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631- 589 -8100
36.57 -1 -16
BOX 18
02107
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02107
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
y LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ROBERT J..BONDI
County Executive
ROBERT MORRIS, PE
Director of Environmental Health
May 1, 2006
Dale Daniels
12 Lafayette Road
Brewster, New York 10509 Y
Re: Addition Approval — Daniels, A- 321 -05
No Increase in Number of Bedrooms
12 Lafayette Road
(T) Southeast, TM# 36.57 -1 -16
Dear Mr. Daniels:
I have received and reviewed the revised 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 April 27, 2006. The addition is approved with the following
conditions:
1. The legal bedroom count for the above referenced lot is two. The new bedroom count
by this Department is one. The total number of bedrooms must remain at one 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, restnctors for shower heads and faucets, etc. _ ,
4. This Department recommends you contact your local Building Department to ensure
setbacks and other current codes can be met.
5. This 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
GDR:cj Senior Engineering Aide
cc: Building Inspector, (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
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PUI NA � '1�Y<D0,14, f MENT -OF HEALTH
AOUSE PLANS APPROVED FOR BEDROOM COUNT .ONLY,
r d ^ S
A-L- SUBSEQUENTT REVISION f ALTERATIONS TO TH ESE UIPUSE
VLANS MUST BE SUBMITTED TO THE PCDOH FORS APPR ,VAL
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SIGNATURE R 'f iTr.. 5 �d' Aa
c�
SHERLITA AMLER, MD, -NJ$, FAAP._.- ...
" Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
October 26, 2005
Dale Daniels
12 Lafayette Road
Brewster, NY 10509
Dear Mr. Daniels:
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ROBERT .I._ BONDI ..
County Executive
Re: Addition — Application Incomplete - Daniels
12 Lafayette Road
(T) Southeast, T.M. 36.57 -1 -16
Review of plans and other supporting documents submitted at this time relative to the above -
regarded project has been completed. The following was not submitted with your application:
1. The residence is noted as a one and a half story dwelling. Plans submitted show only one
floor. Kindly submit additional plans showing all rooms on the half story or an
explanation as to the nature of the one and a half story.
-.._. -... ..___._._..- ._....2..,. The proposed- addition pkpycuxnote the number -of stories proposed nor the addition.
3. The proposed plans must show how the addition will be accessed.
Upon receipt of a submission, revised to reflect the above comments, this application will be
considered further.
GDR:cw
Sincerely,
Gene D. Reed
Environmental Health Engineering Aide
r
h
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
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
October 31, 2005
Putnam County Department of Health
1 Geneva Road
Brewster, NY 10509
Re: Proposed Addition for:
Dale Daniels
12 Lafayette Road
Brewster, NY 10509
I am in receipt of your letter concerning the proposed plans for the
above address. The plans submitted is for the main level of the
house. The one -half story in question is an unfinished attic used for
storage. The attic height is measured at 6 feet high. The one -half
story attic will be remaining as is.
Sincerely,
Ms. Dale Daniels
SHERLITA.AMLER, MD, MS, FAAP
._..._ . .», ._.,.r;Co»tirizssioner�ofFfealth �"--'-• '
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
November 14, 2005
Dale Daniels
12 Lafayette Road
Brewster, NY 10509
Dear Mr. Daniels:
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ROBERT J. BONDI
Re: Addition — Approval — Daniels A- 321 -05
No Increase in Number of Bedrooms
12 Lafayette Road
(T) Southeast, T.M. 36.57 -1 -16
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 November 10, 2005. 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.).
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 your convenience.
Very truly yours,
Gene D. Reed
Senior Environmental Engineering Aide
GDR:cw
cc: Building Inspector, Town of Southeast
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
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
.;f
I�EPAR"IM?v s OF 13:�AL"i:i
BRUCE R roj.zy
PuMc Heck, Direrc-
Division of Ernirvnmantal Health Services r
6 Genava Road
13TOWster, Naw York 10509
M..(914) 278 - 6130 Fax (914) 2179 - 7921
PR02MSED ADD171Q:j APPLICAIIQNN (RESIDEENTL L-0 -Yl
STREET - TOWS! XZVIAP # -54!0-S��'
NAME FHOV CHD r
QQ �
h•:AMWa ADDRESS %vC��i�v �i f' • 3Z �,
D1rSC'.RIPTiO:� OF p- DDiTIO:�I
L IBER OF E :�' BE13R OILS PR PLlSE G'� BEDROOVLS 6
CERTIF(CATIt7 i FR�Iri SGILDLNC 15 ?ECTOR.) p��,C�C�'Z�TP'�'�
Any addition N hich is cors::Ierod a bedroom. requires formal approval o p�� Coakuc icon �
Permit) prepe::ed by a - r,:fessioral Engineer or Reg= st°red Aic'i tect Ln accordance with
aoplicab:e sections of the Pu=n, County Sanita-*y Code.
Please submit tEs fer=: and, the fo'lauing to Putnam Co=v Health D;,pt., 4 Genera Rd.,
Brewster, NTY 1.0509, Phone 2'S -6130.
1. Certified -check or,mgze; -b dsr for 5100.00 - -
-- �. 5'setches of cxisting floor plan (drawn to scale,. all living area Including basement)
* Non - professional skeichts are accep&ble
3. Two sets of proposed r:oor plan (drawn to scare, with =ne, street, and tax. rap T)
�* iron -p.o essionai sketches are acceptable
✓4. Copy of dive} shAcwio; well and septic location, to Ll<e best of your knowledge. Include date
of installation if kno.,vn: Label all ti.eLs and septic syste=s within 200 feet of the pmperty, lane.
Centact this office wi any qaestions-
Copy of Cen. of Occupancy frcm Town or Certification ft-a= Building Dept. Nith legal.
bedroom court of dwellLg.
OFFFC.'IE tr,)F
coriirnew.s
F-b 93
DEPARTMENT OF HEALTH
Division i Of Environmental Health Services
4 Ceneya* Road, Brewster, New York 10509
(914) 278-6130 -
Putram C6unry Dept. of Health
4 Geneva Road
Brewster, NY 105G9
Re:
Rcsldcnoc
Tax Map
Town
-
f-
Gend!t.men:
Acting
-i Lo I
According'. re-�o7ds maintax.t.d by the To\�-,L, the above noted dwelling
IS
inc;om-phan..."e ,j th lomtcd -d-
.-,nd the CCIL'a'In'Urn&ir "f6edroomsonrecord
This ;nfor,mation aas bce n obtal led from :
:
C-ERTIFICATIE, OF OCCUPAT-ICY:
ASSESSORS REZORD:
Building inscreclor
t
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Caw � i � ... .
hY�.Ysyyry^
Nk6i I
is
,.:. ..... .........................: :: ::. -.... i
i
1
TOWN OF PATTERSON .
oPUTNAM COUNTY
Z PATTERSON, NEW YORK 12563
9
TTERSO�'
Building Department
January 23, 2002
a
Telephone
878 -6319
Premier Abstract, Ltd.
Routes 100 & 202
Somers, New York 10589
RE: TM — 36.57 -1 -16 PAL -17677
RAPP, RICHARD
12 Lafayette Road
Brewster, New York
(T/Patterson)
TO WHOM IT MAY CONCERN:
According to our records, the dwelling on the above numbered lot was evidently
constructed prior to our Zoning Ordinance requiring a Certificate of Occupancy.
The BUilding,Department does not have a file or record of construction or violation for
this dwelling.
All dwellings for resale MUST have heat and smoke detectors in each bedroom and
hallways prior to closing.
If you have any questions, please do not hesitate to contact this office.
Very truly yours,
C leryl L .'mith
Building Department
TOWN ROAD xxx
STATE ROAD
COUNTY ROAD
PRIVATE ROAD
PU'IMM (7" Y HEALTH DEPARTMENT
DIVISION dE ENVIRONMENTAL HEALTH SERVICES
225 - 3838/225 - 3833/225• -3641
PROPOSAL FOR SEx^1AM DISPOSAL
SYSTEM REPAIR
,gNER'S NAME Mrs. Ann Impieri PHONE 914- 279 -2066 _
ITE JOCATION Lafayette Road 20 30 -3 -5
?AILING ADDRESS Patterson, N.Y. 12563
ERSON INTERVIEWED PCHD Canplaint #
Name & Relationship (i.e, owner,tenant, etc.)
?ATE August 28, 1990 TypE FACILITy Private Dwelling
10POSED INSTAUM Dave Burdette PHONE 914-878-9074
roposal (include sketch locating all adjacent wells):
JTE: Repair must be in same location and of same type as original sewage disposal system.
ifferent location may require submittal of proposal fran licensed professional engineer or
- gisteted architect.
1) The existing 500 gal. tank is to be pumped out and removed or filled with sand.
A new 1,000 gal. polyethylene tank is to be installed in its place outside the
bathroom entension. (A Polyethylene tank was selected because the area is
inaccessible to a large vehicle).
2) An existing dry well is.to be eliminated and filled with clean earth.
3) The existing laterals have rocks in them with no disribution pipes. We propose
to remove the rocks and add R.O.B. in their place with perforated distribution
pipes.
xposal
ture & T
Proposal Disapproved
NE
�pposal approved with the follgWiog 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
d. System description (e.g., 1250 gal. concrete septic tank,
drywells surrounded by one foot + gravel).
e. Installer's name and number.
to
(e.g.,house corners).
three precast 6' diam. x 61 d@@p
3. System repair to be performed in accordance with the above proposal and conditions.
as owner, reported nt of owner agree to the above conditions. j C
LGNATURE TITLE
IS: WUte (FUD); Yellow (Tbwn BI); ]pink Wit) 36.57 -1 -16 '
D*&'S_ NAMb" M-.s_. Anne
B1Th."LO,C-ATj0N` Lafayette
MM" LANd-ADD1M-SS'-Patterson
Na
Dh August. 1, 1990
PWE'WED ii&
puiTiriK-icbuNT'.,.iic..A-L-Tii' -DZP N2
S
225;3838/225-3833/225-3641-
- M -_- -MS'MA. RE PAIR
PE UPOWLFOT�.�Srl dk:DiSl��.
zmpier . ..... .... pJJGN.E-;-' 91.4-279-2066
Road. '30n3-5
,,N.Y. .1-2563
Re & R_-I&Fl_o_nihip li; ek ow%er..'tenant, etc.
T -XPE .PK
FACILITY. PrivgLte - piling
Burdetj:e. 9�14-878-9074
Pi6 sal- ( indlbde- skbtch locating, all-'adjacent wells)
NWg. Repair mu.5t, bd- in same lo6ation- and --of-�'siz6e- type as:,Qricjinai sewage BILE 'shl'-system.
Diffeki--ht--loca ion- may.* requite` sutini, tt;al. Of propdsal --fran liqpnsed prof essior�Alen4inedr- or
r6416t@`r', 66-'ar�iil test: -
Is ta. -be-. pumped out and .removed or.,_Ulled - wi ti. sand.
A new 1,000 gal. polyethylene tank is to be installed in its place outside the
bathroom extension. (A Polyethylene tank was selected because the area is
inaccessible to a large vehicle)
An--existing dry well is to be eliminated and filled with clean earth..
Proposal- Disappi;9vec!
/574d ..
Date'
r'4 sal- app6ii6d with` -_'the following- conditions:
I.- , Procurement - of any' Town- permit', if apol'icable.
2:, S�ii fission' of as built repair r skp-tcfi in daplic'a'te showing:
a." O.wter Is name.
b,."Site Street Name, Town
C and*TaXMap'nuMbe*r.--
I- 'Location' of installed canporients tied to . tw6 . - .'fixed points (e.gi,,house W . tnprs).
Y.*SypUm description (e-4.j 1250 gal. dqn&-btEi septic tank, three precai &d-" diam.-x 61
drywells S"rounded by ore fWt, + graV
r'! s' - name and number': ..
N Ji'th-- bei per:fdnTled -in - accordan6e Vith the above proposal anti odildi O' as:'.
8er6p--6,ft;9, of` , owner' agrdd,* t6' the above conditions.
Ti
ZL
36.57-1-16
Permit #
I Permit Date
a
Compliance Certificate
Project Title: proposed addition
Report Date: 04 119/06
Data filename: Untitied.rck
Energy Code:
Location:
Construction Type:
Heating Type:
Glazing Area Percentage:
Heating Degree Days:
Construction Site:
12lafayette drive
patterson, NY 12563
New York State Energy Conservation
Construction Code
Putnam County, New York
Detached 1 or 2 Family
Non - Electric
11%
5750
Owner /Agent:
dale daniels
12 lafayette drive
patterson, NY 12563
5M 7
RE
Designer /Contractor
harry nichols
harry w. nichols,jr pe
2050 route 22
brewster, NY 10509
845- 279 -4003
hnengineer @aol.com
Ceiling 1: Cathedral Ceiling (no attic): 330 38.0 0.0 9
Wall 1: Wood Frame, 16- o.c.: 448 19.0 0.0 24
Window 1: vinyl Fr6rtle:pouble Pine; _48.. _. . — . 0.340 - e 16_
T Floor 1: Slab -0n - Grade: Unheated:, Insulation Depth: 2.0' 27 0.0 28
The proposed building represented in this document is consistent with the building plans, specifications, and other calculations
submitted with this permit application. The proposed systems have been designed to meet the New York State Energy Conservation
Construttii nts. When a Registered Design Professional has stamped and signed this page, they are attesting that
to the .befiief, d rofessional judgment, such plans or specifications are in compliance . this Code.
Bu der si ec mpany Name D e
LU
i w
140 66124
OOf fi 0
>851�P/
proposed addition Page 1 of 1
._.
-
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
November 14, 2005
Dale Daniels
12 Lafayette Road
Brewster, NY 10509
Dear Mr. Daniels:
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ROBRRTT'Ji"BON61 -
County Executive
Re: Addition — Approval — Daniels A- 321 -05
No Increase in Number of Bedrooms
12 Lafayette Road
(T) Southeast, T.M. 36.57 -1 -16
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 November 10, 2005. 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. ry _..
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. 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 your convenience.
Very truly yours,
W4;e-�' 7-,), a-�'
Gene D. Reed
Senior Environmental Engineering Aide
GDR:cw
cc: Building Inspector, Town of Southeast
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
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
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ftTNAM COUNTY T`094ALTI€
HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY,
f
BEDROOMS l m � �
�" p
ALL SUBFEQJEr T"Ph LSIONI(,LTEi3ATION= TO THESE HOUS9,
PLANS lt!VST BE S JBAUTTs -,L �. -L "' PCDOH FOR APPROVAL -
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PUTNAM COUNTY DEPARTMENT OF- HEALTH
,'HOUSE PLANS APPROVED FOR BEDROOM
COUNT ONLY,
;2- BEDROOMS
ALL SIJBSEQUENT REVISIONJALTERATIONS TO THESE HOUSIF
PLAN MUST EE SUBMITTED TO 'rHE
PCDOH FOR APPROVAL
A : TUIJfvyrTLE L. ll
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f Patterson.
Zoning Board of Appeals .ry. .
Determination
ZBA OFFICE USE ONLY
Case # 04 -06 Tax Map: 36.57 -1 -16
Applicant: Daniels, Dale
Application Description: Area Variances — To construct a 10 %' x S' addition
239m Referal Q Yes. ® No Date Sent:
Public Hearing Date: 2[15/06
Site Walk:❑ Yes Fl:-. Noa: `'�' Situ Walk'Date:
Decision of Board:Granted Decision Date: 2/15/06 -
Resolution # 04 -06
Conditions if Any: See Resolution
Date Filed with Building Department & Town Clerk: 2/21/06
Melissa A. Brichta
Zoning Board of Appeals Secretary
A Building Permit must still be obtained for this request if applicable.
PLANNING DEPARTMENT
P.O. Box 470
1142 Route 311
Patterson, . 12563^
Melissa Brichta
Secretary
Richard Williams
Town Planner
Telephone (845) 878 -6500 TOWN OF PATTERSON
FAX (845) 878 -2019 PLANNING & ZONING OFFICE
ZONING BOARD OF APPEALS
Howard Buzzutto, Chairman
Marianne Burdick
Lars Olenius
Martin Posner
TOWN OF PATTERSON
COUNTY OF PUTNAM, STATE OF NEW YORK
RESOLUTION # 04 -06
IN THE MATTER OF THE APPLICATION OF
Dale Daniels TM# 36.57 -1 -16
PLANNING BOARD
Herb Schech, Chairman
Michael Montesano
David Pierro
Shawn Rogan
Maria Di Salvo
FOR AN AREA VARIANCE OF
§154 -62 (C) Buildings on nonconforming lots
To Construct a 10 %' x 8' addition to the existing dwelling.
INTRODUCED BY: Board Member Olenius:: „
SECONDED BY: Board Member Burdick
DATE OF CONSIDERATION /ADOPTION: February 15, 2006
WHEREAS, Dale Daniels is the owner of real property located at 12 Lafayette Rd identified as
Tax Map Parcel # 36.57 -1 -16, and
WHEREAS, Dale Daniels has made application to the Patterson Zoning Board of Appeals for a
variance of § 154 -62 (c) of the Patterson Town Code to construct a 10 %z' x 8' addition to the existing
dwelling, and
WHEREAS, 154 -62 (C) of the Patterson Town Code requires a lot with an area equal to or less
than 19,500 s.f., minimum lot area required to enlarge a principal structure shall be equal to areas shown in
the schedule; Applicant's lot area is 8,000 s.f the maximum principal structure size allowed is 667 s.f.;
Applicant proposes a total of 681 s.f.; variance requested is for 14 s.f, and
- WHEREAS, Chapter 154 of the Patterson Town Code requires 15 feet for the front yard setback in
the RPL -10 Zoning District; Applicant will have 14.5% variance requested is for .5', and
WHEREAS, the proposed action constitutes a Type H action under 6 NYCRR Part 617, and
therefore, requires no further review under the State Environmental Quality Review Act (SEQRA), and
WHEREAS, a public hearing was held at the Patterson Town Hall, 1142 Route 311, Patterson,
New York on February 15, 2006, to consider the application, and
WHEREAS, The Patterson Zoning Board of Appeals has given careful consideration to the facts
presented in the application and at the public hearings and finds that:
1. the proposed application will not produce an undesirable change in the character of the
neighborhood because the proposed addition can only enhance the property values of all
surrounding,
2. the benefit sought by the applicant cannot be achieved by any other feasible means because
the Applicant is already putting the addition towards the interior of her property and not
extending any further towards the frontage;
3. the variance requested is not substantial because the pre - existing home is already .5 foot
into the front yard setback;
4. the proposed variance will not have an adverse effect or impact on the physical or
environmental conditions in the neighborhood or district because as shown by the schedule
the varlance requested for more square footage is minimal, 14 square feet;
5. the alleged difficulty necessitating the variance was either not self - created, or not sufficient
so as to cause a denial of the requested variance.
NOW, THEREFORE BE IT RESOLVED, that the Patterson Zoning Board of Appeals hereby
grants the application of Dale Daniels the variances as requested to construct a 10 %z' x 8' addition to the
existing dwelling.
AND BE IT FURTHER RESOLVED, that the variance granted herein is subject to the following
special conditions:
1. That the siding and roof shingles on the addition should match the existing structure.
If UPON ROLL CALL VOTE:
Board Member Bodor - yes
Board Member Burdick.. -
`''-'Board Member Olenius - yes
Board Member Posner - yes
Chairman Buzzutto - yes
VOTE: Resolution carried by a vote of 5 to 0
STATE OF NEW YORK )
ss.:
COUNTY OF PUTNAM )
I, Melissa A. Brichta, Secretary of the Zoning Board of Appeals, do hereby certify that the above is an
excerpt/summary /fair representation of the Resolution adopted by the Zoning Board of Appeals of the
Town of Patterson at a meeting of said Board on February 15, 2006.
DATE FILED: CL
Melissa A. Brichta
Secretary Zoning Board of Appeals
PUrNAM COUN'T'Y HEALTH DZPARI E-N`r *
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
225-3838/225-3833/225• 3641
PROPOSAL FOR S&qAGE DISPOSAL SYSTEM REPAIR
V-M'S NAME Mrs. Ann Impieri PHONE
-TF
LOCATION Lafayette Road
9147279-2066
30-3-5 -
1ILING ADDRESS Patterson., N.Y. 12563
MSON INTERVIEWED PCHD Capplaint. #
Name & Relationship (i..e, owner,texiant, etc,)
iTE August 28, 1990 TYPE FACILITY Private Dwelling
ZOPOSED INSTAtIER Dave Burdette PHONE 914-878-9074'
:op (include sketch locating all adjacent wells):
)TE: Repair must be in same location and of same type as original sewage disposal'system.
.fferent location may require submittal of proposal frcrn licensed professional engineer or
.1isteted architect.
1) The existing 500 gal. tank is to be pumped opt and removed or filled with sand.'
A new 1,000 gal. polyethylene tank is to be installed in its place outside the
bathroom entension. (A Polyethylene tank was selected because the area is
inaccessible to a large vehicle).
2) An exi's'ting dry well is.to'be eliminated and filled with clean earth.
3) The existing laterals have rocks in them with no disribution pipes. we propose..
to remove the rocks and add R.O.B. in their place with perforated distribution
pipes.
-oposal approvea-'-�-, Proposal Disapproved
11 7'
I
Signature &
to
-pposal approved with the following conditions:
Procurement of any Town permit, if applicable.
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.,bouse corners).
d. SysUm. description (e.g., 1250 gal. concrete septic tank, three precast 61 diam. X 61 di@@P.'
drywella surrounded by one foot + gravel).
e. Installer's rkmm and number.
System repair to be performed in accordance with the above proposal and conditions.
as owner, er, eported aont of owner agree to the above conditions.
.GNNTURE TITLE DATE
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PUMAM 0X0MrY HEALTH DZE)AR1M N r
DIVISION OF ENVIRONMEMAL HEALTH SERVICES
• 225 - 3838/225- 3833/2253641 ,
R- 198 -90
OWNERS NAME Mrs. Ann Impieri PHONE 914 - 279 -2066
SITE LOCATION Lafayette Road# 30 -3 -5
MAILING ADDRESS Patterson, N.Y.
PERSON INTERVIEWED PCHD Canplaint #
Name & Relationship (i.e, owner,tenant, etc.)
DATE August 28, 1990 TYPE FACILITY Private Dwelling
PROPOSED INSTALLER, Dave Burdette PHONE 914- 878 -9074
? roposal (include sketch locating all adjacent wells):
4OM: Repair must be in same location and of same type as original sewage disposal system.
)afferent location may require submittal of proposal fran licensed professional engineer or
registered architect.
1) The existing 500 gal. tank is to be pumped out and removed or filled with sand.
A new 1,000 gal, polyethylene tank is to be installed in its place outside the
bathroom entension. (A Polyethylene tank was selected because the area is
inaccessible to a large vehicle).
2) An existing dry well is to be eliminated and filled with clean earth.
3) The existing laterals have rocks in them with no disribution pipes. We propose
to remove the rocks and add R.O.B. in their place with perforated distribution
pipes.
roposal approv�,�. Proposal Disapproved
to
M,
nature &
roposal 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
d. System description (e.g., 1250 gal. concrete septic tank,
drywell:s surrounded by one foot + gravel).
e. Installer's name and number.
(e.g.,house corners).
three precast 6' diam. x 61 gyp:
3. System repair to be performed in accordance with the above proposal and conditions.
as owner, reported nt of owner agree to
MATURE
the above conditions.
TITLE ' DATE
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