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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -3 -8 BOX 5 I I ' , 10 ' - 16 r9 I.'I - 9A i 00194 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMI TREATMENT SYSTEM PERMIT # Located at PAN g.a!�S-p Town or Village Subdivision name =5S !G Subd. Lot # Tax Map _ Block _5_ Lot _ Date Subdivision Approved Renewal Revision Owner /Applicant Name (a j�MF F4rzj?kFeQ Date of Previous Approval Mailing Address -2 -� -vL. :�,;1 , A= ye, iA7•, Zl,,SI .o Zip f D Amount of Fee Enclosedtzm Building Typ E& j Lot Area. No. of Bedrooms -4— Design Flow GPD Fill Section Only Depth . Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED I Separate Sewerage System to consist of gallon septic tank and W-1PF� 1 Other Requirements: D f g 0 To be constructed by !]M jM tlress Water Suuuly: Public Supply From Address or: _7C Private Supply Drilled by ID °B'-. `D5'T Address I represent that I am wholly and completely responsible. for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will 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 treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto , I Signed: V P.E. �_ R.A. Date ?mil i� INZE Address z= �� L uA cC^Piyt5L N_Al License # 10 CS z APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified wh"nsidered n qcessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe rt. proved JVJ discharge of domestic sanitary sewage only. f By: Title: fAL Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: o a Inspecte y: G, 2Z 622 Street Location PA Xt 721, Owner 72OSAFo7z Town Fx Z-L y Sew Permit # `! — it - 9 9 r TM #- /3 --3 - 8 Subdivision Lot # --7 1cptoss KU4 s 1. Sewaee Svstem Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ....................:"****- d. .Stone, brush, etc., greater than 15' from STS area ......... e. 100' from water course / wetlands ................. !. 2.91.6. k. II. Sewage System / °w Avefa'"e a. Septic tank size - 1,000 ......... 1, 250 ......... other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2.. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & Irenches e. Junction Box - properly set ........... ................ ................ f. Trenches Length required Dp Length installedo� 2. Distance to watercourse measured -t- /a o Ft.......... 3. Installed according to plan ......... ..............................: 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... . 8. Size of gravel 3/4 -1 %Z" diameter clean .................... 9.. "IIepth of gravel in trench 12" minimum ................... I, Pipe ends capped ........................ ............................... g. Pump or Dosed Systems Size ot pump chamber ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade....... :......... 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Buildin a. House l6cated per approved plans ........ :........... .............. b. Number of bedrooms ....................... ... ? ................... IV. Well a -Well located as per approved plans . ............................... - b. Distance from STS area measured ;�-- -2o ft........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted .......:....................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 6/97 V. ^av 'y-e BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 . Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 Date: S Z2. 5 ) O D 'Kell 4,j From: Gene D. Reed Putnam County Department of Health ZFor your information For your review As discussed Fax #: 27? --G76 9 No. Pages (Including cover sheet) Please respond Attached as requested Please call Notes/Messages 5. -T 5 , ©. l':Z- _ '% ? AG �-- F/ Z ry .! GAGL In/%/'6N �oiv1 /�LETEn /..d2friVkS / In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 2261. FROM PUTNAM ENGINEERING PLLC PHONE NO. :'914 225 2955 Aug. 23 2000 05:54PM P1 'o PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION ❑ ADAM �CYIENE All information must be fully completed prior to any Trenches V inspections being made. . PCHD Construction Permit it i- //` 19 Located: &a f?oa.d (T) (V) AY"ray, Owner /Applicant Name: 60f. Qasr-r TM L3._ _ Block -1 _ Lot Je, Formerly: Subdivision Name: (,mss 92ac s Subdivision Lot # Is system fill completed? �fR Date: A119 Is system complete? 1 ,Y Date: ®2 V02 Is system constructed as per plans? _ Is well drilled? ".e Date: Is well located as per plans? AeS Are erosion control measures in place? „ kS, I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Constnrction Permit and approved plans and the Standards, Rules and Regulations the County Department of Health. Date: 2 4'a Certified by: PE RA Design Professional �ria�w• Cng1,W.eir ,11 At Address: :Z .&ter _ . n Lic. # 0i %q comments: Form FIR -99 01/09/2001 08:10 FAX 845 2796769 PUTNAM ENGINEERING a PUT CO HEALTH LJTN M I �IGI�ELI�PLLCrnginee rs atects DATE., TO: FAX M4: RE: lQQ5AF -6'rTc'. e-O T. q-�,,2SurJ PAGES: , Including this ever sheet. J IA 001/002 (1�Y1��1'v�C�1VN ���fCti'�1C2 �Vi��• iifmf�� t �S i.�� fry► l dav� �t r� � CCi:� t u�o �c�cII.ti, � c�iCi.�� ��( -- - s s- �LQw,ef C, A- 5 tzw�p ac re • K1 From the desk o ... GARYA. TRETSCH 4 Old Route 6, Brewster, New Fork 10509 • Phone (845)279 -6789 • Fax (845)179 -6769 01/09/2001 08:11 FAX 845 2796769 PUTNAM ENGINEERING PUT CO HEALTH [MO02 /002 01/08/01 ?MON 16:49 FAX 002•._ N� NORTHEAST LA130RATORY OF DANBURY 39 ,MILL PLAiN ROAD - )DANSWItY, CT 06811E CT Cert: PH-D404 7a1i$S (203) 748-7903 - FAX (203) 74"652 NY Cert; 11471 REPORT TOt P.P. DEAL & SONS 4 PUINAM AVENUE BREWSTFA N.Y. 10509 SAMPLE SITE: SAMPLE PONT, SOURCE; 3=A.TMSNT 'x'EST P$RFORMED CH- ENISIRY: '+ Iron v Mangmcse LABORATORY REPO DATE SAMPLE COLLECTED: 12/27/2000 TINIE COLLECTED: 2-1.00 P.M, COLLECTED BY: Ism BF.AL DATE RECEIVED @ LAB: 12/27/2000 TESTED BY: LAB» l 1471 LAB Y.D.# HEAL-150 ._ ._ .... REPOAZ'DALTTIT ROSAFORTE, PAN RD., pATT'ERSON, N.Y. HOSE BIB AT TANK WELL NONE )MA X7IV W CONTA AI!TT R�E- SiiLT5 OD # LEVQ (MCL) OR STANDARD 0.041 mgt EPA236.1 0.30mg/L 4.01 MA EPA 243.1 0.50M31 CumbincdllrmtforiroaylusMmpna a-O.somg/L ml =milliliter mg/Ipmilligratns pea Liter NA -noue detected MCL--Mxximwn Contaminant LCV Cl k !Notification Level *'"Action Level . COMMENTS; All holding times (were) met. USMTS BASED ON SAM -PLES SUBMITTED: 12l28/2000 i i:a�0ldt03� DI7'BCtOI I- ABORATORY,129 M[i.,L STREET, BERLIN, CT 060370 (860)828 -4,787 - FAX (860)829.1050 TOLL FREE WITH N C!: 800 -826 -0105 ® OUTSIDE CT: 8004554 -1230 ,. :, "3. .. ._,. „� i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR S MENT SYSTEM PCHD CONSTRUCTION PERMIT #. ?-1 - 9 � b 7 Located at Q-b PRO (!_ooro Town or Village e� LT SOS Owner /Applicant Name c'ul: 2oy4fbw -T : - Tax Map 13 Block 3 Lot Q Formerly '` 2U i A4--alL c Subdivision Name s S �AfJ S Subd. Lot # Mailing Address Ub W af, Af T 3 Z n-r Y-t5ca N1 Zip %054q Date Construction Permit Issued by PCHD r Separate Sewerage System built by 6OX MAS payLT- Address KT- t✓tsc o k;-x jus -4 q . Consisting of 1 `2A5'O Gallon Septic Tank and 4-00 t-F ar 2' wi06 A(�ScsrtRQ Jtmj YL � Other Requirements: Water Supply: .A Public Supply From. Address on X Private Supply Drilled by F. F,12,eg-t., Asp i (rJ z_ Address _ s 2 �, 105oci' 1• Building Type 1 Pa vw\ k&-S . Has erosion control been completed? Number of Bedrooms 4 Has garbage grinder been installed ?' 1� I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam Department of Health. Date: �'lf `� 4,00'0 Certified by ^ P.E. R.A. (Design Profes ' Address QTUAro►,\ L->J6M,.le25(L4,t, u c- License # 0(o Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, r cat ion ' r change is necessary. s. By: Title: Date: /,/4J White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Pan Road Town/Village: Patterson Tax Grid # Map Block Lot(s) Well Owner: Name: Address: Gene Rosaforte, 280 West Street, Apt 3C, Mt. Kisco, NY 10549 Use of Well: 1- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm' Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 32 ft. - Length below grade 31 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: X Steel _ Plastic _ Other Joints: Welded X Threaded Other Seal: X Cement grout _ Bentonite Other Drive shoe: X Yes No _ Liner Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed X Pumped X Compressed Air Hours 6 Yield 5 gpm Depth Data Measure from land surface- static specify ft) During yield test(ft) 620' Depth of completed well in feet 705' Well Log If more detailed information, descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land surface 10 Drilling in over urden clay and boulders 10 Hit rock at 10' 10 32 Drilling in rock, set casing, grouted 32 705 Drilling in rock granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 5gpm Depth 640, Model 5GS15412 Voltage 230 HP 12 Tank Type WX251 Volume 62 gal . Date Well Competed 1/24/00 Putnam County Certification No. 002 Date of Report 9/26/00 IPerryL. Well Driller (signature) Beal NOTE:. Exact location of well with distances'to at leas"o permanent landmarks to be provided on a separate sheet/plan. Well Driller's Name P. s nc. Address: 4 Putnam Ave., Brewster, NY 1050 Signature: Date: 9/26/00 White copy: HD File; ,!�Xllow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 UTNAM l- NGINEEl4INE. PLLE. Englneers and Architects .SEPTIC SUBMISSION FORM TO: .Y c_, DATE: UV `I ZOO O PUTNAM COUNTY HEALTH D PARTMENT PROJECT: 6� \q-05 A f-' YZ-,T6 f Phi go-Ar p 'n\4 3" 6c,uj —Ia1*rZ -,rta -j ClSY� P CA l� u ENCLOSED, PLEASE. FIND: COPIES OF THE SSDS PLAN ❑ 2 COPIES OF THE HOUSE PLANS , , rdl Z Ml- = 2 A p� WELL L� HEALTH DEPARTMENT FEE ($ 2 ❑ SHORT EAF ❑ DESIGN DATA FORM ❑ LETTER OF AUTHORIZATION ❑ APPLICATION FOR WASTEWATER TREATMENT (PC -97) ❑ LETTER OF EXPLAINATION REMARKS: UI(ATUYL U—* Oki i FtNu•lvk S�Y1.vt� COPIES TO: SIGNED: 6�L A 4 OLD ROUTE 6, BREWSTER, NEW YORK 10509 - (845) 279 -6789 - PAX (845) 279 -6769 - EMAIL: pufeng@besfweb.nef ALASS NORTHEAST LABORATORY OF DANBURY 39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404 (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: P.F. BEAL & SONS 4 PUTNAM AVENUE BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: Total Coliform (Bacteria) PHYSICALS: Color Odor pH Turbidity CHEMISTRY: Nitrite N Nitrate N Alkalinity Hardness Iron Manganese Sodium Lead DATE SAMPLE COLLECTED: 9/11/2000 TIME COLLECTED: 11: 10 A.M. COLLECTED BY: ED. SCHAFFLER DATE RECEIVED @ LAB: 9/11/2000 TESTED BY: LAB #11471 REPORT DATE: 9/18/2000 ROSAFORTE, PAN RD., PATTERSON, N.Y. HOSE BIB @ TANK WELL NONE RESULT: 0 15 3- ORGANIC 8.13 2.9 <0.005 0.68 93.0 32.0 0.332 <0.01 110.6 ** 0.002 m1= milliliter mg/L = milligrams per Liter * *Notification Level ** *Action Level MAXIMUM CONTAMINANT LEVEL per 100 ml 0 per 100 ml 15 3 Units no designated limit NTUs 5 NTUs mg/L as N 1 mg/L as N mg/L as N 10 mg/L as N mg/L no designated limits mg/L no designated limits mg/L 0.30 mg/L mg/L 0.30 mg/L [Note: Combined Limit for Iron plus Manganese = 0.50 mg/L] mg/L 20 mg/L ** mg/L 0.015*** ND = none detected NTU =Units RESULTS BASED ON SAMPLES SUBMITTED:9 /11/2000 SAMPLE, AS TESTED ABOVE: X❑ OTABLE or INOT POTABLE (PER NEW YORK STATE DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Laboratory Director - NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 9 OUTSIDE QT: 800 - 654 -1230 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM or Purchas4r of Building Building Constructed by 'per ed)ID Location - Street I� Building Type I3 3 Tax Map Block Lot Town/Village C(L�SS �oY� Subdivision Name Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to. operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful .or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month Day Year 00 Signature: �U Contractor (OWwne "r) - Signature Corporation Name (if corporation) Address: `2180 �,i, �'`. A*1-f 3 C:, RT'( sco State Zip Title: ovi.��,r/' Corporation Name (if corporation) , Address: Z,00 (,J • S + • IXT. 3G �NrT I�t�Ca State i f Zip 1OV Form GS -97 NOV -09 -00 09:11 AM TOWN OF PATTERSON 9148782019 FROM : PUTNAM ENGINagRING PLLc PHONE N0, 914 22S 2955 Nov, 09 2000 W OEPM P2 a1lUcs R FOLAY * Lan TA 14OLINARI- iLNM M," 1. A&LO Kt fth oknw .34tadWt AAb A10 Dbraa► D&OW of hwsw 8rrrkw . DEFARTMW OF HEALTH I GWv4 Road BreWMI *W Yak 10509 • irlvlrN�ene11 Itutm pigra.it7o awc W1u 2z3 • mi Nluniq Smiew (914)111i6!!i WIC (914371 -MI To (014) V2 -=5 1437 ly In tmadu (914)171-4014 ftm69d 0141714414 Ax (914)1!1.6643 TAX MAP NUMBER: 5.0 );9911 ADDRESS: i Q TOWN: AUTff0A=l)'T0VVN OFFTCIAL: (Bw�lature) DAB: The Putnam County Department of Health will not issue a Certiticmte of Construction Compliance unless the above form is completed, Le., a legal 1911 address is assigned by an authoi ted town ot�ic�lai. This form is to be submitted with the application for a Certificate of Construction Compliance, (1911 vm*?" P.02 PUTNAM ENGINEERING, PLLC 102 Gleneida Avenue Carmel, NY 10512 Phone: 914 - 225 -3060 Fax: 914 - 225 -2955 e -mail: www.puteng @bestweb.net LETTER OF TRANSMITTAL Date: 41?1 T RE: ?4C36A70 1 °�PdvG TZ-T� CTS p�-r��san� �)I-3-a We are sending you attached under separate cover, the following items: Shop drawings Specifications Plans No. of Conies . Prints Copy of letter Other: Description These are transmitted: — For approval _ _ For your use _ — As requested — For review /comment _ Submit _ copies for distribution REMARKS: Copies to: Approved as submitted Approved as noted Returned for corrections Resubmit copies for approval SIGNED: If enclosures are not as noted, kindly notify this office. BRUCE R. FOLEY Public Health Director Paul M. Lynch Putnam Engineering 102 Gleneida Avenue Carmel NY 10512 Dear Mr. Lynch: LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 April 30, 1999 RE: Application to Construct a Subsurface Sewage Treatment,System at Rosaforte Pan Road (T) Patterson, TM# 13 -3 -8 The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on April 27, 1999 is incomplete. Please be advised that the following information is required before the Department may commence its review. • Please submit two sets of house plans for the above - referenced project. The review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information as to the completeness of your application. Please be advised that failure to submit information to the Department or to follow procedures is sufficient grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed Regulations and Putnam County Department of Health regulations. Should you have any questions or care to discuss this matter, please contact me at (914) 278 -6130 ext. 166. Ve ly yours, Robert Morris, P. E. RM/tn Senior Public Health Engineer 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 # kEpq Map 1-3 Block Lot(s) Well Owner: Name: Address: 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 M16_ gpm # People Served (- F*7, Est. of Daily Usage al. . Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................... ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes__X No Name of subdivision /, ZQ. 6 PnoskT -- xj _ _ _ __ Lot No. Water Well Contractor: 3:n 2Ft ��111 L,445D Address: Is Public Water Supply available to site? .................................. ............................... Yes No >_ Name of Public Water Supply: ''- Town/Village Distance to property from nearest water main: Proposed well location & sources of contaminat' sheet/plan. Date: 4 2t 9 Applicant Signature: A reGn-7sepwW 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. Aay revision or alteration of the approved plan requires a new permit. Well to be constructed by a water 1 iller cert' ied by Putnam County. IthDate of Issue Permit Issuing icial: Date of Expiration Title: Permit is Non - Transfers 1 White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 1A CI -- ---- - -- ...... '--................... r BATH %� 1 I <% I • •LS AJJ. ...� �s- -�1 BEDROOM 4 J� ` •�,� DRESSING' BEDROOM 3. WALK' 13' -0•' x 10• -0• — IN Imo, CLOSET MASTER BEDROOM BEDROOM 2 OPEN N 17'-0 x 18'•8'• 13.0' 15••s• i —� J PUTW! l COUNT Z Dummug in : sl.Z? .. .1 Roux '. r�r�;.tvi3 :1i f .O V I D —VIE. WMIS k. SECOND FL0.0R — - • T 60 r 828= 11344SF _. , , a OU KITCHEN i`% p DINING ROOM - ..f MORNING AGOM 13' 0•• w 12.,0.. L.....j LIVING ROOM 13'•O" • i �'•O'• L FIRST FLOOR L.. ii. •._ _ .� - .._ .. _ -1 OPEN ABOVE I FAMILY ROOM 13' 0" ■ 1 I' 0•• FOYER �• _ l 4828 1 Date 1 _ vl�_ RE: Property of C--t,—r1�. Located at ptrrJ (Town) PA-i Section Block Lot r � Subdivision of:� -y_ 11 Subdv. Lot # Filed Map # Gentlemen: Date This letter is to authorize PUTNAM ENGINEERING PLLC, a duly licensed , k professional engineer to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulgated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the constructia -s ids ystem or systems in conformity with the provisions of Article 145 or e4o OFN1 , c��in�La qft Public Health Law, and the Putnam County Sanitary Code. P.E., R.A., #b(42-TeI4 ( �q- FROM111121 1 Very truly yours, Signed ��✓4 Own r of Property ��O W,SVCjT E 3C Address rit; lm co co /Os-Ll � Town Telephone 14 -16.4 (2187) —Text 12.. SEG[R PROJECT I.D. NUMBER 617.21 k Appendix C State Environmental Ouallty Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART 1- PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR� l� " 1 2. PROJECT � 3. PROJECT LOCATION: Municipality ?'4 County . 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., ojrr provide emma 5. IS PROPOSED ACTION: 9,New ❑ Expansion ❑ Modification /alteratlon 6. DESCRIBE PROIEFLY: 'T/i7 ��/�C� �E FAM4 z-y ArV PF7 W 0-7 7. AMOUNT OF LAND AF ECTED: i 4 CD r Initially — acres Ultimately acres 8. WILL-PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ILa +Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? gResidential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ❑ Yes RNo If yes, list agency(s) and permlVaporovals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes �KNo If yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? 1 Yes 9410 I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE THE BEST OF MY KNOWLEDGE -TO Applicant /spun e: `' LL6-- Date: 4A,7) \ Signature: If the action is In the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER rHn t It— envIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.127 If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No 1. B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another Involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or.cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explain bi C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. ', C6. Long term, short term, cumulative, or other effects not identified In C1-057 Explain briefly. n C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. IS.THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (fo be completed by Agency) INSTRUCTIONS: For each adverse effect Identified above, determine whether It Is substantial, large, important or otherwise significant. Each effect should be assessed in connection with Its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant, adverse Impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box if you have determined, based on the Information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Name of Lead Agency Date E Title of Responsible Officer Signature of Preparer (If different from responsible officer) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES J APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: G 8WV F— 00'Z-nAgD 07E 2. Name of project: �1� 4-,�,e j 3. Location TN: ,4 �Sani 4. Design Professional: )7yJ7ttArn &^J IN PJxb Address: 10.,. en LC/yC -iPA AV9. 6. Drainage Basin: 5�, „ � c _.I-•� �,� n L "Al! • / L 2 7. Type of Project: _ Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this. project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ..:.................... ......:........................ Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 10. Has DEIS been completed and found acceptable by Lead Agency' ...:............ 11. Name of Lead Agency ��- 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ......................... ....... No 13. If so, have plans been submitted to such authorities? ........ ............................... /ll 14. Has preliminary approval been granted by such authorities? Date granted: t/,tLq 15. Type of Sewage Treatment System Discharge ................. surface water groundwater 16. If surface water discharge, what is the stream class designation? .................... I 17. Waters index number (surface) ..............................:............ ............................... N 18. Is project located near a public water supply system? ....... ............................... 19. If yes, name of water supply Distance to water supply���i'- 20. Is project site near a public sewage collection or treatment system? ................ 21. Name of sewage system Distance to sewage systed�f t 22. Date test holes observed 4/(6-/'J!7 23. Name of Health Inspector 6-er w �� . 24. Project design flow (gallons per day) ................................. ............................... 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? ......................... �. 2 27. Is any portion of this project located within a designated Town or State wetland? 28. Wetlands ID Number .................................... ............................... _ 29. Is Wetlands Permit required? ...... ............................... Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? /VZ 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No &L�2 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge'di §posal site or any other potentially known source of contamination? ............................... Yes/No /V (J DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... 34. Are community water and/or sewer facilities; planned to be developed within 15 years in or adjacent to project site ? ....................._ 35. Are any sewage treatment areas in excess of 15% slope? . ............................... A/0 36. Tax Map ID Number .......................... ............................... Map_ Blocks_ Lot 37. Approved plans are to be returned to ..... Applicant _� Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury) that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant SIGNATURES & OFFICIAL TITLE,,-,S,•,., 1 Mailing Addres s: ............. . V)--ekLEN e_1 DA Aqe PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES k DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM • Address• Located at (Street) -PAN Tax Map Block _� Lot &__ (indicate nearest cross street) Municipality F,4 zTE IE-50^J Drainage Basin L�57 B-R,,�IL4 SOIL PERCOLATION TEST DATA Date of Pre - soaking "7 Date of Percolation Test 4 t S Hole No. Run No. Time Start - Stop Ela Mi se Time n.) Dep th to Water' )From Ground Surface (Inches) Start Stop Water Level Dropp In Inches Percolation Rate Min/Inch .- 1 �a,o4- 3 2�3 3 0 : 2l 60: , l 1 �2. Z� 4 5 1 10:02 -0/7 2l ` 2 ' 4 5 l 2 4 5 i ests to oe repeatea at same aepth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. ` 2. Depth measurements to be made from top of hole. Form DD -97 DEPTH G.L. 0.51 1.01 1.5' 2.0 2.51 3.01 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.01 7.51 8.01 8.5' 9.01 9.51 10.01 TEbT FIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO.' HOLE NO. ) Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered /V/,4 Deep hole observations made by: Date -4/) Design Professional Name:,O ern A&/ Address: _(CD-2- C, L-r-Al �tC;A 4,V� J5, Signature:-: Design Professional's Seal OF NEW ROpell 08746 �ti t)P(Ay 011 av PUTNAM COUNTY DEPARTMENT OF HEALTH -A DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM 00" Owner Ro5A Fog r EA A/ KOA-D Address Located at (Street) 4e7NAI.IE-r Z- A VF Tax Map Block 3 Lot (indicate nearest cross street) Municipality PA-rzEr--no& Watershed j2A5-T 'Bl�-,ANc_H SOIL PERCOLATION TEST DATA Date of Pre-soaking 7 Date of Percolation Test .......... ............ ....... ........... I .... ........... ... ............... ..... ... ........... ... . ........... . . ........ .. ..................... .. ....... ................. ........... . . ........ - D th't ep .. . .... ......... .... ... ... ....... ... ... ..... ......... . ............. . ........ From F . ......... .. �rcd ... ......... ... ... .... ...... .. ..... ....... Hole)�o .. ............... .... ..... .... Ruff No ....... - ............ - Start ....... S Ela se TIme. ( Inches); , Stop QP Inches — .... .. .. . . fiA 2 91 3 4 02 1 lgt'024 L h p+ 7 2 '/ 7 -/01'33 1,6 aL 15.3 3 4 5 2 .3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE N.O. �_ HOLE NO. WA HOLE NO. Indicate level at which groundwater is encountered z1/a 117 Indicate level at which mottling is observed &014 P Indicate level to which water level rises after n g encountered _Alle / -� Deep hole observations made by: ' eee Date `f / Design Professional Name: Address: Signature: Design Professional's Seal :. `. 2 Na FINDINGS.vo e Zi2 r • u i �u•ui .: L-4 S A7 e I6 ' V,- i � i 6 � 0 >c TN r TO'R /C"2D.1/ 1 TRI o� "" Signature and Title " z Lapk,n 6 edge-redeipt of this report SIGNATtTRE '- u Jv: 02/96 • ` " `Title, � _ - Rev. - - - -- Yp Ilk � 6 t 9g _ l O• i. 6:1 —1000 Z4�41) V7 P7 91,4N om .c IS'OFj' ti � f , L L� iSO hi y 49 -t ' v ,�� X10 • I RECORD OF PHONE CONVERSATION Time: Q� Dater Person calling: j�.�t� Phone #: dq-95- �dfv0 Reason O Inspection: eep and /or Peres: Scheduled Field Meeting Time: Date'..__ Y N Tentative /to be confirmed (} ( ) Town: , Road /Street: 011/(Gf i Tax Map Comments: _: 53Z? 3 -I-e7 9 \ IC. 99 5 'ICAL, 130 110 . 53Z7• yb 7 . C. yea • I.IT At I � 6�a06 .i 600.00 SPA00 600.00 57 0 ,Jaw 57 i 58 6.49 AC. I3,.a ' g !' ti B331s 58 N 6.49 AC. 3.20 3.20 59 21.97 AC. 59 21.97 AC. CAI. SO 110,29. 60 ' – 60� oca0 &99 es ' 61 3&• 5.7f +xo2 1_.79 AC N \ �. —�� 6 506.62 � • 1 206 90 217.02 / 1 41 21L02 ' d 1 63 ;4 ' 63 I ac e e s a ( • 15.71 Al n65 � • s e l ' 115.71 AC. & is 3 At; •" . ,�� a ��•) �'� if J �eo�l \ eo5.'le � \ 13.07 1` IP6.� 8 1319.33 AL � 54 \ } e ee.ae 53 5.9� 52 55 `1 1 7.9 AC. 1 o. 78.90 AC. ,\ J eej5B0 J 9 l JL 1 1161.63 4 ' 47.4`. S 67 1 O 56 81.48 AC. Denton: '.,Holme Lake (Solomon S Lake I. 12531 0 f I ill 84 May Corn 311 .;� / 1' n QQ J 311 164 ES, f 1.. U 12563 Mendel Pond .61 m. 22 R 164 iaines 0 ffva Lake, num rn ....y l RECORD OF PHONE CONVERSATION Time: Date: Person calling: &I NazG� Phone #: Reason O Inspection: eep and /o Peres: Scheduled Field Meeting Pere-5 t"�1"e -socK Time: Date: / Y N Tentative /to de confirmed ( ) ( ) Town: PA -rT Road /Street: Tax Map #: Comments: owner 2©:�4ro9TL� ' - Ld f 7 (f ? S c OAD 's BRUCE R. FOLEY Public Health Director Paul M. Lynch Putnam Engineering 102 Gleneida Avenue Carmel NY 10512 Dear Mr. Lynch: LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 'Fax (914) 278 - 6085 April 30, 1999 RE: Application to Construct a Subsurface Sewage Treatment System at Rosaforte Pan Road (T) Patterson, TM# 13 -3 -8 The Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on April 27, 1999 is incomplete. Please be advised that the following information is required before the Department may commence its review. • Please submit two sets of house plans for the above - referenced project. The review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information 'as to the completeness of your application. Please be advised that failure to submit information to the Department or to follow procedures is sufficient grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed Regulations and.Putnam County Department of Health regulations. Should you have any questions or care to discuss this matter, please contact me at (914) 278 -6130 ext. 166. Ve U ly yours, Robert Morris, P. E. RM /tn Senior Public Health Engineer &6 L'? _ / PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT STREET LOCATION 7,l/l+i R04'A NAME OF OWNER &A roP— REVIEWED BY RINI, GR, AS, NIB, B S K, DATE Sy TAX MAP # L3--3 —,' Y N DOCUMENTS Y '�; 60* 4_1 7 PERMIT APPLICATION PC -1- PC 9iz WELL PERMIT _ PWS LETTER LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) <ORPORATE RESOLUTION SHORT EAF PLANS - THREE SETS REQUEST ,;��URIII- YISIOY LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED PERERA,TE O�aZ 1 F3LU QUIRED DEPTH CURTAIN DRAIN REQUIRED GENERAL .00ATED IN NYC WATERSHED 'LANS SUBMITTED TO DEP )�ELEGATED TO PCHD )fP APPROVAL, IF REQ'D )EEP TEST HOLES OBSERVED 'ERCS TO BE WITNESSED ?X- APPROVAL SSDS ADJ. LOTS q LANDS (TOWN/DEC PERMIT REQ'D ?) DATA ON DDS PLANS & PERMIT SAME FIFE 1969 NEIGHBOR NOTIFICATION t TTER BI/ZBA i00 YR. FLOOD ELEVATION OTHER REQ'D PER,MIIT(S) REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE GRAVITY FLOW - EROSION CONTROL:HOUSE,WELL, SSDS PERC & DEEP HOLES LOCATED ° REPRESENTATIVE OF PRIMARY & EXPANSION LOCATION MAP EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE ff:MPED, PIT & D BOX SHOWN & DETAILED HOUSE - NO.OF BEDROOMS WELLS & SSDS'S WAN 200' OF PROPOSED SYS. PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) 1�1.OUSE SEWER -1/4" FT. 4 "0; TYPE PIPE INO BENDS; MAX.BENDS 45° W /CLEANOUT FILL SYSTEMS CLAY BARRIER 1 HORIZ�TA 'LOP ADE FILLS FILL NO FILL CER NOTE IFIRIL PROFILE & DIMENSIOR�,� OLUME FILL IN EXPANSION AREA TRENCH ,q_� LF TRENCH PROVIDED �li'�' 60 FT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED SEPARATION DISTANCES SPECIFIED BARGE TREES OP OF FILL 20" TO FOUNDATION WALLS _ 'WELL TO PL I00' TO WELL, 200' IN DLOD, 150' PITS TO STREAM WATERCOURSE LAKE (inc. expan) CATCH BASIN, 35' STORMDRAIN, PIPED WATER IO' TO WATER LINE (pits -20') TERMITTENT DRAINAGE COURSE 4007500'RESERVOIR, ETC. _150' GALLEY SYSTEMS CONSTRUCTION NOTES FN to CDS= >50/oJW- 4%,25'- 3 0/o,30'- 2 %,35' -1 0/o,100' - <I% DESIGN DATA: PERC & DEEP RESULTS M to CD discharge /100'with 182 cons day discharge T CONTOURS EXISTING & PROPOSED SEPTIC TANK Uo DRIVEWAY & SLOPES, CUT Eq!jT10' FROM FOUNDATION; 50' TO WELL FOOTING /GUTTER/CURTAIN DRAINS WELL OIL TYPE BOUNDARIES DIMENSIONS TO PROPERTY LINE [�o TITLE BLOCK; OWNERS NAME,ADDRESS LOCATION OF SERVICE CONNECTION M #,PE/P A; NAME,ADDRESS,PHONE# DATE OF DRAWING/REVISION TUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET PROPOSED FINISH FLOOR AND BASEMENT EL. COMMENTS: PT 1 ''A r X MM j",. L um : z �a' #kM� {�i•"�ht�a 1 - � . Uj L.- :. ...- �Lf - --�� . (•I ?' ?�? •• „ H tr * a OV r ,-' 2.50 GAL TANK 0 VAR, if Y ry ,,• 12.50 L- . p� 3` ,.4 PUTNAM ENGINEERING, PLUG- ENGINEERS - ARCHITECTS 4 OLD ROUTE 6, BREWSTER, NEW YORK 10509 r. (845) 279 -6789 FAX (845) 279 -6769 REVISIONS NO: . -I DATE WELL;: C to 5 JR S r D."S+7x 1 2 3 4 5 10 11 12 13 14 l5 / Co lk z6 SL 5� 64 72 7y l3a X32 y _ 1Z9 `iz6 8� 90 94 9q 90 93 q7 to �D 75 27 37 'il 130 I Z� %Z�: /2f . 7f 76 78 82 79 7-1. g ( 83 ,.4 PUTNAM ENGINEERING, PLUG- ENGINEERS - ARCHITECTS 4 OLD ROUTE 6, BREWSTER, NEW YORK 10509 r. (845) 279 -6789 FAX (845) 279 -6769 REVISIONS NO: . -I DATE WELL;: C to 5 JR 'i L-D No.6 r8 AMAA--,I No. A�:t 8 WELL 5"Y .OF" FROM z1'Y rMPA W FOR W., ^goQk`'i'�, Il l LVqq��.1�q(yV�L/� -7 . " A{NEN"V FINAL 51WM5m FLAT OF Q805 ". FA.ED mAP NO. icAw. FILep 10 -26-84 SFT we IN -rom Or IPA 1'T R5ON 12MAM GO,, N.Y, 5GA X: I" - 50' MaAAMk -4,1999 COPri2a-r p 1999 TeWY BERMWOWF COWM5. &L. Ma—ff5 RFSERVeV PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL U)/b -0 please print or type PCHD Permit # p'° 1 1' q•-1 Well Location: Street Address: Town/Village Tax Grid # 20 A'i-i 9m 'T14TTZ=,3s,1 Map 13 Block 3 Lot(s) Well Owner: Name: Address: &'>t - Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitonng Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought S gpm # People Served _+�_ Est. of Daily Usage (opo gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason CX1 S 06, i,N&U, 5 Ve, k +164 S ly L NIL CdIJ -u 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. J— Water Well Contractor: P rF 6e__. a S'b1 j-' Address: 'Sv2k'L , "I Is Public Water Supply available to site? ................................................ :................ Yes No Name of Public Water Supply: �l� Town/Village Distance to property from nearest water main: ►M0 1 + Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: 1 16't 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 wat ell driller ce 'fied by Putnam County. Date of Issue Permit Issuin al: e tII&O Date of Expiration C Title:., . � ` "" Permit is Non- Transf rrab e White copy - HD file; Yellow copy - Building Inspector; P A ppy: = Owriei grange copy -Well driller Form WP -97. a, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL �q K41 please print or type PCHD PERMIT. # • Well Location• Street Address: TownNillage Tax Grid # AR%Z'o?./ Map 13 Block 3 Lot(s) Well Owner: Name: Address: Well Type: Drilled Driven Dug Gravel Other Depth Data: Well Depth %S-- ft ` Static Water Level G Zv ft Date Measured Z a� Use of Well: 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: - �/ /6j 0 Reason For Abandonment: S ✓LC7uP'- GrilsT�T Description of Work To Be Performed: Date: 1 Z� / Applicant Signature: fly ��S�rFo�s 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 in tion delineated on the application for this permit has been completed. 131101 Dat of Issue Permit Issuing Official Title White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 PLiTNAM NGINEERING, PLLC. Engineers and Architects January 26, 2001 Robert Morris, P.E. Putnam County Health Department Geneva Road Brewster, New York 10509 RE: Well Permit Gene Rosaforte Lot 7 Crossroads Pan Road Town of Patterson Dear Mr. Morris: Attached for your review and approval is a Well Permit Application and an Application to Abandon a Well. Also attached is a copy of the As -Built Plan showing the location of the existing well and the proposed location of the new well. In addition, a copy of a portion of the original filed map showing the surrounding wells and septic systems is submitted for your information. The existing well at the Rosaforte residence has an extremely high content of sulfur, which upon investigation, will be very costly and ultimately less desirable to treat as compared to drilling for a new source. It is therefore requested that you review and approve the attached Permit Application at your earliest convenience. Very truly yours, PUTNAM ENGINEERING, PLLC Gary A. 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