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HomeMy WebLinkAbout2015DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.39 -1 -23 BOX 18 02015 �. ,� 31. 02015 I IV-111 10"o 16:33 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Z Address 12,2 Located at (Street) 4*_' < U Tax Map.T Block Lot (indicate nearest cross street) Municipality PAr7'_/1_CQ1y0/1) Watershed ��'j -;r- 4__1C_ /LI SOIL PERCOLATION TEST DATA Date of Pre-soaking Date of Percolation Test �,7 6'�L NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, :g 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 ................... X X '­.: ........ X.: . . . ............ ........ .. ........ . ....... .... Water ............ h T ... . .. ............... ........ ............. .. ...... ... . ..... Hole No .... .... ...... ........... . ... .. T roun d j: X.X., ur ace h : Ang ... .. ....... -xmsiti �`::Level . . Ifron ' P 0 Rate ....... ... . ...... t' f t St'** tt.:. .... ....... ................. ... ... 0 Stogy . . ...... ...... ... Jach I . .... .. 2 y 3 16,03 d'3j 30 4 5 2- 2 yW- 167' 20 f 0"v 4 5 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. s I min for 1-30 min/inch, :g 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 08- 01 -'07 11;19 FROM -PC. Septi c vasa.aa vaara ral.a va.aa, I•a ar, aeav, • loss t Commissioner of Health LORETTA MOLINARI, RN', MSN Associore Commissioner of Health & Repair 845 -278 -2318 r� OEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 REQUEST FOR FIELD TESTING T -119 P003/006 F-056 Ia"tltit \t J. "WrILPL County Erecurive ROBERT MORRIS, PE Director of Environmental Health All information below must be IMIly completed R>rior to any scheduling. DATE; ENGINEtR OR FIRM: tj PHONE #: V5 - 0313 PERSON TO CONTACT: O NEW CONSTRUCTION PAIR PROGRAM 0 ADDITION PROGRAM REASON: DkEPS: Q . PERCS: PUMP TEST: 0 ROAD /STREET: 15-5 k LA ke TOWN: ?471—!LW a y TAX MAP 9 SUIBDMSION: LOT #: OWNER: �i e' V, NYCDEP CRITERIA FOR JOINT REVUW AND WITNESSING OF SO11L TESTING 9�� o Proposed SSTS' within *the drainage b asin of West Branch of Boyds Corner & Croton Falls Reserv*oirs. O Proposed' 98TS within 600 feet of a reservoir, reservoir stem or control lake. 0 Proposed SSTS within 200 feet of m watercourse or a DEC wetland. o Proposed SSTS design flow greater than 1000 galidnvlday or SPDES Perniit required. O Proposed SSTS for a Commercial Project. It is the responsibility of the design professional to provide the above'informatiou prior-to soil testing_ The 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 matually suitable time for field testing with the Desigu Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates MICDEP 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: TIME: COMMENTS: W4. FOIL FUorestnia:lur 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 08- 07 -'07 10:38 FROM -PC. Septic & Repair 845- 278 -2318 T -161 P005/010 F -069 a ' � f' ~1 I Ord -'�/ � ��/ I • � � 0 .�eaHG.c+r• � aern� S V Q � u R S i c u as �✓ adz, ae . aw. ..._s. a, �y{p1Y iN L1.9. DrANUM9 1e�p Mn� N dMCO peazasa�iW n� wma .1"01TIOM 0 G Mama TUN CPP�' /O'��:$ As��i9F�+ /ice /.fir /Dr.��• ' o FRO" TOM A ii p� p � 1�F�.� ���,s7yp�>AOOI• ORIOy IrOOpfP se va�i� T`p� 1eA � b�pa•,�"�•� - "`- � ago swpD To "• ' QAi� g eWTIQN BLOCK - /i• �xr� pAtwww/f�p 1'O+�• vaoaa �'�� Prr+��''� '" % w� - any -0% Robert J. Bondi Cris Dellaripa County Executive Septic Repair Inspector . Edward A. Barnett Michele Palermo Watershed Information Coordinator Office Manager - PUTNAM COUNTY SEPTIC REPAIR PROGRAM _ ...., 100 Rte. 312 Bldg. ##4 Brewster, NY 10509 Date: PCDOH Attn: Michael Budzinski 1 Geneva Rd. Brewster, NY 10509 Dear Mr. Budzinski; wish to report that the following job: Name �� Ir le- We Address Tax ID# has been completed as per the approved drawings. As -Built Attached: Yes No Signed CC: Dan Shedlo, P.E. Telephone; (895) 278 -8313 Faux: (895) 278 -2318 I 9 f f M l t� � �. w x , .A � -�:/ w.t 4ir�'�.6f � /�,•y.���.4! r��.�6 jV,. � • �� _- -� t ul . ..... .... -le ilk 1 te DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR YES Internal Use Only L un ❑ Repair Permit issued in last 5 years ❑ Not 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 Je. ke- S4i`. �. �dr TM # OWNER'S NAME P), '/ fle.r foes -a2-- .4 lake- PHONE # MAILING ADDRESS APPLICANT (� o. ... Name & Relationship (F.e., owner, tenant, contractor) DATE 6 FACILITY TYPE jZ,. PCHD COMPLAINT # PROPOSED INSTALLER %✓ PHONE # ADDRESS 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 trenches) NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location and proposed pump systems will require submittal of proposal from licensed professional engineer or registered architect. ; �+q�''(, �q. Mt4 id! 1�. d+.... ' ,A/i ��. t ! - i�.a./ 7 I, as owner, or reported agent of owner agree to the conditions stated on this form SIGNATURE �� .._,. TITLE DATE Proposal approved with the following conditions: 1. .Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name b. Site Street.Name, Town and Tax Map number c. Location of installed components tied to two fixed points d. System description (e.g., 1250 gal. Concrete septic tank, etc.) e. Installers' name and phone number 3. System repair to be performed in accordance•with the above proposal and conditions. Priosal Approved A Proposal Denied I a it Date COPIES: e (PCHD); Yellow o n 1); Pink (Installer), Orange (Applicant) PC -RP 99ML Rev. 8/05 a-' )> ALZorneY s rule ins. wluvc 0 a� e` 4 MEASUREMENT IN U.9- 9TANDARO TFM awmtaloNl! !wcvm oduorm . mm NOT "Wit"090 TO be USED PC" !A UI0AYTNORIZ60 M- Tr11AT10N Oq AA L L"D r SeAMNG Owwwo".aaftc. it A yl0ytTlpN o>' ayCTON r om, i4a• EDUCATION MW E N1HW �ORit BTATi UL D6YNE p='l �lutia a,R9�iE Ib1N 4a1.p�6D P. o. Dolt 17r 1Q/cI 7 ?a wersTaf.""m AVR. (map W-3663 POUND RIDGM NY. 1rsM Te►ePgGNI= 2949 1124 AS�erN Tw SX19MINce OFRIONT OF 1 C 01' 19o.ao' 3 Jo 1 /a �qC� v � v d S q MEASUREMENT IN U.9- 9TANDARO TFM awmtaloNl! !wcvm oduorm . mm NOT "Wit"090 TO be USED PC" !A UI0AYTNORIZ60 M- Tr11AT10N Oq AA L L"D r SeAMNG Owwwo".aaftc. it A yl0ytTlpN o>' ayCTON r om, i4a• EDUCATION MW E N1HW �ORit BTATi UL D6YNE p='l �lutia a,R9�iE Ib1N 4a1.p�6D P. o. Dolt 17r 1Q/cI 7 ?a wersTaf.""m AVR. (map W-3663 POUND RIDGM NY. 1rsM Te►ePgGNI= 2949 1124 AS�erN Tw SX19MINce OFRIONT OF 1 C 01' 19o.ao' 3 1 /a �qC� ♦ / �r � v d 0 �✓w.F..� t-1 4 i "CA7QAIE 1i N 1 .nrre, .a a N �� ---- -- Tom,. y O b Q ' it I to � i kw fE.✓l,.K/ 16"o- eve- 1 -0-14 ei4.res 4-0 or'r 68. XfMMTUROO 00 ANr O OIM.r t0f"Sk FROM TMH QVWUOAL OF 611[0 1•uR1ldv WxPluro vam AN 40MGMAL OP "49 + 4NO suAVtW 011'0 100,908,260 % "L ="ALL pm C�/A60 TO De WUO TAI+i +rw ■rr.rr kDOAO, i@ ANY, lust 6HOYM ARi NOT QUARANTIMb ow pwwom'soNLr.1145V ARK i BLOCK MARAMTKED TO lra.T.►4.A. �. �7�s[e .p.Ce.�t n.a.r•A. �Ii..CaY�ri..i sr..wgd WAR AGM. CATS 49 -ii • eaad . 408 NO. CAO - soww9w • PUTNAM COUNTY DEPARTMENT OF HEALTH H � -- . -.. ��DIVISION= ;OF- ENVIRONMENTAL.HIEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GE14ERAL INFORMATION. Name of Project l 'V (T ) County Site Location Building construction begun Extent ` Is property within NYC Watershed ? ................. Yes 0 No JV SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. Hilly Rolling Steep slope Gentle slope Flat 2. F--] Evidence of wetlands 0 Low area subject to flooding F7 Bodies of water 1 0 Drainage ditches F7 Rock outcrops 3. Property lines or corners evident ....................... ............................... E7E Yes F--J No 4. Do water courses exist on or adjoin the property? ............................ ffyes 0 No 5. Will these affect the design of the sewage system facilities ?............ Yes F--J. No 6. Do watershed regulations apply in this development ? ....................... Ell`/Yes F7 No 7 Will extensive grading be necessary? ................. ............................... . F Yes No 8. Will extensive fill be necessary for SSTS? ......... ............................... 0 Yes M No 9. Do filled areas exist within the SSTS area ? ....................................... F—� Yes No If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: F-� Sand F--] Gravel 11. Observed from: . F7 Borings E:] I t 0 Loam EXClay F--� Hardpan F--J Mixture cut Backho//e``excavations 12. Soil borings /excavations observed by l W on 13. Depth to groundwater 7 f on !� 14. Depth to mottling (Q on - 15. Are test holes representative of primary & reserve areas ...... ............................... L� Yes U No 16. Soil percolation tests made by 17. Soil percolation tests witnessed by SECTION D (on back) on on Form ST -1 SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? F7 Yes ffNo 19. Will groundwater or surface drainage require special consideration? ..................... Yes �No 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... . Yes QNo SECTION E. REMARKS 21. If a common water supply is proposed, has an. inspection been mad f existing or proposed source and facilities? .. ............................... ... ................. F Yes F No Inspection data 22. Do adjacent wells and/or sewage systems exist? ..................... ............................... rV1 Yes F_� No 23. Additional comments] h 24. Site observer /inspector and title b 25. Date(s) of observation(s)inspection(s) TEST PIT PROFILES Hole # Lot # Hole # Lot # Hole # Lot # Depth to water Depth to water Depth to water De th to _ g. - . .,... p..._:... _.mottlin Depth to mottling _ - Depth to mottling Depth to rock/imp. Depth to rock/imp. OQ to rock/imp. De th p p. G.L. G.L. G.L. 0.5 0.5 0.5 1.0 1.0 1.0 2.0 2.0 2.0 3.0 3.0 3.0 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6.0 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 1 � ,SHERLITA ANTLER, MD, MS, FAAP 1'ommissioner of Health + LORETTA MOLJNARI, RN, MSN Associate Comm issionmof Health - . , . . , _ -; ROBERT1 BONDI Counry f reeurive ROBERT MORRIS, PE r;. Directorofl;nvironmenta/ Health. DEPARTMENT OF HEALTH • I Geneva Road, Brewster, New York 10509 REQUEST FOR FIELD TESTING All information below must be fully completed prior to any scheduling. DATE: 3 Ole) ENGINEER OR FIRM: C S j� PHONE #: PERSON TO CONTACT: r ❑ NEW CONSTRUCTION L7 REPAIR PROGRAM ❑ ADDITION PROGRAM REASON: DEEPS: PERCS: ❑ PUMP TEST: ❑ ROAD /STREET: TOWN: e, - e.rso. -, TAX MAP 4, SUBDIVISION: LOT #: OWNER: << j/e_ NYCDEP CRITERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING YES NO O Proposed SSTS within "the draina ge. basin of West. Branch or Boyds Corner & . ..Croton Falls - Reservoirs:" 0. Proposed SSTS Within 500 feet of a reservoir, reservoir stem or control lake. - �T O Proposed SSTS within 200 feet of a watercourse or a DEC wetland. 0 Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required, 0 �o 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 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 field testing with the Design Professianal 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: TIME: COMMENTS: REQ. MIL HELD TEST(NG:KLY 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 1 07/03%2007 10:44 FAX 19142443814 Attorney's T1tle Ins. ° Q002 r `1 1 d.vm.aSSSG.sr i Y 9OD. Gd 3 e ' Gc4,s,c jAG^$UpEML5N'f MI U.9.STANDARD THE aNBrLS10NQ 9HC1MN MegNaM ROiON KOT (PTiR1lO�0 TO &l 1U EP POR TN6 CAI UNAYTMOAIZ60 A4TBOIAT#ax 40 J UCGNwm LAMO.OIMV91 oom* an" Div N 7. N � T� ?"I- VORU EDUGTIOM MW VoX.AN [81H 431.6!60 V. a box 176 ("40 si403" rr WM8TO►(O UVLAVB. (71 EU 2:1P.3060 ADyNO ftmd L Wr. 1067'6 TBtt:at�t s� -6�.ts 0a 12 u d 4 1 � C A0 r �j lO V Cp /+mil /O��i9r �6✓.9P� /O /Arm /O /.f7� T11Ts fiX.f4iS)ICe OP'inGNT O: ONLY Coons%FROW TMB OAta(MA'L OI TMO auwVB+ eo WAVItwrfM AM bRIpIMA6 OP TM! LAND SUAVCV� OIYA wedoBiNp t"L !MALL OR ¢¢OMSID.YSD TD Be VA WO TOCAH COp. ' . . . . IP AMY, NOT WOWN AM MOT QVAAAMTVM PIipAOmEO/A T.1flbV AAR ap0#. $�CTOON BLOCK DATE - //- lam, cuwwarrts8o To K�.C�bBAs+VN/ IBC/ »6A�6/7 /�.OM i'MSICM��J'O.e� svWVIC� @�tlNTV � 1 ..or I 0 7 I ^ � yC S n . jAG^$UpEML5N'f MI U.9.STANDARD THE aNBrLS10NQ 9HC1MN MegNaM ROiON KOT (PTiR1lO�0 TO &l 1U EP POR TN6 CAI UNAYTMOAIZ60 A4TBOIAT#ax 40 J UCGNwm LAMO.OIMV91 oom* an" Div N 7. N � T� ?"I- VORU EDUGTIOM MW VoX.AN [81H 431.6!60 V. a box 176 ("40 si403" rr WM8TO►(O UVLAVB. (71 EU 2:1P.3060 ADyNO ftmd L Wr. 1067'6 TBtt:at�t s� -6�.ts 0a 12 u d 4 1 � C A0 r �j lO V Cp /+mil /O��i9r �6✓.9P� /O /Arm /O /.f7� T11Ts fiX.f4iS)ICe OP'inGNT O: ONLY Coons%FROW TMB OAta(MA'L OI TMO auwVB+ eo WAVItwrfM AM bRIpIMA6 OP TM! LAND SUAVCV� OIYA wedoBiNp t"L !MALL OR ¢¢OMSID.YSD TD Be VA WO TOCAH COp. ' . . . . IP AMY, NOT WOWN AM MOT QVAAAMTVM PIipAOmEO/A T.1flbV AAR ap0#. $�CTOON BLOCK DATE - //- lam, cuwwarrts8o To K�.C�bBAs+VN/ IBC/ »6A�6/7 /�.OM i'MSICM��J'O.e� svWVIC� @�tlNTV 400 NO. Gsf - 6CI.�RO AO'W ff BMNCOY M�3K6.d'Al! d' I b South Lake Drive JIF 7■wr #AF la wr wi�w was �w ev a��rw l�M pew w�uEwlt wwaew ww w+tf �s w. ONas l now wwww"s a was of ■'13 133 (Miller) i I :,1137 r I i i I I rf /I I r I� i t '• I I � r f WeQ r A"" OR mm"Wwr..w""me.".inmt Awe! "we a.V. "r+.a.1 w w ". ea r: � �.aw!wwppwww *WO wa►wpRwpa.1 �.... aW..........,..,...w.....t�� 1 I it i � ■ I r � Jf ■ � I t � I ■ � I I M ,I ■ � I I � r ■ ■ww w #wwww wwr ww� IL mm dk*VA 06M ar fats war mSap l I '"n CL Cl) Page 1 of 1 WOOD-_-, \,SrEps 0 FT. yt f4' OF 4 "0 PVC SDR- J5 PIPE 0 1.09' MIN PITCH TO PUMP. (, 1-1,4 VqFP C) EXISTING 1 1-72 S TOR Y :.� % .:FPAAItF USE EXISTING SEP TIC PIPE FROM HOUSE 106.9 CONC. DIST BOX 4 OWALL ONC T ' PA VED DRI VE PROPOSED 1000 GALLON PUMP /0 VERf -L OW - TANK (SEE DE TA IL) \/50 A PPROXIMA TE L OCA TION OF PROPOSE5 SCHEDULE MAIN FROA TANK TO A PEA T MOD . 11 CL IRON ROD x FOUND ON ROB EXIST, BE Rl SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Chris Dellaripa Putnam County Septic System Repair Program 100 Route 312, Building # 4 Brewster, NY 10509 Dear Mr. Dellaripa: ROBERT I BONDI County Executive Director of Environmental Health December 31, 2007 Re: Septic Repair Permit (WS- 264 -07) for Miller at 133 S. Lakeshore Drive (T) Patterson, T.M. # 36.39 -1 -23 This Department, in conjunction with the NYCDEP, has received and reviewed the submitted repair permit, engineer's report and plans for the above referenced project. The repair permit is hereby approved with the following conditions. 1. The owner must maintain an effective septic pump -out schedule until the subject repair is completed. 2. The septic system repair shall be fully constructed and completed in compliance with the _. approved permit and engineering plans.__... 3. The Health Department shall be notified when constructions starts on the system and also notified prior to backfill of the system. 4. The subject repair cannot be used as a system to provide'sewage treatment for new construction or expansions on the site. Should you have any questions concerning this matter, please feel free to contact this office. Respectfully, Michael J. Director of MJB:kly cc: T. Cronin, PE D. Shedlo, DEP MAB 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 I v a iv .... vv v... . . ,— ...._. . . -- . .. ....I­ .. DIVISION OF ENVIRONMENTAL HEALTH SERVICES PRO OSAL FOR SEWAGE TREATMENT SYSTEM REPAIR .YES NO; - Internal Use Only PERMIT # ❑ Repair Permit issued in last 5 years ❑"Not in WateTShEd ❑ ❑ Repair within Boyd's Corners, W. Branch or Croton Falls Res. ❑ Delegated ❑ ❑ Repair within 200 ft. of a watercourse or DEC- mapped wetland ❑ Joint Review SITE LOCATION r33:S Z,, TOWN P� M # - OWNER'S NAME, %j�� PHONE #27 MAILING ADDRESS �5r1le-. APPLICANT t,,,_ Name & Relationship (i.e., owner, tenant, contractor) DATE /0 /�2 FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER PHONE # ADDRESS 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 off / thle (f/ repair. (]�_ ((�� �q / /,,] J / // , _ S 4 I f -i � d� �✓ .� J .�.� P ` _c (� r :Y. �� �• "_ .w.'b_ . sad L ^.. I, as owner,agree to the conditions stated on this form SIGNATURE TITLE DATE (owner) I, the septic installer, agree to comply with the conditions of this. permit for the septic system repair _DATE_ (installer) r _ . _...._ 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 oposal Approve Proposal Denied ❑ Inspector's Sign ure T le ate Expiration Date ,Repair proposal is in com liance with a li a e codes Yes ❑ No COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 CITY DerypT 2 0� h o R�N'HENTAl PRA (718) DEP -HELP If you have any questions, I may be reached at (914)742 -2055. Sincerely, Danny Shedlo, P.E. Civil Engineer III Wastewater Design Review EOH xc: Michael Meyer, NYCDEP EOH Planning Edward Barnett, PCSRP Watershed Information Coordinator Chris Dellaripa, PCSRP Inspector Roger Sokol, P.E., NYSDOH December 19, 2007 .�ewor Department. of . Environmental Mr. Michael Budzinski, P.E. Protection. Putnam County Health Department 1 Geneva Road 466 Columbus Avenue Valhalla, New York Brewster, New York 10509 10595= 1336' Re: Miller SSTS Repair — Putnam County Septic Repair Program ( PCSRP) ". (T) Patterson, Putnam County East Branch Reservoir Drainage Basin Emily uoyd Commissioner TM# 36.39 -1 -23 DEP Log # 2007 -EB- 1049 -DJR.1 Tel. (718).595 -6565. Fax (718) 595 -3557 ' Dear Mr. Budzinskl: This letter is to inform you that the New York City Department of Environmental Protection (DEP) has no objection to the approval of the above- referenced activity, subject to the following conditions: Bureau of Water Supply, '. , . 1. The owner must maintain an effective septic tank pump -out schedule • Paul V. Rush, P gf oner Deputy'Commissi until the subject repair is completed. 2. The subject repair cannot be used as a system to provide sewage Tel (914) 742 -4 8. Fax (91.4) 741 -03034 treatment for new construction or expansions on this site. p This determination is based on the review of submitted documents including the drawings titled "SSTs Repair PIan = lffiiller Properly' ; T33 S�utYr'Lakeshore - " - -" -- Drive, Patterson, New York, revised 12/3/07. CITY DerypT 2 0� h o R�N'HENTAl PRA (718) DEP -HELP If you have any questions, I may be reached at (914)742 -2055. Sincerely, Danny Shedlo, P.E. Civil Engineer III Wastewater Design Review EOH xc: Michael Meyer, NYCDEP EOH Planning Edward Barnett, PCSRP Watershed Information Coordinator Chris Dellaripa, PCSRP Inspector Roger Sokol, P.E., NYSDOH .. L 46S.Col.umbus-Avartue.. -4 1 $0111341114., .4� A 7-7 Fax:914-773-0343 Dec 19 2007 15:03 P.01 Mr. Michael Budzinski, P.E. Putnam County Health Department I Geneva Road Brewster, New York 10509 Re: Miller SSTS Repair — Putnam County Septic Repair Program (PCSRP) (T) Patterson, Putnam County East Branch Reservoir Drami age Basin TM# 36-39-1-23 DEP Log# 2007-EB- 1049-I)JR I Tel. (718) 595-6565 Fi* (718) Dear Mr. Budzinski: This letter is to inform you that the New York City Department of Environmental Protection (DEP) has no objection to the approVal of the above- referenced activity, subject to the following conditions: 6 1. The owner must maintain an effective septic tank p UMP -out schedule PauVV.'Rtiih;T, L until the subject repair is completed. 2 . me subject repair cannot be used as a system to provide sewage (91 4Y treatment for now construction or expansions on this site. -1411-1 348 _77 This ati&'is'based oil the•review of sub rm -tted-docurn6nts -ilicludin g_ the drawings titled "SSTS Repair Plan - Miller Property", 133 South Lakeshore '7' Drive, Patterson, New York, revised 12/3/07. -2055� I may be reached at (914)742 If you have any questions a. Sincerely, k6t T-1, __ (z iledIrl P P , �77 '71"' P .T I .. Civil Engineer 111 Wastewater Design Review EOH xe: Michael Meyer, NYCDEP EOH Planumig Edward Barnett, PCSRP Watershed Information Coordinator Chris Dellaripa, PCSRP Inspector Roger Sokol, P.E., NYSDOH SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 LA-6 &+'EtUD ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health TO: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW PRIORITY - SEPTIC REPAIR DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT. SYSTEM PROGRAM PROJECT: IUI) L-L�� TOWN: P01- I .r, O K) JOINT REVIEW SUB'D APP DATE DATE: • Within the drainage basins of West Branch, Boyds Corner Reservoirs or Croton Falls. • Within 500 feet of a reservoir, reservoir stem or control lake. Within 200 feet of a watercourse or a DEC wetland and appearing on a subdivisbn map approved after December 31, 1992. ❑ Design flow greater than 1000 gallons /day. ❑ Commercial SSTS. jtreviewrepair 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 CRONIN ENGINEERING P.E., P.C. December 4, 2007 The Lindy Building; Suite 200 . '2 John Walsh Boulevard Peekskill, NY 10566 914- 736 -3664 Fax 914 -736 -3693 Michael J. Budzinski, PE Director of Engineering Putnam County Department of Health 1 Geneva Road Brewster, N.Y. 10509 RE: SSTS Repair Miller Property 133 South Lakeshore Drive, Patterson THESE ARE TRANSMITTED. as checked below: ❑ FOR APPROVAL ❑ FOR YOUR USE ❑ AS REQUESTED ❑ FOR REVIEW AND COMMENT ❑ PLEASE REPLY Mike, Based on your November 26, 2007 review memo, please find enclosed the following: 3- Copies of "Subsurface Sewage Treatment Repair Plan for PCSRP - Miller Property" . - - -- sheets SPA A- &•1:2; dated-October 16; 2047; = re4ised - through, December 3, 2007-- ....:__ _.:,._.._.:._.....::. . 1- Copy of the soil data sheet The following are responses to the comments of the above mentioned memo: 1. Comment noted, please see enclosed soil data sheet. 2. Adjacent wells have been shown on the plan, see sheet SP -1.1. _r 3. Percolation holes have been labeled P -1 & P -2 on the plan, see sheet SP- 1.1. 4. Comment noted, please see Design Note #3 on sheet SP -1.1. 5. The footing and leader drains have been shown discharging away from the treatment area, see sheet SP -1.1. The above mentioned changes to the plan should satisfy your comments as set forth in your November 26, 2007 memo. If you have any further questions please contact me. Respectfully submitted, 1'1—� ✓"i Patrick M. Bell Project Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH . DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATNfkNT'cSVSrT�M Owner cam. 4 1q, / 14 r Address 133 S, L a kt G k v r c. D �r Located at (Street) S k c-ko arc t f-a i r � i e Id Tax Map 3� , 3 B lock j Lot Z 3 (indicate nearest cross street) Municipality Ira } 1 e r s o o. Watershed Pu + n r, m �_,e_ SOIL PERCOLATION TEST DATA Date of Pre - soaking A vvT . I : 2 o o J- Date of Percolation Test Av� . 2, 2 o o -f No ole Run No. Time Start - Stop Elapse Time (Min.) Depth to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min /Inch i 1 q -0-7 -9:31 Z4 21 1" -2q' 2 3a —)o:o 0 1'12" -, �, a 4" (i 3 j�,o3 -10:33 p 1 ' U I ' 3! i/ y n 4 , 5 2 1 L2 -1 2,G _Z 30 6 2gg" �o 4 5 1 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. 5 1 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. Pomi DD -97 Ps. 1 or, TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. I� G.L. eyec z6 0.5' 1.0' 1.5' 2.0' V 2.5' SA �d 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' .6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' Indicate level at which groundwater is encountered ki Indicate level at which mottling is observed Al I A Indicate level to which water level rises after being encountered. Deep hole observations made by: (ft- vv \lamr��h -e per ��►�, �? �.C• Date,+J� Design Professional Name: r %�•lll Address: ... �2���si��lt ,,IV�F IoS�b6 Signature: &-� ID-e pP t-� �e5 ivlS�-1 C C'P( " +) Design Professional =s Seal C�.s l �ztL�.r���pcSRp� `P,4 --r tc-L 3o k C cr o w vi \� �r NEW )10 629$0 �`��NKU F ESS\ SHERLITA AMLER, MD, MS, FAAP Commissioner of Health K s LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Patrick Bell DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Cronin Engineering The Lindy Building, Suite 200 2 John Walsh Blvd. Peekskill, NY 10566 Dear Mr. Bell: November 26, 2007 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Proposed SSTS Repair for Miller At 133 S. Lakeshore Drive (T) Patterson, TM # 36.39 -1 -23 This Department, in conjunction with the NYCDEP, has received and reviewed the submitted application and plans for the above referenced project and the following comments are offered for your consideration. '/ A soil data sheet with the percolation and deep test hole information is to be submitted. _._:......._ .. __ - ✓_.2.. The location of the adjacent wells are. to be shown on.the plan. X. Pere are two (2) percolation holes labeled P -1 on the plan. The design engineer is to verify the condition of the existing septic tank prior to ncorporating it into the design scheme. ,,The location of the dwelling footing and leader drains are to be shown discharging away from the treatment area. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. Respectfully, Michael J. Director of MJB:kly cc: D. Shedlo, DEP 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 (718);O.EP•HELP November 15, 2007 Mr. Mike Budzinski, P.E. Putnam County Health Department 1 Geneva Road Brewster, New York 10509 Re: Miller SSTS Repair — Putnam County Septic Repair Program ( PCSRP) (T) Patterson, Putnam County East Branch Reservoir Drainage Basin TM# 36.39 -1 -23 DEP Log # 2007 -EB- 1049 -DJR.1 Dear Mr. Budzinski: This letter is to inform you that the New York City Department of Environmental Protection (DEP) has reviewed above - referenced repair application, has determined it to be incomplete, and requests the following: 1. Engineer must verify condition of existing septic tank prior to incorporating into design scheme. 2. Show location of residence footing/leader drains and ensure they are discharged away from treatment area. 3. Show location of all neighboring wells. These comments -are. based on_the .review of submitted documents including drawings titled "SSTS Repair Plan — Miller Property", 133 South Lakeshore Road, Patterson, New York, dated 10/22/07. If there are any questions, I may be reached at (914)742 -2055. Sincerely, Danny Shedlo, P.E. Civil Engineer III Wastewater Design Review EOH xc: Michael Meyer, NYCDEP EOH Planning Edward Barnett, PCSRP Watershed Information Coordinator Chris Dellaripa, PCSRP Inspector Roger Sokol, P.E., NYSDOH Fax:914-773-0343 ' 2007 e r 15, Nov 15 2007 12:19 "D ;ht OU'.. Mr. Mike Budzinski, P.E. -.7r, Putnam County Health Department .-Prote I Geneva Road "a m. Brewster, New York 10509 .465Colunitkus'Avi,-fiue Vaibaiia: New York- _ f Re: Miller SSTS Repair - Putiam County Septic' Danny Shedlo, P.E. (T) Patterson, Putnam County East Branch Reservoir Drainage Basin TM# 36.39-1-23 DEP Log # 2007-EB- 1049-DJR, I 4. 5" j Dear Mr. Budzinski: 595 -3557: ....... This letter is to inform you that the New York City D Environmental Protection (DEP) has reviewed abov( L "0 application, has determined it to be incomplete, and r Otar S.Up 1. Engineer must veri condition of existing s fy incorporating into design scheme. L.10 P 2. Show location of residence footing/leader drai discharged away from treatment area. 74�200 3. Show location of all neighboring wells. These comments are based on the review of st drawings titled "SSTS Repair Plan - Miller Pt Road, Patterson, New York, dated 10/22/07. P. 01 it Program (FCSRP) of d repair � following: tank prior to and ensure they are mitre d0 Uia�ejat .3erty 133 South Lakeshore If there are any questions, I may be reached at (914)742-2055, Wu•Wol C. 0". A q P) C' 181) D E:P;K.V. Edward Barnett, PCSFT Watershed Infori Chris Dellaripa, PCSRF Inspector Roger Sokol, P.E., NYSDOH Coordinator Sincerely, "a m. Danny Shedlo, P.E. Civil Engineer 1H. Wastewater Design Review EOH xc: Michael Meyer, NYCDEP EOH Planning Wu•Wol C. 0". A q P) C' 181) D E:P;K.V. Edward Barnett, PCSFT Watershed Infori Chris Dellaripa, PCSRF Inspector Roger Sokol, P.E., NYSDOH Coordinator ENGINEER'S REPORT MILLER SEPTIC REPAIR 133 S. LAKESHORE DRIVE TOWN OF PATTERSON, NEW YORK October 18, 2007 Revised: October 22, 2007 Reference.is made to plans prepared by this office entitled "SSTS Repair Plan for PCSRP - Miller Property" dated October 18, 2007, revised through October 22, 2007. PROJECT LOCATION: The existing residence is located at 133 S. Lakeshore Drive in the Town of Patterson, New York. The property is approximately 50' from Putnam Lake. This property is within the watershed for the New York City Reservoir System. PROJECT AND SITE DESCRIPTION: The existing Miller residence is situated on a lot of approximately 8,000 sq. ft (0.18 acres) in an area of built out development. Approximately 6,820 sq. ft of the property is landscaped with grass, miscellaneous planting areas and native trees. The remaining 1,180 sq. ft of the property is impervious, consisting of the ..residence, the access driveway and walkways on the property. The property is served by private water supply and sewage disposal system, as is typical of the surrounding- residences The existing sewage disposal system consisted of a septic tank and various areas for trench and pit treatment. The existing septic system was identified, by the Putnam County Septic Repair Program, to be a failing system. As part of this repair, the Putnam County Septic Repair Program, installed a temporary repair to replace the existing system. This system includes the 1,000 gallon septic tank as shown on the above mentioned plan and infiltration trenches in an area at the northeast corner of the property. There is very limited area to replace the existing SSDS based on the following: the location of the existing septic areas, the location of house and driveway and the proximity of the private water supply for the property. Based on these limitations, the viable area identified through field reconnaissance for the replacement SSDS would be in the northeastern portion of the property (as illustrated on the plan). Deep Test Hole inspections were conducted on the site, in the area identified as suitable for installation of the replacement SSDS, on July 31, 2007. Present for the Deep Test Hole were the following: Mike Budzinkski (PCDOH), Danny Shedlow (NYCDEP), Pat Tyndall (Excavator) and Patrick Bell (Cronin Engineering). The Deep Test Hole inspection revealed suitable soils for the installation of a replacement SSDS. Percolation Tests, were conducted by staff at the Putnam County Septic Repair Program, and the information was used in the design of the replacement SSDS. PROPOSED DESIGN OF REPLACEMENT SSDS: Based on the constraints of the property it was determined at the July 31, 2007 site visit that the replacement system for the SSDS should be a peat biofilter system, as manufactured by Puraflo. These systems offer a high level of treatment to the sewage outflow from the house in a relatively small area. The system will consist of three (3) peat biofilter modules (See Appendix A for peat module design data) and will have a weep design that will discharge the effluent for further treatment into a pad disposal system. The pad disposal was designed on existing soil conditions and percolation rates in the soil. The proposed disposal pad is 22' x 10' (220 sq. ft.) with a 6" layer of W washed stone between the bottom of the modules and top of soil, As part of the repair installation, a 1000 gallon concrete pump /overflow chamber is being proposed. The effluent flow from the septic tank will be pumped to the peat biofilter modules on a time - dosing process of no greater than 37.5 gallons every two hours. In order to provide a level pad for the disposal beds re- grading will be neces area. Approximately 15 cubic yards of fill will be needed for the pad area and s�6fRfr�`d1% CD r� L. C,.rU �a CRONIN ENGINEERING P.E. P.C. —< !Mx � UJ w� BY: FOR �s. � 62980 NIYOFESS %o ' i Patrick M. Bell Timothy L. Cronin l Project Engineer Professional Engineer Cronin Engineering 2 Miller- October 22, 2007 Appendix A Peat Module Design Data I PEAT MODULE DESIGN DATA I PROJECT OVERVIEW: THE PUTNAM COUNTY SEPTIC REPAIR _.. -.._ , ,, .,:_.:.P,R.OGRAM HA$ DETERMINED --THAT..- THE EXISTING. SS TS FOR THIS PROPERTY HAS FAILED AND REQUIRES A NEW REPLACEMENT SYSTEM. THE PROPOSED REPAIR, USING A PEAT MODULE FILTER SYSTEM, SHALL BE BASED ON MANUFACTUR'S SPECIFICATIONS AND EXISTING SITE CONSTRAINTS. NUMBER OF BEDROOMS: 3 BEDROOMS NUMBER OF MODULES: 1 PER /BEDROOM X (3 BEDROOMS) = 3 MODULES FOR REPAIR PERCOLATION DESIGN RATE: 15 MIN /INCH DISPOSAL AREA REQUIRED: BASED ON MANUFACTUR'S 111112004 DESIGN REFERENCE MATERIAL THE SOIL GROUP 1S INDENTIFIED AS GROUP 3 WITH A 1-5-MINIINGH- P- ERGOLA -T(.ON ...:_ RATE. THE APPLICATION RATE IS 2.21 GDP /SQ. FT. A 150 GPD PER BEDROOM FLOW RATE WILL BE USED. DESIGN FLOW: 3 BDRMS X 150 GPD /BDRM = 450 GPD BED SIZE: 450 GPD /2.21 (GPD /SQ. FT.) = 203.6 SQ. FT BED SIZE DIMENSION: 10' WIDTH X 22' LENGTH = 220 SQ: FT. ADDITIONAL REQUIREMENTS: A 1000 GALLON PUMP CHAMBER WITH TIME DOSING +/- 15 CU. YDS. ENGINEERED FILL 0 SHERLITA AMLER, MD, MS, FAAP Commissioner of Nea!(h., LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI Count, EX_cuttVd' ROBERT MORRIS, PE Director of Environmental Health L A-4 SffeL LD TO: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW PRIORITY - SEPTIC REPAIR WS-744-o'-7 DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM JOINT REVIEW IM 3�p f PROJECT: TOWN:_] SUB 'D APP DATE NOTICE OF COMPLETE APPLICATION: DATE: ❑ Within the drainage basins of West Branch, Boyds Corner Reservoirs or Croton Falls. �0, Within 500 feet of a reservoir, reservoir stem or control lake. Within 200 feet of a watercourse or a DEC wetland and appearing on a subdivision map approved after December 31, 1992. ❑ Design flow greater than 1000 gallons /day. ❑ Commercial SSTS. jtreviewrepair 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 W L/NK \� ENCE 1 _-104 FOR IULD =IED. #4. ��l j�. .7 .j ,102 LOT 21 . AREA -= 1-8, 000 SO. FT. v v - S EXISTING STOR Y / FRAME / / / /.- 100 �G USE EXISTING SEPTIC PIPE FROM -HOUSE D2 98 PROPOSED PIPING FOR - I / --- A A /i1 a f4' OF 470 PVC SDR -35 PIPE 0 1.09 MIN PITCH TO PUMP CHAMBER O A7JI 1 eox coNc R WALL PAVED APPROXIMA TE L OCA TION OF EXISTING 1000 GALLON SEPTIC TANK. SEE DESIGN NOTE #3. 'j s, PROPOSED 1000 GALLON PUIVP /OVERFLOW TANK (SEE DETAIL) ho PROPOSED 1 -1/2 "0 SCHEDULE 40 FORCE MAIN FROM PUMP TANK TO INLET OF PEA T MODULES IRON ROD , Qur PROPOSED LIMITS FOUND ON R" OF PAD BED. BED TO BE 220 SO. FT. PROPOSED PURAFL 0 PEA T FIBRE BIOFIL TER "BLUE UN1 TS (3 TO TAL) 1 (SEE DETAIL) EXISTING TREE TO BE REMOVED IN 1 �P SO �OpF'QTY O 'QO,y� , 'poll- PROPOSED o'9� �grre . EROSION [� CONTROL (SEE DETAIL) ^V Lake LOCATION MA Ioo� "op" '\k�, Dl� PR 133 S. LAKE: UNDER NEW YORK STA" UNLAWFUL FOR ANY PE ACTING UNDER THE DIF ITEM IS ALTERED, THE / AND THE NOTATION "AL OF SUCH ALTERATION,