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13.07 -1 -3
BOX 6
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
FINAL SITE INSPECTION
Date: 1
Inspected by: 1�
Street Location �S �(CGl,re_ -� Owner
Town 4 �1 Permit #,d
TM # i 3 7 -1- 3 Subdivision Lot # N//y
1. Sewaze Svstem Area
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 / wetlands ...... ...............................
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 Box - properly set ........:. ...............................
6. renc hes
1. Length required Length installed
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 - 11/2" diameter clean ...................:
9. Depth of gravel in trench 12" minimum....... :............
10. Pipe ends capped ........................ ...............................
g. PUmp or Dosed Systems
1. Size of pump chamber ................. ...............................
2. Overflow tank ............................. ...............................
3. Alarm, visual / audio ........ :... .......
. ...............................
4. Pump easily accessible, manhole to grade .................
5. First box ba$ led .......................... ...............................
6. Cycle witnessed by H.D.estimated flow /cycle...........
III. House/Buildin2
a. house located per approved plans ... ....................:..........
b. Number of bedrooms ....................... ...............................
IV. W ell
Well located, as per approved plans .......:............. �...:......
b. Distance from STS area measured >#0 ft...
c. Casing 18" above grade ................ .............:.................
d. Surface drainage around well acceptable .......................
V. Overall Workmanship .
a. 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 & dir.to exist watercourse
g. Footing drains discharge away from STS area ...............
h. Surface water protection adequate ..... ...:...........................
i. Erosion control provided ................. ...............................
Rev. 12/02
PIJTNAM COUNTY DEPARTMENT OF HEALTH..
-t")
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM
PERMIT #,-,
Located at - LIV- Vl 6 Town or Village P
Subdivision name
Date Subdivision Approved
Subd. Lot # Tax Map 13.1 Block d Lot 3
Owner /Applicant Name CJVAT ji ]M'a p 0 VX-
Mailing Address 45 P-d If P,
Amount of Fee Enclosed 0
Renewal Revision_
Date of Previous Approval // /
®ld i✓t I Zip J.g 56 3
T / 4C g
Building Type ' 00 JI/f r Lot Area , D No. of Bedrooms Design Flow GPD lD�
Fill Section Only Depth Volume
PCIID NOTIFICATION IS RE UIRED WHEN FILL. IS COMPLETED
Separate Sewerage System to consist of gallon septic tank and L)0. � AJ l
q. a
Other Requirements: Q
To be constructed by ��, {_�'�°�['�f/ARdress
Water• Su pl - Public Supply From
Address
or: Private Supply Drilled by i /S7/A) 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 Director /Commissioner 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
Addres
R.A. Date
License # S327 :2
APPROVED FOR CONSTRUCTION: This approval expires two years fr(iff he 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 Director /Commissioner. Any revision or alteration of the approved plan requires
a new permit. Approved for discharge of domestic sanitary sewage only.
By 1. Title: E Date:
Vhitcopy - HD File; Yellow copy - B ilding Inspector; Pink copy - Owner; Orange copy - Design Profes Tonal
Form CP -97
it
ALLEN BEALS, M.D., J.D.
Commissioner of Health
ROBERT MORRIS, P.E., MPH
Director of Environmental Health
November 12, 2014
Chris & Tara Purr
45 Brickhouse Road
Patterson, NY 12563
Dear Mr. & Mrs. Purr:
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Phone # (845) 808 -1390 Fax # (845) 278 -7921
MARYELLEN ODELL
County Executive
Re: Addition — Approval - Purr
Increase in Number of Bedrooms with new SSTS
45 Brickhouse Road
(T) Patterson, T.M. 13.7-1-3
I have 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:November 12, 2014. The addition is approved with the
following conditions:
1. The total number of bedrooms must remain at five without prior approval by this
Department.
2. All plumbing fixtures must be updated with water saving devices (i.e. new low flush
toilets, restrictors for shower heads and faucets, etc ... ).
3. Approved SSTS must be constructed according to the approved plans certified by
John Karell, Jr., P.E. Any deviation from the plan requires a revision be submitted to this
Department.
4. SSTS must be inspected by this Department before any backfilling.
5. A satisfactory water sample for bacteria only is to be provided before compliance is
issued.
6. The house must be inspected for bedroom count before the compliance is issued.
7. Once SSTS has been inspected and backflled, a construction compliance package must
be submitted for review and approval before operation of the new SSTS.
8. The approval is for the proposed changes only. This approval does not validate any
construction shown as existing that has not obtained proper approvals.
9. This approval is valid for two years and expires on November 12, 2016.
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 (845) 808 -1390 ext. 43157.
JSP:cml
cc: BI (T) Patterson
trully,
S. Paravati, Jr., P.E.
nt Public Health Engineer
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
LETTER OF AUTHORIZATION
RE: Property of /Wt • W ,NII% S . POR 9
Located at S" 'exI ck ooV 3 e Rd
TN 19a; &r s'c /I Tax Map # 1-1,7-1-3
Subdivision of
Subdivision Lot #
To whom it may concern:
Filed Map # Date Filed
This letter is to authorize 'G7L pn Kit 1- -2..LC r JP' P(5
A duly licensed Professional Engineer -,,,/ _or ��eet to apply for the required
wastewater treatment and/or water supply permits(s) to serve the above -noted property in accordance with the
standards, rules or regulations as promulgated by the Commissioner of Health of the Putnam County
Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to
supervise the construction of said wastewater treatment and/or water supply systems in conformity with the
provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County
Sant Code.
Countersigned: Signed:
esign professional) (Owner of property)
(Print
P.E., ter.; # w 3 U-]
Mailing Address: It
AREj \G
State Li i Zip /05-4 3
Telephone: k4.!;-- g 18 '76 9 y
Date: /Q-3,/—/q
Email: / ( (P 407 -MAi L . C, wi
i2)gp P (he g
(Print name)
Mailing Address: 4-', 5 JZ1 CV— P 011 s 6 Jed
fal-e rx6.1 'la 7
State A) � Zip /p S 6 3
Telephone: 6q-4 -- $i' 6 & 0 1
Revised July 2013 kly
J'r N,q
1
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner: $ �� Address: 45 WCk1461266 2�
Located at (street): A xi ng jg� 4mf TM # 13-:z— 1— 3
Municipality: Evie lr.Sc% ,1") Watershed:
Date of Pre - soaking:
SOIL PERCOLATION TEST DATA
Witnessed f by:
Date of Percolation Test:
Hole
No.
Hole
depth
(Inches)
Run
No.
Time
Start —Stop
Elapse
Time
(min.)
Depth to
water from
ground
surface
(inches)
Start - Stop
water
level drop
in inches
.Percolation
Rate
min/inch
324
2,1
1
1:1 -11.1Z
12
16- z.1
3
4
2
14
I - ZI
3
3
3
4
5
P,2
24
1
1! 19 - 11!3&
7
1 _22
3
$ -7
2
: 51
2 0
_ 2 2
3
r,
3
Z
V
4
5
1
2
3
4
5
1
2.
3
4
5
Notes:
L. I tests to be repeated at same depth until approximately equal percolation rates are
obtained at each percolation test hole. (i.e., < 1 min 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 hole.
Form DD -97, pg I oft
TEST PIT DATA
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE
G.L.
0.5'
1.0'
1.5'
2.0'
2.5'
3.0'
3.5'
4.0'
4.5'
5.0'
5.5'
6.0' .
6.5'
7.0'
7.5'
8.0'
8.5'
9.0'
9.5'
10.0'
HOLE # I
HOLE #
HOLE # HOLE #.
Indicate level at which groundwater is encountered
Indicate level at which mottling is observed
Indicate level to which water level rises after being encountered
Deep hole observations made by: Je) sign h PA ^C-1V P Date b I bq-
11.
Design Professional Name:
Address: 12,1 C it S fl A44d 9
All Ed- 56#0 /f i /0SC- 3.
Signature:
OF V
r, C.O� NWY
1.,Nf�=
Revised July 2013 — � IC
Design Professional's Seal
pf NEW
e
n �o.• 5 � 3211
�
PUTNAM COUNTY DEPARTMENT OF HEALTH .
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION FOR APPROVAL OF PLANS FOR
A WASTEWATER TREATMENT SYSTEM
1. Name and address of applicant: G 4 RA S
2. Name of Project: 61c r r4e-s i d e kA r� e '3. Location: TN:
4. Design Professional: .Jo J DAreLCTi2 5. Address: ?-I C' u s H Al,a gJ
6. Drainage Basin:
7. Type of Project:
Private/Residential 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) ? .............. Yes/No ao
Type Status (check one) ............. ........:.......... ............................... Type I Exempt
Type, II Unlisted
9. Is a Draft Environmental Impact Statement (DEIS) required ? .................... Yes/No
10. Has DEIS been completed and found acceptable by Lead Agency ? ............. Yes/No ✓ ^r(j
11. Name of Lead Agency hJ /A
12. Is this project in an area under the control of local planning, zoning, or other officials,
ordinances? ............................................................. ............................... Yes/No -YiO eL&
13. If so, have plans been submitted to such authorities? ............. :..... .I............. Yes/No , i-o
14. Has preliminary approval been granted by such authorities? Date .granted: ti-v
15. Type of sewage treatment system discharge ........................ surface water groundwater
16. If surface water discharge, what is the stream class designation? ....................:..... "JA
17. Waters index number (surface) ................................................ ............................/ "I A
18. Is project located near a public water supply system? . ............................... Yes/No t*-M
19. If yes, name of water supply Distance to water supply
20. Is project site near a public sewage collection or treatment system? .......... Yes/No r!�3
21. Name of sewage system Distance to sewage system
22. Date test holes observed 1.0 Iq /CF 23. Name of Health Inspector chv'p7
24. Project design flow (gallons per day),.... L,,0 1 .:::........... ...............................
25. Is State Pollutant Discharge Elimination system ( SPDES) Permit required? .... Yes/No
26. Has SPDES Application been submitted to local DEC office? ......................... Yes/No -r—
Rev. 11/02 Form PC -97
Pg. 1 of 2
27.
28.
29.
30.
31.
32.
33.
34
Is any portion of this .project located within a designated Town or State wetland ?... Yes/No t J-0
WetlandsID number ................. : ..................................................... ................. ............
Is Wetlands Permit required? ...................................... .... ....:................ ........ Yes/No JJ O
Has application been made to Town or Local DEC .. .... ......................:.Yes/No.
Does project require a DEC Stream Disturbance Permit? .... ......:..................Yes/No AI 0
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
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 nl 0
DESCRIBE:
Is there a local master plan on file with the Town or Village? .............:...........Yes/No
Are community water and/or sewer facilities planned to be developed within
>y..0
15 years in or adjacent to project site? .................................................... 4 ...... Yes/No N"
35. Are any sewage treatment areas in excess of 15% slope? .............................. Yes/.No #J 10
36. Tax Map ID Number ...�` �.. �.: - ..�? ............. Map Block Lot
37. Approved plans are to be returned to ................ 1/ __,Applicant Design Professional
NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall
be sent 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 1, 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
my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor
pursuant to Section 210.45 of the Penal L w
SIGNATURES& OFFICIAL TITLES.
Mailing Addressg,.r0! 1-t\ :............
1<S crJ ni
0� X Form PC -97
qtr
ALLEN BEALS, M.D., J. D. MARYELLEN ODELL
Commissioner of Health County Executive
ROBERT MORRIS, P.E.
Director of Environmental Health
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Phone # (845) 808 -1390
ADDITION APPLICATION - RESIDENTIAL ONLY
Owner's Name: Owner's Phone #:
Site Address: � ��r 4 1z,71.P�U _ Town:
Owner's Mailing Address:
Owner's Signature:
PCHD#
Tax Map #/131�)_/_ -3
Description of Proposed Addition: Z rJ_0 FZtaR_ A,DDI rivAl . r"4Y 6- .14p 0J6
-_' ao s . ADD 1J6W 95oo4A-(L 5,wnc T ,4Nk-
*Number of existing bedrooms: C� Total number of bedrooms (existing + proposed):
* (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 Department of Health, 1 Geneva Rd,
Brewster, NY 10509, Phone: (845) 808 -1390.
1. Certified check or money order for $100.00.
2. Two sets of 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. 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
Rev. July 2013
5.
Town Legal Bedroom Count & Proposed Addition Status
y '
Re: (Owner's Name)
Tax Map # Address:
Town:
Town:.2�/`'
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: 6
This information has been obtained from:
Certificate of Occupancy:
Other:
The plans for t e proposed addition are considered:
eAddition to existing house only
Teardown and/or re -build allowed under Town Regulations
Building specto Date
�� ✓ 6.
�•faY �
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner: d�
Located at (street): �)� l'l L �v✓
Municipality:
Address:
i4JEJ
Watershed:
SOIL PERCOLATION TEST DATA
Witnessed by:
Date of Pre- soaking: /'v l 3 ' Date of Percolation Test:
Hole
No.
Hole
de th
p
(Inches)
Run
No.
Time
Start— Stop
Elapse
Time
(min.)
Depth to
water from
ground
surface
(inches)
Start - stop
Water
level drop
in inches
Percolation
Rate
min/inch
2
.4
5
3
-�
4
5
1
2
3
4
5
1
2
3'
4
5
Notes:
1. Tests to be repeated at same depth until approximately equal percolation rates are
obtained at each percolation test hole. (i.e., < 1 min 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 hole.
Forth DD-97, pg l of 2
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
REQUEST FOR FIELD TESTING
All information must beLully completed prior to any scheduling. Date: /619 9 I
Engineer or Firm: 12#k Y j�,X 7 � S i rG, til Phone #: l i q -,33.6 - ql q l
Person to Contact: _� cllir� I�C,1ir�
❑ New Construction ❑ Repair Program )(Addition Program
Reason: ❑ Deeps ;Peres ❑ Pump Test
Road /Street: 45? Flru jo y S E a j -
Town• {�� % /C%2SDri� Tax Map #• -
Subdivision: ---- Lot #:
Owner: C. H (j2 ( S
❑ Project not within NYC Watershed
NYCDEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL. TESTING
YES NO
❑ Proposed SSTS within the drainage basin of West Branch, Croton Falls, or Boyds Corner
reservoirs.
❑ 2"" 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.
❑ 6- Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required.
❑ C3' Proposed SSTS for a Commercial Project.
It is the responsibility of the design professional to provide the above information prior to soil testing.
This Department will determine the NYCDEP project status (Joint or Delegated) based on the response.
If you answered ,yes 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 Professions 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.
FOR COUNTY USE ONLY
DATE: 7 1,0/ l K 1 ( t� TIME:
COMMENTS:
Req.for field test:kly 10/8/2014
Chris Purr
45 Brickhouse Rd,
Patterson
Driveway
/*
47'
50'
>30'
>30'
>35'
>35'
>35'
1311 -3
House
gal.)
43'
42'
42'
40'
Loc—t n are ij.prmhal? I:1 2
® p � Q G rl- D.Reis 8/20114
DhT# I
A71
WTVI
IP
/
�� //
NCW 1500 GALLON
ONCPt7E 5EPTIC
/ >-
TANK
Ki
DhT# I
A71
WTVI
vv, •.J„•�v, I. I LV11 IVPIIVIV.J.
,pp t tea' 1. FILTER FABRIC TO BE EMBEDDED IN SOI
o.a�ao oa -o y o
1 2. INSPECTION SHALL BE FREQUENT AND F
cross section REPLACEMENT SHALL BE MADE PROMPTL
3. SILT FENCE TO BE REMOVED AT END OF
.'EPTIC TANK DETAIL BUT NOT BEFORE ALL DISTURBED AREAS
r I I AND VEGITATED.
N.T.S.
;TW PIT DATA
Di $CRIPTION;OF SOICS;ENCOUIY BRED IN;TESTcHOLES
SOIL PERCULATION TEST DATA
.
Hok
No.
. ,Hole
depth
(��)
:...:....
Run
No:
....... .
T ®e
Sfii. =$top
EI e:'
or :
Time
(min)
Depth M, ,
WAtlrf-
ground
■urface
(mchee).
Start - St
Water
kveYdiop.
ia'iaelwy
'PercolAf.op;
Rate:
.:mfa/inch
2
I.
r.
s:
3:
4:
SOIL DATA:
1- TRENCHES FOR 4 BEDROOM HOUSE
PROVIDED 427 L.F. ] EX15W
REQUIRED 300 L.F.
100% EXPANSION 427. L.F. PROVIDE[
2- DESIGN .PERC 7 MIN /INCH