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Home My WebLink About1181DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25:62 -1 -28 BOX 12 I I I I r ,ti i iilrdrl rP i 01181 I PUTNA? ev. "3/86., : Dlvision of ftv J� 4, CATE :OF CONSTRUCTION; CON Llle Owaer� caotWain .0 QT ,e 'r. Y1& Mdung Address' Co,�t�rrs 6k JANCI I�CQ -T �. Adana.aS I �r�avich /d•,�TaAe�sd✓1. Ny Separn.tesewerage System built by �'°c' / / ` r F. a c3 [,YI t° ' �z •io_Oa .��L '. 300 LF' �BS:'T��IVC� -i s6� Co tin of - G1JIon Septic Tank and Watei Supply:. P6611c Supply From' 1 Address t pdvate�Sup _F BQ I 5. ¢ e 10 by e on e S 1 e ✓1 4 d He Erosion Cntrol Been Complet edY ge Yew Namber of Bedrooms Hue .Garbage Grinder Been InataiiedY Odw Requirements { I certify hgt,the ayatem(e) as Misled serving tAe above_prewiaes were constructed eeeentially ae shown ' the'plene of the completed -work (copies PutnamicCount are'attachi4),..and in. Of Healthordance with "tlie standhzda rules and`reg _ ions in ocorQa}`s wi a led Ibn„ and the permit issued by the r '`/ Y L ✓ Oats J 9 7 Certified by P.E. ^ R.A. c ; Addreu License No. S "}'rte 8few5 er 509 6 I Z 4 Any person occupyinq premiss Carved by the above systam(s) shali, promptly take such action as may be necessary to secure the coriegtion of any Yntanitary eondifbns�rasultihq, from such' usage .Approval of the separate faweraUe.fystem shalt become hull end void as woo as a Dubt;: unitary sewer, becomes avallatile, and the apDrov I of•the private'water, supply stialt.become null and '.void WIN tar supply becomes avallebw Such approvals an wbJaet ;to modification or eha i4e wheh;f'in the 'ludgrr t •of ths,'Commis toner of th;: ey n, mod lfleatlon or ehanga Is ,necessary.,, j �J 2 cam' a" Tit er :Oats - _ ._._ .. y ; ti WELL CUMYLETIUN t(rxutci F" DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only . — S� 57- WELL LOCATION STREET AOURESS. WNIVI TAX GRID NUMBEk Newburg Rd & Lakeport Rd, Patterson, NY WELL OWNER NAME: ADDRESS: Catherine Stephens, 3043 Horseshoe Springs Dr,Conyers, GA ❑ PBINATE O PUBLIC USE OF WELL 1 - primary 2 - secondary ® RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM O TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR. DRILLING []REPLACE .-EXISTING SUPPLY []TEST /OBSERVATION []ADDITIONAL SUPPLY ®NEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 205 ft. STATIC WATER LEVEL 60 ft. DATE MEASURED 2/26/96 DRILLING EQUIPMENT 12 ROTARY 0 COMPRESSED AIR PERCUSSION ❑ DUG O WELL POINT O CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED ❑ OPEN END CASING ® OPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH MATERIALS: Q STEEL O PLASTIC ❑ OTHER LENGTH BELOW GRADE fit. JOINTS: ❑ WELDED ® THREADED ❑ OTHER DIAMETER 6 in. SEAL: Q CEMENT GROUT' O BENTONITE OOTHER WEIGHT PER FOOT 19, Ib. /ft. I DRIVE SHOE: ® YES ONO LINER: CJ YES Q NO SCREEN DETAILS _.. DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TU SCREEN (It) DEVELOPED? FIRST O YES ONO HOURS e� SECOND _ _. _..... GRAVEL PACK ❑'YES ❑ NO GRAVEL SIZE; DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH ft. WELL YIELD TEST If detailed pumping METHOO: ❑ PUMPED tests were done is in- X) COMPRESSED AIR ,' ormation attached? O BAILED O OTHER ; ❑ YES I] NO It more detailed formation descriptions or Sieve analyses WELL LOG tlg are available, please attach. DEPTH FROM SURFACE water Bear. ino Well Dla• neter FORMATION DESCRIPTION woe ft. ft. WELL DEPTH It. DURATION hr, min. DRAWOOWN It. YIELD 9Cm- LuAa ce 16 Dr lli in overburden clay &boulders 16 Hi roO.,k at 16' 205' 6 165' 12 16 41 Dr lli in rock, set casing, routed 41 205 Dr lli g in rock granite WATER ❑ CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? ❑ YES O NO STORAGE TANK : TYPE CAPACITY GAYS. PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAME P. F. Beal & Sons, In e 0 2/14/97 ADDRESS 4 Putnam Avenue SIGNATURE Brewster, NY 10509 i Xery Le Bel LAURENT ENGINEERING ASSOCIATES, P.C. MILtBROOKE OFFICE CENTRE- Route 22 & Milltown Road Brewster, New York 10509 . RANDOLPH W. LAURENT, P.E. (914)278 -6108 - (FAX) 278 -2658 HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS i March 5, 1997 Robert Morris, R.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 RE: Individual SSDS Compliance Newburgh & Lakeport Patterson,, N. Y. Dear Robert: Enclosed are.the following: 1. Four (4) prints of Drawing AS -1 "As -Built Plan ", dated 2- 28 -97. • , 2. "Certificate,of Construction Compliance for Sewage Disposal System ", dated 3 -5 -97. 3. "Guarantee of Subsurface Sewage Disposal System ", dated 3 -5 -97. 4. Well Completion and Well Log Report, dated 2- 14 -97, 5. Water Analysis Report, dated 2- 17 -97. 6. Money order in the amount of $200.00 payable to Putnam County Health Department. If there are any questions concerning the enclosed, please call. Very truly yours, LAURENT ENGINEERING ASSOCIATES, P.C. ; I I Harry W. hols, ;Jr., P.E. HWN:RL:bd 87109 'x Y0 e ' .._.... ... .•. - y.nr�.u,;r � +nr•,n,ti ry pree /dwwttlrtNdxte:7,weww.,�.",�. -.. ... .w�.".eai,J•�K'W+IWw• - .. — �•••••. —.••. ... . t Its MW W%. 4 ,�� :[ �N ON!01 LAT3 ID NUMBER: 97 -0972 CLIENT: IIavilandi Plumbing I<enw'ood Rd Patterson NY 12563 SAMPLING LOCATION: Pump pipe, Lakeport Rd & Newburg Rd, Patterson NY COLLECTED TAY: 11. Havilttnd DATE COLLT?CTED: 02/12/97. TIME COLT., CTED: 2:00 PM DATE IZ1?CEIVED: 02/13/97 DATE OF REPORT: 02/17/97 ANALYTIw ._ �.._.._ RESULT* �+UNIT5+ -- -MAX CNTMT LEVEL" METHC)D�� —_ - ANALYZED Total Coliforin Absent Must be "Absent" SM18(9223) 02/13/97 E. Coll Absent Must be "Absent" SM18(9223) 02/13/97 This sample, as submitted to the laboratory, and as compared to the New York State limits for drinking water quality for the tests performed, was: V ACCEP'1"ABLE. NOT ACCEPTABLE. 117 YI d Maryann I'asano, Assistmit Laboratory Director NYS ELAP 1111218 CT Lab Approval #PI-I -0171 " Underlined rr'!+tilk are unacceEttabki according to health departnwiit and /or US EPA codes, " maxitnuin Contaminant LevL1 (maximum permissible concoitration allowed by }health department and /or US EPA codee). :;i,'ll;�,,;:k ii}��_� t.a��rnn;�:�, L3rc�•sc�.r,Nl" i0�09.9��II j�?1�- 3;8.7(100 /fax )1� -278. 7754 (f:•mail;'�!oAtnl.tti,�noi•c��m RA am,,Ai•i COUNTY DBpA_rM/ADF ZT OF fE.aLjH DIVISION OF ENVIRON?PL fiEP.i1TH SERVICES ' / 2, % 3 C,wner or Purchaser of Building Section Block Lot Building Constructed by 11 ( LcicPor' 7d .. Location —:!,Street. Subdivision tea i•iuucipality Subdivision Lot ll S Gi _V 1 0.1 Building Lyc- GUaR%NTEE OF SU BSL71_01 ✓, Sark -k E DI S-PO&PL SYS EM I represent that. S an wholly and completely responsible for the lcc:ation, wor;aia.nshio, matpr.ia.l, 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 o! the :Putna'•,t County Lhpartire_nt of Bealth, and ,hereby guarantee to Une. criner, his successors, heirs or assigns, to place in gold 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 cusposal system; or any recairs made, by, n�_ to such. system, except- where the failure .to operate properly is caused: by the willz�u'1 or negligent act of the occulpant.of the bailding utilizing the system The undersigned further agrees to accept as conclusive the detejanirati on of the Director of the Division of rnvixon�.-ent.al_ Bealth Services of the Putna a County Department o health es to w,mether or not- the failure of the system to operate was caused by the willful or negligent act of the occupant of the bui g utilizing the system Dated this day of are 19 q7 G— ex-all Co.^. � (Cwr • 'e GCj�eBB'' �v CorT:joration N�,e (if corp.) .P.ddxess rev_ 9jd5 Sionature Ti tle Co=rati.cn ha ,,a (if Coro. ) 611S 7 /3h1 tvcO. �P ess - -- ri:'f''7 A !N �.ul if Yn Ur i!7 A rT'RIiF'r'T of F WIR A 1 Ti:1 UM.i�t� 1 Pa.1.. fi4odt4 1�.t« l.ars�l V Y 1KI: � ,tor+e. ea rr6 t:2. 9..,.rsp uoirl�.� nvnti 2mrpw nos =Am a,r.�� 7sTt_w • LL __ ,. d •_ ti} �..■ Q ems. ti.bd I� I I / u: M.p E4i«i r, , �G.� R.., '/h r. �1 f' . 2 :2` :3 j1 �' 1It�Q tea 1A010 OZ y 06PA do t? d.� 3 as 4 ID o� IPC�r 6 wbm nu e Cm 'g-2,0,08, ; � f 13 D, nos M� 1 ropvosonmq "tFwQ'1 sin c✓P011y aro® tom9btbly roegouisi6lo for.tho oO'tsan and location of tho propov6d Bystonl(s); 1) that Rho sOparOto . di ` cnl a atom Mow Comribod will bo o�atvuctcd oa aPOGrn on'tho Opprovcd omondmont clam to'and in occordanco tafth tho standards, rulo8 a ►Cgu ns 0 Pa CouptV t ve tcnj.: ®f Mc6M. oral that on eom"Idn- thoroOf 0 "Cc7tia0cOto of Construction Complianeo" otisloctory to tho Commlwbomci of Mc71Qhtjill lb QC2 am Qcm to MID f gQuraaaQ, Or.*1-O wittopi gaeorontog, Criil polo furnishog tho aanc,:Pis aeecam=s 110174 cr'OI by tho 09dift-Zi. t6ot mt;l DMlcma v110 =oa fa 0=8 .0 7o4i eoc�olaaon . any, mort of :mid pao g, aflisp0ml sysRom .durirq ,tho pa7Easa of "(8) y�6 Ign" W— QOIy tolt=iao too to OQ tho lt�- 09 mo op 7mot of Q4`.a C&tiQlcato 00 Conn¢ ruction. CompObnto of .oho ovlhinal sy64oin w any ropt76 Qf=OQO; 8) thO4'QPO drillI t7001 40=m cg c�� Cl CO MWQCM O4 1 W,00 ¢rte a�r0 jb,Ian and that saibl moil gill k�, in occordonco cr84P Po a rda, rubs, d rqd na OP Qpo GuQROM AV OSc� in . 00 M ato. QaRo chi 19 i 9 9 $ Pca AdC Litonso No AMOV EO FOR CONSTRUCTION: This Opwoval oupyos.tcjo yoars from qho doto. issuod un0oas construction of tho Building ,hos beon undortatton and is rc wolo for caua7 :or May bo arnc#WI 1' O► mcZjific8 "njconWdCiod.nctostiry, by_ �tho Commissionot of Health. Any Chng*o or altaotton of construction oc�luiroa 0 nosy pormit. �rC" for 1i'4oml:of dom09tk <inifory case 5111 cj orator supply only. Rev. 1088 Titb' -s. e PUTNAM COUN DEPARTMENT OF HEALTH NO. 94 -96 -19 TY COMPLAINT OR SERVICE'REQUEST RECORD ' IN PATT.ERS.QN._ DATE 2/26/96. REFERRED "TO BH TAKEN BY BH TELEPHONE CALL X IN PERSON LETTER CONFIDENTIAL REQUEST FROM Mrs. Niemela ADDRESS : .Lakeport Drive, Patterson TELEPHONE - 279 -3882 ENVIRONMENTAL HEALTH: home Sewage Rodents. Refuse Public Water Food Service Migrant Camp Other COMPLAINT OR REQUEST New house being built on Lakeport and Newburgh. SDS may be too close to NiemelaIs' well. BY�� FOLLOW UP INSPECTION (s) _ .FINDINGS• :.... __....._.. .... _. _. ... ..... _ ....... _ ....._.... f DATE FINDINGS PROBLEM ABATED DATE PERSON NOTIFIED ' y ESTIMATED TOTAL MAN HOURS SPENT 77 LAURENT ENGINEERING ASSOCIATES, P.C. MILLBROOKE OFFICE CENTRE Route 22 8 Milltown Road Brewster, New York 10509 RANDOLPH W. LAURENT, P.E. (914)278 -6108 - (FA)0 278 -2658 HARRY W. NICHOLS JR., P.E. W1 CONSULTING SITE ENGINEERS March 1, 1994 Putnam County Health Department 4 Geneva Road Brewster, NY 10509 ATT: Mr. William Hedges. RE: Proposed SSDS & Well - Newburgh Road Patterson, New York T.M. 25°62 -1 -28 Permit P -97 -87 - (for renewal) Dear Bill: Enclosed are copies of the following: 1. Copy of "Construction Permit ", approved 10 -26 -870 20 "Construction Permit" for renewal dated 3 -1 -940 30 "Application Form ", dated 3 -1 -940 40 "Authorization Form ", dated 3 -1 -940 A Construction Permit was issued on 10 -26 -87 and a renewal of the : -permits. given ..9.7.14 -49, and. 3-19--.92. We are herewith submitting the above to obtain a renewal permit. Thank you for your cooperation. Sincerely, LAURENT ENGINEERING ASSOCIATES, P.C. i' Randolph W. Laurent, P.E. RWL:bd encso 87109 cc: Ms. M. LoBraico w/1 ea. 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 5k7'f WELL LOCATION Street Add¢ress =M7 trbuv-� h `t�oa.cd 1 Tax Grid Number V. ,H 2 •- / _�2p WELL OWNER Name C rPtnin� L: S Mailinq' Add ess ✓e�15 /d�rzg e5 Pe 0yersg 2,: Private �ti S �r�t J a O Public 0 E OF WELL primary 2 - secondary RESIDENTIAL D BUSINESS D INDUSTRIAL D PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify C]INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE6oe9 Sal O REPLACE EXISTING SUPPLY O TEST /OBSERVATION M ADDITIONAL SUPPLY f4kEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN DDUG []GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? 'YES _ C NO IF WELL IS LOCATED IN :A REALTY SUBDIVISION, NAME 'OF SUBDIVISION: V 1 Lot No. WATER WELL CONTRACTOR: Name T-0 be P�eA 4YLl P Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: 'O LOCATION SKETCH & SOURCES OF CONTAMINATION PROVID D MOAA /,19 ON SEPARATE SHEET p (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 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:-.,,., �'�"�.`� 19 Date of Expiration 19 Permit Issuing ffic Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller ,. a ,. , si r TY DEPARTMIENT OF HEALTH tal Health Serylow. Carmel, N.Y. IOS12 Engineer to ProvidiPermit a on CERTIFICATE OF COW CE Permit - 0 7 Located at Town 4_-_NM%0. Sulidividon Name l gob-d. Lot 0 Tax Nhp -.Block 6 Lot Renew ❑ Revision _CJ Owner/Appilcaut Name Date of P;Yvlo* us App Malling Addreca Town �V=d-0a0A 7JI) a*&s CA 7- t Lot Area— volume Building Type _7& ta 1 Fill 0 Depth Numhe rooma Design F1 PCHDI Notification In Reqnll;¢d When Fill to cumnleted Flow P D Separate Sew emse Syateia. to. consist oQ 9 Gallon Septic Tank and'. A To W constructed Water Sqpp,3,. Public. Su:pp,iy:Fr um 7 or: gt Private Supply lied y. D by 00 .9 Other Reaulre ento ,represent that I am wholly and completely responsible for the desigmand 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 an rogulationof Ing Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commiitjoner.of Healthwill be submitted to the. Department. and D written guarantee will be furnished the owner, his.successors, heirs or assigns by the builder, that said builder Will place_ in, good. Operating condition. any part of- caid -sawag4.- disposal - systorrv.-during -the period•of two (2)-years immediately fo llk7wlnj. tho.daig once. Of the approval. of. thoXertilicato at Construction Compliance of taro original system or any repairs thoroto.2) that tho dr '11"doscribod above n the approved will be located as sho!!�vn`6: Plan and that said well will be install In accordance with Stan _.'ToLnF7U* the' Putnam h the Ord irtz.-ana-rcqui County, Department of Health.' 'Al Date Signed P.E. Address L11cefinso N'o:- APPROVED FOR CONSTRUCTION: Thii approval expires two years from the date issued unless construction of -the building has been undertaken and is revocable for cause Or may be amended or.modified when considered necessary. by-,the-•Commissionor of Health. '.Any change or altaration of'construction . • requires. a.. new qerffy iL.Vkpprcvec fwcisposal of demerits sanitary sewage, and/or 6rivatd w at or supply 0 I V. 37 Date Title! 7— PUTNAM COUNTY DEPARTMENT'OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date 12 9zl` �) + Re: Property of 0,o[�t e�(in F S✓el1 3 Located at /G'(;I'w,- CQ vjz tt R0Cq' Block ___Z Lot Subdivision of 11f1/e} Subdv. Lot # Filed clap # Date Gentlemen: This letter is' to authorize C1,9 Gle a duly licensed professional engineer X 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., ruleq or regulations as promulagated by the Commissioner of the Putnam County Dep air trrient of Health', . 'and to `sign ali. necessary papers:: on'' my`; behalf. 3. 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. 1 Court ersign P.E. , ,. Very truly yours, Sign Address A)Y, Telephone T To Telephone N-1 IM a -27, Poo C&,tTQ1mc;v MU6 C7 ik6v {o 'm Rev, z= wwJq� all to j6t��: male= ca�@dwt Itow ;*.aiai .@q I lk 7=0 aqz3:t±m- Q=C t 91, QCZN aw C70= zm c cc:l C�= 9Mtm Dan PA.>� on .09 tko Oulcolm ADS fx ucica Is ARV ckovco w"boic7bain� CIF4 maig cbmwmtem 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 #�7 WELL. LOCATION Stree Addre l -w-L v s Town Tax Grid Number fi& l _ a sc- -G2 — / -z WELL OWNER Name Id C M . ling Add ss C0 it ers "S tVe Private OPublic. USE OF WELL 1 primary 2- secondary GMSIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY D ABANDONED O OTHER (specify O 'AMOUNT OF USE. YIELD SOUGHT gpm /# PEOPLE SERVED-3 5 /EST. OF DAILY USAGE 6av Sal REASON FOR DRILLING 13 REPLACE EXISTING SUPPLY O TEST/ OBSERVATION Q ADDITIONAL SUPPLY 19NEW SUPPLY NEW DWELLING D DEEPEN EXISTING WELL DETAILED REASON FOR 'DRILLING -w- _IRC- eKe- WELL TYPE ®DRILLED ®DRIVEN DUG OGRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES %< NO. IF WELL IS LOCATED IN,A REALTY SUBDIVISION, NAME OF SUBDIVISION: IV Lot No. WATER WELL CONTRACTOR: Name %p 6-e Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES C NO NAME OF PUBLIC WATER SUPPLY: /�� TOWN /VIL /CITY DISTANCE' TO PROPERTY FROM NEAREST WATER MAIN c' ' LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED [9ON.SEPARATE SHEET - �b.vg�cg�v =- (date) (s gnature) 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 reiquirements 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:'�1� /` 19 `% Z_c Date of Expiration 19T�, Permit Issuing Official Permit is Non - Transferrable White ,copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller RANDOLPH W. LAURENT, PE. HARRY W. NICHOLS. JR., PE. March 2, 1992 LAURENT ENGINEERING ASSOCIATES, FC. 73 FAIRFIELD DRIVE PATTERSON, NEW YORK 12563 (914) 278.6108 -(FAX) 278.2658 CONSULTING SITE ENGINEERS Putnam County Health Department 110 Old Route Six Center = Carmel, NY 10512 Att:• Mr. William Hedges Re: Proposed SSDS & Well - Newburgh Road Patterson, New York TM 25.62 -1 -28 P "ermit P -97 -87 for renewal Dear Bill: Enclosed are copies of the following: 1. `Copy of "Construction Permit ", approved 10- 26 -87. 2. "Construction Permit" for renewal dated 2- 29 -92. 3. "Application to Construct a Water Well ", dated 2- 29 -92. 4. !'Authorization Form ",.dated 2- 29 -92. A Construction Permit was issued on 10 -26 -87 and a' renewal of the permits given 9- 14 -89. We are herewith submitting the above to obtain a renewal.permit. Thank you for your cooperation. Sincerely, LAURENT ENGINEERING AS OCIATES, P.C. Randolph W. Lau ent, P.E. RWL:bd encs. 87109 cc: C. Stephens w/1 ea. I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Dates, 7, Z Re: Property of (.�caC7 ` P Y �PY'rvi -2 ��p ✓Ph S Located. at IV (21, rIb •L, y (T) { ' Section _Block 417 Loth Subdivision of '/VA Subdv. Lot # Filed'Map # Date Gentlemen: J I'' / This letter is to authorize dd /w K/ c LIQGL %�'1 a duly licensed professional engineer %C 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- conformkty -with- *•the"-Provisions "'o'f "Article 14Tj 'or- 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Co 0 Address z;7 - -zoo Telephone Very truly yours, Signed Owner Pro y� Ad ress , To zIle Telephone veZe! a o �' o. P.O. BOX 323 o BERWICK, PENNSYLVANIA 18603 o (717) 752-5914 -7.14r FU_ -.'1i C 0 Ti IN T Y DEE 'r- A R T 141 E N T OF HEATH I I cl 7 17' A I -_-) - A ? F Rr) V E D F 010, Bnl"Dlt"';'-'�r""�'i 0111-JiN,111 ON'Lly; SUGGESTED LOWER LEVEL Opt. doo� opt. s•g.d. 0 17-1 E :d w UTILITY TWO CAR GARAGE FAMILY ROOM Zilc-natare 'iti ate.— ------------------------ 1-------------- - - - - -! Elevations are artist renderings and may vary to actual construction. Floor plans and room sizes are approximate. Appliances shown are optional. Plans, Specifications and Prices are subject to change without notice. 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 # 1 V/ WELL LOCATION Street Address V 4 Town' �'�age Gi*y Tax Grid Number WELL OWNER Name Mailing Address YES _�/ NO OPrivate O Public USE OF WELL 0- primary . 2 - secondary ('RESIDENTIAL (3 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O FARM 1 01NSTITUTIONAL. Q AIR /COND /HEAT PUMP O TEST /OBSERVATION O STAND -BY O ABANDONED O OTHER (specify, O .AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED' /EST. OF DAILY USAGE gal REASON FOR DRILLING ZEW SUPPLY O PROVIDE ADDITIONAL SUPPLY OREPLACE EXISTING SUPPLY. ODEEPEN EXISTING WELL O TEST OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN ODUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES L/ NO 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 _�/ NO NAME OF PUBLIC WATER SUPPLY: N�lr TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: �( LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED O ON REAR OF THIS APPLICATION ON SEPA TE T �'y...(date) I ( gnature) 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 I thirty (30) days of the completion of water well construction, the applicant shall: 1. 2. 3. Date of Date of Permit 2/87 .Pump the well until the water is clear. Disinfect the well in accordance with the.requ'irements of the Putnam County Health Department attached to this pe;fmit. Submit a Well Completion Report on a form provided by the Putnam County Health Depart ent. N_� Issue: ermit Issuing icial— -- Expiration: 19 i White copy: H.D. File s Non - Transferrable Yellow copy: Building Inspector Pink Copy: Owner I Orange copy: Well Driller, F Town of Patterson Highway Department P.O. Box 445 Patterson, N.Yi 12563 October 23, 1987 Mr. John Karell Jr., P.E. Putnam County Health Department County Center, Carmel, N.Y. 10512 Dear Mr. Karell: We have 'reviewed the proposed drainage work at the intersection of Newburgh Road and Lakeport Drive, as shown on Laurent Engineering Assoc., P.C. Drawing for: Cathy Stephens, and find it. acceptable provided the following isIncorporated: 1. 40 L.F. 24" ACCMP from the property line on Newburgh Road around the proposed well location. 2. The proposed ditch on Newburgh Road is minimum 18" deep, 2' bottom width, sloped sides and stone lined. .._..._...,.A.11.....the- _above .improvemen,ts to -be completed. -by. the- a-ppli•cant prior to receiving a C.O.. Very truly yours, 1 3 Mr. Donald B. Smith Highway Superintendant z 1 �r 1 / RANDOLPH W.LAURENT.RE. HARRY W. NICHOLS JR., P.E. September 04, 1987 LAU RENT- ENGINEERING ASSOCIATES, PC. -73- FAIRFIELD DRIVE PATTERSON, NEW YORK 12563 914.278.6108 CONSULTING SITE ENGINEERS Putnam County Department of Health 110 Old Route 6 Center Carmel, N.Y. 10512 Att: John Karell, Jr., P.E. Re: Proposed SSDS - Stephens Newburgh Road Patterson, NY 12563 Dear Mr. Karell: Enclosed are the following: to Three (3) prints of Drawing SS -21 "Proposed SSDS" dated 9 -04 -870 20 "Construction Permit for Sewage Disposal System ", dated 9 -04 -870 30 "Application to Construct a Water well ", dated 9 -04 -870 4e "Design Data Sheet" 5< Letter of Authorization ", dated 9 -04 -870 6, Two (2) copies of Residence Floor Plan(s), -for "Bedroom Count Only". 7. Check in amount of $100000 payable to The Putnam County Health Department. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Sincerely, LAURENT ENGINEERING ASSOCIATES, P.C. Harry W. Nichols, Jr., P.E. /map CC: Mrs. Catherine Lo Stephens w/1 copy each enclosures: I � --PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of. Located a t 1 AQ . (T) S� S_ T?Z5 .—Block rj, Lot JfO E2 Subdivision of Subdv. Lot # Filed Map # Dat.e- 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, Edu cation'Law, the.Public.He'a'lth Law, and the Putnam County Sani- tary Count P.E. , Alldress_ Very truly yours, Telephone Owner of Proper y Addres's On, - u, Telephone a. COUNTY DEPAFJ -MhtVT OF 1�111 - ll1V151UN Ur' - MV11t�UAL HhAUI -U br.KV1C- 'F.'S' /�/ 411/ /: �l:jfMaC�'1iii��' ' lq: ��' IOC17h. �M�l. �7a' �I: �e t��l \.`1�•:��1� \!�.'�4.'114��5!•'1 REVIEW SKEET - CONSTRUCTION•• PERMIT DATA BY: - owner) -- CCMMENTS YES, + r� �i require .0 Parelle _ r '� � �i! 0 �ocatron) _ . DOCUMEN'T'S Pemdt Application Corporate.Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth H Plans - Two sets e11 permit; PWS letter fiance Reguest GENMA.L Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Vetland (Tcwn /DEC Permit R & D) Data Cn DDS Plans & Permit Same •. REQULRED DETAILS ON PLANS Sewage System Plan - orth arrow) Sewage Systeu Hydra e - Gravity Flcw Fill Profile & Dimensions - Volune D or�x;Trench /Gallery; 't details Septic Tank.- Size, Detail / ✓ Well Detail, Service Line if over Construction Notes Design Data: perc and deep results Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter, Curtain Drains'(discnarge OK) Perc & Deep Holes Located Representative of prim:.ry and e- �-ansion _ Expansion Area; she vn; gravity size If Paned Pit & D Box Shcwn & Detailed House - No. of Bedroans Wells & SSDS's Win 200 . of Proposed Syst�ns Property Metes & Bounds •House Setback Necessary (Tight lot) House Sewer - 1 1/4" /ft. 4 "0; Type pice No Bends; IZA-aa. Bends 450 w /cleancut SEPARATION DISCvCES SrFCL" TED ON PT �N Field P.L., Driveway, Large Trees,Top of fil_ 20' to Fcu:_;t1 n Wal 100' to 4G�1; 200' i.n D.L.O.D, 150' pits 100' to Str 1m, a ercourse, e (inc. eKpar. 15' to Drai ^s- Curtain, Leader, Footing 35't0 catch basin, stormdrain,piped wateurs or 10' to Water Line (pits-201) 50' inte_nnittent drainage course Septic Tanks 10' from Foundation; 50' to w�11 • _ 15' Well to PL /117 6 f � -4, 9 AIX, 10 s/s SUBDIVISION Perc (3) Fil cd -11 1 -0 'COUN'T'Y DEPARII OF RMTH DIVISION OF ENVIROMMM HEALTH SERVICES DFsiGN'DAT1C*SHEET-SUBSUFACE SEMGE DISPOSAL SYSTEM -FILE, M. r 'r Owner TH Address 1 KA Located at (street), see. Bloc)c Lot (indicate nearest cross street) Municipality ovotz" q Watershe.1 SOIL P==ON TEST DATA REQI= TO BE SUBMTEED WITH APPLICATIONS Date of Pre-Sdaking � Date of Per-colation Test e- fez 237 C1= TIME PERCOLATION PERCOLATION Run i I 4apse, Depth to Water From Water Level No. f Time ; Ground Surface In Inches Soil Rate Start St8p Min. a Start Stop Drop In Min /In Drop Inches inches Inches 4• .5 4 2 3 4 5 Tests t6 bei 'rdp&ted' at same depth until apprmimately equal soil rates are cbtiined at each percolation test hole. All data to* be. m*mittt!d for review....., . Depth measurements to be made frcra top of bole. 1. I TEST PIT DATA SUBMITTED WITH APPLICATION )OUNTERED IN MEST HOLES ' . DEPTEI BOLE NO. BOLE IJOe '� e . __ SOLE No.. . GoLo - 2° 3 4° 5' 79= col 88. 9' • f . 10 , - 11' . 12' Y 131 r LxJ - 14'= - INDICATE LEVEL, AT WHICH GROUNI7KPiTER IS ENCOUNTERED �oJE- INDICATE LEVEL, TO WHICH F6,TAM LEVEL RISES AFTER BEING ENCOUNTERED DEEP BOLE OBSERVATIONS MADE BY ki , 'M, Z . DATE: DESIGN Soil Rate Used Min/1" Drop: S.D. Usable Area Provided' No. of Bedrocros Septic Tank Capacity 1,dDD gals. Type z1 Absorption Area Provided By '%DD L.F. x 24" width trench Other Nam �I,�i�j2'� dU . L f 2494? ZT_ Signature cc Address - f? SEAL r :; ; ; i Uj LU �� No. 56124 THIS SPACE FOR USE BY HEALTH DEPARZVM ONLY: \ FESS10 Soil Rate Approved sgo#/gal. Checked by Date f . 10 , - 11' . 12' Y 131 r LxJ - 14'= - INDICATE LEVEL, AT WHICH GROUNI7KPiTER IS ENCOUNTERED �oJE- INDICATE LEVEL, TO WHICH F6,TAM LEVEL RISES AFTER BEING ENCOUNTERED DEEP BOLE OBSERVATIONS MADE BY ki , 'M, Z . DATE: DESIGN Soil Rate Used Min/1" Drop: S.D. Usable Area Provided' No. of Bedrocros Septic Tank Capacity 1,dDD gals. Type z1 Absorption Area Provided By '%DD L.F. x 24" width trench Other Nam �I,�i�j2'� dU . L f 2494? ZT_ Signature cc Address - f? SEAL r :; ; ; i Uj LU �� No. 56124 THIS SPACE FOR USE BY HEALTH DEPARZVM ONLY: \ FESS10 Soil Rate Approved sgo#/gal. Checked by Date \G t !VlllAl[ CODIfR DWARnA !Q OF D RUM f `\ .0 a91�Ulw et ea�whl Bnll� 8�nker.'t��iil. N.Y. \n two to PCOM a C.�IIRCAIB OF. DOIID'IJAM i 'iawA"�L Sr P4 Oki V. _ o.r /��ro.et ii. C�r1Yf= T2 I YID E= L ',' ST �° p � Phi' s� '�...�"'— ■evlow. � Harp •Subdivis � - �. ion Avvroded :. � Fee •:Enclosed ❑ Amrnmt -� ' ' Depth value. [ale r i[ Deiee�a 3 a ` .Flew G P 'D ` elb Q e( Nel� b Wa1e4e6 F10 le as�iebd S�ue'r a r wain swptrl PdWk Sap* Fees Aare.. OdW S� ti 4 I �I i I _ _ .. .. ,. .. Spa. K DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y.' 10512 (914) 225 -3641 APPLICATION TO GONSTRUCT .A- WATER WELL PCHD PERMIT #P97--J> 7 WELL LOCATION Stre t Address to Town City- Tax Grid Number — 12—,13 WELL OWNER Name Mailing Address WPrivate D Public USE OF WELL Q_ primary 2 - secondary RESIDENTIAL CYBUSINESS 0 INDUSTRIAL 0 PUBLIC SUPPLY O FARM CIINSTITUTIONAL O AIR /COND /HEAT PUMP O TEST /OBSERVATION O STAND -BY O ABANDONED O OTHER (specify O AMOUNT OF USE YIELD. SOUGHT 2_;_gpm /# PEOPLE SERVED�3 -!; /EST. OF DAILY USAGE_4o REASON FOR DRILLING MEW SUPPLY O PROVIDE ADDITIONAL SUPPLY OREPLACE EXISTING SUPPLY ODEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE ®DRILLED 11 DRIVEN - ODUG DGRAVEL OTHER IS WELL SITE SUBJECT.TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: L1 Lot No. WATER WELL CONTRACTOR: Name T'$ ,j�,. Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: lIJ,,Pl' TOWN /VIL /CITY ''..- DISTANCE TO-PROPERTY FROM NEAREST WATER MAIN: 7/ l i LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED O ON REAR OF THIS APPLICATION J aON EPARATE E (d e) (sig ature) 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: / y 19 2 ''9 Permit Date of Expiration: 19 2z ssuing ffi a Permit is Non - Transferrable White copy: H.D. File Yellow Copy: Building Inspector 2/87 Pink Copy: Owner Orange copy: Well Driller I NN LAURENT ENGINEERING .ASSOC.IATES,.PC RANDOLPH W. LAURENT, PE. HARRY W. NICHOLS, JR., PE. Putnam County Health Department 110 Old Route Six Center Carmel, New York 10512 :.._ .. . . 73 FAIRFIEI_D DRIVE PATTERSON, NEW YORK 12563 (914) 278.6108 - (FAX) 278.2658 CONSULTING SITE ENGINEERS Atta Mr. William Hedges RE.- Proposed SSDS & WE11 - Newburgh Road Patterson, New York TM 55 -5 -12,13 Permit P -97 -87 Dear Bill: Enclosed are copies of the followings (a) Copy of "Construction Permit ", approved October 26, 19870 (b) "Application to Construct a Water Well ", dated August 26, 1989> (c) "Construction Permit" for renewal dated 8- 26 -89e (d) Three (3) copies of Approved SSDS plan. (e) Three (3) photocopies of "Approval" stamp. A Construction Permit was issued on 10- 26 -87, submitting the above to obtain a renewal permit. Thank you for your cooperation. Sincerely, LAURENT ENGINEERING ASSOCIATES, P.C. Randolph o Laurent. P.E. 87109 /map cc: Co Stevens w/ 1 each August 29, 1989 We are herewith t I SSE= /O W + /55.00' " a gc - ip0 LF Bl/ /LT D /HENS /ON -.. - .G'HART(, n FT. w _ 60 y. .1 Y% ITEM A B C D f 23:83 4 0. 75 rYPrcA�;A S TRENCH i000'GAG•.. 2: 41;00 3 SEP.ZIGTANK _ - 3> t. s o L/O PC 4. :7 A4, 78. 67 :400 _. . 92.58 80:00 Q c D - • °' � �:: • ,. y ..: - . ._ �- - GROOM , r ' 3 BE /O .:g4c75 zw z iT g - - _ ,. URGN ..ROAD `• 0 t