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631- 589 -8100
24.18 -1 -14
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PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
ca 714`1 t'I
i ll6p
PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR
SITE LOCATION Ll J 21 r) ICJ .q.m )l TOWN TM # .'L1/. /� — (— /•�l
OWNER'S NAME VlAa r C k l V n leh +l'h PHONE #q 17.,aOi' -1
MAILING ADDRESS : C2 yyt�
APPLICANT 'W r1 V., Y"
Name & Relationship (i.e., owner, tenant, contractor)
DATE j ( FACILITY TYPES _ PCHD COMPLAINT #
PROPOSED INSTALLER VJ0, F`C PHONE # $�1 ' )—'7
ADDRESS
REGISTRATION /LICENSE #
Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200
feet of repair and the location of existing and proposed system)
NOTE: The Department may require submittal of proposal from licensed professional depending on the
nature and extent of the repair,
_ 36 G`
I, as owner,agree to the conditions stated on this form
SIGNATURE TITLE DATE
(owner)
I, the septic installerjagree to comply with the conditions of this permit for the septic system repair
SIGNATURE C�'/ TITLE_ DATE tsJ
(installer)
Proposal aggroved with the foll conditions:
1. Procurement of any Town Permit, if applicable.
2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing:
a. Owner's name, Site Street Name, Town and Tax Map number
b. Location of installed components tied to two fixed points
c. System description (e.g., 1250 gal. Concrete septic tank, etc.)
d. Installers' name and phone number
3. System repair to be performed in accordance with the above proposal and conditions
4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the
completed SSTS repair will function.
5. No completed work is to be backfilled until authorization to do so has been obtained from the Department.
1k11r0n\IAI 110C A \II V
IN I G"#,IP% VJG Will i
Proposal Approved Proposal Denied ❑
6; /
Inspector's Signature & Title Datt I
_ / Ex rati Date
,Repair proposal is in compliance with applicable codes Yes No O
COPIES: PCHD; Owner; Installer
PC -RP 99ML Rev. 2/07
Sheet of
PUTNAM COUNTY DEPARTMENT OF HEALTH "i:
DIVISION OF ENVIRONMENTAL IIEATLH SERVICES
FIELD ACTIVITY REPORT
NAMR: y4Le,jLf�dAL- TPI:
AT)T)RF44;
Street Town State Zip
PERSON IN CHARGE
nn TATTL'DXTTUX]rUTl.
Name and Title
TYPE OF FACILITY :,`/
FINDINGS: -St
Signature and Title
RFPQRT RF.CF.TVFT) BY:
I acknowledge receipt of this report: SIGNATURE:
02/96 Title:
3
W
O
o SKY LAND
e- c4i
VA �E /V T //Vf-
'Y/2.7 01-P RT 22
rOWAI of R Teo
SITE LOCATION TOWN TM #
OWNER'S NAME
MAILING ADDRESS
APPLICANT
Name & Relationship (i.e., owner, tenant, contractor)
DATE
PROPOSED INSTALLER
ADDRESS
FACILITY TYPE
PHONE # jq tl) �Aq .11 y b
PCHD COMPLAINT #
PHONE #
REGISTRATION /LICENSE #
Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200
feet of repair and the location of existing and proposed system)
NOTE: The Department may require submittal of proposal from licensed professional depending on the
nature and extent of the repair.
I, as owner,agree to the conditions stated on this form
SIGNATURE , TITLE DATE `, 3 \ 1
(owner)
th the conditions of this permit for the septic system repair
1, the septic installer, agree to comply�i
SIGNATURE TITLE DATE
(installer) .
Proyosalaapproved with the following conditions:
1. Procurement of any Town Permit, if applicable.
2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing:
a. Owner's name, Site Street Name, Town and Tax Map number
b. Location of installed components tied to,hvo fixed points
c. System description (e.g., 1250 gal. Concrete septic tank, etc.)
d. Installers' name and phone number
3. System repair to be performed in accordance with the above proposal and conditions
4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the
completed SSTS repair will function.
5. No completed work is to be backfilled until authorization to do so has been obtained from the Department.
INTERNAL USE ONLY
Proposal Approved ❑ Proposal Denied ❑
Inspector's Signature & Title Date Expiration Date
Repair proposal is in com liance with applicable codes Yes ❑ No ❑
COPIES: PCHD; Owner; Installer
RC -RP 9 Z941L Rev. 2/01
ICU FNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR
YES
NO
internal Use Only PERMIT #
Q -- I'J
❑
Repair Permit issued in last 5 years ❑
Not in Watershed
0
E❑
U
Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑
Delegated.
D
❑
Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑
Joint Review
SITE LOCATION TOWN TM #
OWNER'S NAME
MAILING ADDRESS
APPLICANT
Name & Relationship (i.e., owner, tenant, contractor)
DATE
PROPOSED INSTALLER
ADDRESS
FACILITY TYPE
PHONE # jq tl) �Aq .11 y b
PCHD COMPLAINT #
PHONE #
REGISTRATION /LICENSE #
Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200
feet of repair and the location of existing and proposed system)
NOTE: The Department may require submittal of proposal from licensed professional depending on the
nature and extent of the repair.
I, as owner,agree to the conditions stated on this form
SIGNATURE , TITLE DATE `, 3 \ 1
(owner)
th the conditions of this permit for the septic system repair
1, the septic installer, agree to comply�i
SIGNATURE TITLE DATE
(installer) .
Proyosalaapproved with the following conditions:
1. Procurement of any Town Permit, if applicable.
2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing:
a. Owner's name, Site Street Name, Town and Tax Map number
b. Location of installed components tied to,hvo fixed points
c. System description (e.g., 1250 gal. Concrete septic tank, etc.)
d. Installers' name and phone number
3. System repair to be performed in accordance with the above proposal and conditions
4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the
completed SSTS repair will function.
5. No completed work is to be backfilled until authorization to do so has been obtained from the Department.
INTERNAL USE ONLY
Proposal Approved ❑ Proposal Denied ❑
Inspector's Signature & Title Date Expiration Date
Repair proposal is in com liance with applicable codes Yes ❑ No ❑
COPIES: PCHD; Owner; Installer
RC -RP 9 Z941L Rev. 2/01
Sketch proposal
No wells within 100'
of proposed ssts
ex. septic tank 1, 000
gal
new 1, 000 gal pump station —y
128gal per inch }
2" sch 40 pump line
Large pine
trees
well
approx 300 bq
Valentine
4127 Old Route 22
Run
��ii EZSo�
Property line
ADS 36" w Bio
Diffussers 6' o. c
Dosing schedule will be set at I min on 2hr off
Goulds PE31J {. 4110 hp} at 35gal per min.
NO!4LL
Dose volume will be approx. 30 gal
EXCAVATING CONTRACTORS
every 2hr. . If enable float is activated
845- -279 -8809
www tyn�Ia / /sopt /c.com
As Built
Fil
MM
53'
MM
52'
MM
45'
MM
38)
5.
22'.
MM
MM
MM
MM
MM
MM
Large pine
trees
No wells within 100'
of proposed ssts
F--',
1. 1
53'
2.
52'
3.
45'
4.
38)
5.
22'.
,,yell
B
15
ex. septic tank 1, 000 6 new outlet
gal baffle
new 1, 000 galpump station
128galper inch 1
2" sch 40 pump line
ex. septic system to
be rested
Dosing schedule will be set at 1min on 2hr off
Goulds PE31J f 4110 hp I at 35galper min..
Dose volume will be approx. 30 gal
every 2hr. If enable float is activated
Valentine
4127 Old Route 22
Brewster
PliuOlij
75' radius
Property line
ADS 36" w Bio
Diffussers 6' o. c
20(6112)X36"
0,
D- box 3
Of-
SEA �i4L
EXCAVATING CONTRACTORS
4945-.27-9-4980-9
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IIII
PUTINTAIM COUNTYDEPARTIVIEN-T OF HEALTH
DMSION OF EIN_VIRO_N_-,VIEIN_T_-kL HEALTH SERVICES
DES IGN DATA ShTET ' SUBSURFACE SEWAGE TREATMENI SYSTEM
Owner: Address: W47 61-D -IZ-h 2Z_
Located at (street): TM '* Section: Block'_Lot
. �-467_
Municipality: 247_7,677Z-S6A) Watershed:
SOIL PERCOLATION TEST DATA
Witnessed by:
Date of Pre-soaking: Date of Percolation Test:'
Hole No.
Run N-7 o.
Time
Start-
Stop
Elapse
T . ime
(min-)
Depth to
water from
ground surface
(inches)
Start - stop
Water
level drop
in inches
Percolation
Rate
min/inch
1
1/0,37- fi-' nZ
1 30
1 /8 - N,_
I
.2
1 QV - 1/" YO
I - 30
1 /6- 17Y;L
1.
7- 0
I1VY9-IIJi5-I
30
/A - /?%
2
3
4
3-
4
2
4
Noces:
I 7Z7 M hp rpnp-rp• ir ;;rnp Hf-rrli miril
I
re•: t: e.: �.,,,. w.... r.. ..,;....�r.:m,:.w..,wna..u�., <. �.:. • • �.�:i5.4l+b`Y.- .��-.'.. •1tW:lWY�IN'ltya•� .� .e,:.. •: : �I GYLb :IWS ^.�%i'LiCfiYi.'!8%W:oW�.V ..u�wae4LwW`.r,1wWWwWWAWU. use. auW. lw .rrwa...vi.uurl..w4..�..M4w.wr Aw.M..!., - �iMLY�
TEST PIT DATA
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
G.L.
Ale
2.5,. <i
3.17
3.5
a
4.5
5.01
5.�
�GJ.Q'
G. v'
7.Q'
731
Q.J
9.
1Q.G'
H0L--c # 3
H0LL 4 HOLE
Lndi cate level t which g Ln dwater is zcount.e-red
S Qgy. C 6.
L-tdicate level at w1mchmottling is observe
Indicate level to which w'at °r level rises after being encountered
Deer, hole observations made bv: C Date z
Desia---q Professional
S!a iar-Lre:
BioDiffuse? Trench Installation Detail
16" High Capacity
NOTES'
1. EXCAVATE TRENCHES TO PROPER WIDTH, AND PROPER
DEPTH AS REQUIRED BY STATE AND LOCAL CODES,
2. SMOOTH. IRREGULARITIES IN THE EXCAVATION. A LEVEL,
FLAT SURFACE IS REQUIRED.
3. ASSEMBLE BIODIFFUSER LEACHING CHAMBERS AND
UNIVERSAL ENDPLATES TOGETHER IN TRENCH(ES). is
4. INSTALL UNIVERSAL END CAP AND SECURE IN PLACE WITH .
BACKFILL.
5. PUNCH OUT PIPE HOLE OPENINGS IN THE END PLATES AS
NEEDED AND CONNECT INLET PIPES.
6. FILL SIDEWALL AREA TO TOP CHAMBERS .WITH NATIVE
SOIL (COARSE SAND OR FINE GRAVEL MAY ALSO BE-USED,
NO HEAVY CLAY, SILT, OR DEBRIS SHALL BE INCLUDED).
7. 'WALK IN' FILL TO COMPACT SOIL ALONG SIDES OF
BIODIFFUSER. THIS IS VERY IMPORTANT TO ACHIEVE
LOAD RATING.
8. COVER BIODIFFUSER LEACHING CHAMBERS TO A MINIMUM OF
12' OF GRANULAR COVER AFTER CONSOLIDATION FOR H -10
APPLICATIONS. AVOID LARGE ROCKS .OR DEBRIS IN COVER
MATERIAL.
MIN. COVER = 12'
INLET
INVERT = 29.5"
TRENCH
WIDTH = 36"
CHAMBER
HEIGHT = 16"
NOTES:
1. EXCAVATE TRENCHES TO PROPER WIDTH, AND PROPER DEPTH AS
REQUIRED BY STATE AND LOCAL CODES.
2. SMOOTH IRREGULARITIES IN THE EXCAVATION. A LEVEL, FLAT
SURFACE IS REQUIRED.
3. ASSEMBLE BIODIFFUSER LEACHING CHAMBERS AND UNIVERSAL
ENDPLATES TOGETHER IN TRENCH(ES).
4. INSTALL UNIVERSAL END CAP AND SECURE IN PLACE WITH
BACKFILL.
5. PUNCH OUT PIPE HOLE OPENINGS IN THE END PLATES AS
NEEDED AND CONNECT INLET PIPES.
ADS SEWER $ DRAIN
AND /OR ADS TRIPLEWALL
OR PER LO^
DISTRIBUTI
6. FILL SIDEWALL AREA TO TOP CHAMBERS WITH NATIVE SOIL
(COARSE SAND OR FINE GRAVEL, MAY ALSO BE USED: NO HEAVY
CLAY, SILT, OR DEBRIS SHALL BE INCLUDED.)
7. "WALK IN" FILL TO COMPACT SOIL ALONG SIDES OF BIODIFFUSER.
THIS IS VERY IMPORTANT TO ACHIEVE LOAD RATING.
8. COVER BIODIFFUSER LEACHING CHAMBERS TO A MINIMUM OF 12"
OF GRANULAR COVER AFTER CONSOLIDATION FOR H -10
APPLICATIONS. AVOID LARGE ROCKS OR DEBRIS IN COVER MATERIAL.
COVER HEIGHTS AND LIVE LOADING LIMITS ARE IMPACTED BY BOTH
SOIL TYPE AND COMPACTION REQUIREMENTS. CONTACT ADS WHEN
POOR SOILS ARE ENCOUNTERED AND FOR MAXIMUM FILL HEIGHTS.
BY STATE
CODES.
I MODIFYORAWMGB CKS 6/27Po1 5,;.,z ;�` 3 F1
Oa AD%W. REV. DESCRIPTION BY MMIDD/YY CHMD
ADVANCED DRAINAGE SYSTEMS, INC. ADU HAS PREPARED THIS DEVIL BASED ON INFORMATm PROVIDED To ADS. THIS a ;_:• ,s KAM yY
DRAWING IS INTENDED TO DEPICT THE C01(PONENIS AS REOUEVED. ADS WAS NOT PERFORMED ANY EN=EIIBNG OR DESIGN "-
SERVICES FOR THIS PROJECT, NOR HAS-ADS DNDEPENDENTLY VERIFIED THE INFORMATION SUPPLIED. THE INSTALLATION DETAILS 16' BI CAPACnT BIODUTUSEB 4640TRUEMANBLVD 11HPo4
PROVIDED - HEREIN ARE GENERAL RECOMMENDATIONS AND ARE NOT SPECIFIC FOR THIS PROJECT. THE DESIGN ENGINEER SHALL II7BlAila'PIOp HILLIARD.OHIO43026
REVIEW THESE DETAILS PRIOR TO CONSTRUCTION. R IS THE DESIGN ENGINEERS RESPONSIBILTTY TO ENSURE THE DETAILS 9 NTS
PROVIDED HEREIN MEETS OR EXCEEDS THE APPLICABLE NATIONAL. STATE, OR LOCAL REQUIREMENTS AND TO ENSURE THAT THE DRAWING NUMBER STD -9108 � aw a a*sum na OF
DETAILS PROVIDED HEREIN ARE ACCEPTABLE FOR THIS PROJECT.
SHEF6.IVA AMLER, MD, MS, FAAP
C omtnissioner of Health
LORETTA MOLINARI, RN, MSN
.Associate Commissioner of Health
DEPARTMENT OF HEALTH
1 Geneva head, Bmmar, Nevi York 10509
REOU"T FOR FWLD TESTING
ROBE T 3. BONDS
Cou Facetuave
All informatioD below must be fully completed prior to any sobeduling. DATR:
T MORRIS, PE
of Environmental Health
�~ mS� PHONE #•
NGMRR OR FXRiVf:. - _O .�
PERSON TO CONTACT_`
a NF W CONSTRUCTION 0 REPAIR PROGRAM Q AMMON PR GRA
RFASON: DREPS: ,O' PERCS: Q' KW TEST_ o
SUBDIMION :_
wo-
YES NO
O O
❑ ❑
❑ ❑
❑ ❑
0 0
TAX MAP #:
LOT #:
Proposed SSTS wiffin the drainage basin of West Bmcb or Boyds Col
Groton Pans Reservoirs.
Proposed SETS within 500 feet of a reservoir, reservoir stems or control
Proposed SSTS wictina 200 feet of a watercourse or a DEC wetland.
Proposed SSTS design Dow greater &-m. 1000 gallonsiday or SPDES Pe
Proposed SETS for a Commerdal Project.
M.
required.
M
It is the responsfilty of the design professional to provide the above information pr or to soil testing. The
Department will determine the NYCDEP project status (join! or Delegated) based o i the response.. If you
answered yes to any of the questions, NYCDEP must witness the soil tests. This Depar raent'WiU coordinate a
mutually suitable time for Feld testing with the Design Professional and NYCDFP.
If a project • has been determined to be Delegated based on, the above response and then subsequent
information indicates NYCDEP is required to witness the soil tests, it will be the so a responsibility of the
design professional to schedule re- witnessing of the soil testing with NYCDEP.
FOR COUNTY USE ONLY
DATE: /� TIE:
COMAMTS-
IM. Eft Fxo TERN&RLY Eoviremmeut d (845) 278 -6130 Fsx (845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 27&-6558 Fax (845)1278-6026 WIC (845) 278 -6678
Nursing Homq Care Fax (845) 278400
Early Interven ieWPrmchool (845) 278 -6014 Fax (845) 278 -6648
L'd 69%-6LZ (9t8) 118PUAi d9t:Z6 l6 % AV
tSHEl& ITA AM LER, MD, MS, FAAP
F Commissioner of Health
LORETTA MOLINARI, RN, MSN
.4ssociate Commissioner of Health
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
REQUEST FOR FIELD TESTING
All information below must be fully co3mpleted prior to any scheduling. DATE:_
ENGINEER OR FIRM: PHONE #: t.S
PERSON TO CONTACT: P41 k L�
❑ NEW CONSTRUCTION ❑ REPAIR PROGRAM ❑ ADDITION PRO
REASON: DEEPS: ❑ PERCS: ❑ PUMP TEST: ❑
ROAD /STREET:
TOWN:
r J. BOND[
Executive
r MORRIS, PE
of Environmental Health
TAIL MAP #: )-'f ,, I q `r / - l-/'
SUBDIVISION: LOT #:
NYCDEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING
YES NQ� -
❑ p Proposed SSTS within the drainage basin of West Branch or Boyds Corne & � a�
Cl � Croton Falls Reservoirs.
/Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake.-
0 Proposed SSTS within 200 feet of a watercourse or a DEC wetland.
o Proposed SSTS design flow greater than 1000 gailons/day or SPDES Permit required.
❑ Proposed SSTS for a Commercial Project.
It is the responsibility of the design professional to provide the above information prio 'to soil testing. The
Department will determine the NYCDEP project status (Joint or Delegated) based on a response. If you
answered ►es, to any of the questions, NYCDEP must witness the soil tests. ,This Departm
jent will coordinate a
mutually suitable time for field testing with the Design Professional and NYCDEP.
If a project. has been determined to be Delegated based on the above response a d then subsequent
information indicates NYCDEP is required to witness the soil tests, it will be the sole iresponsibiEiiy of the
design professional to scheln�e ire- Ivitn�ssing of the soil testing with NYCDEP.
Environmental Health (845) 278 -6130 Fax (845) 278 4/921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 27 8-6678
Nursing Home Care Fax (845) 278.6085
Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648
IlepuAj
i
Appointment Date: Time:
r
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
THIS IS NOT A REPAIR PERMIT
PROPOSAL FOR EXPLORATION! OF SEPTIC SYSTEM F.
All information below must be fully completed prior to any scheduh
SITE LOCATION �-1 z7 0!Jae, zZ TOWN r � �l an
OWNER'S NAME � r a� 1 PHONE # f 6? --
N9nILING ADDRESS
PROPOSED CONTRACTOR/INSTALLER yt �+ PHONE # _5i
ADCRESS 2-0 f, /a 6sJ �f REGISTRATION ;LICENSE # P.
Reason for exploration:
C failure to surface IV it house ❑ find limits of system for repair ❑ other (ex lain below)
� r
FOR COUNTY USE ONLY
Inspector's Signature & Title Date
Appointment Date: Time:
kly :excel:septic
R86M-6LZ (9bg)
IIepuAi e9£ :80 L L ti0 Uer .
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COtMIV LIM
1011111 LIRE.
VILLAGE LINE
SAM LIMIT
PROPERLY LINE
-- oalrlw
-- ROAD 0.1
STREAw
SPECIAL
— sapaL
PART O
n ,
279,48
2
7,21.40
35.06 -1 -13 — — P/O 35.06 1 12
—_ - -- - --
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LEGEND
I "NA RAY
...........
*runs LINE Re SYMBOL
P R E L• I• M
-
OEVELWM LOT RIIMOER J
DEED DIAAENS104 1001D1
24.19.
r`
asR TOWN', OF- PAT.TERSON
---
SGIEDDIAG781011 100151
t, �iex
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CALCUI 7ED AM 754 AL CAL
COMIC)
35.06 35.07
...... 8
PUTNAM COUNTY NEtN YORr
—S
VISUFL
— —
f-mm MAVEER
3
383 -
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/Preschool (845) 278 - 6014 Fax (845) 278 - 6648
February 20, 2003
Marcial Valentin
4127 Old Rt. 22
Brewster, NY 10509
Re: Addition - Valentin, Old Rt. 22
No Increases in Number of Bedrooms
(T)Patterson, TM #24.18 -1 -14
Dear Mr. Valentin:
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:from this
Department dated February 19, 2003 The addition is approved with the following conditions.
1. The total number of bedrooms must remain at three 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 yours,
Michael Luke
ML:lm Public Health Technician
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DIEPAR i MEN i OF I-MALTH
L'hWon of Environmental Health Services
4 Genova Road
Brewster, New York 10509
T :L (9:4) 278.6130 Fax (914) 1.79-7921
. � .. a,
BRUCE R. FOLcY
Public; Hecith Dir_,c cr
STRF-F,T LA Ga O k ) QT Oa TO Witt \)Ak\?A�tJ TX NIA}P # 34-11S-t-14-
AaG0 L \1 94ketA; VA P140147- 3-I 0.5N4 PCHD r 30t 0
NILAMM ADDRFEsS yka) (X) ?-OUVE as 29.6W%�W ,ion
DESCRI'TiON OF ADDITION W\06-kr h2 I0-0rv,,M0AW bop, Oe-VD
\Li3ER OF EMSTIivG BEDROOMS 3 PROPOSED # OF BEDR4MAS 3
(MOM CERT. OF OCCUPA CY OR
CERTIFICATION' FROM &L;ILOLNC- P;SPECTOR)
*:env addition N),hich is corn -demd a bedroom requires formal approval of plans (Construction
Permit) prepa ed by a - ref_ssio :.a1 Eri veer or Registered Arciiitect in accordance with
applicable sections of tlht Purmn Coanty Sanitazy Code.
Please submit this fc= and ,: fo'lowing to P, &am County Health D!:pt., 4. Geneva Rd.,
Brewster, NY 10509, Phcue 2'5 -6130.
I Certified check or money order for S 100.00
Sketches of existing floor p;an (drawn to scale, all living area including basement)
I Jon - professional skeie=s are acceptable
3. Two sets of proposed floor plan (drawn to scare, with name, street, and ter;: reap �)
* Non -p.o essionai sketches are acceptable
4. Copy of surveys :awing well and septic location, to the best of your kmowledge. Inc'oade date
of installation if knovm label all wells and septic systems within 200 feet of the p:ope'rty lane.
Contact this office wi h any questions.
5. Copy of Cert. of Occupancy frcm Town or Certification fram Building Dept. ,pith legal
bedroom court of dwelling.
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OFELE L i F,
Commel.s
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DEPARTMENT OF HEALTH
Division . Of Environmental Health Services
Cene,4 Road, Brewster, New York 10509
(914) 278 -6130
Putr:am County Dept. of Heaitlh
4 GeneN!a Road
3:e1Msm-1 NY 10509 .
Genti t.men:
BRUCE R._FOLEY. A c
Acting PUhlle Mealth Di.-e -tor
Re: 411 z 7 0 L Z
Residence
Tax Map Z 4,
Aceoi ding to records maintained by the Town, the above noted & elling
iS � 13er1 � at
:S 1\10 71'
in compliame v,ith To%% . code and ttte total number of bedrooms on record
is
This inforriation ;gas been obtaL*'Ied from:
CERTIFICATE Or OCCUPAIN"CY:
ASSESSORS RECORD: ^k/
0-['HER
Building inS;,ectOr
PUTNAM COUNTY DEPARTMENT OF HEALTH
HOUSE PLATS APPROVED FOR
BEDROOM COUNT ONLY;
3 BEDROOMS
` /ft(rgi�3
Signature & Title Date
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/Preschool (845) 278 - 6014 Fax (845) 278 - 6648
February 13, 2003
Marcial Valentin
4127 Old Rt. 22
Brewster, NY '10509
Re: Addition - Valentin, Old Rt. 22
(T)Pattersn, TM #24.18 71 -14
Dear Mr. Valentin:
I have received and reviewed the plans for the proposed addition to the above mentioned
residence. The plans indicate that the proposed addition will consist of the following:
Master bedroom suite, den & finished basement.
Based on the information submitted, the above mentioned addition cannot be approved for the
following reasons:
1. The labeling of bedrooms on the floor plans are not clear._
2. The den is a potential bedroom.
3. The legal bedroom count for the dwelling is three . The potential bedroom count of
the dwelling with your proposed addition is five .
4. The addition of a potential bedroom requires this Department's approval of a revised
septic system plan from a professional. engineer.
Please revise the proposed floor plan to reflect no more than three potential bedrooms, or
have a professional engineer or registered architect design a sub - surface sewage treatment
system meeting present code requirements.
If you have any questions, please contact me at your convenience.
ML :Im
Very �trulyy o _.
Michael Luke
Public Health Technician
a
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A mop entitled "Mop of Lokespring Meadows".
said map filed in the Putnam County Clerk's
office on 31 November 1959 as map
number 872.
Survey of Property for
VA L E N TI h
located in the
Town of. Patterson
Putnam County — New- Yoi
I+•_ 30 , (date 8 May 1995 { nee no.
95-
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TAX MAP DATA:
Section: 24.18
Block. 1
Lot: 14
Deed Libor. 969, Page: 82
Deed Llber. 701 , Page: 930
A mop entitled "Mop of Lokespring Meadows".
said map filed in the Putnam County Clerk's
office on 31 November 1959 as map
number 872.
Survey of Property for
VA L E N TI h
located in the
Town of. Patterson
Putnam County — New- Yoi
I+•_ 30 , (date 8 May 1995 { nee no.
95-
HOWARD W. WEEDS
x� -eM
158 West Main Street
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