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00506
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
FACSIMILE TRANSMITTAL
To: LLe, Fax:
From: j,, e- /2, —P k J-,. A-01+E
ROBERT J. BONDI
County Executive
Date:
Re: Pages:
CC:
❑ Urgent kFor Review ❑ Please Comment ❑ Please Reply
CONFIDENTIALITY STATEMENT: The information contained in this facsimile may contain CONFIDENTIAL
and legally protected infonnation intended only for the use of the individual or entity named above. If the reader of
this message is not the intended recipient, you are hereby notified that.any dissension, distribution, or copying of this
telecopy is strictly prohibited. If you have received this telecopy in error, please immediately notify us by telephone
(845- 278 -6130) and destroy all documents associated with this facsimile.
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648
C5 -- \-�
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N.Y. 10512
!Ir Engineer Mast Provide _� — ��
P.C.H.D. Permit /f - --
CATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM
Located at--\#
Owner /applican(
Mailing Address
Qw-,/ ff Formerly
i� 4 –Zip
Sewerage System
i
Consisting of f � `.�� / '=Ion -Sep ctl Tank
Town or Village
Tax Map Block Lot
t;ccvte.f f
Subdivision Name Subdv. Lot H :;F —
Date Permit Issued
31 khz.- Fmzrr4,t�,
Water Supply: Public Supply From Address �+
or: %� te.S4Pply-DrWed by '� Address 2T Z Gan z'_ . /�-
Building Type �Oa Has sion Control Been Completed? yL'S
tai �c
Number of Bedrooms � Has Garbage Grinder Been Installed?
Other Requirements - -✓
I certify that the s tem(s) as listed serving" "the above premises were constructed essential) as shown on the plans of the completed work ( copies
of which are attached), coordan'ce with the standards, rules and re in ance with the filed plan, and the permit issued by the
Putnam County Department Of Health.
Date
/ Z Certified by P.E. R.A.
Address iP�,� rf�L w �l iux License No.
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 sewerage system shall become null and void at soon as a pubs:': unitary 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 Commissioner oogL_U th, revocation modification or change Is necessary.
Mate OC /' Title
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PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
' Simons, M.D.
Cm nissioner of Health - FIELD ACTIVITY REPORT -
Sheet I of i
_ ✓1 iJy11V..
NAME 1�i0 Orig. Routine
n
ADDRESS !.l P,�aE: co, 'c R �� _ Orig. Request
No. Street Town TH No. C:anpliance
Complaint Carp
MAILING ADDRESS _ Final
P.O. Box Post Office Zip Code Group Illness
Construction
TELEPHONE
Reinspection
PERSON IN CHARGE Field, Sampling Only
OR INTERVIEWED Field Conference
Name and Title
_ Other
DATE , Z TYPE FACILITY
TIME ARRIVED too. 34 TIME LEFT 11.00 Explain
FINDINGS:
tt.L 1 1 AA M p9OU£ID ^1LEA
JP IL flu 04.
S 12 � OIG,
MAV.2JAL 04.E
SST' t Ji FRZ -SfGT' WILI .
3PECTOR: TELEPHONE:
Signature and Title
60N IN CHARGE OR INTERVIEWED:
icknowledge this Field Activity Report. SIGNATURE:
'86 TITLE:
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MEMORY TRANSMISSION REPORT
TIME JUN -09 -2008 02:35PM
TEL NUMBER 8452787921
NAME ENVIRONMENTAL HEALTH
FILE NUMBER 378
DATE JUN -09 02:34PM
TO 98782019
DOCUMENT PAGES 005
START TIME JUN -09 02:34PM
END TIME JUN -09 02:35PM
SENT PAGES 005
STATUS OK
FILE NUMBER 378 * ** SUCCESSFUL TX NOT ICE **
o
SHERLITA AMLEI{., wIn, Ms. FRAY a RC/BE12T J. 130N "1
Conamissloner of Health -!c at County Exucatttvs
LORE"I"I'A MOLINARI. IiN. M3N �� Q �
Arsoclare CoT ns4ssloner ofHealtla
DEPAFiTMaN -T OF HEALTH
i Geneva Road, Brewster, Ncw York 10$09
i
FACS,,��I--M //IL__E TI- ZANSMITTAL
Fax-
From- �O � %� �- >.�•s+ -�: .rt-. r4 -f�N-E Date' � �o /����
Re- `% Pages -
CC- '
i
-------------••------------------------...-•----.--------------•-.---------------•------------------------•----------
O Urgent �Or Review Cl Please Corrtrrlcrxt o Please Reply
CON1� 7]}E.NTIALITY STATEMENT: The informadoa contained in this fac:aimi)e may contain CONFTI7)✓NT1AL
and ]ggally protected inforti—tion intended only for the use of the individual or entity named above. I£ the reader of
this ntassagc is not the intended recipient, you are hereby notified thtat. any dissension, distribution, or copying of this
re lecopy is strictly prohibited. If you have received this tciccopy in error, please immediately notify u3 by telephone
(845 -275 -6130) and destroy all documents associated with this 'facsimile.
Env[ronmentat
11catt6 (845) 278 -6130 Tax (845) 278 -7921
Naarring Servlcas (845) 278 -6558 Fax (845) 27S -6026 WIC (845) 278 -6678
N ursing Homo Cara Fax C845) 278 -60BS
Ssriy Iatnrvontiaa n/P rescnoa,l (84.S)279-6014 Fax (84S) 278 -6648
06/06/200 17:03 8452789266 JMT CONSULTING GROUP PAGE 01/02
T.
j
4 �
l�dnftiregCrbrr�r ..
2200- 2202 RouTE 22, PAT T>~ Its ON, NY 12563
PH! R45- 278 -4262 * PAX; 845 - 278.4266 M
WaB: WWW.JM'iCONSULT'ING.COM
FACSIMILE TRANSMITTAL SHEET
To: FROM:
Joe Paravati ,JMT Consulting Group
COMPANY: DATE:
Health Department 6/6/08
FAX NUMBER: TOTAL NO, OF PAGES INCLUDING COVER:
278-7921 2
RHONE NUMBER: SENDER'S REFERENCE NUMBER:
RE; YOUR REFERENCE NUMBER:
Patterson Notice of Violation
❑ URGENT X FOR REVIEW ❑ PLEASE COMMENT ❑ PLEASE REPLY ❑ PLEASE RECYCLE
Thank you for your help with. this. I know you can appreciate that the house was built 18
ears ago and at that time we did everything we needed to do to. To now find ourselves in d s
aw£ ,pxedicars�ent is .terrible It iw'•t z t to .hold •us respo�ast`ble :fox whatcrrcr •cltange5 have
occum. d in the law or filing requim eats 18 year. later. Whatever you and the team can. figure
out to do to help us that won't cost us a fortune (wbicli xcally we do not have) would be greatly
appreciated.
Tbank you,
j jacki Tiso
I
06/06/209,8
17:03 8452789266
JMT CONSULTING GROUP
TOWN OF PATTERSON
CODE ENFORCEMENT OFFICE
PU1'NAM COUNTY
P.O. Box 470
Patterson, New York 12563
PAGE 02/02
DAVM I. RAMS
Code Enforcement Officer TEL (845) 878 - 6319
F< :e Inspector FAX (845) 878 - 2019
NOTJCE OF VIOLATION - ORDER TO REMEDY
May 14, 2008
Name: Mr. & Mrs. fury Viso
Address: 201 Stagecoach koad.
City, State, Zip: Patterson., New York 12563
Dear Mr. & .Mrs. Tiso,
You are hereby notified that you have been found to be in violation of the Building Code / Zoning Code,
Tovin Code, Article XX11, Section § 154126. The specific violation is: Certificates of Occupancy
regaired. Certificate of occupancy required for additional bedroom&
As observed by the Code Enforcement Officer on May 14, 2008
s
Tic following corrective measures should be taken no later than June 11, 2008 or penalties may be
assessed. Return dwelling to four bedroom, single family dwelling.
For the purposes of applying the penalties described in the Administrative Section of the Zoning, law,
your first violation shall be deemed to have occurred as of May 14, 2008
if You have questions, please contact me.
Sincerely,
r
David 1. Raines,
Code Enforcement Officer
,Pleptse Note: §154 -1311. Penalties for offenses. (ace attached)
,e ...p,. ' � :. +.. �_: �.,. ... � :.� .. ..( f.v. A --� 4v .ri ..- ,.,,.. ¢..,..�.++^ %a, J �I:...7. -"-K t -%?i•' r� 1�:..'r.?"V ., "�...,.� � � ..,I h ..
PUTNAM COUNTY DEPARTMENT OF HEALTH
e r 3 % 86 Division of Enviro'nmeatel Health Services, Carmel, N:Y.10512
Engineer Must Provide �� ��
P.0 H D;'Permlt N-- - -- —
CATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM�,� .
Towq or Village
Located at Tax Map Block Lot
Owner /applicant Name '! /� ! ��`' Fornserly Subdivision NameSdbdv.,Lot p
Mailing Address -P R S � k c/Ei?,C N /� 11 Zip Date Permit Issued
i•!rt'rTip.J2 S N / - V —
Separate Sewerage System built by f ' eni 1°' +` o"! Addresta �D r3 or �Q3 % Nl �RI IktIJ �81�
1 —_
Consisting of '60 Gallon Septic Tank and
Sj�tr�-SvSrr� w DtSTnr4u770•4 CanK._
Water Supply: Public Supply From ' Address
2r �z CRr:�,� . N
or: X Private Supply DrWed by , j ") � V � Address --
Building Type L0000 F ;47C- Has Erosion Control'Been Completed? yes
Number of, Bedrooms Has Garbage Grinder Been Installed? ��^
Other Requirements
I certify that'the system(s) as listed .serving the above premises were constructed essentiall as shown on the plans of the completed work ( copies
of which are attached), .and in accordance with the standard, rules and're in o ance with the filed plan, and the permit issued by the
Putnam County Department Of Health.
Date Z�7z- Certified by
P.E:�(_R.A.
VLF -N License No. VS>f 342,
Address qLfal
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 sepaiate,ssweroge system shall become , null and void as soon as a pubt;: 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 approval's are
subject to modification or change when, in the judgment. of the Commissioner qLJ:N"h, revocation modification or change Is necessary.
r7
T It Is
ate
y:
Q, -e
w
WL'LL LourlrLLiium ALrVAl
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
WELL LOCATION
STREET ADDRESS: wN /VIL 1 1 Y W GRID NUMBER:
WELL OWNER
NAME: ADDRESS: 23ARE 672_&/ j
C i T T/SO let) �3 f C/EZT2/R^! �C.E'E5_ �� ; /0.3'0
EZ781VATE
❑ PUBLIC
USE OF WELL
1 - primary
2 - secondary
)'RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED
❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT gpm.1NO. PEOPLE SERVED 5 / EST. OF DAILY USAGE �.(� gal.
REASON FOR
DRILLING
'ANEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH 925 ft.
STATIC WATER LEVEL ft.
I DATE MEASURED 90
DRILLING
EQUIPMENT
❑ ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT' ❑ CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING. tWOPEN HOLE IN BEDROCK ❑ OTHER
TOTAL LENGTH cl ft-
MATERIALS: ]STEEL ❑ PLASTIC ❑ OTHER
CASING
DETAILS
LENGTH.BELOW GRADE AO ft.
JOINTS: ❑ WELDED )'THREADED ❑ &HER
DIAMETER 40 in.
SEAL: gCEMENT GROUT ❑ BENTONITE ❑ OTHER
WEIGHT
PER FOOT lb./ft.
DRIVE SHOE-,RYES ❑ NO LINER: ❑ YES X00
SCREEN
DIAMETER (in)
'SLOT SIZE
LENGTH
(It)
DEPTH TO SCREEN (it)
DEVELOPED?
DETAILS
FIRST
O YES ONO
HOURS
SECOND
GRAVEL PACK
O YES
❑ NO
GRAVEL
SIZE:
DIAMETER
OF PACK in.
TOP
DEPTH ft.
BOTTOM
DEPTH It.
WELL YIELD TES? If detailed pumping
METHOD: WUMPED tests were done is in-
COMPRESSED AIR. , formation attached?
O BAILED ❑ OTHER ; 0 YES O NO
�p /ELL LOG It more detailed formation descriptions or sieve analyses
lly are available, please attach.
DEPTH FROM
SURFACE
Water
Bear-
ing
Well
Oia-
meter
FORMATION DESCRIPTION
CUE.
ti
It
WELL DEPTH
It.
DURATION
hr, min.
DRAWOOWN
It,
YIELD
gpm.
Surface
j
h571
E
/
rS
5
WATER O CLEAR TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED ANALYZED? OYES ❑ NO
ANALYSIS ATTACHED? O YES ONO
STORAGE TANK: TYPE
CAPACITY GAL.
WELL DRILLER �NAAME O (,6 /kj2;T14A,� Oa L C'D, Z3t/C -. DA
ADDRESS pc_- lCod1�J LSIGfr>tTURE
PUMP INFORMATION
TYPE CAPACITY
MAKER DEPTH
MODEL VOLTAGE HP/�
M
Yorktown` Medical Laboratory, Inc.
321 Kear Street
Yorktown Heights, N. Y. 10598
(9 14) 245 -2800
Director: Albert H. Padovani M. T. (ASCP)
i
CJ. BROS. PLUMBING & HEATING
403 LEXINGTON AVENUE
MT. KISCO, NY 10549
L J
LAB #
/Ij - el"'CT _15,91
Date Taken: e�_ .Vy �O Time lD �
Date Rc ' d : S - G� Time: ys-
Date Reported: APH. 2 1990
Collected By: C.T. PIUMBTNG
PO /Client #
Referred By:
Sampling Site: &,t_ 7SinC %/w
C'GrU
i
REPORT ON THE QUALITY OF WATER
Phone ( 914 ) 666 -4555
INORGANICS (mg /L) MICROBIOLOGICAL 100mL
_ Alkalinity
Chloride
_ Copper,
_ Detergents, MBAS
— Hardness, Calcium
_ Hardness, Total
Iron
_ Lead
_ Manganese
_ Mercury
_ Nitrogen, Ammonia
_ Nitrogen, Nitrate
_ Nitrogen, Nitrite
_ Phosphate, Total
_ Silver
Sodium
+_ Sulfate
_ Sulfide
_ Sulfite
Zinc
PHYSICAL MISCELLANEOUS
_ pH (S.U.)
_ Color (Units)
Conductance (uhms /c)
_ Odor (TON)
_ Turbidity (NTU)
Standard Plate Count
(CFU /1 mL)
Membrane Filtration Method
,/ Total Coliform e- 1
Fecal Coliform
— Fecal Streptococcus
Most Probable Number Method
Total Coliform
Fecal Coliform
_ Fecal,Streptococcus
Presence /Absense (PA)
Total Coliform P A
KEY FOR TERMINOLOGY
CFU = Colony Forming Units
IT =
<
= Less Than
GT =
>
= Greater Than
NA =
Not
Applicable
SA =
See
Attached
TNTC
= Too Numerous To Count
REMARKS /COMMENTS For b se
(For Lab Use)
SAMPLE TYPE:
(Check One)
-t/ Potable
_ Non - potable
OUTGOING:
(Check Each)
HNO
HC13
— H2SO4
_ NaOH
ZnOAc
Na2S203
Other:
INCOMING:
(Check Each)
✓IE
40C
GT
4 /LE 200C
_
GT
200C
pH
LE 2
_ pH
GE 12
Other:
THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS'y (WAS NOT) (NA) OF A
SATISFACTORY SANITARY QUALITY ACCORDING TO YORK STATE PUBLIC DRINKING
WATER CODES, FOR THE PARAMETERS TESTED, AT THE IME OF SAMPLE COLLECTION.
THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DID NOT) (NA) MEET THE
SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STATE L DRINK-
ING WATER CODES, FOR T FA ERS TESTED, AT THE TIME OF SAMP OLLECTION.
X 7 /87(Rvsd1 /90)RWE
Albert H. Padovani, M.T. Director
PUTNAM COUN'T'Y DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Owner or Purchaser of Building
Building Constructed by
-:-�; 7`Qr, - G c 4 4
Location i —on — Street
Section Block /'— ot
L�
� --7e,9 --7e,9 - �y O / g
Subdivision Name
Municipality Subdivision Lot #
J/
Building Type
GUARAN -1EE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM
I represent that I am wholly and completely responsible for the location,
workmanship, material, construction and drainage of the sewage disposal system
serving the above described property, and that it 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 disposal system, or any
repairs made by me to such system, except where the failure to operate properly is
caused by the willful or negligent act of the occupant of the building utilizing
the system.
The undersigned further agrees to accept as conclusive the determination of
the Director of the Division of Environinental Health Services 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 this day of 19,
General Contractor (Owner) - Signature
Corporation Name (if Corp.)
Address
rev. 9/85
mk
Signature
Title
Corporation Name (if Corp.)
Address
G.
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John M. Simmons, M.D.
-f
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Deputy Commissioner of Health - FIELD ACTIVITY REPORT -
Sheet of
NAME `1'�
ADDRESS -:5rr ►(,g:
No. Street Town TH No.
MAILING ADDRESS
P.O. Box Post Office Zip Code
TELEPHONE
PERSON IN CHARGE
OR INTERVIEWED
Name and Title
DATE TYPE FACILITY
TIME ARRIVED 10 : 3a TIME LEFT 1% 00
INSPECTION .
_ Orig. Routine
_ Orig. Complain
Orig. Request
Compliance
_ I Complaint Canp
_ Final
Group Illness
Construction
Reinspection
Field, Sampling Only
_ Field Conference
Other
Explain
FINDINGS:
-
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U.C.. PLA4C W h2 290%)CrD AILEA
S 12 E Ole,
U IE P U O 1G
MAI*AmL. Oie.
INSPECTOR:
Signature and Title
PERSON IN CHARGE OR INTERVIEWED:
I acknowledge this Field Activity Report. SIGNATURE:
6/86 TITLE:
TELEPHONE:
FDiIAr, c_ CIS =Et ?' =�V CcC=
2AIn =�t� b•
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crtr^ DISr0.caL AREA
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C _ .�. `._^,IIE , brtL' r=-C:- , Ci _% t.c_n 1 ^ _ C.
e_ 1r0 ft_ f ..*HC t =— C:L =c /:VC �i C.7.
I-T E'.-' DIE—=C 27.
C' ? ^ C
C.
G. iG goo �cC_ =, C_ _ -Cut W4 to Z= C, 450
L
stanca
C 10 y— _Lat
-- - <
C= ==
BCCl ci j r'4&-- fcr 50- l�
Liao c.= 3/== - 1-z"
1 Pire E ^c C'
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V=
__cti La cr c! e
Li
Pla -c--
N.' e_'" C-,
4
rh.
Shi,F
c._
Ecxees
C_
1' i piCcS f '' °', W'? L'1 Inside Gf lzCl
`�; i i rr�� _ice cent =i n= s�cr_es < L„
e_
C_ min c-_i _ instil-
r .
C=— _ ^_
C_
CC? 5! GCES CIE L_ —'
NKI
/l'"
p(,�C up /)I.IAWA
Building Type {t(bCD Lot Area 4, 0 �"l Fill Section,Otily Depth Volmne
Number of Bedlroome Design Flow G. P D PCIfD NotlHcatiou le Required Whea Fll Is completed
Separate Seweiage System to conslst.ef 2 0 Gapon Septic Tend and �- �— t f tJ l l� A�>tf
To be constructed by s
Water Sappb': Pdbllc Spppiy. From • ""-�
ort _Prlvlte Sappiy Drilled by
Other lteoulremenfs /
I represent that I am wholly and .completely responsible for the design
above. described will am
be constructed as shown on the approved endmenl
County .Department of Health, and that on completion :Hereof a "Cart
be submitted to the Department,.and a written .guarantee�will'be furl
place in good operating .condition' any part of said sewage disposal -s
ance.of the approval of, the Certificate of: Construction Compliance r
will be located as shown on the approved plan and that said well will 'be"
rkr
County Department of .Health.
Date Signed'_
APPROVED FOR CONSTRUCTION: This approval, "expires two years'tr
revocable for cause or may be amended or modified when considered ne
requires a new permit. Approved for disposal of domestic sanitary I
Re
1%87 Date .By,.
1 I.WlL n of the proposed'system(s); 1) that the separate sewage disposal system
thereto and in, accordance with the standards, rules an regu a ions o e' u nam
ificite ,of Construction Compliance" satisfactory to the'Commissioner of Healthwill
fished the owner, his -successdis, heirs or'assigns by the builder, that said builder Will
yitem;_during,tlie period of,two (2) years Imme,diately following thedate of the Issu-
if thi,oHginai systemtor any repairs thereto; 2)'that the drilled wail described above 11711 1 It 1 acco c with -the standards,' rules and regu a ons of the Putnim
P.E.–>— R.A.
!S •- Y112KMtJAJ lAdi License No
im the. date•:isuefl:un leis ` construction of the Iuilding has been undertaken and is
essary.by the..Commissioner of Health. Any change or alteration of construction
iwage, and /or private water supply 'only. .
Title
plece, in toed operatie"' condition Oily- pet of said
Greg of ,the aw"al of tM; Cartifkate.of Constructs
arw be l6cate4 ea ikMv on.tlu_approvad Olen and .thst s
County Opertnatt :Of 1Na1tR..
Doti / 9 , -�/�
Addn� a
APPAOVEO F COMSTAUCTIOPI This aiwovel imp
revocable for cause or may be-amended or medifled wh
folluirea , a new permit ApOroved or dispern of,. do
REV.
10/88 °iii__
,ertifieate of Copftiubti"'Complbnee" satisfactory to. the Commissioner of MMKhwill,
futnishW-the owner; his succksois. IaMf or assigns by the 'builder. that said ,bulkwr rill
s1 system during the period of two (2) year; Immediately followin, the date of the lieu -
w of the wphNI syrteoi or any.repotr eto-..2) that the drilled well described above
` allad in ,accordance wit ids. rubs and e I ns of the • Putnam
V R:A.
- t- No X578 /
from the "te; ,issued unless construction of -the building has been undertaken and is
neCei9.i by 'ttK Commissioner of.Haulth. Any chango or alteration of construction
V aeiAr�e i da private'* or. water supply only.
Title �/T
PETER C. ALEXANDERSON
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225-0310
Ronald Gabriele
2661 Springhurst Street
Yorktown Heights, IVY 10593
Dear Mr. Gabriele:
JOHN KARELL Jr., P.E., M.S.
Public Health Director
April 25, 1990
RE: Tiso
Stagecoach Road
(T) Patterson TM #8 -1 -3
A routine field inspection was conducted on April 20, 1990.
Comments are offered as follows:
At that time it was determined that the existing house had
five (5) rooms, which by size, location, etc., would be
considered potential /existing bedrooms.
As the initial approval for the SSDS was based upon a four
(4) bedroom count, the SSDS must be increased to reflect a
five (5) bedroom count.
If you have any questions, please contact the writer at ext
320.
Ver trnu�l�y� yours,
.ENS
Robert Morris
Assistant Public Health Engineer
RM:mk
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date
Re: Property of ��`� JHG�J ! rs
Located at 77_fi6G
(T) PI'}-frCJZ�A) Section Block Lot
Subdivision of S-79GE ('_ i e 4GH aQPr,70rl5s /iNG:
Subdv. Lot # 2a Filed Map # Date
Gentlemen:
This letter is to authorize K.WLY_F H IAI). I-/9ttgEV V7T I r . � •
a duly licensed professional engineer V or registered architect
(Indicate
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 promulagated 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 construction of said
system or systems in conformity with the provisions of Article 145 or
147,
Education Law, the Public Health Law,
tary Code.
Coun
P.E.,
and the Putnam .County Sani-
I c " 19 � I i Very truly yours,
' m '; t
• c` Z ,+w Signed
$1 er of Property
ersigne N0.04 \, /
Address
278 - & LOF
Telephone
i2�3 r� EsrRiq „i 4cX!1�S
Address
62E-O.s76,e, /Q
Town
Z7,?- � 332
Telephone
CEPA. 'ImE''T CF =E l DL Tl'SIC_`I Gs E: ;.02m —E M-L S`'T _C S
Supor.I .DrSP- - , c-_c r —,E
" NS %C=ICN P=-',IIT
C= YES I NO I CCG2 �'gr' � � �
pe_7- c=t_cr ° '
C ;=- -Crate. Reescl'1t2.C:1
E :Cin�r� Au cr. z
cZ.- sC�r L rGrc C.E_t_�
ps-C E.^,1= Cam_ `1 CC ;®
Ci E F2 L )
SET
31 Z-
CN
F _1rFrof_1 -- & C ;,-= -c =s
D Cr
tic %--k - S_3 e, Da
F= =c &
i=: Pit Pitr& D rcx S:lcwti & Devil z
Ecuse Inc. cf Eed-f- .arLs -
Necs_= ii- ( =_c- _ ?cc)
4"0; T:: C1Cc
No Bze—�-; Ma-c. Eer.CL- 4S° �viC_ Cl1L
1�3' to _ .L_ , Dr_�rc.��_;, T= := T_ y =,TC: c= =
20' to Walls
1001 ttc Wsll; 200' in D.L.—D, 1 -F0' P - ==
100' Sly_ =fir atzrC..Lt.-. Sa,
15' to urn__ ^_S
35't "4a`__ .:
1
C0 jrte.. - -._^t G =' _C_°
I
I I
I I
I II
per® 0xh
I
I I
I I
I
to f�_ I I I
-Fill
I
.
I
I I
C ;=- -Crate. Reescl'1t2.C:1
E :Cin�r� Au cr. z
cZ.- sC�r L rGrc C.E_t_�
ps-C E.^,1= Cam_ `1 CC ;®
Ci E F2 L )
SET
31 Z-
CN
F _1rFrof_1 -- & C ;,-= -c =s
D Cr
tic %--k - S_3 e, Da
F= =c &
i=: Pit Pitr& D rcx S:lcwti & Devil z
Ecuse Inc. cf Eed-f- .arLs -
Necs_= ii- ( =_c- _ ?cc)
4"0; T:: C1Cc
No Bze—�-; Ma-c. Eer.CL- 4S° �viC_ Cl1L
1�3' to _ .L_ , Dr_�rc.��_;, T= := T_ y =,TC: c= =
20' to Walls
1001 ttc Wsll; 200' in D.L.—D, 1 -F0' P - ==
100' Sly_ =fir atzrC..Lt.-. Sa,
15' to urn__ ^_S
35't "4a`__ .:
1
C0 jrte.. - -._^t G =' _C_°
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATION TO CONSTRUCT A WATER WELL /D-- v O °�
PCHD PERMIT #
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: F114G H
r D weog 0 Lot No. i
WATER'WELL CONTRACTOR: Name -IV 6 GF DBE 1AJ6V Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _Z __NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: D Veqe_ I MJLAe�
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
rr/ ❑ ON REAR OF THIS APPLICATION /i SEPARATE
(date) (signature)
PERMIT
TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the
provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and
provided, that within thirty (30) days of the completion of water well construction,
the applicant shall:
1. Pump the well_ur-i1 the water is clear.
2. Disinfect the well in accordance with the requirements of the Putnam
County Health Department attached to this permit.
3. Submit a Well Completion Report on a form provided by the Putnam County
Health Department.
Date of Issue:- ���` /Y 19�
Date of Expiration: 19
Permit Issuing ffici
White copy: H.D. File
Permit is Non - Transferrable
Yellow copy: Building Inspector
Pink Copy: Owner
287 Orange copy: Well Driller
j
Street Address
o V'llage City Tax Grid Number
WELL LOCATION
Name
Mailing Address aPrivate
WELL OWNER
4-
cam,
j/fiU -� ST P O Public
USE OF WELL
ET RESIDENTIAL
0 PUBLIC SUPPLY 0 AIR /COND /HEAT PUO"73 ABANDONED
&2- primary
0 BUSINESS
0 FARM
O TEST /OBSERVATION 0 OTHER (specify
2 — secondary
0 INDUSTRIAL
13INSTITUTIONAL - 0 STAND -BY. 0
AMOUNT OF USE
YIELD SOUGHT
gpm /ll
PEOPLE SERVED_ /EST. OF DAILY USAGE S -aa gal
.REASON FOR
JZNEW SUPPLY
0 PROVIDE ADDITIONAL SUPPLY 0 TEST /OBSERVATION
DRILLING
OREPLACE EXISTING SUPPLY
0DEEPEN EXISTING WELL
DETAILED
tZFS l
ofewcrG
REASON FOR
DRILLING
WELL TYPE
®DRILLED
DRIVEN
®DUG ®GRAVEL ® OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: F114G H
r D weog 0 Lot No. i
WATER'WELL CONTRACTOR: Name -IV 6 GF DBE 1AJ6V Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _Z __NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: D Veqe_ I MJLAe�
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
rr/ ❑ ON REAR OF THIS APPLICATION /i SEPARATE
(date) (signature)
PERMIT
TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is granted under the
provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and
provided, that within thirty (30) days of the completion of water well construction,
the applicant shall:
1. Pump the well_ur-i1 the water is clear.
2. Disinfect the well in accordance with the requirements of the Putnam
County Health Department attached to this permit.
3. Submit a Well Completion Report on a form provided by the Putnam County
Health Department.
Date of Issue:- ���` /Y 19�
Date of Expiration: 19
Permit Issuing ffici
White copy: H.D. File
Permit is Non - Transferrable
Yellow copy: Building Inspector
Pink Copy: Owner
287 Orange copy: Well Driller
j
.. PUINAM CDMM DEPARMM ' OF . HEALTH ..
DIVISION .OF HEALTH .•SERVICES.
DESIGN DATA SEMT- SUBSUFACE SEWAGE- DISPOSAL SYSTi2yi FILE 1U. '
Addr /e��ss .%�A 3. �DfL�7�2/f /tG , � 'ElUS 2, tj
...........
Located at (street) sec. A Block / Iot
.- (indicate nearest cross street)'
Municipality ens_ Watershed- OT�•�J
SOIL PEROOLATTION -•TEST DATA PgounuD TO BE .SUBM TTED WITH APPLICATIONS
Date of Pre- Soaking - / 3 �� .. Date of Percolation Test jz /± /N
'HOLE
• •NOMM C[ACK TIME PEROOLATION PERCX)L�ITION
Run Elapse Depth to Water From Water Level.
No. Ground . Surface In Inches .Soil Rate ..
Stmt Stop M Start .. Sf_op Drop In Min,/In Drop
Inches Inches Inches
'3 D7
'2-� Ye
I Vt
2 / r
5
P44: - �: Flo : 2� 25 /z. Z, �a
} ' � ' r8 . � ?�'
5 .
1
2
3
NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates
are obtained.at each percolation test hole. All data to'be submitted
for review.
2. Depth measuraT nts to be made - froa top of hole.
G. L.
29
3'
4'
5'
1.1
71
9'
10'
ll'
12'.
13'
TEST PIT DATA •D•11'E1 TO BE SUBMITTED WITH APPLICATION
M-�TJON OF SOILS RMMWM IN TEST HOLES
HOLE NO HOLE NO. HOLE NO. G
5I0Y 5t 0Y I oF}N1
14'
INDICATE LEVEL AT WHICIi GROUNDWATER IS ENQOUNTERE D iU f�
INDICATE LEVEL TO MICH WATER LEVEL =ES AFTER BEING RMNiF UM N lH
C
DEEP HOLE OBSERVATIONS MADE BY: DATE:
DESIGN
Soil Rate Used 21- o Min/l" Drop: p. (D p S.D. Usable Area Provided
No. of Bedrooms Septic Tank Capacity / 'OE�o gals. Type
Absorption Area Provided By (y l0 L.P. x 24" width trench
Other ! nF NEWS
FA
Name
Signature,
Address 2� F�9i��iE�G: D/�dE
Z
SEAL �.
it
m .J
N
UA
NO. 04581
•
�Rvp _
�.
-
THIS SPACE FOR USE BY MLTH DEPAfDEM ONLY:
`-
Soil Rate Approved sq.ft gal. Checked by Date
"-'if UET,., Y- 'M".,
DlVis-10`17 OF L FIEZIL11H SMVICSS
DESIGN ICLAM S,'-TEET-SU&,-)'Ul----XM SDIAGE DISEPOSALI SYSTEM, FIT 12 NNO.
Dim= Nip- f, Midress /kats
rilt P
Located at (Street)
'Block Lot
finclimate neau--es t cj--oss street]
jC
:,fj.,I4 7�7�n SO.J
. pa-Lity Watershed
SOIL PERCOIATITUN TEST DADA REYDUCRIED 'VO BE, RT2%UYCTEP WI-1-111 APPTJCMr!MS
Date of -Prp-So-�n6duig
TDate of Pei mllat.ion Test
HOLC
11KNIBEIR CU-Y-M
TTMILIE,
PaROD.,901ION
n
Inapse
-Ih
Dept to
Water 7
ororn
Water Level
yo.
Tore
Ground
Sarf ace
in Did-le-S
Soil Rate
Start -SLr.Dp
Min,
Start
Stop
Drop in
Mlin/In Drop
Inchas
Inches
Inches
4
5
_LAJ
2
4
1
2
3
4'
has to he repeated at sam;a depth until app
raximat-e-ly eklun-I swil rates
a 0 4 t eam -,ercolation teal_ hole. ))J-" data -to' b(--- suhidtU�d
are ,),,a-..ne<3 a C, 1. z,-
for revie4.
2. Depth rni�s=sinnts to bs miade t-Dr, of hole,,
9 /86
RQ'r--S 2,
'SC 'Oob�rEam Itll
kz;
31
51
61
-7'
•12
!NDT JP1>fP R
R 1EVEL R SE, ArT
1ND1C'NTJE LE-VEL, .Lo wHICE-1 El
"IONS MME' 131Y D A' . 0
DR-H-P HOLE OBSERV]K
i-t- S.D. Usc,!--),I.e Pxea Pr idad
ii- used :21-3c Mlin/111 I-1kruc- So OVI
sO Drop. _A
4-
Nqo, of E,&5rcaTE Septic Tan3c a,,pacitv gals. rL'ype
Absorption Area Provid&-1 By -66,S L: F. x 24" width trend-a �f N E IV
ro?
DRA0k) 1 -0 & -j" 7Z-,A/ 1P_ r,
lane.
11,1&tjVP, ST-
!�)a USE BY HET,LT-H D.c��,'[TaLDTT&,Ku ONLY.
Soil
cc
SiqT
"Vo
0
F09PP0FE
. . ........
\ i / P \ ♦ \ /
t°
7A
ooG rM,N)
1 � - _r•-= - I � -- � _ _ �,� � _ Ian , \\ \\ \
_ \ Y / \ \ ♦ 1 Ip / 1 1 \ I
f N
I �—\ , 1\`• ♦ I 1 ♦ r� t I I I \
� r
_�- -- 60UNI7/\t2Y TOPOGKAI H10 OA-rA 'TAKEN
of
c
I-KOM FINAL 5U0,12I\/1510N PVA I OP W// I \
I- 5-fA� GOAGH I°I e6KTIE� INO- PKE
PA ZtEP OY R068p(�T H.
FfLED ON
s`
51TE z
�p v
N,
r4o o
I
r
SITE [-OCATiON' PLAT
SCALF"
S5D5 DE51GN DATA
!D E_ SIC>N Fi_04'J_` � =E S1CJE- -.N T -IAL
4 Nj DtZ2 F.1�, ( 'LOO & FD - 800 r
SOIL RA>'t' USF " =D'. D'tO "IN11 " r-'
AE'F'LI[;Al1L'N iZAl'G :
0-&0
aB�C'RP PION TKGNGN
PGC'uIr e-0
T EST PIT DF�SG ir-' (0?
- IOt�E'°kh o�-ro 3r0�� 4iiLTY SAND
fr 0, -(p A'0"
(i O' -(p 4-,&,
l,�GENC
_ s.� r,•-r� __,�,_pR?PEIZ'fY :LINE_ ..-- --