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Home My WebLink About0079DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 3.16 -1 -4 BOX 1 ' l l"■ ' I . , -�� u Jr - 64 1 *;r, I. ILP rill • 1 •� J PUTNAM �`-`- HEALTH DEPARIMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES lJ PROPOSAL FOR SRO= DISPOSAL SYSTEM REPAIR MUM'S NAME �-ktA-fb '13 • QJ *1?-- PHCNE Y 7 k -6.6 Zy SITE IACATION `i' `F m P,-r- C ri -- A-m r-s r-,-/ MAILING ADDRESS PERSON PCHD Canplaint # Name & Relationship (i.e, owner tenant, etc.) DATE l 7 7 j �i' �' _ TYPE FACILITY REGISTRATION # 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. Proposal Disapproved Proposal approved with the following conditions: 1. Procurement of any Town permit, inapplicable. 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. (e.g. #house corners). three precast 6' diam. x 6' deep 3. System repair to be performed in accordance with, the above proposal and conditions. I, as owner, or reported agent of owner a re a above conditions. SIGNAZiJRE TITLE _2 LATE I IPgS: Hhite (PC H)): Yellc7w (7= HE); Pink (A:plicmit) Pr-pp 07 C� of i'ber out.. /} 1 1 ees % EASEMENT (See Note 6) � � r 20 dpr Gf prey �CGE55 tv5y°�i7' ao "w /oo. 56' o Al 2 OAS pp 01. �n%el gar per r p OPh e i C 0� 50 e /3 a 30 ASP halt 5 g Sa . a 0 -{ Z C 2 Sq. Ft. 1.17.Ar F/ within Gravel / Story Frame Shed 0 guy yyrn� o 96 07(l w 'ti 0Q, X � o / Co vered 1D_�` / Stoop T r 59.' C ver d 510 OP 0 O N x —� .. C°ye2 V4e- L L N Fiome Swing Set 5.0'•.. From c, Well w 0 -L� a� N O_ O \ O v co Z O C rn 0 n t N 58 ° 55 / 40 W 250.00 Formerly NELSON Now or Former l y COLT _ Liber 545 cp 154 SUR VEY OF PROPER -Y PREPARED FOR GERALD B. B LO /S A SITUATE ;N THf. TOWN OF PATTERS PUTNAM COUNT' k6 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVUDAL ADDITION/REPAIR FORM SECTION A: GENE L INFORMATION Name of Project (T)(V)Jf" TMr "` Year of Construction Size of Parcel SECTION B. TOPOGRAPHY (Please check all appropriate boxes) l.. ❑Hilly ❑Rolling []Steep Slope ❑Gentle Slope Flat 2. ❑Evidence of wetland Clow area subject to flooding ❑Bodies of water ❑Drainage ditches, Clock outcrop ' YE.S Ll_Q 3. Property lines evident? 4. Water courses exist on, or adjacent to parcel: ❑ Lam' 5. Existing individual wells within 200ft of the existing SSTS? ❑ SECTION C. EXISTING SUBSURFACE SEWAGE TREATMENT SYSTEM(SSTS) 1. Physical character of existing SSTS area. A. Level ❑Gentle Slo ❑Steep slope B. ❑Well drained Moderately well drained ❑Somewhat poorley drained ❑Poorly drained C. Area available for SSTS. (Primary & Reserve) ❑Extremely limited ❑Somewhat limited 9Adeaqualte ft x ____ft D. ItiTSPECTION ONo evidence of failure Date Inspector .Evidence of failure DEvidenee of seasonal failure ------------------------------------------------------- �Q (Indicate North) Y Cn xo�s= ., r t w Y (1) Indicate location of SSTS rr� A. Size and type of septic tank V �"- gallons Metal 0-c-onc-rete la;tic B. Type of absorption area 1. Fields ft. 2. Pits 3. Gallies ft. (2) Indicate setbacks, front street, backyard, and side yard dimensions (3) Show location of well (4) Show location of driveway (5) Note physical features (steep slopes, rock outcrops, streamshvetlands) SECTION E. EXISTING NYATER SUPPLY CIPWS CIShared well Individual well DDrilled []Dug Clasing above ground COMSENTS : cA em a C Olor v. r (7� IT-5,-4 —f, fNI Of I -)No Q PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES 225- 3838/225- 3833/225 -3641 PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR if - 5--:1 - 'ig 7 OWNER'S NAME .L O err'. r e_ 4. C,0Ve.1 1 PHONE SITE LOCATION TM# MAILING • a�: �,� r�N4�; ��ai7 PCHD Complaint # Name & Relationship (i.e, owner,tenant, etc.) DATE TYPE FACILITY PROPOSED INSTALLER �i (v.\ Lz , ��Q' ►S ,� �'. 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 ggphitect. We Proposal approved._ Proposal Disapproved Da 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 drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, or reported agent of owner agree to the above conditions. � SIGNATURE � �J �(I I ,4 Q TITLE EPIM5: Wiibe (PCHD); YeUcw (Tom HI); Pink (Ani icaYt) DATE � " °�f °- & J i'd r_ Fi q In 6 C-6V-2 0 1.(ovSc 171 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health July 6, 2006 Lois and Gerald Ward 44 Maple Avenue Patterson, NY 12563 Dear Mr. Ward: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive Re: Addition — Approval - Ward No Increase in Number of Bedrooms 44 Maple Avenue (T) Patterson, T.M. #3.16 -1 -4 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 July 6, 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. 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 Patterson. If you have any questions, please contact me at your convenience. V truly yo s, Robert Morris, PE Senior 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 9 FIRST FLOOR PLAN •milm air. ro. SECOND FLOOR PLAN AILIF . 74 PUTNAM COUNTY DETARTMEN'J" OF MALTil HOUSE PLANS APPROVED FOR BEDU00110 COUNT ONLY, 3 BEDROOMS ALL SUBSEQUENT 1;1:V1-S'-':!'�!A 31)'rHESF HOUSE Z�A FOR API'ROVAI or �S'('XATtM D � E, gifts lie mill Lu Z Lu 213 1= 10% VATMA = YM IM35 IL (914) M-017 ■Mw mmu MUL401111111 M414110 owl A-1 mu-MEMN-Millm IN FIRST FLOOR PLAN •milm air. ro. SECOND FLOOR PLAN AILIF . 74 PUTNAM COUNTY DETARTMEN'J" OF MALTil HOUSE PLANS APPROVED FOR BEDU00110 COUNT ONLY, 3 BEDROOMS ALL SUBSEQUENT 1;1:V1-S'-':!'�!A 31)'rHESF HOUSE Z�A FOR API'ROVAI or �S'('XATtM D � E, gifts lie mill Lu Z Lu 213 1= 10% VATMA = YM IM35 IL (914) M-017 ■Mw mmu MUL401111111 M414110 owl A-1 EXISTING FIRST FLOOR PLAN 0cue w. ry EXISTING FOUNDATION PLAN . aeur w . r-Ir TH: lW1% i y1y R 4 W LU US LLI _ < o oil r 3 gad SQN OSp]Y6kYP Q1 T13 MM boa UIWW Eff vm to= m (nq m-0mi 0 oma� =mm� Y �, F�(IBTM. FrDFAT10N ROOM A C FxIBTING- 6TOR G -E ROOM b F 6TMG BOIL: ROOM 1 EXISTING FOUNDATION PLAN . aeur w . r-Ir TH: lW1% i y1y R 4 W LU US LLI _ < o oil r 3 gad SQN OSp]Y6kYP Q1 T13 MM boa UIWW Eff vm to= m (nq m-0mi 0 oma� =mm� SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ADDITION APPLICATION RESIDENTIAL ONLY STREET . 1 °� rl e TOWN TAX MAP# -� ,Ao i. o i- a — NAME Gic.riiA �. Acz,: -r4; PHON&�, i 7 Zr, P C H D # MAILING ADDRESS DESCRIPTION OF rr ADDITION�a_�' r n 5:` Inc,; 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 BRUCE R FOXY Publi; Health Direc :cr DE PAR i lYM i OF IEALTIH L'lvision of Environmental Health Serviees 4 Genava Road BTeWStsr, New York 10509 Tel. (9114) 278-6130 Fax (914) 279-7921 STREET L' TOWN X MA.P # 3_ %� — -- ?Vfa4/HOti'E PCHD T1 17 U Y-AZ -C� ADDRESS ` !% /� `�� A)v DESCR1PTi0N OF ADDITIO Aj i NUNMER OF EXISTING BEDROOMS � � PROPOSED # OF BEDROGNIS (FROM CERT. OF OR CERTIFICATIO'i FROM SUILDNC IN- SPECTOR) *Any addition «"hick is cors:derod a bedroom requires formal approval of plans (Construction Permit) prepu -Pd by a Prcf:ssioral Engin e. or Registered Azclritect in accordance with anplicable sections of the Pur7srzl Co=ty Sanitary Code. Please submit this ferr. and the 16'1ovAng to ?ztnam Coun+y Hea th Lept., 4 Geneva Rd., Bmwster, NIY 10509, Phone'7rs -6130. 1. Certifiers check or money- order for 5100.00 Sketches of existing floor plan (drawn-,o scale," all living area including basement) " Non- professional sketc'h.s are accept =ble 3. Two sets of proposed floor plan (draw7l to scale, with name, street, a :d tall r__ap �) * Non - professional sketches are acceptable 4. Copy of survey shlowing well and septic location, to the best of your k :-,O led-e. Inc :ude date- of installation if Label all wells and septic systems within 200 feet of the property lire. Contact this office wi-h any questions. S. Copy of Cen. of Occupancy firm Town or Certification frog: Building Dept. ,Kith legal bedroom court of dw -.!lines. r comments rob 93 DEPARTMENT OF HEALTH Division . Of Environmental Health Services Geneva' Road, Brewster, New York 10509 (914) 2 75 -6130 Pu*.n r County Dept. of Heait" 4 reneva Roar! 37ewstcr, NY 105C9 Centi� men: BRUCE R. JOSE` . P c_ Aeting Puhiie Mealch Gi.-e ^t.,e Re:G Residenec Tax map 167 Town 45AIW �� . z AccerdiZg to re;.crds maintained by the Town, the above noted dv.eliins is r c+ �j :J 'i . .0-IT' i*t compc� �, nth To,,%,. cod-. and zre total rturnber cf bedroom: on record This information has been obtai.Ied from: CERTIFICATE Or OCCUPA14CY: ASSESSORS RECORD: 9 0—l"H ,R Building ins � ctor V a� 3 0 a� v U U 3 m `a PO �O MM a 559-17'40"E e p "N', i" /00.00' P�E DER wi Fo °�d N, P P 2�� 153.98 E'e° gof a 1� FaJ"� t�etotme89cP �� - - -' -- F� Ot bet 14 p °�...� / / /�� 00 !°� EASEMENT (See Note 6) e5 201 t / • 1 �t0✓� / GESS N59°/7'40 °W /o0. 5 a A-1 ced °// / PG a2 OP 1' o� poor e9� o r � il � 4 / ..3Q Grovel pyphott 0, — — hY -� ° ;z -90 z Coveied 32 stoop .. mw 0 + pePh °�i Wlrea D� � rn C rn Area= 36, 022 Sq. Ft which includes 7, 589 Sq. Ft within 30'Access Easement Cpr ;° P O 5.0� ' Pin Found l.OS, LOSE - W \ 0 M_ O — � Q � a / Story Frame �- Shed N 0 A � D rn D r° CA J0 . O 'Frame well V Swing � I Se ;:.nc Pp9t found 03 W N 58 ° 55'40"W 250. 00' • s o• „ Formerly NEL SON f- -- Now or Formerly COLT Liber 545 cp 154 SURVEY OF PROPERTY PREPARED FOR GERALD B. B LO /S A. WARD 517UA IE /N 7HE TOWN OF PA TTERSON PUTNAM COUNTY PIEW YORK r.n,. r , 7 r3— /AA ////IOV 7197 /(X311 Notes: COPYRIGHT 1994 by TACONIc st/RVEYING9 ENGINEERING, Pc.