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HomeMy WebLinkAbout2051DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.48 -1 -7 BOX 18 02051 l+ 17% ' 19 Ir 1 i .' .�. I . 'NI-6 '. i:t� ,' ' 1 r . .�' Ln . I Vil�. r I' I ML.1 I L 02051 � 3 b -off — � �.�, �..,� �� -� �� �; �,. PUTNAM COUNTY HEALTH DEPARTMENT �, ✓ DIVISION OF ENVIRONMENTAL HEALTH SERVICES ✓ �-v PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR Y NO Internal Use Only PERMIT# ►_ "��� ,'- ❑ Repair Permit issued in last &lean; ❑ Wot 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 /'�f ld Ar TOWN TM #k 3C • �-- `° OWNER'S NAME PHONEXS2�� 6� MAILINGADDRESS APPLICANT, Name elationship p.e., owner, tenant, contractor) DATE 10-11, ;W'Z - FACILITY TYP 1(}t> �,la HD COMPLAINT # PROPOSED INSTALLER It PHONE # ADDRESS �% i ..J__ t REGISTRATION /LICENSE # Pro sal (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. JJ /� n / /7 -�+ s rl A e �lZh // A4i / (ic/�91c 0� A /v / 4;k r I, as owner,agree to the con itions stated on this form SIGNATURE TITLE lag Upn DATE Q (owner) I, the septic i taller, agree to comply with the conditions of this permit for the septic system repair SIGNATURE Vio"Z TITLE, .� ��' DATE (installer) Pro 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. X INTERNAL USE ONLY . Proposal Approved 0 Proposal Denied ❑ [ re & Title Dat6 Expifational is in comDliance with awlicable codes Yes 2 No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 4a,. Date: �(- StreetLo� /A�f�,'.r Town: 7404eo , Putnam County Department.of Health Division of Environmental Health Services SS TS Repair - Final Site Inspection Inspected by: 6 1 Leee) Install Owner: ;-7 f: fla � 01 Repair Permit #: -Z- 2-3V-12-- TM # 36. V-9 ° / - 7 1. Type of System: Conventional 0 Alternate 0 Comments: 2. Septic Tank Yes No N/A Comments a. Septic tank size - 1,000. .1,250 .... other ..... b. Septic tank installed level ...................... c. 10' minimum from foundation .................. d. Distribution Boa i. All outlets at same elevation (water tested) ... ii. Protected below frost ............................. iii. Minimum 2 ft. Original soil between box & trenches e,.V e. Junction Box - �ro erl set .......................... f. Trenches i. Systenicompletely 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 '/Z " diameter clean ......... vii. Depth of gravel in trench 12" minimum ......... viii. Ends capped .... ............................... . Pump or Dosed Systems 3. Sewage System Area a. SSTS Area located as per a roved 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 ............................ ay Additional Comments: r� l: ' r IFSI Rev - 011312 ­- 0 6;r 14f- JVdVA .,///.;r-o I . z '. -C>12 --55,r. RET WALL W1 c t�p- '00-, OV oo� go od� f�oo 50 CONC. WALL \ C / 52 \ QUND J TOP OF IRON PIPE FOUND a2' N. OF P.L. COR. M M ALLEN BFALSALD.,JD. Camnissionerofflealth ROBERT MORM Px- DiMCWd&wkanmmWH=M A)EPARMENT'O. PAEALTH I Geneva ROE4 Bmwda, New York 10509 Telephone: (945) 908-1390; Fax: (945) 278-7921 May 17, 2013 Angelo Zegarelli 176 Fairfield Drive Brewster, NY 10509 MARYZLLE.NODft,L - COWLYEhe6ad" Re: Well Permit Application for Angelo Zegarelli W14-13 at 185 Fairfield Drive (T) Patterson, TM 36.48-1-7 Dear Mr. Zegarelli: This Department has approved the well permit for Well W14-13 at the above referenced property. The location approved is for the drilling of a new source supply well. Please be advised that if site conditions and/or site plans change and/or are revised, thereby compromising the minimum required separation distances, siting approval of the well must be reapproved by this Department. The above well to be drilled will be required to be sampled for a NYS Sanitary Code Part 5 analysis (see attached). Prior to placing the well into service, the well completion report and water quality analyses results are to be submitted to this Department. In addition, plans for a permanent disinfection system must be submitted to this Departnent:for-approval. - If-an ultraviotet.disinfection-systemis-�.-"-'a''-"';--,-.t--'- then the following additional water quality parameters are to be sampled for: hardness, hydrogen, sulfide, suspended solids and UV absorbance or UV transmittance. All necessary Town permits for the installation of the well are required to be issued prior to well construction. Should you have any questions, please contact this office. Michael I BIA!�gt' P Director of BhLqn errm MJB:cw cc: A. Bittner R. Carano PUTNAM, COUNTY DEPARTMENT OF HEALTH `DIVISIOWO: F ENVIRONMENTAL HEALTH SERVICES ✓ APPLICATION TO CONSTRUCT A WATER WELL please print or type Well Location Street Address:. Town/Village: Tax Map # 36 49 1- ;z - : i�sS A I tECD �Gt �Gt s . QY 10<09 Map Block Lot(s) Well Owner: Name: Address: 1%6,fA 1JIT -1 CLO Phone #: i(EAE siqnrn V y 10) Use of Well: Residential Public Supply Air /cond /heat pump _Irrigation . '1- Primary =Business Farm Test/monitoring _Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield Sought = gpm # People Served Est. of Daily usage gal. Replace Existing Supply Test/Observation. Additional Supply Reason for Drillin New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding?..:...... ............................................... ............................... Yes _ No Is well located in a realty subdivision? ........................................... ............................... Yes _ No Name of subdivision Lot No. Water Well Contractor: "1 1 (i Address: Is Public Water Supply available on site? ........................................ ............................... Yes — Nom . Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to b prov'ded on s parat eet/plan. Date:- (� - Applicant Signature rCKMI 11 V UWINIQ 1 Rut.. t 4% errs I r-K vrr-L-1- This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and.Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. - APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless, construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified'.. when considered necessary by the Commissioner of Health. Any revision or alteration of the approv d plan requires a new permit. Well to be constructed by a water well driller certified by Putnam 99tnty. n t Date of.lssue /� " Permit I Date -of Expiration — Title:_ Permit is Non- Transferable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Rev. 3/06 T-D. -. ALLEN BEALS, M.D., J.D. . Commissioner of calth ROBERT MORRL% P.E. Director ofJEnviron 4mW ffc th May 17, 2013 Angelo Zegarelli 176 Fairfield Drive Brewster, NY 10509 Dear Mr. Zegarelli: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Telephone: (845) 808 -1390; Fax: (845) 278 -7921 MARYELLEN ODE`LL CovntyExedfive Re: Well Permit Application for Angelo Zegarelli W14 -13 at 185 Fairfield Drive (T) Patterson, TM 36.48 -1 -7 This Department has approved the well permit for Well W14 -13 at the above referenced property. The location approved is for the drilling of a new source supply well. Please be advised .that if site conditions and/or site plans change and/or are revised, thereby compromising the minimum required separation distances, siting approval of the well must be reapproved by this Department. The above well to be drilled will be required to be sampled for a NYS Sanitary Code Part 5 analysis (see attached). Prior to placing the well into service, the well completion report and water quality analyses results are.to.be,..submitted.to_ this.Department .- .In.addit.toti,,plans_fora. permanent _disWeetiousystem........ - must be submitted to this Department for approval. If an ultraviolet disinfection system is proposed, then the following additional water quality parameters are to be sampled for: hardness, hydrogen, sulfide, suspended solids and LTV absorbance or LTV transmittance. All necessary Town permits for the installation of the well are required to be issued prior to well construction. Should you have any questions, please contact this office. Michael J. Bins P Director of izinee MJB:cw cc: A. Bittner R. Carano ALLEN BEALS, RLD., J.D. Commissioner of Health ROBERT MORRIS, P.E. DirectorofEwhonmmW HoM May 17, 2013 Angelo Zegarelli 176 Fairfield Drive Brewster, NY 10509 Dear Mr. Zegarelli: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Telephone: (845) 808 -1390; Fax: (845) 278 -7921 MARYELLEN ODtU CourtyExecative Re: Well Permit Application for Angelo Zegarelli W14-13 at 185 Fairfield Drive (T) Patterson, TM 36.48 -1 -7 This Department has approved the well permit for Well W14 -13 at the above referenced property. The location approved is for the drilling of a new source supply well. Please be advised .that if site conditions and/or site plans change and/or are revised, thereby compromising the minimum required separation distances, siting approval of the well must be reapproved by this Department. The above well to be drilled will be required to be sampled for a NYS Sanitary Code Part 5 analysis (see attached). Prior to placing the well into service, the well completion report and water quality analyses results ....are to,be.submitted to this - Department. In addition, plans-for a permanent. disinfection system- -di . - _...... _- .._..�__.____. _ - . .. _ must be- submiti &fo thi Department for apprrova7. If an ultraviolet disinfection system is proposed, then the following additional water quality parameters are to be sampled for: hardness, hydrogen, sulfide, suspended solids and UV absorbance or UV transmittance. All necessary Town permits for the installation of the well are required to be issued prior to well construction. Should you have any questions, please contact this office. MJB:cw cc: A. Bittner R. Carano Full Part 5-1 Water Testing Requirements and Standards :4&orgmkCbemlcals and Physical -Characterlsdcs Maidmum- ContaininmdLevel lEntry Point Turbidity Maximum Contaminant 4vel Entry point tinbidity4surface, water and groundwater I NTU " directly influenced by surface water) (Monthly Average) 1.0 million fibers/liter. (longer than 10 microns) Asbestos Antimony 0.006 Arsenic 0.010 Barium 2.00 Beryllium 0.004 Cadmium 0.005 Chromium 0.10 Cyamde(as free cyanide) 0.2 .Mercury 0.002 Selenium 0.05 Silver 0'1 Thallium 0.002 . Phioride 2.2 r 1 ,h1oride 250.0 Iron .3 0.3z Manganese 6-37 Sodium No designated limits' Sulfate 250.0 Zinc 5.0 Color 15 Units .Odor --- -3 Units. tromaO 0.010 Chlorite 1.0 lEntry Point Turbidity Maximum Contaminant 4vel Entry point tinbidity4surface, water and groundwater I NTU " directly influenced by surface water) (Monthly Average) Microbiological Contaminants Maximum Contaminant Level (MCL) lit 1 : 1 1 • � + '"�. 1 t'"� -� � .Is � i)9 islilf sli4� r r.'�'��1 � 1 � e 9 ib:., F )IY�.diF�'�U7.�'13nIE�.6,�f��is 1 - 1 •/ - Microbiological Contaminants Maximum Contaminant Level (MCL) I Radiological MaAmum Con t Level. Combined radium-llkand Yicocuries per liter radium -228 '"�. 1 t'"� -� � .Is � i)9 islilf sli4� r r.'�'��1 � 1 � e 9 ib:., F )IY�.diF�'�U7.�'13nIE�.6,�f��is +v 1 ,_i3��F 5 .i4 =y vyi ^�, u.'irs� �, §''� ��-�•�w`� s iy� � � r -r� rssr v^�.i�4µsi6� radon and uranium Uranium ...-.� �Gr`�u. -._- -,.. 1 11Y :111 Beta particle and oton F per year as radioactivity m manmade se • 1 1 II tol equivalent ttten-M'I' body or any, orga n.. 1 1 1 1 111 " Esche-Fichia / No 11 I • " • fecal indicator I samples I1 • 1 1 / collected. from raw source water / I % 1 • , from .1 � 1 11 source. _ enterococciii. • 11 and/or 1 • 1 - Source I Radiological MaAmum Con t Level. Combined radium-llkand Yicocuries per liter radium -228 Gross -alpha activity (inc l 15 picocuries per liter radium-226 but excludin radon and uranium Uranium jh4eLcrograms per liter Beta particle and oton F per year as radioactivity m manmade se radionuclide tol equivalent ttten-M'I' body or any, orga n.. Organic Chemicals Maidunun Contaminant Level 4 Benzene' Bromobenzene, Bromochloromedune Bromomethane N-Butylbenzene, Sec-Butylbefizene Tert;-Butylbenzene Carbon Tetrachloride' Chlorobenzene Odoroethane biloromethane 2-Chlorotoluene 4-ChlorotDluene Dibromomethane 1,2-Dichlorobenzene' 1,3-Dichlorobenzene 1,4-Dichlorobenzene' Dichlorodifluoromethane 1,1-Dichloroedme-. 1,2-Dichloroethaael 1, 1 -Dichlorcethene' cis- 1,2-Di6hloroethe.ne' trans-1,2-Dichloroiethenel 1,2-Dichloropropane' 1,3-Dichloropropane 2,2-Dichloropropane 1,1-DichlorciproDene ii Fr cis -1, 3- Dichloropropene Trans-1,3-Dichlor6propsne ethylbenzenel hexachlorobutaffiene Isopropylbenzene 5; p-Isopropyholuene Methylene Chloride' n-Propylbenzene Styrene' 1,13,2-Tetrachl6roe" 1,1,2,2-Tetrachlomethahe Tetrachloroethene' Toluene' 1,2,3-Tiichlorobenzene'�-` 1,2,4-Trichlorobenzene 1,1,1 -Trichloro 1,1,2-Trichloroediime' Trichloroethene' ' I Trichlorof luoromethanei 1,2,3-Trichloropropane.1" 1,2,4-Trimethylbenzeni. 1,3,5-Trimethylbenzene, m-Xylefiel O-Xykne' P-Xylenel ar Alachlor 0.002 Aldicarb 0.003 Aldicarb s ne 0.002' Aldicarb sulfo We 0.004 Atrazine 0.003 Benzo(a)pyrene 0.0002 Carbofuran 0.04 Chloidane 0.002 Di(2--ethylhexy 0.006 Dibromochloroprop 0.0002 2,4-D 0.05 Dinoseb 0.007 Diquat 0.02 Endrin 0.002 Ethylene dibromide 0.00005 Heptachlor 0.0004 Heptachlor epoxide 0.0002 Hekachlorobenzene 0.001 Lindane 0.0002 Methoxychlor 0.04 Methyl-tertiary- tyl-ethmI(MME) 0.010 Pentachlorophe of 0.001 Polyc biphanyl§(PCBs) .0005 Propylene gly of I S&wAne .0 04 Toxaphene 0.0 2,4,5-TP. (Silvex) 0.01 2,3,7,8-TCDD (dioxin) 0.00000003 [Vinyl chloride 90.002 Organic Chemicals Maidunun Contaminant Level 4 Benzene' Bromobenzene, Bromochloromedune Bromomethane N-Butylbenzene, Sec-Butylbefizene Tert;-Butylbenzene Carbon Tetrachloride' Chlorobenzene Odoroethane biloromethane 2-Chlorotoluene 4-ChlorotDluene Dibromomethane 1,2-Dichlorobenzene' 1,3-Dichlorobenzene 1,4-Dichlorobenzene' Dichlorodifluoromethane 1,1-Dichloroedme-. 1,2-Dichloroethaael 1, 1 -Dichlorcethene' cis- 1,2-Di6hloroethe.ne' trans-1,2-Dichloroiethenel 1,2-Dichloropropane' 1,3-Dichloropropane 2,2-Dichloropropane 1,1-DichlorciproDene ii Fr cis -1, 3- Dichloropropene Trans-1,3-Dichlor6propsne ethylbenzenel hexachlorobutaffiene Isopropylbenzene 5; p-Isopropyholuene Methylene Chloride' n-Propylbenzene Styrene' 1,13,2-Tetrachl6roe" 1,1,2,2-Tetrachlomethahe Tetrachloroethene' Toluene' 1,2,3-Tiichlorobenzene'�-` 1,2,4-Trichlorobenzene 1,1,1 -Trichloro 1,1,2-Trichloroediime' Trichloroethene' ' I Trichlorof luoromethanei 1,2,3-Trichloropropane.1" 1,2,4-Trimethylbenzeni. 1,3,5-Trimethylbenzene, m-Xylefiel O-Xykne' P-Xylenel ar ENVIRONMENTAL .HEALTH MANUAL NEW YORK STATE DEPARTMENT OF HEALTH NO: PWS -186 DATE: 3/6/04 OFFICE OF PUBLIC HEALTH CENTER FOR ENVIRONMENTAL HEALTH TECHNICAL REFERENCE PURPOSE SUBJECT: Ultraviolet Light Disinfection Page 1 of 9 To provide updated guidance on the use and acceptance of ultraviolet light disinfection for public water supplies. The major revision in this document from the 10/25/01 release is that ultraviolet disinfection units rated at 30 gpm or less must now be ANSVNSF standard 055, listed under. the Class A Disinfection Performance standard. BACKGROUND Over the past two decades Ultraviolet radiation (UV) applied at a 254 run wavelength has been shown to be an effective disinfection. process against bacteria. The Department has approved the use of this technology during that period for non - community water systems with properly protected groundwater sources. Research has documented that UV (using low and medium pressure lamps) is also effective for inactivating organisms found in surface water, such as giardia and cryptosporidium, if properly'applied design criteria are used. GENERAL . ---__. - : �•1:-- -- Tl��disr�etion�proee�swvilinow- be' co�ideredas- a- prinrary�disinfectionprocess�or an �._.., - -.. __ T.._ ..:.:; expanded range of public water supplies (PWS). These include community and non - community systems using groundwater sources as well as properly filtered surface water sources. In addition, the UV process can be considered for surface supplies that meet the filtration avoidance criteria enumerated in Subdivision of 5- 1.30(c) of Subpart 5 -1 of the State Sanitary Code. 2. Since no disinfection residual results from the UV process it will be necessary to supplement this disinfection process with post - chlorination to achieve a distribution residual for those systems with - an external distribution system. (Please note that our existing guidance of allowing UV without post - chlorination at groundwater systems without an external. distribution system, e.g., restaurants, Agriculture and Markets facilities, single building apartment complexes, etc. will . continue.) 3. For simple design/installations for existing non - community systems utilizing a properly protected groundwater source with no external distribution network, the system owner may not need to engage the services of a licensed professional engineer (PE) or registered architect (RA) provided that the cost of the UV system is less than $5000. The reviewing Local Health Department (LHD) will have the discretion to accept the design. The decision by the LHD will .�1 ENVIRONMENTAL HEALTH MANUAL NEW YORK STATE DEPARTMENT OF HEALTH I ITEM NO: PWS -186 DATE: 3/6/04 OFFICE OF PUBLIC HEALTH CENTER FOR ENVIRONMENTAL HEALTH TECHNICAL REFERENCE SUBJECT: Ultraviolet Light Disinfection Page 2 of 9 depend upon the availability of a PE on staff to accept and conduct a thorough design review and approval and LHD staff conducting a Completed Works inspection of the installation to verify that it was completed in accordance with approved plans /schematics at the time of the completed work inspection. A PE or RA must be utilized in situations when pro- or post - treatment is necessary due to source water. quality conditions, where a surface source is employed, or where an external distribution system exists. DESIGN SUBMITTALS AND APPROVAL The UV disinfection installation proposal must address source and site conditions, raw water quality characteristics, other existing or proposed treatment processes and details on the proposed UV unit. Information required includes: a) Source water type i.e., ground water or surface water, location, any available well log (if ground water) information and construction details. b) Locations of, and distances to, potential sources of contamination. Raw -and filtered - water- data* including- microbiological data ., total culifo quality - g gl ( nn; ° %c°ar__.._.__...:__.____ coliform, heterotrophic plate count), and the following inorganic and physical constituents: PARAMETER Iron Manganese Hardness (calcium) Hydrogen Sulfide Turbidity Color Suspended solids UV Absorbance UV Transmittance DESIGN LIMIT 0.3 mg/1 0.05 mg/1 300 mg/1 1 mg/1 1 ntu 15 APHA units 10 mg/1 0.155 cm -1 or 70% d) If any of the design limits for the water quality parameters included in c) are exceeded, a proposal for additional treatment to achieve acceptable levels must be included. e) Applicants with surface sources or groundwater sources under the direct influence of surface jwater must provide filtration prior to the UV unit or meet filtration avoidance criteria. *The water quality pwamet n listed are for existing solaces. New somces require nim extensive testing Le. full Pact 5 analysis to dement ate satisfactory quality, refer to the Enviremaental Health Manual Item PW5 -131 for a definition of a full part 5 analysis. ENVIRONMENTAL HEALTH MANUAL NEW YORK STATE DEPARTMENT OF HEALTH OFFICE OF PUBLIC HEALTH CENTER FOR ENVIRONMENTAL HEALTH TECHNICAL REFERENCE ITEM NO: PWS -186 DATE: 3/6/04 SUBJECT: Ultraviolet Light Disinfection Page 3 of 9 The design must incorporate those criteria listed in Appendix A "Design Criteria for Ultraviolet Disinfection Units" (Appendix A is available separate from this Technical Reference for distribution to the public). In addition, for those installations being considered for surface sources, the number of units/lamps, intensities and dosage must be appropriately selected to insure 2 log crypto inactivation; an even higher inactivation capability may be_ required depending source water quality. Water quality parameters that could impair this intensity /dosage such as turbidity, naturally occurring UV absorption matter etc. must be factored into these decisions. Where necessary the design must incorporate appropriately selected and sized pre — and/or post- treatment. Appendix B — "Ultraviolet Disinfection Unit Review and Approval" is available separate from this Technical Reference as a useful handout that LHD's can provide to applicants, particularly for installations at small PWS's. COMPLETED WORKS Following installation, the supplier of water must submit total coliform sample results demonstrating satisfactory performance prior to providing water to the consumer. In addition, the LHD at the time of the completed work inspection must determine that the appropriate UV Dosage (minimum of � MiL��.being..acbieved. by-- that -the ~intensity meter. - reading is-at or.— _...._ _ above 70 %. In addition, at least one total coliform sample must be collected during the first month of operation and at the prescribed monitoring frequency thereafter to ensure satisfactory performance. An operation log shall be maintained at. the facility and entries shall be made for dates and types of maintenance and repair, including cleaning, bulb replacement, etc. At a minimum annual cleaning of the quartz sleeve and annual bulb replacement shall be required OPERATION REPORTS A separate water systems operation report for UV disinfection will be available and will also include sampling information similar to the current water systems operation reports (DOH -360). A draft of the UV operations report is attached for use until the final report is released. UV operation reports should be submitted along with any microbiological sampling reports (monthly, quarterly, or otherwise; as required). ENVIRONMENTAL HEALTH MANUAL NEW YORK STATE DEPARTMENT OF HEALTH OFFICE OF PUBLIC HEALTH CENTER FOR ENVIRONMENTAL HEALTH TECHNICAL REFERENCE ITEM NO: PWS -186 DATE: 3/6/04 SUBJECT: Ultraviolet Light Disinfection Page 4 of 9 APPENDIX A DESIGN CRITERIA FOR ULTRAVIOLET DISINFECTION UNITS 1. Ultraviolet Disinfection units with a capacity of 30 gpm or less must be ANSI/NSF validated and listed with the National Sanitation Foundation under Standard ANSI/NSF Standard 055 Disinfection Performance Class A. 2. Ultraviolet radiation at a wavelength of 254 nm must be applied at a minimum dosage of 40,000 microwatt seconds per square centimeter at all points throughout the water disinfection chamber. 3. Maximum water depth in the chamber, measured from the tube surface to the chamber wall shall not, exceed three inches unless the applicant can demonstrate the ability to achieve the requisite UV intensity transmitted through the proposed depth. a) The ultraviolet tubes shall be; -_ __Tb)— jacketed so-that a proper oporating-tube-temperaturc is mmahrtdmd and; _.._, ` c) the jacket shall be of quartz or high silica glass with similar optical characteristics. 4. The unit shall be designed to permit mechanical cleaning of the water contact surface of the jacket without disassembly of the unit or be of such design that quick disassembly is possible for surface cleaning. 5. An automatic flow control valve, accurate within the expected pressure range, shall be installed to restrict flow to the maximum design flow of the treatment unit. The treatment unit shall be located before any storage tanks. 6. An accurately calibrated ultraviolet intensity meter, properly filtered to restrict its sensitivity to the disinfection spectrum shall be installed in the wall of the disinfection chamber at the point of greatest water depth from the tube or tubes. 7. A flow diversion valve or automatic shut-off valve shall be installed which will permit flow into the potable water system only when at least the minimum ultraviolet dosage is applied. When i power is not being supplied to the unit, the valve should be in a closed (fail -safe) position which prevents the flow of water into the potable water system. ENVIRONMENTAL HEALTH MANUAL NEW YORK STATE DEPARTMENT OF ]HEALTH I ITEM NO: PWS-186 DATE: 3/6/04 OFFICE OF PUBLIC HEALTH CENTER FOR ENVIRONMENTAL HEALTH TECHNICAL REFERENCE SUBJECT: Ultraviolet Light Disinfection Page 5 of 9 8. An automatic, audible alarm shall be installed to wain of malfunction or impending shutdown. 9. The unit shall be designed to protect . the operator against electrical shock or excessive radiation. 10. Installation of the unit shall be in a protected enclosure not subject to extremes of temperature. 11. A spare ultraviolet tube and other necessary equipment to effect prompt repair by qualified personnel properly instructed in the operation and maintenance of the equipment shall be provided on site. 12. For units larger than 30 gpm, a copy of the bioassay results validating the units ability to deliver 40,000 iniscrowatt-seconds per square centimeter for the specified unit must be submitted. The bioassay shall have been performed by an independent laboratory for the manufacturer and be for the full operation range (e.g. 100%-70%). ENVIRONMENTAL HEALTH MANUAL NEW YORK STATE DEPARTMENT OF HEALTH I ITEM NO: PWS -186 DATE: 3/6/04 OFFICE OF PUBLIC HEALTH CENTER FOR ENVIRONMENTAL HEALTH TECHNICAL REFERENCE SUBJECT: Ultraviolet Light Disinfection Page 6 of 9 APPENDIX B Ultraviolet Disinfection Unit Review and Approval Installation of an ultraviolet (UV) light disinfection unit may be allowed for some public water supplies required to provide disinfection. Prior to installation, the unit must be approved by the local health department (LHD) having jurisdiction. Following, in order, are the steps to take: 1. A raw water sample must be collected and tested by a certified laboratory for the parameters listed below in item La. The results must be sent to the LHD for review and acceptance.. If the results indicate that pretreatment is necessary, the proposal must also include additional information on the type of pretreatment proposed. a), Raw and filtered water quality data *, including microbiological data (total .coliform, fecal coliform, heter trophic plate count), and the following inorganic and physical constituents: PARAMETER UPPER GUIDANCE LEVELS Iron 0.3 mg/1 Manganese 0.05 mg/1 _ --900 _ - -- Hydrogen,Sulfide 1 mg/1 Turbidity 1 ntu Color 15 APHA units Suspended solids 10 mg/l UV Absorbance 0.155 cm " or UV transmittance 70%. 2. The proposal submitted to the LHD for approval must include the following: a) All the criteria detailed in the enclosed guideline, "Design Criteria for Ultraviolet Disinfection Units ". b) A sketch or schematic of the water system showing all. plumbing and treatment (meters, storage tanks, raw and finished water sampling taps, filters, softeners, disinfection, etc.). A schematic of an acceptable ultraviolet installation is attached. c) Manufacturer information sheets for the system components. ENVIRONMENTAL HEALTH MANUAL NEW YORK STATE DEPARTMENT OF HEALTH OFFICE OF PUBLIC HEALTH CENTER FOR ENVIRONMENTAL HEALTH TECHNICAL REFERENCE NO: PWS -186 DATE: 3/6/04 SUBJECT: Ultraviolet Light Disinfection Page 7 of 9 *The water quality pars listed are for existing sources. New sources require more extensive testing i.e. full Part 5 analysis to demonstrate satisfactory quality, refer to the Environmental Health Manual Item PWS -131 for a definition of a full part 5 analysis. d) A plot plan showing the location of the well, sewage disposal system, buildings, etc. e) A well log showing gallons per minute, depth of casing, soil conditions, capacity and type of PUMP. 0 A signed and dated formal request (see page 8). 3. After receiving proposal approval, install the unit as approved. If any changes are anticipated during installation, contact your LHD for prior approval. 4. After installation, contact your LHD to arrange an inspection of the unit's installation. 5. After the unit has been installed correctly, the water should be analyzed for bacteriological quality according to the following schedule: a. One sample the fimst'week. b. One sample monthly or quarterly as directed by the LHD. If you have any questions, please contact your LHD. a' ENVIRONMENTAL HEALTH MANUAL NEW YORK STATE DEPARTMENT OF HEALTH ITEM NO: PWS -186 DATE: 3/6/04 OFFICE OF PUBLIC HEALTH CENTER FOR ENVIRONMENTAL HEALTH SUBJECTS Ultraviolet Light Disinfection TECHNICAL REFERENCE Page 8 of 9 ULTRAVIOLET DISINFECTION UNIT SCHEMATIC Manufacturer Model # NSF or equivalent Approved UV Intensity & Dosage Flow Rate (mfg) - - Intensity Meter . Automatic Shut Off Valve Micron Filter Provided* Alarm Location to be Installed * The 5 micron filter is recommended but not required Inlet-), Intensii Meter RawtJ or Tap Ultraviolet Light Unit 5 Micron Flier. Automatic Solenoid V&e r� outlet -> Finished Water TO Flova Restridor FORMAL REQUEST I request that this schematic for UntraViolet Disinfection and related information be accepted in lieu of plans prepared by a design professional. I certify that the aforementioned information is correct and accurate and the estimated cost of the project is less then $5000. I agree to assume all responsibility- for the disinfection system including hiring a design professional and replacement of the system if requested should the system fail to perform as required by Subpart 5 -1 of the State Sanitary Code. I agree not to make changes to the proposed system without receiving prior approval from this office. Facility Name Facility Address Owner/Applicant Signature Owner /Applicant Name (clearly printed) Acceptance Recommended by: NYS Health Department or LHD Staff IIM Phone Number . Date Accepted by: Permit Issuing Official Date _ - NYS Health Department or LHD Staff Inspected by: NYS Health Department or LHD Staff Date This formal request is available separate from tins Technical Reference for distribution to the public ss s UTILITY POLE \ W/ W/ 6�RE , ............. 3 CONC. WALL N63. 52 \ IRON PI UND \ �Cli@lN UNK FENCE \ �� ,WffH ROOF E r 1 .y X100 w f a 3 �© dlHt0 SSiS's WIIkIDv Ico -f ci--T O� 280 `Ft . 10 PtGtcC-L- &i AJ�C Ot' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF E I�V 7N EN��TAAL HEALTH SERVICES. APPROVED AS NOTED FOR"C"ONFORMANCE WITH APPLICABLE RULES AND REGULATIONS OF THE DATE ' 1�