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Home My WebLink About0892DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.38 -1 -24 BOX 10 O . kLpw J 1.6" X, . r,6,L. . r Or r 1'96 _� O M LORETTA MOLINARI R.N., M.S.N. Acting 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/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 April 11, 2003 Joe Dimperio 64 Overlin Rd. Patterson, NY 12563 Re:Addition- Dimperio, 64 Overlin Rd. No Increases in Number of Bedrooms (T)Patterson, TM #25.38 -1 -24 Dear Mr. Dimperio: ROBERT J. BONDI County Executive 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 April 11, 2003 The addition is approved with the following conditions: 1. The total number of bedrooms must remain at four without prior approval by this department. 2. The area of the sewage disposal system, must be expanded as shown on R58 -03. 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 yo William Hedges WH:lm Senior Public Health Sanitarian cc:BI Received of The Sum Of%.. e ,�,� �� a Dollars $ /moo o d For( /D d3 d . � /V 77 THANK YOU Cash ❑ Check ".0. ❑ Credit Card By f';tAAzr,: O 1 SITE LOCATION OWNER'S NAM PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR OFFICIAL USE ONLY TM# 2 S MAILING ADDRESS 6 y 4'14,,' PERSON INTERVIEWED J ; x"'7 c:--- PCHD Complaint # ame Relationship (i.e., owner, tenant, etc. DATE PROPOSED ADDRESS O TYPE FACILITY PHONE T' 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. - A -as - owner, or -A e ed e*�± of mamer agree tc the condiw�ons stated on this form. - SIGNATURE TITLE 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 comers). 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 '/DAI T/ s BRTJOE , R. FOLE I Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI RN., M- .S.N. Associate Public Health Director 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, ADDITION APPLICATION PRESIDENTIAL ONLY) STREET t'l `� �/t NAIL PHONE PCHD# MAILING ADDRESS (L y DESCRIPTION OF ADDITION J�Q` its Sc° G dam✓ ,S- NUMBER OF EXISTING BEDROOMS -.3 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:, 4 Geneva Road, Brewster, NY 10509, Phone 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) *Non- professional sketches are acceptable. 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 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 BFhouseguidelines JJ i z1 -Viol A- A di l 1=1m, AR ip NAM: C' OU]ITY DE'P USE LANS, APP,ROVEb FO slmzaiure & Titie to ,� __.. � �,t /,. i __.. � 0 s �yq FF . 1 - FTI y'r �(Z3�76� _ t; o* 1� et nie �c ,wgr rFar.�rt_ -+� Building Type % Lot Area 1f�1 � Ffil Section Y Ll L Depth Votome Number of Bedrooms 3 Design Flow G /P /D Goo PCHD Notification Is Retjalrell When Pill is completed . Separate Sewerage System to consist of on Septic Tank and 1 �-1" T12i GAL—t - To be constructed by Address Water supply: Publi'Supply From Address or: X Pri vate Supply. Drilled by _Address Other Requirements represent that 'I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage „disposal system above described will be con structe0 as shown on the approved amendrnent there to and, in accordance with. the standards, rulesand regulations o : o u ham County Department. of .Health, and that on completion thereof a "Certificate of Construction Compliance "satisfactory to the Commissioner of. Healthwill be submitted to the Department, and a written guarantee will be. furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any 'part .of . saitl sewage disposal. system during the .period of two.(2) years immediately following the date of the issu- ance of the approval of the Certificate' of Construction 'Compliance of the original system o► any repairs'the►eto, 2) that the drilled well described above will be located as shown on the approved plan and that said well will be Install etl in accordance with the standard s, les and ce9u aTfons of _the., 'Putnam County Department 'of Health. IS}�� Signed �[ P.E. L R. A. - Date �J ..�1 AAt Address ` «�"`� /V - OA5 License No APPROVED FOR CONSTRUCTION: This approval expires one year fro the date s ed unless constr cti n of the build1 g has bean undertaken and is revocable for cause or may be amended or modified when considered ece nary by th ommissioner f H- Ith.. Any chang or alteration of construction requires a n p it Approved for disposal of domestic sanita� age, and /o i tow r ply i Date By Title PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N: Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Mg. + N• ec;, 70 Z l Address Located at (Street C)\/;C- L1N4 VZ!�)- Sec. Block 3 Lot 2•Z �' i"� �Indicate nearest cross street) Municipality. PA -7 TC!eC--�N Watershed C, -�- pQ� SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole �p 2v Z a 2 Lt -tS -1� Z4 Number CLOCK TIME 2-0 PERCOLATION PERCOLATION apse Depth to Water Water ve No. Time From Ground Surface in Inches Soil Rate .Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 2 ��:��- It?�° °J �dj 3lr:z� 4 VAA V2-- 0) �� 2 5 4 1 y°J - t '� \h �p 2v Z a 2 Lt -tS -1� Z4 G1 2-0 _z .. 4 5 5 Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO.- HOLE NO. HOLE NO. G.L. 6" 12" 18" 24" 3011 36" 42' 48" 5411 60" 66" 7211 7811 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED . TES T S - 1Y1h -DE-- 9i-- - - - Date- DESIGN Soil Rate Used6 -rte Min/1 "Drop: S.D. Usable Area Provided :2eyDO No. of Bedrooms � Septic Tank Capacity / �� Gals A Absorption Area Provided By /L. F. x24" 3b7r-- �5 �� nc . 2 l _ 1. L� ame c. -�.� r`1, n— - �� i�>.( i.gna ure c., Address SEAL t4. o. 2600 i hE ST A`i THIS SPACE FOR USE BY .HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING,.CARMEL, N. Y. - -- 10512 - DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owners `Tb"�' Z,.l Address Located at ( Street C)\/E- 2 t_, i N See. Block ___S Lot ica a nearest cross s reeLt Municipality. A -T Watershed. G I_r>-�'U SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS 5 o e Number CLOCK TIME PERCOLATION PERCOLATION .' apse No. Time ..Start- Stop :. Min. ..Depth to a erg - From Ground Surface Start Stop Inches Inches a. er Level - -.iii Inches Drop in Inches Soil Rate Min. /in drop 2 t��i- �� 9 26 Iz- 5 26 5 Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. DEPTH G.L. 6" 12" 1811 24" 36" 42,E .4811 n 60" 66" 72 7811 8411 r TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO._ l HOLE NO. HOLE NO. INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED _INDICATE - LEVEL TO WHICH _WATER' LEVEL RISES.AFTER_.BEING ENCOUNTERED._..,_ TESTS MADE BY . ) ►= �1 Datea8� DESIGN Soil Rate Used6`.5 Min/1 "Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity ` Gals Sg \0 A NSd�1� Absorption Area Provided - By J04 L F x � � ��' nc e P� Name V.aignature Address SEAL!'" t �n��• 2600a THIS SPACE FOR USE.BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by, Date PUTNAM COUNTY DEPARTMENT OF HEALTH a ev 318 Division of Environmental Health Services, Carmel, N.Y.. 16n Mast PIMA P :4 5 8 5 P.QMD. Permit'. CE C TE OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM`' Pattbrs6n Town or V e Lbeated at Overlin Road Tax Map 51 Block Lot 12.2 14 Owner/applicant Name iMr. ,G -Mrs . Tozzi Fosmerl Same _ Subdivision Name Put Lake Snbdv.•Lot p 4200 - Y , Mailing Address r/n Bi 1 T Iii ti na ZIP '10509 Date Permit Issued RD 6, Ballynack Road: Brewster +, . Separate Sewerage System built by Robert B i 11 Address Patel ing New Yn# Consisting of 1000. Gallon Septic Tank•."d 104 LP of tri- Salleys Water Supply: Public Supply From Address PF Beal & Sons, Inc PO Box 13, Brewster, NY 10509 ors x Prlvate. Supply Drilled by Address Building Type .1. ia;l!1) 3geglE1ei;e a —Has Erosion Control Been Completed? )Les Number of Bedrooms 3 Has Garbage Grinder Been Installed? DO Other Requirements cleanout dis'tribution' box I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work ( copies of which are attached), and in accordance with the s£aidards, rules and regulations, in accordance with the filed plan, and the permit issued by the Putnam County Department Of Health. Date i Sl Ya. Certified by P.E.... R.A. Address Cashin Associates'' P..C, Rou 52 Carmel NY l.icenseNo. 26008 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate Sewerage system shall become null and void as soon as a pub;'-- sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply 'becomes available. Such approvals are subject to modification or change when, In the Judgment of the,CoMmissiOner of Meal ocation, modification or change is necessary. Date ��"'~� U� y Title n � 4�' w O WMLL k1LI -LI LLL LVLM Lu &i �t DEPARTMENT OF HEALTH Division Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH _ Office Use Only WELL LOCATION i WELL OWNER STREET ADDRESS: WN /wl / I!Y TAX GRIO NUMBER: Quebec Road Patterson, NY NAME: ADDRESS: ❑ PBIVATE Mareen Lobra' c Corners NY Brewster ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary OcRESIDENTIAL ❑ PUBLIC SUPPLY . ❑ AIR/COND./HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING CCNEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 225 ft. STATIC WATER LEVEL 20 ft. DATE MEASURED 1/21/87 DRILLING EQUIPMENT EKROTARY ® COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. IN OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH -3 ft- MATERIALS: ® STEEL ❑ PLASTIC ❑ OTHER CASING LENGTH.BELOW GRADE 2A ft. JOINTS: ❑ WELDED ® THREADED ❑ OTHER DETAILS DIAMETER h in. SEAL: 0 CEMENT GROUT ❑ BENTONITE D OTHER WEIGHT PER FOOT - 9 Ib. /ft. I DRIVE SHOE: OYES. ❑ NO 1, LINER: OYES ONO SCREEN DETAILS DIAMETER (in) SL07 SIZE LENGTH (ft) DEPTH TO SCREEN (f t) DEVELOPED? FIRST O-YES: ONO. - — ------ HOURS .. _ GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft- BOTTOM DEPTH It. WELL YIELD TEST pumping If detailed METHOD: $1 PUMPED i tests were done is in- • COMPRESSED AIR , formation attached? ❑ BAILED ❑ OTHER ; ❑ YES ❑ NO I�LL LOG ff more detailed formation descriptions or sieve analyses a're available, please attach. DEPTH FROM SURFACE Water Bear- ing Well Oia- In FORMATION DESCRIPTION CODE, ft. ft. WELL DEPTH ft. DURATION hr. min. DRAWOOWN it. YIELD gpm.. surface 10 Drilling in overburden clay & bldrs H t Tock at 10 fee. 225 6 205. 9 10 29 Drilling in rock,set.casing,grouted _225j232;.11jng in rock granite. WATER ❑ CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS ❑ COLORED ANALYZED? ❑ YES ❑ NO ANALYSIS ATTACHED? ❑ YES ❑ NO STORAGE TANK: TYPE CAPACITY GAL. WELL DRILLER NAME P.F. Beal & Sons , Inc . DAT ADDRESS PO Box B SIGs Brewster,NY 10509 PUMP INFORMATION TYPE CAPACITY MAKER DEPTH MODEL VOLTAGE HP i -- BREWST'ER LABORATORIES - Box 224 - BREWSTER, N.Y. (914) 225 -2072 - WATER ANALYSIS REPORT - SAMPLE NO. 6566 SOURCE: Amedio Tozzi 64 Overli - Rd. Putnam Lake Patterson, NY COLLECTED: May 28, ' 1987 BY: Haviland Plumbing BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method L faucet - well'' ' i MI! -4 {,q t r i / This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. Pay. 30, .` i987 � � . Roy Bickwit P.E. Director 0 per 100 ml. PUTNAM COUNTY DEPART OF HEALTH DIVISION OF ENVIR01Z=AIT HEALTH - SERVICES Owner or Purchaser of Building Section Block Lot Building Constructed by 00 ear i t 4 U RI l (a L_ Location - Street Subdivision Name Municipality Subdi vision-.; t # l �awi.c �v ReS�c�P —a-ce , Building Type r -s GUARA= OF SUBSURFACE SEWAGE DISPOSAL SYSTEM .0 t. 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 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` -t)ie 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 occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environmental 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 _3 day of J 19 e7 General Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk Signature Title Corporation Name (if Corp.) Address