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HomeMy WebLinkAbout0746DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 24. -1 -23 BOX 8 17-2 i 74A a , r i 1; �i L . �u , f or i 2� 00746 BRUCE R FOLEY Public Health Director LORETTA MOLINARI- RN., M.S.N. F J101:_ Associate Public Health Director Director of Patient Services DEPARTNIENT OF HEALTH 1 Geneva Road Brewster, New . York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 . Fax (914) 278 - 6085 Early Intervention (914) 278.- 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 May 19, 2000 Philip Guion 1 Country Hill Rd. Patterson NY 12563 Re: Addition-' Guion - Country Hill Rd. No Increases in Number of Bedrooms (T) Patterson Tax # 24. -1 -23 De_ ar Mr. Guion: 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 -May 19,-2000 .The addition-is approved with the following conditions: 1. The total number of bedrooms must remain at Two 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 yours, � Michael Luke 44 ML: kg Public Health Sanitarian cc: BI 6' - "6 7/8• 8•- 1 7/8' G'- 6' 52'- 0' 13'- 5' 17'- 4 1/4' f9 a 0, O' HOR: 2- 2X8 SPF 12 12'- 1 3/4'. 1530 2430 O O 2430 c �• O - 2 3'- <� I S 3 S 3 •� 835 DW SOB 36 812 I �� II 2x6 II II 2x6 II -i ' it SKY II 1 SKY- LIGHT ( LIGHT 11 12 - 11' 1 /1' 0'- II 11 II II o w3. � � ' ' 6 7/d �{ II 9- 6 7/8.11 —•I 11 II + I I m BATH #2 OMIT -1 /e' SOFFIT II n Ill. u nDINING ROOMI u I I B62 ®® �, N a ALK -IN a . 1s'- 2• CLODET U 4 II 11 ° II II p 11 -� I I I 1 i23 OO ®OO o 0 II II 11 11 I I n � - iu KITCHEN OMIT -1 /x' o S ' 26'- S 1/4- ° CATHEDRAL CEILING :� 1 ya•rnL f BATH #1 T/_c_ 8N - 0 f0'- 9 3/�' — RCB: 2-1 1 /2'x 14' _3615 2430 jy 1 / / / / n,.r1 A� BY� • 1 W pip, ❑ ' - _ - - - - / / BC& 2L1 i/2'x.f4' / / aw SHIPLOOSE DOORS o i z Sz - 1 3/.• 5' 4 1/2• . 3' B• �/ / / / / UNTY pFpARrMENT HALL o °� OF 1lEAL' 0. x o o; E'PL r AAS ❑ Z ,W� APP ROVED FOR O�M COU NT ONLY; N BEDROOM # 1 m Z ~ ° a U,< 1 PLEASE SIGN_ & RETURN AS 0. GROOMS v CONFIR;`ATION OF ORDER o2w G ROOM I m ui BEDROOM #2 z o °W WGV*l 'Z _w BUILDERS SIGNATURE w °LL= re tie C"THE�AL4CEILI a `�l><! GATE: 1- z I !6'- S' - !0' f0'. 2' /2• 13'- 10' imr = cc cz� . HOR: 2- 2x8 SPF 12 N I , HOR 2- 2XB SPF 02 .4 �. 1 HOR: 2 -2 SPF 12 H = ? 12 OHO I O,O O' Wmw UNF. -.Z B'- 7 1/2' tl'- 10 1/4• 8' 11 3/4• 16' f /2' G' -. 6' " m o >. " 6. 0' 6' 9' 1. 3' . 8. 0' e' o• 7. 6' 6' 8' 0' B' 0• SERIAL NO' 7081E BUILDER:- PROJ N0: 92 -231 TES: 2x6 EXTERIOR WALLS W/ 1" R -MAX CL IENT: PATTERSON DROER NO: 'CATHEDRAL CEILING IN: LIVING ROOM, DINING ROOM & KITCHEN a PEN LYON HOMES, IN N C. DRAWN BY' JDS °AT E 4/21/92 STATE NY EXTERIOR WALL HEIGHT 8' -0' P.O. BOX 27, AIRPORT ROAD REVISED BV' CCM DATE: 4/30/92 SCALE: 1/4' -1' OMIT ALL FLOOR COVERINGS SELINSGROVE. -PA 17870 N0 °a LYNNWOOD DISK NO' 287 DRAWING: FLOOR PLAN ROOF SYS: HM��B -37 GA�,�e s 6 }' i 0.5,e.� . PUP,`�H'':� COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR i BEDROOM COUNT ONLY, � "Z""'QEDROQM$ � S O fill l Signature & T►Ls Oai� N MAL :LNe DEPARTMENv'T OF BEALT i Division of E'nvironimntal Health Services 4 Genava Road Brewster, Naw York 10509 rel. (914) 21-6130 Fax (914) 278-7921 . 10 L DESC`.ROTiON OF ADDITION BRUCE R. FOLEY Public Health Director - TOW, 0992 TX MAP # o :�Z PHONE PCHI•D 0 0 NUNSER OF EMSUNG BL73R004 (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BU LDLNG INSPECTOR) PROPOSED # OF BEDROOMS 0 *Any addition vvhich is cots dered a bedroom requires formal approval of plans (Construction Permit) prepered by a Prof:ssiorlal Engineer or Registered Architect in accordance with applicable sections of the Pumam County Sanitsty Code. Please submit this form and the. fol.lowing to Putnam Coua y Health Dept., 4 Geneva Rd., Brewster, NY 10509, Phone 278 -6130. 1. Certified check or money ordar for $100.00 Sketches of existing floor plan (drawn to scale, all living area including basement) " Non - professional sketches are acceptable 3. Two sets of proposed floor plan (drawn to scale, with name, street, and tai: map 0) * Non-professional sketches are acceptable 4. Copy of suvey Showing well and septic location, to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the proparty line. Contact this office with any questions. 5. Copy of Cert, of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. DF I :E FJ- fiE commen�s Feb 93 U iv L DEPARTMENT OF HEALTH Division ,Of Environmental Health Services 4 Ger.eve Road, Brewster, New York 10509 (914) 278-6130 Putnarr. County Dept, Of Health 4 Geneva Rgad BT,ewste-' NY 105P9 Re: R Idencz Tax I ap Town * , , , -4 Gentlemen-. BRUCE R.JOLEY. RS Acting PUNIG.Mealth Direcv3p According to records maintained by the ToNNTi, the above noted dwelling IS JS NOT in cOmpliance. vJth ToA7n code and the total number of bedrooms on record is This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER _ -� OZ- �i ildinc, Inspector ' ��: ?G:/Gt'L ii � 6 -� i � � ' o c`` - (i1NNi1/ 11111 11 3 11 11IK1/ 11/ liY�l r/ 1J 'bl1/V'iILT111r':YVlllilillVlV VI1l HIMNIIJ11IY1 /I1fHL�(HINVIIJNIYi'11111�/If 1 �S C o NITTOLO LAND DEVELOPMENT ASSOCIATES, INC. 404 Sheffield Court, Brewster„ N.Y. 10509 PHONE (914) 278 -4445 NEIL NITTOLO, PRESIDENT FAX (914) 278 -4448 May 15, 00 TO: Ms. Cathy Graap INFORMATIONAL CONTENT: Bank Check Enclosed -Sturcture Addition To Existing Single Family Dwelling, Attached Garage With Bonus Room, Country Hill Road, Guion As Owner, Map 24 -1 -23, Bill Hedges B.O.H Contact FILE CONTENTS: -Cover Letter Review, -Bank Check In The Amount Of $ 100.00, To Putnam County Board Of Health PAGES: 1 Dear Kathy, As per our most recent conversation, please find attached the above noted check to complete our file and Requested for B.O.H. review of a proposed structure addition. The file documents were submitted on or about May 10th without the required B.O.H. fee for review. Please advise Mr. Hedgers of the Fee submission so that his official review of the file can be implemented. Your attention to this matter will be greatly appreciated. r ' ■ ■�� ■■ ■■■■■■■�■ }�F f • ......... '.,...s, �t,s'! rdcn*�' ,l�.y��-u?i g�'.1 -d( rid _ '•'v ��fi.'�'t; ^tj n�,(S � '15¢7 nP. 04� 2s t �t �L�M4ia v 3 iic S rt a -. •` r�F �^��{� qq,,3 #�i *��'' ra; +'xY�itw'�k++�i w 57rA a1 iu 7i r 1' 0g 9� � s N 0 to ,. . _.. _...___ _ - - ­­- N 11'17'26.7 "_K OED l .0 -f RPO G '1�1 ! � OYIEV' �hoo9 � o 0 �g �A ' • Ag A y� 5 275.00 ' Lod A 7aa:= 43, 0.9. 0 _.._ 2.6 3' 225 00 P y SILL co Certified to: >. Philin C. NITTOLO LAND DEVELOPMENT ASSOCIATES, INC. 404 Sheffield Court„ Brewster„ N.Y. 10509 PHONE (914) 278 -4445 NEIL NITTOLO, PRESIDENT FAX (914) 278 -4448 May 5, 00 00 TO: Bill Hedges, Putnam County Heath Department INFORMATIONAL CONTENT: Request For File Review - Garage /Room Addition Planed. Country Hill Road, Country Hill Estates. Map 24 -1 -23, Philip And Ann Guion As Owners. FILE CONTENTS: -Cover Letter Review, - Patterson Building Department Forms, -Survey Copy Showing Proposed, -House Picture With Main Level Floor Plan PAGES: 1 Dear Sir, Please review the following and advise as to what steps need to be taken to certify your approval of the addition as described herein; It Is Hereby Proposed that a 25 X 28 Attached Garage be attached to an Existing 52 X 26 Raised Ranch With AMain Level 2 Bedroom Conjiguration.(SEE PLAM Said Attached Garage To have a 14 X 28 Bonus Room with access to said roomfrom the Garage Area only. The room will have electric heat and No Water Or Bath Plumbing capability. The Roomfunction is to be utilized as a personel exercise facility, above the garage with interior access from the Main Level garage area via Pine Stairs. Please review the enclosed information and advise if your fine offices can assist in granting your acknowledgment and approval of the proposed addition Thal Neil Lot lamted 't Tax Map Separate Sewerage Syatemluflt.bY Numlier of Bedrooms Has Gftd6r Been Installed? I certify that -ihe systim(i),"aq listed -serving -the above prei;isei4� weie ons ructed, essentially �as showin ontba�ans of the comp;eted work I copies of which'are attache;5)1�'and in aecordan�e with* the standards, rdles , and.'r e4ulitio I ni - L cordahce w i plan, and the permit iss�ed by the am 0 Coft w 468 6mpil� tali6'suih iction'es"May b necessary to secure the correction of, any unsanitary Any, person occupying promises ed co . n . ditions resulting. fro 9 m such uiige. AOOroval'.of tl%6'-seppiate - se"rage. sy a., ecorhe hull and -void as soon is apubt%'ainitary sower becomes d' id:when.a Oui)lk�ivatef su-PipjIbecomis available. Such approvals are subject to Agodlftat!on or change vvhen in' the judjm4ni of' the: dommigiloner ioL,�lt such,r Ocation.'modification or change Is nocalury. Dot" Title o .." ':ii +IY'+1Y +t is +IY +I��� y Y• PUTTNAM COUN'T'Y DEPART OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES �'6 QgSS arS &N" AZ Owner or Purchaser of Building M(f up, 50 V1 I yi c Building Constructed by G�n'C12`i �hw rlh. Location - Street Is- L4 Seebien Block. Lot ' TVA WU✓41'r,,y Jl Lti c5 il-T -e l Subdivision Name Municipality Subdivision Lot # Building Type GUARANTEE 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" for 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 stem to operate was caused by the willful or negligent act of the occupant of e 'lding utilizing the system. Dated i day of 19 Signature Title (7 General Con (Owner) - Signaturen�W1550N Corporation Name (if Corp.) Address rev. 9/85 mk Corporation Name (if Coop.) E29 (In I ess C� � � N11y, (1015 - . �. a, * �* �W YO WtLL U1J1"1rLtT1ULV rUXUMI DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET ADDRESS: U,t FS , WRIVI 1 I Y TAX GRID NUMBER: �6u �j- v1,f� � ,lean WELL OWNER NAME. ADDRESS: L �e . d L10 10 PRIVATE o PueLlc USE OF WELL 1 - primary 2 - secondary R RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION O OTHER (specify) p INDUSTRIAL 0 INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /NO. PEOPLE SERVED E / EST. OF DAILY USAGE �D� gal. REASON FOR DRILLING .[]REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION []ADDITIONAL SUPPLY ®NEW SUPPLY (NEW DWELLING) ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH a©'5— ft. STATIC WATER LEVEL J�r ft. DATE MEASURED DRILLING EQUIPMENT ❑ ROTARY ® COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT 0 CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE D SCREENED O OPEN END CASING 0 OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH v'? l fL MATERIALS: Q STEEL ❑ PLASTIC ❑ OTHER LENGTH BELOW GRADE a-O ft. JOINTS: ❑ WELDED . Q THREADED . o OTHER DIAMETER ____� in. SEAL: 0CEMENT GROUT ❑ BENTONITE ❑OTHER WEIGHT PER FOOT lb./ft. DRIVE SHOE 10 YES ❑ NO I LINER: O YES 63 NO SCREEN DETAILS DIAMETER (in) SLOT SIZE LENGTH (11) DEPTH TO SCREEN (ft) DEVELOPED? FIRST O YES ONO HOURS SECOND GRAVEL PACK ❑ YES O NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPT}{ ft. BOTTOM DEPTH h. WELL YIELD TEST 1 If detailed pumping t METHOD: ❑ PUMPED tests were done is in- IW COMPRESSED AIR , formation attached? O BAILED ❑ OTHER ; ❑ YES ❑ NO WELL LOG )f more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Bear- ing Well Oia- meter FORMATION DESCRIPTION CODE ft. 1t WELL DEPTH It. DURATION hr. min. ORAWOOWN 1t. YIELD gpm. Surface (/• OS ' �r d1,c yv • WATER O CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS ❑ COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP LL�I WELL DRILLER NAM GATE a ADDRESS S Pf 57 - sIGijMRE C W alk' o24-1 "11 I D s-o. i 'az. J/ tSy %� 'e - -'r r vl COUNTY: Putnam LOCATION: Country Hill Estates REPORT TO: McGlassen Realty Inc. ADDRESS: PO Box 610 . CITY, STATE, ZIP: Carmel, NY 10512 DATE COLLECTED: 5-27-92 TIME COLLECTED: 10 AM COLLECTED BY: TM REPORT DATE: 5 -29 -92 SAMPLE: DW 5850 SAMPLE SOURCE: _ Lot #1 —• -- - - DATE ANALYSIS RESULT UNITS METHOD ANALYZED Total Coliform MF: Absent SM 16 (909A) 5 -27 -92 THIS SAMPLE AS RECEIVED AT THIS LABORATORY MET THE REQUIREMENTS OF NEW YORK STATE DRINKING WATER STANDARDS. borato ry Director NEW YORK STATE ELAP CERTIFICATION NUMBER: 11218 618 CLOCK TOWER COMMONS, RTE 22, BREWSTER, NY 10509 / 914 - 278 -7600 / FAX 914- 278 -7754 0 -s. c 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 AddFess Town/Village/City Tax tLk/ 0 5 - Grid Number ►1 —�(0 C0�.17 WELL OWNER Name G Mailing Address , D WPfivate W ❑ Public USE OF WELL ©- primary 2 - secondary SIDENTIAL 0 BUSINESS ❑ INDUSTRIAL ❑ PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP ❑ FARM [)TEST/OBSERVATION U INSTITUTIONAL ❑ STAND -BY ABANDONED ❑ OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED. <5 /EST. OF DAILY USAGE �al REASON FOR DRILLING D XPLACE , EXISTING SUPPLY ❑ TEST /OBSERVATION L1 ADDITIONAL SUPPLY Er EW SUPPLY NEW DWELLING ) 0 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING New WELL TYPEILLED DRIVEN ODUG O GRAVEL. OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: LL Lot No. 1 WATER WELL CONTRACTOR: Name �j,ID Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ENO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION KETCH & SOURCES OF CONTAMINATION PROVIDED [YON SEPARATE SHEET Z ?/ 0� (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 thirt;7 (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: Zli0l -7r j Z3 19 Date of Expiration 19 Permit Issuing icial 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 AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT - TO: Commissioner of Health In the matter of application for: WIC L l a 5 S o,v Q e.4 l rz I've Is ��r., � IV ICGi✓I S SV� represent that I am.an officer or employee of the corporation and am authorized to act for (Name of having offices at' > > �f- orporation) '11,4 b.4 (e P� � Ca rm - d t oso-- Whose officers are: President: P�A-CAIV�� (Name and Address Vice - President: (Name and Address) PC> (:2,/o Ca rA, -✓n,e / &Y, l0�-' ), Secretary: (Name and Address) Treasurer: (Name and Address) and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all sequ t acts relating thereto. � f Sworn to before me this day Signed: ; of 19L Title: „ Notary Public EiLEFN A. iEZZI Notary .e of N8 vYork aua$ilia.d iii',- 3uti"9ram f.G°�dn f�+3 tonirlission Expires �/ // 8/84 Corporate Sea y. -- 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 Add Mbgp Town Village City �1 Tax Grid Number g-- q---1 b O WELL OWNER Name Mailing (iG G Address gLPrivate ki O Public USE OF WELL primary - secondary M- SIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED 0 BUSINESS O FARM O TEST /OBSERVATION. p OTHER (specify 0 INDUSTRIAL b INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT �7 _gpm /# ❑ REPLACE EXISTING SUPPLY L1-II& S PLY DWELLING ) PEOPLE SERVED_ /EST. O TEST /OBSERVATION 13 DEEPEN EXISTING WELL OF DAILY USAGE :gal M ADDITIONAL SUPPLY REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE ILLED O DRIVEN ODUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES c1 NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name. L (�j ,: Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES C—.W NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: n LOCATIO SKETCH .& OURCES OF CONTAMINATION PROVIDED N 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 thirt37 (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: �"� -2- 19 Z Date of Expiration e-' 19 Permit Issui icia 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 AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health In the matter of application for: I, represent that I am an officer or employee of the corporation and am authorized to act for uWUPLCoAmztT— l.t�,> ' (Name of C rporation) having p offices at 1 l_ •k- Whose officers are: i President: Vice - President: I I (Name and Address) Secretary: Treasurer: �q17 (Name and Address 33Y0 and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested anr'l' �ubsequent acts relating thereto. / % Sworn to before me this _/7 day of _:1aP\sA�-X 199,L No`tary Pu4 is i TNR`i I�UBLIC, STATE OF FLORIDA. MY CO3NIM!SSIti?:N EXPIRES: OCT. 1, 1993. SONDED THRU NOTARY PUBLIC UNDERWRITERS: 8/84 Sited: Title: Corporate Seal Of' to elan Complianu"-tatisfactory to the Commisslonor of HeaKhwill his `sucpe as. i i or assigns by the builder. that said builder will p«bd oftwo (2F years i nssOk$aly, follewkrp tlwd•ti of t1N ifmL- toin of nY_riMir _ -.2) . that the Arhlad "l do a mm above Mae h lM , rubs no rNuST n�f M Putnam P.A. Litahso No !,,unless Con • uction'.of the building has been undertaken and is rrlrhlstiOMr, of Heajth. 'Any'change or altoration of Construction late water supply` only. TRIG 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 # ? _ -11 -86 WELL LOCATION Street Address wn Village City Tax Grid Number WELL OWNER Name Mailing Address Wrivate O Public USE OF WELL 1 - primary 2- secondary G RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL .O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION b INSTITUTIONAL O STAND -BY 13 ABANDONED O*OTHER (specify, O AMOUNT OF USE YIELD SOUGHT 6— gpm / #.. PEOPLE SERVED (9 OF DAILY USAGE(:,O O gal REASON FOR DRILLING Ol WLACE EXISTING SUPPLY. O TEST /OBSERVATION E2 ADDITIONAL SUPPLY E EW UPPLY NEW DWELLING) O DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN QDUG C] GRAVEL OTHER ,IS WELL SITE SUBJECT TO FLOODING? YES `� NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:. r Lot No. 1 WATER WELL CONTRACTOR: Name `Ta t--J.7 ' 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 Iq ON SEPARATE SHEET (date) ( ignature) PERMIT TO CONSTRUCT�A WATER WELL This Fermit to construct one water well as set forth above is granted under the provisions of S utpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirt;,(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. Durin€ all well drilling operations, the applicant shall take appropriate action to assure that any aid all water or waste products from such well drilling operations be contained on this prop city and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date cE Issue: 19 Date cE Expiration 19 G1 Permit Issuing ficial Perm itis Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller . •.ti..... ._ .....t— i'�Y— �A.twwa�_.. rte. ygiId4U►io17.YS+ CALl 4�F :(1F�'1zM?a'�iS�i(.9L'Jiijiytar PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PER24IT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health In the matter of application for: I, represent that I am an officer or employee of the corporation and am authorized to act for�G'�GIIJ(,(1.6 (Name of Corporation) having offices at Z-Z ti C' Whose officers are: / President: Name and Ykddress) Vice - President: IN LL (Name` and Address)' ' Secretary: (Name and Address) Treasurer: . (Name and Address) ljr and that I am and will be individually responsible for any and all acts of the. corporation with respect to the approval requested and all subsequent acts relating thereto. / Sworn to before me this _ day Sig Notary Public 8/84• Corporate Seed. i o � s DlvlebnIl�svhonmenW Hedt6 Services. OC�HEALTH 1051? E�. _ Provide Pessnit N I w CERTIFICATE OF COMPLIANCE Permit `M / " �! j CID IICT[ON PERMIT' FOR'SEWAGE DISPOSAL SYSTEM r+ • f j ,Viptage Incited sit own o r. Subdlvialon Name - Sabel. Lot fY l . Tax Map— Lit Renewtal_ Cp Revision ❑ Owner/Applicant Name I Ae- K 1 nCarlarYl IMP ✓ �brD —7 r� Date d PPreAtitis Approvol�,_T Mailing Town '::�)fZ°i1tJSTel Ba, dWg Type' Ike. l :sail 1 a 1 Lot Area � 9q NO S "n S"n onl, Dopes ��' Volume one. Number of Bedro � oms Design Flow "G P D S 0 0 PCHD Notification Is Required When Fill Is completed Separate Sewerige Sy, *m to oo0" of 2 50 Gallen Septic Tau* end G / ' �Al — �Rr�G y. To be constructed by Address Water SuPPb': Public Supply From Address or: ✓ Private SpPPhY.Drllled by °Address Other Re�eemente K b I represent that 1 am wholly and com ilolely responsible for the design and location ;of the, Oroposed system(s)..1) that the separate sewage disposal sty tom above described will be constructed as,snown on the approved .amendment there to and.in accordance with the standards. rules and regulaEiOns of-TFi rum County' Department '!Of Heattti; and that:on completwn.tliereo ( s''CertNicate' of,Conitruction Compliance" satisfactory to the Commissior+sr of Health will ,bo.'submitted •to- the; Department, and a written ?.guarantee will, De tu►nished' the owner. :hii successors, heirs or assigns by the builder, that said builder .will P in'good'operating 'condition any .Part of saitl - sewage disposal system'during.the period of two W years im etllately following thedate of the issu- once of tha` approval 'of the .Cer4lany of Construction Compliance of the original system o any repairs the► , 211that hs drilled well described show Will ba'locitetl es shown on the approved plan and,that said well will installed in a or dhZt :stndar r s regu a ons of the Putnam County Department`of Health. Oats Signed P,E.� R.A. SEP:i 1�, Iq37 L� Ci Al L5 r (� license No APPROVED FOR CONSTRUCTION: This, approval expires two years ,from the date issued unles s. fto.wuction of the building has been undertaken-and Is revocable for cause or may be ' amended or`modilied when considered necessary -by the:Commissioner of Health. Any change Or alteration of construction requires a pew psi it. Approved Tor disposal iof domestic sanotary sewage, ,a / rove a water, suDD1Y only: �J ,, i .. . ,�✓� �jy Date. //� // O� By /� ` `�."` –��— %..,rG /� Title 7"�i� -Y. i tT k Lot Area `� sanding Typed. o' LtDc- FIR Section Only Depth r Volame �• , Namber of sedrooms Deslgn Flow G /P /D 8 D (2 PCHD Notification is Required When "Fill li completed Separate Sewerage'Syetem to consist of ^- �- Gallon Septic Tank end �_ ;LA � FIT— OF To be contracted by ' �' ° �'. Address Water Saoply: Pdbuc Sapply From Address or: "_aPrivate Snpply Drllled.by 'T b'i .. _Address . Other Requirements I represent that -I am wholly and completely responsible= forthedesign_ and location of the proposed system(s); 1) that. the separate sewage disposal system 'above described, will be. constructed.as :shown Om the, approved amendment there to and in accordance with. the standards, rules an regU a Ions,O 8 u nam County Department ;of Health,,_and that -on.completion thereof a", Certificate .of.Construction Compliance'. satisfactory to`the. Commisslonerof, Healthwill 1. be submitted.:to the Department, and .a '.written gu5rante'e.will be furnished tiie owner, his successors;, heirs or ,assign ;:by the builder.' that said builder will place in good. operating cond'tion any "part of said 'sewage disposal system during the period of two (2)' years ' immediately, following ttiedate of the issu- ance of -the' approval of the`Cgrtiflcita. -of Construction Compliance of the. original system or any repairs th to; 2 that the drilled well described above will be located as shown on the appioved,plan and that said.:well will be. installed 'in !cc ance itli the and d , r and regu aeons of the "Putnam County Department',of Health Date ! t gf� L Signed' P.E. V R.A. _ Adtlress '' ` License No 7YOfJ APPROVED FO,R,C STRUCTION: This approval expires one year fro the, iss d unless constructs n of the building has been undertaken and is reJocable for cause' may t a ended or modified when considered net' s r the_ o ssioner of H 1 . .Any.change or alteration of constru tion requires a new p p for disposal of'domestic sanitary s it and /or" "rv' w e s nly. Date BY Title PUTNAM COUNTY DEPAR'IlMENr OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS REVIEW SHEET - CONSTRUCTION PERMIT. DATE REV51ENf� , At BY: (Name of Owner) (Street Location) COMMENTS YES NO DOCUMENTS Permit Application Corporate Resolution Plans - Three setsJ�'�/J Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results (3) 30" Perc Hole / CJ Other l 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 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) 15' to Drains- Ciirtain,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 GOAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town/DEC Permit R & D) I Data On DDS Plans & Permit Same Division Of Environmental H%z,Jth Services TWO COUNTY CENTER - CARMEL, N.Y.. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL WELL TYPE DRILLED F_� DRIVEN DUG F� GRAVEL F� OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:r —o LOT NO -:a WATER WELL CONTRACTOR: Name 13r;7 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ✓ NO NAME OF PUBLIC-WATER SUPPLY: - TO4v,1 /V /C DISTANCE TO PROPERTY FROM NEAREST 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 Well Completion Report on a for p vi ed by the Putnam County Health partment. i Date of Issue: 1 i _T Pe it Issuing Official Permit is Non - Transferrable IUWNiVILLAGEJCi1Y TAX GRiU NUMBER, WELL LOCATION WELL OWNER NAME. • ADDRESS: prPSIVATE �3U k4421, Kaf?--P �� 7 zZ 2 ❑ PUBLIC USE OF WELL &'RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /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 •(000 gal. REASON FOR @fi NEW.SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ORILLING ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL WELL TYPE DRILLED F_� DRIVEN DUG F� GRAVEL F� OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:r —o LOT NO -:a WATER WELL CONTRACTOR: Name 13r;7 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ✓ NO NAME OF PUBLIC-WATER SUPPLY: - TO4v,1 /V /C DISTANCE TO PROPERTY FROM NEAREST 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 Well Completion Report on a for p vi ed by the Putnam County Health partment. i Date of Issue: 1 i _T Pe it Issuing Official 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 a A, .4t��! (1p-p Address Located at (Street t� _Tess C� Block _Lot -5a ( l n ica e nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION. PERCOLATION Run No. ..Start Elapse Time -Stop Min. Depth to Water From Ground Start Inches Water Level Surface in Inches Stop Drop in Inches Inches Soil Rate Min. /in drop I D_ i tZ 2a 2 p _ I)� . �� '40 2 [ 3 0- 2a 3� 5 _ —_I o - So .. Q3o Zc> �, L O0 3co ZZ� Z 1 .3[7 Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. DEPTH G.L. 6" 12" 1811 24.11 30" 36" 42" 48t' 5411 60" 66" TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. k HOLE NO. loth HOLE NO. 72'• 78" 84" INDICATE. LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL' TO'" WHICH WATER. LEVEL RISES AFTER BEING ENCOUNTERED - 2 TESTS MADE . BY Date E5 z- �9 r DESIGN Soil Rate Used Min/1 "Drop: S.D. Usable Area Provided O. No. of Bedrooms �- Septic Tank Capacity 17hz0 Gals. °� Absorption Area Pr— ovide By Low L F ✓ �� s 0h Address 3o,t- 2;43 SEAL s THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. R /Cal. Checked by Date Putnam County M- partment of steal th Division of Environmental Sanitation of AFFIDAVIT - CORPOR,ITE OWNER APPLICATION . FOR PLR.`1IT APPLICATIO:J •.SUBMITTED TO a . PUTNAM COUNTY HEALTH DEPARTMENT. TO: Commissioner of Health - In the matter•of application for _• Q_onotruction ,permit for separate sewage system` I. Jerry Weissman, V. Pres._ — — — — — _ represent - - -. -- -• — -- that I am an officer or employee of the corporation and.am authorized' to act for (name o.corporation)— having offices at — Rt. 22, P.O. Box 377'' — — — — — — — — — — — — — — — — — Brewster, N.Y..1.0509 Whose -officers are " - - — — — -- President _ Robert Fregosi _ Name FnIff Address) . Jerry Weissman Vice- President . . - - - -- — — — — — — - (Name and Address Secretary — — — — — - - — — _ _ 7r r r r r r rr r (Name and Address) .Treasurer (Name and Address) *and that I am and will be individually responsible f r., any or.sll sets. of the corporation with respect .to the' approv a ted and •a 1 sub - sequent acts relating thereto. /L Sworn to before me this U day S' e of 19 jj� Title Notary Public motary Yu,,) ie, Stnae of Ntu Yalt ti 1•,... a ✓ yy a 'Corporate Seal u -Z y Ll :1 IN 9Z 01, 'kil 7p., +�ou tf-, --rp*rf-j • Iwv Soo �f (a) a -4'-�" 9E-r,(2 WAS i);' CATI 1) TH jr 1 1: TRE ;,f, D OVER. CONs,micryco V;ITH ALL RULPS 4 lisiath serwicetDEPAdtV Ved go fkoted for oonformame WIth %99110able Rules and Regulations at the h4tma CamtY RG&1th DOWtmsut- A,� &OLJPJ-F LA/ 0 Ar -I- My ffPf- L, RM JL11r, 110, liu -76 0, 14- OW 1 177" -7 3' 79 79 J65 Pi 2l' (v2 &T Y- &Z. us' &9' I o " 105' 106) +�ou tf-, --rp*rf-j • Iwv Soo �f (a) a -4'-�" 9E-r,(2 WAS i);' CATI 1) TH jr 1 1: TRE ;,f, D OVER. CONs,micryco V;ITH ALL RULPS 4 lisiath serwicetDEPAdtV Ved go fkoted for oonformame WIth %99110able Rules and Regulations at the h4tma CamtY RG&1th DOWtmsut- A,� &OLJPJ-F LA/ 0 Ar -I- My ffPf- L, RM JL11r,