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HomeMy WebLinkAbout2019DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.40 -1 -4 BOX 18 02019 WI 1 I ti,. Y; I' �0 f Ll ~' '� ,16 1 `� J .NI. '. ' �� T F 11 ! �L �1 r � i 1 em L Z 02019 •gin PUTNAM COUNTY HEALTH DEPARTMENT S� DIVISION OF ENVIRONMENTAL HEALTH SERVICES .PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR YES NO Internal Use Onl PERMIT #R' ❑ r Permit issued in last 5 years r-� ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. within 200 ft. of a watercourse or DEC - mapped wetland in Watershed Ll Delegated ❑ Joint Review SITE LOCATION /oAlm TOWN�AQre,,Sc TM # J6.1f U j 7 OWNER'S NAME ��y/ 42,E6F PHONE # MAILING ADDRESS Si ne .a4 xw APPLICANT .�!!�2c%N'.... �� -Z- Name & Relationship (i.e., owner, tenant, Tact r DATE I FACILITY TYPE ;) S PCHD COMPLAINT # PROPOSED INSTALLER &glow Z c d _r, C PHONE #S at ADDRESS -Zj 3 D���,urw // PJ,#5f&. REGISTRATION /LICENSE # AZ2 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. /alot Cam-e,-,t it V-^ 4/ I, as owner,agree to the conditions stated on this form SIGNATURE /�'�i _� TITLE DATE / /- i.S�- ?sf r 3 (owner) I-, the-septic installer, agree to comply with the conditions of this permit for the septic system repair SIGNATUR / TITLE sy-s� DATE (Installer) Proposal aooroved 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 u thorization to do so has been obtained from the Department. INTERNAL USE ONLY Proposal Approved Proposal Denied ❑ Inspector's Signature & Title Dat6 Ex ration bate Reoal r Drowsal is in compliance with applicable codes Yes No 0 COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 JOB / ss�� , ��,�ydyy<�����""% /M ZnZ 9 �I ARROW EXCAVATING, INC. SHEET NO. y2_ �L/ �� O OF T �j 33 CALCULATED BY��xt• �K DATE (845) 227 -4505 (914) 5284395 CHECKED SV • � • /y` /'7 DATE SCALE JOB be-ho-to ARROW EXCAVATING, INC. SHEET NO-3 OF 6 15 AVALON COURT 'S-7 HOPEWELL JCT., NY 12533 CALCULATED DATE (845) 227-4505.(3.14) - 52$14395- CHECKED BY DATE SCALE . .. ........... a LORETTA MOLINARI Public Health Director ROBERT J. BONDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278.6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845)278 - 6648 Putnam County Dept. of Health 1 Geneva Road Brewster, NY 10509 To Whom It May Concern: Re: Residence Tax Map .24�° %"'V Town According to records maintained by the Town, the above noted dwelling, IS NOT bL In compliance with Town code and the total number of bedrooms on record is This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: houseguidelines N ,i ,Y po GO NS i tAA 3s"l� � -7)r) 9 i� - rJvV4 � - ltii.'!g 111� M AI AVbW UO3 d3AOWdV •SNV W 2w, �'� %� 74YHrWIH 40 IN3RMdl(l AM= MUM LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH I Geneva Road, Brewster., New York 10509 Environmental Health (845) 278 6130 Pax (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 October 18, 2004 Daria ` 3 Palmyra Rd. Brewster, NY 10509 Re: -Accessory Apartment- Daria, 3 Palmyra Rd. Three Year Approval (T) Patterson, TM #36.40 -1-4 Dear Mr. Daria: ROBERT J. BONDI County Executive I have received and reviewed the plans for the proposed accessory apartment at the above- mentioned residence. The proposal for the apartment has been:approved as per plans bearing the; approval stamp from this- Department dated October 18; 2004, ;Tli.e apartment is approved for three years with the following conditions: 1. The total number of bedrooms in the apartment must remain at one without prior approval by this department. 2. The -total number of bedrooms in the main House must . remain,at� three - without: prior approval by this department.. 3. The area of the existing sewage 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. 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. Sincerely, Michael Luke ML:Im Public Health Sanitarian LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Daria 3 Palmyra Rd. Brewster, NY 10509 Dear Mr. Daria: ROBERT J. BONDI County Executive October 13, 2004 Re: Accessory Apartment — Daria, Palmyra Rd. (T) Patterson, TM #36.40 -1 -4 I have received and reviewed the plans for the proposed accessory apartment at the above mentioned residence. The plans indicate that the proposed apartment will consist of the following: Two bedrooms in the main house and two bedrooms in the apartment. Based on the information submitted, the above - mentioned addition cannot be approved for the following reasons: 1. The 2nd floor living room, dining room, and kitchen are considered potential bedrooms. -- 2: - The- legal bedroom count-for the dwelling is four. The potential bedroom count of your proposed addition is seven. 3. 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 four potential bedrooms, or have a professional engineer or registered architect design a sub - surface sewage treatment system meeting present code requirements. If you have any questions, please contact me at your convenience. ML: hn Sincerely,, -W zz o,� Michael Luke Public Health Sanitarian BRUCE R. FOLEY Public Heclth Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director . Director of Patient Services DEPARTMENT - OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Ndrsing Services (845) 278.6558 WIC (845) 278.6678 Fax (845) 278 - 6085 • Early Intervention (845j,278-6014 Preschool (845) 278.6082 Fax(845)279-6648 Date q /� c Renewal ❑ ELI' Yes , No STREET 3 TOWN X MAP ti NA_NEAgZ PHONE PCHD # y -O MAILNG ADDRES MAILING ADDRESS OF APARTMENT NUMBER OF BEDROOMS IN MAIN HOUSE -� NUMBER OF BEDROOMS Iiv APARTMENT Please submit this form and the requirements on page two to the Putnam. County Health Dept., 4 Geneva Rd., Brewster; NY 10509, Phone 278 -6130. Approval is effective for a three year period. The applicant must reapply at the end of och period to renew the legal status of the apartment. Signature of ApIflicant /A PP roved bate � to- la ti t ,o -7 By %/ vG_fjrA_ Title 10l-�S OFFICE USE Comments ��.ratigP�. l ��M 1 r f. 4 1y �' its b '. t .y ,� S y `� `�'=i '• � "L� •, .[ �et sa S �'�.# ,ae�� -d` t� 4Eh'�+'�n rr ,ik �s,..�' t' "4 � %��� -' '2j��"`b�'� �`e�•�t rt��15"��r�4kcs°-kp•'+.� }� 5tk -.rsr r�� t�'r "pfd 'M��f S I _ ^. S 1 4 '_ t ,r �. e •):+„aru. �+1.�. sip -/{.0 � "r Yfx NAME kiectricSnaking { f ' t ADDF�SS "" v1 - - - -" I� I t` y F 6 lJ + Tanf�,Gondib ,.. � �,� I Ski .. � ��y����,�r� _x I••, nh99##d Y � BY _ CASH .,.ft e n n'" • 01U A n^� 77 .t. 1f _' a 0509 'tic ,s DATE , f a`� T'D P D OUT ` W={ +..i AMOUNT ski }Ip� f Iq Sva :. rt'r �� n'Y r• q.'1FAYl� F F ,y i M1i� t l2y� { I F Y Al r �. S, t sf a � 3 -�5t �� i•C•• 'xH[1ii 1 t, 1 Yx I W+s kiectricSnaking { f ' t Materials #> } ; y + Tanf�,Gondib 4 1 nh99##d Y to z, a t S 77 7 � t I R iL � _. .� 11• 77 .t. 1f _' a 0509 'tic ,s DATE , f a`� T'D P D OUT ` W={ +..i AMOUNT ski }Ip� f Iq Sva :. rt'r �� n'Y r• q.'1FAYl� F F ,y i M1i� t l2y� { I F Y Al r �. S, t sf a � 3 -�5t �� i•C•• 'xH[1ii 1 t, 1 Yx MI.- ENVIRONME::NT{ -ii_ SERVICES 321' Kear Street Yor t k,.iwn Heights, N -.-v '"IO�r?�" ( 914) 24.S-°2800 Albrar•t H. Padovani, Director LAB #: 93.401955 CLIENT #-. 57777 NON STA T ?" ROC F eAG)k: t. w/N IIINNwJN NA /wI III NIN JVN NNII/NN NIVN NNN.w _ IV JVN IV_ III, IVNNIV INwI nIIV IV Ne •:NNIM N1N NMI IN •V JV IVVIII nr IV .,I INN /IN nI nJIU rUN ne.V IU ... •.: ..y r••..• DP.RIA, PAUL. DATE /TIME TAKEN.,. 013/17/(34 3 POL.IMYRA RT) DATE: /TIME RFX' C):i Ofi /17/04 1-:'­10 PREWSTt-H-.h, NY 1 03509 fitr.F'ORT DATE t: t:A4II H/04 PHONE.- (845)­279­3371 SAMPLING S Y TE a SANE SAMPLE TYPE,_!- ,.:: c KITCHEN TAE' PRESERVATIVESa N(Jh;C (;OL.1 D RY -. PALIL -)AR YA -r:,MPlF-'WNTt tRr' ...:o h t:.' i+317T S _ % ME:1 H: Iw IwNNNNwIIV nI IV•VNIVNrV INNIV JVIV INNNw.NNIV wI:UW ne NIV w1W nI IN IN wI rV JVI V IVNIVNIV IV INNNNIV wI HI IV IV IV IV IN IV IN l:I1V IN J4IV IN IJ11V n /•V wl of ew r�:V -: DATE_ FLAG 1**,'ROClrD1JRF RESULT NORMAL — RANC31_: l„.'1 "HOT: 08/17/04 MF T. CDL Y. f= ORM ABSENT /LOO ML ABSENT t 008 COMMENTS A E3ACT THEME RESUL.'i°S INDICATE THAT THE WATER WA,�,') (WA8 h10T) taw' A SATISFACTORY SANITARY QUALITY ACCURD HE: NEW YORK' STATE' AND EPA FEDERAL DR I lVt =:7 Nt3 DATER wiTANDARDC, FOR THE FIAK'AMETEI•k'S 'r'ESTEZ) AT THE T I ME. OF COLLECTION. SUBMITTED SY a v v s - A1be!r�t: 11. Pac. vani, M.T. (Ai CP) Director �.._ ... '...:' ....':..'Jl:. ....: .. ..�.:: ':�J...��;�<„r,.:.i ::..:4ii.�YwaCyX�:I�GLL'Ih.■ 10323; I U,Akllj-o( op t ai 5 "I, BRUCE R. FOLEY __Public -Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Public wealth Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 August 18, 2000 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Paul Daria . 3 Plmyra Road Brewster, New York 10509 Re: Existing Septic System 533 Lake Shore Drive Town of Patterson Dear Mr. Daria: I have received and reviewed the survey for the above mentioned parcel. The survey indicates that the parcel contains two (2) residences located near the rear property line. The septic system servicing these residences is located behind these residences apparently on property owned by others (Putnam Lake Park Association). I have inspected the property on 2 occasions to determine if the septic system could be relocated entirely on your parcel. The location of your well as well as the location of surrounding wells make relocation of this system difficult. Relocation of the existing septic will not be possible without abandoning the well serving your parcel and constructing a septic system in this area in front of the residence. It also appears that relocation of the well may not meet the requirements of this department. This department would recommend that you attempt to obtain an easement from the adjacent property to maintain the septic system in its existing area. If this is not possible, please contact a professional engineer to design a subsurface sewage treatment system and individual water supply within your property. Please be aware that meeting even minimum requirements does not appear possible and variances or waivers from minimum setbacks would need to be considered by this department. -- .;Please contact this department immediately if an acceptable arrangement cannot be achieved with the adjacent property. WH:cj cc: Building Inspector Putnam Lake Association Very truly yours, William Hedges Sr. Public Health Sanitarian PUTNAM COUNTY HEALTH DEPART DIVISION OF ENVIRONMENTAL HEALTH SERVICES 225 -0310 __ -- PRQPOSAL. FOR, §RLAGE ,DISPOSAL .SYSTEK..REPAIR_ OWNER'S NAME �� u f A IC R PHONE SITE LOCATION M 7 TO MAILING ADDRESS V J N AM 409 r25 R S0^J ev Z25 -337/ PERSON INTERVIEWED PCHD Complaint # Name & Relationship (i.e, owner,tenant, etc.) DATE TYPE FACILITY PROPOSED INSTALLER lVa4 A` W 1AJ&5' Pc Av 7S9 PHONE 2-�T 00ZFS' Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal fram licensed professional engineer or registered architect. Alb -1/9" PoUS , "c. l /110 '5 S Proposal approved Inspector's Signature & Proposal Disapproved to Proposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed canponents tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diem. x 6' deep . drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, or report@d agent of owner agree to the above conditions. SIGNATURE TITLE DATE A111219Y PIES: Wite (POEO); Yellcw Mun BI); Pink (Appli®nt) bd Nib 21 �7ie-