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36.23 -1 -40
BOX 17
01930
,J
6
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
P"i 4r:'9'
. PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR._. -_. J
YES NO Internal Use Only PERMIT #
-.,
El Ty Repair Permit issued in last 5 years ❑ N In'Watershed
❑ ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. 20 Delegated
❑ ❑ Repair ii� ,wthin 200 ft. of a watercourse or DEC - mapped wetland El Joint Review
SITE LOCATION l � � I-�'.v t a,,J � ",-TOWN Vc,,T k 2r5 TM # 3G, 13 I "f 6
OWNER'S NAME Fr6 t o I u (- pr s PHONE # 9W- 766 - 13 7S rns ;d
MAILING ADDRESS In l ivt-
APPLICANT U t4 I l-e_0 S e q'r c. t "l —I c.� 1 a,�y' ?/Y-. 760 -'1/1/61
Name & Relati6nship (i.e., owner, tenant, contractor)
DATE /a - r7g l/ FACILITY TYPE S�nI /n% PCHD COMPLAINT #
PROPOSED INSTALLER J)Aft U f n r' fi PHONE #
ADDRESS 3 qv e- eci-yJ JT(f 4EGISTRATION /LICENSE # / 0
I.y
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 to0he condi ns stated on this form
SIGNATURE
(owner)
I, the- sept�C, inst_ rag
TITLE o `—`J e r__
DATE / – ) S- /°)-
the. conditions of-this permit.for the- septic_system_ repair_ _:.._._
�/J
SIGNATURE [,/K--' –� TITLE DATE /#r
(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.
!MTF:QNAL I ISE ONLY
Proposal Approved Proposal Denied ❑
Inspecto s Signature & Title Date Expiration Date
Repair proposal is in compliance with applicable codes Yes ❑ No E3'--'
COPIES: PCHD; Owner; Installer
PC -RP 99ML Rev. 2/07
Putnam County Department of Health
Division of Environmental Health Services
SSTS Repair. - Final Site Inspection
G
__ ------- Date: 3),7- 6�/ Z .,Inspected by: Cns T��4.... -- Installer. �_ �
Street Location: /%1 /�u�� /.��: Z (L `Ownei:. L ..v ._..,..
Town: P � aG�b Repair Permit #: - a 12 - rx- TM #
1. Type of System: Conventional Q Alternate 0 Comments:
2. Septic Tank
Yes
No
N/A
Comments
a. Septic tank size - 1,000... 1,250 ... other .....
f
b. Septic tank installed level ......................
c. 10' minimum from foundation ..................
d. Distribution Bog
i. All outlets at same elevation (water tested) ...
ii. Protected below frost.............................
iii. Minimum 2 ft. Original soil between box &
trenches
e. Junction Bog -- -properly set ...........................
f. Trenches
i. - System eompletely opened for ' inspection
ii. Length required Length installed
iii. Pie slope checked ... .................... ............
iv. Installed according to plan .....................
!�
v. 10 ft. from property line - 20 ft - foundations ...
vi. Size of gravel % -1 '/s " diameter clean .........
vii. Depth. of gravel in trench 12" minimum .........
-
viii. Ends c ed .... ...............................
n C a -
Pump or Dosed Systems
3. Sewa e System Area
a. SSTS Area located as per approved plans
b. Fill section -
c. Distance from water coursetwetlands
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
FUTNAM COLN TY DEFAR'TAMNT OF. H.FAL 1 H. .
V
DIVISION OF ENVIRONMENTAL HEALTH_ SERVICES_ _
INITIAL M. IVIDUAL/COAUYMRCIAL SITE INSPECTION FORM
- F
SECTION A.' GENERAL INFORMATION
Name of Project - ,!—r; LO,_.9 (T)(V} — ` .Ae,6.,
County �ii �► c-�,' __
Site Location- ///`�,'
Building construction begun ,Extent
Is property within .... ......... ...... Yes ` No
SECTION B. TOPOGRAPHY (Please check all appropriate boxes)
1. 'dilly' • 'a Rolling Steep slope : Gentle slope
Flat '
2. Evidence of wetlands (;� Low a' rea sub }ect to flooding
�` Bodies of water.
Drainage ditches Rock outcrops
3. Property lives or corners evident ...................................................... :
Yes
No
4.. - 'Do water courses exist on or adjoin- the•property? :........... ..........
Ye s .
a N o
5. Will these affect the design of the sewage system facilities ?............
Yes.
'No
61 Do watershed regulations apply in this development? ............................
0 Yes
No
..7. Will extensive grading be necessary? ....... ,.....:...: ._... : :........:.......... :.:..
� Yes
No _ ...._.
8: will- extensive fill be necessary for SSTs ?.. ....... .. ........... .
— Yes
No'
9. Do -filled areas exi.g within the SSTS area7 ....... .............:.................
Yes .
No
If yes, what is. the condition of the fill?
SECTION C. SOIL OBSERVATIONS
10. Appearance of soil: (� Sand =Gravel Loam Clay Q Hardpan Mixture .
e - -. $wrings -- - Banlo- cut.....:_
12. Soil borings /excavations observed by C, c J. r on
.13. Depth'to groundwater 3 y on
.14. Depth to mottling on
15. Are test holes reor- .sentative of primary & reserve areas ...... .......... ...................... Yes a 1N0
1£...Soil percolation tests made by on Z
17. Soil percolation tests witnessed by C Y De_ V � , � �. on
SECTION D (on back)
Form ST -1
_,.._ �..
SECTION D. DR.AJNAGE_-
18.. Will proposed grading materially alter the natural drainage in this
or adjacent areas? F)-�J Yes
E No
19. Will groundwater or surface drainage require special consideration? .. .... ..... FZ*Yes
No '
20.' gill gullies, ditches, -etc., be filled and watercourses be relocated ?
'
..... F7-yes
........................ s
MNo
SECTION E. RETVLk S.
21. If a common water supply is proposeed; has an-inspection been made of the
existing or proposed source and facilities? ......................:......... ............................... Yes:
EE Np
Inspection data
22. Do adjacent wells and/or sewage systems exist? .............. ............!..................
.No
M Yes
23. Additional comments
24. Site observer /inspector and title
25. Date(s)-of observation(s)inspectibn(s)
TEST PIT PROFILES
-
.Hole r - Lot Dole Lot
Hole Lot Tr
p 7 Depth to water
Depth to water .
Depth to.Wat €,r
Depth to mottling. 4 _. _ Depth to mottling
Depth to mottling
Depth to rock/imp. - Depth to rock/nnp.
Depth to roll mp.
G.L.
0. . 0.5
0.5
1.0 1.0
.1.0
2.0 Sa.^ � .� ' 2.0
2'.0
•
3.a 3 c ,,4 3.Q
3.o _
5.0 4s 5.0 •
5.0
.6 :0 �oy r.S e__ �'a. v 6.0
6.0
l
7.0 10 7.0
7.0
8.0
8.0
9.0 9:0
9.0
10,0. 10.0
10.0
0
A-
PUTNAIM COUNTY DEPARTMENT OF HEALTH
IIIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHEET — SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner:
Located at (street):
Municipality:
Address:
TM # Section: _ Block _ Lot
Watershed-'
SOIL PERCOLATION TEST DATA
Witnessed by:
Date of Pre - soaking; � z_ Date of Percolation Test:
Hole No.
•
Run No.
Time
Start —
Stop
Elapse
Time
(min.)
Depth to .
water from
ground
surface
(inches.)
Start - Stop
Water
IeveI drop
in inches
Percolation
Rate
min /inch
2
��, / y�
c— 2 fle
-r/,v
r y
° 3
_
4
5
I
2
3
4
S.
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 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, pa I of''_
x
PUTNAJIVI COUNTY D'EEARR'T1IVIENT OF HEALTH
DMSION OF ENVIRO MT ENTAL HEALTH SERVICES
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
1
Owner: LA � r b L P Address:
Located at (street): �/ /�Gd <' lar7� (�/° TMI Seetion� 1 B[oct�- Lot `/-b
Lvlunicipality: PC_ Watershed: Cc,,j
SOIL PERCOLATION TEST DATA
Witnessed by: S
Date of Pre - soaking: ' I Date of Percolation Test:
Hole. No.
Run No.
Time
Start —
Stop
Elapse
Time
(min.)
Depth to
water.fro.m
round
surface
(inches)
Start - Stop
eater
level drop
in inches
Percolation
Rate
min/inch
2
w
>o
/
3
--
4-
5
I
..
2
3
4
1
2
3
4
-5.
I
2
3
4
5
Notes:
I. Tests to be repeated at same depth until approximately equal percolation rates are,
obtained at each percolation test hole. (i.e., _< I min for I -30 min/inch, < 2 min for 3I -60 miniinch).
All data to be submitted for review.
2. Depth measurements to be made from top of hole.
Form DD -97, pg I of'_
• - •.4sLY- • �R
4.
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
REQUEST FOR FIELD TESTING
All information must beA& completed prior to any schedri ing. Date:
Engineer or Firm: Ulyrru Sip i 7 c 1��' Phone #: 9 `fir 760— Y K /
Person to Contact :_ y Ty / P i
❑ New Construction A Repair Program ❑ Addition Program
Reason: X Deeps ❑ Peres ❑ Pump Test
Road /Street: 1 �� �• ' `� °� D
Town • Tax Map M
Subdivision:
Lot #:
Owner: �` tib 0 U 5
❑ Project not within NYC Watershed.
NYCDEP CRITERIA FOR JOLN T REVIEW AND WITNESSING OF SOIL TESTliVG
YES NO
❑ ❑ Proposed SSTS within the drainage basin of West Branch, Croton Falb, or Boyds Corner
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.
❑ 9 Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required.
❑ ET 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 Held 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 COUNT TY USE ONLY
DATE: TIME:
COMMENTS:
Req.for field testAly 4/16/2009
331
/C - L �- 6 C-
C'o
Iv
Property Details - Image Mate Online
Putnam County
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Residential
Tax Info
Comparables _
1,t+r�• / /rn�tnam cry
Municipality of Patterson, Town of
SWIS:
372400
Tax ID:
36.23 -1 -40
Tax Map ID / Property Data
Status:
Active
Roll Section:
Taxable
Address:
111 Haviland Dr
Property
210- 1
Site
210- 1
Class:
Family Res
Property
Family Res
Class:
Site:
Res 1
In Ag.
No
District:
Zoning Code:
RPL10 -
Bldg. Style:
Old style
Put. Lake
School
Neighborhood:
00536-
District:
Brewster
Legal Property
03800000020130000000 38 -2 -13
Description:
2011-
Total
Equalization
Tentative
Acreage /Size:
0.23
Rate:
100.00%
2010-
100.00%
2011-
2011-
Land
Tentative
Total
Tentative
$23,300
$195,500
Assessment:
2010-
Assessment:
2010-
$23,300
$201,500
2011-
Full Market
Tentative
Value:
$195,500
2010-
$201,500
Deed Book:
1863
Deed Page:
197
Grid East:
753705
Grid North:
959031
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Map
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Special Districts for 2011
(Tentative)
Description
Units
Percent
Type
Value!
Fire #1
0
0
0
Put lake light
0
0
0
Sanitation - putik
1
0
1
0
Special Districts for 2010
Description
Units
Percent
Type
Value
Fire #1
0
0
0
Put lake light.
0
0
0
Sanitation -putik
1
0 1
0
Land Types
Type
Size
Primary
0.23 acres
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Residential
Property_ Info
Owner /Sales
Inventory
Improyemert s_
Tax Info
Report_
Comparables
Municipality of Patterson, Town of
SWIS:
372400
Tax ID:
1 36.23 -1 -40
Structure
Building Style:
Old style
Number of Baths:
2 (Full)
Number of Bedrooms:
2
Number of Kitchens:
2
Number of Fireplaces:
0
Overall Condition:
Normal
Overall Grade:
Economy
PorchType: ___._..___
..._.., ._.......
_.. _ __ ..._....
Porch Area:
Year Built:
1938
Basement Type:
Full
Basement Garage Cap.:
0
Attached Garage Cap.:
0 sq. ft.
Area
Living Area:
1,048 sq. ft.
First Story Area:
1,048 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
ra
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Utilities
Sewer Type:
Private
Water Supply:
Private
Utilities:
Electric
Heat Type:
Hot air
Fuel Type:
Oil
Central Air:
No
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Residential
Property_ Info_.
Owner /Sales
Inventory, _,_
Improvements
Tax Info
rReport u�_.._
Comparab_
Municipality of Patterson, Town of
SWIS:
372400
Tax ID:
1 36.23 -1 -40
Ownership Information
Name
Address
Fabio Lucas
111 Haviland Dr
Patterson NY 12563
Sandra Lucas
111 Haviland Dr
Patterson NY 12563
Sale Information
Sale Date
Price
-Property
Class
Sale...... ......
Type
Prior.
Owner'
10/8/2010
$160,000
210- 1
Family
Res
Land &
Building
Estate of
De
Santis,
Dorothy
Value
Usable
Arms
Length
Deed
Book
Deed
Page
No
No
1863
197
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