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HomeMy WebLinkAbout2065DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www . s ca n y o u rd o cs . co m 631- 589 -8100 36.48 -2 -4 BOX 18 02065 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES -716 v� Lr z e QA D,— (�-ecvs1Pt' N S% TM # 36. Ll2 "'ems OWNER'S NAME AWC -0 7-Cio ng-LL t PHONE # & S 27& 7174, MAILING ADDRESS SA VA C APPLICANT IX0 O C I\ P) Name & Relationship (i.e., owner, tenant, contractor) DATE '31 13 1 k) 6 FACILITY TYPE Q)Z M IL N PCHD COMPLAINT # PROPOSED INSTALLER J-r ��,tL i �f� �ZCC PHONE #gl140 ->&-1I ADDRESS eMW§�Ce- N y REGISTRATION /LICENSE # I )— lo� QG J 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 I, as owner, or re orted agent of owner agree to the conditions stated on this form SIGNATURE �A�YJ -W10� TITLE OWCR 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. Proposal Approved 3X Proposal Denied T 4 ^ Date �Y COPIES: bNhite (PCHD); Yellovt, T�lw BI); Pink (Installer), Orange (Applicant) PC -RP 99ML Rev. 8/05 DATE I3 t It pUTNAM, COUNTY- HEALTH,, DEPARTMENT. DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Commissioner of Health - FIELD ACTIVITY REPORT - Sheet of r n INSPECTION NAME t G 4 R-e C `.r V' /oe q Orig. Routine i Orig. Ccmplain ADDRESS ��L % ' E ,� �. pA ,j Orig. Request No. Street Town" TH No. Compliance Canplaint Cramp MAILING ADDRESS T� Final P.O. Box Post Office Zip Code Group Illness Construction TELEPHONE PERSON IN CHARGE OR INTERVIEWED G cam- X c Name and Title DATE Y l TYPE FACILITY TIME ARRIVED J' G TIME LEFT — FINDINGS: Reinspection Field, Sampling Only Field Conference Other . Explain INSPECTOR: tune and Title PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity.Report. SIGNATURE: 6/86 TITLE: TELEPHONE: Department .of Environmental .Protection April 4, 2006 Mr. Mike Budzinski, P.E. Putnam County Health Department 1 Geneva Road Brewster, New York 10509 Re: Zegarelli Pizzeria Septic Repair (T) Patterson, Putnam County East Branch Drainage Basin DEP Log # 2006 -EB- 0415 -CR.1 (Joint Review) 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 septic system repair. This determination is based on the review of submitted documents including the drawings titled "Proposal for Sewage Disposal System Repair — 176 Fairfield Drive, Brewster, New York ", dated 3/13/06. Please contact me after the repairs are completed to schedule a follow -up inspection. I may be reached at (914)742 -2055. Sincerely, Danny Shedlo, P.E. Civil Engineer II Project Review xc: Roger Sokol, P.E., NYSDOH T 'd JO IN3WidUd30 AlNno:� WUNind:3WUN ,April. 4, 2006 Mr. Mike Budzinski, P.E. Putnam County Health Dep I Geneva Road Brewster, New York 10509 Re: Zegarelli Pizzeria Septic (T) Patterson, Putnam Ci East Branch Drainage & DEP Log # 2006-BB-0415- Dear Mr. Budzinski: This letter is to inform you that t] Environmental Protection (DEP) referenced septic system repair. submitted documents including t Disposal System :Repair — 176F 3/13/06. Please contact me after the repairs inspection. I may be reached at Sincerely, Danny Shedlo, P.E. Civil Engineer 11 Project Review xc: Roger Sokol, P.E., MY j. (Joint Review) New York City Departmciri o I Ls no objection to the approval of-'Llieabove- Lis detenidnation is based on'the of drawings titled "Proposal f. o fieldDrive, Brewster., -Mrw are completed to schedule -,3 fiAlov'! tir �14)742-2055. 99:01 9007 V JOV �:VCO-M-PL6:x6j PUTNAM COUNTY- DEPARTMENT OF- HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 4 GENEVA ROAD BREWSTER, NY 10509 TELEPHONE: (845) 278 -6130 FAX: (845) 278 -7921 FAX COVER SHEET TO: FIRM: FAX: FROM: MICHAEL BUDZINSIG, PE DIRECTOR OF ENGINEERING # OF PAGES: v (including cover sheet) MESSAGE: �F ( % -- DATE: 4- e7 �o L-2s-F- A14-74 IN THE EVENT OF TRANSMISSION/RECEPTION DIFFICULTIES, PLEASE CONTACT OUR OFFICE AT THE ABOVE NUMBER T 'd 30 IN3Wid0d30 AiNI103 WdNind:3WUN March 27, 2006 TO: P.C.H.D. ATT: M. BUDZINSKI WATER USAGE REPORT FOR ZEGARELLI'S PIZZA 176 FAIRFIELD DRIVE BREWSTER N.Y, 10509 (—r) PA—(-r 3/2106 11:00 AM 978010 2� 10 3/22/06 9:15 AM 978220 J '340 3/23/06 9:45. AM 978560 310 3/24/06 10:45 AM. 978870 39 D 3J25/06 9:45 AM 979260 3/26/06 NO READING JT5Di Z = 27 3/27/06 10,45 AM 979810 My AJ &i = 2 -5 7 e'lpi� IF YOU HAVE ANY QUESTIONS PLEASE CALL 845 278 7174 tlioill 9002-L? -duw e V10H 9 Cl Cl 3 - 17 - >A Fj L.j SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health ROBERT J. BONDI County Executive r ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 TO: DEPARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE TREATMENT SYSTEM PROGRAM JOINT REVIEW G Is '� F-PA- t (�!- PROJECT: Z &GI 61 A-C,� uJ 1 ,�YL TOWN: �A�7�So� SUB'D APP DATE NOTICE OF COMPLETE APPLICATION: DATE: 2 D ❑ 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 subdivision map approved after December 31, 1992. ❑ Design flow greater than 1000 gallons /day. ( Commercial SSTS J treview 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 T 'd d0 1N3Wlddd30 AiN00o WblAlnd :3WUN T26Z- 8Z2 -Sb8 : -131 Hill 9002- Z2 -2UW March 27, 2006 TO: P.C.H.D. ATT: M. BUDZINSKI WATER USAGE REPORT FOR ZEGARELLI'S PIZZA 176 FAIRFIELD DRIVE BREWSTER N.Y. 10509 COPA77 3/2106 11:00 AM 978010 2i p 3/22/06 9:15 AM 978220 3/23/06 9:45 AM 978560 31O 3/24/06 10;45 AM.. 978870 �,,�3qo 3/25/06 9:45 AM 979260 3/26/06 NO READING 550) -Z, : 275 3/27/06 10:45 AM 979810 A Aj 6, IF YOU HAVE ANY QUESTIONS PLEASE CALL 845 278 7174 TO -d 9669 qtZ 2►b7. r. UK, du.c. Jr,� D 1 =adsui a 0 ii , 111 ?lif , 11 ; FT iifi! I!!i' i i I , I I t 1 I EE � ! � ���� f .♦ .. ��t� i' •.. ur �.._... �a u 1 • � r•. '' ...�.. +:m ♦♦ .w ., r•!. •. 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BUDZYNSKI WATER USAGE REPORT FOR ZEGARELLI'S PIZZA 176 FAIRFIELD DRIVE BREWS'TER N.Y. 10509 3/2106 3/22/06 3/23/06 3/24/06 3/25/06 3/26/06 3/27/06 11:00 AM 9:15 AM 9:45 AM 10:45 AM. 9:45 AM NO REAL 10:45 AM 978010 978220 978560 978870 979260 )ING 979810 IF YOU HAVE ANY QUESTIONS PLEASE CALL 845 278 7174 Froi 9669 9tr.J- 207 fiuodwo:]EL40! loadsui awOH L•a.- 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION _OF -ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project (T ) County Site Location Building construction begun Extents Is property within NYC Watershed ? ................. Yes 0 No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. F_� Hilly F7 Rolling F__� Steep slope F—] Gentle slope ©Flat 2. F7 Evidence of wetlands Low area subject to flooding a Bodies of water aDrainage ditches F_� Rock outcrops 3. Property lines or corners evident ....................... ............................... 'Yes a No 4. Do water courses exist on or adjoin the property? ............................ F—] Yes EEfr No 5. Will these affect the design of the sewage system facilities ?............ a Yes E[ No 6. Do watershed regulations apply in this development ? ....................... 'Yes F_� No 7 Will extensive grading be necessary? ................. ............................... 0 Yes t�3 No - ... a8: Will extensive fill-be- SSTS ? ................: ...................... � Yes �-- No 9. Do filled areas exist within the SSTS area? ........ ................. ............... Yes ENo F__] If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS t 10. Appearance of soil: 0 Sand E:J Gravel FTrLoam F_� Clay. F__] Hardpan F--] Mixture 11. Observed from: 0 Borings /0 Bank cut ED 3ackhoe excavations 12. Soil borings /excavations observed by on 13. Depth to groundwater �' (p i on 3 Z' 14. Depth to mottling on 15. Are test holes representative of primary & reserve areas ...... ............................... Yes No 16. Soil percolation tests made by 17. Soil percolation tests witnessed by SECTION D (on back) on on Form STA 2 k SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? F7 Yes FNo 19. Will groundwater or surface drainage require special consideration? ..................... Yes P-_'�No 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... a .Yes F---TN o SECTION E. REMARKS 21. If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities? ................................ ............................... Yes No Inspection data 22. Do adjacent wells and/or sewage systems exist? ..................... ............................... Yes F_� No 23. Additional comments 24. Site observer /inspector and title 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 Depth.to. mottling.... Depth to mottling Depth to mottling - Depth to rock/imp. �� Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L. 4 0.5 0.5 0.5 1.0 1.0 1.0 2.0 Gt" 2.0 2.0 3.0 ©lam 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 __