Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
1619
DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34.13 -1 -8 BOX 15 ti ; ' i i IL 6m .01 r MIT r' MT 01619 _ PUTNAM COUNTY ' DEPARTMENT OF HEALTH _... _._ ._ _.... _. _.. DIVISION..OF - ENVIRO _ _ _ .�.. �....:.. ..vo _ :NMENTAL ..__., �. _. , -. _._, . _ ;.: HEAI,T SERVL. ES u: CERTIFICATE OF CONSTRUCTION COMPLIANCE PCHD CONSTRUCTION PERMIT # A °'L1 1 - Dry Located at r9l'- PGPr Pk% — /1r4ff FOR SEWAGE TREATME TEM jD 3 (� D Town or Village P A"TIE-r' Owner /Applicant Name FOOD Tax Map gig-+ iii Block Lot 6 Formerly Subdivision Name AN G 1 b 1-1 (14 f l I Subd. Lot # 4' Mailing Address 1:Rf1i F-mp -- 0 if Zip 1056- Date Construction Permit Issued by PCHD 0 6 - ),I - 0(0 Separate Sewerage System built by AF—w- • "1J614; SON► Address pob 414 fAri EMotJ ti� MM Consisting of 1 © o ts Gallon Septic Tank and ) 6 4 i-r= , A¢,"2 - 14l-I644 Other Requirements: W 14�On 1A Water Supply: Public Supply From Address a; or: Private Supply Drilled by JE5Q/VT1 Hb Address .'...Building. Type 1 H as . ero.s.i o.n..c.o.n. _ tr ol.been .completed ?..- .a--- -.... _16-j:::::_.�.._ .... .....,..�..;'. Number of Bedrooms ' Has garbage grinder been installed? �0 I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulati of the Pu am County p ent of Health. Date: l 0 Q Certified by P.E. R.A. �j 9 be i ofessional Address )V - b IOSfl License # 6 (, 1 i,' 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 sewage treatment system shall become null and void as soon as a public 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 Public Health Director, such White copy - HD Y change is necessary. Title: - Building Inspector; F Date: ::Q - Design Professional Form CC -97 PUTNA.M COUNTY DEPARTMENT OF HEALTH ]DIVISION Off'. ENVIRONMENTAL HEALTH' SERVICES GUARANTEE OF SU13SURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building PF-r► - Li1 Ar► It�L Building Constructed by Tax Map B lock Lot TownNillage L Location - Street Subdivision Name D 4- Building Type.' Stibdivision Lot # I represent that 1. am wholly and cbmpletely responsible for the location, workmanship, material, coristrnrt;tiori and`draina`ge of the sewage - reatment.system serving the above- described` property," and- ` that is 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 'Systein consiructed by ' me which fails, to operate fora period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment 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.. The undersigned further agrees to accept as conclusive the determination of the Public Health Director 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: onth - Sv°%. Day3O Year General Contractor (Owner) = signature Corporation Name (if eorpbratition) -et ol J§ StateoAeonte,L Zip Signature:" Title: /,:,/f es: x/'s 1. 11-11e, Corporation Name (if corporation) Address: PC% �?Ox l c�_6 StateP M& Zip Form GS -97 k October 25, 2006 Michael J. Budzinski, P.E. Putnam County Health Department 1 Geneva Road Brewster, New York 10509 Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 Tel: (845) 279 -4003 Fa;i: (845) 279 -4567 Email: hnengineer @aol.com RE: Individual SSTS Compliance / Addition - James Rood 512 East Fair Street Patterson, NY T.M. # 34.13 -1 -8 Dear Mr. Budzinski: Enclosed are the following: 1. Five (5) prints of Drawing S -4, "As Built SSTS ", dated 10/25/06. - 2. "Certificate of Construction Compliance for Sewage Treatment System ", dated -10 /25/06: - ... ..., - - ...... _.._..__... ......_..__ .......1. ... ... ._ .._. - ....._ _ _ — ....,.... _... 3. Three (3) copies of "Guarantee of Subsurface Sewage Treatment System ", dated 10/25/06. 4. Application Fee in the amount of $300.00 payable to Putnam County Health Department. If there are any questions concerning the enclosed, please call. Very truly yours, Harry W. ichols Jr., P.E. HWN:gav 05- 071.00 SHERLITA A1Y LER, MD, ISIS, D±AAP Commissioner of Health 1LORETTA MO LINARI, RN, MSN Associate Commissioner of Health Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Dear Mr. Nichols: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 July 25, 2006 R®HERT J. H®NDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Proposed SSTS Revision for Rood @ 512 Fair Street (T) Patterson, TM# 34.13 -1 -8 This Department has received and reviewed the submitted application and plans for the above referenced project and the following comments are offered for your consideration. 1. Note # 3 under the pump pit detail is to be deleted. 2. The distribution box detail is to be revised to specify a minimum of two (2) feet of solid pipe out of the distribution box. Upon completion of the above, this Department will continue its review. Kindly advise us if mere are -any questions.. MJB:cj l I e. Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAG T ENT SYSTEM PERMIT # A' ��l 0 Located at Ji�- �9't� l�-- ��1�"I� � Town or Village PATTT -L ©� Subdivision name ANWOW Subd. Lot # Tax Map Block 1_ Lot g Date Subdivision Approved 11 (61 Renewal Revision_ Owner /Applicant Name J A, H� �-tOD Date of Previous Approval 11 1,1l0 Mailing Address 121.L I N6 FIJI �L- j5T- � Ci��E�l N�Y Zip 10SI Amount of Fee Enclosed t$ 15mj Building Type Lot Area No. of Bedrooms Design Flow GPD �-©'0 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of I OQO gallon septic tank and i- b Other Requirements: To be constructed by -tbi) Address Water Sup&: Public Supply From Address on __ .. . _ . ..PP Y . y. u_. P'rrvate Su 1 "DrilIed- X " ".,�' �' i-1 V� r Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will 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 said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. „ Signed: YIQLA Address 616- 0 P.E. R.A. Date ,T5'P- t37 1O'-50(License # '561 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only. Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY .DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AITI'HORIZATION ICE: Property of 7xAve7 �Da) Located at Ail, 0�t WK TN PAT-MM Dt` Tax Map .# Subdivisionof��IOV� Block d Lot Filed Map # � 05j - Date Filed I Subdivision Lot # . Gentlemen: This letter is to authorize W b O L ALL JP - a duly licensed Professional Engineer or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article445 and/or 147 of the Education Law, the Public Health Law, and the Putnam CAuft. Code. _ _� ._.. _ .... ,_ ....._..... ti:. _... . U Countersigned: P.E., R.A., # _ Nor A Mailing Address X05 O-'�'`�'''� State zip.Q� Telephone: ZACZ� 1 Very Lru - - �- 'r Signed: Mailing Address: State Telephone:, Form LA -97 larry..W. Nichols Jr., P.E. . Patterson Park, , * Suite ' , 106 2050 Route 22 Brewster, NY 10509 '845) 279 44P0$, Fax. ONSULTING SITE ENGINEERS . .......... ....... JOB No. ?-MO .. : SHEET No. COMPUTED BY DATE CHECKED BY -DATE 14EAb _U6X.jAv C 4-4,m 13 E R -130 T-ro M _.EL_F_:v' 5-rAm c- Ab: .................. ....... 14, OW L9 Tdje!a ✓L -j T . ...... .... 7 . ........... 14 ..................... . ......... A- UAA A ---------- ........ ........ . . ......... Harry W. Nichols Jr., P.E. JOB No. Patters on.Pa'rk; Suite 106. . 2050 .Route 22... , .. , SHEET No. 2 ; °OF 'Z Brewster, NY 10509 COMPUTED BY ft� DATE 0 6'�JO'P6 (8.4$ X79 =4003, Fax 279 -4567 _- -_ CONIWETtN'dt1TF:tl 'GINE5RS - CHECKEDBY `' "9 -:: .DATE c6' ubb .: ::: Goes N SubmersOW 'SL a'4 ski' '�e- a;�l , Pump 388.71 MODEL a�„ . �� 9 h .....,. .,... - June June 30, 2006 Larry. W: Ni6h &Jr.; P:E. W. 77V 4Pttterson•Park,-Suite 106 2050 Route 22 _ Brewster, NY 10509 Telephone (845) 279-4003'" Fax (845) 2794567 Putnam County Health Department 1 Geneva Road Brewster, NY 10509 ATT: Mike Budzinski,_ P.E. RE Individual SSTS - Addition - Jart.Ws Rood (Pump Revision) 512 E. Fair. Street Town of Patterson T. M. # 34.13 -1 -8 Dear Mr. Budzinski: During the course of construction, it basL become apparent that a pump system will be required. Enclosed are the, following- - -1. Five (5 prints of SS -4 `_Proposed SSTS" rev. 06/30/06. 2. "Construction Permit for Sewage Disposal System ", 'dated 06/16/06. 3. "Letter of Authoriza$�'on ". 4. Fee of $250.00. � 5. Pump Calculations. Please note project will utilize previous Design Data information for the Lot. Site is served by existing drilled well. We would appreciate, your review, approval and issuance of the Construction Permit at your earliest convenience. Very t Harry W. Nichols Ir., P. E. HWN:gav 05- 071.00 MAW-, PUTNAM COUNTY DEPARTMENT OPMEALTH DIVISION OF! ENVIRONMENTAL HEATL.H SERVICES...--. TIELD ACTIVITY REPORT .Street Town State' Zip PERSON IN CHARGE nR TNTF7-RVMVT.T)- PUW TEST I IN-1 TEST /z, 1ZRbTffRRD GALLONS , ' / Y /C %71 r UdS EL START 35 EL. STOP' Signaturj( ,afid 'TiWe RT:PnTzT 12FrPTVF-D RY-* acknowledge receipt of this report: SIGNATURE; )2/96 Title: �o 0 0 I IN-1 TEST /z, 1ZRbTffRRD GALLONS , ' / Y /C %71 r UdS EL START 35 EL. STOP' Signaturj( ,afid 'TiWe RT:PnTzT 12FrPTVF-D RY-* acknowledge receipt of this report: SIGNATURE; )2/96 Title: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION �. _. ....., .Street Location - -..... `Town TM # 3 y, -3 — / — 1. Sewage Svstem Area � of Date: 1� O ed by: Permit # ff — .? 7 9 —6.5 Subdivision Lot # a. STS area located as per approved plans .......... .. ................ b.. Fill section - date of placement 3 :1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................: d. Stone, brush, etc.; greater than 15' from STS area.......... e. 100' from water course /wetl s ...... ............................... II. Sewage System a. Septic tank size - 1,000 .... .... 1, 250 .......... other ................ b. ' Septic tank installed level ............................................... c. 10' minimum from foundation ........... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3... Minimum 2 ft.Original soil between box & trenches e. Junction Bog - properly set .......... ............................... 6. Irenches 1. Length required %JCy Length installed �S 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ........................................ 4. Slope of trench acceptable 1/16 -1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100 % ......................... 8. Size of gravel 3/4 -1'/2" diameter clean ...................: 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ......................... ............................... .._..g.�. -Puffin orposed- Systems...----- •-------------- _...ti_.___... . - 1. Size of pump chamber ...................................... * ....... .. 2. Overflow t .................... ............................... 3. Alarm, vi's audio .......:........... ............................... 4. Pump easily, accessi le, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... M. House/Building T house located per approved plans ... ....................:.......... b. Number of bedrooms ....................... ............................... IV. Well Well located as per approved plans . ......:........................ b. Distance from STS area measured . . ft........... c. Casing-18" above grade ................ ............. ................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship . T Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall protected & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface = provided rotection adequate ........ :........................... i. Erosion ................. ............................... Rev. 2/02 .11,JT 116 _ r cCONSTRU CYffON P ER `IV ffT IF® SEWAGE TREATMENT S YS'Il' �1 Located at 6-12- IE, N t r S' ',r llll Subdivision name ti y t o �j��� Subd. Lot # Date Subdivision Approved % Owner/Applicant Name V q "-i e- 20 o� Town or V /0�i77,B r3 Tax Map 34,1 3 Block I Lot Renewal Revision l,e"' Date of Previous Approval O Mailing Address q st Fel a �_ S e v- k, e, IT % Zip U tt Amount of Fee Enclosed 6Y. is4, Building Type 1 dt'it-tc-e.,. Lot Area 1 2.13 No. of Bedrooms i r''fed Design Flow GPD 2-0 0 MDR Section OnRy Depth VoRa mne 1PCHD NOTIFICATION IS REQUIRED WHEN EFIILL IS COMPLETED Separate Seweu•age System to consist of gallon septic tank and 14 3 /Ir, Other Requirements: To be constructed by T 13 0 . Address Water Suap >mllv: Public Supply From Address --or. - , yr -Private-Supply •Drilled by X (s - { J._ - _.:: _ Address-__ I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will 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 said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Y Signed: Address P.E. R.A. License # Date / l 0 S'C d Zft APPROVED EIlD ]FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modifiel when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new rmit. Approv for discharge of domestic sanitary s age only. By: ! Title: Date: Y White copy - HD F(j Yel o copy - Building Inspector; Pink copy - Ow r; ran a copy - Design Professional Form CP -97 Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 Tely:�(845)u279 4003 Email: hnengineer@aol.com August 11, 2006 Putnam County Health Department 1 Geneva Road Brewster, NY 10509 ATT: Michael J. Budzinski, P.E.. Director of Engineering RE: Individual SSTS - Addition - James Rood (Pump Revision) 512 E. Fair Street Town of Patterson T.M. # 34.13 -1 -8 Dear Mr. Budzinski: During the course of construction, it became apparent that a pump system will be required to serve the proposed addition. The bedroom count. that the Construction Permit is based on is three (3) existing and one (1) proposed. Enclosed are the following: Five...Cq)_prints of SS -4 "Proposed SSTS' .rev. :06 /30/06:_ r.b_. ..- - ~2. "Construction Permit for Sewage Disposal System ", dated 08/10/06. 3. Revised Fee of $250.00. 4. Pump Calculations. 5. Four (4) sets of Architectural Plans for four (4)- bedroom residence. Kindly utilize the previously submitted Design Data information for the Lot which will be served by the existing drilled well. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, i t Harry W. NiQUbIs Jr., P.E. HWN:gav 05- 071.00 — ......... —'— -----'— '' — | -Ni Patterson Park, Suitc 106' 2050 Route 22 Brewster, NY 10509 'b45) 27-9�4003 *Fax .279-4567 —J3 Ow . SHEET^`" —' COMPUTED BY DATE — CHECKEDBY -DATE \j _�_ Harry W. -Nichols Jr., P' 'Patterson Perk; Suite 106. 2050_Route 22_: Brewster, N`� 10509 (0;1$ 279 =4003, Fax 279 -4567 CONSULTING�I E;ENGNE F2S JOB No. SHEET No. 2 COMPUTED BY Jm DATE CHECKED BY . ..... 67s% d s�.va t ,^ ,X - - -- L F ' R '7�f8 = 1 v ti, kl. IZi N6-' 1 - �. - �! —_— , i 14 ` MODEL THP Models Models 38 g. , SHERLITA AMLER, MD, MS, FAAP Commissioner of Health - Z :.,.LORETTA- �MOLLNARJ;:RN,•MSN= ,..:. : ;w:;, Associate Commissioner of Health August 2, 2006 James Rood 512 Fair St. Carmel, NY 10512 Dear Mr. Rood: ROBERT J. BONDI County Executive ' ' :_� _� �" °" ROBERT MORRIS;.1'•E�� ,••;: •� Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Addition Approval- Revision No Increase in Number of Bedrooms Rood -512 Fair Street (T) Patterson, TM # 34.13 -1 -8 I have received and reviewed the plans for the proposed addition to the above mentioned residence. The proposal for the revised addition has been approved as per plans bearing the approval stamp from the Department dated. 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 expansions area must be maintained. 3. All.plumbing fixtures must be updated with water saving devices (i.e. new.low _.,_..e,,......._.,,_._. _..- _-flush- toilets ; -restrictors'f - or,'shower- hen' ds -arid faucets- eta:)-- -- _.____._._.. _.._.- 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. ectfully, Michael J. Director u 1: , 9 cc: Building Inspector, (T) Patterson Harry Nichols, PE 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 July 31, 2006 Putnam County Health Department One Geneva Road Brewster, New York 10509 Aft: Michael J. Budzinski, P.E. Director of Engineering Re: Proposed Addition — James Rood 512 East Fair Street Patterson, New York T.M. # 34.13 -1 -8 Dear Mr. Budzinski: Larry W. Nichols Jr., P.P. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 Tel: (845) 279 4003 -•... -. _ ...... r. __.._.... _ . _, .... —G . Fax: (845) 279 -4567 Email: hnengineer@aol.com /7 -aa,� oG Mr. Rood's existing residence is an approved three (3)- bedroom home with one of the bedrooms functioning as a home office. The proposed addition contains one (1) additional bedroom for which an SSTS permit was previously issued and recently a revision was submitted to the Putnam County Health Department for inclusion of a pump. Mr. Rood's preference is to keep the residence as a three (3)- bedroom structure and to continue using one of the original bedrooms as an office. Based on our recent telephone conversation, we._ have _revised .the floor plans to reduce width�to-tes�-then T- 0 " ;-- eliminated,thetk)set and- propose -a *aik -in= closet- for-° bedroom # 2. We have also eliminated the proposed partitions within the existing garage area and labeled it unfinished storage area. Reflecting the above, enclosed are four (4) sets of Architectural Plans 1 thru 4 revised July 28, 2006. Kindly review the enclosed at your earliest convenience and if it meets with your acceptance, approve the architecturals as a three (3)= bedroom residence. Should you have any questions concerning'the enclosed, please call. Very ly yours, Harry W. Nic Is Jr., P.E. HWN:jmm 05- 071.00 cc: Mr. J. Rood — w /enc. Mr. D. Finney — w /enc. To. Q Attention: (aet�6 f'5P Gentlemen: We enclose (Copies*of. k/W Prints Reproducibles Specifications Memorandum Harry W. Nichols Jr., P.E. ' Patterson Park, Su ito '106 2050 Route 22' Brewster, NY 10509 Tc1epboxtc.(84J.).279. -4003: Faz (845)..279-4567 Date: Job No.: 0� Project 0 S2E. FBI Reports Tracings Copy of letter. Description: RevisionlDate.,'No. Q ' J?,rj*g r AA. UAW ,i TQ Se Via: ur Messenger Blueprinter First Class-Wif Special Delivery . -;a. . Your Messenger Hand Delivery . Copy to Very tryq yours _ • ` . :(`iichols 6'���• 1 PUTNAk CO'UN'TY DEPARTMENT OF HEALTH DIVISION OF EWIRONMENTAL HEALTH ]tMrVIDtJAL WATER SUPPLY •& SUBSURFACEA WA GE:TREATI NT'SYSTEIVYS'' :� <:_a,.�•, c- ,.__x. :• ... -REVIEW SHEET FOR CbNSTRUCTIQN PERMIT NAME OF 'OWNER: R STREET LOCATION: 7' REVIEWED.BY: RM, GP, TSP, SRDATE: / G. TAX 1�AP #: (CONFDZIvIED) ` •' '� Y N DOCUMENTS Y/ N ffiKQ RED DETAILS ON PLA 4s CONT'Dl (�( „)PERMIT e�PPLICATION + HOUSE SEWER - lYP ITT, 4 "0'; TYPE PIPE. CAST IRON IL-)WELL PERMIT OR PWS LETTER �q CA6UNO BENDS; MAX BENDS 45' W /CLEANOUT (Z PCG97WA7,S L) )LETTER OF AUTHORIZATION UjCUSrm NOT$.(No •CHANGE) L_)L)DESIGN DATA SHEET (DDS) FILL S STEMS (__)CORPORATE RESOLUTION IV4 (_)L_)10' ECORIZONTTAAL;; P.�A--S�C'1 UM SLOPF.%3:1 TO GRADE (�/ SHORT EAF . (�(_ jFILL SPECS / Kb: NOTES 1 -5 (PLANS -Tflm SETS J C,UU�L FI�.E & DIMENSIONS HOUSE PLANS - TWO SETT (� IN MANSION AREA - UUVARTAPICEREQUEST III// 11 --_- - -�.�_ SUBDIVISION LEGAL SUBDIVISION ' Lc-)L}SUBDIVISION APPROVAL• CHECKED U(_JPERC RATE U REQUIRED DEPTH L)L,CURTAIN DRAIN REQUIRED • GENERAL . U�IL jLOCATED .IN NYC WATERSHED (��PLANS SMMCTTED TO DEP 04 DELEGATED TO PCHD U)U.)DEP APPROVAL, IF REQ'D i✓) UUDEEP TEST HOLES OBSERVED y (_} 0 S ADT LO TLANDS (TOWN/DEC PERMIT REQ'D ?) (-- )DATA ON DDS- PLANS & PERMIT SAME 1969 NIEiGHBOR NOTIFICATION A114 U(�JLE'ITER BY/ZB,&. ").: FLOOD ELEVATION W1I 200' (_)(,)SOIL- TESTlKG LOTS>10 YEARS OLD 9E413IRED -DETAILS ON PLANS SEWAGE SYSTEM PLAN -(NORTH ARROW) SSDS HYDRAULIC PROFILE GRAVgTi' FLOW L4LJCONSTRiJCn0K NOTES I -IS DESIGN DATA: IPERC & DEEP RESULTS +j(,_,)2' CONTOURS EXISTIKG & PROPOSED )L,DRtVEWAY & SLOPES, CUT N11 FoOTIN(;/GUTTER/CUFETAIT DRAINS - )vUSDDA SOIL TYPE BOUNDARIES r/ (,,,_ j'T,TLE BLOCK; OWNERS NAME ADDRESS TM#, PE/RA, NAME, ADDRESS, PHONE# ATE OF DRAWINGMEVISION _L-)DATUM REFERENCE , 1.�6 LOCATION OF WATERCOURSES, PONDS LAI ,wzTLANDS wrrEcftq 200' OF P.L. L--)PROPOSED FYNM FLOOR AND BASEIVIENT ELEVATIONS tg�L&ROPZRTY ELLS 4 SSDS'S WIIIN 200' OF SSTS MTES & BOUNDS EROSION CONTItOL FOAZOUSE, WELL & SSTS, EROSION CONTROL NOTE . MMENTS: VSHUTIO9 101100 ,c-JLj CLAY BARRIER UUF�'CERTIFI N NOTE L)L)DEPTE[ G GES L)L jVO PLAN FOR RO.B., t NCLASSIFIED & %MPERVIOUS U ARATION DISTANCE FROMTOE OF SLOPE (�� -JU TRENCH PROVIDED 60FT MAFC. LjPARALLEL TO CONTOURS ` �L 100% EXPANSIONPRomED (�DETAGJDUST FREE CkUSHED'STONE OR WASHED GRAVEL GEOTEXTILE COVER- SEPARATION DISTANCES ON PLAN J FROFM'SSTS 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL. Z0' TO FOUNDATION WALLS . 100''TO WELL, 200' INDLOD,-150' TQ PITS 100' TO STREAM, WATERCOURSE, LAKE•(iap. ezp -9) / (.�.�ioi TO WATER LM (ptti - 20') /Q� (�50'• DUlAb i'TTWT DRAINAGE COURSE 200'/500' RESERV0J$4 ETC. 150' GALLEY SYSTEMS 10' MIN TO LEDGE OUTCROP Z- L-J-10'FROX FO'UrIDtiTION -, 50' TO WELL (-JL)DIMENSIONS OPERTY LINES LjL-uOC OF SERVICE CONNECTION Lj 15' TO'PROPERTY LM (`(-JSILOP9 YN SSTS AREA 6 (S20 %) (__)(-,)REGRADED 1015 %, 2 REQUIRED f'%41. • • DOSE/PUIVIP SYSTEMS (-JUPUMP Nons . C-)(—)DOSE 75% OF PIPE V OSE VOLUME NOT= U(_ jDETAIG FO MAIl+i, (PIPE E, ETC.) , LUL.)PIT -BOK SHOWN &DETAiI.ED '' ' U AY STORAGE ABOVE ALARM ' CURTAIN DRAiN ' L— )LSTANDPIPES, S' BOTH SIDES, DETAIL to CDS ->S %, 100 % -41% L JL-)20' MIK to CD DISCHARGE/100' with 132 cons day discharge L j(•_)10' M W to NON- PERFORATED PIPE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES "CONSTRUCTION PERMIT FOR - SEWAGE "TREATMENT SYSTEM' PERMIT # s - � V APO I T f D H Located at 5i� � 1� �? Town or Village P1�`li�69 Subdivision name AH t1►lt' A X94' Subd. Lot # Tax Map X144' 0 Block Lot Date Subdivision Approved Renewal Revision Owner /Applicant Name J toA�; P 00 0 Date of Previous Approval d6/ 11) 1'4 Mailing Address )�L FA5L 60-675�1 �. c'�11: �— �1T Zip ,4 cG )Cl! ENi b05%� Amount of Fee Enclosed et ad i �;� �� +��rt>:0 "WOUV) 'O�H4 Ek Building Type � Lot Area �'� , No. of Bedrooms i f1 L Design Flow GPD I-00 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1000 gallon septic tank and 14$, 'a- "i k"O To 6 E PI?Wc Ia i Of-, A-FAPPtJ Other Requirements: To be constructed by 1 %� Address Water Supply: Public Supply From Address Address o .. Private Supply Drilled by I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will 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 said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. n Signed: Address 'Z e 5 o /fZ Z.2 P.E. R.A. Date li o i l 057, T&IZ - Nrl f°50 License # °J 12,+, APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless conspri►c`tion of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may/"be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Approved for discharge of domestic sanitary sewage only. G Date: > /` D BY: Title: — ite copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 November 2, 2005 Putnam County Health Department 1 Geneva Road Brewster, NY 10509 ATT: Robert Morris, P.E. Harry W. Nichols Jr., P.E. Patterson Park - Suite 106 2050 Route 22 Brewster, NY 10509 Tel: (845) 279-4003 -Fax: *'(845).i79L45,6-7".*-;,;r.-.--4-t Email: hnengineer@aol.com RE: Individual SSTS — Addition — James Rood 512 E. Fair Street Town of Patterson T.M. # 34.13-1-8 Dear Mr. Morris: Enclosed are the following: 1. Five (5) prints of SS-4 "Proposed SSTS", dated 11/01/05. 2. "Short EAF", dated 11/01/05. 3-. !'Ap ication for Apprgyql. - etana.fio,.C�,a a ef --Wastew t. Dis, 4. "Construction Permit for Sewage Disposal System", dated 11/01/05. 5. "Letter of Authorization". 6. Two (2) copies of Residence Floor Plan(s), for "Bedroom Count Only". 7. Application Fee of $400.00 ($100.00 submitted previously., $300.00 enclosed). Please note project will utilize previous Design Data information for the Lot. Site is served by existing drilled well. We would appreciate your review, approval and issuance of the Construction Permit at your earliest convenience. Very truly yours, Harry 'W. Nic ols Jr., P.E. HWN:gav 05-071.00 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR 1. Name and address of applicant: C- P�Q -N1�� 2. Name of project: jkMll aO 4. Design Professional:.�Pt W ��lkWLi Jim 6. Draiaage.Basin: 3. Location TN: PAIT54b J 5. Address:. 9,09 ILI, 7. T e of Project: Private/ esidential Food Service Commercial Apartments Institutional Mobile Home Park Office Building. Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review -(SEQR)? . Type Status (check one) ....................... ............................... Type I Exempt Type.II Unlisted X 9. Is a Draft Environmental Impact Statement (DEIS) required? .......................... Nb 10. Has*DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency A 12. Is this project in. an area under the control of local planning, zoning; or other. officials,. ordinances? ...::. .................................................. 13. Ifso, have plans been submitted-to such authorities? ... :.................. :....... .........:... N� 14. Ids preliminary approval been granted by such authorities? 00 Date granted: NIR 15. Tfpe of Sewage Treatment System Discharge ................. surface water groundwater 16. Z surface water discharge, what. is the stream class designation? .................... �1 A 17. Yaters index number (surface) :......:.......................::........... ............................... rJ : 18_ project located near .a public water supply system? ...:..... NQ 19. '►.f yes, name.of water. supply NA Distance to water. supply �g 20. t project-site near a public sewage collection or treatment system? .......:........ �3p 21. name of sewage system N N Distance to sewage system NA 22. )ate test holes observed 23.. Name of Health Inspector 24. koject design flow (gallons per day) ........................................... I.....................: fop 25. is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 00 26. Has SPDES Application been submitted to local DEC office? ......................... tf ti Form PC -97 2 -27. Is any portion of this project located within a designated Town or State wetland? 00 28. Wetlands ID Number ............:.....................::....................... ............................... �✓ 29' Ts °Wetlands Permit requiredZ ..:.................. ............ ............................... ..... NO Has application been made to Town or Local DEC office? .:............................. 30. Does project require a DEC Stream Disturbance Permit? .. ............................... 4 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling; sludge application or industrial activity? ............................ Yes/No o 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No "DESCRIBE: . 33. Is. there a local master plan.on file with the Town or Village? � 34. Are community water and/or sewer facilities planned to be developed within 15 .years in or adjacent to project site ?............................................................... 35. Are any sewage treatment areas in.excess-of 15% slope?. .................. :.:...... ::.::: 36. Tax Ma p ID Number ............................................... ............ Map *6 Blockot °° 37. Approved plans are to be. returned to...... Applicant Design'Profession _ - N6TE:.Al1 applications.for review and approval of a new S STS to be located within the:IV:YC. , atershed shall be"seh -t to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval. by the Department. Projects within the watershed may also require DEP review and approval of other.aspects of a project, such as stormwater plans or the creation of impervious surfaces; and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item L,the application must be accompanied by a Letter 'of Authorization (Form LA -97). Failure to comply.with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of any knowledge and belief. False statements made.herein are punishable as a Class A misdemeanor pursuant to Sectior1210.45 of the Palest Laopg SIGNATURES & OFFICIAL ?TITTLES: Mailing Address :.... ......... .................:..... H OA.%� 1. 1416 -4 (9/95) —Text 12 PROJECT I.D. NUMBER •617.20 SEAR Appendix C :--State. EnvIroru alertita #- Quallty;Review•.., .wr...n ♦r.,v.. r�,.�.I -�.ry •q. __x•...+.-.v_— �.W wr. I, ♦• Jc SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR �o0 � J! 2. PROJECT NAME AYY1 -Flop Tb 3. PROJECT LOCATION: A (� i � (� �/► p + N>�C� Municipality i��1 JO County 4. PRECISE LOCATION (Street and road Intersections, prominent landmarks, etc., or provide map) (address 5. IS PROPOSED ACTION: ❑ New 9 Expansion ❑ Modiflcatlon /alteration 6. DESCRIBE PROJECT BRIEFLY: -_-7 T-J 1-0 �� -'JILC $Q-- 91 to t� 7. AMOUNT OF LAND AFFECTED: I It V't l` v`� Initially acres Ultimately acres 8. W141_ PROPOSED ACTION COMPLY WITH EXISTING ZONING OR-OTHER EXISTING LAND USE RESTRICTIONS? es ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park/Forest/Open space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STAT OR LOCAL)? Yes ❑ No If yes, list agency(s) and permit /approvals Towd FAMMQrA 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? MYes ❑ No . If yes, list agency name and permit/approval nwd 'SOD- a fl ' G Q dhT l 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? 'KYes ❑ No. CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE V_ °� Applicant/sponsor name: Dale: Signature: /,/J. al If the action is in the Coastal Area, and you. are a. state agency, complete the . Coastal Assessment Form before proceeding with this assessment OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate'the review process and use the FULL EAF. ❑ Yes ❑ No B' WfL'C ACTION RECEIVE C06RDfNATED'REVIEW`AS`PROVIDED FOR UNLISTED `ACTIONS1N -6 NYCRR,'PART. 617:6 ?' ` ='Ii No a negati "ve "decl'aration may be superseded by another involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly. C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. Ct'f < C . C6. Long term, short term, cumulative, or other effects not identified in C1-05? Explain briefly. Utz �3 r C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly.f; ! o. D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF ❑ Yes ❑ No F. JS THERE, OR.JS:T.H ERE. LIKELY..TO_BE, CONT.ROVERSx BELATEb..T0 POTENTIAL ADVERSE ENV.IRONMENT.AL.IMPACTS?.._. ; .. ❑ Yes ❑ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring;; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part II was checked yes, the determination and significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary,. the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) to 4 PUTNAM COUNTY .DEPARTMENT OF HEALTH . DIVISION OF ENVIRONMENTAL HEALTH SERVICES RE: Property of LETTER OF AUTHORIZATION JAM61.5 11-OOD Located at �)2- �' P4"f—' T/V p/�iT��oH Tax Map # �� �J Block �. Lot Subdivision of �'`� 0 Vl Lo Subdivision Lot # Gentlemen: 2 Filed Map # i Date Filed 'l _ d This letter is to authorize �'��''rLi W ' H10+DL'6 j J1— pi a duly licensed Professional Engineer or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health and ,the Putnam tary "Code:._... _ .. . .......... _.. _...... „ _. ..... _� .. 4� Very truly yours, e � Countersigne Signed: P.E., R.A., #J+ v (Owner of Property) Mailin g Address AO° �� �!Z Mailing Address: A(R- %9 6945 W State 4 Zip Telephone: ( ��) State 01 Zip�� �2 Telephone: (%A'5) 22$ _ 00-(' Form LA -97 III:ER,..AM,.MS; FAAP: Commissioner of Health LORE'ITTA MOLINARI, RN, MSN Associate Commissioner of Health October 26, 2005 James Rood 512 Fair Street Carmel, NY 10512 Dear Mr. Rood: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New. York 10509 Re: Addition — Rood 512 Fair Street (T) Patterson, T.M. 34.13 -1 -8 ROBERT J.. BONDI_- County Executive I have received and reviewed the plans for the proposed addition at the above mentioned residence. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons: 1. The legal bedroom count for the dwelling is three. The. potential bedroom count of your proposed addition is four. The room in the basement, "formerly the original garage" is considered a potential. bedroom. _.2 --- The- dditidn ofa potential bedroom requires this-Department's approval-of -a revised septic system plan from a professional engineer. Please revise the proposed floor plan to reflect no more than three potential bedrooms, or have a professional engineer or registered architect design a sub - surface sewage treatment system meeting present code requirements for four bedrooms. If you have any questions, please contact me at your convenience. GDR:cw cc: Jeff Moore Sincerely, Gene D. Reed Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 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 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health October 7, 2005 James Rood 512 Fair Street Carmel, NY 10512 Dear Mr. Rood: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Addition - Rood 512 Fair Street (T) Patterson, T.M. 34.13 -1 -8 ROBERT J. BOND) County Executive I have received and reviewed the plans for the proposed addition at the above mentioned residence. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons: 1.. The legal bedroom count for the dwelling is three. The potential bedroom count of your proposed addition is four. The room in the basement entitled "storage" is considered a potential bedroom. 2. The addition of a potential'bedroom requires this Department's approval of a revised septic system plan from a professional engineer. Please revise the proposed floor plan to reflect no more than three potential bedrooms, or have a professional engineer or registered architect design a sub - surface sewage treatment system meeting present code requirements for four bedrooms. If you have any questions, please contact me at your convenience. GDR: cw Sincerely, -�). oR:� Gene D. Reed Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 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 IL:EIt;:ll�llD;;:lI�S;.1i - AR.: Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health September 28, 2005 James Rood 512 Fair Street Carmel, NY 10512 Dear Mr. Rood: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Addition — Rood 512 Fair Street (T) Patterson, T.M. 34.13 -1 -8 J..:.- B0NID1-:::- County Executive I have received and reviewed the plans for the proposed addition at the above mentioned residence. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons: 1. The legal bedroom count for the dwelling is three. The potential bedroom count of your proposed addition is four. 2. The addition of a potential bedroom requires this Department's approval of a revised septic system plan-froma professional- engineer. _..._ _._.......::... _._ .. _......., _.......... ,�.._ 1: _. __..._...�_.._.. Please revise the proposed floor plan to reflect no more than three potential bedrooms, or have a professional engineer or registered architect design a sub - surface sewage treatment system meeting present code requirements for four bedrooms. If you have any questions, please contact me at your convenience. GDR: cw Sincerely, Gene D. Reed Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax(845)278-7921 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 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health -4 - -r- LORETTA-MOLINARI -,-RN, MSN Associate Commissioner of Health ROBERT J. BONDI County Executive DEPARTMENT ' OF HEALTH 1 Geneva Road, Brewster, New York 10509 RAE@ ADDITION APPLICATION RESIDENTIAL ONLY STREET '5 rk EP51- 1V-- 6 -E5'TOWN T )k1 ' G �-�� TAX MAP# NAME `� � M�`'I � PHONE �� � � Z'I-� " O P � (� PCHD# r - W ik MAILING ADDRESSrJ)�- DESCRIPTION OF ADDITION �'tk44l. '�4— GINPA4 Wive or- !F-1 CJ'r- 4- KWLM\Dr1 El- DWl; -Wrn- 'f-aBt� R'Ivwft'v -Tuk-11 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, st bet 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 SHEMTA AMLER, MD, HS, FAAP Commissioner qf Heallh LORETTA MOL,INARI, RN, MSN Associate Commissioner ofHealth DEPARTMENT OF HEALTH i Geneva Road, Brewster, New York 10509' PUTN'AM COUNTY DEPT. OF HEALTI -I 1 1 GENEVA ROAD BREWSTEP NY 10509, To Whom It May Concern: Re: Residence oop RODE1tT J. BOND] Counry Executive TOWN- YEAR TOWN- YEAR BUILT According to records maintained by the Town, the above noted dwelling, YN COMP L C-E WI-TH TOE eODR. - - - . - IS OT INI COMPLIANCE. WITH TO" CODE LEGAL BEDROOM COIN IT 15 This information has been obtained from: CERT'IRCATE OF OCCUPANCY: OTHER.: N e CERTCRCATIr OF CCCVPANCv lm Wo2mr Supply Sm Ilon (845) 225.5186 Pax (845) 2294418 Eimvlronmental Hwatb (845) 278 -6130 Fax (845) 278 -7921 Nuirdug Services (845) 278 -6558 WIC(845)278-6679 Fax(845)278-6985 Ewiy (845; 278 -6014 Fax (845) 278.6648 1: - d 2 9SV6126 :Ol Z261- 8)-2-Sb6 12ud30 uNnoo WUNlfld : W dI 60 : Z 1: S002 -0c--mo Harry W. Nichols Jr., P.E. Patterson Park, Suitc'106 _ 2050 Rout, 22 Brewster, NY 10509 ... _ . _ ... . — _ - - • e .49n, (845) 279-4003 - - Tc]_ Fax (W.) 279 -4567 Date: To: Job No.: • Projcot A �� Attention: v���� I�;"'I�► >-I Gentlemen: We enclose ( copies of B/W Prints Reproducibles Reports .Tracings Specifications Memorandum Copy of letter. Descri ption: Revision/Date No. S t Via: Our Messenger Blueprinter First Class Wil Special Delivery . Your Messenger Hand Delivery . Copy to . : Very truly yo ' Ha7 oKohols Jr., FIE. ; P�1B'Ia1AM -CON1�1TY HDEPARTI��R1'II' ®F, . E —AILTH i Division of. Environmental kelalth Seivices, N V '9Og92 CE6RT0,0icATE. OF" CdNl t'iUCVlON .COMPLIANCE I'OR SI:INAGE ®,ISPO'SA' SYSTERA Town ,or'viiihge L.. Located at 11�� 0$s 'Block �- i , /���N Owner A- A elp Tax Map Lot # Subd'. q Separate Sewerage System built by �ev&,vA�a L) Address Consisting of Y !CJ 4�l Ay Vie ��u Gala Septic Tank and Other requirements Water Supply: Public Supply From Private Supply: Drilled BY�ds�.l Address ZIF Mu Building Type No. of BeIrooms Date Permit ,Issued Has Erosion Cpntrol Been 'Completed? I' certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plaps.,of the completed work ( copies of which are attached) , and in accordance with the standards, rules and regulations, in accordance with the filed, ;.and the permit issued by the Putnam County Department Of Health.. Date Certified by ~. P.E'' 'R A. Address N License o. Any. person occupying premises served Dy the above shall'.promptly. take such action as mpy be necessary to cure the correction o4 eny.uneanitary conditions resulting -from such usage. Approval of the separate sewerage system shall become null and void as soon as a public sanitary sewer becomes available ".and tho approval of the private water supply shall.Dec0 -null and` void when a public water supply becomes available. Such approvals are sub)ect •fo modification or change when,'in fhe` judgment `of t e; missioner of Health, su revocation, modification or ehango is asa►y, Oate L \ k S n WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services r� COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report is to be completed by well driller and submitted to County Health Department together with laboratory report of niilysis•of. water .sample- indicatingwater -;is off: satisfactory •bacterial..quaUty;-be.fore certificate,of construction compliance is-issued: REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME An ioli Corp. ADDRESS Ludingtonville Rd. Holmes, NY LOCATION OF WELL (No. 6 Street) (Town) (Lot Number) Fair St. Patterson PROPOSED USE OF WELL BUSINESS DOMESTIC ESTABLISHMENT El FARM TEST WELL SUPPLY INDUSTRIAL CONDITIONING Sped y) DRILLING EQUIPMENT ROTARY � ACOMPRESSED IR PERCUSSION El PERCCUSSION Ej OTHER ) CASING DETAILS LENGTH (fo;7 41 DIAMETER ,(Inches) WEIIG► PER FOOT `� ® THREADED ❑ WELDED YES NO YES NO YIELD TEST HOURS G.P.M. SAILED PUMPED ® COMPRESSED AIR 1 2 15 YIELD (G.P.M.) 15 WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify lost) 35 DURING YIELD TEST [feet) total drawdown Depth of Completed Well 325 in feet below land surface: SCREEN MAKE LENGTH OPEN TO AQUIFER (lest) DETAILS $LOT SIZE DIAMETER (inches) If GRAVEL PACKED: Diameter of well including grovel pack (Inches): GRAVEL SIZE (Inch..) ROM (1001) TO (loot) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distance., to at toast two permanent landmarks. FEET to FEET 0 30 clay 30 325 granite with quartz If yield was tested of different depths during drilling, list below FEET GALLONS PER MINUTE. DATE WELL COMPLETED 10/9, DATE OF REPORT 4/16/85 WELL DRILLER (Signature) �y J, Owner or urchaser o i ing I nil ing Constr ete.d:�by 112 Location - Street Municipality Building Type Section _ Block- Lot . Subdivision Name 7' Subdvo Lot ## GUARANTEE OF SEPARATE SEWAGE SYSTEM 'y I represent that:I am wholly.and completely responsible for the ,u. location, workmanship, material, construction and drainage of the sewage I. disposal system serving the above described property, and that it has been constructed'as shown on-the approved plan or approved amendment the re to9 +.: and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his success - r: ors, 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 initial use of the 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 occu- pant of the building utilizing the system. i' The undersigned further agrees to accept as conclusive the determin- ation of the Director of the Division of Environmental Health Services of'the Putnam.County Department of Health as to whether or not the fail- ure of the system to operate was caused by the willful or negli ent act of the occupant of the building utilizing the system. ., i Dated this day of 19 Signature. Title Corla6ration Name if corp.) Address -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE.ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health �/n�KT�V/N L<�D|�&| LABORATORY lNy~ "°°^`' ~~' -~-'-- —_ LOCATIONS: � M"��| �� ��1 \��8[ ��'�ut ' ' ^ ^w�" ^ �� �^^ '` Street 331%EAHST,YOnKTOwm HEIGHTS. w.v.10598 245'2203 Yorktown Heights, N.Y. � ^O°q� 0201uVTTOmwUOD AvE,pEEK%s|LL .m. y . 1056G 737-8777 ' 245-32U , . O'*95mm|mST MT. mSCO'm.Y.105*g 666-3335 J� � LAB .4 � DAT2 E - ---[ ---'--- - ' RECEIVED: DATE REPORTED, SAMPLE SOURCE:. / � REFERRED BY: -j COLLECTED 8Y: LABORATORY REPORT mV/L ` O��um/wmw � � []�cm/Tv -..--..-..,'~_-~_._-.~--'~,, --~--'^-'^-'~-^^-'^`'r-----~-~~~--~^ � []��K�ummrY ............................................. OAwT/wmwY --..--..--.-_-^--_..--_.-'......--' � / �� []�nssw/o AorsmA'ToTAL/mL .--.�-v---.------. ^~--.-'^...-..---.^--'-..--.-_....--_ a�n/mw djaoc\s DAY -_-..,--..-_^.'-..'.~~-.-.^- �� OusnY�uuw []gnOwmE .--.^.r-^..-^^`^'~~^-~~~~~'~^^~'^' --~------~--'''--------'----- � []CAR13Uw DIOXIDE. FREE ............................... Oa/omuTx -----.---.-..--_._.______.._..,._ � []CHLORIDE ................................................... Ouonow ----....---.-----_-_...-__.-___ [] o*uOn|ws .................................................. O cAom/um -.---------_.-..---.---� ^ -..____ ]oJo -/ ........................................................ Oo��c/ uw .. .. ^_..___.^ - � ^[]COLOR ........................................................ O CHROMIUM (m`J ........................................................... []CYANIDE .................................................. O CHROMIUM (h*"mm/v",)................................................... [] DETERGENT. ANIONIC .................................. O000AcT --....-.-----------.-----.--.-. Ocoppsn � []r�uopxns ....................... --'--'-_-__-__ ' _ ,_�..___._,._.___._____.____._. � ] HARDNESS ................................. ................. Oou o __._..__~__-~_.,.___.__.^___.__ couponm COUNT/ 1uunm .-'-' Omow .-..-....-.....-...~.^^^---^^.--..^,_. _-'�+�-' ' couFonw COUNT/ /uoml ........... � OLa^o -.----_---..---'--'..-'------ �Ecownnw��onrrssr -_-'' ........................ OuTx/um ........................................................... ,—._ � ' ' °--'-] -`- ---^---- ' --- ^-- ------ ' � O MAGNESIUM ----.-----�--- '-- — .'- '-- � _ `.- ,,' . ` .................................. O ��������________._._________.__^.~_...._ ]wowucLoA*L [] NITROGEN, NITRATE .................................. Omsncunv .---.-__.-.---..-~.-...--.--.,___ ` [] NITROGEN. ORGANIC .................................. []NICKEL ..---.-_-'----.----------..^.-.-_,^, � []000m ...................................................... []PALLADIUM ............................................................... Oouu GREASE ............................................... []POTASSIUM _----_---------.--.--.---^-r-_ []o* .......................................................... 0 n*0o/uw .---.--.-.--.-----...---_-.-_.__ [] PHENOL ..-------------'--'-----'-... � []SELENIUM .-_--.-----.-_----.-------^ [] PHOSPHATE �*,»o> --.--..-'-------�.-. []su/com ---''-_----.-.--.-.--._--_.__ []r*o�r*ATs(cvouo^seu) ................... `.............. Os/u/sn ......................................... ............................. � [] PHOSPHATE (total) ...................................... Omoo/Uw ..----_---------.-----_---_,__. [] SOLIDS, SETTLEABLE. mVL .......................... Onw ---..-----_-------.---.-----..-_.___^ ] SOLIDS, SUSPENDED .................................. Oz /w o ,--------^-..--._~-_____^_.,,___. [] SOLIDS, DISSOLVED _'..-.,..---.-.-°-' 11 .................................................................................... [] SOLIDS, TOTAL .......................................... O ................................................................................... Oncm�n�s � []smuo�voLATus .--, .............................. : __ ,. [] SPECIFIC CONDUCTANCE .....--.-'.-'.--'�-,. [] .-.-.--..-'p���I&~ ... >°�����&&�..'��Y��/����--.-, []SULFATE .................................................. O ................................................................................... [] suLF/bi ................................................... [] ,...--.--.--,-..-.-.-....._._-^---.^-..,-----,,,, �[] SULFITE ..................... [] .--.-..-----.-.-_-'/---.-'~,,'^______.,_,,_,._^,^^,, [].� []SURFACTANTS ........................................... ^_~_.,,,^^,_~,_,^,^,_,,,~_,,.^^,.,_,_,_,,,,,_^,^^^^,_,.^^~,,^,,,,, []TuR�/��' `��..~,�,'.....~~~~,,_,,,_.,,,~~~,^,_ []r'^^^^,^,,^.� ..._,^,,,,,,_.__,,___,,^,,,_,,___~�_.___,,,,,� � TBESC.RE'� L S INDICATE �� THE W�� WAS A SATISFACTORY S�%�� ��I� pB� . � IBC 8&���� �&� CO���C�2D, THESE RESULTS INDICATE THAT THE WATER DID MEET, THE SATISFACTORY CllCMICAL QUALITY', OF NEW YORK STATE ADMINISTRATIVE RULES & ON INKINC WATER STANDARDS (PART 72) FOR THE PARAMETERS TESTED. IT r � P6J H Iv AAI COUTT'Y � ®EP_ ®� HE } AtTMEN Ag� $ PermitlY _���_12L Division of Enwconmenral , Hea /rh Servrces Carme/ N Y 10592 CONSY;RUCT:BON! PERAAIT 'FOR SE-WAG E „DISPOSAL,SYSTEflN Y ,. h Subdivision. Subd Lot it t Renewal Q Revision 0 Owner /Address Date Of Previous Approval - Building Type ►� ��� Lot Area, �Zh Fill "Section -Only ❑ 'Number`of Bedrooms _- 'Design Flow G /P /D nO� ci _ P C `H D Notification Required i ..� Separate:.S ewer age System to consist of Y �O® Gal Septic Tank and ? ✓ -�( A-1 z Z� �`� -To be .constructetl by tom' Address Water Supply Public Supply From t` w ✓Private Supply to be drilled by t r :.�'• 4 - Y Address 1 r Other Requirements sl represent that fam wholly and completelyFresponsibleforthedesign and location of cthe proposed systems) 1) that he se arate,sewage disposal system ;' above descrlbed;wlll be constructed as shown on the approved amendment there to and - lnaccordance With the standards, -rules an .regu a ions o e ” ,u nam - rCounty- :.Departrrient of "_Health, and that'on completion thereof a ,tCertrficate ' of C6iistruction Complianca'-;atisfactory to the, Commissioner•of Health Will i be submitted toahe Department and a' wrdten °,guaranteewulabe?.furnlihed the owner his successors heirsoi assigns'by the ,b "udder ,that said builder will .. ','-',.place in good operating `condition any,;part of said sewage disposal system during, the period of. two (2) years imrrieClately_followlng thedate of •the issu ance of :the :approval of. t'he Ce LItiCAte of Construction 'Compliance of "the origipal`rystein'or any :repairs thereto'2)`_that the drilled well' described, above will be located as' oaten on the' approved, plan antl,that said well will tv installed ,in accordance wdh the standards les a regu a�r�s'-', of the Putnam ;County Departure t of H Ith s �, Date ; gned.' ' P E R A • � t '. Address - - F License No 2 si ?APPROVED FOR CONSTRUCTION This approval expires one year from the date issued unless constr Lion" of the tiuilding.aias been' undertaken and is x. revocable for cau3e of may be amended ormodifiedEwhen co;n re'd`` ecessaiy by the, Com er`io Health. Any change,. or alteration of construction requues -a n w parmit ;Ap rove for disposal of domestic sari to sews and /orsprry a w r sup Date X ,ey Title Rev 9 81 ' ^6 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES - "'COUNTY OFFICE- DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner j. S Address rAV-Mn-z Located at (Street) TA-�(Z.. Sec. Block (Indicate neares cross street) Municipality Watershed Lot SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number C CLOCK T TIME 6e- P PERCOLATION P PERCOLATION Run a apse D Depth to Water W Water vel No. T Time F From Ground Surface i in Inches S Soil Rate Start -Stop M Min. S Start Stop D Drop in M Min. /in drop Inches Inches I Inches 1 Q ` -7-� /Z w 3 3 /Z 20 3 3 g g.6 ( 4 Q - -_2�9 i i7 3 3.. ' '5, 3 5' o / /0. '2 1 D- 2 27 3 3 9 9 30 3 I Z- 5 1 2 3 4 5 Notes: 1) Tests to be repeated at same depth until approximatelyy 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 i=OURTERED IN TEST HOLES DEPTH .' HOLE ` NO . �rj y HOLE N0 , HOLE NO. G.L. ���,��_ 6" t 18' " 21i 1, 01 30,, 41 36" 42" 48" 54" , t 60" 66" ' y 7211 v 78•• 8411. _ INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED 7� INDICATY LEVEL TO WHICH WATER LEVEL RISES,AFTER BEING ENCOUNTERED TESTS- MADE' BY Date _ DESIGN Soil Rate Used e-DMin/1 "Drop: S.D. Usable Area Prov OF TV No. of Bedrooms Septic Tank Capacity \,C)oQ Gals Absorption Area Provided By 2� _L.F.x24" 3b" Address THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date G3 on;, _ ........... _ JJ'•� .T'1IsTD CIR:CI; 7,'L'ST. .� INITTII.L SI`L'T INSP.sCTIOP: yes. No Comment.- ,Property lines or corners found . . . . . . . Can cstima.te house location . Will drivcway need cut .. . Must trees be removed -note these Is deep hole representative of entire SDS area Additionral deep holes needed. Sufficient SDS area available considering driveway cut, house location, separation . distances, etc. DEEP HOVE DATA Dapth: Water elevation: Rock elevation: Soils d.escr:intlon: Date: FINAL SIT. II•T SP13C`rIO� Insp. by: House located wber.•e on approved plan SDS located Vl ore approved :1erZ- th of trench measured-' • Width of trench average S1opc .of _tile line and trenc acceptable.. _ .. . Room -aIlo� -ied- °for- 'cYuansion 'trenches Over 50 ft. from swamp, watercourse Ratural soil r_ot_ stripped or SDS area tuznecessarily graded . . . . .. 10 Ft. ma.intained ' from ' prop . line and 20 ft. from house Separation of trench from house, well -- etc,follows plan Ni'mber of bedrooms checks . . . . . . . . . . . Stones.' brush, stumps, rubble, etc'. greater than 15 ft. from nearest. trench 15 Ft. of peripheral soil horizontally from trench .Jwlction boxes properly set Could surface run off from driveway, roads, • ground surface, etc. channel near SDS ... . area. . . . . . . . . . . . . . . . Does l.ot. dr. atiro -�,e zrt�e �r 0. K. in area of SD3 j FINAL GPADING OF SITE ACCEPT_AME- 1 -1- .n �7 IJ 6 op, . . . . . ......... MJ :� tv "- "V ��� . . . . . . . . . . . . . . . . . . . . . i�ni Rx. I A ti 31, , h . Ypjj7 rA ' i50 , 5 r_ ' • ., .,tip • 4_J r. 50 mss` - .,.� -. ... ... �....... ..ro -. ..p.. r •/ •` ..� .. ... .- _ - �_...... w. CP�.. .-... .. .ter .. .�� a - .,._•P. .. ........• •.^ ) ...Yf l'��r 4 O.,p n. 0 1 1w: IN- tom,. CD jk y o pi ?�. ac., :r..t . � • „ .. y .�i!:. ,. a ,.1� t ,. .- _ � . _...... . t .... - �.. N.: , ,� , .r, Tdsti � +s' } �::�� �}� _.:�.