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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
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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
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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.
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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,_!-
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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
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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)
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