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Home My WebLink About0937DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.40 -2 -2 BOX 10 ME Loss W IN IN IN � i , IN fIN '' �� col i r ,. IN I NJ -. lAmm 00937 Iff rn1 SITE LOCATION OWNER'S NAME MAILING ADDRESS PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES Internal Use Repair Permit issued in last 5 years Repair within Boyd's Comers, W. Branch or Croton Falls Res. within 200 ft. of a watercourse or DEC - mapped wetland TOWN n #9- ;- i �l LJ of In Watershed Delegated ❑ Joint Review I TM #-A6-• PHONE # Z`% Ir- q / q.- APPLICANT �u ��tis Name & Rellationship p.e., o ner, tenant, contractor) DATE l/ FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER PHONE # ADDRESS Q t/ �rs REGISTRATION /LICENSE # /O S"7 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. I, as owner,agree to the conditions stated on this form y l/ SIGNATURE Segoarct& ooag g_ TITLE DATE (owner) i, the3 Se'iptii; iiIstz�iler, agree to cornply-wiith 'ilia conditions of this permit for fns septic system n3pair, l - SIGNATURE r TITLE DATE 2- / (Installer) 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 dupbcate shi wNtp: 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 backfilled until authorization to do so has been obtained from the Department. INTERNAL USE ONLY Proposal Approved Proposal Denied ❑ Inspedo?r9gRgfure & Title v Date Expiration Date Repair proposal is in compliance with applicable codes Yes 0 No O COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2107 4 August 9, 2011 mi ex. plastic Junction boxes R � 1 36' 1 32' 2 38'6" 2 45' 3 51" 3 57' 4 56' 4 58' 5 40" 5 32' 6 46' 6 33' 7 50' 7 54' 20', i 1 i B tank yrds bankrun DS Bio Diffusers Butler 15 Irby Rd Patterson NY .ia►�w/oaLL EXCAYAVEMS CONTRACTORS 845 —�79 -8809 www ty�da/ /s ®pt /o.00m PUTNNAIN4 COLNITY DEPARTMENT OF HEALTH DItiZSION OF ENNIVIRONFIVIENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATIMINT S YS-17EM Owner; Address: Zt;'- Located at (street): 7',V1 _—" Section: Block Lot Municipality SOIL PERCOLATION TEST DATA Witnessed by: Date of Pre - soaking: Z;L-0 Zzz Date of Percolation Test:- ZZOA0, Hole `+.o. Run No. Time Start - Stop Elapse Time (min.) Depth to water from 1 ground g, surface (inches.) Start - Sto'p Water level drop in inches P ercotatio n Rate min/inch 30 2 .30 I 0 .3 Im Y 6 - 3o I �Lo ;L 1--51- 4 1- 5 2 4 2 3 4 5 Noces: G. L. 0'. 5, 1.0' 2.0 3 3.5' 4. C' 4.r V e 7.0' DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE # � HCLZE # HOLE 9 HCLZ-: 9 LidicaLe levy �-lat w1nich poundwaier is encountered Indicate level at w� -ich mottlin is obse-r,--.d A I -I * - being dici.,z I.ev--t to which water le uses af-,-, n- ,Coun.tered Den hc.le obser-vauons mad-- bv: ..Daie ;-Pozzz- 0 - f f Desia:ll Professionial N7 amd Address: ;z * �; P at Sheet of PUTNAM COUNTY DEPARTMENT OF HEALTH+: FIELD ACTIVITY REPORT � � : ► it �' .+ Street Town State Zip PERSON IN CHARGE / OR TNTER VTFWRT): %vYJ� nstP: 4 ALO Z zz Name and Title TYPE OF FACILITY: :&�, °� FINDINGS: 41e.1/ oj�r 100 *,Oqk 0Ar ,— Signature and Title R FPnR T R F.(- FTVFT) BY., I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Jun 09 11i 01:51 p Tyndall SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health (845) 279 -5989 p.1 - - - ROBERT J. BONDI - County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 RE VEST FOR FIELD TESTING ROBERT MORRIS, PE Director of Environmentai Health All information below must be fully completed prior to any scheduling. DATE: ENGINEER OR FIRM: PERSON TO CONTACT: ❑ NEW CONSTRUCTION ❑ RE AIR PROGRAM ❑ ADDITION PROGRAM REASON: DEEPS: 2 PERCS: Z' PUMP TEST: ❑ ROAD /STREET: + .5 -L r h TOWN: �GL �� i" Son SUBDIVISION: -$WNER:. L 4-te- TAX MAP #: 91-!—>i VO -- 2 ` 2- LOT #: NYCDEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING C1N - Proposed SSTS within the drainage basin of West Branch or Boyds Corner & ❑ �Croton Fails Reservoirs. / Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. 13 V"- Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. 13 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) based on the response. If you answered yes to any of the questions, NYCDEP must witness the soil tests. This Department will coordinate a mutually suitable time for field testing with the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response' and then subsequent information indicates NYCDEP 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 NYCDEP. DATE:FOR COUNTY USE ONLY TIME: 9 i COMMENTS: REQ. Fl01tFMLDTESTR*rLV 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 pNd) °^ 2 ?. a y t § t ♦rF 5 x o¢7 gv 17~` S AdH , � Y � UH � • z_ D6 c �� . satr� <,�z�t�a ��" z , s � '� Q?'> ;( N�'N,• y y V �t�L3 jk {TfiY C f ANAY an �' o u� N3llbr p RLIN RRD oa' � ` RE RD .VIGTO k! ly�PO a � M {`"{ NRl- RD UTI 091 ANS o FAIR ILIE D�O6.. A a, v� CaH )d ; w a 4r RD 13 0JP i w p NEB $¢ O WI K � g NARD RD Q g� PL ? OUT. cc O TER PL sru nMN PL py ��a � as � ° � . • �� : x II HAM + �V G Ob 0 ��N RD �p ' �; r� t F . H ►lW {6W O P I RO C LL O QRD ZW OH ¢ > v>:. 6 ►- a a C�. frd SWE fS3 OdHlio RO ti�j Q: coo 1,(�I 0& = Np Q ID O¢ MADI CC n � ONE= ml pNd) °^ 2 ?. a y t § t ♦rF 5 x o¢7 gv 17~` S AdH , � Y � UH � • z_ D6 c �� . satr� <,�z�t�a ��" z , s � '� Q?'> ;( N�'N,• y y V �t�L3 jk {TfiY C f ANAY an �' o u� N3llbr p RLIN RRD oa' � ` RE RD .VIGTO k! ly�PO a � M {`"{ NRl- RD UTI 091 ANS o FAIR ILIE D�O6.. A a, v� CaH )d ; w a 4r RD 13 0JP i w p NEB $¢ O WI K � g NARD RD Q g� PL ? OUT. cc O TER PL sru nMN PL py ��a � as � ° � . • �� : x II OKNE 'SITE MAIL PERS( DATE TYPE FACILITY PROPOSED INSTALLER PHCNE Proposal (Include sketch locating*,all adjacent wells): ' -NOM -: ROpair-must be in same 1666Ltion and of same type as original sewage disposal system. Different location may require submittal of proposal fran licensed professional engineer or registered architect. i-?- ti r-ja f-l-o k��Lj V-- I/V a 0/ A xlv 7 Proposal approved Proposal Disapproved tions: ,PLte 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 caqponents tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank,, three precast 61 diem. x 61 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. as owner,, or reported agent of owner agree to the above conditions. SIGNATURE GU t, "I, TIME DATE 00MS: Mite GMD); YeUcw Mm ESL); Pink (flia3nt) I / /* BRUCE R. FOLEY Public Health Director J & C Bulter 15 Isby Rd. Patterson, NY DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., 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 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Dear Mr. & Mrs. Bulter: May 30, 2002 Re: Addition- Bulter- 15 Irby Rd. No Increases in Number of Bedrooms (T) Patterson Tax # 25.40 -2 -2 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 form this Department dated May 30, 2002. 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. 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 yours, William Hedges WH:kg Senior Public Health Sanitarian cc: BI BRUCE' R. FOLEY --T -- - - 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 (RESIDENTIAL ONLY STREET Z TOWN TX MAP# o2..Ss ZD--o2 62 r NAME PHONE t j o2 PCHD# �— — l MAILING ADDRESS ,�S DESCRIPTION OF ADDITION N- • ! � OF EXISTING BEDROOMS_PR/ 0$D # OF.BEDR MS_ (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) *Any addition which is considered a bedroom requires formal approval of plan's (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 - 61.30. 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 P- *- BRUCE R FOLEY' Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate 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 (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Gentlemen: i Re: c/ Residence Tax Map Town According to records maintained by the Town, the above noted dwelling IS - IS NOT in compliance with Town code and the total number of bedrooms on record is This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD:_ OTHER Building Inspect r BFhouseguidelines fill '�' V•%iTf 0/17 _ T-/i- '�_.- -_ -'T� -- - -1 - -- - -- i - -� I i - -� - - -- - -- -- -- -- - -- - TI � I I 1 it T ON ► , 1 1 ' I 1 I I � I _ - -r-r- It I Ail, -LBOIJ BEDROOM EALAINS- CO PR -D OR DROO I ol or,ONO 116US� -B DROO PIIANS EDROO AT APPROVE FqMP%— T S 11, — N D FOR .--.I t & T -�ls- 'or IL _-A --- - -- ---- --------- ft(T C OUNTY DEP ARTMENT ol, m -A fibusi PrA NIS APAROVED m OUNT 0__ NTT. 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