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BOX 11
01056
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310 February 25, 1992
Rudolph Stasswimmer
12 Lawrence Drive
Brewster, NY 10509
Re: Proposed addition Stasswimmer
Lawrence & Oneida Drive
(T) Patterson, NY
Dear Mr. Stasswimmer:
JOHN KARELL Jr.. P.E.. M.S.
Public Health Director
I have received and reviewed the plans for the proposed addition to the above mentioned
residence.
The.plans indicate that a 25' x 241 addition will be added consisting of a bedroom and
living room. The existing bedroom and living room will become the dining room.
The survey indicates that sufficient area exists to expand or repair the sewage disposal
system, should it become necessary in the future. Therefore, based on the information
submitted, the above mentioned addition is APPROVED with the following conditions:
L The total number of bedrooms must remain at one 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 replaced or updated with water saving devices, i.e., low
flush.toilets, restrictors for shower heads and faucets, etc.
4. The existing well must be properly abandoned and a new well (W -7 -92) constructed as
shown on the attached plans.
Approval is granted for sewage disposal only. 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 /JP
cc: BI (T) Patterson
DEPARTMENT OF HEALTH
Division of Environmental Health Services
110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310
APPLICATION TO CONSTRUCT A WATER WELL
PCHD PERMIT .#
WELL LOCATION
Street Address
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Town Vi
lage City Tax Grid Number
WELL OWNER.
Name
Mailing
Address
private
t 1117 ,0" V0 4— 0 Public
USE OF WELL
kCL primary
2- secondary
AD RESIDENTIAL
0 BUSINESS
0 INDUSTRIAL
0 PUBLIC SUPPLY
E3 FARM
O INSTITUTIONAL
0 AIR /COND /HEAT PUMP O ' ABANDONED..''
O TEST /OBSERVATION 0 OTHER (specify,
0 STAND -BY O
AMOUNT OF USE
YIELD SOUGHT gpm/ #
PLACE EXISTING SUPPLY
O NEW SUPPLY NEW DWELLING
PEOPLE SERVED 3 -!5"_%EST . OF DAILY USAGE�al
0 TEST/ OBSERVATION 16 ADDITIONAL SUPPLY
' 13 DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
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WELL TYPE
�LED
®DRIVEN
ODUG OGRAVEL .0 OTHER
IS WELL SITE SUBJECT TO FLOODING? YES DLO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:'
Lot No.
WATER WELL CONTRACTOR: Name
Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: -YES ^W--NO
NAME.OF PUBLIC WATER SUPPLY: /li TOWN /VIL /CITY
DISTANCE TO PROPERTY" FROM - NEAREST' WAiiR MAIN : °
... .
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
IAI ❑ ON 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 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
any and all water or waste products from such well
property and in such /a manner as not to degrade or
Date of Issue �eP6 19
... /
Date of Expiration 19-
shall take appropriate action to assure that
drilling operations be contained on this
otherwise contaminate surface or groundwater.
?ermit Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
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HEALTH -DEPARarr
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DIVISION OF.
TrAL`i LTH SERVICES
PROPOSAL FOR SEWAGE DISP0 Ss!t II REPAIR •
UAW! PHCNE
SITE IAGATION
•
� ADDRESS � �.�. � � %P �%�• � �����-,,- :L.r^- =='' -� . ' >� r r •
PERSON i1VTERVIEWED''t ""'!�?; PCEID' Complaint
Name :Relationship (i.e, owner tenant, etc:) i
L1ATE � -•' � ,.., TYPE FACILITY '`�`' -�i. + � ---.`' .-;�
PROPOSED IlSST
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` .PHONE ,b
r
include :sketch locain
7
all ad acent wells);• i
Prowl:( g ._
NCITE. Repair ,must be m same location and of same type as original sewage disposal system.:
a
Different location may +require submittal of proposal fro licensed professional engineer or;:`
LTA`
e
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proposal approved � t
Proposal Disapproved
;
'.Inspector! s Signature & Ti e i ,';, Date. .
b.
?roposal :approved "with :the following conditions
1. ;' Procurement' of.' any Town ;permit, if applicable:: .
L'Submission of as built repair sketch in.:duplicate showing;
a. Owner's name:
!.b. Site Street -Name, Town.: and Tax, Map number,
c.. lvocation . of installed: eanponents '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
drywalls .surrounded .by.. one .foot ; ± gravel )
e.- :.Installer's name and number.
3. System repair to be'perfornied in accordance with the above, proposal and conditions.
[, as owner, or reported agent of owner agree to the above conditions.
iIGNATURE k� .[ �. �� �.t ri.< c !_�._ -�' TI, TLE DATE
;MS; %rite MD); YeUcw Mun EL); Plink (ARalicant•)
OW
SIT
PER
DAT
PROS
Proposal (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 from licensed professional engineer or
registered architect.
s./
Proposal approved
Inspector's Signature & Ti
Proposal Disapproved
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
d.'System description (e.g., 1250 gala concrete septic tank,
drywalls surrounded by one foot + gravel).
e. Installer's name and number.
c'7
Dated
(e.g.,house corners).
three precast 6' diam. x 6' deep
3. System repair to be performed in accordance with the above proposal and conditions.
r
I, as owner, or reported agent of owner agree to the above conditions.
SIGNATURE TITLE DATE
PIES: Mite (POD): YeUow (Tim HT); Pink Qalicent)