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631- 589 -8100
35. -4 -67.1
BOX 16
r �
01729
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
•LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
Eric Nelson
17 Old Road
Brewster, NY 10509
Dear Mr. Nelson:
ROBERT J. BONDI
County Executive
___...� ROBERT MORRIS, PE
Director of Environmental Health
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
May 7, 2008
Re: Addition- A- 059 -08
No Increase in Number of Bedrooms
17 Old Road
(T) Southeast, T.M. # 35.4-67.1
I have received and reviewed the plans for the proposed addition to the above - mentioned
residence. The proposal for the addition has been approved as per plans bearing the approval
stamp from this Department dated May 7, 2008. 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.P <;:nPw lnw flrish__, _
toilets, restrictors for shower heads and faucets etc.
4. The approval is for the proposed changes only. This approval does not validate any
construction shown as existing that has not obtained proper approvals
Any other permits or variances required are the responsibility of the applicant and the
jurisdiction of the Town of Southeast.
If you have any questions, please contact me at (845) 278 -6130, ext. 2261.
Sincerely,
Gene D. Reed
Senior Engineering Aide
GDR:kly
cc: BI, (T) Southeast
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention /Preschool(845)278 -6014 Fax(845)278 -6648
SAP
BASEMENT
STORAGE
UNFINISHED i
d
EXISTING BASEMENT
1A " SCALE
BASEMENT f
STORAGE
UNFINISHED.
JI
f.
i
,
�1
1
L
1!
p
DECK
i
i
KITCHEN
FAMILY ROOM
1
PROPOSED LAYOUT
1/8 scale
i'
Eric and Jeanie Nelson
17 Old Road, Brewster
Tax Map #35. - 4 - 67.1
FO
ff BATH_
r
4
PUTNAi COUNTY DEPARTMENT.OF HEALTH
HOUSE PLANS APPROVED FOR BEDROOM'COUNT ONLY
�
BEDROOMS
T
ALL SUBSEQUENT REVISION /ALTERATION TO THESE HOUSE
PLANS MUST BE SUBMITTED TO THE PCQOH FOR APPROVAL
S+
SIGNATURE & TITLE DATE
;l •
S�
r
DINING ROM
R•
3
F
j
k
LIVING ROOM!
P'
9�
f t.
1
:5
t
u 6
PORCH IuNI
H
DECK
Closet
1�
ehf'l
C
Hallway
Bedroom #2
poi G`J`I'OG�1l�
Master Bedroom
Closet
C
BEDROOM
Bedroom #3
1
PORCH ROOF
�4
PUTNAM COUNTY DEPARTMENT OF HEALTH
r,
HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY!
BEDROOMS ,49-10
ALL SUBSEQUENT REVISION /ALTERATIONS TO THESE LOUSE
PLANS MUST BE SUBMITTED TO THE PCDOH FOR APP�OVAL
SIGNATURE & TITLE D, ATE
r
F'
Y
f
t
EXISTING SECOND FLOOR r:
r.
1/8" SCALE
tic �Tro Pose C-Y Q S E r:
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u,
t_.
is
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b
1
PUTNAM COUNTY DEPARTMENT OF HEALTH
HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY
BEDROOMS
ALL SUBSEQUENT REVISION /ALTERATIONS TO THESE HOUSk
PLANS MUST BE SUBMITTED TO THE PCDOH FOR APPHOVA'
_ ii] o
SI NATURE & TITLE A1�"'
Y
t
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
'. = Ai' 1SL1CA' I` I17N..`TO-'CON'S'1*RUCT`.A,"in1ATER -WELL
PCHD PERMIT #�
WELL LOCATION
Street Address
o Village City Tax
Grid Number
WELL OWNER
Name
°( �'
Mailing
Addr ss
-�
Private
O Public
4�SE OF WELL
- primary
2- secondary
r$ RESIDENTIAL
O BUSINESS
D INDUSTRIAL
O PUBLIC SUPPLY O AIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION
b INSTITUTIONAL O STAND -BY
O ABANDONED
O OTHER (specify,
Q
AMOUNT OF USE
YIELD SOUGHT
gpm /#
PEOPLE SERVED - 5 /EST. OF DAILY USAGELC 0 al
REASON FOR
DRILLING
10 REPLACE EXISTING SUPPLY
MNEW SUPPLY NEW DWELLING
O TEST/ OBSERVATION Q. ADDITIONAL SUPPLY
D DEEPEN EXISTING WELL
DETAILED
REASON FOR
DRILLING
WELL TYPE
DRILLED
DRIVEN
ODUG
GRAVEL
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES _ -NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:iF
Lot No. A
WATER WELL CONTRACTOR: Name -Tf 39 Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES I -NO
NAME OF PUBLIC WATER SUPPLY: IVA TOWN /VIL /CITY
_. DISTANCE.. TQ._PROPERTY FROM_ NEARESI- WATER..MAIN.: -f.,! ., .
LOCATION SKETCH & SOURCES OF CONTAMINATION P DED
MON SEPARATE SHEET
-I -,1 _9 z. (date) s 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
thirt;• (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 5,1manner 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
,I . i
LAURENT ENGINEERING
ASSOCIATES, PC.
73 FAIR FIELD DRIVE - ..
-PATTeRSON, NEWYORK12588
RANDOLPH W. LAURENT, PE. (914) 278.6108 -(FAX) 278 -2658
HARRY W. NICHOLS, JR., PE. CONSULTING SITE ENGINEERS
September 21, 1992
Putnam County Health Department
Route 312 / Geneva Road
Brewster, NY 10509
ATT: William Hedges
RE: Proposed SSDS
Old Road
Patterson, N.Y.
Dear Bill:
Enclosed are the following:
1. One (1) print of Drawing SS-1 "Proposed SSDS", dated 9-9-92.
2. Three (3) prints of Drawing SS -1F "Preliminary Design For
Fill Placement Only", dated 9-9-92.
3. "Application For Approval of Plans For a Wastewater Disposal
System".
4. "Construction Permit for Sewage Disposal System", dated
9-9-92.
5. "App -to Construct a Water We-112',- -dated 9"992;
"Application rn
6. "Design Data Sheet".
7. "Letter of Authorization", dated 9-21-92.
8. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count
Only".
9. #300.00 review fee.
-0
Kindly review the enclosed and notify us of any comments at your
earliest convenience.
Very truly yours,
ENGINEERING ENGIN ASSOCIATES, P.C.
Randolph W. Laurent, P.E.
RWL:bd
92045
enc.
cc: E. & J. Nelson
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LAURENT ENGINEERING
ASSOCIATES, P.C.
r i _ _ ..:..MII:LR ^t�:'JKFEiF.��G.' -� CF•�lTRF":_...� .. ...,- __,,,.....,.� _ ��_<...,e.,
Route 22 8 Milltown Road
r Brewster, New York 10509
RANDOLPH W. LAURENT, P.E. (914)278-6108 - (FA)Q 278 -2658
HARRY W. NICHOLS JR., P.E. ? CONSULTING SITE ENGINEERS
July 18, 1994
Putnam County Department of Health
4 Geneva Road
Brewster, NY 10509
ATT: Mr. William Hedges
RE: Individual SSDS
Old Road - Edwards Road
Patterson, N.Y.
Dear Bill:
Enclosed are the following:
1. Four (4) prints of Drawing S -1 "As -Built Plan ", dated
6- 29 -94.
2. "Certificate of Construction Compliance for Sewage Disposal
System ", dated 6- 24 -94.
3. Three (3) copies of "Guarantee of Subsurface Sewage Disposal
System ", dated 7- 15 -94.
4. Well Completion and Well Log Report, dated 7- 14 -94.
5 , [1: ter- Ans °lysis Rep*drt,._ dated 7- 14 -94'.
6. Check in the amount of $200.00 payable to Putnam County
Health Department.
If there are any questions concerning the enclosed, please call.
Very truly yours,
LAURENT ENGINEERING ASSOCIATES, P.C.
Harry W. N hols, Jr., P.E.
HWN:bd
92045
enc.
cc: Mr. & Mrs. E. Nelson w/1 copy ea.
9
BREWSTER LABORATORIES
_ Box 224 - BREWST_ER�
_ ..N.Y�
- (914) 279 -4945 :
- WATER ANALYSIS REPORT ---
SAMPLE N0. A L A n 'PEST WELL
SOURCE: Eric Neleon
Brewster, N.Y.
COLLECTED: 7/13/94
SY: P.E. Real. & SonR
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
This result Indicates the source of the sample was
of satisfactory sanitary quality when the sample was collected,
1/14/94
-ThWas Meyer
OIreClbr
U per 100 mi.
A9 10. F A.
WJILL %ovrirl"JI11un lxE.rvA-L
DEPARTMENT OF HEALTH
Division Of Environmental Health Servicga
ILNA
Office Ume Only
WELL LOCATION
tiiRE4 ADDRESS: TAx 00 Num&Ek
Old Road, Brewster, New York
.
WELL OWNER
NAME, ACCRISS.
Eric Nelson, RFD 06, Old Road, Brewster, NY 10509
PSIVATE
PUBLIC
USE OF WELL
1- primary
2 • secondary
0 RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP ClABANDONED
Q BUSINESS 0 FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify)
C1 INDUSTRIAL 0 INSTITUTIONAL. E3 STANO-BY ❑
MUNT OF USE
YIELD- SOUGHT — gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
[3REPLACE EXISTING SUPPLY C3TEST/OBSERVATICO)N [3ADDITIONAL SUPPLY'
NEW SUPPLY (NEW DWELLING) [3DEEPEN EXISTING WELL
DEPTH DATA
245
WELL- DEPTH It.
C
STATIC WATER LEVEL
DATE MEASURED 6/15/94
DRILLING'
EQUIPMENT
0 ROTARY M COMPRESSED AIR PERCUSSION ❑ DUG
0 WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify);
WELL TYPE
❑ SCREENED ❑ OPEN END CASING OPEN HOLE IN BEDROCK 0 OTHER
CASING
DETAILS
TOTAL LENGTH tt
MATERIALS: '12 STEEL 0 PLASTIC 0 OTHER
LENGTH BELOW GRADE 90-1 ft.
JOINTS; ❑ WELDED M THREADED 0 MER
DIAMETER in.
SEAL: 112 CEMENT GROUT 0BENTONITE (30THER
WEIGHT
PER FOOT ___12
1011,
1 DRIVE SHOES} YES ❑ NO
I 'LINER: DYES CINO
SCREEN
DETAILS
DIAMETER (in)
'SLOT SIZE
LENGTH (I 1)
DEPTH TO SCREEN (ft)
OVILMM
1111T
0 YES a No
IOU"
SECOND
U 0 YES -
C3 ho
_L1
GRAVEL
SIZE:
0! AM It T FE R
OF PACK � In.
V0
b"El"N --ft.
KM r%
WELL YIELD TEST If detailed pumping
METHOD: 0 PUMPED 1 tests were done Is In.
t
(x CuPRESSED AIR i formation attached?
0 SAILED 0 OTHER 0 YES 0 No
---
11 more
WELL LOG are available,
detailed lormatG ducri;1lano or clove analysu
I
please attach.
DEPTH
SURFACE.
FROM
1walgr
:star-
Ing
will
oil"
Molar
In
FORMATION DESCRIFT16H
CM
WELL OEM
0.
0
hu
rNnT
DRAW
It,
Y
YIELD
Opal.
and
WWI
75
Dr
11
ng in overburden clay _& boulc!erl
A
72-451
6
ISO,
15
Ck at 751.,
75
91
Dr
11
ng_ in rock, set qaqin2 groul
ad,
91
245
Dr
11
ngin rock granite.
';ATM
0 CLEAR TEMP.
QUALITY 0 CLOUDY HARDNESS
13 COLORED ANALYZED? M YES Q No
ANALYSIS ATTACHED? C3 YE3 , ONO
STORAGE TANK: TYPE
CAPACITY GAT,.
PliiiP IN—FORMATION
TYPE _UbMerdiblt I CAPACITY zg
MAKE Could - DEPTH 200'
MODEL 7EN05412 VOLTAGE230HP
wILL DRILLER NAMEnr-T77 onsf INc.
e a 17 S , DATI 7 0-4'A
A00REss 4 Putnam Ave . 6161MM111
Brewster, NY 10509
if va
PUTNAM COUNTY DEPART OF HEALTH
DIVISION OF ENVIRO*EaqTAL HEALTH SERVICES
owner or
Lot
Purchaser of
Building
Section
Block
Building Constructed by
1 d', I
Location - Street Subdivision Name
n
Municipality Subdivision Lot
Building Type
GiJARAN= OF SUBSURFACE SEWAGE DISPOSAL 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 shoran on
the approved plan or approved amendment thereto, and in accordance with the
standards, rules and.regulations of the Putnam County Dent of Health, and
hereby guarantee to the owner, 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 of approval ' of the
_ °Certificate of Construction. Compliance" for the sewage disposal system, or any
.- ....- .- __._ :_. repairs --made f��- me- �o•suah- systenr-- e�c --ept= sphere ...tine: :failure„to__o!�er3�? .ox.operly�x�.���._. :. -.�
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 detennination of
the Director of the Division of Environh -ntal 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 J;1� 19 ct q Signature
Title
General Contractor (Owner) - Signature
ryas () 1a • fcrjlz
Corporation Name (if Corp.)
21, C-1W J, �L � w-0-1
rev. 9/85
Mk
&akk LT O
corporation Name (iff gbrp. )
P.d&ess
189
Any pio,ison"6cWpylr4. pre- Mifef,igrvetl 'Ji 1;4 oviei M-pt
yt
� 1,11--.- - --', I --,
and the approval_ aii. sthe%,�privstC water 'supply Omit bet6rna'n6fl
ly.iale
becomem4li smi'vold all so"
M4 W,io . lil wh on a , I , le :w water or - su - ppl y b4a
li"ne'r of *Healthi au odatkin n�lfs
Mrs this Corred"
iia.:a is , ulst.': wnR4
M.4valtibk -s
tion or-change Is
proysts P . r , a-
r Y.
F ,
PUTNAM
COUNTY
DEPARTMENT OF
HEALTH
APPLICATION
FOR APPROVAL OF
PLANS FOR A WASTEWATER DISPOSAL
SYSTEM
t;. Name and Address of Applicant: ' i21C '; Jr'AW tF- t ELSOw
'r-0 # Co O U2 C- OAP
:2. Name of Project: SE=17 sc Cos .3.-.-Location T/V/C: 'F'c—MF-gSoN
f-'AtJ VV Ln4 V4. LAUKF:--T P, i< I
A, Project Engineer: LAL) F_M:�: ASSCC. I',C, 5. Address: -15 f- %iKfAf-�L'L7 t::,tKrJ -5
. • .. `Q��iT1:I�So�t , w\��S 1256
License Number: 497�> 1 Phone: 070 -(,,rOS
' S. Type of Project: ;
_ Private /Residential Food Service - Commercial
Apartments Institutional Mobtle Home Park
!� Office Building Realty Subivisior� ` Other (specify)
(f r 7. Is this project subject to- 'aie Environmental Quality Review (SEQR)?
Type Status (Check One) Type I.. Exempt
F Type II. Unlisted _X___
8. Is a Draft Environmental Impact Statement (DEIS) required? M0
9. Has DEIS been completed and found acceptable by Lead Agency? ........ ....
10. Name of Lead Agency N /A _ - -'� -- --- - --
1.1. Is this" ro ect in an area under-the-control-olf Mll1 -
or other officials ordinances? ...... .. .......
12. If so, have plans been submitted to such authorities? ..................
13. Has preliminary approval been granted by such authorities ? h17A- Date Granted:
14. Type of Sewage Disposal_ System Discharge...... Surface Water _ &_Ground Waters`
15. If surface water discharge, what is the stream class designation ?........ _+41A_____
16. Waters index number (surface) ........... ............................... -N-Z4
17. Is project located near a public water supply system? .................. V40
18. If yes, name of water supply Distance to water supply
19. Is project site near a public sewage collection or disposal system ?..... N D
20. Name of sewage system t.( /A, Distance to sewage system K/A-
-21. Date observed: 1 23. Name of Health Inspector:
24. Project design flow (gallons per day) ...... ............................... (eco
f 9
2.
25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. '-Ka _
26: Has^`SPDES'Application been submitted to local DEC Office? ............... W L^
27. Is any portion of this project located within a designated Town or tat
wetland? ................... ............................... .......... N O
28.. Wetland ID Number ........ ............................... ..... ........ �A
29. Is Wetland Permit,required? .... �_
...................... .................
Has application been made to Town or Local DEC Office? ..................fR
30. Does project require a DEC Stream Disturbance Permit? ................... i�tD
31. Is or was project site used for agricultural activity involving application
of pesticides to orchards or other crops, solid or hazardous waste disposal; y
landfilling, sludge application or industrial activity? ........ YES or NO N 0
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? .............. or NO i-16
DESCRIBE:
33. Is there a local master plan or file with the Town or Village? ........... `(P S
34. Are community water, sewer facilities planned to be developed within 15 years? No
35.
Are
any
sewage disposal
areas in excess of 15% slope? ......................... N O
IO..Number ........................ ...........................35.-
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 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. False statements made
herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of
the Penal Law.
SIGNATURES & OFFICIAL TITLES
AILING ADDRESS:
I 170 Z' 1 < .
E. ■ • :REQLJ= TO BE SUR4IT= Y: • •
.DESCR'I'--ION OF SOILS ENCOUMEPM IN TF;-,- HOLES
DEPTH HOLE NO. I :. �t 2 HOLE NO. 3 * HOLE NO. G
:2' S r c iY S 4,&/v y GI L-( �rl D'( Lori S I SA IPY )A
31 C 0A M
4'
5' 1 S /cT
6'
8' WAr��Z rev e Sao''
9' A10 20cr
10' Nlornst.11ye
12`
VI,4rk4- //✓ e rr -0"
o C
Mor74E4 //,/c @ 2' -O
DESIGN
Soil Rate Used //% S Min/1" Drop: S.D. Usable Area Provided G OOQ
No. of Bedroon_s .. _ .... _. g _ ......T . .
Septic Tank--Ca % z SO G •y c,.
Absorption Area Provided By 5+0 0..__ L.F. x-'24"
NE
Other .
pF W
LA(IRF-MT FAIGIAIREIAIC _ k - -,•� -
Name ASSOCIATES. P.C. Signatur
&ITO
. �
Address 7 3 O i R F /EGO M v E SEAL
cn
�pR N0. 04518,
- - PA TTERSOAl., �c1.E�YORr 1 z &.3 `� o
a
THIS SPACE FOR USE BY FIFALTH DEPARDEM ONLY:
. - ... ;....:. ..
Soil Rate Approved sq.ft / gal. Checked by Date
P(r"'qAM CC= DEPARTMERr OF r.
• IVIS- OF-ENVIPDR MML HEALTH SEM-,,
DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO.
/.(s rt';J ;iC'.v ✓STEi2 ...... J.` ...
Located at (Street) 04 12 Sec. 90 Block Z- Lot % /
(indicate nearest cross street)
Municipality )PA T 7-F_j'S 0i✓ Watershed
C I2 U TI-) /./
Date of Pre- Soaking Z / 3 q / Date of Percolation Test z- / 3/9 J
HOLE
12:3S- /: o S
:3z,
Z 4''
2 ?'!
NUMBER
CL= TIME
2
PERCOLATION
PERCOLATION
Run
Elapse
Depth to
Water From
Water Level .
No.
Time
Ground
Surface
In Inches
Soil Rate
Start -Stop Min.
Start
Stop
Drop In
Min /In Droo
Inches
Inches.
Inches
ZG�`
2
lZ =Ze,
4
5
1
12:3S- /: o S
:3z,
Z 4''
2 ?'!
-3 It
/ o
2
1:06
3./:3'7- 7-:07 :3o
4
5. _
NOD'S: -1. Tests to be repeated at same depth until approximately egual, soil rates
are obtained at each percolation test hole. All data to'be submittmr3
for review.
2. Depth measurenents to be made from top of hole.
rev. 9/85
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date
Re: Property of C�1 / /" LCD i7 11 .� IV G��i s1
Located at R F D e2 `c � Rn p
(T pq 11 ' �) 1." Section S Block Lot /
Subdivision of ft-� & ue-1.11 IV-'e lS 0 h
Subdv. Lot E I Filed Map �Date
Gentlemen:
This letter is to author izc �V CU `
a duly licensed professional engineer or registered architect
(Indicate,
to apply for a Construction Permit for a separate sewage system, to
serve the above noted property in accordance with the standards, rules
or regulations as promulagated by the Commissioner of the Putnam County
Department of Health, and to sign all necessary papers on my behalf in
connection with this matter and to supervise the construction of said
system or systems in conformity with the provisions of Article 145 or
147, Education Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Co tersigned. C467g1
P.E. , . , /#u
73 /A C t-i �/ r�
Address
7 P- /OP
Telephone
Very truly yours,
Signed
Owner of Property
9 7144 41" .
Address
Town
Telephone
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id-awwRftnpwaotftowiUbefumidodthe-owoW._his -m—s. hokspraniW by the buNder." pio,buNder -10
mv, owt uld'i"S", O'N"MI GYM I m dWWQ the.owlad of two (81 YONS knwAdirAW ""owl" tpiOdBti of the New
ate 61 icomitruction the orlowel sy"" or a 1'2) Met the drWW Well d@WNiGd 0600
ii=.my . Ni , . I wittr ma 'M —
ad 96M Oki thel aid " be I VIN andlev Mrs, of -.troe Pwtnam.
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A2r4 It 4M'l 44, P.E. OU46
C'Xpbm,two4e r( `from the'd ate Isik" u,nows � iconstruction of the bulldft J
awry by the Commiseic~ of MiaCtIL Any ChOW or alteration of Construction
or dkooW of.dowtoOk womorymvp%, lwkvto %voter OUPPOV Only.
TMt.9 42
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EL TING
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4-
tiy
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AREA = WELL
1.455 AC.
TWO STY.
fl FRAME
CEL. ENTR.
CENTERLINE s\
STREAM
0
SO, 'b
T, 0.80'
O. H. SSB3
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EL TING S25 2720'W
32.37' ` ` ^ P
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L
OLD'' ROA E-DWARD S OAO POLE
30 "CMP ---G
R s o.
C
SUR vEY OF PROPERTY
Prepared for
ERIC R
& jEANNEI NELSON
LOT N0, 1
AS SHOWN ON
"FINAL SUBOMSION PLAT PREPARED FOR MARIE NELSON', FILED MAP NO. 2522, FILED f0 -15 -91
Situate in
T0#rjV OF PATTERSON PUTNAM CO., N. Y.
SCALE- > "
= 40' MARCH 7, 1994
CERTIFIED TO.
APRIL 15, 1994 (UPDATE)
AFFORDABLE MORTGAGEE CORP.
JULY 12, 1994 (UPDATE)
CERTIFICATIONS INDICATED HEREON VGNIFY THIS'
UNAUTHORIZED ALTERATION OR ADDITION TO THIS
SURVEY WAS PREPARED IN ACCORDANCE WIN THE
SURWY IS A MOLiTION OF N.Y.S. EDUC. LAW
EXISTING CODE OF PRACTICE FOR LAND SURVEYS
S<CTM NO 7209.
ADOPTED BY THE N. Y.S. ASSOC. OF PROFESSIONAL
LAND SUR`WYVRS.
IMDERORGUND STRUCTURES, 1F ANY, NOT SHONN.
CER77RCAIIOMS SHALL RUN ONLY TO 174E PERSON
FOR W40M THIS SURVEY WAS PREPARED AND ON HIS
� CERTIFICATIONS ARE VALID FOR THIS MAP
MA
BEHALF TO 174E TITLE CO. AND LENDING /NSTITUTIAN
LISTED HEREON.
ALL, COPTS ThlEREOF ONLY IF SAID MAP COPIES
BEAR TNE IMPRESSED SEAL OF 774E SURVEYOR WHOSE
SKSVAnIRF APPiARG NFAFlMI
h
N/F °1
1
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h1
41
ti
+p9 y4J,
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oy
S44'59'20"W O
28.2 1 '
AREA = WELL
G
1.455 AC. . +/-
TWO STY.
,fl FRAM£
ate- CEL. ENTR.
j %f-
CENTERLINE .P •�•�.- � �p
STREAM
0.80' O
O.H. SS
N/F j s3
EL TING S25.27 20-W \P
32.37' V�
.OLD " ROA EDWARD S � POLE
3o"cMP -- OAD
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F
SUR vE'Y OF PROPERTY
Prepared for
ERIC R & JEAVINE NELSON
LOT NO. 1
AS SHOWN ON
"FINAL SUBOMSION PLAT PREPARED FOR MARIE NELSON", FILED MAP NO. 2522, FILED 10- 15 -91
Situate in
TOXAT OF PATTE'RS'ON PUTNAM CO., N. Y.
SCALE: 1 = 40' MARCH 7, 1994
CERTIFIED TO: APRIL 15, 1994 (UPDATE)
AFFORDABLE MORTGAGEE CORP. JULY 12, 1994 (UPDATE)
CERTTFTCATTONS INDICATED HEREON SIGNIFY THIS
SURVEY WAS PREPARED IN ACCORDANCE W7H THE
EXISTING CODE OF PRAC77CE FOR LAND SURVEYS
ADOPTED BY THE N.Y.S. ASSOC. OF PROFESSIONAL
LAND SURVEYORS.
C£R77F'ICATIONS .SHALL RUN ONLY TO THE PERSON
FOR W40M IMS SLIRWY WAS PREPARED AND ON HIS'
BEHALF TO THE 777LE CO. AND LENDING INS777VWN
IIS7m Hli7i nu
UNAUTHORIZED ALTERA77ON OR ADD17ION TO THIS
SURVEY IS A WOL.A MN OF N. YS. EDUC. LAW
SEC770N NO 7209.
LINDERGROlM STRUCTURES, IF ANY, NOT SHORN.
ALL : CERT F7C4 WNS ARE VALID FOR 7H/S MAP
AND COPIES PM?EOF ONLY IF' SAID MAP OR COPIES
BEAR nlFAdPRESSED SEAL OF THE SURVEYOR WHOSE
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FAMILY ROOM
DECK
0
KITCHEN
DINING 80017
BATH
LIVING ROOM
PROPOSED LAYOUT
1/8" scale
Eric and Jeanie Nelson PORCH
17 Old Road, Brewster N.Y.
Tax Map #35. - 4 - 67.1
o.
SHERLITA AMLER, MD, MS, FAAP
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
ROBERT J. BONDI
,P A
SHERLITA AMLER, MD, M
Commissioner of Health
_. -. L:,l7TtOF-I A iViul.;0XM1, t N,__ NSly
Associate Commissioner of Health
ROBERT 3. BONDI .
County Executive
ROBEkr MORRIS, PE-
Director of Environmental Health
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ADDITION APPLICATION RESIDENTIAL ONLY .
STREETS �&. TOWN' �TAXMIAP&SY.
NAME �� �/� /j��isr./ PHONEQ221f, 2, PCHD#
MAILING ��
-63
ADDRESS: % ���.// Z1.
DESCRIPTION OF.:. .
ADDITION o� /,[l d / //1ti1iX�,ei /�
NUMBER OF EXISTING BEDROOMS _ PROPOSED # OF BEDROOMS 4
(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: (8451.278- 6130.
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. .
. 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
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 i Fax . (845)278 -6026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648