Well Formation ft. ft. If iinore detailed Bearing btameterpn) Description information Land Surface 7 in descriptions or 57 Flit at 57, 57 72 - sieve analyses are available, Drillint in r ® ou 72 20 brilli in _cMani. please attach. If yield was tested Feet Gallons Per Minute Pump /Storage Tank Information at different depths Pump Type sub_ Capaeity7, during drilling, Depth 200' Model 3GSO5412 Iist. 'Voltage 230 HP Tank Type _Nggg Volume al. Date Well Completed Putnam Couniy=tication 90. Dale of Report el ► c si u 9/13/99 002 11/4/99 ea NOTE: Exact location of well wi tances to at least permanent landmarks to be proud on a separate sheet/plan. Well Driller's Name P. Address: Signature: Date: 11 Z4L99 _ White copy: HD File; YeliA copy - Building Inspector; Pink copy - Owner; orange copy - Well driller - Well Location Owner: Use of Well; ]I-PrkMary 2- secondary Casing Details Screen Details Well Yield Test Depth Data .ell Log If pnoro dotailed aescripnons or sieve analyses are available, please attach. If yield was tested at different depths during drilling, list: 9/13/99 Well Driller's Name Signature; PUTNAM COUNTY DEPARTMENT OF HEALTIi DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Street Address: TownNillage: Taal (arid # coun!�EX Dill Road Patterson . Map Block Lot(s) Name: Address: Westchester Nodular Homes r to . j 2910-ft 22, Patter; ,Residential Public Supply Air cond/heat pump Irrigation Business _ Farm Test/monitoring Other(specify) Industrial Institutional Standby X Rotary Cable percussion X Compressed air pemussiori Other (specify) Screened _ Open end casing X Open hole in bedrock Other Total length 72 ft. Materials: _X_ Steel PIastic _ Other Length below grade 71 $. Joints: _Welded x rareaded _ Other Diameter 6 in. Seal: ,X Cement grout Sentonite Other Weight per foot lglb /fi. Drive shoe: X Yes No Liner: Yes ,gNo Diameter (in) Slot Size' Length(ft) Depth to Screen (ft) Developed? First r Yes_ 4o Second Hours._,_ _ Bailed x Pumped _X_ Compressed Air Hotus _6 Yield 20 gpm ensure Rom an surfaces o specs ounag yield tos o 'completed well et 30, I$0' 245' Depth From Surface Water Well Formation f. tit Bearing b1ameter0n) Description Land Surface _97 D=i in Wirdan (-I jig and- bMil dem 57 Hat roci at 57 -i -in set gasili �otid 7 f An -aranita- Feet Gallons Per Minute Pump /Storage Tank Information Pump Type _A&_ CapaeitY7j_ epth 2001 Model GS-P-5412 Voltage 230 HP,_ Tank Type MP02 Volume a -al. Pu aunty cation o. Data of Report e Icy(al tupr 002 11/4/99 or wen wt tances to at yeast permanent mnamarms to ne propw on a separate sneevpjan. F Address: 4 g� Date: .11Z4L99 White copy: HD File; YeltA copy- Building Inspector; Pink copy - Owner; Orange copy- Well driller NB NORTHEAST LABORATORY OF DANBURY 39 MILL PLAIN RoAD - DANBURY, CT 06811 CT Cert: PH -0404 LABS 203) 748 -7903 - FAX (203) 748- 0652 NY Cert: 11471 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: P.F. BEAL AND SONS 4 PUTNAM AVENUE BREWSTER, NY 10509 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: Total, Coliform (Bacteria) PHYSICALS: Color Odor pH Turbidity DATE SAMPLE COLLECTED: 10 /27/99 TIME COLLECTED: 1:30 PM COLLECTED BY: MTB DATE RECEIVED @ LAB: 10/27/99 TESTED BY: LAB# 11471 REPORT DATE: 10 /29/99 WESTCHESTER MODULAR, COUNTRY HILL, PATTERSON NOT STATED WELL NONE RESULT: 0 10 2 -STALE 7.56 4.8 MAIIIMUM CONTAMINANT LEVEL per 100 ml 0 per 100 ml 15 3 Units no designated limit NTUs 5 NTUs CHEMISTRY: Nitrite N <0.005 mg/L as N 1 mg/L as N Nitrate N 1.18 mg/L as N 10 mg/L as N Alkalinity 75 mg/L no designated limits Hardness 154 mg/L - _ -- -_no designated limits Iron 0.846 mg/L 0.30 mg/L Manganese 0.031 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium 6.0 mg/L 20 mg/L ** Lead 0.002 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: 10/27/99 SAMPLE, AS TESTED ABOVE: ❑X OTABLE or AMNOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060370 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 * OUTSIDE CT: 800 - 654 -1230 0 NORTHEAST LABORATORY OF DANBURY 39 MELL PLAN ROAD - DANWRY, CT 06811 CT Cert: PH -0404 203) 748 -7903 - FAX (203) 748- 0652 NY Cert: 11471 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: P.F. BEAL AND SONS 4 PUTNAM AVENUE BREWSTER, NY 10509 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: Total Coliform (Bacteria) PHYSICALS: Color Odor pH Turbidity CHEMISTRY: m1= milliliter "'Notification Level Nitrite N Nitrate N Alkalinity Hardness Iron Manganese DATE SAMPLE COLLECTED: 10 /27/99 TIME COLLECTED: 1:30 PM COLLECTED BY: MTB DATE RECEIVED @ LAB: 10/27/99 TESTED BY: LAB# 11471 REPORT DATE: 10/29/99 WESTCHESTER MODULAR, COUNTRY HILL, PATTERSON NOT STATED WELL NONE RESULT: 0 10 2 -STALE 7.56 4.8 <0.005 1.18 75 154 0.846 0.031 Sodium 6.0 Lead 0.002 mg/L = milligrams per Liter ** *Action Level MA3M1[UM CONTAMINANT LEVEL per 100 ml 0 per 100 ml 15 3 Units no designated limit NTUs 5 NTUs mg/L as N 1 mg/L as N mg/L as N 10 mg/L as N mg/L no designated limits mg/L _ no designated_ limits mg/L 0.30 mg/L mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] mg/L 20 mg/I. ** mg/L 0.015 * ** ND = none detected NTU =Units RESULTS BASED ON SAMPLES SUBMITTED: 10/27/99 SAMPLE, AS TESTED ABOVE: DOTABLE or F ] POTABLE PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) !< f i Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826- 0105.OUTSIDE CT: 800 - 654 -1230 NR NORTHEAST LABORATORY OF DANBURY 39 MELL PLAIN ROAD - DANBuRY, CT 06811 CT Cert: PH -0404 LAW 203) 748 -7903 - FAX (203) 748- 0652 NY Cert: 11471 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: P.F. BEAL AND SONS DATE SAMPLE COLLECTED: 10 /27/99 4 PUTNAM AVENUE TIlV1E COLLECTED: 1:30 PM BREWSTER, NY 10509 COLLECTED BY: MTB DATE RECEIVED @ LAB: 10/27/99 TESTED BY: LAB# 11471 REPORT DATE: 10 /29/99 SAMPLE SITE: WESTCHESTER MODULAR, COUNTRY HILL, PATTERSON SAMPLING POINT: NOT STATED SOURCE: WELL TREATMENT: NONE TEST PERFORMED RESULT: MAXIMUM CONTAMINANT LEVEL BACTERIAL: Total Coliform (Bacteria) 0 per 100 ml 0 per 100 ml PHYSICALS: Color 10 15 Odor 2 -STALE 3 Units pH 7.56 no designated limit Turbidity 4.8 NTUs 5 NTUs CHEMISTRY: Nitrite N <0.005 mg/L as N 1 mg/L as N Nitrate N 1.18 mg/L as N 10 mg/L as N Alkalinity 75 mg/L no designated limits Hardness 154 mg/L no designated limits Iron 0.846 mg/L 0.30 mg/L Manganese 0.031 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] Sodium 6.0 mg/L 20 mg/L ** Lead 0.002 mg/L 0.015*** ml = milliliter mg/L = milligrams per Liter ND = none detected NTU =Units * *Notification Level ** *Action Level RESULTS BASED ON SAMPLES SUBMITTED: 10 /27/99 SAMPLE, AS TESTED ABOVE: 0 OTABLE or aOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) .i; 1117f Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: 92.6 V/ ! 99 Inspected y: �crp Street Location Co dyTp y �!`�/ i2 Owner _ 5-2- 7�ta a Tz c4 /t�� Town j_ATTE 72 5,?N Permit # — 6 7 £3 A TM # — / / Subdivision Lot # S "G ©�ht�•, fr:�/ Est. 1. Sewage System Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil riot stripped .................................................. d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/ wetlands ...... .....................4......... II. Sewage System a. Septic to c size - 1,000 ....... .1,250 .......other ................ b. Septic tank installed level ................ ............................... -,,c. 10 mum f� rom�foundation .......... ............................... nbution DTI out e—I ts��at -same elevation -water tested........ Q; 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box improperly set............................... � /y, , r � gt : q � �_p p ° Length installed 2. Distance to watercourse measured -� %Ao Ft: "...:..... 3. Installed according to plan ...... ..............................Q 4. Slope of trench acceptable 1/16 - 1/32 " /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6 Depth of trench <30 inches from surface .................. Room allowed for e p ion,,10D% .............. S`ize of gravel 3/4 = 1'72 d' clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped - /``/��1�'� r.�f +r ' -N r'Lt -r� ``I "..:OS ^.,. ........... ............................... r � stems �r ize o p c arri er ........ ............................... a :a .�� 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. House/Building a.House located per approved plans ... ............................... b Number of bediooms .........e/., 4,.. IV. Well'' ' a. Well located as per approved plans . ............................... ,�- b Distance from STS area measured 'ft........... !9'c `Gasmg 18" above g ..................................... �` `m`a`d. S�rface�drain g aroun well acceptable ..................... V. Overall Workmanship a. Boxes properly grouted .................................................. b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 6/97 YES I NO I . COMMENTS or+ A��eC�S D.IC, I acknowledge receipt'of.this, report; SIGNATURE: Title 02/96 . U l " rr \\ 10.97 AC. CAL. r1+ INII 43 0' DISTRICT 1 , CA9l CE6TRAl 5,", s 4 52.33 AC.L. 53 I ` 49 47 _ - _ 10.96 AC. 32.47 AC. CAL. K F 91i 1 � x .R 34.67 AC CAL ' S0 + 3 1 soJ3 cD o44 422 13.9tlAG Iuo ria �I Y� 44 ..b 124.01 AC. CAL. \ \. V so 46 .� , +3 a "se' ° ' of ".. �• a • °, I.sTk`'d ROUTE rnr •' 1+� a I6 � S s ?ac �tS 29 22 'G 'I.n sc b/e V 112 AC. 0 21 1.9•AC o c z32 A F 12 63.92 AC. CAL. 14.�13.2; 62 ., 1659 AG -- tea% a I.v1.86 AC.'••' 20 42E5 AC, CAL 3233 AC. CAL. 12.32 AC. �/ ,�I,`�p g 9 +� L _ 37 K . - FW..OSES.ONLY FOR COWETANCES, ALL COMPANY OLD TOWN, MAINE 378 • A 4 � vw •1.. � iyr4 w1S.SI. AC. C •. unI• �4, ri 3 r P/0 LOl LEGI I4 22 AL< +, p,^ cµ•9 m - 'T6S 6 O 45 100 j5 \ EL 11.66A o I. 1 P n q STATE wsT x � 2i5iN �, nA t,( 4 x -""- - - - - -_ 12.00 AC. R I 1 11 n. ry. 0 14Am •u ++ utll.0 3 /J..J ad70 g} 36.99 Ac. W 134 It 200'A6a.. 103 01 3.19AC. 2.34 AC. / ° 102 00 2.14 AC: 24..18 Rio I / �• 96 ¢ 12 ,° 3 x3..333 AC 196 93• 9y 126 12 T I.p 136 1\ e r °C 23AC: u4 •P 1 nN • a , ' 81 I 44 3 •B2 Ac. AC. l P70 35.3.26 I. P 0 35 -3.23 � as " _. ..,,.•` _..._.e \CL- _ -..__. _,. REVISIONS SPECIAL •wrMn.wM r• DISTRICT INFORMATION ..m�a 6040. •+q. tA,iQ mM6LL -ox •I "Alm . ann SUN un w>sr a sw LIN I'm --_ rivn�i rlAl •r• fII¢ 1IITRCrIa 61n111m s4 1 ,9•• L �-- E II6 s9s . 'WIILI xoa u11Ir - - - � •1x69r u1c g1nM111m UAC — — — .�.. 378 • A 4 � vw •1.. � iyr4 w1S.SI. AC. C •. unI• �4, ri 3 r P/0 LOl LEGI a N � w a N 0 �i .p - 1 OO U30 —0 0% > 0 O �rn0 r 0 y � O �1U➢D m rn�c N drnn �� � p rn �\ ,Pow �\ \\ O x04°53 50T 152.00' K3 I IT �x \ rn 1 _. -- _ — - ; - - �... Wetar Sa4pb: P am, Suppiril m Adder otb.. ' 1 represent that l_ am wholly and.cornpletely ►esponsibto for the design and location of -the proposed system(s)l 1) that theseparate, sour' di l Math above described will be constructed,as shown on tho r ipp►oved amendment there to,and in accordance with the standards, rules a ►Pill ns o n m County pepaitment of.* Meanly,, and thait on compNtion'thpeof a "Certificate, of Construction Complianu", satisfactory to the Commissioner of. Maeithwill be 'submnted to tea Department,.rand "fi written guarantee will be furn'is'hed the owner. his successors, heirs or assigns' by the builder, that NW builder will Piece in go" operating conditiowany Part of said saws" disposal system during the puiod of two (2► y s mroedistely following thedaN of the Issu- ance, of the approval of t11i .Certificate of Construction :Complienee, of. the orq 1 syst*m or any repair o; 2) that the drilled well described above will be located as drown on the approved Plan and that said well will beinsts n ith the ` s, ► s and reyu ns of the Putnam County D art"WM of "with. / / Date S P.E. RA. Add' u License No APPROVED FOR CONSTRUCTION -This approval expiry two yNrf fi m,tM date issued unNSf nst►uctlon of the building .has been undertaken and U "vocable IM cause or aY W amended Or modified when COnfidM n a ry by the�Imistwonsr of Naenh: Any change o► an•ratbn of construetbn requires a no ms' owed for disposalof dom•stk rani r age, and /or er supply only. zeV . .0/88 Palo.- By Titer PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF.ENVIRONMENTAL HEALTH SERVICES Date Re: Property of Located a (T)�� Section Bloc, k 4 Lot Subdivision of. 1i7 Subdv. Lot ' *led, Map Date IC MICHAEL DALY, P.E. Gentlemen: CONSUMNG MJNFE" This letter is to authorize R0. BaX a duly licensed professional engineer Y or t (Indicate to apply for a Construction permit fora separate sewage system, . to serve the above noted.propor,ty in accordance with the standards, rules or reguhations as promulagated by the Commissioner of the Putnam, County Department ..of Health, and to sign all necessary papers on my behalf in connection with *h:Lo iaattsr and to supervise the construction of said system or systems inconformity with the provisions of Article 145 or 147, Education • Lair,' .the..Public Health Law, and the Putnam County Sani- tary.. Code . Very.truly yours, Signed (� l�Q� Countersi 0 of P pe y Gam._ A ress I'V; Address Q. jgC"AEL DALy► p.�. Town CoIdULiJNG EKMER q u EOROCr, N. Telephone Telephone j i 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 # WELL LOCATION Street dres J1 o Village City Tax Grid Numb WELL OWNER a Mails g A dress v rivate O Public USE OF WELL primary - secondary SIDENTIAL 0 BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION b INSTITUTIONAL O STAND -BY 0 ABANDONED 0 OTHER (specify, O AMOUNT OF USE YIELD SOUGHT !r gpm /# PEOPLE SERVED /EST. OF DAILY USAGE,gal O LACE EXISTING SUPPLY O TEST /OBSERVATION 12-ADDITIONAL SUPPLY REW SUPPL N DWELLING) O DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE RILLED DRIVEN DDUG GRAVEL 0OTHER IS WELL SITE SUBJECT TO FLOODING? YES V NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:[- jL�b_'7t'.(4 Lot No. WATER WELL CONTRACTOR: Name `��'' ,� 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: LO TION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON EP RATE SHEET (date) (signatur ) 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 drills operations be contained on this property and in such -a manner as not to degra�de or other co aminate surface or groundwater. Date of Issue: Z . 19 fi Date of Expiration 19 ✓ Perm t Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller .�i ..� veil,. SZ P L Az�9 f, EA c-T.Y ° Date of Pmvkn Ate+ 1 represent, that l am wholly and completely;responsibie for the design and location of the proposed system($); 1) that the Separate Sawage di lal s stem above dnaibed will be constructed as shown on the approved amendment there to and in accordance with the standards, rules a regu ions o n m s. County pepartment; of HeektK- and that on cornpNtion thereof a "Certificat , of Consta�two ance" tisfactory to the Commissioner of Healthwill DO 'submitted to tea: 6 1 ' AniAnt, and a wrlttanyuarant S will be furnished. the owner, h assigns by the builder, that laid bulkier will puce in food op«iting cmdition' any part -of'laid :sawage disposal system durhq th y sImmediately following the date of the tau- Mq 01 tha apprdeal o f tea, Cestifkate of Constiuctbe'CornplMhce of the sire Isereto; 2) that Ue dulled wNl aeaalbed above wfN.Oe`loeatad as oe the ipprowA,l+lan and,that Said wall will be installed rds, rules and rpu�aiions of the Putnam County O rt of Health. i� Rate O ' Sign P.E. A.A. j5 _d %i� 2 �� J . s No riGK 4�3�f lob - - '.Atldres■ License No APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the building has been undertaken and is revocable for cause or may 0e amended or modified whin considered nece sy -Oy-M ;mluloner of health. Any change or alteration of construction requires new perm t Appro4ad for `disposal of dome, c senktary Pwal; an y�`p mate ater supply only. REV Oai� 1122 Title 10/88. .. 1�--- . 3186 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services. Carmel, N.Y. 16.512 Engineer to Provide Permit # PERMIT FOR SEWAGE DISPOSAL SYSTEM Located at<foubj� Subdivision Nairt on CERTIFICATE OF COMFUANlz peirlilt # dJ Town, or Village Tax Map IE— Block 4— Lot 5'. 6 _0� . Renewal —0—Revision—El Owner /Applicant Name IPj.� kQ'V h4 OdVA.� Date of Previous Approval 4 Mailing Address —Z. . Town _ Z TAP OAT' — Building Type 1�61712✓LMt%a— 'Lot Area o SGQ FIB Section Only Depth —Volume of Bedrooms Flow G/P/D - PCW Notification Is Required When Fill Is co, Number .4 completed tt _T -Separate Sewers Gallon Septic Tank and 6D Sewerage System to consist 4 f To be cousirti.eted, by Address Water Supply: Public Supply From Address or: ___� PrI,.ti Supply Drifted by 71F, I- M1 --Address Other Requirements I represent that I 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 the 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 b uilder. 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 the date of the issu- ance of the approval of the Ceitificate of Construction Compliance of the original system or any repair$ thereto; 2) t . the drilled well described above 2 will be located as shown on the approved plan and that said well will be Installed in accordance wo the r d s,: thereto; ul Ions of the Putnam st /7snd County Department of Health. Ir I/ � z �t Date am APPROVED FOR COWSTRUCTION: This approval expires one year revocable for or mended or modified. when considered ri ,,,(use requires efffr'oved for disposal of domestic sanitary Date— By, M�4±rqLgg he d issued K unless construction of the building has been undertaken and is the Cgissoner If h Iteration f t ti Mgt y. Any change t a.d/o pre It le 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 — &7- WELL LOCATION Street Address' KTo COUNTA N/1-1- AOAD Village City P TTE -5oN Tax Grid Number Z4 —1 —1 9 WELL OWNER Name. Mailing 6;2 Pi-AZA R EA1-s'y Address j3Private O Public USE OF WELL (0- primary 2 - secondary RESIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP D ABANDONED 0 BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify, 0 INDUSTRIAL C]INSTITUTIONAL O STAND -BY 13. AMOUNT OF USE YIELD SOUGHT S gpm /# PEOPLE SERVED /EST. OF DAILY USAGE 600 gal REASON FOR DRILLING 0 REPLACE EXISTING SUPPLY 8 NEW SUPPLY NEW DWELLING ❑ TEST /OBSERVATION 16 ADDITIONAL SUPPLY O DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING qr=w Nou5E WELL TYPE ®DRILLED DDRIVEN []DUG GRAVEL. D OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: COUNTRY µ1L t- ESTA TF.5 Lot No. WATER WELL CONTRACTOR: Name �> �� Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ,k NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATI N SK CH & SOURCES OF CONTAMINATION PROVIDE ON SEPARATE SHEET ( e signature PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump,the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwi urface or groundwater. Date of Issue: 00,-/ 19_c 7-57 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 TINE 9.149625837 PUTNAM COUNTY DEPARTMENT OF ilZ ALTH DIVISION OF BNVIROMlENTAL HEALA11 SERVICES Date _�.Q..L �� _ ,� Re; Property.,of, Located at ULLA---"J� (T) S t; j. On Subdivision of BI u Lot Subdv. Lot io filed Map4 (0t Date, Gentlemen; T, �LTP C0N8M,'0','i(-' Z.- WEEK P, I.. - 1, This letter is to autlwrize SHEDI 4-P a duly licensed professional I cvigineer (Indicate) to apply for a Construction -Porti):1A. for a sewage system, P.02 t1i. the standardti, -i-ii-Lo* serve the above noted proporty In accordarco or regulations as promialagaLod by the of. tho Putnam Department of Health and 1-(.) :sign all papers on my, behe I f i.t► connection with this rnattex- tino to supervise -1-he construction of So i-1-1 system tem or systems in con'rormity wAth the prov"it,''lons of Articlo, '145 147, Educatio)a Law, the Pub.'Itc I1calth. Law, wo(y (J-1e Putnam Cowity 6 aj--L tary Code. Very truly tirs, Signed lilf PrQpierty C,ountersignec� k6 P.E., R.A., T'I-11 Ad, s s MI PAM, P.E Address CONSULTING FLNGINEER, . P, 0. BOX Z43 Telephone Tol,V71 're'. ('phone wed ,sy tero(s)l i) .that th. -r Mo el sat stern . aft :sr{th tna'stanAirOs. rum a nW ns o 171411 rm"IMM Co 4liir4w- .06ifeetoryr to, the OominflOWnr of MSO*hVAII caarers. Mfrs or. a,Nlps by the buN w. MW aid WNNr•wlll vof two' ) VMS Unnwla" folsowini thagto of the New. r irs rul that tlla MME wan �ase►tiM aiow filth / rules •nA ►yZi o�T ni Of the' wtMnt of the tlullelinipAss bian undertaken and Is Any cMnp or alteration of eonstrudlon Y. 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 #1 WELL LOCATION Street Address irm .o Village City Tax Grid Number -1 -19 WELL OWNER N Mailing Address'fivate Qg_ — 0 Public e U E OF WELL 1 primary 2- secondary OKESIDENTIAL O BUSINESS D INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION ❑ OTHER (specify O INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /# O REPLACE EXISTING SUPPLY 9-9E_W SUPPLY (NEW DWELLING PEOPLE SERVED _ /EST. OF DAILY USAGE 600gal ❑ TEST /OBSERVATION Q ADDITIONAL SUPPLY D DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING U WELL TYPE 920fILLED DRIVEN DUG GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES [iIQO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Chu 1LC, TES Lot No. c' WATER WELL CONTRACTOR: Name T'•,� 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 ON SEPARATE SHEET 2 WA 5;'�l (date) s 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 thirti- (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: �Gy�/ 19� Date of Expiration 19� Permit Issuing Officia 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 52- Located at coV ffP7 -( 1 Ll , 'i OAV (T) ?A Kei2-5ot'3 Section Block Lot Subdivision of C,>Jh111�4 t�A�/l, ?i5-ro-ne,5 Subdv. Lot # 5 Filed Map # Date T. MICHAEL DALY, P.E. Gentlemen: CONSULTING ENGINEER P. 0. BOX 243 This letter is to authorize sHENOROCKF N.Y. 10587 a duly licensed professional engineer VXor 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 you s, Signed,X b� Own e Countersigne ." o roperty r / P.E. , R.A. , # � -y • ��! (� � ik Address T. MICHAEL DA1-Y' P !: se� Address CONSULTING ENGINEER Town P. 0. BOX 243 SHENOROUL N. Y_ insw Telephone Z 9.f 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. p PCHD PERMIT $ P- 61 "86 WELL LOCATION Street Address Vv� IW Town/Village/City Tax Grid Number eA ,WELL OWNER Name Mailing Address.. VLA !ALA Plug Tael:� pit Z Ii-Afor04 Wrivate 0Public SE OF WELL 1 - primary - secondary 'RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY 0 AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL 0 STAND-BY D ABANDONED 0 OTHER (specify, O AMOUNT OF USE YIELD SOUGHT 5' gpm /# PEOPLE SERVED e) /EST. OF DAILY USAGE (o u gal ❑ REPLACE-EXISTING SUPPLY 0 TEST/ OBSERVATION d ADDITIONAL SUPPLY SUPPLY NEW DWELLING) 0 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING New WOOS WELL TYPE . RILLED I "11P []DRIVEN — []DUG [:]GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME :OF SUBDIVISION: Coon%f New ES rfr s Lot No.� WATER WELL CONTRACTOR: Name13-0- 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 S SOURCES. OF CONTAMINATION PROVIDED SEPARATE SHEET (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 Department attached to this permit. 3. Submit a Well Completion Report on a.form requirements of the Putnam County Health provided by the Putnam County Health Department. During all well drilling operations, the applicant any and all water or waste products from such well property and in such a.manner as not to degrade or Date of Issue: Date of Expiration %i3 1913 Permit is Non - Transferrable White 3/89 Yelloi shall take appropriate action.to assure that dr�'erw g operations be contained on this a contaminate surface or groundwater. rmit Issuing Official copy: HD File Pink copy: Owner a copy: Bldg. Insp. Orange copy: Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property o Located at Date (T) Se ion Subdivision of '074 Block Lo t 19 Subdv. Lot # yj'— Filed Map # Date Gentlemen: I MICHAEL DALY, P.E. CONSULTING ENGINEER This letter is to authorize Pe O. BOX 243 .1. 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, i ne Countersigned° wz-e" P.E., R.A., # Address ALY, P.E. CONSULTING ENGINEER P. 0. BOX an"UROCK, N. Y. 10587 Telephone s d Ownej or Prope y ddress Town AJ3,7 Telephone I repre *Mt -thann sM-wholly and completely responsible for.thi design and location of the proposed system($): 1) that the a stest• sew ai =wl sgste�m avow d.,gribad wilt ba oon,stiuetad as mown on the approved &mendment. there to and in accordance with the standards, rums are regu _ niai%nsi or m County Dapar meat of. Hftftl%' and that on CoenpNtioii'aAereof a "Cer<ificah 'ot Construction Comptianci" satisfactory to the Commistbttarof f leaKhwill .68 submRtedi to the Oepinm ent, and -a ;written .warantes will be furnished the owner. his successors, heirs or isslgns by the bulttler, that uld builder will platy Mpod - ePiratin/ condttbn 'any' part; of ;saki sewage disposal, iystaln during the period of two (t) $ Immediately following tlw,daN of the issu- 000 dt the ,app�arai of the' irtNkate of Consiruct" Compliance of the original system or any repo t - 0:2) that the drilled well doicrleed tOovo wNl be as. slidwll on thadpp►ored plen and i6it said well will be.ln in rda with .t rd k» and reduStrons of the Putnam Cbs I .0 ftrr vm`; Of Ciat's 2e.2 r. j. AAdra License N D uc d9 �/ A APPROVED FOR, CONSTRUCTION. This app► vii expires two yaws froim the data issued unless construction of the building has been undertaken and is fiirocabN for �uii or maY a amended or,moAtfled when'et►nskferad necessary -by the-!Commissioner of Health. Any charge or alteratbn of cpintructk►n 1 i roOuMas a pamK A yroied for disposal of dornastie nnKery and/�Pp[Ilate water wpply only. By DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y.. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL I PCHD PERMIT # P O -F� WELL LOCATION Stre t Addr s Town Village City Tax Grid Number WELL OWNER. f Name J Maili A dres 1� n' rivate 0 Public USE OF WELL 1 - primary 2- secondary G /RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL b PUBLIC SUPPLY O AIR /.COND /HEAT PUMP O FARM O TEST /OBSERVATION M INSTITUTIONAL O STAND -BY O ABANDONED 13 OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED g /EST. OF DAILY USAGE VDU gal REASON FOR DRILLING NEW. SUPPLY OPROVIDE ADDITIONAL SUPPLY OREPLACE EXISTING SUPPLY ODEEPEN EXISTING WELL OTEST /OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE. ©DRILLED DRIVEN []DUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES k-' NO IF WELL IS.LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: ZS' Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO.SITE: YES 1/� NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED O ON REAR OF THIS APPLICATION AROE S ( e signature PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty.(30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam . County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. Date of .Issue: _19 � 9 .`� Permit Issuing f cl Date of Expiration. 19 White Permit is Non - Transferrable copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner 2/87 rfrnnrrc r nrw. Wol 1 r'Tri 1 1 or fi .. AM COUNTY DEPABTIrffiIPP OF 1�ALTH Divitilop d Eflivboamentel Health Serv" Carmel. N.Y dM2 L+�Igineer to PsvvMe' Permlt,M CONSTR ON PERM r FOR C, on CERTIFICATE OF C01Y�IdANCE 1 permit SEWAGE DISPOSAL SYSTL114 \ c, �� wn or., e\ VIP Located u VUlag .. Stibdlvtaba Nam abd. Lot lY " im Me Bloch Lol ` i. ,I Renewal_ Revision : ❑ App U�c C'f 1Ctnj Owner/ Resat Name . �.� f Date'ot[ Previous A pp vol — 2C J Miiltiag Address Town lKf.l�.� -T Tdp Building Type' 1, a, Lot ,are, I ; 0(r;{0 p o Only Number Bedeoome Design Ftow,G P -D , ( PCHD Notlfl atlon to Regdeed Wbeii Fill•te completed: Separate Sewerage Systom to oonalst of l x.11 LGalloa Septic Tank and _` ; . To be oonateacted by Address Water SUFI dlbllc Supply From Address on - Private Sapply;DrlUed by D' Address Other Requirements. I represent that f am wholly and completeiy responsible for Cho design and location of 'he Droposed system(s),' 1) that the separate sewage diipoYl s stem above Aescribed will tie constructed as shown on the approved amendment there .to and in accordance with the standards, rules an ►ego a ions o e• u nam .County ,Department .of Health and that on completion thereof a "Ce►t�twate of ConstructionCompliince" satisfactory to the,Commissioner of Hrialthwin be submitted to the.0epaitment and a wiittan guarantee .will De' urh`ishetl the owner his successors„heirsor issigns.by the builder. that said buildsrwill place m good :operating `condition my ':part "oiaaid sewage tllsDOSa) system'du►i'p` the period`of two (2) yeais"Immediately following the data of the issu= ance `Of the app►OViI of the Ceti /isle of Construction Compliance' of- the`original system or, inyaepaira M e ; Z) that the drilled well deicfI above will be looted as,shown on the approved plan and that said well will ba installed in accordance with th stand ds, rubs and .repo a�iTons . of , the, Putnam f, County epart eat of, Health e' Date , Signed P.E R.A. Atltl►ess zicerise No APPROVED FOR CONSTRUCTN IO Thl`S approval akpires twotyeais „from the date,.issued unless nstruction of the building has'.been undertaken'and is revocable for cause or may be amended or modified when considere, necessary by :the; Commissioner Af Hailth. Any change or alteration of construction requires a new be mil. Appro ad for disposal .of domestic samtSry'sew /oi .private. water supply. only. qC�y nd 1/8I Oate e %� I -�/ , /J�. ��1/'2 ice' G ills ��°.�! fu✓d/ CH-5- 4rt 3- PUTNAM COUNTY DEPAZZ= OF HEALTH - DIVISION OF ENVIROMWAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEMGE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT DATE EWER: U, J, 0 BY: Ma of Owner) (Street Location) CAS YES NO DOCUMOUS Permit Application 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 Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions. - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over 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 45° 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) 15' to Drains- Curtain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -20') Septic Tanks 10' from 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 DIVISION OF ENVIRONMENTAL.HEALTH SERVICES Date Re: Property of Buckingham Development Corp. Located at Rt. 164, Patterson Section Man 15 Block 4 Lot a 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 conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County San,i- tary Code. . Very t Signed Countersign p 1 P.E ., R.A. I ## CJ �c2'J (914) 279 -ohnn Telephone Rt. 22, P.O. Box 377, Brewwter, N.Y. 10509 Address Address Telephone Putnam County Ikpartment of Health Division of Environmental Sanitation AFFIDAVIT - CORPORATE CUNER APPLICATION FOR PERMIT APPLICATION'SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health - In the matter'of application for �onst�uction ,permit for separate sewage system_ _ _ r _ — — — — — — I6 Jerry Weissman, V. Pres.— _ _ — — ` _ _ _ _ — — represent that I am an officer or employee of the corporation and.am authorized a to act for T3 �c►�„� _'nom! • _ _ • (name off`. corporation) - ` having offices at Rt. 22, P.O..Box 377 — _ — — Brewster, N.Y..10509 Whose officers are — ..--- - - - - -- President ` Robert Fregosi —` --' --'— (Nam —e Jerry Weissman Weissman Vice- President . . - - — — — — — — — (t�'ame and Address` ) Secretary _ — — _ _ ___ ..- (Name and Address) — Treasurer -- — — —• — — — _ l -• — _ . • (Name —n— a Addr—ess) — ' sand tha t I am and will be individually responsible for..any or.all'aets' of the' corporation with respect _to the aparov sted a d al-1 sub - sequent acts relating thereto. Shorn to before me this d day S' e of A 19 Title Notaz* flublic tt: =,x VLrY S. 13'i -i R Notary Publ ic. State oat Never To* ResidiP. i�n} Rc 'KWUj C40UCc 2 2 t:(: 'Corporate Seal - •Division Of Environmental H%aA Services TWO COUNTY CENTER — CARMEL, N.Y.. 10512 �14Z 225-3641 APPLICATION TO CONSTRUCT A WATER WELL leo-g.1 WELL LOCATION STREEI AUUHESS. WWNIYILLAG / 1 Y [Ax GRW Numuil. WELL OWNER NAME. NAME. • ADDRESS: ["PSIVAT( i?_ %z.z cDxc _ ❑ PUBLIC USE OF WELL E rRESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /CONO. /HEAT PUMP ❑ ABANDONED 1 - primary ❑ BUSINESS ❑ _FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify) 2 - secondary ❑ INDUSTRIAL ❑INSTITUTIONAL ❑ STAND -BY ❑ AMOUNT OF USE YIELD SOUGHT 5 gpm. /NO. PEOPLE SERVED 8 / EST. OF DAILY USAGE - OO gal. REASON FOR R"NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION GRILLING ❑ .aEPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL WELL TYPE I aDRILLED DRIVEN E] DUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF' iELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:Co,��l T, LOT NO WATER WELL CONTRACTOR: Name v'3;.T) Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES +/ NO NAME OF PUBLIC -WATER SUPPLY: - TOW1I /V /C DISTANCE TO PROPERTY FROM • N•EAREST WATER•.MAIN LOCATION SKETCH & SOURCES OF CONTAMINATION (date) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well asset 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 Wel. Completion Report on a form rovided by the Putnam unty Healt partment. 4 Date of Issue: 1 Pe Issuirig Office 1 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. U ern 1�r 1, C�e' Addre s ss 27 - -z,-L 3 r, x 3'i-► �S i b��.� . Located at ( Street ts tt� ,�. Z, See . Block 4 Lot So ��: ,icat neares cross s ree Municipality, 2/1_,� Watershed�sZ- '3;za�.�l�- eE,-tba {2•�cM SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATIONS--O PERCOLATION Run Elapse Depth to _ Water Water.Levei No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches- Inches 1 1 0 .yam 2 0 -, o a 1�� 17 3 3 aF4- 31 40. 5 z0 S3 cn z0 4 5- 1 2' 3 4 5 Notes: 1) Tests 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 ENCOUN`1'ERED IN TEST HOLES DEPTH HOLE NO. I HOLE NO. HOLE NO. G. L. 611 fl 1211 (�cycJv✓l� _ 18" 24" �r 3011 if 36" , I 42" ,1 48" 54" 60" r 66" + 7211 78`• 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE'LEVEL'TO WHICH.WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY -z') ('le� Date 6` Z-5t>3 -g DESIGN Soil Rate Used B - lVin/l "Drop: S.D. Usable Area Prov �� OF NC -: No. of Bedrooms Septic Tank Capacity IZ� Gal p Absorption Area Provided By�L.F.x2411 � 0 midth e O Address oK 24-3 A'o C a b1gna THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: SEAL ��OA �• 045��� ���� Soil Rate Approved Sq. Ft /Gal. Checked by Date