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DEPATMEPT OFHEALTH
REy. PUTNAM COUNTY . ,
Division of Environmental Health Services; Carmel, N.Y. A512 f
n Engineer Mast Provide
P.C.H.D. Permit q � • �✓'
RTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM.
h.
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aat_
Town or Village
Tax Map s•
Luca
Block Lot
Owner /sspplleaat Name s �' o vt Cy H trta c j t h Formerly
Subdivision Name' s rlc r f- Subdv. Lot
#
Mailing Address' l 60,"—:451
Date Permit Issued
Separate. Sewerage System built by Address
Consisting of " ; .: ] 0 o � : Gallon Septic Task and � `f �.
L � 2- j: r- +V,e•,, c
Water Supply: 'Public Supply From Address
Le
or: Private Supply Drilled by , C <. ( Addre R .
r
W �1r1 /lI f'1/�i Gl?,o . Hae'Eroelon Coattol Been Completed?
Ate'
Building Type P '`
..'�
Namber.of Bedrooms Has Garbage Grinder Been InetalledY_.
Other Requirements
I certify that the system (a) as listed serving the above premises.were construct Posen all no of a completed work ( copies
of which are ittabhed),.and in accordance.with the standards; rules and iegulati no in. a `c k. d the permit issued by the
Putnam county Department Of Health.
Date .
(rr y� _G� l� . • Certified ;by . Q P.E. R.A.
a Llcn NO. Addieu YQ Z ;p
Any person occupying premises served by the above system(s) shall promptly take such action as may be neCe secure the correction of any unsanitary
conditions resulting from such usage.•. , Approval of the separate* seweiage':system shall become null and void as soon a$ a pubtt: sanitary sower becomes
available and the approval of the .private water supply shall become null •and volt! .when a public water supply becomes available. Such approvals are
subject to modification or change when, In the judgment of the Commissioner of _Heo teh Revocation, modification or change Is necessary,
Date Y' ��— �! Title
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WELL COMPLETION REPORT
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
g.ot •#21 s '' obi ckt
Office Use manly');;
_
Mi ET AOURESS:
wN/ TAX SAID NUCASEA:
tkj WELL LOCATION
•.:. Steinbeck Hill Brewster, IVY Lot #21
WELL OWNER
NAME: ADDRESS: ❑ P81VATE
Crompond Contracting Corp ,Box451,CrompondyNY 10517 Q PU ®LiC '
x
USE OF WELL
19 RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEATPUMP O ABANDONED
1- primary
O BUSINESS O
FARM O TEST /OBSERVATION O OTHER (specify)
. 2- secondary
O INDUSTRIAL O
INSTITUTIONAL O STAND -BY O
MOUNT OF USE
YIELD SOUGHT
gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal.
REASON FOR
'DRILLING
[]REPLACE EXISTING SUPPLY OTEST /OBSERVATION ®ADDITIONAL SUPPLY =
:-
ANEW SUPPLY (NEW DWELLING) O DEEPEN EXISTING WELL
.DEPTH DATA
WELD DEPTH 225 rc. I
STATIC WATER LEVEL 40 ic.
DATE MEASURED
I
DRILLING
CIr.ROTARY Ck COMPRESSED AIR PERCUSSION ❑ DUG
EQUIPMENT
O WELL POINT O CABLE PERCUSSION ❑ OTHER (specify):
`=
WELL TYPE
O SCREENED O OPEN
END CASING ® OPEN HOLE IN.BEDROCK O OTHER
TOTAL LENGTH
__37,— tt
MATERIALS: 13 STEEL O PLASTIC ❑ OTHEH
LENGTH BELOW GRADE
_ __36 ft.
JOINTS: O WELDED . aTHREADED ® OTHER
CASING
DETAILS
DIAMETER . 5 in.
SEAL: D CEMENT GROUT O BENTONITE ®OTHER:
WEIGHT
PER FOOT
19 lb./It.
DRIVE SHOE: AYES ONO
UNER:GYES .0NO
SCREEN
DIAMETER (in)
SLOT SIZE
LENGTH (Iq
DEPTH TO SCREEN (it) DEVELOPED, :' ?
'
r...::
FIRST
0 YES 0;;
®ETAILS
-r
SECOND
HOURS
.:GRAVEL PACK
C3 YES
GRAVEL
DIAMETER .TOP
BOTTOM .
O NO
SIZE:
OF PACK in..
DEPTH IL OEP1It
:WELL YIELD TEST c It detailed pumping
EL� LOG
It more detailed lorm;tian descriptions or -stave aeal yses'.
'
MMOD: O PUMPED ° tests were done Is in-
tl�
are available, please attach.
DEPTH FROM
Well
El CO AAPRESSED AIR
°
Q formation attached?
SURFACE
Wafer
Bear-
Dia-
G. ®BAIL O OTHER ❑YES 0 NO
.
mete
FoRaAnoH DESCRIPTION
WELL OEM
IL
DURATION
hr. min.
ORAWDOWN
IL
YIELD
Suirace
20
D:Iilling
in overburden clay & bouldir
gFm.
H
t rock
at 20-l' =;
.-
<�
20
37
Di
111
ing in rock set ceise
7
225
bAill1ing
in rock granite.
>�rArEa o-cLEAIt
TEMP.
:..'
lIAUTY 0 CLOUDY
0 COLORED
HARDNESS
ANALYZED? O YES O No
>Rl Xtrol #250
ANALYSIS ATTACHED?
OYES. ONO
STORAGE TANK : TYPE ell
:� s�::
CAPACITY 4 0� &� =
r,`�-
xi�:r
1�UNP IWFORA9AT10P1
WELL DRILLERHAM9 P.F. Beal & Sons, ca
subm era ibleCAPACITY 7 �
Gould 180 °
dARtER DEPTH
- 7EHO3 12
4. Putnam Ave,
AooRESS sr�raTiIRE
Brewster, NY 10509
�: °.
bOLTAGE230 HP
.::ti3
..._ .. .. _
.___._... _.___..
.... .,.�
BREWSTER LABORATORIES
Box 224 - BREWSTER, N.Y.
(914)"855-1930
- WATER ANALYSIS REPORT -
SAMPLE NO.' 8429 TEST WELL
SOURCE: Compound Construction
Lot #21,Steinbeck Estates
Brewster, N.Y.
i
COLLECTED: ; 4/21/94
BY:; P.F. Ben]. & Sons
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method 0 per 100 mi.
PUTNAM COLUfY DEPART OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Owner or Purchaser of Building
Building Constructed by
Location - Street-
Municipality
Building Type
�-5 's— el" _�
Section Block Lot
G4-- % '0 -
Subdivision Name
Subdivision Lot #
GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM
I represent that I am wholly and completely responsible for the location,
workmanship, material, construction and drainage of the sewage disposal system
serving the above described property, and that it has been constructed as shown on
the approved plan or approved amendment thereto, and in accordance with the
standards, rules and regulations of the Putnam County Department of Health, and
hereby guarantee to the owner, his successors, heirs or assigns, to place in good
operating condition any part of said system constructed by me which fails to
operate for a period of two years immediately following the date of approval of the
"Certificate of Construction Compliance" for the sewage disposal system, or any
repairs made by me to such system, except where the failure to operate properly is
caused by the willful or negligent act of the occupant of the building utilizing
the system.
The undersigned further agrees to accept as conclusive the determination of
the Director of the Division of Environmental Health Services of the Putnam County
Department of Health as to whether or not the failure of the system to operate was
caused by the willful or negligent act of the occupant of the building _utilizing
the system.
Dated this day of 19 Signature <ti'UT
Title
General Contractor (Owner) - Signature
Corporation Name (if Corp.)
Corporation Name (if Corp.)
Address
Address
rev. 9/85
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PUTNAM COUNTY HEALTH. DEPT. .012 0
110 Old Rt. 6 Ctr. Phone 914 -225 -0310. PUTNAM COUNTY
i Carmel, New York 10512 EnviTOnmeat8l H h Servi / 9
Geneva d Rt. 312
I . 10509
„ Received of '
The Sum,aOf, y Dollar s.$
ep` \I
fill
MM
4",
. . . . . . . . . . p
neo - I /
Dcn� � ALIV-140
1, R-11MMM0- ad S.
C71 by
cab=, aoijztamamm
I ropreganilhot I am wholly and comptotoly r6sacinsiblo for tho dalligniand location of tho PrOP090d SYSI
above. 400scribod trill bo constructed as shown on tho 00provod ame ndmont thero to and in accordanco with
County Dopmwmt of HmOth,, and that On compkition thiar6of a "Cortificoto of Construction Complio
ft m0mlt" to tho DqjOrtment, aft a, tvrittbn Villiarontoo %401 bo furnishod tho ownc7, his euccomwiti,
ofto is C*W aWatkilo conditeen any port ,of mW bwoqo disporol sycitom.durina tho porW of two
00= of 110c; anmriiial of W Cortificitito of Construction Corn6flat►co of tho original systom or any roe
t7v0 IDO cacotcg 06 gum= 00.2fto app7ovC0 plan and that 616 troll will ba Installed irdan �Olwith tho
County epo W070 1400Ith.
Sioned
z d�te� (?'Or e 1'leelf��
I 1-1�
USION
Ate
69 Hoolthwill
d, builder will
to of the IMU.
IiWQKW 06WO
tho- Putnam
A.A.
61
APPROVED FOR CONSTRUCTION: This appr4val Qupiros two years from the dato issuod unless construction undertaken and is
'40�fttation of construction
rotlocablo for COUCIS) or may bo amondesi or modif" whon consid&od nocesmiry by the Commissioner of Health. 0 An�-
=Uiroo a w pew t.. Appr f disp000l of domestic sonitory,�56w d
aeo, and private tutor cupply only.
Rev. -
---- s ei!��
10/88 Tto
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
j (914) 278 -6130
APPLICATION TO CONSTRUCT A WATER WELL
PCHD PERMIT #f-1 ff'-n
WELL LOCATION
S re t Addref s To Vi age City Tax Grid Number
WELL OWNER
�?Name Ma' ling Address OPrivate
rasa'!. %�,� �!!i1 fre� Public
,01
USE OF WELL
1 - primary
2- secondary
i SIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED
D BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify,
D INDUSTRIAL U INSTITUTIONAL O STAND -BY O
i
AMOUNT OF USE
YIELD SOUGHT_ -' gpm /# PEOPLE SERVED _ /EST. OF DAILY USAG () Sal
O RE ACE EXISTING SUPPLY EI TEST /OBSERVATION G1 ADDITIONAL SUPPLY
131 SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
44 ,
WELL TYPE
M15iILLED
D
DRIVEN DDUG
GRAVEL. 0 OTHER
IS WELL SITE SUBJECT TO FLOODING? YES0
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: �
Lot No. ,
WATER WELL CONTRACTOR: Name AddressI'�
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES Q/ NO
NAME OF PUBLIC WATER SUPPLY: TOWN /.VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:
LOCATION SKETCH &SOURCES OF CONTAMINATION PROVIDE'' '�
N SEPARATE SHEET ��� �
C w
(dat Tom- ;r (signature) '
PERMIT TO CONSTRUCT A WATER WELL •
This permit to construct one water well as set forth above is
of Subpart 5 -2 of Part 5 of the New York State Sanitary Code,
thirty (30) days of the completion of water well construction,
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
granted under the provisions
and provided that within
the applicant shall:
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 4ma r,(as not to degrade or otherwise contaminate surface or groundwater.
Date of Issue: ; '/ C 19 - f <,
Date of Expirations 19 � Permit Issuing Officia
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
y
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PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date
Re: Property of
Located at - -'
(T) �� /f�a�Y��' Section_? Block Lot 3 C
Subdivision of pis ray, %� ✓'�����`
Subdve Lot # Filed Map # Date
Gentlemen: ' ?. .Anri!�eiPi
` ..: a Bedford, .N. Y. M46
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, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
� f
Countersigned:,
P.E., R.A., #
Address
. Y, 10546
t3eoforcl)
Telephone
Very truly yours,
Signed _ 0"
F` caner of Property
at ` /✓4c
X-
Addr6ss
Telephone
PMWO COUNTY DEPARTMENT OF
DIVISION OF 1' •' ' 1N Y• L HEALTH SERVICES
DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner (f 6� Address
Located at (Street) Sec. Block Lot Z /
(indicate nearest cross street) I
Municipality '�'�� u% Watershed -
• Y• • �• /• �I• • 1 III • • •
Date of Pre - Soaking Date of Percolation Test
HOLE
NUCER CLaY TIME
PERCOLATION
PERCOLATION
Run Elapse
Depth to Water From
Water Level
No. Time
Ground Surface
In Inches Soil Rate
Start-Sthp Min.
Start Stop
Drop In Min /In Drop
Inches Inches
Inches
1
2
3
4
5
2
4
5
1
2 i
3
4
5 --
I
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 submitted
for review.
2. Depth measurements to be made fran top of hole.
i
rev. 9/85
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES,
DEPTH HOLE NO.
HOLE NO. HOLE NO.
G.L.
1°
2'
3'
4°
5'
6'
7'��
8'
9°
10°
11°
12° - --
13'
14'
INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: DATE:
DESIGN -
Soil Rate Used l� Min /1" Drop: S.D. Usable Area Provided j 'Velo
No. of Bedroans Septic Tank Capacity /L f e-) gals.
Absorption Area Provided By L.F. x 24" width trench
Other �/ v
Nam Signature
Address r,: ,_. SEAL
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved sq.ft /gal. Checked by Date
Ci
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0
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59.12'
9
4
1. !P!N Ft?t.►ND
..LOT
2>
K�OD
® WELL. ,cto o
- -�-�+- - 4.6.72'
jA
B
C (7 NOTES
1
i 1
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1-7
10001 ,Pp c i
1 2
''f3
Y6
-3 60" 1
j 3
5o
S
7—
14
5$
s l
-3
s
iivision of Environmental Health Servicb.
_ 6
70
q
eH✓
- - -- -- --- - - - - --
e
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1 y 40 6
AN.D.R.�'A DRIVE
�Itih
�cwlc I� =io
3s 27 f
�ecr: C o,.+r vr/d ron /,,a C-/, n Lo.r Lo f W 2�
�Hlfers.h fir)
iFa nAf 'Ai q.rr �•1
o.'Yr:Ti7LE: �cJCv ✓X'1EOP�'J- }�L5`,�jLNI .
,,.M rICf- R -
porv.�? r�e�✓�: �.�
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17 14
:570AEJVC£
iell
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9
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100o5, t..p},', Ianl�
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12
iivision of Environmental Health Servicb.
_ Yo' 6
p
; >:ccved as noted for conformance with
3 vd
p llcable Vule^ and Re;nilations of the
1 y 40 6
utnam Cownty Health Dopartment.
-,-
F,t£4'tlllfl is tJ.p tri ,—
Mco•-
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"Tnis is to certify that
-
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the sewage disposal syst--n was constructed as indicated'04 this plan and
that the system was inspected by me before it was covered over. The
/ORILLHOL
system was constructed in accordance with all standard rules and
health the New York
FOUND
regulations of the Putnam County Department of and
1'58.00
State >poexbTeent of Health."
AN.D.R.�'A DRIVE
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�cwlc I� =io
3s 27 f
�ecr: C o,.+r vr/d ron /,,a C-/, n Lo.r Lo f W 2�
�Hlfers.h fir)
iFa nAf 'Ai q.rr �•1
o.'Yr:Ti7LE: �cJCv ✓X'1EOP�'J- }�L5`,�jLNI .
,,.M rICf- R -
porv.�? r�e�✓�: �.�
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.: '� •..._...r: �... ..FVi^• --• .... � St:� 'ice'` ,rit � ,,T� 'l 1�'. S_� �
PUTNAM CODPITY DEPABTMENT OF �ALTH
Divi�lou o[wh+oamgetalH ill& Sei vie: Caeme�l :;N.Y. lOS1? ' '� ProvWe Pormlt 1
afa CERM LATE OF CO
)lt.$EWA(iE1D L4POSAL,SYSTEM .
Separate $eM0me $yetem `110, 1M M or c Don sepHe Toll a"_: � ek-r- f OfJ TfL�n aas
�s
To be oon.tedcfed b? %J111N(LOft ��'tS 1�;' t—t Addie.r r 0. 66C T76 f ti,�nh B_l. f�l
Wsite; SoPPb. Pitblk Sapply:Fegm - 'Addreii
en .t� s pa named by pm A J4M
other' xeQt>,t�emeota
I represent .tMt;14 am wholly antl comDk+taly responsible for the tlaagn.and location of -the proposed systam(s);, i) that the, separate so'
ewage .dis offal system
aboye,dssciiDeA will bel onst►ucted as "shown on.the approved'ame�dment theie'to and'in �ccortla "na a with;the standards, rules an regulations or
e u nam
County Department of Health, and tnat'on completion thajr".f a 'Cerbf,cate 'of Construction Compliant'!. satisfactory to tM Commissioner of HultliwIll
be submittaq 'to the :Department, and a wr(tten'quaranbe. :wilt De; turnisheoi fhe owner his successors, heirs or. assigns by the Duikler, that Uld builder will
:ptac ,n .good operitiig coriditisin. any. part of `saitl 'seway disposal, sYfteni; during aM period of two,(2) Y.Nrs Immediately following tMdaq of the isw•
ante of the appoval' of. tk,cirtmcate of Construction* •Compliince of the' original., system or an ripairr t at that the drilled well deii0lbed above
will De located is shown ,on tM.ipp►oved plan and Chit aid wall will be install a secordanee ,with t e. stands ,� r and r u a�iions of the ' Putnam
County D"a It nt /Ii of yMNlth;
Date 7 �'��. / SgneA c P.E. R.A.
1
APPROVED FOR CONSTRUCTION This �� (��W -�.. �� fiXl, wsj - N IZ' Lice se No- 5�e'IZ4-
' A
ddrea n
approval expires two years from the_tla a issuetl unless construction of the building has been undertaken and is
revocable for cause or may De amended or modified wh- 'orisitle► nacesjary D .the COmrnisfi0 er Health. Any 'change o► alteration of construetio
requires a new- permit, ;. ADpr wed f0►, disposal._O, Aomestic�. fan, ai age, /O -Df .a 9w a pply only. -
87 Date-'... By Title
pF3io 6;?:g3,op�atbs40;a>ttlon,�iey .�Cdrt .o@'c`mk
0"..sE! oQ Hti9. eifJB o9 tte®`- .Cstti@lc&t ®; ®¢ Cvu
ems: E�o:O�¢0�1 mt'w oia tom° oia6i ¢im
_ Coto
APMOVED GOBI COPSTM SCTIC04S TV%% IWOM001
cramesbco ¢oR cava a or mor Do asiansim.or naoi0t@wal t
rQ3jtit70a O; low G99 6n14. 49ro�47 @or Aft=$ i
I REV
1O/8. 8 co - — — by
a: Aaroo4.ta "Cmtf@isoeo coB CoilatruCQlaica Coes�l6ta�¢o":et�ttu@ae8®dg to tho camp oimism r of me ottiltvill
ateo wild be'fu►nag9" tho off. dais taisoc wa. hobs iwamtans ®g too WIDOW. "tot tots lbeegar Will
> .ille®olil }YyG$ ui 6 fib; 2016 Dario® 04 two I8D two htiwic llot ®Oy 4 ®B6omkiq thoat® ® @.8010
Wi :;Com®01®,wso � t i•
of 4, or imi'syca- of JORY d0�ba21M37d q) the¢ th0 atrNk� WW doaciracs a)m
� w6910 caao"
aecor'96 cad¢h tho ctakard a, t3a w® u a of 2010 NtriDFJi
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W6 @roan dato iosuoit nsm co"muetion of QPoO_bultdm boo hEBarl uP0®OrtOk Ong Is
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by t Issionor of 6 mCk Any ehonipor onGiation or congructtan
07 ISpIv fly' d�
TWO
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 To
1� wn fity Tax Grid Number
��!ge
cr v z3Jf�
WELL OWNER
;Name
0"'a0,c
Mailing Addr ss
J. 4f � D &.,&kublic
Private
USE OF WELL
primary
- secondary
tjRESIDENTIAL
0 BUSINESS
,0 INDUSTRIAL
0PUBLIC SUPPLY ❑AIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION
0 INSTITUTIONAL O STAND -BY
❑ABANDONED
0 OTHER (specify
0
AMOUNT OF USE
YIELD SOUGHT gpm /4i PEOPLE SERVED 42 /EST. OF DAILY USAGE 9( () gal
i
:13 REPLACE EXISTING SUPPLY O TEST/ OBSERVATION 12- ADDITIONAL SUPPLY
ANEW SUPPLY NEW DWELLING 0 DEEPEN EXISTING WELL
REASON.FOR
DRILLING
DETAILED
REASON FOR
DRILLING
i
WELL TYPE
1ADRILLED
DRIVEN
DDUG
11
GRAVEL.
�
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES V NO
i
IF WELL IS LOCATE IN A %)REA TY SUB IVI ION, NAME OF SUBDIVISION:
u 11 Lot No.
WATER WELL CONTRACTOR: Name Address:
;
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES 1% NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: /4
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
!� WON ! SEPARATE SHEET
(date) (s ture)
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
thirtv (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 ake appropriate action to assure that
any and all water or waste products from such.well dr' ing operations be contained on this
property and in s qh /a- manner as not to degrade or r conta a surface or groundwater.
Date of Issue: 11A 19
Date of Expiration_; 19 ermit Issuing Of icial
Permit is Non - Transfer ble White copy: HD File Pink copy: Owner
3/89 1 Yellow copy: Bldg. Insp. Orange copy: Well Driller
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATION TO CONSTRUCT A WATER WELL �f
PCHD PERMIT
.WELL LOCATION
Street Address
FAAM 'Za lA-C W
Town �gi y' Tax Grid Number
rZD> PA-t 6ac.so,J N Po - 2- Z&, i
WELL OWNER
Name Mailing Address
1001VfU& t fl • KZS' T ✓, Ce, C r
P0, 60)c q-70' rivate
GAa-t4e L tiLl jo,51-2, O Public
USE OF WELL
0- primary
2- secondary
RESIDENTIAL 0 PUBLIC SUPPLY
13 BUSINESS O FARM
0 INDUSTRIAL O INSTITUTIONAL
Q AIR /COND /HEAT PUMP O ABANDONED
O TEST /OBSERVATION O OTHER (specify
O STAND -BY 0
AMOUNT OF USE
YIELD SOUGHT_ gpm /# PEOPLE
SERVED /EST. OF DAILY USAGE_00 gal
REASON FOR
DRILLING
VNEW SUPPLY
OREPLACE EXISTING
O PROVIDE ADDITIONAL SUPPLY ® TEST /OBSERVATION
SUPPLY 0 DEEPEN EXISTING WELL
DETAILED
REASON FOR
DRILLING
rg-66>
crz.
WELL TYPE
DRILLED
®DRIVEN
ODUG
®GRAVEL
OOTHER
IS WELL SITE SUBJECT TO FLOODING? YES K 0
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: - -rf_4'Jj15kc4e- P((t.J,
Lot No. 2l
WATER WELL CONTRACTOR: Name P� ", tea.
I U. bt`2'1 I.t. -t oti3C� � (!.) G Address ; f3 2f�•�v" S"�Z�- ..9s Li
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO
NAME OF PUBLIC WATER SUPPLY: fA- TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
[]ON REAR OF THIS APPLICATION 'N SEPARAT SHE
'79,P) , 11— �
(date)
(signjltte)
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 s.hall:
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 pro ided y th �Putnam .Co n ,
Health Departmen /t.r
Date of Issue:
Date of Expiration: t 19 �, ! ermit Issuing Official
Permit is Non - Transferrable Wh to copy: H.D. File
Yellow copy: Building Inspector
2/87 Pink Copy: Owner
Orange copy: Well Driller
Putnam County Department.of Health:
Division of Environmental. Sanitation.
AFFIDAVIT - CORPORATE OWNER APPLICATION.
j FOR PERMIT. APPLICATION SUBMITTED TO ..
j PUTNAM f-OURTY .1itALTH DEPARTMENT !
Tb: Commissioner of,. Health In :the, matter 'of application for
n t; �� 5 E �EGo�iYl �u 7 . �2�� � L-7fl
I J.� 7) e !O C��� •NT-� •a represent ;
that I am an officer or employee of.the corporation and ara authorized_..
to act' for
(name. of corporation)
having offices at .�E'QU-t� .;�,;, •�„l �'i/),p,�J oJ...,?�D ,_ ,�1��
Whose.• officers -are
President c loccc?..�,, i--� �,� L3�Ews7 Ci2-: _
??Jame anT•Address) ',
i •
Vice - President _�i}v 1 C1(o eC�� -71 ---------
�- C%
(Name and Address)
Secretary J� _ GLo:000 - s}vt7/ — G -- 2`•'- E— _ /- J�,_
(Name and Address)y
Treasurer
(Name- and Address) —
and that I am anp will be individually responsible for any or all :acts
ok the corporation with•respect to the approval r quested and all'sub-
-
sequot actt relating - thereto.• - '
Sworn to before me this // day Sinned
of 198' Title
1 .
-' otgry Public
ANNE B. COhRIDiN
• .. w� pro �' ; pq�m�-
Corporate Seal
I ..NOR'1[`H AMEI2gC'�N
ROUSING
28'
TWO STOftY
48'
SECOND FLOOR 4828= 1344SF
48'
1� 1
M. BATOR O
O
W.LC.
MASTER BATH
W /GARDEN TUB
I
t•T-f j
1
E- !
`ta 1
F1 Q
J
nom:_
til O —
f -'ti O 4�
TO O
fit, Ci . I=3 N
A a [=a
FIRST FLOOR 4828= 1344SF
ALL FLOOR PLANS AND ROOM SIZES ARE APPROXIMATE
NORTH AMERICAN HOUSING CORP./ (301) 948- 8500Do (301). 694 -9100 o (301) 4421 4 0
Plans, Prices And Specifications Subject To Change Without Notice Copyright 1985 (See Reverse Side)
BATH� ,_
'
I
BEO ROOMS
m
DRESS NO
BEDROOM ].
1]'-0" a 10-O"
L-1
.
1
t I - - '.F
MASTER BEDROOM
1T' -0a 16 B'•
BEDROOM 2
I .._ OPEN
a
1
STOOT
SECOND FLOOR 4828= 1344SF
48'
1� 1
M. BATOR O
O
W.LC.
MASTER BATH
W /GARDEN TUB
I
t•T-f j
1
E- !
`ta 1
F1 Q
J
nom:_
til O —
f -'ti O 4�
TO O
fit, Ci . I=3 N
A a [=a
FIRST FLOOR 4828= 1344SF
ALL FLOOR PLANS AND ROOM SIZES ARE APPROXIMATE
NORTH AMERICAN HOUSING CORP./ (301) 948- 8500Do (301). 694 -9100 o (301) 4421 4 0
Plans, Prices And Specifications Subject To Change Without Notice Copyright 1985 (See Reverse Side)
LAURENT ENGINEERING
ASSOCIATES, PC.
73 FAIRFIELD DRIVE
PATTERSON, NEW YORK 12563
914.278.6108
RANDOLPH W LAURENT. P.E.
HARRY W. NICHOLSI I JR.. PE. CONSULTING SITE ENGINEERS
I
I
July 11, ,1988
Putnam County Department of Health
110 Old Route 6 Center
Carmel, Ni.Y. 10512
Att: Joh;njKarell, Jr., P.E.
Re: Stei'nbeck Hill
Lot '# 21
Farm ;To Market Road
Patterson, NY
Dear John:
Enclosed are the following:
i
1. Four (4) prints of-Drawing SS -21, "Proposed SSDS -
Lot 21 ", dated 7- 11 -88;
2. 'Construction Permit for Sewage Disposal System ",
dated 7- 11 -88;
3. "Application to Construct a Water Well ", dated 7- 11 -88;
I
4. "Design Data Sheet"
5. '.Letter of Authorization ", dated 8- 11 -87;
i
6. Two (2) copies of Residence Floor Plan (s), for "Bedroom
Count Only ".
7. ,'Affidavit - Corporate Owner Application ", dated 8- 11 -87.
i
8. One hundred dollar review fee has been prepaid by
the developer.
We would ;appreciate your review, approval and issuance of the
Construction Permit at your earliest convenience.
Sincerely;
LAURENT ENGINEERING ASSOCIATES, P.C.
Harry W. Nichol Jr., P.E.
/map
CC: Mr. David Cioccolanti w /1 copy each
enclosures:
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date WCAUS-L 9 I , Iq a7
Located at �,U,(Z,P� --t "CD �- WZ((E< lao ,
(T) Section gjn Block Z Lot
Subdivision of
Subdvo Lot # -2- Filed Map # Date b �, 87
Gehtlemen: ;
This letter is I to authorize 4.AIZZY Gk -koLS , Ar-
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`wi.th the provisions of Article 145 or
1479 Education Law,�'the Public Health Law, and the Putnam County Sani-
tary Code
Countersi
P.E., R.A
Very truly yours,
MOA R o& f#6 (c-0 TS 1> /I�caP
Signed C
Owner of Property
Address
Address Town �—
(a `d\ _ � Cam, Telephone
Telephone
1
S�
APPENDIX B {ir).iw uv v -%..j
PUINPM CCLTft"' _ DEP_AR`IIMgT OF HEALTH - DIVISICN OF ENVIRCMMM HFALI i SERVICES
MTER SUPPLY &
i
REVIFW S'I'FT - CONSZ"_cCtTION PERMIT
(U---me pt Cwne-r) (Street Lccrtica)
c's
YES
I tM
I
I x
I
I
I
I
I i
J
t
I I
fil
I
60 ft. max.
Pirellel to ..ntours---
I
I
1 ----��
Fall, _ ' STEMS
c-laNpzrie
10 f t.
fill otesj
naY s
c_otn uce's
1
l
100 vr. f ccd elev.
I
I
i
200 ft. rese_Yvoir, etc. Lj
150 ft. trig'a11 /call.
n
I
DATE R�,vcT'D i
BY: t7 �--
DCC'i'S l
Pe-mat Application
Corporate Resolution
Plans - Three sits
Engineers P_uthorizaticn —
Design Data Sheet (DDS) SUB D SICK
Deep Role Lcg Perc
Consistent Perc Res,, .s (3) Fill
Perc Hole Dept's ca
HCLL�c PcI1S — Two Se�
Well „/ Permit;
Variance Re?uuest
-r T,
Leal S&division
K S �•r_sion Approval Cnecked
Ea-a_ rcval SSDS Pd-: Lots Che_k
wet ar-d (Tcw -n/DEC Pe-=ai t R & D)
Data Cn DDS Plans & Pe--nit Same
REQTj=K D= T c CN PUL S
SzFwa,e Sys tr-m Plan - (nor=e an_; . )
csjace Sy stern Hydraulic P_ or le - Grav i t_r F _;,,
Fill Profile & Dimensions - VciI Z
D or J Eox;Trencn /Gallery; _P=q, pit det:.ils
Septic Tank - Size, Der..: �l
well Detail, LS--rV1ce Line i= over
Ccnst:.ucticn Notes (grinder rte)
Design Data: perc and deep res�.s
Two4cot Contours F„i sting & Pr _ccsed
Drivevav & Slopes Out
Footin�Gatter,Ctilrtain Drains (discharge CK)
Perc & Deep Holes Loca=ted
Representative of prLnary and e -, ansicn
Expansion Area; shcw-n; gravity fle,,r, ssff ..size
If Pmved Pit & D Box Shorn & Detailed
House - No. of Bedroans
Wells & SSDS's w /in.200 ft. of Proposed Syst`-
Propel Metes & Bounds
House Setback Necessary (Tight lot)
House Server - 1 /4 " /ft. 4 1'0; T_�ce, pipe
No Bends; Max. Bends 45° w /cierout
SEP=ON DISTALNCES SPECIF= CN PLAN
Fields
10' to P.L. Driveway, Urge Tre°.s,Top of f;
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pats
1001 to Strum, Watercourse, Lake (inc. elc_a
15' to Drains- �iirtain, Leaser, Footing
35'to mten hasin,stom=' ain,oi d waterccur
10' to Water Line (pits -20')
50' int.=nittent drainacte course
Seot?c Tanks
10' from Foundation; 50' to we l!
15' Well to PL 9
RANDOLPH W. LAURENT, P.E.
HARRY W. NICHOLS JR.. P.E.
:;
...
LAURENT ENGINEERONG
ASSMATES, PCB.
73 FAIRFIELD DRIVE
PATTERSON, NEW YORK 12563
914.278.6108
CONSULTING SITE [ENGINEERS
September 6, 1988
Putnam County Department of Health
110 Old Route 6 Center
Carmel, N.Y. 16512
Att: John Karell, Jr., P.E.
Rea Steinbeck Hill
Lot #21
Farm To Market Road
Patterson, NY
Dear John:
Enclosed are four (4) prints Drawing SS -21 "Proposed
SSDS - Lot 21 ", revised 8- 25 -88.
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: Mr. David Cioccolanti w /1 copy
enclosures:
j Date: 5 -31 -91
To: ! Job No.:
Putnam County Health Department 8776
110 Old Route Six Center
Carmel, NY 10512
Attention:
Mr. Robert MOrris
I
Gentlemen: We enclose (4 ) copies of:
B/W Prints 0 Reproducibles
0 Specifications' 0 Memorandum
Project:
Steinbeck Hill - Lot #21
Farm to Market Road
Patterson, NY
0 Reports 0 Tracings
0 Copy of Letter 0
Description: Revision /Date No.
SS -21 "Proposed SSDS" Rev. 8 -25 -88
Construction Permit dated 5 -31 -91
Authorization Form dated 5 -31 -91
i
a
For ri enewal
i
Sent Via:
• Our Messenger 0 Blueprinter 0 First Class Mail 0 Special Delivery
• Your Messenger alland Delivery 0
Copy to: David Cioccolanti Very truly yours.
LAURENT ENGINEERING ASSOCIATES,P.C.
Per:
i Harry W. 'chols, Jr., P.E.
LAURENT ENGINEERING
ASSOCIATES, P.C.
73 FAIRFIELD DRIVE
PATTERSON, NEW YORK 12563
914.278.6108
CONSULTING SITE ENGINEERS
j Date: 5 -31 -91
To: ! Job No.:
Putnam County Health Department 8776
110 Old Route Six Center
Carmel, NY 10512
Attention:
Mr. Robert MOrris
I
Gentlemen: We enclose (4 ) copies of:
B/W Prints 0 Reproducibles
0 Specifications' 0 Memorandum
Project:
Steinbeck Hill - Lot #21
Farm to Market Road
Patterson, NY
0 Reports 0 Tracings
0 Copy of Letter 0
Description: Revision /Date No.
SS -21 "Proposed SSDS" Rev. 8 -25 -88
Construction Permit dated 5 -31 -91
Authorization Form dated 5 -31 -91
i
a
For ri enewal
i
Sent Via:
• Our Messenger 0 Blueprinter 0 First Class Mail 0 Special Delivery
• Your Messenger alland Delivery 0
Copy to: David Cioccolanti Very truly yours.
LAURENT ENGINEERING ASSOCIATES,P.C.
Per:
i Harry W. 'chols, Jr., P.E.
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Re: Property o
Located at
(T) v5- Section
Date S -3l —T%
Subdivision of )I'eL
Sir Bl o c k Y Lo t
Subdve Lot # Filed Map # Z Date 3 j 87
Gentlemen: J q�
This letter is to authorize OvYv
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, 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, the Public Health Law, and the Putnam County Sani-
tary Code.
Very
Sign(
Countersigned:
P.E., R.A., # 1D � 1
73 Fairfield Drive
Address
Patterson, N.Y. 12563
914 - 278 -6108
Telephone
Town
��4 1
Telephone W43---
1
2
3
NOM:
rev.
1. Tests to be repeated at same depth until apprcximately equal soil rates
are obtained .at each percolation test hole. All data to* be submittlad
for review. .
2. Depth measurements to be made from top of hole.
9/85
Name i l -y "4VT rzN'6j /Jrm4,gfv , - A -Ssec- P . Signature
Address 7 FAI n.r` r fib b O-A v C SEAL
No. 56124 ��.
p O
THIS SPACE MR USE BY HEALTH DEPARTMEW ONLY.*
Soil Rate Approved sgoft/galo Checked by Date