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25.41 -1 -1
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p.._ PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION TO CONSTRUCT A WATER WELL
please print or type PCHD Permit #
Well Location:
Street Address: Town/Village Tax Grid # 25- 41 -1 -1
SAME Map Block Lot(s)
Well Owner:
Name:
Address:
Hector Vigo Jr.
#5 Deerfield Rd., Patterson, NY 12563
Use of Well:
X Residential. Public Supply Air /Cond/Heat Pump Irrigation
1- primary X
Business Farm Test/Monitoring Other (specify)
2- secondary
Industrial Institutional Standby
Amount of Use
Yield Sought 5 gpm # People Served 5 Est. of Daily Usage _gal.
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
New Supply (new dwelling) X Deepen Existing Well
Detailed Reason
6" Di a drilled well dry
DIERGENCY
for Drilling
Well Type
X Drilled Driven Gravel Other
Is well site subject to flooding? ........................................ ............................... ..... Yes No X
Is well located in a realty subdivision? ...................................... ............................... Yes X No
Name of subdivision Putnam lake, NY Lot No.
Water Well Contractor: Mill Drilling, Inc Address: 75 Putnam .Ave.,. Brewster, NY
Is Public Water Supply available to site? ..........:. ................. Yes No )
Name of Public Water Supply: Town/Village
Distance to property from nearest water main:
Proposed well location & sources of contamination to be provided on separate.sheet/plan.
10/15/.01_ Applicant Signature ::: -. __ ----------- - - - - -- - --
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the
Putnam County Sanitary Code and 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 or their designated
representative 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. 3) Submit a Well Completion Report on a form
provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or
well driller shall take appropriate action to assure that any and all water and 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.
APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless
construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be
amended or modified when considered necessary by the Public Health Director. Any revision or alteration
of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam
County.
_ �y
Date of Issue 0 �'— .� 00/ Permit Issuing Official: -�
Date of Expiration : B dG Z-- Title:
Permit is Non-Tra6fefrable
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
e
PUTNAM COUNTY DEPARTMENT OF HEALTH -
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT
Well Location
Street Address:
5 Deerfield Rd
Town/Village:
Patterson
Tax Grid # , .
Map 25 Block 41 Lot(s)1 -1
Well Owner:
Name: Address:
Hector Vigo 5 Deerfield Rdo,'Patterson, NY 10563
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
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 64 ft.
Length below grade 63 ft.
Diameter 6 in.
Weight per foot 17 lb /ft.
Materials: X Steel _ Plastic _ Other
Joints: _ Welded _ Threaded _ Other
Seal: _ Cement grout ` Bentonite Other
Drive shoe: X Yes No
Liner _ Yes No
Screen Details
Diameter (in)
Slot Size
Length(ft)
Depth to Screen (ft)
Developed?
First
Yes No
Hours
Second -
Well Yield Test
_ Bailed _Pumped _Compressed Air
Hours _
Yield gpm
Depth Data
Measure from land surface- static (specify ft)
.50
During yield test(ft)
.60
Depth of completed well in feet
405
Well Log
If more detailed
information
descriptions or
.,e_ " l�,�o�_- -
s.e - aria , se -
are available,
please attach.
Depth From
Surface
Water
Bearing
Well
Diameter(in)
Formation
Description
ft.
ft.
Land Surface
18
yes
Sand « Gravel
L_18
50
Soft Ledge
I r,n
4nn
_
Medium Ha r.. Granita
I
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump /Storage Tank Information
405
6Q
Pump Type subp rsiqAltactty 10
Depth 200 Model lOGS07412
Voltage230 HP .3/4
Tank Typpl adder Volume 62
Date Well Completed
10 -23 -01
Putnam County Certification No.
2
D t of po
-� -�`1
Well Driller (signature)
NOTE: Exact location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan.
Well Driller's Naine, Mill Drilling, Inc. Address: 75 Putnam Ave, Brewster, NY
Signature: Date: 11ink
White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller
Form WC -97
BRUCE R. r OIJEY
Public Health Director
LORrTTA MOLINARI R.N., M.S.N.
Associate Public. Health.... Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648
Preschool (845) 228 - 5912 Fax (845) 228 - 6113
September 20, 2001
Hector & Lucia Vigo
5 Deerfield Rd.
Patterson, NY
Re: Addition- Vigo- Deerfield Rd.
No Increases in Number of Bedrooms
(T) Patterson Tax # 25.41 -1 -1
r Dear Mr. & Mrs. Vigo:
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 September 20, 2001 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
ML:kg Public Health Technician
cc: BI(T)
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PUTNAM COUNTY DEPARTMENT OF HEALTH
HOOSf. PLANS APPROVED FOR
BEDRQUM COUNT ONLY;
Elm
RAt.i61 NC
?BEDROOtAS Z
ate
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BRUCE R. FOLEY
i ! Public Health Director
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York. 10509
LORETTA MOLINARI RN., M.S.N.
Associate. Public Health Director.
Director of Patient Services.
Environmental Health (845)278-6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax'(845) 278 - 6648
PROPOSED ADDITION APPLICATION (RESIDENTIAL ONLY)
STREET a Q - TOWN P<=e*;6�TXMAP#, 7?
NAB HONE PCI�#
MAILING ADDRESS
_..
_DESCRIPTION OF ADDITION
NUMBER OF EXISTING BEDROOMS PROPOSED # OF BEDROOMS
(FROM CERT. OF OCCUPANCY OR
CERTIFICATION FROM BUILDING INSPECTOR)
*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 Dept., 4 Geneva Road, Brewster, NY
10509, Phone 278 -6130.
1 ' Ce'rhJfied ,check_or money order,for $.100 00 - - - - - - - -
2 3Sketches of existing floor plan (drawn to scale mall living area including basement)
*Non- professional sketches are acceptable..-
3? Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #)
' on 4. Co of survey o h
shoswingwell are
and septic location, to the best of your knowledge
f PY . 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.
;.1115: r -Copy of Cert Of Occupancy from Town or Certification from Building Dept. with legal bedroom
;_ Lcount of- dwelling. -
Comments
Feb98
Whousepidelines
BRUCE R. FOLEY, R.S.
Acting Public Health Director
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
0
Putnam County Dept. of Health
4 Geneva Road
Brewster, NY 10509
Re:�� mil_
Residence
Tax
ToNNM
Gentlemen:
According to records maintained by the Town, the above noted dwelling
is
IS NOT
in compliance with To,,ti-n code and the total number of bedrooms on record
is
This information has been obtained from:
CERTIFICATE OF OCCUPANCY:
ASSESSORS RECORD:
iluildine Insoectoriv ,
06/18/2001 14:35 FAX _ _ _.-ALBERT WARD &JOHNSON 0001/007
LUCIA VIGO - --
S DEERFIELD ROAD
BREWSTER, NEW YORK 10509
June 18, 2001
Dear Mr. Hedges:
You and I spoke a couple of weeks ago regarding a proposed additionjo
our house. You asked me to send you floor plans of how it looks now and what I
would like to do (1 hope what 1 drew is satisfactory) and that you would let me.
know. Accordingly, attached are my "plans" (don't laugh too loud) together with
a copy of the tax card for the property.. If you approve. this, I will then following
the instructions on the "Addition Application" you also faxed me.
1 am trying to refinance but I can't do that until I know if it is possible to do
the addition. I would appreciate it if you would call me at your earliest
conveoicnce to talk about this. My work number is (203) 661 -8600. I am here
from 8_30 a,tn_ to 4 :00 p.m. -- - -��i— - -- -- —
Thank you in advance for your anticipated cooperation.
Sine ely,
ucia Vi o
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RESIDENTIAL BUILDING SECTION
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RESIDENTIAL SOILOING AREA SECTION
RRSTSTOBYAF7A
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A E%CEALENI 0 EOOfAOAYY
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PUTNAM COUNTY HEALTH DEPARTMENT
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DIVISION OF -E VIRO A-L H -_LTH. SERVICES
O`IMI S NAME PHCNE /' 03 K/- "00
SITE LOCATION s ® • ` TO
MAILING ADDRESS Ake
PERSON INTERVIEWED ��- PCHD Complaint #
Name & Relationship (i.e, owner,tenant, etc.)
DATE - - TYPE FACILITY
PROPOSED INSTALLER PHONE7� -�9y a
REGISTRATION #
(include sketch locating all adjacent wells):
NOTE: Repair must be in same location and of same type as original sewage disposal system.
Different location may require submittal of proposal fran licensed professional engineer or
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Proposal approved PC- Proposal Disapproved
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Proposal approved with the following conditions:
1. Procurement of any Town permit, if applicable. _
2. Submission of as built repair sketch in duplicate showing:
a. Owner's name. _
b. Site Street Name, Town "'and Tax Map.number.
c. Location of installed components tied to two fixed points (e.g.,house corners)...-
d. System description (e.g.-, 1250 gal. concrete septic tank® three precast 6' diam. x 6' deep
drywells surrounded by one foot + gravel).
e. Installer's name and number.
3. System repair to be performed in accordance with the above proposal and conditions.
I, as owner, or reported agent of owner agree to the above conditions.
SIGNATURE. TITLE DATE
7JPg5: gibe (PQD); YeUcw (Tam ffi)a Pink (AApliamt)
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