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Home My WebLink About0998DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.47 -1 -10 BOX 10 ?r � ! ' I r r 11••: BRUCE R FOLEY Public Health 'Director_.. DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI RN., M.S.N. .Associate Public- Health- - Director--• Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 June 6, 2000 Jonathan Stipak 37 Java Rd. Patterson NY 12563 Re: Addition- Stipak- Java Rd. No Increases in Number of Bedrooms (T) Patterson Tax # 25.47 -1 -10 Dear Mr. Stipak: 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 June 6, 2000 The addition is approved with the following conditions: 1. The total number of bedrooms must remain at Two 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 Patter -son. •— -- - - ----- If you have any questions, please contact me at your convenience. ML:kg cc: BI Very truly yours, Michael Luke Public Health Technician PUTNAM' rtCOUNTY>~.HEALTH DePT K? 2° 59'6 %� a- �"� � 3" .� 7 -"A^.z. � k..a�s -. .^. -at' Lam,.. -, s Y ...E -,r � •k" �--�a- .'� s �� -c Dat et m''� a- } ,,, _: -c. t },- a • r- r :: s n 'k. _ r "hif- �` v.- ^�"" a-. , Received of ..� F L a tN- .-r .'�,. .„ TherStam Of k Dollars" J' N 341F ❑ cash ❑ Checks } M O _ ❑ credit ,s: rd , -K. By ` �`..:> _x ,m::, _ 0 MAY-L7-00 11:12 AM. TOWN OF PATTERSON 9140792019 P.03 ., �`�' � .: -.� ! t!• .:•.. i :`� ". ,.S Sri ..� �+li� . :�CLI� ii w:i, Plry "... �.-��. .. ....... ..... . -...__ Y. . 41 BRUCE' R, FOLRY .....- • Potb�ry H�ahh DGwctrr DBPAR -DoXNT OF HEALTH Dhdrioa qr Iffiremme1w 17t4ftlr Ser►�oea i Gum Rad IBTVM a, Now York 10309 Tot, (914) 371.6137 Fax (Wi 271 -7901 AnTrI V �,PPL ATII� ($�5.1�E!ti'T7AL t"�I�'LYl STREET 37 Java, Road TO'%'Ai act,_v- ,t,eart.TXMAP# 23.47 -1 -1D lctd TM - 53 -4 -51 Ng1vM STIPAK, JONATHOu PHONE 9'GPCEiD _. —0 MAMM ADDRESS 37 Jau Road Pate► NPW V_QAk 72569. DEMCi "ION OF ADDITION 12 x 'Lo �A M ► LY IoM NUMBER OF E=STING BEDROOMS 2 pROPOSrED # OF UDR00,MS l (MM CERY. OF OCCUPANCY oR CERTIFICATION MM Bf.7 DMO r.NSPECTOR) *Auv addition %Ul h is eoadered a bedroam requim formal approval of playa (Com1ruction Pemtit) prepcod by a Professiznal En&w- or Registered Architect in actor► snce with applicable sections of the putnam Ca=ty Se, ury Code. - Please submit Us forra and the to!jcwjng to Pttt= County Health Dept., 4 Genera Ind., Browster, NY 30504, ,phone 2784130. l.- C-milled check or money ozder for $100.00 Sket,:hos of existing Boar p;u (drawn to sca'e, all living area lacltt8iti� tiasom "slit) "Non- professional skmL-s ate weeptablo , 3. Two sets of proposed floor plan (drawn to scale, with name, strcall sad tax trap #) • Non- p;ofusioiW sketcbes are sccogtable 4. Copy of s.uycy shawine veil ad septic location, to tk bees of your krowledge.1'aelude date of iesf�allatlon if knno,vn. Label, all weD and septic ayoncas wwrith.n 200 feat of the property litre, Comm Ws office with W quationa• 5. Copy of Cert. of Occup:zacy ftc m Town or Certification franl Blinding Dept. with teW bedroom count of dwe?lizt ' OFMSS M Comments 0�r-0 3._ �X. o A —1-1.r O' %A l,:4 :w 4-.v- i s �1b 4 MAY -17 -00 11:12 AM TOWN OF PATTERSON 9148782019 P. 02 r }�r:• .. C. .. L :�� . .,i,.:j el �J:Tr ~. fir. a .t * KAUCE R .FOUY. PS ' AtIlnp FAIN M AIIh Olrelthr DEPARTMEW OF NEALTH Dloslon ' of Entrtronw+enta) Meslth Serv!C!S 4 C,er,e4 Road, 6rewst4r, N6w York V309 %14) 276 -6130 Putnam Cdunty Dopvof�Uatth 4 Genera Road B:owstcr, NY 105C9 Re; STIPAK, JONATHON Residence Tax Map 25.41-1- 0 (old TM - 53 -4 -5) Town patte�c on Gentlrrnen: According to rece *ds meintained by the Too c,4 the above noted dwelling IS XXX is NOT in compliance v i th To-47i cods and the total number of bedrooms on record is 2 'ibis idotmation has been obtained from: CERTIFICATE Of OCCUPANCY: ASSESSORS RECORD: GMER Buitd�n-q DewAtment Heatth Depa tmv »f PPAMit nspector 60. 4 , �EPR- ooM Z 0 C CD o' CD C3 m 41 0 ati2 C -- 7T.. t M POTNA COUN 1, DEPARTMENT OF HEALTH Dlvidoa`of Pwlroomenhl Reilt6 Seivloes; Carmel, N:Y 1QS1Z ,,,� Eogmeer Mast Provide P.0 H D Peimit N 7 __ 4. TF, OF CONSTBUCTION COMPLIANCE FOR SEWAGEDISPOSAL SYSTEM�SQ CFJffMCA .ti �� - �. Towmo Vn Ta:_Map _B Owoer /applicant Name F�u� N Subdivision Name - MaWugAddrea �1T� Sulidv. Fee :Enclosed Amount 2'DO, Date. Permit Issued 2 Sep-ate Sewerage Systeet bout by X12 ► L l Address L Conefstbrg of j 291 Gagoo Septic Teak end Water Sapply: Mile Supply From - on Private SaPP(YDrMed°,by /r(1�..L_ gft? T1$1 :Lot .Size�.,'�j,tH3s ;EYOSloil'('nnt.rnl 'Reran •Cmm�latari9 `(.J n Muidw of Bedrooms `!` Elmis - rbage,.Grinder Beeu'IestalledY' ' N a . . Otlr� R I certify thatFthe system,(s)" as lieted-`ssrvinq the above premises ware constructed eaaentially ab,aham on the plans of the completed work -( copies of'which•are attached); and in accordance vith'the standsrda; i ulsi ''m ulationa, .in'accordance;y e. filed pi ' ,'.and the _permit ;issued by the Putnam county Depaitme�nnttAr Of Health t�ata �/ n Certified Y P E.� RA. Address ' IwnM NO Apy person occupylnq,pnmises sw"d by.,60 above sliic",(t) shall: promptly take such action as n!al/.be moiuiry to azure tM co7edlon' of any ununttary eor q)tlons nsuttins from c such: tisasa Approvai::of tlw':lepinte'iaw}iay� system shill bacoms♦ null" cod votd 'ai'aoon is a pubt;_ iMltary s�wlN' Mcolmes available and the approval of tM priwte,watsr supply shall tiordmi null.and void Kwh.n • - pu01k water wpply OoCOmes avtatlatiM _ -,Such epp►,ovals a. wblfict to modlfMatbh or:'changs -whop; fn the``ju_ gmei t of, to .Comtnlisioriaru of flat , "weut rivoeatbn,'moOlffeatbn or eAenOi; Is nitwnryS /, Date 13Y Title Nz TARLTON ENVIRONMENTAL LABORATORIES, INC. CT Cert: PH -0404 A Division of Northeast Laboratories, Inc. "- -- DANBURY: P.O. BOX Z32$� 22 KENOSIA AVENUE DANBURY; CT-068T3 =2328 LABS BERLIN: 129 MILL STREET • BERLIN, CT 06037 LABORATORY REPORT -- WATER SUPPLY TESTING REPORT TO: MILL DRILLING, IN.0 PUTNAM AVENUE BREWSTER, N.Y. 10509 DATE SAMPLE COLLECTED: 2/14/94 TIME COLLECTED: 2:30 P.M. COLLECTED BY: ROB MILL DATE RECEIVED @ LAB: 2/14/94 DATE(S) TESTED: 2/14/94 TESTED BY: TEL PURCHASE ORDER NO.: N/A REPORT DATE: 2/16/94 - - -- SAMPLE -SITE: - — — SAMPLING POINT QUALITY BUILT HOMES BILL ELTING NOT STATED JAVA ROAD PATTERSON, N.Y. SOURCE: TREATMENT: WELL NONE TEST PERFORMED RESULT: 3 RECOMMENDED LIM T BACTERIAL: Mg/L = A=grams per liter. Total Coliform (Bacteria) '0 Per 100 ml 0 per 100 ml CHENIISTRY: Chlorine Residual .00 -1-m - - - -- SAMPLE, AS TESTED ABOVE: [S POTABLE or OT POTABLE (PER EPA STANDARDS FOR POTABLE WATER) COMMENTS OR NOTES (IF ANY): 0 CT: DANBuRrAREA (203) 748 -7903 — FAx (203) 748 -0652 • CT: New BRmAiNIHARTFORD AREA (203) 828 -9787 — FAX (203) 829 -1050 TOLL FREE WITHIN CT: 800- 826- 0105.OUTSIDE CT: 800- 654 -1230 PUrN M ODU= DEPARTMERr OF HEALM DIVISION OF ENVIRONiM?rAL REALM SERVICES Building Constructed by i it Location - Street T Municipality Building Type Sub�:::aision bar[ S# i _ision Lot # GUARANTEE OF SUBSURFACE SF: ,Y--GE DLSP6SA_Ei- SYSTEd I represent that I.am wholly -and completely. responsible for. the location, wor)ananship, material, construction and drainage :of the sewage disposal system sefving 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 Coun of Health; :and hereby guarantee to the timer, 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 o:� approval of the - "Certificate of Construction Compliance" -for the sewage disposal system, or any _._....._:... rePai_rs .made...by__ me .to .such_systan, 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 r�ov General. Contractor (Owner) - Signature Zq Corporation Naue (if Corp.) rev. 9/85 Mk Signature Title Corporation\tlh�� (if Corp.) Address fA7411A ;8TiPA1Z-.: 41 fry owner or Purchaser of Building Section Block Lot Building Constructed by i it Location - Street T Municipality Building Type Sub�:::aision bar[ S# i _ision Lot # GUARANTEE OF SUBSURFACE SF: ,Y--GE DLSP6SA_Ei- SYSTEd I represent that I.am wholly -and completely. responsible for. the location, wor)ananship, material, construction and drainage :of the sewage disposal system sefving 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 Coun of Health; :and hereby guarantee to the timer, 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 o:� approval of the - "Certificate of Construction Compliance" -for the sewage disposal system, or any _._....._:... rePai_rs .made...by__ me .to .such_systan, 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 r�ov General. Contractor (Owner) - Signature Zq Corporation Naue (if Corp.) rev. 9/85 Mk Signature Title Corporation\tlh�� (if Corp.) Address WELL COMPLETION REPORT Office Use Only DEPARTMENT OF HEALTH �lr� �� Division Of Environmental HeaTtli`"SeYvi:�ces - - -- - -- - --- -- — Surface ioq PUTNAM COUNTY DEPARTMENT OF HEALTH STREET ADO ESS: TOWNIMLEIGILICHY TAX GRID NUMBER: WELL LOCATION Java Rd . Putnam Lake, Patterson, NY :�z, `jam. 7-- WELL OWNER NAME: ADDRESS: Wi I Lam t It L nq Quatity built Homes, bal lyhack ltd. , $rewster, `��fTyr I'll, 81VATE USE OF WELL >OAESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP 0 ABANDONED 1 - primary O BUSINESS O FARM O TEST/ OBSERVATION O OTHER (specify) 2 - secondary ❑ INOUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY O MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED 2 — 4 / EST. OF DAILY USAGE gal. REASON FOR []REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY DRILLING ,STEW SUPPLY (NEW DWELLING) ❑DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 185 , _fd STATIC WATER LEVEL ¢5 ft. DATE MEASURED 02115194 DRILLING O ROTARY x6cbcCOMPRESSED AIR PERCUSSION O DUG EQUIPMENT O WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED O OPEN END CASING xZ; OPEN HOLE IN BEDROCK 0 OTHER CASING DETAILS SCREEN TOTAL LENGTH ' S 1 ^ k MATERIALS: x4g)6TEEL O PLASTIC 0 OTHER LENGTH BELOW GRADE 50 ft. JOINTS: O WELDED xWHREADED ❑ OTHER DIAMETER 6 in. SEAL:MRREMENT GROUT O BENTONITE OOTHER WEIGHT PER FOOT 19 lb. /ft. DRIVE SHOE O YES 0 NO LINER: O YES ONO DIAMETER (in) 'SLOT SIZE LENGTH (It) DEPTH TO SCREEN (It) DEVELOPED? DETAILS FIRST SECOND GRAVEL PACK ❑ YES O NO WELL YIELD TEST METHOD: ❑ PUMPED cGeCOMPRESSED AIR O YES ONO HOURS GRAVEL DIAMETER TOP BOTTOM SIZE: OF PACK in. DEPTH ft. DEPTH ft. If detailed pumping WELL LOG If more detailed formation descriptions or sieve analyses are available, please attach. tests were done is in- DEPTH FROM water Well .formation attached? SURFACE Bear- Oia- FORMATION DESCRIPTION pnE ! °I -1`YES �yNO ___ . .r��. _r�_.. ina- meter_._ ... WELL DEPTH ft. I DURATION hr. min. DRAWOOWN ft. YIELD gpm. Surface Gv .Loose overouraen 2 35 Sand ave1, 185. 6 — 150 20 38 Hard ledqe 60 Hard bedrock 61 Light brown seam .64 651 Soft seams 1051 Medium to hard grey granite WATER -Na CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS ❑ COLORED ANALYZED ? AYES ONO ANALYSIS ATTACHED ?AYES O NO PUMP INFORMATION TYPE CAPACITY MAKER DEPTH MODEL VOLTAGE HP STORAGE TANK: TYPE CAPACITY WELL DRILLER NAME M%I.1!.. DRI ADDRESS Putnam Avenue Brewster, Mi GA 0 I represent -:that I am wholly and-completely ►esponswle:Io the design and location of the- propose 'system(s); 1( that tbo soperate lasv dispoYl.s stem . above described will be constructed.,as shown on the approved amendment there to and in accordance with the standards, rut" a regu ne,o or County Opartment ' of Health, and that on eompNtion'itinreof a. ^Ciertificate of Construction Compliance• satisfactory to the Commissioner. of Heelthwill be submitted 20 The Department and'i written . guarantee wilt; be furnished the owner, his succesaers,'hei ► s or assigns by t t►uildei, thetsaid builder will pbee in good opmating, condition any' port of-said sewage difposel syetem du inli the period of two yearsimmWiettely 4pllOdiiflg the date Of the issu• ahce of the approval of the 'Certificate; of Construction, Compliance of t6 Original system or any. rep_ airs thereto; 2j that theArllted. well dsswi0ed above wa1 0e located es ihowh On the app►osed.pbn anQ that foe droll will be In o in accordance with the sta rd rules and regulations of the Putnam County Oapertmem of H"Im . . Oats a rZ , -1/ e2-11 APPROVED FOR CONSTRUCT revocable for- Cause or may be ai w bats r a" mi' Rev. 10/88 Signad P.E. _ R.A._ iL1 C ,e • `' �' 31_icenso No ;)e✓r %r>2 Ns approval eupl►estwo years from the .dato issued unless construction of the building has been undertaken and is o►*modified considered when considere nocary ey the Commissioner of Health. Any chango or alteration of construction disposal of domestic. sanitary saraage aprate .water supply only, P DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New.York 10509 (914) 278 -6130 ._..__..APPLICAT.ION TO - CONSTRUCT A WATER WELL - .. ...._ - - - -- - - - PCHD PERMIT WELL LOCATION T Street Address Town/Village/City Tax Grid Number WELL OWNER Name c.0 t; M. tarr.;iY Mailing Address tr.) 15!O A V-?- - d ALVOwn APrivate 0Public USE OF WELL 1)- primary 2- secondary RESIDENTIAL O BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY (3 AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED; -4 /EST. OF DAILY USAGE Ur al ❑ REPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION 12. ADDITIONAL SUPPLY ' NEW SUPPLY NEW DWELLING 0 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING -o &Ps; idp n c e WELL TYPE JC DRILLED DRIVEN E]DUG GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISI -ONN: Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES __X_NO NAME OF PUBLIC WATER SUPPLY: N 1A TOWN /VIL /CITY -r DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: N/A LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED MON SEPARATE SHEET /0--12 . -CIA (date) �2 (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 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 take appropriate action to assure that any and all water'or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: 19 Date of Expiration 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well.Driller 8 LAURENT ENGINEERING �2 ASSOCIATES P.C. 73 FAIRFIELD DRIVE PATTERSON, NEW YORK 12563 914.278.6108 CONSULTING SITE ENGINEERS Date: 10 -1 -92 To: Putnam County Health Dept. Route 312 Geneva Rd. Brewster, NY 10509 Attention: Mr. William Hedges Gentlemen: We enclose ( 4) copies of: ® B/W Prints ❑ Reproducibles ❑ Specifications ❑ Memorandum Description: SS -1 "Proposed SSDS" - . Revised per your comments: Job No.: 91096 Project: Proposed SSDS Java Road Patterson, NY • Reports ❑ Tracings • Copy of Letter ❑ Revision /Date No. -Rev. 9 -30 -92 Copy of Neighborhood Notification Letters sent to abutters, with list and location map. Sent Via: • Our Messenger • Your Messenger ❑ Blueprinter ❑ First Class Mail ❑ Special Delivery X Hand Delivery ❑ Copy to: Ms. M. Horowitz Very truly yours, LAURENT ENGINEERING ASSOCIATES, P. C. Per:/0 (9� - US b v Harry W. Nichols, Jr., P.E. 31UPSM91110 No. NfIff'02- D3 1021:. Pcrwling Savings Bank PAY THE SUM OF NOT GOOO OVER $1.000. ORDER 6F SENDER'S NAME AND ADDRESS SEFOAE CASONG READ NOTICE'.ON Issued by American Express Payable at iiavel Related Services Company, Inc. United Bank of Grand Junction - Downtown Grand Junction, Colorado Englewood, Colorado � � P UT NAM COUNTY DEPARTMENT OF HEALTfi APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: L.00iS1= K4.OA(�a ihl&TOM Le�F_`(FK I-iO► oV1I-r; _► e5 f O h�a 12Th 2. Name of Project: P(zOP0S•E O SSC.�15 3. _-Location T/V /C: eA T'TFRSOt ;f Project Engineer: 14At2 J, Nlrl -�nl_s e. 5. Address: -7 - 5 1=-A 6,' L 172, PA- rzso M NY 1256 � rTE License Number: 5V01.2� Phone:Zb -61 Db 6. Type of Project: ; _ Private /Residential Food Service - ..Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted X 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. Nn 9. Has DEIS been completed and found acceptable by Lead Agency? ........... NZA 10. Name of Lead Agency _. N,ZA in -an area under-the control"of'•loca1 planning, - zoning or other officials, ordinances? ......... ............................... t� O N 12. If so, have plans been submitted to such authorities? ILA 13. Has preliminary approval been granted by such authorities? Date Granted: M/A 14. Type of Sewage Disposal.System Discharge...... Surface Water K Ground Waters 15. 'If surface water discharge, what is the stream class designation ?........ N�.4 :6. Waters index number (surface) ........... ............................... N/, 17. Is project . located near a public water supply system? .................. N O 8. If yes, name of water supply N'/'A Distance to water supply N 9. Is project site near a public sewage collection or disposal system ?..... 90 0. Name of sewage system NZA Distance to sewage system NZA 1. Date observed: 2 23. Name. of Health Inspector: IA/, S Y. Project design flow (gallons per day) ...... ............................... 1+00 t ' 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. 26. Has SPDES Application been submitted to local DEC Office? ............... 27. Is any portion of this project located within a designated Town or State wetland? .................... ............................... ND 28. Wetland ID Number ........................ ............................... W /0— 23. Is Wetland Permit,required? . .............. ............................... �d Has application been made to Town or Local DEC Office? .........,......... 30. Does project require a DEC Stream Disturbance Permit? ................... 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal,-'` landfilling, sludge application or industrial activity? ........ YES or NO d 32. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or NO d DESCRIBE: 33. Is there a local master plan or file with the Town or Village? ........... 34: Are community water, sewer facilities planned to be developed within 15 years? _N_ 35. Are any sewage disposal areas in excess of 15% slope? ......................... l: 5 36. Tax Map ID Number ............. ............................... ..........25.4 -1 (D t� 37. Approved Plans are to be returned to: ................ Applicant _) Engineer If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter_of Authorization. Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. Fa Ise statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the Pena 1 Law. SIGNATURES & OFFICIAL TITLES: TAILING ADDRESS: c . is a r. R WINAM 00 DEPARM-fEn OF HEALTH_ DIV 3N OF P •' m 1N Y• HEALTH SER is DESIGN DATA SHEET- SUBSUFACE SEWS DISPOSAL SYSTEM FILE NO. oane_Y ►2A EF 2 W-20V•.I rrZAddress 15 Located at (Street) JA \,/A "A rV Sec.05 Block �_ Lot i (indicate nearest cross street) Municipality Watershed SOIL, PERCDL=CN TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre-Soaking.,. Date of Percolation Test Z HOLE NUM= CI= TIME PERCOLATION 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 1 ,� , 2,t 25-� i3 2 C 3 4 5 _....'.-t'. :�2_ (3 1,350 4 5 1 2 3 4 5 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 submittbd for review. 2. Depth mfla.5urements to be made frcm top of hole. rev. 9/85 DEPTH G.L. it 2' 3' 4' 5' 6' T 8' 9' 10' 11' 12' 13' 14' TEST PIT DATA REQUIRED TO BE SUBMITTED WIM APPLICATION DESCRI ON OF SOILS. ENCOUNTERED IN TE 30LES HOLE NO. HOLE NO. 2 HOLE NO. L,VAIEFK & !2'-(n'' 4. INDICATE LEVEL AT WHICH GROUNUgAIM IS ENCOUNTERED INDICATE LEVEL TO WHICH DATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: ,,.i G{ ILLS � / • F r�Y S Dom :. - 2 DESIGN Soil Rate Used .1 p Min/1" Drop: S.D. Usable Area Provided No. of Bedroams 2 Septic Tank Capacity 1 O da gals., Type z�� iA G . Absorption Area Provided By L.F. x 24" width trench Other OF SEW. y„ �Q `sue Name LA( V7. C—. Signature.. � r w LU Address '7) 4—A I fZ F- 1 i.:D 17 \ SEAL J' No.56124 ��pROFESS1011P � THIS SPACE FOR USE BY ,HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date PUMAM COMM DEPAEflMNI OF HEALTH DIt1{isa of ■awir..ss mw He" S.s.io.s. C NEWL N.T. 11611 g/Iror in Prow kis Permit _ .. ......_... _-- - - - -._ .r- aa•C�!'iHrOCA� 0ir'OOil�tlAFit� - - CONNTRUCMIN POlm' POR UWAGE Ds1PORAL SMW Pelt / QATTE�2So t�l Lambda 201�r7 Town or vim. SWW%I a tat Tau x.r ?ry, 061, ..i _(� 1 Lov(Se M - t-iA�iZIt�1C3TDN ❑ s..i.i.. ❑ Cw=dAMa..t Nr.. tz. r_21 E eLf F ki7`5 rZQ w i LL- Deft of Pros A+gewwd MW&s Addr.ba 15 i o AAIF-tAy E 'i \(2'2TA Two '0R L`f ,N_- zip 11 '7_-::� D Date Subdivision Approved Fee Enclosed ® Amnnnt $ SOD lri+rs ry" It ,1a.. el . '7 ± PM_ seers.. o.b Depti Vie. "Wens r 1 Beale. Des hp Flow G P D �t a� PM is ROWN&ld W`ast FS is co abided ss*.mb s.wsssa iris. to ...silt at J C OD G.iaa s.Plie T.sk ..d��f ` 1, A � S TiQF I�t GFt� S To M eswarowed by i �i� Addew ws/sr Swer ma Sates/ Prove, Addrw an )( Pd ,b =wppb Dead Ii, _f'15 0 ' i Otgar 2' Fi l ► tD K L..E\J F Li W-!:,- Pi ) r2PnS S 1 represent that I am wholly a" completely refponslbie for the design and location of the proposed syatem(s); .1) that the at. anw dI sel atom abOre described will M constructed as shown on the approved amendment there to and in accordance with the standard; rules a regu { O plV OOpsrtmdnt M M mltl% and that on cornplatbn thereof A "Certificate of Construction CompilaaWl satisfactory to the Commiselonw Of Healthwill be uibMat.d to tha Oepwtinego, and a written guarantee wile be furnished the ownw, his laaeomors, Mks or assigns by the builder. that said builder will ItteOe M good OWNIIIIlg CM&N On any part of raid sawW dbpdsal system during the period of two (2) yews Immdiatefy foibw" thadot. M the inu- awt. Of 11140 8WOM of the CwtKkate of Construction Compliance of�t;rljlnal "am or any regrkt hwKO; 2) that the drMld weft demo" o6on wM loo looatd M staairw M tha apprewd plea aM that sab weK will t►e Msta n accofdanDS w tM sta r and regTi i o1 the Putnam COtiwty DOpwta.ead of "a"K Due . I C., 12- A SIM.d P.E. Astor ;�i`t I Sf� Lieetlee No Z AMROVEO FOR CONSTRIJCTIgM1� TMs aVKOwI etpkp two yews from the dete { unless construction of the building has been underUksn and Is rewdt.bie for uun of may be amended Of modified when tpntidwed necessary by t Commissionw of NMKh. Any change or aKwatbn of construction fe1a1MM a new pwrMt. Appr.ved for die.eaal of demetie sanismy *swag*. and /a private water w y only. By Tit DEPARTMENT OF HEALTH 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 YES Town/Village/City Tax 0 25 . Grid Number -i - { - a WELL OWNER I.OUA'V, 14A(ZfZ &jfhpg Address LL OLPrivate O Public USE OF WELL - primary 2 - secondary (.RESIDENTIAL ❑ BUSINESS ❑ INDUSTRIAL D PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify Q AMOUNT OF . USE YIELD SOUGHT gpm /# El REPLACE EXISTING SUPPLY R NEW SUPPLY NEW DWELLING PEOPLE SERVED '' - /EST. OF DAILY USAGE:12D gal O TEST /OBSERVATION GIADDITIONAL SUPPLY ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED. REASON FOR DRILLING LOCATION (date) SKETCH & SOURCES OF CONTAMINATION GgON SEPARATE SHEET i V(gi-n-nature) WELL TYPE DRILLED O DRIVEN DDUG D GRAVEL. ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: =-- Lot No. WATER WELL CONTRACTOR: Name _MO Address: 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:` LOCATION (date) SKETCH & SOURCES OF CONTAMINATION GgON SEPARATE SHEET PROVIDED V(gi-n-nature) 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 take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: Date of Expiration Permit is Non - Transferrable 3/89 19 19 Permit Issuing Official White copy: HD File Pink copy: Owner Yellow copy: Bldg. Insp. Orange copy: Well Driller To: P C t4 gie- Attention: Gentlemen: We enclose ( ) copies of: O B/W Prints O Reproducibles O Specifications ❑ Memorandum Description: 4 Date: Job No.: W69<� Project: j 9 O Reports IvZopy of Letter 0 Sent Via: ❑ Our Messenger O Blueprinter 0 First Class Mail ❑ Your Messenger Hand Delivery O i O Tracings Revision /Date No. l� f j4z O Special Delivery Copy to: Very truly yours, s� �L LAURENT ENGINEERING ASSOCIATES, P.C. Per: F� LAURENT ENGINEERING /% ASSOCIATES, PC. 73,FAIRFIELD DRIVE %i PATTERSON, NEW YORK 12563 CONSULTING SITE ENGINEERS To: P C t4 gie- Attention: Gentlemen: We enclose ( ) copies of: O B/W Prints O Reproducibles O Specifications ❑ Memorandum Description: 4 Date: Job No.: W69<� Project: j 9 O Reports IvZopy of Letter 0 Sent Via: ❑ Our Messenger O Blueprinter 0 First Class Mail ❑ Your Messenger Hand Delivery O i O Tracings Revision /Date No. l� f j4z O Special Delivery Copy to: Very truly yours, s� �L LAURENT ENGINEERING ASSOCIATES, P.C. Per: o � Q JOHN N. CALBO Building Inspector TOWN OF PATTERSON PUTNAM- COUNTY- _ .:_ .._. _ -_... . - _...._ Telephone .-._._ 878 -6319 PATTERSON. NEW YORK 12563 October 21, 1992 Putnam .County Health Department Rt. 312 Geneva Road Brewster, New York 10509 RE: TM 25.47-1 -10 & 11 Java Road Patterson, New York Dear Mr. Hedges, This is to inform you that the above noted tax parcels constitute a single building lot in the Town of Patterson. If you have any questions, please do not hesitate to contact my office. Sincerely, 1: ohn N. Calbo Building Inspector cs cc: Mr. H. Nichols ®SENDER: Complete items 1 and 2 when additional services are desired, and complete items 3 and 4. Put your address in the "RETURN TO" Space on the reverse side. Failure to do this will prevent this card from being returned �o you. The return receipt fee will rovide ou the name of the erson delivered to and the date of deliver .For ad itiona fees the o owing services are available. onsult postmaster or fees an checc box (es) or additional service(s) requested. 1. ❑ Show to whom delivered, date, and addressee's address. 2. ❑ Restricted Delivery (Extra charge) (Extra charge) 3. Article Addressed to: 4 4. Article Number 4710 Type of Service: ❑ Registered ❑ Insured -rtvry G ' [ [RCertified \ ❑ COD ❑ Express -Tvl i ❑ Return Receipt for Merchandise Always obtain signature of addressee or agent and DATE DELIVERED. 5. Sim ure - Addressee B B. Addressee's`Address (ONLY if X r requested and fee paid) 6. Signature - Agent X i 7. Date of Delivery Will vv r r, Apr. tyay * U.S.G.P.O. 1989 - 238 -815 ®SENDER:' Complete items 1 and 2 when additional services are desired, and complete items 3 and 4. 1 Put your address in the "RETURN TO" Space on the reverse side". Failure to do this will prevent this card from being retarned,to you: The return recei t fee will rovide ou the name of the erson delivered.to and the date of delive . For ad itiona ees t e o lowing services are avails e. onsu t postmaster or fees an check ox es or additional service(s) requested. 1. ❑ Show io or delivered, date, and addressee's address. 2. ❑ Restricted Delivery t (Extra charge) (Extra charge) 3. Article Addressed to: �i 4. Article Number Pei r . �) u�� ►� P Eubss �t o 11 i Type of Service: -Q /a Q(� _ ❑Registered ❑Insured �- Certified ❑ COD Express Mail E] Return Receipt J for Merchandise AO' /6 `Always obtain signature of addressee -or agent ,,nd DATE DELIVERED. 5. S�ar A� ress :%i 8. A�d4ressee's Address (ONLY if X (/ requested and fee paid) i r C✓) (w } 6. Signature- - Agent X 7. Date of Delivery; i DOMESTIC RETURN RECEIPT PS Form 381;1, Apr. 1989 I cSEt11DER: Complete items 1 and 2 when att rvices are desired, and complete items `' Put,your address in the "RETURN TO" Space on e. Failure to do this will prevent this card u the name of the erson delivered to and are avai a e. onsu t postmaster or ees ess. 2. ❑ Restricted Delivery (Extra charge) (Extra charge) 3. Article Addressed to: 4. Article Nurriber n j'} GtYO1ken `� ��C�� Type of Service: 0 q13 j�r-r .!� ❑ Registered ❑ Insured (D / "lt �� ✓ V Certified ❑ COD I )� ❑Express Mail ❑Return Receipt l� ! - for Merchandise Always`otitain signature of addressee or agent and DATE DELIVERED. 5. Sig ure - Addr ee B. Addressee's Address (ONLY if X 14 -1 r > requested and fee paid) 6. Signature -Agent X 7. Date of Delivery - PS Form 381 1 ;. Apr. 1989 *U.S.G.P -0. 1989- 238 -815 U%Jlvl . w n. . v.... ..�..�.. . *U.s.G.RO. 1989 - 238 -915 DOMESTIC RETURN RECEIPT SENDER: Complete items 1 land 2 when additional services are desired, and complete items 3 and 4.. Put your address in the "RETURN TO" Space on the reverse side. Failure to do this will prevent this card from being returned to you. The return recei t fee will nrovide ou the name of the erson delivered to and the date of deliver For additional fees the following services are avai a e. onsu t postmaster or tees an c ec<,boxlas or additional service(s) requested. 1. ❑ Show to whom delivered, bate, and addressee's address. 2. ❑ Restricted Delivery (Extra charge) (Extra charge) 3. Article Addressed to: I 6 4. Article Number Ojai+e.F C. � �; �2en S ieC� _r. P 7G5 76 q) Type of Service: ne, ❑'Registered El Insured �_ TCl v 111 9ertified ❑ COD I�LI.t �r{� R j(_ 1 IDU`� ❑ Express Mail ❑ Retn Receipt for ur Merchandise s obtain signature of addressee nd DATE,DELIVERED. 5. na - Add see 8. A re ee's Address (ONLY if X i regq st and fee paid) 6. SIgnakure - Agent X r 7. Date of Delivery PS Form 3811, Apr. 1989 t ) i I ,t U.S.G.P.O. 1989 - 238 -815 DOMESTIC RETURN RECEIP DOMESTIC RETURN RECEIPT PS Form 381;1, Apr. 1989 I cSEt11DER: Complete items 1 and 2 when att rvices are desired, and complete items `' Put,your address in the "RETURN TO" Space on e. Failure to do this will prevent this card u the name of the erson delivered to and are avai a e. onsu t postmaster or ees ess. 2. ❑ Restricted Delivery (Extra charge) (Extra charge) 3. Article Addressed to: 4. Article Nurriber n j'} GtYO1ken `� ��C�� Type of Service: 0 q13 j�r-r .!� ❑ Registered ❑ Insured (D / "lt �� ✓ V Certified ❑ COD I )� ❑Express Mail ❑Return Receipt l� ! - for Merchandise Always`otitain signature of addressee or agent and DATE DELIVERED. 5. Sig ure - Addr ee B. Addressee's Address (ONLY if X 14 -1 r > requested and fee paid) 6. Signature -Agent X 7. Date of Delivery - PS Form 381 1 ;. Apr. 1989 *U.S.G.P -0. 1989- 238 -815 U%Jlvl . w n. . v.... ..�..�.. . *U.s.G.RO. 1989 - 238 -915 DOMESTIC RETURN RECEIPT SENDER: Complete items 1 land 2 when additional services are desired, and complete items 3 and 4.. Put your address in the "RETURN TO" Space on the reverse side. Failure to do this will prevent this card from being returned to you. The return recei t fee will nrovide ou the name of the erson delivered to and the date of deliver For additional fees the following services are avai a e. onsu t postmaster or tees an c ec<,boxlas or additional service(s) requested. 1. ❑ Show to whom delivered, bate, and addressee's address. 2. ❑ Restricted Delivery (Extra charge) (Extra charge) 3. Article Addressed to: I 6 4. Article Number Ojai+e.F C. � �; �2en S ieC� _r. P 7G5 76 q) Type of Service: ne, ❑'Registered El Insured �_ TCl v 111 9ertified ❑ COD I�LI.t �r{� R j(_ 1 IDU`� ❑ Express Mail ❑ Retn Receipt for ur Merchandise s obtain signature of addressee nd DATE,DELIVERED. 5. na - Add see 8. A re ee's Address (ONLY if X i regq st and fee paid) 6. SIgnakure - Agent X r 7. Date of Delivery PS Form 3811, Apr. 1989 t ) i I ,t U.S.G.P.O. 1989 - 238 -815 DOMESTIC RETURN RECEIP PS Form 381 1 ;. Apr. 1989 *U.S.G.P -0. 1989- 238 -815 U%Jlvl . w n. . v.... ..�..�.. . *U.s.G.RO. 1989 - 238 -915 DOMESTIC RETURN RECEIPT SENDER: Complete items 1 land 2 when additional services are desired, and complete items 3 and 4.. Put your address in the "RETURN TO" Space on the reverse side. Failure to do this will prevent this card from being returned to you. The return recei t fee will nrovide ou the name of the erson delivered to and the date of deliver For additional fees the following services are avai a e. onsu t postmaster or tees an c ec<,boxlas or additional service(s) requested. 1. ❑ Show to whom delivered, bate, and addressee's address. 2. ❑ Restricted Delivery (Extra charge) (Extra charge) 3. Article Addressed to: I 6 4. Article Number Ojai+e.F C. � �; �2en S ieC� _r. P 7G5 76 q) Type of Service: ne, ❑'Registered El Insured �_ TCl v 111 9ertified ❑ COD I�LI.t �r{� R j(_ 1 IDU`� ❑ Express Mail ❑ Retn Receipt for ur Merchandise s obtain signature of addressee nd DATE,DELIVERED. 5. na - Add see 8. A re ee's Address (ONLY if X i regq st and fee paid) 6. SIgnakure - Agent X r 7. Date of Delivery PS Form 3811, Apr. 1989 t ) i I ,t U.S.G.P.O. 1989 - 238 -815 DOMESTIC RETURN RECEIP 6. SIgnakure - Agent X r 7. Date of Delivery PS Form 3811, Apr. 1989 t ) i I ,t U.S.G.P.O. 1989 - 238 -815 DOMESTIC RETURN RECEIP DSENDER: Complete items 1 and 2 when additional services are desired, and complete items 3 and 4. Put your address in the "RETURN TO" Space on the reverse side.. Failure to do this will prevent this card from being returned to you. The return recei t fee will rovide ou the name of the erson delivered to and the date of deliver X. For additional fees t e of owing services are avai a le. Consult postmaster or tees and - checFC ox(es ) for additional service(s) requested. 1. ❑ Show to whom delivered, date, and addressee's address. 2. ❑ Restricted Delivery (Extra charge) (Extra charge) 3. Article Addressed to: + /r� 4. Article Number Jcl VcL, . Signature - Addressee nature 7,,Agent 7. Date of Delivery S Form 3811, Apr, 1989 *U.S.MP.0.1989- 238.815 1�. i i Type of Service: Put your address�'in the "RETURN TO" Space on the reverse side. Failure to do this will prevent this card from being returned to you. The return recei t fee will rovide ou the name of the erson delivered to and ❑ Registered ❑ Insured 59-Certified ❑ COD ❑ Express Mail ❑ Return Recei for Merchan( Always obtain signature of addressee or agent and DATE DELIVERED. B. Addressee's Address (ONLY iJ requested and fee paid) DOMESTIC RETURN RECEIPT SENDER: Complete items 1 and 2 when additional services are 3 and 4. - desired, and complete items Put your address�'in the "RETURN TO" Space on the reverse side. Failure to do this will prevent this card from being returned to you. The return recei t fee will rovide ou the name of the erson delivered to and the date of delivery. For ad etiona ees t e of owing services are avae able. onsult postmaster or ees an check ox es or additional service(s) requested. 1. ❑ Show to whom delivered, date, and addressee's address. 2. ❑ Restricted Delivery (Extra charge) (Extra charge) 3. Article Addressed to: 4. Article Number PQ/ r - / J Gt( `� �I�eDi' JC�C', �Y�Ydil rGL 7�0 -7 0 �p��rvice: QJ� ❑. Registered ❑ Insured /C} sa� bo r n ,�� _ JG�` , peai s ale_ j u Ses�ri [Certified El COD r•r� J J 3 ❑ Express Mail ❑ Return for Merchandis Receipt e Always obtain signature of addressee C1C Always of addressee or agent and DATE DELIVERED. 5. Signature -Addressee 8. Addressee's Address (ONLY if X requested and fee paid) 6. gnature Agent X requested and fee paid) ate of 'a r. aentutri: uompiete items 'I ana z when aaartionai services are aesirea, ana complete items 3 and 4. Put your address in the "RETURN TO" Space on the reverse side. Failure to do this will prevent this card from being returned to you. The return recei t fee will rovide ou the name of the erson delivered to and the date of delivery. For ad itional ees t e o owing services are avaela e. onsult postmaster or tees and chec ox es tor additional service(s) requested. 1. ❑ Show to whom delivered, date, and addressee's address. 2. ❑ Restricted Delivery (Extra charge) (Extra charge) 3. Article Addressed to: 4. Article Number J) � .�a i 0 -to P -_7U7 76 91t) Type of Service: JG�` , peai s ale_ j u Ses�ri ❑ Registered El Insured _VCertified ❑ COD _ h► l t as G 3 El Express Mail ❑Return Receipt for Merchandise Always obtain signature of addressee C1C Always of addressee or agent and DATE DELIVERED. 5. t 8. Addressee's Address (ONLY if Mir ZAd requested and fee paid) 6. Ignatur - Agent X requested and fee paid) 7. Date of Delivery JAa 6. Signature - Age . t PS Foi•m 3811, Apr. 1989 eU.S.G.P.o.1989- 238.815. DOMESTIC RETURN RECEIPT • �•••• ...+ • _IJ1. r70, aU.5- U.P.O. 1989.238 -815 DOMESTIC RETURN RECEIPT PS Form 3811, Apr. 1980 a aU.S.G.P.O.1989- 238-815 DOMESTIC RETURN RECEIP' SENDER: Complete items 1?and 2 when additional services are desired, and complete items 3 acrd -4. -Put your address in, the "RETURN TO" Space on the reverse side. Failure to do this .will prevent this card from being returned to you: The return recei t fee will rovide oiiahe name of the erson delivered to and the date of 'delivery. For additional tees the o owing services are avae a e. Consu t postmaster tor tees an c ec c ox es or additional services) requested. 1. 'Cl Show to whom delivered, date, and addressee's address. 2. ❑ Restricted Delivery (ExtraIcharge) (Extra charge) 3. Article Addressed.to: i Jr 4. Article Number �JI h� iChct I L)s y--10 91 � Type of Service: Registered ❑Insured JG�` , peai s ale_ j u Ses�ri { �/�i rt❑ ,& Certified ❑ COD Return Receipt ❑ Express Mail ❑ for Marc. handise ^/_-� �1 Always of addressee obteirl:signature r ,.. �SE DELIVERED. or agent, arii: r! 5. Signattire - Addressee 8. Addressee's Address (ONLY if X i requested and fee paid) tsi 6. Signature - Age . t X��, 6! 7. Date of oli fir"'_ • �•••• ...+ • _IJ1. r70, aU.5- U.P.O. 1989.238 -815 DOMESTIC RETURN RECEIPT PS Form 3811, Apr. 1980 a aU.S.G.P.O.1989- 238-815 DOMESTIC RETURN RECEIP' ! d / 1. \ : "'� ' 1 ► an, / ' I / / /rn ' � \ ♦ Y r 22'j f � �1 � ` ` � a � rat 1 .1 / / ' ' " /'' \ /\ av/` F rill I I . 1 / r � � � � s� � � �►:, 1 n /.,( ,n, • - ---/ / � l 1 f /.�`.�. .._.. .._� ... -- _- ._..._.`££ ��'y- dry °\ tc' \ / / / �� \All \ I I ► / � / rrr, /� � ays � _ � ` � AV \ /ri' 'iin le If. how \ 1/ / \111 \ \ �� / „� / d u/ / / / ' / ♦ 22 /rt! •mil O PAV ` ♦ ` 92 \ ♦ \ ♦ cc Qw ffIl \ \ \ \ 8 ♦ \ \ \ rn! IVA `u.c { \ ,� \ \\ °d0� \♦ \CZ \ ♦ty♦ _ rr'.i\ �ct t`-(�s- h1 -L►"9Z 0/d rp' \� ♦ 88 ; \.;•I\CjSt•0 /d\ 'P.7 \ \ \ \ i \ Sa- i - u e L i •- [— :- \ 9B I �L S2 b d / fpv 01 At? , d • ° \ \� -;°i'• - \ 1 t � „1` \ `rt ;rte•` '- :[i ' �'.�.. . aw im ...... \ ter \... _ \._.........._ ... -- �_ ... .-... .�... ,. I ........ - - . .a., _ -. \ ! . � �- F"x�'GiVS i 0f I Op• \ 21 b !I .' , 6 !' ' ' ° — m ®_ 'fir' 4!i ' .tq 1X1 r'•.. \ - �;_ `:r! \ eo d - - - - - - - ' 006 Yri ` ♦qs trJi mi _ 3 ' Z'SZ y -- - - - - -- _ -- - - - ` -- - -a� - -- - - - - - n'- - /1 - - - - -- �' - - -- I "— - Q 1 •1N Ar' OfA !R' 0000, A/ :000 — _ _ — _ I Doe ¢ rM all ic" — A ll C. K1' y - LIST OF ABUTTING PROPERTY OWNERS JAVA ROAD PATTERSON, NEW YORK 25.46 -1 -85 - -- Presti, Philip & Carole 50 Java Rd. Patterson, NY 12563 25.47 -1 -9 Gross, Peter A. & Judith P. 45 Java Rd. Patterson, NY 12563 25.47 -1 -12 Cowhey, Maureen 1 Stone Rd. Chappaqua, NY 10514 25.47 -1 -13 Okeefe, Ann & Kathleen 6 Manchester Dr. Patterson, NY 12563 24.47 -1 -7 County of Putnam Lise -Rann Corp. 25.47 -1 -19 Sieck, Walter C. Jr., & Eileen Greystone Lane Brewster, NY 10509 25.- 47 - -1 -26 Ammirator. Paul & Giaconda 10 Sanborn Rd. Patterson, NY 12563 25.55 -1 -23 Notaro, Joseph & Adeline 46 Java Rd. Patterson, NY 12563 25.55 -1 -24 Salcito, John 30 Java Rd. Patterson, NY 12563 r i FORMAT " NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT Dear John Salcito Date October 1, 1992 RE: Department of Health Review of Proposed Sewage Disposal System for property: Louise M. Harrington & Name: Rabbi Meyer Horowitz Address: Java Road Town: Patterson, NY 12563 Tax Map : 25.47 -1 -10,11 Please be advised that an application for a Construction Permit relative to the construction of a sewage system and /or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call Mr. Hedges or Mr. Morris of the Health Department at 273 -6130. 'JerY_..rtu.ly_.Yours., By R� J� Title �.; RECEIVED BY: Address: Tax Map: JK;cj FORMAT _ ._ _ _ D.at_e......October 1,_ 1992.... NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT. RE: Department of Health Review of Proposed Sewage Disposal System for property: Louise M. Harrington & Name: Rabbi Meyer Horowitz Address: Java Road Town: Patterson, NY 12563 Tax Map: 25.47 -1 -10,11 Dear Joseph & Adeline Notaro Please be advised that an application for a Construction Permit relative to the construction of a sewage system and /or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any.questions, concerns or information which may bear on the Health Department's review of this application, you may call Mr. Hedges or Mr. Morris of the Health Department at 273 -6130. Ke'r.k .- .f. r u ly•.I y.o u r-s .j. . B y jl� Title RECEIVED BY: Address: Tax Map: JK;cj _..F RMI AT..: Date October 1, 1992 NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT RE: Department of Health Review of Proposed Sewage Disposal System for property: Louise M. Harrington & Name: Rabbi Meyer Horowitz Address: Java Road Town: Patterson, NY 12563 Tax Map: 25.47 -1 -10,11 Dear Paul & Giaconda Ammirato Please be advised that an application for a Construction Permit relative to the construction of a sewage system and /or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any. questions, concerns or information which may bear on the Health Department's review of this application, you may call Mr. Hedges or Mr. Morris of the Health Department at 273 -6130. _ Very truly ..y.ou -rs, B y j J.. Title RECEIVED BY: Address: Tax Map: J K ; c j FORMAT,_.: _ NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT Dear Walter C. Jr., & Eileen.Sieck _Date October 1, 1992. - RE: Department of Health Review of Proposed Sewage Disposal System for property: Louise M. Harrington & Name: Rabbi Meyer Horowitz Address: Java Road Town: Patterson, NY 12563 Tax Map: 25.47 -1 -10,11 °lease be advised that an application for a Construction Permit relative to the construction of a sewage system and /or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any.questions, concerns or information which may bear on the Health Department's review of this application, you may call Mr. Hedges or Mr. Morris of the Health Department at 273 -6130. :_...:..:...._ .. _...._ .. _ . _:.:.:.: _ ....._..._.,..... V.-e r ur ... ::.: __:.:... .. _.._ ........._. _..._ .... JviB Y Title RECEIVED BY: Address: Tax Map: JK;cj FORMAT "NE`IGHBOR' NOTIFICATION CONSTRUCTION PERMIT Dear County of Putnam Date October.l, 1992 RE: Department of Health Review of Proposed Sewage Disposal System for property: Louise M. Harrington & Name: Rabbi Meyer Horowitz Address: Java Road Town: Patterson, NY 12563 Tax Map: 25.47 -1 -10,11 Lise -Rann Corp. Please be advised that an application for a Construction Permit relative to the construction of a sewage system and /or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any. questions, concerns or information which may bear on the Health Department's review of this application, you may call Mr. Hedges or Mr. Morris of the Health Department at 273 -6130. `; ery. �ru.jy. . —yours., . _...w _.._.._.... i 1 Title C�N RECEIVED BY: Address: Tax 'slap: JK;cj FORMAT NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT Dear Ann & Kathleen O'Keefe' Date. October 1, 1992 RE: Department of Health Review of Proposed Sewage Disposal System for property: Louise M. Harrington & Name: Rabbi Meyer Horowitz Address: Java Road Town: Patterson, NY 12563 Tax Map: 25.47 -1 -10,11 Please be advised that an application for a Construction Permit relative to the construction of a sewage system and /or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any. questions, concerns or information which may bear on the Health Department's review of this application, you may call Mr. Hedges or Mr. Morris of the Health Department at 273 -6130. Very. t.ruly...yo.ur.s.,.__ Title �.� RECEIVED BY: Address: Tax Map: JK;cj FORMAT : Date October 1, 1992 NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT RE: Department of Health Review of Proposed-Sewage-Disposal System for property: Louise M. Harrington & Name: Rabbi Meyer Horowitz Address: Java Road Town: Patterson, NY 12563 Tax Map: 25.47 -1 -10,11 Dear Maureen Cowhey °lease be advised that an application for a Construction Permit relative to the construction of a sewage system and /or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any-questions, concerns or information which ma-y bear on the Health Department's review of this application, you may call Mr. Hedges or Mr. Morris of the Health Department at 273 -6130. ,- . ._ ... .. ... ..._ ... ..... ..... ... Very .. truly- yours ,.. _- . y 40"', 1'. Title RECEIVED BY: .Address: Tax Map: JK;cj Y .FOR,MAT.__: NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT Dear Peter A. & Judith P. Gross Date October - -1 1992 RE: Department of Health Review of Proposed Sewage Disposal System for property: Louise M. Harrington & Name: Rabbi Meyer Horowitz Address: Java Road Town: Patterson, NY 12563 Tax Map: 25.47 -1 -10,11 Please be advised that an application for a Construction Permit relative to the construction of a sewage system and /or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any. questions, concerns or information which may bear on the Health Department's review of this application, you may call Mr. Hedges or Mr. Morris of the Health Department at 273 -6130. RECEIVED BY: Address: Tax Map: JK;cj 31 -ery- truly yours-, .... .. . B y !✓�'i Title ,. I . it _ -FORMAT NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT Dear Philip & Carole Presti Date October 1, 1992 RE: Department of Health - Review of Proposed-Sewage Disposal System for property: Louise M. Harrington & Name: Rabbi Meyer Horowitz Address: Java Road Town: Patterson, NY 12563 Tax Map: 25.47 -1 -10,11 °lease be advised that an application for a Construction Permit relative to the construction of a sewage system and /or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any. questions, concerns or information which may bear on the Health Department's review of this application, you may call Mr. Hedges or Mr. Morris of the Health Department at 273 -6130. _. :..............._ -.. Very truly yours, By Title RECEIVED BY: Address: Tax Map: JK;cj t � L .� AP�s- I��f�lGl -4 �T�(P.) i t