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Home My WebLink About1546DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -4 -44 BOX 14 . � r ;1!61 ■ �. f ■ 6 117. ■ 01546 , { ` SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI RN, MSN Associate Commissioner of Health ROBERT J. BONDI County Executive DEPARTMENT OF HEALTH c 1 Geneva Road, Brewster, New York 10509 ADDITION APPLICATION RESIDENTIAL ONLY STREET TOWN �c� i�(� TAX MAP# y . 4 ^ L( Y NAME C_i'li:� A.Mczre.�� n�UCJ PHONEI'�S'�IS�o� CR��1 PCHD# t �d u MAILING ADDRESS DESCRIPTION OF ADDITION A r,lj.r 6ALa- c.��(;�(� try't hW NUMBER OF EXISTING BEDROOMS PROPOSED # OF BEDROOMS _ (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., 1 Geneva Rd, Brewster, NY 10509, Phone: (845) 278 -6130. 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) 3. 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 locations 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 Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 P SHERLITA AMLER, MD, MS, FAAP Commissioner of Health "'TORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 1050.9 ROBERT J. BONDI County Executive PUTNAM COUNTY DEPT. OF HEALTH 1 GENEVA ROAD BREWSTER, N.Y. 10509 ICE: lis Residence TAX MAP# TOWN L To Whom It May Concern: According to records maintained by the Town, the above noted dwelling: IS X_ IS NOT IN COMPLIANCE WITH town code and the total number of bedrooms is This information has been obtained from: CERTIFICATE OF OCCUPANCY ASSESSOR'S RECORD OTHER BUILDING INSPE OR Environmental Health (845) 278 -6130 Fax(845)278-7921 Nursing Services (845) 278 -6558 WIC(845)278-6678 Fax(845)278-6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 tj ro I I/ PTPI tbo GPA wl 5.p lte,� Li 4� 8 .t 3 i i' �, �,-' .��'; ,1' �� .: . E� U - }; -:��. 4 i'1 �� ' �y-s � >� 0i j HaS ; rcer, at'tac ``Any perso conditions available ,a sublectato .`.Date ''``` In •. � NANCOENViR01�/IN�"AL SER�iCS;tNG� UNITY STREETAT,IOUTE 376 P O BOX tU HOPEWELL JUNCTION;` NEW YORK 12533 191421 - 2485E % zz V ry ADDRESS. Nks 4 I tf31I9t@5 S MPLING POINT r v TREATMENT CHLORINATED ❑(PPM), S6FTENEpsC1; Ol HERQ SOURCE DRINKING WATER OWASTEWTER EFFLUENT 13 QTHEI AMA+ COLLECTEQ PM .. DATE Q APARTMENT COMRLEX ❑ INSTITl1T(O�l ❑ PRIV TE F�ESIDEi CE .- 6 SWIM'I,O6L, 9 ❑ BEACH ❑MUNICIPAL ❑ #iEST UA T -'❑ T.EMFORAFIY RESIDENCE h � i`❑ CAMP ❑NURSING HONE ❑ SCt10Ql i 3 CV- RA(L B PARK FARM LA80R CAMI? ❑,`PfiIVkTE COMPANY ❑ SE4VAG'EST EATMEN PLANT. OTHER �TOTAL COLIFflRM COUIkT M F T PER iQ0 M L ❑ TOTALCOLIFORM COUNT M P N PER 100 ML. ECAL COLIFQRM COUNT M F T PEAR 400'M L _❑ FE ' '__OUIFgRM COUNT M P N PER 100 M.L �" f S2. 3..` ,.� i `- k `rh l� tix S -•i+., FROZEN RESSERT PLACE COUNTn r AG RPLATE COUNT •` _ i' ti_J•'&"TM {' Y.4.,, PER 1 M.L: ,r a ' - s 9' At 1A1 Owner or Purchaser -of Building Tx�q�►� Building Constructed =By- Location - Street &t&11:9092 Municipality Building Type Lot Subdivisio ame Subdvo Lot GUARANTEE OF SEPARATE SEWAGE SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and.drainage of the sewage disposal system serving the above described property, and that it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his success- ors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of initial use of the sewage disposal system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determin- - ationeof the Director of the Division of Environmental Health Services Of the Putnam County Department of.Health as to whether or not the'fail- ure of the system to operate was caused by -the willful or negligent act ';,4of the occupant of the building utilizing the system Dated this ® day of jM X19 6 L. Signature • Title Corporation Name (if corp.) Addres a - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE'NOTICE OF DATE OF FIRST USE Ofs YSTEM. Division of Environmental Health Services, Putnam County Department of Health _ . M �° _; .: _ ✓ Sods,_. �..s. X� a i,••_ =::- ;_::. -. - -•-r. -- Owner or Purchaser of Building Municipality 0Q2 rdkA.0- pS Building constructed -by H-a A—M tea$ 44% Location - Street Building T"e Tx7 a Block 2,4" Lot ' GUARANTY OF SEPARATE SEWAGE-SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it ha.s been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guaranty to the owner, his succes- sors, heirs or assigns, to.place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of initial use of the sewage disposal system,. or any repairs made by me to such system, except where the failure to operate properly is :caused by the willful or negligent act of.the occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the de- termination of the Director of the Division of Environmental Health Ser- vices of the Putnam County_D.epartment. -of - Health as to whether or not the__ :..� failure --of the system, to- op- e'rate was- caused by- trie'w llful' or- negligent act of the occupant of the building utilizing the s Dated this day of Aft zA 19 dZ Signature Title Z-7l44/ //07g (If corp tion, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health �. , , , :. '. �z � . ,A I � - . 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' _- ' � � ,6 , .i -4" 1� le �--U, KT I � Frt-'�- � �, I � � 46 , Jr . . 'p � '. . � . , �t -�"Vf �t 6 C,MNV��' . � , , 6 . - . I I � - .. I � � - I 1 6 . . M!� D _ . A I � � . � - r . � . � 11-1 1 ��7 z -- - - � .--T-. �6'SA. � , #� . . " " 1 6 J, I I . . 'I _ 1 :6 --!r : E�kdr on - r. , side' . . I I , " . I- � � -� '��l 1� 6 - 6 ' ' I � . _ _ .. � . - - I ' �_�6 1 '. � -.. . - �- � ' ��i��4. I ?' . 1�'6��ai6es, ,�, , - - - 1�--- � ' 6 . - 666 _ . , ��- , , -Z , � , , I � , _ _ __:;__ "'I, �� , , - - �,��- - - — - f � _ .L _7 =-L--fL� _ - . . . , _ " - — � _,!�, =;��,i,6 , , - � . -� - � - , , , , . w , - - , 1. V-- . . - I I V m --- ,�I� ;� T- - � , � , , -1 I. ,Z- - � ,- - � -, , , - -,-'�, SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health May 20,2005 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Georgina Marek & Ken Evans 1923 Bullet Hole Road Patterson, NY 12563 Dear Ms. Marek and Mr. Evans: ROBERT J. BONDI County Executive Re: Addition — Approval — Marek/Evans No Increases in Number of Bedrooms 192 Bullet Hole Road (T) Patterson, T.M. #34. -4 -44 I have received and reviewed the plans for the proposed addition to the-above mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from the Department dated May 19, 2005. 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.). 4. Addition is for a two car garage, existing one car garage to remain. 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 ruly yours, Robert Morris, PE Public Health Engineer RM:cw cc: Building Inspector,,.(T) Patterson Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES SITE LOCATION Qa'V-I,C-� /40 lad OWNER'S NAME J M,,�--, : C-,9-0 4 i nC MAILING ADDRESS OFFICIAL USE ONLY (o9 -03 TM# 5y, -" � — VV PHONE .(„� 445) a�a— C) 9 4j PERSON INTERVIEWED PCHD Complaint # ame & Relationship i.e., owner, tenant, etc. DATE TYPE FACILITY PROPOSED INSTALLER j j Ccn A; k5tswrz,t✓ 9Q ,rn�� C4�ir�. PHONE II I `f0-*s - (,01(0 (p ADDRESS Qq (kSJIe-- (oLA&dL BA • VU Aod\ , NToy*,aREGISTRATION# Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system .Different location may require submittal of proposal from licensed professional engineer or registered architect. I, as owner, r po -agent of owner agree to the conditions stated on this form. -- - - - SIGNATURE TITLE DATE 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 components tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Proposal approved Inspector's Signature & Title COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML i /� r ' PROPOSAL ALL COUNTY RESOURCE MANAGEMENT CORP Septic Installation & Repairs p - _... = � "- �-� • � =- - �-•� _ - -= I �ine• - -- ..1 768 -8877 "�, -' Hackettstown- - 852 =9818 � onroe' °' � " -- 783- 1729"` ' *'Port ervis " " 856 -2222 Basking Ridge 766 -1706 Hamburg 827 -7731 Morristown 540 -1655 Rockland 425 -6336 Bedford Hills 666 -8858 Highland 691 -3793 Newburgh 562 -5040 Somerville 722 -4452 Califon 832 -9443 Hopatcong 398 -5353 Newton 383 -9871 Succasunna 584 -2810 Cold Springs 265 -2055 Hopewell 221 -0725 New Windsor 561 -3355 Sussex 875 -6002 Dingmans 828 -7748 Kingston 336 -5503 Oakland 337 -5505 Vernon 764 -6100 Franklin Lks. 891 -0351 Middletown 342 -1900 Pawling 855 -5055 Walden 778 -1333 Goshen 294 -8299 Millwood 762 -9411 Pompton 838 -1555 Warwick 986 -1147 Billing Address: 99 Maple Grange Road, Vernon, New Jersey 07462 1- 800 - 428 -6166 fax -973- 764 -6404 PRA FOSAL SUBMITTED TO: BILL TO A-4 A vi/e, R9 s�zEET We hereby submit specifications and estimates for. INSTALLATION OF A 1000 GAL. PRECAST CONCRETE SEPTIC TANK CONNECTED TO EXISTING INLET AND OUTLET PIPES. PUMPING OF UP TO 1000 GALS. IS INCLUDED. Please Note: 1. Above is subject to a test hole and Board of Health approval. 2. Property will be roue - graded upon completion of work. Final grade, topsoil, seed and hay are additional. �^ 3. Pumping, if required is additional. TOTAL:$, cs o. OQ 4. Not responsible for any off -road damages, including driveways. 5. Tree removal, if required is additional. We Propose hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: AND 00 CENTS * * * * * * * * * * * * * * * * ** Payment to be made as follows: COD ON COMPLETION OF WORK: CASH, CHECK, MASTER CARD, VISA, DISCOVER. All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized manner according to standard practices. Any alterations or deviation from above Signature specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, Note: This proposal may be accidents or delays beyond our control. Owner to carry fire, tornado and other necessary withdrawn by us if not accepted within 3 days. insurance. Our workers are fully covered by Workmen Comnensation Insurance. Acceptance Of PROPOSAL - -- The above prices, specifications and conditions are satisfactory and hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Any payments not made when due shall be subject to a 1 -1/2% interest fee per month until paid and I shall be responsible for all collection costs including a reasonable attorney's fee. DAMAGE RELEASE -I am aware that some damage might occur during commission of this work and I agree not to hold All County Resource Management Corporation responsible for any off road damages. Signature Signature DateAcceptance: N ,i ra SU,le 6 ✓a„cf1 e+r ' Eolry N. B •) X15 35 /StJ`aCth �.,d XV AB F. -S f' %oR %(•C . c %anowv A r�ll� j1 t a, a � O Ir 3s , L O q Putnam County Department of Health Division of Enviroria_rrtal 3ealth'Servicee Approved as'rc'.•,3 ` ^r co^formanoe with applicable 4` _U a,,l re;_.latione of the tp /� /#1A \aID Cnozen�( \�y��/� vhea/lth Department. .413UI -LT__' Structure located from survey by surveyor noted below�3__ -_ Well located by: Surveyors atrvey._ _ _ ❑_ J, well Grillers report'. -- - rnesuremen9s.y�.- - Tank, t+oxes, pl +s, galleries 6 laterals Iocatwa oy:contractpr: s EnglnesK.,, � H e a (ih va.lri: Fiala Inspection by: Health dept d t o:�J d �1 -- _ Engineer aate _✓- Lr._:V - s NOTES: p) S� {;c: TanK -1000 rql, Cer.c, r>$+ b) �o�y I d Ezra S: I l x 3 5r X t D t DI MENS•10N t A 6 A E " -� LI B �f �9- - - - A - Li =-�� % _6 - { _ -`S7 N ._ _. 0 0. PRE %�,• ssi c 2620, lt�/ i SANITARY FSYSTEM DESIG A BUj,Lj" LOCATION.St.[ecr:- 1�1irSJ( >0�2�,..- Town:_ _Pd- fefjpta .-County: _dd'c�►1�d t+s - Stole -+� .__ _ Susvlvls'IaN:_.�%�eda Block.. _ _ 2_ _ LOT Ns I Svrveyor:�j�L1gr� �•,83�.ev'.rf�L.S_.. -- --- - --- ^_ -__- Drawn�q �=�pote_ ilScele: 1' "�r Job}3i45 �1t9 wg.ivg J_ OHN H, PP ENTISS PE: CONSULTING ENGINEER 1 t PA 1L JL ERSONy NE I I I I i I i I i . B A' BLDG. DEPT. REV'. No. ISSUED FOR RE\/ISIOC I \\ i new 6" pvc drain pipe . KEY PLAN to drain to daylight I \ new 4wc drain pipe \ from leaders and drain \ Ito drain to 6 "pvc line tankLJ I 35' -6" new trench drain existing wood deck !" to,be removed proposed deck over (r7. _ 2 car gaeoge existing drivewoy to be repaved and expanded p� i-�•- � 36' -5" I EXISTING I FRAME DWELLING STORY existing drivewoy MAN \7 GH ELLING I I ARCHI 7EM & IENC to be rebuilt in. stone 480 NORTH BR( YONKM NEW YO w (914)423-U" PH (914) 423 -8981 P O O 00 ROBERT R 1 AVa= M RONALD P. MANOLONE 1 LO DRAWING FILE — _ PROJECT No. DRAY FT LT ., T __.,_