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00231
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
I(�-- WELL COMPLETION REPORT
Well Location
Street Ad re s:
IS
�AAe
Town Nillage.
6C . oh
Tax Grid #
Map Block Lots)
Well Owner:
Name: Address:
3-6 e C4 an i�u► i�G
Use of Well:
1- primary
2- secondary
_L Reside tial
Business
Industrial
Public Supply Air cond/heat pump Irrigation
Farm Test/monitoring Other(specify)
Institutional Standby
Drilling Equipment
Rotary
Cable percussion _X_ Compressed air percussion Other (specify)
Well Type
Screened
Open end casing Open hole in bedrock Other
Casing Details
Total length M ft.
Length below grade 3 ?ft.
Diameter 7 in.
Weight per foot _lb/ft.
Materials: Steel _ Plastic _ Other
Joints: _ Welded _X Threaded _ Other
Seal: _ Cement grout X Bentonite Other
Drive shoe: >( Yes No
Liner _ Yes XNo
Screen Details
i
Diameter (in)
Slot Size
Length(ft)
Depth to Screen (ft)
Developed?
First
_ Yes—No
Hours
Second
Well Yield Test
Bailed
Pumped _ Compressed Air
Hours _
Yield gpm
Depth Data
Measure from land surface- static (specify ft)
X02 Teel-
During yield test(ft)
&A
Depth of completed well in feet
6DS
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
6
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump /Storage Tank Information
A
Pump Type d: ; ; Capacity /'
Depth Wb Model /j
Voltage V6 HP_
Tank Type4WiV� Volume
aQ
Date Well Com leted
a i9 D5
Putnam County Certification No.
O6�
Date of R port
z �9 �S
Well Driller (signature)
NOTE: Exact location of well with distances to at least two permanenf landinarks to be provided on a separafsheet/plan.
Well Driller's Name Z41&rt R, 11L, a;# tsos Address: / AlAr90, NY 1?03
Signature: Date: q O,S
White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC -97
�0*v
UT NAM COUNTY DEPARTMENT OF HEALTH
ISION OF ENVIRONMENTAL HEALTH SERVICI
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM
PCHD CONSTRUCTION PERMIT #
/6- of
Located at 31 V", s lii 6 4/1-f
Owner /Applicant Name
Formerly ASn A `�&Xm TES
aigjWA
Town_ or Village 01 r -,— Rs -0,V
Tax Map 6 Block Lot
Subdivision Name
A ST"O 4 SPCC ATE S
Subd. Lot # (L
Mailing Address 16 Fo (Z'069I a-Z UA -/, MA H010/i C Zip rah
Date Construction Permit Issued by PCHD for zl —04
Separate Sewerage System built by
Consisting of Gallon Septic Tank and
Other Requirements: POPE
COA)SMUCT11W 4T �vA91/1fr7 t)4-V P.
Address �G lmlz
5'00 LF 1J690iZPT70,Q 71MOCHIFS
Water Supply: Public Supply From '^ Address
Iot t AZT-31t, j , ,try
r: x Private Supply Drilled by i � `SON S Address Y �3 "
Building Type
,QS 10E/U7tA L Has erosion control been completed? YES
Number of Bedrooms
5% Has garbage grinder been installed?
�J
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 County epartment of Health.
_ ZY OS %�S i TII'E�� G� rN�Fa'21NC�
Date: Certified by v�I lip/ —P.E. R.A.
hArZ � P4ACE, ,� (Design ofessional) q cr0
Address r License # J
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
revocat' n, modificati or change is necessary.
By: Title; Date:
White copy - HD Fil ; Yell w py - Building Inspector; Pink copy - Own r; Ae copy - Design Professional
Form CC -97
PUTNAM'COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
,40*# 1(-- 'WELL COMPLETION REPORT
Well Location
Street Ad re s:
IS
hE
Town/Village:
ph
Tax Grid # '
Map 6 Block 3 Lot(s)
Well Owner:
Name:
Toe, M
Address:
8u;1c��.
Use of Well:
1- primary
2- secondary
1_ Reside tial
Business
Industrial
Public Supply Air cond/heat pump Irrigation
Farm Test/monitoring Other(specify)
Institutional Standby
Drilling Equipment
Rotary
Cable percussion _.k Compressed air percussion Other (specify)
Well Type
Screened
Open end casing Open hole in bedrock Other
Casing Details
Total length I
JD ft.
Length below grade ?eft.
Diameter % in.
Weight per foot 1Z_1b /ft.
Materials: Steel _ Plastic _ Other
Joints: Welded _X Threaded Other
Seal: Cement grout Y_ Bentonite Other
Drive shoe: X Yes No
Liner:_ Yes 7, No
Screen Details
Diameter (in)
Slot Size
Length(ft)
Depth to Screen (ft)
Developed?
First
_ Yes No
Hours
Second
Well Yield Test
Bailed _
Pumped Compressed Air
Hours..6-1
Yield gpm
Depth Data
Measure from land surface- static (specify ft)
tee'
During yield test(ft)
Depth of completed well in feet
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
:IX
Kai✓
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump /Storage Tank Information
Pump Type�1 Capacity A&M
Depth v M odel7 d
Go
Voltage ,06 HP /
Tank Type %iYaf Volume�� /ah
Q
1;10
Date Well Com leted
a X905
Putnam County Certification No.
00-7
Date of Report
a �9as
Well Driller (signature)
NOTE: Exact location of well with distances to at least two permanenf landmarks to be provided on a separafsheet/plan.
Well Driller's Name 141&rt A 11qTA t.2-hs Address:
Signature: Date: gll dS
White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC -97
Mar 13 08 04:07p TOWN OF PRTTERSO 845- 878 -2019
co,,,
le- {
sR.t;Cc R -OLD`` . ��1 LUR�TiA Iti10Li2tiAR; N., I�LS.N.
pub!!:: Fieahh D.r'ec:c.- �f : :ocia c P�o!(c HecL'?: Dirz:tcr
D(rec:or of Pstlarr se ^)(ct:
DEPARTtiLET,7 OF PMALTH
1 Geneva. Road
Hrcws:cr, Now York 10509
'Eo.iroameatal Health ;9L) 278 -6136 Fax (414) 279-7921
tu:oltxt Sa vices (9141 275 - 555E WIC (91.412 IS - 667.3 Fite (914) '_78 - 60®_
Early IntetYeacioa (911)2;8 -0:4 'Prtschaal (914)78.6032 Fnz(914)2 ?8 -6643
r
OWNERS NAME: J d rt /��t �- '4
E911 ADDRESS. 3 / ✓` " `,�� /.��� � ✓r
TOWN: / [�Ji ✓' J�h T'-� o ti'
AUTI• CL L.
(Signature)
A, -rE :
3/ /S /t��
The Putnam. County Depa.-tment of Health will not issue a Certificate of
Construction Compliance unless the above form is completed, i.e., a lec al E91.1
address is assi;ned by an authorized town official. This form is to be submitted
*Zth the application for a Certificate of Construction Compliance.
1t7 : ! YFt: ��•1)
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40, W 46
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AS -BUILT MEASUREMENTS
NO.
rA RACE
CORNER
GAB GE
COMB?
REMARKS
1
47'
78'
1•5W cAUON SiPnc TANK
2
86.5'
95'
d.EANOUT
3 j
135'
132'
DROP eox
4
141'
137'
DRDP BOX
5
147'
142.5'
DRW Box
6
153'
148'
DROP BOX
7
159'
153'
DROP eox
8
154'
122'
OW OF nwvQ"
9
160'
128'
80 OF nwva+
10
165'
134'
M of MCH
11
171'
140'
END OF MCH
12
176
145.5'
END OF nMVCH
13
135'
160'
END of MCH
14
141'
164.5'
END OF nWvCH
15
147'
168.5'
END c." MVCH
16
152.5'
173'
avD of MCH
17
158'
177'
END OF n?DVCH
f'cztr._�!n [�c�s,,, 7 oya *r► ;�t of Health
J)ivision of L�r�i onLzaatal Realth Services.
:.pproved as noted for con.forp ance with
applicable F'ule;s and Re L,j.ations of tha
Putnam County HAlth DUart�,ont_
e _
=,,Yr ,y _
NO. I DATE I REVOfON I BY
....J N S T E
l` ENGINEERING, SURVEYING &
Vyii .f
LANDSCAPE ARCHITECTURE, P. C.
PROJECT
SS TS FOR CAMPANA
LASTRO ASSOCIATES LOT 72)
M VISTA LAN& PATIERSM PUMAM CWNTY, NEW YORK
3 Garrett Place
Carmel, NY 10512
(845) 225 -9690
(845) 225 -9717 fax
www.insite— eng.com
INS/ TE -
ENGINEERING, -SURVEYING B
LANDSCAPEARCHITECTURE, P.C.
3 Garrett Place (845) 225 -9690
Carmel, New York 10512 Fax: (845) 225 - 9717
TO: Putnam County Health, Department
1 Geneva Road
Brewster, NY 10509
LETTER OF TRANSMITTAL
Date: -0,8
Job No._ 98105.312
Attn: Mike Budzinski,.P.E.
Re: SSTS for Astro Associates, Lot 12
31 Vista Lane, Patterson
TM# 13 -3 -82
WE ARE SENDING YOU N Enclosed ❑ Under separate cover via the.following Items:.
❑ Shop Drawings N Prints ❑ Plans ❑ Samples ❑ Specifications
❑ Copy of Letter ❑ Change Order ❑
COPIES
DATE
NO.
DESCRIPTION
1 - T
Revised 10 -30 -07
CC -97
SSTS Certificate of Compliance
1
3 - (� ®8
—
E -911 Form
3 _
9 -30 -07
GS -97
Guarantee of SSTS
1 �~
2 -27 -08
- -
Well Test Results
1
2 -19 -05
WC -97
Well Completion Report
5 _... --
3 -12 -08
AB -1
As Built Drawing
1
3 -6 -08
21340019
$300.00 Fee
THESE ARE TRANSMITTED as checked below..
NFor approval ❑Approved as submitted ❑ Resubmit Copies for approval
❑ For your use ❑ Approved as noted ❑ Submit Copies for distribution
❑ As requested ❑Returned for corrections ❑ Return Corrected prints
❑ For review and comment ❑
REMARKS:
This submission is revised for a permit renewal.
/J
COPY TO: Joseph Campana SIGNED:
Joh M. Watson, P.E.
President / Senior Project Manager
IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE
lot 3- 12- 08.dot
YML ENVIRONMENTAL SERVICES
321 Kear Street
Yorktown HeiQ_hts, N.Y. 10598
(914) 245 -2800
Albert H. Padovani, Director
LAB #:'1.801285 CLIENT #: 11447 STAT PROC PAGE: 1 of 1
PIEKOS, MALGONZATA DATE /TIME TAKEN: 03/14/08 09:00
285 - SECOf2- R-D -:- . DATE /TIME REC ' D : 03/14/08 09:50
MAHOPAC, NY 10541 REPORT DATE: 03/17/08
PHONE: (914)- 621 -2885
SAMPLING SITE: 36 LOCKWOOD RD, MAHOPAC, NY SAMPLE TYPE..: POTABLE
: LAUNDRY TAP PRESERVATIVES: NONE
COLD BY: JERZY PIEKOS TEMPERATURE..: < 4C
NOTES...: COLIFORM METH: N/A
DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD
03/17/08 TURBIDITY (TUR
>, v3
ca
i
`
C
C-4
SUBMITTED BY:
Albei'"C
Direc or
<1 NTU
Padovani, M.T.(ASCP)
0 -5 NTU
SM 18 (21305)
ELAP# 10323
YML ENVIRONMENTAL SERVICES
321 Kear Street
Yorktown Heights, N.Y. 10598
(914) 245 -2800
,Albert H. Padovani, Director
LAB #: 1.800837 CLIENT #: 8279 NON STAT PROC PAGE: 1 of 2
CAMPANA, JOSEPH
16 FORRESTAL WAY'
MAHOPAC, NY 10541
DATE /TIME TAKEN: 02/18/08 10:00
DATE /TIME RECD: 02/20/08 02:50
REPORT DATE: 02/27/08
PHONE: (914)- 621 -5414
SAMPLING SITE: 31: VISTA LANE, PATTERSON, NY SAMPLE TYPE.'.: POTABLE
:.KITCHEN TAP PRESERVATIVES: NONE
COL'D BY: JOSEPH CAMPANA TEMPERATURE..: < 4C
NOTES...: COLIFORM METH: MF
DATE
FLAG PROCEDURE
RESULT
NORMAL - RANGE
METHOD
PUTNAM
CNTY PROFILE
02/20/08
MF T. COLIFORM
ABSENT
/100 ML
ABSENT
SM
18 -20 9222B
02/23/08
LEAD (IMS)
<1
ppb
0 -15 ppb
SM
18 -19 3113B
02/27/08
NITRATE NITROG
1.09
MG /L
0 - 10
SM18- 20450ONO3
02/20/08
NITRITE NITROG
<0.01
MG /L
1.0 MG /L
SM18- 20450ONO2
02/21/08
IRON (Fe)
<0.060
MG /L
0 -0.3 mg /l
SM
18 -20 3111B
02/21/08
MANGANESE (Mn)
<0.010
MG /L
0 -0.3 mg /l
SM
18 -20 3111B
02/21/08
SODIUM (Na)
28.9
MG /L
N/A
SM
18 -20 3111B
02/20/08
pH'
6.9
UNITS
6.5 -8.5
SM18 -20 4500HB
02/21/08
HARDNESS,TOTAL
288
MG /L
N/A
SM
18 -20 2340C
02/21/08
ALKALINITY (AS
278
MG /L
N/A
SM
18 -20 2320B
02/22/08
TURBIDITY (TUR
<1
NTU
0 -5 NTU
SM
18 (21308)
COMMENTS:
MFTC THESE
RESULTS INDICATE
THAT THE
WATE G
) (WAS NOT) OF A
SATISFACTORY SANITARY QUALITY ACCORDI
HE NEW YORK STATE
AND EPA FEDERAL DRINKING WATER
STANDARDS,
FOR THE PARAMETERS
TESTED, AT THE TIME OF
COLLECTION.
Pb /Cu LEAD limits for p
EPA Lead & Copper
than 10% of their
than 15 ppb ; and a
treatment must be
potential.
ablic schools are set at 15 ppb.
Rule for Public Systems requires that no more
distribution points have a LEAD value of more
COPPER value of 1.3 mg /L,.else water
undertaken to reduce the waters corrosive
Fe /Mn If both iron and manganese are present, their total value
combined shall not exceed 0.5 mg /L.
Na No limits for Sodium are proscribed. Suggested guidelines state
that for people on a sodium restricted diet,the water should
contain no more than 20 mg /L of Sodium. For those on a
moderately restricted diet, a maximum of 270 mg /L of Sodium
YML ENVIRONMENTAL SERVICES
321 Kear Street
Yorktown Heights, N.Y. 10598
(914) 245 -2800
Albert H. Padovani, Director
LAB #: 1.800837 CLIENT #: 8279 NON STAT PROC PAGE: 2 of 2
CAMPANA, JOSEPH
16 FORRESTAL WAY
MAHOPAC, NY 10541
DATE /TIME TAKEN: 02/18/08 10:00
DATE /TIME RECD: 02/20/08 02:50
REPORT DATE: 02/27/08
PHONE: (914)- 621 -5414
SAMPLING SITE: 31 VISTA LANE, PATTERSON, NY SAMPLE TYPE..: POTABLE
: KITCHEN TAP PRESERVATIVES: NONE
COLD BY: JOSEPH CAIVIPANA TEMPERATURE..: < 4C
NOTES...: COLIFORM METH: MF
DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD
is suggested.
pH pH SCALE IN WATER RANGES FROM 1 -14. MEASUREMENT OF pH IS ONE OF
THE IMPORTANT AND FREQUENTLY USED TESTS.IN WATER CHEMISTRY.
WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL .PIPES AND
FIXTURES. THE NORMAL RANGE OF pH IS 6.5 TO 8.5.
Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM
CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG /L. THE
HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG /L, DEPENDS ON THE
SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED.
SOFT WATER: 0 -70 MG /L VERY HARD WATER: ABOVE 300 MG /L
MODERATELY HARD WATER: 70 -140 MG /L I MG /L = MILLIGRAM PER LITER
HARD WATER: 140 -300 MG /L (1 grain /gallon = 17.2 MG /L)
1
SUBMITTED BY: v
Albert H. adovani, M.T.(ASCP)
Director
ELAP# 10323
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner or Purchaser of Building Tax Map Block Lot
Building Constructed by TownNillage
Location - Street Subdivision Name
t.2
Building Type
Subdivision Lot #
I represent that 1 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 Departm ent I 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 VV Day .70 Year � –=_-- Signature:
— Title: TL��
General Contractor (Owner) - Signature
eX
Corporation Name (if corporation),' 11'1_ Corporation Naive (if corporation)
Address: Address: ` 7r-
State Zip State A/_ �° Zip l�)�i�
T'orm GS -9'
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
r� CONSTRUCTION PERMIT FO GE TREATMENT SYSTEM
,/PERMIT #
Located at Oti l E 3 11 IV LA E Town r Village- MSW
Subdivision name As& 4550 1ATES Subd. Lot # A&2 Tax Map I.3 Block Lot S5 I;2
Date Subdivision Approved /0 Renewal Revision
A5fK0 PtSSoGt�fES
Owner /Applicant Name Gln loves pESCg106 Date of Previous Approval ----
Mailing Address qZ - ,s0 a t)E 45 bLyLEVA R EGtO 'PAZ. N' y Zip t 3
Amount of Fee Enclosed �300=o4
Building Type &� 5101501AL Lot Area 1, Iq c No. of Bedrooms :J Design Flow GPD JOOO
Fill Section Only Depth Volume
PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Separate Sewerage System to consist of 1 YQ0 gallon septic tank and S OO V of
2' I j06- j (�SDR Qfialy" �Q�r�ct�ES
Other Requirements: )VIA d/A
To be constructed by w wow Address
Water Supper Public Supply From
Address
,,or: _ Private Supply Drilled by LI N ICNOWW Address
]!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.
Signed:
Address
P.E. R.A. — -- -- Date 2)
i MEF 1�E) ~ +��i�t 1�►'G, Lq�',DScJti'� ri�TECii��, �;
2- w sac License # 61131
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 whe nsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires
a new pe t. proved r discharge of domestic sanitary sewage only.
By: / Title: O �' 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
APPLICATION TO CONSTRUCT A' WATER WELL
please print or type PCHD Permit # — <]
Well Location:
Street Address: QT (3-2 f
Tax Grid #
Map Block 3 Lot(s)S5,
Well Owner:
Name: A';- IKOASScciAreS
Address:
qZ -SG QUEENS PvvLE AIV
CIO lour5PESc ��•
�
f f6d PARK, N Y.
Use of Well:
Residential Public Supply Air /Cond/Heat Pump Irrigation
1- rimary
Business Farm
Test/Monitoring Other (specify)
2- secondary
Industrial Institutional
Standby
Amount of Use
Yield Sought __,57 gpm # People Served —,5:— Est. of Daily Usage _30.0 gal.
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 No
Name of subdivision ASM A SST CiAffj
Lot No. �_
Water Well Contractor: u�oK,ya6JN
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 contamination to be provided on separate sheet/plan.
Date: b -cal 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 (3 0) days of the completion of water well construction, the applicant or their designated
representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the
requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form
provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or
+ well driller shall take appropriate action to assure that any and all water and waste products from such
well drilling operations be contained on this property and in such a manner as not to degrade or otherwise
contaminate surface or groundwater.
APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless
construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be
amended or modified when considered necessary by the Public Health Director. Any revision or alteration
of the approved plan requires a new permit. Well to be constructed by a water 11 iller certified by Putnam
County.
Date of Issue Permit Issuin g Off
�
DDate of Expiration Title:
Permit is Non- Transferra le
White copy -,HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
Department of
Environmental
Protection
465 columbus Avenue
Valhalla, New York
10595 -1336
Joel A. Miele Sr., P.E.
Commissioner
Bureau of Water Supply
Michael A. Principe, Ph.D.
Acting Deputy Commissioner
Tel (914) 742 -2001
fax (914)742 -2027
va��TV o�rne F�T
ENTAL PR�'tE��
www.nyc.gov /dep
(718) DEP -HELP
April 19, 2001
Robert Morris, RE
Putnam Co. Health Dept.
4 Geneva Road
Brewster, NY 10509
Re: Astro Associates Subd. Lot 12
NYS Route 31 lNista Lane
Patterson, Putnam
East Branch Reservoir
DEP Log # 10842 (Joint Review)
IONMOV MUSTRIs
This letter is to inform you that the New York City Department of
Environmental Protection (Department) has determined that the above -
referenced application is complete. In addition, the Department has no objection
to the approval of the above - referenced regulated activity. This determination is
based on the review of submitted documents including the plan titled "SSTS for
Astro Associates Lot 12 ", dated 03/13/01.
The applicant must contact Sissy De La Ossa of my staff at (914) 773 -4416 at
least 2 days prior to the start of construction of the SSTS so that a Department .
representative may inspect and monitor the installation.
Sincerely,
Margaret Lloyd, P.E.
Supervisor
Engineering Design & Review
xc: James Covey, P.E., NYSDOH
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 (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648
April 12, 2001
John Watson, P.E.
Insite Engineering & Survey
Route 22
Brewster NY 10509
RE: Astro Associates
Vista Lane, Lot #12.
(T) Patterson, TM# 13 -3 -55.12
Reservoir Bas in
Dear Mr. Watson:
The Putnam County Department of Health (Department) has determined that the above referenced
application, including fee, and received by this Department on March 27, 2001 is complete. The
Department will; notify you by May 6, 2001 of its determination.
0- The Project has been. delegated to the Putnam County Health Department for
review pursuant to the guidelines set forth in the Watershed Agreement.
® Joint review with the NYCDEP will commence pursuant to the guidelines set forth
in the Watershed Agreement.
If the Department fails to notify you within the above referenced time frame, you may notify the
Department of its failure by certified mail, return receipt requested. The notice should be sent to my
attention at the above address. This notice must include your name; the location of the project,.the
office with which you filed the application originally, and a statement that a decision is sought in
accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed
Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the
notice, your application will be deemed complete, subject to standard terms and conditions as set
forth in the regulations.
Please be advised that projects within the NYC Watershed may also require Department of
Environmental Protection review and approval of other aspects of a proj ect, such as stormwater plans
or the creation of impervious surfaces, and the project applicant should contact the Department of
a. -,
Letter to: John Watson, P.E. - April 12,. 2001
-2-
Environmental Protection regarding such. activities, to see if Department of Environmental
Protection review and approval is required.
If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2166.
Ve PZAM
Robert Morris, PE
RM:tn Senior Public Health Engineer
DEPTH
G.L.
0.5'
1.0'
1.5'
2.0'
2.51
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'
2
,. TEST PIT DATA
i ,
DES CRIPTION _.O,SOILS.,ENCOUITERED IN TEST DOLES
HOLE NO. 1,24 `HOLE NO. >�
HOLE N0.
.Indicate level at which groundwater is encountered . &ZIA
Indicate level at which mottling is observed
Indicate level to which water level rises after being encountered�,g
Deep hole observations made by: SegV M. %—A r5O,J Date
Design Professional Name: Jeffrey J. Contelmo, P. E.
Address: insite axJirx:_-ring, sure, y, n & landscape Architecture, P
1-195` =Route 22
Brewster, New York 10509
Signature: -�
Design Professional's Seal
'PUTNAM COUNTY DEPARTMENT OF HEALTH
DWISION_OF ENVIRONMENT a' ` REAL .
TI3 SERVICES
DESIGN DATA SHEET - SUBSURFACE SEWAGE 'TREATMENT SYSTEM
Owner ,4-57P,o %�SSOG �rS �.>G, Address RjrG o 04Rx
Located at (Street),, ,v YS Ar 311 Tax Map 13 Block 3 . Lot
(indicate nearest cross street)
Municipality ;��. ,y, m� ��lTr�s�acl Drainage Basin 8R/bvc•1 +'-ArOAs EiJ
SOIL PERCOLATION TEST DATA
Date of Pre - soaking nLA A� Date of Percolation Test 41
Hole No.
gun No.
Time
Start - Stop
Ela se Time
min.)
De th to Water
From Ground
Surface (Inches)
Start Stop
Water
Level
Drop In
Inches
Percolation
Rate
Min/Inch
jz A
��
zu �s.•'
3 ��} �►
3
!ey ,
zu �i_ z3-"
3
4
5
3 ?�
3
2
1290I�
4
y
5
1 l
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 1 min for 1 -30 min/inch, s 2 min for 31- 60'min/inch) All data to be
submitted for review.
2. Depth m` easurements to be made from top of hole.
Form DD -97
PART II— ENVIRONMENTAL ASSESSMENT (To be completed by 4gency)
A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF.
❑ Yes ❑ No „
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.61 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 tevels,.exlsting traffic patterns, solid waste production or disposal, 1.
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 briefly
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 C1-05? Explain briefly.
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 (To 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-Wesponsible Officer in Lead Agency
Name of lead Agency
Date
2
Title of Responsible Officer
Signature of Preparer (if different from responsible officer)
/NS/ T
, ENG /NEERING, SURVEYING &
LANDSCA PEA RCHITECTURE, P.C.
1485 Route 22 (845) 278 -4990
Brewster, New York 10509 Fax: (845) 278 -6392
T0: Putnam County Health Department
1 Geneva'Road
Brewster, New York 10509
LETTER OF TRANSMITTAL
Date: S-7-L- 0 (
Job No. 98105.312
Attn: Robert Morris, P.E.
Re: SSTS for Astro Associates - Lot 12
Vista Lane, Town of Patterson
TM# 13 -3 -55.12
WE ARE SENDING YOU ® Enclosed ❑ Under separate cover via
❑ Shop Drawings ® Prints ❑ Plans
❑ Copy of Letter ❑ Change Order ❑
the following items:
❑ Samples ❑ Specifications
COPIES DATE
NO.
DESCRIPTION
5 3 -13 -01 _-_ _
-
CD -1
Construction Drawing
1 � 3- 0
CP -97
Construction Permit
1 3 -15 -01
WP -97
Well Permit
1 - - -------------------
LA -97
Letter of Authorization
1 12 -27 -00
CA -97
Corporate Affadavit
1 I ---------------------
_......_..._....__._....___... _..,_.w__._____.
PC -97
i Application for Approval of Plans
1
1 -
� 2 -12 -01
12 -23 -98
-- - - - - --
DD -97
Short EAF _____.__.__.. ._,..._..._.._..____..._..._...
Design Data Sheet (previously submitted with subdivision application) _M
2
_..1 ._..._.._ ............. ---
--------------- - - - - --
_ ........ ___.___
-- - - - - --
•Z1846
Modular 5 Bedroom House Plans
$300.00 Fee
THESE ARE TRANSMITTED as checked below:
® For approval
❑ Approved as submitted
❑ Resubmit
copies for approval
❑ For your use
❑ Approved as noted
❑ Submit
copies for distribution
❑ As requested
❑ Returned for corrections
❑ Return
corrected prints
❑ For review and comment ❑
REMARKS:
COPY TO: SIGNED: _,. -- -. o
J n M. Watson, P.E.
IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US AT ONCE
lot2000.dot
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
LETTER OF AUTHORIZATION
RE:. Property of A SfRO ASSSQCAff 5
Located at
SQp ' Tax Map # Block Lot 5
Subdivision-of ASSoctAf6S
Subdivision Lot # )z Filed Map # 28gy Date Filed 1 i - 8 °06
Gentlemen:
This letter is to authorize Insite Engineering, b=veying & Landscape Architecture, P.C. (Jeffrey J. contelim
a duly licensed Professional Engineer x apply for the required
wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance
with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam
County Health Department, and to sign all necessary papers on my behalf in connection with this
matter and to supervise the construction of said wastewater treatment and/or water supply systems
in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health
Law, and the Putnam Count Sanitary. Code.
Countersigned:
P.E., X.A., # E
Mailing Address
X xt i
t"r R
Very truly yours,
` 1
Signed:
(Owner of Property)
& Landscape Architecture, P.C.
Route 22 7 ,,^^
anei�Jbe'r,, �l W yerAe 1i1C/1'TV 09 - --
State New York Zip
Telephone: (914) 278 -4990
10509
AWO ASW'AlES
Mailing Address: C/o L ou) S PESCAfo RE
q2--5-0 6LUEEr 5 50ULEVA9L AE60 ARK
State AlEy YDA K Zip 113V q
Telephone: 1 -718 - q75 -2600
Form LA -97
PU
TNAM'C0i1NTY DEPARTMENT OF HEALTH
DIVISION OF ENVIR0NMENTAL HEALTH SERVICES
AFFIDAVIT - CORPORATE OWNER APPLICATION
FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT
To: Public Health Director
In the matter of application for: s SS_ OC lA a- - i.Or )l
I, Louis ff 5CA _29 E-
represent that I;am an officer or employee of the corporation and am authorized to act for:
Name of Corporation: A520 AA SSO �IAM S
I
Having offices at: _Z-_ ,5a QUf_ LVS_ WLEVA& -t—UP
Whose Officers Are:
President- Name: 10U)5 5 PMSCA'roa
Address: , 51aM F,
Vice President - Name:
Address: .
Secretary -Name:
Address:
Treasurer -Name:
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 of
1"U I month) (year)
Notary Public
CARL M. CESA'N�
Notary Public, Stota of New York
No.5001043
Qunli(ind in Queens Counr/ �'
Commiss:n,1 r:::;: i)ec - - 29 f
Form CA -97
Corporate Seal
PUTNA.M COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION FOR APPROVAL OF PLANS FOR
A WASTEWATER TREATMENT SYSTEM
1. Name and address of applicant:
10. Has DEIS been completed and found acceptable by Lead Agency? ............... LV -
I I . Name of Lead Agency
12. Is this project in an area under the control of local planning, zoning, or other
officials, ordinances? ......................................................... ...............................
13. If so, have plans been submitted to such authorities? ........ ............................... (�
14. Has preliminary approval been granted by such authorities? A/Q Date granted: i
15. Type of Sewage Treatment System Discharge ................. surface water groundwater
16. If surface water discharge, what is the stream class designation? ....................
17. Waters index number (surface)
WA
18. Is project located near a public water supply system? K0
19. If yes, name of water supply % Distance to water supply 4A
20. Is project site near a public sewage collection or treatment system? ................ ,JkJO
21. Name of sewage system N/A Distance to sewage system *k
22. Date test holes observed 2- JO -�9 23. Name of Health Inspector AnAN S&�uNC
24. Project design flow (gallons per day) ................................: :.............................. (,6
25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... X10
26. Has SPDES Application been submitted to local DEC office? ......................... NIA
Form PC -97
2.
Name of project: �Sl5 C AS1W Location (5V:
V:
4.
Design Professional: Jeffrey J. Contelm, P.E. 5. Address:
Incite Engineering, Suxwying & Landscape
Architecture, p. c,
6.
Drainage Basin: �A "1 61 / Wjgi E'S( t'D
Route 22
7.
Type of Project:
X 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? ....................
A10
10. Has DEIS been completed and found acceptable by Lead Agency? ............... LV -
I I . Name of Lead Agency
12. Is this project in an area under the control of local planning, zoning, or other
officials, ordinances? ......................................................... ...............................
13. If so, have plans been submitted to such authorities? ........ ............................... (�
14. Has preliminary approval been granted by such authorities? A/Q Date granted: i
15. Type of Sewage Treatment System Discharge ................. surface water groundwater
16. If surface water discharge, what is the stream class designation? ....................
17. Waters index number (surface)
WA
18. Is project located near a public water supply system? K0
19. If yes, name of water supply % Distance to water supply 4A
20. Is project site near a public sewage collection or treatment system? ................ ,JkJO
21. Name of sewage system N/A Distance to sewage system *k
22. Date test holes observed 2- JO -�9 23. Name of Health Inspector AnAN S&�uNC
24. Project design flow (gallons per day) ................................: :.............................. (,6
25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... X10
26. Has SPDES Application been submitted to local DEC office? ......................... NIA
Form PC -97
2
27. Is any portion of this project located within a designated or tate wetland? YfS
28. Wetlands ID Number .......................................................... ...............................
29. Is Wetlands Permit required? ..... ..................... ............. ............................... IVY
Has application-been made to Town or Local DEC. office? ............................... LVIA
30. Does project require a DEC Stream Disturbance Permit? .. ............................... O
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 o O
32. Is project located within 1,000 feet of existing or abandoned landfill,
hazardous waste'site, salt stockpile, landfill, sludge disposal site or any
other potentially known source of contamination? ............................... Yes o LI)
DESCRIBE:
')3. Is there a local master plan on file with the Town or Village? ......................... (I 'll W
34. Are community water and/or sewer facilities planned to be developed within
15 years in or adjacent to project site? ...............:................ ............................... UN lvowiv
35. Are any sewage treatment areas in excess of 15% slope? ]rl
36. Tax Map ID Number .......................................................... Map Block Lott
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 Depaitment,,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 th is form is true
to the best of my knowledge and belief. False statements made herein are punishable as
a Class A misdemeanor pursuant to Section 210.45 of the Penal Law.
SIGNATURES & OFFICIAL TITLES.
Mailing Address:...............:...... Landscape ArchitecWre R�
Route
Brewster New Yerk '1
14 -16-4 (2187) —Text 12
PROJECT I.D. NUMBER 617.21 SEAR
Appendix C
State Environmental Quality Review/
SHORT .ENVIRONMENTAL ASSESSMENT. FORM
For UNLISTED ACTIONS Only •
PART I— PROJECT INFORMATION (To be completed by Applicant"or Project sponsor)
1. APPLICANT /SPONSOR
Si a x; ,e
2. PROJECT NAME.
' SS- CS o L ) -O--
3. PRO ECT LOCATION:
gs
Municipality Of� County (f J
4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map)
5, IS PROPOSED ACTION:
New ❑ Expansion ❑ Modification /alteration
6. DESCRIBE PROJECT BRIEFLY:
�`e;u►�r1Cr',r<c✓ o� G� ✓� )=� IZY i<�Y
��S6dE�lCr , ��r�`c
Apjo qVkf Wcr-_S�'
7. AMOUNT OF LAND AFFECTED: p
Initially j. /gAct 1,
acres Ultimately Iff:t acres
8. PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
Yes ❑ No If No, describe briefly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/ForesVOpen ❑Other
space
Describe:
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL,
STATE.OR LOCAL) ?.
lNes ❑ No
if yes, list agency(s) and permlVapprovals
��ivE"aly flFRAI r— 1 C-WAI OF ('f�T 15R; Gov
Ss�hwru: P!1;-A1AAl liElIN P9
NIL -Olix PIFPA I -� ..C'aA! r iE .K
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
❑ Yes `N-0 If yes, list agency name and permit/approval
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION?
❑ Yes
1. CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
lizi l i F 0961tim',w, •�v g"EYli�, � LAN& rg 4141 tFi70�� f. C,
Applicant/sponsor name: J,O& 11'.- WAlloW P. L" . Date: 2— 1L Jo i
Ott
Signatur
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
1
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: o illage Tax Grid #
3k V 1 S %A U30 C Map 1.S Block Lot(s)
Well Owner:
Name:Ns=#-o A ,, f5
Address:
C40 La.'s 1(5LAn►2(,
(rte QAiz1� , �iy
Use of Well:
Residential Public Supply Air /Cond/Heat Pump Irrigation
1- primary
Business Farm Test/Monitoring Other (specify)
2- secondary
Industrial Institutional Standby
Amount of Use
Yield Sought gpm # People Served Est. of Daily Usage gal.
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
New Supply (new dwelling) Deepen Existing Well
Detailed Reason
for Drilling
Well Type
Drilled Driven Gravel Other
Is well site subject to flooding? .......... ..............................+ ....... ............................... Yes No
rn ES
Is well located in a realty subdivision? ....... ........................ ............................... Yeses— No
Name of subdivision AST d o 455 a5ctAT�_ t Lot No. : 1 k .
Water Well Contractor: �O % 0t-%'W ,%,it9 Address:
Is Public Water Supply available to site? .................................. ............................... Yes No
Name of Public Water Supply: d Town/Village NfIN
Distance to property from nearest water main: NIK .
Proposed well location & sources of contamination to be provided on separate sheet/plan.
Date: t�� -,�1' ° 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.
i
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 rev o le for cause or may be
amended or modified when considered necessary by the Public Health Director. y evision or alteration
of the approved plan requires a new permit. Well to be constructed by a wate 11 ller ce ' ed by Putnam
County.
Date of Issue /0 �Z� `' , Permit IssLg
Date of Expiration ' . /.D f2-1 % e) & Title:
Permit is Non- Transferrfabl
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
October 15, 2004
Robert Morris; P.E
Putnam co: Health Dept. =
4: Geneva Road
Brewster, NY10509
Re: Astro Associates Subd. Lot 12
NYS Route 31 lNista Lane
Patterson, Putnam
East Branch Reservoir
DEP Log # 2001 -EB- 0240 -SS.2 (Renewal)
Dear Mr. Morris:
This letter is to inform you that the New York City Department of
Environmental Protection (Department) has determined that the above -
referenced application is complete. In addition, the Department has no objection
to the approval of the above- referenced regulated activity. This determination is
based..on the review of submitted documents including the plan titled "SSTS for
Astro.Ass`ociates.Lot 12 ", dated 03/13/01 and last revised 9/10/04.
The applicant must contact Sissy De La Ossa of my staff at (914) 773 -4416 at
least 2 days prior to the start of construction of the SSTS so that a Department
representative may inspect and monitor the installation.
Sincerely,
Danny Shedlo, P.E.
Civil Engineer II
Engineering Review Group
xc: John M. Dunn, P.E., NYSDOH
/NS/ T
ENGINEERING, SURVEYING a
LANDSCA PEA RCHITECTURE, P.C.
3 Garrett Place (845) 225 -9690
Carmel, New York 1,0512 Fax: (845) 225 -9717
TO: Putnam County Health Department
1 Geneva Road
Brewster, NY 10509
LETTER OF TRANSMITTAL
Date: 9 -10 -04
Job No. 98105.112
Attn: Robert Morris, P.E.
Re: SSTS for Astro Associates, Lot 12
31 Vista Lane, Town of Patterson
TM# 13 -3 -82
WE ARE SENDING YOU ® Enclosed ❑ Under separate cover via
❑ Shop Drawings ® Prints ❑ Plans ❑ Samples
❑ Copy of Letter ❑ Change Order ❑
the following items:
❑ Specifications
THESE ARE TRANSMITTED as checked below:
®For approval
❑Approved as submitted ❑ Resubmit copies for approval
❑ For your use
❑ Approved as noted ❑ Submit copies for distribution
❑ As requested
❑Returned for corrections ❑ Return corrected prints
❑ For review and comment
❑
REMARKS:
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