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3.19 -1 -11
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PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR
SITE LOCATION
OWNER'S NAME
MAILING ADDRESS
FACILITY TYPE
PROPOSED INSTALLER
PHONE # ?02%
contractor)
}' j- eAC� PCHD COMPLAINT #
,r
e-, PHONE # e��2 7-- M9
REGISTRATION /LICENSE # 4�
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 reoair.
I, as owner,agree to;the,con itions stated on this form
SIGNATURE v 'G TITLE DATE
(owner)
I, the septic installer, agree to com ly with the conditions of this permit for the septic system repair
SIGNATURE TITLE DATE 36-T/0
(installer)
Proposal appr oved with the 101wina conditions: t
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..
O INTERNAL USE ONLY
P osal Appro d Proposal Denied
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In ector's Signature & Title
Date I
Exp' ation Date
Repair proposal is in compliance with applicable codes
Yes
❑
No ®,--'
COPIES: PCHD; Owner; Installer
`
PC -RP 99ML 1
6
Rev. 2/07
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PtiTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHEET — SUBSURFACE SEWAGE TREATivIENT SYSTEM
Owner:
Located at (street):n> S�
Municipality:�f /S
Address:
TM # Section: Block Lot
Watershed:w�
SOIL PERCOLATION TEST DATA
Witnessed by:
Date of Pre-soaking: `''� Date of Percolation Test:
Hole No.
I
Run No.
Time
Start —
Stop
Elapse
Time I
(min.)
Depth to.
water from `
ground
surface
(inches)
Start - Stop
Water
level drop
in inches
Percolation
Rate
min /inch
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3
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Notes:
t. Tests to be repeated at same depth until approximately equal percolation rates are
obtained at each percolation test hole. (i.e., < train for 1 -30 min / inch, < 2 min for 31 -60 min/inch).
All data to be submitted for review.
2. Depth measurements to be made from top of Note.
Form DC -97 nJ 1 of ,
TEST PIT DATA
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE #_ HOLE # HOLE # HOLE # HOLE #
G. L.
0.5'
1.0'
1.5' ,
J 1 )
2.01
2.5'
C4
3.0'
3.5'
4.0'
4.5'
5.0' ))
5.5' 7°
6.5'
7.0'
7.5'
8.5':aa{
9.0'
9.5'
10.0'
Indicate level at which groundwater is encountered i'VA
Indicate level at which mottling is observed
Indicate level to which water level rises after being encountered Aa
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Deep hole observations made by: Date
Design Professional Name:
Address:
Signature:
Design Professional = Seal
0
SHERbTA AMLER, SID, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
ROBERT J. BONDI
County Erecutive
ROBERT MORRIS, PE
Director of Environmental Health
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509 LA/.
REQUEST FOR FIELD TESTING
All information below must be fully completed prior to any scheduling. DATE: S31HI10
ENGINEEROR F ✓� I��C In PHONE #: ?�:" °ate
PERSON TO CONTACT: '
0 NEW CONSTRUCTION "EPAIR PROGRAM 0 ADDITION PROGRAM
REASON: DEEPS: 91 PERCS: 9 PUMP TEST: O
ROAD /STREET: /yS,'"i7��2i✓l
E
TOWN: PzP�?(--L;Vn TAX MAP
SUBDIVISION: �/�' LOT #:l
YES NO
❑ ❑ Proposed SSTS within the drainage basin of West Branch or Boyds Corner &
Croton Falls Reservoirs.
❑ ❑ Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake.
❑ ❑ Proposed SSTS within 200 feet of a watercourse or a DEC wetland.
❑ ❑ Proposed SSTS design flow greater than 1000 gallons/day or SPDES Permit required.
D ❑ Proposed SSTS for a Commercial Project.
It is the responsibility of the design professional to provide the above information prior to soil testing. The
Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you
answered ves to any of the questions, NYCDEP must witness the soil tests. This Department will coordinate a
mutually suitable time for field testing with the Design Professional and NYCDEP.
If a project has been determined to be Delegated based on the above response and then subsequent
information indicates NYCDEP is required to witness the soil tests, it will be the sole responsibility of the
design professional to schedule re- witnessing of the soil testing with NYCDEP.
DATE:
COMMENTS:
FOR COUNTY USE OVLY ,
TIME:
REQ. F00. FIELD TESTINGALY
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) 27"026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278-6085
Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648
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Tax map # 3.19 -1 -11
March 23, 2010
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Docherty
15 North Rd
Patterson NY
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Tax map # 3.19 -1 -11
March 23, 2010
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Docherty
15 North Rd
Patterson NY
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845- 279 -8809
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REBECCA WIITENBERG, RN, BSN
Public HeaM Dkwdor
ROBERT MORRWh PE
Director ofEwiromnad /Health
DEPARTMENT. OF
Geneva Road, Brewster, New York 10509
Phone # (8457 808 -1390
Fax # (845) 278 -7921
May 7, 2012
Kevin & Jennifer Docherty
15 North Street
Patterson, NY 12563
Re: ' Addition Approval - Docherty
No Increase in Number of Bedrooms
15 North Street
(T) Patterson, T.M. 3.19 -1 -11
Dear Mr. & Mrs. Docherty:
MARYELLEN ODELL
. CouWy EwcutaW
This Department has 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 this Department dated May 7, 2012. The addition is approved with the
following conditions:
1. The total number of bedrooms must remain at four 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 flush
toilets, restrictors for shower heads and faucets, etc ...
4. The approval is for the modifications only and does not validate any construction shown
as existing that has not obtained proper approvals from other agencies having
jurisdiction.
5. This approval is valid for two (2) years and expires on May 7, 2014.
Any permits or variances required under the jurisdiction of the Town of Patterson are the
responsibility of the applicant.
If you have any questions, please contact me at (845) 808 -1390 ext. 43157.
Respectfully,
Joseph S. Paravati Jr., P.E.
Assistant Public Health Engineer
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cc: BI (T) Patterson
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ADDITION APPLICATION
V
RESIDENTIAL ONLY
STREET / -6 d� TOWN TAX MAP #
NAME PRONE
MAILING t
ADDRESS
DESCRIPT -� -- --
ADDITION
NUMBER OF EXISTING BEDROOMS Y PROIPOSED # 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 H_ ealth 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, to be
shown and dimensioned and use of each room specified). (See Section 3.c of Bulletin
HA -1)
3. Two sets of proposed floor plans (drawn to scale — with name, street and tax map #)
* Non- professional sketches are acceptable and preferred. (See. Section 3.d of Bulletin
HA -1)
4. Copy of survey showing all well and septic locations on the subject property to the best
of your knowledge. Include date of installation known. Contact this office with any
questions.
5. Copy of Certificate of Occupancy from the Town or Certification from the Building
Department with legal bedroom count of dwelling.
OFFICE USE
COMMENTS
Town Legal Bedroom Count & Proposed Addition Status
i
Re: wner's Name)
Tax Map #
Address:
Town: AIJj�
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:
Certificate of Occupanc
Other:
The plans fo the proposed addition are considered:
New Construction
-k"-- Addition to existing house only
Teardown and/or re -build allowed under Town Regulations
Of icAaon-- Lei 4
Bui ding Vspecto, Date
6.
IS North St.
Patterson, NY 12563
April 19, 2012
Mr. Joe Paravati
Putnam County Dept. of Health
1 Geneva Road
Brewster, NY 10509
Dear Mr. Paravati,
Please find enclosed a money order for $100.00 as payment for the application for our
extension. Thanks so much for all your help!
4
Sincerely,
Jennifer Docherty
Mr. Joe Paravati
Putnam County Dept. of Health
f Geneva Road
Brewster, NY 10509
Dear Mr. Paravati,
15 North St.
Patterson, NY 12563
April 13,2012
Please find attached another set of proposals for my first floor addition. The last time we met,
you had kindly offered to bring my plans to the engineering meeting that you have on Mondays.
Further to our conversation, we have cut 10 feet off the proposed addition and moved the bathroom to,
be closer to our original structure.
If possible, I would like some feedback on this revised proposal. I don't really want to pay. a
$100 fee if there 'is really no hope in getting approval for this addition. I have already paid the building
dept. $75.00, so I don't want to throw away another $100 if the project is doomed from the start.
Could you please let me know how this revised project looks to the engineers? My phone
number is 845- 878 -3827. Thanks you very much for your help.
Sincerely,
Jennifer Docherty
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