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Home My WebLink About2616DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 52. -3 -6 BOX 22 02616 1 '. f }'i' . ' r. ... 'r . L • L 02616 _-l- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT I 572. - 3 - G ell )l;ocafon 'Street Addre s: , ._ 130 A ae- �r�v(� To /Village: �j � Tax Grid # Mape Block Lot(s) Well Owner: Name: Address: Use of Well: 1- primary 2- secondary Resid ntial Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing Open hole in bedrock _ Other Casing Details Total length 9 ft. Length below grade �' Diameter in. Weight per foot le- lb /ft. Materials: 2!C Steel Plastic _ Other Joints: _ Welded Threaded _ Other Seal: _ Cement grout _ Bentonite Other Drive shoe: ?.Yes _No Liner _ Yes _J,:� No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _ Yes—No Hours Second Well Yield Test Bailed _Pumped Compressed Air Hours Yield 10 gpm Depth Data Measure from land surface- static (specify R) During yield test(ft) Depth of completed well in feet Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameteron) Formation Description ft. A. Land Surface ;2 v2j it ✓r r If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information - Pump Type 3 ,rye Capacity S Depth 3OU Mode14ao Voltage 2_�36 HP i Tank Type i ✓X 2Sv Volume< .s Date Well Completed Putnam County Certification No. Date of Report We I Driller (signature) nv i m rxact location or wets witn aistances to at least two permanenylandmarks to be provided on a separate sheeVpian. �� Well Driller's Name ��-r� ��ory, �Lzc� Address; Signature: —717 Date: White copy: HD File; Yellow copy- Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 � ~�= � YML ENVIRONMBNITAL SERVlCES 321 Kear Street Yo"..ktomn `Heigh��,c�N+y.` 10598 ' ~ (914) 245-2800 Albert H. Padnvani, Director LAB #: 1.502473 CLlENT #: 55057 NON STAT PROC PAGE: .1 NIESE, RALPH DATE /TIME TAKEN: 04/21/05 10:50 134 WICCOPEE RD DATE/TIME REC'D: 04/2J/05 10:35 PUTNAM VALLEY, NY 10579 REPORT DATE: 04/28/05 PHONE: (845>-528-8684 SAMPLING SITE: 130 WICCOPEE ROAD, PUTNAM VALLEY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIV ES: NDNE COL 'D BY: RALPH NIESE TEMPERATURE..: NOTES...: COLlFORM METH� N/A ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROCEDURE PUTNAM CNTY PROFlLE 04/21/05 IlF T. COLIFORM 04/27/05 LEAD (IMS) 04/22/05 NITRATE NITROG O4/21/05 NITRITE NITROG 04/27/O5 lRON (Fe) O4/p5/m5 - I44NGANESE (Mn) 04/25/O5 SODIUM (Na) 04/21/05 pH 04/26/05 HARDNESS,TOTAL 04/26/05 ALKALINITY (AS ()+/26/0�[�� .� �rURBIDITY` (TUF| RESULT NDRMAL - RANGE METHOD ABSENT /100 ML 13.8 p p b 1.03 MG /L <0.01 MG /L 0.19O MG/L. O'.036MG/L 55.7 MG/L 6.7 UNITS 232 MG /L. 46.0 MG/L lVTU. ABSENT 0-45 ppb 0 - 10 N/A 0-0.3 mg/l 0-0 3- /1 . mg N/A 6.5-8.5 N/A N/A COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDIN��f�'THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE 'TIME OF COLLECTION. � Pb/Cu LEAD limits for public schools are set at 15 ppb. EPA Lead & Copper Rule for Public Systems reqt-tires that no morez than 10% of their distribution points have a LEAD value of more�'� than 15 ppb and a COPPER value of 1.3 mg/L, else water � u� treatment must be undertaken to reduce the waters corrosive potential. Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. , ` Na No limits for Sodium are., proscribed� Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L. of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L. of* Sodium 1008 9O03 90152 9l62 9002 9002 90O2 9O43 / 9001 . - o -' ' .. .. ' - ..��.' �z' � d 2 —os S —og APR-15 -2008 12:55P1t FROM - ENVIRONMENTAL HEALTH 0452787821 T -283 P.002/002 F -188 - D Il_Q- IRONMEI7, FiAL PROPOSAL F0,13 SoffA RE REPAIR E YES No al Use On PERMIT Repair Permit issued In last 6 years tin a rs Repair within 9dyd s Comers, W. Branch or CnAun Falls Res, Delegated o 6P Repair within 200 ft or a waterooursa OF OEGppmapped wetland 'tQ Joint Review SITE LOCK ON �� TOWN f(fIV A IM U41kY TM # c� . -J 40 . OWNER'S NAME d PHONE # S9r.-C-- J MAILING AdDRESS� Name & Relationship (La., m der, tenant, contractor) r r DATE Jp $ FACILITY TYPE t'S ilel?14, a t 1 PCHQ COMPLAINT # PROP03E17 INSTALLER ADDRESS - l REGISTRATION /LICENSE*. Proppsal (include a separates etch locating the house, property Imes, all adjacent wells within 200 That of repair and the location of existing and propoeed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature and extent of the repair. A -.--Y O —1 A, I, as owner,agree to the conditions stated on this form SIONATLJRE is _ J ITLE Q�%J�41� CRATE (owner) 1, the septic instal arm to comoiv with the conditions of this permit fbr the septic system repair SIGNATURE TITLE & / fee rt . r DATE (installer) Proposal aaan3y d with a oll g conditions: _... 1..: Procurement of.any Town.Pemnit, if 3ppiloble._ _.: m... 2. Submission of as built repair ®ketch by the septic- system installer within 30 days of the repair, In duplicate showing: - a. Owner's nave, Site Street Name, Town and Tex Map number b. Location of Installed components tied to two tined points c. System description (e.g., 1250 gal. Concrete septic tank, eta.) 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 fn design and there is no guarantee to the duration at which the completed SETS repair will function. . S. No completed worts is to be backfilled L"ll authorization to do so has been obtained from the Department. INTI KNAL Ubr. UNLT Proposal Approved _ S Pro o al Denied S 4., , 02. e4 - Da e 5 COPIES: PCHD; Owner, installer PC-RP 99ML . Rev. 2107 .0 .. ,:5 '. 1f .. v.,Y... i .`:Y •.4'. ".Ali... -. . c._ �i. ar_ amavr.., rw,:.... r. �., a. c. w.. cu.. rn. ra.. �.. i.-..... r....- �... w........ �..., �...... r................. w. �....... ..e�.,_.r._- ......x�,......_... _..._�.. .. ZOO /Z00 ' d 9V L # E L : Z L 8002 /g L /b0 BO L S b9L ELS L Aquno0 11V a.lp3 41.ap3 : W0.a3 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR "O YES Internal Use Only PERMIT Repair Permit issued in last 5 years Not in Watershed 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 °L CATION J OWN c�'� o, V41) v �x OWNER'S NAME y1� Gl�1c PHONE #�: �l -J- MAILING ADDRESS , f , �► 17 T APPLICANT COF,;gi)� a f1 -d�1S C�LsD�h� Name & Relationship (i.e., ow der, tenant, contractor) DATE (J FACILITY TYPE grj p� a PCHD COMPLAINT # + PROPOSED INSTALLER r A4 -PHONE# ADDRESS Apk - ,a A l po' 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 of the repair. I, as owner,agree to -the conditions stated on this form DATE ± T I, the septic installer, agree to com ly with the conditions of this permit for the septic system repair SIGNATURE , .. TITLE C�ttt tf DATE-- -`—�`� (installer) Proposal approved with the following conditions: 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's nave, 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. Proposal Approved <_ Proposal Denied '3 ^® Repair proposal is in compliance with applicable codes: Ubt• UNLY < 5 0 Da e Yes < No s COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 SHERLITA AMLER, MD, MS, FAAP Commissioner_ of Health_ LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Date: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 FAX COVER SHEET ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health To: z r S A Fax #: °l 7 3 76 V- 9/y& No. Pages: ;Z (including cover sheet) From: Gene D. Reed Putnam County Department of Health /For your information Please respond F r your review Attached as requested . :..:.. ......_ As discussed _ ._ __ °_: _ _. e Please call ......_.. - - _ _...._ - Notes/Messages, i ° In the event of transmission /reception difficulties please contact this office at (845) 278 -6130, ext. 2261 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 shect I of j PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISIQN.O.T�- T-.AL:U-EA-,T- L11- SERVIC -S--.� FIELD ACTIVITY REPORT Street PERSON IN CHARGE Town 4),441 44---TZWAA1Cd ng mTF-RvFFvTFT)-- Aimni�c-Azze:-14W c,:,uvz-)/ Name and Title TYPE OF FAC.ELITY: 7Z 4�7p ,417Z, State Zip FINDINGS: a 7;;hJw- 411-71-v 'coo Rvan- nA2k .11V -5,441a Signature and Title REPQRT'R'F.C-F,TVF-T-)RV: I acknowledge receipt of this report: SIGNATURE: 0219 6 Title: EI.T'I' T COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT # tgWg7' Well Location• Street Address: TownNillage Tax Grid # • f � Lj t`L� ( a_ �,�-', vult . MapSl.vBlock j Lot(s) ell Owner: Reason For Abandonment: Description of Work To Be Performed: +Z� +0P LAJ'�� Date: /�' Lo d Applicant Signature: L'' ` -% 1 ' This permit, to abandon one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code, Subpart 5 -2 of Part 5 of the New York State Sanitary Code and/or Part 75 of 10 NYCRR and provided that: Within 30 days of the completion of the abandonment of the water well, the applicant shall submit to the Department a certified statement that the ' o ation delineated on the application for this permit has been completed. i �S Date o ssue Permit Issuing Official Title White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 Iv tL .5�AmA' Well Type: Drilled Driven Dug Gravel Other Depth Data: Well Depth ft Static Water Level ft JDate Measured Use of Well: Residential Public Supply Air /Cond/Heat Pump Abandoned 1- primary Business Farm Test/Observation Other (specify) 2- secondary Industrial Institutional Standby Water Well Contractor: Name: -1 ,jam,,, Address: 1" %.S _-�' 7 Reason For Abandonment: Description of Work To Be Performed: +Z� +0P LAJ'�� Date: /�' Lo d Applicant Signature: L'' ` -% 1 ' This permit, to abandon one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code, Subpart 5 -2 of Part 5 of the New York State Sanitary Code and/or Part 75 of 10 NYCRR and provided that: Within 30 days of the completion of the abandonment of the water well, the applicant shall submit to the Department a certified statement that the ' o ation delineated on the application for this permit has been completed. i �S Date o ssue Permit Issuing Official Title White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 (i �• -t*- /ate Y �J J Y / PUTNAM COUNTY DEPARTMENT OF HEALTH Q DIVISION OF ENVIRONMENTAL HEALTH SERVICES p APPLICATION TO CONSTRUCT A WATER W_ E_ LL., __..e.... please print or type PCHD Permlt # 14/1 J to — O L/ Well Location: Street Address: Town/Village Tax Grid # ,,3--6 c, 12J) ti- iiu.y,,. �� Map Block Lot(s) Well Owner: Name: JAddress: Use of Well: x Residential Public Supply Air /Cond/Heat Pump rrigat' n 1- primary Business Farm ' Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 3— gpm # People Served 9 Est. of Daily Usage _gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason ('�� i� ?ti %�L� ,�� h , `,� j N 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:: V,; - Address: icy f v, 4 h, lrw /Abg Is Public Water Supply available to site? .................................. ............................... Yes Nom Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: 4- -2 8 : y -'-Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL 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. During all well drilling operations, the applicant and/or well driller shall 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 Public Health Director. An revision or alteration of the approved plan requires a new permit. Well to be constructed by a water ller ce ified by Putnam County. % r Date of Issue ,/ V Permit Iss ' fficial: Date of Expiratio !� Title: ` Permit is Non - Transfer abl White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Norman Anderson, Inc. 152 Barger Street Putnam Valley, NY 10579 January 4, 2005 Dear Mr. Anderson: ROBERT J. BONDI County Executive Re: Proposed Well O'Dell Estate 130 Wiccopee Road (T) Putnam Valley 52.-3-6 A field inspection was conducted on the above referenced lot by Briaai Stevens, Public Health Technician. The application to replace the existing well is approved with the following stipulations: 1. The existing well is to be abandoned once the new well construction is complete. Please provide notice to this Department five days prior to abandoning the existing well so that this Department may witness it. A Well Completion Report (WC -97) shall be submitted no later than 30 days after the well completion by the permittee. Please contact the writer at (845) 278 -6130 ext.2235 if you have any questions. Sincerely, Brian R. Stevens Public Health Technician cc: RM, file LETTERS TESTAMENTARY -File No.. 218/2004- r- .....:- _.- - THE PEOPLE OF THE STATE OF NEW YORK SEND GREETINGS: TO THE FIDUCIARY(S) AND OTHERS CONCERNED: Letters are on this date granted by the Surrogate's Court of Putnam County, New York, as follows: Name of Decedent: VIVIEN 0-'DELL a /k /a VIVIEN D. O'DELL Domicile of Decedent: Putnam Valley, New York Date of Death: November 6, 2004 Name of Each Fiduciary: VIVIEN NIESE Date Will Admitted to Probate: Type of Letters Issued Limitations on Letters December 3, 2004 LETTERS TESTAMENTARY NONE THESE LETTERS, granted pursuant to a decree entered by the Court, authorize and empower the above named fiduciary to perform all acts requisite to the proper administration and disposition of the estate of the decedent in accordance with the decree and the laws of the State of New York, but subject to the limitations, if any, as set forth above. _ Dated: December 3, 2004 IN TESTIMONY WHEREOF, the seal of the Surrogate's Court of Putnam County has been affixed. WITNESS: Hon. Robert E. Miller, Surrogate of the County of Putnam. Chief Clerk of the Surrogate's Court THESE LETTERS ARE NOT VALID WITHOUT THE RAISED SEAL OF THE COURT A C K E S lI V i'I I F � L I L M A P' .'C 0 M P I E T ED dI% 0 s E p 9 A N D ZIE N S E 3 MCI O 4 /q� � as '� :+� r e16"ii1 '�I. � 42; ;A; i \ Et* AQI