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Home My WebLink About0195DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 4.14 -1 -13 BOX 3 1 ru :s W, Wp .. Z . Ell m 1111 ,.j :�, RECEI '`- D, 2' BREWSTER LABORATORIES Box 224 - BREWSTER, N.Y. (914) 279 -4945 - WATER ANALYSIS REPORT - SAMPLE NO. 8044 TEST WELL SOURCE: Mr. Wheeler, DoveaGroup Playland Road Patterson, N.Y. COLLECTED: 5-15-91 BY: P.F. Beale & Sons BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. 5 -19 -91 0 per 100 ml. RECEI` 'MAY g ern n - r n ) .� . * i r W NO Wr.LL UVrJrLz11V" atr,rviti DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only i WELL LOCATION STREET AOURESS: TAX GRID NUb ER: Playland Rd. Patterson, NY WELL OWNER NAME. ADDRESS: John Wheeler of the Dover Group, FoxHill,BerwickCt.,Fish ja ;BIVATE UBLIC USE OF WELL 1 - primary 2 - secondary ® RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE . gal. REASON FOR DRILLING QREPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY. []NEW SUPPLY (NEW DWELLING) ❑ DEEPEN EXISTING WELL _ DEPTH DATA WELL DEPTH 490 ft. STATIC WATER LEVEL 30 �DATE SURED 5 /8/91 DRILLING EQUIPMENT -El ROTARY E1 COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING ID OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH 163 _ fL MATERIALS: 15 STEEL ❑ PLASTIC ❑ OTHER LENGTH BELOW GRADE 162 ft. JOINTS: ❑ WELDED 7 THREADED ❑ OTHER DIAMETER 6 in. SEAL: n CEMENT GROUT ❑ BENTONITE ❑ OTHER WEIGHT PER FOOT 19 Ib. /ft. DRIVE SHOE iJ YES ❑ NO I LINER: ❑ YES IJ NO SCREEN DIAMETER (in) 'SLOT SIZE LENGTH (It) DEPTH TO SCREEN (ft) DEVELOPED? DETAILS FIRST O YES ONO HOURS SECOND GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK In. TOP DEPTH ft. BOTTOM . DEPTH It. WELL YIELD TEST It detailed pumping METHOD: O PUMPED 1 tests were done is in- i Y9 COMPRESSED AIR , formation attached? ❑ BAILED ❑ OTHER ; ❑ YES ❑ NO 1�IELL LOG -if more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE.. Water pear- ing Well- Dia- meter FORMATION DESCRIPTION CoOE ft. ft. WELL DEPTH ft. DURATION hr. min. ORAWOOWN ft. YIELD 0M. La�a cc 65 Dr 11 ng in overburden clay & bldrE. Hi rock at 65' 490 6 470 12 65 163 D it ing in rock,set casing,groute . 163 490 D it ing in rock granite. 1 WATER ❑ CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? ❑ YES ❑ No STORAGE TANK: TYPE WellXtrol 302 CAPACITY 86 GAL. PUMP INFORMATION TYPE submersible CAPACITY 5 g MAKER Gou OE TFi MODEL 5 VOLTAGE ij HP WELL DRILLER NAME P.F. Beal & Sons, OAT 5/21/91 ADDRESS PO Box B S Brewster, NY 3/ 07 PUTNAM C OWI'Y =AR=,9 TT OF HEALTH DIVISION OF IINVIRONMEMAL HEALTH SERVICES �4AWYER SAVIN GS A7� N Omer or Purchaser of Building SAWYER SAVINGS BANK Building Constructed by PLAY LAND DRIVE LNmtion - Street PATTER rSQN - -- Municipality SINGLE FAMILY RESIDENCE Building Type 5 - :9- 12 Section Block Lot QUAKER RIDGE ESTATES Subdivision Name 12 Subdivision Lot GUARANM OF SUBSURFACE SEWAGE DISPOSAL, SYSTMM I represent that I am wholly and completely responsible for the ]cxmtion, workmmship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as sham 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 goad 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 Director of the Division of Environinental. Health Services Department of Health as to whether or not the failure of the caused by the willful or neglicrent act of the occupant o£"th' the system. Dated this l5th day of Octo 1991 General.c:ontractor (Owner) - Signature SAWYER SAVINGS. BANK Corporation Name (if Corp.? Signature Title 87 MARKET STREET, SAUGERTIES, NY 12477 Address - rev. 9/85 MIF the determination of of the Putnam County system to operate was e building utilizA FM .... �! FLi T ell V. ARE;. a_ z L =`= as 2:1 1::---�? C- 1!az=a EC� hr= e--*---_ , C- == te- h -azi 151 L r c-c cr E_ 100 f i_- a_ C-ct.-,Ic t__= --- - ? '(300 !:_ E=CM ?C t._-.: c==—Liz—=Z T _ice C_ C�o c:--cut t S:. =:1 ?�j =- C_ BaK _ _ _ ___ t A� TT Ca -__ c. Ems_- :c_C:7 - wc__. `�_-_- F =C� Lrc` - _ _ SiGZ.c C= /i2 - < -0 -- - - i - 10 - r == c= c-_ r= ii-! t=om 1_ pi'a e c= __ Faf-D C'_D LAC S= i S =2E C_ c-=— C— -r 2- Cv a=-71 c-w by E =sT F MIAL c ---c �r�= -_,_fit CcL= /o CWNLIER f - au car, l arm O d c= plac= -- mt- C_ C -_mac 13° c=;-c C= -= == C_c_ . JCL = KILL. C_ Ez-.- ?r`il1 C= I=ta?ns SCC^E_c < " in Ei:_:zEr_ r I �1 • 'I I _ I I I I ( I ->OL) ?_ C-- t _':? (i 1 C rcr -a & C_ -_t� C. i��CL'_ ^_C C== -- C_ °C^_�r'C� cwcV t =t�u ►�� ter= I C== Cr S t CCES Cr == =Er `=--'- 1 =�V'— i 1 I I I / I I ' ( I ( � ._ ' Dado et cad Approval _ Mdfts AA&Me zap 1 ZQ 7 1 DatC Subdjyision Apgroved Fee Enclosed 1:1 -ATMlInt* > Typo Aar Serer Oaf Day& 9•iaame Dt Pot ( We•s Required Wbm M canped Nait d ®iaa � :::j Sepeetle SW"WW *@be is alibis¢ tab Sop* 21" To he amebumd to— Wass, 1 represent'. that 1 am wholly and eOmp Rely responsible for the design and location or the Proposed system(s)i 1) that the se ate tanv di YI Rem above described will be constructed as shown on the approved amsnd.m. there to and in accordance with the standards6 rules a regu M o meanly Department of HMKN and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of NNnhwill M submitted to the Dep•it, and a written guarantee will be furnished the owner. his successors. Mfrs or a s by the builder. that Yid builder will ptflce in good .OpMUW* condition ally part of Yid IN disposal system during the porkld of two (2) year medtately following thed•te Of the MU- Once Of the approval M the CertNicate of Construction Compliance of the orb $yet or ny reps t 2 2) that the dritled well A . lb" above who he WC@W "lboo1a the approved pbm and that Ykl well will be instal: w h the ru and rMu M ' of the Putnam COOKY MGM h. Data / Si2hea 94 P.E P.A. Address License No — APPROVED FOR CONSTRUCTION, This 0001OtS1 OUP es two year rare M data issued unless construction t building has been undertaken and is rovOable for M be amleed•d or modified when can rig Oy the CO 1ssioner of Nunn. A charge or alteration of construction ro"W" a permit. pg a: for disposal of domestic y a water supply only. Rev.. ' 1088 Oate Qy Title `. PUMM CDUM Dl6PANITAIM OF RZAIM ^ Weldon a[NodmonmOd Rodin Swells Ct>tsssL N.Y. IIW D�aM r lawli lwlnit / "CDRIERCA!E OF POD M > AOE SWOUL S,M L� j Yae�lt / Laatle/ KQ1 3 AKGlF-- -P" Taria as, Vllqp Sebilibia� te.. A�G� �t�Xti: f `J 1,e� i.l / Tell mop h� Mai 4 iii - i• Sepals" Sagn a w Sysi n to son" 41 SWO iW6 and 1020 L19 T=F U ba.e..r.aw IV 1 3 Address Wallis! saw Fl.. Agar•.. on ✓ PsIveft s=Wh, Dawes by l , �3 , . 1 ►epres nt that 1 am wholly ana COmommy responsible for the design and location of the Proposed system(s)i 1) that the se era)• Ywa • di OYI s stem above deseritle0 Will be constructed as shown On the approved amendment there to and in accordance with the standards, rules an regu OM o • COOKY D•PMtilM Of Means. and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner M Neanhwill be Olblattt•d to the Dyeftment. ON a written guarantee win be furnishes the owner. his ta/teeleare. heirs or uslons by the builder, that Yid builder win ace in goad .Oparatbg cledRi*n, any port of Yid sewap disposal system during the Period of two (2) mMl•tNy following thedste of the Wait- Once of the sop foe I of the Cortlfkato of Construction Compliance of the original system or any OWNS t 2) Mt the drWW will dse•►Md s6eve Will M loath N *$Own M the approver plan and shat Yid will will M M wit Res r and rquOo t Of the Putnam Cava* Deport eat Of MWIL mil. ("2a gc �,� Signed � - - : - 2, APPROVED PON CONSTRUCTION: Thu approval expires two yid+ fr the date issue: unless tonRrut3lon 6 the uikiwe has ban undertaken and it revocable for or be amerlded or modified when can rig Oy the mission of Health. A Chan" or alts ration of construction ��. "'""""'2il (A�p►anM for dispeW of domestk �/ �, /no/��i/%/Iatar supple only. ! //J /lt. 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 #P42-84 WELL LOCATION Street Adds A Town lage City Tax rid Number WELL OWNER a A Mailing A 4g Address rivate O Public USE OF WELL - primary 2 - secondary RESIDENTIAL O BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION CIINSTITUTIONAL O STAND -BY 0 ABANDONED O OTHER (specify Q AMOUNT OF USE YIELD SOUGHT_____t�_:gpm /# PEOPLE SERVED ( /EST. OF DAILY USAGE (per Sal REASON FOR DRILLING E] REPLACE EXISTING &9EW SprIPLY SUPPLY NEW DWELLING) O TEST/ OBSERVATION 0 DEEPEN 11 ADDITIONAL EXISTING WELL SUPPLY DETAILED REASON FOR 'DRILLING WELL TYPE � ILLED DRIVEN DUG O GRAVEL. OTHER IS WELL SITE SUBJECT TO FLOODING? YES L--"NO 'IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. i WATER WELL CONTRACTOR: Name �(—'o '�'� Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES L140 NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SDURCES OF CONTAMINATION PROVIDED MI;—PSEPARATE SHEET (date t (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 thirt3� (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well (.Yrl operations be contained on this property and in such a'manner as not to degrade or e contami nat,e surface or groundwater. Date of Issue: `- Z 19� '�� / d/ /�� ' Date of Expiration '�1/7-3 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. ' 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. . -Owner 1, 6 aA S046,-UCAddress Located at ( Street) a/ CQ ; 6E Die Sec. Block Lot - ( ndica e nearest cross.s ree / Municipality Watershed A C..`` � SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Water ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches J® 77 I e 32 -, 4Z -- 3; 53 :51 2 3 Z(P ( � 1 1+ 3 4 5 Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPpTION OF- „SOILS ��NCOUNTERED IN TEST HOLES DEPTH HOLE NO. l HOLE NO. HOLE NO. G.L.�c9 . 6” 12" 18" /� 2411 OILA OV _ 3 C 9Y 6" `t2" 48" 54 60" ' 66" 7211 78ti 8411 INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WBICI- WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS-MADE BY �] ]'� Date Soil Rate Used S= {0Min/l "Drop: S.D. Usable Are -�� dv No. of Bedrooms Septic Tank Capacity (ls �. e= p�,a Absorption Area Provided By. L.F.x24" iaidth' Piz, RN� PILL CO21A/A( Name Signature Address SEAL THIS SPACE FOR USE BY HEALTH DEPARTMMI T ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date >, Y, .. .- Rev. 31'86 jb131( CONSTRUCTION PERMIT\ Located at_ Subdivision PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services. Carmel, N.Y. 10512 :WAGE DISPOSAL SYSTEM Owner /Applicant Nam uri e_ c uQ Mailing Address Lot N I Z Engineer to Provide Permit # on CERTDFICA OF COMPLIANCE Permit Town or VDbtge Tax Map Block Lot Renewal_ Revision Date of Previous Approvai a al O Town - -.r.� � 1- ZIP - � � Building Type '�= =�L� Lot Ares FID Secdon Only Depth —Volume Number of Bedrooms Design Flow G /P /D PCHD Notification Is Required When Fill Is completed Separate Sewerage System to -s1-td-1Q06—G.I1.n.Sptl.TankanA taW ik ' To be constructed by T Address Water Supply; pdbllc Supply From Address or: y Private Supply Drilled by I ddress Other Requirements 3 I '�' represent that 1 am wholly and completely responsible for the design and location of the% proposed system(s); 1) hat the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regu a :ons of e Putnam . County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following thedate of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2)>Q the drilled well described above will be located as shown on the approved plan and that said well will be installed . cor arc ith the st dards, ru s d ragu a iii o s of ithe Putnam County Department f Health. 9// Date Sign P.E. _O R.A. _ Address /10- � ,tense No a_ IF APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued un ss construction of the -building has been undertaken and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health. Any change Or alteration of construction requires a new permit. Approved for disposal of domestic sanitary sewage d rivate water pply only. Date Zj - `"' � �%i z 2! BY Title ��--•� r PUTNAM ENGINEER TO PROVIDE PERMIT # COUNTY DEPARTMENT OF HEALTH ON CERTLFICAT OF COMPLIA CE, iti' 2 L Division of Environmental Health Services, Carmel, N. Y. 10512 PERMIT # it u CON TRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Pmtr5c) Q (% , "_�� 1) p Town or Vi lage / ^ Located at QkX l n � - *-- typ ^—� "° T" �1 v'L� Tax Map Block rot p� Subdivision ! % nV- A l..v W Subd. Lot # ]`n Renewal _� Revision Owner /Address ! Ari-R Pi ' t E �c) n 5 Date Of Previous Approval Building Type �� 1 LU '111 1 edl.� Lot Area Fill section only U Number of Bedrooms -- Design Flow G /P /D Goo P.C. N. D. Notification Required Separate Sewerage System to consist of /000 Gal. Septic Tank and at -Y" 7- ,R6A16 - . ; To be constructed by + / Address Water Supply: Public Supply From Private Supply to be drilled by L �'r3 -,� Address /_ Other Requirements -3 VA V 1 represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an regulations o e u nam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Healthwill be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage disposal system during the period of two (2) years Immediately following the date of the issu- ance of the approval of the Certificate of Construction Compliance of the original system or any repairs th eto ;2) that the drilled well describe above will be located as shown on the approved plan and that said well will be installed in ac ante th th J-atan rd 1 6 and regu a :ons of th Putnam County Department of /Healt . C} c{_ , 9 '/) Date(/ / / `�J S)gnedc G� P.E. R.A. APPROVED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and is revocable for cause or may be amended or modified when con ered n es y by the Commi oner of Health. Any change or alteration of construction requires a new permit. Ap roved for sal of domestic sa itar sewag and, iv ater _�\ — `^ Date BY ^e Title —, 3°t ; fi<* — , ` m^ $ 'PUTN AM • COUNTY: DEPARTMENT OF HEALTH . Pezmit` a �J lb, Division -of Environments Heal1`li Services, Carmel /V 'Y ••105-12 .:,=N UCTION PERMIT :FOR_ SEWAGE 'DISPOSAL SYSTEM Town or itl/�age Slock Lot fi_Located at Tax Map .-tr Sulxi., Lot # Renewal Revision Subdivision � � A �,�j��- t- •- "�/��pp�� (] 0 `•Owner /Address - _'�H�- Date .Of Previous Approval - - : i1(�(,�r�� 4>r Z Bwlding Type' Lot Area Fi11 Section only - Number of Bedrooms ' Design Plow c /P /D D..Notification Required Separate Sewerage System to tonsis of ! Gal Septic Tank. and-- To •y(%/ be constructed by �� K-Nf� Address Water', Supply: ` Pubhc SuPPIy', From T ' i Private- Supply' to be drilled by [ t:. -Address Other Requirements �� 1L;L 1 Z e_.A_)lr-/ ,y E _.. t 6 represent that l am wholl antl reompletely.responsible for'the design and location ot, ,the proposed system(s)i'1) that the separata sewage. disposal system Y above.:describeg will be constructetl as shown on;the approved amendment where to and `in accortlenee with the•standards; rules an regu a ions o r e . u nam ;County' bepartment of Health, and that on completion thereof a "Certificate of Construction Compliance ^. satisfactory; to the Commissioner of ";Heaithwitl ,, . milted to `the' Department, and a written guarantee =will De furnished the owner; .his successors, heirs -or assigns by the wilder, that said :tiuilder -will be sub,. _.. _ , place .:in good operating - condit,on bny` -part of .,said :sewage disposal system during the period of -two (2) years irnmedi ely.following, the- da'te of the issu- ance of the approval -qf 'the Certificate of Construction Compliance of the original system'or. any repairs thereto: h t the drilled well - described above will'be_ located as shown on the_appioved plan and.that said well will De` installed• in a tlance wdh the Bards e' ` nd iegu aeons, of* 'the Putnam' County-Departmeent -of Health - Date�( tc�77 r . Signed Add►ess`_ nse No a. APPROVED FOR CONSTRUCTION •This approval, expires: one year from the- date issued u` s nstru.tion of the building has be en.�undertaken and -is <. '.revoeatile for cause or maybe; amended or modified when considered',nece'sary` by, the Com' issioner of Health ° Any .change teration ,of- construction arequires a ne permit. -. Appro for disposal of: domesti mar a age; :an or pnvat -' water. only Oate ,i _ - - 'ey - Title ''!Rev.: 9 -81 s Ntnam County Department of Health Division of Environmental Sanitation AFFIDAVIT - CORPORATE (AvNER APPLICATION FOR PER_ %1JT APPLICATION SUBMITTED TO PUM4M COUNTY }HEALTH DEPARTMENT I TO: Commissioner of Health - In the matter of application for ------------ represent- that I am an officer or employee of the corporation and am authorized to act for ,l. iyl!b4 4 L�/a_,-ne of corporation) having offices at �! ✓4� e� J. Ae_,�Vvyc:K /�Y,Z, , 10 - _ _ _ - - - ________________ /______ - __ -Whose officers are President /i_iS_f_ ��iK EC.LI� �//�._ `�''� /13 / i4_V /le" S Name and Tddress) Vice - President _ _ _ _ _ _ _ _ _ _ _ _ _ _ /- (Name and Address) - - Secretary Gf� /�_C��iE%LL�_. -- - (Name and Address) Treasurer_ _ ___ _ ___ __ f - - (Name and Address) and that I am and will be individually responsible for any or all acts of the corporation with respect to the approval re ested and all sub- sequent acts relating thereto. Sworn to before me this day Signed I--- _ - of (o 19k, Title -_ - -_- Notary Publ ". `DUAME A, YOUNG WfiaAe: ; aqd' Cayneeltor at Law State "ew York ., No. 01YO4624= ,,��f_iopl in Putnam County e Irea 16�a+eh�39—t9 DES ®�- Corporate Seal PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health In the matter of application for: represent that I am an officer or employee joff the corporation and am authorized to act for �-) irJ® i•_c' Aq %� `C f .. l?C'V Z" c having offices at Name of Corporation Whose officers are: President: C, lCla LS (Name and Address) Vice - President: (Name and Address) i Secretary: L''lalc V0, (Name and Address) Treasurer: (Name and Address) and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Sworn to before me this day Signed: C of 19 T i t- e: �� ---�.. Notary Public Cornorate Seal 8/84 K PUTNAM COUNTY DEPARTMENT 7 Camel N Y.10511 r iII4�4e P 0 DIVI56ii 4 EnVIE0111111111,01111tal flOdthk SOM96i.' on eiiacAft-oCOMPLIANCE CONSTBUCTION PERMPt FOR SEWAGE - DISPOSAL SYSTEM 4 Town 44 V111mm, Located SubdMslon Nams SWW. Lot # oa LW Own 40 N al Revhtlon Date of P�re ", Approval �Cf M.1.g AM. Ti fiCl tom, To" � ZIP Only Type or -4--, iLot. 'Area BuIldfug' A V Depth V -TT-04 Numlier.qF Bed"ma -belsigif Fidiw G P D FCjiD NotlBcatlon 1. k.QWiW,*hii FM Is completed Seoarate'Sewpmge ya lo condstof 'GWI& Sepde 7[— To be colistmeW by - Address Pslbli S UPPLV, From �►ddreee 12--A&Irm on Other f `o�Poo� its' spies ei pq.Sibie si4n4nd location'o theL-.p that, 6,�,separate , L sewage - disposal syitem SM I �r M,tha� I in, wholly L :an CqTl above described %�#J!i,be cqnstru';!:edo� Shown On the aL :i'v;iih'tiie sian aids, rules ano.regula"ons:of tne; M-8 ppr4byed irrie - o and in KU County' Dipartmirit of. Health, and that'oh completion thereof a "Certificate, - of Construction 'Compliance ". , L - saitisi . actory to the hwill- Comrnissloner�of Healt be subMitted to the Deportrhent, -and a'-m4itten guarantee will be furnished the owner;-his successors, -heirs or assigns byjhe builder,L that said builder wi I place- in-, good 'oporati -condition -any of said sewage'- ;disposal . . systarn , duriimg the 'period 6f.itro�; air t �Wjll�Lcleildibird 4bove anCeLof the ippro%�&I:of �hi Certificate ,of-,C6nstr6c66h CornPlianci;of the oiiglnil:systirn or. 0 thit.-the drilled.- 0 app pan oil will be installed I a 'r wit the $to 'd -regulation Will lie Joiated as S66Wn q�.th Ad tjjjt�'S" we TPOL Putnam d ou* ' nty cleiiartn 04t of Health Date �o Ianad ' I A ,�_kq ress— License N . P i'6;iU6ctio a buildin has 1 an -APPROVE FOR-�CONSTRUCT16N:-.Thii�-p"p-r-oyiliik expires two.,ki4rs, from A tie, date 61 0 9 son ur�der'ta'k` d is revocable for cause he ane6dell or modified when considered necessary by' CbrirnlSsioner of Neat h:` Any-change or- alteration . , of co I hstruction Y L L requires •a new permit. A pproved for disposal of cloniisiic sanktry sawaglil, anoAaW private water er vqaply only. ev. Is? Date /4 - - --------- m "N 13 - - -� ------- - - - - -- '91 07/16 14:36 a 914 838 2052 FOX HILL FHKI 03 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health In the matter of.application for: Playland Drive, Patterson, New York 10504 I, Richard C. Heese represent that I am an officer or employee of the corporation and am authorized to act for SAWYER SAVINGS BANK (Name of Corporation) having offices at 87 Market Street Saugerties, New York 12477 Whose officers are: President: Anthony T. Semento Hoodstock, New pork (Name and Address) vice - President: Richard C. Heese. Kingston New York (Name and Address) Secretary: Gabriel Sottile Kinnston. Nev! York (Name and Address) Treasurer: Jannin,jen De Jager Saugerties, New York (Name and Address) and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and - all -subsequent--se s re t-ing thereto. Sworn to before me this 17th day of Jule 1991 Notary Public DIANE NELSON Notary Public. State of Now YG* No.4975416 OualVW In UWW Cole ft Commission Expires I —I y 93 8/84 Signed: Title: Vice President Corporate Seal Sawyer Savings Bank 87 Market Street Saugerties, NY 12477 (914) 246 -9541 To Whom it May Concern: SSME 1871 PEMII' O FDIC July 16, 1991 Mortgage /Loans 141 Ulster Ave. Saugerties, NY 12477 (914) 246 -2894 This letter is to authorize John V. Wheeler to act as the agent of-..Sawyer Savings Bank in connection with all permit applications for the property known as Lot 412, Playland Drive, Patterson, N.Y. RCH/ j mt tMember F.D.I.C. Very truly yours, SAWYER SAVINGS BANK C� Richard : "C. Heese Vice President into our second century... on the mainstream for savings