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Home My WebLink About0804DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 24. -2 -29 BOX 9 ,II:I� Rev. "3186' PUT Dlvlsio6of. Cat R TE OF., CONSTRUCTION C Located'at EAST BRANCH -ROAD Owner /appl, NameR .chard Rapp; Mfg 'Address Drewville , Road LM COUNTY DEPARTMENT 017-HEALTH ivironmental Health Services, Cacmel, N.Y 10512' Engineer Must Provide P 87 86 P C:H D. Permit N . MPLIANCE FOR SEWAGE DISPOSAL SYSTEM P SON, Tax Mai -� Town or a P :.B oc J Y Sr. . = S r .. Formerly Subdivision Name wo dS. Subdv. Lot q S BID 10509 Date Permit;Iseued 10%15/86 Separate Sewerage System built by _' R&R Builders, Address Drewvill`e. Road, Brewster,, •.NY Consisting of JLUVO Gallon Septic Tank and 316 L.F. PPUC water Supply: Public Supply From Address or X. rrivate Supply Drilled by P.F. Beal. Address Carmel Avenue,, - Brewster, NY Building Type . Colonial:, 'Has Emsion Control Been Completed? N/A Number of Bedrooms Has :Garbage Grinder Been Installed? No , Other: Requirements I certify that the syetem(s) as lia.ted, serving the above premises were constructS4 essentially as shoyriolln the pla ti of the completed work ( copies of Xcti are:attb6hed),'and in accordance with the standards; rules end,regul e, in eccorda a th he f 1pn, and the permit issued by the Putnam County, Department 0 .Health. r . Date "°� lJ Certified by P.E. Address %lMn & Cm -elia P.C. BD 6 Br Ralte.� ,.ass NY. License No. Any person occupying premises served by the above'system(s),shall . promptw take'.such action as may be necessary to secure the correction of any ununita►y conGitions ►esultino,'from such usage. Approval of. the sepa ►ate' "seweieoe system; shall become null and void ai won as a pubti_ sanitary sower becomes �avallable'.and the approval'of the private water supply shell.become null `and_ void,. when a..publie water supply becomes available. Such approvals are subject to odification o► change when, in ttie judgment of the Commisstoner of. H! revocation, inodlficatlon or change Is necessary. �eY _ Title 0 am DCHD WWC COMPLETION REPORT WELL C DUTCHES$� COUNTY • HEALTH DEPARTMENT 22 MARKET STREET; POUGHKEEPSIE, N.Y: 12601 (914) 431-2044 PLEASE PRINT OR TYPE ' ` r -.OFFICE.,,' SE ONLY NYS C ' GRID C NO. N WOUND ELEVATION GR ft. WELL COMPLETION DATE SOURCE LOG. NO. WELL LOCATION STREET ADDRESS: TOWN/VILLAGE/CITY TA RID NUMBER: East Branch Rd, Patterson, NY Lot #5 WELL OWNER NAME: ADDRESS: R &R Develo ment Drewville Rd. Brewster NY 10509 ❑ P 1--] PUBLIC IVATE USE OF WELL 1 - primary 2 - secondary 0 RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑FARM ❑ .TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑INSTITUTIONAL ❑ RTAND -BY E3 MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING ® NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA 25 WELL DEPTH 5 ft. STATIC WATER LEVEL 20 ft. DATE MEASURED 8/25/87 DRILLING EQUIPMENT El ROTARY 0 COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL _COINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING (3 OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH 31 ft, MATERIALS: ® STEEL ❑ PLASTIC ❑ OTHER LENGTH BELOW GRADE 30 ft. JOINTS: ❑ WELDED [3THREADED ❑ OTHER DIAMETER . 6 in. SEAL: ® CEMENT GROUT ❑ RENTONITE ❑QTHER WEIGHT PER FOOT 19 Ib. /ft. DRIVE SHOE: ® YES ❑ NO LINER: ❑ YES ® NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST ❑ YES ❑ NO HOURS SECOND GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH ft. WELL YIELD TEST I If detailed pumping METHOD: ❑ PUMPED 1 tests were done is in- 0 COMPRESSED AIR , formation attached? ❑ BAILED ❑QTHER ; ❑ YES ❑ NO WELL LOG If more detailed formation descriptions or sieve analyses are available, please attach. DEPTH SURFACE FROM water Bear- in9 Well Dia- In FORMATION DESCRIPTION COOt ft. ft. WELL DEPTH ft. DURATION hr. min. DRAWDOWN ft. YIELD gpm. Surtace 10 Brilling in overburden clay & bould 'rs:, Bli t rock at 101 525 6 505 5 a =t 31 525 Dr ill ng in' granite t. IF AVAILABLE, PLEASE COMPLETE: WATER ❑ CLEAR ° TEMP. QUALITY ❑ CLOUDY HARDNESS ❑ COLORED ANALYZED? ❑YES ❑ No ANALYSIS ATTACHED ?. ❑ YES ❑ NO' "' SITE MAP: A SITE MAP MUST BE ATTACHED SHOWING LOCATION OF WELL AND DISTANCES TO AT LEAST TWO LANDMARKS AND ANY POTENTIAL POLLUTION SOURCES. PUMP INFORMATION TYPE submersible CAPACITY 5 g _ DEPTH f,',_ MAKER Co u1 d MODEL 5ES07412 VOLTAGE 230HP _L4 WELL DRILLER NAME P . F. Beal & Sons , Inc. DATE 1 88 PO Box B ADDRESS Brewster,NY 1050�IGNATURE ,r ( r C 1 BREWSTER LABORATORIES Box 224 - BREWSTER, N.Y. (914) 225 -2072 - WATER ANALYSIS REPORT - SAMPLE NO.. 6829 SOURCE: R &R Construction East Branch Rd. Patterson, NY COLLECTED: December 29, 1987 BY: P.F.Beal & Sons, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method hose bibb -well This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. January 5, 1988 oy Bickwit P.E. Director 0 per 100 ml. PUTNAM COUNTY DEPARTKE T OF HEALM DIVISION OF ENVIRONMURAL HEALTH SERVICES ^Yoe Own or Purchaser of Building - 1 Building Construe ed by Location L- Street Municipality pu Building Type . /5`-3 '' Section Block Lot 3 7t-xC-V — /s - 3 — !. ,- Tax Map Number 11;1s7- A./&rj.4 Subdivision Name 11ft,tj Subdivision Lot # GUARATfI'EE OY 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 irmediately 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 system to operate was caused by the willful or negligent act of the occupant of the bu'ld'n ti 'zing the system. Dated this day of J�� 19<s Signature - � Title General - Contractor (OWher) = Corporation N64f Corp.) V yn Y ess G rev. 9/85 mk /C t-le- %� - Corporation N (if Corp. PC. 41'eP - D -Q. & Address /L) sry 7 41T # �- II. • ^y r, IV. V. VI. APPENDIX C r FINAL SITE INSPECTION Date Inspected b OWNER 0 T9 # ORS DIVISION LOT # - — CCY�AIEN'I'S SEWAGE DISPOSAL AREA a. SDS area located as per approved plans b. Fill section - Date of placement 2:1 barrier. LGTH WIDTH AVG.DPTH c. Natural soil not stripred d. Stone, brush, etc., greater than 15' fran SDS area. e. 100 ft. from water course /wetlands. SFiAGE DISPOSAL SYSTEM I a. Septic tank size - 1,000 1,250 b. Se tic tank installed level c. 10' minimum fran foundation d. No 90° bends, cleancut within 10 ft. of 45° bend e. DISTRIBUTION BOX 1. All outlets at same elevation - water tested ,. 2. Protected below frost 3. Minimum 2 ft. original soil betwe ern box and trenches f. JUNCTION BOX - properly set g. ZRFN= 1. Le-rigth required y Length install 2. Distance to watercourse measured. ft. 3. Installed according to plan 4. Distance center to center 5. Slope of trench acceptable 1/16 - 1/32 " /foot. 6. 10 feet from property line - 20 feet - foundations 7. Depth of trench < 30 inches fran surface 8. Roan allowed for expansion, 50% .- 9. Size of gravel 3/4 - 1P diameter 10. Depth of gravel in trench 12" minimum 11. Pipe ends capped - ' h. P,2�2 OR DOSE SYSTEMS 1. Size of pump chamber 2. Overflow tank 3. Alarm, visual /audio 4. Pump easily accessible manhole to grade 5. First box baffled 6. Cycle witnessed by Health Department estimated flaw per cycle H-CUSE _. '_rouse located per approve~ plans. h. tik:.mber of be'arccros a. Well located as per azorzi:a<3 plans b. Distance fran SDS are- measured _- c. Casing 18" above arade. d. Surface drainace around well acceptab_e. OVERALL WORRAA.SHIP a. Boxes properly crcut b. All i s partially = = i fled c. All pilDes flush wit1Z inside of box `. d. Backfill material contains stones < 4" in diameter e. Curtain drain installed according to plan f f. Curtain drain outfall protected & dir.to esist_watercours r-- g. Fcotin drains discharge away fran SDS area h. Surface water 2rotection adequate « , i. Errosion control provided on slopes gr-,_ater than 15 %. Cyr' ✓" C c� -� r \__- . Bonding Type S 1 fl g 1b'= F a M D W@ 1 .Lot Area 6 0 3 0 Ac. lim Section only LJ Depth volume Number of Bedrooms 3 Design Flow G /P /D 6 FCD Notification Is Required When Fill Is completed Separate Sewerage System to consist of 1 0 0 OGsnon Septic, Tank sad To be'constrdcted by . T 0 b I' d'e t 2 T fTl.l C1.1? d Address Water S411131 X Pd lie Sapply'From :TO b& determined Address 0 r Private Supply Drilled by _Address Oilier Requirements represent that I .am wholly and .Completely responsible for - the design and location 'ot the proposed system(s); 1) that the separate sewage disposal. system above described wilP;be, constructed as shown on the approved amendment there Wand in accordance with the standards, rules an regu a ons o e u nam .County ,Department, of';Healtll, :and that on completion thereof a "Certificate -of Construction: Compliance" satisfactory to the Commissionerof Healthwill be submitted to, the Department, and 'a' written ,guarantee will.De `furnished; the owner,' his successors, heirs or assigns by the builder, that said builder will place in good' operating condition any `part of said sewage disposal, system during the period, of..two (2j years Immediately following the date of ^the,issu- anca of the :,approval of the'Certihcate of Construction Compliance' of t' indl stem or any repairs t o; 2j t t the drilled well CescriDetl above will ,a located'a; Shown on the approveG plan and•that sa�tl -well will be instaa ante with the MO�' egu aTfronsGL� Putnam County. Department of Health, ' CJ Date Signed P•E 1 . 9/4/86 ;...,_ ._.. -.. Address Eor B &C RD6 R . 22 Brewster NY 1 V0.9 L,Cense No APPROVED. FOR CONSTRUCTION This approval. expires one year from the date issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when consideredhecefsary:,tiy the Commissioner of Health. Any change or alteration of construction requires a new perm' ,. /Appry fool disposal 'of domestic saahi�tarry`sewage,.sn ate w or lepP o ly. � Date-, ! ,�� By 1 Title �s 0AI, 5 TWO COUNTY CENTER - CARMEL, N.Y.. 10512 (914) 225-3641 APPLICATION TO CONSTRUCT A WATER WELL M 'WOO I LOCATION TA N-1 WILLAIG-L I G I IV 1AX URM NUMBER. East Branch Road Patterson 18 - 1 - 18• . O�,)iE� NAME ?. ADDRESS:' Richard Ra pp' Sr. Drewville Road UBT[ LI ❑PUBLIC IF WELL ® RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED imary ❑ BUSINESS ❑_FARM 11 TEST /OBSERVATION ❑ OTHER (specify) xoridary ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ IT. OF USE YIELD SOUGHT 5+ gpm. /N0. PEOPLE SERVED 3 -5 / EST. OF DAILY USAGE ' 450 gal. ,UN FOR IZ) NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION LLING C1 REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL TYPE Q DRILLED DRIVEN' E] DUG GRAVEL OTIIER ELL SITE SUBJECT TO FLOODING? _ YES _ NO ELL IS LOCATED IN A REALTY SUBDIVISION, NAME. OF SUBDIVISION:E. Branch Woods LOT NO.: 5 R WELL CONTRACTOR: Name Address: JBLIC WATER SUPPLY AVAILABLE TO SITE: YES x NO ' OF PUBLIC •WATER SUPPLY: TOW1V /V /C I WCE TO PROPERTY FROM NEAREST WATER MAIN 'ION SKETCH & SOURCES OF CONTAMINATION 0/8/86' `G G (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 2. Disinfect the of the Putnam permit. 3. Submit a Well the Putnam Coi until the water is;.clear. well in accordance with the requirements County Health Department attached to this Completion Report on a form provided by anty Health Department. Date of Issue: %�� 191- -Z�'`� Perm 4 t I 4 f ssu ng O f c 1 Permit is Non - Transferrable i pun COUNTY DEPARTm= OF HEALTH - DIVISION Oil ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACM SEiAGE DISPOSAL SYSTEMS -'REVIEW SHEET '- CONSTRUCTION PERMIT . ` DAZE REVIEWED: 7 "e' BY:. (Street Location) % �,d ,/ .�o.a o/ DOCUMENTS ; L G � � 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 M - Letter Variance Request RDQUIRED DETAILS ON PLANS, Sewage System Plan Sewage System Hydraulic Profile - Gravity Fla. Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Puma 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 Ares Expansion Area; shown; gravity flow,suff. size If 'Pumped Pit & D Box Shown & Detailed House - No. of Bedroans Wells & SSDS's'w /in 200 ft. of Property Loc_--ted 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. ev-pan). 15' to Drains-Curtain, Storm,. Leader, Footing 25' to Catch Basin 10' to Water Line (pits -201) 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 Saine ImArrrn of Owner) PUTNAM COUNTY -DEPARTMENr OF. HEALTH -.DIVISION OF. ENVIRONMENTAL* HEALTH-SERVICES INDIVIDUAL WATER SUPPLY _ SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIELD INSPECTION REPORT DATE: 4�� ell INSP. BY: (Name of Owner) (Street Location) -INSPECTION INITIAL SITE 'K':M :CCMMENTS ` Wetlands 6n/or.`projcimate ...,to Property lines or corners found..,.... Can estimate house location.......... ........... Will driveway need cut ............................ Must trees be removed - note these ................. . Deep holes representative of entire SDS area...... Additional deep holes needed ...................... Sufficient SDS area available considering driveway cut, house location, separation distances,eitc... Adjacent wells/septics ............................ D.H. 1 Lot Depth to G.W. Depth to rock Soil Descriptiq 0 ft. I /,Z;l 3 it. 6 ft. D.H. 2 Lot Depth to G.W. Depth to rock 0 ft. 3 ft. 6 ft. ;9 ft. 1.2.. ft. 1901-L D.H. - Deep Hole G.W.-Groundwater D.H. 3 Lot Depth to G.W. Depth to rock 0 ft. 3 ft. 6 ft. 9 ft. -12 ft. Soil Descriptio DATE: FINAL SITE INSPECTION— INSP.BY: YES NO COMMENTS House SSDS located per approved plan ............. Length of trench measured Width of trench average Slope of tile line and trench acceptable ......... Roan allowed for expansion trenches.............. Over 100 ft. fran watercourse .................... Natural soil not stripped or SDS ' area. unnecessarly graded ............................. 10 ft. maintained fran property line and 20 ft. fran house... ......................... Distance well to SSDS (ft.) .................. Number of bedrooms checks............ :........... Stones,.brush, stumps, rubble, etc., greater than 15 ft. fran nearest .trench ..-.... ....... 15 ft. of peripheral soil horizontally fran trench ......... o ...... Boxes properly set .............. o ...... ........ Could surface runoff from driveway, rl;; �s ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of.SDS ..... FINAL GRADNG OF SITE ACCEPTABLE, ............... . r DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 BRUCE R. FOLEY, R.S. Acting Public Health- Director "� ADDITION APPLICATION _ (RESIDENTIAL ONLY STREET : y7 a �`� �Jp-W q TOWN A D TX MAP # c;2 i,, +02c7 NAME ,2r:�c;� 14.oO! '1n PHONE 91'7• ':37�/a PCHD PERMIT # ICJ D �0 MAILING ADDRESS Description of Addition (_Y) VEtr I 8LI t-er Number of existing bedrooms_ Proposed number of bedrooms Q' Any addition which is considered a bedroom requires formal approval of plans (Construction Permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to PUTNAM COUNTY, HEALTH DEPARTMENT, 4 GENEVA ROAD, SREWSTEP,, NY 10509, Phone 278 -6130 with the of owing information. 1. Certified Check for $100.00. 2. Sketch of existing floor plan (all living area including basement, if any) Non - professional drawing is acceptable. 3. Sketch of proposed floor plan. Non professional drawing is acceptable-. 4. Copy of survey showing well and.septic location, to the best of your knowledge. Include date of installation if known. Include all wells and septic systems within 200 feet of property line. Any questions please contact this office. OFFICE USE Comments and /or conditions application August 1995 _r Received of The Sum Of wcrowve�n�wiw� �W�w�� ti • DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster,, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 July 21, 1998 Lawrence Maggiotto 779 East Branch Road Patterson, NY 12563 Re: Addition - Maggiotto, East Branch Rd.. No Increase in Number of Bedrooms (T) Patterson TM# 24 -2 -29 Dear Mr. Maggiotto, BRUCE R. FOLEY Public Health Director 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 latest revision date of July 20, 1998 and this Department's approval stamp. Based on the information submitted, the above mentioned addition is approved with the following conditions: 1. The total number of bedrooms must remain at 3 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, William Hedges Sr. Public Health Sanitarian WH: dk i DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Gentlemen: BRUCE R. FOLEY, R.S. Acting Public Health Director Re: Reside C Tax Map y• " o? ��' To"m According to records maintained by the Town, the above noted dwelling IS IS NOT in compliance with Town code and the total number of bedrooms on record is 'S This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER�� . �/, '//�- a& Building Inspector C4, X5 — \ — V'-:5 I ~ | i --'�-_� / _ | � -__-- HOUSE PLANS -APPROVED FOR 7. -- __ | ............... X >all V, ON cn. P.C.H.D. Pormll 0--- q. Mr: Ell Z- M 10 M 0! > C ranch Iubd Owner/&"Hcant N Rapp; Sr. Formerly Subdivision Name I- > Brewster, NY Cn W Builders Address Drewille Road, Brewster, NY Is Mi> cn. 011 Colo Water Supplys.Peblic Supply From Address x P.F. Beal Carmel Avenue, Brewster, NY ch Ort ri ate Supply Drilled by . —Address P Building Tn- Colonial Hu Eroslon Control Been Completed7 N/A _q: Sh. Other Requirements Z we t aunt a t I certify that the yet=(*) as listed serving the above prealses met —pl...d,k I c.p... h -�o ; • i ... ed by he of which are attached). and in accordance with the standards, rule. ::d,=,. eco the roit Putnas County Deparnsent Of Health. Cwtitl* >all Rev. 3186 Meet Provide P-87-86 cn. P.C.H.D. Pormll 0--- q. Mr: Ell 45 Town of 915 BRANCH ROAD Tax Map' 0! > C ranch Iubd Owner/&"Hcant N Rapp; Sr. Formerly Subdivision Name I- _q 0! Z 01 Brewster, NY Cn W Builders Address Drewille Road, Brewster, NY Is 0 se Consisting of Gallon pd. Tkd 316 L.F. PPVC 011 Water Supplys.Peblic Supply From Address x P.F. Beal Carmel Avenue, Brewster, NY ch Ort ri ate Supply Drilled by . —Address P PUTNAM COUNTY DEPARTMENT OF HEALTH Rev. 3186 Meet Provide P-87-86 P.C.H.D. Pormll 0--- OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM PATTERS TE ON 45 Town of 915 BRANCH ROAD Tax Map' tA ranch Iubd Owner/&"Hcant N Rapp; Sr. Formerly Subdivision Name I- Drewille Road 10509, 10/15/86 Melling Address —Zip Mto Permit Issued Brewster, NY W Builders Address Drewille Road, Brewster, NY Separate Sewerage System built by 0 se Consisting of Gallon pd. Tkd 316 L.F. PPVC Water Supplys.Peblic Supply From Address x P.F. Beal Carmel Avenue, Brewster, NY Ort ri ate Supply Drilled by . —Address P Building Tn- Colonial Hu Eroslon Control Been Completed7 N/A 3 No Number of Bedrooms, Has Garbage Grinder Been lnstallet!7 Other Requirements we t aunt a t I certify that the yet=(*) as listed serving the above prealses met —pl...d,k I c.p... h -�o ; • i ... ed by he of which are attached). and in accordance with the standards, rule. ::d,=,. eco the roit Putnas County Deparnsent Of Health. Cwtitl* Address Mlddin & Ccnvljm, P.C. RD 6, Paite 22, Bcekst!9K W llcensa No. Any person on occupying promises served by the above systarn(s) shall promptly take wen action as may be necessary to Secure the correction of any un sanitary conditions resulting from such usage. Approval Of the separate sewerage system Shall become null and void *a soon as a publ.'z sanitary oewof becomes available and the approval of the Private Water Supply shall become null and void When a public Water Supply becomes, avaltabis. Such approvals are sublect t odificatio of change when. in the judgment of the COMMISMOndf Of H!"!!Iit. rev!vs �10". modification or thongs li.necessary. n Title -ey N// {7ALL[N N/f Lor.. • " �—irs:�-I � � i rye i,�. � S ` ;� ^; eILUNORLCeV M/r LOT .► • . . ► NERr2 PARCEL PLAN • emu r•►oo•• �y� l'7�c.+�.�i:�yf,Fe:•� +�..,..,::.,r„• :w {y�.E:1,i}•ddid:.,".✓:�� ux;NrION UlAl(I' 171 S. U151% 111,14. u I ST. All 66' [Ill 54' AE 89.51 Bl. 61' AP 91.51 Di 67.5' AG 95' Cl) 22' All 99, co 26' Al 103' Kr 52.5' Ai 107.51 u 52.5' BI) 17.5' PIN 64' BE 34' CN 76.5' OF 40.5' HK 45' Rc 47' 13L 78' T Yucu- County 1)0,partmenz of Jisa.Lru JIVIaion of Environmental Health Service, OProved as noted for oonfo rm,noe with Ipplioable Eules .4 R.91,latious-.09 the PutwA COUUtY Rea th Department.. County suture b le � 741-. is To cv-F-Tlf'f -THAT THE t7l,-r--A.L S'Ysrrr-?l ILIMPIC-AT'SrMp 97W -rl-1155 FL-AW AQt , T4AT THr.* iT WA,-- c-6vr-z-aG THE S-:f'-T--rl WAS e.4'w'&rz-Lr-rFc;' WITH' ALL owo z-ru-uLA--ncPw-s, or-T-Ha PUTKIAJI 4-OUKJIy HEALTH I;M M L4 TO S, ;C? l3iV.MVI V C HN;:;.I( :OA,TE M%081 11164 %019 1 NYS OUTCHESS COUNTY HEALTH DEPARTMENT GRID E 22 MARKET STREET, POUGHKEEPSIE, N.Y. 12601 NO.' N 1914) 431-2044 SOURCE STREET ADDRESS: East Branch Rdy f GIN 14 IILLAGE/CITY TAX GRID NUMBER: Pa:;terson, NY Lot -13 NAME: ADDRESS: USE OF WELL 0 EESIDENTIAL PUBLIC SUPPLY .0 AIR/COND./HEAT PUMP C3 ABANDONED I primary 0 RUSINESS C: FARM 0 TEST/ OBSERVATION 0 OTHER (specify) AOIUNT OF USE YIELD SOUGHT gpm. /NO. PEOPLE SERVED EST. OF DAILY USAGE gal. REASON FOR IN NEW SUPPLY PROVIDE ADDITIONAL SUPPLY 0 TEST/OBSERVATION DRILLING 0 aEPLACE EXISTING SUPPLY L DEEPEN CXISTING WELL 11 E PTH DATA WELL DEPTH 525 - —ft. [STATIC WATER LEVEL 20 ft. I DATE MEASURED 8/25/87_ EQ,,UIPMENT [3 CrMPRESSED AIR PERCUSSION .0 DUG 0 kLLfOINT 0 CABLE PERCUSSION 0 OTHER (specify): 'HELL TYPE OaCREENED 0 OPEN END CASING OPEN HOLE IN BEDROCK C2 OTHER TOTAL LENGTH 3 1 f t. MATERIALS: El STEEL 0 PLASTIC 0 OTHER LENGTH BELOW GRADE 30 ft. JOINTS: OWELDED OTHREADED. OOTHER CASING DETAILS DIAMETER 6 -in. SEAL: 129 CEMENT GROUT ClaENTONITE C]�THER WEIGHT PER FOOT Ib./ft. DRIVE SHOE: M YES C3 NO I LI ER: 0 YES E! NO SCREEN DETAILS DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST 0 YES ONO SECOND HOURS ,RAVEL PACK - O_YES GRAVEL DIAMETER OF PACK in. TOP. ----.I--.BOTTOM- DEPTH -ft. DEPTH it. 'ELL YIELD TEST If detailed pumping ET400: O*PUMPED tests were done is if. CO,MPRESSED AIR formation attached? WELL LOG if more detailed formation descriptions or sieve analyses - are- available, please attach. DEPTH FROM SURFACE water Bear- wen Di3- In FORMATION DESCRIPTION CODE :LL DEPTH DURATION DRAWDOWN YIELD Land Surface 10 lCrill-ing in overburden clay & bould(rs, 52-7 Drilltng in granite, AVAILABLE. PLEASE COMPLETE: ALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? 0 YES 0 NO' SITE MAP: A SITE MAP MUST BE ATTACHED SHOWING LOCATION OF WELL AND DISTANCES TO AT LEAST TWO LANDMARKS AND ANY POTENTIAL POLLUTION J;MO; INFORMATION SOURCES. �E 'submersible CAPACITY 5 9 ',KER G0111CI DEPTH 46o, )DEL 5ES07412 VOLTAGE � _30HP IL-4 WELL ORILLER NAME P.F. Beal & Sons, Inc. ATE ADDRESS PO Box B GNATURE IT BrewsterNY 105-09 .-------�--'-----'--- �z07r' yr LlvV1MUMk1 AL Owner or Purchaser of Building d 1 n Building Constructed by 4A:5 T Location - Street Municipality Building Type HEALTH SERVICES Section Block Lot Tax Map Number. ��r9s i Subdivision Name Subdivision Lot # GUARA= 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 system to operate was caused by the willful or negligent act of the occupant of the bu' ld' n ti 'zing the :system. this day of -�� <C� signature - Dated i y �l '� 19 ig Title L g-e,�3 iZ r� General Wher) = Phature z. ft,' 'A 4 f4-XL14_L Corporation Name fff Corp.) rA Address �- / 5 rev. 9/85 mac Corporation Nam (if Corp. Se, /C- Pr. -� ess tZd s A r 5EPTtL t AivK C o O C= b O Sc-ALF 1" = Zo' N EAST B R A l! V C LI U 1 LOT #5 1 ) in cn r z 440 11-11' 8 LIKgIY BUFFER EXPANSION AR�> 50' _ n > 0� D i 5.0' r 5 0'16 M I N m N O 1 ) in cn r z 440 11-11' 8 LIKgIY BUFFER EXPANSION AR�> 440 r"�°,�T,+''�'7�". .- .�r�', +�•• m "y ''..p�?°.�'".,' _ .F�a�� ;'dF.y.�,�'.R...,..�?•a».'e� ._ _i g" s_ � ^c.t , 450-- `\ \ 450 O �\ :' o 460---- m' ��4c r X460 i �L ROAD DOANSBURG _ J l .: 50' _ + > 0� rieu�S i 5.0' 5 0'16 M I N HOUSE I 3 BEDROOM J — BASEMENT-450 OSED) 440 r"�°,�T,+''�'7�". .- .�r�', +�•• m "y ''..p�?°.�'".,' _ .F�a�� ;'dF.y.�,�'.R...,..�?•a».'e� ._ _i g" s_ � ^c.t , 450-- `\ \ 450 O �\ :' o 460---- m' ��4c r X460 i �L ROAD DOANSBURG _ J l .: