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BOX 13
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01340
Rev. . 3 86 eCONSTRI PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of En vironmental Health Services; Carmel, N.Y.1051Eeer Mdet Provide P.C.H D. Permit M CERTIFICA CTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM
_ Town or Village:
Located at a !r ✓ Ta Map a Block Lot — —
Owner /applicant Name r �4 9 ` o'rmerly Subdivision Name Subdv. Lot p
Maling Address ��C"0'"T ' `� `� z� ��—u 7. �p ���G —= Date Permit Issued
a! A f� .
Separate Sewerage System built by 1`r'�g "� • �tLe \ T �' Address S
Consisting of l d d U : Gallon Septic Tank and 32 I S. y.li 11111 T'►... t ,� c
Water Supply= Public Supply From / Address'
ors Private Supply Drilled by l Ha 4 S1I, i T,c_Ad
Building Type �`-e.� �Gf dh c 'v Has Erosion Control Been CompletedY�,/ ��
Number of Bedrooms _ Has Garbage Grinder Been Installed? , v a
Other Requirements
I certify that the system(i) as listed serving the above premises were constructed essentially as oho on the plane of the completed work ( copies
of which are attached), and in accordance with the standards, rules and re lations, do ecordanee.wi the filed plan, and'the permit issued by the
Putnam County tOepartment Of wealth.
Date -��T— Certified DY P.E. y R.A.
Address, ° ``ii License No. 1
Any person occupying' promises served by the above system ce
s) shall promptly take. such action as may be necessary to secure the correction' of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a pub," sanitary sower becomes
avollable and the approval of the private water supply shall become euil•.ind ,void when. a public water' supply becomes available. Such approvals are
'sublect to
modification or change when, in the Judgment of th, -commissioner of. Health, rovocatZoe;ltsoOWeatlon or'cnango is necessary.
Date
m
T
/ LAURENT ENGINEERING
ASSOCIATES, P.C._ _.
MILLBROOKE OFFICE CENTRE
Route 22 & Milltown Road
Brewster, New York 10509
RANDOLPH W. LAURENT, P.E. (914)278 -6108 - (FA)O 278 -2658.
HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS
February 4, 1997
Mr. William Hedges
Putnam County Health Department
4 Geneva Road
Brewster, NY 10509
RE: Individual SSDS Compliance
Maine & Victory Roads
Patterson, N.Y.
Dear
Enclosed are the following:
1. Four (4) prints of Drawing S -1 "As -Built Plan ", dated 1- 27 -97.
2. "Certificate of Construction Compliance for Sewage Disposal System ", dated 2 -4 -97.
3. "Guarantee of Subsurface Sewage Disposal System ", dated 1- 29 -97.
4. Well Completion and Well Log Report.
5. Water Analysis Report.
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.
Harry W. ichols, Jr., P.E.
HWN:bd
92047
cc: Mr. A. Krasniqi
NORTH AMERICAN
LABORATORIES, INC.;
LAB ID NUMBER:
CERTIFICATE OF LABORATORY ANALYSIS
97 -0543 FEDERAL ID NUMBER: 3903713
CLIENT: Arianit Krasniqi
3 Victory Rd
Patterson NY 12563
SAMPLING LOCATION: Kitchen tap
COLLECTED BY: A. Krasniqi
DATE COLLECTED: 01/24/97 TIME COLLECTED: 11:00 AM
DATE RECEIVED: 01/24/97
DATE OF REPORT: 01/27/97
ANALYTE RESULT* UNITS MAX CNTMT LEVEL ** METHOD ANALYZED
Total Coliform Absent
E. Coli . Absent
Must be "Absent" SM18(9223) 01/24/97
Must be "Absent" SM18(9223) 01/24/97
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:
ACCEPTABLE. _ NOT ACCEPTABLE.
Maryann Fasano, Assistant Laboratory Director
NYS ELAP #11218
CT Lab Approval #PH -0171
Underlined results are unacceptable according to health department and/or US EPA codes.
** Maximum Contaminant Level (maximum permissible concentration allowed by health department and /or US EPA codes).
618 Clock Tower Commons, Brewster, NY 10509 -9241 / 914- 278 -7600 / Fax 914 -278 -7754 / E -mail: NoAmLab ®aol.com
PUTIOPI•i CrJUbaY D�A?2MrENT OF HEkMH
DMSx0� OF ENVIRD'MiE CAL RFP.LTH SERVICES
1
q 1�
owner or Purchaser of B-ui ding
sal
Building Constructe/,d by /I
Location - StreeL
Section Block Lot
SLIbiivision N�q-e
c1 ��•G�iG� / Y � � •
Mxucirality Subdivision Lot
Bu i.lding TIpe
GoAa V'! ".GE OP SUI6SUP.F .0 - SE',Z-'GE DISP0a* -k , SYS r 1
I represent that I an wholly and campletely responsible for the loca-i ion,
cnr }�,G1 =hip, i-'aterial, construction and drainage of the sewage disposal syste_-,l
serving Lhe above descrii proresty, and. that it has -been constructed as show-n' oa
the anoroved -plan or anorov'ed. amendment. thereto,..and-. in accordance with the
standards, rules and regulations of the :Putna *M, County De_par -trent of Health, and
he-reby cur�ntee to tr•e crner, his successors, heirs or assigns, to place in go&*d
operating condition 'any part of said system constructed'by me which fails to
operate for a per_icd of two years i_rr:ediately following the date of approval of the
"Certificate of Construction Comoliance" for the sewage disposal system; or any
_.,recce rs :,ade by me `co- such..system, exceQt-whe_re--the-.failure to operate properly is
caused by the wi•llfu'1 or negligent act of the occupant.of the building utilizing
the sys tcm.
The undersigned further agrees to accept as conclusive the dete_=-mni_r-ation of
the Director of the Division of Sealtn Services of the-Putnam County
Department o= Health as to w,�ether or not. 1,_he failure oa: the system to operate was
caused by the willful or neglicent act o_ the occupant of the building utilizing
the systems.
Date fnis _�_ day of 19 Sicnature
Title
Caneral Co.n.tra.ctcr (Ce: -,- Y - Sianat;L�:e
Cow ration (if Coro. )
pa�k�ioc Sr N�'ce
Corporation Name (if Corp.)
P
�,Krjok /4x l �S(.�3
WELL COMPLETION REPORT office Use 01, Y
DEPARTMENT OF NEALTN
Division lit Envitonmental Health Services
PUTNAM COUNTY DEPARTMENT OF MEALTII —7 ie�<
•.nr_• .mmcce• n r WNW �- —_ _ _ -- .TAX GRID NUA+BER: -
WELL LOCATION
•
t c 50 2 S' .
.r3
NAME:
ADDRESS:
PRIVATE
O PUBLIC
WELL OWNER.
USE OF WELL
1 - primary
2 •secondary
RESIDENTIAL
0 BUSINESS
O INDUSTRIAL
PUBLIC SUPPLY 0 AIR /COND.IHEAT PUMP
0 FARM 0 TEST /OBSERVATION
tj INSTITUTIONAL O STAND -BY
0 ABANDONED.
0 OTHER (specify)
0
MOUNT OF USE
YIELD SOUGH gpm• /NO. PEOPLE SERVED / ESt.
T
OF DAILY USAGE _L 9a1.
REASON FOR
DRILLING
❑ EPLACE EXISTiNG SUPPLY
NG) $N
(GNEW SUP PLY DWELL []DEEPEN EXISTING WELL
CJADDITIONAL SUPPLY
WELD DEPTH
WELL
WATER LEVEL tt. DATE MEASURED
DEPTH DATA
0 ROTARY
0 WELL POINT
b QIR 0 DUG
0 CABLE PERCUSSION d OTHER (specify):
DRILLING
EQUIPMENT
WELL TYPE I tI SCREENED
Cl OPEN END CASING 0 OPEN HOLE IN BEDROCK 0 OTHER
TOTAL LENGTH,
CASING LENGTH BELOW GRADE
DETAILS DIAMETER
WEIGHT PER NOT
�CREEN bIAMETEA (in)
DETAILS FIRST
SECOND
GRAVEL PACK d YES GRAVEL
d Nti SIZE:
WELL YIELD .TEST II detailed pUtripinj
M 00: t] PUMPED 1 tests wtit done Is In-
CoMPRESSEO AIA ; lotmAlioH ittachedl
d bAlt_Eb 0 OTH0 0 YES 0 NO
WELL DEPTH DURATION BRAN10OWN 1�IELD
Z3d It. hr• min, it, 9Cm•
WATER CLEAR TEMP. -
OUALItY t1 CLOUCV 110ONESS
ti COLORED ANALYZEDI b YES b NO
ANALYSIS ATTACHED? tl YES b NO
PUMP INFORMATION
TYPE ' S14 A CAPACITY �-
MAKER bEPTN
MODEL VOLTAGEIP
MATERIALS: tYSTEEL 0 PLASTIC 0 OTHER
a N, JOINTS: 0 WELDED HREADEO . 0 OTHER
_
—In. SEAL: CEMENT GROUT 0 BENTONITE 0 OTHE
Ib./It, DRIVE SHOE YES d NO LINM: DYES 0
sl br SIZE LtNGtf (It) bEPTH to SCREEN (Itj DEVEIOPt 0�
ONES C] NO
HOURS
DIAMETER
Lop, 90Ti0ht
bF PAcx I�. I - -h. DE"H ____. n•
LOG 'It more detailed lorm>itlan descriptions or sieve analyses
WELL LOG are available, please attach.
DEPTH FROM waltf We11 paE
SURFACE Bear- DIa- tdomAboN bESCRIPTIDN
me+er
it It. Id
STORAG9 LANK! TYPt Z9` G_G19*V
CAPACItY GAS. d
WELL DRILLER NAME GATE
ALBERT M. HYATT & SONS, INC-
ADDRESS Well Drilling SIGNAWAE �1A
Rte. 311 R. R. 2 Box 111A
DATT r*P ;ON. NEW YORK 12563
gam—/ Sly /. —IM %� FM swum OW Dew /' 'vahisoo
Syaieas. " d Gam S.P*, daa
T? be by %7
Walile Ste: II ®,. Addiew
1 repravenGthat I em. wholly and compiatoly responsible for the detign.ared location • of tha propoSid . system(s); 1) that the separate saw di sstl�ste�m "
above dasa!ibed will be constructed as shown On the app!owed amendment thereto and in accordance with the standards, rules and regu o 'Tie I nom
County Department of IeaRh, and that on Complation,tharcof a .- Certificate of Construction Compliance- satisfactory to the Commissioner o/ HeaNhwill
be ".submitted to the Oapmrtniant. and a written guarantee will tie�"�furiiished the ownat, his s11ccswork hairs or assigns by the bulkier. that said builder will
place !".good opo.ating "condNidn any tpe►t, of said se rage disposal aysta during the period of two (21 yeas III me0lat following thedat's , the isal-
ance of the approval of the Grtificate, of Construction. Comp lance of ,th 'original system Of any `repsirs.the► o; 2) t he drilled well defera" above
wNl M "l0eat"0 as ahmiiw on the opOro'.0snand that said well will 0o inst 1 in accordion wNh t slandaI'd ule repu ha of the Putnam
County Oepartmant of "With
Date _ rrn Signad
U., oil �J 7'�,t1N'P i ' (License roe
<A-A-1_0
Address
APPROVED -FOR CONSTRUCTION This approval expir"a two y®aia'from the Aato 44d unless construction of the building ,has been undertaken and is
revOCaOki for cause or may be amended of modified When consid®red n6cdG r th .Commissioner. "of Health. Any change or alteration of construction
nequires a now peronit. Apprared : for disposal' of domostk saMtary, OF'
r- tuPpli�e► "
Rev. l/ �� �i . /��� ® TitlnC�
1088 Oat" c— =T
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
WELL LOCATION
Street Address
Village City
Ta/x� /Griidd/ Number
WELL OWNER
Name Mailing
Gd
pq
APrivate
O Public
USE OF WELL
1 - primary
2- secondary
RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP 0 ABANDONED
0 BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify
y
O INDUSTRIAL O INSTITUTIONAL O STAND -BY 0
AMOUNT OF USE
YIELD SOUGHT_ gpm /#
PEOPLE SERVED /EST. OF DAILY USAGE,12j gal
REASON FOR
DRILLING
O REPLACE EXISTING SUPPLY
WNEW SUPPLY NEW DWELLING
O TEST /OBSERVATION
13 DEEPEN EXISTING WELL
13. ADDITIONAL SUPPLY
DETAILED
REASON FOR
DRILLING
� Gt
WELL TYPE
I/MDRILLED ODRIVEN
DDUG
OGRAVEL
0
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name -72> Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES 7,e:�_NO
NAME OF PUBLIC WATER SUPPLY: ���� TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:_
LOCATION SKETCH & SOURCES OF CONTAMINATION P
qON SEPARATE SHEET
(date
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
Department attached to this permit.
3. Submit a Well Completion Report on a form
requirements of the Putnam County Health
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 rface or groundwater.
Date of Issue: *Z"Te-0y -2-1 19�r�'�
Date of Expiration 19. 4?jP*' Permit Issuing Official
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 .:
Date
Re: Property of�E1tf�,�i�.a
Located at /'1�A /.t, /F i�l�
;O A/ Section , 7 Block �. Lot 3'y
Subdivision of
Subdv. Lot # Filed Map # Date
Gentlemen:
This letter is to authorize_w"4y
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 with the provisions of Article 145 or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Cod
Counters
. , R.,
..
Very truly yours,
Signed�,�_L
Owner of Property
Telephone
Telephone
.6. Type of Project:
Ne, Private /Residential Food.Ser:vice ....Cor't'nercial ,
Apartments Institutional H6bile Home Park
Office Building Realty Subdivision Other (specify)
Y. Is this project subject'to �tate Environmental .Quality Review (SEQR)?
T oe Status (Check One) Type I.. Exempt
Type II. Unlisted.
8. Is a Draft Environmental Impact Statement- (DEIS) required? %lo
9. Has DEIS been completed and found acceptable by Lead. Agency?, fylZq
10. Name of Lead Agency -
11. Is this project in an area under.the control of -local planning.,* zoning,
or other officials, ordinances? .......................... t
12. If so, 'have plans been.suL;,nitted to such; author .sties ?.. ........: .........
._
• s
Q.- Has preliminary approval beep 'granted by such authorities? Date Granted:
c '
14' - Type of Sewage Disposal: System Discharge....... Surface water - ,Ground Waters
15. If surface water discharge, what is the stream class designation ?........
:6f Waters index number (surface) ....... ............................... ..
�. Is project located near a public water supply system? .................. /t0
°. If yes, name or water supply _ /V /} Distance to water supply SCI /,4
9: Is
project site near a public sewage collection or disposal system ?..... A/0
0: Name of sewage system �i /� Distance'to sewage system
1. Date observed: 23. Name of Health Inspector:
Project design flow (gallons per day) .....................................
�ll
APPLICATION
FOR APPROVAL
OF PLANS FOR
A WASTEWATER DISPOSAL SYSTEH
`1 : Name and Address of
Applicant:
�R�t.✓s-r��P
Ny fasn�
2. Name of Project:
�'�{o'o,5En
3.,_. Location ® /v /C :Qt�oi`
4. Project Engineer:
i� 1.✓_lf[iFiact�SS�.
,b�-
5. Address: Millbrooke Office Cent:
Brewster, NY IG509
License Number:_ �3l % Zy
Phone: (914)
278 -6103
.6. Type of Project:
Ne, Private /Residential Food.Ser:vice ....Cor't'nercial ,
Apartments Institutional H6bile Home Park
Office Building Realty Subdivision Other (specify)
Y. Is this project subject'to �tate Environmental .Quality Review (SEQR)?
T oe Status (Check One) Type I.. Exempt
Type II. Unlisted.
8. Is a Draft Environmental Impact Statement- (DEIS) required? %lo
9. Has DEIS been completed and found acceptable by Lead. Agency?, fylZq
10. Name of Lead Agency -
11. Is this project in an area under.the control of -local planning.,* zoning,
or other officials, ordinances? .......................... t
12. If so, 'have plans been.suL;,nitted to such; author .sties ?.. ........: .........
._
• s
Q.- Has preliminary approval beep 'granted by such authorities? Date Granted:
c '
14' - Type of Sewage Disposal: System Discharge....... Surface water - ,Ground Waters
15. If surface water discharge, what is the stream class designation ?........
:6f Waters index number (surface) ....... ............................... ..
�. Is project located near a public water supply system? .................. /t0
°. If yes, name or water supply _ /V /} Distance to water supply SCI /,4
9: Is
project site near a public sewage collection or disposal system ?..... A/0
0: Name of sewage system �i /� Distance'to sewage system
1. Date observed: 23. Name of Health Inspector:
Project design flow (gallons per day) .....................................
�ll
2.
25_.. Is State Pollutant Discharge Elimination System (SPDES) 'Permit required. b
26. Has SPDES Application been submitted to local DEC Office? ................
27. Is any portion of this project located within a designated Town or State
wetland ? .................... ........ ..... ............................... �j
28. Wetland ID Number ........................ ............................... ,-A/"I-A
29. -Is Wetland Permit.-required? ............ Flo
Has application been made to Town or Local DEC Office ?. ............... °... X/ /4
30. Does project require a DEC Strum Disturbance Permit? ................... AL
31. Is or was project site used for agricultural activity involving application
OT pesticide$ to orchards-or other crops, solid or hazardous waste disposal,
landfilling, sludge application or industrial activity? ........ YES 'or NO _ /i /ey
32. Is project located-within 1 -,OM feet of existence of abandoned landfill,
hazardous waste site, salt stockpile, landfill, sludge disposal site or
any other potential known-source of contamination? .....'........YES or N0.
DESCRIBE:
33. Is there a local master plan or file with the Town or Village? t
34. Are community water, sewer facilities planned to be developed within 15 years? &6
35. Are- any sewage, disposal areas in excess of 15p slope ? - ; ::. .... %a
36. Tax:Hap ID Number ......................... ............................... 2_5�%
37. Approved Plans are•tobe: returned to: ................. Applicant Engineer
If the applicationiis signed by a person other than tfie applicant shown in Item,1, the.
spplication must be-accompanied by-a. Letter of Authorization: Failure to comply with this
Provision may be grounds : for the rejection °of any submission.
I hereby affirm, under penalty of perjury.;- that information provided on this
form is true to the best -of cry knox7e-8ge and belief. Fa Ise sta'te,,ents made
herein are punishable as a Class A Hisder,eenor pursuant to Section 210..45 of
the Pena 1 Lair. _ , � n
>IGNATURES & OFFICIAL TITLES:
Millbro�? Office Cent
!OILING ADDRESS: Brewster, NY 10509
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
Harry Nichols
Laurent Engineering
Millbrook Office Ct.
Rt'. 22 & Milltown Rd.
Brewster, NY 10509
Dear Mr. Nichols:
BRUCE R. FOLEY, R.S.
Acting Public Health Director
April 1, 1996
Re: Proposed SSDS: Renewal of Lobroico
Maine & victory
(T) Patterson
TM #25.78 -1 -34
Review of plans and other supporting documents submitted at this time relative to
the above - captioned project has been completed. Comments are offered as follows:
1. The original plans were submitted by an engineer not associated with your
firm. Therefore plans, containing your stamp must be'submitted.
2. The original plans show 50% expansion area. 100% expansion is required.
3: P1 ens 'show a1T--restr'i (it ive, di stance, inoluding" minimum house set' back, 100'---
.to existing wells and direct line of drainage noted at a minimum of 200'.
Upon receipt of a submission, revised to reflect the above comments, this
application will be considered further.
Very truly yo
/William Hedges
Sr. Public Health Sanitarian
WH /jP
•
•
*Matins
,:aA
7 junction boxes
230 c. y. R. O.B. fill
30 cy. impervious fill
p e4-15-p0 dv 9J�9,
lb
propose
''A,REA! 0 21 CA s
OD
A,O
\5 85-24 -00 F
i
MAI ROAD -2
� a
o
exlWn9
\ R.O.B till
56jt 74 a IS
7-� impervious fill
16e.37' \-/4
/ a
Vi
6
h
Ly-
0
U1
Or-
M
Q
I r.G0
i
nl
till
n
7
Ly-
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W
a=
tz=
4
b
9. After completion of septic
system top dress
field
area with 3"
t
of topsoil and seed until
a good stand of
grass
has developed
10. Septic area to be kept a
minimum of 100'
from
any watercourse
11. Fill m;Jst be allowed to stabilize
for 60 to 90
days
following place-
ment and be inspected the
County Health Dept.
for acceptance,
prior
to the - installation of the
sewage system. Date of
placement must
be reported to . :the Health Dept.
12. Run of_ bank fill shall be suitable for sewage absorption, be free of
fines or other unsuitable material and shall have in -place percolo-
i tion rate at least equal to that in the natural soil offer the
required stabilization period. The engineer .shall perform a final
s percolation test in the fill after stabilization.
13. Impervious f4j, c(ay barrier, shall be a dense clayey soil with little
or no sewage absorption capacity
14. Zhe sewage system design shown hereon does not provide for install-
ation of a garbage grinder. Such installation requires the app-
roval of the Putnam County Department of Health.
SEPTIC DESIGN
prepared for
- MAUREEN LOBRIANCO
�u�lidW COuI>Ly Li' -` "I n��1tL VICTORY a MAINE RDS. SCALE:- 1= 40
Division of Enviror �^.�1: -.,
.S Inntal I +earth Services
A_o ro7 ci ass, TOWN OF PATTERSON 6/1/88
p rat d J. c - -r L
�t»?ic, k,jc. �11" a- orr -ance with PUTNAM COUNTY, N.Y. M `%� B
'utram �t ,r;a �'•e;nilatior�s of the
�Cou Iioaith Department.., LOTS A 869 — 8.90
��' FM 149 H
!01lIAll[ COUl11'Y DWARTUM ®F EIRALM
I(�Q siT Dew SassOoeo. a6. N.Y ➢BEY e.elm FtabN6e leasni
61 4 � l "- -=-- - -- — - - --- _ � ccAZS of �es_�
- -- - - - -
1,
an R ®.Ivafe DrMw by 'p M
otsa� t ::.�►�oAVrt tau
... , . � dispoYl system
I nprosant`tlidt 1 am wholly and- eompNtely rosponsiblo lor.the desgn and location •of t o proposed system(s); '1) tas. r le separate 1!M
above apore described -Will be,corlitiucted as shown on tht spprove0 amerWment there to and in accordance with the standards; rule; ano ate ns o— LIN ruinam
County Departnwnt, of "gelth, and that on completion thereof .a .- Certificate of Construction Compliance "' satisfactory to the Commissioner of MMiRhwill
be submitted to the Oopartment; and a written - guarantee will be furnished tM'ownp, his wcooseors, heirs of assigns by the builder, that said buildor will
place In fiMd .ogaratklg `conditbh :anY •part. of -1sI0 sewa4o disposal syfl®m AurfnO the porbd of two (2) yeMe Immediately following tMdate of tM, qew
anee of the approval of the Certificate .'of:Constructtoe' ;Compllance of the original'system or any repairs thereto; 2) that the drilled wall dos, ibed 660re
wo be located as-shosm on. the app►oired.I?pn and that Yid wall will n in rdance the rds, rubs and regu ns of the Putnam
county Deportmisk4f Mselth.
PIZ, PA.
Onto �
Addraa License NO
APPROVED FOP CONSTRUCTION: This approval expires two years from the date issued unless construction of the building .has been undertaken and is
roiroeaele for cause or may armnded or modified,when considered'necogmry by the Commissioner of HuIth. Any change or altoration of construction
requires a�� permit.. Appraved for.-disposal of doniestko Unit supply fl..:,a. /Or pr Mat® water supply only. y .
Rev. ws!�i ��— f"' Titles
14
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�.fZ
WELL LOCATION
Street Add ess Town V
%
e eity Tax Grid Number
- -�
WELL OWNER
Name Mailing Address
i
rivate
Public
USE OF WELL
0- primary
2- secondary
Bt RESIDENTIAL O PUBLIC SUPPLY
0 BUSINESS O FARM
0 INDUSTRIAL O INSTITUTIONAL
O 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 0 _7 _gal
O REPLACE EXISTING SUPPLY O TEST/ OBSERVATION CIADDITIONAL SUPPLY
KNEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
AM r
WELL TYPE
DRILLED
DRIVEN
DUG GRAVEL
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 W B +x�) . Address:
IS'PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES e!!�*_NO
NAME OF PUBLIC WATER SUPPLY: WIA TOWN /VIL /CITY
- DISTANCE TO PROPERTY. FROM,NEARE$T.,WATER MAIN: ./
LOCATION SKETCH & SOURCES OF CONTAMINATION D
Z f- �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 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 cs2 m' a urface or groundwater.
Date of Issue: 19- -!�7`�
Date of Expira on 19 Permit Issuing Official
Permit is Non - Transferrable White copy: HD File Pink c Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
0
V v N
h
� O C
y
pt v .n d
O
rP \ O O {
,y 04
.71 *o
v N Oti v
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1
PUTI\ M, COUNTY DEPARTMENT OF HEAI,..H
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date �1 eC.��:
Re: Property of m 2, � {�Pev2s L L, `-eu a—n
Located at oc".' E V L�N4 YC )�20 Ct CYS
(T) Sectiona_5,7a'' Block / Lot.
Subdivision of NA
Subdv.'Lot # Filed Map # Date - -
Gentlemen:,
This letter is to authorize Q
a duly licensed professional engineer " /K 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 sigh al-l- necessary papers on my behalf in
connection with thi's 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-
a
tary Code.
Counter "signed:
P.E.,., #
yv
O F�,
C/)Q' ° °.3 = �c 13
tx _111z'
Telephone
Very truly yours,
S i gn e d
Owner of Property
Address
Town
a7 " 7
Telephone
;r :..::,;ir ".:: :'t;.` '^� ;'S7C�S.:�'v- rJyl -, „i�lof�r�t1r.Y.J�a• ^.,r:'•-.:�w�:•;:.T•Jaj,`� ` iF`T°.�.'7rTTS�►p— 'r•y"_'r
PUTNAM COUNTY.DEPARTMENT OF HEALTH
Division of Envlrontigetst Hnealth Servic". Carmel, N.Y. 10512 Engineer to Provide Permit tl
i" on CERTIFICATE OF CO "TV-1
CONSTRUCTION PERMIT FO EWACE DISPOSAL.SYSTEM ; . Permit tl 7 g�
! f"«�rYffS�
Located at f ; L 5K - - Town or Village
Subdivision Name ubd. Lot tl $6q' 0 Tar Map Z Block Lot l y)
J_
1 Renewal— O_ Revlalon p
Owner /Applicant Name i `
Date of Previous App v&I
ili10.570E �4.
Mang Address �S rt . r . (,. r ..* t S r �) —, : Torn..:; _< r S ' f C : ---..: zip
Building Type Lot Area Fill Section Only Depth Volume
'
f'
Number of Bedrooms 3 Design Flow C P D V PCHD NotlBcadon to Required When FW Is completed
Separate Sewerage System to consist of X00 &Bon Se de Tank and 3l 5 7
To be constructed by t�AY:,.r�` Addreas
Water Suppy,: Publle Supply From 1 J Addmeo
or: Private Supply Drllled by _' ' Address
Other Reoulremente 23 J _` .., lC�« l I ?i l) (. �L _ l 'v / C t'
1 represent that 1 am wholly and com plelely responsible for the design and location of the Proposed system(s): 1) that the separate sewage disposal system
above des ibad will be constructed at shown on the approved amendment there to and in accordance with the standards, rules an regulations o • u nam
County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner Of Hailthwill
be submitted to the Department, and a 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 said sewage disposal system during the period of two (2) year% Immediately following thedate of the'issu-
ance of the approval of the Certificate of Construction 'Compliance of`tne original system or any repairs thereto -. 2) that the drilled well described above
will be located as shown on the approved plan and that said. we 11 will be installed in_accordarl:a with theFstandards, rules and ragula sons of the Putnam
County Depart nt of Health. j`'.- /h! - _
Date ��!(� Si ned ��- •- �Q,IL ". ": Q P.E. - R.A. — ,
' Z1? , r.f So�Vw -, /- /D ?79
APPROVED ' Address � � License No
APPROVED FOR CONSTRUCTION: ;This approval expires two years from the date issued unless construction of the building has been undertaken ",�'•���
revocable for cause' or may be amended or modified when considered necessary• by the Commissioner of Health. Any change or alteration of constrt
requires a new Permit. Approved for disposal of domestic unitary ie aye, anb /or_Ciivate •water su ply-nly.
1/87 Date _s- �, � � . � cr " (o BY ' ~ ^� %� Title •�•_
�_
LAURENT ENGINEERING
ASSOCIATES, P.C.
• JMILLBROOKE-OF'FICE Z`ENiRE' - -- - -
Route 22 & Milltown Road
Brewster, New York 10509
RANDOLPH W. LAURENT, P.E. (914)278 -6108 - (FA)O 278 -2658
HARRY W. NICHOLS JR., P.E. CONSULTING SITE ENGINEERS
June 8, 1994
Putnam County Health Department
4 Geneva Road
Brewster, NY 10509
ATT: Mr. William Hedges
RE: Construction Permit #P -52 -88
Maine & Victoria Roads
Dear Billi
With reference to the aforementioned project, on behalf of our
client, we request a renewal of the Construction Permit.
Enclosed are the following:
1. "Construction Permit ", application, dated 6 -8 -94.
2. Photocopy of the site and the signed plan.
3. Photocopy of the Construction Permit, dated 9- 22 -88.
4. Authorization Letter dated 6 -1 -94.
5. -- "Application to Construct a Water.Well ", dated 6 -8 -94.
Kindly issue a renewal of the Permit at your earliest
convenience.
Very truly yours,
LAURENT ENGINEERING ASSOCIATES, P.C.
Randolph W. Laurent, P.E.
RWL:bd
enc.
cc: M. Lobraico
. a0ovo�dpaibbd wnr'6s.e
CwintY pip►tntont ' 09,
.� `4u1wo1lfta0 to etem::a
titic+'i11 Ooe® otlwatyp
ilia of tIN awoliil �m1
amill M loo tod 4164
Ceunty �/' aetngllt o1 I
REV® '•2
;. -1Q/88 ...x.__.77
the
Sig,
I0/ n>Ni01ed whifll,COlIflOMtd McQbDrY Wtho
r' dIt�DOYI`o4 dOnitiftk sNlkid "BVDp
5
77 1
propond .tyiteomt�y` � theY'tl o aa" iaf® toad; Y Ldi ` i01° stern
aor6anae, awith the,;ta►ida►ds," ►ults e _ "►6itU p111.0 , nAln
Action Compliance" istisfactory to tM:Commistioewr o4 Mwlthwill':;
hi0`cps000s M11eOq ass6®its'.by Oho ®ui0dar ttlsf'aaid OuiWN api00
psrktd of tMVO (2) yea I►Nntedi0taaiY folliaaakt® tliidato ovttla i�ae -.;'
4ain'o► ®ny.'iepatta oto 2) the4 thi'drNhd aroll -doxvA abep®
noi. :wit t1t R ruWS .nd a0 rMurs of tho i�utnaan
x_ nT`�Y iSb3 ' t_kb ;moos
6 :unl®as eoeia}tructicn of tla® .BUaldklg jld S ba39n uedsvtakon' and H s
Onign 0lii0118I :09 F/OaRh.- .Any eMnp® Or•ahcret toW04 consLVUtt ion.
vaft ®.mater .supply only.
Title
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 0_2 -PC9
WELL LOCATION
Street Addr ss , To Vi lage City
Ok in ores -
Tax Grid Number
�. 7 - — 3
WELL OWNER
Name
� � p
Mailing Address
ra 1 �� T h U
n P�
Private/
/� O Public
USE OF WELL
1 - primary
2- secondary
RESIDENTIAL
9BUSINESS
0 INDUSTRIAL
O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O ABANDONED
0 FARM O TEST /OBSERVATION O OTHER (specify,
O INSTITUTIONAL O STAND -BY O
AMOUNT OF USE
YIELD SOUGHT gpm /# PEOPLE SERVED% /EST.
0 REPLACE EXISTING SUPPLY ❑ TEST/ OBSERVATION
DLNEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL
OF DAILY USAGE6gal
M ADDITIONAL SUPPLY
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
9 o
WELL TYPE
MR
DRILLED
❑DRIVEN
[]DUG
C]CRAVEL. 06THER
IS WELL SITE SUBJECT TO FLOODING? YES X' NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: /V7W
Lot No.
WATER WELL CONTRACTOR: Name 7-8-D Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES %C NO
NAME OF PUBLIC WATER SUPPLY: N% TOWN /VIL /CITY
'DISTANCE TO PROPERTY FROM NEAREST_ WATER MAIN:' ' 0'��
LOCATION SKETCH & SOURCES OF CONTAMINATION P
N SEPARATE SHEET
C Z2 [ 902--
(date) (signature)
PERMfT 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 p
During all well drilling operations, the applicant
any and all water or waste products from such well
property and in su a manner as not to degrade or
Date of Issue: �� -,,-1 19 7-e
rovided by the Putnam County Health Department.
shall take appropriate action to assure that
drilling operations be contained on this
otherwise contaminate surface or groundwater.
Date of Exp' tion 19 _7 �_7' Permit Issuing Offi
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
Date C( VIP ZZ "i ?Z
Re: Property of M Q 1.4 j--P Pv',�,
Located at (► `, o tM e- V L lr� cx R �YS
(T)�41 Section Block l Lot
Subdivision of NM
Subdv. Lot # Filed Map # Date
Gentlemen:
This letter is to authorize '� at /10 �(� L M1
v
a duly licensed professional engineer K 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, Education Law, th
tary Code.
@',
Countersigned:
r
P.E., ., #
F
v�cxtri�' o l��c d e
Addre�sss��
0-7 f-- 61ar
Telephone
blic Health Law, and the Putnam County Sani-
Very truly yours,
Signet
'oL:r � //"
Owner of Property
Address
Iq
Town
a;7 f
Telephone
i
• a
O nm
•�Q �1�14 N3 � n � nw
A q
a;
i y �
J , rW b
O W O
c 9 a C 41
to
a o n o 3 ti
U Q
• fir, y C El , 1
b.
an+• c
a� b
c°
ol
LU
I O/
i
: W C) fL F- U
Uf cr Ld d Z
• e, W
�• ° W d0N: fns
M I /300
_ J Yi T91 r
......... � . .... .._....... ._ `� 0.8 ..__... _01.1_. "...��. ".........: .. . _.........._..._ _._..___ __ :._..._..__.:
--7Cc
c I .. 1.?'' ��. ..•�.. 1�,..'i � � :'.:' ^R':; -� ..: ,.4:.„ +.n.�/[ ,rig �- y��y1'�►`� ..
vir
PUTNAM COUIYTY.DEPARTMENT OF HEALTH
\� Division of EnvlrouLnontad Health Services. Carmel, N.Y. 1OS12 Engineer to Provide Permit 0
on CERTIFICATE OF CO
CONSTRUCTION PERMIT FO EWACErr DISPOSAL SYSTEM?". ' /P�erml /i{t 0
Located at f J i t �tc 9d - i RJR I f f S f
ff pp Town or VUlage
Subdivision Name T"'NM- abd. Lot M t1 g69'��� Tax Map �Z Block— ' 3
t Lot $ 7
Owner /Applicant Name ��. h LJ 1 . tin f t� Renewal_ p Revlslon p
.
r• /+ Date of Previous AppJ�val `b,
Mailing Address �S n • w..�. t. er e t S t) Town C."," 1- f
7Jp_- /V 570q
Building. Type C P-'(-; :Nht.t, Lot Area 0-1-V (I rte- Fill Section Only v
y Depth Volume
Number of Bedrooms 3 Design Flew G P D 600 PCHD Notification is Repaired When Fill is completed
r
I�UO
Separate Sewerage System to consist of Clallon Se tic Tank and �7 S
To be constructed by_- A() 1:>( Address
Water Supply; Public Supply From Address
or: Private Supply Drilled by �1' �a'"_Address
Other Reaalremente 23 -`i • I ?i 1� (. V _ t w in r \t
I represent that I am wholly and compteI ely responsible for (he design and location of the proposed system($); 1) that the separate sewage dispo ssl system
above described will De constructed as shown on the approved amendment there to and in accordance with the standards, rules an requ a wn$ o e u nam
County Department of Health, and that on completion thereof a - Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill
be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the Duildar, that said builder will
Place in good operating condition any part of said sewage disposal system during the period of two (2) years Immediately following thedate otthe issu•
ante of the approval of the Certificate of Construction 'Compliance of !the original system or any repairs thereto; 2) that the drilled well described above
will be located as shown on the approved plan and that said well will be Installed in_gccordance with the"7tandard s, rules and r
County Departrj^ rat of Heait h. � . - -- I Ih( {{ ! equl& On$ of the i Putnam
Date f t3 /,� Si ned \�._ !'•.Q/t�.$�: . I Q
P.E. _ R.A.
I tt
Address Z1� ^�(f "^ �f. y f4 „V�)l� /(-�•' License No !
APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the building has been undertaken
revocable for cause or may be amended or modified when considered necessary. by the Commissioner of Health. Any change or alteration of tonsils /
requires a new permit Ap roved for d' I f
D o �sposa o domestic s_anita_ry -sew& e, and /or:Pfivate-water w.,pp y�nty.
Rev. ' t .�.-..
1/87 Date cc / 6 BY
r... ...
. .. „s �_- Title %�'
�i�li Yfra Lt 0 � 86i TozMer '° ,,�'•'
o..�i e�.. ' �1 _ L;�br�co De.ewd_ef- P SZ •.S� .�/,jy� ❑
2 %
Do" 4
Aiirr firth a wv. (,h....- l �¢7 — Tower f�l ew1 1�%�
Y
� ubdivision Aonroved_
12a�e S:..
�. �. .,.- :. Fee Enclosed ❑ Amntint ,
FM Seediss
Nt dr et Dinar Deaip Plsw G P 'D PCHD. b Whs b
sworn" S.w..p S�tllr a e rYtat -Z d Tali -
Ti M erhs>< Aduaa
wa.r $e!!b. PtYe stt�lb _Ff.... edaraN
1 /eoresent' that 1 am wholly anA'COmpMithy nsponsibN for ter dasiq and tion 3bf the proposal systom(q 1) tMt tfin separate »w di sal stem
above 4acri0id will im,constructed as shown on ter approved amendment than to and'.in acCOrslynca. with ter stindirds, rubs a requ- - ns of. m
f�oitMy.;Divsilritsitt„ of PMeKh;' artd.that on eotnpletio�,thaeof a gCatifkati of;donstruotign Compliance' �t(stactory to ter Cornmipbmr of MMlthwill
tie "submitted o-Ahe Q46wtr *d. Mew a written gpuarantw will tii furs t , his suc nsocirs. Mi►s or; assifins.by the'tluildar that said builder will
,kt " opliatkM oondltlon .ant ipart of . said�•sswa�e dis0o sl itm' tluil 'ter' pNfod.of two.(2) Y,eMS kintweiately followlritt tMdstk Of ter Hsu -
Ma 01 ter appro al of the CwtNkate of Contt►uetion,COmplianp o ter Ory ; 1 at or.an Ms tMiatos 2) that ter drilled "I descr,t" allow
wIN a IOeoteA as slioriiw on ter approved pNn and tnet f•W wNl will a insta in n with arwards; ruNS arul rqu�ai not �h} Putnam
COUMy OaM Of "/With. 1 •
pate 5, 'L � Signed. P.1 c._f2LR.A. -
;�- Address "�Z rY 19r.W /o�`Ot.WAIMNO (7V
r.
APPROVED f {OR CONSTRUCTION t.Thh Alkwowt expket;two yw ', fromah date iaued unless construction of the bui1dini'tws _been undertaken and is
toweasN iq. eOVso'or rnay,M,�merWdO or modified whm,ionNMied necowry, by ter d6inAiwo' nee, of Maaltn.: Any. oblige 'or; alteration of construction
.requires • n«ir Ohrmit. Approved fOr: dispoYl of domMk sanRiiy sewap. and /or prWata water suppy only.
ReV . .. ye--. - ,Q
10/88 OMe /�s.a� f my Jam` ` TitN
0
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 ##9_5_Z U
WELL LOCATION
`Sgtr et Address Town V
V c L 14 y 1s� �. C
lags City Tax Grid Number
0-111— pq _
WELL OWNER
Name Mailing Address
ice. �ia�cp , U .. C
A
rivate
_ 0 Public
USE OF WELL
1 = primary
2- secondary
RESIDENTIAL ® PUBLIC SUPPLY
® BUSINESS O FARM
® INDUSTRIAL b INSTITUTIONAL
O AIR /COND /HEAT PUMP
O TEST /OBSERVATION
O STAND-BY ,,
O ABANDONED
O OTHER (specify,
O
AMOUNT OF USE
gpm /# PEOPLE SERVE/EST. OF DAILY USAGE al
YIELD SOUGHT &V-k< D
17 REEJLACE EXISTING SUPPLY ® TEST /OBSERVATION O ADDITIONAL SUPPLY
Q I EW SUPPLY NEW DWELLING) ® DEEPEN EXISTING WELL
'REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
WELL TYPE
RILLED
®DRIVEN
®DUG []GRAVEL
OOTHER
IS WELL SITE SUBJECT TO FLOODING? YES -,-'NO
IF WELL IS Lf= IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
L„L EM 04f Lot No. $90
WATER WELL CONTRACTOR: Name °kO Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES �0
NAHE OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
'DISTANCE TO 'PROPERTY FROM" NEAREST WATER-MAIN:
LOCATION SKETCH_ &., AURCES OF CONTAMINATION PROVIDED
N SEPARATE SHEET
�o J
(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: � �i �� 19
Date of Expiration 19 -�� Permit Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
7 `777
CATKO CO
CERTM
Date ai
lie ploval
Maullsg�A" Town zip 10
Number Bedramus Fl?vi G P_131, ot!9eadon is Required When FIU
loot
to -by iL "q-. A S
Olthei Requirements'—
pr- tion.�of 'the pro I posed system(s); i) that-th46 seParati.'sawage disposal System
�.bblfa,de'scrii&,Bd' will be 00i%StrUcte�i is �1116Wn'on i6'sp6i6ve'd' a-'mWd m�enf!thire,to'_and in accordance wifii.tns'standirds;,.ru!� -of� the" Putnam,
it A H64 t
or
.D ldiaisi as sh&vn'o. in
Date
2N P
APPROVED FOR,CONSTR,UCT :This approval ex pares -two'years iiio- of -the buildihg. has. been undertaken and is
i/q7 Dot Title
=
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATION TO CONSTRUCT A WATER WELL
PCHD PERMIT
WELL LOCATION
Street Ad— d res G
Mi L
r Tot W age City Tax Grid 'Number
a(v
WELL OWNER
Name
Mailing Address ,
Q. k i_
rivate
O Public
USE OF WELL
1 - primary
2 - sedondary
('RESIDENTIAL
O BUSINESS
® INDUSTRIAL
O PUBLIC SUPPLY O AIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION
O INSTITUTIONAL O STAND -BY
O ABANDONED
O OTHER (specify
AMOUNT OF USE
YIELD SOUGHT bjtA a gpm /# PEOPLE SERVED, /EST. OF DAILY USAGESo�_ gal
REASON FOR
DRILLING
NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION
OREPLACE EXISTING SUPPLY ®DEEPEN EXISTING WELL
DETAILED
REASON FOR
DRILLING
WELL TYPE
®DRILLED
DRIVEN ®DUG ' OGRAVEL
®OTHER
IS WELL SITE SUBJECT TO FLOODING? YES 4 NO .
IF WELL.IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name kt 10t ;mv. Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO
NAME OF PUBLIC WATER SUPPLY: Q )T' TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM'NEAREST'WATER MAIN:
N
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
VO ON REAR OF THIS APPLICATION S TE SHEE
�
(date) 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 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. s
Date of Issue: ��z 19� �-
Date of Expiration: 19 �� emit Issuing fficial
Permit is Non - Transferrable White copy: H.D. File
Yellow copy: Building Inspector
Pink Copy: Owner
2/87 Orange copy: Well Driller
PLMMM COUNTY DEPAi TM Nr OF HEALTH
DIVISION OF ENVIPLNMENTAL HEALTH SERVICES
'BT MCE � S7WAGE DISPOSAL -SSI D SIGH DATA' SHEET- SL F= I ."
Owner a V LILeV� _Lo 6 r a 1 to Address V1 C6 1 Y df M41 me-
Located at (Street) IN irren Pyi Ve Sec."N11 Block I Lot
(indicate nearest cross street)
Municipality p - Watershed C'n,+an
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Date of Pre - Soaking l 0 t3 18 C Date of Percolation Test (0/1 66
HOLE
NUMBER CLOCK TIME
PERCOLATION
PERCOLATION
Run
Elapse
Depth to Water From
Water Level
No.
Time
Ground Surface
In,Inches Soil Rate
Start -Stop
Min.
Start Stop
Drop In Min/In Drop
.rte
Inches Inches
Inches
1 131.E 1339
ZL
?-4
3
2 1339 1+K'
34
4
3 141 S 14-f 1 3 G 19, y¢ 3 0 (" ff
J
5
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 suhnitted
for review.
2. Depth measure ants to be made from top of hole.
rev. 9/85
2
-
:.;_n
3
.rte
4
5
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 suhnitted
for review.
2. Depth measure ants to be made from top of hole.
rev. 9/85
TEST PIT DATA RDQUIRED TO BE SUBMITTED WITH APPLICATION
DESCPMPTION OF SOILS ENCOUNTERED IN TEST HOLES
-
DEPTH-. -- HOLE-NO.- �. - HOLE Imo:
G.L.
it
2'
3'
4'
5'
6'
7'
8'
9'
10'
11'
12'
13'
14'
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED �q;nca
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED " Rom. RA-6
DEEP HOLE OBSERVATIONS MADE BY: R►.T: DATE: (0 we 6
DESIGN
Soil Rate Used II- I. Min /1" Drop: S.D. Usable Area Provided 4-600''
No. of Bedrocros ` h re e Septic Tank Capacity gals. Type
Absorption Area Provided By _ 3 7-57 L.F. x 24" width drench
Other (Z -0.tP. E°sil � SeAI,- 6ao!� �'4'1i V d'k I® "PO-20 �2.t3i Ads!)
Name Signature -
JOHN H. PRENTISS. P.E.
Address RD9 FAIR S 914-879-9110 SEAL G
11 NEW YORK 10512
�0 ...292��0
THIS SPACE FOR USE BY HEALTH DEPAR21IENT ONLY: ` =�
Soil Rate Approved sq.ft /gal. Checked by Date
PUTNAM COMM DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENIAL HEALTH SERVICES
-.-.--DE91GN --DATA- -SHMD-SUBSUF
ACE SEWAGE
Owner Address 6 1
Located at (Street) Sec. Block Lot 3,1+,,
(indicate nearest cross street)
Municipaiity Watershed
Date of Pre- Soaking 5 }z, q3 Date of Percolation Test
HOLE
NUMBER CL= TIME PERCOLATION
PERCOLATION
Run Elapse Depth to Water Fran
Water Level
No. Time Ground Surface
In Inches Soil Rate
Start-Stop Min. Start stop
Drop In Min/In Drop
Inches Inches
Inches
2
—3 3� 2Lt
4 12- 0
5
61
2
3
/ 0
7, 2
3o
9
26
12-0
3
4
? �,0
61
2
3
NOTES.1 Tesl�s.',td' be repeated at same depth until approximately equal soil rates
�re`i b' ained at each percolation test hole. All data to' be submitted
,�--fdi'review.
2. Depth measurements to be made frcx► top of hole.
rev. 9/85
/ 0
NOTES.1 Tesl�s.',td' be repeated at same depth until approximately equal soil rates
�re`i b' ained at each percolation test hole. All data to' be submitted
,�--fdi'review.
2. Depth measurements to be made frcx► top of hole.
rev. 9/85
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION`
DESC PJ -PTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. HOLE NO. Z HOLE NO.
G. L. dGDyv,�
1' �\
j
31
4' a', k� �10�
6' �rk�
8'
9'
10'
11'
12'
13'
14'
- INDICATE LEVM AT Wriica GROrjlgDMTER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: J- pszx, 55 - W 4Arlgcs Dom: g�
DESIGN t2
Soil Rate Used S nnttMin/1" Droo: S.D. Usable Area Provided e�
No. of Bedrooms 3 Septic Tank capacity Poe gals. Type
Absorption Area Provided -.B 7 L.F. x 24" width trench
Other
Q�AICK
Name Signature
Address Z 21�'j r 54 _
SEAL
losib It
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: V'°ROFESStON��
Soil Rate Approved sq.ft /gal. Checked by _� Date
,a
e
Town of Patterson
Highway Department
P.O. Box 445
Patterson, NY 12563
(914) A78 -6130 or (914) 878-4341
Fax: (914) 878 -4379
FAX'fRANSM1SStON COVER SHEET
DATE:
To:
FROM: Melissa or Bill Burdick
StYWECT:
SHEET. IF 1'OL► UO NOT R .FIVE ALL THE PAGES. PLEASE CALL.
TO 39Vd Nnsmi1IVA Nmni RIFbAIRVTR AG:RS gRRT /b7/4A
GAEMER-- WYLBUR PAWLTWG.WY 9t4938tT88 P.01
F
Mw
On Monday. August 15. 1994, Maureen Lobraico, having been referred to our offfim by
Town Hall, contacted us to discuss two different problems which exist on properties she
owns In Putnam l ke. For both of these problems, she wanted the Town to take action to
resolve her concerns. I made 8rre498mettts to meet with her at 3:30 PM on Wednesday.
August 17 at the sites.
Subs®quently, the site visit was pertbrrned with I.obraieo. Commenta offered dwiug the site
inspection of each parcel are presented below:
I. RAM Drive bmptm
She reported_tbpt for the past 6,yeam 9 e -o as- owned several con�uows Iota at the Cornea
Of Warren Mvc and Summit Drive. Apparently, the parcels were purchased without
benefit of a property survey. More recently. she had a survey of the property made, as she
was plannft to market the property for sale. Once the Field survey was done, she found
out that the Town roadway actually has over a portion of this property. Labraic o provided
us with a Copy of the stuvey (Copy enclowd). She indicates that this problem is causing her
problems in her attempts to sell the property.
She believes that the Town should be responsible to rebate the roadway to the original
R.O.W. whore the road was intended to be. kIlowever, from my observations, the R.O.W.
Iles in extremely steep terrain, and probably Is the reason the roadway was actually
constructed wbete it exists today. She felt that, if the Town did not want to relocate the
rated. that there were two other options she would consider.
block it off the roadway, to prevent public access clteofth her property, or
have ft Town purchase the property from her.
I explained that all Putnam Lake roadways were constructed by private developers, and not
by the Town. The Town has only Me-Ptod maintenance responsibility for the roads actually
Rweived: 05/23/96 03:31:24 Vzrom: 9140551700
7A qn"A Nf1(--)471IWA KIWI G,If='bPl PhTC, PC:rP QrrTft,7fCP
GAINER- WIUDUR PAWLING.NY 9148551780 P.02
Town of Patterson August 18, IM
Highway Department - Lobraico Drainage Complaint Page 2
in place, and not for any 'paper" roads which may exist. Further, NYS "Highway Law"
allows the town to legally take as a public road any roadways which they have performed
maintenance responsibilities for at least 10 years. It would appear that this roRd was in its
current location for a long time, and so the, Town probably has a right to continuing to use
the roadway in its present location. Therefore, she couldif t legally block it oft; nor would
the Town want to purchase the property they already have rights to since this condition
probably exists in many locations throughout Putnam Lake.
She objected to this opinion, and then offered the opinion that the roadway was relocated
from its original location (within the R.O.W.) within the last 10 years. I said that I would
contact prior highway superintendents to clu* what work, if any, was done to relocate the
roadway. I also offered to review my understanding of NYS Highway Law with the Town
Attorney.
[From my subsaquent disausions with Big Burdkk he corn, med that the only work he did was
to pis ce gurderrail along the east side of the roadway adjacent to the intersection. Be was
certain that the roadway w= in any other location j.
M41111 M" I
She owns several (8 ?) contiguous lots along Sullivan Drive, and a rnefghbor owns an
additional S lots. Her interest is in combining these lots so that she can get an SSDS
approved for the combined property, and so agow her to sell the land as one legal building
lot. However, there is drainage from the 'gown road which is piped onto, her. property. and
this is iiiakiag "the entire parcel "wet" and so unsalable. She believes that the Towne should
extend the drainage along Sullivan Drive down to and across Zurich Road, and so relocate
the pipe outlet to the downstream intersection (beyond her property).
,Again, t explained that since drainage flows downhill, drainage along the roadway must have
historically ran onto this property (i.e.; was riot a "changed" condition that was cheated by
any action by the Town). Therefore, the Town probably has some right to maintain this
point of discharge of run-off from the Town roadway system.
Sha also objected to this position- Again, I said that I would determine, if possible, whether
the town has done any work in tuts location which would have changed drainage patterns,
and also discuss the matter with the Town Attorney to confirm our understanding of this
legal issue.
(Front my sesbsegtsent 4=5161U with RiN Bwdh * he believed that the only work that mlghr
have been done in this area ww to replat'e piping under the street. This would not have created
any new drainage onto her property%
Received: 05/23/96 03:37:28 PrcQu: 9188SS1780
PA ggvA wngNg1 ItA wmni r,/PbQi bTa MC!rO QrrT1t)7fC0
GAINER- WILBUR PAWLING,NY 9148551788 P. ®3
Town of Patterson Au pst 18, 1994
� ghway MPuftent -10braico Dratuge C:vm faint Pago 3
This concluded our Site visits. I later stopped at Lobraieo's office to obtain copies of tax
maps of cub parcel. I said that I would review these platters with the Town Attorney, and
subsequendly contact her to con&m the Towns position on each of these matters,
Reaeived: 05 /23 /96 03:37:24 ftcm: 9140551790
.c.
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05/24/1996 09:50 91487843713
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