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01810
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR
YES NO Internal Use Only PERMIT # � J
❑ Repair Permit issued in last 5 years ❑ Not in Watershed
❑ Repair within Boyd's Corners, W. Branch or Croton Falls Res. Delegated
❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review
SITE LOCATION -z, /yam Z Z TOWN ,� _ TM #
OWNER'S NAME A6 ;t PHONE # y
MAILING ADDRESS 9 ion A� Z 7 /�h lG_. _. i� ,r /.? r—1
APPLICANT,,,/,,
Nam & Relationship (i.e., owner, tenant, contractor)
DATE 41— Z" FACILITY TYPE .Ss,�li+,.'�✓ PCHD COMPLAINT #
PROPOSED INSTALLER 4 ,}ca PHONE #
ADDRESS /ZJ- Seel- &,I !L/1� jLVY� REGISTRATION /LICENSE
/q—c-j /
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. �1 ,
I, as owner,agree to the cgnditions stated on this form
SIGNATURE f/ rr TITLE (?�;,, -� DATE
(owner) LT
I, the septic installer, agree to comply, with the conditions of this permitJor the septic system repair
SIGNATURE /�/
-GUS. -,..i � �,� � � TITLE DATE i"/-Lo •- �
(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.
INTERNAL USE ONLY
Pro osal Approved Proposal Denied ❑
Ins'pecwr 5 Oiyir re br, III p�„ Date Expiration Date
Repair proposal/is in coRrpft�nce wi Aol a codes Yes No El
COPIES: PCHD; Owner; Installer
PC -RP 99ML Rev. 2/07
a
Jul 20 2010 16: 21 P. 01
Protection New York City Department.of Environmental
_ . Protection
SUE URFACE SEWAGE TREATMENT SYSTEM REPAIR
........ . ....... DETERMINATION
Pursuant to the a
Article 1
Protectioi
Supply a
Appendi)
Putnam
DEP Project# c
Site Location: _
thority granted under:
of the:New York State Public Health Law; Rules and Regulations For The
From Contamination, Degradation. and Pollution Of The New Fork City Water
d Its Sources, 15 RCNY Section 18 -38 (or Chapter 18); and 10 NYCRR
75 -A Wastewater Treatment Standards - ,Individual Household Systems;
'Aunty Septic Repair Program, Plan — March 2005.
o/J `" ! — b S' -4 PCHD Repair# %U " 10
T.MG# �J _
season for loin t. Review:
Drainage Basin 200' of WC/Wetland Repeat Repair in 5 Yrs.
Name of +owner �"°h i n�kye l�
° .
. . Owner's Addr s:
' Drainage Basin of Project Site: o
Installer: `'�' °u✓tu o
General Description of Sewage System Repair:
e., D JA VPk r n a .p M.J
%�l 3oo r e, P�
^ _.... Dates of Site Ins ectiorns and Soils Tests: / r/' //a .
Approved *Iricornplete _ Delegated "Denied
*Required: Soils eats Repair Sketch .._. WC/Wetlands Wells . Other
� Reason
_ _ ....... .Dete rp de by_ .
2-
Engineering Divi ion Date
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ROBERT J. BONDI
County Executive
ROBERT MORRIS, PE
Director of Environmental Health
TO: D ARTMENT OF ENGINEERING AND DESIGN REVIEW
DELEGATION STATUS
FOR
SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM
t( p v
�.�}�[ JOINT REVIEW 7�
PROJECT:-Bo"/;&0 2190 �7 2z
TOWN: P-r�-r-6q,-j2,<aJ SUB'D APP DATE
NOTICE OF COMPLETE APPLICATION:
DATE: - Z d
❑ Within the drainage basins of West Branch, Boyds Corner Reservoirs OTCroton
Falls.
❑ Within 500 feet of a reservoir, reservoir stem or control lake.
CWithin 200 feet of a watercourse or a DEC wetland and appearing on a
subdivision map approved after December 31, 1992.
❑ Design flow greater than 1000 gallons /day.
❑ Commercial SSTS.
j treview
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
INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM
SECTION A. GENERAL INFORMATION
Name of
Site Location
ZZ
County
/1W ____
Building construction begun Extent cs
Is property within NYC Watershed .................. Yes
� No a
SECTION B.. TOPOGRAPHY (PIease check all appropriate boxes).
1. F-1 Hilly a Rolling 0 Steep slope Gentle slope F7 Flat
2. Evidence of wetlands 0 Low area subject to flooding F7 Bodies of water
F7 Drainage ditches 0 Rock outcrops
3. Property lines or comers evident ....................... ............................... Yes No
4.
Do water courses exist on or adjoin the property? ............................
0
Yes
V No
5.
Will these affect the design of the sewage system facilities? ............
F7
Yes
No
6.
Do watershed regulations apply in this development ? .......................
En
Yes
F7 No
7
Will extensive gradin be necessary? .......
Yes
No
8..
Will extensive fill be necessary for SSTS? ......... ...............................
0
Yes
No
9.
Do filled areas exist within the SSTS area? ........ ...............................
Yes
0 No
If yes; what is the condition of the fill?
a
SECTION C. SOIL OBSERVATIONS
10. Appearance of soil: Sand F_TGravel Loam 0 Clay 0 Hardpan . E]EIMixture
11. Observed from: Borings Bank cut E:oBackhoe excavations
12. Soil borings/excavations observed by lnskA on- ~l
13. Depth to groundwater �? �j on
/,, f �,
14. Depth to mottling l� on
15. Are test holes representative of primary & reserve areas..........
16. Soil percolation tests made by
I7. Soil percolation tests witnessed by
SECTION D (on back)
f....... F--] Yes a No
..
on
Form STA
2
SECTION D. DRAINAGE
18. Will proposed grading materially alter the natural drainage in this or adjacent areas? F-7J.Yes F,�-o
19. Will groundwater or surface drainage require special consideration? ..................... . a Yes [No
watercourses be relocated? .................. Yes E�No
20. Will gullies, ditches, etc., be filled and .......
SECTION E. REMARKS
21. If a common water supply is proposed, has, an inspection been made of th
existing or proposed source and facilities?........ .. .. ...................................................... F-� Yes F7No
Inspection data
No
22. Do adjacent wells and/or sewage systems exist? ....................................................... F7 Yes a
23. Additional comments
24. Site observer/inspector and title
25. Date(s) of observati6n(s)inspection(s)
TEST PIT PROFILES
Hole # -Lot # Hole # Lot #
Hole'# Lot #
Depth to water Depth to water
Depth to water
Depth to mottling Depth to mottling
Depth to mottling
Depth to rock/imp. Depth to rock/imp.
Depth to rock/imp.
G.L. G.L.
G.L.
0.5 Lee 0.5
0.5
1.0 1.0
1.0
2.0- 2.0
2.0
3.0
4.0 4.0
4.0
5.0 5.0
5.0
6.0- 6.0
6.0
7.0 7.0
7.0
8.0 8.0
.8.0
9.0 9.0
9.0
.10.0 10.0
10.0
—
�pU - -
TE 22 -- -f
o NO9 57'40"'E-
JF,7
O, ,
..'. C'�'`'y
I � ' nta ny �•
l
sOg•57'40"y, 13 3000'
8.00,
ryi
1\ 5
w
o
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA WCINARI, RN, MSN.
Associate Commissioner of Health
ROBERT J. BONDI
County Executive
.ROBERT MORRIS, PE
Director of Envi mental Health
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ADDITION APPLICATION' RESIDENTIAL ONLY
STREET_,,,2� , - TOWN -,�TAX MAP #�
NAME 5. . HONE PCHD#
MAILING
ADDRESS
DESCRIPTION O .:. .
ADDITION
NUMBER OF EXISTING BEDROOMS 3 PROPOSED # OF BEDROOMS
(FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR)
..**Any addition which is considered a. bedroom requires formal approval of plans (Construction permit)
prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the
Putnam County Sanitary Code.
Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd,
Brewster, NY 10509, Phone: (845) 278-6130: _ --
L Certified check or money order for $100.00.
2. Sketches of existing floor plan (drawn to scale, all living area including basement)
3. Two sets of proposed floor plan (drawn to scale — with name, street and tax map #)
*Non- professional sketches are acceptable
4. Copy of survey showing well and septic locations to the best of your knowledge.
Include date of installation if known. Label all wells and septic systems within 200 feet
of the property line. Contact this office with any questions.
5. Copy of Certificate of Occupancy from Town or Certification from Building
Dept. with legal bedroom count of dwelling.
OFFICE USE
COMMENTS
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax. (845) 278 -6026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention/Preschool (845)M-6014 Fax(845)278-6648, .
V
SHERLITA AMLER, MD, M$, FAAP
'x'° = "' = Commissioner of Health
LORETTA MOLINARI, RN, MSN
ROBERT J. BONDI
County Executive
Associate Commissioner of Health
DEPARTMENT:. OF HEALTH
1 Geneva Road, Brewster, New York 10509
Town Legal Bedroom Count
Re: (Owner's Name.)
Tax Map #: 3 .S;
Address:�Q
Town: /ter
Year Built:
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:
f s
t �
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
June 2, 2008
Joel Greenberg, R.A.
2 Muscoot No. RFD 2
Mahopac, NY 10541
Dear Mr. Greenberg:
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ROBERT J. BONDI
County Executive
ROBERT MORRIS, PE
Director of Environmental Health
Re: Addition Application for Boniello
At 2190 Route 22
(T) Patterson, TM # 35 -5 -29
The Putnam County Department of Health (Department) has determined that the above
referenced application, received by the Department on May 30, 2008 is incomplete.
Please be advised that the following information is required before the Department may .
commence its review.
I
f Survey or site plan showing existing and proposed house along with well
and septic system locations. .
_ _.�he,.houge addition plans must show the finished attic area on the second
floor which maybe considered a potential bedroom.
The review of your application will commence once the Department receives the
requested information and determines that the application is complete.
Should you have any questions or care to discuss this matter, please contact me at (845)
278 -6130 ext. 2148.
MJB:kly
Y)
Michael I. Bu
Director of. Er
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention /Preschool(845)278 -6014 Fax(845)278 =6648
B '
ti
n
TWO MUSCOOT ROAD NORTH
MAHOPAC, NY 10541
P 1345- 628 -6613
F 845 -628 -2807
TRANSMITTAL LETTER
TO: PCHD -LARRY WERPER
FROM: JOE FASSACESIA
SUBJECT: APPROVAL
WE TRANSMIT: ® Attached
VIA: 0 Mail
FOR:
THE FOLLOWING
❑ Other
DATE: MAY 28, 2009
PROJECT: ANTHONY BONIELLO
❑ Under separate cover
❑ E -mail ❑ Courier
0 Approval /Action ❑ Information
❑ Use as requested
❑ Comment ❑ Distribution ❑ Other
0 Drawings ❑ Specifications ❑ Submittals
❑ Other
No. of Copies
Date
Drawing
Description
3- - -
27 May 20078
A -1
Home Addition
REMARKS:
BY:
COPIES TO:
o
Q,
No. of Copies
MAHOPAC, NY 10541
Drawing
Description
3. �. _ _ .,...........
P 845 -628 -6613
$_1.,A- 1__:,._._ ; ' . _;:;:_. ,:,_. ::_ _._.:.
Site Plan, Architectural_Plans'
F 845 - 628 -2807
TRANSMITTAL LETTER
i
TO: Mike Budzinski, P.E.
DATE: June 17, 2008
FROM: Joe Fasacessia
PROJECT: Anthony Boniello
SUBJECT: Anthony Boniello
WE TRANSMIT:
® Attached
❑ Under separate cover
l A .
VIA:
❑ Mail
❑ E -mail m Courier
❑ Other
FOR:
0 Approval /Action
❑ Information
❑ Use as requested
- "�
;a
❑ Comment
❑ Distribution ❑ Other
THE FOLLOWING:
0 Drawings
❑ Specifications ❑ Submittals
❑ Other
No. of Copies
Date
Drawing
Description
3. �. _ _ .,...........
.June 11,'20.0$"__ ._.
$_1.,A- 1__:,._._ ; ' . _;:;:_. ,:,_. ::_ _._.:.
Site Plan, Architectural_Plans'
REMARKS:
Attached please find revisions requested in your letter. Please contact me when the approval is ready.
BY: JF /sem
COPIES TO:
d'
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
Anthony Bonniello
P.O. Box 32'2
Brewster, NY 10509
Dear Mr. Bonniello:
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ROBERT J. BONDI
County Executive
ROBERT MORRIS, PE
Director of Environmental Health
June 20, 2008
Re: Addition — Approval — A- 094 -08
No Increases in Number of Bedrooms
2190 Route 22
(T) Patterson, T.M. # 35 -5 -29
This Department 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 June 20, 2008. The addition is approved with the
following conditions:
1. The total number of bedrooms must remain at three without prior approval by this
Department.
2. The area of the existing sewage disposal system, and its expansion area, must be
maintained.
3; All-plumbing fixtures must be updated- with_ water saving devices; i.e., new_ low_ fl_ u_sh_
toilets, restrictors for shower heads and faucets, etc. _
4. The approval is for the proposed changes only. This approval does not validate any
construction shown as existing that has not obtained proper approvals.
Any 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.
Respectfull�l
I "
Michael J.
Director of
MJB:kly
cc: J. Greenberg, RA
BI (T) Patterson
Environmental Health (845) 278 -6130 Fax.(845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845)278 -6558 Fax (845) 278 -6026 WIC (845)278 -6678
'Nursing Home Care Fax (845) 278 -6085
Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648
01/27/2010 SUED 14:03 FAX INSITE ENG. 9001/001
INSI TH
LANDSCAPEARCHITECTURE, P.C.
Facsimile Cover Sheet
To:
Company.,
Phone:
Fax.
Karen Yates
Putnam County Department of Health
845- 278 -6130.
845- 278 -7921
From:
Company:
Phone:
Fax.
Date :.
Pages
(Including this cover page):
RE:
Brian Hildenbrand
Insite Engineering, Surveying & landscape Architecture, P.C.
(845) 225 - 9690'
(845) 225 -9717
1 -27 -10
1
Well and SSTS Information
.. Comments:
Karen, 1 was wondering if you could pull your riles for the following properties in the Town of Patterson-
Tax Map # 35.-5-28,29,34,35,37, 38.1, 38.2, 38.3, 43, 45, 46.1, 46.2 & 47
35.7 -1 -7; 13, 14 & 15
I am looking for any Well and SSTS information you may have on these properties. Please call the office
when you have the records pulled. and I will come to PCDOH to look at the information. Thank. You
-Brian -
3 Garrett Place, Carmel, New York 10512 (845) 225 -9.690 Fa_ x: (845) 225 -9717
www.inslte- eng.com
Mx cover.dot
MEMORY TRANSMI SS ION REPORT
TIME
> -..,_ . ...._ 'JAN- 2�•- 2•�10..�:1.:Or02AM -=.� .•�_t, �__:;,;,
TEL NUMBER 8452787921
NAME ENVIRONMENTAL HEALTH
FILE NUMBER 604
DATE JAN -27 10:01AM
TO 82280231
DOCUMENT PAGES 001.
START TIME JAN -27 10:01AM
END TIME JAN -27 10:02AM
SENT PAGES 001
STATUS OK
FILE NUMBER 604 * ** SUCCESSFUL TX NOT] CE * **
JAN -28 -2010 TUE 03:35 PM Hills Adjustment Bureau FAX NO. 5167830800
JAN- Z6 -ZO18 a3 =48FM FROA?- ENVIRONMENTAL HEALTH 84SR787 9:1 T -7al P.00Z,
113onni$ J. Sant
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Publl= lnforrrm on QftYcer
Aapiloatborg for Pubtic Aooaas to Rtacords
Ta:n Riecorcfs Acc��sis CS�Cer Ctsack one:
•Y� 4M G7.' Fr,e�.e�7f'— ��_./�,� - E] I will fturvd deiiva'r rnysat•F R"
Names of Agency ♦ ri-I ..® submit to the specifier
arttnant for me
Address �- � j0;� i � A pi nature
P. 03
F -986
m J
APPRC7VEQ - ,
OENiEC
Rncarc4 of which this Agcnoy is L_egai Custodian' Cannot Too founct.
REncord is not mainta "awed 4y this Agency.
W g naturo Ting Sato .
NOTICE= YOLS HAVE A RMHT O p A OENEXE OF THIS .A ?P CATIORi TO _
• - 'R'1 -IS Pill NA3N CC�VNTY C°.XSGLITl1lE.
Nance Ba.tsIness Arciress
WHO MUST FULLY S7iCPLA 4 1-11S SIPASC�1%48 F nM SUCH flEaN1AL IN WFZF -rl"Cs SL-- EMN5 MAY$
C?F RMCEIPT pF AN - APCBAL. I Fit =ROM -Y Af+pEA,t.•c .
SignaLi�ra Date
X 6
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WL #11
WL #11
Zu
WL 13
X
630.3
X 614.5
X 618,
S84 °°
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333.00,