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Home My WebLink About1808DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -5 -25 BOX 16 ti I Nis Ll IN, min 1 t *� ■1 , ■, ANN ,, �T . Lo ♦ .� . SITE LOCATION 0 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENIAL HEALTH SERVICES 40OPOSAL FOR SFWAGE-'DISPOBAL tkSTEk- REPAIR PHONE`l .20_, MAILING ADDRESS PC) PERSON INTERVIEWED PCHD Complaint ! Name & Relationship (i.e, ,tenant, etc.) DATE TYPE FACILITY PROPOSED INSTALLER REGISTRATION # lot (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original Different location may require submittal of proposal from licensed registered architect. PHONE sewage disposal system. professional engineer or �r 100c) >Y `3 11' 2Y t ,0 e -.. .e X u --2 vim. "4 GL l °,- e GL Proposal appr _ Proposal Disapproved Inspector's Signature & Title to Proposal approved with the following conditions:_ 1. procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed components tied to two fixed points (e.g. ,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diem. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, or reported agent of owner agree to the above conditions. SIGMaUREl i -ems �� TITLE LATE DP'S: Write MD); Yel]row (fin ED; Pink Allicizt) PC -RP 97 ir-a 04/22/99 08:95 Eh001 i +�► � o tee, � PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL ADDITION / REPAIR FORM SECTION A. GENERAL INFORMATION Name of Project DSO % Year of Construction �L Size of Parcel ?� SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. Mill Molling ❑ y d Steep slope e p Flat 2. ❑Evidence of wetlan ' ow areas subject to flooding odies of water DDraina'e ditches El Rock outcrops YES NO 3. Property lines evident? ❑ 4. Water courses exist on, or adjacent to parcel? 5. Existing individual wells within 200ft of the existing SSTS? SECTION C. EXISTING SUBSURFACE SEWAGE TREATMENT SYSTEM (SSTS) 1. Physical character of existing SSTS area. vel ntle slope osteep slope B. OWell drained Moderately well drained ClSome what poorly drained Choorly drained C. Area available for SSTS. (Primary & Reserve) ClEx'trernely limited OSomewhat limited dequate ft x ft L - .:_.:- ..s -.>^. -arm. :r._T.nswc- .�a✓:: was <:+�r - � :. �. .:... .- _v..��...•.•+. ..,. �. ... -. ..a..- n -_ —.. - _-. s. :m- . ^�.- rcr._..arx:.w�sn......_ �... _ .or.. .m.. r rr . .gym �.. D. INSPECTION Date �V Vr Inspector ONo evidence of failure ClEvidence of failure . mvide.ncd of seasonal failure -= - - - - -- - -- ..---------=------------------------------ (Indicate North) Y HOUSE I I ------ - - - - -- -- ----------------------- ;� ----------------- -------------------- ---------- - - - - -- Vs v (1) Indicate location of SSTS A. Size and type of septic tank � allons -- , Metal Con Plastic B. Type of absorption area . 1. Fields ft. 2. Pits 3. Gallies ft. (2) Indicate setbacks, front street, backyard, and side yard dimensions*-*-".- (3) Show location of well (4) Show location of driveway (5) Note physical features (steep slopes, rock outcrops, streams /wetlands) SECTION E. EXISTING WATER SUPPLY DPW ®Shared well Individual well o� Mrilled Dug ®Casing above ground COMMENTS ��L S A�" G4::�- C�-/,-z5- G' c�/< t - -1;7 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL Well Location: Street Address: Town/Village Tax Grid # 62 °1 o Map Block ";'- Lot(s) 2-'['- Well Owner: Name: Address: - c"(1c- a e.zout PO gop K12 r3 �ws�er- Use of Well: --- Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage _gal. Reason for _)L Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason ( e kk for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No _ C Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Lot No. Water Well Contractor: PP Address: Is Public Water Supply available to site? ................:................. ............................... Yes No _ C Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be ovided on separate sheet/plan. Date: ' e96-0 i Applicant Signature:. PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water• )el, driller certified by Putnam County. _ ' / Date of Issue /'03i Permit Iss ' icial: Date of Expiration Title: Permit is Non- Transf rra e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 0 PU TNAM COUNTY DEPAR'TMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT # s Wdv —Q Well Location: • Address: TownNillage Tax Grid # j ,(� � V Map 3 S- Block S_ Lot(s) -'- Well Owner: Name: Address: l _ 06 Well Type: Drilled Driven Dug Gravel Other Depth Data: Well Depth 2 5- ft Static Water Level ft late Measured Use of Well: K Residential Public Supply Air /Cond/Heat Pump Abandoned 1- primary Business Farm Test/Observation Other (specify) 2- secondary Industrial Institutional Standby Water Well Name: Address: Contractor: r (se C'\ Reason For Abandonment: e(��ce e act 0 k%' S We I Description of Work To Be Performed: ;scocn�ec� e %V %i4A �ovv, Ate, koLkSe. <.c N rY �:�• _ co ?" . Date: Applicant Signature: PERMIT Y This permit, to abandon one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code, Subpart 5 -2 of Part 5 of the New York State Sanitary Code and/or Part 75 of 10 NYCRR and provided that: Within 30 days of the completion of the abandonment of the water well, the applicant shall submit to the Department a certified statement that the ' rmation d lineated.on the application for this permit has been completed. Date of Issue Permit Issuing Official Title White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 40RETTA_ MQUNARI R.N.,_-M_.S.N. ` Acting Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 P.F. Beal & Sons, Inc 4 Putnam Avenue Brewster, NY 10509 Re: Proposed Well - Bezold 629 East Branch Road (T) Patterson 35.0 -5 -25 May 27, 2003 Dear Mr. Beal: County Executive On May 27, 2003, a field inspection was conducted. on the above referenced lot by Daniel Hadden, Public Health Technician. The application to drill a new well is approved with the following stipulation: 1. The proposed well location is within 15 feet of a property line. Therefore, the well location must be staked by a licensed New York State Land Surveyor prior to any drilling. As -built plan, Well Completion Report (WC -97), Well abandonment, if applicable, and water quality analysis shall be submitted no later than 30 days after the well completion by the permittee:,, Please contact the writer at (845)278 -6130 ext.2235 if you have any questions. Sincerely, nwmj &T Daniel Hadden Public Health Technician cc: RM, file J.F.M. ENGINEERING_ , INC. '440 : MAIN STREET RIDGEFIELD, CT .06877. noultria CM, 9u$ 2Q3 438 -9928 EngInnn FAX (203) 438 -0310 Sam Location Plan 629 East Branch Road, Patterson, NY. for Schoepp & Bezold Approximate Lot Area = 6 + acres Aiv Sc(3, c 5ySv•N.S C �nSer- AA'"' t001 . X\/ , SCALE: 1..40 P. LEADER:' P. ENGINEER: DRAWN Sr G@ J09 Na DATE 12 -11 -Ot X\/ Proposed 24' x 36' Barn 'PD- k.�k Ex 0' 0 �! isting Approximate 3 Bedroo Residence � Residenc Septic System ` Ex Well DRAWING Na SK1 REMSIO J DATA V ' i x All 'S- �O 7Q 160 --N �� o'b J� Q 1A) i 'v cF.A'C 6---' Mop compiled using 1938 Properly survey fo, M60 e Murray and field measurements Dislonces are shown far appro'imcle location purposes onry X BTooh BRIMST MTI IBI &0 A 0 x 745 BR-3 HAVILAND HOLLOW /Id' SDP -22 993 X BROWNS MTN -5 BR Qll X 756 L: PUTNAM LAKE BARNUM CORNERS i 241 �;F. ;R-9. X73 Lake Charles L: PUTNAM LAKE BARNUM CORNERS I -463=-. Lu X73 Lake Charles I -463=-. Lu