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631- 589 -8100
35. -4 -72
BOX 16
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b fr'
01734
V
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR ,
YES NO Internal Use Only PERMIT
❑ Repair Permit issued in last 5 years ❑ NO in Watershed
❑ ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Delegated
❑ ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review
SITE LOCATION TOWN( -_ TM # 4
OWNER'S NAME yc okC "etc -Nk-t PHONE # 5yA5 -t)%a �R1ryO
MAILING ADDRESS jCA QQ� `' C kCRZXPZ.t t-'1W
APPLICANT lP r-
Name & Relationship (i.e., owner, tenant, contractor)
DATE -A_ a$- L j FACILITY TYPE PCHD COMPLAINT #
PROPOSED INSTALLER �)�4"� i�+t -cg ✓4}�i PHONE #�'
ADDRESS ?76;-,-t 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 extent of the repair. _
I, as owner,agree to the conditions stated on this form
SIGNATU TITLE DATE —1 t
(owner)
I, the septic installer, agree to comply with the conditions of this permit for the septic system repair
SIGNATURE, ,�;`f TITLE DATE
(installer)
Proposa l �V/ed with ` /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 Proposal Denied ❑
Inspector's Signature & Title Date / Expiration Date
,Repair proposal is in compliance with applicable codes Yes P7' No 0
COPIES: PCHD; Owner; Installer
PC -RP 99ML Rev. 2/07
_ _
®f 6s" v
_ '71 - -�
&a-a? A-9-
SX
a
0-
Memo
10/3/11
97 Old Rd.
Mr. Mrs. Lando Tax # 35.4-72 Permit # R- 144 -11
Inspection on the above site, was a final inspection for a septic
repair. J Gagliardi Excavating done the work as per drawing and is
approved.
Waiting for as- built
Received as -built
Abated 10/4/11
7 7 /l 7
w
.
.
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SPECIAL DISMICT INFORma
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JAMES W. SEWALL COMPANY
N
SPECIAL DISMICT INFORma
LEGEND
23
21i 25
MAP
PRELIMINARY SCALE 1•.16a
TOWN OF i?ATTERSON
� .ao u � ..o.
, PUTNAM COUNTY NEW YORK
om
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PUTNAINI COUNTY DEPARTiMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner:
Located at (street): / O �Ci �� 1 t,`.J !/✓ °^
Municipality: 'ed;14G-5a.,
Address:
TM ;# Section,.3 Block Lot l ,;Z
Watershed:
SOIL PERCOLATION TEST DATA
Witnessed by: vC '--j �c �4 _ a,
Date of Pre- soakin ` Date of Percolation Test: e9/z- 6
Dole No.
Run No.
Time
Start —
Stop
Elapse
Thine
(min.)
Depth to
water from
roud
surface
(inches)
Start - Stop
Water
level drop
in inches
Percolation
Rate
min /inch
2
6146 — la `
"I'd
�,
3
3
I
4
t
s
r
2
3
4
3
1
2
3
f
4
2
3
4
5
Notes:
1. Tests to be repeared at same depth until approximately equal percolation rates are
obtained at each percolation test hole. (i.e.,.< I min for 1 -36 min%inch, < 2 min for 31-60 miniinch).
All data to be submitted for review.
2. Depth measurements to be made from top of hole.
Form DD -97, pe I of
Zl �
�M
Z v
3
If Dovl�`� -J
L,/ 1/.1/4
Property Details - Image Mate Online
Putnam County AdDG
Image Mate Online
Navigation GIS Map Tax Maps
Residential
Tax Info
v.,Report
Comparables
ORPS Links I Assessment Info
Municipality of Patterson, Town of
Price
SWIS:
372400
Tax ID:
35.4-72
$340,000
210 - 1
Family
Res
Land &
Building
Gallowitz,
Eric
Price per
sgft
Ownership Information
Name
Address
Christain S Lando
97 Old Rd
Brewster NY 10509
Holly A Lando
97 Old Rd
Brewster NY 10509
Sale Information
Sale Date
Price
Property
Class
Sale
Type
Prior
Owner
6/15/2010
$340,000
210 - 1
Family
Res
Land &
Building
Gallowitz,
Eric
Price per
sgft
Value
Usable
Arms
Length
Deed
Book
Deed Page
$266
Yes
Yes
1855
425
Sale Date
Price
Property
Class
Sale
Type
Prior
Owner
1/29/1993
$180,000
210 - 1
Family
Res
Land &
Building
Eickelback,
Mark
Price per
sgft
Value
Usable
Arms
Length
Deed
Book
Deed Page
$141
Yes
Yes
1187
72
Sale Date
Price
Property
Class
Sale
Type
Prior
Owner
7/1/1989
$196,500
210 - 1
Land &
Cheetham,
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Family
Building
Kevin ]
Res
Price per
Value
Arms
Deed
Deed Page
sgft
Usable
Length
Book
N/A
Yes
Yes 1
848
189
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Putnam County _ "G
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Residential
Property Info
Owner /Sales
inventory
Improvements
Tax Info
Report ,
Comparables .
Municipality of Patterson, Town of
SWIS:
372400
Tax ID:
1 35. -4 -72
Tax Map ID / Property Data
Status:
Active
Roll Section:
Taxable
Address:
97 Old Rd
Property
210- 1
site
210- 210 - 1
Class:
Family Res
Family Res
Class:
Site:
Res 1
In g.
No
Zoning Code:
Bldg. Style:
Raised
Residential
a nch
Neighborhood:
00200-
School
Brewster
District:
Legal Property
06900000040060010000
Description:
002170000000000000105 69 -4 -6.1
Total
1.05
Equalization
Acreage /Siz
Rate:
-
2011 -
Land
Tentative
Total
Tentative
$70,400
$341,800
Assessment:
2010-
Assessment:
2010-
$70,400
$359,800
2011-
2011 -
Full Market
Tentative
Market
Tentative
Value:
$341,800
Value /sgft:
$189
2010-
2010-
$359,800
$199
Deed Book:
1855
Deed Page:
425
Grid East:
743818
Grid North:
957925
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Special Districts for 2011
(Tentative)
Description
Units
Percent
Type
Value
Garbage dist
1
0
0
Park district
0
0
0
Fire #1
0
0
10
Special Districts for 20110
Description
Units
Percent
Type
Value
Fire #1
0
0
0
Park district
0
0
0
Garbage dist
1
0
1
0
Land Types
Type
Size
Residual
0.05 acres
Primary
1.00 acres
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Property In
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Comparables
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Municipality of Patterson, Town of
SWIS:
372400
Tax ID:
1 35. -4 -72
Structure
Building Style:
Raised ranch
Number of Baths:
u11)
Number of Bedrooms:
3
Number of Kitchens:
Number of Fireplaces:
1
Overall Condition:
Normal
Overall Grade:
Average
Porch Type:
Porch Area:
Year Built:
1978
Basement Type:
Full
Basement Garage Cap.:
2
Attached Garage Cap.:
0 sq. ft.
Area
Living Area:
1,806 sq. ft.
First Story Area:
1,278 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:
528 sq. ft.
Number of Stories:
1
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Utilities
Sewer Type:
Private
Water Supply:
Private
Utilities:
Electric
Heat Type:
Hot wtr /stm
Fuel Type:
Oil
Central Air:
No
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- - -
. PUTNAM CQUNTN DEPARTMENT OF HEALTH
Division of Environmental Heakh Services, Carmel, . N. Y. 10512
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM Patterson
v-
Located at � buy *� `'�"��•'
Subdivision
Town v _..
or Village
Lot �.I Job +
Own er Maspernic Realty, % N. M. Barbour
Building Type Frame, Lot Area 45804'x' Sq.Ft.
Number of Bedrooms Three Design Flow 600 Gal.
Separate Sewerage System to consist of 10010 Gal. Septic Tank
To _ be constructed by ?
Water Supply: Public Supply From
X Private Supply to, be drilled by
AddressBrush Ho I.ow Rd. on Route 6.
Brewster, NY110509
Total Habitable Space 1250 Square Feet 1
and 333 . L. F. x 24" Width Trench
Address
Address
Other Requirements.
24". R-o -B FT11,Section x 42241
1'represent, that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage disposal system
above described wil(be constructed as shown on the approved amendment there to and in accordance with the standards, rules and regulations of, the u narh .
County Department` of Health, and that.on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of:Healthwill
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 disposal system during the period of two (2) years immediately following the date of the issu-
ance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above
will be located as shown on the approved plan and that said well will be installed in accordance with ndartls, rules and regulat ons ' of. the Putnam
County Department of Health
Date 1.5 l�ar-ch 197 -7 signed P.E. X . R.A.
dd R'. D. 6, BOx , arme I ; NY 105k 29206
License No
ress
APPROVED FOR. CONSTRUCTION: This approval expire one from t dat issu less onst►uction of the building has been undertaken and 'is
revocable for use o may be amended or modified when onsi d neces ry b e mmis ' r of Health. Any change t ati construction
requires a ne per it.` Approved for disposal of do nitary se age, d /or rivat er supply only.
Date g r Tit le D
WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH
3/71 Division of Environmental Health Services
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
This report is to be completed by well driller and submitted to County Health Department together with laboratory report of
analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued.
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWNER
NAME
Leonard Cerlich
ADDRESS PUtnam Avenue Brewster N.Y. 10509
01MMI RXX 3s= mx
LOCATION
OF WELL
(No. 8 Street) (Town), (Lot Number)
Old Route 22 Patterson NY
PROPOSED
USE OF
WELL
INESS j
® DOMESTIC ❑ E TABL SHMENT ❑ FARM ❑ TEST WELL
11 SUPP Y El INDUSTRIAL ❑ CONDITIONING El ((Specify)
DRILLING EQUIPMENT
El ROTARY ACORESSED CABLE IR PERCUSSION ❑ PERCUSSION ❑ ((speciify)
CASING
DETAILS
LENGTH (feet)
20
DIAMETER (inches)
6
WE:t tIT PER FOOT
17
® THREADED ❑ WELDED
S
X YES ❑ NO
LXJ
CASING
YES
NO
YIELD
TEST
HOURS G.P.M.
❑ BAILED ❑ PUMPED❑ COMPRESSED AIR 4 6
YIELD O.P.M.)
(
6
WATER
LEVEL
MEASURE FROM LAND SURFACE —STATIC (Spec l /y feet)
37
DURING YIELD TEST (feet)
560
Depth of Completed Well
in feet below land surface: 560
MAKE LENGTH OPEN TO AQUIFER (feet)
DETAILS
SLOT SIZE
DIAMETER (inches)
IF GRAVEL
PACKED:
Diameter of well including
gravel pack (Inches):
GRAVEL SIZE (Inches)
FROM (feet)
TO (feet)
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION.
Sketch exact location of well with distances, to at least
two permanent landmarks.
FEET to FEET
0
2
Soft cla .
®�tttL
/
joor r /
dh'f�r-
I I
2
545
Liard gray Cfranite.
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
MKn f,
r
DATE WELL COMPLETED
3 -2 -78
DATE OF REPORT
13-17-78
WELL DRILLER (Signature)
, Pres
MILL DRILLING, INC.
BRE STER LABORATORIES
Box 224 - BREWSTER, N. Y.
WATER ANALYSIS REPORT
SAMPLE No. 4024
SOURCE: Lenord Cerlich
Hayt Road
Patterson, N.Y.
COLLECTED:March 8, 1978
Rg :Mill Drilling, Inc,
BACTERIOLOGICAL _EXAKrNA_TION
Coliform Count, MF Method
well
This result indicates the source 'of the sample was
of satisfactory sanitary quality when the saAi le was collected
March 15, 1978
0 per 100 ml.
Owner
Patterson
H?
411 ty
1:
Alb -
L low
GUARANTY OP SEPARATE SEWAGE, $YSTEM
r!opraaont that I AM wholly 4n4 CoMplotaly reapppalbxf for tho
�e►oetie � ` w Ir �r Sh Ra m+stert4s eonstMotipn and 'IraIPgr of the eavago
dispoe�l yater aery ng the above described.prQiaerty, anal that t has een►
QQnatruat d as shown on tho approved plan or approved amendment thereto,
and In aceo ' a►a +a with the atandards, rul.ea and regul.ationa of tho Putnam
County Dooartinpnt caf HaAlths and horaby guy rgnty to the Qwnerp hip aiaacap,-
ara,.: h ire or` aaaigr a, tea p�aoa in gaud ap.arat3 Tie 0044 c ,on Vin .pert o?� ....
said a ntem eQhatructed by mo whiph fuila to operate for a poriQ ni' two
yearo � p— 041 ►toly fql. q* the date of lr �itia uae of the eawago diaponAl
ayet m or any repairs made by me to a4ch systems exoopt where the fAiloro
to op ra pMWna erly i� cawed by the wll ful or ngg11$ent, sot at the pCpLi-
P4 4t of the util.iming the syatet;.
Tho u0aralgne4. fgrthor agraos to upopt 4a aoncI40ve: the # @q5.
�ermi��t�o� s�f the A
octo of the Wvi4ion of $nvironmenGal. H#A, th $er- .
v1Ges� c,f the Futna . Comity Department Qt App th a to whether or not the.
i'ai nr+ "the aye to Qiaerata wan caNsed lay tho willful or neoliseat
dot of tho. Qgeupant o f the buij ng the ey tem,
1.Oth Dgt O t h i @ da ... Qi _..M.a. Y ., 7$ Si ruro'Q."'�-
corpora? i► h
OLnd address
/'�nj� e p rTr y�. m, p��t
RF 4 0 4f!�4R' !i�! �M! 1111ITr} J.gAI.G Z
E Ok' SAT C1F FIRST USE QF 3Y'STJ
CiUARANTO►A , RQUIRED TO F. Q OF �--5T USE M
At � �!!r t! M �I !!R e,E! A R7 n � A � w ^'� p+! 4S.t Pr � . 4!L T! r„2 p! 7f' R! c-n w n . 1f+ e!A e• ell Rs CR A Q.?
0441, "!4..1on of A !1!IrQrpR PAt+R.1 40,iM1th $`Qvv11 0R# r"tn57M 09gAty pN„ 1, Vt MOO 99 IRVAI ,1
•Prc ' !t,rty lines or corner.- _
Cap estJ.mat" 1,ou:,0
V ill drivc-way n^ . . . .
i ui:t trees be rcmoved -note these • . _ --
Is deep hole rcr);- .,— .enta.tivc of' entire SM arca
--_ -
dc,,--T) moles needed..
Sufi.':i.cie;nt SDS area alai= la.blc c:onsiderin
dri -vewaq cut, house location, scpar. ation . • .
distan:.•es, etc. _
hcpth : f^p
Water elcva:tion: a
Rock elevation:
Soils description: -- °
?IIq'q.L SITE IP?SP CTION, Insn. by. .
louse located where shown on approved plan
W loc:ate'd, wh..ere approved ... _
,lope of tile: -1 irc::and trench acceptable ,00M ,•;ed f expansion teen c s • ' _
,o all o or _ ch.. .
rver. 50 -Ct . from swctniL). x. at.ercourse
atural soil not striDu °d or SDS area --
unnecessarily graded
0 Ft.. irzinta=i :ed from prop-line. and
20 ft. from douse . . -
cparation of trench from house, well --
etc. follows plan .
umber of b`droc -ms checks .
genes, bn sh, stumps, rubble, etc greater
than 15 ft. from near °st trer_ch
FL of ycripheral soil horizontally from
trench . • . . . . . . . . o . . . _
inction boxes properly set
)uld surface run off from driveway, roads,
ground surfz:ce, etc. clnrlinel roar SDS . .
Area .... • 00 .. ..• •. • o
yes 16t drainzre anr.•car O.K. in area of SDS
11ML GRADING OF SITE ACCEPLIBLE ,
Commc-rnts
0
•
e
0
11-15 V 1.L' N la iL',1:11. iJi l t!iL5'1'
Meets Std.[ Remarks
DOCUMNTS
House plans O.K.
Design data sheet i
Peres presoaked? i
Min., 30" perc test depth I
Cont. results for 3 runs i
D. Hole log O.K. i
Corporate Affidavit for. other than individual
Authorization for .engineer I
Letter from Water Supply if applicable
If variance requested -such noted on plans & apps._
i
DETAILS
Rhow f charge is proposed, )
Existing contours shown new contours)
Slopes for driveway cuts, etc. shown I
Water service line location
Footing.drain, etc. location I ,/
Top slope, bottom slope of fill. !
..Per,cla tion -tests. and deep to --st p Q-.-1 acat bn
Septic tank size and conformance to std.
3 B.R. house minimum I
rHouse s}etbu ck shown I
t 1 1..1 (..- 1 .cam.'..'. L
�1'__1J VCl L�tJ:'�. J �,j= ! 11- %.Ll7iv 11'VJ
kul Wa l mil• w i-ui hiij. 56 i i . ui. L ai1UW'!1
Plan and profile SDS ' v'
All other wells and SDS closer 200'
shown ox-'reference made j ,l
Property boundaries (metes and bounds- clearly shoe`
i
SEPARATION DISTAI`10ES SPECIFIED ON PLAN
10' to.P.L.
20' to FoiL dation walls
100'
to
'Nearest
well
50'
to.stream,
storm
march, lake, etc. incl.expansion ):
15'
to
Curtain
drain
10'
to
water
lire (pits -20'
15'
to
storm
drain
10'
to
lame
trees
10'
from foundation to septic tank
5'
to
pipe
from leader drain & fooLin ra1r.
ti
t.
StiucturP i,R.c�ted trom,�rotlCve b i 4 u Vey or: ate y
u ^f
weiI in el t .S`tUKi- o V 5i
r�•+1�::.,.= •--'., �c... e�� YrkFit �rr�t erg rB�(u�r {F• ..� y ..,.. ...
Q 6gtzJtr#4Prs r�uffrT�t *rim �. .�1�.
ToC, Ft C`YSaS t9'�. ja lid�ta 5: $r it)ic f-0lStin Qfl -:tR�t Ly:.�R13tlgti ttil „
eat
p
irk t { ; t
1
M 9i r t T.r
Ftata� ,irtspj�ctlpq by weaign qp ❑1
RI
7
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- rd• e 5 av
:L N F'
tjr
S_?F
Q,IMtNI.Oh
y t A f n 1C a At �.r
E
Fs H a_ =G_ APPROVED.
Lo3L�
MAY15197
MTN uCI_I__Of HENTh
u..CCey
�i�
^-�-•- - - mvtaon m
ARl SYS. E M DEStC�N
dW(4LR: _
LOCATION ^.,tre y:__
Tcwn:
- `: SU9Cri�i�tt3N '- _TtA•- S�'tu'r..t?��.. ��°�.•-t�^r•} _� _ .._ _ __ ._. .-
:Mop
rtes, nnr
lOT N
`
a N t'k., Y�'Gii Builder C F- ti.I..JC +i vw .t- rt.,.�c^r•tap..i. _ f?..� _ ... __ – .
it kle."Ywl/t r {Qote �t1 IB �Scnle: �c�'ec�.. vat=to %ct�3
— y.CUNSULTINGyENCINtrR s 's
54
PUTNAM COUNTY. DEPA _ . ._ ..
. ,_....n�...?� T ! SENT- -_.�..OF.:H.�:T:�'�-Z- :.:.:�:._
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM
Owner '�_ egrAle Address A4, 0
M
Located al(Street) Q /d/ ,�. , �-1. 4s e.-q� 1
e nearest cross scree
FILE NO.
Lot /
Municipality. sQ,,, Watershed 6V
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number
CLOCK TIME
PERCOLATION
PERCOLATION
Run
Elapse
Depth to
Water Water Level
No.
Time
From Ground Surface in Inches
Soil Rate
Start -Stop
Min.
Start
Stop Drop in
Min. /in drop
Inches
Inches Inches
Z3 �
2
/WD yv -t
- G
�•L
) j I
3
/yob !1/L
Lt
z3
_2 _ /iii
5
•1
2 :.
:: f.�• : ^�.1 1 I.i
Notes: 1) Tests to be:ret5eated at same depth until approximately egxa1 -s61l
rates are obtained at.:,egch percolation test hole. All data to bL sr�binitted
for review.
2) Depth measufleinent4": Ito be made from top of hole.
_.TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SQIL� EMO`UNTERED IN' TEST HOLE -S
DEPTH HOLE NO._ ..HOLE NO. Z.. HOLE NO.-
- INDICATE 17VEL
INDICATE LEVEL
"PESTS MADE BY
`� .° a -o 4
ORG ?u M---- 1WATER I'S ENCrOU TERZ- ) do O40P ._ .: .
1J1:l -LV1V
Soil Rate Used Min/1 "Drop: S.D. Usable Area Provided ¢.Ya* +
No. of Bedrooms �/� Septic Tank Capacity p®® Gals. Type _
Absorption Area Provided By tj� L.F.x24 width trohc
Other
'0 17
Name Signature
Address
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Cal. Chec by �° Date
191
IVE