HomeMy WebLinkAbout1407DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
33. -2 -29
BOX 13
01407
Ll
U.til
` 1.
y l
L
1'
:..
01407
n
Public Health Director
I:,vR'r: FA -MGLENARi' 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) 218 - 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 Fax (845) 278 - 6648
May 3, 200,1
Joe Matius
134 Highview Dr.
Carmel NY 10512
M
Re: Addition- Matius- Highview Dr.
No Increases in Number of Bedrooms
(T) Patterson Tax # 33. -2 -29
Dear Mr. Matius:
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 3, 2001 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:kg Public Health Technician
cc: BI(T)
4 h
b
BRUCE R. FOLEY
Public Health 'Liiector r
._ LORETTA _MOLINART -
Associate Public ^Wealth 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) 278 -6082 Fax (845) 278 - 6648
ADDITION APPLICATION (RESIDENTIAL ONLY)
STREET o TOWN.TX MAP#
NAM)TG - PxoNI~� a2ss' �J PCHD#
MAI ADDRESS
DESCRIPTION OF ADDITION�7.�ir� -�
NUMBER OF EXISTING BEDROOMS PROPOSED # OF BEDROOMS ,a2-
(FROM CERT. OF OCCUPANCY OR
CERTIFICATION FROM BUILDING INSPECTOR)
*Any addition which is considered a bedroom requires formal approval of plans (Construction Permit)
prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the
Putnam County Sanitary Code.
" Please submit this form and the following to Putnam County Health Dept., 4 Geneva Road, Brewster, NY
10509, Phone 278 -6130.
1. Certified check or money order for $100.00. .
Sketches of existing floor plan (drawn to scale, all living area including basement)
*Non - professional sketches are acceptable.
Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #)
*Non- professional sketches are acceptable.
4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of
installation if known. Label all wells and septic systems within 200 feet of the property line.
Contact this office with any questions.
5. Copy of Cert. Of Occupancy from Town or Certification from Building Dept. with legal bedroom
count of dwelling.
OFFICE USE
Comments
Feb98
Whouseguidelines
ts;
I
cr)
ct
Ct.
BRUCE R. FOLEY
> . Public KeaIth . D rgctor --
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
LORETTA MOLINARI R.N., M.S.N.
_-AjsLci4c,,7Publ c- .- .k:e.ltli:. ~�? ectar -
Director of Patient Services
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278.- 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648
Putnam County Dept. of Health
4 Geneva Road
Brewster, NY 10509
Re:
Residence
Tax Ma
r
Town
Gentlemen:
According to records maintained by the Town, the above noted dwelling
IS
ISTvT,- -...._,..
in compliance with Town code and the total number of bedrooms on record is " 6,24-
This information has been obtained from:'"
CERTIFICATE OF OCCUPANCY:
ASSESSORS RECORD:
OTHER
ding Inspector .
BFhouseguidelines
Els
E�1
CL.
w
N
i3..=
Uj
CD
OF
"IGH\JleW
scams
GnL-ULAS A. C,FAkW
-rC) EA _-
�jeV_j _V- TITLE (00 -n Poe- 71*-(L- POU L(
c -nc* A" -fl-W
E.enpick -* WjC*cdjEr> VW-REA=wJ SIW
.'r,- -•z ..r- *,o...�.- - ,r.,.« .:try - c--�'. - •,y�^�-- `3'<'t'?'^ -�.r ••rep .-w '. r:' T.n rt;'S c - y,w ..
/ 1 lQi� ODUNrr DEPAlTNMNl' OF>�ALTH
f (l DIo1iimw itl fY�wftl Ha�Mb S�edoe�: Q�a1.'N.Y. law jcmw e M lsfw W lysM
A
' at (B!!IIp[GT$ OF QO
Cfl P Or PO= S MAGN 101011im"L SYST®[ Pr•� � � .
►� -�I \I Imo/
_ ;.vall�a,
sob .:..COY L1 Tim t t � • -.
• Mep
p f o..eg /ASprt,:.t rr...�F�1 �-1 -I-i Pw I � 1� ! �i � U% K P, :. .
Daft of Peevko A 11 rove)
Aalt... �g (�` 'TIC 1 i Town
�ubdivisioli Anvroved Fee Enelosed �—
911IM1116 Tho S I19em T1 Al, Let Aiea I C t Fm secttm herb
lJ Depth vat,
Deaipl Flow G' P D POSD NoUHriliea k Wbaa FID k 0"a *'ed
S-rWaft SVwmW Splrmg a in" "et i L 0 GaHw S�ptic T.& eaa I LE AV S T_Kr_5 6
To b• 1 CJ p Add.a..
WISW Se>+pb: Pdit S"_* Ptsab AMbrems
S pb DrOed � Q ---4d&.
Other b
I represent that lain wholly ano;:completaly responsible+ for the design and i"tion of the proposed syttxm(s); :1) that the separate sew di sal : stem
abOw described will be constructed as shown on tlie;approved amandnient there to and in aceordanq with the standards, rule" a reyu ns o m
County .DOPWt"Mt ' O} NMItA, ,and that on completion :thereof a "COrtificaEe of Construction Compliance" satisfactory. to the Comfnisabner of Mealthwill
be sisbrnined to the Depdtmaht. end a written auarahtee will W .-furnished the owner, his sueeasaerti heirs of eosins by the buikte , that old builder will
Islaee in port 'opwatki� condition anY part .of told eiwasx+ disposal system durirp the period of two (2) yews immWiatol } Iksvring thaWtO of the laver
erne of the aplroiial of aha Cert)fk:ate of. Construction Compllence of; th orginal system or any repairs_tM► o; 2) that t drilled well desori6W a6oee
well be located as shown on tM'appr6wd plan and that said well will be in'st, _ `in aeeoMance with slander ru, and putiiions of the Parham
Cemity Department 'of ►IMlth.
Date Siano
. r—Al Er-)�Li2 Gd:
Address l icense No
I 'TROVED.FOR CONSTRUCTION: This approval: expires.two years from the .date i ed unless construction of the building has been undertaken and is
reiioc" for cause Or "may be anNr doe or niodi}kld whenconfiderad riecesYrY by the COMmlffionet Of. Health. Any charge or alteration of construction
p�
reauires a flew permit.. Approved -for disposal of domestic - sanitary-iearaga. a Or' water supply only. .
Rev.
10/88 Date sv /` �./'%'� Title
i
t
Yr1Y+ IYaIYaIYaIYUIY+ I✓•:✓ at val✓• 1✓ r: ✓ +IJ +IY�IY +IY +I✓aIY +I ✓�IY•I ✓ +IV aI✓at✓ui✓ +�Y +I + +I ✓al ✓ ✓ly ✓ +1 ✓v1Y ✓1 ✓�IY�IY UI ✓alY +l ✓alY +1Yr1YalYYlY Vi ✓+l✓rlr l ✓Ylr lY +i✓rl✓ +I ✓ +IY�IVrIY +IY'al✓ 1 l✓ 7�
'I
i
�i
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New-York 10509
(914) 278 -6130
t PPLIC:�►'T-ION TO CC IJS^'RUCT Ii `WF;TER WE ;�
PCHD PERMIT
WELL LOCATION
Street Address
, i
Town/Village/City Tax Grid Number
- �� r ` �52)' , `_
1. t.
WELL
Name
TI-� ' �'
Mailing Address
G 0 : V = (
.Private
D Public
SE OF WELL
1 - primary
- secondary
8,RESIDENTIAL
D BUSINESS
D INDUSTRIAL
i
O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION
O INSTITUTIONAL O STAND -BY
O ABANDONED
O OTHER (spec ifq
O
AMOUNT OF USE
YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGElS Sal
O REPLACE EXISTING SUPPLY O TEST/ OBSERVATION 13. ADDITIONAL SUPPLY
® NEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL _
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
Oellu
WELL TYPE
DDRILLED
ODRIVEN DUG GRAVEL
❑ OTHER
IS WELL SITE SUBJECT TO FLOODING? YES K NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No �}-
WATER WELL CONTRACTOR: Name Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES DC NO
NAME OF PUBLIC WATER SUPPLY: (,%1 TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
(BON SEPARATE SHEET
o �F L4'1'4'
gn t re
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
thirt -y (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 co nate surface or groundwater.
Date of Issue • 19
Date of Expiration 19CF'S_ Permit Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
1 - -1. -J
MrJ,+?A.TT IOOK
O •16.O�/l =0• .
Lw«oar ROOM IZA� -- FAMILY NOOM
xo sY a o'
LEv
to s
b�IMO L"O NOON
T.0 CIA uiurc Innr3W .6,t■o• -o'
73' -0"z23' -0' racy . _.
1 `
Garage & laundry room by builder.
1st Floor
2nd Floor
:Two Story 32x66
2505 Square Feet
I !iL.1.
DIVISION OF r r to v HEALTH SERVICES
DESIGN DATA SREET- SUBSUFACE
SEWPLE DISPOSAL SYSTEM
FILE No.
A& ess`
z
Located at (Street) ajrj4�-
EJAJ
Sec. 3�. Bloc'<
o2 Lot o
(indicate nearest cross street)
4
mmicicaiity
Watershed
S
SOIL PF.�2MI TiCN TEST
akTA RAID To BE SU&41= W=' A.PPLICAITCNS
Date of Pre- Soaking I -� � Date of Percolation Test
HOLE
NL�FiZ CLOG -R 1'72
PERCOLATION
PERCDLA CN
Run Elapse
Depth to Water Fran
Water Levu
.
No. Time
Ground Surface
In Inches
Soi Rate
Start -Stop Min_
Start Stop
Drop In
Min /In Drop
Inches Inches
Inches
4.
3
4
'h.' 1 'Iz .
s
1
z
3
4
S
NOTES: 1.• Tests to be repeated• at same depth until appra dpately equal soil rates
are' obtained at each percolation test hole... All data to' be submitted
for review. -.
2. Depth measureTents to be made fran top of hole
rev. 9 /gs
TEST PIT DATA REQUIRED To BE SUBMITTED WITH APPLICATION
DESO=ION OF SOILS EZX=NMMM IN TEST HOLES
DEPTH HOLE NO. I
2'
�v
HOLE NO. HOLE .:NO.
3'
4'
5'
6'
7'
8'
9'
10'
11' -
12'
13'
14'
INDICATE LEVEL ATwaica-GROONDRATER IS ENCODED
IN-DILATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
DEEP BOLE OBSERVATIONS MADE BY:At� KRO W N DATE:.
DESI&N
Soil Rate Used 2I"3) Min/1" Drop_ S.D. Usable Area Provided
No. of Bedroans Septic Tank Capacity 12 S 0 ga- s - • Type CO M G
Absorption Area Provided By__( L.F. x 24" width trench
Other
f
Nan-p- L,�yi��NT t�lC�: ASSOG. pG . Signature Q'� r
Address 73 :EA I Kr-1 E L tl OKW 1✓ SEAL
C� :.5 (�
No. sJ;z4���%
THIS SPACE FOR USE BY•�LTH DEPARDO ONLY:
Soil Rate Approved sq.ft /gal. Checked by Date
Patnam County Department of Health
Division of Environmental Sanitation
AFFIDAVIT -- CQRPORATR a4NER APPLICATION
_ ._I'OR, PERMIT. _APj fr CATZ_0N, :- SL1BMTTTEL- TO
PUTNAM COUNTY HEALTH DEPARTMENT
TO: Commissioner of Health •- In the matter of application far
, f
represent.
that .1 am an officer or emp] oyee of the corporation and an authorised
f��,,�
to act for. _I.TG�.�! l �/-•,
(name of corporation)
having offices at P&W MA: --4,
Whose officers -Are
President
w (Name ana-T Kddres`s) ._•
Vice - Pre$14nt
ai
e and Address) .
Secr4tar !f
(Name and Address)
Treasurer' ��...�..�'�`�'�� �.wr_ �����, /� / • • '
(Name and Address)
- - - -- - --
and teat I= am-and wall. be individually responsible fon any' or all aptp
of the- eorporation with respect to the approval reque , ed and -al.l. -sub-
f
sequeiit a.c;t$ rel.,atii g thereto.
SwOrrk to •15efoi a me this '.r da
_ , this Y Signed _ •.
of 19 Title
Tb b. a �11 5
. w � wr' � we. r,r r.. • � r.. � r � •rr
Notary wi iie' ""„�- --,-- -• -�_--.
NATALIE M. COLLETTA
NOTARY PUBLIC. $tats of New York
No. 4993009
ouaiified in, Ulster u
Commission Expir2�/
' Corpor4te Seal
192 10: 12 POK eSUHV �J14 DEF kIPENT OF HI�AUI'h
bCT .05 TNAA t,�U'U-NTI
DIVISION OF SNVIRONAJLNIPAL HEALTH SERVICO,'!".
73.
Dote 44
b* 7-,6
Re; Property of� -41_TTF_JL9d>NJ
Loeat4d at
_�
(T) - 5,6 Block
Subdi.Vision Of �A
Filcd Map ate
Subdv. Lot
Gentlemen%
This letter is to Authqx'jze IAJ
A duly licensed profes.5io I nal angixjeer or registered arohitect
(indicate
to apply for a Construct
ormit. for a separate 'S614aZe system, to
ion )P
gerVe the above noted property in accordance with the standards, rules,
pr
or regulations a.9 the Commissioner of the Putnam County .
f in
t e . nt of He m I alth, And to sign all necessary papers 0� Y b
ehal
D4p r m
ion Of said
connection with this matter and to Supervise the oonstruot
system or sySte i
"Is n eonforrnity with the provisions of Article 145 or
147, Education Law, the public Health Law, and the p"vaam County Sani-
,
tart' Code*
1XIA
g
countersig
P#F..'-v I R•A• I #
4& dross
"
Teleph6ne
Very truly,
Ur
�r�Vpart� r
--2461
Address
Toun
(q,4-)42,t .,8ZA&
Telephone
.r,-,- - I,. M. -.
PiTTNAM COUNTY DEPARTMENT Ol= HEALTH
APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM
1. Name and Address of Applicant: __Z991T4 12ylLn ,Ier C mr.
Maye:lk- A\1ff NVF-
LSE W KCX,91;1- 9.T -1��(
2. Name ' of Project: fyVIM00S90 SS05 3.._ Location T/V /C: fAna14t_
4. Project Engineer: I -AQ "- T A;SSDG•Pc.• 5. Address: 3 .4ir2 1)✓LD �i72•
&-s0 �1
License Number: I : '-4 Phone: 27g -IoID S�
6. Type of Pro ect:
_ Private /Residential Food- Service ..Commercial ,
Apartments Institutional Mobile Home Park
Office Building : Realty Subdivision Other (specify)
7. Is this project subjeA to State Environmental Quality Review (SEQR)?
Type Status (Check One) Type I.. Exempt
Type II. Unlisted, r[
j
8. Is a Draft Environmental Impact Statement (DEIS) required? ............. 1AQ
9. Has DEIS been completed and found acceptable by Lead Agency? 14 /A
10, Name of Lead Agency N /A.
1-1,•. Is: tM-s-- project - --in an- a -rea -under -the --control- local- p1eannin9; -zon #ng;
or other officials, ordinances? .......................... N h
12. If so, have plans been. - submitted to such: author .sties ?.. ...................
13. Has preliminary approval' been' granted by such authorities? Date Granted _
14. Type of Sewage Disposal_ System Discharge...... -Surface Water _Ground Waters
15. If surface water discharge, what is the stream.class designation ?........ _ /4
:6. Waters index number (surface) W/A
17. Is project located near a public water supply system? .................. �4 G
:8. If yes, name of water supply j�fJS. Distance to water supply �1A
:9. Is project site near a public sewage collection or disposal system ?..... N l5
-'0: Name of sewage system i I /A - Distance- to sewage system •/1_k
1. Date observed: N <mo j&J W_ 23. Name of Health Inspector: 0t,1KtAnWW
4. Project design flow (gallons per day). .............. 600
.. �..-; �2. 5- Fs��• ta- ta-- �oll�xa• nt,. .p;isc;�a- rge�- Eliminat:ian�; Sys_ tet», ;'.(�- PaES�.- Pe,c�rl= t--- :eq-ui -red? -:-- -�.�1(. -- -
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? ...................•................ ............................... N D
28. Wetland ID Number .. .................... ............................... — JA,/A
29. -Is Wetland Permit, required? ....... t�16
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 pesticide$ to orchards or other crops, solid or hazardous waste disposal;l```
landfi11ing,*sludge application or industrial activity? YES or NO _
32. Is project located-within 1.000-feet of .existence of abandoned landfill,
hazardous waste site, salt stockpile, landfill, sludge .d : isposal site or
al
any other potenti known source of contamination? .............. or N0 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? N1 0 _
. 35.,, -.Are any sewage..di- sposal areas -in excess of--- 15 %-- sTopeT..;_
36. Tax Map ID Number . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . ............ ..........
• R
37. Approved Plans are to'be returned to: ................ . Applicant X Engineer
If the application is signed by a person other than the applicant shown in Item.1, the.
application must be-accompanied by y-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 l Law.
SIGNATURES & OFFICIAL TITLES:_
'AILING ADDRESS:
�3 1- A1gnr, -L.J R1 125 &?2
LAURENT ENGINEERING
ASSOCIATES, P.C.
_. ..__ __._ _ _......... ., .._MILLERMKEOF.FICECENTRE
Route 22 S Milltown Road
Brewster, New York 10509
RANDOLPH W. LAURENT, P.E. (914)278- 6108 - (FA)) 278 -2658
HARRY W. NICHOLS JR., P.E. H CONSULTING SITE ENGINEERS
November 8, 1996
Mr. William Hedges
Putnam County Health Department
4 Geneva Road
Brewster, NY 10509
RE: Individual SSDS Compliance
Lot 45 Windsor Oaks Subdivision
Highview Drive
Patterson, N.Y.
Dear Bill:
Enclosed are the following:
1. Four (4) prints of Drawing S -45 "As -Built Plan ", dated 11 -7 -96.
2. "Certificate of Construction Compliance For Sewage Disposal System ", dated 11 -7 -96.
3. Three (3) copies of "Guarantee of Subsurface Sewage Disposal System ", dated 10- 29 -96.
4. Well Completion and Well Log Report, dated 10- 30 -96.
5. Water Analysis Report, dated 10- 30 -96.
6. Money order in the amount of $200.00 payable t6 Putnam County Health Department.
If there are any questions concerning the enclosed, please call.
Very truly yours,
LA NT ENGINEERING ASSOCIATES, P.C.
Harry W. Ni ols, Jr., P.E.
HWN:DJ:bd
LAURENT ENGINEERING
ASSOCIATES, PC.
73 FAIRFIELD DRIVE
PATTERSON, NEW YORK 12563
-(-I�,14),27P,-610S,—.(FAX-,'s273-2658--.-
AWbLPHW.LAL1RtN1f,PL
HARRY W NICHOLS, JR., PE. WTV CONSULTING SITE ENGINEERS
October 5, 1993
Mr. William Hedges
Putnam County Health Department
4 Geneva Road
Brewster, NY 10509
RE: Proposed SSDS
Lot 45 Fair Street Subdivision
Highview Drive
Town of Patterson, N.Y.
Dear Bill:
Enclosed are the following:
,-1. One (1) print of Drawing SS-45 "Proposed SSDS", dated
10-4-93.
2. "Application For Approval of Plans For a Wastewater Disposal
System".
3. "Construction Permit for Sewage Disposal System ", dated
10-4-93.
4. "Application to Construct a Water Well", dated 10-4-93.
5. "Design Data Sheet".
6. "Letter of Authorization", dated 10-5-93.
7. "Corporate Affidavit",, dated 10-4-93.
S. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count
Only".
9. Check in the amount of $300.00 for Review Fee.
Please review the enclosed and issue a Permit at your earliest
convenience.
Very truly yours,
LAURENT ENGINEERING ASSOCIATES, P.C.
H a fiy r
W. .14chols, Jr., P.E.
HWN: bd
93072
enc.
cc: Zenith Building Corp. w/enc.
77;.. _ •r...- "nit -y^ i i ..�1 't
PMAM GOZJNTY DEPARTMENT OF HEALTH.
}
R v / 86 Division of L�vlroomentia Health Serviceay Citrmel, N.Y. 10512
- Engineer Must Provide
P C:H D Permit N
'� (" FR7°• I> C.:' L� O*?.!'!11N1PI�AN('F - EfR ._ SF WAGE DISPOSAL SYSTEM:-e F .00NST RCC
Village
'd
at tax Mitp ck
� Blo_Iot_
b✓ii/bio?
Owner plicant -Name ZfA411W ;a/ /L 0&1V 924 Formerly Stibdivision Nerve Lot N
ddress -MR:k FY° �� Zip_ Date Permit issued
parate Sewerage- System built by��6G sE�G �(S�qs`' Address
Consisting of /'% �) GeRon.Septic Tsnk and _�!Z L• f`- /�iSr,�rfriD�c�
Water Supply: Pubile'Supply From Address
or:n_ Private Supply .�ed by �c�N -�
Alk Address �r 3,(3 CRo n/ �•ef LL5
BaUding Type �iLz1���:'i Hite Erosion ,Control Been CompletedY
Nmnber of Bedrooms 14 IT Garbage Grinder Been Installed?
Other Requirements
I certify that the systems) as' listed, serying the -above premises were.constructed;essentially as shown on the plan of the copsleted work ( copies
rmit issued by the
of which are attached), and in accordance with the standards, rules and:requlat on , in accord a with the filed n, pe„
Putnam County department of Health.
Data! '� Certified by P R,A.
Address Al LI M No.
Any person occupying premises served by'the above "system(s) shall promptly,take. such actioriaa may be necessary to secure the correction. of any unsanitary
conditions .resulting' from .such usage. _:Approval oL the; separate ahwerags sy'em shall become null and void as won as a pubt ?: sanitary saws► becomes
available and the approval of the. piivate.wster supply shall pecomeAull and volt whe r wn difl finis available. Such.'.approvals are
wb)set to modification or change when; In the Judgment of.,alie Commissioner'• F1W flttlr�tlQLl or eluhge It necessary.,
{ T It 1.0
Date
al
�.k Co�.
��ti ry
Y0
WZIA, UVr1rLZ11VL1 AC,rVAl
DEPARTMENT OF HEALTH
ntv sign. Of
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
.,. ere
WELL LOCATION
STREET AOURESS. FUWN1V1tLACMCIIY 0 NUMBEtI:
) I � H V11 FVI �- _� F- VJ0 �,/
WELL OWNER
NAME. ADDRESS:
�0l2
® P8IVATE
O PUBLIC
USE OF WELL
primary
2 - secondary
IDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED
O BUSINESS ❑ FARM ❑ TEST /OBSERVATION O OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT gpm. /NO..PEOPLE SERVED _5L/ EST. OF DAILY USAGE S gal.
REASON FOR
DRILLING
[]REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION [ADDITIONAL SUPPLY
UPPLY (NEW DWELLING) ❑DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH ,/ ft.
STATIC WATER LEVEL ft.
DATE MEASURED Qe'i° Jh
DRILLING
EQUIPMENT
❑ ROTARY ❑ C9MfRESSED AIR PERCUSSION ❑ DUG
❑ WELL POINT 6 ABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
O SCREENED EN END CASING O OPEN. HOLE IN BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL LENGTH 3 2--ft-
MATERIALS: a EELP 0 P STIC . O OTHER
LENGTH BELOW GRADE R ft.
JOINTS: OWE DED E HREADED O OTHER
DIAMETER in.
SEAL: meeENT G UT ❑ BENTONITE ❑ OTHER
WEIGHT
PER FOOT_ Ib. /it.
DRIVE SHOE S ❑ NO
LINER: G YES ;
SCREEN
DETAILS
DIAMETER (in)
SLOT SIZE
LENGTH
(ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIf35T
O YES ❑
_HOUIRS. �
SEGO D
'�
GRAVEL PACK
o NOS
GRAVEL/"'
RAVEw
SIZE:
DIAMETER
OF PACK In.
TOP
DEPTH ft.
BOTTOM
DEPTH Al.'
WELL YIELD TEST t If detailed Pumping
t p p 9
METHOD: ❑ PUMPED ; tests were done is in-
❑ CO RESSED AIR , formation attached?
AILED ❑ OTHER ; ❑ YES 0 NO
IPI�LL LOG
'It more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE.
Water
Bear-
ing
We11
Dia-
In
FORMATION DESCRIPTION
CODE
tt.
ft
WELL DEPTH
it.
DURATION
hr, min.
DRAWOOWN
tt,
YIELD
gGm.
Surface
4
r ,.
! „/
WATER EAR TEMP.
QUALITY ❑ CLOUDY HARDNESS �%✓ d
❑ COLORED ANALYZED? S' ONO
ANALYSIS ATTACHED? ES ❑ NO
STORAGE TANK: TYPE P1- 4A2a
CAPACITY GAL.
PUMP INFORM TION
TYPE If CAPACITY �
MAKER .) DEPTH Z�
MODEL ��j VOLTAGE 11,I: HP '�
WELL DRILLER NAME. � 1 / '
e7 68 / ,� e �� t.
�'�►
AOORESS 190 � � � � slGtnMRE
A
J/ ov
I
-'
YML ENVIRONMENTAL SERVICES .
- 321 Kear Street
"
Yorktown Heights, N.Y. 10598
(914) 245-2800 _
Albert H. Padovani, Director
-=:Z--7��-�=`�
LAB #: 32.418158 CLIENT #: 5669 NON STAT PROC PAGE 1
MALANCHUK, DENNIS DATE/TIME TAKEN: 10/25/96 11:00
BOX 313 DATE/TIME REC'D: 10/25/96 12:30
CROlDN FALLS, NY 10519 REPORT DATE: 10/30/96'
SAMPLING SITE: HIGH VIEW TERRACE SAMPLE TYPE..: POTABLE.`
: ZENITH BUILDING CORP.. PATTERSON PRESERVATIVES: NONE
COL'D BY: DENNlS MALANCHUCK `� ' ` TEMpE..TURE,.: < 4C
NOTES... 9 KITCHEN TAP COLIFORM METH! MF
DATE FLAG PROCEDURE RESULT* NORMAL - RANGE METHOD
10/25/96 MF T. COLIFOHM ABSENT /100 ML ABSENT
COMMENTS*'.
BACT THESE RESULTS INDICATE THAT (WAS NU.) OF A
SATISFACTORY SANITARY QUALITY ACCORDING—�} THE NEW YORK STATE
AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS
TESTED, AT THE TIME OF COLLECTION.
i
Albert H. Padovani, M.T.(ASCP)
Director ELAP# 10323,
PUINIP11 00:7N"Z'Y DZEPAPMaDE ZT OF HEALTH,
DIVISION OF 1WI.R .LT!4 C'FS_
Z� '+I`iN • �?�I I l�_i rte. �r I i\�� . ... . .
a,mer or Purchaser of Euilding
-i77(A1 1 rJ C
Building Constructed by
Location - Street
hi,n; c " o.lity
Building e
Section Block Lot
Sul divisi.on bl?-1 ,
Subdivision Lot
GLI.� R7-N—L = OF - S=- U, .F r Cv SLr2L -E D I S -P aq-P. SX.,STr I
I represent that S am wholly and completely responsible for the location,
wor }a�nship, material, construction and drainage of the sewage disposal system
serving the above describes property, and that it has -been constructed as shaan on
the approved plan or approved amendment thereto, and in accordance with the
stand: rds, rules and regulations of the Putnam County D`rzrtT nt of Health, and
hereby guarantee to the cr, ner,. his successors, heirs or assigns, to place in god-d
operating condition any part of said system constructed by me. which fails to
operate for a period of two years ianiediately following the date of approval of the
"Certificate of Construction Compliance" for for the se°aa e: dis_ sal systemt._.gr _any
repairs rnade by me to such . system, except where the failure to operate properly is
caused by the willful or negligent act of the cccupeant.of the.};ui? ding 'utilizing
the stem.
The undersigned further agrees to accept as conclusive the determination or
the Director of the Division of_ Rnviror, rental Health Services of the Putnam County
Department of Health as to wht er or not the failure of the sysA"an to operate was
caused by the willful or negligent act of -he occupant of the building uti-lizi:n
the system.
'�_ '�i��W ��•'� Nei +; �'GHF- -t-t -� � � `f I ��'�
Address r I
S? G na
Title
Corporation Na-ma (if Corp.)
�^ �ess
I
`- BkUCE -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 - 6134 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 March 21, 2002
Jose Matias Preschool (845) 228 - 5912 Fax (845) 228 - 6113
134 Highview Dr.
Carmel, NY 10512
Re: Accessory Apartment - Matias, 134 Highview Dr.
Three Year Approval
Town:Patterson, TM #33 -2 -29
Dear Mr. Matias:
I have received and reviewed the plans for the proposed accessory apartment at the above -
mentioned residence. The proposal for the apartment has been approved as per plans bearing the
approval stamp form this Department dated —March 21, 2002. The apartment is approved for three
years with the following conditions:
1. The total number of bedrooms in the apartment must remain at one without prior
approval by this department.
_ - ....2...... -The total - number_. of bedrooms in_the m in house - must remain at t ea without prior
approval by this department.
3. The area of the existing sewage disposal system, and its expansion area, must be
maintained.
4. 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 :hn Public Health Technician
cc: BI
11
..- - =BRUCE ° tZ�::FOL'F`f = .... _ .... � <- :- _•._. z .- . _ -,.. , ..
Public Health Director
-- TORE'iTX- MOL AR%1
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 Fax (845) 278 - 6648
Preschool (845) 228 - 5912 Fax (845) 228 - 6113 .
Date —0-022
ACCESSORY APARTMENT APPLICATION
Renewal .❑ DO
Yes No
STREET _. j/Jlr l/& yA TOWNBrS— WX -MAP # 3 —� — .Z q
y ��a -ter
NAME D` PHONES vZ.S PCBD # ` 66
jr),
ADDRESS % 3� ll�h?�1�✓ ��' G'�1� y /�S /,2
MAILING ADDRESS OF APARTMENT Al Y %6/ Z
NUMBER OF BEDROOMS IN MAIN HOUSE,
NUMBER OF BEDROOMS IN APARTMENT : - -
Please submit this form and the requirements on page two to the Putnam County Health Dept., 4
Geneva Rd., Brewster, NY 10509, Phone 278 -6130.
Approval is effective for a three year period. The applicant must reapply at the end of each
period to renew the legal status of the apartment.
Signature of Applicant
2t�o�
Approved Date 3 �— to 12-131 oS
By. Title P�
OFFICE USE
Comments
Nov. 2000
ACCESAPT
co
co
co
C-4
-
--------- - - - - --
I
------------- - -
9080
GARAGE
35'1 x 23'
----------------
L--------- - - - - -1
9080
LIVING AREA
74 sq ft
PUTN*h COUNTY DEFARTMIENT OF HEALTH
"OUSE PLAN'S APPROVED FOR
BEDROOM COUNT ONLY,
--�BEDROOMS
9080
1,
4
I
C,
m
_ . - __ . �.-PTC PUt�iPIwC; RcPAfRS
INSTALLATION
Billing Address:
99 Maple Grange Road Cust. #!�77�'
All Count Vernon, NJ 07462 Inv. #� 3f'O�
Resource Management Corp, 800"428-6166 I
an EarthCare Company G,
Date: 117, !
Alpine 768 -8877 Hackettstown 852 -9818 Monroe 783- 29 Po ton 838 -1555
Basking Ridge 766 -1706 Hamburg
Bedford Hills 665 -5555 Highland 827 -7731 Monticello 794 -2901 Port Jervis 856 -2222 �
Califon 9 691 -3793 Morristown 540 -1655 Rockland 425 -6336
Cold Springs 265 -20 5 Hopewell Hopatcong 227 -8092 Newburgh 562 -3440 Succasunna 584-2840
Dingmans 828 -7748 Kingston 336 -5503 Newton 383 -9871 Sussex 875 -6002
Ellenville 647 -3832 'Liberty 292 -3679 New Windsor 561 -3355 Vernon 764-6666
Franklin Lks. 827 -0911 ;Middletown 343 -1500 Oakland 337 -5505 Walden 778 -1333
Goshen 294 -8299 Millwood 762 -9411 Pawling 855 -5055 Warwick 986 -1147
Job Site: .o '.; r.
" Phone _
ADDRESS / � ,�U� .
CITY
STATE _e:11
ZIP
Bill To:
CC #
CLEANIN Septic i
FIELD PIT 3 6
9
A#
Lech. Sludge Gallons � @ � �o
Gallons ®1�X��
DIGGING/LABOR CHARGE
CLEANED LINE__ INLET—OUTLET —
TREATMENT
COVER
TRUCK CHARGE s
MISCELLANEOUS2
COMMENTS:_
At �Iplermatjngg
Ab
Suggest Aeration
System Saturated
Run Back
Recommend Bacteria
Not responsible for driveway or any
Customer's Sign.Q J
BAFFLE
:>
Suggest Tank Replacement
Heavy Sludge or Solids
Suggest Outlet Cleaning
Suggest Reg. Contract Maintenance
Suggest Riser
Other:
above statement is
Driver's Sign.
Tax
Total " 7.,2
and PaymeA is d�lw e6.�1
^ YmL ENVIRONMENTAL SERVICES
` 321 Kear Street
Yorktown Heigh N.Y..10598
(914) 245-2808
Albert H. Padovani, Director.
`
LAB #: 93.200654 CLIENT #: 55259 NON STAT PROC PAGE 1
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~�~~~~~~~~~~~~~~~
MATI S, JOSE | TONI(HI DATE/TIME TAKEN: 03/13/02 08:30A
134 HIGHVIEW DR DATE/TIME REC'D: 03/13/02 09:00A
CARMEL, NY 10512 REPORT DATE: 03/16/02
PHONE: (845)-228-2577
SAMPLING SITE: 134 HIGHVIEW DR, CARMEL,NY SAMPLE TYPE..: POTABLE
: KIT TAP PRESERVATIVES: NONE
COL'D BY: JOSE MYTIAS TEMPERATURE..: < 4C
NOTES... : COLIFORM METH: MF
DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD
03/13/02 MF T. COLIFORM ABSENT /100 ML ABSENT 1008
COMMENTS:
BACTO THESE RESULTS INDICATE THAT THE (WAS NOT) OF A
SATISFACTORY SANITARY QUALITY ACCO THE NEW YORK STATE
AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS
TESTED, AT THE TIME OF COLLECTION.
SUBRITTED BY:
Albert ~ Padovani, ~~~�_/
Director ELAP# 10323
N
N
N
0
m
N
m
oN
0
m
z
ml
N
to
`J
� 2
i
I N N
f�
0 ELEr-
i
N-72
HIGHVIeW ORNIE
TiFiED TD oo�x SAS L.. C R,&� -KM cLAODeTIE E. JOSEPH
.ricim -ro ea► O►Jrteo of 7EXAS FSg A4JD -ro
,j Yo24 TITI-F- Foo- TI-fE.tl? Pr->ucY -4- o-cF - I I -IZ .
�T1LIC.l�'�iOs f�i IL.b WEMC," 6W."Ple W —m-'TMK
FM=-P REI> IU VM - krz-
r% I ►MAIL S l;
—row
tQ c
SGAI -E :
m
r
x
rn
m
N
O
o
T
�
--s
S X
.4S- ,BUILT
0/MENS /0N C
CHART(IN FT.)
NO A
A B
B
/
41.0
2/.O
2 /
/04.5 8
81.0
3 /
/05.0 8
83.0
4 /
/06.0 8
85.0
5 /
/07.5 8
875
6 1
109.0 9
9 L 0
7 /
/12.0 9
950
a 1
116.0 /
/00.0
9 /
/20.0 1
105.0
l0 1
124.0 /
//0.0
64.5 4
49.0
12 .
.66.0 4
46.0
19 6
68.5 5
51.0
14 6
69.0 5
54.0
15 6
68.5 5
570
16 7
79.0 C
C3.5
/7 6
64.0 7
74.0
/e 9
93.0 6
69.0
1
109:0.-
155.5 151.0
2l /55.0 132.0
22 154.5 /32.5
23 156.0 135.0
24 159.0 /39.0
25 162.0 1¢3.0
26 16'S 0 146.5
THIS IS TO CERT /FY THAT THE SEWAGE D /SPOSAL
SYSTEM WAS CONSTRUCTED 45 /NO/CATEO OA/,r/71/ f
THIS IS TO CERT /FY THAT THE SEWAGE D /SPOSAL
SYSTEM WAS CONSTRUCTED 45 /NO/CATEO OA/,r/71/ f