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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.31 -2 -51 BOX 18 �,yti ti � � . 01993 'r.,h. .pw..rnq� :mrt•'N'%L•'- .ertC.q. �r-vMi4"F;wt :Y.:..:.�;; ...�,ag, �..r, w. r:4l;C3 �'�T 4w ;�.. ,, i -: .. P {.. •:`4y`m vi.�'•). 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 S eet dress To 4. Tax Grid Number WELL OWNER am Mail' g A dress .0 d rivate :v r D Public USE OF WELL T- primary 2- secondary RESIDENTIAL O PUBLIC SUPPLY D BUSINESS O FARM 0 INDUSTRIAL O INSTITUTIONAL' O AIR /COND /HEAT PUMP 0 ABANDONED O TEST /OBSERVATION O OTHER (specify O STAND -BY O AMOUNT OF USE YIELD SOUGHT _gpm /# PEOPLE SERVED_j /EST. OF DAILY USAGE (%Q [j Sal REASON FOR DRILLING REPLACE EXISTING SUPPLY 0 TEST /OBSERVATION O NEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL GlADDITIONAL SUPPLY DETAILED REASON FOR DRILLING o �. �►/.r .. P P.-.m .sue is ,� o • , 1 0 `U /L r �s WELL TYPE DRILLED .DRIVEN []DUG []GRAVEL ❑ OTHER IS WELL SITE SUBJECT TO FLOODING? YES _ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: N Lot No. WATER WELL CONTRACTOR: Name 713 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _)C_NO NAME OF PUBLIC WATER SUPPLY: /U %/� TOWN /VIL /CITY ' DISTANCE TO PROPERTY FROM NEAREST WATER MAIN : over Z LOCATION SKETCH & SOURCES OF CONTAMINATION PROV MON SEPARATE SHEET (date) (si nature) 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 surface or groundwater. Date of Issue: �' Date of Expiration � 19 Permit Issuing Of icial Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 rx� S�� �i /� �� Yellow copy: Bldg. Insp. Orange copy: Well Driller £' � 0 — N�G, S R G m o - c ,K �Ol sUfl D c m z fn �27 rZm mpo T � II -011 c oD D 3 M Io � N m Z I �fN oz� -u 0 L "I N CZ o m rO {Dr � 0 o Qu • ,` r � ` 02 rib` m I m I. m� A II ° m o ,D 70 o 0 < 1 m fl T� �y A D N In / I I w n ,0027 ir_�026 /000s i.. 0 vl • OD �( ry I � /0024 N \ — N8 °26'�Jc7 °W R79.c73 N DANBURY � ROAD 7CD �C Ile R/F .AKIzA x ° GXl6Y• `daps —� I� � � � F 4 IL y OgERMAN I N/ F M F N DOZA F KLEIN r V-x1671NG WEw ` I Q (VACANT ) \ APP1COx. UX. r T. 3 �XISiING �- X\'� ?1� 2,5742.( V- A `V � Ktslv�NC� "s N n'F':'ri✓':.i r _ D° 09. 5150, Z . s } { J� SIT MOMKI TAX N PROJECT Pi2G PAM OWN OF CLIENT .N 15 °2a'5 °W- 15.55 i1 y S 8l° 34,0o W it - ;��'J' N t (AOAKIRVN N/F KOOSA Q \ APP1COx. UX. r T. 3 �XISiING �- X\'� ?1� 2,5742.( V- A `V � Ktslv�NC� "s N n'F':'ri✓':.i r _ D° 09. 5150, Z . s } { J� SIT MOMKI TAX N PROJECT Pi2G PAM OWN OF CLIENT /o?ol ,IU / ,1,0661 f30V Co / N /5. se /L on KE SHORE DRIVE F4 1. � ►Q 1.0 ► oc I} 3 Q JI N a I ► r[7uN0 AS SHOWN ON uTENTH MAP OF FUTNAM LAKE 11 FILED MAP# 149 L FILED 10 -30 -31 TOWN OF PATTERSON PUTNAM CO., NY SCALE 0 OULY. 28,1989 lT — e°za CERTIPIED TO COMMONWEALTH MORTC5AGE COMPANY OPAMERfcA Q LAWYERS TITLE (MS. COMFlAnfY FOR POLICY tt LTP 89- 1IF-�. CErnCllr A1'oOW,c7 ILIDICATE.D 44EZEos i -TFN,i Ur\14L7f�lol?17F� Al:lEPAT10Q CO AcOMOP.I -o-7 :. jLl4e:Y UA& FV-E PAVE n IQ .dccr�o41JCE Y1f7N "haE 5�.�/EY K �l �/IOL4T7oQ cF SE! -Tlol1 TZ[t3 c EXI5TTI,JG,•,C crc PfzdGT_ P:)O L,Al.lo 5U2�Wi Aoc> -ED 114F- "Ek.! -(OOV- STATE. 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CErnCllr A1'oOW,c7 ILIDICATE.D 44EZEos i -TFN,i Ur\14L7f�lol?17F� Al:lEPAT10Q CO AcOMOP.I -o-7 :. jLl4e:Y UA& FV-E PAVE n IQ .dccr�o41JCE Y1f7N "haE 5�.�/EY K �l �/IOL4T7oQ cF SE! -Tlol1 TZ[t3 c EXI5TTI,JG,•,C crc PfzdGT_ P:)O L,Al.lo 5U2�Wi Aoc> -ED 114F- "Ek.! -(OOV- STATE. EtOlx llai.l Lsuc1. e ( "711E LJEU -(00G '5 � A44OCJATOLI GF F�bFES<i10/.lAL Qtr 1PAJ.H, AY9-.SFiOk LAwo ,!qjm iE`(ozol, 4A,c> cEzT Rc- Arun.* SWAL...L a)Q ooLY AL-L AL-L Cle- -iP(:A"TTat- i 1,* -9-&j AZE. \14u C> R -ro 'WE. FEZ-$'O" F:tl-- \c.IWOM ThLc.5L'eve-( I-i POEFAZEO Aijo 1 4 K MAP AWD CnRE`i 7}IE.e- -=C- C1LILY IF '5AIc OU Nt<, eEkOA-F• -ro 1)4E. -rM-F- COAAPAJ -r( fwC> L.eXJc>IWG M&- CO- UEAV- '7NE MPo- -- %E > SEAL - tWerIT %-MC 1.1 L ASTLES> 4E2S0#J- c.E2:n97lCA- rlo1._Ie7 AYE LJCSr OF -n4F- sve\AE�-(oe tbk�o:,E. - 15iGxiATLgnF- APFEQ >ZQeL.F- -TO Ac;c To"AL IQ5TTt'UrOkJe7 Oe NE a.J• 5tJB5EJQVEI.li- oltll..l�.�S. H MAR VIN ¢ y OF _ O O 8.REWSTER ISAI BE "IL __ B- K o GAR P \ / � v 9A R��t C A R M E L 21 /gyp HIGH LA j¢ V 9aF,y F L A RD R rn a NpG EKE C C G < 9 RACK LA 4x0 m 2 Wppp LA CO L S / F zD 9 VALLEY Z RD 4,t SIR VARNA VA cGp� Qo y Z t- 0 -R D 0 ct�� ARTESIAN WELL CONTRACTORS Putnam Ave. Brewster, N.Y. 10509 [914] 279 -5041 March 2nd, 1992 Mr. & Mrs. Scott Roosa 10 Danbury.Rd. Patterson, N k 12563 RE: Well Site .10..Danbury..Rd. Patterson, NY Dear Mr, & M After lookin _.the. above---ad it could be i RMM: tb e� L osa, he proposed well site.at _we._ have- determined- .that. ccessible for our drill rig, S'ncerely, LL DRIL G,. NC, Robert'M. M 11 President DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 March 17, 1992 Mr. & Mrs. Scott Roosa 10 Danbury Road Patterson, NY 12563 Re: Variance Request Name: Scott /Roosa Street: Danbury Road Town: Patterson Tax Map: Lots 10024 -10028 Dear Mr. & Mrs.Scott /Roosa: JOHN KARELL Jr., P.E, M.S. Public Health Director Review of the submission for the above captioned variance request indicates the following has not been submitted to date: 1. Neighbor Notification procedure has not been satisfied as outlined in this Departments letter to you dated. March 13, 1992. 2. 'A professional engineer is to locate adjacent subsurface sewage disposal systems and submit a plan showing .their.location -with respect to your Ws-outlined you--dated - February 20, 1992. If the above is incorrect, or if there are any questions do not hesitate to contact the writer at ext 320. our s, V Robert Morris Assistant Public Health Engineer RM/jp PLITNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 110 OLD ROUTE 6 CENTER - CARMEL, NEW YORK 10512 (914) 225 -0310 A1pPL I CATION JT b ABANDON' "A WATER " WVL PLEASE PRINT OR TYPE WELL LOCATION• STREET ADDRESS TOWN TAX GRID NO. WELL OWNER: NAME ADDRESS Zee, ��' V P PRIVATE PUBLIC oa s � - �"� .�'-�AY1 — WELL TYPE: DRILLED DRIVEN DUG GRAVEL OTHER DEPTH DATA: WELL DEPTH ft STATIC WATER LEVEL ft DATE MEASURED USE OF WELL: RESIDENTIAL PUBLIC SUPPLY AIR /COND /HEAT PUMP ABANDONED rimary BUSINESS _ _ _ FARM TEST /OBSERVATION OTHER(specify) 2- secondary _ INDUSTRIAL _ INSTITUTIONAL _ STANDBY NAME ADDRESS WATER WELL CONTRACTOR: --r- p REASON _FOR ABANDONMENT: -- -rc� DESCRIPTION OF WORK TO BE PERFORMED: . �c�' �� . i� _ .b � rem a � c� ; ��iS �tii► � ua �'f% 11'e r. 0 DATE: -5 13 -q 2-- SIGNATURE 1"E1ZM I T This permit to abandon one water well as set forth above, is granted under provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code 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 information delineated on the application for this permit has been completed. DATE OF ISSUE PERMIT ISSUING OFFICIAL . Putnam County Health'Department Division of Environmental Health Services 110 Old Route 6 Center Carmel, New York 10512 I, the undersigne,d,- hereby- certify-that the abandonment of my -water well has been accomplished in accordance with the methods described in my application for a permit to abandon said water well. DAT.E.:. -.._.. :dSIGNATURE: PRINT NAME: ADDRESS: Returned as requested Please see me Read and return COMMENTS: i ! l "CATO AJ ! A40 7W O 0 04 At �Qeucy. . 7WAV ,r opoA s t1-d SCSI S vJ c 6 d�' Febuary 4, 1992 DEPARTMENT OF HEALTH Division of Environmental Health Services, 110 Old Route Six Center Carmel, New York 10512 Dear Sir: This would be our second to third letter requesting a variance. Unfortunetly our plans and other supporting in- formation was lost or misplaced in you're office. We were told that we would be on the January's agenda. When we arrived at the meeting on January 27th, know one had a clue who we were or why we were there. Yes, I am a little upset,.but I know you will work with me on this matter this month. My request still stands for a variance regarding an ad -- ditlon to my home. I was turned down by Robert Morris on ,__October 4, 1991. Reasons as follows. 1 seperation distance between my septic and well are ` ,approximately 60 feet, 100 feet is the required distance. 2. tj The expansion area for the existing septic system is not available. I was told to measure the distance of the neighbors septic _ and.: we,1;1�_fr.om..;our..:.p'opert T h a t_ . n_f O r.a.t i_o_r .a_so_.: o u'r _ survey. I was also told that I had to ask for a variance for 50% expansion for our septic. I really do not understand this process. We would just like to know if we can build a 100% expansion to our home. If this is not possible we would like as much of that percent quoted as possible. Thank You, Sincerely. ' JSR /lr r , r ' DEPARTMENTOFu�HEALTH Division OfEnviromental Health Services 110 Old Route Six Center, Carm.el, New York 10512 Dear Mr. John Karell: 1 1 ^ November 14, 1991 I applied for a building permit on September 12, 1991, and received a letter of denial from Mr.Robert Morris on October 4, 1991. His comments were as such: 1. The seperation distance of the well and septic are not up to todays standards of 100 feet. 2. The expansion area existing for the septic is not available. Therefore application is denied.- I understand that there is no room for expansion for the septic. It is the exist -in 9- sep-t-ic and well, so t lye re-for-e i-t-has -.a- re ason for not meeting todays standards. Unfortunetly, there is no room on my property to get the proper distance required. This leads me back to you and the Board of Health. I am "' - 'r'equest'ing "a 'vdtiancd for ari. expansion of -a- -100% to make my small 2 bedroom living space a little bigger. If the 100% expansion is not granted, we would be happy to hear a percent that is-close-as possible to our request. So, to close we are asking you to please put us on you're BOARD OF HEALTH agenda. We would appreciate a reply as soon as possible. Thank -you. Sincerely, /1 SR /lr 1 iL x. I. : 1 1 v 1 I � 1 • 1 . 1 - , : , J .. i I 1 j � 1• , I r' 1 I` , 1 , I- --j-- A 10 lil 42, , I -J- -1 - - - - --F -FiF - - - -- I - - -- - - I I , 1 DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 February 13, 1992 Jeffrey Scott and Lisa Roosa 10 Danbury Road Patterson, NY 12563 Re: Variance Request Name: Scott /Roosa Street: Danbury Road Torn: Patterson Tax Map: Lots 10024 -10028 Dear Kr. Scott & Ms. Roosa: JOHN KARELL Jr., P.E., M.S. Public Health Director Please be advised that a request for a variance from certain provisions of the Putnam County Sanitary Code has been placed on the agenda for the next meeting of the Board of Health to be held on February 24, 1992 at 7:30 P.M. in our Health Department Conference Room, BOCES Complex, 110 Old Route 6, Carmel, Nev York. - You or y_ our representative must -attend the meeting to present your case. You are referred to the attached 'Neighbor Notification' procedures vhich must be satisfied. Ve y tru y yo rs, n Karell, Jr. , P. E. Public Health Director JK /jp For: The Board of Health cc: JK File I. DEPARTMENT OF HEALTH Division Of Environmental Health : Services 110 Old Route Six Center, Carmel, New . York 10512 (914) 225-0310 February 28, 1992 Jeffrey Scott and Lisa Roosa 10 Danbury Road Patterson, New York 12563 Re: Proposed Addition - Scott and Roosa 10 Danbury Road (T) Patterson Dear Mr. Scott and Ms. Roosa: F. JOHN KARELL Jr., P.E. M.S. Public Health Director You are hereby advised that your request for a variance from the provisions of Article III of the Putnam County Sanitary Code and the standards of the Putnam _ ... __.County _.Health -Department - _relative - -to .- the__ design __of__.a. -sub surface -sewage _disposal_ ___ system to serve the above captioned addition has been considered by the Putnam County Board of Health on February 24, 1992 and denied for the following reasons: 1. The proposal does not meet the standards for design and construction of sewage disposal systems in effect this day, specifically the requirement to: "Provide 'a subsurface sewage disposal area of sufficient size and 100 foot separation distance between a subsurface sewage disposal area and well:' The existing well and subsurface sewage disposal system approximately 30 feet apart. 2. It is the opinion of the Board that the approval of the requested variance from design standards would constitute a potential public health hazard. 3. A hardship has not been demonstrated that overrides the public health issues. Ver tru ou c Sara McGlinchy President, Putnam County Board of He lth SM:pt cc:Local Building Inspector, Town of Patterson Carl Lodes, County.Attorney ��Atll Cp � 4 JOHN KARELL Jr., P.E. M.S. Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 Date February 24, 1992 Applicant Name Scott - Roosa Address nnnhiirg Road Property Street Location (T) Patterson Tax Map Designation Municipality Patterson (S) Variance Request Ex-tsting well to SSDS diAtance ± 30 ft. Applicant proposes to add a two story addition. to.. the house._, No room is' available -to `expan:d the,SSDS-.- -The proposal - ..does noa new well. It does not appear that a well can be drilled to significantly inckease'Ahe well to SSDS separation distance. Approved Denied X Conditions /Remarks: Potential health hazard due to proximity of wells and sewage nraa_ DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 February 13, 1992 Jeffrey Scott and Lisa Roosa 10 Danbury Road Patterson, NY 12563 Re: Variance Request Name: Scott /Roosa Street: Danbury Road Torn: Patterson Tax Map: Lots 10024 -10028 Dear - - Mr.. Scott . -A Ms._- ".Roosa: 0 i JOHN KARELL Jr., RE, KS. Public Health Director Please be advised that a request for.a variance from certain provisions of the Putnam County Sanitary Code has been placed on the agenda for the next meeting of the Board of Health to be held on February 24, 1992 at 7:30 P.M. in our Health Department Conference Room, BOCES Complex, 110 Old Route 6, Carmel, New York. you 'or y-our-repr2sentative must attend the meeting to present your ' caee. You are referred to the attached "Neighbor Notification"' procedures which must be satisfied. - Ve y tru y yo rs, n Karell, Jr., P. E. Public Health Director JK /jp For: The Board of Health cc: JK File r DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 Re: Name: Street: Torn: Tax Map: Dear--Sir: -- -- - Variance Request Scott /Roosa Danbury Road Patterson Lots 10024 -10028 JOHN KARELL Jr.. P.E., M.S. Public Health Director Please be advised that a request for a variance from provisions of the Putnam County Sanitary Code relative to the construction of a sewage system and well proposed for the captioned property which is contiguous to your property, will be heard.by_ the Putnam County_..Board of Health on February 24,.1992 at 7:30 P.M. in - -our - Health --Department- Conference' Room,` 'BOCES Complex, -110 Old- Route '6, Carmel; Her York. If you have any questions, concerns or information which may bear on our deliberations, you may appear at this meeting or contact the writer at Ext. 324. Because scheduling sometimes are modified at a late date, if you are planning to attend this meeting you should contact the Department on the day of the meeting to assure that this item is still on the agenda. /Johnry tru your Karell , Jr., P. E. Public Health Director JK /jp For: The Board of Health cc: JK File DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225-0310 BOARD OF HEALTH VARIANCE REQUESTS NEIGHBOR NOTIFICATION JOHN KARELL Jr., P.E., M.S. Public Health Director Beginning January 1, 1989 appeals (petitions) requests to the Board of Health for a variance from provisions of the Putnam County Sanitary Code will not be heard by the Board until such time as the Director of Environmental Health Services of the Department of Health is provided with proof that notification of the date of the "variance hearing wa"s --made to all- property owners contiguous -to -the property in question. A location map with contiguous properties shown along with the property owners name and Tax Map # must also be provided to the Department. Notification shall mean receipt by each contiguous property owner and the local ..municipal Building--Inspect-or of--a -co .of .the:- attached: notification fo=--alon with a copy of the latest site plan and letter requesting variance. (see item -1 (a) (b) (c) in "Procedure for Variance Request ". Proof of receipt of notice by contiguous property owners and the Town official can include either of the following: 1. Copies of registered mail receipts 2. Copies of the notification form signed by the contiguous property owners Notice shall be made at least 7 days prior to the date of the meeting and no earlier than 21 days prior to the meeting. Failure to provide the Board with adequate documentation of the performance of the notice may result in the Board delaying action on the request until proper notice is executed. The proof of notice shall be submitted to the Director of the Division of Environmental Health Services on or before 2 PM. on the day of the hearing. JK:pt 10/91 JOHN KARELL Jr., P.E., M.S. Public Health Director . DEPARTMENT- OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225=0310 October 4, 1991 Jeffrey Scott and Usa Roosa 10 Danbury Road Patterson, NY 12563 Re: Proposed Addition - Scott & Roosa 10 Danbury Road (T) Patterson Dear Mr. Scott & Ms. Roosa: 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. Separation distance between well and septic is approximately 60 feet, 100 feet is required by today's standards. 2. Exzpansion area for the existing septic systeml 100 feet from the existing is not ava-i-lable.. In light of the foregoing, you application is hereby denied. It is advised that the proposed addition is revised to meet current standards. I may be reached at ext. 320 to discuss this possibility. Robert Morris Assistant Public Health Engineer RM/j p I DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 February 28,.1992 Jeffrey Scott 10 Danbury Road Patterson, New York 12563 Dear Mr. Scott: P JOHN KARELL Jr., P.E., M.S. Public Health Director Re: Variance Request: - Scott - Roosa, Tax Map: -Lots 10024 -1002 Location: - Danbury Road, Patterson,,NY On February 26, 1992, Mr. Morris of this office reinspected your-property as a result of discussions at the Board of Health Meeting on February 24, 1992. Mr. Morris' inspection indicated as follows: 1. There appears to be subsurface sewage disposal systems located with 100 feet of the suggested well location in the upper corner of your.property. - . 2'. " T "t `dues not "'appear" the upper area -is i cdessible'-tb "it well' drilling If you wish to pursue this matter further, you should: 1. Hire a professional engineer to locate adjacant subsurface sewage disposal systems and submit a plan showing their locations with respect to your. proposed well. 2. Have a well driller inspect your property and advise the Department if the area is accessible to a well rig. If you have any questions, contact the writer at Ext. 324. Ver tr ly yours; hn Kar AR. VA. . ublic Health Director JK:pt DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 February 28, 1992 Jeffrey Scott 10 Danbury Road Patterson, New York 12563 JOHN KARELL Jr., P.E., M.S. Public Health Director Re: Variance Request: - Scott - Roosa, Tax Map: -Lots 10024 -1002 Location: - Danbury Road, Patterson, NY Dear Mr. Scott: On February 26, 1992, Mr. Morris of this office reinspected your-property as a result of discussions at the Board of Health Meeting on February 24, 1992. Mr. Morris' inspection indicated as follows: 1. There appears to be subsurface sewage disposal systems located with 100 feet of the suggested well location in the upper corner of your.property. •-•2-r-- -- It --does-mot- --appear* the- upper' -area - is 'accessible,.-to- -a-.- well-- drilling • r-ig'. • ^ - If you wish to pursue this matter further, you should: 1. Hire a professional engineer to locate adjacant subsurface sewage disposal systems and submit a plan showing their locations with respect to your proposed well. 2. Have a well driller inspect your property and advise the Department if the area is accessible to a well rig. If you have any questions, contact the writer at Ext. 324. Ver tr ly yours, hn Kar E. ublic Health Director JK:pt PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services / 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 I N F 0 R M A T I.0 N HOUSE ADDITION APPROVAL REQUIREMENTS JOHN KARELL Jr., P.E., M.S. Public Health Director 1. THE DETERMINATION OF WHETHER A PROPOSED ROOM ADDITION TO A HOUSE IS CONSIDERED A BEDROOM WILL BE MADE BY DEPARTMENT STAFF BASED UPON: - LOCATION OF THE.ROOM IN THE HOUSE - SIZE OF THE ROOM. 2. ANY ADDITION WHICH IS CONSIDERED A BEDROOM REQUIRES A FORMAL APPROVAL OF PLANS, (CONSTRUCTION PERMIT) BY THE - DEPARTMENT WHICH PLANS ARE TO BE PREPARED BY A PROFESSIONAL ENGINEER IN ACCORDANCE WITH APPLICABLE SECTIONS OF OUR . - - - - - - SUBMISSION -- GUI DELI NES. -- PLANS -WILL PROVIDE -FOR- THE -- INSTALLATION - OF -. ADDITIONAL - - -- -_ SDS AREA MEETING PRESENT CODE REQUIREMENTS. 3. ANY ADDITION WHICH IS NOT A BEDROOM BUT WHICH INCREASES THE LIVING AREA BY 15%* -OR MORE; EXAMPLE,_.ENLARGING LIVING ROOM, ENLARGING KITCHEN, ADDING A DEN, REQUIRES THAT SD.S_EXPANSION AREA OF.AT LEAST 50% OR MORE BE DOCUMENTED. AS_ A1�AiLY(BLE; -'NCrZL©SER THAN -100 -FEET° TO'- -EX�ISTING�' WELLS:-kND /-OR W-ATERC0URSES — -.,:_ ... _....._.. :_... A PLAN MAY BE PREPARED BY THE PROPERTY OWNER SHOWING HOUSE FLOOR PLAN, BEFORE AND AFTER, LOCATION OF WATER SUPPLY SOURCE, EXISTING AND PROPOSED SSDS AREA ON THIS LOT AND ADJACENT LOTS, WITHIN 200 FEET. AN APPROVAL LETTER WILL BE ISSUED BY THE'DEPARTMENT. IT WILL GENERALLY NOT BE NECESSARY TO INSTALL THE SEWAGE FACILITIES AT THE TIME OF THE APPROVAL UNLESS PROBLEMS EXIST OR ARE SUSPECTED TO EXIST WITH THE OPERATION OF THE SEWAGE SYSTEM OR IF THE ADDITION IS SIGNIFICANTLY LARGER THAN THE 15%. SUCH DECISION TO REQUIRE THE INSTALLATION OF ADDITIONAL TRENCHES AT THIS TIME WILL BE MADE AFTER CONSULTATION WITH THE DIRECTOR. ALL INFORMATION PROVIDED ON PLANS WILL BE VERIFIED IN THE FIELD BY STAFF. 4/24/90 ------ - ---- -- - - --- - - --- i-rlv --------- - --- E- - I I - -- i ! ) f , L- I ? f t I y f ! '} ii i i 1 f I ) 1 - , _1 J F ( i I ` i + " ! I • I _ _ _ _ i ! -f L I , r. _ Al ' t i f I i I j I ' { 1 �0- bi ..... . ..... j I 4 I L J. . - X-41 . ....... .... Lt l ID , 1- i r I -i-- i I i I i j I -• � _ _ ! , ; I ! II ! j ! 1 1 i r ; , t I ! I , I ! s I I , I r , I f { , , I , 4 f , it RK , i DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225-0310 February 13, 1992 Jeffrey Scott and Lisa Roosa 10 Danbury Road Patterson, NY 12563 Re: Variance Request Name: Scott /Roosa Street: Danbury Road Torn: Patterson Tax Nap: Lots 10024 -1.0028 Dear Kr. Scott b Hs. Roosa: r JOHN KARELL Jr., P.E., M.S. Public Health Director Please be advised that a request for a variance from certain provisions of the Putnam County Sanitary Code has been placed on the agenda for the next meeting of the Board of Health to be held on February 24, 1992 at 7:30 P.M. in our Health Department Conference Room, BOCES Complex, 110 Old Route 6, Carmel, Her York. _You -or. your: representative , must; attend the meeting to present- your.. case. - You are referred to the attached 'Neighbor Notification' procedures which must be satisfied. i 4,rell,lJr. ys, K , P. E. Public Health Director JK /jp For: The Board of Health cc: JK File J JOHN KARELL Jr., P.E., M.S. Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 Jeffrey Scott and U sa Roosa 10 Danbury Road Patterson, NY 12563 October 4, 1991 Re: Proposed Addition - Scott & Roosa 10 Danbury Road (T) Patterson Dear Mr. Scott & Ms. Roosa: 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. Separation distance between well and septic is approximately 60 feet, 100 feet is required by today's standards. 2. Exzpansion area for the existing septic system, 100 feet from the existing well; is not available In light of the foregoing, you application is hereby denied. It is advised that the proposed addition is revised to meet current standards. I may be reached at ext. 320 to discuss this possibility. Ver ruly yours, Robert Morris Assistant Public Health Engineer RM/jp JOHN KARELL Jr., P.E., M.S. Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 October 4, 1991 Jeffrey Scott and U sa Roosa 10 Danbury Road Patterson, NY 12563 Re: Proposed Addition - Scott & Roosa 10 Danbury Road (T) Patterson Dear Mr. Scott & Ms. Roosa: Review of plans and other supporting documents submitted at this time relative to the above- capiioned project has been completed. Comments are_ offered as follows: 1. Separation distance between well and septic is approximately 60 feet, 100 feet is required by today's standards. 2. Exzpansion area for the existing septic system, 100 feet from the existing well, is-not available. �- In light of the foregoing, you application is hereby denied. It is advised that the proposed addition is revised to meet current standards. I may be reached at ext. 320 to discuss this possibility. Ver ruly yours, Robert Morris Assistant.Public Health Engineer RM/j P C PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL_ .. _.._ _._. > -- Please print or type PCHD Permit # Well Location: Street Address: Town/Village Tax Grid #3l Da- bU P, 00.�Q �a t,y Map ;3 G, Block 2 Lot(s) � Well Owner: Name: Address: Use of Well: _Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Moniton'ng Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason 1< - t J a- i o ;,`, 1' 4-� — e X , :S a h n for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No _ Name of subdivision Lot No. Water Well Contractor: -h4:11 L NS =wc- - Address: `75r ?.,�W Ark •R%e.. Is Public Water Supply available to site? :................................. ............................... Yes No X_ Name of Public Water Supply: Town/Village . Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: -J _3 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 well driller certified by Putnam County. Date of Issue g Permit Issuing Date of Expiration 2 -� Title: Permit is Non- Transfefrabl"e j White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL pleme print -or type ....= K� PCHD Permit # Well Location: Street Address: TownNillage Tax Grid #3l 34-PAURV odj 7� Q Map 3 Block 2. Loi(s) Well Owner: Name: I JAddress: '5*4 1-i'Se, t�W' so`. nn u� K�•: a c� 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 Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason r, • o ; N ��- _ P , ;� w ,�,` a for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ..........................:...................... ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No —-- Name of subdivision Lot No. Water Well Contractor: M J Lk; 11 W!4 SNc Address: -75' PAw rangy •fit_ 3e ex�t'-e.nC Is Public Water Supply available to site? : .............................................. .................. Yes No _'X N. ame of Public Water Supply: TownNillage Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: AJ 3 l�� 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 well driller certified by Putnam County. Date of Issue '? Permit Issuing Official�J_� Date of Expiration g , Title: -:�S' .7 Permit is Non- Transfefrabie White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A.WATER -WELL z..:.. r . please print or type t..� PCHD Permit Well Location: Street Address: Town/Village Tax Grid # 31 -Da-ry bV R poj �4- LI Map 3 G, Block 2 Lots) Well Owner: Name: Address: �- r!.,so. � Oosa Jff 0 W Use of Well: .'JL'2 _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 5' gpm # People Served _� Est. of Daily Usage _gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason r - ' C` 0- 0-• o;�,1 tf - 7 'e C-5/1 , w �,` - v for Drilling Well Type Drilled Driven Gravel Other 5 Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Lot No. Water Well Contractor: :l - l� ; �� i NG , Address: '7S ?�� AyA Ave.. Is Public Water Supply available to site? :................................. ............................... Yes No X Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. '' A pp licant igiauieHate:_: r.. 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 well driller certified by Putnam County. Date of Issue -9y� Permit Issuing Official �--�� Date of Expiration 2 �1d zi Title: .� /✓/,�� Permit is Non- Transfefrable j White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 �nY , R-;j>K,pt[iw <'i ors x3 ?4xp " d-�� WELL 'COMPLETION REPORT i E ' Office Use, Only; �e DEPARTMENT OF HEALTH: � ',nbl��r* i, ��.� { }t.)d'`4l �"�P' SIP A€ � af`'. : _i.,i 1 �'. t fP,`f _ •. ... isitan n �dtitiezta_ 4ea zS;e#4ices ^,> PUTNAM COUNTY .DEPARTMENT: QF HEALTH ; hdaz , i- p R r. ~. Ri t�t� rSiREcT ADDRESS 1 i tl! t X d t WN! i 1 TAX GRID NUMBEd [o TioN D nbur,a Roa' 0 l`txNY� t- " �,,a�'k;�i....a NAME.•-- ---* t t :: '. �• as :<`. Al)ORESS ')sue ix i ,: " I IL�O,WNER i SGOtt `Lisa Roos ' j Dor t f Rootl Patterson PJY PUBLIC* � .,- __...... ... _. t'Y O :PUBLIC . •1Yt ;�yYV Y "Yi!4T2 ....... 5.t1 _ . 7 -., 1 - - JSE OF Yfl M1 3 ESIDENTIAL O PUBLIC SUPPLY; ❑_AIRICOND !HEAT PUMP O ABANDONED, BUSINESS O FARM' ,r O TEST /OBSERVATION.: ❑ OTHER (Specify P Y) p,Frry� _p }INOl1STRIAL ❑ ,INSTITUTIONAL O STAND 8Y p 2 seconds Y'c'�,'�.'rrrS�F�r,'�t'K7••gk' i� s�4�%"�q�'t A w .. . riOUNTOF�US �r. M _, t 1f1ELD SOUGHT Y 5 gpm5 /NO PEOPLE SERVED - /EST. OF DAILY USAGE gala AEA`SON FNq S "REPLACE �'EXISTINr9 SUPPLY ❑TEST /OBSERVATION Q ADDITIONAL SUPPLY DRII�,N ,r, .QNEW °SUPPLY (N)✓W DWELLIrNG) .•'DEEPEN EXISTINGiWELL DEPTH bAYA. f° , t reaiu�yr4, `{ WELD DEPTH 3OO r r eft ,STATIC :WATER ;LEVEL.;__ ft DATE MEASUREDy 7/IO/92 OR`�trl NG O�ROTARY� ::u' k r DCCOMPRESSED AIR PERCUSSION � ' p DUG EQUIPµ ENTWELL POINT #� O� CABLE PERCUSSION _ C1 UTHER {specify) WELL�k�PE r0' SCREENED Ij OOPEiV END CASING; �( OPEN HOLE IN BEDROCK' D OTHER �# , �� TOTAL LENGTii �� -r it MATERIALS STEEL t7 PLASTIC OTHER CASING LENGTH BELOW GRADE A ,t "` _ ff. JOINTS °` p WELDED ` THREADED 6, 07HER' DIAMETER G x r. I�. ,' `r Y, �. , d in: SEAL= i;CEMENT.GROUT. GBENTONITE D OTHER ! . i ,: -,?- -- ',,WEIGHT PER `FOOT: ; _ ., t .. Ib /(t. r ;DRIVE SHOE 6}(1fES iJ0 LINER :CJ YES "I OrNO >1 h 71 t �R :} tl r jF a +. DIAMETER (in) SLOT SIZE LENGTH (11) DEPTH70 SCREEN (it) -DEVELOPED ROM AA;UEL >RACK`i O��YES` R, 6RAVEG + +1+ Y '- �t 4 *� a DIAMETER TOP` BOTTOM SIZE '` . OF PACK in.- DEPTH ft." DE►'T}t tt BEM: YIFMFTEST} Et, Ii detailed urn m if more detatled ltirmation descriptions or -sieve analyses ,.- t P, P 9 �Y11 ELL LOG are avallable. please attach E[H001]PUMPED `ri #ests.were done is in, 1.,0EPTH FROM Well Water �'Q%A ! � ,�OrtU�, �formaUon SURFACE 8pr D,a "SIKNP}/rrtt� nurwer. �oQ Yl:$ ! Q NU FORt1AT10N OESCRIPiION poE. g WDEPIH f DURATION ORAWOOWN YIELD 1. r" Land TICS ``hr °' mfn`i It _ 9Cm Surlace . L30t� ": urdsa,s d 200' „ o .:i 10 :300 Hard :grey �rcIi.te, Wq '1t Yid v #F C"i1i4� >� ! l•�l f C t' t < < i..! a l f ` P! ITER NEAR ,�� TEMP AIJTY'44 C1000Y s^aHARDNESS 03COLORED,� ANALYZED? DES ONO T ANALY$IS;ATTAC"t ,YES O N0 , STORAGE TANK TYPE . IMPIHFORMATIONI CAPACITY GAlr t CAPACITY F Y WEL DRILLER NME MILL DRILLINGocIrL, D� �rr m EPTH +AOOR 'SIG '"'t VOLTAGE HP PreMAve wster, NY MILL PPUSIDE]'dT ELLIS A. TARLTON LABORATORY Ce 'c' DIVISION OF ELLIS A. TARLTON, ENGINEERS, INC. CHEMICAL 34 PLEASANT STREET DANBURY, CONN. 06813 -2328 WATER - WASTEWATER PHYSICAL METHODOLOGY " BIOLOGICAL P.O. BOX 2328 203- 748 -7903 APHA - EPA - ASTM NAME AND ADDRESS OF PERSON TO RECEIVE .REPORT EPQRT -.0 -BACTERIOLOGICAL AND. CHEMICAL ..EXAMINATION OF WATER L DATA Mill Drilling, Inc. Putnam Ave Brewster, NY 10509 Li SOURCE OF SAMPLE Water Supply, Roosa, Res. 11 Danbury Road Patterson, MY DATE OF COLLECTION July 13, 1992- COLLECTED BY Mill Drilling Hydrogen ion COLOR TURBIDITY ODOR CORROSION INDEX DISSOLVED SOLIDS Concentration LANGELIER (PM) NTU RYZNAR ' MOIL Alkalinity is CaCO3 Fluoride (F) Bicarbonate Nitrite MOIL MOIL MOIL NITROGEN Alkalinity as CaC00 Chlorine Residual CONSTITUENTS Nitrate MOIL Carb one t s Mp /l .00 MOIL AS NITROGEN N (� Total Hardness as CaCO3 Conductivity Ammonia MOIL MOIL Mlcromohos /cm • MOIL Iron as Fe MOIL MOIL Chlorides as CL MOIL Manganese as Mn MOIL MOIL Detergent as MB AS Mg/L.11 Sulfate as SO4 MO It. MOIL TM arllhrlonnotio mean of all standard samples examined per month using the membrane filler technique shell not exceed MEMBRANE FILTER TEST Ono Oog per 100ml. Collform colonies per standard sample shell not exceed 9 /50ml. 4 /100mi. 7/200m1, or 10 /500ml Collform Colonies /tOOML ins (a) Two consecutive samples: (b) More than one standard sample when loss than 20 ere examined per month: or (c) Mon than 0ve per cent of the whoa' 20 -or 'more are examined per month. — _....Q�._. . AT THE TIME THE SAMPLE WAS SUBMITTED: �. 1. The results of the analysis of this sample were satisfactory and met requirements for a potable water. Z The results of the analysis of this sample were satisfactory for a potable water but certain of the chemical or physical constituents were high. These are as follows: 9. This sample was not satisfactory since It did not meet the bacterial requirements for potable water. The presence of organisms of the coliform group I^ a sample of potable water Is undersirabfe and. while not necessarily Indicating the presence of any disease producing organisms. does Indicate that such contamination might we to the same extent. The presence of organisms of the Collform group may also Indicate that the treatment was not adequate at the time the sample was collected. 4. This sample was unsatisfactory as a potable water because certain chemical or physical constituents were above acceptable limits. These are as follows: COMMENTS The bacterial analysis showed no organisms of the coliform group at the time the sample was collected which indicated the water potable. Certified ........................................ .... ..... ... ..... F� ,�3'x a_:.c.,�t.�aR�.e l+,:f�•�r rt. ��__..a .., v � .., t,. :+ _.:�,'. _a .. �. ,__�,�_�.._�� - �:.} ,. .?;�. �.. . _. .. 3y i X `% L LAW PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Permit #W -51 -98 ell "Location "y .-, Street �Cddress: •.`" ° ,_ ti .°" , - -° _._ . pa.nbury Road ` 60WffVi1lage: Patterson, NY Map �1 Block 2 Lot(s) 51 Well Owner: Name: Scott & Lisa Address: Roosa Danbury Road, Patterson, New York Use of Well: 1- primary 2- secondary xx Residential Business Industrial Public Supply Air cond/heat pump Irrigation Farm Test/monitoring Other(specify) Institutional Standby Drilling Equipment Rotary Cable percussion xx Compressed air percussion Other (specify) Well Type Screened Open end casing xx Open hole in bedrock _ Other Casing Details Total length eft. Length below grade 52 ft. Diameter min. Weight per foot 19 lb /ft. Materials: xx Steel Plastic _ Other Joints: _ Weldedxx Threaded _ Other Seal: xx Cement grout _ Bentonite . Other Drive shoe: xx Yes _ No Liner: Yes _ No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield Test _ Bailed _ Pumped xx Compressed Air Hours 6 Yield .60 gpm" , Depth Data Measure from an su ace - static (specify ft) 30 During yield test(ft) 200 Depth of completed well in feet .300 Well Log If more detailed information descriptions or are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 10 Subsoil: & cobbles .10 .15 Weathered soft . ledge gran.te w.Loft .quartz se If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information 300 60 Pump Type s mers1. pacity 7 Depth 180 . Model 7GS07. Voltage 230. Hp -3/4 Tank TypeDi aphragmVolume 62 Date ell Comp eted 8/.6/98 Putnam County Certification No. 2 Date o Report Well Dr' s' r 8/1.0/98 lVU'I'iN;: Exact location of well wttn atstances to at least two permanent ianumarxs w ucypuW dFjasa«y�a. u� Well DrilleesN IL IN Addres`s:75 Putnam .AVe.,' Brewster, NY. Signature; Date: 8/1:0/ 98 obert 1, President White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WC -97 ms;_ __1 08 -12 -1998 02 :31AM FROM NORTHEAST LAB OF DANBURY TO 19142795075 P.01 NOI2THt-&g' - t;ABORATORY OF DANBURY CT Cert: PH -0404 39' -3 WELL: PILAiN ROAD - DANBURY, CT 068111 NY Cert: 11471 (203)148 -7903 FAX (2031748-0652 LABORATORY REPORT -- WATER SUPPLY TESTING MILS. DRI ,LING, INC. DATE SAMPLE COLLECTED: 8/7/98 PUT�IJAI�I AVENUE TIME COLLECTED: 8:00 P,It1, BREW'S'' R, N.Y. 10509 COLLECTED BY: BOB MILL, !. DATE RECEIVED @ LAB: 3/7/98 TESTED BY: L.AB #11471 REPORT DATE! 8/11/98 SAMPLE: I'i'E: ROOSA, LAKE SHORE DR.tti�, PATTERSON, N.Y. SAMPU N POINT: FTE)GA TEST DISCHARGE SOURCE.' WELL Ta Nt.- NONE TES ' PE FORIIIED: RESULT! MAX __YMUM CONTAMINANT LEVEL i SAC.T L: T'otalll Ooliform (Bacteria) 0 per 100 nil 0 per 100 nil ' Piws CIS: - -- — = -- pH . 7.20 - - -no designated limit Turbidity. 3.6 N,rus 5 NTUs j Nitrite N [0.01 mg/L as N 1 mg/L as N Nitrate N TO FOLLOW m&IL as N 10 m Las N Hardness 144.0 mg/L no designated limits Iron 0.104 mg/L, 0.30 mg/L Manganese 0.041 mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 050 mg/L] Sodium 17.1 mg/L, 20 mg/L ** Lead: 0.010 mg/L 0.015*** ml — millilitre mstL _ raifligra�n s per Liter ND = none detected NTL1 =Units i I "Nodflo lonjI.ovol *?* *Action Levcl 1 ?RE ' 11 I BASED. ON S',A1A PLES SUBMITTED :8/7/98 SAMPLIAS TESTED ABOVE: 0 OTABLE or ❑ OT POTABLE j :(PER NEW YCk�K sTATE'i)k rr, OF HEALTH SERVICES STANDARDS FOR POTABLE•. WATER) Laboratory Director J Y. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL .HEALTH SERVICrS APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT .# Well Location: Street Address: TownNillage Tax Grid # 36 -31 Danbury Rd,, Patterson, NY Map Block 2 Lot(s)51 Well Owner: Name: Address: Scott & Lisa Roosa Danbury Road, Patterson, New York Well Type: xx ` Drilled . Driven Dug Gravel Other Depth Data: Well Depth 300 ft Static Water Level 30 ft Date Measured 8/4798 Use of Well: xx Residential Public Supply Air /Cond/Heat Pump Abandoned 1- primary Business Farm T Test/Observation Other (specify) 2- secondary. Industrial: Institutional Standby Water Well Name: Address: Contractor: MILL DRILLING, INC., 75,,PUTNAM AVENUE, BREWSTER, NEW YORK .1.0509 Reason For Abandonment: Well was located on adjoining property. Description .of Work To Be Performed: Filled with concrete. Date: 8/.4/ 98 Applicant Signature: IF obert M. re ident PERMIT 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 information delineated on the application for this permit has been completed. Z ;V Date if Issue Permit Issuing Official Title White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 7 '0) f'. A'fl -7- (u r?j J ^F-E=-A = 0.245 Ar-t 55 SHORE 0 D 19) z ,SURVEY-0F'PfkbPitfRty PREPARED FOR LOTS * 10024 -10028 AS SHOWN ON rn TENTH MAP OF FUTN,-,M LAKE 11 PILED MAF-:t 149 L FILED 10-30-51 N Z TOWN OF PATTERSON PUTNAM CO., NY SCALE I" = 20' JULY 2811989. u ;x C O� co CERTIFIED TO COMMONWEALTH MC)R7C-jAeE COMPANY O'F-AMER;CGA I L-A\,/,Ysr-% -r'-T-L-E INS. 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