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Home My WebLink About2059DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.48 -1 -39 BOX 18 02059 am I No I us �- kc J ■ IF . ' �� 'l ; �. . - 02059 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/Vi la e Tax Grt # `% d' -Bock I" 3 Lot(s� J'A'S 12elt- /7� Map :5 Well Owner: am e:' Address: 7 -/Pee' 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 al. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason R61DOUIF V-J) L /-, 6t) 1 / G � %--- 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: Address: &/m , 'yr� Is Public Water Supply available to site? .................................. ............................... Yes No X Name of Public Water Supply: Town/Village Distance to property from nearest water main: /V A Proposed well location & sources of contamination to rov'Wed on separate sheet/plan. Date: &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. y revision or alteration of the approved plan requires a new permit. Well to be constructed by a Ovate well iller ce ified by Putnam County. Date of Issue //4 0 Permit Issuing Official: Date of Expiration J 2- Title: Permit is Non- Transfe ra e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH f DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL ' r lease print f p p' or type PCHD PERMIT # • Well Location • Street Address: TownNillage Tax Grid # a _ y�' --139' - 7 .PsPf:'51'2 A? D, 13 V'Wsj-�5.-Z ap Block Lot(s) Well Owner: Name:A /Rlc, Name: ` &O y Address. � -�� - 7 JAS i�2 lZ �� Well Type: Drilled Driven Dug Gravel Other Depth Data: Well pth 2,40 ft Static Water Level ft JDate Measured Use of Well: 1;= primary ater Well ntractor: Re Abs V Residential Public Supply Air /Cond/Heat Pump Abandoned _ Business Farm Test/Observation Other (specify) _ Industrial Institutional Standby ime: Address: /_4 'O'v S ,n For donment: /VO N P U , L-C_ J G— iption of Work To Be Performed: Date: 0 L J41 kpplicant Signature: /j I ezi '�t c a/l2 &c)"U PERMIT A v � 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 info atl delineated on the application for this permit has been completed. �. l U1� �o 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 0 J7/ 9 Y50- 275- s /�'/ Fxi it 1VL q1q- may 7% �:- _/� i OA -son== �JO'77 FICO-170el S*�'je- 0 19X fWl y� � .� ✓ ✓e �i r Gays _�..� � _ —ev � � — �%: � Ixe-a-Z 0 J7/ 9 Y50- 275- s /�'/ Fxi it 1VL q1q- may 7% �:- _/� i - _. APPENDLX E FORMAT CONSTRUCTION PERMIT NEIGHBOR NOTIFICATION LETTER Date RE: Department of Health Review of Proposed Sewage Treatment System for Property Name: V 1•n/ C �W Address: / '0 a Town: PA t r c= nP s o �✓ J ✓J �. Tax Map 9: 3 6 Dear Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or ell roposed for the captioned property has been made to the Putnam County -- _ Department of Health. ttached please find a copy of the latest site plan. If you have any questions, concerns or information which may bear on the Health Department's review of this application, ydw" may call the Health Department at (914) 273 -6130. n Received By Very truly yours, WE Title: Address: 1� fv1v /v 64Z -as- Tax Map 9: 7Z August, 1999 AppndxE ,U 25 APPENM E FORMAT-CONSTRUCTION PERMIT NEIGHBOR NOTIFICATION LETTER Date RE: Department of Health Review of Proposed Sewage Treatment System for Property Name: �� ' ��► Address: Town: "rP)_t.3_'5ro Tax Map 9: - t Dear Please be advised that an application for a Construction Permit relative to the construction of a well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please -find a co of the-latest site plan., - - - If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at (914) 278 -6130. Received By: ab_-61` Address: /V Tax Map g: G ° August, 1999 AppndxE Very truly yours, By: Title: , Ad � ��' q T i5 �, N/ , d� , p S� o PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL.. HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR 'S NAME A, C /lAtl- _VIIX /% )/ W 6/C./-F Z/ /V - PHONE SITE LOCATION /f , l 1 °L=7Z ,i�o TO _ IG — `I- ° MAILING ADDRESS f� PERSON INTERVIEWED PCHD Complaint �C' Sf Name &Relationship (i.e, owner, tenant, etc.) / DATE / hi TYPE FACILITY/ PROPOSED INSTALLER, -S i allkL r PHONE Pro (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal from licensed professional engineer or registered arrhiWt. No Proposal approved s & Title Proposal Disapproved rondsal approved with the followincr 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 d. System description (e.g., 1250 gal. concrete septic tank, drywells surrounded by one foot + gravel). e. Installer's name and number. i (1 1 lq/? Elate (e.g.,house corners). three precast 6' diam. x 6' deep 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, or gent of owner agree to the above conditions. SIGNATURE TITLE BATE rPM: Vbite MD); YeUc w Mytin EI) a Pink Lkji iamt.) SITE LOCATION MAILING ADDRESS DATE ER PHONE T1�!# z� r Sss9 PaM Complaint. # Name & Relationship (i.e, owner,tennant, etc.) TYPE FACILITY PHONE 7 J Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal from licensed professional engineer or registered architect. QF®, &y� -- g1 h )q,11JS tw l /h fcva IPou►s 21 �.C'79��1 -7rvf 004-rg5 y— - Proposal approved Inspector's Signa Proposal Disapproved roposal 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 Nam, 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' diam. 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 repor agent of owner agree to the above conditions. 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"3 rw ir'�Yi .:t '=4-+ � r � r_1 t .3- ?t 'r. r % .�c.,� ';{ f t >'' ,c f ,, ,. t t �y ? M }. ' ._ .'. �.. ! _ -.: -:, - - � . . OAK& * , 0 - , - . '"'_ .:-.---,r-�.,�:�,,:,�.,�l-,.--,,.,..-�,,,',,.',,,':��..,..,..---,,-,- -"--;",.,.,�.."-."��,,�.�...,.—.. . � �..,� m._ ..-'�� -_;�.":�, "."_�:'..'l-�. � , " * ,—,--��,�--"-'-��,�'�,-,-:��,..�,'!,�;�—,,,�, ci - %_� ..._. - '' .,-.- �''.., ��--'4,,�;-Tt-.:'.?'�W; ._. - -, ,,_:. _ — -__1 1. - �,� —, y4 .. .. > .. v .,- J - _t PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES b YES MW Internal Use Only PERMIT # ❑ ,�/ Repair Permit issued in last 5 years VDelegated ot in Watershed ❑ ,t- �-�,!/ Repair within Boyd's Corners, W. Branch or Croton Falls Res. ❑ l;G Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION rj 3cL5!D� i a9 TOWN TM # 3(p. OWNER'S NAME L, 00:-) I+r�o�J ;� z PHONE # Cm •ti`iq _�(QD 3 MAILING ADDRESS `1 10� , APPLICANT Name & Relationship (i.e., owner, tenant, contractor) DATE Z). S. 00k FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER @kq Qom,, "\,�.�_ PHONE # ADDRESS Ao-,6ok `1%ko Jl �.a REGISTRATION /LICENSE # NOC6 . Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature and extent of the repair. I, as owner,agree to the conditions stated on this form y y v SIGNATURE TITLE DATE _ .. _(owner) - - - -+ -the septic installer, agree -to comply with the conditions of this permit for the septic system repair- SIGNATURE TITLE �4_a-1 • DATE (installer) Proposal approved with the following conditions: , 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. No completed work is to be backfillo until authorization to do so has been obtained from the Department. INTERNAL USE ONLY Proposal Approved B Proposal Denied ❑ avei In pector's Signature & Title Date Expi ation Date Repair proposal is in compliance with applicable codes Yes No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 it a 'i iy a 6; J 1 NOTTO SCALE 1 f �s s Louis Rodriguez 7 Jasper Road Brewster NY 10509 ii 1� q: I �l HOUSE s f i DECK DECK 20' SEWER LINE h O 1 SEPTIC .TANK f— POOL f i T t) f NOT TO SCALE i �- 80'+/- O -- WELL PHONE (845)635 -2102 r P L U M B I N G NOT TO SCALE Sent By: MR ROOTER PLUMBING; 845 635 1173; Feb -5 -09 .5:57PM; Page 1/2 b PUTNAM COUNTY HEALTH DEPARTMENT Df,UIS.ia�vu[olv.TJHFALTH SEFyIs�ES - O.p1,.,,ee_^n...nztT.x. L*_ufltt.'�nG .•s -yn •. ,0• =-'bl. e _ _.• - 5 -+ .: L- -, - .mss Ta2'. . .PROPOSAL FOR SEWAGE TREATMENT. SYSTEM REPAIR_ PERMIT SITE LOCATION "1 .. c,� a� f i),Y SJ TOWN ' TM C�,e ,� PHONE # OWNER'S NAME �„ �� , ,� , - MAILING ADDRESS APPLICANT. ,� . t _• +.aa✓ Name & Relationship (Le caner, tenant, contractor) DATE , �. fj. (Dq _._ FACILITY TYPE -PCHD COMPLAINT # PROPOSED. INSTALLER lkg k --J 1� ��.,\ -, ;� PHONE # 0. � ADDRESS kt�..4 >z.,x REGISTRATION /LICENSE # Proposal (iriclude a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) - NOTE: The Department maysequire submittal of proposal from.licensed professional depending on the nature, and extent of the repair. .ri l'�-f• ft, Qf• ��d•1' ,n P-'1 v,. %•C l.A., r � �, /l /?1, ..._. -+�'T / 4� !� f . t' /1 1 - L/e [ I, as owner,agree to the conditions stated on this form (owner) I, the septic installer, agree to comply with the conditions of this�permit for the septic system repair SIGNATURE �J" LI. Wi �^^ TITLE DATE (Installer) Proposal agorov with the following conditions: 1. Procurgment of any Town Permit, it applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate snowing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of instailed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. 'No completed work'is to be backfilled until authorization► to do so has been obtained from the Department. INTERNAIL USE ONLY Proposal Approved is in compliance with COPIES: - PCHD; Owner; Installer Pr,-Pp QQMI Proposal Denied ❑ ; T_C- Date codes Yes Expiration Date No 0 Rev. 2/07 Repair Permit issued in last 5 years Ll Not in Watershed U ( � Repair within Boyd's Comers, W. Branch or Croton Falls Ass, Lr.Delegated. ❑ Repair within 200 ft. of a watercourse or DEC-mapped wetland Q Joint Review SITE LOCATION "1 .. c,� a� f i),Y SJ TOWN ' TM C�,e ,� PHONE # OWNER'S NAME �„ �� , ,� , - MAILING ADDRESS APPLICANT. ,� . t _• +.aa✓ Name & Relationship (Le caner, tenant, contractor) DATE , �. fj. (Dq _._ FACILITY TYPE -PCHD COMPLAINT # PROPOSED. INSTALLER lkg k --J 1� ��.,\ -, ;� PHONE # 0. � ADDRESS kt�..4 >z.,x REGISTRATION /LICENSE # Proposal (iriclude a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) - NOTE: The Department maysequire submittal of proposal from.licensed professional depending on the nature, and extent of the repair. .ri l'�-f• ft, Qf• ��d•1' ,n P-'1 v,. %•C l.A., r � �, /l /?1, ..._. -+�'T / 4� !� f . t' /1 1 - L/e [ I, as owner,agree to the conditions stated on this form (owner) I, the septic installer, agree to comply with the conditions of this�permit for the septic system repair SIGNATURE �J" LI. Wi �^^ TITLE DATE (Installer) Proposal agorov with the following conditions: 1. Procurgment of any Town Permit, it applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate snowing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of instailed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. 'No completed work'is to be backfilled until authorization► to do so has been obtained from the Department. INTERNAIL USE ONLY Proposal Approved is in compliance with COPIES: - PCHD; Owner; Installer Pr,-Pp QQMI Proposal Denied ❑ ; T_C- Date codes Yes Expiration Date No 0 Rev. 2/07 COAYLw Oi cm IAer. NYMD 1+FIYYTY AYK( • ::' 'N r 1 Gq U ` 'NLe PICK OATL `. aOMG. WALK T yATI + _�l¢4 ate rlwe. Ary. LTD TWO STORY ' { 7 �S �4 RoD'aLgKp. a . Ab wiad7 AMY a(sN ti 4 1L 1 L 21' 199 t ..i I .,yF a OATC L: pay � �: Y t h ry I I i ;Nrc( Y O. L' Y.e•T zs o g 35'.29' W a a STORL MALOMRY RLTAIr O WALL • OOIL _ .. MAi iLTeriar�s erAr .. ✓A SPER�;� �I 4 V �F yCl AREA 14,72-0,5,4- . + 0. ;337 ;4`-RES RR� ��