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HomeMy WebLinkAbout1280DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.70 -1 -55 BOX 12 IN7% 0 'llol rrmim i R, A, .1 1 I Iwo m 1 or 6.1 ol r 01280 r I PUTNAM COUNTY. HEALTH DEPARTMENT\°� DIVISION OF ENVIRONMENTAL HEALTH SERVICES YES NO ❑ V ❑ ❑. ❑ ❑ SITE LOCATION OWNER'S NAME MAILING ADDRESS Internal Use Only PERMIT # <•Q:;�;IS\ n-A n� Repair Permit issued in last 5 years Repair within Boyd's Comers, W. Branch or Croton Falls Res. Repair within 200 ft. of a watercourse or DEC-mapped wetland VI"Ct'y {, TOWN APPLICANT �f j, XJ6-? Ae- Name & Relationship (i.e., owner, tenant, contractor) ❑ In Watershed v / a- Delegated ►� ❑ Joint Review DATE 002- 1 /0 W/O— FACILITY TYPE ' hfVMe. PCHD COMPLAINT # PROPOSED INSTALLER me- (o /r4 J PHONE # ADDRESS 37 REGISTRATION /LICENSE # A6 d03l 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. I, as owner,agree to ; e conditions stated on this form SIGNATURE /61/1/, + TITLE c DATE (owner) _,......_.: ._- i,.the. septic- iirlstall-er, a tee tA:como.ly_with:_th.e conditions..of tnis.,p-errDit.forthe septa system: repair i✓' TG'� SIGNATURE � TITLE DATE S (installer) Pro osaI a r ed with t 4 lowing conditions: 1. Procurement of anyl 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. IAITCI'f AIAI 1211L AAII V 11\ 1 C�1\AL V7L VI \L i Proposal Approved Proposal Denied ❑ Inspector' ignature &Title Date Expiration Date ,Repair proposal is in compliance with applicable codes Yes ❑ No B—' COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 am! pop ri TOM ............. fl. 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I I % N p -D-S,loo PUTNI A�`VI C ®UNTY DEPARTI 1IENT OF HEALTH DIVISION OF E RONNIi IENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATIVEENT SYSTEM ©wner: D_ r A 4, 6n t-4-1j Located at (street): (Municipality: Address: Tit:.* Section. _Block_ Lot Watershed: SOIL PERCOLATION TEST DATA Witnessed by: ��iy Date of Pre- soaking:2 h2- 2 -- Date of Percolation Test: 2! 23 Dole No. Run No. Time Start - Stop Elapse Time (min.) Depth to vaster from round surface (inches) Start - Stop Water level drop in inches Percolation hate min /inch 1 2-D '_2a _ 1.L3 ! Z b z— 10 �4 1 z 2, Z. —zT 1 6152 I— 4 9 I I f 2 3 I I k 4 I I Z I f 3 k k 4 g I � I 9 3 4 5 1 I Notes: 1. Tests to be repeaced at same depth untill approximately equal percolation rates are obtained at each percolation test hole. (i.e., < !thin for I -36 min/inch, < 3 min for 31 -60 miniinch). All data to be submitted for review. 3. Depth measurements to be made from top of hole. Form DD -97, pe I of'_ P U NAIM COUNTY DEPARTIVi'{`N T OF. HEALTH, DIVISION OF ENVIRONMENTAL I3EALTH SER yIS C� INITIAL WDIVIDUAL/COMM . RCL4•L SITE INSPECTION FORM SECTION A.' GENERAL INFORMATION Name of Projects r ohe�' (T)(V) PG :sue County Site Location C eJ / k e) : Building construction oegun Extent Is property within NYC "Watershed ? ................. a Yes No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. Hilly Rolling 0 Steep slope entle 2. Evidence .of wetlands a Low area sub' e ct to flooding Drainage ditches Rock outcrops 3. Property Riles or comers evident ..................: 4. 'Do water courses exist on or adjoin the.property? ............... 5. G�'ill these street the design of the sewage system facilities ?............ 6. Do watershed regulations apply in this development ? ....................... slope a Flat Bodies of water es F7, No Yes �o DYes "..No Yes No .7. Will extensive grading be necessary? ................. . Yes .................. No 'will- ;Xtensivef l'15 ...... sary :far SST.S ? ...............�...... ............... -=Yes 0 No._........_...._ _ ._....._ - ..i 9. Do filled areas exist wiain the SSTS area? ........ .......................... :.... a Yes a No If yes, what is. the condition of the fill? SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: Q Sand =Gravel =Loam =Clay Q Hardpan u Mixture :..._L1.. Observed from; , : Borings.. -.F- 7- Bank cut Backhoe excavations_...._.. -... 12. Soil borings/ excavations observed by on L21 J L 13. Depth-to groundwater on .14. Depth to mottima on 13 . Are test holes representative of primary & reserve areas ......................................... Yes No 16.. Soil percolation tests made by on�� l Z 17. Soil percalation tests witnessed by on LC S ' "5' SECTION D (on back) Form ST.-1 .. x SECTION D. DR kPgAGE 18. Will proposed grading materially alter the natural drainage in this or adjacen areas? Yes �NO 19. Will groundwater or surface drainage require special consideration? ... ................... F7 Yes EZN o 20: Will gullies, ditches, etc:, be filled and watercourses be relocated ? .................... .... F7 Yes IZIN'o SECTION E. REMARKS 21. Ii a common water supply is proposed; has an inspection been made of the existing or pr000sed source and facilities ? ............... ...... YesNo InsDection data 22. Do adjacent wells and/or sewage systems exist ? .................................................... Yes -No 23. Additional comments 24. Site observer /inspector and title 25. Date(s)-of observation(s)inspection(s) TEST PIT PROFILES Hole Hole L Lot 4- Hole -rr Lot r Depth to water Depth to water Depth to mottlinj Depth to mottling Depth to mottling Depth to rocklimp. �'%� ' Depth to rock/imp. Depth to rock/imp. G.L. G.L. ? G.L. 0.5 ro 0_ s . 0.5 rb pis Q 0.5 1.0 /nor, lbi•, 1.0 2.0 q(�e 2.0 2.0 :.0' G "'Vc -1 3.0 3.0 4.0 ;.0 5.0 .4�` �O ✓G ! .6.0 6.0 7 ��Soc` 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 i Property Details - Image Mate Online Putnam County A&GI Image Mate Online Navigation GIS Map Tax Maps I ORPS Links Assessment Info Residential _Property, Info;,_; : Owner /Sales Inventory Improvements ; Comparables Municipality of Patterson, Town of ISWIS: 1 372400 ITax ID: 1 25.70 -1 -55 1 Tax Map ID / Property Data Status: Active Roll Section: Taxable Address: 15 Victory Rd Property 210- 1 Site 210- 1 Class: Family Res Property Class: Family Res Site: Res 1 In Ag. No t: Zoning Code: RPL10 - Bldg. Style: Old style Put. Lake Neighborhood: 00536-- SC11o0l Brewster District: Legal Property 06400000040020000000 Description: 003160000072000000000 64 -4 -2 2011 - Total Equalization Tentative Acreage /Size: 316 x 72 Rate: 100.00% 2010- 100.00% 2011 - 2011 - Land Tentative Total Tentative Assessment: $25,500 Assessment: $211,100 2010- 2010- $25,500 $217,600 2011 - Full Market Tentative Value: $211,100 2010- $217,600 Deed Book: 11794 Deed Page: 1138 Grid East: Grid North: Pagel of 2 Help I Log In Photographs I No Photo Available Maps View Tax Map Pin Property on GIS Map View in Google Maps View in Yahoo! Maps View in Bing Maps Map Disclaimer Property Details - Image Mate Online :j752713 I 961253 Special Districts for 2011 (Tentative) Description Units Percent Type Value Fire #1 0 0 0 Put lake light 0 0 0 Sanitation - putlk 1 0 0 Special Districts for 2010 Description Units Percent Type Value Sanitation -putlk 1 0 0 Put lake light 0 0 0 Fire #1 0 0 1 10 Land Types Type Size Primary 316 x 72 http://putnam.sdgnys.com/propdet; Page 2 of 2 Property Details - Image Mate Online Pagel of 2 Putnam County Image Mete Online Residential Property Info L_IIIIF,lIUVCII,ICIIW J Tax Info Report Comparables _.._ ._.. „..____._.__. -. http: Municipality of Patterson, Town of SWIS: 372400 Tax ID: 1 25.70 -1 -55 Navigation GIS Map I Tax Maps ORPS Links Assessment Info Help Log In Residential Property Info L_IIIIF,lIUVCII,ICIIW J Tax Info Report Comparables _.._ ._.. „..____._.__. -. http: Municipality of Patterson, Town of SWIS: 372400 Tax ID: 1 25.70 -1 -55 Structure Building Style: Old style Number of Baths: 1 (Full) Number of Bedrooms: 2 Number of Kitchens: 1 Number of Fireplaces: 1 Overall Condition: Normal Overall Grade: Average Porch Type: Porch Area: Year Built: 1931 Basement Type: Crawl Basement Garage Cap.: 0 Attached Garage Cap.: 0 sq. ft. Area Living Area: 1,027 sq. ft. First Story Area: 1,027 sq. ft. Second Story Area: 0 sq. ft. Half Story Area: 0 sq. ft. Additional Story Area: 0 sq. ft. Three - Quarter Story Area: 0 sq. ft. Finished Basement: 0 sq. ft. Number of Stories: 1 Photographs No Photo Available Ma View Tax Map Pin Property on GIS Map View in Google Maps View in Yahoo! Maps View in Bing Maps Map Disclaimer .,,nys.com/j)roodetail.ast)x?swis=372400&t)rintke... 2/15/2012 Property Details - Image plate Online Utilities_..__ . Sewer Type: Private Water Supply: Private Utilities: Electric Heat Type: Hot wtr /stm Fuel Type: Oil Central Air: No htt-P:Hputnam.sdgnys.com/prop-detail Page 2 of 2 ?swis= 372400&printke... 2/15/2012 Property Details - Image Mate Online Putnam County rSDGI Image Mate Onli ne Page 1 of 1 Navigation GIS Map I Tax Maps 11 ORPS Links Assessment Info Help Log Ir Residential Property�_Info OwneNS'ales Inventory Improvements Tax I nfo Report _ Comparables, httn-fln» c�1 � Municipality of Patterson, Town of SWIS: 372400 Tax ID: 1 25.70 -1 -55 Ownership Information Name Address Sally Dragonetti 15 Victory Rd Patterson NY 12563 Sale Information Sale Date Price Property Class Sale Type Prior Owner .12/28/2007 $270,000 _. _ "-- 210- 1 - Family- Res Land & Building Lowry, John D, Value Usable Arms Length Deed Book Deed Page Yes Yes 1794 138 Sale Date Price Property Class Sale Type Prior Owner 1/15/2004 $190,000 210- 1 Family Res Land & Building O'brien, Jane Value Usable Arms Length Deed Book Deed Page No No 1652 215 ra No Photo Available Maps View Tax Map Pin Property on GIS Map View in Google Maps View in Yahoo! Maps View in Bing Maps Map Disclaimer o,nm /nrnn(lPtai1.a.qnx ?awi-,= 372400 r.nrintkP... 2/15/2012 Property Details - Image Mate Online - .. 7:' Putnam County .-. image Mate Online Page 1 of 1 Navigation GIS Map Tax Maps ORPS Links Assessment Info Help Log Ir Residential Tax Info Report , Comparables Municipality of Patterson, Town of SWIS: 372400 Tax ID: 1 25.70 -1 -55 Improvements Structure Size Grade Condition Year Gar -1.5 det 20 x 20 Average Normal 1948 Pavng -concr 12 x 14 Average Normal 1948 httn-//nutnam.sdgnvs.com hs No Photo Available View Tax Map Pin Property on GIS Map View in Google Maps View in Yahoo! Maps View in Bing Maps Map Disclaimer i s =3 i 2400&nr; n tke ... 2/15/201 It Bill It I % W.W z ROAD LU _j 0 % CL ----------- ...................... ---- -------- — ------------ --------- ......... . :J "VAmns t ----------- % .... ...... .. N. 4 1 J 1 713MC11vo ------------------ ------------------ _--------------- L -----------_-------- ........¢. i§ „� :< 9 .... ----------- --------------_- .............. -------- ; ---------- o. ........... ..... . . ---------------- - ---------------- --­-------------- ROAD SAWIWD ---------- t—t ................ .......... 111111 I" t � � •� � 1 ( i1) [ � I � �1� I I" �� PZ I � 1 I �: I (1> ! 111 �� l 14 � DMMN ®IF IENWROIVM ENTA L HEALTH S E1R ROTES APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT # Wellll Location: Street Address: TownNillage Tax Grid # 15 Victory Road Patterson Map 25•70Block —1 Lot(s) 55 Wen Owner: Name: Address: John Lowry 15 Victory Road, Patterson, NY 12563 Wen Type: X Drilled Driven Dug Gravel Other Depth Data : Well Depth ° C ft Static Water Level 1A, ft Date Measured 6.3'If—o ;" Use of Wen: X Residential Public Supply Air /Cond/Heat Pump Abandoned I- primalry Business Farm Test/Observation Other (specify) 2-secondary Industrial Institutional Standby Water Wen Name: Address: Contractor: P. F. Beal & Sons, Inc., 4 Putnam Ave., Brewster, NY 10509 ReasonlFor They have no water. Existing well is inside the house in the basement. Abandonment: Description of Work To Be Performed: Fill well from bottom to top with concrete. Date: 7/11/05 Applicant Signature: Matthew L. Beal P 1 1 475 I This permit, to abandon one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code, Subpart 5 -2 of Part 5 of the New York State Sanitary Code and /or Part 75 of 10 NYCRR and provided that: Within 30 days of the completion of the abandonment of the water well, the applicant shall submit to the Department a certified statement that the info ati n delineated on the application for this permit has been completed. Date of Issue Permit Issuing Official Title White copy: HD file; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WA -97 ' :,I, .., ,r. . IPUTNAM COUNTY DEPARTMENT 07 HEALTH DffWSRON OF IENVERO MENTAL HEALTH SIERVffCIES _ - AP1PLIC-ATION'TO CONSTRUCT -A WATER WELL; _- ---. - - �� please print or type PCHD Permit # I ) — 05 Well Location: Street Address: Town/Village Tax Grid # 15 Victory Road Patterson Map25.70 Block -1 Lot(s) -55 Well Owner: Name: Address: John Lowry 15 Victory Road, Patterson, NY 12563 Use of Wepl: X Residential Public Supply Air /Cond/Heat Pump Irrigation I- Primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5 gpm # People Served Est. of Daily Usage gal. Reason ffo>r X Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason . They have no water. Existing well is inside the house in thinasemen for Drilling Well Type X Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No O Name of subdivision Lot No. Water Well Contractor: P. F. Beal & Sons, Inc. Address: 4 Putnam Ave., Brewster, NY 10509 Is Public Water Supply available to site? .................................. ............................... Yes No O Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided separate sheet/plan. Date: 1/-11 /05 Applicant Signature. Lam- f Matthew L. e PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a'Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED ]FOR CONSTRUCTIION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. revision or alteration of the approved plan requires a new permit. Well to be constructed by a wate ell 'ller ce ed by Putnam County. , Date of Issue'/ Permit Issuing Official: V� Date of Expiration Z n e, Title: Permit is Non- 'p'ransf rrab e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health P.F. Beal & Sons, Inc. c/o Philip Beal 4 Putnam Avenue Brewster, NY 10509 July 21, 2005 Dear Mr. Beal: DEPARTMENT. OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive Re: Proposed Well Lowry 15 Victory Road (T) Patterson 25.70 -1 -55 A field inspection was conducted on the above referenced lot by Brian Stevens, Public Health Technician. The application to replace the existing well is approved with the following stipulations: 1. A minimum casing length of.40 feet is required. 2. The existing well is to be abandoned within 30 days of the completion of the new well construction. Please provide notice to this Department two days prior to abandoning the existing well so that this Department may witness it. A Well Completion Report (WC -97) shall be submitted no later than 30 days after the well completion by the permittee. Please contact the writer at (845) 225 -5186 ext.2235 if you have any questions. cc:RM, File Sincerely, Brian R. Stevens Public Health Technician Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 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 FOF. SEAL & SONS9 9NC . 4 PUTNAM AVENUE � AfAYESIAN t�YIELLS BREWSTER, RIEIRI.YORK 10509- WATER SYSTEMS rla6l r�aeorl891 -Over 14,4.7_f Z�el! Gomp%feod JET PUMPS SUBMERSIBLE PUMPS TIEL. (8415) 279 -2460 - 2461 FAX (8415) 279-6613 COMPLETE INSTALLATION, REPLACEMENT AND REPAIR SERIVICE John Lowry 15 Victory Road Patterson, NY Tax ID #25.70 -1 -55 _i WATER TANKS COMMERCIAL WATER SYSTEMS HYDROFRACYURING WATER CONDITIONING EQUIPMENT 'E P. F. BEAL & SONS, INC. 62549 ARTESIAN WELLS - PUMPING EQUIPMENT WATER CONDITIONING EQUIPMENT BREWSTER, NY 10509 50_2352M768 DATE 7 / / -O_5^ 219 PAY n L/ n TO THE ORDER OF /.t�C dM&2 ? / s �1�.( .(� DOLLARS �q� oar.meu�. l I1L` BANKOF NEW 700 Clock 7bwv Common, RT 22 �] - J! YORK Brewster, NY 10509 d !/ AV VAII �L 11106 254900 41:0219023520: 000-713 20 2 3 78ol