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Home My WebLink About4842I II 7 � PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR ,. Internal Use Li LffZ ` Repair-Permit issued in last 5 years U 419Lin Watersn9d ❑ 0 Repair within Boyd's Comers, W. Branch or Croton Falls Res. WDelegated ❑ t Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION OWNER'S NAME MAILING ADDRESS TOWN TM PHONE # �! /., � % lot, APPLICANT Name _& Relationship (i.e., owner, tenant, contractor) DATE � J�811 FACILITY TYPE PCHD COMPLAINT # PROPOSED INST LLER OA U, S IG %M* PHONE # ADDRESS /��N d`� REGISTRATION, /LICENSE # PropQal (include a separate sketch locating the house, property Imes,' 811 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 SIGNATURE °�' TITLE Du`N�� . DATE. (owner) I, the septic installer, a to comp) with the conditions of this permit for the septic system repajr SIGNATURE TITLE )ATE�� pnstaller) Proposal aooroved 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 Proposal Denied l7i . Inspectors Si ndfure & Title 1 -D to Expiration to Repair proposal is in compliance with applicable codes Yes ❑ No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2107 Putnam County (Department of Health Division of )Environmental Health Services SSTS Repair - Fina ite Inspection /�� r- Date: (31 ! Inspected by: S Installer: J `�T �� l Street Location: Owner: Town: �, e,rf�.�. Repair Permit #: 2 -191?- 0- TM # oVS.- 761 • -de l - t-- 1. Type of System: Conventional VLAlternate O Comments: 2. Septic Tank Yes No N/A Comments a. Septic tank size - 1,000:.. 1,250 ... other ..... L� b. Septic tank installed level ...................... c. 10' minimum from foundation .................. d. Distribution Box I i. All outlets at same elevation (water tested) ... I I I I 1 ii. Protected below frost ............................. iii. Minimum 2 ft. Original soil between box & trenches e. .function Box -properly set ....... .. ................... f. Trenches i. System:completely opened for inspection ii. Length required .1- Length installedL�j_ iii. Pie slope checked ... ............................... iv. Installed according to plan ..................... ol v. 10 ft. from property line - 20 ft - foundations ... vi. Size of gravel % - 1 %2 " diameter clean ......... tl vii. Depth of gravel in trench 12" minimum ......... viii. Ends capped .... ............................... g. Pumg or Dosed Systems 3. Sewage S stem Area a. SSTS Area located as per approved plans b. Fill section - 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: RFS1 Rev - 011312 tN is T YNDA L L PT /G SYSTEMS.... EXCAVATING CONTRACTORS 20 Ivy Hill Rd., Brewster, NY 10509 (845) 279 -8809 AU REMCCA WITTENBERG, ITT, BSN PubliCHedt% D!Y'BCbr ROMT KORPA PIZ d7baC9 %vfEIzVi vmxentali Health DEPARTMENT. OF AL I Geneva Rtoad, Brewster, New Y®gk I ®5 ®9 Phone # (845),808-1390 Fax # (945) 279 -7921 M9RiMU1\ ®i ni, TO: " 1YCDEP DEPARTMENT OF ENGINEERING AND DESIGN REVIEW FROM:� DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM DELEGATED New A pplication e Renewal ❑ PROJECT: s� n CA e - -z-LOCATION:g� tree,,n- TOWN: DATE SUED APPROVAL TM # j-0 NOTICE OF COMPLETE APPLICATION DATE: DELEGATED • r� �e G x PUTNAIM COUNTY DEPARTMENT QF HEAD °• DMSIGN OF ENVIRON1VIENTAL HEALTH SERVICES DESIGN DATA SHEET — SUBSURFACE SEWAGE 'TREATMENT SYSTEM owner: Alo n Pr y SAn Located at (street): ' Municipality: CL �/ Address: TM # Section: _ Block , Lot WatersEied•a, .L� . SOIL PERCOLATION TEST DATA Witnessed by: Date of Pre - soaking: 7/7 Z-1 Date of Percolation Test �'I L Hole No. Run No. Time Start — Stop Elapse Time (min;) Depth to . water from ground surface (inches) Start -. Stop Water level`drop is inches Percolation Rate min/inch 2 2D, 3 3 4 - I .2 3 4 t 2 3 4 i 2 3 4 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. T.ES,T, JPIT' DATA DESCRIPTION OF S®ILS :NCO. 'EKED IT TEST HOLES DEPTH HOLE* HOLE # HOLE # HOLE # HOLE #_ G.L. 2.0' 2.5' Koo 3.5' ke L 1 trove) 4.0' 4.5' i,�i f SDti,f� 5.0' �rraV -14 6.0' • 7.0' 7.5' 8.0' ' 9.5' 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: Date Design Professional Name: Address: Signature: Design Professional = Seal SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health 1 Geneva Road, Brewster, New York 10509 REQUEST FOR FIELD TESTING All information below must be fully completed prior to any scheduling. DATE-. 1 Ix �/ PHONE #: ENGINEER OR FIl2M: i� .G PERSON TO CONTACT: ❑ NEW CONSTRUCTION ❑ REPAIR PROGRAM ❑ ADDITION PROGRAM REASON: I DEEPS: ROAD /STREET: TOWN: SUBDIVISION: PERCS: PUMP TEST: ' ❑ lgelh TAX MAP #: LOT #: NYCDEP CRITERIA. FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING YES NO ❑ ❑ Proposed SSTS within the drainage basin of West Branch or Boyds Corner & Croton Falls Reservoirs. ❑ ❑ Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. ❑ 0' Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ ❑ Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. ❑ ❑ Proposed SSTS for a Commercial Project. It is the responsibility of the design professional to provide the above information prior to soil testing. The Department will determine the NYCDEP project stains (Joint or Delegated) based on the response. If you answered ves 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 Professional 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: TD IE: COMMENTS: MQ.FOrtFlEcoTWWrraa,• Environmental Health (845) 278 -6130 Fax(845)278-7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278-6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 Property Details - Image Mate Online Putnam, County G Image- Mate Online Page 1 of 2 Navigation GIS Map I Tax Maps 1, ORPS Links Assessment Info Help Log Ir Residential Property, nfo Owner /Sales Inventory .:_ Improvemerits Report_, w Comparables Municipality of Patterson, Town of Units SWIS: 372400 Tax ID: 1 25.79 -1 -65 0 0 0 J Tax Map ID / Property Data Status: Active Roll Section: Taxable Address: 1 Warren Dr Property Class: 210-1 Family Res Site Property Class: 210- 1 Family Res Site: Res 1 In Ag. District: No Zoning Code: RPL10 - PutnamLake Bldg. Style: Old style Neighborhood: .00536 - School District: Brewster Legal Property Description: 04000000010090000000 001000000090000000000 40 -1 -9 Total Acreage /Size: 100 x 90 Equalization Rate: 2012- 100.00% Land Assessment: 2012- $19,800 Total Assessment: 2012- $217,700 Full Market Value:. 2012- $217,700 Deed Book: 1759 Deed Page: 140 Grid East: 753741 lGrid . North: 1960063 Special Districts for 2012 Description Units Percent Type Value Fire #1 0 0 0 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 http:// putnam .sdgnys.comlpropdetaii.aspx ?swis= 372400 &printkey = 02507900010650000000 8/22/2012 Property Details - Image Mate Online Put lake light 0 0 0 Put. Lake Park Dist. 0 0 0 Sanitation -putlk 1 0 0 Land Types Type Size Primary 100 x 90 Page 2 of 2 Property Details Image Mate Online Putnam County Navigation GIS Map Tax Maps Residential ProPeriy Info _ Owner /Sales 1. inventory,-,,-,] Improvements Tax Info , Report _., Comparables_. A6G Image Mate Online Page 1 of 2 Municipality of Patterson, Town of Price SWIS: 372400 Tax ID: 25.79 -1 -.65 $308,250 210 - 1 Family Res Land & Building Federico, Fortunato Ownership Information Name Address Henry Sanchez 1 Warren Dr Patterson NY 12563 Sale Information Sale Date Price Property Class Sale Type Prior Owner 10/10/2006 $308,250 210 - 1 Family Res Land & Building Federico, Fortunato Value Usable Arms Length Deed Book Deed Page Yes Yes 1759 140 Sale Date Price Property Class Sale Type Prior Owner 6/16/2004 $1 210- 1 Family Res Land & Building Albanese, Isidoro Value Usable. Arms Length Deed Book Deed Page No No 1687 112 Sale Date Price Property Class Sale Type Prior Owner 6/15/2004 $320,000 210- 1 Family Res Land & Building Federico, Fortunato Photographs 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 http:// putnam .sdgnys.com/propdetail.aspx ?swis= 372400 &printkey = 02507900010650000000 8/22/2012 Property Details - Image Mate Online http: / /putr Page 2 of 2 Value Usable Arms Length Deed Book Deed Page Yes Yes 1671 213 Sale Date Price Property Class Sale Type Prior Owner 8/29/2002 $202,000 210- 1 Family Res Land & Building Ambrus, Zoltan Value Usable Arms 1 Length I Deed Book Deed Page Yes Yes 1 1604 304 Sale Date I Price jPropertyl Sale I Prior Page 2 of 2 Property Details - Image Mate Online Page' 1 of 2 Putnam County _ Image `.Mate Online Navigation GIS Map. Tax Maps ORPS L1. S Assessment Info Help Log I Residential Property Info Owner /Sales Inventory'µ L. I mprovements Tax Info Comparables _ Municipality of Patterson, Town of SWIS: 372400 Tax ID: 1 25.79 -1 -65 Structure Building Style: Old style Number of Baths: 2 (Full) Number of Bedrooms: 3 Number of Kitchens: 1 Number of Fireplaces: 1._ Overall Condition: Normal Overall Grade: Average Porch Type: Porch Area: Year Built: 1932 Basement Type: Partial Basement Garage Cap.: 0 Attached Garage Cap.: 0 sq. ft. Area Living Area: 1,652 sq. ft. First Story Area: 1,135 sq. ft. Second Story Area: 0 sq. ft. Half Story Area: 0 sq. ft. Additional Story Area: 0 sq. ft. Three - Quarter Story Area: 517 sq. ft. Finished Basement: 0 sq. ft. Number of Stories: 1.7 ■ 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 http:// putnam .sdgnys.com/propdetail.aspx ?swis= 372400& printkey = 02507900010650000000 8/22/201 Property Details - Image Mate Online Utilities Sewer Type: Private Water Supply: Private Utilities: Electric Heat Type: Hot wtr /stm Fuel Type: Oil Central Air: Yes Page 2 of -2 /nrondetsil acnx ?swis= 372400 &nrintkev = 025079000146 50000000 8/22/2012 Property Details - Image Mate Online Putnam County Image Mate Online Navigation GIS Map I Tax Maps Residential _Property_ Info_,.. Owner /Sales Invento ..rY .Improvements Tax .Info Comparable5 Page 1 of 1 Municipality of Patterson, Town of SWIS: 372400 Tax ID: 1 25.79 -1 -65 Improvements Structure Size Grade Condition Year Porch - open /deck 396 sq ft Good Good 2007 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 http: // Putnam. sdgnys .comlpropdetail.aspx ?swis = 372400 &printkey = 02507900010650000000 8/22/2012