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01620
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01620
PUTNAM COUNTY HEALTH DEPARTMENT ✓
DIVISION _OF.ENVIRONMENTAL HEALTH SERVICES
'OSAL FOR SEWAGE TREATMENT SYSTEM REPA
YES N Internal Use Only PERMIT # Z i '
❑ � Repair Permit issued in last 5 years 01 yot in Watershed
Q U Repair within Boyd's Comers, W. Branch or Croton Falls Res. Delegated
Repair within 200 ft. of a watercourse or DEC - apped wetland ❑ Joint Review
SITE LOCATION TOWN Gt ✓1 TM # 1 I'
OWNER'S NAME r(* Q .4 . �'� 0L ^J PHONE # aJLS r
MAILING ADDRESS S3� Fmir & (�
APPLICANT
Name & Relationship (i.e., owner, tenant, contractor
DATE — " �` )CILIT�TYPE - PCHD COMPLAINT #
PROPOSED INSTALLER � Gt6 "Y� PHONE # 67 . A
ADDRESS 0 ',3 REGISTRATION /LICENSE #
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 a ent of the rerir� ,
7-ri S % l .Z i I t'rn,�r.�,y W I-� Cra 'e)-/ � J' A q
I, as owner,agree the conditions stated on this form
SIGNATURE TITLE UI �° /^ DATE
(owner)
I, the septic installer, agree o comply with the conditions of this permit for the septic system repair
>t y SIGNATURE TITLE r-e, DATE
(installer)
Proposal approved 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 until authorization to do so has been obtained from the Department.
INTERNAL USE ONLY
Proposal Approved B� Proposal Denied ❑
1 ; �/� cu
Inspe tr0s' rg "nature & Title llaie Expirati n Date
,Repair proposal is in compliance with applicable codes Yes O No
COPIES: . PCHD; Owner; Installer
PC -RP 99ML Rev. 2/07
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Putnam County Department of Health
Division of Environmental Health Services
Date. r ✓���� SSTS Repair — Fl "I Site Inspection
Inspected by: c iJ � \ \.;,� Installer: 1`� ci cn.,_�•
�.._� .. _... �., .... , . .• . . .... ,...., ,..,........
Street Locatton• ��7''a !`- °- �c«� °� � - — „Owner. °° ��+L:'0,;; •` - �. ”.
Town: `. 'n Repair Permit #: k — QR V— /z TM #
1. Type of System: Conventional ❑ Alternate Comments:
a61- C'
2. Septic Tank
Yes
No
N/A
Comments
a. Septic tank size — 1,000... 1,250 ... other .....
L�
T?A
b. Septic tank installed level ......................
c. 10' minimum from foundation ..................
d. Distribution Box
i. All outlets at same elevation (water tested) ...
ii. Protected below frost......... I ...................
iii. Minimum 2 ft. Original soil between box &
trenches
e. Junction Box — �ro erl set .............................
f. Trenches
i. _System completel opened for inspection
ii. Length required Length installed
iii. Pie slo a checked ... .................... ............
iv. Installed according to plan ......................
v. 10 ft. from property line — 20 ft — foundations ...
vi. Size of gravel 3/. -1 diameter clean .........
vii. Depth of gravel in trench 12" minimum ::..::..:
viu. Ends capped .... ...............................
g. Pump or Dosed Systems
3. SewaLre System Area
a. SSTS Area located as per approved plans
b. - Fill section —
r/
c. Distance from water course /wetlands
4. Overall Workmanship
a. Boxes properly grouted and installed correctly ...........
b. All pipes flush with inside of box .........................
c. Backfill material contains stones <4" diameter .........
d. Curtain drain & standpipes installed according to plan
e. Curtain drain outfall protected & dir to exist watercourse
f. Footing drains discharge away from SSTS area .........
g. Erosion control provided ............................
Additional Comments:
RFSI Rev - 011312
REBECCA WITTENBERG, RN, BSN
Public Health Director
Director of Enviromxentd Health
MARYELLENODELL
County Ekecutive
DEPARTMENT. OF HEALTH
1 Geneva Road, Brewster, New York 10509
Phone # (845) 808 -1390
Fax # (845) 278 -7921
TO: NYCDEP DEPARTMENT OF ENGINEERING AND DESIGN REVIEW
ATTN: t -'(A P-n
FROM:
DELEGATION STATUS
FOR
SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM
- -- DELEGATED -
New Application �� Renewal CJ
..-, ... .__ ....__...... ��.. ......_.. .. .w... ......• . -. w.__.. _ -.- J.. -... �.. rr mss- . n.... x._._............. ....._....._.....- .........__r. .._...... -.. .. .. ..�._... .. -. �.... ........ J. ...�v- m��e�. .. a.... __a
PROJECT: J o 0—
LOCATION: S-o
TOWN: DATE SUB'D APPROVAL6�z
TM # 3 V l,3 —�—
NOTICE OF COMPLETE APPLICATION DATE:
DELEGATED,
MEMORY TRANSMISSION REPORT
',--TIME- _ . :.APR - 6201.2 �:0948AM
TEL NUMBER 8452787921
NAME ENVIRONMENTAL HEALTH
FILE NUMBER . 624
DATE APR -26 09:47AM
TO . 88553733
DOCUMENT PAGES 001
START TIME APR -26 09:47AM
END TIME' APR -26 09:48AM
SENT PAGES 001
STATUS OK
FILE NUMBER 624 * ** SUCCESSFUL TX NOT ICE * **
� � .1��.- • Imo.- . - -•4.-
Ru-rNAM COUEV-►Y HEALTH QEPARTMEIVT ✓_/
MIVISION OF ENV1FtONMEN-TAL "m^1- -1-1-1 SERVICES �,.�.��
AROPOSAL- FOR SEWAGE TREATMENT SYSTEM ME 11'+� ii4y.11�- -iy��7
. S Internal USe On PERMIT ati �-.` ' -r1'�.
f� Repair Permit leauad In last s years blot In Wet �7rsh Repoir wlthln Boyds Corners. W. Branch or Croton Falls Ron. __mRo r within 2o0'tt'M a watarcwirco o: l? appod wetland LI JOlnt RBVIa
SITE LOCATION TOWN - -m 0 — %-
OWNER'S NAME G rI s` �/✓Ir m� Q -w) PHONE v -::2 ,g — .-2Q j
MAIUNt3A001RESS S'OG
APPLICANT '
Nam. & Res"Onshfp Q.e., owner. tonargrkpoift.
MATE (D,3'- L-.Z 17 011-- I�/J�/ TYPE orm�• -- PCHD, COM�aPIALI�NT N
PROPOSED, INnS,TALL/E�R '-
_ � _._._.... ....AOt�FaES�,,. !rZ (' �.�- `.�� -Z•• L�!'O +� �S' REQI$TRATION /LICENSE'!I'
Proposal (Include a saperate sketch locating Me house, property lines, all acliacent wells wlthln 200
*eet of repair and t"e looaltlon of exists
P log. and proposed system) -
NOTE: The D,epartmant may require submittal Of proposal from IlCensad pl'ofesslonal depending on the
naturB d 2 rnt of the raq�Ir ..L�
3 . a"7' o. G( 1-e _ �+ 1-i Jfyo.�oS �..� l ` �i Cro ..�- / j1^� �a 4E L Ore- oNi aL.� ca-5
1, as owner,agraa the conditions statad on this form
$IQNATUF TITLE C_.•rC.C! `J I" D,ATE
1, the Septic Installer, agree/ /comply with the conditions of this permit for the septic systam rep /air
SIGNATURE - Tim ® / /J /�i�•s....ry TITLE � 7R D,ATE T� 1G ®-• 4. >
(tnsia /lar) - -'
Proraost3l set�rovrtst with th fono Fop c nd111. a-
1. ProCUrament of on]r Town PermK, tf aPPllcabla.
2. 3ubmisslon of as built repair sketch by the septfc system Installs wKhin 30 days of the ropotr. In dupll.ato showing:
0. Own.r"a name, SKa Street Name. Town and Tax Map number
b. `-- atlon of instulled components dod to two lb and points .
o. Syntem descrlPtlon (a.g -, 1250 gal. Concrete septic rank, otq.)
d_ Installers' name and phono numbs
3. Gyatem repair to ba pertbrmed In aocordance wKh the shave proposal and oondKlona
4. The proposal SETS rep.ir to conaltlered a best fit design and there is no guarantee to the duratton at lNhloh the
completed GS-17S ropdr will function -
S. No oompleted work Is to be baoldillad until authortaatlon To do no has beon obtained from the Oopartmont.
INTE$RNAL Uf9E_ONLV _
Approvad .{cam -- Proposal panted
! l- �
COPIES: PCHO: Owner, Installer
PC-RP 99ML
Rev. 2J07
C-Aris -elt4fkt, 7-o-zow
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�D b
S � PUINAM COUNTY DEPARTMENT OF HEALTH
DIVISIUFI OF ENVIRONMENTAL HEALTH SERVICES
a
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner: cL7- A/ Address:
Located at (street): tai�f�s TM # Section.-;/ Block L6t
Municipality: Watershed:
SOIL PERCOLATION TEST DATA
Witnessed by: ( " , i S
Date of Pre - soaking: Date of Percolation Test: 41,;g
Hole No.
•
Run No.
- Time
Start —
Stop
Elapse
Time
(miii-
Depth to .
water from
ground
- surface -
(inches)
Start - Stop
dater
level drop
in inches
Percolation
Rate
- — -
min/inch
l A �,
j
,dv —J00"
D
Z
fd o-1430
7o
/
p
_
-3
o
4
5
I
2
3
4
I
'
2
3
4
I
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., < l min for I -30 min/inch, < ? 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, p; I of''-
1.
TEST PIT DATA
DESCRIPTION OF SOILS ENC0. NTERED IN TEST HOLES
DEPTH HOLE # HOLE # HOLE # HOLE # HOLE #
. G.L.
0.5' �o S01
1.0' /o
1.5' 1�OU 4
20
2.5' /� �✓► D
3.0' +o y�
3.5' ►,✓
4.0'
4.5'
5.0'
6.0'
6.5'
8.0'
8.5'
9.0'
10.0'
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: ;,'Ie Date
Design Professional Name:
Address:
Signature:
Design Professional = Seal
a:
,Property Details - Image Mate Online
Putnam County AbG
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Navigation GIS Map I Tax Maps]jj ORPS Links Assessment Info
Residential
Propertylnfo::j
Owner /Sales..;
Ljnventory'
Improvements
Tax lnfo�
Comparables
Municipality of Patterson, Town of
SWIS: 372400 Tax ID: 34.13 -1 -9
Tax Map ID / Property Data
Status:
Active
Roll Section:
Taxable
Address:
506 Fair St
Property
2107-1
Site
property
210 - 1
Class:
Family Res
Class: - .
Family Res
-
Site:
Res 1
In. Ag.
No
District:
Zoning Code:
Bldg. Style:
Residential
ranchd
Neighborhood:
School
Carmel
100900-
District:
Legal Property
07600000010130000000
Description:
001250000225000000000 76 -1 -13
2011 -
Total
Equalization
Tentative
Acreage /Size:
125 x 220
Rate:
100.00%
2010-
100.00%
2011-
2011 -
Land
Tentative
Total
Tentative
$63,400
$315,000
Assessment:
2010-
Assessment:
2010-
$63,400
$331,600
2011-
Full Market
Tentative
Value:
$315,000
2010-
$331,600
Deed Book:
1869
Deed Page:
338
Grid East:
Grid North:
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726317
955147
Special Districts, for 2011
(Tentative)
Description
Units
Percent
Type
Value
Fire #1
0
0
0
Park district
0
0
0
Garbage dist
11 10
1
10
Special Districts for 2010
Description
Units
Percent
Type
Value
Fire #1
0
0
0
Park district
0
0
0
Garbage dist
1
0
10
Land Types
Type
Size
Primary
125 x 220
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Putnam-County.._... _....�..w_ ..m.
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Navigation GIS Map Tax Maps
Residential
Tax'.Info _
_ Report
Comparables ;
ORPS Links I Assessment Info
Municipality of Patterson, Town of
SWIS:
372400
Tax ID:
1 34.13 -1 -9
Structure
Building Style:
Raised ranch
Number of Baths:
2 (Full)
Number of Bedrooms:
3
Number of Kitchens:
1
Number of Fireplaces:
i
Overall Condition:
Normal
Overall Grade:
Average
Porch..Type: .
Porch Area:" -
Year Built:
1968
Basement Type:
Full
Basement Garage Cap.:
2
Attached Garage Cap.:
0 sq. ft.
Area
Living Area:
1,874 sq. ft.
First Story Area:
1,202 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:
672 sq. ft.
Number of Stories:
1
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Utilities
Sewer Type: ..i
Private
Water Supply:
Private
Utilities:
Electric
Heat Type:
Hot wtr /strn
Fuel Type:
Oil
Central Air:
No
Page 2 of 2,