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631- 589 -8100
22.84 -2 -17
BOX 7
J ).m- 4,, t
&, I ' 111'r i
Lo
IM
00546
_ 12!08/2000. 17:08 9142250690
1%ev -
BRUCE R. FOLEY
hob; Health Director
PRUDENTIAL WORLD HOM PAGE 02
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10309
LORMA MOLINARI R.N., M.S.N.
Associale Ptrbbr Hfalth Director
Director of Patent Servreet
tEuvtrsea�cnal tteuu, las) rn •6uo res (as) a?e • Al2t
Nwttim$ :trrlees ($41) 27i • 63i4 WIC datti) 178 -6478 Pax (W)J76 -6085
Early inhrygedes (10)27S.6014 Preathml (845) 276.608! F%x (845) 27i • 664E
STREET t .tom ?!LOW e►� f e TOWN �•i !'��' TX 1VW4 _
�.
NANM c ^S Z c. 6 PH, &as - 2Z:�' i `l :2 Cl-ID#
mAiL NG Amass S 0 - 6 aU, c- v-,,4 RD Coo r m _I b
DESCRPTION OF Amu=
Ni3Iv n Of E asnNo BEDROOM$ 2—_ PRC3POSFD # OF BEDR00.`
MM CERT. OF OCCUPANCY OR
CERTMCATION FROM 11MLDINO JNVBCTORJ
"Any addiRion which is consldeted a bedroom ragWtea fGmxl approval of plane (Cowtmttion Permit)
prepared by 'a ProfuOoaal Tmgln•er or Rajistered Archium in accerdime, with appLicable sections of the.
Putnam Couaty Sanitary Code.
Phase submit this form and tits t*UwNing to Pubuun. County Health Dept., 4 G vft Road, Brawst•r, NY
10509, Phone 278 -6130,
1. CerUed check or money order for S 100.00. .
2. Sketches of exist og loor plan (drawn to Scale, aI! living area Lizludwg basement)
*Ns on-profusiond skcWm are 4captable.
3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map}
*'Non - professional A*ohss are a"spteble,
4. Copy of survoy Showing well and septlo location, to the best of your knowledge. Include date of
ilsstsllation if known. Label all well: and septic systems witbin 200 feet of the property line.
Contact this office with vAy questions.
S. Copy of Cut. Of Ocaupmy from Town or Certification froer< Building Dept. with legal bedroom
taunt of dwelling.
QF= USE
Feb98
BFhourcg�tidelincs
BRUCE R. FOLEY
Public Health Director
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 (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 FMJ�15127$06EP8
Steven Rosario
58 Concord Rd.
Carmel NY 10512
Re: Addition -_Rosario - Concord Rd. - - - - No Increases in Number of Bedrooms
(T) Patterson Tax # 22.84 -2 -17
Dear Mr. Rosario:
I have received and reviewed the plans for the proposed addition to the above - mentioned residence.
The proposal for the addition has been approved as per plans bearing the approval stamp form this
Department dated May 1, 2001 The- addition is approved with the following conditions:
1. The total number of bedrooms must remain at hree without prior approval
by this department.
2. The area of the existing sewage disposal system; and its expansion area, must be -
maintained.
3. All plumbing fixtures must be updated with water saving devices, i.e., new low
flush toilets, restrictors for shower heads and faucets, etc.
Any other permits or variances required are the responsibility of the applicant and the jurisdiction
of the Town of Patterson.
If you have any questions, please contact me at your convenience.
Very truly you
G
William Hedges
WH:kg Senior Public Health Sanitarian
cc: BI
Zo
Mrs °),
Be -droo m I EGfk
C )oSe4
C
Be-d roov"
L
S
38.0'
Mf�Cke- n
Lfvl'y;,ql Room
1�: 0 '
,S �oSltl���0
C
C CA CA re,
MUM COUNTY DEPARTMENT OF RBAL„�
HOUSE PLANS APPROVED FOR
BEDROOM COUNT ONLY;
16.0' .�
Sigan-aturp $ Title to
12109/ 2000 17: 08 5142250690
BRUCIr R. FOLE Y
Pua'a6 Ifeauh Virearor
WORLD HOM
PAGE 01
LOKETTA MOLMAKI R.N., M.S.N.
Asiooioto Pubho tkaRh Dirmor
Dirsercr of Patient Services
DUARTMENT OF HEALTH
I Geneva Road
Brewster, Now York 10509
Lnvireumentel health (u4s) 278.8134 Fan ($4s)178.79,21
Murviaa Servicee (846) 178 - 6338 WIC (tai) 278.6678 Fu (84!' .'78 - $085
Lert7 Inrarventton (8aS }278.60te PreasQoW (843 }2'SbC9x Fax(9Z)278 "48
Putnam County Dept. of Health
4 Genc%•a Road
Brewuer. NY 10509
Re,— - -
Residenr•e
l Tax Map �2 a.
Town
Gentlemen: -
According to records maintained by the Town, the above noted dwelling
IS
IS NOT _
in compliance with Town code and the total number of bedrooms on record is
This information has been obtained from:
CERTLRCATE OF OCCUPANCY:
ASSESSORS RECORD____r_`___�,_
C
Inspector.
B.Phouseguidelines
a
R
Pis
TYK
ire G,AL Oro
. cotes s>r -P-t� F,. -
rw1-4A
\ PPO I
N 4 vd y
m Aor /ZG • S G'
o.d O
P�t��m 4,DbudniyC� of Hem► . 8� - 'Sri ' �_ _ y w+ l
I b,�. ian of F.wiror� HeaRh Senric�
`pprc —,�1 as Wed for oo .rmarto'� with K -Az spy
i" �� bons f the ,? j0 0.^pvel I
Putnam'Oo . O. ent
/7Zo f
D d@ County DePwrhimt at loath
ti. .. i
xvuion o lth &os:loa
f: pnyt�neental
Moved as now for oonxas'ee�1oe *ith
\ 'a We. aaa tioos od the
a t.
Title Dat=
•
TO fm
VVA Qn:nn Tnn717nicn
OWNER'S NAME S I
SITE 10CATION
..,• 0 . •.. ' �• • r.
PERSON INTERVIEWED PCSD Ccuplaint 0
Name & Relationship (i.e, owner tenant, etc.)
DATE TYPE FACILITY
PROPOSED INSTALLER f PRA
REGISTRATION #
proposal (include sketch locating all adjacent wells):
NOTE: Repair must be in same location and of same type as original sewage disposal system.
Different location may require submittal of proposal from licensed professional engineer or
registered architect
r
Inspector's Signature & Title
Proposal Disapproved
Fi4mmet—_
Proposal approved with the following conditions:
1. Procurement of any Town permit, if applicable.
2. Submission of as built repair sketch in duplicate showing:
a. Owner's name.
b. Site Street Name, Town and Tax Map number.
c. Location of installed oarponents tied to two fixed points (e.g.,house corners).
d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x.61 deep
drywalls surrounded by one foot + gravel).
e. Installer's name and number.
3. System repair to be performed in accordance with the above proposal said conditions.
I. as owner, r epo gent of owner agree to the above conditions.
SIGNATURE TITLE DATE
QPIESS: VdW)i MV; YeUcw Can EI); Pirk (Appliamt)
Pf_RP 07 �~-
12/08/2000 1?: 08 9142250690 PRUDENTIAL. WORLD HOM PAGE 03
SITE LOCATION
OWNER'S NAME„
ENO ADDRESS
PUTNAM COUNTY HEALTH DEPART
DIV15ION OF ENVM0NMI~NTAL HEALTH SERVICES
a. ot A( TM#
OMCtAL ONLY
� -o
— 22.E -
PERSON M TERVIEWED ..PCHD Complaint #
t., owAR,
DATE T`qE FACUrY
PROPOSED INSTALLER PMMB
ADDRESS .. �REGISTRATION*
(include sketch locatial all adjacent Welk);
NOTE: Repair must bt in same location end of Ma type as original sewage disposal system .Dififerent location
may require submittal of proposal from lioet:sed pmfessioud onsinter er Mustered architect.
r
n
i, as owner, or rept�rt�td asettt;gr owner agree to the cvneiittians stated on tits$ form.
DATE 1.2
t . Procurement of any Town permit, if applicable.
2. Submission of as built repair sketch in duplicate showing:
a. Owner's name
b. Site strut Nme, To At mad Tex Map number,
C, Location of inatuiled oomporunta iced to two fixed points (C-5-,house cor11US).
d. System 4W.Aption {e,g., WO gal. Concrete septic tank, three precast 60= X 6' deep
C. Installers' name and number.
3. System repair to be performed in toordame with the above proposal and conditions.
Propond apipmved,_,_
lopector's Signature & Title
COM, Wbkt (p' UM; YgUaw(Town B* Tarok ("Plic")
DATE
n •i I�+. kh 4 �.al• •J I" la
• •• • a •r,;,I�! v •ly ; tie• 4W 3:
EWAN
•
�: • �;• av
PERSON PM Cm plaint #
Name & Relationship (i.e, owner,tenant, etc.)
DUE TYPE FACILITY .
PROPOSED I15Tar,rM r ` PHONE Fl 24L—L-3 2, T J
REGISTRATION #
Proposal (include sketch locating all adjacent dells):
NOTE: Repair must be in same location and of same type as original sewage disposal system.
Different location may require submittal of proposal from licensed professional engineer or
registered architectj I / / c
Inspector's Signature &
Proposal Disapproved
roposal approved with the following conditions:
1. Procurement of any Town permit, if apple blow e.
2. Submission of as built repair sketch in duplicate shaving:
a. Owner's name.
b. Site Street Name, Town and Tax Map number.
c. Location of installed components tied to two fixed points (e.g.,house corners).
d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' deep
drywells surrounded by one foot + gravel).
e. Installer's name and number.
3. System repair to be perfo=ed in accordance with the above proposal said conditions.
I, as owner, r epo gent of owner agree to the above conditions.
SIGNATURE TIME
J
ITF& fttei (MD); Ye]1rw CTbwn HI); Pink Ug2iant)
PC -RP 97 `•��
Q
OWNER'S NAME S l e
SITE LOCATION
r• �. ii.7' �,.�• ' •�i is
PERSM INTERVIEWED PCHD Caaplaint #
Name & Relationship (i.e, owner,tenant, etc.)
DATE __- -- _ TYPE FACILITY
PHONE Y'YS % 3 - I Z (, I
REGISTRATION #
Proposal (include sketch locating all adjacent wells):
NOTE: Repair must be in same location and of same type as original sewage disposal system.
Different location may require submittal of proposal from licensed professional engineer or
registered architect %� /
'roposal approved with the following conditions:
1. Procurement of any Town permit, if applicable.
2. Submission of as built repair sketch in duplicate showing:
a. Owner's name.
b. Site Street Name, Town and Tax Map number.
c. Location of installed canponents tied to two fixed points (e.g.,house oorners).
d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' deep
drywells surrounded by one foot + gravel).
e. Installer's name and number.
3. System repair to be performed in accordance with the above proposal and conditions.
I, as owner, r epo gent of owner agree to the above conditions.
SIGNUE)RE(t TITLE
_w>
T;M: WW36 (FAD); *111113w (tea HI); Pink (ARIkent)
PC-RP 97 °1''
t l�
u,
°Lu/cLt, v "i M I
a2
78 0 8 /O �� /ZG • SG'
_ co /- /co,ey �od�
Putnam County Department of Health
Division of Environmental Roulth Bervioes
Ayproved as noted for ootdormanoe eitb
able Rules and 8e6ulstlone.of the
C Health Dspartme t•
Title Day)t.
Signature
.f I
1"G _ W / I1
4- �o 4 X <ol �f I DGfl
f' IZG FA b -ra O
A` BUILT' DATA.
Structure located train survey by surveyor noted below_
Weil locotea by; Surveyors wrvey•_ _— Wt— — — __
Wall -drillers report x
Engineers ' rnesurementsD_
Tons, boxes, p;14r galleries 9 lafetals located by:Contractor:
Engineers
Health dept:
laid inspection by: Health dept to ®�► doter -
_
Engineer 14I date
Titic :o .or,t (v that the
disposal Rest CM .•as construl
NOTES: indicated oc this plan and :
ter, t,zs inspected Ly me i
was covered moor. The sect.
Constructed in accordance s.•
+'t aq<;atd rules and reculati,
the N. .S.D.!
D I M E N SION S
A - B =_
"A - c =_liar
A - E £ - —C 7,B - E II _ - "� - QPOFESSIt
2-
A - F =mot�f t B _ C •_ 29�_O oar aR
AJ -- - -- --B J — A. - K'
yg
of rwr S7
SANITARY SYSTEM DESIGN_ AS BUIL
OWNLR:Qae�E F,e j_isTi?�(cJ�o
LOCATION Street:
Town: County:1(1T14v/ S!tat %e;
SUBDl Yisls10
Ma p:t7;Lx
Block; _ _ (p _ LOT Ns,
Budder:��/L.1
Surveyor: - --
Drawn: Dote; 17 scale: 4_ /Job
JOHN H, PR "ENTISS PE
CONSULTING ENGINEER
i�ed
04
Orr
-rA.1-LA
poD
T—MV
Ls
Ego
m TIN
30
ti la
N dl A-04)
4W
e coA C>
Al -3 e
Dr,4
INA,
Heaft SWC*
rmarwe
PT;7t*,d as nowd for -AZ
tc
b=.Of /0' -L-Vwel
Rkift end L
at
th
County rioea
Division of Iftle
Avomna es notAa for tug
ana lealth so
"le
bass
C
000AWS
!/-)f
Tide �aYs
TO' Yva 90,00 TOOZ/ZO/90
\f' \1%'\
. . dd
\2«�,�
may
\§��� ■
<f: eta
"'APPROVEI
)
Yorktown Medical Laboratory, ;Inc.
321 Kear Street
Yorktown Heights, N. Y. 10598
(914) 245 -2800
Director: Albert H. Padovani M. T. (ASCP)
T— Carr
DOUGLAS WALLA-CE Pew,
R.F.D 9 FAIR STREET
CARM"L, NY. .10512
r
LAB 4� rr , o'.�
Date Taken: 7 Time: -11am
Date Rc'd: 7/12/-9, 'Time 7uat—
Date Reported:
Collected By: Da ace
PO /Client
Referred By: _ "`
Sampling Site: Kitchen apV,,�&�
Phone 8i'8 -95+8
J
(For, Lab Use)
REPORT ON THE QUALITY OF WATER.
SAMPLE TYPE:
(Check One)
MICROBIOLOGICAL U -10� 0niI� '
Potable
Alkalinity Standard Plate Count _ Non- potable
C3 11.oride ( CFU /1 mL.)
_. Copper
Detergents, MBAS _ Membrane Filtrtion Method
Hardness, Calcium
Hardness, Total Total Colifoft
Iron _
••�-
Lead
Manganese _ Penal. Streptococcus
Mercury
—__ Nitrogen, Ammonia Most Probable Number Methocl
Nitroge ,, Nitrate _
-.LV1tro�- jeL;..1V:I:t1'11`'Ls.
�T •
Phosphate, Total w
Fecal, Colif(
S 41 ver t
Sodium Fecal. Streptococous z•�4'-
Sulfate
^ Sulfide Presence A -sense PA S
Sulfite
Linc Totall Coliiorm P
PN.YS CAL,�rMT GE LAIyEOUS ��� KEY FOR TEPHIN@LOGY
_ pH (S.U.)
_ Color (Units)
Conductance (ohms /c)
Odor (TON)
_ Turbidity (NTU) _
CFU = Colony Forming Units
IT =
<'
= Less Than
GT =
>
= Greater Than
NA =
Not
Applicable
SA =
See
Attached
TNTC
= Too Numerous To Count
REMARKS COMMENTS For Lab Us'e
OUTGO 11VG :
(Check Each)
HNO
HC1
_
NaOH
_— ZnOAc
— Na2S203
Other:
INCOMING:
.(Check Each)
ICE
40C
GT
4 /LE 200C
_
GT
200C
.M_. i�iJA
IIE
_ pH
GE 12
Other: . .
THESE RESULTS :INDICATE THAT THE WATER SAMPLE AS .(WAS NOT) (NA) OF A
SATISFACTORY.SANITARY QUALITY ACCORDING TO TH 7 YORK STATE PUBLIC DRINKING
WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME 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 PUBLIC DRINK-
ING-WATER CODES,�FOP/VHE PARAMETERS TESTED, AT THE TIME OF SAMPLE COLLECTION.
WNW - %81 e, MT:
0
7 /87(Rvsd1 /90)RWE
WhLL UUr1rLL1LUV �rual
DEPARTMENT OF HEALTH
Division Of .Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
WELL LOCATION
ISTREET ADDRESS: 7OWNIVILLAC11CHY, W GRID NUMBER:
C P4
WELL, OWNER
NAME.- ADDRESS:
(E(PRIVATE
❑ PUBLIC
USE OF WELL
1 - primary
2 - secondary
RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP 0 ABANDONED
0 BUSINESS 0 FARM 0 TEST/ OBSERVATION 0 OTHER (specify)
C3 INDUSTRIAL 0 INSTITUTIONAL ❑- STAND-BY ❑
AMOUNT OF USE.
YIELD SOUGHT S gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE Uv gal.
REASON FOR
DRILLING
VNEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION
0 REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
.DEPTH DATA
. WELL DEPTH �LQ/Z;51 ft.
STATIC WATER LEVEL _��fjqATE
MEASURED
DRILLING
EQUIPMENT
❑,ROTARY VCOMPRESSED AIR PERCUSSION ❑ DUG
0 WELL ;POINT C1. CABLE 'PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING. [!(OPEN HOLE IN BEDROCK 0 OTHER
TOTAL LENGTH tL
MATERIALS: &STEEL ❑TLASTIC 00'THER
._-- CASING -
DETAILS
---LENGTH BELOW--GRADE- _fL_AQ_1NTS:__
- O.WELDED.---.Y-THREADED-:-O*-�0-I.HER'-
—DIAMETER --7--in.
SEAL: O' CEMENT GROUT 126ENtONITE 06THER
WEIGHT
PER FOOT Ib./ft.
DRIVE SHOE: IKYES ONO LINER: OYES NO
SCREEN
DETAILS
DIAMETER (in j_
'SLOT SIZE
LENGTH
(it)
OEM TO SCREEN
DEVELOPED?
<rWS 0 NO
HOUM —
tOCOND
GRAVEL PACK
❑ YES
❑ NO
GRAVEL
SIZE.
DIAMETER
OF PACK in:
TOP
DEPTH —ft.
BOTT4
DEPTH It.
WELL YIELD TEST If detailed pumping
MOOD: 0 PUMPED i tests were done is in-
VCOMPRESSED AIR ! formation attached " ?
0 BAILED ❑ OTHER :OYES ONO
It more detailed formation descriptions or sieve analyses
'WELL LOG are available, please attach.
DEPTH FROM -
SURFACE
water
pear-
ing
well
Oia-
meter
In
FORMATION DESCRIPTION
CDOE
ft.
IL
WELL OEM
ft.
DURATION
hr. min.
DRAWOOWN
ft.
YIELD
9Pm-
Land
Surface
F
d Asa c K
O
g5
WATER iCLEAR TEMP.
QUALITY 0 CLOUDY HARDNESS
0 COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED! 0 YES 0 No
STORAGE TANK: TYPE
CAPACITY Aorj?` �,,n ' 2(j C,411,9,q GAL. _aO
PUMP INFORMATION
TYPE :5111 SCE CAPACITY 7
MAKER -15- DEPTH �Itj 0
MODEL VOLTAGE 2kkP
WELL DRILLER NAME ATE
N#RT M. H417 & SONS, INC.
At . Well Drilling, StGN1TURE
Rte. 311 R.R. 2 -Box 1.71A
PATT17141RON, NEW Y.Q.Rlk=-L2563
:SITif�Ma1f ;. fix +r)�A1ar, f M, ^+`
.f:. n< f1" �ykiVtiYdy '�Yif�;1�r'r61�"j^i�i���r�jy 6?A4 y�W�� tt449fro! *rYi. "gM�441,�jNtt�l l ::.
u, PUMAM COUN'IrY DEPARTMENT OF. HEALTH
DIVISION OF ENVIRONMBpTrAL HEALTH SERVICES
tbrchester Construction Corp:
Owner or Purchaser of Building
Owner
Building Constructed by
Concord Road
r
Location - Street
75 6 4 & 5
Section Block Lot
Fifth Map Of Lake Carmel
Subdivision Nance
T. Patterson !
Municipality Subdivision Lot #
Existing
Building Type
GUARANTEE 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 approve d - amendment thereto- and -in- accord-ance- wi -th- the- -:
standards, rules and regulations of the Putnam County bepartment 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 an
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 ot'4the building utilizing
the system.
The undersigned further agrees to accept as conclusive thES deternu.nation of
the Director' of the Division of Environmental. Health Services of the Putnain`�County
Department of Health as to whether or not the failure of the systE�m to operate was
caused by the willful or negligent act of the occupant of the bpilding' utilizing
the system.
Dated this 18 day of July 1990 Signature ! i�A'
()Z;7- Av� Title Presi ent G
- Signature
Douglas Wallace, President
Corporation Name (if Corp.)
c/o Dorchester Construction Corp.
Address RD9 -Fair St., Carmel, N.Y. 10512
rev. 9/85
Dorchester Construction Corp.
Corporation ZIame (if Corp.)
Rd9 -Fair Street, Carmel, N.Y. 1051:
ess
1
P -
, o `
PVAP-4 111 8
WOO a A.L. rgZc" , o
C10 t k. '6
vi000 p'�„ a PIS Piz- lc lb- -1'cia
?s.,•t arc
CoNc.o�y X0,40
Putnam County Departowt of Health' aa3.
Division °of Environs[ental Health Serviced t'
,{yproved as noted for oonforuanoe with
. sDDli ble Haled and �Balat�
Via of the
tore, a ntle
/D
AS BUILT QATA,
Structure located from survey by surveyor noted b'elowm _
eli located by: Surveyors survey.-
Weil drillers report —
Engineers mesu!einentsD_-
Tank, boxes, pits, galleries B lateral located by:Contractor:
Engtneer:
Heaithd apt:
Field inspection by: Health dept ® do 16!—
Engineer dote
This is .o ccreiip Ghat the s
� disposa; sysi<r ri was constnic[
NOTES: indicated un this. plan and.tli
• e:ystem waa inspected by me be
was covered :,ve -r. The Svetrm
constructed in accordance; wit:
standard rules and reguN4tii_n
the
DIMENSIONS
A - c _ c a _ /y✓� -o`er
A - D 1$t _/0 8 D 2�-- 17
A - E a_ ?r?� %figg - E a. z� . — tRMESSietyn
A _ b. a- l /_. %nB - G
A J 8 J
A K -_Z- --- K - - -- - --
ha 2920
114E STAV
�ANITARY SYSTEM DESIGN, AS'- UIL
OWNER:��$���Q Ga/- �STi`J1� - -woe
LOCATION Street: ���. ��K.L7 �� /7 a .
Townounty �4 State:Z
S U B D I y�I ,S, I O �� /_j? o� 459-1�
Block.. _ LOT Ns_.
Buader_O�/L� ?� -- _ - -- - --
Surveyor:• -
Drawn; a, 2 Dote:7_�_� Scale: 4: COL Job N$.�
D
JOHN H PRENTISS 'PE
CONSULTING E'NGIN'EER
RD 1 Fl+ii2 '!'. 1 AI7 hAFI NV IAR19 _r0�A1 070_Q/7n 1•.
s
PUTNAM COUNTY
DEPARTMENT OF HEALTH
MEMORANDUM
Date:r�
To:
From:,✓
Subject:
F
i �J_
;'l.
�,r?,fi � i
y
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DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATION TO CONSTRUCT.A WATER WELL n y�q
PCHD PERMIT 09 50-67
WELL LOCATION
Street Address
Concord Road
Town/Village/City Tax Grid Number
T. Patterson 75 -6 -4 &.5
WELL OWNER
Name
George D. Howell,
Mailing Address,
Jr., Terry Hill Rd., Carmel, N.Y. 10512
AXPrivate
O Public
USE OF WELL
1 - primary
2- secondary
It RESIDENTIAL
(3 BUSINESS
10 INDUSTRIAL
[]PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP
0 FARM .O TEST /OBSERVATION
M INSTITUTIONAL O STAND -BY
❑ ABANDONED
0 OTHER.(specify
p
AMOUNT OF USE
YIELD SOUGHT
Five gpm /# PFOPLE SERVED Four /EST. OF DAILY USAGE 400 gal
REASON FOR
DRILLING
N NEW SUPPLY ❑PROVIDE ADDITIONAL SUPPPLY
❑REPLACE EXISTING SUPPLY 0DEEPEN EXISTING WELL
❑TEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
New Well. or existing residence
WELL TYPE
DRILLED
DDRIVEN
DDUG
1:1 GRAVEL
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES x NO.
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Fifth Map of Lake Carmel Lot No. 'Filed .Map #130 -DD
WATER WELL CONTRACTOR: Name P.F. Beal & Sons,Inc. Address :P.O. Box "B ", Brewster, N.Y
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES x NO
NAME OF PUBLIC"WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY.FROM NEAREST WATER MAIN: None
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED(See Dwg. Job # S.0.2511,By John H. Prentiss,
[]ON REAR OF THIS APPLICATION [DON S PARATE SH ET P,E,)
25 August 1989
(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 s.hal l' :
1., Pump the well until the water is clear.
2. Disinfect the well in accordance with the requirements of the Putnam
County Health Department attached to this permit. "
3.' Submit a Well Completion Report on a form provided by the Putnam County
Health Department.
Date of Issue: ? 19 10" 7
Date of Expiration: 19� Permit �su ng f i is
Permit is Non - Transferrable copy: H.D. File
Y 1 'ldin
el ow cppy. Bui g Inspector
2/87 Pink Copy: Older
Orange copy: Well Driller
•' • ENVIRCRM?ML HEALTH BERVICES
DESIGN DATA SHEET =SUBS CE,.SF3nTAME DISPOSAL SYSTEM FILE NO.
Owner c� ` U c�U r7Z -f-___: Address 0 t��� j C
Located at (Street)
C-7 C-. •Kc-J Seca 7-r Block Lot
(indicate nearest cross street)
Municipality C-11 \-`�T`1= i 1� Watershed C
SOIL PERCOLATION TEST DATA RBQUIRED TO BE SUBMITTED WITH APPLICATIONS
Date of Pre - Soaking '.' t-j i 5 Date of Percolation Test
HOLE
NUMBER C= TIME PEROQLATION PERCOLATION
Run Elapse Depth to Water Fran Water Level
No. Time Ground Surface In Inches Soil Rate
Start-Stop Min. Start Stop Drop In Min /In Drop
Inches Inches Inches t-
2 106-11
3
4 It
5 -
1
3�'� }�L�
NOTES: 1. Tests to be repeated at .same depth until approximately equal soil rates
..are obtained- ,at...each,percolation test hole. All data to'be submitted
for review.
2. Depth measurements to be made fran top of hole.
rev: 9/85
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE NO. l HOLE NO. HOLE NO.
G.L.
2'
3'
4'-1
6'
7'
8��.
9'
10'
11'
12'
13'
� L
1/Acx"'Ve t «mil,
—
��
—T -
14'x}
INDICATE LEVEL AT; ;WHICH GROUNDWATER IS,ENCOUNTERED G---
INDICATE LEVEL TO WHICH DATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP HOLE OBSERVATIONS MADE BY: �L ��r� • �P��� DATE:
Soil Rate Used C) Min /1" Drop: S.D. Usable Area I1'rovided
No. of Bedrooms Septic Tank Capacity 00 gals. Type i' i i4Sc
its
Absorption Area Provided B
Q�pFESSIOfYgd Fy
Others
I m = ' � A mmzi V :V����"PIVLire
Address JOHN H. PRENTISS, P.E. G
a•
CARMEL. NEW YORK 10512 `F�AJ�� NO,
OF THE SZA"
SPACE FOR USE BY HEALTH DEPARIMENP ONLY:
s►
Soil Rate Approved sq.ft /gal. Checked by Date
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PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
John M. Simmons, M.D.
Deputy Commissioner of Health - FIELD ACTIVITY REPORT -
Sheet of
/ S rti ,-- -�, it c NSPECTION
NAME G Urd X-7'/ - f - OD 7 5- Orig. - Routine
ADDRESS. ' /,-, �e 1 A/ry ,-) .�
TM No.
MAILING ADDRESS
P.O. Box Post Office Zip Code
-*C*2
PERSON IN CHARGE
OR INTERVIEWED
Orig. Canplain
Orig. Request
Compliance
Complaint Camp
_ Final
Group Illness
Construction
Reinspection
Field, Sampling Only
Field Conference
Name and Title f
Other
DATE �/2 �� TYPE FACILITY
TIME ARRIVED
TIME LEFT
FINDINGS:
h z3-'_7
i
Explain
INSPECTOR:
ture and Title
PERSON IN CHARGE OR INTERVIEWED:
I acknowledge this Field Activity Report. SIGNATURE:
6/86 TITLE:
TELEPHONE:
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date 26 March 1987
Re: Property of Mr. George Howell
Located at I Concord Road
(T) Patterson Section 75 Block
6 Lot 4/5
Subdivision of Lake Carmel Subdivision
Subdv. Lot # Filed Map # Date
Gentlemen:
This letter is to authorize John H. Prentiss
a duly licensed professional engineer % 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, and the Putnam County Sani-
tary Code.
N PR'
Very truly yours,
/ Signed
d � 0 r o Property
jo nter igne
��r
lr%eLr t� Terry Hill Road
P.E., R.A., #
Address
Address JOHN N. PRENTISS, P E
RD9 FAIR ST 918- 878 -6170
CARMEL. NEW YORK, 10512
Telephone
Carmel, NY 10512
Town
914 - 225 -6851
Telephone
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APPROVED 'IFO, R CONSTRUCTION ToH.appovalsxplres ,jW6 vows frovil,the date I
foviiiCable or cause..'Or .!I,
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