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HomeMy WebLinkAbout1063DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.49 -1 -2 BOX 11 01063 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR Internal Use Only PERMIT # U❑ In Repair Permit issued In last 5 years ❑ Not in Watershed 0 Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland Joint Review SITE LOCATION a� . S It �IWN _Pol*e,^Sd,7 T i y q� OWNER'S NAME A AAe r a, i PHONE # MAILING ADDRESS 4- PCA APPLICANT V r o l Name & Relationship (i.e., er, tenant, contractor) DATE 0 / `%l (7 FACILITY TYPE %� PCHD COMPLAINT # PROPOSED INSTALLER t J PHONE # . $ cl -T-iSG r 5791 -1 ADDRESS P� ® ��i Ali /li REGISTRATION /LICENSE # Proposal (Include a separate sketch locating the hou §e, property lines, all adjacent wells within 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 L -f- I n °1-- s"141/-2 s a5 ©aS IeS /I I, as owner,agree� a conditions stated on this form LP XSIGNATURE�� �i1r. �i-Gt c'GCi TITLE �'Lt�'I..PiC- DATE _ l / p (owner) % I, the septic installer, agree to comply with the conditions of this permit for the septic system repair SIGNATUR ITLE DATE 9/3/ C (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 backfilled until authorization to do so has been obtained from the Department. 11\ 1 L1,1111ptL war. WRL.1 Proposal Approved Proposal Denied ❑ Inspector's Signature & Title Date Exp ation Oa to ,Repair proposal is in compliance with applicable codes Yes H No O COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 Michael J. Nesheiwat, M.D. Interim Commissioner of Health Robert Morris, P.E., MPH Director of Environmental Health Department of Health 1 Geneva Road, Brewster, New York 10509 (845) 808 -1390 MaryEllen Odell County Executive TO: NYCDEP DEPARTMENT OF ENGINEERING AND DESIGN REVIEW ATTN: -D A ti nl `/ S 146T> L o FROM: 4L—SWe 2 ^� DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM JOINT REVIEW PROJECT: %lc Cori e LOCATION: 2_ p s/� S/4y -2.1F, X21 y TO WN: FP ii t� wit/ TM # 1f 9; - / - NOTICE OF COMPLETE APPLICATION: DATE: ❑ Within the drainage basins of West Branch, Boyds Corner, or Croton Falls eservoirs Within 500 feet of a reservoir, reservoir stem or control lake. ❑ Within 200 feet of a watercourse or a DEC wetland and appearing on a subdivision map approved after December 31, 1992 ❑ Design flow greater than 1,000 gallons /day. ❑ Commercial SSTS. SEPTIC REPAIR JOINT REVIEW Environmental Protection New York City Department of Environmental Protection SUBSURFACE SEWAGE TREATMENT SYSTEM REPAIR DETERMINATION Pursuant to the authority granted under: Article 11 of the New York State Public Health Law; Rules and Regulations For The Protection From Contamination, Degradation and Pollution Of The New York City Water Supply and Its 'Sources, 15 RCNY Section 18 -38 (or Chapter 18); and 10 NYCRR. Appendix 75 -A Wastewater Treatment Standards - Individual Household Systems; Putnam County Septic Repair Program Plan - March 2005. DEP Project# Tg /l PCHD Repair# 7 — l6 Site Location: 2 2,0 T.M.# el 4 — lam! Z Reason for Joint Review: Drainage Basin 200' of WC/Wetland Repeat Repair in 5 Yrs. Name of Owner: Owner's Address: �J ctijv t!e Drainage Basin of Project Site: Installer:ri (!� ✓ef�- -rQp f�v y���.! General Description of Sewage System Repair: -�"✓�' 4 « %Q GJ U`'"' ,f �^-� . �f to /d+i. {tea Q'h 3 3 a xL 6-i?i J 4 H+.¢.. l r�L�iPr�.., Cif e }Gr!'C� Y �a, �� ✓P i�t ,/''fF �`•1. Dates of Site Inspections and Soils Tests: Approved *Incomplete Delegated * *Denied *Required: Soils Tests Repair Sketch WC/Wetlands Wells Other. * *Reason Dete on made by: Engineering Division Date Owner: Address: 2:Z0 L,ftkf,,% pre Drr Located at (street): TM #2-5, Municipality: ?0Ae?Sm►7 Watersbed: "575- 04C-H SOIL PERCOLATION TEST. DATA Witnessed by: ( G Date of Pre-smaking: !v15-116 Date of Percolation Test- Date Flo. Hole ' -depth (Inches) Run No. Time Start —Stop Elapse Time (nain.) Depth to water from ground surface (inches) . Start - stop �$ger level drop in inches Percolation . Rate Min/inch 1 - '9"32 S A I - 3 2 3 4 0 + — 0' '16. -- 02 3 . 3 5 1 2 3 4 5 r 1 2 3 4 5 . 1 . 2 3 5 Notes: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each. percolation test hole. ,(i.e., < 1 min for 1 -30 min/inch, < 2 min for 31 -60 min/inch). All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97, pg 1 of 2 Sheet t _of PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FIELD ACTIVITY REPORT ' - NAM P.: ;e —e- 0g4U,- Tel: - annRF.cc� 224 444r- . 1.�ve, Street Town State Zip' PERSON IN CHARGE nD TT�TT�T?'(IT��xT�ll, Name and Title ' TYPE OF FACILITY : 5�.•�ca% �oe�, / Z,�..��� _ FINDINGS: Signature and Title RFPCIRT RFC FTVF-n BY., I acknowledge receipt of this report: SIGNATURE: 02/96 Title; Rev. i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH -SERVICES.. REQUEST FOR FIELD TESTING ATTENTION: ❑ Michael J.`Budzinski, PE ❑ Joseph S. Paravati, Jr. All information must be Lull y completed prior to any scheduling. Date: r� -• Engineer or Firms e-3 e, Phone # �•' 6 S��7��� Reason:. L!Deeps l SYeres Road /Street: �dt� p �1(a9� 1✓ P' Town: �(,�Ll •eY. Tax Map #• 4� Subdivision: Lot #: Owner: C ' ❑ . Project not within NYC Watershed r J t NYCDEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING YES NO ❑ ❑ Proposed SSTS within the drainage basin of West Branch, Croton Falls, or Boyds Corner - reservoirs. ❑ ❑ Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. ❑ ❑ 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. ❑ ❑ Proposed SSTS for a Commercial Project. It is .the responsibility of the design professional to provide the above information prior to soil testing.. This 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 Professions 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. FOR COUNTY USE ONLY DATE: TIME: COMMENTS: . (FIELDTrST) Putnam County Department of Health - Division of Environmental Health Services SSTS Repair — Final Site Inspection Date: v X 2. Inspected by: , TZ.-C f Installer: 5my,,r`s t Street Location: ,226 Ga-ke -s"6t b r, Owner: cc�r Town: aq, s o o Repair Permit #: jZ- 1117-/6 TM # y g, 1. Was System inspected? Yes FV ` No 0 If not, explain: . '2. Type of System: Conventional ❑ Alternate ❑ Comments: 3. Septic Tank Yes No N/A Comments a. Septic tank size ,000 .. 1,250... other ..... b. Septic tank installed level ...................... 4. Distribution Box a. All outlets at same elevation (water tested) ... 5. Junction Box — properly set ........................... 6. Trenches a. System completely opened for inspection b. Length required 1 Length installed 3 6 c. Pipe slope checked ... ............................... d. Installed according to plan ...................... e. Size of gravel % - 1 '/z " diameter clean ......... f. Depth of gravel in trench 12" minimum ......... g. Ends capped .... ............................... 7. Pump or Dosed Systems 8. Sewage System Area a. SSTS Area located as per approved plans b. Fill section — c. Distance from water course /wetlands (00 �o �a.�s �s:�• {j,`.fe 9. Overall Workmanship a. Boxes properly grouted and installed correctly ........... b. Backfill material contains stones ul" diameter ......... c. Curtain drain & standpipes installed according to plan d. Curtain drain outfall protected & dir to exist watercourse e. Erosion control provided ............................ COPIES: PCHD; Owner; Installer RFSI Rev - 011916 -- ° -., I I ��.,�,�, ivlaj)s oogl * r` apS 41028-32.9"N 73 °32'09.7 "W Page 1 of 1 M) Imagery ©201,6 Cnes /Spot linage, DigitalGlobe, New York GIS, USDA Farm Service Agency, Map data ©2016 Google 500 ft a --a 41028'32.9"N 73 032'09.7 "W 41.475812,-73.536017 https: / /www.google.com/maps /place /41 % C2% B028' 32 .9 %22N +73 %C2 %B032109.7 %22W/... 9/1/2016 j, SHERLITAAMLER, MD, MS; FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health July 13, 2009 DEPARTMENT .OF .HEALTH 1 Geneva Road. Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Ms. Angela Macri 220 Lakeshore Drive Brewster, NY 10509 ' Re: .'Addition- Approval — Macri No Increase in Number of Bedrooms 220 Lakeshore Drive (T) Patterson, T.M. # 25.49 -1 -2 Dear Ms. Macri: 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 13, 2009. 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. Before the addition is constructed, the existing septic tank is to be relocated from under the dining room floor to an area 10' from the existing foundation. A separate repair permit is to be-approved. by this Department and a licensed septic system contractor is to execute the repair.. 3..—The area.of the.existing gewage_disposal.system, .and- its'expansion.:area,.must be:maintained.. :... .._... .4. All plumbing fixtures must be updated with water saving devices,- i.e., new low flush toilets, restrictors for shower heads and faucets, etc. 5. 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 meat your convenience. . Respectfully, 4oseph S. Paravati, Jr. Assistant Public Health Engineer JSP:kly cc: BI, (T) Patterson Environmental Health (845)278-61')0 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 Nursing Home Care Fax (845)278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 9 12 I &iwll P-mu rnZ F-1 r 'I'LL p—, 7r, 11 m (J) L ,, m Ix0 1 p 11 V: 3-X Z. mx In rS- SLOPE. -""a ------ jI K a =C:3 rn m (11 r� IX COUNTY DEPARTMENT OF HEALTH r �46USE PLANS A PROVED FOR BEDROOM COUNT ONLY9 BEDROOMS Y —19 ALL SUBSEQUENT REVISION/ ALTERATIONS TO THESE HOUSE PLANS MUST BE SUBWTTED TO THE PCDOH FOR APPROVAL. ATURE & TITLE 711 3 /0 e 5 DATE ,4 9"..011 �N c� rcy NEW 1 CLOSETS /f I I tip' i DA5HED LINE DENOTES' POINT OF LG HT 00 N�� EN I STEP MASTER NEW BALCONY 12' -42" a uEYANTMENT OF HEALTH ROUSE PLAN) APPROVED FOR BEDROOM COUNT ONLY, BEpROO�ls. ) �.-/ 9 I AU.SUBSEQUb'T riEvisTONJALTERATTONS TO THESE HOUSE 'NS MUST IE SUB117ITTED TO THE PCDOH FOR APPROVAL NEw rrlt =r� —I 5KYLT.1 i I5' -(I 5'_p" II'- II'.Is YLT.I NEW BATH O OFFICE M f/ no- 'IT. (1) STEP UP ! BALCONY t OPEN TO BELOW 1/4" Lt C 1 c 2 T z 1 ll tl N cr I- o° E -- - -_ - -- — - - I - -- ------- Ex DECK 5T5 a. OWK JETS ex oeac,BTs VERIFY IN RBA I VERIFY IN FIELD I ERIFY V_ MReIA I r 9 u_i I— EXIST. VIF II VERIFY IN R8D ( I' Ex 0.b J9TS Ex Glb J9T5 —� f .-. — — 2 both* M 3x8016' m li I I 1 rt- -4 - I __ EMT. �` _ —_ -- _ -- - - - - -- =� I 41-0• ,1 I I it 1 111 II I II I i 8� II I I 1 I 11 I II I� I 1 I P TNAM COUNTY DEPARTMENT OF HEALTH -44 WSE PLANS APPROVED FOR BEDROOM COUNT ONLY, BEDROOM ALL SUBSEQUENT REVISION/ ALTERATIONS TO THESE HOUSE C'l,A S MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL, _ a 70/05 SI.G ATURE ITLE DATE • A ,:o SHERLITA AMLER,.MD, -MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Health �e r --ROBERT J. BONDI County Executive ROBERT MORRI; Director of Environs DEPARTMENT OF .HEALTH 1 Geneva Road,. Brewster, New York 10509 ADDITION APPLICATION. RESIDENTIAL ONLY STREET �(�= 1 10A TOWN AX MAP # NAME PHONE PCHD #—. MAILING ADDRESS Z) 11M1 % DESCRIPTION OF ADDITION , - ,NUMBER OF E STING BED Q'OM PROPOSED # F BED OMS (FROM CERT. OF OCCUPANCY OF 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 know. 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 (345) 275 -6130 Fax (845) 273 -79 2_7 Water Supply Section (345) 225 -5186 Fax (345) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 27"026 WIC (845) 278 -6673 Nursing Home Care Fax (845) 278 -6085 Early Inteivention /Preschool (845) 225 -2847 Fax(845)225-1,580 d SHERLITA AMLER,INID, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Health ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental . DEPARTMENT OF HEALTH. 1 Geneva Road, Brewster, New York 10509 J Town Legal Bedroom Count Re: !" Gt �✓ l ��-� i (Owner's Name). Tax Map #: Address: U �- Town: . �,�- �e�2SoN. Year Built: 19 YO According to records maintained by the Town, the above noted dwelling,_. Is in compliance with Town Code. Is not in compliance -with Town Code. The Legal Bedroom Count is: This information has been obtained from: . Certificate of Occupancy: • • . • • /! Date, 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) 228 -2847 Fax (845) 228 -1580 A' 11, i4 il-j r L)-C) L 44.q- A'Gtnatl'), G(ke z pt' 7 Pdg� I 0r �fzj Liber r TZ r 669, p-R, R ge 72, pin �fence 4'44'06)" 04 I W/,-c T -feat cornw," 2' W. ferrCA A)-V' • CL E3 13 a 0 a cl wood concrete ch omber 00 "Id pumr.% , lk -te concrl p of. . ENCE FRAM RES,,'D Z' Ca TYPE 6. OPEN Vk U, p;*n founa �ron pfps mon. I g, ti $IO'le fet0j;7ing wo"! wall' o rtm�,,onry 2 .06 3' 0" 7 /V 3.84 00 i-e C" C, �ODL- i r SA a V'J T�ye*J, ` O l i f net$ � � � � � _ .f � • _ `j �. _ ,._ / 10. V'J T�ye*J, A-1 ya 4o eil * to QA Vvu p VA ",q L*,�e coG SHERLITA AMLER, MD, MS, FAAP L a ROBERT J. BONDI Commissioner of Health * * County Executive LORETTA MOLINARI, RN, MSN�w Y O�� _ ROBERT MORRIS, PE Associate Commissioner of Health Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 June 22, 2009, Angela Macri 220 Lakeshore Drive :Brewster, NY 10509 Re: Proposed Addition — Macri 220 Lakeshore,Drive (T) Patterson, TM # 25.4.9-1-2.. Dear Ms. Macri: The application for the above referenced project is incomplete. Please provide the following: 1. - Existing floor plans showing the house in its present state. 2. A walk through of the house is to be.conducted by a representative of this Department. Please contact us to set up a mutual time for inspection. Review of your application will continue once the above documentation is received. Please do not hesitate to contact us if any q iestions arise. . Sincerely, ��s✓ Joseph S. Paravati, Jr. Assistant Public Health. Engineer JSP:kly 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 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580