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HomeMy WebLinkAbout0967DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.41 -1 -35 BOX 10 00967 I,y,. . . r . J r I' Le ym I , . L ■ L I 00967 DEPARTMENT OF HEALTH W Division of Environmental Health Services 110'OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION Street Address D n�'Town Vil a City Tax Grid Number WELL OWNER f © Mailing Addr ss A � � �,�j 2 rivate O blic USE OF WELL' 1 - primary 2- secondary PRESIDENTIAL 0 BUSINESS 0 INDUSTRIAL D PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION b INSTITUTIONAL O STAND -BY O ABANDONED 0 OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm /# REPLACE EXISTING SUPPLY ❑ NEW SUPPLY NEW DWELLING PEOPLE SERVED_ /EST. OF DAILY USAGE/-_9'i 0al O TEST /OBSERVATION 13 ADDITIONAL SUPPLY 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING - WELL TYPE I DRILLED DRIVEN DUG []GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES IF WELL n LOCI ED IN � RNA�TY SUBDIN AIP, Pff OF WATER WELL CONTRACTOR: NO VISION: Lot No. Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY -u STfiiiCc TO PROPERTY FROM- NEAREST WATER MAIN. LOCATION SKETCH & SOURCES OF CONTAMINATION ffkOV ED /7�7 ON SEPARATE SHEET (da ) (si ture) 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 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. During all well drilling operations, the applicant shall ake appropriate action to assure that any and all water or waste products from such well drill g opera ions a contained n thi property and in such a nner as not egrade or other i e co ami.n e o gr dwater. Date of Issue: 19 / Date of Expiration 1 Pe t Issue g 0 ficial Permit is Non - Transferrable White c py: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller 0 I SST �. :�Oly CDT 3084 / ssg, s ,�pF 3094 / / 3p8s T� 2Q -3oe6 / /.Q ACES N` / 0 3D8> t.F / 20' SET 3o O / 0 CV / 2 / PARCEL 2 3 0.205 Ac. v p /N / O GN o, PK NAIL SET oL$ I.P. ?T to , / / / / 21:326 FD 21326' 6.23 21.32S' _ _ / O PK 93.534' N 850' 16' W to NAIL _ !y SET O LDP- r - -- — - -- 1 HEItEBY:.CERTIFY T0- __ COMFEO MORTGAGE GO.- r ,;+' � - . ' .?'s � •ate Q�+��v t' . s, f . Y CHICAGO: TITLEt-INSURAtdCEZ THIS SURVEY IS' A-CCURATE AND COR LOT NUMBERS ARE ~AS SHOWN a:Y - ON: PLAN TITLED 'FIFTH MAP i OF PUTNAM LAKE" AND F! LE D GERALD' LYNN WAPPINGER FAL AS MAP No. 149 -D N.Y. REG. SURVEYOR` No. 049292 !. PUTNAM COUN'T'Y HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR OWNER'S NAME —Jo- Cy �E2 crrrl a PHONE SITE LOCATION ! !"B e Q . ,+ r P : `r1 S Al, Y '1M$ MAILING ADDRESSn1�°Nt PERSON INTERVIEWED PCHD Complaint # Name & Relationship (i.e, owner,tenant, etc.) DATE TYPE FACILITY PROPOSED... INSTALLER b-_ yaw tZ �c c �°° �M; +�, S a oo PHONE Z..? 9 - s 2 $ a REGIStkATION # Pro (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 fram licensed professional engineer or registered architect. 51 VI-O0 Proposal approved Proposal Disapproved Inspector's Signature & Title Da 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 canponents 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' creep drywalls 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, or reported agent of own to the above conditions. SIGNATURE TITLE DATE . & V&te (POD): YeUc w (fin BI); Pink (An2 iaint) Am lost .'xa+x X rx,3 S, e.r --.— mot' � ' ` ._` � �z "�• fi � ; iy �s4.t d..'>'. �"".` -?�.. `.• ,P .r t .� ,�- t.. .x• £ 3,. c ScE` ...ev' W" � Qi J .£ 6. 5 C' 'p'""•'� 3 X 4^ � t S"E,'+ - .� r g S xc i- 5,x':•6 .� �' u�`a 2 r. �"` a. $i an L -' `' 3 z., -4s � .� � x +ate a .,u• �+- a ���?'E 'g, '�.'^, a }�'.. s .s•� `r -�`' .,� .$#' ,� - p i ! is r �8 - -� ww - * n 4r '-c - a'" 'x 'S x - r• own so an, to— one SA K Sk as -n,'' £• xg,.{' ,+s § •' `k '"r,+ x, is �„ � "'�r� ;�� �� .i � - ss'`t.� Iry l4 � '�;ir �'.��"m - ,�. '�'"�' � �.� `�'S -��- _,.,�' rs*-s s• � ♦ -_- a' MOVE y h x•x s- r �,a" �c .�, - m J- 'A�,✓ a3- # K t, s v '� ""MAN ti .¢t '� ''k`� q � t k `' - 1 h»,., . - a m - a4z •hv€�, f,. xSZ #=y, Ni a+,x. '°�_�:" a #",. sh rm h F a �, i r �y.3F g fi ' .A a .,.` ,� -'&`" �' ft r b •'� S �f Y - ,,. Ars +. .z� s` i£ �• �., .,... s � �� i g . �= 9 s € ,. ` � e� a �.vi 4'c^'3� e 7 '+� ;' � '° � ss 3' ;'�' a' ° $°- :� cat 1 WORM € �� 5 sc5a ` t r OR y 7r =, .�1 r -- 'r<- �. �swa^� r€� -_a ,.�" "- :.p'. -^'x �-�,-.* -s E now �-`'-t'. �# $� �-� t 'n`t "'s -�i°s -. "• „p T°j - 6-s'S, - #»., as.- ^c*�.- ser+aaeas;.T•..,aa ,- e.,,,., ;ate £ } "a; yon, t If x ,�4s� � p ;' i. ba `:'�" �," ; N � $,;� � � a+� � <+ fi � c� r � •a. � ^ �a -AM ven"t- ' "+_,a �a a. - '`rs- xrb',n TIC 'd ie .,a. Y ^' a . -',E S[' `r: w -„x21 ay. r c ._ mss h�. `�• �' q rfiY ' r .. .. 2's 1, -r' Ufa' - .-j- � a d- -` s �- Y ,� ti [ zJ R s. !- g l a9 " x w4 n .z� $ .. rY VS _ �F .,N aeb .�.� : .�" :. �` � ro `� � .�:' S'a ,� 4 ,- '3 � -€ . s� �. s _:.- ,�. S --t`- r••°" -" -'�. -R r 4 ,.�:`- e*,�`'fi:� , ".� � w Hf����.eaa.�`"�'ae:�� 4 �� '•n?'�, _z fi� c: � �- ,.-`.� o - .�vt � s-.� ��,�� � .�`?.�,.- �"P,��'< �. +. -�v ,�' �i� ..�- :I DEPARTMENT OF HEALTH - Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 -_.-- Acting Public Health Director ADDITION APPLICATION = (RESIDENTIAL ONLY STREET: /'0 eG 1,15C /D TOWN e jd ` TX MAP # NAME: :D61AJ POk, "eW 06-6-�Q. PHONE r.; 79 S7 V PCHD PERMIT #_ 0.z4v-4 -it wit )77 - S' 3'J -v MAILING ADDRESS Description of Addition X 0— Number of existing bedrooms 3 Proposed number of bedrooms Any addition which is considered a bedroom requires formal approval of plans (Construction Permit) prepared by a Professional Engineer or Registered Architecr, in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to PUTNAM COUNTY HEALTH DEPARTMENT, 4 GENEVA ROAD, BREWSTER, NY 10509, Phone 278 -6130 with the following information. 1. Certified Check for $100.00. 2. Sketch of existing floor plan (all living area including basement, if any) Non - professional drawing is. acceptable. Non professional drawing is acceptable. 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Include all wells and septic systems within 200 feet of property line questions please contact this office. OFFICE USE Comments and /or conditions application August 1995 Any i. 1 DEPARTMENT OF HEALTH - Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 -_.-- Acting Public Health Director ADDITION APPLICATION = (RESIDENTIAL ONLY STREET: /'0 eG 1,15C /D TOWN e jd ` TX MAP # NAME: :D61AJ POk, "eW 06-6-�Q. PHONE r.; 79 S7 V PCHD PERMIT #_ 0.z4v-4 -it wit )77 - S' 3'J -v MAILING ADDRESS Description of Addition X 0— Number of existing bedrooms 3 Proposed number of bedrooms Any addition which is considered a bedroom requires formal approval of plans (Construction Permit) prepared by a Professional Engineer or Registered Architecr, in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to PUTNAM COUNTY HEALTH DEPARTMENT, 4 GENEVA ROAD, BREWSTER, NY 10509, Phone 278 -6130 with the following information. 1. Certified Check for $100.00. 2. Sketch of existing floor plan (all living area including basement, if any) Non - professional drawing is. acceptable. Non professional drawing is acceptable. 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Include all wells and septic systems within 200 feet of property line questions please contact this office. OFFICE USE Comments and /or conditions application August 1995 Any i. ti DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278 - 6130 Fax (914) 278 - 7921 January 6, 1999 John and Donna Vogler 10 Deerfield Road Patterson NY 12563 Re: Addition - Vogler, Deerfield Road Increase in Number of Bedrooms (T) Patterson, TM# 25.41 -1 -35 Dear Mr. and Mrs. Vogler: _ BRUCE R. FOLEY — Pubtic Health Director - 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 latest revision date of January 6, 1999 and this Department's approval stamp. Based on the information submitted, the above - mentioned 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. WH:tn cc: BI (T) Very truly yours, William Hedges Senior Public Health Sanitarian DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Gentlemen: BRUCE R. FOLEY, R.S. Acting Public Health Director Re: Residen Tax Map c>2-:!5� Town jiye7a,�O� According to records maintained by the Town, the above noted dwelling IS IS NOT in compliance with Tovim code and the total number of bedrooms on record is 13 This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER Rrtilrlina Tncnertnr 1-j-4 I o�z max' at G \j4oUTt'ftA9S APPROVED fop o �iNAiA C�1U3ZY TIEPJ�TiJI�T�fiiF HEAt�ik fQ i � �`� ^ � . 16EORUOM��UPkT�PilY: '.' � . 9 ml al .ati �1CN c vT # �J .'.. Q (:,IX(- 1 I 9 � f - A2 "I---. �T. �c�,a,� ✓ Z�.s' �'r. ri,�yLr 1-7- 7S JQ �J • l'L17 �, .ati �1CN c vT # �J .'.. Q (:,IX(- 1 I 9 � f - A2 "I---. 7�v HAIL. SrT SPT 1 : ; ; - . - � - i I..- ', S[pi'� w ;-". / - o". . : :-.� /* ,PXNAIL - Z--ii 21.328' ' 21 wj 0 P. p -93.534' 85* W 777.. HEDGE f-,qow AIL SET SET 10 1p F ............ ....... 7�v II PUTNANI COUNTY DEPARTMENT OF HEALTH HOUSE PLANS 'APPROVED FOR BEDROOM COUNT ONLY; BEDROOMS ire &Nle D �r �;4 v �qQo K rf . j 0-) Pz,4t . C Vi((�� �-} av SQL ' eegw�- sP�X / i M &�j ef�ras � 1, r 1491- 31, "a! r�' j + I 3 Nti oirr v� JI N0 PUTNANI COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY; BEDROOMS nature �r j q b..e , f,, 1A I A (T) !S--4+- -L 5, L/ ! - r -3S vo CegwL- qv Q l a S. El 3� 2 . - /�? / k--- E- W410i i /01- 31, C PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL ADDITION / REPAIR FORM SECTION A. GENERAL INFORMATION .._rI� Name of Project !� i t (T)(V) TM# Year of Construction Size of Parcel SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. Milly Molling CISteep slope 9G -entle slope OFlat 2. Rr' ividence of wetlands Clow areas subject to flooding Modies of water DDrainage ditches DRock outcrops YES NO 3. Property lines evident? ❑ p --- 4: IN T. ouurses exis ori; ur aujaecntft� parcel ? -_ _._..__._- _. -._._. �... =_ :_�:�._..__❑ . _. - -- - __.__--- .___ -- 5. Existing individual wells within 200ft of the existing SSTS? LJ" ❑ SECTION C.. EXISTING SUBSURFACE SEWAGE TREATMENT SYSTEM (SSTS) 1. Physical character of existing SSTS area. A. OLevel, 016entle slope OSteep slope B. OWell drained rxoderately well drained . ❑ Some' what poorly drained nPoorly drained C. Area available for SSTS. (Primary. & Reserve) Z CIE xtremely limited 0/somewhat limited MAdequate ft x [ll D. INSPECTION Date l % Inspector rte. •' ON-o evidence of failure ®Evidence of failure ®Evidence of seasonal failure �4 - -- - - �- `-- - - - - -- - - ---- -- -------------------- M.� (Indicate North) • �;;^ � ,' ROUSE / \V "�� (1) Indicate location of SSTS A. Size and type of septic tank gallons Metal OConcrete OPlastic, B. Type of absorption area 1. Fields ft. 2. Pits 3. Gallies ft. (2) Indicate setbacks; front street, backyard, and side yard dimensions (3) Show location of well (4) Show location of driveway (5) Note :physical features (steep slopes, rock outcrops, streams /wetlands) SECTION E. EXISTING WATER SUPPLY OPWS ®Shared well 19bdividual well Mrilled ®Dug LJCasing above ground COMMENTS: 11 -,.,...DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 January 3, 1991 John Vogler 10 Deerfield Road--- Patterson, New York 12563 Re: Addition Deerfield Road (T) Patterson Dear Mr. Vogler: JOHN KARELL Jr., RE, M.S. Public Health Director I have received and reviewed the plans for the proposed addition to the above mentioned residence. The plans indicate that a 22' x 16' master bedroom is proposed. The existing third bedroom is to be revised to a utility room. The survey indicates that sufficient area exists to expand or repair the sewage disposal system, should it become necessary in the future. Therefore, based on the information submitted, the above mentioned addition is approved with the -f ay:Lng 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 replaced or updated with water saving devices, i.e., low flush toilets, restrictors for shower heads and faucets, etc. Approval is granted for sewage disposal only. 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. Ve my yours, Robert Morris Assistant Public Health Engineer RM /jp cc: BI (T) Patterson r JV ♦ v 0 rt 1 -A P�n AM- Env �? an 4„ ylt j f/ s sh, MP k ,Q: iI is- not sN4r - SUHIJ VUGI -E2. �� y. 40 1 Z f VAT r r 1-! 3 b 3.. } k a .. erg l . s oo r 1 ` oil, , P 4 "Cr t � f P�n AM- Env �? an 4„ ylt j f/ s sh, MP k ,Q: iI is- not sN4r - SUHIJ VUGI -E2. �� y. 40 Z f 3 lot k .. erg s P 4 "Cr t � f < H• - F AT A _ _ win 11 jM7 P�n AM- Env �? an 4„ ylt j f/ s sh, MP k ,Q: iI is- not sN4r - SUHIJ VUGI -E2. �� y. a= 1 lism SURVEY IS ACCURATE AN CORRECT !tenn q' TOWN ' OF ,PATTER"SON BY :., ysfp S� PUTNAM . COUNTY .ALO'C LYNN WAPPIN.GER `FALLS, N.Y.'' LAND NEW YORK REG' SURVEYOR,`' No 049292 r SEPT. 9,! I� GLL