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HomeMy WebLinkAbout0912DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.39 -1 -35 BOX 10 00912 ,. I,N- ti, , . Ike J lem 1 �.I; f : j �� I 6 L`, ` 00912 �l A PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES - PROPOSAL FOR SEWAGE - TREATMENT SYSTEM REPAIR - Internal Use Only PERMIT #� 1� Repair Permit issued in last 5 years ❑ Not in Watershed Repair within Boyd's Comers, W. Branch or Croton Falls Res. O-Zoelegated Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION OWNER'S NAME MAILING ADDRESS APPLICANT TOWN /V l%j V TM # PHONE # ©o r rCar� Name & Relationship (i.e., 6wner, tenant, contractor) DATE �� FACILITY TYPE jsij PCHD COMPLAINT # PROPOSED. INSTALLER PHONE # 5�b -qa- Pik ADDRESS c� ((�- REGISTRATION /LICENSE # / / Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature and extent of the repair. jj ` � J MC '�! � � k- ra I, as owner,agree to SIGNATURE TITLE QtLrA e/'_ DATE 0`1 C) (owner) -tI?e ce- ntin.installcr.- agree tn. co.. W With +h "Dnd'ition -of this- p rmit fer. the septic - system- repair — -- - SIGNATUR TITLE DATE (installer) Proposal approved with the following conditions: , 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. No completed work is to be backfild until authorization to do so has been obtained from the Department. INTERNAL USE ONLY FT!;�roved El Proposal Denied ❑ In ector's Signature & Title y Date Expiration Date Repair proposal is in compliance with applicable codes Yes 0 No A COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 (off •a, r (1, IENT OF E A�LH T PUT-NA-M COUNTY DEPART '-N H DFVISIQ� OfF ENVIRONMENT -41 HEALTH SERVICES DESIGN DATA SHEET — SUBSURFACE SEVVAGE TREATMENT SYSTEM Owner: Address: Located at ;street;: Section: —Block Lot 3 Municipalitil: Watershed: &,s-v ga"'u-61 SOIL PERCOLATION TEST DATA Bate . of Pre-soaking: (00 Witnessed by- I N , Date of Percolation Test: p N, 0 les: 4 5 1 Tests to be iepeaied at same depth until apprommaielly -_qual oe-,colarion rates are 1 Mir, for min � -,16 incn r obtained a�. each percolation esF hole. < 3 C; ii h. < --. Mir.. for rruni, ,kil data to be submitted for review. ofho t made from tar i.t. Depth measurtrn c) 1, be .nis LO Depth to Time Elapse water from I Water 1 Per colation Hole No. Run No. Start — Time 11 around M_ d 0 Rate Stop (min.) surface in inches min/inch (inches) Start - Stop 11 106 _1130 1 30 1 6q q 2 I f!37- D1:07 3 - �- A 4 5 ii 2 3 4 5 2 3 4 3 N, 0 les: 4 5 1 Tests to be iepeaied at same depth until apprommaielly -_qual oe-,colarion rates are 1 Mir, for min � -,16 incn r obtained a�. each percolation esF hole. < 3 C; ii h. < --. Mir.. for rruni, ,kil data to be submitted for review. ofho t made from tar i.t. Depth measurtrn c) 1, be .nis LO ovi IVVU D ... . ..... . A, o1 06/02/2010 23:32 19737646404 ALLCOUNTY PAGE 02/02 APRI08 1008 11:08AM . FRO►.I- ENVIRONMENTAL HEALTH __ ..._...... SNERLITA AMLER, M% M$. FAAP Commissioner of Hialih I.ORETTA MOLINARI, RN, MSN Assoaiare Commissioner of Health 0432787921 DEPARTMENT OF HEALTH 1 Crtrieva Road, Brewster, New York 10509 REMST FOR FIFLD TESTING All information below must be Illy completed prior to army scheduling. E,NG.[NEER OR FIRM: )HONE T -144 P. M /002 P ^024 ROBERT J. 80NDI County txecwtve - - -- . -- -- - . ROBERT MORRIS, PC Director of Environmental Health DATE: ff02 a /)�o PERSON TO CONTACT,.—, �sd &4C __ s I'X ❑ NEW CONSTRUCTION EPAYR PROGPL&M ❑ ADDITION PROGRAM ,SON: DZEPS:0� PERCS: X PUMP TEST: 0 ROAD /STREET: G-a- a TOWN: fel4r SUBDIVISION: TAX MAP #: 3 -7,2 Yoo cX, 3� r 1 ,.3 NYCDEP CRITEPIA FOR JOINT R);i'I M &N Vn SSIN.G_Of SOIL TESTI11G YES Nri 9 o Proposad SSTS within the drainage.basin.of West Broach or $oyds Corner & Croto3iiFalls lie�ervoirs: __._.. .... _..._...- _--- ._.- •--- .____.�__ • ...___ _._..__.__.- --- _ -._ -- Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. O Proposed SSTS within 200 feet of a watercourse or a DEC wetland- 0 Proposed SSTS design flow greater than 1000 gallonslday or SPIES Permit required. Q Proposed SSTS for a Commercial Project It is the responsibility of the design professional to provide the above information prior to soil testing. The Department will determine the NYCDEP project status (Joint or Delegated) bared on the response. If you answered= to any of the questions, NYCDEP must witness the soil tests. This Departmant will coordinate a mutually suitable time for field teftino With the Design Professional and NYCDEP, If a project has been determined to be Delegated based an the above response and then subsequent information indicates NYC -DEP is required to witness the soil tests, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDF -P. FO r co u USE, ONL Y DATE: �% ` TU4E:_ COM - , T—S: ,t �z- ►'z- -s AM ftmrllLD?U7AtQMy Envir6nolcro1i Hevith (845) 279.6130 Fax (94 5) 27$ -7431 Watcr Supply Scetioe (845) 225.51186 Fax (845) 225-5412 Nursing Service+ (945) 278 -65$2 Far. (845)279.6026 WIG (845) 278 -6678 Nursing" Hama Care FMA (843)278-60S5 Early InterventiCrilPreachool (945) ?78 -6014 Fax (845) 279 -W8 ,v v, a fl Q,6/02/2010 23:32 ' T 19737646404 ALLCOUNTY PAGE 01/02 EARTH CARE /ALL COUNTY DIVISION INSTALLATION DIVISION - - 99 MAPLE GRANGE RD VERNON,NJ 07462 Date May 24, 2010 Number of pages including cover sheet 2 To: Putnam County Health Department Attention: Request for Field Testing RE; 8 Lavonia Road Patterson, N.Y. 12563 Tax Map# 372400 25.39 -1 -35 Phone 845. 278 -6130 Fax Phone 845- 278 -7921 CC: From: ED BOWER EXTENS: 112 INSTALLATION /REPAIR COORDINATOR e- rnail: ebower@earthcare.us Phone: 800428.6186 Ex. 112 Fax Phone: 973 - 764 -6404 I IXl Urgent �-- Foryou revlew-.-- _-°GNI ASAP -- - --- - - Z- - - To whom it may concern, Please review our application for request for field testing for the above referenced address. If possible please call me with some dates that your engineer's would be available. As in the past we will arrange to go out the day prior and dig peres and pre -soak, This is for replacing existing system in kind. Thank you and hope to hear from you soon. Ed Bower Installations /Repair Coordinator EarthCare /All County Division An RMS Company 1- 800 - 428 -6166 @ Extension 112 q, 19 -1008 10:11AM FROM - ENVIRONMENTAL HEALTH SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLIPIARI; Rte; MSN- Associate Commissioner ofHealth 8452TBT921 T -745 P- 004/005 F-487 RODERT J. BONDI County Fxeertixe — • ROBERT MORRIS, PE Director of F.rvviriom»emal Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 �1 ADDITION APPLICATION RESIDENTIAL ONLY STREET g L�VoNII+, pRIvE TOWN f KT_rer o? 1 TAX ZS• 39 -1' 35 NA 15 AK$ L. Af—h S. h V�t MS PHONE 8qS 259-38o I PCHD# � ME MAILING ADDRESS LI v a 101 A b RI U C 2A -r I 1 X,Su •✓ , I-1 Y. 12 S re 3 DESCRIPTION OF t. t V 19 4 F-., o •v% A O D 1 T t o &$1 ADDITION MAS,'E(, 6eorao*," EXeAN4.101V t NEW 8A+-tM CL�O^'t NUMBER OF EXISTING BEDROOMS 3 PROPOSED # OF BEDROOMS,_ 3 (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) " *Any addition which is considered a bedroom rcquires formal approval of plans (Construction permit) prcparcd 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 ares.tncluding basement) 3. Two sets of proposed floor plan (drawn, to-scale = with name., street and tax 4ap_ #). _. *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 Lie Cavironmenlal tteellh (845)271B-6130 fax(845)278-7921 Water Supply Section ('845) 225.5186 Fax(845)225-5418 Nursing Services (94S) 278 -6558 Fax (94S)2784026 WIC (845) 278-6678 Nursing Home Care Fax (845)279-609S Early intervention #reschool(845)278.6014 Fax(845)278 -6648 SEP-18 -1008 10:11AM FROWENVIRONMENTAL HEALTH Q SHER TA AiiMEX RD, W FAAP _ -- Commissioner of 4eallh— - - - I.®ItEVA R OLVIAM. RN, N1ESN Anodate Commissioner of Health 8451787821 DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 Town begat Bedroom Count T -745 P_005/005 F -407 Could &wudve Re: $AY-SA ZA S L Na v L-L) N S (Owner's Name) Tax Map P 2-5. Address: 8 L I V o of IA pr-I v E Town: P AT`f 6R-S o r4 Year Built: 9 S C According to records maintained by the Town, the above noted dwelling, in compliance with Tov%,n Code. is not 'in compliance with Town Code. The Leal Sedroom Count is: 3 This information has been obtained from: Certificate of Occupancy: Other: Buil ' Inspector Hate Environmental Halth (845) 278-6130 Fax (845) 278-7931 Narsine Services (845) 278-6558 Fax (845)27$-026 WIC (845) 278 -6678 Nursing Hame Care Fax (845) 278 -6085 Early Intervention/Preschod (845) 278 -6014 Fax (845) 276-6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Barbara S. Mullins 8 Livonia Drive Patterson, NY 12563 Dear Ms. Mullins: DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health October 2, 2008 Re: Addition- Approval — Mullins No Increase in Number of Bedrooms 8 Livonia Drive (T) Patterson, TM # 25.39 -1 -35 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 date October 2, 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.e., new low flush toilets,..- - resiriciors- 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. Respectfully, i Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:kly cc: BI, (T) Patterson 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 b SY 24001 25&39,r 1 -35 Y 4J ESTIMATE' .OWNER M V L..(..I /V cj��%�ieB R K f�- S�PaOP CLASS He 5 = NO ENTRY SEWER 1 NONE _ 2 PRIVATE 3 COMM/ PUBLIC SOURCE, WATER 1 NONE 2 PRIVATE 3 COMM/ PUBLIC ; LOCATION NIL LOCATION SCHOOL DIST i JOWNER 4 = OTHER 2 = RELATIVE 6 . NOAH UTILITIES 1 NONE 2 GAS 3 ELECTRIC 4 GAS & ELECTRIC a L I V a I A DRIVE,." 3 7 3 U.01. 3 e TENANT 8= ASSESSOR DATA SALE PRICE SALE DATE LOT SIZE SITE DESIRABILITY 1 INFERIOR 2 TYPICAL 3 SUPERIOR ! SALES INFORMATION CODES NEIGHBORHOOD TYPE I RURAL 2 SUBURBAN 3 URBAN 4 COMMERCIAL .9,0. 0,0 X ;900. CC: SALE'TYPE I = LAND ONLY NEIGHBORHOOD RATING 1 BELOW AVERAGE 2 AVERAGE 3 ABOVE AVERAGE TN 2 41.00. 3 JLAND & BLDG., ROAD TYPE 1 NONE 2 UNIMPROVED 3 IMPROVED LABEL - SWIS TAX OWNER PROP LOC IOC 8CH LOT CORRECTION AREA MAP 0 MAN Y ms SME VALID 0 = INVALID SALE AUDIT CONTROL SECTION I VIWO SALE QUALITY CONTROL REVIEWER I DATE (W � ®x O � _rn � / ,3 9 — / ` � ' REJECT CODE ASSISTANCE CODE _ ! -4- - q SIGNATURE BELOW DOES NOT MEAN CONTENTS'VERIHED ONLY THAT DATA WAS COLLECTED IN YOUR PRESENCE - t• ( SIGNATURE DATE COLLECTOR DATE (MMDDYY) TIME ACTIVITY ENTRY SOURCE C�2� �j26'1 C,`j" SALES INFORMATION SECTION I DATE jMMDOYY) SALE PRICE TYPE VAUD k i LAND BREAKDOWN SECTION LAND CODES EA31D0.BEV 2/91 NEW YORK STATE LAND FRONT FEET DEPTH ACRES SIIUARE FEET SOIL WtR NF INFLU• I AUDIT CONTROL CODES LAND TYPES SWIS /SBUCO DIVISION OF EQUALIZATION AND ASSESSMENT ACTIVITY ' 11 ORCHARD 372400 x 23& y..° DN0. OF - L —. 07 WOODLAND 12 REAR N =NONE L =LISTED OB WASTELAND 13 VINEYARD l 04 RESIDUAL 09 MUCK RESIDENTIAL, FARM AND VACANT LAND PROPERTY RECORD CARD 05 TILLABLE I M = MEASURED ONLY 10 WATERFRONT 15 LEASED LAND SITE PaOPEflTY Pi f (05) 01-10 1 TOPOGRAPHY N NORMAL SITE INFORMATION SECTION NUMBER O `' CLASSI (07) C UM- P! UT H AN L TOW : T V W'! 1P A T T E R S G N I SHAPE ENTRY 1 m INTERIOR INSPECTION (09) NEIGHBORHOOD CODE RESTRICTED USE LJ� 3 SWIS TAX MAP NUMBER CD 01-10 5 2 INTERIOR REFUSAL 3 = TOTAL REFUSAL ZONING CODE 01-10 5 WETNESS 7... SY 24001 25&39,r 1 -35 Y 4J ESTIMATE' .OWNER M V L..(..I /V cj��%�ieB R K f�- S�PaOP CLASS He 5 = NO ENTRY SEWER 1 NONE _ 2 PRIVATE 3 COMM/ PUBLIC SOURCE, WATER 1 NONE 2 PRIVATE 3 COMM/ PUBLIC ; LOCATION NIL LOCATION SCHOOL DIST i JOWNER 4 = OTHER 2 = RELATIVE 6 . NOAH UTILITIES 1 NONE 2 GAS 3 ELECTRIC 4 GAS & ELECTRIC a L I V a I A DRIVE,." 3 7 3 U.01. 3 e TENANT 8= ASSESSOR DATA SALE PRICE SALE DATE LOT SIZE SITE DESIRABILITY 1 INFERIOR 2 TYPICAL 3 SUPERIOR ! SALES INFORMATION CODES NEIGHBORHOOD TYPE I RURAL 2 SUBURBAN 3 URBAN 4 COMMERCIAL .9,0. 0,0 X ;900. CC: SALE'TYPE I = LAND ONLY NEIGHBORHOOD RATING 1 BELOW AVERAGE 2 AVERAGE 3 ABOVE AVERAGE TN 2 41.00. 3 JLAND & BLDG., ROAD TYPE 1 NONE 2 UNIMPROVED 3 IMPROVED LABEL - SWIS TAX OWNER PROP LOC IOC 8CH LOT CORRECTION AREA MAP 0 MAN Y ms SME VALID 0 = INVALID SALE AUDIT CONTROL SECTION I VIWO SALE QUALITY CONTROL REVIEWER I DATE (W � ®x O � _rn � / ,3 9 — / ` � ' REJECT CODE ASSISTANCE CODE _ ! -4- - q SIGNATURE BELOW DOES NOT MEAN CONTENTS'VERIHED ONLY THAT DATA WAS COLLECTED IN YOUR PRESENCE - t• ( SIGNATURE DATE COLLECTOR DATE (MMDDYY) TIME ACTIVITY ENTRY SOURCE C�2� �j26'1 C,`j" SALES INFORMATION SECTION I DATE jMMDOYY) SALE PRICE TYPE VAUD k i LAND BREAKDOWN SECTION LAND CODES LAND FRONT FEET DEPTH ACRES SIIUARE FEET SOIL WtR NF INFLU• LAND TYPES TYPE I FTTNG TYP ME ENCE % 01 PRIMARY 05 PASTURE 11 ORCHARD 02 SECONDARY 07 WOODLAND 12 REAR r 0 03 UNDEVELOPED OB WASTELAND 13 VINEYARD l 04 RESIDUAL 09 MUCK 14 WETLAND 05 TILLABLE I 10 WATERFRONT 15 LEASED LAND SOIL RATING i INFLUENCE CODE P POOR (05) 01-10 1 TOPOGRAPHY N NORMAL (05) 01-10 2 LOCATION 0 GOOD (07) 01.04 3 SHAPE (09) 01-04 4 RESTRICTED USE 1 1 (11) 01-10 5 VIEW 113) 01-10 5 WETNESS 7... ' WATERFRONT TYPE i POND 3 LAKE 6 OCEAN irm XCHIT�cf - " - Joe Mansfield, Peq5tered Architect- 6 Horner Prlve Brewster, New York 10509 ( 845) 259 -3801 www.jfmarchitect.com September 19, 2005 Mr. Joe Paravati, Assistant Public Health Engineer . Putnam County Health Department 1 Geneva Road Brewster, New York 10509 Re: 5 Livonia Drive — Verification of Bedroom Count Patterson, New York 12563 Town of Patterson - Tax Map Number: 25.39 -1 -35 Dear Mr. Paravati, Attached please find the following: • One money order payable to Putnam County Reath Department ($100.00) • One Town Legal Bedroom Count Certification ® One Application for verification of bedroom count .One copy of Tax Assessor's card for the above referenced address *Two signed and sealed existing condition & proposed construction drawings ® One copy of the plot plan with existing septic and well locations indicated The current owner is proposing to expand the existing living room, relocate the kitchen and expand the master bedroom with a new bath room.. The existing three bedroom count remains the same. The Building Inspector will not accept the construction drawings until the Putnam County Health Department verifies the bedroom count. Please review these drawings to verify the bedroom count. The Town of Patterson's Tax Assessor's Card states the dwelling has 3 bedrooms. The existing condition drawings and proposed construction drawings show 3 bedrooms. Please call me if you have any questions. Sincerely, 9a-k- Illy Joe Mansfield, R.A.